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

Objective: To compare maternal and perinatal outcomes in pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection among admissions in public and private maternity hospitals before COVID-19 vaccination.

Methods: We performed a secondary analysis of the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed SARS-CoV-2 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. The clinical and laboratory findings and maternal and perinatal outcomes were compared between the two groups. The prevalence ratio and its 95% confidence interval for each predictor and outcome were calculated.

Results: Of the 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) and 76 (27.3%) women in public and private hospitals, respectively. The frequency of SARS-CoV-2 infection did not differ significantly between the groups. Women treated at public hospitals had lower education levels (p<0.001), and 50% declared that their pregnancy was unplanned. We recorded 13 maternal deaths among women treated at public hospitals and no maternal deaths among pregnant women treated at private hospitals (p=0.024). Pregnant women in public hospitals had higher rates of fever (p=0.041), tachypnea (p=0.003), abnormal laboratory findings of liver enzymes (p=0.005), and severe acute respiratory syndrome (SARS) (p=0.014), and their neonates presented with more neonatal respiratory distress (p=0.020).

Conclusion: Adverse maternal and perinatal outcomes were worse in the public hospital group, with increased rates of SARS and neonatal respiratory distress. The alarming difference in the number of deaths between patients treated in the public and private sectors highlights the urgency of better understanding the social determinants of health and calls the attention of leaders and policymakers to take action in mitigating their impact.

•Address the types of immunodeficiency and the greater susceptibility to severe infections compared to the general population, as well as a less efficient response to vaccine stimuli. •Provide information on the negative impacts of infections on the health of immunodeficient individuals and their complications. •Provide knowledge of studies on the efficacy and safety of vaccines in the immunosuppressed population. •Clarify which vaccines should be indicated, the best time to administer them, and when to revaccinate. •Update gynecologists and obstetricians on the vaccination schedule for this population and on the position of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) regarding the vaccines made available by the National Immunization Program, including by the Reference Centers for Special Immunobiologicals (Portuguese acronym: CRIEs) and private vaccination services.

Objective: Endometriosis, a gynecological condition characterized by the presence of endometrial tissue outside the uterus, affects millions of women worldwide. This study aimed to investigate neurotrimin (NTM)'s expression, a glycerophosphatidylinositol-anchored neural adhesion molecule, in endometriotic lesions and eutopic endometrial tissue.

Methods: In this laboratory based observational study NTM expression was measured in patients with early- and advanced-stage endometriosis and controls (patients without endometriosis who underwent gynecological surgery. Peritoneal endometriosis (peritoneum for controls) and eutopic endometrial tissue samples were collected from patients. Polymerase chain reaction and immunohistochemistry (IHC) were used to detect NTM in the tissue samples. Additionally, NTM levels in peripheral blood samples of all participants were measured using an enzyme-linked immunosorbent assay.

Results: NTM mRNA and protein levels were significantly higher in the endometriotic foci of the stage 3-4 endometriosis group than in the control group (p<0.01). Stage 1-2 endometriotic foci showed significantly higher NTM IHC staining than the control group; however, no significant difference was found between the mRNA levels. Eutopic endometrial tissue from the stage 3-4 group had significantly higher NTM mRNA levels than the other groups. No significant difference was found between the control and stage 1-2 groups for eutopic tissue. Eutopic endometrial NTM IHC staining did not differ between groups. No significant difference was observed in peripheral blood NTM levels.

Conclusion: This study found increased NTM expression, a neural adhesion molecule, especially in advanced endometriosis. The endometrial tissue of patients with early-stage endometriosis also showed increased NTM expression in ectopic locations but not in eutopic tissue.

Objective: To evaluate the effects of aerobic and resistance exercise on body mass index (BMI), insulin levels, lipid profiles, and hormonal parameters in women with polycystic ovary syndrome (PCOS).

Data sources: We searched PubMed, Web of Science, and Embase databases for publications up to September 2024. Fully published articles involving reproductive-age women diagnosed with PCOS were included.

Study selection: Randomized controlled trials comparing supervised aerobic or resistance exercise to no intervention in women diagnosed with PCOS based on Rotterdam or NIH criteria were included. The Rayyan Systematic Review tool was used to organize study data.

Data collection: Data extraction was conducted independently by two reviewers. Meta-analysis employed random-effects modeling.

Data synthesis: Ten randomized controlled trials with 382 women were analyzed. Aerobic exercise interventions (12-24 weeks) reduced BMI, waist circumference, insulin levels, total cholesterol, and low-density lipoprotein. Effects on fasting glucose, high-density lipoprotein, and triglycerides varied. Hormonal assessments showed reduced testosterone and increased sex hormone-binding globulin in some studies. Resistance exercise improved lean body mass and reduced body fat percentage but showed minimal effects on hormonal parameters. Meta-analysis revealed aerobic exercise decreased insulin, cholesterol, and triglycerides compared to no intervention, while other metabolic and hormonal markers showed inconsistent changes.

Conclusion: Aerobic and resistance exercise improve anthropometric measures, metabolic health, and hormonal balance in women with PCOS. These findings highlight exercise as a valuable therapeutic strategy for managing PCOS and enhancing overall health outcomes.

Objective: Pain is an unavoidable reality of labor and the most noticeable determinant of the labor experience. The present study was conducted to assess the effect of auriculotherapy on labor pain and labor duration.

Methods: This double blind, randomized, controlled clinical trial was conducted from 2021-2022 in Kerman, Iran. The sample consisted of 60 primiparous women assigned to an Intervention Group (n = 30) and a Control Group (n = 30). The study began after participants entered the active phase of labor at 37-40 weeks of pregnancy. In the Intervention Group, the researcher stimulated the desired points (uterus, pituitary gland, pelvis, cerebral, autonomous, sensory, endocrine gland, shen men, zero, external genitalia, and thalamus). Sham auriculotherapy (patches without seeds at the same acupoints) was done in the Control Group. Pain intensity in the two groups was recorded using the VAS before and after the intervention, when the cervix was dilated 4, 6, and 8 cm. Duration of labor was also recorded. Data were analyzed using SPSS 21 statistical software.

Results: Pain intensity was significantly lower in the Intervention Group than in the sham Control Group (P < 0.0001) in different cervical dilatations after intervention. Compared to the sham Control Group, the intervention group was significantly different in the average duration of labor (P < 0.0001).

Conclusions: Auriculotherapy was demonstrated to attenuate the severity of labor pains and expedite the labor duration. Hence, policymakers in this field are recommended to pay greater attention to this non-invasive method.

Objectives: To translate and cross-culturally adapt the standard version of the WERF EPHect EPQ into Brazilian Portuguese and migrate it to an electronic version using REDCap.

Methods: The study included 120 women aged 18-50 years, with half completing the paper version and half the electronic version. The sample comprised 80 individuals with chronic pelvic pain (CPP), including 60 with endometriosis, recruited from a tertiary referral centre, and 40 women from a primary healthcare unit with no diagnosis of CPP or endometriosis. Illiterate or cognitively impaired individuals were excluded. The electronic migration was implemented in REDCap.

Results: The Brazilian Portuguese EPQ-S demonstrated linguistic accuracy and cultural equivalence to the original English version. The paper version consisted of 35 pages, and 86.7% of respondents commented on its length. Despite this, it was well-received, although minor difficulties were observed among participants with lower education levels. The electronic version provided a more accessible experience, with a significantly shorter completion time (52.1 ± 13.2 minutes) compared to the paper version (70.9 ± 21.4 minutes). Both formats exhibited similar rates of missing data for questions related to symptoms and contraceptive use.

Conclusion: This study successfully translated, adapted, and migrated the WERF EPHect EPQ-S into Brazilian Portuguese using REDCap. The findings underscore the linguistic and cultural challenges of such adaptations and highlight the electronic version's advantages in accessibility, efficiency, and participant satisfaction. This research supports the development of cross-cultural assessment tools for endometriosis research and healthcare delivery.

Objective: Endometriosis is known as a chronic inflammatory disease. This study investigates the differences in the inflammatory response between endometriomas and benign ovarian cysts during the preoperative and postoperative periods.

Methods: A retrospective analysis was conducted on patients who underwent laparoscopic cystectomy for endometriomas or non-endometriotic benign cysts between 2010 and 2021. The study compared demographic and gynecological characteristics, lesion size, serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and preoperative and postoperative values of erythrocyte distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and leukocytes between the two groups.

Results: The study included 116 patients (48.13%) in the Study Group and 125 (51.87%) in the Control Group. The mean age of the Study and Control Groups was 27.76 years and 24.54 years, respectively (p<0.001). A non-significant discrepancy in preoperative AMH and FSH values was observed between the two groups (p>0.05). Preoperative RDW (14.50±1.56 vs. 14.04±1.40), PLR (160.82±44.52 vs. 136.83±48.72), and NLR (2.60±1.10 vs. 2.17±1.13) were significantly higher in the Study Group (p<0.05). Nevertheless, only in the Study Group NLR exhibited a notable increase in the postoperative period (p<0.05). Preoperative NLR was positively correlated with cyst size in endometriomas but was not correlated with rASRM score, AMH, or FSH levels.

Conclusion: The inflammatory markers RDW, PLR, and NLR were significantly elevated in endometriomas compared to other benign cysts during preoperative and postoperative periods. The inflammatory response increased with cyst size but was not related to ovarian reserve as measured by serum AMH or the stage of endometriosis.

Objective: In this systematic review, we aim to compare the GWG in pregnant women with diabetes treated with metformin and other interventions.

Methods: Data Sources: The searched baselines included PubMed, Scopus, Web of Science, Embase, and Virtual Health Library (BVS). Study selection: We selected articles that compared the GWG in women with diabetes treated with metformin or insulin. We have included clinical trials (randomized or not), observational studies (cohort, case control, and cross-sectional). Reviews (systematic or not), posters, event abstracts, and letters were excluded. Data Collection: We pooled odds ratios (OR) and mean difference (MD) and used a random effect model using R Studio software to compare the weight gain, fetal birthweight and preeclampsia according to treatment.

Results: On research conducted in January 2024, with no data limit of the search, 433 trials were identified, of which 175 remained after duplicate removal. 50 studies were analyzed in the full text analyses and 9 were selected for the systematic review. 8 studies demonstrated that gestational weight gain during metformin treatment is lower when compared to other treatments, especially insulin, although it was not different from other outcomes. Meta-analyses demonstrated that oral medication GWG is lower than insulin with a standard mean difference (SMD) -1,05 [-1,87, - 0,23].

Conclusion: Oral medication has a lower gestational weight gain in patients with gestational diabetes when compared to insulin.

International prospective register of systematic reviews prospero: CRD 42024492158.

Objective: This study aims to to evaluate the frequency of ovarian involvement in endometrial cancer patients aged 50 years and younger, identify associated clinicopathological factors, and uniquely assess the role of the Systemic Immune-Inflammatory Index (SII) in predicting ovarian involvement.

Methods: Patients aged 50 years and younger diagnosed with endometrial cancer between 1992 and 2022 were retrospectively analyzed. Two groups were formed based on adnexal involvement: those with (ovarian metastasis or synchronous ovarian cancer) and without adnexal involvement. Clinicopathological predictors of adnexal involvement were evaluated. Preoperative complete blood count values (platelet, leukocyte, lymphocyte, and neutrophil counts) were used to calculate inflammatory indices: PLR (platelet-to-lymphocyte ratio), NLR (neutrophil-to-lymphocyte ratio), and SII (neutrophil × platelet / lymphocyte). A two-group analysis was performed based on the cut-off values of statistically significant parameters. Univariate and multivariate logistic regression analyses were conducted.

Results: Among 205 patients, histopathological ovarian metastasis was identified in 5.9% (n=12), and synchronous ovarian tumors in 2.4% (n=5). Significant differences were observed in neutrophil counts, NLR, and SII values between the groups (p<0.05). ROC analysis showed the optimal SII cut-off value as 992.58, with 70% sensitivity and 76% specificity (AUC=0.726). Ovarian involvement was significantly more frequent in patients with SII ≥ 992 (p<0.05). Univariate analysis revealed that myometrial invasion, LVSI, cervical stromal invasion, lymph node metastasis, omental involvement, grade of tumor, NLR and SII were significantly associated with ovarian involvement (p<0.05). Multivariate analysis identified histological grade, myometrial invasion, pelvic lymph node metastasis and SII as independent risk factors (p<0.05).

Conclusion: Ovarian involvement is uncommon in patients under 50 years of age with low-grade tumors, absence of myometrial invasion, negative pelvic lymph nodes, and preoperative SII < 992.58. Ovarian-sparing surgery may be a safe option in selected cases, and SII could serve as a valuable index in guiding ovarian preservation decisions.