Corrimentos vaginais em gestantes : uma comparação da abordagem sindrômica com exames da prática clinica da enfermagem

Abstract

The aim was to compare the findings of vaginal infections in pregnant women obtained from the vaginal discharge flowchart with tests present in the clinical practice. This was an evaluation study, with a transversal delineation and quantitative boarding, developed in the Center of Natural Birth Lígia Barros Costa in Fortaleza – CE, with a sample of 104 pregnant women. The data was collected through interviews and gynecological examination from January to July of 2011. Statistical analysis was carried through, using absolute and average frequency and Standard Deviation. It was also conducted tests of sensitivity, specificity, predictive positive and negative values, accuracy and reasons of positive and negative probability, where it was established a significance value of p< 0,1. The research project was approved by the Research Ethics Committee of the Federal University of the Ceará, under the protocol nº 298/10. The pregnant women presented an average age of 23,7 years, fixed partnership (78; 75%), average of 12,3 years of study and family income between one and two minimum wages (59; 56,7%). The menarche occurred with an average age of 12,8 years and the first sexual intercourse with 16 years. They did not present history of STDs (90; 86.5%) and did not take cytological examinations regularly (58; 55,8%). The majority of the women are multiparous (58; 55.8%), with an average of 20,24 weeks of gestation. The predominant gynecological complaints were: vaginal discharge (87; 83.7%), vaginal secretion odor (45; 43.3%), dyspareunia (36; 34.6%), itch (27; 26%), dysuria (12; 11.5%), sinusorragia (6; 5.8%) and fever (4; 3,9%). It was observed a prevalence of 13,5% of positivity for at least one of three vaginal infections investigated according to the fresh examination. It was observed predominantly a pH value of 5 (50; 48.1%) and whiff test negative (66; 63,5%). The flowchart did not reveal efficient in the identification of candidiasis, presenting a low sensitivity (0.0%) and positive predictive value (0.0%), a high specificity (97.9%), negative predictive value (90.2%) and accuracy (88.5%), as well as null positive likelihood ratio and negative likelihood ratio equal to 1. For trichomoniasis, it presented low sensitivity (50%), specificity (46%), positive predictive value (3.6%) and accuracy (46.2%), a high negative predictive value (95.8%), positive likelihood ratio equal to 0,9 and negativo likelihood ratio 1,08. For bacterial vaginosis, it revealed satisfactory, with a high sensitivity (100%), negative predictive value (100%) and accuracy (74%), a low sensitivity (64%) and positive predictive value (51.8%), as well as positive likelihood ratio equal to 2,7 and null negative likelihood ratio. In conclusion, the use of a syndromic boarding for vaginal infections in pregnant women needs to be reevaluated, since the flowchart was not efficient in identifying infections such as candidiasis and trichomoniasis. The efforts for the development of simple and accessible tests must be continuous. However, more advance and techniques, like the fresh examination, in the practical clinic, aiming to contribute to the improvement of the sexual health and reproductive practices, preventing the dissemination of infections, reducing unnecessary treatments and improving the quality of life of these women.