Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):317-321
DOI 10.1590/S0100-72032003000500003
PURPOSE: to evaluate the rate of seropositivity for parvovirus B19 (PB19) among pregnant women and the rate of seroconversion against this infection during pregnancy. METHODS: prospective study carried out in the Hospital of the Medical School of Ribeirão Preto, University of São Paulo. In the first stage of the present study, we evaluated 245 pregnant women with gestational age less than 16 weeks to determine the seroprevalence of PB19 infection by ELISA. According to the serological results we determined if the PB19 infection was an acute infection (IgM positive and IgG negative or positive), or a former infection (IgM negative and IgG positive). In the second stage of this study, 73 previously seronegative pregnant women were tested again when they came to the hospital for delivery (IgM and IgG), to detect the seroconversion rate during pregnancy. RESULTS: the seroprevalence of the PB19 infection until 16 weeks of gestation was 62.9% (95% IC: 56.8-68.9), divided into acute infection (8.1%), or former infection (54.8%). Of the 73 patients, seronegative in the first stage of this investigation, seven (9.6%) showed seroconversion during pregnancy (95% IC: 2.8-16.3), two (2.7%) showed acute serological infection and five (6.9%) presented markers of past infection. The final seroprevalence of PB19 infection during pregnancy was 72.5%. CONCLUSIONS: considering that only the acute PB19 infection is associated with risk for vertical transmission, the high seroprevalence of this infection observed in this study would be protecting these fetuses against this form of infection. Despite the relatively high rate of seroconversion against PB19 infection during the pregnancy period, we did not observe any symptomatic neonate in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):317-321
DOI 10.1590/S0100-72032003000500003
PURPOSE: to evaluate the rate of seropositivity for parvovirus B19 (PB19) among pregnant women and the rate of seroconversion against this infection during pregnancy. METHODS: prospective study carried out in the Hospital of the Medical School of Ribeirão Preto, University of São Paulo. In the first stage of the present study, we evaluated 245 pregnant women with gestational age less than 16 weeks to determine the seroprevalence of PB19 infection by ELISA. According to the serological results we determined if the PB19 infection was an acute infection (IgM positive and IgG negative or positive), or a former infection (IgM negative and IgG positive). In the second stage of this study, 73 previously seronegative pregnant women were tested again when they came to the hospital for delivery (IgM and IgG), to detect the seroconversion rate during pregnancy. RESULTS: the seroprevalence of the PB19 infection until 16 weeks of gestation was 62.9% (95% IC: 56.8-68.9), divided into acute infection (8.1%), or former infection (54.8%). Of the 73 patients, seronegative in the first stage of this investigation, seven (9.6%) showed seroconversion during pregnancy (95% IC: 2.8-16.3), two (2.7%) showed acute serological infection and five (6.9%) presented markers of past infection. The final seroprevalence of PB19 infection during pregnancy was 72.5%. CONCLUSIONS: considering that only the acute PB19 infection is associated with risk for vertical transmission, the high seroprevalence of this infection observed in this study would be protecting these fetuses against this form of infection. Despite the relatively high rate of seroconversion against PB19 infection during the pregnancy period, we did not observe any symptomatic neonate in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):331-335
DOI 10.1590/S0100-72032003000500005
PURPOSE: to evaluate whether there is an association between recurrent spontaneous abortion and atopy. METHODS: this was a case-control study with 230 women: 71 with a history of recurrent spontaneous abortion (group A) and 159 with a history of successful pregnancy (group B). The evaluation included a questionnaire in order to investigate the personal history of atopy, considering symptoms of atopic dermatitis, urticaria, rhinitis, asthma, conjunctivitis and gastric or intestinal symptoms. The presence of specific IgE in response to a pool of inhalants, Phadiatop, detected by an enzymatic fluorescence reaction in blood was also investigated. The data were analyzed by Fisher's exact test and a p value < 0.05 was set as level of significance. RESULTS: a positive history of atopy was observed in 57.7% of group A patients and in 55.3% of group B patients. The incidence of positive IgE against Phadiatop was 38% and 33.9% in groups A and B, respectively. Association of allergy disease with positive Phadiatop (presence of specific IgE) was detected in 28.2% of group A and in 22% of group B patients. There was no significant difference between the groups. CONCLUSIONS: we did not observe any association between recurrent spontaneous abortion and atopy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):331-335
DOI 10.1590/S0100-72032003000500005
PURPOSE: to evaluate whether there is an association between recurrent spontaneous abortion and atopy. METHODS: this was a case-control study with 230 women: 71 with a history of recurrent spontaneous abortion (group A) and 159 with a history of successful pregnancy (group B). The evaluation included a questionnaire in order to investigate the personal history of atopy, considering symptoms of atopic dermatitis, urticaria, rhinitis, asthma, conjunctivitis and gastric or intestinal symptoms. The presence of specific IgE in response to a pool of inhalants, Phadiatop, detected by an enzymatic fluorescence reaction in blood was also investigated. The data were analyzed by Fisher's exact test and a p value < 0.05 was set as level of significance. RESULTS: a positive history of atopy was observed in 57.7% of group A patients and in 55.3% of group B patients. The incidence of positive IgE against Phadiatop was 38% and 33.9% in groups A and B, respectively. Association of allergy disease with positive Phadiatop (presence of specific IgE) was detected in 28.2% of group A and in 22% of group B patients. There was no significant difference between the groups. CONCLUSIONS: we did not observe any association between recurrent spontaneous abortion and atopy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):353-358
DOI 10.1590/S0100-72032003000500008
PURPOSE: to determine interobserver reliability of site-specific measurements and stages according to the proposed International Continence Society prolapse terminology document. METHODS: we analyzed 51 women during urogynecological investigation performed at the Urogynecology and Vaginal Surgery Sector of UNIFESP / EPM. We recorded the locations of point-specific measures proposed by the International Continence Society (ICS). They are: two in the anterior vaginal wall, two in the superior vagina, two in the posterior vaginal wall, genital hiatus, perineal body and total vaginal length. Then we recorded the stage of genital prolapse. Women underwent pelvic examinations by two investigators, each blinded to the results of the other's examination. The reproducibility of the nine site-specific measurements and the summary stage were analyzed using Pearson's correlation coefficient and the median measurements were compared by the paired-t test. RESULTS: there were substantial and highly significant correlations for each of the nine measurements. Correlation coefficient for point Aa was 0.89 (p<0.0001), point Ba 0.90 (p<0.0001), point C 0.97 (p<0.0001), point Ap de 0.72 (p<0.0001), point Bp 0.84 (p<0.0001), point D 0.91 (p<0.0001), genital hiatus 0.65 (p<0.0001), perineal body 0.66 (p<0.0001) e total vaginal length 0.73 (p<0.0001). We also did not note differences between the means of measurements by the two examiners. Staging was highly reproducible (r=0.81, p<0.0001). ln no subject did the stage vary by more than one; in 86,2%, stages were identical. CONCLUSIONS: there is a good reproducibility of measures using the system proposed by the International Continence Society prolapse terminology document.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):353-358
DOI 10.1590/S0100-72032003000500008
PURPOSE: to determine interobserver reliability of site-specific measurements and stages according to the proposed International Continence Society prolapse terminology document. METHODS: we analyzed 51 women during urogynecological investigation performed at the Urogynecology and Vaginal Surgery Sector of UNIFESP / EPM. We recorded the locations of point-specific measures proposed by the International Continence Society (ICS). They are: two in the anterior vaginal wall, two in the superior vagina, two in the posterior vaginal wall, genital hiatus, perineal body and total vaginal length. Then we recorded the stage of genital prolapse. Women underwent pelvic examinations by two investigators, each blinded to the results of the other's examination. The reproducibility of the nine site-specific measurements and the summary stage were analyzed using Pearson's correlation coefficient and the median measurements were compared by the paired-t test. RESULTS: there were substantial and highly significant correlations for each of the nine measurements. Correlation coefficient for point Aa was 0.89 (p<0.0001), point Ba 0.90 (p<0.0001), point C 0.97 (p<0.0001), point Ap de 0.72 (p<0.0001), point Bp 0.84 (p<0.0001), point D 0.91 (p<0.0001), genital hiatus 0.65 (p<0.0001), perineal body 0.66 (p<0.0001) e total vaginal length 0.73 (p<0.0001). We also did not note differences between the means of measurements by the two examiners. Staging was highly reproducible (r=0.81, p<0.0001). ln no subject did the stage vary by more than one; in 86,2%, stages were identical. CONCLUSIONS: there is a good reproducibility of measures using the system proposed by the International Continence Society prolapse terminology document.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):365-370
DOI 10.1590/S0100-72032003000500010
PURPOSE: to assess the performance of hybrid capture II (HCII) HPV viral load in predicting the grade of cervical lesions. METHODS: between August 2000 to November 2002, 309 women admitted due to an abnormal Pap smear result were recruited. Histological disease confirmation was done in all women and cervical intraepithelial neoplasia (CIN) grade 2 or above was considered as severe disease. HCII was done for high-risk HPV types and viral load was estimated in relative light units (RLU). Receiver operating characteristics analysis was used to test the performance of HCII. RESULTS: histological findings included 140 (45.3%) cervicitis or CIN 1 and 199 (54.7%) CIN 2/3, in situ adenocarcinoma or invasive cancer. The best cutoff for HCII in detecting severe disease was 35 RLU, showing a sensitivity of 69% and a specificity of 70%. Association of high-grade cervical lesions at Pap smear and HCII at 35 RLU showed a positive predictive value of 88.2% in diagnosis of CIN 2 or above. On the other hand, 95.7% of the women with low grade lesion at cytology and HCII below 1 RLU presented no severe histological disease. CONCLUSIONS: the best performance of HCII in diagnosing CIN 2 or above was found at 35 RLU. Association of cytology and HCII in different settings provided very high positive and negative predictive values.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):365-370
DOI 10.1590/S0100-72032003000500010
PURPOSE: to assess the performance of hybrid capture II (HCII) HPV viral load in predicting the grade of cervical lesions. METHODS: between August 2000 to November 2002, 309 women admitted due to an abnormal Pap smear result were recruited. Histological disease confirmation was done in all women and cervical intraepithelial neoplasia (CIN) grade 2 or above was considered as severe disease. HCII was done for high-risk HPV types and viral load was estimated in relative light units (RLU). Receiver operating characteristics analysis was used to test the performance of HCII. RESULTS: histological findings included 140 (45.3%) cervicitis or CIN 1 and 199 (54.7%) CIN 2/3, in situ adenocarcinoma or invasive cancer. The best cutoff for HCII in detecting severe disease was 35 RLU, showing a sensitivity of 69% and a specificity of 70%. Association of high-grade cervical lesions at Pap smear and HCII at 35 RLU showed a positive predictive value of 88.2% in diagnosis of CIN 2 or above. On the other hand, 95.7% of the women with low grade lesion at cytology and HCII below 1 RLU presented no severe histological disease. CONCLUSIONS: the best performance of HCII in diagnosing CIN 2 or above was found at 35 RLU. Association of cytology and HCII in different settings provided very high positive and negative predictive values.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):371-373
DOI 10.1590/S0100-72032003000500011
PURPOSE: to evaluate the effect of lyophilized and liquid heparin on umbilical cord blood pH measure. METHOD: we carried out a prospective study with 102 newborn arterial umbilical cord blood samples at the Obstetrics Department of the "Hospital Geral de Caxias do Sul". The authors used 51 syringes previously prepared with lyophilized heparin (syringe A) and 51 syringes prepared with liquid heparin (syringe B) for sample collection. Immediately after delivery a segment of the umbilical cord was doubly clamped and blood samples were obtained for measurements of pH and gases. The umbilical arterial blood pH was analyzed within 20 minutes by an AVL OMNI pH analyzer (Vienna, Austria). RESULTS: the average values of umbilical cord arterial blood pH in groups A and B were 7.246±0.086 and 7.244±0.084, respectively. The analysis showed no significant differences between blood samples in both syringes. CONCLUSION: we conclude that the two types of syringes have similar effects on blood pH analysis, allowing us to choose the less expensive one.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):371-373
DOI 10.1590/S0100-72032003000500011
PURPOSE: to evaluate the effect of lyophilized and liquid heparin on umbilical cord blood pH measure. METHOD: we carried out a prospective study with 102 newborn arterial umbilical cord blood samples at the Obstetrics Department of the "Hospital Geral de Caxias do Sul". The authors used 51 syringes previously prepared with lyophilized heparin (syringe A) and 51 syringes prepared with liquid heparin (syringe B) for sample collection. Immediately after delivery a segment of the umbilical cord was doubly clamped and blood samples were obtained for measurements of pH and gases. The umbilical arterial blood pH was analyzed within 20 minutes by an AVL OMNI pH analyzer (Vienna, Austria). RESULTS: the average values of umbilical cord arterial blood pH in groups A and B were 7.246±0.086 and 7.244±0.084, respectively. The analysis showed no significant differences between blood samples in both syringes. CONCLUSION: we conclude that the two types of syringes have similar effects on blood pH analysis, allowing us to choose the less expensive one.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):229-235
DOI 10.1590/S0100-72032003000400002
PURPOSE: to determine the association between ultrasonographic, hysteroscopic and histopathologic findings in women with postmenopausal uterine bleeding. METHODS: a retrospective, cross-sectional study was conducted enrolling 156 women with postmenopausal bleeding attended at the Diagnostic Center - IMIP during the period of January 1995 to December 2001. According to the results of the endometrial examination (ultrasound), the patients were classified as having an abnormal or normal finding depending on the cutoffs of 4 or 5 mm. The most common histologic and hysteroscopic findings were studied and classified as premalignant/malignant lesions (hyperplasia/endometrial cancer) or benign findings. These results were compared using the kappa index, to establish the agreement between these techniques. RESULTS: the frequency of endometrial thickening was 75.0 and 67.3% according to cutoffs of 4 mm and 5 mm, respectively. Hysteroscopic findings were atrophic endometrium in 59 (37.8%), endometrial polyp in 56 (35.9%), endometrial hyperplasia in 17 (10.9%), cancer in 16 (10.3%), still active endometrium in 1 (3,2), and other findings in 3 (1.9%). The two most frequent histopathologic findings were also atrophic endometrium (31.4%) and endometrial polyps (26,.3%), followed by scanty material (16.0%), endometrial cancer (10.9%), endometrial hyperplastic changes (9.0%), and others (6.4%). A good agreement between hysteroscopic and histopathologic findings was observed (kappa = 0.61). CONCLUSIONS: the frequency of endometrial thickening was 75.0 and 67.3% according to cutoffs of 4 mm and 5 mm, respectively. No premalignant or malignant lesions were missed when an endometrial cutoff of 4 mm was used. The most frequent hysteroscopic and histopathologic findings were atrophic endometrium and endometrial polyps and a good agreement between these findings was encountered.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):229-235
DOI 10.1590/S0100-72032003000400002
PURPOSE: to determine the association between ultrasonographic, hysteroscopic and histopathologic findings in women with postmenopausal uterine bleeding. METHODS: a retrospective, cross-sectional study was conducted enrolling 156 women with postmenopausal bleeding attended at the Diagnostic Center - IMIP during the period of January 1995 to December 2001. According to the results of the endometrial examination (ultrasound), the patients were classified as having an abnormal or normal finding depending on the cutoffs of 4 or 5 mm. The most common histologic and hysteroscopic findings were studied and classified as premalignant/malignant lesions (hyperplasia/endometrial cancer) or benign findings. These results were compared using the kappa index, to establish the agreement between these techniques. RESULTS: the frequency of endometrial thickening was 75.0 and 67.3% according to cutoffs of 4 mm and 5 mm, respectively. Hysteroscopic findings were atrophic endometrium in 59 (37.8%), endometrial polyp in 56 (35.9%), endometrial hyperplasia in 17 (10.9%), cancer in 16 (10.3%), still active endometrium in 1 (3,2), and other findings in 3 (1.9%). The two most frequent histopathologic findings were also atrophic endometrium (31.4%) and endometrial polyps (26,.3%), followed by scanty material (16.0%), endometrial cancer (10.9%), endometrial hyperplastic changes (9.0%), and others (6.4%). A good agreement between hysteroscopic and histopathologic findings was observed (kappa = 0.61). CONCLUSIONS: the frequency of endometrial thickening was 75.0 and 67.3% according to cutoffs of 4 mm and 5 mm, respectively. No premalignant or malignant lesions were missed when an endometrial cutoff of 4 mm was used. The most frequent hysteroscopic and histopathologic findings were atrophic endometrium and endometrial polyps and a good agreement between these findings was encountered.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):237-241
DOI 10.1590/S0100-72032003000400003
PURPOSE: to investigate the accuracy of hysteroscopy as a method for the evaluation of the uterine cavity in women with postmenopausal bleeding. METHODS: a cross-sectional study that consisted of the evaluation of 78 women with postmenopausal bleeding submitled to histeroscopy and directed biopsy in the period from January 2000 to June 2002 in the Bahia State Oncology Center. Hysteroscopy findings were classified as benign (leiomyoma, polyp, atrophy, normal) and suspect (hyperplasia, thickening, cancer) and the histopathologic findings as benign (leiomyoma, polyp, non-atypical hyperplasia, atrophy) and malignant (cancer and atypical hyperplasia). The results of hysteroscopy were compared with the pathologic findings. RESULTS: in relation to the suspect results (thickening, hyperplasia and cancer) hysteroscopy sensitivity and specificity were 85.7 and 88.7%, respectively. Positive and negative predictive values were 42.83 and 98.4%. Likelihood ratios of positive and negative tests were 7.6 and 0.16. Accuracy was 88.4% and kappa index, 0.5. CONCLUSION: hysteroscopy alone did not show an acceptable accuracy in the study, reinforcing the idea that its main advantage is to direct the biopsy, and it must always be associated with the histological diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):237-241
DOI 10.1590/S0100-72032003000400003
PURPOSE: to investigate the accuracy of hysteroscopy as a method for the evaluation of the uterine cavity in women with postmenopausal bleeding. METHODS: a cross-sectional study that consisted of the evaluation of 78 women with postmenopausal bleeding submitled to histeroscopy and directed biopsy in the period from January 2000 to June 2002 in the Bahia State Oncology Center. Hysteroscopy findings were classified as benign (leiomyoma, polyp, atrophy, normal) and suspect (hyperplasia, thickening, cancer) and the histopathologic findings as benign (leiomyoma, polyp, non-atypical hyperplasia, atrophy) and malignant (cancer and atypical hyperplasia). The results of hysteroscopy were compared with the pathologic findings. RESULTS: in relation to the suspect results (thickening, hyperplasia and cancer) hysteroscopy sensitivity and specificity were 85.7 and 88.7%, respectively. Positive and negative predictive values were 42.83 and 98.4%. Likelihood ratios of positive and negative tests were 7.6 and 0.16. Accuracy was 88.4% and kappa index, 0.5. CONCLUSION: hysteroscopy alone did not show an acceptable accuracy in the study, reinforcing the idea that its main advantage is to direct the biopsy, and it must always be associated with the histological diagnosis.
