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Summary
Rev Bras Ginecol Obstet. 2012;34(8):351-356
DOI 10.1590/S0100-72032012000800002
PURPOSE: To evaluate the diagnostic agreement between the cytopathology reports issued by accredited laboratories and those obtained by quality control. METHODS: We calculated the overall agreement and Cohen's kappa coefficients of a convenience sample of smears selected monthly by the Information System of Cervical Cancer (SISCOLO) for External Quality Control of the 15 laboratories that performed cytopathological PAP tests for the Brazilian Public Health System (SUS) between 2002 and 2011 in Mato Grosso do Sul, a State of the Midwest Region of the country. A comparison of the reliability values (coefficient of concordance and Kappa coefficient) between the initial and final years was computed by the absolute change (delta) and relative percent difference (RPD). RESULTS: There were 15.989 smears sent for rereading, 48.1% of which had a report of normal/benign changes, followed by atypical/low-grade squamous intraepithelial lesions (36.3%), high grade squamous intraepithelial lesion/carcinoma/adenocarcinoma (4.2%), and unsatisfactory (11.4%). The overall correlation coefficient ranged between 0.2 and 1.0, and the median value increased from 0.7 in 2002 to 1 in 2011 (RPD=+36.6%). During the same period, the median values of the Kappa coefficient increased from 0.5 to 0.9 (RPD=+80.8%). CONCLUSIONS: These results emphasize the feasibility of the External Quality Control of cytopathology at the state level and its implementation results in improvement in the diagnoses performed in the SUS network.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):351-356
DOI 10.1590/S0100-72032012000800002
PURPOSE: To evaluate the diagnostic agreement between the cytopathology reports issued by accredited laboratories and those obtained by quality control. METHODS: We calculated the overall agreement and Cohen's kappa coefficients of a convenience sample of smears selected monthly by the Information System of Cervical Cancer (SISCOLO) for External Quality Control of the 15 laboratories that performed cytopathological PAP tests for the Brazilian Public Health System (SUS) between 2002 and 2011 in Mato Grosso do Sul, a State of the Midwest Region of the country. A comparison of the reliability values (coefficient of concordance and Kappa coefficient) between the initial and final years was computed by the absolute change (delta) and relative percent difference (RPD). RESULTS: There were 15.989 smears sent for rereading, 48.1% of which had a report of normal/benign changes, followed by atypical/low-grade squamous intraepithelial lesions (36.3%), high grade squamous intraepithelial lesion/carcinoma/adenocarcinoma (4.2%), and unsatisfactory (11.4%). The overall correlation coefficient ranged between 0.2 and 1.0, and the median value increased from 0.7 in 2002 to 1 in 2011 (RPD=+36.6%). During the same period, the median values of the Kappa coefficient increased from 0.5 to 0.9 (RPD=+80.8%). CONCLUSIONS: These results emphasize the feasibility of the External Quality Control of cytopathology at the state level and its implementation results in improvement in the diagnoses performed in the SUS network.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):357-361
DOI 10.1590/S0100-72032012000800003
PURPOSE: To compare the frequency of metabolic syndrome (MetS) and the risk factors associated with this syndrome in women from the Brazilian Southeast with polycystic ovary syndrome (POS) evaluated during adolescence and adult age. METHODS: This was a cross-sectional study conducted on 147 patients with a diagnosis of POS who were divided into two groups: Adolescents, 42 adolescents aged 13 to 19 years, and Adults, 105 women aged 20 to 40 years. The following factors were evaluated: clinical characteristics (body mass index - BMI, Ferriman index, abdominal circumference - AC, and systemic arterial pressure), mean ovarian volume, laboratory variables (serum androgen profile, lipid profile, glycemia, and fasting insulin), and frequency of MetS. The results were expressed as mean±standard deviation. We used multiple logistic regression with the response variable being the presence of MetS and the predictor variables the levels of total testosterone, insulin and BMI. RESULTS: The frequency of MetS was approximately twice higher in the group of adult women compared to the adolescents with POS (Adolescents: 23.8 vs. Adults: 42.9%, p=0.04). Among the defining criteria of MetS, only the qualitative variable of systemic arterial pressure ≥130/85 mmHg was more frequent among the adult women (p=0,01). The BMI was an independent predictor of MetS among the adolescent (p=0.03) and adult women (p<0.01) with POS. Serum insulin level was a predictor of MetS only among adult women with POS (p<0.01). AC was greater among adult women (p=0.04). CONCLUSION: Adult women with POS have a twice higher frequency of MetS than adolescents with POS from the Brazilian Southeast. Although the BMI is associated with the development of MetS in any phase of life in women with POS, serum insulin level was an independent predictor of MetS only among adult women with this disorder.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):357-361
DOI 10.1590/S0100-72032012000800003
PURPOSE: To compare the frequency of metabolic syndrome (MetS) and the risk factors associated with this syndrome in women from the Brazilian Southeast with polycystic ovary syndrome (POS) evaluated during adolescence and adult age. METHODS: This was a cross-sectional study conducted on 147 patients with a diagnosis of POS who were divided into two groups: Adolescents, 42 adolescents aged 13 to 19 years, and Adults, 105 women aged 20 to 40 years. The following factors were evaluated: clinical characteristics (body mass index - BMI, Ferriman index, abdominal circumference - AC, and systemic arterial pressure), mean ovarian volume, laboratory variables (serum androgen profile, lipid profile, glycemia, and fasting insulin), and frequency of MetS. The results were expressed as mean±standard deviation. We used multiple logistic regression with the response variable being the presence of MetS and the predictor variables the levels of total testosterone, insulin and BMI. RESULTS: The frequency of MetS was approximately twice higher in the group of adult women compared to the adolescents with POS (Adolescents: 23.8 vs. Adults: 42.9%, p=0.04). Among the defining criteria of MetS, only the qualitative variable of systemic arterial pressure ≥130/85 mmHg was more frequent among the adult women (p=0,01). The BMI was an independent predictor of MetS among the adolescent (p=0.03) and adult women (p<0.01) with POS. Serum insulin level was a predictor of MetS only among adult women with POS (p<0.01). AC was greater among adult women (p=0.04). CONCLUSION: Adult women with POS have a twice higher frequency of MetS than adolescents with POS from the Brazilian Southeast. Although the BMI is associated with the development of MetS in any phase of life in women with POS, serum insulin level was an independent predictor of MetS only among adult women with this disorder.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):362-368
DOI 10.1590/S0100-72032012000800004
PURPOSE: To determine the nutritional status of vitamin E in breastfeeding women through the analysis of alpha-tocopherol concentration in serum and colostrum, to analyze its relation with maternal variables and to determine the prevalence of vitamin E deficiency in these women. METHODS: The study included 103 mothers who were classified according to maternal variables: age, nutritional status before pregnancy, gestational weight gain, parity and mode of delivery. Colostrum and serum samples were collected under fasting conditions in the immediate postpartum period. Alpha-tocopherol was analyzed by high performance liquid chromatography (HPLC). A serum cutoff of 697.7 μg/dL was adopted to define the nutritional status of vitamin E. Statistical analysis was performed with the Student's t test for independent samples and Pearson's correlation. Differences were significant when p<0.05. RESULTS: The average concentration of alpha-tocopherol was 1.125±551.0 μg/dL in colostrum and 1,138.6±346.0 μg/dL in serum, indicating adequate biochemical nutritional status. However, when analyzing the mothers individually, a 16% rate of subclinical vitamin E deficiency was detected. Women undergoing cesarean delivery had significantly higher alpha-tocopherol levels in colostrum (1.280±591 μg/dL) compared with those undergoing normal delivery (961.7±370 μg/dL) (p<0.05). It was found that mothers who were overweight before pregnancy had higher vitamin concentration in colostrum (1,331.5±548 μg/dL) when compared to underweight women (982.1±374 μg/dL) or women of normal weight (992.3±346 μg/dL) (p<0.05). However, the other variables were not associated with alpha-tocopherol in colostrum. Moreover, no variable showed association with vitamin E levels in maternal serum and no correlation was demonstrated between the alpha-tocopherol levels in serum and in milk. CONCLUSIONS: Despite the diagnosis of satisfactory nutritional status, breastfeeding women showed significant risk of subclinical vitamin E deficiency. We suggest that the concentration of alpha-tocopherol in colostrum be associated with type of delivery and pre-gestational nutritional status of women.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):362-368
DOI 10.1590/S0100-72032012000800004
PURPOSE: To determine the nutritional status of vitamin E in breastfeeding women through the analysis of alpha-tocopherol concentration in serum and colostrum, to analyze its relation with maternal variables and to determine the prevalence of vitamin E deficiency in these women. METHODS: The study included 103 mothers who were classified according to maternal variables: age, nutritional status before pregnancy, gestational weight gain, parity and mode of delivery. Colostrum and serum samples were collected under fasting conditions in the immediate postpartum period. Alpha-tocopherol was analyzed by high performance liquid chromatography (HPLC). A serum cutoff of 697.7 μg/dL was adopted to define the nutritional status of vitamin E. Statistical analysis was performed with the Student's t test for independent samples and Pearson's correlation. Differences were significant when p<0.05. RESULTS: The average concentration of alpha-tocopherol was 1.125±551.0 μg/dL in colostrum and 1,138.6±346.0 μg/dL in serum, indicating adequate biochemical nutritional status. However, when analyzing the mothers individually, a 16% rate of subclinical vitamin E deficiency was detected. Women undergoing cesarean delivery had significantly higher alpha-tocopherol levels in colostrum (1.280±591 μg/dL) compared with those undergoing normal delivery (961.7±370 μg/dL) (p<0.05). It was found that mothers who were overweight before pregnancy had higher vitamin concentration in colostrum (1,331.5±548 μg/dL) when compared to underweight women (982.1±374 μg/dL) or women of normal weight (992.3±346 μg/dL) (p<0.05). However, the other variables were not associated with alpha-tocopherol in colostrum. Moreover, no variable showed association with vitamin E levels in maternal serum and no correlation was demonstrated between the alpha-tocopherol levels in serum and in milk. CONCLUSIONS: Despite the diagnosis of satisfactory nutritional status, breastfeeding women showed significant risk of subclinical vitamin E deficiency. We suggest that the concentration of alpha-tocopherol in colostrum be associated with type of delivery and pre-gestational nutritional status of women.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):369-375
DOI 10.1590/S0100-72032012000800005
PURPOSE: To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS: A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Student's t test were used for data analysis, as well as descriptive statistical methods. RESULTS: Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION: In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):369-375
DOI 10.1590/S0100-72032012000800005
PURPOSE: To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS: A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Student's t test were used for data analysis, as well as descriptive statistical methods. RESULTS: Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION: In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):376-380
DOI 10.1590/S0100-72032012000800006
PURPOSES: To describe the process of gait initiation of pregnant women and to compare the behavior of the pressure center in the three trimesters of pregnancy. METHODS: Fifty-seven low-risk pregnant women were evaluated, aged 18 to 35 years, selected for convenience location during the three trimesters of pregnancy. The women were divided into three groups of 19 subjects each, according to gestational age - 1st quarter (4-12 weeks), 2nd quarter (13-28 weeks), and 3rd quarter (29-42 weeks,). Each patient was positioned standing up with one foot on each AMTI force platform until she heard a beep indicating that she should start walking a distance of four meter. Data were analyzed using the SPSS software. The Kolmogorov Smirnov test, Tukey's test and Spearman correlation coefficient were used for group comparisons, with 5% significance level in all tests. RESULTS: Significant differences were found between the 1st quarter (GFT) and 3rd quarter (GTT) groups regarding mediolateral oscillation amplitude (GFT: 0.4 cm and GTT: 0.2 cm) and mediolateral displacement rate (GFT: 0.9 cm/s and GTT: 0.4 cm/s). There was a gradual decrease in anteroposterior and mediolateral oscillation rate, and in the speed of displacement from platform 1 to platform 2 in GFT. There was a significant difference in oscillation amplitude and mediolateral displacement speed between GFT and GTT. CONCLUSION: The variables analyzed showed minor differences and do not constitute an imminent risk for the stability dynamics of pregnant woman.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):376-380
DOI 10.1590/S0100-72032012000800006
PURPOSES: To describe the process of gait initiation of pregnant women and to compare the behavior of the pressure center in the three trimesters of pregnancy. METHODS: Fifty-seven low-risk pregnant women were evaluated, aged 18 to 35 years, selected for convenience location during the three trimesters of pregnancy. The women were divided into three groups of 19 subjects each, according to gestational age - 1st quarter (4-12 weeks), 2nd quarter (13-28 weeks), and 3rd quarter (29-42 weeks,). Each patient was positioned standing up with one foot on each AMTI force platform until she heard a beep indicating that she should start walking a distance of four meter. Data were analyzed using the SPSS software. The Kolmogorov Smirnov test, Tukey's test and Spearman correlation coefficient were used for group comparisons, with 5% significance level in all tests. RESULTS: Significant differences were found between the 1st quarter (GFT) and 3rd quarter (GTT) groups regarding mediolateral oscillation amplitude (GFT: 0.4 cm and GTT: 0.2 cm) and mediolateral displacement rate (GFT: 0.9 cm/s and GTT: 0.4 cm/s). There was a gradual decrease in anteroposterior and mediolateral oscillation rate, and in the speed of displacement from platform 1 to platform 2 in GFT. There was a significant difference in oscillation amplitude and mediolateral displacement speed between GFT and GTT. CONCLUSION: The variables analyzed showed minor differences and do not constitute an imminent risk for the stability dynamics of pregnant woman.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):386-393
DOI 10.1590/S0100-72032012000800008
PURPOSE: To evaluate sociodemographic, behavioral and reproductive factors and morbidities associated with inadequate weight gain during pregnancy. METHODS: Cohort study conducted from December 2007 to August 2008 with women in the first trimester of pregnancy looking for prenatal care in the Public Health System who lived in the cities of Petrópolis or Queimados, Rio de Janeiro state (Brazil). Women with multiple pregnancy, who had a miscarriage in the index pregnancy or who lacked information for the assessment of pregravid nutritional status or weight gain were excluded. Pregravid nutritional status and weight gain during pregnancy were determined according to the criterion established by the Institute of Medicine (IOM). Statistical analysis was performed using a multinomial logistic regression model. RESULTS: A total of 1,287 women were included in the study; 26.6% of them were overweight or obese while 11% were underweight. Inadequate weight gain during pregnancy was observed in 71.4% of pregnant women; 35.6% of them did not gain enough weight while 35.8% gained more weight than recommended by the IOM. In the multivariate analysis, women with hypertension (OR=2.1; 95%CI 1.4-3.1), pregravid overweight (OR=2.5; 95%CI 1.4-4.5) or obesity (OR=2.7; 95%CI 1.8-3.9) and who had a higher educational level were more likely to gain more weight than recommended, while pregravid underweight (OR=0.6; 95%CI 0.4-0.9) represented a protection against excessive gain. CONCLUSION: Pregravid nutritional diagnosis and weight gain monitoring should be actions effectively instituted in the routine of health professionals.
Summary
Rev Bras Ginecol Obstet. 2012;34(8):386-393
DOI 10.1590/S0100-72032012000800008
PURPOSE: To evaluate sociodemographic, behavioral and reproductive factors and morbidities associated with inadequate weight gain during pregnancy. METHODS: Cohort study conducted from December 2007 to August 2008 with women in the first trimester of pregnancy looking for prenatal care in the Public Health System who lived in the cities of Petrópolis or Queimados, Rio de Janeiro state (Brazil). Women with multiple pregnancy, who had a miscarriage in the index pregnancy or who lacked information for the assessment of pregravid nutritional status or weight gain were excluded. Pregravid nutritional status and weight gain during pregnancy were determined according to the criterion established by the Institute of Medicine (IOM). Statistical analysis was performed using a multinomial logistic regression model. RESULTS: A total of 1,287 women were included in the study; 26.6% of them were overweight or obese while 11% were underweight. Inadequate weight gain during pregnancy was observed in 71.4% of pregnant women; 35.6% of them did not gain enough weight while 35.8% gained more weight than recommended by the IOM. In the multivariate analysis, women with hypertension (OR=2.1; 95%CI 1.4-3.1), pregravid overweight (OR=2.5; 95%CI 1.4-4.5) or obesity (OR=2.7; 95%CI 1.8-3.9) and who had a higher educational level were more likely to gain more weight than recommended, while pregravid underweight (OR=0.6; 95%CI 0.4-0.9) represented a protection against excessive gain. CONCLUSION: Pregravid nutritional diagnosis and weight gain monitoring should be actions effectively instituted in the routine of health professionals.