Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

Background The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. Methods This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Results Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. Conclusion The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

[Responsiveness of the chilean version of the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF)]. / Sensibilidad al cambio de la versión español-chileno del cuestionario International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) para incontinencia urinaria femenina.

BACKGROUND: A symptom questionnaire must be able to detect minimal changes after treatment to be clinically useful. AIM: To evaluate the responsiveness of the Spanish-Chilean version of the ICIQ-SF questionnaire after medical and surgical procedures for the treatment of urinary incontinence (UI) in women consulting at a public Chilean Hospital. MATERIAL AND METHODS: Data of 124 women aged 59 ± 10 years who were treated for UI and in whom ICIQ-SF questionnaire was applied in two opportunities (before and after medical or surgical treatment), was analyzed. The sign test for paired samples was used to compare the response of each item of the questionnaire. Responsiveness of the total severity score for UI was assessed by changes of slopes estimated by Generalized Estimating Equations. Slopes of change for every type of treatment were also compared. RESULTS: Sixty two percent of the women underwent surgical treatment. The slope of the total severity score for medical treatment was -4.4 (p-value < 0.001 for change) and 12.6 (p-value < 0.001 for change) for surgical treatment. Changes in surgical treatment were significantly higher than those of medical treatment (p-value < 0.001). CONCLUSIONS: The Spanish-Chilean version of the ICIQ-SF questionnaire was able to detect changes as a result of surgical and medical treatment for urinary incontinence in the study population, fulfilling the validity of responsiveness criterion.

Evaluación por médicos especialistas de curso de urgencias gineco-obstétricas utilizando metodología de simulación clínica / Evaluation by emergency medical specialists gyneco-obstetricians using clinical simulation methodology

Introducción: La simulación clínica es una herramienta de aprendizaje complementaria a los métodos tradicionales en la práctica clínica. Permite desarrollar habilidades y destrezas en escenarios seguros. La división de ginecología y obstetricia de la Universidad Católica (UC) imparte un curso de emergencias obstétricas para especialistas utilizando esta metodología. Presentamos la evaluación de los especialistas que realizaron el curso en el año 2016. Materiales y métodos: se realizó un curso de simulación de escenarios de emergencia en obstetricia, con un total de 16 horas separadas en 2 días. Con simuladores de alta y mediana complejidad. Tutoriados por instructores acreditados por el Institute of medical simulation de la Universidad de Harvard. Al finalizar el curso los participantes respondieron una encuesta escrita de diversos tópicos del curso. Resultados: participaron 93 especialistas. 76 por ciento de los participantes estuvo completamente de acuerdo y 23 por ciento de acuerdo con que la práctica con modelos simulados mejora la destreza relacionada con la realización de los procedimientos propuestos en el curso. El 100 por ciento de ellos indica que recibió retroalimentación considerada como útil durante las sesiones de entrenamiento y consideran que están completamente de acuerdo o de acuerdo con que esta metodología les permite cometer errores en forma segura. Conclusiones: la implementación de la metodología de simulación clínica en la docencia de emergencias obstétricas es muy bien evaluada por los especialistas, ya que entrega retroalimentación académica útil de cada caso y les permite cometer errores sin riesgos para los pacientes con un alto nivel de realismo.(AU)

Introduction: Clinical simulation is a learning tool complementary to traditional methods in clinical practice. It allows the development of skills and abilities in safe scenarios. The department of obstetrics and gynecology at the Catholic University offers an obstetrics emergency course for specialists using this methodology. Below we present the evaluation of the specialists who completed the course in 2016. Methods and Materials: A simulation course of emergency scenarios in obstetrics was carried out, distributed in clinical stations, with high and medium complexity simulators for a total of 16 hours' duration in 2 days. The tutors where instructors accredited by the Institute of medical simulation of Harvard University. At the end of the course the participants answered a written survey including various topics of the course. Results: Ninety-three specialists participated. 76 percent of the participants were in complete agreement and 23 percent agreed that the practice with simulated models improved the skills related to the clinical procedures proposed in the course. One hundred percent of them considered that the feedback received was useful during the training sessions and completely agreed that this methodology allows them to make mistakes in a safe form. Conclusions: The implementation of the methodology of clinical simulation in the teaching of obstetrical emergencies was very well evaluated by the specialists, since it provides useful academic feedback of each case and allows them to make mistakes without risks for the patients with a high level of realism.(AU)

Morbimortalidad perinatal en pacientes con rotura prematura ovular ≤24 semanas según cantidad de líquido amniótico al momento del diagnóstico / Perinatal morbidity and mortality in patients with premature ovular rupture ≤24 weeks according to amount of amniotic fluid at diagnosis

Introducción: La rotura prematura ovular (RPO) antes de la viabilidad fetal consiste en una complicación obstétrica de baja incidencia, pero de alta morbimortalidad perinatal asociada. Estudios sugieren que el volumen de líquido amniótico (LA) es un factor importante a considerar. El objetivo de este trabajo es evaluar si en RPO ≤24 semanas, un bolsillo vertical máximo (BVM) <2cm al diagnóstico es un factor de riesgo para aparición de morbimortalidad fetal y neonatal. Métodos: Estudio de cohorte longitudinal retrospectivo de 94 pacientes con RPO ≤24 semanas ingresadas a un hospital terciario para manejo expectante entre los años 2005 y 2014. Embarazo gemelar o malformaciones congénitas fueron criterios de exclusión. Se obtuvieron y compararon 2 grupos según BVM al ingreso (BVM ≥ 2 cm y BVM < a 2 cms) y se comparó la edad gestacional (EG) al momento de la RPO y al parto, la latencia desde la RPO al parto, la presencia de corioamnionitis clínica, el número de óbitos fetales, muerte neonatal precoz (primeros 7 días de vida), tardía (entre los 7 y 28 días) y sobrevida global. Resultados: El 58 por ciento de las pacientes presentó un BVM <2 cm al ingreso, el cual se asoció a menor latencia al parto (p:0,01), menor EG al parto (p:0,02), más óbito fetal (p:0,04), mayor muerte neonatal precoz y tardía (p:0,02 y 0,01 respectivamente) además de menor sobrevida global (p:0,01). Conclusiones: La medición de BVM <2 cm al ingreso en pacientes con RPO ≤24 semanas, es un factor de mal pronóstico y debe ser considerado en el manejo clínico de estas pacientes.(AU)

Introduction: Previable premature rupture of membranes (pPROM) is a low-incidence obstetric complication associated with high perinatal morbidity and mortality. Studies suggest that the volume of amniotic fluid (AL) is an important factor to consider. The aim of this study is to evaluate if in RPO ≤24 weeks, a maximum vertical pocket (MVP) <2 cm to the diagnostic is a risk factor for fetal and neonatal morbidity and mortality. Objectives: Evaluate fetal and neonatal morbidity and mortality according to amniotic fluid (AL) Maximum Vertical Pocket (MVP) ≥ or

Sensibilidad al cambio de la versión español-chileno del cuestionario International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) para incontinencia urinaria femenina / Responsiveness of the chilean version of the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF)

Background: A symptom questionnaire must be able to detect minimal changes after treatment to be clinically useful. Aim: To evaluate the responsiveness of the Spanish-Chilean version of the ICIQ-SF questionnaire after medical and surgical procedures for the treatment of urinary incontinence (UI) in women consulting at a public Chilean Hospital. Material and Methods: Data of 124 women aged 59 ± 10 years who were treated for UI and in whom ICIQ-SF questionnaire was applied in two opportunities (before and after medical or surgical treatment), was analyzed. The sign test for paired samples was used to compare the response of each item of the questionnaire. Responsiveness of the total severity score for UI was assessed by changes of slopes estimated by Generalized Estimating Equations. Slopes of change for every type of treatment were also compared. Results: Sixty two percent of the women underwent surgical treatment. The slope of the total severity score for medical treatment was -4.4 (p-value < 0.001 for change) and 12.6 (p-value < 0.001 for change) for surgical treatment. Changes in surgical treatment were significantly higher than those of medical treatment (p-value < 0.001). Conclusions: The Spanish-Chilean version of the ICIQ-SF questionnaire was able to detect changes as a result of surgical and medical treatment for urinary incontinence in the study population, fulfilling the validity of responsiveness criterion.