Abstract Objective: To evaluate whether the continuous support provided by doulas influences the endogenous release of serotonin in parturients. Methods: This pilot study included 24 primigravidae at term. Of these, 12 women received continuous doula support (Experimental Group), whereas the other 12 received the usual assistance without doula support (Control Group). Blood samples were collected from all the women at the active and expulsion stages of labor and at the fourth period of labor (Greenberg period) for evaluation of their serotonin levels using high-performance liquid chromatography. Results: The average serotonin concentrations in the control and experimental groups were respectively 159.33 and 150.02 ng/mL at the active stage, 179.13 and 162.65 ng/mL at the expulsion stage, and 198.94 and 221.21 ng/mL at the Greenberg period. There were no statistically significant differences in serotonin concentrations between the two groups at the active and expulsion stages of labor. By contrast, within the experimental group, a significant increase in serotonin concentration was observed in the Greenberg period compared with the levels in the active and expulsion stages (p < 0.05). Conclusion: The novelty of this study relies on the ability to correlate the influence of the continuous support offered by doulas with the release of serotonin in parturients, with the results suggesting that the assistance received during labor can modulate the levels of hormone release in the Greenberg period. Brazilian Registry of Clinical Trials: RBR-4zjjm4h Objective parturients Methods 2 term these 1 Experimental Group, Group , Group) Control Group. . highperformance high performance chromatography Results 15933 159 33 159.3 15002 150 02 150.0 ngmL ng mL stage 17913 179 13 179.1 16265 162 65 162.6 19894 198 94 198.9 22121 221 21 221.2 contrast group p 0.05. 005 0.05 0 05 0.05) Conclusion Trials RBR4zjjm4h RBRzjjmh RBR 4zjjm4h zjjm h 1593 15 3 159. 1500 150. 1791 17 179. 1626 16 6 162. 1989 19 9 198. 2212 22 221. 00 0.0 zjjmh 0.

Abstract Objective: Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods: Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results: Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion: Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health. Objective women Methods Crosssection Cross section 201 2019 recorded observed diploid precursors. precursors . precursors) Results Eightysix Eighty six included arrest Conclusion Crosssex sex are health 20 2

Abstract Objective: Seminal cryopreservation causes significant damage to the sperm; therefore, different methods of cryopreservation have been studied. The aim of the study was to compare the effects of density gradient processing and washing/centrifugation with seminal plasma removal for cryopreservation in semen parameters. Methods: Seminal samples of 26 normozoospermic patients were divided into 3 parts: with seminal plasma; after washing/centrifugation; and after selection through density gradient. The samples were cryopreserved for at least two weeks. Motility, sperm count, morphology and viability were evaluated before cryopreservation and after thawing. Results: Density gradient processing selected motile and viable sperm with normal morphology in fresh samples (p<0.05). Cryopreservation negatively affected all sperm parameters regardless of the processing performed, and even if the sperm recovery was lower in the density gradient after the thawing, progressive motility, total motility, viability and morphology remained higher (p<0.05). Conclusion: Cryopreservation significantly compromises sperm parameters (motility, morphology, viability). In normozoospermic patients, the density gradients select better quality spermatozoa compared to other processing methods; this benefit was kept after thawing. Objective therefore studied washingcentrifugation washing centrifugation Methods 2 parts weeks Motility count thawing Results p<0.05. p005 p p<0.05 . 0 05 (p<0.05) performed motility Conclusion (motility viability. viability) p00 p<0.0 (p<0.05 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

Abstract Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann–Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women. Objective highrisk risk factors Methods crosssectional cross sectional personal perinatal hospitals s records Chisquare, Chisquare Chi square, square Chi-square Fishers Fisher exact MannWhitney Mann Whitney ROC (ROC 5 5% Results 1629 1 629 1,62 201 included 348 34 8 34.8% p 0.039, 0039 0.039 , 0 039 0.039) 0.027, 0027 0.027 027 0.027) 0.003, 0003 0.003 003 0.003) 0.001 0001 001 nonattendance. nonattendance non attendance. attendance non-attendance Conclusion cases 162 62 1,6 20 3 34.8 0.03 03 002 0.02 02 000 0.00 00 16 6 1, 2 34. 0.0 0.

Abstract Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost. Objective Alegre Brazil Methods crosssectional cross sectional antibiograms 201 2022 Results 12 Hospital 9 76.7% 767 76 7 (76.7% sp 92% 92 (92% S 32 clindamycin 26 5 trimethoprimsulfamethoxazole. trimethoprimsulfamethoxazole sulfamethoxazole. trimethoprim-sulfamethoxazole vancomycin Conclusion period home cost 20 202 1 76.7 (76.7 (92 3 2 76. (76. (9 (76 ( (7

Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings. Objective middleincome middle income country Methods Crosssectional Cross sectional 26 obstetriciangynecologists obstetrician gynecologists facilities administered Results 445 44 5 44. years 785 78 78.5 female 977 97 7 97.7 program i.e., ie i e (i.e. length 113 11 3 11.3 43 abnormal 746 74 6 74.6 Conversely 607 60 60.7 p 0.001. 0001 0.001 . 0 001 0.001) 90.6% 906 90 (90.6% cervix Conclusion common prevalent settings 2 4 78. 9 97. i.e. (i.e 1 11. 74. 60. 000 0.00 00 90.6 (90.6 i.e 0.0 90. (90. 0. (90 (9 (

Abstract Objective: To compare Transforming growth factor beta-1 (TGF-β1) expression in patients with and without adenomyosis. Methods: A prospective design was performed including 49 patients submitted to hysterectomy. Immunohistochemistry was performed on anatomopathological samples staged in paraffin blocks from patients with and without adenomyosis. The sample contained 28 adenomyosis cases and 21 controls. Student's t-test and multivariate logistic regression tests were used for statistical analysis. Associations were considered significant at p < 0.05. Results: We found no significant association between adenomyosis and: smoking (p = 0.75), miscarriage (p = 0.29), number of previous pregnancies (p = 0.85), curettage (p = 0.81), pelvic pain (p = 0.72) and myoma (p = 0.15). However, we did find a relationship between adenomyosis and abnormal uterine bleeding (AUB) (p = 0.02) and previous cesarean section (p = 0.02). The mean TGF-β1 intensity (mean ± SD) in the ectopic endometrium of women with adenomyosis showed no significant association (184.17 ± 9.4 vs.184.66 ± 16.08, p = 0.86) from the topic endometrium of women without adenomyosis. Conclusion: TGF-β1 expression was not increased in the ectopic endometrium of women with adenomyosis. Objective beta1 beta 1 beta- TGFβ1 TGFβ TGF β1 β (TGF-β1 Methods 4 hysterectomy 2 controls Students Student s ttest t test analysis 005 0 05 0.05 Results 0.75, 075 0.75 , 75 0.75) 0.29, 029 0.29 29 0.29) 0.85, 085 0.85 85 0.85) 0.81, 081 0.81 81 0.81) 0.72 072 72 0.15. 015 0.15 . 15 0.15) However AUB (AUB 0.02 002 02 0.02. TGF-β SD 184.17 18417 184 17 (184.1 94 9 9. vs18466 vs 66 vs.184.6 1608 16 08 16.08 0.86 086 86 Conclusion (TGF-β 00 0.0 07 0.7 7 0.2 0.8 8 01 0.1 184.1 1841 18 (184. vs1846 6 vs.184. 160 16.0 0. 184. (184 vs184 vs.184 16. (18 vs18 vs.18 (1 vs1 vs.1 ( vs.

Objective: We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section. Methods: A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration. Results: One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration. Conclusion: Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration. Objective (VSBE section Methods crosssectional cross sectional virtually 23 97 invited Clinical sociodemographic content index testretest test retest reliability constructstructural construct validity. . validity) Results Onehundred One hundred fiftyeight fifty eight 2479 24 79 24.79 perineum 3333 33 33.33 94 9 4 9.4 episiotomy 7 sections older p<0.05. p005 p p<0.05 0 05 (p<0.05) Cronbachs Cronbach s 0.7 07 observed Index however Moreover (UI OR=2.7161.0154.667p=0.046 OR271610154667p0046 ORp OR=2.716 1.015 4.667 p=0.046 OR 2 716 1 015 667 046 (OR=2.716[1.015-4.667];p=0.046 OR=1.0561.0371.075p<0.001 OR105610371075p0001 OR=1.056 1.037 1.075 p<0.001 056 037 075 001 (OR=1.056[1.037-1.075];p<0.001 Conclusion discriminantconstruct 247 24.7 333 3 33.3 9. p00 p<0.0 (p<0.05 0. 7161 0154 667p OR=2.7161.0154.667p=0.04 OR271610154667p004 OR2716 OR=2.71 1015 1.01 4667 4.66 p0046 p=0.04 71 01 66 04 (OR=2.716[1.015-4.667];p=0.04 0561 0371 075p OR=1.0561.0371.075p<0.00 OR105610371075p000 OR1056 OR=1.05 1037 1.03 1075 1.07 p0001 p<0.00 03 00 (OR=1.056[1.037-1.075];p<0.00 24. 33. p0 p<0. (p<0.0 OR=2.7161.0154.667p=0.0 OR271610154667p00 OR271 OR=2.7 101 1.0 466 4.6 p004 p=0.0 6 (OR=2.716[1.015-4.667];p=0.0 OR=1.0561.0371.075p<0.0 OR105610371075p00 OR105 OR=1.0 103 107 p000 (OR=1.056[1.037-1.075];p<0.0 p<0 (p<0. OR=2.7161.0154.667p=0. OR271610154667p0 OR27 OR=2. 10 1. 46 4. p=0. (OR=2.716[1.015-4.667];p=0. OR=1.0561.0371.075p<0. OR105610371075p0 OR10 OR=1. (OR=1.056[1.037-1.075];p<0. p< (p<0 OR=2.7161.0154.667p=0 OR271610154667p OR2 OR=2 p=0 (OR=2.716[1.015-4.667];p=0 OR=1.0561.0371.075p<0 OR105610371075p OR1 OR=1 (OR=1.056[1.037-1.075];p<0 (p< OR=2.7161.0154.667p= OR= p= (OR=2.716[1.015-4.667];p= OR=1.0561.0371.075p< (OR=1.056[1.037-1.075];p< (p OR=2.7161.0154.667p (OR=2.716[1.015-4.667];p OR=1.0561.0371.075p (OR=1.056[1.037-1.075];p

Objective: Fertility preservation is a priority in oncology for female cancer patients. However, there is a lack of communication between infertility specialists and oncologists. This study aimed to evaluate infertility specialists’ perceptions and experiences regarding fertility preservation. Methods: Conduct an online survey to profile infertility specialists. Participants were infertility affiliated with the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO). The specialists received an online survey, which response rate were 30.9%, most of whom were in southern and southeastern. The survey consisted on 14 questions about the infertility specialists’ location, techniques in clinical practice, treatment successful rate, patients idea, etc. Results: The average experience in human reproduction were 15.5 ± 10.2 years (mean ± standard deviation, range 1-40). Among reproductive-aged female cancer patients recommended for fertility preservation, 60.3 ± 28.8% (range 10-100%) underwent preservation procedures. Main barriers were cost (41%), oncologists’ knowledge or acceptance (35%) and accessibility (9%). Most infertility specialists (58%) considered 40 years the limit for fertility preservation. Leukemia, lymphoma, breast and ovarian cancers were prioritized for fertility preservation, while lung, thyroid, gastric, and brain cancers were less relevant. Conclusion: This is the first Brazilian study about infertility specialists’ perceptions on oncology patients access to fertility preservation. These patients primarily receive treatment in the public health system, while infertility specialists mainly work in the private healthcare. This healthcare mode is currently fragmented, but integrating these experts is enhancing patient access to fertility preservation. Studies on this topic are still warranted. Objective However oncologists Methods FEBRASGO. FEBRASGO . (FEBRASGO) 309 30 9 30.9% southeastern 1 location practice idea etc Results 155 15 5 15. 102 10 2 10. mean deviation 140. 140 1-40) reproductiveaged reproductive aged 603 60 3 60. 288 28 8 28.8 10100% 10100 100% 100 10-100% procedures 41%, 41 41% , (41%) 35% 35 (35% 9%. 9% (9%) 58% 58 (58% 4 Leukemia lymphoma lung thyroid gastric relevant Conclusion system fragmented warranted (FEBRASGO 30.9 1-40 6 28. 1010 10-100 (41% (35 (9% (58 30. 1-4 101 10-10 (41 (3 (9 (5 1- 10-1 (4 ( 10-

Abstract Objective Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario. Methods This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period. Results We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52). Conclusion Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario. (NACT triplenegative triple negative (TNBC nodes (pCR scaling realworld real world scenario 201 2020 records followup follow up period 15 58.2% 582 58 2 (58.2% highgrade high grade 60.8%. 608 60.8% . 60 8 (60.8%) 346 34 6 34.6% 41 Diseasespecific Disease specific DSS (DSS p<0.0001. p00001 p p<0.0001 0 0001 (p<0.0001) p=0.52. p052 p=0.52 52 (p=0.52) 20 202 58.2 (58.2 60.8 (60.8% 3 34.6 4 p0000 p<0.000 000 (p<0.0001 p05 p=0.5 (p=0.52 58. (58. 60. (60.8 34. p000 p<0.00 00 (p<0.000 p0 p=0. (p=0.5 (58 (60. p00 p<0.0 (p<0.00 p=0 (p=0. (5 (60 p<0. (p<0.0 p= (p=0 ( (6 p<0 (p<0. (p= p< (p<0 (p (p<

Abstract Objective This study aimed to investigate the effects of the presence of subchorionic hematoma (SH) in early pregnancies with threatened miscarriage (TM) on levels of first-trimester maternal serum markers, pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG) levels. Methods The data of TM cases with SH in the first trimester between 2015 and 2021 were evaluated retrospectively. The data of age and gestational age-matched TM cases without SH were also assessed to constitute a control group. Demographic characteristics, obstetric histories, ultrasonographic findings, and free β-hCG and PAPP-A levels of the groups were compared. Results There were 119 cases in the study group and 153 cases in the control group. The median vertical and longitudinal lengths of the SH were 31 mm and 16 mm. The median age of both groups was similar (p=0.422). The MoM value of PAPP-A was 0.088 (.93) in the study group and 0.9 (0.63) in the control group (p=0.519). Similarly, the MoM value of free β-hCG was 1.04 (0.78) in the study group and 0.99 (0.86) in the control group (p=0.66). No significant relationship was found in the multivariate analysis between free β-hCG MoM, PAPP-A MoM, age, gravida, and vertical and longitudinal lengths of the hematoma (p>0.05). Conclusion The level of PAPP-A and free β-hCG were not affected by the SH. Therefore, these markers can be used reliably in TM cases with SH for the first-trimester fetal aneuploidy screening test. (SH (TM firsttrimester pregnancyassociated pregnancy associated proteinA protein A PAPPA, PAPPA PAPP , (PAPP-A) βhuman β human βhCG hCG (β-hCG 201 202 retrospectively agematched matched characteristics histories findings compared 11 15 3 1 p=0.422. p0422 p p=0.422 . 0 422 (p=0.422) 0088 088 0.08 .93 93 (.93 09 9 0. 0.63 063 63 (0.63 p=0.519. p0519 p=0.519 519 (p=0.519) Similarly 104 04 1.0 0.78 078 78 (0.78 099 99 0.86 086 86 (0.86 p=0.66. p066 p=0.66 66 (p=0.66) gravida p>0.05. p005 p>0.05 05 (p>0.05) Therefore test (PAPP-A 20 p042 p=0.42 42 (p=0.422 008 08 0.0 .9 (.9 0.6 06 6 (0.6 p051 p=0.51 51 (p=0.519 10 1. 0.7 07 7 (0.7 0.8 8 (0.8 p06 p=0.6 (p=0.66 p00 p>0.0 (p>0.05 2 p04 p=0.4 4 (p=0.42 00 (. (0. p05 p=0.5 5 (p=0.51 p0 p=0. (p=0.6 p>0. (p>0.0 (p=0.4 ( (0 (p=0.5 p=0 (p=0. p>0 (p>0. p= (p=0 p> (p>0 (p= (p> (p