Preterm birth prevention.

Preterm birth (PTB), which occurs in about 12% of pregnancies worldwide, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids and antibiotics has improved neonatal outcomes but has not reduced the incidence of PTB. Evidence suggests that the rate of PTB may be reduced by the prophylactic use of progesterone in women with a previous history of preterm delivery and in those with a short cervical length identified by routine transvaginal ultrasound. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of PTB.

Stress and anxiety in pregnant women exposed to ultrasound.

AIM: To investigate the levels of anxiety and stress during pregnancy among women who are routinely offered ultrasound at first and second trimesters. METHODS: This is a cross-sectional study involving 296 women, in which 146 pregnant women without any medical problem were compared with 150 nonpregnant women. Both groups were submitted to the Lipp Inventory of Stress Symptoms for Adults and to the State-Trait Anxiety Inventory. Logistic regression analysis was used to evaluate the effect of pregnancy on the anxiety and stress levels. RESULTS: There was no statistical difference between pregnant and nonpregnant women [56.8% (83/146) vs. 48.6% (73/150), odds ratio (OR) 1.39 95% confidence interval (CI) 0.88-2.19] regarding the level of stress. Logistic regression analysis demonstrated that the only significant independent predictor of stress was maternal age (OR 0.95, 95% CI 0.91-0.96; P = 0.045) for the pregnant women and monthly income and religious belief for the nonpregnant group. Pregnant women had a higher level of anxiety compared with the nonpregnant (15.7% vs. 2.6%, P = 0.0002) and ultrasound examination decreased the anxiety level. CONCLUSION: Pregnant women did not have a higher level of stress compared with the nonpregnant women, and maternal age is the only significant independent predictor of stress. Pregnant women are more anxious, and after the ultrasound examination, the level of anxiety decreased.

Reference ranges for cervical length by transvaginal scan in singleton pregnancies.

OBJECTIVE: The aim was to construct a chart for cervical length measured by transvaginal ultrasound. RESEARCH DESIGN AND METHODS: Singleton pregnant women underwent a transvaginal scan to measure the cervical length (CxL) from 20 to 34 weeks. Exclusion criteria were preterm delivery, preterm rupture of membranes, multiple pregnancies, cerclage, and those who have taken vaginal progesterone. For statistical evaluation, we used regression analysis and calculation of 5th, 50th, and 95th centiles was performed. RESULTS: In the 1061 women with follow up, there were 94 (8.8%) spontaneous and 27 (2.5%) iatrogenic preterm delivery before 37 weeks. The CxL decreased with gestational age (r(2) = 0.0799). The coefficient for the interpolated median is y = 37.754 - 0.0148 x (GA)(2) + 0.2556 x (GA) (r(2) = 0.7247); for the 5th centile is y = 5.9171 - 0.0467 x (GA)(2) + 1.7059 x (GA) (r(2) = 0.6502); and for the 95th centile is y = 114.72 + 0.0758 x (GA)(2) - 4.6706 x (GA) (r(2) = 0.7783). CONCLUSION: CxL shortened throughout the pregnancy. The chart present 5th, 50th, and 95th centile, respectively, at 23 weeks of 20 mm, 36 mm, and 47 mm; at 28 weeks of 17 mm, 33 mm, and 43 mm; and at 34 weeks of 10 mm, 29 mm, and 43 mm.

Evaluation of the risk of spreading endometrial cell by hysteroscopy: a prospective longitudinal study.

Objective. The aim was to assess the intraperitoneal spread of endometrial cells during hysteroscopy. Study Design. Seventy-six women were submitted to a hysteroscopy with CO(2) under a low pressure. Group 1 had not previous diagnosis of endometrial cancer, and group 2 had previous diagnosis of endometrial cancer (stage I-92.3%). Two peritoneal washing samples were taken before (PW1) and immediately after (PW2) the procedure. The dissemination for the peritoneal cavity was defined by the presence of endometrial cells in the PW2; such cells should be absent in WP1. Results. Four patients were excluded for presenting endometrial cells in PW1. In the 72 patients left, there was no passage of cells for the peritoneal cavity. In group 1, 88% presented secretory endometrial phase with correlation of 80% between hysteroscopy and biopsy. Conclusion. Hysteroscopy performed under a low pressure of CO(2) does not cause spreading of endometrial cells into the peritoneal cavity.

Prevention of preterm birth based on short cervix: progesterone.

Preterm delivery, which occurs in about 5%-13% of pregnancies in most countries, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids has improved perinatal outcome but has not reduced the incidence of preterm delivery. Recent evidence suggests that the rate of preterm delivery may be reduced by the prophylactic use of progesterone in women with a history of preterm delivery and in those with a short cervical length identified by routine transvaginal sonography. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of preterm birth.

Prematurity prevention: the role of progesterone.

PURPOSE OF REVIEW: This review summarizes the evidence of the effectiveness of progesterone on the rate of preterm birth and evaluates the most recent studies. RECENT FINDINGS: The incidence of preterm delivery is about 7-11% of all pregnant women and preterm birth is one of the most important causes of neonatal morbidity and mortality. Interventions to reduce such complications have been attempted for several years. Most efforts so far have been tertiary interventions, such as treatment with antenatal corticosteroids, tocolytic agents, and antibiotics. Some of these measures have reduced perinatal morbidity and mortality, but the incidence of preterm birth is increasing. Recently, researches have suggested prophylactic progesterone could reduce the preterm birth rate in a select group presenting previous preterm birth and a short cervical length by transvaginal scan at mid-trimester pregnancy. SUMMARY: This review intends to define the current indication for administration of progesterone for pregnant women. On the basis of current knowledge, progesterone should be offered to women with a documented history of a previous spontaneous birth at less than 37 weeks and for those found to have a short cervical length of 15 mm or less. Studies are needed to evaluate progesterone efficacy on other risk factors.

Avaliação da influência de cesárea prévia na técnica de histerectomia laparoscópica / Assessment of previous cesarean section influence on laparoscopic hysterectomy technique

Objetivo: Avaliar a influência da cesárea prévia na realização da histerectomia laparoscópica. Métodos: Foram analisados retrospectivamente 253 prontuários de pacientes submetidas à histerectomias laparoscópicas realizadas no período de janeiro de 2000 a janeiro de 2006. Rresultados: Foram realizadas 153 histerectomias totais (60,5%), sendo 84 (54,9%) com cesárea prévia e 69 (45,1%) sem. Dos cem casos de histerectomias subtotais (39,5%), 53 (53%) tinham cesárea prévia e 47 (47%) não. Cconclusões: A cesárea prévia não aumentou a incidência de histerectomia subtotal laparoscópica.

Dismenorréia e endométrio / Dysmenorrhea and endometrium

A dismenorréia caracteriza-se por dor intensa, sob forma de cólica, durante a menstruação, manisfestando-se habitualmente no baixo ventre ou região lombar. É causa de substanciosos prejuízos econômicos devido à perda de horas de trabalho e/ou diminuição na produtividade das mulheres acometidas. A dismenorréia primária, diferente da secundária, não está associada a uma doença orgânica pélvica, mas certamente a um processo patogênico em nível bioquímico. O objetivo deste trabalho é, a partir de levantamento bilbiográfico (base de dados PUBMED-MEDLINE), avaliar a literatura médica sobre a relação entre a dismenorréia e o endométrio. Muitas linhas de evidências destacam o endométrio como responsável pela dismenorréia, devido ao aumento na produção e secreção de prostanóides e também pelo desbalanço entre seus componentes (prostaglandinas, leucotrienos, tromboxanos e prostaciclinas). Alterar a síntese e/ou o metabolismo dessas substâncias ou, ainda, excisar o endométrio por histeroscopia cirúrgica proporcionam melhora da dismenorréia.

Passagem de células endometriais para a cavidade peritoneal durante histeroscopia diagnóstica / Dissemination of endometrial cells into the peritoneal cavity during diagnostic hysteroscopy

OBJETIVO: avaliar a passagem de células endometriais para a cavidade peritoneal durante histeroscopia diagnóstica. MÉTODOS: estudo descritivo, prospectivo, envolvendo 61 pacientes sem afecção endometrial maligna e 15 com câncer do endométrio. Duas amostras de lavado peritoneal foram colhidas, uma antes (LP-1) e outra (LP-2), imediatamente após a realização da histeroscopia diagnóstica. A passagem para a cavidade peritoneal foi definida como a presença de células endometriais no LP-2, devendo tais células estarem ausentes no LP-1. Utilizou-se histeroscópio com 5 mm de diâmetro (Storz). O meio de distensão foi o CO2 com pressão de fluxo de 80 mmHg controlada eletronicamente. O LP foi fixado em álcool absoluto (1:1). As lâminas foram preparadas pelo método de Papanicolaou e todas as leituras feitas pelo mesmo observador. RESULTADOS: foram excluídas quatro pacientes (5,26 por cento) por apresentarem células endometriais no LP-1, sendo duas em cada grupo. Nas 72 restantes, não houve passagem de células para a cavidade peritoneal. No grupo sem afecção maligna endometrial, 88,1 por cento (52/59) apresentaram endométrio secretor, com correlação de 80 por cento entre o diagnóstico histeroscópico e a biópsia do endométrio. No grupo com afecção maligna endometrial, a maioria das pacientes encontrava-se no estádio I (92,3 por cento). A correlação entre histeroscopia/biópsia endometrial e exame anatomopatológico da peça cirúrgica foi de 100 por cento. CONCLUSÕES: a realização de histeroscopia diagnóstica com CO2 e pressão de fluxo de 80 mmHg não determinou passagem de células endometriais para a cavidade peritoneal em ambos os grupos, sugerindo que a histeroscopia é método seguro nas pacientes com suspeita de câncer endometrial.

PURPOSE: to evaluate the spreading of endometrial cells to the peritoneal cavity during diagnostic hysteroscopy. METHODS: a prospective, descriptive study involving 76 patients divided in two groups: one with 61 patients without malignant endometrial cancer, and the other with 15 patients with endometrial cancer. Two samples of peritoneal fluid were collected, one before (PF-1) and the other immediately after (PF-2) the diagnostic hysteroscopy. Spread to the peritoneal cavity was defined by the presence of endometrial cells in PF-2, with the absence of such cells in PF-1. The 5 mm diameter Storzs hysteroscopy was used. Distention was obtained by CO2 with electronically controlled flow pressure of 80 mmHg. The PF was fixated in absolute alcohol (ratio1:1). The PF samples were centrifuged and aliquots were smeared and stained using the Papanicolaou method. Analyses were performed by the same observer. RESULTS: during the study, four patients (5.26 percent) were excluded for presenting endometrial cells in PF-1. In the remaining 72 patients, there was no spread of cells to the peritoneal cavity. In the non-endometrial cancer group, 88.1 percent (52/59) presented secretory endometrial phase, with correlation of 80 percent between the hysteroscopy and the biopsy. In the group with endometrial cancer, most of the patients were in stage I (92.3 percent). There was a 100 percent correlation between the hysteroscopy/biopsy and histopathology of the surgical sample. CONCLUSIONS: the diagnostic hysteroscopy with CO2 at flow pressure of 80 mmHg did not cause spread of endometrial cells to the peritoneal cavity in both groups, thus suggesting that the diagnostic hysteroscopy is safe for patients at high risk for endometrial cancer.

Estudo comparativo entre o diagnóstico histeroscópico e o anatomopatológicode pacientes com sangramento uterino anormal, na menacme / Comparative study between the hysteroscopic and histological diagnosis of patients with abnormal uterinebleeding during menacme

O objetivo deste trabalho foi avaliar a exeqüibilidade e as propriedades diagnósticas da histeroscopia em uma população de pacientes com queixa de sangramento uterino anormal, namenacme, comparando os achados endoscópicos com os resultados dos exames anatomopatológicos. Foram analisados de maneira retrospectiva os resultados de 314 histeroscopias, realizadas em igual número de pacientes, no ambulatório sem necessidade de internação hospitalar. Fez-se em todas as pacientes biópsia endometrial orientada, com cureta de Novak de 3 ou de 5 mm. Os histeroscópios utilizados foram de3 ou de 5 mm de calibre com visualização da imagem em monitorde televisão por endocâmera. Os resultados do exame histeroscópico foram comparados com os achadosanatomopatológicos. Em 151 (48%) das pacientes não foi detectada qualquer afecção da cavidade do útero. A alteração mais freqüentemente encontrada foi o miomasubmucoso em 45 (14,3%) casos. Diagnosticou-se malignidade em nove pacientes, com confirmação anatomopatológica em sete. Para a detecção de anormalidades da cavidade do útero, a sensibilidade e a especificidade da histeroscopia foram,respectivamente, 86,4% e 75,9%. Para o diagnóstico de malignidade, foram de 100% e 99,3% e, para o diagnóstico dehiperplasias endometriais, de 57,7% e 88,5%. Em 5 (6,6%) pacientes o exame histeroscópico não pôde ser realizado devido à estenose do canal do colo. Em 2% houve reações vagais, como sudorese, náuseas e tonturas, com recuperação após alguns minutos. A histeroscopia diagnóstica deve ser somada ao exame anatomopatológico da biópsia endometrial para aferir ao método mais sensibilidade e especificidade. Estaconduta deve ocupar lugar privilegiado na propedêutica das pacientes na menacme com queixa clínica de sangramento uterino anormal.

Cólera em Joäo Pessoa / Cholera in Joäo Pessoa

Analisamos prelinamente a incidência de cólera no município de Joäo Pessoa, no ano de 1994, perfazendo um total de 138 casos através de levantamento epidemiológico realizado na Secretaria de Saúde do Município de Joäo Pessoa. Descrevemos os dados segundo a localizaçäo dos casos, a sua distribuiçäo no tempo e atributos pessoais. Observamos uma relaçäo da ocorrência de casos da doença com o período de chuva e aumento da sensibilidade do sistema de informaçöes (adoçäo do critério clínico-epidemiológico). Verificamos uma diminuiçäo de casos provavelmente decorrentedas açöes educativas e de medidas de controle efetivadas pela Comissäo Municipal de Prevençäo da Cólera

Aspectos epidemiológicos e genéticos da acne vulgar em universitários de Joäo Pessoa - PB / Epidemiological and genetic aspects of acne vulgaris in university of Joäo Pessoa - PB

Os autores analisaram os aspectos genéticos e epidemiológicos da acne vulgar num grupo de 2.170 jovens da faixa etária de 17 a 25 anos e verificaram que a incidência de acne vulgar foi 39,9// e que os aspectos genéticos desta enfermidade säo bastante significantes