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Summary
Rev Bras Ginecol Obstet. 2010;32(3)
Summary
Rev Bras Ginecol Obstet. 2010;32(3)
Summary
Rev Bras Ginecol Obstet. 2010;32(3)
Summary
Rev Bras Ginecol Obstet. 2010;32(3)
Summary
Summary
Rev Bras Ginecol Obstet. 2010;32(3):105-111
DOI 10.1590/S0100-72032010000300002
PURPOSE: to evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. METHODS: this was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortion's experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. RESULTS: the prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. CONCLUSIONS: the non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):105-111
DOI 10.1590/S0100-72032010000300002
PURPOSE: to evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. METHODS: this was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortion's experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. RESULTS: the prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. CONCLUSIONS: the non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):112-117
DOI 10.1590/S0100-72032010000300003
PURPOSE: to compare the lamellar body number density (LBND) count in amniotic fluid using the fluorescent polarization (FP) test as a diagnostic parameter for the assessment of fetal pulmonary maturity. METHOD: this was an analytical, controlled cross-sectional study conducted on 60 pregnant women from March 2002 to December 2007. Amniotic fluid specimens were obtained by amniocentesis or at the time of caesarean section, and submitted to the LBND and FP tests (TDxFLM®, Abbott Laboratories), the latter considered to be a reference test, and compared in terms of the presence or absence of respiratory distress syndrome (RDS). Cut-off values for maturity were established at 30,000 lamellar bodies/µL for the LBND test and 55 mg/g albumin for the FP test. Maternal and perinatal characteristics and neonatal evolution were evaluated, and the performance of the diagnostic tests regarding fetal pulmonary maturity was determined. In the statistical analysis, descriptive measures were used and the sensitivity, specificity and positive and predictive values of the tests were determined with the level of significance set at p<0.05. RESULTS: maternal age ranged from 15 to 34 years (mean: 26.6 years) and gestational age ranged from 24.3 to 41.6 weeks (mean: 35.1 weeks). RDS was diagnosed in 35.1% of neonates. Perinatal characteristics such as weight, Apgar score, and RDS incidence were compared to the results of the LBND and FP tests and a significant correspondence (p<0.05) was observed between the groups of neonates clinically classified as mature and immature in both tests. The tests were concordant in 68.3% of the cases. Comparison of the PF and LBND tests revealed 100% specificity for both and a higher specificity for the LBND test (73.1% as opposed to 51.9% for the PF test). The gold standard for the determination of fetal maturity is the occurrence of RDS. The positive predictive value of the LBND test was higher (36.4%) than that of the FP test (24.2%) (p<0.05) and the negative predictive value was 100% for both tests. CONCLUSIONS: the present study demonstrated that the LBND test has 100% sensitivity and higher specificity than the reference test (FP). In addition, the LBND test is considered to be rapid, accessible, inexpensive and feasible for the Brazilian reality, and it can be used as a reliable test for the prediction of fetal pulmonary maturity.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):112-117
DOI 10.1590/S0100-72032010000300003
PURPOSE: to compare the lamellar body number density (LBND) count in amniotic fluid using the fluorescent polarization (FP) test as a diagnostic parameter for the assessment of fetal pulmonary maturity. METHOD: this was an analytical, controlled cross-sectional study conducted on 60 pregnant women from March 2002 to December 2007. Amniotic fluid specimens were obtained by amniocentesis or at the time of caesarean section, and submitted to the LBND and FP tests (TDxFLM®, Abbott Laboratories), the latter considered to be a reference test, and compared in terms of the presence or absence of respiratory distress syndrome (RDS). Cut-off values for maturity were established at 30,000 lamellar bodies/µL for the LBND test and 55 mg/g albumin for the FP test. Maternal and perinatal characteristics and neonatal evolution were evaluated, and the performance of the diagnostic tests regarding fetal pulmonary maturity was determined. In the statistical analysis, descriptive measures were used and the sensitivity, specificity and positive and predictive values of the tests were determined with the level of significance set at p<0.05. RESULTS: maternal age ranged from 15 to 34 years (mean: 26.6 years) and gestational age ranged from 24.3 to 41.6 weeks (mean: 35.1 weeks). RDS was diagnosed in 35.1% of neonates. Perinatal characteristics such as weight, Apgar score, and RDS incidence were compared to the results of the LBND and FP tests and a significant correspondence (p<0.05) was observed between the groups of neonates clinically classified as mature and immature in both tests. The tests were concordant in 68.3% of the cases. Comparison of the PF and LBND tests revealed 100% specificity for both and a higher specificity for the LBND test (73.1% as opposed to 51.9% for the PF test). The gold standard for the determination of fetal maturity is the occurrence of RDS. The positive predictive value of the LBND test was higher (36.4%) than that of the FP test (24.2%) (p<0.05) and the negative predictive value was 100% for both tests. CONCLUSIONS: the present study demonstrated that the LBND test has 100% sensitivity and higher specificity than the reference test (FP). In addition, the LBND test is considered to be rapid, accessible, inexpensive and feasible for the Brazilian reality, and it can be used as a reliable test for the prediction of fetal pulmonary maturity.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):118-125
DOI 10.1590/S0100-72032010000300004
PURPOSE: to compare the serum levels of five markers of oxidative stress and assisted reproduction (AR) outcomes among infertile patients, with tubal and/or male factor and with polycystic ovary syndrome (PCOS). METHODS: 70 patients were included, 58 with tubal and/or male factor infertility and 12 with PCOS, who underwent controlled ovarian stimulation to perform intracytoplasmic sperm injection (ICSI). A blood sample was collected between the third and fifth day of the menstrual cycle in the month prior to ovarian stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein oxidation products, glutathione and vitamin E, by reading the absorbance with a spectrophotometer and by high performance liquid chromatography (HPLC). Data were analyzed statistically by the Student's t-test and Fisher's exact test. RESULTS: significant increases in the body mass index, ovarian volume and number of antral follicles were observed in PCOS patients, as well as the use of a lower total dose of follicle stimulating hormone for these patients. There were no differences in the response to ovarian stimulation, in the results of AR or serum levels of malondialdehyde, hydroperoxides, advanced oxidation protein products, glutathione and vitamin E between groups. CONCLUSIONS: the present data did not demonstrate a difference in the levels of serum markers of oxidative stress or in AR results when comparing non-obese infertile patients with PCOS and controls. These data suggest that the results of AR may not be compromised in this specific subgroup of patients with PCOS. However, interpretations of the action of oxidative stress on the results of AR are still not clear and the reproductive implications of oxidative stress need to be better evaluated.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):118-125
DOI 10.1590/S0100-72032010000300004
PURPOSE: to compare the serum levels of five markers of oxidative stress and assisted reproduction (AR) outcomes among infertile patients, with tubal and/or male factor and with polycystic ovary syndrome (PCOS). METHODS: 70 patients were included, 58 with tubal and/or male factor infertility and 12 with PCOS, who underwent controlled ovarian stimulation to perform intracytoplasmic sperm injection (ICSI). A blood sample was collected between the third and fifth day of the menstrual cycle in the month prior to ovarian stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein oxidation products, glutathione and vitamin E, by reading the absorbance with a spectrophotometer and by high performance liquid chromatography (HPLC). Data were analyzed statistically by the Student's t-test and Fisher's exact test. RESULTS: significant increases in the body mass index, ovarian volume and number of antral follicles were observed in PCOS patients, as well as the use of a lower total dose of follicle stimulating hormone for these patients. There were no differences in the response to ovarian stimulation, in the results of AR or serum levels of malondialdehyde, hydroperoxides, advanced oxidation protein products, glutathione and vitamin E between groups. CONCLUSIONS: the present data did not demonstrate a difference in the levels of serum markers of oxidative stress or in AR results when comparing non-obese infertile patients with PCOS and controls. These data suggest that the results of AR may not be compromised in this specific subgroup of patients with PCOS. However, interpretations of the action of oxidative stress on the results of AR are still not clear and the reproductive implications of oxidative stress need to be better evaluated.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):126-132
DOI 10.1590/S0100-72032010000300005
PURPOSE: to compare serum homocysteine levels in polycystic ovary syndrome (PCOS) and non-PCOS women and correlate them with clinical, hormonal and metabolic parameters. METHODS: transverse study with carried out on 110 women, including 56 with PCOS and 54 normal controls. Patients were submitted to anamnesis, physical examination and pelvic sonograms and to the determination of homocysteine, C-reactive protein (CRP), glucose insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free thyroxin (Free T4), prolactin, and testosterone. For the statistical analysis, we used the Student's t test, Pearson's product-moment correlation coefficient and the χ2 test. The "enter" method was used to determine independent association between variables. RESULTS: there was a significant increase in the average serum homocysteine levels in the group of patients with PCOS compared to controls (5.97±2.95 versus 5,17±1.33 µmol/L; p=0,015). As expected, since they are affected by PCOS, values of body mass index (BMI), waist circumference, total cholesterol, HDL cholesterol, triglycerides, insulin and HOMA were significantly different between groups. Serum homocysteine levels, BMI and PCOS were correlated. Multivariate analysis showed that PCOS, by itself, does not correlate with high serum homocysteine levels. CONCLUSIONS: PCOS women have significantly higher serum levels of homocysteine that may increase their risk for cardiovascular disease. However, other intrinsic PCOS-related factors, not identified in this study, may be responsible for this alteration.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):126-132
DOI 10.1590/S0100-72032010000300005
PURPOSE: to compare serum homocysteine levels in polycystic ovary syndrome (PCOS) and non-PCOS women and correlate them with clinical, hormonal and metabolic parameters. METHODS: transverse study with carried out on 110 women, including 56 with PCOS and 54 normal controls. Patients were submitted to anamnesis, physical examination and pelvic sonograms and to the determination of homocysteine, C-reactive protein (CRP), glucose insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free thyroxin (Free T4), prolactin, and testosterone. For the statistical analysis, we used the Student's t test, Pearson's product-moment correlation coefficient and the χ2 test. The "enter" method was used to determine independent association between variables. RESULTS: there was a significant increase in the average serum homocysteine levels in the group of patients with PCOS compared to controls (5.97±2.95 versus 5,17±1.33 µmol/L; p=0,015). As expected, since they are affected by PCOS, values of body mass index (BMI), waist circumference, total cholesterol, HDL cholesterol, triglycerides, insulin and HOMA were significantly different between groups. Serum homocysteine levels, BMI and PCOS were correlated. Multivariate analysis showed that PCOS, by itself, does not correlate with high serum homocysteine levels. CONCLUSIONS: PCOS women have significantly higher serum levels of homocysteine that may increase their risk for cardiovascular disease. However, other intrinsic PCOS-related factors, not identified in this study, may be responsible for this alteration.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):133-138
DOI 10.1590/S0100-72032010000300006
PURPOSE: to assess the influence of physiotherapy performed during radiotherapy (RT) on the quality of life (QL) of women under treatment for breast cancer. METHODS: this was a randomized clinical trial conducted on 55 women under RT treatment, 28 of whom were assigned to a group submitted to physiotherapy (PG) and 27 to the control group receiving no PG (CG). The physiotherapy technique used for PG was kinesiotherapy for the upper limbs using 19 exercises actively performed, with a series of ten rhythmic repetitions or stretching movements involving flexion, extension, abduction, adduction, internal and external shoulder rotation, separate or combined. QL was evaluated using the Functional Assessment of Cancer Therapy-Breast (FACT-B), at the beginning and at the end of RT and six months after the end of RT. The physiotherapy sessions were started concomitantly with RT, 90 days after surgery, on average. RESULTS: there was no difference between subgroups regarding the following subscales: physical well-being (p=0.8), social/family well-being (p=0.3), functional well-being (p=0.2) and breast subscale (p=0.2) at the three time points assessed. A comparison of the emotional subscale applied at the three evaluations demonstrated a better behavior of PG as compared to CG (p=0.01), with both groups presenting improvement on the breast subscale between the beginning and the end of RT (PG p=0.0004 and CG p=0.003). There was improvement in FACT-B scores at the end of RT in both groups (PG p=0.0006 and CG p=0.003). However, at the sixth month after RT, this improvement was maintained only in PG (p=0,005). QL assessed along time by the FACT B (p=0.004) and the Trial Outcome Index (TOI) (sums of the physical and functional well-being subscales and of the breast subscale) was better for PG (p=0.006). There was no evidence of negative effects associated with the exercises. CONCLUSIONS: the execution of exercises for the upper limbs was beneficial for QL during and six months after RT.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):133-138
DOI 10.1590/S0100-72032010000300006
PURPOSE: to assess the influence of physiotherapy performed during radiotherapy (RT) on the quality of life (QL) of women under treatment for breast cancer. METHODS: this was a randomized clinical trial conducted on 55 women under RT treatment, 28 of whom were assigned to a group submitted to physiotherapy (PG) and 27 to the control group receiving no PG (CG). The physiotherapy technique used for PG was kinesiotherapy for the upper limbs using 19 exercises actively performed, with a series of ten rhythmic repetitions or stretching movements involving flexion, extension, abduction, adduction, internal and external shoulder rotation, separate or combined. QL was evaluated using the Functional Assessment of Cancer Therapy-Breast (FACT-B), at the beginning and at the end of RT and six months after the end of RT. The physiotherapy sessions were started concomitantly with RT, 90 days after surgery, on average. RESULTS: there was no difference between subgroups regarding the following subscales: physical well-being (p=0.8), social/family well-being (p=0.3), functional well-being (p=0.2) and breast subscale (p=0.2) at the three time points assessed. A comparison of the emotional subscale applied at the three evaluations demonstrated a better behavior of PG as compared to CG (p=0.01), with both groups presenting improvement on the breast subscale between the beginning and the end of RT (PG p=0.0004 and CG p=0.003). There was improvement in FACT-B scores at the end of RT in both groups (PG p=0.0006 and CG p=0.003). However, at the sixth month after RT, this improvement was maintained only in PG (p=0,005). QL assessed along time by the FACT B (p=0.004) and the Trial Outcome Index (TOI) (sums of the physical and functional well-being subscales and of the breast subscale) was better for PG (p=0.006). There was no evidence of negative effects associated with the exercises. CONCLUSIONS: the execution of exercises for the upper limbs was beneficial for QL during and six months after RT.