Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):447-452
DOI 10.1590/S0100-72032002000700004
Purpose: to compare the size of locally advanced breast tumors through clinical examination, mammography, and ultrasound, and describe the parameters of color Doppler ultrasound evaluated before and after primary chemotherapy. Methods: it was a prospective and descriptive clinical study. Eighteen women with the diagnosis of breast carcinoma, with clinical primary tumors of 50 mm or larger, were submitted to palpation, mammography, ultrasound and color Doppler ultrasound at the moment of diagnosis and after 3 cycles of chemotherapy. The response was considered present when there was a clinical decrease of 50% or more and an ultrasonographic decrease of 25% or more, and absent when there was a clinical decrease less than 50% and ultrasonographic decrease less than 25%. A descriptive statistical analysis and Wilcoxon test were used. Results: regarding the size of the tumors, the method whose results were closer to pathological examination was the clinical examination after chemotherapy, when compared with sizes on ultrasound and mammography. The mammography helped to evaluate 44% of the cases before chemotherapy (8/18). In the cases where the response was absent, the Doppler showed a significant increase of the flow and a decrease of resistance and pulsatility index. In the cases where the response was present (9 cases), the Doppler did not show any significant change regarding the studied parameters. Conclusion: clinical examination was the most efficient method to evaluate the decrease of the volume of tumors submitted to neoadjuvant chemotherapy when compared with ultrasound and mammographic examinations. Doppler showed increase of the flow in the cases of absent response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):447-452
DOI 10.1590/S0100-72032002000700004
Purpose: to compare the size of locally advanced breast tumors through clinical examination, mammography, and ultrasound, and describe the parameters of color Doppler ultrasound evaluated before and after primary chemotherapy. Methods: it was a prospective and descriptive clinical study. Eighteen women with the diagnosis of breast carcinoma, with clinical primary tumors of 50 mm or larger, were submitted to palpation, mammography, ultrasound and color Doppler ultrasound at the moment of diagnosis and after 3 cycles of chemotherapy. The response was considered present when there was a clinical decrease of 50% or more and an ultrasonographic decrease of 25% or more, and absent when there was a clinical decrease less than 50% and ultrasonographic decrease less than 25%. A descriptive statistical analysis and Wilcoxon test were used. Results: regarding the size of the tumors, the method whose results were closer to pathological examination was the clinical examination after chemotherapy, when compared with sizes on ultrasound and mammography. The mammography helped to evaluate 44% of the cases before chemotherapy (8/18). In the cases where the response was absent, the Doppler showed a significant increase of the flow and a decrease of resistance and pulsatility index. In the cases where the response was present (9 cases), the Doppler did not show any significant change regarding the studied parameters. Conclusion: clinical examination was the most efficient method to evaluate the decrease of the volume of tumors submitted to neoadjuvant chemotherapy when compared with ultrasound and mammographic examinations. Doppler showed increase of the flow in the cases of absent response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):455-462
DOI 10.1590/S0100-72032002000700005
Purpose: to determine the Maternal Mortality Ratio (MMR) among women living in the city of Recife, Brazil through the analysis of all death certificates of women aged 10-49 years from 1994 to 2000. To determine the underreporting rate and to study the main characteristics, basic causes, classification and avoidance of maternal deaths. Methods: a descriptive population-based study was conducted and all death certificates of women aged 10-49 years were analyzed and classified as declared or presumed (Laurenti criteria). Clinical records and autopsy data, when available, were studied and basic cause and underreporting rate were determined. Maternal Mortality Ratio was calculated using information on live births from SINASC ("Sistema de Informações dos Nascidos Vivos"). Results: a total of 144 maternal deaths were identified (declared=104; presumed and confirmed after investigation=44). The Maternal Mortality Ratio was 75.5 per 100,000 live births. The underreporting rate was 27.8%. A predominance of direct causes was observed (about 69%) and the most frequent causes of death were hypertension (19%), hemorrhage (16%) and infection (11%). About 82% of the deaths were considered avoidable by adequate antenatal, delivery and post-partum care. Conclusions: Maternal Mortality Ratio is high in the city of Recife, Brazil and the underreporting rate is still high. Direct obstetric causes and avoidable deaths are predominant. There is a lack of adequate antenatal, delivery and post-partum care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):455-462
DOI 10.1590/S0100-72032002000700005
Purpose: to determine the Maternal Mortality Ratio (MMR) among women living in the city of Recife, Brazil through the analysis of all death certificates of women aged 10-49 years from 1994 to 2000. To determine the underreporting rate and to study the main characteristics, basic causes, classification and avoidance of maternal deaths. Methods: a descriptive population-based study was conducted and all death certificates of women aged 10-49 years were analyzed and classified as declared or presumed (Laurenti criteria). Clinical records and autopsy data, when available, were studied and basic cause and underreporting rate were determined. Maternal Mortality Ratio was calculated using information on live births from SINASC ("Sistema de Informações dos Nascidos Vivos"). Results: a total of 144 maternal deaths were identified (declared=104; presumed and confirmed after investigation=44). The Maternal Mortality Ratio was 75.5 per 100,000 live births. The underreporting rate was 27.8%. A predominance of direct causes was observed (about 69%) and the most frequent causes of death were hypertension (19%), hemorrhage (16%) and infection (11%). About 82% of the deaths were considered avoidable by adequate antenatal, delivery and post-partum care. Conclusions: Maternal Mortality Ratio is high in the city of Recife, Brazil and the underreporting rate is still high. Direct obstetric causes and avoidable deaths are predominant. There is a lack of adequate antenatal, delivery and post-partum care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
DOI 10.1590/S0100-72032002000700006
Purpose: to evaluate, in the first and second trimesters of pregnancy, the correlation between cervical length and spontaneous preterm delivery. Methods: cervical length was evaluated in 641 pregnant women between 11-16 weeks' and 23-24 weeks' gestation. Cervical assessment was performed by a transvaginal scan with the patient with empty bladder in a gynecological position. Cervical length was measured from the internal to the external os. The gestational age at delivery was correlated with the length of the cervix. To compare the means in groups of pregnant women who had a term or preterm delivery, we used Student's t test. Sensitivity, specificity, false-positive and false-negative rates, and accuracy were calculated for cervical length of 20 mm or less, 25 mm or less and 30 mm or less in the prediction of preterm delivery. Results: the measurement of cervical length, between 11 and 16 weeks of pregnancy, did not show any statistically significant difference on comparing women who had preterm and term delivery (40.6 mm and 42.7 mm, respectively, p=0.2459). However, the difference between the two groups at 23 to 24 weeks was significant (37.3 mm in the group who delivered prematurely and 26.7 mm in the term group, p=0.0001, Student's t test). Conclusion: there was no significant difference in cervical length, at 11 to 16 weeks, between pregnant women who had a preterm and term delivery. However, at 23 to 24 weeks, cervical length was significantly different between the two groups, and this measurement might be used as a predictor for prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
DOI 10.1590/S0100-72032002000700006
Purpose: to evaluate, in the first and second trimesters of pregnancy, the correlation between cervical length and spontaneous preterm delivery. Methods: cervical length was evaluated in 641 pregnant women between 11-16 weeks' and 23-24 weeks' gestation. Cervical assessment was performed by a transvaginal scan with the patient with empty bladder in a gynecological position. Cervical length was measured from the internal to the external os. The gestational age at delivery was correlated with the length of the cervix. To compare the means in groups of pregnant women who had a term or preterm delivery, we used Student's t test. Sensitivity, specificity, false-positive and false-negative rates, and accuracy were calculated for cervical length of 20 mm or less, 25 mm or less and 30 mm or less in the prediction of preterm delivery. Results: the measurement of cervical length, between 11 and 16 weeks of pregnancy, did not show any statistically significant difference on comparing women who had preterm and term delivery (40.6 mm and 42.7 mm, respectively, p=0.2459). However, the difference between the two groups at 23 to 24 weeks was significant (37.3 mm in the group who delivered prematurely and 26.7 mm in the term group, p=0.0001, Student's t test). Conclusion: there was no significant difference in cervical length, at 11 to 16 weeks, between pregnant women who had a preterm and term delivery. However, at 23 to 24 weeks, cervical length was significantly different between the two groups, and this measurement might be used as a predictor for prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):365-370
DOI 10.1590/S0100-72032002000600002
Purpose: to study the relationship between pelvic floor function and bladder neck mobility in women with and without stress urinary incontinence (SUI), in menacme and postmenopausal. Methods: sixty-one SUI patients were evaluated; 31 of them were in menacme and of these 17 had SUI and 14 did not have any complaint; 30 were postmenopausal and of these, 15 with SUI and 15 without SUI. Simple cystometry and empty supine stress test were performed in those who had urinary incontinence complaint. Bladder neck mobility was studied by ultrasound and by the Q-tip test. To study pelvic floor function, vaginal cones and digital palpation were used. Results: the bladder neck position in the incontinent women (Groups A and C), determined by ultrasound or the Q tip-test, was --11.8 cm in Group A and --12.5 cm in Group C, lower than the continent women, in whom the bladder neck was at +4.4 cm in Group B and +2.3 cm in Group D. There were no differences in bladder neck mobility among the continent menacme (9.1 cm) and postmenopausal (9.5 cm) groups. Also there were no differences among the incontinent groups (17.1 cm for Group A and 16.6 cm for Group C). The bladder neck mobility was greater in the incontinent women (A and C). Continent women had better results on evaluation of pelvic floor muscles than the incontinent ones, even using vaginal cones or digital palpation, and these results were not dependent on the hormonal status. Conclusion: a positive correlation was found between the Q-tip tests and ultrasound, and between test with vaginal cones and digital palpation. No significant correlation was found between pelvic floor function and bladder neck mobility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):365-370
DOI 10.1590/S0100-72032002000600002
Purpose: to study the relationship between pelvic floor function and bladder neck mobility in women with and without stress urinary incontinence (SUI), in menacme and postmenopausal. Methods: sixty-one SUI patients were evaluated; 31 of them were in menacme and of these 17 had SUI and 14 did not have any complaint; 30 were postmenopausal and of these, 15 with SUI and 15 without SUI. Simple cystometry and empty supine stress test were performed in those who had urinary incontinence complaint. Bladder neck mobility was studied by ultrasound and by the Q-tip test. To study pelvic floor function, vaginal cones and digital palpation were used. Results: the bladder neck position in the incontinent women (Groups A and C), determined by ultrasound or the Q tip-test, was --11.8 cm in Group A and --12.5 cm in Group C, lower than the continent women, in whom the bladder neck was at +4.4 cm in Group B and +2.3 cm in Group D. There were no differences in bladder neck mobility among the continent menacme (9.1 cm) and postmenopausal (9.5 cm) groups. Also there were no differences among the incontinent groups (17.1 cm for Group A and 16.6 cm for Group C). The bladder neck mobility was greater in the incontinent women (A and C). Continent women had better results on evaluation of pelvic floor muscles than the incontinent ones, even using vaginal cones or digital palpation, and these results were not dependent on the hormonal status. Conclusion: a positive correlation was found between the Q-tip tests and ultrasound, and between test with vaginal cones and digital palpation. No significant correlation was found between pelvic floor function and bladder neck mobility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
