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Bettencourt-Silva B, Rego MT, Miranda C, Cunha AI, Brás F, Lopes-Guerra C, Miguelote R, Sousa-Santos R, Furtado JM. The role of mifepristone on first trimester miscarriage treatment - A double-blind randomized controlled trial - MiFirsT. Eur J Obstet Gynecol Reprod Biol 2023; 289:145-151. [PMID: 37678127 DOI: 10.1016/j.ejogrb.2023.08.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To evaluate the efficacy of combined mifepristone and misoprostol compared to misoprostol alone in outpatient medical treatment of first trimester miscarriage. Additionally, the study intends to compare the rate of complications, adverse effects, and treatment acceptability between groups. STUDY DESIGN Single-center double-blind randomized placebo-controlled trial including women with diagnosis of missed first trimester miscarriage up to 9 weeks of gestation. RESULTS Between April 2019 and November 2021, 216 women diagnosed with first trimester miscarriage up to 9 weeks of gestation were randomly assigned to mifepristone group or to misoprostol-alone group. Data from 105 women in mifepristone group and 103 women in misoprostol-alone group were analyzed, with no differences in baseline characteristics. The median time between medications (oral mifepristone/placebo and vaginal misoprostol) was nearly 43 h in both groups (p = 0.906). The median time to first follow-up was 2.6 weeks (IQR 1.0) in mifepristone group and 2.4 weeks (IQR 1.0) in misoprostol-alone group (p = 0.855). The overall success rate of medical treatment was significantly higher in the mifepristone-group comparing to misoprostol-alone group (94.3% vs. 82.5%, RR 1.14, 95% CI, 1.03-1.26; p = 0.008). Accordingly, the rate of surgical treatment was significantly lower in the mifepristone-group (5.7% vs.14.6%, RR 0.39, 95% CI, 0.16-0.97; p = 0.034). The composite complication rate was similar and lower than 4% in both groups. No case of complicated pelvic infection, hemodynamic instability or inpatient supportive treatment was reported. There were no significant differences in the rates of adverse events, median score for vaginal bleeding intensity or analgesics use. Despite the same median value, the score of abdominal pain intensity was significantly higher in the mifepristone-group (p = 0.011). In both groups, more than 65% of the women classified the treatment as "good" and 92% would recommend it to a friend on the same clinical situation. CONCLUSION The mifepristone plus vaginal misoprostol combined treatment for medical resolution of first trimester miscarriage resulted in significant higher success rate and lower rate of surgical uterine evacuation comparing to misoprostol-alone treatment, with no relevant differences in adverse events or treatment acceptability.
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Affiliation(s)
- Beatriz Bettencourt-Silva
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal.
| | - Maria Teresa Rego
- School of Health Science, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Cláudia Miranda
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Ana Isabel Cunha
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Filipa Brás
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Cláudia Lopes-Guerra
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Rui Miguelote
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal; School of Health Science, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Life and Health Sciences Research Institute (ICVS), Campus de Gualtar, 4710-057 Braga, Portugal
| | - Ricardo Sousa-Santos
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine of Porto University, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Manuel Furtado
- Department of Obstetrics and Gynecology, Hospital Senhora da Oliveira, Rua dos Cutileiros, 4835-044 Guimarães, Portugal
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Pereira da Silva D, Nogueira-Silva C, Lima J, Braga A, Saraiva J, Águas F, Nogueira-Martins N, Santo S, Furtado JM, Almeida MC, Guerreiro C, Veríssimo C, Bernardes J. [Demographic and Professional Characteristics of Specialists in Obstetrics and Gynecology Registered in Portugal: Needs, Resources and Challenges]. ACTA MEDICA PORT 2022; 35:343-356. [PMID: 35073253 DOI: 10.20344/amp.16282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/20/2021] [Accepted: 09/09/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The demographic and professional characteristics of specialists in Obstetrics and Gynecology registered in Portugal are presented and current and future needs assessed. MATERIAL AND METHODS An analysis of the data from Instituto Nacional de Estatística, Ordem dos Médicos and a survey sent to the directors of the departments of Obstetrics and Gynecology of Portuguese hospitals was perfomed. In order to calculate the necessary number of specialists, established indicators of the activity of the specialty were used. RESULTS In 2018, there were 1 437 441 consultations of Obstetrics and Gynecology, 89 110 major gynecologic surgeries and 85 604 deliveries. For that, 1065 Obstetrics and Gynecology physicians, working 40 hours per week, with no more than 40% aged 55 years of age and older or including 30 residents per year, are deemed necessary. According to the National Institute of Statistics, in the same year there were 1143 specialists in Portuguese hospitals, of which 234 worked in private hospitals. On the other hand, 1772 specialists were registered with the Ordem dos Médicos: 1163 (66%) were aged 55 years old or above and 84% of specialists under the age of 40 were females. In 2020, there were 864 specialists, 46% of which aged years of age and older working in 39 out of the 41 public or public-private departments that answered the survey. In 2035, an increase of 7% in the required number of specialists is expected. CONCLUSION In Portugal, there is not lack of Obstetrics and Gynecology specialists in absolute numbers, but the large number of specialists aged 55 years of age and older, who are exempt from shifts in emergency department work, and the existence of regional asymmetries contribute to the perpetuation of some shortages of these healthcare professionals in several departments, namely in public hospitals.
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Affiliation(s)
| | - Cristina Nogueira-Silva
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital de Braga. Braga. ICVS e ICVS/3B's - Laboratório Associado. Escola de Medicina. Universidade do Minho. Braga. Portugal
| | - Jorge Lima
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital da Luz Lisboa. Lisboa. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - António Braga
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Serviço de Obstetrícia. Departamento da Mulher e da Medicina Reprodutiva. Centro Materno-Infantil do Norte. Porto. Portugal
| | - João Saraiva
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Fernanda Águas
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Nuno Nogueira-Martins
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital de S. Teotónio. Centro Hospitalar Tondela-Viseu. Viseu. Portugal
| | - Susana Santo
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - José Manuel Furtado
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital Senhora da Oliveira. Centro Hospitalar do Alto Ave. Guimarães. Portugal
| | - Maria Céu Almeida
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Obstetrícia. Maternidade Bissaya Barreto. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Cristina Guerreiro
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Maternidade Alfredo da Costa. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Carlos Veríssimo
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Serviço de Ginecologia e Obstetrícia. Hospital Beatriz Ângelo. Loures. Portugal
| | - João Bernardes
- Colégio da Especialidade de Ginecologia-Obstetrícia. Ordem dos Médicos. Lisboa. Faculdade de Medicina. Universidade do Porto. Porto. Serviço de Ginecologia. Centro Hospitalar Universitário de S. João. Porto. Portugal
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Coutinho CM, Negrini SFBM, Araujo DCA, Teixeira SR, Amaral FR, Moro MCR, Fernandes JDCP, Motta MSF, Negrini BVM, Caldas CACT, Anastasio ART, Furtado JM, Bárbaro AAT, Yamamoto AY, Duarte G, Mussi‐Pinhata MM. Early maternal Zika infection predicts severe neonatal neurological damage: results from the prospective Natural History of Zika Virus Infection in Gestation cohort study. BJOG 2020; 128:317-326. [DOI: 10.1111/1471-0528.16490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Affiliation(s)
- CM Coutinho
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - SFBM Negrini
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - DCA Araujo
- Epidemiology and Disease Control Division Department of Public Health and Surveillance Secretary of Health Ribeirão Preto Brazil
| | - SR Teixeira
- Department of Imaging, Haematology and Oncology Ribeirão Preto Medical SchoolUniversity of São Paulo Ribeirão Preto Brazil
| | - FR Amaral
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MCR Moro
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - JDCP Fernandes
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MSF Motta
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - BVM Negrini
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - CACT Caldas
- Rehabilitation Centre of Clinics Hospital at the Ribeirão Preto School of Medicine Ribeirão Preto Brazil
| | - ART Anastasio
- Department of Health Sciences Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - JM Furtado
- Division of Ophthalmology Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - AAT Bárbaro
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - AY Yamamoto
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - G Duarte
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MM Mussi‐Pinhata
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
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Miranda C, Coelho D, Pereira E, Rosmaninho A, Furtado JM. Spine Abnormality in a Fetus at 21 Weeks of Gestation. J Med Ultrasound 2020; 29:144-146. [PMID: 34377654 PMCID: PMC8330673 DOI: 10.4103/jmu.jmu_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Cláudia Miranda
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Diana Coelho
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Elsa Pereira
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Adosinda Rosmaninho
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - José Manuel Furtado
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
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Miranda C, Coelho D, Pereira E, Rosmaninho A, Furtado JM. Spine Abnormality in a Fetus at 21 Weeks of Gestation. J Med Ultrasound 2020; 29:72-73. [PMID: 34084725 PMCID: PMC8081102 DOI: 10.4103/jmu.jmu_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cláudia Miranda
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Diana Coelho
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Elsa Pereira
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Adosinda Rosmaninho
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - José Manuel Furtado
- Department of Obstetrics and Gynaecology, Hospital Senhora da Oliveira, Guimarães, Portugal
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Nunes JS, Ladeiras R, Machado L, Coelho D, Duarte C, Furtado JM. The Influence of Preeclampsia, Advanced Maternal Age and Maternal Obesity in Neonatal Outcomes Among Women with Gestational Diabetes. Rev Bras Ginecol Obstet 2020; 42:607-613. [PMID: 32559795 DOI: 10.1055/s-0040-1710300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The present study aims to analyze adverse fetal or neonatal outcomes in women with gestational diabetes, including fetal death, preterm deliveries, birthweight, neonatal morbidity and mortality, as well as the synergic effect of concomitant pregnancy risk factors and poor obstetric outcomes, as advanced maternal age, maternal obesity and pre-eclampsia in their worsening. METHODS The present cohort retrospective study included all pregnant women with gestational diabetes, with surveillance and childbirth at the Hospital da Senhora da Oliveira during the years of 2017 and 2018. The data were collected from the medical electronic records registered in health informatic programs Sclinico and Obscare, and statistical simple and multivariate analysis was done using IBM SPSS Statistics. RESULTS The study participants included 301 pregnant women that contributed to 7.36% of the total institution childbirths of the same years, in a total of 300 live births. It was analyzed the influence of pre-eclampsia coexistence in neonatal morbidity (p = 0.004), in the occurrence of newborns of low and very low birthweight (p < 0.01) and in preterm deliveries (p < 0.01). The influence of maternal obesity (p = 0.270; p = 0.992; p = 0.684) and of advanced maternal age in these 3 outcomes was also analyzed (p = 0,806; p = 0.879; p = 0.985).Using a multivariate analysis, the only models with statistic significance to predict the three neonatal outcomes included only pre-eclampsia (p = 0.04; p < 0.01; p < 0.01). CONCLUSION Only coexistence of pre-eclampsia showed an association with adverse neonatal outcomes (neonatal morbidity, newborns of low and very low birthweight and preterm deliveries) and can be used as a predictor of them in women with gestational diabetes.
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Affiliation(s)
- Joana Sousa Nunes
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - Rita Ladeiras
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal
| | - Luísa Machado
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - Diana Coelho
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - Carla Duarte
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
| | - José Manuel Furtado
- Obstetrics & Gynecology Department, Senhora da Oliveira Hospital, Guimarães, Portugal.,Obstetrics & Gynecology Department, Faculty of Medicine, Minho University, Braga, Portugal
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