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Original Article06-27-2024
Risk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital
- Amanda Botelho
, - Adriana Luckow Invitti ,
- ,
- Rosiane Mattar ,
- David Baptista da Silva Pares , [ ... ],
- Sue Yazaki Sun
Abstract
Original ArticleRisk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo53
- Amanda Botelho ,
- Adriana Luckow Invitti ,
- ,
- Rosiane Mattar ,
- David Baptista da Silva Pares ,
- Camilla Parente Salmeron ,
- João Victor Jacomele Caldas ,
- Nathalia Mello ,
- Alberto Borges Peixoto ,
- Edward Araujo Júnior ,
- Sue Yazaki Sun
Views233Abstract
Objective
To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital.
Methods
We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression.
Results
There were 11,935 deliveries during the study period. According to Robson’s Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653).
Conclusion
Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.
Key-words Hospitals, maternityPostpartum hemorrhagePostpartum periodPregnancyRisk factorsrobson classificationSee moreViews233
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. Abstract
Original ArticleRisk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo53
- Amanda Botelho ,
- Adriana Luckow Invitti ,
- ,
- Rosiane Mattar ,
- David Baptista da Silva Pares ,
- Camilla Parente Salmeron ,
- João Victor Jacomele Caldas ,
- Nathalia Mello ,
- Alberto Borges Peixoto ,
- Edward Araujo Júnior ,
- Sue Yazaki Sun
Views233Abstract
Objective
To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital.
Methods
We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression.
Results
There were 11,935 deliveries during the study period. According to Robson’s Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653).
Conclusion
Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.
Key-words Hospitals, maternityPostpartum hemorrhagePostpartum periodPregnancyRisk factorsrobson classificationSee 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. - Amanda Botelho
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Original Article06-27-2024
The impact of surgical treatment for deep endometriosis: metabolic profile, quality of life and psychological aspects
- Claruza Braga Holanda Lavor ,
- Francisca Adriele Vieira Neta ,
- Antonio Brazil Viana Júnior ,
- Francisco das Chagas Medeiros
Abstract
Original ArticleThe impact of surgical treatment for deep endometriosis: metabolic profile, quality of life and psychological aspects
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo42
- Claruza Braga Holanda Lavor ,
- Francisca Adriele Vieira Neta ,
- Antonio Brazil Viana Júnior ,
- Francisco das Chagas Medeiros
Views261Abstract
Objective
To evaluate the effects of surgical treatment of deep endometriosis on the metabolic profile, quality of life and psychological aspects.
Methods
Prospective observational study, carried out with women of reproductive age diagnosed with deep endometriosis, treated in a specialized outpatient clinic, from October/2020 to September/2022, at a University Hospital in Fortaleza - Brazil. Standardized questionnaires were applied to collect data on quality of life and mental health, in addition to laboratory tests to evaluate dyslipidemia and dysglycemia, at two moments, preoperatively and six months after surgery. The results were presented using tables, averages and percentages.
Results
Thirty women with an average age of 38.5 years were evaluated. Seven quality of life domains showed improved scores: pain, control and impotence, well-being, social support, self-image, work life and sexual relations after surgery (ES ≥ 0.80). There was an improvement in mental health status with a significant reduction in anxiety and depression postoperatively. With the metabolic profile, all average levels were lower after surgery: total cholesterol 8.2% lower, LDL 12.8% lower, triglycerides 10.9% lower, and fasting blood glucose 7.3% lower (p < 0.001).
Conclusion
Surgical treatment of deep endometriosis improved the quality of life and psychological aspects of patients. The lipid profile of patients after laparoscopy was favorable when compared to the preoperative lipid profile.
Key-words AnxietyDepressionEndometriosisInflammationLaparoscopyLipidsMental healthPelvic painQuality of lifesurveys and questionnairesSee moreViews261This 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. Abstract
Original ArticleThe impact of surgical treatment for deep endometriosis: metabolic profile, quality of life and psychological aspects
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo42
- Claruza Braga Holanda Lavor ,
- Francisca Adriele Vieira Neta ,
- Antonio Brazil Viana Júnior ,
- Francisco das Chagas Medeiros
Views261Abstract
Objective
To evaluate the effects of surgical treatment of deep endometriosis on the metabolic profile, quality of life and psychological aspects.
Methods
Prospective observational study, carried out with women of reproductive age diagnosed with deep endometriosis, treated in a specialized outpatient clinic, from October/2020 to September/2022, at a University Hospital in Fortaleza - Brazil. Standardized questionnaires were applied to collect data on quality of life and mental health, in addition to laboratory tests to evaluate dyslipidemia and dysglycemia, at two moments, preoperatively and six months after surgery. The results were presented using tables, averages and percentages.
Results
Thirty women with an average age of 38.5 years were evaluated. Seven quality of life domains showed improved scores: pain, control and impotence, well-being, social support, self-image, work life and sexual relations after surgery (ES ≥ 0.80). There was an improvement in mental health status with a significant reduction in anxiety and depression postoperatively. With the metabolic profile, all average levels were lower after surgery: total cholesterol 8.2% lower, LDL 12.8% lower, triglycerides 10.9% lower, and fasting blood glucose 7.3% lower (p < 0.001).
Conclusion
Surgical treatment of deep endometriosis improved the quality of life and psychological aspects of patients. The lipid profile of patients after laparoscopy was favorable when compared to the preoperative lipid profile.
Key-words AnxietyDepressionEndometriosisInflammationLaparoscopyLipidsMental healthPelvic painQuality of lifesurveys and questionnairesSee 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. - Claruza Braga Holanda Lavor
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Original Article06-27-2024
The impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation
- Gustavo Werutsky ,
- Mahira Lopes ,
- Rafaela Gomes de Jesus ,
- Antonia Angeli Gazola ,
- Rodrigo Azevedo Pellegrini , [ ... ],
- Andre Poisl Fay
Abstract
Original ArticleThe impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo60
- Gustavo Werutsky ,
- Mahira Lopes ,
- Rafaela Gomes de Jesus ,
- Antonia Angeli Gazola ,
- Rodrigo Azevedo Pellegrini ,
- Taiane Francieli Rebelatto ,
- Laura von Wallwitz Freitas ,
- Ana Paula Heck ,
- Arthur Ferreira da Silva ,
- Matheus Füehr Rodrigues ,
- Gustavo Gössling ,
- Juliana Giacomazzi ,
- Matheus Soares Rocha ,
- Daniela Dornelles Rosa ,
- Carlos Henrique Barrios ,
- Eduardo Henrique Cronemberger ,
- Geraldo Silva Queiroz ,
- José Bines ,
- Sérgio Daniel Simon ,
- Andre Poisl Fay
Views270See moreAbstract
Objective
To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis.
Methods
We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil.
Results
Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 – 3.72, p = 0.0366) than those who underwent breast-conserving surgery.
Conclusion
Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.
Views270This 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. Abstract
Original ArticleThe impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo60
- Gustavo Werutsky ,
- Mahira Lopes ,
- Rafaela Gomes de Jesus ,
- Antonia Angeli Gazola ,
- Rodrigo Azevedo Pellegrini ,
- Taiane Francieli Rebelatto ,
- Laura von Wallwitz Freitas ,
- Ana Paula Heck ,
- Arthur Ferreira da Silva ,
- Matheus Füehr Rodrigues ,
- Gustavo Gössling ,
- Juliana Giacomazzi ,
- Matheus Soares Rocha ,
- Daniela Dornelles Rosa ,
- Carlos Henrique Barrios ,
- Eduardo Henrique Cronemberger ,
- Geraldo Silva Queiroz ,
- José Bines ,
- Sérgio Daniel Simon ,
- Andre Poisl Fay
Views270See moreAbstract
Objective
To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis.
Methods
We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil.
Results
Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 – 3.72, p = 0.0366) than those who underwent breast-conserving surgery.
Conclusion
Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.
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. - Gustavo Werutsky
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Original Article06-27-2024
The profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study
- Mayara dos Santos Farias Ferreira Silva ,
- Melania Maria Ramos de Amorim ,
- Brena Melo ,
- André Vieira Lanza ,
- Maria Eduarda Trigueiro Ramos , [ ... ],
- Leila Katz
Abstract
Original ArticleThe profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo47
- Mayara dos Santos Farias Ferreira Silva ,
- Melania Maria Ramos de Amorim ,
- Brena Melo ,
- André Vieira Lanza ,
- Maria Eduarda Trigueiro Ramos ,
- Bruna Antunes Durães de Carvalho ,
- Natalia Nunes Tenório ,
- Leila Katz
Views251See moreAbstract
Objective
In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO).
Methods
A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU.
Results
The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO.
Conclusion
The principal factors associated with poor maternal outcome were being multiparous and placental abruption.
Views251This 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. Abstract
Original ArticleThe profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo47
- Mayara dos Santos Farias Ferreira Silva ,
- Melania Maria Ramos de Amorim ,
- Brena Melo ,
- André Vieira Lanza ,
- Maria Eduarda Trigueiro Ramos ,
- Bruna Antunes Durães de Carvalho ,
- Natalia Nunes Tenório ,
- Leila Katz
Views251See moreAbstract
Objective
In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO).
Methods
A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU.
Results
The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO.
Conclusion
The principal factors associated with poor maternal outcome were being multiparous and placental abruption.
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. - Mayara dos Santos Farias Ferreira Silva
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Original Article06-27-2024
Prevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity
- Kellen Silva Sousa ,
- Henrique Vitor Leite ,
- Mário Dias Corrêa Júnior ,
- Matheus Silva Sousa ,
- Anna Luíza Rocha Queiroz
Abstract
Original ArticlePrevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo48
- Kellen Silva Sousa ,
- Henrique Vitor Leite ,
- Mário Dias Corrêa Júnior ,
- Matheus Silva Sousa ,
- Anna Luíza Rocha Queiroz
Views199Abstract
Objective
Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams.
Methods
This is an observational study, case-control type, carried out by searching for data in hospital’s own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis.
Results
From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common.
Conclusion
Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.
Key-words Diabetes, gestationalFetal macrosomiaFetal weightJaundice, neonatalPregnancy, high riskRisk factorsShoulder dystociaSee moreViews199This 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. Abstract
Original ArticlePrevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo48
- Kellen Silva Sousa ,
- Henrique Vitor Leite ,
- Mário Dias Corrêa Júnior ,
- Matheus Silva Sousa ,
- Anna Luíza Rocha Queiroz
Views199Abstract
Objective
Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams.
Methods
This is an observational study, case-control type, carried out by searching for data in hospital’s own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis.
Results
From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common.
Conclusion
Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.
Key-words Diabetes, gestationalFetal macrosomiaFetal weightJaundice, neonatalPregnancy, high riskRisk factorsShoulder dystociaSee 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. - Kellen Silva Sousa
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Original Article06-03-2024
Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome
- Rayanne Moreira da Cunha ,
- Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros , [ ... ],
- Leonardo Robson Pinheiro Sobreira Bezerra
Abstract
Original ArticleSexual function in women with endometriosis and pelvic floor myofascial pain syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo40
- Rayanne Moreira da Cunha ,
- Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros ,
- Germana Mesquita Magalhães ,
- Pedro Olavo de Paula Lima ,
- Simony Lira do Nascimento ,
- Leonardo Robson Pinheiro Sobreira Bezerra
Views247Abstract
Objective:
To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS).
Methods:
Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests.
Results:
There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG.
Conclusion:
Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Key-words EndometriosisMuscle tonusMyofascial pain syndromesPelvic floorPelvic painsexual satisfactionTrigger pointsSee moreViews247This 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. Abstract
Original ArticleSexual function in women with endometriosis and pelvic floor myofascial pain syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo40
- Rayanne Moreira da Cunha ,
- Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros ,
- Germana Mesquita Magalhães ,
- Pedro Olavo de Paula Lima ,
- Simony Lira do Nascimento ,
- Leonardo Robson Pinheiro Sobreira Bezerra
Views247Abstract
Objective:
To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS).
Methods:
Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests.
Results:
There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG.
Conclusion:
Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Key-words EndometriosisMuscle tonusMyofascial pain syndromesPelvic floorPelvic painsexual satisfactionTrigger pointsSee 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. - Rayanne Moreira da Cunha
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Original Article06-03-2024
The top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening
- Juliana Yoko Yoneda ,
- Aline Evangelista Santiago ,
- Julio Cesar Teixeira ,
- Helymar Costa Machado ,
- Sophie Derchain , [ ... ],
- Diama Bhadra Vale
Abstract
Original ArticleThe top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo44
- Juliana Yoko Yoneda ,
- Aline Evangelista Santiago ,
- Julio Cesar Teixeira ,
- Helymar Costa Machado ,
- Sophie Derchain ,
- Milena Yonamine ,
- Diama Bhadra Vale
Views209Abstract
Objective:
To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil.
Methods:
A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression.
Results:
The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative.
Conclusion:
The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.
Key-words Cervical intraepithelial neoplasiaCervix uteriColposcopyConizationElectrosurgeryGynecologic surgical proceduresUterine cervical neoplasmsSee moreViews209This 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. Abstract
Original ArticleThe top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo44
- Juliana Yoko Yoneda ,
- Aline Evangelista Santiago ,
- Julio Cesar Teixeira ,
- Helymar Costa Machado ,
- Sophie Derchain ,
- Milena Yonamine ,
- Diama Bhadra Vale
Views209Abstract
Objective:
To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil.
Methods:
A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression.
Results:
The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative.
Conclusion:
The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.
Key-words Cervical intraepithelial neoplasiaCervix uteriColposcopyConizationElectrosurgeryGynecologic surgical proceduresUterine cervical neoplasmsSee 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. - Juliana Yoko Yoneda
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Original Article06-03-2024
Women’s experiences with the post-placental intrauterine device: a qualitative study
- Ana Beatriz Venturin ,
- Debora Bicudo Faria-Schützer ,
- Odette del Risco Sánchez ,
- Larissa Rodrigues ,
- Thuany Bento Herculano , [ ... ],
- Fernanda Garanhani Surita
Abstract
Original ArticleWomen’s experiences with the post-placental intrauterine device: a qualitative study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo45
- Ana Beatriz Venturin ,
- Debora Bicudo Faria-Schützer ,
- Odette del Risco Sánchez ,
- Larissa Rodrigues ,
- Thuany Bento Herculano ,
- Fernanda Garanhani Surita
Views167Abstract
Objective:
To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period.
Methods:
A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation.
Results:
Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question.
Conclusion:
Professionals’ communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion.
Key-words Intrauterine deviceslong-acting reversible contraceptionPostpartum periodReproductive healthSee moreViews167This 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. Abstract
Original ArticleWomen’s experiences with the post-placental intrauterine device: a qualitative study
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo45
- Ana Beatriz Venturin ,
- Debora Bicudo Faria-Schützer ,
- Odette del Risco Sánchez ,
- Larissa Rodrigues ,
- Thuany Bento Herculano ,
- Fernanda Garanhani Surita
Views167Abstract
Objective:
To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period.
Methods:
A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation.
Results:
Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question.
Conclusion:
Professionals’ communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion.
Key-words Intrauterine deviceslong-acting reversible contraceptionPostpartum periodReproductive 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. - Ana Beatriz Venturin
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