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Overview and aims: External cephalic version (ECV) is a maneuver that can diminish the cesarean section rate. The objective of our study was to assess women’s perception with ECV to improve counselling and its implementation. Study Design: Semi structured interviews with closed and open questions were conducted by phone. Population: Women subjected to ECV between January 2015 and August 2018. Methods: Women’s answers descriptive analysis. Results: Sixty six women answered the questionnaire. Pain was reported as intense by 48,5% and severe by 12,1%. The majority considered ECV as an alternative to cesarean section and 22,7% had tried other techniques before ECV. Twenty four women felt anxious before ECV but only 15,1% regretted their decision to undergo ECV. More than 60% would consider this maneuver in a subsequent pregnancy or recommend it to a friend. There was no association between the referred pain and the success of ECV. Conclusion: ECV is perceived as painful by most women and causes anxiety to a significant number of patients. Therefore, ECV must be attempted by experienced practitioners with careful attention to maternal mood.

Term breech presentation is a common indication for cesarean delivery. However, concern over the implications of planned cesareans on maternal morbidity and complications for future pregnancies as well as the limitations attributed to the Term Breech Trial have shed new light on the vaginal breech delivery, with different approaches being attempted. We report three cases of term vaginal breech delivery in the upright position, one of them requiring Piper’s forceps for fetal head delivery. No other relevant complications occurred. As with deliveries in lithotomy position, clinical expertise and case selection are prerequisites for favorable maternal and neonatal outcomes.

The high maternal mortality rate in the United States has worried health care providers. Portugal has a lower maternal mortality rate but with the finantial constraints of the National Health Service can face the same problem in the future

Spina bifida is one of the most common severe congenital defects of the central nervous system. Prenatal diagnosis is currently performed in second trimester. First trimester diagnosis is rare and can be challenging, but it can be suspected in the absence of intracranial translucency. We report images of a case of spina bifida detected at 13 weeks scan. The fetus presented images suggestive of open spina bifida and intracranial translucency was absent, also the crown-rump length evolution in serial ultrasound examinations was deficient. At 16 weeks a spontaneous abortion occurred and the histopathology analysis confirmed the diagnosis of spina bifida.

Referral Centers for particular situations are necessary and an added value for Nacional Obstetrics. Centers for fetal therapy and for management of placenta accreta spectrum disorders are a good example of this need. Creating teams with experience is the only way to answer to the challenges that Modern Obstetrics poses to us.

Overview and aims: Standardization of screening tests lead to better care. The aim of this study was to describe and analyse screening practices during pregnancy among Portuguese Centres. Study Design and Methods: Written survey sent electronically to 41 public Portuguese Health Institutions which have an Obstetrics Department. Descriptive analysis of the collected data was performed. Results: Twenty-four surveys were obtained (58.5%). In most Centres combined aneuploidy screening is performed universally (79%). Preterm birth screening is performed through evaluation of cervical length at 20-22 weeks in most Centres (58%). A broad variety in performance was observed between Institutions regarding which infections were screened and their timing. Most institutions do perform preeclampsia screening (92%) and do not perform systematic evaluation of thyroid function in the absence of known pathology or signs/symptoms suggestive of thyroid disfunction. Conclusions: Although with some differences it was found that for preeclampsia, preterm birth and aneuploidy screening, the Centres have consistent practices

Pre-eclampsia is a common and potentially serious disorder of pregnancy. An antiangiogenic state appears to be central to its development. In particular, the sFlt-1/PlGF ratio increases in pre-eclampsia, leading to its potential use as a marker for prediction and diagnosis. Immunoassays for the sFlt-1/PlGF ratio are now commercially available and can assist in the diagnosis of women with a clinical suspicion of pre-eclampsia, leading to a decrease in hospital admissions. Remarkably, information is missing on the impact of its use in pregnancy outcomes

The Robson Ten-Group Classification System has been viewed by the majority of the clinicians as way of classifying cesarean section according to maternal characteristics. Recent WHO and FIGO statements suggest that Robson classification should be used by all healthcare facilities where deliveries occur to collect and analyze perinatal data

A pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge. Resumo Descreve-se um caso clínico em que às 20 semanas de gestação é diagnosticada síndrome hemolítica-urêmica com isolamento de Escherichia coli produtora de toxina Shiga. A terapêutica com plasmaferese permitiu a manutenção da gravidez ao longo de 5 semanas. O surgimento de proteinúria nefrótica, hipertensão e recorrência de hemólise conduziu ao diagnóstico de sobreposição de pré-eclâmpsia e síndrome HELLP. Este caso é singular, pois demonstra que a síndrome HELLP pode se sobrepor a uma síndrome hemolítica-urêmica, um fato que pode influenciar futuras investigações no âmbito de imunologia reprodutiva. Reforça-se, ainda, que o diagnóstico de outras microangiopatias trombóticas durante a gestação é um desafio clínico ocasionado pela sobreposição de manifestações clínicas e laboratoriais com a síndrome HELLP.

Introduction: Shoulder dystocia (SD) is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. The aim of this study was to determine the incidence of SD in a tertiary care hospital and the morbidity according to the type of maneuvers (McRoberts' maneuver and suprapubic pressure versus rotational maneuvers or delivery of the posterior arm) used to resolve the dystocia. Methods: This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half. Maternal characteristics, duration of second stage of labor, type of delivery, fetal weight, neonatal morbidity (Apgar score