Variação de peso em usuarias de sistema intra-uterino liberador de levonorgestrel, acetato de medroxiprogesterona de deposito e dispositivo intra-uterino de t-cobre por cinco anos

Orientador: Ilza Maria Urbano Monteiro, Luis Guillermo BahamondesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O objetivo deste estudo foi determinar a variação de peso corpóreo em mulheres brasileiras usuárias de sistema intra-uterino liberador de 20µg/dia de levonorgestrel (SIU-LNG, Mirena®) e compará-la com a variação de peso de usuárias de dispositivo intra-uterino T cobre 380A (DIU Tcu) e usuárias de acetato de medroxiprogesterona de depósito (AMP-D) ao longo de cinco anos. Foram analisadas 163 mulheres usuárias de SIU-LNG que tiveram a inserção do mesmo em 1998 durante a admissão para o estudo. Cada mulher foi pareada por peso (± 1kg) e por idade (± 1 ano) no início do estudo, com as usuárias de DIU Tcu e AMP-D. Todas as mulheres foram seguidas por até cinco anos. Nesse período foram medidos seus pesos e calculados os índices de massa corpóreos. A média de idade das usuárias de SIU-LNG foi 27 ± 6,7 anos, enquanto que das usuárias de DIU Tcu foi 28 ± 6,6 anos e das usuárias de AMP-D foi de 26,9 ± 6,5 anos. O peso inicial era 62,9 ± 0,8kg, 62,8 ± 0,8kg e 62,5 ± 0,9kg para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente. O IMC no início do estudo era 25,0 (± 0,3), 26,4 (± 0,3) e 25,5 (± 0,4) para as usuárias de SIU-LNG, DIU Tcu e AMP-D respectivamente. Foi observado um aumento de peso de 3,1kg, 4,9kg e 8,2kg para as usuárias de SIU-LNG, DIU Tcu e AMP-D, respectivamente, ao final do quinto ano (p = 0,009). O IMC também apresentou um aumento em todos os grupos (IMC final de 26,3 ± 0,7, 28,5 ± 0,8 e 28,7 ± 1,3 para as usuárias de SIU-LNG, DIU Tcu e AMPD respectivamente). A análise multivariada mostrou que o uso de AMP-D e seu tempo de uso foram significativos em relação ao ganho de peso. Em conclusão, o uso de SIU-LNG não mostrou aumento significativo no ganho de peso ao longo dos cinco anos, berm como diferença na variação de peso quando comparado com o uso de DIU TcuAbstract: The objective of the study was to assess the weight variations in Brazilian users of the 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®) and to compare them to a cohort of users of the TCu 380A intrauterine device (IUD) and to another cohort of users of the injectable contraceptive, depot-medroxyprogesterone acetate (DMPA) during five years of use. A total of 163 users of the LNG-IUS, who had the device inserted in 1998, were admitted to the study. Each woman was matched by weight (± 1kg) and age (± 1year) at the time of enrollment to a woman using a TCu 380A IUD and to another woman using DMPA. All women were followed up for a maximum of 5 years. Weight was measured yearly during five years and the body mass index (BMI,kg/m2) was calculated. The age of the LNG-IUS users was 27.0 ± 6.7 years (mean ± SD), while the age of the copper IUD users was 28.0 ± 6.6 years and that of DMPA users was 26.9 ± 6.5 years. The weight recorded at the beginning of the study was 62.9 ± 0.8kg, 62.8 ± 0.8kg, and 62.5 ± 0.9kg (Mean ± SD) for users of the LNG-IUS, the copper IUD, and DMPA, respectively. The BMI of women at the beginning of the study was 25.0 (±0.3), 26.4 (±0.3), and 25.5 (±0.4), (Mean ± SD), for users of the LNG-IUS, copper IUD, and DMPA, respectively. Increases in weight of 3.1kg, 4.9kg and 8.2kg were observed in the fifth year among users of the LNG-IUS, copper IUD, and DMPA, respectively (p = 0.009). Increase in BMI was observed among all the groups too (BMI at the end was 26.3 ± 0.7, 28.5 ± 0.8 and 28.7 ± 1.3 for users of the LNG-IUS, copper IUD and DMPA, respectively). Multivariate analysis showed that the time of use of the contraceptive method and the use of DMPA were significantly associated with weight increase. In conclusion, the use of a LNG-IUS resulted in no significant weight increase during the 5 years of use and the difference in weight was of the same magnitude as that of copper IUD usersMestradoTocoginecologiaMestre em Tocoginecologi

Sucesso no tratamento conservador da gravidez ectópica em cicatriz de cesárea

AbstractImplantation of a pregnancy within a cesarean delivery scar is considered to be the rarest form of ectopic pregnancy, with a high morbidity and mortality. Pregnancy in a cesarean delivery scar may cause catastrophic complications which may result in hysterectomy and compromise the reproductive future of a woman. We report a case that was treated conservatively with success

Prevalence Of Uterine Synechia After Abortion Evacuation Curettage.

Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. The prevalence of IUA was 37.6%. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1%) presented IUA grade I. In the present study, 37.6% of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.125261-

Comparação do ultrassom transvaginal e da histeroscopia ambulatorial no diagnóstico das doenças endometriais em mulheres menopausadas

OBJETIVO: Comparar a eficácia do ultrassom transvaginal e da histeroscopia diagnóstica ambulatorial no diagnóstico das doenças intrauterinas em mulheres menopausadas. MÉTODOS: Foram selecionadas 243 mulheres menopausadas que se submeteram a uma histeroscopia diagnóstica no ano de 2006. Todas essas mulheres vieram encaminhadas da rede básica de saúde após terem realizado um ultrassom transvaginal para avaliar a cavidade endometrial. RESULTADOS: As mulheres tinham em média 61±9,4 anos e encontravam-se na menopausa em média há 11±8,3 anos. Observamos 6,6% de casos de hiperplasia endometrial e câncer de endométrio. O ultrassom apresentou uma sensibilidade de 95,6%, uma especificidade de 7,4%, um valor preditivo positivo de 53,3% e valor preditivo negativo de 60%, enquanto a histeroscopia apresentou 95,7%; 83%; 82,2% e 95,9%, respectivamente. CONCLUSÃO: A histeroscopia apresentou maior acurácia que o ultrassom no diagnóstico das doenças endometriais.OBJECTIVE: To compare the efficiency of transvaginal sonography and outpatient hysteroscopy in the diagnosis of intrauterine pathology in postmenopausal women. METHODS: Two-hundred and forty-three postmenopausal women were selected. All women had undergone outpatient hysteroscopy in the year 2006. These women were referred from the Basic Healthcare Units in Campinas, where they underwent ultrasonography for the evaluation of the endometrial cavity. RESULTS: The mean age of these women was 61±9.4 years. These women were menopausal for 11±8.3 years.. We observed 6.6% cases of endometrial hyperplasia and cancer. The ultrasonography had a sensitivy of 95.6%, a specificity of 7.4%, a positive predictive value of 53.3% and a negative predictive value of 60%, while the hysteroscopy had 95.7%, 83%, 82.2% and 95.9% respectively. CONCLUSION: Hysteroscopy was a more accurate method for the detection of intrauterine pathology than ultrasonography

Increasing the chances of natural conception: opinion statement from the the brazilian federation of gynecology and obstetrics associations - FEBRASGO - committee of gynecological endocrinology

Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception41318319