Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia最新文献

• Although advances in the treatment of gynecological cancer have improved survival rates, they may also increase the effects of induced menopause, especially in young women. • Cancer treatments such as oophorectomy, gonadotoxic chemotherapy, and pelvic radiotherapy can induce menopause. • Gonadotoxic chemotherapy, especially alkylating-containing regimens, often damages ovarian function and may result in permanent menopause. • Pelvic radiotherapy usually results in permanent loss of ovarian function unless ovarian transposition is performed. • Diagnosing menopause after cancer is challenging, and common diagnostic criteria such as 12 months or more of amenorrhea and elevated follicle-stimulating hormone (FSH) levels are not entirely reliable, since ovarian function may return years after treatment. • A multidisciplinary approach to post-cancer menopause is essential and should include an appropriate line of care, since hormone replacement therapy after treatment of gynecologic malignancy is controversial.

Objective: The aim of the study was to identify non-pharmacological therapeutic resources used by physiotherapists for pain relief during labor and childbirth.

Methods: This is a cross-sectional study conducted from January to March 2021, followed the STROBE guidelines. It included Brazilian physiotherapists with a minimum of two years in obstetric care experience. Data were collected using a 33-item online questionnaire, which covered sociodemographic details and the utilization of non-pharmacological resources. Descriptive analysis was used to determine participant characteristics. Associations between sociodemographic variables, specialist titles, participation in scientific events, and methods for pain relief methods during childbirth were assessed using chi-square or Fisher's exact tests. Data were analyzed using SPSS version 23.0, with a significance level set at 5% (p < 0.05).

Results: A total of 114 Brazilian physiotherapists participated in this study. Participants chose to utilize non-pharmacological therapies and resources that are within the scope of physiotherapists' practice for labor pain. Kinesiotherapy with the use of devices was the most employed technique for pain relief during the birthing process.

Conclusion: The study highlights the prevalent use of non-pharmacological therapeutic resources, particularly kinesiotherapy with devices, among Brazilian physiotherapists for labor pain relief.

Objective: The study investigates the influence of positive-approach counseling through both online and face-to-face group therapy on the sexual intimacy of women after benign complete abdominal hysterectomy, addressing challenges such as the loss of femininity and other psychosexual complications that disrupt the couple's relationship post-surgery.

Methods: This is a parallel clinical trial, conducted in 2023 in Yazd, Iran; with sixty-six participants post- benign complete abdominal hysterectomy were randomly assigned to online and face-to-face counseling groups. Each group had eight 90-minute sessions, and data were collected using demographic and intimacy scale (IS) questionnaires at baseline, eighth week, and twelfth week follow-up. Statistical analysis used SPSS version 23 (P < 0.05).

Results: In the Online Group, the mean sexual intimacy score significantly increased from 72.42 ± 9.05 to 87.06 ± 7.98 at eight weeks and 90.30 ± 8.23 at twelve weeks (P < 0.001). In the Face-to-Face Group, the mean score increased from 70.21 ± 6.75 to 81.24 ± 5.55 at eight weeks and 85.03 ± 5.40 at twelve weeks (P < 0.001). Online counseling proved more effective than face-to-face counseling in enhancing sexual intimacy (P = 0.043).

Conclusion: Online and face-to-face counseling based on the positive approach improved sexual intimacy in women with a history of benign hysterectomy. Moreover, it seems that online counseling was more effective, so it is recommended that this method be employed in follow-up sessions after hysterectomy. Iranian Registry of Clinical Trials - IRCT20230209057373N1.

Objective: Our aims to compare level of serum ischemia modified albümin(IMA) between healthy and preeclamptic pregnancies and to evaluate the relationship of IMA with preeclampsia, preeclampsia severity and perinatal outcomes.

Methods: Our study is a prospective case-control study. A total of 134 pregnant women (66 preeclamptic and 68 healthy pregnant) between 18-45 years of age and between 24- 41 gestational weeks participated. Serum IMA levels were measured by the Albumin Cobalt Binding (ACB) test.

Results: The mean IMA values were found to be significantly higher in the preeclampsia group compared to the control group (p<0,001). Patients were divided into 3 groups; severe preeclampsia(n=29), non-severe preeclampsia(n=37) and healthy pregnant(n=68). Statistically significant difference was not found between severe preeclampsia and non-severe preeclampsia (p=0.505). The performance of IMA values in predicting the development of preeclampsia among all participants was evaluated with Receiver Operating Characteristic (ROC) analysis. According to the ROC analysis, the best cut-off value at which the maximum area under the curve (AUC) was obtained was found when IMA>0.98(AUC: 0.690 95% Confidence Interval (CI): 0.600-0.781 p<0.001). When IMA threshold value of >0.98 was taken to predict preeclampsia; the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated as 65.15%, 64.71%, 64.18%, and 65.67%, respectively.

Conclusion: IMA level may be a useful new marker in recognizing and predicting preeclampsia. However, despite the power of recognizing the disease, serum IMA levels do not give an idea about the severity of the disease. More comprehensive studies are needed in order to use IMA levels in the diagnosis of preeclampsia.

Objective: To determine if maternal erythrocytosis is a risk factor for small-for-gestational age at term at 3,400-m altitude in pregnant women without intercurrent disease.

Methods: Analytical study of retrospective cohorts at Cusco, a city at 3,400-m altitude. Our participants were 224 and 483 pregnant women with and without exposure to maternal erythrocytosis, respectively. A logistic regression with the goodness of fit to the proposed model was also performed with the Hosmer and Lemeshow test, evaluating the small-for-gestational-age results with or without exposure to hemoglobin >14.5 g/dl.

Results: The incidence of small-for-gestational-age was 6.9% for this entire cohort. The maternal erythrocytosis during gestation without any maternal morbidity at 3,400-m altitude has an ORa=0.691 (p=0.271) for small-for-gestational-age at term. Inadequate prenatal control has an ORa=2.115 (p=0.016) for small-for-gestational-age compared to adequate prenatal control.

Conclusion: Maternal erythrocytosis in pregnant women without any morbidity is not a risk factor for small-for-gestational-age at 3,400 m-altitude.

Objective: To evaluate the maternal outcomes in women with postpartum depression using zuranolone, the first oral medication indicated to treat postpartum depression.

Methods: We conducted a systematic search in September 2023, on Pubmed, Embase and Cochrane Trials. We included randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. No time or language restrictions were applied. 297 results were retrieved, of which 11 papers were selected and fully reviewed by two authors. Review Manager 5 was used for statistical analysis and Cochrane Risk-of-bias tool for randomized trials was applied for quality assessment.

Results: We included 2 studies, with 346 women, of whom 174 (50.2%) were treated with zuranolone. Zuranolone was significantly associated to an improvement of Clinical Global Impression response rate; Hamilton Depression Rating Scale 15 days and 45-day remission, 3-day, 15-day, and 45-day symptom remission, and reduction in the dose of antidepressants. As for safety outcomes, it was noticed that zuranolone increases sedation risk, which can be dose related. No significant differences were found for other adverse events.

Conclusion: These findings suggest that zuranolone might present a safe and effective medication for out-of-hospital treatment of PPD. Sedation effects need to be further assessed.

Objective: To analyze the prognosis of patients with breast cancer who developed trastuzumab-induced cardiotoxicity and to analyze factors associated with and resulting from cardiotoxicity.

Methods: This was a retrospective cohort study that included 255 HER2-positive breast cancer patients who received adjuvant trastuzumab therapy. The inclusion criteria were a diagnosis of HER2-positive breast cancer and adjuvant trastuzumab therapy; disease stage I-III; <70 years; and a baseline echocardiogram showing a left ventricular ejection fraction (LVEF) ≥ 55%. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model were used.

Results: In all, 15.3% (39/255) of patients presented with cardiotoxicity. Treatment was suspended in 92.3% (36/39) of patients who presented with cardiotoxicity during trastuzumab treatment. The treatment was suspended in 46 of 255 patients and it was permanently interrupted in 84.8% (33/46) of these patients, with 84.8% (28/33) due to cardiotoxicity. Cardiotoxicity was not associated with disease-free survival (DFS) (hazard ratio (HR) = 1.48; 95% confidence interval (CI = 0.79-2.78) or overall survival (OS) (HR = 1.68; 95%CI= 0.83-3.41). Patients with clinical stage III and whom trastuzumab therapy was suspended (all causes) had worse DFS; (HR = 3.19; 95% CI=1.77-5.74) and (HR = 1.83; 95% CI=1.01-3.32) respectively. Those with clinical stage III and whom trastuzumab therapy was permanently interrupted had worse OS; (HR = 3.80; 95% CI =1.82-7.94), and (HR = 2,26; 95% CI =1.09-4.68 respectively.

Conclusion: Cardiotoxicity was not associated with DFS or OS. Clinical stage III, Suspension and permanent interruption of treatment regardless of the cause were associated with worse DFS and OS in breast cancer patients.

Objective: An in-depth evaluation of the published evidence is needed on self-medication, specifically the evidence focusing on vulnerable groups, such as pregnant women. This scoping review aims to provide an overview of the differences in self-medication prevalence and study characteristics among different groups, while identifying gaps in the literature.

Methods: A literature search was performed in PubMed and Web of Science, including articles published in the last 10 years for the pregnant women group (PWG) and the general population group (GPG). Data on study design, self-medication prevalence, medications used, and other variables were collected, tabulated, and summarized.

Results: From 2888 screened articles, 75 were considered including 108,559 individuals. The self-medication (SM) in the PWG ranged from 2.6 to 72.4% and most studies had an SM prevalence between 21 and 50% and in the GPG, 32 from 50 studies had a SM prevalence higher than 50%. The reviewed studies varied considerably in methodology, requiring careful interpretation. While most of the studies assessed self-medication during the entire pregnancy, self-medication definition was often inconsistent between studies. Acetaminophen was the most used medication and headache was the most frequent symptom leading to self-medication initiation in the PWG.

Conclusions: Self-medication among pregnant women showed a lower prevalence when compared to the general population. The medications used and symptoms reported were similar between groups. However, methodological differences must be carefully considered. Pregnant women should carefully follow their physicians' advice before initiating self-medication to avoid preventable maternal and fetal adverse effects.

Objective: The average age of patients with vulvar squamous cell carcinoma (SCC) has been reported to have declined. Human papilloma virus (HPV)-related lesions have been shown to be associated with the expression of the immunohistochemical (IHC) marker p16. Non-HPV-related tumors have been characterized by p53 abnormal expression and PDL1 expression. We aimed to evaluate the correlation between these markers and vulvar SCC and to relate it to the clinical and pathological characteristics.

Methods: Histopathologic assessments and IHC analyses of p16, p53, and PDL1 were performed in 41 samples of vulvar SCC collected between 2016 and 2021. The data were correlated with clinical and pathological characteristics of the patients.

Results: The mean age of the patients was 72.1 years. Positive p16 and PDL1 staining was detected in 24.4% and 17.1% of the samples, respectively. p53 expression was negative in 19.5% of the samples, whereas it was overexpressed in 24.4%. p16-positive tumors showed a smaller depth of invasion (DOI) (p = 0.014), while tumors with p53 abnormal expression showed greater DOI (p = 0.041). PDL1 expression was correlated with increased number of inflammatory cells (p = 0.055). In addition, lesions with lymphovascular space invasion were p16-negative.

Conclusion: In our sample, regarding to the SCC incidence the patients' mean age did not change. The expression of p16 was inversely correlated with p53 results. Tumors with p53 abnormal expression and absence of p16 showed a greater DOI. Our data suggest an association between PDL1 expression and increased inflammatory infiltrates in vulvar SCC.

Objective: To verify the prevalence and factors associated with Non-Alcoholic Fatty Liver Disease (NAFLD) among women with Polycystic Ovary Syndrome (PCOS).

Methods: A cross-sectional study was conducted with 53 patients with PCOS. The diagnosis of PCOS followed the Rotterdam criteria. The diagnosis of NAFLD was made through US showing hepatic steatosis, excluding significant alcohol consumption and chronic liver disease. The following variables were compared between the groups of women with and without NAFLD: age, race, anthropometric data, blood pressure levels, liver enzymes, glycemic and lipid profiles, total testosterone, presence of hirsutism, and metabolic syndrome (MS). Variables were compared between the groups using T-test, Mann-Whitney, and Chi-square tests.

Results: Among 53 patients with PCOS, 50.9% had NAFLD. The NAFLD group had higher weight (p=0.003), BMI (p=0.001), waist circumference (p≤0.001), fasting glucose (p=0.021), HbA1C% (p=0.028), triglycerides (p=0.023), AST (p=0.004), ALT (p=0.001), higher prevalence of MS (p=0.004), and lower levels of HDL cholesterol (p=0.043). The other variables did not differ between the groups. Both groups were predominantly of caucasian race, and there was no significant difference in age.

Conclusion: The prevalence of NAFLD among patients with PCOS was 50.9%. Metabolic and hepatic enzyme abnormalities were more prevalent in this group compared to the group without the disease. Obesity tripled the prevalence of NAFLD.