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.     

Sífilis y embarazo: incidencia y evolución histórica en el área sur de Granada

Objective

To evaluate the prevalence of syphilis infection in pregnancy and the results of the management of this disease.

Material and methods

We performed a retrospective study of all cases of syphilis infection in pregnancy diagnosed and treated between January 1996 and December 2006 in the San Cecilio University Hospital in Granada.

Results

During the 11-year period studied, the overall incidence of syphilis infection in pregnancy was 2.42 × 10⁻⁰⁴ (seven cases), with three cases occurring in the final year.

Conclusions

In our area, the incidence of syphilis in pregnancy was higher than the average reported in other countries of a similar socioeconomic level (e.g. the USA with 1.1 × 100,000 pregnancies), possibly due to the increase in the immigrant population     

Malformación adenomatoide quística congénita pulmonar. Una entidad infrecuente

Objective

We want to stress an infrequent entity and his histipathological features.

Material and methods

It was a voluntary interruption of the pregnancy.

Resultados

The prognosis is poor due to the clinical characteristics and the frequent association with other malformations.

Conclusions

Cystic adenomatoid malformation of the lung is classified according to clinical and pathological criteria and the prognosis is ominous.     

Pronóstico y resultados en pacientes diagnosticadas de endometriosis a las que se les ha realizado por primera vez una cirugía conservadora por dolor o esterilidad

Objective

To analyze clinical outcomes in patients with suspected endometriosis undergoing conservative surgery. Pain reduction, pregnancy rates, and reinterventions were analyzed.

Material and methods

Patients with suspected endometriosis and symptoms of pain or infertility undergoing conservative surgery for the first time were included (n = 128). Exclusion criteria consisted of incomplete medical histories and interventions indicated for reasons other than pain or infertility.

Results

Surgery was indicated for pain in 70.3% and for infertility in 29.7%. A total of 32.5% of the patients had pain at the first postsurgical visit, 42.5% at 6 months and 58.3% at 1 year. Reintervention was performed in 11.29%. Among reinterventions for pain, there was a higher percentage of intestinal symptoms before surgery (P=.07), as well as episodes of abdominal pain requiring hospital care (P=.08); a higher proportion of these patients had pain in the first visit (P=.05) and at 1 year (P=.03) than patients not undergoing reintervention. Postsurgical medical treatment was less frequent in patients undergoing reintervention (P=.11). Among patients undergoing surgery for infertility, pregnancy was achieved in 65.8%.

Conclusions

Pain was less frequent in the first postsurgical visit than in subsequent visits. Among patients undergoing reintervention for pain, there was a higher percentage of intestinal symptoms and episodes of abdominal pain requiring hospital care prior to the intervention. Pain at the first visit and at 1 year are factors of poor prognosis for reintervention. Patients undergoing reintervention for pain less frequently required postsurgical medical treatment. More than half of patients with interfertility and endometriosis achieved spontaneous pregnancy after surgery.     

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.     

Etiología y sensibilidad antimicrobiana en las infecciones urinarias bajas de la embarazada en España

Introduction

To improve antibiotic use in the treatment of urinary tract infections during pregnancy, knowledge of the most frequent pathogens and their susceptibilities is required.

Methods

Between march and july 2004, a prospective multicenter study was conducted in 15 national microbiology laboratories. The laboratories used their standard methods to process the samples.

Results

Pregnancy or non-pregnancy was recorded in only 1521 women; of these, 150 women were pregnant. The most frequent pathogen in pregnant women was Escherichia coli (54.6%), followed by Streptococcus agalactiae (24.3%). Isolation of gram positive strains (32.2%) was significantly more frequent in pregnant women (p < 0.001). The susceptibility rates of E.coli were 98.8% for fosfomycin, 96.2% for cefixime, and 97.6% for nitrofurantoin; these rates were lower for ampicillin (41.6%).

Conclusions

E.coli is the main uropathogen during pregnancy, because of the materno-fetal complications of urinary tract infections during pregnancy, alternative antibiotics should be used to reduce the high resistance to antibiotics that are useful in neonatal sepsis.     

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.     

Ensayo clínico controlado de la influencia del entrenamiento aeróbico en la tolerancia al ejercicio y los síntomas depresivos en primigestantes colombianas

Introduction

Depression in pregnancy affects almost 60% of pregnant women and several studies have shown that aerobic exercise can reduce depressive symptoms by increasing physical capacity. However, this effect has not been determined in pregnancy.

Objective

To evaluate the influence of aerobic training on exercise tolerance and depressive symptoms in Colombian nulliparous pregnant women.

Materiales and methods

We carried out a simple controlled trial in 80 nulliparous pregnant women, between 16 and 20 weeks of pregnancy, randomized to two groups. 1) The control group continued their usual activities, with no specific exercise regime. 2) The intervention group performed aerobic training between 50% and 65% of their maximal heart rate for 50 minutes, three times a week for 12 weeks. Exercise tolerance was assessed using the 6-minute walk test and symptoms of depression were assessed by the Center for Epidemiological Studies Depression Scale (CES-D) at baseline and immediately after the 3-month intervention.

Results

The mean age was 21 ± 3 years and gestational age was 18 ± 2 weeks. Seventy-four women completed the study. After the intervention, participants who exercised had a higher exercise tolerance, measured by the 6-minute walk test, and a greater reduction in depressive symptoms than the control group, as measured by the CES-D scale, P<.05.

Conclusions

A supervised 3-month program of primarily aerobic exercise during pregnancy reduces depressive symptoms and improves exercise tolerance. These results provide new evidence of the benefits of exercise in preventing maternal depression.     

La malformación arteriovenosa uterina. Una lesión más frecuente y grave de lo sospechado

Introduction

Uterine arteriovenous malformation (AVM) is more common than it is reported to be and is a potentially life-threatening condition often secondary to uterine trauma or pregnancy. Congenital origin is also reported but is less common.

Material and methods

Eight cases are described.

Results and discussion

AVM is characterised by the presence of an intra-myometrial arteriovenous skein. Congenital cases may extend to vascular zones of the minor pelvis and/or other organs. The onset of AVMs is usually severe bleeding. Doppler ultrasound is the first diagnosis approach, but, angiography remains the gold standard for diagnostic evaluation. A previous negative pregnancy test is a “sine qua non” condition. Embolization is the more acceptable form of treatment. The therapeutic advances in their diagnosis and treatment are described, based on 8 personal cases.     

Miomectomía laparoscópica frente a laparotómica

Objectives

To analyze the benefits of laparoscopic myomectomy (LM) versus open myomectomy (OM) and to assess the limits of its indications.

Material and methods

Data from 210 OM and 128 LM performed between 2002 and 2006 were retrospectively analyzed. Postoperative follow-up (complications, length of stay, blood loss) and the pregnancy rate according to the surgical procedure were also analyzed.

Results

We performed 338 myomectomies, 210 OM (62.1%) and 128 LM (37.9%). Analysis of both techniques revealed that only myoma size, myoma number, operating time, length of hospital stay and the complications rate showed statistically significant differences. The pregnancy rate was 14.1% (18 patients) in LM and 16.3% (34 patients) in OM.

Conclusions

LM requires longer operating time but speeds recovery, reduces length of hospital stay and produces fewer adhesions and less blood loss than OM. The pregnancy rate is similar with both procedures.     

Niveles de proteína placentaria A asociada a la gestación: Predictor de macrosomía fetal en gestantes no diabéticas

Objectives

To determine whether plasma levels of pregnancy-associated plasma protein-A (PAPP-A) expressed in multiples of the median (MoM) can be used to predict fetal macrosomia, independently of other clinical or ultrasound parameters, and to determine the risk of having a macrosomic fetus in pregnant women, based on PAPP-A values.

Material and methods

An epidemiological, observational, analytical, case-control study was performed between June 2011 and July 2012 in patients at the the University Hospital of Ourense.

Results

The results of this study suggest that maternal levels of PAPP-A (MoM) are positively associated with fetal weight. A 2.6-fold increment in the risk of having a macrosomic neonate was found for each point-increase in PAPP-A.

Conclusions

PAPP-A values expressed in MoM are an independent predictor of fetal macrosomy and are not influenced by maternal factors or early fetal ultrasound parameters. PAPP-A (MoM) values exceeding 1.89 can predict fetal macrosomia with a specificity of above 80%. In 75% of cases, PAPP-A (MoM) values discriminate between future neonates with normal weight and those with macrosomia.     

Inseminación artificial intrauterina en mujeres con síndrome de ovario poliquístico resistentes al citrato de clomifeno

Objective

To evaluate the results of ovulation induction cycles with gonadotropins and intrauterine insemination (IUI) carried out in women with polycystic ovary syndrome (POS) resistant to clomiphene citrate.

Material and methods

We performed an observational retrospective study of 462 ovulation induction cycles with IUI in women with SOP and clomiphene citrate resistance.

Results

The clinical pregnancy rate was 11.9% per cycle initiated and 14.74% per insemination and 45.45% of the pregnancies terminated in abortion. The effective accumulative percentage of term pregnancies per cycle initiated was 8% for the first cycle and 10.23% for insemination, increasing to 26.15% from the fifth cycle and to 32.24% from the fifth insemination. A total of 19.26% of the cycles was cancelled.

Conclusions

IUI is a useful method in women with SOP who are resistant to clomiphene citrate, with similar results to those obtained with other indications. These patients have high abortion and cycle cancellation rates. The high abortion rate should prompt research into ways of reducing reproductive loss.     

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.     

Abordaje laparoscópico del dolor abdominal agudo en mujeres en edad fértil

Objectives

To assess the effectiveness of the laparoscopic approach in acute abdominal pain in women of reproductive age presenting to the Emergency Department.

Material and methods

We performed an observational, prospective study of acute abdominal pain treated by gynecological laparoscopic procedures. The main variables evaluated were the cause of pain, type of surgery, complications, and conversions to open surgery.

Results

Between January 2009 and December 2011, we performed 110 urgent laparoscopic interventions. The reasons for surgery were rupture of an ovarian cyst in 40 interventions (36.7%), an ectopic pregnancy in 24 (21.8%), a pelvic inflammatory disease in 23 (20.9%), adnexal torsion in 12 (10.9%), and other reasons in 11 (10%). In these 110 interventions, there was one case of postoperative bleeding requiring reintervention and one case of conversion.

Conclusions

The laparoscopic approach is safe and effective in urgent gynecological surgery.     

Embolización de las arterias uterinas en hematoma disecante de la episiotomía

Background

Postpartum hemorrhage is a potentially serious complication and includes bruising of the birth canal. It is vitally important that the diagnosis and treatment take place at an early stage.

Case

We report a serious case of bruising of the birth canal that required selective embolization after unsuccessful local surgical treatment, with hypovolemic shock and disseminated intravascular coagulation.

Conclusion

Embolization requires an infrastructure and technology that are available in tertiary care hospitals. Early diagnosis allows embolization to be performed in hemodynamically stable patients. Uterine artery embolization in expert hands enables future fertility to be preserved with few complications.     

Epidemiología de las estrías gravídicas en España

Objective

To assess the influence of different factors on the presence of striae prior to pregnancy as well as the development of new lesions during and after pregnancy.

Subjects and methods

An observational epidemiologic study was carried out on the prevalence and incidence of striae gravidarum and stretch marks in pregnant women. Data from 519 pregnant women were registered, including obstetric history, family history of striae gravidarum, weight prior to pregnancy, skin type, Fitzpatrick skin phototype, and current use of body creams and lotions. A multivariate analysis was used to determine the factors associated with the incidence of striae gravidarum during current pregnancy.

Results

The prevalence of pre-pregnancy stretch marks was 85.5%, mainly observed in patients with a first pregnancy (OR = 2.6), body mass index ≥ 25 (OR = 2.2), and family history of striae gravidarum (OR = 2.1). The overall incidence of striae gravidarum during pregnancy was 36.8% and most of these patients had a body mass index ≥ 25 (OR = 2.2) and were younger (< 30 years old; OR = 1.9). Risk analysis of all the variables registered indicated a higher risk of striae gravidarum in women who were overweight prior to pregnancy (OR = 1.8), those aged under 30 years (OR = 2.4), and those with previous pregnancies (OR = 4.3).

Conclusions

Prevention of striae gravidarum should be recommended in all cases, with special emphasis on younger women and those who are overweight or obese due to their higher risk for the development of these marks during pregnancy.     

Estudio prospectivo,aleatorizado y controlado para evaluar la utilidad de la radiopelvimetría en la inducción de parto en primigrávidas

Introduction

There are very few studies published in the scientific literature to assess the real value of the x-ray pelvimetry (X-PM). The current recommendations on its use are based on a single meta-analysis that includes only four studies with a very low level of scientific evidence.

Objectives

To evaluate the usefulness of the X-PM in induction in primiparous women for the diagnosis of pelvic-cephalic disproportion and analysing its influence on the duration of pregnancy, neonatal mortality and the rate of caesarean sections.

Materials and methods

The observational, prospective, randomised, double-blind, study, in a population of 264 primigravid pregnant women in whom induction of labour was an indication.

Results

X-ray pelvimetry did not influence the rate of caesarean section or the perinatal results, and has a low predictive value as a prognostic factor in the method of delivery.     

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.     

La histerectomía laparoscópica: un abordaje posible. Estudio retrospectivo de las histerectomías laparoscópicas realizadas en un hospital público

Objective

To assess the outcomes of laparoscopic hysterectomy in a public hospital.

Material and methods

We performed a retrospective study of laparoscopic hysterectomies carried out between January 2005 and December 2007. The parameters evaluated were indication, type of hysterectomy, uterine weight, length of hospital stay, and complications.

Results

In the period analyzed, we performed 284 hysterectomies, of which 103 (36.36%) were laparoscopic. The morbidity rate was 9.7% and complications were related to the learning curve. The mean length of hospital stay was 2.56 days.

Conclusions

Laparoscopic hysterectomy is a safe procedure that requires a learning curve of 30-40 procedures. Due to its advantages, this option should be offered in all gynecology services.