Impact of the COVID-19 Pandemic on Diagnosis and Management of Gynecological Cancer: A Single-Center Analysis.

Background and Objectives: The COVID-19 pandemic impacted health systems worldwide, particularly cancer care. Because the actual implications of these changes on gynecological oncology healthcare are still unclear, we aim to evaluate the impact of this pandemic on the diagnosis and management of gynecological cancer. Materials and Methods: This is a single-center retrospective observational study, including patients diagnosed with gynecological malignancies between January 2019 and December 2021. Patients were included into three groups based on the timing of cancer diagnosis: pre-pandemic (2019), pandemic with high restrictions (2020) and pandemic recovery (2021). Results: Overall, 234 patients were diagnosed with gynecological cancer during the period of study. A decrease in the number of newly diagnosed cervical cancers and other rare tumors (leiomyosarcoma, invasive hydatidiform mole) was apparent in 2020. Some aggressive histological types of endometrial and ovarian cancer were more commonly diagnosed in the pandemic recovery group (p < 0.05), although no differences were demonstrated concerning tumor staging in all gynecological cancers. The median time between the first multidisciplinary team meeting and the treatment initiation was higher after the COVID-19 pandemic in endometrial cancer (23.0 vs. 34.0 vs. 36.0 days, p < 0.05). Patients with ovarian cancer were more frequently proposed for neoadjuvant therapy in 2020 compared to the other periods (33.3% vs. 55.0% vs. 10.0% p < 0.05). A significant reduction in the laparoscopic approach was observed during 2020 in endometrial cancer (32.1% vs. 14.3% vs. 36.4%, p < 0.05). No significant differences were registered regarding median hospitalization days or intra- and post-operative complications between these periods. Conclusions: The COVID-19 pandemic had a significant impact on the diagnosis and management of most gynecological malignancies, namely, on time to first treatment, chosen oncological therapies and surgical approaches. These results suggest important clinical and healthcare implications that should be addressed in future prospective studies.

The impact of anemia on treatment management and clinical outcomes of women hospitalized for uterine leiomyomas.

OBJECTIVES: Uterine leiomyomas are the most common benign gynecological tumors. Symptomatic leiomyomas represent a major cause of hospitalization, particularly those associated with abnormal uterine bleeding (AUB) and anemia. The aim of this study was to identify predictors of anemia in women hospitalized due to uterine leiomyomas and evaluate its impact on treatment management and clinical outcomes. MATERIAL AND METHODS: Population-based retrospective study of women hospitalized for uterine fibroids in public hospitals in mainland Portugal between 2010 and 2015. Data were extracted from the national database of the Central Administration of the Portuguese Health System. Comparative and multivariable logistic regression analysis was performed to assess outcomes. RESULTS: A total of 36 295 patients were hospitalized due to uterine leiomyomas during this period. Of those, 11.5% presented with anemia. Age, obesity, intramural type of leiomyoma and AUB are independent predictors of anemia (p < 0.001, AUC 0.7056). Anemia was associated with a high risk of inpatient hospitalization (OR: 5.161, 95% CI: 4.376-6.085), urgent admission (OR: 1.953, 95% CI: 1.797-2.121), radical surgical approach (OR: 2.559, 95% CI: 2.298-2.849), laparoscopic hysterectomy (OR: 1.575, 95% CI: 1.393-1.780) and intra- and post-operative complications (OR: 5.285, 95% CI: 4.332-6.448). It was also associated with longer hospital stays (p < 0.001). These outcomes were more pronounced in acute anemic patients. CONCLUSIONS: Anemia has a significant impact on treatment approaches and clinical outcomes of women hospitalized for uterine leiomyomas. Age, obesity, intramural leiomyomas and AUB are some predictors of anemia that could represent a risk-stratification opportunity, allowing for its prompt identification and correction, therefore improving patient care.

Kidney graft function before pregnancy as a predictor of graft, maternal and fetal outcomes in pregnant renal transplant recipients.

OBJECTIVES: Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients. METHODS: All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated. RESULTS: There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes. CONCLUSIONS: A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m2 before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.

[Gestational Diabetes Mellitus: Is There an Advantage in Using the Current Diagnostic Criteria?] / Diabetes Gestacional: Serão os Atuais Critérios de Diagnóstico Mais Vantajosos?

INTRODUCTION: There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria. MATERIAL AND METHODS: Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed. RESULTS: The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes. DISCUSSION: Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit. CONCLUSION: The Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.

Introdução: Não existe consenso internacional quanto aos critérios de diagnóstico da diabetes gestacional. Em Portugal, os critérios de Carpenter e Coustan foram substituídos por uma adaptação dos critérios da International Association of Diabetes and Pregnancy Study Groups. O objetivo deste estudo foi comparar a incidência e outcomes obstétricos/perinatais das grávidas com diabetes gestacional segundo os critérios atuais e prévios. Material e Métodos: Estudo retrospetivo de 1218 gestações únicas complicadas com diabetes gestacional cuja vigilância/parto ocorreu entre 2008-2015. Consideraram-se dois grupos: diagnóstico pelos critérios da Direção Geral da Saúde ­ International Association of Diabetes and Pregnancy Study Groups (grupo 1); diagnóstico segundo Carpenter e Coustan (grupo 2), tendo sido feita análise estatística comparativa. Resultados: A incidência da diabetes gestacional duplicou (9,4% vs 4,6%) e o número de consultas/ano aumentou consideravelmente (~ 3 000 vs ~ 2 000). No grupo 1 verificou-se um risco inferior de recém-nascidos macrossómicos em relação ao grupo 2 [RR 0,44 (IC (95%): 0,26 ­ 0,76)], e um risco mais elevado de recém-nascidos leves para a idade gestacional (LIG) [RR 1,99 (IC (95%):1,19 ­ 3,31)]; um risco cerca de seis e quatro vezes superior de hipoglicémia [RR 6,30 (IC (95%): 3,39 ­ 11,71)] e hiperbilirrubinémia [RR 3,89 (IC (95%): 2,25 ­ 6,72)] neonatais, respetivamente. Não houve diferenças em relação a outros outcomes. Discussão: A redução dos recém-nascidos macrossómicos não resultou em melhoria dos outcomes, havendo um aumento dos recém-nascidos leves para a idade gestacional bem como de complicações neonatais. Os critérios atuais poderão associar-se a maiores gastos em saúde, devido ao aumento considerável da incidência de diabetes gestacional e maior vigilância em consultas, sem benefícios obstétricos/perinatais. Conclusão: A aplicação dos critérios da Direção Geral da Saúde ­ International Association of Diabetes and Pregnancy Study Groups associou-se a redução da macrossomia, não acompanhada de uma melhoria dos outcomes. É discutível o benefício destes critérios em relação aos anteriormente preconizados.