Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):326-334
DOI 10.1590/S0100-72032009000700002
PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old), adults (20 to 34 years old), and aged women (>35 years old). Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR) or the cross product ratio, with confidence intervals (CI) of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88), and low birth weight (OR=1.47; CI95%=1.13- 1.90), higher incidence of normal delivery as compared to the other groups (65.2%), besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43), lower number of appointments (OR=2.03; CI95%=1.57-2.63), and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98). Among aged women, there was strong association with diabetes mellitus (OR=9.00; CI95%=3.18-25.19), pre-eclampsia (OR=4.38; CI95%=3.02-6.34), premature membrane rupture (OR=5.81; CI95%=3.08-10.89), besides a higher chance of presenting Apgar index lower than seven at the fifth minute (OR=2.90; CI95%=1.37-6.01), and higher ratio of cesarean section (60.3%). CONCLUSIONS: pregnancy in adolescence is associated to late onset of pre-natal care and few appointments along it, use of abortive procedures at the onset of gestation, low schooling, no mates, low birth weight, prematurity, and lower incidence of cephalo pelvic disproportion and pre-eclampsia. Among aged pregnant women, there was association with diabetes, pre-eclampsia, premature membrane rupture, Apgar index lower than seven at the fifth minute and higher ratio of cesarean section.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):342-348
DOI 10.1590/S0100-72032009000700004
PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m²) and 60 non-obese (BMI<30 kg/m²) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1±11.7 kg versus 61.4±10.7 kg, p<0.0001) and had a larger waist circumference (105.0±10.4 cm versus 78.5±9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1±10.9 mmHg versus 115.8±9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51±0.07 mm versus 0.44±0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (β). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):349-352
DOI 10.1590/S0100-72032009000700005
PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed, through the basal (U/L) follicle stimulating hormone (FSH), between the third and fifth days of the cycle, 12 months after the surgery. The body mass index (BMI) was calculated according to Quetelet's formula [weight (kg)/height(cm²)]. The Mann-Whitney non-parametric U test was used to compare the variables "age", "BMI" and "basal SFH" between the groups. RESULTS: there was no significant difference between the groups about age and BMI. Concerning basal FSH, in the group of patients with severe endometriosis, the average value was 7.0 U/L, while in the Control Group, it was 5.6 U/L (p=0.3), what demonstrates that the difference between the two groups was not significant. CONCLUSIONS: the surgery did not affect the ovarian reserve of patients with severe ovarian endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):353-360
DOI 10.1590/S0100-72032009000700006
OBJECTIVE: to evaluate by photogrammetry, postural changes in women with chronic pelvic pain. METHODS: thirty women with complaint of chronic pelvic pain and 37 without it, in a total of 67 women, were evaluated. The evaluation was realized through anamnesis, fixed markers in defined anatomical sites, and frontal, posterior, left and right lateral photographies. Photo analysis has been done by the software CorelDraw®, version 11.0. Quantitative values for postural analysis of the ankle, the knee in the saggittal plan, pelvis, lumbar lordosis, thoracic kyphosis, adducted/abducted scapula, shoulders, head and third finger on the floor test were obtained. The qualitative variables studied were the knee (varus, valgus or normal), the presence or not of winged scapula and leveling of shoulders. The Statistical Package for Social Sciences, version 16.0 was used for the statistical analyses. Fisher's exact test and Monte-Carlo method were used to compare the qualitative variables, and for the quantitative data, t or Mann-Whitney test was used. The comparisons among continuous data, corrected for possible confusion variables were realized by the univariate covariance analysis. Significance level was established at 0.05 or 5%. RESULTS: there were significant differences between cases and controls for protruded head (47.5 and 52.0º, respectively; p<0.0001) and for protruded shoulders (1.9 and 1.6 cm, respectively; p=0.03). The other variables did not show significant differences. CONCLUSIONS: based on these results, attention to head and shoulder posture, to antalgic postures and to the emotional factor is recommended. Women with chronic pelvic pain should be treated, taking into consideration individual muscle-skeletal changes, and social and emotional conditions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):361-366
DOI 10.1590/S0100-72032009000700007
PURPOSE: to identify sensitivity alteration in the intercostal brachial nerve pathway using an extensiometer, and to observe the measurement reproducibility of the apparatus. METHODS: the Semmes-Weinstein extensiometer was used to evaluate the sensitivity along the intercostal brachial nerve pathway. Ninety-four women have participated in the study, divided into two groups: a CA Group composed of 47 women submitted to breast cancer axillary lymphadenectomy, and a comparative group composed of 47 women without breast cancer, who had not been submitted to any kind of axillary surgery. Each participant underwent anamnesis and two consecutive applications of the extensiometer. The Control Group responses to the extensiometer test were used as normality reference values. RESULTS: based on Control Group responses, the prevalence of sensitivity changes was 85.1% in the CA Group. Reproducibility of the extensiometer application was confirmed in the CA Group through the Kappa's test (p=0.8). CONCLUSIONS: in this studied sample, sensitivity alterations had high prevalence; evaluations made with the extensiometer were reproducible, and thus we consider the equipment reliable to evaluate sensitivity along the intercostal brachial nerve pathway.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):380-384
DOI 10.1590/S0100-72032009000800002
PURPOSE: to determine weight variation in women with different Body Mass Index (BMI) in use of trimestral injections of depot-medroxyprogesterone acetate (DMPA), and compare it to women users of a non-hormonal method. METHODS: retrospective study with the chart review of 226 DMPA users and 603 controls, users of DIU TCu380A. Women were distributed in categories, according to their initial BMI, as having normal weight (<25 kg/m²), overweight (25 to 29,9 kg/m²) and being obese (>30 kg/m²), and were followed-up for six years, with yearly measurements of weight and BMI. The statistic test ANOVA was used to measure the weight variation among the groups in each BMI category every year. RESULTS: the average age at the onset of the method employed was higher in the study group than in the controls, in all the BMI categories: 31.6±SD 7.1 X 27.4±SD 5.5 in the normal weight category (p<0.0001); 37.3±SD 6.8 X 29.2±SD 6.0 in the overweight category (p<0.0001); and 35.3±SD 6.4 X 29.7±SD 5.8 among obese women (p<0.0001). DMPA users showed weight increase as compared to the controls in the overweight category (p=0.0082); and the weight increase along the observation period was also higher among the DMPA users than among the controls, for the normal weight (p<0.0001) and overweight (p=0.0008) categories. In the obese group, there was no BMI variation between the groups, nor along the period during which they were using the method. CONCLUSIONS: there was no change in weight gain among DMPA users from the obese category. Prospective studies should be done with metabolic tests to establish the determining factors of weight gain in normal and overweight women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):385-390
DOI 10.1590/S0100-72032009000800003
PURPOSE: to evaluate the effect of hyperprolactinemia induced by metoclopramide on the endometrium and myometrium of female mice in the proestrus phase. METHODS: 24 female mice were randomly divided in two groups: CtrG/control and ExpG/treated with metoclopramide (6.7 mg/g daily). After 50 days, the animals were sacrificed in the proestrus phase, and the blood was collected to determine the levels of estradiol, progesterone and prolactin. The uterine horns were removed, fixed in 10% formaldehyde and processed before being included in paraffin. Slices of 4 µm were stained by hematoxylin and eosin (H/E). In the morphological analysis, a Carl Zeiss light microscope, with objectives varying from 4 to 400 X was used for each histological slice characterization. In the morphometrical analysis, the superficial epithelium, the lamina propria and the myometrium thickness were evaluated, with the help of an image analyzer (AxionVision - Carl Zeiss) attached to the light microscope (Carl Zeiss). The statistical analysis was done by ANOVA, followed by the Wilcoxon test. P-value was considered as significant, when <0.05. RESULTS: our findings have shown an increase in the seric levels of prolactin (295.6±38.0 ng/mL) and significant decrease in the progesterone levels (11.3±0.9 ng/mL) in the ExpG, as compared to the CtrG (45.5±5.2 ng/mL and 18.2±1.6 ng/mL, respectively; p<0.001). Concerning the seric level of estradiol, significant differences between the groups were not obtained (ExpG=119.1±12.3 pg/mL and CtrG=122.7±8.4 pg/mL; p=0.418). The morphological study has shown that the uterus from the ExpG presented the endometrium with more developed superficial epithelium and lamina propria, as compared to the CtrG, the same happening with the myometrium. The thickness morphometrical values of the luminal epithelium (8.0±1.1 µm) and endometrium (116.2±21.1x10² µm) from the CtrG were lower than the ones from the ExpG (10.2±0.8 µm and 163.2±23.3x10² µm, respectively) with p<0.05. Nevertheless, data obtained in the myometrium have not shown significant differences between the groups (CtrG=152.2±25.2x10² µm and ExpG=140.8±18.0x10² µm). CONCLUSIONS: data have shown that hyperprolactinemia induced by metoclopramide determines endometrial proliferation and interferes with the ovarian function, mainly in the progesterone production.