Abstract Introduction: External cephalic version (ECV) is a procedure to change the presentation of the fetus from breech, transverse, or oblique to vertex by applying pressure externally to the fetus through the gravid abdomen. Aim: To evaluate the use of external cephalic version (ECV) among the portuguese obstetric community and the reasons for not performing this procedure. Study design: Cross-sectional study. Population: Doctors attending the 5th national Congress of Obstetrics and Maternal-Fetal Medicine in 2019. Methods: A cross-sectional survey using self-administered questionnaires was conducted among doctors attending the national obstetrics congress in 2019. The survey evaluated the local of work, the level of experience, motivation, and capability of performing an ECV by the participants as well as the reasons for not suggesting or performing an ECV. The statistical analysis included descriptive and comparative analysis. The chi-square test was used with a significance level < 0,05. Results: Ninety-nine clinicians answered the questionnaire; fifty-two worked in a differentiated perinatal hospital. ECV was mainly recommended by doctors from differentiated perinatal hospital (n=29) when compared to doctors from private hospitals (n=2) and perinatal hospitals (n=10) (p =0,010). Most clinicians (n=58) would not recommend this procedure to pregnant women. The main reasons for this were the lack of clinical experience (n=39) and the fact that participants believed that cesarean was a more adequate procedure (n=15). Eighty-one participants were interested in attending training sessions to learn how to perform an EVC in safe conditions. Conclusion: Overall, ECV is not widely practiced in Portugal despite being a safe procedure recommended by the Portuguese Society of Obstetrics and Maternal-Fetal Medicine. Efforts should be done to implement this safe technique among clinicians through training sessions or to enhance referral of these patients to institutions where ECV is performed.

Resumo Introdução: A versão cefálica externa (VCE) permite, utilizando manobras externas sobre o abdómen materno, converter um feto em apresentação não cefálica num feto em apresentação cefálica. Objetivo: Avaliar a opinião da comunidade obstétrica nacional sobre a VCE e quais os condicionantes para a sua não realização. Desenho do estudo: Estudo transversal. População: Médicos que participaram no V Congresso Nacional de Obstetrícia e Medicina Materno-Fetal em 2019. Métodos: Distribuição de questionários anónimos aos participantes do congresso. O questionário avaliou o local de trabalho habitual, o nível de experiência clínica do inquirido, a experiência, motivação, e capacidade de realização da VCE e as razões apresentadas pelos clínicos para não proporem/realizarem a manobra. A análise estatística incluiu a analise descritiva e comparativa. Foi utilizado o teste qui-quadrado e considerou-se um nível de significância de p<0,05. Resultados: Noventa e nove médicos responderam ao questionário. A maioria dos participantes (n=58) não proporia a VCE às grávidas. As principais razões apontadas foram a falta de experiência na realização da manobra (n=39) e o facto de os participantes considerarem a cesariana um procedimento mais adequado (n=15). Cinquenta e dois pertenciam a um hospital de apoio perinatal diferenciado. A VCE foi proposta com maior frequência nos hospitais de apoio perinatal diferenciado (n=29) face aos hospitais de apoio perinatal (n=10) e hospitais privados (n=2), (p=0,010). A maioria dos participantes (n=81) estaria interessado em participar em sessões de treino sobre a execução da manobra. Conclusão: A VCE não parece ser amplamente realizada nos hospitais portugueses, apesar de ser uma manobra segura e recomendada pela Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal. É fundamental difundir a VCE na comunidade obstétrica nacional, investir em sessões de formação para que os clínicos adquiram competências na sua execução e fomentar a referenciação destas doentes para centros onde a VCE seja realizada.

Abstract The authors present a selection of articles published in 2022 considered as the most relevant for clinical practice in Maternal Fetal Medicine, Tocology and Pre-Natal Diagnosis.

Resumo Os autores apresentam uma seleção de artigos publicados em 2022 e que consideram importantes para a prática clinica em Medicina Materno-Fetal, Tocologia e Diagnóstico Pré Natal.

Abstract Overview and aims: External cephalic version (ECV) is a maneuver that can diminish the cesarean section rate. The objective of our study was to assess women’s perception with ECV to improve counselling and its implementation. Study Design: Semi structured interviews with closed and open questions were conducted by phone. Population: Women subjected to ECV between January 2015 and August 2018. Methods: Women’s answers descriptive analysis. Results: Sixty six women answered the questionnaire. Pain was reported as intense by 48,5% and severe by 12,1%. The majority considered ECV as an alternative to cesarean section and 22,7% had tried other techniques before ECV. Twenty four women felt anxious before ECV but only 15,1% regretted their decision to undergo ECV. More than 60% would consider this maneuver in a subsequent pregnancy or recommend it to a friend. There was no association between the referred pain and the success of ECV. Conclusion: ECV is perceived as painful by most women and causes anxiety to a significant number of patients. Therefore, ECV must be attempted by experienced practitioners with careful attention to maternal mood.

Resumo Objetivo: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. Métodos: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. Resultados: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. Conclusão: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.

Abstract Objective: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. Methods: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. Results: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. Conclusion: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.

presented to our emergency department with a sudden late postpartum haemorrhage 30 days after a caesarean section. The transvaginal ultrasound examination revealed a pulsatile and tortuous vessel in the inner third of the posterior uterine wall with an increased peak systolic velocity and a low-resistance waveform. The diagnosis of subinvolution of the placental site was suspected and a Foley catheter with 40cc of normal saline was used as uterine tamponade. After the tamponade, the bleeding subsided. The Foley catheter was removed after 48 hours. Revaluation with ultrasound showed no evidence of abnormal vessels in the myometrium.

Resumo Objetivo A Classificação de Robson é um instrumento reprodutível, clinicamente relevante e prospectivo proposto pela Organização Mundial de Saúde (OMS) para avaliar, monitorar e comparar as taxas de cesarianas.Oobjetivo do presente estudo é analisar a taxa de cesarianas ao longo de 3 anos de acordo com a Classificação de Robson e identificar os grupos que contribuíram mais significativamente para essa taxa. Métodos Recolhemos dados relativos aos partos ocorridos entre 2014 e 2016 em um hospital terciário de Portugal e classificamos todas as grávidas de acordo com a Classificação de Robson. Analisamos a taxa de cesarianas em cada grupo. Resultados Incluímos dados relativos a 6,369 partos. Os grupos 1 (n = 1,703), 2 (n = 1,229) e 3 (n = 1,382) representaram 67.7% da população obstétrica. A taxa de cesarianas foi de 25% (n = 1,594). Os grupos 1, 2, 5 e 10 contribuíram para 74.2% da taxa de cesarianas. Conclusão Tal como esperado, os grupos 1, 2, 5 e 10 foram os quemais contribuíram para a taxa de cesarianas. Aumentar o número de partos vaginais nestes grupos, principalmente nos grupos 2 e 5, poderá contribuir para a redução da taxa de cesarianas.

Abstract Objective The Robson 10 group classification system (RTGCS) is a reproducible, clinically relevant and prospective classification system proposed by the World Health Organization (WHO) as a global standard for assessing, monitoring and comparing cesarean section (CS) rates. The purpose of the present study is to analyze CS rates according to the RTGCS over a 3-year period and to identify the main contributors to this rate. Methods We reviewed data regarding deliveries performed from 2014 up to 2016 in a tertiary hospital in Portugal, and classified all women according to the RTGCS. We analyzed the CS rate in each group. Results We included data from 6,369 deliveries. Groups 1 (n = 1,703), 2 (n = 1,229) and 3 (n = 1,382) represented 67.7% of the obstetric population. The global CS rate was 25% (n = 1,594). Groups 1, 2, 5 and 10 were responsible for 74.2% of global CS deliveries. Conclusion As expected, Groups 1, 2, 5 and 10 were the greatest contributors to the overall CS rate. An attempt to increase the number of vaginal deliveries in these groups, especially in Groups 2 and 5, might contribute to the reduction of the CS rate.

The 2018 portuguese maternal mortality rate raised concern between obstetric caregivers and pregnant women. A fast answer to the multiple questions aroused by the unexpected high maternal mortality rate could have reassured all. Probably the solution is on informatic programs that can fast and efficiently generate detailed and actualized data

Term breech presentation is a common indication for cesarean delivery. However, concern over the implications of planned cesareans on maternal morbidity and complications for future pregnancies as well as the limitations attributed to the Term Breech Trial have shed new light on the vaginal breech delivery, with different approaches being attempted. We report three cases of term vaginal breech delivery in the upright position, one of them requiring Piper’s forceps for fetal head delivery. No other relevant complications occurred. As with deliveries in lithotomy position, clinical expertise and case selection are prerequisites for favorable maternal and neonatal outcomes.

The high maternal mortality rate in the United States has worried health care providers. Portugal has a lower maternal mortality rate but with the finantial constraints of the National Health Service can face the same problem in the future