Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):32-37
DOI 10.1590/S0100-72032006000100006
PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum beta-HCG>25 mIU/mL levels obtained fourteen days after the embryonic transfer) clinically diagnosed pregnancy (gestational sac visualized by ultrasound four to six weeks after the embryonic transfer) and miscarriage rates in women submitted in vitro fertilization to (IVF) and intracytoplasmic sperm injection (ICSI) in a tertiary center of assisted reproduction and to correlate these rates with age. METHODS: retrospective transverse study with analysis of 1016 cycles of controlled ovarian hyperstimulation of 932 infertile women with indication of IVF (370 cycles) or ICSI (646 cycles). The patients' age ranged from 22 to 46 years. All women with age over 35 years included in the study had FSH<15 IU/L. The studied cycles were divided into two groups: the first including the cycles referring to women of 22 to 30 years and the second group, to those of 31 to 46 years. The studied variables were: pregnancy (chemical or clinical) and miscarriage rates. The chi2 test was used to compare these rates between the groups. RESULTS: the total pregnancy rate was 36.42%, with a significant reduction starting at 30 years (p=0.0001). From 22 to 30 years (303 cycles) the pregnancy rate was 45.4%, while in the range from 31 to 46 years (713 cycles), it was 25.1%. The miscarriage rates were, 10.2 11,6%, respectively (p=0.6854). CONCLUSION: although the miscarriage rates did not differ between the groups, a decrease in the pregnancy rate of infertile women submitted to IVF or ICSI was observed after the age of 30 years. Thus, we recommend the gynecologists not to postpone the investigation and the referral for treatment of infertility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):38-43
DOI 10.1590/S0100-72032006000100007
PURPOSE: to determine the intraobserver and interobserver reproducibility of endometrial volume measurements using the VOCAL®-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: one three-dimensional (3-D) ultrasound dataset of the endometrium was obtained from each of five infertile women with different endometrial volumes. For each 3-D dataset, the endometrial volume was calculated by two different observers using the manual mode in four different rotational steps (30º, 15º, 9º and 6º). Ten measurements were obtained with each method and observer from each 3-D dataset. We have used one-way ANOVA and the Tukey post-test to verify the differences among means and the intraclass correlation coefficient to test reliability. RESULTS: rotational methods employing a rotation step of 30º were associated with lower endometrial volume readings in 3 of the 5 patients. There were no significant differences between the means obtained by the 15º, 9º or 6º step rotation. No significant difference was found between the means obtained by the two different observers. The intraclass correlation coefficients were significantly lower with 30º (all under 0.984) than with the other step rotations (all above 0.996). CONCLUSIONS: the use of a rotational step of 15º or less provides reliable readings of endometrial volume: there were no significant differences between the means calculated by the two observers, associated with highintraclass correlation coefficient (>0.996). We recommend the 15º step rotation because it is quicker to be performed than 6º and 9º.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):44-49
DOI 10.1590/S0100-72032006000100008
PURPOSE: to evaluate the influence of abstinence period on seminal characteristics in infertile men and to establish a better seminal quality after pooling the samples. METHODS: a retrospective study was performed on 88 oligozoospermic (n=25), asthenozoospermic (n=43), and oligoasthenozoospermic (n=20) men whose partners underwent intrauterine insemination between September 2002 and December 2004. We excluded men with a normal semen analysis or women with abnormalities suggestive of infertility. Each man produced two semen samples in a short period of time (30 min to 1 h). We evaluated semen volume, total motile sperm count and percentage sperm motility. Comparisons were made between the first and second semen samples. After pooling the samples, we compared the total motile sperm count between the first sample and the pooled samples. Statistical evaluation was performed by Student's t test and the chi2 test. RESULTS: in oligozoospermic men, there were no differences in the semen characteristics between the first and the second seminal samples (p>0.05). The total motile sperm count increased significantly in the second sample in comparison to the first sample in asthenozoospermic (42.4±6.8 vs 51.5±7.2x10(6) sperm/mL) and oligoasthenozoospermic men (11.1±7.4 vs 14.35±7.2x10(6) sperm/mL (p<0.05). The pool of two ejaculates increased the total motile sperm count in comparison to the first sample (p<0.05) in oligozoospermic, asthenozoospermic and oligoasthenozoospermic men by 110.5, 110.3 and 136.03%, respectively. CONCLUSIONS: a short period of abstinence is associated with higher sperm motility in infertile men. The pool of two semen samples is a way to increase the total motile sperm count in this group of patients whose wives want to undergo an intrauterine insemination instead of in vitro fertilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):712-718
DOI 10.1590/S0100-72032005001200002
PURPOSE: to verify the fetal heart rate (FHR) patterns of large for gestational age (LGA) fetuses in pregnancies at term complicated by pregestational diabetes. METHODS: fetal surveillance was performed weekly in 64 fetuses of mothers with pregestational diabetes. Inclusion criteria were: diagnosis of pregestational diabetes mellitus, single pregnancy, alive fetus, absence of fetal anomalies, and computerized cardiotocography performed at the 37th week of gestation. Exclusion criteria included: postnatal diagnosis of fetal anomalies and delivery not performed at the local hospital. The FHR patterns were studied with computerized cardiotocography and the parameters were analyzed according to a fetal weight as LGA (birth weight above percentile 90). The cardiotocography parameters included: basal FHR, episodes of high variation, episodes of low variation, and short-term variation. RESULTS: forty-two patients fulfilled the proposed criteria. Ten (23.8%) newborns were LGA. Normal criteria were met in all performed examinations. FHR accelerations (above 15 bpm) were present in 7 (70%) LGA cases and in 29 (90.6%) non-LGA (p=0.135). Accelerations were more frequent in the non-LGA group (1.5±1.3 accelerations/10 min) when compared to LGA group (0.8±0.9 accelerations/10min, p=0.04, Mann-Whitney test). The high variation episodes were detected in all cases. The mean FHR variation in these episodes was different in the LGA group (16.2±2.5 bpm) when compared to the non-LGA group (19.7±4.2 bpm, p=0.02, Mann-Whitney test). CONCLUSION: the FHR patterns of non-LGA (higher frequency of accelerations and higher FHR variation in the high variation episodes) reflect parameters commonly analyzed by traditional cardiotocography of a healthy fetus. This fact appears to confirm the patterns of better oxygen supply to the fetuses less compromised by diabetes in pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):719-725
DOI 10.1590/S0100-72032005001200003
PURPOSE: to evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLV I/II infection in pregnant women screened by the Pregnant Protection Program of the State of Mato Grosso do Sul Brazil. METHODS: it is a descriptive and transversal study of 32,512 pregnant women submitted to a prenatal screening from November 2002 to October 2003. HTLV I/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western blot and PCR performed on the child's blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by the chi2 test considering p<0.05 to reject the null hypothesis. RESULTS: a prevalence of 0.1% (37) 0.1% HTLV I/II among 32,512 pregnant women was found. The mean age of the infected women was 25.4 ± 6.4 years, and 78.4% of them were from other areas than the capital. There was no association between maternal age and the patients' origin and infection. In all the eight evaluated newborns, which represented 21.6% of the sample, HTLV I/II serum antibodies were found. Only one newborn infant was breast-fed. CONCLUSIONS : HTLV I/II prevalence among pregnant women of the State of Mato Grosso do Sul Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same as that described for non-endemic areas and in some Brazilian reports. The vertical transmission rate of HTLV I/II was 100%, in spite of breast-feeding having been proscribed. Improving the follow-up of the pregnant women and their newborns in the State is mandatory, since only a few infants were investigated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):726-730
DOI 10.1590/S0100-72032005001200004
PURPOSE: to study the influence of the use of oral contraceptives (OC) on the number of Langerhans' cells in women without cervical infection by human papillomavirus (HPV). METHODS: thirty women who presented abnormal cervical cytology and colposcopy-guided biopsy with samples of uterine cervix negative for HPV were selected. The absence of HPV DNA was confirmed by hybrid capture. Langerhans' cells were identified by immunohistochemistry using anti-S100 antigens. The cells visualized in light microscopy were counted using the Cytoviewer software. The nonparametric Wilcoxon rank sum test was employed for statistical analysis. RESULTS: the average number of Langerhans' cells in OC users was 320.7/mm² and in non-users 190.7/mm², this difference being statistically nonsignificant. In the intermediary layer of the cervical epithelium a tendency towards the increase of these cells was observed, with the averages 192.1/mm² for OC users and 93.4/mm² for non-users (p=0.05). CONCLUSIONS: the present study reports a tendency towards the increase in the number of the Langerhans' cells among OC users. This result suggests the OC may induce alterations in the number of Langerhans' cells, but considering the limited number of cases, more studies should be developed for a definitive conclusion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):731-736
DOI 10.1590/S0100-72032005001200005
PURPOSE: to evaluate the prevalence of reported sleep disturbances through polysomnographic recording (PSG) in a sample of postmenopausal women. METHODS: thirty-three postmenopausal women with a mean age of 56 years, a mean body mass index (BMI) of 27 kg/m², with 7.7 years of recognized postmenopausal period, and a mean Kupperman index of 17, were selected. The inclusion criteria were: age range from 50 to 65 years, at least one year of amenorrhea and an FSH which equaled or exceeded 30 mU/ml; they should not be undergoing hormone therapy, and should display normal laboratory test results. The patients with severe clinical diseases and/or decompensated were excluded; also the ones with suspicion of carcinoma of endometrium and/or breast cancer, a BMI over 30 kg/m² and those who ingested hypnotic drugs. The patients followed a routine climacteric check-up, answered a questionnaire about sleep and underwent an all-night PSG recording. Frequencies in percentage of emerging sleep complaints based on the questionnaire and those pertaining to PSG diagnosis were then calculated separately. RESULTS: the subjective prevalence of insomnia was 61% against 83% in the PSG recordings. The prevalence of apnea reported was 23% against 27% in the PSG. The subjective restless legs syndrome prevalence was 45%, and the objective, 27%. CONCLUSION: there was a high prevalence of sleep disturbances in postmenopausal patients, specially insomnia, apnea and restless legs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):737-743
DOI 10.1590/S0100-72032005001200006
PURPOSE: to evaluate the frequency of anxiety and depression in main caretakers of patients with terminal breast or gynecological cancer. METHODS: for this cross-sectional study, 133 informal caretakers of terminally-ill breast and gynecologic cancer patients were included. Patients were hospitalized for palliative care in the Oncology Clinic of the "Centro de Atenção Integral à Saúde da Mulher (Campinas, Brasil) from August 2002 to May 2004. Seventy-one of the patients had breast cancer and 62 had gynecological malignancies. Hospital Anxiety and Depression Scale (HAD) was applied to these informal caretakers, in order to detect anxiety and depression, and they were also interviewed to provide additional information regarding their age, gender, religion, relation to patient, current occupation, if they cared for other people, whether their routine had changed and whether other people helped them to care for the patient. Logistic regression was used to calculate the odds ratio (OR) and its confidence interval (CI), used to assess the relationship between the diagnoses of anxiety and depression among the informal caretakers. For multiple analyses, the stepwise criterion for variable selection was used. RESULTS: 43% percent of the patients identified their daughters as their main caretaker, and 24%, their husbands. Most of the caretakers were over 35 years old (63%), 68% were female, 59% were unemployed, 47% cared for another person and 84% referred that his/her routine had changed because of caring. Anxiety was detected in 99 caretakers (74.4%) and depression in 71 (53.4%). Anxiety and depression were strongly correlated (odds ratio 5.6; 95% confidence interval 2.2 to 15.9). Bivariate analysis disclosed that the patients' husbands were less affected by depression, but multivariate analysis revealed that only the fact of being male was related to a lower prevalence of anxiety. CONCLUSION: caring for terminally-ill cancer patients led to high prevalence of anxiety and depression. Only men and the patients' husbands were found to have a lower prevalence of anxiety.