Browsing by Author "Palma, F"
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- Analgesia no Trabalho de PartoPublication . Santos, L; Palma, F; Roncon, AOs autores fazem uma breve revisão da literatura sobre os métodos disponíveis para a analgesia durante o trabalho de parto: indicações, contraindicações, complicações e efeitos secundários.
- Contracepção de Emergência: o que há de Novo?Publication . Soares Albergaria, F; Machado, AI; Palma, F; Sobral, D; Aleixo, F; Delgado, E; Moniz, LA Contracepção de Emergência é um método simples, seguro e não-abortivo de evitar gravidezes não desejadas. O desconhecimento dos métodos disponíveis compromete a difusão do seu uso e reduz as suas potencialidades na melhoria da Saúde Reprodutiva. Em Portugal estão disponíveis métodos hormonais (método de Yuzpe e pílula de Levonorgestrel) e o DIU de cobre. A pílula de Levonorgestrel impõe-se sobre o método de Yuzpe por ser mais eficaz (até 98,9%), apresentar consideravelmente menores efeitos secundários (redução superior a 50% da ocorrência de náuseas e vómitos) e por ser cómodo (administrável em toma única). Estudos recentes demonstraram que ambos os métodos hormonais podem ser usados até 120 horas após relações sexuais (RS) não protegidas com eficácia, embora esta pareça ser maior quanto maior a precocidade da toma, o DIU de cobre é o método de eleição para a CE que se inicia 72 horas após RS não protegidas.
- Contraceptive Choices Pre and Post Pregnancy in AdolescencePublication . Correia, L; Martins, I; Oliveira, N; Antunes, I; Palma, F; Alves, MJSTUDY OBJECTIVE: The main aim of this study is to evaluate the impact of adolescent pregnancy in the future contraceptive choices. A secondary aim is to verify whether these choices differ from those made after an abortion. DESIGN: Retrospective study. SETTING:Adolescent Unit of a tertiary care center. PARTICIPANTS:212 pregnant teenagers. INTERVENTIONS: Medical records review. MAIN OUTCOME MEASURES:Intended pregnancy rate and contraceptive methods used before and after pregnancy. For contraceptive choices after pregnancy we considered: Group 1 - teenagers who continued their pregnancy to delivery (n = 106) and Group 2 - the same number of adolescents who chose to terminate their pregnancy. RESULTS: The intended pregnancy rate was 14.2%. Prior to a pregnancy continued to delivery, the most widely used contraceptive method was the male condom (50.9%), followed by oral combined contraceptives (28.3%); 18.9% of adolescents were not using any contraceptive method. After pregnancy, contraceptive implant was chosen by 70.8% of subjects (P < .001) and the oral combined contraceptives remained the second most frequent option (17.9%, P = .058). Comparing these results with Group 2, we found that the outcome of the pregnancy was the main factor in the choices that were made. Thus, after a pregnancy continued to delivery, adolescents prefer the use of LARC [78.4% vs 40.5%, OR: 5,958 - 95% (2.914-12.181), P < .001)], especially contraceptive implants [70.8% vs 38.7%, OR: 4.371 - 95% (2.224-8.591), P < .001], to oral combined contraceptives [17.9% vs 57.5%, OR: 0.118 - 95% CI (0.054-0.258), P < .001]. CONCLUSION:Adolescent pregnancy and its outcome constitute a factor of change in future contraceptive choice.
- Current Trends and Perceptions of the Portuguese Gynecology Experts on Hormonal Intrauterine Contraception: The DIOGIN StudyPublication . Brito, M; Costa, AR; Pacheco, A; Rebelo, C; Castro, MG; Martins, I; Palma, FOverview 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 womens 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.
- Estetrol/Drospirenone – an Advance on CHC with Ethinyl Estradiol?Publication . Palma, F; Pacheco, A; Costa, AR; Rebelo, C; Bombas, TA contraceção hormonal combinada (CHC) é um dos métodos contracetivos mais utilizados em todo o mundo. As questões relacionadas com a segurança, particularmente o risco tromboembólico (TE), estão em permanente avaliação. A combinação estetrol/ drospirenona (E4/DRSP) é um contracetivo oral combinado (COC) eficaz, com um perfil de hemorragia estável e regular e efeito favorável na pele e no controlo do peso. Tem menor impacto nos fatores pró-trombóticos que as combinações com etinilestradiol (EE), o que configura um perfil de maior segurança, que importa confirmar em estudos de base populacional.
- Implant Site Nexplanon Reaction?Publication . Pedroso, C; Martins, I; Palma, F; Machado, AINexplanon (Schering-Plough Limited/Merck Sharp & Dohme Limited (MSD)) is a long active reversible contraceptive method that provides effective contraception for 3 years. It consists of a single, flexible, rod-shaped implant, containing 68 mg etonogestrel. It is 4 cm long, consists of an ethylene vinyl acetate copolymer, a non-absorbable material, and also contains 15 mg of barium sulfate, which makes it visible by X-ray. We describe a case of a 39-year-old woman who experienced a local reaction to the barium sulfate in Nexplanon. She was given medical treatment, but only the removal of the implant resolved the symptoms. After removal there was gradual improvement and 72 h later the patient was asymptomatic. Allergic reaction to barium sulfate is extremely rare: until now, there have only been two cases associated with Nexplanon described in the literature.
- Misoprostol na Indução do Trabalho de Parto: Oral ou Vaginal?Publication . Godinho, C; Santos, L; Palma, F; Campos, AAlgumas complicações maternas ou fetais no decorrer da gravidez tornam necessária a indução do trabalho de parto. O misoprostol é um análogo sintético da prostaglandina Eı que mimetiza a acção endógena destas substâncias na maturação do colo do útero. A dose ideal, via e frequência de administração continuam sob investigação. O objectivo deste trabalho foi avaliar a eficácia do misoprostol na indução do trabalho de parto e a morbilidade associada à sua administração oral e vaginal. Foi efectuada uma avaliação retrospectiva das grávidas internadas para indução do trabalho de parto durante o ano de 2002, no serviço de Medicina Materno Fetal da Maternidade Dr. Alfredo da Costa. Foram seleccionadas as grávidas que efectuaram misoprostol oral (100 mg) e vaginal (50 mg). Foi avaliado o intervalo de tempo até à fase activa, ao parto, a necessidade de perfusão com occitocina, a via de parto e a morbilidade materna e fetal. Consideraram-se 238 grávidas, 194 efectuaram misoprostol oral e 44 vaginal. O intervalo da indução ao parto vaginal foi 24,3 horas na via oral e 16,9 horas na via vaginal (p=0.01), a dose total administrada foi significativamente inferior na via vaginal (p=0.00), a paridade foi um factor importante na via de parto (p=0.01). Não se verificaram diferenças entre os dois grupos em relação às complicações maternas e fetais. A administração vaginal de misoprostol, quando comparada com a oral, mostrou-se mais eficaz.
- A Rare Obstetric Outcome in Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal AgenesisPublication . Mendes, N; Lermann, R; Francisco, C; Palma, FBackground: The unique clinical syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal anomaly is very rare and can be quite difficult to recognize because of the enormous heterogeneity in its clinical presentation. There are few long-term reports of the reproductive performance of women with this syndrome following treatment, or about the location of subsequent pregnancies. Case: A case in which two spontaneous pregnancies occurred alternatively in both hemiuteri: one despite a previous ipsilateral large hematometra and hematocolpos and the other, 8 years after, simultaneously with contralateral hematometra and hematocolpos(because of vaginal restenosis), is reported. Drainage of hematocolpos was performed at 14 weeks of pregnancy with immediate pain relief. Results: Pregnancy proceeded without complications. Eight month after delivery, a vaginoplasty was performed by excising the longitudinal vaginal septum, and marsupializing the vaginal cuff. Conclusions: This case highlights the importance of a correct and early diagnosis of developmental anomalies of the urogenital tract, as well as how a conservative approach in a Mullerian anomaly with unilateral obstruction led to two successful pregnancies occurring alternatively in the unaffected and in the previously blocked side. This is additional information supporting that every effort should be made to preserve the obstructed uterus.
- Saúde Sexual e Reprodutiva das Adolescentes - a Nossa RealidadePublication . Oliveira Marques, C; Gomes, G; Correia, L; Palma, F; Martins, I; Alves, MJOverview and Aims: Several behavioral and biological factors can make adolescents particularly vulnerable to unwanted pregnancies and sexually transmitted diseases. The aim of this study was to evaluate sexual behavior and contraceptive use patterns of a population of adolescents. Study Design: Retrospective study. Population: 163 female adolescents attending an Adolescence Unit for the first time, during 2010. Methods: Analysis of clinical charts and assessment of demographic data, smoking and drinking habits, drug use, gynecologic and obstetric history, sexual behavior and contraceptive use. Results: The mean age was 16.04 years (±1.32). 71.7% were students (of these, 70% had failed one or more years and were behind in their studies), 2.5% were working and 23.9% were neither studying or working. 95.1% had already had sexual intercourse and the mean age of first coitus was 14.53 years (±1.24). There was a history of at least one previous pregnancy in 77.3% of the cases. Before the first appointment at the AU, the contraceptive methods used were: the pill (33.2%, but 41.3% of these reported inconsistent use), and the condom (23.9%, with inconsistent use in 28.3% of these cases). 19.6% did not use any contraceptive method.. After counseling at the AU, 54% of the teenagers chose the contraceptive implant and 35% preferred the pill. Adolescents who had already been pregnant preferred a long acting method (namely, the contraceptive implant)in 61.9% of cases; those who had never been pregnant decided to use an oral contraceptive in 67.6% of cases (p<0.001). Conclusions: After counseling the number of teenagers using contraception increased. In this population there were a high number of adolescents with a previous pregnancy. This factor seems to have influenced the choice of the contraceptive method, with most of these adolescents choosing a long-acting method.
- Sirenomelia. A Propósito de um Caso ClínicoPublication . Cordeiro, A; Palma, F; Machado, AI; Martins, P; Correia, JA Sirenomelia é uma malformação congénita rara e letal, que se caracteriza pela fusão dos membros inferiores em posição mediana, estando associada a outras malformações graves esqueléticas, dos aparelhos urogenital e gastro-intestinal inferior. Os autore3s, a propósito de um caso clínico, realizaram uma revisão da literatura relativa à etiologia, diagnóstico diferencial, bem como as possibilidades de diagnóstico pré-natal.