Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):147-152
DOI 10.1590/S0100-72031999000300005
Purpose: to determine the possible occurrence of hemodynamic changes in the middle cerebral artery of the fetus (MCA) using color doppler after vibro-acoustic stimulation. Methods: thirty fetuses from pregnant women considered to be clinically normal, with a gestational age of 28 weeks or more were submitted to vibro-acoustic stimulation. We examined the changes in blood flow rate in the middle cerebral artery of the fetus on the basis of resistance index (RI) and fetal heart rate (FHR) by color doppler before and after the sound stimulus. Results: mean FHR before vibro-acoustic stimulation was 142.41 beats per minute (bpm) with a standard deviation of 9.01 and a range of 122 to 162 bpm. After stimulation, mean FHR was 159.44 bpm with a standard deviation of 15.49 and a range of 130 to 187 bpm (p<0.01). Mean RI in the MCA of the fetuses was 75.89% (range: 64 to 91%) before the experiment. After the vibro-acoustic stimulation, mean RI was 66.93% (range: 47 to 83%; p < 0.01). Conclusions: we observed that a sound stimulus provokes the well-known immediate and significant elevation of FHR and a decrease in cerebral vascular resistance when evaluated by the RI of the fetal middle cerebral artery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):147-152
DOI 10.1590/S0100-72031999000300005
Purpose: to determine the possible occurrence of hemodynamic changes in the middle cerebral artery of the fetus (MCA) using color doppler after vibro-acoustic stimulation. Methods: thirty fetuses from pregnant women considered to be clinically normal, with a gestational age of 28 weeks or more were submitted to vibro-acoustic stimulation. We examined the changes in blood flow rate in the middle cerebral artery of the fetus on the basis of resistance index (RI) and fetal heart rate (FHR) by color doppler before and after the sound stimulus. Results: mean FHR before vibro-acoustic stimulation was 142.41 beats per minute (bpm) with a standard deviation of 9.01 and a range of 122 to 162 bpm. After stimulation, mean FHR was 159.44 bpm with a standard deviation of 15.49 and a range of 130 to 187 bpm (p<0.01). Mean RI in the MCA of the fetuses was 75.89% (range: 64 to 91%) before the experiment. After the vibro-acoustic stimulation, mean RI was 66.93% (range: 47 to 83%; p < 0.01). Conclusions: we observed that a sound stimulus provokes the well-known immediate and significant elevation of FHR and a decrease in cerebral vascular resistance when evaluated by the RI of the fetal middle cerebral artery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):153-157
DOI 10.1590/S0100-72031999000300006
Purpose: to evaluate the efficacy of color Doppler in the prediction of results of the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Methodology: twenty patients with a diagnosis of ectopic pregnancy were included in the study. The inclusion criteria were: hemodynamic stability, adnexal mass < 5.0 cm and decline of the titers of beta-hCG less than 15% in an interval of 24 h. The exclusion criteria were hepatic or renal disease and blood dyscrasias. Follow-up was by serial determinations of beta-hCG on days 4 and 7 after the beginning of the treatment, and weekly until the titers were negative. The patients were classified into 3 groups according to color Doppler: high risk (trophoblastic flow covering more than 2/3 of the mass), medium risk (when trophoblastic flow compromised 1/3 to 2/3 of tubal mass) and low risk (when trophoblastic flow covered less than 1/3 of the mass). Results: the success of the treatment with a single dose was 75% (15/20); when a second dose of MTX was used, the success rate was 85%. When comparing color Doppler with the results of the medical treatment, we had high risk in 4 patients and in all the treatment failed; medium and low risk in 16 patients, and in 15 the treatment was successful. Conclusion: color Doppler showing high risk indicated an unfavorable situation for the medical treatment with MTX, while medium and low risk in color doppler were favorable situations for the clinical treatment. However, these results should always be analyzed in association with the evolution curve of the beta-hCG titers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):153-157
DOI 10.1590/S0100-72031999000300006
Purpose: to evaluate the efficacy of color Doppler in the prediction of results of the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Methodology: twenty patients with a diagnosis of ectopic pregnancy were included in the study. The inclusion criteria were: hemodynamic stability, adnexal mass < 5.0 cm and decline of the titers of beta-hCG less than 15% in an interval of 24 h. The exclusion criteria were hepatic or renal disease and blood dyscrasias. Follow-up was by serial determinations of beta-hCG on days 4 and 7 after the beginning of the treatment, and weekly until the titers were negative. The patients were classified into 3 groups according to color Doppler: high risk (trophoblastic flow covering more than 2/3 of the mass), medium risk (when trophoblastic flow compromised 1/3 to 2/3 of tubal mass) and low risk (when trophoblastic flow covered less than 1/3 of the mass). Results: the success of the treatment with a single dose was 75% (15/20); when a second dose of MTX was used, the success rate was 85%. When comparing color Doppler with the results of the medical treatment, we had high risk in 4 patients and in all the treatment failed; medium and low risk in 16 patients, and in 15 the treatment was successful. Conclusion: color Doppler showing high risk indicated an unfavorable situation for the medical treatment with MTX, while medium and low risk in color doppler were favorable situations for the clinical treatment. However, these results should always be analyzed in association with the evolution curve of the beta-hCG titers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):161-165
DOI 10.1590/S0100-72031999000300007
Purpose: to evaluate the social, demographic and obstetrical profile of adolescents as compared with adult women hospitalized for abortion complications. Material and methods: this is a descriptive study that evaluated 230 women with abortion complications. Among them, 59 were adolescents hospitalized at the IMIP Maternity (Recife, Brazil) from August 1994 to July 1995. The variables studied were: educational level, marital status, any paid activity, gestation age, number of pregnancies, desire to become pregnant, use of anticonceptive method, kind of relationship, reason for voluntary interruption, clinical classification of abortion and associated complications. The procedure for data analysis was the distribution of variables among adolescents and adults, the differences being evaluated through chi² and chi² for trend. Results: compared with the adult women who aborted, the adolescents showed a lower number of paid activity and multiparity and a higher number of pregnancies resulting from an unstable relationship. Conclusions: the results indicated that biologicallly the adolescents who were hospitalized for abortion have a similar profile to adult women. What differentiates them are the unfavorable social and demographic conditions that they are faced with at their generally unplanned first pregnancies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):161-165
DOI 10.1590/S0100-72031999000300007
Purpose: to evaluate the social, demographic and obstetrical profile of adolescents as compared with adult women hospitalized for abortion complications. Material and methods: this is a descriptive study that evaluated 230 women with abortion complications. Among them, 59 were adolescents hospitalized at the IMIP Maternity (Recife, Brazil) from August 1994 to July 1995. The variables studied were: educational level, marital status, any paid activity, gestation age, number of pregnancies, desire to become pregnant, use of anticonceptive method, kind of relationship, reason for voluntary interruption, clinical classification of abortion and associated complications. The procedure for data analysis was the distribution of variables among adolescents and adults, the differences being evaluated through chi² and chi² for trend. Results: compared with the adult women who aborted, the adolescents showed a lower number of paid activity and multiparity and a higher number of pregnancies resulting from an unstable relationship. Conclusions: the results indicated that biologicallly the adolescents who were hospitalized for abortion have a similar profile to adult women. What differentiates them are the unfavorable social and demographic conditions that they are faced with at their generally unplanned first pregnancies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):261-266
DOI 10.1590/S0100-72031999000500003
Purpose: to evaluate the immune status of women in reproductive age regarding the rubella virus. Methods: 2,243 samples of serum from women in the age range of 15 to 45 years, with an average of 26 years, living in the urban area of Natal, RN were analyzed, to evaluate the immune status in regard to rubella virus. Of these women, 1,170 (52.1%) were pregnant and 1,073 (47.9%) were not. IgM and IgG antibodies were determined, using solid phase ELISA and fluorescence (ELFA) techniques. Results: of the 2,243 women, 1,632 showed immunity to rubella virus and 611 did not, therefore being susceptible to this virus. The rates of immunity and susceptibility in this study were 73.0% and 27.0%, respectively. In 611 susceptible woman, 14.5% did not present antibodies against rubella virus, 7.7% had only IgM antibody and 4.8% had IgG and IgM antibodies. Conclusions: our findings show that a significant group of women from Natal, in reproductive age, is still susceptible to rubella virus, indicating the risk of congenital infection by this pathogen. We advise the selective vaccination of those women against rubella to prevent clinical manifestations related to the congenital form of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):261-266
DOI 10.1590/S0100-72031999000500003
Purpose: to evaluate the immune status of women in reproductive age regarding the rubella virus. Methods: 2,243 samples of serum from women in the age range of 15 to 45 years, with an average of 26 years, living in the urban area of Natal, RN were analyzed, to evaluate the immune status in regard to rubella virus. Of these women, 1,170 (52.1%) were pregnant and 1,073 (47.9%) were not. IgM and IgG antibodies were determined, using solid phase ELISA and fluorescence (ELFA) techniques. Results: of the 2,243 women, 1,632 showed immunity to rubella virus and 611 did not, therefore being susceptible to this virus. The rates of immunity and susceptibility in this study were 73.0% and 27.0%, respectively. In 611 susceptible woman, 14.5% did not present antibodies against rubella virus, 7.7% had only IgM antibody and 4.8% had IgG and IgM antibodies. Conclusions: our findings show that a significant group of women from Natal, in reproductive age, is still susceptible to rubella virus, indicating the risk of congenital infection by this pathogen. We advise the selective vaccination of those women against rubella to prevent clinical manifestations related to the congenital form of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
