Influencia de la edad y de las técnicas de reproducción asistida en nuestros resultados obstétricos y perinatales

Objective

To evaluate the influence of age ≥ 40 years and ART in our obstetric and perinatal outcomes.

Material and methods

Retrospective study of 14805 singleton pregnancies in our Institute from January 1, 2000 to December 31, 2006. We compared obstetric and perinatal outcome between: Age group: women ≥ 40 years (N = 557) vs. group of women < 40 years (N = 14248); ART group < 40 years: ART pregnancies (N = 1150) vs. spontaneous pregnancies (N = 13098); ART group ≥ 40 years: ART pregnancies (N = 126) vs. spontaneous pregnancies (N = 431).Results: Age ≥ 40 years is significantly associated with preterm birth under 34 weeks (odds ratio [OR] = 2.148 [1.237-3.730]), gestational diabetes (OR = 2.25 [1.799-2.815]), placenta previa (OR = 3.346 [1.516-7.386]), caesarean delivery (OR = 1.831 [1.539-2.177]), and peripartum hysterectomy (OR = 6.414 [1.359-2.177]). In the ART group < 40 years assisted conception (ART) is significantly associated with preterm birth under 37 (OR = 1.67 [1.337-2.088]) and 34 weeks (OR = 1.8 [1.162-2.822]), with gestational diabetes (OR = 1.5 [1.273-1.844]), pre-eclampsia (OR = 2.1 [1.456-3.164]), placenta previa (OR = 5.29 [2.973-9.437]), choriamniotic infection (OR = 3.8 [1.029-14.072]), caesarean delivery (OR = 1.5 [1.346-1.737]) and low birth weight ≤ 2500 g. (OR = 1.67 [1.329-2.114]) and ≤ 1500 g. (OR = 2.44 [1.442-4.135]). In the ART group ≥ 40 years we only find a significantly increased rate of caesarean delivery (OR = 1.76 [1.183-2.635]) in ART group vs. spontaneous pregnancy group.

Conclusions

Age ≥ 40 years increases the risk of adverse obstetric outcome. ART increase the risk of adverse obstetric and perinatal outcome in the group < 40 years, but not in the group of women aged 40 years and older, probably due to the small size of the sample.     

Lesiones vaginales por pesario. Estudio de casos y revisión de la literatura

Objective

We studied the adverse events occurring with the use of vaginal ring pessaries.

Material

We report a series of nine cases of adverse events involving vaginal pessaries occurring within a 4-year period with over 23719 consultations and representing an incidence of 0.03%.

Results

The mean age of the patients was 83 years (range: 70-96), and the mean parity was 3.77 (range: 2-6 children). The mean age of onset of the use of a pessary was 80 years. The mean number of years of use was 3 (range 1-5 years).The indications for pessary use were contraindication of surgery due to heart disease and, in women with prior surgery, the recurrence of prolapse or vaginal vault prolapse, and waiting for surgery.The adverse events found consisted of vaginal erosion and bleeding in 4/9 (44.44%) and vaginal discharge with vaginal infection in 5/9 (55.55%).

Conclusion

The use of a pessary warrants special care and hygiene measures to ensure long-term successful use.     

Prolapso genital en una gestante con antecedente de accidente de tráfico y lesión perineal severa

The association between genital prolapse and pregnancy is more common in the second half of pregnancy and is often corrected after childbirth. There are no data on the incidence or prevalence of uterine prolapse from the beginning of pregnancy or on those developing during the course of pregnancy or in the postpartum.     

Aplicabilidad de la técnica de identificación y biopsia del ganglio centinela en el cáncer de vulva

Objectives

To assess the percentage detection of sentinel-lymph-node in vulval cancer, its sensitivity and negative predictive value (NPV). To ascertain the adverse effects of this technology and long term relapses of tumour.

Material and methods

Systematic review of literature and subsequent critical appraisal of the evidence.

Results

A total of 29 studies were selected, all of which were observational in nature. The sentinel lymph node was detected by Tc⁹⁹-colloid and combined technique in 98% of patients. The percentage of false negatives observed was less than 2%, the sensitivity values and NPV were over 95% and the lymph node relapse rate around 3%.

Conclusions

Sentinel-lymph-node technique would seem to be a reasonable alternative to inguinal lymphadenectomy in patients with early stages of vulval cancer. When it comes to implementing the technique, a series of factors must be borne in mind with respect to the work team, patient selection, detection technique, surgical and anatomopathological techniques and learning curve.     

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.     

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.     

Neoplasia sincrónica de endometrio y ovario

We report the case of a patient with synchronous neoplasms of the endometrium and ovary, which developed at a relatively young age (45 years). Clinical presentation consisted of hypermenorrhea. An ovarian tumor was subsequently detected through ultrasound and computed tomography. Pathological examination revealed endometrioid histology at both sites and, as in most synchronous tumors occurring in these locations, both the grade and the stage of the tumors were low. All these factors indicate a good prognosis.     

Cáncer oculto de la mama. Caso clínico y revisión de la literatura

We report the case of a patient with occult cancer of the breast. A finding of metastatic adenocarcinoma to the axillary nodes with no apparent mass in the breast is rare, occurring in 0.3% to 0.8% of all breast tumors.     

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas

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.     

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.     

Rotura uterina. Diagnóstico y consecuencias en una gestante de 30 semanas

Uterine rupture is an infrequent obstetric complication with high morbidity and mortality for both the mother and fetus. Early diagnosis and treatment of this entity are important prognostic factors. We report the case of woman at 30 weeks of pregnancy with spontaneous uterine rupture in a previous scar from a laparoscopic myomectomy, giving rise to maternal hemoperitoneum and intrauterine fetal death. Emergency surgery was performed with subtotal abdominal hysterectomy.     

Comparación de la efectividad de la pulsioximetría y el electrocardiograma fetal en las situaciones de riesgo de pérdida de bienestar fetal

Objective

To evaluate the effectiveness of pulse oximetry and fetal electrocardiogram in the management of labor with fetal heart rate patterns associated with a risk of loss of fetal well-being.

Subjects and methods

We performed an open, randomized, experimental trial with two groups: pulse oximetry was used in one group and the STAN® technique was used in the other. Each group included 40 women with single, term pregnancies in cephalic presentation and fetal heart rate patterns associated with a risk of loss of fetal well-being. The overall cesarean section rate, indications of risk of fetal distress, and neonatal acid-base balance were evaluated.

Results

No significant differences were found in the rate of cesarean section (47.5 vs 40%; P = .33), indications of risk of fetal distress (32.5 vs 37.5%; P = .41), or neonatal outcomes.

Conclusions

The use of pulse oximetry and STAN®21, as auxiliary methods to cardiotocographic recording, showed no superiority in reducing the cesarean section rate or improving neonatal outcomes.     

Análisis de la variabilidad interobservador en la interpretación de la radiopelvimetría y su utilidad en la práctica obstétrica actual

Introduction

X-ray pelvimetry has been directly associated with an increase in the rate of cesarean sections and consequently this technique has fallen into disuse.

Objectives

To analyze the impact of evaluator subjectivity in the interpretation and evaluation of X-ray pelvimetry in order to determine the usefulness of this technique as an objective complementary test.

Materials and methods

We carried out a prospective study of X-ray pelvimetry in 113 primiparous pregnant women prior to labor induction. The scans were measured and interpreted independently and blindly by three researchers with wide experience in obstetrics.

Results

There were discrepancies between the first two researchers on 60 occasions (45.11%) and assessment by the third researcher was required on 49 occasions (36.84%).

Conclusions

X-ray pelvimetry lacks value in predicting delivery route since there is wide interobserver variability in the measurement and interpretation of scans.     

El SeXO de los obstetras y el género de parto vaginal

Objective

To determine whether the instrumental delivery rate changes according to the number of men among thirdand fourth-year resident physicians.

Materials and methods

The proportion of instrumental deliveries was determined among 54,961 births in a single hospital from 1990 to 2006. Annual rates were calculated based on the gender of thirdand fourth-year resident physicians. For each annual rate, a 95% confidence interval was calculated and the χ² test was performed to verify the significance of differences.

Results

When the number of male physicians increased so did the rate of instrumental deliveries. Differences were significant for years in which the number of male physicians was equal to three or more.

Conclusions

The instrumental delivery rate seems to be related to the gender of third-and fourth-year resident physicians.     

Estudio observacional de la efectividad y seguridad de nifedipino en la amenaza de parto prematuro

ObjectivesTo determine the effectiveness and safety of nifedipine as a tocolytic agent in pregnant women with preterm labor (PL).Subjects and methodsWe performed a prospective observational study (April 2003 - December 2004) and a retrospective study (January- December 2008). A total of 106 pregnant women were included and the hospital PL protocol was applied. Thirty-three patients were excluded for different reasons, mainly because of a false PL diagnosis.ResultsPregnancy was prolonged by more than 48 hours in 56.2% [95% CI: 44.8-67.5] and 2 doses of betametasone were administered in 69.9% [95% CI: 59.3-80.4]. The incidence of maternal adverse reactions was 29.4% (95% CI: 7.8-51.2), mainly mild hypotension. Of the 99 newborns, 10 died, mainly because of infectious complications and low birthweight and there was one case of hypoxic-ischemic encephalopathy.ConclusionsTocolysis with nifedipine is safe and effective if precautions for use are strictly respected. In this study, there was a low incidence of maternal and fetal adverse effects.     

Adenocarcinoma de vagina escasamente diferenciado: caso y revisión de la literatura

Primary adenocarcinoma of the vagina is an extremely rare malignancy. We report the case of a poorly differentiated adenocarcinoma of the vagina. Immunochemical analysis is the key to determining the origin of undifferentiated adenocarcinomas affecting gynecologic and digestive organs.