984 resultados para Toque vaginal


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Objetivo: avaliar o colo uterino por meio do toque vaginal e da ultra-sonografia transvaginal em gestantes de risco elevado para o parto prematuro. Métodos: durante o período compreendido entre fevereiro de 1995 e setembro de 1997 foram acompanhadas 38 gestantes com elevado risco para o parto prematuro entre a 20ª e 36ª semana de gestação. Estas pacientes foram submetidas semanalmente ao toque vaginal e ao exame ultra-sonográfico transvaginal. O toque vaginal avaliou o colo uterino quanto a dois parâmetros: comprimento e dilatação. A ultra-sonografia transvaginal estudou o comprimento e o diâmetro anteroposterior do colo uterino. Foram analisados os comportamentos destas medidas cervicais ao longo da gestação. Os dois métodos foram comparados quanto à avaliação cervical e à acurácia no diagnóstico do parto prematuro. Resultados: a incidência de partos prematuros foi de 18,4% (7/38). As medidas do comprimento cervical obtidas pela ultra-sonografia foram sempre maiores em relação às medidas obtidas pelo toque vaginal. Mediante análise pelo teste de hipóteses foram observadas uma relação indireta entre o comprimento cervical e a idade gestacional por meio do toque e do estudo ultra-sonográfico (p<0,05 e p<0,01, respectivamente) e uma relação direta entre a dilatação cervical e a idade gestacional observada pelo toque (p<0,01). Conclusões: dos parâmetros estudados por meio do toque e da ultra-sonografia transvaginal, o comprimento cervical ultra-sonográfico apresentou melhor acurácia no diagnóstico do parto prematuro, revelando ser o mais confiável para a avaliação das alterações cervicais em gestantes de risco elevado para o parto prematuro.

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Entre os vários fatores clínicos para o parto prematuro, alguns apresentam riscos substanciais, tais como história de parto prematuro, gemelidade e sangramento vaginal do segundo trimestre. No entanto, tais fatores estão presentes na minoria das mulheres que evoluem para o parto prematuro e, portanto, possuem baixa sensibilidade. A dilatação, o esvaecimento e a posição do colo uterino diagnosticados pelo toque vaginal têm sido relacionados ao aumento do risco para o parto prematuro, mas possuem baixas sensibilidades e baixos valores preditivos positivos. A diminuição do comprimento do colo uterino detectada pela ultrassonografia transvaginal também constitui risco para parto prematuro. Sua sensibilidade é melhor quando são considerados outros testes, mas o valor preditivo positivo é baixo. A principal utilidade do teste da fibronectina fetal reside em seu valor preditivo negativo em mulheres sintomáticas. Observa-se aumento da sensibilidade para a detecção do parto prematuro quando a medida do colo do útero é utilizada juntamente com o teste da fibronectina fetal.

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Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

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Objetivos: a laparoscopia pode auxiliar na conversão de uma histerectomia abdominal em vaginal quando esta última está contra-indicada, não devendo substituir a histerectomia vaginal simples quando esta é viável. Este estudo tem por objetivo discutir o papel da laparoscopia na histerectomia vaginal. Métodos: de fevereiro de 1995 a setembro de 1998, 400 pacientes foram consideradas candidatas à histerectomia vaginal. Foram excluídas as pacientes portadoras de prolapso uterino, tumor anexial associado e útero fixo ao toque bimanual. Os procedimentos foram realizados com a técnica de Heaney utilizando métodos de redução do volume uterino no caso de úteros miomatosos. Resultados: A média de idade e paridade foi de 46,9 anos e 3,2 partos, respectivamente. Vinte e nove pacientes (7,2%) eram nulíparas e 104 (26,0%) não tinham antecedente de parto vaginal. Trezentas e três pacientes (75,7%) apresentavam cirurgia pélvica prévia, sendo a cesárea a mais freqüente (48,7%). A principal indicação cirúrgica foi miomatose uterina (61,2%), e o volume uterino médio foi de 239,9 cm³ (30-1228 cm³). A histerectomia vaginal foi realizada com sucesso em 396 pacientes (99,0%), sendo que 73 cirurgias (18,2%) foram realizadas por residentes. O tempo cirúrgico médio foi de 45 min. A laparoscopia diagnóstica/cirúrgica foi realizada em 16 pacientes (4,0%). As complicações intra-operatórias incluíram 6 lesões vesicais (1,5%) e uma lesão retal (0,2%). Quatro procedimentos (1,0%) foram efetivados pela via abdominal. Ocorreram complicações pós-operatórias em 24 pacientes (6,0%). Duzentas e oitenta e uma pacientes (70,2%) receberam alta hospitalar 24 h após a cirurgia. Conclusões: O laparoscópio não parece ser necessário nos casos em que o útero é móvel e não existe tumor anexial associado. Em última análise, o principal papel do laparoscópio parece ser o de permitir que o ginecologista se dê conta de que histerectomia vaginal simples pode ser realizada na grande maioria dos casos.

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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.

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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.

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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.

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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.

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Purpose: The objective of this Pilot Study was to determine pain characteristics of pregnant women immediately before and after childbirth by vaginal delivery and to compare them with the pain intensity reported by physicians. Methods: We evaluated 20 Brazilian women between September and December 2007 with the WHOQOL-Bref instrument, VAS, McGill Pain Questionnaire, and Anxiety Adapted Scale. We interviewed the obstetrician with the VAS about the patient`s pain, Data were analyzed with the chi-square test. Results: Mean age was 22.35 years (SD = 6.24, range 15-39 years). It was necessary to use oxytocin in 15 (75%) patients, which had no correlation with anxiety degree. Higher intensity of pain (p < 0.05) and higher anxiety index (p < 0.05) were more common in women in the first pregnancy. Conclusions: Higher pain intensity was associated with higher anxiety levels (p < 0.05). Around half of the obstetricians` VAS scores were lower than the VAS scores of women, and probably pain at labor was underestimated and not controlled. Higher indices of anxiety and pain were associated, and were more frequent in women in the first pregnancy.

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Methods: We conducted a randomized controlled trial at the Amparo Maternal Birth Center in Sao Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). Results: A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). Discussion: The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

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Culture-dependent PCR-amplified rRNA gene restriction analysis and culture-independent (PCR-denaturing gradient gel electrophoresis) methodologies were used to examine vaginal lactobacilli from Brazilian women who were healthy or had been diagnosed with vulvovaginal candidiasis (VVC) or bacterial vaginosis. Only Lactobacillus crispatus was detected accordingly by both methods, and H2O2-producing lactobacilli were not associated with protection against VVC.

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Background: Reports on microbiologic cure rates following syndromic management (SM) of women with nonulcerative sexually transmitted infections (STIs) are limited. Goal. The goal of the study was to determine the effectiveness of the drugs used in SM of nonulcerative STIs and bacterial vaginosis in women and to compare the response among those with and without HIV-1 coinfection. Study Design: This was a cohort study of women with nonulcerative STIs who were treated according to local SM protocols. Results: Of 692 women recruited, 415 (80%) returned 8 to 10 days later, and 290 (70%) consented to a second examination, in which specimens were obtained. Clinical cure was reported by 67%, and microbiologic cure ranged from 80% to 89% for the three discharge-causing STIs and was independent of HIV-1 status. Only 38% of those with bacterial vaginosis were cured, and HIV-1-infected women were less likely to be cured (28% versus 52%; P < 0.001). Conclusions: Clinical and microbiologic response to SM of the nonulcerative STIs was not affected by HIV-1 coinfection, but cure rates for bacterial vaginosis were reduced.

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A local cultural practice that may enhance sexually transmitted infections (STIs) and HIV transmission is vaginal douching and vaginal substance use. These activities also have potential implications for the acceptability of HIV-prevention strategies such as the use of condoms and vaginal microbicides. We aimed to establish the prevalence, determinants and reasons for these practices among sex workers in KwaZulu-Natal, South Africa. A structured questionnaire was administered to 150 sex workers, who were being screened for a vaginal microbicide-effectiveness trial in the province. The questionnaire sought information on the frequency, reasons for and nature of vaginal douching and vaginal substance use and was drawn up on the basis of findings from a pilot study. Seventy per cent (95% CI: 62.0-77.2%) of the sex workers were HIV positive and on average they had five sexual partners per day. Vaginal douching and vaginal substance use were common among the sex workers. Vaginal douching was reported by 97% (n = 146) of the respondents and 94% reported vaginal substance use for 'dry sex'. A combination of traditional remedies, patent medicines, antiseptics and household detergents was used to clean and make the vagina dry and tight. The primary reasons reported for dry sex were to increase men's sexual pleasure (53%) and to attract clients and generate more money (20%). Sixty-five per cent of the women reported the practice of douching mainly for hygienic purposes and 13% for the prevention and treatment of sexually transmitted infections. Douching and dry-sex practices may increase women's risk of HIV and STI infection, and may have implications for the acceptability and development of HIV-prevention barrier methods such as microbicides and the use of condoms. These barrier methods may enhance or reduce sexual pleasure for men and women who engage in the practice of vaginal douching and vaginal substance use for 'dry sex'.

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OBJECTIVE: We evaluated whether vaginal concentrations of hyaluronan were altered in women with recurrent vulvovaginal candidiasis (RVVC). STUDY DESIGN: Lavage samples from 17 women with acute RVVC, 27 women who were receiving a maintenance antifungal regimen, and 24 control women were tested for hyaluronan and interleukin (IL)-6, IL-12, and IL-23 by enzyme-linked immunosorbent assay. RESULTS: Median vaginal hyaluronan concentrations were 33.8 ng/mL (range, 21.6-66.3 ng/mL) in women with acute RVVC, 15.0 ng/mL (range, 11.2-50.6 ng/mL) in women who were receiving maintenance therapy, and 4.2 ng/mL (range, 3.6-12.0 ng/mL) in control subjects (P <= .02). The vaginal hyaluronan concentration was 27.4 ng/mL (range, 15.4-37.7 ng/mL) when Candida was detected by microscopy and 9.5 ng/mL (range, 7.7-14.6 ng/mL) in microscopy-negative cases (P = .0354). Elevated hyaluronan levels were associated with itching plus burning (40.7 ng/mL) or itching plus discharge (42.1 ng/mL), as opposed to itching only (6.2 ng/mL; P = .0152). Hyaluronan and IL-6 levels were correlated (P = .0009). CONCLUSION: Hyaluronan release is a component of the host response to a candidal infection and may contribute to symptoms.

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Infections caused by the yeast Candida albicans represent an increasing threat to debilitated and immunosuppressed patients, and neutropenia is an important risk factor. Monoclonal antibody depletion of neutrophils in mice was used to study the role of these cells in host resistance. Ablation of neutrophils increased susceptibility to both systemic and vaginal challenge. The fungal burden in the kidney increased threefold on day 1, and 100-fold on day 4, and infection was associated with extensive tissue destruction. However, a striking feature of the disseminated disease in neutrophil-depleted animals was the altered pattern of organ involvement. The brain, which is one of the primary target organs in normal mice, was little affected. There was a threefold increase in the number of organisms recovered from the brains of neutrophil-depleted mice on day 4 after infection, but detectable abscesses were rare. In contrast, the heart, which in normal mice shows only minor lesions, developed severe tissue damage following neutrophil depletion. Mice deficient in C5 demonstrated both qualitative and quantitative increases in the severity of infection after neutrophil depletion when compared with C5-sufficient strains. The results are interpreted as reflecting organ-specific differences in the mechanisms of host resistance.