Attention-deficit/hyperactivity disorder as a risk factor for being involved in intimate partner violence and sexual violence: a systematic review and meta-analysis.

BACKGROUND: Intimate partner violence (IPV) and sexual violence (SV) are significant problems world-wide, and they affect women disproportionally. Whether individuals with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of being involved in these types of violence is unclear. METHODS: We carried out a systematic review and meta-analysis (PROSPERO registration CRD42022348165) of the associations between ADHD and being the victim or perpetrator of IPV and SV. Ratios of occurrence of violence were pooled in random-effects models and study risk of bias was evaluated using the Newcastle-Ottawa Scale. RESULTS: A search on multiple databases, carried out on 7 October 2022, yielded 14 eligible studies (1 111 557 individuals). Analyses showed a higher risk of ADHD individuals being involved in IPV as perpetrators (six studies, OR 2.5, 95% CI 1.51-4.15) or victims (four studies, OR 1.78, 95% CI 1.06-3.0). Likewise, individuals with ADHD were at increased risk of being perpetrators (three studies, OR 2.73, 95% CI 1.35-5.51) or victims of SV (six studies, OR 1.84, 95% CI 1.51-2.24). Results were overall robust to different analytical choices. CONCLUSIONS: Individuals with ADHD are at an increased risk of being involved in cases of violence, namely IPV and SV, either as victims or perpetrators. Although the causal path or mediating variables for these results are still unclear, this increased risk should inform evidence-based psychoeducation with individuals with ADHD, their families, and partners about romantic relationships and sexuality.

Associations between mental and physical conditions in children and adolescents: An umbrella review.

We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 systematic reviews/meta-analyses, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHD-obesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.

Personal Protective Equipment during the COVID-19 pandemic and operative time in cesarean section: retrospective cohort study.

INTRODUCTION: The covid-19 pandemic has meant a change in working protocols, as well as in Personal Protective Equipment (PPE). Obstetricians have had to adapt quickly to these changes without knowing how they affected their clinical practice. The aim of the present study was to evaluate how COVID-19 pandemic and PPE can affect operative time, operating room time, transfer into the operating room to delivery time and skin incision to delivery time in cesarean section. METHODS: This is a single-center retrospective cohort study. Women with confirmed or suspected SARS-CoV-2 infection having a cesarean section after March 7th, 2020 during the COVID-19 pandemic were included in the study. For each woman with confirmed or suspected SARS-CoV-2 infection, a woman who had a cesarean section for the same indication during the COVID-19 pandemic and with similar clinical history but not affected by SARS-CoV-2 was included. RESULTS: 42 cesarean sections were studied. The operating room time was longer in the COVID-19 confirmed or suspected women: 90 (73.0 to 110.0) versus 61 (48.0 to 70.5) minutes; p < .001. The transfer into the operating room to delivery time was longer, but not statistically significant, in urgent cesarean sections in COVID-19 confirmed or suspected women: 25.5 (17.5 to 31.75) versus 18.0 (10.0 to 26.25) minutes; p = .113. CONCLUSIONS: There were no significant differences in the operative time, transfer into the operating room to delivery time and skin incision to delivery time when wearing PPE in cesarean section. The COVID-19 pandemic and the use of PPE resulted in a significant increase in operating room time.

Risk of poisoning in children and adolescents with ADHD: a systematic review and meta-analysis.

Poisoning, a subtype of physical injury, is an important hazard in children and youth. Individuals with ADHD may be at higher risk of poisoning. Here, we conducted a systematic review and meta-analysis to quantify this risk. Furthermore, since physical injuries, likely share causal mechanisms with those of poisoning, we compared the relative risk of poisoning and injuries pooling studies reporting both. As per our pre-registered protocol (PROSPERO ID CRD42017079911), we searched 114 databases through November 2017. From a pool of 826 potentially relevant references, screened independently by two researchers, nine studies (84,756 individuals with and 1,398,946 without the disorder) were retained. We pooled hazard and odds ratios using Robust Variance Estimation, a meta-analytic method aimed to deal with non-independence of outcomes. We found that ADHD is associated with a significantly higher risk of poisoning (Relative Risk = 3.14, 95% Confidence Interval = 2.23 to 4.42). Results also indicated that the relative risk of poisoning is significantly higher than that of physical injuries when comparing individuals with and without ADHD (Beta coefficient = 0.686, 95% Confidence Interval = 0.166 to 1.206). These findings should inform clinical guidelines and public health programs aimed to reduce physical risks in children/adolescents with ADHD.

Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis.

A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents ("risk analysis"); 2) assess the effect of ADHD medications on this risk ("medication analysis"). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI=1.40,1.67) and 1.39 (95% CI=1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a "difference in differences" methodology)]. The pooled effect size was 0.879 (95% CI=0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.

DNA Methylation of miR-7 is a Mechanism Involved in Platinum Response through MAFG Overexpression in Cancer Cells.

One of the major limitations associated with platinum use is the resistance that almost invariably develops in different tumor types. In the current study, we sought to identify epigenetically regulated microRNAs as novel biomarkers of platinum resistance in lung and ovarian cancers, the ones with highest ratios of associated chemo-resistance. Methods: We combined transcriptomic data from microRNA and mRNA under the influence of an epigenetic reactivation treatment in a panel of four paired cisplatin -sensitive and -resistant cell lines, followed by real-time expression and epigenetic validations for accurate candidate selection in 19 human cancer cell lines. To identify specific candidate genes under miRNA regulation, we assembled "in silico" miRNAs and mRNAs sequences by using ten different algorithms followed by qRT-PCR validation. Functional assays of site-directed mutagenesis and luciferase activity, miRNAs precursor overexpression, silencing by antago-miR and cell viability were performed to confirm their specificity in gene regulation. Results were further explored in 187 primary samples obtained from ovarian tumors and controls. Results: We identified 4 candidates, miR-7, miR-132, miR-335 and miR-148a, which deregulation seems to be a common event in the development of resistance to cisplatin in both tumor types. miR-7 presented specific methylation in resistant cell lines, and was associated with poorer prognosis in ovarian cancer patients. Our experimental results strongly support the direct regulation of MAFG through miR-7 and their involvement in the development of CDDP resistance in human tumor cells. Conclusion: The basal methylation status of miR-7 before treatment may be a potential clinical epigenetic biomarker, predictor of the chemotherapy outcome to CDDP in ovarian cancer patients. To the best of our knowledge, this is the first report linking the regulation of MAFG by miRNA-7 and its role in chemotherapy response to CDDP. Furthermore, this data highlights the possible role of MAFG as a novel therapeutic target for platinum resistant tumors.

Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: protocol for a systematic review and meta-analysis.

INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) has been related to increased rates of unintentional injuries. However, the magnitude of the effect and to which extent variables such as sex, age or comorbidity can influence this relationship is unknown. Additionally, and importantly, it is unclear if, and to which degree, ADHD medications can decrease the number of unintentional injuries. Due to the amount of economic and social resources invested in the treatment of injuries, filling these gaps in the literature is highly relevant from a public health standpoint. Here, we present a protocol for a systematic review and meta-analysis to estimate the relationship between ADHD and unintentional injuries and assess the impact of pharmacological treatment for ADHD METHODS AND ANALYSIS: We will combine results from 114 bibliographic databases for studies relating ADHD and risk of injuries. Bibliographic searches and data extraction will be carried out independently by two researchers. The studies' risk of bias will be assessed using the Newcastle-Ottawa Scale. Articles reporting ORs or HRs of suffering an injury in ADHD compared with controls (or enough data to calculate them) will be combined using Robust Variance Estimation, a method that permits to include multiple non-independent outcomes in the analysis. All analyses will be carried out in Stata. Age, sex and comorbid conduct disorders will be considered as potential causes of variance and their effect analysed through meta-regression and subgroup analysis. Sensitivity analyses will exclude articles with longer follow-ups, non-stringent definitions of ADHD or controls and statistically uncontrolled/controlled outcomes. Studies implementing a self-controlled case series methodology to investigate if ADHD drugs reduce the risk of injuries will be combined with a generalised linear mixed model using the Poisson distribution and a log link function. REGISTRATION DETAILS: PROSPERO-Prospective Register of Systematic Reviews (CRD42017064967).

A systematic review of high quality randomized controlled trials investigating motor skill programmes for children with developmental coordination disorder.

OBJECTIVE: To identify effective motor training interventions for children with developmental coordination disorder from research graded as high quality (using objective criteria) for the purpose of informing evidence-based clinical practice. DATA SOURCES: We followed the guidance for conducting systematic reviews issued by the Centre for Reviews and Dissemination. Six OvidSP electronic databases (AMED, All EBM reviews (including Cochrane), Embase, Ovid MEDLINE, PsychARTICLES Full Text, PsycINFO) were searched systematically. We aimed to retain only randomized control trials and systematic reviews of randomized control trials, defined as the highest level of evidence by the Oxford Centre for Evidence-Based Medicine. We searched reference lists of retained articles to identify further appropriate articles. REVIEW METHODS: Two reviewers critically appraised and categorized articles by effect size (including confidence intervals), inclusion of power calculations and quality using the Physiotherapy Evidence Database (PEDro) scale. Only studies scoring seven or more on the PEDro scale (classed by the PEDro as high reliability) were retained. RESULTS: No systematic reviews met our criteria for inclusion from 846 articles yielded by the systematic search. Nine randomized control trials investigating 15 interventions to improve motor skills met our inclusion criteria for 'high quality'. Nevertheless, not all included studies were adequately powered for determining an effect. CONCLUSION: Large effect sizes associated with 95 % confidence intervals suggest that 'Neuromotor Task Training', 'Task-oriented Motor Training' and 'Motor Imagery + Task Practice Training' are the most effective reported interventions for improving motor skills in children with developmental coordination disorder.

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children.

BACKGROUND: Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience. METHODS: The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6-12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance. RESULTS: TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task. CONCLUSIONS: These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures.

La adaptación al castellano de la Children’s Communication Checklist permite detectar las dificultades en el uso pragmático del lenguaje y diferenciar subtipos clínicos / The Spanish adapted version of the Children’s Communication Checklist identifies disorders of pragmatic use of language and differentiates between clinical subtypes

Introducción. La Children’s Communication Checklist (CCC) de Bishop es una prueba útil para la valoración de la pragmática verbal en los escolares. El objetivo del trabajo es comprobar la fiabilidad y la validez de esta escala en castellano. Sujetos y métodos. Se analiza la CCC contestada por los padres de 360 niños/as de 4-12 años, con inteligencia normal, 160 controles y 200 de cuatro grupos clínicos: trastorno por déficit de atención/hiperactividad (n = 68), trastorno de aprendizaje no verbal procedimental (n = 77), trastorno de la comunicación social (n = 25) y trastornos del espectro autista de nivel 1 (n = 30). Se realizan análisis: factorial para agrupar los ítems del cuestionario, de fiabilidad de las nuevas escalas y discriminante para comprobar si clasifica bien a los afectos de dificultades en el uso del lenguaje. Resultados. Se obtienen siete factores (Kaiser-Meyer-Olkin: 0,852) con moderada similitud a las de la CCC original: relaciones sociales, intereses y otros cinco que constituyen pragmática (habilidades conversacionales, coherencia-comprensión, compenetración, comunicación no verbal y pertinencia). La correlación es significativa entre todos ellos, en el grupo control, y entre los cinco que configuran pragmática, en los grupos clínicos (r de Pearson). La fiabilidad de las escalas es buena (alfa de Cronbach: 0,914). El cuestionario clasifica bien al 98,9% de los casos agrupados con y sin trastorno pragmático; y al 78% de los participantes en sus correspondientes grupos clínicos. Además, permite diferenciar las patologías según la presencia e intensidad de los síntomas. Conclusiones. Esta versión española de la CCC es altamente válida y fiable. Los estadísticos aportados pueden utilizarse como valores de referencia (AU)

Introduction. The Children’s Communication Checklist (CCC) by Bishop is a useful scale for evaluation of pragmatic verbal abilities in school children. The aim of the study is to ascertain the validity and reliability of the CCC in Spanish. Subjects and methods. Answers to the CCC items by parents of 360 children with normal intelligence were analyzed. There were five groups: 160 control children; 68 children with attention deficit hyperactivity disorder, 77 with procedural non-verbal disorder, 25 children with social communication disorder and 30 with autism spectrum disorder. Investigations included: factorial analysis in order to cluster checklist items, reliability analyses of the proposed scales and discriminant analysis to check whether the scale correctly classifies children with pragmatic verbal abilities. Results. Seven factors were obtained (Kaiser-Meyer-Olkin: 0.852) with moderate similarity with those of the original scale: social relationships, interests, and five more that can be grouped into pragmatic verbal ability (conversational abilities, coherence-comprehension, empathy nonverbal communication and appropriateness). All factors are significantly correlated with each other in the control group, and the five that compose pragmatic verbal ability correlate with each other in the clinical groups (Pearson r). The scales have good reliability (Cronbach’s alpha: 0.914). The questionnaire correctly classifies 98.9% of grouped cases with and without pragmatic disorder and 78% of subjects in their appropriate clinical group. Besides, the questionnaire allows to differentiate the pathologies according to the presence and intensity of the symptoms. Conclusions. This Spanish version of the CCC is highly valid and reliable. The proposed statistics can be used as normativereference values (AU)

Procedural Learning in Children With Developmental Coordination, Reading, and Attention Disorders.

The aim is to assess repetition-based learning of procedures in children with developmental coordination disorder (DCD), reading disorder (RD) and attention-deficit hyperactivity disorder (ADHD). Participants included 187 children, studied in 4 groups: (a) DCD comorbid with RD and ADHD (DCD+RD+ADHD) (n = 30); (b) RD comorbid with ADHD (RD+ADHD) (n = 48); (c) ADHD (n = 19); and typically developing children (control group) (n = 90). Two procedural learning tasks were used: Assembly learning and Mirror drawing. Children were tested on 4 occasions for each task: 3 trials were consecutive and the fourth trial was performed after an interference task. Task performance by DCD+RD+ADHD children improved with training (P < .05); however, the improvement was significantly lower than that achieved by the other groups (RD+ADHD, ADHD and controls) (P < .05). In conclusion, children with DCD+RD+ADHD improve in their use of cognitive-motor procedures over a short training period. Aims of intervention in DCD+RD+ADHD should be based on individual learning abilities.

Spontaneous Hemoperitoneum due to Rupture of Uterine Varicose Veins during Labor Successfully Treated by Percutaneous Embolization.

Hemoperitoneum during pregnancy is a rare but potentially lethal clinical condition. Improvements in antenatal and intrapartum care, especially in surgical and anesthetic techniques, have reduced maternal mortality; perinatal mortality remains very high (31%). Treatment is based on the systemic correction of hypovolemia and immediate surgery via laparotomy or laparoscopy in cases in the first trimester of pregnancy for hemostatic purposes. Sometimes, hysterectomy is needed. A 35-year-old Asiatic primigravid woman at 37 weeks' gestation with otherwise uneventful pregnancy came to the hospital referring abrupt-onset lumbar and abdominal pain. A bleeding uterine superficial varicocele of about 7 cm was found on the left uterine horn during Caesarean section. Interventional radiologic embolization of both uterine arteries was successfully performed. Posterior evolution of the patient was favorable. Percutaneous vascular embolization of the uterine arteries is an effective alternative treatment for many obstetrical and gynecological causes of bleeding. The main advantage of this technique is the low rate of serious complications and the preservation of reproductive function. To our knowledge, this is the first case of spontaneous intrapartum hemoperitoneum treated with this technique. An early diagnosis and a rapid indication of this therapeutic option are essential. Hemodynamic stability is needed to decide this conservative management.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder. Reply]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental. Réplica.

TITLE: Disfuncion de la coherencia central en ninos con trastorno de aprendizaje procedimental. Replica.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental.

INTRODUCTION: Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. AIM: Validation of two different visual tasks to measure central coherence function of children with PLD. SUBJECTS AND METHODS: A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images. RESULTS: Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. CONCLUSIONS: Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity.

Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental / Dysfunction of central coherence in schoolchildren with procedural learning disorder

Introducción. Los niños con trastorno de aprendizaje procedimental (TAP) tienen dificultades para percatarse rápidamente de la coherencia o incoherencia de un material complejo y describirlo verbalmente. Objetivo. Estudiar la capacidad de escolares con TAP para percatarse de las incoherencias presentes en dos imágenes complejas. Sujetos y métodos. Se muestran el test de imagen quimérica y la escena visual incoherente a 200 escolares: 20 afectos de TAP, 60 con trastorno por déficit de atención/hiperactividad (TDAH), 60 con TDAH + TAP y 60 escolares típicos como grupo control. Se comparan las respuestas de todos los grupos mediante chi al cuadrado. Se calcula la sensibilidad, eficiencia y especificidad de cada prueba por separado y se realiza análisis discriminante según el rendimiento conjunto en ambas. Resultados. El rendimiento en los dos grupos con TAP es inferior al de los grupos control y TDAH, tanto en el test de imagen quimérica como en la escena visual incoherente. El 93 y el 92% de los niños que, respectivamente, rinden bajo en el test de imagen quimérica y en la escena visual incoherente están afectos de TAP (con o sin TDAH comórbido). El 87% de los sujetos con TDAH + TAP falla en una de las pruebas o en ambas, mientras que sólo lo hace el 15% de los niños con TDAH. Conclusiones. Las dificultades específicas para la comprensión rápida, simultánea y coherente de imágenes o escenas complejas, que forman parte del perfil neuropsicológico del TAP, son detectables mediante el test de imagen quimérica y la escena visual incoherente. Estos instrumentos se han revelado altamente sensibles, eficaces y específicos (AU)

Introduction. Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. Aim. Validation of two different visual tasks to measure central coherence function of children with PLD. Subjects and methods. A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images.Results. Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. Conclusions. Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity (AU)

Successful delivery of a twin pregnancy in a bicornuate uterus (uterus bicornis unicollis) by bilateral Caesarean section.

BACKGROUND: Müllerian duct anomalies occur in 0.1% to 3% of women, and they are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Having a twin pregnancy in a patient with a bicornuate uterus (uterus bicornis unicollis) is rare, especially if it is a spontaneous conception. CASE: A 40-year-old primigravid woman conceived a twin dichorionic diamniotic pregnancy after three years of primary infertility. She was found on 3-D ultrasound examination to have a bicornuate uterus with one fetus in each horn The prenatal course was uncomplicated. At 38 weeks' gestation, twin babies were successfully delivered by elective bilateral low transverse Caesarean section. CONCLUSION: Because the incidence of such pregnancies is very low, it remains unclear whether a twin pregnancy in a bicornuate uterus is better delivered vaginally or by elective Caesarean section.

Cesárea corporal y miomectomía: indicaciones actuales / Classic cesarean section and myomectomy

Actualmente, tanto la realización de una cesárea corporal como la práctica de una miomectomía en el transcurso de una cesárea, suponen dos hechos muy infrecuentes. No obstante, en determinados casos, ambos procedimientos pueden ser necesarios. La cesárea corporal es una técnica quirúrgica poco menos que abandonada, si bien aún mantiene algunas indicaciones; y la exéresis de un mioma durante una cesárea está clásicamente contraindicada, salvo en circunstancias muy concretas. Sin embargo, hay que destacar que en los últimos años se está constatando un incremento significativo de ambos procedimientos, siendo las razones muy diversas (aumento de las gestaciones pretérmino que se finalizan por vía abdominal, incremento de la edad materna, mayores tasas de cesáreas, etc.). Se presenta el caso clínico de una gestante con un gran mioma localizado en segmento inferior uterino y en la que fue preciso llevar a cabo una cesárea corporal, seguida de una miomectomía.

Nowadays, it is very rare to perform both classic cesarean section or myomectomy during cesarean section. However, sometimes it is necessary to do them. The classic cesarean section is a very uncommon chirurgical technique, however, it still has some indications. The performance of a myomectomy during a cesárea section although it is to be avoided, it might be necessary under specific circumstances. However, it is necessary to emphasize that in recent years it is more and more frecuent to performe these chirurgical techniques, due to different reasons such as the increasing of preterm pregnancies that are finished by an abdominal delivery, the increasing of the age of pregnancy and higher cesarean rates. We present a case report of large myoma situated at the lower uterine segment. Classic caesarean section followed by myomectomy was performed to allow the delivery.