Clinica e Investigacion en Ginecologia y Obstetricia最新文献

{"title":"Descripción de un caso: liposarcoma de mama radioinducido","authors":"","doi":"10.1016/j.gine.2024.100998","DOIUrl":"10.1016/j.gine.2024.100998","url":null,"abstract":"<div><h3>Main symptoms and/or clinical findings</h3><div>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.</div></div><div><h3>Main diagnoses</h3><div>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.</div></div><div><h3>Therapeutic interventions and results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on second trimester ultrasound scanning in pregnancy","authors":"","doi":"10.1016/j.gine.2024.100997","DOIUrl":"10.1016/j.gine.2024.100997","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal outcomes in pregnant women over 45 years old: Singleton or multiple pregnancy?","authors":"","doi":"10.1016/j.gine.2024.100996","DOIUrl":"10.1016/j.gine.2024.100996","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Material and methods</h3><p>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 (<em>n</em> <!-->=<!--> <!-->22) and 3 controls for each case (<em>n</em> <!-->=<!--> <!-->65) were included. Perinatal outcomes were assessed and compared between singleton pregnancies and twins.</p></div><div><h3>Results</h3><p>The frequency of preeclampsia was statistically higher in the twin group (27.3% vs 7.7%; <em>p</em> <!-->=<!--> <!-->0.017) (OR 4.5 (1.21–16.65)). Cesarean section was significant more frequent in the twin group (90.9% vs 49.2%; <em>p</em> <!-->=<!--> <!-->0.001) (OR 10.31 (2.23–47.75)). In twins, prematurity rate (68.2% vs 17.2%; <em>p</em> <!-->&lt;<!--> <!-->0.001) and admission to neonatal ICU (63.6% vs 14.5%; <em>p</em> <!-->&lt;<!--> <!-->0.001) were increased. No differences were found in gestational diabetes, pregnancy-induced hypertension, small for gestational age, Apgar test<!--> <!-->&lt;<!--> <!-->7 at 5<!--> <!-->min or in the pH<!--> <!-->&lt;<!--> <!-->7.10 in cord blood at birth.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric anal sphincter injuries (OASIS) incidence. Twenty-five years’ evolution","authors":"","doi":"10.1016/j.gine.2024.100990","DOIUrl":"10.1016/j.gine.2024.100990","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>p</em> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconceptional micronutrient supplementation and spontaneous pregnancy rates in women of higher reproductive age and unexplained infertility: A comparative study","authors":"","doi":"10.1016/j.gine.2024.100988","DOIUrl":"10.1016/j.gine.2024.100988","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Materials &amp; methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>p</em> <!-->=<!--> <!-->0.018). Moreover, the cumulative pregnancy rate in the study group taking micronutrient supplementation was 54.5%, and 34.1% in the control group.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodology and utility of intrapartum ultrasound","authors":"","doi":"10.1016/j.gine.2024.100995","DOIUrl":"10.1016/j.gine.2024.100995","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0210573X24000583/pdfft?md5=55f1d887e96db244ec6a17e55994cfa0&pid=1-s2.0-S0210573X24000583-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restos ovulares y placentarios (ROP) y nódulo del lecho placentario (NLP) en un istmocele tras un parto vaginal: diagnóstico y corrección laparoscópica","authors":"","doi":"10.1016/j.gine.2024.100994","DOIUrl":"10.1016/j.gine.2024.100994","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Symptoms and clinical findings</h3><p>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.</p></div><div><h3>Therapeutic interventions</h3><p>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.</p></div><div><h3>Results</h3><p>After the surgical procedure, the patient remains asymptomatic and without any additional treatment.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parecoxib vs. Dexketoprofeno, en combinación con paracetamol, como analgesia adicional en pacientes que reciben morfina neuraxial para el alivio del dolor postoperatorio en la cesárea: estudio prospectivo, aleatorizado, controlado, doble ciego","authors":"","doi":"10.1016/j.gine.2024.100993","DOIUrl":"10.1016/j.gine.2024.100993","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synchronous presentation of endometrial adenocarcinoma and incidental paratubal borderline serous tumor: A rare case report","authors":"","doi":"10.1016/j.gine.2024.100989","DOIUrl":"10.1016/j.gine.2024.100989","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Main symptoms and/or clinical findings</h3><p>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.</p></div><div><h3>Main diagnoses, therapeutic interventions, and outcomes</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal echocardiography: The technique","authors":"","doi":"10.1016/j.gine.2024.100991","DOIUrl":"10.1016/j.gine.2024.100991","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}