Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain.

BACKGROUND: The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS: Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS: The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS: In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.

Diagnóstico precoz del cáncer de cérvix: correlación entre citología, colposcopia y biopsia / Early diagnosis of cervix cancer: Correlation between cytology, colposcopy and biopsy

Objetivo: Determinar la concordancia entre citología, colposcopia y biopsia cervical ante una citología alterada. Material y métodos: Se realizó un estudio observacional transversal, de base clínica, en un único centro. La población seleccionada consistió en 416 mujeres, de entre 25 y 65 años, con citología alterada, del 1 de agosto de 2014 al 30 de septiembre de 2016, y remitidas para estudio colposcópico y anatomopatológico al Hospital Reina Sofía de Córdoba. Se realizaron análisis estadísticos, utilizando el índice de Kappa para el grado de concordancia entre citología, colposcopia y biopsia. Resultados: Se encontró una concordancia insignificante entre citología y colposcopia (k=0,16; IC 95% 0,09-0,22); una concordancia moderada entre colposcopia y biopsia (k=0,57; IC 95% 0,47-0,68); y una concordancia insignificante entre citología y biopsia (k=0,21; IC 95% 0,08-0,34). Conclusiones: El grado de acuerdo fue mejor entre colposcopia y biopsia que entre citología y biopsia o entre citología y colposcopia

Objective: To determine the concordance between cytology, colposcopy and cervical biopsy in abnormal cytologies. Material and methods: An observational cross-sectional, clinically based, single center study was performed. The selected population consisted of 416 women between the ages of 25 and 65 who had undergone colposcopy for abnormal cytologies at the Reina Sofía Hospital, Córdoba, between August 1st, 2014, and September 30th, 2016. Statistical analysis was performed using the Kappa index for the degree of concordance between cytology, colposcopy and biopsy. Results: There was an insignificant concordance between cytology and colposcopy (k=0.16; 95% CI 0.09-0.22), a moderate concordance between colposcopy and biopsy (k=0.57; 95% CI 0.47-0.68) and an insignificant concordance between cytology and biopsy (k=0.21 (95% CI 0.08-0.34). Conclusions: Better concordance was found between colposcopy and biopsy than between either cytology and biopsy or cytology and colposcopy

[Early diagnosis of cervix cancer: Correlation between cytology, colposcopy and biopsy]. / Diagnóstico precoz del cáncer de cérvix: correlación entre citología, colposcopia y biopsia.

OBJECTIVE: To determine the concordance between cytology, colposcopy and cervical biopsy in abnormal cytologies. MATERIAL AND METHODS: An observational cross-sectional, clinically based, single center study was performed. The selected population consisted of 416 women between the ages of 25 and 65 who had undergone colposcopy for abnormal cytologies at the Reina Sofía Hospital, Córdoba, between August 1st, 2014, and September 30th, 2016. Statistical analysis was performed using the Kappa index for the degree of concordance between cytology, colposcopy and biopsy. RESULTS: There was an insignificant concordance between cytology and colposcopy (k=0.16; 95% CI 0.09-0.22), a moderate concordance between colposcopy and biopsy (k=0.57; 95% CI 0.47-0.68) and an insignificant concordance between cytology and biopsy (k=0.21 (95% CI 0.08-0.34). CONCLUSIONS: Better concordance was found between colposcopy and biopsy than between either cytology and biopsy or cytology and colposcopy.

Influencia de la obesidad en el tipo de parto en pacientes con inducción del parto a término sin patología obstétrica relevante / Influence of obesity on the type of delivery in patients with induction of labor at term without relevant obstetric pathology

Objetivo: analizar si la vía de parto varía en función del índice de masa corporal de las pacientes a las que se les induce el parto y evaluar la influencia de otros factores. Sujetos y métodos: estudio con diseño clínico-epidemiológico observacional retrospectivo. Analizamos 172 inducciones del parto entre agosto y octubre del 2016. Comparamos las diferentes variables en función de la vía del parto mediante test estadísticos paramétricos. Conclusiones: el peso excesivo, tanto al inicio como al finalizar la gestación, así como una ganancia ponderal elevada incrementan el riesgo de finalizar el parto mediante cesárea. Otros factores que incrementan el riesgo de cesárea en una paciente a la que se induce el parto son: tener una cesárea anterior, ser primípara o que la inducción se realice con dinoprostona (AU)

Objective: To analyze whether the way of delivery varies according to the body mass index of the patients who are induced of labor and to evaluate the influence of other factors. Subjects and methods: A cross-sectional observational clinical-epidemiological study. We analyzed 172 inductions of labor between August and October 2016. We compared the different variables according to the way of delivery using parametric statistical tests. Conclusions: Excessive weight, as at the beginning as at the end of gestation, as well as a high weight gain increase the risk of terminating delivery by caesarean section. Other factors that increase the risk of cesarean section in a patient to whom labor is induced are: having a previous cesarean section, being primiparous or inducing labor with dinoprostona (AU)

Efficacy and safety of misoprostol, dinoprostone and Cook's balloon for labour induction in women with foetal growth restriction at term.

BACKGROUND AND OBJECTIVES: To compare effectiveness and safety of dinoprostone, misoprostol and Cook's balloon as labour-inducing agents in women with intrauterine growth restriction (IUGR) at term. METHODS: Retrospective cohort chart review of women diagnosed with foetal growth restriction at term in Reina Sofia Hospital, Cordoba, Spain from January 2014 to December 2015. Registration of baseline characteristics and method of induction was made. The main outcome was time from induction to delivery. Obstetric and perinatal outcomes were also collected. RESULTS: A total of 99 women were diagnosed with IUGR in the mentioned period. Of them, 21 women were induced with dinoprostone [dinoprostone group (DG)], 20 with misoprostol (MG) and in 58 with Cook's balloon (CG). Groups were homogeneous regarding pre-induction Bishop score and parity. The CG required more time (24.36 vs. 19.23 h; p = 0.02) and more oxytocin dose for conduction of labour from induction to delivery (6.75 vs. 1.24 mUI; p < 0.01) than DG. Moreover, the CG also needed more oxytocin than MG, 6.75 vs. 2.37 mUI (p < 0.001). Caesarean rate was 5, 14.9 and 17.3% in MG, DG and CG, respectively. No differences were observed in rates of uterine tachysystole, non-reassuring foetal status and neonatal adverse events. INTERPRETATION AND CONCLUSIONS: Prostaglandins were more effective than Cook's balloon to induce labour and achieve vaginal birth in this sample of women with IUGR at term, with a similar safety profile.

Diagnóstico precoz del cáncer de cérvix: correlación entre citología, colposcopia y biopsia / Early diagnosis of cérvix cancer: correlation between cytology, colposcopy and biopsy

Objetivo: determinar la concordancia entre citología, colposcopia y biopsia cervical ante una citología alterada. Material y métodos: se realizó un estudio observacional retrospectivo transversal, de base clínica, único centro. La población seleccionada fue 416 mujeres, entre 25 y 65 años con citología alterada, del 1 de agosto de 2014 al 30 de septiembre de 2016, y remitidas para estudio colposcópico y anatomopatológico al Hospital Reina Sofía, Córdoba. Se realizaron análisis estadísticos, utilizando el índice de Kappa para el grado de concordancia entre citología, colposcopia y biopsia. Resultados: se encontró una concordancia insignificante entre citología: colposcopia, k = 0,16 (IC 95% = 0,09- 0,22); una concordancia moderada entre colposcopia: biopsia, k = 0,57 (IC 95% = 0,47-0,68); y una concordancia insignificante entre citología: biopsia, k = 0,21 (IC 95%, 0,08-0,34). Conclusiones: el grado de acuerdo fue mejor entre colposcopia y biopsia; que entre citología y biopsia o entre citología y colposcopia (AU)

Objective: To determine the concordance between cytology, colposcopy and cervical biopsy in altered cytology. Material and methods: An observational cross-sectional, clinically based, single center study was performed. The selected population were 416 women between 25 and 65 years old with altered cytology, from August 1, 2014 to September 30, 2016, and submitted for colposcopic and anatomopathological study to the Reina Sofía Hospital, Córdoba. Statistical analyzes were performed using the Kappa index for the degree of concordance between cytology, colposcopy and biopsy. Results: There was an insignificant concordance between cytology: colposcopy, k = 0.16 (95% CI = 0.09-0.22), a moderate concordance between colposcopy: biopsy, k = 0.57 (95% CI = 0.47-0.68); And an insignificant concordance between cytology: biopsy, k = 0.21 (95% CI, 0.08-0.34). Conclusions: The degree of agreement was better between colposcopy and biopsy; that between cytology and biopsy or between cytology and colposcopy (AU)

What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study.

OBJECTIVE: To evaluate the costs associated with induction of labour in intrauterine growth restriction fetuses comparing different procedures. STUDY DESIGN: 150 pregnancies at term diagnosed with intrauterine growth restriction and indication for induction of labour were included. 24 were ripened with misoprostol 25 µg tablets, 24 with dinoprostone 10 mg vaginal insert, and 77 with Cook® cervical ripening balloon. To determine the costs of induction of labour, method of induction, intrapartum medication, epidural analgesia, type of delivery, and maternal and neonatal admissions were considered. Statistical analysis was performed using the G-Stat 2.0 free statistical software. ANOVA test was used for comparisons between quantitative parametric variables. Chi-squared test or Fisher test was used for qualitative variables. A value of p < 0.05 was considered statistically significant. RESULTS: Up to 70.83% women in dinoprostone group gave birth within the first 24 h compared to 42.66% in misoprostol group and 36.36% in CG (p < 0.01). Misoprostol tablets were cheaper (9.45 ± 1.52 US dollars) than dinoprostone or Cook® balloon (41.67 ± 0 and 59.85 ± 0 54.45 ± 0 US dollars, respectively) (p < 0.01). Costs related to maternal admissions were higher in CG (475.13 ± 146.95$) than dinoprostone group (475.13 ± 146.95$) or MG (427.97 ± 112.65$) (p = 0.03). Total costs in misoprostol group (2765.18 ± 495.38$) were lower than in the dinoprostone group (3075.774 ± 896.14$) or Cook® balloon group (3228.02 ± 902.06$) groups. CONCLUSIONS: Misoprostol for induction of labour had lower related costs than dinoprostone or Cook® balloon, with similar obstetrical and perinatal outcomes.

Influencia de la morfología del espermatozoide en los resultados obtenidos tras inyección intracitoplasmática de espermatozoides / Influence of sperm morphology on results obtained after intracytoplasmic sperm injection

Objetivo: estudiar la influencia de la morfología del espermatozoide seleccionado para inyección intracitoplasmática de espermatozoides sobre la tasa de gestaciones tras la realización de la técnica. Material y métodos: análisis retrospectivo de 174 parejas sometidas a inyección intracitoplasmática. Estudio descriptivo de las variables del seminograma y de variables clínicas de la mujer, así como un análisis multivariante de regresión logística de las mismas para valorar su influencia en el éxito de inyección intracitoplasmática de espermatozoides. Resultados: encontramos que la morfología del espermatozoide usado para la fecundación se manifiesta como factor independiente de influencia negativa, OR de 2,94 [IC 95% (1,10-7,83)], junto con una edad mayor de 35 años, OR 1,98 [IC 95% (1,03-3,81)], para el éxito de la inyección intracitoplasmática de espermatozoides. Conclusiones: la morfología del espermatozoide inyectado influye negativamente en la tasa de embarazos bioquímicos tras inyección intracitoplasmática de espermatozoides, apoyando por lo tanto, que es una buena técnica, ya que permite seleccionar espermatozoides de morfología normal en pacientes con teratozoospermia (AU)

Objective: To study the influence of spermatozoa morphology selected for intracytoplasmic sperm injection on the rate of pregnancies after the completion of the technique. Material and Methods: Retrospective analysis of 174 couples undergoing Intracytoplasmic sperm injection. Descriptive study of seminogram variables, clinical variables of women and a multivariate logistic regression analysistoassesstheinfluenceonthesuccess of Intracytoplasmic sperm injection. Results: We found that the morphology of the spermatozoa used for fertilization is manifested as an independent factor of negative influence, OR 2.94 [95% CI (1.10 to 7.83)], together with an age over 35 years, OR 1, 98 [95% CI (1.03 to 3.81)], for the success of Intracytoplasmic sperm injection. Conclusions: Abnormal spermatozoa morphology injected influences negatively in the rate of biochemical pregnancies, supporting therefore the Intracytoplasmic sperm injection as a good technique because it allows us to select normal spermatozoa morphology in patients with teratozoospermia (AU)

Incontinencia urinaria 6 meses tras parto. Factores de riesgo asociados / Urinary incontinence since 6 months after delivery. Associated risk factors

Este estudio permite aproximarnos a la incidencia de incontinencia urinaria de esfuerzo a los 6 meses postparto en nuestro medio, lo que puede ser útil para proponer una actuación tanto a nivel de atención primaria como hospitalaria para poder disminuir el impacto que los posibles factores de riesgo ejercen, como por ejemplo un buen programa de entrenamiento de la musculatura pélvica con ejercicios de Kegel podría reducir la aparición de esta patología, de esta forma, se podría minimizar la morbilidad que sufren estas pacientes. Handa y cols. (21) concluyó que las pacientes que presentaban incontinencia urinaria o anal presentaban un moderado o alto impacto negativo en su vida diaria tras encuestar a 759 pacientes. Para finalizar, se concluye que existen diferentes evidencias en cuanto a los factores de riesgo asociados a la aparición de incontinencia urinaria postparto. El tipo de parto no tiene relación estadísticamente significativa con la aparición de esta sintomatología. No obstante, al existir literatura a favor y en contra de esta hipótesis se precisan más estudios que permiten concluir que vía del parto es la menos favorable para presentar incontinencia urinaria. Los autores, admiten que se podrían inferir más datos si se aumenta el número de pacientes evaluadas (AU)

This study allows us to approach the incidence of stress urinary incontinence at 6 months postpartum in our setting, which may be useful to propose a performance at both primary and hospital care levels, in order to reduce the impact that possible risk factors exert, such as for example, a good pelvic muscle training program with Kegel exercises could reduce the onset of this pathology, thus minimizing the morbidity of these patients. Handa et al. (21) concluded that patients with urinary incontinence or anal had a moderate or high negative impact in their daily lives after surveying 759 patients. Finally, we conclude that there is different evidence regarding the risk factors associated with the occurrence of postpartum urinary incontinence. The type of delivery has no statistically significant relationship with the appearance of this symptomatology. However, because there is literature for and against this hypothesis, more studies are needed to conclude that the way of delivery is the least favorable for presenting urinary incontinence. The authors admit that more data could be evidenced by increasing the number of patients evaluated (AU)

Vaginal misoprostol and cervical ripening balloon for induction of labor in late-term pregnancies.

AIM: The aim of this study was to compare vaginal misoprostol with the Cook cervical ripening balloon (CCRB) for induction of labor in late-term nulliparous women. METHODS: This open, quasi-experimental, prospective study included 109 nulliparous women with late-term pregnancies and Bishop scores < 7. Fifty-five women were allocated to receive vaginal misoprostol 25 mcg and 54 received the CCRB to induce labor. The primary outcome was the time until delivery. Secondary outcomes included time to the onset of labor and obstetric and perinatal outcomes. RESULTS: Women in the misoprostol group experienced shorter time until delivery (25.41 h vs 31.26 h; P < 0.01) and in a greater percentage gave birth within the first 24 h. Time to active stage of labor was 19.5 h and 23.8 h (P < 0.01) for misoprostol and the CCRB, respectively. There were no differences in the rates of cesarean section or post-partum anemia. Additionally, there were no differences in rates of tachysystolia, intrapartum fever, or meconium. Perinatal outcomes, post-partum pH, Apgar scores, and neonatal admissions were similar in the two groups. CONCLUSION: Misoprostol 25 mcg reduces labor induction time compared with the CCRB with similar safety in late-term pregnancies.

Essure a novel option for the treatment of hydrosalpinx: a case series and literature review.

OBJECTIVE: The aim of this study is to evaluate the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx (HS)-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following IVF-ICSI treatment with those patients having had laparoscopic tubal occlusion (LTO). PATIENTS: From 2008 to 2014 a total of 50 patients were diagnosed with unilateral or bilateral hydrosalpinges: 29 patients had laparoscopic contraindications and were treated hysteroscopically and 21 patients were treated with laparoscopical salpingectomy. RESULTS: Of the 29 patients who underwent treatment with Essure(®), 21 began a cycle of in vitro fertilization (IVF), and 13 finished in embryo transfer that resulted in seven clinical pregnancies. Furthermore, in the group of women treated with salpingectomy, 17 started an IVF cycle that resulted in 12 clinical pregnancies. The clinical pregnancy rate per patient with an IVF cycle started was 33.3% and 70.6%, the live-birth rate per patient was 14.3% and 52.9%, the miscarriage rate was 57.1% and 18.2%, and the implantation rate was 16.3% and 34.1% for hysteroscopy and laparoscopy, respectively. CONCLUSION: Essure(®) placement is an alternative method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option may be considered when laparoscopy is impossible or contraindicated.

Influencia de la obesidad en la evolución del parto / Influence of obesity on mode of delivery

Objetivo: Analizar la influencia de la obesidad mórbida en la vía y comienzo del parto. Hipótesis: La obesidad mórbida aumenta la tasa de cesáreas e inducciones. Sujetos y métodos: Se diseñó un estudio retrospectivo, descriptivo poblacional, con gestantes que dieron a luz durante el año 2012 en el Hospital Universitario Reina Sofía; fueron excluidas las gestaciones gemelares. Se incluyó en el grupo de gestantes con obesidad mórbida a aquellas con un índice de masa corporal en la primera visita de embarazo (en torno a las 8 semanas de gestación) igual o superior a 40. El resto de las gestantes se incluyeron en el grupo de gestantes control. Las variables analizadas fueron: edad, paridad, comienzo del parto y tipo de parto. Resultados: Las gestantes con obesidad mórbida tienen una tasa más elevada de cesáreas que el resto de las gestantes (36,76% vs. 18,49%), p < 0,001, al igual que un mayor porcentaje de inducciones (50,79% vs. 25,81%), p < 0,001. Conclusiones: La obesidad mórbida aumenta el riesgo de cesáreas e inducciones (AU)

Objective: To analyze the influence of morbid obesity on mode of delivery and onset of labor. Hypothesis: Morbid obesity increases the cesarean section and induction rates. Subjects and methods: A population-based, retrospective, descriptive study was designed in women giving birth in 2012 at the Reina Sofía Hospital. Twin pregnancies were excluded. The women were classified according to body mass index (BMI) at the first prenatal visit (at around 8 weeks of gestation) into those who were morbidly obese (BMI greater than or equal to 40 kg/m2) and a control group (BMI less than 40 kg/m2). The variables analyzed were age, parity, onset of labor, and mode of delivery. Results: Morbidly obese pregnant women have a higher rate of cesarean sections than the control group (36.76% vs. 18.49%, P<.001) and a higher rate of inductions (50.79% vs. 25.81%, P<.001). Conclusions: Morbid obesity increases the risk of cesarean sections and inductions (AU)

Luteal phase support with progesterone in intrauterine insemination: a prospective randomized study.

OBJECTIVE: To determine the effect of vaginal progesterone as luteal support on pregnancy outcomes in infertile patients who undergo ovulation induction with gonadotropins and intrauterine insemination (IUI). DESIGN: Prospective randomized trial. SETTING: Tertiary referral center. PATIENT(S): About 398 patients with primary infertility were treated during 893 ovarian stimulation and IUI cycles from February 2010 to September 2012. METHODS: All patients underwent ovarian stimulation with gonadotropins combined with IUI. Patients in the supported group received vaginal micronized progesterone capsules 200 mg once daily from the day after insemination until next menstruation or continuing for up to 8 weeks of pregnancy. Women allocated in the control group did not receive luteal phase support. MAIN OUTCOME MEASURE(S): Livebirth rate, clinical pregnancy rate and early miscarriage rate per cycle. RESULT(S): Of the 893 cycles, a total of 111 clinical pregnancies occurred. There were no significant differences between supported with progesterone and unsupported cycle in terms of livebirth rate (10.2% versus 8.3%, respectively, with a p value = 0.874) and clinical pregnancy rate (13.8% compared with 11.0% in unsupported cycle with a p value = 0.248). An early miscarriage rate of 3.6% was observed in the supported cycles and 2.7% in the unsupported cycles, with no significant differences between the groups (p value = 0.874). CONCLUSION(S): In infertile patients treated with mildly ovarian stimulation with recombinant gonadotropins and IUI, luteal phase support with vaginal progesterone is not associated with higher livebirth rate or clinical pregnancy rate compared with patients who did not receive any luteal phase support.