Medicina Materno-Fetal
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- Abcesso Renal na GravidezPublication . Santos, L; Borges, A; Serrano, F; Alves, MJ; Campos, AApesar das infecções urinárias serem relativamente frequentes durante a gravidez, a ocorrência de um abcesso renal é muito raro. A patogénese do abcesso renal tem mudado ao longo dos anos. Actualmente, mais de 75% dos casos têm origem numa infecção do aparelho urinário. Os autores apresentam o caso clínico de uma grávida de 35 anos, internada às 38 semanas e cinco dias de gestação por febre, náuseas, vómitos e dor lombar à direita. Os dados clínicos e os exames complementares realizados levaram ao diagnóstico de abcesso renal. É feita uma revisão da literatura acerca do tema.
- Abdominal Circumference Ratio for the Diagnosis of Intertwin Birth Weight DiscordancePublication . Simoes, T; Julio, C; Cordeiro, A; Cohen, A; Silva, A; Blickstein, IOBJECTIVES: We assessed the accuracy of predicting severe twin birth weight discordance (>25%) using the estimated fetal weights (EFW) and abdominal circumference (AC) ratio. METHOD: A cohort of twin gestations underwent ultrasound examinations within two weeks from birth. We focused on the accuracy of EFW and on the diagnosis of severe birth weight discordance by the difference in EFWs and the AC ratio. RESULTS: The 661 eligible twin pairs included 51 (7.7%) severely discordant pairs. The accuracy of an EFW to predict the actual birth weight was quite poor, with an acceptable specificity (96.4%), but low sensitivity (28.6-40.5%), to detect severely discordant pairs, whereas an AC ratio of 1.3 detected these discordant pairs with sensitivity and specificity of 97.3-100% and 99.6-99.7%, respectively. CONCLUSION: By comparing EFWs, 59.5-71.4% of discordant pairs >25% are missed, whereas an AC ratio >1.3 would identify almost all cases.
- Acute Sheehan's Syndrome Presenting as Central Diabetes InsipidusPublication . Robalo, R; Pedroso, C; Agapito, A; Borges, ASheehan's syndrome occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. Improvements in obstetrical care have significantly reduced its incidence in developed countries, but postpartum pituitary infarction remains a common cause of hypopituitarism in developing countries. We report a case of severe postpartum haemorrhage followed by headache, central diabetes insipidus and failure to lactate, which prompted us to investigate and identify both anterior and posterior pituitary deficiency compatible with Sheehan's syndrome. A timely diagnosis allowed us to implement an adequate treatment and follow-up plan, which are known to improve clinical status and patient outcome.
- Amniocentesis in HIV Pregnant Women: 16 Years of ExperiencePublication . Simões, M; Marques, C; Gonçalves, A; Pereira, AP; Correia, J; Castela, J; Guerreiro, CThe iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A--women under HAART when submitted to amniocentesis (n = 20) and Group B--women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.
- Anticoagulação e Cirurgia GinecológicaPublication . Furtado Lima, A; Fatela, A; Borges, AOs acidentes tromboembólicos são uma das causas de maior morbilidade pós-cirúrgica. Com esta revisão os autores pretendem recordar alguns conceitos sobre hemóstase, são ainda abordadas as indicações e o perfil dos fármacos mais utilizados para profilaxia de tromboembolismo venoso em doentes submetidas a cirurgia ginecológica. As doentes cirúrgicas que fazem anticoagulação com Varfarina levantam algumas questões aquando do momento da cirurgia pelo que, por fim, se propõe um protocolo de actuação em doentes cirúrgicas sob anticoagulação de longa duração.
- Association Between Glycated Albumin, Fructosamine, and HbA1c with Neonatal Outcomes in a Prospective Cohort of Women with Gestational Diabetes MellitusPublication . Mendes, N; Alves, M; Andrade, R; Ribeiro, R; Papoila, AL; Serrano, FObjective: To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). Methods: Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. Results: A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. Conclusion: Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.
- Avaliação e Atitude Terapêutica nos Quistos Endometriais OváricosPublication . Marques, AC; Carvalho, MJ; Neves, A; Maia, AP; Oliveira, LC; Sá e Melo, PForam avaliadas 233 laparoscopias realizadas na Unidade de Medicina de Reprodução da Maternidade Dr. Alfredo da Costa no período compreendido entre Janeiro de 1996 e Dezembro de 1997. A prevalência de endometriose foi de 36% com uma incidência de 28,5% de Quistos Endometriais. Confirmou-se na laparoscopia o diagnóstico ecográfico de Quisto Endometrial em 95,8% dos casos. Foram analisados os resultados da atitude terapêutica dos 24 Quistos Endometriais submetidos a laparoscopia cirúrgica. A taxa de recidiva foi de 16,6%. A taxa de gravidez corrigida avaliada com um recuo mínimo de 6 meses foi de 21,0%.
- Beyond Self-Monitored Plasma Glucose and HbA1c: the Role of Non-Traditional Glycaemic Markers in Gestational Diabetes MellitusPublication . Mendes, N; Tavares Ribeiro, R; Serrano, FStrict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.
- Burkitt’s Lymphoma Related to Epstein–Barr Virus Infection During PregnancyPublication . Cordeiro, A; Machado, AI; Borges, A; Alves, MJ; Frade, MJSetting: Burkitt’s lymphoma is a rare form of cancer and is an extremely rare diagnosis during pregnancy. This form of lymphoma is a very fast growing B cell neoplasm and chemotherapy is the treatment of choice for the disease in all its stages. Case report: The authors describe the case of a Caucasian 40-year-old nulliparous woman, with previous known Epstein–Barr virus infection, that presents at 28 weeks gestation with supraclavicular adenopathy and multiple bilateral breast nodules, in which biopsy showed non-Hodgkin lymphoma, Burkitt’s type. Discussion: There are few described cases of Burkitt’s lymphoma during pregnancy and in general the outcomes have been poor. In most of the cases, the patients were not treated by current standards or instead had a late diagnosis. This neoplasia is the most rapidly progressive human tumor, and any delay in initiating therapy can adversely aVect patient’s prognosis. The authors discuss treatment options in pregnancy and its perinatal implications.
- Casuística da Consulta de Diabetes da Maternidade Dr. Alfredo da Costa no Ano de 1997Publication . Baleiras, C; Nabais, H; Gonçalves, G; Neves, V; Rocha, T; Aleixo, F; Delgado, EA Diabetes Mellitus é uma doença crónica que frequentemente complica a gravidez. Por outro lado, as perturbações do metabolismo glucídico podem ser exageradas pela gravidez, com as suas alterações endócrino-metabólicas. A vigilância da grávida diabética é complexa e deve envolver uma equipa multidisciplinar. Com o objectivo de avaliar as repercussões da diabetes no prognóstico da gravidez e vice-versa, os autores efectuaram a casuística da Consulta de Diabetes da Maternidade Dr. Alfredo da Costa durante o ano de 1997. Das 138 doentes que recorreram à consulta, 108 apresentavam Diabetes Gestacional/Intolerância à glicose oral (DG/IGO) e 30 Diabetes prévia à gravidez. Apenas 2 destas últimas tiveram uma consulta pré-concepcional. Cerca de 44% das mulheres com DG/IGO necessitaram de insulina em algum momento da gestação. A doença hipertensiva constituiu a complicação obstétrica mais frequente. A taxa de cesarianas (49%) situou-se acima da mencionada por outros estudos. Não se registaram mortes fetais in útero e a morbi/mortalidade neonatal foi semelhante à referida por outros autores. O dado mais importante que interessa salientar deste estudo reside no trabalho desta equipa multidisciplinar, sem o qual não se teria conseguido uma diminuição da morbilidade materna e peri-natal.