Infección vaginal por tricomonas (e infecciones mixtas) y atipias celulares, en la citología cervicovaginal

Objective

We present a series of 380 cytologies with a diagnosis of vaginal infection due to Trichomonas vaginalis, representing 0.31% of 121,688 cytologies in a 10-year period (2000-2009). We compared these cytologies with a control group of 535 cytologies.

Results

Cytology detecting Trichomonas showed greater inflammation and mixed infections were found in 36 cases (9.4). Atypia were found in 19 cases (5%).

Conclusions

In our study, vaginal infection due to Trichomonas in the cytology was significantly associated with bacterial vaginosis (P < .05) and atypia of undetermined significance (ASCUS) (P < .01).     

Assessment of HPV infection among female university students in Honduras via Roche linear array

Objective

To determine the prevalence of specific types of human papillomavirus (HPV), and the association with possible risk factors, among female university students at university in Honduras.

Methods

In a cross-sectional study, cervical samples from 400 women aged 18-35 years were tested using a Roche HPV linear array to differentiate 37 genotypes of HPV. Associations with risk factors were assessed.

Results

Of the 400 participants, 393 completed the study. HPV DNA was detected in 45% of these women, of whom 73% were infected with high-risk types of HPV and 46% had multiple infections. Overall, 36 HPV genotypes were identified, of which HPV types 16, 51, 84, 66, and 39 were the most common. There was a marked decrease in the prevalence of multiple and high-risk infections with age. The factors that were independently associated with risk of being infected were related to sexual behavior and smoking habits.

Conclusion

The study showed that genital HPV infection is common among sexually active women at university in Honduras. In addition, the Roche linear array was shown to be a valuable tool for HPV genotyping, which will be useful for monitoring the future effectiveness of an HPV vaccine in the population.     

Anticoncepción posparto en mujeres con riesgo de exclusión social

Objective

Improve birth control rates in women from vulnerable populations, space time out between pregnancies and reduce the rate of abortions.

Material and methods

We gave 90 pregnant women at risk of social exclusion an appointment for a postpartum check- up a month and a half after their expected due date, with a SMS reminder 48 hours before the appointment and a phone number in case they failed to make the appointment. We strive to implement long-term methods on the day of appointment.

Results

92% attended the postnatal visit. The overall rate of contraception was 86%, 68% were long-term methods: subdermal implants and IUDs.

Conclusion

Consultation with postpartum women from disadvantaged social groups can be very useful to facilitate contraceptive methods which are safe, effective and long-lasting. Flexibility and agility in the implementation of the methods are essential.     

Estacionalidad y distribución mensual de las infecciones vaginales y lesiones cervicales diagnosticadas por la citología cervicovaginal. Estudio de 10 años (2000-2009)

Based on a series of 121,629 cervicovaginal cytologies carried out over 10 years in our hospital, we present the seasonal and monthly distribution of vaginal infections and cervical lesions diagnosed. Vaginal infections consisted of seven cases of genital herpes, 133 cases of Actinomyces, 381 cases of Trichomonas vaginalis, 2,946 cases of bacterial vaginosis and 5,450 cases of candidiasis. Cervical lesions consisted of 237 cases of low-grade squamous intraepithelial lesion (LSIL), 256 cases of high-grade squamous intraepithelial lesion (HSIL) and 14 cases of carcinoma. Seasonal variation and monthly distribution showed that Actinomyces tended to occur in winter (November to February), Trichomonas in summer (August). Bacterial vaginosis peaked in spring (May) and autumn (October) and candidiasis in winter (February). LSIL peaked in winter (February) and autumn (October), and HSIL in summer (July to September). A notable finding in this series was the marked decreases in bacterial vaginosis, Candidiasis and LSIL in August, which could be explained by the staff vacation period, with a reduction in workload. However, when the percentage of the total number of cytologies was analyzed, instead of the number of cases for each disease, peak reductions in August were reduced or disappeared for bacterial vaginosis and Candidiasis. The peaks in November in LSIL and HSIL were confirmed. Carcinomas showed no seasonal variation.     

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas

Objective

To evaluate the mode of delivery and maternal morbidity associated with pregnancies ending at 41 weeks.

Material and methods

We designed a retrospective cohort study. The mode of delivery and maternal complications of 230 pregnancies ending at 41 weeks were compared with those in 234 pregnancies ending between 37 and 40 weeks at the Miguel Servet University Hospital in 2005.

Results

Women delivering at 41 weeks had an increased risk of membrane sweep, unfavorable Bishop score at admission, induction and longer duration of labor. These increases were also seen in the rates of operative vaginal delivery (25.6 vs 17.6%, p < 0.001) and cesarean section (21.7 vs 8.5%, p < 0.001).

Conclusions

The rates of maternal peripartum complications increase as pregnancy reaches 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction.     

Miomas y función sexual. Estudio prospectivo de un año

Objective

To prospectively study sexual function in women with myomas over a 1-year period. Absence of sexual desire, absence of arousal, anorgasmia, dyspareunia and pelvic pain were compared in women with myomas versus controls.

Design and method

A total of 172 women with myomas (largest diameter: 3-5 cm) and 80 women (largest diameter > 5 cm) were examined in the author's consulting rooms in 2009. Both groups were compared with control groups paired by age. The two myoma groups were also compared between each other. Sexual data were gathered through personal interviews.

Results

The most statistically significant differences were the following: in the group of women with myomas measuring 3-5 cm, differences were found in medical history (P < .001), absence of sexual desire (P < .01), vaginal dryness (P < .05), subserosal myomas (P < .001) and in equal size of the myoma at 1 year (P < 0,001); in the group of myomas measuring > 5 cm, differences were found in the absence of sexual relations (P = .02), intramural myomas (P < .001), increased size of the myoma at 1 year (P < .001), and in pain (P = .02). No significant differences were found in sexual parameters (sexual desire, arousal, orgasm, dyspareunia, and vaginal dryness) between each group or their controls.

Conclusions

1) In women with myomas measuring 3-5 cm, statistically significant differences were found in the absence of sexual desire (P < .01) and in vaginal dryness (P < .05). 2) In myomas measuring > 5 cm, statistically significant differences were found in the absence of sexual intercourse (P = .02), in increased size of the myoma at 1 year (P < .001) and in chronic pelvic pain (P = .02).     

Etiología y sensibilidad antimicrobiana en las infecciones urinarias bajas de la embarazada en España

Introduction

To improve antibiotic use in the treatment of urinary tract infections during pregnancy, knowledge of the most frequent pathogens and their susceptibilities is required.

Methods

Between march and july 2004, a prospective multicenter study was conducted in 15 national microbiology laboratories. The laboratories used their standard methods to process the samples.

Results

Pregnancy or non-pregnancy was recorded in only 1521 women; of these, 150 women were pregnant. The most frequent pathogen in pregnant women was Escherichia coli (54.6%), followed by Streptococcus agalactiae (24.3%). Isolation of gram positive strains (32.2%) was significantly more frequent in pregnant women (p < 0.001). The susceptibility rates of E.coli were 98.8% for fosfomycin, 96.2% for cefixime, and 97.6% for nitrofurantoin; these rates were lower for ampicillin (41.6%).

Conclusions

E.coli is the main uropathogen during pregnancy, because of the materno-fetal complications of urinary tract infections during pregnancy, alternative antibiotics should be used to reduce the high resistance to antibiotics that are useful in neonatal sepsis.     

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación

Objective

To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination.

Material and methods

We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800 μg /24 h) and between June 2007 and December 2008 (regimen B: 400 μg /4 h). Induction-expulsion time was taken as the main outcome.

Results

The mean expulsion time was similar in both regimens (19.7 h for A and 17.7 h for B). No significant differences were found in the expulsion rate at 12, 24 and 48 h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed.

Conclusions

No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B.     

Estudio comparativo de conizaciones realizadas en la provincia de Segovia antes y después del uso del test del virus del papiloma humano (2007-2010)

Objective

To assess epidemiological, diagnostic and therapeutic changes in the province of Segovia since the introduction of techniques for the detection of human papillomavirus (HPV) DNA in cervical cancer screening in women aged more than 30 years in primary care in January 2009.

Material and methods

We carried out an observational retrospective study of conization procedures undertaken from January 2007 to December 2010. Eighty-six patients were included: 40 women who underwent conization from 2007-2008 and 46 who underwent the procedure from 2009-2010.

Results

The number of conization procedures showed no significant change but the number of high-grade lesions found in cytology (P=.017) and postsurgical histological analysis (P=.047) increased. The positive predictive value (PPV) of screening for high-grade lesions showed a nonsignificant increase (P=.059).

Conclusions

The PPV of cervical cancer screening increased in our province with the HPV test, without increasing the number of conization procedures.     

Papel de p16 en lesiones preinvasivas e invasivas de cáncer de cuello uterino. Aplicación de la técnica a citología convencional

Introduction

Detection of p16 expression by immunohistochemistry and immunocytochemistry is a good standard for the identification of high-grade cervical epithelial lesions and low-grade lesions with DNA HPV viral integration (with a tendency for progression).

Material and methods

We evaluated p16 expression in 58 HPV-positive cervical biopsies and 53 conventional cytological samples that tested HPV-positive with immunohistochemical and immunocytochemical techniques.

Results

All high-grade lesions were positive for p16 while only some of the low-grade lesions were positive. The results obtained in histological samples could be extrapolated to cytological samples from the same patients.

Conclusions

p16 expression in conventional cytology provides similar results to those in histological samples.     

Síndrome metabólico y riesgo cardiovascular en mujeres posmenopáusicas de una institución de primer nivel de Envigado (Colombia)

Objective

To compare the prevalence of metabolic syndrome in postmenopausal women by applying the IDF and the NCEP/ATPIII criteria and to assess the risk of cardiovascular disease in postmenopausal women and associated risk factors.

Material and methods

A cross-sectional study of 224 women aged ≥45 years was carried out following IDF and NCEP/ATPIII guidelines. Cardiovascular risk was estimated using Framingham projections of 10-year absolute cardiovascular disease risk and AHA cardiovascular disease risk assessment.

Results

Among evaluated women, the mean age was 59 years (SD 8.36 years). Half of the women had had their last menstrual period >10 years previously, from the FUM (RIQ: 5-18). A total of 62.9% were overweight or obese. The prevalence of metabolic syndrome was 57.1% according to the IDF criteria (IC 95%: 50.4-63.7) vs. 37.5% according to the NCEP/ATPIII criteria (IC 95%: 31.1-44.2). Framingham score was >10% in 46% of the women. According to AHA criteria, 76.8% were at risk, or at high risk, for cardiovascular disease. In the multivariate analysis, the factors most strongly associated with metabolic syndrome according to IDF criteria were obesity (OR 5.05; IC 95%: 2.18-11.69) and age >65 years (OR 2.75; IC 95% 1.34-5.64). The factors most strongly associated with cardiovascular risk were hypertension (OR 11.58; IC 95%: 4.81-27.86), low levels of high-density lipoprotein cholesterol (OR 16.63; IC 95%: 5.96-46.37), and age >55 years (OR 4.5; IC 95%: 1.90-10.67).

Conclusion

The joint application of the IDF criteria for metabolic syndrome and the AHA criteria for cardiovascular disease risk assessment is useful to identify a greater number of women at risk.     

Infecciones vaginales y lesiones celulares cervicales (III). Características de la sexualidad

Objective

To study the characteristics of sexuality in a series of patients: 399 with vaginal infections and 32 with cervical cell lesions, diagnosed by cervicovaginal cytology during a 1-year period.

Material and methods

We performed personal interviews to inquire about the presence or absence of sexual intercourse and the reasons, sexual desire, arousal, orgasm, dyspareunia, vaginal dryness, the frequency of coitus, contraceptive methods, anal coitus and simultaneous multiple sexual partners. The 399 patients were compared with a control group of 252 women without vaginal infections or cervical lesions.

Results

The group with infections and lesions were younger, with a mean age of 34 years, and there were more nulligravidas (33.25%), p < 0.001. A total of 60.23% used no contraceptive method. The most commonly used methods were the pill in 14.31% and the condom in 12.23%. Seventy patients (16.27%) were not having intercourse due to lack of a sexual partner. The frequency of coitus was once a week in 20%.The characteristics of sexuality were as follows: 45.15% had no sexual desire, 32.5% experienced no arousal, 21.94% had no orgasm, and 43.88% had dyspareunia. These percentages were higher than in the control group (p < 0.001). Anal intercourse was practiced by 15.83% and 2.5% had simultaneous multiple sexual partners.The following significant differences were found according to infection types: absence of sexual desire was greater in bacterial vaginosis (p < 0.05), lack of arousal was greater in Gardnerella vaginalis (p < 0.01), and dyspareunia was greater in Candidas (p < 0.001), bacterial vaginosis (p < 0.001), in women with a history of human papilloma virus (HPV) (p < 0.01) and in Trichomonas vaginalis (p < 0.05). Anal intercourse was more frequent in women with HPV (p < 0.01) and those with cervical lesions (p < 0.05).

Conclusions

Women with vaginal infections and cervical cell lesions were younger, with fewer pregnancies despite low use of contraception, had low coital frequency and more dyspareunia. These women practiced anal coitus and more frequently had simultaneous multiple sexual partners.Individuals are responsible for their sexuality and sexual health. Concern for sexually-transmitted diseases, HIV and cervical cancer should be universal.     

Resultados obstétricos y perinatales de la implementación de un programa de versión externa cefálica

Objectives

To evaluate the effectiveness of the external cephalic version, the time required for its completion, the safety of the technique, its effectiveness in reducing the rate of caesarean sections and the perinatal outcomes.

Methods

The study included 180 pregnant women with pelvic presentation at term. Routine cardiotocographic monitoring and an ultrasound were used pre-and post-release version for foetal welfare and presentation.

Results

Success was achieved in 30% of the external cephalic version (ECV) cases during the first year, while 61.90% was successfully achieved during the fourth year. Vaginal births accounted for 61 out of the 93 successful versions, the spontaneous reversal rate was 5.37% and the spontaneous version rate following failed external version, was 3.44%. In 45 cases (25%) some kind of minor adverse effect was found and in 18 cases it was due to the use of uterine relaxants.

Conclusions

The ECV is safe and useful for reducing caesarean rates. The experience of the obstetrician who performed the technique plays a key role in ensuring success.     

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.     

Campaña de lucha contra el cáncer de cuello uterino en Guinea-Bissau. Estudio de las citologías de un trimestre

Objective

To study 300 cytologies from a single trimester, within a campaign against uterine cervical cancer in Guinea-Bissau.

Design

We compared 300 cytologies from Guinea-Bissau with 880 cytologies performed in a single month in autochthonous women attending our hospital for vaginal infections and cervical lesions.

Results

Significant differences between women in Guinea-Bissau and autochthonous women were found in Trichomonal infection (2% versus 0,34%, respectively; P < .001) and in low-grade squamous intraepithelial lesions (2% versus 0,68%, respectively; P = .05). One case of cervical cancer was detected in a 75-year-old multiparous woman. The mean number of deceased children in these women was 2 (range 1-8).

Conclusions

To avoid both cervical cancer and neonatal mortality, a permanent program for the early detection of cervical cancer in Guinea-Bissau is clearly needed, together with family planning, prenatal care and obstetric assistance.     

Conocimiento de los mecanismos de acción de los métodos de planificación familiar

Objective

To investigate women's knowledge of the mechanisms of action of birth control methods, especially those that act after fertilization, and to identify whether women want more information on this issue.

Methods

We performed a cross sectional study in a sample of 725 fertile women from primary care health centers in Pamplona (Spain) through a self-administered, anonymous, 30-item questionnaire on family planning. Univariate and multivariate logistic regression analyses were performed.

Results

Less than 5% knew all the mechanisms of action of oral contraceptives and the intrauterine device and only 7% knew those of the emergency contraception pill. Regardless of their beliefs, most women (91%) believed that they should be informed of any postfertilization effects.

Conclusions

To ensure their right to free choice,women should be informed of all the mechanisms of action of birth control methods.     

Éxito del tratamiento de las infecciones urinarias en gestantes tratadas con cefditoren pivoxilo vs. amoxicilina

Objectives

To compare the efficacy of cefditoren pivoxil versus amoxicillin in the treatment of urinary tract infections (UTI) and to evaluate the rate of reinfection and of maternal-fetal complications in both groups.

Material and methods

We performed a cohort study in pregnant women with a diagnosis of UTI in the Vall d’Hebron Hospital from January, 2010 to June, 2010. Diagnosis, follow-up and subsequent evaluation of the mother and infant were performed in both groups.

Results

We included 300 pregnant women diagnosed with a UTI: 150 patients received oral cefditoren pivoxil (400 mg/12 hours for 5 days) and 150 women received amoxicillin. No demographic differences were observed between the two groups. Disappearance of the infection was confirmed in 150 patients in the cefditoren pivoxil group versus 67% of those in the amoxicillin group (P=.03). Both the reinfection rate and the frequency of pyelonephritis were higher in the amoxicillin group [17.3% versus 4.6% (P=.02) and 40.6% vs 2.6% (P=.01) respectively]. There were no differences in hospital stay (2.4 days vs 2.5 days). Adverse effects were observed in 1.33% (two patients) in the cefditoren pivoxil group versus 0% in the amoxicillin group.

Conclusions

In this study, cefditoren pivoxil produced a higher cure rate and a lower reinfection and pyelonephritis rate than did amoxicillin. Cefditoren pivoxil might be a therapeutic alternative in pregnant women with UTI. Further studies are needed to confirm these results.     

Comparación de la efectividad de la pulsioximetría y el electrocardiograma fetal en las situaciones de riesgo de pérdida de bienestar fetal

Objective

To evaluate the effectiveness of pulse oximetry and fetal electrocardiogram in the management of labor with fetal heart rate patterns associated with a risk of loss of fetal well-being.

Subjects and methods

We performed an open, randomized, experimental trial with two groups: pulse oximetry was used in one group and the STAN® technique was used in the other. Each group included 40 women with single, term pregnancies in cephalic presentation and fetal heart rate patterns associated with a risk of loss of fetal well-being. The overall cesarean section rate, indications of risk of fetal distress, and neonatal acid-base balance were evaluated.

Results

No significant differences were found in the rate of cesarean section (47.5 vs 40%; P = .33), indications of risk of fetal distress (32.5 vs 37.5%; P = .41), or neonatal outcomes.

Conclusions

The use of pulse oximetry and STAN®21, as auxiliary methods to cardiotocographic recording, showed no superiority in reducing the cesarean section rate or improving neonatal outcomes.     

Torsión anexial: experiencia en el Complejo Hospitalario Universitario de Albacete

Objective

To evaluate the management of adnexal torsion in our center during a 10-year period.

Patients and methods

We studied cases of adnexal torsion in patients of reproductive age treated surgically between 1997 and 2007. The clinical, ultrasonographic, surgical and histological findings, as well as the treatment and follow-up of these patients, were retrospectively analyzed.

Results

We identified 25 cases of adnexal torsion in 24 patients. Abdominal pain was present in 92%, nausea and/or vomiting in 32%, fever in 4% and leucocytosis in 54.2%. The most frequent echographic findings were complex tumors (52.2%). Torsion was suspected in the first evaluation in only 8% of the cases and before surgery in 36%. Most (72%) of the torsions involved the right adnexa and 52% a tumoral adnexa. Suspicion of necrosis was confirmed in 66.6% and the most frequent histopathological diagnosis was teratoma (28.6%). Conservative treatment was performed through detorsion and/or cystectomy in 40% and in patients whose subsequent clinical course was normal.

Conclusions

When an adnexal torsion is present, the most frequent symptom is abdominal pain. Clinical suspicion in the first evaluation is infrequent, and diagnosis is usually made during surgery. When a tumoral adnexa is torsioned, a teratoma is usually present. Conservative treatment is often performed with good results.