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

Objective: To investigate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) infection and preeclampsia (PE); to verify whether the strength of the association differs according to the infection onset (trimester of pregnancy).

Methods: Retrospective cross-sectional study. Included women giving birth at a public hospital in Brazil from July 2020 to January 2021. All women were offered testing for COVID-19 during birth; they were also offered to test during prenatal care if symptomatics or contactants. Excluded women not tested. Compared the frequency of PE as well as of PE superimposed to chronic hypertension (PESCH) in women with versus without infection. Associations were accessed using bivariate and multivariable logistic regression analysis.

Results: Among 1,575 women included, 288 (18.3%) had infection, 53 (3.4%) had PE, and 32 (2.1%) had PESCH. In univariate analysis, infection was significantly associated with PE, but not with PESCH. We then considered only PE as the outcome. The multivariable model included PE, infection, primigravida, fewer than seven prenatal visits. We found association between infection and PE, adjusted odds ratio 2.1; p=0.017. Women infected in the first trimester had a higher frequency of PE than those with infections in the second/third trimester, suggesting a temporal sequence, but the difference wasn't significant (p=0.054).

Conclusion: Our data suggests association between SARS-CoV-2 infection and PE without chronic hypertension. The greater frequency of PE in women who had infection in the first trimester suggests a temporal sequence, but the small numbers are a limitation. Studies with larger samples are welcome.

Objective: To evaluate psychological support data for survivors of sexual violence (SV) and compare the attitudes, responses, and feelings in adolescent and adult women.

Methods: This was a retrospective study with two cohorts of female survivors of sexual violence, treated between 2011 and 2022. Women who had at least one psychological evaluation were included. The variables were sociodemographic; characteristics of violence; feelings; attitudes; symptoms observed/reported during support; time until emergency care; and indication of psychotropic medications. We calculated the mean and standard deviation (SD) and used the λ-Square or Fisher's Exact test and the Mann-Whitney test for comparative analysis. The significance level adopted was 5%.

Results: Five hundred and twenty-one adolescents, mean age 14.8 (SD±2.0) and 312 adult women, mean age 31.7 years (SD±10.7), were compared. Two-thirds of all women reported themselves as white; adolescents took longer to seek care (p<0.001) more frequently than the adult group. Adult women had more histories of sexual abuse (p<0.001), penetration attacks (p<0.001), reported greater perception and disclosed violence more frequently (p<0.001) than the adolescent group. Adolescents reported more shame (p<0.001) while the group of adults more frequently expressed feelings of insecurity, anguish, expressions of crying, revolt, anger, humiliation and apathy. Anxious symptoms were expressed by 60% of adults and 44% of adolescents and the prescription of psychotropic medications was higher in the adult group compared to adolescents (p<0.001).

Conclusion: Both groups of survivors suffered psychological impacts after SV, expressing/reporting different reactions to distress. These results highlight the importance of access to psychological support after SV.

Background: During pregnancy, the maternal supine position may reduce uterine and placental perfusion due to compression of the aorta and inferior vena cava by the gravid uterus, potentially impairing maternal and fetal oxygenation.

Objective: This scoping review aimed to summarize the available evidence on the impact of maternal positioning during ultrasound examinations on fetal Doppler indices of the umbilical artery (UA) and middle cerebral artery (MCA).

Methods: Studies were eligible if they included pregnant women undergoing fetal Doppler assessment in at least two different maternal positions and reported outcomes related to UA and/or MCA indices. Only studies published in English in the past 20 years were included.

Sources of evidence: A comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, and Scopus databases between September and October 2023.

Charting methods: Two independent reviewers conducted the initial screening for relevance, with conflicts resolved by consensus or by a third reviewer.

Results: Thirteen studies were initially identified. After applying the eligibility criteria, six observational prospective studies were included. These studies assessed changes in UA-PI, MCA-PI, and/or the cerebroplacental ratio (CPR) in response to different maternal positions during Doppler ultrasound.

Conclusions: Evidence suggests that maternal positioning during fetal Doppler ultrasound can influence arterial indices, particularly when comparing supine and lateral decubitus positions. However, variability in methodology and small sample sizes limit the generalizability of findings. Further standardized studies are needed to guide clinical recommendations.

Objective: Successful measures to address the increasing prevalence of sexually transmitted infections (STIs) require practical and accessible education and detection programs.

Methods: The ability to detect Chlamydia trachomatis and Neisseria gonorrhoeae may be hindered by a lack of adherence to proper cervical sampling. To address this, we compared the sensitivity and specificity of self-obtained samplings, such as self-collection and first-catch urine samples, to cervical samples taken by a practitioner using the nucleic acid amplification test (NAAT) cobas^® 4800 for C. trachomatis and N. gonorrhoeae in 244 women attending gynecological services in Quito, Ecuador. Regardless of sampling method, only 12 patients tested positive for C. trachomatis (4.9% prevalence, 95% CI 2.8 to 8.4%), and no samples tested positive for N. gonorrhoeae.

Results: The analysis revealed that self-collection was 100% sensitive (95% CI 66.4% to 100.0%) and 100% specific (95% CI 98.25%-100%), and first-catch urine was 90% sensitive (95% CI 55.5% to 99.8%), and 99% specific (95% CI 96.5% to 99.9%) compared to cervical brushing for the detection of C. trachomatis. No symptoms were associated with a positive C. trachomatis result, highlighting the need for testing even in asymptomatic patients. Furthermore, having a stable intimate relationship in the past year was associated with a negative result for C. trachomatis (χ² 14.01, p < 0.001).

Conclusion: This study demonstrates the feasibility and reliability of self-collection and first-catch urine samples as alternative methods for detecting Chlamydia trachomatis and has practical implications for improving STI detection and management programs.

Objective: This study aimed to investigate the persistence of hypertension at three months postpartum in women who experienced preeclampsia during pregnancy.

Methods: A prospective observational study at Hospital das Clínicas de Ribeirão Preto, Brazil, included 24 women. Blood pressure measurements and/or antihypertensive use were assessed, alongside risk factors such as body mass index (BMI), heart rate, lipid profile and C-reactive protein (CRP). Data on demographic, obstetric and lifestyle factors were also collected.

Results: Out of 24 postpartum women enrolled in this study, 15 (62.5%) of participants remained hypertensive three months after delivery. Women with early-onset preeclampsia had a 2.36-fold increased risk of persistent hypertension at three months postpartum. No significant differences were found among risk factors for persistent hypertension.

Conclusion: Our results indicate a high prevalence of persistent hypertension in women with preeclampsia in Brazil. The findings highlight the need for extended monitoring specially in early onset preeclampsia and targeted lifestyle interventions.

Objective: This study aims to compare the plasma protein profiles between 7 preeclampsia patients with severe features (PE+) and 7 preeclampsia patients without severe features (PE-) and 10 healthy pregnancies (HP); identify differentially expressed proteins among these groups and explore the altered signaling pathways and their association with the severity of this cardiovascular condition.

Methods: Plasma proteins were quantified using mass spectrometry, followed by comprehensive bioinformatics and statistical analyses. Protein identification and annotation were performed using UniProt and PatternLab for Proteomics. Multivariate statistical analyses, including PLS-DA and sPLS-DA, as well as VIP score evaluation and Volcano plot visualization, were conducted with MetaboAnalyst to assess group separation and identify key discriminative features. Functional enrichment and pathway analyses were carried out using Metascape.

Results: Using a fold change and volcano plot validation of 1.2, comparisons between HP and PE+ revealed that proteins such as AMBP (inter-alpha trypsin inhibitor light chain), VTN (vitronectin), CLU (clusterin), F2 (prothrombin), and PZP (pregnancy zone protein) were upregulated in PE+. Conversely, ITIH4 (inter-alpha trypsin inhibitor heavy chain H4), APOL1 (apolipoprotein 1) and SERPIND1 (heparin cofactor II) were downregulated in PE+ relative to HP. When comparing HP with PE-, SERPINA3 (alpha-1-antichymotrypsin) and HBB (hemoglobin subunit beta) were downregulated in PE-. Between PE- and PE+, APCS (serum amyloid P component) and HBB were upregulated in PE+; whereas SERPINC1 (antithrombin), PSG1 (pregnancy-specific beta-1-glycoprotein 1), ITIH4, and C5 (complement C5) were downregulated in PE+ compared to PE-.

Conclusion: These findings offer valuable insights into the different pathophysiological mechanisms underlying the two subgroups of PE. The upregulated proteins in PE+ (AMBP, VTN, CLU, F2, PZP, APCS, and HBB) play key roles in regulating blood pressure, modulating the extracellular matrix and influencing immune responses. Overall, this research deepens our understanding of the complexity and clinical significance of PE.

Objective: To identify the frequency of functional constipation in women with urinary incontinence.

Methods: A cross-sectional, quantitative, descriptive, and exploratory study was conducted from September 2019 to January 2020 with 227 women (over 18 years old) at the Hospital de Clínicas, Universidade Federal do Paraná. A structured form collected sociodemographic and general health data, while bowel habits were assessed using the Rome IV criteria, the Bristol Stool Scale, and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Comparisons between women with and without constipation involved χ², Fisher's Exact, Student's t-test, Mann-Whitney U, and univariate logistic regression was performed to assess the association between sociodemographic/personal factors and the risk factor constipation. All women had a clinical diagnosis of urinary incontinence, and the analysis also compared those with and without constipation. Odds ratios and their respective 95% confidence intervals were estimated for each univariate model. A 5% significance level was adopted.

Results: The participants had a median age of 62 years (range 23-97). Functional constipation was identified in 80.2%(n=182), and mixed urinary incontinence was predominant in this group (88.5%, n=161). Physical activity emerged as a protective factor against constipation (OR=0.47; 95% CI=0.22-1.01; p=0.05), though only 22.5%(n=41) reported regular exercise. Conclusion: The high frequency of functional constipation in women with urinary incontinence highlights a significant impact on quality of life and underscores the importance of integrated, conservative therapeutic strategies, including early lifestyle interventions such as regular physical activity, to prevent worsening of both conditions. Longitudinal investigations are recommended.

Objective: Assess survival outcomes and risk of recurrence in vaginal estrogen therapy (VET) users with medical history of breast cancer.

Data source: The search strategy was guided by standardized terms and keywords were identified from controlled vocabularies. Following databases were used for literature search: Pubmed, EMBASE, Cochrane, Scopus and Web of Science. Only studies published in the 21st century (2001-present) and written in English were included.

Study selection: A total of 988 records were reviewed by two independent authors. After full-text analysis of 38 of them, 7 articles were included in the meta-analysis.

Data collection: Data from eligible studies were extracted and tabulated based on predefined criteria: author, country, year, study type, sample size, type of intervention, use of aromatase inhibitors, duration of follow-up, and main outcomes.

Results: 118.659 breast cancer survivors were analyzed, of whom 6.358 were treated with VET. The overall analysis showed no significant increase in the risk of recurrence (RR = 0.87, 95%CI: 0.67-1.11). VET users had a significant reduction in all-cause mortality (RR = 0.80, IC95%: 0.75-0,86).

Conclusion: Vaginal estrogen therapy appears to be safe in the management of menopausal genitourinary syndrome in breast cancer survivors and it is related to significantly lower all-cause mortality.

Prospective register of systematic reviews prospero: CRD42024602047.

Objective: To assess the association between early menarche and the nutritional status of the adolescents from the RPS - Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) birth cohort in São Luís, Maranhão.

Methods: A longitudinal study with data from the first and third follow-up of the cohort was conducted. A total of 1,225 adolescents aged 18 to 19 years were surveyed and analyzed for age at menarche, defined as early if <12 years old, and for the variable body mass index (BMI) for age, classified into z-scores by sex, as underweight (z-score <-2), adequate weight (z-score ≥-2 and ≤+1), and excess weight (z-score >+1). Directed acyclic graphs were constructed using the DAGitty^® program to select confounding variables for adjustment. Multinomial logistic regression adjusted for confounding variables such as parental obesity (yes or no), skin color (white or non-white), and birth weight (low birth weight, adequate birth weight, and high birth weight) was used to assess the association between early menarche and nutritional status. Statistical analyses were performed using STATA 15.0 software.

Results: Out of the 1,225 adolescents investigated, 32.6% experienced early menarche, and the majority had a BMI appropriate for their age (75.2%). Among adolescents with early menarche, 28.3% were classified as excess weight for their age. Multinomial logistic regression revealed an association between early menarche and excess weight (OR = 1.80; 95% CI = 1.21-2.69; p-value = 0.004).

Conclusion: Thus, the results indicate an association between the occurrence of early menarche and excess weight in the investigated adolescents.

Objective: This study aimed to identify the patterns and factors associated with congenital anomalies in newborns from a tertiary hospital maternity ward.

Methods: A case-control study was conducted at the Hospital Regional do Sudoeste Walter Alberto Pecóits in Francisco Beltrão (PR), between December 2023 and September 2024. Among the 1,400 births that occurred in the hospital's delivery room between December 1, 2023, and the end of September 2024, 37 newborns (2.6%) with congenital anomalies were identified during the study period. A total of 37 case mothers and 120 controls were included (a ratio of approximately 1:3). The sociodemographic variables included maternal age, residence, marital status, race, education level, family income, and maternal occupation. The behavioral variables considered smoking, alcohol consumption, and the use of drugs or medications during pregnancy. The fetal variables included the number of pregnancies, gestational age, type of delivery, miscarriage, Apgar score, birth weight, sex, fetal status, congenital anomalies, and the number of prenatal visits, with a minimum of six (one in the first trimester, two in the second, and three in the third), following the Ministry of Health guidelines.

Results: Among 1,400 live births, 37 cases of congenital anomalies were identified (2.6%, 95% CI: 1.80-3.48), while the control group included 120 women with newborns without congenital anomalies. Among cases, isolated anomalies were most common (62.2%), predominantly affecting the cardiovascular system (27.0%), followed by recognized syndromes (21.6%) and multiple malformations (16.2%). Data were collected through face-to-face interviews and medical record reviews. Bivariate analysis revealed significant associations between congenital anomalies and a family history of congenital anomalies (p = 0.02), low apgar scores at the 1st and 5th minutes (p < 0.01), and fetal status at birth (p < 0.01). Model 1, which integrates family history of congenital anomalies, apgar score at the 5th minute, and fetal status, showed the best predictive fit, consistent with previous findings. Bayesian logistic regression highlighted this model with the lowest AIC (295.98) and BIC (326.22) values, achieving 89% predictive accuracy.

Conclusion: These results reinforce the importance of family history and neonatal vitality in the context of congenital anomalies, indicating the need for future studies to confirm these findings and improve prevention strategies.