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

Objective: This study aimed to assess the prevalence of cervical High-Grade Squamous Intraepithelial Lesions (HSIL) in women outside the screening age recommended by the Brazilian Guidelines for Cervical Cancer Screening (under 25 and over 64 years old).

Methods: The cross-sectional study was conducted at a reference hospital in Rio de Janeiro with a histopathological report of CIN 2 + from January 2010 to December 2020 through the analysis of medical records.

Results: Among 406 women diagnosed with Cervical Intraepithelial Neoplasia (CIN) 2+, 63 patients (15.5%) were outside the recommended screening age, 17(4.2%) of whom were under the age of 25, and 46 (11.3%) were older than 64 years. CIN 2 was most prevalent in women under 25 years old (29.4%); CIN 3 in those between 25 and 64 years old (55.1%); and invasive cancer predominated in women over 64 years old, with statistical significance (<0.001).

Conclusion: The higher frequency of CIN 2 in young women under 25 years old supports the transient nature of these lesions, reinforcing that screening this age group may lead to unnecessary treatment. Conversely, the detection of high-grade lesions and cancer in older women is a consequence of inadequate screening earlier in life.

Objective: This review evaluated myo-inositol supplementation's effectiveness in pregnant women at high risk for Gestational Diabetes Mellitus (GDM).

Sources: A systematic search in PubMed/MedLine, Cochrane, and VHL databases was conducted using the following terms: "inositol," "diabetes," "gestational diabetes," and "prevention," with no limits on publication period or language. The reference lists were scanned for additional articles.

Selection criteria: Relevant studies were identified by screening titles, abstracts, and full texts, following inclusion and exclusion criteria and eliminating duplicates. One additional study was added after reviewing references.

Data collection: Guided by the PRISMA Statement, data were extracted using Microsoft Excel. The primary outcome was GDM incidence; secondary outcomes included maternal, birth, neonatal health, and adverse effects.

Data synthesis: Five studies were included. Myo-inositol supplementation significantly decreased the incidence of GDM in all studies. One study noted significant weight loss. Three studies found no reduction in insulin treatment needs with myo-inositol supplementation. One study showed a decrease in macrosomia incidence. No decrease in cesarean delivery rates was verified, though one study noted reduced hypertensive disorders' incidence with myo-inositol. Four studies evidenced no reduction in premature birth or shoulder dystocia. There was no significant difference in hypoglycemia incidence in three studies. One study showed a decrease in Neonatal Intensive Care Unit admissions with myo-inositol supplementation. One patient reported headaches.

Conclusion: Due to study divergences, no clinical recommendations can be made. However, myo-inositol supplementation appears effective in reducing GDM incidence in at-risk pregnant women.

Objective: To conduct a systematic review of the literature, compiling the available evidence from the last decade to better understand the relationship between the Dietary Inflammatory Index and the risk of Gestational Diabetes Mellitus.

Methods: A comprehensive search was systematically conducted including cohort and case-control studies, researched from the BVS, PubMed, Embase, and Google Scholar platforms with articles published between 2014 and 2024. The risk of bias was assessed using the Quality Assessment Tool.

Results: This review included 10 studies from five countries with participant numbers ranging from 164 to 90,740. In total, four case-control studies found higher DII values in the groups of pregnant women diagnosed with Gestational Diabetes Mellitus compared to those without the diagnosis. When analyzing the remaining cohort studies, one study showed a higher distribution of Gestational Diabetes Mellitus in the highest tertile of Dietary Inflammatory Index, and the other (five studies) showed an association between DII and Gestational Diabetes Mellitus risk when using models adjusted for anthropometry, gestational history, and dietary intake.

Conclusion: Pregnant women diagnosed with Gestational Diabetes Mellitus have a diet with more pro-inflammatory characteristics, which increases the risk of adverse perinatal outcomes.

Registry of systematic reviews prospero: CRD42024573560.

Objective: Endometriosis pain is associated with inflammatory cytokines, such as leptin (LEP), through activation with its receptor (LEPR), and its expression can be influenced by the presence of genetic polymorphisms. Therefore, this study aims to evaluate the role of the LEP rs7799039 and LEPR rs1137100 polymorphisms in the painful symptoms of endometriosis in Brazilian women.

Methods: A retrospective study was carried out in two Brazilian public hospitals with 237 cases of endometriosis, divided into two comparison groups according to the painful symptoms associated with the disease (absence or presence of severe and disabling symptoms). Genetic analysis was performed by real-time PCR technique, and association analyses were estimated using odds ratio (OR) and 95% confidence interval (CI), using a non-conditional logistic regression model.

Results: Endometriosis cases showed a high prevalence of painful symptoms: 82% dysmenorrhea, 67% dyspareunia, 53% chronic pelvic pain, and 52% cyclical intestinal and 25% urinary complaints. Regarding genetic analyses, cases had 32.7% of the A allele and 11.4% of the AA genotype for the LEP rs7799039 G>A SNP, and 17.5% of the G allele and 2.5% for of GG genotype for the LEPR rs1137100 A>G SNP. There is a significant association of the LEPR rs1137100 polymorphism with chronic pelvic pain (OR=1.75; CI 95%=1.05-2.89) and dyspareunia (OR=1.78; CI 95%=1.01-3.12) in women with endometriosis.

Conclusion: Our findings suggest that the LEPR rs1137100 polymorphism is associated with increased endometriosis-related gynecological pain and may be a potential target for molecular diagnosis of the disease and development of individualized treatment strategies.

Objective: This study aims to characterize voiding urodynamics parameters suggestive of bladder outlet obstruction (BOO) diagnosis in women with and without symptomatic pelvic organ prolapse (POP).

Methods: Cross-sectional research. Patients were selected and clinically evaluated with anamnesis, pelvic organ prolapse quantification system and standard Urodynamic Testing, performed according to International Continence Society and International Urogynecological Association guidelines (noninvasive uroflowmetry, followed by invasive cystometry and a Pressure/Flow Study). Included criteria: women aged 18 to 94 years with and without symptomatic POP and lower urinary tract symptoms . Exclusion criteria: patients who were not clinically feasible, undesirable, or impossible urodynamic test, or patients with urinary tract infection or neurological lower urinary tract dysfunction.

Results: Voiding urodynamics parameters suggestive of BOO diagnosis found in women with POP were: maximum flow rate (Qmax) in the uroflowmetry ≤12mL/s; detrusor pressure at maximum flow (PdetQmax) >20cmH2O. When evaluating the differences between patients with and without POP, it was observed that those who presented some type of pPOP were mean age (y) older (67.6 × 58.9); had higher post-void residue volume (mL) (85.9 × 33.9); higher PdetQmax (cmH₂O) values (41.3 × 28.5); lower Qmax (mL/s) values on uroflowmetry (8.5 × 20.4), lower maximum cystometric capacity (mL) (325.7 × 381.2), lower bladder compliance (mL/cmH2O) (39.8 × 46.1) and lower Qmax (mL/cmH2O) in the flow/pressure study (8.4 × 18.0) (p<0.001).

Conclusion: The voiding urodynamics parameters listed in this study allows the evaluation of variables suggestive of BOO diagnosis in women with and without POP.

Objective: To identify pain, sexual function, and quality of life patterns in women with endometriosis, taking into consideration the American Society for Reproductive Medicine (ASRM) classification for endometriosis.

Methods: A cross-sectional study of quantitative descriptive nature was conducted, including women with surgical recommendation due to endometriosis. The Numeric Pain Rating Scale, Endometriosis Health Profile, and Female Sexual Function Index tools were used for data collection. Descriptive and frequency analysis were employed. Using the K-means algorithm, cluster analysis was performed to group participants based on response similarities.

Results: 104 women with endometriosis were included with a median age of 35 years. The majority were classified as grade III (57.69%) and IV (25.96%) for endometriosis. There was a significant difference in the division of two clusters concerning ASRM, with ASRM IV women more frequently associated with Cluster B, while Cluster A being predominantly formed by ASRM III women. Cluster B showed significantly worse data for dyspareunia and dysuria pain levels and for all variables in the FSFI and EHP-30 instruments, except for infertility, which did not differ between the groups.

Conclusion: ASRM classification is not directly related to clustering. Women diagnosed with endometriosis, mostly ASRM III and IV, exhibit two distinct patterns, with one group having worse pain, sexual function and quality of life scores compared to the other group. Infertility is a crucial aspect to study concerning the quality of life of women living with the disease and aspiring for motherhood irregardless of the clustering.

Objectives: This study aimed to compare the effect of Gender Affirming Hormone Therapy with Testosterone (GAHT-T) discontinuation and dose spacing on Hct, hemoglobin (Hb) and total testosterone levels in users of testosterone cypionate and testosterone undecanoate.

Methods: This retrospective cohort analyzed data collected from the medical records of trans men older than 18 years who developed erythrocytosis during GAHT-T between 2020 and 2023. Participants were divided into three groups according to formulation in use when the diagnosis of erythrocytosis occurred and analyzed according to therapeutic approaches: discontinuation of GAHT-T for 3 months or, for the testosterone cypionate fourthly users, dose spacing.

Results: A total of 49 trans men (mean age, 28.0 ± 7.8 years) were diagnosed with erythrocytosis, totalizing 104 tests. After discontinuing GAHT-T, a greater decrease in Hct, Hb and total T levels was observed in the testosterone cypionate (Cip 14 and Cip 28) users than in the testosterone undecanoate users (Und90). In Und90, discontinuation resulted in decrease of Hct and Hb levels, without difference in total T levels. Cip14 and Cip28 exhibited greater reductions in the Hct level than Und90 did with discontinuation. In Cip14, dose spacing had no effect on decreasing Hb, Hct and total T levels.

Conclusion: Discontinuation of testosterone undecanoate for 3 months in trans men undergoing GAHT-T who had developed erythrocytosis reduces hemoglobin and hematocrit levels without a significant reduction in testosterone levels. Dose spacing in fortnightly testosterone cypionate users was not effective to reduce hematocrit and hemoglobin.

Objective: To develop the Brazilian Portuguese version of the Follow-up Form for the Creighton Model FertilityCare™ System.

Methods: Translation and cultural adaptation of the Follow-up Form for use in Brazil, in 6 steps: Translation, Expert Panel, Back-Translation, Pre-test, Review, and Final Version, according to the World Health Organization methodology.

Results: The 25 sections comprising the Follow-up Form were translated with 14 sections undergoing an adaptation process in one of the stages. In order to maximize semantic, idiomatic, experiential, and conceptual equivalence of the items from the original English version to Portuguese. The need for adaptation was due to four reasons: first, the format of paired and seemingly repetitive questions. Second, the difference in cultural reality, such as hygiene and consumption habits, between the United States and Brazil. Third, the use of technical terms, medical vocabulary. And fourth, sentences that contain many concepts related to the use of the Creighton Model FertilityCare™ System. The sample included 127 Creighton Model FertilityCare™ System users, with an average age of 33.7 years, and 88.2% were married. The majority, 68 (53.5%), were not using any family planning method when they started Creighton Model FertilityCare™ System 49.2% were trying to conceive in the past year.

Conclusion: The translation of the Follow-up Form into Brazilian Portuguese resulted in a final version that maintained the intercultural and conceptual equivalence to the original English version. This instrument can be used by all practitioners in Brazil with the assurance that the standardization in the application of Creighton Model FertilityCare™ System reflects the original purpose of the method.

Objective: The Robson Ten Group Classification System categorizes women into groups based on obstetric characteristics. For each group there is a suggested cesarean section rate. Robson Ten Group Classification System allows for surveillance and evaluation of increasing cesarean section rate. This study aimed to evaluate deliveries in a Brazilian referral maternity hospital in the last decade using the Robson Ten Group Classification System.

Methods: This was a retrospective cross-sectional study performed in a referral hospital, analyzing deliveries from January 2009 to August 2022. Women were classified into Robson's 10 groups based on electronic medical charts. Overall rates per year and cesarean section rate within each group were calculated and compared.

Results: There was an increasing cesarean section rate over time (46.23% in 2009 vs 62.99% in 2022) in all groups. Groups 1-4, 5 and 10 had a significant increase. Among Groups 1-4 cesarean section rate increased from 34.06% to 38.59% (PR 1.132, CI 1.007-1.274), group 5 from 67.66% to 83.53% (PR 1.234, CI 1.151-1.323) and group 10 from 51.55% to 60% (PR 1.163, CI 1.017-1.332). In global analysis, groups 1-4 corresponded to 57.3% of included cases and its relative contribution to cesarean section rate was 31.6%, while group 5 represented 18.9% of cases and its relative contribution to cesarean section rate was 28.5%.

Conclusion: Groups 1-4 and 5 contributed significantly to cesarean section rate in our analysis and group 10 (preterm birth) also had a major impact, considering the high risk setting. Cesarean section rate increased over time. Groups 1, 2, 5, and 10 contribute significantly to such an increase.