Revista colombiana de obstetricia y ginecologia最新文献

Reply to the letter to the Editor

Contrary to popular belief, the true architect of success in the care of critically ill patients and their families is not the use of complex interventions or advanced hemodynamic or multimodal monitoring. It is human talent that, with determination, vocation, and dedication, provides every day the best possible care in pursuit of the best clinical outcome. Recognizing the importance of human resource training and the promotion of critical-disruptive thinking, this article aims to present a dynamic account of the birth of critical care medicine as a specialty, its development in Colombia, and how obstetricians' interest in acquiring the necessary competences to lead the management of these patients evolved. Throughout this document, the reader will find an engaging narrative that pays tribute to the contributions made by visionaries who, by challeging the status quo, paved the way for future generations. This historical account also seeks to inspire the reader to embark on a path that leads to the breaking of paradigms, since death is not the cessation of the heartbeat or the absence of the respiratory impulse; it is an existence free from any questioning that undoubtedly marks the demise of the spirit.

Objective: To describe the lived experience of women with polycystic ovary syndrome (PCOS) in central Chile.

Material and methods: Qualitative study with an interpretative phenomenological approach. Individual interviews were conducted with seven women diagnosed with PCOS. Participants were identified through key informants using purposive sampling. Data interpretation was performed through thematic analysis.

Results: The lived experience highlights PCOS as a negative condition in their lives. The findings of this study were consolidated into two main categories, which describe the experience of discovering their diagnosis and what it means to live with PCOS.

Conclusion: It is essential to assess the mental health and quality of life of women with PCOS. Adolescents and adult women should receive adequate information about the syndrome, and their perspectives should be considered when determining the best management approach.

Objectives: To present a case of gestational syphilis (GS) caused by reinfection and conduct a systematic review of the literature regarding the frequency, diagnosis, treatment, and follow-up of reinfection.

Materials and methods: A 21-year-old immigrant woman was hospitalized for preeclampsia and bacterial vaginosis. She reported being diagnosed and treated for GS in the first trimester, with a subsequent decrease in Venereal Disease Research Laboratory (VDRL) titers, followed by a new elevation detected at week 39. A diagnosis of syphilis reinfection was made, and she was treated again with benzathine penicillin. The newborn presented a positive VDRL test with a titer of 1:2, but without clinical signs or sequelae of Treponema pallidum infection. The infant was diagnosed with Congenital Syphilis (CS), and treated with intravenous crystalline penicillin G, with satisfactory outcomes. A systematic review of the literature was conducted from the inception of each database until November 2023 in Medline (PubMed), Embase, Scopus, Web of Science, and Lilacs. Case reports, case series, and cohorts of pregnant women with syphilis reinfection were selected. Two authors independently selected the studies and extracted the data. Study characteristics, population details, diagnostic features, GS treatment, and reinfection frequency were described. Descriptive analysis was performed.

Results: A total of 208 potentially relevant titles were identified, of which 12 were reviewed in full text. Ultimately, six articles were included. In total, 85 women experienced syphilis reinfection during pregnancy (3.8%). The incidence of syphilis reinfection during pregnancy ranged from 1.5% to 7.3%. Diagnosis was predominantly made using non-treponemal tests (83.3%). Available information regarding the treatment of pregnant women with reinfection, follow-up, partner treatment, and perinatal outcomes was limited.

Conclusions: Active and individualized monitoring of treated GS cases is crucial, as it enables the identification of reinfection and ensures the treatment of sexual partners to prevent recurrence. Prospective studies are needed to assess the magnitude of this problem, its perinatal consequences, and potential resistance to penicillin.

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.