Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2001;23(8):481-488
DOI 10.1590/S0100-72032001000800002
Purpose: to investigate leptin levels in patients with polycystic ovary syndrome (PCOS), and relationships with testosterone, estradiol, follicle-stimulating hormone (FSH) and insulin levels. Methods: transversal study on 40 patients with PCOS divided into two groups: Group I (n = 20)- obese women (body mass index - BMI > or = 28 kg/m²), and Group II (n = 20) - non obese women (BMI <28 kg/m²). Results: BMI was different between the two groups (p=0.04). We observed that leptin concentrations were significantly correlated with BMI (p<0.001). After adjusting for BMI, no correlation between leptin, insulin (p=0.194), FSH (p=0.793), and total (p=0.441) and free (p=0.422) testosterone was found. However, we only observed positive correlations between leptin and estradiol (p=0.043). Conclusions: there is a strong correlation between leptin levels, BMI and estradiol levels in women with PCOS.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):481-488
DOI 10.1590/S0100-72032001000800002
Purpose: to investigate leptin levels in patients with polycystic ovary syndrome (PCOS), and relationships with testosterone, estradiol, follicle-stimulating hormone (FSH) and insulin levels. Methods: transversal study on 40 patients with PCOS divided into two groups: Group I (n = 20)- obese women (body mass index - BMI > or = 28 kg/m²), and Group II (n = 20) - non obese women (BMI <28 kg/m²). Results: BMI was different between the two groups (p=0.04). We observed that leptin concentrations were significantly correlated with BMI (p<0.001). After adjusting for BMI, no correlation between leptin, insulin (p=0.194), FSH (p=0.793), and total (p=0.441) and free (p=0.422) testosterone was found. However, we only observed positive correlations between leptin and estradiol (p=0.043). Conclusions: there is a strong correlation between leptin levels, BMI and estradiol levels in women with PCOS.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Purpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Purpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):499-504
DOI 10.1590/S0100-72032001000800004
Purpose: to evaluate factors that might influence the results of nonphamacological treatment (verbal guidance) in women with clinical mastalgia. Methods: an uncontrolled study of the experimental type was conducted on a sample of 128 women with a clear history of clinical mastalgia treated with verbal guidance. A visual analogue scale for pain was used before and after treatment to evaluate pain intensity and mastalgia was classified into grade I (mild), grade II (moderate) and grade III (severe) according to pain intensity. The Cardiff Breast Score (CBS), modified, was also used to evaluate the clinical response to treatment. Data were analyzed statistically using the chi² test (Epi-Info 6.04). Results: we noted that factors such as parity, menarche, age at first term delivery and breast-feeding had no significant effect (p=0.19, p=0.31, p=0.80 and p=0.54, respectively) on the results of nonpharmacological treatment (verbal guidance). On the other hand, when age was taken into consideration, 26 patients (78.8%) aged 40 years or older were found to benefi more from verbal guidance, with a significant difference (p=0.01) when compared to younger women. Conclusion: reproductive factors such as parity, menarche, age at first term delivery and breast-feeding did not affect the results of nonpharmacological treatment (verbal guidance), whereas the age factor had a specific and significant effect on the results.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):499-504
DOI 10.1590/S0100-72032001000800004
Purpose: to evaluate factors that might influence the results of nonphamacological treatment (verbal guidance) in women with clinical mastalgia. Methods: an uncontrolled study of the experimental type was conducted on a sample of 128 women with a clear history of clinical mastalgia treated with verbal guidance. A visual analogue scale for pain was used before and after treatment to evaluate pain intensity and mastalgia was classified into grade I (mild), grade II (moderate) and grade III (severe) according to pain intensity. The Cardiff Breast Score (CBS), modified, was also used to evaluate the clinical response to treatment. Data were analyzed statistically using the chi² test (Epi-Info 6.04). Results: we noted that factors such as parity, menarche, age at first term delivery and breast-feeding had no significant effect (p=0.19, p=0.31, p=0.80 and p=0.54, respectively) on the results of nonpharmacological treatment (verbal guidance). On the other hand, when age was taken into consideration, 26 patients (78.8%) aged 40 years or older were found to benefi more from verbal guidance, with a significant difference (p=0.01) when compared to younger women. Conclusion: reproductive factors such as parity, menarche, age at first term delivery and breast-feeding did not affect the results of nonpharmacological treatment (verbal guidance), whereas the age factor had a specific and significant effect on the results.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):507-513
DOI 10.1590/S0100-72032001000800005
Purpose: to evaluate the effect of hormone replacement therapy on breast cell proliferation and on collagen and elastic fiber formation and to analyze the changes occurring in the breast parenchyma as a whole. Method: a total of 61 adult Wistar rats were divided into 5 groups. The standard group (12 rats) represented the normal hormonal ovarian status. The remaining 49 rats were oophorectomized and, starting on the 96th P.O. day, received the specific drug for 30 days. The CEE group received 50 mg/day conjugated equine estrogens (13 rats); the MPA group, 2.0 mg/day medroxyprogesterone acetate (12 rats); the CEE + MPA group, both drugs (12 rats), and the DW group, distilled water (12 rats). On the 31st day of medication, the animals were sacrificed and the inguinal mammary glands were removed for histological analysis. Cell proliferation was assessed at the ductal and acinar levels using anti-PCNA antibody. Mature collagen (type I) and immature collagen (type III) were quantified by Sirius-Red staining, and elastic fiber formation was quantified by Weigert staining. Anatomopathological analysis was performed by hematoxylin-eosin staining, with the determination of number of acini per terminal duct, number of ducts per field, presence of intraductal secretion, and intensity of intracytoplasmic vacuolization. Results: the CEE + MPA group presented a smaller percentage of proliferating ductal cells (46.1%) (p<0.0001) and a greater proliferation of acinar cells (66.3%), similar to those detected in the MPA group (p=0.075) but differing from those detected in the remaining groups (p<0.004). The CEE group showed the largest amount of immature collagen (33.6%) (p<0.01) and the MPA group showed the highest concentration of elastic fibers (11.7%) (p<0.0001). The CEE + MPA and MPA groups showed secretory acinar hyperplasia that was intense (91.7%) in the CEE + MPA group and mild (41.7%) or moderate (58.3%) in the MPA group, but differering in both cases from the remaining groups (p<0,097). Conclusions: conjugated equine estrogens in combination with medroxyprogesterone inhibit ductal cell proliferation and stimulate acinar cell proliferation causing secretory acinar hyperplasia; conjugated horse estrogens intensify the formation of immature (type III) collagen, and medroxyprogesterone acetate increases the formation of elastic fibers.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):507-513
DOI 10.1590/S0100-72032001000800005
Purpose: to evaluate the effect of hormone replacement therapy on breast cell proliferation and on collagen and elastic fiber formation and to analyze the changes occurring in the breast parenchyma as a whole. Method: a total of 61 adult Wistar rats were divided into 5 groups. The standard group (12 rats) represented the normal hormonal ovarian status. The remaining 49 rats were oophorectomized and, starting on the 96th P.O. day, received the specific drug for 30 days. The CEE group received 50 mg/day conjugated equine estrogens (13 rats); the MPA group, 2.0 mg/day medroxyprogesterone acetate (12 rats); the CEE + MPA group, both drugs (12 rats), and the DW group, distilled water (12 rats). On the 31st day of medication, the animals were sacrificed and the inguinal mammary glands were removed for histological analysis. Cell proliferation was assessed at the ductal and acinar levels using anti-PCNA antibody. Mature collagen (type I) and immature collagen (type III) were quantified by Sirius-Red staining, and elastic fiber formation was quantified by Weigert staining. Anatomopathological analysis was performed by hematoxylin-eosin staining, with the determination of number of acini per terminal duct, number of ducts per field, presence of intraductal secretion, and intensity of intracytoplasmic vacuolization. Results: the CEE + MPA group presented a smaller percentage of proliferating ductal cells (46.1%) (p<0.0001) and a greater proliferation of acinar cells (66.3%), similar to those detected in the MPA group (p=0.075) but differing from those detected in the remaining groups (p<0.004). The CEE group showed the largest amount of immature collagen (33.6%) (p<0.01) and the MPA group showed the highest concentration of elastic fibers (11.7%) (p<0.0001). The CEE + MPA and MPA groups showed secretory acinar hyperplasia that was intense (91.7%) in the CEE + MPA group and mild (41.7%) or moderate (58.3%) in the MPA group, but differering in both cases from the remaining groups (p<0,097). Conclusions: conjugated equine estrogens in combination with medroxyprogesterone inhibit ductal cell proliferation and stimulate acinar cell proliferation causing secretory acinar hyperplasia; conjugated horse estrogens intensify the formation of immature (type III) collagen, and medroxyprogesterone acetate increases the formation of elastic fibers.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):517-521
DOI 10.1590/S0100-72032001000800006
Purpose: to verify the association of the use of abortifacient drugs during the first 3 months of gestation with the occurrence of congenital malformations in live births. Patients and Methods: population-based case-control study through selection of the first six live births on a day, over the period of a year, at a public maternity in Salvador, Bahia, with a total of 800 cases. Studies were performed through investigation of birth records in the search of congenital malformation data, observation of selected malformed newborns, followed by interview with the mothers for collection of anamnesis data, by application of a questionnaire. Later on data were statistically evaluated by Epi-Info 5.0 software. Results: puerperae came from a low socialeconomic class (74.8%), without any or almost any schooling (61.1%). The general percentage of birth defects was estimated at 4.7%. Out of 800 puerperae, 16% reported abortifacient drug intake during the first 3 months of gestation and 10.9% of them had malformed babies. This incidence was 3.6% in children whose mothers denied the intake of any abortifacient drugs. Agents most commonly taken in those unsuccessful abortive attempts were misoprostol (Cytotec) and herbs, specially "alumã" (Vermonia baiensis Tol) and "espinho cheiroso" (Kanthoxilum shifolium Lam), which, according to the literature, do not really have any abortive effect. Conclusion: the study revealed the extension of intentional miscarriage in a low income population and showed that the occurrence of birth defects could be related to gestational exposure to misoprostol and herbal medicine intake.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):517-521
DOI 10.1590/S0100-72032001000800006
Purpose: to verify the association of the use of abortifacient drugs during the first 3 months of gestation with the occurrence of congenital malformations in live births. Patients and Methods: population-based case-control study through selection of the first six live births on a day, over the period of a year, at a public maternity in Salvador, Bahia, with a total of 800 cases. Studies were performed through investigation of birth records in the search of congenital malformation data, observation of selected malformed newborns, followed by interview with the mothers for collection of anamnesis data, by application of a questionnaire. Later on data were statistically evaluated by Epi-Info 5.0 software. Results: puerperae came from a low socialeconomic class (74.8%), without any or almost any schooling (61.1%). The general percentage of birth defects was estimated at 4.7%. Out of 800 puerperae, 16% reported abortifacient drug intake during the first 3 months of gestation and 10.9% of them had malformed babies. This incidence was 3.6% in children whose mothers denied the intake of any abortifacient drugs. Agents most commonly taken in those unsuccessful abortive attempts were misoprostol (Cytotec) and herbs, specially "alumã" (Vermonia baiensis Tol) and "espinho cheiroso" (Kanthoxilum shifolium Lam), which, according to the literature, do not really have any abortive effect. Conclusion: the study revealed the extension of intentional miscarriage in a low income population and showed that the occurrence of birth defects could be related to gestational exposure to misoprostol and herbal medicine intake.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):523-527
DOI 10.1590/S0100-72032001000800007
Purpose: to study perinatal outcome in asthmatic pregnant patients who required hospital admission to control acute exacerbations. Patients and Method: retrospective study of 12 pregnant asthmatic patients admitted at the Hospital das Clínicas, Department of Obstetrics and Gynecology, FMRP-USP, during the period between 1992 and 1996. The analyzed data included: maternal age, prenatal care, length of hospitalization, gestational age at delivery, type of delivery, neonatal weight and Apgar score. Results: among the 12 asthmatic pregnant patients 7 did not have prenatal care for acute exacerbation treatment before hospitalization. Three of 12 developed preeclampsia (one with premature rupture of membranes and infection of the amniotic cavity and one with premature separation of the placenta); 2 of 12 were diagnosed with premature placental aging (one with premature labor and twin-to-twin transfusion syndrome and one with oligohydramnios); 1 of 12 was diagnosed with oligohydramnios and fetal death and had pneumonia, and 1 of 12 was diagnosed with polyhydramnios. Among the infants, 3 were small for gestational age. Conclusions: perinatal complications were more frequent in asthmatic pregnant patients who required hospital care for the acute exacerbations. Chronic asthmatic patients in reproductive age should be advised before pregnancy about the prophylactic measures to reduce the incidence of acute crises and exacerbations during pregnancy should be treated promptly.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):523-527
DOI 10.1590/S0100-72032001000800007
Purpose: to study perinatal outcome in asthmatic pregnant patients who required hospital admission to control acute exacerbations. Patients and Method: retrospective study of 12 pregnant asthmatic patients admitted at the Hospital das Clínicas, Department of Obstetrics and Gynecology, FMRP-USP, during the period between 1992 and 1996. The analyzed data included: maternal age, prenatal care, length of hospitalization, gestational age at delivery, type of delivery, neonatal weight and Apgar score. Results: among the 12 asthmatic pregnant patients 7 did not have prenatal care for acute exacerbation treatment before hospitalization. Three of 12 developed preeclampsia (one with premature rupture of membranes and infection of the amniotic cavity and one with premature separation of the placenta); 2 of 12 were diagnosed with premature placental aging (one with premature labor and twin-to-twin transfusion syndrome and one with oligohydramnios); 1 of 12 was diagnosed with oligohydramnios and fetal death and had pneumonia, and 1 of 12 was diagnosed with polyhydramnios. Among the infants, 3 were small for gestational age. Conclusions: perinatal complications were more frequent in asthmatic pregnant patients who required hospital care for the acute exacerbations. Chronic asthmatic patients in reproductive age should be advised before pregnancy about the prophylactic measures to reduce the incidence of acute crises and exacerbations during pregnancy should be treated promptly.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):529-533
DOI 10.1590/S0100-72032001000800008
Purpose: to evaluate the relationship between bacterial vaginosis (BV) and spontaneous preterm delivery. Method: a total of 611 pregnant women from the general antenatal clinic of the "Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo" were enrolled in this study. All pregnancies were dated by an early scan. Iatrogenic preterm deliveries were excluded. The presence of bacterial vaginosis was evaluated between 23 and 24 weeks of pregnancy by a Gram stain of the vaginal smear collected from the posterior vaginal wall using a sterile swab. Vaginal pH was also assessed from the lateral vaginal wall by a Universal 0-14 pH strip produced by Merck. Result: a complete follow-up was obtained in 551 patients and bacterial vaginosis was diagnosed in 103 (19%) cases. Among the patients with BV in the vaginal smear, 9.7% delivered before 37 weeks against only 3.2% in the group with normal vaginal smear (p=0.008). The sensitivity, specificity, accuracy and false-positive rate for preterm delivery in the presence of bacterial vaginosis on Gram stain of the vaginal smear were 41.7, 82, 80.2 and 18%, respectively, with a relative risk of 1.8 for preterm delivery. The mean vaginal pH in the group of positive BV was 4.9 and in the group with normal smear it was 4.3 (p=0.0001). Conclusion: bacterial vaginosis during pregnancy increases the risk for spontaneous preterm delivery, with a relative risk of 1.8.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):529-533
DOI 10.1590/S0100-72032001000800008
Purpose: to evaluate the relationship between bacterial vaginosis (BV) and spontaneous preterm delivery. Method: a total of 611 pregnant women from the general antenatal clinic of the "Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo" were enrolled in this study. All pregnancies were dated by an early scan. Iatrogenic preterm deliveries were excluded. The presence of bacterial vaginosis was evaluated between 23 and 24 weeks of pregnancy by a Gram stain of the vaginal smear collected from the posterior vaginal wall using a sterile swab. Vaginal pH was also assessed from the lateral vaginal wall by a Universal 0-14 pH strip produced by Merck. Result: a complete follow-up was obtained in 551 patients and bacterial vaginosis was diagnosed in 103 (19%) cases. Among the patients with BV in the vaginal smear, 9.7% delivered before 37 weeks against only 3.2% in the group with normal vaginal smear (p=0.008). The sensitivity, specificity, accuracy and false-positive rate for preterm delivery in the presence of bacterial vaginosis on Gram stain of the vaginal smear were 41.7, 82, 80.2 and 18%, respectively, with a relative risk of 1.8 for preterm delivery. The mean vaginal pH in the group of positive BV was 4.9 and in the group with normal smear it was 4.3 (p=0.0001). Conclusion: bacterial vaginosis during pregnancy increases the risk for spontaneous preterm delivery, with a relative risk of 1.8.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):535-539
DOI 10.1590/S0100-72032001000800009
Luteomas of pregnancy are ovarian pseudotumors diagnosed by ultrasound, during cesarean section or at postdelivery tubal ligation. Twenty-five per cent of the cases appear around the second half of pregnancy. Usually there are signs of maternal virilization and 50% are detected because female newborns show clitorimegaly and/or labial fusion. The concentrations of androgenic steroids in the maternal blood during pregnancy and in the cord blood at child-birth show significantly increased rates. The ultrasound shows solid or cystic-solid structures and few weeks after the delivery they decrease and the ovary size returns to normal. The authors report a case of a patient who exhibited virilization signs in two consecutive pregnancies as well as in the two female fetuses. At adnexal sonographic examination a solid tumoral image was found in both pregnancies. Serum androgen levels were increased.
Summary
Rev Bras Ginecol Obstet. 2001;23(8):535-539
DOI 10.1590/S0100-72032001000800009
Luteomas of pregnancy are ovarian pseudotumors diagnosed by ultrasound, during cesarean section or at postdelivery tubal ligation. Twenty-five per cent of the cases appear around the second half of pregnancy. Usually there are signs of maternal virilization and 50% are detected because female newborns show clitorimegaly and/or labial fusion. The concentrations of androgenic steroids in the maternal blood during pregnancy and in the cord blood at child-birth show significantly increased rates. The ultrasound shows solid or cystic-solid structures and few weeks after the delivery they decrease and the ovary size returns to normal. The authors report a case of a patient who exhibited virilization signs in two consecutive pregnancies as well as in the two female fetuses. At adnexal sonographic examination a solid tumoral image was found in both pregnancies. Serum androgen levels were increased.
