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Abstract Objective The study aimed to determine the level of anemia in pregnant women in the first trimester and in the preconception period by conducting nationwide research. Methods The study was designed as retrospective, cross-sectional, and multicenter research. A total of 17 centers from 13 provinces were included in the study. The study was conducted with the participation of two groups of patients who applied to the obstetrics polyclinic between 1 January 2023 and 1 July 2023, who were in the first trimester of pregnancy and who were in the preconception period planning pregnancy. Results In total 4,265 women were included in the study. Of these women, 3,884 (91%) were in the first trimester of their pregnancy and 381 (9%) were in the preconception period. Anemia was detected in 24.1% (n=1030) of the patients. Of these patients, 20.6% (n=877) were pregnant women in the first trimester and 3.6% (n=153) were in the preconception period. A statistically significant and positive relationship was found between anemia and meat consumption frequency, educational status, and socioeconomic status of the patients (p=0.000, p=0.000, p=0.000). In addition, a statistically significant and negative correlation was determined between anemia and the number of pregnancies and the parity number (p=0.001, p=0.000) in both groups. Conclusion Anemia is a public health problem. Anemia has been determined to be an important problem both in the preconception period and early periods of pregnancy. It is necessary to revise the programs and interventions to reduce the prevalence of anemia and redesign them in line with current conditions.

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Abstract Objective: This study aimed to verify the relation between gastrin-releasing peptide receptor (GRPR), oncogenic Human Papillomavirus (HPV) and cervical lesions severity. Methods: GRPR mRNA levels were evaluated in cervical cancer-derived cell lines and in primary keratinocytes expressing HPV16 oncogenes by RT-PCR. GRPR protein expression was assessed by immunohistochemistry in organotypic cell cultures derived from keratinocytes transduced with HPV16 oncogenes and in 208 cervical samples, including 59 non-neoplastic tissue, 28 cervical intraepithelial neoplasia grade 3 (CIN3), 44 squamous cell carcinomas (SCC) and 77 adenocarcinomas (ADC). Generic primers (GP5+/GP6+) were used to identify HPV infection in tissue samples. Experiments involving cell lines were analyzed through non-parametric tests (Kruskal Wallis), and Fisher's Exact Test for human tissues samples. All statistical tests were considered significant at p <0.05. Immunohistochemical evaluation was conducted independently and blindly by two observers (AD- LO). Any discordant findings were resolved through discussion to reach a consensus score. Results: GRPR mRNA levels were not increased in cells expressing HPV16 or HPV18 oncogenes. However, at the protein level, GRPR was upregulated in organotypic cell cultures containing HPV oncogenes. Besides, it was identified an association between GRPR expression and cervical lesion severity (p < 0.0001). The detection rate of high-risk HPV DNA was directly correlated with cervical disease. Nonetheless, HPV infection was not directly associated with GRPR in cervical samples. Conclusion: GRPR expression is highly predictive of cervical lesion severity, irrespective of HPV infection and might contribute to improving patient's therapeutic management as well as being used a marker of disease progression.

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Abstract Objective: To determine the validity of the angle of progression (AoP) in predicting delivery mode among women in the second stage of labor. Designs: This prospective cohort study was conducted at the Obstetrics and Gynecology unit (OBGYN) of two hospitals in Vietnam. Transperineal ultrasound was performed for each woman to measure the progression angle in the second phase of labor. data were collected from Participants: A total of 725 women with singleton pregnancies with cephalic presentation at term Methods: Transperineal ultrasound was used to measure the angle of progression in the second labor phase and to identify the delivery method. Results: The rate of vaginal birth in women with an AoP ≥ 120° on transperineal ultrasound was 70.2%. The optimal cutoff point of AOP ≥122° with sensitivity and specificity for vaginal birth were 87.8% and 80.7%, respectively the area under the ROC curve of 0.887 (p<0.0001). The study's sample size was restricted owing to deficiencies in resources and time. Conclusion: The likelihood of achieving spontaneous vaginal delivery can be predicted by the angle of progression measured with transperineal intrapartum ultrasonography during the second stage of labor in women.

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Abstract Objective: To investigate the relationship between prematurity and cesarean section rate in Brazil during the beginning of COVID-19 pandemic. Methods: Utilizing the Robson Classification, this study analyzed data from the Brazilian Ministry of Health's Live Births Panel, comparing CSR) and group 10 (preterm deliveries) between 2019 (pre-pandemic) and 2021 (pandemic) in each of Brazilian states and the overall country. The prematurity and CSR were compared using prevalence ratio and confidence interval, and p-value was obtained. The variation of prematurity and CSR were compared through the coefficient of determination (R2). Results: A total of 5,522,910 deliveries were evaluated during the period. The CSR increased from 56.34% to 57.05% (p<0.01), and the frequency of preterm deliveries rose from 8.99% to 9.13% (p<0.01). The CSR increased in 23 States and decreased in 4 States, while the prematurity rate increased in 16 States and decreased in 10 States. A positive relationship between the increase of CSR and prematurity was observed during COVID-19, with an R2 value of 0.3121, suggesting a moderate association between these two variables. Conclusion: Between 2019 (pre-COVID-19 pandemic) and 2021 (the first full year of the COVID-19 pandemic), there was an increase in prematurity and CSR in Brazil. These increases were observed in most Brazilian states and may be correlated. However, it is impossible to establish a cause-effect relationship given the design of this study.

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Abstract Objective: To describe women's experience of pregnancy during the COVID-19 pandemic. Methods: A qualitative study conducted in a private maternity hospital, from May, 2020 to November, 2021, with women aged ≥ 18 years, gestational age ≥ 36 weeks at birth and ≥ 24 hours post-partum. Data collected through semi-structured interviews, recorded, transcribed, and analyzed adopting Krippendorff's Content Analysis as theoretical-methodological framework. Results: Four main themes emerged: Fear, Taking care and celebrating pregnancy: adjusting to the new reality, Harms of Isolation, and Benefits of Isolation. The fear of contamination and its impact on the health of mother and child resulted in the adoption of severe social isolation, including from those considered sources of support by the expecting mother. Overwhelmed, some of the participants reported loneliness and psychic suffering. The opportunity to focus on the pregnancy, the preparations for the arrival of the child, and the family made isolation a beneficial and positive period for other women. Conclusion: The experience of pregnancy in the Pandemic was an event outside of the ordinary and common. The expecting mother faced her worst fears on a daily basis and attended prenatal care, in order to ensure her child would be born healthy. The celebration of the baby's life, amid so many deaths, had to be adjusted to the virtual environment. It was a tense, solitary, and ambiguous period, which demanded a lot from the mental health of some participants, but to others, brought advantages that would not have been possible in different times.

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Abstract Objective: To evaluate anxiety, depression, sexual function and quality of life in women with hyperprolactinemia. Methods: Cross-sectional study with 80 women divided into two groups: 30 women with hyperprolactinemia (Study Group) followed and treated at the endocrine gynecology outpatient clinic and 50 women without hyperprolactinemia, with regular menstrual cycles (Control Group) followed at the family planning outpatient clinic of the State University of Campinas from June 2021 to October 2022. Sociodemographic characteristics, quality of life (SF-36 Questionnaire), sexual function (Female Sexual Function Index Questionnaire), depression (Beck Depression Inventory) and anxiety (Beck Anxiety Scale) were evaluated in both groups. Categorical variables were described as absolute frequency and percentage; numerical variables as mean and standard deviation. Comparison of numerical variables between two groups was performed by Mann-Whitney test, while categorical were compared by Chi-Square or Fisher's exact tests. Results: The mean age of women with hyperprolactinemia was 39.6±8.1 years and the Control Group was 31.2±9.5 years (p<0.001). There was no difference in anxiety scores (p=0.66), depression (p=0.08) and general sexual function (p=0.08) in both groups. However, women with hyperprolactinemia had lower scores in the domains of pain and arousal and worse functional capacity than Control Group (p<0.05). Conclusion: Women with hyperprolactinemia under treatment do not show any impairment in their anxiety, depression and sexual function when compared to women without hyperprolactinemia. However, analysis of quality of life showed that women with hyperprolactinemia have poor functional capacity.

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Abstract Objective: This study aims to assess the rate of pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant therapy and to explore its correlation with clinical, molecular, and prognostic factors. Methods: We conducted this retrospective observational study at Liga Contra o Câncer, a major public oncology reference center in Northeast Brazil. We included patients diagnosed with breast cancer who initiated neoadjuvant therapy between June 2018 and June 2019. Patients with a history of recurrent breast cancer or those who did not undergo surgery were excluded. The primary outcome was the pCR rate, with secondary outcomes including Overall Survival (OS), Disease-Free Survival (DFS), mortality, and disease recurrence. Follow-up extended until August 2022. We performed multivariate Cox regression analysis to correlate outcomes with predetermined variables. Results: Of the 292 included patients, 63 (21.6%) achieved pCR. The mean follow-up duration was 42.8 months. Multivariate logistic regression analysis revealed an association between pCR and the AC-TH regimen [OR = 2.4; 95%CI = 1.13 - 5.24; p=0.023], as well as between pCR and HER2-positive tumors [OR 2.49; 95% CI = 1.14 - 5.86; p=0.028]. Complete pathological response was associated with higher DFS [HR 0.33; 95%CI 0.13-0.86; p=0.024]. Conclusion: Neoadjuvant therapy demonstrated significant efficacy in achieving pathological response in breast cancer patients. We observed a strong association between the AC-TH regimen, HER2-positive status, and pCR.

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Abstract Objective: This study described the clinical and epidemiological profile and the management provided to pregnant and postpartum women with COVID-19 who required respiratory support. Methods: A descriptive study was conducted with pregnant and postpartum women with confirmed COVID-19 who received care between April 2020 and December 2021 in eight referral centers in northeastern Brazil. Statistical analysis was conducted using Epi-Info 7.2.5 and Medcalc, version 20.112. Results: Of the 720 patients admitted, 208 (32.7%) required respiratory support. Mean age of the participants was 28.9±7.1 years. Most (52.8%) were brown-skinned; 31.3% had little formal schooling; 41.1% had a personal income and 23.1% were married. Around half were referred from another hospital. Overall, 36.8% were obese and 36.9% were hypertensive. Criteria for severe acute respiratory syndrome (SARS) were present in 80.7% of cases. Overall, 151 patients (74.7%) required corticoids, and 150 (76.1%) were admitted to an intensive care unit. Non-invasive ventilation was needed in 89.4% of cases, with nasal catheters being the most common type (55.3% of cases). Invasive mechanical ventilation was necessary in 35.5% of cases and 91.6% had a cesarean section. Maternal near miss and death occurred in 24% and 12.9% of cases, respectively. Conclusion: Pregnant and postpartum women with COVID-19 who required respiratory support were predominantly brown-skinned, in the third trimester of pregnancy and had been referred from another hospital. The cesarean section rate was high; the presence of criteria for SARS was common and the rates of COVID-19-related maternal near miss and death were high. Clinical Trials registry: NCT04462367

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Abstract Objective: This study aims to examine the effects of sociodemographic and obstetric factors on traumatic birth perception and breastfeeding attitudes in primiparous mothers who have had a vaginal birth in the early postpartum period. Methods: The sample of the research, developed with a cross-sectional and correlational design, consisted of 252 women residing in a province in the Western Black Sea region of Türkiye. The data were obtained by employing a Personal Information Form, Traumatic Childbirth Perception Scale, and Breastfeeding Attitudes of The Evaluation Scale. Data analysis was conducted using the statistical programming language R (R version 4.3.3). Results: Women who were not employed, had a planned pregnancy, and did not experience health problems during pregnancy had higher mean breastfeeding attitude scores, and this difference was statistically significant. It was determined that a one-unit increase in gestational week led to an average increase of 1.926 units in breastfeeding attitude score, and a one-unit increase in Traumatic Childbirth Perception Scale score led to an average decrease of 0.110 units in breastfeeding attitude score. The mean traumatic childbirth perception scores of women living in urban areas were found to be lower than those living in villages or towns, and the difference was statistically significant. Conclusion: The research findings indicate that gestational age, perception of traumatic childbirth, and certain sociodemographic factors significantly affect breastfeeding attitudes. Additionally, mothers living in urban areas have a lower perception of traumatic childbirth. Therefore, individualized approaches to childbirth and breastfeeding support are crucial.

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Abstract Objective: To investigate the association between lifetime experience of domestic violence and climacteric symptoms, sexual function, and quality of life in climacteric women in Rio Grande do Sul, Brazil. Methods: A cross-sectional study was conducted with 700 pre-, peri-, and postmenopausal women, recruited online via an anonymous questionnaire (REDCap platform). Women aged 40 to 65 years, residing in Rio Grande do Sul, and classified by the STRAW+10 criteria were included. Climacteric symptoms and sexual function were assessed using the 10-item Cervantes Scale (CS-10) and the 6-item Female Sexual Function Index (FSFI-6). Data were analyzed using SPSS version 18.0; quantitative data as median [IQR], qualitative as frequencies. Group comparisons used Kruskal-Wallis, Chi-Square, and Spearman's correlation between violence against women (VAW) and/or climacteric groups on CS-10 or FSFI-6. Significance was set at 5%. Results: The median [IQR] age of pre- (46 [43 - 50] years), peri- (50 [47 – 52] years), and postmenopausal (55 [51 – 58] years) were different among groups. Prevalence rates of psychological (38.8%), sexual (34.9%), and physical (21.3%) violence were observed. Postmenopausal women showed the poorest outcomes. Premenopausal women experiencing violence had severe anxiety, while postmenopausal women reported feeling worthless. Various sexual dysfunctions were associated with violence, including low desire, lubrication issues, and sexual pain. Conclusions: Domestic violence was linked to worse climacteric symptoms, sexual function, and quality of life, particularly in postmenopausal women. These findings underscore the need for improved care and public policies to enhance safety and well-being among women of all ages.

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Abstract Objective: This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×platelet×monocyte)/lymphocyte)], SII (neutrophil×platelet/lymphocyte), and NLR neutrophil/lymphocyte) values were evaluated in all three trimesters, and their correlation with neonatal outcomes was examined. Methods: We included 82 cases of PGDM pregnancies delivered after 32 weeks. Maternal age, gravidity, parity, types of diabetes, and route of delivery were noted. For neonatal outcomes, we recorded gestational age at birth, birth weight percentile, existence of fetal growth restriction, LGA, neonatal intensive care unit (NICU) requirement, Apgar Score <7 at 1, 5, or 10 minutes, need for positive pressure ventilation (PPV), need for mechanical ventilation, hypoglycaemia, hyperbilirubinemia and the need for phototherapy. PIV, SII and NLR values were calculated in each trimester and their association with adverse neonatal outcomes was analyzed. Results: We could not detect any consistent and significant correlation between SII and PIV values and adverse neonatal outcomes for each trimester. There was a correlation between 3rd trimester NLR and adverse neonatal outcomes, including APGAR <7, the requirement for PPV and mechanical ventilation (p=0.056, 0.013 and 0.060, respectively). Conclusion: While SII and PIV values did not consistently correlate with adverse neonatal outcomes throughout each trimester in PGDM pregnancies, 3rd-trimester NLR showed a notable association with the requirement for PPV with statistical significance and with Apgar Score <7 and the requirement for mechanical ventilation without statistical significance. NLR in the third trimester may hold potential as a predictive marker for specific adverse neonatal outcomes in PGDM pregnancies, warranting further investigation.

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Abstract Objective: This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes. Methods: This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses. Results: A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 – 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 – 0.853); P=0.002]. Conclusion: The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.

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Abstract Objective: In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents the imbalance between the production of reactive oxygen species and their detoxification. Total Antioxidant and Oxidant Status, and Oxidative Stress Index levels are the main oxidative stress markers. This study investigated the effects of oxidative stress markers on infertility etiology, embryo quality, and success of In vitro fertilization. Methods: Before enrolling in the ICSI-ET cycle, participants had their FSH and LH levels assessed on the second day of the cycle. The ovarian degrees of the participants were evaluated by transvaginal ultrasonography. Participants underwent controlled ovarian stimulation using the GnRH antagonist protocol. TV-USG and serial E2 measurements were performed at appropriate intervals to follow follicular development. Follicle sizes, quantity, and endometrial thickness were recorded. Total Antioxidant and Oxidant Status, and Oxidative analyses were conducted using Rel Assay Diagnostics Assay Kits. Results: The average number of total oocytes in the participants was 10.25±6.66, and the average of mature M2 stage oocytes was 6.71±3.72. The average number of fertilized oocytes was 4.65±2.81. Fertilization rates were calculated as approximately 54.75±25.58%. A statistically significant positive correlation was found between embryo quality and serum Total Antioxidant Status levels (p=0.004). Similarly, a significant positive correlation was observed between embryo quality and follicular Total Antioxidant Status values (r = 0.42, p = 0.01). Conclusion: This study concluded that oxidative stress markers affect certain stages of the IVF treatment process.

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Abstract Objective: This study aimed to evaluate the prevalence of antiphospholipid syndrome (APS) among women experiencing recurrent pregnancy loss (RPL). Methods: A cross-sectional was conducted, reviewing the medical records of 134 women with a history of two or more miscarriages, treated between January 2014 and May 2024 at a tertiary university center in Belo Horizonte, Brazil. APS screening was performed by assessing anticardiolipin (IgG and IgM), lupus anticoagulant, and anti-β2-glycoprotein-1 (IgG and IgM) antibodies, based on Sapporo criteria. All tests were performed during non-pregnant periods and at least 12 weeks after the last miscarriage. Results: The study included 134 women with a mean age of 33.8 ± 5.7 years. The number of prior miscarriages ranged from 2 to 11 per couple. Among the patients who presented the lupus anticoagulant, only two (1.49%) tested positive in two samples, as per revised Sapporo criteria. Considering IgG and IgM anticardiolipin antibodies, four patients (2.98%) tested positive in two samples according to old Sapporo criteria, with one patient having a positive IgG test in two samples, two having positive IgM in two samples and a single patient having both positive tests. None of the 56 patients tested positive for anti-β2-glycoprotein-1 antibodies in two samples. Conclusion: The prevalence of antiphospholipid antibodies, in line with revised Sapporo criteria, is low among Brazilian women with recurrent pregnancy loss, consistent with recent studies in literature. Ensuring the appropriateness of diagnostic criteria is crucial to avoid unnecessary treatment with platelet anticoagulants and heparin in this population.

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Abstract Objective: Analyze the hysterectomy rates per resident in graduation year in teaching hospitals in the state of São Paulo (Brazil). Methods: We selected teaching hospitals in the state of São Paulo and gathered information from two public databases to estimate the hysterectomy rates per resident in their final year of training between 2009 and 2019. Results: Between 2009 and 2019, there was a 37.5% increase in the number of residents in their final year of training, a 4.31% increase in the number of hysterectomies, and a drop in the hysterectomy rates per resident of 24.1%. The reduction of the rate of hysterectomy per resident was more pronounced for vaginal route (46.4%) followed by abdominal route (23.3%). The ratio of laparoscopic hysterectomy per resident increased 264% during the period, however, this route was used in only 7% of the surgeries in 2019. Conclusions: The hysterectomy rates per resident in their final year of training showed a notable reduction. This trend, particularly pronounced in vaginal and abdominal routes, signals a shift towards minimally invasive techniques.

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Abstract Objective: This study aimed to evaluate the results of the Obstetric Hemorrhage Prevention and Management Course – Zero Maternal Death by Hemorrhage Strategy (0MMxH) among healthcare professionals before and after participation. Methods: A quasi-experimental design was employed, assessing the educational intervention in a convenience sample of healthcare professionals who had participated in the 0MMxH at least one year prior. Participants completed a retrospective pre-post questionnaire sent via email, focusing on self-perceived knowledge levels and the adoption of best practices in postpartum hemorrhage (PPH) management. Results: Out of 129 professionals who completed the 0MMxH training, 85 (65.9%) responded to the questionnaire. The percentages of respondents reporting no or low knowledge before and after the course were: shock index (52.8% to 0%, before and after, respectively), blood loss estimation (35.2% to 1.1%), care sequence for PPH (44.6% to 0%), rational use of crystalloids (37.5% to 1.1%), non-pneumatic anti-shock garment (83.5% to 3.4%), and damage control surgery (74.1% to 8.1%). These results indicate a significant improvement in self-perceived knowledge. After the course, the highest adoption rates of best practices were for shock index (83.5%), blood loss estimation (67.1%), and use of warm crystalloids (58.8%). However, gaps remained regarding non-pharmacological interventions for PPH management. Conclusion: Participants reported improved knowledge on most topics covered by the 0MMxH. The program was recognized as a crucial factor in adopting effective PPH management practices, underscoring the importance of training in enhancing obstetric care.

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Abstract Objective: A combination of chemotherapy and pelvic radiotherapy is recommended to treat locally advanced cervical cancer (CC), which has been associated with acute and chronic toxicities, especially radiation proctitis (RP). The objective of this study was to evaluate the frequency of RP and treatment management in females with CC who underwent pelvic radiotherapy at an oncology referral hospital. Methods: This cross-sectional study analyzed the medical records of patients treated with radiotherapy for CC between 2015–2017. We assessed sociodemographic, lifestyle, cancer, treatment, and clinical variables. We identified 298 records of females with CC who underwent pelvic radiotherapy during the defined period. Of these, 14 records were duplicates, 25 were excluded for lacking essential information, and 33 were missing in the archive. Accordingly, 226 relevant medical records were analyzed, with data regarding sociodemographic, clinical, cancer-related, treatment-related, and RP-related variables collected. Pearson's chi-square test was used to compare symptomatic and non-symptomatic patients. Fisher's exact test was used to compare chemotherapy doses. Statistical analysis was performed with Stata V12.1. A P-value less than 0.05 was considered significant. Results: The median patient age was 48 years (interquartile range 38–61). Patients predominantly had CC stages IIB and IIIB (>70%). Of the 226 females analyzed, 87(38.5%) experienced RP symptoms, represented by rectal bleeding; of these, 59 underwent colonoscopy, confirming RP in 58(98.3%). Accordingly, of the 226 females analyzed, 58(25.7%) had a confirmed diagnosis of RP. There was a statistically significant association between rectal bleeding and cumulative radiation dose (P < 0.001) and the presence of systemic arterial hypertension (P = 0.036). Regarding treatment, 38(65.5%) participants underwent argon plasma coagulation (APC), and of these, 22(57.9%) had no post-treatment macroscopic bleeding. Conclusion: Patients with CC who received radiotherapy at an oncology referral service had a high frequency of RP, and APC helped control bleeding in certain patients.

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Abstract Objective: To describe the epidemiological data of women with breast cancer at a referral center in oncology in the northern region of Brazil. Methods: This is a retrospective cohort study. The study population consists of patients who were diagnosed with in situ or invasive BC (invasive carcinoma of no special type (ICNST) and invasive lobular carcinoma (ILC)) at the Hospital de Amor da Amazônia, in Porto Velho – Rondônia, between January 2012 and December 2021. The sampling plan adopted was of the convenience type. All patients who received the anatomopathological diagnosis of in situ or invasive BC at the Hospital de Amor da Amazônia from 2012 to 2021 and came from the North region were included. Exclusion criteria were non-origin from the North region and absence of diagnosis established by anatomopathological examination of breast cancer. Analysis of the database and medical records of the Hospital de Amor da Amazônia was carried out to collect information. Results: 420 patients were included, 99.5% female, with complete elementary school (32,6%) and brown skin (68,1%). The mean age at diagnosis was 49 years. Forty-five percent were born in the northern region and 55% in other regions of Brazil. Eighty percent of tumors were invasive ductal carcinoma; 32.7% were luminal A-like, 25.1% luminal B-like, 19.4% HER2 enriched and 12.8% triple negative. When patients were subdivided by age ≤40 years and > 40 years, there was a statistically significant difference in the association with staging (p=0.000), histological type (p= 0.035), immunohistochemistry subtype (p=0.000), neoadjuvant chemotherapy (p=.000) and genetic counseling (p=0.001). The median survival was 7.99 years. The 5-year overall survival was 81%. The higher the stage, the lower the survival rate. Twenty-four distinct variants were described in patients undergoing genetic testing, 16 of uncertain significance and 8 pathogenic. Three new variants were described: ATM (c.8726G>C), BRCA2 (c.2232A>C) and ERCC5 (c.2164G>Ap). Conclusion: In this study, the age at diagnosis of breast cancer was lower, the tumor subtype was more aggressive, and patients were admitted in more advanced stages. Overall survival is lower compared to national and international data. Despite the small number of patients referred to genetic testing, it is important to search for germline mutations to improve patients’ diagnosis and treatment.

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Abstract Objective: To assess the association between early menarche and the nutritional status of the adolescents from the RPS - Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) birth cohort in São Luís, Maranhão. Methods: A longitudinal study with data from the first and third follow-up of the cohort was conducted. A total of 1,225 adolescents aged 18 to 19 years were surveyed and analyzed for age at menarche, defined as early if <12 years old, and for the variable body mass index (BMI) for age, classified into z-scores by sex, as underweight (z-score <-2), adequate weight (z-score ≥-2 and ≤+1), and excess weight (z-score >+1). Directed acyclic graphs were constructed using the DAGitty® program to select confounding variables for adjustment. Multinomial logistic regression adjusted for confounding variables such as parental obesity (yes or no), skin color (white or non-white), and birth weight (low birth weight, adequate birth weight, and high birth weight) was used to assess the association between early menarche and nutritional status. Statistical analyses were performed using STATA 15.0 software. Results: Out of the 1,225 adolescents investigated, 32.6% experienced early menarche, and the majority had a BMI appropriate for their age (75.2%). Among adolescents with early menarche, 28.3% were classified as excess weight for their age. Multinomial logistic regression revealed an association between early menarche and excess weight (OR = 1.80; 95% CI = 1.21-2.69; p-value = 0.004). Conclusion: Thus, the results indicate an association between the occurrence of early menarche and excess weight in the investigated adolescents.

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Abstract Objective: Placenta previa is a risk factor for obstetric hemorrhage, which, if not managed, can lead to maternal and neonatal death. Most cases are diagnosed after 28 weeks of gestation; in many cases, prenatal diagnosis is not timely. The objective of this study was to estimate the prevalence of placenta previa and its risk factors. Methods: A retrospective case-control study was carried out with a total of 35 cases and 138 controls among pregnant women. The variables studied were previous cesarean section, BMI, abortions, uterine surgeries and maternal age, among others. The chi-square test was used to examine differences between groups; the OR was calculated for each factor via univariate and multivariate analyses. Results: The prevalence of placenta previa was 0.57%. The risk factors identified were advanced maternal age (OR 3.0; 95% CI 1.3-7.1) and previous cesarean section (OR 10.7; 95% CI 1.7-68.5). Conclusion: The prevalence of placenta previa was similar to that reported in the literature, and the most prevalent risk factors were advanced maternal age and previous cesarean section. The identification of risk factors in women with placenta previa makes it possible to establish action plans for personalized care during pregnancy and childbirth and to reduce complications.

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Abstract Objective: Successful measures to address the increasing prevalence of sexually transmitted infections (STIs) require practical and accessible education and detection programs. Methods: The ability to detect Chlamydia trachomatis and Neisseria gonorrhoeae may be hindered by a lack of adherence to proper cervical sampling. To address this, we compared the sensitivity and specificity of self-obtained samplings, such as self-collection and first-catch urine samples, to cervical samples taken by a practitioner using the nucleic acid amplification test (NAAT) cobas® 4800 for C. trachomatis and N. gonorrhoeae in 244 women attending gynecological services in Quito, Ecuador. Regardless of sampling method, only 12 patients tested positive for C. trachomatis (4.9% prevalence, 95% CI 2.8 to 8.4%), and no samples tested positive for N. gonorrhoeae. Results: The analysis revealed that self-collection was 100% sensitive (95% CI 66.4% to 100.0%) and 100% specific (95% CI 98.25%-100%), and first-catch urine was 90% sensitive (95% CI 55.5% to 99.8%), and 99% specific (95% CI 96.5% to 99.9%) compared to cervical brushing for the detection of C. trachomatis. No symptoms were associated with a positive C. trachomatis result, highlighting the need for testing even in asymptomatic patients. Furthermore, having a stable intimate relationship in the past year was associated with a negative result for C. trachomatis (χ2 14.01, p < 0.001). Conclusion: This study demonstrates the feasibility and reliability of self-collection and first-catch urine samples as alternative methods for detecting Chlamydia trachomatis and has practical implications for improving STI detection and management programs.

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Abstract Objective: Sexuality plays an important role in quality of life, and the postpartum period may negatively affect women's sexual function. This study aimed to translate, culturally adapt, and validate the Sexual Quality of Life – Female (SQoL-F) for use for use in Brazilian women in the postpartum period. Methods: The original version of the SQoL-F was translated and back translated by four independent sworn translators. A sample of 125 women in the late postpartum phase participated in the cultural adaptation (n=30) and convergent validation (n=95) phases. For the latter, the instrument was compared with the Brazilian version of the Female Sexual Function Index (FSFI). To assess reproducibility, 25 of the 95 women who participated in the validation phase completed the SQoL-F twice, at different times (two interviewers administered the SQoL-F, 15 to 20 days apart). Results: Cronbach's alpha was 0.905 (intraclass correlation=0.974; 95%CI: 0.943–0.988; p<0.001). Significant, moderate, positive correlations were observed between the SQoL-F score and the FSFI total score (r=0.572; p<0.001) and domains ‘Desire’ (r=0.502; p<0.001), ‘Arousal’ (r =0.576; p<0.001), and ‘Satisfaction’ (r=0.637; p<0.001). Excellent reproducibility was obtained for the SQoL-F score (intraclass correlation=0.974; 95%; CI: 0.943–0.988; p<0.001). Conclusion: The SQoL-F was adapted to the cultural context of Brazilian postpartum women, proved reproducible, and exhibited face, content, and construct validity.

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Abstract Objectives: This study aimed to compare the effect of Gender Affirming Hormone Therapy with Testosterone (GAHT-T) discontinuation and dose spacing on Hct, hemoglobin (Hb) and total testosterone levels in users of testosterone cypionate and testosterone undecanoate. Methods: This retrospective cohort analyzed data collected from the medical records of trans men older than 18 years who developed erythrocytosis during GAHT-T between 2020 and 2023. Participants were divided into three groups according to formulation in use when the diagnosis of erythrocytosis occurred and analyzed according to therapeutic approaches: discontinuation of GAHT-T for 3 months or, for the testosterone cypionate fourthly users, dose spacing. Results: A total of 49 trans men (mean age, 28.0 ± 7.8 years) were diagnosed with erythrocytosis, totalizing 104 tests. After discontinuing GAHT-T, a greater decrease in Hct, Hb and total T levels was observed in the testosterone cypionate (Cip 14 and Cip 28) users than in the testosterone undecanoate users (Und90). In Und90, discontinuation resulted in decrease of Hct and Hb levels, without difference in total T levels. Cip14 and Cip28 exhibited greater reductions in the Hct level than Und90 did with discontinuation. In Cip14, dose spacing had no effect on decreasing Hb, Hct and total T levels. Conclusion: Discontinuation of testosterone undecanoate for 3 months in trans men undergoing GAHT-T who had developed erythrocytosis reduces hemoglobin and hematocrit levels without a significant reduction in testosterone levels. Dose spacing in fortnightly testosterone cypionate users was not effective to reduce hematocrit and hemoglobin.

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Abstract Objective: To investigate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) infection and preeclampsia (PE); to verify whether the strength of the association differs according to the infection onset (trimester of pregnancy). Methods: Retrospective cross-sectional study. Included women giving birth at a public hospital in Brazil from July 2020 to January 2021. All women were offered testing for COVID-19 during birth; they were also offered to test during prenatal care if symptomatics or contactants. Excluded women not tested. Compared the frequency of PE as well as of PE superimposed to chronic hypertension (PESCH) in women with versus without infection. Associations were accessed using bivariate and multivariable logistic regression analysis. Results: Among 1,575 women included, 288 (18.3%) had infection, 53 (3.4%) had PE, and 32 (2.1%) had PESCH. In univariate analysis, infection was significantly associated with PE, but not with PESCH. We then considered only PE as the outcome. The multivariable model included PE, infection, primigravida, fewer than seven prenatal visits. We found association between infection and PE, adjusted odds ratio 2.1; p=0.017. Women infected in the first trimester had a higher frequency of PE than those with infections in the second/third trimester, suggesting a temporal sequence, but the difference wasn't significant (p=0.054). Conclusion: Our data suggests association between SARS-CoV-2 infection and PE without chronic hypertension. The greater frequency of PE in women who had infection in the first trimester suggests a temporal sequence, but the small numbers are a limitation. Studies with larger samples are welcome.

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Abstract Objective: To evaluate psychological support data for survivors of sexual violence (SV) and compare the attitudes, responses, and feelings in adolescent and adult women. Methods: This was a retrospective study with two cohorts of female survivors of sexual violence, treated between 2011 and 2022. Women who had at least one psychological evaluation were included. The variables were sociodemographic; characteristics of violence; feelings; attitudes; symptoms observed/reported during support; time until emergency care; and indication of psychotropic medications. We calculated the mean and standard deviation (SD) and used the λ-Square or Fisher's Exact test and the Mann-Whitney test for comparative analysis. The significance level adopted was 5%. Results: Five hundred and twenty-one adolescents, mean age 14.8 (SD±2.0) and 312 adult women, mean age 31.7 years (SD±10.7), were compared. Two-thirds of all women reported themselves as white; adolescents took longer to seek care (p<0.001) more frequently than the adult group. Adult women had more histories of sexual abuse (p<0.001), penetration attacks (p<0.001), reported greater perception and disclosed violence more frequently (p<0.001) than the adolescent group. Adolescents reported more shame (p<0.001) while the group of adults more frequently expressed feelings of insecurity, anguish, expressions of crying, revolt, anger, humiliation and apathy. Anxious symptoms were expressed by 60% of adults and 44% of adolescents and the prescription of psychotropic medications was higher in the adult group compared to adolescents (p<0.001). Conclusion: Both groups of survivors suffered psychological impacts after SV, expressing/reporting different reactions to distress. These results highlight the importance of access to psychological support after SV.

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Abstract Objective: This study aimed to investigate the persistence of hypertension at three months postpartum in women who experienced preeclampsia during pregnancy. Methods: A prospective observational study at Hospital das Clínicas de Ribeirão Preto, Brazil, included 24 women. Blood pressure measurements and/or antihypertensive use were assessed, alongside risk factors such as body mass index (BMI), heart rate, lipid profile and C-reactive protein (CRP). Data on demographic, obstetric and lifestyle factors were also collected. Results: Out of 24 postpartum women enrolled in this study, 15 (62.5%) of participants remained hypertensive three months after delivery. Women with early-onset preeclampsia had a 2.36-fold increased risk of persistent hypertension at three months postpartum. No significant differences were found among risk factors for persistent hypertension. Conclusion: Our results indicate a high prevalence of persistent hypertension in women with preeclampsia in Brazil. The findings highlight the need for extended monitoring specially in early onset preeclampsia and targeted lifestyle interventions.

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Abstract Objective: Low- and middle-income countries face significant challenges in managing women diagnosed with pre-eclampsia, from making the clinical decision about whether to deliver to transferring these women to healthy facilities where they can receive appropriate care. The aim of this study was to evaluate the performance and accuracy of the fullPIERS model in a referral Brazilian maternity hospital - to assess maternal and fetal morbidity and impatient mortality at birth admission. Methods: A cross-sectional study analyzed pregnant women with preeclampsia diagnosis, between 2014 and 2023. The full PIERS model was applied to a database retrospectively collected and its accuracy to predict maternal and perinatal outcomes during the hospital stay was determined through a receiver operating curve. Results: Analyzing 207 pregnant women with fullPIERS had an Area Under the Curve (AUC) for adverse maternal outcome discrimination of 0.672 (0.576-0.767 95% CI, p<0.001) and AUC 0.582, (0.504-0.6661 95% CI, p = 0.041) for maternal and perinatal outcomes. Nevertheless, the model had no discrimination utility to assess perinatal outcomes (AUC 0.561, 0.480-0.642 95% CI, p = 0.642). Conclusion: The fullPIERS model had limited performance in identifying women at increased risk of adverse outcomes birth admission and absent utility to assess perinatal outcomes. Future studies, combining different tools and validated in low- and middle-income countries should be carried out to improve maternal health.

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Abstract Objective: To identify the frequency of functional constipation in women with urinary incontinence. Methods: A cross-sectional, quantitative, descriptive, and exploratory study was conducted from September 2019 to January 2020 with 227 women (over 18 years old) at the Hospital de Clínicas, Universidade Federal do Paraná. A structured form collected sociodemographic and general health data, while bowel habits were assessed using the Rome IV criteria, the Bristol Stool Scale, and the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). Comparisons between women with and without constipation involved χ2, Fisher's Exact, Student's t-test, Mann-Whitney U, and univariate logistic regression was performed to assess the association between sociodemographic/personal factors and the risk factor constipation. All women had a clinical diagnosis of urinary incontinence, and the analysis also compared those with and without constipation. Odds ratios and their respective 95% confidence intervals were estimated for each univariate model. A 5% significance level was adopted. Results: The participants had a median age of 62 years (range 23–97). Functional constipation was identified in 80.2%(n=182), and mixed urinary incontinence was predominant in this group (88.5%, n=161). Physical activity emerged as a protective factor against constipation (OR=0.47; 95% CI=0.22–1.01; p=0.05), though only 22.5%(n=41) reported regular exercise. Conclusion: The high frequency of functional constipation in women with urinary incontinence highlights a significant impact on quality of life and underscores the importance of integrated, conservative therapeutic strategies, including early lifestyle interventions such as regular physical activity, to prevent worsening of both conditions. Longitudinal investigations are recommended.

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Abstract Objective: Endometriosis pain is associated with inflammatory cytokines, such as leptin (LEP), through activation with its receptor (LEPR), and its expression can be influenced by the presence of genetic polymorphisms. Therefore, this study aims to evaluate the role of the LEP rs7799039 and LEPR rs1137100 polymorphisms in the painful symptoms of endometriosis in Brazilian women. Methods: A retrospective study was carried out in two Brazilian public hospitals with 237 cases of endometriosis, divided into two comparison groups according to the painful symptoms associated with the disease (absence or presence of severe and disabling symptoms). Genetic analysis was performed by real-time PCR technique, and association analyses were estimated using odds ratio (OR) and 95% confidence interval (CI), using a non-conditional logistic regression model. Results: Endometriosis cases showed a high prevalence of painful symptoms: 82% dysmenorrhea, 67% dyspareunia, 53% chronic pelvic pain, and 52% cyclical intestinal and 25% urinary complaints. Regarding genetic analyses, cases had 32.7% of the A allele and 11.4% of the AA genotype for the LEP rs7799039 G>A SNP, and 17.5% of the G allele and 2.5% for of GG genotype for the LEPR rs1137100 A>G SNP. There is a significant association of the LEPR rs1137100 polymorphism with chronic pelvic pain (OR=1.75; CI 95%=1.05-2.89) and dyspareunia (OR=1.78; CI 95%=1.01-3.12) in women with endometriosis. Conclusion: Our findings suggest that the LEPR rs1137100 polymorphism is associated with increased endometriosis-related gynecological pain and may be a potential target for molecular diagnosis of the disease and development of individualized treatment strategies.

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Abstract Objective: This study aimed to identify the patterns and factors associated with congenital anomalies in newborns from a tertiary hospital maternity ward. Methods: A case-control study was conducted at the Hospital Regional do Sudoeste Walter Alberto Pecóits in Francisco Beltrão (PR), between December 2023 and September 2024. Among the 1,400 births that occurred in the hospital's delivery room between December 1, 2023, and the end of September 2024, 37 newborns (2.6%) with congenital anomalies were identified during the study period. A total of 37 case mothers and 120 controls were included (a ratio of approximately 1:3). The sociodemographic variables included maternal age, residence, marital status, race, education level, family income, and maternal occupation. The behavioral variables considered smoking, alcohol consumption, and the use of drugs or medications during pregnancy. The fetal variables included the number of pregnancies, gestational age, type of delivery, miscarriage, Apgar score, birth weight, sex, fetal status, congenital anomalies, and the number of prenatal visits, with a minimum of six (one in the first trimester, two in the second, and three in the third), following the Ministry of Health guidelines. Results: Among 1,400 live births, 37 cases of congenital anomalies were identified (2.6%, 95% CI: 1.80–3.48), while the control group included 120 women with newborns without congenital anomalies. Among cases, isolated anomalies were most common (62.2%), predominantly affecting the cardiovascular system (27.0%), followed by recognized syndromes (21.6%) and multiple malformations (16.2%). Data were collected through face-to-face interviews and medical record reviews. Bivariate analysis revealed significant associations between congenital anomalies and a family history of congenital anomalies (p = 0.02), low apgar scores at the 1st and 5th minutes (p < 0.01), and fetal status at birth (p < 0.01). Model 1, which integrates family history of congenital anomalies, apgar score at the 5th minute, and fetal status, showed the best predictive fit, consistent with previous findings. Bayesian logistic regression highlighted this model with the lowest AIC (295.98) and BIC (326.22) values, achieving 89% predictive accuracy. Conclusion: These results reinforce the importance of family history and neonatal vitality in the context of congenital anomalies, indicating the need for future studies to confirm these findings and improve prevention strategies.

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Abstract Objective: To identify pain, sexual function, and quality of life patterns in women with endometriosis, taking into consideration the American Society for Reproductive Medicine (ASRM) classification for endometriosis. Methods: A cross-sectional study of quantitative descriptive nature was conducted, including women with surgical recommendation due to endometriosis. The Numeric Pain Rating Scale, Endometriosis Health Profile, and Female Sexual Function Index tools were used for data collection. Descriptive and frequency analysis were employed. Using the K-means algorithm, cluster analysis was performed to group participants based on response similarities. Results: 104 women with endometriosis were included with a median age of 35 years. The majority were classified as grade III (57.69%) and IV (25.96%) for endometriosis. There was a significant difference in the division of two clusters concerning ASRM, with ASRM IV women more frequently associated with Cluster B, while Cluster A being predominantly formed by ASRM III women. Cluster B showed significantly worse data for dyspareunia and dysuria pain levels and for all variables in the FSFI and EHP-30 instruments, except for infertility, which did not differ between the groups. Conclusion: ASRM classification is not directly related to clustering. Women diagnosed with endometriosis, mostly ASRM III and IV, exhibit two distinct patterns, with one group having worse pain, sexual function and quality of life scores compared to the other group. Infertility is a crucial aspect to study concerning the quality of life of women living with the disease and aspiring for motherhood irregardless of the clustering.

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Abstract Objective: To develop the Brazilian Portuguese version of the Follow-up Form for the Creighton Model FertilityCare™ System. Methods: Translation and cultural adaptation of the Follow-up Form for use in Brazil, in 6 steps: Translation, Expert Panel, Back-Translation, Pre-test, Review, and Final Version, according to the World Health Organization methodology. Results: The 25 sections comprising the Follow-up Form were translated with 14 sections undergoing an adaptation process in one of the stages. In order to maximize semantic, idiomatic, experiential, and conceptual equivalence of the items from the original English version to Portuguese. The need for adaptation was due to four reasons: first, the format of paired and seemingly repetitive questions. Second, the difference in cultural reality, such as hygiene and consumption habits, between the United States and Brazil. Third, the use of technical terms, medical vocabulary. And fourth, sentences that contain many concepts related to the use of the Creighton Model FertilityCare™ System. The sample included 127 Creighton Model FertilityCare™ System users, with an average age of 33.7 years, and 88.2% were married. The majority, 68 (53.5%), were not using any family planning method when they started Creighton Model FertilityCare™ System 49.2% were trying to conceive in the past year. Conclusion: The translation of the Follow-up Form into Brazilian Portuguese resulted in a final version that maintained the intercultural and conceptual equivalence to the original English version. This instrument can be used by all practitioners in Brazil with the assurance that the standardization in the application of Creighton Model FertilityCare™ System reflects the original purpose of the method.

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Abstract Objective: To evaluate the impact of São Paulo State Law n° 17.137/2019 on the cesarean section rate at a public secondary-level maternity hospital and to analyze predictive factors and complications associated with cesarean under request. This law was enacted to allow pregnant women in São Paulo to request a cesarean section without medical indication. Methods: This retrospective study analyzed medical records of pregnant women ≥ 39 weeks gestation attended at the Ribeirão Preto Women's Health Reference Center (CRSMRP-Mater). Two groups were evaluated: 1,999 patients before the law (July 2018–July 2019) and 3,207 after its implementation (August 2019–July 2021, excluding the suspension period). Descriptive and analytical statistical methods were applied. Results: The overall cesarean rates increased significantly from 23.6% to 27.7% (p < 0.01), with 15,1% of cesareans during the law period being under maternal request (134 patients). A previous cesarean was the only factor significantly associated with electing a new cesarean. Hospital length of stay was significantly longer in the law period (p < 0.01), possibly reflecting the increased cesarean rate. No significant differences were observed in maternal or neonatal complications between cesareans under request and those conducted for medical reasons. Conclusion: São Paulo State Law n°. 17.137/2019 was associated with an increased cesarean rate in CRSMRP-Mater. The findings highlight the need for robust educational approaches and evidence-based obstetric practices to reduce unnecessary elective cesareans.

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Abstract Objective: The Robson Ten Group Classification System categorizes women into groups based on obstetric characteristics. For each group there is a suggested cesarean section rate. Robson Ten Group Classification System allows for surveillance and evaluation of increasing cesarean section rate. This study aimed to evaluate deliveries in a Brazilian referral maternity hospital in the last decade using the Robson Ten Group Classification System. Methods: This was a retrospective cross-sectional study performed in a referral hospital, analyzing deliveries from January 2009 to August 2022. Women were classified into Robson's 10 groups based on electronic medical charts. Overall rates per year and cesarean section rate within each group were calculated and compared. Results: There was an increasing cesarean section rate over time (46.23% in 2009 vs 62.99% in 2022) in all groups. Groups 1-4, 5 and 10 had a significant increase. Among Groups 1-4 cesarean section rate increased from 34.06% to 38.59% (PR 1.132, CI 1.007-1.274), group 5 from 67.66% to 83.53% (PR 1.234, CI 1.151-1.323) and group 10 from 51.55% to 60% (PR 1.163, CI 1.017-1.332). In global analysis, groups 1-4 corresponded to 57.3% of included cases and its relative contribution to cesarean section rate was 31.6%, while group 5 represented 18.9% of cases and its relative contribution to cesarean section rate was 28.5%. Conclusion: Groups 1-4 and 5 contributed significantly to cesarean section rate in our analysis and group 10 (preterm birth) also had a major impact, considering the high risk setting. Cesarean section rate increased over time. Groups 1, 2, 5, and 10 contribute significantly to such an increase.

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Abstract Objective: This study aims to characterize voiding urodynamics parameters suggestive of bladder outlet obstruction (BOO) diagnosis in women with and without symptomatic pelvic organ prolapse (POP). Methods: Cross-sectional research. Patients were selected and clinically evaluated with anamnesis, pelvic organ prolapse quantification system and standard Urodynamic Testing, performed according to International Continence Society and International Urogynecological Association guidelines (noninvasive uroflowmetry, followed by invasive cystometry and a Pressure/Flow Study). Included criteria: women aged 18 to 94 years with and without symptomatic POP and lower urinary tract symptoms . Exclusion criteria: patients who were not clinically feasible, undesirable, or impossible urodynamic test, or patients with urinary tract infection or neurological lower urinary tract dysfunction. Results: Voiding urodynamics parameters suggestive of BOO diagnosis found in women with POP were: maximum flow rate (Qmax) in the uroflowmetry ≤12mL/s; detrusor pressure at maximum flow (PdetQmax) >20cmH2O. When evaluating the differences between patients with and without POP, it was observed that those who presented some type of pPOP were mean age (y) older (67.6 × 58.9); had higher post-void residue volume (mL) (85.9 × 33.9); higher PdetQmax (cmH2O) values (41.3 × 28.5); lower Qmax (mL/s) values on uroflowmetry (8.5 × 20.4), lower maximum cystometric capacity (mL) (325.7 × 381.2), lower bladder compliance (mL/cmH2O) (39.8 × 46.1) and lower Qmax (mL/cmH2O) in the flow/pressure study (8.4 × 18.0) (p<0.001). Conclusion: The voiding urodynamics parameters listed in this study allows the evaluation of variables suggestive of BOO diagnosis in women with and without POP.

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Abstract Objective: This study aimed to evaluate awareness, perceptions, and attitudes toward oocyte cryopreservation among a diverse group of women. Methods: A cross-sectional study was conducted in November 2023 using snowball sampling to distribute a structured questionnaire. The target population included women aged 18+ with childbearing potential, proficient in English. An anonymous online survey with 22 questions collected data on demographics, education, occupation, relationship status, reproductive intentions, and perceptions of oocyte cryopreservation. Results: A total of 502 responses were analyzed. Most participants were in their thirties, had higher education, and were in committed relationships. They represented 24 countries, mainly in Europe. Over 60% planned to have children, but 85% were unfamiliar with oocyte cryopreservation. Social media (56%) was the primary information source, followed by acquaintances (33%) and healthcare professionals (25%). Only 4.6% were actively considering the procedure, while 41.3% showed potential interest. Barriers included perceived lack of necessity, age concerns, and limited information. Women considering cryopreservation were typically younger and childless. Financial constraints and information gaps significantly influenced decision-making, with about one-third suggesting better information and cost reduction could increase willingness to pursue the procedure. Conclusion: Despite relatively high awareness of oocyte cryopreservation, actual consideration and uptake remain low. Addressing financial and informational barriers could improve acceptance, especially among younger women and those uncertain about their reproductive plans.

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Abstract Objective: This study aims to compare the plasma protein profiles between 7 preeclampsia patients with severe features (PE+) and 7 preeclampsia patients without severe features (PE-) and 10 healthy pregnancies (HP); identify differentially expressed proteins among these groups and explore the altered signaling pathways and their association with the severity of this cardiovascular condition. Methods: Plasma proteins were quantified using mass spectrometry, followed by comprehensive bioinformatics and statistical analyses. Protein identification and annotation were performed using UniProt and PatternLab for Proteomics. Multivariate statistical analyses, including PLS-DA and sPLS-DA, as well as VIP score evaluation and Volcano plot visualization, were conducted with MetaboAnalyst to assess group separation and identify key discriminative features. Functional enrichment and pathway analyses were carried out using Metascape. Results: Using a fold change and volcano plot validation of 1.2, comparisons between HP and PE+ revealed that proteins such as AMBP (inter-alpha trypsin inhibitor light chain), VTN (vitronectin), CLU (clusterin), F2 (prothrombin), and PZP (pregnancy zone protein) were upregulated in PE+. Conversely, ITIH4 (inter-alpha trypsin inhibitor heavy chain H4), APOL1 (apolipoprotein 1) and SERPIND1 (heparin cofactor II) were downregulated in PE+ relative to HP. When comparing HP with PE-, SERPINA3 (alpha-1-antichymotrypsin) and HBB (hemoglobin subunit beta) were downregulated in PE-. Between PE- and PE+, APCS (serum amyloid P component) and HBB were upregulated in PE+; whereas SERPINC1 (antithrombin), PSG1 (pregnancy-specific beta-1-glycoprotein 1), ITIH4, and C5 (complement C5) were downregulated in PE+ compared to PE-. Conclusion: These findings offer valuable insights into the different pathophysiological mechanisms underlying the two subgroups of PE. The upregulated proteins in PE+ (AMBP, VTN, CLU, F2, PZP, APCS, and HBB) play key roles in regulating blood pressure, modulating the extracellular matrix and influencing immune responses. Overall, this research deepens our understanding of the complexity and clinical significance of PE.

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Abstract Objective: This study aims to evaluate the clinical and functional implications of cesarean section (CS) skin scars on women's lives, emphasizing the relationship between scar characteristics and quality of life. Methods: In this cross-sectional study, women older than 18 years old who had undergone CS with a Pfannenstiel incision within the past 6-36 months were evaluated. The Patient Scar Assessment Questionnaire (PSAQ) and the Patient and Observer Scar Assessment Scale (POSAS) were used to assess clinical scar parameters. Functionality was appraised using eight questions derived from the International Classification of Functionality, Disability, and Health (ICF). The association between scar appearance scores and functionality questions was analyzed statistically. Results: Ninety-six women were assessed, revealing that appearance and satisfaction with appearance had the worst scores on the PSAQ. Scar irregularity was the most frequently reported scar characteristic on the POSAS. On the ICF-derived questionnaire, the "self-care" domain was the most affected, with women reporting problems on activities such as choosing swimwear and lingeries. There was a significant correlation (p < 0,05) between the women dissatisfaction with the scar appearance and impairment in ‘interpersonal interactions and relationships’ and ‘self-care’, as the "domestic life" domain wasn't affected. Conclusions: Cesarean section skin scars can lead to dissatisfaction and functional impairments, affecting women's quality of life. These findings underscore the necessity for multidisciplinary care and thorough discussions about delivery methods to improve post-surgical outcomes.

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Abstract Objective: To assess the prevalence of VL in primiparous women undergoing vaginal birth or caesarean section; and its association with obstetric, urinary, intestinal and sexual factors for its occurrence. Methods: This is a cross-sectional study carried out between July 2021 and January 2023. Primiparous women who underwent vaginal birth or caesarean section without complaints of VL during pregnancy were included. Clinical and obstetric data were collected and participants completed questionnaires on the impact of urinary incontinence (ICIQ-SF), vaginal symptoms (ICIQ-VS) and sexual distress (FSDS-R) at recruitment and six-months postpartum. Univariate and multivariate logistic regression was performed, considering VL as the outcome and p=0.05. Results: One hundred participants were included for data analysis. The prevalence of VL was 8%. In the univariate analysis, SUI, urgency urinary incontinence (UUI), coital incontinence, constipation and the ICIQ-VS and ICIQ-SF scores were associated with VL. The ICIQ-VS, FSDS-R and ICIQ-SF scores increased the risk of VL by one-fold. However, only UUI (OR 10.50(CI 95% 1.90-58.10), coital incontinence (OR 42.00(CI 95% 3.11-566.38), and ICIQ-VS (vaginal symptoms OR 1.32(CI 95% 1.05-1.66) and ICIQ-SF (OR 1.25(CI 95% 1.02-1.54), scores remained associated with VL in multivariate-analysis. Conclusion: The prevalence of VL in primiparous women was lower than that reported in other studies and showed an association with the occurrence of vaginal symptoms, UUI and coital incontinence, six- months postpartum.

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Abstract Objective: Pain is an unavoidable reality of labor and the most noticeable determinant of the labor experience. The present study was conducted to assess the effect of auriculotherapy on labor pain and labor duration. Methods: This double blind, randomized, controlled clinical trial was conducted from 2021–2022 in Kerman, Iran. The sample consisted of 60 primiparous women assigned to an Intervention Group (n = 30) and a Control Group (n = 30). The study began after participants entered the active phase of labor at 37–40 weeks of pregnancy. In the Intervention Group, the researcher stimulated the desired points (uterus, pituitary gland, pelvis, cerebral, autonomous, sensory, endocrine gland, shen men, zero, external genitalia, and thalamus). Sham auriculotherapy (patches without seeds at the same acupoints) was done in the Control Group. Pain intensity in the two groups was recorded using the VAS before and after the intervention, when the cervix was dilated 4, 6, and 8 cm. Duration of labor was also recorded. Data were analyzed using SPSS 21 statistical software. Results: Pain intensity was significantly lower in the Intervention Group than in the sham Control Group (P < 0.0001) in different cervical dilatations after intervention. Compared to the sham Control Group, the intervention group was significantly different in the average duration of labor (P < 0.0001). Conclusions: Auriculotherapy was demonstrated to attenuate the severity of labor pains and expedite the labor duration. Hence, policymakers in this field are recommended to pay greater attention to this non-invasive method.

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Abstract Objectives: To translate and cross-culturally adapt the standard version of the WERF EPHect EPQ into Brazilian Portuguese and migrate it to an electronic version using REDCap. Methods: The study included 120 women aged 18–50 years, with half completing the paper version and half the electronic version. The sample comprised 80 individuals with chronic pelvic pain (CPP), including 60 with endometriosis, recruited from a tertiary referral centre, and 40 women from a primary healthcare unit with no diagnosis of CPP or endometriosis. Illiterate or cognitively impaired individuals were excluded. The electronic migration was implemented in REDCap. Results: The Brazilian Portuguese EPQ-S demonstrated linguistic accuracy and cultural equivalence to the original English version. The paper version consisted of 35 pages, and 86.7% of respondents commented on its length. Despite this, it was well-received, although minor difficulties were observed among participants with lower education levels. The electronic version provided a more accessible experience, with a significantly shorter completion time (52.1 ± 13.2 minutes) compared to the paper version (70.9 ± 21.4 minutes). Both formats exhibited similar rates of missing data for questions related to symptoms and contraceptive use. Conclusion: This study successfully translated, adapted, and migrated the WERF EPHect EPQ-S into Brazilian Portuguese using REDCap. The findings underscore the linguistic and cultural challenges of such adaptations and highlight the electronic version's advantages in accessibility, efficiency, and participant satisfaction. This research supports the development of cross-cultural assessment tools for endometriosis research and healthcare delivery.

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Abstract Objective: This study aimed to assess the prevalence of cervical High-Grade Squamous Intraepithelial Lesions (HSIL) in women outside the screening age recommended by the Brazilian Guidelines for Cervical Cancer Screening (under 25 and over 64 years old). Methods: The cross-sectional study was conducted at a reference hospital in Rio de Janeiro with a histopathological report of CIN 2 + from January 2010 to December 2020 through the analysis of medical records. Results: Among 406 women diagnosed with Cervical Intraepithelial Neoplasia (CIN) 2+, 63 patients (15.5%) were outside the recommended screening age, 17(4.2%) of whom were under the age of 25, and 46 (11.3%) were older than 64 years. CIN 2 was most prevalent in women under 25 years old (29.4%); CIN 3 in those between 25 and 64 years old (55.1%); and invasive cancer predominated in women over 64 years old, with statistical significance (<0.001). Conclusion: The higher frequency of CIN 2 in young women under 25 years old supports the transient nature of these lesions, reinforcing that screening this age group may lead to unnecessary treatment. Conversely, the detection of high-grade lesions and cancer in older women is a consequence of inadequate screening earlier in life.

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Abstract Objective: Endometriosis is known as a chronic inflammatory disease. This study investigates the differences in the inflammatory response between endometriomas and benign ovarian cysts during the preoperative and postoperative periods. Methods: A retrospective analysis was conducted on patients who underwent laparoscopic cystectomy for endometriomas or non-endometriotic benign cysts between 2010 and 2021. The study compared demographic and gynecological characteristics, lesion size, serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and preoperative and postoperative values of erythrocyte distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and leukocytes between the two groups. Results: The study included 116 patients (48.13%) in the Study Group and 125 (51.87%) in the Control Group. The mean age of the Study and Control Groups was 27.76 years and 24.54 years, respectively (p<0.001). A non-significant discrepancy in preoperative AMH and FSH values was observed between the two groups (p>0.05). Preoperative RDW (14.50±1.56 vs. 14.04±1.40), PLR (160.82±44.52 vs. 136.83±48.72), and NLR (2.60±1.10 vs. 2.17±1.13) were significantly higher in the Study Group (p<0.05). Nevertheless, only in the Study Group NLR exhibited a notable increase in the postoperative period (p<0.05). Preoperative NLR was positively correlated with cyst size in endometriomas but was not correlated with rASRM score, AMH, or FSH levels. Conclusion: The inflammatory markers RDW, PLR, and NLR were significantly elevated in endometriomas compared to other benign cysts during preoperative and postoperative periods. The inflammatory response increased with cyst size but was not related to ovarian reserve as measured by serum AMH or the stage of endometriosis.

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Abstract Objective: This study aims to to evaluate the frequency of ovarian involvement in endometrial cancer patients aged 50 years and younger, identify associated clinicopathological factors, and uniquely assess the role of the Systemic Immune-Inflammatory Index (SII) in predicting ovarian involvement. Methods: Patients aged 50 years and younger diagnosed with endometrial cancer between 1992 and 2022 were retrospectively analyzed. Two groups were formed based on adnexal involvement: those with (ovarian metastasis or synchronous ovarian cancer) and without adnexal involvement. Clinicopathological predictors of adnexal involvement were evaluated. Preoperative complete blood count values (platelet, leukocyte, lymphocyte, and neutrophil counts) were used to calculate inflammatory indices: PLR (platelet-to-lymphocyte ratio), NLR (neutrophil-to-lymphocyte ratio), and SII (neutrophil × platelet / lymphocyte). A two-group analysis was performed based on the cut-off values of statistically significant parameters. Univariate and multivariate logistic regression analyses were conducted. Results: Among 205 patients, histopathological ovarian metastasis was identified in 5.9% (n=12), and synchronous ovarian tumors in 2.4% (n=5). Significant differences were observed in neutrophil counts, NLR, and SII values between the groups (p<0.05). ROC analysis showed the optimal SII cut-off value as 992.58, with 70% sensitivity and 76% specificity (AUC=0.726). Ovarian involvement was significantly more frequent in patients with SII ≥ 992 (p<0.05). Univariate analysis revealed that myometrial invasion, LVSI, cervical stromal invasion, lymph node metastasis, omental involvement, grade of tumor, NLR and SII were significantly associated with ovarian involvement (p<0.05). Multivariate analysis identified histological grade, myometrial invasion, pelvic lymph node metastasis and SII as independent risk factors (p<0.05). Conclusion: Ovarian involvement is uncommon in patients under 50 years of age with low-grade tumors, absence of myometrial invasion, negative pelvic lymph nodes, and preoperative SII < 992.58. Ovarian-sparing surgery may be a safe option in selected cases, and SII could serve as a valuable index in guiding ovarian preservation decisions.

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Abstract Objective Endometriosis, a gynecological condition characterized by the presence of endometrial tissue outside the uterus, affects millions of women worldwide. This study aimed to investigate neurotrimin (NTM)’s expression, a glycerophosphatidylinositol-anchored neural adhesion molecule, in endometriotic lesions and eutopic endometrial tissue. Methods In this laboratory based observational study NTM expression was measured in patients with early- and advanced-stage endometriosis and controls (patients without endometriosis who underwent gynecological surgery. Peritoneal endometriosis (peritoneum for controls) and eutopic endometrial tissue samples were collected from patients. Polymerase chain reaction and immunohistochemistry (IHC) were used to detect NTM in the tissue samples. Additionally, NTM levels in peripheral blood samples of all participants were measured using an enzyme-linked immunosorbent assay. Results NTM mRNA and protein levels were significantly higher in the endometriotic foci of the stage 3–4 endometriosis group than in the control group (p<0.01). Stage 1–2 endometriotic foci showed significantly higher NTM IHC staining than the control group; however, no significant difference was found between the mRNA levels. Eutopic endometrial tissue from the stage 3–4 group had significantly higher NTM mRNA levels than the other groups. No significant difference was found between the control and stage 1–2 groups for eutopic tissue. Eutopic endometrial NTM IHC staining did not differ between groups. No significant difference was observed in peripheral blood NTM levels. Conclusion This study found increased NTM expression, a neural adhesion molecule, especially in advanced endometriosis. The endometrial tissue of patients with early-stage endometriosis also showed increased NTM expression in ectopic locations but not in eutopic tissue.

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Abstract Objective: To test the hypothesis that the quarterly injectable contraceptive increases the activity of the renin-angiotensin-aldosterone system. Methods: This was a cross-sectional observational study that included eutrophic, irregularly active women, aged between 18 and 30 years, who had been taking quarterly injectable contraceptive (150mg of medroxyprogesterone acetate) for at least 6 months or who had not used any type of hormonal contraceptive for at least 6 months. At first the volunteers underwent a physical examination and answered a standard questionnaire. They were then sent for blood collection of laboratory variables: plasma renin activity and concentration, angiotensin-converting enzyme 1 (ACE 1), and aldosterone. The data was analyzed using the two-tailed Student's t-test, with significance <0.05. Results: Sixty-two women were included in this study, divided into the Injectable Contraceptive Group (ICG) with n=23 and the No Contraceptive Group (NCG) with n=39. ICG had lower mean plasma renin activity values than NCG, respectively 0.4 ± 0.17 vs 1 ± 0.6 (p <0.01). The mean values for plasma renin concentration, ACE 1, and aldosterone did not differ between the groups (respectively, p= 0.21; 0.66; 0.09). Conclusion: Women using quarterly injectable contraceptives do not show greater activity of the renin-angiotensin-aldosterone system than their counterparts who do not use this drug.

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Abstract Objective: To compare the efficacy of a traditional open ASC technique (ASC-T) to an open modified technique (ASC-M). Methods: Retrospective cohort study with stage 3 or 4 apical prolapse women, who operated on using one of the two techniques were included in the study: ASC-T (vaginal mesh is secured with eight sutures) and ASC-M (four sutures). The POP-Q was used to objectively assess anatomical improvement. Women with less than one year of follow-up, without POP-Q classification, or with incomplete data were excluded. Results: A total of 223 women underwent ASC: 120 in ASC-T and 103 in ASC-M. The average age was 65.3 (±6.5) years in the ASC-T group and 65 (±8.5) years in the ASC-M group, with no difference between them (p=0.706). There was no difference in intraoperative increased bleeding (p=1.000) and bladder injury (p=0.706) in both groups. Comparing the POP-Q points pre- and postoperatively, we observed improvement in all points in both groups (p<0.001) without difference between them. The analysis of variance for repeated measures was used to compare the outcomes between the two groups. The postoperative prolapse stage was similar between the two groups in the apical (p=0.251) and anterior (p=0.052) vaginal compartments. In the subjective evaluation, we observed a high rate of cure and improvement in both groups, respectively 81.7% and 16.7% in the ASC-T group, and 91.3% and 8.7% in the ASC-M group (p=0.100). Conclusion: Both sacrocolpopexy techniques were effective in treating apical prolapse, as evidenced by both objective and subjective cure rates, with a low complication rate.

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Abstract Objective: To evaluate adherence to preeclampsia prophylaxis with aspirin and calcium carbonate among pregnant women with chronic hypertension attending a specialized hypertension in pregnancy center at a tertiary hospital in Brazil. Methods: A cross-sectional study was conducted at the Hospital das Clínicas de Ribeirão Preto. Adherence to aspirin and calcium carbonate was assessed using the Morisky-Green questionnaire. Additionally, we assessed the knowledge of these women regarding preeclampsia. A total of 101 pregnant women were interviewed, and 98 were included in the final analysis. Results: Non-adherence rates were 64.3% for aspirin and 59.2% for calcium carbonate. The overall incidence of preeclampsia was 22.4% with 11% requiring magnesium sulphate for blood pressure control. No significant differences in preeclampsia incidence were observed among adherent and non-adherent groups for either aspirin or calcium carbonate. Most participants demonstrated high (78.6%) or medium (18.4%) levels of knowledge about preeclampsia. Conclusion: There was low adherence to aspirin and calcium carbonate prophylaxis among pregnant women with chronic hypertension, with no difference in preeclampsia prevention between adherent and non-adherent groups. These findings raise important questions about the effectiveness of aspirin in reducing preeclampsia risk in chronic hypertension. Further studies should be conducted to evaluate the reasons for low adherence.

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Abstract Objective: This study aims to explore the combined role of ANGPTL3, 4, 8, omentin-1, leptin, TNF-α, and IL-6 molecules known for their roles in fat metabolism, obesity, and inflammation, yet whose connection to PCOS is still debated in the development of PCOS. Methods: A prospective cross-sectional study involving PCOS patients (n=30) and BMI-matched controls (n=30) was conducted. Levels of ANGPTL3, 4, 8, omentin-1, leptin, TNF-α, and IL-6 were measured in peripheral venous blood samples. Results: When dividing both the PCOS and control groups into six BMI-based subgroups normal weight (20-24.9 kg/m2), slightly overweight (25-29.9 kg/m2), and obese (30-39.9 kg/m2) there were significant differences in levels of ANGPTL3 and 8, omentin-1, leptin, IL-6, and TNF-α (p<0.05). Comparison between the entire PCOS and control groups showed that CRP levels were significantly higher in the PCOS group (p<0.0001), while omentin-1 levels were significantly lower (p=0.022). Regression analysis, including ANGPTL3, 4, 8, IL-6, and TNF-α alongside CRP and omentin-1, indicated a significant model for PCOS (Nagelkerke R2=0.698, p<0.0001, PPV=80%, NPV=90%). In ROC analysis, the AUC for CRP and omentin-1 were significant (p<0.05; AUC=0.800-0.328). Conclusion: This study suggests a continuous interaction among ANGPTL, omentin-1, leptin, and cytokines in the etiopathogenesis of PCOS.

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Abstract Objective: This study aimed to analyze the relationship between aneuploidy and maternal age based on preimplantation genetic testing for aneuploidies (PGT-A) and the distribution of aneuploidy across individual chromosomes. Methods: This is a single-center retrospective cohort study. The study included patients who underwent PGT-A during their in vitro fertilization (IVF) cycle between 2016 and 2024. PGT-A was performed on 1,341 embryos from 481 patients using next-generation sequencing (NGS)–based techniques. We conducted a Logistic regression analysis to determine the relationship between maternal age and the rate of aneuploidy; additionally, the most commonly affected chromosome and the characteristics of the detected alterations were evaluated. Statistical analysis was performed using STATA v17. Results: Among all patients, the observed aneuploidy rate was 55.85%. In patients younger than 30 years, the aneuploidy rate was 26.92%, with a progressive increase to 62% in women older than 40 years. Chromosomes 22, 21, 16, and 15 were the most frequently affected. Logistic regression indicated that age is a significant predictive factor for aneuploidy (coefficient = 0.0956; p < 0.001), with an odds ratio of 1.10 (95% CI: 1.07–1.13), meaning that the probability of aneuploidy increases by approximately 10% for each additional year of age. Conclusion: Our results indicate that an increase in maternal age is significantly associated with a higher incidence of aneuploidy in embryos that underwent PGT-A. These findings are significant for patient counseling and optimizing embryo selection in assisted reproduction treatments.

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Abstract Objective: To analyze recall rates in a public breast cancer screening facility in Campinas, Brazil. Methods: A prospective assessment of outcomes on screening mammographies (MMG) between July 2023 and August 2024. BI-RADS® 0,4/5 indicated positive results, and women recalled. The variables were age, whether first or subsequent MMG, and biopsy (cancer positive or negative). The outcomes were recall rate and cancer detection rate on the recall (CDR). Prevalence ratio with 95% confidence interval (PR) estimated the risk. Results: There were included 19,377 MMG on women over 40: 15,983 subsequent MMG (82.5%), and 1,646 women recalled (BR 0,4/5). Adherence to recall was over 99%. The recall rates were 12.4% at first and 7.7% at subsequent MMG. Recall rate was 1.6 times higher at first than at subsequent MMG (PR 1.61;1.45-1.79). CDR was higher at subsequent MMG. A first MMG reduced the risk of cancer detection by 71% (PR 0.29-0.15;0.58). Compared to women 50-69, there were no differences in the risks of recall and cancer detection at first MMG. At subsequent MMG the recall risk was higher in women 40-49 (PR 1.16;1.03-1.30), and over 69 (PR 1.47;1.03-2.12). The risk of cancer detection was 60% lower in women 40-49 (PR 0.60;0.36-0.99), and 2.7 times higher in women over 69 (PR 2.78;1.32-5.84). Conclusion: The recall rates were 12.4% at first and 7.7% at subsequent MMG. Adherence was high. Screening efficiency was higher in women 50-69. At subsequent screenings women 40-49 showed a higher recall rate and a lower CDR when compared to women 50-69.

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Abstract Objective: To estimate age-adjusted mortality rates at the national and state levels, evaluates trends and their spatial distribution during the period 2000-2023 among Mexican women. Methods: Ecological study conducted from open access data, the age-standardized mortality rate of breast cancer during the period 2000-2023 was calculated. Joinpoint regression models were estimated for breast cancer mortality in Mexico and its states. Spatial analysis was performed using Moran's I statistic. Results: The age-adjusted mortality rate at the national level during 2000 was 18.99 per 100,000 women, the highest mortality rate occurred in the year 2020. Joinpoint analysis shows a decrease in mortality in the last five years, being greater in urban areas. For 2023, the highest mortality occurred in Sonora and Chihuahua, while Mexico City (-0.71; 95%CI −0.98 to −0.44) was the entity that showed a significant reduction in the mortality rate from breast cancer. The spatial analysis showed a local indicator of spatial association of 0.458 (p<0.05) for 2000 and 0.524 (p<0.05) for 2023 in the northern states of the country. Conclusion: Public health interventions must be implemented according to the social, economic, and cultural context to reduce mortality from breast cancer.

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Abstract Objective: Advanced maternal age has become more common due to factors such as increased academic preparation for women, labor market participation, delayed family planning, and advances in reproductive medicine. This phenomenon raises questions about the risks and gestational outcomes associated with advanced maternal age (AMA). This study aims to explore the gestational and perinatal outcomes in pregnant women with AMA (> 35 years), comparing them with those of women aged 20 to 34 years. Methods: The research was conducted as an observational and retrospective analysis, examining data from 2012 to 2022 from the Hospital Production System (SIH/SUS) available on the DATAsus platform, covering all regions of Brazil. Variables analyzed included gestational duration, type of pregnancy (single or multiple), mode of delivery, Robson group, APGAR score at five minutes, birth weight, and occurrence of congenital anomalies. Results: Pregnant women with AMA showed statistically significant differences in the higher percentage of cesarean sections (63.3% AMA vs 58% non-AMA, p<0.05), higher percentage of low birth weight newborns (12.5% AMA vs 6.7% non-AMA, p<0.05), lower APGAR scores at the fifth minute (OR = 1.08, p<0.001) and a higher prevalence of any congenital anomalies (1.23% AMA vs 0.77% non-AMA, OR =OR = 1.34, p < 0.001). In addition, this group had a higher incidence of premature births (12.99% AMA vs 8.78% non-AMA) and multiple pregnancies (1.39% AMA vs 0.83% non-AMA). Furthermore, in the Robson classification, there was a predominance of older mothers in Group 5 (previous cesarean section) and in the groups with nulliparity. Conclusion: Pregnant women with AMA face higher gestational and perinatal risks, such as preterm births and an increased need for cesarean sections. These findings underscore the importance of public policies and personalized management strategies to improve maternal and neonatal outcomes for older pregnant women.

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Abstract Objectives: Clavicle fractures are the most common birth-related fractures. They may cause pain, arm mobility impairment, and brachial nerve injury (temporary or definitive). Therefore, we aimed to review the incidence, risk factors and prognosis of neonatal clavicle fractures in our hospital. Methods: All cases of clavicle fractures diagnosed and registered during the neonatal period between 2018 and 2022, in a tertiary-care Portuguese hospital, were reviewed. Statistical descriptive analysis, odds ratios (ORs), and 95% confidence intervals(95%CI) were calculated. Results: A total of 8132 births and 91 clavicle fractures were identified (1.1% incidence) – 0.04% (1/2512) in cesarean sections and 1.7% (90/5453) in vaginal births. An instrumental vaginal birth doubled the probability of clavicle fractures (OR 2.072, 95%CI 1.365-3.145 compared to spontaneous births). In 15.4% of clavicle fractures, births were complicated by shoulder dystocia. Shoulder dystocia significantly increased the risk of clavicle fracture (OR 35.71; 95% CI 17.86-71.43). Of the 91 cases, 22% resulted from pregnancies complicated by gestational diabetes; in these cases, the risk of clavicle fractures increased 76% (OR 1.761, 95%CI 1.068-2.904). Most of the cases were referred to a Neonatology follow-up appointment (92.3%). Fifteen neonates had a clinical suspicion of brachial plexus injury, but all of them regained normal arm mobility after physiotherapy. Conclusion: The incidence of clavicle fractures in our hospital is comparable to the literature (1.1%). To reduce the incidence of clavicle fractures not only its risk factors must be reduced, but a simulation-based labor ward team training program on shoulder dystocia should also be implemented.

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Abstract Objective: To identify factors that predict the likelihood of a successful vaginal birth after cesarean section (VBAC). Methods: An observational, case-control study was conducted at Hospital das Clínicas, Botucatu Medical School, a tertiary referral center in Brazil. Medical records of women with singleton term pregnancies, one previous cesarean section, and a live fetus in cephalic presentation who delivered between January 2013 and December 2015 were reviewed. Participants were classified according to delivery mode: vaginal birth after cesarean section or repeat cesarean section. Maternal demographics, clinical and obstetric characteristics, and neonatal outcomes were analyzed. Associations were assessed using chi-square, and significant variables were entered into a multivariate logistic regression model. Results: A total of 653 women met the inclusion criteria. Of these, 324(49.6%) achieved a vaginal birth, and 329(50.4%) underwent a repeat cesarean section. Factors associated with a higher likelihood of vaginal birth included a history of prior vaginal delivery, cervical dilation of at least 4 cm at admission, a Bishop score of 6 or higher, spontaneous onset of labor, absence of chronic hypertension, and neonates classified as appropriate or small for gestational age. In contrast, advanced maternal age, unemployment, diabetes, and hypertensive disorders were associated with an increased likelihood of cesarean delivery. Conclusion: VBAC was more likely in women with cervical dilation of 4 cm or more at admission, a Bishop score of 6 or higher, a history of vaginal birth, spontaneous labor onset, absence of chronic hypertension, and lower neonatal birth weight.

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Abstract Objective: To analyse the effectiveness of kinesiotherapy in the labour of pregnant women induced by misoprostol. Methods: This is a clinical trial carried out with pregnant women pharmacologically induced by misoprostol (25mcg, vaginally). They were randomised into two groups: Intervention Group (IG) of induced pregnant women who underwent kinesiotherapy during the active phase of labour; and Control Group (CG), of induced pregnant women who did not do physical therapy during the active phase of labour. Among the variables studied were vaginal delivery, induction time, duration of the labour, and the number of misoprostol doses. Data were analysed by the Statistical Package for the Social Sciences (SPSS). The IG had more vaginal deliveries (p=0.016). The other variables analysed showed no difference between groups. Results: Kinesiotherapy during the active phase of labour in women induced by misoprostol was effective for performing more vaginal deliveries despite not showing any difference in the other outcomes studied. Conclusion: The findings of this study indicate that after the application of kinesiotherapy, during the active phase of labour in pregnant women induced by misoprostol, the number of vaginal deliveries increases. Brazilian Registry of Clinical Trials (REBEC): RBR-3mvj4m7

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Abstract Objective: Allogeneic bone marrow transplantation (BMT) carries the risk of the donor's cells recognizing the recipient as abnormal, triggering Graft Versus Host Disease (GVHD). This study aimed to understand the prevalence and gynecological complications, including vaginal microbiota evaluation. Methods: A descriptive cross-sectional study was carried out from December 2022 to October 2023. Post-allogeneic BMT patients underwent gynecological evaluation at the Assis Chateaubriand Maternity School in Fortaleza-Ceará, Brazil, composed of structured interview and physical examination, which included collection of fresh examination of vaginal content, gram bacterioscopy and cervicovaginal cytology. Results: A total of 22 patients between 21 and 61 years old (average: 38) were evaluated, with an average of 1028 (± 979) days post BMT. Of these patients, whether or not they had Vulvar and Vaginal Graft Versus Host Disease (VVGVHD), 15 reported various gynecological complaints (dryness being the most common). Of the total, twelve showed signs of genital atrophy on examination. A 45% prevalence of VVGVHD was found, with vulvar and vaginal involvement of 100% and 60%, respectively. Burning and dyspareunia symptoms were more prevalent in patients with VVGVHD than in those without it (p<0.05); there was no difference in Human Papillomavirus (HPV) induced lesions between the two groups. However, compared to the population not undergoing allogeneic BMT, these patients had a higher prevalence of induced HPV lesions and intermediate vaginal flora. Conclusion: The findings described in the present work are consistent with other studies available in recent literature. In conclusion, VVGVHD is a potentially mutilating condition, with a significant prevalence among post-BMT patients.

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Abstract Objective: This study sought to analyze the profile of fetuses, newborns and pregnant women with alloimmunization (anti-RhD) referred to and treated over the twenty years since the launch of the Rio de Janeiro State. Methods: An observational, retrospective, descriptive study was conducted, with data obtained by analyzing the medical records of 481 mothers and their newborns. The study cohort consisted of pregnancies affected by RhD alloimmunization who delivered between March 2004 and March 2024 in Rio de Janeiro. Results: The absolute number of cases declined over the study period. Only 5.2% of the cohort began prenatal care in the first trimester of pregnancy and more than half (51.6%) of women arrived at the referral center in the third trimester. 40% of the women had prior severe HDFN. During this period, 422 intrauterine transfusions were performed on 71 fetuses, an average of 5.9 transfusions per patient. Infant mortality; was low, with 4% stillborn or evolving to neonatal mortality. Conclusion: The trend observed over the last 20 years is a reduction in the absolute number of HDFN cases which is perhaps more related to reproductive issues, particularly the sharp reduction in parity in our state, rather than to the implementation of alloimmunization prophylaxis.

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Abstract Objective: This study aimed to investigate the relationship between blood pressure (BP) responses during a mental stress test with 24-hour ambulatory BP (ABPM) and its variability (BPV) in postmenopausal hypertensive women. Methods: BP reactivity under mental stress and ABPM were evaluated in 75 postmenopausal hypertensive women between 50 and 70 years, on non-consecutive days. We used the values of the variation (∆) of systolic BP (SBP) and diastolic BP from the reactivity test as independent variables, and the BPV indexes Average Real Variability (ARV), 24-hour SD, and SDdn (standard deviation weighted by daytime and nighttime duration) as dependent variables. In the multiple linear regression analysis, three models were tested: 1) without adjustment; 2) adjusted for time since menopause; and 3) adjusted for both nocturnal BP dipping classification and time since menopause. Results: The ARV index showed a significant association with ∆SBP variation in all models (model 1,2 and 3: β coefficient: 0.04, CI 95%: [0.00;0.08]). Conclusion: In conclusion, blood pressure variation during the mental stress test is related to ambulatory blood pressure variation, specifically to ARV in postmenopausal hypertensive women. These findings suggest that systolic blood pressure responses to mental stress may be a relevant predictor of daily blood pressure variability.

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Abstract Objective: To evaluate the types of treatments used for non-tubal ectopic pregnancy (NTEP), the success rates of medical treatment, and the incidence of severe complications. Methods: Retrospective study of all NTEP admitted in the University of Campinas (UNICAMP) Women's hospital, Brazil, from 01/01/2000 to 01/31/2023. Outcome variables were medical treatment success and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran–Armitage and chi-square test. Results: In total 60 cases of NTEP were included (3 abdominal, 15 cervical, 12 cesarean scar, 24 interstitial fallopian tube, 3 heterotopic e 3 ovarian). In cases of abdominal, cesarean scar, heterotopic and ovarian NTEP, the main type of treatment was surgery. Medical treatment was used mainly in cervical and interstitial NTEP (p<0.01). Medical treatment (included methotrexate single dose, multiple doses or direct injection) success rate was 73.7%, with no correlation with NTEP location (p=1.000). No change in trend was identified in the success rate of medical treatment for NTEP in the period evaluated (Cochran-Armitage test: z=0.46; p= 0.644). Severe complications occurred in 12(20) of NTEP, with no association with NTEP location (p=0.27), but with hemodynamic instability (p=0.01). Conclusion: The medical treatment success rate found in our study for NTEP was similar to that reported in the medical literature for tubal EP. Two out of ten women with NTEP had severe complications. The occurrence of severe complications was not associated to the site of NTEP but to the presence of hemodynamic instability at admission.

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Abstract Objective: To analyze maternal request cesarean section (CDMR) through the perceptions of placenta accreta spectrum (PAS) survivors. Methods: This retrospective observational study was conducted at a university hospital, a reference center for the management of placenta accreta spectrum (PAS). Case identification was performed through a review of medical records, based on diagnoses related to placental disorders and postpartum hemorrhage. Only women who underwent puerperal hysterectomy between 2005 and 2023, with a PAS diagnosis confirmed by ultrasound conducted at the institution, were included. Eligible participants were contacted via instant messaging apps and invited to complete an online structured questionnaire, which included questions about their prior knowledge and post-event perceptions regarding cesarean delivery. Responses were compared between women in the cesarean delivery on maternal request (CDMR) group and those who underwent cesarean delivery for other indications. Results: A total of 89 cases of hysterectomy for PAS were identified during the study period. Of the 60 eligible women contacted, 41 responded to the questionnaire. Among them, 11 (26.8%) reported having requested the cesarean delivery, while 30 (73.2%) underwent the procedure for other reasons. It was found that 81.8% of women in the CDMR group had private health insurance, compared to 46.6% in the "other indications" group. High parity (≥3 pregnancies) was more common in the "other indications" group (80.0%) than in the CDMR group (36.4%). Overall, 36.6% were unaware of the risks of cesarean delivery, 48.8% did not receive adequate counseling during prenatal care, and 85.4% of participants were unaware of PAS. In the CDMR group, these values were 36.4%, 45.5%, and 72.7%, respectively. After the adverse experience, 51.2% of participants reported a change in their perception of cesarean delivery, 53.7% stated that they would have made a different choice if they had more information at the time, and 78.0% believed that the general population was unaware of the risks associated with cesarean delivery. Conclusion: The perceptions of women who experienced a "near miss" contributed to a better understanding of the process behind Brazilian women's preference for cesarean section. Decisions influenced by a pro-cesarean cultural context and misinformation tend to be poorly founded and more prone to regret. In Brazil, while CDMR is framed as an expression of autonomy, inadequate information and limited freedom can exacerbate inequalities, disproportionately affecting women in vulnerable situations.

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Abstract Objective: To compare maternal and perinatal outcomes in pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection among admissions in public and private maternity hospitals before COVID-19 vaccination. Methods: We performed a secondary analysis of the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed SARS-CoV-2 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. The clinical and laboratory findings and maternal and perinatal outcomes were compared between the two groups. The prevalence ratio and its 95% confidence interval for each predictor and outcome were calculated. Results: Of the 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) and 76 (27.3%) women in public and private hospitals, respectively. The frequency of SARS-CoV-2 infection did not differ significantly between the groups. Women treated at public hospitals had lower education levels (p<0.001), and 50% declared that their pregnancy was unplanned. We recorded 13 maternal deaths among women treated at public hospitals and no maternal deaths among pregnant women treated at private hospitals (p=0.024). Pregnant women in public hospitals had higher rates of fever (p=0.041), tachypnea (p=0.003), abnormal laboratory findings of liver enzymes (p=0.005), and severe acute respiratory syndrome (SARS) (p=0.014), and their neonates presented with more neonatal respiratory distress (p=0.020). Conclusion: Adverse maternal and perinatal outcomes were worse in the public hospital group, with increased rates of SARS and neonatal respiratory distress. The alarming difference in the number of deaths between patients treated in the public and private sectors highlights the urgency of better understanding the social determinants of health and calls the attention of leaders and policymakers to take action in mitigating their impact.

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Abstract Objective: To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperative complications. Methods: This retrospective cohort study included 25 pregnant women whose fetuses were diagnosed with myelomeningocele and underwent open intrauterine surgery between February 2019 and October 2023. Maternal demographic data, surgical outcomes, and neonatal variables were collected from medical records. Statistical analyses included Chi-squared test, Fisher's exact test, Mann–Whitney U test, and Pearson's correlation coefficient (r). Results: The mean gestational age (GA) at surgery was 25.7 ± 1.2 weeks, and the mean GA at delivery was 34.3 ± 2.0 weeks. Preterm birth was the most common complication (40%), followed by premature rupture of ovular membranes (32%). Two stillbirths occurred (8%) at 31 and 33 weeks of gestation. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Low birth weight (<2,500 g) was observed in 44% of neonates. Neonatal hospitalization was significantly longer in cases of preterm birth (p = 0.044), and intensive care unit stay was longer in deliveries before 34 weeks (p = 0.044). No correlation was found between GA at intrauterine surgery and GA at delivery (r = 0.252, p = 0.22). Conclusion: Fetal myelomeningocele surgery was successfully performed in a tertiary public hospital. However, preterm birth remains a major concern, as consistently reported in the literature. Nevertheless, the results confirm that intrauterine repair of myelomeningocele is indeed feasible in the public healthcare setting.

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Abstract Objective: Women may experience cognitive, emotional, and physical changes during the menstrual cycle, which can impact their physical and athletic performance. This study aimed to investigate whether Brazilian female swimmers in the senior category, i.e., over 18 years of age, federated with the Brazilian Confederation of Aquatic Sports (CBDA), use hormonal contraceptives (HCs) and assess the impacts on their health, athletic performance, and overall well-being. Methods: This is a cross-sectional descriptive observational study conducted via an online questionnaire based on the Google Forms® platform, sent via WhatsApp® and email to the participants. Questions were asked about age, use of contraceptive methods, observed changes in performance, among others. A total of 136 senior athletes participated in the study. Inclusion criteria were senior female athletes using hormonal contraceptive methods. Athletes who were not in the senior category and/or did not use hormonal contraceptive methods were excluded from the research. Results: A total of 136 senior athletes responded to the questionnaire. Of this total, 108 reported using hormonal contraceptive methods and were therefore included in the study. The results indicate that the majority of participants use oral contraceptives, with 61 (57%) using this method. Regarding the reason for using hormonal contraceptives, 88 (82.4%) use the method to control the menstrual cycle, in addition to alleviating menstrual symptoms, 63 (59.2%); 62 (57.9%) reported improvement in mood patterns, and 69 (64.55%) stated that they experience benefits from using the method. Conclusion: It is concluded that the use of hormonal contraceptives presents benefits related to the professional careers of athletes. Besides improving their training performance, HCs also help alleviate menstrual symptoms and control the menstrual cycle and flow.

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Abstract Objective: To analyze the vaginal microbiota before and after the treatment with vaginal microablative fractional radiofrequency (FRAXX) and compare it with topical estriol treatment in women with GMS. Methods: Pilot clinical trial, double-blind, randomized, and placebo-controlled. Thirty women diagnosed with SGM were evaluated regarding the vaginal microbiota before and one month after the end of the treatment protocol, through culture, bacterioscopy by Gram and pHmetry. Then, they were randomized into two groups: one with application of topical estriol for 21 days of attack and then 3 times a week until completing 3 months, together with placebo radiofrequency (RF) pulses, and the other group, with monthly radiofrequency pulses for 3 months, together with placebo vaginal cream. Results: The average age of participants was 56.33 ± 7.10 (minimum 42 and maximum 69 years of age), average age at onset of menopause 44.70 ± 5.74. In the estriol group, the participants showed no significant difference after treatment in relation to the number of basal and parabasal cells (p = 1.000), type of vaginal microbiota (p = 0.544), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Coccobacillus (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000), except for the presence of Candida (p = 0.025) and decrease in vaginal hydrogen potential (pH) (p = 0.006). In the group treated with FRAXX, it was observed that the participants showed no significant difference after treatment regarding the number of basal and parabasal cells (p = 0.500), type of vaginal microbiota (p = 0.637), presence (or absence) of Lactobacillus (p = 1.000), presence (or absence) of Cocobacilli (p = 1.000), presence (or absence) of grouped or chained Cocci (p = 1.000) and presence (or absence) of Candida (p = 1.000), except for pH variation (p = 0.037). Comparing the groups, women treated with FRAXX had a higher proportion of Lactobacillus (type I) than women treated with estriol (66.7% and 26.7%, respectively; p = 0.057). On the other hand, the proportional presence of other bacteria, but with a predominance of Lactobacillus (type II a) was higher in the group treated with estriol, when compared to the FRAXX group (46.6% and 6.7%, respectively; p = 0.057). And the application of estriol significantly increased the Candida concentration when compared to FRAXX (p = 0.042). Conclusion: There was improvement in the parameters analyzed regarding the vaginal microbiota in the intervention with FRAXX with a higher proportion of Lactobacillus and a decrease in pH. And there was no superiority of FRAXX in relation to the use of topical estriol.

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Abstract Objective: The aim of this study was to evaluate the effect of vaginal pH on the efficacy of the dinoprostone vaginal insert for cervical ripening in patients with unfavorable Bishop Score. Methods: Prospective observational cohort study, conducted at a Portuguese tertiary hospital. Term pregnant women with a singleton pregnancy and vertex presentation who had indication for labor induction with Bishop's Score ≤ 6 were included. Vaginal pH was measured with high accuracy strips before vaginal examination for Bishop Score was performed. The intravaginal dinoprostone insert (Propess®) was then applied into the posterior fornix. The primary outcome was the change of the Bishop's Score before placement and after removal of the dinoprostone insert. Spearman correlation was analyzed (SPSS 16.0). Results: A total of 75 women were included, with a gestational age of 39 ± 1,2 weeks. Mean initial vaginal pH was 4.67 ± 0.51. Mean variation of Bishop Score was 1.8 ± 2.3 points. There was a weak correlation between vaginal pH and changes on the Bishop Score with dinoprostone vaginal insert use (ρ = −0.123; p = 0.3). Conclusion: Vaginal pH does not appear to be a major influencer of the efficacy of dinoprostone vaginal insert for cervical ripening.

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Abstract Objective: Preterm birth is a leading global cause of neonatal mortality and morbidity, with oxidative stress playing a role in its pathogenesis. Vitamin C, a powerful antioxidant, may help reduce this risk. This study assessed the effectiveness of vitamin C supplementation, both alone and with vitamin E, in preventing preterm birth compared to a placebo. Data source: Databases were systematically searched in PubMed, Cochrane and Embase in December 2023 and updated in May 2024. Study Selection: Included RCTs evaluated vitamin C's effect on preterm birth and related neonatal outcomes. Data collect: Statistical analyses used a random-effects model for pooled risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity was assessed with the I² statistic. Data synthesis: Seventeen RCTs (21,567 patients) were analyzed. Vitamin C supplementation showed no significant difference compared to placebo for preterm birth (RR 1.04; 95% CI 0.96, 1.14). No significant differences were observed for neonatal death (RR 0.77; 95% CI 0.55, 1.08), NICU admission (RR 1.03; 95% CI 0.95, 1.13), preterm PROM (RR 1.04; 95% CI 0.63, 1.71), or birth weight (MD 52.41; 95% CI −19.65, 124.47). A slight decrease in gestational age was observed (MD 0.26; 95% CI −0.02, 0.55). Conclusion: Vitamin C supplementation alone or in combination with vitamin E does not significantly prevent preterm birth or improve related neonatal outcomes.

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Abstract Statins are the most widely used pharmacological class for treating hyperlipidemia, although they are contraindicated during pregnancy. This study aims to demonstrate the clinical effects of statins in pregnant women through an interactive review. Fifteen original articles were selected, in English or Portuguese, within of five years. Statins have not been associated with the development of fetal malformations and their use may be useful in preventing unfavorable cardiovascular outcomes, with the potential to reduce oxidative stress and angiogenic dysfunction. However, the use of statins to prevent pre-eclampsia in humans has not been properly clarified and further studies are needed. Pravastatin is considered safer than statins for use during pregnancy.

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Abstract Objective: This study aimed to investigate the effect of low-level laser therapy (LLLT) on nipple trauma and pain during breastfeeding through a systematic review with a meta-analysis of selected studies. Source of the data: A thorough search was conducted on March 22, 2022, using the databases PubMed, SciELO, LILACS, PEDro, CINAHL, EMBASE, ScienceDirect, Scopus, Google Scholar, MEDLINE, the Cochrane Library, Clinical Trials, Web of Science, TRIP, DARE, and ProQuest. The search terms included various combinations of low-level laser therapy, nipple pain, nipple trauma, and breastfeeding. Studies selection: Out of 107 articles identified, only three controlled and randomized clinical trials was included. The extracted data encompassed breast and trauma characteristics, treatment types, outcomes (pain and healing process), evaluation tools, LLLT usage, laser brand, and parameters. Data collection: Data extraction was performed using RAYYAN for systematic reviews. The risk of bias in the studies was evaluated. Data synthesis: Pain was measured using the visual analog scale (VAS). The included studies did not use validated tools for assessing physical conditions. All studies employed LLLT with a 660-nm wavelength, though there were variations in equipment power, energy dose, and application methods. The meta-analysis revealed an average difference of −0.60 points (95% CI: −1.52 to 0.31) in the VAS pain scores between the LLLT and control groups. No heterogeneity was observed among the studies (I2=0%), indicating no significant difference in pain relief between LLLT (red light) and control groups. Conclusion: LLLT may offer a promising option for managing breastfeeding-related complications, though further research is required.

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Abstract Objective: Preterm birth remains a significant contributor to neonatal morbidity and mortality. The use of cervical pessaries as an intervention for preventing preterm delivery in women with a short cervix has been a subject of interest. We evaluated the effectiveness of cervical pessary compared to standard care in preventing preterm delivery in women with a short cervix. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in December 2023. Study selection: Randomized clinical trials with the outcomes of interest were included. Data collect: We computed risk ratios for binary endpoints, with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. Data were analyzed using R software (version 4.3.0). The primary outcomes of interest were preterm delivery before 37 weeks, and preterm delivery before 34 weeks. Data synthesis: Seventeen studies with 5,704 patients were included. The use of cervical pessary was associated with a decreased risk of preterm delivery before 37 (RR 0.88; 95% CI 0.81-0.96) and 34 weeks (RR 0.79; 95% CI 0.63-0.99) of gestation in twin pregnancies as compared to standard care without progesterone. There were no significant differences in preterm delivery in singleton pregnancy, neonatal outcomes, preterm premature rupture of the membranes or chorioamnionitis. Conclusion: The use of cervical pessary was associated with a significant reduction in preterm delivery at 34 and 37 weeks of gestation in twin pregnancies among patients with a short cervix compared to no treatment. No significant difference was found in singleton pregnancies or maternal outcomes.

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Abstract Objective: This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures. Methods: We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term "tranexamic acid". Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively. Results: Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate. Conclusions: This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.

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Abstract Objective: We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS). Data Sources: We systematically searched EMBASE, PubMed, and Cochrane databases on October 31, 2024. Study selection: We included studies of women with PCOS treated with a combination of clomiphene and letrozole or letrozole alone to induce ovulation that reported any of the outcomes of interest, namely rate of mature follicles and ovulation, ovulation, pregnancy, miscarriages, endometrial thickness, and number of mature follicles. Data collection: We pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) using a random effects model using R statistical software, version 4.2.1. Heterogeneity was assessed with I2 statistics, and a random effects model was used. Data Synthesis: Four RCTs and two observational studies comprising 592 patients were included. Combined therapy was associated with a higher rate of a mature follicle (OR 2.74; 95% CI 1.72-4.37; p< 0.001; I2=0%) and ovulation (OR 2.55; 95% CI 1.57-4.12; p< 0.001; I2=35.9%). The number of mature follicles, number of pregnancies, thickness of endometrial lining, and the incidence of adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups. Conclusion: In women with anovulatory infertility secondary to PCOS, letrozole and clomiphene citrate combined therapy was associated with improved mature follicle and ovulation rates, with a similar safety profile compared to letrozole alone. However, no significant impact was observed on pregnancy rates.

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Abstract Objective: Placenta accreta spectrum (PAS) describes the failure of placental detachment. PAS is a pregnancy-associated life-threatening condition which increases hemorrhage risk. We evaluated safety and efficacy of internal iliac artery balloon occlusion (IIABOC) on bleeding volume among pregnant women with diagnosis or suspicion of PAS. Data source: We searched PubMed, Embase and Cochrane databases. Study selection: Randomized controlled trials (RCTs) and observational studies comparing the efficacy of preoperative prophylactic balloon catheters to a control group with standard care in patients with a prenatal screening of PAS. Data collect: We computed odds ratio (OR) for binary endpoints and mean difference (MD) for continuous endpoints, with 95% confidence intervals (CIs). We performed random effects models and assessed I2 heterogeneity statistics. Data synthesis: Twenty-four studies were included, of whom 1,023 (51%) received balloons and 983 (49%) did not undergo balloon management. Patients receiving IIABOC had a greater decrease in estimated blood loss (MD −0.33; 95% CI −0.55, 0.11) and increase in operation time (MD 17.21; 95% CI 3.43, 30.99). Apgar score at fifth minute (MD −0.22; 95% CI −0.36,−0.07) significantly decreased. There were no significant differences between groups regarding hysterectomy rates (OR 1.35; 95% CI 0.88, 2.09) and maternal intensive care unit admission (OR 0.81; 95% CI 0.51,1.29). Conclusion: While IIABOC have demonstrated a significant reduction in estimated blood loss, these findings have not been consistently replicated in RCTs and the surgeon's level of experience must be taken into account since it biases the analysis.

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Abstract Background: During pregnancy, the maternal supine position may reduce uterine and placental perfusion due to compression of the aorta and inferior vena cava by the gravid uterus, potentially impairing maternal and fetal oxygenation. Objective: This scoping review aimed to summarize the available evidence on the impact of maternal positioning during ultrasound examinations on fetal Doppler indices of the umbilical artery (UA) and middle cerebral artery (MCA). Methods: Studies were eligible if they included pregnant women undergoing fetal Doppler assessment in at least two different maternal positions and reported outcomes related to UA and/or MCA indices. Only studies published in English in the past 20 years were included. Sources of evidence: A comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, and Scopus databases between September and October 2023. Charting methods: Two independent reviewers conducted the initial screening for relevance, with conflicts resolved by consensus or by a third reviewer. Results: Thirteen studies were initially identified. After applying the eligibility criteria, six observational prospective studies were included. These studies assessed changes in UA-PI, MCA-PI, and/or the cerebroplacental ratio (CPR) in response to different maternal positions during Doppler ultrasound. Conclusions: Evidence suggests that maternal positioning during fetal Doppler ultrasound can influence arterial indices, particularly when comparing supine and lateral decubitus positions. However, variability in methodology and small sample sizes limit the generalizability of findings. Further standardized studies are needed to guide clinical recommendations.

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Abstract Objective: Assess survival outcomes and risk of recurrence in vaginal estrogen therapy (VET) users with medical history of breast cancer. Data source: The search strategy was guided by standardized terms and keywords were identified from controlled vocabularies. Following databases were used for literature search: Pubmed, EMBASE, Cochrane, Scopus and Web of Science. Only studies published in the 21st century (2001–present) and written in English were included. Study selection: A total of 988 records were reviewed by two independent authors. After full-text analysis of 38 of them, 7 articles were included in the meta-analysis. Data collection: Data from eligible studies were extracted and tabulated based on predefined criteria: author, country, year, study type, sample size, type of intervention, use of aromatase inhibitors, duration of follow-up, and main outcomes. Results: 118.659 breast cancer survivors were analyzed, of whom 6.358 were treated with VET. The overall analysis showed no significant increase in the risk of recurrence (RR = 0.87, 95%CI: 0.67-1.11). VET users had a significant reduction in all-cause mortality (RR = 0.80, IC95%: 0.75–0,86). Conclusion: Vaginal estrogen therapy appears to be safe in the management of menopausal genitourinary syndrome in breast cancer survivors and it is related to significantly lower all-cause mortality. Prospective Register of Systematic Reviews (PROSPERO): CRD42024602047

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Abstract Objective: This review evaluated myo-inositol supplementation's effectiveness in pregnant women at high risk for Gestational Diabetes Mellitus (GDM). Sources: A systematic search in PubMed/MedLine, Cochrane, and VHL databases was conducted using the following terms: "inositol," "diabetes," "gestational diabetes," and "prevention," with no limits on publication period or language. The reference lists were scanned for additional articles. Selection criteria: Relevant studies were identified by screening titles, abstracts, and full texts, following inclusion and exclusion criteria and eliminating duplicates. One additional study was added after reviewing references. Data collection: Guided by the PRISMA Statement, data were extracted using Microsoft Excel. The primary outcome was GDM incidence; secondary outcomes included maternal, birth, neonatal health, and adverse effects. Data synthesis: Five studies were included. Myo-inositol supplementation significantly decreased the incidence of GDM in all studies. One study noted significant weight loss. Three studies found no reduction in insulin treatment needs with myo-inositol supplementation. One study showed a decrease in macrosomia incidence. No decrease in cesarean delivery rates was verified, though one study noted reduced hypertensive disorders’ incidence with myo-inositol. Four studies evidenced no reduction in premature birth or shoulder dystocia. There was no significant difference in hypoglycemia incidence in three studies. One study showed a decrease in Neonatal Intensive Care Unit admissions with myo-inositol supplementation. One patient reported headaches. Conclusion: Due to study divergences, no clinical recommendations can be made. However, myo-inositol supplementation appears effective in reducing GDM incidence in at-risk pregnant women.

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Abstract Objective: To conduct a systematic review of the literature, compiling the available evidence from the last decade to better understand the relationship between the Dietary Inflammatory Index and the risk of Gestational Diabetes Mellitus. Methods: A comprehensive search was systematically conducted including cohort and case-control studies, researched from the BVS, PubMed, Embase, and Google Scholar platforms with articles published between 2014 and 2024. The risk of bias was assessed using the Quality Assessment Tool. Results: This review included 10 studies from five countries with participant numbers ranging from 164 to 90,740. In total, four case-control studies found higher DII values in the groups of pregnant women diagnosed with Gestational Diabetes Mellitus compared to those without the diagnosis. When analyzing the remaining cohort studies, one study showed a higher distribution of Gestational Diabetes Mellitus in the highest tertile of Dietary Inflammatory Index, and the other (five studies) showed an association between DII and Gestational Diabetes Mellitus risk when using models adjusted for anthropometry, gestational history, and dietary intake. Conclusion: Pregnant women diagnosed with Gestational Diabetes Mellitus have a diet with more pro-inflammatory characteristics, which increases the risk of adverse perinatal outcomes. Registry of Systematic Reviews (Prospero): CRD42024573560

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Abstract Objective: In this systematic review, we aim to compare the GWG in pregnant women with diabetes treated with metformin and other interventions Methods: Data Sources: The searched baselines included PubMed, Scopus, Web of Science, Embase, and Virtual Health Library (BVS). Study selection: We selected articles that compared the GWG in women with diabetes treated with metformin or insulin. We have included clinical trials (randomized or not), observational studies (cohort, case control, and cross-sectional). Reviews (systematic or not), posters, event abstracts, and letters were excluded. Data Collection: We pooled odds ratios (OR) and mean difference (MD) and used a random effect model using R Studio software to compare the weight gain, fetal birthweight and preeclampsia according to treatment. Results: On research conducted in January 2024, with no data limit of the search, 433 trials were identified, of which 175 remained after duplicate removal. 50 studies were analyzed in the full text analyses and 9 were selected for the systematic review. 8 studies demonstrated that gestational weight gain during metformin treatment is lower when compared to other treatments, especially insulin, although it was not different from other outcomes. Meta-analyses demonstrated that oral medication GWG is lower than insulin with a standard mean difference (SMD) -1,05 [-1,87, - 0,23]. Conclusion: Oral medication has a lower gestational weight gain in patients with gestational diabetes when compared to insulin. International Prospective register of Systematic Reviews (PROSPERO): CRD 42024492158

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Abstract Objective To evaluate the effects of aerobic and resistance exercise on body mass index (BMI), insulin levels, lipid profiles, and hormonal parameters in women with polycystic ovary syndrome (PCOS). Data sources We searched PubMed, Web of Science, and Embase databases for publications up to September 2024. Fully published articles involving reproductive-age women diagnosed with PCOS were included. Study selection Randomized controlled trials comparing supervised aerobic or resistance exercise to no intervention in women diagnosed with PCOS based on Rotterdam or NIH criteria were included. The Rayyan Systematic Review tool was used to organize study data. Data collection Data extraction was conducted independently by two reviewers. Meta-analysis employed random-effects modeling. Data synthesis Ten randomized controlled trials with 382 women were analyzed. Aerobic exercise interventions (12–24 weeks) reduced BMI, waist circumference, insulin levels, total cholesterol, and low-density lipoprotein. Effects on fasting glucose, high-density lipoprotein, and triglycerides varied. Hormonal assessments showed reduced testosterone and increased sex hormone-binding globulin in some studies. Resistance exercise improved lean body mass and reduced body fat percentage but showed minimal effects on hormonal parameters. Meta-analysis revealed aerobic exercise decreased insulin, cholesterol, and triglycerides compared to no intervention, while other metabolic and hormonal markers showed inconsistent changes. Conclusion Aerobic and resistance exercise improve anthropometric measures, metabolic health, and hormonal balance in women with PCOS. These findings highlight exercise as a valuable therapeutic strategy for managing PCOS and enhancing overall health outcomes.

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Abstract Objective: Thyroid peroxidase antibody (TPOAb) is a prevalent condition amongst women of reproductive age and has been associated with adverse pregnancy outcomes. However, there is currently no proven treatment for euthyroid pregnant women with TPOAb. Therefore, we aimed to investigate the efficacy of levothyroxine treatment in this population. Methods: We searched PubMed, Embase and Cochrane Central from inception to or randomized controlled trials (RCTs) comparing levothyroxine with placebo or no treatment in euthyroid pregnant women who were positive for TPOAb. Our main outcomes were miscarriage, preterm birth, and live birth. We performed subgroup analysis based on recurrent pregnancy loss (RPL). Results: We included 8 RCTs comprising 1,645 pregnant women, of whom 814 (49.5%) were randomized to receive levothyroxine. Pregnant women treated with levothyroxine had significantly lower miscarriages (RR 0.78; 95% CI 0.63-0.98; p=0.035). No significant difference was found regarding pre-term birth (RR 0.78; 95% CI 0.55-1.13; p=0.189) and live birth (RR 1.05; 95% CI 0.99-1.12; p=0.097). Our subgroup analysis demonstrated a significant interaction (p=0.048) between patients with RPL (RR 1.21; 95% CI 1.03-1.42; p=0.023) and no RPL (RR 1.00; 95% CI 0.92-1.09; p=0.922). Conclusion: Levothyroxine reduced miscarriage in pregnant women with TPOAb and improved live birth rate when associated with RPL. Our subgroup analysis also provides evidence that levothyroxine may have a higher benefit for patients with a history of RPL. PROSPERO Registry: CRD42023410433

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Abstract Objective: To synthesize current scientific evidence on the benefits and potential contributions of integrating AI-based technologies with traditional diagnostic methods used for the detection and early diagnosis of cervical cancer in adult women. Methods: An exhaustive search was conducted in academic databases (PubMed, Scopus and BIREME) using specific search terms and Boolean operators in December 2024. Independently conducted by three researchers across all databases, the selection process included articles involving adult women with either suspected or confirmed cervical cancer, in which the application of artificial intelligence (AI) technologies was examined across various techniques used for early diagnosis of the disease, such as cytology, colposcopy, and radiological imaging, among others. Only articles published between 1999 and 2022 were included. The included articles were reviewed in full text by all authors, and relevant data were extracted and organized into a chart comprising the following items: author and year of publication, title, study design, type of AI technology used, and a summary of the content. Results: AI, particularly through Machine Learning (ML) algorithms, demonstrated significant improvements in the accuracy, sensitivity, and efficiency of cervical lesion classification when combined with conventional diagnostic techniques like cervical cytology, colposcopy, and biopsy. This combined approach outperformed traditional methods used in isolation. Conclusion: The integration of AI with standard cervical cancer screening and diagnostic methods offers substantial benefits, including faster detection times, reduced workload for pathologists, and improved patient outcomes by facilitating earlier treatment initiation and reducing diagnostic variability. Considering the available literature, the use of AI may offer potential benefits; however, further studies are required.

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Abstract Objective: When spontaneous vaginal delivery is not feasible, Instrument-assisted vaginal delivery (IVD) is utilized, which often involves the use of vacuum extractors (VE) and obstetric forceps. This study intent to evaluate the risks and benefits associated with utilizing obstetric forceps vs vacuum extractors for IVD, focusing on maternal and neonatal outcomes. Methods: Following PRISMA guidelines, a full literature search was done in PubMed, Embase, and Google Scholar until April 2024. The review examined randomized controlled trials (RCTs) that compared forceps and vacuum extractors. Two writers extracted the data and assessed its quality separately, with a third resolving any inconsistencies. The statistical study was conducted using R software, with a random-effects model used to quantify risk differences and evaluate heterogeneity. Results: Seven RCTs, totalling 2,299 individuals, were included. A meta-analysis revealed that forceps significantly increased the incidence of perineal tears (Risk difference = 0.08, 95% CI 0.02-0.13) and vaginal injuries (Risk Difference = 0.12, 95% CI 0.05-0.19). Vacuum extractors were associated with an increased risk of infant cephalohematoma (Risk Difference = −0.06, 95% CI −0.08, −0.04). There was no significant difference in maternal anaesthesia required or failure to accomplish vaginal delivery with the intended instrument. Conclusion: Obstetric forceps are more likely to cause maternal perineal tears and vaginal injuries, whereas vacuum extractors increase the likelihood of neonatal cephalohematoma. Both methods have comparable anaesthetic needs and success rates for vaginal birth. The clinical scenario ought to guide the choice of instruments, with an emphasis on risk minimization through proper training. PROSPERO: CRD42024577839.

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Abstract Objective: Evaluate the application and effectiveness of the problem-based learning (PBL) teaching model in Obstetrics and Gynecology (OB/GYN) undergraduate education. Data sources: A systematic search was performed in five electronic databases (LILACS, PubMed/MEDLINE, EMBASE, CINAHL, and Cochrane Library) for studies published between January 1, 2000, and December 31, 2021. The search strategy used descriptors in English, portuguese, and Spanish based on the PICO framework: "Education, Medical, Undergraduate" (P); "Problem-Based Learning", "Gynecology", and "Obstetrics" (I); no comparator (C); and "Patient Satisfaction" or "Knowledge" (O). Study selection: A total of 24 studies were included. Selection criteria encompassed original articles that evaluated the impact of PBL in OB/GYN undergraduate education, without language restrictions. Data collection: Two independent reviewers extracted data regarding study characteristics, participant profiles, methodology, and outcomes. Discrepancies were resolved by consensus. Data synthesis: Among the included studies,14(58.33) of them coming from Asian, most of them 16(66.66) having been published between the years 2006-2010 and 2016-2021. About 15(62.5) dealt only with students, the majority consisting of surveys/questionnaires 8(30) and non-randomized comparative studies 7(29.16). As for academic performance, 14(58.33) demonstrated that the PBL methodology is superior considering the ability to sediment information, and 8(30) indicated PBL is superior concerning developing clinical reasoning. Regarding student satisfaction, 11(45.83) of the studies indicated a positive experience with the method. Conclusion: The PBL model appears more effective than traditional teaching methods in enhancing clinical competence and student satisfaction in OB/GYN education. However, further well-designed studies are necessary to confirm these findings and guide educational strategies. PROSPERO Registry CRD42021282337

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Abstract Objective: To review the real benefits of using combined oral contraceptives (COCs) containing natural hormones, also known as estradiol-containing COC (estradiol and estradiol valerate) in controlling abnormal uterine bleeding (AUB) compared to the already established data on treatment with combined pills containing ethinylestradiol (EE). Methods: Narrative review with analysis of studies published between 2010 and 2023, comparing the effects of EE and natural estrogen in the treatment of AUB, indexed in the PUBMED, WebOfScience, and Scielo databases. Results: A total of 342 articles were found in the selected databases. Of these, 235 articles were excluded because they were published before 2010 or lacked an explicit relationship with the topic; 107 articles were selected for title and abstract screening, of which 27 were fully read by the researchers, and 6 were included in the study. It was observed that the use of natural estrogens is effective in controlling abnormal uterine bleeding, often with fewer side effects and less cardiovascular and prothrombotic impact compared to ethinylestradiol (EE). However, some non-contraceptive benefits of EE, such as less water retention, improved skin oiliness, and acne, were not consistently observed with the use of natural estrogens. Conclusion: Estradiol-containing COC have proven to be effective in controlling AUB, in addition to reducing spotting and intermenstrual bleeding, with fewer undesirable side effects when compared to COCs with EE. On the other hand, COCs with estradiol and estradiol valerate less frequently present other non-contraceptive benefits.

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Abstract An 8-year-old girl presented with vaginal bleeding without puberty signs. During investigation at 10 years old, the patient presented with advanced bone age, prepubertal hormone levels and internal genitalia. Hysteroscopy and vaginoscopy at 10 years and 10 months of age revealed endometrial proliferation despite infantile genitalia. Histopathology showed positive receptors for estrogen and progesterone. This is the first report of endometrial estrogen and progesterone receptor activity in this context. Despite normal serum estradiol, the findings suggest a local action of estrogen. Follow-up until 11 years of age showed progressive development of secondary sexual characteristics. This case report emphasizes the need to consider isolated vaginal bleeding, without the development of secondary sexual characteristics, as a result of endometrial hypersensitivity to low estrogen levels during pubertal development, which may alter the chronology of pubertal development in girls.

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Key points • Although advances in the treatment of gynecological cancer have improved survival rates, they may also increase the effects of induced menopause, especially in young women. • Cancer treatments such as oophorectomy, gonadotoxic chemotherapy, and pelvic radiotherapy can induce menopause. • Gonadotoxic chemotherapy, especially alkylating-containing regimens, often damages ovarian function and may result in permanent menopause. • Pelvic radiotherapy usually results in permanent loss of ovarian function unless ovarian transposition is performed. • Diagnosing menopause after cancer is challenging, and common diagnostic criteria such as 12 months or more of amenorrhea and elevated follicle-stimulating hormone (FSH) levels are not entirely reliable, since ovarian function may return years after treatment. • A multidisciplinary approach to post-cancer menopause is essential and should include an appropriate line of care, since hormone replacement therapy after treatment of gynecologic malignancy is controversial.

Resumen en Inglés:

Key points •The population of female cancer survivors has increased over the last few years, highlighting the importance of appropriate follow-up of these patients. •The main objective of long-term follow-up for patients treated for cancer is the early detection of recurrences, whether local, lymph node or distant metastases. •Symptom assessment and physical examination play an important role in the follow-up of patients treated for gynecological neoplasms. •The use of laboratory or imaging tests to detect recurrence in asymptomatic patients should be based on evidence that it improves survival or provides less morbid treatments, also considering cost and availability.

Resumen en Inglés:

Key points •Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the leading cause of vaginal agenesis. •It is characterized by primary amenorrhea with typical adrenarche and telarche and may be associated with congenital urological and skeletal conditions that should be investigated. •Differential diagnoses include: vaginal obstructions (imperforate hymen, distal vaginal atresia, transverse vaginal septum), uterine obstructions (cervical atresia), and differences in sexual development (gonadal dysgenesis, complete androgen insensitivity and congenital adrenal hyperplasia due to CYP17 deficiency). •Laboratory tests (testosterone, follicle-stimulating hormone [FSH] and karyotype) and radiological tests (pelvic ultrasound and MRI) are necessary. •Vaginal dilation is the first line of treatment with high success rates.

Resumen en Inglés:

Key points •Asthma is the most common lung disease during pregnancy and its diagnosis is determined in the same way in pregnant and non-pregnant women. •Spirometry is a simple test used to confirm and monitor the disease, and has no contraindications for use during pregnancy both in the pre- and post-bronchodilator phase. •The control of asthma before pregnancy is the main predictor of disease severity during pregnancy. Other predictors of asthma attacks include smoking, overweight and obesity. •Inadvertent interruption of maintenance medication is one of the factors most associated with exacerbation and complications related to asthma during pregnancy. •In general, treatment of pregnant women with asthma should be similar to that of non-pregnant women. Inhaled corticosteroids (ICS) are the main medication to achieve and maintain control of the disease during pregnancy. •Corticosteroids prescribed for maintenance treatment of chronic asthma have no effect on accelerating fetal maturity. The usual protocol should be used when this acceleration is necessary. •Moderate asthma exacerbation includes at least one of the following criteria: 1) worsening of respiratory symptoms; 2) worsening of lung function; 3) increased use of inhaled pump medication (e.g., salbutamol; at least two-day duration). •Severe asthma exacerbation includes at least one of the following criteria: 1) use of systemic corticosteroids or increased dose of maintenance oral corticosteroids for at least three days; 2) hospitalization or visit to the emergency room (ER) due to asthma requiring the use of systemic corticosteroids. •Asthma does not normally affect labor or the choice of delivery route.

Resumen en Inglés:

Key points •Differences between laser, radiofrequency (RF) and microfocused ultrasound (MFU) energy-based devices (EBD). •Indication of energy-based devices in genitourinary syndrome of menopause (GSM). •Indication of energy-based devices in urinary incontinence (UI). •What is known about the use of energy-based devices in sexual dysfunction (SD)? •Indication of energy-based devices in vulvar lichen sclerosus (VLS).

Resumen en Inglés:

Key points •Address the types of immunodeficiency and the greater susceptibility to severe infections compared to the general population, as well as a less efficient response to vaccine stimuli. •Provide information on the negative impacts of infections on the health of immunodeficient individuals and their complications. •Provide knowledge of studies on the efficacy and safety of vaccines in the immunosuppressed population. •Clarify which vaccines should be indicated, the best time to administer them, and when to revaccinate. •Update gynecologists and obstetricians on the vaccination schedule for this population and on the position of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) regarding the vaccines made available by the National Immunization Program, including by the Reference Centers for Special Immunobiologicals (Portuguese acronym: CRIEs) and private vaccination services.

Resumen en Inglés:

Key points Chronic pelvic pain is a common and complex condition that significantly affects women’s quality of life. Neuropathic pain and nociplastic pain are important components in the pain picture of these patients and should be considered in clinical treatment. Oral neuromodulators, antidepressants and anticonvulsants for the control of neuropathic and nociplastic pain should be present in the therapeutic arsenal of the gynecologist who treats patients with chronic pelvic pain. Pregabalin is the medication with the best pharmacokinetic profile; nortriptyline has the best adverse effects profile; duloxetine is the most widely used and has the lowest risks; and venlafaxine should be used as a second-line inhibitor. Although the drug classes can be combined to reduce the total doses and minimize side effects, maximizing the analgesic effect, monotherapies are recommended as the first line to avoid polypharmacy.

Resumen en Inglés:

Key points Prompt care for victims of sexual violence is essential in the implementation of measures to prevent pregnancy resulting from violence and sexually transmitted infections, and to assess and monitor serological follow-up and gather evidence for possible criminal proceedings. In the absence of a referral service, any health service should take the appropriate initial measures and refer the victim to the referral service (if there is one) as quickly as possible. Referral services for immediate care for victims of sexual violence allow victims to be followed up for a longer period of time. However, acute care should be provided by any health unit to avoid care delays. There is no need for any legal complaint or registration of a police report for providing healthcare to victims of sexual violence. However, victims should be informed about their right to report the assault at any time, so an appropriate legal and police investigation can be carried out. It is important to address this topic during medical care. All services providing care to victims of sexual violence must be open and receiving victims continuously, without the need for other health units or a police authority. Obstetrician/gynecologists are often the professionals responsible for caring for victims of sexual violence and must be familiar with the initial care protocols for these patients.

Resumen en Inglés:

Abstract Objective: To evaluate the continuation rate, satisfaction, and reasons for discontinuation of depot medroxyprogesterone acetate (DMPA) in adolescents treated in a mental health service. Methods: Prospective cohort study conducted in a reference unit for the care of adolescents with mental disorders (MDs) and intellectual disabilities (IDs). All patients received a gynecological consultation and an educational group on contraceptive methods. Sociodemographic data on age, education and gynecological data (menarche, coitarche, regularity of menstrual cycles and presence of symptoms) were collected. Follow-up was quarterly for 12 months, during which symptoms, desire to continue, and satisfaction with the use of the quarterly injectable were assessed. Results: Eight hundred and sixty-two sexually active adolescents were supported, 532 adolescents chose to use the quarterly injectable, and 69 of these agreed to participate in the study. The mean age of users was 15.5 years (SD=0.91). After 12 months of follow-up, 34 (49.3%) of the 69 adolescents continued to use the method and 36 (52.3%) were satisfied. Among the 33 (47.8%) who discontinued use, the most common reasons were irregular bleeding and weight gain. Conclusions: Adolescents with intellectual disabilities and/or other mental disorders showed a significant rate of continuation and satisfaction with the use of the depot medroxyprogesterone acetate at 12 months, and the most common reasons for discontinuation were irregular uterine bleeding and weight gain.