The uterocervical angle and its relationship with preterm birth.

OBJECTIVES: The objective of this study is to determine whether the uterocervical angle (UCA) correlates with the risk of spontaneous preterm birth (sPTB) < 34 weeks and assess its interobserver variability. STUDY DESIGN: Case-control study of 275 women including 34 who started labor spontaneously and gave birth before 34 weeks of gestation (preterm group) and 241 who gave birth at term (control group). Images used to report cervical length were re-measured for UCA. RESULTS: Mean UCA in the second trimester was wider in the preterm group (105.16°) compared with the control group (94.53°), p = .015. The intraclass correlation coefficient was 0.821 (95% CI: 0.74-0.97) for masked interobserver variability, which implies correct agreement among UCA measurements. Mean UCA increased from the first to the second trimester (84.2° versus 94.5°; p = .019). CONCLUSIONS: Wider UCA in the second trimester is related to sPTB. UCA measurement is a reproducible technique. UCA appears to increase from the first to the second trimester. Prospective studies, with ultrasound examinations aimed at measuring UCA in vivo, are needed to accurately assess the characteristics of this marker and its potential as a predictor of sPTB in clinical practice.

Usefulness of progesterone-only components for contraception in patients with congenital heart disease.

The objective of the study is to report the contraceptive methods used by patients with congenital heart disease (CHD) before referral to a specific preconception clinic and evaluate safety and treatment adherence of the alternative contraception method, progesterone-only component (PC), offered. Contraceptive methods in the CHD population reported included estrogen-progesterone combined contraceptives (EPCC), despite the potential risk for thromboembolism. PC has been suggested as an alternative, but, no information on its use has been reported. Retrospective analysis was performed of all patients (n = 237) referred to the preconception clinic of an adult CHD center. Thirty-three percent of patients had used EPCC in the past; 3.8% had had thromboembolic events during its use. Current contraception consisted of barrier methods in 58% of patients, EPCC in 18%, and PC in 1.3%; 21.7% of patients were not using any contraception. PC was offered as an alternative in 146 patients; 73% of patients agreed to start the treatment. At a median follow-up of 1 year, 73% of patients who started PC maintained the treatment. Gynecologic side effects were reported in 25% of patients, with no cardiovascular effects. In conclusion, a significant proportion of patients with CHD were former users of EPCC, although some had formal contraindications, and the rate of PC use before referral to the preconception clinic was low. After being offered as an alternative treatment, the use of PC in its various forms was extensive, with no thrombogenic side effects and an acceptable rate of gynecologic side effects being reported.

Tratamiento de la hiperdinamia en el trabajo de parto con atosibán / Atosiban therapy for uterine hyperactivity during labour

Objetivo: El objetivo principal ha sido conocer laefectividad del atosibán como tratamiento tocolíticointraparto; como objetivo secundario se haestablecido la identificación de los efectossecundarios provocados por el tocolíticoadministrado.Material y método: Se realizó un estudiodescriptivo incluyendo a las pacientes en períodode dilatación que presentaran hiperdinamia uterina,con o sin repercusión fetal. Este estudio se realizódesde el 1 de julio de 2003 hasta el 31 de agostode 2004; se obtuvo un total de 80 parturientas, deltotal de 9.017 partos asistidos en este período. Serealizó el análisis estadístico mediante la prueba delos signos para variables cuantitativas y la pruebade la χ2 con corrección de Yates para variablescualitativas (SPSS v.12 for Windows®).Resultado: Se logró una efectividad total o parcialen un 93,8% de los casos. No se encontrarondiferencias estadísticamente significativas en lapresión arterial ni en la frecuencia cardíacamaterna en relación con la administración deatosibán. No hubo efectos secundarios tras laadministración de atosibán en el 85% de laspacientes; se registraron náuseas y vómitos en un13,7 % de las pacientes y sólo hubo un caso dehipotensión sintomática.Conclusiones: El atosibán es una opción segura yeficaz para el tratamiento de las hiperdinamias deltrabajo de parto

Objective: The primary objective of the study wasto assess the effectiveness of atosiban as a tocolyticdrug during labour. A secondary objective was toidentify the adverse effects of this drug.Material and methods: A descriptive study wasperformed including patients who had uterine hyperactivity during labor whether resulting in fetalcompromise or not. We included 80 patients froma total of 9017 deliveries assisted during the studyperiod in our hospital (from 1st July 2003 until 31stof August 2004). Numeric data were comparedwith the sign test and categorical data werecompared with χ2 test with Yates’ correction(SPSS v.12 for Windows®).Results: Total or partial effectiveness was achievedin 93.8% of the patients. No statistically significantdifferences were found in relation to bloodpressure or maternal heart rate after atosibanadministration. No adverse effects were noted in85% of the patients after drug administration, 13.7%of the patients had nausea and vomiting, and onlyone patient had symptomatic hypotension.Conclusions: Atosiban is a safe and effectiveoption for the treatment of uterine hyperactivityduring labor

La esplenosis como diagnóstico diferencial de la endometriosis / Splenosis in the differential diagnosis of endometriosis

La esplenosis, o autotrasplante de tejido esplénico, es una entidad clínica de la que se han documentado aproximadamente 100 casos. Esta entidad se define como el autotrasplante de tejido esplénico después de un traumatismo o cirugía. Presentamos un caso clínico de una mujer con dolor abdominal con alta sospecha de endometriosis en la que, tras la intervención, se detecta una esplenosis

Splenosis is the heterotopic autotransplantation of splenic tissue usually following traumatic rupture of spleen. Approximately 100 cases have been reported. We report the case of a woman who presented with a pelvic mass, which was preoperatively mistaken for endometriosis. Splenosis was diagnosed after surgery