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.

The MML technique is faster to perform and similar in terms of febrile morbidity, time to bowel restitution, or need for postoperative medications. It is likely to be more cost-effective.

BackgroundBiologic agents are routinely used in the treatment of severe psoriasis. The evaluation of treatment response is mainly based on the physician’s global clinical assessment.ObjectiveTo investigate whether dermoscopy might enhance the assessment of response of psoriasis to treatment with biologic agents.MethodsPatients with severe psoriasis scheduled to receive a biologic agent were enrolled in the study. A target lesion from each patient was clinically and dermoscopically documented at baseline and after one, two and six months. The clinical response was evaluated by the recruiting clinicians at all visits, while dermoscopic images were evaluated by two independent investigators, blinded to the clinical information. Chi Square test was used for cross-tabulation comparisons, while odds ratios, 95% confidence intervals and p values were calculated using univariate logistic regression.ResultsOverall, there was a significant correlation between clinical response and vessel distribution at all time points: a regular vessel distribution correlated with no response, a clustered distribution with partial response, and the dermoscopic absence of vessels with complete response. The presence of dermoscopic hemorrhagic dots was a potent predictor of favorable clinical response at the subsequent visit at all time points. Among lesions initially clinically responding and later recurring, 87.5% displayed dermoscopic dotted vessels despite the macroscopic remission.ConclusionDermoscopy might be a useful additional tool for evaluating the response of psoriatic patients to biologic agents. Hemorrhagic dots represent an early predictor of clinical response, while the persistence or reappearance of dotted vessels might predict clinical persistence or recurrence, respectively.

The risk of using thrombolytics in pregnancy seems reasonable taking into account the risk of death in a life-threatening event, with the majority of cases presented in this article resulting in encouraging outcomes. The complication rate of thrombolytic treatment does not seem higher in pregnant women than in the nonpregnant. Poor fetal outcome occurred in mothers with poor prognosis. Specific consensus recommendations are needed in the use of thrombolytics in pregnancy.

Background. Modifications to the classic cesarean section technique described by Pfannenstiel and Kerr have been proposed in the last few years. The objective of this trial was to compare intraoperative and short-term postoperative outcomes between the Pfannenstiel-Kerr and the modified Misgav-Ladach (MML) techniques for cesarean section.Methods. This prospective randomized trial involved 162 patients undergoing transverse lower uterine segment cesarean section. Patients were allocated to one of the two arms: 88 to the MML technique and 74 to the Pfannenstiel-Kerr technique. Main outcome measures were defined as the duration of surgery, analgesic requirements, and bowel restitution by the second postoperative day. Additional outcomes evaluated were febrile morbidity, postoperative antibiotic use, postpartum endometritis, and wound complications. Student's t, Mann-Whitney, and Chi-square tests were used for statistical analysis of the results, and a p < 0.05 was considered as the probability level reflecting significant differences. Results. No differences between groups were noted in the incidence of analgesic requirements, bowel restitution by the second postoperative day, febrile morbidity, antibiotic requirements, endometritis, or wound complications. The MML technique took on average 12 min less to complete (p ¼ 0.001). Conclusion. The MML technique is faster to perform and similar in terms of febrile morbidity, time to bowel restitution, or need for postoperative medications. It is likely to be more cost-effective.