Scielo RSS http://scielo.pt/rss.php?pid=1646-583020210004&lang=en vol. 15 num. 4 lang. en http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400322&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400324&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400327&lng=en&nrm=iso&tlng=en Abstract Overview and Aims: Maternal mortality has significantly decreased in past decades, especially in developed countries, where maternal morbidity became a main topic of research. Admission to an Intensive Care Unit (ICU) is considered an objective marker of severe maternal morbidity (SMM). Better knowledge of these patients is vital to achieve further maternal health improvements. This study aims to review obstetric ICU admissions. Study Design, Population and Methods: Retrospective transversal analysis of all obstetric ICU admissions between 2010 and 2019, in a tertiary care centre. Results: Thirty-eight women required obstetric ICU admission (1,59 for 1000 deliveries, 1,07% of all ICU admissions). Mean maternal age was 32 years, 57,9% were nulliparous, 34,2% were non-caucasian and 21,1% did not live in Portugal. Caesarean section was the main mode of delivery (86,8%), with 52,6% prematurity rate. The majority of ICU admissions were postpartum (97,4%), and median length of ICU stay was 3 days. Major obstetric haemorrhage (MOH) (44,7%) and hypertensive disorders (21,1%) were the most common diagnostics. The main interventions required were blood transfusion (57,9%) and mechanical ventilation (52,9%). No maternal deaths were recorded. Postpartum hysterectomy was performed in 5 patients (29,4% of MOH cases). Conclusions: Maternal morbidity and mortality analysis is vital, regarding maternal health care improvement. Few obstetric patients required ICU admission, with good outcomes. MOH and hypertensive disorders are the main causes for obstetric ICU admission. An increased number of non-caucasian and non-resident women can have some impact on ICU admission trends. Nonetheless, critically ill patients can be successfully managed with a multidisciplinary approach. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400336&lng=en&nrm=iso&tlng=en Abstract Overview and Aims: The incidence of women in their antenatal and postpartum period who require hospitalization in the Intensive Care Unit (ICU), has been repeatedly used as a marker of quality for health services. In Portugal there are currently few studies that report on obstetric complications and the need for a more multidisciplinary approach after admission to an ICU. The main objective of this study is to determine the probability for intensive care admission need of this Centre’s obstetric population. The secondary objectives are to characterize the obstetric population, it’s risk factors and outcomes. Study design: Descriptive and retrospective study Population: All women hospitalized at an ICU in our Centre, during pregnancy or in the 42 days postpartum, in 2013 and 2020. Methods: We assessed the electronic and physical records of our eligible population and analyzed relevant variables such as maternal age, body mass index, gestational age at admission, and delivery route. Neonatal variables, such as weight at delivery, apgar scores and adverse neonatal outcomes were also evaluated. Results: During the study period, 41 women required hospitalization in ICU, out of a total of 14 688 births. The most frequent diagnosis at admission were hypertensive disorders and postpartum hemorrhage. Mean age was 30.4 years. Most admissions were in the postpartum period (97,6%). We observed two maternal deaths and one fetal death. Conclusions: The admission rate to the ICU was 2.8 per 1000 births. Most admissions occurred in the postpartum period (97.6%), with the most common reasons being hypertensive disorders (56.1%) and postpartum hemorrhage (31.7%). The maternal mortality rate was 0.14 per 1000 births. These results were similar to those found in other international and national studies. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400342&lng=en&nrm=iso&tlng=en Abstract Overview and aims: There is a large debate on the need to perform luteal phase supplementation in intrauterine insemination (IUI) cycles. This study aimed at describing the use, indications and protocols of luteal phase progesterone supplementation among Portuguese reproductive medicine doctors. Study design: An online anonymous survey about luteal phase progesterone supplementation in intrauterine insemination cycles was conducted. Population: Portuguese reproductive medicine doctors. Methods: The survey was sent by e-mail to the mailing list of the Portuguese Reproductive Medicine Society. Results: Forty-one doctors participated in the study. An equal distribution between doctors working in private and in state institutions was verified. 61.0% of those doctors had more than ten years of experience. The most common reason to indicate an IUI was unexplained infertility (51.2%), followed by anovulation (36.6%). Concerning the type of medication prescribed, in case of unexplained or male infertility, the vast majority of doctors use gonadotropins, followed by ovulation trigger with human chorionic gonadotropin (hCG). In case of ovulation induction with clomiphene citrate or letrozole, 53.7% and 48.8% of doctors, respectively, supplement the luteal phase, mostly through 200 mg progesterone vaginal capsules twice a day. Most doctors initiate progesterone supplementation on the day of the IUI. When ovulation induction is performed with gonadotropins, 85.4% use luteal phase supplementation, 58.5% with 200 mg progesterone vaginal capsules twice a day, starting mostly on the day of the IUI. 36.6% of the doctors end progesterone supplementation at 10 weeks’ gestation and 36.6% at 12 weeks. Conclusions: The vast majority of Portuguese reproductive medicine doctors prescribe similar drugs for ovulation induction. However, there is some variability concerning luteal phase supplementation and the day of starting and ending progesterone use. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400352&lng=en&nrm=iso&tlng=en Abstract Overview and aims: Cervical cancer (CC) is the fourth leading cause of cancer death in women globally, and accounts around 311,000 deaths annually, being the persistent infection with high-risk Human Papilloma virus the most common cause. The prevention of CC is based on gynecological screening, which allows to classify the degree of existing lesion, as well as to identify other changes which may contribute to the development of these lesions and subsequent neoplasia. We aim to analyze the prevalence of cancerous and pre-cancerous lesions in the Algarve population attending the Private Hospital of Algarve (HPA), through the study of the results of gynecological cytology performed in this Hospital. Study design: Retrospective observational study from the clinical database. Methods: Data collected from the gynecological cytological analysis of female users between 25 up to 65 years old, carried out between January 2013 and December 2017. Results: It was found that the number of samples increased over the five years, making a total of 28346 samples, in which the cytological result with the highest percentage is the negative, with 95.6%. Of the cytology’s with lesions (4.4%), the one with the highest percentage is ASCUS with 2.2%, followed by LSIL with 1.7%. The Algarve municipality with the highest number of injuries identified is Faro 19.7%, followed by Portimão 15.8%. On the other hand, Castro Marim is the county with the lowest frequency of injuries 0.3%, and Alcoutim did not present any detected injuries; the age range with the largest number of samples is from 35 to 40 years old. Conclusion: This study showed that, in Algarve, the adherence to greater female health care increased in the population that uses the HPA, with the negative cytologic result being the most prevalent. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400362&lng=en&nrm=iso&tlng=en Abstract Corpus Callosum Agenesis (CCA) is a rare clinical entity. The diagnosis of CCA is mostly made in the prenatal period and includes genetic factors as one of the main causes for its development. Parental counseling is extremely difficult particularly in cases of isolated malformation due to the wide variety of possible clinical presentations. The article reviews this pa-thology with a particular focus on isolated agenesis of corpus callosum and its associated neurological prognosis. The analysis is essential so that parental counseling can be adequately given when this diagnosis is made in the prenatal period. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400370&lng=en&nrm=iso&tlng=en Abstract Breast cancer (BC) is the leading cause of cancer death in women. Mammography has been the gold-standard exam in population-based BC screening. Despite reducing BC mortality, there is no international consensus regarding its implementation and methodology, concerning the age of onset, frequency with which it should be performed, and its risk-benefit balance. We present a review of the literature that brings together the most recent evidence on BC screening: benefits in early detection and reduction of mortality, associated risks (overdiagnosis, false positives, false negatives) and future perspectives for changing from its current paradigm to a model based on individual risk. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400378&lng=en&nrm=iso&tlng=en Abstract Uterine leiomyomas are the most common gynecologic tumors and occur commonly in women of reproductive age1. Frequently they are asymptomatic, but they can present with abnormal uterine bleeding, abdominal pain and pressure symptoms if there is a large tumor size2. Hemoperitoneum due to spontaneous bleeding from a uterine leiomyoma is an extremely rare situation, with less than 100 cases described in literature3. We report a case of a 46 -year- old woman presenting acute abdominal pain with a spontaneous hemoperitoneum caused by a uterine leiomyoma. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400381&lng=en&nrm=iso&tlng=en Abstract The aim of this report is to contribute to the pool of data on clinical outcomes in SARS-CoV-2 infected infected pregnant patients. We present a case of fetal demise in an asymptomatic infected women, admitted at 39 weeks gestation with severe preeclampsia and late-onset fetal growth restriction. Higher incidence of preeclampsia among infected patients has been reported. Similar clinical, laboratorial and histopathological findings between systemic infection and preeclampsia suggest a common theme of endothelial damage and abnormal maternal circulation resulting in placental hypoperfusion, possibly leading to adverse obstetric outcomes. Further studies urge to access the impact of COVID-19 in pregnancy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400384&lng=en&nrm=iso&tlng=en Abstract Desmoid-type fibromatosis is a rare neoplastic tumor of fibroblastic proliferation that arises from muscle, fascia or aponeurotic complexes. Although usually benign, it is capable of significant local morbidity resulting from infiltration of surrounding structures. The etiology of desmoid-type fibromatosis is multifactorial since genetic, endocrine, and physical factors play an important role in its pathogenesis. Prognosis is mainly related to the anatomical site. We report a case of an intra-abdominal desmoid-type fibromatosis, arising from the retroperitoneum, diagnosed at 15 weeks of gestation and resected during pregnancy. This case demonstrates de diagnostic and management challenge posed by an abdominal mass during pregnancy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400388&lng=en&nrm=iso&tlng=en Abstract Breast angiosarcoma is an aggressive malignancy with a high recurrence rate and poor overall survival. It is the type of sarcoma most related with previous radiotherapy. The diagnosis is still a challenge because of the long latency period until its development and also because of its subtle and apparently benign presentation. There is still lack of evidence about treatment. We report a case of a 69 year-old women, who has had breast-conserving surgery and adjuvant radiotherapy after a breast invasive carcinoma, and developed a high grade angiosarcoma nine years after the first diagnosis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400391&lng=en&nrm=iso&tlng=en Abstract Leiomyossarcomas of the vagina are extremely rare and may arise years after pelvic radiation therapy. Information about clinical and imaging findings, as well as ideal treatment strategies for these potentially aggressive malignancies are lacking. We report a case of a leiomyosarcoma of the vagina in a 65-year-old postmenopausal woman who presented with vaginal bleeding and a palpable hard mass, 11 years after postoperative pelvic radiation therapy for an endometrial cancer. Despite surgical resection and adjuvant chemotherapy, she passed away soon after, endorsing the reserved prognosis of these malignancies. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400396&lng=en&nrm=iso&tlng=en Abstract Uterine rupture in pregnancy is a rare complication that can be life-threatening for the mother and fetus. The severity of the outcomes depends on factors such as size and location of the rupture and speed of intervention. We report a case of uterine rupture at a 26 weeks twins' gestation in a woman with previous laparoscopic myomectomy. She was admitted to the emergency department with abdominal pain and urinary frequency and a urinary tract infection was diagnosed. One week later, she was re-admitted with worsening abdominal pain and hemodynamic instability. An hemoperitoneum and uterine rupture were diagnosed during an emergency laparotomy. The mother survived with no complications. The neonates died on the first day due to complications associated with extreme prematurity. This case outlines that given the severity of a uterine rupture and the nonspecific symptoms associated, a high index of suspicion is mandatory in order to avoid poor outcomes. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400400&lng=en&nrm=iso&tlng=en Abstract Uterine rupture in pregnancy is a rare complication that can be life-threatening for the mother and fetus. The severity of the outcomes depends on factors such as size and location of the rupture and speed of intervention. We report a case of uterine rupture at a 26 weeks twins' gestation in a woman with previous laparoscopic myomectomy. She was admitted to the emergency department with abdominal pain and urinary frequency and a urinary tract infection was diagnosed. One week later, she was re-admitted with worsening abdominal pain and hemodynamic instability. An hemoperitoneum and uterine rupture were diagnosed during an emergency laparotomy. The mother survived with no complications. The neonates died on the first day due to complications associated with extreme prematurity. This case outlines that given the severity of a uterine rupture and the nonspecific symptoms associated, a high index of suspicion is mandatory in order to avoid poor outcomes. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302021000400407&lng=en&nrm=iso&tlng=en Abstract Uterine rupture in pregnancy is a rare complication that can be life-threatening for the mother and fetus. The severity of the outcomes depends on factors such as size and location of the rupture and speed of intervention. We report a case of uterine rupture at a 26 weeks twins' gestation in a woman with previous laparoscopic myomectomy. She was admitted to the emergency department with abdominal pain and urinary frequency and a urinary tract infection was diagnosed. One week later, she was re-admitted with worsening abdominal pain and hemodynamic instability. An hemoperitoneum and uterine rupture were diagnosed during an emergency laparotomy. The mother survived with no complications. The neonates died on the first day due to complications associated with extreme prematurity. This case outlines that given the severity of a uterine rupture and the nonspecific symptoms associated, a high index of suspicion is mandatory in order to avoid poor outcomes.