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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
DOI 10.1590/S0100-72031998000300002
A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 - 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
DOI 10.1590/S0100-72031998000300002
A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 - 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144
DOI 10.1590/S0100-72031998000300003
Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144
DOI 10.1590/S0100-72031998000300003
Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):145-149
DOI 10.1590/S0100-72031998000300004
Although 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):145-149
DOI 10.1590/S0100-72031998000300004
Although 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
DOI 10.1590/S0100-72031998000300005
A retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
DOI 10.1590/S0100-72031998000300005
A retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
DOI 10.1590/S0100-72031998000300006
Management of prenatally diagnosed uropathies is controversial, mainly because the prognosis for these fetuses is quite different. However pioneering studies have shown that prenatal drainage of obstructed urinary tract can improve the outcome of selected fetuses. The aim of this study is to describe the experience of the Service with the treatment of fetal obstrutive uropathy with the catheter developed by the Centro de Medicina Fetal do Hospital das Clínicas da UFMG. A total of 25 fetuses with obstructive uropathy received the catheter. Three fetuses required more than one insertion. Ten of 25 (40%) shunted fetuses survived with good postnatal renal and pulmonary function. Complications occurred in 12/25 (48%) cases including: 06/25 (24%) inadequate shunt drainage or migration; 01/25 (04%) urinary ascitis; 01/25 (04%) DPP, 01/25 (04%) premature rupture of membranes, 02/25 (08%) premature labor, 01/25 (04%) scarring and fibrosis of the renal parenchyma. Three of 25 (12%) fetuses died intra-utero and 12 (48%) died during the neonatal period. In conclusion, the drainage of the obstructed urinary tract with this catheter proved to be technically feasible and safe for both mother and fetus, with a survival rate of 40%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
DOI 10.1590/S0100-72031998000300006
Management of prenatally diagnosed uropathies is controversial, mainly because the prognosis for these fetuses is quite different. However pioneering studies have shown that prenatal drainage of obstructed urinary tract can improve the outcome of selected fetuses. The aim of this study is to describe the experience of the Service with the treatment of fetal obstrutive uropathy with the catheter developed by the Centro de Medicina Fetal do Hospital das Clínicas da UFMG. A total of 25 fetuses with obstructive uropathy received the catheter. Three fetuses required more than one insertion. Ten of 25 (40%) shunted fetuses survived with good postnatal renal and pulmonary function. Complications occurred in 12/25 (48%) cases including: 06/25 (24%) inadequate shunt drainage or migration; 01/25 (04%) urinary ascitis; 01/25 (04%) DPP, 01/25 (04%) premature rupture of membranes, 02/25 (08%) premature labor, 01/25 (04%) scarring and fibrosis of the renal parenchyma. Three of 25 (12%) fetuses died intra-utero and 12 (48%) died during the neonatal period. In conclusion, the drainage of the obstructed urinary tract with this catheter proved to be technically feasible and safe for both mother and fetus, with a survival rate of 40%.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):161-163
DOI 10.1590/S0100-72031998000300007
A tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):161-163
DOI 10.1590/S0100-72031998000300007
A tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.