Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain.

BACKGROUND: Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis? METHODS: This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation. RESULTS: We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment. CONCLUSIONS: Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.

Aspiración manual endouterina para el tratamiento del aborto incompleto / Manual endouterine aspiration in the treatment of incomplete abortion

La aspiración manual endouterina (AMEU) es un procedimiento propuesto para el vaciamiento uterino, en casos de aborto incompleto, mediante una jeringa de plástico con la que se produce una presión negativa para realizar la aspiración. Con esta técnica, se efectuaron 122 tratamiento de aborto en sus diferentes variedades, en el Instituto Nacional de Perinatología, y los resultados obtenidos se compararon con los logrados en el mismo periodo en 126 mujeres tratadas, también por aborto, mediante legrado uterino instrumental (LUI). Las características sociodemográficas de ambos grupos de pacientes fueron similares; pero, en cuanto las variedades de aborto, la de aborto molar y la de aborto diferido predominaron en las pacientes tratadas con AMEU. Los procedimientos anestésicos usados fueron similares en ambos grupos, salvo en 10 casos tratados con AMEU, en que se empleó bloqueo paracervical. Sólo se observaron 4 complicaciones transoperatorias: dos casos de hemorragia, uno en AMEU y otro en LUI; y 2 en AMEU, en que la evacuación resultó insuficiente y obligó a LUI posterior. El estudio histopatológico con técnicas morfométricas mostró proporción relativa de tejidos fetales, vellosidades coriónicas, decidua, miometrio y coágulos, similar para ambos procedimientos. Los autores concluyen que la técnica de AMEU es igulamente eficaz y segura que el LUI, su práctica es fácil de realizar, evita complicaciones importantes y puede constituir una alternativa ventajosa en los casos de aborto molar