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

Objective: To evaluate the types of treatments used for non-tubal ectopic pregnancy (NTEP), the success rates of medical treatment, and the incidence of severe complications.

Methods: Retrospective study of all NTEP admitted in the University of Campinas (UNICAMP) Women's hospital, Brazil, from 01/01/2000 to 01/31/2023. Outcome variables were medical treatment success and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage and chi-square test.

Results: In total 60 cases of NTEP were included (3 abdominal, 15 cervical, 12 cesarean scar, 24 interstitial fallopian tube, 3 heterotopic e 3 ovarian). In cases of abdominal, cesarean scar, heterotopic and ovarian NTEP, the main type of treatment was surgery. Medical treatment was used mainly in cervical and interstitial NTEP (p<0.01). Medical treatment (included methotrexate single dose, multiple doses or direct injection) success rate was 73.7%, with no correlation with NTEP location (p=1.000). No change in trend was identified in the success rate of medical treatment for NTEP in the period evaluated (Cochran-Armitage test: z=0.46; p= 0.644). Severe complications occurred in 12(20) of NTEP, with no association with NTEP location (p=0.27), but with hemodynamic instability (p=0.01).

Conclusion: The medical treatment success rate found in our study for NTEP was similar to that reported in the medical literature for tubal EP. Two out of ten women with NTEP had severe complications. The occurrence of severe complications was not associated to the site of NTEP but to the presence of hemodynamic instability at admission.

Objective: Allogeneic bone marrow transplantation (BMT) carries the risk of the donor's cells recognizing the recipient as abnormal, triggering Graft Versus Host Disease (GVHD). This study aimed to understand the prevalence and gynecological complications, including vaginal microbiota evaluation.

Methods: A descriptive cross-sectional study was carried out from December 2022 to October 2023. Post-allogeneic BMT patients underwent gynecological evaluation at the Assis Chateaubriand Maternity School in Fortaleza-Ceará, Brazil, composed of structured interview and physical examination, which included collection of fresh examination of vaginal content, gram bacterioscopy and cervicovaginal cytology.

Results: A total of 22 patients between 21 and 61 years old (average: 38) were evaluated, with an average of 1028 (± 979) days post BMT. Of these patients, whether or not they had Vulvar and Vaginal Graft Versus Host Disease (VVGVHD), 15 reported various gynecological complaints (dryness being the most common). Of the total, twelve showed signs of genital atrophy on examination. A 45% prevalence of VVGVHD was found, with vulvar and vaginal involvement of 100% and 60%, respectively. Burning and dyspareunia symptoms were more prevalent in patients with VVGVHD than in those without it (p<0.05); there was no difference in Human Papillomavirus (HPV) induced lesions between the two groups. However, compared to the population not undergoing allogeneic BMT, these patients had a higher prevalence of induced HPV lesions and intermediate vaginal flora.

Conclusion: The findings described in the present work are consistent with other studies available in recent literature. In conclusion, VVGVHD is a potentially mutilating condition, with a significant prevalence among post-BMT patients.

Objective: This study aimed to investigate the relationship between blood pressure (BP) responses during a mental stress test with 24-hour ambulatory BP (ABPM) and its variability (BPV) in postmenopausal hypertensive women.

Methods: BP reactivity under mental stress and ABPM were evaluated in 75 postmenopausal hypertensive women between 50 and 70 years, on non-consecutive days. We used the values of the variation (∆) of systolic BP (SBP) and diastolic BP from the reactivity test as independent variables, and the BPV indexes Average Real Variability (ARV), 24-hour SD, and SDdn (standard deviation weighted by daytime and nighttime duration) as dependent variables. In the multiple linear regression analysis, three models were tested: 1) without adjustment; 2) adjusted for time since menopause; and 3) adjusted for both nocturnal BP dipping classification and time since menopause.

Results: The ARV index showed a significant association with ∆SBP variation in all models (model 1,2 and 3: β coefficient: 0.04, CI 95%: [0.00;0.08]).

Conclusion: In conclusion, blood pressure variation during the mental stress test is related to ambulatory blood pressure variation, specifically to ARV in postmenopausal hypertensive women. These findings suggest that systolic blood pressure responses to mental stress may be a relevant predictor of daily blood pressure variability.

Objective: To review the real benefits of using combined oral contraceptives (COCs) containing natural hormones, also known as estradiol-containing COC (estradiol and estradiol valerate) in controlling abnormal uterine bleeding (AUB) compared to the already established data on treatment with combined pills containing ethinylestradiol (EE).

Methods: Narrative review with analysis of studies published between 2010 and 2023, comparing the effects of EE and natural estrogen in the treatment of AUB, indexed in the PUBMED, WebOfScience, and Scielo databases.

Results: A total of 342 articles were found in the selected databases. Of these, 235 articles were excluded because they were published before 2010 or lacked an explicit relationship with the topic; 107 articles were selected for title and abstract screening, of which 27 were fully read by the researchers, and 6 were included in the study. It was observed that the use of natural estrogens is effective in controlling abnormal uterine bleeding, often with fewer side effects and less cardiovascular and prothrombotic impact compared to ethinylestradiol (EE). However, some non-contraceptive benefits of EE, such as less water retention, improved skin oiliness, and acne, were not consistently observed with the use of natural estrogens.

Conclusion: Estradiol-containing COC have proven to be effective in controlling AUB, in addition to reducing spotting and intermenstrual bleeding, with fewer undesirable side effects when compared to COCs with EE. On the other hand, COCs with estradiol and estradiol valerate less frequently present other non-contraceptive benefits.

Objective: To analyze the vaginal microbiota before and after the treatment with vaginal microablative fractional radiofrequency (FRAXX) and compare it with topical estriol treatment in women with GMS.

Methods: Pilot clinical trial, double-blind, randomized, and placebo-controlled. Thirty women diagnosed with SGM were evaluated regarding the vaginal microbiota before and one month after the end of the treatment protocol, through culture, bacterioscopy by Gram and pHmetry. Then, they were randomized into two groups: one with application of topical estriol for 21 days of attack and then 3 times a week until completing 3 months, together with placebo radiofrequency (RF) pulses, and the other group, with monthly radiofrequency pulses for 3 months, together with placebo vaginal cream.

Results: The average age of participants was 56.33 ± 7.10 (minimum 42 and maximum 69 years of age), average age at onset of menopause 44.70 ± 5.74. In the estriol group, the participants showed no significant difference after treatment in relation to the number of basal and parabasal cells (p = 1.000), type of vaginal microbiota (p = 0.544), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Coccobacillus (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000), except for the presence of Candida (p = 0.025) and decrease in vaginal hydrogen potential (pH) (p = 0.006). In the group treated with FRAXX, it was observed that the participants showed no significant difference after treatment regarding the number of basal and parabasal cells (p = 0.500), type of vaginal microbiota (p = 0.637), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Cocobacilli (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000) and presence (or absence) of Candida (p = 1.000), except for pH variation (p = 0.037). Comparing the groups, women treated with FRAXX had a higher proportion of Lactobacillus (type I) than women treated with estriol (66.7% and 26.7%, respectively; p = 0.057). On the other hand, the proportional presence of other bacteria, but with a predominance of Lactobacillus (type II a) was higher in the group treated with estriol, when compared to the FRAXX group (46.6% and 6.7%, respectively; p = 0.057). And the application of estriol significantly increased the Candida concentration when compared to FRAXX (p = 0.042).

Conclusion: There was improvement in the parameters analyzed regarding the vaginal microbiota in the intervention with FRAXX with a higher proportion of Lactobacillus and a decrease in pH. And there was no superiority of FRAXX in relation to the use of topical estriol.

Objective: To analyze maternal request cesarean section (CDMR) through the perceptions of placenta accreta spectrum (PAS) survivors.

Methods: This retrospective observational study was conducted at a university hospital, a reference center for the management of placenta accreta spectrum (PAS). Case identification was performed through a review of medical records, based on diagnoses related to placental disorders and postpartum hemorrhage. Only women who underwent puerperal hysterectomy between 2005 and 2023, with a PAS diagnosis confirmed by ultrasound conducted at the institution, were included. Eligible participants were contacted via instant messaging apps and invited to complete an online structured questionnaire, which included questions about their prior knowledge and post-event perceptions regarding cesarean delivery. Responses were compared between women in the cesarean delivery on maternal request (CDMR) group and those who underwent cesarean delivery for other indications.

Results: A total of 89 cases of hysterectomy for PAS were identified during the study period. Of the 60 eligible women contacted, 41 responded to the questionnaire. Among them, 11 (26.8%) reported having requested the cesarean delivery, while 30 (73.2%) underwent the procedure for other reasons. It was found that 81.8% of women in the CDMR group had private health insurance, compared to 46.6% in the "other indications" group. High parity (≥3 pregnancies) was more common in the "other indications" group (80.0%) than in the CDMR group (36.4%). Overall, 36.6% were unaware of the risks of cesarean delivery, 48.8% did not receive adequate counseling during prenatal care, and 85.4% of participants were unaware of PAS. In the CDMR group, these values were 36.4%, 45.5%, and 72.7%, respectively. After the adverse experience, 51.2% of participants reported a change in their perception of cesarean delivery, 53.7% stated that they would have made a different choice if they had more information at the time, and 78.0% believed that the general population was unaware of the risks associated with cesarean delivery.

Conclusion: The perceptions of women who experienced a "near miss" contributed to a better understanding of the process behind Brazilian women's preference for cesarean section. Decisions influenced by a pro-cesarean cultural context and misinformation tend to be poorly founded and more prone to regret. In Brazil, while CDMR is framed as an expression of autonomy, inadequate information and limited freedom can exacerbate inequalities, disproportionately affecting women in vulnerable situations.