Acta Obstétrica e Ginecológica Portuguesa

Interrupção da gravidez por opção da mulher até às 10 semanas: um estudo demográfico

Overview and Aims: In Portugal, induced abortion for non-medical reasons by woman's choice until 10 weeks of gestation is permitted since 2007, when conducted in official recognized establishments. The main goal was to compare the demography of women admitted for abortion by request, following depenalization and the beginning of the world financial crisis, with the period post-troika, represented by the years 2008 and 2015, respectively. Study design and Population: Retrospective, observational and comparative study of women's clinical files that attended at our service for abortion in 2008 and 2015. Methods: We compared the referral source, women's age, number of previous induced abortions, nationality, place of residence, marital status, progeny, couple cohabitation, literacy, women and partner labor, contraception use and gestational age. Results: Were included 1212 women (2008: 665 and 2015: 547). The mean age was 28,1 vs 27,99 (2008 vs 2015). The results were higher at 2008 than 2015 in couple cohabitation: 52% vs 42% (p=0.001) and contraception use: 74% vs 65% (p=0,002). The results were lower at 2008 than 2015 in number of previous induced abortions: 19% vs 29% (p<0,001), in women inhabiting in the same area of our institution: 87% vs 94% (p <0.001), in unmarried women: 63% vs 77% (p< 0,001), in women with more than third grade of primary school: 76% vs 89% (p <0.001), on unemployment in woman: 17% vs 28% (p=0.002) and partner: 8% vs 19% (p <0.001) and in abortions at 10 weeks: 2% vs 14% (p<0.001). We haven't observed statistically significant alterations on the other cases. Conclusions: Between 2008 and 2015 there was an increase in previous induced abortions, women inhabiting in the same area of our institution, unmarried women, literacy, unemployed woman and partner and gestational age attended for abortion. There was a decrease in couple cohabitation and in contraception use choice until 10 weeks of gestation is permitted since 2007, when conducted in official recognized establishments. The main goal was to compare the demography of women admitted for abortion by request, following depenalization and the beginning of the world financial crisis, with the period post-troika, represented by the years 2008 and 2015, respectively

Interrupção da gestação por opção na Póvoa de Varzim: análise e perspectivas

The history of the interruption of pregnancy merges with the ancients of humanity, rising medical, religious, cultural and philosophical issues for millennia. In Portugal, voluntary interruption of pregnancy (VIP) was approved in Law no. 16/2007, after a second population referendum (first in 1998). The application of the new law was fast and effective. Since its publication, the law is monitored. The last national analysis report was published in 2015. Ten years after the Law, we proposed to analyze its application in a hospital of 150000 inhabitants in Greater Oporto, also looking for previous contraception, the results and failures of post-abortion visit. It highlighted a very positive scenario, both locally and nationally

Infeções urinárias na gravidez

Overview and Aims: Urinary tract infections (UTI) are frequent in pregnancy and are associated with increased preterm delivery and low birth weight. Asymptomatic bacteriuria (ABU) is the most common clinical entity and in the absence of treatment it can progress to pyelonephritis in 25% to 30% of the cases. The culture of a urine specimen is the gold standard for the diagnosis of UTI, being Escherichia coli the most common agent. The aim of this study is 1) to identify which are the main microbial agents of the urine cultures in a pregnant population, 2) to observe the agents' antibiotic resistance and sensitivity, 3) to investigate which are the best antimicrobials for the treatment of an UTI in pregnant women, and 4) to compare with a similar study conducted at the same hospital between 2005 and 2006 in order to analyze the evolution of the antimicrobial resistances pattern. Study design: Retrospective observational study. Population: 305 cases with positive urine cultures obtained in the obstetrics outpatient clinic of a tertiary care hospital, between January 2014 and December 2015. Results: E. coli was isolated in 48,9% of cases. Streptococcus agalactiae was identified in 18,4%, Klebsiella pneumoniae in 10,1% and Proteus mirabilis in 8,5%. The global antimicrobial resistance profile was: ampicillin 50%, nitrofurantoin 24%, cotrimoxazole 17%, cefalotin 11%, amoxicilin+clavulanate and gentamycin both 6%, cefuroxime 3%, ceftazidime ceftriaxone and piperacilin-tazobactam 0%. Conclusions: In our population, the most frequent agent was E. coli. Cefuroxime is a good choice as a first-line agent for empiric treatment. Ampicillin and cotrimoxazole presented both high global and E. coli specific resistance rates. Comparatively to 2005 and 2006, the resistances have increased for nitrofurantoin and decreased for amoxicilin+clavulanate

Histerectomia totalmente laparoscópica: as primeiras 300 de um novo serviço de Ginecologia e Obstetrícia

Laparoscopic and vaginal routes are the preferable routes to consider when planning a hysterectomy. Laparoscopy brings advantages to vaginal route when there are concomitant adnexal masses, endometriosis, pelvic inflammatory disease or previous abdominal surgeries. However, the learning curve in laparoscopy is slower and the surgery itself is, consequently, very dependent on the surgeon's experience. In this article, the authors review the first 300 total laparoscopic hysterectomy (TLH) surgeries in a new Obstetric/Gynecology Department. A retrospective analysis to clinical files of patients submitted to TLH between January 2013 and February 2016. Data was divided in 2 groups: group A, corresponding to the first 150 HTL and group B, with the 150 subsequent HTL. The results showed 2 similar groups, with median ages of 51 years old, with 27 median corporeal mass index, with 41% of the patients having previous abdominal surgeries. The main surgical indication was anomalous uterine bleeding secondary to mioma/adenomyosis (53%), and 309 concomitant surgeries were performed during surgical time (the majority in the adnexal area, 84%). Globally the intra-operatory and post-operatory complications rate was 1% and 2.3%, respectively, and most occurred in group A. The conversion rate to laparotomy or vaginal assisted laparoscopic hysterectomy was low (2.3%), and was only verified in group A, with statistic significance (p-value - 0.024). The blood loss volume was also statiscally different between the 2 groups (p-value < 0.001), with less volume blood loss in group B. The average uterine weight was similar in the 2 groups, with 187 and 168 grams, and the average surgical time was 155 and 148 minutes, which included the concomitant surgeries. In conclusions, despite the small number of cases, our study seems to show a tendency towards decrease in complications rate, conversion rate and blood loss, probably due to increased experience of the surgeons

Síndrome de transfusão feto-fetal

Twin-Twin Transfusion Syndrome affects 10-15% of monochorionic twin gestations. When left untreated, the perinatal mortality rates are above 90%. The surveillance of these pregnancies allows early detection of this syndrome to improve long-term outcomes. There are several forms of treatment but laser ablation is the first-line treatment in severe cases occurring before 26 weeks. In stage I the best management is not defined. The preterm birth influences negatively perinatal morbidity and mortality

Sistema intrauterino de libertação de levonorgestrel e cancro da mama

Levonorgestrel intrauterine system (LNG-IUS) is a highly effective long-term contraception that causes endometrial suppression with considerably lower systemic exposure than oral progesterone. It is currently approved for the treatment of abnormal uterine bleeding, dysmenorrhea, for endometrial protection during estrogen therapy and its use in patients with breast cancer taking tamoxifen (TMX) is being debated. The aim of this systematic review was to describe the risk of breast cancer in LNG-IUS users and to define it safety in women taking adjuvant TMX following breast cancer, for the outcomes of endometrial and uterine pathology and secondary breast cancer events

Abordagem de endometriose vesical

Endometriosis is not only a source of individual distress but also a burden for health care systems. Endometriosis’ prevalence remains unknown, however, it was estimated to be 6-20%, minimum. Urinary tract endometriosis (UTE) is found in 1-2% of patients with endometriosis. Bladder endometriosis (BE), defined as endometriosis infiltrating the detrusor, is relatively rare, representing 1% of all endometriosis cases and 84% of cases of urogenital endometriosis. The treatment of urinary tract endometriosis is controversial because the rarity of this condition makes randomized studies almost unfeasible. This literature review was performed to evaluate urinary tract endometriosis’ management, from diagnosis to treatment

Esteatose hepática aguda da gravidez: caso clínico

Acute fatty liver of pregnancy (AFLP) is a rare and life-threatening disorder. The etiology of AFLP is still unclear, however recent studies demonstrated association with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency1-3. In this report we describe a 27-year-old woman that presented at 38 weeks of gestation in spontaneous labour. She underwent emergency caesarean for non-reassuring fetal heart tracing. After caesarean the patient developed confusion, tremor, vomits and pruritus. She also presented jaundice and choluria. Laboratory data revealed hepatic dysfunction and imaging exams demonstrated hepatic lipid infiltration. The diagnosis of AFLP was defined based on clinical, laboratory and ultrasound findings and was confirmed by liver biopsy. She was successfully treated with supportive therapy. This case report reinforces the importance of recognition of clinical, laboratory and imaging findings suggestive of AFLP and demonstrates that early diagnosis and prompt supportive therapy improve the outcome reducing maternal and neonatal mortality1,4

Carcinoma de mama invasivo trifocal síncrono: um caso clínico

We report the case of a 50-year-old female diagnosed with bilateral breast carcinoma. The patient was submitted to bilateral mastectomy with sentinel LN biopsy and immediate breast reconstruction. The histopathology diagnosed a trifocal bilateral breast carcinoma. The incidence of bilateral breast carcinoma is increasing. There are no clear treatment guidelines for BBC.

Fasceíte necrotizante após cesariana: combinação de terapia de pressão negativa e instilação de solução antisséptica como tratamento eficaz

Necrotizing Fasciitis (NF) is an infectious and inflammatory process, with necrosis of the fascia muscularis and surrounding subcutaneous adipose tissue, evolving quickly and that can be potentially fatal. Although rare, NF can be one of the possible clinical presentations of surgical wound infection after cesarean delivery. A case of a patient who was submitted to a cesarean section during labor with later development of NF of the abdominal wall is presented. An integrated therapeutic approach with multiple surgical debridments and a combination of negative pressure wound therapy and instillation of antiseptic solutions was used, with full recovery of the patient

Uma massa anexial durante uma cesariana

Splenosis refers to the presence of ectopic splenic tissue through autotransplantation following traumatic rupture of the spleen or splenectomy. We report the case of a previously asymptomatic 31-year-old pregnant woman who had undergone splenectomy at 12 years of age after traumatic splenic rupture. She was submitted to cesarean section, during which multiple bluish-red nodules were found on the greater omentum and a bigger one adjacent to the right ovary as an incidental finding. Histopathology revealed the presence of supernumerary splenic tissue. We aim to raise awareness to this diagnosis since this benign finding can mimic several gynecological diseases.

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