Pessary use for conservative treatment of pelvic organ prolapse: literature review

INTRODUÇÃO: O prolapso de órgãos pélvicos (POP) sintomático afeta a qualidade de vida (QV) das mulheres e demanda tratamento. Por ser mais prevalente em pacientes idosas seu tratamento cirúrgico pode ser limitado por contraindicações clínicas ou desejo da paciente por um tratamento conservador; e por isso estas pacientes poderão se beneficiar com o uso de pessários. OBJETIVO: analisar os trabalhos publicados referentes ao impacto na qualidade de vida (QV) das mulheres com POP através do tratamento com pessário, bem como os fatores descritos como risco para o insucesso deste método. MÉTODO: revisão bibliográfica utilizando as Bases de Dados Scientific Electronic Library On-line (SciELO) e PubMed®, com os termos “pelvic organ prolapse, pessary and quality of life” publicados entre janeiro de 2011 a dezembro de 2016. RESULTADO: Os estudos mostram que o tratamento com pessário apresenta boa evolução, melhorando a sintomatologia causada pelo prolapso, semelhantes às pacientes que foram submetidas à tratamento cirúrgico. Os questionários para avaliação de QV utilizados foram diversificados, mas todos observaram melhora. CONCLUSÃO: o tratamento conservador com pessário é uma opção viável para mulheres com POP mesmo em estadio avançado, mas é mais utilizado naquelas nas quais há contraindicação para tratamento cirúrgico.INTRODUCTION: Symptomatic pelvic organ prolapse (POP) affects the quality of life (QoL) of women and requires treatment. Because it is more prevalent in elderly patients, its surgical treatment may be limited by clinical contraindications or the patient’s desire for conservative treatment. These patients may, therefore, benefit from the use of pessaries. PURPOSE: to analyse the published studies concerning the impact on the quality of life (QoL) of women with POP through the use of pessary treatment, as well as the risk factors arising from the failure of this method. METHOD: bibliographic review using the Scientific Electronic Library Online (SciELO) and PubMed® databases, using the terms “pelvic organ prolapse, pessary and quality of life”, published between January 2011 and December 2016. RESULT: The studies show that treatment using a pessary reports good progress, improving the symptomatology caused by the prolapse, and this result is similar to patients who underwent surgical treatment. The questionnaires for the evaluation of QoL used were diverse, but all observed improvement. CONCLUSION: conservative pessary treatment is a viable option for women suffering from POP, even at an advanced stage of POP, but a pessary is more commonly used by those in whom there is contraindication to surgical treatment

Juridical perspectives of interruption of pregnancy with zika virus infection regarding medical, emotional and social consequences

 Uganda and isolated in humans in 1952 in the same country. Up to 2007 there were few cases of human infection in African and Asian countries. The first outbreak of the Zika virus occurred in Brazil in 2015, becoming a serious public health problem due to the increase in the number of cases of microcephaly in infected pregnant women. Objective: To describe the legal abortion at Zika virus infection during pregnancy regarding medical, emotional and social consequences. perspectives of abortion for the pregnant woman with Zika virus regarding the medical, emotional and social consequences. Methods: This is a documentary study based on documents about abortion and its outcomes in Brazil. Technical norms, textbooks, indexed articles of Scopus and PubMed, documents extracted from international human rights treaties and conventions, and legal documents on the subject were used. It was decided to direct the text based on the experiences of each theme on abortion and its outcomes in Brazil, with a synthesis of the current scenario. Results: Recognizing the exceptional nature of this situation, it is sought to confer an interpretation according to the Constitution and Article 128 of the Criminal Code, based on an analogical application, which seeks to protect the physical and mental health of women infected by the Zika virus. It is possible to qualify the practice of abortion in these circumstances as atypical conduct by the state of necessity, excluding the unlawfulness by comparing with articles 23, I and 24 of the Penal Code. Conclusion: Authorizing the termination of pregnancy after diagnosis of the virus Zika guarantees women the free exercise of their reproductive rights, which is not confused with state imposition of abortion or eugenic practice.  Introduction: The Zika virus was identified in 1947 in Rhesus monkeys in the Republic of Uganda and isolated in humans in 1952 in the same country. Up to 2007 there were few cases of human infection in African and Asian countries. The first outbreak of the Zika virus occurred in Brazil in 2015, becoming a serious public health problem due to the increase in the number of cases of microcephaly in infected pregnant women. Objective: To describe the legal abortion at Zika virus infection during pregnancy regarding medical, emotional and social consequences. perspectives of abortion for the pregnant woman with Zika virus regarding the medical, emotional and social consequences. Methods: This is a documentary study based on documents about abortion and its outcomes in Brazil. Technical norms, textbooks, indexed articles of Scopus and PubMed, documents extracted from international human rights treaties and conventions, and legal documents on the subject were used. It was decided to direct the text based on the experiences of each theme on abortion and its outcomes in Brazil, with a synthesis of the current scenario.  Results: Recognizing the exceptional nature of this situation, it is sought to confer an interpretation according to the Constitution and Article 128 of the Criminal Code, based on an analogical application, which seeks to protect the physical and mental health of women infected by the Zika virus. It is possible to qualify the practice of abortion in these circumstances as atypical conduct by the state of necessity, excluding the unlawfulness by comparing with articles 23, I and 24 of the Penal Code.  Conclusion: Authorizing the termination of pregnancy after diagnosis of the virus Zika guarantees women the free exercise of their reproductive rights, which is not confused with state imposition of abortion or eugenic practice.

A liminar do STF sobre aborto em casos de anencefalia: onde estamos e para onde deveríamos ir?

Trata do aborto de anencéfalos e como o tema vem sendo tratado no Brasil. Aborda a legislação em outros países sobre o tema, afirmando que a maioria teve sua legislação adaptada à moderna técnica de diagnóstico intra-uterino ainda na década de 70

A case of prenatal diagnosis of fetal hydantoin syndrome by ultrasound

Fetal hydantoin syndrome (FHS) is a set of disruptions occasionally present in fetuses exposed in utero to phenytoin or other anticonvulsants. Administration of phenytoin in early pregnancy may impair proper psychomotor performance expected for children's development. Several combined phenotypic markers delineate the syndrome, but the presence of single clinical signs is more common. There is controversy about the etiology of FHS. Associated disruptions may be related to a deficiency in a detoxifying enzyme (epoxide hydrolase), vascular problems, and/or factors not yet known. Genetic causes are believed to influence susceptibility to the drug. This text reports an unusual pattern of malformations detected in an ultrasound scan (gastroschisis, sacral meningomyelocele, and absence of the right lower limb) and in the anatomopathological study (left-side gastroschisis, sacral meningomyelocele, scoliosis, left clubfoot, absence of the right lower limb, and pectus carinatum) of a fetus whose mother took phenytoin. These defects may have been provoked by exposure to the drug during embryogenesis. In view of similar malformations observed in cases of prenatal exposure to cocaine, a recognized vasoconstrictor, it is suggested that vascular disruptions of hemodynamic origin constituted the event leading to some of the anomalies caused in the developing embryo. A complication of the chorionic villus sampling procedure, used for cytogenetic analysis, is another possibility

Hibridación in Situ por Fluorescencia (Fish) en Muestras de Líquido Amniótico Obtenido por Amniocentesis Precoz

Fluorescent in situ hybridization can be used to diagnose prenatally the most frequent aneuploidies. Nucleic from non-cultivated fetal cells are used. This is an important advance in prenatal diagnosis. We describe the application of FISH in 15 non-cultivated amniotic fluid samples collected between 12 ± 5/7 and 14 6/7 weeks (m ± 1 s.d. = 13.63 ± 0,52). Amniotic fluid volume ranged from 2 to 4 ml (3,16 ± 0.58). All indications were advanced maternal age. The time to obtain the results ranged from 1 to 5 days (2.13 ± 1.55 days). The times to deliver the cytogenetic results ranged from 13 to 22 days (18.4 ± 3.2). In total, 14 cases (93.33%) were informative. The five aneuploidies diagnosed by FISH were confirmed after the traditional cytogenetic analysis. However, the cytogenetic analysis identified one balanced chromosomal rearrangement [46,XY,t(16;17)(q24;q12)pat] and a case of mosaicism 46.XX/47.XX,+mar. Conducting FISH requires many steps that may prevent results from being obtained; the most important of these steps is to obtain an enough number of nucleic for hybridization. We conclude that the study of aneuploidies in non-cultivated amniocytes should be introduced to the prenatal diagnosis protocol in pregnant women with an increased risk of conceiving an aneuploid fetus.La hibridación in situ por fluorescencia (FISH) se puede utilizar para diagnosticar prenatalmente las aneuploidías más frecuentes. Se utilizan núcleos interfásicos de células fetales no cultivadas. Este es un avance importante en el diagnóstico prenatal. Se describe la aplicación de la FISH en 15 muestras de líquido amniótico no cultivado extraído entre la 12 ± 7.5 y 14 6/7 semanas de gestación (m ± 1 sd = 13,63 ± 0,52). El volumen de líquido amniótico recolectado oscilo entre de 2 y 4ml (3,16 ± 0,58). Todas las pacientes presentaban como principal indicación para la realización del procedimiento la edad materna avanzada. El tiempo para obtener los resultados varió de 1 a 5 días (2,13 ± 1,55 días). El tiempo de entrega de los resultados citogenéticos osciló entre 13 y 22 días (18,4 ± 3,2). En total, 14 casos (93,33%) fueron informativos. Las cinco aneuploidías diagnosticadas por FISH fueron confirmadas por citogenética tradicional, sin embargo, el análisis citogenético tradicional identificó un caso de rearreglo cromosómico equilibrado: [46, XY, t (16; 17) (q24; q12) pat] y un caso de mosaicismo: 46,XX/47,XX,+mar. La realización de FISH requiere muchos pasos que pueden impedir que los resultados sean obtenidos, es importante obtener un número suficiente de núcleos para la hibridación. El estudio de aneuploidías en amniocitos no cultivados debe ser introducido en el protocolo de diagnóstico prenatal en mujeres embarazadas con riesgo aumentado de concebir un feto con aneuploidias

Amniocentesis Precoz: Estudio Citogenético en 505 Embarazadas

Cytogenetic diagnosis in amniotic fluid after early amniocentesis is an alternative to woman in the first trimester of pregnancy. The aim of this study was to ascertain the type and frequency of chromosomal aberrations in amniotic fluid samples collected after early amniocentesis (EA). In the period of five years, 531 EA were carried out in 505 patients (479 single and 26 multiple gestations) the gestational age of whom varied between 12 + 0/7 - 14 + 6/7 weeks + days. The main indication for offering the procedure was advanced maternal age (66.3% cases). Cultures were established in Chang or Amniomax media, using flask incubation. The time to obtain the cytogenetic preparations ranged from 7 to 22 days (15,5± 2.8m ±s.d.). At least 25 cells were analyzed per patient. The time to provide the cytogenetic results ranged from 12 to 25 days (18.7± 2.8 days, m ±s.d). The culture success rate was 98.7%. Abnormal karyotypes were identified in 22 cases (4.2%); three (0.6%) of these were balanced and 19 (3.6%) were unbalanced chromosomal rearrangements. The most frequent unbalanced chromosomal aberration was trisomy 21 (27.3%). Five cases of marker chromosomes were identified, three of which were mosaic. Six abnormal results found in chorionic villus sampling were confirmed. The frequency of pseudomosaicism was 2.3%. Our data confirm the accuracy of cytogenetic studies on amniotic fluid collected through EA. When established routine procedures and standardized protocols are used, the incidence of culture success increases significantly, and the mean time to deliver the results decreases.El diagnóstico citogenético en líquido amniótico obtenido por amniocentesis precoz (AP) es una alternativa a la embarazada de primer trimestre. El objetivo de este trabajo fue investigar el tipo y la frecuencia de anormalidades cromosómicas encontradas en muestras de líquido amniótico obtenido por medio de esa técnica de colecta. En un periodo de 5 años, 531 AP fueron realizadas en 505 pacientes (479 gestaciones únicas y 26 gemelares), con edad gestacional variando de 12 0/7 a 14 6/7 semanas. La principal indicación para la realización del procedimiento fue edad materna avanzada (66,3% de los casos). Los cultivos fueron establecidos en medio Chang y Amniomax (cultivo en frasco). El tiempo de colecta para la obtención de las preparaciones citogenéticas varió de 7 a 22 días (15,5 ± 2,8). Por lo menos 25 células fueron analizadas por paciente. El tiempo de entrega de resultados varió de 12 a 25 días (18,7±2,8 días). La frecuencia de éxito de cultivo fue del 98,7%. Cariotipos anormales fueron identificados en 22 casos (4,2%), siendo tres (0,6%) rearreglos cromosómicos equilibrados y 19 (3,6%) anomalías cromosómicas no equilibradas. De estas, la anormalidad cromosómica más frecuente fue la trisomía del cromosoma 21 (27,3%). Fueron identificados cinco casos de cromosomas marcadores, tres en forma de mosaico. Fueron confirmados seis (18,2%) resultados anormales detectados en Vellosidad Corial (VC). La frecuencia de pseudomosaicismo encontrada fue del 2,3%. Nuestros datos confirman la precisión del estudio citogenético en líquido amniótico obtenido por AP. Con procedimientos de rutina bien establecidos y protocolos adecuadamente estandarizados en el laboratorio de diagnóstico prenatal, se aumenta el éxito de los cultivos de células de líquido amniótico obtenido por AP y se reduce el tiempo medio de entrega de resultados

Diagnóstico pré-natal de seqüestração pulmonar: apresentação de um caso

A seqüestração broncopulmonar consiste em massa de tecido pulmonar anormal que usualmente não mantém comunicação com a árvore traqueobrônquica e cujo suprimento sangüíneo deriva-se da circulação sistêmica, na maior parte das vezes da aorta. Por tratar-se de malformação muito rara, nem sempre é lembrada como possibilidade diagnóstica. Apresentamos o relato de um caso de seqüestração broncopulmonar ressaltando a importância da dopplervelocimetria para o seu diagnóstico ao identificar a artéria originária da aorta descendente irrigando a seqüestração. Apresentamos também o aspecto evidenciado pela ultra-sonografia tridimensional