Application of pelvic floor ultrasound during pregnancy to detect patients at risk of cesarean section due to failure of labor progression in a Spanish population.

OBJECTIVE: Our study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy. STUDY DESIGN: Transperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data. RESULTS: In the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm2 for cesarean sections, compared to 16.2 ± 2.7 cm2 for vaginal deliveries with an OR of 0.57 (0.34-0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35-0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60-1.00, 95% CI). CONCLUSION: The hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression.

Evaluation of pain in office hysteroscopy with prior analgesic medication: a prospective randomized study.

OBJECTIVE: To evaluate whether administration of analgesic medication one hour before undergoing office hysteroscopy decreased pain and other side effects. STUDY DESIGN: A prospective randomized study was carried out in 200 patients who underwent office hysteroscopy from November 2011 until May 2012. 100 patients received 1000 mg paracetamol and 600 mg ibuprofen one hour before the procedure and 100 did not receive any medication. RESULTS: We observed significant differences (p = 0.013) regarding the occurrence of non-pain side effects, 6% in the non-medicated group and none of the patients in the medicated group. The main pain score was always slightly higher in the group receiving no medication, though there was no statistically significant difference when compared to the medicated group. CONCLUSION: Administration of 1 g paracetamol and 600 mg ibuprofen one hour prior to office hysteroscopy decreased statistically the occurrence of non-pain side effects such as nausea, emesis, and hypotension. No differences in pain scores were observed.

[Endometrial ablation: comparative study between hysteroscopic resection and Novasure system]. / Ablación endometrial: estudio comparativo entre la resección histeroscópica y el sistema Novasure.

BACKGROUND: Many women experience menorrhagia episodes resistant to medical treatment requiring definitive surgical treatment. OBJECTIVE: To analyze the effectiveness of hysteroscopic endometrial resection versus Novasure system. MATERIAL AND METHODS: A descriptive and retrospective study comparing 20 patients who underwent endometrial ablation with Novasure vs 20 patients who underwent hysteroscopic endometrial resection. We analyzed the indication, age, time of surgery, the incidence of complications, satisfaction at 3, 6 and 12 months and technical failure. RESULTS: No significant differences were found in terms of failure to complete the technique, and satisfaction at 3, 6 and 12 months. But significant differences regarding the mean operation time, which was reduced to 15 minutes among Novasure system patients. This could influence the total costs of the procedure. CONCLUSION: There were no significant differences between the two methods in terms of efficacy and safety; however, the final costs seem to be higher for the Novasure system.

The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: results from a pivotal phase III study.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of a new low-concentration estriol formulation (0.005% estriol vaginal gel), providing an ultra low dose of estriol per application (50 µg), for the local treatment of postmenopausal vaginal atrophy. METHODS: Postmenopausal women with symptoms and signs of vaginal atrophy were enrolled in a prospective, double-blind, placebo-controlled study. Women received either 1 g of vaginal gel containing 50 µg of estriol or placebo gel, daily for 3 weeks and then twice weekly up to 12 weeks. A cytological vaginal study, evaluation of vaginal pH, and assessment of symptoms and signs of vaginal atrophy were performed, and changes between baseline and weeks 3 and 12 were assessed. Adverse events were recorded. RESULTS: A total of 167 women were included (114 received estriol and 53 received placebo). After 12 weeks of therapy, a superiority of estriol compared with placebo gel was shown in the change in maturation value and vaginal pH (P < 0.001 and P < 0.001, respectively). The superiority of estriol was well demonstrated in improvement of vaginal dryness (P = 0.001) and the Global Symptom Score (P = 0.018). Estriol gel proved also superior in the improvement of several of the most outstanding vaginal signs of vaginal atrophy evaluated. After 3 weeks, estriol gel also showed a superiority over the placebo gel in most symptoms and signs evaluated. Treatment-related adverse events were similar among groups. CONCLUSIONS: 0.005% Estriol vaginal gel, a new formulation providing an ultra low dose of estriol per application, was shown to be safe and effective in the treatment of postmenopausal vaginal atrophy.

[Postpartum urinary and fecal incontinence in gemelar pregnancy according to route and mode of delivery]. / Incontinencia urinaria y fecal postparto en gestación gemelar según vla y tipo de parto.

BACKGROUND: The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida. OBJECTIVE: To determine the different risk factors for urinary incontinence after a twin pregnancy. PATIENTS AND METHODS: 331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence. RESULTS: The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058). CONCLUSIONS: The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.

Un nuevo escenario asistencial / A new healthcare scenario

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Los procedimientos diagnósticos y los tratamientos excesivos en obstetricia y ginecología / Diagnostic procedures and overtreatment in obstetrics and gynecology

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