Scielo RSS <![CDATA[Revista Brasileira de Ginecologia e Obstetrícia]]> http://www.scielo.br/rss.php?pid=0100-720320180008&lang=en vol. 40 num. 8 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Enhanced Recovery After Surgery (ERAS): New Concepts in the Perioperative Management of Gynecologic Surgery]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800433&lng=en&nrm=iso&tlng=en <![CDATA[Hazards of Repeat Pregnancy during Adolescence: A Case-control Study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800437&lng=en&nrm=iso&tlng=en Abstract Objective To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers. Methods A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues. Results Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults.Moreover, adolescents withmore than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy. Conclusion There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.<hr/>Resumo Objetivo Avaliar a associação entre fatores de risco sociais, obstétricos e psicológicos relacionados a repetição da gravidez em adolescentes. Métodos Estudo caso-controle realizado num Hospital Universitário de Campinas, Brasil, de 2015 a 2017. Foram selecionados três grupos: um grupo-caso de adolescentes com repetição de gravidez, e dois grupos controles, umde adolescentes primíparas e outro demulheres adultas com mais de umparto. Foram coletados dados referentes a aspectos sociodemográficos, história reprodutiva e obstétrica e fatores psicológicos. Resultados Foram incluídas 90 mulheres, 30 em cada grupo de estudo. Adolescentes comrepetição de gravidez apresentaram menor autoestima e mais uso inadequado de contraceptivos. Quando comparadas a adolescentes primíparas, tiveram menor nível escolar (razão de probabilidades [RP] 4.03 [1.37-11.8]), maior interrupção dos estudos (RP 16.3 [3.61-73.6]) e maior uso de drogas (RP 4.97[1.39-17.8]). A comparação entre adolescentes com repetição de gestação e mulheres adultas revelou maior risco para cor da pele não-branca (RP 6.2 [1.15-41.0]), uso de drogas (RP 17.5 [2.62-116.6]) e primeira relação sexual com menos de 15 anos 15y (RP 18.0 [2.82-115.0]). Além disso, as adolescentes com segunda gravidez apresentam menor autoestima, baixo uso de contracepção e maior suscetibilidade a gravidez não planejada. Conclusão Houve associação entre repetição de gravidez na adolescência e menor tempo de estudo, início precoce de atividade sexual, cor da pele não branca e maior uso de drogas. <![CDATA[Maternal Factors Associated with Low Birth Weight in Term Neonates: A Case-controlled Study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800444&lng=en&nrm=iso&tlng=en Abstract Objective To identify maternal factors associated with the presence of low birth weight in term neonates. Methods Matched hospital-based case-controlled study performed in a high complexity institution located in the city of Neiva, Colombia. The study included women with term gestation and singleton live fetuses. Patients with prior diseases, coming from other regions, with pregnancy resulting from assisted reproduction, or with a diagnosis of fetal abnormality or aneuploidy were excluded. Low birth weight was the dependent variable, and the independent variables that were analyzed were maternal sociodemographic and clinical characteristics. Adjusted and non-adjusted odds ratios (aOR and OR) together with the 95% confidence intervals (95% CI) were reported. Results The study included 270 participants (90 cases and 180 controls). Controlling for maternal age, educational level, socioeconomic and civil status, social security and the presence of maternal disease during gestation, it was found that weight gain (aOR 0.77, 95% CI 0.70-0.85) and the absence of prenatal care (aOR 8.20, 95% CI 3.22-20.87) were among the factors associated with low birth weight. Conclusions The absence of weight gain and of prenatal care are factors associated with the presence of low birth weight in term neonates and should be considered in clinical practice.<hr/>Resumo Objetivo Identificar fatores maternos associados à presença de baixo peso ao nascer em neonatos a termo. Métodos Estudo de caso-controle realizado emuma instituição de alta complexidade localizada na cidade de Neiva, Colômbia. O estudo incluiu mulheres com gestação a termo e fetos vivos únicos. Pacientes com doenças prévias, provenientes de outras regiões, com gravidez resultante de reprodução assistida, ou com diagnóstico de anormalidade fetal ou aneuploidia foramexcluídos. O baixo peso ao nascer foi a variável dependente, e as variáveis independentes analisadas foram as características sociodemográficas e clínicas maternas. Razões de chance ajustadas e não ajustadas (RCa e RC) juntamente com os intervalos de confiança de 95% (IC 95%) foram relatadas. Resultados O estudo incluiu 270 participantes (90 casos e 180 controles). Controlando a idade materna, nível escolar, socioeconômico e civil, segurança social e a presença de doença materna durante a gestação, constatou-se que ganho de peso (RCa 0,77, IC 95% 0,70-0,85) e ausência de pré-natal (RCa 8,20, IC 95% 3,22-20,87) estavam entre os fatores associados ao baixo peso ao nascer. Conclusão As ausências de ganho ponderal e de pré-natal são fatores associados à presença de baixo peso ao nascer em recém-nascidos a termo e devem ser considerados na prática clínica. <![CDATA[Gene Polymorphisms in FAS (Rs3740286 and Rs4064) Are Involved in Endometriosis Development in Brazilian Women, but not those in CASP8 (rs13416436 and rs2037815)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800450&lng=en&nrm=iso&tlng=en Abstract Objective The present study aims to investigate the association between caspase-8 (CASP8) (rs13416436 and rs2037815) and Fas cell surface death receptor (FAS) (rs3740286 and rs4064) polymorphisms with endometriosis in Brazilian women. Methods In the present case-control study, 45 women with a diagnosis of endometriosis and 78 normal healthy women as a control group were included. The genotyping was determined by real-time polymerase chain reaction (PCR) with Taqman hydrolysis probes (Thermo Fisher Scientific, Darmstadt, Germany). Genotypic and allelic frequencies were analyzed using Chi-squared (χ2) test. In order to determine the inheritance models and haplotypes ,SNPStats (Institut Català d’Oncologia, Barcelona, Spain) was used. Levels of 5% (p = 0.05) were considered statistically significant. Results No significant difference was observed in genotypic or allelic frequencies between control and endometriosis groups for rs13416436 and rs2037815 (CASP8 gene). On the other hand, a significant difference between rs3740286 and rs4064 (FAS gene) was found. Regarding polymorphisms in the FAS gene, a statistically significant differencewas found in co-dominant and dominantmodels. Only the haplotype containing the rs3740286A and rs4064G alleles in the FAS gene were statistically significant. Conclusion The polymorphisms in the CASP8 gene were not associated with endometriosis. The results indicate an association between FAS gene polymorphisms and the risk of developing endometriosis.<hr/>Resumo Objetivo Investigar a associação entre os polimorfismos dos genes caspase-8 (CASP8) (rs13416436 e rs2037815) e FAS (rs3740286 e rs4064) em mulheres brasileiras com endometriose. Métodos Trata-se de um estudo do tipo caso-controle, no qual foram incluídas 45 mulheres com diagnóstico de endometriose e 78 controles. A genotipagem das amostras foi determinada usando a reação em cadeia de polimerase em tempo real com sondas de hidrólise TaqMan (Thermo Fisher Scientific, Darmstadt, Germany). As frequências genotípicas e alélicas foram analisadas usando o teste do qui-quadrado. O SNPStats (Institut Català d’Oncologia, Barcelona, Espanha) foi usado para determinar os modelos de herança e os haplótipos. Os níveis de significância estatística considerados foram de 5% (p = 0,05). Resultados Não foi observada diferença significativa nas frequências genotípicas ou alélicas entre os grupos de controle e de endometriose para os polimorfismos rs13416436 e rs2037815 (gene CASP8). Por outro lado, foi encontrada uma diferença significativa entre os polimorfismos rs3740286 e rs4064 (gene FAS). Em relação aos polimorfismos do gene FAS, foi encontrada uma diferença estatisticamente significativa nos modelos codominante e dominante. Apenas o haplótipo contendo os alelos rs3740286A e rs4064G no gene FAS foi estatisticamente significativo. Conclusão Não há associação entre os polimorfismos do gene CASP8 e endometriose. Entretanto, há associação entre os polimorfismos do gene FAS e o risco de desenvolver endometriose. <![CDATA[Frozen Section in the Management of Ovarian and Uterine Tumors: The Past 5 Years in a Tertiary Centre]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800458&lng=en&nrm=iso&tlng=en Abstract Objective Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is. Methods A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion. Results A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma. Conclusion The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.<hr/>Resumo Objetivo O diagnóstico intraoperatório por congelação é umrecurso importante cujo uso empatologia ginecológica não tem sido suficientemente enfatizado. O objetivo do presente estudo foi avaliar as taxas de concordância entre o diagnóstico intraoperatório por congelação e o estudo anatomopatológico definitivo e determinar o quanto o diagnóstico intraoperatório por congelação é um método confiável. Métodos Um estudo retrospectivo de todos os diagnósticos intraoperatórios por congelação realizados em tumores uterinos e massas anexiais suspeitas entre janeiro e 2012 e dezembro de 2016 (excluindo metástases) no serviço de ginecologia e obstetrícia do Centro Hospitalar Tondela Viseu. Comparação do diagnóstico intraoperatório por congelação com o resultado do estudo definitivo em relação ao tipo histológico do tumor e profundidade de invasão miometrial. Resultados Um total de 286 casos foram elegíveis para o estudo, incluindo 102 (35.7%) tumores uterinos e 184 (64.3%) tumores ovarianos. A taxa global de casos deferidos foi de 5.2% (15/286). Entre os tumores uterinos, a acuidade de diagnóstico nos casos de carcinoma endometrial foi de 96.25% (77/80). Entre os tumores ovarianos, não se verificou concordância em 2 casos (1.1%), correspondendo a um tumor borderline do tipo seroso e a um adenocarcinoma de células claras intracístico. Conclusão O diagnóstico intraoperatório por congelação apresenta-se com um importante papel em situações selecionadas, sendo acompanhado de elevada taxa de sensibilidade e especificidade para tumores endometriais e ovarianos. A sua elevada acuidade diagnóstica encontra-se associada à possibilidade de obter um tratamento cirúrgico adequado na primeira abordagem cirúrgica <![CDATA[A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800465&lng=en&nrm=iso&tlng=en Abstract Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using lowcost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.<hr/>Resumo Objetivo Descrever e avaliar a utilização de um simulador simples, de baixo custo e reprodutível para o ensino de sutura de lacerações perineais de 4° grau. Métodos Participaram da simulação 20 residentes de ginecologia e obstetrícia e quatro profissionais especialistas. Um modelo de laceração de 4° grau foi criado com materiais de baixo custo (preservativo simulando a mucosa retal, tecido de algodão simulando o esfíncter anal interno e carne bovina simulando o esfíncter anal externo). O simulador foi inicialmente montado com ajuda de fotos anatômicas, para estudar a anatomia e o significado de cada componente do modelo. A laceração foi criada e suturada, utilizando técnicas de borda a borda e de sobreposição do esfíncter anal. Resultados O modelo custou menos de R$ 10,00 e foi montado sem dificuldade, aprimorando os conhecimentos dos participantes sobre anatomia e fisiologia. As suturas das camadas (mucosa retal, esfíncter interno e esfíncter externo) foram realizadas seguindo a técnica cirúrgica. Todos os participantes ficaram satisfeitos coma simulação e consideraram que estamelhorou seus conhecimentos e habilidades. Entre 3 a 6 meses após o treinamento, 7 participantes presenciaram em sua prática lacerações graves e relataram que a simulação foi útil para a correção cirúrgica. Conclusão A utilização de um simulador para treinamento de sutura de lacerações obstétricas graves é acessível (baixo custo e fácil execução). A simulação parece aprimorar conhecimentos e habilidades cirúrgicas para sutura de lacerações graves. Mais estudos sistematizados devem ser realizados para avaliação. <![CDATA[Prenatal Care and Hypertensive Gestational Syndromes: A Systematic Review]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800471&lng=en&nrm=iso&tlng=en Abstract Objective Evaluate the influence of prenatal care on the occurrence of gestational hypertension. Methods The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103). Results The seven studies hada lowriskof bias,withmethodological quality scores ranging fromsix to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size. Conclusion Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.<hr/>Resumo Objetivo Avaliar a influência da assistência pré-natal no acometimento de síndromes hipertensivas gestacionais. Métodos A revisão buscou artigos publicados nas plataformas eletrônicas de pesquisa Web of Science, Scopus, Pubmed, Cochrane e Clinical Trials, sem restrições de linguagem e com os artigos publicados entre 01/01/2012 e 31/12/2016. Os descritores utilizados foram: assistência pré-natal, assistência médica, educação pré-natal, hipertensão induzida pela gravidez, gestação. Foi utilizado o checklist preferred reporting items for systematic reviews and meta-analyses PRISMA. A busca na literatura, de acordo com a estratégia adotada, identificou 240 artigos. Contudo, somente 7 artigos foram selecionados de acordo com os critérios de inclusão. A revisão sistemática foi incluída no registro prospectivo internacional de revisões sistemáticas (PROSPERO, na sigla em inglês; #CRD42017064103). Resultados Cinco estudos encontraram relação positiva entre a assistência pré-Natal e síndromes hipertensivas gestacionais. Dois estudos não encontraram uma associação estatística significativa entre estas duas variáveis. Os sete estudos apresentam um baixo risco de viés, com as pontuações na análise de qualidade variando entre seis e oito. As possíveis diferenças entre os achados podem ser devidas ao momento do diagnóstico das síndromes hipertensiva gestacionais, tipo de serviço onde foi realizada a pesquisa e o tamanho amostral. Conclusão Embora os estudos apresentem diferentes aspectos metodológicos, observou-se a importância da implementação da Assistência Pré-Natal durante o período gestacional, o que atuará como medida de promoção e prevenção em saúde. <![CDATA[Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800477&lng=en&nrm=iso&tlng=en Abstract Objective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39- 0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. Therewas no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.<hr/>Resumo Objetivo comparar tratamentos cirúrgicos para incontinência urinária de esforço (IUE), quanto à eficiência e complicações, por meio de revisão sistemática seguida de metanálise. Fonte dos dados Fizemos busca nas bases de dados MEDLINE e COCHRANE, utilizando os termos stress urinary incontinence, surgical treatment for stress urinary incontinence e sling. Seleção dos estudos Selecionamos 48 estudos, totalizando 6.881 pacientes com pontuação igual ou maior do que 3 na escala de Jadad. Coleta de dados Cada estudo foi lido por um autor, colocado em tabela, e checado por outro autor. Extraímos dados como detalhes das intervenções, tempo de seguimento, resultados do tratamento e eventos adversos. Síntese dos dados Não houve diferença nas comparações: sling de uretra média versus cirurgia de Burch, quanto às curas objetiva (razão de chances [RC]: 1,29; intervalo de confiança de 95% [IC95%]: 0,76-2,20) e subjetiva (RC: 1,16; IC95%: 0,67- 2,00); sling de uretramédia transobturatório outside-in versus inside-out quanto às curas objetiva (RC: 0,78; IC95%: 0,45-1,35) e subjetiva (RC: 0,83; IC95%: 0,58-1,18); sling pubovaginal e de uretra média quanto à cura objetiva (RC: 1,64; IC 95%: 0,52-5,15). Comparando sling retropúbico comtransobturatório, o retropúbico foi superior quanto às curas objetiva (RC: 1,27; IC95%: 1,05-1,54) e subjetiva (RC: 1,23; IC95%: 1,02-1,48). Entre minislings e outros slings, houve diferença favorável a outros slings quanto à cura subjetiva (RC: 0,58; IC95%: 0,39-0,86) mas não quanto à cura objetiva (RC: 0,72; IC95%: 0,47-1,10). No grupo sling pubovaginal e Burch, houve diferença quanto à cura objetiva (RC: 2,04; IC95%: 1,50-2,77) e subjetiva (RC: 1,64; IC95%: 1,10-2,44). Slings de uretra média apresentam mais erosão, enquanto a cirurgia de Burch tem mais complicações na ferida operatória e infecção do trato urinário. Slings retropúbicos e pubovaginais sãomais retencionistas. Slings retropúbicos estãomais associados a lesão vascular, hematomas e perfuração vesical, e transobturatórios, à dor na perna e virilha, lesão neurológica e perfuração vaginal. Conclusão Slings pubovaginais são superiores à cirurgia de Burch, porém mais retencionistas. Slings retropúbicos são superiores aos transobturatórios, embora tenham mais eventos adversos. Outros slings são superiores aos minislings em relação ao aspecto subjetivo. Não houve diferença nas comparações entre slings de uretra média e cirurgia de Burch, slings pubovaginais, transobturatórios inside-out e inside-in. <![CDATA[Fine-needle Aspiration Cytology to Identify a Rare Mimicker of Breast Cancer: Plasma Cell Mastitis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800491&lng=en&nrm=iso&tlng=en Abstract There are rare benign diseases that can mimic malignant breast neoplasms in the clinical exam and in mammography. We evaluated the contribution of an accessible procedure to most clinicians, the fine-needle aspiration cytology, to identify a rare mimicker of malignant breast neoplasms. A type 2 diabetic 85-year-old female presented with a 6-month history of a left breast lump. The physical exam and mammography were compatible with breast cancer. Nevertheless, after fine-needle aspiration cytology, the diagnosis was plasma cellmastitis. Once this rare diagnosis was established, the tumor was extirpated, and the final histologic diagnosis corroborated chronic plasma cellmastitis. The patient’s postoperative evolution was uneventful, and no other treatment was needed. Fine-needle aspiration cytology could be a valuable tool to identify rare mimickers of malignant breast neoplasms.<hr/>Resumo Existem doenças benignas raras que podem mimetizar neoplasias malignas de mama no exame clínico e na mamografia. Avaliamos o valor de um procedimento acessível para a maioria dos clínicos, a citologia por aspiração com agulha fina, para identificar um imitador raro de neoplasias malignas de mama. Uma mulher de 85 anos com diabetes tipo 2 apresentou histórico de 6 meses de um nódulo no seio esquerdo. O exame físico e a mamografia foram compatíveis com câncer de mama. No entanto, após realizar uma citologia por aspiração com agulha fina, o diagnóstico foi mastite celular plasmática. Uma vez que este diagnóstico raro foi estabelecido, o tumor foi extraído e o diagnóstico histológico final corroborou a mastite crônica das células plasmáticas. A paciente teve uma boa evolução pós-operatória, e nenhum outro tratamento foi necessário. A citologia por aspiração com agulha fina pode ser uma ferramenta valiosa para identificar os raros mimetizadores de neoplasias malignas da mama. <![CDATA[Conservative Surgical Treatment of a Case of Placenta Accreta]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800494&lng=en&nrm=iso&tlng=en Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received <![CDATA[Abortion and Zika Virus Congenital Infection]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800497&lng=en&nrm=iso&tlng=en Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received <![CDATA[Answer - Abortion and Zika Virus Congenital Infection]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800498&lng=en&nrm=iso&tlng=en Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received <![CDATA[Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800499&lng=en&nrm=iso&tlng=en Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received <![CDATA[Answer - Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032018000800500&lng=en&nrm=iso&tlng=en Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received