Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2000;22(9):543-549
DOI 10.1590/S0100-72032000000900002
Purpose: to compare the efficiency between magnesium sulfate and phenytoin in the control of convulsions in patients with eclampsia and to evaluate the effects of magnesium sulfate and phenytoin on the maternal and perinatal prognosis in patients with eclampsia. Methods: this is a prospective, randomized and controlled study in which the results obtained with the use of anticonvulsive treatment in 77 women with eclampsia, treated with either magnesium sulfate or phenytoin, were analyzed comparatively. The drugs which were used in both therapeutic schemes were distributed in a one to one ratio, in randomly numbered boxes which presented similar characteristics. When a patient was admitted, a box was opened and its contents were given to the patient. Results: in the group whose patients were treated with magnesium sulfate, 19.5% had recurrent convulsions while in the group whose patients used phenytoin, 36.1% had new crises (p<0,05). The patients who were treated with magnesium sulfate showed a greater prevalence of postpartum hemorrhage (14,7%) than those to whom phenytoin was administered (2.7%) (p<0.05). In relation to the newborns, 17.0% of the group from mothers treated with magnesium sulfate presented respiratory distress as opposed to the group of newborns from mothers treated with phenytoin (11.8%), (p> 0,05). Conclusion: magnesium sulfate is shown to be more efficient than phenytoin in the control and the prevention of convulsions in patients with eclampsia. However, its utilization showed a higher prevalence of postpartum hemorrhage and respiratory distress. Phenytoin should be used in cases where the use of magnesium sulfate is contraindicated.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):543-549
DOI 10.1590/S0100-72032000000900002
Purpose: to compare the efficiency between magnesium sulfate and phenytoin in the control of convulsions in patients with eclampsia and to evaluate the effects of magnesium sulfate and phenytoin on the maternal and perinatal prognosis in patients with eclampsia. Methods: this is a prospective, randomized and controlled study in which the results obtained with the use of anticonvulsive treatment in 77 women with eclampsia, treated with either magnesium sulfate or phenytoin, were analyzed comparatively. The drugs which were used in both therapeutic schemes were distributed in a one to one ratio, in randomly numbered boxes which presented similar characteristics. When a patient was admitted, a box was opened and its contents were given to the patient. Results: in the group whose patients were treated with magnesium sulfate, 19.5% had recurrent convulsions while in the group whose patients used phenytoin, 36.1% had new crises (p<0,05). The patients who were treated with magnesium sulfate showed a greater prevalence of postpartum hemorrhage (14,7%) than those to whom phenytoin was administered (2.7%) (p<0.05). In relation to the newborns, 17.0% of the group from mothers treated with magnesium sulfate presented respiratory distress as opposed to the group of newborns from mothers treated with phenytoin (11.8%), (p> 0,05). Conclusion: magnesium sulfate is shown to be more efficient than phenytoin in the control and the prevention of convulsions in patients with eclampsia. However, its utilization showed a higher prevalence of postpartum hemorrhage and respiratory distress. Phenytoin should be used in cases where the use of magnesium sulfate is contraindicated.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain (
= 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):567-572
DOI 10.1590/S0100-72032000000900005
Purpose: to study the repercussion of arterial hypertension regarding body weight gain and body length, as well as liver and brain weight of offspring. Methods: a total of 82 animals in reproductive age were used. They were randomly assigned to 4 different groups (control, handled, nephrectomized and hypertensive). Renal hypertension was produced by a controlled constriction of the main left renal artery and contralateral nephrectomy, according to the technique described by Goldblatt (Goldblatt I: one kidney - one clip hypertension). Afterwards, they were distributed among nonpregnant and pregnant groups. The following newborn groups resulted from the pregnant groups: RN-C (control-newborn group of pregnant rats without surgical treatment), RN-M (manipulation-newborn group of the pregnant rats with surgical manipulation), RN-N (nephrectomized-newborn group of pregnant rats with nephrectomy) and Rn-H (hypertensive-newborn group of pregnant rats with hypertension). Results: the RN-N and RN-H groups showed body weight gain ( = 3,64 ± 0,50; or = 3,37 ± 0,44), body length ( = 3,89 ± 0,36; or = 3,68 ± 0,32) and brain weight ( = 0,16 ± 0,01; or = 0,16 ± 0,05), respectively, smaller than the control group ( = 5,40 ± 0,51; or = 4,95 ± 0,23 and or = 0,22 ± 0,04, respectively). In addition, the RN-H group showed the lowest liver weight ( = 0,22 ± 0,03) compared with the other three groups. Conclusion: after statistical analysis, the results obtained showed that the arterial hypertension determined a reduction in body weight, body length, and liver and brain weight of the offspring.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):573-577
DOI 10.1590/S0100-72032000000900006
Purpose: to verify the frequency of cervical intraepithelial neoplasia in human immunodeficiency virus (HIV) ¾ infected women. Methods: ninety-nine HIV-seropositive women were studied. The diagnosis of the HIV infection was established through two ELISA tests complemented by Western blot test or indirect immunofluorescence test. As control group, 104 women whose ELISA test was not positive were analyzed. The investigation of cervical intraepithelial neoplasia was achieved by association of Pap smear and colposcopy in both groups. In the cases where colposcopy revealed existence of abnormal transformation zones, NIC diagnosis was obtained through colposcopy-guided biopsy complemented or not by conization. Results: cervical intraepithelial neoplasia was found in 15 of the 99 patients (15.2%), and among them there were ten NIC I, one NIC II and four NIC III. Among the 104 women of the control group, four presented cervical intraepithelial neoplasia (3.8%), one being NIC I and three NIC III. Conclusion: the comparative analysis of the results showed that the frequency of cervical intraepithelial neoplasia was significantly higher among those patients infected with HIV.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):573-577
DOI 10.1590/S0100-72032000000900006
Purpose: to verify the frequency of cervical intraepithelial neoplasia in human immunodeficiency virus (HIV) ¾ infected women. Methods: ninety-nine HIV-seropositive women were studied. The diagnosis of the HIV infection was established through two ELISA tests complemented by Western blot test or indirect immunofluorescence test. As control group, 104 women whose ELISA test was not positive were analyzed. The investigation of cervical intraepithelial neoplasia was achieved by association of Pap smear and colposcopy in both groups. In the cases where colposcopy revealed existence of abnormal transformation zones, NIC diagnosis was obtained through colposcopy-guided biopsy complemented or not by conization. Results: cervical intraepithelial neoplasia was found in 15 of the 99 patients (15.2%), and among them there were ten NIC I, one NIC II and four NIC III. Among the 104 women of the control group, four presented cervical intraepithelial neoplasia (3.8%), one being NIC I and three NIC III. Conclusion: the comparative analysis of the results showed that the frequency of cervical intraepithelial neoplasia was significantly higher among those patients infected with HIV.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):579-584
DOI 10.1590/S0100-72032000000900007
Purpose: to evaluate the avoidable mortality among women in reproductive age, living in Campinas, SP, comparing two five-year periods: 1985-89 and 1990-94. Methods: death certificates of 3.086 women aged 10 to 49 years were studied, representing the total number of deaths during the period from January 1985 through December 1994. The criteria for avoidance were applied to these deaths using preventive, sanitary, early diagnosis and treatment, and mixed measures. The deaths were also classified as: with hardly avoidable causes, not well-defined causes and other causes. The specific mortality coefficient for each period of five years and the ratio between these coefficients were calculated. Results: there was a 20% increase in the avoidable mortality rate from the first to the second period. The main failure was observed among the group of avoidable causes by preventive and sanitary measures. The main increase in death causes by preventive measures resulted from AIDS. Among the causes of death avoidable by mixed measures, the increase of 50% in maternal mortality caused by abortion, as well as causes due to violence specially homicides, are emphasized. Conclusion: there was an increase in the proportion of avoidable death causes. Measures to prevent AIDS, abortion and to reduce violent deaths, specially homicides, should be political and social priorities in our Country.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):579-584
DOI 10.1590/S0100-72032000000900007
Purpose: to evaluate the avoidable mortality among women in reproductive age, living in Campinas, SP, comparing two five-year periods: 1985-89 and 1990-94. Methods: death certificates of 3.086 women aged 10 to 49 years were studied, representing the total number of deaths during the period from January 1985 through December 1994. The criteria for avoidance were applied to these deaths using preventive, sanitary, early diagnosis and treatment, and mixed measures. The deaths were also classified as: with hardly avoidable causes, not well-defined causes and other causes. The specific mortality coefficient for each period of five years and the ratio between these coefficients were calculated. Results: there was a 20% increase in the avoidable mortality rate from the first to the second period. The main failure was observed among the group of avoidable causes by preventive and sanitary measures. The main increase in death causes by preventive measures resulted from AIDS. Among the causes of death avoidable by mixed measures, the increase of 50% in maternal mortality caused by abortion, as well as causes due to violence specially homicides, are emphasized. Conclusion: there was an increase in the proportion of avoidable death causes. Measures to prevent AIDS, abortion and to reduce violent deaths, specially homicides, should be political and social priorities in our Country.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):585-591
DOI 10.1590/S0100-72032000000900008
Purpose: to test the adrenal function by a potent stimulus to its reticular layer verifying 3beta-hydroxysteroid dehy-drogenase (3beta-HSD) and 21-hydroxylase (21OH) enzymatic activities. Methods: plasma concentrations of 17alphaOH-pregneno-lone, 17alphaOH-progesterone, cortisol, progesterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (SDHEA) and free testosterone were determined in 39 women, 13 of whom were normal (2 of them used in a pilot study) and 26 had idiopathic hirsutism, 0, 12 and 24 h after injection of ACTH-depot. Results: among hirsute women, we identified different responses that could diagnose any blockage in the steroid pathways leading to the diagnosis of a mild/moderate decreased adrenal function. The 17alphaOH-pregnenolone concentrations varied from 2.0 to 24.6 ng/mL, cortisol values increased from 2.1 to 45.3 and 38.4 mug/dL, 17alphaOH-progesterone levels varied from 50.7 to 346 and 218 ng/mL and progesterone increased from 0.3 to 4.4 and 2.2 ng/mL. Among the reticular layer hormones a rise of SDHEA from 274.7 to 495.5 and 505.8 mg/dL, and of androsterone from 1.1 to 4.0 and 4.5 ng/mL was observed, the levels of free testosterone increased from 1.3 to 1.8 and 2.7 pg/mL and the DHEA levels from 2.4 to 4.7 and 8.5 ng/mL. One patient showed 3beta-HSD deficiency and two others a possible 21OH deficiency. Conclusions: these findings suggest that the ACTH-depot test could be used to exclude the adrenal gland as the possible source of hyperandrogenism in women with idiopathic hirsutism.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):585-591
DOI 10.1590/S0100-72032000000900008
Purpose: to test the adrenal function by a potent stimulus to its reticular layer verifying 3beta-hydroxysteroid dehy-drogenase (3beta-HSD) and 21-hydroxylase (21OH) enzymatic activities. Methods: plasma concentrations of 17alphaOH-pregneno-lone, 17alphaOH-progesterone, cortisol, progesterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (SDHEA) and free testosterone were determined in 39 women, 13 of whom were normal (2 of them used in a pilot study) and 26 had idiopathic hirsutism, 0, 12 and 24 h after injection of ACTH-depot. Results: among hirsute women, we identified different responses that could diagnose any blockage in the steroid pathways leading to the diagnosis of a mild/moderate decreased adrenal function. The 17alphaOH-pregnenolone concentrations varied from 2.0 to 24.6 ng/mL, cortisol values increased from 2.1 to 45.3 and 38.4 mug/dL, 17alphaOH-progesterone levels varied from 50.7 to 346 and 218 ng/mL and progesterone increased from 0.3 to 4.4 and 2.2 ng/mL. Among the reticular layer hormones a rise of SDHEA from 274.7 to 495.5 and 505.8 mg/dL, and of androsterone from 1.1 to 4.0 and 4.5 ng/mL was observed, the levels of free testosterone increased from 1.3 to 1.8 and 2.7 pg/mL and the DHEA levels from 2.4 to 4.7 and 8.5 ng/mL. One patient showed 3beta-HSD deficiency and two others a possible 21OH deficiency. Conclusions: these findings suggest that the ACTH-depot test could be used to exclude the adrenal gland as the possible source of hyperandrogenism in women with idiopathic hirsutism.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):593-596
DOI 10.1590/S0100-72032000000900009
Paracoccidioidomycosis is an important systemic endemic mycosis in Latin America. This infection is usually acquired via inhalation of mycelial particles. Most infected subjects develop an asymptomatic infection, which is associated with various host-related factors such as sex, age, genetic, as well as characteristics of the infecting agent, mainly its virulence. It is a systemic pathology. A case of mastitis due to paracoccidioidomycosis is presented with the objective to demonstrate that elderly patients with a breast abscess should be submitted to biopsy.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):593-596
DOI 10.1590/S0100-72032000000900009
Paracoccidioidomycosis is an important systemic endemic mycosis in Latin America. This infection is usually acquired via inhalation of mycelial particles. Most infected subjects develop an asymptomatic infection, which is associated with various host-related factors such as sex, age, genetic, as well as characteristics of the infecting agent, mainly its virulence. It is a systemic pathology. A case of mastitis due to paracoccidioidomycosis is presented with the objective to demonstrate that elderly patients with a breast abscess should be submitted to biopsy.
