Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):251-258
DOI 10.1590/S0100-72031999000500002
Purpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):261-266
DOI 10.1590/S0100-72031999000500003
Purpose: to evaluate the immune status of women in reproductive age regarding the rubella virus. Methods: 2,243 samples of serum from women in the age range of 15 to 45 years, with an average of 26 years, living in the urban area of Natal, RN were analyzed, to evaluate the immune status in regard to rubella virus. Of these women, 1,170 (52.1%) were pregnant and 1,073 (47.9%) were not. IgM and IgG antibodies were determined, using solid phase ELISA and fluorescence (ELFA) techniques. Results: of the 2,243 women, 1,632 showed immunity to rubella virus and 611 did not, therefore being susceptible to this virus. The rates of immunity and susceptibility in this study were 73.0% and 27.0%, respectively. In 611 susceptible woman, 14.5% did not present antibodies against rubella virus, 7.7% had only IgM antibody and 4.8% had IgG and IgM antibodies. Conclusions: our findings show that a significant group of women from Natal, in reproductive age, is still susceptible to rubella virus, indicating the risk of congenital infection by this pathogen. We advise the selective vaccination of those women against rubella to prevent clinical manifestations related to the congenital form of the disease.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):261-266
DOI 10.1590/S0100-72031999000500003
Purpose: to evaluate the immune status of women in reproductive age regarding the rubella virus. Methods: 2,243 samples of serum from women in the age range of 15 to 45 years, with an average of 26 years, living in the urban area of Natal, RN were analyzed, to evaluate the immune status in regard to rubella virus. Of these women, 1,170 (52.1%) were pregnant and 1,073 (47.9%) were not. IgM and IgG antibodies were determined, using solid phase ELISA and fluorescence (ELFA) techniques. Results: of the 2,243 women, 1,632 showed immunity to rubella virus and 611 did not, therefore being susceptible to this virus. The rates of immunity and susceptibility in this study were 73.0% and 27.0%, respectively. In 611 susceptible woman, 14.5% did not present antibodies against rubella virus, 7.7% had only IgM antibody and 4.8% had IgG and IgM antibodies. Conclusions: our findings show that a significant group of women from Natal, in reproductive age, is still susceptible to rubella virus, indicating the risk of congenital infection by this pathogen. We advise the selective vaccination of those women against rubella to prevent clinical manifestations related to the congenital form of the disease.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):267-272
DOI 10.1590/S0100-72031999000500004
Purpose: to check if physiotherapy immediately after childbirth may contribute to early diastasis reduction. Methods: longitudinal and randomized study with 50 parturient women recruited in the Maternidade-Escola Hilda Brandão of the Santa Casa of Belo Horizonte, from April to September 1998. The control group (N = 25) was submitted to evaluation and measurement (6 h and 18 h after labor), and the treatment group (N = 25) was submitted to the same evaluation and measurement as above, as well as to a protocol for physiotherapeutic assistance, 6 and 18 h after labor. For the evaluations, a pachymeter, a precision instrument, was used to measure diastasis. Results: at 18 h after parturition, the control group presented a diastasis reduction of 5.4%, and the treatment group of 12.5%, as related to the first measure (6 h after delivery) (p<0.001, with a confidence interval of 99%). Conclusions: these results show that the physiotherapeutic assistance immediately after childbirth determines a significant reduction in the diastasis of the recti abdominis muscles (DRAM) after every treatment session, as well as a relevant reduction when compared to the control group, positively contributing to the earlier recovery of the recti abdominis muscles.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):273-277
DOI 10.1590/S0100-72031999000500005
Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, chi², Fisher's exact and t Student's tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):281-284
DOI 10.1590/S0100-72031999000500006
Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):287-290
DOI 10.1590/S0100-72031999000500007
Purpose: to evaluate the knowledge and practice of breast self-examination among medical students and to determine possible factors associated with this practice. Method: the authors used a questionnaire to gather information about the students and their knowledge of this self-examination. This questionnaire also allowed the authors to verify the frequency with which the female students performed breast self-examination. The chi² test and Student's "t" test were used, when applicable, to check the association of certain factors. Results: of the 348 questionnaires which were answered, 16% (55) were submitted by 5th year medical students, who had already attended the Gynecology course; 43% were answered by females, 62% of the students had medical doctors among their relatives, and 17% had a family history of breast cancer. In terms of breast self-examination, 95% knew about the method. Of the 149 females who answered the questionnaire, only 64% checked their breasts regularly. The reasons given for not performing self-examination varied: 24% considered themselves to be too young, 4% thought they would not have cancer, 9% listed fear as the reason, 19% reported they were too lazy, and 44% of the female students had no clear reason for not performing breast self-examination. Neither the knowledge nor the practice of the breast self-examination were associated with the subjects the students had or had not yet taken in medical school, with a family history of breast cancer or with the fact that one or more relatives were medical doctors. Conclusion: breast self-examination is known by practically all the medical students; nevertheless, only one third of the female students performed it regularly. This fact highlights the importance of emphasizing breast self-examination among medical students, so that they can help to disseminate this practice among the general population, rather than delegating this responsibility to the midia.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):287-290
DOI 10.1590/S0100-72031999000500007
Purpose: to evaluate the knowledge and practice of breast self-examination among medical students and to determine possible factors associated with this practice. Method: the authors used a questionnaire to gather information about the students and their knowledge of this self-examination. This questionnaire also allowed the authors to verify the frequency with which the female students performed breast self-examination. The chi² test and Student's "t" test were used, when applicable, to check the association of certain factors. Results: of the 348 questionnaires which were answered, 16% (55) were submitted by 5th year medical students, who had already attended the Gynecology course; 43% were answered by females, 62% of the students had medical doctors among their relatives, and 17% had a family history of breast cancer. In terms of breast self-examination, 95% knew about the method. Of the 149 females who answered the questionnaire, only 64% checked their breasts regularly. The reasons given for not performing self-examination varied: 24% considered themselves to be too young, 4% thought they would not have cancer, 9% listed fear as the reason, 19% reported they were too lazy, and 44% of the female students had no clear reason for not performing breast self-examination. Neither the knowledge nor the practice of the breast self-examination were associated with the subjects the students had or had not yet taken in medical school, with a family history of breast cancer or with the fact that one or more relatives were medical doctors. Conclusion: breast self-examination is known by practically all the medical students; nevertheless, only one third of the female students performed it regularly. This fact highlights the importance of emphasizing breast self-examination among medical students, so that they can help to disseminate this practice among the general population, rather than delegating this responsibility to the midia.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):291-295
DOI 10.1590/S0100-72031999000500008
Purpose: to verify changes in amnion epithelia after neovaginoplasty and the presence of estrogen receptor in this tissue using electron microscopy (TEM). Methods: a group consisting of 33 young patients with vaginal agenesy, most of them amenorreic, either incapable or having difficulty to adequately perform sexual activity, underwent surgical correction of the anomaly by the McIndoe-Banister technique. In each woman, a cavity was created through an opening of the vesicorectal space. A mold made of artificial sponge with a condom recovered by amniotic membrane was introduced into the cavity. After eight days, the mold was removed, leaving a developing neoepithelium from the amniotic membrane. Results: The TEM conducted in samples of tissue obtained from neovaginas showed similar results in all three layers of these epithelia, either in the cytoplasm or the cellular microstructures in comparison with normal women. The intensity of staining of the estrogen receptors on the vaginal neoepithelium of the group of women who underwent the surgical procedure was similar to that of normal women. The estrogen receptors were heterogeneously distributed in the three layers of the tissue in all women. The analysis of the vaginal neoepithelium obtained from amniotic membrane revealed, through the TEM, all the characteristics of a regular vaginal epithelium.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):291-295
DOI 10.1590/S0100-72031999000500008
Purpose: to verify changes in amnion epithelia after neovaginoplasty and the presence of estrogen receptor in this tissue using electron microscopy (TEM). Methods: a group consisting of 33 young patients with vaginal agenesy, most of them amenorreic, either incapable or having difficulty to adequately perform sexual activity, underwent surgical correction of the anomaly by the McIndoe-Banister technique. In each woman, a cavity was created through an opening of the vesicorectal space. A mold made of artificial sponge with a condom recovered by amniotic membrane was introduced into the cavity. After eight days, the mold was removed, leaving a developing neoepithelium from the amniotic membrane. Results: The TEM conducted in samples of tissue obtained from neovaginas showed similar results in all three layers of these epithelia, either in the cytoplasm or the cellular microstructures in comparison with normal women. The intensity of staining of the estrogen receptors on the vaginal neoepithelium of the group of women who underwent the surgical procedure was similar to that of normal women. The estrogen receptors were heterogeneously distributed in the three layers of the tissue in all women. The analysis of the vaginal neoepithelium obtained from amniotic membrane revealed, through the TEM, all the characteristics of a regular vaginal epithelium.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):297-298
DOI 10.1590/S0100-72031999000500009
Endometrial ablation is a useful technique in patientes with abnormal uterine bleeding without response to clinical measures. Pregnancy is possible even after the destruction or resection of the endometrium. The case reported is a normal term pregnancy after endometrial ablation because ot menorrhagia without successful prior clinical treatment.
Summary
Rev Bras Ginecol Obstet. 1999;21(5):297-298
DOI 10.1590/S0100-72031999000500009
Endometrial ablation is a useful technique in patientes with abnormal uterine bleeding without response to clinical measures. Pregnancy is possible even after the destruction or resection of the endometrium. The case reported is a normal term pregnancy after endometrial ablation because ot menorrhagia without successful prior clinical treatment.