Abstract in English:

Abstract Objective The study aimed to determine the level of anemia in pregnant women in the first trimester and in the preconception period by conducting nationwide research. Methods The study was designed as retrospective, cross-sectional, and multicenter research. A total of 17 centers from 13 provinces were included in the study. The study was conducted with the participation of two groups of patients who applied to the obstetrics polyclinic between 1 January 2023 and 1 July 2023, who were in the first trimester of pregnancy and who were in the preconception period planning pregnancy. Results In total 4,265 women were included in the study. Of these women, 3,884 (91%) were in the first trimester of their pregnancy and 381 (9%) were in the preconception period. Anemia was detected in 24.1% (n=1030) of the patients. Of these patients, 20.6% (n=877) were pregnant women in the first trimester and 3.6% (n=153) were in the preconception period. A statistically significant and positive relationship was found between anemia and meat consumption frequency, educational status, and socioeconomic status of the patients (p=0.000, p=0.000, p=0.000). In addition, a statistically significant and negative correlation was determined between anemia and the number of pregnancies and the parity number (p=0.001, p=0.000) in both groups. Conclusion Anemia is a public health problem. Anemia has been determined to be an important problem both in the preconception period and early periods of pregnancy. It is necessary to revise the programs and interventions to reduce the prevalence of anemia and redesign them in line with current conditions.

Abstract in English:

Abstract Objective: This study aimed to verify the relation between gastrin-releasing peptide receptor (GRPR), oncogenic Human Papillomavirus (HPV) and cervical lesions severity. Methods: GRPR mRNA levels were evaluated in cervical cancer-derived cell lines and in primary keratinocytes expressing HPV16 oncogenes by RT-PCR. GRPR protein expression was assessed by immunohistochemistry in organotypic cell cultures derived from keratinocytes transduced with HPV16 oncogenes and in 208 cervical samples, including 59 non-neoplastic tissue, 28 cervical intraepithelial neoplasia grade 3 (CIN3), 44 squamous cell carcinomas (SCC) and 77 adenocarcinomas (ADC). Generic primers (GP5+/GP6+) were used to identify HPV infection in tissue samples. Experiments involving cell lines were analyzed through non-parametric tests (Kruskal Wallis), and Fisher's Exact Test for human tissues samples. All statistical tests were considered significant at p <0.05. Immunohistochemical evaluation was conducted independently and blindly by two observers (AD- LO). Any discordant findings were resolved through discussion to reach a consensus score. Results: GRPR mRNA levels were not increased in cells expressing HPV16 or HPV18 oncogenes. However, at the protein level, GRPR was upregulated in organotypic cell cultures containing HPV oncogenes. Besides, it was identified an association between GRPR expression and cervical lesion severity (p < 0.0001). The detection rate of high-risk HPV DNA was directly correlated with cervical disease. Nonetheless, HPV infection was not directly associated with GRPR in cervical samples. Conclusion: GRPR expression is highly predictive of cervical lesion severity, irrespective of HPV infection and might contribute to improving patient's therapeutic management as well as being used a marker of disease progression.

Abstract in English:

Abstract Objective: To determine the validity of the angle of progression (AoP) in predicting delivery mode among women in the second stage of labor. Designs: This prospective cohort study was conducted at the Obstetrics and Gynecology unit (OBGYN) of two hospitals in Vietnam. Transperineal ultrasound was performed for each woman to measure the progression angle in the second phase of labor. data were collected from Participants: A total of 725 women with singleton pregnancies with cephalic presentation at term Methods: Transperineal ultrasound was used to measure the angle of progression in the second labor phase and to identify the delivery method. Results: The rate of vaginal birth in women with an AoP ≥ 120° on transperineal ultrasound was 70.2%. The optimal cutoff point of AOP ≥122° with sensitivity and specificity for vaginal birth were 87.8% and 80.7%, respectively the area under the ROC curve of 0.887 (p<0.0001). The study's sample size was restricted owing to deficiencies in resources and time. Conclusion: The likelihood of achieving spontaneous vaginal delivery can be predicted by the angle of progression measured with transperineal intrapartum ultrasonography during the second stage of labor in women.

Abstract in English:

Abstract Objective: To investigate the relationship between prematurity and cesarean section rate in Brazil during the beginning of COVID-19 pandemic. Methods: Utilizing the Robson Classification, this study analyzed data from the Brazilian Ministry of Health's Live Births Panel, comparing CSR) and group 10 (preterm deliveries) between 2019 (pre-pandemic) and 2021 (pandemic) in each of Brazilian states and the overall country. The prematurity and CSR were compared using prevalence ratio and confidence interval, and p-value was obtained. The variation of prematurity and CSR were compared through the coefficient of determination (R2). Results: A total of 5,522,910 deliveries were evaluated during the period. The CSR increased from 56.34% to 57.05% (p<0.01), and the frequency of preterm deliveries rose from 8.99% to 9.13% (p<0.01). The CSR increased in 23 States and decreased in 4 States, while the prematurity rate increased in 16 States and decreased in 10 States. A positive relationship between the increase of CSR and prematurity was observed during COVID-19, with an R2 value of 0.3121, suggesting a moderate association between these two variables. Conclusion: Between 2019 (pre-COVID-19 pandemic) and 2021 (the first full year of the COVID-19 pandemic), there was an increase in prematurity and CSR in Brazil. These increases were observed in most Brazilian states and may be correlated. However, it is impossible to establish a cause-effect relationship given the design of this study.

Abstract in English:

Abstract Objective: To describe women's experience of pregnancy during the COVID-19 pandemic. Methods: A qualitative study conducted in a private maternity hospital, from May, 2020 to November, 2021, with women aged ≥ 18 years, gestational age ≥ 36 weeks at birth and ≥ 24 hours post-partum. Data collected through semi-structured interviews, recorded, transcribed, and analyzed adopting Krippendorff's Content Analysis as theoretical-methodological framework. Results: Four main themes emerged: Fear, Taking care and celebrating pregnancy: adjusting to the new reality, Harms of Isolation, and Benefits of Isolation. The fear of contamination and its impact on the health of mother and child resulted in the adoption of severe social isolation, including from those considered sources of support by the expecting mother. Overwhelmed, some of the participants reported loneliness and psychic suffering. The opportunity to focus on the pregnancy, the preparations for the arrival of the child, and the family made isolation a beneficial and positive period for other women. Conclusion: The experience of pregnancy in the Pandemic was an event outside of the ordinary and common. The expecting mother faced her worst fears on a daily basis and attended prenatal care, in order to ensure her child would be born healthy. The celebration of the baby's life, amid so many deaths, had to be adjusted to the virtual environment. It was a tense, solitary, and ambiguous period, which demanded a lot from the mental health of some participants, but to others, brought advantages that would not have been possible in different times.

Abstract in English:

Abstract Objective: Preterm birth is a leading global cause of neonatal mortality and morbidity, with oxidative stress playing a role in its pathogenesis. Vitamin C, a powerful antioxidant, may help reduce this risk. This study assessed the effectiveness of vitamin C supplementation, both alone and with vitamin E, in preventing preterm birth compared to a placebo. Data source: Databases were systematically searched in PubMed, Cochrane and Embase in December 2023 and updated in May 2024. Study Selection: Included RCTs evaluated vitamin C's effect on preterm birth and related neonatal outcomes. Data collect: Statistical analyses used a random-effects model for pooled risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity was assessed with the I² statistic. Data synthesis: Seventeen RCTs (21,567 patients) were analyzed. Vitamin C supplementation showed no significant difference compared to placebo for preterm birth (RR 1.04; 95% CI 0.96, 1.14). No significant differences were observed for neonatal death (RR 0.77; 95% CI 0.55, 1.08), NICU admission (RR 1.03; 95% CI 0.95, 1.13), preterm PROM (RR 1.04; 95% CI 0.63, 1.71), or birth weight (MD 52.41; 95% CI −19.65, 124.47). A slight decrease in gestational age was observed (MD 0.26; 95% CI −0.02, 0.55). Conclusion: Vitamin C supplementation alone or in combination with vitamin E does not significantly prevent preterm birth or improve related neonatal outcomes.

Abstract in English:

Abstract Statins are the most widely used pharmacological class for treating hyperlipidemia, although they are contraindicated during pregnancy. This study aims to demonstrate the clinical effects of statins in pregnant women through an interactive review. Fifteen original articles were selected, in English or Portuguese, within of five years. Statins have not been associated with the development of fetal malformations and their use may be useful in preventing unfavorable cardiovascular outcomes, with the potential to reduce oxidative stress and angiogenic dysfunction. However, the use of statins to prevent pre-eclampsia in humans has not been properly clarified and further studies are needed. Pravastatin is considered safer than statins for use during pregnancy.

Abstract in English:

Abstract Objective: This study aimed to investigate the effect of low-level laser therapy (LLLT) on nipple trauma and pain during breastfeeding through a systematic review with a meta-analysis of selected studies. Source of the data: A thorough search was conducted on March 22, 2022, using the databases PubMed, SciELO, LILACS, PEDro, CINAHL, EMBASE, ScienceDirect, Scopus, Google Scholar, MEDLINE, the Cochrane Library, Clinical Trials, Web of Science, TRIP, DARE, and ProQuest. The search terms included various combinations of low-level laser therapy, nipple pain, nipple trauma, and breastfeeding. Studies selection: Out of 107 articles identified, only three controlled and randomized clinical trials was included. The extracted data encompassed breast and trauma characteristics, treatment types, outcomes (pain and healing process), evaluation tools, LLLT usage, laser brand, and parameters. Data collection: Data extraction was performed using RAYYAN for systematic reviews. The risk of bias in the studies was evaluated. Data synthesis: Pain was measured using the visual analog scale (VAS). The included studies did not use validated tools for assessing physical conditions. All studies employed LLLT with a 660-nm wavelength, though there were variations in equipment power, energy dose, and application methods. The meta-analysis revealed an average difference of −0.60 points (95% CI: −1.52 to 0.31) in the VAS pain scores between the LLLT and control groups. No heterogeneity was observed among the studies (I2=0%), indicating no significant difference in pain relief between LLLT (red light) and control groups. Conclusion: LLLT may offer a promising option for managing breastfeeding-related complications, though further research is required.

Abstract in English:

Abstract Objective: Preterm birth remains a significant contributor to neonatal morbidity and mortality. The use of cervical pessaries as an intervention for preventing preterm delivery in women with a short cervix has been a subject of interest. We evaluated the effectiveness of cervical pessary compared to standard care in preventing preterm delivery in women with a short cervix. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in December 2023. Study selection: Randomized clinical trials with the outcomes of interest were included. Data collect: We computed risk ratios for binary endpoints, with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. Data were analyzed using R software (version 4.3.0). The primary outcomes of interest were preterm delivery before 37 weeks, and preterm delivery before 34 weeks. Data synthesis: Seventeen studies with 5,704 patients were included. The use of cervical pessary was associated with a decreased risk of preterm delivery before 37 (RR 0.88; 95% CI 0.81-0.96) and 34 weeks (RR 0.79; 95% CI 0.63-0.99) of gestation in twin pregnancies as compared to standard care without progesterone. There were no significant differences in preterm delivery in singleton pregnancy, neonatal outcomes, preterm premature rupture of the membranes or chorioamnionitis. Conclusion: The use of cervical pessary was associated with a significant reduction in preterm delivery at 34 and 37 weeks of gestation in twin pregnancies among patients with a short cervix compared to no treatment. No significant difference was found in singleton pregnancies or maternal outcomes.

Abstract in English:

Key points • Although advances in the treatment of gynecological cancer have improved survival rates, they may also increase the effects of induced menopause, especially in young women. • Cancer treatments such as oophorectomy, gonadotoxic chemotherapy, and pelvic radiotherapy can induce menopause. • Gonadotoxic chemotherapy, especially alkylating-containing regimens, often damages ovarian function and may result in permanent menopause. • Pelvic radiotherapy usually results in permanent loss of ovarian function unless ovarian transposition is performed. • Diagnosing menopause after cancer is challenging, and common diagnostic criteria such as 12 months or more of amenorrhea and elevated follicle-stimulating hormone (FSH) levels are not entirely reliable, since ovarian function may return years after treatment. • A multidisciplinary approach to post-cancer menopause is essential and should include an appropriate line of care, since hormone replacement therapy after treatment of gynecologic malignancy is controversial.

Abstract in English:

Key points •The population of female cancer survivors has increased over the last few years, highlighting the importance of appropriate follow-up of these patients. •The main objective of long-term follow-up for patients treated for cancer is the early detection of recurrences, whether local, lymph node or distant metastases. •Symptom assessment and physical examination play an important role in the follow-up of patients treated for gynecological neoplasms. •The use of laboratory or imaging tests to detect recurrence in asymptomatic patients should be based on evidence that it improves survival or provides less morbid treatments, also considering cost and availability.

Abstract in English:

Abstract Objective: To evaluate the continuation rate, satisfaction, and reasons for discontinuation of depot medroxyprogesterone acetate (DMPA) in adolescents treated in a mental health service. Methods: Prospective cohort study conducted in a reference unit for the care of adolescents with mental disorders (MDs) and intellectual disabilities (IDs). All patients received a gynecological consultation and an educational group on contraceptive methods. Sociodemographic data on age, education and gynecological data (menarche, coitarche, regularity of menstrual cycles and presence of symptoms) were collected. Follow-up was quarterly for 12 months, during which symptoms, desire to continue, and satisfaction with the use of the quarterly injectable were assessed. Results: Eight hundred and sixty-two sexually active adolescents were supported, 532 adolescents chose to use the quarterly injectable, and 69 of these agreed to participate in the study. The mean age of users was 15.5 years (SD=0.91). After 12 months of follow-up, 34 (49.3%) of the 69 adolescents continued to use the method and 36 (52.3%) were satisfied. Among the 33 (47.8%) who discontinued use, the most common reasons were irregular bleeding and weight gain. Conclusions: Adolescents with intellectual disabilities and/or other mental disorders showed a significant rate of continuation and satisfaction with the use of the depot medroxyprogesterone acetate at 12 months, and the most common reasons for discontinuation were irregular uterine bleeding and weight gain.