Current situation: lower genital tract pathology and colposcopy training in spanish gynecology and obstetrics residents.

OBJECTIVE: This study aimed to evaluate the impact of an educational intervention in lower genital tract pathology (LGTP) on the knowledge and skills acquired by the Spanish specialist residents. This didactic change was carried out under the auspices of the Asociación Española de Patología Cervical y Colposcopia and the Sociedad Española Ginecología y Obstetricia and its Resident Section. STUDY DESIGN: This is an observational, descriptive, and cross-sectional study. The survey was composed of 15 questions voluntarily answered by Spanish gynecology and obstetrics trainees. RESULTS: Compared with a previous survey, a substantial increase in the proportion of Spanish teaching hospitals with an LGTP unit (9/42 vs 47/59) has been detected while doubling the percentage of residents who acknowledge medium to high knowledge on this pathology. The same cannot be said about the handling capacity of vulvodynia registering a great improvement. CONCLUSIONS: Spanish scientific societies, concerned in the quality of LGTP training gained by their residents, have focused on the necessity of LGTP units. Our study confirms the usefulness of this performance in the new continued LGTP education.

Cord blood collection for banking and the risk of maternal hemorrhage.

We determined the effect of cord blood collection before placental expulsion on postpartum maternal blood loss in a retrospective study between a group of cord blood donors and a group of non-donors. The study was conducted in a university hospital blood bank and obstetric services and included Spanish women entered in a European study project (EUPHRATES) and who had consented to donate cord blood for public banking purposes. We measured blood volume lost during delivery by a bag collection method, as well as the need for transfusion and postpartum anemia symptoms. Deliveries at which cord blood was collected presented a significant increase in blood loss (321 ± 273 vs. 255 ± 237 ml, p=0.02). Instrumental deliveries were associated with higher postpartum blood loss than spontaneous deliveries. Cord blood collection can increase intrapartum blood loss, especially at instrumental deliveries. Additional staff who handle the collection are required to allow the leading clinician to focus on maternal care.

Are plasma total homocysteine and other amino acids associated with glucose intolerance in uncomplicated pregnancies and preeclampsia?

OBJECTIVE: To evaluate the possible association between plasma total homocysteine or other amino acid concentrations and gestational diabetes or glucose intolerance (GI), in normotensive and preeclamptic pregnant women. STUDY DESIGN: Prospective study including 243 pregnant women without previous risk factors. O'Sullivan test (plus oral glucose tolerance test when necessary) was performed, and homocysteine, B vitamins and plasma amino acids (AA) were measured at 24-25 weeks. Homocysteine and other amino acids were also measured in the third trimester. RESULTS: Significant differences were observed in the incidence of preeclampsia in relation to abnormal glucose tolerance (P < 0.012). In normotensive patients, the glucose intolerance group showed significantly lower tHcy (P = 0.021) and increased plasma alanine concentrations in comparison with controls (P = 0.046), although no correlation was observed between both amino acid concentrations. CONCLUSIONS: (a) A higher incidence of preeclampsia was observed in abnormal glucose tolerance patients, (b) total homocysteine and alanine were the only individual amino acids whose plasma concentrations varied according to the glucose tolerance classes, and (c) an association between hyperhomocysteinemia and glucose intolerance in our preeclamptic patients could not be demonstrated.

Polymorphisms of genes involved in homocysteine metabolism in preeclampsia and in uncomplicated pregnancies.

OBJECTIVE: To evaluate the possible relationship between preeclampsia and polymorphisms in the main genes involved in folate-homocysteine metabolism. STUDY DESIGN: Case-control study: 43 patients with preeclampsia and 122 controls without pregnancy complications. Laboratory studies: tHcy and other amino acids, folate and vitamin B(12) and polymorphisms: 677C > T and 1298A > C (MTHFR); 699C > T, 844ins68 and 1080C > T (CBS); 2756A > G (MTR); and 66G > A, IVS1+766G > A and IVS1+754A > C (MTRR). RESULTS: Plasma tHcy and folate values were significantly higher (P = 0.004 and P = 0.019), while Met/tHcy ratios were lower (P < 0.001) in the patients compared with controls. No association was observed between polymorphisms tested and preeclampsia. In the control group, four such associations were found: the 1298A > C polymorphism (MTHFR) with the ratio Met/tHcy (P = 0.014); the 699C > T polymorphism (CBS) with the ratio tHcy/SigmaAA (P = 0.013); the 2756A > G polymorphism (MTR) with tHcy (P = 0.034); and the IVS1+766G > A polymorphism (MTRR) with hyperhomocysteinemia (P = 0.012). CONCLUSION: An association between the polymorphisms analysed and preeclampsia could not be demonstrated.

Homocysteine and other plasma amino acids in preeclampsia and in pregnancies without complications.

OBJECTIVES: To evaluate a). the plasma amino acid changes observed in pregnant women (n = 124) and b). the homocysteine and other amino acid changes in preeclampsic patients (n = 18), and to determine c) whether these changes were also evident in nonpregnant women with a prior history of preeclampsia (n = 18). DESIGN AND METHODS: Case-control study. Plasma total homocysteine (tHcy): HPLC with fluorescence detection, and amino acids (AA): ion exchange chromatography. RESULTS: a). Significantly lower absolute AA values were observed in the pregnant controls for homocysteine, total, essential, and nonessential AA compared with nonpregnant controls. b. In preeclampsia, significantly higher absolute values of tHcy, total, essential and nonessential AA were observed, but relative values referred to total AA were not different. These changes corrected after delivery. CONCLUSIONS: Hyperhomocysteinemia and an increase in most AA levels were observed in preeclampsia. Relative AA values suggested that these changes might be explained by fluctuations in plasma volume. Abnormal AA levels corrected after delivery.

Perinatal outcome prediction by maternal homocysteine and uterine artery Doppler velocimetry.

OBJECTIVES: (a) To evaluate the predictive value of uterine Doppler velocimetry for pregnancy complications, (b) to study the relationship between abnormal uterine Doppler velocimetry and plasma homocysteine, and (c) to determine whether homocysteine measurement improves the predictive value of uterine Doppler screening. STUDY DESIGN: Prospective study including 94 pregnant women without previous risk factors. Total homocysteine, folate and Vitamin B(12) were analysed. Uterine Doppler velocimetry at weeks 24-25 was performed. RESULTS: The presence of any uterine Doppler alteration had a sensitivity of 66.7%, and a specificity of 81.2%, in predicting obstetric complications. The likelihood ratio was 3.6. The positive and negative predictive values were 27.3 and 95.8%, respectively. The global efficiency was 83.0%. The addition of hyperhomocysteinemia to Doppler alterations increased the sensitivity from 66.7 to 77.8%. CONCLUSIONS: The addition of homocysteine determination to uterine Doppler evaluation in the second trimester does not usefully improve its predictive value.

Value of endocervical ureaplasma species colonization as a marker of preterm delivery.

AIMS: To study the predictive value for preterm delivery of colonization of the cervix and vagina by ureaplasmas and other potentially pathogenic microorganisms. METHODS: Prospective analysis of a study group of 200 pregnant women with preterm labor and intact membranes, and a control group of 50 pregnant women. The subjects in both groups were between 24 and 34 weeks of gestation. Ureaplasma spp. and Mycoplasma hominis endocervical cultures were performed for both groups. RESULTS: In the study group, 70 of the women delivered preterm, and all women in the control group carried their pregnancies to full term. Cervical cultures for Ureaplasma spp. were positive in 119 women, and were isolated more frequently in the study group (51.5%) than in the control group (32%), and more frequently in subjects in the study group who delivered preterm (65%) than in those who had a full-term delivery (45%), differences that were statistically significant. CONCLUSION: Detection of Ureaplasma spp. in the endocervix has a statistically significant relationship to preterm labor (p = 0.03) and preterm delivery (p = 0.02) in pregnant women with preterm labor and intact membranes.

The value of interleukin-8, interleukin-6 and interleukin-1beta in vaginal wash as predictors of preterm delivery.

AIMS: To study the value of interleukin (IL)-8, IL-6 and IL-1beta in vaginal wash as predictors of preterm delivery. METHODS: A prospective analysis of a study group of 200 pregnant women between 24 and 34 weeks of gestation with intact membranes and preterm labor and a control group of 50 pregnant women during the same period of gestation. The controls had uncomplicated pregnancies and subsequently delivered at term. Samples of vaginal secretions were collected from both groups and analyzed for IL-1beta, IL-6 and IL-8 concentrations. RESULTS: Of the women in the study group, 70 had preterm deliveries, while all women in the control group had full-term deliveries. Compared with the control group, the study group had significantly higher concentrations (p < 0.021) of IL-1beta, IL-6 and IL-8. The women in the study group delivering preterm also had IL-1beta, IL-6 and IL-8 concentrations significantly greater (p < 0.001) than those of the same group delivering full term. ROC curves were used to establish cut-off points for the three interleukins to predict preterm delivery. We did not find a cut-off point with an appropriate sensitivity and specificity. CONCLUSION: The concentrations of interleukins in vaginal wash were significantly higher both in the women with preterm labor and in those delivering preterm. While values differed between controls and those with the preterm labor, no cut-off can be obtained to use the results of IL-1beta, IL-6 and IL-8 as a predictor clinically.

Situación actual: docencia en patología del tracto genital inferior y colposcopia en España / Current scenario: teaching of lower genital tract pathology and colposcopy in Spain

Objetivo. Evaluar el impacto que una intervención educativa en patología de tracto genital inferior (TGI) emprendida por la Asociación Española de Patología Cervical y Colposcopia (AEPCC) y la Sociedad Española de Ginecología y Obstetricia (SEGO) ha tenido en la asistencia de los hospitales docentes españoles y en los conocimientos y habilidades de los residentes españoles de la especialidad. Sujetos y métodos. Estudio observacional descriptivo transversal, basado en una encuesta de 15 preguntas contestadas voluntariamente por residentes españoles de ginecología y obstetricia. Resultados. Comparado con una encuesta previa de 2006, se detecta un sustancial incremento en la proporción de hospitales docentes españoles que disponen de unidad de TGI (40% vs 80%). Se dobla el porcentaje de residentes que declara tener conocimientos medio/altos sobre esta patología; persiste baja la capacidad de manejo de la patología vulvar. Conclusiones. Se confirma la utilidad del plan de actuación sobre la formación continuada en TGI emprendido por la AEPCC y la SEGO(AU)

To evaluate the impact of an educational intervention in lower genital tract pathology (LGTP) on the knowledge and skills acquired by Spanish resident physicians. The intervention was carried out by the Spanish Association of Colposcopy and Cervical Pathology and the Spanish Society of Obstetrics and Gynecology. Subjects and methods. We performed an observational, descriptive and cross-sectional study, based on a 15-item questionnaire voluntarily completed by Spanish Obstetrics and Gynecology trainees. Results. Compared with a previous survey in 2006, the proportion of Spanish teaching hospitals with a LGTP unit substantially increased (40% vs 80%), while the percentage of residents who reported fair to good knowledge of this field doubled. However, knowledge of the management of some vulvar diseases remains poor. Conclusiones. Se confirma la utilidad del plan de actuación sobre la formación continuada en TGI emprendido por la AEPCC y la SEGO. Conclusions. This study confirms the usefulness of the continuing education in LGTP carried out by Spanish Scientific Societies(AU)