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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):105-110
DOI 10.1590/S0100-72032004000200004
PURPOSE: to evaluate the high-risk oncogenic human papillomavirus (HPV) detection rate of patients with cervical intraepithelial neoplasia (CIN), checking the association between high-risk HPV, viral load and severity of the lesion, as well as the best viral load cutoff to predict lesion severity. METHODS: this is a cross-sectional study. One hundred and ten patients were selected by cytology and/or biopsy with CIN diagnosis. All of them were submitted to a new oncologic cytology, hybrid capture II (HC II), colposcopy, and loop electrosurgical excision and fulguration procedures (LEEP). RESULTS: the global detection rate of high-risk oncogenic HPV in these women was 77.3%. Eighty-one women (73.7%) had CIN with a detection rate of HPV-DNA of 87.6%. In women with CIN 2 or 3 the detection rate was 85.9%. HC II had a sensitivity of 87.8%, specificity of 56.0%, predictive positive value of 86.6% and predictive negative value of 58.3%, with an odds ratio of 7.76 (2.47 < OR < 25.15) for CIN 2 or 3 diagnosis. Using a receiver operator characteristic curve a viral load cutoff was set at 20 pg/mL in this population, with a predictive positive value of 81.3%. CONCLUSIONS: HPV DNA detection rate of patients with CIN was 77.3%. In women with CIN 2/3 it was 85.9%. The best viral load cutoff to predict cervical lesion severity was 20 pg/ml. Above this level the probability of high-risk oncogenic HPV detection is greater than 80%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):105-110
DOI 10.1590/S0100-72032004000200004
PURPOSE: to evaluate the high-risk oncogenic human papillomavirus (HPV) detection rate of patients with cervical intraepithelial neoplasia (CIN), checking the association between high-risk HPV, viral load and severity of the lesion, as well as the best viral load cutoff to predict lesion severity. METHODS: this is a cross-sectional study. One hundred and ten patients were selected by cytology and/or biopsy with CIN diagnosis. All of them were submitted to a new oncologic cytology, hybrid capture II (HC II), colposcopy, and loop electrosurgical excision and fulguration procedures (LEEP). RESULTS: the global detection rate of high-risk oncogenic HPV in these women was 77.3%. Eighty-one women (73.7%) had CIN with a detection rate of HPV-DNA of 87.6%. In women with CIN 2 or 3 the detection rate was 85.9%. HC II had a sensitivity of 87.8%, specificity of 56.0%, predictive positive value of 86.6% and predictive negative value of 58.3%, with an odds ratio of 7.76 (2.47 < OR < 25.15) for CIN 2 or 3 diagnosis. Using a receiver operator characteristic curve a viral load cutoff was set at 20 pg/mL in this population, with a predictive positive value of 81.3%. CONCLUSIONS: HPV DNA detection rate of patients with CIN was 77.3%. In women with CIN 2/3 it was 85.9%. The best viral load cutoff to predict cervical lesion severity was 20 pg/ml. Above this level the probability of high-risk oncogenic HPV detection is greater than 80%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):111-116
DOI 10.1590/S0100-72032004000200005
PURPOSE: to evaluate the characteristics of sexual violence against women, the types of sexual crimes and resulting body lesions. METHODS: descriptive study based on the information obtained from the medical records of 102 victims of sexual violence who were seen at the Maria-Maria project from March 2002 to March 2003 and who fulfilled the eligibility criteria. The characteristics of the violence, the types of crimes and the body injuries are described. For calculation and analysis of the data, the Epi-Info, version 6.04, program, for simple percentages and frequency distribution were used. RESULTS: ages of the victims ranged from 1 to 68 years, 65.7% were younger than 20 years and one in four was younger than 9 years. The majority were single (78.3%) and with a low educational level (74.2%). The crime predominated at night (64.7%), in a secluded area (39.2%), followed by the victim's home (34.3%), and at the location of the attack (67.6%). Among the adolescent victims, the unknown attacker predominated, while among the children the attackers were men known to the victims. In the case of the children younger than 10 years, indecent assault was the most frequent crime (73.8%) while rape was the most frequent crime among the adolescents (66.4%). Body trauma occurred in 76.7% of the cases, mainly hematomas, vulva edema and abrasions. CONCLUSION: sexual violence predominated among children and adolescents, single women and with low educational level. The aggression happened more frequently during the night, by an unknown person, in a secluded area, in the case of adolescents, and by a known person (mainly neighbour), in the victim's home, in the case of children. Rape was the most frequent kind of crime among adolescents and among children it was indecent assault, usually associated with genital and corporeal trauma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):111-116
DOI 10.1590/S0100-72032004000200005
PURPOSE: to evaluate the characteristics of sexual violence against women, the types of sexual crimes and resulting body lesions. METHODS: descriptive study based on the information obtained from the medical records of 102 victims of sexual violence who were seen at the Maria-Maria project from March 2002 to March 2003 and who fulfilled the eligibility criteria. The characteristics of the violence, the types of crimes and the body injuries are described. For calculation and analysis of the data, the Epi-Info, version 6.04, program, for simple percentages and frequency distribution were used. RESULTS: ages of the victims ranged from 1 to 68 years, 65.7% were younger than 20 years and one in four was younger than 9 years. The majority were single (78.3%) and with a low educational level (74.2%). The crime predominated at night (64.7%), in a secluded area (39.2%), followed by the victim's home (34.3%), and at the location of the attack (67.6%). Among the adolescent victims, the unknown attacker predominated, while among the children the attackers were men known to the victims. In the case of the children younger than 10 years, indecent assault was the most frequent crime (73.8%) while rape was the most frequent crime among the adolescents (66.4%). Body trauma occurred in 76.7% of the cases, mainly hematomas, vulva edema and abrasions. CONCLUSION: sexual violence predominated among children and adolescents, single women and with low educational level. The aggression happened more frequently during the night, by an unknown person, in a secluded area, in the case of adolescents, and by a known person (mainly neighbour), in the victim's home, in the case of children. Rape was the most frequent kind of crime among adolescents and among children it was indecent assault, usually associated with genital and corporeal trauma.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):117-123
DOI 10.1590/S0100-72032004000200006
PURPOSE: to assess the natural pregnancy rates in rabbits submitted to bilateral oophorectomy and orthotopic autologous (both intact and sliced) ovarian transplantation without vascular pedicle and to verify the morphofunctional aspects of reimplanted ovaries. METHOD: thirty-two female New Zealand White rabbits were studied. The ovaries were removed and orthotopically replaced without vascular anastomosis. In the control group (GC) (n=8), only laparotomy was carried out. In the RI group (n=8) intact ovaries were reimplanted in both sides. In the RF group (n=8) the ovaries were sliced and orthotopically reimplanted. In the RIF group (n=8), in one side the intact ovary and in the other side the sliced ovary was reimplanted.Three months later, the animals were paired with sexually mature males for copulation. Estradiol, progesterone, follicle stimulating hormone and luteinizing hormone levels were assessed nine months after surgery. Histologic study of the transplanted ovaries, tubes and uteri was carried out, and the number of pregnancies and animals per litter in each group was taken into account as well. The chi² test compared the pregnancy and the litters between the groups. Student's t test compared the hormone determinations. Significance was set at p<0.05. RESULTS: pregnancies occurred in all rabbits of the GC, between the second and third months after copulation, with 6 to 10 animals per litter for animal. In the other groups, the pregnancies occurred between the fifth and eighth postoperative month. Pregnancies occurred in 37.5% of rabbits in group RI, and in 50% of the RF and RIF groups. There was no difference between the number of animals per litter in the reimplanted groups, with 1 to 4 animals per litter for each animal. Hormone levels and histology confirmed the vitality of all ovaries. CONCLUSIONS: intact or sliced orthotopic autologous ovarian transplantation without vascular pedicle is viable in rabbits, and preserves the hormonal and fertile functions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):117-123
DOI 10.1590/S0100-72032004000200006
PURPOSE: to assess the natural pregnancy rates in rabbits submitted to bilateral oophorectomy and orthotopic autologous (both intact and sliced) ovarian transplantation without vascular pedicle and to verify the morphofunctional aspects of reimplanted ovaries. METHOD: thirty-two female New Zealand White rabbits were studied. The ovaries were removed and orthotopically replaced without vascular anastomosis. In the control group (GC) (n=8), only laparotomy was carried out. In the RI group (n=8) intact ovaries were reimplanted in both sides. In the RF group (n=8) the ovaries were sliced and orthotopically reimplanted. In the RIF group (n=8), in one side the intact ovary and in the other side the sliced ovary was reimplanted.Three months later, the animals were paired with sexually mature males for copulation. Estradiol, progesterone, follicle stimulating hormone and luteinizing hormone levels were assessed nine months after surgery. Histologic study of the transplanted ovaries, tubes and uteri was carried out, and the number of pregnancies and animals per litter in each group was taken into account as well. The chi² test compared the pregnancy and the litters between the groups. Student's t test compared the hormone determinations. Significance was set at p<0.05. RESULTS: pregnancies occurred in all rabbits of the GC, between the second and third months after copulation, with 6 to 10 animals per litter for animal. In the other groups, the pregnancies occurred between the fifth and eighth postoperative month. Pregnancies occurred in 37.5% of rabbits in group RI, and in 50% of the RF and RIF groups. There was no difference between the number of animals per litter in the reimplanted groups, with 1 to 4 animals per litter for each animal. Hormone levels and histology confirmed the vitality of all ovaries. CONCLUSIONS: intact or sliced orthotopic autologous ovarian transplantation without vascular pedicle is viable in rabbits, and preserves the hormonal and fertile functions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):125-130
DOI 10.1590/S0100-72032004000200007
PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46) or quadrantectomy (13) were included in this clinical, prospective and randomized study. On the first day after surgery 30 women were randomized to do the shoulder movement with free amplitude and 29 women had this amplitude restricted to 90º in the first 15 days. Nineteen exercises were done, three sessions per week, for six weeks. Mean (± standard error) deficits of shoulder flexion and abduction were compared, as well as gross and adjusted incidence rates of seroma and dehiscence. RESULTS: 42 days after surgery, flexion and abduction means were similar in the two groups. Both presented a mean flexion deficit (17.2º and 21.6º, respectively), and abduction deficit (19.7º and 26.6º, respectively). The incidence rates of seroma and dehiscence were neither related to exercise nor to the type of surgery, time of drain permanence, number of dissected or compromised lymph nodes, age or obesity. CONCLUSION: early physiotherapy with free movement of the women's shoulder was associated neither with functional capacity nor with postsurgical complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):125-130
DOI 10.1590/S0100-72032004000200007
PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46) or quadrantectomy (13) were included in this clinical, prospective and randomized study. On the first day after surgery 30 women were randomized to do the shoulder movement with free amplitude and 29 women had this amplitude restricted to 90º in the first 15 days. Nineteen exercises were done, three sessions per week, for six weeks. Mean (± standard error) deficits of shoulder flexion and abduction were compared, as well as gross and adjusted incidence rates of seroma and dehiscence. RESULTS: 42 days after surgery, flexion and abduction means were similar in the two groups. Both presented a mean flexion deficit (17.2º and 21.6º, respectively), and abduction deficit (19.7º and 26.6º, respectively). The incidence rates of seroma and dehiscence were neither related to exercise nor to the type of surgery, time of drain permanence, number of dissected or compromised lymph nodes, age or obesity. CONCLUSION: early physiotherapy with free movement of the women's shoulder was associated neither with functional capacity nor with postsurgical complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):131-138
DOI 10.1590/S0100-72032004000200008
PURPOSE: to analyze the management for reduction of HIV transmission from mother to infant in infected pregnant women who delivered in public maternity hospitals of the municipality of Fortaleza, Ceará, from 1999 to 2001. METHODS: a descriptive study where data of SINASC, SINAN and LACEN data bank systems were cross-checked looking for HIV-infected pregnant women, followed by an active search for complementary information on the subject through medical records of the maternity hospitals. RESULTS: a hundred and thirty-eight pregnant women infected with HIV were identified. It was observed that 35.5% knew their serum status before pregnancy and 48.6% (67/138) were diagnosed during the prenatal visits. Of those 101 women that knew their serum status before or during pregnancy, only 47.5% followed all steps of prophylaxis, including the management of the newborns. The previous knowledge of the serum status was found to be significantly related to following the correct steps of prophylaxis (p<0.001). CONCLUSIONS: an increasing number of women who had no access to the different strategies for the reduction of vertical transmission were found in Fortaleza, Ceará, especially among those who became pregnant without knowing their serum status. Continuous awareness and training are very important for all health care providers involved in attending the pregnant women for the application of correct management in order to reduce HIV transmission from mother to infant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):131-138
DOI 10.1590/S0100-72032004000200008
PURPOSE: to analyze the management for reduction of HIV transmission from mother to infant in infected pregnant women who delivered in public maternity hospitals of the municipality of Fortaleza, Ceará, from 1999 to 2001. METHODS: a descriptive study where data of SINASC, SINAN and LACEN data bank systems were cross-checked looking for HIV-infected pregnant women, followed by an active search for complementary information on the subject through medical records of the maternity hospitals. RESULTS: a hundred and thirty-eight pregnant women infected with HIV were identified. It was observed that 35.5% knew their serum status before pregnancy and 48.6% (67/138) were diagnosed during the prenatal visits. Of those 101 women that knew their serum status before or during pregnancy, only 47.5% followed all steps of prophylaxis, including the management of the newborns. The previous knowledge of the serum status was found to be significantly related to following the correct steps of prophylaxis (p<0.001). CONCLUSIONS: an increasing number of women who had no access to the different strategies for the reduction of vertical transmission were found in Fortaleza, Ceará, especially among those who became pregnant without knowing their serum status. Continuous awareness and training are very important for all health care providers involved in attending the pregnant women for the application of correct management in order to reduce HIV transmission from mother to infant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):139-146
DOI 10.1590/S0100-72032004000200009
PURPOSE: to evaluate whether oral and vaginal sex practice, with or without exposure to semen, decrease the occurrence of recurrent spontaneous abortion. METHOD: this was a case-control study carried out between May 2000 and April 2003. A questionnaire was applied analyzing the clinical, obstetric and sexual history of women, who were divided into two groups: a case group comprised 116 patients with a history of at least two spontaneous abortions, without previous pregnancy longer than 22 weeks, and a control group that included 241 women with history of one or more term pregnancies with live birth and no miscarriage. The analyzed variables included the number of sexual partners, condom use, oral sex practice, and the exposure of female oral mucosa to semen. RESULTS: in the control group 38.8%, and in the patients group 35.7% of the women had only one partner. In both groups about 75% of the women reported that the partners did not use condom. Approximately 55% of the women of both groups referred oral sex practice, and 13.8% of those with recurrent abortion and 20.3% with a history of successful pregnancies had oral mucosa exposed to semen. There was no difference between the patients with recurrent abortion and women with successful pregnancies regarding number of sexual partners, use of condom, practice of oral sex, and exposure of oral mucosa to the partner's semen. CONCLUSION: our results did not confirm the hypothesis that sexual behavior influences the occurrence of spontaneous abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):139-146
DOI 10.1590/S0100-72032004000200009
PURPOSE: to evaluate whether oral and vaginal sex practice, with or without exposure to semen, decrease the occurrence of recurrent spontaneous abortion. METHOD: this was a case-control study carried out between May 2000 and April 2003. A questionnaire was applied analyzing the clinical, obstetric and sexual history of women, who were divided into two groups: a case group comprised 116 patients with a history of at least two spontaneous abortions, without previous pregnancy longer than 22 weeks, and a control group that included 241 women with history of one or more term pregnancies with live birth and no miscarriage. The analyzed variables included the number of sexual partners, condom use, oral sex practice, and the exposure of female oral mucosa to semen. RESULTS: in the control group 38.8%, and in the patients group 35.7% of the women had only one partner. In both groups about 75% of the women reported that the partners did not use condom. Approximately 55% of the women of both groups referred oral sex practice, and 13.8% of those with recurrent abortion and 20.3% with a history of successful pregnancies had oral mucosa exposed to semen. There was no difference between the patients with recurrent abortion and women with successful pregnancies regarding number of sexual partners, use of condom, practice of oral sex, and exposure of oral mucosa to the partner's semen. CONCLUSION: our results did not confirm the hypothesis that sexual behavior influences the occurrence of spontaneous abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Pustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Pustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
