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- Development and evaluation of an algoritm for computer analysis of maternal heart rate during laborPublication . Pinto, Paula; Bernardes, João; Costa-Santos, Cristina; Amorim-Costa, CéliaBackground Maternal heart rate (MHR) recordings are morphologically similar and sometimes coincident with fetal heart rate (FHR) recordings and may be useful for maternal–fetal monitoring if appropriately interpreted. However, similarly to FHR, visual interpretation of MHR features may be poorly reproducible. Methods : A computer algorithm for on-line MHR analysis was developed based on a previously existing version for FHR analysis. Inter-observer and computer-observer agreement and reliability were assessed in 40 one-hour recordings obtained from 20 women during the last 2 h of labor. Agreement and reliability were evaluated for the detection of basal MHR, long-term variability (LTV), accelerations and decelerations, using proportions of agreement (PA) and Kappa statistic (K), with 95% confidence intervals (95% CI). Changes in MHR characteristics between the first and the second hour of the tracings were also evaluated. Results There was a statistically significant inter-observer and computer-observer agreement and reliability in estimation of basal MHR, accelerations, decelerations and LTV, with PA values ranging from 0.72 (95% CI: 0.62–0.79) to 1.00 (95% CI: 0.99 1.00), and K values ranging from 0.44 (95% CI: 0.28–0.60) to 0.89 (95% CI: 0.82–0.96). Therover, basal MHR, number of accelerations and LTV were significantly higher in the last hour of labor, when compared to the initial hour. Discussion The developed algorithm for on-line computer analysis of MHR recordings provided good to excellent computer-observer agreement and reliability. Moreover, it allowed an objective detection of MHR changes associated with labor progression, providing more information about the interpretation of maternal–fetal monitoring during labor.
- External Uterine Contractions Signal AnalysisPublication . Gonçalves, H; Pinto, Paula; Ayres-de-Campos, D; Bernardes, JoãoLabor dystocia is a major cause of operative delivery, which is associated with ncreased risks for both mother and fetus. We assessed linear and non-linear dynamics of external uterine contraction signals, in relation to labor progression and dystocia. Linear time domain, spectral and entropy methods were used to analyze external uterine contraction recordings obtained during the last two hours of labor, in 28 cases with normal and 27 cases with operative deliveries (forceps, vacuum or caesarean). Progression of labor was associated with a statistically significant increase in most linear time domain and spectral indices, both in normal and operative deliveries, whereas most entropy indices increased in normal deliveries, but did not change in operative deliveries. On the other hand, when compared with normal births, operative deliveries were associated with significantly increased entropy indices before the last hour of labor and significantly decreased (a probably associated) sympatho-vagal balance in the last hour of labor. Linear and non-linear analysis of external uterine contraction recordings may provide useful physiopathological and clinical information on the progression of labor and the diagnosis of dystocia.
- Computer analysis of maternal–fetal heart rate recordings during labor in relation with maternal–fetal attachment and prediction of newborn acidemiaPublication . Pinto, Paula; Costa-Santos, Cristina; Ayres-de-Campos, DiogoAbstract Objective: To assess combined maternal (MHR) and fetal heart rate (FHR) recordings during labor, in relation with maternal–fetal attachment and prediction of newborn acidemia.Study design: Fifty-nine simultaneous MHR and FHR recordings were acquired in the final minutes of labor. Computer analysis followed the FIGO guidelines with estimation of MHR and FHR baselines, accelerations, decelerations, short- (STV) and long-term variabilities. MHR and FHR characteristics, their differences and correlations were assessed in relation to labor progression and to newborn umbilical artery blood (UAB) pH lower than 7.15 and 7.20. To assess prediction of acidemia, areas under ROC curves (auROC) were calculated.Results: Progression of labor was associated with a significant increase in MHR accelerations and FHR decelerations both in the non-acidemic and acidemic fetuses (p50.01). At the same time there was an increase in MHR–FHR correlations and differences in accelerations and decelerations in acidemic fetuses. The auROC ranged between 0.50 for FHR accelerations and 0.77 for MHR baseline plus FHR STV. Conclusions: MHR and FHR respond differently during labor with signs of increased maternal– fetal attachment during labor progression in acidemic fetuses. Combined MHR–FHR analysis may help to improve prediction of newborn acidemia compared with FHR analysis alone.
- Vulvar Lobular Capillary Hemangioma: A Rare Location for a Frequent EntityPublication . Abreu-dos-Santos, F.; Câmara, S.; Reis, F.; Freitas, T.; Gaspar, H.; Cordeiro, M.Lobular capillary hemangioma, or pyogenic granuloma, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. The pyogenic granuloma of the vulva is a rare finding and a limited number of case reports are available in the literature. To the best of our knowledge this is the first case described as a single pyogenic granuloma on the vulva.
- Short and long acting reversible contraceptivePublication . Câmara, SaraOverview: The daily pill, a short-acting reversible contraceptive (SARC), is more used than long-acting reversible contraceptives (LARC) though these are highly effective, safe and less dependent on women use. It is important to identify which differences between SARC or LARC users can justify this choice.Aims: Describe and compare the two types of contraceptive methods users (age, marital status, previous history of pregnancy, level of education, age at which the method was started, level and source of knowledge, medical advice and level of satisfaction with the information received). As a secondary objective, we aimed to identify the existence of myths and misbeliefs about contraception and the reasons for choosing or discontinuation of the contraceptive method.Study Design: Observational and retrospective. Population:Women who use or had used contraception, aged 18 -50 years. Methods: A self-report and anonymous questionnaire, available in primary health care centers and hospitals. Results:In a group of 300 women, with a median of 35,6 years (18 - 50 years; s = 8,3 years), 68% (203/300) were using a contraceptive method and 28% (83/300) were no longer using it . Among these, 75% were using SARC or these corresponded to the last method used. Single women prevailed in the SARC group (p=0,002) and those with a previous pregnancy prevailed in the LARC group (p=0,002). No other statistically significant differences were identified. 86% (237/274) had a medical consultation before beginning to use a contraceptive, and 59% (139/237) were very satisfied with the information received. The control of the menstrual cycle was important for SARC users whether the using facility was important for LARC users. Conclusions:Although effective and safe,LARC where less prevalent in our study. History of previous pregnancy was the only clinically significant difference between SARC and LARC users..
- Métodos contracetivos reversíveis de curta e longa duraçãoPublication . Câmara, Sara; Abreu-dos-Santos, Filipa; Freitas, CláudiaABSTRACT Overview: The daily pill, a short-acting reversible contraceptive (SARC), is more used than long-acting reversible contraceptives (LARC) though these are highly effective, safe and less dependent on women use. It is important to identify which differences between SARC or LARC users can justify this choice. Aims: Describe and compare the two types of contraceptive methods users (age, marital status, previous history of pregnancy, level of education, age at which the method was started, level and source of knowledge, medical advice and level of satisfaction with the information received). As a secondary objective, we aimed to identify the existence of myths and misbeliefs about contraception and the reasons for choosing or discontinuation of the contraceptive method. Study Design: Observational and retrospective. Population: Women who use or had used contraception, aged 18 -50 years. Methods: A self-report and anonymous questionnaire, available in primary health care centers and hospitals. Results: In a group of 300 women, with a median of 35,6 years (18 - 50 years; s = 8,3 years), 68% (203/300) were using a contraceptive method and 28% (83/300) were no longer using it . Among these, 75% were using SARC or these corresponded to the last method used. Single women prevailed in the SARC group (p=0,002) and those with a previous pregnancy prevailed in the LARC group (p=0,002). No other statistically significant differences were identified. 86% (237/274) had a medical consultation before beginning to use a contraceptive, and 59% (139/237) were very satisfied with the information received. The control of the menstrual cycle was important for SARC users whether the using facility was important for LARC users. Conclusions: Although effective and safe, LARC where less prevalent in our study. History of previous pregnancy was the only clinically significant difference between SARC and LARC users..
- Vulvar Lobular Capillary Hemangioma: A Rare Location for a Frequent Entity - Case ReportPublication . Abreu-dos-Santos, F; Câmara, S; Reis, F; Freitas, T; Gaspar, H; Cordeiro, MLobular capillary hemangioma, or pyogenic granuloma, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. The pyogenic granuloma of the vulva is a rare finding and a limited number of case reports are available in the literature. To the best of our knowledge this is the first case described as a single pyogenic granuloma on the vulva.
- Métodos contracetivos reversíveis de curta e longa duração - estudo observacionalPublication . Câmara, Sara; Abreu-dos-Santos, F; Freitas, CAbstract:Overview: The daily pill, a short-acting reversible contraceptive (SARC), is more used than long-acting reversible contraceptives (LARC) though these are highly effective, safe and less dependent on women use. It is important to identify which differences between SARC or LARC users can justify this choice. Aims: Describe and compare the two types of contraceptive methods users (age, marital status, previous history of pregnancy, level of education, age at which the method was started, level and source of knowledge, medical advice and level of satisfaction with the information received). As a secondary objective, we aimed to identify the existence of myths and misbeliefs about contraception and the reasons for choosing or discontinuation of the contraceptive method. Study Design: Observational and retrospective. Population: Women who use or had used contraception, aged 18 -50 years. Methods: A self-report and anonymous questionnaire, available in primary health care centers and hospitals. Results: In a group of 300 women, with a median of 35,6 years (18 - 50 years; s = 8,3 years), 68% (203/300) were using a contraceptive method and 28% (83/300) were no longer using it . Among these, 75% were using SARC or these corresponded to the last method used. Single women prevailed in the SARC group (p=0,002) and those with a previous pregnancy prevailed in the LARC group (p=0,002). No other statistically significant differences were identified. 86% (237/274) had a medical consultation before beginning to use a contraceptive, and 59% (139/237) were very satisfied with the information received. The control of the menstrual cycle was important for SARC users whether the using facility was important for LARC users. Conclusions: Although effective and safe, LARC where less prevalent in our study. History of previous pregnancy was the only clinically significant difference between SARC and LARC users..
- Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during laborPublication . Gonçalves, Hernâni; Pinto, Paula; Silva, Manuela; Ayres-de-Campos, Diogo; Bernardes, JoãoEvaluation of maternal heart rate (MHR) variability provides useful information on the maternal-fetal clinical state. Electrocardiography (ECG) is the most accurate method to monitor MHR but it may not always be available, and pulse oximetry using photoplethysmography (PPG) can be an alternative. In this study we compared ECG and PPG signals, obtained with conventional fetal monitors, to evaluate signal loss, MHR variability indices, and the ability of the latter to predict fetal acidemia and operative delivery.
- Umbilical Nodule with Cyclical Bleeding: A Case Report and Literature Review of Atypical EndometriosisPublication . Teixeira Andrade, Marlene; V. Marques de Freitas, Cláudia; Câmara, Sara; Vieira, José JoaquimEndometriosis is defined as the presence of endometrial glands and stroma outside the uterus. It affects 3 to 10 percent of women of reproductive age. Umbilical endometriosis is rare, with an estimated incidence of 0.5-1.0% among all cases of endometriosis, and is usually secondary to prior laparoscopic surgery involving the umbilicus. In this report, we described a case of umbilical endometriosis treated with surgical resection and highlight the great importance of medical history compared to complementary diagnostic tests that can be sometimes inconclusive.
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