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Publications (9)6.98 Total impact

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    ABSTRACT: Pregnancy in patients with severe pulmonary arterial hypertension is a high risk situation, which makes pregnancy prevention or termination in the first trimester advisable. For this reason, patients of reproductive age with this pathology are referred for gynecology consultation. Since our unit began operating in 1999, we have had three pregnant patients with severe pulmonary arterial hypertension--one our patient and the other two referred from other centers. In this article we describe these three cases and review the literature on pregnancy and pulmonary arterial hypertension.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2010; 29(1):95-103. · 0.59 Impact Factor
  • International Journal of Gynecology & Obstetrics - INT J GYNECOL OBSTET. 01/2009; 107.
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    ABSTRACT: The term placenta accreta is used to describe any placental implantation in which there is abnormally firm adherence to the uterine wall. This condition complicates 1/2,500 deliveries and is rising in incidence. Abnormal placentation is associated with increased maternal morbidity and mortality from severe hemorrhage, uterine perforation, infection and loss of fertility. The reported experience of methotrexate treatment in the conservative management of placenta accreta is scant. Three cases of partial placenta increta managed with methotrexate are described. The patients were assessed with clinical surveillance, serum beta human chorionic gonadotrophin (beta-hCG) and imaging (ultrasonography and magnetic resonance in one case). In all cases conservative management with methotrexate resulted in undetectable serum beta-hCG, a decrease in the size of partial placenta retained, and undetectable vascularization.
    Clinical and experimental obstetrics & gynecology 02/2008; 35(3):221-4. · 0.38 Impact Factor
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    ABSTRACT: We describe the case of a pregnant woman with idiopathic pulmonary arterial hypertension, a responder in right heart catheterization, followed since the first trimester in outpatient consultations, admitted to hospital at 23 weeks gestation. She was treated with inhaled iloprost until delivery (at 34 weeks gestation) and continuous infusion of iloprost throughout the perioperative period and following days. This line of therapy has proved efficacious in previous cases. The authors present echocardiographic images that document acute changes in ventricular synchrony during inhalation of iloprost.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 06/2006; 25(5):529-33. · 0.59 Impact Factor
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    ABSTRACT: This study was undertaken to evaluate the efficacy and safety of intravaginal administration of glyceryl trinitrate plus dinoprostone versus dinoprostone, for cervical ripening and induction of labor. A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted among 196 singleton low-risk nullipara women with term pregnancies and unfavorable cervices who were randomly assigned to receive intravaginal glyceryl trinitrate plus dinoprostone or placebo plus dinoprostone. The main outcome variables were time from application to active phase of labor and to delivery. Secondary outcomes were change in Bishop score, fetal and maternal morbidity, and incidence of cesarean deliveries. The interval from application of the initial dose to the beginning of active phase of labor was 868 +/- 582 and 1136 +/- 692 minutes (P = .004) and from initial dose to delivery was 1339 +/- 826 and 1620 +/- 975 minutes (P = .03) for the glyceryl trinitrate and placebo groups, respectively. There were no significant differences in Bishop score change, cesarean section rate, and in the incidence of hypersystole and hyperstimulation. The incidence of tachysystole was significantly lower in the glyceryl trinitrate group (4% vs 15%, P < or = .02). No maternal and neonatal adverse effects were noted. The association of glyceryl trinitrate with dinoprostone is more effective than dinoprostone alone for labor induction in low-risk patients at term with unfavorable cervices.
    American journal of obstetrics and gynecology 05/2006; 194(4):1022-6. · 3.28 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction. 110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50-100 microg), every 6 h until a maximum of three doses or beginning of labor. The average interval (+/- S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5 +/- 5.7 h and 14.8 +/- 9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted. Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.
    International Journal of Gynecology & Obstetrics 03/1998; 60(3):233-7. · 1.84 Impact Factor
  • Acta médica portuguesa 11/1997; 10(10):677-9.
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    ABSTRACT: To evaluate the influence of the therapy with high-dose corticoids on the clinical and laboratory evolution of HELLP syndrome. We reviewed all the cases of pregnancy complicated with HELLP, admitted to the Garcia de Orta Hospital from 1993 to 2000. We compared the patients without corticosteroid therapy or with a standard corticosteroid regimen for promotion of fetal lung maturation--group 1, with the patients who received dexamethasone (10 mg intramuscular every 12 hours)--group 2. Out of 48 patients, 13 were included on group 1 and 35 on group 2. The time from admission to delivery was longer for the group on dexamethasone (3.7+/-4.5 days) compared to the group without (1.8+/-2.4). There was a significant improvement in the symptom of epigastric pain (P<0.05) and in the laboratory findings--platelets (P<0.000), liver enzymes (P<0.000) and lactic dehydrogenase (P<0.001), in the dexamethasone group. The number of caesarean deliverys was similar on both groups (group 1--46% and group 2--48%). The use of regional anesthetic techniques for delivery, was higher on group 2--66% (23 of 35) compared with group 1--15% (2 of 13), P=0.006. There was no significant difference in the maternal morbidity or number of blood transfusions. Perinatal mortality was associated with prematurity, and similar in the two groups. This study confirms the positive influence of the high-dose corticosteroid therapy on HELLP syndrome.
    Acta medica portuguesa 18(3):177-82. · 0.15 Impact Factor
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    ABSTRACT: The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined as development of maternal congestive heart failure, in the last month of pregnancy or within five months after delivery, with documented left ventricular systolic dysfunction, in the absence of a demonstrable cause for heart failure in a previously healthy woman. The diagnosis is commonly established with chest radiography, electrocardiogram and echocardiography. Treatment consist in medical therapy with inotropic support, afterload and preload redution, and anticoagulation. Surgical care with cardiac transplantation is indicated in severe cases with progressive left ventricular dysfunction, despite medical therapy. Prognosis seems dependent on recovery of left ventricular function and maternal mortality rates could reach 50%. Future pregnancy is not recommended in woman with persistent ventricular dysfunction. The authors present a case report in a black nuliparous woman at term, with 33 years old, without previous heart disease that presents a sudden heart failure, with ventricular dysfunction on echocardiography, after the caesarean, with recovery of normal ventricular function at 11th day of puerperium.
    Acta medica portuguesa 20(5):447-52. · 0.15 Impact Factor