SOG - Artigos publicados em revistas indexadas na Pubmed/Medline
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- Pregnancy and the thyroidPublication . PEREIRAS, C.; HORTA, C.Acta Med Port. 2003 Sep-Oct;16(5):329-31. [Pregnancy and the thyroid] [Article in Portuguese] Pereiras C, Horta C. Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital Geral Sto António, Porto. Abstract The author points out the changes occurred in the axis hypothalamus/hypofysis/thyroid during normal pregnancy. They mention fetus thyroid development different stages, as well as the thyroid hormone secretion through the fetus. They also give special attention to those pregnancies and its special features occurring in places where the amount of iodine isn't enough and how treatment must be carried out. PMID: 14750275 [PubMed - indexed for MEDLINE]
- Grávidas adolescentes e grávidas adultas. Diferentes circunstâncias de risco?Publication . Figueiredo, B.; Pacheco, A.; Magarinho, R.Resumo: Este estudo teve por objectivo caracterizar as circunstâncias em que decorre a gravidez na adolescência e na idade adulta e analisar as principais diferenças, ao nível das condições demográficas, sociais, anteriores de existência e actuais da gravidez. Uma amostra de 130 utentes da Maternidade Júlio Dinis (Porto) (66 grávidas adolescentes e 64 grávidas adultas) foi entrevistada através da Contextual Assessment of the Maternity Experience (CAME, Bernazzani, Marks, Siddle, Asten, Bifulco, et al, 2004), no último trimestre de gravidez. Os resultados mostram que à gravidez na adolescência se associa um elevado número de condições menos favoráveis, que podem comprometer a gestação e os cuidados ao bebé, como por exemplo: desemprego, monoparentalidade, consumo de tabaco, condições anteriores de existência adversas e gravidez não desejada. No entanto, outras circunstâncias adversas estão associadas à gravidez na idade adulta, como seja: história de problemas de fertilidade e de problemas psicológicos com tratamento ou internamento e ausência por morte de pelo menos um dos pais. Conclui-se que um número considerável de grávidas adolescentes vive em condições desfavoráveis, pelo que, não obstante a sua variabilidade, o grupo enquanto um todo pode ser considerado de risco, quando comparado ao grupo de grávidas adultas. Conclui-se ainda que grávidas adolescentes e adultas vivem a gravidez em condições específicas; observam-se diferentes circunstâncias de risco junto de cada um destes dois grupo, que devem ser atendidas na adequação da ajuda prestada pelos técnicos de saúde às reais necessidades das mães.
- Crescimento e actividade fetal às 20-24 semanas de gestação (estudo preliminar)Publication . Conde, A.; Figueiredo, B.; Tendais, I.; Pereira, A.; Nogueira, R.BACKGROUND: Recent researches show that psychological development begins much before birth and prenatal influences can explain a significant part of the future variability in infants' behaviour and development. AIMS: The aim of this study was to characterize the fetal development between 20 and 24 weeks of gestation, related to the measures of fetal growth-- iparietal diameter, abdominal circumference, head circumference, femur length and fetal weight-- and fetal activity--fetal heart rate and fetal movements. We also tried to establish if there are any differences in these measures related to the mothers' and fetus' sociodemographic features, obstetrical conditions and exposure to drugs. METHOD: The sample of this study involved 48 fetus (52.1% female and 47.9% male) with an estimated gestational age (GA) between 20-24 weeks (Mean = 21 weeks and 1 day), whose mothers had appointments at the Obstetric and Gynaecological medical consultation of Júlio Dinis Maternity Hospital (MJD, Oporto). A video tape of the fetal behaviour was made and ultrasound biometry measurements were collected from the morphological ultrasound report. RESULTS: A statistical analysis of fetal data, after gestational age control, showed differences in fetal growth measures related to mothers' occupational status [F(1,41) = 7.28; p = .000], marital status [F(1,41) = 2.61; p = .04], household arrangements [F(1,41) = 2.91; p = .03] and coffee consumption [F(1,40) = 2.55; p = .05]. Differences in fetal activity measures (fetal heart rate) associated to fetus gender [F(1,16) = 5.84; p = .009] were also found. CONCLUSIONS: We can conclude about the sensibility of fetal development to prenatal factors related to the mothers' and fetus' sociodemographic features and exposure to drugs.
- Successful pregnancy in a severely hypoxemic patient with pulmonary alveolar proteinosisPublication . Belchior, I.; Cerdeira, A.; Santos, M.; Braga, J.; Aragâo, I.; Martins, A.Abstract Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a wholelung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response. Resumo A proteinose alveolar pulmonar (PAP) é uma doença rara caracterizada pela acumulação anormal de material lipoproteináceo nos alvéolos, que pode levar a insufi ciência respiratória, estando associada a um risco elevado de infecções. O tratamento gold-standard da PAP é a lavagem pulmonar total.
- Buschke-Lowenstein TumorPublication . Pinto, A.; Guedes-Martins, L.; Marques, C.; Cabral, J.Introduction: Giant condyloma acuminatum belongs to a spectrum of diseases with malignant degeneration. Clinically, it presents as exophytic, fungating masses, sometimes with a cauliflower-like morphology. Case presentation: We present a case of a 32-year-old female patient with a 180x95x80mm exophytic mass of the vulvar region suggestive of Buschke-Lowenstein Tumour. Treatment included wide local excision with electrosurgery and CO2 vaporization of recurrent focal lesions. Histopathological analysis confirmed the expected diagnosis. Surgery went without complications and the patient is lesion-free at the 12th month of follow-up. Conclusion: There is a lack of consistent trials regarding optimal treatment of BLT. Surgery, when feasible, remains the mainstay of treatment. It allows quick lesion size reduction, with fewer side effects and more rapid return to daily living activities, when compared to other treatment options.
- Fathers’ emotional involvement with the neonate: impact of the umbilical cord cutting experiencePublication . Brandão, S.; Figueiredo, B.Abstract Aims. This paper is a report on a study analysing the effect of the umbilical cord cutting experience on fathers’ emotional involvement with their infants. Background. Participation in childbirth offers an opportunity for father and mother to share the childbirth experience, so it is vital that midwives improve the fathers’ participation in this event. Design. A quasi-experimental study with a quantitative methodology was implemented. Methods. One hundred and five fathers were recruited as part of a convenience sample in a Maternity Public Hospital in a Metropolitan City in Portugal, between January and May of 2008. The Bonding Scale, the Portuguese version of the ‘Mother-to-Infant Bonding Scale’ was used to evaluate the fathers’ emotional involvement with the neonate at different moments: before childbirth, first day after childbirth and first month after childbirth. After childbirth, the fathers were divided into three separate groups depending on their umbilical cord cutting experience. Results. The results demonstrate that the emotional involvement between father and child tends to increase during the first days after childbirth and to decrease when evaluated 1 month after birth, for fathers who did not cut the umbilical cord. However, fathers who cut the umbilical cord demonstrate an improvement in emotional involvement 1 month later. Conclusion. Results suggest that the umbilical cord cutting experience benefits the father’s emotional involvement with the neonate, supporting the benefits of his participation and empowerment in childbirth.
- Management of von Willebrand disease type 3 during pregnancy - 2 cases reports.Publication . Inocêncio, G.; Braga, A.; Azevedo, S.; Buchner, CBACKGROUND: von Willebrand disease type 3, is an extremely rare condition. It can be severe and potentially life-threatening, particularly in pregnant women during labor and subsequently during early puerperium. Due to its rarity, there is no optimal treatment/management during pregnancy. CASE: We describe two cases of pregnant women with von Willebrand disease type 3, and its successful surveillance and treatment with Haemate P FVIII (human plasma-derived von Willebrand Factor-ristocetin co-factor associated with human coagulation factor VIII), during pregnancy, partum and puerperium. CONCLUSIONS: Daily prophylaxis with Haemate P FVIII in women with von Willebrand disease type 3, starting 2 hours before caesarean section until the 7th day of puerperium, associated with close analytical and clinical surveillance seems to be a safe clinical option.
- Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant womenPublication . Guedes-Martins, L.; Cunha, A.; Saraiva, J.; Gaio, R.; Macedo, F.; Almeida, H.The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1(st), 2(nd) and 3(rd) trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.
- First trimester aneuploidy screening program for preeclampsia prediction in a portuguese obstetric populationPublication . Teixeira, C.; Tejera, E.; Martins, H.; Pereira, A.; Costa-Pereira, A; Rebelo, IObjective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions. Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (free β -hCG). Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, free β -hCG, CRL, and NT, but not PAPP-A, for prediction of PE. Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs.
- The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal studyPublication . Guedes-Martins, L.; Graça, H.; Saraiva, J.; Guedes, L.; Gaio, R.; Cerdeira, A.; Macedo, F.; Almeida, H.BACKGROUND: Despite the known effects of neuraxial blockade on major vessel function and the rapid decrease in uterine vascular impedance, it is unclear how the blockade affects the utero-placental circulation in the near-term. We hypothesize that among women with chronic hypertension, a loss of sympathetic tonus consequent to spinal block may cause significant changes in the utero-placental haemodynamics than the changes typical in normal pregnant women. Therefore, the main study objective was to analyse the effect of spinal anaesthesia for caesarean section on uterine and umbilical arterial impedance in pregnant women at term diagnosed with stage-1 chronic hypertension. METHODS: A prospective, longitudinal study was performed in singleton pregnant women (203 low-risk and 33 with hypertension) scheduled to undergo elective caesarean section. The mean arterial blood pressure and pulsatility indexes for the uterine and umbilical arteries were recorded before and after spinal anaesthesia was performed using 8-9 mg hyperbaric bupivacaine (5 mg/mL) and 2-2.5 μg sufentanil (5 μg/mL). Multiple linear regression models with errors capable of correlation or with unequal variances were fitted using the generalized least squares. RESULTS: In normotensive women, the mean arterial blood pressure decreased after administering spinal anaesthesia (p < 0.05). The pulsatility index of the uterine and umbilical arteries did not change after spinal anaesthesia. In the hypertensive women, the mean arterial blood pressure (p < 0.05) and uterine artery pulsatility index (p < 0.05) decreased. In both groups, the umbilical artery pulsatility index did not change after spinal anaesthesia. CONCLUSIONS: In stage-1 chronic hypertensive pregnant women at term, spinal anaesthesia for caesarean section reduces uterine artery impedance but not umbilical artery impedance.