Parto pré-termo tardio e de termo precoce em Portugal

Copyright © Ordem dos Médicos 2016Introduction: Late preterm birth (defined as birth between 34 and 36 complete weeks' gestation) and early term birth (defined as birth between 37 and 38 complete weeks' gestation) have become a topic of recent discussion as the morbidity associated with delivery at these gestational ages has become increasingly evident. Our objective was to evaluate the characteristics of late preterm and early term birth in Portugal. Material and methods: We developed a survey questionnaire that was sent to the Obstetric Department of all public hospitals in Portugal. The questionnaire consisted on questions on prevalence and mode of delivery of late preterm and early term period and associated neonatal morbidity and mortality. The questions referred solely to single births occurred during 2013. Results: We received completed questionnaires from 14 hospitals, corresponding to nearly one third (33.5%) of total deliveries in Portugal. We report 5.4% of late preterm and 27% of early term deliveries. Approximately two thirds of late preterm and three quarters of early term deliveries were spontaneous. The cesarean section rate was higher in late preterm (39.1%) than in early term (26.4%) births. Neonatal complications were more frequent in late preterm neonates (34.2%) when compared to early term neonates (14.2%). Discussion: The prevalence of late preterm and early term birth in our cohort is comparable, although slightly reduced, to other published series. Conclusion: The obstetric community should raise efforts to limit deliveries below 39 weeks' gestation to the ones with a valid medical indication.Introdução: Nos últimos anos, vários autores evidenciaram a morbilidade associada aos partos ocorridos entre as 34 e 36 semanas (pré-termo tardio) e entre as 37 e 38 semanas de gestação (termo precoce). Neste sentido, pretendemos realizar um estudo epidemiológico dos partos que ocorrem nestas idades gestacionais, em Portugal. Material e Métodos: Realizámos um inquérito, que foi aplicado a todos os hospitais públicos de Portugal, acerca da prevalência e via de parto nos partos pré-termo tardios e de termo precoce, e morbilidade e mortalidade neonatal associada. As questões referiam-se apenas a gestações de feto único e a partos ocorridos em 2013. Resultados: Incluímos 14 hospitais, correspondendo a 33,5% dos partos ocorridos em Portugal, em 2013. Verificámos que 5,4% dos partos ocorreram no período pré-termo tardio e 27% no termo precoce. Aproximadamente dois terços dos partos pré-termo tardio e três quartos dos partos de termo precoce foram espontâneos. A taxa de cesariana foi mais elevada entre as 34 e 36 semanas de gestação (39,1%) do que entre as 37 e 38 semanas (26,4%). As complicações neonatais foram mais frequentes após um parto pré-termo tardio (34,2%), quando comparadas com os de termo precoce (14,2%). Discussão: Na nossa amostra, a prevalência de parto pré-termo tardio e de termo precoce, ainda que ligeiramente inferior, é comparável à publicada em estudos anteriores. Conclusão: É importante que a comunidade obstétrica nacional adote atitudes no sentido de limitar os partos antes das 39 semanas de gestação. Assim, nestas idades gestacionais os partos devem possuir uma indicação médica válida.info:eu-repo/semantics/publishedVersio

Predição de sucesso na versão cefálica externa sob tocólise : ainda um desafio

Copyright © Ordem dos Médicos 2015Introduction: External cephalic version is a procedure of fetal rotation to a cephalic presentation through manoeuvres applied to the maternal abdomen. There are several prognostic factors described in literature for external cephalic version success and prediction scores have been proposed, but their true implication in clinical practice is controversial. We aim to identify possible factors that could contribute to the success of an external cephalic version attempt in our population. Material and methods: We retrospectively examined 207 consecutive external cephalic version attempts under tocolysis conducted between January 1997 and July 2012. We consulted the department's database for the following variables: race, age, parity, maternal body mass index, gestational age, estimated fetal weight, breech category, placental location and amniotic fluid index. We performed descriptive and analytical statistics for each variable and binary logistic regression. Results: External cephalic version was successful in 46.9% of cases (97/207). None of the included variables was associated with the outcome of external cephalic version attempts after adjustment for confounding factors. Discussion: We present a success rate similar to what has been previously described in literature. However, in contrast to previous authors, we could not associate any of the analysed variables with success of the external cephalic version attempt. We believe this discrepancy is partly related to the type of statistical analysis performed. Conclusions: Even though there are numerous prognostic factors identified for the success in external cephalic version, care must be taken when counselling and selecting patients for this procedure. The data obtained suggests that external cephalic version should continue being offered to all eligible patients regardless of prognostic factors for success.info:eu-repo/semantics/publishedVersio

Prevalência e factores de risco para Anemia Ferropénica e Ferropénia durante a gravidez : um estudo prospectivo

Copyright © Ordem dos Médicos 2016Introduction: Anemia and iron deficiency during pregnancy are a worldwide concern and are more frequent among women of reproductive age, pregnant women, and young children. The aim of this study was to assess the prevalence of iron deficiency anemia and the risk factors for iron depletion during the first half of pregnancy, in a Portuguese population. Material and Methods: A prospective study was conducted at a tertiary hospital and included pregnant women, until the 20th week of gestation. Data was collected regarding demographic and pregnancy features and hemoglobin and serum ferritin concentrations were determined. A multivariate logistic regression was performed to identify potential risk factors for iron deficiency. Results: Two hundred and one women were included, from which five (2.49%) presented anemia. Additionally, 77 (38.3%) exhibited iron deficiency and 22 (10.9%) revealed severe iron depletion. Maternal age was the only risk factor identified. The odds ratio (OR) was equal to 12.99 (95% CI 2.41 - 70.0) for women under twenty years of age and 2.09 (95% CI 1.05 - 4.14) for women older than thirty years of age. Discussion and Conclusion: The prevalence of maternal anemia in the first half of pregnancy was lower than in other studies. However, more than one-third of the women exhibited iron deficiency. With the exception of maternal age, no other risk factors were identified.info:eu-repo/semantics/publishedVersio

From plates to baits: using a remote video foraging system to study the impact of foraging on fouling non-indigenous species

Marinas are a gateway for the introduction and establishment of non-indigenous species (NIS). In these habitats, competition and predation are crucial determinants for NIS establishment and invasiveness. However, fish trophic preferences and biotic effects inside marinas are poorly known. This study proposes a novel method that combines the deployment of settlement plates to recruit different assemblages, followed by their use as bait in remote underwater video systems. This combined approach, addressed as a remote video foraging system (RVFS), can record fish foraging behaviour, including feeding choices and their impacts on fouling assemblage composition. An experimental RVFS trial carried out in a marina of Madeira Island, Portugal (NE Atlantic), identified the Mediterranean parrotfish, Sparisoma cretense, as the most important fouling grazer in the area. S. cretense behaved as a generalist and increased the heterogeneity of fouling assemblages, which can hamper NIS dominance of the fouling and reduce the pressure of propagules from the marina to the natural environment. The RVFS tool was useful to understand the trophic links between foragers and fouling and has the potential to provide relevant information for the management of NIS introductions, establishment and spread.info:eu-repo/semantics/publishedVersio

A Randomized Trial

Policiano, C., Mendes, J. M., Fonseca, A., Barros, J., Vargas, S., Cal, M., Martins, I., Carvalho, C., Martins, D., Clode, N., & Graca, L. M. (2023). Routine Ultrasound at 30th–33rd weeks versus 30th–33rd and 35th–37th weeks in Low-Risk Pregnancies: A Randomized Trial. Fetal Diagnosis and Therapy , 49(9-10), 425–433. https://doi.org/10.1159/000527112 --- Funding Information: This work was supported by a Research Grant from Fundação para a Ciência e Tecnologia (FCT)-SFRH/SINTD/92997/2013. The funder was not involved in the study design, collection, analysis, data interpretation, or in the writing of this report. The trial was registered in ClinicalTrials.gov with the identification number: NCT03200665.INTRODUCTION: The aim of this study was to evaluate the accuracy of 35-37 weeks' ultrasound for fetal growth restriction (FGR) detection and the impact of 30th-33rd weeks versus 30th-33rd and 35th-37th weeks' ultrasound on perinatal outcomes. METHODS: This was a randomized controlled trial that enrolled 1,061 low-risk pregnant women: 513 in the control group (routine ultrasound performed at 30th-33rd weeks) and 548 in the study group (with an additional ultrasound at 35th-37th weeks). FGR was defined as a fetus with an estimated fetal weight (EFW) below the 10th percentile. p values < 0.05 were considered statistically significant. RESULTS: The ultrasound at 35-37 weeks had an overall accuracy of FGR screening of 94%. Spearman's correlation coefficient between EFW and birthweight centile was higher for at 35-37 weeks' ultrasound (ρ = 0.75) compared with 30-33 weeks' ultrasound (ρ = 0.44). The study group had a lower rate of operative vaginal deliveries (24.4% vs. 39.3%, p = 0.005) and cesarean deliveries for nonreassuring fetal status (16.8% vs. 38.8%, p < 0.001). DISCUSSION/CONCLUSION: A later ultrasound (35-37 weeks) had a high accuracy for detection of FGR and had a higher correlation between EFW and birthweight centiles. Furthermore, it was also associated with lower adverse perinatal outcomes compared to an earlier ultrasound.authorsversionpublishe

Disease Outbreak in a Keystone Grazer Population Brings Hope to the Recovery of Macroalgal Forests in a Barren Dominated Island

Macroalgal forests play a key role in shallow temperate rocky reefs worldwide, supporting communities with high productivity and providing several ecosystem services. Sea urchin grazing has been increasingly influencing spatial and temporal variation in algae distributions and it has become the main cause for the loss of these habitats in many coastal areas, causing a phase shift from macroalgae habitats to barren grounds. The low productive barrens often establish as alternative stable states and only a major reduction in sea urchin density can trigger the recovery of macroalgal forests. The present study aims to assess if the 2018 disease outbreak, responsible for a strong reduction in the sea urchin Diadema africanum densities in Madeira Island, was able to trigger a reverse shift from barren grounds into macroalgae-dominated state. By assessing the diversity and abundance of benthic sessile organisms, macroinvertebrates and fishes before, during and after that particular mass mortality event, we evaluate changes in benthic assemblages and relate them to variations in grazer and herbivore densities. Our results revealed a clear shift from barren state to a macroalgae habitat, with barrens characterized by bare substrate, sessile invertebrate and Crustose Coralline Algae (CCA) disappearing after the mortality event. Overall variations in benthic assemblages was best explained by four taxa (among grazers and herbivores species). However, it was the 2018 demise of D. africanum and its density reduction that most contributed to the reverse shift from a long stable barren state to a richer benthic assemblage with higher abundance of macroalgae. Despite this recent increase in macroalgae dominated habitats, their stability and persistence in Madeira Island is fragile, since it was triggered by an unpredictable disease outbreak and depends on how D. africanum populations will recover. With no control mechanisms, local urchin populations can easily reach the tipping point needed to promote a new shift into barren states. New conservation measures and active restoration are likely required to maintain and promote the local stability of macroalgal forests

Testing differences of marine non-indigenous species diversity across Macaronesia using a standardised approach

12 pages, 7 figures, 4 tables.-- Under a Creative Commons licenseThe introduction of non-indigenous species (NIS) induces severe impacts on marine biodiversity and ecosystems. Macaronesia is an ecologically relevant region where several NIS were detected recently. For the first time, a standard experimental approach was designed to examine biofouling assemblages and investigate NIS across the region. In this context, sessile biofouling assemblages were examined in four recreational marinas in all the Macaronesian archipelagos from 2018 to 2020: the Azores, Madeira, Canary Islands, and Cabo Verde. We hypothesised that NIS numbers, abundance, and recruitment differed in each location due to abiotic and biotic features. From the Azores (higher latitudes) to Cabo Verde (lower latitudes), NIS recruitment and percentage cover decreased following a partial latitude gradient. The present study unveiled 25 NIS, with new records for the Azores (two cryptogenic species), Canary Islands (one NIS and two cryptogenic species), and Cabo Verde (three NIS and three cryptogenic species). The present research represents a pioneer and relevant step in advancing our current understanding of marine biological invasions in Macaronesia, employing a standard and low-cost approachNC is funded by a doctoral grant (SFRH/BD/146881/2019) awarded by Fundação para a Ciência e a Tecnologia (FCT). PR is financed by project MARE - Centro de Ciências do Mar e do Ambiente (UIDB/04292/2020). IG is supported financially by a Maria Zambrano contract UCA under the grants call for the requalification of the Spanish university system 2021–2023, funded by the European Union – NextGenerationEU. AC and MP had the support of FEDER funds through the Operational Programme for Competitiveness Factors -COMPETE and by National Funds through FCT under the UID/BIA/50027/2020 and POCI-01-0145-FEDER-006821. JCC is funded by FCT under the Scientific Employment Stimulus - Institutional Call - (CEECINST/00098/2018). This work was partially funded by MIMAR+ (MAC2/4.6.d/249) in the INTERREG MAC 2014-2020 Programme framework. This study had the support of FCT through the strategic project UIDB/04292/2020, awarded to MARE and through project LA/P/0069/2020, granted to the Associate Laboratory ARNET. This is contribution 129 from the Smithsonian's MarineGEO and Tennenbaum Marine Observatories NetworkPeer reviewe

Diversity and patterns of marine non-native species in the archipelagos of Macaronesia

Tiago Marques and Carolina Marques thank partial support by CEAUL (funded by FCT through the project UIDB/00006/2020).Aims The present study is the first attempt to grasp the scale and richness of marine biological invasions in Macaronesia. We pioneered a comprehensive non-native species (NNS), inventory in the region to determine their diversity patterns and native distribution origins. NNS were defined here as the result of both introductions and range expansions. We also used statistical modelling to examine relationships among NNS richness, anthropogenic activities, demographic and geographical variables across Macaronesia. Location Macaronesia. Methods A comprehensive literature search was conducted for marine NNS records in Macaronesia, registering the first record's location and year from 1884 to 2020. We used univariate and multivariate analyses to evaluate differences and similarities in community composition. By applying a Generalized Linear Model (GLM), we tested hypotheses regarding NNS richness as a function of anthropogenic activities, demographic and geographical variables. Results A total of 144 marine non-native species (NNS) were recorded for the whole of Macaronesia. The highest NNS richness was registered in the Canary Islands (76 NNS), followed by the Azores (66 NNS), Madeira (59 NNS) and finally Cabo Verde (18 NNS). Some differences amongst archipelagos were observed, such as the high number of non-native macroalgae in the Azores, fishes in the Canary Islands and tunicates in Cabo Verde. Overall, macroalgae, tunicates and bryozoans were the predominant taxonomic groups in the Macaronesian archipelagos. Madeira and Canary Islands were the archipelagos with more similarity in marine NNS, and Cabo Verde the most divergent. Finally, GLM suggested that non-native richness patterns across Macaronesia were dependent on the considered archipelago and strongly affected by (1) minimum distance to the mainland, (2) the total number of ports and marinas and (3) total marinas area (km2). Conclusions The model results and NNS listing in the present study will likely raise the awareness and response regarding marine NNS in the whole Macaronesia region, serving as a baseline for future research as well as implementing and enforcing regulations related to the introduction of marine NNS in oceanic islands.Publisher PDFPeer reviewe

A global-scale screening of non-native aquatic organisms to identify potentially invasive species under current and future climate conditions

The threat posed by invasive non-native species worldwide requires a global approach to identify which introduced species are likely to pose an elevated risk of impact to native species and ecosystems. To inform policy, stakeholders and management decisions on global threats to aquatic ecosystems, 195 assessors representing 120 risk assessment areas across all six inhabited continents screened 819 non-native species from 15 groups of aquatic organisms (freshwater, brackish, marine plants and animals) using the Aquatic Species Invasiveness Screening Kit. This multi-lingual decision-support tool for the risk screening of aquatic organisms provides assessors with risk scores for a species under current and future climate change conditions that, following a statistically based calibration, permits the accurate classification of species into high-, medium-and low-risk categories under current and predicted climate conditions. The 1730 screenings undertaken encompassed wide geographical areas (regions, political entities, parts thereof, water bodies, river basins, lake drainage basins, and marine regions), which permitted thresholds to be identified for almost all aquatic organismal groups screened as well as for tropical, temperate and continental climate classes, and for tropical and temperate marine ecoregions. In total, 33 species were identified as posing a 'very high risk' of being or becoming invasive, and the scores of several of these species under current climate increased under future climate conditions, primarily due to their wide thermal tolerances. The risk thresholds determined for taxonomic groups and climate zones provide a basis against which area-specific or climate-based calibrated thresholds may be interpreted. In turn, the risk rankings help decision-makers identify which species require an immediate 'rapid' management action (e.g. eradication, control) to avoid or mitigate adverse impacts, which require a full risk assessment, and which are to be restricted or banned with regard to importation and/or sale as ornamental or aquarium/fishery enhancement. Decision support tools AS-ISK Hazard identification Non-native species Risk analysis Climate changepublishedVersio