Efectos del ejercicio en la depresión durante el embarazo y el posparto. Una revisión sistemática

The aim of this paper is to evaluate the current scientific literature on the effects of exercise on depression during pregnancy and postpartum. A search was conducted in the Medline, Web of Science and Scopus databases using the MeSH terms “depression”, “pregnancy”, “postpartum” and “exercise”. Fifteen studies were analysed in which the most commonly used intervention protocol was supervised structured aerobic exercise, strength, stretching, relaxation, and pelvic floor exercise. Non-regulated physical activity based on activities of daily living such as walking was also applied. Significant improvements were observed in variables indicative of depression and other factors of psychological well-being. Therefore, exercise has been shown to be a valid method to improve depression during pregnancy and postpartum. The findings in this work could represent a further method of treatment for depression during these stages.     

Validez diagnóstica del ratio sFlt-1/PlGF en la identificación de la preeclampsia: una revisión sistemática

Pre-eclampsia (PE) is a multisystem disorder that occurs during pregnancy. It involves alterations that lead to high morbidity and mortality in mother and newborn. It has been shown that the aetiology of PE is linked to angiogenic and anti-angiogenic factors, specifically the serum levels of soluble tyrosine kinase 1 similar to fms (s-Flt1) are elevated in pregnant women with PE, while the circulating levels of the free placental growth factor decrease.In this work, a systematic review of the literature has been carried out to evaluate the validity of the s-Flt1 / placental growth factor ratio for the diagnosis of PE.Seven studies have been selected: one meta-analysis, 4 prospective studies, 2 case-control studies and 2 cohort studies; and 2 retrospective studies.The conclusion of this review is that the sFlt-1 / placental growth factor ratio has a moderate diagnostic accuracy, and is useful as a support technique in the diagnosis and follow-up of pregnant women with suspected PE, especially to rule it out.     

Vida sexual tras histerectomía por motivos benignos. Una revisión sistemática

Hysterectomy is one of the most frequent gynaecological interventions in the world. This surgery can sometimes generate important changes in the emotional, psychic, anatomical and social aspects, including alterations of sexual functioning in women who suffer from it. The aim of this study is to analyse the impact on sexual function in women hysterectomised for benign reasons. During the month of January 2018 a systematic search was carried out in the databases Medline, Cinahl, PubMed, LILACS, Scopus, and Web of Science. After applying the selected inclusion and exclusion criteria, a total of 15 articles were obtained. An analysis was performed on variables such as the basic pathology, type of intervention, and altered items in sexual function. As a conclusion, there is some controversy over the effects of hysterectomy on sexuality, although most determine that an improvement in sexual function occurs after the surgery.     

Efectos maternos y neonatales del parto en el agua. Una revisión sistemática

The objective of this literature review is to determine the maternal and neonatal effects of immersion in water during childbirth. A literature review was carried out in the PubMed, Medline, Scopus, and Cinahl databases. The search terms used were: “Water”, “Delivery”, “Obstetrics”, “Labour”, “Parturition”, and “water birth”. A total of 526 results published in the last 5 years were obtained, of which 13 articles were selected according to the inclusion and exclusion criteria. The studies aimed to evaluate maternal and / or neonatal outcomes after immersion in water during childbirth, although some of them only focus on one of these two aspects. In conclusion, immersion in water provides a reduction in pain and in the duration of labour at maternal level. At neonatal level, no adverse effects are found in newborns.     

Factores que influyen en la dispareunia posparto: una revisión sistemática

Dyspareunia is defined as the presence of persistent or recurrent pain during sexual intercourse and is considered one of the main postpartum sexual dysfunctions. The aim of this study is to determine the factors that influence the appearance of dyspareunia in the postpartum period. A literature review was conducted in the following databases in January 2018: Medline, PubMed, CINAHL, Web of Science and Scopus. A total of 15 articles were obtained after applying the inclusion and exclusion criteria. The main risk factors in postpartum dyspareunia are the type of delivery (being higher in caesarean sections and instrumental deliveries), perineal trauma and/or episiotomy, and breastfeeding. The psychosocial situation can also affect the appearance of this disorder.     

Asociación entre diabetes mellitus gestacional y enfermedad periodontal: revisión sistemática

AimTo determine whether there is an association between periodontal disease in pregnant women and the development of gestational diabetes mellitus during their pregnancy.ObjetiveTo determine if there is an association between periodontal disease in pregnant women and the development of gestational diabetes mellitus during her pregnancyMethodsThe present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. Four electronic data bases were searched: MEDLINE (via PubMed), Cochrane Library, Scopus and Web of Science, through February 2021. Eligible studies were assessed for methodological quality using the Newcastle-Ottawa scale.ResultsFrom 161 studies, 8 were eligible: 3 case-control, 2 cross-sectional and 3 cohort studies. Most of the studies supported an association between periodontitis and GDM.ConclusionPeriodontitis is associated with increased risk for GDM compared to woman without periodontitis. Future robust studies with different designs in distinct populations are needed to enlarge on these findings.     

Riesgo de cáncer de mama en portadoras de DIU de levonorgestrel. Revisión sistemática

IntroductionBreast cancer is the leading cause of cancer death in European women. The question arises whether the use of levonorgestrel IUD (LNG-IUD) could be associated with an increased risk of breast cancer.Material and methodsWe conducted a systematic review to identify the risk of breast cancer among LNG-IUD users.ResultsWe found 8 articles, all of them observational and concerning the Mirena® IUD. Half of the studies do not find an increased risk of breast cancer in LNG-IUD carriers and the other half do. The heterogeneity of these studies, as well as the existence of bias in them, and the absence of control for other factors prevent us from performing a meta-analysis.ConclusionsWith the current scientific evidence we cannot confirm that there is a reater risk of breast cancer in LNG-IUD carriers. Well-designed studies are required to draw clear conclusions.     

Uso de inhibidores de la aromatasa en el tratamiento del dolor pélvico asociado a endometriosis: revisión sistemática

ObjectiveTo know the effect of the use of aromatase inhibitors (AI) in the treatment of endometriosis-associated pelvic pain (EAPP).Material and methodsSystematic review of the literature.Results173 articles were identified of which 25 were valid for the review, of which 4 were randomized clinical trials, 3 were non-randomized clinical trials, 10 were prospective non-comparative studies and 8 were clinical case reports. In most of the studies and/or case reports (24 of 27) the use of AI was associated with an improvement in EAPP. Important biases were identified that may influence the efficacy analysis, primarily the combined use of AI with other drugs widely used in the treatment of endometriosis.ConclusionsDespite the existence of numerous articles presenting and/or analysing the effect of AIs in the control of EEAP, the biases in the interpretation of their results, together with the side effect profile of this group of drugs, mean that their use has not become widespread, and they continue to be considered an experimental treatment for endometriosis. To date, there is insufficient evidence of sufficient quality to recommend the use of AI in the treatment of EEAP in routine clinical practice.     

Eficacia del ejercicio terapéutico en el síndrome del ovario poliquístico. Una revisión sistemática

Polycystic ovary syndrome is one of the most frequent hormonal problems in women of reproductive age, this syndrome presents many symptoms such as hormonal disorders, irregular menstrual cycles or amenorrhea, presence of masses in the ovaries, weight gain, hirsutism, acne, infertility, among other symptoms of hyperandrogenism. Physical exercise has been prescribed in these women with the aim of weight loss; however, it would be interesting to know the effects of exercise other than on weight loss. Therefore, the objective of this work is to know the effects that therapeutic exercise produces in women with this syndrome. A bibliographic search was conducted in February 2021 in the CINAHL, Medline and PubMed databases. Using the terms Medical Subject Heading (MeSH): “Exercise therapy”, “Polycystic Ovary Syndrome”, and “Therapeutic Exercise”. Clinical trials published in the last 10 years in Spanish or English were included. After application of the exclusion criteria, 10 clinical trials resulted from the analysis. In most of the publications, aerobic exercise and progressive resistance exercise are used, verifying the effects that are achieved at the end of the treatment. An improvement in anthropometric and hormonal parameters was observed.After analysing the different results of this review, we can conclude that therapeutic exercise has a benefit in polycystic ovary syndrome, especially for hormonal levels and the menstrual cycle.     

Cáncer sincrónico de carcinosarcoma uterino y carcinoma seroso tubárico. A propósito de un caso y revisión de la bibliografía

We report a rare case of uterine carcinosarcoma involving a 74-year-old woman. The patient complained of posmenopausal bleeding. The disease was eventually diagnosed as simultaneous uterine carcinosarcoma and high-grade serous tubal carcinoma.Clinical examination found a cervical tumour and transvaginal ultrasound showed a heterogeneous intrauterine image. The histological result of both findings was carcinosarcoma.The computed tomography scan and magnetic resonance imaging reported similar findings for intrauterine and cervical tumour, with the same features as a possible myoma or mass with sarcomatous degeneration.Given the suspicion of a high-risk variant of endometrial adenocarcinoma, the primary management of carcinosarcoma is surgery. Complete surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissection.The pathological findings revealed a uterine carcinosarcoma tumour, invading less than half the myometrium and the stromal connective tissue of the cervix but not extending beyond the uterus. The histopathological studies of bilateral adnexectomy and the peritoneal biopsy demonstrated the presence of high-grade serous tubal carcinoma. The lymph study was negative for malignancy.We concluded a synchronous diagnosis of uterine carcinosarcoma stage II and high-grade serous tubal carcinoma stage IIIB.A detailed literature search and management of this entity are discussed.     

MicroARN: la biología molecular como herramienta de predicción en preeclampsia

Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.     

Úlcera vulvar de Lipschütz: comunicación de 2 casos y revisión de la literatura

Vulvar ulcer of Lipschütz it is an uncommon form of painful genital ulceration that appears in female children or adolescents and that is self-limited with fever, and systemic and flu-like symptoms. Its diagnosis is fundamentally clinical and through ruling out other more common reasons for genital ulcers. It is important to be familiar with this condition to be able to properly diagnose it, since most cases tend to resolve spontaneously. We present two new cases in girls with this condition.     

Diagnóstico atípico de un tumor trofoblástico del lecho placentario: presentación de un caso y revisión de la literatura

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease. The most common clinical manifestation is abnormal vaginal bleeding. Due to its rarity there is no optimal standardised treatment. A case is presented of placental site trophoblastic tumour after an atypical diagnosis associated with a postpartum haemorrhage that required an emergency peri-partum hysterectomy.     

Trombosis de la vena ovárica: casuística en 5 años y revisión de la literatura

The ovarian vein thrombosis (OVT) is a rare but serious complication in the postpartum. It affects between 0.02% and 0.2% of all pregnancies, from 0.02% to 0.18% of vaginal deliveries and between 1% and 2% of caesarean sections. In up to 90% of cases it affects the right ovarian vein and it may extend as far as the inferior vena cava, causing serious complications. Early diagnosis and treatment are crucial. We present the cases of ovarian vein thrombosis having occurred in the postpartum period during the last 5 years in the Complejo Hospitalario de Pontevedra and a review of existing literature.     

Embarazo y cáncer de mama en el primer trimestre,reporte de un caso y revisión de la literatura

Introduction

Breast cancer is the second most common cause of oncological death around the world, only surpassed by lung cancer. In addition, breast cancer is one of the most commonly diagnosed malignancies during pregnancy, followed by blood and skin cancers. Until recently, chemotherapy and radiation during pregnancy were considered incompatible with normal fetal development. Here we present the case of a pregnant female diagnosed with stage IIB (T3N1) infiltrating ductal breast adenocarcinoma at 13 weeks of gestation. Based on Adjuvant Online, the risk of recurrence is thought to be 65%, but with chemotherapy and hormone therapy systemic treatment, this risk falls to 22%. For this reason, it was decided to start therapy at 20 weeks of gestation. At 37 weeks, after hematologic evaluation, labour was electively induced. A baby weighing 2,900 grams, with no obvious congenital abnormalities and Apgar scores of 9 and 9 was born. The baby had no immediate post-natal complications and was taken to the newborn nursery.

Síndrome de Klippel-Trenaunay en la gestación: a propósito de un caso y revisión de literatura reciente

Klippel-Trenaunay syndrome is a rare entity with associated risks, mainly haemorrhagic and thromboembolic. Given the low incidence of this syndrome, there is little evidence on its obstetric management. We present a review of the recent literature about a case, with the aim of synthesizing the obstetric management of patients with Klippel-Trenaunay syndrome.In the case of a pregnant woman with this pathology, multidisciplinary management should be considered, which would mainly include obstetricians, haematologists, and anaesthesiologists. It is very important to perform imaging studies, especially in the third trimester, to help determine the delivery route. Given the increased risk of thrombotic events, the use of prophylactic measures during pregnancy and the puerperium is indicated. The evidence regarding the increase in bleeding complications in these patients is not so conclusive, however it is a complication that we must take into account to establish the necessary therapeutic measures.     

Enfermedad de Crohn: hemorragia fatal en paciente con 19.3 semanas de gestación. Reporte de un caso y revisión de la literatura mundial

Crohn's disease (CD) affects 0.3% of pregnant women and can infrequently cause fatal bleeding. We report a fatal case of intra–abdominal haemorrhage caused by CD and review the world literature on the topic.A 20-year-old primigravida with a live fetus of 19.3 weeks was admitted to the accident and emergency department with intra–abdominal pain and systemic hypotension. Exploratory laparotomy was performed, revealing a hemoperitoneum of 2,000 ml and a live intrauterine fetus. The site of bleeding was not detected and intraabdominal packing was performed. Due to persistent systemic hypertension, premortem computed tomography was carried out, revealing the persistence of intra–abdominal bleeding. Emergency laparotomy was scheduled but the patient died before entering the operating theatre. Histological examination showed lesions consistent with CD.As a conclusion, CD during pregnancy affects 0.3% of patients. Intestinal perforation with fatal bleeding has not previously been reported in the world literature.