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

Objective: The aim of this study was to evaluate the effect of vaginal pH on the efficacy of the dinoprostone vaginal insert for cervical ripening in patients with unfavorable Bishop Score.

Methods: Prospective observational cohort study, conducted at a Portuguese tertiary hospital. Term pregnant women with a singleton pregnancy and vertex presentation who had indication for labor induction with Bishop's Score ≤ 6 were included. Vaginal pH was measured with high accuracy strips before vaginal examination for Bishop Score was performed. The intravaginal dinoprostone insert (Propess^®) was then applied into the posterior fornix. The primary outcome was the change of the Bishop's Score before placement and after removal of the dinoprostone insert. Spearman correlation was analyzed (SPSS 16.0).

Results: A total of 75 women were included, with a gestational age of 39 ± 1,2 weeks. Mean initial vaginal pH was 4.67 ± 0.51. Mean variation of Bishop Score was 1.8 ± 2.3 points. There was a weak correlation between vaginal pH and changes on the Bishop Score with dinoprostone vaginal insert use (ρ = -0.123; p = 0.3).

Conclusion: Vaginal pH does not appear to be a major influencer of the efficacy of dinoprostone vaginal insert for cervical ripening.

Objective: Evaluate the application and effectiveness of the problem-based learning (PBL) teaching model in Obstetrics and Gynecology (OB/GYN) undergraduate education.

Data sources: A systematic search was performed in five electronic databases (LILACS, PubMed/MEDLINE, EMBASE, CINAHL, and Cochrane Library) for studies published between January 1, 2000, and December 31, 2021. The search strategy used descriptors in English, portuguese, and Spanish based on the PICO framework: "Education, Medical, Undergraduate" (P); "Problem-Based Learning", "Gynecology", and "Obstetrics" (I); no comparator (C); and "Patient Satisfaction" or "Knowledge" (O). Study selection: A total of 24 studies were included. Selection criteria encompassed original articles that evaluated the impact of PBL in OB/GYN undergraduate education, without language restrictions.

Data collection: Two independent reviewers extracted data regarding study characteristics, participant profiles, methodology, and outcomes. Discrepancies were resolved by consensus.

Data synthesis: Among the included studies,14(58.33) of them coming from Asian, most of them 16(66.66) having been published between the years 2006-2010 and 2016-2021. About 15(62.5) dealt only with students, the majority consisting of surveys/questionnaires 8(30) and non-randomized comparative studies 7(29.16). As for academic performance, 14(58.33) demonstrated that the PBL methodology is superior considering the ability to sediment information, and 8(30) indicated PBL is superior concerning developing clinical reasoning. Regarding student satisfaction, 11(45.83) of the studies indicated a positive experience with the method.

Conclusion: The PBL model appears more effective than traditional teaching methods in enhancing clinical competence and student satisfaction in OB/GYN education. However, further well-designed studies are necessary to confirm these findings and guide educational strategies.

Prospero registry: CRD42021282337.

Objective: This study aimed to analyze the relationship between aneuploidy and maternal age based on preimplantation genetic testing for aneuploidies (PGT-A) and the distribution of aneuploidy across individual chromosomes.

Methods: This is a single-center retrospective cohort study. The study included patients who underwent PGT-A during their in vitro fertilization (IVF) cycle between 2016 and 2024. PGT-A was performed on 1,341 embryos from 481 patients using next-generation sequencing (NGS)-based techniques. We conducted a Logistic regression analysis to determine the relationship between maternal age and the rate of aneuploidy; additionally, the most commonly affected chromosome and the characteristics of the detected alterations were evaluated. Statistical analysis was performed using STATA v17.

Results: Among all patients, the observed aneuploidy rate was 55.85%. In patients younger than 30 years, the aneuploidy rate was 26.92%, with a progressive increase to 62% in women older than 40 years. Chromosomes 22, 21, 16, and 15 were the most frequently affected. Logistic regression indicated that age is a significant predictive factor for aneuploidy (coefficient = 0.0956; p < 0.001), with an odds ratio of 1.10 (95% CI: 1.07-1.13), meaning that the probability of aneuploidy increases by approximately 10% for each additional year of age.

Conclusion: Our results indicate that an increase in maternal age is significantly associated with a higher incidence of aneuploidy in embryos that underwent PGT-A. These findings are significant for patient counseling and optimizing embryo selection in assisted reproduction treatments.

Objective: To analyse the effectiveness of kinesiotherapy in the labour of pregnant women induced by misoprostol.

Methods: This is a clinical trial carried out with pregnant women pharmacologically induced by misoprostol (25mcg, vaginally). They were randomised into two groups: Intervention Group (IG) of induced pregnant women who underwent kinesiotherapy during the active phase of labour; and Control Group (CG), of induced pregnant women who did not do physical therapy during the active phase of labour. Among the variables studied were vaginal delivery, induction time, duration of the labour, and the number of misoprostol doses. Data were analysed by the Statistical Package for the Social Sciences (SPSS). The IG had more vaginal deliveries (p=0.016). The other variables analysed showed no difference between groups.

Results: Kinesiotherapy during the active phase of labour in women induced by misoprostol was effective for performing more vaginal deliveries despite not showing any difference in the other outcomes studied.

Conclusion: The findings of this study indicate that after the application of kinesiotherapy, during the active phase of labour in pregnant women induced by misoprostol, the number of vaginal deliveries increases.

Brazilian registry of clinical trials rebec: RBR-3mvj4m7.