Scielo RSS http://scielo.pt/rss.php?pid=1646-583020210001&lang=en vol. 15 num. 1 lang. en http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100007&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100010&lng=en&nrm=iso&tlng=en Abstract Overview and aims: Surgery for Pelvic Organ Prolapse (POP) is increasing with the aging of population. When maintenance of vaginal length and coital function is not a surgical goal, obliterative surgery is effective for POP treatment, especially in women with comorbidities. Our primary study goal was to evaluate the objective and subjective cure rates of different obliterative surgeries. We also aimed to characterize this population of women and the complications of this type of surgery. Study design: We conducted an observational retrospective cohort study Population: 82 patients who underwent obliterative surgery as a treatment for primary or recurrent POP. Methods: Retrospective review of clinical charts, with descriptive and bivariate analysis. Results: All women were sexually inactive and their mean age was 77.3 years-old. Overall, they had excessive weight and 97.6% of them had a POP-Q stage of III or more. The majority of these women had two or more comorbidities at time of surgery, and cardiovascular disease was the most severe in 40% of them. Twenty eight percent of them had already underwent a surgery for POP. There were only two cases of minor complications after surgery, specifically lower urinary tract infection. Overall, objective cure rate was 89.7% and subjective cure rate was 98.5%, for a mean time of follow-up of 18.5 months. We found no differences between different obliterative procedures. De novo urge urinary incontinence developed in 22% of patients. Conclusions: Obliterative surgery is a good treatment option for severe POP, especially in women with anesthetic risk and no desire for future vaginal coitus. In our cohort we found excellent objective and subjective POP cure rates after obliterative surgeries, combined with low risks.. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100017&lng=en&nrm=iso&tlng=en Abstract Overview and aims: Recent studies suggested that low vitamin D levels during pregnancy can increase the risk of pre-eclampsia, gestational diabetes mellitus, cesarean section, preterm birth, and low birthweight. This study aims to investigate the association between first trimester vitamin D status and pregnancy outcomes. Study design, Population and Methods: A prospective observational study was performed including women with vitamin D measurement in the first trimester of pregnancy. Results: One hundred and eighty five pregnant women were recruited. There were 141 (76,2%) women who revealed low levels of vitamin D. With regards to pregnancy outcomes, there was no significant association between vitamin D status and preeclampsia, cesarean section, preterm birth, and low birthweight. Low vitamin D level was associated with a higher risk of gestational diabetes (adjusted odds ratio, 0.876, CI 0.789-0.972; p=0.013). Conclusions: A high prevalence of low vitamin D levels among pregnant women in the first trimester was seen in the Portuguese population. Low vitamin D level in the first trimester of pregnancy was a predictor of gestational diabetes mellitus. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100023&lng=en&nrm=iso&tlng=en Abstract The axillary surgery in breast cancer has become progressively less invasive. Historically, all patients with a positive sentinela lymph node(SLN) biopsy result underwent axillary lymph node dissection(ALND). Recent trials show that ALND can be safely omitted in those women with clinically node negative, T1-T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. The SLN biopsy in node-positive patients with a radiologic axillary response after neoadjuvant chemotherapy is feasible and a sign of good practice. This change in practice has implications in study techniques of the SLN. The OSNA assay proved to be an effective technique with prognostic value. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100034&lng=en&nrm=iso&tlng=en Abstract Importance: Hysterectomy is the most common non-pregnancy surgical procedure performed on women. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not feasible. Complex situations that distort the pelvic anatomy make surgery more difficult. There is a need to determine how to do this approach in complex situation. Objectives: The aims of this summary are to review the surgical technique for complex situations in laparospic hysterectomy such as fibroids, endometriosis, adhesions and obesity, possible complications, advantages and disadvantages with other approachs in these situations for best clinical practice. Evidence Acquisition: We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on laparoscopic hysterectomy and management in complex situations (large uterus, endometriosis, adhesions and obesity). Conclusions: We concluded that laparoscopic hysterectomy is effective and efficient in difficult situations. These should not be considered contraindications to this technique. With good training and an understanding of laparoscopy, it is possible to have a low complications rate and a short-term recovery. Relevance: This review is beneficial for all providers caring for women needing laparoscopic hysterectomy with complex situations. Target Audience: Obstetricians and gynecologists. Learning Objectives: After completing this CME activity, physicians should be able to (1) identify the complex situations for hysterectomy; (2) describe advantages and disadvantages for laparoscopic hysterectomy in these cases; and (3) discuss the possibles changes in surgical technique that allow to perform this approach. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100044&lng=en&nrm=iso&tlng=en Abstract Congenital anomalies of kidney and urinary tract are the most frequently diagnosed malformations in the prenatal period, accounting for 20-30% of the cases. Prenatal diagnosis plays an important role in the early identification of these anomalies, being essential for the treatment and prevention of renal function deterioration. The purpose of this article is to present a brief review of the most common malformations of the kidney and urinary tract, with emphasis on the ultrasound findings and differential diagnosis, and to propose a clinical recommendation on how to manage these situations based on the literature review. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100056&lng=en&nrm=iso&tlng=en Abstract In triplet pregnancies, the risk of spontaneous delivery <32 weeks gestation may be predicted by serial sonographic cervical evaluation. However, no intervention has been shown to improve neonatal outcomes in triplets with cervical shortening. Most data suggest no usefulness of ultrasound-indicated cerclage in multiple pregnancies, although recent studies in twin pregnancies reported promising results. The authors describe a case of a triplet gestation with pronounced mid-trimester asymptomatic cervical shortening. A cervical cerclage was performed as an effort to allow pregnancy viability. At the 28th gestational week, three newborns were delivered and had no severe complications in neonatal period. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100061&lng=en&nrm=iso&tlng=en Abstract Epidural analgesia is frequently used for labour analgesia, and major complications are rare. This article illustrates a case of a healthy woman submitted to a caesarean section under epidural anaesthesia, which developed postpartum fever, worsening abdominal and lumbar pain and neurologic deficits. Lumbar magnetic resonance confirmed the epidural abscess with spinal compression, demanding urgent laminectomy and surgical drainage , along with prolonged antibiotic therapy. Epidural abscess, although a rare complication, can have an important impact on neurologic integrity. The clinical manifestations are unspecific, and timely diagnosis and treatment are crucial to prevent permanent neurologic damage and death. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100065&lng=en&nrm=iso&tlng=en Abstract Vulvar malignant melanoma (VMM) is a rare type of tumor, accounting for 5% of all vulvar malignancies, with an incidence of 1.36 cases per million women per year. Patients usually present a pigmented lesion or nodule, but VMM can be macroscopically amelanotic in 30% of cases. The authors report the case of a 64-year-old woman presenting a nodular unpigmented vulvar lesion, whose histology revealed a vulvar malignant melanoma. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100067&lng=en&nrm=iso&tlng=en Abstract Obstetric injuries comprising tearing of the rectovaginal septum or rectal mucosa with intact anal sphincters are highly uncommon and few reports are published. Obstetric perineal tears have precise guidelines regarding their risk factors, classification and management, but they don’t include isolated rectal mucosa injuries. We present a report of isolated rectovaginal tear detected after a vacuum delivery. The rectal laceration was promptly repaired, with optimum results and no complaints of flatus or stool incontinence at the follow-up visits. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100069&lng=en&nrm=iso&tlng=en Abstract Obstetric injuries comprising tearing of the rectovaginal septum or rectal mucosa with intact anal sphincters are highly uncommon and few reports are published. Obstetric perineal tears have precise guidelines regarding their risk factors, classification and management, but they don’t include isolated rectal mucosa injuries. We present a report of isolated rectovaginal tear detected after a vacuum delivery. The rectal laceration was promptly repaired, with optimum results and no complaints of flatus or stool incontinence at the follow-up visits. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000100075&lng=en&nrm=iso&tlng=en Abstract Obstetric injuries comprising tearing of the rectovaginal septum or rectal mucosa with intact anal sphincters are highly uncommon and few reports are published. Obstetric perineal tears have precise guidelines regarding their risk factors, classification and management, but they don’t include isolated rectal mucosa injuries. We present a report of isolated rectovaginal tear detected after a vacuum delivery. The rectal laceration was promptly repaired, with optimum results and no complaints of flatus or stool incontinence at the follow-up visits.