Fátima Serrano

Recurrent miscarriage : Psychological and relational consequences for couples

Recurrent miscarriage is a rare condition that has been described as a traumatic event for couples. Although symptoms of depression, anxiety and lowered self-esteem have been related after recurrent miscarriage, little is known about its impact on couple sexuality and on gender differences in attitude and the grief that follow. The objectives of this study are to describe the consequences of recurrent pregnancy loss for the couples relationship, and explore gender differences in attitudes and grief intensity toward this kind of reproductive failure. Each member of 30 couples with at least 3 recurrent miscarriages answered a set of questionnaires, including the Impact of Events Scale (Horowitz, Wilnwe, & Alvarez, 1979), the Perinatal Grief Scale (Toedter, Lasker, & Qlhadeff, 1988), the Partnership Questionnaire (Hahlweg, 1979) and the Intimate Relationship Scale (Hetherington & Soeken, 1990). Results showed that men do grieve, but less intensely than their partners. Although the couples relationship seemed to not be adversely affected by recurrent miscarriage, couples described sexual changes after those events. Grief was related to the quality of communication in the couple for women, and to the quality of sex life for men.

Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study

The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The studys inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: oral-low-dose steroids (10-20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral-intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The studys primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine (p = 0.036) and its administration before versus during pregnancy (p = 0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones (p = 0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.

Antiphospholipid Syndrome: A complex disease

In the last three decades, a variety of clinical manifestations involving almost all organs and tissues (cardiac, pulmonary, neurological, renal, cutaneous, haematologic, gastrointestinal, ocular, skeletal and endocrinologic), have been described associated with antiphospholipid antibodies (aPL) (1). Nevertheless, the exact mechanism underlying the pathogenesis of aPL-mediated damage has been poorly recognized. Inflammatory mechanisms beyond thrombosis have been proposed in some clinical presentations, suggesting a role for immunomodulation in therapeutic strategy (2). This interesting case-report by Ardalan et al. (3) definitely illustrates the multiple expressions of this disease. Although the classical criteria included in the revised classification for antiphospholipid syndrome (APS), pregnancy morbidity or thrombosis and persistence of positive aPL (4) were not present, clinical features such as thrombocytopenia, renal dysfunction and mitral valve regurgitation, undoubtedly support the diagnosis of APS. Motor neuropathy, a rare and recently described presentation (5), added complexity to the diagnosis and highlights the importance of a multidisciplinary approach of these patients. Antiphospholipid syndrome is really a disease with protean faces.

Sexual and reproductive health of Portuguese adolescents

Abstract Background: As adolescent pregnancy and sexually transmitted infections (STIs) are major sources of morbidity, preventing them is an important health goal for Portuguese society. Objective: To review data on the knowledge, attitudes and statistics on sexual and reproductive health. Methods: A systematic review was conducted including peer-reviewed articles addressing issues influencing the sexuality of Portuguese adolescents (aged 13 to 19), published up to 2011 and conducted in any type of setting. After crossing-cleaning the reference list, 33 articles were included. Results: The rate of sexual activity by Portuguese adolescents is high (44%–95%), but there has been an increase in the age of intercourse debut (currently 15.6 years). Early commencement of sexual intercourse is associated with smoking and regular alcohol consumption. Condoms are the most frequently chosen contraceptive method for first (76%–96%) and subsequent (52%–69%) sexual encounters. The perception of a double standard in sex still exists in teenage culture for both genders and influence behavior. There are significant differences between migrant and native adolescents: African adolescents initiate sexual intercourse at earlier ages and are more likely to have unprotected sex. Only one-third of Portuguese teenagers have ever visited a health facility to seek counseling concerning contraception or STIs, and less than half have ever attended classes on reproductive health. Very few (12%) have knowledge about Chlamydia trachomatis infection. The prevalence of STIs in Portuguese youth is unknown. The adolescent fertility rate is still high (14.7 births per 1000 females aged 15–19 years), but it, as well as the rate of abortion, is steadily decreasing. Conclusions: There is still a long way to go towards promoting a resourceful young population. Citizens and institutions must focus on increasing both the competence of youths and external supports. Information must be provided systematically and health services must have greater accessibility. Studies addressing cultural and environmental determinants that contribute to the molding of the sexual conduct of Portuguese adolescents must be held to produce new and effective culturally sensitive health interventions.

Inferior Vena Cava Filter Placement during Pregnancy: An Adjuvant Option When Medical Therapy Fails

The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.

A multichannel time-frequency and multi-wavelet toolbox for uterine electromyography processing and visualisation

The uterine electromyogram, also called electrohysterogram (EHG), is an electrical signal generated by the uterine contractile activity. The EHG has been considered a promising biomarker for labour and preterm labour prediction, for which there is a demand for accurate estimation methods. Preterm labour is a significant public health concern and one of the major causes of neonatal mortality and morbidity [1]. Given the non-stationary properties of the EHG signal, time-frequency domain analysis can be used. For real life signals it is not generally possible to determine a priori the suitable quadratic time-frequency kernel or the appropriate wavelet family and relative parameters, regarding, for instance, the adequate detection of the signal frequency variation in time. There has been a lack of a comprehensive software tool for the selection of the appropriate time frequency representation of a multichannel EHG signal and extraction of relevant spectral and temporal information. The presented toolbox (Uterine Explorer) has been specifically designed for the EHG analysis and exploration in view of the characterisation of its components. The starting point is the multichannel scalogram or spectrogram representation from which frequency and time marginals, instantaneous frequency and bandwidth are obtained as EHG features. From this point the detected components undergo parametric and non-parametric spectral estimation and wavelet packet analysis. Intrauterine pressure estimation (IUP) is obtained using the Teager, RMS, wavelet marginal and Hilbert operators over the EHG. This toolbox has been tested to build up a dictionary of 288 EHG components [2], useful for research in preterm labour prediction.

Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus

Abstract Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2–3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.