Trabalhos Originais Archives - Page 22 of 50 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):287-290
DOI 10.1590/S0100-72031999000500007
Purpose: to evaluate the knowledge and practice of breast self-examination among medical students and to determine possible factors associated with this practice. Method: the authors used a questionnaire to gather information about the students and their knowledge of this self-examination. This questionnaire also allowed the authors to verify the frequency with which the female students performed breast self-examination. The chi² test and Student's "t" test were used, when applicable, to check the association of certain factors. Results: of the 348 questionnaires which were answered, 16% (55) were submitted by 5th year medical students, who had already attended the Gynecology course; 43% were answered by females, 62% of the students had medical doctors among their relatives, and 17% had a family history of breast cancer. In terms of breast self-examination, 95% knew about the method. Of the 149 females who answered the questionnaire, only 64% checked their breasts regularly. The reasons given for not performing self-examination varied: 24% considered themselves to be too young, 4% thought they would not have cancer, 9% listed fear as the reason, 19% reported they were too lazy, and 44% of the female students had no clear reason for not performing breast self-examination. Neither the knowledge nor the practice of the breast self-examination were associated with the subjects the students had or had not yet taken in medical school, with a family history of breast cancer or with the fact that one or more relatives were medical doctors. Conclusion: breast self-examination is known by practically all the medical students; nevertheless, only one third of the female students performed it regularly. This fact highlights the importance of emphasizing breast self-examination among medical students, so that they can help to disseminate this practice among the general population, rather than delegating this responsibility to the midia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):287-290
DOI 10.1590/S0100-72031999000500007
Purpose: to evaluate the knowledge and practice of breast self-examination among medical students and to determine possible factors associated with this practice. Method: the authors used a questionnaire to gather information about the students and their knowledge of this self-examination. This questionnaire also allowed the authors to verify the frequency with which the female students performed breast self-examination. The chi² test and Student's "t" test were used, when applicable, to check the association of certain factors. Results: of the 348 questionnaires which were answered, 16% (55) were submitted by 5th year medical students, who had already attended the Gynecology course; 43% were answered by females, 62% of the students had medical doctors among their relatives, and 17% had a family history of breast cancer. In terms of breast self-examination, 95% knew about the method. Of the 149 females who answered the questionnaire, only 64% checked their breasts regularly. The reasons given for not performing self-examination varied: 24% considered themselves to be too young, 4% thought they would not have cancer, 9% listed fear as the reason, 19% reported they were too lazy, and 44% of the female students had no clear reason for not performing breast self-examination. Neither the knowledge nor the practice of the breast self-examination were associated with the subjects the students had or had not yet taken in medical school, with a family history of breast cancer or with the fact that one or more relatives were medical doctors. Conclusion: breast self-examination is known by practically all the medical students; nevertheless, only one third of the female students performed it regularly. This fact highlights the importance of emphasizing breast self-examination among medical students, so that they can help to disseminate this practice among the general population, rather than delegating this responsibility to the midia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):323-326
DOI 10.1590/S0100-72031999000600004
Purpose: to offer new data for the conflicting reports which present different prognosis for patients with breast carcinoma, according to the timing of surgery in relation to the menstrual cycle. Patients and Methods: in a retrospective study on 451 premenopausal women with breast cancer, aged between 26 and 52 years, 130 cases were selected and followed for 60 months, at least. Sixty-eight were operated during the follicular phase and 62 in the luteal period, whose findings regarding clinical stages, axillary involvement and estrogen and progesterone hormonal receptor concentrations of the neoplasms were also analyzed. Results: the follow-up of 130 patients showed that 64.4% had a disease-free survival after five years and 43% exceeded 10 years. Subdividing the cases into 2 subgroups, according to the timing of surgery, the survival rates were different, 58.8% at 5 and 36.7% at 10 years, when the operation occurred in the follicular phase, and 70.9% and 50%, at 5 and 10 years, respectively, during the luteal period. Conclusions: in this study, the patients operated in the luteal phase reached higher survival rates than the women operated during the follicular period. However, these values were lower than those displayed by the classic prognostic factors of axillary involvement and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):323-326
DOI 10.1590/S0100-72031999000600004
Purpose: to offer new data for the conflicting reports which present different prognosis for patients with breast carcinoma, according to the timing of surgery in relation to the menstrual cycle. Patients and Methods: in a retrospective study on 451 premenopausal women with breast cancer, aged between 26 and 52 years, 130 cases were selected and followed for 60 months, at least. Sixty-eight were operated during the follicular phase and 62 in the luteal period, whose findings regarding clinical stages, axillary involvement and estrogen and progesterone hormonal receptor concentrations of the neoplasms were also analyzed. Results: the follow-up of 130 patients showed that 64.4% had a disease-free survival after five years and 43% exceeded 10 years. Subdividing the cases into 2 subgroups, according to the timing of surgery, the survival rates were different, 58.8% at 5 and 36.7% at 10 years, when the operation occurred in the follicular phase, and 70.9% and 50%, at 5 and 10 years, respectively, during the luteal period. Conclusions: in this study, the patients operated in the luteal phase reached higher survival rates than the women operated during the follicular period. However, these values were lower than those displayed by the classic prognostic factors of axillary involvement and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):341-345
DOI 10.1590/S0100-72031999000600007
Objectives: to analyze the medical and legal aspects in order to contribute to the study and standardization of this obstetrical surgery in Brazil. Methods: our study was based on 11 cases of cesarean section performed in the imminence of maternal death or just after death. These cases were attended at UNIFESP - EPM from 1988 to 1998. Results: there were 7 live births, five of them with a gestational age over 26 weeks. Most deaths occurred within the first 48 hours after admission. The predominant age range was the third decade. Conclusions: although postmortem cesarean section is indicated to save the fetus, it is rarely performed. The conditions for its indication involve knowledge of the technique as well as of the ethical and legal principles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):341-345
DOI 10.1590/S0100-72031999000600007
Objectives: to analyze the medical and legal aspects in order to contribute to the study and standardization of this obstetrical surgery in Brazil. Methods: our study was based on 11 cases of cesarean section performed in the imminence of maternal death or just after death. These cases were attended at UNIFESP - EPM from 1988 to 1998. Results: there were 7 live births, five of them with a gestational age over 26 weeks. Most deaths occurred within the first 48 hours after admission. The predominant age range was the third decade. Conclusions: although postmortem cesarean section is indicated to save the fetus, it is rarely performed. The conditions for its indication involve knowledge of the technique as well as of the ethical and legal principles.