Scielo RSS <![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]> vol. 13 num. 3 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Placenta Accreta Spectrum Disorders</b>: <b>something we can’t ignore</b>]]> <![CDATA[<b>Placenta accreta - clinical experience of a tertiary care center over 8 years</b>]]> Overview and aims: Placenta Accreta Spectrum disorders are the leading cause of emergency hysterectomy in developed countries and are associated with high maternal morbidity and mortality (60% and 7%, respectively). The objective of our study was to review cases of PAS disorders occurring in the last 8 years (2010-2017) in a tertiary care centre, evaluating the forms of treatment chosen and the maternal and fetal outcomes. Methods: Retrospective cross-sectional study using hospital databases (Obscare®, SClinico®) to identify cases of placenta accreta during the study period. Diagnosis was made based on the histological study of placentas submitted for anatomo-pathological study. Results: During the study period, 38 cases of a PAS disorder were diagnosed in 20,910 births (1.8 / 1000), a number that is possibly underestimated. There were 8 women with a previous caesarean section and 6 had placenta previa (2 of them with previous caesarean section). There was ultrasound suspicion of a PAS disorder in 3 cases; of the 4 most severe cases (3 percretas and 1 increta), there was an ultrasound suspicion in 2. Regarding method of delivery, 21 births were by caesarean section and 16 by vaginal delivery. There was 1 case of spontaneous uterine rupture at 20 weeks' gestation with fetal loss; gestational age of birth varied between 32 and 41 weeks; 5 peri-partum hysterectomies were performed; transfusions of blood derivatives were required in 8 women. As for the newborns, there were 8 cases of prematurity and 7 hospitalisations in the Neonatal Intensive Care Unit; fetal death was observed in 2 cases. Conclusion: This case series demonstrate the high prevalence of PAS disorders and the great morbidity associated with it. Adequate antepartum care is essential in women with riskfactors to make the diagnosis timely, thus enabling a multidisciplinary approach with better maternal and fetal outcomes. <![CDATA[<b>Detection of human ovarian carcinoma from blood samples using scent dogs</b>]]> Ovarian cancer is the most lethal of all common gynecologic malignancies, with more than 204,000 new cases and 125,000 deaths/year worldwide. Currently, there are no acceptable screening techniques available. Body odors are the result of volatile organic compounds that are originally secreted from various cells. Tumors likely have distinctive odors that can be recognized by trained dogs. In a double-blinded test, three detection dogs were trained to identify blood samples obtained from patients with ovarian carcinoma. Animals where presented to three equal copies of five different test sets, each comprising five samples. Each set had a positive target sample, non-ovarian malignant tumor sample(s), healthy donors sample(s) or benign tumor sample(s). Individual success rate was 40%, while if an identification was considered when two or more dogs mark the same sample, success reached 60%. A malignant sample was identified 64.45% of the times. If the identification was made by two dogs at the same time, malignant samples were identified 80% of the times. The present study consists, in the authors’ knowledge, the first description of the use of scent dogs to detect ovarian tumors from blood samples, when up against blood samples containing any other possible type of tumor. <![CDATA[<b>Induction of labor in twin pregnancies vs single pregnancies</b>: <b>a systematic review</b>]]> To determine if the induction of labor in twin pregnancies is associated with greater risk of cesarean delivery than the induction of labor in single pregnancies, we performed a systematic review. Only in one of three studies included cesarean delivery after induction is more frequent in twin than in single pregnancies. Through a multivariable analysis, maternal age and nulliparity are more important risk factors to cesarean delivery than twin pregnancy. Twin pregnancies have a higher risk of cesarean delivery than single pregnancies, but this does not appear to be related with induction of labor. <![CDATA[<b>Primary functional tumors of the ovary</b>]]> Functional ovarian tumors present a distinct biology and oncological behavior in comparison to epithelial malignancies, and its knowledge will majorly impact the diagnostic, therapeutic and prognostic approach. Hyperandrogenism, hyperestrogenism, hyperthyroidism, hypercalcemia, HCG production, carcinoid and Cushing syndrome are some of the most relevant clinical profiles. A brief discussion on the main endocrine manifestations, histological entities and differential diagnosis will be provided. <![CDATA[<b>Vaginal breech delivery seen from a different perspective - a case series</b>]]> Term breech presentation is a common indication for cesarean delivery. However, concern over the implications of planned cesareans on maternal morbidity and complications for future pregnancies as well as the limitations attributed to the Term Breech Trial have shed new light on the vaginal breech delivery, with different approaches being attempted. We report three cases of term vaginal breech delivery in the upright position, one of them requiring Piper’s forceps for fetal head delivery. No other relevant complications occurred. As with deliveries in lithotomy position, clinical expertise and case selection are prerequisites for favorable maternal and neonatal outcomes. <![CDATA[<b>Recurrent acute pancreatitis in pregnancy</b>]]> Introduction: During pregnancy pancreatitis is a rare and diagnosis is difficult. Cholelithiasis is the most frequent risk factor. Case report: A 26-year-old pregnant woman with abdominal pain, vomiting and low-grade fever. Hyperamylasemia and cholelithiasis was found and pancreatitis diagnosis was made. A second episode of acute pancreatitis was observed and treated with medical therapy. There was no foetal or neonatal complications. In puerperium a third pancreatitis occurred, a laparoscopic cholecystectomy was performed. Discussion: Diagnosis of acute pancreatitis in pregnancy is challenging and it may have serious maternal-fetal implications. Recurrent pattern should be taken into account when choosing the best treatment. <![CDATA[<b>Laparoscopic repair of post-hysterectomy vesicovaginal fistula</b>]]> Currently, in developed countries, vesicovaginal fistulas are mostly complications of gynecologic surgery. Laparoscopic vesicovaginal fistula repair has been reported with good results. We describe a technique to successfully repair, by laparoscopy, a vesicovaginal fistula following total laparoscopic hysterectomy for benign pathology. To our knowledge, this is the first reported case of vesicovaginal fistula repair using a laparoscopic technique in Portugal. <![CDATA[<b>Pararretal hematoma after delivery</b>]]> A puerperal vulvovaginal hematoma is not an unusual finding after vaginal deliveries. However, most of them are small and self-limited. Even though there are multiple risk factors identified, the majority of cases happen in low risk settings. We here report a case of a nulliparous young woman who developed a massive pararretal hematoma after an uncomplicated vaginal delivery. Surgical intervention was useful but selective embolization was required. Our goal is to highlight the importance of being aware of this potential complication of a vaginal delivery and the need of an early diagnosis in order to offer the most suitable treatment and prevent severe damages.