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.     

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación

Objective

To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination.

Material and methods

We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800 μg /24 h) and between June 2007 and December 2008 (regimen B: 400 μg /4 h). Induction-expulsion time was taken as the main outcome.

Results

The mean expulsion time was similar in both regimens (19.7 h for A and 17.7 h for B). No significant differences were found in the expulsion rate at 12, 24 and 48 h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed.

Conclusions

No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B.     

Enfermedad de Chagas y gestación

Chagas’ disease can be transmitted through vertical transmission and breast feeding in non-endemic areas. Migration is spreading new diseases in these areas, which may have diagnostic and therapeutic implications in pregnancy. The main effects in newborns reported in the literature are prematurity, low birth weight, and low Apgar score. Placental involvement does not imply fetal disease in all cases. Treatment must be postponed until the end of pregnancy due to the possibility of teratogenic effects.     

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.     

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro

Objective

To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Subjects and methods

The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62 ± 4.87 years and that of women was 33.88 ± 3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates.

Results

DNA fragmentation was negatively correlated with progressive motility (p = 0.000) of fresh and capacitated (p = 0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p = 0.034) and worse sperm DNA quality (p = 0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates.

Conclusions

DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age.     

Impacto de la edad materna avanzada en las complicaciones obstétricas y perinatales de las gestaciones gemelares

Objective

To evaluate the pregnancy and perinatal outcomes of twin gestations in women aged 35 or older.

Material and methods

We designed a retrospective cohort study. Maternal complications, mode of delivery and perinatal outcomes were compared in 229 women who delivered at age 35 or older and in 374 women who delivered at age less than 35 years. The computerized database and medical records of pregnant women attending the Miguel Servet University Hospital from January 2001 to December 2007 were retrospectively reviewed.

Results

Older women had an increased risk of conceptions after assisted reproductive techniques (p > 0.001), dichorionic pregnancies (p > 0.001) and gestational diabetes (p = 0.007; 95% CI: 1.119-3.19). There was no significant association between older maternal age and an increased incidence of preterm labor, premature rupture of membranes, fetal growth restriction, cesarean delivery or perinatal mortality.

Conclusion

Based on our data and previous studies, advanced maternal age in twin pregnancies does not seem to significantly increase obstetric complications or adverse perinatal results.     

Cribado de aneuploidía en gestación gemelar: resultados de la aplicación del test combinado

Objective

To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin pregnancies with one or two affected fetuses. To compare the value of markers according to chorionicity and the mode of conception.

Material and methods

Retrospective study including 161 twin pregnancies. Maternal serum fß-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risk of trisomy 21 was calculated in each fetus using the Combined Test. In monochorionic pregnancies, the single risk for the pregnancy was obtained with the largest NT. An invasive diagnostic procedure was offered when the risk was 1:250 or more in one or both of the fetuses.

Results

All trisomy 21 pregnancies were identified (three pregnancies and four fetuses) by the combined testfor a false-positive rate of 6.4% of pregnancies and 3.5% of fetuses. The median fß-hCG level, expressed in MoM, was 1.72 and the median PAPP-A level was 2.01. The median NT was 1.05 MoM. Both fß-hCG and PAPP-A levels were significantly decreased in monochorionic pregnancies and PAPP-A was significantly decreased in pregnancies resulting from assisted reproduction. No significant differences were observed in NT measurement between monochorionic and dichorionic fetuses or between those conceived naturally or by assisted reproduction.

Conclusions

The combined test shows high sensitivity and specificity in screening for trisomy 21 in twin pregnancies. The differences obtained in the biochemical markers according to chorionicity or the mode of conception require confirmation in further studies with a larger number or cases.     

Análisis del valor del misoprostol en el tratamiento del aborto diferido

Objective

To study the use of misoprostol as an alternative management for early pregnancy loss.

Materials and methods

Patients (n = 109) diagnosed with early pregnancy loss between December 2009 and December 2010 were offered medical treatment with 600 μg intravaginal misoprostol or surgical curettage.

Results

Ninety-two patients (84.40%) received medical treatment and 17 (15.60%) were treated surgically. Medical treatment was successful in 78 patients (84.8%). Compared with surgery, medical treatment was more painful (visual analog scale 1-10) (6.29 [2.46] vs. 4.24 [3.35]; P = .026), required fewer days of absence from work (3.0 [1.3-7.0) vs. 6.5 [4.0-14.8]; P = .007), and increased the need for painkillers (P = .014). Overall satisfaction (scale 1-10) was higher with surgery 9.33 (1.32) vs. 8.26 (1.64) P = .024. The cost of medical treatment was 123,04 euros lower per procedure.

Conclusion

Medical treatment with misoprostol was successful in almost 90% of patients, with few adverse effects, a good satisfaction rate and lower cost than surgical curettage.     

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.     

Piomioma tras aborto de segundo trimestre de gestación

Pyomyoma is a rare disease but carries high morbidity and mortality. Because of the non-specific nature of the symptoms, subacute course of the disease and its low incidence, early diagnosis is difficult. We report a case of septic shock due to pyomyoma after a miscarriage in the second trimester of pregnancy. Because of the torpid clinical course –despite the use of a broad-spectrum antibiotic– hysterectomy was performed. When there are signs of infection in a patient with myomas and a recent history of uterine instrumentation, the presence of a pyomyoma must be excluded.     

Exposición prenatal a ftalatos. Anemia materna,duración de la gestación y somatometría del recién nacido

Phthalic acid esters, commonly known as phthalates, are ubiquitous pollutants in foods, air, ground, sediments, beauty products and construction materials to which pregnant women are exposed.     

Agenesia lumbosacra. Expresión del síndrome de regresión caudal

Lumbosacral agenesis is an uncommon condition which is part of the caudal regression syndrome.     

Cribado combinado del síndrome de Down: validación del riesgo estimado por Fetaltest

Objective

To validate empirically the risk for Down syndrome estimated by Fetaltest using biochemical markers in the first trimester (PAPP-A and free beta subunit of hCG) and nuchal translucency.

Material and methods

We performed a retrospective study of the data from 15,009 pregnant women screened for Down Syndrome in the first trimester, included in the database prospectively maintained by the Fetaltest multicenter study, and completed before December 31, 2007. The study included 39 cases of Down syndrome detected either prenatally or postnatally, and used a previously established analysis method.

Results

The correlation between predicted risk and the observed prevalence of Down syndrome was very high (r = 0.999967).

Conclusions

The risk estimated by Fetaltest agrees closely with the observed prevalence of Down syndrome. Therefore, this calculation system is valid and can be used with confidence when counseling pregnant women in our environment.     

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.     

Estudio aleatorizado del dispositivo liberador de levonorgestrel frente a resección endometrial para el tratamiento de la menorragia

Objective

To asses the efficacy of endometrial resection and the levonorgestrel intrauterine system (LNG-IUS) in the treatment of menorrhagia.

Material and methods

Fifty women were randomized to either insertion of a LNG-IUS or endometrial resection. Hemoglobin levels, menstrual bleeding patterns and degree of satisfaction were evaluated during a 12-month follow-up.

Results

Hemoglobin levels increased in both groups. The most frequent bleeding patterns were amenorrhea and hypomenorrhea. The most common adverse effect in the LNG-IUS group was the presence of spotting. Ninety-four percent of the patients in the resection group and 86% of those in the LNG-IUS group were satisfied with the treatment.

Conclusions

Both treatments were effective in reducing menstrual blood loss.     

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.     

Recuperación del parto vaginal de nalgas y versión cefálica externa

Objective

To review the obstetric and neonatal outcomes of the application of an updated vaginal breech delivery protocol 10 years after this practice had been discontinued.

Methods

Breech presentations were referred to a dedicated breech unit at 36 weeks where the external cephalic version was offered. If breech presentation persisted, the patients were selected to undergo attempted vaginal delivery if the following criteria were met: a) estimated fetal weight of 2.500-3.600 g; b) frank or complete breech presentation; c) absence of hyperextension of the fetal head; and d) a clinically adequate pelvis. Intrapartum criteria included: a) progression of labor of ≥ 1 cm/hour in the first hour; b) In the second stage, 90 minutes were allowed for adequate descent of the breech, and 1 hour of active pushing, and c) the availability of an on-call expert.

Results

A total of 93 patients showed single live pregnancies in breech presentation after external cephalic version. Sixty-nine patients (73.4%) underwent elective prelabor cesarean delivery, and 24 (26.6%) progressed to attempted vaginal breech delivery, which was successful in 19 (20.1%). Cesarean indications for breech presentation were reduced from 5.7% in 2009 to 2.02% after the application of external cephalic version and vaginal breech delivery (P<.001). We observed no fetal deaths, no Apgar test at 5 minutes of less than 7, no umbilical artery pH of less than 7, and no fetal injuries.

Conclusions

. When antepartum and intrapartum criteria are met, vaginal breech delivery is safe. The availability of an on-call expert allows vaginal breech delivery to be safely performed. The combination of external cephalic version and vaginal breech delivery decreases the cesarean rate for breech presentation.     

Utilidad de la determinación del virus del papiloma humano en el primer control tras una conización

Objective

To estimate the negative predictive value of human papilloma virus (HPV) status in the first visit at 3 months after conization.

Material and methods

We evaluated the first follow-up visit in 208 patients who underwent conization in Hospital Donostia between January 1, 2003 and December 31, 2006.

Results

The negative predictive value of HPV status at 3 months after conization was 97.99% (95% CI 95.40-100), the positive predictive value was 47.92% (95% CI 32.74-63.09), sensitivity was 88.46% (95% CI 74.26-100) and specificity was 85.38% (95% CI 79.79-90.97).

Conclusions

Negative HPV status 3 months after conization is useful to evaluate cervical disease and could reduce the number of cytological examinations.     

Tratamiento conservador del adenocarcinoma de endometrio. Obtención de dos gestaciones con recién nacidos sanos

We present the case of a 30-year-old childless woman who was diagnosed with a well-differentiated endometrial adenocarcinoma. The patient chose conservative treatment consisting of megestrol and hysteroscopic resection. After this treatment, a normal pregnancy ensued, followed by contraception with an intrauterine device (IUD) delivering levonorgestrel for 18 months. After removal of the IUD, a second normal pregnancy occurred. After the second pregnancy, the patient had no desire for more children and a total hysterectomy with bilateral salpingo-oophorectomy was performed. We discuss the ethical, diagnostic and therapeutic dilemmas posed by this case, including the possibility of progression and patient death.     

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor

Objective

To identify groups of women with changes in cesarean rates in two different periods.

Subjects and methods

Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsońs classification.

Results

The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital.

Conclusion

A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase.