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- Age-related expression of TGF beta family receptors in human cumulus oophorus cellsPublication . Ribeiro, A.; Freitas, C.; Matos, L.; Gouveia, A.; Gomes, F.; Silva Carvalho, J. L.; Almeida, H.During ovarian follicle growth, local cellular interactions are essential for oocyte quality acquisition and successful fertilization. While cumulus cells (CCs) nurture oocytes, they also deliver oocyte-secreted factors (OSFs) that activate receptors on CCs. We hypothesized that disturbance of those interactions contributes to age-related lower reproductive success in women submitted to assisted reproductive technology treatments.
- Cancro Hereditário dados da RAMPublication . Câmara, Sara
- Case Report: Septate Uterus in a Girl with Rubinstein–Taybi SyndromePublication . Coellho, Filipa de Castro; Câmara, Sara; Alves, Inés; Brazão, KathleenRubinstein–Taybi syndrome is an extremely rare plurimalformative condition that can affect any organ. However, reports regarding gynecological problems are unusual. We report the first case of a septate uterus in an adolescent with this syndrome, in agreement with the American Society for Reproductive Medicine (ASRM) and the Congenital Uterine Malformations by Expert (CUME) criteria for uterine septum. Additional studies are required to determine whether there is an increased frequency of m¨ullerian duct anomalies with the condition. Our report extends the data on the clinical phenotype associated with Rubinstein–Taybi syndrome.
- 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.
- 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.
- 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.
- Essure* present controversies and 5 years learned lessons: a retrospective study with short and long term follow-up.Publication . Câmara, Sara; de Castro Coelho, Filipa; Freitas, F; Remesso, LiliaThe risk.benefit of contraception with ESSURE* is being readressed due to na increase of reports of adverse effects with with this device. Our aim was to proceed to na interna quality evaluation and to identify opportunities for protocol improvement .We proceeded to a one-center, retrospective consecutive case series of women admitted for Essure* placement from 1 January 2012 until 31 December 2016(5 years).Results: In a total of 274 women, tecnhical difficulties were mainly unilateral, with na acute or short-term severe complications The procedure was brief, median 3.2 min, IQR 2.5-5.2 and moderately painful (median of 4 in a -0-10 scale; , IQ,3-5). At 3 months, the failure rate was 2%, with no pregnancies. etc...
- 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.
- Giant phyllodes tumour – Case report, oncoplastic treatment and literature controversiesPublication . Câmara, Sara; Gonzàlez-Farré, Xavier; Vargas-Moniz, JoãoPhyllodes tumour corresponds to 1% of breast primary tumours. Its primary treatment is presently surgical and, for several reasons, it usually requires breast reconstruction. First of all, an important breast volume is often removed, not only because it can easily achieve great dimensions, thanks to it fast growing potential, but also because wide excision is recommended to avoid its frequent but unpredictable local recurrence (meaning that ideal tumour resection margins are unknown). Second, it frequently affects young woman with more aesthetic concerns. We present a case of phyllodes tumour recurrence where oncoplastic surgery was necessary at both episodes and discuss the literature controversies on this subject, mainly related to treatment and prognosis prediction factors.
- Hormonal contraception and bleeding pattern changes: where do we stand?Publication . Castro Coelho, Filipa; Macedo, Francisco; Freitas, CláudiaUnscheduled bleeding is a major current problem in women's health. The management of bleeding pattern changes in women using hormonal contraception is challenging.Recommendations for the best practices are provided where evidence exists.This paper provides an updated review regarding the approach of unscheduled bleeding in women who use hormonal contraception.
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