Scielo RSS <![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]> http://www.scielo.mec.pt/rss.php?pid=1646-583020200002&lang=es vol. 14 num. 2 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.mec.pt/img/en/fbpelogp.gif http://www.scielo.mec.pt <![CDATA[<b>Research training leads to better researchers, but also better doctors and critically minded readers</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200001&lng=es&nrm=iso&tlng=es <![CDATA[<b>The COVID-19 pandemic impact on ART. Proposal for individualized clinical management on resume of treatments</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200002&lng=es&nrm=iso&tlng=es As in many areas of medicine, also in reproductive medicine and especially in assisted reproductive treatments (ART), the impact of the COVID-19 pandemic has been significant. The context that led to the suspension of ART and some clinical options for restarting the activity is presented. <![CDATA[<b>Grisotti flap reconstruction</b>: <b>on the edge of breast conserving surgery</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200003&lng=es&nrm=iso&tlng=es Overview and aims: Breast tumors that invade or are proximal to the nipple-areolar complex (NAC) have been classically treated with mastectomy. As an alternative, on the edge of breast conserving surgery, these cases may be approached using central lumpectomy and immediate reconstruction with Grisotti flap. The aim of this study was to determine the involved margins rate and locoregional and systemic relapse rates in patients that underwent this surgical technique. Study Design: Retrospective observational descriptive study. Population: Women that underwent central lumpectomy and Grisotti flap reconstruction in our center, during a 4-year period. Methods: We reviewed clinical charts on patients’ data including: diagnosis, indication for surgery, pathological findings, adjuvant treatments and relapse. Descriptive and bivariate analysis was performed. Results: A total of 45 women were enrolled in the study. From these, 82.2% had invasive breast cancer, and the others had in situ disease. For characterization of tumor proximity to NAC, all patients were evaluated using Magnetic Resonance Imaging. All women underwent central lumpectomy with NAC excision, followed by Grisotti flap reconstruction. From these, 68.9% also underwent contralateral symmetrization on the same operating time. Also, in 80% we were able to perform sentinel lymph node biopsy and in 20% axillary lymphadenectomy was done. Median surgery duration was 71 minutes and median in-hospital stays was 1 day. In two cases, positive margins were present and reintervention was necessary. Considering other cancer treatments, 8.9% underwent neoadjuvant chemotherapy, 48.9% adjuvant chemotherapy, 93.3% radiotherapy and 88.9% hormonal therapy. For a median follow-up time of 31 months, we report one case of locoregional relapse and one case of systemic relapse. Conclusions: Central lumpectomy combined with immediate Grisotti flap reconstruction is a good alternative for centrally located breast tumors. We report low positive margins rates (4.4%) and low relapse rates (2.3% for locoregional and 2.3% for systemic relapse). <![CDATA[<b>Current trends and perceptions of the Portuguese Gynecology experts on hormonal intrauterine contraception</b>: <b>The DIOGIN study</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200004&lng=es&nrm=iso&tlng=es Overview and Aims: Intrauterine systems (IUS) are one of the most effective forms of long acting reversible birth control, with low failure rates and high continuity and satisfaction rates. Still, they account for a small proportion of contraception use, which may be due to several myths and misperceptions. With this study, we aimed to assess Portuguese experts’ perceptions on potential benefits and fears that may limit women’s contraception choice and to identify current trends in clinical practice. Methods and Population: We performed an observational, descriptive and analytical study in which gynecologists/obstetricians were invited to answer an anonymous questionnaire by call or email made of multiple-choice questions on IUS use. Results: A total of 482 Portuguese Gynecologists answered the survey, of which 97.1% revealed that the insertion of IUS is a common procedure in their current clinical practice. More than 95% considered the insertion of IUS an easy procedure and a safe contraceptive method. Cost-efficacy and the fact that this method doesn’t rely on women´s action to be effective were the top benefits for IUS users, perceived by the physicians. On the other hand, concern about having a foreign object inside the body and fear of insertion pain were perceived by the physicians as the top barriers to IUS use. Female gynecologists perceived a higher degree of pain associated with IUS insertion (p=0.021). Overall, gynecology experts’ opinions were conservative regarding IUS recommendations to women. Conclusions: The results of this study provide a general insight towards Portuguese gynecologists’ perceptions, opinions and attitudes on the use of IUS. Most of the experts consider IUS a safe contraception method but, on the other hand, there is still concern about its use in particular female conditions which may in part contribute to the low rate of IUS use in Portuguese women. <![CDATA[<b>Smoking and smoking cessation during pregnancy - State of the art</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200005&lng=es&nrm=iso&tlng=es Smoking is the leading avoidable cause of adverse outcomes in pregnancy. Smoking cessation has been clearly associated with health benefits to both mother and foetus. However, only a minority of smokers will cease. Healthcare professionals’ guided interventions could be a critical step in prenatal smoking cessation, requiring knowledge in the management of non-pharmacological and pharmacological techniques. The data from available trials has not yet succeeded to assess the safety and effectiveness of pharmacological methods in pregnancy and breastfeeding. Thus, the recommendations support preferably the use of non-pharmacological strategies. <![CDATA[<b>Mesonephric hyperplasia can cause abnormal papanicolaou smears</b>: <b>a case report</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200006&lng=es&nrm=iso&tlng=es Mesonephric hyperplasia (MH) is a very rare condition. There are few cases in the literature. Mesonephric remnants (MR) or MH can be a rare source of abnormal Papanicolaou smears. The most common, often difficult, in the differential diagnosis of MH is mesonephric carcinoma that has a poor prognosis. We report a case of a 29-years-old with a routine Papanicolaou smear reported as atypical glandular cells. The patient underwent to a loop electrosurgical excision procedure and because it is a benign condition and a strong desire to preserve fertility, we opted for clinical surveillance. <![CDATA[<b>Spontaneous rupture of splenic artery aneurysm during a multiple pregnancy</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200007&lng=es&nrm=iso&tlng=es We report a rare case of a 39-year-old woman, twin pregnancy with 32 weeks’ gestation, who underwent an emergency caesarean section and subsequent exploratory laparotomy with splenectomy due to hypovolemic shock secondary to splenic artery aneurysm rupture. The patient was admitted for observation due to suspicion of threatened preterm labour. The final diagnosis was not considered due to its rarity. The postoperative course was favourable for the mother, the newborns died. Spontaneous rupture of splenic artery aneurysm during pregnancy is a life-threatening event. This condition is commonly asymptomatic, and diagnosis is often incidental: during an ultrasound, intraoperatively or at autopsy. <![CDATA[<b>Primary syphilis - an atypical presentation</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200008&lng=es&nrm=iso&tlng=es Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. The clinical manifestations of this disease vary widely, according to its stage. Primary syphilis typically presents as a single painless genital ulcer. The authors report a case of an atypical presentation of primary syphilis: multiple vulvar, perianal and between the buttocks ulcerated and very painful papules and plaques, with seropurulent exudate. <![CDATA[<b>Secondary postpartum haemorrhage</b>: <b>when subinvolution of the placental site is suspected</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200009&lng=es&nrm=iso&tlng=es presented to our emergency department with a sudden late postpartum haemorrhage 30 days after a caesarean section. The transvaginal ultrasound examination revealed a pulsatile and tortuous vessel in the inner third of the posterior uterine wall with an increased peak systolic velocity and a low-resistance waveform. The diagnosis of subinvolution of the placental site was suspected and a Foley catheter with 40cc of normal saline was used as uterine tamponade. After the tamponade, the bleeding subsided. The Foley catheter was removed after 48 hours. Revaluation with ultrasound showed no evidence of abnormal vessels in the myometrium. <![CDATA[<b>Pregnancy after bariatric surgery</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200010&lng=es&nrm=iso&tlng=es presented to our emergency department with a sudden late postpartum haemorrhage 30 days after a caesarean section. The transvaginal ultrasound examination revealed a pulsatile and tortuous vessel in the inner third of the posterior uterine wall with an increased peak systolic velocity and a low-resistance waveform. The diagnosis of subinvolution of the placental site was suspected and a Foley catheter with 40cc of normal saline was used as uterine tamponade. After the tamponade, the bleeding subsided. The Foley catheter was removed after 48 hours. Revaluation with ultrasound showed no evidence of abnormal vessels in the myometrium. <![CDATA[<b>COVID-19</b>: <b>Stay at Home</b>]]> http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000200011&lng=es&nrm=iso&tlng=es presented to our emergency department with a sudden late postpartum haemorrhage 30 days after a caesarean section. The transvaginal ultrasound examination revealed a pulsatile and tortuous vessel in the inner third of the posterior uterine wall with an increased peak systolic velocity and a low-resistance waveform. The diagnosis of subinvolution of the placental site was suspected and a Foley catheter with 40cc of normal saline was used as uterine tamponade. After the tamponade, the bleeding subsided. The Foley catheter was removed after 48 hours. Revaluation with ultrasound showed no evidence of abnormal vessels in the myometrium.