Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):345-351
DOI 10.1590/S0100-72032006000600005
PURPOSE: to evaluate association between CD4+ cell count and cervical intraepithelial lesion severity in HIV-infected women. METHODS: cross-sectional study of 87 HIV-infected patients which were confirmed by previous serologic examinations. All had cervical HPV diagnosed by polymerase chain reaction (PCR). All patients underwent anamnesis, physical examinations and colposcopy. Cervix biopsy was performed when indicated by colposcopical examination. Histopathological results followed Richart's classification, adapted by Wright, and CD4+ cell count and cervical intraepithelial lesion severity association was analysed by comparison of means using analysis using analysis of variance (ANOVA). RESULTS: among 60 biopsied women 24 were found (40.0%) with CIN I, eight (13.3%) with CIN II, three (5%) with CIN III, 14 (23.3%) with chronic cervicitis and 11 with cytopathic effect of HPV, without cell polarity loss. This corresponds to 35 (58.3%) women with intraepithelial lesion of low grade (CIN I + HPV) and 11 (18.3%) with intraepithelial lesion of high grade (CIN II + CIN III). There was no significant association between CD4+ cell count mean and cervical intraepithelial lesion severity (p=0.901). CONCLUSIONS: there was no association between CD4+ cell count and cervical intraepithelial lesion severity diagnosed by histopathological examination.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):345-351
DOI 10.1590/S0100-72032006000600005
PURPOSE: to evaluate association between CD4+ cell count and cervical intraepithelial lesion severity in HIV-infected women. METHODS: cross-sectional study of 87 HIV-infected patients which were confirmed by previous serologic examinations. All had cervical HPV diagnosed by polymerase chain reaction (PCR). All patients underwent anamnesis, physical examinations and colposcopy. Cervix biopsy was performed when indicated by colposcopical examination. Histopathological results followed Richart's classification, adapted by Wright, and CD4+ cell count and cervical intraepithelial lesion severity association was analysed by comparison of means using analysis using analysis of variance (ANOVA). RESULTS: among 60 biopsied women 24 were found (40.0%) with CIN I, eight (13.3%) with CIN II, three (5%) with CIN III, 14 (23.3%) with chronic cervicitis and 11 with cytopathic effect of HPV, without cell polarity loss. This corresponds to 35 (58.3%) women with intraepithelial lesion of low grade (CIN I + HPV) and 11 (18.3%) with intraepithelial lesion of high grade (CIN II + CIN III). There was no significant association between CD4+ cell count mean and cervical intraepithelial lesion severity (p=0.901). CONCLUSIONS: there was no association between CD4+ cell count and cervical intraepithelial lesion severity diagnosed by histopathological examination.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):340-344
DOI 10.1590/S0100-72032006000600004
PURPOSE: the study the effects of maternal cigarette smoking during pregnancy on placental maturation (calcifications) and the placental-uterine circulation, evaluated through umbilical and uterine Doppler. METHODS: prospective cohort study involving 244 pregnant women, 210 of them non-smokers and 34 smokers. Participants were submitted to four serial sonograms. The first was performed up to the 16th week of pregnancy to determine gestational age, and the other three at 28, 32 and 36 weeks for fetal biometry, evaluation of placental texture and Doppler studies of the uterine and umbilical arteries. Premature placental calcification was defined as grade III before 36 weeks. The chi2 and Fisher exact tests were used to compare placental grading, and the Mann-Whitney test to evaluate the resistance index of uterine and umbilical arteries. RESULTS: the frequency of grade III placenta and the resistance of the uterine arteries did not differ significantly between smokers and non-smokers, at all gestational ages. Umbilical artery Doppler was significantly higher in smokers than in non-smokers at 32 weeks. CONCLUSIONS: no association was found between cigarette smoking and premature placental calcification. Smoking was associated with increased umbilical artery resistance at 32 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):340-344
DOI 10.1590/S0100-72032006000600004
PURPOSE: the study the effects of maternal cigarette smoking during pregnancy on placental maturation (calcifications) and the placental-uterine circulation, evaluated through umbilical and uterine Doppler. METHODS: prospective cohort study involving 244 pregnant women, 210 of them non-smokers and 34 smokers. Participants were submitted to four serial sonograms. The first was performed up to the 16th week of pregnancy to determine gestational age, and the other three at 28, 32 and 36 weeks for fetal biometry, evaluation of placental texture and Doppler studies of the uterine and umbilical arteries. Premature placental calcification was defined as grade III before 36 weeks. The chi2 and Fisher exact tests were used to compare placental grading, and the Mann-Whitney test to evaluate the resistance index of uterine and umbilical arteries. RESULTS: the frequency of grade III placenta and the resistance of the uterine arteries did not differ significantly between smokers and non-smokers, at all gestational ages. Umbilical artery Doppler was significantly higher in smokers than in non-smokers at 32 weeks. CONCLUSIONS: no association was found between cigarette smoking and premature placental calcification. Smoking was associated with increased umbilical artery resistance at 32 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):331-339
DOI 10.1590/S0100-72032006000600003
PURPOSE: to evaluate the impact of supplementary ferrous sulfate and dietary counseling on hemoglobin levels in pregnant women. METHODS: a total of 197 pregnant women were evaluated during antenatal care at a health center. The treatment group consisted of 105 women who were prescribed 60 mg dietary iron per day, received dietary counseling and had hemoglobin measured by a portable photometer between the 14th and 20th week of pregnancy. The treatment group was reevaluated according to hemoglobin levels and food intake by a semiquantitative food frequency questionnaire after the 34th week of pregnancy. The control group consisted of 92 women in a cross-sectional study, at no less than 34 weeks of pregnancy. Hemoglobin was analyzed by a portable photometer and anemia was defined concentrations of less than 11 g/dL. All pregnant women had their weight and height measured. Hierarchical logistic regression model was developed for the multivariate analysis. RESULTS: prevalence of anemia at the end of the third trimester was 31.6% in the treatment group and 26.1% in the control group (p=0.43). Use of the prescribed supplement was reported by 65% of women in the treatment group, of which 67.7% interrupted the treatment at some point. Principal reasons for interrupting treatment were forgetting (43.2%) and nausea or vomiting (27.2%). Risk of anemia in the third trimester was three times higher in women with less than 8 years of schooling. CONCLUSIONS: use of ferrous sulfate was not shown to be associated with lower prevalence of anemia. The results suggest that structural changes in socioeconomic conditions are needed in order to alter the current situation regarding iron deficiency anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):331-339
DOI 10.1590/S0100-72032006000600003
PURPOSE: to evaluate the impact of supplementary ferrous sulfate and dietary counseling on hemoglobin levels in pregnant women. METHODS: a total of 197 pregnant women were evaluated during antenatal care at a health center. The treatment group consisted of 105 women who were prescribed 60 mg dietary iron per day, received dietary counseling and had hemoglobin measured by a portable photometer between the 14th and 20th week of pregnancy. The treatment group was reevaluated according to hemoglobin levels and food intake by a semiquantitative food frequency questionnaire after the 34th week of pregnancy. The control group consisted of 92 women in a cross-sectional study, at no less than 34 weeks of pregnancy. Hemoglobin was analyzed by a portable photometer and anemia was defined concentrations of less than 11 g/dL. All pregnant women had their weight and height measured. Hierarchical logistic regression model was developed for the multivariate analysis. RESULTS: prevalence of anemia at the end of the third trimester was 31.6% in the treatment group and 26.1% in the control group (p=0.43). Use of the prescribed supplement was reported by 65% of women in the treatment group, of which 67.7% interrupted the treatment at some point. Principal reasons for interrupting treatment were forgetting (43.2%) and nausea or vomiting (27.2%). Risk of anemia in the third trimester was three times higher in women with less than 8 years of schooling. CONCLUSIONS: use of ferrous sulfate was not shown to be associated with lower prevalence of anemia. The results suggest that structural changes in socioeconomic conditions are needed in order to alter the current situation regarding iron deficiency anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):324-330
DOI 10.1590/S0100-72032006000600002
PURPOSE: to compare the maternal factors, clinical aspects and perinatal results in placental abruption during two periods. METHODS: retrospective analysis of placental abruption cases that occurred from January 1, 1994 through December 31, 1997 (period 94-97), and from April 4, 2001 through March 3, 2005 (period 01-05), in singleton delivery with birthweight higher than 500 g and after 20 weeks of gestation. The following factors were analyzed: maternal age, previous obstetric history, prenatal care, premature rupture of membranes, obstetric and/or clinical intercurrent events, vaginal bleeding, uterine tonus, fetal anomaly, mode of delivery, hemoamnion and maternal complication (hysterectomy, uterine atony, disseminated intravascular coagulation, acute renal failure, and maternal death), and the perinatal results. RESULTS: the rate of placental abruption was 0.78% (60 cases) in the period 94-97 (n=7692 deliveries), and 0.59% (51 cases) in the period 01-05 (n=8644 deliveries), without significant difference. A significant difference was observed between the periods 94-97 and 01-05 regarding mean number of previous gestations (3.5±2.4 and 2.6±1.8, p=0.04), patients without prenatal care (13.3 and 2.0%, p=0.03) and maternal intercurrences (38.3 and 64.7%, p=0.01). No significant difference was observed related to vaginal bleeding, tonus abnormalities and perinatal results, between the periods, but a higher proportion of hemoamnion in 94-97 was found when compared to 01-05 (28.3 and 11.8%, p=0.03). CONCLUSIONS: in spite of obstetrical advances, maternal complications and perinatal results were similar in the analyzed periods. The severity and the unexpected results emphasize the importance of prevention and adequate control of associated factors, when this pathology is approached.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):324-330
DOI 10.1590/S0100-72032006000600002
PURPOSE: to compare the maternal factors, clinical aspects and perinatal results in placental abruption during two periods. METHODS: retrospective analysis of placental abruption cases that occurred from January 1, 1994 through December 31, 1997 (period 94-97), and from April 4, 2001 through March 3, 2005 (period 01-05), in singleton delivery with birthweight higher than 500 g and after 20 weeks of gestation. The following factors were analyzed: maternal age, previous obstetric history, prenatal care, premature rupture of membranes, obstetric and/or clinical intercurrent events, vaginal bleeding, uterine tonus, fetal anomaly, mode of delivery, hemoamnion and maternal complication (hysterectomy, uterine atony, disseminated intravascular coagulation, acute renal failure, and maternal death), and the perinatal results. RESULTS: the rate of placental abruption was 0.78% (60 cases) in the period 94-97 (n=7692 deliveries), and 0.59% (51 cases) in the period 01-05 (n=8644 deliveries), without significant difference. A significant difference was observed between the periods 94-97 and 01-05 regarding mean number of previous gestations (3.5±2.4 and 2.6±1.8, p=0.04), patients without prenatal care (13.3 and 2.0%, p=0.03) and maternal intercurrences (38.3 and 64.7%, p=0.01). No significant difference was observed related to vaginal bleeding, tonus abnormalities and perinatal results, between the periods, but a higher proportion of hemoamnion in 94-97 was found when compared to 01-05 (28.3 and 11.8%, p=0.03). CONCLUSIONS: in spite of obstetrical advances, maternal complications and perinatal results were similar in the analyzed periods. The severity and the unexpected results emphasize the importance of prevention and adequate control of associated factors, when this pathology is approached.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):304-309
DOI 10.1590/S0100-72032006000500007
PURPOSE: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. METHODS: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. RESULTS: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by level I had sensitivity of 72% and specificity of 98% and there were 28% of false-positive cases. In level II, the sensitivity and specificity of the diagnosis of congenital heart disease were 100 and 99%, respectively. The kappa index was 57% and indicated a moderate degree of concordance between the two levels. Fifty-one percent of the fetuses with diagnosis of cardiac malformations required pharmacological or invasive intervention immediately after birth. CONCLUSION: morphological ultrasound examination is a important tool in the screening of arrhythmias and congenital heart defects during fetal life. The sensitivity and specificity of the fetal echocardiogram were very high and the early diagnosis made it possible to treat the fetus with severe cardiac disease either during pregnancy or immediately after birth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):304-309
DOI 10.1590/S0100-72032006000500007
PURPOSE: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. METHODS: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. RESULTS: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by level I had sensitivity of 72% and specificity of 98% and there were 28% of false-positive cases. In level II, the sensitivity and specificity of the diagnosis of congenital heart disease were 100 and 99%, respectively. The kappa index was 57% and indicated a moderate degree of concordance between the two levels. Fifty-one percent of the fetuses with diagnosis of cardiac malformations required pharmacological or invasive intervention immediately after birth. CONCLUSION: morphological ultrasound examination is a important tool in the screening of arrhythmias and congenital heart defects during fetal life. The sensitivity and specificity of the fetal echocardiogram were very high and the early diagnosis made it possible to treat the fetus with severe cardiac disease either during pregnancy or immediately after birth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):298-303
DOI 10.1590/S0100-72032006000500006
PURPOSE: to assess p53 protein expression in infiltrating ductal breast carcinoma and to analyze its association with histological and nuclear grade. METHODS: sixty-five consecutive females who were diagnosed with primary infiltrating ductal breast tumor from July 1999 to July 2001 were included in the present study. Mean patient age at diagnosis was 69.2 years (range 41 - 90). All patients were first treated with surgical therapy, conservative surgery or mastectomy. None of the patients received any preoperative adjuvant therapy. Resected breast tumor specimens were fixed in 10% formalin, paraffin embedded, and conserved for immunohistochemical analysis. p53 protein expression was evaluated. Primary monoclonal anti-human p53 antibody DO-7 (DAKO) was used. Frequency distributions were tested by the chi2 test. A level of p<0,05 was considered significant. RESULTS: p53 expression was detected in 24 (36,9%) of 65 carcinomas. Of the cases with protein expression, 13 (54,2%) were high or histological grade III, 8 (33,3%), were grade II, 3 (12,5%) were grade I. On nuclear grade analysis, of the cases with protein expression, 13 (4,2%) were nuclear grade III, 9 (37,5%) were grade II and 2 (8,3%) were grade I. p53 expression was frequent in carcinomas with high histological and nuclear grades. CONCLUSIONS: p53 expression was significantly associated with the histological grade. On the other hand, nuclear grade was not significantly related to p53 expression.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):298-303
DOI 10.1590/S0100-72032006000500006
PURPOSE: to assess p53 protein expression in infiltrating ductal breast carcinoma and to analyze its association with histological and nuclear grade. METHODS: sixty-five consecutive females who were diagnosed with primary infiltrating ductal breast tumor from July 1999 to July 2001 were included in the present study. Mean patient age at diagnosis was 69.2 years (range 41 - 90). All patients were first treated with surgical therapy, conservative surgery or mastectomy. None of the patients received any preoperative adjuvant therapy. Resected breast tumor specimens were fixed in 10% formalin, paraffin embedded, and conserved for immunohistochemical analysis. p53 protein expression was evaluated. Primary monoclonal anti-human p53 antibody DO-7 (DAKO) was used. Frequency distributions were tested by the chi2 test. A level of p<0,05 was considered significant. RESULTS: p53 expression was detected in 24 (36,9%) of 65 carcinomas. Of the cases with protein expression, 13 (54,2%) were high or histological grade III, 8 (33,3%), were grade II, 3 (12,5%) were grade I. On nuclear grade analysis, of the cases with protein expression, 13 (4,2%) were nuclear grade III, 9 (37,5%) were grade II and 2 (8,3%) were grade I. p53 expression was frequent in carcinomas with high histological and nuclear grades. CONCLUSIONS: p53 expression was significantly associated with the histological grade. On the other hand, nuclear grade was not significantly related to p53 expression.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):292-297
DOI 10.1590/S0100-72032006000500005
PURPOSE: to verify if there is a relationship between the clinical periodontal parameters and estrogen levels and bone mineral density (BMD). METHODS: forty-six post-menopausal women aged 44 to 68 years (52.2±4.8) and 15 women aged 35 to 54 years (44.7±7.5) were evaluated. Periodontal parameters like probing depth (PD), clinical attachment loss (CAL), and missing teeth (MT) were compared with estrogen levels (sufficient and insufficient) and BMD (normal, osteopenic and osteoporotic). Data of the mean difference between the groups were compared by the Aspin-Welch test. RESULTS: the means of PD, CAL and MT, when associated with the normal (2.1±0.5; 2.9±1.4 and 10.6±5.0), osteopenic (2.3±0.7; 3.0±1.1 and 12.8±5.1) and osteoporotic BMD (2.4±0.6; 2.7±0.9 and 14.3±5.7), did not show statistical difference (p>0.05). A significant difference was found between the control group and postmenopausal women for CAL and MT. When compared with the estrogen levels the results did not show a difference regarding the periodontal parameters. CONCLUSION: although some studies showed a positive correlation with osteoporosis and estrogen level, in this population of menopausal women these findings were not confirmed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):292-297
DOI 10.1590/S0100-72032006000500005
PURPOSE: to verify if there is a relationship between the clinical periodontal parameters and estrogen levels and bone mineral density (BMD). METHODS: forty-six post-menopausal women aged 44 to 68 years (52.2±4.8) and 15 women aged 35 to 54 years (44.7±7.5) were evaluated. Periodontal parameters like probing depth (PD), clinical attachment loss (CAL), and missing teeth (MT) were compared with estrogen levels (sufficient and insufficient) and BMD (normal, osteopenic and osteoporotic). Data of the mean difference between the groups were compared by the Aspin-Welch test. RESULTS: the means of PD, CAL and MT, when associated with the normal (2.1±0.5; 2.9±1.4 and 10.6±5.0), osteopenic (2.3±0.7; 3.0±1.1 and 12.8±5.1) and osteoporotic BMD (2.4±0.6; 2.7±0.9 and 14.3±5.7), did not show statistical difference (p>0.05). A significant difference was found between the control group and postmenopausal women for CAL and MT. When compared with the estrogen levels the results did not show a difference regarding the periodontal parameters. CONCLUSION: although some studies showed a positive correlation with osteoporosis and estrogen level, in this population of menopausal women these findings were not confirmed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
