Torsión anexial bilateral en la posmenopausia

Adnexal torsion is a relatively common complication of adnexal masses that occur mainly in reproductive age. Diagnosis is difficult and the definitive diagnosis is usually established after surgery. We report a case of bilateral ovarian torsion in a post-menopausal woman who complained of sudden abdominal pain. After laparotomy, two serous cystadenomas were discovered, the largest measuring 26 cm. Both adnexa were twisted. Subtotal hysterectomy and bilateral oophorectomy was performed, producing symptom resolution.     

Torsión anexial como causa de abdomen agudo en una paciente adolescente

Acute abdomen due to adnexal torsion in adolescence is rare. One of the main reasons this diagnosis is frequently missed at first presentation is the diverse clinical presentation. When ovarian torsion cannot be excluded, diagnostic laparoscopy should be performed.We present a rare case of ovarian and fallopian torsion in a 15-year-old girl who presented with acute lower left abdominal pain and was treated by laparoscopic surgery.     

Esterilización histeroscópica con Essure: experiencia en el Hospital Universitario Vall d’Hebron

Female sterilization is frequently chosen as a permanent method of family planning. Traditionally, such methods have been associated with surgery, with abdominal incisions and a recovery period of several days. In the last few years, hysteroscopic sterilization has become more widely accepted, because this procedure can be performed in the office and is incision-free, safe, rapid and permanent. In a large percentage of patients, no anesthesia is required. We report the results obtained by the Gynecology Service of the Vall d’Hebron University Hospital in Barcelona, Spain, after 8 years of using the Essure^® system as the method of choice in patients requiring permanent contraception. The devices implanted in the fallopian tubes trigger a process of fibrosis leading to tubal occlusion. The occurrence of this process was confirmed by follow-up hysterosalpingography performed 3 months after the procedure. Our results are similar to those reported in the literature, with a success rate (tubal occlusion at 3 months) of 98.8%.     

Torsión tubárica tras ligadura de trompas

Fallopian tube torsion is a very uncommon event, even though many cases have been described in all ages and in a wide range of situations. This entity most frequently occurs in women of fertile age after tubal sterilization, because postsurgical hydrosalpinx is a predisposing factor. Diagnosis is often made late, at the moment of surgery, with a finding of tubal necrosis. Usually, salpingectomy is subsequently performed.     

Incarceración y torsión uterina en gestante

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed.     

Teratoma inmaduro de ovario en la gestación

Ovarian tumors are estimated to occur in about 1 in 1000 pregnancies; of these, 3% are malignant. Most patients are clinically asymptomatic and the masses are usually detected in a routine abdominal examination during the second trimester of pregnancy. The management of these ovarian masses depends on their etiology and clinical findings. Surgical intervention is required when malignancy is suspected. Neoadjuvant chemotherapy is also indicated. Fertility conserving surgery should be attempted.     

Intoxicación por misoprostol en el tercer trimestre de gestación

Background

Misoprostol is a prostaglandin analogue, authorised use for the treatment of stomach or duedenal ulcers. In Spain, this drug is no authorised use for obstetrics and gynecology.

Pacientes y métodos

Gravida 5, para 3, 1 ectopic, at 32 week? gestation. Presents disorientation, confusion, intense abdominal pain, hyperthermia 41 °C, 83/46 mmHg and 100 bpm. Fetal monitoring reveals foetal tachycardia of 170 bpm with good variability and irregular contractions. The woman admitted self-medication intravaginal 4.000 μg misoprostol.The treatment was: rehydration, antipyretic medication, fetal monitoring and treatment of suspected chorioamnionitis and prematurity. Five days after, normal delivery.

Conclusion

Overdose and toxicity of misoprostol in pregnant women during the third trimester presents with hyperthermia, altered consciousness, hypotension, uterine hypertonia and or polisistolia, even fetal death. There is no antidote, so the treatment is symptomatic.     

Diagnóstico ecográfico de quistes del cordón umbilical en el primer trimestre de la gestación

Although umbilical cord cysts are a relatively frequent entity they cannot be considered a nonpathological sonographic finding. In the first trimester pregnancies the prevalence of umbilical cord cysts has been reported about 3%. Sometimes are associated to other chromosomal and/or structural abnormalities. If they are persistent and progressive in the size, could restrict the fetal sanguineous flow.     

Pronóstico perinatal y materno de la gestación múltiple en función del protocolo intraparto

Objectives

To evaluate maternal and fetal outcomes of multiple pregnancy according to route of delivery.

Material and methods

We performed a retrospective study of all twin deliveries in the previous 5 years and evaluated the route of delivery, especially in the final year. The information was recorded with Microsoft EXCEL and was analyzed with the statistical program SPSS 12.0 for Windows.

Results

The mean gestational age was 35.3 weeks. Route of delivery was through cesarean section in 59.8%. The mean interval between twins was 7.82 minutes when the first twin was delivered vaginally. Neonatal morbidity was found in 49%, and was higher in the second twin and in preterm deliveries.

Conclusions

Multiple pregnancies are associated with a large number of maternal and perinatal complications, as well as with a greater number of cesarean sections. Consequently, correct intrapartum management is required to reduce neonatal morbility as far as possible.     

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor

Objective

To identify groups of women with changes in cesarean rates in two different periods.

Subjects and methods

Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsońs classification.

Results

The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital.

Conclusion

A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase.     

Situación de la conización del cuello uterino en el País Vasco

Objective

The main objective of this study was to evaluate the conization technique used in Basque Country hospitals and to determinate the most appropriate place to perform this procedure (outpatient clinic or operating room) by evaluating pain, early and late complications and histological results.

Materials and methods

We selected 232 patients with a cytologic and colposcopic diagnosis of cervical dysplasia requiring surgical cervical conization between September 2006 and July 2007 in eight public hospitals of the Basque Country.

Results

A total of 94.8% of conizations were performed with long loop excision of transformation zone (LLETZ) and, exceptionally, with cold knife conization. Local anesthesia was used in tertiary hospitals and regional anesthesia in county hospitals. Pain tolerance in outpatient conization with LLETZ under local anesthesia was excellent. In Hospital Donostia, pain was scored on a visual analogue scale and low scores were achieved, in accordance with the high degree of satisfaction obtained with the procedure. Conization margins depended on the grade of dysplasia rather than on the technique. There were few early complications and even fewer late complications.

Conclusion

The LLETZ method performed under local anesthesia in the outpatient clinic is very well tolerated by patients and has few complications. Consequently, this option is a valid alternative to conization under general or regional anesthesia. The LLETZ technique provides multiple advantages for the patient and health service due to its lower cost, without medical disadvantages, and satisfactory tolerance.     

Evaluación del protocolo de actuación clínica en el legrado obstétrico por aspiración

Objectives

To assess a clinical intervention protocol for aspiration curettage based on a nonstandard procedure for presurgical evaluation, continuous ultrasonographic monitoring, and performance of the process in an outpatient room.

Subjects and methods

We reviewed 1,600 surgical procedures carried out in our hospital according to our protocol. Surgical times, the complication rate and patient satisfaction were analyzed.

Results

The mean surgical time was 6.88 minutes. There were five surgical complications (0.3%). Medical complications occurred in 39 patients (2.4%). Dilatation was easy in 97.8%, difficult in 1.7% and very difficult in 0.6%. Tolerance to the technique was considered as excellent or good by 96.8% of the patients.

Conclusions

Assessment of the clinical intervention protocol in obstetric aspiration curettage is safe, effective and quick.     

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.     

Adecuación de la profilaxis antibiótica en el parto por cesárea

Objective

To evaluate compliance with a protocol for antibiotic prophylaxis in cesarean sections and its influence on the incidence of surgical wound infection.

Patients and methods

A prospective cohort study was carried out to assess compliance with our antibiotic prophylaxis protocol. Percentages of compliance and the cumulative incidence of infection were calculated. The effect of compliance with the protocol for antibiotic prophylaxis on surgical wound infection was estimated with the relative risk.

Results

We included 680 patients. Overall compliance with the protocol was 95.7%. The most frequent cause of lack of compliance was the time of administration (96.6%). The cumulative incidence of infection was 2.5% and there was no association between compliance with the protocol and the infection rate (RR = 4.5; 95% CI: 0.55-38.4; P>.05).

Conclusions

Compliance with the protocol for antibiotic prophylaxis was high. The cumulative incidence of surgical wound infection was low and was unrelated to antibiotic prophylaxis.     

Valoración de la invasión miometrial en el carcinoma de endometrio mediante resonancia magnética

Objective

Evaluation of feability of magnetic resonance (MRI) in the assessment of the grade of myometrial invasion in endometrial carcinoma in our service.

Material and method

Retrospective study about pelvic MRI (dynamic, intravenous contrast media with gadolinium) sistematically made in the presurgical study of endometrial carcinoma in our service. 123 MRI were made in many other patients diagnosed of endometrial carcinoma between the year 2000-2004, both included. Afterwards, the results were contrasted with the histologic studies of the surgical piece.

Results

In 112 of the 123 neoplasms studied there was myometrial invasion valorated in the anatomopathologic study (paraffin sections). The MRI presented concordance with the histology in 101 cases, the positive predictive value (PPV) was 97% and although the negative predictive value (NPV) was 38.8%, the corrected negative predictive value (cNPV) was 87.5%.

Conclusions

Pelvic magnetic resonance with intravenous contrast media is a good technique to leave out deep myometrial invasion in endometrial carcinoma (cNPV: 87.5%), but its value is lower when pretending to asses superficial myometrial invasion (NPV 38,8%).When the uterine miomas are associated to endometrial carcinoma the specificity (25%) and the cNPV (14%) endure a great descent.     

Manifestación de leucemia promielocítica aguda en el embarazo

Acute promyelocytic leukemia, also known as M3 in the French-American-British classification, presents as severe hemorrhagic syndrome in 80% of affected pregnant women, posing a lethal threat to both mother and fetus. The results of multicenter studies suggest that the most effective treatment consists of the concomitant use of all-trans retinoic acid plus idarubicin. We present the case of a 32-year-old woman at 33 weeks of pregnancy with severe coagulation abnormalities due to acute promyelocytic leukemia, who was admitted to the intensive care unit for respiratory insufficiency due to an acute pulmonary lesion. The interest of this case lies in its infrequency. We describe the therapeutic management and initial course of the disease, as well as the prognostic implications of treatment during pregnancy.