Evaluación de la seguridad y la eficacia de la endometrectomía histeroscópica en la menometrorragia

Objective

To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia.

Material and methods

We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated.

Results

The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients.

Conclusions

Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia.     

Utilidad de la eco-Doppler en la consulta de ginecología

In the last 30-40 years, diagnosis in gynecology has been radically changed by the widespread use of abdominal – and especially vaginal – ultrasonography. The present case illustrates how suspicious images necessitate more detailed investigation and follow-up to rule out an underlying malignancy. In the present case, ultrasonography – and especially Doppler – was the only procedure suggesting neoformation. Therefore, we believe that an echo-Doppler-color ultrasound system should be available in all gynecology consulting rooms. This non-invasive technique has demonstrated effectiveness and reproducibility, provides a high diagnostic yield, and requires minimal time to perform. The use of this procedure in the routine follow-up of patients could help in the early diagnosis of neoformative processes, with clear benefits.     

Tratamiento con análogos de la GnRH en la endometriosis de la pared abdominal

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years.     

Recomendaciones de la Sociedad Española de Ginecología y Obstetricia sobre la prevención y el tratamiento de la atrofia vaginal

Vaginal atrophy, caused by estrogen deficiency, leads to the development of symptoms that affect quality of life.     

Papel de la inseminación intrauterina en la era de la fertilización in vitro

Intrauterine insemination is a low-complexity assisted reproduction technology in which previously washed sperm are deposited in the uterine cavity with ovarian stimulation. This invasive technique is well accepted by patients and achieves cumulative pregnancy rates similar to those obtained in a single cycle of more complex assisted reproduction techniques. We compared two methods of assisted reproduction: in vitro fertilization and intrauterine insemination in relation to their effectiveness and cost. We conclude that intrauterine insemination is the first-line treatment in male factor infertility without severe disruption or unexplained infertility; pregnancy can be achieved with 3 to 6 cycles in a high percentage of these cases at lower cost and with lower risk of multiple pregnancy than with in vitro insemination. We did not consider other techniques, such as intracytoplasmic sperm injection, which is also indicated for the treatment of male factor infertility, since this technique requires greater technical and human resources, thus precluding comparison.     

Utilidad de la prueba de la fibronectina fetal y de la longitud del cérvix en la predicción del parto prematuro en gestantes sintomáticas

Objective

To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.

Material and methods

A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.

Results

The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.

Conclusion

Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions.     

Influencia de la visita puerperal temprana en la detección y evolución de la depresión posparto

Objectives

The aim of this study was to determine the influence of early postpartum home visits in reducing the incidence of puerperal depression in our environment.

Material and methods

A total of 430 patients with uncomplicated pregnancy and delivery were randomized to two homogeneous groups (one group receiving an early postpartum home visit and a control group). The hospital anxiety and depression scale was used to assess puerperal depression at 7 and 30 days.

Results

At 7 days, 10.2% of the patients had a positive score for puerperal depression. At 30 days, the incidence of puerperal depression was lower in the group receiving an early home visit (0.9%) than in the control group (3.7%).

Conclusion

The incidence of postpartum depression in our setting was similar to the expected incidence. Early postpartum home visits seem to be useful in detecting this disorder and in reducing symptoms.     

Sensibilidad de la ecografía transvaginal en el diagnóstico de la mola hidatiforme de primer trimestre

Objective

To assess the accuracy of first trimester ultrasound to diagnose complete or partial hydatidiform moles.

Patients and methods

All cases of sonographically suspected and/or histologically proven complete or partial hydatidiform mole diagnosed in our center from January 1998 to December 2010 were analyzed. The sensitivity and positive predictive value of ultrasound in the detection of molar pregnancies were calculated.

Results

The study group included 59 patients. Of these, 49 were suspected of having hydatidiform mole by ultrasound, 39 of which were histologically confirmed (27 partial and 12 complete). In the remaining 10 cases, the histological diagnosis was pregnancy loss. During the same period, histopathology demonstrated molar pregnancy in a further 10 patients (nine partial and one complete) previously diagnosed as pregnancy loss by ultrasound. Therefore, the study included a total of 49 cases with a final diagnosis of hydatidiform mole (36 partial, 13 complete). The sensitivity and positive predictive value of ultrasound in first-trimester hydatidiform mole was 79.6% (39/49) and 79.6% (39/49) respectively. Of the 49 molar pregnancies, 10 (20.4%) were not identified correctly. The detection rate for complete mole (12/13, 92.3%) was slightly better than that for partial mole (27/36, 75%) but this difference was not significant (p=0.18).

Conclusion

The accuracy of first-trimester ultrasound in the diagnosis of hydatidiform mole is high. No significant differences were found between the diagnosis of partial and complete hydatidiform mole. In view of the significant number of molar pregnancies not diagnosed by ultrasound, we recommend histopathological evaluation of all cases of pregnancy loss.     

Análisis de coste-efectividad de la prueba de citología cervicovaginal

Introduction

Cervical cancer is a major public health concern, causing approximately 10% of deaths from cancer in women worldwide.

Objective

To determine the cost-effectiveness ratio of liquid-based cytology compared with the conventional cytological smear test for the detection of precancerous lesions of the cervix.

Methods

A decision analysis model was constructed from the perspective of the public healthcare system. The alternatives compared were conventional and liquid-based cytology. The economic evaluation compared the short-term effectiveness and cost of testing. The measures of effectiveness used were the yield of the test (the proportion of correctly identified cases of cervical lesion in the population) and the «adjusted yield» (the proportion of cases identified minus false negatives). Data on diagnostic accuracy (sensitivity and specificity) and prevalence were obtained from a meta-analysis. Cost values were provided by the Virgen de las Nieves Hospital (Granada, Spain). To assess the uncertainty of the variables included in the model, several univariate and probabilistic sensitivity analyses were carried out.

Results

The incremental cost of liquid-based cytology compared with conventional cytology was €919.49 for each cervical intraepithelial neoplasia (CIN1) or higher-stage lesion found. When the adjusted yield was used as the measure of effectiveness, the incremental cost-effectiveness ratio increased to €574 per lesion identified.     

Optimización del manejo de la mujer osteoporótica en la consulta de ginecología

Osteoporosis is a skeletal metabolic disorder characterized by compromised bone strength predisposing to an increased risk of low-impact fractures. This disorder is highly prevalent in postmenopausal women. Evaluation of bone mineral density, bone markers and osteoporosis risk factors allow to identify patients that may benefit from specific treatment to be identified. Vertebral fractures are common among postmenopausal women aged less than 65 years. The treatment of osteoporosis and osteopenia associated with a previous fracture should be based on adherence to potent drugs along with vitamin D and calcium supplements to prevent the hyperparathyroidism associated with low vitamin D levels.     

Documento de consenso del Grupo de Trabajo sobre las Adherencias de la sección de endoscopia de la SEGO

Adhesions are the most frequent complication of abdominopelvic surgery. These complications have major short- and long-term consequences, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. Adhesions complicate future surgery, leading to high associated morbidity and expense and a considerable risk of mortality. Despite advances in surgical techniques, the burden of adhesion-related complications has remained unchanged in recent years. Adhesiolysis is still the main treatment, although adhesions reform in most patients. This consensus position provides a comprehensive overview of adhesions and their consequences and describes practical proposals for actions that gynecological surgeons in Spain should take. Developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving patient outcomes.     

Análisis de la variabilidad interobservador en la interpretación de la radiopelvimetría y su utilidad en la práctica obstétrica actual

Introduction

X-ray pelvimetry has been directly associated with an increase in the rate of cesarean sections and consequently this technique has fallen into disuse.

Objectives

To analyze the impact of evaluator subjectivity in the interpretation and evaluation of X-ray pelvimetry in order to determine the usefulness of this technique as an objective complementary test.

Materials and methods

We carried out a prospective study of X-ray pelvimetry in 113 primiparous pregnant women prior to labor induction. The scans were measured and interpreted independently and blindly by three researchers with wide experience in obstetrics.

Results

There were discrepancies between the first two researchers on 60 occasions (45.11%) and assessment by the third researcher was required on 49 occasions (36.84%).

Conclusions

X-ray pelvimetry lacks value in predicting delivery route since there is wide interobserver variability in the measurement and interpretation of scans.