Identification of vaginal microbiome associated with IVF pregnancy.

The factors that cause a preterm birth (PTB) are not completely understood up to date. Moreover, PTB is more common in pregnancies achieved by in-vitro fertilization (IVF) than in spontaneous pregnancies. Our aim was to compare the composition of vaginal microbiome at 12 weeks of gestation between women who conceived naturally or through IVF in order to study whether IVF PTB-risk could be related to vaginal microbiome composition. We performed an observational, prospective and multicentre study among two public hospitals and a fertility private clinic in Spain. Vaginal swabs from 64 pregnant women at 12 weeks of gestation were collected to analyse the microbiome composition by sequencing the V3-V4 region of the 16S rRNA. Our results showed that the vaginal microbiome signature at 12 weeks of pregnancy was different from women who conceived naturally or through IVF. The beta diversity and the genus composition were different between both cohorts. Gardnerella, Neisseria, Prevotella, and Staphylococcus genus were enriched genus in the vaginal microbiome from the IVF group, allowing us to create a balance model to predict both cohorts. Moreover, at species level the L. iners abundance was higher and L. gasseri was lower in the IVF group. As a conclusion, our findings were consistent with a proposed framework in which IVF pregnancy are related to risk for preterm birth (PTB) suggesting vaginal microbiome could be the reason to the relation between IVF pregnancy and risk for PTB.

Congenital vesicovaginal fistula with or without menouria: a literature review.

Congenital vesicovaginal fistula (CVVF) is a rare, complex female genital malformation that is difficult to diagnose, classify and treat. Symptoms include menouria, cyclical haematuria and urinary incontinence from birth. The aim of this review was to highlight the importance of correct diagnosis and treatment of this congenital anomaly. A comprehensive literature review was conducted to identify articles on CVVF with and without menouria. Forty-one articles were found, of which 31 described 37 original cases of congenital fistula (30 CVVF, six uterovesical fistula and one urethrovaginal fistula): 14 in girls and 23 in adults. The cases were classified according to clinical, diagnostic and therapeutic parameters in order to unify concepts and terms. Menouria occurred in 21 of the 23 adults: 14 cases were CVVF, six cases were congenital uterovesical fistula, and one case was congenital urethrovaginal fistula in a young woman without congenital adrenal hyperplasia. Sixteen (53%) of the 30 patients with CVVF had urinary incontinence or hydrocolpometra, and 14 (47%) had menouria. There were associated anomalies in 91% of cases, 29 (48%) of which involved the urinary tract. Various diagnostic and therapeutic methods were used, and there was confusion surrounding the aetiopathogenesis in most cases. CVVF should be suspected in any girl with urinary incontinence, urinary tract infections from birth, vaginal swelling or hydrocolpometras, as well as in adults with menouria. Diagnosis should be based on physical examination and imaging (cystoscopy during menouria, ultrasound and magnetic resonance imaging). Surgical treatment should be based on correction of the vaginal defects (obstructive problem opening or vaginal reconstruction) and CVVF closure. The embryological origin of CVVF lies in the abnormal persistence of the urogenital sinus due to lack of formation and caudal growth of the urogenital wedge, combined with distinct degrees of agenesis or hypoplasia of the entire urogenital ridge or the mesonephric ducts (which affects development of the Müllerian ducts).

Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial.

OBJECTIVE: Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90-200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. DESIGN: Randomised controlled double-blind multicentre trial (1:1:1). SETTING: The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). POPULATION: Women with dichorionic diamniotic twin pregnancies. METHODS: The women self-inserted two vaginal pessaries daily, containing placebo (n = 96), 200 mg of natural progesterone (n = 97) or 400 mg of natural progesterone (n = 97), from 20 to 34 weeks of gestation or delivery. Randomisation was performed by an external centre. Data were analysed on an intention-to-treat basis. MAIN OUTCOME MEASURE: Preterm birth rate. RESULTS: The baseline characteristics for placebo and progesterone groups were similar. Comparison of the three groups and analysis of progesterone-treated versus untreated women showed similar pregnancy and neonatal outcomes. The proportion of preterm and very preterm births, low birthweight, perinatal mortality and neonatal morbidity showed no differences between the three groups. Similar results were also obtained when comparing the 200- versus 400-mg progesterone groups. No serious adverse effects were encountered. CONCLUSIONS: Vaginal progesterone therapy was generally well tolerated, but failed to prevent preterm births in unselected dichorionic diamniotic twin pregnancies. The 400-mg progesterone dose offered no advantages over the 200-mg regimen.

Cálculo de prevalencia y riesgo atribuible de los factores de riesgo relacionados con la persistencia o recidiva de neoplasia cervical intraepitelial (CIN) / Calculation of prevalence and attributable risk of risk factors associated with persistence or recurrence of cervical intraepithelial neoplasia

Con la finalidad de conocer mejor a ese porcentaje de población en el que existe un fallo terapéutico, se ha realizado el siguiente estudio cuyos objetivos son: conocer la prevalencia de los factores de riesgo relacionados con el fallo terapéutico en el momento del diagnóstico de neoplasia cervical intraepitelial (CIN), conocer el aumento de riesgo que éstos generan y definir un prototipo de paciente con alto riesgo de persistencia o recidiva. Los factores de riesgo demográficos-ambientales más prevalentes en nuestra población fueron la presencia del DNA-VPH-AR. A continuación el hábito tabáquico, multiparidad, historia de anticoncepción hormonal y VIH-inmunosupresión. Al realizar el estudio colposcópico se encontraron las siguientes características: el 53,30% presentan lesiones múltiples, el tamaño es superior a los 2cm en el 30% de las pacientes y se hallaron cambios mayores en la zona de trasformación en el 49,51% del total. Tras completar el estudio se obtuvieron los siguientes resultados: curación: superior al 90%, persistencia: de 4,35% y recidiva: de 1,8%.Con estos resultados se puede concluir que existen unos factores de riesgo comunes relacionados con el fallo terapéutico, como son: la persistencia del VPH-AR postratamiento y la respuesta inmunológica deficiente. El resto de los factores se distribuye de forma desigual para las pacientes con CIN I y CIN II-III, por lo que se puede decir o pensar que son 2 poblaciones distintas, con factores de riesgo específicos (AU)

The most prevalent demographic and environmental risk factors in our population were the presence of high-risk human papillomavirus (HR-HPV)-DNA, followed by smoking, multiparity, a history of hormonal contraception, and HIV-immunosuppression. When performing colposcopic study, the following characteristics were found: 53.30% of the patients had multiple lesions, size was greater than 2cm in 30.00% of patients and major changes were found in the area of transformation in 49.51% of the total. After completing the study, the results were as follows: cure was achieved in more than 90%, persistence was found in 4.35% and recurrence occurred in 1.8%. These results indicate that there are common risk factors associated with treatment failure, including the persistence of HR-HPV after treatment and poor immune response. The remaining factors were unevenly distributed among patients with CIN-I and CIN-II-III, suggesting that these patients constitute two distinct populations with specific risk factors. The present study aimed to determine the prevalence of risk factors associated with treatment failure at diagnosis of cervical intraepithelial neoplasia (CIN), identify the increased risk posed by treatment failure, and define the prototype of high-risk patients with persistent or recurrent CIN with a view to characterizing the percentage of the population with treatment failure (AU)

Prevalencia de la incontinencia urinaria en la población femenina atendida en el área sanitaria de Alicante / Prevalence of urinary incontinence among women in the health area of Alicante (Spain)

Fundamento y objetivo. Estimar la prevalencia de la incontinencia urinaria (IU), sus características e impacto en la calidad de vida mujeres atendidas en el área sanitaria de Alicante. Pacientes y método. Estudio epidemiológico, transversal, multicéntrico, desarrollado durante un mes, en el que participaron 639 mujeres que acudieron consecutivamente a consultorios de ginecología por motivos diferentes de la IU y accedieron voluntariamente a cumplimentar una encuesta que contenía el International Consultation on Incontinence Questionnaire. Se recogió información referente a la frecuencia, cantidad y afectación. Se analizó la posible relación de diferentes factores con la gravedad. Resultados. El 39,97% reconocía tener IU; la más frecuente fue la de esfuerzo (IUE) (72,53%). La IUE fue más frecuente en el grupo de mayor edad (p < 0,001). Se observó mayor afectación en la calidad de vida en el grupo de menor edad, aunque la diferencia no fue significativa. La mayoría (77,25%) presentó gravedad leve y en general (63,95%) tenían pequeñas pérdidas. Menos del 16% refirió algún tratamiento para la IU. La gravedad se correlacionó con pérdidas «al esfuerzo», «continua» y «sin motivo evidente», así como con la IU de tipo IUU e IUM. Conclusiones. El 40% de las mujeres que acuden a los consultorios de ginecología de nuestro entorno presentan IU, la mayoría tipo IUE. La IU de mayor severidad, según el ICIQ-SF, apenas afecta al 11% de los casos, no se relaciona con la edad y sí con ciertos tipos de pérdida (AU)

Background and objective. To estimate the prevalence and characteristics of urinary incontinence (UI) and its effects on quality of life in women in the health area of Alicante. Patients and method. We performed an epidemiological, cross sectional, multicenter study over a 1-month period in 639 women who consecutively attended the gynecology clinic for reasons other than UI and who voluntarily agreed to participate in a survey that included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Information on the frequency and quantity, as well as on the effects of UI, was gathered. The possible association of several factors with severity was analyzed. Results. A total of 39.97% of the women reported having UI. The most frequent type of UI was stress incontinence (SUI). Quality of life was more adversely affected in younger women, although this difference was not significant. The severity of UI was mild in 77.25% of the women and urine leaks were small in 63.95%. Less than 16% reported having treatment for UI. Severity was correlated with stress leaks, continuous leaks and leaks with no apparent cause, as well as with SUI and mixed urinary incontinence. Conclusions. Forty percent of the women attending the gynecology clinic in our environment had UI, mostly SUI. The most severe UI, according to the ICIQ-SF, affected only 11% of patients with UI and was associated with certain types of leakage but not with age (AU)

Evaluación de las nuevas técnicas quirúrgicas para tratar la incontinencia urinaria femenina / Evaluation of the new surgical techniques in the treatment of female urinary incontinence

Objetivo: Evaluar la eficacia y seguridad de distintas técnicas quirúrgicas con bandas para la IUF, realizadas entre febrero de 2000 y junio de 2004, así como el grado de satisfacción de las pacientes operadas en nuestro servicio. Material y métodos: Se ha realizado un estudio transversal, retrospectivo, analizando distintas variables en las 77 pacientes con IUF que fueron intervenidas en el Servicio de Obstetricia y Ginecología del Hospital General Universitario de Alicante. La evaluación objetiva (eficacia y efectos adversos) se obtuvo al revisar los controles realizados a los 2 y 6 meses y anualmente, teniendo en cuenta la exploración vaginal, las maniobras de Valsalva, el Q-test, el diario miccional, la valoración de síntomas hecha por la paciente e incluso la urodinámica, si se precisó. La evaluación subjetiva se realizó mediante una encuesta telefónica siguiendo el esquema de cuestionarios ya validados. Resultados: De las 77 pacientes, sólo en 60 (77,92%) pudieron valorarse los resultados objetivos en su historia clínica. Objetivamente se consideraron continentes al 59,74% (46/77) o el 76,66% (46/60) si no se contabilizan las no controladas. Subjetivamente, sólo contestaron 65 (84,41 %) pacientes, cuyas respuestas de «satisfacción» se situaron entre el 72,72% y el 86,14% (al excluir las que no respondieron). Las complicaciones fueron similares a otros grupos. Fue difícil establecer un análisis comparativo, ya que los criterios de seguimiento y evaluación son muy distin tos y apenas incluyen el componente subjetivo de la paciente, sin tener en consideración la repercusión en la calidad de vida, presentándose muy dispares y poco reproducibles. Conclusiones: Las intervenciones con bandas son eficaces y seguras, si bien la conclusión de su grado de recomendación debe deducirse de trabajos a largo plazo y donde se incluyan parámetros de calidad de vida en el seguimiento de la paciente. La introducción de nuevas técnicas quirúrgicas debe estar precedida por ensayos controlados y aleatorizados que muestren los resultados objetivos y subjetivos de éstas (AU)

Objective: Evaluation of the efficiency and safety of different surgical techniques with bands for urinary incontinence (VI) in the period February 2000-June 2004, and also the patient satisfaction post-operatively. Material and methods: We made a retrospective transversal study, analyzing different variables in 77 patients with UI who had surgery in the Obstetric and Gynaecology Department of the G.U. Hospital in Alicante. Objective evaluation (efficacy and adverse effects) was obtained on checking the follow up at 2 months, 6 months and annually. This consisted of vaginal examination, Val salva manoeuvre, Q-test, mictional diary, patient self evaluation of symptoms and urodynamics if necessary. Subjective evaluation was made by telephone with the questionnaire already in use. Results: Objective results could be valued in only 60 of the 77 patients (77.92%). We considered 59.74% to be objectively continent (46/77) or 76.66% (46/60) if we don't count those who were not controlled. Subjectively, only 65 patients (84.41 %) replied, their "satisfaction was between 72.72% and 86.14% (excluding those who did not reply). Complications were similar to other groups. It was difficult to establish a comparative analysis since criteria of followup and evaluation are very different. Normally they do not include a subjective component of the patient without taking into consideration her quality of life. They are disparate and reproducing them is of little value. Conclusions: The surgery with bands is effective and safe although its recommendation needs long term studies where the quality of life should be included. The introduction of new surgical techniques must be preceded by controlled and randomized studies including not only the objective but also the subjective results (AU)

Marcadores tumorales en la endometriosis: relación con la gravedad de la enfermedad / Tumoral markers in endometriosis: relationship with disease severity

Objetivo: Demostrar la relación entre los valores preoperatorios de Ca-125 y Ca 19.9 con el grado de enfermedad en las pacientes intervenidas por endometriosis. Sujetos y métodos: Estudio retrospectivo. Muestra aleatoria de 85 casos de pacientes sometidas a cirugía por endometriosis, confirmada durante la intervención, en el Hospital General Universitario de Alicante, entre febrero de 1996 y enero de 2003. Resultados: Se encontraron diferencias estadísticamente significativas en los valores medios de Ca-125 (p = 0,006) y Ca 19.9 (p = 0,003), en función del grado de enfermedad (III o IV). Se construyó una curva ROC (receiver operating characteristics) para ambos parámetros. Conclusiones: Los marcadores Ca-125 y Ca 19.9 son útiles para descartar endometriosis de grado IV en el preoperatorio, y así una intervención dificultosa. Los umbrales óptimos para su valoración son Ca-125 < 38,5 U/ml y Ca 19.9 < 13 U/ml.La presencia de ambas condiciones descartará endometriosis de grado IV, con una probabilidad del 97,7 por ciento (AU)

140 exéresis de lesiones de cérvix con asa de diatermia. Márgenes, tabaco y persistencia / Management of 140 cervical lesions by loop escision. Margins, tobacco and persistance

Objetivo: Evaluar qué factores influyen en la persistencia de la lesión de cérvix tras la exéresis.Diseño: Estudio retrospectivo.Sujetos de estudio: 140 pacientes a las que se les realizaron técnicas de exéresis de lesiones del cérvix uterino con asa de diatermia.Resultados: La edad media de las pacientes fue de 37,5 (19-74). El 72,5 por ciento eran fumadoras. Con márgenes afectados, la persistencia de la lesión a los 6 meses fue del 31,3, frente al 17,2 por ciento si los márgenes estaban libres (15 de 87) (odds ratio [OR]: 2,18; intervalo de confianza [IC]: 0,6-7,2) (p = 0,2). A los 18 meses, persistían dos lesiones (curación en el 96,1 por ciento); ambos casos tenían márgenes libres. En las fumadoras, persiste en el 26,5 por ciento a los 6 meses, frente al 13,3 por ciento en las no fumadoras (OR: 2,34; IC: 0,5-11,8) (p = 0,3). Las dos pacientes con persistencia a los 18 meses eran fumadoras. Las lesiones de alto grado persistieron en un 19,3 por ciento a los 6 meses y en un 3,9 por ciento a los 18 meses; las de bajo grado persistieron en un 29,4 por ciento a los 6 meses y en ningún caso a los 18 meses (p = 0,8).Conclusiones: La persistencia de la lesión a los 18 meses no dependió de la afectación de los márgenes de resección, de la histología ni del hábito tabáquico. No es necesaria la cirugía posterior en las pacientes que tienen resección incompleta de una lesión del cérvix uterino, y sólo la evolución tras el seguimiento con citología y colposcopia puede justificar la reintervención. (AU)

Estudio de las alteraciones cromosómicas detectadas por amniocentesis genética en nuestro medio / Study on the chromosomal abnormalities detected by amniocentesis in our enviroment

Realizamos una revisión de todas las amniocentesis genéticas (447) realizadas en el Hospital General Universitario de Alicante entre enero 1997 a diciembre 1999 (AU)

Diagnóstico prenatal del sexo, diferencias anatómicas yantropométricas / Prenatal diagnosis of sex and anatomic and anthropometric differences

No disponible

Diagnóstico de la endometriosis. ¿Es posible plantearse el diagnóstico precoz de la endometriosis? / Diagnosis of endometriosis. Is it possible to establish an early diagnosis of endometriosis?

No disponible