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  • Non-RhD alloimmunization in pregnancy: an updated review

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo22

    Summary

    Non-RhD alloimmunization in pregnancy: an updated review

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo22

    DOI 10.61622/rbgo/2024AO22

    Views220

    Abstract

    RhD alloimmunization in pregnancy is still the main cause of hemolytic disease of the fetus and neonate (HDFN). Nevertheless, there are other antigens that may be associated with the occurrence of this phenomenon and that have been growing in proportion, given that current prevention strategies focus only on anti-RhD antibodies. Although not widespread, the screening and diagnostic management of the disease caused by these antibodies has recommendations in the literature. For this reason, the following review was carried out with the objective of listing the main red blood cell antigen groups described — such as Rh, ABO, Kell, MNS, Duffy, Kidd, among others — addressing the clinical importance of each one, prevalence in different countries, and recommended management when detecting such antibodies during pregnancy.

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    Non-RhD alloimmunization in pregnancy: an updated review
  • Original Article

    Tubal ectopic pregnancy: comparative management between pre and Covid-19 pandemic periods

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo64

    Summary

    Original Article

    Tubal ectopic pregnancy: comparative management between pre and Covid-19 pandemic periods

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo64

    DOI 10.61622/rbgo/2024rbgo64

    Views18

    Abstract

    Objective:

    To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic.

    Methods:

    We performed a retrospective cohort study of all cases of tubal EP between March 2019 and March 2020 (pre-pandemic) and between March 2020 and March 2021 (pandemic). We compared between these two groups the risk factors, clinical characteristics, laboratory data, sonographic aspects, treatment applied and complications.

    Results:

    We had 150 EP diagnoses during the two years studied, of which 135 were tubal EP. Of these, 65 were included in the pre-pandemic and 70 in the pandemic period. The prevalence of lower abdominal pain was significantly higher in the pandemic compared to the pre-pandemic period (91.4% vs. 78.1%, p=0.031). There was no significant difference in shock index, initial beta-hCG level, hemoglobin level at diagnosis, days of menstrual delay, aspect of the adnexal mass, amount of free fluid on ultrasound, and intact or ruptured presentation between the groups. Expectant management was significantly higher during the pandemic period (40.0% vs. 18.5%, p=0.008), surgical management was lower during the pandemic period (47.1% vs. 67.7%, p=0.023), and number of days hospitalized was lower in the pandemic period (1.3 vs. 2.0 days, p=0.003).

    Conclusion:

    We did not observe a significant difference in patient history, laboratory and ultrasound characteristics. Abdominal pain was more common during the pandemic period. Regarding treatment, we observed a significant increase in expectant and a decrease in surgical cases during the pandemic period.

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  • Original Article

    Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting

    Rev Bras Ginecol Obstet. 2023;45(1):03-10

    Summary

    Original Article

    Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting

    Rev Bras Ginecol Obstet. 2023;45(1):03-10

    DOI 10.1055/s-0042-1759629

    Views8

    Abstract

    Objective

    To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario.

    Methods

    This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I – patients who did not use nonpharmacological methods for pain relief and Group II –patients who used these methods.

    Results

    A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2– maximum 10] versus 10 [minimum 6–maximum 10] p = 0.334).

    Conclusion

    In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

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    Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting
  • Original Article

    Association between Dietary Glycemic Index and Excess Weight in Pregnant Women in the First Trimester of Pregnancy

    Rev Bras Ginecol Obstet. 2019;41(1):04-10

    Summary

    Original Article

    Association between Dietary Glycemic Index and Excess Weight in Pregnant Women in the First Trimester of Pregnancy

    Rev Bras Ginecol Obstet. 2019;41(1):04-10

    DOI 10.1055/s-0038-1676096

    Views3

    Abstract

    Objective

    To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy.

    Methods

    A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation.Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed.

    Results

    The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). InthetertilewiththehigherGIvalue, therewasa lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL.

    Conclusion

    A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.

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  • Editorial

    Second Trimester Fetal Cardiac Screening – Current Opinion

    Rev Bras Ginecol Obstet. 2023;45(2):055-058

    Summary

    Editorial

    Second Trimester Fetal Cardiac Screening – Current Opinion

    Rev Bras Ginecol Obstet. 2023;45(2):055-058

    DOI 10.1055/s-0043-1764492

    Views3
    Congenital malformations are a major cause of miscarriage, perinatal mortality, prematurity, childhood death and disability worldwide. The well-being of each affected child with a birth defect depends primarily on which organ or body part is affected and how severely. The World Health Organization (WHO) estimates that approximately 295,000 newborns die each year as a result […]
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    Second Trimester Fetal Cardiac Screening – Current Opinion
  • Review Article

    How to Reach the Best Ultrasound Performance in the Delivery Room

    Rev Bras Ginecol Obstet. 2022;44(11):1070-1077

    Summary

    Review Article

    How to Reach the Best Ultrasound Performance in the Delivery Room

    Rev Bras Ginecol Obstet. 2022;44(11):1070-1077

    DOI 10.1055/s-0042-1759773

    Views1

    Abstract

    Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.

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    How to Reach the Best Ultrasound Performance in the Delivery Room
  • Original Article

    Fetal brain fissures development a three-dimensional ultrasonography study

    Rev Bras Ginecol Obstet. 2011;33(3):111-117

    Summary

    Original Article

    Fetal brain fissures development a three-dimensional ultrasonography study

    Rev Bras Ginecol Obstet. 2011;33(3):111-117

    DOI 10.1590/S0100-72032011000300002

    Views2

    PURPOSE: to assess the distance of the fetal cerebral fissures from the inner edge of the skull by three-dimensional ultrasonography (3DUS). METHODS: this cross-sectional study included 80 women with normal pregnancies between 21st and 34th weeks. The distances between the Sylvian, parieto-occiptal, hippocampus and calcarine fissures and the internal surface of the fetal skull were measured. For the evaluation of the distance of the first three fissures, an axial three-dimensional scan was obtained (at the level of the lateral ventricles). To obtain the calcarine fissure measurement, a coronal scan was used (at the level of the occipital lobes). First degree regressions were performed to assess the correlation between fissure measurements and gestational age, using the determination coefficient (R²) for adjustment. The 5th, 50th and 95th percentiles were calculated for each fissure measurement. Pearson's correlation coefficient (r) was used to assess the correlation between fissure measurements and the biparietal diameter (BPD) and head circumference (HC). RESULTS: all fissure measurements were linearly correlated with gestational age (Sylvian: R²=0.5; parieto-occiptal: R²= 0.7; hippocampus: R²= 0.3 and calcarine: R²= 0.3). Mean fissure measurement ranged from 7.0 to 14.0 mm, 15.9 to 28.7 mm, 15.4 to 25.4 mm and 15.7 to 24.8 mm for the Sylvian, parieto-occiptal, hippocampus and calcarine fissures, respectively. The Sylvian and parieto-occiptal fissure measurements had the highest correlations with the BPD (r=0.8 and 0.7, respectively) and HC (r=0.7 and 0.8, respectively). CONCLUSION: the distance from the fetal cerebral fissures to the inner edge of the skull measured by 3DUS was positively correlated with gestational age.

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    Fetal brain fissures development a three-dimensional ultrasonography study
  • Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

    Rev Bras Ginecol Obstet. 2013;35(3):117-122

    Summary

    Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

    Rev Bras Ginecol Obstet. 2013;35(3):117-122

    DOI 10.1590/S0100-72032013000300005

    Views2

    PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

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    Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

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