Scielo RSS http://scielo.pt/rss.php?pid=1646-583020210003&lang=pt vol. 15 num. 3 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300208&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300210&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300214&lng=pt&nrm=iso&tlng=pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300218&lng=pt&nrm=iso&tlng=pt Abstract Overview and Aims: Brazilian women younger than 25 years old have a significant frequency of abnormal cervical cytology results. Once The Brazilian National Healthcare System advocates that screening for cervical cancer should begin after the age of 25 years, we aimed to analyze the frequency of abnormal cervical cytology results in women who are younger than 25 year old compared to women from 25 to 64 years old. Methods and Population: This retrospective and observational study analyzed all exams which were performed in medium-sized countryside Brazilian town during 11 years. The prevalence ratio (PR) test was used to assess the possible statistical difference of cytology results in both groups. Results: There were 1,185 (3.15%) abnormal cases among women younger than 25. The most frequent lesion among this group was atypical squamous cells of undetermined significance (PR 2.29; 95% CI 2.10-2.49) followed by low-grade squamous intraepithelial lesion category (PR 4.31; 95% CI 3.66 - 5.06). Conclusion: There was a significant frequency of abnormal cervical cytology results in women younger than 25 years old. Nevertheless, the prevalence of true precursor lesions was not associated with this group reinforcing the possible adequacy of current guidelines. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300225&lng=pt&nrm=iso&tlng=pt Abstract Overview and Aims: There have been social and lifestyle changes, leading to 14% of couples who want to conceive being diagnosed with infertility. In some cases, Assisted Reproductive Technology (ART) is pursued. This study aimed to understand the course of couples being followed at the fertility consultation of an ART Centre and to establish predictive characteristics of success and cumulative live birth probabilities of the available treatments. Study design: Retrospective cohort. Population: Couples with infertility of the sphere of influence of a public hospital at the consultation of the Medically Assisted Reproduction Centre. Methods: It was collected clinical information regarding couples with infertility diagnosis, without previous treatments in a public ART Centre, who started being followed between January 2016 and June 2017. Results: 397 infertile couples were included, of which 47.6% had a live birth or got an ongoing evolutive pregnancy during the follow-up period (0 to 55 months), being 23.7% ART-related. There were significant differences (p<0.05) between couples with and without a live birth regarding female and male ages, antimullerian hormone concentration, number of children from previous female relationships, male smoking status, male ethnicity, congenital uterine malformation, polycystic ovary syndrome, early pregnancy loss, varicocele, couples whose men have neither medical nor surgical history and infertility causes. The logistic regression model concerning couples being followed at the fertility consultation showed that female age was the most relevant predictor of live birth. The cumulative live birth probability is 87.2% after 12 months of ovulation induction, 47.4% after 3 intrauterine inseminations and 60.6% after 3 in vitro fertilizations/intracytoplasmic sperm injections. Conclusions: It is of the utmost importance to increase social, medical and political awareness to achieve an earlier referral of these couples, a shorter waiting time between treatments and the most suitable treatment for each couple. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300244&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Ulipristal acetate (UPA) was introduced in clinical practice for the treatment of uterine fibroids in February 2012. During the post-marketing exposure, there were reports of liver injury and the European Medicine Agency recommended monitoring of liver enzymes for safety reasons. Objectives: The aim of this survey was to gather information about Portuguese gynaecologists’ experience with UPA regarding liver function and other complications related to UPA use. Material and methods: The study consisted of a cross-section survey among members of the Portuguese Society of Gynaecology between April and May 2018. The responders used an online platform to answer a survey that focused on safety and specific alterations in laboratory analyses of liver function considering treatment with UPA since January 2018. Results: In the period considered in this survey, 199 women were treated with UPA by the responders. Monitoring of liver function was performed in 93 women and alterations in liver function laboratory tests were reported in five cases (2.5%). In two of these cases, the past medical history was associated with liver diseases, namely alcoholic, infectious and autoimmune. The clinical course was favourable in all cases. Conclusions: Despite temporary UPA temporary suspension, this survey reinforced the need of clinical database for UPA safety monitoring, particularly regarding the possible application in selected clinical cases. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300251&lng=pt&nrm=iso&tlng=pt Abstract Overview and Aims: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on maternal/fetal wellbeing remains unknown. Currently, epidemiological data regarding pregnant women infected in Portugal are scarse. Our aim was to describe the clinical characteristics and maternal-fetal outcomes of pregnant women infected with SARS-CoV-2 in a Portuguese hospital. Study design: Single-center, retrospective, cohort-study. Population: Pregnant women with SARS-CoV-2 infection between March-30 and July-31, 2020, in a tertiary referral center for obstetrical care. Methods: Pregnant and immediately postpartum women with positive RT-PCR test for SARS-CoV-2 were included. We reviewed mother and neonate medical records for demographics, medical history, disease severity and pregnancy and neonatal outcomes including newborn infection. Results: 75 women were included, the majority infected in the 3rd-trimester (66.7%). Most were asymptomatic or had mild disease, with fever, cough and headache being commonly found. Only 2 cases presented with severe disease. SARS-CoV-2 prevalence rate at delivery was 6.2% and most patients had a cesarean delivery (64%). Lymphopenia was associated with symptomatic disease (p<0.001) and preterm delivery (p=0.025). Preterm birth was also more frequent in symptomatic women (p=0.048). There were 2 confirmed cases of vertical transmission (4%), one of which died. Conclusion: SARS-CoV-2 infection in pregnancy was associated with higher caesarian rates and prematurity. Lymphopenia may be an important marker for fetal distress and consequent iatrogenic preterm delivery. Vertical transmission occurred in 4% and may lead to fetal death. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300259&lng=pt&nrm=iso&tlng=pt Abstract Uterine septum is the most common uterine anomaly and is more prevalent in women with infertility and a history of recurrent miscarriage. There is no consensus on what the indications for treatment are, nor the specific surgical approach to be used. It is reasonable to consider incision of the septum in a patient with infertility, history of spontaneous abortion or adverse obstetric outcomes, but no solid published evidence supports surgical treatment in asymptomatic women. The decision on therapy must be shared with the patient, explaining the potential risks and benefits. The surgical technique must be chosen regarding the surgeon’s experience. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300264&lng=pt&nrm=iso&tlng=pt Abstract Bacterial vaginosis (BV) is a frequent cause of genital discomfort. It is characterized by an imbalance in the vaginal microbiota, with a decrease of Lactobacillus. The hypothesis was raised that the administration of Lactobacillus probiotics could restore flora balance, reducing risk and recurrence of BV. The purpose of this review is to evaluate the short and long-term efficacy of probiotic therapy, when associated with antibiotics, in BV. The authors concluded that the association of probiotics does not seem to significantly improve the effectiveness of standard antibiotic therapy. Despite not being advised, this association also has not prove to be harmful. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300274&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Since the first two successful cases reported in 1984, oocyte donation has become widespread all over the world, currently being an important part of assisted reproductive technologies (ART), with numerous indications that the authors intend to address. Methods: A total of 231 articles were identified through PubMed. A selection was made based on the language, title, abstract and relevance of the articles. 60 articles were included for this review. Discussion: Initially, the main objective of the technique was to treat infertility in women with premature ovarian insufficiency. Over the years, the safety and success of the technique allowed the inclusion of women with advanced reproductive age, after recurrent failure in ART treatments, with recurrent pregnancy loss and with genetic disease not eligible for ART with preimplantation genetic testing, in order to avoid transmission to offspring. In some countries where the law allows it, single men or couples of men can also use this technique. Conclusion: Currently, oocyte donation corresponds to an important and growing percentage of ART cycles worldwide, with a wide range of indications, standing out as an important component of infertility treatment, enabling motherhood and paternity in several cases where it proved impossible. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300281&lng=pt&nrm=iso&tlng=pt Abstract Interstitial ectopic pregnancy is rare, but can cause severe complications. The diagnosis is challenging and the optimal treatment varies according to each case. The authors present two case reports of early interstitial pregnancies diagnosed in asymptomatic or mildly symptomatic women. One was submitted to laparoscopic excision of the ectopic mass without complications. As for the other, she was treated with intramuscular methotrexate. In both cases, human chorionic gonadotropin decreased consistently until it became undetectable 4 weeks after treatment. An early and accurate diagnosis is fundamental to avoid major complications. Conservative treatment is possible and should be recommended in selected cases. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300286&lng=pt&nrm=iso&tlng=pt Abstract A 76 years old woman presented to our emergency department because of post-menopausal bleeding in June 2019. Gynaecological ultrasound was performed detecting an heterogeneous endometrial thickness of 9,3 mm. An endometrial biopsy with Novak system was performed showing an endometrioid adenocarcinoma. A total hysterectomy with adnexectomy along with lymph node dissection and pelvic washing was performed for tumour staging. Anatomopathological and histological evaluationrevealed a primary endometrial endometrioid adenocarcinoma with signet ring cells that was confirmed by immunohistochemical studies and imaging/endoscopic studies that excluded non-gynaecological tumour origin. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300289&lng=pt&nrm=iso&tlng=pt Abstract The two main risk factors for developing hydatidiform mole (HM) are history of previous mole and extremes of reproductive age, although HM is extremely rare in perimenopausal women. We present a rare case of complete hydatidiform mole in a 50-year-old woman that developed severe preeclampsia. Our goal is to highlight that pregnancy is always a possibility in perimenopausal patients that presents with vaginal bleeding and therefore should be excluded. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300293&lng=pt&nrm=iso&tlng=pt Abstract The identification of anti NMDA-Receptor encephalitis made it possible to recognise that some patients with rapidly progressive psychiatric symptoms, cognitive impairment, seizures, movement disorders, or coma of unknown cause, had an autoimmune disease.There are a female predominance, affecting young adults. with diverse clinical presentation and frequent association with tumours (ovarian teratoma).In the acute stage of the disease, many patients need to be hospitalised for at least 3-4 months, including admission to an Intensive Care Unit, followed by several months of physical and behavioural rehabilitation The first management should focus on immunotherapy and the detection and subsequent removal of tumour. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300296&lng=pt&nrm=iso&tlng=pt Abstract A 15 years-old woman presented with an abnormal mass prolapsing through the introitus. An operative hysteroscopy revealed an elongated mass with 7 cm in length consistent with an endocervical polyp. The histopathology confirmed the diagnosis. At 3 months follow-up, there was no evidence of recurrence. Cervical polyps are rare in adolescents, with few cases with a size ≥3 cm reported in the literature. Minimally invasive surgery through vaginoscopic approach is a good option to see and treat genital tract pathology in women with intact hymen or limited vaginal access. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300298&lng=pt&nrm=iso&tlng=pt Abstract The authors present a case of subchorionic placental cysts associated with fetal growth restriction and intracystic hemorrhage in the third trimester. In general, placental surface cysts are small and remain uneventful during pregnancy. However, larger cysts and cysts near the umbilical cord may be associated with adverse neonatal outcomes. It is therefore essential to recognize situations that may require an individualized approach. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300301&lng=pt&nrm=iso&tlng=pt Abstract The authors present a case of subchorionic placental cysts associated with fetal growth restriction and intracystic hemorrhage in the third trimester. In general, placental surface cysts are small and remain uneventful during pregnancy. However, larger cysts and cysts near the umbilical cord may be associated with adverse neonatal outcomes. It is therefore essential to recognize situations that may require an individualized approach. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000300308&lng=pt&nrm=iso&tlng=pt Abstract The authors present a case of subchorionic placental cysts associated with fetal growth restriction and intracystic hemorrhage in the third trimester. In general, placental surface cysts are small and remain uneventful during pregnancy. However, larger cysts and cysts near the umbilical cord may be associated with adverse neonatal outcomes. It is therefore essential to recognize situations that may require an individualized approach.