Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):437-444
DOI 10.1590/S0100-72032008000900003
PURPOSE: to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV. METHODS: 158 patients who had undergone a first collection of material from the uterine cervix with Ayre's spatula for PCR were included in the study. Then, another collection with Ayre's spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years. RESULTS: the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the χ2 test with Yates's correction to compare the ratios. The Fisher's test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83). CONCLUSIONS: As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):445-451
DOI 10.1590/S0100-72032008000900004
PURPOSE: to determine the prevalence and risk factors associated to anemia in pregnant women from the semiarid region of Alagoas, Brazil. METHODS: transversal study comprising a sample (n=150) obtained taking into consideration the prevalence estimated by World Health Organization of 52%, an error of 8% and a confidence interval of 95%. Sampling has been done in three stages: 15 towns among the 38 in the region, four census sectors by town and 24 residences by sector. All the resident pregnant women were eligible, and their socio-economic, demographic, anthropometric and health data have been collected. Anemia was identified at the <11 g/dL hemoglobin level (Hemocue®), and its association with risk factors, tested by multiple linear regression analysis. RESULTS: anemia prevalence was 50%. Seventy eight per cent of the pregnant women were under pre-natal care. From those, 79.3% were in the second or third trimester of gestation. Nevertheless, only 21.2% of them were taking iron supplementation. Variables (p<0.05) independently associated with anemia (anemic versus not-anemic pregnant women) were: larger number of family members (4.5±2.3 versus 4,3±2.3; p=0.02), lower age group of the pregnant woman (23.9±6.3 versus 24.7±6.7; p=0.04), or of her partner (34.5±15.8 versus 36±17.5; p=0.03), no toilet in the house (30.7 versus 24%; p<0.001), history of child abortion and/or death (32.4 versus 16.4%; p<0.001), living in the country (60 versus 46.7%; p=0.03), average per capita income
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):452-458
DOI 10.1590/S0100-72032008000900005
PURPOSE: to evaluate the experience of Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista "Júlio de Mesquita Filho", in the follow-up of pregnant women with hyperthyroidism. METHODS: Sixty patients, divided in groups with compensated hyperthyroidism (CHG=24) and with uncompensated hyperthyroidism (UHG=36) were retrospectively studied and compared concerning clinical-laboratorial characteristics and intercurrences. The t-Student test, contingency tables, multiple linear regression and multiple logistic regression with significance level at 5.0% were used. RESULTS: propylthiouracil (PTU) was used by 94.0% of UHG and by 42.0% of CHG (p<0.0001); maternal complications close to delivery have occurred in 20.6% of UHG and in 11.8% of CHG, and UHG presented three fetal deaths, influenced by the mother age, higher level of T4L (lT4L) and of PTU dose (PTUd) in the third trimester (p=0.007); restriction of intra-uterine growth, influenced by lT4L and PTUd in the third trimester has occurred in nine UHG and in three CHG cases, and oligoamnios has occurred in 12 patients (83.3% of UGH and 16.7% of CGH), influenced by age and lT4L in the third trimester (p=0.04); the gestational age at delivery was 34.4±4.6 weeks in UHG and 37.0±2.5 in CHG, influenced by the T4Ll in the third trimester (p<0.05). CONCLUSIONS: the UHG has presented less satisfactory results than CHG, influenced by high lT4L and PTUd in the third trimester, and by more advanced age of some pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):459-465
DOI 10.1590/S0100-72032008000900006
PURPOSE: to evaluate the effect of maternal, socioeconomic and obstetric variables, as well the presence of artery incisions in the 20th and 24th weeks on the fetal weight estimated at the end of pregnancy (36th week) in pregnant women attended by Programa Saúde da Família, in an inland town of the northeast of Brazil. METHODS: a longitudinal study including 137 pregnant women, who have been followed up every four weeks in order to assess clinical, socioeconomic and obstetric conditions, including their weight. The uterine arteries were evaluated by Doppler in the 20th and 24th weeks, the fetal weight and the amniotic fluid index (AFI), determined in the 36th week. The initial maternal nutritional state has been determined by the body mass index (BMI), the pregnant women being classified as low weight, eutrophic, over weight and obese. Weight gain during gestation has been evaluated, according to the initial nutritional state, being classified at the end of the second and third trimester as insufficient, adequate and excessive weight gain. Analysis of variance was performed to evaluate the association of the fetal weight in the 36th week with the predictor variables, adjusted by multiple linear regression. RESULTS: an association between the fetal weight estimated in the 36th week and the mother's age (p=0.02), mother's job (p=0.02), initial nutritional state (p=0.04), weight gain in the second trimester (p=0.01), presence of incisions in the uterine arteries (p=0.02), and AFI (p=0.007) has been observed. The main factors associated to the fetal weight estimated in the 36th week, after the multiple regression analysis were: BMI at the pregnancy onset, weight gain in the second trimester, AFI and tabagism. CONCLUSIONS: in the present study, the fetal weight is positively associated with the initial maternal nutritional state, the weight gain in the second trimester and the volume of amniotic fluid, and negatively, to tabagism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):379-383
DOI 10.1590/S0100-72032008000800002
PURPOSE: to verify the association of osteoporosis with periodontal disease. METHODS: the study has included 39 postmenopausal women divided in three groups according to bone mass categories, through evaluation of mineral bone density (MBD), measured by X-ray double emission absorbimetry in the lumbar area (L1-L4): ): normal bone; osteopenia and osteoporosis. In all the participants the Clinical Insertion Level (CIL) index has been determined at the research onset and after one year, by the same examiner. The periodontal situation data have been submitted to statistical analysis with the paired t-Student test. RESULTS: the periodontal exam has shown that postmenopausal women in the osteopenia presented lower CIL at the initial periodontal clinical exam (2.1±1.1 mm), while the ones in the normal bone showed less teeth support tissue loss after one year (3.1±1.6 mm). The statistical analysis has shown that there was no significant difference for the periodontal situation in the normal bone, but there was significant statistical difference for the osteopenia and osteoporosis patients, when CIL values from both evaluation periods were compared. CONCLUSIONS: it is concluded that postmenopausal osteoporosis may be a possible risk factor for periodontal disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):384-392
DOI 10.1590/S0100-72032008000800003
PURPOSE: the objective of the present study was the development of the Brazilian Portuguese version of Endometriosis Health Profile Questionnaire (EHP-30), the cross-cultural adaptation to Brazil and the evaluation of EHP-30 Portuguese psychometric measures in a Brazilian sample. METHODS: the original instrument in English was translated into Portuguese following international guidelines, going through all stages of translation, back-translation and comparison of the versions for cross-cultural adaptation, face and content validity. A sample of 54 patients with endometriosis was used for internal consistency analyses using the Cronbach alpha. Test-retest reliability was evaluated through the intraclass correlation coefficient (ICC). In order to evaluate the convergent construct validity, the correlation between EHP-30 Portuguese and WHOQOL-Bref and Beck Depression Inventory (BDI) was tested. RESULTS: internal consistency presented alpha values of 0.8 to 0.9 suggesting homogeneity between questions. The test-retest reliability presented ICC of 0.8 to 0.9 showing instrument stability. In the construct validation, strong correlations were demonstrated of the EHP-30 Portuguese self-image scale with physical (-0.6) and psychological domains (-0.6) of WHOQOL-Bref, and EHP-30 Portuguese social support scale with BDI (0.5), confirming good correlation with other quality of life evaluation instruments. CONCLUSIONS: the EHP-30 Portuguese was found to be an easy, quickly applied instrument, and well-accepted by the patients. It presented good psychometric properties with appropriate reliability measures (internal consistency and test-retest reliability) and construct validity. These results show that EHP-30 Portuguese is an adequate instrument for quality of life evaluation in Brazilian women with endometriosis, both in clinical and research setting.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):393-399
DOI 10.1590/S0100-72032008000800004
PURPOSE: to study cervical colonization in women with preterm labor or premature rupture of membranes. METHODS: two hundred and twelve pregnant women with preterm labor or premature rupture of membranes were studied. Two cervical samples from each woman were collected and bacterioscopy and culture were performed. Association of cervical microorganisms and urinary tract infection, chorioamnionitis, fetal stress, antibiotic use, prematurity, neonatal infection, and neonatal death were evaluated. RESULTS: the prevalence of endocervical colonization was 14.2% (CI95%=9.5-18.9%), with similar results in preterm labor or premature rupture of membranes. Group B streptococcus was the most prevalent organism (9.4%). Other organisms isolated were Candida sp, Streptococcus sp, Streptococcus pneumoniae, Escherichia coli and Enterococcus sp. The most common findings of bacterioscopy were a reduced number of lactobacilli and a great number of leukocytes. Endocervical colonization was associated with a higher occurrence of urinary tract infection (23.8 versus 5.4%; p<0.01), early-onset neonatal infection (25.0 versus 7.3%; p<0.01) and neonatal mortality (two cases in colonized women; p<0.02) when compared with a negative culture of endocervical mucus. CONCLUSIONS: this study showed high prevalence of endocervical colonization despite the use of a nonselective culture media. The main microorganism isolated was group B streptococcus, but other organisms were present in one third of the studied population. More studies are needed to evaluate the influence of endocervical colonization on obstetrical outcome and on neonatal infection and mortality.