Acta Obstétrica e Ginecológica Portuguesa

Sexually Transmitted Infections: past, present or future challenge?

How do obstetricians and gynaecologists score good prognostic factors of vaginal breech delivery?

Overview and aims: Caesarean section has been considered the optimal mode of delivery for breech presentations, but in selected cases breech vaginal delivery (BVD) may be acceptable. The aim of this study was to evaluate the importance attributed by obstetricians and gynecologists (ObGyns) to a set of good prognostic factors for BVD. Study Design: Cross-sectional study Population: Specialists and residents of Obstetrics and Gynecology from two hospitals with advanced perinatal support. Methods: Fifteen good prognostic factors for BVD were scored by ObGyns, according to a 5-point Likert scale (5=maximum clinical relevance). Medians and interquartile ranges were calculated and the Mann-Whitney test was used to compare ObGyns with experience with <15 versus ≥15 BVD. Results: Of the 58 participants, 74.1% were specialists but only 34.4% had experience with ≥15 BVD. Twelve of the 15 good prognostic factors were scored with a median of 4, while two factors (>10 years of experience in BVD and training in fetal head extraction with forceps) obtained a median of 5 and one (maternal pelvis imaging evaluation) a median of 2. The main differences between more or less experienced ObGyns was in the importance given by the former to training with simulators (p=0.006) and existence of internal protocol for BVD assistance (p= 0.032). Conclusion: Most good prognostic factors for BVD were well scored by ObGyns, but it is disturbing that the two most scored ones (experience in BVD assistance and training in fetal head extraction with forceps) represent areas with reported low levels of experience among us

Pregnancy after kidney transplantation: interaction between gestation and the graft

Overview and aims: Kidney transplantation has brought a new hope to women with end stage renal disease (ESRD) who wish to become pregnant, as it can improve the reproductive function and restore fertility. A successful pregnancy after kidney transplant is possible, at expenses of high rates of maternal and fetal morbidity. The objective of the study is to investigate the impact of renal transplantation in obstetric and neonatal outcomes as well as the effect of pregnancy itself in the graft. Study design: Retrospective study and descriptive analysis Methods and population: Retrospective study of nine pregnancies in eight renal transplant recipients between 1995 and 2015 in Centro Hospitalar São João. We evaluated the pre-pregnancy and post-delivery renal function, outcomes of gestation, as well as maternal and fetal complications. Results: The average time between transplant and pregnancy was 51.1 ± 25.3 months. The most common complications were urinary tract infections (7 cases), preterm delivery (6 cases), fetal growth restriction (3 cases), and pre-eclampsia (2 cases). One case of intrauterine fetal death was recorded. The cesarean section rate was 66.7%. There were two cases of graft dysfunction, which resolved in the postpartum period, without rejection or graft loss. In one patient, graft dysfunction recurred five months post-delivery due to native kidney disease relapse. Currently, one year after delivery, her creatinine plasmatic level is 2.2 mg/dL. Conclusions: This study suggests that successful pregnancy is possible in renal transplant recipients. Neverthless, these pregnancies should be considered at high risk and we must be alert to the complications that may occur

Screenings during pregnancy: the national panorama

Overview and aims: Standardization of screening tests lead to better care. The aim of this study was to describe and analyse screening practices during pregnancy among Portuguese Centres. Study Design and Methods: Written survey sent electronically to 41 public Portuguese Health Institutions which have an Obstetrics Department. Descriptive analysis of the collected data was performed. Results: Twenty-four surveys were obtained (58.5%). In most Centres combined aneuploidy screening is performed universally (79%). Preterm birth screening is performed through evaluation of cervical length at 20-22 weeks in most Centres (58%). A broad variety in performance was observed between Institutions regarding which infections were screened and their timing. Most institutions do perform preeclampsia screening (92%) and do not perform systematic evaluation of thyroid function in the absence of known pathology or signs/symptoms suggestive of thyroid disfunction. Conclusions: Although with some differences it was found that for preeclampsia, preterm birth and aneuploidy screening, the Centres have consistent practices

Headache and hormones

As hormonas desempenham um papel fundamental na modulação e exacerbação da cefaleia. A revisão da literatura apresentada descreve e diferencia os vários tipos de cefaleias hormonais, sendo igualmente abordados os mecanismos fisiopatológicos assim como as diversas opções terapêuticas. Dado o maior atingimento no sexo feminino e em idade reprodutiva várias questões se colocam no que concerne ao uso de contraceção hormonal. Por último será discutido o risco vascular na presença de enxaqueca o qual contraindica o uso de estrogénios em mulheres com aura

Fetal repercussions of Zika virus infection during pregnancy

Recently, Zika virus infection has been rapidly spreading, rising the cases of fetal abnormalities. A review was performed from February 2016 to January 2017, selecting articles that evaluated the fetal repercussions of maternal infection, considering fetal autopsies, clinical examinations and imagiology. The most frequent abnormalities were in the central nervous system, namely microcephaly, intracranial calcifications and ventriculomegaly. Death and fetal growth restriction were also reported. Anomalies in other systems were found to a lesser extent. Despite enough evidence proving this causality, it is important to document all these changes, allowing the comprehension of the virus' full width

Adenomyosis and Reproductive Health

Despite the hesitancy in the past to associate adenomyosis with infertility, nowadays this association is established, with a prevalence of 1-14%, according to the literature. Structural and functional changes resulting from adenomyosis appear to be related to embryo implantation failure, infertility and adverse obstetric outcomes, such as abortion and preterm delivery. The available infertility treatments are a complex subject, since they lack a good scientific support. Nevertheless, assisted reproductive technology is an option, and the use of GnRH agonists is one the treatments that revealed better results. There is a need for further studies, in order to answer remaining questions

Adnexal cyst at 19th weeks of gestation: laparoscopic approach

The diagnosis of adnexal masses in pregnancy has increased in the last decades. The advantages of histopathological confirmation as well as avoidance of possible complications as torsion, rupture or hemorrhage must be weighed against the risks of fetomaternal morbimortality associated with surgery during pregnancy. We present a case of a 19 week pregnant woman with an adnexal mass excised laparoscopically

Vaginal leiomyoma: a common disease with a rare presentation

Leiomyomas are pelvic smooth muscle tumours that present with a variety of clinical symptoms depending on site location. Although leiomyomas can be present in the uterus, round ligament, peritoneum and blood vessels, vaginal occurrence is a rare finding. This report describes a patient with a vaginal leiomyoma in the posterior wall of the vagina with complaints of abundant vaginal discharge and pelvic pain. Transvaginal excision of the tumour was performed with histopathologic diagnose and complete cure of the patient

Posterior vaginal cyst: case report of an uncommon entity

Vaginal cysts are uncommon and frequently diagnosed incidentally. A 20-year-old nulliparous woman, presented at her gynecologist for a routine appointment. An asymptomatic cystic mass on the posterior vaginal wall was found during physical examination. Surgical excision of the cyst was performed and pathological examination revealed a Mullerian cyst. These cysts usually arise at the level of cervix and extend anteriorly in relation to bladder, but very rarely they may also appear posteriorly. This paper illustrates a rare case of a posterior vaginal wall cyst of Mullerian origin

Leiomyomatosis peritonealis disseminata: a rare condition

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease primarily found in young women. LPD has a genetic and hormonal component. Normally the diagnosis is established during an abdominal surgery because most of the affected women are asymptomatic. There aren't guidelines for LPD treatment, but it can involve surgery or hormonal therapy. The authors describe the case of a young asymptomatic pregnant woman who was diagnosed with LPD during cesarean. As it is a rare condition, it is important to report clinical cases with different experiences to alert the medical community to this patology