Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2006;28(5):271-277
DOI 10.1590/S0100-72032006000500002
PURPOSE: to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. METHODS: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. RESULTS: most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. CONCLUSIONS: it was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):271-277
DOI 10.1590/S0100-72032006000500002
PURPOSE: to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. METHODS: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. RESULTS: most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. CONCLUSIONS: it was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):278-284
DOI 10.1590/S0100-72032006000500003
PURPOSE: to analyze race, parity and presence of the progesterone receptor polymorphism, named PROGINS, as factors related to uterine leiomyoma occurrence in Brazilian women. METHODS: we carried out a case-control study, composed of 122 patients with the diagnosis of uterine fibroid and 125 women without the disease. After recording the clinical data, we collected biological material for DNA extraction, polymerase chain reaction and agarose gel electrophoresis in order to identify the presence of PROGINS polymorphism. Statistical analysis was performed using the non-parametric Mann-Whitney test or the chi2 test, depending on the studied variable. The risk for the occurrence of the disease was calculated by the logistic regression model, providing the odds ratio (OR). The adopted significance level was 5% (p<0.05) and the confidence interval was 95% (95% CI). RESULTS: we observed a higher prevalence of "non-white"women - mulatto and black - (50 vs 22.4%) and nulliparas (23.8 vs 11.2%) in the cases, while the progesterone receptor genotype was more often PROGINS positive - heterozygous or mutant homozygous - among the controls (21.6 vs 10.7%). The OR indicated an elevated risk for leiomyoma related to the "non-white"race (OR=3.46; 95% CI: 2.0-6.0) and the nulliparity (OR=3.30; 95% CI: 1.9-5.6), with reduction in the presence of PROGINS-positive genotypes (OR=0.43; 95% CI: 0.2-0.9). CONCLUSIONS: the "non-white"race and nulliparity were considered risk factors for the occurrence of uterine fibroid in the studied population, while PROGINS polymorphism showed to be a protective factor.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):278-284
DOI 10.1590/S0100-72032006000500003
PURPOSE: to analyze race, parity and presence of the progesterone receptor polymorphism, named PROGINS, as factors related to uterine leiomyoma occurrence in Brazilian women. METHODS: we carried out a case-control study, composed of 122 patients with the diagnosis of uterine fibroid and 125 women without the disease. After recording the clinical data, we collected biological material for DNA extraction, polymerase chain reaction and agarose gel electrophoresis in order to identify the presence of PROGINS polymorphism. Statistical analysis was performed using the non-parametric Mann-Whitney test or the chi2 test, depending on the studied variable. The risk for the occurrence of the disease was calculated by the logistic regression model, providing the odds ratio (OR). The adopted significance level was 5% (p<0.05) and the confidence interval was 95% (95% CI). RESULTS: we observed a higher prevalence of "non-white"women - mulatto and black - (50 vs 22.4%) and nulliparas (23.8 vs 11.2%) in the cases, while the progesterone receptor genotype was more often PROGINS positive - heterozygous or mutant homozygous - among the controls (21.6 vs 10.7%). The OR indicated an elevated risk for leiomyoma related to the "non-white"race (OR=3.46; 95% CI: 2.0-6.0) and the nulliparity (OR=3.30; 95% CI: 1.9-5.6), with reduction in the presence of PROGINS-positive genotypes (OR=0.43; 95% CI: 0.2-0.9). CONCLUSIONS: the "non-white"race and nulliparity were considered risk factors for the occurrence of uterine fibroid in the studied population, while PROGINS polymorphism showed to be a protective factor.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):292-297
DOI 10.1590/S0100-72032006000500005
PURPOSE: to verify if there is a relationship between the clinical periodontal parameters and estrogen levels and bone mineral density (BMD). METHODS: forty-six post-menopausal women aged 44 to 68 years (52.2±4.8) and 15 women aged 35 to 54 years (44.7±7.5) were evaluated. Periodontal parameters like probing depth (PD), clinical attachment loss (CAL), and missing teeth (MT) were compared with estrogen levels (sufficient and insufficient) and BMD (normal, osteopenic and osteoporotic). Data of the mean difference between the groups were compared by the Aspin-Welch test. RESULTS: the means of PD, CAL and MT, when associated with the normal (2.1±0.5; 2.9±1.4 and 10.6±5.0), osteopenic (2.3±0.7; 3.0±1.1 and 12.8±5.1) and osteoporotic BMD (2.4±0.6; 2.7±0.9 and 14.3±5.7), did not show statistical difference (p>0.05). A significant difference was found between the control group and postmenopausal women for CAL and MT. When compared with the estrogen levels the results did not show a difference regarding the periodontal parameters. CONCLUSION: although some studies showed a positive correlation with osteoporosis and estrogen level, in this population of menopausal women these findings were not confirmed.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):292-297
DOI 10.1590/S0100-72032006000500005
PURPOSE: to verify if there is a relationship between the clinical periodontal parameters and estrogen levels and bone mineral density (BMD). METHODS: forty-six post-menopausal women aged 44 to 68 years (52.2±4.8) and 15 women aged 35 to 54 years (44.7±7.5) were evaluated. Periodontal parameters like probing depth (PD), clinical attachment loss (CAL), and missing teeth (MT) were compared with estrogen levels (sufficient and insufficient) and BMD (normal, osteopenic and osteoporotic). Data of the mean difference between the groups were compared by the Aspin-Welch test. RESULTS: the means of PD, CAL and MT, when associated with the normal (2.1±0.5; 2.9±1.4 and 10.6±5.0), osteopenic (2.3±0.7; 3.0±1.1 and 12.8±5.1) and osteoporotic BMD (2.4±0.6; 2.7±0.9 and 14.3±5.7), did not show statistical difference (p>0.05). A significant difference was found between the control group and postmenopausal women for CAL and MT. When compared with the estrogen levels the results did not show a difference regarding the periodontal parameters. CONCLUSION: although some studies showed a positive correlation with osteoporosis and estrogen level, in this population of menopausal women these findings were not confirmed.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):298-303
DOI 10.1590/S0100-72032006000500006
PURPOSE: to assess p53 protein expression in infiltrating ductal breast carcinoma and to analyze its association with histological and nuclear grade. METHODS: sixty-five consecutive females who were diagnosed with primary infiltrating ductal breast tumor from July 1999 to July 2001 were included in the present study. Mean patient age at diagnosis was 69.2 years (range 41 - 90). All patients were first treated with surgical therapy, conservative surgery or mastectomy. None of the patients received any preoperative adjuvant therapy. Resected breast tumor specimens were fixed in 10% formalin, paraffin embedded, and conserved for immunohistochemical analysis. p53 protein expression was evaluated. Primary monoclonal anti-human p53 antibody DO-7 (DAKO) was used. Frequency distributions were tested by the chi2 test. A level of p<0,05 was considered significant. RESULTS: p53 expression was detected in 24 (36,9%) of 65 carcinomas. Of the cases with protein expression, 13 (54,2%) were high or histological grade III, 8 (33,3%), were grade II, 3 (12,5%) were grade I. On nuclear grade analysis, of the cases with protein expression, 13 (4,2%) were nuclear grade III, 9 (37,5%) were grade II and 2 (8,3%) were grade I. p53 expression was frequent in carcinomas with high histological and nuclear grades. CONCLUSIONS: p53 expression was significantly associated with the histological grade. On the other hand, nuclear grade was not significantly related to p53 expression.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):298-303
DOI 10.1590/S0100-72032006000500006
PURPOSE: to assess p53 protein expression in infiltrating ductal breast carcinoma and to analyze its association with histological and nuclear grade. METHODS: sixty-five consecutive females who were diagnosed with primary infiltrating ductal breast tumor from July 1999 to July 2001 were included in the present study. Mean patient age at diagnosis was 69.2 years (range 41 - 90). All patients were first treated with surgical therapy, conservative surgery or mastectomy. None of the patients received any preoperative adjuvant therapy. Resected breast tumor specimens were fixed in 10% formalin, paraffin embedded, and conserved for immunohistochemical analysis. p53 protein expression was evaluated. Primary monoclonal anti-human p53 antibody DO-7 (DAKO) was used. Frequency distributions were tested by the chi2 test. A level of p<0,05 was considered significant. RESULTS: p53 expression was detected in 24 (36,9%) of 65 carcinomas. Of the cases with protein expression, 13 (54,2%) were high or histological grade III, 8 (33,3%), were grade II, 3 (12,5%) were grade I. On nuclear grade analysis, of the cases with protein expression, 13 (4,2%) were nuclear grade III, 9 (37,5%) were grade II and 2 (8,3%) were grade I. p53 expression was frequent in carcinomas with high histological and nuclear grades. CONCLUSIONS: p53 expression was significantly associated with the histological grade. On the other hand, nuclear grade was not significantly related to p53 expression.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):304-309
DOI 10.1590/S0100-72032006000500007
PURPOSE: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. METHODS: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. RESULTS: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by level I had sensitivity of 72% and specificity of 98% and there were 28% of false-positive cases. In level II, the sensitivity and specificity of the diagnosis of congenital heart disease were 100 and 99%, respectively. The kappa index was 57% and indicated a moderate degree of concordance between the two levels. Fifty-one percent of the fetuses with diagnosis of cardiac malformations required pharmacological or invasive intervention immediately after birth. CONCLUSION: morphological ultrasound examination is a important tool in the screening of arrhythmias and congenital heart defects during fetal life. The sensitivity and specificity of the fetal echocardiogram were very high and the early diagnosis made it possible to treat the fetus with severe cardiac disease either during pregnancy or immediately after birth.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):304-309
DOI 10.1590/S0100-72032006000500007
PURPOSE: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. METHODS: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. RESULTS: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by level I had sensitivity of 72% and specificity of 98% and there were 28% of false-positive cases. In level II, the sensitivity and specificity of the diagnosis of congenital heart disease were 100 and 99%, respectively. The kappa index was 57% and indicated a moderate degree of concordance between the two levels. Fifty-one percent of the fetuses with diagnosis of cardiac malformations required pharmacological or invasive intervention immediately after birth. CONCLUSION: morphological ultrasound examination is a important tool in the screening of arrhythmias and congenital heart defects during fetal life. The sensitivity and specificity of the fetal echocardiogram were very high and the early diagnosis made it possible to treat the fetus with severe cardiac disease either during pregnancy or immediately after birth.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):310-315
DOI 10.1590/S0100-72032006000500008
Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):310-315
DOI 10.1590/S0100-72032006000500008
Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases.
