Artigos Originais Archives - Page 14 of 81 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):64-70
DOI 10.1590/SO100-720320150005115
To determine the prevalence of toxoplasmosis and to identify the main factors associated with seroreactivity in pregnant women cared for at two reference centers in a city in Northeast Brazil.
A cross-sectional study was conducted on 561 pregnant women at two high-risk prenatal reference centers in a city in Northeast Brazil. All women were interviewed using an epidemiological questionnaire and had their blood samples collected for the following serological tests: anti-Toxoplasma gondii IgG and IgM (ELISA), IgG avidity test, and polymerase chain reaction (PCR). Statistical analysis was carried out using SPSS version 18.0 for Windows, calculating odds ratio, confidence interval of 95% and with the level of significance set at 5%.
Seroreactivity for toxoplasmosis was detected in 437 women (77.0%), susceptibility in 124 (22.1%) and active infection in 5 (0.9%). There was no significant association between seroreactivity for toxoplasmosis and age, location, income, education, availability of sewage, number of pregnancies or gestational age. The variables significantly associated (p≤0.05) with seroreactivity were multiparity (p=0.03) and living with stray dogs (p=0.01).
This study identified high seroreactivity for toxoplasmosis among patients seen during prenatal care, as well as factors associated with seroreactivity. Appropriate guidelines about primary preventive measures should be emphasized and quarterly serological monitoring is recommended for pregnant women in this city and elsewhere in the Northeast of Brazil.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):64-70
DOI 10.1590/SO100-720320150005115
To determine the prevalence of toxoplasmosis and to identify the main factors associated with seroreactivity in pregnant women cared for at two reference centers in a city in Northeast Brazil.
A cross-sectional study was conducted on 561 pregnant women at two high-risk prenatal reference centers in a city in Northeast Brazil. All women were interviewed using an epidemiological questionnaire and had their blood samples collected for the following serological tests: anti-Toxoplasma gondii IgG and IgM (ELISA), IgG avidity test, and polymerase chain reaction (PCR). Statistical analysis was carried out using SPSS version 18.0 for Windows, calculating odds ratio, confidence interval of 95% and with the level of significance set at 5%.
Seroreactivity for toxoplasmosis was detected in 437 women (77.0%), susceptibility in 124 (22.1%) and active infection in 5 (0.9%). There was no significant association between seroreactivity for toxoplasmosis and age, location, income, education, availability of sewage, number of pregnancies or gestational age. The variables significantly associated (p≤0.05) with seroreactivity were multiparity (p=0.03) and living with stray dogs (p=0.01).
This study identified high seroreactivity for toxoplasmosis among patients seen during prenatal care, as well as factors associated with seroreactivity. Appropriate guidelines about primary preventive measures should be emphasized and quarterly serological monitoring is recommended for pregnant women in this city and elsewhere in the Northeast of Brazil.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):71-76
DOI 10.1590/SO100-720320140005223
To investigate the association between polymorphisms in genes that encode enzymes involved in folate- and vitamin B12-dependent homocysteine metabolism and recurrent spontaneous abortion (RSA).
We investigated the C677T and A1298C polymorphisms of the methylenetetrahydrofalate reductase gene (MTHFR), the A2756G polymorphism of the methionine synthase gene (MS) and the 844ins68 insertion of the cystathionine beta synthetase gene (CBS). The PCR technique followed by RFLP was used to assess the polymorphisms; the serum levels of homocysteine, vitamin B12 and folate were investigated by chemiluminescence. The EPI Info Software version 6.04 was used for statistical analysis. Parametric variables were compared by Student's t-test and nonparametric variables by the Wilcoxon rank sum test.
The frequencies of gene polymorphisms in 89 women with a history of idiopathic recurrent miscarriage and 150 controls were 19.1 and 19.6% for the C677T, insertion, 20.8 and 26% for the A1298C insertion, 14.2 and 21.9% for the A2756G insertion, and 16.4 and 18% for the 844ins68 insertion, respectively. There were no significant differences between case and control groups in any of the gene polymorphisms investigated. However, the frequency of the 844ins68 insertion in the CBS gene was higher among women with a history of loss during the third trimester of pregnancy (p=0.003). Serum homocysteine, vitamin B12 and folate levels id not differ between the polymorphisms studied in the case and control groups. However, linear regression analysis showed a dependence of serum folate levels on the maintenance of tHcy levels.
The investigated gene polymorphisms and serum homocysteine, vitamin B12 and folate levels were not associated with idiopathic recurrent miscarriage in the present study. Further investigations are needed in order to confirm the role of the CBS 844ins68 insertion in recurrent miscarriage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):71-76
DOI 10.1590/SO100-720320140005223
To investigate the association between polymorphisms in genes that encode enzymes involved in folate- and vitamin B12-dependent homocysteine metabolism and recurrent spontaneous abortion (RSA).
We investigated the C677T and A1298C polymorphisms of the methylenetetrahydrofalate reductase gene (MTHFR), the A2756G polymorphism of the methionine synthase gene (MS) and the 844ins68 insertion of the cystathionine beta synthetase gene (CBS). The PCR technique followed by RFLP was used to assess the polymorphisms; the serum levels of homocysteine, vitamin B12 and folate were investigated by chemiluminescence. The EPI Info Software version 6.04 was used for statistical analysis. Parametric variables were compared by Student's t-test and nonparametric variables by the Wilcoxon rank sum test.
The frequencies of gene polymorphisms in 89 women with a history of idiopathic recurrent miscarriage and 150 controls were 19.1 and 19.6% for the C677T, insertion, 20.8 and 26% for the A1298C insertion, 14.2 and 21.9% for the A2756G insertion, and 16.4 and 18% for the 844ins68 insertion, respectively. There were no significant differences between case and control groups in any of the gene polymorphisms investigated. However, the frequency of the 844ins68 insertion in the CBS gene was higher among women with a history of loss during the third trimester of pregnancy (p=0.003). Serum homocysteine, vitamin B12 and folate levels id not differ between the polymorphisms studied in the case and control groups. However, linear regression analysis showed a dependence of serum folate levels on the maintenance of tHcy levels.
The investigated gene polymorphisms and serum homocysteine, vitamin B12 and folate levels were not associated with idiopathic recurrent miscarriage in the present study. Further investigations are needed in order to confirm the role of the CBS 844ins68 insertion in recurrent miscarriage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):77-81
DOI 10.1590/SO100-720320140005199
To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision.
A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses.
The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; 95%CI 5.26-107.05; p=0.001).
Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):77-81
DOI 10.1590/SO100-720320140005199
To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision.
A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses.
The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; 95%CI 5.26-107.05; p=0.001).
Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):82-86
DOI 10.1590/SO100-720320140005040
To analyze the risk factors for urinary incontinence (UI) in older women practicing physical exercises (PE).
A total of 152 older women with a mean age of 68.6±5.8 years who regularly practiced PE participated in the study. The presence of UI and gynecological, obstetric, clinical, behavioral, hereditary and anthropometric risk factors was determined identified. It was also applied the Domain 4 of the International Physical Activity Questionnaire (IPAQ) to determine the level of physical activity and body mass index and waist circumference were measured. Data were analyzed using descriptive and inferential statistics, with the level of significance set at 5%.
The prevalence of UI in the sample was 32.2%. Among the factors evaluated, only the use of diuretics (OR=2.7; 95%CI 1.0-7.0) and a positive family history of urinary incontinence (OR=2.3; 95%CI 1.1-4.8) were associated with UI symptoms.
The use of diuretics is considered to be a modifiable risk factor for UI, whereas a family history is not considered to be a modifiable risk factor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):82-86
DOI 10.1590/SO100-720320140005040
To analyze the risk factors for urinary incontinence (UI) in older women practicing physical exercises (PE).
A total of 152 older women with a mean age of 68.6±5.8 years who regularly practiced PE participated in the study. The presence of UI and gynecological, obstetric, clinical, behavioral, hereditary and anthropometric risk factors was determined identified. It was also applied the Domain 4 of the International Physical Activity Questionnaire (IPAQ) to determine the level of physical activity and body mass index and waist circumference were measured. Data were analyzed using descriptive and inferential statistics, with the level of significance set at 5%.
The prevalence of UI in the sample was 32.2%. Among the factors evaluated, only the use of diuretics (OR=2.7; 95%CI 1.0-7.0) and a positive family history of urinary incontinence (OR=2.3; 95%CI 1.1-4.8) were associated with UI symptoms.
The use of diuretics is considered to be a modifiable risk factor for UI, whereas a family history is not considered to be a modifiable risk factor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):87-93
DOI 10.1590/SO100-720320140004650
To assess the relationship between the histological classification and the quality of life of patients operated for endometriosis. METHODS: A cross-sectional observational study, with assessment of 32 biopsies of the intestine, peritoneum and uterosacral ligament from 40 women with deep endometriosis. The quality of life (QOL) was determined by applying the SF-36 questionnaire pre-operatively and at 6 and 12 months postoperatively. Biopsies were histologically classified into pure stromal (EP), glandular differentiated (GD), glandular undifferentiated (GI) and mixed (GM), remaining in the sample only GI and GM, which are related to eight domains of the SF-36.
According to the histologic type, the following distribution was observed: peritoneum 63% GI and 35% GM; intestine 19% GI and 24% GM; uterosacral ligament with 41% GI and 35% GM. Regarding the QOL and the histological classification, in the intestine only GM was associated with improvement of social and emotional aspects from 0 to 6 months; the domains general health status (p=0.01) and social aspect (p=0.04) were significantly related to improvement of the QOL from 0 to 6 months, and the general health status tended to improve from 0 to 12 months. Regarding pain (p=0.06) and the emotional aspect (p=0.05), the QOL tended to improve from 0 to 6 months and the vital capacity (p=0.1) improved from 0 to 6 months and from 0 to 12 months. Regarding the emotional aspect, evolution of the two histological types was not favorable for improvement in MG from 0 to 6 months. No significant relationships between histologic type and QOL were evident in the uterosacral ligament samples.
Improvement in the QOL of women undergoing laparoscopic surgery for deep endometriosis is associated with the histologic grade. The peritoneal biopsy of GI revealed improved QOL after surgery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):87-93
DOI 10.1590/SO100-720320140004650
To assess the relationship between the histological classification and the quality of life of patients operated for endometriosis. METHODS: A cross-sectional observational study, with assessment of 32 biopsies of the intestine, peritoneum and uterosacral ligament from 40 women with deep endometriosis. The quality of life (QOL) was determined by applying the SF-36 questionnaire pre-operatively and at 6 and 12 months postoperatively. Biopsies were histologically classified into pure stromal (EP), glandular differentiated (GD), glandular undifferentiated (GI) and mixed (GM), remaining in the sample only GI and GM, which are related to eight domains of the SF-36.
According to the histologic type, the following distribution was observed: peritoneum 63% GI and 35% GM; intestine 19% GI and 24% GM; uterosacral ligament with 41% GI and 35% GM. Regarding the QOL and the histological classification, in the intestine only GM was associated with improvement of social and emotional aspects from 0 to 6 months; the domains general health status (p=0.01) and social aspect (p=0.04) were significantly related to improvement of the QOL from 0 to 6 months, and the general health status tended to improve from 0 to 12 months. Regarding pain (p=0.06) and the emotional aspect (p=0.05), the QOL tended to improve from 0 to 6 months and the vital capacity (p=0.1) improved from 0 to 6 months and from 0 to 12 months. Regarding the emotional aspect, evolution of the two histological types was not favorable for improvement in MG from 0 to 6 months. No significant relationships between histologic type and QOL were evident in the uterosacral ligament samples.
Improvement in the QOL of women undergoing laparoscopic surgery for deep endometriosis is associated with the histologic grade. The peritoneal biopsy of GI revealed improved QOL after surgery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):94-99
DOI 10.1590/SO100-720320150005206
The aim of this study was to compare the performance of two human papillomavirus (HPV) genotyping techniques, Linear Array and PapilloCheck, in women with high-grade squamous intraepithelial lesion (HSIL).
A total of 88 women with cytological diagnosis of HSIL were recruited at 2 reference centers in cervical pathology in Salvador, Bahia, Brazil, from July 2006 to January 2009. After the cytological diagnosis of HSIL, cervix cells were collected to determine the HPV genotype and a biopsy was obtained under colposcopic vision for histopathological analysis. After the confirmation of CIN2+ by histopathology, HPV genotyping was performed on 41 women by the Linear Array and PapilloCheck methods.
Both tests showed an overall concordance rate for HPV detection of 97.2% (35/36). Of the 36 valid samples, 35 (97.2%) were positive in both tests and 1 (2.8%) was discordant, with the Linear Array indicating the presence of multiple types. The most prevalent HPV genotypes detected by the Linear Array technique were HPV 16, HPV 56, HPV 35, HPV 45, and HPV 70; and those detected by the PapilloCheck technique were HPV 16, HPV 56, HPV 11, HPV 35, and HPV 42. A similar rate of infection with multiple HPV types was observed with the two tests (72.5% with the Linear Array and 75.0% with the PapilloCheck).
Linear Array genotyping assay and PapilloCheck showed equivalent performance for the detection of oncogenic HPV types in women with HSIL, with PapilloCheck having the advantage of being a method that avoids subjectivity when reading the HPV genotypes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):94-99
DOI 10.1590/SO100-720320150005206
The aim of this study was to compare the performance of two human papillomavirus (HPV) genotyping techniques, Linear Array and PapilloCheck, in women with high-grade squamous intraepithelial lesion (HSIL).
A total of 88 women with cytological diagnosis of HSIL were recruited at 2 reference centers in cervical pathology in Salvador, Bahia, Brazil, from July 2006 to January 2009. After the cytological diagnosis of HSIL, cervix cells were collected to determine the HPV genotype and a biopsy was obtained under colposcopic vision for histopathological analysis. After the confirmation of CIN2+ by histopathology, HPV genotyping was performed on 41 women by the Linear Array and PapilloCheck methods.
Both tests showed an overall concordance rate for HPV detection of 97.2% (35/36). Of the 36 valid samples, 35 (97.2%) were positive in both tests and 1 (2.8%) was discordant, with the Linear Array indicating the presence of multiple types. The most prevalent HPV genotypes detected by the Linear Array technique were HPV 16, HPV 56, HPV 35, HPV 45, and HPV 70; and those detected by the PapilloCheck technique were HPV 16, HPV 56, HPV 11, HPV 35, and HPV 42. A similar rate of infection with multiple HPV types was observed with the two tests (72.5% with the Linear Array and 75.0% with the PapilloCheck).
Linear Array genotyping assay and PapilloCheck showed equivalent performance for the detection of oncogenic HPV types in women with HSIL, with PapilloCheck having the advantage of being a method that avoids subjectivity when reading the HPV genotypes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(1):05-09
DOI 10.1590/SO100-720320140005130
To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side.
Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil.
Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7.
To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(1):05-09
DOI 10.1590/SO100-720320140005130
To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side.
Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil.
Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7.
To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(1):10-15
DOI 10.1590/SO100-720320140005202
To determine if the presence of infectious agents in vaginal or cervical content can alter the results of the insulin-like growth factor binding protein-1 (phIGFBP-1) test and the measurement of cervical length (CC) by transvaginal ultrasonography.
A total of 107 pregnant women with a history of spontaneous preterm birth were submitted to the phIGFBP-1 test and to measurement of CC by transvaginal ultrasonography every 3 weeks, between 24 and 34 weeks of gestation. Genital infections were determined immediately before testing. The patients were distributed into four groups (GA, GB, GC, and GD) and the correlation between genital infection and changes in the tests was determined within each group based on the odds ratio (OR) and the Pearson correlation coefficient.
In each group, over 50% of the patients had genital infections (GA 10/17; GB 28/42; GC 15/24; GD 35/53), with bacterial vaginosis being the main alteration of the vaginal flora. Positive results for phIGFBP-1(GA 10/10; GB 18/28; GC 15/15; GD 19/35) and CC≤20 mm (GA 10/10; GB 20/28; GC 10/15; GD 20/35) were obtained more frequently in patients with genital infection in all groups. Nonetheless, when applying the Pearson correlation coefficient we detected a poor correlation between genital infection and positivity for markers.
The presence of changes in the vaginal flora and of other genital infections does not significantly alter the results of phIGFBP-1 and the measurement of cervical length when compared to cases without infection. However, more studies with larger samples are necessary to confirm these results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(1):10-15
DOI 10.1590/SO100-720320140005202
To determine if the presence of infectious agents in vaginal or cervical content can alter the results of the insulin-like growth factor binding protein-1 (phIGFBP-1) test and the measurement of cervical length (CC) by transvaginal ultrasonography.
A total of 107 pregnant women with a history of spontaneous preterm birth were submitted to the phIGFBP-1 test and to measurement of CC by transvaginal ultrasonography every 3 weeks, between 24 and 34 weeks of gestation. Genital infections were determined immediately before testing. The patients were distributed into four groups (GA, GB, GC, and GD) and the correlation between genital infection and changes in the tests was determined within each group based on the odds ratio (OR) and the Pearson correlation coefficient.
In each group, over 50% of the patients had genital infections (GA 10/17; GB 28/42; GC 15/24; GD 35/53), with bacterial vaginosis being the main alteration of the vaginal flora. Positive results for phIGFBP-1(GA 10/10; GB 18/28; GC 15/15; GD 19/35) and CC≤20 mm (GA 10/10; GB 20/28; GC 10/15; GD 20/35) were obtained more frequently in patients with genital infection in all groups. Nonetheless, when applying the Pearson correlation coefficient we detected a poor correlation between genital infection and positivity for markers.
The presence of changes in the vaginal flora and of other genital infections does not significantly alter the results of phIGFBP-1 and the measurement of cervical length when compared to cases without infection. However, more studies with larger samples are necessary to confirm these results.