RESUMOO caso apresentado diz respeito a uma grávida saudável, de termo, que teve o parto por cesariana num hospital nível III. Pela presença de contexto epidemiológico de risco, foi realizado o teste de pesquisa de SARS-CoV-2 que foi positivo no dia do internamento para indução do trabalho de parto. Dada a presença de um índice de Bishop < 4 e os antecedentes obstétricos, com uma cesariana anterior, foi decidido proceder à realização de um parto por cesariana. Durante todo o procedimento e contacto com a grávida foram utilizados dispositivos de proteção individual adequados e respeitados circuitos previamente definidos, que são descritos de seguida de forma mais pormenorizada. Quer a mãe, quer o recém-nascido encontram-se bem à data da descrição deste caso. Trata-se do primeiro parto por cesariana de uma grávida com COVID-19 em Portugal. Com esta publicação, o objetivo dos autores é apresentar as preocupações, orientação clínica face à presença de doença, os desfechos maternos e neonatais, bem como os circuitos definidos e as adaptações adotadas para dar resposta à situação atual de pandemia que vivemos. ABSTRACTWe report the first cesarean delivery in a woman with COVID-19 in a level III hospital in Portugal. It refers to a healthy woman with a term pregnancy that tested positive for COVID-19 on the day of labor induction. Given a Bishop score < 4 and the prior history of a cesarean section, the team decided to perform a surgical delivery. Appropriate personal protective equipment and safety circuits were employed, as described in more detail in the case report. Both the mother and the newborn are well. With this report we aimed to share our concerns, clinical management, maternal and neonatal outcomes, and to present our current circuits and adjustments regarding the COVID-19 pandemic in our maternity hospital.

Objective The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients. Materials and Methods A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated. Results A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1–11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed. Conclusions Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.

To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease or misoprostol allergy; no more than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 µg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later - if the intrauterine gestational sac was still present, the application of 800 µg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol - if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac ( = 0.049). We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

No abstract

Article published with errors:https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13883On page 430, section “Discussion”, line 5, where it reads: (...) given the conflicting data about pre and postnatal transmission,6,7 a multi-disciplinary team consensus comprising obstetricians, neonatologists and infectious diseases specialists at our institution decided on mother-neonate separation immediately after birth until both were tested negative for SARS-CoV-2.4It should read: (...) given the conflicting data about pre and postnatal transmission,6,7 after thoughtful discussion between a multidisciplinary team and the mother, and respecting her expressed will, a shared decision was made of mother infant separation immediately after birth until both were tested negative for SARS-CoV-2.4 Artigo publicado com erros:https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13883Na página 430, secção “Discussão”, linha 6, onde se lê: (...) given the conflicting data about pre and postnatal transmission,6,7 a multi-disciplinary team consensus comprising obstetricians, neonatologists and infectious diseases specialists at our institution decided on mother-neonate separation immediately after birth until both were tested negative for SARS-CoV-2.4Deverá ler-se: (...) given the conflicting data about pre and postnatal transmission,6,7 after thoughtful discussion between a multidisciplinary team and the mother, and respecting her expressed will, a shared decision was made of mother infant separation immediately after birth until both were tested negative for SARS-CoV-2.4