Resultados obstétricos en cribado combinado de las aneuploidías en el primer trimestre superior al corte con resultado de amniocentesis con cariotipo fetal normal

Introduction

To evaluate whether there are adverse pregnancy outcomes in pregnant women with a risk index above the cut-off point in first-trimester screening for fetal chromosomal abnormalities and an amniocentesis result of normal fetal karyotype in a sample of pregnant women attending our clinic at the beginning of pregnancy.

Subjects and methods

We performed a case-control study. A series of patients who underwent first-trimester combined screening as part of antenatal care between January 2009 and January 2010 were selected.

Results

Of the maternal complications registered during the pregnancy, gestational diabetes was more frequent among cases.

Conclusions

The incidence of the remaining complications analyzed (intrauterine restricted growth, preeclampsia, oligoamnios) was similar in the two groups. In most of the pregnant women, delivery occurred after 37 weeks through the vaginal route.     

Embarazo triple espontáneo en paciente con síndrome de ovario poliquístico. Tratamiento con metformina

We describe a triplet pregnancy in an obese patient with primary sterility and polycystic ovary syndrome treated with metformin. The patient, who was previously nuliparous, achieved a triamniotic trichorid pregnancy that developed normally, except for cervical incompetence resolved by cervical cerclage. The importance of insulin resistance in this type of patient is stressed.     

La variabilidad en las mediciones ecográficas de la longitud céfalo-nalga y de la translucencia nucal. Problemas en un programa de cribado

Objective

To describe the learning curve in nuchal translucency and crown-rump length measurements and changes in the accuracy of these measurements during the initial phase of a screening program and during the following 2 years.

Material and methods

The learning phase was based on discussion of the methodology for performing the measurements, with observation and discussion of images, followed by a second period, with observation of the accuracy of 6 operators in their first 100 measurements. Changes in the accuracy of 3 operators in an additional 3,601 examinations were assessed. Differences in accuracy between the 3 operators were analyzed when maximal accuracy was achieved.

Results

In the first 100 observations, 4 of the 6 operators showed deviation from the model of less than 10%.Accuracy increased until 350 examinations had been performed and then stabilized. Two operators showed deviations of less than ± 5% while a third maintained a difference of 10% below the model. When maximal accuracy was reached, differences between 2 operators were negligible, while the third operator overestimated crown-rump length by 2 mm and underestimated nuchal translucency by 0.1 mm, which translates into a lower proportion of patients with a positive screening result.

Conclusions

The deviations detected in nuchal translucency measurements with respect to the reference model, as well as those in crown-rump length, indicate the advisability of auditing the accuracy of sonographic measurements in addition to routine assessment of the effectiveness of screening programs.The model proposed by Nicolaides is suitable for our environment since deviations, which mainly occur in the extreme values of crown-rump length, can be explained by inadequate methodology in the performance of the measurements. Therefore, personalized references need not be prepared. Rather, the methodology should be improved.     

Translucencia nucal y ductus venoso: valores de referencia en el primer trimestre de la gestación

Objective

To establish the reference ranges for nuchal translucency (NT) and ductus venosus (DV) pulsatility index for veins (PIV) in our population.

Methods

During a 4-year period, pregnancies originated from the general population undergoing 11.1-14.0 weeks ultrasound examination were studied. Reference intervals were constructed following the methodology described by the National Committee for Clinical and Laboratory Standards. According to the conclusion of the partition test, gestational age-related reference intervals were estimated using linear regression models for the NT. Deviances from linearity in the estimated models were evaluated using fractional polynomials of 1st or 2nd degree.

Results

2,612 pregnancies were studied. No significant differences were found for DV PIV between gestational age groups. There was a significant difference of the NT values between age groups (p < 0.001) and the gestational age-related estimation of reference intervals showed a no-linear increase.

Conclusion

A significant increase was found for NT with gestational age, whereas the DV PIV remained constant.     

Influencia de la gestación de bajo riesgo en la calidad de vida relacionada con la salud percibida por las gestantes

Objectives

The aims of the present study were four-fold: to assess health-related quality of life (QoL) perceived by women with low-risk pregnancies in comparison with reference population values for women in the same age group; to determine whether low risk pregnancy by itself can modify perceived QoL; to determine the association between the physiological changes of pregnancy and perceived loss of QoL; to obtain reference values for QoL from the questionnaire Medical Outcomes Study (MOS) 36-Item Short Form (SF-36) for expectant mothers in their first or third trimester, given that to date we have found no Spanish publications on the topic.

Material and methods

We performed a cross-sectional survey of prevalence, with comparison of two independent groups. Measuring instrument: SF-36.

Conclusions

The expectant mothers showed a statistically significant loss in physical dimensions in comparison with the reference population values for women in the same age group; this loss was more significant as the pregnancy progressed, that is, the chronological progression of a normal pregnancy is, by itself, able to alter the quality of life perceived by the pregnant women, especially in the physical domain. No changes in the dimensions related to social or emotional functions were observed.The typical symptoms of pregnancy such as nausea and vomiting are able to alter physical and emotional functions.     

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.     

Encuesta SEGO. Control del feto de bajo riesgo durante el embarazo y el parto en los hospitales españoles

Objective

To determine how low-risk fetuses are monitored during the last few weeks of pregnancy and labor in Spanish hospitals.

Method

An electronic survey on the management of low-risk fetuses was conducted under the aegis of the Spanish Society of Obstetrics and Gynecology in 31 public hospitals and in 5 private hospitals.

Results

During pregnancy, a non-stress test (NST) was used in 34 hospitals and the abbreviated biophysical profile was used in 5.6%. When a non-reassuring fetal pattern was found, the abbreviated biophysical profile was used in 10 hospitals, fetal Doppler in four and amnioscopy in three.During labor, all hospitals performed cardiotocographic monitoring (CTG), which was continuous in 83.3% and through windows in the remainder. When the results of CTG were non-reassuring, pulse-oximetry was used in five centers, ST space analysis (STAM) in three and fetal Doppler in a further three. Microtome and umbilical artery pH sampling were performed in 69.4% of hospitals.

Conclusion

NST is the preferred test for fetal monitoring in the last few weeks of pregnancy. During labor, CTG is currently used, and only 69.4% of centers use microtome when a non-reassuring CTG pattern is observed.     

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.     

Diagnóstico posparto de la enfermedad de Wilson en gestante con síndrome HELLP y coagulopatía

HELLP syndrome is a clinical-analytical entity defined by microangiopathic hemolytic anemia, elevated liver enzymes, and thrombocytopenia. Liver involvement in this syndrome is common to several liver diseases. Some of these liver diseases are inherent to pregnancy (acute fatty liver of pregnancy, gestational intrahepatic cholestasis), while others are related to intercurrent disease (acute viral hepatitis) or to previous chronic liver disease. We report a case of postpartum diagnosis of chronic liver disease secondary to Wilson disease, with onset in the third trimester of pregnancy and HELLP syndrome associated with acute liver failure and coagulopathy. We review the differential diagnosis and the scientific literature on the topic.     

Histerectomía radical laparoscópica total en el cáncer de cérvix. Factibilidad,morbilidad y supervivencia

Objective

To assess feasibility, perioperative morbidity and medium term survival of total laparoscopic radical hysterectomy in cervical cancer.

Material and methods

A total of 31 consecutive patients diagnosed FIGO clinical stage IA2 (n = 4), IB1 (n = 22), IIA (n = 2) and IB2 (n = 3) in Son Llàtzer hospital (Palma de Mallorca) that were programmed for a total laparoscopic radical hysterectomy were studied. We analyzed tumor histological characteristics, surgical technique, perioperative variables, postoperative complications and mid-term survival results.

Results

Feasibility rate was 96%. The most frequently operative complication was accidental bladder incision (3 cases). Postoperative complications rate was 20% (6 cases) which includes one surgical reintervention. Average operative time was 258 minutes (range: 180-360). Blood transfusion rate was 17% (n = 5) and mean hospital stay was 7.8 days (range: 2-29). After one month after surgery 72% of patients had a normal miccional function. Mean tumoral size was 26.5 mm and lymphatic positive nodes rate was 17% (n = 5). Mean follow-up time was 26 months. Tumor relapse rate was 17% (n = 5) and survival-free disease of 100% for IA2 stage, 82.6% of IB1/IIA stages and 66.7% for IB2 stage.

Conclusions

Total laparoscopic radical hysterectomy is a feasible technique in most of the patients with cervical cancer. It needs more operative time than abdominal route but it presents less perioperative morbidity, less blood transfusion and less ospitalization days. The medium term survival is comparable with conventional abdominal route.