Leukocyte telomere length in women with and without polycystic ovary syndrome: a systematic review and meta-analysis.

AIM: To study the telomere length and the telomerase activity in women with and without polycystic ovary syndrome (PCOS). METHODS: Relevant studies were searched from PubMed, Embase, and LILACS online databases and manual screening. The mean differences (MDs) or standardized MDs (SMDs) with their 95% confidence intervals (CIs) were calculated. The methodological quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS), and heterogeneity with the I2 and Tau2 statistics. RESULTS: Six studies including 2109 non-pregnant women with (n = 1155) or without (n = 954) PCOS assessed leukocyte telomere length. There was a non-significant leukocyte telomere length difference (SMD = 0.25, 95% CI: -0.01, 0.51, p = .06, I2 = 81%, Tau2 = 0.08) comparing PCOS patients with the control group. Studied PCOS women were younger (MD = -1.39, 95% CI: -2.47, -0.31 years, I2 = 83%), and had higher body mass index (BMI; MD = 3.66, 95% CI: 2.11, 5.20 kg/m2, I2 = 94%). There were significantly higher testosterone (SMD = 0.88, 95% CI: 0.65, 1.10) and luteinizing hormone levels (SMD = 0.60, 95% CI: 0.12, 1.08) in women with PCOS as compared to controls. There was a low risk of bias and there were not sufficient studies to meta-analyze other cell types. CONCLUSIONS: Leukocyte telomere length did not differ between women with and without PCOS. Further studies with large sample sizes and including other outcomes are warranted to further substantiate the reported evidence.

Obstetric and perinatal outcomes of pregnancies with COVID 19: a systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aimed at comparing obstetric and perinatal outcomes in laboratory-tested pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before delivering. METHOD: We performed a comprehensive systematic review of electronic databases for studies reporting pregnant women with and without SARS-CoV-2 infection, as determined by polymerase chain reaction (PCR) before delivery, during the pandemic period published up to June 25, 2021. Results are reported as mean difference (MD) or odds ratio (OR) and their 95% confidence interval (CI). RESULTS: Seventeen observational studies with low to moderate risk of bias, reported on 2,769 pregnant women with a positive SARS-CoV-2 PCR test and 13,807 with a negative test. Pregnant women with a positive PCR test delivered at an earlier gestational age (MD -0.19; 95% CI -0.36 to -0.02 weeks), smoked less (OR 0.75; 95% CI 0.61-0.94) and were associated with higher odds for preeclampsia (OR 1.30; 95% CI 1.09-1.54), NICU admissions (OR 2.37; 95% CI 1.18-4.76), stillbirths (OR 2.70; 95% CI, 1.38-5.29), and perinatal mortality (OR 3.23; 95% CI 1.23-8.52). There were no significant differences between positive and negative tested women in terms of nulliparity, multiple pregnancies, gestational diabetes, route of delivery, labor induction, preterm birth, infant birth weight, 5 min Apgar scores < 7, small-for-gestational-age infants and fetal malformations. Eleven studies included neonatal PCR SARS-CoV-2 testing which was performed on 129 infants, of which 20 were positive. CONCLUSION: Positive SARS-CoV-2 tested pregnant women had higher odds for preeclampsia/hypertensive disorders of pregnancy, NICU admissions, stillbirths and perinatal mortality.

Psaudoaneurisma de la arteria hipogástrica izquierda, una causa extremadamente rara de sangrado puerperal tardío / Pseudoaneurysm of the left hypogastric artery, an extremely rare cause of late puerperal late puerperal bleeding

Resumen ANTECEDENTES: La hemorragia puerperal tardía implica una importante morbilidad y mortalidad que requiere una actuación urgente. Su causa es muy variada y requiere una cuidadosa valoración que permita detenerla, sin complicaciones. CASO CLÍNICO: Paciente de 42 años que a las cinco semanas posteriores a una cesárea acudió a Urgencias debido a un sangrado puerperal abundante. Enseguida de un legrado y exhaustiva revisión en el quirófano en la ecografía se identificó un área parauterina anecogénica sugerente de dilatación aneurismática comunicada con la cavidad uterina. El diagnóstico se estableció con base en la angiografía y se confirmó luego de la embolización mediante radiología intervencionista, sin contratiempos, y resolución del cuadro. La paciente se dio de alta del hospital en los siguientes dos días, con posteriores revisiones que se reportaron normales. CONCLUSIONES: La patología vascular debe formar parte del diagnóstico diferencial del sangrado puerperal tardío y, si se diagnostica adecuadamente, puede facilitar el procedimiento terapéutico mediante radiología intervencionista y evitar, así, otros tratamientos más invasivos.

Abstract BACKGROUND: Late puerperal hemorrhage is a major morbidity and mortality that requires urgent action. Its cause is very varied and requires careful assessment to stop it without complications. CLINICAL CASE: A 42-year-old woman came to the emergency department five weeks after cesarean section for heavy puerperal bleeding. After curettage and thorough examination in the operating room, ultrasound identified an anechogenic parauterine area suggestive of aneurysmal dilatation in communication with the uterine cavity. The diagnosis was established based on angiography and confirmed after embolization by interventional radiology, without mishap, and resolution of the picture. The patient was discharged in two days, with subsequent revisions reported as normal. CONCLUSIONS: Vascular pathology should be part of the differential diagnosis of late puerperal hemorrhage and, if properly diagnosed, may facilitate the therapeutic procedure by interventional radiology and thus avoid other more invasive treatments.

Urgencias ginecológicas y obstétricas en la pandemia por COVID-19, ¿qué fue lo que dejamos de ver? / Gynecological and obstetric emergencies in the COVID-19 pandemic, what did we stop attending?

Resumen OBJETIVO: Determinar si disminuyeron las urgencias ginecológicas y obstétricas atendidas en un hospital de tercer nivel durante el periodo de confinamiento domiciliario ocasionado por la pandemia de SARS CoV-2 y analizar a expensas de qué tipo de urgencias se produjo la disminución. MATERIALES Y MÉTODOS: Estudio retrospectivo y observacional efectuado en el Hospital Maternal del Hospital Universitario Miguel Servet del 15 de marzo al 15 de abril de 2019, 2020 y 2021. Se incluyeron todas las pacientes atendidas y se determinó el número absoluto de urgencias entre los diferentes periodos. Además, se analizaron las características de las pacientes atendidas con una comparación entre los tres periodos con χ2 de Pearson. RESULTADOS: Se atendieron menos de la mitad de las urgencias ginecoobstétricas que en el mismo periodo de los años anteriores y posteriores. La disminución fue, sobre todo, a expensas de pacientes mayores de 40 años, embarazadas y no embarazadas, con niveles de prioridad bajos según la priorización efectuada y que tuvieron como destino el alta a su domicilio. CONCLUSIONES: La situación de pandemia ocasionada por el SARS CoV-2 y las medidas de confinamiento domiciliario provocaron una disminución en la demanda de atención por parte de las pacientes obstétricas y ginecológicas.

Abstract OBJECTIVE: To determine whether there was a decrease in gynecological and obstetric emergencies attended in a tertiary hospital during the period of home confinement caused by the SARS CoV-2 pandemic and to analyze what type of emergencies caused the decrease. MATERIALS AND METHODS: Retrospective and observational study performed at the Maternal Hospital of the Miguel Servet University Hospital from March 15 to April 15, 2019, 2020 and 2021. All patients attended were included and the absolute number of emergencies between the different periods was determined. In addition, the characteristics of the patients attended were analyzed with a comparison between the three periods with Pearson& s χ2. RESULTS: Fewer than half as many obstetric and gynecological emergencies were attended as in the same period of the previous and subsequent years. The decrease was mainly at the expense of patients older than 40 years, pregnant and non-pregnant, with low priority levels according to the prioritization performed and who had discharge home as their destination. CONCLUSIONS: The pandemic situation caused by SARS CoV-2 and home confinement measures led to a decrease in demand for care by obstetric and gynecologic patients.