Misoprostol Administration Before Hysteroscopy Procedures - A Retrospective Analysis / O uso do misoprostol prévio aos procedimentos histeroscópicos - Um estudo retrospectivo

Abstract Objective To evaluate the use of misoprostol prior to hysteroscopy procedures regarding technical ease, the presence of side effects, and the occurrence of complications. Methods This is a retrospective, observational, analytical, case-control study, with the review of medical records of 266 patients followed-up at the Gynecological Videoendoscopy Sector of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (HCFMRP - USP, in the Portuguese acronym) from 2014 to 2019, comparing 133 patients who used the drug before the procedure with 133 patients who did not. Results The occurrence of postmenopausal uterine bleeding was the main indication for hysteroscopy and revealed a statistical difference between groups (p < 0.001), being present in 93.23% of the patients in the study group and in 69.7% of the patients in the control group. Only 2 patients (1.5%) in the study group reported adverse effects. Although no statistical differences were observed regarding the occurrence of complications during the procedure (p = 0.0662), a higher total number of complications was noted in the group that used misoprostol (n = 7; 5.26%) compared with the group that did not use the drug (n = 1; 0.75%), a fact that is clinically relevant. When evaluating the ease of the technique (measured by the complete performance of all steps of the hysteroscopy procedure), it was verified that although there was no difference between groups (p = 0.0586), the control group had more than twice as many incompletely performed procedures (n = 17) when compared with the group that used misoprostol previously (n = 8), which is also clinically relevant. Conclusion The use of misoprostol prior to hysteroscopy in our service indicated that the drug can facilitate the performance of the procedure, but not without side effects and presenting higher complication rates.

Resumo Objetivo Avaliação do misoprostol prévio à histeroscopia quanto à facilidade técnica, efeitos colaterais e a ocorrência de complicações durante o procedimento. Métodos Estudo analítico observacional retrospectivo tipo caso controle com revisão de prontuários de 266 pacientes do Setor de Videoendoscopia Ginecológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (HCFMRP - USP), de 2014 a 2019, sendo comparadas 133 pacientes que utilizaram o medicamento prévio ao procedimento com 133 pacientes que não o utilizaram. Resultados Sangramento uterino após a menopausa foi a principal indicação de histeroscopia, apresentando diferença estatística (p < 0,001), estando presente em 93,23% das pacientes do grupo de estudo e em 69,17% das pacientes do grupo controle. Apenas 2 pacientes (1,5%) do grupo de estudo relataram efeitos adversos. Não foram observadas diferenças quanto à presença de complicações durante o procedimento (p = 0,0662), mas observamos um número total de complicações maior no grupo de estudo (n = 7; 5,26%) do que no grupo controle (n = 1; 0,75%), o que é clinicamente relevante. Não houve diferença entre os grupos quanto à facilidade técnica (p = 0,0586), mas o grupo controle apresentou mais do que o dobro de procedimentos não completamente realizados (n = 17) quando comparado com o grupo de estudo (n = 8), o que é clinicamente relevante. Conclusão O uso de misoprostol prévio à histeroscopia no nosso serviço demonstrou que ele pode facilitar a realização do procedimento, mas não é isento de efeitos colaterais e apresenta maiores taxas de complicações.

Misoprostol Administration Before Hysteroscopy Procedures - A Retrospective Analysis.

OBJECTIVE: To evaluate the use of misoprostol prior to hysteroscopy procedures regarding technical ease, the presence of side effects, and the occurrence of complications. METHODS: This is a retrospective, observational, analytical, case-control study, with the review of medical records of 266 patients followed-up at the Gynecological Videoendoscopy Sector of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (HCFMRP - USP, in the Portuguese acronym) from 2014 to 2019, comparing 133 patients who used the drug before the procedure with 133 patients who did not. RESULTS: The occurrence of postmenopausal uterine bleeding was the main indication for hysteroscopy and revealed a statistical difference between groups (p < 0.001), being present in 93.23% of the patients in the study group and in 69.7% of the patients in the control group.: Only 2 patients (1.5%) in the study group reported adverse effects. Although no statistical differences were observed regarding the occurrence of complications during the procedure (p = 0.0662), a higher total number of complications was noted in the group that used misoprostol (n = 7; 5.26%) compared with the group that did not use the drug (n = 1; 0.75%), a fact that is clinically relevant. When evaluating the ease of the technique (measured by the complete performance of all steps of the hysteroscopy procedure), it was verified that although there was no difference between groups (p = 0.0586), the control group had more than twice as many incompletely performed procedures (n = 17) when compared with the group that used misoprostol previously (n = 8), which is also clinically relevant. CONCLUSION: The use of misoprostol prior to hysteroscopy in our service indicated that the drug can facilitate the performance of the procedure, but not without side effects and presenting higher complication rates.

OBJETIVO: Avaliação do misoprostol prévio à histeroscopia quanto à facilidade técnica, efeitos colaterais e a ocorrência de complicações durante o procedimento. MéTODOS: Estudo analítico observacional retrospectivo tipo caso controle com revisão de prontuários de 266 pacientes do Setor de Videoendoscopia Ginecológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (HCFMRP ­ USP), de 2014 a 2019, sendo comparadas 133 pacientes que utilizaram o medicamento prévio ao procedimento com 133 pacientes que não o utilizaram. RESULTADOS: Sangramento uterino após a menopausa foi a principal indicação de histeroscopia, apresentando diferença estatística (p < 0,001), estando presente em 93,23% das pacientes do grupo de estudo e em 69,17% das pacientes do grupo controle. Apenas 2 pacientes (1,5%) do grupo de estudo relataram efeitos adversos. Não foram observadas diferenças quanto à presença de complicações durante o procedimento (p = 0,0662), mas observamos um número total de complicações maior no grupo de estudo (n = 7; 5,26%) do que no grupo controle (n = 1; 0,75%), o que é clinicamente relevante. Não houve diferença entre os grupos quanto à facilidade técnica (p = 0,0586), mas o grupo controle apresentou mais do que o dobro de procedimentos não completamente realizados (n = 17) quando comparado com o grupo de estudo (n = 8), o que é clinicamente relevante. CONCLUSãO: O uso de misoprostol prévio à histeroscopia no nosso serviço demonstrou que ele pode facilitar a realização do procedimento, mas não é isento de efeitos colaterais e apresenta maiores taxas de complicações.

Endometriose: aspectos clínicos do diagnóstico ao tratamento / Endometriosis: clinical aspects from diagnosis to treatment

A suspeita clínica de endometriose geralmente envolve a história clínica da paciente e exame físico, abordando sua sintomatologia e história pessoal e familiar. Entretanto, a apresentação clínica da doença varia consideravelmente, sem características clínicas patognomônicas, fato que dificulta o seu diagnóstico. Um diagnóstico presuntivo de endometriose pode ser fortemente sugerido pela ultrassonografia transvaginal e pela ressonância magnética em casos de endometrioma ou endometriose infiltrativa profunda. No entanto, esses exames de imagem não possuem a sensibilidade e a especificidade necessárias quando se trata de endometriose peritoneal superficial. O biomarcador sérico mais utilizado na investigação da endometriose foi o CA-125, que não apresenta sensibilidade (70%-75%) suficiente para sua indicação na prática clínica. Portanto, apesar de seu risco e alto custo, a videolaparoscopia e a análise anatomopatológica subsequente ainda se apresentam como o procedimento padrão-ouro para o diagnóstico definitivo de endometriose. Assim, com o objetivo de demonstrar quais exames seriam necessários para o diagnóstico dessa doença, realizamos uma revisão sistemática da literatura, cujos dados estão descritos a seguir.(AU)

Anamnese em sexologia e os critérios diagnósticos das disfunções sexuais / Anamnesis in sexology and diagnostic criteria for sexual dysfunctions

Este protocolo visa apresentar os critérios e o algoritmo para o diagnóstico e o tratamento das disfunções sexuais femininas (DSFs), de acordo com os critérios da Classificação Internacional das Doenças (CID-10) utilizados pelo Sistema Único de Saúde (SUS) no Brasil. A classificação e os conceitos do DSM-V são utilizados para complementar a CID-10.(AU)

Diagnosis and Treatment in a Tertiary Hospital of a Series of Complex Genital Malformations Corresponding to Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis.

AIM: To evaluate the clinical features, diagnostic routine, treatment, and prognosis of patients with double uterus with obstructed hemivagina and ipsilateral renal agenesis at a University Hospital. METHODS: A retrospective study analyzing the medical charts of outpatients with similar complex genital malformations seen at the University Hospital of the Ribeirão Preto Medical School from 1994 to 2015. RESULTS: Fourteen patients were included in this retrospective study, all presenting with double uterus with obstructed hemivagina and ipsilateral renal agenesis. The main symptom was dysmenorrhea occurring shortly after menarche, and pelvic ultrasound was the examination of choice. The treatment consisted of resection of the vaginal septum, complemented by an abdominal approach in 5 cases. Complications of the syndrome observed in this case series included severe endometriosis, pelvic abscess, need for hysterectomy, and salpingectomy. CONCLUSIONS: Severe dysmenorrhea shortly after menarche is a typical symptom of this kind of malformation, even though the diagnosis of patients who present with fistulization of the vaginal septum can be delayed due to milder clinical features. Pelvic ultrasound can be considered the first-choice examination in diagnostic routine. Relief of pain and prevention of complications can be achieved successfully in most cases by resection of the vaginal septum.

A Model for the Management of Female Sexual Dysfunctions.

Introduction Sexual pleasure is fundamental for the maintenance of health and well-being, but it may be adversely affected by medical and psychosocial conditions. Many patients only feel that their health is fully restored after they resume normal sexual activities. Any discussion of sexuality in a doctor's office is typically limited, mainly because of a lack of models or protocols available to guide the discussion of the topic. Objectives To present a model designed to guide gynecologists in the management of female sexual complaints. Methods This study presents a protocol used to assess women's sexual problems. A semi-structured interview is used to assess sexual function, and the teaching, orienting and permitting (TOP) intervention model that was designed to guide gynecologists in the management of sexual complaints. Results The use of protocols may facilitate the discussion of sexual issues in gynecological settings, and has the potential to provide an effective approach to the complex aspects of sexual dysfunction in women. The TOP model has three phases: teaching the sexual response, in which the gynecologist explains the physiology of the female sexual response, and focuses on the three main phases thereof (desire, excitement and orgasm); orienting a woman toward sexual health, in which sexual education is used to provide information on the concept and healthy experience of sexuality; and permitting and stimulating sexual pleasure, which is based on the assumption that sexual pleasure is an individual right and is important for the physical and emotional well-being. Conclusion The use of protocols may provide an effective approach to deal with female sexual dysfunction in gynecological offices.

A Model for the Management of Female Sexual Dysfunctions / Modelo para abordagem das disfunções sexuais femininas

Abstract Introduction Sexual pleasure is fundamental for the maintenance of health and well-being, but it may be adversely affected by medical and psychosocial conditions. Many patients only feel that their health is fully restored after they resume normal sexual activities. Any discussion of sexuality in a doctor's office is typically limited, mainly because of a lack of models or protocols available to guide the discussion of the topic. Objectives To present a model designed to guide gynecologists in the management of female sexual complaints. Methods This study presents a protocol used to assess women's sexual problems. A semi-structured interview is used to assess sexual function, and the teaching, orienting and permitting (TOP) intervention model that was designed to guide gynecologists in the management of sexual complaints. Results The use of protocols may facilitate the discussion of sexual issues in gynecological settings, and has the potential to provide an effective approach to the complex aspects of sexual dysfunction in women. The TOP model has three phases: teaching the sexual response, in which the gynecologist explains the physiology of the female sexual response, and focuses on the three main phases thereof (desire, excitement and orgasm); orienting a woman toward sexual health, in which sexual education is used to provide information on the concept and healthy experience of sexuality; and permitting and stimulating sexual pleasure, which is based on the assumption that sexual pleasure is an individual right and is important for the physical and emotional well-being. Conclusion The use of protocols may provide an effective approach to deal with female sexual dysfunction in gynecological offices.

Resumo Introdução O prazer sexual é fundamental para a manutenção da saúde e do bem-estar da mulher, mas pode ser afetado negativamente por condições médicas e psicossociais. Em muitos casos, a mulher sente que sua saúde geral é restaurada após retomar sua vida sexual. Porém, a discussão sobre função sexual no consultório do ginecologista é limitada devido à falta de modelos ou protocolos disponíveis para orientar a intervenção neste tema. Objetivos Apresentar um modelo de intervenção nas disfunções sexuais femininas para ser utilizado pelo ginecologista. Métodos Foi realizada uma revisão da literatura com levantamento de estudos sobre o manejo das disfunções sexuais femininas nas diferentes culturas. A partir desta revisão, foi elaborado um protocolo que consiste da história clínica e de um modelo de intervenção para orientar os ginecologistas no tratamento das queixas sexuais femininas. Resultados O uso de protocolos pode facilitar a discussão sobre questões sexuais pelo ginecologista, e pode fornecer uma abordagem eficaz para lidar com os aspectos complexos da disfunção sexual feminina. O modelo proposto, ensinar, orientar e permitir (EOP), tem três fases: ensinar sobre a resposta sexual, na qual o ginecologista explica a fisiologia da resposta sexual feminina, e se concentra nas suas três principais fases (desejo, excitação e orgasmo); orientar sobre saúde sexual para fornecer informações sobre vivência saudável da sexualidade; e permitir a estimulação do prazer sexual, que é um direito individual e importante para o bem-estar físico e emocional do indivíduo. Conclusão O uso de protocolos pode fornecer uma abordagem eficaz para o ginecologista lidar com a disfunção sexual feminina.

Endometriosis in a patient with mayer-rokitansky-küster-hauser syndrome.

Objective. To report a case of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) in which there were two nonfunctional rudimentary uteruses with the presence of ovarian endometrioma, corroborating that there are valid alternative theories to the existence of endometriosis, rather than Sampson's theory alone, such as the coelomic metaplasia theory. Design. A case report. Setting. A tertiary referral center, which is also a university hospital. Patient. A fifteen-year-old patient with MRKH syndrome and endometriosis. Intervention. Laparoscopic approach for diagnostic confirmation and treatment of the endometrioma. Results. Evidence of endometriosis in a patient with no functional uterus. Conclusions. This case report and a few others that are available in the literature reinforce the possibility that coelomic metaplasia could be the origin of endometriosis. Patients with müllerian agenesis and pelvic pain should be carefully evaluated, and the presence of pelvic endometriosis should not be excluded.

[Maternal mortality in a reference center in the Brazilian Southeast]. / Mortalidade materna em um centro de referência do Sudeste Brasileiro.

PURPOSE: To describe the prevalence of maternal mortality at a tertiary care hospital and to assess its preventability. METHODS: This study, through the analysis of maternal deaths that occurred during the period from 1999 to 2010 at a reference in Campinas--Brazil, CAISM/ UNICAMP, discusses some of the factors associated with the main causes of death and some structural problems of structure of the health services. It is a retrospective descriptive study with evaluation of sociodemographic variables and the medical and obstetric history of women, and the causes of death. RESULTS: The majority of maternal deaths occurred due to direct obstetric (45%) and avoidable (36%) causes, in women with preterm gestation, who delivered by cesarean section (56%) and received various management procedures, including blood transfusion, ICU admission and need for laparotomy and/or hysterectomy. The hospital transfer was associated with the predominance of direct obstetric (19 versus 6, p=0.02) and avoidable causes (22 versus 9, p=0.01). CONCLUSIONS: We conclude that, despite current advances in Obstetrics, infections and hypertensive disorders are still the predominant causes of maternal mortality. We observed an increase of clinical-surgical conditions and neoplasms as causes of death among women during pregnancy.

Mortalidade materna em um centro de referência do Sudeste Brasileiro / Maternal mortality in a reference center in the Brazilian Southeast

OBJETIVO: Descrever a frequência da mortalidade materna em um hospital de atendimento terciário e avaliar a sua evitabilidade. MÉTODOS: O presente estudo, mediante a análise das mortes maternas ocorridas no período de 1999 a 2010 em uma maternidade de referência de Campinas - Brasil, aborda alguns dos fatores associados, as principais causas de óbito e alguns problemas de estrutura dos serviços de saúde. É um estudo descritivo retrospectivo com avaliação de variáveis sociodemográficas, história clínica e obstétrica das mulheres, além das causas do óbito. RESULTADOS: A maioria dos óbitos maternos ocorreu por causas obstétricas diretas (45%) e evitáveis (36%), em mulheres com gestação pré-termo que tiveram o parto por cesárea (56%) e vários procedimentos de manejo, incluindo transfusão sanguínea, admissão em UTI e necessidade de laparotomia e/ou histerectomia. A transferência de outro hospital esteve associada ao predomínio de causas obstétricas diretas (19 versus 6, p=0,02) e evitáveis (22 versus 9, p=0,01). CONCLUSÃO: A mortalidade materna por causas infecciosas e hipertensivas ainda predomina. Observamos o aumento de causas clínico-cirúrgicas e neoplásicas como causa do óbito em mulheres durante o ciclo grávido puerperal.

PURPOSE: To describe the prevalence of maternal mortality at a tertiary care hospital and to assessits preventability. METHODS: This study, through the analysis of maternal deaths that occurred during the period from 1999 to 2010 at a reference in Campinas - Brazil, CAISM/ UNICAMP, discusses some of the factors associated with the main causes of death and some structural problems of structure of the health services. It is a retrospective descriptive study with evaluation of sociodemographic variables and the medical and obstetric history of women, and the causes of death. RESULTS: The majority of maternal deaths occurred due to direct obstetric (45%) and avoidable (36%) causes, in women with preterm gestation, who delivered by cesarean section (56%) and received various management procedures, including blood transfusion, ICU admission and need for laparotomy and/or hysterectomy. The hospital transfer was associated with the predominance of direct obstetric (19 versus 6, p=0.02) and avoidable causes (22 versus 9, p=0.01). CONCLUSIONS: We conclude that, despite current advances in Obstetrics, infections and hypertensive disorders are still the predominant causes of maternal mortality. We observed an increase of clinical-surgical conditions and neoplasms as causes of death among women during pregnancy.

Prevalência de obesidade em crianças de uma escola pública e de um ambulatório geral de pediatria de hospital universitário / Obesity prevalence among students of a public school and a pediatric out-patient clinic of a university hospital

OBJETIVO: Verificar a associação entre atividade física e características socioeconômicas com a presença de obesidade e/ou sobrepeso em crianças de seis a 14 anos, escolares da Escola Sérgio Porto e pacientes que procuraram o Ambulatório de Pediatria no Hospital de Clínicas (HC), ambos no campus da Universidade Estadual de Campinas (Unicamp). MÉTODOS: O estudo foi realizado por meio da aplicação de questionário aos pais ou responsáveis e coleta de dados de peso e altura das crianças. Foi calculado o índice de massa corpórea (IMC), e feita a classificação em normal, sobrepeso ou obesidade, a partir dos dados do Centers for Disease Control and Prevention (CDC), dos Estados Unidos. Foi feita análise descritiva dos dados e utilizados os testes do qui-quadrado ou exato de Fisher. RESULTADOS: A amostra ambulatorial foi composta por 107 crianças (13,1 por cento com sobrepeso e 11,2 por cento obesas) e a escolar de 109 (16,5 por cento com sobrepeso e 20,2 por cento obesas). Não foi observada diferença significante entre a prevalência de obesidade ou de obesidade e sobrepeso entre as duas amostras, apesar de as amostras serem diferentes em relação à renda mensal (p<0,0001), escolaridade materna (p<0,0001) e atividade física (p<0,0001), sendo que a população ambulatorial apresentou menores índices nestas três variáveis, comparada à escolar. CONCLUSÕES: Os índices de sobrepeso e obesidade encontrados no presente estudo foram elevados, confirmando que houve a transição nutricional em ambas as amostras, de maneira similar à observada no resto do nosso país, independentemente do sexo, da classificação socioeconômica e da atividade física.

OBJECTIVE: The aim of this study was to verify the association between physical activity and socio-economic status with the presence of obesity and/or overweight in children aged six to 14 years of two different sources: an elementary school and an out-patient Pediatric clinic of one university hospital of Campinas, São Paulo. METHODS: A socio-demographic questionnaire was answered by parents and the evaluation of children's weight and height was performed according to Centers for Disease Control and Prevention (CDC), USA, standards for body mass index (BMI) The children were divided in three categories: normal, overweight and obese. Chi-square and Fisher exact test were used to compare both groups of children. RESULTS: 107 children from the university hospital were studied (13.1 percent with overweight and 11.2 percent obese) as well as 109 from the elementary school (16.5 percent overweight and 20.2 percent obese). Both groups were similar regarding the prevalence of obesity alone or obesity and overweight. Groups differed in family income (p<0.0001), number of maternal years in school (p<0.0001) and physical activity (p<0.0001), with disadvantage of the clinic patients. CONCLUSIONS: The frequency of overweight and obesity observed in this study were high, pointing out that a nutritional transition has occurred in both samples independently of gender, socio-economic status and physical activity.