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Original Article
Trends Associated with Stillbirth in a Maternity Hospital School in the North Zone of São Paulo: A Cross-Sectional Study
- Raissa Magalhães de Mendonça Fonseca,
- Carolina Laila Garcia,
- Talita Sampaio Angimahtz,
- Cindy Fazio Battaglia1,
- Elisa Chalem, [ ... ],
- Nelson Sass
11-07-2019
Summary
Original ArticleTrends Associated with Stillbirth in a Maternity Hospital School in the North Zone of São Paulo: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):597-606
11-07-2019- Raissa Magalhães de Mendonça Fonseca,
- Carolina Laila Garcia,
- Talita Sampaio Angimahtz,
- Cindy Fazio Battaglia1,
- Elisa Chalem,
- Nelson Sass
Views159See moreAbstract
Objective
To evaluate conditions associated with stillbirth (SB), and possible trends related with it, in a maternity hospital school in the North zone of São Paulo.
Methods
An observational, cross-sectional study conducted at the Hospital Maternidade- escola de Vila Nova Cachoeirinha with 1,139 SBs in the period of 2003 to 2017. Cases of intermediate SB (ISB) (weight between 500 and 999 g) and late SB (LSB) (weight ≥ 1,000 g) were compared. We evaluated clinical data, laboratory tests, and fetal and placental studies. Data were stored in Windows Excel (Microsoft Corp., Redmond, WA, USA) worksheets, according to which graphs and tables were constructed. We used the statistical software SPSS for Windows version 18.0 (SPSS In., Chicago, IL, USA), estimating the prevalence ratio (PR) and odds ratio (OR), considering the 95% confidence interval (95% CI).
Results
The general SB rate was 11.9%, and the in-hospital SB rate was 2.8%. Pregnant women younger than 16 years of age were more likely to have ISB (OR 0.32, 0.15- 0.76), while patients older than 40 years old had a higher chance of LSB (PR 0.85, 0.72- 0.99). A total of 25.7% of the general population did not have prenatal care, and 77.1% of the cases presented fetal death at admission. The cases of ISB had a statistically significant association with home birth (OR 0.61, 0.46-0.80). Cesarean section was performed in 16.1% of the subjects, and misoprostol was the most used method for induction. Necropsy and placental study of the fetuses were performed, respectively, in 94.2% and 97.3% of the cases. Associated causes were not identified in 22.1% of the cases, and the main causes identified were amniotic sac infections (27.9%), fetal malformations (12.5%), placental abruption (11.2%), hypertensive syndromes (8.5%), and maternal syphilis (3.9%), the latter with an increasing trend.
Conclusion
Among the factors associated to SB were: hypertensive syndromes, amniotic sac infections, fetal malformations, placental abruption and syphilis. There was a growing trend in the number of cases of syphilis, which translates an alert. Diagnostic limitations justify indeterminate causes.
Views159
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleTrends Associated with Stillbirth in a Maternity Hospital School in the North Zone of São Paulo: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):597-606
11-07-2019- Raissa Magalhães de Mendonça Fonseca,
- Carolina Laila Garcia,
- Talita Sampaio Angimahtz,
- Cindy Fazio Battaglia1,
- Elisa Chalem,
- Nelson Sass
Views159See moreAbstract
Objective
To evaluate conditions associated with stillbirth (SB), and possible trends related with it, in a maternity hospital school in the North zone of São Paulo.
Methods
An observational, cross-sectional study conducted at the Hospital Maternidade- escola de Vila Nova Cachoeirinha with 1,139 SBs in the period of 2003 to 2017. Cases of intermediate SB (ISB) (weight between 500 and 999 g) and late SB (LSB) (weight ≥ 1,000 g) were compared. We evaluated clinical data, laboratory tests, and fetal and placental studies. Data were stored in Windows Excel (Microsoft Corp., Redmond, WA, USA) worksheets, according to which graphs and tables were constructed. We used the statistical software SPSS for Windows version 18.0 (SPSS In., Chicago, IL, USA), estimating the prevalence ratio (PR) and odds ratio (OR), considering the 95% confidence interval (95% CI).
Results
The general SB rate was 11.9%, and the in-hospital SB rate was 2.8%. Pregnant women younger than 16 years of age were more likely to have ISB (OR 0.32, 0.15- 0.76), while patients older than 40 years old had a higher chance of LSB (PR 0.85, 0.72- 0.99). A total of 25.7% of the general population did not have prenatal care, and 77.1% of the cases presented fetal death at admission. The cases of ISB had a statistically significant association with home birth (OR 0.61, 0.46-0.80). Cesarean section was performed in 16.1% of the subjects, and misoprostol was the most used method for induction. Necropsy and placental study of the fetuses were performed, respectively, in 94.2% and 97.3% of the cases. Associated causes were not identified in 22.1% of the cases, and the main causes identified were amniotic sac infections (27.9%), fetal malformations (12.5%), placental abruption (11.2%), hypertensive syndromes (8.5%), and maternal syphilis (3.9%), the latter with an increasing trend.
Conclusion
Among the factors associated to SB were: hypertensive syndromes, amniotic sac infections, fetal malformations, placental abruption and syphilis. There was a growing trend in the number of cases of syphilis, which translates an alert. Diagnostic limitations justify indeterminate causes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):607-612
11-07-2019
Summary
Original ArticleEmpowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):607-612
11-07-2019Views148Abstract
Objective
Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers.
Methods
Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The datawas compared with previous series followed in a period before the implementation of the education group - a historical control group.
Results
We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%).When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs.
Conclusion
Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.
Key-words Adolescentantenatal educationContraceptionlong-acting reversible contraceptionPostpartum periodSee moreViews148This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleEmpowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):607-612
11-07-2019Views148Abstract
Objective
Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers.
Methods
Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The datawas compared with previous series followed in a period before the implementation of the education group - a historical control group.
Results
We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%).When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs.
Conclusion
Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.
Key-words Adolescentantenatal educationContraceptionlong-acting reversible contraceptionPostpartum periodSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Attitudes and Personal Attributes Regarding Patient Receptivity towards the Participation of Medical Students in Gynecological Consultations: A Cross-Sectional Study
- Miriam da Silva Wanderley ,
- Dejano Tavares Sobral,
- Brenda Alves de Oliveira Lima,
- Maria Elisa de Bessa Freire,
- Mariana Albuquerque Campos da Silva, [ ... ],
- Thaís Ferreira Souza
11-07-2019
Summary
Original ArticleAttitudes and Personal Attributes Regarding Patient Receptivity towards the Participation of Medical Students in Gynecological Consultations: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):613-620
11-07-2019- Miriam da Silva Wanderley ,
- Dejano Tavares Sobral,
- Brenda Alves de Oliveira Lima,
- Maria Elisa de Bessa Freire,
- Mariana Albuquerque Campos da Silva,
- Marina Prado e Silva Gonçalves Rosa,
- Thaís Ferreira Souza
Views165See moreAbstract
Objective
To evaluate the association between the acceptance on the part of the patients and their reasons to consent to or refuse medical student attendance during gynecological outpatient care, considering the participants’ demographic characteristics, consultation experience, and gender bias or lack thereof.
Methods
Face-to-face interviews with patients waiting for gynecological consultations that had been scheduled in advance at Hospital Universitário de Brasília. Contingency analyses were used to determine the levels of association among the patient variables. The accepted significance level was values of p<0.05.
Results
We interviewed 469 patients. The comfort level with the presence of a student was strongly related to the number of students present during the consultation (Cramér V=0.671). The inclination to grant consent (a series of reasons to consent to or refuse student attendance) was significantly related (p<0.001) to the overall receptivity to student participation (ρ=0.482), the positive appraisal of student-doctor demeanor in previous consultations (ρ=0.253, N=408), and to greater levels of schooling (ρ=0.158). The patients’ receptivity was significantly related (p<0.001) to the lack of bias regarding the gender of the physician (CramérV=0.388), previous experience with students (Cramér V=0.235) and awareness of the fact that they would be present (Cramér V=0.217), older age (ρ=0.136, p=0.003), and multiparity (ρ=0.102, p=0.027).
Conclusion
Greater receptivity to student participation related significantly to five conditions in decreasing order of strength of association: lack of bias regarding the gender of the Ob-Gyn, previous experience with student involvement, awareness of the presence of students, older age, and multiparity. We also found that a more positive inclination to consent to student attendance correlated positively with a greater receptivity to student participation and to a suitable student-doctor demeanor.
Views165This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleAttitudes and Personal Attributes Regarding Patient Receptivity towards the Participation of Medical Students in Gynecological Consultations: A Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):613-620
11-07-2019- Miriam da Silva Wanderley ,
- Dejano Tavares Sobral,
- Brenda Alves de Oliveira Lima,
- Maria Elisa de Bessa Freire,
- Mariana Albuquerque Campos da Silva,
- Marina Prado e Silva Gonçalves Rosa,
- Thaís Ferreira Souza
Views165See moreAbstract
Objective
To evaluate the association between the acceptance on the part of the patients and their reasons to consent to or refuse medical student attendance during gynecological outpatient care, considering the participants’ demographic characteristics, consultation experience, and gender bias or lack thereof.
Methods
Face-to-face interviews with patients waiting for gynecological consultations that had been scheduled in advance at Hospital Universitário de Brasília. Contingency analyses were used to determine the levels of association among the patient variables. The accepted significance level was values of p<0.05.
Results
We interviewed 469 patients. The comfort level with the presence of a student was strongly related to the number of students present during the consultation (Cramér V=0.671). The inclination to grant consent (a series of reasons to consent to or refuse student attendance) was significantly related (p<0.001) to the overall receptivity to student participation (ρ=0.482), the positive appraisal of student-doctor demeanor in previous consultations (ρ=0.253, N=408), and to greater levels of schooling (ρ=0.158). The patients’ receptivity was significantly related (p<0.001) to the lack of bias regarding the gender of the physician (CramérV=0.388), previous experience with students (Cramér V=0.235) and awareness of the fact that they would be present (Cramér V=0.217), older age (ρ=0.136, p=0.003), and multiparity (ρ=0.102, p=0.027).
Conclusion
Greater receptivity to student participation related significantly to five conditions in decreasing order of strength of association: lack of bias regarding the gender of the Ob-Gyn, previous experience with student involvement, awareness of the presence of students, older age, and multiparity. We also found that a more positive inclination to consent to student attendance correlated positively with a greater receptivity to student participation and to a suitable student-doctor demeanor.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Miriam da Silva Wanderley
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Original Article
Progesterone’s Serum Level and a New Ultrasonographic Parameter in the First Trimester Pregnancy – Prognostic Factors for Embryonic Demise
- Carmen Elena Bucuri ,
- Razvan Ciortea,
- Andrei Mihai Malutan,
- Costin Berceanu,
- Maria Patricia Rada, [ ... ],
- Dan Mihu
09-30-2019
Summary
Original ArticleProgesterone’s Serum Level and a New Ultrasonographic Parameter in the First Trimester Pregnancy – Prognostic Factors for Embryonic Demise
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):525-530
09-30-2019- Carmen Elena Bucuri ,
- Razvan Ciortea,
- Andrei Mihai Malutan,
- Costin Berceanu,
- Maria Patricia Rada,
- Dan Mihu
Views164See moreAbstract
Objective
The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). The purpose of the present study is to evaluate the correlation between a serum biomarker, progesterone, and an ultrasonographic parameter, the distance between yolk sac and embryo (DYSE) in assessing the prognosis of pregnancy outcome in the 1st trimester.
Methods
The present study is a prospective case-control analysis that includes 2 groups of patients: 81 patients with first-trimester normal evolutive pregnancy and 89 patients with embryonic demise, all of the patients having between 6 and 11 weeks of amenorrhea. Endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20ml of blood was collected for progesterone serum level measurement.
Results
Regarding the DYSE in the case group, lower values were observed compared with the control group, the difference being statistically significant. In the statistical analysis of serum progesterone values, statistically significant differences were observed between the 2 groups (p<0.05).
Conclusion
The DYSE has a high positive predictive value in identifying pregnancies with potentially reserved outcome, with the present study demonstrating that a DYSE<3mm causes an unfavorable evolution of the pregnancy. Low serum levels of progesterone are associated with an increased rate of nonviable embryos. The correlation between these two parameters increases the effectiveness of screening methods in prenatal monitoring and improves the diagnostic methods for the firsttrimester pregnancies whose outcome potential can be reserved.
Views164This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleProgesterone’s Serum Level and a New Ultrasonographic Parameter in the First Trimester Pregnancy – Prognostic Factors for Embryonic Demise
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):525-530
09-30-2019- Carmen Elena Bucuri ,
- Razvan Ciortea,
- Andrei Mihai Malutan,
- Costin Berceanu,
- Maria Patricia Rada,
- Dan Mihu
Views164See moreAbstract
Objective
The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). The purpose of the present study is to evaluate the correlation between a serum biomarker, progesterone, and an ultrasonographic parameter, the distance between yolk sac and embryo (DYSE) in assessing the prognosis of pregnancy outcome in the 1st trimester.
Methods
The present study is a prospective case-control analysis that includes 2 groups of patients: 81 patients with first-trimester normal evolutive pregnancy and 89 patients with embryonic demise, all of the patients having between 6 and 11 weeks of amenorrhea. Endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20ml of blood was collected for progesterone serum level measurement.
Results
Regarding the DYSE in the case group, lower values were observed compared with the control group, the difference being statistically significant. In the statistical analysis of serum progesterone values, statistically significant differences were observed between the 2 groups (p<0.05).
Conclusion
The DYSE has a high positive predictive value in identifying pregnancies with potentially reserved outcome, with the present study demonstrating that a DYSE<3mm causes an unfavorable evolution of the pregnancy. Low serum levels of progesterone are associated with an increased rate of nonviable embryos. The correlation between these two parameters increases the effectiveness of screening methods in prenatal monitoring and improves the diagnostic methods for the firsttrimester pregnancies whose outcome potential can be reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Carmen Elena Bucuri
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Original Article
Is Moderate Intensity Exercise during Pregnancy Safe for the Fetus? An Open Clinical Trial
- Adriana Suely Oliveira Melo,
- João Luiz Pinto e Silva,
- Fabiana de Oliveira Melo,
- Emanuela Santos Barros,
- Hugo Leonardo Santos, [ ... ],
- Alex Sandro Rolland Souza
09-30-2019
Summary
Original ArticleIs Moderate Intensity Exercise during Pregnancy Safe for the Fetus? An Open Clinical Trial
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):531-538
09-30-2019- Adriana Suely Oliveira Melo,
- João Luiz Pinto e Silva,
- Fabiana de Oliveira Melo,
- Emanuela Santos Barros,
- Hugo Leonardo Santos,
- Melania Maria Ramos Amorim,
- Alex Sandro Rolland Souza
Views184See moreAbstract
Objective
To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks.
Methods
A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery).
Results
The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p<0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p<0.001) and 7.6, 10.8 and 7.6 bpm (p=0.002) in the resting, walking and recovery phases, respectively. Themean number of fetalmovements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p<0.001). In overweight/obese women, the mean FHR was lower (p=0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk).
Conclusion
In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.
Views184This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleIs Moderate Intensity Exercise during Pregnancy Safe for the Fetus? An Open Clinical Trial
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):531-538
09-30-2019- Adriana Suely Oliveira Melo,
- João Luiz Pinto e Silva,
- Fabiana de Oliveira Melo,
- Emanuela Santos Barros,
- Hugo Leonardo Santos,
- Melania Maria Ramos Amorim,
- Alex Sandro Rolland Souza
Views184See moreAbstract
Objective
To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks.
Methods
A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery).
Results
The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p<0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p<0.001) and 7.6, 10.8 and 7.6 bpm (p=0.002) in the resting, walking and recovery phases, respectively. Themean number of fetalmovements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p<0.001). In overweight/obese women, the mean FHR was lower (p=0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk).
Conclusion
In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Follow-up of Toxoplasmosis during Pregnancy: Ten-Year Experience in a University Hospital in Southern Brazil
- Amanda Andrade Diesel,
- Suzana de Azevedo Zachia,
- Ana Lúcia Letti Müller ,
- Amanda Vilaverde Perez,
- Flavio Antonio de Freitas Uberti, [ ... ],
- José Antônio de Azevedo Magalhães
09-30-2019
Summary
Original ArticleFollow-up of Toxoplasmosis during Pregnancy: Ten-Year Experience in a University Hospital in Southern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):539-547
09-30-2019- Amanda Andrade Diesel,
- Suzana de Azevedo Zachia,
- Ana Lúcia Letti Müller ,
- Amanda Vilaverde Perez,
- Flavio Antonio de Freitas Uberti,
- José Antônio de Azevedo Magalhães
Views191See moreAbstract
Objective
To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up.
Methods
Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded.
Results
A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications.
Conclusions
The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.
Views191This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleFollow-up of Toxoplasmosis during Pregnancy: Ten-Year Experience in a University Hospital in Southern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):539-547
09-30-2019- Amanda Andrade Diesel,
- Suzana de Azevedo Zachia,
- Ana Lúcia Letti Müller ,
- Amanda Vilaverde Perez,
- Flavio Antonio de Freitas Uberti,
- José Antônio de Azevedo Magalhães
Views191See moreAbstract
Objective
To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up.
Methods
Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded.
Results
A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications.
Conclusions
The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Quality of Life Assessment by the Endometriosis Health Profile (EHP-30) Questionnaire Prior to Treatment for Ovarian Endometriosis in Brazilian Women
- André Vinícius de Assis Florentino ,
- Ana Maria Gomes Pereira,
- João Alfredo Martins,
- Reginaldo Guedes Coelho Lopes,
- Raquel Martins Arruda
09-30-2019
Summary
Original ArticleQuality of Life Assessment by the Endometriosis Health Profile (EHP-30) Questionnaire Prior to Treatment for Ovarian Endometriosis in Brazilian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):548-554
09-30-2019- André Vinícius de Assis Florentino ,
- Ana Maria Gomes Pereira,
- João Alfredo Martins,
- Reginaldo Guedes Coelho Lopes,
- Raquel Martins Arruda
Views182See moreAbstract
Objective
To evaluate the existence of an association between ultrasound findings and epidemiological and clinical factors using results obtained from the EHP-30 questionnaire in women with ovarian endometriosis.
Methods
A cross-sectional observational study was performed between July 2012 and May 2015, in which patients with chronic pelvic pain suggestive of endometrioma, as indicated by the results from a transvaginal pelvic ultrasonography, completed the standardized Endometriosis Health Profile - 30 (EHP-30) questionnaire to access quality-of-life scores before beginning treatment for endometriosis. A total of 65 patients were included. The data was analyzed in the statistical program IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) for the comparison of data through linear multiple regression.
Results
The suitability of the linear regression model was confirmed by the histogram of the dependent variable and the residue distribution plot, confirming the trend of linearity as well as the homogeneous dispersion of the residues. The mean age of the patients was 39.7 ± 7.1 years old. Themajority was Caucasian (64.5%), had completed higher education (56.5%) and was nulligravida (40.3%). Infertility was present in 48.4% of the patients studied. Out of the total sample, 80.6% of the cases were symptomatic and complained mainly of acyclic pain, 79% of dysmenorrhea, and 61.3% of dyspareunia. This reflects the negative influence of endometriosis on the quality of life of patients with this disease.
Conclusion
Dyspareunia and acyclic pain were independent factors of correlation with high scores in the EHP-30 questionnaire, reflecting a worse quality of life.
Views182This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleQuality of Life Assessment by the Endometriosis Health Profile (EHP-30) Questionnaire Prior to Treatment for Ovarian Endometriosis in Brazilian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):548-554
09-30-2019- André Vinícius de Assis Florentino ,
- Ana Maria Gomes Pereira,
- João Alfredo Martins,
- Reginaldo Guedes Coelho Lopes,
- Raquel Martins Arruda
Views182See moreAbstract
Objective
To evaluate the existence of an association between ultrasound findings and epidemiological and clinical factors using results obtained from the EHP-30 questionnaire in women with ovarian endometriosis.
Methods
A cross-sectional observational study was performed between July 2012 and May 2015, in which patients with chronic pelvic pain suggestive of endometrioma, as indicated by the results from a transvaginal pelvic ultrasonography, completed the standardized Endometriosis Health Profile - 30 (EHP-30) questionnaire to access quality-of-life scores before beginning treatment for endometriosis. A total of 65 patients were included. The data was analyzed in the statistical program IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) for the comparison of data through linear multiple regression.
Results
The suitability of the linear regression model was confirmed by the histogram of the dependent variable and the residue distribution plot, confirming the trend of linearity as well as the homogeneous dispersion of the residues. The mean age of the patients was 39.7 ± 7.1 years old. Themajority was Caucasian (64.5%), had completed higher education (56.5%) and was nulligravida (40.3%). Infertility was present in 48.4% of the patients studied. Out of the total sample, 80.6% of the cases were symptomatic and complained mainly of acyclic pain, 79% of dysmenorrhea, and 61.3% of dyspareunia. This reflects the negative influence of endometriosis on the quality of life of patients with this disease.
Conclusion
Dyspareunia and acyclic pain were independent factors of correlation with high scores in the EHP-30 questionnaire, reflecting a worse quality of life.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
- André Vinícius de Assis Florentino
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Original Article
Prevalence of Sexual Dysfunctions and their Associated Factors in Pregnant Women in an Outpatient Prenatal Care Clinic
- Julianna Azevedo Guendler ,
- Leila Katz,
- Maria Eduarda Duarte Mello Flamini,
- Andrea Lemos,
- Melania Maria Amorim
09-30-2019
Summary
Original ArticlePrevalence of Sexual Dysfunctions and their Associated Factors in Pregnant Women in an Outpatient Prenatal Care Clinic
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):555-563
09-30-2019- Julianna Azevedo Guendler ,
- Leila Katz,
- Maria Eduarda Duarte Mello Flamini,
- Andrea Lemos,
- Melania Maria Amorim
Views177See moreAbstract
Objective
To determine the prevalence of sexual dysfunction and its associated factors in pregnant women.
Methods
A descriptive, cross-sectional study including 262 pregnant women aged 18 years or older with gestational age between 10 and 35 weeks. Women with urinary tract infections and conditions of gestational risk were excluded. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was used. We performed a univariate descriptive analysis, and comparisons between the mean values of the sexual function domains were made using the Student t-test. The chi-squared test was used to determine the association between the independent and dependent variables. The prevalence ratios, with their respective 95% confidence intervals, were also estimated, and a multivariate analysis was performed.
Results
A total of 64.9% of women reported a decrease in the frequency of sexual activity during pregnancy. Slightly more than half of the women (50.8%) were satisfied, and arousal was reported as excellent/good by 30.5% of them. The frequency of sexual difficulties/dysfunctions increased with pregnancy, rising from 5.7% to 58.8%, and pain during sexual intercourse was reported by 45.8% of them. Having higher education degree decreased the chance of being sexually dissatisfied by 50%. The total PSRI score showed a significant decrease from the prepregnancy period (mean score = 89.8, “excellent”) to the pregnancy period (mean score = 59.2, “good”).
Conclusion
The mean sexual function score during pregnancy was classified as good, although most pregnant women reported at least one type of alteration in the sexual function domains, and the report of dissatisfaction was more frequent in women with lower schooling.
Views177This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlePrevalence of Sexual Dysfunctions and their Associated Factors in Pregnant Women in an Outpatient Prenatal Care Clinic
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):555-563
09-30-2019- Julianna Azevedo Guendler ,
- Leila Katz,
- Maria Eduarda Duarte Mello Flamini,
- Andrea Lemos,
- Melania Maria Amorim
Views177See moreAbstract
Objective
To determine the prevalence of sexual dysfunction and its associated factors in pregnant women.
Methods
A descriptive, cross-sectional study including 262 pregnant women aged 18 years or older with gestational age between 10 and 35 weeks. Women with urinary tract infections and conditions of gestational risk were excluded. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was used. We performed a univariate descriptive analysis, and comparisons between the mean values of the sexual function domains were made using the Student t-test. The chi-squared test was used to determine the association between the independent and dependent variables. The prevalence ratios, with their respective 95% confidence intervals, were also estimated, and a multivariate analysis was performed.
Results
A total of 64.9% of women reported a decrease in the frequency of sexual activity during pregnancy. Slightly more than half of the women (50.8%) were satisfied, and arousal was reported as excellent/good by 30.5% of them. The frequency of sexual difficulties/dysfunctions increased with pregnancy, rising from 5.7% to 58.8%, and pain during sexual intercourse was reported by 45.8% of them. Having higher education degree decreased the chance of being sexually dissatisfied by 50%. The total PSRI score showed a significant decrease from the prepregnancy period (mean score = 89.8, “excellent”) to the pregnancy period (mean score = 59.2, “good”).
Conclusion
The mean sexual function score during pregnancy was classified as good, although most pregnant women reported at least one type of alteration in the sexual function domains, and the report of dissatisfaction was more frequent in women with lower schooling.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
- Julianna Azevedo Guendler
Original Article Archives - Page 3 of 55 - Revista Brasileira de Ginecologia e Obstetrícia
