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Original Article
Validation of the Six-item Female Sexual Function Index in Middle-Aged Brazilian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):432-439
08-15-2019
Summary
Original ArticleValidation of the Six-item Female Sexual Function Index in Middle-Aged Brazilian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):432-439
08-15-2019Views191See moreAbstract
Objective
To validate the six-item female sexual function index (FSFI-6) in middleaged Brazilian women.
Methods
Cross-sectional observational study, involving 737 (premenopausal n = 117, perimenopausal n = 249, postmenopausal n = 371) Brazilian sexually active women, aged between 40 and 55 years, not using hormonal contraceptive methods. The Brazilian FSFI-6 was developed from the translation and cultural adaptation of the Portuguese FSFI-6 version. The participants completed a general questionnaire, the FSFI-6, and the menopause rating scale (MRS). The validation was performed by AMOS 16.0 software (SPSS, Inc., Chicago, IL, USA) for a confirmatory factor analysis (CFA). The chi-square of degrees of freedom (χ2/df), the comparative fit index (CFI), the Tucker- Lewis index (TLI) and the root-mean-square error of approximation (RMSEA) were used as indices of goodness of fit. Cronbach α coefficient was used for internal consistency.
Results
The process of cultural adaptation has not altered the Brazilian FSFI-6, as compared with the original content. The CFA for the FSFI-6 score showed an acceptable fit (χ2/df = 3.434, CFI = 0.990, TLI = 0.980, RMSEA = 0.058, 90% confidence interval (90%CI) = 0.033-0.083, p ≤ 0.001) and a good reliability was established in FSFI-6 and MRS (Cronbach α = 0.840 and = 0.854, respectively). In addition, 53.5% of the sample had low sexual function.
Conclusion
The FSFI-6 was translated and adapted to the Brazilian culture and is a consistent and reliable tool for female sexual dysfunction screening in Brazilianmiddleaged women.
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Original Article
Ovarian Sertoli-Leydig Cell Tumors: Epidemiological, Clinical and Prognostic Factors
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):440-448
08-15-2019
Summary
Original ArticleOvarian Sertoli-Leydig Cell Tumors: Epidemiological, Clinical and Prognostic Factors
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):440-448
08-15-2019Views132See moreAbstract
Objective
To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs).
Methods
Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017.
Results
The median age of the patients was 31 years old (15-71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presentedwith virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138-569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1-11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0-2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7-3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1-147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2-23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation ofGynecology andObstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of themunderwent 3 cycles of paclitaxel and carboplatin every 21days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred.
Conclusion
Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.
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Original Article
Is the Expression of the Components of the Carotid Matrix of Rats Influenced by Estrogen, Progestin and Tibolone?
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):449-453
08-15-2019
Summary
Original ArticleIs the Expression of the Components of the Carotid Matrix of Rats Influenced by Estrogen, Progestin and Tibolone?
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):449-453
08-15-2019Views93See moreAbstract
Objective
To analyze the effects of estrogen alone or in combination with progestogens and tibolone (TIB) on the expression of the extracellular matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9), of perlecan, and of heparanase (HPSE) of the vascular walls of the carotid arteries.
Methods
A total of 30 250-day-old ovariectomized Wistar rats were orally treated for 5 weeks with: a) 1 mg/kg of estradiol benzoate (EB); b) EB + 0.2 mg/kg of medroxyprogesterone acetate (MPA); c) EB + 0.2mg/kg of norethisterone acetate (NETA); d) EB + 2 mg/kg of dydrogesterone (DI); e) 1 mg/kg of TIB; f) placebo (CTR). Following treatment, the expression of mRNA for MMP-2, MMP-9, and HPSE was analyzed by realtime polymerase chain-reaction (PCR), and the expression of MMP-2, of MMP-9, of tissue inhibitor of metalloproteinase 2 (TIMP-2), and of perlecan was quantified by immunohistochemistry in the carotid arteries.
Results
The groups showed significant differences on mRNA HPSE expression (p = 0.048), which was higher in the EB, EB + MPA, and TIB groups. There was no statistically significant difference in mRNA MMP-2 or MMP-9 expression. The immunohistochemical expression of MMP-2, of TIMP-2, of MMP-9, of HPSE, and of perlecan showed no differences between groups.
Conclusion
Estradiol alone or associated with MPA and TIB treatment can increase mRNA HSPE expression of the walls of the carotid arteries in ovariectomized rats.
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Original Article
Pregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):419-424
08-15-2019
Summary
Original ArticlePregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):419-424
08-15-2019Views118See moreAbstract
Objective
To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil.
Methods
Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, andmaternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum.
Results
A total of 22 women had at least 1 pregnancy during the considered timeinterval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3months. Themost frequent complication during pregnancywas hypertension, which affected 11 (64.7%)women. The gestational age at delivery was 34.7 ± 4weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy.
Conclusion
Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.
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Original Article
Assessment of Polymorphismof the VDR Gene and Serum Vitamin D Values in Gestational Diabetes Mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):425-431
08-15-2019
Summary
Original ArticleAssessment of Polymorphismof the VDR Gene and Serum Vitamin D Values in Gestational Diabetes Mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):425-431
08-15-2019Views108See moreAbstract
Objective
To evaluate the relationship between vitamin D receptor (VDR) gene polymorphism (FokI [rs10735810]) and serum vitamin D concentration in gestational diabetes mellitus (GDM).
Methods
A prospective case-control study that recruited healthy pregnant women (control group) (n = 78) and women with GDM (GDM group) (n = 79), with no other comorbidities. Peripheral blood samples were collected in the 3rd trimester of gestation, and all of the pregnant women were followed-up until the end of the pregnancy and the postpartum period. Serum vitamin D concentrations were measured by high-performance liquid chromatography (HPLC). For genomic polymorphism analysis, the genomic DNA was extracted by the dodecyltrimethylammonium bromide/ cetyltrimethylammonium bromide (DTAB/CTAB) method, and genotyping was performed by the polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) technique, using the restriction enzyme FokI. The Student-t, Mann- Whitney, chi-squared, and Fischer exact tests were used for the analysis of the results.
Results
There was no significant difference between the pregnant women in the control and GDM groups regarding serumvitamin D levels (17.60 ± 8.89 ng/mL versus 23.60 ± 10.68 ng/mL; p = 0.1). Also, no significant difference was detected between the FokI genotypic frequency when the 2 groups were compared with each other (p = 0.41).
Conclusion
There was no association between the FokI polymorphism and the development of GDM, nor was there any change in serum vitamin D levels in patients with GDM.
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Original Article
Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):363-370
07-22-2019
Summary
Original ArticleFactors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):363-370
07-22-2019Views167See moreAbstract
Objective
To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil.
Methods
A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016.
Results
During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth.
Conclusion
Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.
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Original Article
Content and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Crossculturally Adapted to Brazilian Portuguese
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):371-378
07-22-2019
Summary
Original ArticleContent and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Crossculturally Adapted to Brazilian Portuguese
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):371-378
07-22-2019Views127See moreAbstract
Objective
The aim of this study was to determine the content and face validity of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) questionnaire cross-culturally adapted to Brazilian Portuguese.
Methods
The MCSRS is a questionnaire with 34 items related to childbirth satisfaction. The forward- and back-translated versions were compared with the original material, and 10 experts analyzed each item according to the following criteria: clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 10 mothers for face validation to ensure the questionnaire would suit the target population.
Results
The total of 34 items assessed by experts for clarity, semantic equivalence, appropriateness, and relevance showed positive agreement of 0.85, 0.92, 0.97 and 0.97; negative agreement of 0.13, 0.09, 0.04 and 0.04; and total agreement of 0.75; 0.85, 0.94 and 0.94, respectively. Multilevel linear modeling was applied with crossed random effects and with nested random effects for each judge. The intercept of each criterion was as follows: clarity, 0.87; semantic equivalence, 0.92; appropriateness, 0.96; and cultural relevance, 0.96. The overall mean of agreement was 92.8%. The face validity measurement yielded 80% of agreement on the items, all of them clearly understood.
Conclusion
The final version of the Brazilian Portuguese MCSRS questionnaire had face and content validity confirmed. This instrument of evaluation of maternal satisfaction during childbirth was validated to be applied in the Brazilian female population.
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Original Article
Lessons from the Field Beyond the Numbers: Narratives of Professionals on Women who Experienced Severe Maternal Morbidity
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):379-386
07-22-2019
Summary
Original ArticleLessons from the Field Beyond the Numbers: Narratives of Professionals on Women who Experienced Severe Maternal Morbidity
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):379-386
07-22-2019Views218See moreAbstract
Objective
Several factors might affect the health and the quality of life of women who had a severe maternal morbidity (SMM) or a maternal near-miss (MNM) episode. The objective of the present study was to explore the perspectives of the professionals on the repercussions of SMM or of MNM after interviewing women who survived such episodes.
Method
Selected cases that captured the attention of professionals were reported. The professionals built individually 10 narratives, which were analyzed with the technique of content analysis.
Results
According to the perspectives of the professionals, women surviving a severe maternal condition and their families experienced clinical and psychosocial consequences. Some cases portrayed the intense psychological distress in mourning for the loss of the fetus or of their reproductive capacity and changes in family dynamics generating emotional overload, depression, and gender violence.
Conclusion
The analysis of narratives may offer an idea on the complexity of the perception of care by professionals and on the need for an interdisciplinary follow-up of women surviving an SMM or an MNM episode.