Perinatal outcomes from the use of antiepileptic drugs during pregnancy: a case-control study.

OBJECTIVE: To evaluate the perinatal results from epileptic women using antiepileptic drugs during prenatal care. METHODS: This was a retrospective longitudinal study assessing the perinatal results of women exposed to antiepileptic drugs during pregnancy, and we compared these results with those of pregnant women who were not exposed. The development of pregnancy, gestational age at delivery, Apgar scores, biometric data, morbidity, stillbirths and neonatal mortality were analyzed. The chi-square test and Fisher's exact test were used for the categorical variables, while Student's t-test was used for independent numerical variables. RESULTS: Over a 10-year period, 12 790 singleton gestations were analyzed, among which 104 (0.8%) consisted of epileptic pregnant women. From this total, 82 evolved to childbirth and their neonatal data were compared with those of 316 newborns from non-epileptic women. The most-used antiepileptic drug was phenobarbital in 70% of the cases. There was greater neonatal mortality (p = 0.006), occurrence of neonatal hemorrhagic disorders (p = 0.005), and occurrence of minor congenital anomalies (p = 0.03) among the children of women exposed to antiepileptic drugs. CONCLUSION: The antenatal exposure to antiepileptic drugs is associated mainly with occurrences of hemorrhagic complications during the neonatal period; furthermore, great prevalence of newborns presenting minor congenital anomalies and elevated risk of neonatal mortality.

Ultrasound and Doppler assessment of uterus during puerperium after normal delivery.

OBJECTIVE: To describe the biometric and morphological characteristics of the uterus through ultrasound (US) and Doppler on the uterine arteries in the initial and late puerperium after normal delivery. METHODS: This was a prospective longitudinal study on full-term singleton pregnancies without complications. The patients were divided into two groups: 31 primiparous and 28 multiparous women. Two US exams were carried out with Doppler evaluation: firstly, within the initial 48 h; and secondly, between 31 and 50 days after childbirth. The US assessed the position and biometry of the uterus, appearance of the myometrium, measurement and content of the uterine cavity, and Doppler velocimetry indices of uterine arteries. To compare the groups at the two times, the paired Student t-test, Fisher's exact test and chi-square test were used. RESULTS: In the initial puerperium, the position of the uterus was retroversion (98.3%); the appearance of the myometrium was heterogeneous (96.6%); the uterine cavity was filled with some type of material (72.9%). After the 30th day, a position was anteversion (74.6%); the appearance of the myometrium was homogeneous (91.5%); and the uterine cavity was empty (81.3%). There was an evolution in the pulsatility index between the two US exams, with an increase of 52.03% among the primiparous and 53.13% among the multiparous for the right uterine artery. CONCLUSION: Significant changes were observed in the morphological and biometric characteristics of the uteruses evaluated through US, as well as in the uterine arteries Doppler, between the initial and late puerperium.

Effect of a combination of ethinylestradiol 30 microg and drospirenone 3 mg on tolerance, cycle control, general well-being and fluid-related symptoms in women with premenstrual disorders requesting contraception.

PURPOSE: Positive effects on premenstrual symptoms have been observed with low-dose oral contraceptives. Drospirenone is a synthetic progestogen with antiandrogenic and antimineralocorticoid effects. This open-label, multicenter study evaluated the effects of a combination of ethinylestradiol 30 microg and drospirenone 3 mg on safety, cycle control, general well-being and fluid-related symptoms in women with premenstrual disorders requesting contraception. MATERIALS AND METHODS: A total of 241 healthy volunteers with symptoms of premenstrual disorder was enrolled in the study. Of the final sample, 203 completed the six-cycle treatment and were included in the efficacy analysis whereas 236 were included in the tolerability analysis. The subjects recruited to the study were required to fill up the Psychological General Well-Being Index (PGWBI). RESULTS: There was no significant change in body weight or blood pressure throughout the treatment. Adverse events reported by patients during treatment consisted of those already known to be associated with oral contraceptive use. PGWBI scores were significantly higher after six cycles of treatment compared with baseline values (p<.0001). A total of 198 (84.2%) subjects reported a great improvement in premenstrual symptoms. CONCLUSIONS: The results of this study confirm that oral use of a combination of ethinylestradiol 30 microg and drospirenone 3 mg provides good cycle control, is well tolerated and has a positive impact on symptoms of premenstrual disorder.

Anticoncepção em mulheres com câncer / Contraception in women with cancer

Atualmente em nosso país e no mundo, um grande número de mulheres em idade reprodutiva apresentam diagnóstico de câncer e estão em tratamento ou seguimento desta doença. Assim, não pode ser esquecido o risco de gravidez nestas pacientes, que devem ser orientadas a usar métodos anticoncepcionais eficazes, imediatamente após o diagnóstico. A gravidez em momento inoportuno pode agravar o prognóstico estimulando a manifestação de metástases e alterando a remissão de alguns tumores. O câncer de mama vem incidindo cada vez mais entre as mulheres durante o menacme; opções contraceptivas adequadas seriam o uso de DIU ou de métodos de barreira. Nas pacientes com câncer de colo de útero damos preferência ao uso do injetável trimestral que contém somente progestagênio. Nas portadoras de melanoma deve ser evitado o uso dos hormonais. Nas mulheres com doenças oncológicas, pelo alto risco de intercorrências clínicas e maior incidência de mortalidade, a gravidez deve ser postergada até momento oportuno, diminuindo assim as conseqüências nefastas para sua própria saúde e para a do concepto. A indicação, o seguimento e controle dos métodos contraceptivos devem ser precoces e criteriosos.

Anticoncepcao hormonal / Hormonal anticonception

Os anticoncepcionais hormonais sao esteroides que possuempropriedades contraceptivas. Sao bastante difundidos, pois apresentam grande eficacia e boa tolerabilidade. Destacam-se, dentre os fatores que contribuiram para o sucesso do metodo, o progresso nas pesquisas sobre a fisiologia da reproducaohumana e o desenvolvimento de fontes comercialmente eficientes de esteroides

Dispositivo intra-uterino / Intrauterine devices

O dispositivo intra-uterino(DIU) constitui metodo anticoncepcional para ser inserido dentro da cavidade uterina, de grande eficacia e comalta taxa de continuidade.

Planejamento familiar / Family Planning

Planejamento familiar, como conceitua a Organizacao Mundial de Saude(OMS), e uma atividade de saude que visa a proporcionar as pessoas informacoes e meios a fim de que possam, livre, consciente e responsavelmente ,decidir sobre o numero e a epoca de terem seus filhos

Herpes simples I e II

O termo "herpes" foi usado durante séculos para denominar várias patologias, sendo muito temido. Hoje, ocorre principalmente em crianças de até cinco anos e adultos jovens, com uma expressividade clínica bastante variável. O período de incubaçäo varia de três a dez dias, existindo diversas modalidades de infecçäo herpética. Quanto ao diagnóstico do herpes simples dos tipos I e II, ele é eminentemente clínico, contando com exames laboratoriais, culturas, dosagens de anticorpos no soro, imunofluorescência e microscopia eletrônica. O tratamento esbarra na falta de uma terapêutica antivirótica específica

Herpes / Herpes

É apresentada uma revisäo das publicaçöes mais recentes sobre o herpes, com ênfase às relaçöes com a toco-ginecologia