Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2004;26(10):218-218
Summary
Rev Bras Ginecol Obstet. 2004;26(10):218-218
Summary
Rev Bras Ginecol Obstet. 2004;26(10):218-218
Summary
Rev Bras Ginecol Obstet. 2004;26(10):218-218
Summary
Rev Bras Ginecol Obstet. 2004;26(10):757-764
DOI 10.1590/S0100-72032004001000002
PURPOSE: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. METHODS: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. Twenty-three of them presented vaginal vault prolapse (GVault), and 23 had total uterovaginal prolapse (GUterus). The inclusion criterion was the presence of symptomatic prolapse grade III or IV according to the classification proposed by the International Continence Society. Patients presenting lower grade prolapse were excluded. The average age of the patients was similar: 67.0 years in GVault and 67.5 years in GUterus. Average body mass index was also similar: 27.4 kg/m² in GVault and 25.6 kg/m² in GUterus. Deliveries varied from 0 to 13 in GVault (average: 4.4 deliveries), and from 1 to 13 in GUterus (average: 6.2 deliveries). Among the 23 patients in GVault, eight had undergone previous surgical repair without success. The results obtained in both groups were analyzed and compared. The used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. RESULTS: average duration of the surgery was 90.0 min in GVault and 119.5 min in GUterus, a statistically significant difference (p<0.05). Three blood transfusions were needed, one in GVault and two in GUterus. There was no bladder, rectal or ureteral injury nor death in any of the groups. The incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and blood transfusion. Average vaginal length after the operation was 7.6 cm in GVault and 7.3 cm in GUterus (p>0.05). The anatomical result of the apical, anterior and posterior vaginal compartments was satisfactory in more than 90% of the patients of both groups. The functional result was also similar in both groups, and among the sexually active patients, only one (7.7%) in GVault and two (13.3%) in GUterus complained of dyspareunia after the surgery. There was no association between age, parity, obesity, and the anatomical and functional results. CONCLUSION: analysis of the obtained data demonstrates that this modification of sacrospinous colpopexy is technically simple, safe and effective, providing similar results in both groups of the studied patients.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):757-764
DOI 10.1590/S0100-72032004001000002
PURPOSE: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. METHODS: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. Twenty-three of them presented vaginal vault prolapse (GVault), and 23 had total uterovaginal prolapse (GUterus). The inclusion criterion was the presence of symptomatic prolapse grade III or IV according to the classification proposed by the International Continence Society. Patients presenting lower grade prolapse were excluded. The average age of the patients was similar: 67.0 years in GVault and 67.5 years in GUterus. Average body mass index was also similar: 27.4 kg/m² in GVault and 25.6 kg/m² in GUterus. Deliveries varied from 0 to 13 in GVault (average: 4.4 deliveries), and from 1 to 13 in GUterus (average: 6.2 deliveries). Among the 23 patients in GVault, eight had undergone previous surgical repair without success. The results obtained in both groups were analyzed and compared. The used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. RESULTS: average duration of the surgery was 90.0 min in GVault and 119.5 min in GUterus, a statistically significant difference (p<0.05). Three blood transfusions were needed, one in GVault and two in GUterus. There was no bladder, rectal or ureteral injury nor death in any of the groups. The incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and blood transfusion. Average vaginal length after the operation was 7.6 cm in GVault and 7.3 cm in GUterus (p>0.05). The anatomical result of the apical, anterior and posterior vaginal compartments was satisfactory in more than 90% of the patients of both groups. The functional result was also similar in both groups, and among the sexually active patients, only one (7.7%) in GVault and two (13.3%) in GUterus complained of dyspareunia after the surgery. There was no association between age, parity, obesity, and the anatomical and functional results. CONCLUSION: analysis of the obtained data demonstrates that this modification of sacrospinous colpopexy is technically simple, safe and effective, providing similar results in both groups of the studied patients.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):765-771
DOI 10.1590/S0100-72032004001000003
PURPOSE: to identify factors associated with the occurrence of hot flashes in climacteric women living in Campinas, São Paulo. METHODS: data bank secondary analysis of a cross-sectional descriptive population-based study. The selection of 456 women aged 45-60 years was done through area cluster sampling. Data were collected via home interviews using structured, pre-tested questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. The analyzed variables were age, race, use of contraceptive methods and hormonal therapy, tubal ligation, body mass index, menopausal status, time since menopause, hysterectomy, and cigarette smoking. Statistical analysis was performed using the mean, median and the prevalence ratio (PR). Multiple logistic regression was performed using the stepwise selection process with a 95% confidence interval (95% CI). RESULTS: bivariate analysis showed that postmenopausal women (PR: 1.42, CI 95%: 1.06-1.90) and those who were submitted to hysterectomy (PR: 1.50, CI 95%: 1.05-2.14) had a significantly greater chance of presenting hot flashes. After applying multiple regression analysis, there was no significant association between hot flashes and any of the evaluated variables. CONCLUSION: results were consistent with previous studies. Many doubts still exist about which factors are associated with hot flashes.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):765-771
DOI 10.1590/S0100-72032004001000003
PURPOSE: to identify factors associated with the occurrence of hot flashes in climacteric women living in Campinas, São Paulo. METHODS: data bank secondary analysis of a cross-sectional descriptive population-based study. The selection of 456 women aged 45-60 years was done through area cluster sampling. Data were collected via home interviews using structured, pre-tested questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. The analyzed variables were age, race, use of contraceptive methods and hormonal therapy, tubal ligation, body mass index, menopausal status, time since menopause, hysterectomy, and cigarette smoking. Statistical analysis was performed using the mean, median and the prevalence ratio (PR). Multiple logistic regression was performed using the stepwise selection process with a 95% confidence interval (95% CI). RESULTS: bivariate analysis showed that postmenopausal women (PR: 1.42, CI 95%: 1.06-1.90) and those who were submitted to hysterectomy (PR: 1.50, CI 95%: 1.05-2.14) had a significantly greater chance of presenting hot flashes. After applying multiple regression analysis, there was no significant association between hot flashes and any of the evaluated variables. CONCLUSION: results were consistent with previous studies. Many doubts still exist about which factors are associated with hot flashes.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):773-780
DOI 10.1590/S0100-72032004001000004
PURPOSE: to compare the information obtained with pelvic and transvaginal ultrasonography (USG), hystero-salpingography (HSG), diagnostic hysteroscopy (HSC), pelvic nuclear magnetic resonance imaging (PNMR), three-dimensional hysterosonography (3D HSSNG), to optimize and simplify the investigation about cervical and corporeal uterine factors in conjugal infertility. METHODS: in the period between January and July 2003, fifty women reporting infertility for at least two years were submitted to USG, HSG, HSC, PNMR, and 3D HSSNG as tracking examinations for uterine factor diagnosis. The endocervical canal, as well as the endometrium, myometrium, and the presence of uterine malformations were investigated. The results of each examination were analyzed and compared. RESULTS: of the 50 women studied, 12 (24%) presented alteration in at least one of the examinations. When 3D HSSNG was compared to USG, 3D HSSNG provided additional information in 7 cases (58.3%); when compared to HSG, it provided additional information in 7 cases (58.3%); when compared to HSC, it provided additional information in 4 cases (32.1%), and when compared to PNMR, it provided additional information in 6 cases (50%). There were only two cases in which HSG detected alterations of the endocervical canal that were not visualized using 3D HSSNG. In the other cases 3D HSSNG imparted the same diagnosis; furthermore, it provided additional information in comparison to the other examinations. Statistical analysis using the kappa test demonstrated that the diagnoses obtained by 3D HSSNG were in agreement with those obtained with USG, HSG and PNMR (p<0,05). When the HSG and 3D HSSNG results were combined, all conditions associated with infertility could be precisely diagnosed, using only these examinations. CONCLUSION: the association of the HSG with 3D HSSNG may be sufficient for the diagnosis of cervical and corporeal uterine factors in infertility, reducing the number of examinations for each patient, the total cost, as well as the anxiety and the delay in treatment.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):773-780
DOI 10.1590/S0100-72032004001000004
PURPOSE: to compare the information obtained with pelvic and transvaginal ultrasonography (USG), hystero-salpingography (HSG), diagnostic hysteroscopy (HSC), pelvic nuclear magnetic resonance imaging (PNMR), three-dimensional hysterosonography (3D HSSNG), to optimize and simplify the investigation about cervical and corporeal uterine factors in conjugal infertility. METHODS: in the period between January and July 2003, fifty women reporting infertility for at least two years were submitted to USG, HSG, HSC, PNMR, and 3D HSSNG as tracking examinations for uterine factor diagnosis. The endocervical canal, as well as the endometrium, myometrium, and the presence of uterine malformations were investigated. The results of each examination were analyzed and compared. RESULTS: of the 50 women studied, 12 (24%) presented alteration in at least one of the examinations. When 3D HSSNG was compared to USG, 3D HSSNG provided additional information in 7 cases (58.3%); when compared to HSG, it provided additional information in 7 cases (58.3%); when compared to HSC, it provided additional information in 4 cases (32.1%), and when compared to PNMR, it provided additional information in 6 cases (50%). There were only two cases in which HSG detected alterations of the endocervical canal that were not visualized using 3D HSSNG. In the other cases 3D HSSNG imparted the same diagnosis; furthermore, it provided additional information in comparison to the other examinations. Statistical analysis using the kappa test demonstrated that the diagnoses obtained by 3D HSSNG were in agreement with those obtained with USG, HSG and PNMR (p<0,05). When the HSG and 3D HSSNG results were combined, all conditions associated with infertility could be precisely diagnosed, using only these examinations. CONCLUSION: the association of the HSG with 3D HSSNG may be sufficient for the diagnosis of cervical and corporeal uterine factors in infertility, reducing the number of examinations for each patient, the total cost, as well as the anxiety and the delay in treatment.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):781-786
DOI 10.1590/S0100-72032004001000005
PURPOSE: to assess the obstetric and perinatal outcomes in cases of term newborns in breech presentation, in patients with previous vaginal deliveries, comparing them to term newborns in vertex presentation. METHODS: 8,350 deliveries retrospectively from March 1998 to July 2003 were analysed. Of 419 deliveries (5.1%) in breech presentation, 58 cases were selected for the study (breech group), according to the following criteria: patients who had had one or more babies through vaginal delivery, gestational age ³37 weeks, no fetal malformation, no complications in the current pregnancy, birth weight between 2,500 and 3,750 g, and no previous cesarean section. The breech group was matched to 1,327 newborns in vertex position from pregnant women with no previous cesarean section (vertex group). Maternal age, parity, gestational age, delivery way, birth weight, meconium-stained amniotic fluid, 1- and 5-min Apgar score, need of neonatal intensive care unit, and small- and big-for-gestational age newborns were analyzed. Statistical analysis was performed by the c² test and by Student's t test, with the level of significance set at p<0.05. RESULTS: when breech and vertex groups were compared, they showed significant differences regarding the following variables: birth weight (3,091±538 g vs 3,250±497 g; p<0.01), vaginal delivery (63.8 vs 95.0%; p<0.0001), cesarean section (36.2 vs 5.0%; p<0,0001), and 1-min Apgar score (p<0.0001), respectively. CONCLUSIONS: we conclude that in term fetuses in breech position from pregnant women with previous vaginal deliveries, birth weight, delivery way, and 1-min Apgar score were different compared to fetuses in vertex position from women with the same characteristics.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):781-786
DOI 10.1590/S0100-72032004001000005
PURPOSE: to assess the obstetric and perinatal outcomes in cases of term newborns in breech presentation, in patients with previous vaginal deliveries, comparing them to term newborns in vertex presentation. METHODS: 8,350 deliveries retrospectively from March 1998 to July 2003 were analysed. Of 419 deliveries (5.1%) in breech presentation, 58 cases were selected for the study (breech group), according to the following criteria: patients who had had one or more babies through vaginal delivery, gestational age ³37 weeks, no fetal malformation, no complications in the current pregnancy, birth weight between 2,500 and 3,750 g, and no previous cesarean section. The breech group was matched to 1,327 newborns in vertex position from pregnant women with no previous cesarean section (vertex group). Maternal age, parity, gestational age, delivery way, birth weight, meconium-stained amniotic fluid, 1- and 5-min Apgar score, need of neonatal intensive care unit, and small- and big-for-gestational age newborns were analyzed. Statistical analysis was performed by the c² test and by Student's t test, with the level of significance set at p<0.05. RESULTS: when breech and vertex groups were compared, they showed significant differences regarding the following variables: birth weight (3,091±538 g vs 3,250±497 g; p<0.01), vaginal delivery (63.8 vs 95.0%; p<0.0001), cesarean section (36.2 vs 5.0%; p<0,0001), and 1-min Apgar score (p<0.0001), respectively. CONCLUSIONS: we conclude that in term fetuses in breech position from pregnant women with previous vaginal deliveries, birth weight, delivery way, and 1-min Apgar score were different compared to fetuses in vertex position from women with the same characteristics.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):791-798
DOI 10.1590/S0100-72032004001000006
PURPOSE: to find out the preference in regard to the way of delivery among primigravidae, as well as the reasons for their choice, in order to improve the quality of the doctor-patient relationship. METHODS: a qualitative-type study was conducted through analysis of the collective subject, including primigravidae attended from September to November 2003 at the emergency rooms of the hospital of the "Faculdade de Medicina de Jundiaí". A questionnaire, specially developed to accomplish the proposed objectives was applied. An informed and free consent, signed by the pregnant woman and one of the researchers in charge was obtained. This questionnaire was based on doubts of patients attended at this hospital some months before the trial. For the purpose of sample standardization, the patients' selection followed some inclusion criteria: age above 16, primigravidae that were receiving prenatal assistance and a post-informed and free consent. Mental disorders and clinical and/or obstetric pathologies that could interfere in the patient's choice were considered exclusion criteria. RESULTS: the studied population had as prevailing profile women in the third quarter of gestation, above 21 years of age, white, married and with completed school. Most of the women (90%) preferred vaginal delivery for the following main reasons: ease to be done (94%) and the fear of suffering and pain during the postpartum period caused by cesarean section. There was a relationship between older and married women and the preference for vaginal delivery, with no significant difference between races. CONCLUSION: these results show an enormous contrast between women's preference and the high cesarean section rates in Brazil. We conclude that there may be a lack of information and dialogue between the health professionals and patients about the possible difficulties, doubts and anxieties that involve the women's choice for a specific way of delivery. From an ethical point of view, we conclude that obstetricians should question every cesarean section indication and take into account the women's right to choose, without ignoring clinical criteria, when making the medical decision about the way of delivery.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):791-798
DOI 10.1590/S0100-72032004001000006
PURPOSE: to find out the preference in regard to the way of delivery among primigravidae, as well as the reasons for their choice, in order to improve the quality of the doctor-patient relationship. METHODS: a qualitative-type study was conducted through analysis of the collective subject, including primigravidae attended from September to November 2003 at the emergency rooms of the hospital of the "Faculdade de Medicina de Jundiaí". A questionnaire, specially developed to accomplish the proposed objectives was applied. An informed and free consent, signed by the pregnant woman and one of the researchers in charge was obtained. This questionnaire was based on doubts of patients attended at this hospital some months before the trial. For the purpose of sample standardization, the patients' selection followed some inclusion criteria: age above 16, primigravidae that were receiving prenatal assistance and a post-informed and free consent. Mental disorders and clinical and/or obstetric pathologies that could interfere in the patient's choice were considered exclusion criteria. RESULTS: the studied population had as prevailing profile women in the third quarter of gestation, above 21 years of age, white, married and with completed school. Most of the women (90%) preferred vaginal delivery for the following main reasons: ease to be done (94%) and the fear of suffering and pain during the postpartum period caused by cesarean section. There was a relationship between older and married women and the preference for vaginal delivery, with no significant difference between races. CONCLUSION: these results show an enormous contrast between women's preference and the high cesarean section rates in Brazil. We conclude that there may be a lack of information and dialogue between the health professionals and patients about the possible difficulties, doubts and anxieties that involve the women's choice for a specific way of delivery. From an ethical point of view, we conclude that obstetricians should question every cesarean section indication and take into account the women's right to choose, without ignoring clinical criteria, when making the medical decision about the way of delivery.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):799-805
DOI 10.1590/S0100-72032004001000007
PURPOSE: to assess risk factors for low Apgar score. METHODS: this was a cross-sectional study preformed in a random sample of patients admitted to a level III maternity hospital in 2001. The outcome was low Apgar score defined as an Apgar score 1-6 (study group) versus Apgar score 7-10 (control group) in the first minute of life. The first step was the evaluation of the association of each possible risk factor with low Apgar score. The second step was multivariate analysis with the backward stepwise logistic regression model. RESULTS: there were 39 (14%) depressed newborns which were compared to 238 (86%) not depressed babies. The final analysis (multivariate) showed an association between low Apgar score and previous case of stillbirth (OR=52.6), preterm labor threat (OR=33.8), low birth weight, less than 2,500 g body weight (OR=11.2) and previous cesarean section (OR=7.4). Some factors acted as a protection, including birth weight, in grams (OR=0.9), female sex of the newborn (OR=0.1), medical complications (OR=0.4) and prematurity (gestational age < 37 weeks, OR=0.1). CONCLUSION: the study may help in the identification of fetuses at great risk of asphyxia, allowing proper reference within the health system and planning of effective assistance in neonatal intensive care units.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):799-805
DOI 10.1590/S0100-72032004001000007
PURPOSE: to assess risk factors for low Apgar score. METHODS: this was a cross-sectional study preformed in a random sample of patients admitted to a level III maternity hospital in 2001. The outcome was low Apgar score defined as an Apgar score 1-6 (study group) versus Apgar score 7-10 (control group) in the first minute of life. The first step was the evaluation of the association of each possible risk factor with low Apgar score. The second step was multivariate analysis with the backward stepwise logistic regression model. RESULTS: there were 39 (14%) depressed newborns which were compared to 238 (86%) not depressed babies. The final analysis (multivariate) showed an association between low Apgar score and previous case of stillbirth (OR=52.6), preterm labor threat (OR=33.8), low birth weight, less than 2,500 g body weight (OR=11.2) and previous cesarean section (OR=7.4). Some factors acted as a protection, including birth weight, in grams (OR=0.9), female sex of the newborn (OR=0.1), medical complications (OR=0.4) and prematurity (gestational age < 37 weeks, OR=0.1). CONCLUSION: the study may help in the identification of fetuses at great risk of asphyxia, allowing proper reference within the health system and planning of effective assistance in neonatal intensive care units.