Associação entre temperatura ambiental e hipertensão arterial em primigestas

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Midline supraumbilical incision as an option for morbidly obese patients? : case report

Background: Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach. Aim: To discuss different approaches to abdominal incision in cesarean section in obese patients. Case presentation: Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications. Conclusion: It’s important to evaluate and chose the best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage

Infecção pelo papiloma vírus humano (HPV)

Infection by the human papillomavirus (HPV) is a prevalent case of infection and is frequently the reason for complaints in Gynecology services as well as in those of other branches of specialization, such as Dermatology, Urology, and Proctology. The objective of this study is to contribute to the understanding of this viral agent, which is fundamental for both the control and eradication of other sexually transmitted diseases, including infection by the HIV, and the control of collum cancer, a common neoplasia, especially in developing countries such as Brazil.A infecção pelo HPV é extremamente prevalente e transformou-se em queixa freqüente tanto na prática ginecológica como em outras especialidades, como dermatologia, urologia e proctologia. O objetivo deste trabalho é esclarecer sobre este agente viral. A compreensão de sua importância é fundamental tanto para o controle e erradicação de outras doenças sexualmente transmissíveis, entre as quais a infecção pelo HIV, quanto para o controle do câncer de colo uterino, uma neoplasiaa freqüente, principalmente em países em desenvolvimento, como é o caso do Brasil.

Hereditary angioedema in pregnancy and management without recombinant human C1-INH

A pregnant woman diagnosed with type 1 angioedema seeks care at a public hospital for planning the delivery. This report presents ways to prevent and manage an acute HAE crisis during childbirth and early postpartum without the availability of first-line medications, such as plasma-derived human C1-INH concentrate

Avaliação dos programas de screening para o câncer de colo uterino no Estado do Rio Grande do Sul

OBJECTIVE: To compare two modalities of cervical cancer screening using Pap Smearthat were carried out in the state of Rio Grande do Sul - Southern Brazil. The first oneis a seasonal and isolated campaign that was promoted by the Brazilian Ministry ofHealth in 1998; the second one is a regular screening program promoted by the RioGrande do Sul State Department of Health from 1991 to 1996. MATERIAL AND METHODS: We carried out a retrospective study of the results of thetwo screening campaigns.RESULTS: Comparison of the Pap smear sample alterations verified from 1991 to 1996by the State Department of Health with the Pap smear sample alterations verified in1998 by the Ministry of Health allowed for the following data, respectively: CIN 1 -0.55%/0.29%; CIN 2 - 0.25%/0.15%; CIN 3 - 0.16%/0.14%; carcinoma - 0.04%/0.04%.Out of the samples collected by the State Department of Health, 58.64% were notrepresentative for squamous columnar junction (SCJ), out of which 13.74% of highgrade lesions were not representative for SCJ and 85.22% of high-grade lesions wererepresentative for ECJ (1.04% of results were ignored).CONCLUSIONS: The isolated campaign of the Brazilian Ministry of Health in the stateof Rio Grande do Sul presented poorer results when compared to the regular screeningprogram promoted by the Rio Grande do Sul State Department of Health, suggesting,thus, that isolated screening efforts do not offer results that are as good as those ofplanned and continuous screening programs. However, the regular screening programhas faults that need to be corrected, such as that in the reduced number of Pap smearsamples representative of squamous columnar junction.  OBJETIVO: Comparar duas modalidades de screening de câncer de colo uterino porexame citopatológico (CP) desenvolvidas no Estado do Rio Grande do Sul: uma, sazonale isolada, promovida pelo Ministério da Saúde em 1998; outra, regular, promovida pelaSecretaria da Saúde do Estado do Rio Grande do Sul no período de 1991 a 1996.MATERIAIS E MÉTODOS: avaliou-se retrospectivamente os resultados obtidos com acoleta de exames citopatológicos de colo uterino da campanha do Ministério da Saúdee do programa regular da Secretaria da Saúde do Estado do Rio Grande do Sul.RESULTADOS: Comparando-se o percentual de alterações nos exames coletados pelaSecretaria da Saúde em 1996 com os exames coletados pelo Ministério da Saúde em1998, obteve-se, respectivamente: NIC I - 0,55% / 0,29%; NIC II - 0,25% / 0,15%; NICIII - 0,16% / 0,14%; carcinoma - 0,04% / 0,04%. Quanto aos exames coletados pelaSecretaria da Saúde no período 1991-1996, 58,64% não eram representativos da junçãoescamo-colunar (JEC). Sobre estes, somente 13,74% das lesões de alto grauencontravam-se em CPs não representativos da JEC, enquanto 85,22% das lesões dealto grau encontravam-se nos CPs representativos da JEC (1,04% dos resultadosignorados).CONCLUSÕES: A campanha sazonal do Ministério da Saúde no Rio Grande do Sulapresentou desempenho desfavorável quando comparada ao programa regular daSecretaria da Saúde, sugerindo que rastreamentos isolados tenham eficácia menorque rastreamentos planejados e contínuos. O próprio rastreamento regular possui falhasque devem ser corrigidas, como a baixa representatividade da junção escamo-colunar

Fertilização in vitro e vasa previa : relato de dois casos

Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks þ 4 days of gestation, without complications. A 36-yearold primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks þ 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.Vasa previa (VP) é uma condição obstétrica perigosa associada a mortalidade e morbidade perinatais. Fertilização in vitro (FIV) é um fator de risco para VP devido à alta incidência de placentação anormal. O diagnóstico deve ser realizado no período pré-natal, pois a possibilidade de mortalidade fetal é extremamente elevada. Relatamos dois casos para demonstrar a acurácia da ultrassonografia transvaginal no diagnóstico pré-natal de VP. Mulher caucasiana, primigesta, de 40 anos, submetida a FIV, foi diagnosticada com VP na 29ª semana de gestação e hospitalizada para observação na 31ª semana de gestação. A paciente foi submetida à cesariana eletiva com 34 semanas e 4 dias, sem complicações, com recém-nascido do sexo masculino, pesando 2.380 g, e com Apgar de 10 no 5° minuto. Mulher caucasiana, primigesta, de 36 anos, subetida a FIV, foi diagnosticada com placenta prévia, placenta bilobada, acretismo placentário e VP. Cordão umbilical com inserção velamentosa. A paciente foi hospitalizada para observação na 26ª semana de gestação. Foi submetida à cesariana de emergência com 33 semanas e 4 dias por sangramento vaginal. O recém nascido do sexo feminino pesou 2.140 g, com Apgar de 9 no 5°minuto. O diagnóstico de VP no período pré-natal associou-se a um desfecho favorável nos dois casos, corroborando observações anteriores de que a FIV é um fator de risco para VP e de que todas as gestações por FIV deveriam ser avaliadas por ultrassonografia transvaginal

Acute generalized exanthematous pustulosis during puerperal period induced by azithromycin : case report

Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics

Correlation between late cord clamping and phototherapy and other neonatal unfavorable outcomes : a randomized clinical trial

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia; however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping < 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate

Female sexual function after surgical treatment of urinary incontinence

Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery