Scielo RSS http://scielo.pt/rss.php?pid=1646-583020200004&lang=pt vol. 14 num. 4 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400202&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400204&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400208&lng=pt&nrm=iso&tlng=pt Abstract Overview and Aims: Infertility is a rising problem in our society, with an increasing prevalence in the past years, resulting of an interaction of multifactorial causes, with great demand and personal suffering, being imperative to adopt an integrated view where physiology is intimately related to social and psychological processes. This study aims to identify the factors that contribute to the effectiveness of infertility treatments and overall outcomes of pregnancy and birth, with a special focus on the psychosocial component. Study Design and Population: This is a retrospective, descriptive and causal study of 278 infertile couples followed from 2015 to 2018. Methods: Data was collected on the causes of infertility, the treatments performed, and their effectiveness. The aim was to cross these data with clinically relevant psychological symptoms, through Brief Symptom Inventory (BSI) and Fertility’s Problem Inventory (FPI), in order to assess the stress inherent to their condition. Results: Emotional disorders are significantly more prevalent in women (p<0.05), as well as social and sexual concerns. The Need for parenthood and the Rejection of childfree lifestyle are the problems that most concern both elements of the couple. Conclusions: It was found that the couple's psychosocial component has an influence on the infertility’s treatment process, with an impact on its outcome. Symptoms such as Depression, Hostility and Phobic anxiety were higher in women who did not become pregnant after the treatment, as well as in men. Results were even more enlightening regarding pregnancy. For women, somatization is related to abortion (p<0.05), as well as most symptoms of BSI; whereas for men, sexual and relationship concerns are associated with male etiology and less likelihood to give birth. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400217&lng=pt&nrm=iso&tlng=pt Resumo Introdução: A investigação clínica (IC) é essencial para a formação médica, além de requisito obrigatório do currículo de Ginecologia e Obstetrícia (GO). Contudo, a literatura acerca da atitude dos internos portugueses relativamente à IC é escassa. O objetivo deste estudo foi avaliar obstáculos e incentivos à IC no internato de GO em Portugal. Materiais e Métodos: Estudo transversal, com realização de um questionário, anónimo, aos internos portugueses de GO, avaliando dados demográficos, experiência e perceções acerca dos obstáculos e incentivos à IC. Resultados: Dos 65 (25,5%) internos que responderam ao questionário, 90,8% eram mulheres. Destes, 58,5% provinham de hospital central e 41,5% de periférico. Todas as regiões do país e anos de internato estiveram representados. A maioria respondeu que: o seu hospital não disponibilizava centro de bioestatística de apoio (66,2%), mas que esta medida seria importante (96,9%), e não oferecia formação em bioestatística (93,8%). A maioria dos centros (81,5%) tem uma reunião científica semanal e 9,2% referiu ter mais que duas. Na análise da perspetiva relativamente à IC, 80% considerava uma experiência positiva, contudo que o ambiente do seu serviço não a promovia (60%). Os obstáculos à investigação mais apontados foram: tempo disponível insuficiente, falta de apoio em bioestatística e dificuldade no acesso aos registos clínicos. A formação num hospital central associou-se significativamente a disponibilização de apoio em bioestatística (p=0,03), maior número de artigos publicados (p=0,001) e de reuniões científicas (p=0,006). Discussão e Conclusão: O conhecimento dos fatores que influenciam a motivação dos internos relativamente à investigação é fulcral para a implementação de medidas de otimização da produção científica. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400226&lng=pt&nrm=iso&tlng=pt Abstract Overview and aims: Obstetric care during delivery is guaranteed for 24 hours a day in the national health system. The aim of this work is to assess the differences in the clinical activity of a labour ward between day and night periods. Study design: Descriptive retrospective study. Population: Pregnant women whose deliveries occurred at a tertiary Portuguese hospital between 1 st January 2018 and 29 th February 2020. Methods: We included all the deliveries of a tertiary Portuguese hospital, divided in two periods - day (9am-9pm) and night (9pm-9am). Results: A total of 5306 births have occurred during this period. Of these, 43.1 % (2286) occurred during the night. The distribution of deliveries was balanced between the two periods considered in this study. Urgent or emergent caesareans took place mainly between 23pm and 1am. There were no differences regarding adverse maternal or perinatal outcomes, except for a higher rate of admissions into the neonatal intensive care unit during the day (p=0.01). Conclusions: There were no differences in the number of deliveries or complications between the day and the night periods. This reinforces the need to guarantee an adequate number of members composing the emergency teams, both doctors and nurses, 24 hours a day. It is also of paramount importance to guarantee the support of both Neonatologists and Anaesthesiologists. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400232&lng=pt&nrm=iso&tlng=pt Abstract Overview and Aims: During the COVID19 pandemic, preconception counselling has been a big challenge for health professionals, due to the potential complications of this infection during pregnancy. This study aimed to evaluate the preconception counselling of the Portuguese Obstetricians. Study Design: Cross-sectional study. Population: Portuguese Obstetricians and residents in Obstetrics and Gynaecology. Methods: The Portuguese obstetricians were asked to complete a survey comprising questions regarding their preconception recommendations in general and in specific situations during the pandemic. Their major concerns towards pregnancy during this period and their opinion about vaccination against SARS-CoV2 before pregnancy were also addressed. Results: A total of 325 answers were obtained. More than half of the Portuguese obstetricians and residents would be in favor of plans of pregnancy (53,2%) especially in a young and healthy woman, while some would rather recommend waiting a few months (39,7%). Most of them would also endorse reproductive treatments (51,4% in young patients and 57,5% in patients older than 40 years old). On the other hand, most of them would not encourage planning pregnancy in case of immunosuppression (72,3%), respiratory or cardiac maternal condition (74,2%). In general, the main concerns about pregnancy during the pandemic were the risk of preterm labor, risks related to maternal health and lower availability of medical care services. The vast majority of the respondents were in favor of vaccinating women during the preconception period, both during (93,3%) and after the pandemic (76,6%). Conclusion: The Portuguese obstetricians are aware of some potential complications of COVID19 pandemic during pregnancy, especially those concerning preterm labor and maternal health, but the majority of the respondents would be in favour of pregnancy planning during the pandemic period. If available, vaccination would be highly recommended before pregnancy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400243&lng=pt&nrm=iso&tlng=pt Abstract Mastalgia is frequent in women of childbearing age. It may be cyclical (mastodynia) which is premenstrual, diffuse and bilateral; or non-cyclical, unilateral, localized and more frequent in perimenopause. Evening Primrose Oil has been used to treat mastalgia. Therefore we conducted an evidence-based review to assess the effectiveness of Evening Primrose Oil in improving mastodynia in adult women. It included 4 articles and allowed to conclude there seems to be no evidence of a statistically significant efficacy of Evening Primrose Oil compared to placebo in the treatment of cyclic mastodynia (Strength of Recommendation B). http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400249&lng=pt&nrm=iso&tlng=pt Abstract Synchronous tumors are rare. Endometrial and ovarian cancer presents with different clinical characteristics compared to patients with isolated tumors. The authors present a case of a 49 years old woman with synchronous endometrial and ovarian cancer (SEOC) identified by clinical and imagiologic exams. The patient underwent an exploratory laparotomy. SEOC were diagnosis and treated in early stage for both type of cancer with a good prognosis and survival. This article aims to draw attention to the need to distinguish of a diagnosis of a primary endometrial cancer with ovarian metastasis or primary ovarian cancer with endometrial metastasis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400253&lng=pt&nrm=iso&tlng=pt Abstract The primitive malignant cancer of the Fallopian tube is a rare entity. Breast metastasis of this cancer are also rare. This is the fifth reported case. 61-year-old woman was diagnosed, in 2007, with serous adenocarcinoma of the tube, stage IV of FIGO. She underwent 2 cycles of chemotherapy (Paclitaxel and Carboplatin) but remained with residual disease. In 2009, she appeared with a breast nodule, suggestive of metastasis of the primitive cancer. She was considered unable to undergo specific treatment (poor general condition and multiple metastasis). The literature review only allowed the identification of four similar cases, all with poor prognosis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400257&lng=pt&nrm=iso&tlng=pt Abstract Menstrual irregularities account for up to 30% of outpatient visits to gynecologists. We present a case of a 29-year-old nulliparous woman with abnormal vaginal bleeding for the last five years. A transvaginal ultrasound revealed both ovaries enlarged with multiple cysts. Blood tests showed mildly elevated levels of estradiol and prolactin, and a suppressed LH. Cerebral MRI showed a pituitary macroadenoma. The patient was submitted to transsphenoidal surgery. The final diagnosis was pituitary adenoma with FSH and LH expression. Cases of pituitary adenomas causing clinical symptoms are unusual This diagnosis should be considered in women with menstrual irregularities and hyperstimulated ovaries. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400263&lng=pt&nrm=iso&tlng=pt Abstract Loeys-Dietz syndrome is a rare autosomal dominant connective tissue disorder characterized by vascular, skeletal, craniofacial and cutaneous abnormalities. During pregnancy, women with this syndrome have an increased risk of aortic aneurysm and dissection, preterm birth, uterine rupture and postpartum hemorrhage. Appropriate preconceptional, pregnancy and postpartum evaluation, counseling and surveillance by a specialized and multidisciplinary team might improve maternal and pregnancy outcomes. We present two cases of pregnant women with this syndrome surveilled at a tertiary high-risk obstetrics center. Both delivered at term without major complications. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400267&lng=pt&nrm=iso&tlng=pt Abstract Ectopic interstitial pregnancy is a rare entity associated to higher mortality when compared to other ectopic pregnancies. We present a singular case of a seven weeks interstitial pregnancy in a patient with ipsilateral adnexectomy highlighting intrauterine transmigration as an etiology of spontaneous ectopic pregnancy even after complete resection of fallopian tube. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400270&lng=pt&nrm=iso&tlng=pt Abstract Existe um grande número de recomendações e tomadas de posição a nível mundial sobre o uso de fitas sintéticas (slings) no tratamento da Incontinência Urinária de Esforço (IUE), o que reflete a importância da sua discussão e a controvérsia que tem sido gerada. Em geral, há uma sinergia e concordância entre as diferentes sociedades científicas, considerando-as uma opção segura, apesar de correrem risco de serem retiradas do mercado, devido ao seu uso indiscriminado1. Desta forma, a Secção Portuguesa de Uroginecologia da Sociedade Portuguesa de Ginecologia, em conjunto com a Associação Portuguesa de Neurourologia e Uroginecologia, percebeu a necessidade de emitir recomendações sobre este assunto para apoiar os cirurgiões pélvicos no uso de redes vaginais em Portugal. Este documento visa defender a segurança do uso de redes no tratamento da IUE no nosso país. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000400273&lng=pt&nrm=iso&tlng=pt Abstract O Prolapso dos Órgãos Pélvicos (POP) é uma patologia que afecta grande percentagem de mulheres, apresentando graves repercussões na qualidade de vida. O tratamento desta patologia, passa, também pela utilização de redes transvaginais. Existe controvérsia em relação ao uso destas redes devido ao uso indiscriminado e a graves complicações que daí advieram. A Secção Portuguesa de Uroginecologia da Sociedade Portuguesa de Ginecologia e a Associação Portuguesa de Neurourologia e Uroginecologia, percebeu a necessidade de emitir recomendações sobre este assunto para apoiar os cirurgiões uroginecológicos, no uso de redes transvaginais em Portugal.