Revista Brasileira De Ginecologia E Obstetricia[JOURNAL]
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200 papers
Association between coronavirus 2 infection and preeclampsia among unvaccinated women.
Henrique M, Machado LC, Luppi CG … +4 more , Maciel VO, Mazzei CC, Lemos JM, Steiner ML
Rev Bras Ginecol Obstet · 2025 · PMID 40673015 · Full text
OBJECTIVE: To investigate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) infection and preeclampsia (PE); to verify whether the strength of the association differs according...
OBJECTIVE: To investigate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) infection and preeclampsia (PE); to verify whether the strength of the association differs according to the infection onset (trimester of pregnancy). METHODS: Retrospective cross-sectional study. Included women giving birth at a public hospital in Brazil from July 2020 to January 2021. All women were offered testing for COVID-19 during birth; they were also offered to test during prenatal care if symptomatics or contactants. Excluded women not tested. Compared the frequency of PE as well as of PE superimposed to chronic hypertension (PESCH) in women with versus without infection. Associations were accessed using bivariate and multivariable logistic regression analysis. RESULTS: Among 1,575 women included, 288 (18.3%) had infection, 53 (3.4%) had PE, and 32 (2.1%) had PESCH. In univariate analysis, infection was significantly associated with PE, but not with PESCH. We then considered only PE as the outcome. The multivariable model included PE, infection, primigravida, fewer than seven prenatal visits. We found association between infection and PE, adjusted odds ratio 2.1; p=0.017. Women infected in the first trimester had a higher frequency of PE than those with infections in the second/third trimester, suggesting a temporal sequence, but the difference wasn't significant (p=0.054). CONCLUSION: Our data suggests association between SARS-CoV-2 infection and PE without chronic hypertension. The greater frequency of PE in women who had infection in the first trimester suggests a temporal sequence, but the small numbers are a limitation. Studies with larger samples are welcome.
Early preeclampsia is associated with persistence of hypertension 3 months postpartum in women: an observational study at a tertiary hospital in Brazil.
Tallarico GM, Barbosa PO, Lima-Junior LS … +1 more , Cavalli RC
Rev Bras Ginecol Obstet · 2025 · PMID 40673014 · Full text
OBJECTIVE: This study aimed to investigate the persistence of hypertension at three months postpartum in women who experienced preeclampsia during pregnancy. METHODS: A prospective observational study at Hospital das Clí...
OBJECTIVE: This study aimed to investigate the persistence of hypertension at three months postpartum in women who experienced preeclampsia during pregnancy. METHODS: A prospective observational study at Hospital das Clínicas de Ribeirão Preto, Brazil, included 24 women. Blood pressure measurements and/or antihypertensive use were assessed, alongside risk factors such as body mass index (BMI), heart rate, lipid profile and C-reactive protein (CRP). Data on demographic, obstetric and lifestyle factors were also collected. RESULTS: Out of 24 postpartum women enrolled in this study, 15 (62.5%) of participants remained hypertensive three months after delivery. Women with early-onset preeclampsia had a 2.36-fold increased risk of persistent hypertension at three months postpartum. No significant differences were found among risk factors for persistent hypertension. CONCLUSION: Our results indicate a high prevalence of persistent hypertension in women with preeclampsia in Brazil. The findings highlight the need for extended monitoring specially in early onset preeclampsia and targeted lifestyle interventions.
How maternal position affects umbilical and middle cerebral artery Doppler indices: insights from a scoping review.
Hammes LR, Miyague AH, Nisihara RM
Rev Bras Ginecol Obstet · 2025 · PMID 40673013 · Full text
BACKGROUND: During pregnancy, the maternal supine position may reduce uterine and placental perfusion due to compression of the aorta and inferior vena cava by the gravid uterus, potentially impairing maternal and fetal...
BACKGROUND: During pregnancy, the maternal supine position may reduce uterine and placental perfusion due to compression of the aorta and inferior vena cava by the gravid uterus, potentially impairing maternal and fetal oxygenation. OBJECTIVE: This scoping review aimed to summarize the available evidence on the impact of maternal positioning during ultrasound examinations on fetal Doppler indices of the umbilical artery (UA) and middle cerebral artery (MCA). METHODS: Studies were eligible if they included pregnant women undergoing fetal Doppler assessment in at least two different maternal positions and reported outcomes related to UA and/or MCA indices. Only studies published in English in the past 20 years were included. SOURCES OF EVIDENCE: A comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, and Scopus databases between September and October 2023. CHARTING METHODS: Two independent reviewers conducted the initial screening for relevance, with conflicts resolved by consensus or by a third reviewer. RESULTS: Thirteen studies were initially identified. After applying the eligibility criteria, six observational prospective studies were included. These studies assessed changes in UA-PI, MCA-PI, and/or the cerebroplacental ratio (CPR) in response to different maternal positions during Doppler ultrasound. CONCLUSIONS: Evidence suggests that maternal positioning during fetal Doppler ultrasound can influence arterial indices, particularly when comparing supine and lateral decubitus positions. However, variability in methodology and small sample sizes limit the generalizability of findings. Further standardized studies are needed to guide clinical recommendations.
Vaginal estrogen therapy for treatment of menopausal genitourinary syndrome among breast cancer survivors: a systematic review and meta-analysis.
Santos GML, Magalhães AO, Teichmann PDV … +1 more , Wender MCO
Rev Bras Ginecol Obstet · 2025 · PMID 40673012 · Full text
OBJECTIVE: Assess survival outcomes and risk of recurrence in vaginal estrogen therapy (VET) users with medical history of breast cancer. DATA SOURCE: The search strategy was guided by standardized terms and keywords wer...
OBJECTIVE: Assess survival outcomes and risk of recurrence in vaginal estrogen therapy (VET) users with medical history of breast cancer. DATA SOURCE: The search strategy was guided by standardized terms and keywords were identified from controlled vocabularies. Following databases were used for literature search: Pubmed, EMBASE, Cochrane, Scopus and Web of Science. Only studies published in the 21st century (2001-present) and written in English were included. STUDY SELECTION: A total of 988 records were reviewed by two independent authors. After full-text analysis of 38 of them, 7 articles were included in the meta-analysis. DATA COLLECTION: Data from eligible studies were extracted and tabulated based on predefined criteria: author, country, year, study type, sample size, type of intervention, use of aromatase inhibitors, duration of follow-up, and main outcomes. RESULTS: 118.659 breast cancer survivors were analyzed, of whom 6.358 were treated with VET. The overall analysis showed no significant increase in the risk of recurrence (RR = 0.87, 95%CI: 0.67-1.11). VET users had a significant reduction in all-cause mortality (RR = 0.80, IC95%: 0.75-0,86). CONCLUSION: Vaginal estrogen therapy appears to be safe in the management of menopausal genitourinary syndrome in breast cancer survivors and it is related to significantly lower all-cause mortality. PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS PROSPERO: CRD42024602047.
Short cervix and use of cervical pessary for preventing preterm birth in singleton and twin pregnancies: a systematic review and meta-analysis.
Santos ACFF, Pimenta NDS, Pereira AGA … +3 more , Molino GOG, Dias MMF, da Silva PHCM
Rev Bras Ginecol Obstet · 2025 · PMID 40584397 · Full text
OBJECTIVE: Preterm birth remains a significant contributor to neonatal morbidity and mortality. The use of cervical pessaries as an intervention for preventing preterm delivery in women with a short cervix has been a sub...
OBJECTIVE: Preterm birth remains a significant contributor to neonatal morbidity and mortality. The use of cervical pessaries as an intervention for preventing preterm delivery in women with a short cervix has been a subject of interest. We evaluated the effectiveness of cervical pessary compared to standard care in preventing preterm delivery in women with a short cervix. DATA SOURCE: Databases were systematically searched in PubMed, Cochrane, and Embase databases in December 2023. STUDY SELECTION: Randomized clinical trials with the outcomes of interest were included. DATA COLLECT: We computed risk ratios for binary endpoints, with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. Data were analyzed using R software (version 4.3.0). The primary outcomes of interest were preterm delivery before 37 weeks, and preterm delivery before 34 weeks. DATA SYNTHESIS: Seventeen studies with 5,704 patients were included. The use of cervical pessary was associated with a decreased risk of preterm delivery before 37 (RR 0.88; 95% CI 0.81-0.96) and 34 weeks (RR 0.79; 95% CI 0.63-0.99) of gestation in twin pregnancies as compared to standard care without progesterone. There were no significant differences in preterm delivery in singleton pregnancy, neonatal outcomes, preterm premature rupture of the membranes or chorioamnionitis. CONCLUSION: The use of cervical pessary was associated with a significant reduction in preterm delivery at 34 and 37 weeks of gestation in twin pregnancies among patients with a short cervix compared to no treatment. No significant difference was found in singleton pregnancies or maternal outcomes.
Efficacy of vitamin C supplementation during pregnancy in the prevention of preterm birth: a systematic review and meta-analysis.
Pereira AGA, Molino GOG, Santos ACFF … +3 more , Dias MMF, Pimenta NDS, da Silva PHCM
Rev Bras Ginecol Obstet · 2025 · PMID 40584396 · Full text
OBJECTIVE: Preterm birth is a leading global cause of neonatal mortality and morbidity, with oxidative stress playing a role in its pathogenesis. Vitamin C, a powerful antioxidant, may help reduce this risk. This study a...
OBJECTIVE: Preterm birth is a leading global cause of neonatal mortality and morbidity, with oxidative stress playing a role in its pathogenesis. Vitamin C, a powerful antioxidant, may help reduce this risk. This study assessed the effectiveness of vitamin C supplementation, both alone and with vitamin E, in preventing preterm birth compared to a placebo. DATA SOURCE: Databases were systematically searched in PubMed, Cochrane and Embase in December 2023 and updated in May 2024. STUDY SELECTION: Included RCTs evaluated vitamin C's effect on preterm birth and related neonatal outcomes. DATA COLLECT: Statistical analyses used a random-effects model for pooled risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity was assessed with the I² statistic. DATA SYNTHESIS: Seventeen RCTs (21,567 patients) were analyzed. Vitamin C supplementation showed no significant difference compared to placebo for preterm birth (RR 1.04; 95% CI 0.96, 1.14). No significant differences were observed for neonatal death (RR 0.77; 95% CI 0.55, 1.08), NICU admission (RR 1.03; 95% CI 0.95, 1.13), preterm PROM (RR 1.04; 95% CI 0.63, 1.71), or birth weight (MD 52.41; 95% CI -19.65, 124.47). A slight decrease in gestational age was observed (MD 0.26; 95% CI -0.02, 0.55). CONCLUSION: Vitamin C supplementation alone or in combination with vitamin E does not significantly prevent preterm birth or improve related neonatal outcomes.
Epidemiological profile of breast cancer in a reference center in the north region of Brazil.
Carvalhais França D, da Silva AL, Chami AM … +1 more , Braga LDC
Rev Bras Ginecol Obstet · 2025 · PMID 40535424 · Full text
OBJECTIVE: To describe the epidemiological data of women with breast cancer at a referral center in oncology in the northern region of Brazil. METHODS: This is a retrospective cohort study. The study population consists...
OBJECTIVE: To describe the epidemiological data of women with breast cancer at a referral center in oncology in the northern region of Brazil. METHODS: This is a retrospective cohort study. The study population consists of patients who were diagnosed with or invasive BC (invasive carcinoma of no special type (ICNST) and invasive lobular carcinoma (ILC)) at the , in Porto Velho - Rondônia, between January 2012 and December 2021. The sampling plan adopted was of the convenience type. All patients who received the anatomopathological diagnosis of or invasive BC at the from 2012 to 2021 and came from the North region were included. Exclusion criteria were non-origin from the North region and absence of diagnosis established by anatomopathological examination of breast cancer. Analysis of the database and medical records of the was carried out to collect information. RESULTS: 420 patients were included, 99.5% female, with complete elementary school (32,6%) and brown skin (68,1%). The mean age at diagnosis was 49 years. Forty-five percent were born in the northern region and 55% in other regions of Brazil. Eighty percent of tumors were invasive ductal carcinoma; 32.7% were luminal A-like, 25.1% luminal B-like, 19.4% HER2 enriched and 12.8% triple negative. When patients were subdivided by age ≤40 years and > 40 years, there was a statistically significant difference in the association with staging (p=0.000), histological type (p= 0.035), immunohistochemistry subtype (p=0.000), neoadjuvant chemotherapy (p=.000) and genetic counseling (p=0.001). The median survival was 7.99 years. The 5-year overall survival was 81%. The higher the stage, the lower the survival rate. Twenty-four distinct variants were described in patients undergoing genetic testing, 16 of uncertain significance and 8 pathogenic. Three new variants were described: (c.8726G>C), (c.2232A>C) and (c.2164G>Ap). CONCLUSION: In this study, the age at diagnosis of breast cancer was lower, the tumor subtype was more aggressive, and patients were admitted in more advanced stages. Overall survival is lower compared to national and international data. Despite the small number of patients referred to genetic testing, it is important to search for germline mutations to improve patients' diagnosis and treatment.
Prophylactic internal iliac artery balloon occlusion in the management of placenta accreta spectrum disorders: a meta-analysis.
Pimenta NDS, Felix de Farias Santos AC, Ferreira Dias MM … +3 more , Molino GOG, Alves Pereira AG, da Silva PHCM
Rev Bras Ginecol Obstet · 2025 · PMID 40535423 · Full text
OBJECTIVE: Placenta accreta spectrum (PAS) describes the failure of placental detachment. PAS is a pregnancy-associated life-threatening condition which increases hemorrhage risk. We evaluated safety and efficacy of inte...
OBJECTIVE: Placenta accreta spectrum (PAS) describes the failure of placental detachment. PAS is a pregnancy-associated life-threatening condition which increases hemorrhage risk. We evaluated safety and efficacy of internal iliac artery balloon occlusion (IIABOC) on bleeding volume among pregnant women with diagnosis or suspicion of PAS. DATA SOURCE: We searched PubMed, Embase and Cochrane databases. STUDY SELECTION: Randomized controlled trials (RCTs) and observational studies comparing the efficacy of preoperative prophylactic balloon catheters to a control group with standard care in patients with a prenatal screening of PAS. DATA COLLECT: We computed odds ratio (OR) for binary endpoints and mean difference (MD) for continuous endpoints, with 95% confidence intervals (CIs). We performed random effects models and assessed I heterogeneity statistics. DATA SYNTHESIS: Twenty-four studies were included, of whom 1,023 (51%) received balloons and 983 (49%) did not undergo balloon management. Patients receiving IIABOC had a greater decrease in estimated blood loss (MD -0.33; 95% CI -0.55, 0.11) and increase in operation time (MD 17.21; 95% CI 3.43, 30.99). Apgar score at fifth minute (MD -0.22; 95% CI -0.36,-0.07) significantly decreased. There were no significant differences between groups regarding hysterectomy rates (OR 1.35; 95% CI 0.88, 2.09) and maternal intensive care unit admission (OR 0.81; 95% CI 0.51,1.29). CONCLUSION: While IIABOC have demonstrated a significant reduction in estimated blood loss, these findings have not been consistently replicated in RCTs and the surgeon's level of experience must be taken into account since it biases the analysis.
Impact of the Zero Maternal Death by Hemorrhage Strategy on health professionals' self-perceived knowledge in managing postpartum hemorrhage.
de Oliveira GG, Larissa Oliveira Dos Santos M, Osanan GC … +2 more , de Azevedo GD, Freitas RAO
Rev Bras Ginecol Obstet · 2025 · PMID 40535422 · Full text
OBJECTIVE: This study aimed to evaluate the results of the Obstetric Hemorrhage Prevention and Management Course - Zero Maternal Death by Hemorrhage Strategy (0MMxH) among healthcare professionals before and after partic...
OBJECTIVE: This study aimed to evaluate the results of the Obstetric Hemorrhage Prevention and Management Course - Zero Maternal Death by Hemorrhage Strategy (0MMxH) among healthcare professionals before and after participation. METHODS: A quasi-experimental design was employed, assessing the educational intervention in a convenience sample of healthcare professionals who had participated in the 0MMxH at least one year prior. Participants completed a retrospective pre-post questionnaire sent via email, focusing on self-perceived knowledge levels and the adoption of best practices in postpartum hemorrhage (PPH) management. RESULTS: Out of 129 professionals who completed the 0MMxH training, 85 (65.9%) responded to the questionnaire. The percentages of respondents reporting no or low knowledge before and after the course were: shock index (52.8% to 0%, before and after, respectively), blood loss estimation (35.2% to 1.1%), care sequence for PPH (44.6% to 0%), rational use of crystalloids (37.5% to 1.1%), non-pneumatic anti-shock garment (83.5% to 3.4%), and damage control surgery (74.1% to 8.1%). These results indicate a significant improvement in self-perceived knowledge. After the course, the highest adoption rates of best practices were for shock index (83.5%), blood loss estimation (67.1%), and use of warm crystalloids (58.8%). However, gaps remained regarding non-pharmacological interventions for PPH management. CONCLUSION: Participants reported improved knowledge on most topics covered by the 0MMxH. The program was recognized as a crucial factor in adopting effective PPH management practices, underscoring the importance of training in enhancing obstetric care.
Evaluation of chronic radiation proctitis in patients with cervical cancer treated with pelvic radiotherapy: a cross-sectional study.
Aragão RS, Santos CL, Impieri Souza A … +5 more , Fassizoli da Fonte AL, Ximenes Bandeira de Moraes B, Sandes de Lima L, Dias Aguiar L, Lima JTO
Rev Bras Ginecol Obstet · 2025 · PMID 40535421 · Full text
OBJECTIVE: A combination of chemotherapy and pelvic radiotherapy is recommended to treat locally advanced cervical cancer (CC), which has been associated with acute and chronic toxicities, especially radiation proctitis...
OBJECTIVE: A combination of chemotherapy and pelvic radiotherapy is recommended to treat locally advanced cervical cancer (CC), which has been associated with acute and chronic toxicities, especially radiation proctitis (RP). The objective of this study was to evaluate the frequency of RP and treatment management in females with CC who underwent pelvic radiotherapy at an oncology referral hospital. METHODS: This cross-sectional study analyzed the medical records of patients treated with radiotherapy for CC between 2015-2017. We assessed sociodemographic, lifestyle, cancer, treatment, and clinical variables. We identified 298 records of females with CC who underwent pelvic radiotherapy during the defined period. Of these, 14 records were duplicates, 25 were excluded for lacking essential information, and 33 were missing in the archive. Accordingly, 226 relevant medical records were analyzed, with data regarding sociodemographic, clinical, cancer-related, treatment-related, and RP-related variables collected. Pearson's chi-square test was used to compare symptomatic and non-symptomatic patients. Fisher's exact test was used to compare chemotherapy doses. Statistical analysis was performed with Stata V12.1. A P-value less than 0.05 was considered significant. RESULTS: The median patient age was 48 years (interquartile range 38-61). Patients predominantly had CC stages IIB and IIIB (>70%). Of the 226 females analyzed, 87(38.5%) experienced RP symptoms, represented by rectal bleeding; of these, 59 underwent colonoscopy, confirming RP in 58(98.3%). Accordingly, of the 226 females analyzed, 58(25.7%) had a confirmed diagnosis of RP. There was a statistically significant association between rectal bleeding and cumulative radiation dose (P < 0.001) and the presence of systemic arterial hypertension (P = 0.036). Regarding treatment, 38(65.5%) participants underwent argon plasma coagulation (APC), and of these, 22(57.9%) had no post-treatment macroscopic bleeding. CONCLUSION: Patients with CC who received radiotherapy at an oncology referral service had a high frequency of RP, and APC helped control bleeding in certain patients.
Efficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials.
Lottermann NC, Andreazza NL, de Araújo Moura Cavalcante M … +3 more , Fernandez LA, Vitola Gonçalvez C, Zhang L
Rev Bras Ginecol Obstet · 2025 · PMID 40406479 · Full text
OBJECTIVE: This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures. METHODS: We searched Medline, Embase, Sc...
OBJECTIVE: This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures. METHODS: We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term "tranexamic acid". Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively. RESULTS: Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate. CONCLUSIONS: This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.
Incidence of small-for-gestational-age newborns in pregnant women with COVID-19.
Raupp GDS, Souza RT, Costa ML … +5 more , Cecatti JG, Barros A, Arlindo EM, Cunha EV, Vettorazzi J
Rev Bras Ginecol Obstet · 2025 · PMID 40406478 · Full text
OBJECTIVE: This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes. METHODS: This study involved a second...
OBJECTIVE: This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes. METHODS: This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses. RESULTS: A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 - 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 - 0.853); P=0.002]. CONCLUSION: The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.
Evaluation of pathological complete response rates in breast cancer patients undergoing neoadjuvant therapy.
Ferezini Oliveira de Sá G, Villarim PVO, Saboia da Escossia Melo PH … +4 more , Sarmento ACA, Gonçalves AK, Santos de Medeiros K, Rocha de Medeiros Miranda C
Rev Bras Ginecol Obstet · 2025 · PMID 40406477 · Full text
OBJECTIVE: This study aims to assess the rate of pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant therapy and to explore its correlation with clinical, molecular, and prognostic facto...
OBJECTIVE: This study aims to assess the rate of pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant therapy and to explore its correlation with clinical, molecular, and prognostic factors. METHODS: We conducted this retrospective observational study at Liga Contra o Câncer, a major public oncology reference center in Northeast Brazil. We included patients diagnosed with breast cancer who initiated neoadjuvant therapy between June 2018 and June 2019. Patients with a history of recurrent breast cancer or those who did not undergo surgery were excluded. The primary outcome was the pCR rate, with secondary outcomes including Overall Survival (OS), Disease-Free Survival (DFS), mortality, and disease recurrence. Follow-up extended until August 2022. We performed multivariate Cox regression analysis to correlate outcomes with predetermined variables. RESULTS: Of the 292 included patients, 63 (21.6%) achieved pCR. The mean follow-up duration was 42.8 months. Multivariate logistic regression analysis revealed an association between pCR and the AC-TH regimen [OR = 2.4; 95%CI = 1.13 - 5.24; p=0.023], as well as between pCR and HER2-positive tumors [OR 2.49; 95% CI = 1.14 - 5.86; p=0.028]. Complete pathological response was associated with higher DFS [HR 0.33; 95%CI 0.13-0.86; p=0.024]. CONCLUSION: Neoadjuvant therapy demonstrated significant efficacy in achieving pathological response in breast cancer patients. We observed a strong association between the AC-TH regimen, HER2-positive status, and pCR.
Clinical and epidemiological profile of pregnant and postpartum women affected by COVID-19 who required respiratory support.
Cunha CMP, Amorim MMR, Guendler JA … +2 more , Souza ASR, Katz L
Rev Bras Ginecol Obstet · 2025 · PMID 40406476 · Full text
OBJECTIVE: This study described the clinical and epidemiological profile and the management provided to pregnant and postpartum women with COVID-19 who required respiratory support. METHODS: A descriptive study was condu...
OBJECTIVE: This study described the clinical and epidemiological profile and the management provided to pregnant and postpartum women with COVID-19 who required respiratory support. METHODS: A descriptive study was conducted with pregnant and postpartum women with confirmed COVID-19 who received care between April 2020 and December 2021 in eight referral centers in northeastern Brazil. Statistical analysis was conducted using Epi-Info 7.2.5 and Medcalc, version 20.112. RESULTS: Of the 720 patients admitted, 208 (32.7%) required respiratory support. Mean age of the participants was 28.9±7.1 years. Most (52.8%) were brown-skinned; 31.3% had little formal schooling; 41.1% had a personal income and 23.1% were married. Around half were referred from another hospital. Overall, 36.8% were obese and 36.9% were hypertensive. Criteria for severe acute respiratory syndrome (SARS) were present in 80.7% of cases. Overall, 151 patients (74.7%) required corticoids, and 150 (76.1%) were admitted to an intensive care unit. Non-invasive ventilation was needed in 89.4% of cases, with nasal catheters being the most common type (55.3% of cases). Invasive mechanical ventilation was necessary in 35.5% of cases and 91.6% had a cesarean section. Maternal near miss and death occurred in 24% and 12.9% of cases, respectively. CONCLUSION: Pregnant and postpartum women with COVID-19 who required respiratory support were predominantly brown-skinned, in the third trimester of pregnancy and had been referred from another hospital. The cesarean section rate was high; the presence of criteria for SARS was common and the rates of COVID-19-related maternal near miss and death were high. CLINICAL TRIALS REGISTRY: NCT04462367.
Assessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus.
Bayrak AC, Fadiloglu E, Tuncer H … +3 more , Kir EA, Kayikci U, Deren O
Rev Bras Ginecol Obstet · 2025 · PMID 40406475 · Full text
OBJECTIVE: This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×plate...
OBJECTIVE: This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×platelet×monocyte)/lymphocyte)], SII (neutrophil×platelet/lymphocyte), and NLR neutrophil/lymphocyte) values were evaluated in all three trimesters, and their correlation with neonatal outcomes was examined. METHODS: We included 82 cases of PGDM pregnancies delivered after 32 weeks. Maternal age, gravidity, parity, types of diabetes, and route of delivery were noted. For neonatal outcomes, we recorded gestational age at birth, birth weight percentile, existence of fetal growth restriction, LGA, neonatal intensive care unit (NICU) requirement, Apgar Score <7 at 1, 5, or 10 minutes, need for positive pressure ventilation (PPV), need for mechanical ventilation, hypoglycaemia, hyperbilirubinemia and the need for phototherapy. PIV, SII and NLR values were calculated in each trimester and their association with adverse neonatal outcomes was analyzed. RESULTS: We could not detect any consistent and significant correlation between SII and PIV values and adverse neonatal outcomes for each trimester. There was a correlation between 3rd trimester NLR and adverse neonatal outcomes, including APGAR <7, the requirement for PPV and mechanical ventilation (p=0.056, 0.013 and 0.060, respectively). CONCLUSION: While SII and PIV values did not consistently correlate with adverse neonatal outcomes throughout each trimester in PGDM pregnancies, 3rd-trimester NLR showed a notable association with the requirement for PPV with statistical significance and with Apgar Score <7 and the requirement for mechanical ventilation without statistical significance. NLR in the third trimester may hold potential as a predictive marker for specific adverse neonatal outcomes in PGDM pregnancies, warranting further investigation.
Letrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis.
Eskandar K, Oliveira JA, Ribeiro SA … +4 more , Chavez MP, Zotti AIA, Dias YJM, Novellino AMM
Rev Bras Ginecol Obstet · 2025 · PMID 40406474 · Full text
OBJECTIVE: We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS). DATA SOURCES: We systematically searche...
OBJECTIVE: We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS). DATA SOURCES: We systematically searched EMBASE, PubMed, and Cochrane databases on October 31, 2024. STUDY SELECTION: We included studies of women with PCOS treated with a combination of clomiphene and letrozole or letrozole alone to induce ovulation that reported any of the outcomes of interest, namely rate of mature follicles and ovulation, ovulation, pregnancy, miscarriages, endometrial thickness, and number of mature follicles. DATA COLLECTION: We pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) using a random effects model using R statistical software, version 4.2.1. Heterogeneity was assessed with I statistics, and a random effects model was used. DATA SYNTHESIS: Four RCTs and two observational studies comprising 592 patients were included. Combined therapy was associated with a higher rate of a mature follicle (OR 2.74; 95% CI 1.72-4.37; p< 0.001; I=0%) and ovulation (OR 2.55; 95% CI 1.57-4.12; p< 0.001; I=35.9%). The number of mature follicles, number of pregnancies, thickness of endometrial lining, and the incidence of adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups. CONCLUSION: In women with anovulatory infertility secondary to PCOS, letrozole and clomiphene citrate combined therapy was associated with improved mature follicle and ovulation rates, with a similar safety profile compared to letrozole alone. However, no significant impact was observed on pregnancy rates.
Prevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study.
de Oliveira ECF, Ribeiro DD, Senra JC … +1 more , Dos Reis FM
Rev Bras Ginecol Obstet · 2025 · PMID 40406473 · Full text
OBJECTIVE: This study aimed to evaluate the prevalence of antiphospholipid syndrome (APS) among women experiencing recurrent pregnancy loss (RPL). METHODS: A cross-sectional was conducted, reviewing the medical records o...
OBJECTIVE: This study aimed to evaluate the prevalence of antiphospholipid syndrome (APS) among women experiencing recurrent pregnancy loss (RPL). METHODS: A cross-sectional was conducted, reviewing the medical records of 134 women with a history of two or more miscarriages, treated between January 2014 and May 2024 at a tertiary university center in Belo Horizonte, Brazil. APS screening was performed by assessing anticardiolipin (IgG and IgM), lupus anticoagulant, and anti-β2-glycoprotein-1 (IgG and IgM) antibodies, based on Sapporo criteria. All tests were performed during non-pregnant periods and at least 12 weeks after the last miscarriage. RESULTS: The study included 134 women with a mean age of 33.8 ± 5.7 years. The number of prior miscarriages ranged from 2 to 11 per couple. Among the patients who presented the lupus anticoagulant, only two (1.49%) tested positive in two samples, as per revised Sapporo criteria. Considering IgG and IgM anticardiolipin antibodies, four patients (2.98%) tested positive in two samples according to old Sapporo criteria, with one patient having a positive IgG test in two samples, two having positive IgM in two samples and a single patient having both positive tests. None of the 56 patients tested positive for anti-β2-glycoprotein-1 antibodies in two samples. CONCLUSION: The prevalence of antiphospholipid antibodies, in line with revised Sapporo criteria, is low among Brazilian women with recurrent pregnancy loss, consistent with recent studies in literature. Ensuring the appropriateness of diagnostic criteria is crucial to avoid unnecessary treatment with platelet anticoagulants and heparin in this population.
Follow-up of women after gynecological cancer treatment.
da Silva AL, Praça MSL, Pinhati MES … +4 more , Castro LG, Moretti-Marques R, Nogueira-Rodrigues A, Cândido EB
Rev Bras Ginecol Obstet · 2025 · PMID 40406472 · Full text
•The population of female cancer survivors has increased over the last few years, highlighting the importance of appropriate follow-up of these patients. •The main objective of long-term follow-up for patients treated fo...
•The population of female cancer survivors has increased over the last few years, highlighting the importance of appropriate follow-up of these patients. •The main objective of long-term follow-up for patients treated for cancer is the early detection of recurrences, whether local, lymph node or distant metastases. •Symptom assessment and physical examination play an important role in the follow-up of patients treated for gynecological neoplasms. •The use of laboratory or imaging tests to detect recurrence in asymptomatic patients should be based on evidence that it improves survival or provides less morbid treatments, also considering cost and availability.
The ımpact of demographic and obstetric factors on perception of traumatic birth and breastfeeding attitudes.
Çuvadar A, Karamelikli E, Çuvadar Baş Y
Rev Bras Ginecol Obstet · 2025 · PMID 40406471 · Full text
OBJECTIVE: This study aims to examine the effects of sociodemographic and obstetric factors on traumatic birth perception and breastfeeding attitudes in primiparous mothers who have had a vaginal birth in the early postp...
OBJECTIVE: This study aims to examine the effects of sociodemographic and obstetric factors on traumatic birth perception and breastfeeding attitudes in primiparous mothers who have had a vaginal birth in the early postpartum period. METHODS: The sample of the research, developed with a cross-sectional and correlational design, consisted of 252 women residing in a province in the Western Black Sea region of Türkiye. The data were obtained by employing a Personal Information Form, Traumatic Childbirth Perception Scale, and Breastfeeding Attitudes of The Evaluation Scale. Data analysis was conducted using the statistical programming language R (R version 4.3.3). RESULTS: Women who were not employed, had a planned pregnancy, and did not experience health problems during pregnancy had higher mean breastfeeding attitude scores, and this difference was statistically significant. It was determined that a one-unit increase in gestational week led to an average increase of 1.926 units in breastfeeding attitude score, and a one-unit increase in Traumatic Childbirth Perception Scale score led to an average decrease of 0.110 units in breastfeeding attitude score. The mean traumatic childbirth perception scores of women living in urban areas were found to be lower than those living in villages or towns, and the difference was statistically significant. CONCLUSION: The research findings indicate that gestational age, perception of traumatic childbirth, and certain sociodemographic factors significantly affect breastfeeding attitudes. Additionally, mothers living in urban areas have a lower perception of traumatic childbirth. Therefore, individualized approaches to childbirth and breastfeeding support are crucial.
An assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients.
Okuducu U, Bayhan G, Ulusoy Karatopuk D
Rev Bras Ginecol Obstet · 2025 · PMID 40406470 · Full text
OBJECTIVE: In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents t...
OBJECTIVE: In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents the imbalance between the production of reactive oxygen species and their detoxification. Total Antioxidant and Oxidant Status, and Oxidative Stress Index levels are the main oxidative stress markers. This study investigated the effects of oxidative stress markers on infertility etiology, embryo quality, and success of In vitro fertilization. METHODS: Before enrolling in the ICSI-ET cycle, participants had their FSH and LH levels assessed on the second day of the cycle. The ovarian degrees of the participants were evaluated by transvaginal ultrasonography. Participants underwent controlled ovarian stimulation using the GnRH antagonist protocol. TV-USG and serial E2 measurements were performed at appropriate intervals to follow follicular development. Follicle sizes, quantity, and endometrial thickness were recorded. Total Antioxidant and Oxidant Status, and Oxidative analyses were conducted using Rel Assay Diagnostics Assay Kits. RESULTS: The average number of total oocytes in the participants was 10.25±6.66, and the average of mature M2 stage oocytes was 6.71±3.72. The average number of fertilized oocytes was 4.65±2.81. Fertilization rates were calculated as approximately 54.75±25.58%. A statistically significant positive correlation was found between embryo quality and serum Total Antioxidant Status levels (p=0.004). Similarly, a significant positive correlation was observed between embryo quality and follicular Total Antioxidant Status values (r = 0.42, p = 0.01). CONCLUSION: This study concluded that oxidative stress markers affect certain stages of the IVF treatment process.
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