FEBRASGO POSITION STATEMENT Archives - Revista Brasileira de Ginecologia e Obstetrícia

Key points

•Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the leading cause of vaginal agenesis.

•It is characterized by primary amenorrhea with typical adrenarche and telarche and may be associated with congenital urological and skeletal conditions that should be investigated.

•Differential diagnoses include: vaginal obstructions (imperforate hymen, distal vaginal atresia, transverse vaginal septum), uterine obstructions (cervical atresia), and differences in sexual development (gonadal dysgenesis, complete androgen insensitivity and congenital adrenal hyperplasia due to CYP17 deficiency).

•Laboratory tests (testosterone, follicle-stimulating hormone [FSH] and karyotype) and radiological tests (pelvic ultrasound and MRI) are necessary.

•Vaginal dilation is the first line of treatment with high success rates.

Key points

• Although advances in the treatment of gynecological cancer have improved survival rates, they may also increase the effects of induced menopause, especially in young women.

• Cancer treatments such as oophorectomy, gonadotoxic chemotherapy, and pelvic radiotherapy can induce menopause.

• Gonadotoxic chemotherapy, especially alkylating-containing regimens, often damages ovarian function and may result in permanent menopause.

• Pelvic radiotherapy usually results in permanent loss of ovarian function unless ovarian transposition is performed.

• Diagnosing menopause after cancer is challenging, and common diagnostic criteria such as 12 months or more of amenorrhea and elevated follicle-stimulating hormone (FSH) levels are not entirely reliable, since ovarian function may return years after treatment.

• A multidisciplinary approach to post-cancer menopause is essential and should include an appropriate line of care, since hormone replacement therapy after treatment of gynecologic malignancy is controversial.

Key points

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services.

•The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health.

•Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet.

•The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy.

•To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women.

•The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question.

•Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles.

The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.