Resumo Objetivo A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose. Métodos Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas. Resultados Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de préeclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa. Conclusão A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de préeclâmpsia precoce.

Abstract Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria weremultiple pregnancy andmajor fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of earlyonset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

Introduction: Hysteroscopic sterilization with the Essure® device is a method of contraception considered safe and effective already applied in more than 200,000 women. This study aims to evaluate the efficacy of this method of contraception and the adverse events associated with the placement of Essure®, including pain during the procedure and postprocedure complications. Material and methods: We performed a retrospective observational study with inclusion of all the women submitted to Essure® placement in a large urban hospital in Portugal, from January 2008 to December 2015 (7 years). The variables age, parity, duration and intercurrences of the procedure, follow-up exams and final outcome were evaluated. The statistical analysis was performed with STATA 12.1. Results: Of the 118 women only 100 finished the procedure with 16.9% reporting moderate or severe pain. Although less than 3 intrauterine rings were found in 8.5% of cases, the success rate was 92%. The complications described were tubal perforation (0.8%), pregnancy (1 case) and incorrect positioning of the implants (3%). Discussion/Conclusion: The success rate of the procedure was very close to that described in the literature with a low incidence of complications. That advantages make it an ideal method for women with high surgical risk and multiple comorbidities

Laparoscopic and vaginal routes are the preferable routes to consider when planning a hysterectomy. Laparoscopy brings advantages to vaginal route when there are concomitant adnexal masses, endometriosis, pelvic inflammatory disease or previous abdominal surgeries. However, the learning curve in laparoscopy is slower and the surgery itself is, consequently, very dependent on the surgeon's experience. In this article, the authors review the first 300 total laparoscopic hysterectomy (TLH) surgeries in a new Obstetric/Gynecology Department. A retrospective analysis to clinical files of patients submitted to TLH between January 2013 and February 2016. Data was divided in 2 groups: group A, corresponding to the first 150 HTL and group B, with the 150 subsequent HTL. The results showed 2 similar groups, with median ages of 51 years old, with 27 median corporeal mass index, with 41% of the patients having previous abdominal surgeries. The main surgical indication was anomalous uterine bleeding secondary to mioma/adenomyosis (53%), and 309 concomitant surgeries were performed during surgical time (the majority in the adnexal area, 84%). Globally the intra-operatory and post-operatory complications rate was 1% and 2.3%, respectively, and most occurred in group A. The conversion rate to laparotomy or vaginal assisted laparoscopic hysterectomy was low (2.3%), and was only verified in group A, with statistic significance (p-value - 0.024). The blood loss volume was also statiscally different between the 2 groups (p-value < 0.001), with less volume blood loss in group B. The average uterine weight was similar in the 2 groups, with 187 and 168 grams, and the average surgical time was 155 and 148 minutes, which included the concomitant surgeries. In conclusions, despite the small number of cases, our study seems to show a tendency towards decrease in complications rate, conversion rate and blood loss, probably due to increased experience of the surgeons