Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):161-163
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):164-169
The objective of this study is to associate the results obtained while assessing the pelvic floor muscles (PFM) functionality with the score of sexual satisfaction of young adult women.
This is an observational and cross-sectional study. The inclusion criteria were women aged between 20 and 40 years who have had sexual intercourse, nulliparous, BMI lower than 25 kg/m2, and absence of pelvic floor dysfunction. The evaluation consisted of both the medical history and assessment of the PFM functionality using the Perina pressure biofeedback and Oxford Scale. We measured sexual satisfaction using the Female Sexual Quotient questionnaire and used the KolmogorovSmirnov test to verify the normality of the data. We analyzed non-parametric variables using the Spearman correlation test. The significance level was 5 %.
A total of 80 women with a median age of 26 years and median BMI of 21.64 kg/m2 participated in this study. We divided the subjects into two groups, best and worse PFM functionality, according to median Perina pressure biofeedback and Oxford scale. We found no difference between the groups when comparing the sexual satisfaction scores. There was only a slight significant correlation between the Contraction Voluntary Average obtained using the pressure biofeedback and the primary domain (r = 0.27; p = 0.01).
This study found a slight correlation between PFM functionality and the functionality of the primary domain of the Female Sexual Quotient questionnaire. Therefore, it is not possible to state whether there is an association between the PFM functionality and female sexual satisfaction in young adults.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):170-176
The objective of this study is to assess whether the largest cyst diameter is useful for BI-RADS ultrasonography classification of predominantly solid breast masses with an oval shape, circumscribed margins, and largest axis parallel to the skin, which, except for the cystic component, would be likely classified as benign.
This study received approval from the local institutional review board. From March 2009 to August 2014, we prospectively biopsied 170 breast masses from 164 women. We grouped the largest cyst and mass diameters according to histopathological diagnoses. We used Student's t-test, linear regression, and the area under the receiver operating characteristic curve (AUC) for statistical assessment.
Histopathological examination revealed 143 (84%) benign and 27 (16%) malignant masses. The mean largest mass diameter was larger among malignant (mean standard deviation, 34.1 16.6 mm) than benign masses (24.7 16.7 mm) (P < 0.008). The mean largest cyst diameter was also larger among malignant (9.9 7.1 mm) than benign masses (4.6 3.6 mm) (P < 0.001). Agreement between measurements of the largest mass and cyst diameters was low (R2 = 0.26). AUC for the largest cyst diameter (0.78) was similar to the AUC for the largest mass diameter (0.69) ( p = 0.2). A largest cyst diameter < 3, 3 to < 11, and 11 mm had a positive predictive value of 0, 15, and 52%, respectively.
A largest cystic component < 3 mm identified within breast masses that show favorable characteristics may be considered clinically inconsequential in ultrasonography characterization. Conversely, masses with a largest cystic component 3 mm should be classified as BI-RADS-US category 4.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):177-182
The amniotic fluid volume (AFV) is known as a predictor for the wellness of a fetus. We aimed to investigate whether N-terminal pro-brain natriuretic peptide (NTproBNP) levels reflect AFV abnormalities in otherwise normal fetuses.
We recruited 24 women with isolated oligohydramnios, 23 women with isolated polyhydramnios, and 36 women with normal AFV at a tertiary referral center. NT-proBNP levels in umbilical venous samples and the individual characteristics of the three groups were compared. One-way ANOVA and Kruskal-Wallis analysis of variance were used for multi-group comparisons of continuous variables. When a significant difference was detected, the Scheffe test was performed as a post-hoc analysis. Proportions were compared using the Chi-square (2) test.
Maternal age, body mass indices, weight gained in pregnancy and NT-proBNP levels were similar among the three groups. Apgar scores at 1 and 5 minutes significantly correlated with NT-proBNP levels in all newborns (Spearman's r = 0.23 ; p = 0.03 and Spearman's r = 0.24; p = 0.02, respectively). The umbilical venous NTproBNP levels did not differ between newborns who needed mechanical ventilation and those who didn't (p = 0.595).
NT-proBNP is a biomolecule that may provide insights into the pathogenesis of fetal circulatory problems and subsequent renal failure. Further investigations are warranted.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):183-188
The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs.
A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group.
We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs.
The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):189-195
Previous studies have shown that low birth weight (LBW) is associated with cardiovascular risk in late adulthood. Recent studies in adolescents suggest that modifiable factors may have greater influence on increased cardiovascular risk. This study aims to investigate the association between LBW and changes in anthropometric and biochemical risk factors during adolescence in a population with low average socioeconomic status.
In a retrospective double cohort, data of birth weight were extracted from hospital records of children born on the same day between 1992 and 2002. According to the World Health Organization, we classified the children as having LBW or normal birth weight. A total of 172 subjects among children, adolescents and adults were researched. We measured anthropometric and clinical data, lipid profile and glucose after an overnight fasting. The low and normal weight groups were compared using Mann-Whitney U, Fischer exact, Chi-square (2) and Student's t tests.
Pregnant women with preeclampsia delivered more newborns with LBW (p< 0.001). Anthropometric and clinical parameters were similar between groups. No differences were found in the family history of cardiovascular diseases (p= 0.1), family incomes (p= 0.8) and maternal school education (p= 0.8) between groups.
In this study, LBW did not increase cardiovascular disease risk factors in adolescents. We observed absence of association between low birth weight and poor health outcomes among adolescents with low socioeconomic status from an urban city in the Brazilian northeast.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):196-200
Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation.
The fetal karyotype was normal. The title of CMV's IgG antibodies almost tripled. Since the first semester,analysisof the polymerasechainreaction(PCR)forCMVDNAintheamniotic fluid was negative. The pregnancy was terminatedat 23weeks. Neuropathologicalfindings at autopsy showed severe brain lesions associated with CMV infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):201-206
Lissencephaly is a genetic heterogeneous autosomal recessive disorder characterized by the classical triad: brain malformations, eye anomalies, and congenital muscular dystrophy. Prenatal diagnosis is feasible by demonstrating abnormal development of sulci and gyri. Magnetic resonance imaging (MRI) may enhance detection of developmental cortical disorders as well as ocular anomalies. We describe a case of early diagnosis of lissencephaly type 2 detected at the time of routine second trimester scan by three-dimensional ultrasound and fetal MRI. Gross pathology confirmed the accuracy of the prenatal diagnosis while histology showed the typical feature of cobblestone cortex. As the disease is associated with poor perinatal prognosis, early and accurate prenatal diagnosis is important for genetic counseling and antenatal care.