Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):519-525
DOI 10.1590/S0100-72031999000900004
Purpose: to present the perinatal outcomes resulting from the use of a protocol for assistance to diabetic pregnant women used at the Center for Integral Assistance to Women's Health (CAISM), of the University of Campinas. Methods: ninety diabetic pregnant women, who were assisted at the institution with this protocol, were compared with two control grups: the first consisted of 180 pregnant women with equal number of gestations and same age (control A) and the second consisted of 180 randomly selected pregnant women (control B). The study variables were route of delivery, indication for cesarean section, gestational age, Apgar score at first and fifth minute, weight, adequacy of weight for gestational age and perinatal morbidity and mortality. For the statistical analysis Student's t-test and the chi2 test were used. Results: there was a higher incidence of cesarean sections, prematures and large to gestational age (LGA) babies among diabetic women, as well as higher occurrence of neonatal morbidity such as hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress and neonatal depression. The incidence of low Apgar score and perinatal mortality was significantly higher than in the randomly selected group, but the same as in the group matched regarding age and number of pregnancies. Conclusions: although this protocol intends to obtain a perfect metabolic control among diabetic pregnant women, the perinatal outcomes are still unfavorable in comparison to nondiabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):519-525
DOI 10.1590/S0100-72031999000900004
Purpose: to present the perinatal outcomes resulting from the use of a protocol for assistance to diabetic pregnant women used at the Center for Integral Assistance to Women's Health (CAISM), of the University of Campinas. Methods: ninety diabetic pregnant women, who were assisted at the institution with this protocol, were compared with two control grups: the first consisted of 180 pregnant women with equal number of gestations and same age (control A) and the second consisted of 180 randomly selected pregnant women (control B). The study variables were route of delivery, indication for cesarean section, gestational age, Apgar score at first and fifth minute, weight, adequacy of weight for gestational age and perinatal morbidity and mortality. For the statistical analysis Student's t-test and the chi2 test were used. Results: there was a higher incidence of cesarean sections, prematures and large to gestational age (LGA) babies among diabetic women, as well as higher occurrence of neonatal morbidity such as hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress and neonatal depression. The incidence of low Apgar score and perinatal mortality was significantly higher than in the randomly selected group, but the same as in the group matched regarding age and number of pregnancies. Conclusions: although this protocol intends to obtain a perfect metabolic control among diabetic pregnant women, the perinatal outcomes are still unfavorable in comparison to nondiabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):527-531
DOI 10.1590/S0100-72031999000900005
Purpose: to compare the efficacy and safety between two doses of intravaginal misoprostol for cervical ripening and induction of labor. Patients and Methods: sixty-one patients with medical indication for induction of labor and unfavorable cervix were included in this study. Twenty-eight of them received 25 µg and thirty-three 50 µg misoprostol, every four hours until delivery. Results: premature rupture of membranes, prolonged gestation and preeclampsia were the main indications for labor induction. The time interval, in minutes, from insertion of misoprostol until delivery was similar for the 25 µg (416.3 ± 148.1) and 50 µg (425.0 ± 135.9) groups. The percentage of vaginal delivery was 82.2% and 81.9% in the groups of 25µg and 50 µg, respectively. There was no significant difference between the two groups regarding fetal or maternal complications. Conclusions: the administration of intravaginal misoprostol was shown to be an efficient and safe method for cervical ripening and induction of labor. The dose of 25 µg was similarly effective and safe when compared to 50 µg.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):527-531
DOI 10.1590/S0100-72031999000900005
Purpose: to compare the efficacy and safety between two doses of intravaginal misoprostol for cervical ripening and induction of labor. Patients and Methods: sixty-one patients with medical indication for induction of labor and unfavorable cervix were included in this study. Twenty-eight of them received 25 µg and thirty-three 50 µg misoprostol, every four hours until delivery. Results: premature rupture of membranes, prolonged gestation and preeclampsia were the main indications for labor induction. The time interval, in minutes, from insertion of misoprostol until delivery was similar for the 25 µg (416.3 ± 148.1) and 50 µg (425.0 ± 135.9) groups. The percentage of vaginal delivery was 82.2% and 81.9% in the groups of 25µg and 50 µg, respectively. There was no significant difference between the two groups regarding fetal or maternal complications. Conclusions: the administration of intravaginal misoprostol was shown to be an efficient and safe method for cervical ripening and induction of labor. The dose of 25 µg was similarly effective and safe when compared to 50 µg.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):533-538
DOI 10.1590/S0100-72031999000900006
Purpose: to develop an animal model for the study of, and training in, bovine biopsies. Methods: cow ovaries were obtained from a slaughterhouse and transported to the laboratory where the oocytes were aspirated, maturated and submitted to in vitro fertilization. On the 5th day after fertilization, the embryos were biopsied, with the zona pellucida being opened with a cutting blade fitted to the light microscope. One or two blastomeres were removed from the embryos and left in coculture for three additional days. After this time, embryo development was evaluated in comparison to a control group by morphological study and cell counts using specific staining for nuclei. Results: forty of the 57 biopsied embryos reached the blastocyst stage (70.2%) and hatching was observed in 11 (27.5%). Forty-two blastocysts were obtained in the control group (73.7%) and 11 of them hatched (26.2%). Cell counts showed no significant differences between groups. Conclusions: we conclude that the proposed protocol is technically feasible and supplies a good number of embryos because of the easy technique for obtaining bovine oocytes, thus representing a method that could be adopted for training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):533-538
DOI 10.1590/S0100-72031999000900006
Purpose: to develop an animal model for the study of, and training in, bovine biopsies. Methods: cow ovaries were obtained from a slaughterhouse and transported to the laboratory where the oocytes were aspirated, maturated and submitted to in vitro fertilization. On the 5th day after fertilization, the embryos were biopsied, with the zona pellucida being opened with a cutting blade fitted to the light microscope. One or two blastomeres were removed from the embryos and left in coculture for three additional days. After this time, embryo development was evaluated in comparison to a control group by morphological study and cell counts using specific staining for nuclei. Results: forty of the 57 biopsied embryos reached the blastocyst stage (70.2%) and hatching was observed in 11 (27.5%). Forty-two blastocysts were obtained in the control group (73.7%) and 11 of them hatched (26.2%). Cell counts showed no significant differences between groups. Conclusions: we conclude that the proposed protocol is technically feasible and supplies a good number of embryos because of the easy technique for obtaining bovine oocytes, thus representing a method that could be adopted for training.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):539-544
DOI 10.1590/S0100-72031999000900007
Purpose: some medical institutions have been prophylactically ministrating anti-HIV therapy in cases of sexual violence, although there are no appropriate basic facts to establish its efficacy. The aim of the present study was to evaluate the acceptance, tolerance and adhesion of these women under a chemoprophylaxis plan for HIV. Methods: sixty-two women victims of rape and/or anal intercourse with unknown aggressors have been evaluated. Prophylaxis has been started within the first 48 h after violence and maintained for 4 weeks, with daily administration of zidovudine, 600 mg; indinavir, 2,400 mg and lamivudine, 300 mg. Results: the discontinuance rate was 24.2%, withe 12 cases (80%) due to gastric intolerance. The side effects were present in 43 cases (69.4%), including nausea and vomitting as the most frequent. Complex dosage and time of administration were factors possibly related to the inadequate use of the drugs in 10.6% of the cases. Conclusion: the authors concluded that the chemoprophylaxis discontinuance rate was similar to that observed in other indications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):539-544
DOI 10.1590/S0100-72031999000900007
Purpose: some medical institutions have been prophylactically ministrating anti-HIV therapy in cases of sexual violence, although there are no appropriate basic facts to establish its efficacy. The aim of the present study was to evaluate the acceptance, tolerance and adhesion of these women under a chemoprophylaxis plan for HIV. Methods: sixty-two women victims of rape and/or anal intercourse with unknown aggressors have been evaluated. Prophylaxis has been started within the first 48 h after violence and maintained for 4 weeks, with daily administration of zidovudine, 600 mg; indinavir, 2,400 mg and lamivudine, 300 mg. Results: the discontinuance rate was 24.2%, withe 12 cases (80%) due to gastric intolerance. The side effects were present in 43 cases (69.4%), including nausea and vomitting as the most frequent. Complex dosage and time of administration were factors possibly related to the inadequate use of the drugs in 10.6% of the cases. Conclusion: the authors concluded that the chemoprophylaxis discontinuance rate was similar to that observed in other indications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):549-552
DOI 10.1590/S0100-72031999000900008
Purpose: to evaluate the correlation between clinical and surgical staging of patients with vulvar carcinoma, according to the "Federação Internacional de Ginecologia e Obstetrícia" (FIGO 95). Methods: the authors studied 66 consecutive cases of vulvar carcinoma from 1977 to 1997. All patients were clinically staged to verify size and localization of the lesion as well as inguinal lymph node involvement and invasion of other organs. Forty-four patients were submitted to surgical treatment and 34 could be staged according to FIGO 95. Results: among the 34 patients staged through surgery, 17 (50%) showed agreement between clinical and surgical staging. Thus, in 17 patients the staging was different and in these the surgical staging was higher than the clinical in 13 cases and lower in 4 cases. We found in the clinical staging I, 2 cases that were surgical stage II and 1 case that was surgical stage III. Conclusion: the surgical staging could detect lymph node metastasis in patients with clinically negative nodes, as well as exclude false-positive cases. The clinical staging was not accurate for patients with vulvar carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):549-552
DOI 10.1590/S0100-72031999000900008
Purpose: to evaluate the correlation between clinical and surgical staging of patients with vulvar carcinoma, according to the "Federação Internacional de Ginecologia e Obstetrícia" (FIGO 95). Methods: the authors studied 66 consecutive cases of vulvar carcinoma from 1977 to 1997. All patients were clinically staged to verify size and localization of the lesion as well as inguinal lymph node involvement and invasion of other organs. Forty-four patients were submitted to surgical treatment and 34 could be staged according to FIGO 95. Results: among the 34 patients staged through surgery, 17 (50%) showed agreement between clinical and surgical staging. Thus, in 17 patients the staging was different and in these the surgical staging was higher than the clinical in 13 cases and lower in 4 cases. We found in the clinical staging I, 2 cases that were surgical stage II and 1 case that was surgical stage III. Conclusion: the surgical staging could detect lymph node metastasis in patients with clinically negative nodes, as well as exclude false-positive cases. The clinical staging was not accurate for patients with vulvar carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):555-559
DOI 10.1590/S0100-72031999000900009
Purpose: high parity and/or young age at first sexual intercourse have been reported as risk factors for cervical cancer development. Actually, little research has been devoted to these risk factors. The aim of the present study was to analyze the parity and age at first sexual intercourse in women with invasive cervical cancer. Methods: we have retrospectively studied the age at first sexual intercourse and parity of 362 women with invasive cervical cancer diagnosed at the Outpatient Clinic of Oncological Gynecology of the "Faculdade de Medicina do Triângulo Mineiro" from 1978 to 1995. The cases were analyzed according to the date of diagnosis and divided into three groups: from 1978 to 1983 with 65 cases, from 1984 to 1989 with 127 cases and from 1990 to 1995 with 170 cases. Results: the results showed that high parity (4 or more births) diminished from the first to the third period (82, 67.3 and 63.8%, respectively) (p<0.02, chi² test). The first sexual intercourse before 18 years occurred respectively in 59.2, 54.5 and 55.5% of the patients (p, not significant). Conclusions: it was concluded that high parity seems to be related to invasive cervical cancer, although in recent years the parity decreased. The first sexual intercourse occurred before the age of 18 years in the patients of the three periods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):555-559
DOI 10.1590/S0100-72031999000900009
Purpose: high parity and/or young age at first sexual intercourse have been reported as risk factors for cervical cancer development. Actually, little research has been devoted to these risk factors. The aim of the present study was to analyze the parity and age at first sexual intercourse in women with invasive cervical cancer. Methods: we have retrospectively studied the age at first sexual intercourse and parity of 362 women with invasive cervical cancer diagnosed at the Outpatient Clinic of Oncological Gynecology of the "Faculdade de Medicina do Triângulo Mineiro" from 1978 to 1995. The cases were analyzed according to the date of diagnosis and divided into three groups: from 1978 to 1983 with 65 cases, from 1984 to 1989 with 127 cases and from 1990 to 1995 with 170 cases. Results: the results showed that high parity (4 or more births) diminished from the first to the third period (82, 67.3 and 63.8%, respectively) (p<0.02, chi² test). The first sexual intercourse before 18 years occurred respectively in 59.2, 54.5 and 55.5% of the patients (p, not significant). Conclusions: it was concluded that high parity seems to be related to invasive cervical cancer, although in recent years the parity decreased. The first sexual intercourse occurred before the age of 18 years in the patients of the three periods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):569-576
DOI 10.1590/S0100-72031999001000002
Purpose: to estimate growth curves and tables of average biparietal diameter and average head circumference of twin gestations and to compare them with published growth curves for singletons and twins. Methods: growth curves and tables of average biparietal diameter and average head circumference were obtained from sonographic examinations of 34 patients with twin gestations without maternal and fetal complications. Sonographic examinations were performed each 2 or 3 weeks by a single observer. The parameters were compared with existing growth curves for singletons and twins. Results: curves and tables of biparietal diameter and head circumference in relation to gestational age were obtained. The study revealed difference in growth pattern mainly regarding the 3rd trimester in relation to singletons (Hadlock et al.15). The difference between the average values were 6 mm (biparietal diameter) and 2.0 cm (head circumference) at the 39th week of gestation. Also, some differences were observed relative to the twin studies. Conclusion: this study revealed that growth curves for average biparietal diameter and average head circumference of singletons are not appropriate to determine gestational age in twin gestations of the studiced population principally at the 3rd trimester
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):569-576
DOI 10.1590/S0100-72031999001000002
Purpose: to estimate growth curves and tables of average biparietal diameter and average head circumference of twin gestations and to compare them with published growth curves for singletons and twins. Methods: growth curves and tables of average biparietal diameter and average head circumference were obtained from sonographic examinations of 34 patients with twin gestations without maternal and fetal complications. Sonographic examinations were performed each 2 or 3 weeks by a single observer. The parameters were compared with existing growth curves for singletons and twins. Results: curves and tables of biparietal diameter and head circumference in relation to gestational age were obtained. The study revealed difference in growth pattern mainly regarding the 3rd trimester in relation to singletons (Hadlock et al.15). The difference between the average values were 6 mm (biparietal diameter) and 2.0 cm (head circumference) at the 39th week of gestation. Also, some differences were observed relative to the twin studies. Conclusion: this study revealed that growth curves for average biparietal diameter and average head circumference of singletons are not appropriate to determine gestational age in twin gestations of the studiced population principally at the 3rd trimester
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):579-584
DOI 10.1590/S0100-72031999001000003
Purpose: to evaluate the accuracy of maternal perception of fetal movements (MPFM) in diabetic pregnant women, using Apgar score at the 1st and 5th min of life, intrapartum fetal distress and neonatal hypoxia as parameters. Methods: two hundred and nine diabetic women evaluated at the High Risk Prenatal Care Clinic of the Women's Hospital (CAISM) were analyzed retrospectively between June 1988 and May 1996. All patients had MPFM records within three days before delivery, fetal heart rate recordings during labor, gestational age greater than 30 weeks and a complete neonatal evaluation. MPFM was classified as normal if seven movements were recorded in 60 min. Results: the sensitivity of the test was 23 and 29% for Apgar score <7 at the 5th min and intrapartum fetal distress, respectively, and close to 50% for neonatal hypoxia (45.5%). Specificity was near 95% for the three standards, and the negative predictive value (NPV) was 80% for fetal distress, increasing to 97 and 98% for Apgar >7 at 5 min and neonatal hypoxia. Conclusions: MPFM is a useful test to identify diabetic women needing fetal evaluation with more complex techniques, given the high NPV, that indicates the capacity to separate the cases where the fetus is in good condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(10):579-584
DOI 10.1590/S0100-72031999001000003
Purpose: to evaluate the accuracy of maternal perception of fetal movements (MPFM) in diabetic pregnant women, using Apgar score at the 1st and 5th min of life, intrapartum fetal distress and neonatal hypoxia as parameters. Methods: two hundred and nine diabetic women evaluated at the High Risk Prenatal Care Clinic of the Women's Hospital (CAISM) were analyzed retrospectively between June 1988 and May 1996. All patients had MPFM records within three days before delivery, fetal heart rate recordings during labor, gestational age greater than 30 weeks and a complete neonatal evaluation. MPFM was classified as normal if seven movements were recorded in 60 min. Results: the sensitivity of the test was 23 and 29% for Apgar score <7 at the 5th min and intrapartum fetal distress, respectively, and close to 50% for neonatal hypoxia (45.5%). Specificity was near 95% for the three standards, and the negative predictive value (NPV) was 80% for fetal distress, increasing to 97 and 98% for Apgar >7 at 5 min and neonatal hypoxia. Conclusions: MPFM is a useful test to identify diabetic women needing fetal evaluation with more complex techniques, given the high NPV, that indicates the capacity to separate the cases where the fetus is in good condition.