Abstract Overview and aims: There is a large debate on the need to perform luteal phase supplementation in intrauterine insemination (IUI) cycles. This study aimed at describing the use, indications and protocols of luteal phase progesterone supplementation among Portuguese reproductive medicine doctors. Study design: An online anonymous survey about luteal phase progesterone supplementation in intrauterine insemination cycles was conducted. Population: Portuguese reproductive medicine doctors. Methods: The survey was sent by e-mail to the mailing list of the Portuguese Reproductive Medicine Society. Results: Forty-one doctors participated in the study. An equal distribution between doctors working in private and in state institutions was verified. 61.0% of those doctors had more than ten years of experience. The most common reason to indicate an IUI was unexplained infertility (51.2%), followed by anovulation (36.6%). Concerning the type of medication prescribed, in case of unexplained or male infertility, the vast majority of doctors use gonadotropins, followed by ovulation trigger with human chorionic gonadotropin (hCG). In case of ovulation induction with clomiphene citrate or letrozole, 53.7% and 48.8% of doctors, respectively, supplement the luteal phase, mostly through 200 mg progesterone vaginal capsules twice a day. Most doctors initiate progesterone supplementation on the day of the IUI. When ovulation induction is performed with gonadotropins, 85.4% use luteal phase supplementation, 58.5% with 200 mg progesterone vaginal capsules twice a day, starting mostly on the day of the IUI. 36.6% of the doctors end progesterone supplementation at 10 weeks’ gestation and 36.6% at 12 weeks. Conclusions: The vast majority of Portuguese reproductive medicine doctors prescribe similar drugs for ovulation induction. However, there is some variability concerning luteal phase supplementation and the day of starting and ending progesterone use.

Abstract Overview and Aims: To investigate the association between fetal nuchal translucency (NT) thickness and perinatal and long-term neurodevelopmental outcomes in singleton euploid pregnancies, in the absence of chromosomal and structural anomalies or confirmed genetic syndromes. Study design, Population and Methods: Retrospective cohort study including 1648 pregnant women submitted to routine first-trimester screening in a portugueses central hospital between December 2014 and December 2015. Three groups were defined by NT thickness: NT<95th percentile, 212 cases - randomly selected in a 2:1 ratio to cases with increased NT; NT> 95th-99th percentile, 89 cases (5,4%); and NT>99th percentile, 16 cases (1,0%). Gestational and perinatal outcomes were compared in the three groups. Additionally, a screening tool for neurodevelopmental delay (Parent Report of Children’s Abilities - PARCA) was applied, with follow-up at a mean age of 2,0 years. Results: For children with a NT>99th percentile, there was a 7-fold increased risk of positive screening for neurodevelopmental delay (OR 6,80, 95% CI 0,03-0,65; 3 cases). For children with NT between the 95th and 99th percentile, the risk was also increased - about 3-fold (OR 2,9, 95% CI 0,12-0,94; 9 cases). Both results were compared with the group of children with NT<95th percentile (7 cases). No significant statistical differences were found between the groups regarding perinatal outcomes, except for fetal sex. The prevalence of fetuses with NT 95th-99th percentile was higher in males (59 cases, 66,3%), compared to fetuses with NT<95th percentile (106 cases, 56,7%). Conclusions: Among euploid fetuses with increased TN, there was an increased risk of positive screening for neurodevelopmental delay, particularly when NT>99th percentile. This does not represent a turning point in counselling, but alerts to the need for long-term follow-up of these children and the potential benefits of clinically assessing their neurodevelopment.

Resumo Objetivo Analisar a reprodutibilidade inter e intraobservador da visualização e continuidade da zona juncional (ZJ) por ecografia tridimensional (3D) em mulheres inférteis, e avaliar os fatores sociodemográficos, hormonais e estruturais que afetam essas avaliações. Métodos Um estudo prospectivo conduzido no Centro de Procriação Medicamente Assistida do Hospital Senhora da Oliveira, em Guimarães, Portugal. Foi realizada ecografia transvaginal 3D e gerados 2 volumes por caso. Dois observadores, cegos às avaliações um do outro, analisaram os volumes obtidos e escolheram o melhor corte coronal. Após quatro meses, a mesma análise foi realizada por um dos observadores. A visualização da ZJ foi classificada como ótima, satisfatória e não satisfatória, e a continuidade, como contínua ou descontínua. Foram avaliadas as reprodutibilidades inter e intraobservador. A influência de fatores sociodemográficos, hormonais e estruturais na ZJ foi analisada. Resultados No total, 65 mulheres foram incluídas no presente estudo. A reprodutibilidade interobservador foi substancial para a visualização e continuidade da ZJ (k = 0,635 e 0,753, respetivamente). A reprodutibilidade intraobservador foi muito boa para a visualização e continuidade da ZJ (k = 0,884 e 0,816, respetivamente). Endométrio trilaminar associou-se à visualização ótima da ZJ (p = 0.012). O aumento de 1 unidade no nível de estradiol diminuiu a chance de visualização não satisfatória da ZJ em 9,9% (razão de probabilidades [RP] = 0,9; intervalo de confiança de 95% [CI95%] = 0,814–0,996; p = 0,042). Endometriose aumentou a chance de visualização não satisfatória da ZJ em 24 vezes (RP = 23,7; CI95% = 1,262–437,057; p = 0,034). A prevalência de ZJs descontínuas foi de 60%. Miomas e endometriose associaram-se a ZJs descontínuas (p = 0,034 e 0,016, respetivamente). Conclusão A avaliação da visualização e continuidade da ZJ por ecografia 3D é reprodutível, podendo ser utilizada na prática clínica.

Abstract Objective To analyze the interobserver and intraobserver reproducibility of the visualization and continuity of the juncional zone (JZ) by three-dimensional (3D) ultrasound in infertile women, and to evaluate the sociodemographic, hormonal, and structural factors that influence these assessments. Methods A prospective study conducted at the Assisted Reproductive Technology Unit of Hospital Senhora da Oliveira, in the city of Guimarães, Portugal. Transvaginal 3D ultrasonography was performed, and 2 volumes were generated per case. Two observers who were blinded to each other's work analyzed these volumes, choosing the best coronal section. Four months later, one of the observers performed the same methodology. The JZ visualization was classified as optimal, satisfactory, and unsatisfactory, and the JZ continuity, as continuous and discontinuous. The interobserver and intraobserver agreements were analyzed. The influence of hormonal, structural, and sociodemographic factors on the JZ was evaluated. Results In total, 65 women were included in the present study. The interobserver reproducibility was substantial for JZ visualization and continuity (k = 0.635 and 0.753 respectively), and the intraobserver reproducibility was very good for JZ visualization and continuity (k = 0.884 and 0.816 respectively). Trilaminar endometrial pattern was associated with optimal JZ visualization (p = 0.012). The increase of 1 unit in the level of serum estradiol represents a 9.9% decrease in the odds of unsatisfactory visualization of the JZ (odds ratio [OR] = 0.9; 95% confidence interval [95%CI] = 0.814–0.996; p = 0.042). Endometriosis increases the odds of unsatisfactory visualization by 24 times (OR = 23.7; 95%CI = 1.262–437.057; p = 0.034). The prevalence of discontinuous JZs was of 60%. Myomas and endometriosis were associated with discontinuous JZs (p = 0.034 and 0.016 respectively). Conclusion The assessment of JZ visualization and continuity by 3D ultrasound is reproducible enough to be used in the clinical practice.

RESUMO Objetivos Calcular a prevalência de sintomatologia depressiva pré-natal em grávidas de baixo risco, no termo da gestação, avaliar seus preditores e desfechos materno-fetais. Para tal, avaliar-se-á a aplicabilidade da Escala de Rastreio de Depressão Pós-Parto (PDSS 24) nessa fase da gravidez. Métodos A PDSS 24 e um questionário sociodemográfico, psicossocial e médico (antecedentes obstétricos e patológicos) foram autoaplicados a 403 grávidas (37-40 semanas de gestação), com idade média de 30,5 anos (DP = 4,67). Por meio do processo clínico, foram recolhidos dados de resultados materno-fetais. Resultados A PDSS 24 possui propriedades psicométricas adequadas para a deteção de sintomatologia depressiva pré-natal. A prevalência de sintomatologia depressiva pré-natal foi de 41,7%. Grávidas com níveis de escolaridade inferiores, não casadas, cuja gravidez não foi planejada e com antecedentes de acontecimentos de vida significativos apresentam risco duas vezes superior de sintomatologia depressiva no período pré-natal. Grávidas cujo apoio social percebido ao longo da gravidez não correspondeu ao desejado e com história prévia de depressão apresentam cerca de três vezes maior risco sintomatologia depressiva no período pré-natal. Para desfechos materno-fetais (pré-eclâmpsia, restrição de crescimento fetal, Apgar 1º/5º minuto, tipo de parto, percentil de peso, oligoâminos e necessidade de cuidados intensivos), as diferenças foram não significativas. Conclusão O rastreio da depressão pré-natal deve ser realizado na gravidez. Porém, no termo da gestação o uso da PDSS 24 como ferramenta de deteção de sintomatologia depressiva deve ser feito com cautela. A elevada prevalência de sintomas relacionados com o sono nessa fase da gestação pode conduzir ao sobre diagnóstico, usando a PDSS 24.

ABSTRACT Objectives The aims of the study were to estimate the prevalence of depressive symptomatology in full-term pregnancy (low risk), evaluate their predictors and maternal-fetal outcomes. To this end, the applicability of Postpartum Depression Screening Scale (PDSS 24) will be evaluated, at full-term pregnancy. Methods PDSS 24 and a sociodemographic, psychosocial, pathological and obstetrical background questionnaire were self-administered to 403 pregnant women (37-40 weeks gestation), with a mean age of 30.5 years (SD = 4.67). Data from maternal, fetal and neonatal outcomes were collected from the patient clinical process. Results PDSS 24 revealed adequate psychometric properties to screening depressive symptomatology in full-term pregnancy. The prevalence of depressive symptomatology was 41.7%. Pregnant women with lower study levels, who weren’t married, whose pregnancy was unplanned and with a previous history of significant life events present twice the risk to present depressive symptomatology. Pregnant women who hadn’t received the desired social support in pregnancy and with a history of depression present about a 3-fold increased risk to present depressive symptomatology. For maternal-fetal outcomes (pre-eclampsia, fetal growth restriction, Apgar score at 1st/5th minute, type of delivery, weight percentile, oligohydramnios and need for neonatal intensive care), the differences were not significant. Conclusion Screening for prenatal depression should be conducted during pregnancy. However, in full-term pregnancy women, the use of PDSS 24 as a screening tool for depressive symptomatology should be done with caution. The high prevalence of sleep-related symptoms, in full-term pregnancy, may lead to overdiagnosis, using PDSS 24.

Overview: Integrity of the uterine cavity is critical to embryonic implantation and it is mandatory to evaluation it in the routine investigation of infertility. Hysteroscopy is considered the gold standard, allowing concomitant treatment , which optimizes the conditions for future embryo transfers. Nevertheless, controversies still exist in its routine performance prior to the first assisted reproductive technique. Aims: To assess the concordance between the findings of transvaginal ultrasonography and hysteroscopy and to investigate risk factors for intracavitary pathology. Study Design: Retrospective observational study. Population: 104 women submitted to transvaginal ultrasonographic evaluation (with normal uterine cavity evaluation) and hysteroscopy before the first assisted reproductive technique. Methods: A database was constructed through the analysis of each patient's file. Descriptive and inferential statistical analysis was performed with Statistical Package for Social Sciences, version 20.0. P ≤0,05 was considered statistically significant. Results: The study group had a mean age of 33,3 years and a mean duration of infertility of 45,6 months. About 87% patients had primary infertility. Hysteroscopy revealed intracavitary alterations in 20 women. In 6 patients a simultaneous surgical procedure was performed and 4 had an alteration of the therapeutic plan. No complications were documented. Descriptive analysis revealed that uterine abnormalities observed in hysteroscopy were significantly more frequent in women aged ≥ 35years (35,1 vs 32,8%, p=0,008). In the logistic regression it was observed that hysteroscopic alterations were significantly and positively associated with female age ≥35years (OR=2,85; IC95%: 1,1-7,7). Conclusions: Ultrasound findings were not consistent with hysteroscopic findings in 19,23% patients, and this was more frequent in women aged ≥35years. Hysteroscopy has a special role in the investigation of infertility, mainly in populations with risk factors for intracavitary anomaly and its impact should be reassessed.

OBJETIVO: avaliar a validade de várias tabelas de peso fetal, habitualmente usadas em Portugal, para classificar a sua população. MÉTODOS: estudo observacional retrospectivo. Foram analisados os registos de nascimentos no período de dois anos (Maio de 2008 a Abril de 2010), decorrentes de gestações unifetais com datação precisa por ecografia entre as 8ª e 14ª semanas de gestação, na mesma instituição. Após validação dos registos, foram analisados os percentis de peso gerados para cada semana de gestação completa, suavizados por uma função polinomial de dois graus, comparando-os com as tabelas mais usadas na instituição e no país, através do uso de Z-scores, valores de percentis, sensibilidade para detecção do percentil 10 (P10) da amostra e comparação de médias de peso. RESULTADOS: um total de 5.378 recém-nascidos (RN) foi registado no período; 2.195 (42%) RN corresponderam aos critérios de inclusão, com idade gestacional (IG) entre as 24ª e 42ª semanas, permitindo uma análise estatística entre as 34ª e as 41ª semanas. Foram detectadas diferenças no peso médio por IG entre tabelas e em relação à amostra, bem como diferenças entre os sexos. O P10 de outros trabalhos mostrou diferenças entre -288g na 37ªs (-11% nos dados de Lubchenco et al.) e +133g na 34ªs (+7,6% nos dados de Carrascosa et al.) em relação ao obtido na amostra. A sensibilidade para detecção de um RN abaixo do P10 na amostra variou, às 39ªs, entre 14,1e 100%, dependendo da tabela usada. DISCUSSÃO: as limitações deste tipo de valores de referência devem ser tidas em consideração, tentando minimizá-las, nomeadamente pela criação de valores locais/regionais ou nacionais, com a contemplação de outras variáveis, sobretudo o sexo do RN, em gravidezes rigorosamente datadas e pela validação in loco dos valores utilizados.

PURPOSE: to assess the validity of several fetal weight charts, commonly used in Portugal, to classify its population. METHODS: observational retrospective study. Singleton birth data was analyzed, from a two- year period (May 2008 to April 2010), from pregnancies with an ultrasound in the same institution, between the 8th and 14th gestational week. Upon data validation, percentiles for each completed gestational week were created, smoothed by a quadratic function, analyzed and compared to the tables more commonly utilized, in the institution and country, by using Z-scores, percentile comparison, sample 10th percentile detection sensibility and birthweight means comparison. RESULTS: a total of 5,378 newborns (NB) were born in the period; 2,195 (42%) NB were included, born from the 24th to 42nd gestational week, allowing statistical analysis from the 34th to the 41st week. There were differences in the mean birthweight for each gestational age, between references and with the sample, as well as between sexes. The 10th percentile from some references has shown differences ranging from -288g at 37 weeks (-11% in Lubchenco et al. data), with and +133g at 34 weeks (+7,6% with Carrascosa et al. data) compared to the values found with the sample. Differences were also found concerning the sensitivity of the identification of a sample birthweight below the 10th percentile, which was between 14.1 and 100%, depending on the reference used. DISCUSSION: the limitation of these kinds of reference values must be remembered and minimized, with the adoption of regionally or nationally produced references, contemplating other variables, such as sex, with precisely known gestation duration and with validation of the utilized references in loco.