Scielo RSS http://scielo.pt/rss.php?pid=1646-583020220001&lang=es vol. 16 num. 1 lang. es http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100008&lng=es&nrm=iso&tlng=es http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100010&lng=es&nrm=iso&tlng=es Abstract Overview and Aims: The number of voluntary interruptions of pregnancy, despite its decreasing trend, remains with marked regional asymmetries. The profile of the populations that most perform voluntary abortion is not known. With this study, we aim to establish the profile of these women and analyse their temporal evolution, to build effective and targeted preventive measures. Study Design: Cross-sectional study. Population: Women who had a voluntary abortion in a district hospital between 2012-2018. Methods: We collected sociodemographic, gynaecological and obstetric data from the database of the voluntary abortion consultation. Statistical analysis was performed with SPSS®. Results: Most women who had a voluntary abortion were between 20 and 40 years old, were Portuguese, had a 3 rd cycle or secondary education, were single, had children, and were unemployed or had unskilled work. However, young women under 20 years old and immigrants were the ones with higher risk of voluntary interruption of pregnancy. Regarding women with a history of previous voluntary abortions, they tended to have more children and there was a greater proportion of immigrant and women with low education or professional qualification in this subgroup. Conclusion: Socio-economic frailty, which is more pronounced among young women, immigrants, and precarious workers, seems to be the main predisposing factor for voluntary interruptions of pregnancy. It is imperative to invest in sexual education and health literacy, improve access to family planning consultations and contraceptive methods and invest in closer and regular follow-up of these women at higher risk. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100023&lng=es&nrm=iso&tlng=es Abstract Introduction and Objectives: Tocology knowledge is crucial in obstetrician's decisions and actions. The aim of this research is to assess the experience of Portuguese Gynecology and Obstetrics residents in performing operative vaginal delivery. Study design, population and methodology: Observational and transversal study with collecting an anonymous online survey with 47 questions, performed to 2nd to 6th year residents of Gynecology and Obstetrics. Results: 82 responses to the survey were obtained. The mean age of the sample was 29.3±0.248 years and 92.7% (n=76) of the participants were female. About half of the participants (53.7%, n=44) were working in a central hospital. The vacuum was the instrument most frequently used by the residents (95.1%). When asked about their level of confidence in performing an instrumented delivery, 6th-year residents (n=20) gave, on average, on a 1 to 9 scale, a score of 4.25±0.56 for the use of forceps and 8.05 ±0.22 for the use of vacuum (p<0.001). In this sample, 90.2% of the residents had the opportunity to undergo practical training in instrumented deliveries during the residency. Regarding maternal morbidity, the main concern using forceps are obstetric anal sphincter injuries (74.4%) and using vacuum are vaginal lacerations (32.9%). Conclusions: This survey allowed to characterize and to assess the residents experience, as well as their limitations, on performing operative vaginal deliveries. The knowledge acquired is essential to adapt and homogenize training plans, whenever needed. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100029&lng=es&nrm=iso&tlng=es Abstract Overview and Aims: Numerous studies have shown that burnout has high incidence among medical doctors, being especially high among gynecologists and obstetricians. Since there is no known study on the incidence in this medical residency in Portugal, our primary goal was to evaluate the incidence of burnout in gynecologists and obstetricians, to understand which factors are most associated with the syndrome and to contribute to the prevention of burnout. Study Design: Cross-sectional survey. Population: Gynecologists and obstetricians practicing in Portugal. Methods: A survey was elaborated and validate by the authors about sociodemographic and professional and personal life questions with burnout assessment through Copenhagen Burnout Syndrome Questionnaire adapted to Portuguese. The questionnaire was addressed via e-mail to all members of the Portuguese Society of Gynecology and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine. Anonymity was ensured through the Google Forms platform. The results were analyzed using the SPSS statistical software. Results: It was obtained 217 responses; 56.7% of the gynecologists and obstetricians who participated in the study suffer from burnout, with an average of 54.9 points in the validated scale. Women doctors, younger specialists, few leisure activities; thinking about changing specialty; profession or institution/service; classification of workplace conditions; excessive workload, lack of career progression, lack of autonomy in managing working hours, inequality in working conditions and salary as causes of stress and anxiety; no activities for reducing stress and anxiety; and regular intake of anxiolytic and/or antidepressant drugs were more associated with Burnout. Conclusions: This analysis found a high incidence of burnout in the specialists of gynecology and obstetrics in Portugal, as reported in other international studies. In addition, it was possible to identify aggravating and protective factors amenable to intervention. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100037&lng=es&nrm=iso&tlng=es Abstract Overview and aims: Colposcopy is considered the “gold standard” technique for the evaluation of women with abnormal cervical cancer screening tests or with a clinically suspicious cervix. The aim of this study was to evaluate the applicability of four quality indicators in colposcopy, as defined by the European Federation of Colposcopy (EFC), in a Portuguese colposcopy unit. Study design: Descriptive retrospective study. Methods and Population: We included all patients who had been submitted to excision of the cervical transformation zone in a Colposcopy unit of a tertiary Portuguese hospital, from January to December 2020. Results: A total of 110 excisions of the cervical transformation zone were performed. We found that in all cases (100%) the types of transformation zones were described and colposcopy was performed before treatment in all. In 78.2% of cases a CIN2+ lesion was described in biopsy or in the excision specimen. The resection margins were free at 90.9%. Conclusions: With this work we intend to highlight the possibility of applying the EFC criteria as a tool for the internal and external assessment of colposcopy units in Portugal. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100045&lng=es&nrm=iso&tlng=es Abstract Ovarian fibromatosis refers to a rare benign phenomenon where there is a tumor-like ovarian enlargement up to 6-12cm in size due to diffuse ovarian fibrosis and it is more frequently seen unilaterally. It is characterized by a proliferation of collagen-producing spindle cells surrounding normal ovarian structures, thus causing thickening of the superficial cortex and enlargement of the ovary. It affects predominantly young women and common clinical manifestations include abdominal pain, menstrual irregularities, hirsutism and virilization. Ovarian fibromatosis may mimic malignant ovarian tumors due to similar presentation and radiological findings. The “black garland sign” refers to a marked T2 hypointense thick rim of fibrous tissue surrounding the ovary in the setting of ovarian fibromatosis on magnetic resonance imaging (MRI). http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100048&lng=es&nrm=iso&tlng=es Abstract Gitelman's syndrome is characterized by a mutation of SLC12A3 gene, which encodes the NaCl cotransporter of distal convoluted tubule resulting in hypokalaemia. During pregnancy its approach and treatment become a challenge. We report the case of a pregnant woman, with a history of previous abortions, who needed a tight analytical control with several hospital admissions throughout pregnancy and more agressive and controled oral and intravenous therapy, which allowed to preserve a good fetal development and normal delivery without complications. This disease in pregnant women has a good prognosis, although it imposes the need of a tight multidisciplinar follow-up. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100052&lng=es&nrm=iso&tlng=es Abstract Preterm birth rate is increased in twin pregnancies and there is currently no proven effective intervention for the prevention of this complication. The authors present a case of cervical insufficiency in a twin gestation identified in the 21st week. Although the patient was asymptomatic, the cervix was dilated with exposed membranes and physical examination-indicated cerclage was performed. The cervical length remained stable over the rest of the pregnancy. Gestation was terminated in the 35th week due to fetal growth restriction in fetus 2. Both fetuses had an Apgar score of 9/10/10 at 1, 5 and 10 minutes post-birth. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100056&lng=es&nrm=iso&tlng=es Abstract Endometrial hyperplasia (EH) is a frequently found in postmenopausal women. Cases of recurrence are seen in women with multiple risk factors, unopposed estrogen therapy, and in estrogen-secreting tumors. Granulosa cell tumors of the ovary are a rare malignant type of estrogen-secreting tumor, usually presenting as a pelvic mass. In this report, we present the case of a 68-year-old asymptomatic woman submitted to total hysterectomy and bilateral salpingo-oophorectomy due to recurrent EH. Histology found an adult granulosa cell tumor of the ovary. This case aims to highlight that, although very rare, the presence of an estrogen-secreting tumor should be considered. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100059&lng=es&nrm=iso&tlng=es Abstract Sustained fetal tachyarrhythmias (most commonly supraventricular fetal tachycardia) can lead to hydrops fetalis and eventual fetal demise if untreated. Although many centers now use flecainide as first-line therapy there is still some controversy. Effectiveness and safety are two major concerns regarding anti-arrhythmic therapy. We describe three cases of fetal supraventricular tachyarrhythmia, one of which presenting with hydrops fetalis, two of them successfully treated with monotherapy flecainide. The third case, an atrial flutter that was initially resistant to sotalol therapy converted to sinus rhythm with combination therapy with flecainide and digoxin after 48 hours. There were no side effects. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100062&lng=es&nrm=iso&tlng=es Abstract Fanconi Anemia (FA) is a rare hereditary syndrome which commonly causes infertility. We present a case of a spontaneous successful pregnancy in a patient with FA. During pregnancy, she had a progressive worsening of baseline thrombocytopenia without improvement with corticosteroid or platelet transfusions. Due to inability to maintain a safe platelet level, therapy with a thrombopoietin receptor agonist (Eltrombopag), previously used in patients with refractory immune thrombocytopenia, was started with good response. As this report shows, pregnancy with good perinatal outcome in patients with FA is possible with appropriate multidisciplinary follow-up. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100066&lng=es&nrm=iso&tlng=es Abstract Leiomyomas are the most common benign tumors in reproductive age women. The incidence is higher in African descent women. Development and growth of fibroids is estrogen and progesterone dependent. Besides excessive menstrual bleeding, pelvic pain is also a common symptom. Doppler ultrasound (dUS) or magnetic resonance imaging (MRI) are useful for preoperative differentiation between benign and the more uncommon malignant forms. Treatment of leiomyomas depends on size, location, severity of symptoms and patient desire to preserve fertility. The authors present a case of a 16 cm subserous cervical myoma that occupied the pelvic cavity. Laparotomy was performed for tumor excision. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100068&lng=es&nrm=iso&tlng=es Abstract The Essure® (Bayer) system was introduced in 2002, as a hysteroscopic sterilization technique, however, serious long-term adverse events raised concern about its use and lead to the discontinuation of the device in 2017. The authors present a report of intrauterine migration from one of the microinsert components in a woman with abnormal uterine bleeding. Transvaginal ultrasound was the key to the diagnosis, finding in the endometrial cavity a hyperechogenic structure with a coiled shape. The hysteroscopic removal of the migrated component conducted to the resolution of the clinical complaints. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100070&lng=es&nrm=iso&tlng=es Abstract The Essure® (Bayer) system was introduced in 2002, as a hysteroscopic sterilization technique, however, serious long-term adverse events raised concern about its use and lead to the discontinuation of the device in 2017. The authors present a report of intrauterine migration from one of the microinsert components in a woman with abnormal uterine bleeding. Transvaginal ultrasound was the key to the diagnosis, finding in the endometrial cavity a hyperechogenic structure with a coiled shape. The hysteroscopic removal of the migrated component conducted to the resolution of the clinical complaints. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302022000100075&lng=es&nrm=iso&tlng=es Abstract The Essure® (Bayer) system was introduced in 2002, as a hysteroscopic sterilization technique, however, serious long-term adverse events raised concern about its use and lead to the discontinuation of the device in 2017. The authors present a report of intrauterine migration from one of the microinsert components in a woman with abnormal uterine bleeding. Transvaginal ultrasound was the key to the diagnosis, finding in the endometrial cavity a hyperechogenic structure with a coiled shape. The hysteroscopic removal of the migrated component conducted to the resolution of the clinical complaints.