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  • Original Article

    Vaginal hysterectomy versus abdominal hysterectomy in patients without uterine prolapse: a randomized clinical trial

    Rev Bras Ginecol Obstet. 2003;25(3):169-176

    Summary

    Original Article

    Vaginal hysterectomy versus abdominal hysterectomy in patients without uterine prolapse: a randomized clinical trial

    Rev Bras Ginecol Obstet. 2003;25(3):169-176

    DOI 10.1590/S0100-72032003000300005

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    PURPOSE: to compare intra- and postoperative results of vaginal hysterectomy with those of abdominal hysterectomy in women without genital prolapse or adnexal pathology. METHODS: a randomized, open clinical trial was conducted, involving 35 patients without genital prolapse scheduled for total hysterectomy due to benign disease, at IMIP, Recife, Brazil. These patients were randomly assigned to vaginal hysterectomy (19 patients) or abdominal hysterectomy (16 patients). Main outcome measures included estimated blood loss, rate of blood transfusion, duration of surgery, postoperative pain (intensity and analgesic requirement), time in hospital, postoperative complications, recovery time and patient satisfaction. Statistical analysis was performed using chi2, exact Fisher and Mann-Whitney tests at a 5% level of significance. RESULTS: estimated blood losses were significantly lower in vaginal hysterectomy (median of 520 mL) than in abdominal hysterectomy (median 902 mL). There was no blood transfusion among patients of the vaginal hysterectomy group, in contrast to 19% of the abdominal hysterectomy group. Duration of surgery was similar (median of 120 min in both groups). Postoperative pain, as measured by visual analog scale and analgesic requirement, was lower for vaginal hysterectomy than for abdominal hysterectomy. There was no statistically significant difference regarding frequency of postoperative complications. There was one case of infection in each group and one case of thrombosis in the vaginal hysterectomy group. Postoperative hospital stay was shorter in the vaginal group. Recovery time was significantly shorter in the vaginal group (median of 35 days) versus the abdominal group (median 40 days). Overall patient satisfaction with the operation was similar in the two groups. CONCLUSIONS: patients without genital prolapse submitted to vaginal hysterectomy for treatment of benign diseases had some advantages in relation to those submitted to abdominal hysterectomy: lower intraoperative blood loss, lower postoperative pain and faster recovery time. Vaginal hysterectomy may replace abdominal hysterectomy in most patients who require hysterectomy.

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  • Original Article

    Maternal mortality in Recife

    Rev Bras Ginecol Obstet. 2002;24(7):455-462

    Summary

    Original Article

    Maternal mortality in Recife

    Rev Bras Ginecol Obstet. 2002;24(7):455-462

    DOI 10.1590/S0100-72032002000700005

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    Purpose: to determine the Maternal Mortality Ratio (MMR) among women living in the city of Recife, Brazil through the analysis of all death certificates of women aged 10-49 years from 1994 to 2000. To determine the underreporting rate and to study the main characteristics, basic causes, classification and avoidance of maternal deaths. Methods: a descriptive population-based study was conducted and all death certificates of women aged 10-49 years were analyzed and classified as declared or presumed (Laurenti criteria). Clinical records and autopsy data, when available, were studied and basic cause and underreporting rate were determined. Maternal Mortality Ratio was calculated using information on live births from SINASC ("Sistema de Informações dos Nascidos Vivos"). Results: a total of 144 maternal deaths were identified (declared=104; presumed and confirmed after investigation=44). The Maternal Mortality Ratio was 75.5 per 100,000 live births. The underreporting rate was 27.8%. A predominance of direct causes was observed (about 69%) and the most frequent causes of death were hypertension (19%), hemorrhage (16%) and infection (11%). About 82% of the deaths were considered avoidable by adequate antenatal, delivery and post-partum care. Conclusions: Maternal Mortality Ratio is high in the city of Recife, Brazil and the underreporting rate is still high. Direct obstetric causes and avoidable deaths are predominant. There is a lack of adequate antenatal, delivery and post-partum care.

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    Maternal mortality in Recife
  • Original Article

    Transdermal nitroglycerin versus oral nifedipine administration for tocolysis: a randomized clinical trial

    Rev Bras Ginecol Obstet. 2009;31(11):552-558

    Summary

    Original Article

    Transdermal nitroglycerin versus oral nifedipine administration for tocolysis: a randomized clinical trial

    Rev Bras Ginecol Obstet. 2009;31(11):552-558

    DOI 10.1590/S0100-72032009001100005

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    PURPOSE: to compare the effectiveness of transdermal nitroglycerin with oral nifedipine in the inhibition of preterm delivery. METHODS: a clinical essay has been performed with 50 women in preterm delivery, randomly divided into two groups, 24 receiving oral nifedipine (20 mg), and 26, transdermal nitroglycerin (10 mg patch). Patients with a single gestation, between the 24th and the 34th weeks and diagnosis of preterm delivery were selected. Women with fetal malformation and clinical or obstetric diseases were excluded. The variables analyzed were: effective tocolysis, time needed for tocolysis, recurrence frequency, progression to preterm delivery, and side effects. RESULTS: tocolysis efficacy in the first 12 hours was similar between the groups (nitroglycerin: 84.6% versus nifedipine: 87.5%; p=0.50). The time average time needed for tocolysis was also similar (6.6 versus 5.8 hours; p=0.30). There was no difference between the groups, concerning the recurrence of preterm delivery (26.9 versus 16.7%; p=0.30), and neither in the rate of preterm delivery within 48 hours (15.4 versus 12.5%; p=0.50). Nevertheless, the cephalea rate was significantly higher in the Nitroglycerin Group (30.8 versus 8.3%; p=0.04). CONCLUSIONS: transdermal nitroglycerin has presented similar effectiveness to oral nifedipine to inhibit preterm delivery in the first 48 hours, however with higher cephalea frequency.

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    Transdermal nitroglycerin versus oral nifedipine administration for tocolysis: a randomized clinical trial

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