Artigos Originais Archives - Page 4 of 81 - Revista Brasileira de Ginecologia e Obstetrícia

  • Artigos Originais

    Low dose of sublingual misoprostol (12.5 µg) for labor induction

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):164-169

    Summary

    Artigos Originais

    Low dose of sublingual misoprostol (12.5 µg) for labor induction

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):164-169

    DOI 10.1590/S0100-72032012000400005

    Views10

    PURPOSE: To describe the maternal and perinatal outcomes after the use of 12.5 µg of sublingual misoprostol for labor induction in women with term pregnancy and a live fetus. METHODS: We conducted a multicenter, open and non-randomized clinical trial during the period from July to December 2009. We included 30 pregnant women with an indication for labor induction at term, carrying a live fetus, with a Bishop score of six or less, cephalic presentation, estimated fetal weight of less than 4,000 g and an amniotic fluid index greater than five. We excluded women with a previous uterine scar, non-reassuring fetal status, congenital anomalies, multiple pregnancy, intrauterine growth restriction, genital bleeding, and contraindications of vaginal delivery. A tablet of 12.5 µg sublingual misoprostol was administered every six hours, until the beginning of labor, with the maximum of eight doses. RESULTS: Labor was successfully induced in 90% of pregnant women. The mean interval between the first dose and the onset of uterine contractions and delivery was 14.3±11.7 hours and 25.4±13 hours, respectively. The frequency of vaginal delivery was 60%. Uterine tachysystole occurred in two pregnant women, being reversed in both cases without the need for cesarean section. Meconium-stained amniotic fluid was observed in four patients, and an Apgar score of less than 7 at five minutes in only one newborn. CONCLUSION: Maternal and perinatal outcomes were favorable after induction of labor with sublingual misoprostol at a dose of 12.5 µg every six hours. However, controlled trials are needed to compare this regimen with other doses and routes of administration.

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  • Artigos Originais

    Lacrimal dysfunction and pregnancy

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):170-174

    Summary

    Artigos Originais

    Lacrimal dysfunction and pregnancy

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):170-174

    DOI 10.1590/S0100-72032012000400006

    Views7

    PURPOSE: To assess the prevalence of lacrimal dysfunction during pregnancy comparing it to non-pregnant women and to correlate these findings with obstetric history. METHODS: We interviewed 150 pregnant and 150 non-pregnant women for symptoms of dry eyes and obstetric history. Both groups underwent Schirmer I testing and responded to a questionnaire on dry eye symptoms. Patients with collagen diseases, medications associated with dryness of mucous membranes, hepatitis C infection and AIDS, previous intraocular inflammation and eye surgery were excluded. Data were analyzed by the Χ2 and Fisher tests when the data were nominal and by the Student´s t-test and Mann-Whitney test when numerical. The level of significance was set at 5%. RESULTS: The two groups did not differ in symptoms of lacrimal dysfunction. The results of Schirmer's test were equal in both groups for the right eye (p=0.3) and left eye (p=0.3). However, pregnant women had a higher prevalence of at least one dry eye (p=0.004). The occurrence of dry eye in both groups (patients and controls) was associated with a greater number of full-term pregnancies/patient (p=0.04) but not with pregnancy time (p=0.5) or number of abortions (p=0.9). CONCLUSIONS: Pregnant women suffer more from lacrimal dysfunction than non pregnant women; in both groups the prevalence of tear dysfunction is more elevated in women with higher parity.

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    Lacrimal dysfunction and pregnancy
  • Artigos Originais

    Nutritional status and quality of life of climacteric women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):175-183

    Summary

    Artigos Originais

    Nutritional status and quality of life of climacteric women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):175-183

    DOI 10.1590/S0100-72032012000400007

    Views9

    PURPOSE: To associate the quality of life with the nutritional status of climacteric women. METHODS: This was a cross-sectional study on a sample of 200 climacteric women aged 40 to 65 years who responded to a 24-hour food recall and to questions about socioeconomic factors and current, previous and family medical history. Body mass index (BMI), waist circumference (WC) and waist-hip ratio were used for anthropometric evaluation. To assess the quality of life, we applied the MRS-menopause rating scale. RESULTS: The average BMI and waist circumference were 30.1 kg/m² (obesity grade 1) and 99 cm (very increased risk for cardiovascular disease), respectively. Increased protein consumption and decreased fiber, calcium and vitamin D intake were detected. The most prevalent disease was hypertension, 48.5% of the women studied were taking medication for cardiovascular disease and 23% were taking antidepressant medications. Regarding quality of life, significant results related to BMI as well as blood pressure were found. CONCLUSIONS: A nutritional intervention aiming to correct or improve food consumption and anthropometric profile may result in health benefits for climacteric women. The prevalence of obesity, associated with a poorer quality of life, morbidity and mortality underscores the need for a feeding re-education program during the climacteric.

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  • Artigos Originais

    Correlation between age and antral follicles count in infertile women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):184-188

    Summary

    Artigos Originais

    Correlation between age and antral follicles count in infertile women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):184-188

    DOI 10.1590/S0100-72032012000400008

    Views10

    PURPOSE: To produce age-related nomograms for ovarian antral follicle count (AFC) in infertile women. METHODS: It was done a cross-sectional study of patients attended in the center of assisted reproduction Fêmina, from March 2010 to October 2011. The patients were submitted to transvaginal ultrasonography from day 2 to day 4 of their menstrual period. Patients included were between 21 to 45 years old, with regular menses, two healthy ovaries, without any evidence of endocrinopathies and who gave written informed consent. Patients excluded were smokers, with galactosemia or ovarian cysts, with antecedents of liver disease, ovarian surgeries or who were treated with chemotherapy or radiotherapy. In order to check the evolution of the AFC in relation to patient age, we used the 5th, 25th, 50th, 75th and 95th percentiles. Linear regression was carried out using these percentiles, permitting us to determine the effect of age on the CFA. RESULTS: A total of 172 patients with a mean age of 32.7 years were included in the trial. The male and tubal factors were the main causes of infertility, accounting for 65% of cases. The age-related nomogram for the 5th, 25th, 50th, 75th and 95th percentiles of AFC revealed that changes were best fitted by a linear function. The percentiles that showed the highest correlations were 25 (r=-0.9; p<0.001), 50 (r=-0.9; p<0.001) and 75 (r=-0.9; p<0.001). CONCLUSION: A nomogram was constructed correlating age with the different AFC percentiles in infertile women without endocrinopathies. This showed a linear pattern of decline in AFC with age in all percentiles. These nomograms could provide a reference guide for the clinician. However, future validation, with longitudinal data, still is needed.

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    Correlation between age and antral follicles count in infertile women
  • Artigos Originais

    Serous and non-serous ovarian carcinoma: histological tumor type as related to the grade of differentiation and disease prognosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):196-202

    Summary

    Artigos Originais

    Serous and non-serous ovarian carcinoma: histological tumor type as related to the grade of differentiation and disease prognosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):196-202

    DOI 10.1590/S0100-72032012000500002

    Views12

    PURPOSE: To compare the clinical-pathological features of women with serous and non-serous ovarian tumors and to identify the factors associated with survival. METHODS: In this reconstructed cohort study, 152 women with ovarian carcinoma, who attended medical consultations between 1993 and 2008 and who were followed-up until 2010 were included. The histological type was clearly established for all women: 81 serous carcinomas and 71 non-serous tumors (17 endometrioid, 44 mucinous and 10 clear cell carcinomas). The crude and adjusted odds ratios (OR), with the respective 95% confidence intervals (95%CI), were calculated for the clinical and pathological features, comparing serous and non-serous histological types. The Hazard Ratios (HR) with 95%CI was calculated for overall survival, considering the clinical and pathological features. RESULTS: Comparison of serous to non-serous tumor types by univariate analysis revealed that serous tumors were more frequently found in postmenopausal women, and were predominantly high histological grade (G2 and G3), advanced stage, with CA125>250 U/mL, and with positive peritoneal cytology. After multivariate regression, the only association remaining was that of high histological grade with serous tumors (adjusted OR 15.1; 95%CI 2.9-77.9). We observed 58 deaths from the disease. There was no difference in overall survival between women with serous carcinoma and women with non-serous carcinoma (HR 0.4; 95%CI 0.1 - 1.1). It was observed that women aged 50 years or less (HR 0.4; 95%CI 0.1-0.9) and those who were in menacne (HR 0.3; 95%CI 0.1-0.9) had a longer survival compared respectively to those above 50 years of age and menopaused. High histological grade (G2 and G3) (p<0.01), stages II-IV (p<0.008) and positive cytology (p<0.001) were significantly associated with worse prognosis. CA125 and the presence of ascites did not correlate with survival. Survival was poor when the disease was diagnosed in stages II to IV and compared to stage I (log-rank p<0.01) regardless of histological type (serous and non-serous). CONCLUSIONS: The proportion of high histological grade (G2 and G3) was significantly higher among serous than non-serous carcinomas. Serous and non-serous histological types were not related to overall survival.

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    Serous and non-serous ovarian carcinoma: histological tumor type as related to the grade of differentiation and disease prognosis
  • Artigos Originais

    Apparently matured oocytes injected in telophase I have worse outcomes from assisted reproduction

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):203-208

    Summary

    Artigos Originais

    Apparently matured oocytes injected in telophase I have worse outcomes from assisted reproduction

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):203-208

    DOI 10.1590/S0100-72032012000500003

    Views11

    PURPOSE: To evaluate the nuclear maturation stage and the presence of meiotic spindles of in vivo matured oocytes from infertile women undergoing stimulated cycles for intracytoplasmic sperm injection (ICSI) and compare intracytoplasmic sperm injection outcomes between oocytes in telophase I (TI) and metaphase II (MII), and the ones with and without visible meiotic spindle. METHODS: A prospective and controlled study with 106 infertile patients who underwent ovarian stimulation for intracytoplasmic sperm injection purposes. Patients aged 38 years or less, with basal follicle stimulating hormone (FSH) less than 10 mIU/mL and body mass index (BMI) less than 30 kg/m². Were included patients presenting any systemic diseases, any active infection, smokers or patients who had been using hormonal medications and hormonal and nonhormonal anti-inflammatory drugs for the past two months prior to the assisted reproduction procedure were excluded. The oocytes with the first polar body extruded (in vivo matured oocytes) were imaged by polarization microscopy immediately before intracytoplasmic sperm injection and characterized according to nuclear maturation stage (telophase I and metaphase II) and to the presence of a meiotic spindle. We analyzed the fertilization rates, cleavage, number of good quality embryos on the second day (D2) from oocytes on telophase I versus those in metaphase II, and metaphase II visible spindle versus non-visible ones. Data were analyzed comparatively by Fisher's exact test. The level of significance was set at 5% in all analyses (p<0.05). RESULTS: The meiotic spindles of 516 oocytes were imaged using polarization microscopy. From the 516 oocytes analyzed, seventeen were in telophase I (3.3%) and 499 (96.7%) in metaphase II. The oocytes injected in telophase I had significantly lower fertilization rates than those injected in metaphase II (53 and 78%, respectively) and produced no good quality embryos on day 2. When the oocytes with and without a visible meiotic spindle were compared, there was no significant difference in the intracytoplasmic sperm injection results. CONCLUSIONS: Oocytes injected in telophase I showed lower fertilization rates when compared to those in metaphase II. It is possible that the analysis of oocyte nuclear maturation by polarization microscopy can be used as a predictor of fertilization after intracytoplasmic sperm injection.

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  • Artigos Originais

    Comparative study between the pH test and of the KOH versus Nugent score for diagnosis of bacterial vaginosis in pregnant women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):209-214

    Summary

    Artigos Originais

    Comparative study between the pH test and of the KOH versus Nugent score for diagnosis of bacterial vaginosis in pregnant women

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):209-214

    DOI 10.1590/S0100-72032012000500004

    Views16

    PURPOSE: To assess the prevalence of bacterial vaginosis and to compare the accuracy of testing pH and KOH with the Nugent gradient, the gold standard for the diagnosis of bacterial vaginosis (BV) in asymptomatic and symptomatic pregnant women at low risk. METHODS: We conducted a cross-sectional study on 321 pregnant women with gestational age between 14 and 26 weeks, 218 of them asymptomatic and 103 with vaginal complaints suggestive of bacterial vaginosis. All women were assessed by the criteria of Nugent and subjected to the measurement of vaginal pH and to the 10% KOH test. The Kappa coefficient was used to evaluate the methods in terms of diagnostic agreement. RESULTS: Most patients were adolescents (mean age 21.0±5.6 years), nulliparous and mulattos. The prevalence of bacterial vaginosis was 33.3% as estimated by the pH and KOH method and 35.5% by the Nugent method. Excellent agreement of the methods was found among asymptomatic pregnant women, with 72.5% of them showing negative results to both tests, which resulted in a high Kappa coefficient (k=0.82). The group of symptomatic women showed 49.5% positivity to both diagnostic methods, with excellent agreement (k=0.74). CONCLUSION: The prevalence of bacterial vaginosis determined by both the pH and KOH method and the Nugent score was high. The pH and KOH method can diagnose bacterial vaginosis as accurately as the Nugent criterion.

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  • Artigos Originais

    Morbidity and associated factors in climacteric women: a population based study in women with 11 or more years of formal education

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):215-220

    Summary

    Artigos Originais

    Morbidity and associated factors in climacteric women: a population based study in women with 11 or more years of formal education

    Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):215-220

    DOI 10.1590/S0100-72032012000500005

    Views11

    PURPOSE: To evaluate factors associated with morbidities among Brazilian women aged 40-65 years and with 11 or more years of schooling. METHODS: A secondary analysis of a cross-sectional population-based study was conducted, using an anonymous self-report questionnaire completed by 377 women. Were evaluated, with this instrument, some morbidities (hypertension, diabetes, insomnia and depression) and sociodemographic, behavioral, clinical and reproductive factors. The association between morbidities and independent variables was evaluated by the Χ2 test. Multiple logistic regression analysis with stepwise selection criteria was used to select the major factors associated with morbid conditions. RESULTS: In the multiple regression analysis, insomnia was associated with bad/fair self-perception of health (OR=2.3) and nervousness (OR=5.1). Depression was associated with bad/fair self-perception of health (OR=3.7) and bad/poor leisure (OR=2.8). Hypertension was associated with obesity (OR=3.1) and being in postmenopausal (OR=2.6). Diabetes was associated with age above 50 years (OR=3.9) and obesity (OR=12.5). CONCLUSIONS: The prevalence of morbidities was high and a worse self-perception of health and obesity were the main factors associated with morbidity.

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