Acta Obstétrica e Ginecológica Portuguesa

Communication skills in Obstetrics

Causes of maternal mortality in four reference hospitals in Huambo Province from 2011 to 2013

Aim: Maternal mortality is particularly frequent in Sub-Saharan Africa, and Angola is believed to have one of the highest rates in the world. The aim of this study was to identify the main causes of maternal deaths in the four reference hospitals of the Huambo Province, from 2011-2013. Methods: In this observational study, we analyzed maternal deaths recorded between 2011 and 2013, reviewing the clinical records and corresponding record books of the four main hospitals of the Huambo Province. Results: We identified a total of 164 maternal deaths. Almost 50% of women were between 15 and 24 years, 29.2% only had primary education, 48.1% resided in rural areas, and 39% were transferred from other health facilities. Data on previous pregnancies and deliveries, as well as on prenatal care were frequently missing. Most maternal deaths were from direct causes (77.4%), with hypertensive diseases accounting for 25%, sepsis for 23.1%, haemorrhage for 17.6%, and uterine rupture for 9.7%. Of the indirect causes, the most frequent were hepatitis, malaria, tuberculosis and HIV/AIDS. Conclusions: Hypertension, sepsis and hemorrhage are leading causes of maternal deaths in the Huambo region. Poor quality of hospital and prenatal care records is frequent. These findings can help to guide strategies to reduce maternal mortality in the region.

Postpartum depression: early detection and associated factors

Overview: Introduction: Postpartum depression is a common, often neglected problem and it has implications in the mothers quality of life, her relationship with the newborn and child's development. The study of sociodemographic and obstetric risk factors for the development of puerperal depressive symptomatology assumes a crucial importance in the developing of diagnosis and treatment strategies for postpartum depression. Methods: A questionnaire consisting of the Edinburgh postpartum depression scale and six additional items was applied to the postpartum women in the Obstetrics Service of the Hospital Senhora Oliveira, between February 1, 2016 and January 31, 2017. The cut-off used for the presence of depressive symptomatology was a score =10. The electronic processes were subsequently consulted through the Obscare® program of the puerperal women who completed the questionnaire. Results: 857 women completed the questionnaire between the 2nd and 3rd day postpartum. The prevalence of depressive symptomatology was 10.6%. The factors associated with depressive symptomatology were: history of previous depressive disorder (17.2 vs 7.7%, p = 0.03), Diabetes Mellitus (2.2 vs. 0.1%, p = 0.018, OR 18, 5), fetal growth restriction (8.6 vs. 2.4%, p = 0.003, OR 3.8) and low birth weight (10.8% vs. 5.2%, p = 0.037, OR 2.41). The variables were adjusted to the potential confounding variable - history of previous depression. Conclusions: The history of prior depression, fetal growth restriction, Diabetes Mellitus and low birth weight are associated with higher scores on the Edinburgh postpartum depression scale.

Risk factors for anxiety and pain perception during levonorgestrel intrauterine system insertion

Overview and Aims: Levonorgestrel Intrauterine System (LNG-IUS) is an efficacious and cost-effective long acting reversible contraceptive, with high satisfaction rates among users. Yet, evidence shows that anxiety and fear of pain associated with LNG-IUS insertion prevent women from choosing them as their contraceptive method. We aimed to determine risk factors associated with anxiety and pain perception during LNG-IUS insertion. Methods and Population: We performed a prospective, observational, descriptive and analytical study to a sample of patients of the family planning consultation submitted to insertion of LNG-IUS between may and november 2017. Pre and post insertion questionnaires were given, one directed to the patients and other to the clinicians. Results: From a total of 161 women in analysis, 125 inserted Mirena® and 36 inserted Jaydess®. The patients submitted to the insertion of Jaydess® were significantly younger (median=34) than those who chose Mirena® (median=41) and presented higher frequency of nulliparity and absence of vaginal delivery. Higher levels of anticipated pain correlated with high levels of anxiety (p<0.001). The pain associated to the procedure was mainly referred to as mild or moderated. Higher levels of experienced pain were found in patients with less parity or absence of vaginal delivery and in more technically difficult procedures (p<0.001). After a multivariable regression analysis, only patient's anxiety and anticipated pain have remained associated with the increase of experienced pain (p<0.05). Conclusions: High levels of anxiety and anticipated pain proved to be predictors of high levels of experienced pain during LNG-IUS insertion. Future research should focus on interventions to reduce pre-procedure anxiety and anticipated pain potentially to decrease discomfort experienced with intrauterine device insertion.

Evidence in the maternal position in the second stage of labor

Women have adopted various positions in childbirth over the centuries, changing either by personal preference, by indication from professionals attending the delivery or due to external factors such as use of medication or instrumented delivery. The position at birth may influence the duration of the expulsive period, pain intensity, neonatal outcome, perineal lesions or postpartum haemorrhage and has an effect on general well-being and female satisfaction. This review aims to analyze the benefits and risks associated with the positions most frequently chosen by women and specific advantages of different positions in each context of labor.

Management of cervical cancer in pregnancy

Cervical cancer is one of the most common malignancies diagnosed during pregnancy. Although challenging, this diagnosis does not necessarily mean interruption of pregnancy. The objective is to review the management of invasive cervical cancer in pregnant women, by analyzing guidelines and systematic reviews published over the last couple of decades on staging, management, time and mode of delivery and prognosis. The definition of management strategies aims to obtain a prognosis similar to that of non-pregnant women, taking into account the protection of the mother, the fetus and the newborn. Long term impact on women and descendants remains unclear.

Postmenopausal Meig's syndrome with extremely elevated CA 125: case report and review of the literature

Ectopic pregnancy, a potentially life-threatening condition, represents 1-2% of all pregnancies. Tubal pregnancy represents about 95% of the cases, but other locations can occur such as ovary, uterine cervix and abdominal cavity. Abdominal pregnancy is a rare event, seen in about 1.3% of ectopic pregnancies. We present a case of abdominal pregnancy located at the Douglas pouch and superficially infiltrated the rectovaginal septum in a woman under intra-uterine device contraception.

Benign metastatic leiomyoma: pulmonary and cerebral involvement

Benign metastatic leiomyoma (BML) is a rare disorder characterized by the presence of extrauterine leiomyomatous lesions. The authors report a case of a 70-year-old woman with previous total hysterectomy for uterine leiomyoma, that presented with dry cough and a history of progressive weight loss. Thorax computerized tomography revealed multiple nodular masses, suggestive of pulmonary metastases. The immunohistochemical study showed that the diagnosis was compatible with BML. The patient then presented a nodular brain lesion suspected of metastasis but died before the biopsy for etiologic confirmation.

Genital Warts: not always the human papillomavirus's harmless consequence

Human papillomavirus (HPV)-related genital warts are the commonest viral sexually transmitted disease. We present a case of exuberant vulvar lesions in a human immunodeficiency virus (HIV)-positive and immunosuppressed woman, in which risk factors and clinical features required a differential diagnosis with more serious conditions. The lesions were surgically excised successfully and histopathological outcome was condylomata acuminata. With this clinical report we highlight that benign and apparently harmless situations, such as genital condylomata, can be very morbilliform and even mutilating. Appropriate recognition, proper treatment and follow-up measures as early as possible are cornerstone.

Caesarean scar pregnancy diagnosis

The authors present a clinical case of a young healthy woman with a caesarean scar pregnancy, emphasizing the relevance of an early ultrasound diagnosis.

Corticotherapy for fetal lung maturation

The authors present a clinical case of a young healthy woman with a caesarean scar pregnancy, emphasizing the relevance of an early ultrasound diagnosis.

Vaginal birth after cesarean delivery

The authors present a clinical case of a young healthy woman with a caesarean scar pregnancy, emphasizing the relevance of an early ultrasound diagnosis.

Uma justíssima Homenagem!

The authors present a clinical case of a young healthy woman with a caesarean scar pregnancy, emphasizing the relevance of an early ultrasound diagnosis.