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

Objective: To test the hypothesis that the quarterly injectable contraceptive increases the activity of the renin-angiotensin-aldosterone system.

Methods: This was a cross-sectional observational study that included eutrophic, irregularly active women, aged between 18 and 30 years, who had been taking quarterly injectable contraceptive (150mg of medroxyprogesterone acetate) for at least 6 months or who had not used any type of hormonal contraceptive for at least 6 months. At first the volunteers underwent a physical examination and answered a standard questionnaire. They were then sent for blood collection of laboratory variables: plasma renin activity and concentration, angiotensin-converting enzyme 1 (ACE 1), and aldosterone. The data was analyzed using the two-tailed Student's t-test, with significance <0.05.

Results: Sixty-two women were included in this study, divided into the Injectable Contraceptive Group (ICG) with n=23 and the No Contraceptive Group (NCG) with n=39. ICG had lower mean plasma renin activity values than NCG, respectively 0.4 ± 0.17 vs 1 ± 0.6 (p <0.01). The mean values for plasma renin concentration, ACE 1, and aldosterone did not differ between the groups (respectively, p= 0.21; 0.66; 0.09).

Conclusion: Women using quarterly injectable contraceptives do not show greater activity of the renin-angiotensin-aldosterone system than their counterparts who do not use this drug.

Objective: To compare the efficacy of a traditional open ASC technique (ASC-T) to an open modified technique (ASC-M).

Methods: Retrospective cohort study with stage 3 or 4 apical prolapse women, who operated on using one of the two techniques were included in the study: ASC-T (vaginal mesh is secured with eight sutures) and ASC-M (four sutures). The POP-Q was used to objectively assess anatomical improvement. Women with less than one year of follow-up, without POP-Q classification, or with incomplete data were excluded.

Results: A total of 223 women underwent ASC: 120 in ASC-T and 103 in ASC-M. The average age was 65.3 (±6.5) years in the ASC-T group and 65 (±8.5) years in the ASC-M group, with no difference between them (p=0.706). There was no difference in intraoperative increased bleeding (p=1.000) and bladder injury (p=0.706) in both groups. Comparing the POP-Q points pre- and postoperatively, we observed improvement in all points in both groups (p<0.001) without difference between them. The analysis of variance for repeated measures was used to compare the outcomes between the two groups. The postoperative prolapse stage was similar between the two groups in the apical (p=0.251) and anterior (p=0.052) vaginal compartments. In the subjective evaluation, we observed a high rate of cure and improvement in both groups, respectively 81.7% and 16.7% in the ASC-T group, and 91.3% and 8.7% in the ASC-M group (p=0.100).

Conclusion: Both sacrocolpopexy techniques were effective in treating apical prolapse, as evidenced by both objective and subjective cure rates, with a low complication rate.

Objective: To analyze recall rates in a public breast cancer screening facility in Campinas, Brazil.

Methods: A prospective assessment of outcomes on screening mammographies (MMG) between July 2023 and August 2024. BI-RADS® 0,4/5 indicated positive results, and women recalled. The variables were age, whether first or subsequent MMG, and biopsy (cancer positive or negative). The outcomes were recall rate and cancer detection rate on the recall (CDR). Prevalence ratio with 95% confidence interval (PR) estimated the risk.

Results: There were included 19,377 MMG on women over 40: 15,983 subsequent MMG (82.5%), and 1,646 women recalled (BR 0,4/5). Adherence to recall was over 99%. The recall rates were 12.4% at first and 7.7% at subsequent MMG. Recall rate was 1.6 times higher at first than at subsequent MMG (PR 1.61;1.45-1.79). CDR was higher at subsequent MMG. A first MMG reduced the risk of cancer detection by 71% (PR 0.29-0.15;0.58). Compared to women 50-69, there were no differences in the risks of recall and cancer detection at first MMG. At subsequent MMG the recall risk was higher in women 40-49 (PR 1.16;1.03-1.30), and over 69 (PR 1.47;1.03-2.12). The risk of cancer detection was 60% lower in women 40-49 (PR 0.60;0.36-0.99), and 2.7 times higher in women over 69 (PR 2.78;1.32-5.84).

Conclusion: The recall rates were 12.4% at first and 7.7% at subsequent MMG. Adherence was high. Screening efficiency was higher in women 50-69. At subsequent screenings women 40-49 showed a higher recall rate and a lower CDR when compared to women 50-69.

Objective: To synthesize current scientific evidence on the benefits and potential contributions of integrating AI-based technologies with traditional diagnostic methods used for the detection and early diagnosis of cervical cancer in adult women.

Methods: An exhaustive search was conducted in academic databases (PubMed, Scopus and BIREME) using specific search terms and Boolean operators in December 2024. Independently conducted by three researchers across all databases, the selection process included articles involving adult women with either suspected or confirmed cervical cancer, in which the application of artificial intelligence (AI) technologies was examined across various techniques used for early diagnosis of the disease, such as cytology, colposcopy, and radiological imaging, among others. Only articles published between 1999 and 2022 were included. The included articles were reviewed in full text by all authors, and relevant data were extracted and organized into a chart comprising the following items: author and year of publication, title, study design, type of AI technology used, and a summary of the content.

Results: AI, particularly through Machine Learning (ML) algorithms, demonstrated significant improvements in the accuracy, sensitivity, and efficiency of cervical lesion classification when combined with conventional diagnostic techniques like cervical cytology, colposcopy, and biopsy. This combined approach outperformed traditional methods used in isolation.

Conclusion: The integration of AI with standard cervical cancer screening and diagnostic methods offers substantial benefits, including faster detection times, reduced workload for pathologists, and improved patient outcomes by facilitating earlier treatment initiation and reducing diagnostic variability. Considering the available literature, the use of AI may offer potential benefits; however, further studies are required.

Objectives: Clavicle fractures are the most common birth-related fractures. They may cause pain, arm mobility impairment, and brachial nerve injury (temporary or definitive). Therefore, we aimed to review the incidence, risk factors and prognosis of neonatal clavicle fractures in our hospital.

Methods: All cases of clavicle fractures diagnosed and registered during the neonatal period between 2018 and 2022, in a tertiary-care Portuguese hospital, were reviewed. Statistical descriptive analysis, odds ratios (ORs), and 95% confidence intervals(95%CI) were calculated.

Results: A total of 8132 births and 91 clavicle fractures were identified (1.1% incidence) - 0.04% (1/2512) in cesarean sections and 1.7% (90/5453) in vaginal births. An instrumental vaginal birth doubled the probability of clavicle fractures (OR 2.072, 95%CI 1.365-3.145 compared to spontaneous births). In 15.4% of clavicle fractures, births were complicated by shoulder dystocia. Shoulder dystocia significantly increased the risk of clavicle fracture (OR 35.71; 95% CI 17.86-71.43). Of the 91 cases, 22% resulted from pregnancies complicated by gestational diabetes; in these cases, the risk of clavicle fractures increased 76% (OR 1.761, 95%CI 1.068-2.904). Most of the cases were referred to a Neonatology follow-up appointment (92.3%). Fifteen neonates had a clinical suspicion of brachial plexus injury, but all of them regained normal arm mobility after physiotherapy.

Conclusion: The incidence of clavicle fractures in our hospital is comparable to the literature (1.1%). To reduce the incidence of clavicle fractures not only its risk factors must be reduced, but a simulation-based labor ward team training program on shoulder dystocia should also be implemented.

Objective: Thyroid peroxidase antibody (TPOAb) is a prevalent condition amongst women of reproductive age and has been associated with adverse pregnancy outcomes. However, there is currently no proven treatment for euthyroid pregnant women with TPOAb. Therefore, we aimed to investigate the efficacy of levothyroxine treatment in this population.

Methods: We searched PubMed, Embase and Cochrane Central from inception to or randomized controlled trials (RCTs) comparing levothyroxine with placebo or no treatment in euthyroid pregnant women who were positive for TPOAb. Our main outcomes were miscarriage, preterm birth, and live birth. We performed subgroup analysis based on recurrent pregnancy loss (RPL).

Results: We included 8 RCTs comprising 1,645 pregnant women, of whom 814 (49.5%) were randomized to receive levothyroxine. Pregnant women treated with levothyroxine had significantly lower miscarriages (RR 0.78; 95% CI 0.63-0.98; p=0.035). No significant difference was found regarding pre-term birth (RR 0.78; 95% CI 0.55-1.13; p=0.189) and live birth (RR 1.05; 95% CI 0.99-1.12; p=0.097). Our subgroup analysis demonstrated a significant interaction (p=0.048) between patients with RPL (RR 1.21; 95% CI 1.03-1.42; p=0.023) and no RPL (RR 1.00; 95% CI 0.92-1.09; p=0.922).

Conclusion: Levothyroxine reduced miscarriage in pregnant women with TPOAb and improved live birth rate when associated with RPL. Our subgroup analysis also provides evidence that levothyroxine may have a higher benefit for patients with a history of RPL.

Prospero registry: CRD42023410433.

Objective: To evaluate adherence to preeclampsia prophylaxis with aspirin and calcium carbonate among pregnant women with chronic hypertension attending a specialized hypertension in pregnancy center at a tertiary hospital in Brazil.

Methods: A cross-sectional study was conducted at the Hospital das Clínicas de Ribeirão Preto. Adherence to aspirin and calcium carbonate was assessed using the Morisky-Green questionnaire. Additionally, we assessed the knowledge of these women regarding preeclampsia. A total of 101 pregnant women were interviewed, and 98 were included in the final analysis.

Results: Non-adherence rates were 64.3% for aspirin and 59.2% for calcium carbonate. The overall incidence of preeclampsia was 22.4% with 11% requiring magnesium sulphate for blood pressure control. No significant differences in preeclampsia incidence were observed among adherent and non-adherent groups for either aspirin or calcium carbonate. Most participants demonstrated high (78.6%) or medium (18.4%) levels of knowledge about preeclampsia.

Conclusion: There was low adherence to aspirin and calcium carbonate prophylaxis among pregnant women with chronic hypertension, with no difference in preeclampsia prevention between adherent and non-adherent groups. These findings raise important questions about the effectiveness of aspirin in reducing preeclampsia risk in chronic hypertension. Further studies should be conducted to evaluate the reasons for low adherence.

Objective: To identify factors that predict the likelihood of a successful vaginal birth after cesarean section (VBAC).

Methods: An observational, case-control study was conducted at Hospital das Clínicas, Botucatu Medical School, a tertiary referral center in Brazil. Medical records of women with singleton term pregnancies, one previous cesarean section, and a live fetus in cephalic presentation who delivered between January 2013 and December 2015 were reviewed. Participants were classified according to delivery mode: vaginal birth after cesarean section or repeat cesarean section. Maternal demographics, clinical and obstetric characteristics, and neonatal outcomes were analyzed. Associations were assessed using chi-square, and significant variables were entered into a multivariate logistic regression model.

Results: A total of 653 women met the inclusion criteria. Of these, 324(49.6%) achieved a vaginal birth, and 329(50.4%) underwent a repeat cesarean section. Factors associated with a higher likelihood of vaginal birth included a history of prior vaginal delivery, cervical dilation of at least 4 cm at admission, a Bishop score of 6 or higher, spontaneous onset of labor, absence of chronic hypertension, and neonates classified as appropriate or small for gestational age. In contrast, advanced maternal age, unemployment, diabetes, and hypertensive disorders were associated with an increased likelihood of cesarean delivery.

Conclusion: VBAC was more likely in women with cervical dilation of 4 cm or more at admission, a Bishop score of 6 or higher, a history of vaginal birth, spontaneous labor onset, absence of chronic hypertension, and lower neonatal birth weight.