Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):443-448
DOI 10.1590/S0100-72031998000800003
Purpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):443-448
DOI 10.1590/S0100-72031998000800003
Purpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):449-453
DOI 10.1590/S0100-72031998000800004
Purpose: to determine folate, vitamin B12 and ferritin levels in patients whose fetuses presented neural-tube defects (NTD). Blood folate and vitamin B12 act as cofactors of enzymes involved in DNA biosynthesis. Interruption of this process may block neural-tube closing. Vitamin supplementation with folate may reduce occurrence rates and recurrence of NTD, although there is concern about the fact that this prevention may mask vitamin B12 deficiency. Methods: vitamin B12 and ferritin determinations by enzyme immunoassay with microparticles and folic acid determination using the ion capture method (IMx ABBOTT). Results: the percentage of pregnant women with vitamin B12 deficirncy (serum levels < 150 pg/ml) was 11.8%. There was no case of folate deficiency (serum levels < 3.0 ng/ml) and prevalence of pregnant women with iron store deficiency was 47.1% (serum levels < ng/mg). Conclusions: occording to the results obtained in this study (prevalence of 11.8% of vitamin B12 and 0% of folate deficient pregnant women) we suggest that supplementation should be administered after serum vitamin B12 determination.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):449-453
DOI 10.1590/S0100-72031998000800004
Purpose: to determine folate, vitamin B12 and ferritin levels in patients whose fetuses presented neural-tube defects (NTD). Blood folate and vitamin B12 act as cofactors of enzymes involved in DNA biosynthesis. Interruption of this process may block neural-tube closing. Vitamin supplementation with folate may reduce occurrence rates and recurrence of NTD, although there is concern about the fact that this prevention may mask vitamin B12 deficiency. Methods: vitamin B12 and ferritin determinations by enzyme immunoassay with microparticles and folic acid determination using the ion capture method (IMx ABBOTT). Results: the percentage of pregnant women with vitamin B12 deficirncy (serum levels < 150 pg/ml) was 11.8%. There was no case of folate deficiency (serum levels < 3.0 ng/ml) and prevalence of pregnant women with iron store deficiency was 47.1% (serum levels < ng/mg). Conclusions: occording to the results obtained in this study (prevalence of 11.8% of vitamin B12 and 0% of folate deficient pregnant women) we suggest that supplementation should be administered after serum vitamin B12 determination.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):457-462
DOI 10.1590/S0100-72031998000800005
Objective: to determine the efficacy and safety of misoprostol for cervical ripening and induction of labor in pregnant women at term when compared with placebo. Patients and Methods: fifty-one high-risk pregnant women at term, with unripe cervix, were allocated in a double-blind trial for treatment with intravaginal misoprostol (40 mg, 4/4 h) or intravaginal placebo. Results: thirty-two patients received misoprostol and 19 received placebo. The groups were homogeneous concerning maternal age, gestacional age, parity, and indication for induction (p > 0.05). In the misoprostol group the efficacy was 87.5% and in the placebo group 21.1% (p = 0.0000087). Regarding delivery, in the misoprostol group 75% had vaginal delivery and 25% abdominal delivery, and in the placebo group only 32% had vaginal delivery and 68% abdominal delivery (p = 0.0059).The Apgar score was similar. Conclusion: in this study misoprostol was effective and safe for cervical ripening and induction of labor.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):457-462
DOI 10.1590/S0100-72031998000800005
Objective: to determine the efficacy and safety of misoprostol for cervical ripening and induction of labor in pregnant women at term when compared with placebo. Patients and Methods: fifty-one high-risk pregnant women at term, with unripe cervix, were allocated in a double-blind trial for treatment with intravaginal misoprostol (40 mg, 4/4 h) or intravaginal placebo. Results: thirty-two patients received misoprostol and 19 received placebo. The groups were homogeneous concerning maternal age, gestacional age, parity, and indication for induction (p > 0.05). In the misoprostol group the efficacy was 87.5% and in the placebo group 21.1% (p = 0.0000087). Regarding delivery, in the misoprostol group 75% had vaginal delivery and 25% abdominal delivery, and in the placebo group only 32% had vaginal delivery and 68% abdominal delivery (p = 0.0059).The Apgar score was similar. Conclusion: in this study misoprostol was effective and safe for cervical ripening and induction of labor.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):463-467
DOI 10.1590/S0100-72031998000800006
Purpose: to evaluate, in a prospective way, the performance of the fine needle aspiration biopsy in the differential diagnosis of palpable breast masses. Method: the sensitivity, specificity, positive and negative predictive values for this test were evaluated in 102 women with age above 30 years and a palpable breast mass, who were attended at the University of Campinas. All punctures were performed by the same examiner. Results: the procedure had a sensitivity of 97%, specificity of 87%, positive predictive value of 94% and negative predictive value of 93%. The insufficient or unsatisfactory sample rate was 16% for the first aspiration, decreasing to 2% with a new procedure. Conclusions: this test showed to be highly sensitive and specific for the differential diagnosis of palpable breast masses, reassuring its great importance for the clinical approach of palpable masses.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):463-467
DOI 10.1590/S0100-72031998000800006
Purpose: to evaluate, in a prospective way, the performance of the fine needle aspiration biopsy in the differential diagnosis of palpable breast masses. Method: the sensitivity, specificity, positive and negative predictive values for this test were evaluated in 102 women with age above 30 years and a palpable breast mass, who were attended at the University of Campinas. All punctures were performed by the same examiner. Results: the procedure had a sensitivity of 97%, specificity of 87%, positive predictive value of 94% and negative predictive value of 93%. The insufficient or unsatisfactory sample rate was 16% for the first aspiration, decreasing to 2% with a new procedure. Conclusions: this test showed to be highly sensitive and specific for the differential diagnosis of palpable breast masses, reassuring its great importance for the clinical approach of palpable masses.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):469-473
DOI 10.1590/S0100-72031998000800007
Purpose: to evaluate the association between second-degree family history of breast cancer and the risk to develop the disease. Methods: case-control study of incident cases. Sixty-six incident breast cancer cases and 198 controls were selected among women who were submitted to mammography in a private clinic between January 1994 and July 1997. Cases and controls were paired regarding age, age at menarche, at first live birth, at menopause, parity, oral contraceptives and use of hormonal replacement therapy. Results: there was no significant difference between cases and controls regarding all risk factors evaluated, besides second-degree family history. Patients with breast cancer were more likely to have second-degree relatives with breast cancer when compared to controls (OR=2.77; 95% CI, 1.03-7.38; p=0.039). Conclusions: malignant neoplasm of the breast is significantly associated with a second-degree family history of this disease.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):469-473
DOI 10.1590/S0100-72031998000800007
Purpose: to evaluate the association between second-degree family history of breast cancer and the risk to develop the disease. Methods: case-control study of incident cases. Sixty-six incident breast cancer cases and 198 controls were selected among women who were submitted to mammography in a private clinic between January 1994 and July 1997. Cases and controls were paired regarding age, age at menarche, at first live birth, at menopause, parity, oral contraceptives and use of hormonal replacement therapy. Results: there was no significant difference between cases and controls regarding all risk factors evaluated, besides second-degree family history. Patients with breast cancer were more likely to have second-degree relatives with breast cancer when compared to controls (OR=2.77; 95% CI, 1.03-7.38; p=0.039). Conclusions: malignant neoplasm of the breast is significantly associated with a second-degree family history of this disease.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):475-479
DOI 10.1590/S0100-72031998000800008
Purpose: to analyze the frequency of preoperative bilateral synchronic cancer and occult metastases in 454 operable breast cancer patients, at Instituto Nacional de Câncer (Brazil). Methods: the preoperative evaluation consisted of mammography, bone scan with X-ray if necessary, and chest X-ray. 260 (57.3 %) of 454 patients underwent liver echography. We calculated the cost X effectiveness ratio considering only the direct costs (monetary value) and the effectiveness was analyzed based on the number of metastases identifid by the screening tests. Results: we did not find any case of bilateral synchronic cancer, and the frequency of patients with metastasis was 2% (9/454). The diagnosis of bone metastasis was 1.5 % (7/454). The percentage of lung (2/454) and liver (1/260) metastasis was the same, 0.4 %. Most of the patients with metastases were in stage IIIb (44.5 %). The results of the screening tests showed the alteration of the initial clinical stage in 9 patients only (2%). The total cost of the screening tests for the diagnosis of systemic disease in 9 patients, was US$ 131,020.00. The cost of each diagnosed metastasise, for a total of 10 (two were found in one of the patients), was US$ 29,221.85 and the cost/effectiveness ratio was 22.3%. Conclusious: the results showed that screening for metastases in the preoperative clinical staging of breast cancer should be limited to patients symptomatic for systemic disease or in clinical stage III and that the cost/effectiveness ratio of the tests demonstrated a reduced benefit in the preoperative evaluation.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):475-479
DOI 10.1590/S0100-72031998000800008
Purpose: to analyze the frequency of preoperative bilateral synchronic cancer and occult metastases in 454 operable breast cancer patients, at Instituto Nacional de Câncer (Brazil). Methods: the preoperative evaluation consisted of mammography, bone scan with X-ray if necessary, and chest X-ray. 260 (57.3 %) of 454 patients underwent liver echography. We calculated the cost X effectiveness ratio considering only the direct costs (monetary value) and the effectiveness was analyzed based on the number of metastases identifid by the screening tests. Results: we did not find any case of bilateral synchronic cancer, and the frequency of patients with metastasis was 2% (9/454). The diagnosis of bone metastasis was 1.5 % (7/454). The percentage of lung (2/454) and liver (1/260) metastasis was the same, 0.4 %. Most of the patients with metastases were in stage IIIb (44.5 %). The results of the screening tests showed the alteration of the initial clinical stage in 9 patients only (2%). The total cost of the screening tests for the diagnosis of systemic disease in 9 patients, was US$ 131,020.00. The cost of each diagnosed metastasise, for a total of 10 (two were found in one of the patients), was US$ 29,221.85 and the cost/effectiveness ratio was 22.3%. Conclusious: the results showed that screening for metastases in the preoperative clinical staging of breast cancer should be limited to patients symptomatic for systemic disease or in clinical stage III and that the cost/effectiveness ratio of the tests demonstrated a reduced benefit in the preoperative evaluation.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):481-484
DOI 10.1590/S0100-72031998000800009
Arthrogryposis multiplex congenita is characterized by multiple joint contractures present at birth. Prenatal diagnosis is difficult. There are few reports in the literature. Fetal akinesia, abnormal limb position, intrauterine growth retardation, and polyhydramnios are the main findings of the ultrasonographic diagnosis. The authors describe a case of arthrogryposis multiplex congenita ultrasonographically diagnosed in the third gestational trimester. The main findings were absence of fetal movements, polyhydramnios, symmetrical and non-symmetrical fetal growth retardation with marked decrease of abdominal and thoracic circumference, low-set ears, micrognathia, continuous flexure contracture of limbs, internal rotation of the femur, and clubfoot on the right.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):481-484
DOI 10.1590/S0100-72031998000800009
Arthrogryposis multiplex congenita is characterized by multiple joint contractures present at birth. Prenatal diagnosis is difficult. There are few reports in the literature. Fetal akinesia, abnormal limb position, intrauterine growth retardation, and polyhydramnios are the main findings of the ultrasonographic diagnosis. The authors describe a case of arthrogryposis multiplex congenita ultrasonographically diagnosed in the third gestational trimester. The main findings were absence of fetal movements, polyhydramnios, symmetrical and non-symmetrical fetal growth retardation with marked decrease of abdominal and thoracic circumference, low-set ears, micrognathia, continuous flexure contracture of limbs, internal rotation of the femur, and clubfoot on the right.
