Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino

Objective

To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies.

Material and methods

We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture.

Results

We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid.

Conclusions

Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy.     

Resucitación fetal intrauterina

Introduction

Intrauterine fetal resuscitation includes a series of procedures performed in the mother to improve fetal oxygenation by correcting the cause of fetal compromise manifested by non-reassuring fetal heart rate.

Material and Methods

A literature review was performed with evaluation of the scientific evidence for the techniques traditionally used for this purpose (maternal position, intravenous fluids, oxygen, intrapartum tocolysis and amnioinfusion).

Results

Although the evidence could be more robust, there are sufficient data to suggest that these techniques benefit the fetus, and the risk of harm is minimal when used with common sense. These procedures do not reverse the state of fetal hypoxia but can help to improve fetal oxygenation during the process of preparing for delivery.

Conclusion

Until more data are available, it seems reasonable to err on the side of fetal safety by using these techniques when appropriate, based on the specific fetal heart rate pattern or any other intrapartum fetal surveillance test.     

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.     

Prevención del aborto

Objectives

To assess various social factors related to therapeutic abortion (voluntary pregnancy interruption [VPI], since the term therapeutic was traditionally used for abortions due to medical indication) with the aim of obtaining information in the context of the couple, the family and society.

Subjects and methods

Data were gathered through a personal interview performed in 1,600 patients who underwent VPI.

Results

A total of 26.9% of the patients were visiting a gynecologist for the first time. Most of the patients (84.3%) had said nothing to their parents and 12.9% had said nothing to their partners either. Three-quarters (76%) agreed with the possibility of having a VPI and with its legality; 18.3% were against.

Conclusions

Reducing the number and rate of abortions requires a more open understanding of both sex and sexuality, promoting a dialogue within the family and at school, as well as the design of complete education programs.     

Disección aórtica aguda tipo A,una enfermedad catastrófica asociada al embarazo

Objective

To describe two fatal cases of type A acute aortic dissection associated with pregnancy.

Methods

We reviewed the medical records and autopsies of patients, and then identified some mechanisms linking this entity to pregnancy.

Results

Both deaths occurred in women aged less than 35 years at the end of gestation. One patient had aortic coarctation and bicuspid aortic valve, while the other had no risk factors.

Conclusion

Hemodynamic changes in the third trimester of pregnancy may be involved in the onset of this entity. Rapid diagnosis is essential to prevent its high associated mortality.     

Clasificación morfológico-histeroscópica del cancer endometrial

Objective

To assess the morphological-hysteroscopic nomenclature for endometrial cancer used by our group by evaluating the differences between distinct patterns, both morphological and those related to histological grade and stage at diagnosis.

Material and methods

We analyzed 272 patients with hysteroscopically-diagnosed endometrial cancer. Using our classification, we grouped the tumors into three patterns (pseudohyperplasial,nodular, and malignant transformation of polyps) and one subpattern (advanced). We next compared these patterns with the surgical stage and the final histological grades.

Results

When advanced signs were lacking, the patterns of pseudohyperplasia and malignant transformation of polyps were related to earlier stages and differentiated histological grades.Nodular patterns were related to scarcely differentiated histological grades. Finally, advanced subpatterns, irrespective of the basic pattern to which they belonged, were diagnosed at later stages.

Conclusions

Currently, the value of hysteroscopy in the diagnosis of endometrial cancer and intracavity involvement is widely accepted. This study demonstrates the utility and validity of our morphological-hysteroscopic classification; the nomenclature described can be used to give a name to the malignancies diagnosed and even to hazard a prognosis related to their stage and grade of histological differentiation.     

Evolución del cáncer de mama en Aragón (España). Proyecciones a 15 años

Objective

The aim of this study was to determine the trend in breast cancer in Aragon by projecting the incidence rates, prevalence and mortality over a 15-year period from 2008 to 2022.

Material and methods

Data were obtained from the National Institute of Statistics and the program used was the MIAMOD.

Results

We estimated that from 2008 to 2022, the incidence rate of breast cancer in Aragon will decrease from 53.06 to 45.56 (adjusted from 31.66 to 25.22). Mortality will decline gradually from 15.6 in 2008 to 12.9 (adjusted from 8.13 to 6.37) and the prevalence will decrease from 568.33 to 522.17 (adjusted from 322.15 to 271.32).

Conclusions

These projections indicate that the incidence, mortality and prevalence of breast cancer in Aragon will decrease, although only the reduction in the incidence rate will be statistically significant.     

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.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

Vaginoplastia mediante interposición de membrana amniótica

Objective

To study the results and complications of the technique performed by Dr. G. Sancho Leza for the creation of a neovagina using amnion in patients with vaginal agenesis.

Material and method

A retrospective study of 16 women who were diagnosed with vaginal agenesis in our service from 1989 to 2005 was performed.

Results

The neovagina created with this procedure allowed sexual activity in all women. Two women required reintervention due to stenosis. There were no graft rejections or serious postoperative complications.

Conclusions

Vaginoplasty using amnion produces good results and fewer complications than other procedures using different materials.     

Método Essure: contracepción definitiva por vía histeroscópica

Aim

To describe hysteroscopic permanent contraception through the Essure procedure and to compare this procedure with other already available methods.

Subjects and methods

We analyzed multicenter studies published before approval of the Essure method as well as the experience reported in subsequent studies by groups with expertise in hysteroscopy.

Results

Data from two multicenter, international, prospective, randomized studies published in 2003 demonstrate that the Essure procedure provides high contraceptive efficacy (greater than 99%), with a minor complications rate of less than 3%.

Conclusions

Permanent contraception with the Essure procedure, when performed after an adequate learning curve and by practitioners with extensive experience in diagnostic hysteroscopy, can be carried out as an outpatient technique with a 95% success rate.     

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical

Objective

To present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature.

Subjects and methods

A primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed.

Results

A 3050 g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy.

Conclusions

Umbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed.     

Análisis del dolor en la versión cefálica externa

Objective

To analyze the maternal perception of pain during external cephalic version.

Material and methods

A prospective study was carried out on 71 patients at the Hospital de Cruces between April 2005 and April 2006, based on personal surveys conducted after the version. These surveys included a «numeric pain intensity rating scale» as well as a series of questions regarding the procedure. Results were analyzed in terms of success or failure of the procedure.

Results

The overall success rate was 50.7%. The procedure was well tolerated by all pregnant women, with no complications being observed. The overall median pain stood at 7; 5 in successful versions, as opposed to 8 in unsuccessful versions (P<.01). A total of 83.1% of patients stated that they would be willing to undergo the procedure again in the future, more than 50% of them basing their decision on the benefits of cephalic delivery.

Conclusions

The fact that external cephalic version is a well tolerated procedure is probably due to its brevity, although it must be noted that it is not a pain-free maneuver.     

Inversión uterina puerperal

Introduction

Uterine inversion is a rare obstetric emergency that occurs during the third stage of labor

Objective

To describe the clinical, diagnostic and therapeutic characteristics and outcomes in patients with uterine inversion.

Material and methods

We performed a retrospective study of six patients with uterine inversion during the puerperium in the Hospital de Leon (Spain) in 2005.

Results

All inversions occurred in primiparous women with epidural anesthesia and instrumental delivery at term. Oxytocin was used in 83% during dilatation; the average duration of which was 6.5 hours. Diagnosis was mainly clinical except in one grade II inversion, which required ultrasonography and was resolved surgically. The remaining cases were resolved through manual reduction (83%). After the episode, hemoglobin levels were reduced by an average of 2.7 g/dl from prepartum levels, and only two patients required blood transfusion.

Conclusions

Factors predisposing to uterine inversion were hypotonic uterus, fundal implantation of the placenta, and placenta accreta. Sixty percent of all cases were caused by precipitous maneuvers including traction on the cord or improper fundal pressure. Diagnosis is essentially clinical. Although uncommon, uterine inversion will result in severe hemorrhage and shock if left unrecognized, leading to maternal death. Once a diagnosis is made, immediate measures must be taken to stabilize the mother. Manual manipulation should be attempted immediately to reverse the inversion. Tocolytics, such as ritrodine, magnesium sulphate and terbutaline, or halogenated anesthetics may be administered to relax the uterus and aid its reversal. Intravenous nitroglycerin is an alternative to tocolytics. Failure of reversion or recurrence requires surgical treatment.     

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.     

Predicción de anemia fetal por isoinmunización tras transfusiones intrauterinas. Revisión de los casos tratados en nuestra unidad

Objetive

Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion.

Material and methods

We performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia.

Results

The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series.

Conclusions

Doppler evaluation of the middle cerebral artery as predictor of fetal anemia has a lower detection rate after consecutive transfusions.     

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.     

Concentraciones de interferón gamma en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of interferon-gamma in patients with preeclampsia and healthy normotensive pregnant women.

Material And Methods

One hundred patients were selected. Fifty preeclamptic patients were selected as cases (group A) and 50 healthy pregnant women with a similar age and body mass index to patients in group A were selected as controls (group B). Blood samples for interferon-gamma determination were collected in all patients before labor and immediately after diagnosis in the study group.

Results

There were no significant differences in maternal age, gestational age or body mass index at sample collection (p=ns). Statistically significant differences were found between groups in mean values of systolic and diastolic blood pressure (p<0.05). Interferon-gamma concentrations were significantly higher in group A (75.5±27.7 pg/ml) than in group B (54.2±29.6 pg/ml, p<0.05) and there was a slight, positive and significant correlation with values of systolic blood pressure (r=0.383; p<0.05) and diastolic blood pressure (r=0.259; p<0.05).

Conclusion

Interferon-gamma concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

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.     

Embolización de las arterias uterinas como alternativa de tratamiento para miomas uterinos. Experiencia en 60 pacientes

Introduction

Uterine fibroids are the most common benign solid tumors of the female genital tract. Uterine artery embolization (UAE) is presented as an alternative to surgical treatment.

Objective

To evaluate the efficacy of UAE in the management of symptomatic fibroids, establish the success rate, and evaluate the safety of the technique by detecting complications during the procedure.

Material and methods

A retrospective dual-center study was performed in 60 patients undergoing UAE from 2000 to 2011 in Albacete and the Puerta de Hierro General Hospital in Madrid.

Results

The clinical success of the technique was demonstrated in 41 of the 60 patients (overall success rate of 68% at 4 years of follow-up) Complications occurred in 7 of the 60 patients (11.6%), consisting of embolization syndrome and transient ischemic pain in the first and second, which resolved with medical treatment and without further complications.

Conclusion

UAE is an effective treatment for women with symptomatic fibroids, showing high reliability and a low rate of minor complications.