Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology?

It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.

Rotura espontánea de varices uterinas como causa de hemoperitoneo en la segunda mitad de la gestación / Spontaneous uterine rupture as a cause of hemoperitoneum in the second half of pregnancy

Introducción: el hemoperitoneo durante el embarazo, secundario a la rotura espontánea de varices uterinas, es una condición clínica infrecuente aunque potencialmente letal. La mortalidad materna puede llegar al 49%, aunque, con la rápida atención, ha descendido hasta un 3,4%; la mortalidad perinatal alcanza el 31%. La clínica es inespecífi ca, dolor abdominal y choque hipovolémico, asociado o no a sufrimiento fetal. La laparotomía exploradora es necesaria en estos casos, junto con la reposición de líquidos y sangre. Caso clínico: se presenta el caso de una septigesta de 44 años con edad gestacional de 28 semanas y cinco días, que presentaba dolor abdominal intenso e inestabilidad hemodinámica en la que se objetivó bradicardia fetal mantenida. Se indicó cesárea urgente ante sospecha de desprendimiento prematuro de placenta normoinserta, comprobándose importante hemoperitoneo procedente de dos grandes varices de la pared anterior del útero. Se realizó una histerectomía puerperal al no controlarse el sangrado con puntos de hemostasia (AU)

Background: The hemoperitoneum during pregnancy, secondary to spontaneous rupture of uterine varices, is an infrequent clinic condition but potentially lethal clinical condition. Maternal mortality can reach 49%, although with fast service, has fallen to 3.4%; perinatal mortality is 31%. Symptoms are nonspecifi c, abdominal pain and hypovolemic shock, which may be or not fetal distress. Exploratory laparotomy is necessary in these cases, with fl uid replacement and blood. Case report: We present the case of a 44 septigesta with a gestational age of 28 weeks and fi ve days, which had severe abdominal pain and hemodynamic instability that sustained fetal bradycardia was observed. Emergency cesarean section for suspected abruptio normoinserta placenta was realized and we found important hemoperitoneum from two large veins of the anterior wall of the uterus. Puerperal hysterectomy was performed because was not possible to control the bleeding with hemostasis stitches (AU)