Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2002;24(6):365-370
DOI 10.1590/S0100-72032002000600002
Purpose: to study the relationship between pelvic floor function and bladder neck mobility in women with and without stress urinary incontinence (SUI), in menacme and postmenopausal. Methods: sixty-one SUI patients were evaluated; 31 of them were in menacme and of these 17 had SUI and 14 did not have any complaint; 30 were postmenopausal and of these, 15 with SUI and 15 without SUI. Simple cystometry and empty supine stress test were performed in those who had urinary incontinence complaint. Bladder neck mobility was studied by ultrasound and by the Q-tip test. To study pelvic floor function, vaginal cones and digital palpation were used. Results: the bladder neck position in the incontinent women (Groups A and C), determined by ultrasound or the Q tip-test, was --11.8 cm in Group A and --12.5 cm in Group C, lower than the continent women, in whom the bladder neck was at +4.4 cm in Group B and +2.3 cm in Group D. There were no differences in bladder neck mobility among the continent menacme (9.1 cm) and postmenopausal (9.5 cm) groups. Also there were no differences among the incontinent groups (17.1 cm for Group A and 16.6 cm for Group C). The bladder neck mobility was greater in the incontinent women (A and C). Continent women had better results on evaluation of pelvic floor muscles than the incontinent ones, even using vaginal cones or digital palpation, and these results were not dependent on the hormonal status. Conclusion: a positive correlation was found between the Q-tip tests and ultrasound, and between test with vaginal cones and digital palpation. No significant correlation was found between pelvic floor function and bladder neck mobility.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):365-370
DOI 10.1590/S0100-72032002000600002
Purpose: to study the relationship between pelvic floor function and bladder neck mobility in women with and without stress urinary incontinence (SUI), in menacme and postmenopausal. Methods: sixty-one SUI patients were evaluated; 31 of them were in menacme and of these 17 had SUI and 14 did not have any complaint; 30 were postmenopausal and of these, 15 with SUI and 15 without SUI. Simple cystometry and empty supine stress test were performed in those who had urinary incontinence complaint. Bladder neck mobility was studied by ultrasound and by the Q-tip test. To study pelvic floor function, vaginal cones and digital palpation were used. Results: the bladder neck position in the incontinent women (Groups A and C), determined by ultrasound or the Q tip-test, was --11.8 cm in Group A and --12.5 cm in Group C, lower than the continent women, in whom the bladder neck was at +4.4 cm in Group B and +2.3 cm in Group D. There were no differences in bladder neck mobility among the continent menacme (9.1 cm) and postmenopausal (9.5 cm) groups. Also there were no differences among the incontinent groups (17.1 cm for Group A and 16.6 cm for Group C). The bladder neck mobility was greater in the incontinent women (A and C). Continent women had better results on evaluation of pelvic floor muscles than the incontinent ones, even using vaginal cones or digital palpation, and these results were not dependent on the hormonal status. Conclusion: a positive correlation was found between the Q-tip tests and ultrasound, and between test with vaginal cones and digital palpation. No significant correlation was found between pelvic floor function and bladder neck mobility.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):383-387
DOI 10.1590/S0100-72032002000600005
Purpose: to evaluate the effectiveness of diagnostic amnioinfusion in severe oligohydramnios. Methods: twelve patients with severe oligohydramnios in the second and third trimester of pregnancy were submitted to amnioinfusion. The procedure was done using a warm physiological saline at a rate of 20 mL/min followed by the instillation of 5 mL of dye. The amniotic fluid index (AFI) was measured before the procedure and 30 min afterwards and in case of fetal anomalies, it was documented. The gestational age ranged from 18 to 34 weeks (average 25 ± 4 weeks). The average of the initial ILA was 10.3cm and after the procedure was 16.4 cm. The volume of saline solution infused ranged from 300 to 1000 mL (605.4 ± 224.1 mL). Results: in nine patients (75%) the procedure led to an etiologic diagnosis: four cases of premature rupture of membranes and major malformations in five fetuses. In two patients the oligohydramnios was considered idiopathic and in one patient the pathological examination revealed a placental infarct. Nine pregnancies (75%) were interrupted after the diagnosis and in three cases it was maintained for 8.8 weeks after the amnioinfusion. All fetuses died, seven of them had neonatal death and the remaining had intrauterine death. Conclusion: amnioinfusion is an effective method with high precision, enabling the etiologic diagnosis of severe oligohydramnios in 75% of the cases.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):383-387
DOI 10.1590/S0100-72032002000600005
Purpose: to evaluate the effectiveness of diagnostic amnioinfusion in severe oligohydramnios. Methods: twelve patients with severe oligohydramnios in the second and third trimester of pregnancy were submitted to amnioinfusion. The procedure was done using a warm physiological saline at a rate of 20 mL/min followed by the instillation of 5 mL of dye. The amniotic fluid index (AFI) was measured before the procedure and 30 min afterwards and in case of fetal anomalies, it was documented. The gestational age ranged from 18 to 34 weeks (average 25 ± 4 weeks). The average of the initial ILA was 10.3cm and after the procedure was 16.4 cm. The volume of saline solution infused ranged from 300 to 1000 mL (605.4 ± 224.1 mL). Results: in nine patients (75%) the procedure led to an etiologic diagnosis: four cases of premature rupture of membranes and major malformations in five fetuses. In two patients the oligohydramnios was considered idiopathic and in one patient the pathological examination revealed a placental infarct. Nine pregnancies (75%) were interrupted after the diagnosis and in three cases it was maintained for 8.8 weeks after the amnioinfusion. All fetuses died, seven of them had neonatal death and the remaining had intrauterine death. Conclusion: amnioinfusion is an effective method with high precision, enabling the etiologic diagnosis of severe oligohydramnios in 75% of the cases.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):389-394
DOI 10.1590/S0100-72032002000600006
Purpose: to study the influence of weight differences between twins on the perinatal results. Methods: the twin deliveries at the Maternity of the Hospital Regional de Clínicas de Sorocaba, SP, were retrospectively analyzed from July 1997 to June 1998. The samples were 89 mothers and their twins, divided into three classes of newborn weight differences, as follows: concordant (<15%), mild discordance (15 to 25%) and severe discordance (>25%). The independent variables analyzed were these three classes and the dependent variables were low weight at birth, Apgar index less than 7 at the first and fifth minute, premature delivery, time of permanence of the newborn in the nursery, and perinatal mortality coefficient I. Statistical analysis was performed using Kruskal-Wallis test, completed by Hollander test, and the Blackwell test. Results: the number of pregnancies (62, 17 and 10) and premature deliveries (32, 9 and 7) were observed respectively in the three classes. For the first and second twins we observed: low weight at birth (39/41, 13/12 and 8/9), Apgar index less than 7 at the first minute (16/13, 3/7 and 2/3), Apgar index at the fifth minute (4/4, 0/2 and 1/2), time (in days) of permanence of the newborn in the nursery (3.7/3.7, 4.6/6.0 and 7.3/8.7) and perinatal mortality coefficient I (22.4/16.8, 0/16.8 and 5.6/5.6). Conclusions: the incidence of weight discordance between twins was 30.3%, 19.1% being mild discordance and 11.2% severe discordance. There was a tendency to a progressive aggravation of perinatal results considering the degree of discordance of the classes (concordant < mild discordance < severe discordance).
Summary
Rev Bras Ginecol Obstet. 2002;24(6):389-394
DOI 10.1590/S0100-72032002000600006
Purpose: to study the influence of weight differences between twins on the perinatal results. Methods: the twin deliveries at the Maternity of the Hospital Regional de Clínicas de Sorocaba, SP, were retrospectively analyzed from July 1997 to June 1998. The samples were 89 mothers and their twins, divided into three classes of newborn weight differences, as follows: concordant (<15%), mild discordance (15 to 25%) and severe discordance (>25%). The independent variables analyzed were these three classes and the dependent variables were low weight at birth, Apgar index less than 7 at the first and fifth minute, premature delivery, time of permanence of the newborn in the nursery, and perinatal mortality coefficient I. Statistical analysis was performed using Kruskal-Wallis test, completed by Hollander test, and the Blackwell test. Results: the number of pregnancies (62, 17 and 10) and premature deliveries (32, 9 and 7) were observed respectively in the three classes. For the first and second twins we observed: low weight at birth (39/41, 13/12 and 8/9), Apgar index less than 7 at the first minute (16/13, 3/7 and 2/3), Apgar index at the fifth minute (4/4, 0/2 and 1/2), time (in days) of permanence of the newborn in the nursery (3.7/3.7, 4.6/6.0 and 7.3/8.7) and perinatal mortality coefficient I (22.4/16.8, 0/16.8 and 5.6/5.6). Conclusions: the incidence of weight discordance between twins was 30.3%, 19.1% being mild discordance and 11.2% severe discordance. There was a tendency to a progressive aggravation of perinatal results considering the degree of discordance of the classes (concordant < mild discordance < severe discordance).
Summary
Rev Bras Ginecol Obstet. 2002;24(6):401-406
DOI 10.1590/S0100-72032002000600007
Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm). The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS) and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%), abnormal biophysical profile score (10.5%), abnormal results of middle cerebral artery dopplervelocimetry (54.5%), small for gestational age infants (32.7%) and meconial amniotic fluid (27.9%) when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%), abnormal biophysical profile score (4.3%), abnormal results of middle cerebral artery dopplervelocimetry (33.9%), small for gestational age infants (21.0%) and meconial amniotic fluid (16.8%). Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):401-406
DOI 10.1590/S0100-72032002000600007
Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm). The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS) and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%), abnormal biophysical profile score (10.5%), abnormal results of middle cerebral artery dopplervelocimetry (54.5%), small for gestational age infants (32.7%) and meconial amniotic fluid (27.9%) when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%), abnormal biophysical profile score (4.3%), abnormal results of middle cerebral artery dopplervelocimetry (33.9%), small for gestational age infants (21.0%) and meconial amniotic fluid (16.8%). Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):407-412
DOI 10.1590/S0100-72032002000600008
Purpose: to evaluate the agreement between the theory about informed consent, represented by Resolution 01/88, and the practice according to the report of researchers and of women who were subjects of their research. Methods: eleven researchers from three centers of excellence in research related to fertility regulation in Brazil and 18 women, subjects of their research. Information was obtained through in-depth interviews and content analysis was carried out. Results: the report of the researchers agreed with the requirements of the Resolution; however, the women's report showed that most of the required items were not referred to when they were invited to participate in the research. Conclusion: a disagreement was observed between theory and practice in obtaining informed consent. This may be explained by difficulties in complying with the requirements of the Resolution in force at the time. On the other hand, it is also possible to imagine difficulties experienced by researchers when approaching the women and/or that the women also forgot the received information. Finally, a bias may have resulted from the researchers and women who had to give consent to participate in this study.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):407-412
DOI 10.1590/S0100-72032002000600008
Purpose: to evaluate the agreement between the theory about informed consent, represented by Resolution 01/88, and the practice according to the report of researchers and of women who were subjects of their research. Methods: eleven researchers from three centers of excellence in research related to fertility regulation in Brazil and 18 women, subjects of their research. Information was obtained through in-depth interviews and content analysis was carried out. Results: the report of the researchers agreed with the requirements of the Resolution; however, the women's report showed that most of the required items were not referred to when they were invited to participate in the research. Conclusion: a disagreement was observed between theory and practice in obtaining informed consent. This may be explained by difficulties in complying with the requirements of the Resolution in force at the time. On the other hand, it is also possible to imagine difficulties experienced by researchers when approaching the women and/or that the women also forgot the received information. Finally, a bias may have resulted from the researchers and women who had to give consent to participate in this study.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):413-417
DOI 10.1590/S0100-72032002000600009
Massive hypertrophy of the breast in pregnancy is a rare condition, with few cases reported. In spite of the unknown etiology, it seems to be an exaggerated response of the breast receptors to the pregnancy hormones. Although it can happen in any pregnancy, it presents great capacity to recur in all subsequent pregnancies. The rapid and colossal breast enlargement determines pain and the involvement of the shoulder skeleton and muscles. The excessive enlargement may promote necrosis and ulceration of the skin, leading to breast infection. The authors report one case at the second pregnancy, explaining management during the pregnancy, lactation inhibition with bromocriptine immediately after the delivery and the banding of the elevated breast. They also emphasize the importance of reduction mammoplasty a few months after delivery.
Summary
Rev Bras Ginecol Obstet. 2002;24(6):413-417
DOI 10.1590/S0100-72032002000600009
Massive hypertrophy of the breast in pregnancy is a rare condition, with few cases reported. In spite of the unknown etiology, it seems to be an exaggerated response of the breast receptors to the pregnancy hormones. Although it can happen in any pregnancy, it presents great capacity to recur in all subsequent pregnancies. The rapid and colossal breast enlargement determines pain and the involvement of the shoulder skeleton and muscles. The excessive enlargement may promote necrosis and ulceration of the skin, leading to breast infection. The authors report one case at the second pregnancy, explaining management during the pregnancy, lactation inhibition with bromocriptine immediately after the delivery and the banding of the elevated breast. They also emphasize the importance of reduction mammoplasty a few months after delivery.
