Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):243-248
DOI 10.1590/S0100-72032003000400004
PURPOSE: to analyze the influence of seminal parameters on intrauterine insemination (IUI) outcomes in patients with male factor and to emphasize the predictive value of each parameter for the successful result. METHODS: two hundred and thirty-nine IUI cycles (155 couples) were analyzed for 15 months. Female patients were submitted to ovary hyperstimulation according to the "I Consenso Brasileiro de Indução de Ovulação". Seminal analysis based on the World Health Organization (WHO) for sperm concentration and motility was used and sperm morphology was evaluated according to Kruger's criterion. Samples to be used in IUI were prepared by colloidal discontinued gradient (ISolate®). After IUI two patient groups were formed: group G - positive for pregnancy and group NG - negative for pregnancy. RESULTS: there was no statistical difference in total sperm concentration per mL, total motility and progressive motility before and after the ISolate® procedure. When sperm morphology was compared between the two groups, a statistical difference was observed (group G=10.6% normal morphology; group NG=6.4% normal morphology; p<0.05). Better pregnancy results were obtained when the number of inseminated spermatozoa was more than 15 x 10(6)/mL. CONCLUSIONS: sperm morphology and the number of inseminated sperm seem to be positive parameters for pregnancy and should be emphasized during male infertility propaedeutics.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):243-248
DOI 10.1590/S0100-72032003000400004
PURPOSE: to analyze the influence of seminal parameters on intrauterine insemination (IUI) outcomes in patients with male factor and to emphasize the predictive value of each parameter for the successful result. METHODS: two hundred and thirty-nine IUI cycles (155 couples) were analyzed for 15 months. Female patients were submitted to ovary hyperstimulation according to the "I Consenso Brasileiro de Indução de Ovulação". Seminal analysis based on the World Health Organization (WHO) for sperm concentration and motility was used and sperm morphology was evaluated according to Kruger's criterion. Samples to be used in IUI were prepared by colloidal discontinued gradient (ISolate®). After IUI two patient groups were formed: group G - positive for pregnancy and group NG - negative for pregnancy. RESULTS: there was no statistical difference in total sperm concentration per mL, total motility and progressive motility before and after the ISolate® procedure. When sperm morphology was compared between the two groups, a statistical difference was observed (group G=10.6% normal morphology; group NG=6.4% normal morphology; p<0.05). Better pregnancy results were obtained when the number of inseminated spermatozoa was more than 15 x 10(6)/mL. CONCLUSIONS: sperm morphology and the number of inseminated sperm seem to be positive parameters for pregnancy and should be emphasized during male infertility propaedeutics.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):249-254
DOI 10.1590/S0100-72032003000400005
PURPOSE: to assess the morphological and morphometric alterations in the uterine cervix of pregnant albino rats determined by local hyaluronidase administration. METHODS: ten rats with a positive pregnancy test were randomly distributed into two equal groups. The control group consisted of rats that received a single dose of 1 mL distilled water in the uterine cervix, on gestational day 18, under anesthesia. The experimental group consisted of rats that received 0.02 mL hyaluronidase, diluted in 0.98 ml distilled water (total = 1 mL), in the same conditions as those of the control group. On day 20, the rats were anesthetized and submitted to dissection. The uterine cervix was prepared for morphological and morphometric study at light microscopy (hematoxylin and eosin, and Masson trichrome). RESULTS: in the experimental group, greater thinning of the superficial mucified epithelium was observed, with lamina propria rich in blood vessels and eosinophils. Diversely, the control group showed a large concentration of collagen fibers. The histometric analysis in the experimental group was characterized by a smaller number of collagen fibers (mean = 248 versus 552 of control; SD = 49.7 versus 31.1 of control). The parametric method (Student's t test) showed a significant difference between groups (p<0.0001). CONCLUSION: the local use of hyaluronidase in the cervix of pregnant rats determined predominance of loose connective tissue and a smaller concentration of collagen fibers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):249-254
DOI 10.1590/S0100-72032003000400005
PURPOSE: to assess the morphological and morphometric alterations in the uterine cervix of pregnant albino rats determined by local hyaluronidase administration. METHODS: ten rats with a positive pregnancy test were randomly distributed into two equal groups. The control group consisted of rats that received a single dose of 1 mL distilled water in the uterine cervix, on gestational day 18, under anesthesia. The experimental group consisted of rats that received 0.02 mL hyaluronidase, diluted in 0.98 ml distilled water (total = 1 mL), in the same conditions as those of the control group. On day 20, the rats were anesthetized and submitted to dissection. The uterine cervix was prepared for morphological and morphometric study at light microscopy (hematoxylin and eosin, and Masson trichrome). RESULTS: in the experimental group, greater thinning of the superficial mucified epithelium was observed, with lamina propria rich in blood vessels and eosinophils. Diversely, the control group showed a large concentration of collagen fibers. The histometric analysis in the experimental group was characterized by a smaller number of collagen fibers (mean = 248 versus 552 of control; SD = 49.7 versus 31.1 of control). The parametric method (Student's t test) showed a significant difference between groups (p<0.0001). CONCLUSION: the local use of hyaluronidase in the cervix of pregnant rats determined predominance of loose connective tissue and a smaller concentration of collagen fibers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):255-260
DOI 10.1590/S0100-72032003000400006
PURPOSE: to compare maternal morbidity, neonatal results and some clinical and epidemiological characteristics among primiparous women who had one previous cesarean section, according to the performance of elective cesarean (EC) section or trial of labor (TL) during the second delivery. PATIENTS AND METHODS: this is a retrospective cross-sectional study on the second delivery of women who previously had a cesarean section and were assisted at the Center for Integral Assistance to Women's Health (CAISM/UNICAMP), from 1986 to 1998. Data were collected from 2068 clinical records corresponding to 322 cases of EC and 1746 of TL. Data analysis was performed through percentage distribution of the EC and TL cases and also the distribution of variables between these two groups, using the chi2, chi2 for trend and Fisher exact tests to evaluate the statistical difference, with a significance level of 95%. RESULTS: the indication of EC decreased progressively with time, from 22.6% in 1986 to 5% in 1998. Maternal morbity was similar and low in both groups (1.24% and 1.21%). There was no significant difference between groups regarding Apgar score and stillbirths, but there was a significantly higher proportion of premature newborns and with birth weight below 2.500 g and above 4.000 g in the group who underwent EC. The prevalence of EC was significantly higher in women 35 or more years old, with previous or current history of hypertensive disorder, diabetes or with a first dead child, as well as with changes in the volume of amniotic fluid. CONCLUSIONS: performing TL progressively increased during this period of thirteen years, without any increase of maternal and/or neonatal morbidity. The indication for EC followed medical criteria related to unfavorable maternal and/or fetal clinical conditions for vaginal delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):255-260
DOI 10.1590/S0100-72032003000400006
PURPOSE: to compare maternal morbidity, neonatal results and some clinical and epidemiological characteristics among primiparous women who had one previous cesarean section, according to the performance of elective cesarean (EC) section or trial of labor (TL) during the second delivery. PATIENTS AND METHODS: this is a retrospective cross-sectional study on the second delivery of women who previously had a cesarean section and were assisted at the Center for Integral Assistance to Women's Health (CAISM/UNICAMP), from 1986 to 1998. Data were collected from 2068 clinical records corresponding to 322 cases of EC and 1746 of TL. Data analysis was performed through percentage distribution of the EC and TL cases and also the distribution of variables between these two groups, using the chi2, chi2 for trend and Fisher exact tests to evaluate the statistical difference, with a significance level of 95%. RESULTS: the indication of EC decreased progressively with time, from 22.6% in 1986 to 5% in 1998. Maternal morbity was similar and low in both groups (1.24% and 1.21%). There was no significant difference between groups regarding Apgar score and stillbirths, but there was a significantly higher proportion of premature newborns and with birth weight below 2.500 g and above 4.000 g in the group who underwent EC. The prevalence of EC was significantly higher in women 35 or more years old, with previous or current history of hypertensive disorder, diabetes or with a first dead child, as well as with changes in the volume of amniotic fluid. CONCLUSIONS: performing TL progressively increased during this period of thirteen years, without any increase of maternal and/or neonatal morbidity. The indication for EC followed medical criteria related to unfavorable maternal and/or fetal clinical conditions for vaginal delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):261-268
DOI 10.1590/S0100-72032003000400007
PURPOSE: to evaluate Doppler velocimetry of the ductus venosus as a noninvasive test of abnormal pH and gas analysis in preterm fetuses with "brain sparing reflex". METHODS: a cross-sectional study was performed. The studied population consisted of 48 pregnant women between the 25th and the 33rd week of gestation, whose fetuses presented brain sparing reflex (umbilical/cerebral ratio >1). The time elapsed between Doppler velocimetry and the birth (cesarean section under peridural anesthesia) was of up to 5 h. The following parameters were studied: S/A ratio of the ductus venosus, pH and base excess (BE) of fetal blood sample (collected from the umbilical vein immediately after birth). The S/A ratio of the ductus venosus was considered abnormal when superior to 3.6. The fetuses were classified according to the gas analysis result. They were considered abnormal when pH <7.26 and BE £ 6 mMol/L. Fisher's test was used for statistical analysis and considered significant when p £ 0.05. RESULTS: there was a significant correlation between umbilical blood gas analysis in preterm fetuses with brain sparing reflex and ductus venosus S/A ratio (p = 0.0000082; Fisher test). Ductus venosus Doppler velocimetry identified 10 of 14 fetuses with abnormal gas analysis. On the other hand, 32 of 34 fetuses with normal gas analysis were correctly identified. The sensitivity of the ductus venosus S/A ratio for the diagnosis of abnormal blood gas analysis was 71%, specificity 94%, false-negative rate 8%, false-positive rate 4%, positive predictive value 83% and negative predictive value 89%. Pretest likelihood, post-test posterior probability following a positive test result (post-test likelihood) and post-test posterior probability following a negative test result (post-test likelihood) were 31, 84 and 10%, respectively. CONCLUSION: the analysis of the ductus venosus S/A ratio is adequate for the diagnosis of abnormal blood gas analysis in preterm fetuses presenting brain sparing reflex.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):261-268
DOI 10.1590/S0100-72032003000400007
PURPOSE: to evaluate Doppler velocimetry of the ductus venosus as a noninvasive test of abnormal pH and gas analysis in preterm fetuses with "brain sparing reflex". METHODS: a cross-sectional study was performed. The studied population consisted of 48 pregnant women between the 25th and the 33rd week of gestation, whose fetuses presented brain sparing reflex (umbilical/cerebral ratio >1). The time elapsed between Doppler velocimetry and the birth (cesarean section under peridural anesthesia) was of up to 5 h. The following parameters were studied: S/A ratio of the ductus venosus, pH and base excess (BE) of fetal blood sample (collected from the umbilical vein immediately after birth). The S/A ratio of the ductus venosus was considered abnormal when superior to 3.6. The fetuses were classified according to the gas analysis result. They were considered abnormal when pH <7.26 and BE £ 6 mMol/L. Fisher's test was used for statistical analysis and considered significant when p £ 0.05. RESULTS: there was a significant correlation between umbilical blood gas analysis in preterm fetuses with brain sparing reflex and ductus venosus S/A ratio (p = 0.0000082; Fisher test). Ductus venosus Doppler velocimetry identified 10 of 14 fetuses with abnormal gas analysis. On the other hand, 32 of 34 fetuses with normal gas analysis were correctly identified. The sensitivity of the ductus venosus S/A ratio for the diagnosis of abnormal blood gas analysis was 71%, specificity 94%, false-negative rate 8%, false-positive rate 4%, positive predictive value 83% and negative predictive value 89%. Pretest likelihood, post-test posterior probability following a positive test result (post-test likelihood) and post-test posterior probability following a negative test result (post-test likelihood) were 31, 84 and 10%, respectively. CONCLUSION: the analysis of the ductus venosus S/A ratio is adequate for the diagnosis of abnormal blood gas analysis in preterm fetuses presenting brain sparing reflex.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):271-276
DOI 10.1590/S0100-72032003000400008
PURPOSE: to perform a comparative study between uterine curettage and manual vacuum aspiration (MVA) in the treatment of first-trimester miscarriages. METHODS: a hundred and two patients were included up to the 12th week of pregnancy, with diagnosis of miscarriage, admitted at Maternidade Escola Januário Cicco, between January 1998 and July 2001, and who were randomly submitted to uterine curettage or to MVA. The analyzed variables were: pain control, need of mechanical cervical dilation, uterine emptying time, incidence of complications and stay in hospital. The patients were reevaluated clinically and echographycally between 7 and 10 days after the procedures. The chi2 test was used for statistical analysis. RESULTS: general anesthesia was used in all the patients submitted to uterine curettage and in none of those who were submitted to MVA, whose pain was controlled with local anesthesia in 64% of the cases. The differences between the two methods concerning the need of mechanical cervical dilation, emptying time and incidence of complications were not significant. The stay in hospital was significantly shorter in patients submitted to MVA. CONCLUSIONS: no advantage of one method over the other was observed in regard to the technique and the incidence of complications. The unneeded use of general anesthesia and the significantly shorter stay in hospital indicate that MVA should be recommended for all services with obstetrical assistance, increasing resolvability of the cases and decreasing risks, improving the quality of assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):271-276
DOI 10.1590/S0100-72032003000400008
PURPOSE: to perform a comparative study between uterine curettage and manual vacuum aspiration (MVA) in the treatment of first-trimester miscarriages. METHODS: a hundred and two patients were included up to the 12th week of pregnancy, with diagnosis of miscarriage, admitted at Maternidade Escola Januário Cicco, between January 1998 and July 2001, and who were randomly submitted to uterine curettage or to MVA. The analyzed variables were: pain control, need of mechanical cervical dilation, uterine emptying time, incidence of complications and stay in hospital. The patients were reevaluated clinically and echographycally between 7 and 10 days after the procedures. The chi2 test was used for statistical analysis. RESULTS: general anesthesia was used in all the patients submitted to uterine curettage and in none of those who were submitted to MVA, whose pain was controlled with local anesthesia in 64% of the cases. The differences between the two methods concerning the need of mechanical cervical dilation, emptying time and incidence of complications were not significant. The stay in hospital was significantly shorter in patients submitted to MVA. CONCLUSIONS: no advantage of one method over the other was observed in regard to the technique and the incidence of complications. The unneeded use of general anesthesia and the significantly shorter stay in hospital indicate that MVA should be recommended for all services with obstetrical assistance, increasing resolvability of the cases and decreasing risks, improving the quality of assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):277-281
DOI 10.1590/S0100-72032003000400009
PURPOSE: the aim of the present study was to evaluate the accuracy of microalbuminuria to predict preeclampsia. METHODS: a prospective study of 45 consecutive diabetic gestations that were tested for microalbuminuria before the 18th week, between the 18th and 24th week and between the 32nd and 36th week of gestation. All patients had their prenatal care done from January 2000 to December 2001. The DCA 2000 microalbumin/creatinine assay is a quantitative method for measuring low concentrations of albumin, creatinine and the albumin/creatinine ratio in urine. According to laboratory standards, an albumin/creatinine ratio >16 mg/g (1.8 mg/mmol) indicates incipient renal damage and risk for preeclampsia. The sensitivity, specificity, positive and negative predictive values of the albumin/creatinine ratio were determined to predict the occurrence or the absence of preeclampsia, diagnosed through clinical criteria. RESULTS: of all patients, 17% developed preeclampsia. The sensitivity of albumin/creatinine ratio increased from 12.5% at 18 weeks to 25% between the 18th and 24th week and to 87% after the 32nd week. On the other hand, specificity presented a decreasing value from 97 to 89 and 83%, respectively). The positive predictive value was relatively low in the three different periods of evaluation (50, 33 and 53%, respectively. The negative predictive value was increased in the three stages of gestational age (83, 84 and 96%, respectively). CONCLUSIONS: quantification of microalbuminuria could correctly predict the absence of preeclampsia but was less accurate to predict the occurrence of the disease in diabetic pregnancies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):277-281
DOI 10.1590/S0100-72032003000400009
PURPOSE: the aim of the present study was to evaluate the accuracy of microalbuminuria to predict preeclampsia. METHODS: a prospective study of 45 consecutive diabetic gestations that were tested for microalbuminuria before the 18th week, between the 18th and 24th week and between the 32nd and 36th week of gestation. All patients had their prenatal care done from January 2000 to December 2001. The DCA 2000 microalbumin/creatinine assay is a quantitative method for measuring low concentrations of albumin, creatinine and the albumin/creatinine ratio in urine. According to laboratory standards, an albumin/creatinine ratio >16 mg/g (1.8 mg/mmol) indicates incipient renal damage and risk for preeclampsia. The sensitivity, specificity, positive and negative predictive values of the albumin/creatinine ratio were determined to predict the occurrence or the absence of preeclampsia, diagnosed through clinical criteria. RESULTS: of all patients, 17% developed preeclampsia. The sensitivity of albumin/creatinine ratio increased from 12.5% at 18 weeks to 25% between the 18th and 24th week and to 87% after the 32nd week. On the other hand, specificity presented a decreasing value from 97 to 89 and 83%, respectively). The positive predictive value was relatively low in the three different periods of evaluation (50, 33 and 53%, respectively. The negative predictive value was increased in the three stages of gestational age (83, 84 and 96%, respectively). CONCLUSIONS: quantification of microalbuminuria could correctly predict the absence of preeclampsia but was less accurate to predict the occurrence of the disease in diabetic pregnancies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):609-613
DOI 10.1590/S0100-72032000001000002
Purpose: the effects of corticosteroids on the female urinary tract are not well understood, specially in climacteric women with or without estrogen replacement therapy. We studied the effects of corticosteroids on the blood vessels and epithelium of the bladder and urethra of female rats. Method: fifty-four female rats were used, divided into five groups. Group I - ten castrated female rats; Group II - eleven castrated female rats which receivedintraperitoneally 15 mg/kg weight prednisolone, for 26 days; Group III - twelve castrated female rats which received the same amount of corticosteroid, during the same time, and subcutaneously 10 mg/kg 17 beta-estradiol, in the last five days before they were sacrificed; Group IV - eleven castrated rats which received placebo for 26 days; and Group V - no castrated female rats which received the same dose of corticosteroid during the same time as in Group II. Results: we observed an average of 1.8 vessels in the bladder of the castrated group which received corticosteroid, a similar number to that of those which received corticosteroid and estrogen, compared with 0.8 vessel in the placebo group. Regarding the urethra, 0.7 vessel was observed in the group which received corticosteroid, as compared with 0.9 vessel in the group treated with corticosteroid associated with estrogen and 0.4 in the placebo group. Regarding the mucous membrane, the vesical epithelium thickness of 14.1 mm in the placebo group increased to 20.6 mm in that with corticosteroid and to 22.6 mm in that with corticosteroid plus estrogen. The urethral epithelium thickness of 12.4 mm in the placebo group increased to 15.1 mm in the group with corticosteroid and to 16.7 mm in that with corticosteroid plus estrogen. Conclusion: corticosteroids significantly increased the vascularization and the thickness of the vesical and urethral epithelia of castrated female rats.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):609-613
DOI 10.1590/S0100-72032000001000002
Purpose: the effects of corticosteroids on the female urinary tract are not well understood, specially in climacteric women with or without estrogen replacement therapy. We studied the effects of corticosteroids on the blood vessels and epithelium of the bladder and urethra of female rats. Method: fifty-four female rats were used, divided into five groups. Group I - ten castrated female rats; Group II - eleven castrated female rats which receivedintraperitoneally 15 mg/kg weight prednisolone, for 26 days; Group III - twelve castrated female rats which received the same amount of corticosteroid, during the same time, and subcutaneously 10 mg/kg 17 beta-estradiol, in the last five days before they were sacrificed; Group IV - eleven castrated rats which received placebo for 26 days; and Group V - no castrated female rats which received the same dose of corticosteroid during the same time as in Group II. Results: we observed an average of 1.8 vessels in the bladder of the castrated group which received corticosteroid, a similar number to that of those which received corticosteroid and estrogen, compared with 0.8 vessel in the placebo group. Regarding the urethra, 0.7 vessel was observed in the group which received corticosteroid, as compared with 0.9 vessel in the group treated with corticosteroid associated with estrogen and 0.4 in the placebo group. Regarding the mucous membrane, the vesical epithelium thickness of 14.1 mm in the placebo group increased to 20.6 mm in that with corticosteroid and to 22.6 mm in that with corticosteroid plus estrogen. The urethral epithelium thickness of 12.4 mm in the placebo group increased to 15.1 mm in the group with corticosteroid and to 16.7 mm in that with corticosteroid plus estrogen. Conclusion: corticosteroids significantly increased the vascularization and the thickness of the vesical and urethral epithelia of castrated female rats.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):615-618
DOI 10.1590/S0100-72032000001000003
SUMMARY Purpose: to evaluate the videolaparoscopic surgical mana-gement of 32 patients with ovarian endometrioma. Method: retrospective study of thirty-two patients admitted to the Gynecologic Endoscopy Section - Gynecology and Obstetrics Department of the Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" - São Paulo - Brazil with clinical and ultrasonographic diagnosis of ovarian endometrioma, who have been submitted to videolaparoscopic surgery. Eleven of them had endometriomas less than 3 cm and had the tumor emptied and the capsule excised at the first laparoscopy. Twenty-one patients with endometriomas larger than 3 cm were submitted to emptying and washing of the cyst at the first laparoscopy. These women used GnRH analogues for four months (1 dose each month) and were then submitted to a second laparoscopy when the capsule was excised. Histopathologic study was performed in the surgical tissues of all cases. The early results of the procedure and the recurrence rate were evaluated. Results: there were no surgical intercurrent episodes or postsurgical complications. The problem was solved in all but three patients among the 21 with endometriomas larger than 3 cm. These patients presented recurrence of the disease within a period of 6 to 12 months. Conclusion: the videolaparoscopic surgical management of ovarian endometriomas, with capsule excision, showed good results and small number of recurrences.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):615-618
DOI 10.1590/S0100-72032000001000003
SUMMARY Purpose: to evaluate the videolaparoscopic surgical mana-gement of 32 patients with ovarian endometrioma. Method: retrospective study of thirty-two patients admitted to the Gynecologic Endoscopy Section - Gynecology and Obstetrics Department of the Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" - São Paulo - Brazil with clinical and ultrasonographic diagnosis of ovarian endometrioma, who have been submitted to videolaparoscopic surgery. Eleven of them had endometriomas less than 3 cm and had the tumor emptied and the capsule excised at the first laparoscopy. Twenty-one patients with endometriomas larger than 3 cm were submitted to emptying and washing of the cyst at the first laparoscopy. These women used GnRH analogues for four months (1 dose each month) and were then submitted to a second laparoscopy when the capsule was excised. Histopathologic study was performed in the surgical tissues of all cases. The early results of the procedure and the recurrence rate were evaluated. Results: there were no surgical intercurrent episodes or postsurgical complications. The problem was solved in all but three patients among the 21 with endometriomas larger than 3 cm. These patients presented recurrence of the disease within a period of 6 to 12 months. Conclusion: the videolaparoscopic surgical management of ovarian endometriomas, with capsule excision, showed good results and small number of recurrences.