Miriam da Silva Wanderley

Fatores associados ao futuro reprodutivo de mulheres desejosas de gestação após ligadura tubária

PURPOSE: to analyze the factors associated with the reproductive future of patients wishing to become pregnant after having being submitted to tubal ligation (TL), attended at a public service. METHODS: a prospective study including 98 patients previously submitted to TL, who came to the Human Reproduction Center of the University Hospital of Brasilia (HUB), from January 1996 to January 2004, wishing to become pregnant again These patients were followed up from their first appointment till the end of the study, when they answered a structured questionnaire about the social demographic aspects at both the moment they asked for the TL and the reversion of the procedure. RESULTS: the patientsx92 average age at the TL procedure was 25 years old. Among them, 55.1% were younger than 25, 46.9% had three or more children, and ten of them had only one child. The most common reasons for the TL procedure were: contraception (48%), financial difficulties (25.5%) and marital problems (15.3%). The major causes for wishing a new pregnancy were: a new relationship/marriage (80.6%), the desire of having another child with the same partner (8.2%), and the death of a child (6.1%). The regret time informed by most of the patients was between two and four years, and the search for reversion was between six and ten years. About 83.6% of the sample referred lack of information about the procedure and the difficulties of reversion. Twenty patients were submitted to TL reversal procedure; from the ten who became pregnant, only six delivered babies, after a full-term pregnancy. Eight patients were referred to in vitro fertilization treatment, four of them became pregnant and two delivered healthy babies. CONCLUSIONS: TL in young vulnerable women, not informed about the definitive condition of the method, may increase the search for attended reproduction services and impair their reproductive future, as far as only 8.1% of the sample delivered babies and reached their goal.

Avaliação Clínica e Laboratorial de Crianças e Adolescentes com Queixas Vulvovaginais

Purpose: to assess the commonest vulvovaginal complaints and vaginal discharge etiology in the Child and Teenager Gynecologic Outpatient Clinic of the University Hospital of Brasilia (AGIP/HUB). Methods: we evaluated retrospectively 210 charts of patients, younger than 19 years old, who attended AGIP/HUB with vulvovaginal complaints. Results: the average age of the 210 patients was 12 ± 2.3 years, and the vaginal discharge and vulvar pruritus were the commonest complaints. Unspecific inflammatory conditions were observed in 147 (70%) of these patients and their treatment consisted of appropriate clothing, daily activities and hygienic orientation. Antibiotic treatment was necessary in 63 patients, where specific etiologic agents were found. Gardnerella, Trichomonas, HPV and syphilis were observed only in sexually active patients. They had had their first sexual intercourse when they were 14.1 ± 1.6 years old. Twenty patients also presented vulvar complaints that were easy to handle. Conclusion: Hygiene, clothing and adequate orientation for these patients and their families are fundamental to treat vulvovaginitis, almost always avoiding the use of antibiotics.

Association between Insulin Resistance and Cardiovascular Risk Factors in Polycystic Ovary Syndrome Patients

OBJECTIVEnu2003To analyze the association between the indirect methods of evaluating insulin resistance (IR) and blood pressure, anthropometric and biochemical parameters in a population of polycystic ovary syndrome (PCOS) patients.nnnMETHODSnu2003Cross-sectional study performed at the Hospital Universitário de Brasília (HUB, in the Portuguese acronym) involving PCOS patients diagnosed from January 2011 to January 2013. Four indirect methods, namely, fasting blood insulin level, fasting glucose/insulin ratio (G/I), homeostatic model-assessment-insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI), were used to obtain the IR diagnosis. The data were analyzed using the test of proportions, the Chi-square test, and Fisher exact test, when indicated.nnnRESULTSnu2003Out of the 83 patients assessed, aged 28.79u2009±u20095.85, IR was found in 51.81-66.2% of them using the G/I ratio and the QUICKI, respectively. The test of proportions did not show a significant difference between the methods analyzed. The proportion of IR diagnoses was statistically higher in obese women than in women with normal body mass index (BMI). We observed a statistically significant association between all the methods for diagnosing IR and BMI, waist circumference (WC) and lipid accumulation product (LAP). With regards to arterial hypertension (AH), we observed a significant association according to three methods, with the exception of the ratio G/I.nnnCONCLUSIONnu2003Insulin resistance prevalence varied according to the diagnostic method employed, with no statistical difference between them. The proportion of IR diagnoses was statistically higher in obese women than in women with normal BMI. We observed a significant association between IR and WC, BMI, LAP, as well as dyslipidemia and AH in a high proportion of patients.

Factors Associated with Malignancy in Hysteroscopically Resected Endometrial Polyps: a Systematic Review and Meta-Analysis

In this study, we aimed to estimate the frequency of premalignant and malignant lesions in endometrial polyps, and to evaluate associated clinical and demographic factors. A literature search was performed in major databases and the gray literature using the terms polyps OR endometrial polyp AND endometrial neoplasms OR endometrial cancer OR endometrial hyperplasia OR malignan*. Studies describing the frequency of premalignant and malignant lesions in endometrial polyps and any clinical or demographic factors associated with malignant lesions extracted using hysteroscopy were considered eligible. Independent investigators selected the studies and extracted the data. A meta-analysis was performed using a random-effects model and meta-regression. We identified 37 studies (comprising 21,057 patients) of endometrial polyps. The prevalence of premalignant and malignant lesions was 3.4% (95% confidence interval [CI], 2.8-4.1; I2, 80.5%). Abnormal uterine bleeding (prevalence ratio [PR], 1.47; 95% CI, 1.27-1.69; I2, 82.4%), menopausal status (PR, 1.67; 95% CI, 1.48-1.89; I2, 78.4%), age >60 years (PR, 2.41; 95% CI, 1.84-3.16; I2, 81.5%), diabetes mellitus (PR, 1.76; 95% CI, 1.43-2.16; I2, 0.0%), systemic arterial hypertension (PR, 1.50; 95% CI, 1.20-1.88; I2, 75.9%), obesity (PR, 1.41; 95% CI:1.13-1.76; I2, 41.2%), and tamoxifen use (PR, 1.53; 95% CI, 1.06-2.21; I2, 0.0%) were associated with endometrial polyp malignancy. However, breast cancer (PR, 0.83; 95% CI, 0.44-1.57; I2, 0.0%), hormonal therapy (PR, 0.93; 95% CI, 0.67-1.30; I2, 31.7%), parity (PR, 0.87; 95% CI, 0.39-1.96; I2, 78.1%), and endometrial polyp size (PR, 1.05; 95% CI, 0.70-1.57; I2, 44.7%) were not associated with malignancy of endometrial polyps. Three of every 100 women with clinically recognized polyps, a condition associated with specific clinical and demographic factors, will harbor premalignant or malignant lesions.

Ob-Gyn Gender Preferences of Gynecology Ambulatory Patients and Students' Choice of the Specialty

In a systematic review and meta-analysis of 23 studies from different countries worldwide, Tobler et al1 reported that when choosing an Ob-Gyn physician, 8.3% of the patients investigated preferred a male physician, 50.2% reported a preference for a female physician, and 41.3% indicated no gender preference. Notably, the data from the United States sub analysis of studies showed a similar pattern (53.2% of the patients preferred a female Ob-Gyn, and 38.5% admitted no gender preference).1 Individual studies have reported various rates for the patients’ Ob-Gyn gender preferences, as well as for the factors or motives underlying the patients’responses.2–4 Moreover, gender restriction also occurs regarding student participation in Gynecology consultations, as other articles have mentioned. The bias regarding the involvement of the medical students seems multifaceted and could affect the students’ perceptions of the specialty.5–9 Nevertheless, data froman exploratory studywithGynecology ambulatory patients conducted at a university hospital in the city of Brasília, Brazil, and approved by the Committee of Ethics of the Faculty of Medicine of that institution (under CAAE 45773315.3.0000.5558) unveiled a distinct preference profile regarding Ob-Gyn. In the personal interview with 435 patients awaitinga call for their consultation,2.1%among them preferred a male Ob-Gyn physician, 17.0% preferred a female one, and 80.9% indicated no gender preference. A contingency analysis showed a positive weak relationship of the patients’ Ob-Gyn gender preferences with the frequency in which they attended Gynecology consultations (Kendal tau b 1⁄4 0.116, p 1⁄4 0.011, N 1⁄4 435), but not with their educational level (Kendal tau b 1⁄4 0.70, p 1⁄4 0.116, N 1⁄4 435). The cross-tabulation analysis also revealed a weak association between the patients’ 3 generation categories (age) and the Ob-Gyn gender preference (Cramer V 1⁄4 0.104, p 1⁄4 0.047, N 1⁄4 435). Among the middle generation patients (those aged between 35–54 years), 2.2% reported a preference for a male Ob-Gyn physician, 12.2% preferred a female one, and 85.6% had no gender preference. Both the younger generation (those aged between 12–34 years) and the older generation patients (those aged 55 years) displayed a higher proportion (22.2% and 22.5% respectively) of preference for a female Ob-Gyn physician and a lower percentage (76.9% and 74.2% respectively) of reports of no gender preference. The similarities found between the younger and the older generations are a matter for future discussions. Another contingency analysis revealed a congruence between the Ob-Gyn physician gender preferences and the patients’ feelings about the prospect of the participation of a medical student in the Gynecology appointment: 0.2% of the patients stated they would only feel comfortable with male students, 10.6% reported that theywould not feel comfortable with the participation of any student, 18.9 % said they would only feel comfortable with female students, and 70.3% stated they would feel comfortable with either a female or a male student (70.3%). A test showed a significant association between the two categories (comfort status and Ob-Gyn-gender): 63% of the patients had no gender preferences regarding the Ob-Gyn or the student, while 8.1% showed a preference for the female gender for both the Ob-Gyn physician and the student (Cramer V1⁄4 0.265, p < 0.001, N 1⁄4 433). Could gender issues relate to the medical students’ option for specialization in Ob-Gyn? In the past 23 years, we have observed no significant trends in the preference for the ObGyn specialization upon admission either among male or

Lactation Induction in a Commissioned Mother by Surrogacy: Effects on Prolactin Levels, Milk Secretion and Mother Satisfaction

Case report of a 39-year-old intended mother of a surrogate pregnancy who underwent induction of lactation by sequential exposure to galactagogue drugs (metoclopramide and domperidone), nipple mechanical stimulation with an electric pump, and suction by the newborn. The study aimed to analyze the effect of each step of the protocol on serum prolactin levels, milk secretion and mother satisfaction, in the set of surrogacy. Serum prolactin levels and milk production had no significant changes. Nevertheless, the mother was able to breastfeed for four weeks, and expressed great satisfaction with the experience. As a conclusion, within the context of a surrogate pregnancy, breastfeeding seems to bring emotional benefits not necessarily related to an increase in milk production.

Escolha de ginecologia e obstetrícia por graduandos da Universidade de Brasília: um estudo de influências numa série histórica

The authors studied the choice of Obstetrics and Gynecology (Ob-Gyn) by medical graduates, in relation to personal features, program-related features and historical context. The study involved 792 students who graduated from the University of Brasilia in the period from 1994 to 2006. Data included demographics, learning attributes, early career preference, peer-tutoring experience, academic achievement, selective training in the final semester, and choice of residency training. Contingency and logistic regression analyses were performed with the graduates grouped according to choice of Ob-Gyn or any other option. Overall, 8% graduates selected GO of whom 33% had indicated early attraction to the specialty. No significant temporal trend was observed for either choice or early attraction. However, during a 5-years period, fewer graduates than the initially attracted by the specialty chose Ob-Gyn, a fact associated with program-environment changes. The logistic regression analysis identified six independent predictive factors: selective training, peer-tutoring and incremental achievement in Ob-Gyn, early preference for the specialty, (female) gender and date of graduation. In conclusion, the study revealed that the predictors of Ob-Gyn choice in a 13-years timeframe involved personal features, curricular events and the phase of the institutional conjuncture.

Vaginose Bacteriana em Mulheres com Infertilidade e em Menopausadas

Purpose: to evaluate the prevalence of bacterial vaginosis (BV) in menopausal and in infertile outpatients and to analyze the current clinical diagnostic methods. Methods: we evaluated retrospectively 104 menopausal women and 86 with infertility. Characteristic vaginal discharge on gynecological examination, pH >4.5, positive KOH whiff test, and bacterial vaginosis by Gram test were considered positive. BV was established when at least 3 out of 4 criteria were found. Results: among the menopausal women, 29 patients (28.1%) were clinically positive for BV, 10 (9.6%) had positive whiff test, 68 (65.4%) vaginal pH >4.5, and 34 (32.7%) positive Gram test. For the infertile patients the figures were 20 (23.2%), 13 (15.1%), 61 (70.9%) and 26 (30.2%), respectively. According to our established criteria, BV was diagnosed in 14 menopausal (13.5%) and 15 infertile (17.4%) women. Conclusion: bacterial vaginosis prevalence was similar in both groups of patients. In addition, all diagnostic criteria should be followed in order to avoid underdiagnosing this pathology or treating an otherwise normal vaginal flora.