Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Introduction

Advanced maternal age is associated with a greater number of obstetric complications and adverse perinatal outcomes. It is increasingly common to find pregnant women over 45 years of age and even over 50. There are few studies that evaluate perinatal outcomes at extreme ages, over 45 years of age. Therefore, the objective of this study is to explore perinatal outcomes in the pregnancies of women over 45, as well as to compare twin and singleton pregnancies in this population.

Material and methods

An observational retrospective case–control study was carried in the Obstetrics and Gynecology Department of University Hospital La Paz (Madrid, Spain) between January 2017 and June 2023. All twin pregnancies of mother over 45 at the time of delivery as cases (n = 22) and 3 controls for each case (n = 65) were included. Perinatal outcomes were assessed and compared between singleton pregnancies and twins.

Results

The frequency of preeclampsia was statistically higher in the twin group (27.3% vs 7.7%; p = 0.017) (OR 4.5 (1.21–16.65)). Cesarean section was significant more frequent in the twin group (90.9% vs 49.2%; p = 0.001) (OR 10.31 (2.23–47.75)). In twins, prematurity rate (68.2% vs 17.2%; p < 0.001) and admission to neonatal ICU (63.6% vs 14.5%; p < 0.001) were increased. No differences were found in gestational diabetes, pregnancy-induced hypertension, small for gestational age, Apgar test < 7 at 5 min or in the pH < 7.10 in cord blood at birth.

Conclusions

Advanced maternal age is an independent risk factor for adverse perinatal outcomes and obstetric complications, independently of the number of fetuses, especially at extreme fertile ages above 45 years. In the case of twin gestations, risks inherent to twins also increase, such as prematurity, admission to the NICU and CS.

Introduction

Pelvic floor disorder is an issue that affects quality of life. Obstetric anal sphincter injuries (OASIS) are related to vaginal parity and can lead to anal incontinence in 60% of women in the long term. Its identification is crucial to perform optimal surgical repair. The aim of the study was to describe obstetric trauma in our population and evolution in a 25-year period.

Material and methods

Observational retrospective study of woman who delivered in Hospital Parc Taulí between 1998 and 2021. Patients without vaginal delivery or delivery before 22nd gestational week were excluded. Data processing and analysis were performed using Excel.2016 and IBM SPSS Statistics 17.0.

Results

Sixty thousand one hundred forty-five women who delivered in our hospital over the study period were included. Fifty thousand twenty-two (83.17%) had a vaginal delivery: 82.12% were eutocic and 17.22% operative assisted. Loco regional anaesthesia was performed in 81% and the overall episiotomy rate was 59.7%. OASIS were reported in 369 women, constituting 0.74% of all vaginal deliveries, the major part detected in Kjelland forceps deliveries (representing 46.8% of OASIS) and eutocic deliveries (41.5%). Analysing the evolution of OASIS, an important reduction from 2018 to 2021 was noticeable (1.1 vs. 0.6%) and also a statistically significant difference in OASIS rate between operative and eutocic deliveries (p < 0.05).

Conclusions

The study agrees with the literature on the predominance of OASIS in forceps deliveries. It evidences a decrease in operative vaginal deliveries parallel to a significant decline of OASIS since 2018, when vacuum deliveries increased in detriment of forceps. Establishment of regular training programs appear to increase OASIS detection.

Background

The mean age for women giving birth to their first child is increasing globally, with few therapeutic options to counteract an age-related decline in female fertility. This study aimed to investigate the effect of dietary micronutrient supplements on spontaneous pregnancy rates in women of advanced reproductive age with infertility of unknown etiology.

Materials & methods

This was a retrospective, comparative study of 270 infertile women aged 35–40 years with non-pathological fertility work-up and normal male partner semen analysis attending a fertility clinic in Vienna, Austria. 146 women received an oral micronutrient preparation (omega-3 fatty acids, coenzyme Q10, vitamin E, folic acid, selenium, catechins and glycyrrhizin) daily for 6 months and subsequent monthly rates of spontaneous clinical pregnancy were compared to a control group of 124 women receiving only daily folic acid supplements. No other fertility-related interventions took place during the observation period.

Results

The total spontaneous pregnancy rate after 6 months was significantly higher in the study group, reaching 43.8%, compared to 29.8% in the control group (p = 0.018). Moreover, the cumulative pregnancy rate in the study group taking micronutrient supplementation was 54.5%, and 34.1% in the control group.

Conclusions

The findings of this study suggest that the intake of specific micronutrients might be associated with a higher occurrence of spontaneous pregnancies and thus improvement in female fertility among women of advanced reproductive age who experience unexplained infertility.

The introduction of ultrasound into the delivery room is a challenge in our speciality. Imaging techniques are increasingly used in obstetrics, and we are familiar with ultrasound management and the study of pelvic and foetal structures. Ultrasound has been introduced into the study of labour for decades, with a large number of high quality research papers published in the literature. Various approaches and measurements have been described, and there are parameters that have been shown to have high evidence of intrapartum usefulness, such as assessment of foetal head position. Furthermore, the inaccuracy and subjectivity of the traditional evaluation of labour progress by digital vaginal examination has been demonstrated. All this leads us to support the promotion and implementation of this ultrasound to complement our knowledge and decision-making in delivery. The aim of this review is to describe the appropriate method for this ultrasound evaluation and its main applications in labour.

Objective

To evaluate the effectiveness of parecoxib vs. dexketoprofen, in combination with paracetamol, as additional analgesia in patients receiving neuraxial morphine for postoperative pain relief in cesarean section.

Methods

A total of 380 patients scheduled for a cesarean section received neuraxial morphine for pain management. After the procedure, they were randomized to receive, as additional analgesia, 1 g of paracetamol intravenously every 6 h in combination with either 40 mg of parecoxib intravenously every 12 h or 50 mg of dexketoprofen intravenously every 8 h. A Visual Analog Scale (VAS) was used for evaluation of pain intensity at 12 and 24 h post-operative. Also, the need for additional analgesics, the time (h) required to start patient mobilization and the presence of adverse effects were recorded.

Results

No statistical differences were found between groups in pain intensity, using the VAS-Pain score at 12 h [(Parecoxib vs. Dexketoprofen): 2.76(4.03) vs 2.97(4.34); p = 0.39)], at 24 h [(Parecoxib vs. Dexketoprofen): 2.47(4.62) vs 2.84(5.20); p = 0.11)] or in the need for additional analgesics at 12 h [(Parecoxib vs. Dexketoprofen): 4.21% vs 5.79%; RR = 0.73, 95% CI: 0.33 to 1.77; p = 0.31)] or at 24 h [(Parecoxib vs. Dexketoprofen): 5.79% vs 4.21%; RR = 1.38, 95% CI: 0.57 to 3.34; p = 0.31)]. There were no differences in mobilization time or in the development of adverse effects.

Conclusion

There are no differences concerning the effectiveness of parecoxib vs. dexketoprofen, in combination with paracetamol as additional analgesia in patients receiving neuraxial morphine, for postoperative pain relief in cesarean section.

Introduction

An isthmocele is a disruption of the myometrium that creates a cavity at the level of the hysterorrhaphy because of an impaired cicatrization from a previous caesarean section. In addition to several obstetric and fertility complications, it is possible the presence of retained products of conception inside it. We present the case of an isthmocele without previous cesarean section, with retained products of conception and a placental site nodule.

Symptoms and clinical findings

We present a clinical case of a 32-year-old woman, with no history of previous cesarean section, who consulted due to the presence of latent hypogastric pain. After the initial examination and hysteroscopy, the presence of an isthmocele with retained products of conception was revealed.

Therapeutic interventions

After laparoscopic correction of the isthmocele, the anatomopathological findings showed the presence of a placental site nodule, a benign entity whose atypical variant is related to epithelioid trophoblastic tumor, which is the rarest form of gestational trophoblastic tumor.

Results

After the surgical procedure, the patient remains asymptomatic and without any additional treatment.

Introduction

Paratubal cysts, commonly benign and incidentally found during hysterectomy or salpingectomy, are often termed “hydatid cysts of Morgagni.” While most are benign, borderline and malignant subtypes are rare. This report presents an unusual case of synchronous malignancies involving an endometrioid adenocarcinoma and a paratubal borderline serous tumor, emphasizing the need for careful examination of paratubal cysts.

Main symptoms and/or clinical findings

A 61-year-old postmenopausal woman presented with two months of vaginal bleeding and lower abdominal pain. Elevated CEA and CA 19-9 levels were noted. Ultrasonography showed thickened endometrium and moderate pyometra, and MRI revealed a lesion in the upper endometrium involving the myometrium without extrauterine extension. An endometrial biopsy indicated endometrial intraepithelial neoplasia.

Main diagnoses, therapeutic interventions, and outcomes

The patient underwent a staging laparotomy, bilateral salpingo-oophorectomy, hysterectomy, and pelvic lymphadenectomy. Histopathology confirmed endometrioid adenocarcinoma (FIGO grade II, stage IB) and identified a left paratubal cyst with borderline serous tumor features. Immunohistochemical analysis supported these findings. The post-operative period was uneventful, and the patient remains under follow-up with no signs of recurrence or metastasis.

Conclusion

This case underscores the importance of thorough examination of paratubal cysts. The rare coexistence of endometrioid adenocarcinoma with a borderline serous paratubal tumor highlights the necessity for detailed histopathological and immunohistochemical evaluation in synchronous malignancies. Such meticulous examination ensures accurate diagnosis and appropriate management, potentially enhancing patient outcomes.

Introduction

Shoulder dystocia (SD) is an emergency with risks for mother and newborn. The training of professionals in its resolution is essential to reduce morbidity and mortality and simulation is considered a useful strategy to improve the training of obstetric teams. The aim of this study was to determine the training status of obstetric interprofessional teams in the resolution of shoulder dystocia in hospitals belonging to the Spanish Obstetric Safety Group (GESO).

Materials and methods

A specific survey was carried out between June and December 2023 in hospitals belonging to the GESO group to assess training in SD, addressing protocols, case registry and training programs.

Results

Of the 71 hospitals surveyed, 94,4% responded. These hospitals, mostly public (88%) performed 121,141 deliveries during 2022, representing 37,5% of births in Spain. The incidence of SD was 1.79% and the incidence of obstetric brachial palsy at discharge was 1,08/1000 vaginal deliveries. Regarding the management of SD, 85,1% of the hospitals follow a specific protocol and 88,1% record these cases. Regarding simulation training, 55,2% have programs, 35% of which are voluntary and annual, 5.4% are mandatory and biannual and 2.7% are mandatory and annual. 73,1% have accredited instructors (219 in total between midwives and obstetricians) and 85,1% have their own simulators.

Conclusion

The survey has revealed hitherto unavailable information on the training of obstetric teams and on the frequency and management of SD. Protocols exist in practically all the hospitals surveyed and the number of available SD simulation instructors in the country is noteworthy. Nevertheless, current training programs have room for improvement in order to meet international standards.

Evaluation of the fetal heart is an integral part of prenatal care. Congenital heart defects (CHDs) are the most common major congenital anomalies, affecting approximately 0.8–1% of live births. Screening for CHDs has shown to improve perinatal outcomes. The performance of screening programs lies, among others, in the systematization of the sonographic evaluation. This review aims to outline the technique for conducting a basic fetal cardiac examination as well as to report the main indications for referral for advanced echocardiography and succinctly describe the technique for advanced echocardiography and first-trimester evaluation of the fetal heart.