Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Artigos Originais

    Maternal risk factors associated with the necessity of neonatal intensive care unit

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):29-34

    Summary

    Artigos Originais

    Maternal risk factors associated with the necessity of neonatal intensive care unit

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):29-34

    DOI 10.1590/S0100-72032014000100007

    Views1

    PURPOSE:

    To evaluate the maternal risk factors that require newborn assistance in neonatal Intensive Care Units (ICU).

    METHODS:

    A prospective observational case-control study was conducted on 222 pregnant women (1:1 case-control ratio) attended at a public maternity. The following variables were analyzed in the puerperae: age at menarche, age at first sexual intercourse, history of chronic diseases, habits, prenatal care, obstetric history, clinical complications during pregnancy and childbirth, and sociodemographic variables. The variables of the newborns were: Apgar scores, gestational age, birth weight, presence or absence of malformation, need for resuscitation, and complications during the first 24 hours. Proportions were compared using the Fisher exact test or the Person γ2 test. Multivariable models were developed by logistic regression analysis using adjusted Odds Ratio with a 95% confidence interval (CI).

    RESULTS:

    Regarding reproductive history, ≥3 pregnancies and 2 or 3 previous cesareans were sytatistically significant (p=0.0 and 0.0, respectively). Among the complications that required assistance in the neonatal ICU, prematurity was responsible for 61 cases (55.5%), followed by risk of intrapartum infection in 46 cases (41.8%). Regarding the maternal history, the presence of hypertensive disease showed statistical significance (p=0.0). Premature rupture of membranes was strongly associated with the need for the neonatal ICU (Odds Ratio - OR=6.1, 95%CI 2.6-14.4).

    CONCLUSIONS:

    Premature rupture of membranes and hypertensive disease should receive special attention in prenatal care due to their strong association with newborns requiring assistance in the neonatal ICU.

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  • Artigos Originais

    Influence of cause of death on body and internal organs weight in perinatal autopsies

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):23-28

    Summary

    Artigos Originais

    Influence of cause of death on body and internal organs weight in perinatal autopsies

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):23-28

    DOI 10.1590/S0100-72032014000100006

    Views0

    PURPOSE:

    To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death.

    METHODS:

    One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed.

    RESULTS:

    The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences.

    CONCLUSIONS:

    This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship.

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  • Artigos Originais

    Vertical transmission from abortive material and blood with emphasis on Toxoplasma gondii

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):17-22

    Summary

    Artigos Originais

    Vertical transmission from abortive material and blood with emphasis on Toxoplasma gondii

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):17-22

    DOI 10.1590/S0100-72032014000100005

    Views0

    PURPOSE:

    To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis.

    METHODS:

    A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed.

    RESULTS:

    55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation.

    CONCLUSIONS:

    The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion.

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  • Artigos Originais

    Perinatal variables and association with very low birthweight newborns in a Brazilian public university hospital

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):10-16

    Summary

    Artigos Originais

    Perinatal variables and association with very low birthweight newborns in a Brazilian public university hospital

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):10-16

    DOI 10.1590/S0100-72032014000100004

    Views2

    PURPOSE:

    To investigate the association of perinatal variables with the birth of very low birth weight (VLBW) preterm newborns.

    METHODS:

    It was a retrospective study of the medical records of infants born after spontaneous preterm labor with admission to a neonatal intensive care unit. Preterm infants were divided into two groups: very low birth weight (VLBW) group (weight <1,500 g) and low birth weight (LBW) group (weight ≥1,500 g and <2,500 g). Prenatal variables such as maternal complications during pregnancy and childbirth/postpartum, and fetal/neonatal complications were investigated. Statistical analysis was performed using the Fisher exact test or χ2 test, with calculation of relative risk (RR), and the Student t test for comparison of group means, with the level of significance set at p≤0.05.

    RESULTS:

    Hemorrhagic comorbidities (p=0.006; RR=1.2) and hypertension (p=0.04; RR=1.5), surgical delivery (p=0.001; RR=0.5), gestational age <33 weeks (p< 0.001; RR=16.7) and Apgar score at 1st and 5th minute (p=0.006; RR=1.6; p=0.01; RR=1.9) were associated with the occurrence of VLBW. Infants with VLBW had a significant association with the occurrence of metabolic comorbidities (p=0.01; RR=1.8), neurological (p=0.01; RR=1.7) and infectious diseases (p=0.001; RR=1.9), hospitalization >4 weeks (p=0.02; RR=1.8) and early neonatal death (p=0.0001; RR=2.9).

    CONCLUSIONS:

    Factors such as hypertension and bleeding comorbidities during delivery and management of gestational age of less than 33 weeks were associated with the birth of VLBW newborns. This group of infants also showed higher RR for the occurrence of early neonatal death.

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  • Artigos Originais

    Competences acquired during medical training and the opinions and attitudes about abortion

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):5-9

    Summary

    Artigos Originais

    Competences acquired during medical training and the opinions and attitudes about abortion

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):5-9

    DOI 10.1590/S0100-72032014000100003

    Views4

    PURPOSE:

    To analyze and compare the knowledge, attitudes and opinions of medical students about abortion in Brazil during the progression of the course.

    METHODS:

    This was a cross-sectional study involving 174 medical students. A questionnaire was applied whose dependent variables were degree of information about abortion, including its legal aspects in Brazil, situations in which the students would agree with the expansion of permitted legal abortion, knowledge of someone undergoing abortion, and discomfort about performing the procedure legally. The independent variables were sociodemographic data, religion, and academic standing (first or second half of the course). For data analysis it was used χ2 and Fisher's exact tests, with the level of significance set at 5%.

    RESULTS:

    Among the interviewees, 59.8 % considered themselves well informed about the topic. Students demonstrated knowledge about the complications of abortion, with no differences with the progression of the course. Knowledge about the legal aspects of abortion in Brazil was shown by 48.9% of the sample, being significantly higher among students in the second half of the course (34.0 and 68.9%, respectively; p<0.001). Experiencing situations of clandestine abortion was significantly higher among students in the final half of the course (3.05 and 59.4%, respectively; p<0.001), the same being observed about knowing someone who underwent the procedure illegally (5.0 and 18.9%, respectively; p<0.001). The expansion of permissive legal abortion in Brazil was agreed about by 86.2% students, although 54.6% of the students reported that they felt uncomfortable about performing the procedure even legally, without statistical significance with the evolution of the course regarding the two situations.

    CONCLUSIONS:

    The experiences of abortion and the knowledge of legal aspects were significantly higher among students in the second half of the course, with no significant changes in attitudes or opinions about abortion being observed with the competences acquired during medical training.

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  • Artigos Originais

    Cytological smears of women diagnosed with adenocarcinoma of the uterine cervix

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):40-45

    Summary

    Artigos Originais

    Cytological smears of women diagnosed with adenocarcinoma of the uterine cervix

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):40-45

    DOI 10.1590/S0100-72032014000100009

    Views1

    PURPOSE:

    To analyze the cytological findings of women with cervical adenocarcinoma, taking
    into account the patient's history in the year prior to diagnosis and the
    histopathological aspects of the lesions.

    METHODS:

    A retrospective comparative study was conducted using data from women with
    cervical adenocarcinoma or squamous carcinoma detected between 2002 and 2008. The
    cytological reports were synthesized according to the Bethesda System revised in
    2001 and were compared to the histopathological findings of cervical
    adenocarcinoma and squamous carcinoma. The distributions of cytological findings
    were calculated, as well as the global agreement and chance-corrected agreement
    using the Cohen's Kappa Coefficient. For this purpose, the cytological findings
    were grouped according to the epithelial origin, forming the glandular cell and
    squamous cell groups, with the histopathologically confirmed tumor types
    (adenocarcinoma versus squamous carcinoma) being used as the gold
    standard.

    RESULTS:

    A total of 284 cases of cervical cancer were diagnosed during the study period.
    The effectively studied cases were 27 and 54 patients with adenocarcinoma and
    squamous carcinoma, respectively. The adenocarcinoma group represented 9.5% of the
    total cases diagnosed, and 56.0% of the women in this group were younger than 50
    years. Cervical cytology was collected on average 92 days before the cancer
    diagnosis (range: 19 days to 310 days). In 41.6% of cases the cytological results
    were consistent with glandular alterations such as adenocarcinoma cells or
    atypical glandular cells. The global agreement and Cohen's Kappa Coefficient were
    73.7 and 48.7%, suggesting substantial and moderate agreement, respectively.

    CONCLUSIONS:

    In this population, the cytological smears had an important role in screening
    women with adenocarcinoma, although some of them were referred to clarify the
    clinical symptoms. The agreement between cytological and histopathological
    findings was moderate.

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  • Artigos Originais

    Central nervous system malformations and the presence of the MTHFR-C677T mutation in fetal blood

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):436-441

    Summary

    Artigos Originais

    Central nervous system malformations and the presence of the MTHFR-C677T mutation in fetal blood

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):436-441

    DOI 10.1590/S0100-72032013001000002

    Views1

    PURPOSE: To evaluate the association between central nervous system (CNS) malformations and the C677T-MTHFR mutation in fetal blood. METHODS: A case-control study was conducted to compare the MTHFR-C677T mutation detected in 78 fetuses with CNS malformations and with 100 morphologically normal fetuses. Genomic DNA was extracted and purified from fetal blood using the Wizard® Genomic DNA Purification Kit (Promega Corp., Madison, WI, USA) according to manufacturer's protocol. The polymerase chain reaction (PCR) was used to assay the thermolabile MTHFR-C677T mutation. The γ² and the Fisher's exact tests were used for descriptive analysis and the Wilcoxon test was used for univariate analysis. Logistic regression analysis was performed to identify which variables were predictors of CNS malformation. RESULTS: Cases and controls were similar regarding maternal characteristics such as age and number of deliveries and abortions. The MTHFR-C677T mutation was detected in 20 cases (25.6%) and in 6 controls in its heterozygous form (OR 10.3; 95%CI 3.3-32.2) and in 6 cases (7.7%) and in 1 control in its homozygous form (OR 12.3; 95%CI 1.3-111.1), and the differences were statistically significant. CONCLUSION: The presence of the MTHFR-C677T mutation in fetal blood was consistent with a higher risk of CNS malformations, both in the heterozygous and homozygous forms.

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  • Artigos Originais

    Confiability and reliability of an on-line version of the Female Sexual Function Index by test-retest

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):469-474

    Summary

    Artigos Originais

    Confiability and reliability of an on-line version of the Female Sexual Function Index by test-retest

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):469-474

    DOI 10.1590/S0100-72032013001000008

    Views0

    PURPOSE: It was to test the validity and reliability of an online version of the Female Sexual Function Index (FSFI). METHODS: An online version of the FSFI was compared to the pen and paper traditional version. Physiotherapy students in three cities were randomly allocated to two groups - G-pp/ol (n=126) and G-ol/pp (n=147). G-pp/ol women replied to th FSFI using the traditional pen and paper method, while G-ol/pp women answered an online version of the same questionnaire. Data were collected ageing after 15 days, when G-pp/ol women answered the online version while G-ol/pp women answered on paper. All data were transferred to SPSS software. Demographic differences between the test two groups were determined by Student's t-test or Fisher exact (95%CI; p>0.05). Association and correlation between the responses of G-pp/ol and G-ol/pp were assessed for each sample by the t-test and Pearson's coefficient. An identical strategy was used for intragroup comparisons. RESULTS: A total of 273 women participated in the study and 28 (10.2%) giving up the second collection. There were no demographic differences between groups. Fifteen of the 19 FSFI questions were associated and correlated between the two groups in both test and the retest. The intragroup analysis revealed that all FSFI questions and scores were associated and weakly correlated for the same group during both test and retest. CONCLUSION: The online version of the FSFI showed acceptable validity and reliability when compared to the paper version, and can justify the choice of this modality, especially in studies involving private questions.

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