Daniela Gonçalves

Sepsis during pregnancy or the postpartum period

Sepsis is an important cause of maternal morbidity and mortality worldwide. Early recognition and timely treatment are the key to ensuring a favourable outcome. This article reviews recent literature about definitions, pathophysiology, incidence, diagnosis, management, treatment, prevention and outcome of sepsis during pregnancy and the postpartum period.

Recurrent pregnancy loss and vitamin D: A review of the literature

Recurrent pregnancy loss (RPL) affects approximately 1%‐2% of reproductive women. Auto‐ and cellular immune responses seem to be associated with RPL. Vitamin D (VD) has been shown to play a role in the modulation of the immune system. Effects of VD deficiency (VDD) in pregnancy have been associated with preeclampsia, gestational diabetes, fetal growth restriction, preterm labor, and sporadic spontaneous abortion (SA). We systematically reviewed articles that studied women with 2 or more SA and its association with VD. Eleven studies were included. Studies reported a high prevalence of VD insufficiency (VDI) or VDD in women with RPL and suggested that this could be associated with immunological dysregulation and consequently with RPL. Immunological benefits were reported in the peripheral blood of women with RPL after VD exposure. Thus, it is possible to speculate a beneficial role for VD supplementation in RPL. It seems that there are not differences in the vitamin D receptor (VDR) and CYP27B1 expression in endometrium of women with RPL but, in villous and decidual tissues, RPL women seem to have a decreased expression of VDR and, perhaps, a decreased expression of CYP27B1. Further randomized controlled studies are required to investigate the association between VDD or VDI and RPL.

Prolactinoma and pregnancy - a series of cases including pituitary apoplexy.

Abstract The objective of this article is to evaluate the impact of pregnancy in women with prolactinoma, the possible consequences of therapy maintenance/discontinuation during pregnancy and to assess the type of delivery and maternal–foetal obstetrical outcome. A retrospective study of all pregnant women with prolactinoma in our Centre between 2006 and 2014 was made. We had 35 cases of pregnant women with prolactinoma, two of which had an episode of pituitary apoplexy during the second trimester. At the time of conception, most women were being treated with 5 mg bromocriptine. The majority of women had suspended medication in the 8th week of gestation. Caesarean rate was 48.6%. The maternal foetal outcome was favourable in all cases.

Nonprimary Cytomegalovirus Fetal Infection.

Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation.The fetal karyotype was normal. The title of CMVs IgG antibodies almost tripled. Since the first semester, analysis of the polymerase chain reaction (PCR) for CMV DNA in the amniotic fluid was negative. The pregnancy was terminated at 23 weeks. Neuropathological findings at autopsy showed severe brain lesions associated with CMV infection.

A investigação realizada no âmbito do Mestrado em Ciências da Educação, especialização em Supervisão Pedagógica na ESE de Paula Frassinetti

Instituido pelo Despacho no 20758/2009 de 15 de setembro (2a serie), o Mestrado em Ciencias da Educacao, especializacao em Supervisao Pedagogica (MCESP) da Escola Superior de Educacao de Paula Frassinetti (ESEPF) ja vai na sua 5a edicao e emerge da conscencializacao de que, no atual contexto da carreira docente, a supervisao pedagogica assume-se como a via privilegiada para o assumir de responsabilidades de coordenacao, enquadramento e avaliacao de equipas de professores e agentes educativos. O objetivo desta comunicacao consiste em apresentar os resultados da analise efetuada aos 38 trabalhos de projeto do MCESP da instituicao de ensino superior supracitada; apresentar-se-a as tematicas selecionadas pelos estudantes, a metodologia adotada e os principais contributos/conclusoes apos o percurso investigativo, tendo em um inventario e caraterizacao das tematicas tratadas e natureza metodologica das abordagens efetuadas. Partindo do referencial de trabalhos de projeto ja defendidos e disponiveis no repositorio e centrar-nos-emos no resumo, na introducao, no capitulo da metodologia de investigacao e no capitulo final com vista a identificacao dos dominios de investigacao e respetivas orientacoes metodologicas subjacentes a estes trabalhos academicos.

Avaliação da artéria subclávia direita na ecografia do primeiro trimestre

PURPOSE: To determine the feasibility of evaluation of the right subclavian artery during the first trimester ultrasound scan, as well as to describe the technique for its evaluation and, in case of aberrant right subclavian artery (ARSA) identification, to determine its association with chromosomal abnormalities and/or cardiac malformations and its management. METHODS: A prospective study for evaluation of the right subclavian artery during the first trimester ultrasound scan (crown-to-rump length between 45 and 84 mm), in all consecutive single pregnancies, by a single examiner, using a Voluson E8 system (GE Healthcare, Zipf, Austria) with a 2 to 8 MHz RAB 4-8-D transabdominal probe, within a short period of time (less than 2 minutes), in a general low risk population. Color and/or power Doppler flow mapping was used to classify the right subclavian artery as normal or aberrant. Regression analysis with the IBM SPSS Statistics software for Windows, version 20.0 was used to determine the significance of the association between failure to examine/classify the right subclavian artery and both fetal crown-rump length and maternal body mass index. RESULTS : Median maternal age was 30 years (range: 17-43 years) and median gestational age at the time of evaluation of the right subclavian artery was 12 weeks (range: 11-13 weeks). The evaluation of the right subclavian artery was successful in 138/176 (78.4%) of the cases. ARSA was diagnosed in a single case (0.7%). This fetus with ARSA also presented a hyperechogenic focus on the left cardiac ventricle. Fetal echocardiography at 16 weeks of gestation was performed and confirmed ARSA and the hyperechogenic focus. Amniocentesis revealed a normal 46, XX karyotype. CONCLUSION: ARSA can be identified during a routine first trimester ultrasound scan. Our single ARSA case had a normal karyotype and no associated cardiac malformations.PURPOSE To determine the feasibility of evaluation of the right subclavian artery during the first trimester ultrasound scan, as well as to describe the technique for its evaluation and, in case of aberrant right subclavian artery (ARSA) identification, to determine its association with chromosomal abnormalities and/or cardiac malformations and its management. METHODS A prospective study for evaluation of the right subclavian artery during the first trimester ultrasound scan (crown-to-rump length between 45 and 84 mm), in all consecutive single pregnancies, by a single examiner, using a Voluson E8 system (GE Healthcare, Zipf, Austria) with a 2 to 8 MHz RAB 4-8-D transabdominal probe, within a short period of time (less than 2 minutes), in a general low risk population. Color and/or power Doppler flow mapping was used to classify the right subclavian artery as normal or aberrant. Regression analysis with the IBM SPSS Statistics software for Windows, version 20.0 was used to determine the significance of the association between failure to examine/classify the right subclavian artery and both fetal crown-rump length and maternal body mass index. RESULTS Median maternal age was 30 years (range: 17-43 years) and median gestational age at the time of evaluation of the right subclavian artery was 12 weeks (range: 11-13 weeks). The evaluation of the right subclavian artery was successful in 138/176 (78.4%) of the cases. ARSA was diagnosed in a single case (0.7%). This fetus with ARSA also presented a hyperechogenic focus on the left cardiac ventricle. Fetal echocardiography at 16 weeks of gestation was performed and confirmed ARSA and the hyperechogenic focus. Amniocentesis revealed a normal 46, XX karyotype. CONCLUSION ARSA can be identified during a routine first trimester ultrasound scan. Our single ARSA case had a normal karyotype and no associated cardiac malformations.