Frecuencia de y cesáreas en establecimientos públicos y privados de la Provincia de Concepción, Chile, 2001-2019 / Caesareans section frequency in public and private establishments of the Province of Concepción, Chile, 2001-2019

Introducción: El porcentaje nacional de cesárea supera las recomendaciones internacionales, alcanzando altos niveles, con consecuencias significativas en la salud de la mujer. Por esta razón es un problema necesario de analizar. Objetivo: Describir la situación epidemiológica de las cesáreas en la Provincia de Concepción, periodo 2001-2019, según establecimiento y previsión. Material y métodos: Estudio observacional, descriptivo, ecológico, transversal. Incluye universo de partos en la Provincia de Concepción 2001-2019, datos del Departamento de Estadísticas e Información de Salud (DEIS). Recopilación y análisis según técnicas descriptivas en Microsoft Excel® Resultados: En establecimientos públicos, el número de partos disminuyó un 60.6%. En establecimientos privados aumentó 4.8 veces, junto al 39% de incremento en las cesáreas. Las pacientes pertenecientes al grupo A de menores ingresos de la aseguradora de salud pública, Fondo Nacional de Salud (FONASA), presentaron un porcentaje estable de cesáreas, en torno al 25%, mientras que el grupo D (de mayores ingresos) aumentó un 47.8% entre los años 2005 y 2009. Entre 2002 y 2019 el porcentaje promedio de cesáreas de pacientes pertenecientes a las aseguradoras privadas, Instituciones de Salud Previsional (ISAPRE), fue del 66.5%. Conclusiones: Se observó un aumento de cesáreas muy especialmente en recintos privados. La previsión de salud es un factor que considerar, particularmente el grupo FONASA-D, que presentó la mayor alza en las cesáreas, incluso más que las gestantes de ISAPRE. El porcentaje alarmante de cesáreas, especialmente en establecimientos privados, debe ser preocupación prioritaria para nuestro sistema de salud.

Introduction: The national caesarean section rate exceeds international recommendations, reaching elevated levels, with significant consequences on women's health. For this reason it is a necessary problem to analyze. Objective: To describe the epidemiological situation of caesarean sections in the Province of Concepción, period 2001-2019, according to establishment and forecast. Material and methods: Observational, descriptive, ecological, longitudinal study. Includes universe of births in the Province of Concepción 2001-2019, data from the Department of Statistics and Health Information (DEIS). Collection and analysis according to descriptive techniques in Microsoft Excel®. Results: In public establishments, the number of deliveries decreased by 60.6%. In private establishments it increased 4.8 times, together with the 39% increase in cesarean sections. Patients belonging to group A with the lowest income of the public health insurer, National Health Fund (FONASA), presented a stable percentage of caesarean sections, around 25%, while group D (with the highest income) increased 47.8% between 2005 and 2009. Between 2002 and 2019, the average percentage of caesarean sections of patients belonging to private insurers, Institutions of Social Security (ISAPRE), was 66.5%. Conclusions: An increase in caesarean sections was observed, especially in private facilities. Health insurance is a factor to consider, particularly the FONASA-D group, which presented the highest increase in cesarean sections, even more than ISAPRE pregnant women. The alarming percentage of caesarean sections, especially in private establishments, should be a priority concern for our health system.

Single-Port/Pneumovagina Technique for Two Further Applications.

OBJECTIVE: To demonstrate a novel technique to surgically treat certain vaginal conditions. DESIGN: Technical video demonstrating 2 cases in which the technique is used. SETTING: Gynecological Minimally Invasive and Robotic Surgery Unit at Clínica Universitaria (private clinic), Concepción, Chile. INTERVENTIONS: Local institutional review board was consulted, and this study was exempted from approval. Institutional ethics committee approved the study and publication of these data. A 35-year-old woman with a bicornuate unicollis uterus presented with dyspareunia. Her examination revealed an incomplete longitudinal vaginal septum. Her right hemivagina was slightly wider than the left one. With the patient under spinal anesthesia, we performed a complete resection of the septum using the single-port/pneumovagina technique (SPPT). A 36-year-old woman who was nulligravida presented with dyspareunia. On clinical exam she had a 3-cm leiomyoma in the proximal vaginal third. Doppler-powered pelvic ultrasound ruled out any vascular communication with the cervix. We performed a vaginal myomectomy using the SPPT under spinal anesthesia. In this particular case we used a fourth trocar in the gel cap to use a myoma screw. With this technique we created a pneumovagina occluding the introitus with the aid of a single-port device (GelPoint Path; Applied Medical, Rancho Santa Margarita, CA). We selected this particular device, designed for transanal surgery, because its access channel avoids gas leakage after applying gentle pressure on the cap. The working cannel is 4 × 4.5 cm, and up to 4 trocars can be inserted in the gel cap. We use 12 mm Hg of pressure to create the pneumovagina and 5 L/min flow to maintain it. Similar approaches have been described for treating eroded and/or infected sacrocolpopexy mesh [1-3]. One could question the utility of this approach over conventional vaginal surgery, and in this sense we believe it provides both the surgeon and surgical assistant a much more comfortable and ergonomic position while performing surgery. It also improves the view of anatomic structures for the surgical team, which in conventional vaginal surgery is limited only to the surgeon. Both procedures were uneventful. The operation time for the first patient was 5 minutes, and the patient was discharged 4 hours later. The operation time for the second patient lasted 35 minutes, and she was discharged 12 hours later. CONCLUSION: The creation of a pneumovagina with the application of a single-port device provides an excellent view of vaginal structures and allows the application of laparoscopic techniques to perform vaginal surgeries in a much more ergonomic fashion compared with conventional vaginal surgery.

Variante protrombótica C677T del gen metilenotetrahidrofolato reductasa es un biomarcador molecular de fallas de implantación en mujeres chilenas sometidas a protocolos de reproducción asistida / Prothrombotic variant C677T at the methylenetetrahydrofolate reductase gene is a molecular biomarker of implantation failure in chilean women undergoing assisted reproductive protocols

Las fallas de implantación son consideradas una importante causa de infertilidad en mujeres sometidas a protocolos de Fecundación Asistida. Evidencia reciente sugiere que la presencia de variantes protrombóticas está asociada a diversos defectos obstétricos y falla reproductiva. Sin embargo, los resultados en diversas poblaciones son contradictorios. De acuerdo a esta evidencia, se evaluó la potencial asociación entre variantes protrombóticas y fallas de implantación en mujeres chilenas incluidas en protocolos de fecundación asistida. Un total de 180 mujeres, 80 pacientes sometidas a protocolos de reproducción asistida y 100 controles fueron incluidas en este estudio. La genotipificación molecular de variantes protrombóticas en genes candidatos fue realizada por PCR-RFLP. Observamos una paciente heterocigota para la variante F5 G1691A y ausencia total del polimorfismo F2 G20210A en pacientes y controles. La distribución genotípica y la distribución relativa de alelos del polimorfismo MTHFR C677T fueron significativamente diferentes entre pacientes y controles. Odds Ratio para fallas de implantación asociadas al genotipo homocigoto fue 2,78 (95 por ciento IC 1,147 - 6,755; p= 0,0199). En resumen, nuestros resultados sugieren que la variante MTHFR C677T constituye un biomarcador molecular de susceptibilidad a fallas de implantación población chilena.

Implantation failures are considered an important cause of infertility in women undergoing assisted reproductive protocols. Recent evidence suggests that the presence of prothrombotic variants is associated with obstetric defects and reproductive failure. However, results between several populations are contradictory. According this evidence, we evaluated the potential association between prothrombotic variants and implantation failure susceptibility in Chilean women undergoing Assisted Reproductive protocols. 180 women, 80 patients undergoing assisted reproductive protocols and 100 controls were included in this study. Molecular genotyping of prothrombotic variants in candidate genes was realized by PCR-RFLP. We observed one patient heterozygote for factor V G1691A variant, and total absence to prothrombin G20210A polymorphism in patients and controls. Genotype distribution and allelic frequencies of MTHFR C677T polymorphism were significantly different between patients and controls (p<0.05). Odss Ratio for implantation failure associated to homozygote genotype was 2.78 (95 percent IC 1.147 ¡ 6.755; p= 0.0199). In summary, our data suggest that the MTHFR C677T polymorphism constituted a molecular biomarker of implantation failure susceptibility in Chilean population.

Mixoma de localización prostática como causa de obstrucción urinaria / Myxoma of prostatic location as the cause of urinary obstruction

Se presenta el caso de un hombre de 64 años de edad, afectado por un mixoma en la próstata como causa de obstrucción urinaria baja. Se trataba de un tumor benigno, que presumiblemente provenía de la reversión de tejido mesenquimatoso indiferenciado, de aspecto mucoide o gelatinoso, y que además resulta extremadamente raro en el aparato genitourinario y más aún en la localización prostática. La curación suele obtenerse con la extirpación quirúrgica, sobre todo cuando la masa tumoral está encapsulada, como ocurría en este paciente

Mixoma de localización prostática como causa de obstrucción urinaria / Myxoma of prostatic location as the cause of urinary obstruction

Se presenta el caso de un hombre de 64 años de edad, afectado por un mixoma en la próstata como causa de obstrucción urinaria baja. Se trataba de un tumor benigno, que presumiblemente provenía de la reversión de tejido mesenquimatoso indiferenciado, de aspecto mucoide o gelatinoso, y que además resulta extremadamente raro en el aparato genitourinario y más aún en la localización prostática. La curación suele obtenerse con la extirpación quirúrgica, sobre todo cuando la masa tumoral está encapsulada, como ocurría en este paciente(AU)

Hemangiendoteliosarcoma de los cuerpos cavernosos del pene / Hemangioendotheliosarcoma of the cavernous bodies of the penis

Se presenta un hemangioendoteliosarcoma (angiosarcoma) de los cuerpos cavernosos del pene en un hombre de 53 años de edad; tumor maligno de origen vascular, muy raro en esta localización. Se describe la evolución clínica del paciente, el cual solo pudo ser tratado con medidas paliativas por lo avanzado del proceso neoplásico y falleció a causa de grave edema cerebral e hipertensión endocraneal(AU)

Hemangiendoteliosarcoma de los cuerpos cavernosos del pene / Hemangioendotheliosarcoma of the cavernous bodies of the penis

Se presenta un hemangioendoteliosarcoma (angiosarcoma) de los cuerpos cavernosos del pene en un hombre de 53 años de edad; tumor maligno de origen vascular, muy raro en esta localización. Se describe la evolución clínica del paciente, el cual solo pudo ser tratado con medidas paliativas por lo avanzado del proceso neoplásico y falleció a causa de grave edema cerebral e hipertensión endocraneal

The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.

OBJECTIVE: We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect. METHODS: We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding. RESULTS: In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch. CONCLUSIONS: The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low-cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.