Quality of information provided by Brazilian Fertility Clinic websites: Compliance with Brazilian Medical Council (CFM) and American Society for Reproductive Medicine (ASRM) Guidelines.

OBJECTIVE: To evaluate the websites of Brazilian fertility clinics included in the 11th Report of the National Embryo Production System (SisEmbrio, 2017) for compliance with the 2004 American Society for Reproductive Medicine (ASRM) and the Brazilian Medical Council (Conselho Federal de Medicina, CFM) guidelines for advertising. METHODS: We performed an online evaluation of the websites of clinics listed in the 11th SisEmbrio report based on criteria from the 2004 ASRM guidelines (publication of success rates, live birth rates (LBR), method of LBR calculation, success rates by age range and diagnosis, experimental/investigational nature of procedures and the practice of comparison marketing) and CFM guidelines (clinic director name and register visible on the website; no prices displayed, no photos of patients nor success stories with patient identification). RESULTS: A total of 161 SiSEmbrio-registered clinics were evaluated: 153 (95.0%) had functional websites, and only seven were public clinics. Social media presence was as follows: 87 (54.03%) were on WhatsApp; 128 (79.5%) were on Facebook; and 122 (75.8%) were on Instagram. Seventy-five (46.6%) were on other social media platforms (YouTube, LinkedIn, and Twitter). Regarding CFM recommendations, 49 (30.4%) showed information of a registered director, 85 (52.8%) showed patient photos on their websites and/or social media accounts. Fifty-four clinics published success rates (33.5%) and 19 (11.8%) used their own data, whereas seven (4.3%) showed pregnancy rates by age. None reported LBR or advertised prices. CONCLUSIONS: The information published online by Brazilian fertility clinics is heterogeneous in nature. A significant portion of the websites does not follow some of the ASRM and CFM guidelines for advertising.

Pregnancy Outcomes in Wilson's Disease Women: Single-Center Case Series.

OBJECTIVES: To evaluate and compare pregnancy outcomes in women with Wilson's disease (WD) undergoing different therapies during pregnancy. MATERIAL AND METHODS: Retrospective review of medication in WD patients during pregnancy and the outcomes. RESULTS: Of 26 pregnancies, zinc was used in 14 (53.8%), D-penicillamine in 4 (15.4%) patients, and 8 (30.8%) were untreated. Spontaneous abortion was observed in 8 (30.8%) pregnancies - untreated patients (4/8 pregnancies), zinc (2/14 pregnancies) and D-penicillamine (2/4 pregnancies) -, healthy outcome in 12 (46.1%) and birth defects in 6 (23.1%). All cases of birth defects occurred in patients using zinc therapy (6/14 pregnancies). CONCLUSIONS: A remarkably high frequency of fetal complications shed lights on the potentially harmful effect of WD drugs during childbearing age. Zinc's safety profile may have to be better evaluated during pregnancy, as all of birth defects occurred with zinc therapy.

Bloqueio do Nervo Hipogástrico Superior (BNHS) para o manejo da dor após Embolização de Artérias Uterinas (EAU): revisão de literatura / Superior Hypogastric Nerve Block (SHNB) for pain management in Uterine Artery Embolization (UAE): a literature review

Introdução: a embolização de artérias uterinas (EAU) é uma opção terapêutica no tratamento de miomas uterinos sintomáticos; todavia, a dor pós-procedimento representa um grande desafio para essa técnica. Nesse contexto, o Bloqueio do Nervo Hipogástrico Superior (BNHS), já utilizado no tratamento de dor pélvica crônica associada à malignidade, apresenta-se como opção de intervenção intraprocedimento para melhorar a recuperação das pacientes e fomentar o uso da EAU na prática clínica. Objetivo: realizar uma revisão integrativa da literatura disponível sobre o BNHS no manejo de dor pós EAU. Métodos: bases de dados PubMed, The Cochrane Library, Lilacs e Medline foram avaliadas a partir da combinação dos termos "uterine artery embolization", "pain" e "superior hypogastric block". Foram incluídos estudos clínicos, disponíveis em texto completo, com pacientes adultas, submetidas à EAU, cujo objetivo era avaliar o uso do BNHS e seu impacto na dor pós-procedimento. Foram excluídos artigos de revisão, carta ao editor, e publicação em anais de congresso. Resultados: 8 artigos, em maior parte retrospectivos, indicaram consistência do BNHS em termos de sucesso terapêutico a curto prazo e redução da dor. Apenas uma complicação foi relatada, e evoluiu de forma satisfatória. Conclusões: BNHS tem potencial de aprimorar o manejo da dor após EAU, podendo impactar positivamente no tempo e na qualidade da recuperação, com redução da dor e consumo de opiodes no período pós-operatório. Esses benefícios valorizam o procedimento de embolização como uma alternativa a ser considerada no tratamento de leiomiomas sintomáticos para mulheres candidatas à preservação uterina.

Introduction: Uterine Artery Embolization (UAE) is a therapeutic option in the treatment of symptomatic uterine fibroids; however, post-procedure pain imposes as a great challenge in this technique. In this context, the Superior Hypogastric Nerve Block (SHNB), already used in the treatment of chronic pelvic pain associated with malignancy, presents itself as an option for intraprocedural intervention, to improve patients' recovery and to promote UAE in the clinical setting. Objective: to perform an integrative literature review about the effectiveness of SHNB in pain management after UAE. Methods: databases PubMed, The Cochrane Library, Lilacs and Medline were assessed using the combination of the terms "uterine artery embolization", "pain" and "superior hypogastric block". Clinical studies were included once available in full text, with adult patients submitted to UAE, whose objective was to evaluate the use of SHNB and its impact in post-procedure pain. Review articles, letters to the editor, and publication in conference proceedings were excluded. Results: 8 articles were found, most of them retrospective, indicated SHNB's consistency in terms of short-term therapeutic success and pain reduction. The single reported complication evolved satisfactorily. Conclusions: SHNB has the potential to improve pain management after UAE, which can positively impact recovery time and quality, with reduced pain and consumption of opioids in the postoperative period. Benefits like these can enhance the embolization procedure as an alternative to be considered for the treatment of symptomatic fibroids for women candidates for uterine preservation.