Revista colombiana de obstetricia y ginecologia最新文献

Objectives: To describe the application of Positive Deviance (PD) and its outcomes in the diagnosis and treatment of gestational syphilis (GS) and the prevention of congenital syphilis (CS).

Material and methods: A descriptive cohort study was conducted. Women treated at the Subred Sur (SRS) of Bogotá, diagnosed with GS in 2017-2018, were included. The 2018 cohort was exposed to Positive Deviance (PD) to identify useful practices for CS prevention, implement them, and overcome existing barriers. Adherence to the Colombian Guideline for GS management and CS incidence were described.

Results: A total of 284 GS cases were confirmed. Timely treatment initiation increased from 81.8 % to 90.2 %, penicillin sensitivity testing decreased from 38 % to 12.9 %, and complete treatment improved from 43.8 % to 82.6 %. In 2018, 97.5 % received at least one dose of penicillin. The incidence rate of CS decreased from 41.9 % to 29.6 %. Of the patients, 45% were diagnosed with GS in the third trimester, among whom the CS incidence rate was 59 %.

Conclusions: This study describes the effects of applying PD as an innovative approach to improve adherence to timely and appropriate GS treatment and prevent CS. Prospective studies with a control group are needed to more robustly evaluate the benefits of this methodology in process and outcome indicators, as well as its impact on reducing mother to child transmission of syphilis.

Objectives: To determine the validity and internal consistency of the HELP Score instrument, designed to assess the severity of symptoms in hyperemesis gravidarum.

Material and methods: A validation study of a measurement instrument was conducted within a cross-sectional study framework, that included women with hyperemesis gravidarum. Content validity was evaluated using the Content Validity Coefficient (CVC). Correlation analysis, exploratory factor analysis, and confirmatory factor analysis were performed using the Kaiser method, Cattell’s scree plot, the chi-square/degrees of freedom ratio (χ²/df), the Comparative Fit Index (CFI), and the Standardized Root Mean Square Residual (SRMR). Internal consistency was assessed using Cronbach’s alpha. The sample consisted of 60 pregnant women from the Colombian Caribbean region.

Results: The mean age was 24 ± 5.14 years, and the mean gestational age was 11.2 ± 3.76 weeks. The content validity coefficient ranged from 0.83 to 0.99. Exploratory factor analysis identified two factors with eigenvalues >1, explaining 78.9% of the total cumulative variance, confirmed by Cattell’s scree plot. Confirmatory factor analysis suggested the use of only 10 items from the HELP instrument, with χ²/df, CFI, and SRMR values of 2.9, 0.90, and 0.04, respectively. However, based on expert judgment, two excluded items (items 9 and 12) were retained due to their clinical relevance. Cronbach’s alpha coefficient was 0.95.

Conclusions: The HELP Score instrument is a valid tool for assessing the severity of hyperemesis gravidarum, facilitating medical decision-making regarding necessary interventions. Further evaluation of criterion validity by comparing the HELP Score with the modified PUQE instrument, sensitivity to change, and additional reliability testing are needed to confirm its utility.

Objectives: To present the case of a pregnant woman diagnosed with craniopharyngioma and to review the literature on the diagnosis, treatment, and maternal-perinatal outcomes of this type of tumor.

Material and methods: A 41-year-old multigravida at 23.6 weeks of gestation was admitted to a high-complexity private clinic due to significant bilateral visual acuity reduction and headache. A diagnosis of craniopharyngioma was made, and expectant management was chosen. The patient underwent an uncomplicated cesarean delivery. The literature review included case reports and series on pregnant women diagnosed with craniopharyngioma. Literature was searched on PubMed, EBSCO, and Scopus, along with references from the selected studies. A narrative summary of the findings is provided.

Results: Ten case reports were included. All patients presented with visual disturbances, and eight cases had diabetes insipidus. Magnetic resonance imaging (MRI) was used in nine cases, effectively identifying the tumor. Seven patients underwent craniotomy (four during pregnancy, two postpartum, and one post-abortion), while three had transsphenoidal surgery (two during pregnancy and one postpartum). Three cases experienced tumor recurrence, and two had incomplete resection. During the postpartum period, 9 cases had resolution of visual symptoms. In four cases, follow-up ranged from two to six years without evidence of recurrence.

Conclusions: In pregnant women with bitemporal hemianopsia, a possible suprasellar tumor should be suspected. MRI of the brain and sella turcica is the diagnostic modality of choice. Further studies are needed to document this condition in pregnancy and its obstetric management in greater detail.

Objectives: To present the case of a patient with squamous cell carcinoma of the cervix who developed distal necrosis following treatment with gemcitabine, and to perform a literature review to assess the association between the cumulative dose of gemcitabine, diagnosis, and management of this complication.

Material and methods: A 61 year old patient was treated with gemcitabine (total accumulated dose of 11,744 mg/m²) for metastatic disease at a private, nononcological, fourth level general hospital, where she was receiving outpatient management. She developed distal necrosis of the second finger on her right hand, leading to the discontinuation of gemcitabine and necessitating amputation of the affected finger. A search was conducted in Embase, Medline, and Lilacs for case reports and case series on gemcitabine induced distal necrosis. Data on dosage, diagnosis, and treatment were extracted.

Results: Fifteen case reports including 19 cases of distal necrosis were identified. The cumulative doses of gemcitabine ranged from 1,700 to 28,700 mg/m². Diagnosis was primarily clinical, supplemented by angiography and Doppler ultrasound; treatment included discontinuation of gemcitabine, initiation of vasodilators, anticoagulants, and symptomatic management.

Conclusions: It is essential to recognize vascular toxicity as a potential adverse effect of gemcitabine and to conduct appropriate risk stratification in patients with advanced cancer and multiple prior treatment lines. Increased monitoring for this adverse effect is warranted with the use of this medication.

Objectives: To evaluate the short-term safety and efficacy of vaginal hysterectomy with cervical preservation in patients with genital prolapse stages II to IV.

Materials and methods: This is a descriptive case series study. It included women with genital prolapse stages II to IV, indicated for vaginal hysterectomy, with negative cervicovaginal cytology for malignancy, who underwent subtotal vaginal hysterectomy with suspension of the cervical stump to the sacrospinous ligament between June 1 and December 31, 2023, at a high-complexity general clinic. Sociodemographic variables and complications six months postoperatively were analyzed. The surgical technique is presented, and descriptive analysis, along with a detailed surgical technique exposition of cervical stump suspension to the sacrospinous ligament, was conducted.

Results: During the described period, 10 patients consulted, of whom eight met the inclusion criteria. The mean duration of the surgical procedure was 133 minutes. Average blood loss was 200 cc. One patient required analgesic use of pregabalin for peripheral neuropathic pain, achieving adequate postoperative pain control. No other intraoperative or postoperative complications were reported. No prolapse recurrence was observed six months postevaluation.

Conclusions: Subtotal vaginal hysterectomy with cervical stump suspension to the sacrospinous ligament is a surgical repair technique that could be considered for the management of uterine prolapse. Randomized studies comparing this technique with other management alternatives are needed to evaluate its long-term efficacy and safety.

Objectives: Hospitalization in critical care areas has compromised the well-being of the mother-child bond during childbirth and the postpartum period. Therefore, it is necessary to describe the experiences of pregnant women with hypertensive disorders admitted to the intensive care unit.

Material and methods: A qualitative research study with a phenomenological design, involving a sample of ten participants with a history of hypertensive disorders during pregnancy, admitted to critical care. Using snowball sampling and data saturation, information was gathered through semi-structured interviews following informed consent. Data were analyzed with open coding a posteriori using Colaizzi's method and complemented by MAXQDA 2022 software.

Results: Six categories emerged: 1) consequences of hypertensive disorders in pregnant women in intensive care units; 2) positive aspects during perinatal care; 3) emotions and suffering due to the loss of the newborn; 4) impact of critical conditions on the mother-newborn relationship; 5) lack of resources for timely therapeutic interventions in perinatal care, and 6) lack of assertive communication by healthcare personnel.

Conclusions: Maternal morbidity and mortality caused by hypertensive disorders require high complexity care in specialized institutions to reduce life-threatening risks, leading to disrupted early bonding and separation of the mother-child dyad, as well as negative feelings in the mothers. This situation results in a painful experience for the family. Therefore, healthcare professionals must develop strategies to ensure the preservation of the emotional bond, which can be compromised in critical care areas.

Magnesium sulfate marks 100 years in the medical management of eclampsia. Lazard, starting in May 1924 at the Los Angeles General Hospital, collected clinical evidence of its benefits on the mortality associated with pregnancy convulsions. Doses, regimens, and dilutions were analyzed, revealing therapeutic safety for both mother and fetus. By the end of the 20th century, randomized clinical trials demonstrated the clinical utility of magnesium for the following indications: treatment of eclampsia, prevention of eclampsia, and neurological protection of the brain in preterm infants less than 32 weeks of gestation, among others. This journey has been controversial among many authorities; however, the National University of Colombia and its Department of Obstetrics and Gynecology have defended the Zuspan regimen as the ideal approach for managing these patients since 1982. Through this review, we aim to present all the evidence that has established magnesium as an essential drug for reducing maternal mortality worldwide, especially in developing countries.

Information and data are accelerating the implementation of competency-based medical education. The adoption of precision education can contribute to this purpose. This article discusses the extent to which precision surgical education can be used in assessing the minimum reliability standards of future surgeons - given the advent of Entrustable Professional Activities - and as an option to strengthen the career trajectory of residents.

Editorial.