Articles - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Article09-06-2024

    Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75

    Abstract

    Original Article

    Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75

    DOI 10.61622/rbgo/2024rbgo75

    Views170

    Abstract

    Objective

    To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries.

    Methods

    A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled.

    Results

    In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue.

    Conclusion

    Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.

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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 Article09-06-2024

    Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74

    Abstract

    Original Article

    Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74

    DOI 10.61622/rbgo/2024rbgo74

    Views200

    Abstract

    Objective

    This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis.

    Methods

    A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson’s Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%.

    Results

    A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 – 4000 vs 1700 ml, IQR 1195-2135. p <0.001).

    Conclusion

    Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery

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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 Article09-06-2024

    Biochemical markers for prediction of the first half pregnancy losses: a review

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72

    Abstract

    Review Article

    Biochemical markers for prediction of the first half pregnancy losses: a review

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo72

    DOI 10.61622/rbgo/2024rbgo72

    Views305

    Abstract

    Objective

    26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained.

    Methods

    The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality.

    Results

    Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of β-human chorionic gonadotropin, progesterone, pregnancy-associated protein – A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses.

    Conclusion

    It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.

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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 Article09-06-2024

    Association between dietary patterns and infant birth weight in brazilian pregnancy women with gestational diabetes: a cross-sectional study

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo68

    Abstract

    Original Article

    Association between dietary patterns and infant birth weight in brazilian pregnancy women with gestational diabetes: a cross-sectional study

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo68

    DOI 10.61622/rbgo/2024rbgo68

    Views268

    Abstract

    Objective

    To evaluate the association between the dietary patterns (DPs) of pregnant women with GDM (gestational diabetes mellitus) and the birth weight (BW) of the infants.

    Methods

    Cross-sectional study with 187 adult pregnant women with GDM attended at a maternity in Rio de Janeiro from 2011 to 2014. Dietary intake was assessed in the third trimester using a semiquantitative food frequency questionnaire (FFQ). The outcomes were BW and weight adequacy for gestational age (GA). Reduced Rank Regression (RRR) was used to explain the following response variables: density of carbohydrates, fibres, and saturated fatty acids. Statistical analyzes included multinomial logistic regression models.

    Results

    The mean BW was 3261.9 (± 424.5) g. Three DPs were identified, with DP 3 (high consumption of refined carbohydrates, fast foods/snacks, whole milk, sugars/sweets, and soft drinks and low consumption of beans, vegetables, and low-fat milk and derivatives) being the main pattern, explaining 48.37% of the response variables. In the multinomial logistic regression analysis no statistically significant association was found between the tertiles of DPs and BW or the adequacy of weight for GA, even after adjustments of confounding covariates.

    Conclusion

    No significant associations were found between maternal DPs in the third trimester of pregnancy and infant BW or adequacy of weight for GA.

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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 Article09-06-2024

    Relationship between early age at menarche, older age at menopause and subtypes of breast cancer: a scoping review

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo50

    Abstract

    Review Article

    Relationship between early age at menarche, older age at menopause and subtypes of breast cancer: a scoping review

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo50

    DOI 10.61622/rbgo/2024rbgo50

    Views306

    Abstract

    Objective

    To determine the relationship between early age at menarche, late age at menopause with specific subtypes of breast cancer (BC).

    Methods

    A literature search was conducted in Embase, Lilacs, PubMed, Scopus, and Scielo databases, following the Joanna Briggs Institute scoping review protocol and answering the question “How early age at menarche or late age at menopause are related to different breast cancer subtypes?”.

    Results

    A number of 4,003 studies were identified, of which 17 were selected. Most of the included articles found a clear relationship between early menarche, late menopause and some subtypes of BC, mainly, PR+, ER+, luminal, and HER-2 tumors. However, some studies have found a contradictory relationship and one study didn’t find any relationship between them.

    Conclusion

    A relationship between early age at menarche and advanced age at menopause was observed with some subtypes of breast cancer, since other factors must be considered in its understanding.

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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.
  • Editorial09-06-2024

    The importance of the quadrivalent HPV vaccine in the elimination of cervical cancer in Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt4

    Abstract

    Editorial

    The importance of the quadrivalent HPV vaccine in the elimination of cervical cancer in Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt4

    DOI 10.61622/rbgo/2024EDT04

    Views303
    HPV vaccination program in BrazilThe introduction of the quadrivalent HPV vaccine Gardasil 4V into the Brazilian National Immunization Schedule was approved by the National Committee for Technology Incorporation into the Unified Health System (Conitec) and incorporated into the National Immunization Schedule in 2014. This decision was based on a previous cost-effectiveness study that analyzed different […]
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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 Article09-06-2024

    A new screening of preterm birth in gestation with short cervix after pessary plus progesterone

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo39i

    Abstract

    Original Article

    A new screening of preterm birth in gestation with short cervix after pessary plus progesterone

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo39i

    DOI 10.61622/rbgo/2024rbgo39i

    Views260

    Abstract

    Objective

    This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics.

    Methods

    This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%.

    Results

    The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks.

    Conclusion

    Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.

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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 Article09-04-2024

    Artificial intelligence in mammography: a systematic review of the external validation

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo71

    Abstract

    Review Article

    Artificial intelligence in mammography: a systematic review of the external validation

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo71

    DOI 10.61622/rbgo/2024rbgo71

    Views377

    Abstract

    Objective

    To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography.

    Data source

    Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms “Artificial Intelligence,” “Mammography,” and their respective MeSH terms. We filtered publications from the past ten years (2014 – 2024) and in English.

    Study selection

    A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work.

    Data collection

    The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity.

    Data synthesis

    It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone.

    Conclusion

    AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals.

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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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