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1.
Juan Carlos Delgado Herrero Esther Fandiño GarcíaJosé Luis Dueñas Díez Antonio Carrasco Gallego 《Progresos de Obstetricia y Ginecología》2011,54(2):60-64
Objectives
To identify the association between the adverse effects of the external cephalic version (ECV) and several variables related to the technique.Material and method
We performed a prospective study in 180 pregnant women who delivered through the ECV. We analyzed fetal and maternal adverse effects and their association with the final result of the version, the experience of the obstetrician, the time used in the maneuver, the number of attempts performed in the same session, and the drug used as a uterine relaxant.Results
The ECV was successfully performed in 32.6% of primiparas and 79.19% of multiparas. The overall rate of adverse effects was 28.33%, and was higher in versions that failed, those with a greater number of failed attempts, those with longer duration and those in which ritodrine was used as a uterine relaxant.Conclusions
The factors increasing the probability of success and reducing the rate of adverse effects in ECV are a single attempt at the maneuver, total duration of the maneuver of less than 5 minutes, and use of salbutamol as a uterine relaxant. 相似文献2.
Ignacio Salazar José Antonio SainzEduardo García Vanesa MarrugalRogelio Garrido 《Progresos de Obstetricia y Ginecología》2011,54(2):65-70
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. 相似文献3.
Objective
Carbetocin is a long-acting oxytocin analogue that can be used as a uterotonic agent in the management of postpartum hemorrhage. The purpose of this study was to compare the effectiveness of carbetocin (100 μg IV) with that of oxytocin (20 U IV) in the prevention of postpartum bleeding in grand multiparous patients (five or more pregnancies).Design
Prospective, randomized controlled trial.Population
Patients with vaginal deliveries of singleton pregnancies (≥28 weeks).Methods
A total of 135 patients were selected to receive 100 μg of carbetocin in a single IV dose or 400 mU oxytocin/min (LR 1000 cc+20 U oxytocin, 100 cc/h) at the end of the third stage of labor.Main outcome measures: Postpartum hemorrhage despite the medication used, requiring the use of alternative measures.Results
There were no statistically significant differences in the frequency of therapeutic failures or the need to transfuse blood products. The use of carbetocin was associated with a lesser need to manually explore the uterus (RR: 0.12; 95% CL 0.03-0.48). The incidence of adverse effects was similar in both groups. There were no differences in the effects of drugs on breastfeeding.Conclusions
The use of a single IV dose of carbetocin is as effective as 20 IV units of oxytocin in the prevention of postpartum hemorrhage in grand multiparous women after vaginal delivery. The incidence of adverse effects and complications was similar in the two groups. Carbetocin should be considered a useful alternative to conventional uterotonics in the prevention of postpartum bleeding in grand multiparous patients. 相似文献4.
Laia Martí Malgosa Belén Cochs CosmeJordi Costa Pueyo Sandra Medina ArgemíÀgueda Rodríguez Vicente Yolanda Canet Estévez 《Progresos de Obstetricia y Ginecología》2011,54(6):300-305
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. 相似文献5.
R. Crespo C. LaprestaS. Castán J.M. CampillosB. Rodríguez-Solanilla J.J. Tobajas 《Clínica e investigación en ginecología y obstetricia》2011,38(4):133
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. 相似文献6.
Carola Medina Garrido Nuria Garrido SánchezDaniel Martínez Campo Cristina Canseco Martínez 《Progresos de Obstetricia y Ginecología》2011,54(9):466-468
Background
Coexistence of pregnancy and metastasic cervical cancer in an exceptional situation that will mark, in the presented case, the evolution of the pregnancy.Case
A 34-year-old woman, gravida 2 para 1, at 13 weeks’ gestation was taken to our emergency service with menorragia, and was admitted under the suspicion of invasive cervical cancer. Patient?s evolution was complicated by the detection of supraclavicular metastasis and massive pulmonary tromboembolism. The patient decides voluntary interruption of pregnancy in the 17th week.Conclusions
This is a very unusual case, not as much the presence of an early stage cervical cancer in a pregnant woman. It reminds us of the need to carry out the mandatory gynecological exploration and smear in the first visit of prenatal care, often omitted in our dayly practice. 相似文献7.
Cristina Molina-Reyes M. Dolores Huete-MoralesJosé Carlos Sánchez Pérez M. Dolores Ortiz-AlbarínIsabel Jiménez Barragán M. Ángeles Aguilera Ruiz 《Progresos de Obstetricia y Ginecología》2011,54(3):101-108
Objective
To evaluate maternal and fetal outcomes associated with the selective use of episiotomy.Methods
A retrospective analytical study of births attended in the Hospital of Baza (Granada, Spain).Results
Episiotomy rates fell from 69% (89% of nulliparas and 51.75% of multiparas) to 20% (35.7% of nulliparas and 8.43% of multiparas). Association tests showed that episiotomy was associated with nulliparity, maternal age in nulliparas, epidural analgesia, instrumental delivery and lithotomy position. Selective episiotomy did not affect neonatal Apgar scores. Different lithotomy positions reduced the performance of episiotomy and protected against severe lacerations. A selective episiotomy policy helped to preserve the perineum intact but also increased grade I and II perineal tears.Conclusions
The implementation of a selective episiotomy policy favors humanized birth and helps to preserve the perineum intact, without worsening maternal and fetal outcomes. 相似文献8.
Luis García de Guadiana Romualdo Juan Martínez UriarteMercedes González Morales Rocío López PérezFrancisco Javier Hernández Salinas Elena Martín GarcíaMonica Lorente Fernández 《Progresos de Obstetricia y Ginecología》2011,54(5):225-230
Introduction
Diagnosis and follow-up of preeclampsia requires measurement of proteinuria and the gold standard for this evaluation is the 24-hour collection. However, this collection is cumbersome, time consuming and delays clinical diagnosis. The purpose of this study is assess the diagnostic performance of the spot urine protein/creatinine (P/C) ratio to predict the absence or presence of significant proteinuria (≥ 300 mg per 24 hours) among outpatient pregnant women with suspected or previous diagnosis of preeclampsia.Material and methods
The P/C ratio was calculated in 106 single voided urine samples, obtained after the completion of the 24-hour collection, from 66 outpatient pregnant women admitted to the Maternal Fetal Care Unit at our Hospital to follow-up of hypertension gestational. Correlation between the spot urine P/C ratio with the 24-hour urine protein excretion was calculated. Receiver operator characteristic (ROC) curves analysis was used to evaluate the diagnostic performance and to determinate the best cutoff to predict the absence or presence of significant proteinuria.Results
Significant proteinuria on 24 hour collection urine was identified in 31 urines from 22 pregnant women. There was a significant correlation between the spot urine P/C and 24-hour urine protein excretion (rSpearman = 0,658, p = 0,01). ROC curves analysis revealed an area under the curve for spot P/C ratio of 0,838, greater than urine dipstick (0,629). No single P/C ratio cutoff was appropriate to rule-out or predict significant proteinuria; however, use of dipstick and spot urine P/C ratio, with two cutoffs, 120 mg/g to predict the absence of significant proteinuria and 240 mg/g to confirm it, clasiffied correctly 44,3% of urines and avoided the collection of 24 hours urine in 51% of the cases.Conclusions
Spot urine P/C ratio, in conjunction with dipstick urianalysis, is a useful test in the initial screen for rule-out and predict significant proteinuria in outpatient pregnant women with hypertensive pregnancy or preeclampsia, but it should not be used as an alternative to 24-hour total protein evaluation in midrange P/C ratio, requiring a full 24-hour urine for accurate results. 相似文献9.
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). 相似文献10.
11.
Juan Gilabert Estellés Jose Manuel Castelló TomásJuan José Mañes Fortich Ricardo BaqueroAlberto Romeu Sarrió 《Progresos de Obstetricia y Ginecología》2011,54(4):180-183
Objective
To describe the clinical and therapeutic management of giant adnexal masses in morbidly obese patients at high surgical risk.Subjects and methods
We report the case of a patient with a body mass index of over 60 and a 13-kg ovarian fibroma occupying the entire abdominal cavity.Results
Due to the impossibility of using accessory imaging techniques, we employed a laparoscopic approach to exclude malignancy. Hysterectomy with bilateral salpingo-oophorectomy was performed by a multidisciplinary team without complications.Conclusions
Morbidly obese patients with giant adnexal masses can be safely and effectively managed by a multidisciplinary team. 相似文献12.
Antonio Martín GutiérrezBelén Garrido Luque Luís García MartínLaura Benítez Toledo José C. Maañón di Leo 《Progresos de Obstetricia y Ginecología》2011,54(7):379-382
Objective
To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate.Subjects and methods
Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1 mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment.Results
Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability.Conclusions
Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective. 相似文献13.
José Manuel LozanoFrancisco Sellers Domingo OrozcoAna Fabregat José Manuel GómezJoaquín Llácer Lydia LuqueRafael Bernabeu 《Progresos de Obstetricia y Ginecología》2011,54(4):162-167
Objective
To determine the effectiveness of the combined test for aneuploidies in the first trimester of spontaneous pregnancies in comparison with pregnancies following assisted reproductive technology (ART).Materials and methods
We performed a retrospective study of 1675 triple tests performed in the first trimester in our center, including pregnancy-associated plasma-A (PAPP-A) and the free fraction of the β subunit of human chorionic gonadotropin (free β-hCG), maternal age and nuchal scan. Of these, 1299 (77.5%) were spontaneous pregnancies and 376 (22.5%) were pregnancies following ART. The cut-off point for recommending an invasive test was 1/270.Results
The combined test was carried out in 74 twin pregnancies, with two false-positive results. Among single pregnancies, 70 positive triple tests were obtained, 3.79% of spontaneous pregnancies and 6.84% of ART pregnancies. Eleven chromosomal abnormalities were found, nine in spontaneous pregnancies and two in ART pregnancies. The sensitivity of the test was 89% in spontaneous pregnancies and 100% in ART pregnancies. The specificity was 96% and 93.77%, respectively.Conclusions
The first trimester triple test has high sensitivity and specificity in single pregnancies, whether spontaneous or following ART. The rate of positive triple tests is higher in pregnancies following ART. 相似文献14.
Cristina López del Burgo Carmen Marina López de Fez Ana Herranz Barbero Ramón Saiz Mendiguren Jokin de Irala 《Progresos de Obstetricia y Ginecología》2006
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. 相似文献15.
Elena M.a Losa Pajares Raquel Villar JiménezAna Belén González López Gaspar González de Merlo 《Progresos de Obstetricia y Ginecología》2011,54(7):363-367
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. 相似文献16.
José C. Maañón di Leo José Amores TiradoLuz López Ortiz Mónica Gómez CortésTeresa Pereda Salguero Patricia Moreno Muñoz 《Progresos de Obstetricia y Ginecología》2011,54(10):518-520
Background
The loop electro excision procedure is a simple and widely used diagnostic and therapeutic technique in cervical lesions. This procedure is usually performed in the ambulatory setting under local anaesthesia.Subjects and methods
We describe a case of lymphovascular space invasion detected in the cone biopsy of a high-grade squamous intraepithelial lesion of the cervix.Conclusions
Although the prognostic significance of LVSI is controversial, its identification precludes conservative treatments. 相似文献17.
Jesús Ruiz-Aragón Rocío Rodríguez-LópezAntonio Romero Tabares 《Progresos de Obstetricia y Ginecología》2011,54(3):121-127
Objectives
To evaluate the safety and efficacy of 50% nitrous oxide with oxygen as an inhaled analgesic during delivery.Material and methods
We performed a systematic review of the literature through a literature search (2010) of electronic databases. Studies comparing administration of inhaled nitrous oxide at 50% with another intervention in adult women during labor and reporting results on efficacy and safety were included.Results
A total of 230 references were obtained and 24 studies that met the inclusion criteria were selected. After analysis of the texts, one systematic review and three clinical trials were selected. The quality of the trials included was moderate-high. Nitrous oxide as an analgesic technique produced acceptable results when compared with placebo but the results were less satisfactory when nitrous oxide was compared with other analgesics. Safety results were similar to those found with other analgesic treatments.Conclusions
Administration of inhaled 50% nitrous oxide in women during labor could be an alternative to routinely used techniques. 相似文献18.
Ahmed Y. Shahin Tarek A. Farghaly Mahmoud Shokry Diaa-Eldeen M. Abd-El-Aal 《International journal of gynaecology and obstetrics》2010,108(3):187-190
Objective
To assess the effectiveness of bilateral uterine artery ligation followed by B-Lynch compression suturing in women with atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta.Method
This protocol was followed in 26 women undergoing cesarean delivery for placenta accreta.Results
Two women died from disseminated intravascular coagulopathy. In the remaining 24 women, placental remnants completely disappeared within 8 months and ovulation resumed after a mean ± SD of 51.6 ± 3.2 days. Moreover, 18 women (75%) became pregnant within 12 months.Conclusion
Atonic postpartum hemorrhage and placental site bleeding due to adherent placenta accreta can be safely controlled by bilateral uterine artery ligation followed by B-Lynch compression suturing in women who desire to remain fertile. 相似文献19.
Fernando Althabe Giselle Tomasso Gerardo Vitureira Pierre Buekens 《International journal of gynaecology and obstetrics》2009,107(1):4-7
Objective
To evaluate whether controlled cord traction (CCT) for management of the third stage of labor reduced postpartum blood loss compared with a “hands-off” management protocol.Methods
Women with imminent vaginal delivery were randomly assigned to either a CCT group or a hands-off group. The women received prophylactic oxytocin. The primary outcome was blood loss during the third stage of labor.Results
In total, 103 women were allocated to the CCT group and 101 were allocated to the hands-off group. Median blood loss in the CCT group and the hands-off group was 282.0 mL and 310.2 mL, respectively. The difference in blood loss (- 28.2 mL) was not significant (95% confidence interval, - 92.3 to 35.9; P = 0.126). Blood collection in the hands-off group took 1.2 minutes longer than in the CCT group, which may have contributed to this difference.Conclusion
CCT may reduce postpartum blood loss. The present findings support conducting a large trial to determine whether CCT can prevent postpartum hemorrhage. 相似文献20.