Evaluación de la seguridad y la eficacia de la endometrectomía histeroscópica en la menometrorragia

Objective

To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia.

Material and methods

We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated.

Results

The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients.

Conclusions

Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia.     

Utilidad de la eco-Doppler en la consulta de ginecología

In the last 30-40 years, diagnosis in gynecology has been radically changed by the widespread use of abdominal – and especially vaginal – ultrasonography. The present case illustrates how suspicious images necessitate more detailed investigation and follow-up to rule out an underlying malignancy. In the present case, ultrasonography – and especially Doppler – was the only procedure suggesting neoformation. Therefore, we believe that an echo-Doppler-color ultrasound system should be available in all gynecology consulting rooms. This non-invasive technique has demonstrated effectiveness and reproducibility, provides a high diagnostic yield, and requires minimal time to perform. The use of this procedure in the routine follow-up of patients could help in the early diagnosis of neoformative processes, with clear benefits.     

Tratamiento con análogos de la GnRH en la endometriosis de la pared abdominal

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years.     

Recomendaciones de la Sociedad Española de Ginecología y Obstetricia sobre la prevención y el tratamiento de la atrofia vaginal

Vaginal atrophy, caused by estrogen deficiency, leads to the development of symptoms that affect quality of life.     

Influencia de la visita puerperal temprana en la detección y evolución de la depresión posparto

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.     

Papel de la inseminación intrauterina en la era de la fertilización in vitro

Intrauterine insemination is a low-complexity assisted reproduction technology in which previously washed sperm are deposited in the uterine cavity with ovarian stimulation. This invasive technique is well accepted by patients and achieves cumulative pregnancy rates similar to those obtained in a single cycle of more complex assisted reproduction techniques. We compared two methods of assisted reproduction: in vitro fertilization and intrauterine insemination in relation to their effectiveness and cost. We conclude that intrauterine insemination is the first-line treatment in male factor infertility without severe disruption or unexplained infertility; pregnancy can be achieved with 3 to 6 cycles in a high percentage of these cases at lower cost and with lower risk of multiple pregnancy than with in vitro insemination. We did not consider other techniques, such as intracytoplasmic sperm injection, which is also indicated for the treatment of male factor infertility, since this technique requires greater technical and human resources, thus precluding comparison.