Abstract Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group – 2010–2014; and MDT group – 2015–2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy – one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT). Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) – 2010–2014; e grupo MDT – 2015–2021. Análise descritiva de suas características e desfechos maternos. Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto – uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades. Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Overview and aims: Placenta Accreta Spectrum disorders are the leading cause of emergency hysterectomy in developed countries and are associated with high maternal morbidity and mortality (60% and 7%, respectively). The objective of our study was to review cases of PAS disorders occurring in the last 8 years (2010-2017) in a tertiary care centre, evaluating the forms of treatment chosen and the maternal and fetal outcomes. Methods: Retrospective cross-sectional study using hospital databases (Obscare®, SClinico®) to identify cases of placenta accreta during the study period. Diagnosis was made based on the histological study of placentas submitted for anatomo-pathological study. Results: During the study period, 38 cases of a PAS disorder were diagnosed in 20,910 births (1.8 / 1000), a number that is possibly underestimated. There were 8 women with a previous caesarean section and 6 had placenta previa (2 of them with previous caesarean section). There was ultrasound suspicion of a PAS disorder in 3 cases; of the 4 most severe cases (3 percretas and 1 increta), there was an ultrasound suspicion in 2. Regarding method of delivery, 21 births were by caesarean section and 16 by vaginal delivery. There was 1 case of spontaneous uterine rupture at 20 weeks' gestation with fetal loss; gestational age of birth varied between 32 and 41 weeks; 5 peri-partum hysterectomies were performed; transfusions of blood derivatives were required in 8 women. As for the newborns, there were 8 cases of prematurity and 7 hospitalisations in the Neonatal Intensive Care Unit; fetal death was observed in 2 cases. Conclusion: This case series demonstrate the high prevalence of PAS disorders and the great morbidity associated with it. Adequate antepartum care is essential in women with riskfactors to make the diagnosis timely, thus enabling a multidisciplinary approach with better maternal and fetal outcomes.

Vaginal cysts are uncommon and frequently diagnosed incidentally. A 20-year-old nulliparous woman, presented at her gynecologist for a routine appointment. An asymptomatic cystic mass on the posterior vaginal wall was found during physical examination. Surgical excision of the cyst was performed and pathological examination revealed a Mullerian cyst. These cysts usually arise at the level of cervix and extend anteriorly in relation to bladder, but very rarely they may also appear posteriorly. This paper illustrates a rare case of a posterior vaginal wall cyst of Mullerian origin

Overview and Aims: pregnancy in women with chronic kidney disease (CKD), particularly in terminal CKD, remains a rare event. There are scarce reports of pregnancy in women undergoing peritoneal dialysis. Our study aims to evaluate the outcomes of pregnancies in women with CKD diagnosed at Hospital São João during the study period. Study design: retrospective case series. Population: pregnant women with chronic kidney disease diagnosed between January 2005 and December 2013. Methods: pregnancies in women with severe CKD (GFR <30mL in/1.73m2) were identified by using hospital electronic platforms with evaluation of maternal and fetal outcomes. Results: during the study period 4 cases of pregnancy in women with CKD were identified, including one of a woman in peritoneal dialysis prior to pregnancy - case 1. Case 1 progressed to hemodialysis at 17 weeks (due to haemoperitoneum subsequent to trauma by the peritoneal dialysis catheter) and had an eutocic late preterm delivery at 35 weeks. Case 2 began hemodialysis at 22 weeks, and was submitted to urgent cesarean section at 29 weeks. Case 3 started hemodialysis at 21 weeks, having also undergone urgent cesarean section at 31 weeks. Case 4 began hemodialysis at 21 weeks, presenting with an episode of hepatotoxicity secondary to darbopoietin at 26 weeks. Delivery occurred by Caesarean section at 32 weeks. Conclusion: despite the high fetal morbidity documented, with the strategies adopted there was no fetal or neonatal mortality. The monitoring of these pregnant in specialized consultation favored the positive outcomes.