Pub Date : 2012-06-01DOI: 10.1590/S0100-72032012000600009
Luiz Gustavo Brito
OBJETIVO: conhecer os fatores motivacionais da mulher portadora de leiomioma uterino que influenciam na decisao por realizar a histerectomia. METODOS: estudo qualitativo com grupos focais. As entrevistas foram coordenadas por um moderador/entrevistador e audiogravadas por um relator/observador no Ambulatorio de Uroginecologia, Cirurgia Ginecologica e Reconstrutiva Pelvica do HCFMRP-USP. A analise foi feita com um processador qualitativo (Atlas TI v 6.2). A tecnica empregada foi a analise de conteudo. O referencial teorico empregado foi a Teoria das Atividades. RESULTADOS: a mulher com leiomioma uterino opta (ou nao) por operar (histerectomia) nao somente por influencia do medico assistente, mas principalmente por fatores motivacionais. Estes foram considerados artefatos de mediacao: o(des) conhecimento sobre a evolucao da doenca, a influencia (positiva ou negativa) da familia e/ou terceiros, as crencas pessoais e o quadro clinico. Porem, isso nao foi encontrado nas mulheres que apresentavam crencas sobre uma alteracao sexual e fisica apos a cirurgia. CONCLUSAO: a mulher portadora de leiomioma uterino deve receber do profissional de saude que a assiste informacoes para um conhecimento adequado sobre a evolucao clinica do leiomioma e sobre todos os tipos de tratamento, seus beneficios e riscos, para que assim possa participar junto ao medico do processo de decisao. Palavras-chave Leiomioma uterino Pesquisa qualitativa Motivacao Conhecimento
摘要目的:了解子宫平滑肌瘤女性决定子宫切除术的动机因素。方法:定性研究与焦点小组。访谈由一名主持人/采访者协调，并由一名报告员/观察员在HCFMRP-USP泌尿妇科、妇科和骨盆重建外科门诊进行录音。使用定性处理器(Atlas TI v 6.2)进行分析。所采用的技术是内容分析。所采用的理论框架是活动理论。结果:子宫平滑肌瘤女性选择(或不选择)手术(子宫切除术)不仅受主治医生的影响，而且主要受动机因素的影响。这些被认为是中介产物:关于疾病演变的知识、家庭和/或第三方的影响(积极或消极)、个人信念和临床情况。然而，在那些认为手术后会发生性和身体变化的女性中并没有发现这一点。结论:子宫平滑肌瘤患者应从卫生专业人员那里获得信息，充分了解平滑肌瘤的临床进展和各种治疗、益处和风险，以便参与医生的决策过程。关键词子宫平滑肌瘤定性研究动机知识
{"title":"Fatores motivacionais da mulher portadora de leiomioma uterino para a realização da histerectomia","authors":"Luiz Gustavo Brito","doi":"10.1590/S0100-72032012000600009","DOIUrl":"https://doi.org/10.1590/S0100-72032012000600009","url":null,"abstract":"OBJETIVO: conhecer os fatores motivacionais da mulher portadora de leiomioma uterino que influenciam na decisao por realizar a histerectomia. METODOS: estudo qualitativo com grupos focais. As entrevistas foram coordenadas por um moderador/entrevistador e audiogravadas por um relator/observador no Ambulatorio de Uroginecologia, Cirurgia Ginecologica e Reconstrutiva Pelvica do HCFMRP-USP. A analise foi feita com um processador qualitativo (Atlas TI v 6.2). A tecnica empregada foi a analise de conteudo. O referencial teorico empregado foi a Teoria das Atividades. RESULTADOS: a mulher com leiomioma uterino opta (ou nao) por operar (histerectomia) nao somente por influencia do medico assistente, mas principalmente por fatores motivacionais. Estes foram considerados artefatos de mediacao: o(des) conhecimento sobre a evolucao da doenca, a influencia (positiva ou negativa) da familia e/ou terceiros, as crencas pessoais e o quadro clinico. Porem, isso nao foi encontrado nas mulheres que apresentavam crencas sobre uma alteracao sexual e fisica apos a cirurgia. CONCLUSAO: a mulher portadora de leiomioma uterino deve receber do profissional de saude que a assiste informacoes para um conhecimento adequado sobre a evolucao clinica do leiomioma e sobre todos os tipos de tratamento, seus beneficios e riscos, para que assim possa participar junto ao medico do processo de decisao. Palavras-chave Leiomioma uterino Pesquisa qualitativa Motivacao Conhecimento","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1590/S0100-72032012000600010
Silene Gomes Correa
INTRODUÇÃO: O câncer do colo uterino é considerado atualmente o segundo câncer mais comum no mundo e a segunda causa de morte entre as mulheres no Brasil, sendo uma doença de evolução lenta, podendo chegar a 20 anos. Este período permite que ações preventivas sejam eficientes e alterem o quadro da doença, através da detecção precoce e tratamento das lesões cervicais precursoras. O teste de Papanicolaou vem sendo usado como método de rastreamento populacional para detecção precoce dessas lesões. Contudo, apresenta alta taxa de resultados falsonegativos, os quais são atribuídos principalmente a erros de coleta, escrutínio e interpretação dos resultados. Entre as formas mais comumente usadas como controle de qualidade está a revisão aleatória de 10% dos casos examinados na rotina. Esta revisão é recomendada pelo Ministério da Saúde no Brasil. Porém não tem demonstrado ser eficiente para reduzir os índices de falso-negativos, uma vez que 90% das amostras não passam pelo controle de qualidade. A revisão rápida de 100% das amostras a partir de parâmetros preestabelecidos tem sido descrito por vários autores como um método mais eficiente no controle de qualidade. OBJETIVO: analisar a eficácia do método de revisão rápida de 100% dos testes de Papanicolaou convencionais negativos como método de controle interno da qualidade. MÉTODO: foram avaliadas 2481 amostras citológicas convencionais consideradas negativas do ano de 2008 no Setor de Citopatologia do Departamento de Patologia da UNIFESP. Todos os casos foram revistos pelo método turret de revisão rápida. Os esfregaços identificados como suspeitos foram revistos minuciosamente por dois observadores, sendo que depois de estabelecidos os resultados de cada um, houve uma reunião de consenso para um resultado final. RESULTADOS: dos 2481 casos revistos pela revisão rápida, 279 foram separados para revisão detalhada. Destes, 227 (81,4%) foram considerados negativos, 19 (6,8%) foram considerados ASC-US, 5 (1,8%) ASC-H, 26 (9,3%) LSIL e 2 (0,7%) Insatisfatórios. CONCLUSÃO: estes resultados mostram que a revisão rápida de 100% dos testes de Papanicolaou negativos é um método eficaz como controle interno da qualidade. Palavras-chave Teste de Papanicolaou Revisão rápida Câncer do colo uterino Controle de qualidade
{"title":"Rapid rescreening of 100% of negative cervical smears as a method of internal quality control: conventional method","authors":"Silene Gomes Correa","doi":"10.1590/S0100-72032012000600010","DOIUrl":"https://doi.org/10.1590/S0100-72032012000600010","url":null,"abstract":"INTRODUÇÃO: O câncer do colo uterino é considerado atualmente o segundo câncer mais comum no mundo e a segunda causa de morte entre as mulheres no Brasil, sendo uma doença de evolução lenta, podendo chegar a 20 anos. Este período permite que ações preventivas sejam eficientes e alterem o quadro da doença, através da detecção precoce e tratamento das lesões cervicais precursoras. O teste de Papanicolaou vem sendo usado como método de rastreamento populacional para detecção precoce dessas lesões. Contudo, apresenta alta taxa de resultados falsonegativos, os quais são atribuídos principalmente a erros de coleta, escrutínio e interpretação dos resultados. Entre as formas mais comumente usadas como controle de qualidade está a revisão aleatória de 10% dos casos examinados na rotina. Esta revisão é recomendada pelo Ministério da Saúde no Brasil. Porém não tem demonstrado ser eficiente para reduzir os índices de falso-negativos, uma vez que 90% das amostras não passam pelo controle de qualidade. A revisão rápida de 100% das amostras a partir de parâmetros preestabelecidos tem sido descrito por vários autores como um método mais eficiente no controle de qualidade. OBJETIVO: analisar a eficácia do método de revisão rápida de 100% dos testes de Papanicolaou convencionais negativos como método de controle interno da qualidade. MÉTODO: foram avaliadas 2481 amostras citológicas convencionais consideradas negativas do ano de 2008 no Setor de Citopatologia do Departamento de Patologia da UNIFESP. Todos os casos foram revistos pelo método turret de revisão rápida. Os esfregaços identificados como suspeitos foram revistos minuciosamente por dois observadores, sendo que depois de estabelecidos os resultados de cada um, houve uma reunião de consenso para um resultado final. RESULTADOS: dos 2481 casos revistos pela revisão rápida, 279 foram separados para revisão detalhada. Destes, 227 (81,4%) foram considerados negativos, 19 (6,8%) foram considerados ASC-US, 5 (1,8%) ASC-H, 26 (9,3%) LSIL e 2 (0,7%) Insatisfatórios. CONCLUSÃO: estes resultados mostram que a revisão rápida de 100% dos testes de Papanicolaou negativos é um método eficaz como controle interno da qualidade. Palavras-chave Teste de Papanicolaou Revisão rápida Câncer do colo uterino Controle de qualidade","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1590/S0100-72032012000600006
J. Marin, Lúcia Alves da Silva Lara, Adriana de Oliveira Silva, Rosana Maria dos Reis, Flávia Raquel Rosa Junqueira, Ana Carolina Japur de Sá Rosa-e-Silva
PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.
目的:本研究旨在评价改良mcindo - bannister技术和非手术Frank技术的新阴道成形术的效果。方法:本回顾性研究是对25名在婴幼儿-青春期妇科门诊接受手术或保守治疗的阴道发育不全妇女进行的方便样本。数据来自医疗记录。15名妇女接受手术mcindo - bannister改良技术手术组，10名妇女接受非手术Frank技术手术组。对比分析两种样本的参数:阴道测量、手术和非手术并发症、治疗后的性满意度。性满意度是通过一个简单的问题来评估的:你的性生活怎么样?结果:Frank组(治疗后阴道初始长度为2.4±2.0 cm，治疗后为6.9±1.1 cm, p<0.0001)和手术组(治疗后阴道初始长度为0.9±1.4 cm，治疗后为8.0±0.8 cm, p<0.0001)运动前后阴道长度均有差异。与Frank组相比，手术组阴道长度增加(Frank组=7.0±0.9 cm，手术组=8.0±0.8 cm, p=0.0005)。手术组40%的女性有手术并发症而Frank技术没有并发症。所有女性都对自己的性生活感到满意。结论:目前的数据表明，手术和弗兰克技术是有效的治疗阴道发育不全，导致阴道的建设，允许性交和性满足。弗兰克技术的优点在于其低成本和低并发症发生率。
{"title":"Tratamento cirúrgico e conservador da agenesia vaginal: análise de uma série de casos","authors":"J. Marin, Lúcia Alves da Silva Lara, Adriana de Oliveira Silva, Rosana Maria dos Reis, Flávia Raquel Rosa Junqueira, Ana Carolina Japur de Sá Rosa-e-Silva","doi":"10.1590/S0100-72032012000600006","DOIUrl":"https://doi.org/10.1590/S0100-72032012000600006","url":null,"abstract":"PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1590/S0100-72032012000600004
Fabiano Barreto, R. M. Albuquerque
PURPOSE: To compare the filling out of the prenatal care card of pregnant women at a school-service and other services, as well as to verify the concordance between these records and verbal information provided by the puerperae. METHODS: A two-stage epidemiological, cross-sectional study was performed with stratified sampling, proportional to number of births. In the first stage, the information recorded on the prenatal care card in the school-service was compared to that recorded in units not linked to higher health education in Recife (PE). In the second stage, the information about prenatal care was collected with a semi-structured questionnaire applied to women during the puerperal period. A total of 262 puerperae older than 19 years, who had a prenatal care card at the time of delivery were included in the study from May to July 2008. Data were analyzed statistically by the χ2 test, Student´s t-test or Mann-Whitney test, all one-sided to the right, with the level of significance set at 5%. RESULTS: The information more often recorded on the prenatal care card in the school-service was: schooling (86.5 versus 70.3%; p=0.002), marital status, (83.7 versus 70.9%; p=0.01), weight prior to pregnancy (72.1 versus 46.8%; p<0.001), height (62.5 versus 45.6%; p=0.007), and educational practices (76.9 versus 11.4%; p<0.001) and, at other services, only birth weight <2,500 g (15.4 versus 27.2% at the school-service; p=0.02). There were significant discrepancies between data obtained by verbal information and the prenatal care records of the pregnant women. At the school-service, 40.3% of pregnant women received adequate prenatal care versus 20.3% at other units. CONCLUSIONS: In all services, there was a predominance of recorded information directly related to delivery, while information about actions with preventive characteristics during prenatal care was neglected.
目的:比较学校服务和其他服务机构孕妇产前护理卡填写情况，并验证这些记录与产妇口头提供的信息的一致性。方法:采用分层抽样，按出生人数成比例进行两阶段流行病学横断面研究。在第一阶段，将学校服务部门产前护理卡上记录的信息与累西腓(PE)与高等卫生教育无关的单位记录的信息进行比较。在第二阶段，收集产前护理的信息，采用半结构化的问卷调查妇女在产褥期。2008年5月至7月期间，共有262名年龄在19岁以上、在分娩时有产前护理卡的产妇被纳入研究。数据采用χ2检验、Student’st检验或Mann-Whitney检验进行统计学分析，均为单侧向右，显著性水平设为5%。结果:学校服务处产前保健卡上记录的信息较多的是:在校(86.5% vs 70.3%);P =0.002)、婚姻状况(83.7 vs 70.9%;P =0.01)、孕前体重(72.1%对46.8%;P <0.001)、身高(62.5% vs 45.6%;P =0.007)和教育实践(76.9 vs 11.4%;P <0.001)，而在其他服务中，只有出生体重<2,500 g(15.4%对27.2%的学校服务;p = 0.02)。通过口头信息获得的数据与孕妇的产前护理记录存在显著差异。在学校服务部门，40.3%的孕妇得到充分的产前护理，而在其他单位，这一比例为20.3%。结论:在所有服务中，与分娩直接相关的记录信息占主导地位，而产前护理中具有预防特征的行动信息被忽视。
{"title":"Discrepâncias entre o informe verbal e os registros no cartão da gestante, um instrumento negligenciado","authors":"Fabiano Barreto, R. M. Albuquerque","doi":"10.1590/S0100-72032012000600004","DOIUrl":"https://doi.org/10.1590/S0100-72032012000600004","url":null,"abstract":"PURPOSE: To compare the filling out of the prenatal care card of pregnant women at a school-service and other services, as well as to verify the concordance between these records and verbal information provided by the puerperae. METHODS: A two-stage epidemiological, cross-sectional study was performed with stratified sampling, proportional to number of births. In the first stage, the information recorded on the prenatal care card in the school-service was compared to that recorded in units not linked to higher health education in Recife (PE). In the second stage, the information about prenatal care was collected with a semi-structured questionnaire applied to women during the puerperal period. A total of 262 puerperae older than 19 years, who had a prenatal care card at the time of delivery were included in the study from May to July 2008. Data were analyzed statistically by the χ2 test, Student´s t-test or Mann-Whitney test, all one-sided to the right, with the level of significance set at 5%. RESULTS: The information more often recorded on the prenatal care card in the school-service was: schooling (86.5 versus 70.3%; p=0.002), marital status, (83.7 versus 70.9%; p=0.01), weight prior to pregnancy (72.1 versus 46.8%; p<0.001), height (62.5 versus 45.6%; p=0.007), and educational practices (76.9 versus 11.4%; p<0.001) and, at other services, only birth weight <2,500 g (15.4 versus 27.2% at the school-service; p=0.02). There were significant discrepancies between data obtained by verbal information and the prenatal care records of the pregnant women. At the school-service, 40.3% of pregnant women received adequate prenatal care versus 20.3% at other units. CONCLUSIONS: In all services, there was a predominance of recorded information directly related to delivery, while information about actions with preventive characteristics during prenatal care was neglected.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1590/S0100-72032012000500009
P. Padilha
{"title":"Theoretical and practical contributions to a prenatal nutrition assistance","authors":"P. Padilha","doi":"10.1590/S0100-72032012000500009","DOIUrl":"https://doi.org/10.1590/S0100-72032012000500009","url":null,"abstract":"","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1590/S0100-72032012000200005
Glaucia Rosara Guerra Benute, Daniele Nonnenmacher, R. M. Nomura, M. Lucia, M. Zugaib
PURPOSE: To identify the knowledge and awareness of health professionals regarding the Brazilian legislation on induced abortion. METHODS: Unidentified sealed envelopes containing the questionnaires were sent to all professionals (n=149) working in the Obstetrics Department of a university hospital and public hospital at the periphery of Sao Paulo (SP), Brazil. A total of 119 professionals responded to the questionnaire. The 0.05 confidence interval and the Fisher exact test and χ2 test were used for data analysis. RESULTS: Of the respondents, 48.7% were physicians, 33.6% were nursing professionals and 17.6% were professionals from other fields (psychologists, nutritionists, physiotherapists, laboratory technicians and administrators). There was a significant difference (p=0.01) in the proportion of professionals who believe that abortion for non-lethal fetal malformation and due to unplanned pregnancies should be included in the Brazilian legislation. It was observed that the knowledge about the law and the description of the circumstances allowed by law on abortion was significantly different when comparing health professionals (p=0.01). When asked about the situations in which Brazilian law allows abortion, 32.7% of physicians, 97.5% of nursing professionals and 90.5% of other professionals were unaware of the law. CONCLUSION: This study demonstrated the lack of of knowledge of Brazilian law among health professionals, to a lesser extent among obstetricians and a to a greater extent among nursing professionals. Attitudes of discrimination and prejudice were observed regarding the care provided to women who induce an abortion.
{"title":"Influência da percepção dos profissionais quanto ao aborto provocado na atenção à saúde da mulher","authors":"Glaucia Rosara Guerra Benute, Daniele Nonnenmacher, R. M. Nomura, M. Lucia, M. Zugaib","doi":"10.1590/S0100-72032012000200005","DOIUrl":"https://doi.org/10.1590/S0100-72032012000200005","url":null,"abstract":"PURPOSE: To identify the knowledge and awareness of health professionals regarding the Brazilian legislation on induced abortion. METHODS: Unidentified sealed envelopes containing the questionnaires were sent to all professionals (n=149) working in the Obstetrics Department of a university hospital and public hospital at the periphery of Sao Paulo (SP), Brazil. A total of 119 professionals responded to the questionnaire. The 0.05 confidence interval and the Fisher exact test and χ2 test were used for data analysis. RESULTS: Of the respondents, 48.7% were physicians, 33.6% were nursing professionals and 17.6% were professionals from other fields (psychologists, nutritionists, physiotherapists, laboratory technicians and administrators). There was a significant difference (p=0.01) in the proportion of professionals who believe that abortion for non-lethal fetal malformation and due to unplanned pregnancies should be included in the Brazilian legislation. It was observed that the knowledge about the law and the description of the circumstances allowed by law on abortion was significantly different when comparing health professionals (p=0.01). When asked about the situations in which Brazilian law allows abortion, 32.7% of physicians, 97.5% of nursing professionals and 90.5% of other professionals were unaware of the law. CONCLUSION: This study demonstrated the lack of of knowledge of Brazilian law among health professionals, to a lesser extent among obstetricians and a to a greater extent among nursing professionals. Attitudes of discrimination and prejudice were observed regarding the care provided to women who induce an abortion.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1590/S0100-72032012000200005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1590/S0100-72032012000200003
Maria Isabel Moura Nascimento, A. A. Cunha, Elisângela Victor Guimarães, Felipe Silva Alvarez, S. O. D. Oliveira, Eduardo Dias da Costa Villas Bôas
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguacu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
{"title":"Gestações complicadas por sífilis materna e óbito fetal","authors":"Maria Isabel Moura Nascimento, A. A. Cunha, Elisângela Victor Guimarães, Felipe Silva Alvarez, S. O. D. Oliveira, Eduardo Dias da Costa Villas Bôas","doi":"10.1590/S0100-72032012000200003","DOIUrl":"https://doi.org/10.1590/S0100-72032012000200003","url":null,"abstract":"PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguacu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1590/S0100-72032012000200004
L. Bittencourt, Fabiana Maria Ruiz Lopes-Mori, Regina Mitsuka-Breganó, M. Valentim-Zabott, Roberta Lemos Freire, Simone Benghi Pinto, I. T. Navarro
PURPOSE: To evaluate the susceptibility to toxoplasmosis in pregnant women in the public health service from two cities in the western region of Parana, Brazil. METHODS: Four thousand twenty-two pregnant women were evaluated for anti-Toxoplasma gondii IgG and IgM by ELISA and MEIA. Seronegative pregnant women repeated the serology in the second and third trimester of pregnancy. Neonatal screening of 27 newborns was also performed in one of the cities to detect IgM anti- Toxoplasma gondii by fluorometry. All pregnant women answered an epidemiological questionnaire to analyze the factors associated with the risk of infection by Toxoplasma gondii. For statistical analysis, the presence of IgG anti-Toxoplasma gondii was considered as the dependent variable and the variables contained in the epidemiological questionnaire as the independent ones. RESULTS: The prevalence of anti-Toxoplasma gondii IgG in pregnant women was 59.8 and 60.6%. In one of the cities, the variables associated with the presence of IgG antibodies were low educational level and more than one pregnancy. There was no association with other factors studied such as consumption of raw or undercooked meat, consumption of raw vegetables, consumption of colonial salami, handling soil or sand, the presence of a home vegetable garden and cats in the household. In the other city there was no statistical association with the variables studied. No case of acute infection and no seroconversion were confirmed in either city. None of the infants evaluated were positive for toxoplasmosis. CONCLUSION: Toxoplasmosis is common in pregnant women attended by the public health service in the region studied and 40% of them are susceptible to the infection. These data reinforce the need to keep the screening program in these cities.
{"title":"Soroepidemiologia da toxoplasmose em gestantes a partir da implantação do Programa de Vigilância da Toxoplasmose Adquirida e Congênita em municípios da região oeste do Paraná","authors":"L. Bittencourt, Fabiana Maria Ruiz Lopes-Mori, Regina Mitsuka-Breganó, M. Valentim-Zabott, Roberta Lemos Freire, Simone Benghi Pinto, I. T. Navarro","doi":"10.1590/S0100-72032012000200004","DOIUrl":"https://doi.org/10.1590/S0100-72032012000200004","url":null,"abstract":"PURPOSE: To evaluate the susceptibility to toxoplasmosis in pregnant women in the public health service from two cities in the western region of Parana, Brazil. METHODS: Four thousand twenty-two pregnant women were evaluated for anti-Toxoplasma gondii IgG and IgM by ELISA and MEIA. Seronegative pregnant women repeated the serology in the second and third trimester of pregnancy. Neonatal screening of 27 newborns was also performed in one of the cities to detect IgM anti- Toxoplasma gondii by fluorometry. All pregnant women answered an epidemiological questionnaire to analyze the factors associated with the risk of infection by Toxoplasma gondii. For statistical analysis, the presence of IgG anti-Toxoplasma gondii was considered as the dependent variable and the variables contained in the epidemiological questionnaire as the independent ones. RESULTS: The prevalence of anti-Toxoplasma gondii IgG in pregnant women was 59.8 and 60.6%. In one of the cities, the variables associated with the presence of IgG antibodies were low educational level and more than one pregnancy. There was no association with other factors studied such as consumption of raw or undercooked meat, consumption of raw vegetables, consumption of colonial salami, handling soil or sand, the presence of a home vegetable garden and cats in the household. In the other city there was no statistical association with the variables studied. No case of acute infection and no seroconversion were confirmed in either city. None of the infants evaluated were positive for toxoplasmosis. CONCLUSION: Toxoplasmosis is common in pregnant women attended by the public health service in the region studied and 40% of them are susceptible to the infection. These data reinforce the need to keep the screening program in these cities.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-04DOI: 10.1590/S0100-72032012000400004
Carla Sousa, José Juvenal Linhares, F. Arcanjo, Renata Andrade, Márcio Fragoso Vieira
PURPOSE: To verify cervical length using transvaginal ultrasonography in pregnant women between 28 and 34 weeks of gestation, correlating it with the latent period and the risk of maternal and neonatal infections. METHODS: 39 pregnant women were evaluated and divided into groups based on their cervical length, using 15, 20 and 25 mm as cut-off points. The latency periods evaluated were three and seven days. Included were pregnant women with live fetuses and gestational age between 28 and 34 weeks, with a confirmed diagnosis on admission of premature rupture of membranes. Patients with chorioamnionitis, multiple gestation, fetal abnormalities, uterine malformations (bicornus septate and didelphic uterus), history of previous surgery on the cervix (conization and cerclage) and cervical dilation greater than 2 cm in nulliparous women and 3 cm in multiparae were excluded from the study. RESULTS: A <15 mm cervical length was found to be highly related to a latency period of up to 72 hours (p=0.008). A <20 mm cervical length was also associated with a less than 72 hour latency period (p=0.04). A <25 mm cervical length was not found to be statistically associated with a 72 hour latency period (p=0,12). There was also no significant correlation between cervical length and latency period and maternal and neonatal infection. CONCLUSION: The presence of a short cervix (<15 mm) was found to be related to a latency period of less than 72 hours, but not to maternal or neonatal infections.
{"title":"Comprimento cervical como preditor do período de latência e de infecção na rotura prematura pré-termo de membranas","authors":"Carla Sousa, José Juvenal Linhares, F. Arcanjo, Renata Andrade, Márcio Fragoso Vieira","doi":"10.1590/S0100-72032012000400004","DOIUrl":"https://doi.org/10.1590/S0100-72032012000400004","url":null,"abstract":"PURPOSE: To verify cervical length using transvaginal ultrasonography in pregnant women between 28 and 34 weeks of gestation, correlating it with the latent period and the risk of maternal and neonatal infections. METHODS: 39 pregnant women were evaluated and divided into groups based on their cervical length, using 15, 20 and 25 mm as cut-off points. The latency periods evaluated were three and seven days. Included were pregnant women with live fetuses and gestational age between 28 and 34 weeks, with a confirmed diagnosis on admission of premature rupture of membranes. Patients with chorioamnionitis, multiple gestation, fetal abnormalities, uterine malformations (bicornus septate and didelphic uterus), history of previous surgery on the cervix (conization and cerclage) and cervical dilation greater than 2 cm in nulliparous women and 3 cm in multiparae were excluded from the study. RESULTS: A <15 mm cervical length was found to be highly related to a latency period of up to 72 hours (p=0.008). A <20 mm cervical length was also associated with a less than 72 hour latency period (p=0.04). A <25 mm cervical length was not found to be statistically associated with a 72 hour latency period (p=0,12). There was also no significant correlation between cervical length and latency period and maternal and neonatal infection. CONCLUSION: The presence of a short cervix (<15 mm) was found to be related to a latency period of less than 72 hours, but not to maternal or neonatal infections.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01DOI: 10.1590/S0100-72032012000100002
Anderson Sanches de Melo, C. S. V. Macedo, Lucas Gabriel Maltoni Romano, R. A. Ferriani, P. A. Navarro
PURPOSE: To assess the prevalence of metabolic syndrome and of its defining criteria in women with polycystic ovary syndrome from the Brazilian Southeast, who were stratified according to body mass index and compared to ovulatory controls. METHODS: This was a cross-sectional study conducted on 332 women of reproductive age, who were divided into two groups: Control, consisting of 186 women with regular menstrual cycles and ovulatory symptoms and without a diagnosis of polycystic ovary syndrome or other type of chronic anovulation, and the Polycystic ovary syndrome,Group, consisting of 146 women with a diagnosis of polycystic ovary syndrome (Rotterdam Consensus ASRM/ESHRE). Each group was stratified according to the body mass index, as follows: body mass index ( < 25 ≥25 and <30, and ≥ 30 kg/m2). The frequencies of metabolic syndrome and of its defining criteria and the clinical and hormonal characteristics (follicle stimulating hormone, total testosterone, dehydroepiandrostenedione sulfate) were analyzed. RESULTS: The frequency of metabolic syndrome was six times higher in the obese Polycystic ovary syndrome Group than among control women with the same body mass index (Control with 10.5 versus Polycystic ovary syndrome with 67.9%, p<0.01); twice higher in the Polycystic ovary syndrome Group with body mass index ≥ 25 and <30 kg/m2 (Control with 13.2 versus Polycystic ovary syndrome with 22.7%, p<0.01), and three times higher in the Polycystic ovary syndrome Group with body mass index <25 kg/m2 (Control with 7.9 versus Polycystic ovary syndrome with 2.5%, p<0.01), compared to control women paired for the same body mass index. Regardless of the body mass index, women with polycystic ovary syndrome had a higher frequency of all the criteria defining metabolic syndrome. CONCLUSION: Women with polycystic ovary syndrome have higher frequency of metabolic syndrome and of its defining criteria regardless of the body mass index. Hyperinsulinemia and hyperandrogenism are important characteristics of the origin of these alterations, especially in obese women with polycystic ovary syndrome.
{"title":"Mulheres com síndrome dos ovários policísticos apresentam maior frequência de síndrome metabólica independentemente do índice de massa corpóreo","authors":"Anderson Sanches de Melo, C. S. V. Macedo, Lucas Gabriel Maltoni Romano, R. A. Ferriani, P. A. Navarro","doi":"10.1590/S0100-72032012000100002","DOIUrl":"https://doi.org/10.1590/S0100-72032012000100002","url":null,"abstract":"PURPOSE: To assess the prevalence of metabolic syndrome and of its defining criteria in women with polycystic ovary syndrome from the Brazilian Southeast, who were stratified according to body mass index and compared to ovulatory controls. METHODS: This was a cross-sectional study conducted on 332 women of reproductive age, who were divided into two groups: Control, consisting of 186 women with regular menstrual cycles and ovulatory symptoms and without a diagnosis of polycystic ovary syndrome or other type of chronic anovulation, and the Polycystic ovary syndrome,Group, consisting of 146 women with a diagnosis of polycystic ovary syndrome (Rotterdam Consensus ASRM/ESHRE). Each group was stratified according to the body mass index, as follows: body mass index ( < 25 ≥25 and <30, and ≥ 30 kg/m2). The frequencies of metabolic syndrome and of its defining criteria and the clinical and hormonal characteristics (follicle stimulating hormone, total testosterone, dehydroepiandrostenedione sulfate) were analyzed. RESULTS: The frequency of metabolic syndrome was six times higher in the obese Polycystic ovary syndrome Group than among control women with the same body mass index (Control with 10.5 versus Polycystic ovary syndrome with 67.9%, p<0.01); twice higher in the Polycystic ovary syndrome Group with body mass index ≥ 25 and <30 kg/m2 (Control with 13.2 versus Polycystic ovary syndrome with 22.7%, p<0.01), and three times higher in the Polycystic ovary syndrome Group with body mass index <25 kg/m2 (Control with 7.9 versus Polycystic ovary syndrome with 2.5%, p<0.01), compared to control women paired for the same body mass index. Regardless of the body mass index, women with polycystic ovary syndrome had a higher frequency of all the criteria defining metabolic syndrome. CONCLUSION: Women with polycystic ovary syndrome have higher frequency of metabolic syndrome and of its defining criteria regardless of the body mass index. Hyperinsulinemia and hyperandrogenism are important characteristics of the origin of these alterations, especially in obese women with polycystic ovary syndrome.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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