Utilidad de la prueba de la fibronectina fetal y de la longitud del cérvix en la predicción del parto prematuro en gestantes sintomáticas

Objective

To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.

Material and methods

A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.

Results

The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.

Conclusion

Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions.     

Tumor de células de la granulosa de patrón difuso sarcomatoide. Presentación de un caso

Granulosa-cell tumors are rare malignant neoplasms characterized by a long natural history and a tendency to recur years after the initial diagnosis.     

Tumor de células de Sertoli-Leydig ovárico

We present the rare case of a 62-year-old woman who developed an ovarian tumor associated with severe hirsutism, hypertension, renal insufficiency, and hyperparathyroidism. Hormone evaluation showed high plasma testosterone and estradiol values, with suppressed gonadotropins. Ultrasound examination and computed tomography revealed a large pelvic tumor. Differential diagnosis with a Sertoli-like endometrioid carcinoma of the ovary was contemplated, but inhibin-positive expression established the diagnosis of Sertoli-Leydig cell tumor. Postsurgical outcome was favorable, with normal plasma values of sexual steroids and an increase of gonadotropins to within the normal postmenopausal range.     

Recurrencia del tumor ovárico de las células de la granulosa

We present the case of a 79-year-old woman who was misdiagnosed with an ovarian fibroma 5 years previously. The patient presented with pain in the right iliac fossa with leukocytosis and was diagnosed with diverticulitis. A mass was incidentally found in the anterior abdominal wall, which was later confirmed as metastasis from a granulosa cell tumor of the ovary.We provide a literature review, focussing on the clinical findings and treatment of this tumor. Few reports have been published of this uncommon entity, characterized by a long natural history and tendency to recur years after the initial diagnosis.     

Carcinoma de células pequeñas neuroendocrino de cérvix uterino

We report a case of a neuroendocrine small-cell carcinoma of the cervix seen in our Gynaecology Department. This is a rare diagnosis and is of interest. Small-cell carcinoma of the cervix is a rare tumour with poor prognosis and high aggressiveness. Optimal treatment has not been established due to the rarity of the tumour.     

Adenocarcinoma de cérvix y embarazo

The three percent of cervical cancers are diagnosed during pregnancy. Therapeutic management is according to gestational age, extend of desease and patient desires after being well informed about prognosis and treatement. We report a case of cervical adenocarcinoma wich was diagnosed at 28 weeks of pregnanacy.     

Carcinoma neuroendocrino de cérvix uterino: descripción de 2 casos clínicos,uno de ellos asociado a gestación. Revisión de la bibliografía

Neuroendocrine carcinoma of the uterine cervix is a rare disease with very aggresive behavior. The optimal initial therapeutic approach has not yet been clearly defined. It rarely is complicated by pregnancy.