Perfil de mães e o desfecho do nascimento prematuro ou termo

The birth or delivery under 37 weeks of pregnancy is considered a global public health problem, since it is seen as one of the main risk factors for neonatal morbidity and mortality, particularly in the first week of life. This study had the objective of analyzing the profile of mothers of premature and full-term babies for the outcome of birth. This is an analytical-descriptive and cross-sectional study, with a sample of 109 mothers of all the premature babies and 135 mothers of the randomly selected full-term babies, by drawing, occurred in the period from April to September 2015, in a public maternity. Data were organized on Microsoft Excel 2013; subsequently, there was the analysis of the analytical-descriptive statistics, through Statistica 10, through which the frequencies, proportions, p values, with 5% significance level, through the Chi-square test, were identified. The project was submitted to the Research Ethics Committee of the Federal University of Rio Grande do Norte, receiving a favorable opinion (nº 1047431/2015). This study has enabled us to identify that the socioeconomic profile of mothers of premature and full-term babies showed, in both, low schooling level and low income. In addition, our data point out in the two groups, before and during pregnancy, a high prevalence of sedentariness; statistical significance for overweight and obesity before and during pregnancy, with 42,22% prevalence before pregnancy of mothers of premature babies and 48,62% of mothers of full-term babies; with high blood pressure during pregnancy in 32,11% of mothers of premature babies and 17,04% of mothers of full-term babies. Moreover, pregnancy was only planned in 33,33%, and also unwanted by 21,1% of mothers of premature babies, while 40,37% of mothers of full-term babies planned pregnancy and 17,78% had unwanted pregnancy. With respect to the aggravating factor “illicit drugs”, there was consumption during pregnancy on the part of 8,26% of mothers of premature babies. The most frequent complications were: vaginal bleeding (in 43,12% of mothers of premature babies and 20% of mothers of full-term babies); urinary infection (in 44,95% of mothers of premature babies and 40% of mothers of full-term babies); and stressful pregnancy (in 62,96% of mothers of premature babies and 47,41% of mothers of full-term babies). Accordingly, babies were born with health problems in 58,10% of premature births and there was healthy birth in 96,30% of full-term babies. Therefore, the profile of mothers with obesity and overweight, unwanted pregnancy, user of illegal drugs during pregnancy, stressful pregnancy and vaginal bleeding may be associated with the birth of premature baby as unfavorable and hazardous event for the child’s health.

Perfil de mães e o desfecho do nascimento prematuro ou termo

The birth or delivery under 37 weeks of pregnancy is considered a global public health problem, since it is seen as one of the main risk factors for neonatal morbidity and mortality, particularly in the first week of life. This study had the objective of analyzing the profile of mothers of premature and full-term babies for the outcome of birth. This is an analytical-descriptive and cross-sectional study, with a sample of 109 mothers of all the premature babies and 135 mothers of the randomly selected full-term babies, by drawing, occurred in the period from April to September 2015, in a public maternity. Data were organized on Microsoft Excel 2013; subsequently, there was the analysis of the analytical-descriptive statistics, through Statistica 10, through which the frequencies, proportions, p values, with 5% significance level, through the Chi-square test, were identified. The project was submitted to the Research Ethics Committee of the Federal University of Rio Grande do Norte, receiving a favorable opinion (nº 1047431/2015). This study has enabled us to identify that the socioeconomic profile of mothers of premature and full-term babies showed, in both, low schooling level and low income. In addition, our data point out in the two groups, before and during pregnancy, a high prevalence of sedentariness; statistical significance for overweight and obesity before and during pregnancy, with 42,22% prevalence before pregnancy of mothers of premature babies and 48,62% of mothers of full-term babies; with high blood pressure during pregnancy in 32,11% of mothers of premature babies and 17,04% of mothers of full-term babies. Moreover, pregnancy was only planned in 33,33%, and also unwanted by 21,1% of mothers of premature babies, while 40,37% of mothers of full-term babies planned pregnancy and 17,78% had unwanted pregnancy. With respect to the aggravating factor “illicit drugs”, there was consumption during pregnancy on the part of 8,26% of mothers of premature babies. The most frequent complications were: vaginal bleeding (in 43,12% of mothers of premature babies and 20% of mothers of full-term babies); urinary infection (in 44,95% of mothers of premature babies and 40% of mothers of full-term babies); and stressful pregnancy (in 62,96% of mothers of premature babies and 47,41% of mothers of full-term babies). Accordingly, babies were born with health problems in 58,10% of premature births and there was healthy birth in 96,30% of full-term babies. Therefore, the profile of mothers with obesity and overweight, unwanted pregnancy, user of illegal drugs during pregnancy, stressful pregnancy and vaginal bleeding may be associated with the birth of premature baby as unfavorable and hazardous event for the child’s health.

A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi

Background Cervical cancer is the commonest cancer affecting women in Malawi, which has the highest rate of this disease in the world. Most cases are diagnosed at an advanced stage. Aim To describe the symptom burden, palliative care interventions, and outcomes of cervical cancer patients who entered care at Tiyanjane Clinic in Blantyre, Malawi, between January and December 2012. Methods We reviewed the case files of 72 patients presenting to our hospital-based palliative care service over one year. Results The mean age was 49.5 years. Twenty-six patients (36%) were HIVpositive and the majority of these (n = 22; 85%) were on antiretroviral medication at presentation to palliative care. Pain (n = 66; 92%), vaginal discharge (n = 44; 61%), and unpleasant odour (n = 37; 51%) were commonly reported. Over a third of patients (n = 26; 36%) reported pain in two or more sites. Fourteen patients (19%) reported vaginal bleeding. Spousal breakdown (through widowhood or divorce) was noted in over half (n = 41; 57%) of all cases. Pain relief was provided to 69 (96%) of the patients (morphine to 40 patients; 56%). Common interventions provided included metronidazole tablets (used vaginally), sanitary items, and counselling. At the end of the study period, 18 patients (25%) were still under the care of palliative services. Conclusions Access to medications such as morphine, metronidazole and tranexamic acid can improve quality of life, even when radiotherapy is limited. Health care teams require necessary skills and training, including how to perform a comprehensive assessment, with an emphasis on the provision of psychosexual counselling, to assist with the complexity of symptoms occurring in this vulnerable group.

Miomatosis uterina: frecuencia y características clínico-ecográficas en el Hospital Vicente Corral Moscoso, periodo 2010-2014

Antecedentes: La miomatosis es la neoplasia benigna más común en ginecología, presentándose en 20-30% en mujeres en edad fértil, es indicación frecuente de histerectomía entre los 35 y 54 años y puede producir infertilidad, coexistir con un embarazo y causar complicaciones en el mismo. Son tumores de fibras musculares lisas y tejido conectivo con manifestaciones clínicas variables dependiendo del tamaño, posición y número, aunque la mayoría son asintomáticos, es un diagnóstico común en ginecología y generan importantes gastos en salud. Objetivo: Determinar la frecuencia y las características clínico-ecográficas de la miomatosis uterina en las pacientes atendidas en el Hospital Vicente Corral Moscoso, periodo 2010- 2014 Metodología: Se realizó un estudio descriptivo, retrospectivo. El universo de estudio estuvo conformado por las historias clínicas de pacientes hospitalizadas en el departamento de ginecología del Hospital Vicente Corral Moscoso, periodo 2010-2014, los datos fueron analizados en la base de datos Excel 2010 y SPSS 20, los resultados fueron presentados en cuadros y gráficos, para las variables cualitativas se utilizó medidas de frecuencia absolutas y relativas; y para las variables cuantitativas medidas de tendencia central y dispersión. Resultados: Se obtuvieron 303 casos, se observó que el mayor número de casos (90.1%) se presentó en mujeres que tenían una edad mayor a 35 años con una media de 43.31 años y DS de 6.96. Los miomas más frecuentes fueron los intramurales (50.8 %); El síntoma de consulta más frecuente fue el sangrado transvaginal (74.6%)

Postoperative vaginal vault brachytherapy for node-negative Stage II (occult) endometrial carcinoma

Objective. The aim of this study is to look at the efficacy of extended surgical staging and postoperative vaginal vault brachytherapy in patients with Stage II (occult) endometrial carcinoma. Methods. Between January 1989 and December 1997, there were 30 patients with Stage II (occult) endometrial carcinoma who received postoperative vaginal vault brachytherapy as the only adjuvant treatment. The study group consisted of 15 of these patients who had extended surgical staging (including lymphadenectomy). Results. At a median follow-up of 36 months (range 17 to 113 months), there has been no recurrence. There were no major complications from surgery. Only 1 patient had mild rectal bleeding following vaginal vault brachytherapy and there were no grade 3 or 4 bowel toxicities. Conclusions. Extended surgical staging and postoperative vaginal vault brachytherapy for Stage II (occult) endometrial carcinoma is associated with minimal morbidity and excellent survival. (C) 2001 Academic Press.

Repercussões hemodinâmicas do posicionamento em litotomia exagerada para histerectomia vaginal em paciente cardiopata: relato de caso

JUSTIFICATIVA E OBJETIVOS: A técnica de histerectomia vaginal possibilita menor tempo operatório e o uso do bloqueio do neuro-eixo, com os benefícios de melhor analgesia pós-operatória e menor resposta sistêmica ao procedimento cirúrgico. O objetivo deste relato foi descrever as alterações hemodinâmicas decorrentes do posicionamento em litotomia exagerada em paciente cardiopata. RELATO do CASO: Paciente de 33 anos, G0P0A0, com história de sangramento uterino anormal e anemia. A ultra-sonografia evidenciava útero miomatoso com volume estimado de 420 cm³. Ela era portadora de trombofilia e miocardiopatia dilatada, com passado de dois acidentes vasculares encefálicos isquêmicos e dois infartos agudos do miocárdio. Foi monitorizada com pressão arterial invasiva e cateter de artéria pulmonar com medida de débito cardíaco contínuo. Realizada raquianestesia com bupivacaína hiperbárica e morfina. A paciente foi posicionada em litotomia exagerada sendo realizada histerectomia total pela técnica de Heaney e salpingectomia bilateral. Como intercorrência intra-operatória apresentou diminuição do índice cardíaco e aumento das pressões de câmaras direitas após o posicionamento, necessitando do uso de dobutamina. CONCLUSÕES: O posicionamento em litotomia exagerada pode ocasionar alterações hemodinâmicas que devem ser consideradas na escolha da técnica cirúrgica.

Ovariohisterectomia por videocirurgia (via NOTES vaginal híbrida), celiotomia ou miniceliotomia em cadelas

The elective ovariohysterectomy (OH) is the most frequent procedures performed in dogs. In this study was used three groups of seven animals each (GI, GII, and GIII) that was undergone to three elective OH techniques: (i) mini-celiotomy (Snook-hook technique), (ii) hybrid Natural Orifice Translumenal Endoscopic Surgery (NOTES), and (iii) celiotomy (conventional surgery). The surgical techniques were compared considering the surgery time, trans and postoperative complications, technical difficulties, postoperative pain, surgical bleedind and some vital parameters as: heart rate (FC), respiratory rate (), rectal temperature, invasive blood pressure (PVI) and central venous pressure (PVC). The OH by hybrid vaginal NOTES was the technique with the lowest post-surgical discomfort score and the lowest surgical bleeding, although its surgical time was higher compared to the conventional and the hook (mini-celiotomy) modalities.

Injury of the corona mortis during vaginal tape insertion (TVT-Secur™ using the U-Approach)

We report a serious bleeding complication due to injury of the corona mortis following insertion of a transvaginal tape, TVT-Secur™ (Ethicon Women's Health, Sommerville, NJ, USA).

The vaginal microflora in relation to gingivitis

BACKGROUND: Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. METHODS: Vaginal samples were collected from 180 women (mean age 29.4 years, SD +/- 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at >or= 20% of tooth sites. RESULTS: A Nugent score of 0-3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 x 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5-5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8-7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001). CONCLUSION: Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections.

Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Aims The major aims of the study were to compare the safety of a continuous low-dose estradiol-releasing vaginal ring (ESTring) to that of a vaginal estradiol tablet (Vagifem®) on the endometrium and the relief of subjective symptoms and signs of urogenital estrogen deficiency. Quality of life and acceptability of treatment delivery were also assessed. Study design A prospective, randomized study in which women were assigned in a 2: 1 ratio to ESTring and Vagifem and followed for 12 months. The primary endpoint was endometrial safety, based on the results of ultrasound measurement of endometrial thickness and a progestogen challenge test at baseline and week 48. Efficacy was determined by subjective assessment of urogenital estrogen deficiency symptoms at baseline and weeks 3, 12, 24, 36 and 48 and assessment of signs of vaginal epithelial atrophy by the clinician at baseline, 12 and 48 weeks. In addition, pelvic floor strength, vaginal cytological evaluation and pH, bacteruria and patient acceptability were assessed. Quality of life was assessed using a menopause-specific quality-of-life questionnire and a 2-day bladder diary at baseline and 12 and 48 weeks. The comparability of the two groups was assessed using ANOVA, χ(2) or Fisher's exact tests. Results A total of 126 women were randomized to ESTring and 59 to Vagifem. There was no statistical difference between the groups in the alleviation of symptoms and signs of urogenital estrogen deficiency. Maturation indices increased in both groups, from generally atrophic at baseline to proliferative or highly proliferative at 48 weeks. After 48 weeks of treatment, there was no statistically significant difference in endometrial thickness between the two groups. A statistically smaller proportion of bleeding/spotting occurred in the ESTring group (n = 0) compared to the Vagifem users (n = 4). Estradiol and total estrone serum levels increased during treatment in both groups but remained within the normal postmenopausal range. General health status in both groups was unchanged but the urogenital component of health burden was significantly improved in both groups. Bladder diary variables showed no differences between treatment groups. Conclusion Equivalent endometrial safety and efficacy in the relief of the symptoms and signs of urogenital estrogen deficiency were demonstrated for the 12 months' use of a low-dose estradiol-releasing vaginal ring and a vaginal estradiol tablet.

Dna Extraction From Filter-paper Spots Of Vaginal Samples Collected After Sexual Violence.

To detect the presence of male DNA in vaginal samples collected from survivors of sexual violence and stored on filter paper. A pilot study was conducted to evaluate 10 vaginal samples spotted on sterile filter paper: 6 collected at random in April 2009 and 4 in October 2010. Time between sexual assault and sample collection was 4-48hours. After drying at room temperature, the samples were placed in a sterile envelope and stored for 2-3years until processing. DNA extraction was confirmed by polymerase chain reaction for human β-globin, and the presence of prostate-specific antigen (PSA) was quantified. The presence of the Y chromosome was detected using primers for sequences in the TSPY (Y7/Y8 and DYS14) and SRY genes. β-Globin was detected in all 10 samples, while 2 samples were positive for PSA. Half of the samples amplified the Y7/Y8 and DYS14 sequences of the TSPY gene and 30% amplified the SRY gene sequence of the Y chromosome. Four male samples and 1 female sample served as controls. Filter-paper spots stored for periods of up to 3years proved adequate for preserving genetic material from vaginal samples collected following sexual violence.

Bleeding Complications In Dengue Are Not Associated With Significant Changes In The Modulators Of The Endothelial Barrier.

Bleeding complications in dengue may occur irrespective of the presence of plasma leakage. We compared plasma levels of modulators of the endothelial barrier among three dengue groups: bleedings without plasma leakage, dengue hemorrhagic fever, and non-complicated dengue. The aim was to evaluate whether the presence of subtle alterations in microvascular permeability could be detected in bleeding patients. Plasma levels of VEGF-A and its soluble receptors were not associated with the occurrence of bleeding in patients without plasma leakage. These results provide additional rationale for considering bleeding as a complication independent of endothelial barrier breakdown, as proposed by the 2009 WHO classification.

Dyspareunia And Lubrication In Premature Ovarian Failure Using Hormonal Therapy And Vaginal Health.

To evaluate vaginal microbiological and functional aspects in women with and without premature ovarian failure (POF) and the relationship with sexual function. A cross-sectional study of 36 women with POF under hormonal therapy who were age-matched with 36 women with normal gonadal function. The vaginal tropism was assessed through hormonal vaginal cytology, vaginal pH and vaginal health index (VHI). Vaginal flora were assessed by the amine test, bacterioscopy and culture for fungi. Sexual function was evaluated through the questionnaire Female Sexual Function Index (FSFI). Women in both groups were of similar age and showed similar marital status. The two groups presented vaginal tropic scores according to the VHI but the tropism was worse among women in the POF group. No difference was observed with respect to hormonal cytology and pH. Vaginal flora was similar in both groups. Women with POF showed worse sexual performance with more pain and poorer lubrication than women in the control group. The VHI, the only parameter evaluated showing statistical difference between the groups, did not correlate with the domains of pain and lubrication in the FSFI questionnaire. These findings suggest that the use of systemic estrogen among women with POF is not enough to improve complaints of lubrication and pain despite conferring similar tropism and vaginal flora. Other therapeutic options need to be evaluated.

Vaginal Epithelium And Microflora Characteristics In Women With Premature Ovarian Failure Under Hormone Therapy Compared To Healthy Women.

To evaluate some microbiological aspects of the vaginal flora and the vaginal trophism of women with premature ovarian failure (POF) in use of oral hormone therapy. A cross-sectional study with 36 women with POF under the age of 40 years using oral hormonal therapy. They were age matched with 36 women with normal gonadal function (control group). The characteristics of the vaginal epithelium were assessed through the hormonal vaginal cytology, vaginal pH measurement and vaginal health index to identify vaginal disturbances. Vaginal microflora was evaluated by the amine test, bacterioscopy (Nugent score) and culture for fungi to identify vaginal abnormal microflora and fungi infections. Despite the fact that there were no statistical significant differences related to the cytological aspects and pH measurements, it was found that the vaginal health index was highly superior in the control group than in the POF group (23.4 ± 1.8 vs 20.8 ± 3.5), p < 0.0001 despite both groups had trophic scores. There were no statistical significance differences regarding to vaginal microflora types and fungi infection. Oral hormone therapy for young women with POF seems to be good enough to reestablish the epithelium cells, vaginal pH and microflora.

Usefulness Of Vaginal Cytology Tests In Women With Previous Hysterectomy For Benign Diseases: Assessment Of 53,891 Tests.

To assess the value of vaginal screening cytology after hysterectomy for benign disease. This cross-sectional study used cytology audit data from 2,512,039 screening tests in the metropolitan region of Campinas from 2000 to 2012; the object was to compare the prevalence of abnormal tests in women who had undergone a hysterectomy for benign diseases (n=53,891) to that of women who had had no hysterectomy. Prevalence ratios (95% confidence intervals, 95% CI) were determined, and chi-square analysis, modified by the Cochrane-Armitage test for trend, was used to investigate the effects of age. The prevalence of atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion or squamous-cell carcinoma (HSIL/SCC) was 0.13%, 0.04% and 0.03%, respectively, in women who had undergone hysterectomy, and 0.93%, 0.51% and 0.26% in women who had not undergone hysterectomy. The prevalence ratios for ASC, LSIL and HSIL/SCC were 0.14 (0.11-0.17), 0.08 (0.06-0.13) and 0.13 (0.08-0.20), respectively, in women with a hysterectomy versus those without. For HSIL/SCC, the prevalence ratios were 0.09 and 0.29, respectively, for women <50 or ≥50years. The prevalence rates in women with a previous hysterectomy showed no significant variation with age. The prevalence rates of ASC, LSIL and HSIL/SCC were significantly lower in women with a previous hysterectomy for benign disease compared with those observed in women with an intact uterine cervix. This study reinforces the view that there is no evidence that cytological screening is beneficial for women who have had a hysterectomy for benign disease.