Cartagena-Ramos D, Fuentealba-Torres M, Rebustini F
… +5 more, Alves J, Scholze A, Lara LADS, Arcêncio R, Nascimento LC
Rev Bras Ginecol Obstet
· 2024 · PMID 39530066
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OBJECTIVE: To traslate and validate of the Brazilian version of the SDI-2. METHODS: This was a cross-sectional study. The cultural adaptation considered the stages of initial translation, synthesis of translations, evalu...OBJECTIVE: To traslate and validate of the Brazilian version of the SDI-2. METHODS: This was a cross-sectional study. The cultural adaptation considered the stages of initial translation, synthesis of translations, evaluation by a committee of experts from different regions of Brazil, back-translation, and pre-test. The content validity and psychometric proprieties was assessed. RESULTS: Ten specialists participated in the cultural adaptation of the SDI-2. The content validity showed a Content Validity Ratio (CVR) ≥ 0.75 ( = 0.05). A total of 674 subjects participated in the field study. The Exploratory Factorial Analysis (EFA) presented factor loads ≥ 0.445, and commonalities ≥ 0.40; and two dimensions represented 77% of the total variance explained. The Confirmatory Factorial Analysis CFA presented /df = 4.265; the Root Mean Square Error of Approximation RMSEA = 0.110; the Non-Normed Fit Index NNFI = 0.946; the Comparative Fit Index (CFI) = 0.963; the Goodness of Fit Index GFI = 0.986; and the Adjusted Goodness of Fit Index AGFI = 0.979 for a two-factor model. The coefficient values for the total SDI-2 score were 0.91 for Cronbach's alpha, 0.91 for McDonald's Omega, and 0.97 for the Greatest Lower Bound GLB coefficients. The invariance between sexes was 0.01 for the ΔCFI and ΔRMSEA, showing model stability for these two populations. CONCLUSION: The Brazilian version of the SDI-2 is self-report, valid, reliable and invariant across sex.
Chaves LT, Maia R, Borges Peixoto A
… +2 more, Araujo Júnior E, Elito J
Rev Bras Ginecol Obstet
· 2024 · PMID 39381345
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OBJECTIVE: To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic. METHODS: We performed a retrospective cohort study o...OBJECTIVE: To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic. METHODS: We performed a retrospective cohort study of all cases of tubal EP between March 2019 and March 2020 (pre-pandemic) and between March 2020 and March 2021 (pandemic). We compared between these two groups the risk factors, clinical characteristics, laboratory data, sonographic aspects, treatment applied and complications. RESULTS: We had 150 EP diagnoses during the two years studied, of which 135 were tubal EP. Of these, 65 were included in the pre-pandemic and 70 in the pandemic period. The prevalence of lower abdominal pain was significantly higher in the pandemic compared to the pre-pandemic period (91.4% vs. 78.1%, p=0.031). There was no significant difference in shock index, initial beta-hCG level, hemoglobin level at diagnosis, days of menstrual delay, aspect of the adnexal mass, amount of free fluid on ultrasound, and intact or ruptured presentation between the groups. Expectant management was significantly higher during the pandemic period (40.0% vs. 18.5%, p=0.008), surgical management was lower during the pandemic period (47.1% vs. 67.7%, p=0.023), and number of days hospitalized was lower in the pandemic period (1.3 vs. 2.0 days, p=0.003). CONCLUSION: We did not observe a significant difference in patient history, laboratory and ultrasound characteristics. Abdominal pain was more common during the pandemic period. Regarding treatment, we observed a significant increase in expectant and a decrease in surgical cases during the pandemic period.
Pessoa LLMN, de Souza ATB, Sarmento ACA
… +6 more, Ferreira Costa AP, Kelly Dos Santos I, Pereira de Azevedo E, de Medeiros KS, Gonçalves AK, Cobucci RN
Rev Bras Ginecol Obstet
· 2024 · PMID 39381344
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OBJECTIVE: This meta-analysis of randomized controlled trials (RCTs) aimed to update evidence on the effectiveness and safety of laser therapy for treating genitourinary syndrome of menopause (GSM). DATA SOURCES: Manuscr...OBJECTIVE: This meta-analysis of randomized controlled trials (RCTs) aimed to update evidence on the effectiveness and safety of laser therapy for treating genitourinary syndrome of menopause (GSM). DATA SOURCES: Manuscripts published until May 2023 were systematically searched in PubMed; Embase; Scopus; Web of Science; CENTRAL; CINAHL; and clinical trial databases (www.trialscentral.org, www.controlled-trials.com, and clinicaltrials.gov), with no language and year of publication restriction. STUDIES SELECTION: RCTs with women diagnosed with GSM, and the intervention was vaginal laser therapy (CO2-laser or Er: YAG-laser) comparing with placebo (sham therapy), no treatment or vaginal estrogen therapy. DATA COLLECTION: Two authors evaluated the publications for inclusion based on the title and abstract, followed by reviewing the relevant full-text articles. Disagreements during the review process were addressed by consensus, with the involvement of a third author. DATA SYNTHESIS: Twelve RCTs, representing a total of 5147 participants, were included in this review. Vaginal health index (VHI) significantly improved in the carbon dioxide laser (CO2-laser) therapy group (MD=2.21; 95% CI=1.25 to 3.16), while dyspareunia (MD=-0.85; 95% CI=-1.59 to -0.10), dryness (MD=-0.62; 95% CI=-1.12 to -0.12) and burning (MD= -0.64; 95% CI=-1.28 to -0.01) decreased. No serious adverse effects were reported. CONCLUSION: CO2-laser increases VHI score and decreases dyspareunia, dryness and burning, especially when compared to sham-laser. However, the certainty of the evidence is low, thus preventing the recommendation of laser therapy for GSM management.
Venturin AB, Faria-Schützer DB, Del Risco Sánchez O
… +3 more, Rodrigues L, Herculano TB, Surita FG
Rev Bras Ginecol Obstet
· 2024 · PMID 39381343
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OBJECTIVE: To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period. METHODS: A qualitative design was employed with face-to-face inter...OBJECTIVE: To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period. METHODS: A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation. RESULTS: Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question. CONCLUSION: Professionals' communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion.
Rev Bras Ginecol Obstet
· 2024 · PMID 39381342
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The main causes of difficult fetal extraction during cesarean section are deeply impacted fetal head and floating presentation of the fetus. Studies of management techniques for difficult fetal extraction during cesarean...The main causes of difficult fetal extraction during cesarean section are deeply impacted fetal head and floating presentation of the fetus. Studies of management techniques for difficult fetal extraction during cesarean section and the maternal and neonatal results lack scientific evidence, as these predominantly come from case reports, small case series and expert opinions. The deeply impacted fetal head is usually associated with prolongation of the expulsion period and/or unsuccessful attempts at operative vaginal delivery. The main maternal complications associated with the management of the deeply impacted fetal head are lacerations in the lower uterine segment, hematomas in the uterine ligaments and injuries to the uterine vessels, cervix and/or urinary tract. The main neonatal complications associated with the management of a deeply impacted fetal head are intracranial hemorrhage, fractures of the skull and/or cervical spine, nerve injuries, perinatal asphyxia and even death. Among the maneuvers for delivery of the deeply impacted fetal head, the abdominovaginal delivery (push method) seems to be the most associated with maternal and neonatal complications. In the non-insinuated and floating fetal head, the internal podalic version followed by pelvic extraction differs from the reverse breech extraction (pull method). When the fetal head is high in the pelvis, the fetus is internally ejected before the extraction of its body segments, similar to the internal version performed in the vaginal delivery of the second twin with floating presentation of the fetus.
Korkes HA, Cavalli RC, Oliveira LG
… +14 more, Ramos JGL, Martins Costa SHA, de Sousa FLP, Vieira da Cunha E, de Souza Mesquita MR, Dias Corrêa M, Pinheiro Fernandes Araújo AC, Zaconeta ACM, Freire CHE, Poli de Figueiredo CE, da Rocha EAP, Sass N, Peraçoli JC, Costa ML
Rev Bras Ginecol Obstet
· 2024 · PMID 39381341
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In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associat...In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.
Yoneda JY, Santiago AE, Teixeira JC
… +4 more, Machado HC, Derchain S, Yonamine M, Vale DB
Rev Bras Ginecol Obstet
· 2024 · PMID 39381338
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OBJECTIVE: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. METHODS: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which...OBJECTIVE: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. METHODS: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. RESULTS: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. CONCLUSION: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.
Moreira da Cunha R, Oliveira Veloso M, Coutinho SS
… +6 more, Darc de Menezes Braga L, de Barros AS, Magalhães GM, Lima POP, Lira do Nascimento S, Bezerra LRPS
Rev Bras Ginecol Obstet
· 2024 · PMID 39381337
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OBJECTIVE: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). METHODS: C...OBJECTIVE: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). METHODS: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. RESULTS: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (<.001), difficulty in relaxation (=.019), and lower Endurance on EMG (=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (=.02). TP in the right OIM presented increased muscle tone (=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. CONCLUSION: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Mundim de Oliveira I, Dos Santos RC, Alves Silva R
… +3 more, Figueiredo Alves RR, Teodoro Martins BC, Soares LR
Rev Bras Ginecol Obstet
· 2024 · PMID 39381336
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OBJECTIVE: This systematic review accompanied by a meta-analysis aimed to estimate the prevalence of syphilis in pregnant women in Brazil and describe its associated factors. METHODS: Following the establishment the sear...OBJECTIVE: This systematic review accompanied by a meta-analysis aimed to estimate the prevalence of syphilis in pregnant women in Brazil and describe its associated factors. METHODS: Following the establishment the search strategies and the registration of the review protocol in PROSPERO, we conducted a search for relevant articles in the Pubmed, LILACS, Science Direct, SciELO and Web of Science databases. Our inclusion criteria were cross-sectional studies published between 2005 and 2023, with no language restrictions. The combined prevalence of syphilis infection was estimated using the random effects model in the R Software with a 95% confidence interval (95% CI) and p < 0.01 as statistically significant. RESULTS: A total of 24 articles were recruited, which together investigated 221,884 women. The combined prevalence of syphilis in pregnant women in Brazil was 1.79% (95% CI: 1.24-2.57%), and the main factors associated with its occurrence were black and brown skin color, low education and factors related to the partner. CONCLUSION: There was a high prevalence of syphilis in pregnancy in Brazil, mainly associated with socioeconomic factors.
Lopes da Silva A, Eduardo Soares Pinhati M, Lage Neves G
… +4 more, Naves Gonçalves de Almeida E, Lamaita Lopes T, Mara Lamaita R, Batista Cândido E
Rev Bras Ginecol Obstet
· 2024 · PMID 39381335
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Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This p...Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.
Santos ACFF, Zamora FV, Al-Sharif L
… +4 more, Sehgal K, Cavalcante DVS, Ferreira SH, da Silva PHCM
Rev Bras Ginecol Obstet
· 2024 · PMID 39380592
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OBJECTIVE: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyc...OBJECTIVE: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. DATA SOURCE: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. STUDY SELECTION: Randomized clinical trials and observational studies with the outcomes of interest were included. DATA COLLECT: We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. DATA SYNTHESIS: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). CONCLUSION: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO: CRD42023449655.
Argenta LDCB, Dos Santos NHA, Saunders C
… +4 more, da Costa JD, da Cunha LVS, Fedeszen PMK, Padilha PC
Rev Bras Ginecol Obstet
· 2024 · PMID 39380591
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OBJECTIVE: To evaluate the association between the dietary patterns (DPs) of pregnant women with GDM (gestational diabetes ) and the birth weight (BW) of the infants. METHODS: Cross-sectional study with 187 adult pregnan...OBJECTIVE: To evaluate the association between the dietary patterns (DPs) of pregnant women with GDM (gestational diabetes ) and the birth weight (BW) of the infants. METHODS: Cross-sectional study with 187 adult pregnant women with GDM attended at a maternity in Rio de Janeiro from 2011 to 2014. Dietary intake was assessed in the third trimester using a semiquantitative food frequency questionnaire (FFQ). The outcomes were BW and weight adequacy for gestational age (GA). Reduced Rank Regression (RRR) was used to explain the following response variables: density of carbohydrates, fibres, and saturated fatty acids. Statistical analyzes included multinomial logistic regression models. RESULTS: The mean BW was 3261.9 (± 424.5) g. Three DPs were identified, with DP 3 (high consumption of refined carbohydrates, fast foods/snacks, whole milk, sugars/sweets, and soft drinks and low consumption of beans, vegetables, and low-fat milk and derivatives) being the main pattern, explaining 48.37% of the response variables. In the multinomial logistic regression analysis no statistically significant association was found between the tertiles of DPs and BW or the adequacy of weight for GA, even after adjustments of confounding covariates. CONCLUSION: No significant associations were found between maternal DPs in the third trimester of pregnancy and infant BW or adequacy of weight for GA.
Oliveira JA, da Silva EG, Karasu AFG
… +2 more, Silva AMN, Philip CE
Rev Bras Ginecol Obstet
· 2024 · PMID 39380590
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OBJECTIVE: To compare the effectiveness and safety of non-mRNA versus mRNA COVID-19 vaccines on pregnant women and their newborns in a systematic review with meta-analysis. DATA SOURCES: We searched PubMed, Embase, and C...OBJECTIVE: To compare the effectiveness and safety of non-mRNA versus mRNA COVID-19 vaccines on pregnant women and their newborns in a systematic review with meta-analysis. DATA SOURCES: We searched PubMed, Embase, and Cochrane Central in May 2023. STUDY SELECTION: The search strategy yielded 4451 results, 16 studies were fully reviewed. We selected case-control studies analysing non-mRNA versus mRNA vaccines. Data collection and analysis: we assessed the risk of bias using the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Standardised mean differences were pooled using random-effect models. DATA SYNTHESIS: We identified 8 prospective and retrospective studies with a total of 32,153 patients. Non-mRNA vaccines were associated with a higher incidence of fever (OR 2.67; 95% CI 2.08-3.43; p<0.001), and a lower incidence of fetal or neonatal death (OR 0.16; 95% CI 0.08-0.33; p<0.001). In subgroup analyses, the Jansen vaccine (Ad26.COV2.S) was found to have a higher rate of premature labor/delivery (OR 4.48; 95% CI 1.45-13.83; p=0.009) and missed/spontaneous abortion (OR 1.90; 95% CI 1.09-3.30; p=0.02), as compared with the Pfizer (BNT162b2) vaccine. CONCLUSION: non-mRNA vaccines are associated with a lower incidence of fetal or neonatal death among pregnant women who receive a Covid19 vaccine, although at an increased rate of pyrexia compared with mRNA vaccines. Other studies are required for better assessment. PROSPERO: CRD42023421814.
Branco PESC, Franco AHS, de Oliveira AP
… +5 more, Carneiro IMC, de Carvalho LMC, de Souza JIN, Leandro DR, Cândido EB
Rev Bras Ginecol Obstet
· 2024 · PMID 39380589
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OBJECTIVE: To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography. DATA SOURCE: Our systematic review was cond...OBJECTIVE: To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography. DATA SOURCE: Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms "Artificial Intelligence," "Mammography," and their respective MeSH terms. We filtered publications from the past ten years (2014 - 2024) and in English. STUDY SELECTION: A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work. DATA COLLECTION: The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity. DATA SYNTHESIS: It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone. CONCLUSION: AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals.
França MS, de Andrade VL, Hatanaka AR
… +8 more, Santos R, Carvalho FHC, Costa ML, França GUS, Mattar R, Mol BW, Moron AF, Pacagnella RC
Rev Bras Ginecol Obstet
· 2024 · PMID 39380588
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OBJECTIVE: This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. METHODS: This is a...OBJECTIVE: This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. METHODS: This is a analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. RESULTS: The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. CONCLUSION: Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.
Rev Bras Ginecol Obstet
· 2024 · PMID 39380587
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OBJECTIVE: To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effective...OBJECTIVE: To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries. METHODS: A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled. RESULTS: In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue. CONCLUSION: Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
Saldarriaga-Hoyos JJ, Sarria-Ortiz D, Galindo-Velasco V
… +2 more, Rivera-Torres LF, Nieto-Calvache AJ
Rev Bras Ginecol Obstet
· 2024 · PMID 39380586
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OBJECTIVE: This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a compariso...OBJECTIVE: This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis. METHODS: A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson's Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%. RESULTS: A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 - 4000 vs 1700 ml, IQR 1195-2135. p <0.001). CONCLUSION: Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery.