Reprodu??o & Climatério最新文献

Objectives

To evaluate the occurrence of maternal brain centralization in pregnant women with specific gestational hypertension; to establish normal values of the ratio of the uterine artery with (mean and standard deviation) ophthalmic artery; to compare the ratio of uterine to the ophthalmic artery with normal and abnormal groups; and to establish the Receiver Operator Curve (ROC) for diagnosis of patients with specific hypertensive disease of pregnancy.

Methods

To achieve the proposed objectives a case–control study was carried out where the sample consisted of 178 pregnant patients divided into two groups. The control group included pregnant 83 pregnant normotensive women; a case group included 95 patients with clinical and laboratory diagnoses of specific gestational hypertension.

Results

Patients with preeclampsia had lower values than the patients who had eclampsia. The Doppler parameters that were statistically significant were those of the ratio of uterine artery with the ophthalmic artery (AU/AO) and vice versa. A comparison between the normal curve systole–diastole and the respective cut-off point was performed. A ROC is shown in the cut-off considering the systolic velocity, the diastolic velocity, the systole/diastole relation, and the index of resistance of the ophthalmic artery.

Conclusion

The maternal centralization in high risk pregnancies was observed when specific gestational hypertension is real. The normal curve has a mean and standard deviation of the relative Doppler of the uterine artery to the ophthalmic artery systolic/diastolic ratio was 0.43 ± 0.16 for normal pregnant patients. Comparing the group of patients with normal pathological group of patients there was a statistically significant difference between them considering the relation of Doppler uterine artery with ophthalmic artery. The cut-off point was more sensitive, verified by ROC, which defines maternal brain centralization in patients with specific gestational hypertension as 0.57 for the Doppler systolic/diastolic ratio of the uterine artery compared with the ophthalmic artery, with 78% sensitivity and 13% false positive.

Objectives

This systematic review aimed to evaluate whether Doppler ultrasound of the ophthalmic artery and uterine artery, and ultrasound of flow-mediated dilation of the brachial artery, can be used to effectively assess vascular function in pregnant women without disease or other complications with pre-eclampsia and eclampsia to establish the most appropriate method for evaluating these diseases.

Methods

Two databases were searched for relevant articles: the National Library of Medicine (PubMed) and the Virtual Health Library. Articles published between 1989 and 2014 about Doppler ultrasound of the ophthalmic artery were retrieved; all articles published from 2000 to 2014 about using ultrasound to assess flow-mediated dilation of the brachial artery were retrieved; and for Doppler ultrasound of the uterine artery, only articles published between January 2013 and March 2014 were retrieved because the literature in this area is extensive.

Results

A total of 260 articles were retrieved; 32 were eligible for inclusion. There were 16 articles on using Doppler ultrasound to evaluate the ophthalmic artery and eight about using it to assess the uterine artery, and eight articles evaluated the use of ultrasound to assess flow-mediated dilation of the brachial artery.

Conclusions

Doppler ultrasound is useful in diagnosing pre-eclampsia and eclampsia in pregnant women; the use of this technique makes early intervention feasible, and thereby improves prognosis; and it reduces the morbidity and mortality of pregnant women and their newborns.

Mild clinical signs of hyperandrogenism such as hirsutism may arise during the menopausal transition as part of the aging process. However, development of virilization may be interpreted as the presence a specific source of androgen excess.

66 year‐old menopausal woman, with a record of progressive hirsutism since menopausal age (50 years‐old) exacerbated over the past year. Episodes of metrorrhagia were not valued by the patient. Physical examination showed deepening of voice, frontotemporal alopecia, hirsutism in face, trunk and limbs and hypertrophy of the clitoris.

A transvaginal ultrasound revealed a thickened endometrium and enlarged ovaries considering her age and analytical study showed an increase of total testosterone (225ng/dL). No changes were detected at computerized tomography of adrenals and cerebral magnetic resonance. Performed an hysteroscopy with removal of endometrial polyp, associated to simple endometrial hyperplasia without atypia. The histological diagnosis after hysterectomy and bilateral salpingo‐oophorectomy, revealed a ovarian hyperthecosis. Six months after surgery it was observed a testosterone within the normal range, marked hirsutism reduction and alopecia improvement.

Diagnosis of hyperandrogenism in postmenopausal is a challenging task. Imaging techniques do not always reveal the source of excess androgens. The ovarian hyperthecosis treatment effectively improves hirsutism and reduces the risk of hormone‐dependent tumors.

Introduction

Estimates of induced abortion in Brazil were inaccurate until the early 1990, varying between 300 million and 3.3 million clandestine abortions. In 2000, were estimated 22.3 abortions induced by 1000 women in Brazil, using the methodology proposed by the Alan Guttmacher Institute.

Objective

Update estimates of induced abortion in Brazil during the period of 1995 to 2013.

Method

The primary data source was the number of hospitalizations for abortion registered in the Hospital Information System of the Unified Health System, disaggregated by region and age group. The number of induced abortions has been estimated by interval upper limit, multiplying by five the number of hospitalizations, and by lower bound, by multiplying by four the number of hospitalizations. It was considered under percentage record of 12.5% and the proportion of miscarriages of 25%.

Results

Between 1995 and 2013, the hospitalizations of women from 10 to 49 years by complications from abortion decreased by 27% and the estimate of the annual number of induced abortions declined 26%. It was observed decline of upper limit of induced abortion ratio of 27/1000 women for 16/1000. The same was noticed for the lower bound of 21/12/1000 to 1000. In the two regions with the highest number of hospitalizations for complications of abortion, Northeast and Southeast, showed significant reduction in the number of cases of 35% and 27% respectively. Found a great reduction in the risk of induced abortion, of 43% between 15 and 29 years, 49% between 20 and 29 years old, 26% between 30 and 39 years and 50% of 40 to 49 years. The estimation of induced abortions decreased from 864,628 to 687,347 (lower limit), and from 1,086,708 to 865,160 (upper limit).

Conclusion

Both the reason of abortion per 100 live births and the rate of induced abortions per thousand women aged 15 to 49 years in Brazil showed decrease in the studied period.

Metastatic disease involving the uterus is rare. Typically it is the ovaries that are involved and the primary tumor is usually the breast or the gastrointestinal tract.

Case report

We describe a case of metastatic breast carcinoma involving the uterus in a patient who had had a bilateral mastectomy due to invasive carcinoma NOS more than thirty years ago. Histological assessment of the hysteroscopy biopsy specimen including immunohistochemistry staining confirmed the breast carcinoma as the primary lesion, however it was classified as lobular carcinoma. The patient refused surgery or other invasive procedures, having complied nevertheless to follow up with clinical and ultrasound evaluation.

Conclusion

Metastatic breast disease to the feminine genital tract is more frequently due to lobular invasive carcinoma. We present a case of uterine metastization of invasive lobular carcinoma more than thirty years since the primary tumor, which was classified as invasive carcinoma NOS and confirmed by histological revision. It is of great importance to give the pathologist the correct information about the patient, namely of any oncologic background, so differential diagnosis can be made.

Cabergoline is a dopaminergic agonist and exhibits a suppression effect on prolactin. It is used to treat hyperprolactinemia in infertile patients and to prevent the ovarian hyperstimulation syndrome in vitro fertilization cycles.

Objetive

A systematic review on the literature looking for studies that evaluate the safety use of Cabergoline in the embryogenesis and in pregnancy.

Method

Systematic review of articles published in last 23 years that try to establish the relationship between the use of Cabergoline in the gestational period with a possible teratogenic effect. The papers were available in the following scientific databases: Medline, Lilacs e Scielo. The key words used were cabergoline, pregnancy and teratogen.

Results

Twelve articles published from 1994 to 2013 were selected. It has been found that 800 pregnant women were exposed to cabergoline. Most of the papers analysed showed that the cabergoline is a safety alternative for theconceptus and for the pregnancy outcome. Its use did not increase the risk of fetal malformation, miscarriage and premature birth.

Conclusion

Data regarding the use of cabergoline during pregnancy have become increasingly consistent, and most articles have demonstrated the reliability and safety of this drug.

Objectives

To evaluate the effects of ablation of steroid production and the role of testosterone and dihydrotestosterone in the development of secondary follicles of nonhuman primates (Macaca mulatta) in 3 D matrix.

Methods

The ovarian cortex (n = 8 adult females) was diced and secondary follicles were isolated and cultured individually for 40 days on alginate matrix. Experiment 1: Ablation of steroid production with use of trilostane (TRL) and testosterone replacement. Follicles of 4 animals were assigned to 4 groups: control (vehicle), TRL (TRL from the start of culture), Low testosterone (T) (TRL testosterone and 10 ng/mL), high T (TRL testosterone and 50 ng/mL); Experiment 2: Ablation of steroid production with use of trilostane (TRL) and replacement of dihydrotestosterone (DHT). Follicles of 4 animals were assigned to 4 groups: control (vehicle), TRL (TRL from the start of culture), DHT (DHT 50 ng/mL), DHT + TRL (TRL and DHT 50 ng/mL). It were analyzed: survival, growth, antrum formation, steroid hormone production, and degree of maturation and quality of oocytes.

Results

The percentage of surviving follicles in culture, growth and antrum formation was lower in the presence of TRL in all experiments, compared with the control group. Replacement of T and DHT in the presence of TRL, recovered survival, growth, antrum formation, hormone production, and the quality and maturity of oocytes comparable to the control group. DHT added to standard maturation media promoted an increase in the percentage of survival follicles and antrum formation compared to the control group.

Conclusions

This study provided evidence of the role of androgens since the beginning of folliculogenesis in primates, reinforcing the existence of molecular mechanisms regulating androgenic activity, and new interactions between androgens and steroid hormones. Our findings show that T and DHT can recover survival, growth, antrum formation, hormone production and oocyte viability of in vitro cultured preantral follicles exposed to ablation of steroid production. DHT added to standard maturation media promoted an increase in the percentage of follicle survival and antrum formation compared to the control group, opening perspectives to evaluate whether this androgen supplementation could improve follicular development in vitro. The knowledge obtained contribute to a understanding of the dynamics of folliculogenesis in primates, still poorly understood, and assists in identifying the optimal conditions for growing follicle, which may in future be applied to assist cancer patients who wish to preserve their future fertility

Objective

To evaluate the effectiveness of misoprostol protocol on abortion of pregnancies resulting from sexual violence.

Method

Retrospective study with a convenience sample of 253 patients with pregnancy between 13 and 22 weeks of pregnancy who underwent legal abortion in the Hospital Pérola Byington, São Paulo, Brazil, between January 2008 and December 2014. Doses of misoprostol 400 μg (13–17 weeks of gestation) and 200 μg (18–22 weeks of gestation) were administered vaginally every 12 h. The dose was doubled after two doses of no response and maintained for up to four days. In the absence of fetal expulsion, a second cycle of misoprostol was conducted after a 72-h pause. The failure of misoprostol was considered complete after two cycles without fetal elimination. The outcome was complete or incomplete fetal expulsion, evaluated in number of days and misoprostol dose required for abortion. Data were entered in Microsoft Excel 2010 program.

Results

The age ranged from 11 to 44 years of age, average 22.6 ± 8.2 years of age, with the mean gestational age of 16.8 ± 2.6 weeks. Abortion occurred in 248 cases (98.0%) with an average of 1468.8 μg of misoprostol. The analysis of the dispersion of the total dose of misoprostol indicates no significant change with increasing gestational age (y = 0.9475x + 1453) (R² = 0.0001). The average induction time was 2.3 days and in 81.8% of the cases abortion occurred in the first 72 h. Excessive and immediate uterine bleeding after fetal elimination was observed in 2.6% of the cases.

Conclusion

Misoprostol protocol used was effective and safe for second trimester abortion in pregnancy resulting from sexual violence.