Cervical Digital Photography: An Alternative Method to Colposcopy.

OBJECTIVE: This study sought to evaluate the performance of cervical digital photography as an alternative to colposcopy. METHODS: Colposcopy and cervical digital photography were performed on 228 women. The cervical digital photographs were evaluated through the Internet by three colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Next, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated for colposcopy and cervical digital photography. Histology was used as the gold standard (Canadian Task Force Classification II-2). RESULTS: Cervical digital photography and colposcopy were in agreement in 89.9% of the cases (κ = 0.588). Cervical digital photography had higher sensitivity (52.5%) and positive predictive value (60%) than colposcopy (35% and 48.28%, respectively). There were no other significant differences between cervical digital photography and colposcopy: specificity was 91.86% and 91.28%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. CONCLUSION: Cervical digital photography is a promising alternative method to colposcopy.

Comparison of serum selenium levels among hypertensive and normotensive pregnant women.

OBJECTIVE: To correlate serum selenium levels with hypertensive disorders of pregnancy (HDP) in a selected population and evaluate this mineral as a possible protective factor. METHODS: This case-control study included 32 normotensive, 20 hypertensive (chronic and gestational hypertension), and 38 preeclamptic pregnant women. All patients were recruited from antenatal or obstetric admissions of a tertiary hospital in Brazil. Serum selenium was measured at the time of inclusion. Patients were followed up until hospital discharge after delivery. RESULTS: Groups did not differ with regard to maternal age, ethnicity, educational attainment, parity, or smoking prevalence. Normotensive patients had lower body mass index and were included in the study earlier. These patients also had a higher prevalence of comorbidities other than hypertension. Continuous use of medication and a history of HDP in previous pregnancies were more common in preeclamptic patients. Serum selenium levels were not significantly different between groups, with an average of 56.4 ± 15.3 µg/L in the control group, 53.2 ± 15.2 µg/L in the hypertension group, and 53.3 ± 16.8 µg/L in the preeclampsia group (p = 0.67). Among patients with preeclampsia, 52.6% had the severe form. Serum selenium levels in these patients also did not differ significantly from those of controls (p = 0.77). Preeclampsia was associated with earlier termination of pregnancy and lower birth weight (p < 0.05). There were no significant differences across groups in other outcomes of interest. CONCLUSION: Serum selenium levels did not differ significantly between groups. Thus, we could not establish whether selenium is a protective factor against these conditions.

Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study.

OBJECTIVE: To compare the expulsion rates of intrauterine devices (IUDs) inserted in the immediate postpartum after vaginal birth and cesarean section. METHODS: Nineteen patients who had a vaginal birth and 19 patients who had a cesarean section at Hospital de Clínicas de Porto Alegre, Brazil, were selected for copper T 380A IUD insertion. With the aim of detecting clinically unnoticed dislodged devices, ultrasound examinations were performed at 1 month and between 3 and 12 months after delivery. The IUDs were considered completely expelled when found outside the endometrial cavity (e.g., in the cervical canal) or outside the uterus (in the vagina). RESULTS: Expulsion rates were statistically different between the two groups: after a vaginal birth, 50% (ultrasound only) + 27.8% (clinical examination); and post-cesarean section, 0% (p < .001; OR 5.75, 95% CI 2.36-14.01). CONCLUSION: Considering that the contraceptive efficacy of IUDs is associated with their intrauterine location, the high expulsion rates seen when they are inserted immediately after vaginal delivery contraindicate their use in this setting. The use of IUDs immediately after a cesarean section is still a reasonable alternative because its expulsion rate was zero. Ultrasound assessment of IUD positioning performed better than clinical examination, which failed to detect expulsion after postpartum insertion in 75% of the cases (9 from 12 cases).

Variation in the urinary protein/creatinine ratio at four different periods of the day in hypertensive pregnant women.

OBJECTIVE: To assess the urine protein/creatinine ratio in urine samples of pregnant women with hypertension in regard to: 1) the presence of significant variation at different periods of the day; 2) the differences if they exist, to identify the most reliable period of the day for sampling; and 3) whether the first sample, obtained when the patient arrives at the clinic, correlates with the same accuracy, with the 24-hour proteinuria. DESIGN: Cross-sectional study. PLACE: Obstetrics Emergency Department, Hospital de Clínicas de Porto Alegre, a teaching hospital in Porto Alegre, Brazil. POPULATION: Seventy-five women with hypertension with 20-week gestation or over. METHODS: Urine samples for determination of the protein/creatinine ratio were obtained on arrival (first specimen) and every 6 hours thereafter, totaling four samples in 24 hours. Four sampling periods were established: 1) from 8 am to 2 pm, 2) from 2 pm to 8 pm, 3) from 8 pm to 2 am, and 4) from 2 am to 8 am. The protein/creatinine ratio in the four different day periods were compared with the 24-hour proteinuria obtained simultaneously. The results were analyzed by the Spearman correlation and the receiver-operator characteristic (ROC) curve. RESULTS: The urine protein/creatinine ratio is strongly correlated (Spearman correlation equal to 0.8 or greater) with the 24-hour proteinuria at all four periods of the day (p<0.001), as well as the first sample obtained on arrival (p=0.003). These findings were corroborated by the ROC curve in which the values of four day periods and that of the first sample were equal to or greater than 0.930. CONCLUSION: In hypertensive pregnant women, the single voided urine sample protein/creatinine ratio, irrespective of sampling time, is strongly correlated with the 24-hour proteinuria, as is the sample obtained on arrival.

Are insulin resistance index, IGF-1 and metabolic syndrome components correlates with severe preeclampsia?

OBJECTIVE: Analyse the relation between insulin resistance and severe preeclampsia (SPE). METHODS: Case control study paired by body mass index and gestational age; including 16 patients with severe SPE and 16 normotensive controls. Insulin resistance was assessed through the HOMA-IR and QUICKI-IS indexes. RESULTS: There was no significant difference between the groups regarding the HOMA-IR and QUICKI-IS indexes and HDL cholesterol. Triglyceride levels were higher and the IGF-1 was lower in the SPE group than in the control group. CONCLUSIONS: There were no differences in the insulin resitance indexes between the group with SPE and normal controls.