RESUMO Objetivo: O presente estudo analisou os efeitos da utilização e da percepção de utilidade dos rituais de luto e da satisfação conjugal no luto perinatal. Método: Responderam a um inquérito de autorrelato, 74 mulheres portuguesas que recorreram a um hospital público no Porto - Portugal, após vivenciarem um ou mais abortamentos em 2019. Foram analisados os efeitos da utilidade dos rituais e da satisfação conjugal na vivência do luto, bem como os efeitos de interação. Resultados: Tendo o ajustamento ao luto após a perda gestacional como variável dependente, observou-se um efeito negativo da satisfação conjugal (b=.33) e um efeito positivo da utilidade dos rituais (b =.46). Não foi observado um efeito significativo de moderação. Conclusão: Este estudo vem realçar a importância da abordagem dos rituais de luto e da conjugalidade no apoio emocional à perda, sendo primordial a figura do enfermeiro nos contextos do aborto e da perda neonatal.

ABSTRACT Objective: The present study analyzed the effects of the use and perceived usefulness of bereavement rituals and marital satisfaction on perinatal bereavement. Method: 74 Portuguese women who attended a public hospital in Porto - Portugal, after experiencing one or more abortions in 2019, responded to a self-report survey. The effects of ritual utility and marital satisfaction on bereavement experience, as well as interaction effects, were analyzed. Results: With adjustment to bereavement after pregnancy loss as the dependent variable, a negative effect of marital satisfaction (b=.33) and a positive effect of ritual utility (b =.46) were observed. No significant moderation effect was observed. Conclusion: This study highlights the importance of addressing bereavement rituals and conjugality in providing emotional support for the loss, with the figure of the nurse being paramount in the contexts of abortion and neonatal loss.

RESUMEN Objetivo: El presente estudio examinó los efectos del uso y la utilidad percibida de los rituales de duelo y la satisfacción marital en el duelo perinatal. Método: 74 mujeres portuguesas que acudieron a un hospital público en Oporto - Portugal, después de experimentar uno o más abortos en 2019, respondieron a una encuesta de autoinforme. Se analizaron los efectos de la utilidad ritual y la satisfacción marital en la experiencia del duelo, así como los efectos de interacción. Resultados: Con la adaptación al duelo tras la pérdida del embarazo como variable dependiente, se observó un efecto negativo de la satisfacción marital (b=.33) y un efecto positivo de la utilidad ritual (b=.46). No se observó ningún efecto de moderación significativo. Conclusión: Este estudio pone de manifiesto la importancia de abordar los rituales del duelo y la conyugalidad en el apoyo emocional a la pérdida, siendo la figura de la enfermera primordial en los contextos del aborto y la pérdida neonatal.

Overview and Aims: Colonized pregnant women with group B streptococcus (GBS) are generally asymptomatic, but GBS can cause urinary tract infection, as well as amnionitis, endometritis and bacteraemia. It is also associated with an increased risk of preterm birth and fetal death. In the newborn, GBS is the main cause of infection, which can lead to neonatal GBS early-onset disease (EOD) or late-onset disease. The aim of this study was to evaluate the prevalence of GBS colonization in pregnant women, and to assess differences between groups, risk factors for colonization, and the occurrence of EOD. Study Design, Population and Methods: An observational, retrospective and descriptive study was carried out in pregnant women who had deliveries between January 2013 and September 2019. We evaluated demographic and clinical variables obtained from electronic files. The pregnant women were divided into two groups, colonized by GBS and not colonized by GBS. Descriptive analyses of the study variables and statistical tests were performed to assess risk factors for GBS colonization and to compare means and distributions between colonized and non-colonized pregnant women. Results: A total of 12,315 cases were included in the study. 2,211 pregnant women were colonized by the SGB, corresponding to a prevalence of 18% (95% CI: 17.3 - 18.6). Differences were found for maternal age, educational levels, previous births and pregnancies, weight gain during pregnancy and gestational age. An association was verified between urinary infections during pregnancy and colonization. We identified a prevalence of neonatal GBS EOD of 2.3 per 1000 live births in the colonized group. Conclusions: The prevalence of GBS colonization is similar to that previously reported. The prevalence of EOD in colonized pregnant women is also in accordance with other studies, reflecting the importance of universal screening for GBS and antibiotic prophylaxis.

Fetal death remains the most overwhelming complication in obstetric care. As a sudden event, it entails a huge impact on families, making it difficult to assimilate new information and take important decisions, as well as making important decisions consciously. This literature review aimed to question the validity of the maternal request for delivery after fetal death, as also to reflect the need for proper training of healthcare providers, making them capable of enlighten and guide families. Once the risks and benefits have been elucidated, it is reasonable to grant an elective caesarean delivery, if this is still the mother’s desire.

To determine if the induction of labor in twin pregnancies is associated with greater risk of cesarean delivery than the induction of labor in single pregnancies, we performed a systematic review. Only in one of three studies included cesarean delivery after induction is more frequent in twin than in single pregnancies. Through a multivariable analysis, maternal age and nulliparity are more important risk factors to cesarean delivery than twin pregnancy. Twin pregnancies have a higher risk of cesarean delivery than single pregnancies, but this does not appear to be related with induction of labor.

Fetal growth restriction (FGR) is a challenging complication of pregnancy characterized by severe perinatal morbidity and mortality and long-term adult disease. In this condition, the fetus does not reach his potential growth and is pathologically small. Several biomarkers have been studied as possible predictors of this condition. Pregnancy-associated plasma protein-A stands out as a potential marker of FGR. It is a trophoblast-derived protein involved in the insulin-like growth factor system regulation and thus in the fetal growth. The aim of this review is to assess the current evidence behind the association between this biochemical marker and FGR.

Caesarian section (C-section) is a worrisome issue due to its increasing incidence and associated risks, especially in low risk pregnancies. Maternal age has an increasing tendency in modern societies and appears to be contributing to the rise in the Csection rates - due to co-morbidities, "high risk labeling" or an intrinsic biological cause related to aging. Our aim is to evaluate the association between maternal age and delivery mode in low risk pregnancies. Retrospective observational study using electronic medical records, ICD-9-CM coding system and unit database software Obscare. Data from low risk singleton term labors occurred from January 2008 to December 2012 was included. We assessed 10411 cases, divided in three age groups (<20, 20-34, ≥35 years old) - women with 20 to 34 years old were considered the reference group. Parity, presentation, delivery mode, induction, C-section indication and timing were assessed. Women with ≥35 years old have a higher probability of C-section, 30.7% vs. 22.3%, OR 1.527 [1.371-1.700]. This odd remains higher in non-induced labors, OR 1.367 [1.221-1.531], but loses its significance in the subset of only induced labors. In both multiparous and nulliparous the probability of C-section remains higher for women >35 years old, OR 1.581 [1.356-1.843] and 2.098 [1.742-2.527]. This age group has a higher probability of having a C-section due to "previous C-section" OR 3.121 [2.519-3.865], and a lower probability due to "labor arrest" and "non-reassuring fetal tracing", OR .559 [.457-.685] and .724 [.563-.931], respectively. For the older group, the odd of having an elective C-section was higher, OR 1.844 [1.509-2.254] and of having an urgent C-section lower, OR, .644 [.537-.774]. Older women have a higher probability of having a C-section, even in the absence of identifiable comorbidities. Elective interventions and previous C-sections seem to play a crucial role in this association.

Necrotizing Fasciitis (NF) is an infectious and inflammatory process, with necrosis of the fascia muscularis and surrounding subcutaneous adipose tissue, evolving quickly and that can be potentially fatal. Although rare, NF can be one of the possible clinical presentations of surgical wound infection after cesarean delivery. A case of a patient who was submitted to a cesarean section during labor with later development of NF of the abdominal wall is presented. An integrated therapeutic approach with multiple surgical debridments and a combination of negative pressure wound therapy and instillation of antiseptic solutions was used, with full recovery of the patient

Recently, Zika virus infection has been rapidly spreading, rising the cases of fetal abnormalities. A review was performed from February 2016 to January 2017, selecting articles that evaluated the fetal repercussions of maternal infection, considering fetal autopsies, clinical examinations and imagiology. The most frequent abnormalities were in the central nervous system, namely microcephaly, intracranial calcifications and ventriculomegaly. Death and fetal growth restriction were also reported. Anomalies in other systems were found to a lesser extent. Despite enough evidence proving this causality, it is important to document all these changes, allowing the comprehension of the virus' full width

Fetal drug therapy can be defined as the administration of specific drugs, with the aim of treating any fetal pathology, seeking the improvement of long-term perinatal results. This review will provide updated information about some fetal pharmacologic therapies that are exclusively destined to the treatment of fetal pathologies, which don't include any mother's issues that require simultaneous treatment.

Objective: We aimed to compare elective induction of labor at 39 weeks with expectant management of noncomplicated singleton pregnancies. Material and methods: We performed a systematic review and a meta-analysis with the articles which had the same methodology. Results: Regarding the cesarean section rate at 39 weeks, most studies reported an equal or lower frequency in the elective induction group. Overall, maternal and neonatal complications were not higher after elective induction, with studies associating it to a lower frequency of some adverse outcomes. However, elective induction was associated with a higher rate of shoulder dystocia, epidural use and an increase in labor duration and cost. Conclusion: Elective induction of labor at 39 weeks, when compared to expectant management, has not been associated with a significantly higher rate of caesarean sections. However, there's a lack of evidence to change the current recommendations on induction of labor.

Metformin is an effective oral anti-diabetic that has been used in pregnancy during the last decades. However, metformin crosses the placenta, so its use remains controversial. Scientific evidence suggests that the use of metformin in pregnancy is safe. In the treatment of gestational diabetes has efficacy comparable to insulin, and in polycystic ovary syndrome improves pregnancy success rate, prevents ovarian hyperstimulation syndrome and might reduce some pregnancy complications. Although there is no evidence of modifications in the development of children exposed to metformin, more studies are needed to evaluate the long-term effects.