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

Objective: To assess the prevalence of VL in primiparous women undergoing vaginal birth or caesarean section; and its association with obstetric, urinary, intestinal and sexual factors for its occurrence.

Methods: This is a cross-sectional study carried out between July 2021 and January 2023. Primiparous women who underwent vaginal birth or caesarean section without complaints of VL during pregnancy were included. Clinical and obstetric data were collected and participants completed questionnaires on the impact of urinary incontinence (ICIQ-SF), vaginal symptoms (ICIQ-VS) and sexual distress (FSDS-R) at recruitment and six-months postpartum. Univariate and multivariate logistic regression was performed, considering VL as the outcome and p=0.05.

Results: One hundred participants were included for data analysis. The prevalence of VL was 8%. In the univariate analysis, SUI, urgency urinary incontinence (UUI), coital incontinence, constipation and the ICIQ-VS and ICIQ-SF scores were associated with VL. The ICIQ-VS, FSDS-R and ICIQ-SF scores increased the risk of VL by one-fold. However, only UUI (OR 10.50(CI 95% 1.90-58.10), coital incontinence (OR 42.00(CI 95% 3.11-566.38), and ICIQ-VS (vaginal symptoms OR 1.32(CI 95% 1.05-1.66) and ICIQ-SF (OR 1.25(CI 95% 1.02-1.54), scores remained associated with VL in multivariate-analysis.

Conclusion: The prevalence of VL in primiparous women was lower than that reported in other studies and showed an association with the occurrence of vaginal symptoms, UUI and coital incontinence, six- months postpartum.

Objective: Sexuality plays an important role in quality of life, and the postpartum period may negatively affect women's sexual function. This study aimed to translate, culturally adapt, and validate the Sexual Quality of Life - Female (SQoL-F) for use for use in Brazilian women in the postpartum period.

Methods: The original version of the SQoL-F was translated and back translated by four independent sworn translators. A sample of 125 women in the late postpartum phase participated in the cultural adaptation (n=30) and convergent validation (n=95) phases. For the latter, the instrument was compared with the Brazilian version of the Female Sexual Function Index (FSFI). To assess reproducibility, 25 of the 95 women who participated in the validation phase completed the SQoL-F twice, at different times (two interviewers administered the SQoL-F, 15 to 20 days apart).

Results: Cronbach's alpha was 0.905 (intraclass correlation=0.974; 95%CI: 0.943-0.988; p<0.001). Significant, moderate, positive correlations were observed between the SQoL-F score and the FSFI total score (r=0.572; p<0.001) and domains 'Desire' (r=0.502; p<0.001), 'Arousal' (r =0.576; p<0.001), and 'Satisfaction' (r=0.637; p<0.001). Excellent reproducibility was obtained for the SQoL-F score (intraclass correlation=0.974; 95%; CI: 0.943-0.988; p<0.001).

Conclusion: The SQoL-F was adapted to the cultural context of Brazilian postpartum women, proved reproducible, and exhibited face, content, and construct validity.

Objective: Low- and middle-income countries face significant challenges in managing women diagnosed with pre-eclampsia, from making the clinical decision about whether to deliver to transferring these women to healthy facilities where they can receive appropriate care. The aim of this study was to evaluate the performance and accuracy of the fullPIERS model in a referral Brazilian maternity hospital - to assess maternal and fetal morbidity and impatient mortality at birth admission.

Methods: A cross-sectional study analyzed pregnant women with preeclampsia diagnosis, between 2014 and 2023. The full PIERS model was applied to a database retrospectively collected and its accuracy to predict maternal and perinatal outcomes during the hospital stay was determined through a receiver operating curve.

Results: Analyzing 207 pregnant women with fullPIERS had an Area Under the Curve (AUC) for adverse maternal outcome discrimination of 0.672 (0.576-0.767 95% CI, p<0.001) and AUC 0.582, (0.504-0.6661 95% CI, p = 0.041) for maternal and perinatal outcomes. Nevertheless, the model had no discrimination utility to assess perinatal outcomes (AUC 0.561, 0.480-0.642 95% CI, p = 0.642).

Conclusion: The fullPIERS model had limited performance in identifying women at increased risk of adverse outcomes birth admission and absent utility to assess perinatal outcomes. Future studies, combining different tools and validated in low- and middle-income countries should be carried out to improve maternal health.

Objective: This study aimed to evaluate awareness, perceptions, and attitudes toward oocyte cryopreservation among a diverse group of women.

Methods: A cross-sectional study was conducted in November 2023 using snowball sampling to distribute a structured questionnaire. The target population included women aged 18+ with childbearing potential, proficient in English. An anonymous online survey with 22 questions collected data on demographics, education, occupation, relationship status, reproductive intentions, and perceptions of oocyte cryopreservation.

Results: A total of 502 responses were analyzed. Most participants were in their thirties, had higher education, and were in committed relationships. They represented 24 countries, mainly in Europe. Over 60% planned to have children, but 85% were unfamiliar with oocyte cryopreservation. Social media (56%) was the primary information source, followed by acquaintances (33%) and healthcare professionals (25%). Only 4.6% were actively considering the procedure, while 41.3% showed potential interest. Barriers included perceived lack of necessity, age concerns, and limited information. Women considering cryopreservation were typically younger and childless. Financial constraints and information gaps significantly influenced decision-making, with about one-third suggesting better information and cost reduction could increase willingness to pursue the procedure.

Conclusion: Despite relatively high awareness of oocyte cryopreservation, actual consideration and uptake remain low. Addressing financial and informational barriers could improve acceptance, especially among younger women and those uncertain about their reproductive plans.

Objective: This study aims to evaluate the clinical and functional implications of cesarean section (CS) skin scars on women's lives, emphasizing the relationship between scar characteristics and quality of life.

Methods: In this cross-sectional study, women older than 18 years old who had undergone CS with a Pfannenstiel incision within the past 6-36 months were evaluated. The Patient Scar Assessment Questionnaire (PSAQ) and the Patient and Observer Scar Assessment Scale (POSAS) were used to assess clinical scar parameters. Functionality was appraised using eight questions derived from the International Classification of Functionality, Disability, and Health (ICF). The association between scar appearance scores and functionality questions was analyzed statistically.

Results: Ninety-six women were assessed, revealing that appearance and satisfaction with appearance had the worst scores on the PSAQ. Scar irregularity was the most frequently reported scar characteristic on the POSAS. On the ICF-derived questionnaire, the "self-care" domain was the most affected, with women reporting problems on activities such as choosing swimwear and lingeries. There was a significant correlation (p < 0,05) between the women dissatisfaction with the scar appearance and impairment in 'interpersonal interactions and relationships' and 'self-care', as the "domestic life" domain wasn't affected.

Conclusions: Cesarean section skin scars can lead to dissatisfaction and functional impairments, affecting women's quality of life. These findings underscore the necessity for multidisciplinary care and thorough discussions about delivery methods to improve post-surgical outcomes.

Objective: Placenta previa is a risk factor for obstetric hemorrhage, which, if not managed, can lead to maternal and neonatal death. Most cases are diagnosed after 28 weeks of gestation; in many cases, prenatal diagnosis is not timely. The objective of this study was to estimate the prevalence of placenta previa and its risk factors.

Methods: A retrospective case-control study was carried out with a total of 35 cases and 138 controls among pregnant women. The variables studied were previous cesarean section, BMI, abortions, uterine surgeries and maternal age, among others. The chi-square test was used to examine differences between groups; the OR was calculated for each factor via univariate and multivariate analyses.

Results: The prevalence of placenta previa was 0.57%. The risk factors identified were advanced maternal age (OR 3.0; 95% CI 1.3-7.1) and previous cesarean section (OR 10.7; 95% CI 1.7-68.5).

Conclusion: The prevalence of placenta previa was similar to that reported in the literature, and the most prevalent risk factors were advanced maternal age and previous cesarean section. The identification of risk factors in women with placenta previa makes it possible to establish action plans for personalized care during pregnancy and childbirth and to reduce complications.

Objective: To evaluate the impact of São Paulo State Law n° 17.137/2019 on the cesarean section rate at a public secondary-level maternity hospital and to analyze predictive factors and complications associated with cesarean under request. This law was enacted to allow pregnant women in São Paulo to request a cesarean section without medical indication.

Methods: This retrospective study analyzed medical records of pregnant women ≥ 39 weeks gestation attended at the Ribeirão Preto Women's Health Reference Center (CRSMRP-Mater). Two groups were evaluated: 1,999 patients before the law (July 2018-July 2019) and 3,207 after its implementation (August 2019-July 2021, excluding the suspension period). Descriptive and analytical statistical methods were applied.

Results: The overall cesarean rates increased significantly from 23.6% to 27.7% (p < 0.01), with 15,1% of cesareans during the law period being under maternal request (134 patients). A previous cesarean was the only factor significantly associated with electing a new cesarean. Hospital length of stay was significantly longer in the law period (p < 0.01), possibly reflecting the increased cesarean rate. No significant differences were observed in maternal or neonatal complications between cesareans under request and those conducted for medical reasons.

Conclusion: São Paulo State Law n°. 17.137/2019 was associated with an increased cesarean rate in CRSMRP-Mater. The findings highlight the need for robust educational approaches and evidence-based obstetric practices to reduce unnecessary elective cesareans.