Revista colombiana de obstetricia y ginecologia最新文献

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.

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.

Editorial.

Objectives: Preeclampsia (PE) is a pregnancyrelated hypertensive disorder that can lead to severe complications and adverse maternal and fetal outcomes. This study aimed to estimate the economic impact of integrating the sFlt-1/PlGF ratio into Uruguay's healthcare system as part of routine clinical practice for diagnosing.

Material and methods: A decision tree model was used to estimate the annual economic impact on the Uruguayan healthcare system for a hypothetical cohort of women with suspected PE. This included relevant costs associated with diagnosis, monitoring, and treatment from the initial presentation of suspected PE until childbirth. The study analyzed the annual costs under two scenarios: the standard of care and a scenario incorporating the sFlt-1/PlGF ratio for PE, using 2022 as the reference year. Various deterministic and probabilistic sensitivity analyses were performed.

Results: The economic model estimated that the implementation of the sFlt-1/PlGF ratio could save the Uruguayan healthcare system $95,432,678 Uruguayan pesos (2,320,269 United States Dollars [USD]) annually, representing a 5 % reduction in costs compared with the standard of care. These savings were primarily due to a reduction in hospitalizations of women with suspected PE. The estimated economic impact equated to an annual net saving of approximately $10,602 Uruguayan pesos (258 USD) per patient.

Conclusions: The introduction of the sFlt-1/PlGF ratio into the Uruguayan healthcare system is likely to generate savings due to the optimization of the management of hospitalizations for women with suspected preeclampsia (PE). However, the potential for savings will primarily depend on the current hospitalization rate of these women (the efficiency of managing high-risk PE pregnancies) and the length of stay for hospitalized women.

Reply to the letter to the Editor

Objectives: To describe the prevalence and characterize gestational anemia in women attending prenatal care in the department of Quindío, Colombia, and to identify associated risk factors.

Material and methods: An analytical crosssectional study was conducted. Out of 1,003 pregnant women, 307 were selected. The study included pregnant women aged 18 years or older who attended a prenatal care program at three high-complexity private institutions in Armenia (Quindío, Colombia) from 2018 to 2023, providing a five-year observation window. Pregnant women with a diagnosis of fetal malformations and hemolytic disease, those who changed healthcare centers, or moved out of Quindío were excluded.

Results: The mean age of the participants was 28.14 ± 5.27 years. The prevalence of gestational anemia was identified as 26.38 %, with an average hemoglobin level of 9.82 ± 1.74 g/dL. Of these, 12.37 % had hemoglobin levels of 10.1-10.9 g/dL (mild anemia), 8.46 % had levels of 7.1-10.0 g/dL (moderate anemia), and 5.53 % had levels below 7.0 g/dL (severe anemia). In the third trimester, the prevalence of anemia increased to 41.97 % (n = 34/81), with 91.35 % (n = 74/81) of cases being iron-deficiency anemia. A BMI of < 18.5 (OR: 15.46; 95 % CI: 7.13-28.59), multiple pregnancy (OR: 9.73; 95 % CI: 1.49-26.83), and a history of pregestational anemia (OR: 7.43; 95 % CI: 4.52-9.13) were associated with gestational anemia.

Conclusions: The prevalence of gestational anemia is over 25 % and increases in the third trimester. It is important to identify risk factors during preconception evaluation and prenatal care.