Objectives To compare the ophthalmic artery Doppler indices observed in women with singleton pregnancies complicated by hypertension and to correlate the indices observed in hypertensive pregnant women with those observed in healthy pregnant women. Methods Ophthalmic artery Doppler indices were compared between 30 women with mild preeclampsia, 30 women with severe preeclampsia, and 30 women with chronic hypertension at 20 to 40 weeks' gestation. The control group consisted of 289 normotensive pregnant women. The resistive index, pulsatility index, and peak ratio were measured in the right eye. The mean and standard deviation were calculated for each group. Analysis of variance and the Tukey method were used to compare the means of the Doppler indices between groups. Receiver operating characteristic curves were used to determine the predictive power of the Doppler indices for identification of women with severe preeclampsia. P < .05 was considered statistically significant. Results Significant differences were found between the resistive index, pulsatility index, and peak ratio in women with severe preeclampsia compared to the other groups. The means ± SDs for the resistive index, pulsatility index, and pulse ratio in women with severe preeclampsia were 0.63 ± 0.09, 1.13 ± 0.31, and 0.89 ± 0.12, respectively. The optimal cutoff values for the resistive index, pulsatility index and the peak ratio for identification of women with severe preeclampsia were determined by the receiver operating characteristic curves to be 0.657, 1.318, and 0.784. Conclusions Doppler imaging of the ophthalmic artery showed central overperfusion among pregnant women with severe preeclampsia. The peak ratio was the best index for discriminating between severe and mild preeclampsia or chronic hypertension.

Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated. Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured. Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p ¼ 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p ¼ 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p 0.01 and p ¼ 0.04). Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution. ResumoObjetivo Descrever as alterações observadas pela ultrassonografia nas dimensões uterinas durante o puerpério precoce em mulheres com evolução puerperal não

Background: Patient Navigation Program (PNP) assists patients to reduce delays in diagnosis and treatment. A study was conducted on how PNP in Rio de Janeiro, Brazil, could promote adherence to the "Law of 60 Days", which states that all patients with cancer within the public system should start treatment within 60 days after diagnosis of cancer. Materials and Methods: From August 2017 to May 2018, 105 patients aged 33-80 years (mean 59 years) were recruited for Patient Navigator. Follow-up was by phone, email, or text message. PNP implemented at Rio Imagem was designed to: 1) collect important data on specific barriers, and 2) ensure that at least 70% of the patients recruited with breast cancer initiate treatment within the mandatory 60-days period. Results: Patients presented with stage 0 (4%), I-IIA (38%), IIB-IIIB (48%) and IV (5%). These included barriers to compliance with the law: fear and fatalistic thoughts (99%), financial burden (79%), uncoordinated health care (76%), attitudes towards providers (75%), duplicity of pre-treatment exams (52%), patient-provider communication (52%), transport (42%), scheduling (24%), and queues for surgical treatment (12%). PNP had 100% patient satisfaction and in 52% of the cases it helped the patients to start treatment within the period established by law. Conclusion: PNP in Rio did not reach the success rate a 70% to comply with the law, as intended (it reached 52%). However, the barriers that PN did not manage to overcome the lack of human resources and medical supplies, were informed to the health authorities and to the hospital managers.

Guillain-Barré syndrome (GBS) is an acute or subacute demyelinating polyneuropathy that rarely complicates pregnancy, but increases maternal and perinatal morbidity. A 15-year-old pregnant woman was admitted with ascending paralysis and acellular lumbar puncture suggestive of GBS. She required mechanical ventilation for 26 days, and was treated with intravenous immunoglobulin and corticosteroids. She recovered well and delivered vaginally a healthy newborn at 35 weeks’ gestation. The puerperium was complicated by tracheal stenosis which was surgically corrected.

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