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.     

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.     

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.     

Idoneidad de las indicaciones de cesárea. Una aplicación en la gestión de la práctica clínica

Objectives

To describe the quality management system applied by the Obstetrics and Gynecology Service of the Manacor Hospital, Majorca (Spain) to the process of cesarean section, and to assess the appropriateness of caesarean sections performed in this service between 2004 and 2005.

Subjects and methods

Consensus was reached on evidence-based indications for emergency and elective cesarean sections and on their quality criteria. All clinical records were reviewed to assess the appropriateness of cesarean sections performed from 2004-2005 according to previously established standards.

Results

In all two-monthly periods, appropriateness was achieved according to previously established standards (100% of elective interventions and > 90% of emergency cesarean sections), except in July-August, 2004 and May-June 2005 (appropriateness of elective cesarean sections = 92%), and in July-August 2004 (appropriateness of emergency interventions = 84%).

Conclusions

To reduce unjustified variability in clinical practice, cesarean section indications must be standardized, based on scientific evidence, and regularly assessed.     

Angiomixoma agresivo de la región pelviperineal. Descripción de un caso

Aggressive angiomyxoma is a rare tumor that usually involves the pelvic and perineal regions. These locally infiltrative tumors are associated with a high recurrence rate. The treatment of choice is radical surgical excision.     

Cribado combinado para la detección de trisomía 21 en el primer trimestre de la gestación. Impacto sobre la tasa de procedimientos invasivos de diagnóstico prenatal tras 5 años de implementación

Objective

To assess the effectiveness of first-trimester combined screening in the prenatal detection of Down syndrome after 5 years of use in our hospital and its impact in reducing invasive diagnostic tests.

Material and methods

The risk of fetal chromosomal anomalies was assessed in 10,669 pregnancies with first-trimester combined screening between May 2006 and December 2010. The cut-off to indicate an invasive diagnostic test was 1/270. The amniocenteses performed between 2005 and 2010 were also analyzed.

Results

The detection rate of screening for trisomy 21 was 90% and the false-positive rate was 3.56%. In pregnant women aged 35 years or more, the detection rate was 96.7%. In 2005 there were 496 amniocenteses. In 2010, 5 years after the introduction of screening, 148 amniocenteses were performed, representing a 70% reduction in invasive procedures.

Conclusions

The introduction of combined screening in our environment has proven effective for the detection of trisomy 21 and has substantially reduced the use of invasive prenatal diagnostic procedures. The use of advanced maternal age as an isolated criterion to indicate invasive techniques to study fetal karyotype should be questioned if high-quality universal screening is to be offered.     

Tumor de células de la granulosa de patrón difuso sarcomatoide. Presentación de un caso

Granulosa-cell tumors are rare malignant neoplasms characterized by a long natural history and a tendency to recur years after the initial diagnosis.     

Estudio de la vascularización placentaria mediante power Doppler tridimensional. Validación de la técnica

Objective

To validate the technique to measure placental vascularization grade through three-dimensional power Doppler during the second trimester of pregnancy.

Subjects and methods

Seventy-five pregnant women with no antecedents or obstetric diseases were studied through ultrasound with threedimensional power Doppler and application of the VOCAL system. Validation of the «placental vascular biopsy» for the evaluation of placental vascularization was performed by comparing three methods to obtain vascular parameters: with only one biopsy, with three biopsies of the same central volume of the placenta, and with three biopsies of different volumes. To evaluate the intraobserver correlation, we analyzed the intraclass correlation index (ICC).

Results

A good correlation was found between the age of the pregnant woman, parity and week of delivery with the vascularization indexes. The ICC for the vascularization indexes were acceptable when three biopsies were analyzed.

Conclusions

Reliable vascularization parameters can be determined by obtaining only one volume from the most central part of the placenta and subsequently analyzing three biopsies of this volume.     

Rotura de vasa previa: comunicación de un caso y revisión de la literatura

Vasa previa is a condition in which the intramembranous fetal blood vessels within the placenta or umbilical cord cross the internal os and become trapped between the fetus and the opening of the birth canal. The incidence of this entity varies from 1/2000 to 1/3000 pregnancies and the associated perinatal mortality rate has been reported to be as high as 52-66%. Reduction of this high perinatal mortality depends on prenatal diagnosis.     

Expulsión vaginal de los miomas tras la embolización de las arterias uterinas

We present 2 cases of spontaneous transcervical expulsion of myoma after uterine artery embolization as a primary treatment of leiomyomata, which produced symptom improvement. Subsequent follow-up was performed with hysteroscopy and magnetic resonance imaging.     

Revisión de la evidencia sobre la eficacia de los probióticos en la prevención de las infecciones del tracto urinario inferior y las infecciones vaginales

Objectives

To identify, critically evaluate and describe the available scientific evidence on the efficacy and safety of oral or vaginal administration of probiotics in preventing recurrent urinary tract infections and microbial or fungal vaginal infections.

Methods

An electronic search was performed in PubMed Central, the Cochrane Library and the meta-searcher TRIP databases using the terms: “Lactobacillus”, “probiotics”, “female urogenital diseases”, “urinary tract infections” and “genitourinary infections”.

Results

Of 20 studies that met the selection criteria for this review, a tendency to favor the use of probiotics was observed, especially in the population at high risk of bacterial vaginosis and fungal vulvovaginitis.

Conclusions

Probiotics are a promising option in the prevention of recurrences of lower urinary tract infections. Their use can be recommended as a safe and cost effective option especially in high risk subgroups.     

Cesárea a petición de la embarazada

Objetive

: To know Spanish Obstetrics and Gynaecology Society (SEGO) members about cesarean section on request.

Method

Three questions appeared on SEGO web: 1) If a normal primigravid with a term, cephalic presentation foetus ask you for a caesarean section, would you do it?; 2) If a normal primigravid with a term, breach presentation foetus ask you for a caesarean section, would you do it?; 3) If a woman on her normal third pregnancy with two previous vaginal and with a term, breach presentation foetus ask you for a caesarean section, would you do it? Questions were asked in May 2006 and answers were collected 19^th October 2006. Data analysis was processed with web page statistic method.

Results

Among the 5300 members of SEGO, 1222 contacted the web page (23%). To question n° 1, 57.8% answered no, 24.8% yes and 17.4% had no answer. To question n° 2, 6.1% answered no, 93.8% yes and there were no abstention. To n° 3 question, 16.7% said no, 74.5% said yes and 8.8% has no opinion.Results are commented, advantages and disadvantages of caesarean are discussed as well as sanitary consequences of such an indication.     

Utilización de la resonancia magnética en la detección de los carcinomas ductales ocultos. A propósito de un caso

We present a case of ductal carcinoma in situ, as evidenced by magnetic resonance imaging with negative mammographic and ultrasound studies.