Periodo intergenésico: Revisión de la literature / Intergenesis period: Literature review

RESUMEN ANTECEDENTES: El período intergenésico es importante para la planificación de embarazos subsecuentes a partos, cesáreas y abortos. Actualmente existe falta de consenso en cuanto a las definiciones e importancia clínica de la duración del periodo intergenésico; por lo que se realiza esta revisión de la literatura para definir conceptos. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed y Medline, con periodo de búsqueda del 19992017, con el propósito de identificar publicaciones de relevancia relacionadas a periodo intergenésico. RESULTADOS: Entre los artículos seleccionados, se incluyeron de tipo revisión, originales y guías de práctica clínica. Se considera periodo intergenésico aquel que se encuentra entre la fecha del último evento obstétrico y el inicio del siguiente embarazo. Se sugiere como tiempo recomendado de espera para iniciar un siguiente embarazo mínimo 18 meses (Periodo intergenésico corto, PIC) y no más de 60 meses (Periodo intergenésico largo, PIL), para reducir el riesgo de eventos adversos maternos, perinatales y neonatales. Se debe enfatizar que aunque la dehiscencia de histerorrafia es una grave complicación del PIC menor a 6 meses posterior a una cesárea, no es su única complicación. De igual manera es importante tomar en cuenta el PIL durante la evaluación obstétrica, debido a su asociación con preeclampsia. CONCLUSIONES: Es relevante conocer la terminología adecuada en período intergenésico para evitar complicaciones asociadas a PIC como a PIL. Existe necesidad de estudios clínicos sobre período intergenésico que permitan conocer más consecuencias a corto y largo plazo en nuestra población y tomar medidas para mejorar el desenlace materno-fetal.

ABSTRACT BACKGROUND: Interpregnancy interval is a topic of importance when planning new pregnancies after previous vaginal delivery, cesarean section or abortion. There is currently a lack of consensus in terms of definitions and the clinical importance of interpregnancy interval length, which is the reason to perform a literature review to clarify concepts. METHODS: Published papers from 1999 to 2017 from PubMed/MEDLINE were searched with the purpose of identifying those related to interpregnancy interval. Review articles, original papers, and clinical guidelines in relation to short and long interpregnancy interval were considered. RESULTS: Interpregnancy interval is defined as the period between the last obstetric event and the beginning of the next pregnancy (last menstrual period). Recommended time to initiate the next pregnancy must be at least 18 months (short interpregnancy interval, SII) and no more than 60 months (long interpregnancy interval, LII) to reduce the risk of adverse maternal, perinatal and neonatal outcomes. It is important to emphasize that even though uterine scar dehiscence is a serious complication of SII less than 6 months after a cesarean section, it is not the only complication. It is important to consider LII during obstetric evaluation, due to its association with preeclampsia. CONCLUSION: It is clinically relevant to know the correct definitions of SII and LII to avoid their complications. There is also a need for clinical trials about interpregnancy interval within our population in order to better understand the consequences of SII and LII, thus taking the necessary measures to improve maternal and fetal outcomes.

[Incidence of endometriosis in infertile women: clinical and laparoscopic characteristics]. / Incidencia de la endometriosis en mujeres con infertilidad: características clínicas y laparoscópicas.

BACKGROUND: The incidence and symptomatology of endometriosis vary according to the different populations. OBJECTIVES: To determine the incidence of endometriosis as well as the clinical and laparoscopic characteristics in infertile women with endometriosis. PATIENTS AND METHODS: This study included 68 infertile patients with endometriosis diagnosed by laparoscopy; in all of them we analyzed the demographic and clinical characteristics. RESULTS: In 68 out of 197 medical files that were analyzed, endometriosis was reported (34.5%). The average age was 30.3 +/- 3.9 years. Forty patients had primary infertility (58.8%) and 28 (41.29%) secondary infertility. In 34 patients endometriosis (50%) was mild, moderate in 16 (23.5%) and severe in 18 (26.5%). Only one endometriosic foci was found in 25% of the patients and multiple foci in 75% of them. The most common sites in which it was found were the uterosacral ligaments, Douglas pouch and the ovaries. In patients with primary infertility it predominated the medium-high socioeconomic level and in those with secondary infertility the low one. In severe endometriosis the predominant symptom was the moderate or severe dysmenorrhea, while in mild and moderate endometriosis was mild dysmenorrhea (p < 0.007). Six out of 16 patients with severe endometriosis had endometrioma. CONCLUSIONS: The endometriosis incidence in infertile women was similar to that reported in literature, as well as age of presentation. It was also observed a direct relationship between endometriosis severity and dysmenorrhea intensity.