Revista colombiana de obstetricia y ginecologia最新文献

Objective: To integrate the available evidence into a conceptual framework that supports decision-making on airway management in pregnant patients.

Materials and methods: Using a hypothetical case to illustrate the problem, we developed an explanatory document based on a structured narrative review. It describes key aspects and a step-by-step approach to achieving airway control, culminating with three challenging theoretical scenarios.

Results: Pregnancy induces anatomical and physiological changes that complicate airway management, including edema, laryngeal distortion, and increased bleeding risk. Diaphragmatic elevation, together with reduced functional residual capacity, favors atelectasis, rapid hypoxemia during apnea, and an increased risk of aspiration particularly after 30 weeks’ gestation.We propose a practical framework for evaluation, preparation, planning, and execution of obstetric airway management, integrating these principles across three theoretical scenarios.

Conclusions: Airway management in obstetrics is challenging due to pregnancy-related changes that increase difficulty and complications, especially hypoxemia. Continuous training and a comprehensive, protocol-driven approach are essential to optimize maternal and neonatal outcomes.

Editorial article

Objectives: To evaluate the effectiveness and safety of treatment for gestational syphilis during the third trimester on maternal and perinatal outcomes, according to the timing of administration relative to delivery, and assess the certainty of the body of evidence.

Materials and methods: This systematic review included randomized controlled trials, quasiexperimental studies, cohort studies, and case series involving women diagnosed with GS at 28 weeks’ gestation or later, treated with penicillin or other antibiotics. Search was done in 2023 and updated on June 2025. Two researchers selected studies and extracted data. We assessed the incidence of Congenital Syphilis and maternal treatment failure. Outcomes are presented by maternal and perinatal endpoints and treatment regimen.

Results: No randomized controlled trials were identified. Ten cohort studies comprising 5438 women with GS and three case series of Congenital Syphilis were included. Benzathine penicillin G administered during the third trimester might be associated with a cumulative incidence of Congenital Syphilis of 8% (95% CI: 2–13%). The effectiveness of treatment administered 4 weeks before delivery remains uncertain. Aminopenicillins were possibly associated with a 43% incidence of Congenital Syphilis. Safety data were limited. Case series of foetuses with hidrops fetalis associated with gestational syphilis to mothers treated with a 10-day course of intravenous aqueous crystalline penicillin G showed seven newborns with complete response, suggesting prevention of Congenital Syphilis.

Conclusion: Treatment of GS with benzathine penicillin G during the third trimester is beneficial in reducing the risk of Congenital Syphilis. However, as its effectiveness is uncertain when administered fewer than 30 days before delivery, neonates born within this timeframe should continue to be managed in accordance with current guidelines for possible Congenital Syphilis. Aminopenicillins may be associated with a high rate of treatment failure. Alternative strategies to treat the fetus during the final four weeks of pregnancy are needed to reduce the risk of Congenital Syphilis.

Objective: To present a case of disseminated histoplasmosis with endometrial involvement mimicking advanced endometrial carcinoma in a patient with HIV infection. The endometrial findings are described.

Case presentation: A woman from Guinea-Bissau presented to a general hospital serving immigrant patients and those with public insurance, complaining of costal pain. Multiple pathological vertebral fractures were identified. During studies performed to clarify the cause of the fractures, a de novo diagnosis of HIV infection was made with a CD4 count of 395 cells/μL. Magnetic resonance imaging revealed images suggestive of vertebral abscesses and suspected endometrial cancer. Study of bone material showed presence of fungal spores and endometrial biopsy revealed non-necrotizing granulomas and histiocytic accumulations, without neoplastic lesion. Serological tests were positive for Histoplasma capsulatum. The patient was treated with liposomal amphotericin B and antiretroviral therapy with favorable clinical evolution on follow-up.

Conclusions: It is important to consider opportunistic infections in the differential diagnosis of pelvic masses in immunocompromised patients. Additional studies are needed to determine the frequency of endometrial involvement in disseminated histoplasmosis and to establish specific diagnostic protocols.

Artículo editorial.

Objective: To analyze the diagnostic approach, considerations regarding delivery and treatment for Tarlov cysts during pregnancy, through a case report and literature review.

Materials and methods: We present the case of a 31-year-old woman who was referred to a tertiary care general hospital at 33 weeks of gestation due to a pelvic cystic mass. Magnetic resonance imaging revealed a cystic lesion in continuity with the thecal sac, associated with osseous remodeling of the L4, L5, and sacral vertebral bodies, with presacral extension and displacement of the rectum to the right. A Tarlov cyst was diagnosed. The pregnancy was terminated by cesarean section under general anesthesia at 37 weeks due to mechanical dystocia and the high risk of cyst puncture and subsequent cerebrospinal fluid fistula. A healthy newborn weighing 2,420 g was delivered, and both maternal and neonatal outcomes were satisfactory. At the four-month postoperative follow-up, the patient reported low back pain and was awaiting neurosurgical management. A literature search was conducted in Medline via PubMed, Lilacs, SciELO, and ScienceDirect using the terms “Pregnancy” and “Tarlov cysts.” Case reports, case series of pregnant patients with Tarlov cysts, and literature reviews were included. Titles and abstracts were screened, and data were extracted independently by two authors. Extracted data included study characteristics, patient demographics, diagnosis, obstetric management, treatment, and prognosis of Tarlov cysts. A descriptive summary of the findings is presented.

Results: The review identified five cases which met the inclusion criteria. Simple magnetic resonance imaging was used for diagnosis in all cases. Vaginal delivery was performed in two cases. Neuraxial anesthesia was administered without complications in three cases. No direct maternal-fetal complications attributable to the cysts were reported. None of the cases reported interventions for the cyst during pregnancy.

Conclusions: Tarlov cysts during pregnancy are rare. Non-contrast magnetic resonance imaging is the safest and most effective diagnostic option for this condition during pregnancy. The Tarlov cyst could not increase the risk of perinatal complications or related with the cyst complications. Further reports and multicenter studies are needed to establish optimal obstetric and anesthetic strategies.

Objective: Present the use of ultrasound as a strategy that, together with clinical findings, can guide the use of renal replacement therapy. It also presents images that approximate the vascular pattern present in the vena cava, portal vein, and suprahepatic vein a pregnant woman. The renal vein was not considered due to changes associated with pregnancy that affect its measurement.

Materials and methods: A woman with chronic kidney disease who required renal replacement therapy during pregnancy. Ultrasound monitoring of venous congestion at week 25 was used to guide the ultrafiltrate dose, along with clinical findings. With this approach, the patient presented placental abruption at week 32, and an emergency cesarean section was performed without complications. A fresh 1545 g new born was born. Both patients progressed satisfactorily. The patient continues on hemodialysis.

Conclusions: Bedside ultrasound could be a useful tool to guide the ultrafiltration dose for hemodialysis in pregnant women requiring renal replacement therapy. Further studies are needed to standardize and provide recommendations for this specific population.

Objective: To describe the prevalence of sex toy use in women, characterize the most commonly used devices, and their effect on the Female Sexual Function Index (FSFI) score.

Material and methods: Multicenter crosssectional study. Women over 18 years of age with a stable partner, residing in Colombia, were included. Participants were recruited from the gynecological outpatient clinics of high-complexity private clinics in 21 cities across the country between 2019 and 2024. A sample size calculation was performed, and simple random sampling was used. The IFSF was applied. Socio-demographic characteristics, sexual orientation, use of sex toys, type of device used, individual or partner use, overall and domainspecific Female Sexual Function Index (FSFI) score, were measured. A descriptive analysis was performed.

Results: A total of 1,759 women were included, of whom 1,280 used sex toys, for a prevalence of use of 72.76%. Homosexual women used toys more frequently than heterosexual women. The mean IFSF score for sex toy users was 29.55 (standard deviation (SD) ± 9.12) and for non-users it was 27.43 (SD ± 8.59); (p = 0.027). The highest-scoring domain was orgasm (4.97 ± 1.29), followed by desire (4.95 ± 1.68), (p = 0,027). The most frequently used toys were the dilido (53.49%) and the vibrator (48.15%).

Conclusions: The use of sex toys among Colombian women is a common practice, so their use should be investigated during gynecological consultations. Studies are needed to evaluate the sexual and reproductive health of women who use sex toys.