Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):383-387
DOI 10.1590/S0100-72032002000600005
Purpose: to evaluate the effectiveness of diagnostic amnioinfusion in severe oligohydramnios. Methods: twelve patients with severe oligohydramnios in the second and third trimester of pregnancy were submitted to amnioinfusion. The procedure was done using a warm physiological saline at a rate of 20 mL/min followed by the instillation of 5 mL of dye. The amniotic fluid index (AFI) was measured before the procedure and 30 min afterwards and in case of fetal anomalies, it was documented. The gestational age ranged from 18 to 34 weeks (average 25 ± 4 weeks). The average of the initial ILA was 10.3cm and after the procedure was 16.4 cm. The volume of saline solution infused ranged from 300 to 1000 mL (605.4 ± 224.1 mL). Results: in nine patients (75%) the procedure led to an etiologic diagnosis: four cases of premature rupture of membranes and major malformations in five fetuses. In two patients the oligohydramnios was considered idiopathic and in one patient the pathological examination revealed a placental infarct. Nine pregnancies (75%) were interrupted after the diagnosis and in three cases it was maintained for 8.8 weeks after the amnioinfusion. All fetuses died, seven of them had neonatal death and the remaining had intrauterine death. Conclusion: amnioinfusion is an effective method with high precision, enabling the etiologic diagnosis of severe oligohydramnios in 75% of the cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):383-387
DOI 10.1590/S0100-72032002000600005
Purpose: to evaluate the effectiveness of diagnostic amnioinfusion in severe oligohydramnios. Methods: twelve patients with severe oligohydramnios in the second and third trimester of pregnancy were submitted to amnioinfusion. The procedure was done using a warm physiological saline at a rate of 20 mL/min followed by the instillation of 5 mL of dye. The amniotic fluid index (AFI) was measured before the procedure and 30 min afterwards and in case of fetal anomalies, it was documented. The gestational age ranged from 18 to 34 weeks (average 25 ± 4 weeks). The average of the initial ILA was 10.3cm and after the procedure was 16.4 cm. The volume of saline solution infused ranged from 300 to 1000 mL (605.4 ± 224.1 mL). Results: in nine patients (75%) the procedure led to an etiologic diagnosis: four cases of premature rupture of membranes and major malformations in five fetuses. In two patients the oligohydramnios was considered idiopathic and in one patient the pathological examination revealed a placental infarct. Nine pregnancies (75%) were interrupted after the diagnosis and in three cases it was maintained for 8.8 weeks after the amnioinfusion. All fetuses died, seven of them had neonatal death and the remaining had intrauterine death. Conclusion: amnioinfusion is an effective method with high precision, enabling the etiologic diagnosis of severe oligohydramnios in 75% of the cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):389-394
DOI 10.1590/S0100-72032002000600006
Purpose: to study the influence of weight differences between twins on the perinatal results. Methods: the twin deliveries at the Maternity of the Hospital Regional de Clínicas de Sorocaba, SP, were retrospectively analyzed from July 1997 to June 1998. The samples were 89 mothers and their twins, divided into three classes of newborn weight differences, as follows: concordant (<15%), mild discordance (15 to 25%) and severe discordance (>25%). The independent variables analyzed were these three classes and the dependent variables were low weight at birth, Apgar index less than 7 at the first and fifth minute, premature delivery, time of permanence of the newborn in the nursery, and perinatal mortality coefficient I. Statistical analysis was performed using Kruskal-Wallis test, completed by Hollander test, and the Blackwell test. Results: the number of pregnancies (62, 17 and 10) and premature deliveries (32, 9 and 7) were observed respectively in the three classes. For the first and second twins we observed: low weight at birth (39/41, 13/12 and 8/9), Apgar index less than 7 at the first minute (16/13, 3/7 and 2/3), Apgar index at the fifth minute (4/4, 0/2 and 1/2), time (in days) of permanence of the newborn in the nursery (3.7/3.7, 4.6/6.0 and 7.3/8.7) and perinatal mortality coefficient I (22.4/16.8, 0/16.8 and 5.6/5.6). Conclusions: the incidence of weight discordance between twins was 30.3%, 19.1% being mild discordance and 11.2% severe discordance. There was a tendency to a progressive aggravation of perinatal results considering the degree of discordance of the classes (concordant < mild discordance < severe discordance).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):389-394
DOI 10.1590/S0100-72032002000600006
Purpose: to study the influence of weight differences between twins on the perinatal results. Methods: the twin deliveries at the Maternity of the Hospital Regional de Clínicas de Sorocaba, SP, were retrospectively analyzed from July 1997 to June 1998. The samples were 89 mothers and their twins, divided into three classes of newborn weight differences, as follows: concordant (<15%), mild discordance (15 to 25%) and severe discordance (>25%). The independent variables analyzed were these three classes and the dependent variables were low weight at birth, Apgar index less than 7 at the first and fifth minute, premature delivery, time of permanence of the newborn in the nursery, and perinatal mortality coefficient I. Statistical analysis was performed using Kruskal-Wallis test, completed by Hollander test, and the Blackwell test. Results: the number of pregnancies (62, 17 and 10) and premature deliveries (32, 9 and 7) were observed respectively in the three classes. For the first and second twins we observed: low weight at birth (39/41, 13/12 and 8/9), Apgar index less than 7 at the first minute (16/13, 3/7 and 2/3), Apgar index at the fifth minute (4/4, 0/2 and 1/2), time (in days) of permanence of the newborn in the nursery (3.7/3.7, 4.6/6.0 and 7.3/8.7) and perinatal mortality coefficient I (22.4/16.8, 0/16.8 and 5.6/5.6). Conclusions: the incidence of weight discordance between twins was 30.3%, 19.1% being mild discordance and 11.2% severe discordance. There was a tendency to a progressive aggravation of perinatal results considering the degree of discordance of the classes (concordant < mild discordance < severe discordance).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):401-406
DOI 10.1590/S0100-72032002000600007
Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm). The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS) and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%), abnormal biophysical profile score (10.5%), abnormal results of middle cerebral artery dopplervelocimetry (54.5%), small for gestational age infants (32.7%) and meconial amniotic fluid (27.9%) when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%), abnormal biophysical profile score (4.3%), abnormal results of middle cerebral artery dopplervelocimetry (33.9%), small for gestational age infants (21.0%) and meconial amniotic fluid (16.8%). Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):401-406
DOI 10.1590/S0100-72032002000600007
Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm). The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS) and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%), abnormal biophysical profile score (10.5%), abnormal results of middle cerebral artery dopplervelocimetry (54.5%), small for gestational age infants (32.7%) and meconial amniotic fluid (27.9%) when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%), abnormal biophysical profile score (4.3%), abnormal results of middle cerebral artery dopplervelocimetry (33.9%), small for gestational age infants (21.0%) and meconial amniotic fluid (16.8%). Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):407-412
DOI 10.1590/S0100-72032002000600008
Purpose: to evaluate the agreement between the theory about informed consent, represented by Resolution 01/88, and the practice according to the report of researchers and of women who were subjects of their research. Methods: eleven researchers from three centers of excellence in research related to fertility regulation in Brazil and 18 women, subjects of their research. Information was obtained through in-depth interviews and content analysis was carried out. Results: the report of the researchers agreed with the requirements of the Resolution; however, the women's report showed that most of the required items were not referred to when they were invited to participate in the research. Conclusion: a disagreement was observed between theory and practice in obtaining informed consent. This may be explained by difficulties in complying with the requirements of the Resolution in force at the time. On the other hand, it is also possible to imagine difficulties experienced by researchers when approaching the women and/or that the women also forgot the received information. Finally, a bias may have resulted from the researchers and women who had to give consent to participate in this study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):407-412
DOI 10.1590/S0100-72032002000600008
Purpose: to evaluate the agreement between the theory about informed consent, represented by Resolution 01/88, and the practice according to the report of researchers and of women who were subjects of their research. Methods: eleven researchers from three centers of excellence in research related to fertility regulation in Brazil and 18 women, subjects of their research. Information was obtained through in-depth interviews and content analysis was carried out. Results: the report of the researchers agreed with the requirements of the Resolution; however, the women's report showed that most of the required items were not referred to when they were invited to participate in the research. Conclusion: a disagreement was observed between theory and practice in obtaining informed consent. This may be explained by difficulties in complying with the requirements of the Resolution in force at the time. On the other hand, it is also possible to imagine difficulties experienced by researchers when approaching the women and/or that the women also forgot the received information. Finally, a bias may have resulted from the researchers and women who had to give consent to participate in this study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):315-320
DOI 10.1590/S0100-72032002000500005
Purpose: to study the association between the evaluation or not of the male partner and relapses in women treated for HPV lesions. Methods: a reconstituted cohort study with 144 women with HPV lesions and whose partners had been evaluated, compared with 288 women whose partners had not been examined, controlled regarding date of attendance, age, lesion degree and treatment, attended between July 1993 and March 2000. We evaluated similarity between the groups, the association between the evaluation or not of the partners or the diagnosis of lesions with the occurrence and relapse lesion degree in the women and the disease-free interval (DFI). Results: the groups were similar regarding the control variables. Relapses occurred in 9.0 % of the women whose partners had been evaluated and in 5.9% of those whose partners had not been evaluated (p=0.23). When lesions were diagnosed in the men, 12.5% of their partners had relapses, against 7.3% of the women whose partners had no lesions (p=0.23), but there was no correlation with the relapse lesion degree and DFI. When the men reported a time of monogamous conjugal relationship <12 months, we observed 14.9% relapses in women, against 6.2% for the women whose partners reported a longer time (p=0.08). Conclusions: evaluation of the man did not decrease the relapse risk of HPV lesions in his partner. The presence of lesions in the male partners did not correlate with the occurrence and relapse degree in women and DFI. This study does not support the hypothesis that nonevaluated men would be an important cause of relapses in their partners.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):315-320
DOI 10.1590/S0100-72032002000500005
Purpose: to study the association between the evaluation or not of the male partner and relapses in women treated for HPV lesions. Methods: a reconstituted cohort study with 144 women with HPV lesions and whose partners had been evaluated, compared with 288 women whose partners had not been examined, controlled regarding date of attendance, age, lesion degree and treatment, attended between July 1993 and March 2000. We evaluated similarity between the groups, the association between the evaluation or not of the partners or the diagnosis of lesions with the occurrence and relapse lesion degree in the women and the disease-free interval (DFI). Results: the groups were similar regarding the control variables. Relapses occurred in 9.0 % of the women whose partners had been evaluated and in 5.9% of those whose partners had not been evaluated (p=0.23). When lesions were diagnosed in the men, 12.5% of their partners had relapses, against 7.3% of the women whose partners had no lesions (p=0.23), but there was no correlation with the relapse lesion degree and DFI. When the men reported a time of monogamous conjugal relationship <12 months, we observed 14.9% relapses in women, against 6.2% for the women whose partners reported a longer time (p=0.08). Conclusions: evaluation of the man did not decrease the relapse risk of HPV lesions in his partner. The presence of lesions in the male partners did not correlate with the occurrence and relapse degree in women and DFI. This study does not support the hypothesis that nonevaluated men would be an important cause of relapses in their partners.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):293-299
DOI 10.1590/S0100-72032002000500002
Purpose: to study the prenatal care among Public Health Service ("Sistema Único de Saúde") users from Caxias do Sul - RS. Methods: a transversal study of 702 pregnancies attended at the Hospital Geral -Universidade de Caxias do Sul from March 2000 to March 2001 based on the criteria set by the "Programa Nacional de Humanização do Pré-natal e Nascimento (PNHPN)" of the Brazilian Ministry of Health. Results: the observed prenatal coverage was 95.4%, whereas the average of visits was 6.2. The main reported reason for not following prenatal care was the lack of information about its importance (65.6%). In 51.5% of the cases, prenatal care started in the third month of pregnancy, whereas 44.3% of the pregnant women carried out all the proposed complementary tests. Prenatal care was considered inappropriate in 64.8% and appropriate in 35.2% of the cases. The quality of prenatal attention was significantly associated with the mother's education, as well as with the number of previous deliveries. The higher the educational level, the better the quality of observed prenatal care (p=0.0148). In addition, the higher number of previous deliveries showed to be associated with a later beginning of prenatal care and a lower number of visits (p=0.0008). Conclusions: the prenatal care available at Caxias do Sul in spite of its good coverage, should be reviewed in terms of quality. Special attention should be given to education in health along the prenatal assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):293-299
DOI 10.1590/S0100-72032002000500002
Purpose: to study the prenatal care among Public Health Service ("Sistema Único de Saúde") users from Caxias do Sul - RS. Methods: a transversal study of 702 pregnancies attended at the Hospital Geral -Universidade de Caxias do Sul from March 2000 to March 2001 based on the criteria set by the "Programa Nacional de Humanização do Pré-natal e Nascimento (PNHPN)" of the Brazilian Ministry of Health. Results: the observed prenatal coverage was 95.4%, whereas the average of visits was 6.2. The main reported reason for not following prenatal care was the lack of information about its importance (65.6%). In 51.5% of the cases, prenatal care started in the third month of pregnancy, whereas 44.3% of the pregnant women carried out all the proposed complementary tests. Prenatal care was considered inappropriate in 64.8% and appropriate in 35.2% of the cases. The quality of prenatal attention was significantly associated with the mother's education, as well as with the number of previous deliveries. The higher the educational level, the better the quality of observed prenatal care (p=0.0148). In addition, the higher number of previous deliveries showed to be associated with a later beginning of prenatal care and a lower number of visits (p=0.0008). Conclusions: the prenatal care available at Caxias do Sul in spite of its good coverage, should be reviewed in terms of quality. Special attention should be given to education in health along the prenatal assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):301-306
DOI 10.1590/S0100-72032002000500003
Purpose: to compare the outcome of pregnancies with and without threatened abortion presenting alive embryo/fetus between 6 and 13 weeks at sonographic evaluation. Method: this was a retrospective case-control study, carried out from February 1998 to December 1999. Criteria for inclusion were: topic and single pregnancy; embryo/fetus cardiac activity present in the ultrasound scan; gestational age between 6 weeks and 13 weeks and 6 days, absence of fetal anomalies, absence of attempt of abortion by drugs or manipulation, absence of maternal disease, known pregnancy result. A total of 1531 pregnancies were examined, of which 258 with threatened abortion (case group) and 1273 without threatened abortion (control group). The two groups were compared regarding outcome such as: abortion, stillbirth, prematurity and intrauterine growth restriction. Results: the percentage of abortion (11,7%) and prematurity (17,8%) were higher in the group with threatened abortion (p<0.001 and p=0.026, respectively). The frequency of stillbirth and intrauterine growth restriction did not differ significantly between the groups.Conclusion: threatened abortion with alive embryo/fetus in 6- to 13- week gestation presented a higher abortion risk and subsequent prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):301-306
DOI 10.1590/S0100-72032002000500003
Purpose: to compare the outcome of pregnancies with and without threatened abortion presenting alive embryo/fetus between 6 and 13 weeks at sonographic evaluation. Method: this was a retrospective case-control study, carried out from February 1998 to December 1999. Criteria for inclusion were: topic and single pregnancy; embryo/fetus cardiac activity present in the ultrasound scan; gestational age between 6 weeks and 13 weeks and 6 days, absence of fetal anomalies, absence of attempt of abortion by drugs or manipulation, absence of maternal disease, known pregnancy result. A total of 1531 pregnancies were examined, of which 258 with threatened abortion (case group) and 1273 without threatened abortion (control group). The two groups were compared regarding outcome such as: abortion, stillbirth, prematurity and intrauterine growth restriction. Results: the percentage of abortion (11,7%) and prematurity (17,8%) were higher in the group with threatened abortion (p<0.001 and p=0.026, respectively). The frequency of stillbirth and intrauterine growth restriction did not differ significantly between the groups.Conclusion: threatened abortion with alive embryo/fetus in 6- to 13- week gestation presented a higher abortion risk and subsequent prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):309-313
DOI 10.1590/S0100-72032002000500004
Purpose: to evaluate the importance of endometrial thickness measurement as an orienting factor for the clinical treatment of unruptured tubal pregnancy. Method: longitudinal observational study, in which the greatest measure of the endometrial thickness was evaluated in millimeters, in the uterine longitudinal axis, through transvaginal ultrasonography. Our study group included 181 patients, all of them respecting the utilization criteria for the clinical treatment (expectant or medicated with methotrexate). Through Student's t test we evaluated the difference between the average thickness of the cases who presented successful results with the treatment and the average of those who failed. Results: the average endometrial thickness of the patients who presented successful results with the medical treatment (31 cases) was 6.4 mm, while the average in the cases of failure was 11.5 mm. These results were significantly different. The average thickness of the successful group with expectant management (128 cases) was 9.0 mm, while the average of those who failed was 9.6 mm. These values were not statistically different. Conclusions: the greatest measure of the endometrial thickness of the uterine longitudinal axis through transvaginal ultrasonography proved to be valuable as a new orienting factor for the medical treatment of patients with a diagnosis of unruptured tubal pregnancy. It may become a useful and auxiliary tool for the recommendation of the use of methotrexate. On the other hand, thickness did not show to be useful as an orienting factor for establishing expectant management.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):309-313
DOI 10.1590/S0100-72032002000500004
Purpose: to evaluate the importance of endometrial thickness measurement as an orienting factor for the clinical treatment of unruptured tubal pregnancy. Method: longitudinal observational study, in which the greatest measure of the endometrial thickness was evaluated in millimeters, in the uterine longitudinal axis, through transvaginal ultrasonography. Our study group included 181 patients, all of them respecting the utilization criteria for the clinical treatment (expectant or medicated with methotrexate). Through Student's t test we evaluated the difference between the average thickness of the cases who presented successful results with the treatment and the average of those who failed. Results: the average endometrial thickness of the patients who presented successful results with the medical treatment (31 cases) was 6.4 mm, while the average in the cases of failure was 11.5 mm. These results were significantly different. The average thickness of the successful group with expectant management (128 cases) was 9.0 mm, while the average of those who failed was 9.6 mm. These values were not statistically different. Conclusions: the greatest measure of the endometrial thickness of the uterine longitudinal axis through transvaginal ultrasonography proved to be valuable as a new orienting factor for the medical treatment of patients with a diagnosis of unruptured tubal pregnancy. It may become a useful and auxiliary tool for the recommendation of the use of methotrexate. On the other hand, thickness did not show to be useful as an orienting factor for establishing expectant management.