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8 articles
  • Editorial

    Pre-implantation genetic screening and diagnosis: what doctors should know

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):53-58

    Summary

    Editorial

    Pre-implantation genetic screening and diagnosis: what doctors should know

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):53-58

    DOI 10.1590/SO100-720320140004963

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    Introduction Trends toward delayed childbearing have resulted in an increasing number of women of advanced maternal age (AMA) seeking to become pregnant and in a consequent increase in demand for assisted reproductive technology, most commonly in-vitro fertilization (IVF). In such women, the proportion of aneuploid embryos can exceed 60%, with a risk of miscarriage of […]
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  • Artigos Originais

    Comparison between two growth curves for small for gestational age diagnosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):59-63

    Summary

    Artigos Originais

    Comparison between two growth curves for small for gestational age diagnosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):59-63

    DOI 10.1590/SO100-720320140005180

    Views1

    PURPOSE:

    It was to compare the use of two growth curves for the diagnosis of small-for-gestational-age (SGA) infants, having the 10thpercentile as reference.

    METHODS:

    In a retrospective study, data of 20,567 singleton live births from January 2003 to June 2014 were analyzed, and divided according to gestational age: (a) 23 to 26, (b) 26 to 29, (c) 29 to 32, (d) 32 to 35, (e) 35 to 38, (f) 38 to 41 and (g) >41 weeks. Data were paired and analyzed using the McNemar test, with the level of significance set at 0.05.

    RESULTS:

    The curve designed by Alexander indicated a higher percentage of diagnosis of SGA than the curve constructed by Fenton for every category of gestational age up to 41 weeks, more markedly in the 32-35 week group (18.5%). Between 37 and 40 weeks of gestational age, Alexander's curve exceeded Fenton's curve in 9.1% of the cases in the diagnosis of SGA.

    CONCLUSIONS:

    The Fenton curve provides a more accurate evaluation of an infant's growth since it is gender-specific and allows measurement of three parameters. It has also been constructed with newer data and more sophisticated statistical tools.

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    Comparison between two growth curves for small for gestational age diagnosis
  • Artigos Originais

    Prevalence of toxoplasmosis in pregnant women in two reference centers in a city in Northeast Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):64-70

    Summary

    Artigos Originais

    Prevalence of toxoplasmosis in pregnant women in two reference centers in a city in Northeast Brazil

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):64-70

    DOI 10.1590/SO100-720320150005115

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    PURPOSE:

    To determine the prevalence of toxoplasmosis and to identify the main factors associated with seroreactivity in pregnant women cared for at two reference centers in a city in Northeast Brazil.

    METHODS:

    A cross-sectional study was conducted on 561 pregnant women at two high-risk prenatal reference centers in a city in Northeast Brazil. All women were interviewed using an epidemiological questionnaire and had their blood samples collected for the following serological tests: anti-Toxoplasma gondii IgG and IgM (ELISA), IgG avidity test, and polymerase chain reaction (PCR). Statistical analysis was carried out using SPSS version 18.0 for Windows, calculating odds ratio, confidence interval of 95% and with the level of significance set at 5%.

    RESULTS:

    Seroreactivity for toxoplasmosis was detected in 437 women (77.0%), susceptibility in 124 (22.1%) and active infection in 5 (0.9%). There was no significant association between seroreactivity for toxoplasmosis and age, location, income, education, availability of sewage, number of pregnancies or gestational age. The variables significantly associated (p≤0.05) with seroreactivity were multiparity (p=0.03) and living with stray dogs (p=0.01).

    CONCLUSIONS:

    This study identified high seroreactivity for toxoplasmosis among patients seen during prenatal care, as well as factors associated with seroreactivity. Appropriate guidelines about primary preventive measures should be emphasized and quarterly serological monitoring is recommended for pregnant women in this city and elsewhere in the Northeast of Brazil.

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  • Artigos Originais

    Metabolism and gene polymorphisms of the folate pathway in Brazilian women with history of recurrent abortion

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):71-76

    Summary

    Artigos Originais

    Metabolism and gene polymorphisms of the folate pathway in Brazilian women with history of recurrent abortion

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):71-76

    DOI 10.1590/SO100-720320140005223

    Views1

    PURPOSE:

    To investigate the association between polymorphisms in genes that encode enzymes involved in folate- and vitamin B12-dependent homocysteine metabolism and recurrent spontaneous abortion (RSA).

    METHODS:

    We investigated the C677T and A1298C polymorphisms of the methylenetetrahydrofalate reductase gene (MTHFR), the A2756G polymorphism of the methionine synthase gene (MS) and the 844ins68 insertion of the cystathionine beta synthetase gene (CBS). The PCR technique followed by RFLP was used to assess the polymorphisms; the serum levels of homocysteine, vitamin B12 and folate were investigated by chemiluminescence. The EPI Info Software version 6.04 was used for statistical analysis. Parametric variables were compared by Student's t-test and nonparametric variables by the Wilcoxon rank sum test.

    RESULTS:

    The frequencies of gene polymorphisms in 89 women with a history of idiopathic recurrent miscarriage and 150 controls were 19.1 and 19.6% for the C677T, insertion, 20.8 and 26% for the A1298C insertion, 14.2 and 21.9% for the A2756G insertion, and 16.4 and 18% for the 844ins68 insertion, respectively. There were no significant differences between case and control groups in any of the gene polymorphisms investigated. However, the frequency of the 844ins68 insertion in the CBS gene was higher among women with a history of loss during the third trimester of pregnancy (p=0.003). Serum homocysteine, vitamin B12 and folate levels id not differ between the polymorphisms studied in the case and control groups. However, linear regression analysis showed a dependence of serum folate levels on the maintenance of tHcy levels.

    CONCLUSION:

    The investigated gene polymorphisms and serum homocysteine, vitamin B12 and folate levels were not associated with idiopathic recurrent miscarriage in the present study. Further investigations are needed in order to confirm the role of the CBS 844ins68 insertion in recurrent miscarriage.

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    Metabolism and gene polymorphisms of the folate pathway in Brazilian women with history of recurrent abortion
  • Artigos Originais

    Predictive factors for recurrence of ovarian endometrioma after laparoscopic excision

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):77-81

    Summary

    Artigos Originais

    Predictive factors for recurrence of ovarian endometrioma after laparoscopic excision

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):77-81

    DOI 10.1590/SO100-720320140005199

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    PURPOSE:

    To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision.

    METHODS:

    A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses.

    RESULTS:

    The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; 95%CI 5.26-107.05; p=0.001).

    CONCLUSION:

    Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

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  • Artigos Originais

    Risk factors for urinary incontinence in elderly women practicing physical exercises

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):82-86

    Summary

    Artigos Originais

    Risk factors for urinary incontinence in elderly women practicing physical exercises

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):82-86

    DOI 10.1590/SO100-720320140005040

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    PURPOSE:

    To analyze the risk factors for urinary incontinence (UI) in older women practicing physical exercises (PE).

    METHODS:

    A total of 152 older women with a mean age of 68.6±5.8 years who regularly practiced PE participated in the study. The presence of UI and gynecological, obstetric, clinical, behavioral, hereditary and anthropometric risk factors was determined identified. It was also applied the Domain 4 of the International Physical Activity Questionnaire (IPAQ) to determine the level of physical activity and body mass index and waist circumference were measured. Data were analyzed using descriptive and inferential statistics, with the level of significance set at 5%.

    RESULTS:

    The prevalence of UI in the sample was 32.2%. Among the factors evaluated, only the use of diuretics (OR=2.7; 95%CI 1.0-7.0) and a positive family history of urinary incontinence (OR=2.3; 95%CI 1.1-4.8) were associated with UI symptoms.

    CONCLUSION:

    The use of diuretics is considered to be a modifiable risk factor for UI, whereas a family history is not considered to be a modifiable risk factor.

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  • Artigos Originais

    Histological classification and quality of life in women with endometriosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):87-93

    Summary

    Artigos Originais

    Histological classification and quality of life in women with endometriosis

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):87-93

    DOI 10.1590/SO100-720320140004650

    Views2

    PURPOSE:

    To assess the relationship between the histological classification and the quality of life of patients operated for endometriosis. METHODS: A cross-sectional observational study, with assessment of 32 biopsies of the intestine, peritoneum and uterosacral ligament from 40 women with deep endometriosis. The quality of life (QOL) was determined by applying the SF-36 questionnaire pre-operatively and at 6 and 12 months postoperatively. Biopsies were histologically classified into pure stromal (EP), glandular differentiated (GD), glandular undifferentiated (GI) and mixed (GM), remaining in the sample only GI and GM, which are related to eight domains of the SF-36.

    RESULTS:

    According to the histologic type, the following distribution was observed: peritoneum 63% GI and 35% GM; intestine 19% GI and 24% GM; uterosacral ligament with 41% GI and 35% GM. Regarding the QOL and the histological classification, in the intestine only GM was associated with improvement of social and emotional aspects from 0 to 6 months; the domains general health status (p=0.01) and social aspect (p=0.04) were significantly related to improvement of the QOL from 0 to 6 months, and the general health status tended to improve from 0 to 12 months. Regarding pain (p=0.06) and the emotional aspect (p=0.05), the QOL tended to improve from 0 to 6 months and the vital capacity (p=0.1) improved from 0 to 6 months and from 0 to 12 months. Regarding the emotional aspect, evolution of the two histological types was not favorable for improvement in MG from 0 to 6 months. No significant relationships between histologic type and QOL were evident in the uterosacral ligament samples.

    CONCLUSION:

    Improvement in the QOL of women undergoing laparoscopic surgery for deep endometriosis is associated with the histologic grade. The peritoneal biopsy of GI revealed improved QOL after surgery.

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    Histological classification and quality of life in women with endometriosis
  • Artigos Originais

    Comparison of two techniques for HPV genotyping in women with high-grade squamous intraepithelial lesion

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):94-99

    Summary

    Artigos Originais

    Comparison of two techniques for HPV genotyping in women with high-grade squamous intraepithelial lesion

    Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(2):94-99

    DOI 10.1590/SO100-720320150005206

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    PURPOSE:

    The aim of this study was to compare the performance of two human papillomavirus (HPV) genotyping techniques, Linear Array and PapilloCheck, in women with high-grade squamous intraepithelial lesion (HSIL).

    METHODS:

    A total of 88 women with cytological diagnosis of HSIL were recruited at 2 reference centers in cervical pathology in Salvador, Bahia, Brazil, from July 2006 to January 2009. After the cytological diagnosis of HSIL, cervix cells were collected to determine the HPV genotype and a biopsy was obtained under colposcopic vision for histopathological analysis. After the confirmation of CIN2+ by histopathology, HPV genotyping was performed on 41 women by the Linear Array and PapilloCheck methods.

    RESULTS:

    Both tests showed an overall concordance rate for HPV detection of 97.2% (35/36). Of the 36 valid samples, 35 (97.2%) were positive in both tests and 1 (2.8%) was discordant, with the Linear Array indicating the presence of multiple types. The most prevalent HPV genotypes detected by the Linear Array technique were HPV 16, HPV 56, HPV 35, HPV 45, and HPV 70; and those detected by the PapilloCheck technique were HPV 16, HPV 56, HPV 11, HPV 35, and HPV 42. A similar rate of infection with multiple HPV types was observed with the two tests (72.5% with the Linear Array and 75.0% with the PapilloCheck).

    CONCLUSIONS:

    Linear Array genotyping assay and PapilloCheck showed equivalent performance for the detection of oncogenic HPV types in women with HSIL, with PapilloCheck having the advantage of being a method that avoids subjectivity when reading the HPV genotypes.

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    Comparison of two techniques for HPV genotyping in women with high-grade squamous intraepithelial lesion

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