Difference of endothelial function during pregnancies as a method to predict preeclampsia.

BACKGROUND: Systemic endothelial dysfunction has been identified as one of the main events in preeclampsia (PE). A nonhealthy vascular endothelium can be pointed out as the pathophysiological explanation of the clinical manifestations and complications of PE. Once normal pregnancy is characterized by a constant increase in endothelial function, a follow-up of this physiological event could be used as an early marker or a prediction tool to predict PE. OBJECTIVES: To perform a longitudinal assessment of endothelial function, using an ultrasound study of brachial artery flow Flow-mediated dilation (FMD), in normotensive and preeclamptic pregnancies, to evaluate the difference of FMD values along the second trimester of pregnancy to predict PE. PATIENTS AND METHODS: In a prospective cohort study, 91 pregnant women with a high risk of developing PE were subjected to FMD of the brachial artery. The difference in the FMD values, between 16(+0) and 19(+6) and 24(+0) and 27(+6) weeks of gestation were compared, taking PE development into consideration. Receiver operator characteristics (ROC) curves were created to determine the sensibility and specificity of FMD difference to predict PE. RESULTS: A total of 19 patients developed PE and the other 72 women remained normotensive until 1 week after delivery. When considering a cut off of +2.50 %, FMD difference, between the two evaluations, sensitivity for PE prediction was 87.5 % for early onset PE and 95.5 % for late PE. CONCLUSION: The difference of FMD values between the second trimester of pregnancy can be used for PE prediction for both, early and late forms of PE.

Assessment of endothelial function in pregnant women with preeclampsia and gestational diabetes mellitus by flow-mediated dilation of brachial artery.

PURPOSE: To compare endothelial function, as assessed by flow-mediated dilation (FMD) in pregnant women with preeclampsia (PE), gestational diabetes mellitus (GDM) and healthy pregnant women. METHODS: We conducted a cross-sectional study of eighty women who were selected and divided into three groups: Group A comprising 42 pregnant women with PE, Group B (control) consisting of 19 normotensive pregnant women with no comorbidities and Group C consisting of 19 pregnant women with GDM. The women underwent FMD and the results were compared between groups. The data were obtained from the Center for Fetal Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Brazil (CEMEFE-HC-UFMG) after approval by the Ethics and Research Committee on June 4, 2008 under no CAAE-0280.0.203.000-08. RESULTS: Nonparametric variance analysis showed no statistically significant difference between the characteristics of the three groups. The comparison between the results of the mean values of brachial artery FMD groups of pregnant women with preeclampsia (FMD = 5.36 ± 4.61 %), gestational diabetes (FMD = 9,18 ± 5.98 %) and pregnant women in the control group (FMD = 17.55 ± 8.35 %) showed that a statistically significant difference was found between groups using the Dunn test. The comparison between groups PE × GDM was not statistically significant. The group consisting of pregnant women with GDM associated with those with PE had significantly lower results for FMD (6.55 ± 5.33 %) than the control group (17.55 ± 8.35 %, p = 0.00). CONCLUSIONS: The group consisting of pregnant women with GDM or PE showed results for FMD significantly lower than the control group, suggesting possible endothelial injury in these patients.

Pregnant women autonomy when choosing their method of childbirth: Scoping review.

This paper has as its theme the autonomy of pregnant women in relation to choosing the method of birth for their child. The objective was to carry out a scoping review to study the literature and evidence of how autonomy is being offered to parturient women. Study design and location: In October 2023, a search was carried out using the terms "pregnant women" AND "delivery" AND "autonomy" in the following databases: PubMed, Web of Science, Scopus, Scielo and LILACS. The search included articles from 2016 to 2023. Of the 179 articles found, 15 met the criteria and were selected for this review. Results: the pregnant woman's autonomy in choosing the method of childbirth is influenced by several factors, such as the obstetrician's recommendation, the medical team, and negative and positive experiences. Thus, when this autonomy is shared with the obstetrician, the obstetrician recommends cesarean section as the safest route, but does not explain the benefits and harms of both routes (vaginal and cesarean section), causing the woman to accept the cesarean section. Midwives recommend vaginal birth because they believe it to be natural and safe and explain the benefits and harms of both methods, respecting the pregnant woman's choice of the method she prefers. Conclusion: women have the fundamental right to choose their method of birth and must be properly guided throughout prenatal care, whether by an obstetrician or a midwife, about the options, risks and benefits of each method of childbirth, respecting the ethical principle of beneficence.

Perinatal complications of the maternal-Fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section: A retrospective study of clinical results associated with bioethical precepts.

The obstetrics field is undergoing transformation and committing to ensuring the autonomy of pregnant women in decisions related to birth based on scientific information. The physiological process of birth typically results in vaginal delivery, but medicine has evolved to include obstetric surgeries that are safe and result in few perioperative complications, especially when cesarean section is performed from 39 weeks of gestational age. Thus, the question is whether clinicians should interfere with pregnant women's freedom to choose their mode of delivery by trying to persuade them to choose vaginal delivery. The objective was to analyze the perinatal complications of the maternal-fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section with respect to the bioethical precepts of autonomy, beneficence and nonmaleficence. In total, 2,507 women, including 1,807 (72.1%) with vaginal deliveries and 700 (27.9%) with cesarean deliveries, were analyzed between 2017 and 2020. There was no difference between the types of delivery in maternal readmission, death, admission to the intensive care unit, an Apgar score <7 in the 5th minute of life, maternal blood transfusion or comorbidities of the mothers or newborns. The elective cesarean section group showed less need for therapeutic uterotonics. In primigravidae, it was observed that elective cesarean section did not present a higher risk of complications than vaginal delivery. Therefore, this guarantees the autonomy and right of the individual to choose the mode of delivery.

Effects of estradiol and FSH on leptin levels in women with suppressed pituitary.

BACKGROUND: Female fertility depends on adequate nutrition and energy reserves, suggesting a correlation between the metabolic reserve and reproductive capacity. Leptin regulates body weight and energy homeostasis. The aim of this study was to investigate whether estradiol or FSH alone has a direct effect on the production of leptin. METHODS: A total of 64 patients submitted to controlled ovarian hyperstimulation with recombinant FSH for assisted reproduction and 20 patients using estradiol valerate for endometrial preparation for oocyte donation treatment were included in the study. All patients used GnRH analogues before starting treatment to achieve pituitary suppression. Blood samples for hormonal measurements were collected before starting and after completing the respective treatments. Data were analyzed statistically by the chi-square test, Student's t-test and Pearson's correlation test. RESULTS: We observed an elevation of serum leptin levels secondary to the increase in estradiol, in the absence of influence of any other ovarian or pituitary hormone. The rising rate of leptin levels was higher in women treated with recombinant FSH, which also had higher levels of estradiol, than in those treated with estradiol valerate. CONCLUSIONS: This study demonstrates a correlation between serum levels of estradiol and leptin, suggesting that estradiol is an important regulator of leptin production and that its effects can be amplified by its association with FSH.

Longitudinal evaluation of uterine perfusion, endothelial function and central blood flow in early onset pre-eclampsia.

OBJECTIVES: Physiopathological mechanisms that trigger clinical manifestations in pre-eclampsia (PE) remain unclear, and management is still a challenge. The identification of tools to predict the onset of the disease and prevent its complications is of great interest in medical practice. The present study aims to evaluate uterine perfusion, endothelial function and central nervous system blood flow in pregnant women with high-risk factors for PE, for comparison of the results between the group of patients who developed early onset PE and those who remained normotensive throughout pregnancy. STUDY DESIGN: Sixty-two patients were recruited from our high-risk prenatal service, and followed throughout gestation. Patients were submitted to flow-mediated dilation, Dopplervelocimetry of uterine arteries and Dopplervelocimetry of ophthalmic arteries at three distinct moments of pregnancy: between 16+0 and 19+6weeks, between 24+0 and 27+6weeks and at hospital admission to delivery. MAIN OUTCOME MEASURES: Pulsatility index of uterine arteries, flow-mediated dilation and ophthalmic arteries resistance index were evaluated and compared between the two groups of patients. RESULTS: Ten pregnancies were complicated by early onset PE, and these patients presented a significantly higher pulsatility index of uterine arteries between 16+0 and 19+6weeks of gestation, compared with the normotensive group (p=0,016). Both flow-mediated dilation and ophthalmic arteries resistance index values were lower in affected patients at 24+0 to 27+6weeks (p=0,001), and by the time of delivery (p<0,002). CONCLUSIONS: Those findings suggest that impaired placental perfusion, endothelial dysfunction and central hyperperfusion temporarily precede the clinical manifestations of early onset pre-eclampsia.

Gravidez ectópica em cicatriz de cesárea: série de casos com três possibilidades terapêuticas diferentes / Cesarean scar pregnancy: case series with three different types of management

A gestação ectópica em cicatriz de cesariana prévia é um evento iatrogênico raro, que vem crescendo junto com o aumento das taxas de cesariana. Ela não exi- be manifestação clínica específica, o que dificulta o diagnóstico e não apresenta tratamento preconizado, embora esteja associada a grandes complicações obsté- tricas como hemorragia incoercível, acretismo placentário e rotura uterina. Dessa forma, o presente artigo relata três casos clínicos em que diferentes tratamentos foram propostos, objetivando discutir algumas possibilidades terapêuticas como a aspiração manual intrauterina (AMIU) associada com o uso de metotrexato, lapa- roscopia e laparotomia, comparando os resultados encontrados.(AU)

Ectopic cesarean scar pregnancy is a rare iatrogenic event, which has been increase with growing in the percentage of cesarean delivery. It does not exhibit specific cli- nical manifestation, making diagnosis difficult and does not have yet recommended treatment, although is associated with major obstetrics complication such incoer- cible hemorrhage, abnormally invasive placenta and uterine rupture. Therefore, the present article reports three clinical cases witch different types of management, ai- ming discuss some possibilities such intrauterine manual aspiration after systemic methotrexate, laparoscopy or laparotomy surgical, comparing results.(AU)

Revisiting HELLP syndrome.

HELLP syndrome was first described in 1982 by Weinstein et al. and the term HELLP refers to an acronym used to describe the clinical condition that leads to hemolysis, elevated liver enzymes and low platelets. The syndrome frequency varies from 0.5 to 0.9% pregnancies and manifests preferentially between the 27th and 37th week of gestation. Approximately 30% of cases occur after delivery. Although the etiopathogenesis of this syndrome remains unclear, histopathologic findings in the liver include intravascular fibrin deposits that presumably may lead to hepatic sinusoidal obstruction, intrahepatic vascular congestion, and increased intrahepatic pressure with ensuing hepatic necrosis, intraparenchymal and subcapsular hemorrhage, and eventually capsular rupture. Typical clinical symptoms of HELLP syndrome are pain in the right upper quadrant abdomen or epigastric pain, nausea and vomiting. However, this syndrome can present nonspecific symptoms and the diagnosis may be difficult to be established. Laboratory tests and imaging exams are essential for differential diagnosis with other clinical conditions. Treatment of HELLP syndrome with corticosteroids, targeting both lung maturation of the fetus is still an uncertain clinical value. In conclusion, three decades after the tireless efforts of Dr. Weinstein to characterize HELLP syndrome, it remains a challenge to the scientific community and several questions need to be answered for the benefit of pregnant women.

Doppler flowmetry of ophthalmic arteries for prediction of pre-eclampsia.

BACKGROUND: central nervous system (CNS) hyperperfusion is one of the events that constitute the pathophysiological basis for the clinical manifestations and complications of pre-eclampsia (PE). Detecting the increased flow in the CNS through Doppler flowmetry of the ophthalmic artery might precede the clinical onset of PE and could be used as a marker for subsequent development of PE. OBJECTIVE: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. OBJECTIVE: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. METHODS: a total of 73 patients with risk factors for the development of PE were selected from the prenatal service at the HC-UFMG. They were submitted to ophthalmic artery Doppler flowmetry between 24 and 28 weeks of pregnancy and monitored until the end of the pregnancy to verify the occurrence of PE. ROC curves were created to determine the predictive characteristics of the OARI. RESULTS: fourteen of the patients selected developed PE and 59 remained normotensive until the postpartum period. Patients with subsequent development of PE presented OARI values lower than patients that remained normotensive (0.682 ± 0.028 X 0.700 ± 0.029, p = 0.044). Considering the development of PE as an outcome, the area under the OARI curve was 0.694 (CI 0.543 to 0.845), with no points obtaining good values of sensitivity or specificity. CONCLUSION: Doppler flowmetry of ophthalmic arteries between 24 and 28 weeks of pregnancy did not present itself as a good exam for predicting PE.

Variation of endothelial function during the menstrual cycle evaluated by flow-mediated dilatation of brachial artery.

OBJECTIVE: It is well defined that ovarian steroids play a role in the cardiovascular system, acting as vasoactive compounds. The aim of this study is to assess the endothelial function during the menstrual cycle using flow-mediated dilation of the brachial artery. METHODS: A total of 21 healthy premenopausal women, with regular menstrual cycles, were included in this observational, longitudinal, and prospective study. The endothelium function was assessed by ultrasound during four phases of the menstrual cycle: early follicular phase (EFP), late follicular phase (LFP), early luteal phase (ELP) and late luteal phase (LLP). RESULTS: We observed a significant variation among the vasodilatation response during the menstrual cycle phases (P<0.001). The result was higher during LFP than during ELP (P<0.001) or LLP (P<0.001). Late luteal phase had higher response than observed during ELP (P=0.003) and EFP was higher than LLP (P=0.003). There were no significant differences between the results observed during EFP and LFP (P=1.0), or EFP and ELP (P=0.137). CONCLUSION: Our results suggest that the ovarian steroids may play an important role in modulating endothelial function.

Single-site laparoscopy in gynecology: preliminary study of a series of 50 cases.

OBJECTIVE: to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. METHODS: this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution's Ethics in Research Committee. RESULTS: the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. CONCLUSION: this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.

Prediction of early and late preeclampsia by flow-mediated dilation of the brachial artery.

OBJECTIVE: To assess the accuracy in the prediction of both early and late preeclampsia by flow-mediated dilation of the brachial artery (FMD), a biophysical marker for endothelial dysfunction. MATERIALS AND METHODS: A total of 91 patients, considered at high risk for development of preeclampsia were submitted to brachial artery FMD between 24 and 28 weeks of gestation. RESULTS: Nineteen out of the selected patients developed preeclampsia, 8 in its early form and 11 in the late form. With a cut-off value of 6.5%, the FMD sensitivity for early preeclampsia prediction was 75.0%, with specificity of 73.3%, positive predictive value (PPV) of 32.4% and negative predictive value (NPV) of 91.9%. For the prediction of late preeclampsia, sensitivity = 83.3%, specificity = 73.2%, PPV = 34.4% and NPV = 96.2% were observed. And for the prediction of all associated forms of preeclampsia, sensitivity = 84.2%, specificity = 73.6%, PPV = 45.7% and NPV = 94.6% were observed. CONCLUSION: FMD of the brachial artery is a test with good accuracy in the prediction of both early and late preeclampsia, which may represent a positive impact on the follow-up of pregnant women at high risk for developing this syndrome.

OBJETIVO: Avaliar a capacidade de predição das formas precoce e tardia da pré-eclâmpsia pela dilatação fluxo-mediada da artéria braquial (FMD), marcador biofísico de disfunção endotelial. MATERIAIS E MÉTODOS: Um total de 91 pacientes de alto risco para desenvolvimento de pré-eclâmpsia foi submetido a FMD entre 24 e 28 semanas de gestação. RESULTADOS: Das pacientes selecionadas, 19 desenvolveram pré-eclâmpsia, sendo 8 em sua forma precoce e 11 em sua forma tardia. Usando-se um valor de corte de 6,5%, a sensibilidade (S) da FMD para predição de pré-eclâmpsia precoce foi 75,0%, com especificidade (E) de 73,3%, valor preditivo positivo (VPP) de 32,4% e valor preditivo negativo (VPN) de 91,9%. Para predição de pré-eclâmpsia tardia, encontrou-se valor de S de 83,3%, E de 73,2%, VPP de 34,4% e VPN de 96,2%. Para a predição de todas as formas associadas de pré-eclâmpsia, encontrou-se valor de S de 84,2%, E de 73,6%, VPP de 45,7% e VPN de 94,6%. CONCLUSÃO: A FMD se mostrou uma ferramenta com boa capacidade de predição de pré-eclâmpsia, nas suas formas tardia e precoce, o que pode representar um impacto positivo no acompanhamento de gestantes de alto risco para desenvolvimento dessa síndrome.

Endothelial function, uterine perfusion and central flow in pregnancies complicated by Preeclampsia.

BACKGROUND: The physiopathology of Preeclampsia (PE) is characterized by a deficiency in the process of placentation, systemic endothelial dysfunction and Central Nervous System (CNS) hyperflow. From a clinical point of view, it would be interesting to determine the occurrence of these phenomena before the onset of clinical manifestations of the disease, raising the possibility of new methods for predicting PE. OBJECTIVE: Compare the process of placentation, endothelial function and CNS hyperflow in pregnant women at high risk for the development of PE who subsequently developed or not the syndrome. METHODS: A total of 74 pregnant women underwent the Flow-Mediated Dilation (FMD) of the brachial artery, Doppler study of uterine and ophthalmic arteries for the assessment of endothelial function, process of placentation and central hyperflow, respectively. The examinations were performed between 24 and 28 weeks of gestation and were followed until the postpartum period for data collection. RESULTS: Fifteen patients had PE and 59 remained normotensive until the puerperium. Patients who subsequently developed PE had between 24 and 28 weeks of gestation, higher pulsatility index of uterine arteries and lower values of FMD (p < 0.001 and p = 0.001, respectively). However, there was no difference in the values obtained in the resistive index in the ophthalmic artery (p = 0.08). CONCLUSION: The data obtained suggest that the deficiency in the process of placentation and endothelial dysfunction chronologically precede the clinical manifestations of PE, which does not occur with CNS hyperflow.

Comparative Study of Endothelial Function and Uterine Artery Doppler Velocimetry between Pregnant Women with or without Preeclampsia Development.

Background. Poor placentation and systemic endothelial dysfunction have been identified as main events in Preeclampsia (PE). The relationship and chronology of these phenomena are important if we are to understand the pathophysiological mechanisms underlying this major clinical problem. Objectives. To compare the evolution of placentation and endothelial function in normotensive and preeclamptic pregnancies. Patients and methods. In a prospective cohort study, 59 pregnant women with a high risk of developing PE were subjected to flow-mediated dilation (FMD) and to Doppler velocimetry of uterine arteries in order to obtain their Pulsatility Index (UtA-PI). The variations in the FMD and UtA-PI values, between 16(+0) and 19(+6) and 24(+0) and 27(+6) weeks of gestation, were compared, taking PE development into consideration. Results. Nine patients developed PE and the other 50 women remained normotensive. At 16(+0) to 19(+6) weeks of pregnancy, patients that developed PE presented higher values of UtA-PI than the normotensive group, but there was no difference in FMD results between them. At 24(+0) to 27(+6) weeks, the patients that developed PE presented higher values of UtA-PI and lower values of FMD than the women that remained normotensive. Conclusions. These results corroborate the evidence that endothelial injury is secondary to poor placentation.

Salpingectomia "oportuna" como profilaxia do câncer de ovário / "Timely" salpingectomy for ovarian cancer prophylaxis

O câncer de ovário é o tumor ginecológico mais letal, alvo de interesse de centenas de estudos publicados anualmente, buscando melhor entendimento fisiopatológico e a possibilidade de métodos de rastreio. Trata-se da quinta causa de morte por câncer em mulheres, sendo, na maioria das vezes, encontrado em estágios avançados. Existem diversas teorias sobre a origem do câncer de ovário, sendo uma delas a de que a neoplasia ovariana teria sua origem nas tubas uterinas. Sendo assim, estudos sugerem que a exérese das tubas uterinas poderia reduzir a incidência da neoplasia maligna ovariana. A proposta do artigo é realizar uma revisão sobre a salpingectomia bilateral durante cirurgias pélvicas eletivas e suas implicações na qualidade de vida da paciente, seu potencial preventivo e possíveis complicações.(AU)

Ovarian cancer is the most lethal gynecological tumor. Hundreds of manuscripts are annually published, aiming better pathophysiological understanding and screening strategies. Ovarian cancer is the fifth of cancer death in women worldwide and, in most times, the diagnosis is performed in advanced stages. There are several theories about the origin of ovarian cancer, one of which is that the ovarian cancer would have their origin in the fallopian tubes. Thus, current research suggests that the removal of the tubes could reduce the incidence of ovarian malignancy. The purpose of the article is to review of the bilateral salpingectomy during elective pelvic surgeries and their implications for the quality of life of the patient, its preventive potential and possible complications.(AU)

Disfunção endotelial como um link fisiopatológico entre pré-eclâmpsia e diabetes mellitus gestacional / Endothelial dysfunction as a pathophysiological link between pre-eclampsia and gestational mellitus diabetes

A adaptação fisiológica do organismo materno à gestação inclui principalmente a vasodilatação sistêmica e o aumento do volume sanguíneo para um adequado fluxo sanguíneo placentário. Alterações nesse processo causam o desenvolvimento de doenças potencialmente graves, como a pré-eclâmpsia e o diabetes gestacional. Apesar de serem diferentes entre si, vários estudos vêm apontando uma alteração em comum, que é a base do desenvolvimento das duas doenças: a lesão endotelial. Há diferenças na forma como essa lesão é desencadeada, mas os produtos liberados a partir dessa alteração promovem vasoconstrição sanguínea e levam à piora da lesão endotelial e do quadro clínico, atuando assim como uma reação em cadeia. São mostrados nesse estudo as alterações sofridas no endotélio, o ponto de convergência na fisiopatologia da pré-eclâmpsia e do diabetes gestacional, e as várias formas de avaliação clínica dessa lesão, que podem ser usados para detecção precoce dessas doenças e melhor manejo do seu desenvolvimento.(AU)

The physiological adaptation of the maternal organism to pregnancy mainly includes systemic vasodilation and increased blood volume allowing a suitable placental blood flow. Changes in this process may lead to the development of potentially serious diseases, such as pre-eclampsia and gestational diabetes. Although they are different from each other, a variety of studies points out a common event which is the base of development of two diseases: the endothelial injury. There are differences in how this injury is unleashed, but the products released from this lesion promote vasoconstriction and worse of clinical manifestations, acting just like a chain reaction. This study aims to discuss the changes suffered in the endothelium, the most likely point of convergence in the pathophysiology of pre-eclampsia and gestational diabetes, as well as the various forms of clinical assessment of endothelial dysfunction, potential markers of the clinical onset of these gestational diseases.(AU)

Função endotelial e perfusão uterina e em gestações subsequentementecomplicadas por pré-eclâmpsia / Endothelial function and uterine perfusion in subsequentpregnancies complicated by preeclampsia

Introdução: a fisiopatologia da pré-eclâmpsia (PE) baseia-se em deficiência no processo de placentação, associada à disfunção endotelial sistêmica materna. A investigação da ocorrência desses fenômenos, antes do aparecimento das manifestações clínicas da PE, pode constituir-se em novo método propedêutico para sua predição. Objetivos: comparar o processo de placentação e a função endotelial de gestantes de alto risco para desenvolvimento de PE, correlacionando esses achados com o seu desenvolvimento posterior. Pacientes e métodos: 74 gestantesforam submetidas ao exame de dilatação fluxomediada (DFM) da artéria braquial e dopplerfluxometria das artérias uterinas para avaliação da função endotelial e do processo de placentação, respectivamente. Os exames foram realizados entre 16 e 20 semanas de gestação e as pacientes foram acompanhadas até o puerpério.Resultados: 15 pacientes tiveram a gestação complicada por PE e 59 mantiveram-se normotensas até o puerpério. Pacientes que subsequentemente desenvolveram PE apresentaram, entre 16 e 20 semanas de gestação, maiores valores no índice de pulsatilidade das artérias uterinas (p<0,001), mas a análise da DFM não apresentoudiferença em relação às pacientes que se mantiveram normotensas. Conclusão:os dados observados sugerem que a deficiência no processo de placentação precede cronologicamente as manifestações clínicas de PE, o que não ocorre com a disfunção endotelial.

Introduction: the pathophysiology of preeclampsia (PE) is based on a deficiency in the process of placentation associated with systemic maternal endothelial dysfunction. The investigation on the occurrence of these phenomena before the onset of PE clinical manifestations can become a new diagnostic method for its prediction. Objectives:to compare the process of placentation and endothelial function in pregnant women athigh-risk for PE development, correlating these findings with its further development. Patients and methods: 74 pregnant women underwent flow-mediated dilation (DFM) of the brachial artery and Doppler flowmetry of uterine arteries to assess endothelial function and placentation process, respectively. The examinations were performedbetween 16 and 20 weeks of gestation and patients were followed until the postpartum period. Results: 15 patients had pregnancies complicated by PE and 59 remained normotensive until the postpartum period. Patients who subsequently developed PE presented high values of pulsatility index in uterine arteries (p <0.001), between 16 and 20 weeks gestation, however, the analysis of DFM did not show difference compared to patients who remained normotensive.Conclusion: The observed data suggest that deficiency in the placentation process chronologically precedes the clinical manifestations of PE, which does not occurwith endothelial dysfunction.

Síndromes neurológicas durante a gestação / Neurological syndromes during pregnancy

A ocorrência de sintomas neurológicos agudos em gestantes ou puérperas não é incomum. Podem ser causados tanto pela exacerbação de uma doença neurológica pré-existentes quanto por doenças relacionadas com a própria gravidez. O diagnóstico preciso é essencial para o tratamento adequado. Sendo assim, é recomentado acompanhamento multidisciplinar antes, durante e após a gravidez. O objetivo do presente estudo é realizar uma revisão da literatura sobre as principais síndromes neurológicas durante a gravidez, descrevê-las e elucidar como é feito o diagnóstico adequado. Para isso, foi realizada uma busca de artigos na base de dados do Medline, via Pubmed, sendo selecionados artigos publicados nos últimos 10 anos, nas línguas inglesa ou portuguesa. Desse modo, o presente estudo demonstra a importância de saber reconhecer e tratar adequadamente cada uma dessas síndromes, bem como de um acompanhamento em centro de referência, uma vez que as síndromes neurológicas estão relacionadas com morbidade e mortalidade materna.(AU)

The occurrence of acute neurological symptoms in pregnant women and during puerperium is not uncommon. This symptoms can be caused both by the exacerbation of a preexisting neurological disease and illnesses related to the pregnancy itself. The accurate diagnosis is essential for proper treatment. Therefore, it is recommended that a multidisciplinary monitoring before, during and after pregnancy. The aim of this study is to conduct a review of the literature on the main neurological syndromes during pregnancy, describe them and elucidate how is made the proper diagnosis. For this, a search for articles on Medline database, via Pubmed was performed, being selected articles published in the last 10 years, in English or Portuguese languages. Thus, the present study demonstrates the importance of knowing recognize and properly handle each of these syndromes, as well as a follow-up in tertiary centers, once the neurologicalsyndromes are related to maternal morbidity and mortality.(AU)

Uso da cirurgia minimamente invasiva em ginecologia oncológica / The use of minimally invasive surgery in gynecologic oncology

A cirurgia minimamente invasiva se tornou mais utilizada no campo da ginecologia oncológica. O objetivo deste texto é abordar o seu uso, descrevendo suas indicações, vantagens e desvantagens em relação à laparotomia. As técnicas laparoscópicas continuam a evoluir e novos meios de abordagem como a laparoscopia roboticamente assistida e a laparoscopia por portal único estão também se difundindo. No câncer de endométrio, esse tipo de cirurgia vem sendo utilizada para estadiamento ou mesmo para tratamento de casos em estágios iniciais. No câncer de ovário, destaca­se seu uso para avaliação, diagnóstico e tratamento dos estádios iniciais, tratamento cirúrgico de casos avançados, avaliação da viabilidade de uma cirurgia citorredutora, abordagem após remissão completa com o tratamento primário e citorredução em caso de recorrência da doença. No câncer de colo uterino, vem sendo realizadas histerectomia radical, linfadenectomia e até mesmo alguns casos de exenteração. De uma maneira geral, os benefícios da cirurgia minimamente invasiva são: menores problemas relacionados com a ferida operatória, maior conforto da paciente, melhor visualização do campo cirúrgico, menor perda sanguínea durante o procedimento, recuperação em menor período de tempo, diminuição da necessidade de analgésicos, menor tempo de hospitalização, recuperação precoce e melhora da qualidade de vida. Porém, o tempo de cirurgia por via aberta ainda é menor quando comparado à laparoscópica e robótica

Minimally invasive surgery is increasingly being used in the field of gynecologic oncology. The objective of this paper is to describe its indications, advantages and disadvantages compared to laparotomy. Laparoscopic techniques continue to evolve and new approaches as robotically assisted laparoscopy and single incision laparoscopy had emerged. In endometrial cancer, laparoscopy has been used for staging or definitive treatment of selected cases. In ovarian cancer, it is used for assessment, diagnosis and treatment of early stages, surgical treatment of advanced cases, and to assess the viability of a cytoreductive surgery approach. In cervical cancer, it has been used for radical hysterectomy, lymphadenectomy and even some cases of pelvic exenteration. In general, the benefits of minimally invasive surgery are minor problems with the wound, increased patient comfort, better visualization of the surgical field, less blood loss during the procedure, shorter recovery time, reducing the need of painkillers, shorter hospital stay, early recovery, and improved quality of life. However, the surgical time of laparotomy is still shorter when compared to laparoscopic and robotic approaches

Laparoscopia por portal único em Ginecologia: perspectivas / Single port laparoscopy in Gynecology: perspectives

Os avanços recentes no instrumental de cirurgia laparoscópica tornaram possível realizar uma cirurgia intra-abdominal ou pélvica através de uma incisão que pode ser escondida na cicatriz umbilical. A laparoscopia por portal único (LPU) representa uma novidade tecnológica no campo de cirurgia minimamente invasiva. Suas aplicações nas diversas aréas cirúrgicas são descritas com sucesso, com relatos de ótimos resultados peri e pós-operatórios. Quando comparada a laparoscopia convencional, a LPU mostrou taxas semelhantes de conversão para laparotomia, complicações pós-operatórias e resultado estético final. As evidências ainda não são suficientes para apontar vantagens da LPU sobre a técnica de múltiplos portais. O objetivo desse texto é revisar a literatura médica, procurando evidências concretas sobre aplicabilidade, vantagens e perspectivas da técnica laparoscópica por portal único em ginecologia.(AU)

Single port laparoscopy (SPL) is a technological novelty in the field of minimally invasive surgery. Its applications in various surgical areas are described with success, with reports of great peri and post-operative results. When compared to conventional laparoscopy, SPL showed similar rates of conversion to laparotomy, post-operative complications and final esthetic results. The cumulative evidences are not yet sufficient to point out advantages of SPL over multiple portals technique. The objective of this text is to raise, in the medical literature, concrete evidence about applicability, advantages and perspectives of single port laparoscopic in Gynecology.(AU)