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Original Article
Knowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis inMaternityHospitals in Teresina – PI, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):453-463
09-01-2017
Summary
Original ArticleKnowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis inMaternityHospitals in Teresina – PI, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):453-463
09-01-2017Views130See moreAbstract
Objective
To assess the knowledge and compliance of health professionals regarding the diagnostic and treatment practices for syphilis in patients admitted for childbirth in public maternity hospitals in the city of Teresina, in the state of Piauí, Northeastern Brazil.
Methods
A cross-sectional study was performed in 2015 with obstetricians and nurses working in the public maternity hospitals in Teresina (n = 159) using a selfadministered questionnaire, with 5% of losses and 10% of refusals. The study used 21 evaluation criteria: 13 of them were related to knowledge (5 on serological tests and 8 on treatment adequacy); 8 were related to practices (3 on diagnosis, 4 on treatment, and 1 on post-test counseling). The knowledge of and compliance to the practices was estimated as the proportion of health professionals’ answers that were in agreement with Brazilian Ministry of Health protocols.
Results
The obstetricians were in agreement with twocriteria concerning the knowledge of serological tests, one for diagnostic practices, and one for treatment practice. Among nurses, no single match between actual procedures and guidelines was observed.
Conclusions
Low compliance with the protocols results in missed opportunities for the diagnosis and treatment of pregnant and postpartum women and their partners. Strategies for training and integrating the various professional groups, improved data recording on prenatal cards, and greater accountability of the hospital team in managing the women’s partners are needed to overcome the barriers identified in the study and to interrupt the syphilis transmission chain.
Views130
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 ArticleKnowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis inMaternityHospitals in Teresina – PI, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):453-463
09-01-2017Views130See moreAbstract
Objective
To assess the knowledge and compliance of health professionals regarding the diagnostic and treatment practices for syphilis in patients admitted for childbirth in public maternity hospitals in the city of Teresina, in the state of Piauí, Northeastern Brazil.
Methods
A cross-sectional study was performed in 2015 with obstetricians and nurses working in the public maternity hospitals in Teresina (n = 159) using a selfadministered questionnaire, with 5% of losses and 10% of refusals. The study used 21 evaluation criteria: 13 of them were related to knowledge (5 on serological tests and 8 on treatment adequacy); 8 were related to practices (3 on diagnosis, 4 on treatment, and 1 on post-test counseling). The knowledge of and compliance to the practices was estimated as the proportion of health professionals’ answers that were in agreement with Brazilian Ministry of Health protocols.
Results
The obstetricians were in agreement with twocriteria concerning the knowledge of serological tests, one for diagnostic practices, and one for treatment practice. Among nurses, no single match between actual procedures and guidelines was observed.
Conclusions
Low compliance with the protocols results in missed opportunities for the diagnosis and treatment of pregnant and postpartum women and their partners. Strategies for training and integrating the various professional groups, improved data recording on prenatal cards, and greater accountability of the hospital team in managing the women’s partners are needed to overcome the barriers identified in the study and to interrupt the syphilis transmission chain.
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. -
Original Article
Uterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):464-470
09-01-2017
Summary
Original ArticleUterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):464-470
09-01-2017Views110See moreAbstract
Objective
To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography.
Methods
This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests.
Results
The median uterine volume of the subjects was 556 cm3, while that of the controls was 90.5 cm3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values.
Conclusion
There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.
Views110This 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 ArticleUterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):464-470
09-01-2017Views110See moreAbstract
Objective
To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography.
Methods
This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests.
Results
The median uterine volume of the subjects was 556 cm3, while that of the controls was 90.5 cm3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values.
Conclusion
There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.
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. -
Original Article
Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017
Summary
Original ArticlePelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017Views101See moreAbstract
Objective
Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of midurethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results.
Methods
A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVTO), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons.
Results
Differences among the groups were found in themean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVTS = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVTS = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630).
Conclusions
The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
Views101This 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 ArticlePelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017Views101See moreAbstract
Objective
Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of midurethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results.
Methods
A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVTO), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons.
Results
Differences among the groups were found in themean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVTS = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVTS = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630).
Conclusions
The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
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
Regional and Socioeconomic Differences in the Coverage of the Papanicolau Test in Brazil: Data from the Brazilian Health Survey 2013
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):480-487
09-01-2017
Summary
Original ArticleRegional and Socioeconomic Differences in the Coverage of the Papanicolau Test in Brazil: Data from the Brazilian Health Survey 2013
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):480-487
09-01-2017Views84Abstract
Purpose
To evaluate the coverage of the Papanicolaou test in Brazil and the associated factors.
Methods
Cross-sectional study based on data from the Brazilian Health Survey 2013 comprising the proportion of 25- to 64-year-old women who had undergone a Papanicolaou test within the previous 3 years, categorized by sociodemographic variables and access to healthcare services.
Results
The screening coverage in Brazil was of 79.4% (95% confidence interval [95%CI]: 78.4-80.3), showing significant differences between the different states of the country, with the highest rate in the state of Roraima (86.5; 95%CI: 83.5-89.4), and the lowestone in the state ofMaranhão (67.7; 95%CI: 61.3-74.0).Undergoing the test was significantlymore frequent amongmarriedwomen (83.6%; 95%CI: 82.4-84.8), those with higher educational levels (88.7%; 95%CI: 87.0-90.5), of white ethnicity (82.6%; 95%CI: 81.3-83.9) and who reside in urban areas (80.1%; 95%CI: 79.1-81.2). Those who had undergone the test more than three years prior to the survey and the ones who had never undergone it were associated with a lower level of education, being of black or brown ethnicity, single or divorced, and rural dwellers.
Conclusions
The coverage of cervical cancer screening in Brazil is below the recommended rate and presents regional and sociodemographic disparities.
Key-words cervical neoplasmsearly detection of cancerEpidemiologyinequalities in healthPapanicolaou testWomen's healthSee moreViews84This 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 ArticleRegional and Socioeconomic Differences in the Coverage of the Papanicolau Test in Brazil: Data from the Brazilian Health Survey 2013
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):480-487
09-01-2017Views84Abstract
Purpose
To evaluate the coverage of the Papanicolaou test in Brazil and the associated factors.
Methods
Cross-sectional study based on data from the Brazilian Health Survey 2013 comprising the proportion of 25- to 64-year-old women who had undergone a Papanicolaou test within the previous 3 years, categorized by sociodemographic variables and access to healthcare services.
Results
The screening coverage in Brazil was of 79.4% (95% confidence interval [95%CI]: 78.4-80.3), showing significant differences between the different states of the country, with the highest rate in the state of Roraima (86.5; 95%CI: 83.5-89.4), and the lowestone in the state ofMaranhão (67.7; 95%CI: 61.3-74.0).Undergoing the test was significantlymore frequent amongmarriedwomen (83.6%; 95%CI: 82.4-84.8), those with higher educational levels (88.7%; 95%CI: 87.0-90.5), of white ethnicity (82.6%; 95%CI: 81.3-83.9) and who reside in urban areas (80.1%; 95%CI: 79.1-81.2). Those who had undergone the test more than three years prior to the survey and the ones who had never undergone it were associated with a lower level of education, being of black or brown ethnicity, single or divorced, and rural dwellers.
Conclusions
The coverage of cervical cancer screening in Brazil is below the recommended rate and presents regional and sociodemographic disparities.
Key-words cervical neoplasmsearly detection of cancerEpidemiologyinequalities in healthPapanicolaou testWomen's healthSee 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
The Preference of Women and Men Regarding Female Genital Depilation
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):488-495
09-01-2017
Summary
Original ArticleThe Preference of Women and Men Regarding Female Genital Depilation
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):488-495
09-01-2017Views174See moreAbstract
Purpose
To evaluate the preferences of women and men regarding female pubic hair depilation and identify possible reasons for these preferences.
Methods
This is a cross-sectional study of men and women over 18 years old who were invited by the official blog of our institution to respond anonymously to an online and self-administered questionnairemade by the researchers. The analyses weremade using the Statistical Analysis System (SAS, SAS Inc., Cary, NC, US) software, version 9.3, and contingency tables were used to verify the distribution of variables. The univariate statistical analysis was performed using the Pearson chi-squared test, and the differences for values of p < 0.05 were considered significant.
Results
We obtained data from 69,920 subjects (52,787 women and 17,133 men). Themean age was 31.9 years formen, and 28.5 years for women. Most women (64.3%) and men (62.2%) preferred complete removal of female pubic hair, and this preference wasmore pronounced in younger women andmen. Most women reported performing depilation at home (55.8%), with 44.4% using hot wax and 40.1% using a razor blade. About half of the women (44.7%) and men (50.1%) reported sexual activity, having intercourse 2 to 3 times per week. The frequency of intercourse and sexual satisfaction in women correlated with total pubic hair removal.
Conclusion
Most Brazilian women and men prefer the complete removal of female pubic hair, especially those who are younger andmore sexually active.Women who are satisfied with the appearance of their own genitalia have a stronger preference for complete removal of pubic hair.
Views174This 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 ArticleThe Preference of Women and Men Regarding Female Genital Depilation
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):488-495
09-01-2017Views174See moreAbstract
Purpose
To evaluate the preferences of women and men regarding female pubic hair depilation and identify possible reasons for these preferences.
Methods
This is a cross-sectional study of men and women over 18 years old who were invited by the official blog of our institution to respond anonymously to an online and self-administered questionnairemade by the researchers. The analyses weremade using the Statistical Analysis System (SAS, SAS Inc., Cary, NC, US) software, version 9.3, and contingency tables were used to verify the distribution of variables. The univariate statistical analysis was performed using the Pearson chi-squared test, and the differences for values of p < 0.05 were considered significant.
Results
We obtained data from 69,920 subjects (52,787 women and 17,133 men). Themean age was 31.9 years formen, and 28.5 years for women. Most women (64.3%) and men (62.2%) preferred complete removal of female pubic hair, and this preference wasmore pronounced in younger women andmen. Most women reported performing depilation at home (55.8%), with 44.4% using hot wax and 40.1% using a razor blade. About half of the women (44.7%) and men (50.1%) reported sexual activity, having intercourse 2 to 3 times per week. The frequency of intercourse and sexual satisfaction in women correlated with total pubic hair removal.
Conclusion
Most Brazilian women and men prefer the complete removal of female pubic hair, especially those who are younger andmore sexually active.Women who are satisfied with the appearance of their own genitalia have a stronger preference for complete removal of pubic hair.
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. -
Original Article
Trends in the Prevalence of Live Macrosomic Newborns According to Gestational Age Strata, in Brazil, 2001-2010, and 2012-2014
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):376-383
08-01-2017
Summary
Original ArticleTrends in the Prevalence of Live Macrosomic Newborns According to Gestational Age Strata, in Brazil, 2001-2010, and 2012-2014
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):376-383
08-01-2017Views129See moreAbstract
Purpose
To describe the trends in the prevalence of macrosomia (birth weight ± 4,000 g) according to gestational age in Brazil in the periods of 2001-2010 and 2012-2014.
Methods
Ecological study with data from the Brazilian Live Birth Information System (SINASC, in the Portuguese acronym) regarding singleton live newborns born from 22 gestational weeks. The trends in Brazil as a whole and in each of its five regions were analyzed according to preterm (22-36 gestational weeks) and term (37-42 gestational weeks) strata. Annual Percent Changes (APCs) based on the Prais-Winsten method and their respective 95% confidence intervals (CIs) were used to verify statistically significant changes in 2001-2010.
Results
In Brazil, the prevalence of macrosomic births was of 5.3% (2001-2010) and 5.1% (2012-2014). The rates were systematically higher in the North and Northeast Regions both in the preterm and in term strata. In the preterm stratum, the North Region presented the highest variation in the prevalence of macrosomia (+137.5%) when comparing 2001 (0.8%) to 2010 (1.9%). In the term stratum, downward trends were observed in Brazil as a whole and in every region. The trends for 2012-2014 were more heterogeneous, with the prevalence systematically higher than that observed for 2001-2010. The APC in the preterm stratum (2001-2010) showed a statistically significant trend change in the North (APC: 15.4%; 95%CI: 0.6-32.3) and South (APC: 13.5%; 95%CI: 4.8-22.9) regions. In the term stratum, the change occurred only in the North region (APC:-1.5%; 95%CI: -2.5--0.5).
Conclusion
The prevalence of macrosomic births in Brazil was higher than 5.0%. Macrosomia has potentially negative health implications for both children and adults, and deserves close attention in the public health agenda in Brazil, as well as further support for investigation and intervention.
Views129This 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 in the Prevalence of Live Macrosomic Newborns According to Gestational Age Strata, in Brazil, 2001-2010, and 2012-2014
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):376-383
08-01-2017Views129See moreAbstract
Purpose
To describe the trends in the prevalence of macrosomia (birth weight ± 4,000 g) according to gestational age in Brazil in the periods of 2001-2010 and 2012-2014.
Methods
Ecological study with data from the Brazilian Live Birth Information System (SINASC, in the Portuguese acronym) regarding singleton live newborns born from 22 gestational weeks. The trends in Brazil as a whole and in each of its five regions were analyzed according to preterm (22-36 gestational weeks) and term (37-42 gestational weeks) strata. Annual Percent Changes (APCs) based on the Prais-Winsten method and their respective 95% confidence intervals (CIs) were used to verify statistically significant changes in 2001-2010.
Results
In Brazil, the prevalence of macrosomic births was of 5.3% (2001-2010) and 5.1% (2012-2014). The rates were systematically higher in the North and Northeast Regions both in the preterm and in term strata. In the preterm stratum, the North Region presented the highest variation in the prevalence of macrosomia (+137.5%) when comparing 2001 (0.8%) to 2010 (1.9%). In the term stratum, downward trends were observed in Brazil as a whole and in every region. The trends for 2012-2014 were more heterogeneous, with the prevalence systematically higher than that observed for 2001-2010. The APC in the preterm stratum (2001-2010) showed a statistically significant trend change in the North (APC: 15.4%; 95%CI: 0.6-32.3) and South (APC: 13.5%; 95%CI: 4.8-22.9) regions. In the term stratum, the change occurred only in the North region (APC:-1.5%; 95%CI: -2.5--0.5).
Conclusion
The prevalence of macrosomic births in Brazil was higher than 5.0%. Macrosomia has potentially negative health implications for both children and adults, and deserves close attention in the public health agenda in Brazil, as well as further support for investigation and intervention.
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
Food Insecurity, Prenatal Care and Other Anemia Determinants in Pregnant Women from the NISAMI Cohort, Brazil: Hierarchical Model Concept
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):384-396
08-01-2017
Summary
Original ArticleFood Insecurity, Prenatal Care and Other Anemia Determinants in Pregnant Women from the NISAMI Cohort, Brazil: Hierarchical Model Concept
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):384-396
08-01-2017Views134See moreAbstract
Objective
To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women.
Methods
A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb < 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels.
Results
The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15;95%CI: 1.43-18.50); multiparity (OR = 2.27;95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care.
Conclusions
In the present study, the chance of occurrence of anemia in pregnant women was significantly higher,mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.
Views134This 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 ArticleFood Insecurity, Prenatal Care and Other Anemia Determinants in Pregnant Women from the NISAMI Cohort, Brazil: Hierarchical Model Concept
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):384-396
08-01-2017Views134See moreAbstract
Objective
To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women.
Methods
A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb < 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels.
Results
The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15;95%CI: 1.43-18.50); multiparity (OR = 2.27;95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care.
Conclusions
In the present study, the chance of occurrence of anemia in pregnant women was significantly higher,mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.
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
Profile of Reproductive Issues Associated with Different Sickle Cell Disease Genotypes
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):397-402
08-01-2017
Summary
Original ArticleProfile of Reproductive Issues Associated with Different Sickle Cell Disease Genotypes
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):397-402
08-01-2017Views120See moreAbstract
Purpose
To describe the reproductive variables associated with different sickle cell disease (SCD) genotypes and the influence of contraceptive methods on acute painful episodes among the women with the homozygous hemoglobin S (HbSS) genotype.
Methods
A cross-sectional study was conducted between September of 2015 and April of 2016 on 158 women afflicted with SCD admitted to a hematology center in the Northeast of Brazil. The reproduction-associated variables of different SCD genotypes were assessed using the analysis of variance (ANOVA) test to compare means, and the Kruskal-Wallis test to compare medians. The association between the contraceptive method and the acute painful episodes was evaluated by the Chi-square test.
Results
Themean age of women with SCD was 28.3 years and 86.6% were mixed or of African-American ethnicity. With respect to the genotypes, 134 women (84.8%) had HbSS genotype, 12 women (7.6%) had hemoglobin SC (HbSC) disease genotype, and 12 (7.6%) were identified with hemoglobinopathy S-beta (S-β) thalassemia. The mean age of HbSS diagnosis was lower than that of HbSC disease, the less severe formof SCD (p < 0.001). The mean age ofmenarche was 14.8 ± 1.8 years for HbSS and 12.7 ± 1.5 years for HbSC (p < 0.001). Among women with HbSS who used progestin-only contraception, 16.6% had more than 4 acute painful episodes per year. There was no statistically significant difference when compared with other contraceptive methods.
Conclusion
With respect to reproduction-associated variables, only the age of the menarche showed delay in HbSS when compared with HbSC. The contraceptive method used was not associated with the frequency of acute painful episodes among the HbSS women.
Views120This 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 ArticleProfile of Reproductive Issues Associated with Different Sickle Cell Disease Genotypes
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):397-402
08-01-2017Views120See moreAbstract
Purpose
To describe the reproductive variables associated with different sickle cell disease (SCD) genotypes and the influence of contraceptive methods on acute painful episodes among the women with the homozygous hemoglobin S (HbSS) genotype.
Methods
A cross-sectional study was conducted between September of 2015 and April of 2016 on 158 women afflicted with SCD admitted to a hematology center in the Northeast of Brazil. The reproduction-associated variables of different SCD genotypes were assessed using the analysis of variance (ANOVA) test to compare means, and the Kruskal-Wallis test to compare medians. The association between the contraceptive method and the acute painful episodes was evaluated by the Chi-square test.
Results
Themean age of women with SCD was 28.3 years and 86.6% were mixed or of African-American ethnicity. With respect to the genotypes, 134 women (84.8%) had HbSS genotype, 12 women (7.6%) had hemoglobin SC (HbSC) disease genotype, and 12 (7.6%) were identified with hemoglobinopathy S-beta (S-β) thalassemia. The mean age of HbSS diagnosis was lower than that of HbSC disease, the less severe formof SCD (p < 0.001). The mean age ofmenarche was 14.8 ± 1.8 years for HbSS and 12.7 ± 1.5 years for HbSC (p < 0.001). Among women with HbSS who used progestin-only contraception, 16.6% had more than 4 acute painful episodes per year. There was no statistically significant difference when compared with other contraceptive methods.
Conclusion
With respect to reproduction-associated variables, only the age of the menarche showed delay in HbSS when compared with HbSC. The contraceptive method used was not associated with the frequency of acute painful episodes among the HbSS women.
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.
Original Article Archives - Page 3 of 55 - Revista Brasileira de Ginecologia e Obstetrícia
