Pub Date : 2011-06-01DOI: 10.1590/S0100-72032011000600004
Suzi Roseli Kerber, O. Falceto, C. L. Fernandes
OBJETIVO: Estudar a associacao entre transtornos mentais pos-parto e fatores demograficos e psicossociais, pre e perinatais. METODOS: Todas as familias com criancas de quatro meses da Vila Jardim - Porto Alegre (RS) - nascidos entre novembro de 1998 e dezembro de 1999 foram avaliadas. Utilizou-se o Self Report Questionnaire (SRQ-20) e entrevistas clinicas semiestruturadas individuais e do casal para fundamentar uma hipotese diagnostica segundo os criterios do da quarta edicao do Manual Diagnostico e Estatistico de Transtornos Mentais (DSM-IV). Realizou-se a avaliacao da relacao conjugal e do relacionamento da mae com as familias de origem e a rede social utilizando-se a Escala de Avaliacao Global do Funcionamento Relacional (GARF). RESULTADOS: Foram avaliadas 148 maes e os 116 pais que coabitavam. Segundo o SRQ, 34,4% das maes e 25,4% dos pais apresentaram suspeita de transtorno psiquiatrico. Clinicamente os percentuais foram maiores. Coabitar ou nao com companheiro nao esteve associado com transtorno mental materno. Na analise da totalidade do grupo de mulheres, estiveram associados: baixa renda familiar (OR=0,8; p<0,05) e a presenca de transtorno materno no passado (OR=2,2; p<0,05). O estudo apenas das mulheres que coabitavam (n=116) mostrou associacao exclusivamente com a ma qualidade da relacao conjugal (OR=7,3; p<0,05). CONCLUSAO: Este estudo reforca a necessidade de se verificar a presenca de transtorno mental materno da mae nas consultas de pre-natal e puericultura, e introduz dados sobre o pai e, especialmente, sobre a importância da relacao conjugal.
{"title":"Problemas conjugais e outros fatores associados a transtornos psiquiátricos do pós-parto","authors":"Suzi Roseli Kerber, O. Falceto, C. L. Fernandes","doi":"10.1590/S0100-72032011000600004","DOIUrl":"https://doi.org/10.1590/S0100-72032011000600004","url":null,"abstract":"OBJETIVO: Estudar a associacao entre transtornos mentais pos-parto e fatores demograficos e psicossociais, pre e perinatais. METODOS: Todas as familias com criancas de quatro meses da Vila Jardim - Porto Alegre (RS) - nascidos entre novembro de 1998 e dezembro de 1999 foram avaliadas. Utilizou-se o Self Report Questionnaire (SRQ-20) e entrevistas clinicas semiestruturadas individuais e do casal para fundamentar uma hipotese diagnostica segundo os criterios do da quarta edicao do Manual Diagnostico e Estatistico de Transtornos Mentais (DSM-IV). Realizou-se a avaliacao da relacao conjugal e do relacionamento da mae com as familias de origem e a rede social utilizando-se a Escala de Avaliacao Global do Funcionamento Relacional (GARF). RESULTADOS: Foram avaliadas 148 maes e os 116 pais que coabitavam. Segundo o SRQ, 34,4% das maes e 25,4% dos pais apresentaram suspeita de transtorno psiquiatrico. Clinicamente os percentuais foram maiores. Coabitar ou nao com companheiro nao esteve associado com transtorno mental materno. Na analise da totalidade do grupo de mulheres, estiveram associados: baixa renda familiar (OR=0,8; p<0,05) e a presenca de transtorno materno no passado (OR=2,2; p<0,05). O estudo apenas das mulheres que coabitavam (n=116) mostrou associacao exclusivamente com a ma qualidade da relacao conjugal (OR=7,3; p<0,05). CONCLUSAO: Este estudo reforca a necessidade de se verificar a presenca de transtorno mental materno da mae nas consultas de pre-natal e puericultura, e introduz dados sobre o pai e, especialmente, sobre a importância da relacao conjugal.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234767","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500001
M. Rudge, M. J. B. C. Girão
Faculdade de Medicina de Botucatu Universidade Estadual Paulista 'Julio de Mesquita Filho' UNESP, CEP: 18618-970-Botucatu (SP)
博图卡图州立大学医学院“Julio de Mesquita filho”UNESP, CEP: 18618-970-博图卡图(SP)
{"title":"Diabete gestacional e incontinência urinária: interação entre a Ginecologia e a Obstetrícia","authors":"M. Rudge, M. J. B. C. Girão","doi":"10.1590/S0100-72032011000500001","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500001","url":null,"abstract":"Faculdade de Medicina de Botucatu Universidade Estadual Paulista 'Julio de Mesquita Filho' UNESP, CEP: 18618-970-Botucatu (SP)","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234419","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500003
Meireluci Costa Ribeiro, Mary Uchyiama Nakamura, C. Abdo, M. R. Torloni, M. T. Scanavino, R. Mattar
To compare the sexual function of healthy adult pregnant women with that of gestational diabetes patients (GDM) in the third trimester. METHODS: This cross-sectional study enrolled two groups of women managed antenatal care clinics. Inclusion criteria were: maternal age .20 years, gestational age at least 28 weeks, being in a heterosexual relationship with the same partner for at least 6 months, and being able to read. We excluded women with a medical recommendation for sexual abstinence due to clinical or obstetric disorders; hypertension controlled through medications; pregnancy resulting from rape; absent or sexually unavailable partner in the last month; hospital admission in the last month; use of vaginal creams in the last 30 days; multiple pregnancy, regular use of alcohol or illicit drugs or use of medications that can interfere with sexual function. Eighty-seven patients fulfilled the selection criteria and were included in the study. The Sexual Quotient . Feminine Version (QS-F) questionnaire was used to assess sexual function. Student's t and X2 tests were used to compare differences between groups and p<0.05 was considered significant. RESULTS: The mean gestational age of the participants was 34 weeks. There were no significant differences in the mean QS-F scores between groups (62.5 healthy vs 62.8 GDM women, p=0.9). Approximately half the participants (47 and 47.5% of the healthy and GDM women, respectively, p=0.9) had total scores up to 60, indicative of dysfunction in one of the assessed domains (desire, sexual satisfaction, arousal, orgasm, dyspareunia and vaginismus). CONCLUSIONS: The prevalence of sexual dysfunction was high among women in the third trimester of pregnancy and did not differ significantly between healthy women and women with GDM.
{"title":"Gravidez e Diabetes Gestacional: uma combinação prejudicial à função sexual feminina?","authors":"Meireluci Costa Ribeiro, Mary Uchyiama Nakamura, C. Abdo, M. R. Torloni, M. T. Scanavino, R. Mattar","doi":"10.1590/S0100-72032011000500003","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500003","url":null,"abstract":"To compare the sexual function of healthy adult pregnant women with that of gestational diabetes patients (GDM) in the third trimester. METHODS: This cross-sectional study enrolled two groups of women managed antenatal care clinics. Inclusion criteria were: maternal age .20 years, gestational age at least 28 weeks, being in a heterosexual relationship with the same partner for at least 6 months, and being able to read. We excluded women with a medical recommendation for sexual abstinence due to clinical or obstetric disorders; hypertension controlled through medications; pregnancy resulting from rape; absent or sexually unavailable partner in the last month; hospital admission in the last month; use of vaginal creams in the last 30 days; multiple pregnancy, regular use of alcohol or illicit drugs or use of medications that can interfere with sexual function. Eighty-seven patients fulfilled the selection criteria and were included in the study. The Sexual Quotient . Feminine Version (QS-F) questionnaire was used to assess sexual function. Student's t and X2 tests were used to compare differences between groups and p<0.05 was considered significant. RESULTS: The mean gestational age of the participants was 34 weeks. There were no significant differences in the mean QS-F scores between groups (62.5 healthy vs 62.8 GDM women, p=0.9). Approximately half the participants (47 and 47.5% of the healthy and GDM women, respectively, p=0.9) had total scores up to 60, indicative of dysfunction in one of the assessed domains (desire, sexual satisfaction, arousal, orgasm, dyspareunia and vaginismus). CONCLUSIONS: The prevalence of sexual dysfunction was high among women in the third trimester of pregnancy and did not differ significantly between healthy women and women with GDM.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1590/S0100-72032011000500003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234464","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500004
Gisela Maria Vieira Rodrigues de Carvalho, Mary Uchyiama Nakamura, R. Simões, Eliana Maria Restum Antonio, Adriana Wagngner, Tereza Maria Pereira Fontes, Luiz Kulay Júnior
PURPOSE: to evaluate the effect of administration of a stavudine/nelfinavir combination on the rat pregnancy by assessing maternal and concepts weights, as well as the number of implantations, fetuses, placentas, resorptions and maternal and fetal mortality. METHODS: forty adult pregnant Wistar rats of the EPM-1 strain were randomly divided into four groups: control (GCtrl - drug vehicle control, n=10), and three experimental groups, which were treated with an oral solution of stavudine/nelfinavir (ExpI - 1/40 mg/kg b.w., n=10; ExpII - 3/120 mg/kg b.w., n=10; ExpIII - 9/360 mg/kg b.w., n=10) from day 0 to the 20th day of pregnancy. Maternal body weights were determined at the start of the experiment and on the 7th, 14th and the 20th day thereafter. At term (20th day) the rats were anesthetized and, upon laparotomy and hysterotomy, the number of implantations, resorptions, living fetuses, placentae and intrauterine deaths were recorded. The collected fetuses and placentae were weighed and the concepts were examined under a stereomicroscope for possible external malformations. Statistical analysis was performed by analysis of variance (ANOVA) complemented by the Kruskal-Wallis test (p<0.05). RESULTS: there was a progressive and gradual increase in body weight during the course of pregnancy in all groups, which was more evident in the final period, but with no significant difference between groups. The mean number of fetuses, placentas, implantations, and fetal and placental weights showed no significant differences between groups. Also, no resorptions or external malformations were found in the experimental groups. However, between the 8th and 14th days of gestation, there was one case of maternal mortality in each experimental group. CONCLUSIONS: the administration of a stavudine/nelfinavir combination had no deleterious effects on the concepts.
{"title":"Efeitos da administração diária da associação estavudina/nelfinavir sobre os fetos e placentas da rata albina","authors":"Gisela Maria Vieira Rodrigues de Carvalho, Mary Uchyiama Nakamura, R. Simões, Eliana Maria Restum Antonio, Adriana Wagngner, Tereza Maria Pereira Fontes, Luiz Kulay Júnior","doi":"10.1590/S0100-72032011000500004","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500004","url":null,"abstract":"PURPOSE: to evaluate the effect of administration of a stavudine/nelfinavir combination on the rat pregnancy by assessing maternal and concepts weights, as well as the number of implantations, fetuses, placentas, resorptions and maternal and fetal mortality. METHODS: forty adult pregnant Wistar rats of the EPM-1 strain were randomly divided into four groups: control (GCtrl - drug vehicle control, n=10), and three experimental groups, which were treated with an oral solution of stavudine/nelfinavir (ExpI - 1/40 mg/kg b.w., n=10; ExpII - 3/120 mg/kg b.w., n=10; ExpIII - 9/360 mg/kg b.w., n=10) from day 0 to the 20th day of pregnancy. Maternal body weights were determined at the start of the experiment and on the 7th, 14th and the 20th day thereafter. At term (20th day) the rats were anesthetized and, upon laparotomy and hysterotomy, the number of implantations, resorptions, living fetuses, placentae and intrauterine deaths were recorded. The collected fetuses and placentae were weighed and the concepts were examined under a stereomicroscope for possible external malformations. Statistical analysis was performed by analysis of variance (ANOVA) complemented by the Kruskal-Wallis test (p<0.05). RESULTS: there was a progressive and gradual increase in body weight during the course of pregnancy in all groups, which was more evident in the final period, but with no significant difference between groups. The mean number of fetuses, placentas, implantations, and fetal and placental weights showed no significant differences between groups. Also, no resorptions or external malformations were found in the experimental groups. However, between the 8th and 14th days of gestation, there was one case of maternal mortality in each experimental group. CONCLUSIONS: the administration of a stavudine/nelfinavir combination had no deleterious effects on the concepts.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234481","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500005
Patricia Pereira de Oliveira, Carolina Canton Sandrin, Patricia Hermann Batista, Lizanka P.F. Marinheiro, Maria Celeste Osório Wender, Felipe Roisenberg
PURPOSE: To investigate the relationship between quality of life and spinal fracture in women aged over 60 living in Southern Brazil. METHODS: A case-control study was conducted with the application of the WHOQOL-bref questionnaire to 100 women living in the city of Chapeco (SC), aged over 60, postmenopausal, white or Caucasian, with no important cognitive impairment or a history of diseases known to affect bone metabolism, or malignant neoplasias. The population was divided into two groups depending on the presence or absence of fractures in the spine radiography. We analyzed variables related to the current and previous medical history, life habits and family history of fractures, and the domains and facets that compose the WHOQOL-bref. All participants were informed about the objectives and methodologies adopted and gave written informed consent to participate in the study. RESULTS: The mean age of the women in the fracture group was older than that of women with fractures (p<0.05). Also women with fractures tended to belong to a higher social class, to have more years of study, a higher family income, and a greater use of alcoholic drinks (p<0.05). In the evaluation of the WHOQOL-bref domains, the fracture group had the highest average in the psychological field (x=63.6± 3.0) and the lowest in the environment field (x=9.3±58.8). In the group without fracture, the highest average also occurred in the psychological domain (x=67.2± 9.3) and the lowest in the field of social relations (x=57.5±7.7). Statistical analysis showed no significant correlation between the averages of the facets that make up the areas between the groups with and without fractures. CONCLUSIONS: This study suggests that there is no impairment of quality of life among older women with vertebral fractures, but the relation between QL and time of occurrence and severity of the fractures should be better evaluated. Both groups had higher scores in the psychological domain, showing that the respondents rely on personal beliefs, spirituality and religion, accept their physical appearance while maintaining self-esteem and the ability to think, to learn and to concentrate despite the presence of this disease. There was no statistically significant difference between groups or between domains in the same group.
{"title":"Relação entre qualidade de vida e fratura vertebral em mulheres idosas residentes no Sul do Brasil","authors":"Patricia Pereira de Oliveira, Carolina Canton Sandrin, Patricia Hermann Batista, Lizanka P.F. Marinheiro, Maria Celeste Osório Wender, Felipe Roisenberg","doi":"10.1590/S0100-72032011000500005","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500005","url":null,"abstract":"PURPOSE: To investigate the relationship between quality of life and spinal fracture in women aged over 60 living in Southern Brazil. METHODS: A case-control study was conducted with the application of the WHOQOL-bref questionnaire to 100 women living in the city of Chapeco (SC), aged over 60, postmenopausal, white or Caucasian, with no important cognitive impairment or a history of diseases known to affect bone metabolism, or malignant neoplasias. The population was divided into two groups depending on the presence or absence of fractures in the spine radiography. We analyzed variables related to the current and previous medical history, life habits and family history of fractures, and the domains and facets that compose the WHOQOL-bref. All participants were informed about the objectives and methodologies adopted and gave written informed consent to participate in the study. RESULTS: The mean age of the women in the fracture group was older than that of women with fractures (p<0.05). Also women with fractures tended to belong to a higher social class, to have more years of study, a higher family income, and a greater use of alcoholic drinks (p<0.05). In the evaluation of the WHOQOL-bref domains, the fracture group had the highest average in the psychological field (x=63.6± 3.0) and the lowest in the environment field (x=9.3±58.8). In the group without fracture, the highest average also occurred in the psychological domain (x=67.2± 9.3) and the lowest in the field of social relations (x=57.5±7.7). Statistical analysis showed no significant correlation between the averages of the facets that make up the areas between the groups with and without fractures. CONCLUSIONS: This study suggests that there is no impairment of quality of life among older women with vertebral fractures, but the relation between QL and time of occurrence and severity of the fractures should be better evaluated. Both groups had higher scores in the psychological domain, showing that the respondents rely on personal beliefs, spirituality and religion, accept their physical appearance while maintaining self-esteem and the ability to think, to learn and to concentrate despite the presence of this disease. There was no statistically significant difference between groups or between domains in the same group.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234516","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500006
Carolina Ozawa, L. F. Marcopito
PURPOSE: to compare the coverage of conventional Papanicolaou cytology in women aged 15 to 59 years between two home surveys, related to some personal attributes and to the tendency to die from cervical cancer. METHODS: we analyzed data collected in two home surveys, with complex sampling, in the city of Sao Paulo, Brazil, over the years from 1987 to 2001 and 2002. The self-reported answers of 968 women in the first inquiry and of 1,125 women in the second inquiry were compared regarding the reply to the question about the execution of the Papanicolaou test "sometimes in a lifetime" in relation to age distribution, black skin, marital status, years of education and tendency to die because cervical cancer during the period from 1980 to 2007. The Fisher exact test was used to compare the sample regarding each item, with the level of significance set at p value >5%. RESULTS: from the first to the second inquiry there was a 24% increase in the execution of conventional Papanicolaou cytology (from 68.8% to 85%). The greatest variations in the increased coverage related to the personal attributes of the women were detected in black skin color, among single women and among women of lower schooling. Regarding the tendency to mortality rates due to cervical cancer, no clear ascending or declining tendency was observed along the 28 years studied (1980 to 2007). CONCLUSION: there was an increase in access to the cytological Papanicolaou test among the most vulnerable women. Since 2001 and 2002, the 85% coverage already reached WHO recommendation, although without a clear trend of decline in mortality due to cervical cancer in the following years, indicating that screening is only part of an effective and organized program for the control of cervical cancer, whose model must guarantee full women's health care.
{"title":"Teste de Papanicolaou: cobertura em dois inquéritos domiciliários realizados no município de São Paulo em 1987 e em 2001-2002","authors":"Carolina Ozawa, L. F. Marcopito","doi":"10.1590/S0100-72032011000500006","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500006","url":null,"abstract":"PURPOSE: to compare the coverage of conventional Papanicolaou cytology in women aged 15 to 59 years between two home surveys, related to some personal attributes and to the tendency to die from cervical cancer. METHODS: we analyzed data collected in two home surveys, with complex sampling, in the city of Sao Paulo, Brazil, over the years from 1987 to 2001 and 2002. The self-reported answers of 968 women in the first inquiry and of 1,125 women in the second inquiry were compared regarding the reply to the question about the execution of the Papanicolaou test \"sometimes in a lifetime\" in relation to age distribution, black skin, marital status, years of education and tendency to die because cervical cancer during the period from 1980 to 2007. The Fisher exact test was used to compare the sample regarding each item, with the level of significance set at p value >5%. RESULTS: from the first to the second inquiry there was a 24% increase in the execution of conventional Papanicolaou cytology (from 68.8% to 85%). The greatest variations in the increased coverage related to the personal attributes of the women were detected in black skin color, among single women and among women of lower schooling. Regarding the tendency to mortality rates due to cervical cancer, no clear ascending or declining tendency was observed along the 28 years studied (1980 to 2007). CONCLUSION: there was an increase in access to the cytological Papanicolaou test among the most vulnerable women. Since 2001 and 2002, the 85% coverage already reached WHO recommendation, although without a clear trend of decline in mortality due to cervical cancer in the following years, indicating that screening is only part of an effective and organized program for the control of cervical cancer, whose model must guarantee full women's health care.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234550","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 : 2011-05-01DOI: 10.1590/S0100-72032011000500008
Samira M. Haddad, José Guilheherme Cececatti
Brazil is among the countries with the highest cesarean section rates, especially in the supplementary health sector. However, some characteristics are similar in both the public and private sectors in terms of the wishes and expectations of pregnant women regarding their delivery. There is a preference for vaginal delivery among women of all social, economic, and cultural levels, a fact that shifts the focus of the negative influence of this variable from women to other subjects involved in delivery care. No isolated factor is able to justify the complexity of making a decision for cesarean section, but the physician and the type of hospital are the main associated factors. The several harmful effects of a non-judicious performance of cesarean section are scientifically recognized. It is important to raise the awareness of doctors and of other health professionals about the real consequences of this decision, the ethical deviations when conducts are chosen without exclusively focusing on the patient`s health, and the need for constant updating for the management of the various possible conditions of childbirth.
{"title":"Estratégias dirigidas aos profissionais para a redução das cesáreas desnecessárias no Brasil","authors":"Samira M. Haddad, José Guilheherme Cececatti","doi":"10.1590/S0100-72032011000500008","DOIUrl":"https://doi.org/10.1590/S0100-72032011000500008","url":null,"abstract":"Brazil is among the countries with the highest cesarean section rates, especially in the supplementary health sector. However, some characteristics are similar in both the public and private sectors in terms of the wishes and expectations of pregnant women regarding their delivery. There is a preference for vaginal delivery among women of all social, economic, and cultural levels, a fact that shifts the focus of the negative influence of this variable from women to other subjects involved in delivery care. No isolated factor is able to justify the complexity of making a decision for cesarean section, but the physician and the type of hospital are the main associated factors. The several harmful effects of a non-judicious performance of cesarean section are scientifically recognized. It is important to raise the awareness of doctors and of other health professionals about the real consequences of this decision, the ethical deviations when conducts are chosen without exclusively focusing on the patient`s health, and the need for constant updating for the management of the various possible conditions of childbirth.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234720","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 : 2011-04-01DOI: 10.1590/S0100-72032011000400002
Alex Sandro Rolland Souza, Mário José de Sousa Neto, A. G. D. Cunha, Eveline de Fátima Catão Monteiro, M. M. Amorim
PURPOSE: to determine the best Doppler flow velocimetry index to predict small infants for gestational age (SGAI), in pregnant women with hypertensive syndromes. METHODS: a cross-sectional study was conducted enrolling 129 women with high blood pressure, submitted to dopplervelocimetry up to 15 days before delivery. Women with multiple fetuses, fetal malformations, genital bleeding, placental abruption, premature rupture of fetal membranes, smoking, use of illicit drugs, and chronic diseases were excluded. A receiver operating characteristic (ROC) curve for each Doppler variable was constructed to diagnose SGAI and the sensitivity (Se), specificity (Sp), positive (PLR) and negative (NLR) likelihood ratio were calculated. RESULTS: the area under the ROC curve for the middle cerebral artery resistance index was 52% (p=0.79) with Se, Sp, PLR, and NLR of 25.0, 89.1, 2.3 and 0.84% for a resistance index lower than 0.70, respectively. While the area under the ROC curve for the resistance index of the umbilical artery was 74% (p=0.0001), with Se=50.0%, Sp=90.0%, PLR=5.0 and NLR=0.56, for a resistance index higher or equal to 0.70. The area under the ROC curve for the resistance index umbilical artery/middle cerebral artery ratio was 75% (p=0.0001). When it was higher than 0.86, the Se, Sp, PLR and NLR were 70.8, 80.0, 3.4 and 0.36%, respectively. For the resistance index of the middle cerebral artery/uterine artery ratio, the area under the ROC curve was 71% (p=0.0001). We found a Se=52.2%, Sp=85.9%, PLR=3.7 and NLR=0.56, when the ratio was lower than 1.05. When we compared the area under the ROC curve of the four dopplervelocimetry indexes, we observed that only the resistance index umbilical artery/middle cerebral artery, resistance index middle cerebral artery/uterine artery and resistance index umbilical artery ratios seem to be useful for the prediction of SGA. CONCLUSION: in patients with high blood pressure during pregnancy, all dopplervelocimetry parameters, except the middle cerebral artery resistance index, can be used to predict SGAI. The umbilical artery/middle cerebral artery ratio seems to be the most recommended one.
{"title":"Comparação entre os índices doplervelocimétricos na predição de recém-nascidos pequenos para idade gestacional em gestantes com síndromes hipertensivas","authors":"Alex Sandro Rolland Souza, Mário José de Sousa Neto, A. G. D. Cunha, Eveline de Fátima Catão Monteiro, M. M. Amorim","doi":"10.1590/S0100-72032011000400002","DOIUrl":"https://doi.org/10.1590/S0100-72032011000400002","url":null,"abstract":"PURPOSE: to determine the best Doppler flow velocimetry index to predict small infants for gestational age (SGAI), in pregnant women with hypertensive syndromes. METHODS: a cross-sectional study was conducted enrolling 129 women with high blood pressure, submitted to dopplervelocimetry up to 15 days before delivery. Women with multiple fetuses, fetal malformations, genital bleeding, placental abruption, premature rupture of fetal membranes, smoking, use of illicit drugs, and chronic diseases were excluded. A receiver operating characteristic (ROC) curve for each Doppler variable was constructed to diagnose SGAI and the sensitivity (Se), specificity (Sp), positive (PLR) and negative (NLR) likelihood ratio were calculated. RESULTS: the area under the ROC curve for the middle cerebral artery resistance index was 52% (p=0.79) with Se, Sp, PLR, and NLR of 25.0, 89.1, 2.3 and 0.84% for a resistance index lower than 0.70, respectively. While the area under the ROC curve for the resistance index of the umbilical artery was 74% (p=0.0001), with Se=50.0%, Sp=90.0%, PLR=5.0 and NLR=0.56, for a resistance index higher or equal to 0.70. The area under the ROC curve for the resistance index umbilical artery/middle cerebral artery ratio was 75% (p=0.0001). When it was higher than 0.86, the Se, Sp, PLR and NLR were 70.8, 80.0, 3.4 and 0.36%, respectively. For the resistance index of the middle cerebral artery/uterine artery ratio, the area under the ROC curve was 71% (p=0.0001). We found a Se=52.2%, Sp=85.9%, PLR=3.7 and NLR=0.56, when the ratio was lower than 1.05. When we compared the area under the ROC curve of the four dopplervelocimetry indexes, we observed that only the resistance index umbilical artery/middle cerebral artery, resistance index middle cerebral artery/uterine artery and resistance index umbilical artery ratios seem to be useful for the prediction of SGA. CONCLUSION: in patients with high blood pressure during pregnancy, all dopplervelocimetry parameters, except the middle cerebral artery resistance index, can be used to predict SGAI. The umbilical artery/middle cerebral artery ratio seems to be the most recommended one.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234241","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 : 2011-04-01DOI: 10.1590/S0100-72032011000400005
Vilma Blondet de Azeredo, Kallyne Bolognini Pereira, C. Silveira, Andre Correia dos Santos, Liliana Magnago Pedruzzi
OBJETIVO: avaliar as modificacoes do estado nutricional de nutrizes adolescentes em diferentes momentos no pos-parto. METODO: estudo do tipo analitico observacional longitudinal, com acompanhamento de 50 nutrizes adolescentes da 5a a 15a semana pos-parto (SPP). O estado nutricional foi avaliado na 5a, 10a e 15a SPP, com uso do Indice de Massa Corporal (IMC/idade). Foi utilizado o metodo colorimetrico para avaliacao da hemoglobina e microcentrifugacao para o hematocrito. Usou-se ANOVA com medidas de repeticao e Tukey como pos-teste, para comparacao das medias. Trabalhou-se com nivel de significância de 5%. RESULTADOS: observou-se modificacao no estado nutricional do periodo pre-gestacional para a 15a SPP, com diminuicao na frequencia de voluntarias com baixo peso (de 21% para 9%) e aumento nos casos de sobrepeso (de 21% para 27%) e eutrofia (58% para 64%). Apesar de, em media, as concentracoes de hemoglobina (12,3±1,7g/dL) e hematocrito (39,0±4,0%) apresentarem-se adequados, observou-se grande frequencia de anemia (30%) durante todo o periodo estudado. CONCLUSAO: os resultados mostram incremento no peso corporal em funcao do tempo de lactacao, aumentando o problema da obesidade na adolescencia. Tambem foi apontado que a anemia e um problema nutricional, nao apenas durante a gestacao, mas tambem na lactacao em adolescentes. Portanto, deve-se prevenir e tratar possiveis deficiencias nutricionais subclinicas existentes neste momento biologico.
{"title":"Estado nutricional de nutrizes adolescentes em diferentes semanas pós-parto","authors":"Vilma Blondet de Azeredo, Kallyne Bolognini Pereira, C. Silveira, Andre Correia dos Santos, Liliana Magnago Pedruzzi","doi":"10.1590/S0100-72032011000400005","DOIUrl":"https://doi.org/10.1590/S0100-72032011000400005","url":null,"abstract":"OBJETIVO: avaliar as modificacoes do estado nutricional de nutrizes adolescentes em diferentes momentos no pos-parto. METODO: estudo do tipo analitico observacional longitudinal, com acompanhamento de 50 nutrizes adolescentes da 5a a 15a semana pos-parto (SPP). O estado nutricional foi avaliado na 5a, 10a e 15a SPP, com uso do Indice de Massa Corporal (IMC/idade). Foi utilizado o metodo colorimetrico para avaliacao da hemoglobina e microcentrifugacao para o hematocrito. Usou-se ANOVA com medidas de repeticao e Tukey como pos-teste, para comparacao das medias. Trabalhou-se com nivel de significância de 5%. RESULTADOS: observou-se modificacao no estado nutricional do periodo pre-gestacional para a 15a SPP, com diminuicao na frequencia de voluntarias com baixo peso (de 21% para 9%) e aumento nos casos de sobrepeso (de 21% para 27%) e eutrofia (58% para 64%). Apesar de, em media, as concentracoes de hemoglobina (12,3±1,7g/dL) e hematocrito (39,0±4,0%) apresentarem-se adequados, observou-se grande frequencia de anemia (30%) durante todo o periodo estudado. CONCLUSAO: os resultados mostram incremento no peso corporal em funcao do tempo de lactacao, aumentando o problema da obesidade na adolescencia. Tambem foi apontado que a anemia e um problema nutricional, nao apenas durante a gestacao, mas tambem na lactacao em adolescentes. Portanto, deve-se prevenir e tratar possiveis deficiencias nutricionais subclinicas existentes neste momento biologico.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234399","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 : 2011-04-01DOI: 10.1590/S0100-72032011000400003
Ricardo Filipe Rodrigues Santos, Rui F. Miguelote, D. Coelho, Ana Maria de Andrade, Cristina Santos, João Bernardes, Ricardo Cruz-Correia
PURPOSE: to assess the validity of several fetal weight charts, commonly used in Portugal, to classify its population. METHODS: observational retrospective study. Singleton birth data was analyzed, from a two- year period (May 2008 to April 2010), from pregnancies with an ultrasound in the same institution, between the 8th and 14th gestational week. Upon data validation, percentiles for each completed gestational week were created, smoothed by a quadratic function, analyzed and compared to the tables more commonly utilized, in the institution and country, by using Z-scores, percentile comparison, sample 10th percentile detection sensibility and birthweight means comparison. RESULTS: a total of 5,378 newborns (NB) were born in the period; 2,195 (42%) NB were included, born from the 24th to 42nd gestational week, allowing statistical analysis from the 34th to the 41st week. There were differences in the mean birthweight for each gestational age, between references and with the sample, as well as between sexes. The 10th percentile from some references has shown differences ranging from -288g at 37 weeks (-11% in Lubchenco et al. data), with and +133g at 34 weeks (+7,6% with Carrascosa et al. data) compared to the values found with the sample. Differences were also found concerning the sensitivity of the identification of a sample birthweight below the 10th percentile, which was between 14.1 and 100%, depending on the reference used. DISCUSSION: the limitation of these kinds of reference values must be remembered and minimized, with the adoption of regionally or nationally produced references, contemplating other variables, such as sex, with precisely known gestation duration and with validation of the utilized references in loco.
{"title":"Validade das tabelas de peso fetal clássicas para a população Portuguesa","authors":"Ricardo Filipe Rodrigues Santos, Rui F. Miguelote, D. Coelho, Ana Maria de Andrade, Cristina Santos, João Bernardes, Ricardo Cruz-Correia","doi":"10.1590/S0100-72032011000400003","DOIUrl":"https://doi.org/10.1590/S0100-72032011000400003","url":null,"abstract":"PURPOSE: to assess the validity of several fetal weight charts, commonly used in Portugal, to classify its population. METHODS: observational retrospective study. Singleton birth data was analyzed, from a two- year period (May 2008 to April 2010), from pregnancies with an ultrasound in the same institution, between the 8th and 14th gestational week. Upon data validation, percentiles for each completed gestational week were created, smoothed by a quadratic function, analyzed and compared to the tables more commonly utilized, in the institution and country, by using Z-scores, percentile comparison, sample 10th percentile detection sensibility and birthweight means comparison. RESULTS: a total of 5,378 newborns (NB) were born in the period; 2,195 (42%) NB were included, born from the 24th to 42nd gestational week, allowing statistical analysis from the 34th to the 41st week. There were differences in the mean birthweight for each gestational age, between references and with the sample, as well as between sexes. The 10th percentile from some references has shown differences ranging from -288g at 37 weeks (-11% in Lubchenco et al. data), with and +133g at 34 weeks (+7,6% with Carrascosa et al. data) compared to the values found with the sample. Differences were also found concerning the sensitivity of the identification of a sample birthweight below the 10th percentile, which was between 14.1 and 100%, depending on the reference used. DISCUSSION: the limitation of these kinds of reference values must be remembered and minimized, with the adoption of regionally or nationally produced references, contemplating other variables, such as sex, with precisely known gestation duration and with validation of the utilized references in loco.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234336","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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