Effectiveness of the use of Low Molecular Heparin in patients with repetition abortion history: Systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of using low molecular weight heparin (LMWH) in women with a history of recurrent abortion without an identified cause. METHODS: To develop a systematic review to select the studies. Total found 437 papers. Seven studies were completed or requested. The following variables were analyzed: clinical pregnancy, implantation rate, live births, abortion, premature birth, pregnancy, continuous pregnancy, beyond the 20th gestational week, congenital abnormality, hemorrhage, preeclampsia, placental premature detachment. RESULTS: The LMWH group had a higher incidence of continuous pregnancy after the 20th week of gestation and there was no significant difference between the LMWH group and the expectant management group in the analysis of other variables. CONCLUSIONS: There was no data showing risk and/or less use of LMWH compared to expectant management; on the contrary, LMWH use increased the incidence of evolutionary pregnancy after the 20th gestational week. LMWH has some influence on prophylactic treatment of repeat abortion for unknown cause.

Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate. METHODS: We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. RESULTS: Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88-3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26-88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13-3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference -12.43 min; 95% CI -14.11 to -10.74 ; p < 0.00001) and less blood loss (mean difference -60.42 ml; 95% CI -71.31 to -49.53 ml; p < 0.00001). Other variables were similar between the groups. CONCLUSIONS: Overall, the rate of recurrence of uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger).

Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). However, GnRH agonist has been replacing the use of hCG in certain situations, especially in patients at risk of Ovarian Hyperstimulation Syndrome (OHSS). Some studies have also shown advantages in the combined use of GnRH agonist concurrently with hCG in inducing final oocyte maturation, a treatment known as "Dual Trigger". In theory, this method combines the advantages of both induction regimens, and it has brought promising results. The objective of this study is to compare Dual Trigger with the use of hCG alone or the use of GnRH agonist alone. A systematic review of articles on Dual Trigger and a retrospective cohort study comparing the three methods of induction of final oocyte maturation have been conducted. It has been found that Dual Triggering for poor responder patients had a statistically significant increase in the number of retrieved oocytes, mature oocytes, and fertilized embryos in the positive beta hCG rate, implantation rate, and newborn/transferred embryo (TE) rate.

Complicações fetais na gemelaridade monocoriônica: quadro clínico, fisiopatologia, diagnóstico e conduta / Fetal complications in monochorionic twin pregnancy: clinical features, pathophysiology, diagnosis and management

A incidência de gemelaridade monocoriônica é de um para cada duzentos e cinquenta gestações. A placenta monocoriônica está relacionada a maior risco de complicações gestacionais, como transfusão feto-fetal, restrição seletiva do crescimento fetal, óbito fetal e gêmeo acárdico. Portanto, a avaliação criteriosa da corionicidade, o monitoramento da gestação e a detecção precoce de complicações são fatores importantes para melhorar o desfecho neonatal. Assim, o objetivo deste estudo é descrever as principais complicações fetais da gestação monocoriônica e qual deve ser a conduta obstétrica diante das diversas situações adversas. Foi realizada uma revisão de literatura dos últimos 28 anos, nas bases de dados MEDLINE/Pubmed, Scielo, LILACS e BIREME, sendo encontrados 401 artigos. Dentre estes, 28 estudos foram selecionados para esta revisão.(AU)

The incidence of monochorionic twin pregnancy is one in every two hundred and fifty pregnancies. The monochorionic placenta is associated with higher risk of pregnancy complications, such as fetal-fetal transfusion, selective fetal growth restriction, fetal death and acardiac twin. Therefore, a careful assessment of chorionicity, monitoring of pregnancy and early detection of complications are important factors to improve neonatal outcomes. Thus, the aim of this study is to describe the major fetal complications of monochorionic pregnancy and the better and what should be the obstetric approach considering the various adverse situations. A literature review of the past 28 years was performed in MEDLINE/PubMed, SciELO, LILACS and BIREME, being found 401 articles. Of these, 28 studies were selected for this review.(AU)

Gestação gemelar com mola hidatiforme completa e feto vivo após ovodoação e fertilização in vitro: relato de caso / Twin pregnancy with a complete hydatiform mole and a live fetus following egg donation and in-vitro fertilization: case report

Introdução: a gestação gemelar com mola hidatiforme completa e feto vivo é um evento raro e tem, na maior parte dos casos, evolução para aborto ou interrupção médica por causa dos riscos para a mãe e para o feto. Quando associada à reprodução assistida, a decisão de finalização é mais difícil por causa do desejo do casal em manter a gestação. Método: este artigo apresenta um caso de gestação gemelar dizigótica com mola hidatiforme completa em coexistência com feto diploide e placenta normal em uma paciente de 45 anos após fertilização in vitro por ovodoação. Resultados: paciente optou por manter a gestação e o parto ocorreu com 29 semanas, sem complicações maternas. Recém-nascido evoluiu com bom desenvolvimento neuropsicomotor, sem sequelas. Conclusão: este relato de caso ilustra a possibilidade de conduta expectante, porém não podemos ignorar o fato de que existe um alto risco de permanência da doença trofoblástica gestacional. Infelizmente, a raridade do caso torna o manejo clínico ainda controverso.

Introduction: twin pregnancy with complete hydatiform mole and live fetus is a rare event with the most cases resulting in abortion or medical interruption due to maternal and fetal risks. When associated with assisted reproduction, the decision of pregnancy interruption is more difficult due to the desire of the couple to maintain the pregnancy. Method: this study will present a case of twin dizygotic pregnancy with complete hydatiform mole coexisting with fetus diploid and normal placenta in a patient 45 years old, after in-vitro fertilization by egg donation. Results: patient chose to keep the pregnancy and the delivery occurred at 29 weeks without major maternal complications. Newborn evolved with good psychomotor developmentwithout sequelae. Conclusion: this case report illustrates the possibility of expectant management, but wecannot ignore the fact that there is a high risk of persistent gestational trophoblastic disease. Unfortunately, the rarity of the case makes the clinical management still controversial.