No abstract

Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors' performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty's particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies' results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic.

Evidence suggests that unilateral damage to the insular cortex(IC) leads to autonomic imbalance and cardiovascular (CV) dysfunction. We evaluated the CV effects from focal hemorrhage (ICH) into the left (L) or right (R) IC. Wistar rats were anesthetized for microinjection of autologous arterial blood (ICH) or saline (200nL, n=10 each side/group) into the L or R IC (0mm AP/ ±5.8mm LL/ 7mm DV). After 24 hours, mean arterial pressure (MAP) and heart rate (HR) were measured in awake condition. Then, ICH and control group (n=7 each side) were anesthetized and renal sympathetic activity (RSNA) was record. ICH increased baseline HR (Δ:L‐ICH 471±8 vs saline 407±7bpm; R‐ICH 465±8 vs saline 408±5bpm, P<0.05) without changing MAP. HR was restored to baseline levels after i.v. atenolol injection (2mg/kg). Strikingly, ICH rats presented a reduced baseline RSNA (Δ:L‐ICH 112±5 vs saline 148±7spikes/sec; R‐ICH 121±4 vs saline 149±10spikes/sec, P<0.05). There were no differences between L‐ and R‐ICH. We conclude that focal stroke into posterior IC can alter the cardiac and renal autonomic control without lateral predominance. These findings can help to understand the cardiac and renal dysfunctions observed after cortical damage. Grant Funding Source: CNPq, Fapemig, Capes and INCT NanoBioFar

Placenta accreta spectrum is a serious obstetric condition related to abnormal adherence of placental tissue to the myometrium and high maternal and fetal morbidity. In order to achieve the best outcome, the management of this condition must be carried out by an experienced multidisciplinary team and the individual characteristics of the patient must be taken into consideration, such as comorbidities and desire for reproductive preservation. This case report presents the conservative surgical management of placenta accreta spectrum in a 23-year-old patient who underwent an elective caesarean section with uterine preservation because of anterior placenta increta. The authors performed a transverse uterine incision at the fundus with transitory uterine devascularisation of the lower uterine segment with partial myometrial removal. This technique was successful for controlling the haemorrhage and preserving the uterus, with no complications.