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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):317-321
DOI 10.1590/S0100-72031999000600003
Purpose: to evaluate the effects of oophorectomy and pinealectomy on the ingestion of water and NaCl solution by adults female rats. Methods: forty-eight adult virgin female rats (Wistar EPM 1) weighing 200 g were kept on routine laboratory care and fed water and Purina rat chow ad libitum. The animals were random by divided into four groups: GI - maintained without manipulation as a control group (n = 20); GII - submitted to bilateral oophorectomy (n = 8); GIII - submitted to pinealectomy (n = 12); GIV - submitted to bilateral oophorectomy and pinealectomy (n = 8). All animals were maintained in individual cages. After three weeks the cycle phase was daily determined by vaginal smears and the volume of water and NaCl (0.25 M) solution was daily recorded for approximately three weeks. Results: the main results were: 1) rats submitted to pinealectomy alone presented a greater frequency of the estrous phase, some of these undergoing persistent estrus; 2) the liquid ingestion (water and saline solution) did not alter during the phases of the estrous cycle; 3) rats submitted to oophorectomy presented greater water ingestion and after pinealectomy water consumption returned to normal levels; 4) the oophorectomized and pinealectomized animals and those only oophorectomized showed reduction in the average consumption of saline solution. Conclusions: the data suggest that the ovaries and the pineal gland could have effects on the ingestion of salt and water in adult rats.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):317-321
DOI 10.1590/S0100-72031999000600003
Purpose: to evaluate the effects of oophorectomy and pinealectomy on the ingestion of water and NaCl solution by adults female rats. Methods: forty-eight adult virgin female rats (Wistar EPM 1) weighing 200 g were kept on routine laboratory care and fed water and Purina rat chow ad libitum. The animals were random by divided into four groups: GI - maintained without manipulation as a control group (n = 20); GII - submitted to bilateral oophorectomy (n = 8); GIII - submitted to pinealectomy (n = 12); GIV - submitted to bilateral oophorectomy and pinealectomy (n = 8). All animals were maintained in individual cages. After three weeks the cycle phase was daily determined by vaginal smears and the volume of water and NaCl (0.25 M) solution was daily recorded for approximately three weeks. Results: the main results were: 1) rats submitted to pinealectomy alone presented a greater frequency of the estrous phase, some of these undergoing persistent estrus; 2) the liquid ingestion (water and saline solution) did not alter during the phases of the estrous cycle; 3) rats submitted to oophorectomy presented greater water ingestion and after pinealectomy water consumption returned to normal levels; 4) the oophorectomized and pinealectomized animals and those only oophorectomized showed reduction in the average consumption of saline solution. Conclusions: the data suggest that the ovaries and the pineal gland could have effects on the ingestion of salt and water in adult rats.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):323-326
DOI 10.1590/S0100-72031999000600004
Purpose: to offer new data for the conflicting reports which present different prognosis for patients with breast carcinoma, according to the timing of surgery in relation to the menstrual cycle. Patients and Methods: in a retrospective study on 451 premenopausal women with breast cancer, aged between 26 and 52 years, 130 cases were selected and followed for 60 months, at least. Sixty-eight were operated during the follicular phase and 62 in the luteal period, whose findings regarding clinical stages, axillary involvement and estrogen and progesterone hormonal receptor concentrations of the neoplasms were also analyzed. Results: the follow-up of 130 patients showed that 64.4% had a disease-free survival after five years and 43% exceeded 10 years. Subdividing the cases into 2 subgroups, according to the timing of surgery, the survival rates were different, 58.8% at 5 and 36.7% at 10 years, when the operation occurred in the follicular phase, and 70.9% and 50%, at 5 and 10 years, respectively, during the luteal period. Conclusions: in this study, the patients operated in the luteal phase reached higher survival rates than the women operated during the follicular period. However, these values were lower than those displayed by the classic prognostic factors of axillary involvement and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):323-326
DOI 10.1590/S0100-72031999000600004
Purpose: to offer new data for the conflicting reports which present different prognosis for patients with breast carcinoma, according to the timing of surgery in relation to the menstrual cycle. Patients and Methods: in a retrospective study on 451 premenopausal women with breast cancer, aged between 26 and 52 years, 130 cases were selected and followed for 60 months, at least. Sixty-eight were operated during the follicular phase and 62 in the luteal period, whose findings regarding clinical stages, axillary involvement and estrogen and progesterone hormonal receptor concentrations of the neoplasms were also analyzed. Results: the follow-up of 130 patients showed that 64.4% had a disease-free survival after five years and 43% exceeded 10 years. Subdividing the cases into 2 subgroups, according to the timing of surgery, the survival rates were different, 58.8% at 5 and 36.7% at 10 years, when the operation occurred in the follicular phase, and 70.9% and 50%, at 5 and 10 years, respectively, during the luteal period. Conclusions: in this study, the patients operated in the luteal phase reached higher survival rates than the women operated during the follicular period. However, these values were lower than those displayed by the classic prognostic factors of axillary involvement and tumor size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):335-339
DOI 10.1590/S0100-72031999000600006
Purpose: to study the sensitivity and specificity based on fetal oxygen saturation (SpO2) values and fetal heart rate (FHR) patterns during labor, for the prognosis of acidotic fetuses at birth. Patients and Methods: SpO2 values were obtained by fetal pulse oximetry technique. A fetal SpO2 value > or = 30% was considered normal, and an SpO2 which remained <30.0% for more than 10 min between contractions was considered abnormal. Fetal SpO2 and FHR tracings were obtained during the first and second stage of labor. FHR classification used in the study has been derived from the National Institute of Child Health and Human Development19. Results: a total of 72 subjects were studied. The sensitivity and specificity, based on SpO2, were 61.5% and 96.6%, respectively, whereas the sensitivity and specificity based on FHR patterns were 69.2% and 66.1%. Positive and negative predictive values based on SpO2 were 80% and 91.9%, respectively, and based on FHR patterns were 31% and 90.7%, respectively. Conclusions: a good fetal SpO2 specificity for prognosis of acidotic fetuses at birth was found, if compared with FHR pattern specificity, whereas sensitivity was poor for both methods. However, the number of acidotic fetuses was too small to allow more conclusions
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):335-339
DOI 10.1590/S0100-72031999000600006
Purpose: to study the sensitivity and specificity based on fetal oxygen saturation (SpO2) values and fetal heart rate (FHR) patterns during labor, for the prognosis of acidotic fetuses at birth. Patients and Methods: SpO2 values were obtained by fetal pulse oximetry technique. A fetal SpO2 value > or = 30% was considered normal, and an SpO2 which remained <30.0% for more than 10 min between contractions was considered abnormal. Fetal SpO2 and FHR tracings were obtained during the first and second stage of labor. FHR classification used in the study has been derived from the National Institute of Child Health and Human Development19. Results: a total of 72 subjects were studied. The sensitivity and specificity, based on SpO2, were 61.5% and 96.6%, respectively, whereas the sensitivity and specificity based on FHR patterns were 69.2% and 66.1%. Positive and negative predictive values based on SpO2 were 80% and 91.9%, respectively, and based on FHR patterns were 31% and 90.7%, respectively. Conclusions: a good fetal SpO2 specificity for prognosis of acidotic fetuses at birth was found, if compared with FHR pattern specificity, whereas sensitivity was poor for both methods. However, the number of acidotic fetuses was too small to allow more conclusions
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):341-345
DOI 10.1590/S0100-72031999000600007
Objectives: to analyze the medical and legal aspects in order to contribute to the study and standardization of this obstetrical surgery in Brazil. Methods: our study was based on 11 cases of cesarean section performed in the imminence of maternal death or just after death. These cases were attended at UNIFESP - EPM from 1988 to 1998. Results: there were 7 live births, five of them with a gestational age over 26 weeks. Most deaths occurred within the first 48 hours after admission. The predominant age range was the third decade. Conclusions: although postmortem cesarean section is indicated to save the fetus, it is rarely performed. The conditions for its indication involve knowledge of the technique as well as of the ethical and legal principles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):341-345
DOI 10.1590/S0100-72031999000600007
Objectives: to analyze the medical and legal aspects in order to contribute to the study and standardization of this obstetrical surgery in Brazil. Methods: our study was based on 11 cases of cesarean section performed in the imminence of maternal death or just after death. These cases were attended at UNIFESP - EPM from 1988 to 1998. Results: there were 7 live births, five of them with a gestational age over 26 weeks. Most deaths occurred within the first 48 hours after admission. The predominant age range was the third decade. Conclusions: although postmortem cesarean section is indicated to save the fetus, it is rarely performed. The conditions for its indication involve knowledge of the technique as well as of the ethical and legal principles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):347-350
DOI 10.1590/S0100-72031999000600008
Purpose: to evaluate safety and efficacy of intra-amniotic injection of methotrexate (MTX) for treatment of viable cervical pregnancy. Methods: four women with viable cervical pregnancy confirmed by ultrasound (US) were treated with transvaginal injection of MTX (1 mg/kg) under sonographic control. The follow-up was made with serial dosages of beta-hCG on days 1, 4 and 7 after injection and weekly until the titers were negative. Results: the patients were treated with success. The time for the titers of beta-hCG to become negative after the treatment was: 62 days (case 1), 84 days (case 2), 28 days (case 3) and 10 days (case 4). Conclusion: intra-amniotic injection of MTX can be used to avoid surgery in cases of viable cervical pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):347-350
DOI 10.1590/S0100-72031999000600008
Purpose: to evaluate safety and efficacy of intra-amniotic injection of methotrexate (MTX) for treatment of viable cervical pregnancy. Methods: four women with viable cervical pregnancy confirmed by ultrasound (US) were treated with transvaginal injection of MTX (1 mg/kg) under sonographic control. The follow-up was made with serial dosages of beta-hCG on days 1, 4 and 7 after injection and weekly until the titers were negative. Results: the patients were treated with success. The time for the titers of beta-hCG to become negative after the treatment was: 62 days (case 1), 84 days (case 2), 28 days (case 3) and 10 days (case 4). Conclusion: intra-amniotic injection of MTX can be used to avoid surgery in cases of viable cervical pregnancy.