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04-10-1998
Avaliação longitudinal de aspectos imunológicos e virológicos durante a gravidez e puerpério em mulheres portadoras do vírus da imunodeficiência humana tipo 1 (HIV-1)
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):170-170
Views97This 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
Avaliação longitudinal de aspectos imunológicos e virológicos durante a gravidez e puerpério em mulheres portadoras do vírus da imunodeficiência humana tipo 1 (HIV-1)
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):170-170
DOI 10.1590/S0100-72031998000300011
Views97Avaliação Longitudinal de Aspectos Imunológicos e Virológicos Durante a Gravidez e Puerpério em Mulheres Portadoras do Vírus da Imunodeficiência Humana Tipo 1 (HIV-1) […]See moreThis 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. -
04-10-1998
A dopplervelocimetria com mapeamento em cores dos ramos intramiometriais da artéria uterina de mulheres na pós-menopausa, com e sem carcinoma de endométrio
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):169-170
Views77This 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
A dopplervelocimetria com mapeamento em cores dos ramos intramiometriais da artéria uterina de mulheres na pós-menopausa, com e sem carcinoma de endométrio
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):169-170
DOI 10.1590/S0100-72031998000300010
Views77A Dopplervelocimetria com Mapeamento em Cores dos Ramos Intramiometriais da Artéria Uterina de Mulheres na Pós-Menopausa, com e sem Carcinoma de Endométrio[…]See moreThis 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. -
04-10-1998
Avaliação da esteroidogênese das supra-renais em mulheres normais por meio dos testes de ACTH simples de depósito
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):169-169
Views75This 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
Avaliação da esteroidogênese das supra-renais em mulheres normais por meio dos testes de ACTH simples de depósito
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):169-169
DOI 10.1590/S0100-72031998000300009
Views75Avaliação da Esteroidogênese das Supra-Renais em Mulheres Normais por Meio dos Testes de ACTH Simples de Depósito[…]See moreThis 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. -
Case Report04-10-1998
Recurrent HELLP syndrome: report on two cases
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
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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
Case ReportRecurrent HELLP syndrome: report on two cases
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
Views79See moreHELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
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Case Report04-10-1998
Fetal reanimation: a case report
- José Maria Soares Júnior,
- Wladimir Correa Taborda,
- Anna Maria Bertini,
- Jorge Francisco Kuhn dos Santos
Views84This 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
Case ReportFetal reanimation: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):161-163
DOI 10.1590/S0100-72031998000300007
- José Maria Soares Júnior,
- Wladimir Correa Taborda,
- Anna Maria Bertini,
- Jorge Francisco Kuhn dos Santos
Views84See moreA tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.
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. -
Equipments and Methods04-10-1998
A new catheter in the treatment of fetal obstructive uropathies
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
Views73This 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
Equipments and MethodsA new catheter in the treatment of fetal obstructive uropathies
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
DOI 10.1590/S0100-72031998000300006
Views73See moreManagement of prenatally diagnosed uropathies is controversial, mainly because the prognosis for these fetuses is quite different. However pioneering studies have shown that prenatal drainage of obstructed urinary tract can improve the outcome of selected fetuses. The aim of this study is to describe the experience of the Service with the treatment of fetal obstrutive uropathy with the catheter developed by the Centro de Medicina Fetal do Hospital das Clínicas da UFMG. A total of 25 fetuses with obstructive uropathy received the catheter. Three fetuses required more than one insertion. Ten of 25 (40%) shunted fetuses survived with good postnatal renal and pulmonary function. Complications occurred in 12/25 (48%) cases including: 06/25 (24%) inadequate shunt drainage or migration; 01/25 (04%) urinary ascitis; 01/25 (04%) DPP, 01/25 (04%) premature rupture of membranes, 02/25 (08%) premature labor, 01/25 (04%) scarring and fibrosis of the renal parenchyma. Three of 25 (12%) fetuses died intra-utero and 12 (48%) died during the neonatal period. In conclusion, the drainage of the obstructed urinary tract with this catheter proved to be technically feasible and safe for both mother and fetus, with a survival rate of 40%.
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. -
Original Article04-10-1998
Prevalence and correlates of hiv infection and syphilis in prostitutes attending a STD/AIDS reference center
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
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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 ArticlePrevalence and correlates of hiv infection and syphilis in prostitutes attending a STD/AIDS reference center
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
DOI 10.1590/S0100-72031998000300005
Views112See moreA retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.
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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. -
Original Article04-10-1998
Obstetrical management of fetal death
- Márcia M A de Aquino,
- Ana Cláudia Guedes,
- Maria Rita S Mesquita,
- Mirie Hernandez,
- José Guilherme Cecatti
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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 ArticleObstetrical management of fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):145-149
DOI 10.1590/S0100-72031998000300004
- Márcia M A de Aquino,
- Ana Cláudia Guedes,
- Maria Rita S Mesquita,
- Mirie Hernandez,
- José Guilherme Cecatti
Views205See moreAlthough 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.
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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.
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Original Article12-11-2023
Adaptation and Validation of the International Pelvic Pain Society’s Quality of Life Questionnaire in Portuguese
- LetíciaFerracini Lenharo Hayashi
,
- PauloAugusto Ayroza Galvão Ribeiro
,
- JúlioCesar Rosa e Silva
,
- LuizGustavo Oliveira Brito
,
- HelizabetSalomão Abdalla Ayroza Ribeiro
Views234This 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 ArticleAdaptation and Validation of the International Pelvic Pain Society’s Quality of Life Questionnaire in Portuguese
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):575-583
- LetíciaFerracini Lenharo Hayashi
,
- PauloAugusto Ayroza Galvão Ribeiro
,
- JúlioCesar Rosa e Silva
,
- LuizGustavo Oliveira Brito
,
- HelizabetSalomão Abdalla Ayroza Ribeiro
Views234Abstract
Objective
In the present study, our aim was to translate, adapt, and validate the Pelvic Health History Form (a quality of life [QoL] questionnaire) of the International Pelvic Pain Society (IPPS) from English to Portuguese.
Methods
The study was approved by the Ethics and Research Committee (CEP, in the Portuguese acronym) and the IPPS. The “Transcultural Adaptation” method comprised 5 stages: translation, synthesis, backtranslation, expert review, and pretest. Cultural adaptation and validation included cognitive interviews and statistical analysis of unanswered items (> 15%) in 14 clinic patients from CPP and endometriosis clinic at Santa Casa de São Paulo.
Results
Strong equivalences were established between the USA and Brazil questionnaires in terms of semantics, idioms, experiences, and concepts. Eighteen culturally inappropriate items were identified and adjusted using the revised response rate index. The subjective form underwent rigorous assessments, confirming its accurate measurement of intended targets.
Conclusion
The methodology showed efficiency and equivalence, confirming its validity. The user-friendly format and inclusion of translated, adapted, and validated instruments in Portuguese make the form valuable for evaluating pelvic health, with potential for future research.
Key-words Chronic painPelvic painQuality of lifesurveys and questionnairestranslationvalidation studySee moreThis 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. - LetíciaFerracini Lenharo Hayashi
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Review Article06-19-2019
Hormonal Biomarkers for Evaluating the Impact of Fetal Growth Restriction on the Development of Chronic Adult Disease
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):256-263
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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 ArticleHormonal Biomarkers for Evaluating the Impact of Fetal Growth Restriction on the Development of Chronic Adult Disease
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):256-263
Views196Abstract
The hypothesis of fetal origins to adult diseases proposes that metabolic chronic disorders, including cardiovascular diseases, diabetes, and hypertension originate in the developmental plasticity due to intrauterine insults. These processes involve an adaptative response by the fetus to changes in the environmental signals, which can promote the reset of hormones and of the metabolism to establish a “thrifty phenotype”. Metabolic alterations during intrauterine growth restriction can modify the fetal programming. The present nonsystematic review intended to summarize historical and current references that indicated that developmental origins of health and disease (DOHaD) occur as a consequence of altered maternal and fetal metabolic pathways. The purpose is to highlight the potential implications of growth factors and adipokines in “developmental programming”, which could interfere in the development by controlling fetal growth patterns. These changes affect the structure and the functional capacity of various organs, including the brain, the kidneys, and the pancreas. These investigations may improve the approach to optimizing antenatal as well as perinatal care aimed to protect newborns against long-termchronic diseases.
Key-words biomarkersdevelopmentdevelopmental origins of health and diseaseFetal growth restrictiongrowthSee morePlumX Metrics- Citations
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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. -
Review Article10-23-2020
Characterization of Placental Infection by Zika Virus in Humans: A Review of the Literature
- Emanuella Meneses Venceslau
,
- José Paulo Guida
,
- Eliana Amaral
,
- José Luis Proença Modena
,
- Maria Laura Costa
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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 ArticleCharacterization of Placental Infection by Zika Virus in Humans: A Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):577-585
- Emanuella Meneses Venceslau
,
- José Paulo Guida
,
- Eliana Amaral
,
- José Luis Proença Modena
,
- Maria Laura Costa
Views213See moreAbstract
Objective
The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection.
Data
sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts)
Data collection
We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis.
Data synthesis
The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts.
Conclusion
Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.
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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. - Emanuella Meneses Venceslau
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Original Article05-18-2020
Pubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study
- Raimundo Homero Carvalho Neto
,
- Antonio Brazil Viana Junior
,
- Antonio Fernandes Moron
,
- Edward Araujo Júnior
,
- Francisco Herlânio Costa Carvalho
,
[ … ], - Helvécio Neves Feitosa
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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 ArticlePubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(4):181-187
- Raimundo Homero Carvalho Neto
,
- Antonio Brazil Viana Junior
,
- Antonio Fernandes Moron
,
- Edward Araujo Júnior
,
- Francisco Herlânio Costa Carvalho
,
- Helvécio Neves Feitosa
Views210See moreAbstract
Objective
To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode.
Methods
The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics.
Results
Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026).
Conclusion
Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.
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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. - Raimundo Homero Carvalho Neto
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Original Article05-18-2020
Quality of Life for Women with Human Papillomavirus-induced Lesions
- Natália Maria Vieira Pereira-Caldeira
,
- Fernanda Garcia Bezerra Góes
,
- Maria Cristina Mendes de Almeida-Cruz
,
- Juliano de Souza Caliari
,
- Fernanda Maria Vieira Pereira-Ávila
,
[ … ], - Elucir Gir
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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 ArticleQuality of Life for Women with Human Papillomavirus-induced Lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(4):211-217
- Natália Maria Vieira Pereira-Caldeira
,
- Fernanda Garcia Bezerra Góes
,
- Maria Cristina Mendes de Almeida-Cruz
,
- Juliano de Souza Caliari
,
- Fernanda Maria Vieira Pereira-Ávila
,
- Elucir Gir
Views222See moreAbstract
Objective
To reveal the changes in the quality of life reported by women with Human papillomavirus (HPV)-induced lesions.
Methods
This is a cross-sectional, descriptive-exploratory study of a qualitative approach performed from June to August 2016. Semi-structured face-to-face interviews based on five questions on the concept of quality of life were used. The data were submitted to thematic analysis. All ethical aspects have been contemplated.
Results
A total of 20 women aged between 25 and 59 years old were interviewed. From the analysis of the data, the following thematic units emerged: physical and emotional changes, especially complaints of pruritus, discharge and pain, worry, fear, shame and sadness; changes in sexual and affective relationships with decreased libido, dyspareunia and interruption of sexual activity; changes in social relationships resulting in absenteeism at work.
Conclusion
Human papillomavirus infection impairs the quality of life of women as it significantly affects sexual, affective, physical, emotional, and everyday habits. Therefore, HPV infection can lead to exponential changes in the quality of life of women, which can be mitigated by the availability of sources of support such as family, friends and the multi-professional team, helping to improve knowledge and cope with HPV.
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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. - Natália Maria Vieira Pereira-Caldeira
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Original Article02-28-2022
Epidemiological Survey on the Perception of Adverse Effects in Women Using Contraceptive Methods in Brazil
- Gabriel Duque Pannain
,
- Vivian de Oliveira Rodrigues Brum
,
- Maria Mariana Andrade Abreu
,
- Gabriela Barbosa Lima
Views219This 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 ArticleEpidemiological Survey on the Perception of Adverse Effects in Women Using Contraceptive Methods in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):25-31
- Gabriel Duque Pannain
,
- Vivian de Oliveira Rodrigues Brum
,
- Maria Mariana Andrade Abreu
,
- Gabriela Barbosa Lima
Views219Abstract
Objective
The present study aimed to understand patient perception of the adverse effects of contraceptives to improve health care and adherence to treatment.
Methods
An online questionnaire was available for women in Brazil to respond to assess their perception of adverse effects and their relationship with contraceptive methods.
Results
Of all 536 women who responded, 346 (64.6%) reported current contraceptive use. One hundred and twenty-two (122-34.8%) women reported having already stopped using contraception because of the adverse effects. As for the contraceptive method used, the most frequent was the combined oral contraceptive (212-39.6%). When we calculated the relative risk for headache, there was a relative risk of 2.1282 (1.3425-3.3739; 95% CI), suggesting that the use of pills increases the risk of headache, as well as edema, in which a relative risk of 1.4435 (1.0177-2.0474; 95% CI) was observed. For low libido, the use of oral hormonal contraceptives was also shown to be a risk factor since its relative risk was 1.8805 (1.3527-2.6142; 95% CI). As for acne, the use of hormonal contraceptives proved to be a protective factor, with a relative risk of 0.3015 (0.1789-0.5082; 95% CI).
Conclusion
The choice of a contraceptive method must always be individualized, and the patients must be equal participants in the process knowing the expected benefits and harms of each method and hormone, when present.
Key-words Contraceptiondrug-related side effects and adverse reactionsEpidemiologyGynecologyhormonal contraceptionSee moreThis 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. - Gabriel Duque Pannain
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Original Article12-11-2023
Iron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It
- Carolinade Freitas Alves Amaral-Moreira
,
- Guilherme Redezuk
,
- Belmiro Gonçalves Pereira
,
- Anderson Borovac-Pinheiro
,
- Patricia Moretti Rehder
Views199This 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 ArticleIron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):562-567
- Carolinade Freitas Alves Amaral-Moreira
,
- Guilherme Redezuk
,
- Belmiro Gonçalves Pereira
,
- Anderson Borovac-Pinheiro
,
- Patricia Moretti Rehder
Views199See moreAbstract
Objective
Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population.
Methods
We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors.
Results
We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary.
Conclusion
Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.
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. - Carolinade Freitas Alves Amaral-Moreira
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Original Article07-10-2023
Quality of Life and Depression Conditions of Women with Gestational Diabetes during Pregnancy and Postpartum Period
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):065-073
Views202This 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 ArticleQuality of Life and Depression Conditions of Women with Gestational Diabetes during Pregnancy and Postpartum Period
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):065-073
Views202See moreAbstract
Objective
The study was conducted to determine the quality of life and depression of women with gestational diabetes during pregnancy and the postpartum period.
Methods
100 pregnant women with gestational diabetes and 100 healthy pregnant women were included in the present study. Data were obtained from pregnant women in their third trimester who agreed to take part in the study. The data was collected during the third trimester and six to eight weeks after the baby was born. The data were obtained by socio-demographic characteristics form, postpartum data collection form, the MOS 36 Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale (CESD).
Results
The mean age of pregnant women with gestational diabetes in the study was the same as the average age of healthy pregnant women. The CESD score of pregnant women with gestational diabetes was 26,77 ± 4,85 while the corresponding score was 25,19 ± 4,43 for healthy women. Additionally, the score in the postpartum period was 32.47 ± 5.94 for pregnant women with gestational diabetes and 35.47 ± 8.33 for healthy pregnant women. CESD scores were found to be higher than the cut-off score of 16 in both groups, and the mean scores increased during the postpartum period.
Conclusion
During the postpartum period, the quality of life of pregnant women with gestational diabetes was affected more negatively than healthy pregnant women. Depressive symptoms of women with both gestational diabetes and healthy pregnancy were found to be high in pregnancy and postpartum periods.
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.
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FEBRASGO POSITION STATEMENT06-27-2019
Pre-eclampsia/Eclampsia
- José Carlos Peraçoli
,
- Vera Therezinha Medeiros Borges,
- José Geraldo Lopes Ramos,
- Ricardo de Carvalho Cavalli,
- Sérgio Hofmeister de Almeida Martins Costa, [ … ],
- Edson Viera da Cunha Filho
Views109This 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
FEBRASGO POSITION STATEMENTPre-eclampsia/Eclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):318-332
- José Carlos Peraçoli
,
- Vera Therezinha Medeiros Borges,
- José Geraldo Lopes Ramos,
- Ricardo de Carvalho Cavalli,
- Sérgio Hofmeister de Almeida Martins Costa,
- Leandro Gustavo de Oliveira,
- Francisco Lazaro Pereira de Souza,
- Henri Augusto Korkes,
- Ione Rodrigues Brum,
- Maria Laura Costa,
- Mário Dias Corrêa Junior,
- Nelson Sass,
- Angélica Lemos Debs Diniz,
- Caio Antonio de Campos Prado,
- Edson Viera da Cunha Filho
Views109See moreAbstract
Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age
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. - José Carlos Peraçoli
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Original Article02-01-2019
Syphilis in Pregnancy: The Reality in a Public Hospital
- Rafael Garcia Torres,
- Ana Laura Neves Mendonça,
- Grazielle Cezarine Montes,
- Jacqueline Jácome Manzan,
- João Ulisses Ribeiro, [ … ],
- Marina Carvalho Paschoini
Views295PlumX Metrics- Citations
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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 ArticleSyphilis in Pregnancy: The Reality in a Public Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):90-96
- Rafael Garcia Torres,
- Ana Laura Neves Mendonça,
- Grazielle Cezarine Montes,
- Jacqueline Jácome Manzan,
- João Ulisses Ribeiro,
- Marina Carvalho Paschoini
Views295See moreAbstract
Objective:
The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions.
Methods:
Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution.
Results:
There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births – this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight.
Conclusion:
Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.
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Systematic Review05-01-2017
Zika Virus Infection in Pregnant Women and Microcephaly
- Geraldo Duarte,
- Antonio Fernandes Moron,
- Artur Timerman,
- César Eduardo Fernandes,
- Corintio Mariani Neto, [ … ],
- Rossana Pulcineli Vieira Francisco
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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
Systematic ReviewZika Virus Infection in Pregnant Women and Microcephaly
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):235-248
- Geraldo Duarte,
- Antonio Fernandes Moron,
- Artur Timerman,
- César Eduardo Fernandes,
- Corintio Mariani Neto,
- Gutemberg Leão de Almeida Filho,
- Heron Werner Junior,
- Hilka Flavia Barra do Espírito Santo,
- João Alfredo Piffero Steibel,
- João Bortoletti Filho,
- Juvenal Barreto Borriello de Andrade,
- Marcelo Burlá,
- Marcos Felipe Silva de Sá,
- Newton Eduardo Busso,
- Paulo César Giraldo,
- Renato Augusto Moreira de Sá,
- Renato Passini Junior,
- Rosiane Mattar,
- Rossana Pulcineli Vieira Francisco
Views387Abstract
From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damagetothe central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection’s devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR)with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKVurine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.
Key-words arbovirus infectionsblindness/ etiologydeafness/ etiologymicrocephaly/ ultrasonographyPregnancy complicationsReal-time polymerase chain reactionZika virusSee morePlumX Metrics- Citations
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Editorial09-25-2020
COVID-19 and Maternal Death in Brazil: An Invisible Tragedy
- Marcos Nakamura-Pereira
,
- Melania Maria Ramos Amorim
,
- Rodolfo de Carvalho Pacagnella
,
- Maira Libertad Soligo Takemoto
,
- Fatima Cristina Cunha Penso
,
[ … ], - Maria do Carmo Leal
Views210This 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
EditorialCOVID-19 and Maternal Death in Brazil: An Invisible Tragedy
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):445-447
- Marcos Nakamura-Pereira
,
- Melania Maria Ramos Amorim
,
- Rodolfo de Carvalho Pacagnella
,
- Maira Libertad Soligo Takemoto
,
- Fatima Cristina Cunha Penso
,
- Jorge de Rezende-Filho
,
- Maria do Carmo Leal
Views210The infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for causing the coronavirus disease 2019 (COVID-19), became a devastating threat to the health of the world population and was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020. Beginning in China at the end […]See moreThis 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. - Marcos Nakamura-Pereira
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Original Article04-01-2017
Influence of Body Image in Women Undergoing Treatment for Breast Cancer
- Ana Carolina Lagos Prates,
- Ruffo Freitas-Junior,
- Mariana Ferreira Oliveira Prates,
- Márcia de Faria Veloso,
- Norami de Moura Barros
Views279This 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 ArticleInfluence of Body Image in Women Undergoing Treatment for Breast Cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(4):175-183
- Ana Carolina Lagos Prates,
- Ruffo Freitas-Junior,
- Mariana Ferreira Oliveira Prates,
- Márcia de Faria Veloso,
- Norami de Moura Barros
Views279See moreAbstract
Objective
The objective of this study was to investigate the self-esteem of women with and without breast cancer regarding their body image.
Methods
A quantitative, case-control study in which 90 women with breast cancer were evaluated in the case group, and 77 women without breast cancer in the control group. For data collection, the body satisfaction scale (BSS), a scale adapted and validated in Brazil, and the Rosenberg self-esteem questionnaire were used. For the statistical analysis of the data, the Statistical Package for the Social Sciences software (IBM-SPSS, Chicago, Il, US), version 16.0 was used.
Results
Compared with the women without breast cancer, those with breast cancer were more dissatisfied with body image related to appearance. Women undergoing neoadjuvant chemotherapy were more dissatisfied with their appearance compared with those with cancer who were not undergoing this treatment. Mastectomy also accounted for more dissatisfaction concerning appearance among women who underwent the procedure compared with the women who were submitted to breast-conserving therapy.
Conclusion
Women with breast cancer were more dissatisfied with their body image compared with those without breast cancer, particularly following mastectomy or during chemotherapy. The self-esteem was found to be negatively affected in patients who were dissatisfied with their body image.
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. -
Original Article01-01-2018
Premenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST)
- Aline Henz,
- Charles Francisco Ferreira,
- Carolina Leão Oderich,
- Carin Weirich Gallon,
- Juliana Rintondale Sodré de Castro, [ … ],
- Maria Celeste Osório Wender
Views466This 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 ArticlePremenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(1):20-25
- Aline Henz,
- Charles Francisco Ferreira,
- Carolina Leão Oderich,
- Carin Weirich Gallon,
- Juliana Rintondale Sodré de Castro,
- Maiara Conzatti,
- Marcelo Pio de Almeida Fleck,
- Maria Celeste Osório Wender
Views466Abstract
Objective
To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses.
Methods
A cross-sectional study with 127 women (20 45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values.
Results
Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered “normal” (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis.
Conclusion
The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.
Key-words Diagnosispremenstrual dysphoric disorderPremenstrual syndromeQuestionnaireSigns and symptomsSee moreThis 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. -
Review Article07-01-2017
Abnormal Uterine Bleeding
- Cristina Laguna Benetti-Pinto,
- Ana Carolina Japur de Sá Rosa-e-Silva,
- Daniela Angerame Yela,
- José Maria Soares Júnior
Views315This 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 ArticleAbnormal Uterine Bleeding
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(7):358-368
- Cristina Laguna Benetti-Pinto,
- Ana Carolina Japur de Sá Rosa-e-Silva,
- Daniela Angerame Yela,
- José Maria Soares Júnior
Views315Abstract
Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormaluterinebleeding, both acuteand chronic.Didactically,thetreatmentoptions were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and thelatterisbasedmainlyonhormonaltherapy,anti-inflammatorydrugsandantifibrinolytics.
Key-words Abnormal uterine bleedingdysfunctional uterine bleedingheavy menstrual bleedingmenorrhagiaPALM-COEINSee moreThis 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. -
Original Article03-01-2018
Late-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):127-136
Views165This 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 ArticleLate-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):127-136
Views165Abstract
Objective
To analyze the time trend and the factors regarding the diagnosis of latestage breast cancer in Brazil from 2000 to 2012.
Methods
We conducted a retrospective cohort study using data from hospital-based cancer registries. Joinpoint regression was used to analyze the time trends of stage at diagnosis. The risk of late-stage presentation was estimated using multinomial logistic regression.
Results
A total of 170,757 cases were analyzed. The median time from diagnosis to treatment was of 43 days (range: 0-182 days). The percentage of cases with late-stage diagnosis decreased from2000 to 2002, with an annual percent change (APC) of -6.6%(95%confidence interval [95%CI]: -7.6–5.5%); it increased from 2002 until 2009, with an APC of 1.1% (95% CI: 0.9-1.3%), and remained stable up to 2012.Women with college education (compared with illiterate women) had less chance of having a late-stage diagnosis (odds ratio [OR]: 0.32; 95%CI: 0.29-0.35). The odds were greater among brown women (OR: 1.30; 95%CI: 1.21-1.41) and black women (OR: 1.63; 95%CI: 1.47-1.82), compared with white women. The odds were also higher for women treated in facilities located and in the Northern region of Brazil (OR: 1.23; 95%CI: 1.04-1.45) and in the Midwest (OR: 1.61;95%CI: 1.34-1.94), compared with those treated in the southern region of the country. Age, histological type, and marital status were some of the other factors that were positively related to staging at the diagnosis.
Conclusion
Access to diagnosis of breast cancer is uneven in Brazil, and women with lower socioeconomic status present a greater probability of having an advanced stage at diagnosis.
Key-words Breast neoplasmsdisease registriesHealth services accessibilityoncologywomen’s health serviceSee moreThis 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.
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