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Trabalhos Originais
Hemorrhagic complications of gestational trophoblastic disease
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):551-556
10-14-2004
Summary
Trabalhos OriginaisHemorrhagic complications of gestational trophoblastic disease
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):551-556
10-14-2004DOI 10.1590/S0100-72032004000700007
Views50See morePURPOSE: to report three cases of gestational trophoblastic disease with intense hemorrhagic complications, in which exceptional surgical procedures were used to obtain hemostasis. METHODS: the study comprised three patients: the first, a young woman, 27 years old, nullipara, was submitted to total abdominal hysterectomy and, thereafter, to chemotherapy until remission was achieved. Another patient bled from an extensive vaginal metastasis that could only be treated with hypogastric arterial ligation. Definitive sustained remission was obtained after chemotherapy. Two years after the episode, the patient achieved a new, normal pregnancy. The third patient, with persistent trophoblastic disease, presented a mass of molar tissue within the uterine inferior segment and cervix, extending to the right vaginal cul-de-sac, heavily bleeding at each attempt of surgical removal, whether by sharp or suction curettage. As a consequence of the invasive maneuvers she became seriously infected with sepsis; although being submitted to intensive antibiotic therapy and total abdominal hysterectomy she died a few days later. RESULTS: of the two patients who were submitted to total abdominal hysterectomy, one survived and the other died of septicemia. The third patient, who was submited to hypogastric arterial ligation, had a favorable outcome and achieved a new and normal pregnancy. CONCLUSION: albeit gestational trophoblastic disease usually has an undisturbed course and spontaneous remission, unexpected complications may demand radical approaches leading sometimes to unfavorable results.
Views50
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisHemorrhagic complications of gestational trophoblastic disease
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):551-556
10-14-2004DOI 10.1590/S0100-72032004000700007
Views50See morePURPOSE: to report three cases of gestational trophoblastic disease with intense hemorrhagic complications, in which exceptional surgical procedures were used to obtain hemostasis. METHODS: the study comprised three patients: the first, a young woman, 27 years old, nullipara, was submitted to total abdominal hysterectomy and, thereafter, to chemotherapy until remission was achieved. Another patient bled from an extensive vaginal metastasis that could only be treated with hypogastric arterial ligation. Definitive sustained remission was obtained after chemotherapy. Two years after the episode, the patient achieved a new, normal pregnancy. The third patient, with persistent trophoblastic disease, presented a mass of molar tissue within the uterine inferior segment and cervix, extending to the right vaginal cul-de-sac, heavily bleeding at each attempt of surgical removal, whether by sharp or suction curettage. As a consequence of the invasive maneuvers she became seriously infected with sepsis; although being submitted to intensive antibiotic therapy and total abdominal hysterectomy she died a few days later. RESULTS: of the two patients who were submitted to total abdominal hysterectomy, one survived and the other died of septicemia. The third patient, who was submited to hypogastric arterial ligation, had a favorable outcome and achieved a new and normal pregnancy. CONCLUSION: albeit gestational trophoblastic disease usually has an undisturbed course and spontaneous remission, unexpected complications may demand radical approaches leading sometimes to unfavorable results.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):557-562
10-14-2004
Summary
Trabalhos OriginaisPrevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):557-562
10-14-2004DOI 10.1590/S0100-72032004000700008
Views98See morePURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.
Views98This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisPrevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):557-562
10-14-2004DOI 10.1590/S0100-72032004000700008
Views98See morePURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Mammographic parenchymal pattern in climacteric women receiving hormone replacement therapy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):563-571
10-14-2004
Summary
Trabalhos OriginaisMammographic parenchymal pattern in climacteric women receiving hormone replacement therapy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):563-571
10-14-2004DOI 10.1590/S0100-72032004000700009
Views45See morePURPOSE: to measure changes and predictors of changes in mammographic density of climacteric women, before and one year after hormone replacement therapy. METHODS: seventy climacteric women of 45 years or more participated in the study. They were followed-up at a Climacteric Outpatient Service. All of them used regularly either estrogenic or estroprogestative HRT for one year. They were submitted to one basal mammography and another at the end of the first year. HRT schedules could be different from each other, although with the same bioequivalence. Mammographic density was evaluated blindly at the beginning and at the end of the treatment. Age, ovarian function, time since menopause, body mass index, waist/hip ratio, age at menarche, age at first pregnancy, and smoking were evaluated as well. Mammographic density was classified according to the American College of Radiology BI-RADS system into one of the following four parenchymal patterns: A) entirely liposubstituted breasts, B) liposubstituted breasts with disperse glandular parenchyma, C) heterogeneously dense breasts, and D) extremely dense breasts. We proposed a subdivision of each category in to A e A1, B e B1, C and C1, D and D1 in order to identify smaller variations in mammographic density. Therefore, we attributed initial and final scores of 1-8 to each of the patients according to the mammographic density before and after HRT, corresponding to categories A to D1. The proportions of women that presented increase, decrease and no variation in mammographic density after 1 year of HRT were calculated. In addition, we estimated initial to final score variation using the paired t-test of the Statistical Package for Social Sciences (SPSS). RESULTS: mammographic density increased in 22.9%, decreased in 7.1% and did not change in 70% of the studied cases. A significant difference was observed between the score means before (2.2±1.82) and after HRT (2.5±1.9) (p=0.019). The androgenic distribution of body fat was associated with a denser mammographic pattern. CONCLUSIONS: an increase in mammographic density was shown in women undergoing HRT, and was most pronounced in women with androgenic fat distribution. Additional studies must be carried out in order to evaluate if this increment in mammographic density could impair the mammographic screening of breast cancer.
Views45This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisMammographic parenchymal pattern in climacteric women receiving hormone replacement therapy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):563-571
10-14-2004DOI 10.1590/S0100-72032004000700009
Views45See morePURPOSE: to measure changes and predictors of changes in mammographic density of climacteric women, before and one year after hormone replacement therapy. METHODS: seventy climacteric women of 45 years or more participated in the study. They were followed-up at a Climacteric Outpatient Service. All of them used regularly either estrogenic or estroprogestative HRT for one year. They were submitted to one basal mammography and another at the end of the first year. HRT schedules could be different from each other, although with the same bioequivalence. Mammographic density was evaluated blindly at the beginning and at the end of the treatment. Age, ovarian function, time since menopause, body mass index, waist/hip ratio, age at menarche, age at first pregnancy, and smoking were evaluated as well. Mammographic density was classified according to the American College of Radiology BI-RADS system into one of the following four parenchymal patterns: A) entirely liposubstituted breasts, B) liposubstituted breasts with disperse glandular parenchyma, C) heterogeneously dense breasts, and D) extremely dense breasts. We proposed a subdivision of each category in to A e A1, B e B1, C and C1, D and D1 in order to identify smaller variations in mammographic density. Therefore, we attributed initial and final scores of 1-8 to each of the patients according to the mammographic density before and after HRT, corresponding to categories A to D1. The proportions of women that presented increase, decrease and no variation in mammographic density after 1 year of HRT were calculated. In addition, we estimated initial to final score variation using the paired t-test of the Statistical Package for Social Sciences (SPSS). RESULTS: mammographic density increased in 22.9%, decreased in 7.1% and did not change in 70% of the studied cases. A significant difference was observed between the score means before (2.2±1.82) and after HRT (2.5±1.9) (p=0.019). The androgenic distribution of body fat was associated with a denser mammographic pattern. CONCLUSIONS: an increase in mammographic density was shown in women undergoing HRT, and was most pronounced in women with androgenic fat distribution. Additional studies must be carried out in order to evaluate if this increment in mammographic density could impair the mammographic screening of breast cancer.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Effects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):573-578
10-14-2004
Summary
Trabalhos OriginaisEffects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):573-578
10-14-2004DOI 10.1590/S0100-72032004000700010
Views93See morePURPOSE: to evaluate the effects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women. METHODS: twenty-four healthy postmenopausal women, aged 50 to 70 years, with osteopenia and/or osteoporosis, were submitted to raloxifene therapy, 60 mg/day, for six months. Plasma homocysteine concentration was determined before and after three and six months of therapy, as well as total cholesterol, HDL-cholesterol LDL-cholesterol and triglyceride levels. Plasma homocysteine was measured by a polarized immunofluorescence assay and serum lipids by the enzymatic and colorimetric method. Data were analyzed statistically by ANOVA, Newman-Keuls test and Pearson's correlation test. RESULTS: a significant decrease in total cholesterol of 15.3% (227.6±56.3 vs 200.6±29.8 vs 192.8±32.1 mg/dl; p<0.001) and LDL-cholesterol of 21.4% (151.4±46.3 vs 122.7±29.4 vs 119.0±28.6 mg/dl; p<0.001), and a significant increase in HDL-cholesterol of 9.5% (44.7±10.8 vs 52.2±12.6 vs 49.0±10.8 mg/dl; p<0.05) were observed. There was no reduction in triglyceride levels (134.9±50.3 vs 127.5±50.0 vs 121.0±36.0 mg/dl; p>0.05). Although not significant, a decrease in homocysteine by 4.5% (11.7±3.0 vs 11.0±2.9 vs 11.2±2.1 muM/l; p>0.05) was observed between the pre-and posttreatment periods, with a significant negative correlation between basal levels and posttreatment percentual reduction (r=-0.71; p<0.0001). CONCLUSIONS: raloxifene treatment, 60 mg/day, for six months caused a significant decrease in total and LDL-cholesterol and an increase in HDL-cholesterol in postmenopausal women. Plasma homocysteine concentration tended to decrease, this effect being more favorable in patients with elevated baseline levels.
Views93This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisEffects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):573-578
10-14-2004DOI 10.1590/S0100-72032004000700010
Views93See morePURPOSE: to evaluate the effects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women. METHODS: twenty-four healthy postmenopausal women, aged 50 to 70 years, with osteopenia and/or osteoporosis, were submitted to raloxifene therapy, 60 mg/day, for six months. Plasma homocysteine concentration was determined before and after three and six months of therapy, as well as total cholesterol, HDL-cholesterol LDL-cholesterol and triglyceride levels. Plasma homocysteine was measured by a polarized immunofluorescence assay and serum lipids by the enzymatic and colorimetric method. Data were analyzed statistically by ANOVA, Newman-Keuls test and Pearson's correlation test. RESULTS: a significant decrease in total cholesterol of 15.3% (227.6±56.3 vs 200.6±29.8 vs 192.8±32.1 mg/dl; p<0.001) and LDL-cholesterol of 21.4% (151.4±46.3 vs 122.7±29.4 vs 119.0±28.6 mg/dl; p<0.001), and a significant increase in HDL-cholesterol of 9.5% (44.7±10.8 vs 52.2±12.6 vs 49.0±10.8 mg/dl; p<0.05) were observed. There was no reduction in triglyceride levels (134.9±50.3 vs 127.5±50.0 vs 121.0±36.0 mg/dl; p>0.05). Although not significant, a decrease in homocysteine by 4.5% (11.7±3.0 vs 11.0±2.9 vs 11.2±2.1 muM/l; p>0.05) was observed between the pre-and posttreatment periods, with a significant negative correlation between basal levels and posttreatment percentual reduction (r=-0.71; p<0.0001). CONCLUSIONS: raloxifene treatment, 60 mg/day, for six months caused a significant decrease in total and LDL-cholesterol and an increase in HDL-cholesterol in postmenopausal women. Plasma homocysteine concentration tended to decrease, this effect being more favorable in patients with elevated baseline levels.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Fresh wet mount in pregnancy: correlation with Pap smears
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):509-515
10-14-2004
Summary
Trabalhos OriginaisFresh wet mount in pregnancy: correlation with Pap smears
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):509-515
10-14-2004DOI 10.1590/S0100-72032004000700002
Views38See morePURPOSE: to analyze vaginal contents using the fresh wet mount of a cytological exam in the first prenatal visit of women with or without genital complaints and correlate the conclusion with the results from the Pap smears. Microscopy during pregnancy should be valued and recognized as a method capable of providing immediate diagnosis in 90% of bacterial vaginosis, candidiasis and trichomoniasis cases. METHODS: a prospective study was performed in 216 pregnant women selected from the prenatal department of a public hospital, between October 30, 2001 and November 12, 2002. Two samples were collected from the posterior vaginal vault and deposited onto two separate microscope slides. To one slide, a droplet of 0.9% NaCl was applied and to the other, a droplet of 10% KOH. Both slides were covered with a coverslip for immediate microscopic evaluation. Tests were perfomed in one drop of the material to examine pH and whiff. The microscopic examination of the material was carried out at a 100X, 400X and exceptionally 1000X magnification. Pap smears were performed in all pregnant patients. The correlation between the results of the utilized cytological methods was perfomed by the kappa coefficient, which evaluates the concordance for quality variables. RESULTS: the findings of the normal vaginal microflora in the fresh wet mount were 7.8%, representing the most observed cytological aspect, and without correspondence with the 3.70% verified by the Pap smears. In the fresh wet mount, bacterial vaginosis was found in 30.9% and candidiasis in 7.9% of the cases. However, in the Pap smears no similar event occurred, the diagnosis being 0.7 and 24.3%, respectively. The absence of a diagnosis correlation of nonspecific bacterial vaginitis by direct microscopy (17.5%) and Pap smears (51.3%) is probably due to the undervalued diagnosis of bacterial vaginosis by the latter method. The diagnosis of trichomonas vaginalis observed in both cytological methods (3.70 and 2.78%) represents a low prevalence of these parasites in the course of pregnancy. The kappa coefficient between the two cytological procedures in the several microbiological findings showed low correlation of the diagnosis of bacterial vaginosis with nonspecific vaginitis, as well as the normal vaginal flora. CONCLUSIONS: although the Pap smear presents the best accuracy of the diagnosis of yeast without pseudomycelium, the fresh wet mount has shown to be a better appraiser of nonepithelial cells the vaginal smears. Because Pap smears allow a better evaluation of vaginal epithelial cells, they represent the most important tool to show the aggressions and reactions of the nucleus and cytoplasm.
Views38This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisFresh wet mount in pregnancy: correlation with Pap smears
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):509-515
10-14-2004DOI 10.1590/S0100-72032004000700002
Views38See morePURPOSE: to analyze vaginal contents using the fresh wet mount of a cytological exam in the first prenatal visit of women with or without genital complaints and correlate the conclusion with the results from the Pap smears. Microscopy during pregnancy should be valued and recognized as a method capable of providing immediate diagnosis in 90% of bacterial vaginosis, candidiasis and trichomoniasis cases. METHODS: a prospective study was performed in 216 pregnant women selected from the prenatal department of a public hospital, between October 30, 2001 and November 12, 2002. Two samples were collected from the posterior vaginal vault and deposited onto two separate microscope slides. To one slide, a droplet of 0.9% NaCl was applied and to the other, a droplet of 10% KOH. Both slides were covered with a coverslip for immediate microscopic evaluation. Tests were perfomed in one drop of the material to examine pH and whiff. The microscopic examination of the material was carried out at a 100X, 400X and exceptionally 1000X magnification. Pap smears were performed in all pregnant patients. The correlation between the results of the utilized cytological methods was perfomed by the kappa coefficient, which evaluates the concordance for quality variables. RESULTS: the findings of the normal vaginal microflora in the fresh wet mount were 7.8%, representing the most observed cytological aspect, and without correspondence with the 3.70% verified by the Pap smears. In the fresh wet mount, bacterial vaginosis was found in 30.9% and candidiasis in 7.9% of the cases. However, in the Pap smears no similar event occurred, the diagnosis being 0.7 and 24.3%, respectively. The absence of a diagnosis correlation of nonspecific bacterial vaginitis by direct microscopy (17.5%) and Pap smears (51.3%) is probably due to the undervalued diagnosis of bacterial vaginosis by the latter method. The diagnosis of trichomonas vaginalis observed in both cytological methods (3.70 and 2.78%) represents a low prevalence of these parasites in the course of pregnancy. The kappa coefficient between the two cytological procedures in the several microbiological findings showed low correlation of the diagnosis of bacterial vaginosis with nonspecific vaginitis, as well as the normal vaginal flora. CONCLUSIONS: although the Pap smear presents the best accuracy of the diagnosis of yeast without pseudomycelium, the fresh wet mount has shown to be a better appraiser of nonepithelial cells the vaginal smears. Because Pap smears allow a better evaluation of vaginal epithelial cells, they represent the most important tool to show the aggressions and reactions of the nucleus and cytoplasm.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Preliminary evaluation of the prenatal and birth humanization program in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):517-525
10-14-2004
Summary
Trabalhos OriginaisPreliminary evaluation of the prenatal and birth humanization program in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):517-525
10-14-2004DOI 10.1590/S0100-72032004000700003
Views78See morePURPOSE: to evaluate the experience of implementation of the Brazilian Prenatal and Birth Humanization Program (PHPN) in 2001 and 2002, through a population descriptive study. METHODS: the study was performed through documental analysis and using data generated by SISPRENATAL, comparatively evaluating the indicators concerning criteria for prenatal follow-up in different states, regions and period. RESULTS: until the end of 2002, 3983 municipalities joined the Program (72% adhesion) and, among them, 71% reported results, constituting a data base of 720,871 women. In 2002 only 28% of the pregnant women were already registered, 25% before 120 days of pregnancy. Nearly 22% of the women had six prenatal visits, 6% had the post-partum visit and the compulsory tests performed, only 4% had also the HIV test and were vaccinated against tetanus, and 12% had two examinations performed for syphilis. There were important regional variations, generally showing better indicators for the Southeast and South regions. CONCLUSIONS: although the indicators of quality of care showed an improvement from 2001 to 2002, the recorded low percentages attest the need for permanent evaluations and new interventions with the aim of improving the quality of this care, especially in the North and Northeast regions.
Views78This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisPreliminary evaluation of the prenatal and birth humanization program in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):517-525
10-14-2004DOI 10.1590/S0100-72032004000700003
Views78See morePURPOSE: to evaluate the experience of implementation of the Brazilian Prenatal and Birth Humanization Program (PHPN) in 2001 and 2002, through a population descriptive study. METHODS: the study was performed through documental analysis and using data generated by SISPRENATAL, comparatively evaluating the indicators concerning criteria for prenatal follow-up in different states, regions and period. RESULTS: until the end of 2002, 3983 municipalities joined the Program (72% adhesion) and, among them, 71% reported results, constituting a data base of 720,871 women. In 2002 only 28% of the pregnant women were already registered, 25% before 120 days of pregnancy. Nearly 22% of the women had six prenatal visits, 6% had the post-partum visit and the compulsory tests performed, only 4% had also the HIV test and were vaccinated against tetanus, and 12% had two examinations performed for syphilis. There were important regional variations, generally showing better indicators for the Southeast and South regions. CONCLUSIONS: although the indicators of quality of care showed an improvement from 2001 to 2002, the recorded low percentages attest the need for permanent evaluations and new interventions with the aim of improving the quality of this care, especially in the North and Northeast regions.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Effects of a contraceptive implant containing nomegestrol acetate on ovarian function, cervical mucus and sperm penetration
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):449-454
09-02-2004
Summary
Trabalhos OriginaisEffects of a contraceptive implant containing nomegestrol acetate on ovarian function, cervical mucus and sperm penetration
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):449-454
09-02-2004DOI 10.1590/S0100-72032004000600005
Views65See moreOBJECTIVE: to study the effect of a single contraceptive implant of nomegestrol acetate (Uniplant) on the ovarian function, cervical mucus production and sperm penetration, when inserted in women in the preovulatory phase. METHODS: twenty women with regular menstrual cycles were included in an open comparative study. All participants were investigated during one menstrual cycle before (control) and one menstrual cycle after implant insertion. Measurements of estradiol, LH, and progesterone, as well as transvaginal sonography, cervical mucus examination and sperm penetration test, were carried out. Statistical analysis was performed with the paired t-test and the non-parametric test of Wilcoxon. RESULTS: all control cycles were ovulatory and presented normal parameters. Preovulatory estradiol and LH peak decreased significantly from 603.2 ± 78.0 pmo/l and 22.5 ± 6.5 IU/l at pre-insertion to 380.7 ± 51.9 pmol/l and 4.9 ± 1.3 IU/l 48 hours after implant insertion (p < 0.05 and p < 0.01, respectively). Progesterone levels did not vary significantly (control cycle = 49.8 ± 3.3 nmol/l and treated cycle = 43.2 ± 5.2 nmol/l). Cervical mucus and sperm penetration tests were profoundly affected in 10.5% of the users 20 h after implant insertion, in 68.5% after 24 h and in 100% after 48 h. Follicular rupture occurred in the majority of the cycles 48 h after implant insertion. CONCLUSIONS: the use of a single implant of nomegestrol acetate affected estradiol and LH preovulatory peaks and disrupted the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted at the preovulatory phase, which reinforces the need to insert the implant during the first five days of the menstrual cycle.
Views65This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisEffects of a contraceptive implant containing nomegestrol acetate on ovarian function, cervical mucus and sperm penetration
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):449-454
09-02-2004DOI 10.1590/S0100-72032004000600005
Views65See moreOBJECTIVE: to study the effect of a single contraceptive implant of nomegestrol acetate (Uniplant) on the ovarian function, cervical mucus production and sperm penetration, when inserted in women in the preovulatory phase. METHODS: twenty women with regular menstrual cycles were included in an open comparative study. All participants were investigated during one menstrual cycle before (control) and one menstrual cycle after implant insertion. Measurements of estradiol, LH, and progesterone, as well as transvaginal sonography, cervical mucus examination and sperm penetration test, were carried out. Statistical analysis was performed with the paired t-test and the non-parametric test of Wilcoxon. RESULTS: all control cycles were ovulatory and presented normal parameters. Preovulatory estradiol and LH peak decreased significantly from 603.2 ± 78.0 pmo/l and 22.5 ± 6.5 IU/l at pre-insertion to 380.7 ± 51.9 pmol/l and 4.9 ± 1.3 IU/l 48 hours after implant insertion (p < 0.05 and p < 0.01, respectively). Progesterone levels did not vary significantly (control cycle = 49.8 ± 3.3 nmol/l and treated cycle = 43.2 ± 5.2 nmol/l). Cervical mucus and sperm penetration tests were profoundly affected in 10.5% of the users 20 h after implant insertion, in 68.5% after 24 h and in 100% after 48 h. Follicular rupture occurred in the majority of the cycles 48 h after implant insertion. CONCLUSIONS: the use of a single implant of nomegestrol acetate affected estradiol and LH preovulatory peaks and disrupted the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted at the preovulatory phase, which reinforces the need to insert the implant during the first five days of the menstrual cycle.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Histological results and HPV detection in women with pap smear showing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):457-462
09-02-2004
Summary
Trabalhos OriginaisHistological results and HPV detection in women with pap smear showing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):457-462
09-02-2004DOI 10.1590/S0100-72032004000600006
Views114See moreOBJECTIVE: to assess the ability of Pap smear and hybrid capture II (HCII) to detect clinically significant cervical lesions (CIN2/3) in women referred to hospital due to atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL). METHODS: a cross-sectional study comprising 161 women referred to the Taubaté University Hospital due to ASCUS/LSIL, between August 2000 and September 2002. All women responded to a questionnaire regarding sociodemographic and reproductive characteristics and were subjected to gynecological examination with specimen collection for Pap test and HCII, along with colposcopy and eventual cervical biopsy. The relationship between HCII results and age, use of condom, oral hormonal contraception, and smoking were evaluated by the chi-square test. The sensitivity, specificity, positive and negative predictive values of both Pap test and HCII were calculated. All calculations were performed within 95% confidence intervals. RESULTS: sixty-seven percent of the women that tested positive for HPV were less than 30 years old. Pap smear and HCII showed the same 82% sensitivity in detecting CIN2/3 when the threshold for a positive Pap result was ASCUS, LSIL or HSIL. Pap smear specificity and positive predictive values were substantially increased when only HSIL results were considered as positive (from 29 to 95% and 12 to 50%, respectively). These figures were superior to those of HCII, but at the expense of an expressive loss of sensitivity (from 82% to 41%). CONCLUSIONS: our results substantiate the potential of HCII in detecting CIN2/3 among women referred due to ASCUS/LSIL.
Views114This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisHistological results and HPV detection in women with pap smear showing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):457-462
09-02-2004DOI 10.1590/S0100-72032004000600006
Views114See moreOBJECTIVE: to assess the ability of Pap smear and hybrid capture II (HCII) to detect clinically significant cervical lesions (CIN2/3) in women referred to hospital due to atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL). METHODS: a cross-sectional study comprising 161 women referred to the Taubaté University Hospital due to ASCUS/LSIL, between August 2000 and September 2002. All women responded to a questionnaire regarding sociodemographic and reproductive characteristics and were subjected to gynecological examination with specimen collection for Pap test and HCII, along with colposcopy and eventual cervical biopsy. The relationship between HCII results and age, use of condom, oral hormonal contraception, and smoking were evaluated by the chi-square test. The sensitivity, specificity, positive and negative predictive values of both Pap test and HCII were calculated. All calculations were performed within 95% confidence intervals. RESULTS: sixty-seven percent of the women that tested positive for HPV were less than 30 years old. Pap smear and HCII showed the same 82% sensitivity in detecting CIN2/3 when the threshold for a positive Pap result was ASCUS, LSIL or HSIL. Pap smear specificity and positive predictive values were substantially increased when only HSIL results were considered as positive (from 29 to 95% and 12 to 50%, respectively). These figures were superior to those of HCII, but at the expense of an expressive loss of sensitivity (from 82% to 41%). CONCLUSIONS: our results substantiate the potential of HCII in detecting CIN2/3 among women referred due to ASCUS/LSIL.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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