Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Uso de plasma rico en plaquetas en el campo de la reproducción humana asistida 在人类辅助生殖领域使用富血小板血浆

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-11-27 DOI: 10.1016/j.gine.2024.101016

P. Luque González , M. Pineda Mateo , J. Rodríguez Sánchez-Reyman

Assisted reproductive therapies have a limited success rate. New therapies are currently being investigated to increase their effectiveness, such as the use of platelet-rich plasma (PRP). This agent has demonstrated efficacy at the level of regenerative medicine and consists of the administration of blood plasma extracted from the patient herself with a high platelet count. Given the recent incorporation of this treatment in clinical research, the objective is to carry out a bibliographic review to elucidate the characteristics of its use, effects and benefits. The literature available in the main databases offers very optimistic results. It has been shown that PRP favors endometrial regeneration and folliculogenesis as well as restoration of the menstrual cycle, which may be useful in patients with thin endometrium refractory to classical treatments, chronic endometritis, repeated implantation failure, early ovarian failure or Asherman's syndrome. However, there are few studies and they have a small sample size, so it is necessary to continue and expand the research on PRP.

辅助生殖疗法的成功率有限。目前正在研究新的疗法，以提高其有效性，如使用富血小板血浆（PRP）。这种药物已在再生医学层面上证明了其疗效，其原理是从患者自身提取的高血小板血浆。鉴于这种疗法最近已被纳入临床研究，我们的目的是进行文献综述，以阐明其使用特点、效果和益处。主要数据库中的文献提供了非常乐观的结果。研究表明，PRP 有利于子宫内膜再生和卵泡生成，以及月经周期的恢复，这可能对传统治疗方法难治的子宫内膜薄、慢性子宫内膜炎、反复种植失败、早期卵巢功能衰竭或阿舍曼综合征患者有用。然而，相关研究较少，样本量也较小，因此有必要继续扩大对 PRP 的研究。

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引用次数: 0

Bases fisiológicas, técnicas y principales indicaciones de preservación de la fertilidad en la paciente oncológica 肿瘤患者保留生育能力的生理基础、技术和主要适应症。

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-28 DOI: 10.1016/j.gine.2024.101005

Y. Barral , M. Vidal , S. Peralta , L. Magnano

In recent decades, the use of fertility preservation techniques in women with oncologic pathology has increased, aiming to improve their future reproductive prognosis. This trend is attributed to the increasing incidence of neoplasms in women of reproductive age, improved survival rates, and the progressive delay of motherhood. The gonadotoxicity of chemotherapy is influenced by factors like the patient's age, baseline ovarian reserve, and the type and cumulative dose of chemotherapy. Therefore, it is crucial to provide appropriate reproductive counseling and refer patients to specialized fertility preservation programs, where comprehensive assessment of gonadotoxic risk and individual patient risk are performed. Oocyte cryopreservation is the main technique for fertility preservation, non-experimental since 2013. Controlled ovarian stimulation starts at any phase of the menstrual cycle (random start), avoiding the delay in starting chemotherapy. In addition, the treatment with letrozole is recommended to breast cancer patients performing ovarian stimulation to prevent excessive increases in serum estrogen levels. The ovarian cortex cryopreservation is still considered experimental in many countries. However, it is performed in some cases, for example, when chemotherapy cannot be delayed for 2 weeks or in prepubertal patients. At the present time, gonadotropin-releasing hormone (GnRH) treatment is not regarded as a fertility preservation technique. However, it can be employed in certain clinical contexts.

近几十年来，对患有肿瘤病变的妇女使用生育力保存技术的情况越来越多，目的是改善她们未来的生殖预后。这一趋势归因于育龄妇女肿瘤发病率的增加、生存率的提高以及生育年龄的逐渐推迟。化疗的性腺毒性受患者年龄、卵巢基线储备、化疗类型和累积剂量等因素的影响。因此，为患者提供适当的生殖咨询并将其转诊至专门的生育力保存项目至关重要，在这些项目中，将对性腺毒性风险和患者的个体风险进行全面评估。卵母细胞冷冻保存是保存生育能力的主要技术，自2013年以来一直是非实验性的。受控卵巢刺激可在月经周期的任何阶段开始（随机开始），避免了开始化疗的延迟。此外，建议乳腺癌患者接受来曲唑治疗，以防止血清雌激素水平过度升高。在许多国家，卵巢皮质冷冻保存仍被认为是实验性的。不过，在某些情况下，如化疗不能推迟两周或青春期前的患者，也会进行卵巢皮质冷冻保存。目前，促性腺激素释放激素（GnRH）治疗不被视为生育力保存技术。不过，在某些临床情况下可以使用。

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引用次数: 0

Diagnostic rentability of IOTA models for differentiating between benign and malignant complex adnexal masses 用于区分良性和恶性复杂附件肿块的 IOTA 模型的诊断可租性

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-19 DOI: 10.1016/j.gine.2024.101000

A. Rodríguez Pérez , A. Caruso , M. Pantoja Garrido , I. Rodríguez Jiménez , A. Polo Velasco , J.J. Fernández Alba

Purpose

To evaluate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) Logistic Regression Model 1, 2 (LR1, LR2) ADNEX model and IOTA Simple Rules, in the pre-surgical evaluation of ovarian tumors classified as complex adnexal masses.

Methods

This is a cross-sectional observational study of diagnostic accuracy. We will select patients, who undergo surgical intervention due to adnexal mass with indeterminate, intermediate or high suspicion of malignancy (GI-RADS 4–5), as assessed by an expert ultrasound operator. We analyzed and compared the diagnostic performance and predictive capacity of the different models in the studied population, and also we analyzed each model by creating subgroups based on menopausal status.

Results

One hundred thirty five malignant masses (45%), one hundred forty benign (46.7%) and twenty five border line (8.3%) were included.

LR1 and LR2 models, and ADNEX were applicable to all lesions; however, in 72 lesions (24%), the simple rules were inconclusive.

We observed better performance for LR1 and simple rules, based on the following results: Sensitivity: LR1 91%. Specificity: simple rules 86%. PPV: simple rules 79%. NPV: LR1 88%.

Conclusions

Our study suggests that the subgroup of patients with complex adnexal masses, the IOTA risk stratification through LR1 shows higher sensitivity for risk stratification of malignancy, while simple rules has the highest specificity and diagnostic accuracy. However, it is inconclusive in one out of every four adnexal masses. Additionally, LR1–LR2 and ADNEX do not show significant differences in diagnostic accuracy.

目的评价国际卵巢肿瘤分析（IOTA）逻辑回归模型 1、2（LR1、LR2）ADNEX 模型和 IOTA 简单规则在手术前评估归类为复杂附件肿块的卵巢肿瘤时的诊断准确性。我们将选择因附件肿块而接受手术治疗的患者，由超声波操作专家评估其恶性程度为不确定、中度或高度怀疑（GI-RADS 4-5）。我们分析并比较了不同模型在研究人群中的诊断性能和预测能力，还根据绝经状态创建了亚组，对每个模型进行了分析。LR1和LR2模型以及ADNEX适用于所有病变；然而，在72个病变（24%）中，简单规则无法得出结论：灵敏度灵敏度：LR1 91%。特异性：简单规则为 86%。PPV：简单规则 79%。结论我们的研究表明，在复杂附件肿块患者亚组中，通过 LR1 进行 IOTA 风险分层对恶性肿瘤风险分层的敏感性更高，而简单规则的特异性和诊断准确性最高。然而，每四个附件肿块中就有一个是不确定的。此外，LR1-LR2 和 ADNEX 在诊断准确性上也没有明显差异。

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引用次数: 0

Fisioterapia en el dolor tras cesárea 剖腹产后疼痛的物理治疗

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-16 DOI: 10.1016/j.gine.2024.101002

L. Monroy Martínez , I. Da Cuña Carrera , A. Alonso Calvete , L. Núñez Remiseiro , M. Fernández Paz

Cesarean section is one of the most commonly performed surgeries in obstetrics and involves the removal of a neonate through an abdominal and uterine incision. This intervention can cause different consequences, such as pain, which can be treated using physiotherapy techniques. The objective of this work is to analyze the existing literature to know what the effects of physiotherapy are on pain after cesarean section. A bibliographic search was carried out in the databases PudMed, Cinahl, Medline, PEDro, Scopus, Web of Science and ENFISPO. The search terms «Pain», «Cesarean Section», «Physiotherapy», «Physical Therapy» and «Physical Therapy Modalities» were used. Studies were limited to randomized clinical trials published in English or Spanish. Of the 220 initial results, 12 articles were chosen for analysis. The therapies carried out were varied, including electrotherapy, massage therapy and cryotherapy to analyze different variables. Physiotherapy is beneficial in controlling pain in patients after a cesarean section through techniques such as TENS. Other therapies such as massage therapy and cryotherapy seem to obtain some improvements, but it cannot be concluded that they have significant benefits.

剖腹产是产科中最常见的手术之一，需要通过腹部和子宫切口将新生儿取出。这种干预可能会导致不同的后果，例如疼痛，而疼痛可以通过物理治疗技术进行治疗。本研究旨在分析现有文献，了解物理治疗对剖宫产术后疼痛的影响。我们在 PudMed、Cinahl、Medline、PEDro、Scopus、Web of Science 和 ENFISPO 等数据库中进行了文献检索。搜索关键词为 "疼痛"、"剖腹产"、"物理疗法"、"物理疗法 "和 "物理疗法模式"。研究仅限于以英语或西班牙语发表的随机临床试验。在 220 项初步结果中，有 12 篇文章被选中进行分析。所采用的疗法多种多样，包括电疗、按摩疗法和冷冻疗法，以分析不同的变量。物理疗法有助于通过 TENS 等技术控制剖腹产后患者的疼痛。其他疗法，如按摩疗法和冷冻疗法，似乎也有一定的改善作用，但不能断定它们有明显的益处。

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引用次数: 0

Violencia obstétrica: primera, segunda y tercera víctima 产科暴力：第一、第二和第三受害者

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-15 DOI: 10.1016/j.gine.2024.101001

L. Guillén Vargas , E.M. Aragoneses Tiburcio , M.J. Galván León , J.M. Martínez-Sánchez

引用次数: 0

¿Es la gestación a edad materna muy avanzada éticamente aceptable? 从伦理角度讲，孕产妇晚期妊娠是否可以接受？

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-14 DOI: 10.1016/j.gine.2024.101003

A. Martínez-Varea

In recent years, there has been an increase in the age at which women conceive and have children, especially in developed countries.

This study aims to elucidate whether pregnancy at a very advanced maternal age is ethically acceptable or if it is better to promote pregnancy at a younger age. The specific objectives include evaluating the medical risks associated with pregnancy at a very advanced maternal age and analyzing the ethical and social implications of pregnancies at advanced maternal ages.

A systematic review was conducted using PubMed and Web of Science with the keywords pregnancy outcome, 45 years, 50 years, very advanced maternal age, menopause, ethics, bioethics. Studies published in the last 10 years in Spanish or English were included. Reviews, meta-analyses, clinical cases, letters to the editor, comments, and opinion articles were excluded.

The systematic review revealed that pregnancy at age 45 or older is associated with more adverse maternal-fetal outcomes compared to younger ages. Thus, patients of very advanced maternal age should receive appropriate prenatal counseling and close prenatal monitoring. Women of very advanced age wishing to conceive with their own oocytes should be informed about the low probabilities of success and high risk of embryonic aneuploidies. Preimplantation genetic diagnosis is recommended for women over 43 years with good ovarian reserve, and in vitro fertilization cycles should be limited to three for patients aged 44-45 years. Patients aged 45-46 years should be informed about the minimal probability of success with autologous oocytes.

As a conclusion, pregnancy at a very advanced maternal age is increasingly common and is considered ethically acceptable by both patients and specialists in reproductive medicine and obstetrics and gynecology.

本研究旨在阐明高龄产妇怀孕在伦理上是否可以接受，还是提倡在更年轻的年龄怀孕更好。具体目标包括评估与高龄产妇怀孕相关的医疗风险，并分析高龄产妇怀孕的伦理和社会影响。我们使用 PubMed 和 Web of Science 进行了系统性综述，关键词为妊娠结果、45 岁、50 岁、高龄产妇、绝经、伦理、生物伦理学。纳入了过去 10 年中以西班牙语或英语发表的研究。系统综述显示，45 岁或以上妊娠与年轻妊娠相比，会导致更多不良的母胎结局。因此，高龄产妇应接受适当的产前咨询和密切的产前监护。希望用自己的卵细胞受孕的高龄产妇应了解胚胎非整倍体的低成功率和高风险。建议对 43 岁以上、卵巢储备良好的女性进行胚胎植入前遗传学诊断，44-45 岁的患者体外受精周期应限制在三个以内。总之，高龄产妇怀孕越来越常见，而且患者和生殖医学及妇产科专家都认为这在伦理上是可以接受的。

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引用次数: 0

Management of thoracic neuropathic pain with an ESP block in a pregnant patient 用 ESP 阻滞治疗怀孕患者的胸椎神经痛

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-11 DOI: 10.1016/j.gine.2024.101004

L. Arce Gálvez , R.E. Valencia Gómez , A. Ceballos Vejarano , J. Daes Mora , D.A. Méndez Vega

Introduction

The erector spinae plane block is a useful intervention in the management of somatic and visceral nociceptive pain at different spinal levels. Studies of its use during pregnancy are still limited, however, it has shown interesting results in the management of non-obstetric pain during pregnancy.

Clinical case

We present the case of a 27.5-week pregnant woman with a history of pancreatitis and a thoracotomy with neuropathic pain at intercostal level and repeated emetic symptoms who was taken to an ESP at T6 level with a sudden improvement of her symptomatology, without side effects or maternal–fetal damage.

Conclusion

This is the first description of the use of ESP blockade in intercostal pain during gestation, where we highlight its clinical efficacy and maternal–fetal safety profile.

导言竖脊肌平面阻滞是治疗不同脊柱水平的躯体和内脏痛觉疼痛的有效干预方法。然而，它在治疗妊娠期非产科疼痛方面取得了令人感兴趣的效果。我们介绍了一例妊娠 27.5 周的孕妇，她曾有胰腺炎和开胸手术史，并伴有肋间神经性疼痛和反复呕吐症状，在接受 T6 水平的 ESP 治疗后，症状突然改善，且无副作用或母胎损伤。

引用次数: 0

Diagnóstico de cáncer renal metastásico en gestante a través de lesiones cutáneas: descripción de un caso clínico 通过皮肤病变诊断孕妇患有转移性肾癌：病例报告描述

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-10-05 DOI: 10.1016/j.gine.2024.100999

A. Ramírez Castán , M.J. Cuerva González , J.L. Bartha Rasero

Introduction

Gestational cancer affects approximately 1 in 1,000 pregnant women, with renal cell carcinoma (RCC) being the most common in the urinary tract. RCC dissemination can include cutaneous metastases in 2.8-6.8% of cases. A multidisciplinary approach to RCC during pregnancy is crucial due to diagnostic and therapeutic challenges that can impact maternal and neonatal outcomes.

Symptoms and Clinical Findings

A 15-week pregnant woman presents with asymptomatic cutaneous lesions for 4 months. Physical examination reveals two erythematous-violaceous nodules in the right hypochondrium and two in the right thigh, all adherent to deep planes and without palpable lymphadenopathy.

Diagnosis, Therapeutic Intervention, and Results

Excisional skin biopsy with immunohistochemical and molecular studies suggests cutaneous metastasis of papillary-pattern renal carcinoma. Nuclear magnetic resonance reveals multiple metastatic implants and lymphadenopathies. Despite recommendations to terminate pregnancy for targeted therapy, the patient chooses to continue. At week 31, a cesarean section is performed due to maternal clinical deterioration from disease progression. Oncologic treatment with Cabozantinib begins postpartum. Six months later, the patient remains stable with significant lesion improvement.

Conclusion

Diagnosing cancer during pregnancy presents a complex challenge, balancing maternal prognosis with fetal health is critical. Emphasizing a multidisciplinary approach and early consultation optimizes both clinical and emotional management.

导言妊娠期癌症约影响到千分之一的孕妇，其中肾细胞癌（RCC）在泌尿道最为常见。在2.8%-6.8%的病例中，RCC可发生皮肤转移。由于诊断和治疗方面的挑战可能会影响孕产妇和新生儿的预后，因此对妊娠期 RCC 采用多学科方法至关重要。体格检查发现右侧下腹部和右侧大腿分别有两个红斑橘皮样结节，所有结节均与深面粘连，未触及淋巴结肿大。诊断、治疗干预和结果切除皮肤活检及免疫组化和分子研究提示乳头状肾癌皮肤转移。核磁共振显示有多个转移性植入物和淋巴结病变。尽管医生建议患者终止妊娠以接受靶向治疗，但患者仍选择继续妊娠。第 31 周时，由于疾病进展导致产妇临床症状恶化，患者接受了剖腹产手术。产后开始接受卡博替尼（Cabozantinib）的肿瘤治疗。结论妊娠期癌症诊断是一项复杂的挑战，平衡母体预后和胎儿健康至关重要。强调多学科方法和早期咨询可优化临床和情绪管理。

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引用次数: 0

Descripción de un caso: liposarcoma de mama radioinducido 病例报告：放射性诱导的乳腺脂肪肉瘤

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-09-30 DOI: 10.1016/j.gine.2024.100998

M.I. Limia Pérez , J.A. Moreno Domingo , L. Juez González , M.J. Fernández Mellado , S. Ajuriagogeaskoa , L. Muñoz Arberas , A. Urones Goikoetxea

Main symptoms and/or clinical findings

Breast sarcoma is a very rare entity that constitutes only 1% of all primary malignant breast tumors. It has a very poor prognosis with a high risk of recurrence. In this article, we present the case of a patient diagnosed with breast liposarcoma after having received radiotherapy for a previous breast carcinoma.

Main diagnoses

Due to the rarity of breast liposarcoma, it is important to make an adequate differential diagnosis. In our case, the study of overexpression of the MDM2 and/or CDK4 proteins allowed us to establish the definitive diagnosis.

Therapeutic interventions and results

The patient in our case underwent surgery, obtaining tumor-free margins with a favorable subsequent evolution. She currently has 18 months of disease-free survival.

Conclusion

The treatment of breast liposarcoma is mainly surgical since this sarcoma has a poor response to both chemotherapy and radiotherapy. The correct tumor resection is the most important prognostic factor for local control of the disease and long-term survival.

主要症状和/或临床表现乳腺肉瘤是一种非常罕见的肿瘤，仅占所有原发性恶性乳腺肿瘤的 1%。它的预后很差，复发风险很高。由于乳腺脂肪肉瘤的罕见性，进行充分的鉴别诊断非常重要。在我们的病例中，通过对 MDM2 和/或 CDK4 蛋白过度表达的研究，我们确定了明确的诊断。治疗干预和结果我们病例中的患者接受了手术，获得了无肿瘤边缘，随后的病情发展良好。结论乳腺脂肪肉瘤的治疗以手术为主，因为这种肉瘤对化疗和放疗的反应都很差。正确的肿瘤切除是疾病局部控制和长期生存的最重要预后因素。

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引用次数: 0

Update on second trimester ultrasound scanning in pregnancy 孕期超声波扫描的最新进展

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Clinica e Investigacion en Ginecologia y Obstetricia

Pub Date : 2024-09-25 DOI: 10.1016/j.gine.2024.100997

I. Pelayo-Delgado , E. Gómez-Montes , M. Álvaro-Navidad

Second trimester ultrasound is a standardised examination in pregnancy that should be routinely offered to all pregnant women, both for monitoring foetal growth and for screening for malformations. It should be performed between 18 and 24 weeks (in Spain from 18 + 0 to 22 + 0 weeks of gestation), by trained personnel and with appropriate equipment. The report should reflect foetal position and movements, biometry, amount of amniotic fluid, placental location and appearance, and foetal morphology. The foetal anatomy should include the study of the head (ossification and neurosonography), neck (discarding masses), thoracic cavity and its contents, abdomen and pelvis (studying stomach, umbilical vein, entrance of umbilical cord, kidneys, bladder), spine (in sagittal, coronal and axial planes), extremities (three segments, movement), and genitalia. Special attention should be paid to foetal heart examination (situs, four chamber view, left ventricular and right ventricular outflow-tracts, three-vessel and three-vessel-and trachea views). Neurosonography is also important with the transventricular, transcerebellar and transthalamic plane.

第二孕期超声波检查是一项标准化的孕期检查，应常规提供给所有孕妇，用于监测胎儿生长和筛查畸形。超声波检查应在妊娠 18-24 周之间进行（西班牙为妊娠 18+0-22+0 周），由经过培训的人员使用适当的设备进行。报告应反映胎位和胎动、生物测量、羊水量、胎盘位置和外观以及胎儿形态。胎儿解剖应包括头部（骨化和神经电图）、颈部（剔除肿块）、胸腔及其内容物、腹部和骨盆（研究胃、脐静脉、脐带入口、肾脏、膀胱）、脊柱（矢状面、冠状面和轴状面）、四肢（三节、运动）和生殖器。应特别注意胎儿心脏检查（坐位、四腔切面、左心室和右心室流出道切面、三血管切面、三血管和气管切面）。经脑室、经小脑和经头颅平面的神经超声检查也很重要。

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引用次数: 0