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The majority of these fetal lung masses are isolated findings that partially regress during intrauterine life. With adequate postnatal surveillance and eventual surgery the prognosis is good.

A 30-year-old caucasian primigravida was diagnosed with arterial hypertension at 34 weeks of gestation. At 36 th week, labor induction was performed for severe preeclampsia. During labor, blood pressure was controlled with labetalol and convulsion prophylaxis was performed with magnesium sulfate. She had a vaginal delivery without complications and forty-eight hours later complained of intense fronto-occipital headache, blurred vision and metamorphopsia with a sudden decrease in visual acuity. Blood pressure during the postpartum period was 170/110 mm Hg. Blood samples showed no abnormalities. The previous ocular history was unremarkable. The patient was transferred from a secondary to a tertiary hospital in order to have an adequate ophthalmologic evaluation that revealed visual acuity of 2/10 and 4/10 in the right and left eye, respectively. Fundoscopy, retinography ( Figures 1A and 1B) and Optical Coherence Tomography (OCT) showed bilateral bullous retinal detachment of the posterior pole with no hemorrhage or retinal exudates and also contributed to exclude the presence of a macular hole in both eyes. There was no retinal tear on peripheral retina examination. Neurological examination was normal and cranial computed tomography scan showed no lesions. Blood pressure was controlled with 48 hours of labetalol. Magnesium sulfate was performed in accordance to the Department´s protocol for the management of severe preeclampsia. Ophtalmologic re-evaluation on days 2 and 4 improved significantly, without specific therapy. She was discharged asymptomatic on day 7 with controlled blood pressure. Follow-up examination 2 weeks later showed complete resolution of the retinal detachment ( Figures 1C and 1D). Visual acuity remained 8/10 for both eyes.

(1):135-137 RESUMOA existência de uma gravidez gemelar bicoriónica com uma mola hidatiforme completa e um co-gémeo viável é um evento raro, sendo o diagnóstico habitualmente realizado no segundo trimestre. Pode associar-se a tirotoxicose, pré-eclâmpsia, hemorragia vaginal, doença persistente do trofoblasto e morte fetal. Os autores descrevem o caso de uma grávida com hemorragia do primeiro trimestre. As imagens ecográficas foram interpretadas como uma gravidez gemelar bicoriónica com um embrião vivo e outra placenta com imagem de descolamento. Às 16 semanas visualizou-se um feto vivo com placenta posterior e uma massa vacuolada anterior, vascularizada. Perante a hipótese de doença do trofoblasto o casal optou pela interrupção da gravidez. O exame anatomo-patológico confirmou o diagnóstico. Perante a raridade desta entidade clínica, é necessário um elevado índice de suspeição para estabelecer o seu diagnóstico ecográfico. Apesar de estarem descritos casos com um bom desfecho materno e neonatal, a decisão de continuação da gravidez deve ser tomada pelos progenitores. Palavras-chave: Doenças em Gémeos; Gravidez Gemelar; Mola Hidatiforme; Ultrassonografia. ABSTRACTA complete hydatiform mole coexisting with a live, viable twin is a rare event. The diagnosis is challenging, and is normally achieved only at second trimester. It may be associated with thyrotoxicosis, vaginal bleeding, preeclampsia, fetal death or persistent throphoblastic disease. The authors describe the case of a pregnant woman presenting with first trimester bleeding. Ultrasound revealed a twin pregnancy with a viable twin and another placenta apparently detached. At 16 gestational weeks ultrasound revealed a live fetus with a normal placenta and a separate vacuolated and vascularized mass. Facing the hypothesis of gestational trophoblastic disease, the couple chose pregnancy interruption. Given the rarity of this situation, a high index of suspicion is needed to achieve the diagnosis. Despite the existence of case reports with good fetal and maternal outcome, the decision of pregnancy continuation should be made by the informed parents. Keywords: Diseases in Twins; Hydatidiform Mole; Pregnancy, Twin; Ultrasonography. INTRODUÇÃOA doença trofoblástica gestacional define-se como uma doença proliferativa das células do trofoblasto resultantes de um processo de fertilização aberrante. As doenças do trofoblasto mais frequentes são a mola hidatiforme completa, caracterizada por edema generalizado do tecido vilositá-rio, hiperplasia trofoblástica difusa, sem tecido embrionário presente, e a mola hidatiforme parcial, caracterizada por alterações placentárias hidatiformes focais e presença de embrião, habitualmente triplóide, com múltiplas malformações.1 Estima-se que a incidência de mola hidatiforme seja de 1 para 1 000, embora se verifiquem diferenças geográ-ficas importantes, com uma maior incidência nos países asiáticos e da América do Sul.1 Esta patologia é considerada pré-maligna, pelo que a interrupção da gravidez é a regra assim que se estabelece o di...

BackgroundThe vasculitides are rare conditions that may affect women of childbearing age. These women seem to be at increased risk for developing adverse pregnancy outcomes (APO). Maternal and perinatal outcomes as well as their optimal management during pregnancy remain poorly understood in this population.ObjectivesTo describe maternal and perinatal outcomes in women with vasculitis.MethodsObservational retrospective study including pregnant women with vasculitis followed at a rheumatology-obstetric clinic from 01/2009 to 06/2022.ResultsWe identified 31 pregnancies in 24 women with vasculitis. Table 1 summarizes demographic and clinical data. The most frequent diagnosis were Behçet’s disease (BD) (18; 58%), polyarteritis nodosa (PAN) (4; 13%) and Takayasu arteritis (TAK) (4; 13%). The mean ± SD age at conception was 33 ± 6 years with a median disease duration of 6 (IQ range 3-12) years, 29 (94%) were in remission by the time of conception. We documented 30 live births, 1 early miscarriage (BD) and there was no perinatal mortality or birth defect. The mean ± SD gestational age at delivery was 38.2 ± 2.1 weeks. Five (17%) viable pregnancies resulted in preterm births - 3 BD, 1 TAK and 1 relapsing polychondritis (RP). Fetal growth restriction was detected in 2 (6%) pregnancies (TAK and RP). Eight (30%) newborns were small for gestational age (SGA), most of them from mothers with BD (4; 29%). Cesarean section (CS) was performed in 8 (26%) patients – 2 (TAK) due to vasculitis activity. Nine (36%) patients relapsed during pregnancy (4 BD; 2 PAN; 1 TAK; 1 RP; 1 ANCA-PR3 cutaneous vasculitis) while 6 (22%) relapsed during the post-partum period (4 BD; 1 TAK and 1 RP). A total of 24 (77%) patients were treated with glucocorticoids (GC), most of them (63%) at low doses (≤5mg/day of prednisolone or equivalent). Seven (23%) patients were treated with conventional DMARDs: 2 TAK and 3 BD with azathioprine and 2 PAN with azathioprine and hydroxychloroquine. Biological DMARDs were prescribed in 2 (6%) patients, both with the diagnosis of TAK: one with a multisegmental aortic disease who received tocilizumab during the first 30 weeks of gestation (WG) and had an uneventful pregnancy, and another patient with an ascending aortic aneurism (AAA) who also received tocilizumab, but from the 24thweek onwards showed a gradual worsening of the AAA dimensions (maximum 56 mm). An elective CS at 32 WG was performed in the latter case due to the high risk of aneurysm rupture and a healthy baby with 1900g was born. The occurrence of flares during pregnancy increased the risk for APO (OR 13, 95 CI 2-80; p=0.007). No association was found concerning maternal age or use of DMARDs/GC and the risk of APO (p>0.05).ConclusionMost pregnant women with vasculitis managed at out multidisciplinary unit had successful gestations. However, they may still be at risk for developing APO, namely if they experience disease flares during gestation. SGA was the main APO recorded.Table 1.Maternal and perinatal outcomes in women with vasculitis followed at a rheumatology-obstetric clinicMain diagnosisN (%)Gestational age at delivery (mean ± SD weeks)BW (mean ± SD grams)SGA N (%)Miscarriages N (%)FGR N (%)Preterm births N (%)Pregnancy flares N (%)Post-partum flares N (%)Behçet’s disease18 (58)38.3 ± 1.53013± 4944/14 (29)1/18 (6)03/17 (18)4/17 (24)4/14 (29)Polyarteritis nodosa4 (13)37.4 ± 0.62783± 1751/4 (25)0002/4 (50)0Takayasu arteritis4 (13)38.0 ± 2.12725± 3641/4 (25)01/4 (25)1/4 (25)1/4 (25)1/4 (25)IgA vasculitis1 (3)40.33435000000ANCA-PR3 cutaneous vasculitis1 (3)40.92845100010Relapsing polychondritis1 (3)36.02040101111Cryoglobulinemic vasculitis1 (3)35.93020000000Cryoglobulinemic vasculitis associated with Sjögren’s syndrome1 (3)39.0300000000031 (100)38.2 ± 2.12925± 5668/27 (30)1/31 (3)2/31 (6)5/30 (17)9/25 (36)6/27 (22)BW: birthweight; SD: standard deviation; SGA: small for gestational age; FGR: fetal growth restrictionREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

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79 pregnant women were diagnosed at the 2nd or 3rd trimester with placenta previa and followed at this hospital till birth. 59% were multiparous, and 51% of these had at least one prior Caesarean section. 15 pregnancies resulted from IVF treatment. There were 3 dichorionic/diamniotic twin pregnancies, with placenta previa in one of the fetuses. There were 5 cases of placenta previa with placenta accreta spectrum, one diagnosed intrapartum. The mean age of the women was 35, and the mean gestational age at birth was 36,43 weeks. The outcome was good for most women, with a mean of 3,6 days hospitalised after birth. 32% had post-partum anemia, 41% of which needed blood transfusion. Hysterectomy was performed in 4 of the women with placenta accreta spectrum, and one woman with isolated placenta previa needed a Bakri balloon after the Caesarean section due to uterine atony. Conclusions: Advanced maternal age, multiparity, previous Caesarean section and IVF treatments were associated risk factors, with the majority of women being multiparous. The outcome for most women was good, and the most common consequence was postpartum anemia. VP44.19Placenta accreta spectrum intraoperative finding: always evaluate if possibleto defer surgery and if ''tele-help'' is available