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Original Article11-15-2021
Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):588-594
Abstract
Original ArticlePerineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):588-594
Views141See moreAbstract
Objective
In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events.
Methodology
A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p<0.05 were considered significant.
Results
In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the “hands-off” method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them.
Conclusion
Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.
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Original Article11-15-2021
COVID-19 in Pregnancy: Implication on Platelets and Blood Indices
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):595-599
Abstract
Original ArticleCOVID-19 in Pregnancy: Implication on Platelets and Blood Indices
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):595-599
Views170See moreAbstract
Objective
To describe the hematological changes, the platelet indices in particular, in pregnant women with coronavirus disease 2019 (COVID-19) compared to healthy pregnant women.
Methods
A retrospective case-control study conducted at the Al Yarmouk Teaching Hospital, in Baghdad, Iraq, involving 100 pregnant women, 50 with positive viral DNA for COVID-19 (case group), and 50 with negative results (control group); both groups were subjected to a thorough hematological evaluation.
Results
Among the main hematological variables analyzed, the platelet indices, namely the mean platelet volume (MPV) and the platelet distribution width (PDW), showed statistically significant differences (MPV: 10.87±66.92 fL for the case group versus 9.84±1.2 fL for the control group; PDW: 14.82±3.18 fL for the case group versus 13.3±2.16 fL for the controls). The criterionvalue of the receiver operating characteristic (ROC) curve forPDWat a cutoffpoint of>11.8 fL showed a weak diagnostic marker, while the MPV at a cutoff value of>10.17 fL showed a good diagnostic marker.
Conclusion
The MPV and PDW are significantly affected by the this viral infection, even in asymptomatic confirmed cases, and we recommend that both parameters be included in the diagnostic panel of this infection.
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Original Article11-15-2021
Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):600-607
Abstract
Original ArticleConcordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):600-607
Views200See moreAbstract
Objective
To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota.
Methods
Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis.
Results
Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests.
Conclusion
The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.
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Original Article11-15-2021
Hereditary Breast and Ovarian Cancer Screening Syndrome Profile in Women Diagnosed with Breast Cancer from Paraná State Southwest
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):616-621
Abstract
Original ArticleHereditary Breast and Ovarian Cancer Screening Syndrome Profile in Women Diagnosed with Breast Cancer from Paraná State Southwest
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):616-621
Views180See moreAbstract
Objective
This study evaluated the risk of the hereditary breast and ovarian cancer (HBOC) syndrome in patients with breast cancer by using the Family History Screening 7 (FHS-7) tool, a validated low-cost questionnaire with high sensitivity able to screen the HBOC risk in the population.
Methods
Women diagnosed with breast cancer (n=101) assisted by the Unified Health System at the 8th Regional Health Municipal Office of the state of Paraná answered the FHS-7, and the results were analyzed using IBM SPSS Statistics for Windows, Version 25.0. software (IBM Corp., Armonk, NY, USA).
Results
The risk of HBOC was 19.80% (n=20). Patients at risk exhibited aggressive tumor characteristics, such as high-grade tumors (30%), presence of angiolymphatic emboli (35%), and premenopausal at diagnosis (50%). Significant associations between the prevalence of high-grade tumors were observed inwomen younger than 50 years at diagnosis with HBOC (p=0.003).
Conclusion
Our findings suggest a possible family inheritance associated with worse clinical features in women with breast cancer in this population, indicating that HBOC investigation can be initially performed with low-cost instruments such as FHS-7.
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Original Article11-15-2021
Training Preceptors of Obstetrics-Gynecology Residents through the One-minute Preceptor Model
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):622-626
Abstract
Original ArticleTraining Preceptors of Obstetrics-Gynecology Residents through the One-minute Preceptor Model
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):622-626
Views192See moreAbstract
Objective
To analyze the effect of the One-minute Preceptor model for preceptors who work at the emergency department of a maternity teaching hospital.
Methods
A quantitative intervention study conducted with Obstetrics and Gynecology residency preceptors at amaternity teaching hospital in northeastern Brazil. Three stages were performed: 1) a preintervention survey with the residents; 2) planning and execution of a pedagogical training course for the preceptors, which involved a lecture and a dramatization about the One-Minute Preceptor model; and 3) thirty days after the intervention, the residents answered another survey about the model and its repercussions and advantages.
Results
The preintervention assessment with the residents showed that 91.7% agreed that there were discrepancies regarding the teaching model among the preceptors. After the training, all preceptors agreed that the model engages the student in the decision-making process, and that they would apply it to their routine. The postintervention results showed that 95.8% agreed that themodel ismore inviting than traditional teaching approaches. There was a perception of improvement in learning among 70.9% of the residents. In addition, the present study found a significant change in feedback before and after implementing the model, from 20.8% to 66.7%.
Conclusion
The training course of preceptors in the One-Minute Preceptor model proved to be efficient in providing formative feedback to residents in the emergency department of a maternity school. Further studies are needed to assess the consolidation of the methodology in the long term.
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Original Article10-18-2021
Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):507-512
Abstract
Original ArticleFactors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):507-512
Views191See moreAbstract
Objective
To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish).
Methods
A cross-sectional study withwomen who underwent abortion due to any cause and in any age group at UNICAMP Women’s Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann-Whitney test, and multiple logistic regression were used for the statistical analysis.
Results
Overall, 305 women were enrolled (mean±standard deviation [SD] for age: 29.79±7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71).
Conclusion
Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.
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Original Article10-18-2021
Effectiveness of Counseling Based on Functional Analytic Psychotherapy with Enhanced Cognitive Therapy on the Sexual Quality of Life of Married Adolescent Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):513-521
Abstract
Original ArticleEffectiveness of Counseling Based on Functional Analytic Psychotherapy with Enhanced Cognitive Therapy on the Sexual Quality of Life of Married Adolescent Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):513-521
Views160Abstract
Objective
Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women.
Methods
This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECTwas conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group.
Results
The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33±23.09) and after (88.08±10.51) counseling in the intervention group (p<0.0001). According to the analysis of covariance, there was a significant difference between the score on sexual quality after counseling between the intervention (88.08±10.51) and control (60.32±23.73) groups (p<0.0001). There was also a significant difference between the mean score on the four dimensions of sexual quality of life in the intervention group (p<0.0001).
Conclusion
The results showed that counseling based on FECT improved the sexual quality of life in all dimensions in married adolescent women.
Key-words Adolescentscognitive behavioral therapy (CBT)functional analytical psychotherapy (FAP)married womensexual quality of lifeSee more -
Original Article10-18-2021
Sexual Function and Associated Factors in Postmenopausal Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):522-529
Abstract
Original ArticleSexual Function and Associated Factors in Postmenopausal Women
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):522-529
Views228See moreAbstract
Objective
To assess the sexual function and associated factors in postmenopausal women.
Methods
This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate andmultiple analyses by logistic regression were performed, with adjusted odds ratios (ORad) and 95% confidence intervals (95%CIs).
Results
More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (ORad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (ORad 2.72; 95%CI 1.77-4.19), depressed mood (ORad 2.03; 95%CI 1.32-3.10), sexual complaints (ORad 8.16; 95%CI 5.06-13.15), and vaginal dryness (ORad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction.
Conclusion
There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.