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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):531-538
To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks.
A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery).
The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p<0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p<0.001) and 7.6, 10.8 and 7.6 bpm (p=0.002) in the resting, walking and recovery phases, respectively. Themean number of fetalmovements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p<0.001). In overweight/obese women, the mean FHR was lower (p=0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk).
In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):531-538
To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks.
A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery).
The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p<0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p<0.001) and 7.6, 10.8 and 7.6 bpm (p=0.002) in the resting, walking and recovery phases, respectively. Themean number of fetalmovements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p<0.001). In overweight/obese women, the mean FHR was lower (p=0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk).
In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):132-139
To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs).
A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established.
When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4).
There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):132-139
To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs).
A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established.
When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4).
There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(10):480-485
DOI 10.1590/SO100-720320150005279
To determine the prevalence of HPV-induced lesions in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade 2/3.
A cross-sectional study was carried out from December 2008 to June 2009, in Pernambuco, northeastern Brazil. Only women with grade 2/3 CIN were included, and those who could not undergo anoscopy during their first visit were excluded. A cyttobrush was used for sample collection in order to identify HPV DNA through PCR and anal cytology. An anal biopsy was obtained in cases of abnormal anal cytology or major alterations in high resolution anoscopy (HRA).
Thirty-two percent (n=37/115) of HRA were normal and 63.5% (n=73/115) showed acetowhite epithelium. Twenty-two percent (n=26/115) of anal cytologies were abnormal. Among the latter, 12.2% (n=14/26) were low-grade anal intraepithelial lesions and 3.4% (n=4/26) were high-grade anal intraepithelial lesions. Twenty-two anal biopsies were performed, 13.7% of which (n=3/22) were grade 2 anal intraepithelial neoplasia (AIN2) and 9% (n=2/22) were grade 3 AIN. Th HPV DNA was identified in 72.1% of cases (n=83/115).
Women with CIN grade 2/3 showed a high prevalence of anal HPV infection and HPV-induced lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(10):480-485
DOI 10.1590/SO100-720320150005279
To determine the prevalence of HPV-induced lesions in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade 2/3.
A cross-sectional study was carried out from December 2008 to June 2009, in Pernambuco, northeastern Brazil. Only women with grade 2/3 CIN were included, and those who could not undergo anoscopy during their first visit were excluded. A cyttobrush was used for sample collection in order to identify HPV DNA through PCR and anal cytology. An anal biopsy was obtained in cases of abnormal anal cytology or major alterations in high resolution anoscopy (HRA).
Thirty-two percent (n=37/115) of HRA were normal and 63.5% (n=73/115) showed acetowhite epithelium. Twenty-two percent (n=26/115) of anal cytologies were abnormal. Among the latter, 12.2% (n=14/26) were low-grade anal intraepithelial lesions and 3.4% (n=4/26) were high-grade anal intraepithelial lesions. Twenty-two anal biopsies were performed, 13.7% of which (n=3/22) were grade 2 anal intraepithelial neoplasia (AIN2) and 9% (n=2/22) were grade 3 AIN. Th HPV DNA was identified in 72.1% of cases (n=83/115).
Women with CIN grade 2/3 showed a high prevalence of anal HPV infection and HPV-induced lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(3):127-132
DOI 10.1590/SO100-720320150005120
To describe the maternal and fetal outcomes with the use of the Foley catheter for induction of labor in high-risk pregnant women with previous caesarean section.
An interventive and descriptive study was conducted from November 2013 to June 2014. A total of 39 pregnant women at term, with a live fetus, cephalic presentation, estimated fetal weight <4,000 g, with previous cesarean section, medical indications for induction of labor, Bishop score ≤6 and amniotic fluid index >5 cm were included. A number 16F Foley catheter was introduced for a maximum of 24 hours, and was considered to be satisfactory when the patient began labor within 24 hours.
Labor was successfully induced in 79.5% of pregnant women. Nine women achieved vaginal delivery (23.1%), with a frequency of 18% of vaginal births occurring within 24 hours. The main indications for the induction of labor were hypertensive disorders (75%). The mean interval between the placement of the Foley catheter and the beginning of labor and delivery were 8.7±7.1 and 14.7±9.8 hours, respectively. Meconium-stained amniotic fluid was observed in two patients; and an Apgar score <7 in the first minute was detected in 5 newborns (12.8%).
The Foley catheter is an alternative for the induction of labor in women with previous caesarean section, despite the low vaginal delivery rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(3):127-132
DOI 10.1590/SO100-720320150005120
To describe the maternal and fetal outcomes with the use of the Foley catheter for induction of labor in high-risk pregnant women with previous caesarean section.
An interventive and descriptive study was conducted from November 2013 to June 2014. A total of 39 pregnant women at term, with a live fetus, cephalic presentation, estimated fetal weight <4,000 g, with previous cesarean section, medical indications for induction of labor, Bishop score ≤6 and amniotic fluid index >5 cm were included. A number 16F Foley catheter was introduced for a maximum of 24 hours, and was considered to be satisfactory when the patient began labor within 24 hours.
Labor was successfully induced in 79.5% of pregnant women. Nine women achieved vaginal delivery (23.1%), with a frequency of 18% of vaginal births occurring within 24 hours. The main indications for the induction of labor were hypertensive disorders (75%). The mean interval between the placement of the Foley catheter and the beginning of labor and delivery were 8.7±7.1 and 14.7±9.8 hours, respectively. Meconium-stained amniotic fluid was observed in two patients; and an Apgar score <7 in the first minute was detected in 5 newborns (12.8%).
The Foley catheter is an alternative for the induction of labor in women with previous caesarean section, despite the low vaginal delivery rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):296-302
DOI 10.1590/SO100-720320140004958
To describe the perinatal outcomes after preterm premature rupture of membranes.
A retrospective cohort study was carried out at Instituto de Medicina Integral Prof. Fernando Figueira - IMIP from January 2008 to December 2012. A total of 124 preterm premature rupture of membranes singleton pregnancies, with gestational age <35, were included in the study. Pregnant women carrying fetuses with malformations, hypertensive syndromes, diabetes, or diagnosis of infections at admission were excluded. The pregnant women were hospitalized for conservative treatment with corticosteroids, antibiotics and tocolysis with nifedipine if necessary. The results are reported as frequency distributions and measures of central tendency and dispersion.
Seventeen patients (13.7%) had a gestational age of less than 24 weeks. Mean maternal age was 25.7 years, mean gestational age at the diagnosis of preterm premature rupture of membranes was 29 weeks, mean amniotic fluid index was 3.5 cm, and mean latency period was 10.5 days. Most patients went into spontaneous labor by the 30th week of pregnancy, and the rate of vaginal delivery was 88.2%. Chorioamnionitis was the most frequent maternal complication (34.7%). Neonatal sepsis was observed in 12% of patients, and the perinatal mortality rate was 21.5% for the group at or beyond the 24th week of gestation and 76.5% for the group with less than 24 weeks of gestational age.
A low maternal mortality rate was observed in preterm premature rupture of membranes; however, high rates of complications and perinatal death were observed, suggesting that other conduct protocols should be studied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):296-302
DOI 10.1590/SO100-720320140004958
To describe the perinatal outcomes after preterm premature rupture of membranes.
A retrospective cohort study was carried out at Instituto de Medicina Integral Prof. Fernando Figueira - IMIP from January 2008 to December 2012. A total of 124 preterm premature rupture of membranes singleton pregnancies, with gestational age <35, were included in the study. Pregnant women carrying fetuses with malformations, hypertensive syndromes, diabetes, or diagnosis of infections at admission were excluded. The pregnant women were hospitalized for conservative treatment with corticosteroids, antibiotics and tocolysis with nifedipine if necessary. The results are reported as frequency distributions and measures of central tendency and dispersion.
Seventeen patients (13.7%) had a gestational age of less than 24 weeks. Mean maternal age was 25.7 years, mean gestational age at the diagnosis of preterm premature rupture of membranes was 29 weeks, mean amniotic fluid index was 3.5 cm, and mean latency period was 10.5 days. Most patients went into spontaneous labor by the 30th week of pregnancy, and the rate of vaginal delivery was 88.2%. Chorioamnionitis was the most frequent maternal complication (34.7%). Neonatal sepsis was observed in 12% of patients, and the perinatal mortality rate was 21.5% for the group at or beyond the 24th week of gestation and 76.5% for the group with less than 24 weeks of gestational age.
A low maternal mortality rate was observed in preterm premature rupture of membranes; however, high rates of complications and perinatal death were observed, suggesting that other conduct protocols should be studied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(4):146-151
DOI 10.1590/S0100-720320140050.0003
To describe the potential influence of amniotic fluid on the maternal outcome of preterm premature rupture of membranes (PROM).
An observational, retrospective cohort study was conducted between December 2012 and January 2008 on 86 pregnant women with preterm PROM and a gestational age (GA) of 24 to 35 weeks. The amniotic fluid index (AFI) was used to measure aminiotic fluid volume. Pregnant women were compared at two cut-off points: those with AFI <5.0 and ≥5.0 cm and AFI <3.0 and ≥3.0 cm. We excluded women with hypertensive disorders, diabetesmellitus, fetal malformations and a diagnosis of infections at admission. For statistical analysis, we used the χ2test or Fisher's exact test, when appropriate, and simple linear regression analysis, with the level of significance set at 5%. We calculated the Risk Ratio (RR) and its 95% confidence interval (95%CI).
When maternal outcomes were assessed by comparing ILA ≥5.0versus <5.0 cm, no significant differences were detected. However, when considering ILA <3.0 and ≥3.0 cm, there was an increased risk of chorioamnionitis (36.7 versus10.7%, RR: 3.4, 95%CI 1.4 -8.3, p=0.004), with no significant differences for the other variables. There was also a statistically significant positive correlation between AFI and gestational age at delivery (R2=0.78, p<0.0001).
AFI <3.0 cm causes a three-fold increase in the risk for chorioamnionitis; also, the higher the ILA, the higher the gestational age at delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(4):146-151
DOI 10.1590/S0100-720320140050.0003
To describe the potential influence of amniotic fluid on the maternal outcome of preterm premature rupture of membranes (PROM).
An observational, retrospective cohort study was conducted between December 2012 and January 2008 on 86 pregnant women with preterm PROM and a gestational age (GA) of 24 to 35 weeks. The amniotic fluid index (AFI) was used to measure aminiotic fluid volume. Pregnant women were compared at two cut-off points: those with AFI <5.0 and ≥5.0 cm and AFI <3.0 and ≥3.0 cm. We excluded women with hypertensive disorders, diabetesmellitus, fetal malformations and a diagnosis of infections at admission. For statistical analysis, we used the χ2test or Fisher's exact test, when appropriate, and simple linear regression analysis, with the level of significance set at 5%. We calculated the Risk Ratio (RR) and its 95% confidence interval (95%CI).
When maternal outcomes were assessed by comparing ILA ≥5.0versus <5.0 cm, no significant differences were detected. However, when considering ILA <3.0 and ≥3.0 cm, there was an increased risk of chorioamnionitis (36.7 versus10.7%, RR: 3.4, 95%CI 1.4 -8.3, p=0.004), with no significant differences for the other variables. There was also a statistically significant positive correlation between AFI and gestational age at delivery (R2=0.78, p<0.0001).
AFI <3.0 cm causes a three-fold increase in the risk for chorioamnionitis; also, the higher the ILA, the higher the gestational age at delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):342-348
DOI 10.1590/S0100-72032013000800002
PURPOSE: To determine maternal and perinatal outcomes in pregnant women with low amniotic fluid, according to the amniotic fluid index (AFI). METHODS: A cohort study conducted on 176 patients admitted to the high risk ward of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), in Recife, Pernambuco, Brazil. Amniotic fluid was measured by the amniotic fluid index, and classified as low when between 5.1 and 7.9 cm, moderate oligohydramnios between 3.1 and 5.0 cm, and severe oligohydramnios when less than or equal to 3.0 cm. To determine the difference between the three groups of categorical variables studied the chi-square and Fisher exact tests were used, when applicable, and for the numerical variables the Mann-Whitney test was applied, with the level of significance set at 5%. RESULTS: Fetal malformation more frequently occurred when oligohydramnios was severe. Hypertensive disorders, however, were associated with moderate oligohydramnios. There was similarity between the three groups in relation to premature rupture of membranes and other causes. Low amniotic fluid was more frequently diagnosed when tested at the gestational age of 32 weeks or earlier. Regarding the perinatal outcomes, the incidence of Apgar score <7 in the 1st and 5th minutes, perinatal death, neonatal jaundice and pulmonary hypoplasia was higher when oligohydramnios was moderate to severe. CONCLUSIONS: Maternal and perinatal causes and outcomes in pregnant women with low amniotic fluid vary with respect to their AFI, severe oligohydramnios being associated with fetal malformation and other adverse perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):342-348
DOI 10.1590/S0100-72032013000800002
PURPOSE: To determine maternal and perinatal outcomes in pregnant women with low amniotic fluid, according to the amniotic fluid index (AFI). METHODS: A cohort study conducted on 176 patients admitted to the high risk ward of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), in Recife, Pernambuco, Brazil. Amniotic fluid was measured by the amniotic fluid index, and classified as low when between 5.1 and 7.9 cm, moderate oligohydramnios between 3.1 and 5.0 cm, and severe oligohydramnios when less than or equal to 3.0 cm. To determine the difference between the three groups of categorical variables studied the chi-square and Fisher exact tests were used, when applicable, and for the numerical variables the Mann-Whitney test was applied, with the level of significance set at 5%. RESULTS: Fetal malformation more frequently occurred when oligohydramnios was severe. Hypertensive disorders, however, were associated with moderate oligohydramnios. There was similarity between the three groups in relation to premature rupture of membranes and other causes. Low amniotic fluid was more frequently diagnosed when tested at the gestational age of 32 weeks or earlier. Regarding the perinatal outcomes, the incidence of Apgar score <7 in the 1st and 5th minutes, perinatal death, neonatal jaundice and pulmonary hypoplasia was higher when oligohydramnios was moderate to severe. CONCLUSIONS: Maternal and perinatal causes and outcomes in pregnant women with low amniotic fluid vary with respect to their AFI, severe oligohydramnios being associated with fetal malformation and other adverse perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):309-316
DOI 10.1590/S0100-72032013000700005
PURPOSE: To determine perinatal outcomes and factors associated with fetal brain sparing effect diagnosed by Doppler flow velocimetry in patients with arterial hypertension. METHODS: We performed a cross-sectional retrospective study including 129 pregnant women with arterial hypertension and submitted to Doppler flow velocimetry, within fifteen days before delivery. Women with multiple pregnancies, fetal malformations, genital bleeding, placenta praevia, premature rupture of membranes, smoking, illicit drug use and chronic diseases were excluded. We analyzed the biological, socio-demographic and obstetric characteristics, as well the perinatal outcomes. To determine the association between variables, we used the χ² test, Fisher's exact test and Student's t-test. Multiple logistic regression analysis was performed to determine the factors associated with fetal centralization. RESULTS: Pre-eclampsia was the most frequent hypertensive disorder (53.5%) and fetal brain sparing effect was observed in 24.0% of fetuses. The prenatal factors associated with fetal brain sparing were the persistence of bilateral protodiastolic notches in uterine arteries (OR 3.6; 95%CI 1.4 - 9.4; p=0.009) and intrauterine growth restriction (IUGR) (OR 3.3; 95%CI 1.2 - 9.3; p=0.02). The perinatal outcomes associated with fetal brain sparing were gestational age <32 weeks, small for gestational age (SGA) infants, birth weight <2,500 g and perinatal death. There was no association with other maternal or neonatal variables. CONCLUSIONS: The main factors associated with fetal brain sparing were persistence of uterine arteries notches, IUGR, and increased frequency of adverse perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):309-316
DOI 10.1590/S0100-72032013000700005
PURPOSE: To determine perinatal outcomes and factors associated with fetal brain sparing effect diagnosed by Doppler flow velocimetry in patients with arterial hypertension. METHODS: We performed a cross-sectional retrospective study including 129 pregnant women with arterial hypertension and submitted to Doppler flow velocimetry, within fifteen days before delivery. Women with multiple pregnancies, fetal malformations, genital bleeding, placenta praevia, premature rupture of membranes, smoking, illicit drug use and chronic diseases were excluded. We analyzed the biological, socio-demographic and obstetric characteristics, as well the perinatal outcomes. To determine the association between variables, we used the χ² test, Fisher's exact test and Student's t-test. Multiple logistic regression analysis was performed to determine the factors associated with fetal centralization. RESULTS: Pre-eclampsia was the most frequent hypertensive disorder (53.5%) and fetal brain sparing effect was observed in 24.0% of fetuses. The prenatal factors associated with fetal brain sparing were the persistence of bilateral protodiastolic notches in uterine arteries (OR 3.6; 95%CI 1.4 - 9.4; p=0.009) and intrauterine growth restriction (IUGR) (OR 3.3; 95%CI 1.2 - 9.3; p=0.02). The perinatal outcomes associated with fetal brain sparing were gestational age <32 weeks, small for gestational age (SGA) infants, birth weight <2,500 g and perinatal death. There was no association with other maternal or neonatal variables. CONCLUSIONS: The main factors associated with fetal brain sparing were persistence of uterine arteries notches, IUGR, and increased frequency of adverse perinatal outcomes.