Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):333-338
DOI 10.1590/S0100-720320150005373
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.
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).
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.
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):325-332
DOI 10.1590/S0100-720320150005367
To determine the eating behavior of pregnant women assisted by primary health care and to compare it with women at childbearing age in Brazilian capitals.
A cross-sectional study conducted on 256 pregnant women in the second trimester of gestation, selected by drawing lots from those assisted by primary health care units of a municipality in the state of São Paulo in 2009/2010. Eating habits were investigated via a questionnaire adapted from the VIGITEL system, consisting of questions about eating habits in general and the frequency and consumption characteristics of food groups/specific foods. For tis comparison, we used the indicators reported by the VIGITEL system for women at childbearing age in Brazilian capitals in 2010. The analyses involved the presentation of frequency distribution and descriptive statistics with comparisons according to the age group.
Most patients had breakfast every day (86.7%) and 45.7% habitually exchanged a main meal for a snack once or twice a week. A daily consumption of fruit, raw salad and vegetables was not reported by 48.8%, 41.8% and 55.1% of the women, respectively. Fish was reported to never or almost never be consumed by 64.4% of the pregnant women. At least once a week, 69.9% of them reported the consumption of soda, and 86.4% of wafers/cookies. The comparison between the pregnant women and women at childbearing age in capitals showed a close similar prevalence of overweight, and no difference in the regular consumption of fruit and vegetables. Meat containing excess of fat and whole milk were more consumed by pregnant women, with differences reported in all the age groups analyzed. On the other hand, the pregnant women reported a less regular intake of soft drinks.
The actions that need to be performed in prenatal care are various and very important, promoting the consumption of specific foods and providing guidelines about eating behavior, while reinforcing healthy eating habits already present.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):319-324
DOI 10.1590/S0100-720320150005388
To compare body attitudes of pregnant women in various body mass index categories, during different gestational periods and under gestational risk conditions, as well as to analyze the association of the study variables with the body attitudes of pregnant women.
We included 386 pregnant women in all gestational periods, aged 18 to 46 years (mean 29.32±6.04 years ), who attended prenatal care in the public and private sectors of a city in Southeastern Brazil, excluding women with incomplete data. The instruments for assessment were "Body Attitudes Questionnaire", "Critério de Classificação Econômica Brasil", and a sociodemographic questionnaire. In addition, anthropometric and obstetric data were collected. Descriptive, comparative, and correlational statistical analyses were performed.
The body attitudes of pregnant women were similar in all pregnancy trimesters (F=0.39; p=0.9). Negative body attitudes increased gradually among low weight (108.2±12.5), appropriate weight (116.2±16.0), overweight (125.1±14.3), and obese (132.9±16.4) groups, and among pregnancy women with normal (120.0±17.1) and high-risk pregnancies (124.9±16.7). The sociodemographic, economic, and obstetric variables did not influence the variance of body attitudes. The body mass index explained 11.3% of the variance of body attitudes in pregnant women.
Nutritional status and risk conditions showed an association with negative body image and should therefore be evaluated in pregnant women for a better maternal and child health.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):314-318
DOI 10.1590/S0100-720320150005098
To identify the predominant species and the role of sexual partners in the maintenance of recurrent vulvovaginitis by Candida spp.
A prospective study of 830 patients aged 18 to 65 years with yeast vaginitis was performed between August 2007 and March 2012. Patients with diabetes mellitus, AIDS or taking corticosteroids, antibiotics or hormone therapy and immunosuppressed patients, patients using vaginal douches, spermicides or intrauterine devices were excluded from the study. Candida species were identified by phenotypic and genotypic methods. The chi-square test was used to correlate the presence of Candida spp. in male partners with the recurrence of vaginitis.
The fungal agent was isolated from a total of 40 women, 24 with recurrent vaginitis and from 15 of their sexual partners, 10 of whom were asymptomatic while 5 were symptomatic. There was agreement of the species found in the couple in 100% of recurrences. C. albicans (62.4 and 60%), C. glabrata (29.1 and 33.3%) and C. guilliermondii species were identified. Candida tropicalis (4.1%) was isolated from only one patient. Candida albicans was isolated from the remaining 16 women who had uncomplicated vaginitis. C. glabrata was isolated from only two of the asymptomatic partners.
There was a predominance of C. albicans and symptomatic or asymptomatic partners can play an important role as a reservoir and source of transmission of yeast, especially in cases of recurrent vulvovaginitis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):302-307
DOI 10.1590/S0100-720320150005352
To evaluate the follicular development of female Wistar rats with obesity induced by the cafeteria diet, submitted to the administration of losartan (LOS), an antagonist of the AT1 receptor of Angiotensin II.
At weaning (21 days of age), female Wistar rats were randomly divided, into two groups: control (CTL) that received standard chow and cafeteria (CAF) that received a cafeteria diet, a highly palatable and highly caloric diet. At 70 days of age, at the beginning of the reproductive age, animals of the CAF group were subdivided into two groups (n=15/group): CAF, that received water, and CAF+LOS, that received LOS for 30 days. The CTL group also received water by gavage. At 100 days of age, the animals were euthanized and body weight (BW) as well as the retroperitoneal, perigonadal and subcutaneous fat weights were analyzed. The right ovaries were isolated for counting the number of primary, secondary, antral and mature follicles. Plasma levels of FSH, LH, prolactin and progesterone hormones were analyzed. The results were expressed as mean±standard error of the mean. Data were analyzed statistically by one-way ANOVA followed by the Newman-Keuls post-test (p<0.05).
BW and fat weight, as well as the number of antral follicles, were higher in the CAF group compared to the CTL group. However, FSH and LH levels were lower in CAF animals compared to CTL animals. LOS administration attenuated the reduction of FSH and LH levels. Progesterone and PRL levels were similar among groups.
LOS could improve follicular development in obese females and could be used as an adjunctive drug in the treatment of infertility associated with obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(6):278-282
DOI 10.1590/SO100-720320150005326
to analize the level of functional fitness of a group of postmenopausal women in
the city of Presidente Prudente using the set of functional fitness tests of the
American Alliance for Health, Physical Education, Recreation and Dance and to
check whether there are differences between groups of women in the fifth and sixth
decade of life.
This was a cross-sectional study conducted on 175 postmenopausal women (follicle
stimulating hormone level>26.72 mIU/L) in the city of Presidente Prudente in
2013. The inclusion criteria were not being part of any type of systematic motor
intervention for at least six months before the collection of research data;
absence of motor or cognitive impairment that would prevent the evaluation
protocols, and absence of chronic or degenerative disease, musculoskeletal injury
or comorbidity that could prevent or limit the evaluations. The women were
evaluated by the same trained examiners. The 50 to 59 year group showed a mean age
of 55.3±4.5 years, mean FSH values of 53.5±21.1 mIU/mL, mean coordination of
11.4±2.2 seconds, mean strength of 20.1±3.9 repetitions, mean flexibility of
51.7±11.8 cm, mean 23.2±2.8 seconds agility and mean aerobic resistance of
500±43/2 . The 60 to 69 year group had a mean age of 65.1±4.1 years with FSH
54.9±15.9, 11.6±2.6 seconds coordination, strength 20.3±4.7 repetitions, 54.6±11.2
cm flexibility, agility 24.7±4.3 seconds, and aerobic resistance of 508±51
seconds.
It was possible to analyze the functional fitness of postmenopausal women through
the set of the American Alliance testing for Health, Physical Education,
Recreation and Dance with no significant differences between groups for the
variables strength, flexibility, aerobic capacity and coordination, and with only
the speed variable showing significant differences. We recommend further studies
seeking to formulate normative values for the population in question.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(6):272-277
DOI 10.1590/SO100-720320150005301
To evaluate the ovarian response after cyclophosphamide use (CPM) in patients
with systemic lupus erythematosus (SLE) and to correlate the age and cumulative
dose findings with changes in menstrual cycle and/or progression to ovarian
failure (OF).
This was a cross-sectional, retrospective study of 50 patients with a diagnosis
of SLE who used CFM with a clinical follow-up of at least 1 year. Included were
patients aged 12-40 years, who had undergone chemotherapy for SLE control and who
had regular menstrual cycles before the beginning of CPM treatment. Patients who
discontinued follow-up, who were followed up for less than one year or who had
irregular/absent menses before the beginning of CPM treatment were excluded. All
women studied were submitted to an interview and a questionnaire containing
questions about the pattern of the menstrual cycle before and after therapy, and
about the gestational periods and contraception. We asked if the patients had been
instructed about the side effects and consequences of CFM. Statistical analysis
was performed using the Student t-test and the Mann Whitney, χ2 and
nonparametric Kolmogorov-Smirnov tests.
The mean age of the patients included in the study was 30.8 years and the mean
age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped
menstruating, 28% returned to regular cycles and 48% continued to have irregular
cycles. It was found that the patients who developed OF had longer disease
duration (12.3 years) than those who did not develop it (8.9 years). Thirteen
patients became spontaneously pregnant after CFM; however, 66% progressed to
abortion. The mean age of the patients who used CFM and developed OF was 28.1
years. Amenorrhea occurred in 50% of those aged 31-40 years, in 22.2% of those
aged 21-30 years and in 7.7% of those aged 12-20 years. Our study showed no
statistical correlation between cumulative dose and OF, although cumulative doses
greater than 11grams tended to promote some type of menstrual irregularity.
SLE disease duration, age at the time of treatment and the highest cumulative
doses are important predictors of OF after therapy with CFM. Pregnancy in lupus
patients is more likely to evolve with abortion after the use of chemotherapy. It
was seen that a small proportion of patients were aware of all the implications of
the drug. Therefore, additional studies should be conducted for further knowledge
and awareness of the importance of contraception and the preservation of ovarian
tissue on the part of the medical community.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(6):266-271
DOI 10.1590/SO100-720320150005254
To investigate the relationship between sexual function and quality of life in
pregnant women living in two cities of Northeastern Brazil.
The sample consisted of 207 pregnant women. The data were collected through a
questionnaire containing questions about socio-demographic, gynecological and
obstetrical data, body and sexual knowledge. Quality of life was assessed by
applying the Ferrans & Powers Quality of Life Index (QLI Ferrans and Power).
Sexual function was assessed using the Female Sexual Function Index (IFSF). Data
were statistically analyzed using the Shapiro-Wilk, Mann-Whitney and Wilcoxon
tests.
The pregnant women studied had a median age of 30 years (quartile 26-33 years)
and were approximately at the 26th gestational week. A significant
decrease in the monthly frequency of sexual relations of the couple was observed,
with a median of 12 to 4 times per month (Z=-10.56; p<0.001). Sexual
dysfunction was detected in 35.7% of the pregnant women studied, whose quality of
life was lower when compared to women with unchanged sexual function (Z=-2.9;
p=0.004).
The results of this study show that sexual dysfunction negatively affected the
quality of life of pregnant women, and this should be an important aspect for
review during prenatal consultations.