Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia最新文献

{"title":"Efficacy of obstetrics forceps and vacuum extractor to assist during vaginal delivery: systematic review and meta-analysis.","authors":"Rakhi Gaur, Kalpana Thakur, Navjot Kaur, Rajan Kumar, Vipin Patidar, Priyanka Rai","doi":"10.61622/rbgo/2025rbgo67","DOIUrl":"10.61622/rbgo/2025rbgo67","url":null,"abstract":"<p><strong>Objective: </strong>When spontaneous vaginal delivery is not feasible, Instrument-assisted vaginal delivery (IVD) is utilized, which often involves the use of vacuum extractors (VE) and obstetric forceps. This study intent to evaluate the risks and benefits associated with utilizing obstetric forceps vs vacuum extractors for IVD, focusing on maternal and neonatal outcomes.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a full literature search was done in PubMed, Embase, and Google Scholar until April 2024. The review examined randomized controlled trials (RCTs) that compared forceps and vacuum extractors. Two writers extracted the data and assessed its quality separately, with a third resolving any inconsistencies. The statistical study was conducted using R software, with a random-effects model used to quantify risk differences and evaluate heterogeneity.</p><p><strong>Results: </strong>Seven RCTs, totalling 2,299 individuals, were included. A meta-analysis revealed that forceps significantly increased the incidence of perineal tears (Risk difference = 0.08, 95% CI 0.02-0.13) and vaginal injuries (Risk Difference = 0.12, 95% CI 0.05-0.19). Vacuum extractors were associated with an increased risk of infant cephalohematoma (Risk Difference = -0.06, 95% CI -0.08, -0.04). There was no significant difference in maternal anaesthesia required or failure to accomplish vaginal delivery with the intended instrument.</p><p><strong>Conclusion: </strong>Obstetric forceps are more likely to cause maternal perineal tears and vaginal injuries, whereas vacuum extractors increase the likelihood of neonatal cephalohematoma. Both methods have comparable anaesthetic needs and success rates for vaginal birth. The clinical scenario ought to guide the choice of instruments, with an emphasis on risk minimization through proper training.PROSPERO: CRD42024577839.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal surgery for myelomeningocele: initial results of a tertiary public hospital.","authors":"Ingrid Schwach, Gustavo Yano Callado, Sandra Rejane Silva Herbst, Daniel Dante Cardeal, Milton Hikaro Toita, Giselle Darahem Tedesco, Flavia Canhassi Corigliano, Juliana Dos Passos Pires, Carolina Leite Drummond, Edward Araujo Júnior","doi":"10.61622/rbgo/2025rbgo81","DOIUrl":"10.61622/rbgo/2025rbgo81","url":null,"abstract":"<p><strong>Objective: </strong>To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperative complications.</p><p><strong>Methods: </strong>This retrospective cohort study included 25 pregnant women whose fetuses were diagnosed with myelomeningocele and underwent open intrauterine surgery between February 2019 and October 2023. Maternal demographic data, surgical outcomes, and neonatal variables were collected from medical records. Statistical analyses included Chi-squared test, Fisher's exact test, Mann-Whitney U test, and Pearson's correlation coefficient (r).</p><p><strong>Results: </strong>The mean gestational age (GA) at surgery was 25.7 ± 1.2 weeks, and the mean GA at delivery was 34.3 ± 2.0 weeks. Preterm birth was the most common complication (40%), followed by premature rupture of ovular membranes (32%). Two stillbirths occurred (8%) at 31 and 33 weeks of gestation. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Low birth weight (<2,500 g) was observed in 44% of neonates. Neonatal hospitalization was significantly longer in cases of preterm birth (p = 0.044), and intensive care unit stay was longer in deliveries before 34 weeks (p = 0.044). No correlation was found between GA at intrauterine surgery and GA at delivery (r = 0.252, p = 0.22).</p><p><strong>Conclusion: </strong>Fetal myelomeningocele surgery was successfully performed in a tertiary public hospital. However, preterm birth remains a major concern, as consistently reported in the literature. Nevertheless, the results confirm that intrauterine repair of myelomeningocele is indeed feasible in the public healthcare setting.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial vaginosis: a sexually transmitted disease?","authors":"Paulo César Giraldo, José Eleutério","doi":"10.61622/rbgo/2025rbgo78","DOIUrl":"10.61622/rbgo/2025rbgo78","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulvar and Vaginal Graft-Versus-Host Disease: prevalence and repercussions on vaginal microbiota.","authors":"Luiza de Amorim de Carvalho Araújo, Karinne Cisne Fernandes Rebouças, Fernando Barroso Duarte, Eleutério José, Raquel Autran Coelho Peixoto","doi":"10.61622/rbgo/2025rbgo471","DOIUrl":"10.61622/rbgo/2025rbgo471","url":null,"abstract":"<p><strong>Objective: </strong>Allogeneic bone marrow transplantation (BMT) carries the risk of the donor's cells recognizing the recipient as abnormal, triggering Graft Versus Host Disease (GVHD). This study aimed to understand the prevalence and gynecological complications, including vaginal microbiota evaluation.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was carried out from December 2022 to October 2023. Post-allogeneic BMT patients underwent gynecological evaluation at the Assis Chateaubriand Maternity School in Fortaleza-Ceará, Brazil, composed of structured interview and physical examination, which included collection of fresh examination of vaginal content, gram bacterioscopy and cervicovaginal cytology.</p><p><strong>Results: </strong>A total of 22 patients between 21 and 61 years old (average: 38) were evaluated, with an average of 1028 (± 979) days post BMT. Of these patients, whether or not they had Vulvar and Vaginal Graft Versus Host Disease (VVGVHD), 15 reported various gynecological complaints (dryness being the most common). Of the total, twelve showed signs of genital atrophy on examination. A 45% prevalence of VVGVHD was found, with vulvar and vaginal involvement of 100% and 60%, respectively. Burning and dyspareunia symptoms were more prevalent in patients with VVGVHD than in those without it (p<0.05); there was no difference in Human Papillomavirus (HPV) induced lesions between the two groups. However, compared to the population not undergoing allogeneic BMT, these patients had a higher prevalence of induced HPV lesions and intermediate vaginal flora.</p><p><strong>Conclusion: </strong>The findings described in the present work are consistent with other studies available in recent literature. In conclusion, VVGVHD is a potentially mutilating condition, with a significant prevalence among post-BMT patients.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-tubal ectopic pregnancy: types of treatment and occurrence of severe complications in a university hospital.","authors":"Arthur Chaves de Almeida, Ricardo Ruiz Garcia de Almeida, Barbara Bizzo Castelo, Luiz Francisco Cintra Baccaro","doi":"10.61622/rbgo/2025rbgo70","DOIUrl":"10.61622/rbgo/2025rbgo70","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the types of treatments used for non-tubal ectopic pregnancy (NTEP), the success rates of medical treatment, and the incidence of severe complications.</p><p><strong>Methods: </strong>Retrospective study of all NTEP admitted in the University of Campinas (UNICAMP) Women's hospital, Brazil, from 01/01/2000 to 01/31/2023. Outcome variables were medical treatment success and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage and chi-square test.</p><p><strong>Results: </strong>In total 60 cases of NTEP were included (3 abdominal, 15 cervical, 12 cesarean scar, 24 interstitial fallopian tube, 3 heterotopic e 3 ovarian). In cases of abdominal, cesarean scar, heterotopic and ovarian NTEP, the main type of treatment was surgery. Medical treatment was used mainly in cervical and interstitial NTEP (p<0.01). Medical treatment (included methotrexate single dose, multiple doses or direct injection) success rate was 73.7%, with no correlation with NTEP location (p=1.000). No change in trend was identified in the success rate of medical treatment for NTEP in the period evaluated (Cochran-Armitage test: z=0.46; p= 0.644). Severe complications occurred in 12(20) of NTEP, with no association with NTEP location (p=0.27), but with hemodynamic instability (p=0.01).</p><p><strong>Conclusion: </strong>The medical treatment success rate found in our study for NTEP was similar to that reported in the medical literature for tubal EP. Two out of ten women with NTEP had severe complications. The occurrence of severe complications was not associated to the site of NTEP but to the presence of hemodynamic instability at admission.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Correlation of pelvic ultrasonography with pubertal development in girls\".","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.61622/rbgo/2025rbgo72","DOIUrl":"10.61622/rbgo/2025rbgo72","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal uterine bleeding control with combined oral contraceptives: a review comparing ethinylestradiol and natural hormones.","authors":"Júlia de Oliveira Nadaleto, Juliana Tamada Ebenur, Diandra Ravidá Alves de Macedo, Maria Fernanda Sanfins Marrelli, Lívia Bonin Ferreira, Gabriela Pravatta-Rezende","doi":"10.61622/rbgo/2025rbgo84","DOIUrl":"10.61622/rbgo/2025rbgo84","url":null,"abstract":"<p><strong>Objective: </strong>To review the real benefits of using combined oral contraceptives (COCs) containing natural hormones, also known as estradiol-containing COC (estradiol and estradiol valerate) in controlling abnormal uterine bleeding (AUB) compared to the already established data on treatment with combined pills containing ethinylestradiol (EE).</p><p><strong>Methods: </strong>Narrative review with analysis of studies published between 2010 and 2023, comparing the effects of EE and natural estrogen in the treatment of AUB, indexed in the PUBMED, WebOfScience, and Scielo databases.</p><p><strong>Results: </strong>A total of 342 articles were found in the selected databases. Of these, 235 articles were excluded because they were published before 2010 or lacked an explicit relationship with the topic; 107 articles were selected for title and abstract screening, of which 27 were fully read by the researchers, and 6 were included in the study. It was observed that the use of natural estrogens is effective in controlling abnormal uterine bleeding, often with fewer side effects and less cardiovascular and prothrombotic impact compared to ethinylestradiol (EE). However, some non-contraceptive benefits of EE, such as less water retention, improved skin oiliness, and acne, were not consistently observed with the use of natural estrogens.</p><p><strong>Conclusion: </strong>Estradiol-containing COC have proven to be effective in controlling AUB, in addition to reducing spotting and intermenstrual bleeding, with fewer undesirable side effects when compared to COCs with EE. On the other hand, COCs with estradiol and estradiol valerate less frequently present other non-contraceptive benefits.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure reactivity to mental stress is related to daily blood pressure variability in postmenopausal hypertensive women.","authors":"Ana Clara Ribeiro Cunha, Caroline Pereira Garcês, Tássia Magnabosco Sisconeto, Juliene Gonçalves Costa, Mateus de Lima Rodrigues, Igor Moraes Mariano, Ana Luiza Amaral, Guilherme Morais Puga","doi":"10.61622/rbgo/2025rbgo69","DOIUrl":"10.61622/rbgo/2025rbgo69","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between blood pressure (BP) responses during a mental stress test with 24-hour ambulatory BP (ABPM) and its variability (BPV) in postmenopausal hypertensive women.</p><p><strong>Methods: </strong>BP reactivity under mental stress and ABPM were evaluated in 75 postmenopausal hypertensive women between 50 and 70 years, on non-consecutive days. We used the values of the variation (∆) of systolic BP (SBP) and diastolic BP from the reactivity test as independent variables, and the BPV indexes Average Real Variability (ARV), 24-hour SD, and SDdn (standard deviation weighted by daytime and nighttime duration) as dependent variables. In the multiple linear regression analysis, three models were tested: 1) without adjustment; 2) adjusted for time since menopause; and 3) adjusted for both nocturnal BP dipping classification and time since menopause.</p><p><strong>Results: </strong>The ARV index showed a significant association with ∆SBP variation in all models (model 1,2 and 3: β coefficient: 0.04, CI 95%: [0.00;0.08]).</p><p><strong>Conclusion: </strong>In conclusion, blood pressure variation during the mental stress test is related to ambulatory blood pressure variation, specifically to ARV in postmenopausal hypertensive women. These findings suggest that systolic blood pressure responses to mental stress may be a relevant predictor of daily blood pressure variability.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe preeclampsia: immediate action as a strategy to save lives.","authors":"Antonio Braga, Guilherme Ramires de Jesús, Maria Laura Costa, Leandro De Oliveira, José Geraldo Lopes Ramos, José Carlos Peraçoli, Edson Vieira da Cunha, Agnaldo Lopes da Silva, Maria Celeste Osório Wender, Cláudia Mello, Henri Augusto Korkes","doi":"10.61622/rbgo/2025rbgoedt2","DOIUrl":"10.61622/rbgo/2025rbgoedt2","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Efficacy, safety, and acceptability of misoprostol in the management of incomplete abortion: a systematic review and meta-analysis.","authors":"Leidy Hernández Coronado, Jhonatan Andrés Portes Ortiz","doi":"10.61622/rbgo/2025rbgo88","DOIUrl":"10.61622/rbgo/2025rbgo88","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}