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1.
Femina ; 49(3): 173-176, 2021. ilus
Article in Portuguese | LILACS | ID: biblio-1224083

ABSTRACT

A epilepsia, doença cerebral caracterizada pela predisposição à geração de crises epilépticas, representa a patologia neurológica grave mais frequente na gravidez. Quando não acompanhada corretamente, possui um acentuado nível de morbimortalidade materno-fetal, sendo especialmente relacionada a riscos de convulsão materna na gestação e malformações fetais. Este artigo discute o acompanhamento da gestante epiléptica, trazendo recomendações de cuidados no período pré-concepcional, manejo durante o pré-natal, condução do trabalho de parto, peculiaridades no puerpério e tratamento de crises convulsivas, quando necessário. Serão abordados tanto aspectos de tratamento farmacológico quanto de monitoramento e orientações gerais, com o objetivo de contribuir para um suporte mais abrangente e adequado a esse grupo mais vulnerável de pacientes sob o cuidado do médico ginecologista-obstetra e neurologista.(AU)


Epilepsy, which is a brain disease defined for a greater predisposition for epileptic crisis, represents the most frequent neurological pathology during pregnancy. Without proper monitoring it is related to high morbidity and mortality to both mother and baby, especially due to the risks of mother seizure during pregnancy and fetus malformation. This article discusses about health care giving and follow-up for the epileptic pregnant women, pointing recommendations for preconception care, prenatal management, labor conduct, peculiarities in puerperium and treatment of convulsive crisis when needed. There will be approached pharmacological and non-pharmacological aspects, such as follow up exams and general orientations, having as a goal to contribute to an more abrangent and proper support of this more vulnerable group of patients under the care responsibility of obstetrician-gynecologist ad neurologist doctors.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/drug therapy , Epilepsy/complications , Epilepsy/prevention & control , Epilepsy/drug therapy , Prenatal Care/methods , Seizures/drug therapy , Carbamazepine/administration & dosage , Pregnancy, High-Risk , Postpartum Period/drug effects , Time-to-Pregnancy/drug effects , Lamotrigine/administration & dosage , Levetiracetam/administration & dosage , Obstetric Labor Complications/prevention & control , Anticonvulsants/administration & dosage
2.
Journal of Gynecologic Oncology ; : e61-2019.
Article in English | WPRIM | ID: wpr-764522

ABSTRACT

OBJECTIVE: This study aims to evaluate the effects and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH agonist) combined with aromatase inhibitor (AI) in preserving the fertility of obese women with grade 1 endometrial cancer (EC). METHODS: This study recruited obese EC patients who wished to preserve their fertility. The treatment regimen consisted of intramuscular GnRH agonist 3.75 mg every 4 weeks and oral AI 2.5 mg daily. The maintenance regimen was the same as the initial treatment regimen. Primary outcomes included response rate, time to complete response (CR), and time to recurrence; pregnancy outcomes included the time to pregnancy, pregnancy rate and live birth rate. RESULTS: Six obese patients with EC were included in this study, with the age (mean±standard deviation [SD]) of 30.5±3.3 years and body mass index (mean±SD) of 35.0±1.4 kg/m2. CR rate was 100%, and time to CR was 3–6 months. None of the patients had recurrence after a median follow-up of 4.0 years (range, 1.3–7.0 years). The most common side effects were menopause-like symptoms. Among these patients, no weight gain was observed during treatment. The pregnancy rate and live birth rate was 50.0% and 75.0%, respectively, with a median time to pregnancy of 2.4 years (range, 1.0–5.5 years). CONCLUSION: The combination of GnRH agonist and AI demonstrated promising long-term effect in young obese EC patients who wished to preserve their fertility. No weight gain side effects were observed. Further studies with a larger sample size are needed to fully evaluate this novel treatment regimen.


Subject(s)
Female , Humans , Pregnancy , Aromatase Inhibitors , Aromatase , Body Mass Index , Endometrial Neoplasms , Fertility , Follow-Up Studies , Gonadotropin-Releasing Hormone , Live Birth , Obesity , Organ Sparing Treatments , Pilot Projects , Pregnancy Outcome , Pregnancy Rate , Recurrence , Sample Size , Time-to-Pregnancy , Weight Gain
3.
Clinical and Experimental Reproductive Medicine ; : 31-37, 2018.
Article in English | WPRIM | ID: wpr-713342

ABSTRACT

OBJECTIVE: To evaluate the pregnancy rate and time to pregnancy after timed coitus with or without superovulation in infertile young women younger than 35 years old with low serum anti-Müllerian hormone (AMH) levels (< 25th percentile). METHODS: A total of 202 patients younger than 35 years old were recruited retrospectively between 2010 and 2012. Ninety-eight women had normal serum AMH levels (25–75th percentile), 75 women had low serum AMH levels (5th≤&< 25th percentile) and 29 women had very low serum AMH levels (< 5th percentile), according to reference values for their age group. RESULTS: The clinical pregnancy rate was positively associated with AMH levels, but this trend did not reach statistical significance (43.9% vs. 41.3% vs. 27.6% in the normal, low, and very low AMH groups, respectively). The time to pregnancy was longer in the very low AMH group than in the normal AMH group (13.1±10.9 months vs. 6.9±6.1 months, p=0.030). The cumulative live birth rate over 18 months was lower in the very low AMH group than in the normal AMH group, with marginal significance (20.0% vs. 55.9%, p=0.051). The duration of infertility was negatively correlated with achieving pregnancy (odds ratio, 0.953; 95% confidence interval, 0.914–0.994; p=0.026). CONCLUSION: Conservative management, such as timed coitus with or without superovulation, should be considered in young patients who have low ovarian reserve without any infertility factors. However, for women with a long duration of infertility or very low serum AMH levels, active infertility treatment should be considered.


Subject(s)
Female , Humans , Pregnancy , Anti-Mullerian Hormone , Coitus , Infertility , Live Birth , Maternal Age , Ovarian Reserve , Pregnancy Rate , Reference Values , Retrospective Studies , Superovulation , Time-to-Pregnancy
4.
Rev. Assoc. Med. Bras. (1992) ; 62(9): 837-842, Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-829552

ABSTRACT

SUMMARY Introduction The successful development of chemotherapy enabled a fertilitysparing treatment for patients with trophoblastic neoplasia. After disease remission, the outcome of a subsequent pregnancy becomes a great concern for these women. Objective To analyze existing studies in the literature that describe the reproductive outcomes of patients with trophoblastic neoplasia treated with chemotherapy. Method Systematic review was performed searching for articles on Medline/ Pubmed, Lilacs and Cochrane Library databases, using the terms “gestational trophoblastic disease” and “pregnancy outcome”. Results A total of 18 articles were included. No evidence of decreased fertility after chemotherapy for trophoblastic neoplasia was observed. The abortion rates in patients who conceived within 6 months after chemotherapy was higher compared to those who waited longer. Some studies showed increased rates of stillbirth and repeat hydatidiform moles. Only one work showed increased congenital abnormalities. Conclusion The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications. However, studies in the literature provide reassuring data about reproductive outcomes of these patients.


RESUMO Introdução o sucesso do desenvolvimento da quimioterapia no tratamento da neoplasia trofoblástica proporcionou a possibilidade de conservação da fertilidade das pacientes, tornando o futuro reprodutivo uma nova preocupação após a remissão da doença Objetivo analisar os estudos existentes na literatura que descrevem o futuro reprodutivo de pacientes com neoplasia trofoblástica tratadas com quimioterapia. Método revisão sistemática que buscou artigos nas bases de dados Medline/Pubmed, Lilacs e Biblioteca Cochrane, utilizando as palavras-chave “gestational trophoblastic disease” e “pregnancy outcome”. Resultados foram selecionados 18 artigos de acordo com critérios de inclusão e exclusão. Não foi observada diminuição da fertilidade após a quimioterapia para neoplasia trofoblástica. Pacientes que engravidaram até 6 meses do término da quimioterapia apresentaram maiores taxas de abortamento quando comparadas às que esperaram mais de 6 meses. Alguns artigos encontraram maiores taxas de natimorto e nova mola hidatiforme. Apenas um estudo mostrou aumento da taxa de malformação. Conclusão as gestações subsequentes à neoplasia trofoblástica devem ser acompanhadas com vigilância clínica em decorrência da maior taxa de complicações na gestação, principalmente nas mulheres que engravidam até 6 meses após o término da quimioterapia. No entanto, os dados encontrados nos estudos tranquilizam quanto ao futuro reprodutivo dessas pacientes.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Outcome , Gestational Trophoblastic Disease/drug therapy , Fertility/drug effects , Antineoplastic Agents/adverse effects , Abortion, Spontaneous/chemically induced , Gestational Trophoblastic Disease/complications , Time-to-Pregnancy
5.
Obstetrics & Gynecology Science ; : 487-493, 2015.
Article in English | WPRIM | ID: wpr-228862

ABSTRACT

OBJECTIVE: This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS). METHODS: A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS. RESULTS: Mean (+/-SD) patient age and body mass index (BMI) were 29.5+/-4.6 years and 27.7+/-6.1 kg/m2, respectively. Peak pregnancy incidence was reported at 10 months after HS, although or =30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents. CONCLUSION: This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue.


Subject(s)
Female , Humans , Pregnancy , Body Mass Index , Contraception , Surveys and Questionnaires , Fertilization , Follow-Up Studies , Incidence , Insurance Coverage , Pregnancy, Unplanned , Sterilization , Time-to-Pregnancy
6.
S. Afr. j. obstet. gynaecol ; 19(2): 40-43, 2013.
Article in English | AIM | ID: biblio-1270768

ABSTRACT

Background. It has been found that pregnant women experience a higher rate of intimate partner violence (IPV) than women who are not pregnant. This paper presents findings of a brief IPV intervention provided to pregnant women attending prevention of mother-to-child transmission of HIV services. Methods. Eighteen community workers were recruited and trained in assessment of and intervention for abuse during pregnancy. These were implemented for 10 months at 16 primary healthcare facilities in the Thembisile sub-district; Nkangala district; Mpumalanga Province; South Africa. Results. A total of 2 230 pregnant women were screened for abuse; 7.2 (160) screened positive and received a brief intervention. This was a 20-minute session on safety behaviours and strategies for dealing with the abuse; including referral to local support services. Eighty-four women attended a follow-up interview 3 months after the intervention. The mean danger assessment score of 6.0 before intervention fell significantly to 2.8 after 3 months. Conclusion. The brief intervention provided to these women contributed to a significant reduction in the level of IPV


Subject(s)
Battered Women , Delivery of Health Care , Emergencies , Pregnant Women , Prenatal Care , Spouse Abuse , Time-to-Pregnancy
7.
Article in English | IMSEAR | ID: sea-143630

ABSTRACT

Introduction: Cervical cancer is both a preventable and a curable disease, preventable because the pre-invasive stage can be detected by screening and curable because the verily early stage can be cured. The incidence and mortality from this disease in developing countries is very high.Women of low socio-economic status and minority women are at particular risk for not adhering to recommended cancer screening guidelines. Objectives: 1.To study the cytological abnormalities of pap smear among married women in reproductive age group. 2.To study the risk factors of various stages of cervical dysplasia. Material and Methods: This study was conducted in the urban field practice area of S Nijalingappa Medical College, Bagalkot during 2009-2010. All married women in reproductive age group were included in the study. After obtaining a informed consent, they were interviewed with the predesigned, pre-structured proforma. Data were obtained on social and demographic factors, education, marital and reproductive history and tobacco chewing was obtained. Under aseptic precautions, pap smear was obtained. Results: In the present study, 211 married women participated, among them maximum (45%) were in the age group of 26-35 years. The pap smear report of these participants were inflammatory (57.8%). Severe dysplasia was reported in 9 women. Among the study participants, 66(31.3%) of the women had normal pap smear. Inflammatory smear was present more among 26-35 year age group (30.8%), Class II socio economic status (32.7%) and among Hindus(54.1%). Severe dysplasia was maximum reported among 46-55 years age group, class II socioeconomic status and among Hindus. Recommendation and conclusion: Cervical cancer is a problem with multiple causes and a multipronged approach is essential to combat it. It is essential to provide health education for women, particularly those from the lower socioeconomic strata regarding sexual and genital hygiene and appropriate treatment of sexually transmitted infection.


Subject(s)
Adult , Female , Humans , India , Cytological Techniques , Time-to-Pregnancy , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears
8.
The Nigerian Health Journal ; 12(3): 86-89, 2012.
Article in English | AIM | ID: biblio-1272835

ABSTRACT

Hypertensive disorders of pregnancy constitute major threats to maternal health during pregnancy; labour and the post-partum period. Eclampsia is a leading cause of maternal morbidity and mortality especially in low income and middle-income countries.Method: A retrospective review of the clinical records of women managed for eclampsia during a two-year period from December 2004 to November 2006 at the General hospital Aliero was undertaken.Results: Fifty-eight patients were managed for eclampsia during the 2-year period of study. Eclampsia occurred before and during labour in 47 patients while 11 patients had post-partum eclampsia.Conclusion: The reorientation of caregivers and the community in order to enhance awareness of eclampsia is recommended. The promotion of early presentation; routine antenatal care; and prompt referral to secondary center's as well as the provision of the resources for adequate management of eclampsia is advocated


Subject(s)
Eclampsia , Hypertension , Labor, Obstetric , Maternal Mortality , Maternal Welfare , Morbidity , Postpartum Period , Pregnancy , Time-to-Pregnancy
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