Trabalhos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):77-81
DOI 10.1590/S0100-72031998000200004
Electronic fetal heart rate monitoring (EFM) is the most widely used method of direct fetal surveillance especially during labor. In an attempt to elucidate the effect of EFM on cesarean section (CS) rates, a retrospective study was performed at the University Hospital of Santa Maria (HUSM). We studied two groups of patients, consisting of 2114 pregnant women: EFM group (n=517) and intermittent auscultation (IA) group (n=1597). In the EFM group we observed 38.0% of CS vs. 27.2% in the IA group. For all patients, the CS rate was 29.9%. Fetal distress was the most common indication for CS in the EFM group (40.6%), while previous CS was the third cause (10.1%). On the IA group, fetal distress was the third cause in CS (14.3%), while previous CS was the most common cause (32.4%). On the basis of this study, we believe that EFM has no effect in itself on cesarean section rates considering overall deliveries at HUSM. With proper education of the clinician and correct interpretation of the findings, EFM would not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum fetal well-being.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):77-81
DOI 10.1590/S0100-72031998000200004
Electronic fetal heart rate monitoring (EFM) is the most widely used method of direct fetal surveillance especially during labor. In an attempt to elucidate the effect of EFM on cesarean section (CS) rates, a retrospective study was performed at the University Hospital of Santa Maria (HUSM). We studied two groups of patients, consisting of 2114 pregnant women: EFM group (n=517) and intermittent auscultation (IA) group (n=1597). In the EFM group we observed 38.0% of CS vs. 27.2% in the IA group. For all patients, the CS rate was 29.9%. Fetal distress was the most common indication for CS in the EFM group (40.6%), while previous CS was the third cause (10.1%). On the IA group, fetal distress was the third cause in CS (14.3%), while previous CS was the most common cause (32.4%). On the basis of this study, we believe that EFM has no effect in itself on cesarean section rates considering overall deliveries at HUSM. With proper education of the clinician and correct interpretation of the findings, EFM would not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum fetal well-being.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):67-70
DOI 10.1590/S0100-72031998000200002
The purpose of this study is to evaluate the effects of propoxyphene napsylate on the pregnancy of the rat. We used fifty pregnant rats divided into five groups. All the animals received daily 1 ml of the solution by gavage from day 0 to the 20th day of pregnancy. Group I - only distilled water (control); group II - aqueous solution of acacia 2% (vehicle); groups III, IV and V - respectively, 5, 15 and 45 mg/kg of weight of propoxyphene napsylate diluted in 2% acacia solution. The animals were weighed on days 0, 7, 14 and 20 of pregnancy. All animals were sacrificed on the 20th day of pregnancy. Our results showed that the animals treated with 45 mg/kg of propoxyphene napsylate presented reduction of the individual weights of the fetuses, as well as of the weights of the newborns and placentas. The difference betewwn number of resorptions, implantations and placentas of the treated groups was shown to be non significant cohen compered with the control groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):67-70
DOI 10.1590/S0100-72031998000200002
The purpose of this study is to evaluate the effects of propoxyphene napsylate on the pregnancy of the rat. We used fifty pregnant rats divided into five groups. All the animals received daily 1 ml of the solution by gavage from day 0 to the 20th day of pregnancy. Group I - only distilled water (control); group II - aqueous solution of acacia 2% (vehicle); groups III, IV and V - respectively, 5, 15 and 45 mg/kg of weight of propoxyphene napsylate diluted in 2% acacia solution. The animals were weighed on days 0, 7, 14 and 20 of pregnancy. All animals were sacrificed on the 20th day of pregnancy. Our results showed that the animals treated with 45 mg/kg of propoxyphene napsylate presented reduction of the individual weights of the fetuses, as well as of the weights of the newborns and placentas. The difference betewwn number of resorptions, implantations and placentas of the treated groups was shown to be non significant cohen compered with the control groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):97-104
DOI 10.1590/S0100-72031998000200007
The purpose of the present study was to compare postoperative complications and recurrence rates in 132 women with invasive vulvar carcinoma treated by radical vulvectomy and bilateral groin lymphadenectomy performed with one or three incisions. It was a nonrandomized retrospective clinical study, including 65 women operated using a single incision and 67 with three incisions, between 1986 and 1996. Fischer's, chi-square, Student's t tests followed by logistic regression were used for statistical analysis as well as survival curves by the Kaplan-Meyer method, compared using Wilcoxon test, followed by Cox regression, with the statistical significance limit of 5%. The groups were similar regarding age, smoking, presence of other diseases, histologic type and grade. Pathologic stage III was significantly more frequent in the single incision group, while free lymph nodes were more frequent in the three-incision group. The patients treated with triple incision showed statistically less frequent immediate complications (76% vs 92%, p<0.05), less dehiscence (72% vs 92%, p<0.01), and shorter mean hospital stay (19.4 days vs 38.7 days, p<0.001) and secondary procedures were less necessary (76% vs 94%, p<0.01). Seven postoperative deaths were observed: five with single incision and two with triple incision. Recurrence rate was statistically lower in patients treated with triple incision (19% vs 35%, p<0.01) and with negative lymph nodes (6% vs 15%, p<0.01). After Cox regression, only positive lymph nodes had negative influence on disease-free survival. We concluded that vulvectomy using three incisions shows less complications than single incision, without compromising therapeutic efficacy, independently of the stage of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):97-104
DOI 10.1590/S0100-72031998000200007
The purpose of the present study was to compare postoperative complications and recurrence rates in 132 women with invasive vulvar carcinoma treated by radical vulvectomy and bilateral groin lymphadenectomy performed with one or three incisions. It was a nonrandomized retrospective clinical study, including 65 women operated using a single incision and 67 with three incisions, between 1986 and 1996. Fischer's, chi-square, Student's t tests followed by logistic regression were used for statistical analysis as well as survival curves by the Kaplan-Meyer method, compared using Wilcoxon test, followed by Cox regression, with the statistical significance limit of 5%. The groups were similar regarding age, smoking, presence of other diseases, histologic type and grade. Pathologic stage III was significantly more frequent in the single incision group, while free lymph nodes were more frequent in the three-incision group. The patients treated with triple incision showed statistically less frequent immediate complications (76% vs 92%, p<0.05), less dehiscence (72% vs 92%, p<0.01), and shorter mean hospital stay (19.4 days vs 38.7 days, p<0.001) and secondary procedures were less necessary (76% vs 94%, p<0.01). Seven postoperative deaths were observed: five with single incision and two with triple incision. Recurrence rate was statistically lower in patients treated with triple incision (19% vs 35%, p<0.01) and with negative lymph nodes (6% vs 15%, p<0.01). After Cox regression, only positive lymph nodes had negative influence on disease-free survival. We concluded that vulvectomy using three incisions shows less complications than single incision, without compromising therapeutic efficacy, independently of the stage of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):209-213
DOI 10.1590/S0100-72031998000400006
Fine-needle aspiration cytology (FNAC) is a simple method and free from complications, among great value in mastology. Its accuracy can suffer the influence of several factors, among which we can highlight the experience of the physician who performs it. With the objective of verifying the effectiveness of FNAC performed by general gynecologists, 341 patients were studied concerning the relationship between the results of FNAC and the histology of the breast lesion. We obtained sensitivity of 70.87%, specificity of 70.58%, predictive positive value of 92.40%, predictive negative value of 89.36% and accuracy of 70.67%. We concluded that FNAC is of great value in handling breast lesions and can be appropriately performed by general gynecologists. The method, however, may lead to errors of diagnosis. We do not recommend, therefore, the use of the result of FNAC as a definitive diagnosis; instead this result must be interpreted in the context of the clinical diagnosis and mammography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):209-213
DOI 10.1590/S0100-72031998000400006
Fine-needle aspiration cytology (FNAC) is a simple method and free from complications, among great value in mastology. Its accuracy can suffer the influence of several factors, among which we can highlight the experience of the physician who performs it. With the objective of verifying the effectiveness of FNAC performed by general gynecologists, 341 patients were studied concerning the relationship between the results of FNAC and the histology of the breast lesion. We obtained sensitivity of 70.87%, specificity of 70.58%, predictive positive value of 92.40%, predictive negative value of 89.36% and accuracy of 70.67%. We concluded that FNAC is of great value in handling breast lesions and can be appropriately performed by general gynecologists. The method, however, may lead to errors of diagnosis. We do not recommend, therefore, the use of the result of FNAC as a definitive diagnosis; instead this result must be interpreted in the context of the clinical diagnosis and mammography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):199-205
DOI 10.1590/S0100-72031998000400005
The purpose of the present study was to investigate the menstrual disturbances and the psychological effects of post-tubal sterilization - the so-called post-tubal sterilization syndrome. Does it exist? The authors followed-up prospectively 300 women from the Gynecological Endoscopy and Family Planning Section, Department of Obstetrics and Gynecology, Botucatu Medical School, Universidade Estadual Paulista (UNESP) during one, three and five years after tubal sterilization surgery. Different parameters such as menstrual cycle length, duration of menstrual flow, dysmenorrhea, pelvic pain, regret rates etc, after tubal ligation, were analyzed. Each woman served as her own control. In conclusion, our findings suggest that most women reported no menstrual changes subsequent to sterilization. These findings do not deny or diminish the importance or benefits of tubal sterilization, but serve as a focus for further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):199-205
DOI 10.1590/S0100-72031998000400005
The purpose of the present study was to investigate the menstrual disturbances and the psychological effects of post-tubal sterilization - the so-called post-tubal sterilization syndrome. Does it exist? The authors followed-up prospectively 300 women from the Gynecological Endoscopy and Family Planning Section, Department of Obstetrics and Gynecology, Botucatu Medical School, Universidade Estadual Paulista (UNESP) during one, three and five years after tubal sterilization surgery. Different parameters such as menstrual cycle length, duration of menstrual flow, dysmenorrhea, pelvic pain, regret rates etc, after tubal ligation, were analyzed. Each woman served as her own control. In conclusion, our findings suggest that most women reported no menstrual changes subsequent to sterilization. These findings do not deny or diminish the importance or benefits of tubal sterilization, but serve as a focus for further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.