RESUMO
AIM: To evaluate the reliability of two techniques of cervical ripeness assessment at the beginning of labor induction, as assessed by inexperienced observers. METHODS: A total of 120 women were prospectively studied at admission for labor induction. Two independent physicians examined consenting women successively but separately. One experienced consultant and one of the six first-year obstetrics residents composed the pairs of observers. The trainees had very limited prior experience with cervical ultrasound scan or evaluating Bishop score. Cervical length and Bishop score were evaluated according to standard methodology. Reliability was described by intraclass correlation coefficients (ICC) and coefficients of variation (COV). Ultrasound cervical length was plotted according to the Bland-Altman method. RESULTS: The median Bishop score and mean cervical length were similar for all observers. Ultrasound cervical length and Bishop score were highly reliable when evaluated by first-year residents. Ultrasound cervical length showed the highest interobserver agreement, with ICC values over 0.9 and COV values of approximately 10% or less for all trainees. The Bishop score was also reliable, but with lower ICC and higher COV values. CONCLUSION: Bishop score and ultrasound cervical length examination for the management of labor induction are accurate and easy to learn by inexperienced first-year residents. However, cervical length showed higher reliability than the Bishop score.
Assuntos
Maturidade Cervical , Colo do Útero/diagnóstico por imagem , Exame Ginecológico , Adulto , Competência Clínica , Feminino , Humanos , Internato e Residência , Trabalho de Parto Induzido , Variações Dependentes do Observador , Gravidez , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. MATERIALS AND METHODS: We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. RESULTS: A very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77-6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43-24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09-0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was 3465.56 (95% confidence interval [CI], 3339.53-3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis. CONCLUSION: The cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling.
Assuntos
Cesárea/economia , Idade Gestacional , Trabalho de Parto Induzido/economia , Prova de Trabalho de Parto , Adulto , Algoritmos , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Cesárea/estatística & dados numéricos , Estudos de Coortes , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Feminino , Hospitalização/economia , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Fatores de Risco , Nascimento Vaginal Após Cesárea/economiaRESUMO
OBJECTIVE: To assess health service costs associated with labor induction according to different clinical situations in a tertiary-level hospital. METHODS: In a prospective study, individual patient cost data were assessed for women admitted for induction of labor at a tertiary hospital in Spain between November 1, 2012, and August 31, 2013. The costs of labor induction were estimated according to maternal and neonatal outcomes, method of delivery, cervical condition at admission, and obstetric indication. Direct costs including professional fees, epidural, maternal stay, consumables, and drugs were calculated. RESULTS: Overall, 412 women were included in the final cost analysis. The mean total cost of labor induction was 3589.87 (95% confidence interval [CI] 3475.13-3704.61). Cesarean delivery after labor induction (4830.45, 95% CI 4623.13-5037.58) was significantly more expensive than spontaneous delivery (3037.45, 95% CI 2966.91-3179.99) and instrumental vaginal delivery (3344.31, 95%CI 3151.69-3536.93). The total cost for patients with a very unfavorable cervix (Bishop score <2; 4283.47, 95% CI 4063.06-4503.88) was almost double that for women with a favorable cervix (2605.09, 95% CI 2327.38-2837.58). Labor induction for hypertensive disorders of pregnancy was the most expensive obstetric indication for induction of labor (4347.32, 95% CI 3890.45-4804.18). CONCLUSION: Following the induction of labor, a number of patient- and treatment-related factors influence costs associated with delivery.
Assuntos
Parto Obstétrico/métodos , Custos de Cuidados de Saúde , Trabalho de Parto Induzido/métodos , Resultado da Gravidez/economia , Adulto , Colo do Útero , Cesárea/economia , Parto Obstétrico/economia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/economia , Trabalho de Parto Induzido/economia , Masculino , Gravidez , Estudos Prospectivos , Espanha , Centros de Atenção TerciáriaRESUMO
OBJETIVO Analizar las características poblacionales y los métodos diagnósticos de patología cervical para la prevención del cáncer de cérvix de tres hospitales españoles para mejorar y unificar los programas de cribado y prevención. MATERIAL Y MÉTODOS Estudio retrospectivo de las características demográficas y clínicas de 408 mujeres con patología cervical uterina diagnosticadas en 3 hospitales españoles. Se comparan los factores de riesgo, el proceso diagnóstico y la indicación de tratamiento de dos grupos: las que requirieron conización cervical (n=222) y las que no precisaron tratamiento quirúrgico (n=186). También se analizan las recomendaciones vacunales y su grado de cumplimiento. RESULTADOS Las mujeres conizadas usaron más anticoncepción hormonal y tienen un mayor hábito tabáquico mientras que el número de compañeros sexuales es mayor en pacientes no conizadas. Más del 50% de pacientes con biopsia cervical positiva presentaron un resultado igual o más grave en la anatomía patológica de la pieza quirúrgica. Existen diferencias significativas en sensibilidad y valor predictivo positivo de la citología y de la determinación de HPV entre hospitales. La recomendación de vacunación en ambos grupos fue similar, el porcentaje de mujeres que no la cumplieron fue elevado y significativamente mayor entre pacientes conizadas. CONCLUSIÓN En nuestro medio las mujeres conizadas tienen características clínicas y epidemiológicas diferentes a las no conizadas, existen diferencias entre las técnicas diagnósticas de distintos hospitales y sin embargo la concordancia entre biopsia y resultado del cono es elevada. Sigue siendo necesaria una correcta educación sanitaria en relación con la vacunación en mujeres con patología cervical.
BACKGROUND To analyse the characteristics of the population and diagnostic methods related to the cervical cancer prevention program in three different-level hospitals of a Spanish region in order to improve and unify the screening program. METHODS We retrospectively studied demographic and clinical characteristics of 408 women with cervical lesions diagnosed in three hospitals in Aragon (Spain). Correlation between risk factors, diagnosis process and conisation indication was analysed divided in two groups: conisation required (n=222) or non-conisation (n=186). We also assessed the number of vaccine recommendations made to the patients and the degree of compliance. RESULTS Conisaited women more frequently used a combined hormonal contraceptive method and are more smokers, while the sexual partners are more in women without conisation. More than 50% of women con positive biopsy was confirmed after surgical treatment. There are significant differences between sensibility and positive predictive value of pap-smear and HPV determination in different hospitals. The recombinant vaccine was recommended to both groups at a similar rate. The percentage of women who were recommended to receive the vaccine but chose not to do it, was high in both groups but significantly higher in the Conisation group. CONCLUSION In our environment conisaited women have different clinical and epidemiological profiles, there are differences between diagnosis techniques in different hospitals, however, the concordance between biopsy and definitive result is high. A good sanitary education is necessary in relation with the vaccination of women with cervical pathology.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Esfregaço Vaginal/métodos , Neoplasias do Colo do Útero/prevenção & controle , Colo do Útero/patologia , Conização/métodos , Papillomaviridae , Espanha , Programas de Rastreamento/métodos , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Adenocarcinoma/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/efeitos adversos , Ovariectomia/efeitos adversos , Derrame Pleural/etiologia , Obstrução Ureteral/etiologia , Urinoma/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Obstrução Ureteral/diagnóstico por imagem , Urina , Urinoma/diagnóstico por imagemRESUMO
El síndrome de ovario poliquístico es la alteración endocrino-metabólica que más frecuentemente afecta a las mujeres en edad reproductiva. Sus síntomas y signos característicos son las irregularidades menstruales, amenorrea, acné, hirsutismo, obesidad e infertilidad. El síndrome de ovario poliquístico tiene implicaciones significativas para la salud a largo plazo, que pueden conducir a morbilidad psicológica y a una calidad de vida disminuida. Este artículo revisa la literatura actual en relación con el síndrome de ovario poliquístico y la calidad de vida relacionada con la salud, y evalúa cómo algunas manifestaciones clínicas del síndrome de ovario poliquístico afectan la calidad de vida de las mujeres que lo padecen.
Polycystic ovary syndrome is the most frequent endocrine and metabolic disorder in women of reproductive age. Its characteristic signs and symptoms are menstrual irregularities, amenorrhea, acne, hirsutism, obesity and infertility. Polycystic ovary syndrome has major effects on long-term health, which can lead to psychological morbidity and decreased quality of life. This paper reviews the current literature on polycystic ovary syndrome and health-related quality of life; in addition, it assesses how some clinical manifestations of polycystic ovary syndrome affect the quality of life of women who suffer this disorder.