Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x 2 =4,2) e de pré-eclâmpsia (p=0,03; X 2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X 2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica.

Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The occurrence of endometriosis in the anterior abdominal wall is often associated with previous cesarean section, once the spread of endometrial cells during the surgical procedure is a biologically fact possible. A 43-year-old patient, with cesarean section history and pelvic endometriosis diagnosed for over 10 years, presented with progressive abdominal pain. Tests showed cystic image with 1.6 cm of diameter and debris, located in mid-lower portion of the rectus abdominis left, suggesting abdominal wall endometriosis. This abdominal wall lesion was not identifiable in the clinical examination (impalpable), which is why we opted for the use of preoperative marking technique with radioisotope called Radioguided Occult Lesion Localization (ROLL™). The use of ROLL™ in this case allowed rapid surgical identification of endometriotic lesion and its complete excision.

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

Introduction: Thrombophilias are associated with venous thromboembolism. According to reports, uteroplacental thrombosis can lead to preeclampsia, intrauterine growth restriction (IUGR), placental abruption (PA) and even to fetal death. The Brazilian Ministry of Health recommends the application of heparin treatment-associated, or not, with ASA to pregnant women diagnosed with thrombophilia, based on its type. However, many studies have not been able to confirm the beneficial effects of heparin use on maternal and fetal health. Methods: The current research is a case-control study comprising pregnant women treated at the Obstetrics Service of Federal University of Juiz de Fora and at the Medical School of Barbacena, who used heparin in the current pregnancy due to previously diagnosed thrombophilia. Current pregnancy associated with heparin use was named 'case', whereas previous pregnancy without heparin use was named 'control'. Thus, 47 cases (current pregnancy) and 32 controls were selected (1,4 cases: 1,0 control). Results: Association between heparin and miscarriage, intrauterine fetal death and preeclampsia were analyzed. Results showed that heparin acted as protective factor against miscarriage (OR=0.04; CI=0.01-0.14; p<0.0001), intrauterine fetal death (OR=0.01; CI=0.01-0.11; but heparin use did not reduce the frequency of preeclampsia cases (OR=0.35; CI=0.07-1.6; p=0.17). Conclusion: Based on the current results, the early heparin application to pregnant women with thrombophilia was able to reduce the number of miscarriage, intrauterine death, but did not reduce the frequency of preeclampsia.

Objetivo: Avaliar a participação do inibidor do ativador do plasminogênio (PAI-1) na doença tromboembólica venosa e no tromboembolismo placentário, que são as principais causas de morbimortalidade materna e fetal. Métodos: Trata-se de estudo realizado com 144 pacientes, sendo 70 com diagnóstico de trombofilia e 74 de baixo risco obstétrico. Foi pesquisada a presença do PAI-1 e a associação de polimorfismo – homozigoto (4G/4G) ou heterozigoto (4G/5G) – com mau desfecho obstétrico. Resultados: Identificaram-se 52 casos de trombofilias hereditárias (74,29%), 8 casos de trombofilias adquiridas (11,43%) e 10 casos de associação de trombofilia hereditária e adquirida. O PAI-1 foi identificado em 32 casos (72,73%), sendo 7 homozigotos mutantes (21,88%) e 25 heterozigotos (78,13%). Houve associação das homozigoses com morte fetal intraútero (p=0,003; x²=4,4), pré-eclâmpsia (p=0,004; x²-8,03) e Hellp síndrome (p=0,006; x²=7,31). Conclusão: Apesar das limitações pelo tamanho da amostra, este estudo foi passo importante para identificarmos no gene SERPINE-1 (PAI-1) o nexo causal com alguns desfechos obstétricos desfavoráveis em nossa população. Até o momento, nossos dados sugerem que as homozigoses estão associadas a morte fetal, pré-eclâmpsia e Hellp síndrome.