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The impact of a two- versus three-yearly cervical screening interval recommendation on…

To assess the impact of cervical screening interval recommendations on cervical cancer incidence and mortality during periods of organized and opportunistic screening in Australia (2-yearly screening interval for organized screening), New Zealand (3 yearly interval for organized screening), and England (3/5 yearly interval for organized screening).In the era of opportunistic screening, some reductions were observed in cervical cancer mortality rates, but these were relatively modest and seen inconsistently between countries. After the introduction of organized cervical screening, cervical cancer mortality rates fell by a similar amount (~40 % or more) in all countries, and incidence fell by more than a third in Australia and New Zealand and by approximately one-fifth in England. Although several factors are likely to have influenced these observed reductions in cervical cancer rates, these findings do not support the more frequent 2-yearly cervical screening interval recommendation in Australia.

Risk of cervical cancer associated with extending the interval between cervical cancer…

Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be extended to three years among low-risk women with previous negative tests, the excess risk of cervical cancer associated with less frequent than annual screening is uncertain. Among 31,728 women 30 to 64 years of age who had had three or more consecutive negative tests, the prevalence of biopsy-proven cervical intraepithelial neoplasia of grade 2 was 0.028 percent and the prevalence of grade 3 neoplasia was 0.019 percent; none of the women had invasive cervical cancer. According to our model, the estimated risk of cancer with annual Papanicolaou tests for three years was 2 in 100,000 among women 30 to 44 years of age, 1 in 100,000 among women 45 to 59 years of age, and 1 in 100,000 among women 60 to 64 years of age; these risks would be 5 in 100,000, 2 in 100,000, and 1 in 100,000, respectively, if screening were performed once three years after the last negative test. To avert one additional case of cancer by screening 100,000 women annually for three years rather than once three years after the last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be needed in women 30 to 44 years of age and an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations in women 45 to 59 years of age. As compared with annual screening for three years, screening performed once three years after the last negative test in women 30 to 64 years of age who have had three or more consecutive negative Papanicolaou tests is associated with an average excess risk of cervical cancer of approximately 3 in 100,000.

Epidemiological data on cervical carcinoma relevant to cytopathology

Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.

Principais questões sobre Persistência do Canal Arterial em Recém-nascidos Pré-termo

A persistência do canal arterial em recém-nascidos pré-termo é um dos temas mais controversos em Neonatologia atualmente. Seguem as principais questões abordadas durante Encontro com o Especialista sobre esse tema.

Resumo do Programa de Ação da Conferência Internacional sobre População e Desenvolvimento

A Conferência Internacional sobre População e Desenvolvimento das Nações Unidas (CIPD) foi realizada no Cairo, Egito, de 5 a 13 de setembro de 1994 e reuniu 179 países. A CIPD é considerada um marco histórico, sendo o primeiro encontro global no qual todos os aspectos da vida humana foram abordados de forma abrangente. O resultado da Conferência foi um Plano de Ação, uma agenda de compromissos comuns para melhorar a vida de todas as pessoas por meio da promoção dos direitos humanos e da dignidade, apoio ao planejamento familiar, saúde sexual e reprodutiva e direitos, promoção da igualdade de gênero, promoção da igualdade de acesso à educação para as meninas, eliminação da violência contra as mulheres, além de questões relativas à população e proteção do meio ambiente. O Plano de Ação da CIPD está completando 20 anos e passa atualmente por um processo global de revisão, envolvendo governos e sociedade civil, que vai definir o futuro da agenda de população e desenvolvimento para além de 2014; clique aqui para saber mais.

Portaria GM/MS Nº 426 de 22 de março de 2005

O MINISTRO DE ESTADO DA SAÚDE, no uso de suas atribuições, e Considerando a necessidade de estruturar no Sistema Único de Saúde - SUS uma rede de serviços regionalizada e hierarquizada que permita atenção integral em reprodução humana assistida e melhoria do acesso a esse atendimento especializado; Considerando que a assistência em planejamento familiar deve incluir a oferta de todos os métodos e técnicas para a concepção e a anticoncepção, cientificamente aceitos, de acordo com a Lei nº 9.263, de 12 de janeiro de 1996, que regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar; Considerando que, segundo a Organização Mundial da Saúde- OMS e sociedades científicas, aproximadamente, 8% a 15% dos casais têm algum problema de infertilidade durante sua vida fértil, sendo que a infertilidade se define como a ausência de gravidez após 12 (doze) meses de relações sexuais regulares, sem uso de contracepção; Considerando que as técnicas de reprodução humana assistida contribuem para a diminuição da transmissão vertical e/ou horizontal de doenças infectocontagiosas, genéticas, entre outras; Considerando a necessidade de estabelecer mecanismos de regulação, fiscalização, controle e avaliação da assistência prestada aos usuários; e Considerando a necessidade de estabelecer os critérios mínimos para o credenciamento e a habilitação dos serviços de referência de Média e Alta Complexidade em reprodução humana assistida na rede SUS

Assistência Integral à Saúde da Mulher: bases de ação programática…

O atendimento à mulher pelo sistema de saúde tem-se limitado, quase que exclusivamente, ao período gravídico-puerperal, e, mesmo assim, de forma deficiente. Ao lado de exemplos sobejamente conhecidos, como a assistência preventiva e de diagnóstico precoce de doenças ginecológicas malignas, outros aspectos, como a prevenção, detecção e terapêutica de doenças de transmissão sexual, repercussões biopsicossociais da gravidez não desejada, abortamento e acesso a métodos e técnicas de controle da fertilidade, tem sido relegados a plano secundário. Esse quadro assume importância ainda maior o se considerar a crescente presença da mulher na força de trabalho, além do seu papel fundamental no núcleo familiar. Em relação à atenção à mulher – objeto primordial desta proposta - Os serviços de saúde devem ser dotados de meios adequados, articulando-se os esforços do governo federal, dos estados e municípios, com o objetivo de oferecer atividades de assistência integral clínico-ginecológica e educativa, voltadas para o aprimoramento do controle pré-natal, do parto e do puerpério; a abordagem dos problemas presentes desde a adolescência até a terceira idade; o controle das doenças transmitidas sexualmente, do câncer cérvico-uterino e mamário, e a assistência para concepção e contracepção.

Avaliação do bem-estar fetal intraparto

A avaliação do bem-estar fetal durante o trabalho de parto é crucial para a tomada de decisão sobre uma intervenção oportuna e apropriada.

Intrapartum Care for Healthy Women and Babies

This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy (‘term’). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour.

Intrapartum fetal heart rate monitoring: nomenclature, interpretation …

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009 Jul;114(1):192-202.

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring…

Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour.CTG during labour is associated with reduced rates of neonatal seizures, but no clear differences in cerebral palsy, infant mortality or other standard measures of neonatal wellbeing. However, continuous CTG was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed decision without compromising the normality of labour.The question remains as to whether future randomised trials should measure efficacy (the intrinsic value of continuous CTG in trying to prevent adverse neonatal outcomes under optimal clinical conditions) or effectiveness (the effect of this technique in routine clinical practice). Along with the need for further investigations into long-term effects of operative births for women and babies, much remains to be learned about the causation and possible links between antenatal or intrapartum events, neonatal seizures and long-term neurodevelopmental outcomes, whilst considering changes in clinical practice over the intervening years (one-to-one-support during labour, caesarean section rates). The large number of babies randomised to the trials in this review have now reached adulthood and could potentially provide a unique opportunity to clarify if a reduction in neonatal seizures is something inconsequential that should not greatly influence women's and clinicians' choices, or if seizure reduction leads to long-term benefits for babies. Defining meaningful neurological and behavioural outcomes that could be measured in large cohorts of young adults poses huge challenges. However, it is important to collect data from these women and babies while medical records still exist, where possible describe women's mobility and positions during labour and birth, and clarify if these might impact on outcomes. Research should also address the possible contribution of the supine position to adverse outcomes for babies, and assess whether the use of mobility and positions can further reduce the low incidence of neonatal seizures and improve psychological outcomes for women.

Discutindo a Posição Canguru

A Posição Canguru consiste em manter o recém-nascido em contato pele a pele, junto do peito da mãe ou do pai, em decúbito prono e na posição vertical. Seus benefícios são comprovados por evidências científicas.