Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):147-151
DOI 10.1590/S0100-72032001000300003
Purpose: to evaluate maternal hemodynamic and cardiac structural changes during the three trimesters of pregnancy and to relate them to the weight/gestational age of the newborn. Methods: twenty-two healthy pregnant women were submitted to echocardiography for the study of cardiac output, mean arterial pressure, left atrium diameter, and peripheral resistance during three periods of pregnancy, i.e., before the 12th week and at the 26thand 36th weeks of pregnancy. Seventeen pregnant women gave birth to infants with adequate weight for gestational age, four gave birth to small for gestational age newborns and one gave birth to a large for gestational age infant. Results: among mothers of low weight newborns, cardiac output and left atrium diameter remained constant, mean arterial pressure showed a tendency to increase and peripheral resistance was significantly increased (28%), during the gestation. Among the mothers of adequate weight newborns there was an increase in cardiac output of 19% in the second trimester and 8% in the third. The left atrial diameter increased approximately 9% during the gestation, with maintenance of mean arterial pressure and a tendency to a decrease in peripheral resistance. Conclusion: the present results support an association between hemodynamic adaptation and weight newborn.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):147-151
DOI 10.1590/S0100-72032001000300003
Purpose: to evaluate maternal hemodynamic and cardiac structural changes during the three trimesters of pregnancy and to relate them to the weight/gestational age of the newborn. Methods: twenty-two healthy pregnant women were submitted to echocardiography for the study of cardiac output, mean arterial pressure, left atrium diameter, and peripheral resistance during three periods of pregnancy, i.e., before the 12th week and at the 26thand 36th weeks of pregnancy. Seventeen pregnant women gave birth to infants with adequate weight for gestational age, four gave birth to small for gestational age newborns and one gave birth to a large for gestational age infant. Results: among mothers of low weight newborns, cardiac output and left atrium diameter remained constant, mean arterial pressure showed a tendency to increase and peripheral resistance was significantly increased (28%), during the gestation. Among the mothers of adequate weight newborns there was an increase in cardiac output of 19% in the second trimester and 8% in the third. The left atrial diameter increased approximately 9% during the gestation, with maintenance of mean arterial pressure and a tendency to a decrease in peripheral resistance. Conclusion: the present results support an association between hemodynamic adaptation and weight newborn.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):181-186
DOI 10.1590/S0100-72032001000300008
Purpose: to evaluate the incidence of side effects and acceptance (continuity rate) of depot medroxyprogesterone acetate (DMPA) as an injectable three-monthly contraceptive given to adolescents in our milien. Method: forty adolescents (70% lactating) started to use DMPA and were followed-up for a mean of 14.2 months. Spontaneous complaints, menstrual changes, physical examination and laboratory data were collected and studied using Wilcoxon or McNemar tests. Results: the most frequent complaints were abdominal pain (16.6%) and headache (15.2%). Predominant menstrual patterns were spotting and oligomenorrhea. Significant variation of the systolic blood pressure was not observed during the follow-up. There was a slight fall in the levels of diastolic blood pressure, at the limit of significance. Significant deviations from baseline regarding fasting glucose were not noted, but the mean hemoglobin concentration tended to increase. Weight gain (mean 3.9 kg at 12 months) and menstrual irregularity (occurred in more than 70% of all visits) were the main reasons for discontinuation of the method. Twenty-seven patients were accompanied during 12 months and the continuity rate at that time was 81.5%. Conclusion: depot medroxyprogesterone acetate is a satisfactory contraceptive method for adolescents.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):181-186
DOI 10.1590/S0100-72032001000300008
Purpose: to evaluate the incidence of side effects and acceptance (continuity rate) of depot medroxyprogesterone acetate (DMPA) as an injectable three-monthly contraceptive given to adolescents in our milien. Method: forty adolescents (70% lactating) started to use DMPA and were followed-up for a mean of 14.2 months. Spontaneous complaints, menstrual changes, physical examination and laboratory data were collected and studied using Wilcoxon or McNemar tests. Results: the most frequent complaints were abdominal pain (16.6%) and headache (15.2%). Predominant menstrual patterns were spotting and oligomenorrhea. Significant variation of the systolic blood pressure was not observed during the follow-up. There was a slight fall in the levels of diastolic blood pressure, at the limit of significance. Significant deviations from baseline regarding fasting glucose were not noted, but the mean hemoglobin concentration tended to increase. Weight gain (mean 3.9 kg at 12 months) and menstrual irregularity (occurred in more than 70% of all visits) were the main reasons for discontinuation of the method. Twenty-seven patients were accompanied during 12 months and the continuity rate at that time was 81.5%. Conclusion: depot medroxyprogesterone acetate is a satisfactory contraceptive method for adolescents.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):187-190
DOI 10.1590/S0100-72032001000300009
A vulvar fibroma, of the molluscum pendulum type, was present in a 20-year-old patient. The tumor began to develop slowly after her menarche, when she was 14 years of age. The physical examination revealed a mass with considerable volume, painless, located at the upper third of the greator left lip, elastic consistency, greater diameter at its distal portion measuring 12 cm by 23 cm in length. The treatment was exeresis from the base of the pedicle, under local anesthesia. The tumor weighed 950 g. A literature review is included.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):187-190
DOI 10.1590/S0100-72032001000300009
A vulvar fibroma, of the molluscum pendulum type, was present in a 20-year-old patient. The tumor began to develop slowly after her menarche, when she was 14 years of age. The physical examination revealed a mass with considerable volume, painless, located at the upper third of the greator left lip, elastic consistency, greater diameter at its distal portion measuring 12 cm by 23 cm in length. The treatment was exeresis from the base of the pedicle, under local anesthesia. The tumor weighed 950 g. A literature review is included.
