Showing papers in "Revista Brasileira de Ginecologia e Obstetrícia in 2000"

Métodos de tratamento utilizados na incontinência urinária de esforço genuína: um estudo comparativo entre cinesioterapia e eletroestimulação endovaginal

Abstract: Objetivos: comparar pacientes portadoras de incontinencia urinaria de esforco genuina (IUEG) que se submeteram a um protocolo de cinesioterapia para reforco perineal aquelas que se submeteram a eletroestimulacao endovaginal (EEEV). O objetivo foi tracar uma conduta de tratamento fisioterapico mais adequada para tal enfermidade. Metodos: foram selecionadas 14 pacientes portadoras de IUEG, com idade entre 31 e 64 anos, sendo divididas em dois grupos de 7 mulheres cada. Cada grupo foi submetido a um dos protocolos de tratamento ambulatorial diario durante 10 dias consecutivos. As pacientes foram avaliadas e reavaliadas por somente uma fisioterapeuta. Para as analises estatisticas foram utilizados testes nao-parametricos. Resultados: todas pacientes obtiveram uma melhora parcial ou total da IUEG com 10 sessoes fisioterapicas consecutivas, considerando os criterios objetivos e subjetivos de avaliacao. Conclusao: tanto a cinesioterapia quanto a EEEV se mostraram efetivas no tratamento da IUEG, porem, a cinesioterapia para reforco perineal apresentou uma tendencia para ser o tratamento de escolha.

Mastite Puerperal: Estudo de Fatores Predisponentes

Abstract: Purpose: to investigate clinical and bacteriological aspects, follow-up and treatment of mastitis in our clinic. Methods: this study was performed at Cleriston Andrade General Hospital. Patients were interviewed regarding personal data, prenatal care, care received during delivery and puerperium and clinical aspects. Their mastitides were classified by Vinha's criteria. The patients with abscesses had them drained for bacteriological study. Culture medium Tryptone Soya Broth was used. Results: seventy nursing mothers were interviewed; 57% of them had given birth for the first time, 57% were between 20 and 29 years old, 51% had not finished elementary school, 63% had income less than the minimum wage, 66% of them had nobody to help with the housework. Out of the seventy females, 50% had not had their breasts examined. Approximately half of them had not been told how to breastfeed (50%) or how to express breast milk (58%). Sixty-three percent had not delivered in institutions designated by WHO as "Children's Friends Hospitals". Engorgement occurred in 46% of the cases and nipple fissures in 47%. According to Vinha's criteria, 44% had lobar, 39% ampular and 17% glandular locations. Presence of Staphylococcus aureus was detected in 55% of the cases. Conclusion: factors such as low schooling, low incomes, no assistance in housework, giving birth for the first time and lack of professional help contributed to occurrence of mastitis.

Test-retest Reliability in Application of the Blatt and Kupperman Menopausal Index

Abstract: Purpose: based on the knowledge that the reliability of an instrument is essential for a correct interpretation of the results of research, the purpose of the present study is to evaluate the reliability of one of the menopausal indexes more often used in clinical practice and research, the Blatt and Kupperman Menopausal Index (BKMI). Methods: the population consisted of 60 climacteric patients attended at the Gynecology Outpatient Clinic of the Lauro Wanderley University Hospital of the Federal University of Paraiba in Joao Pessoa city. The reliability coefficient was analyzed by the test-retest method, whose application was done on two different occasions with an interval of four weeks, without administration of medicines. Results: the variation of the score observed with the application of BKMI at the first measurement was 2 to 41, with a median of 18 and mean of 18.8 (± 10.76), while at the second measurement, the menopausal index was 20.2 (± 10.51), median 19, and values ranging from 2 to 39. Despite these results, a Speaman (rs) coefficient of 0.68 (p = 0.001), which is a coefficient of only moderate intensity, was observed. Conclusions: the test-retest reliability in the application of the BKMI shows that, although this instrument presented a statistically moderate reliability, the intensity observed does not represent a reliable measurement. Considering that a correlational study is only a type of screening of the quality of a measurement method, we concluded that other studies must be performed with the purpose of evaluating the reliability and the validity of the BKMI. It is possible that the attribuition of different values to the items of BKMI and the inclusion of symptoms directly related to the estrogenic defficiency, like symptoms of vaginal atrophy, would make the instrument more reliable.

Prevalência dos Sintomas da Síndrome Pré-Menstrual

Abstract: Purpose: to analyze the symptoms of premenstrual syndrome (PMS), its duration, time of presentation and pathogenesis. Methods: a questionnaire was applied to 254 women aged 20 to 44 years, without gynecological or clinical conditions affecting their general state or physical well-being, excluding those with amenorreha for more than six months, hysterectomized or pregnant. Results: one hundred and ten women (43.3%) describing at least one intense symptom causing harm to their life, were considered as having PMS. Irritability was presented by 86.4%, tiredness by 70.9%, depression by 61.8%, headache by 61.8%, breast tenderness by 59.1% and abdominal pain by 54.5%. Almost all (94.5%) had more that one symptom, 89.1% presented psychological complaints, and 76.4% associated physical and psychological complaints. Most declared that duration of the symptoms was three to four days (32.4%) or five to seven days (31.4%). Conclusions: the clinical picture of PMS is generally composed of irritability and/or depression, associated with tiredness and headache or breast pain, there being association of physical and psychological symptoms, for 3 to 7 days, and it is difficult to attribute a single etiology to it at this stage of knowledge.

O Risco para Queixas Ginecológicas e Disfunções Sexuais Segundo História de Violência Sexual

Abstract: 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 Sumare, in the state of Sao 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 c2 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.

Fatores Associados à Realização de Cesárea em Primíparas com uma Cesárea Anterior

Abstract: Objetivo: avaliar a via de parto em um grupo de gestantes primiparas de baixa renda com uma cesarea anterior e os fatores associados a repeticao da cesarea no segundo parto. Pacientes e Metodos: realizou-se um estudo caso-controle com 356 gestantes atendidas de janeiro de 1993 a janeiro de 1996 na Maternidade do CAISM/UNICAMP. Constituiram os casos as 153 gestantes que tiveram o segundo parto por cesarea, e os controles, as 203 que tiveram o segundo parto vaginal. Para a analise utilizaram-se medias, desvio padrao, teste t de Student, teste de Mann-Whitney, c2 e "odds ratio" (OR) e IC 95% para cada possivel fator associado a realizacao de cesarea no segundo parto. Resultados: a via do segundo parto foi vaginal em 57% das vezes. Dentre as diversas variaveis estudadas, as que mostraram estar significativamente associadas a realizacao de cesarea no segundo parto foram: maior idade materna (para mulheres com 35 anos ou mais, OR = 16,4), antecedente de abortamento (OR = 2,09), inducao do trabalho de parto (OR = 3,83), rotura prematura de membranas (OR = 2 ,83), a nao-realizacao de analgesia durante o periodo de dilatacao (OR = 5,3), o diagnostico de algum sinal de vitalidade fetal alterada (OR = 2,7) e a ocorrencia do parto a tarde (OR = 1,92). Conclusoes: os resultados indicam que os fatores associados a repeticao de cesarea em mulheres com uma cicatriz de cesarea nesta populacao sao predominantemente medicos, mas ha a possibilidade de se proporem intervencoes dirigidas a diminuir o indice de repeticao de cesareas.

Malformações Fetais em Gestação Múltipla

Abstract: Objetivos: demonstrar os tipos de malformacoes em gestacoes multiplas assim como a influencia da corionicidade nestes casos. Metodos: foram analisadas 169 gestacoes multiplas submetidas a avaliacao ultra-sonografica no Setor de Medicina Fetal da Clinica Obstetricia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo no periodo de janeiro de 1997 a janeiro de 1999. A corionicidade foi definida por meio de ultra-sonografia no primeiro trimestre, presenca de placentas separadas, sexos diferentes ou exame anatomopatologico da placenta. Resultados: do total de gestacoes, 24 apresentavam malformacoes fetais (14,2%) sendo 22 em gestacoes duplas e 2 em gestacoes triplas. Das gestacoes gemelares que apresentavam malformacoes fetais, 13 eram monocorionicas, 4 dicorionicas e em 5 a corionicidade nao era conhecida. Os tipos de malformacoes fetais foram aquelas associadas unicamente a gestacoes multiplas (gemeos unidos, n = 5; gemeo acardico, n = 3) e as que tambem ocorrem em gestacoes unicas. A idade gestacional do parto de fetos com anomalias foi menor em relacao aos sem anomalias. Conclusoes: a maioria das malformacoes congenitas ocorreu em gestacoes monocorionicas. A determinacao precoce do tipo de placentacao e util no estabelecimento do prognostico de gestacoes gemelares, permitindo o planejamento das condutas em gestacoes complicadas por anomalias congenitas.

Análise da Mortalidade Evitável de Mulheres em Idade Reprodutiva

Abstract: 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.

Avaliação da Vitalidade Fetal em Gestantes Diabéticas: Análise dos Resultados Neonatais

Abstract: Objetivos: estudar os testes de avaliacao da vitalidade fetal em gestantes diabeticas e relacionar com os resultados neonatais. Metodos: estudamos 387 gestantes diabeticas atendidas no Setor de Vitalidade Fetal. O ultimo exame (cardiotocografia, perfil biofisico fetal, indice de liquido amniotico e dopplervelocimetria) foi relacionado com os resultados neonatais. Resultados: a populacao foi de 46 gestantes diabeticas tipo I (12%), 45 tipo II (12%) e 296 gestacionais (76%). Entre as do tipo I, a cardiotocografia suspeita ou alterada correlacionou-se com Apgar de 1o minuto alterado (50 e 75%; p<0,05) e com a necessidade de UTI neonatal (50 e 75%; p<0,05). Nos casos do tipo II, a necessidade de UTI neonatal foi significativamente maior (p<0,05) entre aqueles com perfil biofisico fetal alterado (67%); a dopplervelocimetria da arteria umbilical anormal correlacionou-se com Apgar de 1o minuto alterado (67%; p<0,05). As diabeticas gestacionais com a cardiotocografia alterada apresentaram Apgar de 1o minuto anormal em 36% (p<0,05), Apgar de 5o minuto anormal em 18% (p<0,01) e obito neonatal em 18% (p<0,01). As com indice de liquido amniotico alterado correlacionaram-se com Apgar de 5o minuto anormal (p<0,05) e necessidade de UTI neonatal (p<0,05) e as com dopplervelocimetria da arteria umbilical alterada correlacionaram-se (p<0,05) com Apgar de 1o e 5o minuto alterado (respectivamente 25 e 8%), necessidade de UTI neonatal (17%) e obito neonatal (8%). Conclusoes: os resultados anormais nos testes de avaliacao da vitalidade fetal correlacionaram-se com os resultados neonatais adversos.

Subnotificação da mortalidade materna em Campinas: 1992 a 1994

Abstract: Objetivos: identificar e investigar a subnotificacao da mortalidade materna, a partir das declaracoes de obito (DO) com causa presumivel para morte materna em mulheres de 10 a 49 anos, residentes em Campinas, Sao Paulo, no periodo de 1992 a 1994. Metodos: foram selecionadas, dentre as 1032 DO de mulheres com idade entre 10 e 49 anos, 216 cuja causa de morte era associada a gravidez declarada ou presumivel. Procedeu-se entao a busca ativa da causa materna em prontuarios clinicos, servico de verificacao de obito e domicilios. Resultados: foram identificados oito casos adicionais de morte materna dentre as 204 DO com causa materna presumivel, o que correspondeu a uma subnotificacao de 40% ou a um fator de correcao de 1,67 sobre a RMM "oficial". A principal causa de obito com subnotificacao (71,5% ou 5/7 casos) correspondeu a complicacoes infecciosas do aborto, seguida pela morte materna obstetrica indireta (66,6% ou 2/3 casos). Conclusoes: a DO nao pode ser considerada como unica fonte para identificacao da morte materna, sendo necessaria a investigacao complementar das causas presumiveis. A falta de legislacao local, alem dos aspectos religiosos e sociais, pode estar influindo na omissao do aborto como causa de morte materna.

Fatores Associados à Obesidade e ao Padrão Andróide de Distribuição da Gordura Corporal em Mulheres Climatéricas

Abstract: Purpose: to describe sociodemographic characteristics of a group of climacteric women in order to discover the frequency and the variables associated with obesity and android profile of body fat distribution. Methods: an observational study was carried out in 518 patients aged 45 to 65 years, in a climacterium outpatient clinic. Age, color, menopausal status, duration of menopause, physical activity, smoking status, diet, alcohol intake, personal and family antecedents of arterial hypertension, diabetes mellitus, cardiovascular disease, dyslipidemia and obesity were considered. Body mass index and the waist/hip ratio were the dependent variables. For the statistical analysis Wilcoxon test, Pearson's correlation coefficient, with a 5% level of significance, and multivariate analysis using regression model were used. Results: more than two thirds of the participants were nonobese with an android profile and postmenopausal. One fourth had physical activity and were smokers; half reported an inadequate diet and one fifth were alcoholics. Patients with an android profile presented higher mean age than women with gynecoid pattern. Personal antecedents of obesity, arterial hypertension, diabetes and family history of diabetes were related to obesity and android pattern. Postmenopausal status was significantly associated with the android profile. Conclusions: the majority of the participants were nonobese with an android profile, white, postmenopausal, sedentary, neither smokers nor alcoholics. The main factors related to obesity and android pattern were personal antecedents of obesity, arterial hypertension, diabetes, family history of diabetes and particularly, postmenopausal status with android profile.

Freqüência de Neoplasia Intra-epitelial Cervical em Portadoras do Vírus da Imunodeficiência Humana

Abstract: 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.

Aspectos Morfológicos e Morfométricos do Colo Uterino de Ratas Ooforectomizadas após Aplicação de Óleo de Copaíba

Abstract: Purpose: to study the effect of copaiba oil on the uterine cervix of oophorectomized rats. Method: 120 female adults were used, divided into four groups: control, water, corn oil and copaiba oil. All animals were submitted to bilateral oophorectomy, and kept in cages for twenty days before applying the substances. These substances were applied by vaginal route at a dose of 0.3 ml, once a day until the predetermined day of sacrifice (7, 14 e 21 days). Results: the animals from the copaiba oil group showed on all days of the study exuberant, keratinous stratified squamous epithelium with about 10 epithelial cell layers and the chorion with conjunctive tissue, fibroblasts, collagen fibers, blood vessels and some leukocytes. Conclusions: The copaiba oil used in this experimental model promoted a thickening of the epithelium, which was keratinous stratified squamous, and epithelium increase was progressive along the study.

Fatores Associados ao Aborto Espontâneo Recorrente

Abstract: Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatorio de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients), represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%), followed by hormonal factor (21.2%), mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.

Avaliação do Risco de Parto Prematuro: Teste da Fibronectina Fetal e Medida do Colo Uterino

Abstract: Objetivo: avaliar o risco de parto prematuro em gestantes com antecedentes de parto pre-termo espontâneo por meio do teste da fibronectina fetal e da medida do colo uterino pela ultra-sonografia transvaginal. Metodos: foram relacionadas 107 gestantes na 24a, 28a e 32a semana de gestacao para realizacao do teste da fibronectina fetal no conteudo cervico- vaginal. No mesmo periodo, o comprimento do colo uterino foi medido, entre o orificio interno e externo, pela ultra-sonografia transvaginal. Consideramos o colo curto quando a medida da cervice foi menor ou igual ao ponto de corte estabelecido pela curva ROC ("receiver-operating characteristic") para predicao do parto prematuro. Comparamos o resultado dos exames com a ocorrencia do parto antes de 34 e 37 semanas de gestacao. Resultados: a incidencia do parto prematuro foi de 37,4% (40/107). O melhor ponto de corte do comprimento do colo uterino indicado pela curva ROC para maximizar sensibilidade e especificidade foi 30 mm para 24 e 28 semanas de gestacao e 25 mm para 32 semanas. O teste positivo da fibronectina fetal teve um risco relativo (RR) significante apenas na 28a semana (RR: 1,77; intervalo de confianca (IC) 95%: 1,10-2,84) para a ocorrencia do parto antes de 37 semanas. O colo curto mostrou um RR significativo para ocorrencia do parto antes de 37 semanas, na 24a, 28a e 32a semana. O RR foi mais elevado quando o colo curto esteve presente na 24a semana para ocorrencia do parto antes de 34 semanas (RR: 4,42; IC 95%: 1,25-15,56). Conclusao: em pacientes com antecedentes de prematuridade espontânea, a medida do comprimento do colo uterino por meio da ultra-sonografia transvaginal e melhor que o teste da fibronectina fetal para avaliar o risco de parto prematuro.

Estudo Comparativo dos Resultados Maternos e Perinatais entre Pacientes com Diabetes Pré-gestacional Tipo I e Tipo II

Abstract: Purpose: to evaluate the evolution of gestation, metabolic control and perinatal outcome of pregestational diabetic patients and to perform a comparative study of the results of patients with insulin-dependent diabetes (type I) and non-insulin-dependent diabetes (type II). Methods: retrospective analysis of 57 pregestational diabetic woman charts who began a prenatal follow-up in the Service of Maternofetal Medicine of the Maternidade-Escola Assis Chateaubriand of the Universidade Federal do Ceara, in the period from January 1995 to December 1998. The 57 pregnant women included in the study were divided into groups: the first, composed of 28 patients with insulin-dependent diabetes (type I), and the second with 29 pregnant women with non-insulin-dependent diabetes (type II), controlled with diet or with oral hypoglycemics before pregnancy. Results: there was no statistically significant difference between the two groups in relation to the need of hospitalization for glycemia control (39.2% x 27.5%) and maternal complications, such as: chronic arterial hypertension (14.2% x 27.5%), pregnancy-induced hypertension (14.2% x 17.2%), premature rupture of membranes (3.5% x 10.3%), urinary tract infection (10.7% x 6.8%), and preterm labor (3.5% x 6.8%). However, episodes of maternal hypoglycemia were more frequent among insulin-dependent patients (35.7% x 3.4%). The perinatal results were similar. We observed a great number of congenital anomalies and increased perinatal morbidity and mortality. Conclusion: there was no difference in the incidence of obstetric and clinical complications between insulin-dependent and non-insulin-dependent patients, except for maternal hypoglycemia.

Comparação dos resultados do tratamento cirúrgico da incontinência urinária de esforço por três diferentes técnicas cirúrgicas

Abstract: Objetivo: analisar a prevalencia de recidivas de incontinencia urinaria de esforco (IUE) tratada com diferentes tecnicas cirurgicas apos pelo menos 2 anos de seguimento. Pacientes e Metodos: avaliamos 55 pacientes com diagnostico de IUE que submeteram-se a cirurgia para sua correcao no Servico de Ginecologia do Hospital de Clinicas de Porto Alegre, no periodo de 1992 a 1996. O seguimento pos-cirurgico nesse Servico foi superior a 2 anos. As pacientes foram divididas em 3 grupos conforme a tecnica cirurgica empregada: Kelly-Kennedy (n = 24), Burch (n = 23) e Marshall-Marchetti-Krantz (n = 8). Resultados: nao foram encontradas diferencas significativas quanto ao tempo de recidiva, idade na epoca da cirurgia e da recidiva, estado menopausal, uso de terapia de reposicao hormonal (TRH), numero de gestacoes e antecedentes de parto via vaginal. O numero de casos com perineoplastia posterior foi maior no grupo de cirurgia de Kelly-Kennedy, sem, contudo, influir na recidiva. O grupo de cirurgia de Burch apresentou um tempo de menopausa maior quando da cirurgia (p<0,05). Conclusao: a taxa de recidiva com emprego das tecnicas de Kelly-Kennedy, Burch e Marshall-Marchetti-Krantz foi respectivamente 29,2, 39,1 e 50%, nao diferindo do ponto de vista estatistico. A pesquisa de modificadores de risco para a incontinencia urinaria genuina nao foi estatisticamente diferente nos tres grupos estudados. Observou-se, contudo, que a totalidade das pacientes com cirurgia previa recidivaram.

Correlation between the Assessment of Fetal Well-being, Umbilical Artery pH at Birth and the Neonatal Results in High-risk Pregnancies

Abstract: Purpose: to analyze the relationship between the values of pH at birth, fetal surveillance examinatios and neonatal results. Methods: one thousand, three hundred and forty-six high-risk pregnancies were evaluated at the Fetal Surveillance Unit. The assessment of fetal well-being included cardiotocography, fetal biophysical profile and amniotic fluid index. After birth, the perinatal results (gestational age at birth, birth weight, Apgar scores at 1st and 5th minutes, umbilical cord pH at birth) were collected. To study the results, the patients were divided into four groups: G1 (pH <7.05), G2 (pH between 7.05 and 7.14), G3 (pH between 7.15 and 7.19) and G4 (pH ³7.20). Results: the abnormal patterns of cardiotocography were associated with pH at birth inferior to 7.20 (p = 0.001). Abnormal results of the fetal biophysical profile (£4) were related to decrease in pH values at birth (p<0.001). The adverse neonatal outcomes were associated with acidosis at birth, and they were selected to be analyzed by the logistic regression model, showing that the odds ratio of each adverse neonatal outcome increases significantly when the values of pH at birth decrease. Conclusions: significant correlation was found between the values of pH at birth and adverse neonatal results, providing the possibility to estimate the risk of neonatal complications according to the pH values at birth.

Tratamento da Eclâmpsia: Estudo Comparativo entre o Sulfato de Magnésio e a Fenitoína

Abstract: Objetivos: comparar a eficacia do sulfato de magnesio e da fenitoina no controle das convulsoes em pacientes com eclâmpsia e avaliar os efeitos de sulfato de magnesio e da fenitoina sobre o prognostico materno e perinatal em pacientes com eclâmpsia. Metodos: estudo prospectivo, randomico e controlado no qual foram analisados, de forma comparativa, os resultados obtidos no tratamento anticonvulsivante da eclâmpsia em 77 mulheres tratadas com sulfato de magnesio ou fenitoina. As drogas que constituiram os dois esquemas terapeuticos foram distribuidas, na proporcao de um para um, em caixas numeradas aleatoriamente que apresentavam caracteristicas semelhantes. A medida que cada paciente era admitida, uma caixa era aberta e o esquema nela contido administrado a paciente. Resultados: observou-se que, no grupo tratado com sulfato de magnesio, 19,5% das pacientes apresentaram recidiva de convulsoes, ao passo que no grupo que usou fenitoina, 36,1% manifestaram novas crises (p 0,05). Conclusoes: o sulfato de magnesio mostrou-se mais eficaz que a fenitoina no controle e prevencao da recidiva de convulsoes em pacientes com eclâmpsia, embora sua utilizacao esteja associada a maior prevalencia materna de hemorragia pos-parto e desconforto respiratorio neonatal. A fenitoina apresenta-se como droga alternativa para o tratamento de eclâmpsia nos casos em que houver contra-indicacao ao uso do sulfato de magnesio.

Perfil Lipídico em Pacientes Portadoras da Síndrome dos Ovários Policísticos

Abstract: Purpose: to evaluate the lipid profile (cholesterol, triglycerides, HDL and LDL) of women with polycystic ovary syndrome (PCO) and compare it to that of women with ovulatory menstrual cycles. Methods: the patients were divided into two groups, obese and nonobese, based on body mass index, so that it would be possible to determine the joint effect of PCO and obesity on the lipid metabolism of the studied women. We studied 117 women divided into 4 groups: group I (PCO¾obese), n = 33; group II (PCO¾nonobese), n = 27; group III (control¾obese), n = 28; group IV (control¾nonobese), n = 29. Results: cholesterol levels were elevated (179 mg/dl) in obese patients with ovulatory cycles (group III) compared to group I (147 mg/dl) and group II (149 mg/dl), as also were triglyceride levels (117 mg/dl) compared to group IV (77 mg/dl) and LDL levels (117 mg/dl) compared to group I (82 mg/dl). Conclusion: these data suggest that alterations in lipid profile are related to obesity only.

Complicações da gestação e do parto como fatores de risco de óbito perinatal

Abstract: Objetivo: avaliar as complicacoes clinicas da gestacao e as complicacoes do parto como fatores de risco de obito perinatal. Metodologia - Pacientes: os casos (obitos perinatais) foram identificados a partir de 3.031 partos assistidos em maternidade de nivel terciario (Hospital da Policia Militar do Estado do Rio de Janeiro, PMERJ). Apos cada caso foram selecionados 3 controles de forma sequencial. Metodos: o delineamento foi de caso-controle aninhado. Casos (n = 82) foram obitos perinatais com minimo de 28 semanas de idade gestacional ou 1.000 g de peso. Controles (n = 246) foram recem-nascidos vivos ate uma semana de vida. A variavel dependente foi obito perinatal (28 sem - 7 dias de nascido). Foram variaveis independentes (fatores de risco): idade gestacional, peso do recem-nascido, complicacoes da gravidez e complicacoes do parto. A analise foi feita em tres etapas: univariada, estratificada e multivariada (regressao logistica). Resultados: foi observada uma razao de chances de 4,21 para as complicacoes da gravidez e de 5,26 para as complicacoes do parto. O peso do recem-nascido mostrou OR = 0,999 por grama acima de 1.000 g. A idade gestacional mostrou OR = 0,729 por semana acima de 28. Conclusoes: as complicacoes da gravidez e as complicacoes do parto sao fatores de risco para obito perinatal. A idade gestacional e o peso do recem-nascido comportaram-se como fatores de protecao para o obito perinatal.

Avaliação da Cavidade Uterina: Estudo Comparativo entre Histerografia, Histerossonografia e Histeroscopia

Abstract: Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.

Correlação entre o Diagnóstico Histológico da Biópsia e o da Conização por Cirurgia de Alta Freqüência por Alça (CAF) no Tratamento da Neoplasia Intra-epitelial Cervical

Abstract: Objetivos: avaliar a utilizacao da conizacao por cirurgia de alta frequencia por alca (CAF) na neoplasia intra-epitelial cervical (NIC), a importância do comprometimento das margens de resseccao e o seguimento das pacientes. Metodos: foram avaliadas 95 mulheres submetidas a CAF por NIC entre janeiro de 1996 e dezembro de 1997. Para analise estatistica, utilizamos o coeficiente de concordância kappa e o teste de tendencia de Cochran Armitage. Resultados: dos 63 casos submetidos a biopsia dirigida antes da conizacao, o cone por CAF apresentou lesoes mais graves que a biopsia em 24 casos, sendo um caso microinvasor, e em 8 mulheres a biopsia eliminou a lesao. Entre as pacientes submetidas a conizacao com biopsia previa compativel com cervicite ou NIC 1, 14/25 (56%) apresentavam NIC 2 ou 3. Das 32 mulheres que nao tinham biopsia previa, 15 apresentavam NIC 2 ou 3, e quatro, carcinoma microinvasor no cone. Em relacao as margens do cone, 25 casos (26%) apresentaram margens endocervicais comprometidas e quanto maior o grau da lesao cervical maior a possibilidade de presenca de lesao nas margens (p = 0,024). Dessas pacientes, 2 de 10 submetidas a novo procedimento apresentavam doenca residual na peca cirurgica. Entre as 70 pacientes com margens livres foram realizadas tres conizacoes a frio e uma histerectomia e duas apresentavam doenca residual na peca cirurgica. Conclusoes: a conizacao por CAF sem biopsia previa depende da combinacao entre o diagnostico citologico e a experiencia do colposcopista e, em principio, deve ser reservada para os casos em que a colpocitologia e a colposcopia sao concordantes e compativeis com NIC 2 ou 3. Por outro lado, a ampliacao cirurgica pos-CAF no tratamento da NIC nao e determinada exclusivamente pelo comprometimento das margens, mas sim pelo seguimento, excluindo-se os casos de microinvasao e lesoes glandulares que se beneficiam com a avaliacao histologica posterior.

Características das Curvas de Regressão da Gonadotrofina Coriônica Pós-mola Hidatiforme Completa

Abstract: Purpose: to construct a b-human chorionic gonadotropin (b-hCG) regression curve following complete hydatidiform mole (CHM) of patients with spontaneous remission, and then compare it to that of CHM patients with gestational trophoblastic tumor (GTT). Also, to compare the b-hCG regression curve of CHM patients followed-up at the Service to the regression curve of other authors1-3. Methods: clinical and laboratory evaluations (serum determinations of b-hCG) were performed on admission and during post-molar follow-up of CHM patients treated at the University Hospital of Botucatu between 1990 and 1998. The result of the serial b-hCG determinations was analyzed using log regression curves. The evolution of the b-hCG regression curve was analyzed and compared between cases of CHM with spontaneous remission and with GTT using a log regression curve, with 95% confidence interval. The log regression curve of the spontaneous remission group was compared to those of other authors1,2. Individual log curves for each patient were constructed and classified according to the four curve types (I, II, III, and IV) proposed by Goldstein3 for post-molar follow-up. Results: sixty-one patients received complete post-molar follow-up, 50 (82%) showing spontaneous remission and 11 (18%) developing GTT. In the group of patients with CHM and spontaneous remission, the time to return to normal b-hCG levels after mole emptying was 20 weeks. The patients who developed GTT showed early deviation from normal b-hCG regression curve 4 to 6 weeks after mole emptying. These patients received chemotherapy normally starting during the 9th post-mole emptying week. Conclusions: the regression curve of post-CHM b-hCG in patients with spontaneous remission showed a log-exponential decline similar to that observed by other authors1,2, but different from that of CHM patients who developed GTT. Three types of b-hCG regression curves similar to Goldstein's3, I, II, and IV, were identified, as well as two other different types: V (normal regression) and VI (abnormal regression).

Correção da Incontinência Urinária de Esforço com Sling: Resultados Iniciais

Abstract: Purpose: to analyze the surgical results after slings with vaginal wall, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, for the treatment of incontinent women with hypermobility of the bladder neck, who show great risk of surgery failure with other techniques or in those with intrinsic sphincteric deficiency (ISD) and, also, surgery recurrence. Methods: we studied 21 patients submitted to surgery in order to correct urinary incontinence by the vaginal wall sling technique, in the period from December 1997 to February 1999, with postoperative follow-up which varied between 1 and 14 months (average 8.2). The mean age of patients was 56 years (39 to 77 years), 15 (71.4%) were in menopause and 6 (28.6%) in menacme. All patients were evaluated before the surgery through medical interview, physical examination, ultrasound and urodynamic study, the grade of urinary loss being high in 66.7% and moderate in 33.3% of the patients. All patients showed hypermobility of the bladder neck (more than 10 mm) and 12 patients had previous surgery to correct the urinary incontinence. Regarding the urodinamic study, the patients manifested urinary loss with maximum pressure of urethral closure (MPUC) varying from 20 to 124 cmH2O (average 55.2) and Valsalva leak point pressure (VLPP) varying from 18 to 128 cmH2O (average 60.3). The indications of surgery were: ISD (11 patients ¾ 52.4%), obesity (5 patients ¾ 23.8%), ISD and obesity (2 patients ¾ 9.5%), surgery recurrence (2 patients ¾ 9.5) and ISD and first grade womb prolapse (1 patient ¾ 4.8%). Results: as complications, 6 patients (28.6%) showed temporary urinary retention after surgery, 1 patient (4.8%) infection in the urinary tract, 1 patient (4.8%) presence of polypropylene suture in the vagina, 1 patient (4.8%) infection of the surgery wound, 4 patients (19%) developed urgency/incontinence, 1 (4.8%) urgency and 1 (4.8%) difficulty in urinating (high postvoiding residue). The grade of the patients' satisfaction was satisfactory, with 15 patients (71.4%) referring cure, 3 patients (14.3%) improvement, in 2 patients (9.5%) the urinary loss remained unchanged and in 1 patient (4.8%) the urinary loss got worse. Conclusions: the vaginal wall sling surgery is efficient for the treatment of specific cases of stress urinary incontinence, emphasizing intrinsic urethral sphincteric incompetence, surgery recurrence and predisposing factors to failure of other techniques.

Perfuração de Luvas durante Cirurgias Ginecológicas

Abstract: Objetivo: analisar a incidencia de perfuracao de luvas cirurgicas durante atos operatorios ginecologicos. Metodos: estudo prospectivo de 454 luvas usadas em 65 procedimentos utilizando-se o metodo de pressao de agua. Resultados: do total de 454 luvas examinadas, foram verificadas perfuracoes em 54 (11,9%), sendo estatisticamente significativo o maior numero de perfuracoes em comparacao ao grupo controle, uma (1,7%) em 60 analisadas (p<0,05, teste do c2). Das 65 cirurgias, em 29 (44,6%) ocorreram perfuracoes. Com relacao ao tipo de perfuracao, 44 (81,5%) foram simples e 10 (18,5%) foram multiplas (mais de uma perfuracao em uma unica luva), tendo predominio da mao esquerda com 49 (72,1%) perfuracoes. Entre os membros da equipe, o maior indice de perfuracao foi nas luvas dos cirurgioes com 28 ocorrencias (41,1%), seguido dos primeiros auxiliares e instrumentadores, com 15 (22,1%) cada, e segundos auxiliares, com 10 (14,7%). O local da luva onde ocorreu o maior numero de perfuracoes foi o dedo indicador, com 20 (29,5%), seguido do polegar, com 14 (20,6%). A cirurgia que apresentou o maior indice de perfuracao foi a histerectomia total, com 50% dos casos. Conclusoes: a perfuracao de luvas durante cirurgias ginecologicas e frequente. A histerectomia total e a cirurgia que apresenta maior indice de perfuracao. Entre os membros da equipe, o cirurgiao e quem apresenta o maior indice. O dedo indicador e o local da luva que apresenta maior numero de perfuracoes.

Fatores Prognósticos para o Óbito Perinatal em Gestações com Diástole Zero ou Reversa na Dopplervelocimetria das Artérias Umbilicais

Abstract: Purpose: to study the prognostic parameters for perinatal death in pregnancies with absent or reversed end-diastolic flow velocity on umbilical artery dopplervelocimetry. Methods: two hundred and four pregnancies were retrospectively reviewed. The methods used were cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry of ductus venosus, fetal aorta, middle cerebral artery, umbilical arteries and uterine artery. The logistic regression model was applied to one hundred and seventy cases in order to determine the most accurate variable for predicting perinatal death. Results: the mortality rates were: 28 cases of intrauterine fetal death (13.7%) and 45 neonatal deaths (22.1%). A statistically significant correlation was found between death and the studied variables. The perinatal death rate in the group with birth weight below 1,000 g was 74.7%, and in the group with gestational age at delivery below 31 weeks it was 66.3%. By logistic regression, birth weight was the most accurate variable for predicting perinatal death, and a probability curve for death according to this variable was obtained. Conclusions: absent or reversed end-diastolic flow velocity in the umbilical arteries is a severe fetal condition, where the risk of perinatal death is mainly related to birth weight and a gestational age at delivery below 31 weeks.

Achados Ultra-Sonográficos em Pacientes com Ameaça de Abortamento no Primeiro Trimestre da Gestação

Abstract: Objetivo: avaliar os achados ultra-sonograficos nas gestantes com ameaca de abortamento no primeiro trimestre da gestacao. Metodos: exames de ultra-som obstetrico transabdominal e transvaginal foram realizados nas pacientes com sangramento vaginal e teste de gravidez positivo. Foram incluidas as gestantes entre 6 a 14 semanas de gestacao pela data da ultima menstruacao ou pelo exame ultra-sonografico, que apresentavam colo do utero impervio ao exame clinico. Foram excluidas as gestacoes multiplas ou aquelas que realizaram tentativa de abortamento por meio de drogas ou manipulacao. Resultados: em 132 dos 247 casos (53.4%) foi diagnosticada gestacao viavel e em 46.6% (115/247), gestacao inviavel. Abortamento incompleto foi identificado em 19% (47/247), abortamento completo em 8,5% (21/247), abortamento retido em 7,7% (19/247), gestacao anembrionada em 6,1% (15/247), gestacao ectopica em 4,5% (11/247) e mola hidatiforme em 0,8% (2/247). Conclusao: aproximadamente metade (46,6%) das gestacoes com ameaca de abortamento no primeiro trimestre apresentaram diagnostico de inviabilidade da gestacao. O exame ultra-sonografico pode ajudar a definir esta condicao e a conduta obstetrica.

Correlação entre o Diagnóstico Morfológico Pré e Pós-Natal das Nefrouropatias Fetais

Abstract: Objetivo: avaliar a acuidade da ecografia antenatal no diagnostico das nefrouropatias fetais. Pacientes e Metodos: os autores acompanharam prospectivamente 127 gestacoes, referidas ao Centro de Medicina Fetal da UFMG devido a suspeita de anomalia do trato urinario fetal. Procedeu-se entao ao ultra-som morfologico, no qual procurou-se verificar a biometria, padrao de crescimento fetal, vitalidade, malformacoes associadas e, finalmente, uma descricao sistematizada do sistema renal fetal, visando-se estabelecer o diagnostico pre-natal. Este foi posteriormente correlacionado com o diagnostico obtido apos o nascimento. Resultados: utilizando-se o indice kappa (que mede a concordância entre diferentes medidas, metodos ou instrumentos de medicao com os seguintes criterios: abaixo de 0,40, baixa concordância; entre 0,40 e 0,75, concordância razoavel e acima de 0,75, excelente concordância), os autores encontraram excelente indice de concordância global entre o diagnostico pre e pos-natal (indice kappa 95%). Dos 127 casos, houve apenas 9 casos discordantes, todos referentes as uropatias obstrutivas, nos quais o diagnostico pos-natal mostrou diferente nivel de obstrucao (6 casos) ou confusao com rim multicistico (3 casos). Conclusao: o estudo ecografico sistematizado do sistema renal e um metodo eficaz de diagnostico pre-natal das nefrouropatias, permitindo adocao de medidas que visem melhorar a evolucao destes neonatos, desde o encaminhamento para centros especializados, antecipacao do parto (nos casos em agravamento) ate a terapia intra-utero (para preservar a funcao renal ate que seja possivel o nascimento). O estudo ecografico seriado e a amnioinfusao podem ser uteis para melhorar a precisao do diagnostico pre-natal.