Abstract Introduction and Objectives: Tocology knowledge is crucial in obstetrician's decisions and actions. The aim of this research is to assess the experience of Portuguese Gynecology and Obstetrics residents in performing operative vaginal delivery. Study design, population and methodology: Observational and transversal study with collecting an anonymous online survey with 47 questions, performed to 2nd to 6th year residents of Gynecology and Obstetrics. Results: 82 responses to the survey were obtained. The mean age of the sample was 29.3±0.248 years and 92.7% (n=76) of the participants were female. About half of the participants (53.7%, n=44) were working in a central hospital. The vacuum was the instrument most frequently used by the residents (95.1%). When asked about their level of confidence in performing an instrumented delivery, 6th-year residents (n=20) gave, on average, on a 1 to 9 scale, a score of 4.25±0.56 for the use of forceps and 8.05 ±0.22 for the use of vacuum (p<0.001). In this sample, 90.2% of the residents had the opportunity to undergo practical training in instrumented deliveries during the residency. Regarding maternal morbidity, the main concern using forceps are obstetric anal sphincter injuries (74.4%) and using vacuum are vaginal lacerations (32.9%). Conclusions: This survey allowed to characterize and to assess the residents experience, as well as their limitations, on performing operative vaginal deliveries. The knowledge acquired is essential to adapt and homogenize training plans, whenever needed.

Abstract Introduction: Ulipristal acetate (UPA) was introduced in clinical practice for the treatment of uterine fibroids in February 2012. During the post-marketing exposure, there were reports of liver injury and the European Medicine Agency recommended monitoring of liver enzymes for safety reasons. Objectives: The aim of this survey was to gather information about Portuguese gynaecologists’ experience with UPA regarding liver function and other complications related to UPA use. Material and methods: The study consisted of a cross-section survey among members of the Portuguese Society of Gynaecology between April and May 2018. The responders used an online platform to answer a survey that focused on safety and specific alterations in laboratory analyses of liver function considering treatment with UPA since January 2018. Results: In the period considered in this survey, 199 women were treated with UPA by the responders. Monitoring of liver function was performed in 93 women and alterations in liver function laboratory tests were reported in five cases (2.5%). In two of these cases, the past medical history was associated with liver diseases, namely alcoholic, infectious and autoimmune. The clinical course was favourable in all cases. Conclusions: Despite temporary UPA temporary suspension, this survey reinforced the need of clinical database for UPA safety monitoring, particularly regarding the possible application in selected clinical cases.

Abstract Estetrol (E4) is a native fetal estrogen with a distinct pharmacological profile, acting preferentially on alpha estrogen receptors. Estetrol (15 mg) in combination with drospirenone (3 mg) has been recently approved for contraception. The advantage of hormonal combined contraception with estetrol is demonstrated by neutral impact on hemostatic factors, decreased modulation on lipidic parameters which creates a unique safety profile that emphasizes the utility of E4 in clinical practice. Besides, the E4 use for the treatment of menopause related symptoms and for breast and prostate cancer control has been extensively studied.

Resumo Introdução: A investigação clínica (IC) é essencial para a formação médica, além de requisito obrigatório do currículo de Ginecologia e Obstetrícia (GO). Contudo, a literatura acerca da atitude dos internos portugueses relativamente à IC é escassa. O objetivo deste estudo foi avaliar obstáculos e incentivos à IC no internato de GO em Portugal. Materiais e Métodos: Estudo transversal, com realização de um questionário, anónimo, aos internos portugueses de GO, avaliando dados demográficos, experiência e perceções acerca dos obstáculos e incentivos à IC. Resultados: Dos 65 (25,5%) internos que responderam ao questionário, 90,8% eram mulheres. Destes, 58,5% provinham de hospital central e 41,5% de periférico. Todas as regiões do país e anos de internato estiveram representados. A maioria respondeu que: o seu hospital não disponibilizava centro de bioestatística de apoio (66,2%), mas que esta medida seria importante (96,9%), e não oferecia formação em bioestatística (93,8%). A maioria dos centros (81,5%) tem uma reunião científica semanal e 9,2% referiu ter mais que duas. Na análise da perspetiva relativamente à IC, 80% considerava uma experiência positiva, contudo que o ambiente do seu serviço não a promovia (60%). Os obstáculos à investigação mais apontados foram: tempo disponível insuficiente, falta de apoio em bioestatística e dificuldade no acesso aos registos clínicos. A formação num hospital central associou-se significativamente a disponibilização de apoio em bioestatística (p=0,03), maior número de artigos publicados (p=0,001) e de reuniões científicas (p=0,006). Discussão e Conclusão: O conhecimento dos fatores que influenciam a motivação dos internos relativamente à investigação é fulcral para a implementação de medidas de otimização da produção científica.

Overview and Aims: The decision of the route of delivery in a breech presentation is one of the most controversial topics in contemporary obstetrics. The aim of this study is to develop a predictive model for vaginal breech delivery (VBD). Study Design, Population and Methods: It was performed an observational, retrospective, descriptive study based on the review of clinical records of pregnant woman with singleton gestations in breech presentation at term, with delivery between 2005 and 2015, in Hospital de Braga and Unidade Local de Saúde do Alto Minho. Potential predictors of VBD were analyzed by bivariate analysis and binary logistic regression. Results: There were included 92 VBD and 167 cesareans. The final model includes 6 variables: Maternal age, number of previous deliveries, percentile of estimated fetus weight, weight of the heaviest previous newborn, Bishop’s index and fetal gender. The area under the curve was 0,83, corresponding to a good discriminative ability. A probability equal to or greater than 50.3% may be an adjunct to the decision of the delivery route. Conclusions: A predictive model with good discriminative capacity was developed that can be useful helping the decision of the route of delivery in pregnant woman with singleton gestations in breech presentation at term.

Overview and Aims: Technology has allowed hysteroscopy to be increasingly performed in the office (HO). Yet, fear of patient pain associated with HO still prevents clinicians from choosing it instead of traditional hysteroscopy (HA). We aimed to compare pain perception and satisfaction in patients submitted to HO versus HA and to determine socio-demographic and clinical factors that influence patient experience. Methods: We performed a prospective, observational, descriptive and analytical study, comparing women submitted to HA (n=119) and HO (n=113), between September and December 2016 and January to July 2017, respectively. Three self-report questionnaires were answered by the patients before, immediately and one month after the hysteroscopy, and another questionnaire was answered by the clinician in charge of the technique. Results: Both HA and HO groups showed similar socio-demographic characteristics. Differences were found between felt and expected pain, both in HA (p<0,001) and HO (p= 0,001), with expected pain being higher in both groups. Despite HO group reported higher levels of pain (visual analog scale 4 versus 1,87 in the HA group), patients in this group presented significantly higher satisfaction regarding information given before (p=0,040) and after procedure (p<0,001) and with changes in their daily life (p<0,001). Generally, HO group showed higher levels of global satisfaction concerning the procedure (mean 20,45 versus mean 19,4 in the HA group, p= 0,001). Furthermore, the waiting time until hysteroscopy was lower in the HO group (p=0,007). We found no association between patients characteristics and the level of global satisfaction and experienced pain during hysteroscopy. Conclusion: HO presents higher levels of global satisfaction, which may be related to better communication, less waiting time until procedure and faster return to daily activities. Thus, given the safety and cost-effectiveness of HO, fear of patient pain should not prevent most diagnostic and simple surgical hysteroscopies from being performed in the HO context.

Overview and Aims: Levonorgestrel Intrauterine System (LNG-IUS) is an efficacious and cost-effective long acting reversible contraceptive, with high satisfaction rates among users. Yet, evidence shows that anxiety and fear of pain associated with LNG-IUS insertion prevent women from choosing them as their contraceptive method. We aimed to determine risk factors associated with anxiety and pain perception during LNG-IUS insertion. Methods and Population: We performed a prospective, observational, descriptive and analytical study to a sample of patients of the family planning consultation submitted to insertion of LNG-IUS between may and november 2017. Pre and post insertion questionnaires were given, one directed to the patients and other to the clinicians. Results: From a total of 161 women in analysis, 125 inserted Mirena® and 36 inserted Jaydess®. The patients submitted to the insertion of Jaydess® were significantly younger (median=34) than those who chose Mirena® (median=41) and presented higher frequency of nulliparity and absence of vaginal delivery. Higher levels of anticipated pain correlated with high levels of anxiety (p<0.001). The pain associated to the procedure was mainly referred to as mild or moderated. Higher levels of experienced pain were found in patients with less parity or absence of vaginal delivery and in more technically difficult procedures (p<0.001). After a multivariable regression analysis, only patient's anxiety and anticipated pain have remained associated with the increase of experienced pain (p<0.05). Conclusions: High levels of anxiety and anticipated pain proved to be predictors of high levels of experienced pain during LNG-IUS insertion. Future research should focus on interventions to reduce pre-procedure anxiety and anticipated pain potentially to decrease discomfort experienced with intrauterine device insertion.