Rev Bras Ginecol Obstet
· 2026 · PMID 41815926
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OBJECTIVE: This study aimed to characterize tricuspid valve sound signals in healthy fetuses during the first trimester of pregnancy using Doppler ultrasound and computational analysis. METHODS: A cohort of pregnant wome...OBJECTIVE: This study aimed to characterize tricuspid valve sound signals in healthy fetuses during the first trimester of pregnancy using Doppler ultrasound and computational analysis. METHODS: A cohort of pregnant women at 11-14 weeks of normal-risk gestation was assessed at the (IMIP) between December 2019 and May 2020. Eligible participants were over 18 years old with no pregnancy complications. Doppler recordings of the fetal tricuspid valve were obtained, and linear (wave duration) and non-linear analyses were performed, including approximate entropy (ApEn), Lempel-Ziv complexity (LZC), and detrended fluctuation analysis (DFA). Follow-up in the second trimester with a fetal medicine team and postnatal follow-up with physical examination by an experienced neonatology team confirmed normal cardiac results. RESULTS: Early diastolic (E) wave presented a mean duration of 70.89±9.26 ms, with ApEn 0.25±0.15, LZC 0.77±0.15, and DFA 0.73. Atrial contraction (A) wave had 79.77±7.56 ms, ApEn 0.25±0.15, LZC 0.77±0.19, and DFA 0.52. Systole showed 225.95±15.88 ms, ApEn 0.15±0.17, LZC 0.78±0.15, and DFA 0.75. Diastole had 150.66±13.99 ms, ApEn 0.18±0.11, LZC 0.83±0.22, and DFA 0.66. The full cardiac cycle lasted 376.61±16.40 ms, with ApEn 0.18±0.11, LZC 0.83±0.22, and DFA 0.81. The diastole/cardiac cycle ratio was 0.4±0.3, with ApEn 0.22±0.12, LZC 0.72±0.15, and DFA 0.62. CONCLUSION: This study offers a detailed characterization of tricuspid valve wave segments in healthy fetuses during early gestation. The integration of linear and non-linear analyses may enhance our understanding of fetal cardiac physiology. Further research is needed to evaluate whether these parameters can assist in the early detection of congenital heart diseases. We highlight the potential of these parameters for early screening of congenital heart disease and chromosomal abnormalities, while emphasizing the need for further studies to confirm their diagnostic value.
Behenck GS, Curtois F, El Beitune P
… +9 more, Jimenez MF, Vettorazzi J, da Silva MB, Muller B, Teixeira L, Longo C, Callado GY, Araujo Júnior E, Micheletti T
Rev Bras Ginecol Obstet
· 2026 · PMID 41815925
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OBJECTIVE: To characterize the maternal clinical, ultrasound, and laboratory parameters, maternal and perinatal outcomes of mirror syndrome, and to discuss the role of sFlt-1/PlGF biomarkers in diagnosis and management....OBJECTIVE: To characterize the maternal clinical, ultrasound, and laboratory parameters, maternal and perinatal outcomes of mirror syndrome, and to discuss the role of sFlt-1/PlGF biomarkers in diagnosis and management. METHODS: We conducted a case series including all cases of mirror syndrome diagnosed at a tertiary reference center in Brazil. Clinical, laboratory, ultrasound, and biomarker data were collected, along with maternal and perinatal outcomes. RESULTS: Nine cases of mirror syndrome were identified, with a mean gestational age at diagnosis of 27+6 weeks. The most frequent maternal findings were lower limb edema (n=7), hypertension (n=8), and proteinuria (n=8). Ultrasound demonstrated fetal hydrops (n=7), polyhydramnios (n=6), and placentomegaly (n=7). Laboratory abnormalities included abnormal proteinuria/creatinuria ratio in 5/8 women tested, elevated 24-hour proteinuria in all 5, anemia in 7, thrombocytopenia in 3, and elevated creatinine in 1. The sFlt-1/PlGF ratio was measured in 5 women; 4 had abnormal results, with 3 above 85, all of whom developed maternal complications or fetal death. Resolution occurred after a mean of 3.4±3.6 days, due to fetal death (n=3), delivery (n=5), or fetal surgery (n=1). In one monochorionic twin pregnancy complicated by twin-anemia-polycythemia sequence, biomarker normalization after intrauterine death of the hydropic twin allowed safe prolongation of the pregnancy and term delivery of the co-twin. CONCLUSION: Mirror syndrome should be suspected in pregnancies presenting with preeclampsia-like features in the setting of fetal hydrops or polyhydramnios. The sFlt-1/PlGF ratio may assist in differentiating mirror syndrome from preeclampsia and in identifying women at risk for adverse outcomes.
Fernandes I, Rodrigues CIS, Korkes HA
… +1 more, de Sampaio LF
Rev Bras Ginecol Obstet
· 2025 · PMID 41415712
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OBJECTIVE: Evaluate the application and effectiveness of the problem-based learning (PBL) teaching model in Obstetrics and Gynecology (OB/GYN) undergraduate education. DATA SOURCES: A systematic search was performed in f...OBJECTIVE: Evaluate the application and effectiveness of the problem-based learning (PBL) teaching model in Obstetrics and Gynecology (OB/GYN) undergraduate education. DATA SOURCES: A systematic search was performed in five electronic databases (LILACS, PubMed/MEDLINE, EMBASE, CINAHL, and Cochrane Library) for studies published between January 1, 2000, and December 31, 2021. The search strategy used descriptors in English, portuguese, and Spanish based on the PICO framework: "Education, Medical, Undergraduate" (P); "Problem-Based Learning", "Gynecology", and "Obstetrics" (I); no comparator (C); and "Patient Satisfaction" or "Knowledge" (O). Study selection: A total of 24 studies were included. Selection criteria encompassed original articles that evaluated the impact of PBL in OB/GYN undergraduate education, without language restrictions. DATA COLLECTION: Two independent reviewers extracted data regarding study characteristics, participant profiles, methodology, and outcomes. Discrepancies were resolved by consensus. DATA SYNTHESIS: Among the included studies,14(58.33) of them coming from Asian, most of them 16(66.66) having been published between the years 2006-2010 and 2016-2021. About 15(62.5) dealt only with students, the majority consisting of surveys/questionnaires 8(30) and non-randomized comparative studies 7(29.16). As for academic performance, 14(58.33) demonstrated that the PBL methodology is superior considering the ability to sediment information, and 8(30) indicated PBL is superior concerning developing clinical reasoning. Regarding student satisfaction, 11(45.83) of the studies indicated a positive experience with the method. CONCLUSION: The PBL model appears more effective than traditional teaching methods in enhancing clinical competence and student satisfaction in OB/GYN education. However, further well-designed studies are necessary to confirm these findings and guide educational strategies. PROSPERO REGISTRY: CRD42021282337.
Rev Bras Ginecol Obstet
· 2025 · PMID 41415710
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OBJECTIVE: To analyze the vaginal microbiota before and after the treatment with vaginal microablative fractional radiofrequency (FRAXX) and compare it with topical estriol treatment in women with GMS. METHODS: Pilot cli...OBJECTIVE: To analyze the vaginal microbiota before and after the treatment with vaginal microablative fractional radiofrequency (FRAXX) and compare it with topical estriol treatment in women with GMS. METHODS: Pilot clinical trial, double-blind, randomized, and placebo-controlled. Thirty women diagnosed with SGM were evaluated regarding the vaginal microbiota before and one month after the end of the treatment protocol, through culture, bacterioscopy by Gram and pHmetry. Then, they were randomized into two groups: one with application of topical estriol for 21 days of attack and then 3 times a week until completing 3 months, together with placebo radiofrequency (RF) pulses, and the other group, with monthly radiofrequency pulses for 3 months, together with placebo vaginal cream. RESULTS: The average age of participants was 56.33 ± 7.10 (minimum 42 and maximum 69 years of age), average age at onset of menopause 44.70 ± 5.74. In the estriol group, the participants showed no significant difference after treatment in relation to the number of basal and parabasal cells (p = 1.000), type of vaginal microbiota (p = 0.544), presence (or absence) of (p = 1.000), presence (or absence) of (p = 1.000), presence (or absence) of grouped or chained (p = 1.000), except for the presence of (p = 0.025) and decrease in vaginal hydrogen potential (pH) (p = 0.006). In the group treated with FRAXX, it was observed that the participants showed no significant difference after treatment regarding the number of basal and parabasal cells (p = 0.500), type of vaginal microbiota (p = 0.637), presence (or absence) of (p = 1.000), presence (or absence) of (p = 1.000), presence (or absence) of grouped or chained (p = 1.000) and presence (or absence) of (p = 1.000), except for pH variation (p = 0.037). Comparing the groups, women treated with FRAXX had a higher proportion of (type I) than women treated with estriol (66.7% and 26.7%, respectively; p = 0.057). On the other hand, the proportional presence of other bacteria, but with a predominance of (type II a) was higher in the group treated with estriol, when compared to the FRAXX group (46.6% and 6.7%, respectively; p = 0.057). And the application of estriol significantly increased the concentration when compared to FRAXX (p = 0.042). CONCLUSION: There was improvement in the parameters analyzed regarding the vaginal microbiota in the intervention with FRAXX with a higher proportion of and a decrease in pH. And there was no superiority of FRAXX in relation to the use of topical estriol.
Nadaleto JO, Ebenur JT, de Macedo DRA
… +3 more, Marrelli MFS, Ferreira LB, Pravatta-Rezende G
Rev Bras Ginecol Obstet
· 2025 · PMID 41415708
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OBJECTIVE: To review the real benefits of using combined oral contraceptives (COCs) containing natural hormones, also known as estradiol-containing COC (estradiol and estradiol valerate) in controlling abnormal uterine b...OBJECTIVE: To review the real benefits of using combined oral contraceptives (COCs) containing natural hormones, also known as estradiol-containing COC (estradiol and estradiol valerate) in controlling abnormal uterine bleeding (AUB) compared to the already established data on treatment with combined pills containing ethinylestradiol (EE). METHODS: Narrative review with analysis of studies published between 2010 and 2023, comparing the effects of EE and natural estrogen in the treatment of AUB, indexed in the PUBMED, WebOfScience, and Scielo databases. RESULTS: A total of 342 articles were found in the selected databases. Of these, 235 articles were excluded because they were published before 2010 or lacked an explicit relationship with the topic; 107 articles were selected for title and abstract screening, of which 27 were fully read by the researchers, and 6 were included in the study. It was observed that the use of natural estrogens is effective in controlling abnormal uterine bleeding, often with fewer side effects and less cardiovascular and prothrombotic impact compared to ethinylestradiol (EE). However, some non-contraceptive benefits of EE, such as less water retention, improved skin oiliness, and acne, were not consistently observed with the use of natural estrogens. CONCLUSION: Estradiol-containing COC have proven to be effective in controlling AUB, in addition to reducing spotting and intermenstrual bleeding, with fewer undesirable side effects when compared to COCs with EE. On the other hand, COCs with estradiol and estradiol valerate less frequently present other non-contraceptive benefits.
Rev Bras Ginecol Obstet
· 2025 · PMID 41415707
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OBJECTIVE: To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperat...OBJECTIVE: To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperative complications. METHODS: This retrospective cohort study included 25 pregnant women whose fetuses were diagnosed with myelomeningocele and underwent open intrauterine surgery between February 2019 and October 2023. Maternal demographic data, surgical outcomes, and neonatal variables were collected from medical records. Statistical analyses included Chi-squared test, Fisher's exact test, Mann-Whitney U test, and Pearson's correlation coefficient (r). RESULTS: The mean gestational age (GA) at surgery was 25.7 ± 1.2 weeks, and the mean GA at delivery was 34.3 ± 2.0 weeks. Preterm birth was the most common complication (40%), followed by premature rupture of ovular membranes (32%). Two stillbirths occurred (8%) at 31 and 33 weeks of gestation. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Low birth weight (<2,500 g) was observed in 44% of neonates. Neonatal hospitalization was significantly longer in cases of preterm birth (p = 0.044), and intensive care unit stay was longer in deliveries before 34 weeks (p = 0.044). No correlation was found between GA at intrauterine surgery and GA at delivery (r = 0.252, p = 0.22). CONCLUSION: Fetal myelomeningocele surgery was successfully performed in a tertiary public hospital. However, preterm birth remains a major concern, as consistently reported in the literature. Nevertheless, the results confirm that intrauterine repair of myelomeningocele is indeed feasible in the public healthcare setting.
Carvalho AC, Gaio N, Müller PC
… +1 more, Benincá SC
Rev Bras Ginecol Obstet
· 2025 · PMID 41415706
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OBJECTIVE: Women may experience cognitive, emotional, and physical changes during the menstrual cycle, which can impact their physical and athletic performance. This study aimed to investigate whether Brazilian female sw...OBJECTIVE: Women may experience cognitive, emotional, and physical changes during the menstrual cycle, which can impact their physical and athletic performance. This study aimed to investigate whether Brazilian female swimmers in the senior category, i.e., over 18 years of age, federated with the Brazilian Confederation of Aquatic Sports (CBDA), use hormonal contraceptives (HCs) and assess the impacts on their health, athletic performance, and overall well-being. METHODS: This is a cross-sectional descriptive observational study conducted via an online questionnaire based on the Google Forms® platform, sent via WhatsApp® and email to the participants. Questions were asked about age, use of contraceptive methods, observed changes in performance, among others. A total of 136 senior athletes participated in the study. Inclusion criteria were senior female athletes using hormonal contraceptive methods. Athletes who were not in the senior category and/or did not use hormonal contraceptive methods were excluded from the research. RESULTS: A total of 136 senior athletes responded to the questionnaire. Of this total, 108 reported using hormonal contraceptive methods and were therefore included in the study. The results indicate that the majority of participants use oral contraceptives, with 61 (57%) using this method. Regarding the reason for using hormonal contraceptives, 88 (82.4%) use the method to control the menstrual cycle, in addition to alleviating menstrual symptoms, 63 (59.2%); 62 (57.9%) reported improvement in mood patterns, and 69 (64.55%) stated that they experience benefits from using the method. CONCLUSION: It is concluded that the use of hormonal contraceptives presents benefits related to the professional careers of athletes. Besides improving their training performance, HCs also help alleviate menstrual symptoms and control the menstrual cycle and flow.
Serrano S, Martins I, Gato M
… +4 more, Simões C, Fonseca A, Ferreira H, Centeno M
Rev Bras Ginecol Obstet
· 2025 · PMID 41415704
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OBJECTIVE: The aim of this study was to evaluate the effect of vaginal pH on the efficacy of the dinoprostone vaginal insert for cervical ripening in patients with unfavorable Bishop Score. METHODS: Prospective observati...OBJECTIVE: The aim of this study was to evaluate the effect of vaginal pH on the efficacy of the dinoprostone vaginal insert for cervical ripening in patients with unfavorable Bishop Score. METHODS: Prospective observational cohort study, conducted at a Portuguese tertiary hospital. Term pregnant women with a singleton pregnancy and vertex presentation who had indication for labor induction with Bishop's Score ≤ 6 were included. Vaginal pH was measured with high accuracy strips before vaginal examination for Bishop Score was performed. The intravaginal dinoprostone insert (Propess) was then applied into the posterior fornix. The primary outcome was the change of the Bishop's Score before placement and after removal of the dinoprostone insert. Spearman correlation was analyzed (SPSS 16.0). RESULTS: A total of 75 women were included, with a gestational age of 39 ± 1,2 weeks. Mean initial vaginal pH was 4.67 ± 0.51. Mean variation of Bishop Score was 1.8 ± 2.3 points. There was a weak correlation between vaginal pH and changes on the Bishop Score with dinoprostone vaginal insert use (ρ = -0.123; p = 0.3). CONCLUSION: Vaginal pH does not appear to be a major influencer of the efficacy of dinoprostone vaginal insert for cervical ripening.
Jardine BV, Barbosa PO, Lima-Júnior LS
… +4 more, Alves RA, de Carvalho TD, Santos SLN, Cavalli RC
Rev Bras Ginecol Obstet
· 2025 · PMID 41341951
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OBJECTIVE: To evaluate adherence to preeclampsia prophylaxis with aspirin and calcium carbonate among pregnant women with chronic hypertension attending a specialized hypertension in pregnancy center at a tertiary hospit...OBJECTIVE: To evaluate adherence to preeclampsia prophylaxis with aspirin and calcium carbonate among pregnant women with chronic hypertension attending a specialized hypertension in pregnancy center at a tertiary hospital in Brazil. METHODS: A cross-sectional study was conducted at the Hospital das Clínicas de Ribeirão Preto. Adherence to aspirin and calcium carbonate was assessed using the Morisky-Green questionnaire. Additionally, we assessed the knowledge of these women regarding preeclampsia. A total of 101 pregnant women were interviewed, and 98 were included in the final analysis. RESULTS: Non-adherence rates were 64.3% for aspirin and 59.2% for calcium carbonate. The overall incidence of preeclampsia was 22.4% with 11% requiring magnesium sulphate for blood pressure control. No significant differences in preeclampsia incidence were observed among adherent and non-adherent groups for either aspirin or calcium carbonate. Most participants demonstrated high (78.6%) or medium (18.4%) levels of knowledge about preeclampsia. CONCLUSION: There was low adherence to aspirin and calcium carbonate prophylaxis among pregnant women with chronic hypertension, with no difference in preeclampsia prevention between adherent and non-adherent groups. These findings raise important questions about the effectiveness of aspirin in reducing preeclampsia risk in chronic hypertension. Further studies should be conducted to evaluate the reasons for low adherence.
Rev Bras Ginecol Obstet
· 2025 · PMID 41341949
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OBJECTIVE: To estimate age-adjusted mortality rates at the national and state levels, evaluates trends and their spatial distribution during the period 2000-2023 among Mexican women. METHODS: Ecological study conducted f...OBJECTIVE: To estimate age-adjusted mortality rates at the national and state levels, evaluates trends and their spatial distribution during the period 2000-2023 among Mexican women. METHODS: Ecological study conducted from open access data, the age-standardized mortality rate of breast cancer during the period 2000-2023 was calculated. Joinpoint regression models were estimated for breast cancer mortality in Mexico and its states. Spatial analysis was performed using Moran's I statistic. RESULTS: The age-adjusted mortality rate at the national level during 2000 was 18.99 per 100,000 women, the highest mortality rate occurred in the year 2020. Joinpoint analysis shows a decrease in mortality in the last five years, being greater in urban areas. For 2023, the highest mortality occurred in Sonora and Chihuahua, while Mexico City (-0.71; 95%CI -0.98 to -0.44) was the entity that showed a significant reduction in the mortality rate from breast cancer. The spatial analysis showed a local indicator of spatial association of 0.458 (p<0.05) for 2000 and 0.524 (p<0.05) for 2023 in the northern states of the country. CONCLUSION: Public health interventions must be implemented according to the social, economic, and cultural context to reduce mortality from breast cancer.
de Andrade RP, Surita FGC, Brilhante AVM
… +12 more, de Medeiros RD, Rosas CF, Paro HBMDS, Rocha MNDS, de Moraes OB, Paiva SPC, Lins SDS, Machado MSC, de Albuquerque RM, Guida JPS, Campos ZM, Abelha MC
Rev Bras Ginecol Obstet
· 2025 · PMID 41341948
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Prompt care for victims of sexual violence is essential in the implementation of measures to prevent pregnancy resulting from violence and sexually transmitted infections, and to assess and monitor serological follow-up...Prompt care for victims of sexual violence is essential in the implementation of measures to prevent pregnancy resulting from violence and sexually transmitted infections, and to assess and monitor serological follow-up and gather evidence for possible criminal proceedings. In the absence of a referral service, any health service should take the appropriate initial measures and refer the victim to the referral service (if there is one) as quickly as possible. Referral services for immediate care for victims of sexual violence allow victims to be followed up for a longer period of time. However, acute care should be provided by any health unit to avoid care delays. There is no need for any legal complaint or registration of a police report for providing healthcare to victims of sexual violence. However, victims should be informed about their right to report the assault at any time, so an appropriate legal and police investigation can be carried out. It is important to address this topic during medical care. All services providing care to victims of sexual violence must be open and receiving victims continuously, without the need for other health units or a police authority. Obstetrician/gynecologists are often the professionals responsible for caring for victims of sexual violence and must be familiar with the initial care protocols for these patients.