Comparación de la efectividad de la pulsioximetría y el electrocardiograma fetal en las situaciones de riesgo de pérdida de bienestar fetal

Objective

To evaluate the effectiveness of pulse oximetry and fetal electrocardiogram in the management of labor with fetal heart rate patterns associated with a risk of loss of fetal well-being.

Subjects and methods

We performed an open, randomized, experimental trial with two groups: pulse oximetry was used in one group and the STAN® technique was used in the other. Each group included 40 women with single, term pregnancies in cephalic presentation and fetal heart rate patterns associated with a risk of loss of fetal well-being. The overall cesarean section rate, indications of risk of fetal distress, and neonatal acid-base balance were evaluated.

Results

No significant differences were found in the rate of cesarean section (47.5 vs 40%; P = .33), indications of risk of fetal distress (32.5 vs 37.5%; P = .41), or neonatal outcomes.

Conclusions

The use of pulse oximetry and STAN®21, as auxiliary methods to cardiotocographic recording, showed no superiority in reducing the cesarean section rate or improving neonatal outcomes.     

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.     

Gestación heterotópica triple: gestación gemelar intrauterina

Heterotopic pregnancy is increasingly common in Spain mainly due to the greater use of in vitro fertilization techniques. We report a case of heterotopic pregnancy after artificial insemination in a patient who consulted for mild metrorrhagia. Ultrasound examination showed a diamniotic dichorionic twin pregnancy and a singleton intrauterine gestation in the right tube. The case was resolved by laparoscopic unilateral salpingectomy. The symptoms of these rare pregnancies are nonspecific. Moreover, they are usually underdiagnosed, because the adnexa are not usually examined when an intrauterine gestational sac is found. Due to the severity of maternal and fetal compications, early diagnosis is essential.     

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.     

Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino

Objective

To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies.

Material and methods

We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture.

Results

We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid.

Conclusions

Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy.     

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical

Objective

To present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature.

Subjects and methods

A primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed.

Results

A 3050 g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy.

Conclusions

Umbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed.     

Pronóstico perinatal y materno de la gestación múltiple en función del protocolo intraparto

Objectives

To evaluate maternal and fetal outcomes of multiple pregnancy according to route of delivery.

Material and methods

We performed a retrospective study of all twin deliveries in the previous 5 years and evaluated the route of delivery, especially in the final year. The information was recorded with Microsoft EXCEL and was analyzed with the statistical program SPSS 12.0 for Windows.

Results

The mean gestational age was 35.3 weeks. Route of delivery was through cesarean section in 59.8%. The mean interval between twins was 7.82 minutes when the first twin was delivered vaginally. Neonatal morbidity was found in 49%, and was higher in the second twin and in preterm deliveries.

Conclusions

Multiple pregnancies are associated with a large number of maternal and perinatal complications, as well as with a greater number of cesarean sections. Consequently, correct intrapartum management is required to reduce neonatal morbility as far as possible.     

Manejo obstétrico de la gastrosquisis en una gestación de 26 semanas

Fetal gastroschisis is the most common congenital malformation of the abdominal wall. This anomaly can be corrected by postnatal surgery, either through primary closure of the fascia or delayed closure by means of a silo technique. We present the case of a woman who attended her first prenatal visit in week 26 of pregnancy, with an ultrasonographic finding of fetal gastroschisis.     

Inseminación artificial intrauterina en mujeres con síndrome de ovario poliquístico resistentes al citrato de clomifeno

Objective

To evaluate the results of ovulation induction cycles with gonadotropins and intrauterine insemination (IUI) carried out in women with polycystic ovary syndrome (POS) resistant to clomiphene citrate.

Material and methods

We performed an observational retrospective study of 462 ovulation induction cycles with IUI in women with SOP and clomiphene citrate resistance.

Results

The clinical pregnancy rate was 11.9% per cycle initiated and 14.74% per insemination and 45.45% of the pregnancies terminated in abortion. The effective accumulative percentage of term pregnancies per cycle initiated was 8% for the first cycle and 10.23% for insemination, increasing to 26.15% from the fifth cycle and to 32.24% from the fifth insemination. A total of 19.26% of the cycles was cancelled.

Conclusions

IUI is a useful method in women with SOP who are resistant to clomiphene citrate, with similar results to those obtained with other indications. These patients have high abortion and cycle cancellation rates. The high abortion rate should prompt research into ways of reducing reproductive loss.     

Predicción de anemia fetal por isoinmunización tras transfusiones intrauterinas. Revisión de los casos tratados en nuestra unidad

Objetive

Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion.

Material and methods

We performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia.

Results

The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series.

Conclusions

Doppler evaluation of the middle cerebral artery as predictor of fetal anemia has a lower detection rate after consecutive transfusions.     

Análisis de los factores de influencia sobre el resultado de 500 ciclos de inseminación intrauterina homóloga

Objective

To evaluate the results and analyse different factors influencing pregnancy rate using homologous intrauterine insemination.

Subjects and methods

Retrospective analysis of 500 homologous intrauterine insemination cycles in 183 infertile couples. Only one insemination per stimulated ovarian cycle was performed in patients with: mild endometriosis, ovulatory factor, male subfertility or unexplained infertility. We studied female age, duration of infertility, stimulation protocol, number of cycle, number of preovulatory follicles, motile sperm count and endometrial thickness related to pregnancy rate.

Results

Pregnancy rate per couple was 24% and per intrauterine insemination 9%, 11% was multiple pregnancies. Best outcome has been got in women younger than 37 years (P=.048) and in cycles with more than one preovulatory follicle. Other studied factors did not have influence in homologous intrauterine insemination outcome.

Conclusions

Female age is a prognostic factor for homologous intrauterine insemination with poor outcome in women older than 38 years. Cycles with more than one preovolatory follicle have better outcome. No differences in pregnancy rate have been achieved with motile sperm count over 1.5 millions/0.3 ml.     

Correlación entre la medición ecográfica del cordón umbilical y la edad gestacional,su relación con la biometría fetal y los resultados perinatales

Aim

(a) To evaluate the umbilical cord in normal pregnancies using ultrasonography in the third trimester with a view to obtaining gestational age values according to reference tables. (b) To compare umbilical cord measurements with fetal biometry, length, weight and perinatal outcomes to determine whether this type of correlation exists in our population and whether it could be used to establish values of normality that would help to diagnose abnormalities.

Material and methods

From Juny 2001 to June 2002 we studied 48 pregnat women that have been controlled by ultrasound from week 28 to 38 of gestation. We just included patients with normal and controlled pregnancies, without any associated pathology. We obtain biparietal diameter, abdominal circumference, femoral long measurement, and umbilical cord diameter through a transversal cut of the umbilical area. Gestational age was obtain by last menstruation and by ultrasound according with biometry. measurement of the umbilical cord was compared with a nomogram of the gestational age (GA) performed by the Obstetric and Gynaecology Department of the Insubria University in Italy.We registered the type of birth the GA at birth, APGAR score length, weight, cephalic diameter, and eventually complications. For calculate the normal umbilical cord area according to the gestational age by last menstruation we use the Raio et al equations to construct the corresponding nomogram. It was apply statistics methods with an alfa of 5%.

Results

LMP-based gestational age was highly correlated with ultrasound measurements. Theoretical UCA was not correlated with observed UCA. Only 54.2% of UCAs were found to be within the 5th and 95th percentiles (P =0.001), and consequently only two-thirds of the patients were within the parameters of normality. No correlation was found between UCA and gestational age, when attempting to construct a nomogram for our population (P=.99). No association was found between UCA and fetal biometry parameters. No significant correlation was found with weight, length, head circumference or gestational age at delivery. Apgar score was favorable and stable in all neonates; Apgar score was thus considered a constant and was not correlated with UCA. UCA was significantly lower in women who underwent cesarean section than in those with normal deliveries (P<.05).

Conclusion

UCA was not correlated with gestational age, fetal biometry or perinatal outcomes. Values in our population cannot be extrapolated to existing nomograms.     

Gestación heterotópica en inseminación artificial

We report a case of heterotopic pregnancy, which is of interest due to its low incidence and the serious complications that can ensue when diagnosis is delayed. Most of the heterotopic pregnancies described occurred after in vitro fertilization techniques. These pregnancies are less frequent after artificial insemination and are exceptional in spontaneous pregnancies. Our objective is to emphasize the increase in this type of pregnancy in the last few years due to assisted reproduction techniques and to highlight the importance of early diagnosis.     

Anticoncepción posparto en mujeres con riesgo de exclusión social

Objective

Improve birth control rates in women from vulnerable populations, space time out between pregnancies and reduce the rate of abortions.

Material and methods

We gave 90 pregnant women at risk of social exclusion an appointment for a postpartum check- up a month and a half after their expected due date, with a SMS reminder 48 hours before the appointment and a phone number in case they failed to make the appointment. We strive to implement long-term methods on the day of appointment.

Results

92% attended the postnatal visit. The overall rate of contraception was 86%, 68% were long-term methods: subdermal implants and IUDs.

Conclusion

Consultation with postpartum women from disadvantaged social groups can be very useful to facilitate contraceptive methods which are safe, effective and long-lasting. Flexibility and agility in the implementation of the methods are essential.     

Megavejiga fetal: caso clínico

Megacystis during the first trimester of pregnancy occurs in 1 in 1800 pregnancies. Diameters of 8 to 12 mm during the first trimester resolve spontaneously before 20 weeks, while those over 17 mm are suggestive of progressive urethral obstruction and therefore carry a poor prognosis. We present a case of fetal megacystis, its diagnosis and termination of the pregnancy.     

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.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

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.     

Decidualización peritoneal y embolización de arterias uterinas en la hemorragia puerperal tras cesárea

Deciduosis peritonei consists of the presence of decidua in the peritoneal surface and develops during pregnancy due to the effect of progesterone. The typical lesions are highly vascularized and immunohistochemical studies are required to exclude a diagnosis of malignancy. Selective arterial embolization is a conservative procedure to treat postpartum hemorrhages with minimal side effects and allows fertility to be preserved. We present a case of severe deciduosis peritonei identified during a cesarean section in a patient who subsequently required embolization of the uterine arteries due to a postpartum hemorrhage.     

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.