Scielo RSS <![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]> vol. 13 num. 4 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Controversies in Reproductive Medicine - brief notes</b>]]> <![CDATA[<b>Predictive factors of pathological complete response in a Portuguese population with breast cancer treated with neoadjuvant chemotherapy</b>]]> Overview and Aims: Neoadjuvant chemotherapy is increasingly being used in the treatment of operable breast cancer. Our aim was to evaluate the factors that predict pathological complete response (pCR) after neoadjuvant chemotherapy in a Portuguese population of breast cancer patients. Study design: Retrospective, cross-sectional study. Population: Women diagnosed with breast cancer stage I-III treated with neoadjuvant chemotherapy and subsequent surgery in our institution during a 6-year period. Methods: Clinical records were reviewed. Patient demographics and tumour characteristics were evaluated. Univariate and multivariate analysis were performed to evaluate tumour’s clinical and immunohistochemical characteristics associated with pCR. Results: A total of 164 patients enrolled the sudy. The overall rate of pCR was 17.7%. The rate was significantly higher in HER2-positive (non-luminal) tumours (66.7%) and lower in luminal A tumours (0%). The nuclear grade, estrogen receptor (ER), progesterone receptor (PR), HER2 status and Ki67 proliferation index significantly influenced the rate of pCR. However, multivariate analysis revealed that only negative ER and positive HER2 are significant predictors of pCR [respectively, ORadj 0.187 (95% CI 0.038-0.908; p=0.038) and ORadj 4.186 (95% CI 1.401-12.508; p=0.010)]. Conclusion: ER status and HER2 status are the most important predictors of pathological complete response. These findings should be considered in patient counselling, providing a more customized therapeutic approach. <![CDATA[<b>Breech presentation - Predictive model of the delivery mode</b>]]> Overview and Aims: The decision of the route of delivery in a breech presentation is one of the most controversial topics in contemporary obstetrics. The aim of this study is to develop a predictive model for vaginal breech delivery (VBD). Study Design, Population and Methods: It was performed an observational, retrospective, descriptive study based on the review of clinical records of pregnant woman with singleton gestations in breech presentation at term, with delivery between 2005 and 2015, in Hospital de Braga and Unidade Local de Saúde do Alto Minho. Potential predictors of VBD were analyzed by bivariate analysis and binary logistic regression. Results: There were included 92 VBD and 167 cesareans. The final model includes 6 variables: Maternal age, number of previous deliveries, percentile of estimated fetus weight, weight of the heaviest previous newborn, Bishop’s index and fetal gender. The area under the curve was 0,83, corresponding to a good discriminative ability. A probability equal to or greater than 50.3% may be an adjunct to the decision of the delivery route. Conclusions: A predictive model with good discriminative capacity was developed that can be useful helping the decision of the route of delivery in pregnant woman with singleton gestations in breech presentation at term. <![CDATA[<b>Ptyalism Gravidarum</b>]]> This is a systematic review of ptyalism gravidarum. Very few data concerning ptyalism gravidarum has been published so far, which culminates in health care providers’ lack of knowledge about this disorder and its management. Ptyalism gravidarum is a rare disorder associated with pregnancy, characterized by an excessive production of saliva beginning during the first trimester and persisting until delivery or some weeks after. Its exact pathophysiology remains unknown. Most of the few data published about the subject consider ptyalism gravidarum not to pose any specific risks to pregnancy. It’s a self-limited condition and there is no treatment for the disorder. <![CDATA[<b>Endometriosis and sexual dysfunction</b>]]> Sexual function is essential for women's wellbeing. Chronic pelvic pain and dyspareunia are important symptoms of endometriosis that may contribute to women's sexual dysfunction; however, other biopsychosocial variables may intervene. Treatments for endometriosis are associated with decreased pain and seem to improve sexual functioning in these patients. There is an increasing interest to evaluate the impact of endometriosis and its treatments on women's sexual health. <![CDATA[<b>Endometriosis and infertility - where are we?</b>]]> Endometriosis is a complex disease with a poorly understood etiology. In women with infertility its prevalence reaches 50%. Several pathophysiological mechanisms have been proposed, ranging from a decreased oocyte quantity and quality, modified tube-ovarian function, endometrial receptivity or inflammatory environment due to the peritoneal fluid. The best approach to women with infertility and endometriosis is still under discussion, and assisted reproductive technology treatments are a frequent alternative. <![CDATA[<b>Pseudoangiomatous stromal hyperplasia of the breast</b>: <b>an unusual indication for mastectomy</b>]]> Pseudoangiomatous Stromal Hyperplasia (PASH) is a benign proliferation of the mammary stromal tissue. We present a clinical case of a 74-years-old patient presenting a fast-growing PASH, treated through mastectomy, with no recurrence or breast cancer after a 11-years follow up. The patient’s clinical history, imaging, histopathologic examinations, treatment, and follow up were reviewed, along with 9 other cases described in literature. Considering that PASH is a condition that needs removal through an excision with safe margins, in case of fast-growing or large lesions, mastectomy seems to be a safe long-term treatment, with low risk of relapses or contralateral breast pathology. <![CDATA[<b>Acute myocardial infarction due to spontaneous coronary artery dissection in a twin pregnancy</b>]]> Spontaneous coronary artery dissection is a rare event during pregnancy, resulting in significant acute maternal and foetal mortality rates. We report a case of a mid-left anterior descending artery type I dissection in a 34-year-old primigesta with a 24-weeks monochorionic diamniotic twin pregnancy. She was treated medically with favourable outcome. Although quite rare in obstetric practice, spontaneous coronary artery dissection should be considered in the differential diagnosis of chest pain in pregnant women. <![CDATA[<b>Actinic dark pigmentation of the vagina mimicking melanoma</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. <![CDATA[<b>Prolonged retention of a second trimester tubal pregnancy</b>]]> Outcomes of tubal ectopic pregnancy include tubal rupture with major hemorrhage, tubal miscarriage, or pregnancy failure with spontaneous resolution but there are some reported cases of advancing pregnancy until 2nd or even 3rd trimester. We present the case of a 34-year-old woman admitted to the Gynecology emergency room with pelvic pain and fever as a consequence of a tubo-ovarian abscess in the context of a 16 weeks demised tubal pregnancy. Pelvic ultrasound enlightened the diagnosis and the woman was submitted to surgery with a favorable recovering.