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- Left Ovarian Vein Thrombophlebitis in the Postpartum PeriodPublication . Lopes-Casal, R; Saavedra-Rocha, I; Serrano, F; Djokovic, DAssessment of abdominal pain in puerperal women can be challenging given that physiological and often self-limited benign causes predominate in this clinical context, although the etiological spectrum is wide and includes serious and potentially fatal causes. The paper presents a case of left ovarian thrombophlebitis, clinically manifested from the fifth day of puerperium in a 30-year-old patient. Clinicians should have a high degree of suspicion of rare adnexal thromboembolic events in postpartum period when frequent symptoms (fever, pain) and analytical changes (leukocytosis, increased C-reactive protein) occur in association with the imaging findings of edematous ovary with vascular congestion, even if there are other possible explanations for such a clinical situation.
- Balance Between Maternal Antiviral Response and Placental Transfer of Protection in Gestational SARS-CoV-2 InfectionPublication . Gonçalves, J; Melro, M; Alenquer, M; Araújo, C; Castro-Neves, J; Amaral-Silva, D; Ferreira, F; Ramalho, JS; Charepe, N; Serrano, F; Pontinha, C; Amorim, MJ; Soares, HThe intricate interplay between maternal immune response to SARS-CoV-2 and the transfer of protective factors to the fetus remains unclear. By analyzing mother-neonate dyads from second and third trimester SARS-CoV-2 infections, our study shows that neutralizing antibodies (NAbs) are infrequently detected in cord blood. We uncovered that this is due to impaired IgG-NAb placental transfer in symptomatic infection and to the predominance of maternal SARS-CoV-2 NAbs of the IgA and IgM isotypes, which are prevented from crossing the placenta. Crucially, the balance between maternal antiviral response and transplacental transfer of IgG-NAbs appears to hinge on IL-6 and IL-10 produced in response to SARS-CoV-2 infection. In addition, asymptomatic maternal infection was associated with expansion of anti-SARS-CoV-2 IgM and NK cell frequency. Our findings identify a protective role for IgA/IgM-NAbs in gestational SARS-CoV-2 infection and open the possibility that the maternal immune response to SARS-CoV-2 infection might benefit the neonate in 2 ways, first by skewing maternal immune response toward immediate viral clearance, and second by endowing the neonate with protective mechanisms to curtail horizontal viral transmission in the critical postnatal period, via the priming of IgA/IgM-NAbs to be transferred by the breast milk and via NK cell expansion in the neonate.
- Hysteroscopic Myomectomy: the Guidelines of the International Society for Gynecologic Endoscopy (ISGE)Publication . Loddo, A; Djokovic, D; Drizi, A; De Vree, BP; Sedrati, A; Herendael, BObjective: With this publication, the International Society for Gynecologic Endoscopy (ISGE) aims to provide the clinicians with the recommendations arising from the best evidence currently available on hysteroscopic myomectomy (HM). Study design: The ISGE Task Force for HM defined key clinical questions, which led the search of Medline/PubMed and the Cochrane Database. We selected and analyzed relevant English-language articles, published from January 2005 to June 2021, including original works, reviews and the guidelines previously published by the European Society for Gynecological Endoscopy (ESGE) and the American Association of Gynecologic Laparoscopists (AAGL), in which bibliographies were also checked in order to identify additional references, using the medical subject heading (MeSH) term "Uterine Myomectomy" (MeSH Unique ID: D063186) in combination with ''Myoma" (MeSH Unique ID: D009214) and ''Hysteroscopy" (MeSH Unique ID: D015907). We developed the recommendations through multiple cycles of literature analysis and expert discussion. Results: The ISGE Task Force did develop 10 grade 1A-C and 4 grade 2A-C recommendations. For planning HM, evaluation of the uterus with saline infusion sonohysterography (SIS) or combined assessment by transvaginal ultrasound (TVUS) and diagnostic hysteroscopy is recommended (Grade 1A). The use of STEPW (Size, Topography, Extension of the base, Penetration and lateral Wall position) classification system of submucosal leiomyoma (LM) is recommended to predict the complex surgeries, incomplete removal of the LM, long operative time, fluid overload and other major complications (grade 1B). For type 0 LMs, in addition to resectoscopy (slicing technique), morcellation is recommended, being faster and having a shorter learning curve with respect to resectoscopy (grade 1C). For type 1-2 LMs, slicing technique is currently recommended (grade 1C). A fluid deficit of 1000 mL also in case of bipolar myomectomy with saline solution, in healthy women of reproductive age, contains low risk for major complications. Lower thresholds (750 mL) for fluid deficit should be considered in the elderly and in women with cardiovascular, renal or other co-morbidities (Grade 1B). Conclusion: HM is the most effective conservative minimally invasive gynecologic intervention for submucous LM. The set of 14 ISGE recommendations can significantly contribute to the success of HM and the safety of patients for whom the choice of appropriate surgical technique, as well as the surgeon's awareness and measures to prevent complications are of the utmost importance.
- Congenital Cytomegalovirus Infection in Twin PregnancyPublication . Carvalho, AA; Silva, CB; Martins, ML; Cassiano Santos, GCassianoCytomegalovirus (CMV) infection is one of the preeminent congenital viral infections, and despite its potential morbidity, uncertainty about its physiopathology, prevention and treatment remains until now. We report a case of a dichorionic and diamniotic twin pregnancy in which only one of the fetus had signs of being affected. The first twin had prenatal diagnosis of intrauterine growth restriction and hyperechogenic bowel, attributable to CMV infection, while there was no evidence of infection of the second one. Prenatal treatment was done with maternal administration of valacyclovir and postnatal treatment of the infected newborn with oral valganciclovir with normal neurodevelopment assessment at 12 months corrected age. In this case, maternal CMV infection was not equally transmitted to both fetuses, suggesting that there may be intrinsic fetal and placental factors influencing both transmission and the clinical features of the infection.
- Hypnobirthing: Confiança e Empoderamento no Trabalho de PartoPublication . Gaspar, TEste artigo tem como objetivo dar a conhecer o Hypnobirthing (HB) não só como método de preparação para o parto que harmoniza mente, corpo e feto, promovendo a confiança da mulher e o empoderamento das suas capacidades instintivas para o nascimento, mas também enquanto filosofia de cuidados do enfermeiro especialista em saúde materna e obstetrícia (ESMO), ao entender o nascimento como um evento fisiológico e natural. Propõe-se, portanto, compreender o impacto do ciclo medo-tensão-dor na evolução do trabalho de parto e na experiência de parto de cada mulher, as ferramentas utilizadas por este método e a forma como poderão ser implementadas na prática de cuidados do enfermeiro ESMO.
- Reativação Ocular da Toxoplasmose Durante a GravidezPublication . Olival, V; Correia Reis, A; Bello, A; Cabugueira, A; Nunes, MJToxoplasma gondii infection reactivation is more likely to occur during pregnancy on account of the characteristic physiologic immunotolerance. Visual impairment and retinal scars in a previously infected individual allows the diagnosis. In an immunocompetent woman,transplacentary infection is unlikely to occur, but that possibility carries a well known great risk for the fetus. Fetal infection should be carefully excluded in the amniotic fluid and prophylaxis should be promptly instituted if fetal infection is not proven to have already happened. We report a case of a 30 year-old Brazilian woman diagnosed an ocular reactivation of toxoplasmosis with no evidence of fetal transmission during the initial workup. A careful ultrasound follow-up was performed during pregnancy and a espiramicin-based prophylactic regimen was initiated. After delivery, either the newborn serum analysis nor the hystopathological study of the placenta were suggestive of T. gondii infection.
- Primary Biliary Cholangitis: a Rare Diagnosis During PregnancyPublication . Inês Felizardo Lopes, I; Dos Reis, CP; Alves, MJ; Calinas, F; Borges, MAPrimary biliary cholangitis is an autoimmune disease that mostly affects women. It is uncommon in women of childbearing age and the diagnosis during pregnancy is rare and can be challenging. Described here is a case of primary biliary cholangitis first manifesting during pregnancy, with the onset of pruritus, jaundice, biochemical liver abnormalities and positive antimitochondrial antibodies. Although treatment with ursodeoxycholic acid was started at the time of diagnosis, there was a progressive worsening of cholestatic biochemical markers throughout pregnancy. In addition, fasting hyperglycemia with polyhydramnios was diagnosed, consistent with gestational diabetes. She had a spontaneous preterm delivery at 31 weeks of gestation, of a newborn who was admitted to the neonatal intensive care unit but who subsequently had no long-term sequelae of preterm delivery. A maternal postpartum flare occurred. Treatment with ursodeoxycholic acid was well tolerated during pregnancy and lactation.
- Adaptive Filtering for the Maternal Respiration Signal Attenuation in the Uterine ElectromyogramPublication . Martins, D; Batista, A; Mouriño, H; Russo, S; Esgalhado, F; dos Reis, C; Serrano, F; Ortigueira, MThe electrohysterogram (EHG) is the uterine muscle electromyogram recorded at the abdominal surface of pregnant or non-pregnant woman. The maternal respiration electromyographic signal (MR-EMG) is one of the most relevant interferences present in an EHG. Alvarez (Alv) waves are components of the EHG that have been indicated as having the potential for preterm and term birth prediction. The MR-EMG component in the EHG represents an issue, regarding Alv wave application for pregnancy monitoring, for instance, in preterm birth prediction, a subject of great research interest. Therefore, the Alv waves denoising method should be designed to include the interference MR-EMG attenuation, without compromising the original waves. Adaptive filter properties make them suitable for this task. However, selecting the optimal adaptive filter and its parameters is an important task for the success of the filtering operation. In this work, an algorithm is presented for the automatic adaptive filter and parameter selection using synthetic data. The filter selection pool comprised sixteen candidates, from which, the Wiener, recursive least squares (RLS), householder recursive least squares (HRLS), and QR-decomposition recursive least squares (QRD-RLS) were the best performers. The optimized parameters were L = 2 (filter length) for all of them and λ = 1 (forgetting factor) for the last three. The developed optimization algorithm may be of interest to other applications. The optimized filters were applied to real data. The result was the attenuation of the MR-EMG in Alv waves power. For the Wiener filter, power reductions for quartile 1, median, and quartile 3 were found to be -16.74%, -20.32%, and -15.78%, respectively (p-value = 1.31 × 10-12).
- Thyroid Disease in PregnancyPublication . Centeno, M; Carvalho, MR; Monteiro, MJ; Massa, AC; Belo, S; Namora, G; Paiva, S; Lobo, AC; Lopes Pereira, M
- João Dória Nóbrega (1934-2021): A Unique ManPublication . Campos, A; Soares, C; Serrano, F; Alves, MJ