Trabalhos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):377-382
DOI 10.1590/S0100-72032001000600006
Purpose: to evaluate a group of pregnant women with human papillomavirus (HPV) infection, analyzing age, gestational age, number of gestations and cytological findings. Methods: in the period from July 1993 to December 1998, 245 pregnant patients seen in our service presented cytological alterations compatible with HPV infection, associated or not with cervical intraepithelial neoplasia (CIN) grade 1. Clinical data were related to age, gestational period (first or second half), number of gestations and cytological finding of Trichomonas vaginalis, Candida sp and clue cells. The control group consisted of 386 pregnant patients seen during the same period and without cytological signs of HPV infection. In the statistical analysis, chi² (chi-square) test was used with Yates correction and a significance level lower than 0.05. Results: HPV infection was more frequent among pregnant women younger than 20 years old (45.3% versus 28.2%, p<0.001). The most frequent cytological finding, among the pregnant women with HPV infection, was the presence of clue cells, compared to the controls (21.6% versus 12.4%, p<0.02). Clue cells were more frequent in pregnant women with HPV infection in the second half of gestation and older than 20 years (27% versus 12.2%, p<0,01). The difference regarding number of gestations was not significant. Conclusion: HPV infection was more frequent among pregnant women younger than 20 years old. Clue cells and HPV were the most frequent cytological findings in pregnant women older than 20 years and in the second half of gestation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):377-382
DOI 10.1590/S0100-72032001000600006
Purpose: to evaluate a group of pregnant women with human papillomavirus (HPV) infection, analyzing age, gestational age, number of gestations and cytological findings. Methods: in the period from July 1993 to December 1998, 245 pregnant patients seen in our service presented cytological alterations compatible with HPV infection, associated or not with cervical intraepithelial neoplasia (CIN) grade 1. Clinical data were related to age, gestational period (first or second half), number of gestations and cytological finding of Trichomonas vaginalis, Candida sp and clue cells. The control group consisted of 386 pregnant patients seen during the same period and without cytological signs of HPV infection. In the statistical analysis, chi² (chi-square) test was used with Yates correction and a significance level lower than 0.05. Results: HPV infection was more frequent among pregnant women younger than 20 years old (45.3% versus 28.2%, p<0.001). The most frequent cytological finding, among the pregnant women with HPV infection, was the presence of clue cells, compared to the controls (21.6% versus 12.4%, p<0.02). Clue cells were more frequent in pregnant women with HPV infection in the second half of gestation and older than 20 years (27% versus 12.2%, p<0,01). The difference regarding number of gestations was not significant. Conclusion: HPV infection was more frequent among pregnant women younger than 20 years old. Clue cells and HPV were the most frequent cytological findings in pregnant women older than 20 years and in the second half of gestation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):365-370
DOI 10.1590/S0100-72032001000600004
Purpose: to compare ovarian adhesion according to different types of ovarian cortex closure. Methods: fifteen rabbits were randomly assigned to 3 groups according to the type of ovarian cortex closure, consisting of bipolar diathermy, 5-0 polyglactin 910 and 5-0 plain catgut. After 2 weeks the animals were sacrificed and the adhesion scores were evaluated in the right ovary using the Diamond classification. The left ovary, not incised, was used as control. Statistical analyses were done using analysis of variance (ANOVA), Scheffé test and Student's t test. Results:the mean adhesion scores for the bipolar, polyglactin and plain catgut groups were 0.7, 1.5 and 2.0, respectively. The analysis of variance detected a significant difference (p=0.02) between the three groups. Using Scheffé test for the two by two comparison of the groups, a significant difference was found between the bipolar and the plain catgut groups. Comparing the group in which sutures were used (independent of the material employed) with the bipolar group, a statistically significant difference was observed (1.8 and 0.7, respectively, p=0.01). Conclusions: the results obtained in this study are in accordance with the literature data, showing that second intention closure is more advantageous, concerning adhesion formation, than closure using sutures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):365-370
DOI 10.1590/S0100-72032001000600004
Purpose: to compare ovarian adhesion according to different types of ovarian cortex closure. Methods: fifteen rabbits were randomly assigned to 3 groups according to the type of ovarian cortex closure, consisting of bipolar diathermy, 5-0 polyglactin 910 and 5-0 plain catgut. After 2 weeks the animals were sacrificed and the adhesion scores were evaluated in the right ovary using the Diamond classification. The left ovary, not incised, was used as control. Statistical analyses were done using analysis of variance (ANOVA), Scheffé test and Student's t test. Results:the mean adhesion scores for the bipolar, polyglactin and plain catgut groups were 0.7, 1.5 and 2.0, respectively. The analysis of variance detected a significant difference (p=0.02) between the three groups. Using Scheffé test for the two by two comparison of the groups, a significant difference was found between the bipolar and the plain catgut groups. Comparing the group in which sutures were used (independent of the material employed) with the bipolar group, a statistically significant difference was observed (1.8 and 0.7, respectively, p=0.01). Conclusions: the results obtained in this study are in accordance with the literature data, showing that second intention closure is more advantageous, concerning adhesion formation, than closure using sutures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):355-364
DOI 10.1590/S0100-72032001000600003
Purpose: to compare histopathology and polymerase chain reaction (PCR) for the diagnosis of human papillomavirus (HPV) in cervical lesions of human immunodeficiency virus (HIV)-seropositive women. Methods: fifty-two HIV-seropositive women with suspected HPV cervical lesions were studied. Cervical scrapes were collected for PCR and colposcopy-guided biopsy was made for the histopathologic study. Three samples were disqualified for PCR, leaving a study population of 49 women. Results: the prevalence of HPV was 53% by histopathology and 85.7% by PCR. Among the 42 patients in whom HPV was detected by PCR, 26 were confirmed by histopathology (sensitivity = 61.9%). This method gave no false-positives (specificity = 100%), with 100% of positive prediction. Compared to PCR, the histopathology had: positive predcitive value = 100% and negative predcitive value = 30.4%. Among the 26 patients with HPV-positive biopsy, 15 (57.7%) had cervical intraepithelial neoplasia (CIN); relative risk = 13.3. Conclusion: histopathology was 100% correct for HPV-infection diagnosis. It means that when the biopsy is positive, HPV will be present, confirming the clinical suspicion. However, the low sensitivity excludes histopathology as a screening examination in this group of women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):355-364
DOI 10.1590/S0100-72032001000600003
Purpose: to compare histopathology and polymerase chain reaction (PCR) for the diagnosis of human papillomavirus (HPV) in cervical lesions of human immunodeficiency virus (HIV)-seropositive women. Methods: fifty-two HIV-seropositive women with suspected HPV cervical lesions were studied. Cervical scrapes were collected for PCR and colposcopy-guided biopsy was made for the histopathologic study. Three samples were disqualified for PCR, leaving a study population of 49 women. Results: the prevalence of HPV was 53% by histopathology and 85.7% by PCR. Among the 42 patients in whom HPV was detected by PCR, 26 were confirmed by histopathology (sensitivity = 61.9%). This method gave no false-positives (specificity = 100%), with 100% of positive prediction. Compared to PCR, the histopathology had: positive predcitive value = 100% and negative predcitive value = 30.4%. Among the 26 patients with HPV-positive biopsy, 15 (57.7%) had cervical intraepithelial neoplasia (CIN); relative risk = 13.3. Conclusion: histopathology was 100% correct for HPV-infection diagnosis. It means that when the biopsy is positive, HPV will be present, confirming the clinical suspicion. However, the low sensitivity excludes histopathology as a screening examination in this group of women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):391-396
DOI 10.1590/S0100-72032001000600008
Purpose: to evaluate the prescription of prenatal fluoride supplements by gynecologists and obstetricians in Curitiba and metropolitan region. Methods: two hundred and twenty-three (223) questionnaires were distributed to gynecologist-obstetricians. Questions were about the use of fluoride during pregnancy, time since graduation, workplace, among other parameters. Statistical analyses were carried out using Student's t-test, variance analysis (ANOVA), chi² test or Fisher exact test. Results: only 137 questionnaires were returned, which corresponds to 30% (137/441) of the professionals in the studied area and 61.4% (137/223) of the distributed questionnaires. Of the professionals, 47.5% prescribe fluoride as a supplement during pregnancy. Sixty percent of professionals who prescribe fluoride believe that this procedure leads to a better dental formation and caries prevention in the baby. The professionals who do not prescribe prenatal fluoride graduated more recently than the professionals who prescribe it (t=2.27, p<0.05). Moreover, the professionals who work exclusively in the public service prescribe less than those who work only in the private sector (Fisher exact test, p<0.05). Conclusion: there is a large percentage of gynecologist-obstetricians who still prescribe fluoride in the prenatal period, in spite of the recent studies that have not observed any benefit to the child. Therefore, there is a need to update these professionals about the mechanism of action, indication and clinical use of fluoride.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):391-396
DOI 10.1590/S0100-72032001000600008
Purpose: to evaluate the prescription of prenatal fluoride supplements by gynecologists and obstetricians in Curitiba and metropolitan region. Methods: two hundred and twenty-three (223) questionnaires were distributed to gynecologist-obstetricians. Questions were about the use of fluoride during pregnancy, time since graduation, workplace, among other parameters. Statistical analyses were carried out using Student's t-test, variance analysis (ANOVA), chi² test or Fisher exact test. Results: only 137 questionnaires were returned, which corresponds to 30% (137/441) of the professionals in the studied area and 61.4% (137/223) of the distributed questionnaires. Of the professionals, 47.5% prescribe fluoride as a supplement during pregnancy. Sixty percent of professionals who prescribe fluoride believe that this procedure leads to a better dental formation and caries prevention in the baby. The professionals who do not prescribe prenatal fluoride graduated more recently than the professionals who prescribe it (t=2.27, p<0.05). Moreover, the professionals who work exclusively in the public service prescribe less than those who work only in the private sector (Fisher exact test, p<0.05). Conclusion: there is a large percentage of gynecologist-obstetricians who still prescribe fluoride in the prenatal period, in spite of the recent studies that have not observed any benefit to the child. Therefore, there is a need to update these professionals about the mechanism of action, indication and clinical use of fluoride.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):349-354
DOI 10.1590/S0100-72032001000600002
Purpose: to evaluate the histopathologic results of cone specimens of patients undergoing loop electrosurgical excision procedure (LEEP) and their relationship with the localization of the lesion. Methods: in a retrospective study, 134 clinical reports of patients with abnormal findings of cervical cytology and/or biopsy undergoing LEEP were reviewed. The colposcopic findings were divided into three groups according to the localization of the lesion. Group I (n = 36): patients with ectocervical lesions and fully visible squamocolumnar junction; Group II (n = 50): patients with lesions at the ectocervix and endocervix, and Group III (n = 48): patients with unsatisfactory colposcopy. Results: the mean age in Group I was 33 years and there were 8.3% positive margins. In Group II the mean age was 39 years, with 36% positive margins. Group III had a mean age of 48 years and presented 29.2% positive margins. The percentage of residual disease was 4.2% in Group I, 31.6% in Group II and 35.5% in Group III. Conclusion: patients with lesions at the endocervical canal showed a higher rate of positive margins. Patients with high-grade cervical intraepithelial neoplasia at the endocervical canal and older than 40 years have a greater chance of showing positive margins and residual disease, therefore requiring stricter cytologic and colposcopic follow-up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):349-354
DOI 10.1590/S0100-72032001000600002
Purpose: to evaluate the histopathologic results of cone specimens of patients undergoing loop electrosurgical excision procedure (LEEP) and their relationship with the localization of the lesion. Methods: in a retrospective study, 134 clinical reports of patients with abnormal findings of cervical cytology and/or biopsy undergoing LEEP were reviewed. The colposcopic findings were divided into three groups according to the localization of the lesion. Group I (n = 36): patients with ectocervical lesions and fully visible squamocolumnar junction; Group II (n = 50): patients with lesions at the ectocervix and endocervix, and Group III (n = 48): patients with unsatisfactory colposcopy. Results: the mean age in Group I was 33 years and there were 8.3% positive margins. In Group II the mean age was 39 years, with 36% positive margins. Group III had a mean age of 48 years and presented 29.2% positive margins. The percentage of residual disease was 4.2% in Group I, 31.6% in Group II and 35.5% in Group III. Conclusion: patients with lesions at the endocervical canal showed a higher rate of positive margins. Patients with high-grade cervical intraepithelial neoplasia at the endocervical canal and older than 40 years have a greater chance of showing positive margins and residual disease, therefore requiring stricter cytologic and colposcopic follow-up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):247-251
DOI 10.1590/S0100-72032001000400008
Purpose: to determine the feasibility of early ultrasonographic identification of fetal gender. Methods: a prospective study in a University Department of Obstetrics and Gynecology. A total of 592 women underwent ultrasonography at 11-14 weeks of gestation. Fetal gender was identified according to genital tubercle position (vertical or horizontal) at sagittal plane and confirmed at birth or by karyotype analysis. Results: the overall accuracy of correctly assigning fetal gender was 84%. The success of identification increased with gestational age, being 72%, 85% and 89% at 11, 12 and 13 weeks, respectively. The accuracy of correctly identifying fetal sex significantly changed with operator training, being 83.5% at the beginning and 93.6% at the end of the study. Conclusion: ultrasound determination of fetal gender is feasible, with good accuracy and may be of potential use to avoid invasive testing in family histories of X-linked disorders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):247-251
DOI 10.1590/S0100-72032001000400008
Purpose: to determine the feasibility of early ultrasonographic identification of fetal gender. Methods: a prospective study in a University Department of Obstetrics and Gynecology. A total of 592 women underwent ultrasonography at 11-14 weeks of gestation. Fetal gender was identified according to genital tubercle position (vertical or horizontal) at sagittal plane and confirmed at birth or by karyotype analysis. Results: the overall accuracy of correctly assigning fetal gender was 84%. The success of identification increased with gestational age, being 72%, 85% and 89% at 11, 12 and 13 weeks, respectively. The accuracy of correctly identifying fetal sex significantly changed with operator training, being 83.5% at the beginning and 93.6% at the end of the study. Conclusion: ultrasound determination of fetal gender is feasible, with good accuracy and may be of potential use to avoid invasive testing in family histories of X-linked disorders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):243-246
DOI 10.1590/S0100-72032001000400007
Purpose: to evaluate the possibility and accuracy of fetal karyotyping in pleural effusions. Methods: we studied fifteen fetuses with unilateral or bilateral pleural effusions. All of these fetuses underwent intrauterine thoracocentesis guided by ultrasound examinations. The gestational age varied from 19 to 34 weeks. A morphogenetic ultrasound examination was performed in each case by the authors in order to identify associated structural anomalies. When the cellular cultures of pleural effusion samples were negative, an alternative karyotype was obtained by cordocentesis. A fetal lymphocyte culture was made of pleural effusion samples for karyotype in a similar technique as for fetal blood. Results: the fetal karyotype was successful in 12 cases. There were 4 abnormal results, all of them were Down syndromes, and in the other 8 cases the chromosomal analyses were normal. The fetal karyotype was confirmed and compared by newborn blood chromosomal analysis, genetic evaluation or necropsy. There were no maternal or fetal side effects related to the procedure. Conclusions: the fetal karyotyping performed in pleural effusions obtained by intrauterine thoracocentesis proved to be highly efficient and safe. It must be the method of choice for rapid karyotyping in fetuses with pleural edema.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(4):243-246
DOI 10.1590/S0100-72032001000400007
Purpose: to evaluate the possibility and accuracy of fetal karyotyping in pleural effusions. Methods: we studied fifteen fetuses with unilateral or bilateral pleural effusions. All of these fetuses underwent intrauterine thoracocentesis guided by ultrasound examinations. The gestational age varied from 19 to 34 weeks. A morphogenetic ultrasound examination was performed in each case by the authors in order to identify associated structural anomalies. When the cellular cultures of pleural effusion samples were negative, an alternative karyotype was obtained by cordocentesis. A fetal lymphocyte culture was made of pleural effusion samples for karyotype in a similar technique as for fetal blood. Results: the fetal karyotype was successful in 12 cases. There were 4 abnormal results, all of them were Down syndromes, and in the other 8 cases the chromosomal analyses were normal. The fetal karyotype was confirmed and compared by newborn blood chromosomal analysis, genetic evaluation or necropsy. There were no maternal or fetal side effects related to the procedure. Conclusions: the fetal karyotyping performed in pleural effusions obtained by intrauterine thoracocentesis proved to be highly efficient and safe. It must be the method of choice for rapid karyotyping in fetuses with pleural edema.