Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.
Introduction: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection.Material and Methods: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected.Results: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%.Conclusion: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.
A tuberculose é uma doença infecciosa cuja prevalência tem vindo a diminuir significativamente em Portugal. Dos doentes infetados, apenas 10% desenvolverão a doença, sendo este risco superior em populações imunocomprometidas. Os autores descrevem um caso de uma grávida, previamente saudável e sem contexto epidemiológico, cujo diagnóstico de tuberculose foi estabelecido às 32 semanas de gestação, após ter iniciado um quadro clínico inespecífico. A confirmação diagnóstica e a instituição da terapêutica anti-bacilar foram céleres permitindo um desfecho materno-fetal favorável. O parto decorreu às 36 semanas sem intercorrências. O recém-nascido iniciou de imediato quimioprofilaxia que manteve até confirmação de ausência de doença. A mãe manteve seguimento em consulta de Pneumologia no Centro de Doenças Pneumológico, com boa evolução clínica, radiológica e laboratorial, tendo tido alta sem doença ativa. A abordagem de uma grávida com suspeita de tuberculose deverá seguir a marcha diagnóstica habitual, nomeadamente com os exames imagiológicos necessários e com a instituição da terapêutica o mais precocemente possível.
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