Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study.

OBJECTIVE: To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS: This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS: Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION: HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

WITHDRAWN: Response from original author: Reproducibility of first trimester three-dimensional placental measurements; a methodological issue.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, DOI of original article: http://dx.doi.org/10.1016/j.ejogrb.2016.07.485. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Evaluation of endometrial and subendometrial vascularization and endometrial volume by 3-D power Doppler ultrasound and its relationship with age and pregnancy in intrauterine insemination cycles.

AIMS: To measure endometrial volume and endometrial-subendometrial vascularization by 3-D power Doppler ultrasound in patients undergoing cycles of artificial insemination with ovarian stimulation, to evaluate their relationship with patients' age and pregnancy development. METHODS: We included patients with primary and secondary infertility of one year of evolution. We measured vascular indexes and endometrial volume by 3-D power Doppler ultrasound. RESULTS: Seventy-nine consecutive cycles were studied. Endometrial volume average was 4.7 ± 2.66 ml. We did not find any difference between the endometrial volumes in women who did versus did not become pregnant (9 vs. 70 women, respectively). The endometrial vascular index was significantly higher in patients aged between 31 and 33 years old. In patients between the ages of 31 and 33, both the endometrial flow index (FI; p = 0.017) and the endometrial vascular FI (p = 0.013) were higher. At the subendometrial area, the vascular FI was lower in women older than 33 years old (p = 0.024), while the FI was higher in patients that achieved pregnancy (p = 0.047). CONCLUSIONS: Endometrial volumes were independent of pregnancy development. Endometrial and subendometrial vascularization FIs were significantly higher in younger women. The subendometrial FI was significantly higher in patients who achieved pregnancy.

Long-term evaluation of bilateral cleft lip and palate patients after early secondary closure and premaxilla repositioning.

The aim of this retrospective, mixed longitudinal study was to assess the long-term outcome of early secondary closure and premaxilla osteotomy in 40 bilateral cleft lip and palate patients who underwent early secondary osteotomy of the premaxilla and bone grafting at the age of 8-12 years. Clinical and cephalometric evaluations of profile, lip relation, nasolabial angle and position of the maxilla preoperatively, postoperatively and at adolescence were compared to normal values of non-cleft individuals and the reported data of 90 bilateral cleft lip and palate patients treated in Oslo. In 68% of patients the profile was considered acceptable, but in 26 maxillary growth appeared to be impaired by cephalometric standards. In four patients a Le Fort I osteotomy was carried out and nine patients would have benefited from such a procedure. This study reveals a trend towards maxillary growth retardation partially compensated by orthodontic and dental treatment. Since the results are comparable to those reported for the Oslo group with regard to maxillary growth, the surgical protocol followed does not require revision. Considering the benefits, i.e. closure of alveolo-palatal cleft, continuity of dental arch, eruption of canine in the graft and closure of oro-nasal communications, this mode of treatment should be continued.

Inducción del parto: variables clínicas que influyen hasta el inicio de la fase activa del parto / Induction of labor: clinical variables of influence until the onset of the active phase of labor

Objetivo: Analizar la influencia de diferentes variables clínicas en la duración de la inducción hasta llegar al período de parto activo. Sujetos y métodos: Analizamos 196 gestantes expuestas a inducción del parto. Eran gestaciones entre 37-42 semanas, únicas, en cefálica. Excluimos gestaciones con cicatrices uterinas. Definimos parto activo como cuello borrado, 2 cm y dinámica uterina regular. Dividimos el tiempo entre el comienzo de la inducción y el inicio de parto activo en 4 períodos: 0-6 h, 6-12 h, 12-24 h y más de 24 h. Utilizamos una regresión ordinal politómica. Resultados: El test de Bishop (p < 0,001), la paridad (p = 0,006) y el peso del neonato (p = 0,019) influyen en la probabilidad de llegar a parto activo en cada intervalo. No encontramos relación con la edad materna (p = 0,209), el diámetro biparietal del feto (p = 0,431) y el antecedente de aborto (p = 0,160). Conclusiones: Con el test de Bishop, la paridad y el peso del neonato se podría establecer la probabilidad de llegar a parto activo

Objective: To analyze the influence of several clinical variables on the duration of the interval between induction of labor and the active phase. Subjects and methods: We analyzed 196 pregnant women who underwent induction of labor. All the women had single, cephalic pregnancies at 37-42 weeks of gestational age. Pregnant women with uterine scars were excluded. The active period of labor was defined as cervical effacement, 2-cm dilatation and regular uterine contractions. The interval between the start of induction and the beginning of active labor was divided into four periods: 0-6 h, 6-12 h, 12-24 h and more than 24 h. Ordinal polytomic regression was applied. Results: The probability of reaching the active phase of labour in each interval was influenced by Bishop’s score (p<0.001), parity (p=0.006) and neonatal weight (p=0.019). No relationship was found with maternal age (p=0.209), fetal biparietal diameter (p=0.431) or a history of miscarriage (p=0.160). Conclusions: The probability of reaching the active phase of labor could be established using Bishop’s score, parity and neonatal weight

Manejo de la hemorragia puerperal masiva por atonía uterina con desvascularización progresiva del útero, B-Lynch modificado y antitrombina III / Management of massive puerperal hemorrhage due to uterine atony with progressive uterine devascularization, modified B-Lynch suture technique and antithrombin III

Presentamos un caso de hemorragia puerperal masiva por atonía uterina tras cesárea urgente, que tuvo lugar en nuestro centro. Ante el fracaso del tratamiento médico, la alternativa quirúrgica a la histerectomía fue la realización de una desvascularización progresiva del útero, seguida de coartación de la cavidad uterina mediante la técnica descrita por B-Lynch. Por otra parte, se añadió al tratamiento el empleo de antitrombina III. Se describe la técnica empleada y comparamos su utilidad frente a otras opciones quirúrgicas. La técnica de B-Lynch modificada es una alternativa eficaz en el tratamiento de la atonía uterina, que permite conservar la fertilidad (AU)

We report a case of massive postpartum hemorrhage secondary to uterine atony after an emergency cesarean delivery in our center. Medical therapy was unsuccessful and progressive uterine devascularization followed by coarctation of the uterine cavity using the B-Lynch suture technique were employed as an alternative to postpartum hysterectomy. Treatment was completed with antithrombin III. We describe the B-lynch technique and compare its utility with that of other surgical options (AU)

Fracturas de clavícula en el neonato: incidencia y factores de riesgo / Clavicular fractures in the neonate: incidence and risk factors

Objetivo: Determinar los factores de riesgo en la aparición de fracturas de clavícula en neonatos en un centro hospitalario. Material y métodos: Se realizó un estudio de casos y controles en el que se revisaron los 3.023 partos del año 2000. Las 55 fracturas de clavícula que tuvieron lugar durante ese año constituyeron el grupo de los casos. Para los controles se eligieron 116 mujeres cuyos hijos no tuvieron signos clínicos de fracturas. El estudio se realizó comparando entre ambos grupos variables maternas, fetales y de la evolución del parto. Resultados: La incidencia total de fracturas fue del 1,82 por ciento en el año 2000. El peso en el grupo de los casos resultó ser significativamente mayor que en los controles (odds ratio [OR] = 4,35; intervalo de confianza [IC] del 95 por ciento, 2,9-9,5; p = 0,001). La cesárea fue un factor protector frente a las fracturas de clavícula (OR = 0,06; IC del 95 por ciento, 0,007-0,48; p = 0,0081). No se encontraron diferencias significativas para el resto de las variables. Conclusiones: Las fracturas de clavícula son un traumatismo obstétrico difícil de prevenir. En el grupo estudiado resultan más frecuentes en los niños de mayor peso al nacimiento; mientras que la cesárea disminuye su riesgo de aparición (AU)

[Team management of orofacial clefts]. / Teambehandeling van patiënten met schisis.

In the Netherlands 15 centres provide multidisciplinary care for cleft lip and palate patients. Usually the following disciplines participate in such teams: paediatrics, plastic and reconstructive surgery, orthodontics, genetics, social work or nursing, ENT, speech therapy, maxillofacial surgery, prosthetic dentistry, psychology and oral hygiene. An overview is given of the treatment protocol from birth until 20 years of age for a child with a complete UCLP or BCLP. It is concluded that properly designed prospective clinical trials are rare, resulting in a lack of evidence based care in the field of cleft lip and palate. Furthermore it should be investigated whether it is preferable to centralise the cleft care in less centres than the present 15 ones.

Timing and transplant materials for closure of alveolar clefts. A clinical comparison of 296 cases.

A retrospective study of bone grafting of 296 clefts (165 unilateral and 131 bilateral was required) to answer questions about the most favourable timing and the most appropriate bone graft material. The results as such are not exceptional in comparison with earlier publications by the same or other authors, but it is of special interest that operations with different graft materials applied at different times in development, in (usually) a sufficient number of cases, can be compared together. The patients have been operated on during a period of 11 years, by the same surgeons, applying the same principles and techniques. It is shown that early secondary grafting, before the eruption of the canine, results in by far, the highest success rate. Similarly, chin bone is considerably better than any other type of transplant. Aspects of general planning, timing, technique and failures are extensively discussed. Besides the afore-mentioned most significant findings, it is also concluded that the results of grafting during osteotomies are better than they appear; that tertiary grafting is extremely difficult, and requires special surgical skill; that rib grafts score as high as iliac crest grafts and that materials other than these three types of bone should be avoided.