Acta Obstétrica e Ginecológica Portuguesa

COVID-19 in pregnancy, what do we know?

Article commentary: small and restrict sample size - should we publish it?

Short commentary on an article published last November on JAMA Magazine, on a very relevant topic, where both the size and inclusion criteria make it impossible to generalize the knowledge, or make it aplyable on our daily activities.

Still the 2018 maternal mortality rate in Portugal

The 2018 portuguese maternal mortality rate raised concern between obstetric caregivers and pregnant women. A fast answer to the multiple questions aroused by the unexpected high maternal mortality rate could have reassured all. Probably the solution is on informatic programs that can fast and efficiently generate detailed and actualized data

Early-stage cervical cancer in reproductive-aged women: 10 years of experience of a tertiary care center

Overview and aims: Early-stage cervical cancer has a good prognosis, with survival rates at 5 years >90%. However, while offering the potential for disease cure, treatment often results in the loss of future fertility or impacts the ovarian function. The aim of this study is to examine the characteristics, treatment and survival outcomes of reproductive-aged women with early-stage cervical cancer at a tertiary care center over a period of 10 years. Study design, Population and Methods: Data from patients with early stage cervical cancer (< stage IB1< 2cm) aged 40 years and younger treated between 2008 and 2017 at that institute were collected. Variables selected included patient demographics, tumor information, treatment types, obstetrical outcomes and survival outcomes. Descriptive analysis and a binary logistic regression model were performed using SPSS v. 23.0. Results: In 2008-2017 period, a total of 75 women with stage IA1IB1 (< 2 cm) cervical cancer and ≤40 years at diagnosis were treated. Sixty five percent (49) were squamous carcinomas and 29% (22) adenocarcinomas. Surgical treatment was the first-line option for all patients: 8% (6) cervical conization, 7% (5) trachelectomy with pelvic laparoscopic lymphadenectomy, 21% (16) simple extrafascial hysterectomy and 64% (48) radical hysterectomy. Overall, irrespective of the type of surgical treatment, 75% (56) had conservation of ovaries. In a multivariable analysis, squamous cell carcinoma histology was a predictor of ovarian conservation (adjusted OR 11.03, 95% CI 2.66-45,61, p 0.001) on radical hysterectomy. Three of the patients submitted to trachelectomy got pregnant, one of which had a preterm delivery. Recurrence of the disease was reported in 4% (3) of the cases, only one case of mortality was disease-related. Conclusions: Despite the small case series, our study found a high proportion of reproductive-aged women with early-stage cervical cancer submitted to ovary-sparing surgical treatment, with promising results concerning to recurrence, mortality and pregnancy rates.

A systematic approach of maternal thrombocytopenia during pregnancy

Thrombocytopenia is the second most common haematological disorder during pregnancy, affecting 5-12% of pregnancies. Defining the cause of thrombocytopenia in pregnant women must consider not only causes related to pregnancy, but also those that occur in general population. It imposes a particular approach, because of the possible consequences to both mother and neonate. The authors review the most common causes of thrombocytopenia in pregnant and postpartum women and how to manage this condition (from the clinical history, physical examination to complementary diagnostic exams). Treatment, prognosis and monitoring and their specificities in pregnancy are also discussed in this review.

Solitary fibrous tumor of the uterine cervix - about a case

Solitary fibrous tumors are rare mesenchymal neoplasms. Although first reported in the pleura, they were described at extrapeural sites, but they are uncommon in the female genital tract (less than 30 cases reported). We present a case of solitary fibrous tumor arising from uterine cervix with a benign course, as well as its histopathological and immunohistochemical features that helped establishing the diagnosis.

Abdominal pregnancy with a live fetus - a case report

Abdominal pregnancy is a rare condition defined by the implantation of the embryo in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy. It is a rare event with high maternal morbidity and mortality. The authors report the case of a secondary abdominal pregnancy with a live fetus at 10 weeks of pregnancy.

Ovarian ectopic pregnancy treated with maximum conservative surgery of the ovary in a patient with a copper intrauterine device

The authors present a case of an ovarian ectopic pregnancy in a patient with an intrauterine copper device. Ovarian pregnancies are rare and account for three percent of ectopic pregnancies and the presence of an intrauterine device appears to influence its risk. The sonographic diagnosis of an ovarian pregnancy is difficult and, therefore, its diagnosis is only typically made during surgery and must be confirmed through histopathological analysis. As shown through our case, maximum conservative surgery of normal ovarian tissue can be attempted successfully.

Guidelines for contraception on obese women before and after bariatric surgery

Nas últimas décadas a obesidade tem vindo a aumentar atingindo a nível mundial proporções epidémicas. Portugal ocupa o quarto lugar entre os países da Europa com mais pessoas com obesidade, das quais um grande número são mulheres em idade reprodutiva¹. É por isso importante considerar a influência/importância do peso corporal na segurança e eficácia dos métodos contracetivos e a escolha do método durante os períodos de mudança do comportamento alimentar, tratamento médico e após cirurgia da obesidade. A Sociedade Portuguesa da Contracepção e a Sociedade Portuguesa para o Estudo da Obesidade propõem estratégias efetivas e seguras para o aconselhamento contracetivo nas mulheres com excesso de peso, com obesidade, sob terapêutica médica para a obesidade e após cirurgia bariátrica.

Birthweight standard for the Portuguese population

Pregnancy and Coronavirus 2019 (COVID-19): what obstetricians need to know