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FEBRASGO POSITION STATEMENT
Mayer-Rokitansky-Kuster-Hauser syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-FPS4
16/05/2025
Resumo
FEBRASGO POSITION STATEMENTMayer-Rokitansky-Kuster-Hauser syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-FPS4
16/05/2025Visualizações20Ver maisKey points
•Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the leading cause of vaginal agenesis.
•It is characterized by primary amenorrhea with typical adrenarche and telarche and may be associated with congenital urological and skeletal conditions that should be investigated.
•Differential diagnoses include: vaginal obstructions (imperforate hymen, distal vaginal atresia, transverse vaginal septum), uterine obstructions (cervical atresia), and differences in sexual development (gonadal dysgenesis, complete androgen insensitivity and congenital adrenal hyperplasia due to CYP17 deficiency).
•Laboratory tests (testosterone, follicle-stimulating hormone [FSH] and karyotype) and radiological tests (pelvic ultrasound and MRI) are necessary.
•Vaginal dilation is the first line of treatment with high success rates.
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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Original Article
Hysterectomy rates per resident in final year of training in teaching hospitals: an ecologic study
- Luiza Nestori Chiozzotto
, - Nino José Wilson Moterani Júnior ,
- Laura Bresciani Bento Gonçalves Moterani ,
- Vinicius César Moterani ,
- Francisco José Candido dos Reis
30/04/2025
Resumo
Original ArticleHysterectomy rates per resident in final year of training in teaching hospitals: an ecologic study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo24
30/04/2025- Luiza Nestori Chiozzotto ,
- Nino José Wilson Moterani Júnior ,
- Laura Bresciani Bento Gonçalves Moterani ,
- Vinicius César Moterani ,
- Francisco José Candido dos Reis
Visualizações74Abstract
Objective:
Analyze the hysterectomy rates per resident in graduation year in teaching hospitals in the state of São Paulo (Brazil).
Methods:
We selected teaching hospitals in the state of São Paulo and gathered information from two public databases to estimate the hysterectomy rates per resident in their final year of training between 2009 and 2019.
Results:
Between 2009 and 2019, there was a 37.5% increase in the number of residents in their final year of training, a 4.31% increase in the number of hysterectomies, and a drop in the hysterectomy rates per resident of 24.1%. The reduction of the rate of hysterectomy per resident was more pronounced for vaginal route (46.4%) followed by abdominal route (23.3%). The ratio of laparoscopic hysterectomy per resident increased 264% during the period, however, this route was used in only 7% of the surgeries in 2019.
Conclusions:
The hysterectomy rates per resident in their final year of training showed a notable reduction. This trend, particularly pronounced in vaginal and abdominal routes, signals a shift towards minimally invasive techniques.
Palavras-chave: Clinical competenceEducation, medicalHospitals, teachingHysterectomylearning curveMedical staff, hospitalPhysiciansStudents, medicalSurgical procedures, operativeVer maisThis 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. 
- Luiza Nestori Chiozzotto
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Original Article
Prevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study
- Elaine Cristina Fontes de Oliveira ,
- Daniel Dias Ribeiro ,
- Janaína Campos Senra ,
- Fernando Marcos dos Reis
30/04/2025
Resumo
Original ArticlePrevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo23
30/04/2025- Elaine Cristina Fontes de Oliveira ,
- Daniel Dias Ribeiro ,
- Janaína Campos Senra ,
- Fernando Marcos dos Reis
Visualizações69Abstract
Objective:
This study aimed to evaluate the prevalence of antiphospholipid syndrome (APS) among women experiencing recurrent pregnancy loss (RPL).
Methods:
A cross-sectional was conducted, reviewing the medical records of 134 women with a history of two or more miscarriages, treated between January 2014 and May 2024 at a tertiary university center in Belo Horizonte, Brazil. APS screening was performed by assessing anticardiolipin (IgG and IgM), lupus anticoagulant, and anti-β2-glycoprotein-1 (IgG and IgM) antibodies, based on Sapporo criteria. All tests were performed during non-pregnant periods and at least 12 weeks after the last miscarriage.
Results:
The study included 134 women with a mean age of 33.8 ± 5.7 years. The number of prior miscarriages ranged from 2 to 11 per couple. Among the patients who presented the lupus anticoagulant, only two (1.49%) tested positive in two samples, as per revised Sapporo criteria. Considering IgG and IgM anticardiolipin antibodies, four patients (2.98%) tested positive in two samples according to old Sapporo criteria, with one patient having a positive IgG test in two samples, two having positive IgM in two samples and a single patient having both positive tests. None of the 56 patients tested positive for anti-β2-glycoprotein-1 antibodies in two samples.
Conclusion:
The prevalence of antiphospholipid antibodies, in line with revised Sapporo criteria, is low among Brazilian women with recurrent pregnancy loss, consistent with recent studies in literature. Ensuring the appropriateness of diagnostic criteria is crucial to avoid unnecessary treatment with platelet anticoagulants and heparin in this population.
Palavras-chave: Abortion, habitualAbortion, spontaneousAntibodiesAnticardiolipinAntiphospholipid syndromePrevalenceThrombophiliaVer maisThis 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. - Elaine Cristina Fontes de Oliveira
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Original Article
An assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo22
30/04/2025
Resumo
Original ArticleAn assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo22
30/04/2025Visualizações67Abstract
Objective:
In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents the imbalance between the production of reactive oxygen species and their detoxification. Total Antioxidant and Oxidant Status, and Oxidative Stress Index levels are the main oxidative stress markers. This study investigated the effects of oxidative stress markers on infertility etiology, embryo quality, and success of In vitro fertilization.
Methods:
Before enrolling in the ICSI-ET cycle, participants had their FSH and LH levels assessed on the second day of the cycle. The ovarian degrees of the participants were evaluated by transvaginal ultrasonography. Participants underwent controlled ovarian stimulation using the GnRH antagonist protocol. TV-USG and serial E2 measurements were performed at appropriate intervals to follow follicular development. Follicle sizes, quantity, and endometrial thickness were recorded. Total Antioxidant and Oxidant Status, and Oxidative analyses were conducted using Rel Assay Diagnostics Assay Kits.
Results:
The average number of total oocytes in the participants was 10.25±6.66, and the average of mature M2 stage oocytes was 6.71±3.72. The average number of fertilized oocytes was 4.65±2.81. Fertilization rates were calculated as approximately 54.75±25.58%. A statistically significant positive correlation was found between embryo quality and serum Total Antioxidant Status levels (p=0.004). Similarly, a significant positive correlation was observed between embryo quality and follicular Total Antioxidant Status values (r = 0.42, p = 0.01).
Conclusion:
This study concluded that oxidative stress markers affect certain stages of the IVF treatment process.
Palavras-chave: AntioxidantsFertilization in vitroFollicular fluidInfertilityOocytesOxidantsOxidative stressVer maisThis 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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Review Article
Letrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis
- Karine Eskandar ,
- Juliana Almeida Oliveira ,
- Sandro Augusto Ribeiro ,
- Matheus Pedrotti Chavez ,
- Ana Isabela de Araujo Zotti , [ … ],
- Andrea Mora de Marco Novellino
30/04/2025
Resumo
Review ArticleLetrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo21
30/04/2025- Karine Eskandar ,
- Juliana Almeida Oliveira ,
- Sandro Augusto Ribeiro ,
- Matheus Pedrotti Chavez ,
- Ana Isabela de Araujo Zotti ,
- Yasmin Jardim Meirelles Dias ,
- Andrea Mora de Marco Novellino
Visualizações77Abstract
Objective:
We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS).
Data Sources:
We systematically searched EMBASE, PubMed, and Cochrane databases on October 31, 2024.
Study selection:
We included studies of women with PCOS treated with a combination of clomiphene and letrozole or letrozole alone to induce ovulation that reported any of the outcomes of interest, namely rate of mature follicles and ovulation, ovulation, pregnancy, miscarriages, endometrial thickness, and number of mature follicles.
Data collection:
We pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) using a random effects model using R statistical software, version 4.2.1. Heterogeneity was assessed with I statistics, and a random effects model was used.
Data Synthesis:
Four RCTs and two observational studies comprising 592 patients were included. Combined therapy was associated with a higher rate of a mature follicle (OR 2.74; 95% CI 1.72-4.37; p< 0.001; I=0%) and ovulation (OR 2.55; 95% CI 1.57-4.12; p< 0.001; I=35.9%). The number of mature follicles, number of pregnancies, thickness of endometrial lining, and the incidence of adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups.
Conclusion:
In women with anovulatory infertility secondary to PCOS, letrozole and clomiphene citrate combined therapy was associated with improved mature follicle and ovulation rates, with a similar safety profile compared to letrozole alone. However, no significant impact was observed on pregnancy rates.
Palavras-chave: ClomipheneInfertility, femaleLetrozoleOvulationOvulation InductionPolycystic ovary syndromeVer maisThis 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. 
- Karine Eskandar
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Original Article
Incidence of small-for-gestational-age newborns in pregnant women with COVID-19
- Gustavo dos Santos Raupp ,
- Renato Teixeira Souza ,
- Maria Laura Costa ,
- Jose Guilherme Cecatti ,
- Annerose Barros , [ … ],
- Janete Vettorazzi
30/04/2025
Resumo
Original ArticleIncidence of small-for-gestational-age newborns in pregnant women with COVID-19
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo20
30/04/2025- Gustavo dos Santos Raupp ,
- Renato Teixeira Souza ,
- Maria Laura Costa ,
- Jose Guilherme Cecatti ,
- Annerose Barros ,
- Ellen Machado Arlindo ,
- Edson Vieira Cunha Filho ,
- Janete Vettorazzi
Visualizações64Abstract
Objective:
This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes.
Methods:
This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses.
Results:
A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 – 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 – 0.853); P=0.002].
Conclusion:
The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.
Palavras-chave: coronavirus infectionsCOVID-19Infant, newbornInfant, small for gestational agematernal healthPregnancy complicationsVer maisThis 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. 
- Gustavo dos Santos Raupp
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Review Article
Efficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials
- Nicole Cristina Lottermann ,
- Nathalia Luiza Andreazza ,
- Matheus de Araújo Moura Cavalcante ,
- Laura Andrade Fernandez ,
- Carla Vitola Gonçalvez , [ … ],
- Linjie Zhang
30/04/2025
Resumo
Review ArticleEfficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo18
30/04/2025- Nicole Cristina Lottermann ,
- Nathalia Luiza Andreazza ,
- Matheus de Araújo Moura Cavalcante ,
- Laura Andrade Fernandez ,
- Carla Vitola Gonçalvez ,
- Linjie Zhang
Visualizações67Abstract
Objective:
This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures.
Methods:
We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term “tranexamic acid”. Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively.
Results:
Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate.
Conclusions:
This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.
Palavras-chave: Blood transfusionCesarean sectionEfficacyGynecologic surgical procedureshematocritHemorrhageHysterectomyObstetric surgical proceduresTranexamic acidUterine cervical dysplasiauterine myomectomyVer maisThis 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. 
- Nicole Cristina Lottermann
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Original Article
Assessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus
- Ayse Cigdem Bayrak ,
- Erdem Fadiloglu ,
- Haticegul Tuncer ,
- Edip Alptug Kir ,
- Umutcan Kayikci , [ … ],
- Ozgur Deren
30/04/2025
Resumo
Original ArticleAssessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo17
30/04/2025- Ayse Cigdem Bayrak ,
- Erdem Fadiloglu ,
- Haticegul Tuncer ,
- Edip Alptug Kir ,
- Umutcan Kayikci ,
- Ozgur Deren
Visualizações54Abstract
Objective:
This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×platelet×monocyte)/lymphocyte)], SII (neutrophil×platelet/lymphocyte), and NLR neutrophil/lymphocyte) values were evaluated in all three trimesters, and their correlation with neonatal outcomes was examined.
Methods:
We included 82 cases of PGDM pregnancies delivered after 32 weeks. Maternal age, gravidity, parity, types of diabetes, and route of delivery were noted. For neonatal outcomes, we recorded gestational age at birth, birth weight percentile, existence of fetal growth restriction, LGA, neonatal intensive care unit (NICU) requirement, Apgar Score <7 at 1, 5, or 10 minutes, need for positive pressure ventilation (PPV), need for mechanical ventilation, hypoglycaemia, hyperbilirubinemia and the need for phototherapy. PIV, SII and NLR values were calculated in each trimester and their association with adverse neonatal outcomes was analyzed.
Results:
We could not detect any consistent and significant correlation between SII and PIV values and adverse neonatal outcomes for each trimester. There was a correlation between 3rd trimester NLR and adverse neonatal outcomes, including APGAR <7, the requirement for PPV and mechanical ventilation (p=0.056, 0.013 and 0.060, respectively).
Conclusion:
While SII and PIV values did not consistently correlate with adverse neonatal outcomes throughout each trimester in PGDM pregnancies, 3rd-trimester NLR showed a notable association with the requirement for PPV with statistical significance and with Apgar Score <7 and the requirement for mechanical ventilation without statistical significance. NLR in the third trimester may hold potential as a predictive marker for specific adverse neonatal outcomes in PGDM pregnancies, warranting further investigation.
Palavras-chave: biomarkersDiabetes mellitusGestational ageHypoglycemiaInfant, newbornIntensive care units, neonatalLymphocytesMaternal ageMonocytesNeuthrophilsPregancyPregnancy in diabetesRespiration, artificialVer maisThis 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. - Ayse Cigdem Bayrak
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