Scielo RSS http://scielo.pt/rss.php?pid=1646-583020160002&lang=pt vol. 10 num. 2 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200001&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200002&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200003&lng=pt&nrm=iso&tlng=pt Overview and aims: The incidence of adenocarcinoma in situ (AIS) of the cervix is increasing, particularly in reproductive-age. Conservative treatment with cervical conization is an alternative to hysterectomy. However, concern persists regarding the risk of residual and recurrence of AIS. The purpose of this study was to determine the residual disease and outcome of patients treated for AIS. Study design: Retrospective and descriptive analysis. Population and methods: The medical records of 10 women with cervical AIS followed at the Instituto Português de Oncologia de Francisco Gentil do Porto between 1999 and 2012 were reviewed. Demographic characteristics, treatment, pathologic findings and outcomes were analyzed. Results: The mean age at diagnosis was 41.1 years (range 31-63). All patients had conization performed as the initial treatment. Negative margins after conization were noted in 30% (3/10) and one (1/3) of these had residual disease in the surgical specimen following hysterectomy. In those with positive margins, 43% (3/7) had no residual disease in the surgical specimen after histerectomy. Considering conservative treatment (2/10), a second conization was performed in one patient and showed no residual disease and the other one had no subsequent treatment. None of the patients with conservative or definitive treatment had developed recurrence or invasive disease at 33 months (range 12 to 60) of follow-up. Conclusion: Our study reinforced the evidence that conservative treatment can be performed in patients with clear margins after conization given the low persistence of disease found in surgical specimen after hysterectomy. In global, these patients had favorable outcomes without recurrence or invasive disease. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200004&lng=pt&nrm=iso&tlng=pt Overview and aims: Intrauterine blood transfusion (IBT) is an established technique for the treatment of severe fetal anemia, increasing the survival of these fetuses. We aimed to describe the experience of a single center in pregnancies complicated with severe fetal anemia, that underwent IBT. Study design, Population, Methods: A retrospective cohort study was conducted from January 1996 to June 2014. Data were collected from 98 IBT performed in 44 pregnancies. Data included: anemia etiology, gestacional age at IBT, hemoglobin and hematocrit levels, presence of hydrops, number of IBTs, gestacional age at birth, sex and weight. Neonatal data included: number of exchange transfusions, respiratory distress syndrome, sepsis and other complications. Results: The main cause of fetal anemia was anti-D alloimmunization in 79.5% of the cases and the mean gestational age (GA) of the first IBT was 26 weeks. The minimum pre-transfusion hemoglobin was 1.5 g/dL, with an average of 6.4g/dL. The post transfusion hematocrit increased to the desired values in 90% of cases. Nine fetuses (20.5%) had hydrops at diagnosis. We had 4 cases of fetal death, and 40 pregnancies resulted in live births, with mean gestational age of 34.3 weeks, average weight of 2446g and mean hemoglobin of 11g/dL. A cesarean was performed in most cases. The overall survival was 86.4%, since in addition to the four fetal deaths there were two cases of early neonatal death. Fetal hydrops and early GA seemed to be associated with a poorer prognosis. Conclusions: IBT is a safe and effective procedure for the treatment of severe fetal anemia. Vigilance should be done in hospitals with experience to allow timely and proper treatment of this condition. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200005&lng=pt&nrm=iso&tlng=pt Unscheduled bleeding is a major current problem in women's health. The management of bleeding pattern changes in women using hormonal contraception is challenging. Recommendations for the best practices are provided where evidence exists. This paper provides an updated review regarding the approach of unscheduled bleeding in women who use hormonal contraception. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200006&lng=pt&nrm=iso&tlng=pt Epilepsy is common among women of childbearing age. Maternal-fetal risk is slightly superior to general population, resulting from antiepileptic drugs' teratogenicity and seizures. Optimized disease control and screening for medication's adverse effects are crucial parts of prenatal care. Most pregnant women require chronic therapy to prevent seizures; definition of an effective and least teratogenic regime should be performed preconceptionally. Sodium valproate is the most teratogenic drug; teratogenicity also increases with polytherapy and medication dosage. Labour should take place in a qualified obstetrical and neonatal centre. Usually breastfeeding is safe. Regarding contraception, consider interactions between enzyme-inducing antiepileptics drugs and hormonal contraceptives. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200007&lng=pt&nrm=iso&tlng=pt Pelvic floor disorders, which include pelvic organ prolapse (POP) and urinary incontinence (UI), affect 23% of women that when symptomatic can be surgically approached using synthetic meshes. Imaging techniques, particularly Ultrasound and Magnetic Resonance Imaging, have been increasingly used to evaluate patients submitted to these procedures, in both pre- and post-operative periods. The aim of this review is to assess the contribution of clinical imaging regarding meshes used in urogynecological surgery. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200008&lng=pt&nrm=iso&tlng=pt Breech presentation occurs in approximately 3 to 4% of all women with term pregnancies, and since the publication of the Term Breech Trial, in 2000, in many centers these fetuses are preferably delivered by planned cesarean section. However, some European centers continue to offer planned vaginal delivery for women with singleton term pregnancies in breech presentation under strict pre-labor selection criteria and intrapartum management guidelines. This article reviews the evidence on the ideal route of birth for term breech fetuses, in order to evaluate the current safety of planned vaginal delivery in industrialized countries. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200009&lng=pt&nrm=iso&tlng=pt Atypical fibrous histiocytoma is a rare and poorly documented variant of cutaneous fibrous histiocytoma.The vulvar localization is rare. Its clinical behaviour is generally benign; however, it presents histological features associated with malignancy. The pathological differential diagnoses include benign and malignant skin tumors; namely, atypical fibroxanthoma, cutaneous fibrous histiocytoma, cutaneous leiomyosarcoma, malignant fibrous histiocytoma, malignant melanoma, and dermatofibrosarcoma protuberans. We report a new case of atypical vulvar fibrous histiocytoma in a young woman whose diagnosis was based on morphological and immunohistochemical features of the tumor. According our knowledge this is the second documented case of atypical fibrous histiocytoma of the vulva. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200010&lng=pt&nrm=iso&tlng=pt Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical and radiologic entity characterized by seizure, headaches, visual symptoms and mental status changes associated with a predominantly posterior leucoencephalopathy. The authors report a case of a primigravida with an eclampsia and imagiological findings consistent with PRES. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200011&lng=pt&nrm=iso&tlng=pt Abstract: Diabetic mastopathy is a rare complication of diabetes mellitus that usually occurs in premenopausal women and represents less than 1% of benign breast lesions. This entity may mimic a malignant lesion; appropriate clinical research enables the clinician to reassure the patient and avoid unnecessary interventions. Its diagnosis is histological and core biopsy is the gold standard. The authors present two cases of diabetic mastopathy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200012&lng=pt&nrm=iso&tlng=pt Heterotopic pregnancy refers to the coexistence of intrauterine and extrauterine gestations, which can occur in two or more implantation sites. Although still a rare event, its incidence is increasing because of the use of assisted reproductive techniques (ART). The diagnosis is often delayed, which can lead to serious complications. We present a case of heterotopic pregnancy diagnosed in the emergency room in a pregnant woman with hypovolemic shock with the intrauterine pregnancy reaching term. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302016000200013&lng=pt&nrm=iso&tlng=pt Overview and aims: This article summarises the Portuguese endometriosis consensus elaborated in order to adapt to our population the consensus documents published in the literature. Endorsed by the Portuguese Society of Gynaecology, we established recommendations that provide guidance to our medical society to better decision making concerning the assistance of patients with endometriosis, to improve diagnosis and to optimize management. We expose here a short version of the first section of the guidelines, addressing the clinical and diagnosis management of this disease. Study design and Methods: The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2014) was the reference paper for these clinical recommendations in endometriosis. A group of experts in the field performed a thorough systematic search of the publications between January 2012 up to December 2014 and a quality assessment of the included papers. A consensus meeting with all members of the guidelines developing group reached the final version of the recommendations. Conclusions: The present clinical practice guidelines on endometriosis may improve the accurate clinical and imaging diagnosis of pelvic and extra pelvic endometriosis and enhance endometriosis risk assessment and care.