Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2000;22(4):191-199
DOI 10.1590/S0100-72032000000400002
Purpose: to determine the frequency of prenatal diagnosis in newborns with gastroschisis operated at the Instituto Materno-Infantil de Pernambuco (IMIP) and to analyze its repercussions on neonatal prognosis. Patients and Methods: a cross-sectional study was carried out, including 31 cases of gastroschisis submitted to surgical correction in our service from 1995 to 1999. Prevalence risk (PR) of neonatal death and its 95% confidence interval were calculated for the presence of prenatal diagnosis and other perinatal and surgical variables. Multiple logistic regression analysis was carried out to determine the adjusted risk of neonatal death. Results: only 10 of 31 cases of gastroschisis (32.3%) had prenatal diagnosis and all were delivered at IMIP. No newborn with prenatal diagnosis was preterm but 43% of those without prenatal diagnosis were premature (p < 0,05). Birth-to-surgery interval was significantly greater in the absence of prenatal diagnosis (7.7 versus 3.8 hours). The type of surgery, need of mechanical ventilation and frequency of postoperative infection were not different between the groups. Neonatal death was more frequent in the group without prenatal diagnosis (67%) than in the group with prenatal diagnosis (20%). The main factors associated with increased risk of neonatal death were gestational age <37 weeks, absence of prenatal diagnosis, delivery in other hospitals, birth-to-surgery interval > 4 hours, staged silo surgery, need of mechanical ventilation and postoperative infection. Conclusions: prenatal diagnosis was infrequent among infants with gastroschisis and neonatal death was extremely high in its absence. It is necessary to achieve greater rates of prenatal diagnosis and to improve perinatal care in order to reduce this increased mortality.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):191-199
DOI 10.1590/S0100-72032000000400002
Purpose: to determine the frequency of prenatal diagnosis in newborns with gastroschisis operated at the Instituto Materno-Infantil de Pernambuco (IMIP) and to analyze its repercussions on neonatal prognosis. Patients and Methods: a cross-sectional study was carried out, including 31 cases of gastroschisis submitted to surgical correction in our service from 1995 to 1999. Prevalence risk (PR) of neonatal death and its 95% confidence interval were calculated for the presence of prenatal diagnosis and other perinatal and surgical variables. Multiple logistic regression analysis was carried out to determine the adjusted risk of neonatal death. Results: only 10 of 31 cases of gastroschisis (32.3%) had prenatal diagnosis and all were delivered at IMIP. No newborn with prenatal diagnosis was preterm but 43% of those without prenatal diagnosis were premature (p < 0,05). Birth-to-surgery interval was significantly greater in the absence of prenatal diagnosis (7.7 versus 3.8 hours). The type of surgery, need of mechanical ventilation and frequency of postoperative infection were not different between the groups. Neonatal death was more frequent in the group without prenatal diagnosis (67%) than in the group with prenatal diagnosis (20%). The main factors associated with increased risk of neonatal death were gestational age <37 weeks, absence of prenatal diagnosis, delivery in other hospitals, birth-to-surgery interval > 4 hours, staged silo surgery, need of mechanical ventilation and postoperative infection. Conclusions: prenatal diagnosis was infrequent among infants with gastroschisis and neonatal death was extremely high in its absence. It is necessary to achieve greater rates of prenatal diagnosis and to improve perinatal care in order to reduce this increased mortality.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):201-208
DOI 10.1590/S0100-72032000000400003
Purpose: to evaluate the modifications due to premature rupture of the membranes of variables of the fetal biophysical profile, comparing them to the ones found in pregnant women with intact membranes. In the group with premature rupture of the membranes, the association of biophysical variables with the Apgar score at the first and fifth minutes and with the occurrence or not of clinical chorioamnionitis and neonatal infection was analyzed. Patients and Methods: in a prospective study, 112 fetal biophysical profiles were established in 60 pregnant women with premature rupture of the membranes at a period between the 28th and the 40th week of pregnancy, and only the last fetal biophysical profile was analyzed and compared to other 60 fetal biophysical profiles of pregnant women with gestational ages identical to the group of study and with intact membranes. Results: statistical analysis of the results revealed that the premature rupture of the membranes diminished the reactivity, not interfering with the body movements of the fetus. It also diminished the frequency of the respiratory movements of the fetus, not determining modifications of the fetal tonus, and considerably decreasing the amniotic fluid index. In terms of prediction of chorioamnionitis and neonatal infection, the fetal biophysical profile did not show any significant statistic validity; however, when the biophysical variables were present, the correlation with the absence of chorioamnionitis and neonatal infection was clearly shown. The result of the last fetal biophysical profile was strongly associated with the Apgar score at the 5th minute. Conclusion: the fetal biophysical profile should be used routinely in pregnant women with premature rupture of the membranes with the purpose of evaluating fetal vitality, and in order to detect those fetuses at a higher risk of infection, specially those with gestational ages of less than 34 weeks. Regarding those fetuses it is best to use a conservative approach.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):201-208
DOI 10.1590/S0100-72032000000400003
Purpose: to evaluate the modifications due to premature rupture of the membranes of variables of the fetal biophysical profile, comparing them to the ones found in pregnant women with intact membranes. In the group with premature rupture of the membranes, the association of biophysical variables with the Apgar score at the first and fifth minutes and with the occurrence or not of clinical chorioamnionitis and neonatal infection was analyzed. Patients and Methods: in a prospective study, 112 fetal biophysical profiles were established in 60 pregnant women with premature rupture of the membranes at a period between the 28th and the 40th week of pregnancy, and only the last fetal biophysical profile was analyzed and compared to other 60 fetal biophysical profiles of pregnant women with gestational ages identical to the group of study and with intact membranes. Results: statistical analysis of the results revealed that the premature rupture of the membranes diminished the reactivity, not interfering with the body movements of the fetus. It also diminished the frequency of the respiratory movements of the fetus, not determining modifications of the fetal tonus, and considerably decreasing the amniotic fluid index. In terms of prediction of chorioamnionitis and neonatal infection, the fetal biophysical profile did not show any significant statistic validity; however, when the biophysical variables were present, the correlation with the absence of chorioamnionitis and neonatal infection was clearly shown. The result of the last fetal biophysical profile was strongly associated with the Apgar score at the 5th minute. Conclusion: the fetal biophysical profile should be used routinely in pregnant women with premature rupture of the membranes with the purpose of evaluating fetal vitality, and in order to detect those fetuses at a higher risk of infection, specially those with gestational ages of less than 34 weeks. Regarding those fetuses it is best to use a conservative approach.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):209-216
DOI 10.1590/S0100-72032000000400004
Purpose: to observe the circadian pattern of blood pressure variation in normotensive and hypertensive pregnant women, assessing the occurrence of nocturnal blood pressure decrease, as well as the compliance with the method and possible complications. Methods: the blood pressure measurement was carried out in seventeen normotensive and fourteen hypertensive pregnant women at the Hospital das Clínicas of UFMG. Blood pressure was measured on two different occasions during gestation using the oscillometric technique to compare both groups. Results: in both groups nocturnal decrease in blood pressure as well as an increase in pressure levels was observed as pregnancy advanced. No significant complications were seen and they did not interfere with compliance which was 100%. Conclusions: the ambulatory blood pressure measurement is useful to evaluate pressure variation in normotensive and hypertensive pregnant women confirming the gradual increase in blood pressure throughout pregnancy and the nocturnal physiologic decrease which does not depend on maternal pressure levels.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):209-216
DOI 10.1590/S0100-72032000000400004
Purpose: to observe the circadian pattern of blood pressure variation in normotensive and hypertensive pregnant women, assessing the occurrence of nocturnal blood pressure decrease, as well as the compliance with the method and possible complications. Methods: the blood pressure measurement was carried out in seventeen normotensive and fourteen hypertensive pregnant women at the Hospital das Clínicas of UFMG. Blood pressure was measured on two different occasions during gestation using the oscillometric technique to compare both groups. Results: in both groups nocturnal decrease in blood pressure as well as an increase in pressure levels was observed as pregnancy advanced. No significant complications were seen and they did not interfere with compliance which was 100%. Conclusions: the ambulatory blood pressure measurement is useful to evaluate pressure variation in normotensive and hypertensive pregnant women confirming the gradual increase in blood pressure throughout pregnancy and the nocturnal physiologic decrease which does not depend on maternal pressure levels.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):217-223
DOI 10.1590/S0100-72032000000400005
Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatório de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients), represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%), followed by hormonal factor (21.2%), mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):217-223
DOI 10.1590/S0100-72032000000400005
Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatório de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients), represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%), followed by hormonal factor (21.2%), mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):225-228
DOI 10.1590/S0100-72032000000400006
Purpose: to analyze the frequency of glove perforation during gynecologic surgeries. Methods: a prospective study of 454 gloves used in 65 surgeries by the water pressure method. Results: of a total of 454 gloves, 54 (11.9%) had perforations. Comparison with the control group showed p<0.05 (chi² test), 1 (1.7%) perforation in 60 gloves tested. Of the total of gloves used in 65 surgeries, 29 (44.6%) had perforations, 44 (81%) had one perforation and 10 (19%) had more than one perforation. The two most common sites of perforations were the index finger, 20 (29.5%) and the thumb, 14 (25.9%). Perforation was predominant in the left hand (72.1%). The surgeons were the members of the team with the greatest number of glove perforations. Total hysterectomy was the most frequent surgery in which glove perforations occurred (50% of the cases). Conclusion: the glove perforations occurred with relatively high frequency during gynecologic surgeries. The index finger of the left hand proved to be the most affected region. Among the members of the team, the highest percentage of glove perforations occurred in those of the surgeons. Total hysterectomy had the highest perforation rate.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):225-228
DOI 10.1590/S0100-72032000000400006
Purpose: to analyze the frequency of glove perforation during gynecologic surgeries. Methods: a prospective study of 454 gloves used in 65 surgeries by the water pressure method. Results: of a total of 454 gloves, 54 (11.9%) had perforations. Comparison with the control group showed p<0.05 (chi² test), 1 (1.7%) perforation in 60 gloves tested. Of the total of gloves used in 65 surgeries, 29 (44.6%) had perforations, 44 (81%) had one perforation and 10 (19%) had more than one perforation. The two most common sites of perforations were the index finger, 20 (29.5%) and the thumb, 14 (25.9%). Perforation was predominant in the left hand (72.1%). The surgeons were the members of the team with the greatest number of glove perforations. Total hysterectomy was the most frequent surgery in which glove perforations occurred (50% of the cases). Conclusion: the glove perforations occurred with relatively high frequency during gynecologic surgeries. The index finger of the left hand proved to be the most affected region. Among the members of the team, the highest percentage of glove perforations occurred in those of the surgeons. Total hysterectomy had the highest perforation rate.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):229-233
DOI 10.1590/S0100-72032000000400007
Purpose: to evaluate the effects of hormone replacement therapy on the body mass index of postmenopausal women. Methods: for this purpose, 166 users and 136 non-users of hormone replacement were evaluated retrospectively during a period of three years. All women were assisted at the Menopause Outpatient Clinic of CAISM - UNICAMP, where the variations in this parameter were evaluated at the end of each year in relation to the initial parameters. The data analysis was performed through chi² test, Student's t test, and Mann-Whitney test. Results: we observed no significant variations in the body mass index, when comparing users and non-users during the three years of observation. Conclusion: hormone replacement therapy did not produce changes in this parameter in women properly assisted during its use.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):229-233
DOI 10.1590/S0100-72032000000400007
Purpose: to evaluate the effects of hormone replacement therapy on the body mass index of postmenopausal women. Methods: for this purpose, 166 users and 136 non-users of hormone replacement were evaluated retrospectively during a period of three years. All women were assisted at the Menopause Outpatient Clinic of CAISM - UNICAMP, where the variations in this parameter were evaluated at the end of each year in relation to the initial parameters. The data analysis was performed through chi² test, Student's t test, and Mann-Whitney test. Results: we observed no significant variations in the body mass index, when comparing users and non-users during the three years of observation. Conclusion: hormone replacement therapy did not produce changes in this parameter in women properly assisted during its use.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):235-238
DOI 10.1590/S0100-72032000000400008
Purpose: to evaluate thermal balloon endometrial ablation in the management of menorrhagia. Study design: twenty patients were submitted to endometrial ablation using the thermal balloon device, between June 1996 and June 1997. Local anesthesia was used in 16 patients. The device was introduced into the uterine cavity. The duration of the procedure was 8 minutes and 30 seconds. Results: two patients (10%) did not show improvement of the symptons. Eighteen patients (90%) referred improvement of symptoms. There was no complication during and after the procedure. Conclusions: The thermal balloon seems to be safe and efficient in the management of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):235-238
DOI 10.1590/S0100-72032000000400008
Purpose: to evaluate thermal balloon endometrial ablation in the management of menorrhagia. Study design: twenty patients were submitted to endometrial ablation using the thermal balloon device, between June 1996 and June 1997. Local anesthesia was used in 16 patients. The device was introduced into the uterine cavity. The duration of the procedure was 8 minutes and 30 seconds. Results: two patients (10%) did not show improvement of the symptons. Eighteen patients (90%) referred improvement of symptoms. There was no complication during and after the procedure. Conclusions: The thermal balloon seems to be safe and efficient in the management of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):239-241
DOI 10.1590/S0100-72032000000400009
Osteoporosis is an important disease which can affect millions of patients all over the world, leading to complications, often even to death. Prevention and the early diagnosis may help in the success of treatment but there are diseases which can occur at the same time. Primary hyperparathyroidism is a diagnosis which must be remembered in women after the menopause.
Summary
Rev Bras Ginecol Obstet. 2000;22(4):239-241
DOI 10.1590/S0100-72032000000400009
Osteoporosis is an important disease which can affect millions of patients all over the world, leading to complications, often even to death. Prevention and the early diagnosis may help in the success of treatment but there are diseases which can occur at the same time. Primary hyperparathyroidism is a diagnosis which must be remembered in women after the menopause.
