[Perinatal Outcome in Relation to Chorionicity in Twin Pregnancy]. / Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar.

INTRODUCTION: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. MATERIAL AND METHODS: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. RESULTS: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). DISCUSSION: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. CONCLUSION: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

Introdução: A incidência da gestação múltipla tem vindo a aumentar em todo o mundo e vários estudos têm demonstrado taxas de morbilidade e mortalidade mais elevadas nos gémeos monocoriónicos comparativamente com os bicoriónicos. Os objetivos deste trabalho foram: caracterizar a população de gémeos fruto de gravidez bifetal nascidos num hospital nível três e avaliar o impacto da corionicidade na morbimortalidade perinatal.Material e Métodos: Estudo retrospetivo de todos os gémeos fruto de gravidez bifetal nascidos num hospital nível três entre janeiro de 2004 e dezembro de 2013.Resultados: Neste período nasceram 1051 gémeos, fruto de 540 gestações (26,7% monocoriónicos; 73,3% bicoriónicos). Não houve diferença estatisticamente significativa entre os dois grupos no respeitante às complicações obstétricas. No grupo monocoriónico verificou-se uma incidência mais elevada de restrição do crescimento intra-uterino (20,5 vs 11,3%, p < 0,001), idade materna mais baixa (29,9 vs 31,9 anos, p < 0,001), idade gestacional mais baixa (33,4 vs 34,3 semanas, p < 0,05) e peso de nascimento mais baixo (1943 vs 2147 g, p < 0,001). Os gémeos monocoriónicos tiveram uma incidência mais elevada de doença de membrana hialina (7 vs 4%, p < 0,05), sépsis (10,3 vs 5,8%, p < 0,05) e anemia (9,5 vs 5,4%, p < 0,05). Não se encontrou diferença estatisticamente significativa relativamente à ocorrência de enterocolite necrotizante, hemorragia intraperiventricular ou retinopatia da prematuridade. A mortalidade perinatal foi mais elevada no grupo monocoriónico (5,2 vs 2,9%, p < 0,05).Discussão: Os gémeos monocoriónicos representam um desafio para obstetras e neonatologistas, devendo a vigilância pré-natal e o parto ser realizados em centros de referência.Conclusão: A gemelaridade tem atualmente um importante impacto nos nascimentos, pelo que seria interessante desenvolver protocolos que uniformizassem a prática clínica na abordagem a estes recém-nascidos.

Detection of human mammaglobin mRNA in serial peripheral blood samples from patients with non-metastatic breast cancer is not predictive of disease recurrence.

INTRODUCTION: Human mammaglobin (hMAM) mRNA is a sensitive and specific marker of breast cancer cells. We evaluated if hMAM mRNA detection in serial peripheral blood samples from non-metastatic breast cancer patients predicts for disease recurrence. METHODS: Patients scheduled for adjuvant or neoadjuvant chemotherapy were eligible. Serial blood samples were collected up to 5 years, the first before (neo)adjuvant chemotherapy. hMAM gene expression was analysed by RT-PCR. Specificity was evaluated in blood samples from healthy volunteers. A total of 321 patients were included. RESULTS: The incidence of pre-chemotherapy hMAM-positive samples was similar in patients who latter experienced cancer recurrence (22.4%) and those who remained disease-free (17.9%; P = 0.46). Similarly, the mean number of positive follow-up samples was similar in both groups (0.15 +/- 0.22 and 0.13 +/- 013; P = 0.29). Furthermore, there was no difference in disease-free (P = 0.63) or overall survival (P = 0.57) in patients with and without positive baseline samples or between patients whose follow-up samples were always hMAM negative and those with at least one positive sample. Multivariate survival analysis confirmed that hMAM mRNA detection before or after (neo)adjuvant chemotherapy was not predictive of recurrence. DISCUSSION: There is no evidence that hMAM mRNA detection at diagnosis or during follow-up predicts for breast cancer recurrence.