Original Article Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Article

    Analysis of the Performance of 11 Formulae for Fetal Weight Estimation in Preterm Fetuses with Abnormal Doppler Velocimetry – A Retrospective Multicenter Study

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):580-586

    Summary

    Original Article

    Analysis of the Performance of 11 Formulae for Fetal Weight Estimation in Preterm Fetuses with Abnormal Doppler Velocimetry – A Retrospective Multicenter Study

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):580-586

    DOI 10.1055/s-0038-1670643

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    Abstract

    Objective

    To assess 11 formulae commonly used to estimate fetal weight in a population of premature fetuses who had abnormal Doppler velocimetry due to early-onset placental insufficiency. The performance of each formula was evaluated in subgroups of fetuses with expected growth and intrauterine growth restriction.

    Methods

    Data were collected fromfetuses andmothers who delivered at three Brazilian hospitals between November 2002 and December 2013.We used the following formulae: Campbell; Hadlock I, II, III, IV and V; Shepard; Warsof; Weiner I and II; and Woo III.

    Results

    We analyzed 194 fetuses. Of these, 116 (59.8%) were considered appropriate for gestational age (AGA), and 103 (53.1%) were male. The amniotic fluid volume was reduced in 87 (44.8%) fetuses, and the umbilical artery Doppler revealed absence or inversion of diastolic flow in 122 (62.9%) cases, and the analysis of the ductus venosus revealed abnormal flow in 60 (34.8%) fetuses. The Hadlock formulae using three or four fetal biometric parameters had low absolute percentage error in the estimated fetal weight among preterm fetuses with abnormal Doppler studies who were born within 5 days of the ultrasound evaluation. The results were not influenced by the clinical and ultrasound parameters often found in early-onset placental insufficiency.

    Conclusion

    In this study, the formulae with the best performance for fetal weight estimation in the analyzed population were Hadlock I and IV, which use four and three fetal biometric parameters respectively to estimate the weight of preterm fetuses with abnormal Doppler studies.

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    Analysis of the Performance of 11 Formulae for Fetal Weight Estimation in Preterm Fetuses with Abnormal Doppler Velocimetry – A Retrospective Multicenter Study
  • Original Article

    Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):587-592

    Summary

    Original Article

    Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):587-592

    DOI 10.1055/s-0038-1672136

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    Abstract

    Objective

    To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.

    Methods

    The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).

    Results

    We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).

    Conclusion

    Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.

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  • Original Article

    Negative Correlation between Placental Growth Factor and Endocan-1 in Women with Preeclampsia

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):593-598

    Summary

    Original Article

    Negative Correlation between Placental Growth Factor and Endocan-1 in Women with Preeclampsia

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):593-598

    DOI 10.1055/s-0038-1670713

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    Abstract

    Objective

    To analyze endocan-1, a biomarker of vascular endothelial related pathologies, and the placental growth factor (PlGF), an angiogenic factor and a placental dysfunction marker in patients with preeclampsia (PE).

    Methods

    Case-control study conducted at Hospital São Lucas, in the city of Porto Alegre, Brazil. Endocan-1 and PlGF levels were quantified in the maternal plasma using the MagPlexTH-C microsphere system (MAGPIX System, Luminex, Austin, Texas, US) and evaluated through analysis of covariance (ANCOVA) and adjusted by body mass index (BMI), gestational age and maternal age. To estimate the difference between the groups, the mean ratio (MR) and the 95% confidence interval (95%CI) were calculated. The Pearson correlation test was used to establish any association between endocan-1 and PlGF levels. The null hypothesis was rejected when p < 0.05.

    Results

    The group of patients was composed by normotensive (n = 67) patients and patients with PE (n = 50). A negative correlation between endocan-1 and the PlGF was noted in the entire normotensive group (linear correlation coefficient [r] = -0.605; p < 0.001), as well as in the PE group (r = -0.545; p < 0.001).

    Conclusion

    Endocan-1 levels are increased in patients with PE, and are inversely correlated with PlGF levels. We suggest that it is important to analyze angiogenic and proinflammatory molecules concomitantly in women with PE to better understand the pathophysiology of the disease. Both molecules are strong candidates for PE biomarkers, and future studies will examine any mechanisms connecting these factors in PE.

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    Negative Correlation between Placental Growth Factor and Endocan-1 in Women with Preeclampsia
  • Original Article

    Prevalence, Attitudes, and Factors Motivating Conscientious Objection toward Reproductive Health among Medical Students

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):599-605

    Summary

    Original Article

    Prevalence, Attitudes, and Factors Motivating Conscientious Objection toward Reproductive Health among Medical Students

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):599-605

    DOI 10.1055/s-0038-1673367

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    Abstract

    Objective

    We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil.

    Methods

    The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students’ objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ2 tests and t-tests with a significance level of 5%.

    Results

    Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity (p < 0.001) and higher attendance at worship services (p = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men (p = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional.

    Conclusion

    Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject.

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  • Original Article

    The Apoptotic, Angiogenic and Cell Proliferation Genes CD63, S100A6 e GNB2L1 are Altered in Patients with Endometriosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):606-613

    Summary

    Original Article

    The Apoptotic, Angiogenic and Cell Proliferation Genes CD63, S100A6 e GNB2L1 are Altered in Patients with Endometriosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):606-613

    DOI 10.1055/s-0038-1673364

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    Abstract

    Objective

    The aim of the present study was to analyze the expression of the CD63, S100A6, and GNB2L1genes, which participate in mechanisms related to the complex pathophysiology of endometriosis.

    Methods

    A case-control study was conducted with 40 women who were diagnosed with endometriosis, and 15 fertile and healthy women. Paired samples of eutopic endometrium and endometriotic lesions (peritoneal and ovarian endometriotic implants) were obtained from the women with endometriosis in the proliferative (n = 20) or secretory phases (n = 20) of the menstrual cycle. As controls, paired endometrial biopsy samples were collected from the healthy women in the proliferative (n = 15) and secretory (n = 15) phases of the samemenstrual cycle.We analyzed the expression levels of the CD63, S100A6, and GNB2L1 genes by real-time polymerase chain reaction.

    Results

    An increase in CD63, S100A6, and GNB2L1 gene transcript levels was observed in the ectopic implants compared with the eutopic endometrium of the women with and without endometriosis, regardless of the phase of the menstrual cycle.

    Conclusion

    These findings suggest that the CD63, S100A6, and GNB2L1 genesmay be involved in the pathogenesis of endometriosis, since they participate in mechanisms such as inhibition of apoptosis, angiogenesis and cell proliferation, which lead to the loss of cell homeostasis in the ectopic endometrium, thus contributing to the implantation and survival of the tissue in the extrauterine environment.

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    The Apoptotic, Angiogenic and Cell Proliferation Genes CD63, S100A6 e GNB2L1 are Altered in Patients with Endometriosis
  • Original Article

    Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):614-619

    Summary

    Original Article

    Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):614-619

    DOI 10.1055/s-0038-1670712

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    Abstract

    Objective

    To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results.

    Methods

    A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant.

    Results

    In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001).

    Conclusion

    The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

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    Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon
  • Original Article

    Association between Matrix Metallopeptidase 9 Polymorphism and Breast Cancer Risk

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):620-624

    Summary

    Original Article

    Association between Matrix Metallopeptidase 9 Polymorphism and Breast Cancer Risk

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):620-624

    DOI 10.1055/s-0038-1673366

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    Abstract

    Objective

    Epidemiological studies have shown evidence of the effect of genetic variations in the pathogenesis of breast cancer and have suggested a relationship of the disease with genetic polymorphisms. Matrix metallopeptidase 9 (MMP-9) is a collagenase responsible for the degradation of type IV collagen, the major component of the basement membrane, and other essential extra cellular matrix components, being involved in the tumor cell invasion and metastasis. Our objective was to evaluate the relationship between the MMP-9-1562 C/T polymorphism (rs 3918242) and the risk of developing breast cancer.

    Methods

    In this case-control study, the frequency of the MMP-9-1562 C/T polymorphism (rs 3918242) was determined in 148 women with breast cancer and 245 women without the disease. The DNA was extracted from plasma samples, and the gene was amplified by polymerase chain reaction (PCR); the presence of the polymorphism was determined using restriction enzymes.

    Results

    After adjusting for confounding variables, we found that the polymorphism was not associated with the occurrence of breast cancer (odds ratio [OR] = 1.159, 95% confidence interval [CI]: 0.6625-1.997, p = 0.5964). We also found no association with more advanced disease, the presence of hormone receptors, human epidermal growth factor receptor 2 (HER2) overexpression, or rate of tumor cell proliferation.

    Conclusion

    We did not observe a relationship between MMP-9-1562 C/T polymorphism (rs 3918242) and the occurrence of breast cancer.

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  • Original Article

    Hazards of Repeat Pregnancy during Adolescence: A Case-control Study

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):437-443

    Summary

    Original Article

    Hazards of Repeat Pregnancy during Adolescence: A Case-control Study

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):437-443

    DOI 10.1055/s-0038-1666811

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    Abstract

    Objective

    To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers.

    Methods

    A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues.

    Results

    Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults.Moreover, adolescents withmore than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy.

    Conclusion

    There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.

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