Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2004;26(4):269-275
DOI 10.1590/S0100-72032004000400002
OBJECTIVE: to evaluate the performance of Pap smear, hybrid capture II (HC II), and visual inspection with acetic acid in the detection of pre-invasive and invasive cervical lesions. METHODS: a total of 2281 women were submitted to a clinical exam, including Pap smear, HC II for HPV DNA detection and visual inspection with 5% acetic acid (VIA). When at least one of the tests was positive, colposcopy was performed and targeted biopsies were taken from suspicious lesions. Colposcopy was also performed in 420 women with negative results. Test performance was evaluated, using colposcopy as the gold standard, with or without biopsy. RESULTS: Pap smear, VIA and HC II were positive in 9.2, 10.9 and 17.5% of all women screened, respectively. Although at least one positive test was found in 671 women (29.4%), only 82 (3.6%) presented histologically confirmed disease (50 NIC1, 20 NIC2, 7 NIC3, and 5 invasive carcinoma). VIA and HC II sensitivities were similar and significantly higher than Pap smear. Pap smear showed better specificity than VIA and than HC II. In women with a negative Pap smear result, VIA showed better performance than HC II. CONCLUSION: Pap smear combined with VIA performed better than Pap smear combined with HC II or than Pap smear alone.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):269-275
DOI 10.1590/S0100-72032004000400002
OBJECTIVE: to evaluate the performance of Pap smear, hybrid capture II (HC II), and visual inspection with acetic acid in the detection of pre-invasive and invasive cervical lesions. METHODS: a total of 2281 women were submitted to a clinical exam, including Pap smear, HC II for HPV DNA detection and visual inspection with 5% acetic acid (VIA). When at least one of the tests was positive, colposcopy was performed and targeted biopsies were taken from suspicious lesions. Colposcopy was also performed in 420 women with negative results. Test performance was evaluated, using colposcopy as the gold standard, with or without biopsy. RESULTS: Pap smear, VIA and HC II were positive in 9.2, 10.9 and 17.5% of all women screened, respectively. Although at least one positive test was found in 671 women (29.4%), only 82 (3.6%) presented histologically confirmed disease (50 NIC1, 20 NIC2, 7 NIC3, and 5 invasive carcinoma). VIA and HC II sensitivities were similar and significantly higher than Pap smear. Pap smear showed better specificity than VIA and than HC II. In women with a negative Pap smear result, VIA showed better performance than HC II. CONCLUSION: Pap smear combined with VIA performed better than Pap smear combined with HC II or than Pap smear alone.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):277-287
DOI 10.1590/S0100-72032004000400003
OBJECTIVE: to compare the prevalence of DNA of human papillomavirus (HPV), in samples of normal endometrial tissue, and tissue with endometrial carcinoma of women submitted to surgical treatment (hysterectomy), or between endometrial carcinoma and benign disease, through the PCR technique. METHODS: this is an observational control-case study where 100 women (50 with endometrial carcinoma and 50 with normal endometrial tissue) were analyzed for the detection of HPV DNA in samples of endometrial tissue kept in paraffin blocks by the PCR technique. The cases of endometrial carcinoma with uncertain primary site of the lesion as well as the cases with previous or current history of pre-neoplasic lesions or carcinoma of the lower genital tract were excluded. Variables as age, smoking habit, endometrial trophism, squamous differentiation and degree of tumor differentiation were also evaluated. RESULTS: the estimated relative risk of the presence of HPV in the endometrial carcinoma and in the normal endometrial tissue was the same. HPV was detected in 8% of the cases of carcinoma and 10% in the normal endometrial tissue. In spite of HPV having been 3.5 times more detected in women with smoking habit in the group without carcinoma, there was no statistical difference. The presence of HPV was also not correlated with the women's age, endometrial trophism, squamous differentiation and degree of tumor differentiation. The HPV types 16 (5 cases) and 18 (4 cases) were the viruses most frequently found both in the normal endometrial tissue or in the tissue with carcinoma. No oncogenic low risk virus was detected in the samples. CONCLUSION: The same proportion of HPV is present in the endometrial tissue of women with endometrial cancer and with normal endometrium. It could not be demonstrated a possible correlation of DNA of HPV with the development of endometrial carcinoma.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):277-287
DOI 10.1590/S0100-72032004000400003
OBJECTIVE: to compare the prevalence of DNA of human papillomavirus (HPV), in samples of normal endometrial tissue, and tissue with endometrial carcinoma of women submitted to surgical treatment (hysterectomy), or between endometrial carcinoma and benign disease, through the PCR technique. METHODS: this is an observational control-case study where 100 women (50 with endometrial carcinoma and 50 with normal endometrial tissue) were analyzed for the detection of HPV DNA in samples of endometrial tissue kept in paraffin blocks by the PCR technique. The cases of endometrial carcinoma with uncertain primary site of the lesion as well as the cases with previous or current history of pre-neoplasic lesions or carcinoma of the lower genital tract were excluded. Variables as age, smoking habit, endometrial trophism, squamous differentiation and degree of tumor differentiation were also evaluated. RESULTS: the estimated relative risk of the presence of HPV in the endometrial carcinoma and in the normal endometrial tissue was the same. HPV was detected in 8% of the cases of carcinoma and 10% in the normal endometrial tissue. In spite of HPV having been 3.5 times more detected in women with smoking habit in the group without carcinoma, there was no statistical difference. The presence of HPV was also not correlated with the women's age, endometrial trophism, squamous differentiation and degree of tumor differentiation. The HPV types 16 (5 cases) and 18 (4 cases) were the viruses most frequently found both in the normal endometrial tissue or in the tissue with carcinoma. No oncogenic low risk virus was detected in the samples. CONCLUSION: The same proportion of HPV is present in the endometrial tissue of women with endometrial cancer and with normal endometrium. It could not be demonstrated a possible correlation of DNA of HPV with the development of endometrial carcinoma.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):289-294
DOI 10.1590/S0100-72032004000400004
OBJECTIVE: to study the relationship of biobehavioral factors, such as age, menarche, number of gestations, and age of first sexual intercourse, with changes in Langerhans'cells in women with negative hybrid capture for HPV. METHODS: thirty women referred due to abnormal cervical cytology or premalignant cervical lesions were studied and underwent colposcopy, guided biopsy and histopathological exams. The Langerhans' cells were identified by immunohistochemical (S100+) exams. Langerhans' cells visualized in brown color were counted using the software Cytoviewer. The nonparametric Wilcoxon rank-sum test was employed for statistical analysis. RESULTS: the number of Langerhans' cells in women who had menarche after 13 years old presented statistically significant difference (173.34 cell/mm²) compared to the group whose menarche occurred before 13 (271.41 cell/mm²). The age at the first sexual intercourse was associated with the low number of Langerhans' cells, 127.15 cell/mm² and 250.14 cell/mm², respectively, for the beginning of the sexual activity up to 17 years old and after 17 (p=0.03). Previous cauterizations of the uterine cervix have been related to a lower number of Langerhans' cells in the epithelium, with the average 120.30 cell/mm² as compared to 236.06 cell/mm² for those women who never underwent that procedure (p=0.05). Other factors such as the patient's age and the number of gestations showed no statistically significant differences in the density of Langerhans' cells. CONCLUSIONS: the present study reports the association of biobehavioral factors with decrease in the number of Langerhans' cell.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):289-294
DOI 10.1590/S0100-72032004000400004
OBJECTIVE: to study the relationship of biobehavioral factors, such as age, menarche, number of gestations, and age of first sexual intercourse, with changes in Langerhans'cells in women with negative hybrid capture for HPV. METHODS: thirty women referred due to abnormal cervical cytology or premalignant cervical lesions were studied and underwent colposcopy, guided biopsy and histopathological exams. The Langerhans' cells were identified by immunohistochemical (S100+) exams. Langerhans' cells visualized in brown color were counted using the software Cytoviewer. The nonparametric Wilcoxon rank-sum test was employed for statistical analysis. RESULTS: the number of Langerhans' cells in women who had menarche after 13 years old presented statistically significant difference (173.34 cell/mm²) compared to the group whose menarche occurred before 13 (271.41 cell/mm²). The age at the first sexual intercourse was associated with the low number of Langerhans' cells, 127.15 cell/mm² and 250.14 cell/mm², respectively, for the beginning of the sexual activity up to 17 years old and after 17 (p=0.03). Previous cauterizations of the uterine cervix have been related to a lower number of Langerhans' cells in the epithelium, with the average 120.30 cell/mm² as compared to 236.06 cell/mm² for those women who never underwent that procedure (p=0.05). Other factors such as the patient's age and the number of gestations showed no statistically significant differences in the density of Langerhans' cells. CONCLUSIONS: the present study reports the association of biobehavioral factors with decrease in the number of Langerhans' cell.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):295-298
DOI 10.1590/S0100-72032004000400005
INTRODUCTION: adrenal hyperplasia is a common genetic disorder and 95% of the cases are due to a 21-hydroxylase deficiency. Clinical presentation varies from life-threatening salt-losing adrenal hyperplasia to simple androgenic states, which can be of late-onset and very similar to polycystic ovary syndrome. Diagnosis is usually made by synthetic ACTH provocative tests but efforts are being made to simplify this investigation. OBJECTIVE: to evaluate basal 17-hydroxyprogesterone as a predictor of the provocative test for the diagnosis of late-onset congenial adrenal hyperplasia. METHODS: A total of 122 patients under clinical suspicion of diagnosis of late-onset congenial adrenal hyperplasia were included and retrospectively evaluated in the study. Such suspicion included signs and/or symptoms of hyperandrogenism (hirsutism, acne, oily skin, menstrual irregularity etc.). All the patients were submitted to the 0.25mg synthetic ACTH provocative test (Synacthen®). After resting for 60 minutes, the samples were taken in the basal time and 60 minutes after the administration of 0.25mg synthetic ACTH, in order to assay 17-hydroxiprogesteron, the venous access being kept through a heparinized catheter. Radioimmuoessay was the method used to accomplish the assay of seric 17-hydroxiprogesteron. The sensitivity and specificity of the basal 17-hydroxiprogesteron were measured, assessing several cutoff points. ROC curves were made to analyze the test performance, using the software Medcalc®. RESULTS: ROC curve analysis showed that the best cutoff point was 181 ng/dl, which was very similar to the most common recommendation of 200 ng/dl of the literature. The cutoff point of 200 ng/dl shows positive and negative predictive values of 75 and 100%, and accuracy of 98,4% as a diagnostic test for late-onset adrenal hyperplasia. CONCLUSIONS: considering our data, we suggest that all hyperandrogenic patients should start the investigation with basal 17-hydroxyprogesteron and in case it is above 181 ng/dl, then they should do the synthetic 17-hydroxyprogesteron provocative test.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):295-298
DOI 10.1590/S0100-72032004000400005
INTRODUCTION: adrenal hyperplasia is a common genetic disorder and 95% of the cases are due to a 21-hydroxylase deficiency. Clinical presentation varies from life-threatening salt-losing adrenal hyperplasia to simple androgenic states, which can be of late-onset and very similar to polycystic ovary syndrome. Diagnosis is usually made by synthetic ACTH provocative tests but efforts are being made to simplify this investigation. OBJECTIVE: to evaluate basal 17-hydroxyprogesterone as a predictor of the provocative test for the diagnosis of late-onset congenial adrenal hyperplasia. METHODS: A total of 122 patients under clinical suspicion of diagnosis of late-onset congenial adrenal hyperplasia were included and retrospectively evaluated in the study. Such suspicion included signs and/or symptoms of hyperandrogenism (hirsutism, acne, oily skin, menstrual irregularity etc.). All the patients were submitted to the 0.25mg synthetic ACTH provocative test (Synacthen®). After resting for 60 minutes, the samples were taken in the basal time and 60 minutes after the administration of 0.25mg synthetic ACTH, in order to assay 17-hydroxiprogesteron, the venous access being kept through a heparinized catheter. Radioimmuoessay was the method used to accomplish the assay of seric 17-hydroxiprogesteron. The sensitivity and specificity of the basal 17-hydroxiprogesteron were measured, assessing several cutoff points. ROC curves were made to analyze the test performance, using the software Medcalc®. RESULTS: ROC curve analysis showed that the best cutoff point was 181 ng/dl, which was very similar to the most common recommendation of 200 ng/dl of the literature. The cutoff point of 200 ng/dl shows positive and negative predictive values of 75 and 100%, and accuracy of 98,4% as a diagnostic test for late-onset adrenal hyperplasia. CONCLUSIONS: considering our data, we suggest that all hyperandrogenic patients should start the investigation with basal 17-hydroxyprogesteron and in case it is above 181 ng/dl, then they should do the synthetic 17-hydroxyprogesteron provocative test.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):299-304
DOI 10.1590/S0100-72032004000400006
OBJECTIVE: to determine GSTT1 and GSTM1 null genotype frequencies as well as CYP1A1 polymorphic allele frequencies in a group of women with endometriosis, and to compare these frequencies with those observed in a group without endometriosis (control), aiming at a possible identification of biomarkers of susceptibility to endometriosis. METHODS: a total of 50 women with suggestive clinical signs of endometriosis underwent videolaparoscopy and biopsies were evaluated histologically. Endometriosis was present in 25 women (case group). Negative results were found in 25 women (control group). GSTT1 and GSTM1 null genotypes were assessed by multiplex polymerase chain reaction (PCR). The investigation of the polymorphic allele of the gene CYP1A1 was performed by PCR-RFLP (restriction fragment length polymorphism). For statistical analysis, the Fisher exact test was used. RESULTS: in both groups, the deletion polymorphism frequencies presented values of 16% for the gene GSTT1 and of 44% for the gene GSTM1; therefore, the results did not show differences in the distribution of the GSTT1 and GSTM1 null genotypes among the studied groups. The allelic frequency for the m1 allele of the gene CYP1A1 was higher in the women with endometriosis (0.22), although not statistically significant, when compared to the control group (0.14). CONCLUSION: the results did not show an association between the evaluated polymorphisms and the endometriosis diagnosis.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):299-304
DOI 10.1590/S0100-72032004000400006
OBJECTIVE: to determine GSTT1 and GSTM1 null genotype frequencies as well as CYP1A1 polymorphic allele frequencies in a group of women with endometriosis, and to compare these frequencies with those observed in a group without endometriosis (control), aiming at a possible identification of biomarkers of susceptibility to endometriosis. METHODS: a total of 50 women with suggestive clinical signs of endometriosis underwent videolaparoscopy and biopsies were evaluated histologically. Endometriosis was present in 25 women (case group). Negative results were found in 25 women (control group). GSTT1 and GSTM1 null genotypes were assessed by multiplex polymerase chain reaction (PCR). The investigation of the polymorphic allele of the gene CYP1A1 was performed by PCR-RFLP (restriction fragment length polymorphism). For statistical analysis, the Fisher exact test was used. RESULTS: in both groups, the deletion polymorphism frequencies presented values of 16% for the gene GSTT1 and of 44% for the gene GSTM1; therefore, the results did not show differences in the distribution of the GSTT1 and GSTM1 null genotypes among the studied groups. The allelic frequency for the m1 allele of the gene CYP1A1 was higher in the women with endometriosis (0.22), although not statistically significant, when compared to the control group (0.14). CONCLUSION: the results did not show an association between the evaluated polymorphisms and the endometriosis diagnosis.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):305-309
DOI 10.1590/S0100-72032004000400007
OBJECTIVE: to develop a new preoperative classification of submucous myomas to evaluate the viability and the degree of difficulty of hysteroscopic myomectomy. METHODS: forty-four patients were submitted to hysteroscopic resection of submucous myomas. The possibility of total resection of the myoma, the surgery duration, the fluid deficit, and the incidence of complications were evaluated. The myomas were classified by the Classification of the European Society of Endoscopic Surgery (CESES) and by the classification proposed (CP) by our group, that besides the degree of penetration of the myoma in the myometrium, adds the parameters: extent of the base of the myoma as related to the uterine wall, the size of the myoma in centimeters and its topography at the uterine cavity. For statistical analysis the Fisher test, the Student t test and the analysis of variance were used. Statistic significance was considered when the p-value was smaller than 0.05 in the bicaudal test. RESULTS: in 47 myomas the hysteroscopic surgery was considered complete. There was no significant difference among the three levels (0, 1 and 2) by CESES. By CP, the difference among the number of complete surgeries was significant (p=0.001) between the two levels (groups I and II). The difference between the surgery duration was significant when the two classifications were compared. In relation to the fluid deficit, just CP presented significant differences among the levels (p=0,02). CONCLUSIONS: the proposed classification includes more clues about the difficulties of the hysteroscopic myomectomy than the standard classification. It should be noted that the number of hysteroscopic myomectomies used for that analysis was modest, being interesting to evaluate the performance of the proposed classification in larger series of cases.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):305-309
DOI 10.1590/S0100-72032004000400007
OBJECTIVE: to develop a new preoperative classification of submucous myomas to evaluate the viability and the degree of difficulty of hysteroscopic myomectomy. METHODS: forty-four patients were submitted to hysteroscopic resection of submucous myomas. The possibility of total resection of the myoma, the surgery duration, the fluid deficit, and the incidence of complications were evaluated. The myomas were classified by the Classification of the European Society of Endoscopic Surgery (CESES) and by the classification proposed (CP) by our group, that besides the degree of penetration of the myoma in the myometrium, adds the parameters: extent of the base of the myoma as related to the uterine wall, the size of the myoma in centimeters and its topography at the uterine cavity. For statistical analysis the Fisher test, the Student t test and the analysis of variance were used. Statistic significance was considered when the p-value was smaller than 0.05 in the bicaudal test. RESULTS: in 47 myomas the hysteroscopic surgery was considered complete. There was no significant difference among the three levels (0, 1 and 2) by CESES. By CP, the difference among the number of complete surgeries was significant (p=0.001) between the two levels (groups I and II). The difference between the surgery duration was significant when the two classifications were compared. In relation to the fluid deficit, just CP presented significant differences among the levels (p=0,02). CONCLUSIONS: the proposed classification includes more clues about the difficulties of the hysteroscopic myomectomy than the standard classification. It should be noted that the number of hysteroscopic myomectomies used for that analysis was modest, being interesting to evaluate the performance of the proposed classification in larger series of cases.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):311-316
DOI 10.1590/S0100-72032004000400008
OBJECTIVE: to assess the concordance of different urodynamic parameters with simplified cystometry, thus improving the cost-benefit relationship for stress urinary incontinence (SUI) diagnosis in woman. METHODS: we evaluated retrospectively the medical records of thirty patients treated, from January 2000 to March 2001. All patients had been submitted to physical and gynecological examinations. A conventional urodynamic study had been made using a Dynograph R-611 recorder. Simplified cystometry had used a saline tube with "Y" connector, connected to a Foley 14 Fr catheter, which allowed measurement of intra-vesical pressure at the same time as physiological saline infusion. The following parameters were analyzed: residual volume, bladder capacity, complacency, involuntary detrusor contractions, and abdominal leak-point pressure. The Pearson test of agreement and the Wilcoxon signed rank test were used to verify the concordance between related samples, with p < 0,05. RESULTS: the average age was 50 years old (28-70). Concordance between studies for stress urinary losses was 67%, and for detrusor involuntary contractions, 90%. The average residual volume was significantly different: by simplified cystometry it was 16.8 ml versus 2 ml by conventional urodynamics (p < 0.01). The average maximum vesical capacity by urodynamic study was 440.5 ml, and by simplified cystometry, 387 ml (p < 0.05). Vesical complacency was on average, significantly larger in simplified cystometry (43.0 ml/cmH2O) than in the urodynamic study (31.5 ml/cmH2O), with p < 0.01. CONCLUSION: preliminary evaluations suggest that the urogynecologic propedeutic associated with cystometry is an option to be considered in the clinical and preoperative assessment of patients with SUI instead of conventional urodynamics, particularly when the latter is not available. Simplified cystometry is an accessible exam that grants comparable results for the detection of involuntary detrusor contractions and for the identification of urinary loss, providing the examiner with trustworthy data on vesical behavior.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):311-316
DOI 10.1590/S0100-72032004000400008
OBJECTIVE: to assess the concordance of different urodynamic parameters with simplified cystometry, thus improving the cost-benefit relationship for stress urinary incontinence (SUI) diagnosis in woman. METHODS: we evaluated retrospectively the medical records of thirty patients treated, from January 2000 to March 2001. All patients had been submitted to physical and gynecological examinations. A conventional urodynamic study had been made using a Dynograph R-611 recorder. Simplified cystometry had used a saline tube with "Y" connector, connected to a Foley 14 Fr catheter, which allowed measurement of intra-vesical pressure at the same time as physiological saline infusion. The following parameters were analyzed: residual volume, bladder capacity, complacency, involuntary detrusor contractions, and abdominal leak-point pressure. The Pearson test of agreement and the Wilcoxon signed rank test were used to verify the concordance between related samples, with p < 0,05. RESULTS: the average age was 50 years old (28-70). Concordance between studies for stress urinary losses was 67%, and for detrusor involuntary contractions, 90%. The average residual volume was significantly different: by simplified cystometry it was 16.8 ml versus 2 ml by conventional urodynamics (p < 0.01). The average maximum vesical capacity by urodynamic study was 440.5 ml, and by simplified cystometry, 387 ml (p < 0.05). Vesical complacency was on average, significantly larger in simplified cystometry (43.0 ml/cmH2O) than in the urodynamic study (31.5 ml/cmH2O), with p < 0.01. CONCLUSION: preliminary evaluations suggest that the urogynecologic propedeutic associated with cystometry is an option to be considered in the clinical and preoperative assessment of patients with SUI instead of conventional urodynamics, particularly when the latter is not available. Simplified cystometry is an accessible exam that grants comparable results for the detection of involuntary detrusor contractions and for the identification of urinary loss, providing the examiner with trustworthy data on vesical behavior.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):317-323
DOI 10.1590/S0100-72032004000400009
OBJECTIVE: to evaluate the epidemiological and parturitional aspects of obstetric patients admitted to intensive care units (ICU), and analyze the frequency of intensive support needed by them. METHODS: observational and descriptive study of all obstetric patients' transfers to ICU from the Hospital Materno Infantil of Goiânia-Go, from January 1999 to December 2001. The analysis has included variables as maternal age, parity, obstetric and non-obstetric indications for ICU admissions, moment of transfer, mode of delivery, maternal death, and the frequency of ICU utilization per 1,000 deliveries (IDR - imminent death ratio). The statistical analysis was performed by the chi2 test or the Fisher exact test and a significant difference was set at a level of 5%. RESULTS: over the 36-month period analyzed, 86 pregnancy-associated ICU admissions were identified (among 4,560 deliveries). Of the 86 patients, 52.33% (n=45) were nulliparae and 63 (73.26%) were between 19 and 35 years old. Hypertensive disorders accounted for 41 (57.75%) of the admissions and hemorrhage for 14 (19.72%). Eclampsia (n=23), HELLP syndrome (n=13) and premature abruptio placentae (n=5) were the most common obstetric indications for ICU admissions. Maternal cardiac disorders accounted for 4 cases of non-obstetric indications. There was a predominance of postpartum transfers (82.35%). Fifty-five (72.37%) patients needed delivery by caesarian section. The average time spent in the UCI by those patients was 5.1 days. Maternal mortality found in this study was 24.29%, hypertensive disorders being responsible for 52.94% (9/17) of all obstetric-associated deaths. There were no significant statistical differences (p=0.81) regarding these obstetric-associated deaths and their causes (hypertensive disorders, hemorrhage or infections) or even regarding maternal deaths and duration of stay (< or > 48 hours) in the ICU (p=0.08). The IDR found was 18.8 per 1,000 deliveries. CONCLUSIONS: the need of intensive care estimated by IDR was 18.8 per 1,000 deliveries, the pregnancy-induced hypertension being responsible for the majority of the indications for maternal transfers.
Summary
Rev Bras Ginecol Obstet. 2004;26(4):317-323
DOI 10.1590/S0100-72032004000400009
OBJECTIVE: to evaluate the epidemiological and parturitional aspects of obstetric patients admitted to intensive care units (ICU), and analyze the frequency of intensive support needed by them. METHODS: observational and descriptive study of all obstetric patients' transfers to ICU from the Hospital Materno Infantil of Goiânia-Go, from January 1999 to December 2001. The analysis has included variables as maternal age, parity, obstetric and non-obstetric indications for ICU admissions, moment of transfer, mode of delivery, maternal death, and the frequency of ICU utilization per 1,000 deliveries (IDR - imminent death ratio). The statistical analysis was performed by the chi2 test or the Fisher exact test and a significant difference was set at a level of 5%. RESULTS: over the 36-month period analyzed, 86 pregnancy-associated ICU admissions were identified (among 4,560 deliveries). Of the 86 patients, 52.33% (n=45) were nulliparae and 63 (73.26%) were between 19 and 35 years old. Hypertensive disorders accounted for 41 (57.75%) of the admissions and hemorrhage for 14 (19.72%). Eclampsia (n=23), HELLP syndrome (n=13) and premature abruptio placentae (n=5) were the most common obstetric indications for ICU admissions. Maternal cardiac disorders accounted for 4 cases of non-obstetric indications. There was a predominance of postpartum transfers (82.35%). Fifty-five (72.37%) patients needed delivery by caesarian section. The average time spent in the UCI by those patients was 5.1 days. Maternal mortality found in this study was 24.29%, hypertensive disorders being responsible for 52.94% (9/17) of all obstetric-associated deaths. There were no significant statistical differences (p=0.81) regarding these obstetric-associated deaths and their causes (hypertensive disorders, hemorrhage or infections) or even regarding maternal deaths and duration of stay (< or > 48 hours) in the ICU (p=0.08). The IDR found was 18.8 per 1,000 deliveries. CONCLUSIONS: the need of intensive care estimated by IDR was 18.8 per 1,000 deliveries, the pregnancy-induced hypertension being responsible for the majority of the indications for maternal transfers.
