14 research outputs found
Screening and prevention of preterm birth: how is it done in clinical practice?
Get PDFAbstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings
The impact of the Covid-19 pandemic on the number of gynecological procedures and births in Brazil
Get PDFIntrodução: A pandemia da Covid-19 tem impactado os sistemas de saúde de diversas formas e, em última instância, gera colapso na atenção à saúde. Entre as medidas restritivas para contenção da disseminação da doença, inclui-se o cancelamento de procedimentos cirúrgicos eletivos, e o impacto na saúde da população ainda é incerto. Nosso estudo objetiva avaliar a influência da pandemia na redução de procedimentos cirúrgicos ginecológicos e obstétricos no Brasil. Métodos: Série temporal, descritiva, sobre o número de procedimentos ginecológicos e obstétricos realizados entre janeiro de 2016 e fevereiro de 2021 no Brasil. Os dados foram coletados diretamente de sites oficiais do governo brasileiro. Resultados: No ano de 2020, houve uma diminuição de 35% no número total de procedimentos ginecológicos realizados comparado aos anos anteriores e, em momentos críticos, a redução chegou a 50%. A redução foi mais acentuada nas regiões Nordeste e Sudeste. Quanto ao número de nascimentos, houve retração nos nascimentos no SUS e, no setor privado especificamente na Região Sudeste. Conclusão: A redução de 50% no volume de cirurgias ginecológicas no sistema público de saúde do Brasil é um dado de extrema relevância negativa em nosso sistema de saúde já sobrecarregado. A redução da natalidade foi evidente na região Sudeste do Brasil e, entre as classes sociais de mais baixa renda, ocorreu em todo o território nacional.Introduction: The Covid-19 pandemic has affected health systems in many ways, with a chance of breaking it. Among the restrictive measures to stop the disease’s dissemination there is the elective surgical procedures cancelling. This impact on the population’s health is uncertain. Our aim is to evaluate the influence of the pandemic in the gynecologic and obstetrics procedures reduction in Brazil. Methods: Time series of gynecological and obstetrics procedures between January 2016 and February 2021 in Brazil. The data were collected from Brazilian government official websites. Results: In the year of 2020 there was a 35% reduction in gynecologic procedures performed compared to the 4 past years and. At critical moments, the reduction was 50%. The most affected regions were Northeast and Southeast. The number of births has decreased in the public health system and, in the private system, we saw reduction specifically in the southeast area. Conclusion: The reduction of 50% in gynecologic surgeries in the Brazilian public health system is a relevant negative data in our already overwhelming public health system. The reduction in birth rates was evident in the Southeastern region of Brazil and, among the lowest income classes, occurred throughout the national territory
Uterine arteriovenous malformation acquired after cesarean section : a case report
Get PDFBackground: Uterine arteriovenous malformation (AVM) is a rare, potentially life-threatening cause of abnormal uterine bleeding that can be acquired following a cesarean section. The diagnosis is difficult, often misdiagnosed with retained products of conception and placenta accreta. Transarterial embolization (TAE) is an efficacious and effective method of treating AVM, particularly in patients of reproductive age. Case Report: A 41-year-old, nulliparous woman, started with a history of abnormal uterine bleeding 30 days after a cesarean section. She didn’t have anaemia and beta-human chorionic gonadotropin (beta-hCG) was negative. The transvaginal color Doppler ultrasound showed multiple vascular channels within myometrium showing colored mosaic patterns suggesting AVM, confirmed by Magnetic Resonance Imaging. The patient was referred to perform a Computed Tomography Angiography and right uterine artery embolization without any vascular complications. Conclusion: AVM is a rare consequence of cesarean section but has to be considered in cases of persistent uterine bleeding in the puerperium. Embolization is a safe and effective choice treatment of AVM and an alternative and less invasive option for patients wishing to preserve fertility
