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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):225-229
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):225-229
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):230-234
DOI 10.1590/S0100-72032007000500002
PURPOSE: to analyze the factors associated with the reproductive future of patients wishing to become pregnant after having being submitted to tubal ligation (TL), attended at a public service. METHODS: a prospective study including 98 patients previously submitted to TL, who came to the Human Reproduction Center of the University Hospital of Brasilia (HUB), from January 1996 to January 2004, wishing to become pregnant again These patients were followed up from their first appointment till the end of the study, when they answered a structured questionnaire about the social demographic aspects at both the moment they asked for the TL and the reversion of the procedure. RESULTS: the patients’ average age at the TL procedure was 25 years old. Among them, 55.1% were younger than 25, 46.9% had three or more children, and ten of them had only one child. The most common reasons for the TL procedure were: contraception (48%), financial difficulties (25.5%) and marital problems (15.3%). The major causes for wishing a new pregnancy were: a new relationship/marriage (80.6%), the desire of having another child with the same partner (8.2%), and the death of a child (6.1%). The regret time informed by most of the patients was between two and four years, and the search for reversion was between six and ten years. About 83.6% of the sample referred lack of information about the procedure and the difficulties of reversion. Twenty patients were submitted to TL reversal procedure; from the ten who became pregnant, only six delivered babies, after a full-term pregnancy. Eight patients were referred to in vitro fertilization treatment, four of them became pregnant and two delivered healthy babies. CONCLUSIONS: TL in young vulnerable women, not informed about the definitive condition of the method, may increase the search for attended reproduction services and impair their reproductive future, as far as only 8.1% of the sample delivered babies and reached their goal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):230-234
DOI 10.1590/S0100-72032007000500002
PURPOSE: to analyze the factors associated with the reproductive future of patients wishing to become pregnant after having being submitted to tubal ligation (TL), attended at a public service. METHODS: a prospective study including 98 patients previously submitted to TL, who came to the Human Reproduction Center of the University Hospital of Brasilia (HUB), from January 1996 to January 2004, wishing to become pregnant again These patients were followed up from their first appointment till the end of the study, when they answered a structured questionnaire about the social demographic aspects at both the moment they asked for the TL and the reversion of the procedure. RESULTS: the patients’ average age at the TL procedure was 25 years old. Among them, 55.1% were younger than 25, 46.9% had three or more children, and ten of them had only one child. The most common reasons for the TL procedure were: contraception (48%), financial difficulties (25.5%) and marital problems (15.3%). The major causes for wishing a new pregnancy were: a new relationship/marriage (80.6%), the desire of having another child with the same partner (8.2%), and the death of a child (6.1%). The regret time informed by most of the patients was between two and four years, and the search for reversion was between six and ten years. About 83.6% of the sample referred lack of information about the procedure and the difficulties of reversion. Twenty patients were submitted to TL reversal procedure; from the ten who became pregnant, only six delivered babies, after a full-term pregnancy. Eight patients were referred to in vitro fertilization treatment, four of them became pregnant and two delivered healthy babies. CONCLUSIONS: TL in young vulnerable women, not informed about the definitive condition of the method, may increase the search for attended reproduction services and impair their reproductive future, as far as only 8.1% of the sample delivered babies and reached their goal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):235-240
DOI 10.1590/S0100-72032007000500003
PURPOSE: to establish the prevalence of thrombophilic factors in infertile women. METHODS: a cross-sectional study was performed, in which infertile women, seen in a private clinic with investigation for thrombophilia were included, according to the protocol of the clinic, between March 2003 and March 2005, after the approval of the Research Ethics Committee of the Universidade Estadual de Campinas (UNICAMP). One hundred and forty-four infertile women without any liver disease were evaluated. Infertility is defined as one year of unprotected sexual intercourse without conception. The acquired and/or inherited thrombophilic factors investigated were: anticardiolipin antibody (aCL), lupus anticoagulant (LA), protein C deficiency (PCD), protein S deficiency (PSD), antithrombin III deficiency (ATD), presence of the factor V Leiden, mutation G20 210A in the prothrombin gene, and C677T mutation of methylene tetrahydrofolate reductase (MTHFR). RESULTS: the prevalence values obtained for aCL and LA were 2%. The prevalence of the hereditary thrombophilic factors were: PCD=4%, PSD=6%, ATD=5%, factor V Leiden=3%, prothrombin mutation=3%, MTHFR mutation=57%. Conclusions: of the 144 patients selected, 105 women (72.9%) presented at least one thrombophilic factor. This reinforces the importance and justifies the need of investigation in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):235-240
DOI 10.1590/S0100-72032007000500003
PURPOSE: to establish the prevalence of thrombophilic factors in infertile women. METHODS: a cross-sectional study was performed, in which infertile women, seen in a private clinic with investigation for thrombophilia were included, according to the protocol of the clinic, between March 2003 and March 2005, after the approval of the Research Ethics Committee of the Universidade Estadual de Campinas (UNICAMP). One hundred and forty-four infertile women without any liver disease were evaluated. Infertility is defined as one year of unprotected sexual intercourse without conception. The acquired and/or inherited thrombophilic factors investigated were: anticardiolipin antibody (aCL), lupus anticoagulant (LA), protein C deficiency (PCD), protein S deficiency (PSD), antithrombin III deficiency (ATD), presence of the factor V Leiden, mutation G20 210A in the prothrombin gene, and C677T mutation of methylene tetrahydrofolate reductase (MTHFR). RESULTS: the prevalence values obtained for aCL and LA were 2%. The prevalence of the hereditary thrombophilic factors were: PCD=4%, PSD=6%, ATD=5%, factor V Leiden=3%, prothrombin mutation=3%, MTHFR mutation=57%. Conclusions: of the 144 patients selected, 105 women (72.9%) presented at least one thrombophilic factor. This reinforces the importance and justifies the need of investigation in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):241-247
DOI 10.1590/S0100-72032007000500004
PURPOSE: to evaluate the ultra-sensitive C-Reactive Protein level (us-CRP) in patients with Polycystic Ovary Syndrome (PCOS), and the correlation of clinical and laboratory parameters with the us-CRP level. Methods: in this cross-sectional study, 46 women with Polycystic Ovary Syndrome, according to the Rotterdam criteria, and 44 control women have been included. Serum was analyzed for C reactive protein (CRP) levels. Body mass index (BMI), age, circumference waist, HOMA-IR, total, low and high density lipoprotein cholesterol, triglycerides, glucose, testosterone and insulin levels were correlated to CRP level through a linear regression model. RESULTS: PCOS patients not only were older and had higher BMI, but their waist circumference, fasting insulin, HOMA-IR, total and LDL cholesterol were also higher, as compared to the women from the control group. A significant difference was observed in the us-CRP level between the PCOS (2.7 mg/dL±2.17) the control (1.6 mg/dL±1.49) groups. When us-CRP levels were categorized as of low (<1.0 mg/L), moderate (1-3.0 mg/L) and high (3.0 mg/L) risk for cardiovascular episodes, only 28.3% women with PCOS had us-CRP levels defined as low, 34.8% as moderate and 37% as high risk. The prevalence of Metabolic Syndrome was higher in the women with PCOS (30.4%) than in the women from the control group (6.8%). Through a stepwise linear regression model, only waist circumference, presence of metabolic syndrome and age had a confounding effect in the relation between us-CRP and PCOS. After adjustment for confounding factors, PCOS showed an independent effect on us-CRP level. CONCLUSIONS: the us-CRP levels were higher in the PCOS women than in the healthy controls. By a regression model, PCOS showed an independent effect on us-CRP level.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):241-247
DOI 10.1590/S0100-72032007000500004
PURPOSE: to evaluate the ultra-sensitive C-Reactive Protein level (us-CRP) in patients with Polycystic Ovary Syndrome (PCOS), and the correlation of clinical and laboratory parameters with the us-CRP level. Methods: in this cross-sectional study, 46 women with Polycystic Ovary Syndrome, according to the Rotterdam criteria, and 44 control women have been included. Serum was analyzed for C reactive protein (CRP) levels. Body mass index (BMI), age, circumference waist, HOMA-IR, total, low and high density lipoprotein cholesterol, triglycerides, glucose, testosterone and insulin levels were correlated to CRP level through a linear regression model. RESULTS: PCOS patients not only were older and had higher BMI, but their waist circumference, fasting insulin, HOMA-IR, total and LDL cholesterol were also higher, as compared to the women from the control group. A significant difference was observed in the us-CRP level between the PCOS (2.7 mg/dL±2.17) the control (1.6 mg/dL±1.49) groups. When us-CRP levels were categorized as of low (<1.0 mg/L), moderate (1-3.0 mg/L) and high (3.0 mg/L) risk for cardiovascular episodes, only 28.3% women with PCOS had us-CRP levels defined as low, 34.8% as moderate and 37% as high risk. The prevalence of Metabolic Syndrome was higher in the women with PCOS (30.4%) than in the women from the control group (6.8%). Through a stepwise linear regression model, only waist circumference, presence of metabolic syndrome and age had a confounding effect in the relation between us-CRP and PCOS. After adjustment for confounding factors, PCOS showed an independent effect on us-CRP level. CONCLUSIONS: the us-CRP levels were higher in the PCOS women than in the healthy controls. By a regression model, PCOS showed an independent effect on us-CRP level.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):248-252
DOI 10.1590/S0100-72032007000500005
PURPOSE: to analyze the isoflavone and estrogen effects on the postmenopausal quality of life. METHODS: this is a randomized and double-blind study with 79 postmenopausal patients, 12 months of amenorrhea, 40 years old or more and body mass index (BMI) above 30 kg/m². The participants were randomly divided into two treatment groups: GECP received orally two capsules, every 12 hours, one contained 0.625 mg conjugated equine estrogen and another placebo (n=33); GECS received two capsules of 150 mg extract of soy, with 60 mg isoflavone (n=32). Both treatments were administered for six months. The Quality Menopause Specific Questionnaire of Life was applied before and after one, three and six months of treatment. The parameters of gynecological cancer risk were evaluated. ANOVA and the Tukey test were used for data analysis. RESULTS: there was a reduction in the values of the vasomotor parameters after six months of treatment, 1.6±0.8 and 2.4±1.6, compared to before therapy, 4.0±2.2 and 4.2±2.3 in GECP and GECS, respectively. The psychological aspects showed reduction in values after six months of therapy, 2.5±1.2 and 2.9±1.4, compared to before treatment, 3.6±1.6 and 4.1±1.9 in GECP and GECS, respectively. Similar results were obtained on the physical aspects and in the sexual symptoms. CONCLUSIONS: isoflavones may positively act on life quality of postmenopausal women. This effect was similar to conjugated equine estrogen.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):248-252
DOI 10.1590/S0100-72032007000500005
PURPOSE: to analyze the isoflavone and estrogen effects on the postmenopausal quality of life. METHODS: this is a randomized and double-blind study with 79 postmenopausal patients, 12 months of amenorrhea, 40 years old or more and body mass index (BMI) above 30 kg/m². The participants were randomly divided into two treatment groups: GECP received orally two capsules, every 12 hours, one contained 0.625 mg conjugated equine estrogen and another placebo (n=33); GECS received two capsules of 150 mg extract of soy, with 60 mg isoflavone (n=32). Both treatments were administered for six months. The Quality Menopause Specific Questionnaire of Life was applied before and after one, three and six months of treatment. The parameters of gynecological cancer risk were evaluated. ANOVA and the Tukey test were used for data analysis. RESULTS: there was a reduction in the values of the vasomotor parameters after six months of treatment, 1.6±0.8 and 2.4±1.6, compared to before therapy, 4.0±2.2 and 4.2±2.3 in GECP and GECS, respectively. The psychological aspects showed reduction in values after six months of therapy, 2.5±1.2 and 2.9±1.4, compared to before treatment, 3.6±1.6 and 4.1±1.9 in GECP and GECS, respectively. Similar results were obtained on the physical aspects and in the sexual symptoms. CONCLUSIONS: isoflavones may positively act on life quality of postmenopausal women. This effect was similar to conjugated equine estrogen.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):260-266
DOI 10.1590/S0100-72032007000500007
PURPOSE: to evaluate puerperal morbidity in HIV-infected and HIV non-infected puerperal women. METHODS: longitudinal and controlled study performed from July 2001 to September 2003, in 205 pregnant women admitted for birth delivery at Odete Valadares Maternity, divided in two groups: HIV-infected women (82) and HIV non-infected women (123). Postpartum morbidity evaluation was performed from birth delivery up to 15 days postpartum. Morbidity was categorized as minor (postpartum hemorrhage, fever and endometritis) or major (blood transfusion, deep alterations of the surgical wound and indication for surgical intervention), and was evaluated both according to the presence or absence of HIV infection and the mode of delivery. Continuous variables were analyzed by the Student’s t-test, and categorical variables were analyzed by chi2 and Fisher’s exact test using Epi-Info 2000 (CDC, Atlanta). RESULTS: puerperal morbidity was observed in 18 patients from the HIV group (22%) and in 17 patients from the control group (14%) with predominance of minor morbidity, without statistical significance, except for an increased risk of endometritis in the HIV group (RR=1.05; CI 95%:1.01-1.10). No significant difference was observed concerning the mode of delivery between the two groups. There were only two major morbidities: blood transfusion and necrotizing fasciitis. CONCLUSIONS: HIV-infected and non-infected puerperal women have a similar morbidity, despite the lower morbidity in the HIV non-infected group and the increased risk of endometritis in the HIV group. Clinical puerperium follow-up is a strategic control tool for an early identification of maternal morbidity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):260-266
DOI 10.1590/S0100-72032007000500007
PURPOSE: to evaluate puerperal morbidity in HIV-infected and HIV non-infected puerperal women. METHODS: longitudinal and controlled study performed from July 2001 to September 2003, in 205 pregnant women admitted for birth delivery at Odete Valadares Maternity, divided in two groups: HIV-infected women (82) and HIV non-infected women (123). Postpartum morbidity evaluation was performed from birth delivery up to 15 days postpartum. Morbidity was categorized as minor (postpartum hemorrhage, fever and endometritis) or major (blood transfusion, deep alterations of the surgical wound and indication for surgical intervention), and was evaluated both according to the presence or absence of HIV infection and the mode of delivery. Continuous variables were analyzed by the Student’s t-test, and categorical variables were analyzed by chi2 and Fisher’s exact test using Epi-Info 2000 (CDC, Atlanta). RESULTS: puerperal morbidity was observed in 18 patients from the HIV group (22%) and in 17 patients from the control group (14%) with predominance of minor morbidity, without statistical significance, except for an increased risk of endometritis in the HIV group (RR=1.05; CI 95%:1.01-1.10). No significant difference was observed concerning the mode of delivery between the two groups. There were only two major morbidities: blood transfusion and necrotizing fasciitis. CONCLUSIONS: HIV-infected and non-infected puerperal women have a similar morbidity, despite the lower morbidity in the HIV non-infected group and the increased risk of endometritis in the HIV group. Clinical puerperium follow-up is a strategic control tool for an early identification of maternal morbidity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):267-275
DOI 10.1590/S0100-72032007000500008
Sweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):267-275
DOI 10.1590/S0100-72032007000500008
Sweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.
