Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):441-445
DOI 10.1590/S0100-72031999000800003
SUMMARY Purpose: to estimate the prevalence of Candida sp. and the distribution of its species in the vagina of women attended at a family planning Service. Methods: a cross-sectional study evaluating prospectively 72 nonpregnant women, with or without specific complaints. Samples were checked for the presence of yeast and vaginal pH. Data obtained by gynecologic examination were also recorded. Results: yeast belonging to the genus Candida was isolated from 18 (25%) patients. The most prevalent species was C. albicans (77,8%) and therefore, 22.2% were non-albicans species. The most prevalent among the non-albicans species was C. glabrata (16.7%) followed by C. parapsilosis (5.6%). The symptoms most directly associated with Candida were itching and burning. Different from the symptoms directly associated with C. albicans infection, we observed that C. glabrata does not cause vaginal discharge. There was no positive association between predisponent factors such as age, education and contraceptive method used and the presence or absence of Candida. Conclusions: our results suggest: (i) that there is a high prevalence of Candida species among women; (ii) that non-albicans species play an important role in the vaginal medium; (iii) that itching and burning are the most common symptoms in women with Candida, and (iv) C. glabrata usually does not cause vaginal discharge. Finally, it is important to emphasize that our results are consistent with the present worldwide findings.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):441-445
DOI 10.1590/S0100-72031999000800003
SUMMARY Purpose: to estimate the prevalence of Candida sp. and the distribution of its species in the vagina of women attended at a family planning Service. Methods: a cross-sectional study evaluating prospectively 72 nonpregnant women, with or without specific complaints. Samples were checked for the presence of yeast and vaginal pH. Data obtained by gynecologic examination were also recorded. Results: yeast belonging to the genus Candida was isolated from 18 (25%) patients. The most prevalent species was C. albicans (77,8%) and therefore, 22.2% were non-albicans species. The most prevalent among the non-albicans species was C. glabrata (16.7%) followed by C. parapsilosis (5.6%). The symptoms most directly associated with Candida were itching and burning. Different from the symptoms directly associated with C. albicans infection, we observed that C. glabrata does not cause vaginal discharge. There was no positive association between predisponent factors such as age, education and contraceptive method used and the presence or absence of Candida. Conclusions: our results suggest: (i) that there is a high prevalence of Candida species among women; (ii) that non-albicans species play an important role in the vaginal medium; (iii) that itching and burning are the most common symptoms in women with Candida, and (iv) C. glabrata usually does not cause vaginal discharge. Finally, it is important to emphasize that our results are consistent with the present worldwide findings.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):447-449
DOI 10.1590/S0100-72031999000800004
SUMMARY Purpose: the number of male sexual partners, age, precocious beginning of sexual activity, cigarette smoking and oral contraception were correlated with human papillomavirus (HPV) infection, as were cervical ectopia, although with conflicting results. The objective is to analyze a group of women with HPV infection and to verify the incidence of cervical ectopia. Methods: we have studied 471 women with Papanicolaou smears suggesting HPV infection (Schneider et al.'s criteria) and its relationship with cervical ectopia, beginning of sexual activity and the use of oral contraceptive. Results: of the total of cases, 182 (38.6%) had ectopia. Of these, 157 (86.3%) were 30 years old or less, compared to 47.8% of women without ectopia (p<0.001, chi² test). A percentage of 77.4 of cases with ectopia had the beginning of sexual activity before 18 years compared to 71.3% cases without ectopia. Among women with ectopia, 45.7% had taken the pill recently compared to 24.3% which had not (p<0.001, chi² test). Conclusions: it was concluded that the beginning of sexual activity was not correlated with ectopia. The prevalence of ectopia was more commom in women under 30 years and/or in use of oral contraceptive.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):447-449
DOI 10.1590/S0100-72031999000800004
SUMMARY Purpose: the number of male sexual partners, age, precocious beginning of sexual activity, cigarette smoking and oral contraception were correlated with human papillomavirus (HPV) infection, as were cervical ectopia, although with conflicting results. The objective is to analyze a group of women with HPV infection and to verify the incidence of cervical ectopia. Methods: we have studied 471 women with Papanicolaou smears suggesting HPV infection (Schneider et al.'s criteria) and its relationship with cervical ectopia, beginning of sexual activity and the use of oral contraceptive. Results: of the total of cases, 182 (38.6%) had ectopia. Of these, 157 (86.3%) were 30 years old or less, compared to 47.8% of women without ectopia (p<0.001, chi² test). A percentage of 77.4 of cases with ectopia had the beginning of sexual activity before 18 years compared to 71.3% cases without ectopia. Among women with ectopia, 45.7% had taken the pill recently compared to 24.3% which had not (p<0.001, chi² test). Conclusions: it was concluded that the beginning of sexual activity was not correlated with ectopia. The prevalence of ectopia was more commom in women under 30 years and/or in use of oral contraceptive.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):453-456
DOI 10.1590/S0100-72031999000800005
ABSTRACT Purpose: to evaluate the degree of satisfaction of patients submitted to resection of a supernumerary breast, in terms of esthetics, and the rate of complications. Patients and Methods: twenty-three women submitted to surgical treatment for removal of axillary breast tissue at the Breast Unit of the HC-UFG, between July 1994 and September 1997, were evaluated. Age ranged between 20 and 49 (mean 35 years). Patient complaints included local pain, discomfort and questions on personal esthetics. The patients' satisfaction was evaluated through an interview in which they reported to be very satisfied, satisfied, unsatisfied or regretting the surgery. The HC-UFG team also evaluated each of these patients, considering the cosmetic result as very good, good or poor. Results: according to the evaluation by the patients themselves, 61% were very satisfied and none regretted the surgery. The evaluation carried out by the medical team was stricter, as only 22% of the cases were rated as very good by the evaluators. In terms of complications, there was a 22% incidence of seroma and 13% of infection. Conclusion: the discrepancy among the patients' and doctors' ratings seems to demonstrate that the degree of satisfaction of the patients is higher than that one could initially suppose, a fact that motivates us to carry on offering this treatment modality to those who wish to have it, even considering the relative high rate of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):453-456
DOI 10.1590/S0100-72031999000800005
ABSTRACT Purpose: to evaluate the degree of satisfaction of patients submitted to resection of a supernumerary breast, in terms of esthetics, and the rate of complications. Patients and Methods: twenty-three women submitted to surgical treatment for removal of axillary breast tissue at the Breast Unit of the HC-UFG, between July 1994 and September 1997, were evaluated. Age ranged between 20 and 49 (mean 35 years). Patient complaints included local pain, discomfort and questions on personal esthetics. The patients' satisfaction was evaluated through an interview in which they reported to be very satisfied, satisfied, unsatisfied or regretting the surgery. The HC-UFG team also evaluated each of these patients, considering the cosmetic result as very good, good or poor. Results: according to the evaluation by the patients themselves, 61% were very satisfied and none regretted the surgery. The evaluation carried out by the medical team was stricter, as only 22% of the cases were rated as very good by the evaluators. In terms of complications, there was a 22% incidence of seroma and 13% of infection. Conclusion: the discrepancy among the patients' and doctors' ratings seems to demonstrate that the degree of satisfaction of the patients is higher than that one could initially suppose, a fact that motivates us to carry on offering this treatment modality to those who wish to have it, even considering the relative high rate of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):459-463
DOI 10.1590/S0100-72031999000800006
SUMMARY Purpose: to examine the response of the fetal heart rate (FHR) and middle cerebral artery resistance (MCA PI) to vibratory stimulation (VAS) in normal human fetuses. Methods: when the fetuses were without activity (in apnea and without corporal movements), we obtained baseline measurements of MCA PI and FHR before and after the application of a 3-sec vibratory acoustic stimulus. Real time ultrasonography with pulsed wave and color Doppler imaging was used for the execution of the study. The VAS was performed using a bicycle horn with 400 to 4000 Hz and sound pressure was 65 to 110 dB. Results: the FHR before VAS was 139 ± 3.14 bpm and after VAS was 153 ± 7.23 bpm (p<0.0001). The MCA PI rate before VAS was 1.84 ± 0.07 and after VAS was 1.56 ± 0.04 (p<0.001). In all cases we observed a fetal response with vigorous corporal movements, FHR rise and MCA PI reduction after VAS. Conclusions: we conclude that VAS, in human fetuses near term, for 3 sec as described in this study, determines some response, with increase in FHR and corporal movement and MCA PI reduction. Although we have a tendence to say that VAS determines fetal cerebral flow increase, these data do not allow such clinic interpretation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):459-463
DOI 10.1590/S0100-72031999000800006
SUMMARY Purpose: to examine the response of the fetal heart rate (FHR) and middle cerebral artery resistance (MCA PI) to vibratory stimulation (VAS) in normal human fetuses. Methods: when the fetuses were without activity (in apnea and without corporal movements), we obtained baseline measurements of MCA PI and FHR before and after the application of a 3-sec vibratory acoustic stimulus. Real time ultrasonography with pulsed wave and color Doppler imaging was used for the execution of the study. The VAS was performed using a bicycle horn with 400 to 4000 Hz and sound pressure was 65 to 110 dB. Results: the FHR before VAS was 139 ± 3.14 bpm and after VAS was 153 ± 7.23 bpm (p<0.0001). The MCA PI rate before VAS was 1.84 ± 0.07 and after VAS was 1.56 ± 0.04 (p<0.001). In all cases we observed a fetal response with vigorous corporal movements, FHR rise and MCA PI reduction after VAS. Conclusions: we conclude that VAS, in human fetuses near term, for 3 sec as described in this study, determines some response, with increase in FHR and corporal movement and MCA PI reduction. Although we have a tendence to say that VAS determines fetal cerebral flow increase, these data do not allow such clinic interpretation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):465-470
DOI 10.1590/S0100-72031999000800007
SUMMARY Objective: to evaluate the inclusion parameters in the selection of cases of (tubal) ectopic pregnancy for expectant management and to assess the results. Methods: a prospective study was carried out in 70 patients with unruptured (tubal) ectopic pregnancy, with the objective to carry out an expectant management. The main inclusion criteria in this study were the diameter of the tubal mass, that should be equal or inferior to 5,0 cm, reduced titles of beta-hCG (beta fraction of the chorionic gonadotropic hormone) as compared to the initial value within an interval of 48 h, hemodynamic stability, wishes for future pregnancy and a written permission to participate in the study. All patients were observed in the hospital and when reduction in beta-hCG titles was observed, the patients were discharged from the hospital and followed in the outpatient department, with weekly determinations of beta-hCG until levels lower than 5 mIU/ml were reached, that were considered successful. Results: of the 70 patients who underwent expectant management, only one needed a surgical intervention, because of tubal rupture. The initial values of beta-hCG of the patients ranged from 27 mIU/ml to 41,000 mIU/ml. The average diameter of the tubal mass was 2.9 cm. The presence of free liquid in the peritoneal cavity was observed in 50 patients, small amount in 26 patients, moderate in 16 and large in 8 patients. The ultrasonographic resolution of hematosalpinx occurred in 58 patients and tubal ring was visualized in 12 patients. On color Doppler, 52 were at low risk and 18 at medium risk. Conclusions: the expectant management should be applied with safety in the cases that respect the inclusion criteria, the index of success of this study being 98.6%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):465-470
DOI 10.1590/S0100-72031999000800007
SUMMARY Objective: to evaluate the inclusion parameters in the selection of cases of (tubal) ectopic pregnancy for expectant management and to assess the results. Methods: a prospective study was carried out in 70 patients with unruptured (tubal) ectopic pregnancy, with the objective to carry out an expectant management. The main inclusion criteria in this study were the diameter of the tubal mass, that should be equal or inferior to 5,0 cm, reduced titles of beta-hCG (beta fraction of the chorionic gonadotropic hormone) as compared to the initial value within an interval of 48 h, hemodynamic stability, wishes for future pregnancy and a written permission to participate in the study. All patients were observed in the hospital and when reduction in beta-hCG titles was observed, the patients were discharged from the hospital and followed in the outpatient department, with weekly determinations of beta-hCG until levels lower than 5 mIU/ml were reached, that were considered successful. Results: of the 70 patients who underwent expectant management, only one needed a surgical intervention, because of tubal rupture. The initial values of beta-hCG of the patients ranged from 27 mIU/ml to 41,000 mIU/ml. The average diameter of the tubal mass was 2.9 cm. The presence of free liquid in the peritoneal cavity was observed in 50 patients, small amount in 26 patients, moderate in 16 and large in 8 patients. The ultrasonographic resolution of hematosalpinx occurred in 58 patients and tubal ring was visualized in 12 patients. On color Doppler, 52 were at low risk and 18 at medium risk. Conclusions: the expectant management should be applied with safety in the cases that respect the inclusion criteria, the index of success of this study being 98.6%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):475-479
DOI 10.1590/S0100-72031999000800008
SUMMARY Purpose: to evaluate the role of prenatal diagnosis of gastroschisis in the quality of assistance to and in the evolution of neonates with gastroschisis. Methods: a retrospective survey of 25 charts of neonates with gastroschisis treated at the State University of Campinas, between January 1989 and June 1998. Results: comparing the groups with prenatal (PN) and neonatal (NN) diagnosis, no differences regarding incidence of prematurity, birth weight and relations hip between weight and gestational age were observed. The median time from birth to surgery was 5 h. Such interval was shorter in the PN than the NN group (2.25 h versus 13 h; p<0.05). Primary closure of the defect was achieved in 17 neonates (68%) of both groups. Although this difference was not statistically significant, survival was higher among infants of the PN group (85.7% versus 45.5%). Conclusions: prenatal diagnosis of gastroschisis contributes favorably to improve perinatal assistance, resulting in reduced mortality of these children.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(8):475-479
DOI 10.1590/S0100-72031999000800008
SUMMARY Purpose: to evaluate the role of prenatal diagnosis of gastroschisis in the quality of assistance to and in the evolution of neonates with gastroschisis. Methods: a retrospective survey of 25 charts of neonates with gastroschisis treated at the State University of Campinas, between January 1989 and June 1998. Results: comparing the groups with prenatal (PN) and neonatal (NN) diagnosis, no differences regarding incidence of prematurity, birth weight and relations hip between weight and gestational age were observed. The median time from birth to surgery was 5 h. Such interval was shorter in the PN than the NN group (2.25 h versus 13 h; p<0.05). Primary closure of the defect was achieved in 17 neonates (68%) of both groups. Although this difference was not statistically significant, survival was higher among infants of the PN group (85.7% versus 45.5%). Conclusions: prenatal diagnosis of gastroschisis contributes favorably to improve perinatal assistance, resulting in reduced mortality of these children.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):499-504
DOI 10.1590/S0100-72031999000900002
Purpose: to evaluate the ultrasound characteristics of normal pregnancies, according to the placental maturity, local of insertion and thickness, fetal presentation and position during the second half of pregnancy. Methods: a descriptive study was perfomed, including at least 120 measures in each gestational age, in 2,868 normal pregnant women from Campinas, Brazil, studied through routine obstetric ultrasound examinations, with fetal biometry and placental evaluation, applying Grannum, Berkowitz, Hobbins (1979) criteria for placental maturity. Placental thickness was measured at the cord insertion site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):499-504
DOI 10.1590/S0100-72031999000900002
Purpose: to evaluate the ultrasound characteristics of normal pregnancies, according to the placental maturity, local of insertion and thickness, fetal presentation and position during the second half of pregnancy. Methods: a descriptive study was perfomed, including at least 120 measures in each gestational age, in 2,868 normal pregnant women from Campinas, Brazil, studied through routine obstetric ultrasound examinations, with fetal biometry and placental evaluation, applying Grannum, Berkowitz, Hobbins (1979) criteria for placental maturity. Placental thickness was measured at the cord insertion site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):509-515
DOI 10.1590/S0100-72031999000900003
Purpose: to evaluate the relationship between uterine contractions and premature delivery. Methods: between February 1996 and July 1998, 73 high risk pregnant women for preterm delivery, between the 24th and 34th weeks of gestation, were submitted to uterine contraction monitoring with tokodynamometers for 1 hour twice a week. The positive test was the presence of 4 contractions/h before the 30th week of gestation, and after this time, 6 contractions/h. Result: of 73 women, 17 patients (23.28%) were excluded from the final analysis because they presented obstetric problems or unfavorable development for the final result. The rate of preterm delivery was 21.23% (13/56). The mean frequency of uterine contractions was greater in women with preterm delivery than in those with term delivery. The test presented sensitivity of 69.23%, specificity of 86.04%, positive predictive value of 60% and negative predictive value of 90.24%. Conclusion: negative tests are associated with a low risk of preterm birth. When the test is positive, association with other premature delivery markers is necessary to improve our ability to efficiently identify patients at risk for preterm delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):509-515
DOI 10.1590/S0100-72031999000900003
Purpose: to evaluate the relationship between uterine contractions and premature delivery. Methods: between February 1996 and July 1998, 73 high risk pregnant women for preterm delivery, between the 24th and 34th weeks of gestation, were submitted to uterine contraction monitoring with tokodynamometers for 1 hour twice a week. The positive test was the presence of 4 contractions/h before the 30th week of gestation, and after this time, 6 contractions/h. Result: of 73 women, 17 patients (23.28%) were excluded from the final analysis because they presented obstetric problems or unfavorable development for the final result. The rate of preterm delivery was 21.23% (13/56). The mean frequency of uterine contractions was greater in women with preterm delivery than in those with term delivery. The test presented sensitivity of 69.23%, specificity of 86.04%, positive predictive value of 60% and negative predictive value of 90.24%. Conclusion: negative tests are associated with a low risk of preterm birth. When the test is positive, association with other premature delivery markers is necessary to improve our ability to efficiently identify patients at risk for preterm delivery.
