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- Accuracy of prenatal culture in predicting intrapartum group B streptococcus colonization statusPublication . Florindo, C; Damião, V; Lima, J; Nogueira, I; Rocha, I; Caetano, P; Ribeiro, L; Viegas, S; Gomes, J; Borrego, MJOBJECTIVE: To evaluate the positive predictive value (PPV) of group B Streptococcus (GBS) cultures at 35-37 weeks of gestation relative to GBS colonization status at delivery. METHODS: Rectovaginal swabs from 221 women at labor in four Lisbon hospitals were collected for GBS screening according to the CDC guidelines. RESULTS: The PPV was 24.4%. IAP was administered to 100% of prenatally GBS positive women. There was no case of early onset GBS disease (EOD). CONCLUSIONS: Poor accuracy of prenatal cultures in identifying true candidates for IAP highlights the need for Portuguese clinical and laboratory guidelines to prevent EOD and antibiotic overtreatment of pregnant women.
- Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report.Publication . Caeiro, AF; Ramilo, I; Santos, AP; Ferreira, E; Batalha, IAmniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.
- Carcinóide estrumal associado a teratoma quístico maduro do ovário: um caso clínicoPublication . Osório, F; Franco, A; Pedro, A; Faustino, F; Nazaré, ADermoid ovarian cysts are the most common germ-cells tumours of the ovary, but strumal carcinoid transformation is rare. The authors report the case of an asymptomatic 20 year-old woman, referred to the gynaecological outpatient clinic, because of the ultrasound finding of an adnexal cyst. On physical examination a right adnexal mass was identified. A repeat ultrasound revealed an ovarian mass measuring 11.5cm, with characteristics that were suggestive of an ovarian teratoma. A CT-scan was performed that was also suggestive of this diagnosis. Tumoral markers were negative, except for CA19.9. The patient was submitted to laparoscopic right adnexectomy and histopathological examination revealed an ovarian bigerminal mature cystic teratoma with strumal carcinoid transformation, but no capsular invasion. Currently, 18 months after surgery the patient is pregnant and remains symptom free.
- Complexo íntima-média e patologia hipertensiva associada à gravidez: um estudo prospectivoPublication . Veríssimo, C; Campillo, J; Matos, T; Costa, A; Rocha, IObjectivos: Avaliar o complexo íntima-média(ClM)em grávidas hipertensas e determinar se um CIM aumentado está relacionado com o desenvolvimento da pré-eclâmpsia. Métodos:Elaborou-se um estudo prospectivo, descritivo e controlado na Unidade de Medicina Materno-Fetal de um hospital de nível II com apoio perintal direnciado. Durante seis meses, 48 grávidas aleatoriamente seleccionadas foram distribuidas por três grupos(A - grupo controlo, n=17; B- grupo de hipertensão gestacional n=l7; C- grupo de hipertensâo pré-gestacional). Todas as mulheres foram submetidas a entrevista clínica, exame objectivo, ecografia obstétrica, avaliação analítica, CTG e medição do CIM na parede distal de ambas as artérias carotidas comuns a 1 cm da bifurcação, pelo mesmo operador,de quem o diagnóstico foi ocultado, com recurso a ultrassonografia de alta definição e uma sonda linear de 7,5 MHz. O seguimento inclui o desfecho obstétrico e neonatal. Resultados: o CIM médio de 0,43mm com um desvio-padrão (dp) de 0,09 mm no grupo A; 0,52(dp=0,11), p=0,034 no grupo B; 0,58 (dp=0,11, p=2,3x10-4 no grupo C. Os resultados não foram estatisticamente diferentes nas grávidas hipertensas com e sem pré-eclâmpsia (0,52(dp:0,11)vs 0,57(dp=0,11),p=0,20). Conclusões: o CIM carotídeo, marcador validado de disfunção endotelial,encontra-se aumentado nos grupos B e C, embora não haja diferenças entre as grávidas hipertens com e sem pré-eclâmpsia.
- Diferença tensional entre os membros superiores: um estudo em mulheres grávidasPublication . Veríssimo, C; Matos, T; Rocha, I; Nogueira, FAim: To ascertain the prevalence of inter-arm blood pressure difference in excess of 10 mmHg in pregnant women. Population: A total of 114 pregnant women selected at random from those admitted to our Maternal and Fetal Medicine Unit. Design: Prospective, descriptive study. Methods: Blood pressure was measured on both arms twice (same operator, method and equipment). Other variants analysed were maternal age, admission diagnosis, gestational age, weight, parity, heart rate, ethnicity, handedness and pulse pressure. Results: Mean age was 26.9 years with a standard deviation (sd) of 6.2; Most women were admitted for labour induction (37%) or because of hypertensive disorders of pregnancy (18%). Mean gestational age was 34.1 weeks (sd=6.9) . Right arm blood pressure was on average 121.4 (sd=20.4) over 74.6 (sd=13.8) mmHg. Mean left arm blood pressure was 121.2 (sd=20.1) over 74.7 (sd=13.4). Mean interarm blood pressure differences were 5.2 (sd=4.5) mmHg during systole and 3.3 (sd=3.3) during diastole. Results were not significantly different in hypertensive women. Differences exceeding 10 mmHg were found in 14.0% of women Correlations between inter-arm blood pressure differences exceeding 10 mmHg and age, gestational age, weight, and parity were weak. Conclusions: It is not possible to recommend one arm in which to measure blood pressure. A possible strategy is to evaluate both arms at the first clinical appointment, and to follow-up with the arm showing the highest BP.
- Ectopia cordis: a case reportPublication . Dias, G; Santos, AV; Martins, C; Ferreira, AP; Fonseca, JIntroduction: ectopia cordis is a rare congenital malformation, with an estimated incidence of 5 to 8 per million live births. It is defined as a malformation in which the heart is located in an extra-thoracic position. Ectopia cordis may occur as an isolated malformation or associated with other anomalies such as omphalocele, congenital heart disease or integrating Cantrell syndrome. The size and location of the defect influence the prognosis. Description: we report a case of a 24-year-old nulliparous woman, with no relevant family or personal history, in which the prenatal fetal ultrasound, performed at 21 weeks of gestation, revealed a defect of the anterior chest wall with exteriorization of the heart. Discussion: fetal echocardiography revealed a severe congenital heart disease. The parents decided to continue the pregnancy, after being duly informed by a multidisciplinary team. Delivery occurred at 37 weeks of gestation but the female newborn died one hour afterwards. Pathological examination confirmed the sonographic findings.
- Esforço multidisciplinar para a evicção de um surto de parotidite epidémica numa maternidadePublication . Veríssimo, C; Matos, T; Matos, F; Rocha, I; Nogueira, FMumps is a disease caused by paramyxovirus, whose notification to health authorities is mandatory. Vaccination in Portugal was started in 1987. There have been several outbreaks worldwide, even in populations with high vaccination rates, but none were reported in maternity hospitals. We report the case of a 36 year-old primigravida, admitted in the 37th week of pregnancy, because of fever, painful uterine contractions and a non-reassuring cardiotocograph. A caesarean section was performed 28 hours after admission due to non-reassuring fetal status, and a newborn with normal Apgar score was delivered. The following day she developed headache, tender bilateral parotid swelling, effacement of the mandibular angle, and tender cervical limphadenopathies. The patient was isolated, and blood samples were collected for paramyxovirus’ serology. All her contacts (healthcare providers and puerperas) were clinically evaluated and non-immunized subjects were vaccinated. Relatives were contacted and counselled. Primary healthcare facilities were asked to facilitate access to the vaccination unit. The Neonatology Department was alerted and the newborn’s blood was sampled for serologic testing. Public authorities were notified through an appropriate declaration form. The patient progressively recovered. Disease was serologically confirmed in the newborn but was asymptomatic. Healthcare providers, contacted puerperas and their newborns were followed up for 4 weeks but none developed symptoms
- Estimativa ponderal fetal ecográfica na gravidez de termoPublication . Veríssimo, C; Rocha, IAim: To ascertain the accuracy of ultrasonographic fetal weight estimation in term pregnancy. Population: A total of 446 pregnant women who underwent obstetric ultrasound in our Maternal and Fetal Medicine Unit. Design: Retrospective, transversal, descriptive study. Methods: From the database of ultrasound exams conducted between July 2007 and June 2008, cases were selected if they complied with the following inclusion criteria: singleton pregnancy, absence of malformations, normal amniotic fluid index, complete record of fetal biometries, exam performed between the 37th and 42nd week of gestation by a senior Obstetrician, and delivery of a live newborn within 6 days of the ultrasound. Fetal weight was estimated according to 26 formulas. Results: Mean gestational age at the time of the exam was 38.6 weeks with a standard deviation (sd) of 0.8. Delivery occurred within 3.9 (sd=2.1) days. The most accurate formula for prediction of newborn weight was Hadlock, which revealed an error of 6.2% (sd=5,2%), a Pearson coefficient of 0.81, and 78% of correct estimations considering a +10% error. There were no significant differences in accuracy between the four senior Obstetricians who performed the exam, nor if the subjects were divided according to gestational age. Cephalic presentations rendered more accurate estimations than breech [6.0 (sd=5.2) vs 7.8 (sd=5.1), p = 0.03]. Fetuses with low birth were less accurately estimated than those who were macrossomic [13.3 (sd=5.5) vs 6.9 (sd=5.6), p = 0.03]. Higginbottom and Warsof formulas had the highest accuracy for identification of low birthweight and macrossomic fetuses, respectively. Conclusions: Ultrasonographic fetal weight estimation at term is a relatively accurate procedure, and the Hadlock formula provides the most precise results in fetuses with normal weigh. Breech presentation, low-birth weight and macrossomic fetuses pose specific challenges to this methodology.
- Hemorragia pós-partoPublication . Carvalho, M; Rodrigues, M
- Morcelação uterina. Atualização e proposta de consentimento informadoPublication . Nascimento, S; Reis, JMorcellation is a surgical technique, sometimes necessary to perform minimally invasive surgery, namely laparoscopic hysterectomy and myomectomy. As it is difficult to distinguish preoperatively a fibroid from a leyomiosarcoma, there are concerns that inadvert morcellation of a malignant tumor might occur, in which case the prognosis of the disease might be worsened. As new evidence arises regarding patient selection, preoperative care and preventive measures, it has become mandatory to inform and discuss the risks and benefits of the procedure with the patient, so that a true informed consent is achieved.