Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

BACKGROUND: Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES: To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY: Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA: Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS: Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS: Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS: Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT: Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Uso de productos barrera para prevenir complicaciones en la piel periestomal / Use of barrier products in order to prevent complications in the peristomal skin

OBJETIVO: evaluar la eficacia del uso de un aerosol protector barrera para la prevención de la maceración e irritación de la piel periestomal, en el paciente quirúrgico, antes de la colocación de los discos, y valorar la eficacia de la aplicación de dicho aerosol previo a la retirada de los adhesivos. MÉTODO: se llevó a cabo un ensayo clínico aleatorizado con dos grupos de comparación: grupo control (cura habitual) y grupo experimental (cura habitual + aplicación de aerosol como método barrera antes de la colocación del disco y spray quita-adhesivo para su retirada). Se incluyeron a los pacientes ostomizados en el Hospital Universitario Infanta Cristina (Parla, Madrid) en 2019, atendidos en la Consulta de Cirugía General. Se aleatorizaron a dos grupos, 15 por grupo. Se recogieron variables descriptivas el día de la captación y de resultado a los 10 días del seguimiento. Se llevaron a cabo análisis univariante y bivariante. La relación entre las distintas variables se evaluó mediante pruebas estadísticas. RESULTADOS: se aleatorizaron 30 pacientes, 15 en grupo control y 15 en grupo experimental. Se observaron diferencias clínicas en los grupos de comparación al inicio del estudio. Al comparar las variables de resultado a los 10 días de la cirugía en los dos grupos del estudio, se observaron diferencias estadísticamente significativas en la presencia de complicaciones en la piel periestomal (p< 0,001) con un 80% (n= 12) en el grupo control frente al 6,7% (n= 1) en el grupo experimental, y en el tipo de complicaciones entre ambos grupos (0,002), destacando las lesiones de tipo L2 Erosivas. CONCLUSIONES: la utilización tanto de un aerosol protector barrera sobre la piel del paciente antes de la colocación del disco de ostomías como la aplicación para su retirada de un spray quita-adhesivo, parece reducir el riesgo de complicaciones en la piel periestomal en el paciente quirúrgico

OBJECTIVES: to assess the efficacy of using a protective barrier spray for preventing peristomal skin maceration and irritation in surgical patients before disc placement, and to assess the efficacy of the application of said spray before removing the adhesive discs. METHOD: a randomized clinical trial was conducted with two comparison arms: the control group (standard cure) and the experimental arm (standard cure + application of spray as barrier method before disc placement and adhesive remover spray for removing them). The study included ostomized patients from the Hospital Universitario Infanta Cristina (Parla, Madrid) in 2019, seen at the General Surgery Unit. Patients were randomly assigned to two 15-patient arms. Descriptive variables were collected on recruitment day, and for outcomes at 10 days follow-up. Univariate and bivariate analyses were conducted. The relationship between different variables was evaluated through statistical tests. RESULTS: thirty (30) patients were randomized, 15 patients to the control arm and 15 patients to the experimental arm. Clinical differences were observed in the comparison arms at study initiation. When comparing the outcome variables at 10 days after surgery in the two study arms, statistically significant differences were observed regarding the presence of complications in the peristomal skin (p< 0.001) with 80% (n= 12) in the control arm vs. 6.7% (n= 1) in the experimental arm, and in terms of type of complications between both arms (0,002), particularly L2-type erosive lesions. CONCLUSIONS: the use of a protective barrier spray on the skin of the patient before placing the ostomy disc as well as the application of an adhesive remover spray for removal seems to reduce the risk of complications in the peristomal skin of surgical patients

Systematic review and meta-analysis of performance of second-trimester nasal bone assessment in detection of fetuses with Down syndrome.

OBJECTIVE: To review systematically the literature on diagnostic tests and performance of second-trimester sonographic assessment of nasal bone (NB) in identifying fetuses affected by Down syndrome. METHODS: A search of studies involving screening tests for NB evaluation and measurements was carried out in the main international bibliographic databases (MEDLINE, EMBASE and CINAHL). Those considered to be relevant were then subjected to critical reading, following Critical Appraisal Skills Programme (CASP) criteria, by at least three independent observers. All data were extracted and tabulated by two independent investigators. A statistical synthesis of sensitivity, specificity and likelihood ratios was performed using specific software (Meta-DiSc). RESULTS: From an initial list of 852 articles referring to ultrasound markers for Down syndrome, 207 relevant papers were selected. Following exclusions, 21 studies were included in the quantitative synthesis. The pooled estimates of positive and negative likelihood ratios were 40.08 (95% CI, 18.10-88.76) and 0.71 (95% CI, 0.64-0.79), respectively, for absent NB and 15.15 (95% CI, 8.15-28.16) and 0.47 (95% CI, 0.34-0.64), respectively, for hypoplastic NB. No relevant differences were found between the various means of defining nasal hypoplasia (multiples of the median (MoM) or percentiles). The biparietal diameter/nasal bone length (BPD/NBL) ratio showed somewhat higher sensitivity but lower specificity with a threshold effect. CONCLUSIONS: NB absence or hypoplasia show high specificity and low but acceptable sensitivity in identifying fetuses with Down syndrome. Screening performance is better with NB measurements as a function of MoM or percentiles rather than as the BPD/NBL ratio. Classification of women into various risk groups for Down syndrome does not affect diagnostic performance.

Manejo expectante del período expulsivo frente a actitud activa en gestantes usuarias de analgesia epidural / Passive fetal descent in women with epidural analgesia compared with active pushing

Objetivo: Determinar la influencia de la analgesia epidural sobre el período expulsivo cuando se emplea un protocolo de manejo expectante, con el análisis de su influencia en el desenlace del parto así como en la salud perinatal. Material y métodos: Realizamos un estudio observacional retrospectivo en el que se comparan un grupo de gestantes sin analgesia epidural (238) que comenzó a empujar una vez alcanzada la dilatación completa, con un segundo grupo con analgesia epidural (238) en el que se esperó 1-2 h tras alcanzar la dilatación completa para comenzar a empujar. Las variables estudiadas fueron: duración del período expulsivo, tipo de parto, así como valor del test de Apgar y pH en arteria umbilical. Resultados: En el grupo en el que se aplicó el protocolo de manejo expectante, la duración del período expulsivo es mayor (diferencia de medias [DM] = 39,61; intervalo de confianza [IC] del 95%, 33,2-46,01). Sin embargo, los valores del test de Apgar al minuto (odds ratio [OR] = 1; IC del 95%, 0,44-2,27), del pH de arteria umbilical (DM = 0,0012; IC del 95%, ­0,011-0,013), así como la tasa de cesáreas (OR = 0,81; IC del 95%, 0,42-1,55) y los partos instrumentales (OR = 0,88; IC del 95%, 0,41-1,91) son similares en ambos grupos. Conclusiones: El manejo expectante del período expulsivo, o descenso pasivo de la presentación, se asocia con una mayor duración de éste, pero no con una mayor frecuencia de resultados perinatales adversos

Objective: To determine the influence of epidural analgesia on the expulsion period when a policy of delayed pushing was used by analyzing its effect on type of delivery and perinatal outcomes. Material and methods: We performed a retrospective observational study comparing a group of women without epidural analgesia (238) who were advised to commence pushing at full dilatation with a second group of women with epidural analgesia (238) who were advised to wait 1-2 hours after full dilatation before starting to push. The variables measured included length of second stage, type of delivery, Apgar scores, and arterial cord pH values. Results: The second stage was longer in the group with passive fetal descent (MD = 39.61; 95% CI, 33.2-46.01). However, Apgar scores (OR = 1; 95% CI, 0.44-2.27), arterial cord pH values (MD = 0.0012; 95% CI, ­0.011-0.013), and rates of cesarean (OR = 0.81; 95% CI, 0.42-1.55) and instrumental delivery (OR = 0.88; 95% CI, 0.41-1.91) were similar in both groups. Conclusions: Delayed pushing was not associated with higher rates of adverse outcome, although the second stage of labor was longer

Histerectomía laparoscópica y medicina basada en la evidencia / Laparoscopic hysterectomy and evidence-based medicine

Objetivo: Se analiza el grado de evaluación de la histerectomía laparoscópica mediante estudios prospectivos aleatorizados. Material y método: Artículos prospectivos aleatorizados y metaanálisis sobre histerectomía laparoscópica recogidos en la base de datos médicos PubMed y en la Colaboración Cochrane, en el período comprendido entre enero de 1989 y octubre de 2004. Se analizan los metaanálisis y los estudios prospectivos aleatorizados que comparan la histerectomía laparoscópica con la histerectomía abierta (abdominal o vaginal). Resultados: Se encontraron 1.255 documentos, de los que 53 (4,22%) son estudios prospectivos aleatorizados y, de ellos, 27 (50,94%) comparan la histerectomía laparoscópica con el abordaje tradicional de la histerectomía (abdominal o vaginal). No se encontró ninguna revisión sistemática en la Colaboración Cochrane acerca de la histerectomía laparoscópica. Conclusiones: Los estudios controlados aleatorizados no se han utilizado ampliamente en el análisis de la histerectomía laparoscópica. Las razones son múltiples y están relacionadas fundamentalmente con las dificultades para realizar este tipo de estudios, tanto por parte de los profesionales como de los pacientes

Objective: To evaluate the extent to which laparoscopic hysterectomy has been evaluated through randomized controlled trials. Material and method: Studies on laparoscopic hysterectomy published between January 1989 and October 2004 were retrieved from PubMed and the Cochrane Library. Metaanalyses and randomized controlled trials comparing laparoscopic hysterectomy with open hysterectomy (abdominal or vaginal) were analyzed. Results: Of 1255 documents retrieved, 4.22% (53) were randomized controlled trials; of these, 27 (50.94%) compared laparoscopic hysterectomy with open hysterectomy. No systematic reviews were found in the Cochrane Library. Conclusions: Randomized controlled trials are not widely used in the evaluation of endoscopic surgery. The reasons for this are multiple and are usually related to the technical difficulties of carrying out this type of study for both gynecologists and patients

Expresión de la catepsina D en epitelio escamoso cervical y neoplasia cervical intraepitelial / Cathepsin D expression in cervical squamous epithelia and cervical intraepithelial neoplasia

Objetivo: Determinar las positividades mediante técnicas inmunohistoquímicas de la catepsina D (CD) en nuestras muestras así como la intensidad y localización en el espesor del epitelio de los casos positivos para este marcador. Material y métodos: Nuestro estudio está formado por 113 muestras de tejido cervical divididas en 4 grupos: 30 casos de epitelio escamoso cervical normal (CC), 31 de neoplasia cervical intraepitelial grado 1 (CIN1), 27 de neoplasia cervical intraepitelial grado 2 (CIN2) y 25 de neoplasia cervical intraepitelial grado 3 (CIN3). Se obtienen cortes de tejido, tras su fijación e inclusión en parafina, en los que se aplica una técnica inmunohistoquímica específica para la detección de la CD. Resultados: La distribución de las positividades de este marcador fueron 0 por ciento para el CC, 48 por ciento para el CIN1, 33 por ciento para el CIN2 y 44 por ciento para el CIN3, con p= 0,00001 en la relación CC-CIN1, p = 0,0005 en la relación CC-CIN2 y p = 0,00005 en la relación CCCIN3 (el nivel de significación estadística aplicado ha sido del 5 por ciento). La diferencia en la distribución de las intensidades fue significativa en el grupo de tinción intensa: 6,6 por ciento para CIN1, 0 por ciento para CIN2 y 45 por ciento para CIN3 (p = 0,0476). Conclusión: La expresión de la CD en un alto porcentaje de CIN1 puede atribuirse a su función estimuladora de la mitosis, así como el aumento de intensidad en los CIN3 podría indicar la adquisición temprana de alteraciones propias del fenotipo metastásico. Son necesarios estudios posteriores para sentar como base de la oncogénesis cervical nuestras conclusiones (AU)

Trompa de falopio accesoria / Accessory Fallopian tube

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Síndrome de ogilvie y gestación / Ogilvie's syndrome and pregnancy

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