Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review.

BACKGROUND: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007. OBJECTIVES: To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH. SEARCH STRATEGY: A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library. SELECTION CRITERIA: All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases. DATA COLLECTION AND ANALYSIS: Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review. MAIN RESULTS: The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3-100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9-90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%). CONCLUSIONS: PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.

Desórdenes psiquiátricos en el puerperio: nuestro papel como obstetras / Psychiatric disorders in the puerperium: Our role as obstetricians

La enfermedad mental constituye un grave problema de salud pública en nuestro ámbito, con una elevada morbilidad, unos costes sociosanitarios muy altos y con una mayor incidencia en mujeres. El periodo gestacional y el puerperio se erigen como factores estresantes capaces de desencadenar o exacerbar la enfermedad mental preexistente. Con esta revisión bibliográfica pretendemos sensibilizarnos sobre la importancia que la morbilidad psíquica oculta representa para la mujer (como individuo) y para la sociedad (como colectivo), identificar los grandes síndromes psiquiátricos más frecuentes, (distinguiendo los que nosotros podemos tratar de los que deben ser derivados al especialista en salud mental), y profundizar en las entidades estrechamente relacionadas con la Obstetricia durante el periodo puerperal (depresión y psicosis posparto)

Mental illness is a serious public health problem in our setting, leading to high morbidity and very high social costs. The incidence of mental illness is higher in women. Pregnancy and the puerperium are stressors that can trigger or exacerbate preexisting psychiatric disorders. This review aims to raise awareness of the importance of hidden psychological morbidity in women both for individuals and for society as a whole, to identify the most common major psychiatric syndromes -distinguishing those that can be treated by gynecologists from those that require referral to a specialist mental health service- and to examine in greater depth the disorders that are closely related to Obstetrics during the puerperium (depression and postpartum psychosis)

Correlation between the extent of intraperitoneal disease and nodal metastasis in node-positive ovarian cancer patients.

AIMS: To investigate correlations between extent of disease (ED), frequency and location of nodal metastases in node-positive EOC patients. METHODS: Data were collected from 116 consecutive patients who underwent systematic lymphadenectomy during primary surgery. Patients were grouped in ED1 (disease confined in pelvis), ED2 (disease extended to abdomen), and ED3 (distant metastases). Univariate and multivariate analysis were performed for overall survival and progression-free survival (PFS). RESULTS: Correspondence analysis revealed associations between ED1 and negative nodes, ED2 and positive aortic/pelvic nodes, and ED3 and positive external and common iliac nodes. The most representative group for nodal metastases in ED1 was aortic nodes (77.8%). The number of positive pelvic nodes increased with ED; the RR was 0.58 for ED2 and 0.25 for ED3 (p = 0.004). The RR for positive external iliac nodes was 0.66 in ED2 and 0.31 in ED3 (p = 0.002); the RR for positive common iliac nodes was 0.76 and 0.17, respectively (p = 0.001). Multivariate analysis revealed that aortic nodal metastasis was associated with PFS (p = 0.03; HR, 1.95). CONCLUSION: Distribution and percentage of nodal metastases varied with ED. The risk of pelvic nodal metastasis, increased with ED. Location of positive nodes was correlated with PFS.

Second-trimester fetal aberrant right subclavian artery: original study, systematic review and meta-analysis of performance in detection of Down syndrome.

OBJECTIVES: First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second-trimester ARSA to identify fetuses with Down syndrome. METHODS: ARSA was assessed by ultrasound in the axial plane and confirmed in the longitudinal and coronal planes during the second half of pregnancy in women attending our unit (from February 2011 to December 2012). A search of diagnostic tests for the assessment of ARSA was carried out in international databases. Relevant studies were subjected to a critical reading, and meta-analysis was performed with Meta-DiSc. RESULTS: Of the 8781 fetuses in our population (mean gestational age: 24 ± 5.4 weeks), 22 had Down syndrome. ARSA was detected in the axial view in 60 cases (0.7%) and confirmed in the coronal view in 96.7% and in the longitudinal view in 6.7% (P < 0.001). Seven cases with ARSA had Down syndrome and all were in the non-isolated-ARSA group. The estimates of positive likelihood ratio (LR) were 0 for isolated ARSA and 199 (95% CI, 88.9-445.2) for non-isolated ARSA. In the systematic review, six studies were selected for quantitative synthesis. The pooled estimates of positive and negative LRs for global ARSA were, respectively, 35.3 (95% CI, 24.4-51.1) and 0.75 (95% CI, 0.64-0.87). For isolated ARSA, the positive and negative LRs were 0 (95% CI, 0.0-14.7) and 0.98 (95% CI, 0.94-1.02), respectively. CONCLUSIONS: The prevalence of ARSA seems close to 1%. The coronal plane is the most suitable for its confirmation after detection in the axial plane. Detection of isolated or non-isolated ARSA should guide decisions about karyotyping given that isolated ARSA shows a weak association with Down syndrome.

Cáncer invasivo de vulva: importancia e implicaciones pronósticas de un diagnóstico precoz / Invasive cancer of the vulva: prognostic importance and implications of early diagnosis

A pesar de que el cáncer de vulva se ha considerado tradicionalmente como una enfermedad poco frecuente y de presentación en edades avanzadas, la realidad actual nos muestra una incidencia creciente en mujeres entre la tercera y quinta décadas de la vida, probablemente debido a la adquisición de nuevos hábitos higiénico-dietético-sociales y como consecuencia de una mejoría del conocimiento médico y realización de pruebas complementarias cada vez más específicas que permiten un diagnóstico más temprano. Este diagnóstico precoz es el que marcará el devenir y el mejor pronóstico de esta enfermedad en nuestras pacientes, por lo que debemos ser minuciosos en la valoración clínica de esta región anatómica, en la evaluación de los síntomas referidos por las pacientes, así como en el estudio macroscópico y colposcópico de la presencia o no de lesiones asociadas en la zona (AU)

Although vulvar cancer has traditionally been considered a rare disease that occursat advanced ages, the current reality shows a rising incidence in women in the third to fifthdecades of life. This increase is probably due to new dietary and social hygiene habits and to improved medical knowledge and increasingly specific complementary tests, which allow earlier diagnosis. An early diagnosis is a key factor in achieving an optimal prognosis. Consequently, careful physical examination, assessment of the symptoms reported by patients, and macroscopic and colposcopic study to determine the presence or absence of associated lesions in the area are essential (AU)

Fetal thymus size in uncomplicated twin and singleton pregnancies.

OBJECTIVES: The main objective of this study was to determine whether fetal thymic measurements could be obtained in twins, with a secondary goal to determine whether thymic measurements from uncomplicated singleton and twin pregnancies are comparable. METHODS: The transverse diameter and perimeter of the fetal thymus were measured prospectively in 678 singleton and 56 twin pregnancies, and their relationships with gestational age were determined and compared between groups. RESULTS: Thymic measurements were possible in 757 (95.8%) of the 790 fetuses. Measurements were not possible in 19 of 678 singletons (2.8%) and in 14 of the 112 (12.5%) twins (P < 0.001). After construction of nomograms for the transverse diameter and perimeter of the fetal thymus, similar measurements were noted for singletons and twins. CONCLUSIONS: These results suggest that sonographic measurements of the thymus are feasible in twin pregnancies and that, in uncomplicated pregnancies, these measurements are similar to those noted for singletons. These findings pave the way for future studies aimed at determining the clinical utility of thymic measurements in complicated singleton and twin pregnancies.

Embarazo ectópico cervical: tratamiento combinado de metotrexato sistémico e intrasacular / Cervical ectopic pregnancy: combined treatment of systemic and intrasacular methotrexate

Se describe un caso de embarazo ectópico cervical, cuya presentación habitual es una metrorragia irregular durante el primer trimestre de gestación. La estrategia diagnóstica no difiere de los embarazos ectópicos de otra localización, donde un valor elevado de Beta -HCG y el estudio ecográfico resultan fundamentales. La imagen más frecuente es un útero vacío con anejos normales y una vesícula gestacional a escala cervical, en contadas ocasiones con polo embrionario y latido cardíaco positivo, como en nuestro caso. La importancia del diagnóstico temprano se basa en intentar un tratamiento lo más conservador posible y mantener la fertilidad de la paciente. El tratamiento médico con metotrexato sistémico e intrasacular resulta una alternativa terapéutica bastante eficaz y válida para conseguir una escasa morbilidad (AU)

Diagnóstico ecográfico del quiste de ovario fetal y conducta terapéutica pre y postnatal / Fetal ovarian cysts prenatal diagnostic and pre/postnatal management

Se estudia la conducta diagnóstica y terapeútica del quiste de ovario tanto en el feto como en el recién nacido a propósito de 10 casos habidos en nuestro departamento entre noviembre de 1996 y junio del 2000. La prevalencia fue de 1/1405 nacidos. La edad gestacional media en la que se realizó el diagnóstico fue 31.5 semanas, siendo el diagnóstico más precoz en la semana 28. El tamaño del quiste fue inferior a 40 mm en 4 casos. No se pudo identificar ningún factor materno que tuviera relación epidemiológica en su aparición y desarrollo. Tampoco se produjeron complicaciones fetales que obligasen a interrumpir la gestación antes del término. El único caso de finalización del embarazo mediante cesárea lo fue por indicación obstétrica. La evolución fue variable resolviéndose espontáneamente durante el período fetal en tres casos y en el neonatal en otros 3. Cuatro recién nacidos precisaron cirugía para extirpar el quiste, realizándose en 2 de ellos quistectomía y en otros dos anexectomía. A la vista de nuestros resultados, ante el diagnóstico ecográfico de quiste de ovario fetal se deberá adoptar una conducta expectante, tanto durante la gestación como en el período postnatal. En caso de precisar cirugía, ésta deberá ser lo más conservadora posible (AU)

Patología endometrial y THS / Endometrial disease and THS

No disponible

A new method for the diagnosis of pelvic pathology by gammagraphy. Part I - description of the method and normal results.

This is an original method for the diagnosis of pelvic congestion, consisting in the utilization of a radio-isotope suitable for vascular examinations. We have chosen the 13mIn, injected into the patients under operating conditions identical in dosage per kg weight, position, length of exposure, day of cycle etc. The radioactivity emitted is received by an external detector, in this case the Gamma camera. The correlation between a higher degree of radioactivity and the presence of pelvic varicosities is analysed. The criteria employed were: 1 degrees the gammagraphic immages; 2 degrees the profiles taken at the level of the infundibulus and 3 degrees the "information units" measured and accumulated by the gammacamera at each point of the profile. A description of a normal pelvic gammagraphy was made, with the characteristics which define it and differenciate it from the pathologies. Finally the physiological gammagraphic variations present in multiparous patients were considered.

A new method for the diagnosis of pelvic pathologies Part II - interpretation of abnormal images.

The results presented are those presented are those obtained on the diagnosis of pelvic congestion by means of the use of radioactive isotopes, following an original method proposed by us and previously described. It has been carried out on 100 patients, of whom 6 were normal and 94 presented some gynecological pathology in the internal genitals. Laparatomy was carried out, proving the lesions visually in 51 cases. The diagnosis was correct in 98% of the cases. Finally the advantages which it presents over phlebography were analysed, and the possibilities of the method in gynecological practice suggested, since it can be used in a great number of genital diseases to carry out a diagnosis of vascular pathology.