Scielo RSS http://scielo.pt/rss.php?pid=1646-583020210002&lang=en vol. 15 num. 2 lang. en http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200095&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200097&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200099&lng=en&nrm=iso&tlng=en Abstract Overview and Aims: In Portugal, abortion by women request is allowed by law until 10 weeks of pregnancy. The number of complications due to abortion has fallenconsiderably since its legalization in 2007. The aim of this study is to characterize thewomen admitted to a VIP consultation at a district hospital in the North of Portugal, considering demographic factors, obstetric background, contraception methods and trends. Study design, Population, Methods: This is a descriptive study of the VIP performed between 2008 and 2018. The data were collected through predefined items on the obligatory declaration platform of the Portuguese Directorate-General of Health. Confidentiality has been ensured. Results: 1669 VIP cases were observed, 1406 (84,2%) of which were first interventions. Considering this subgroup, the majority of women were referred from Primary Care units (52,2%) and denied not attended to family planning appointment in the previous year (67.6%). 44,4% had no children and 28,2% were performed on first 6 weeks of gestation. After VIP, the main contraceptive methods chosen were the subcutaneous implant (27,3%), oral or injectable contraceptives (36%); 9.6% did not choose any method. Conclusions: The woman that typically searches for a VIP consultation is born and resident in Portugal, single, between 20 and 24 years old, primiparous, and is a high school graduate. Recognizing this profile makes it essential to promote health literacy at an early age, enabling a conscious choice of the contraceptive method and promoting family planning. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200108&lng=en&nrm=iso&tlng=en Abstract Overview and Aims: In vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) show discouraging results in poor ovarian responders. We aim to characterize low prognosis women, stratifying them according to POSEIDON criteria -based on ovarian reserve markers and response in previous cycles. Study Design: data base retrospective study Population: women undertaking an IVF/ICSI cycle between May/2012 and December/2017 in our public centre. Methods: all women undertaking IVF/ICSI cycles with registered antimullerian hormone levels and antral follicule count (the ovarian reserve markers considered in POSEIDON criteria) were divided in 4 groups -women with normal ovarian reserve markers but low response in previous cycle (<35 years-G1; ≥35 years-G2) and women with at least one low ovarian reserve marker (<35 years-G3; ≥35years-G4). Ovarian reserve markers, previous ovarian response, socio-demographic features, type/etiology of infertility, number of oocytes collected, clinical pregnancy and delivery rates per cycle/ovarian puncture(OP)/transfer were determined. Ovarian response (categorized into optimal/non-optimal based on the number of oocytes collected), clinical pregnancy and delivery rates of the 4 groups were compared to population non-POSEIDON(PNP). X 2 test was used. Significance was set at p-value<0.05. Results: 1789 cycles were analysed; 49.6%(887/1789) of them met POSEIDON criteria - n=86(G1), n=129(G2); n=180(G3); n=492(G4). 85.7% of those reaching OP had a non-optimal response. G4 showed the worse pregnancy and delivery rates, significantly lower than PNP. The highest rates of pregnancy and delivery were verified in a subgroup of G2, except for delivery/cycle; no difference was observed between G1/G2 and PNP. Most women were Portuguese, Caucasian, normal weighted, non-smokers and presented primary infertility. Male factor was the most frequently identified cause. Conclusion: POSEIDON criteria showed high positive predictive value of having a non-optimal response. Results may help managing expectations of women undergoing IVF/ICSI with similar characteristics. Exclusion from POSEIDON group should not be considered reassuring due to low negative predictive value. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200117&lng=en&nrm=iso&tlng=en Abstract Overview and Aims: To investigate the association between fetal nuchal translucency (NT) thickness and perinatal and long-term neurodevelopmental outcomes in singleton euploid pregnancies, in the absence of chromosomal and structural anomalies or confirmed genetic syndromes. Study design, Population and Methods: Retrospective cohort study including 1648 pregnant women submitted to routine first-trimester screening in a portugueses central hospital between December 2014 and December 2015. Three groups were defined by NT thickness: NT<95th percentile, 212 cases - randomly selected in a 2:1 ratio to cases with increased NT; NT> 95th-99th percentile, 89 cases (5,4%); and NT>99th percentile, 16 cases (1,0%). Gestational and perinatal outcomes were compared in the three groups. Additionally, a screening tool for neurodevelopmental delay (Parent Report of Children’s Abilities - PARCA) was applied, with follow-up at a mean age of 2,0 years. Results: For children with a NT>99th percentile, there was a 7-fold increased risk of positive screening for neurodevelopmental delay (OR 6,80, 95% CI 0,03-0,65; 3 cases). For children with NT between the 95th and 99th percentile, the risk was also increased - about 3-fold (OR 2,9, 95% CI 0,12-0,94; 9 cases). Both results were compared with the group of children with NT<95th percentile (7 cases). No significant statistical differences were found between the groups regarding perinatal outcomes, except for fetal sex. The prevalence of fetuses with NT 95th-99th percentile was higher in males (59 cases, 66,3%), compared to fetuses with NT<95th percentile (106 cases, 56,7%). Conclusions: Among euploid fetuses with increased TN, there was an increased risk of positive screening for neurodevelopmental delay, particularly when NT>99th percentile. This does not represent a turning point in counselling, but alerts to the need for long-term follow-up of these children and the potential benefits of clinically assessing their neurodevelopment. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200125&lng=en&nrm=iso&tlng=en Abstract Overview and aims: External cephalic version (ECV) is a maneuver that can diminish the cesarean section rate. The objective of our study was to assess women’s perception with ECV to improve counselling and its implementation. Study Design: Semi structured interviews with closed and open questions were conducted by phone. Population: Women subjected to ECV between January 2015 and August 2018. Methods: Women’s answers descriptive analysis. Results: Sixty six women answered the questionnaire. Pain was reported as intense by 48,5% and severe by 12,1%. The majority considered ECV as an alternative to cesarean section and 22,7% had tried other techniques before ECV. Twenty four women felt anxious before ECV but only 15,1% regretted their decision to undergo ECV. More than 60% would consider this maneuver in a subsequent pregnancy or recommend it to a friend. There was no association between the referred pain and the success of ECV. Conclusion: ECV is perceived as painful by most women and causes anxiety to a significant number of patients. Therefore, ECV must be attempted by experienced practitioners with careful attention to maternal mood. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200130&lng=en&nrm=iso&tlng=en Abstract Twin anemia-polycythemia sequence (TAPS) is a pathology of monochorionic twin pregnancy that results from slow unequal blood distribution that causes the discrepancy of hemoglobin values between the anemic fetus (the donor) and the polycythemic one (the recipient). Unlike twin-to-twin transfusion syndrome (TTTS), twin oligohydramnios-polyhydramnios sequence (TOPS) is not present in TAPS. TAPS might occur spontaneously or after laser treatment for TTTS. Prenatal diagnosis relies on twin discrepant values of middle-cerebral-artery (MCA) peak-systolic-velocity (PSV). Management options include laser surgery, expectant management, intrauterine transfusions, and delivery. This review aims to summarize the research made on the last 7 years on TAPS. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200141&lng=en&nrm=iso&tlng=en Abstract Overview/Aims: Flu increases maternal and fetal complications. Studies recommend the use of neuraminidase inhibitors to treat influenza in pregnant women. This review aims to analyse the evidence about oseltamivir’s effectiveness in the treatment of seasonal flu. Methods: Literature research was conducted in the MEDLINE, DARE, Cochrane, Web of Science, TRIP and NICE, and guidelines databases using the query: “(Treat* OR Therapy) AND (oseltamivir OR neuraminidase inhibitors) AND pregnan*”. Results: Two systematic reviews and eight guidelines were analyzed in this review. Conclusion: Oseltamivir appears to be effective in treatment of seasonal influenza in pregnant women - Strength of Recommendation B. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200149&lng=en&nrm=iso&tlng=en Abstract The unbalance between free radicals and antioxidant mechanisms is known to play an important role on female infertility. Oxidative stress (OS) has been associated with advanced age in women, BMI > 25 (overweight and obesity), as well as with sedentary lifestyle. Studies suggest a correlation between OS and several pathologies of the reproductive tract (e.g. endometriosis, PCOS) in addition to unexplained infertility cases. Here, we review the main studies on the impact of OS on female fertility along with the relationship between antioxidant supplementation intake by patients undergoing assisted reproduction treatments and their pregnancy outcomes. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200161&lng=en&nrm=iso&tlng=en Abstract Estetrol (E4) is a native fetal estrogen with a distinct pharmacological profile, acting preferentially on alpha estrogen receptors. Estetrol (15 mg) in combination with drospirenone (3 mg) has been recently approved for contraception. The advantage of hormonal combined contraception with estetrol is demonstrated by neutral impact on hemostatic factors, decreased modulation on lipidic parameters which creates a unique safety profile that emphasizes the utility of E4 in clinical practice. Besides, the E4 use for the treatment of menopause related symptoms and for breast and prostate cancer control has been extensively studied. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200170&lng=en&nrm=iso&tlng=en Abstract Primary breast lymphoma accounts for 0,04-0,5% of breast tumours and <1% of non‑Hodgkin lymphomas. Its main differential diagnosis is breast carcinoma. Case 1: female, 51 years old, pre-menopause, presented with left axillary adenomegaly with suspicious ultrasound characteristics, breasts without alterations. Ultrasound-guided microbiopsy and excisional biopsy revealed reactive lymphadenitis. Two months later, the patient presents with fever and a lump with fluctuation in the left breast. Surgical exploration was performed for suspected breast abscess and histopathological evaluation diagnosed anaplastic large T-cell lymphoma, ALK-positive. Case 2: female, 89 years old, suspicious left breast lump. Ultrasound-guided breast microbiopsy revealed follicular lymphoma. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200174&lng=en&nrm=iso&tlng=en Abstract Uterine leiomyomas are the most frequently benign smooth muscle tumor of uterus in reproductive age women and may negatively affect fertility and pregnancy outcomes. True prevalence of leiomyomas in pregnancy seems to be underestimated and its growth pattern during pregnancy remains controversial. Despite most leiomyomas present in pregnancy as an asymptomatic incidental finding, it can manifest with pain or discomfort due to torsion or degeneration. Until now, few studies reported cases of postpartum spontaneous vaginal expulsion of leiomyomas. Here we present the progression of a large hybrid leiomyoma through pregnancy and its spontaneous vaginal expulsion 10-weeks after cesarean delivery. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200179&lng=en&nrm=iso&tlng=en Abstract Acute Kidney Injury (AKI) caused by bilateral compression of the ureters by the gravid uterus is a rare complication of pregnancy. We describe the case of a pregnant woman who presented with obstructive AKI, developing severe complications (severe renal hypofunction, fetal growth restriction and urinary tract infections) and requiring invasive treatment. After exclusion of other causes, the diagnosis of AKI caused by bilateral compression of the ureters by the gravid uterus was established and double-J catheters were placed bilaterally with progressive resolution of the condition. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200183&lng=en&nrm=iso&tlng=en Abstract Toker cells are epithelial cells of the nipple epidermis, with a prevalence of about 10% of nipple sections stained with hematoxylin and eosin (H&E). More rarely, these cells are found in increased number, phenomenon known by Toker cell hyperplasia (TCH). TCH is a benign condition not associated with clinical manifestations. Reports regarding TCH refer to it as an incidental finding in skin biopsies, associated with other diseases, particularly, Paget’s Disease (PD). We report a case confirmed of TCH in a nipple associated with a non-specific chronic inflammatory lesion, with at least 17-year evolution. We emphasize the importance of biopsy to obtain a definitive diagnosis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200189&lng=en&nrm=iso&tlng=en Abstract The authors present a case of a retained lobe of an unsuspected succenturiate placenta after a normal vaginal delivery. Succenturiate placenta has a reported incidence of 5% and can be responsible for maternal morbidity as it increases the risk of vasa previa and retained placenta. This case emphasizes the importance of a complete placental inspection in the delivery room. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000200191&lng=en&nrm=iso&tlng=en Abstract The authors present a case of a retained lobe of an unsuspected succenturiate placenta after a normal vaginal delivery. Succenturiate placenta has a reported incidence of 5% and can be responsible for maternal morbidity as it increases the risk of vasa previa and retained placenta. This case emphasizes the importance of a complete placental inspection in the delivery room.