Interval between balloon removal and oxytocin administration in cervical ripening with double-balloon in singleton pregnancies: An observational study.

OBJECTIVE: To analyze the influence of the resting interval after removal of a double-balloon for cervical ripening and oxytocin administration on the time to onset of active labor in singleton pregnancies. METHODS: A retrospective cohort study of women who required a cervical ripening with double-balloon was conducted between January 2019 and December 2022. We collected data for cervical ripening balloon insertion and removal, oxytocin administration, suspicious or pathological cardiotocographic trace, mode of delivery, maternal and neonatal complications, neonatal outcomes. Proportional hazards model comparing resting interval between double-balloon cervical ripening removal and oxytocin administration. RESULTS: A total of 403 singleton pregnancies were recruited and 213 pregnant women experienced a rest of 12 h between cervical balloon removal and oxytocin administration (resting group). Oxytocin was administered immediately after balloon removal in 190 women (non-resting group). Median insertion-to-active labor interval and insertion-to-delivery interval were significantly shorter in the non-resting group: 18.5 versus 24.0 h, HR 2.59 (CI 95%: 1.97-3.41) and 24.0 versus 29.0 h, HR 2.38 (CI 95%: 1.85-3.05) respectively. Bishop score change and mode of delivery between were similar in both groups. No differences in maternal nor neonatal complications between both groups were found. CONCLUSIONS: Oxytocin administration immediately after removal of a double-balloon for cervical ripening compared with 12 h delayed interval resulted in a shortened time from insertion to active labor onset and to delivery interval without increasing maternal or neonatal adverse outcomes.

A Combined Approach: Laparoscopic Partial Bladder Prior Transurethral Resection for Bladder Endometriosis-Case Report and Surgical Video Presentation.

OBJECTIVE: Bladder endometriosis is the presence of stroma and endometrial glands in the thickness of the detrusor muscle. The main symptoms it produces are dysuria and hematuria whose intensity is directly proportional to the size of the nodule. It is a difficult entity to diagnose for which physical examination is essential. Treatment can be medical, with hormonal therapies, or surgical by transurethral resection of the nodule and laparoscopic partial cystectomy. METHODS: To show a clinical case and review the literature about the technique used. RESULTS: A 29-year-old patient diagnosed with bladder endometriosis in which a combined approach was decided by laparoscopic partial cystectomy after transurethral resection: the patient came to our office for chronic pelvic pain, dysuria, dysmenorrhea, and a physical examination that showed a painful nodule on the anterior side of the vagina. A transvaginal ultrasound, magnetic resonance imaging, and cystoscopy confirm the diagnosis of bladder endometriosis. After a review of the literature on the management of this entity, the patient's clinic, and reproductive desires, the combined approach with excellent results was decided. Dysmenorrhea and dysuria disappeared, preserving the fertility of the patient who became pregnant 6 months after the intervention. CONCLUSION: The use of the combined approach allows to reduce the limitations of both techniques separately.

Interval cytoredutive surgery and HIPEC in advanced ovarian cancer with small-bowel disease: results and reflections

Introduction: Small-bowel involvement in patients with ovarian cancer has been strongly correlated with the possibility of cytoreduction and thus with survival. The main objective of this study was to evaluate the prognostic significance of small-bowel involvement in patients undergoing optimal-complete interval cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).Methods: We included a series of patients diagnosed with stage IIIC-IVA (pleural effusion) high-grade serous epithelial ovarian cancer and in whom CRS + HIPEC was indicated after neoadjuvant systemic chemotherapy (NACT). The study period extended from January 2008 to January 2020, with a minimum follow-up of 12 months from the inclusion of the last patient. A multivariate analysis using Cox regression allowed us to identify the variables that were independently related to disease-free survival.Results: A total of 144 patients were selected, 13 (9%) of whom were excluded from the analysis, because their disease was considered unresectable. The study included a series of 131 patients with a median age of 62 years (34-79 years) and a median Peritoneal Cancer Index (PCI) calculated during surgery of 9 (1-35). The median PCI of bowel areas 9-12 (SB-PCI) was 3 (1-10). Performance of a CC-1 cytoreduction (HR: 1.93, 95% CI: 1.02-3.64, p = 0.042) and SB-PCI greater than 3 (HR: 2.25, 95%CI: 1.13-4.48, p = 0.21) were independent factors associated with shorter disease-free survival.Conclusion: Small-bowel involvement, even in patients with a macroscopically complete resection, showed a correlation with worse prognostic outcomes and could be considered as a variable in the postoperative management of these patients. (AU)

Interval cytoredutive surgery and HIPEC in advanced ovarian cancer with small-bowel disease: results and reflections.

INTRODUCTION: Small-bowel involvement in patients with ovarian cancer has been strongly correlated with the possibility of cytoreduction and thus with survival. The main objective of this study was to evaluate the prognostic significance of small-bowel involvement in patients undergoing optimal-complete interval cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). METHODS: We included a series of patients diagnosed with stage IIIC-IVA (pleural effusion) high-grade serous epithelial ovarian cancer and in whom CRS + HIPEC was indicated after neoadjuvant systemic chemotherapy (NACT). The study period extended from January 2008 to January 2020, with a minimum follow-up of 12 months from the inclusion of the last patient. A multivariate analysis using Cox regression allowed us to identify the variables that were independently related to disease-free survival. RESULTS: A total of 144 patients were selected, 13 (9%) of whom were excluded from the analysis, because their disease was considered unresectable. The study included a series of 131 patients with a median age of 62 years (34-79 years) and a median Peritoneal Cancer Index (PCI) calculated during surgery of 9 (1-35). The median PCI of bowel areas 9-12 (SB-PCI) was 3 (1-10). Performance of a CC-1 cytoreduction (HR: 1.93, 95% CI: 1.02-3.64, p = 0.042) and SB-PCI greater than 3 (HR: 2.25, 95%CI: 1.13-4.48, p = 0.21) were independent factors associated with shorter disease-free survival. CONCLUSION: Small-bowel involvement, even in patients with a macroscopically complete resection, showed a correlation with worse prognostic outcomes and could be considered as a variable in the postoperative management of these patients.

Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study.

Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques.

The Nutrition in Early Life and Asthma (NELA) birth cohort study: Rationale, design, and methods.

BACKGROUND: Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease (DOHaD) paradigm suggests. OBJECTIVES: The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility. POPULATION: Randomly selected pregnant women from three health areas of Murcia, a south-eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow-up visit for routine foetal anatomy scan at 19-22 weeks of gestation, at the Maternal-Fetal Medicine Unit of the "Virgen de la Arrixaca" University Clinical Hospital over a 36-month period, from March 2015 to April 2018. DESIGN: Prospective, population-based, maternal-child, birth cohort study. METHODS: Questionnaires on exposures and outcome variables were administered to mothers at 20-24 gestation week; 32-36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points. PRELIMINARY RESULTS: Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months' visit and 532 children (72%) attending the 18 months' visit. CONCLUSION: The NELA cohort will add original and unique knowledge to the developmental origins of asthma.

Prevalence of goiter and iodine deficiency in indigenous pregnant women from five nonmetropolitan areas of Colombia 2019 / [Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019].

Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019 / Prevalence of goiter and iodine deficiency in indigenous pregnant women from five non-metropolitan areas of Colombia 2019

RESUMEN Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

ABSTRACT Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

External Cephalic Version: Is it an Effective and Safe Procedure?

External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the methodology of this procedure. The main objective is to show how to perform ECV with a specific protocol with tocolysis before the procedure and analgesia. Moreover, we describe and analyze the factors associated with successful ECV, and also compare to deliveries in the general pregnant population. A retrospective and descriptive analysis of ECV carried out at the Hospital Clinico Universitario Virgen de la Arrixaca in Murcia (Spain) between 1/1/2014 and 12/31/2018 was assessed. The latest data available of labor deliveries in the local center, which is the biggest maternity department in Spain, were from 2018. 320 patients were recruited and 3 pregnant women were lost during the study. ECV was carried out at 37±3 weeks gestation. ECV was successful in 82.5% (N=264). 19 complications were reported (5.9%): 8 vaginal bleeding (2.5%), 9 fetal bradycardia (2.8%), 1 preterm rupture of membranes (0.3%) and 1 cord prolapse (0.3%). A previous vaginal delivery increases the success rate of ECV ORadjusted=3.03 (1.62-5.68). Maternal Body Mass Index (BMI) affects the success of ECV ORadjusted=0.94 (0.89-0.99). Patients with BMI>40 kg/m2 have an ORadjusted=0.09 (0.009-0.89) compared with those with BMI <25 kg/m2. If ECV was successful, the cesarean delivery index is 22.2% (17.5-27.6%), the eutocic delivery index is 52.1% (46.1-58.1%) and the instrumented vaginal delivery index is 25.7% (20.7-31.2%). There are no differences in cesarean and eutocic delivery indexes after successful ECV. However, a successful ECV is associated with a 6.29% increase in the instrumented delivery rate (OR=1.63). ECV is an effective procedure to reduce the number of cesarean sections for breech presentations. Maternal BMI and previous vaginal delivery are associated with ECV success. Successful ECV does not modify the usual delivery pattern.

Endometriosis sobre ligamento redondo extrapélvico / Endometriosis affecting the extrapelvic round ligament

La afectación del ligamento redondo por endometriosis es infrecuente, oscilando según la bibliografía entre un 0,3 a un 14 % de las pacientes afectadas por endometriosis. Se localiza mas frecuentemente en el lado derecho y en su porción extrapélvica. Produce efecto masa y dolor variable con el ciclo. Generalmente hay afectación del compartimento posterior pélvico. La sospecha diagnóstica se basa en la anamnesis y exploración física, donde se objetiva una masa en región inguinal dolorosa. El diagnóstico por imagen a través de ecografía y resonancia magnética presenta una lesión ocupante de espacio con las mismas características que las lesiones endometrió-sicas pélvicas. Su manejo en la mayoría de las veces implica cirugía para su exéresis. Presentamos un caso de endometriosis sobre el ligamento redondo extrapélvico en el contexto de una endometriosis compleja en una paciente de 23 años con uropatía obstructiva

Endometriosis of the round ligament is a rare entity, it accounts for 0.3 to 14 % of patients affected by endome-triosis. The right side at extrapelvic slice is the most usual affected area. It cause swelling and changing mens-trual pain. Inguinal endometriosis is usually associated with posterior compartment of pelvis affectation. The diagnostic approach is base on accurate anamnesis and physical examination with a painful groin swelling. An space occupying lesion with the same properties as endometriosis pelvics injuries is show in Ultrasonography and Nuclear Magnetic Resonance. En-bloc resection surgery is the treatment of choice almost always. We report on a case of endometriosis of extrapelvic round ligament in a complex endometriosis 23 years-old patient, with obstructive uropathy context

Prognostic importance of atypical endometriosis with architectural hyperplasia versus cytologic atypia in endometriosis-associated ovarian cancer.

OBJECTIVE: Patients with endometriosis are at increased risk of ovarian cancer. It has been suggested that atypical endometriosis is a precursor lesion of endometriosis-associated ovarian cancer (EAOC). The aim of this study is to evaluate if cytologic (cellular) atypia and architectural atypia (hyperplasia), histologic findings described as atypical endometriosis, play a different role in patients with EAOC. METHODS: A prospective study was conducted between January 2014 and April 2017 at our institution with patients undergoing surgery with a histologic diagnosis of endometriosis, ovarian cancer, or EAOC. The prevalence and immunohistologic study (Ki-67, BAF250a, COX-2) of cases of cellular and architectural atypia in endometriosis were analyzed. RESULTS: Two hundred and sixty-six patients were included: the diagnosis was endometriosis alone in 159 cases, ovarian cancer in 81, and EAOC in 26. Atypical endometriosis was reported in 23 cases (12.43%), 39.13% of them found in patients with EAOC. Endometriosis with cellular atypia was found mainly in patients without neoplasm (71.4%), and endometriosis with architectural atypia was seen in patients with ovarian cancer (88.9%) (p=0.009). Ki-67 was significantly higher in endometriosis patients with architectural atypia than those with cellular atypia. CONCLUSION: The diagnosis of endometriosis with architectural atypia is important because it may be a precursor lesion of ovarian cancer; therefore, pathologists finding endometriosis should carefully examine the surgical specimen to identify any patients with hyperplasia-type endometriosis, as they may be at higher risk of developing EAOC.

Resonancia magnética en el cáncer de mama tratado con neoadyuvancia: correlación radiopatológica de la respuesta / Magnetic resonance in breast cancer treated with neoadyuvant therapy: Radiopathological correlation of response

Objetivo: La quimioterapia neoadyuvante (QTN) es una modalidad de tratamiento fundamental en el cáncer de mama (CM). El objetivo de este estudio es analizar las respuestas radiológica (RR) y patológica (RP) de pacientes con CM sometidas a QTN, estudiar su concordancia y las variables relacionadas con dichas respuestas. Pacientes y métodos: Se incluyen 63 pacientes tratadas con QTN en las que se evaluó la RR con RM pre y post-QTN, y la RP, mediante la clasificación de Miller y Payne, tanto para la enfermedad mamaria como para la axilar. Se realizó un análisis univariante y multivariante de las variables clinicopatológicas para la RR y RP, así como un análisis de concordancia entre respuestas. Resultados: Los porcentajes de respuesta fueron del 52,4% para RR, del 63,5% para RP local y del 57,2% para RP axilar. Resultaron factores predictivos independientes de la RR: un BRCA+ y el tipo de curva en la RM post-QTN. El único factor predictivo para la RP en la mama fue el realce tumoral en la RM post-QTN y para la RP axilar: realizar la BSGC y receptores hormonales negativos. Aunque se identifica correlación entre RR y RP, esta solo fue significativa en la enfermedad axilar. Conclusiones: Existen factores predictivos de RR, RP en mama y RP axilar que hacen útil el uso de la RM en la valoración de la QTN. La concordancia entre RR y RP fue mayor a nivel axilar

Aim: Neoadjuvant chemotherapy (NAC) is a fundamental treatment in breast cancer (BC). The objective of this study was to analyse the radiological response (RR) and pathological response (PR) of patients with BC by studying the agreement between RR and PR and response-related variables. Patients and methods: The study included 63 patients treated with NAC. We evaluated RR with pre- and post-CT MRI and PR by the Miller and Payne classification, both for breast and axillary disease. Univariate and multivariate analyses of the clinicopathological variables for RR and PR were carried out, as well as an analysis of the concordance between responses. Results: The response rates were 52.4% for RR, 63.5% for local PR and 57.2% for axillary PR. Independent predictive factors of RR were BRCA positivity and the type of curve post-NAC on MRI. The only independent predictor of PR in the breast was tumor enhancement post-NAC on MRI, while independent predictors of axillary PR were performing SSNB and negative hormone receptors. Although there was a correlation between RR and PR, it was only significant in axillary disease. Conclusions: This study found predictive factors of RR, PR in the breast and axillary PR and consequently RMI is useful in the assessment of NAC. The concordance between RR and PR was greater in the axilla

¿Es la colpopexia sacroespinosa útil para tratar el prolapso de cúpula vaginal a largo plazo? / Is sacrospinous colpopexy useful for treating long-term vaginal vault prolapse?

Objetivo: evaluar los resultados quirúrgicos de pacientes con prolapso de cúpula vaginal operadas mediante técnica de Richter (colpofijación al ligamento sacroespinoso). El objetivo principal del estudio fue valorar los resultados a largo plazo de la intervención mediante parámetros subjetivos y objetivos (grado de satisfacción de las pacientes y ausencia de prolapso de cúpula en la revisión postoperatoria, respectivamente). Material y métodos: estudio descriptivo mediante revisión retrospectiva de 46 pacientes intervenidas mediante técnica de Richter en nuestro hospital. Realización de anamnesis y exploración física. Revisión bibliográfica de los tratamientos del prolapso de cúpula. Resultados: los resultados obtenidos del control postoperatorio a largo plazo (hasta 18 años de seguimiento) son ausencia de prolapso de cúpula en el 91,17% con muy pocas complicaciones, cistocele en el 19,35% y rectocele en el 3,22%. El grado de satisfacción subjetivo, valorado mediante anamnesis, fue del 100% (curación 85,29% y mejoría 14,71%). Conclusión: la técnica de Richter parece tener buenos resultados subjetiva y objetivamente (resultados clínicamente relevantes), por lo que puede considerarse una técnica eficiente en nuestro medio (AU)

Objective: To evaluate the surgical results of patients with vaginal vault prolapse who underwent Richter’s procedure (vaginal sacrospinous colpopexy). The main purpose of this study was to evaluate the success of the surgery, both subjectively (patient satisfaction) and objectively (absence of vault prolapse in long-term postsurgical follow-up). Material and methods: A descriptive study was conducted through a retrospective review of the medical records of 46 patients who underwent Richter surgery in our hospital, followed by medical history and physical examination. A literature review was conducted of procedures for vault prolapse. Results: The results observed in the long-term postsurgical follow-up (up to 18 years of follow-up) were as follows: no vaginal vault prolapse in 91.17% and few complications, cystocele in 9.35% and rectocele in 3.22%. The degree of subjective satisfaction evaluated through the medical history was 100% (cure in 85.29% and improvement in 14.71%). Conclusion: The Richter procedure seems to produce excellent subjective and objective (clinically relevant) results and can therefore be considered an efficient technique in our environment (AU)

Central pontine myelinolysis during pregnancy: Pathogenesis, diagnosis and management.

Central pontine myelinolysis (CPM) is a rare condition usually caused by rapid sodium correction in hyponatraemia after a severe neurological syndrome. Only few cases have been reported during pregnancy, most of which were reported in patients with hyperemesis. We describe the successful management of the first case of twin pregnancy in a patient who presented with CPM after treatment for premature labour and then review the literature on CPM in pregnancy (aetiology, diagnosis and management). Our patient required emergency delivery to achieve electrolyte and fluid balance. At six months, the twins remained asymptomatic and the mother had minor sequelae. The aetiology is not clear, and there is no evidence regarding the optimal treatment or prognosis of CPM. In our patient, desmopressin-contaminated atosiban showed a certain probability in the Karch-Lasagne algorithm of a causality relationship between hyponatraemia and the drug. To our knowledge, this is the first case of myelinolysis reported in a twin pregnancy possibly related to desmopressin-contaminated atosiban.

Embolización arterial selectiva en la hemorragia postparto. Experiencia en nuestro centro / Selective uterine artery embolization in the management of postpartum haemorrhage. Results at our centre

Objetivo: revisión de la casuística de nuestro centro desde la introducción de la radiología intervencionista en el manejo de la hemorragia postparto hace 6 años. Sujetos y métodos: estudio retrospectivo entre 2009 y 2014 en el que se recogen los datos de 18 pacientes. Resultados: la tasa de éxitos en nuestra serie fue del 88,24% y la tasa global de histerectomía tras embolización fue del 11,76%. Conclusiones: la hemorragia postparto complica el 5-15% de los partos y es la causa aislada más importante de mortalidad materna. Existen protocolos individualizados de manejo según el centro, siendo la radiología intervencionista un tratamiento de segunda línea, alternativo a la histerectomía. En nuestro hospital se ha evidenciado una influencia positiva en la disminución de la histerectomía obstétrica. Las complicaciones, aunque infrecuentes, no son despreciables y se precisan estudios a largo plazo que evalúen su impacto en la fertilidad y gestaciones posteriores (AU)

Purpose: To review the patients who presented to our hospital with postpartum haemorrhage and were treated with interventional radiology procedures since the introduction of this technique 6 years ago. Subjects and methods: We collected data from all postpartum haemorrhages treated with arterial embolization at our hospital (n = 18) between 2009 and 2014. Results: Our success rate was 88.24% and the overall rate of obstetric hysterectomy after embolization was 11.76%. Conclusions: Approximately 5-15% of deliveries are complicated by postpartum haemorrhage, which is the most important isolated cause of maternal mortality. There are specific protocols in each centre, interventional radiology being an alternative treatment to hysterectomy. The number of emergency hysterectomies decreased in our hospital after the introduction of the technique. Although infrequent, the complications of this technique are not negligible, and long-term studies are needed to evaluate fertility and the obstetric impact in these patients (AU)

Simple descriptors and simple rules of the International Ovarian Tumor Analysis (IOTA) Group: a prospective study of combined use for the description of adnexal masses.

OBJECTIVE: External validation of the IOTA group's three-step diagnostic model (Strategy 1) and comparison with assessment by an expert sonographer (Strategy 2). STUDY DESIGN: Prospective study in patients with persistent adnexal masses, in which an inexperienced sonographer performed transvaginal ultrasound applying simple descriptors (SD) and rules (SR) for classifying as benign or malignant. Any non-classifiable mass was then submitted to an expert examiner for subjective assessment (SA). RESULTS: Eighty-one patients (mean age, 43; 27.2% postmenopausal) were included in this prospective study. Surgery was performed for 30 (8 malignant and 22 benign) masses; 51 masses were considered as benign and managed expectantly (they were assumed to be benign for statistical purposes). Diagnostic performance for Strategy 1 (SD+SR+SA) was sensitivity (SN): 87.5% (7/8, 95% CI, 47.3-99.7%) and specificity (SP): 100% (73/73, 95% CI, 95.1-100%). For Strategy 2 (SA only) it was SN 87.5% (7/8, 95% CI, 47.3-99.7%), SP 98.6% (72/73, 95% CI, 92.6-100%). CONCLUSIONS: The three-step diagnostic strategy designed by the IOTA group for adnexal masses has a diagnostic performance comparable to that of subjective expert assessment and could be used as a triage method by nonexpert sonographers.

Hemorragia posparto precoz: uso de la radiología intervencionista en el control / Early postpartum hemorrhage treated by interventional radiology

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Reduction of maternal mortality due to preeclampsia in Colombia--an interrupted time-series analysis.

INTRODUCTION: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. METHODS: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. RESULTS: Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). CONCLUSIONS: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

INTRODUCCIÓN: La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. MÉTODOS: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. RESULTADOS: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR=0.77, CI 95% 0.71-0.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88), igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR=0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). CONCLUSIONES: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

Reduction of maternal mortality due to preeclampsia in Colombia - an interrupted time-series analysis / Reducción de la mortalidad materna por preeclampsia en Colombia - un análisis de series de tiempo interrumpido

Abstract Introduction. Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002-2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR= 0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR= 0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

Resumen Introducción. La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. Métodos: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. Resultados: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR= 0.77, CI 95% 0.710.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88 , igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR= 0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). Conclusiones: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

Uterine rupture in twin pregnancy with normal fetus and complete hydatidiform mole.

We describe a rare case of complete hydatidiform mole with twin live fetus (CHMTF) confirmed by histopathology, flow cytometry and polymerase chain reaction techniques. No malformations were observed, fetal karyotype was normal and ß-human chorionic gonadotropin levels were high (>100,000 IU/ml). The patient was informed of the risks and decided to continue with the pregnancy, but at week 15, she had to undergo hysterectomy due to uterine rupture. She subsequently developed persistent trophoblastic disease (PTD) with pulmonary metastases that required treatment with polychemotherapy. Patients with CHMTF should be informed of all known risks, including the considerable risk of PTD, which is similar to or, even higher than that associated with a singleton complete mole. The risk does not appear to be increased by continuing the pregnancy. Because so few series have been published, there is a lack of evidence-based clinical management guidelines. To our knowledge, this is the first report of uterine rupture in CHMTF.