Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo

Background and objectiveThe complex physiology of thyroid function during pregnancy requires a hormonal evaluation according to reference values for each trimester, each area, and with the techniques of each laboratory. The objectives of this study were to analyse thyroid function in the three trimesters of pregnancy and to establish the reference values of hormones in pregnant women in this health area (Lugo).MethodsA total of 831 pregnant women were included in the study (median age: 33 years, age range: 16-47 years). Once the exclusion criteria were applied, the sample consisted of 641 pregnant women, a size that can be considered representative of the reference population.ResultsThe reference intervals were as follows: TSH first trimester, 0.10-3.74 mIU/L; second trimester, 0.45-3.77 mIU/L; and third trimester, 0.36-4.15 mIU/L. For Free T4 in the first trimester, 0.87-1.34 ng/dL; second trimester, 0.78-1.20 ng/dL; and third trimester, 0.78-1.23 ng/dL. For Free T3 in the first trimester, 2.52-3.78 pg/mL; second trimester, 2.22-3.21 pg/mL; and third trimester, 2.17-3.14 pg/mL. The presence of thyroid autoimmunity was confirmed in 109 women (13.1%), who presented with higher TSH values than pregnant women without thyroid autoimmunity.ConclusionThe reference intervals for TSH, Free T4, and Free T3 obtained in this study are below those used in the non-pregnant adult population in this laboratory. This should help to identify more accurately a possible thyroid dysfunction in pregnant women in the study area, avoiding an underdiagnosis of subclinical hypothyroidism and reducing the possible associated perinatal complications.     

Conservation de la plaque aréolo-mamelonnaire en cas de mastectomie

Nipple-Sparing Mastectomy (NSM) is a procedure with skin-sparing mastectomy and nipple–areolar complex preservation in association with immediate reconstruction. The aim of this publication is to perform a review of oncological results, technical procedure, complications and indications of NSM with discussion of post-mastectomy radiotherapy indication. Local areolar recurrence is rare and treatment is performed by resection of the nipple–areolar complex. The nipple–areolar complex necrosis rate is a specific complication, observed between 1 to 30% in literature studies. Incisions and surgical procedure of dissection are discussed.     

Projets de naissance en soins palliatifs : un domaine de la périnatalité à construire

Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.     

Influencia de la edad y el número de hijos previos de la madre en la proporción de sexos al nacer

The aim of this paper is to study the effects of the age and the number of previous children of the mother on the variations in the sex ratio at birth, in order to test Trivers and Willard's model which predicts that, depending on the mother's condition, there can be a biased in the sex ratio at birth. The study sample was made up of 6,994 mothers from Granada (Spain) aged from 20 to 34 who had only one child by non-assisted reproduction, and with more than 35 weeks of gestation. The results show that a significant relationship exists between the number of previous children of the mother and the sex ratio at birth. Moreover, considering that the condition of the uterus improves with the number of pregnancies, within the study range of ages, we could say that variation in the sex ratio at birth, within this study sample, follows the prediction of Trivers and Willard's model     

La qualité du suivi de la grossesse interfère-elle avec les issues de la grossesse,en Guadeloupe ?

ObjectivesTo assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes.Patients and methodsHistorical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or ≥ 500 g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks’ gestation).ResultsPatients without an appointment before 15 weeks or without an appointment each month before their delivery represented 27.4% of women (n = 2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (p < 0,0001). We did not find any difference concerning the perinatal outcomes among the women with an inadequate quality prenatal care.Discussion and conclusionOur study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization.     

Suture péritonéale ou non au cours de la césarienne en 2008 ?

Non closure of the peritoneum at cesarean is still debatable, despite the national and international guidelines. This review aims at exposing risks and benefits of non closure of the peritoneum, focusing on the peritoneum adhesions. Many studies demonstrated no benefits at peritoneum closure in the duration of surgery, the immediate postoperative period and the short-term complications. Data about pelvic adhesion risk are more inconsistent. Different criteria were considered in the studies: adhesions incidence and density during subsequent cesareans or pelvic surgeries, duration of surgery and the delay between incision and birth during the subsequent cesarean and fertility known to be impaired by thick-pelvic adhesions. Most of the studies are exhibiting serious bias, leading to weak conclusions. However, two randomised controlled trials compared pelvic adhesion in the subsequent c-section, in step with closure or non closure of the parietal and visceral peritoneum at first caesarean. The results showed that non closure of the peritoneum does not increase or even reduce the adhesions risk. These results are consistent with results from three studies reporting no modification of patient fertility. As a conclusion, current data are supporting the national and international medical society recommendations about the benefits of the non closure of the peritoneum at caesarean section.     

Étude de la distribution anatomique des lésions endométriosiques : un argument majeur en faveur de la participation de la théorie de la régurgitation dans la physiopathologie de l’endométriose

Endometriosis is a common disease in gynecology. Many theories were proposed to explain the endometriosis pathogenesis. The distribution of the endometriosis lesions seems to be interesting in order to understand the endometriosis pathogenesis. This distribution is asymmetric. This asymmetric distribution of endometriosis is explained by the anatomy of the peritoneal cavity and by the intraperitoneal fluids. It strongly confirms the role of menstrual regurgitation and peritoneal fluid in the endometriosis genesis. The similar asymmetric distribution for all types of endometriosis (superficial lesions, ovarian endometriosis cyst, deep endometriosis) is an argument in favor of a unique origin for the different types of lesions.     

Cambio del modelo asistencial en una unidad de uroginecología de un hospital de tercer nivel: impacto de la pandemia por COVID-19 en la presencialidad

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.     

Compresión de la vena umbilical después de una rotura prematura de membranas en la semana 31

ObjectiveA detailed study of way through ultrasounds on the origin of vaginal bleeding in premature rupture of the membranes.MethodsWe examined sonographically a diabetic pregnancy that showed a premature rupture of the membranes in the 31st week and vaginal bleeding.ResultsAround the placental insertion of the umbilical cord we observed an amniotic band that surrounded and strangled the umbilical vein. This band was the origin of partial abruptio placentae. Through cesarean section we confirmed the diagnosis and a normal baby was born.ConclusionIn a premature rupture of the membranes is advisable a detailed echographic exploration before we decided the conduct to perform.     

Estudio piloto sobre el efecto de la vitamina D en la patogenia de los miomas uterinos: influencia de la terapia con vitamina D en el volumen uterino y en la angiogénesis de los miomas determinados por ECO3DPW y niveles séricos de VEGF

Uterine fibroids are one of the most common gynaecological disorders, being found in 70% of Caucasian women and 80% of Afro-Caribbean women1,2.In recent years, angiogenesis and vascularisation have become a key part of study of tumour growth. Differences in vascularisation have been discovered in uterine fibroids when compared to adjacent uterine tissue.The pathogenesis of uterine fibroids is multifactorial. Several pathways are involved in their growth have been described, such as the oestrogen pathway, the gestagen pathway, and the pathway of the growth factors. Another of the pathways that influences their development is the vitamin D pathway, as inadequate levels of this vitamin may favour the growth of uterine fibroids³.In this work, an analysis is made on how vitamin D therapy influences the volume and vascularity of uterine fibroids, using serum VEGF levels and 3 DPW Ultrasound.     

Manejo activo de la tercera fase del parto más 400 μg de misoprostol sublingual y 200 μg de misoprostol rectal frente a manejo activo solo en la prevención de la hemorragia posparto. Ensayo clínico aleatorizado

Objectives

To evaluate the efficacy and safety of 400 μg sublingual misoprostol and 200 μg rectal misoprostol plus active management of the third stage of labour versus active management only to prevent postpartum haemorrhage.

Subjects and methods

A total of 1400 women were randomly assigned to receive misoprostol plus active management (group I) or active management only (group II). The variables studied were incidence of postpartum haemorrhage, blood volume lost and need of additional uterotonics.

Results

In group I there were 28/702 (4.0%) haemorrhages and in group II 50/698 (7.2%), P=.005; RR =.538; 95% CI for RR (0.335-0.866). In women having postpartum haemorrhage the lost blood volume was 981 ± 309 cc and 888 ± 326 cc. P=.225 in groups I and II, respectively.Additional uterotonics were needed in 33 women in group I (4.7%) vs. 54(7.7%) women in group II (P=.025).

Conclusions

The use of sublingual/rectal misoprostol plus active management appears to be useful for the prevention of postpartum haemorrhage.     

Impact sur la survie de la procédure du ganglion sentinelle dans le cancer de la vulve : analyse de la SEER database

ObjectivesVulvar cancer is usually treated with vulvectomy and bilateral groin lymphadenectomy, which result in serious morbidities while only 30% of patients have positive nodes. The sentinel node technique has good sensitivity and specificity for detecting lymph node involvement while minimizing postoperative morbidity. The aim of this study was to evaluate the specific and overall survival impact of sentinel lymph node procedure versus inguinofemoral lymphadenectomy in patients with vulvar cancer.Patients and methodsThis is a retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database on patients with vulvar squamous cell carcinoma, T1 or T2 stage, metastatis-free, followed between 2004 and 2008.ResultsOne thousand and thirty eight patients had a systematic groin lymphadenectomy and 56 a sentinel node technique (including 22 with an associated lymphadenectomy because of a positive sentinel node). There is no significant difference in overall or specific survival between the two groups. In multivariate analysis, age, T stage and nodal status are prognostic factors for overall and specific mortality (P < 0.05).Discussion and conclusionSentinel node technique is not associated with an excess risk of mortality or recurrence.     

Cancer du sein chez la femme jeune de moins de 35 ans en Tunisie : étude rétrospective à propos de 124 cas

ObjectivesOur aim was to report the epidemiological and clinical characteristics of breast cancer in young women and to evaluate the therapeutic results in the central part of Tunisia.Patients and methodsWe report the results of a retrospective study including 124 patients under 35 years old treated for breast cancer between 1995 and 2007 in the Radiotherapy Department of CHU Farhat Hached, Sousse.ResultsThe mean age of our patients was 31.3 years. T2N0, node positive (N+), high grade (SBRII and III) and endocrine responsive tumors were the most frequent. Fourteen patients had metastatic disease. One hundred and fifteen patients underwent a surgical treatment, which was conservative in 35 cases and radical for the others followed by radiotherapy on 114 patients. Chemotherapy, especially based on the FEC protocol, was administrated to 89% of all patients. Forty-five patients received also hormonotherapy. After a median follow-up of 48.5 months, 51 patients remained free of disease. The 5 years overall survival was 67.7%, the 5 years free disease survival was 58.2%.Discussion and conclusionThe 5 years overall survival of breast cancer in young women varies between 55 and 75%, it was 67.7% on our study. These results can be improved by early diagnosis, adapted treatment and nowadays with targeted therapies.     

Utilización de la longitud cervical para la reducción de la estancia hospitalaria en pacientes ingresadas por amenaza de parto pretérmino

ObjectiveTo evaluate the impact of ultrasound cervical length measurement on length of hospital stay in patients admitted for preterm labor.Material and methodsWe performed a prospective longitudinal study of a sample of patients with preterm labor admitted to two admission wards (units 1 and 2). In unit 1, the patients were managed according to the routine protocol, based on Bishop's index and the presence of uterine activity confirmed by monitoring. In unit 2, the protocol was modified according to cervical length measured by ultrasound and early discharge was planned if cervical length was 25 mm or more. The characteristics of both groups, mean length of hospital stay and delivery rates within 7 days and before 34 and 37 weeks’ gestation were analyzed.ResultsOne hundred thirty-eight patients were included in the study. Delivery rates within 7 days and before 34 and 37 weeks’ gestation and the incidence of readmission were similar in both groups. However, length of hospital stay was significantly reduced in unit 2 (6.14 days vs 3.86; p < 0.001), where cervical length was used as a criterion for discharge.ConclusionsRoutine use of ultrasound assessment of cervical length in patients admitted for preterm labor may reduce length of hospital stay without increasing preterm delivery rates or the percentage of readmissions.     

Características epidemiológicas de la sífilis congénita en Gran Canaria. ¿Es necesario el cribado?

Objectives

To determine the incidence of syphilis infection in pregnant women and neonates and to identify the social and epidemiological characteristics of pregnant women with a diagnosis of syphilis, as well as the risk factors for congenital syphilis in Gran Canaria.

Method

A case-control study was performed over a 6-year period (January 1, 1994 to December 31, 1999). The study was performed using controls (mother-child pairs) to evaluate differences in sociocultural and health characteristics, prenatal care, toxic substance abuse before and during pregnancy, pregnancy complications, and delivery. For the comparison of variables, Student’s t-test or Wilcoxon’s test and the chi-square test or Fisher’s exact test were used. The evolution of syphilis rates in pregnant women and of congenital syphilis was analyzed through a Poisson regression model.

Results

The incidence of women with syphilis during pregnancy was stable. Prenatal care was adequate in 98% of the women in the control group and in only 66% of mothers with syphilis during pregnancy (p < 0.0001). Factors associated with infection were drug abuse and having a history of prior sexually transmitted diseases. Pregnant women with syphilis had shorter pregnancies (1 week less, on average) than women in the control group and a higher rate of prematurity.

Conclusions

The incidence of syphilis in our environment is particularly high: 3.38 cases per thousand inhabitants. Among maternal characteristics, the main independent risk factors for syphilis infection during pregnancy were drug abuse during pregnancy and having a history of prior sexually transmitted diseases.     

¿Es la nacionalidad de la paciente un factor influyente en el proceso de embarazo,parto y puerperio?

ObjectiveTo determine whether the nationality of the patient is a factor that influences pregnancy follow-up, labour characteristics, and subsequent complications during post-partum.Material and methodsAn observational retrospective study was performed that included every delivery registered in Macarena Hospital in Seville during a 5 months period. The sample was divided into 2 cohorts, one including Spanish patients, and the other including foreign patients.ResultsData from 1259 pregnant women (1135 Spanish and 124 foreigners) were registered. The number of visits and prenatal test was greater in the Spanish cohort. The rate of labour induction was higher among Spanish patients (22.1%). However, normal vaginal delivery rate was higher among foreign pregnant women. Caesarean section rate was equal (23.4%) between both cohorts. Tearing rate and non-epidural delivery was higher among foreign patients, while episiotomy rate was lower. Gestational disorders and complications post-partum were higher in the Spanish cohort, with a slightly lower percentage of newborn complications compared to the foreign cohort.ConclusionsOur results show that pregnancy follow-up is more exhaustive among Spanish patients, but some variables such as rate of labour induction, assisted birth, episiotomy, or patients demanding epidural analgesia were lower among the foreign population.