Abstract: The amniotic fluid embolism continues to be an unusual, but catastrophic situation, with high mortality. With a complex pathophysiology, it leads to cardiovascular collapse and disseminated intravascular coagulation. The immediate cardiopulmonary resuscitation and monitoring in an Intensive Care Unit with a multidisciplinary team are essential aspects in the management of this situation.
Abstract: OBJECTIVE: This study was undertaken to evaluate the efficacy and safety of intravaginal administration of glyceryl trinitrate plus dinoprostone versus dinoprostone, for cervical ripening and induction of labor. STUDY DESIGN: A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted among 196 singleton low-risk nullipara women with term pregnancies and unfavorable cervices who were randomly assigned to receive intravaginal glyceryl trinitrate plus dinoprostone or placebo plus dinoprostone. The main outcome variables were time from application to active phase of labor and to delivery. Secondary outcomes were change in Bishop score, fetal and maternal morbidity, and incidence of cesarean deliveries. RESULTS: The interval from application of the initial dose to the beginning of active phase of labor was 868 +/- 582 and 1136 +/- 692 minutes (P = .004) and from initial dose to delivery was 1339 +/- 826 and 1620 +/- 975 minutes (P = .03) for the glyceryl trinitrate and placebo groups, respectively. There were no significant differences in Bishop score change, cesarean section rate, and in the incidence of hypersystole and hyperstimulation. The incidence of tachysystole was significantly lower in the glyceryl trinitrate group (4% vs 15%, P < or = .02). No maternal and neonatal adverse effects were noted. CONCLUSION: The association of glyceryl trinitrate with dinoprostone is more effective than dinoprostone alone for labor induction in low-risk patients at term with unfavorable cervices.
Abstract: OBJECTIVE: To demonstrate the usefulness of a new method of applying compressive sutures to treat postpartum bleeding secondary to uterine atony. METHODS: Multiple sutures were applied longitudinally and transversally around the uterus of 7 women with postpartum uterine atony and postpartum bleeding. RESULTS: The procedure was successful in all cases. CONCLUSION: Compressive sutures of the uterus were effective in treating uterine atony with postpartum bleeding. LEVEL OF EVIDENCE: III.
Abstract: OBJECTIVE: To evaluate the influence of the therapy with high-dose corticoids on the clinical and laboratory evolution of HELLP syndrome. STUDY DESIGN: We reviewed all the cases of pregnancy complicated with HELLP, admitted to the Garcia de Orta Hospital from 1993 to 2000. We compared the patients without corticosteroid therapy or with a standard corticosteroid regimen for promotion of fetal lung maturation--group 1, with the patients who received dexamethasone (10 mg intramuscular every 12 hours)--group 2. RESULTS: Out of 48 patients, 13 were included on group 1 and 35 on group 2. The time from admission to delivery was longer for the group on dexamethasone (3.7+/-4.5 days) compared to the group without (1.8+/-2.4). There was a significant improvement in the symptom of epigastric pain (P<0.05) and in the laboratory findings--platelets (P<0.000), liver enzymes (P<0.000) and lactic dehydrogenase (P<0.001), in the dexamethasone group. The number of caesarean deliverys was similar on both groups (group 1--46% and group 2--48%). The use of regional anesthetic techniques for delivery, was higher on group 2--66% (23 of 35) compared with group 1--15% (2 of 13), P=0.006. There was no significant difference in the maternal morbidity or number of blood transfusions. Perinatal mortality was associated with prematurity, and similar in the two groups. CONCLUSIONS: This study confirms the positive influence of the high-dose corticosteroid therapy on HELLP syndrome.
Abstract: This work is an application of energy dispersive X-ray fluorescence (EDXRF) as analytical technique for trace element determination in human tissues. Potassium (K), calcium (Ca), iron (Fe), copper (Cu), zinc (Zn), bromine (Br), rubidium (Rb) and lead (Pb) were determined directly in blood samples from 66 mothers at delivery after full-term pregnancies. The corresponding 66 cord-blood samples of the newborns were also analysed, in order to find element correlations between maternal and newborn blood at birth. The studied samples were obtained from mothers aged between 15 and 39 years old, the gestational age being between 35 and 41 weeks and the newborns' weight between 2.310 and 4.310 kg. Samples were lyophilised and analysed without any chemical treatment. Very low levels of Pb were found both in maternal and fetal cord blood samples. Cu values ranged from 3 to 13 microg g-1, both for mothers and children. A correlation between Cu and Fe concentrations in maternal and fetal cord blood was found. Zn is considered as one of the key elements in newborn health. Concentrations between 10 and 40 microg g-1 were measured. A positive correlation between Br levels in mothers and children was observed. Positive correlations for mothers were observed between Zn and Rb as well as K and Fe. The corresponding correlations in fetal cord blood samples were not observed, however positive correlations were found between Ca and K; Cu and Fe. The mean concentrations for each element were similar in maternal and in fetal cord blood, except for Cu and Zn, being higher in maternal samples. No correlations between element concentrations and pathologies of the mothers were observed.
Abstract: In the present article, regarding a clinical case of Thrombasthenia of Glanzmann with severe anaemia by menometrorrhagia, the authors propose the vaginal hysterectomy and the administration of the recombinant factor VIIa on the immediate pre and postoperative as effective therapeutical alternatives.
Abstract: This work is an application of energy dispersive X-ray fluorescence (EDXRF) as an analytical technique for trace elemental determination in human membrane and placenta and elemental concentrations correlations in both tissues. Whole samples were collected during the delivery from healthy mothers and full-term pregnancies. The age of the mother was between 25 and 40 years old, and the weight of the infants ranged from 2.56 to 4.05 kg. Samples were lyophilised and analysed without any chemical treatment. No significant differences in elemental content of placenta and membrane samples were observed except for Ca. Very low levels of Se, As and Pb were observed in all the analysed samples. Zn, considered as one of the key elements in newborn health, was not significantly different in the analysed samples, all of which originated from healthy mothers and healthy babies. The obtained values agree with the literature except for Ca, which is much higher in the studied samples.
Abstract: OBJECTIVE: The aim of this study was to evaluate the efficacy of post-caesarean analgesia comparing three techniques most frequently used. PATIENTS AND METHODS: For three months all pregnant women submitted to elective or urgent caesarean section, under general or regional anaesthesia, were evaluate with a total of 129 parturient. These parturient were divided into three groups with different techniques of postoperative analgesia: Group 1 (n = 26) received intravenous pethidine and paracetamol per os, group 2 (n = 58) received epidural morphine and group 3 (n = 45) epidural morphine and intravenous propacetamol. Pain was assessed at rest and during mobilisation using a scale of 0-without pain, 1-mild pain, 2-moderate pain and 3-severe pain. Overall satisfaction was assessed with a verbal qualitative scale of very good, good, sufficient and bad. Side effects were analysed. RESULTS: The records of pain at rest and during mobilisation were significantly lower with epidural analgesia compared with intravenous pethidine. There were no significant differences between groups 2 and 3. Similar results were observed in the degree of satisfaction. For 50% of parturient of epidural analgesia (groups 2 and 3) and only 4% of intravenous pethidine (group 1) the analgesic technique was very good. Propacetamol and epidural morphine (group 3) had better pain scores (very good and good) when compared with morphine alone (group 2) but there were no significant differences. Epidural morphine was associated with more pruritus. CONCLUSION: From this study we are able to conclude that epidural morphine offers a good quality of analgesia with better satisfaction and minimal side effects.
Abstract: OBJECTIVE: We sought to evaluate the efficacy and safety of intravaginal misoprostol and dinoprostone for labor induction. STUDY DESIGN: One hundred eighty-nine women with singleton term pregnancies and unfavorable cervices were randomly assigned to receive intravaginal misoprostol or dinoprostone. The outcome variables were change in Bishop score, time from application to active phase of labor and delivery, fetal and maternal morbidity, and the incidence of cesarean deliveries. RESULTS: The interval from application of the initial dose to the beginning of the active phase of labor was 9.8 +/- 5.8 and 14.2 +/- 10.2 hours (P <.01), and the interval from initial dose to delivery was 15.3 +/- 9.8 and 19.1 +/- 13.2 hours (P =.027) for the misoprostol and dinoprostone groups, respectively. There were no significant differences in Bishop score change, cesarean delivery rate, and the incidence of tachysystole, hypersystole, and hyperstimulation. No maternal and neonatal adverse effects were noted. CONCLUSION: Intravaginal misoprostol is more effective than intravaginal dinoprostone for labor induction in low-risk patients at term with unfavorable cervices.
Abstract: During 1997, The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) circulated a questionnaire to audit training in Europe. Results describe number and gender in each country, access to training, duration of training, tutor/tutee scheme, logbooks, minimum curriculum, assessment, criteria for accreditation, training abroad, final examination, hospital inspection, subspecialty, academic training, and career progression. Quality of life is tried to address with questions relating to salary, working hours, maternity leave, annual leave and study leave. EBCOG has drawn up recommendations to try and achieve a standardisation of quality of training whilst fully understanding that complete standardisation of training is not a realistic possibility due to social, cultural and ethical differences. A repeat audit is planned after 3 years to close the feedback loop.
Abstract: OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction. METHODS: 110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50-100 microg), every 6 h until a maximum of three doses or beginning of labor. RESULTS: The average interval (+/- S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5 +/- 5.7 h and 14.8 +/- 9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted. CONCLUSIONS: Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.
Abstract: OBJECTIVE: The purpose of this study was to characterise the occurrence of multiple primitive gynaecological malignant neoplasias, restricted to the genital tract and breast or associated with other organs, and to detect which types of association are most frequent concerning location, histology and staging. POPULATION AND METHODS: The records of patients with gynaecological cancer at the Portuguese Institute of Oncology--Lisbon Centre, between 1986 and 1993 were used in this study. RESULTS: Of the 10,746 women with gynaecological cancer, 91 (0.8%) were found to have a second primitive malignant neoplasia. Of these neoplasias, 64% (58 cases) were also located at a gynaecological site. The most frequent associations were endometrium/breast (13 cases), bilateral breast (12 cases) and ovary/endometrium (11 cases). The majority of primitive multiple gynaecological tumours were synchronous. Regarding gynaecological cancer and non-gynaecological cancer, in 28 cases (31%), the most common non-gynaecological location was the colon/rectum. Five patients had triple tumours. CONCLUSION: Although these situations are relatively rare the possibility of multiple primitive cancers should be considered with the presence of malignant tumours in two or more organs. This distinction between multiple primitive or metastatic cancers could be important for treatment as well as prognosis.
Abstract: The national survey on the trainees in this specialty was conducted to find out the trainees' opinions and expectations regarding postgraduated in Gynecology and Obstetrics and professional opportunities. A total of 320 questionnaires were send to all the trainees registered with the Portuguese Medical Association. Some of the topics of this survey were: structure and quality; curriculum requirements; assessment and professional opportunities. We received a total of 109 replies, which are presented in this article.
