Browsing by Author "Santos-Silva, I"
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- Anti-MuSK-positive myasthenia gravis diagnosed during pregnancy: New challenges for an old diseasePublication . Neves, AR; Monteiro, P; Matos, A; Santos-Silva, IMyasthenia gravis is an autoimmune disorder affecting predominantly women in their reproductive age. The course of the disease during pregnancy is unpredictable, although it is more difficult to manage earlier in the gestation. Myasthenia gravis with antibodies against the muscle-specific receptor tyrosine kinase (anti-MuSK) has been described as a subtype of disease with more localised clinical features and a poorer response to treatment than acetylcholine receptor antibody (anti-AChR)-positive patients. Few cases have been reported in pregnant women, with deliveries being performed mainly by caesarean section. We report a successful case of vaginal delivery and describe our experience providing the first review of the management of this subtype of disease during pregnancy.
- Corionicidade e complicações perinatais na gravidez gemelar: casuística de 10 anosPublication . Manso, P; Vaz, A; Taborda, A; Santos-Silva, IOVERVIEW AND AIMS: Multiple pregnancy accounts for about 3% of all pregnancies. The monochorionic pregnancy presents a relatively constant incidence (1:250 pregnancies) unlike the dichorionic, which is influenced by race, heredity, maternal age, parity and medically assisted procreation. The purpose of this work was to evaluate the impact of chorionicity on perinatal morbidity of twin pregnancy. POPULATION AND METHODS: Retrospective, longitudinal, descriptive and analytical study of women with twin pregnancy whose birth occurred in our maternity hospital since January/1999 until December/2008. Inclusion criteria: monochorionic and dichorionic twin pregnancies confirmed by ultrasound. Exclusion criteria: monochorionic monoamniotic gestation. Demographic data, delivery variables and perinatal morbidity and mortality were studied. Data were evaluated using the χ2 test (qualitative variables), t-Student (continuous quantitative variables) and Mann-Whitney test (quantitative discrete variables). RESULTS: We studied 504 pregnancies (356 dichorionic diamniotic and 148 monochorionic diamniotic). The monochorionic pregnancy had a higher incidence of threatened preterm labor (43,9% vs 31,5%, p<0,05), of oligohydramnios/hydramnios (9,8% vs 3,3%, p<0,001), discordant fetal growth (26,8% vs 14,8%, p<0,001) and intrauterine growth restriction (7,4% vs 3,7%, p<0,05). Prematurity was more common in the monochorionic group (p<0,001). The cesarean delivery rate was higher in monochorionic pregnancy (58,8% vs 50,3%, p<0,05) and the average weight of newborns was lower in monochorionic pregnancies (1983g vs 2233g, p<0,001). Newborns in the monochorionic group had higher incidence of hyaline membrane disease (5,8% vs 2,8%, p<0,05) and intraventricular haemorrhage (2,1% vs 0,4%, p<0,05). The perinatal mortality was higher in the monochorionic group (7,8% vs 1,8%, p<0,001). CONCLUSIONS: As the morbidity and mortality associated with monochorionic pregnancies are higher, it is essential to perform an early detection of chorionicity by ultrasound (11-13 weeks) in order to place differentiated prenatal and appropriate peripartum surveillance.
- Crescimento discordante precoce numa gravidez gemelar monocoriónicaPublication . Sousa, S; Passarinho, R; Alves, M; Taborda, A; Santos-Silva, IIntroduction: Abnormal growth, including discordant growth and intrauterine growth restriction (IUGR), occurs frequently in twin pregnancies and has been associated with increased risk of perinatal morbidity and mortality. Typically this occurs in the second or third trimester. Discordant growth in monochorionic twin pregnancies is probably related with the complications of a shared placenta. It is not clear whether there is increased risk of perinatal morbidity in both discordant twins or only in those with low birth weight. Case report: A 21 year old primigravida with a spontaneous monochorionic twin pregnancy was seen to have a crown-rump length discordance at 8 weeks of gestation (one fetus with 6mm and the other with 12 mm). All routine tests were normal. No major congenital or karyotype abnormalities or evidence of twin to twin transfusion syndrome (TTTS) were detected during follow up examinations. This discrepancy persisted until birth: fetus A was in the 25th percentile while fetus B below the 5th percentile. Umbilical artery flow in both twins remained normal. At 34 weeks, preeclampsia developed and labor induction was performed. The twins had a birth weight of 2195 g and 1415 g (35,5% discrepancy), and an Apgar score of 7 and 10 at 5th minute, respectively. They remain in the neonatal intensive care unit for 29 days, with the larger twin having more complications: transient tachypnea of the newborn, pneumothorax and hyperbilirubinemia. At two years old, they both had a normal development. Discussion: In monochorionic twins with a normal karyotype and no evidence of TTTS, the causes of discordant growth are not always clear. In this case, the occurrence of discordant growth and IUGR did not lead to more complications in the smaller twin.
- Crise hipercalcémia secundária a hiperparatiroidismo primário durante a gravidezPublication . Branco, MR; Rodrigues, CT; Campos, A; Figueiredo, A; Coucelo, J; Magalhães, C; Santos-Silva, I; Taborda, A; Almeida, MCPrimary hyperparathyroidism is a rare occurrence in pregnancy with significant risks to the mother and the foetus, witch is related to the level of serum calcium. A 41-year-old women, gravida 2, para 1, presented at 22 weeks gestation with nausea, vomiting and mild cognitive dysfunction associated with hypercalcemic crisis. The hypercalcemia was observed to be related to parathyroid hyperplasia that was surgically removed. Complete resolution of her symptomatology and hypercalcemia occurred postoperatively. The pregnancy was complicated with transient hypertension. A small for gestational age healthy male infant was delivered at term with no neonatal complications related with this pathology.
- Epidemiologia da gestação múltipla: casuística de 15 anosPublication . Rodrigues, CT; Branco, MR; Ferreira, ID; Nordeste, A; Fonseca, M; Taborda, A; Santos-Silva, I; Almeida, MCBetween January of 1987 and December of 2001 were born 1243 twins related to 609 multiple pregnancies, in Maternidade Bissaya-Barreto. Data were grouped in periods of three years and several parameters were studied. The rate of multiple gestation has increased probably due to the contribution of the assisted conception techniques, and to the increase of the number of multiple fetal pregnancies (two or more) and to the increase of the mother age. These more frequent obstetric problems were preterm birth, gestational hypertension and abnormal sonographic data of fetal growth. The average age of delivery was 34 weeks and the birth weight has decreased. The most important factors for neonatal morbidity were hyaline membranous disease, intraventricular haemorrhage and the twin-twin transfusion syndrome. The neonatal mortality decreased in the last studied period.
- Epilepsia e gravidez: que conduta? A propósito de um caso clínicoPublication . Rodrigues, CT; Branco, M; Ferreira, I; Estanqueiro, P; Vicente, T; Santos-Silva, I; Couceiro, A; Ramos, C
- Gestações gemelares após PMA versus gestações gemelares espontâneas: avaliação comparativa das complicações obstétricas e dos resultados neonataisPublication . Figueiredo, S; Dionísio, T; Faria, D; Almeida, MC; Oliveira, B; Santos-Silva, I
- Importância da simulação no treino de equipa para eventos críticos em obstetrícia: resultados da primeira fase do plano nacional de educação médica contínuaPublication . Maio-Matos, F; Sousa-Gomes, A; Costa, FJ; Santos-Silva, I; Carvalhas, JAs emergências obstétricas são eventos raros e inesperados. O modelo tradicional para a formação médica nestes eventos críticos apresenta limitações óbvias. Dada a variedade de competências técnicas e o ambiente de alto risco em que são aplicadas, a obstetrícia é uma especialidade que se adequa totalmente ao treino através de técnicas ou tecnologias aplicadas à Medicina ou Obstetrícia. Este modelo de aprendizagem constitui uma oportunidade para aprender e treinar competências técnicas simples e complexas, bem como a oportunidade para ensaiar e aprender com os erros, sem riscos para os doentes. Assim, elaborámos um estudo com o objectivo de avaliar a percepção dos formandos relativamente a quais os factores associados à falibilidade humana antes e após a formação clínica com simulação; comparar o nível de confiança para a resolução de situações emergentes obstétricas entre internos e especialistas com mais de 5 anos de experiência, antes e após uma acção formativa em gestão de eventos críticos de Obstetrícia; determinar o valor atribuído pelos formandos à simulação como instrumento formativo em cuidados emergentes. Nesta fase do programa, correspondente às 3 primeiras sessões formativas em gestão de eventos críticos de Obstetrícia, participaram 31 médicos. Após a acção formativa, verificaram-se alterações na percepção dos formandos relativamente a quais os factores associados à falibilidade humana, no nível de confiança para a resolução de situações emergentes obstétricas e no valor atribuído pelos formandos à simulação como recurso pedagógico.
- Lessons from monochorionic twin deliveryPublication . Ferreira, SA; Januário, GM; Pereira, DF; Santos-Silva, I; Negrão, FThe presence of acute peripartum anaemia in a monochorionic twin pregnancy represents a clinical challenge requiring prompt recognition and management. Twin-to-twin transfusion syndrome (TTTS) is a major complication of these pregnancies and a medical emergency in its acute form. Acute intrapartum fetoplacental transfusion (AIFT) has been reported infrequently. The authors present a case of a probable acute TTTS in an uneventful monochorionic monoamnionic twin pregnancy, where typical ultrasound criteria for long-standing TTTS were absent. The first twin was born pale, hypotonic and developed hypovolemic shock due to acute anaemia. Soon after birth, she presented with seizures and a cerebral ultrasound detected a large parieto-occipital infarction. The second twin, although plethoric, was clinically well. The risk of acute TTTS and AIFT, although infrequent and unpredictable, should be kept in mind when planning delivery of monochorionic twins, because the consequences for one or both twins can be disastrous.
- Neonatal Morbidity in Term Newborns Born by Elective Cesarean SectionPublication . Resende, C; Santos, L; Santos-Silva, IINTRODUCTION: International guidelines suggest that non-urgent planned deliveries be scheduled at or after 39 weeks. Despite this recommendation elective cesarean often occurs before 39 weeks. Some research has demonstrated that elective cesarean before 39 weeks poses a greater risk to the infants than at or after 39 weeks. OBJECTIVE: To evaluate neonatal morbidity in term newborns born by elective cesarean section. MATERIAL AND METHODS: Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared. RESULTS: In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 - 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p < 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 - 3.7] p < 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 - 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p < 0.001. DISCUSSION: As in other studies 'early term' had higher respiratory and metabolic morbidity and consequently had a longer hospital stay. CONCLUSION: These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.