Você pesquisou por y?yr=2019 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):679-681
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):679-681
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):682-687
The present study aims to understand to what extent obesity is related to adversematernal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population.
A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant womenwith 5,399 normal or underweight pregnantwomen for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissionswere also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered.
The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p< 0.001), gestational diabetes (aOR 2.14, p< 0.001), hypertensive pregnancy disorders (aOR 3.43, p< 0.001), and large-for-gestational age ormacrosomic infants (aOR 2.13, p< 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p< 0.009). No significant differences were found in terms of pretermbirths, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy.
Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):682-687
The present study aims to understand to what extent obesity is related to adversematernal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population.
A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant womenwith 5,399 normal or underweight pregnantwomen for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissionswere also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered.
The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p< 0.001), gestational diabetes (aOR 2.14, p< 0.001), hypertensive pregnancy disorders (aOR 3.43, p< 0.001), and large-for-gestational age ormacrosomic infants (aOR 2.13, p< 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p< 0.009). No significant differences were found in terms of pretermbirths, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy.
Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):688-696
, To evaluate the association between early-onset fetal growth restriction (FGR), late-onset FGR, small for gestational age (SGA) and adequate for gestational age (AGA) fetuses and adverse perinatal outcomes.
This was a retrospective longitudinal study in which 4 groups were evaluated: 1 - early-onset FGR (before 32 weeks) (n=20), 2 - late-onset FGR (at or after 32 weeks) (n=113), 3 - SGA (n=59), 4 - AGA (n=476). The Kaplan-Meier curve was used to compare the time from the diagnosis of FGR to birth. Logistic regression was used to determine the best predictors of adverse perinatal outcomes in fetuses with FGR and SGA.
A longer timebetween the diagnosis and birthwas observed forAGAthan for late FGR fetuses (p<0.001). The model including the type of FGR and the gestational age at birth was significant in predicting the risk of hospitalization in the neonatal intensive care unit (ICU) (p<0.001). The model including only the type of FGR predicted the risk of needing neonatal resuscitation (p<0.001), of respiratory distress (p<0.001), and of birth at<32, 34, and 37 weeks of gestation, respectively (p<0.001).
Fetal growth restriction and SGA were associated with adverse perinatal outcomes. The type of FGR at the moment of diagnosis was an independent variable to predict respiratory distress and the need for neonatal resuscitation. The model including both the type of FGR and the gestational age at birth predicted the risk of needing neonatal ICU hospitalization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):688-696
, To evaluate the association between early-onset fetal growth restriction (FGR), late-onset FGR, small for gestational age (SGA) and adequate for gestational age (AGA) fetuses and adverse perinatal outcomes.
This was a retrospective longitudinal study in which 4 groups were evaluated: 1 - early-onset FGR (before 32 weeks) (n=20), 2 - late-onset FGR (at or after 32 weeks) (n=113), 3 - SGA (n=59), 4 - AGA (n=476). The Kaplan-Meier curve was used to compare the time from the diagnosis of FGR to birth. Logistic regression was used to determine the best predictors of adverse perinatal outcomes in fetuses with FGR and SGA.
A longer timebetween the diagnosis and birthwas observed forAGAthan for late FGR fetuses (p<0.001). The model including the type of FGR and the gestational age at birth was significant in predicting the risk of hospitalization in the neonatal intensive care unit (ICU) (p<0.001). The model including only the type of FGR predicted the risk of needing neonatal resuscitation (p<0.001), of respiratory distress (p<0.001), and of birth at<32, 34, and 37 weeks of gestation, respectively (p<0.001).
Fetal growth restriction and SGA were associated with adverse perinatal outcomes. The type of FGR at the moment of diagnosis was an independent variable to predict respiratory distress and the need for neonatal resuscitation. The model including both the type of FGR and the gestational age at birth predicted the risk of needing neonatal ICU hospitalization.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):697-702
, To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).
A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.
A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032).
Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):697-702
, To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).
A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.
A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032).
Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):703-709
To investigate the action of testosterone (T), isolated or associated with estradiol benzoate (EB), on the proliferation markers and apoptosis of breasts of ovariectomized rats.
A total of 48 castrated female Wistar rats were divided into 6 groups, and each of them were submitted to one of the following treatments for 5 weeks: 1) control; 2) EB 50 mcg/day + T 50 mcg/day; 3) T 50mcg/day; 4) EB 50 mcg +T 300 mcg/day; 5) T 300 mcg/day; and 6) EB 50 mcg/day. After the treatment, the mammary tissue was submitted to a histological analysis and immunoexpression evaluation of proliferation markers (proliferating cell nuclear antigen, PCNA) and apoptosis (caspase-3).
There was a statistically significant difference among the groups regarding microcalcifications and secretory activity, with higher prevalence in the groups treated with EB. There was no difference among the groups regarding atrophy, but a higher prevalence of atrophy was found in the groups that received T versus those that received EB +T. There was a difference among the groups regarding the PCNA (p = 0.028), with higher expression in the group submitted to EB +T 300 mcg/day. Regarding caspase-3, there was no difference among the groups; however, in the group submitted to EB +T 300 mcg/day, the expression was higher than in the isolated T group.
Isolated T did not have a proliferative effect on the mammary tissue, contrary to EB. Testosterone in combination with EB may or may not decrease the proliferation, depending on the dose of T.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):703-709
To investigate the action of testosterone (T), isolated or associated with estradiol benzoate (EB), on the proliferation markers and apoptosis of breasts of ovariectomized rats.
A total of 48 castrated female Wistar rats were divided into 6 groups, and each of them were submitted to one of the following treatments for 5 weeks: 1) control; 2) EB 50 mcg/day + T 50 mcg/day; 3) T 50mcg/day; 4) EB 50 mcg +T 300 mcg/day; 5) T 300 mcg/day; and 6) EB 50 mcg/day. After the treatment, the mammary tissue was submitted to a histological analysis and immunoexpression evaluation of proliferation markers (proliferating cell nuclear antigen, PCNA) and apoptosis (caspase-3).
There was a statistically significant difference among the groups regarding microcalcifications and secretory activity, with higher prevalence in the groups treated with EB. There was no difference among the groups regarding atrophy, but a higher prevalence of atrophy was found in the groups that received T versus those that received EB +T. There was a difference among the groups regarding the PCNA (p = 0.028), with higher expression in the group submitted to EB +T 300 mcg/day. Regarding caspase-3, there was no difference among the groups; however, in the group submitted to EB +T 300 mcg/day, the expression was higher than in the isolated T group.
Isolated T did not have a proliferative effect on the mammary tissue, contrary to EB. Testosterone in combination with EB may or may not decrease the proliferation, depending on the dose of T.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):710-717
To identify the biomarkers of response to neoadjuvant chemotherapy in early luminal breast cancer.
A cross-sectional study that included all patients with early or locallyadvanced luminal breast cancer submitted to neoadjuvant chemotherapy between 2013 and 2014. Demographic, clinic and pathologic data were retrieved from patient records. The expressions of the estrogen receptor (ER), the progesterone receptor (PR), and Ki67 were analyzed by immunohistochemistry (IHC). The status of the human epidermal growth factor receptor 2 (HER2) was evaluated by IHC and fluorescent in situ hybridization (FISH). Independent predictors of clinic and pathologic response were evaluated by stepwise logistic regression models and receiver operating characteristic (ROC) curve analysis.
Out of 298 patients identified, 115 were included in the analysis. Clinical complete response (cCR) was observed in 43.4% of the patients (49/113), and pathologic complete response (pCR) was observed in 7.1% (8/115) of the patients. The independent predictors of cCR were premenopausal status (p < 0.001), low PR expression (≤ 50% versus > 50%; p = 0.048), and Ki67 expression ≥ 14% (versus < 14%; p = 0.01). Patients with cCR were more commonly submitted to breast conserving surgery (34.7% versus 7.8%; p < 0.001). Increasing cut-off points for Ki67 expression were associated with an increase in specificity and a decrease in sensitivity to identify patients with cCR.
Premenopausal status, lower PR expression and higher Ki67 expression were associated with a higher rate of cCR to neoadjuvant chemotherapy in luminal breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):710-717
To identify the biomarkers of response to neoadjuvant chemotherapy in early luminal breast cancer.
A cross-sectional study that included all patients with early or locallyadvanced luminal breast cancer submitted to neoadjuvant chemotherapy between 2013 and 2014. Demographic, clinic and pathologic data were retrieved from patient records. The expressions of the estrogen receptor (ER), the progesterone receptor (PR), and Ki67 were analyzed by immunohistochemistry (IHC). The status of the human epidermal growth factor receptor 2 (HER2) was evaluated by IHC and fluorescent in situ hybridization (FISH). Independent predictors of clinic and pathologic response were evaluated by stepwise logistic regression models and receiver operating characteristic (ROC) curve analysis.
Out of 298 patients identified, 115 were included in the analysis. Clinical complete response (cCR) was observed in 43.4% of the patients (49/113), and pathologic complete response (pCR) was observed in 7.1% (8/115) of the patients. The independent predictors of cCR were premenopausal status (p < 0.001), low PR expression (≤ 50% versus > 50%; p = 0.048), and Ki67 expression ≥ 14% (versus < 14%; p = 0.01). Patients with cCR were more commonly submitted to breast conserving surgery (34.7% versus 7.8%; p < 0.001). Increasing cut-off points for Ki67 expression were associated with an increase in specificity and a decrease in sensitivity to identify patients with cCR.
Premenopausal status, lower PR expression and higher Ki67 expression were associated with a higher rate of cCR to neoadjuvant chemotherapy in luminal breast cancer.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):718-725
, To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital.
A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program.
A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p=0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p=0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p=0.030), logistic regression did not find any association between uterine volume and surgical time (p=0.103).
The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):718-725
, To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital.
A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program.
A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p=0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p=0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p=0.030), logistic regression did not find any association between uterine volume and surgical time (p=0.103).
The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.
