Pedro Paulo Pereira

Abortamento espontâneo e provocado: ansiedade, depressão e culpa

BACKGROUND: Pregnancy has a symbolic meaning for each woman. It varies according to personality structure and is related to womens previous life experiences. OBJECTIVES: the aim was to characterize the women that suffered abortion, asking about anxiety and depression, looking for guilty feelings after abortion, and to compare results between women who suffered spontaneous abortion and those who had intentional abortion. METHODS: fifty women with spontaneous and fifty with induced abortion were interviewed 30 days after the procedure. A semistructured questionnaire with open and closed-end questions and Hospital Anxiety and Depression Scale were administered. RESULTS: woman who induced abortion revealed to be more anxious (mean 11) and depressed (mean 8.3) than woman with spontaneous abortion (means 8.7 and 6.1 respectively, p<0.05). CONCLUSIONS: women who presented induced abortion were more anxious and depressed, as shown by later life events, full of problematic feelings and the need fort sychological support.

Emergency contraception and ectopic pregnancy: report of 2 cases

The incidence of ectopic pregnancy has been increasing over the last few years, reaching a value of 1 case in 80 pregnancies, and it continues to be the main cause of maternal death during the first trimester in the United States. The main causes of tubal ectopic pregnancy, which generally results from damage to or dysfunction of the fallopian tubes, are salpingitis, previous tubal surgeries, and alteration in tubal motility mainly due to the use of certain contraceptive methods. Emergency [...]

Serum markers in the diagnosis of tubal pregnancy

The introduction of highly sensitive methods, such as transvaginal sonography and measurement of serum β-human chorionic gonadotropin, has dramatically improved ectopic pregnancy diagnosis in recent years. Early diagnosis is the key to successful and conservative management of women with ectopic pregnancy; however, approximately 50 percent of such women are initially misdiagnosed, resulting in significant morbidity and mortality. In order to improve diagnosis, several serum markers are being investigated including progesterone, CA 125, pregnancy-associated plasma protein-A, vascular endothelial growth factor, and maternal creatine kinase. Measurement of serum vascular endothelial growth factor, alone or together with other markers, could be a promising method for earlier and more accurate differential diagnosis. However, the clinical applicability of these findings remains to be evaluated in larger prospective studies.

Vascular endothelial growth factor and β-human chorionic gonadotropin are associated with trophoblastic invasion into the tubal wall in ectopic pregnancy

OBJECTIVE To assess the association between the depth of trophoblastic penetration into the tubal wall with serum concentrations of vascular endothelial growth factor (VEGF) and β-hCG and to assess its predictive value. DESIGN Prospective study. SETTING Tertiary care university hospital. PATIENT(S) Thirty patients with ampullary pregnancy undergoing salpingectomy were analyzed. INTERVENTION(S) Trophoblastic invasion was histologically classified as stage I when limited to the tubal mucosa, stage II when extending to the muscle layer, and stage III in the case of complete tubal wall infiltration. MAIN OUTCOME MEASURE(S) The relation between depth of trophoblastic infiltration into the tubal wall with VEGF and β-hCG serum concentrations on the day of surgery. RESULT(S) An association between the depth of trophoblastic invasion and maternal serum concentrations of VEGF and β-hCG was observed. VEGF levels of 297.2 pg/mL showed 100.0% sensitivity and 90.0% specificity for stage I, and levels of 440.1 pg/mL showed 81.8% sensitivity and 88.8% specificity for stage III. Beta-hCG levels of 2590.0 mIU/mL showed 88.9% sensitivity and 80.0% specificity for stage I, and levels of 10,827.0 mUI/mL showed 72.7% sensitivity and 88.9% specificity for stage III. CONCLUSION(S) Maternal serum VEGF and β-hCG concentrations are associated with depth of trophoblastic penetration into the tubal wall.

Tratamento do abortamento incompleto por aspiração manual ou curetagem

OBJETIVOS: Comparar aspiracao manual intra-uterina (AMIU) com curetagem uterina (DC anestesia foi realizada em todos os casos. O tempo para realizacao de cada procedimento cirurgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto a idade gestacional (9,93±2,40; 9,73±2,58, p 0,71), espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65). Nao foram observadas complicacoes cirurgicas ou anestesicas em nenhum grupo. Os tempos de realizacao do procedimento e internacao foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p < 0,001) (14,18; 23,06 h, p 0,03). O decrescimo nos niveis de hemoglobina apos o procedimento cirurgico foi maior no grupo D&C (p= 0,02). CONCLUSAO: A AMIU possibilita menor perda sanguinea, requer menor tempo de realizacao do procedimento e menor tempo de internacao hospitalar. Entretanto, ambos os procedimentos cirurgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestacao, nao havendo complicacoes apos a realizacao dos tratamentos.

Intrauterine pregnancy after salpingectomy for tubal pregnancy due to emergency contraception: a case report.

Ectopic pregnancy (EP) is the fourth most frequent cause of maternal death in the United Kingdom, and it is the main cause of maternal death during the first trimester in the United States. The Fallopian tubes are the most frequently affected site by EP. The main causes of tubal pregnancy are salpingitis, previous tubal surgeries, and alteration in tubal motility mainly due to the use of certain contraceptive methods. Most recently, the use of 750 μg of levonorgestrel as an emergency contraceptive method has been identified as another risk factor for EP. The diagnosis of an EP before rupture permits conservative treatment in order to preserve subsequent patient fertility. However, the conservative approach might be questioned because it is associated with a higher recurrence rate when compared with salpingectomy. Additionally, salpingectomy does not change subsequent patient fertility when (i) the contralateral tube seems to be healthy, (ii) the patients are younger than 30 years, and (iii) there is no previous history of infertility. In these patients, subsequent intrauterine pregnancy rate reaches approximately 70% at 2 years. We report here a case of intrauterine pregnancy (IUP) that occurred after salpingectomy in a patient previously undergoing tubal pregnancy without any apparent risk factors for EP other than the use of emergency contraceptive pills containing 0.75 mg levonorgestrel (Postinor 2).

Association between ultrasound findings and extent of trophoblastic invasion into the tubal wall in ampullary pregnancy

Predictive factors of damage to the Fallopian tube may guide the treatment of patients with tubal pregnancy. The aim of the present study was to investigate the association between the depth of trophoblastic invasion into the tubal wall, assessed on postoperative histological examination, with the findings obtained on transvaginal sonography (TVS) in women with ampullary pregnancy.

Ectopic pregnancy following levonorgestrel emergency contraception

This letter to the editor reports on a case of intrauterine pregnancy that occurred after salpingectomy in a patient previously undergoing tubal pregnancy without any apparent risk factors for ectopic pregnancy (EP) other than the use of emergency contraceptive pills containing 0.75 mg levonorgestrel. It emphasizes that salpingectomy does not impede future intrauterine pregnancy especially when the contralateral tube seems normal; in turn conservative treatment should be offered to selected cases.

Achados Ultra-Sonográficos em Pacientes com Ameaça de Abortamento no Primeiro Trimestre da Gestação

Objective: to evaluate ultrasound findings in pregnant women with threatened abortion in the first trimester of pregnancy. Methods: transabdominal and transvaginal ultrasound scans were performed in patients with vaginal bleeding with previous positive pregnancy test. Patients with 6-14-week gestation (by the last menstrual period or ultrasound scan), with closed cervix on clinical evaluation were included. Multiple pregnancies and those patients who have tried abortion by using abortive drugs or manipulation were excluded. Results: in 132 of 247 (53.4%) the pregnancy was viable and in 46.6% (115/247) the pregnancy was nonviable. Incomplete miscarriage was found in 19% (47/247), complete miscarriage in 8.5% (21/247), missed abortion in 7.7% (19/247), anembryonic pregnancy in 6.1% (15/247), ectopic pregnancy in 4.5% (11/247) and hydatidiform mole in 0.8% (2/247). Conclusion: almost half (46.6%) of the pregnancies with threatened abortion in the first trimester were diagnosed as a nonviable pregnancy. The ultrasound scan can help to define this condition and the management of the pregnancy.

Association between ultrasound findings and serum levels of vascular endothelial growth factor in ampullary pregnancy

OBJECTIVE To assess the association between ultrasound images and serum concentrations of vascular endothelial growth factor (VEGF) in ampullary pregnancies. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Fifty patients with ampullary pregnancy. INTERVENTION(S) Criteria for inclusion in the study were: singleton pregnancy from spontaneous conception; diagnosis of tubal pregnancy in the ampullary region; radical surgical treatment (salpingectomy); and measurement of serum VEGF, human chorionic gonadotropin, and progesterone on the day of surgery. An additional criterion was description of an ectopic mass by transvaginal ultrasound, as follows: [1] ectopic gestational sac containing an embryo with cardiac activity; and [2] tubal ring: a paraovarian formation similar to a gestational sac, not containing a viable embryo (an anechoic structure surrounded by a peripheral hyperechogenic halo); an empty ectopic gestational sac; a sac containing an embryo without cardiac activity; or a vitelline vesicle. MAIN OUTCOME MEASURE(S) Association between ultrasound images and serum concentrations of VEGF. RESULT(S) An association was found between ultrasonographic images and VEGF serum concentrations. Ectopic embryos with cardiac activity were associated with higher levels of serum VEGF. CONCLUSION(S) In ampullary pregnancy, higher serum levels of VEGF are associated with the finding of an embryo with cardiac activity on transvaginal ultrasound. Greater production of VEGF likely creates development conditions more conducive to ectopic embryos.