Scielo RSS <![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]> vol. 14 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Gynecology in times of pandemic</b>]]> <![CDATA[<b>Obstetrics and Gynecology Internship and COVID 19</b>: <b>before, during and after</b>]]> The Portuguese College of Obstetrics and Gynecology has been following the evolution of the COVID 19 pandemic since its beginning and all the impact in terms of clinical activities in different areas of the Specialty. Likewise, there has been a concern about how changes in the functioning of the Departments of Obstetrics and Gynecology have been reflected in the Specific Training Internship. This matter was discussed at one of the College Board's meetings, and an opinion document was sent to the National Council of Postgraduate Studies of the Medical College of Physicians. <![CDATA[<b>Pregnant woman in the COVID-19 pandemia</b>]]> The Portuguese College of Obstetrics and Gynecology has been following the evolution of the COVID 19 pandemic since its beginning and all the impact in terms of clinical activities in different areas of the Specialty. Likewise, there has been a concern about how changes in the functioning of the Departments of Obstetrics and Gynecology have been reflected in the Specific Training Internship. This matter was discussed at one of the College Board's meetings, and an opinion document was sent to the National Council of Postgraduate Studies of the Medical College of Physicians. <![CDATA[<b>Radiation-induced endometrial cancer after cervical carcinoma</b>]]> Overview and Aims: Cases of radiation-induced endometrial cancer after cervical carcinoma are characteristically different than sporadic cases of endometrial cancer as they tend to be more aggressive, diagnosed in a more advanced stage, and with a poorer outcome. Therefore, it is important to maintain surveillance, be aware of the warning signs and know how to approach these secondary cancers in order to assure the best outcome for these patients. The goal of our study is to describe a case series of patients with radiation-induced endometrial cancer after cervical carcinoma followed at our institution. Study design: Retrospective, cross-sectional study. Population: Patients with a diagnosis of endometrial cancer who had previously received definitive radiation treatment for cervical cancer. Four patients met our inclusion criteria. Methods: Analyzed parameters included patient demographics, age upon diagnosis, type of radiation therapy, histological grade and subtype of the primary and the secondary cancers. Results: The mean age at diagnosis of the primary cervical cancer was 64 years. All of the patients had received definitive radiation therapy and chemotherapy. The mean latency period between the initial diagnosis of cervical cancer and the development of the endometrial carcinoma was 5.3 years. Two patients had stage I disease, one had stage II and one had stage III. Regarding the histological type, there was one case of endometrioid carcinoma, one of carcinosarcoma and two of serous carcinoma. All of the patients underwent hysterectomy and bilateral salpingo-oophorectomy and three received chemotherapy as adjuvant therapy. Three patients maintain their follow-up in our institution without any evidence of disease. Conclusion: Regular surveillance based on anamnesis and physical examination is of the most importance in women that underwent radiotherapy for cervical carcinoma. Imaging tests can aid in this particular subset of patients as cervical stenosis might hide an underlying condition. In our sample, only one patient complained of abnormal uterine bleeding and three patients had an aggressive histological type of endometrial cancer diagnosed. The latency period between the primary and secondary cancers was shorter than expected and might be related to small size of the sample. <![CDATA[<b>Prevalence of group B Streptococcus colonization in pregnant women of CHUSJ</b>]]> Overview and Aims: Colonized pregnant women with group B streptococcus (GBS) are generally asymptomatic, but GBS can cause urinary tract infection, as well as amnionitis, endometritis and bacteraemia. It is also associated with an increased risk of preterm birth and fetal death. In the newborn, GBS is the main cause of infection, which can lead to neonatal GBS early-onset disease (EOD) or late-onset disease. The aim of this study was to evaluate the prevalence of GBS colonization in pregnant women, and to assess differences between groups, risk factors for colonization, and the occurrence of EOD. Study Design, Population and Methods: An observational, retrospective and descriptive study was carried out in pregnant women who had deliveries between January 2013 and September 2019. We evaluated demographic and clinical variables obtained from electronic files. The pregnant women were divided into two groups, colonized by GBS and not colonized by GBS. Descriptive analyses of the study variables and statistical tests were performed to assess risk factors for GBS colonization and to compare means and distributions between colonized and non-colonized pregnant women. Results: A total of 12,315 cases were included in the study. 2,211 pregnant women were colonized by the SGB, corresponding to a prevalence of 18% (95% CI: 17.3 - 18.6). Differences were found for maternal age, educational levels, previous births and pregnancies, weight gain during pregnancy and gestational age. An association was verified between urinary infections during pregnancy and colonization. We identified a prevalence of neonatal GBS EOD of 2.3 per 1000 live births in the colonized group. Conclusions: The prevalence of GBS colonization is similar to that previously reported. The prevalence of EOD in colonized pregnant women is also in accordance with other studies, reflecting the importance of universal screening for GBS and antibiotic prophylaxis. <![CDATA[<b>Performance of ultrasound models in diagnosis of Ovarian Cancer</b>: <b>Experience of a Portuguese tertiary center</b>]]> Overview and Aims: The purpose of this study was to find the best ultrasound model for preoperative discrimination between benign and malignant adnexal masses in a group of Portuguese women. Methods: Single-centre retrospective study of 123 adnexal masses. The ultrasound images were described by an experienced ultrasonographer and classified as benign or malignant, according to IOTA simple rules (SR), RMI scoring and logistic regression model L2 (LR2). Two study groups were considered according to histologic diagnosis (benign and malignant). Borderline tumours were counted as malignant. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for IOTA SR; LR2 model; RMI score and use of serum CA 125 as a secondstage test in cases of IOTA SR complemented by subjective assessment. Results: Among the 123 tumours, 81.3% were benign and 18.7% were malignant on histolopathology. When inconclusive tumors were considered malignant, the IOTA SR had a sensitivity of 95.6%, specificity of 69.9%, PPV 46.8% and NPV of 98.3%. If inconclusive tumors were classified by subjective sonographic assessment, IOTA SR had a sensitivity of 91.3% and specificity of 78.3%. The LR2 model had a sensitivity of 91.3%, specificity 77.1%, PPV 63.6% and NPV 93.06%. Conclusion: IOTA SR and IOTA LR2 models achieved the best diagnostic accuracy for differentiating between benign or malignant adnexal masses. In case of inconclusive results, subjective assessment of ultrasound findings by expert examiners should be incorporated. <![CDATA[<b>The impact of maternal working conditions on fetal weight</b>: <b>a risk factor for fetal growth restriction?</b>]]> Overview and aims: Several risk factors for fetal growth restriction (FGR) have been described, however the impact of maternal working conditions is still poorly understood. To evaluate the impact of type of transport used, travel time, weekly hours of work, shift work, posture, environmental conditions, physical load and occupational stress on fetal weight. Study design and population: A case-control study was conducted. All professionally active pregnant woman that attended during 3rd trimester a pregnancy surveillance consultation at two Portuguese public hospitals during 4 months were included. The population was divided in two groups: FGR group - fetuses with estimated fetal weight (EFW) below the 10th percentile at 3rd trimester ultrasound; control group - fetuses with EFW equal to or higher than 10th percentile at 3rd trimester ultrasound. Methods: Data about working conditions, anthropometric and sociodemographic characteristics were collected using a questionnaire and the occupational stress questionnaire-general version (QSO-VG). Data on obstetric characteristics was acquired from clinical records. Data analysis was performed using SPSS ®, version 22.0. Results: There were 50 pregnant women in the FGR group and 295 in the control group. A predictive model of FGR was developed including 5 variables - sitting for at least 3 hours, high occupational stress levels, work by shifts, shifts with daytime and night rotation and load or lift weights greater than or equal to 25 Kg - with high specificity (98,5%), a positive predictive value of 85.7% and a negative predictive value of 74.2%, but with a low sensitivity (20.7%). Conclusions: This study showed that maternal working conditions can be important predictors of FGR. <![CDATA[<b>Challenges in care after fetal death</b>: <b>should the mode of delivery be a maternal choice?</b>]]> Fetal death remains the most overwhelming complication in obstetric care. As a sudden event, it entails a huge impact on families, making it difficult to assimilate new information and take important decisions, as well as making important decisions consciously. This literature review aimed to question the validity of the maternal request for delivery after fetal death, as also to reflect the need for proper training of healthcare providers, making them capable of enlighten and guide families. Once the risks and benefits have been elucidated, it is reasonable to grant an elective caesarean delivery, if this is still the mother’s desire. <![CDATA[<b>Fertility preservation in pediatric oncological patient</b>]]> The incidence of pediatric cancer has been increasing, but the improvement in survival rates contributed to the growing number of survivors of reproductive age. Oncological treatments can affect fertility therefore, all patients diagnosed with cancer should be informed about the risks of infertility and advised by a multidisciplinary team on the multiple fertility preservation techniques: before puberty or urgency in starting oncological treatment ovarian or testicular tissue cryopreservation are the ones available, although experimental; after puberty, oocyte and sperm cryopreservation are the techniques recommended. The authors present a review of the literature on this subject. <![CDATA[<b>In utero diagnosis of Autosomal Dominant Polycystic Kidney Disease</b>]]> Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited renal disease; its diagnosis, which used to be made during adulthood, has shifted towards earlier ages due to the development and widespread use of ultrasonography. Very-early onset (VEO) cases represent a high-risk group of patients. We describe a case of prenatal diagnosis in a pregnant woman with ADPKD. This case shows how diagnosis of ADPKD through ultrasound may signal high-risk patients that may benefit from early and timely treatment. <![CDATA[<b>A very unusual presentation of endometrial cancer relapse</b>]]> Endometrial cancer is a frequent gynaecological malignancy, generally associated with good prognosis. Common metastasis sites include lungs, liver and lymph nodes, but not the abdominal wall. A 51-year-old patient, with endometrioid endometrial adenocarcinoma was submitted to hysterectomy and bilateral adnexectomy. Histopathology confirmed FIGO stage IA and absence of lymphovascular invasion. A year later, a suspicious lesion ’s biopsy in the abdominal wall revealed a metastasis of the primary cancer, which was removed. In spite of low risk factors for relapse, the patient developed a rare metastasis site. This emphasises the necessity of close surveillance and high level of suspicion for diagnosis. <![CDATA[<b>Removal of a non-palpable broken contraceptive implant</b>]]> The authors present a case of a non-palpable contraceptive implant removal. Imagiology techniques as an upper arm radiograph can be used to locate non-palpable implants, which can be either migrated, damaged or both. Broken implants are an unusual occurrence but, as shown through our case, this complication may not be associated with an impairment of the contraceptive efficacy.