Trabalhos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Summary
Rev Bras Ginecol Obstet. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):127-135
DOI 10.1590/S0100-72031998000300002
A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 - 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):127-135
DOI 10.1590/S0100-72031998000300002
A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 - 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):137-144
DOI 10.1590/S0100-72031998000300003
Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):137-144
DOI 10.1590/S0100-72031998000300003
Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):145-149
DOI 10.1590/S0100-72031998000300004
Although 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):145-149
DOI 10.1590/S0100-72031998000300004
Although 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):151-154
DOI 10.1590/S0100-72031998000300005
A retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):151-154
DOI 10.1590/S0100-72031998000300005
A retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):551-555
DOI 10.1590/S0100-72031998001000002
Purpose: to assess the validity of fetal weight estimation by a method based on uterine height -- Johnson's rule. Methods: one hundred and one pregnant women and their newborn children were studied. The fetal weight was estimated using an adaptation of Johnson's rule, which consists of the clinical application of a mathematical model to calculate the fetal weight based on the uterine height and the height of fetal presentation. The estimated weight was obtained on the day of delivery and was compared to the weight observed after birth. This, in turn, was the control of the analysis of validity of the method used. On the same date, a detailed obstetrical ultrasonography (US) was conducted which included the fetal weight, calculated by the use of Sheppard's tables. This weight, estimated by US, was compared to the birth weight. Results: the results have proven that the clinical estimate used in this study has a similar value to that of the US calculation of birth weight. The accuracy of the clinical method, with variations of 5%, 10% and 15% between estimated and observed weights, was 55.3%, 73% and 86.7%, respectively. Those of the US were 60.7%, 75.4% and 91.1%, respectively. When comparing both sets of figures, values were not different from a statistical standpoint. Conclusion: the clinical evaluation has shown to be accurate, similarly to the US, when calculating the birth weight.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):551-555
DOI 10.1590/S0100-72031998001000002
Purpose: to assess the validity of fetal weight estimation by a method based on uterine height -- Johnson's rule. Methods: one hundred and one pregnant women and their newborn children were studied. The fetal weight was estimated using an adaptation of Johnson's rule, which consists of the clinical application of a mathematical model to calculate the fetal weight based on the uterine height and the height of fetal presentation. The estimated weight was obtained on the day of delivery and was compared to the weight observed after birth. This, in turn, was the control of the analysis of validity of the method used. On the same date, a detailed obstetrical ultrasonography (US) was conducted which included the fetal weight, calculated by the use of Sheppard's tables. This weight, estimated by US, was compared to the birth weight. Results: the results have proven that the clinical estimate used in this study has a similar value to that of the US calculation of birth weight. The accuracy of the clinical method, with variations of 5%, 10% and 15% between estimated and observed weights, was 55.3%, 73% and 86.7%, respectively. Those of the US were 60.7%, 75.4% and 91.1%, respectively. When comparing both sets of figures, values were not different from a statistical standpoint. Conclusion: the clinical evaluation has shown to be accurate, similarly to the US, when calculating the birth weight.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.