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.     

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.     

Cálculo de la resistencia ósea en la menopausia

Mathematical model must be developed in postmenopausal women to study the physiological mechanism of internal remodelling of the bone, by taking into account isotropy and non-isotropy of bone tissues and the non-uniformity of the bone cross-section Tools and programs designed to communicate information from one computer expert system to another should be developed.     

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.     

Correlacion clínico-gráfica entre la frecuencia cardiaca y la hipomotilidad fetal

Objective

To determine the morphological consequences and heart rate alterations in fetuses with hypomotility.

Material and method

A sample of 40 patients was divided into 2 groups. Group 1 (the problem group) consisted of 20 pregnant patients who had been diagnosed with fetal hypomotility. Group 2 (the control group) consisted of 20 patients with a normal pregnancy.Fetal heart rate (FHR) and uterine contractility were measured for 2 hours. A Corometrics cardiotocograph model 0115JAA, series 0488301 was used.

Results

The baseline FHR of the two groups was compared. The mean and standard deviation (SD) were 136.91 ± 8.75 beats/min in group 1 and 135.5 ± 10.57 beats /min in group 2. The difference between the means was one beat and the t-value was 0.46. This difference was not significant.The mean and SD of the amplitude of the accelerations were calculated in both groups, obtaining values of 22.47 ± 7.76 in group 1 and 24.81 ± 7.41 in group 2. The difference between the means was two beats and the t-value was 0.97. This difference was not significant.The time interval between the mother noticing the lack of fetal movement and the consultation was recorded in hours. The mean and SD were 35.5 ± 22.70 hours.The time periods when FHR did not vary were recorded in minutes. The mean and SD were 28.94 ± 13.50 min.

Conclusions

In group 1, the physical status of the newborns was evaluated using the Apgar test at 1 and 5 minutes. At 1 minute, two of the neonates were depressed (Apgar scores of 2 and 5) and 18 were vigorous (Apgar scores of 7 to 9). At 5 minutes, Apgar scores were between 7 and 9 in 19 neonates. Only one neonate continued to be depressed, scoring -2.In group 2, Apgar scores at 1 minute were between 7 and 9 in nine neonates. At 5 minutes, these scores increased to between 8 and 9.Height and weight were determined. The mean and SD for weight were 3.233 ± 0.395,92 g in group 1 was 2.960 ± 0.421,05 g in group 2. The difference between means was 273 g and the t-value was 0.03. This difference was not significant.The mean and SD for height were 50.46 ± 2.97 cm in group 1 and 49.77 ± 1.09 cm in group 2 and the t-value was 0.82. The difference between the means was not significant.     

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 espontánea de la vena renal izquierda materna durante la gestación

Retroperitoneal hemorrhage is a very rare event, especially during pregnancy, and is associated with high morbimortality for both the mother and fetus. The cause is usually traumatic, but these hemorrhages can occur spontaneously, which further hampers their diagnosis. Presenting symptoms are abdominal pain and maternal hypovolemic shock, with rapid fetal compromise. We present a case of maternal retroperitoneal hemorrhage, which occurred at week 35 of pregnancy due to spontaneous rupture of the left renal vein, although the first manifestation was placental abruption.     

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.