Trabalhos Originais Archives - Page 17 of 50 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):307-312
DOI 10.1590/S0100-72032001000500006
Purpose: to evaluate the effectiveness of color Doppler as a diagnosis method for polycystic ovary syndrome (PCOS) through blood flow variations in the ovarian stroma, in the uterine arteries and in the subendometrial tissue. Methods: thirty patients divided into two groups were selected: fifteen patients with amenorrhea or oligomenorrhea, hirsutism (Ferriman and Gallwey score >8), body mass index >25 kg/m² and echographic examination identifying increased hyperechogenic stromal and ovarian polycystosis (study group), and an identical number of patients presenting normal menstrual cycles, with no signs of hirsutism and with normal ultrasonography (control group). Transvaginal Doppler flowmetry measured systolic peak velocity or maximal velocity (Vmax) pulsatility index (PI) and resistance of ovarian stromal vessels, uterine arteries and subendometrial layer. Results: Doppler velocimetry showed significantly higher Vmax layer (p<=0,0004) in the ovarian stromal of patients with PCOS (12.2 cm/s) when compared to the control group (8.05 cm/s); the uterine artery PI was also higher in the PCOS group (3.3 cm/s) versus the control group (2.7 cm/s); other Doppler velocimetry parameters did not show significant differences. As we established a cutoff = 9 cm/s for the sample for Vmax, we obtained the percentages of 95.2 for sensitivity, 80.0 for specificity, 83.3 for positive predictive value and 94.1 for negative predictive value. Conclusion: Doppler velocimetry might constitute an additional tool to be incorporated in clinical and ultrasonographic investigation concerning the PCOS diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):307-312
DOI 10.1590/S0100-72032001000500006
Purpose: to evaluate the effectiveness of color Doppler as a diagnosis method for polycystic ovary syndrome (PCOS) through blood flow variations in the ovarian stroma, in the uterine arteries and in the subendometrial tissue. Methods: thirty patients divided into two groups were selected: fifteen patients with amenorrhea or oligomenorrhea, hirsutism (Ferriman and Gallwey score >8), body mass index >25 kg/m² and echographic examination identifying increased hyperechogenic stromal and ovarian polycystosis (study group), and an identical number of patients presenting normal menstrual cycles, with no signs of hirsutism and with normal ultrasonography (control group). Transvaginal Doppler flowmetry measured systolic peak velocity or maximal velocity (Vmax) pulsatility index (PI) and resistance of ovarian stromal vessels, uterine arteries and subendometrial layer. Results: Doppler velocimetry showed significantly higher Vmax layer (p<=0,0004) in the ovarian stromal of patients with PCOS (12.2 cm/s) when compared to the control group (8.05 cm/s); the uterine artery PI was also higher in the PCOS group (3.3 cm/s) versus the control group (2.7 cm/s); other Doppler velocimetry parameters did not show significant differences. As we established a cutoff = 9 cm/s for the sample for Vmax, we obtained the percentages of 95.2 for sensitivity, 80.0 for specificity, 83.3 for positive predictive value and 94.1 for negative predictive value. Conclusion: Doppler velocimetry might constitute an additional tool to be incorporated in clinical and ultrasonographic investigation concerning the PCOS diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):299-303
DOI 10.1590/S0100-72032001000500005
Purpose: to evaluate the intrauterine treatment of anemic fetuses that underwent intrauterine transfusions due to rhesus isoimmunization. Methods: the authors studied sixty-one fetuses undergoing intrauterine transfusions by the intravascular, intraperitoneal or both routes. The hydropic fetuses (19.7%) received only intravascular intrauterine transfusions. There was an overall number of 163 intrauterine transfusions with a mean of 2.7 procedures for each case. The indications for intrauterine transfusions were high values of bilirubin in amniotic fluid analyses by the Liley method or a hemoglobin concentration of cord blood below 10.0 g/mL. Results: the overall perinatal survival rate was 46% for hydropic fetuses and 84% for the nonhydropic ones. There were no maternal side effects related to the procedures. Half of the intrauterine transfusions were performed by the intravascular route. The mean gestational age at the delivery was 34.8 weeks. Conclusions: despite better perinatal results with intrauterine transfusions guided by ultrasound, especially using intravascular procedures, rhesus isoimmunization remains as an important cause of high rates of perinatal morbidity and mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):299-303
DOI 10.1590/S0100-72032001000500005
Purpose: to evaluate the intrauterine treatment of anemic fetuses that underwent intrauterine transfusions due to rhesus isoimmunization. Methods: the authors studied sixty-one fetuses undergoing intrauterine transfusions by the intravascular, intraperitoneal or both routes. The hydropic fetuses (19.7%) received only intravascular intrauterine transfusions. There was an overall number of 163 intrauterine transfusions with a mean of 2.7 procedures for each case. The indications for intrauterine transfusions were high values of bilirubin in amniotic fluid analyses by the Liley method or a hemoglobin concentration of cord blood below 10.0 g/mL. Results: the overall perinatal survival rate was 46% for hydropic fetuses and 84% for the nonhydropic ones. There were no maternal side effects related to the procedures. Half of the intrauterine transfusions were performed by the intravascular route. The mean gestational age at the delivery was 34.8 weeks. Conclusions: despite better perinatal results with intrauterine transfusions guided by ultrasound, especially using intravascular procedures, rhesus isoimmunization remains as an important cause of high rates of perinatal morbidity and mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):291-298
DOI 10.1590/S0100-72032001000500004
Objective: to study the value of Doppler velocimetry of the ductus venosus and of the umbilical artery and vein, in the screening for chromosomal abnormalities at 10-14 weeks of gestation. Patients and Methods: a total of 314 fetuses were studied consecutively. In 112 cases a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus, and in 202 cases the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the umbilical artery and vein, particularly of the ductus venosus. For statistical analysis the Fisher exact test and the Mann-Whitney test were used. Results: twenty-three cases of chromosomal abnormalities occurred. Of these abnormal cases, the ductus venosus blood flow during atrial contraction was absent (1 case) and reverse (22 cases), sensitivity was 92%. In the group of normal fetuses (289 cases), 6 evaluations demonstrated alterations in the Doppler of the ductus venosus (specificity of 97.6%, positive and negative predictive values of 76.7% and 93.3%, respectively); the false-positive rate was 2.4%. In reference to the umbilical vein and umbilical artery, there was no statistically significant difference between the abnormal and the normal group. Conclusion: The only parameter of Doppler velocimetry of the umbilical artery and vein which contributed to the detection of aneuploidies was the accidental discovery of the reverse blood flow in both vessels. Although our favorable results demonstrated that the Doppler velocimetry of the ductus venosus is effective in detecting aneuploidies, this conclusion, however, is preliminary and needs further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):291-298
DOI 10.1590/S0100-72032001000500004
Objective: to study the value of Doppler velocimetry of the ductus venosus and of the umbilical artery and vein, in the screening for chromosomal abnormalities at 10-14 weeks of gestation. Patients and Methods: a total of 314 fetuses were studied consecutively. In 112 cases a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus, and in 202 cases the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the umbilical artery and vein, particularly of the ductus venosus. For statistical analysis the Fisher exact test and the Mann-Whitney test were used. Results: twenty-three cases of chromosomal abnormalities occurred. Of these abnormal cases, the ductus venosus blood flow during atrial contraction was absent (1 case) and reverse (22 cases), sensitivity was 92%. In the group of normal fetuses (289 cases), 6 evaluations demonstrated alterations in the Doppler of the ductus venosus (specificity of 97.6%, positive and negative predictive values of 76.7% and 93.3%, respectively); the false-positive rate was 2.4%. In reference to the umbilical vein and umbilical artery, there was no statistically significant difference between the abnormal and the normal group. Conclusion: The only parameter of Doppler velocimetry of the umbilical artery and vein which contributed to the detection of aneuploidies was the accidental discovery of the reverse blood flow in both vessels. Although our favorable results demonstrated that the Doppler velocimetry of the ductus venosus is effective in detecting aneuploidies, this conclusion, however, is preliminary and needs further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):283-287
DOI 10.1590/S0100-72032001000500003
Purpose: to study in primigravid adolescents the behavior of serum leptin levels during the evolution of normal pregnancy, comparing the results with those obtained from preeclamptics. Methods: prospective, longitudinal study conducted in 15 normotensive pregnant adolescents and 5 preeclamptic adolescents. Serum leptin levels (ng/mL) were determined by radioimmunoassay. Blood pressure was measured by the oscilometric method by using DINAMAP 1846. Patients were evaluated in two different gestational periods: between the 21st and 30th week and between the 31st and 40th week. The ratio leptin/body mass index (BMI) was used to correct changes observed in BMI throughout gestation. Preeclamptic pregnant patients were diagnosed when the blood pressure was > or = 140/90 mmHg, proteinuria >300 mg/24 h and when arteriolar spasm was present in the optic fundi. Results: there was a trend towards an elevation of serum leptin at the end of pregnancy in both groups although more pronounced in preeclamptic patients. In pregnant normotensive patients serum leptin increased from 11.9±1.20 (21stto 30th week) to 13.9±2.23 ng/mL (31st to 40th week), and in preeclamptic from 11.9±1.20 to 17.6±4.565 ng/mL. In preeclamptic patients the BMI increased significantly in the period from the 21st to 30th week when compared to the period between the 31st and 40thweek: 21.5±0.8 vs 27.4±1.7 kg/m², p<0.05.In normotensive these values were maintained stable: 24.9±1.5 vs 25.1±1.00 kg/m². At the end of gestation the ratio leptin/BMI was significantly higher in preeclamptics: 0.56±0.06 (21stto 30thweek) vs 0.70±0.15, p<0.05. The values of the ratio leptin/BMI in normotensive pregnants varied from 0.44±0.02 between the 21st and 30th week to 0.41±0.04 between the 31st to 40thweek. In normal pregnants there was a direct and significant correlation between the levels of leptin and BMI in both periods of pregnancy: r = 0.7, p<0.004 (31st to 40th ) vs r = 0.94, p<0.0001 (31st to 40th week). These correlations were lost in preeclamptic patients in both gestational periods. Conclusion: the higher concentrations of leptin and leptin/BMI ratio observed when preeclamptics were compared with normotensive patients, in both gestational periods, suggest a leptin resistance pattern in preeclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):283-287
DOI 10.1590/S0100-72032001000500003
Purpose: to study in primigravid adolescents the behavior of serum leptin levels during the evolution of normal pregnancy, comparing the results with those obtained from preeclamptics. Methods: prospective, longitudinal study conducted in 15 normotensive pregnant adolescents and 5 preeclamptic adolescents. Serum leptin levels (ng/mL) were determined by radioimmunoassay. Blood pressure was measured by the oscilometric method by using DINAMAP 1846. Patients were evaluated in two different gestational periods: between the 21st and 30th week and between the 31st and 40th week. The ratio leptin/body mass index (BMI) was used to correct changes observed in BMI throughout gestation. Preeclamptic pregnant patients were diagnosed when the blood pressure was > or = 140/90 mmHg, proteinuria >300 mg/24 h and when arteriolar spasm was present in the optic fundi. Results: there was a trend towards an elevation of serum leptin at the end of pregnancy in both groups although more pronounced in preeclamptic patients. In pregnant normotensive patients serum leptin increased from 11.9±1.20 (21stto 30th week) to 13.9±2.23 ng/mL (31st to 40th week), and in preeclamptic from 11.9±1.20 to 17.6±4.565 ng/mL. In preeclamptic patients the BMI increased significantly in the period from the 21st to 30th week when compared to the period between the 31st and 40thweek: 21.5±0.8 vs 27.4±1.7 kg/m², p<0.05.In normotensive these values were maintained stable: 24.9±1.5 vs 25.1±1.00 kg/m². At the end of gestation the ratio leptin/BMI was significantly higher in preeclamptics: 0.56±0.06 (21stto 30thweek) vs 0.70±0.15, p<0.05. The values of the ratio leptin/BMI in normotensive pregnants varied from 0.44±0.02 between the 21st and 30th week to 0.41±0.04 between the 31st to 40thweek. In normal pregnants there was a direct and significant correlation between the levels of leptin and BMI in both periods of pregnancy: r = 0.7, p<0.004 (31st to 40th ) vs r = 0.94, p<0.0001 (31st to 40th week). These correlations were lost in preeclamptic patients in both gestational periods. Conclusion: the higher concentrations of leptin and leptin/BMI ratio observed when preeclamptics were compared with normotensive patients, in both gestational periods, suggest a leptin resistance pattern in preeclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):277-282
DOI 10.1590/S0100-72032001000500002
Objective: to test the effectiveness of the polymerase chain reaction (PCR) in the amniotic fluid for the detection of fetal contamination due to Toxoplasma gondii in pregnant women with acute infection and to correlate it with the inoculation technique and the histology of the placenta. Methods: thirty-seven patients were prospectively studied and the diagnosis was based on the identification of maternal acute infection followed by amniocentesis guided by ultrasound to obtain amniotic fluid for PCR and mice inoculation. The mothers were treated with spiramycin throughout pregnancy; when fetal infection was demonstrated, pyrimethamine and sulfadiazine were added to the regimen. The placentas were processed for histologic examination. The infants were followed for a period that varied from three to 23 months for the confirmation or exclusion of congenital toxoplasmosis. Results: association measures such as sensitivity, specificity and predictive values were calculated for PCR in the amniotic fluid, detection of the parasite through mice inoculation and placental histology and showed the following results: PCR values of sensitivity = 66.7% and specificity = 87.1%; the respective values for mice inoculation were 50 and 100% and for the placental histology were 80 and 66.7%. Conclusion: although PCR should not be used alone for the prenatal diagnosis of congenital toxoplasmosis, it is a promising method and deserves more studies to improve its efficacy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):277-282
DOI 10.1590/S0100-72032001000500002
Objective: to test the effectiveness of the polymerase chain reaction (PCR) in the amniotic fluid for the detection of fetal contamination due to Toxoplasma gondii in pregnant women with acute infection and to correlate it with the inoculation technique and the histology of the placenta. Methods: thirty-seven patients were prospectively studied and the diagnosis was based on the identification of maternal acute infection followed by amniocentesis guided by ultrasound to obtain amniotic fluid for PCR and mice inoculation. The mothers were treated with spiramycin throughout pregnancy; when fetal infection was demonstrated, pyrimethamine and sulfadiazine were added to the regimen. The placentas were processed for histologic examination. The infants were followed for a period that varied from three to 23 months for the confirmation or exclusion of congenital toxoplasmosis. Results: association measures such as sensitivity, specificity and predictive values were calculated for PCR in the amniotic fluid, detection of the parasite through mice inoculation and placental histology and showed the following results: PCR values of sensitivity = 66.7% and specificity = 87.1%; the respective values for mice inoculation were 50 and 100% and for the placental histology were 80 and 66.7%. Conclusion: although PCR should not be used alone for the prenatal diagnosis of congenital toxoplasmosis, it is a promising method and deserves more studies to improve its efficacy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.