Artigos Originais Archives - Page 9 of 81 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):347-352
DOI 10.1590/SO100-720320140005061
To evaluate the validity of cervicovaginal cytology performed at LAPER, the main Laboratory of Pathology of the State of Roraima, Brazil, by interrater agreement (external monitoring) and agreement with histopathologic results.
One hundred women were included, a population-based convenience sample. Their cervical cytological exams were evaluated by the laboratory staff and reviewed by expert medical pathologists, external to the laboratory. Cohen's Kappa index, sensitivity and specificity were evaluated. The study was approved by LAPER coordination and Federal University of Roraima Research Ethics Commitee.
Regarding the prevalence of human papillomavirus-related atypical, there was no concordance between the results issued by LAPER and by the external pathologists (k=0.21). A low sensitivity (28.5%) and specificity (89,2%) was detected for the diagnostic performance of LAPER, with a high proportion of false positive and false negative results. The cytological reports of the external pathologists showed higher sensitivity and specificity (71.4 and 98.9%, respectively), ruling out the possibility that errors related to collection methods and staining would explain the low performance of the laboratory.
A low diagnostic accuracy of cervicovaginal cytology can be a barrier against the control of cervical cancer in Roraima. We emphasize the need for professional training and internal and external monitoring in Brazilian states with a high incidence of cervical cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):347-352
DOI 10.1590/SO100-720320140005061
To evaluate the validity of cervicovaginal cytology performed at LAPER, the main Laboratory of Pathology of the State of Roraima, Brazil, by interrater agreement (external monitoring) and agreement with histopathologic results.
One hundred women were included, a population-based convenience sample. Their cervical cytological exams were evaluated by the laboratory staff and reviewed by expert medical pathologists, external to the laboratory. Cohen's Kappa index, sensitivity and specificity were evaluated. The study was approved by LAPER coordination and Federal University of Roraima Research Ethics Commitee.
Regarding the prevalence of human papillomavirus-related atypical, there was no concordance between the results issued by LAPER and by the external pathologists (k=0.21). A low sensitivity (28.5%) and specificity (89,2%) was detected for the diagnostic performance of LAPER, with a high proportion of false positive and false negative results. The cytological reports of the external pathologists showed higher sensitivity and specificity (71.4 and 98.9%, respectively), ruling out the possibility that errors related to collection methods and staining would explain the low performance of the laboratory.
A low diagnostic accuracy of cervicovaginal cytology can be a barrier against the control of cervical cancer in Roraima. We emphasize the need for professional training and internal and external monitoring in Brazilian states with a high incidence of cervical cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):353-358
DOI 10.1590/SO100-720320140005009
To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil.
A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χtest or Fisher's exact test to evaluate the association between infection and variables.
The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004).
There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):353-358
DOI 10.1590/SO100-720320140005009
To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil.
A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χtest or Fisher's exact test to evaluate the association between infection and variables.
The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004).
There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):359-366
DOI 10.1590/SO100-720320140005065
To evaluate the effects of ovariectomy and the hyperprolactinemia procedure in the tibial epiphyseal growth plate of female mice.
In this study, the epiphyseal growth plate of ovariectomized (OVX) and/or rendered hyperprolactinemic female mice by 50 days of treatment with 200 μg metoclopramide (M) was evaluated morphologically, morphometrically and immuno-histochemically. Forty female and adult mice were divided into four groups according to treatment: V group - animals treated with saline solution; H group - hyperprolactinemic animals; Ovx/V group - ovariectomized animals and treated with saline solution; Ovx/H group - hyperprolactinemic and ovariectomized animals. After the treatment period, the animals were sacrificed, tibia was removed and fixed in 10% buffered formalin and decalcified in 10% formic acid. The material was immersed in paraffin and subjected to histological processing in paraffin. The sections were stained with Masson's trichrome and immunohistochemistry was carried out for the pro-apoptotic protein BCL-2. The images for the morphological and morphometric study were analyzed with the imaging program AxioVision 4.8 (Carl-Zeiss(r), Germany).
The combination of hyperprolactinemia and the ovariectomy procedure decreased the number of resting chondrocytes 1.5-fold, the number of proliferative chondrocytes 1.8-fold; the percentage of resting cartilage 2.4-fold and the percentage of trabecular bone 2.1-fold, compared with respective control animals.
The procedure of ovariectomy combined with the metoclopramide-induced hyperprolactinemia in female mice has showed marked bone degeneration due to significant decrease of cell proliferation in the epiphyseal growth plate and bone formation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):359-366
DOI 10.1590/SO100-720320140005065
To evaluate the effects of ovariectomy and the hyperprolactinemia procedure in the tibial epiphyseal growth plate of female mice.
In this study, the epiphyseal growth plate of ovariectomized (OVX) and/or rendered hyperprolactinemic female mice by 50 days of treatment with 200 μg metoclopramide (M) was evaluated morphologically, morphometrically and immuno-histochemically. Forty female and adult mice were divided into four groups according to treatment: V group - animals treated with saline solution; H group - hyperprolactinemic animals; Ovx/V group - ovariectomized animals and treated with saline solution; Ovx/H group - hyperprolactinemic and ovariectomized animals. After the treatment period, the animals were sacrificed, tibia was removed and fixed in 10% buffered formalin and decalcified in 10% formic acid. The material was immersed in paraffin and subjected to histological processing in paraffin. The sections were stained with Masson's trichrome and immunohistochemistry was carried out for the pro-apoptotic protein BCL-2. The images for the morphological and morphometric study were analyzed with the imaging program AxioVision 4.8 (Carl-Zeiss(r), Germany).
The combination of hyperprolactinemia and the ovariectomy procedure decreased the number of resting chondrocytes 1.5-fold, the number of proliferative chondrocytes 1.8-fold; the percentage of resting cartilage 2.4-fold and the percentage of trabecular bone 2.1-fold, compared with respective control animals.
The procedure of ovariectomy combined with the metoclopramide-induced hyperprolactinemia in female mice has showed marked bone degeneration due to significant decrease of cell proliferation in the epiphyseal growth plate and bone formation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):367-371
DOI 10.1590/SO100-720320140005052
To study the incidence of tumors in a Brazilian sample of women with systemic lupus erythematosus.
This is a retrospective study of 395 medical charts from women with systemic lupus erythematosus diagnosed by the presence of at least 4 of the American College of Rheumatology classification criteria for the diagnosis of this disease and followed for the last 10 years in a rheumatology outpatient clinic. Demographic data (age and ethnicity of patients), data on disease duration, use of immunomodulators and on the presence of neoplasms were listed. Results are presented in frequency and contingency tables. The incidence rate of malignancies in women with lupus was compared with that of the general population for the same demographic region for the past ten years, using data published by the Brazilian National Cancer Institute (INCA). Association studies were carried out by the Fisher and χ tests, when the data were nominal, and by Mann-Whitney test, when numeric. The level of significance was set at 5%.
Twenty-two cases of malignant tumors were identified during these 10 years of follow-up (22 cases/395 or 5.5% of the sample), being the most common those of the uterine cervix (10 cases/395 or 2.5% of the sample) and breast cancer (9 cases/395 or 2.2% of the sample). The presence of tumors was associated with disease duration (p=0.006) and was not influenced by treatment with methotrexate (p=0.1), azathioprine (p=0.9), cyclophosphamide (p=0.6) and glucocorticoids (p=0.3). Breast and uterine cervix tumors were more common in systemic lupus erythematosus women than in the general population (p<0.0001 for both).
A high prevalence of malignant tumors was found in this sample, with tumors being more common in patients with longer disease duration. The most frequent tumors affected the breast and uterus at a higher incidence than in the general population. The presence of tumors was not influenced by the use of glucocorticoids or immunosuppressors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):367-371
DOI 10.1590/SO100-720320140005052
To study the incidence of tumors in a Brazilian sample of women with systemic lupus erythematosus.
This is a retrospective study of 395 medical charts from women with systemic lupus erythematosus diagnosed by the presence of at least 4 of the American College of Rheumatology classification criteria for the diagnosis of this disease and followed for the last 10 years in a rheumatology outpatient clinic. Demographic data (age and ethnicity of patients), data on disease duration, use of immunomodulators and on the presence of neoplasms were listed. Results are presented in frequency and contingency tables. The incidence rate of malignancies in women with lupus was compared with that of the general population for the same demographic region for the past ten years, using data published by the Brazilian National Cancer Institute (INCA). Association studies were carried out by the Fisher and χ tests, when the data were nominal, and by Mann-Whitney test, when numeric. The level of significance was set at 5%.
Twenty-two cases of malignant tumors were identified during these 10 years of follow-up (22 cases/395 or 5.5% of the sample), being the most common those of the uterine cervix (10 cases/395 or 2.5% of the sample) and breast cancer (9 cases/395 or 2.2% of the sample). The presence of tumors was associated with disease duration (p=0.006) and was not influenced by treatment with methotrexate (p=0.1), azathioprine (p=0.9), cyclophosphamide (p=0.6) and glucocorticoids (p=0.3). Breast and uterine cervix tumors were more common in systemic lupus erythematosus women than in the general population (p<0.0001 for both).
A high prevalence of malignant tumors was found in this sample, with tumors being more common in patients with longer disease duration. The most frequent tumors affected the breast and uterus at a higher incidence than in the general population. The presence of tumors was not influenced by the use of glucocorticoids or immunosuppressors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):372-376
DOI 10.1590/SO100-720320140005006
To compare the concentration of serum alpha-tocopherol during the postpartum period in women admitted to public and private hospitals in Natal (RN), Brazil.
The study included 209 women in the postpartum period, 96 of them from private hospitals and 113 from public hospitals, studied between 24 and 48 hours postpartum. Inclusion criteria were: mothers aged 12 years or more, without diseases associated with pregnancy, who had given birth to a singleton with no malformations. Clinically decompensated women with multiple fetuses were excluded. A 5 mL blood sample was obtained from each participant under fasting conditions, before the first meal of the day. The concentration of alpha-tocopherol in serum (µg/dL) was determined by high performance liquid chromatography (HPLC). The statistical difference between means was tested by the Student's t-test.
The mean concentration of alpha-tocopherol was 1.115.7 µg/dL in puerperae from the public network and 1.355.7±397.6 µg/dL in puerperae from the privte network , with a significant difference between groups (p=0.000687). Vitamin E concentration was determined individually and an alpha-tocopherol level <11.6 µmol/L or <499.6 µg/dL was considered to indicate deficiency. Vitamin E deficiency was detected in 5.3% of puerperae from the public network (n=6), whereas no deficiency was detected among women from the private network. However, low concentrations of alpha-tocopherol (11.6 to 16.2 µmol/L or 499.6 to 697.7 µg/dL) was detected in both groups, i.e., in 9.7% of the women from the public network (n=11) and in 4.2% for the women from the private network (n=4).
These results highlight that women assisted in the public sector were more vulnerable to developing low concentrations of alpha-tocopherol than women assisted in the private sector.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(8):372-376
DOI 10.1590/SO100-720320140005006
To compare the concentration of serum alpha-tocopherol during the postpartum period in women admitted to public and private hospitals in Natal (RN), Brazil.
The study included 209 women in the postpartum period, 96 of them from private hospitals and 113 from public hospitals, studied between 24 and 48 hours postpartum. Inclusion criteria were: mothers aged 12 years or more, without diseases associated with pregnancy, who had given birth to a singleton with no malformations. Clinically decompensated women with multiple fetuses were excluded. A 5 mL blood sample was obtained from each participant under fasting conditions, before the first meal of the day. The concentration of alpha-tocopherol in serum (µg/dL) was determined by high performance liquid chromatography (HPLC). The statistical difference between means was tested by the Student's t-test.
The mean concentration of alpha-tocopherol was 1.115.7 µg/dL in puerperae from the public network and 1.355.7±397.6 µg/dL in puerperae from the privte network , with a significant difference between groups (p=0.000687). Vitamin E concentration was determined individually and an alpha-tocopherol level <11.6 µmol/L or <499.6 µg/dL was considered to indicate deficiency. Vitamin E deficiency was detected in 5.3% of puerperae from the public network (n=6), whereas no deficiency was detected among women from the private network. However, low concentrations of alpha-tocopherol (11.6 to 16.2 µmol/L or 499.6 to 697.7 µg/dL) was detected in both groups, i.e., in 9.7% of the women from the public network (n=11) and in 4.2% for the women from the private network (n=4).
These results highlight that women assisted in the public sector were more vulnerable to developing low concentrations of alpha-tocopherol than women assisted in the private sector.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):290-295
DOI 10.1590/SO100-720320140004892
To identify the major causes of maternal death in the State of Pará, Brazil.
A descriptive, observational and retrospective study was conducted using data from the Mortality Information System (SIM) of the State Department of Public Health of Pará. SIM information was obtained using the TabWin 3.2 software and recorded in a research protocol developed by the investigators. The sample included 383 maternal deaths of 10-49-year-old women, which occurred from 2006 to 2010. Data were analyzed using non-parametric tests (χ2 and G-tests). The BioStat(r) 5.0 software was used for statistical analysis and Microsoft(r) Excel 2007 for the preparation of database and tables.
The Maternal Mortality Ratio was 51.9 and did not decrease significantly during the period. Most deaths occurred during the postpartum period (up to 42 days) (51.7%), and some diagnostic confirmation was used. Direct obstetric causes were dominant (90.6%), mainly hypertension (34.6%), with emphasis on eclampsia (70%), and hemorrhage (22.2%). All of these maternal deaths were avoidable (100%).
Maternal death in Pará is characterized by occurring during the puerperium (up to 42 days), due mainly to direct obstetric causes, such as hypertension, with emphasis on eclampsia, and hemorrhage. This evidences the need for complete attention with good quality for pregnant women, from prenatal care to puerperium, in the state of Pará.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):290-295
DOI 10.1590/SO100-720320140004892
To identify the major causes of maternal death in the State of Pará, Brazil.
A descriptive, observational and retrospective study was conducted using data from the Mortality Information System (SIM) of the State Department of Public Health of Pará. SIM information was obtained using the TabWin 3.2 software and recorded in a research protocol developed by the investigators. The sample included 383 maternal deaths of 10-49-year-old women, which occurred from 2006 to 2010. Data were analyzed using non-parametric tests (χ2 and G-tests). The BioStat(r) 5.0 software was used for statistical analysis and Microsoft(r) Excel 2007 for the preparation of database and tables.
The Maternal Mortality Ratio was 51.9 and did not decrease significantly during the period. Most deaths occurred during the postpartum period (up to 42 days) (51.7%), and some diagnostic confirmation was used. Direct obstetric causes were dominant (90.6%), mainly hypertension (34.6%), with emphasis on eclampsia (70%), and hemorrhage (22.2%). All of these maternal deaths were avoidable (100%).
Maternal death in Pará is characterized by occurring during the puerperium (up to 42 days), due mainly to direct obstetric causes, such as hypertension, with emphasis on eclampsia, and hemorrhage. This evidences the need for complete attention with good quality for pregnant women, from prenatal care to puerperium, in the state of Pará.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):315-319
DOI 10.159/S0100-720320140004977
To analyze associations between mammographic arterial mammary calcifications in menopausal women and risk factors for cardiovascular disease.
This was a cross-sectional retrospective study, in which we analyzed the mammograms and medical records of 197 patients treated between 2004 and 2005. Study variables were: breast arterial calcifications, stroke, acute coronary syndrome, age, obesity, diabetes mellitus, smoking, and hypertension. For statistical analysis, we used the Mann-Whitney, χ2 and Cochran-Armitage tests, and also evaluated the prevalence ratios between these variables and mammary artery calcifications. Data were analyzed with the SAS version 9.1 software.
In the group of 197 women, there was a prevalence of 36.6% of arterial calcifications on mammograms. Among the risk factors analyzed, the most frequent were hypertension (56.4%), obesity (31.9%), smoking (15.2%), and diabetes (14.7%). Acute coronary syndrome and stroke presented 5.6 and 2.0% of prevalence, respectively. Among the mammograms of women with diabetes, the odds ratio of mammary artery calcifications was 2.1 (95%CI 1.0-4.1), with p-value of 0.02. On the other hand, the mammograms of smokers showed the low occurrence of breast arterial calcification, with an odds ratio of 0.3 (95%CI 0.1-0.8). Hypertension, obesity, diabetes mellitus, stroke and acute coronary syndrome were not significantly associated with breast arterial calcification.
The occurrence of breast arterial calcification was associated with diabetes mellitus and was negatively associated with smoking. The presence of calcification was independent of the other risk factors for cardiovascular disease analyzed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):315-319
DOI 10.159/S0100-720320140004977
To analyze associations between mammographic arterial mammary calcifications in menopausal women and risk factors for cardiovascular disease.
This was a cross-sectional retrospective study, in which we analyzed the mammograms and medical records of 197 patients treated between 2004 and 2005. Study variables were: breast arterial calcifications, stroke, acute coronary syndrome, age, obesity, diabetes mellitus, smoking, and hypertension. For statistical analysis, we used the Mann-Whitney, χ2 and Cochran-Armitage tests, and also evaluated the prevalence ratios between these variables and mammary artery calcifications. Data were analyzed with the SAS version 9.1 software.
In the group of 197 women, there was a prevalence of 36.6% of arterial calcifications on mammograms. Among the risk factors analyzed, the most frequent were hypertension (56.4%), obesity (31.9%), smoking (15.2%), and diabetes (14.7%). Acute coronary syndrome and stroke presented 5.6 and 2.0% of prevalence, respectively. Among the mammograms of women with diabetes, the odds ratio of mammary artery calcifications was 2.1 (95%CI 1.0-4.1), with p-value of 0.02. On the other hand, the mammograms of smokers showed the low occurrence of breast arterial calcification, with an odds ratio of 0.3 (95%CI 0.1-0.8). Hypertension, obesity, diabetes mellitus, stroke and acute coronary syndrome were not significantly associated with breast arterial calcification.
The occurrence of breast arterial calcification was associated with diabetes mellitus and was negatively associated with smoking. The presence of calcification was independent of the other risk factors for cardiovascular disease analyzed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):296-302
DOI 10.1590/SO100-720320140004958
To describe the perinatal outcomes after preterm premature rupture of membranes.
A retrospective cohort study was carried out at Instituto de Medicina Integral Prof. Fernando Figueira - IMIP from January 2008 to December 2012. A total of 124 preterm premature rupture of membranes singleton pregnancies, with gestational age <35, were included in the study. Pregnant women carrying fetuses with malformations, hypertensive syndromes, diabetes, or diagnosis of infections at admission were excluded. The pregnant women were hospitalized for conservative treatment with corticosteroids, antibiotics and tocolysis with nifedipine if necessary. The results are reported as frequency distributions and measures of central tendency and dispersion.
Seventeen patients (13.7%) had a gestational age of less than 24 weeks. Mean maternal age was 25.7 years, mean gestational age at the diagnosis of preterm premature rupture of membranes was 29 weeks, mean amniotic fluid index was 3.5 cm, and mean latency period was 10.5 days. Most patients went into spontaneous labor by the 30th week of pregnancy, and the rate of vaginal delivery was 88.2%. Chorioamnionitis was the most frequent maternal complication (34.7%). Neonatal sepsis was observed in 12% of patients, and the perinatal mortality rate was 21.5% for the group at or beyond the 24th week of gestation and 76.5% for the group with less than 24 weeks of gestational age.
A low maternal mortality rate was observed in preterm premature rupture of membranes; however, high rates of complications and perinatal death were observed, suggesting that other conduct protocols should be studied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):296-302
DOI 10.1590/SO100-720320140004958
To describe the perinatal outcomes after preterm premature rupture of membranes.
A retrospective cohort study was carried out at Instituto de Medicina Integral Prof. Fernando Figueira - IMIP from January 2008 to December 2012. A total of 124 preterm premature rupture of membranes singleton pregnancies, with gestational age <35, were included in the study. Pregnant women carrying fetuses with malformations, hypertensive syndromes, diabetes, or diagnosis of infections at admission were excluded. The pregnant women were hospitalized for conservative treatment with corticosteroids, antibiotics and tocolysis with nifedipine if necessary. The results are reported as frequency distributions and measures of central tendency and dispersion.
Seventeen patients (13.7%) had a gestational age of less than 24 weeks. Mean maternal age was 25.7 years, mean gestational age at the diagnosis of preterm premature rupture of membranes was 29 weeks, mean amniotic fluid index was 3.5 cm, and mean latency period was 10.5 days. Most patients went into spontaneous labor by the 30th week of pregnancy, and the rate of vaginal delivery was 88.2%. Chorioamnionitis was the most frequent maternal complication (34.7%). Neonatal sepsis was observed in 12% of patients, and the perinatal mortality rate was 21.5% for the group at or beyond the 24th week of gestation and 76.5% for the group with less than 24 weeks of gestational age.
A low maternal mortality rate was observed in preterm premature rupture of membranes; however, high rates of complications and perinatal death were observed, suggesting that other conduct protocols should be studied.