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Rev Bras Ginecol Obstet. 2002;24(2):121-127
DOI 10.1590/S0100-72032002000200008
Purpose: to estimate the performance of ultrasound to detect gestations at risk for fetal chromosomal abnormalities. Methods: four hundred and thirty-six patients selected for the study had undergone ultrasound examination and fetal karyotyping, between March 1993 and March 1998. Two hundred and seventy-seven patients had fetal karyotype for fetal malformation detected on ultrasound and 158 for parental anxiety with normal ultrasound examination. Ultrasound sensitivity and specificity were calculated using fetal karyotype as gold standard. The relative risk for each chromosomal abnormality was calculated according to the altered system on ultrasound examination and the risks of the presence of one or more abnormalities on ultrasound, using the Epi-Info 6.0 software package for statistical analysis. Results: the relative risks for chromosomal abnormalities were 89 for face malformations, 53 for abdominal wall and cardiovascular, 49.6 for neck, 44.6 for extremities, 42.4 for lung, 32.7 for gastrointestinal tract, 27.4 for central nervous system and 23.0 for urinary tract malformations. The relative risk for fetal chromosomal anomalies for genital, thorax, spine and muscle and/or skeletal malformations was not appropriate for calculation because they occurred at very low frequencies. An isolated malformation detected by ultrasound is associated with a 7.8 times higher relative risk for chromosomal anomalies than none, and associated morphologic malformations have a 33.8 times higher relative risk for chromosomal abnormalities. Conclusion: ultrasound has good performance to detect gestations at risk for chromosomal abnormalities.
Summary
Rev Bras Ginecol Obstet. 2002;24(2):121-127
DOI 10.1590/S0100-72032002000200008
Purpose: to estimate the performance of ultrasound to detect gestations at risk for fetal chromosomal abnormalities. Methods: four hundred and thirty-six patients selected for the study had undergone ultrasound examination and fetal karyotyping, between March 1993 and March 1998. Two hundred and seventy-seven patients had fetal karyotype for fetal malformation detected on ultrasound and 158 for parental anxiety with normal ultrasound examination. Ultrasound sensitivity and specificity were calculated using fetal karyotype as gold standard. The relative risk for each chromosomal abnormality was calculated according to the altered system on ultrasound examination and the risks of the presence of one or more abnormalities on ultrasound, using the Epi-Info 6.0 software package for statistical analysis. Results: the relative risks for chromosomal abnormalities were 89 for face malformations, 53 for abdominal wall and cardiovascular, 49.6 for neck, 44.6 for extremities, 42.4 for lung, 32.7 for gastrointestinal tract, 27.4 for central nervous system and 23.0 for urinary tract malformations. The relative risk for fetal chromosomal anomalies for genital, thorax, spine and muscle and/or skeletal malformations was not appropriate for calculation because they occurred at very low frequencies. An isolated malformation detected by ultrasound is associated with a 7.8 times higher relative risk for chromosomal anomalies than none, and associated morphologic malformations have a 33.8 times higher relative risk for chromosomal abnormalities. Conclusion: ultrasound has good performance to detect gestations at risk for chromosomal abnormalities.
Summary
Rev Bras Ginecol Obstet. 2006;28(2):126-135
DOI 10.1590/S0100-72032006000200009
Gender-based violence is related to the power imbalance between men and women that is present, to a greater or lesser degree, in all societies. It was recognized as a human rights problem by the UN relatively recently. It includes emotional, physical and sexual violence. Sexual violence is the extreme form of gender violence, usually accompanied by the other types of violence. Its prevalence is difficult to determine, but it most probably affects at least one third of women some time in their life. It has multiple consequences to women's physical and gynecological health, which depends in great part on the quality of the care the woman received immediately after the assault. Unfortunately, most emergency health services, including those in women's hospitals, are rarely prepared to provide the correct care for these women. Care should be multidisciplinary and involves crisis treatment, meticulous clinical examination with complementary auxiliary methods, treatment of physical lesions, prevention of pregnancy and of sexually transmitted infections and AIDS, and follow-up for at least six months after the aggression.
Summary
Rev Bras Ginecol Obstet. 2006;28(2):126-135
DOI 10.1590/S0100-72032006000200009
Gender-based violence is related to the power imbalance between men and women that is present, to a greater or lesser degree, in all societies. It was recognized as a human rights problem by the UN relatively recently. It includes emotional, physical and sexual violence. Sexual violence is the extreme form of gender violence, usually accompanied by the other types of violence. Its prevalence is difficult to determine, but it most probably affects at least one third of women some time in their life. It has multiple consequences to women's physical and gynecological health, which depends in great part on the quality of the care the woman received immediately after the assault. Unfortunately, most emergency health services, including those in women's hospitals, are rarely prepared to provide the correct care for these women. Care should be multidisciplinary and involves crisis treatment, meticulous clinical examination with complementary auxiliary methods, treatment of physical lesions, prevention of pregnancy and of sexually transmitted infections and AIDS, and follow-up for at least six months after the aggression.
Summary
Rev Bras Ginecol Obstet. 2000;22(3):153-157
DOI 10.1590/S0100-72032000000300006
Purpose: to evaluate, in a Brazilian population, the possible association between history of sexual violence and some of the more frequent gynecologic complaints related by women. Methods: secondary analysis of data from a cross-sectional study in which 1838 women between 15 and 49 years of age were interviewed in their homes. They were residents of the cities of Campinas and Sumaré, in the state of São Paulo. A structured and pretested questionnaire was used, which allowed to characterize the interviewees' history of sexual violence, the existence of sexual dysfunctions and the presence of gynecologic symptoms in the year previous to the interview. The statistical differences were evaluated by the chi² test. Results: little more than one third (38.1%) of the women did not report history of sexual violence; 54.8% related that at least once they had had sexual intercourse against their will, without being forced to, although 23% mentioned some kind of coercion; 7.1% reported having been forced to have sex. Statistical association was found between history of sexual violence and the reference to gynecologic complaints and sexual dysfunctions. Conclusions: it was observed that even less aggressive forms of imposition of the man's will in the couple's sexual life were associated with a higher prevalence of the most frequent gynecologic complaints. The gynecologist must, therefore, have in mind this etiological factor which is rarely being considered at the present time.
Summary
Rev Bras Ginecol Obstet. 2000;22(3):153-157
DOI 10.1590/S0100-72032000000300006
Purpose: to evaluate, in a Brazilian population, the possible association between history of sexual violence and some of the more frequent gynecologic complaints related by women. Methods: secondary analysis of data from a cross-sectional study in which 1838 women between 15 and 49 years of age were interviewed in their homes. They were residents of the cities of Campinas and Sumaré, in the state of São Paulo. A structured and pretested questionnaire was used, which allowed to characterize the interviewees' history of sexual violence, the existence of sexual dysfunctions and the presence of gynecologic symptoms in the year previous to the interview. The statistical differences were evaluated by the chi² test. Results: little more than one third (38.1%) of the women did not report history of sexual violence; 54.8% related that at least once they had had sexual intercourse against their will, without being forced to, although 23% mentioned some kind of coercion; 7.1% reported having been forced to have sex. Statistical association was found between history of sexual violence and the reference to gynecologic complaints and sexual dysfunctions. Conclusions: it was observed that even less aggressive forms of imposition of the man's will in the couple's sexual life were associated with a higher prevalence of the most frequent gynecologic complaints. The gynecologist must, therefore, have in mind this etiological factor which is rarely being considered at the present time.
Summary
Rev Bras Ginecol Obstet. 1998;20(4):181-185
DOI 10.1590/S0100-72031998000400002
With the purpose of identifying the social, demographic, pregnancy-related and medical care factors associated with maternal death, this study evaluated all deaths of women aged 10 to 49 years occurring in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained reviewing 1,013 death certificates, with 42 cases of identified maternal deaths. The data of these deaths were complemented with information from medical records, autopsies and also interviews with physicians from the hospitals where the death took place, and with the dead women's relatives. Almost two thirds (62%) of maternal deaths occurred among women aged 20 to 29 years and more than half of them were single. There was a higher number of deaths among caesarean deliveries than among vaginal ones. The majority of deaths occurred within the first three days of hospitalization and approximately 90% of hospital charges were sponsored by the National Health System (SUS).
Summary
Rev Bras Ginecol Obstet. 1998;20(4):181-185
DOI 10.1590/S0100-72031998000400002
With the purpose of identifying the social, demographic, pregnancy-related and medical care factors associated with maternal death, this study evaluated all deaths of women aged 10 to 49 years occurring in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained reviewing 1,013 death certificates, with 42 cases of identified maternal deaths. The data of these deaths were complemented with information from medical records, autopsies and also interviews with physicians from the hospitals where the death took place, and with the dead women's relatives. Almost two thirds (62%) of maternal deaths occurred among women aged 20 to 29 years and more than half of them were single. There was a higher number of deaths among caesarean deliveries than among vaginal ones. The majority of deaths occurred within the first three days of hospitalization and approximately 90% of hospital charges were sponsored by the National Health System (SUS).
Summary
Rev Bras Ginecol Obstet. 2007;29(4):192-199
DOI 10.1590/S0100-72032007000400005
PURPOSE: to evaluate and compare the knowledge and the opinion of gynecologists and obstetricians regarding termination of pregnancy, in 2003 and 2005. METHODS: a structured and pre-tested questionnaire was sent to all the members of the Brazilian Federation of Gynecologists and Obstetricians (FEBRASGO). They were asked to answer the questions, anonymously, and return the questionnaire in a stamped envelope provided. They were asked about their knowledge of and opinion on Brazilian legislation related to abortion. RESULTS: in both surveys the percentage of doctors who knew under which circumstances abortion was not penalized was over 80%. However, there was a significant reduction in the percentage of doctors who knew that abortion was legal if the woman’s life was at risk. The participants who knew that abortion because of a severe congenital malformation of the fetus was not currently permitted by law increased by a third. The percentage of doctors in favor of allowing abortion increased consistently for the various circumstances presented. The proportion of those who thought that abortion should not be permitted in any circumstances decreased. The percentage of those who judged that the legal consents should not be modified decreased. There was an increase in the proportion of those who considered that abortion should not be considered a crime under any circumstance. CONCLUSIONS: in general, it seems that people have been thinking more about induced abortion during the time elapsed between the two surveys. Nevertheless, there is the need to correctly inform Brazilian gynecologists and obstetricians on the laws and norms that regulate the practice of legal abortion in the country, so as to ensure that women who need one have, in fact, access to this right.
Summary
Rev Bras Ginecol Obstet. 2007;29(4):192-199
DOI 10.1590/S0100-72032007000400005
PURPOSE: to evaluate and compare the knowledge and the opinion of gynecologists and obstetricians regarding termination of pregnancy, in 2003 and 2005. METHODS: a structured and pre-tested questionnaire was sent to all the members of the Brazilian Federation of Gynecologists and Obstetricians (FEBRASGO). They were asked to answer the questions, anonymously, and return the questionnaire in a stamped envelope provided. They were asked about their knowledge of and opinion on Brazilian legislation related to abortion. RESULTS: in both surveys the percentage of doctors who knew under which circumstances abortion was not penalized was over 80%. However, there was a significant reduction in the percentage of doctors who knew that abortion was legal if the woman’s life was at risk. The participants who knew that abortion because of a severe congenital malformation of the fetus was not currently permitted by law increased by a third. The percentage of doctors in favor of allowing abortion increased consistently for the various circumstances presented. The proportion of those who thought that abortion should not be permitted in any circumstances decreased. The percentage of those who judged that the legal consents should not be modified decreased. There was an increase in the proportion of those who considered that abortion should not be considered a crime under any circumstance. CONCLUSIONS: in general, it seems that people have been thinking more about induced abortion during the time elapsed between the two surveys. Nevertheless, there is the need to correctly inform Brazilian gynecologists and obstetricians on the laws and norms that regulate the practice of legal abortion in the country, so as to ensure that women who need one have, in fact, access to this right.
Summary
Rev Bras Ginecol Obstet. 2006;28(4):220-226
DOI 10.1590/S0100-72032006000400003
PURPOSE: to verify the possibility of identifying oocytes that would result in a higher fertilization rate. METHODS: retrospective analysis of the fertilization rate after ICSI of 957 oocytes in metaphase II according to three morphology parameters: cytoplasm inclusions, thickness of the perivitelline space, and fragmentation of the first polar body. Oocytes were obtained from 115 cycles performed among 107 women attended at the "Centro de Reprodução Humana de Campinas", from April to December of 2004. For the statistical analysis of differences in the fertilization rate between 'normal' oocytes and those presenting each alteration, the chi2 test was used with confidence levels of 5 and 10%. RESULTS: no significant difference in fertilization rate was observed regarding characteristics of the polar body or thickness of the perivitelline space. Fertilization rate among oocytes with perivitelline space with debris was 14 percentage points lower than among oocytes with absent space (p=0.055) and the rate among oocytes with granular cytoplasm was seven percentage points lower than among oocytes with normal cytoplasm (p<0.10>0.05). CONCLUSIONS: the morphological parameters of oocytes currently being evaluated do not allow us to clearly distinguish those that would lead to a higher fertilization rate and could be used in clinical practice.
Summary
Rev Bras Ginecol Obstet. 2006;28(4):220-226
DOI 10.1590/S0100-72032006000400003
PURPOSE: to verify the possibility of identifying oocytes that would result in a higher fertilization rate. METHODS: retrospective analysis of the fertilization rate after ICSI of 957 oocytes in metaphase II according to three morphology parameters: cytoplasm inclusions, thickness of the perivitelline space, and fragmentation of the first polar body. Oocytes were obtained from 115 cycles performed among 107 women attended at the "Centro de Reprodução Humana de Campinas", from April to December of 2004. For the statistical analysis of differences in the fertilization rate between 'normal' oocytes and those presenting each alteration, the chi2 test was used with confidence levels of 5 and 10%. RESULTS: no significant difference in fertilization rate was observed regarding characteristics of the polar body or thickness of the perivitelline space. Fertilization rate among oocytes with perivitelline space with debris was 14 percentage points lower than among oocytes with absent space (p=0.055) and the rate among oocytes with granular cytoplasm was seven percentage points lower than among oocytes with normal cytoplasm (p<0.10>0.05). CONCLUSIONS: the morphological parameters of oocytes currently being evaluated do not allow us to clearly distinguish those that would lead to a higher fertilization rate and could be used in clinical practice.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Rev Bras Ginecol Obstet. 1998;20(5):253-260
DOI 10.1590/S0100-72031998000500004
Objectives: To determine sensitivity, specificity, positive and negative predictive values of the shake test (Clements) for evaluation of fetal lung maturation in preeclamptic patients. Methods: A prospective study for validation of a diagnostic method was conducted enrolling 163 preeclamptic patients (gestational age between 28-34 weeks) admitted at CAM-IMIP with indication for fetal maturity testing. Preeclampsia diagnosis and classification followed criteria of the National High Blood Pressure Working Group, 1990. Clements' test was performed in three tubes and positive, negative or intermediate results were considered for analysis (related to presence or absence of fetal lung maturity). Accuracy parameters were calculated considering actual incidence of hyaline membrane disease (positive maturity = absent disease) after birth. Hyaline membrane disease was defined by criteria of CLAP, 1978. Statistical analysis was performed using c² test (Epi-Info 6.04b) with a 5% significance level. Results: Intermediate results were considered alternately as positive or negative for analysis. When considered positive, sensitivity was 87.9% and specificity 74.5% with positive and negative predictive values of 8.9.4% and 71.4% respectively - efficiency was 84%. When intermediate results were evaluated as negative, sensitivity decreased to 62% and specificity raised to 89.4% and positive and negative predictive values were 93.5% and 51.2% respectively (efficiency = 70%). False-positive results were rare and usually related to neonatal hypoxia: only 5 (6.5%) of 77 neonates with previous positive Clements had hyaline membrane disease. Nevertheless, false negatives were frequent: almost 40% for negative/intermediate results. Conclusions: Despite its limitations, Clements' test remains a good method for investigation of fetal lung maturation in preeclamptic patients since false positive results are unusual. However sensitivity is low and results have be cautiously analyzed because of elevated rate of false negative results. A good policy is to complement fetal maturity investigation with other tests if a negative result is determined, specially in severe cases when confirmed maturity represents indication for interruption of pregnancy.
Summary
Rev Bras Ginecol Obstet. 1998;20(5):253-260
DOI 10.1590/S0100-72031998000500004
Objectives: To determine sensitivity, specificity, positive and negative predictive values of the shake test (Clements) for evaluation of fetal lung maturation in preeclamptic patients. Methods: A prospective study for validation of a diagnostic method was conducted enrolling 163 preeclamptic patients (gestational age between 28-34 weeks) admitted at CAM-IMIP with indication for fetal maturity testing. Preeclampsia diagnosis and classification followed criteria of the National High Blood Pressure Working Group, 1990. Clements' test was performed in three tubes and positive, negative or intermediate results were considered for analysis (related to presence or absence of fetal lung maturity). Accuracy parameters were calculated considering actual incidence of hyaline membrane disease (positive maturity = absent disease) after birth. Hyaline membrane disease was defined by criteria of CLAP, 1978. Statistical analysis was performed using c² test (Epi-Info 6.04b) with a 5% significance level. Results: Intermediate results were considered alternately as positive or negative for analysis. When considered positive, sensitivity was 87.9% and specificity 74.5% with positive and negative predictive values of 8.9.4% and 71.4% respectively - efficiency was 84%. When intermediate results were evaluated as negative, sensitivity decreased to 62% and specificity raised to 89.4% and positive and negative predictive values were 93.5% and 51.2% respectively (efficiency = 70%). False-positive results were rare and usually related to neonatal hypoxia: only 5 (6.5%) of 77 neonates with previous positive Clements had hyaline membrane disease. Nevertheless, false negatives were frequent: almost 40% for negative/intermediate results. Conclusions: Despite its limitations, Clements' test remains a good method for investigation of fetal lung maturation in preeclamptic patients since false positive results are unusual. However sensitivity is low and results have be cautiously analyzed because of elevated rate of false negative results. A good policy is to complement fetal maturity investigation with other tests if a negative result is determined, specially in severe cases when confirmed maturity represents indication for interruption of pregnancy.