Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):627-632
DOI 10.1590/S0100-72032000001000005
Purpose: to investigate clinical and bacteriological aspects, follow-up and treatment of mastitis in our clinic. Methods: this study was performed at Cleriston Andrade General Hospital. Patients were interviewed regarding personal data, prenatal care, care received during delivery and puerperium and clinical aspects. Their mastitides were classified by Vinha's criteria. The patients with abscesses had them drained for bacteriological study. Culture medium Tryptone Soya Broth was used. Results: seventy nursing mothers were interviewed; 57% of them had given birth for the first time, 57% were between 20 and 29 years old, 51% had not finished elementary school, 63% had income less than the minimum wage, 66% of them had nobody to help with the housework. Out of the seventy females, 50% had not had their breasts examined. Approximately half of them had not been told how to breastfeed (50%) or how to express breast milk (58%). Sixty-three percent had not delivered in institutions designated by WHO as "Children's Friends Hospitals". Engorgement occurred in 46% of the cases and nipple fissures in 47%. According to Vinha's criteria, 44% had lobar, 39% ampular and 17% glandular locations. Presence of Staphylococcus aureus was detected in 55% of the cases. Conclusion: factors such as low schooling, low incomes, no assistance in housework, giving birth for the first time and lack of professional help contributed to occurrence of mastitis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):627-632
DOI 10.1590/S0100-72032000001000005
Purpose: to investigate clinical and bacteriological aspects, follow-up and treatment of mastitis in our clinic. Methods: this study was performed at Cleriston Andrade General Hospital. Patients were interviewed regarding personal data, prenatal care, care received during delivery and puerperium and clinical aspects. Their mastitides were classified by Vinha's criteria. The patients with abscesses had them drained for bacteriological study. Culture medium Tryptone Soya Broth was used. Results: seventy nursing mothers were interviewed; 57% of them had given birth for the first time, 57% were between 20 and 29 years old, 51% had not finished elementary school, 63% had income less than the minimum wage, 66% of them had nobody to help with the housework. Out of the seventy females, 50% had not had their breasts examined. Approximately half of them had not been told how to breastfeed (50%) or how to express breast milk (58%). Sixty-three percent had not delivered in institutions designated by WHO as "Children's Friends Hospitals". Engorgement occurred in 46% of the cases and nipple fissures in 47%. According to Vinha's criteria, 44% had lobar, 39% ampular and 17% glandular locations. Presence of Staphylococcus aureus was detected in 55% of the cases. Conclusion: factors such as low schooling, low incomes, no assistance in housework, giving birth for the first time and lack of professional help contributed to occurrence of mastitis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):633-639
DOI 10.1590/S0100-72032000001000006
Purpose: to evaluate the risk of preterm delivery using the fetal fibronectin test and the measurement of the cervix by transvaginal ultrasonography in pregnant women with previous preterm delivery. Methods: one hundred and seven women were enrolled in the study at 24th, 28thand 32ndweek to detect the presence of fetal fibronectin by immediate-reading membrane test and to perform vaginal ultrasonography to measure the length of the cervix between the internal and external cervical os. The cervix was considered to be short when the cervical length was at or below the cutoff set by the receiver-operating characteristic (ROC) curve for prediction of preterm delivery. Sonographic cervical length and fetal fibronectin were compared to assess the risk of preterm birth before 34 and 37 weeks. Results: the spontaneous preterm delivery rate was 37.4% (40/107). The analysis made by the ROC curve indicated 30 mm as the best cutoff to maximize sensitivity and specificity at 24 and 28 weeks and 25 mm at 32 weeks of gestation. The positive test of fetal fibronectin had a significant relative risk (RR: 1.77; 95% confidence interval (IC): 1.10-2.84) to predict delivery before 37 weeks, when compared with a negative test, only at 28 weeks. The presence of short cervix at 24, 28 and 32 weeks showed a significative RR for birth before 37 weeks. The highest RR occurred with a short cervix at 24 weeks (RR: 4.42; 95% CI: 1.25-15.56). Conclusion: we concluded that the measurement of uterine cervix by vaginal ultrasonography is better than the fetal fibronectin test for evaluating the risk of preterm delivery in women with previous preterm delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):633-639
DOI 10.1590/S0100-72032000001000006
Purpose: to evaluate the risk of preterm delivery using the fetal fibronectin test and the measurement of the cervix by transvaginal ultrasonography in pregnant women with previous preterm delivery. Methods: one hundred and seven women were enrolled in the study at 24th, 28thand 32ndweek to detect the presence of fetal fibronectin by immediate-reading membrane test and to perform vaginal ultrasonography to measure the length of the cervix between the internal and external cervical os. The cervix was considered to be short when the cervical length was at or below the cutoff set by the receiver-operating characteristic (ROC) curve for prediction of preterm delivery. Sonographic cervical length and fetal fibronectin were compared to assess the risk of preterm birth before 34 and 37 weeks. Results: the spontaneous preterm delivery rate was 37.4% (40/107). The analysis made by the ROC curve indicated 30 mm as the best cutoff to maximize sensitivity and specificity at 24 and 28 weeks and 25 mm at 32 weeks of gestation. The positive test of fetal fibronectin had a significant relative risk (RR: 1.77; 95% confidence interval (IC): 1.10-2.84) to predict delivery before 37 weeks, when compared with a negative test, only at 28 weeks. The presence of short cervix at 24, 28 and 32 weeks showed a significative RR for birth before 37 weeks. The highest RR occurred with a short cervix at 24 weeks (RR: 4.42; 95% CI: 1.25-15.56). Conclusion: we concluded that the measurement of uterine cervix by vaginal ultrasonography is better than the fetal fibronectin test for evaluating the risk of preterm delivery in women with previous preterm delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):641-646
DOI 10.1590/S0100-72032000001000007
Purpose: to evaluate the influence of cigarette smoking on uteroplacental, fetoplacental and fetal blood flow by obstetric Doppler velocimetry of the uterine, umbilical and middle cerebral arteries. Method: a prospective study with 42 healthy pregnant women, 20 of whom were smokers and 24 nonsmokers. Ultrasound was performed initially to determine the gestation time. The pregnant women next underwent pulsed and color Doppler velocimetry of the uterine, umbilical and middle cerebral arteries at the 24th, 28th, 32nd, 36th, and 40th week. The smokers were instructed not to smoke for at least two hours before the test. Results: the mean resistance index (RI) of the right and left uterine arteries was greatest in the smoking group at the 36th week [mean (SD) = 0.501 (0.034)], (p = 0.002). The pulsatility index (PI) of the umbilical artery was greatest in the smoking group at the 28th week [mean (SD) = 1.135 (0.182)], (p = 0.008). No difference in the PI of the middle cerebral artery (MCA) was detected between the two groups. However, the MCA/umbilical PI ratio was lower in the smoking group at the 32nd [mean (SD) = 1.977 (0.291)], (p = 0.027), and 36th week [mean (SD) = 1.850 (0.465)], (p = 0.014). Conclusion: it was concluded that smoking increases resistance in the uteroplacental and fetoplacental circulation while simultaneously reducing resistance in the MCA, imitating a "brain-sparing" effect, most likely due to chronic hypoxia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):641-646
DOI 10.1590/S0100-72032000001000007
Purpose: to evaluate the influence of cigarette smoking on uteroplacental, fetoplacental and fetal blood flow by obstetric Doppler velocimetry of the uterine, umbilical and middle cerebral arteries. Method: a prospective study with 42 healthy pregnant women, 20 of whom were smokers and 24 nonsmokers. Ultrasound was performed initially to determine the gestation time. The pregnant women next underwent pulsed and color Doppler velocimetry of the uterine, umbilical and middle cerebral arteries at the 24th, 28th, 32nd, 36th, and 40th week. The smokers were instructed not to smoke for at least two hours before the test. Results: the mean resistance index (RI) of the right and left uterine arteries was greatest in the smoking group at the 36th week [mean (SD) = 0.501 (0.034)], (p = 0.002). The pulsatility index (PI) of the umbilical artery was greatest in the smoking group at the 28th week [mean (SD) = 1.135 (0.182)], (p = 0.008). No difference in the PI of the middle cerebral artery (MCA) was detected between the two groups. However, the MCA/umbilical PI ratio was lower in the smoking group at the 32nd [mean (SD) = 1.977 (0.291)], (p = 0.027), and 36th week [mean (SD) = 1.850 (0.465)], (p = 0.014). Conclusion: it was concluded that smoking increases resistance in the uteroplacental and fetoplacental circulation while simultaneously reducing resistance in the MCA, imitating a "brain-sparing" effect, most likely due to chronic hypoxia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):647-651
DOI 10.1590/S0100-72032000001000008
Purpose: to study the effects of ciprofloxacin on abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes. Methods: we used 30 Wistar rats, divided into three groups: D50-treated (ciprofloxacin, 50 mg/kg); D100-treated (ciprofloxacin 100 mg/kg) and control group which received physiological saline per os, from the 1st to the 7th day after mating. We studied abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number and weight at 1st, 3rd, 5th and 10th day of life and newborn neurological reflexes at 1st, 3rd, 5th and 10th day of life. Results: there was no difference between groups in the number of rats that became pregnant. The same was found for maternal weight gain and newborn number. There was a difference in newborn mean weight on day 3rd, 5th and 10th (p = 0.006, 0.01 and 0.03, respectively). The D100 newborn group was the one with less weight gain up to the 10th day of life. We found a significant difference (p = 0.002) in the newborn orientation reflex on the 1st day of life, that disappeared afterwards. No abortion or gross malformation was found in this study. Conclusions: ciprofloxacin modified the newborn weight and reflex on the first days of life. In conclusion, we consider that the use of ciprofloxacin should be restricted during the pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(10):647-651
DOI 10.1590/S0100-72032000001000008
Purpose: to study the effects of ciprofloxacin on abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes. Methods: we used 30 Wistar rats, divided into three groups: D50-treated (ciprofloxacin, 50 mg/kg); D100-treated (ciprofloxacin 100 mg/kg) and control group which received physiological saline per os, from the 1st to the 7th day after mating. We studied abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number and weight at 1st, 3rd, 5th and 10th day of life and newborn neurological reflexes at 1st, 3rd, 5th and 10th day of life. Results: there was no difference between groups in the number of rats that became pregnant. The same was found for maternal weight gain and newborn number. There was a difference in newborn mean weight on day 3rd, 5th and 10th (p = 0.006, 0.01 and 0.03, respectively). The D100 newborn group was the one with less weight gain up to the 10th day of life. We found a significant difference (p = 0.002) in the newborn orientation reflex on the 1st day of life, that disappeared afterwards. No abortion or gross malformation was found in this study. Conclusions: ciprofloxacin modified the newborn weight and reflex on the first days of life. In conclusion, we consider that the use of ciprofloxacin should be restricted during the pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain (
= 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain ( = 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
