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

Objective: To estimate age-adjusted mortality rates at the national and state levels, evaluates trends and their spatial distribution during the period 2000-2023 among Mexican women.

Methods: Ecological study conducted from open access data, the age-standardized mortality rate of breast cancer during the period 2000-2023 was calculated. Joinpoint regression models were estimated for breast cancer mortality in Mexico and its states. Spatial analysis was performed using Moran's I statistic.

Results: The age-adjusted mortality rate at the national level during 2000 was 18.99 per 100,000 women, the highest mortality rate occurred in the year 2020. Joinpoint analysis shows a decrease in mortality in the last five years, being greater in urban areas. For 2023, the highest mortality occurred in Sonora and Chihuahua, while Mexico City (-0.71; 95%CI -0.98 to -0.44) was the entity that showed a significant reduction in the mortality rate from breast cancer. The spatial analysis showed a local indicator of spatial association of 0.458 (p<0.05) for 2000 and 0.524 (p<0.05) for 2023 in the northern states of the country.

Conclusion: Public health interventions must be implemented according to the social, economic, and cultural context to reduce mortality from breast cancer.

Objective: Advanced maternal age has become more common due to factors such as increased academic preparation for women, labor market participation, delayed family planning, and advances in reproductive medicine. This phenomenon raises questions about the risks and gestational outcomes associated with advanced maternal age (AMA). This study aims to explore the gestational and perinatal outcomes in pregnant women with AMA (> 35 years), comparing them with those of women aged 20 to 34 years.

Methods: The research was conducted as an observational and retrospective analysis, examining data from 2012 to 2022 from the Hospital Production System (SIH/SUS) available on the DATAsus platform, covering all regions of Brazil. Variables analyzed included gestational duration, type of pregnancy (single or multiple), mode of delivery, Robson group, APGAR score at five minutes, birth weight, and occurrence of congenital anomalies.

Results: Pregnant women with AMA showed statistically significant differences in the higher percentage of cesarean sections (63.3% AMA vs 58% non-AMA, p<0.05), higher percentage of low birth weight newborns (12.5% AMA vs 6.7% non-AMA, p<0.05), lower APGAR scores at the fifth minute (OR = 1.08, p<0.001) and a higher prevalence of any congenital anomalies (1.23% AMA vs 0.77% non-AMA, OR =OR = 1.34, p < 0.001). In addition, this group had a higher incidence of premature births (12.99% AMA vs 8.78% non-AMA) and multiple pregnancies (1.39% AMA vs 0.83% non-AMA). Furthermore, in the Robson classification, there was a predominance of older mothers in Group 5 (previous cesarean section) and in the groups with nulliparity.

Conclusion: Pregnant women with AMA face higher gestational and perinatal risks, such as preterm births and an increased need for cesarean sections. These findings underscore the importance of public policies and personalized management strategies to improve maternal and neonatal outcomes for older pregnant women.

Objective: This study aims to explore the combined role of ANGPTL3, 4, 8, omentin-1, leptin, TNF-α, and IL-6 molecules known for their roles in fat metabolism, obesity, and inflammation, yet whose connection to PCOS is still debated in the development of PCOS.

Methods: A prospective cross-sectional study involving PCOS patients (n=30) and BMI-matched controls (n=30) was conducted. Levels of ANGPTL3, 4, 8, omentin-1, leptin, TNF-α, and IL-6 were measured in peripheral venous blood samples.

Results: When dividing both the PCOS and control groups into six BMI-based subgroups normal weight (20-24.9 kg/m²), slightly overweight (25-29.9 kg/m²), and obese (30-39.9 kg/m²) there were significant differences in levels of ANGPTL3 and 8, omentin-1, leptin, IL-6, and TNF-α (p<0.05). Comparison between the entire PCOS and control groups showed that CRP levels were significantly higher in the PCOS group (p<0.0001), while omentin-1 levels were significantly lower (p=0.022). Regression analysis, including ANGPTL3, 4, 8, IL-6, and TNF-α alongside CRP and omentin-1, indicated a significant model for PCOS (Nagelkerke R²=0.698, p<0.0001, PPV=80%, NPV=90%). In ROC analysis, the AUC for CRP and omentin-1 were significant (p<0.05; AUC=0.800-0.328).

Conclusion: This study suggests a continuous interaction among ANGPTL, omentin-1, leptin, and cytokines in the etiopathogenesis of PCOS.

Prompt care for victims of sexual violence is essential in the implementation of measures to prevent pregnancy resulting from violence and sexually transmitted infections, and to assess and monitor serological follow-up and gather evidence for possible criminal proceedings. In the absence of a referral service, any health service should take the appropriate initial measures and refer the victim to the referral service (if there is one) as quickly as possible. Referral services for immediate care for victims of sexual violence allow victims to be followed up for a longer period of time. However, acute care should be provided by any health unit to avoid care delays. There is no need for any legal complaint or registration of a police report for providing healthcare to victims of sexual violence. However, victims should be informed about their right to report the assault at any time, so an appropriate legal and police investigation can be carried out. It is important to address this topic during medical care. All services providing care to victims of sexual violence must be open and receiving victims continuously, without the need for other health units or a police authority. Obstetrician/gynecologists are often the professionals responsible for caring for victims of sexual violence and must be familiar with the initial care protocols for these patients.

•Chronic pelvic pain is a common and complex condition that significantly affects women's quality of life. •Neuropathic pain and nociplastic pain are important components in the pain picture of these patients and should be considered in clinical treatment. •Oral neuromodulators, antidepressants and anticonvulsants for the control of neuropathic and nociplastic pain should be present in the therapeutic arsenal of the gynecologist who treats patients with chronic pelvic pain. •Pregabalin is the medication with the best pharmacokinetic profile; nortriptyline has the best adverse effects profile; duloxetine is the most widely used and has the lowest risks; and venlafaxine should be used as a second-line inhibitor. •Although the drug classes can be combined to reduce the total doses and minimize side effects, maximizing the analgesic effect, monotherapies are recommended as the first line to avoid polypharmacy.

Objective: Women may experience cognitive, emotional, and physical changes during the menstrual cycle, which can impact their physical and athletic performance. This study aimed to investigate whether Brazilian female swimmers in the senior category, i.e., over 18 years of age, federated with the Brazilian Confederation of Aquatic Sports (CBDA), use hormonal contraceptives (HCs) and assess the impacts on their health, athletic performance, and overall well-being.

Methods: This is a cross-sectional descriptive observational study conducted via an online questionnaire based on the Google Forms® platform, sent via WhatsApp® and email to the participants. Questions were asked about age, use of contraceptive methods, observed changes in performance, among others. A total of 136 senior athletes participated in the study. Inclusion criteria were senior female athletes using hormonal contraceptive methods. Athletes who were not in the senior category and/or did not use hormonal contraceptive methods were excluded from the research.

Results: A total of 136 senior athletes responded to the questionnaire. Of this total, 108 reported using hormonal contraceptive methods and were therefore included in the study. The results indicate that the majority of participants use oral contraceptives, with 61 (57%) using this method. Regarding the reason for using hormonal contraceptives, 88 (82.4%) use the method to control the menstrual cycle, in addition to alleviating menstrual symptoms, 63 (59.2%); 62 (57.9%) reported improvement in mood patterns, and 69 (64.55%) stated that they experience benefits from using the method.

Conclusion: It is concluded that the use of hormonal contraceptives presents benefits related to the professional careers of athletes. Besides improving their training performance, HCs also help alleviate menstrual symptoms and control the menstrual cycle and flow.

An 8-year-old girl presented with vaginal bleeding without puberty signs. During investigation at 10 years old, the patient presented with advanced bone age, prepubertal hormone levels and internal genitalia. Hysteroscopy and vaginoscopy at 10 years and 10 months of age revealed endometrial proliferation despite infantile genitalia. Histopathology showed positive receptors for estrogen and progesterone. This is the first report of endometrial estrogen and progesterone receptor activity in this context. Despite normal serum estradiol, the findings suggest a local action of estrogen. Follow-up until 11 years of age showed progressive development of secondary sexual characteristics. This case report emphasizes the need to consider isolated vaginal bleeding, without the development of secondary sexual characteristics, as a result of endometrial hypersensitivity to low estrogen levels during pubertal development, which may alter the chronology of pubertal development in girls.

Objective: This study sought to analyze the profile of fetuses, newborns and pregnant women with alloimmunization (anti-RhD) referred to and treated over the twenty years since the launch of the Rio de Janeiro State.

Methods: An observational, retrospective, descriptive study was conducted, with data obtained by analyzing the medical records of 481 mothers and their newborns. The study cohort consisted of pregnancies affected by RhD alloimmunization who delivered between March 2004 and March 2024 in Rio de Janeiro.

Results: The absolute number of cases declined over the study period. Only 5.2% of the cohort began prenatal care in the first trimester of pregnancy and more than half (51.6%) of women arrived at the referral center in the third trimester. 40% of the women had prior severe HDFN. During this period, 422 intrauterine transfusions were performed on 71 fetuses, an average of 5.9 transfusions per patient. Infant mortality; was low, with 4% stillborn or evolving to neonatal mortality.

Conclusion: The trend observed over the last 20 years is a reduction in the absolute number of HDFN cases which is perhaps more related to reproductive issues, particularly the sharp reduction in parity in our state, rather than to the implementation of alloimmunization prophylaxis.

Objective: To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperative complications.

Methods: This retrospective cohort study included 25 pregnant women whose fetuses were diagnosed with myelomeningocele and underwent open intrauterine surgery between February 2019 and October 2023. Maternal demographic data, surgical outcomes, and neonatal variables were collected from medical records. Statistical analyses included Chi-squared test, Fisher's exact test, Mann-Whitney U test, and Pearson's correlation coefficient (r).

Results: The mean gestational age (GA) at surgery was 25.7 ± 1.2 weeks, and the mean GA at delivery was 34.3 ± 2.0 weeks. Preterm birth was the most common complication (40%), followed by premature rupture of ovular membranes (32%). Two stillbirths occurred (8%) at 31 and 33 weeks of gestation. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Low birth weight (<2,500 g) was observed in 44% of neonates. Neonatal hospitalization was significantly longer in cases of preterm birth (p = 0.044), and intensive care unit stay was longer in deliveries before 34 weeks (p = 0.044). No correlation was found between GA at intrauterine surgery and GA at delivery (r = 0.252, p = 0.22).

Conclusion: Fetal myelomeningocele surgery was successfully performed in a tertiary public hospital. However, preterm birth remains a major concern, as consistently reported in the literature. Nevertheless, the results confirm that intrauterine repair of myelomeningocele is indeed feasible in the public healthcare setting.

Objective: When spontaneous vaginal delivery is not feasible, Instrument-assisted vaginal delivery (IVD) is utilized, which often involves the use of vacuum extractors (VE) and obstetric forceps. This study intent to evaluate the risks and benefits associated with utilizing obstetric forceps vs vacuum extractors for IVD, focusing on maternal and neonatal outcomes.

Methods: Following PRISMA guidelines, a full literature search was done in PubMed, Embase, and Google Scholar until April 2024. The review examined randomized controlled trials (RCTs) that compared forceps and vacuum extractors. Two writers extracted the data and assessed its quality separately, with a third resolving any inconsistencies. The statistical study was conducted using R software, with a random-effects model used to quantify risk differences and evaluate heterogeneity.

Results: Seven RCTs, totalling 2,299 individuals, were included. A meta-analysis revealed that forceps significantly increased the incidence of perineal tears (Risk difference = 0.08, 95% CI 0.02-0.13) and vaginal injuries (Risk Difference = 0.12, 95% CI 0.05-0.19). Vacuum extractors were associated with an increased risk of infant cephalohematoma (Risk Difference = -0.06, 95% CI -0.08, -0.04). There was no significant difference in maternal anaesthesia required or failure to accomplish vaginal delivery with the intended instrument.

Conclusion: Obstetric forceps are more likely to cause maternal perineal tears and vaginal injuries, whereas vacuum extractors increase the likelihood of neonatal cephalohematoma. Both methods have comparable anaesthetic needs and success rates for vaginal birth. The clinical scenario ought to guide the choice of instruments, with an emphasis on risk minimization through proper training.PROSPERO: CRD42024577839.