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- Recomendações sobre Contraceção em Mulheres com Cancro Ginecológico: Do Diagnóstico ao Pós-Tratamento.Publication . Correia, Lúcia; Teves, Mariana; Pires, Mónica; Pacheco, Amália; Palma, FátimaA incidência de cancro ginecológico em mulheres durante a idade fértil está a aumentar, suscitando uma preocupação crescente com a preservação da fertilidade. Nesse contexto, torna-se essencial oferecer aconselhamento contracetivo adequado a estas doentes. Na escolha do método contracetivo, é fundamental considerar o tipo histológico do tumor e a sua expressão de recetores hormonais, bem como o momento em que o aconselhamento está a ser prestado no cuidado da doente oncológica, seja na fase de diagnóstico, de tratamento ou após o tratamento oncológico. A Sociedade Portuguesa da Contraceção e a Secção de Ginecologia Oncológica da Sociedade Portuguesa de Ginecologia apresentam recomendações sobre contraceção nas mulheres com diagnóstico de cancro ginecológico submetidas a tratamentos preservadores da fertilidade, desde o diagnóstico até ao término da idade fértil
- Contraception in Transgender People Who Were Assigned a Female Sex at Birth – A Narrative ReviewPublication . Albuquerque Brás, Sofia; Isidro Amaral, Patricia; Machado, Ana IsabelBackground and Purpose: Transgender people often experience suboptimal contraception counseling due to clinicians’ insufficient experience in this topic, and practitioners themselves report lack of satisfactory training. We aim to summarize the current literature on contraception counselling in transgender men and nonbinary people assigned female at birth. Methods: The present article is a narrative review. Searches were performed in Pubmed and Google Scholar databases using the terms ‘transgender’, ‘transmen’, ‘contraception’, ‘family planning’, ‘reproductive care’. Only English and Portuguese written articles published in the last six years were considered. A manual search of references from identified studies was also conducted and international guidelines were searched for information of interest. Results: Existing literature suggests that transgender men and nonbinary people assigned female at birth experience significant barriers to health services that can compromise their reproductive health. Regarding contraceptive options, all methods can be offered, according to the same eligibility criteria used for cisgender women. Nevertheless, specificities must be considered: differential acceptance of side effects, potential emotional and physical discomfort inherent to pelvic examination. Both patients and their healthcare providers may be unaware of the fact that ovulation may occur during testosterone treatment, even if the person is in amenorrhea. Hence, it should not be considered for effective contraception. Also, it has known teratogenic effects, which highlights the need for preventing unplanned pregnancies. Until date, there is no evidence that testosterone use is a contraindication to any contraceptive method, therefore, transmen on this medication should be offered all options. Conclusions: All contraceptive methods can be offered to transgender men and nonbinary individuals assigned female at birth, but the specific needs and concerns of these individuals should be considered in counseling. Literature on this field is still scarce and more studies are needed to evaluate preferences and satisfaction rates.
- Insidious Perforation of the Rectum by a Fallopian Tube: the Need to Keep 'an Open Mind' When Dealing With Deep Infiltrating Endometriosis (DIE).Publication . Marujo, Ana Teresa; Abreu, Bruna; Nogueira, Bruno; Reis, JoséEndometriosis is a benign chronic disease which can have different degrees of severity and can potentially affect any organ. Intestinal endometriosis occurs in 3%â€"37% of the cases, being more frequent in the rectosigmoid transition. Transmural involvement of intestinal endometriosis is extremely rare and is usually associated with recurrent abdominal pain. Due to the cyclical hormone influence, endometriosis implants may infiltrate the deeper layers of the intestinal wall and may lead to bowel obstruction or perforation. We present a case of transmural perforation of the rectum wall by an adjacent organ (left fallopian tube) that occurred insidiously in a patient with deep infiltrative endometriosis. A complete set of images is presented, regarding the preoperative, intraoperative and postoperative findings.
- A Rare Case of En Bloc Endometrium SheddingPublication . Mamede, R; Costa, C; Djokovic, DThe human endometrium is a unique tissue capable of repeated degradation, loss and self-repair in response to fluctuating levels of sex steroids, in a tightly regulated process. It takes place hundreds of times in a woman’s lifetime, manifesting as vaginal expulsion of blood mixed with cellular debris for a period of several days. The aim of this work is to present a case of en bloc endometrial desquamation in a teenage patient using combined oral contraception. Several mechanisms are proposed, although further studies are needed to better understand this extremely rare phenomenon.
- Review of Piezoelectrical Materials Potentially Useful for Peripheral Nerve RepairPublication . Casal, D; Casimiro, MH; Ferreira, L; Leal, JP; Rodrigues, G; Lopes, R; Lino Moura, D; Gonçalves, L; Lago, J; Pais, D; Santos, PIt has increasingly been recognized that electrical currents play a pivotal role in cell migration and tissue repair, in a process named "galvanotaxis". In this review, we summarize the current evidence supporting the potential benefits of electric stimulation (ES) in the physiology of peripheral nerve repair (PNR). Moreover, we discuss the potential of piezoelectric materials in this context. The use of these materials has deserved great attention, as the movement of the body or of the external environment can be used to power internally the electrical properties of devices used for providing ES or acting as sensory receptors in artificial skin (e-skin). The fact that organic materials sustain spontaneous degradation inside the body means their piezoelectric effect is limited in duration. In the case of PNR, this is not necessarily problematic, as ES is only required during the regeneration period. Arguably, piezoelectric materials have the potential to revolutionize PNR with new biomedical devices that range from scaffolds and nerve-guiding conduits to sensory or efferent components of e-skin. However, much remains to be learned regarding piezoelectric materials, their use in manufacturing of biomedical devices, and their sterilization process, to fine-tune their safe, effective, and predictable in vivo application.
- The sFlt1/PlGF Ratio Predicts Faster Fetal Deterioration in Early Fetal Growth Restriction: a Historical Cohort StudyPublication . Palma dos Reis, C; Brás, S; Meneses, T; Cerdeira, A; Vatish, M; Martins, ATIntroduction: The velocity of fetal deterioration in fetal growth restriction is extremely variable, which makes monitoring and counseling very challenging. The soluble fms-like tyrosine kinase to placental growth factor (sFlt1/PlGF) ratio provides a readout of the vasoactive environment that correlates with preeclampsia and fetal growth restriction and that could be useful to predict fetal deterioration. Previous studies showed a correlation between higher sFlt1/PlGF ratios and lower gestational ages at birth, although it is unclear whether this is due to the increased incidence of preeclampsia. Our goal was to evaluate whether the sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction. Material and methods: This was a historical cohort study in a tertiary maternity hospital. Data from singleton pregnancies with early fetal growth restriction (diagnosed before 32 gestational weeks) confirmed after birth monitored between January 2016 and December 2020 were retrieved from clinical files. Cases of chromosomal/fetal abnormalities, infection and medical terminations of pregnancy were excluded. The sFlt1/PlGF ratio was acquired at diagnosis of early fetal growth restriction in our unit. The correlation of log10 sFlt1/PlGF with latency to delivery/fetal demise was assessed with linear, logistic (positive sFlt1/PlGF if >85) and Cox regression excluding deliveries for maternal conditions and controlling for preeclampsia, gestational age at time of ratio test, maternal age and smoking during pregnancy. Receiver-operating characteristic (ROC) analysis tested the performance of sFlt1/PlGF ratio in predicting delivery for fetal reasons in the following week. Results: 125 patients were included. Mean sFlt1/PlGF ratio was 91.2 (SD 148.7) and 28% of patients had a positive ratio. A higher log10 sFlt1/PlGF ratio predicted shorter latency for delivery/fetal demise in linear regression after controlling for confounders, β = -3.001, (-3.713 to -2.288). Logistic regression with ratio positivity confirmed these findings (latency for delivery 5.7 ± 3.32 weeks for ratios ≤85 vs 1.9 ± 1.52 weeks for ratios >85); β = -0.698 (-1.064 to -0.332). Adjusted Cox regression showed that a positive ratio confers a significantly positive hazard ratio (HR) for earlier delivery/fetal demise, HR 9.869 (5.061-19.243). ROC analysis showed an area under the curve of 0.847 (SE ± 0.06). Conclusions: sFlt1/PlGF ratio is correlated with faster fetal deterioration in early fetal growth restriction, independently of preeclampsia.
- Congenital Malformations of the Female Genital Tract: a Review of Available Classification SystemsPublication . Pereira Amaral, P; Ambrósio, P; Coelho, A; Condeço, R; Bello, A; Djokovic, DCongenital malformations of the female genital tract are being diagnosed more frequently due to advances in imaging techniques. A broad international consensus on their classification is still lacking. This paper aimed to comparatively summarize the most frequently and widely used, as well as the most recently developed classification systems of congenital female genital malformations. A non-systematic review was done through a search on major databases with the medical subject heading (MeSH) term ‘‘congenital abnormalities” in combination with ‘‘classification” and ‘‘female genitalia”. All available systems, including, among others, the American Fertility Society Classification (1988), the Acien and Acien classification (1992, 2004), the VCUAM system (2005), the European Society for Human Reproduction and Embryology - European Society for Gynecological Endoscopy classification (2013), the Congenital Uterine Malformation Experts (CUME) group recommendations, and the American Society for Reproductive Medicine Classification (2021) possess the advantages and disadvantages listed in this article. Regarding the most common situations, the criteria for differentiating physiologic arcuate and discrete partial septate uteri vary widely between classifications, while difficulties also persist with the rarer complex abnormalities that cannot be easily classified, contributing to a gap in clinical and research protocols. The main factor compromising any attempt to reach an ideal classification system is the lack of evidence-based data, justifying the need for comparative multicenter international randomized control trials in this field. Pending new research data and a broad international consensus, it seems essential for adequate patient orientation to describe each detected malformation in detail and to correlate it with the clinical presentation, regardless the type of classification used.
- Prevenção do Tromboembolismo Venoso na Gravidez, Parto e Pós-Parto: Norma de Orientação ClínicaPublication . Lima, J; Domingues, AP; Amaral, AC; Borges, A; Nogueira-Silva, C; Serrano, F; Marques, I; Pinto, L; Guimarães, M
- Fístula Vesicovaginal Associada a Ruptura UterinaPublication . Reis Correia, A; Ferreira, C; Bernardo, MJVesicovaginal fistula (VVF) is an obstetric complication rarely reported in developed countries. The occurrence of uterine rupture is a potentially catastrophic event, and its incidence is estimated in 1/1146 (0.07%) pregnancies.The main risk factorsfor its occurrence are: congenital uterine changes, multiparity, history of previous cesarean or myomectomy,fetal macrosomia and induced labor. Association between uterine rupture and bladder lesions has been rarely reported. The authors describe a case of a VVF associated with uterine rupture
- Repercussions of the COVID-19 Pandemic in the Emergency Department of Gynecology and Obstetrics at a Referral Hospital in PortugalPublication . Jovina Domingues, S; Ormonde, M; Miguel, A; Martins, A; Saavedra, I; Silva, MCObjective. COVID-19 has spread worldwide and Portugal decreed the State of Emergency on March 18th, 2020. During this period, the population was encouraged to stay at home. Still, there were no restrictions on access to health care. Therefore, we aimed to compare the major causes for attending the Obstetrics and Gynaecology Emergency Department (ED) from a referral centre (Maternidade Dr. Alfredo da Costa, in Lisbon). Materials and Methods. Several variables were collected and compared between two periods of time: from 19th March to 2nd April 2020 and the same period of 2019. Results. During the COVID-19 pandemic period, 49.4% fewer patients visited the ED. We observed a higher number of urgent patients and hospitalization rate than previous year. Conclusions. We experienced a reduction number of admissions to the Obstetrics and Gynaecology ED, but apparently the severity of cases that visited the ED increased.