Articles - Revista Brasileira de Ginecologia e Obstetrícia

Review Article12-04-2024

Metformin versus insulin in gestational diabetes mellitus: a systematic review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo89
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Abstract
Review Article
Metformin versus insulin in gestational diabetes mellitus: a systematic review
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo89
DOI 10.61622/rbgo/2024rbgo89
Giovanna Noronha Berti ,
Igor Gutschov Oviedo Garcia ,
João Pedro Ruas Floriano de Toledo ,
Júlia Rodrigues Tatemoto ,
Lais Watanabe Marino ,
Mariana de Medeiros Legori ,
Sérgio Floriano de Toledo
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Abstract

Objective:

The aim of this study is to assess the use of metformin with or without insulin for the treatment of Gestational Diabetes Mellitus compared to insulin alone.

Data sources:

This article consists of a systematic review of randomized clinical trials. The searches were carried out on MEDLINE including 7 studies, between 2010 to 2021.

Study selection:

Randomized clinical trials comparing metformin and insulin written in English, Spanish or Portuguese, with no time limit, were included.

Data collection:

Data was extracted from all the 7 articles and compared statistically when possible. Whenever data was not available or couldn’t be statistically compared, the main results were described in detail.

Data synthesis:

Insulin alone is not superior than metformin with or without insulin on gestational diabetes mellitus.

Conclusion:

There is a potential viability of using metformin as an alternative compared to insulin alone in the treatment of Gestational Diabetes Mellitus. However, all assessed outcomes have a very low level of certainty of evidence and more studies are necessary to support these findings.

Key-words Gestational diabetes Insulin therapy Metformin Pregnancy complications
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Letter to the Editor12-04-2024

Comment on: Effects of COVID-19 on human placentas in the second and third trimester
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo88

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Abstract
Letter to the Editor
Comment on: Effects of COVID-19 on human placentas in the second and third trimester
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo88
DOI 10.61622/rbgo/2024rbgo88
Nayara Ribeiro Máximo de Almeida ,
Mateus Augusto Felix de Melo ,
Pâmela Marillac Rodrigues Feijó de Melo ,
Julio Martinez Santos ,
Johnnatas Mikael Lopes
Views189
Recent evidence demonstrates na increase in negative maternal and neonatal outcomes in cases of SARS-CoV-2 infection, such as greater severity of the disease, need for mechanical ventilation and longer hospitalization in intensive care units.(,) The greater severity of infectious diseases in pregnancy occurs due to anatomical and immunological changes, such as a change in the […]
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Original Article12-04-2024

Analysis of vaginal microbiota before and after treatment of high-grade squamous intraepithelial lesions of the uterine cervix
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo86
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Abstract
Original Article
Analysis of vaginal microbiota before and after treatment of high-grade squamous intraepithelial lesions of the uterine cervix
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo86
DOI 10.61622/rbgo/2024rbgo86
Patrícia Mendonça Ventura ,
Isabel Cristina Chulvis do Val Guimarães ,
Luis Guillermo Coca Velarde ,
Susana Cristina Aidé Viviani Fialho ,
Douglas Guedes Ferreira ,
Matheus Madureira Fernandes ,
Rafael Augusto Chaves Machado
Views243
Abstract

Objective:

HPV infection is considered the most common sexually transmitted virus today. The persistence of HPV is the main cause for the development of precursor lesions and cervical cancer. There are environmental and non-environmental factors that contribute to the persistence of the virus. Studies indicate a possible relationship between the vaginal microbiota (environmental factor) and the risk of high-grade cervical squamous intraepithelial lesions and cervical cancer. This study evaluates the association between the type of vaginal microbiota and the occurrence of high-grade squamous intraepithelial lesions of the cervix.

Methods:

Observational, longitudinal, prospective, and analytical studies carried out between 2019 and 2021, which evaluated the vaginal microbiota of patients diagnosed with high-grade cervical squamous intraepithelial lesion before and after treatment in two collections with an interval of 6 months, using scrapings and vaginal swabs.

Results:

In Group I (with lesions) 28 women participated and 29 in Group II (without lesions). According to Nugent, in the initial collection of Group I, 16 women (57%) had lactobacillary microbiota, eight (28%) intermediate, and four (14%) coccus. In Group II, twenty-one (75%) were lactobacillary, one (3%) was intermediate, and seven (24%) werecoccus. With p=0.03.

Conclusion:

According to Nugent’s criteria, there was an association between the type of vaginal microbiota and the occurrence of high-grade cervical squamous intraepithelial lesions of the cervix. The same was not observed in the Donders classification. Studies with a larger sample are needed to confirm our results.

Key-words Cervixuteri microbiota Papillomavirus infections squamous intraepithelial lesions of the cervix Uterine cervical neoplasms Vaginosis, bacterial
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Original Article12-04-2024

Systemic inflammatory indices as a non-invasive grading modality for endometriosis: a comparative study versus exploratory laparoscopy
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo84
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Abstract
Original Article
Systemic inflammatory indices as a non-invasive grading modality for endometriosis: a comparative study versus exploratory laparoscopy
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo84
DOI 10.61622/rbgo/2024rbgo84
Ahmed Sabra Ibrahim Mohammed Sabra ,
Shreen Naguib Aboelezz Moselhy ,
Ahmed Kasem Mohamed Zain Eldin
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Abstract

Objective:

Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy

Methods:

88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging.

Results:

Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy

Conclusion:

The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making.

Key-words CA125 antigen Endometriosis Inflammation Laparoscopy Leukocyte count Lymphocytes Neutrophils
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Review Article12-04-2024

Female genital tract microbiome: the influence of probiotics on assisted reproduction
- Ana Sofia Almeida Santana ,
- Ana Margarida Póvoa
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo82
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Abstract
Review Article
Female genital tract microbiome: the influence of probiotics on assisted reproduction
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo82
DOI 10.61622/rbgo/2024rbgo82
Ana Sofia Almeida Santana ,
Ana Margarida Póvoa
Views267
Abstract

Assisted reproductive technology (ART) has been evolving since 1978, with the number of techniques performed increasing over the years. Despite continued advances, some couples continue to have difficulties getting pregnant, and it has recently been considered that the microbiome of the female genital tract (FGT) may influence embryo implantation and the establishment of pregnancy. This review aims to evaluate the role of probiotics on reproductive outcomes in infertile women on ART. A search throughout medical databases was performed, and six articles met the criteria. Five studies showed improvements in pregnancy rates, with only one demonstrating statistical significance. One article showed no improvement but reported a statistically significant reduction in the miscarriage rate in the probiotic group. Further research is needed to evaluate the true potential of probiotics, namely to assess whether they effectively modulate the FGT microbiome and if these changes are maintained over time.

Key-words Abortion, spontaneous Embryo implantation Genitalia, female Infertility, female Pregnancy outcome Pregnancy rate Probiotics Reproductive techniques, assisted, Microbiota
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Original Article12-04-2024

Prevalence and factors associated with non-alcoholic fatty liver disease among women with polycystic ovary syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo81
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Abstract
Original Article
Prevalence and factors associated with non-alcoholic fatty liver disease among women with polycystic ovary syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo81
DOI 10.61622/rbgo/2024rbgo81
Maria Elisa Franciscatto ,
Juliana Bosso Taniguchi ,
Raquel Wohlenberg ,
Isadora Luísa Riedi ,
Karen Oppermann
Views304
Abstract

Objective:

To verify the prevalence and factors associated with Non-Alcoholic Fatty Liver Disease (NAFLD) among women with Polycystic Ovary Syndrome (PCOS).

Methods:

A cross-sectional study was conducted with 53 patients with PCOS. The diagnosis of PCOS followed the Rotterdam criteria. The diagnosis of NAFLD was made through US showing hepatic steatosis, excluding significant alcohol consumption and chronic liver disease. The following variables were compared between the groups of women with and without NAFLD: age, race, anthropometric data, blood pressure levels, liver enzymes, glycemic and lipid profiles, total testosterone, presence of hirsutism, and metabolic syndrome (MS). Variables were compared between the groups using T-test, Mann-Whitney, and Chi-square tests.

Results:

Among 53 patients with PCOS, 50.9% had NAFLD. The NAFLD group had higher weight (p=0.003), BMI (p=0.001), waist circumference (p≤0.001), fasting glucose (p=0.021), HbA1C% (p=0.028), triglycerides (p=0.023), AST (p=0.004), ALT (p=0.001), higher prevalence of MS (p=0.004), and lower levels of HDL cholesterol (p=0.043). The other variables did not differ between the groups. Both groups were predominantly of caucasian race, and there was no significant difference in age.

Conclusion:

The prevalence of NAFLD among patients with PCOS was 50.9%. Metabolic and hepatic enzyme abnormalities were more prevalent in this group compared to the group without the disease. Obesity tripled the prevalence of NAFLD.

Key-words Alcohol drinking Hyperandrogenism metabolic syndrome non-alcoholic fatty liver disease Obesity Polycystic ovary syndrome Waist circumference
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Review Article12-04-2024

Zuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo79
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Abstract
Review Article
Zuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo79
DOI 10.61622/rbgo/2024rbgo79
Juliana Almeida Oliveira ,
Karine Eskandar ,
Marcos Aurélio Araújo Freitas ,
Chris Elizabeth Philip
Views328
Abstract

Objective:

To evaluate the maternal outcomes in women with postpartum depression using zuranolone, the first oral medication indicated to treat postpartum depression.

Methods:

We conducted a systematic search in September 2023, on Pubmed, Embase and Cochrane Trials. We included randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. No time or language restrictions were applied. 297 results were retrieved, of which 11 papers were selected and fully reviewed by two authors. Review Manager 5 was used for statistical analysis and Cochrane Risk-of-bias tool for randomized trials was applied for quality assessment.

Results:

We included 2 studies, with 346 women, of whom 174 (50.2%) were treated with zuranolone. Zuranolone was significantly associated to an improvement of Clinical Global Impression response rate; Hamilton Depression Rating Scale 15 days and 45-day remission, 3-day, 15-day, and 45-day symptom remission, and reduction in the dose of antidepressants. As for safety outcomes, it was noticed that zuranolone increases sedation risk, which can be dose related. No significant differences were found for other adverse events.

Conclusion:

These findings suggest that zuranolone might present a safe and effective medication for out-of-hospital treatment of PPD. Sedation effects need to be further assessed.

Key-words Major depressive disorder postpartum depression Synthetic neurosteroid Zuranolone
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Review Article12-04-2024

Self-medication among pregnant women in comparison to the general population: a scoping review of the main characteristics
- Gabriela Pereira ,
- Cinthia Madeira de Souza ,
- Amanda Canato Ferracini ,
- Fernanda Garanhani Surita ,
- Sherif Eltonsy ,
- Priscila Gava Mazzola
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo77
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Abstract
Review Article
Self-medication among pregnant women in comparison to the general population: a scoping review of the main characteristics
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo77
DOI 10.61622/rbgo/2024rbgo77
Gabriela Pereira ,
Cinthia Madeira de Souza ,
Amanda Canato Ferracini ,
Fernanda Garanhani Surita ,
Sherif Eltonsy ,
Priscila Gava Mazzola
Views327
Abstract

Objective:

An in-depth evaluation of the published evidence is needed on self-medication, specifically the evidence focusing on vulnerable groups, such as pregnant women. This scoping review aims to provide an overview of the differences in self-medication prevalence and study characteristics among different groups, while identifying gaps in the literature.

Methods:

A literature search was performed in PubMed and Web of Science, including articles published in the last 10 years for the pregnant women group (PWG) and the general population group (GPG). Data on study design, self-medication prevalence, medications used, and other variables were collected, tabulated, and summarized.

Results:

From 2888 screened articles, 75 were considered including 108,559 individuals. The self-medication (SM) in the PWG ranged from 2.6 to 72.4% and most studies had an SM prevalence between 21 and 50% and in the GPG, 32 from 50 studies had a SM prevalence higher than 50%. The reviewed studies varied considerably in methodology, requiring careful interpretation. While most of the studies assessed self-medication during the entire pregnancy, self-medication definition was often inconsistent between studies. Acetaminophen was the most used medication and headache was the most frequent symptom leading to self-medication initiation in the PWG.

Conclusions:

Self-medication among pregnant women showed a lower prevalence when compared to the general population. The medications used and symptoms reported were similar between groups. However, methodological differences must be carefully considered. Pregnant women should carefully follow their physicians’ advice before initiating self-medication to avoid preventable maternal and fetal adverse effects.

Key-words drug-related side effects and adverse reactions Medication use Pregnant women Self-medication
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Original Article03-01-2018

The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
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Abstract
Original Article
The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
DOI 10.1055/s-0038-1623511
Jessica Fernandes Cirelli,
Fernanda Garanhani Surita,
Maria Laura Costa,
Mary Angela Parpinelli,
Samira Maerrawi Haddad,
José Guilherme Cecatti
Views214
Abstract

Objective

The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil.

Methods

Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity.

Results

A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/ mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99-11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70-3.74), diabetes (PR: 1.90; 95%CI: 1.24-2.90), neoplasia (PR: 1.98; 95%CI: 1.25-3.14), kidney diseases (PR: 1.99; 95%CI: 1.14-3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16-5.41) and drug addiction (PR: 1.98; 95%CI: 1.03-3.80) were independentlyassociatedwithworseresultsintheindirectcausesgroup.Someprocedures for the management of severity were more common for the indirect causes group.

Conclusion

Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/ mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.

Key-words indirect causes Maternal death maternal near miss Reproductive health
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Case Report06-19-2019

Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):268-272
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Abstract
Case Report
Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):268-272
DOI 10.1055/s-0039-1683910
Adriano Carvalho Guimarães ,
Luciano Dias de Oliveira Reis,
Fabio Chaves Leite,
Cassiana Franco Dias dos Reis,
Alex Paula Costa,
Walter Junior Boim de Araujo
Views213
Abstract

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8weeks of gestation, with amisdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Key-words heterotopic pregnancy Multiple pregnancy obstetrical surgery Pregnancy complications tubal pregnancy
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Original Article08-26-2020

Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):380-389
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Abstract
Original Article
Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):380-389
DOI 10.1055/s-0040-1712996
Monique Tavares Pereira ,
Monica Cattafesta ,
Edson Theodoro dos Santos Neto ,
Luciane Bresciani Salaroli
Views198
Abstract

Objective

To analyze the consumption of minimally-processed and ultraprocessed foods in relation with sociodemographic variables, maternal habits, educational activity received during prenatal care and clinical history.

Methods

A cross-sectional, analytical and descriptive study with 1,035 pregnant women who lives in the municipalities of the metropolitan region of Grande Vitória, Espírito Santo, Brazil (RMGV-ES), and who were hospitalized in establishments of the Unified Health System (SUS) due to childbirth (April-September 2010). The food frequency questionnaire, pregnant woman’s card and information from the medical records of the health facility unit were analyzed. The Chi-square test and the binary logistic regression model were used to investigate the association between the independent variables and the consumption of ultraprocessed foods.

Results

It was identified that pregnant women ≤ 19 years of agewere 2.9 timesmore likely to consume ultraprocessed foods (confidence interval [CI] 95% 1.683-5.168, p< 0.001), while those ≥ 35 years old were less likely to consume them (odds ratio [OR] 0.265, 95% CI 0.105-0.666, p= 0.005). Maternal smoking increased the odds of consumption of ultraprocessed foods by 2.2 times (95% CI 1.202-4.199, p= 0.011) and pregnant womenwho did not obtain information on healthy food during prenatal care presented 54.1% less chances of consuming minimally-processed foods (OR 0.459, 95% CI 0.307-0.687, p< 0.001).

Conclusion

Smoking during the gestational period and being a teenager are factors that influence the consumption of ultraprocessed foods of pregnant women. Race/ color, head of household, age group, receiving of information about feeding in the prenatal period and not having smoked in gestation determined the consumption of minimally-processed foods.

Key-words dietary habits Feeding behavior Maternal nutrition pregnant ultraprocessed foods
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Original Article01-12-2021

Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(11):834-839
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Abstract
Original Article
Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(11):834-839
DOI 10.1055/s-0041-1739464
Christiane Ricaldoni Giviziez ,
Eliane Gouveia de Morais Sanchez ,
Yanna Andressa Ramos de Lima ,
Mário Silva Approbato
Views202
Abstract

Objective

It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles.

Methods

We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0- 29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels.

Results

Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels>5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98).

Conclusion

Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.

Key-words Anovulation Assisted reproductive techniques female infertility Overweight
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Original Article03-11-2022

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):385-390
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Abstract
Original Article
Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):385-390
DOI 10.1055/s-0042-1743102
Fernanda Villar Fonseca ,
Maria Victória Gutierrez Cordeiro ,
Ariadne Cristine Pozza ,
Carlos Afonso Maestri
Views201
Abstract

Objective

To evaluate the role of cervical cytology (Pap smear) in the diagnosis of cervical intraepithelial neoplasia 2 or greater (CIN2+), presented exclusively in the endocervical canal, the clinical-epidemiological characteristics of this lesion, the necessary length of canal to be removed to treat, and the rate of invasive lesion hidden in the endocervical canal.

Methods

Cross-sectional study, by database analysis, of patients with abnormal cytology (high-grade squamous intraepithelial lesion [HSIL]), without visible colposcopy lesion, submitted to loop electrosurgical procedure (LEEP) to evaluate the association of cytology results with the histological product of the conization, to identify the epidemiological characteristics of endocervical lesion and clinical evolution, using a pvalue< 0.05 and 95% CI.

Results

In 444 cases, the Pap smear sensitivity for CIN2+ diagnosis was 75% (95% CI: 69.8-79.7), specificity was 40% (95% CI: 30.2-49.5), and the prevalence rate of histological lesion was 73% (95% CI: 70.1-78.7). There was a higher prevalence of CIN2+ in women over 42 years old and invasive cancer in those over 56 years old (p<0.001), and it was necessary to remove 2.6 cm in length of the canal to reduce the chance of recurrence (p<0.006). The rate of invasive cancer was 2.7%.

Conclusion

Cytology was related to a high prevalence to histological lesion (73%) in the diagnosis of CIN2+ in the endocervical disease; older patients presented a higher relationship with histological lesions in the canal disease, and it was necessary to remove an average of 2.6 cm in length of the endocervical canal to avoid the persistence and progression of CIN. The rate of occult neoplasia in the endocervical canal was 2.7%.

Key-words Cervical intraepithelial neoplasia CIN oncotic cytology
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Review Article12-11-2023

Prognostic Impact of AGR3 Protein Expression in Breast Cancer: A Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):609-619
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Abstract
Review Article
Prognostic Impact of AGR3 Protein Expression in Breast Cancer: A Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):609-619
DOI 10.1055/s-0043-1772183
Carolina Leão de Moraes ,
Carolina Rodrigues Mendonça ,
Natália Cruz e Melo ,
Fernanda Sardinha de Abreu Tacon ,
Jair Pereira de Melo Junior ,
Waldemar Naves do Amaral
Views201
Abstract

Objective

To investigate the clinicopathological significance and prognosis of the expression of the anterior gradient 3 (AGR3) protein in women with breast cancer.

Data Sources

The PubMed, CINAHL, EMBASE, Scopus, and Web of Science databases were searched for studies published in English and without restrictions regarding the year of publication. The search terms were: breast cancer AND anterior gradient 3 OR AGR3 expression.

Study Selection

We included observational or interventional studies, studies on AGR3 protein expression by immunohistochemistry, and studies on invasive breast cancer. Case reports, studies with animals, and reviews were excluded. In total, 4 studies were included, containing 713 cases of breast cancer.

Data Collection

Data were extracted on clinicopathological characteristics and survival. A meta-analysis of the prevalence of AGR3 expression was performed according to the clinicopathological characteristics, hazard ratios (HRs), and overall survival and disease-free survival.

Data Synthesis

The expression of AGR3 was found in 62% of the cases, and it was associated with histological grade II, positivity of estrogen and progesterone receptors, low expression of ki67, recurrence or distant metastasis, and lumen subtypes. In patients with low and intermediate histological grades, AGR3 expression was associated with worse overall survival (HR: 2.39; 95% confidence interval [95%CI]: 0.628–4.159; p = 0.008) and worse disease-free survival (HR: 3.856; 95%CI: 1.026–6.686; p = 0.008).

Conclusion

The AGR3 protein may be a biomarker for the early detection of breast cancer and predict prognosis in luminal subtypes. In addition, in patients with low and intermediate histological grades, AGR3 protein expression may indicate an unfavorable prognosis in relation to survival.

Key-words Breast neoplasms human AGR3 protein Immunohistochemistry Prognosis survival
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Original Article10-01-2017

Clinical Characteristics in a Sample of Transsexual People
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):545-551

Views208

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Original Article
Clinical Characteristics in a Sample of Transsexual People
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):545-551
DOI 10.1055/s-0037-1604134
Maria Rita Lerri,
Adriana Peterson Mariano Salata Romão,
Manoel Antônio dos Santos,
Alain Giami,
Rui Alberto Ferriani,
Lúcia Alves da Silva Lara
Views208
Abstract

Purpose

To assess the clinical characteristics of subjects with gender dysphoria (GD).

Method

A cross-sectional study of adults with GD. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic data, clinical data and life habits were recorded.

Results

Total of 44 subjects participated in the study: 36 (82%) trans women and 8 (18%) trans men. Forty-three (98%) of the GD patients had anxiety (36 [100%] trans women and 7 [87.5%] trans men), and 36 (82%) had depression (29 [80.5%] trans women and 7 [87.5%] trans men). Suicide had been attempted by 32 (73%) subjects. The rates of depression were lower among the subjects living with partners, parents, or other people than among those living alone (p = 0.03), and it was also lower among the subjects who were married compared to those who were dating or single (p = 0.03).

Conclusion

Improving the relationship status may reduce the prevalence of depressive symptoms in GD patients. There was a high rate of attempted suicide in this sample.

Key-words Anxiety Depression gender dysphoria sex reassignment surgery transsexual
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Review Article09-18-2024

Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo70

Views308

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Review Article
Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo70
DOI 10.61622/rbgo/2024rbgo70
Ana Clara Felix de Farias Santos ,
Fernanda Valeriano Zamora ,
Lubna Al-Sharif ,
Kush Sehgal ,
Deyvid Vieira Silva Cavalcante ,
Sarah Hasimyan Ferreira ,
Pedro Henrique Costa Matos da Silva
Views308
Abstract

Objective

To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.

Data source

Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.

Study Selection

Randomized clinical trials and observational studies with the outcomes of interest were included.

Data collect

We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.

Data synthesis

Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).

Conclusion

Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.

PROSPERO

CRD42023449655

Key-words Cyclosporine A Prednisolone Immunosupressive agents Prednisone Repeated implantation failure Reproduction Reproductive techniques, assisted
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Original Article07-01-2015

Prevalence of congenital abnormalities identified in fetuses with 13, 18 and 21 chromosomal trisomy
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):333-338

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Abstract
Original Article
Prevalence of congenital abnormalities identified in fetuses with 13, 18 and 21 chromosomal trisomy
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):333-338
DOI 10.1590/S0100-720320150005373
Caroline Soares Cristofari Emer,
Julio Alejandro Peña Duque,
Ana Lúcia Letti Müller,
Rejane Gus,
Maria Teresa Vieira Sanseverino,
André Anjos da Silva,
José Antonio de Azevedo Magalhães
Views212
PURPOSE:

To describe the prevalence of malformations found in fetuses with trisomy of chromosomes 13, 18 and 21 by identifying the most frequent within each condition.

METHODS:

A retrospective cross-sectional study with the analysis of trisomy cases of chromosomes 13, 18 and 21 diagnosed through fetal karyotype obtained by amniocentesis/cordocentesis, between October 1994 and May 2014, at a Teaching Hospital in Brazil Southern Region. Malformations identified through morphological ultrasonography were described and, subsequently, confirmed in newborn examinations and/or fetal autopsy. The results were analyzed using Fisher’s test and analysis of variance (ANOVA), with a 5% level of significance (p=0.05).

RESULTS:

Sixty-nine cases of trisomy were diagnosed among 840 exams; nine were excluded due to outcome outside Hospital de Clínicas de Porto Alegre or incomplete records, remaining 60 cases (nine cases of chromosome 13 trisomy, 26 of chromosome 18, and 25 of chromosome 21). In all three groups, heart disease occurred in most cases; the ventricular septal defect was more prevalent and occurred in 66.7% of the trisomy 13 group. Gastrointestinal abnormalities were more prevalent in the trisomy 18 group, especially omphalocele (38.5%; p<0.01). Genitourinary anomalies were more significantly frequent in the trisomy 13 group (pyelectasis, 55.6% - p<0.01; ambiguous genitalia, 33.3% - p=0.01). Central nervous system defects were identified in all cases of trisomy 13. Facial cracks were significantly more prevalent among fetuses with trisomy 13 (66.7%; p<0.01). Hand and feet malformations significantly differed among the trisomy groups. Hand defects occurred in 50% of trisomy 18 cases, and in 44.4% of all trisomy 13 cases (p<0.01); congenital clubfoot was more common in the trisomy 18 group, being detected in 46.2% of fetuses (p<0.01). The abnormalities were found in 50.9, 27.3 and 21.7% of trisomy 18, 13 and 21 cases respectively.

CONCLUSION:

Many fetal malformations identified at ultrasound are suggestive of trisomy and represent an important tool for etiologic diagnosis and prenatal and pre-conception genetic counseling.

Key-words Aneuploidy Chromosome aberrations Fetus/abnormalities Trisomy Ultrasonography, prenatal
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Review Article04-15-2019

Isthmocele: From Risk Factors to Management
- Piergiorgio Iannone ,
- Giulia Nencini,
- Gloria Bonaccorsi,
- Ruby Martinello,
- Giovanni Pontrelli,
- Gennaro Scutiero
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):44-52

Views292

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Review Article
Isthmocele: From Risk Factors to Management
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):44-52
DOI 10.1055/s-0038-1676109
Piergiorgio Iannone ,
Giulia Nencini,
Gloria Bonaccorsi,
Ruby Martinello,
Giovanni Pontrelli,
Marco Scioscia,
Luigi Nappi,
Pantaleo Greco,
Gennaro Scutiero
Views292
Abstract

Objective

The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within themyometriumat the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition.

Methods

A comprehensive review of the literature was performed to identify the most relevant studies about this topic.

Results

Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data.

Conclusion

Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.

Key-words cesarean section scar defect Hysteroscopy isthmocele Laparoscopy niche
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Original Article05-16-2019

Variables Associated with Endometriosis-related Pain: A Pilot Study using a Visual Analogue Scale
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(3):170-175
Views183

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Abstract
Original Article
Variables Associated with Endometriosis-related Pain: A Pilot Study using a Visual Analogue Scale
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(3):170-175
DOI 10.1055/s-0039-1679879
Mauro Cozzolino ,
Maria Elisabetta Coccia,
Giacomo Lazzeri,
Francesca Basile,
Gianmarco Troiano
Views183
Abstract

Objective

Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it.

Methods

We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms.

Results

Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age couldinfluencethe pain associated to constipation, to dyspareunia,and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain(CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria.

Conclusion

Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

Key-words Chronic pelvic pain constipation Dysmenorrhea Dyspareunia Endometriosis visual analogue scale
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Original Article11-01-2018

Do Food Intake and Food Cravings Change during the Menstrual Cycle of Young Women?
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):686-692

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Abstract
Original Article
Do Food Intake and Food Cravings Change during the Menstrual Cycle of Young Women?
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):686-692
DOI 10.1055/s-0038-1675831
Luciana Bronzi de Souza,
Karine Anusca Martins,
Mariana Morais Cordeiro,
Ymárdila de Souza Rodrigues,
Bruna Paola Murino Rafacho,
Rafael Aiello Bomfim
Views401
Abstract

Objective

The aim of the present study was to assess the anthropometric measures, food intake and food cravings during the menstrual cycle of undergraduate students of the faculty of nutrition.

Methods

A cross-sectional study was performed with 27 students from a public university in the state of Mato Grosso do Sul, Brazil, who had their food intake evaluated through a 24-hour food recall, their nutritional status evaluated based on anthropometric measures, and food cravings evaluated using the Food Desire Questionnaire. Data were collected during an evaluation in the follicular phase (between the 5^th and the 9^th day of the menstrual cycle) and another in the luteal phase (LP) (between the 20^th and the 25^th day of the menstrual cycle). For food intake variables, the analysis of variance (ANOVA) test was used, followed by the Tukey test. The Mann-Whitney test was used for the analysis of food cravings, considering a significance level of 5% (p< 0.05).

Results

The desire for foods rich in sugar, salt, and fat, such as chocolate, pastries, snacks and desserts were higher (p< 0.05) during the premenstrual period, although it did not reflect neither a higher energy intake nor an alteration in the distribution of macronutrients. A higher intake of carbohydrates, proteins, fibers, and calcium was observed during the LP; however, without statistical difference between the groups. There were no differences either in the intake of any food group or in the anthropometric measurements (p> 0.05).

Conclusion

Food cravings of nutrition students differed between the phases of the menstrual cycle; however, with no difference in food intake and in anthropometric measures.

Key-words Feeding behavior follicular phase food intake luteal phase Menstrual cycle Nutrition assessment
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Original Article04-17-2020

Quality of Life in Women with Deep Endometriosis: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(2):90-95
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Abstract
Original Article
Quality of Life in Women with Deep Endometriosis: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(2):90-95
DOI 10.1055/s-0040-1708091
Daniela Angerame Yela ,
Iuri de Paula Quagliato ,
Cristina Laguna Benetti-Pinto
Views227
Abstract

Objective

To describe clinical and sociodemographic characteristics of women with deep infiltrating endometriosis (DIE) and assess their quality of life (QOL) during 6 months of medical treatment.

Methods

A descriptive cross-sectional study of 60 women diagnosed with DIE either by surgery or image methods (ultrasound or magnetic resonance), who received clinical treatment for at least 6 months in the Universidade de Campinas, Campinas, state of São Paulo, Brazil. Both the SF-36 and the EHP-30 questionnaires were used to assess the quality of life.

Results

The mean age of the patients was 37.7 ± 6.0 years old, with 50% presenting dysmenorrhea; 57% dyspareunia; and 50% chronic pelvic pain. The SF-36 and the EHP-30 revealed impaired quality of life. In the SF-36, the worst domains were limitation due to emotional aspects (40.2 ± 43.1) and self-esteem and disposition (46.1 ± 24.8), whereas in the EHP-30 they were social well-being (50.3 ± 30.6); infertility (48.0 ± 36.3); and sexual intercourse (54.0 ± 32.1).

Conclusion

Although clinically treated, women with deep endometriosis present impairment in different domains of quality of life regardless of the questionnaire used for evaluation.

Key-words Dysmenorrhea Endometriosis Pelvic pain Quality of life
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Review Article09-30-2019

Pharmacological Treatment for Symptomatic Adenomyosis: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):564-574
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Abstract
Review Article
Pharmacological Treatment for Symptomatic Adenomyosis: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):564-574
DOI 10.1055/s-0039-1695737
Cristina Laguna Benetti-Pinto ,
Ticiana Aparecida Alves de Mira,
Daniela Angerame Yela,
Cassia Raquel Teatin-Juliato,
Luiz Gustavo Oliveira Brito
Views232
Abstract

Objective

To assess the efficacy of non-surgical treatment for adenomyosis.

Data Sources

A search was performed by two authors in the Pubmed, Scopus, and Scielo databases and in the grey literature from inception to March 2018, with no language restriction.

Selection of Studies

We have included prospective randomized studies for treating symptomaticwomen with adenomyosis (abnormal uterine bleeding and/or pelvic pain) diagnosed by ultrasound or magnetic resonance imaging.

Data Collection

Studies were primarily selected by title and abstract. The articles that were eligible for inclusion were evaluated in their entirety, and their data was extracted for further processing and analysis.

Data Synthesis

From567retrieved records only 5 remained for analysis. The intervention groups were: levonorgestrel intrauterine system (LNG-IUS)(n= 2), dienogest (n= 2), and letrozole (n= 1). Levonorgestrel intrauterine system was effective to control bleeding when compared to hysterectomy or combined oral contraceptives (COCs). One study assessed chronic pelvic pain and reported that LNG-IUS was superior to COC to reduce symptoms. Regarding dienogest, it was efficient to reduce pelvic pain when compared to placebo or goserelin, but less effective to control bleeding than gonadotropin-releasing hormone (GnRH) analog. Letrozolewas as efficient asGnRHanalog to relieve dysmenorrhea and dyspareunia, but not for chronic pelvic pain. Reduction of uterine volumewas seen with aromatase inhibitors, GnRH analog, and LGN-IUD.

Conclusion

Levonorgestrel intrauterine system and dienogest have significantly improved the control of bleeding and pelvic pain, respectively, in women with adenomyosis. However, there is insufficient data from the retrieved studies to endorse eachmedication for this disease. Further randomized control tests (RCTs) are needed to address pharmacological treatment of adenomyosis.

Key-words abnormal menstrual bleeding Adenomyosis medical treatment Pelvic pain systematic review
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Review Article03-24-2022

Commercial Surrogacy: An Overview
- Pedro Brandão ,
- Nicolás Garrido
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1141-1158

Views452

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Review Article
Commercial Surrogacy: An Overview
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1141-1158
DOI 10.1055/s-0042-1759774
Pedro Brandão ,
Nicolás Garrido
Views452
Abstract

Objective

Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

Methods

This is a review of the literature published in the 21^st century on commercial surrogacy.

Results

A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

Conclusion

Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

Key-words Bioethics Fertilization in vitro legislation medical medical tourism surrogacy
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Review Article07-30-2021

The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):395-402
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Abstract
Review Article
The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):395-402
DOI 10.1055/s-0041-1730289
Alexandra Ruivo Coelho ,
Gonçalo Cardoso ,
Marta Espanhol Brito ,
Inês Neves Gomes ,
Maria João Cascais
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Abstract

In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, andmenstrual cycle.Onthe other hand, an imbalance causedby low energy availability dueto a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of themost recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote theacquisition ofmore consolidated knowledgeon an undervaluedtheme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Key-words Amenorrhea bone health female athlete low energy availability menstrual dysfunction
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