Progresos en Obstetricia y Ginecologia最新文献

Objective

To describe complications and clinical evolution of patients underwent to total laparoscopic hysterectomy.

Material and method

A retrospective study was performed after reviewing 120 patients who were subjected to laparoscopic hysterectomy in the period between January 2012 and December 2014. Medium age was 54 years (23-94) and BMI 27.6. The general characteristics, indications, presence of previous surgery, perioperative complications were analyzed and postoperative duration of the procedure and rate of conversion to laparotomy.

Results

The intraoperative complications were bladder injury (0.8%) and ureteral injury (1.7%). There were postoperative complications in 6 patients (three febrile syndrome, fistula ureterovaginal, two vaginal cuff dehiscence, two vaginal bleeding and hemoperitoneum). The conversion rate to abdominal hysterectomy was 1.6%.

Conclusion

Laparoscopic hysterectomy is a reproducible process with a low complication rate accepted by the patients quality of life, and with rapid postoperative recovery.

Objective

To analyse perinatal outcomes in nulliparous adolescents compared with nulliparous women aged 20-29 years.

Material and methods

This large hospital-based retrospective cohort study included singleton births at ≥ 24 weeks to women younger than 30 years from 2008 to 2009. The There were two cohorts: a) a study cohort consisting of nulliparous adolescents aged 11 to 19 years (n = 3555), and b) a control cohort comprising nulliparous women aged 20-29 years (n = 7040). In addition to a bivariate analysis, logistic regression was performed to adjust for confounding variables. Perinatal outcomes included low birth weight, preterm delivery, antepartum foetal death, caesarean section, and Apgar score at five minutes < 7.

Results

Preterm delivery < 37 weeks was more frequent among adolescents than among women aged 20–29 years (7.5% vs 5.4% respectively, p < 0.001). There was no difference in the number of neonates with low birthweight < 2500 g (6.8% vs 5.8% in adolescents vs adults, respectively, p = 0.05), the rate of preterm delivery < 34 weeks (1.7% vs 2.1% in adolescents vs adults, respectively, p = 0.17), or in preterm delivery < 28 weeks (0.4% vs 0.3% in adolescents vs. adults, respectively, p = 0.32). There were no differences in antepartum foetal deaths (0.7% vs 1.0% in adolescents vs adults, respectively, p = 0.11) or in Apgar score < 7 at 5 minutes (0.4% vs 0.4% in adolescents vs adults, respectively, p = 0.983). Logistic regression analysis showed a significant difference in the risk of preterm delivery < 37 weeks (OR = 1.3, 95% CI: 1.1-1.6), but not in low birthweight < 2500 g (OR = 1.0, 95% CI 0.8–1.3).

Conclusions

Preterm delivery < 37 weeks was more frequent in nulliparous adolescents than in women aged 20-29 years. There was no association between pregnancy in nulliparous adolescents and other adverse perinatal outcomes such as low birth weight, low Apgar score and antepartum foetal death.

Radical trachelectomy is a surgical technique that allows young women with early invasive cervical carcinoma to preserve their fertility. Although its safety has been demonstrated in squamous histology, doubts remain about the advisability of this intervention in histological types traditionally associated with a worse outcome. We describe two cases of rare cervical tumors (clear cell adenocarcinoma and synchronous invasive squamous cell carcinoma and invasive adenocarcinoma) treated with radical trachelectomy after pelvic sentinel node biopsy.

Objectives

To analyse differences between preoperative and postoperative staging in a series of patients with endometrial cancer who underwent surgery in our department.

Material and methods

We conducted a retrospective study of malignant endometrial tumours treated by laparoscopic surgery between January 1^st 2005 and August 31^st 2014. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging and biopsy performed before the intervention. We estimated the percentage of women at risk of over- and under-treatment if intraoperative biopsy had not been performed.

Results

We included 174 malignant endometrial tumours. The sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging was 95.09, 63.33, 93.37 and 70.37%, respectively. For preoperative biopsy, the results were sensitivity (90.91%), specificity (65.38%), positive predictive value (74.77%) and negative predictive value. (86.44%). If intraoperative biopsy had not been performed, 12 of 166 (12.65%) women in stage 1 would have been undertreated and 3.61% would have been overtreated.

Conclusion

Intraoperative biopsy should be mandatory in the early the stages of endometrial cancer to avoid under- and over-treatment.