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.     

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.     

Aportación del Doppler de la arteria cerebral media y del genotipado RHD fetal en el manejo de la isoinmunización

Objective

To assess the clinical application of non-invasive methods in the management of alloimmunization from 2006 to 2010.

Subjects and methods

Seventy pregnancies with risk of fetal anemia were studied by fetal middle cerebral artery peak systolic velocity (MCA-PSV). The efficacy of MCA-PSV was compared between the first, second and third transfusions. Prenatal testing of fetal RHD blood group using maternal blood was performed in pregnancies followed-up in our center.

Results

Fetal blood sampling was performed in 22 pregnancies; of these, fetal transfusion was carried out in 20. Detection rates and the false-positive rate of MCA-PSV in the prediction of severe or moderate fetal anemia were 89% and 15% in pregnancies with no previous transfusions, 100% and 41% in patients with one previous transfusion, and 40% and 24% when more than one transfusion was performed.

Conclusion

MCA-PSV has high sensitivity when there is one previous fetal transfusion but its specificity is lower.     

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.     

Recurrencia del tumor ovárico de las células de la granulosa

We present the case of a 79-year-old woman who was misdiagnosed with an ovarian fibroma 5 years previously. The patient presented with pain in the right iliac fossa with leukocytosis and was diagnosed with diverticulitis. A mass was incidentally found in the anterior abdominal wall, which was later confirmed as metastasis from a granulosa cell tumor of the ovary.We provide a literature review, focussing on the clinical findings and treatment of this tumor. Few reports have been published of this uncommon entity, characterized by a long natural history and tendency to recur years after the initial diagnosis.     

Utilidad de la resonancia magnética en la estadificación prequirúrgica del cáncer de endometrio

Objective

To evaluate the usefulness of magnetic resonance imaging (MRI) for preoperative staging of endometrial carcinoma.

Materials and methods

We performed a retrospective study of 71 endometrial neoplasms diagnosed in Hospital Sant Joan de Déu. The results of preoperative MRI scans were compared with those of the definitive histological examination.

Results

The preoperative stage obtained by MRI and the final stage were concordant in 69% of cases.

Conclusion

MRI is the most useful diagnostic method for preoperative staging of endometrial carcinoma     

Resultado de la cirugía del prolapso del suelo pélvico a largo plazo

Objective

To evaluate the long-term outcomes of pelvic floor prolapse surgery.

Patients and methods

We recruited 252 patients who underwent surgery in Donostia Hospital between 2000 and 2001. There were 194 vaginal hysterectomies, 219 anterior colpoplasties, 218 posterior colpoplasties, 41 placements of tension-free vaginal tape associated with prolapse surgery, 15 colpopexies and three colpocleises. Follow-up was performed in November and December 2005. The patients were questioned about risk factors for pelvic organ prolapse, current symptoms, and subjective appraisal of surgical outcomes. A questionnaire on symptoms and quality of life was administered. The Pelvic Organ Prolapse Quantification System (POPQ) was used for pelvic examination. We defined surgical failure as a symptomatic prolapse or POPQ-S grade II or higher.

Results

Five years after surgery, the reintervention rate was 2.7%. Surgical failure in one or more compartment was found in 28.18% of the examined women, distributed in 18.12% anterior, 4% apical and 11.4% posterior. Eighty-five percent of the interviewed patients had no sensation of prolapse. Urgency incontinence was reported by 17.1% and stress incontinence by 7.3%. Dyspareunia was found in 14.3%. In the subjective appraisal, 86.2% reported they were symptom-free, 6.3% felt marked improvement, 2.9% felt slight improvement, 1.96% experienced no change, 1.96% felt worse and 0.5% did not know.

Conclusions

Our long-term outcomes are good compared with those of other series. There is little correlation between symptomatic and anatomical failure. Secondary symptoms of the surgery should be included in the appraisal of surgical outcome. Further studies should be carried out with a higher number of patients and long-term prospective follow-up to correctly define the criteria for surgical failure.     

Encuesta sobre el uso en España de la prueba para la determinación del virus del papiloma humano

Objective

To determine knowledge of the Spanish guidelines for cervical cancer screening, and to evaluate the use of tests for the detection of human papilloma virus (HPV) by Spanish gynecologists.

Subjects and methods

The survey focused on gynecologists who were members of the Spanish Society of Gynecology and Obstetrics and the Spanish Association of Cervical Pathology and Colposcopy. One hundred forty-one specialists completed the questionnaire.

Results

Thirty percent of the target population participated. A total of 95.6% were aware of the recommendations and 93.5% routinely used the test for the detection of the HPV (77.7% for cervical cancer screening). The criteria for the use of the test varied considerably among participants. The main reason for not using the technique was its unavailability.

Conclusions

Training and information on the available recommendations for the new screening strategies and, particularly, on the clinical use of HPV determination should be reinforced.     

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro

Objective

To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Subjects and methods

The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62 ± 4.87 years and that of women was 33.88 ± 3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates.

Results

DNA fragmentation was negatively correlated with progressive motility (p = 0.000) of fresh and capacitated (p = 0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p = 0.034) and worse sperm DNA quality (p = 0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates.

Conclusions

DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age.     

Efectos del butil bromuro de hioscina-oxitocina u oxitocina intravenosos en la duración del parto de embarazos a término

Objective

To compare the effects of intravenous hyoscine butylbromide-oxytocin or oxytocin on the duration of labor in term pregnancies.

Method

Ninety patients were selected and randomly assigned to receive intravenous hyoscine butylbromide-oxytocin (n = 45) or intravenous oxytocin (n = 45). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1 hour after drug administration and the interval between the onset of labor and delivery.

Results

There were no significant differences between the two groups in maternal age, gestational age, or Bishop score at drug administration (p = ns). No significant differences were observed in the duration of the first, second or third phases of labor between the two groups (p = ns). No significant differences were found between the groups in Apgar scores at 1 and 5 minutes (p = ns). No maternal adverse effects were observed or reported due to the use of hyoscine-butylbromide or oxytocin.

Conclusion

The effect of hyoscine butylbromide-oxytocin on the duration of labour in term pregnancies is similar to that of oxytocin. The drug does not alter Apgar score or produce maternal adverse effects.     

Utilidad de la ecografía del primer trimestre en el diagnóstico de la pentalogía de Cantrell: a propósito de un caso

We report the case of a 33 year old patient, G2P1, who presented with a Pentalogy of Cantrell in the first trimester ultrasound scan (13+2 weeks). The ultrasound shows a single pregnancy, with CRL of 51.1 mm and nuchal translucency of 7.5 mm that has a toracic mass diagnosed as ectopia cordis, a megabladder, bilateral renal malformation and clubfoot, being diagnosed of Pentalogy of Cantrell. The patient asked for abortion. Pathology analysis described a fitus adequate for gestational age with midline toraco-abdominal defect with evisceration of heart, intestines and bladder.     

Revisión de la evidencia sobre la eficacia de los probióticos en la prevención de las infecciones del tracto urinario inferior y las infecciones vaginales

Objectives

To identify, critically evaluate and describe the available scientific evidence on the efficacy and safety of oral or vaginal administration of probiotics in preventing recurrent urinary tract infections and microbial or fungal vaginal infections.

Methods

An electronic search was performed in PubMed Central, the Cochrane Library and the meta-searcher TRIP databases using the terms: “Lactobacillus”, “probiotics”, “female urogenital diseases”, “urinary tract infections” and “genitourinary infections”.

Results

Of 20 studies that met the selection criteria for this review, a tendency to favor the use of probiotics was observed, especially in the population at high risk of bacterial vaginosis and fungal vulvovaginitis.

Conclusions

Probiotics are a promising option in the prevention of recurrences of lower urinary tract infections. Their use can be recommended as a safe and cost effective option especially in high risk subgroups.     

Impacto de la introducción en el primer trimestre del cribado combinado de trisomía 21 en la tasa de procedimientos invasivos

Objective

To study the impact of introducing first-trimester combined Down syndrome screening on invasive prenatal testing for prenatal diagnosis, together with the criteria change from 35 to 38 years old as the indication for obtaining the fetal karyotype.

Material and methods

A retrospective population-based study was carried out of invasive tests for prenatal diagnosis performed at the Cabueñes Hospital in Gijón (Spain). A first period from 31-1-2004 to 30-1-2006 (without the screening program) was compared with a second period from 31-1-2006 to 30-1-2008 (with the screening program). During the second period the impact of screening (31-1-2006 to 30-1-2007) was differentiated from that linked to changing the maternal age criteria to 38 years old as the indication for invasive testing (31-1-2007 to 30-1-2008).

Results

During the second period there was an overall reduction of 31.2% in invasive testing; 21.6% was exclusively attributable to first-trimester combined Down syndrome screening. In expectant mothers aged 35 or more at delivery, the number of amniocentesis performed in the second period was reduced by 30.74%; this tendency was maintained for pregnant women aged 38 years or more, showing a reduction of 25.92%. In the second period, 30% of the expectant mothers aged 38 years or more chose to have an invasive test due to their age compared with 61.53% in the first period.

Conclusions

First-trimester combined Down syndrome screening had a major impact on invasive testing, increasing its efficiency and, moreover, allowing detection rates to be improved.     

Control de calidad de la translucencia nucal. Experiencia en 6 centros del ámbito de primaria

Objective

To apply quality control to nuchal translucency (NT) measurements in the scans performed in two primary care health regions (Vallès and Centre de Catalunya) in Catalonia, Spain.

Subjects and methods

We evaluated 7,386 TN measured in 2009 in the prenatal care centers of two health areas (Vallès and Centre de Catalunya) of the Catalan health service. We applied two methods of quality control: the method proposed by the Fetal Medicine Foundation (FMF) and that proposed by the Women and Infants’ Hospital, Rhode Island (WIHRI) group.

Results

The FMF method showed that 68% of sonographists underestimated NT when the 50^th percentile was assessed. For the 95^th and 5^th percentiles, the underestimation rates were 89% and 32%, respectively. When the WIHRI method was applied to the overall series, all parameters were within the normal range. Results by individual sonographists showed that 43% underestimated the median value of the multiple of the median (MoM) measurements.

Conclusions

NT quality control was not useful when applied to the entire series. Instead, its application in individual sonographists allows those that significantly deviate from the expected values to be identified and corrections to be proposed.     

Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección

Objectives

To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection.

Subjects and methods

Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II^® test, histological study, and analysis of other sexuallytransmitted diseases.

Results

Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman’s lifetime was significantly associated with HPV infection (χ² for trend: 4.187; p = 0.0407).

Conclusions

Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman’s lifetime.     

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.