Clinica e Investigacion en Ginecologia y Obstetricia最新文献

{"title":"Perinatal outcomes in pregnant women over 45 years old: Singleton or multiple pregnancy?","authors":"S. Ruiz-Martínez ,&nbsp;C. Sánchez Cabezas ,&nbsp;N. Mateos Canals ,&nbsp;N. Martínez-Sánchez ,&nbsp;M. Muner ,&nbsp;E. Martin-Boado ,&nbsp;M. Calvo ,&nbsp;J.L. Bartha ,&nbsp;M. De la Calle","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":"52 1","pages":"Article 100996"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","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":"Update on second trimester ultrasound scanning in pregnancy","authors":"I. Pelayo-Delgado ,&nbsp;E. Gómez-Montes ,&nbsp;M. Álvaro-Navidad","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":"52 1","pages":"Article 100997"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","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":"Obstetric anal sphincter injuries (OASIS) incidence. Twenty-five years’ evolution","authors":"E. Alberch Camprubí ,&nbsp;M. Mestre Costa ,&nbsp;J. Costa Pueyo ,&nbsp;J. Pubill Soler","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":"52 1","pages":"Article 100990"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","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":"Fisioterapia en el dolor tras cesárea","authors":"L. Monroy Martínez ,&nbsp;I. Da Cuña Carrera ,&nbsp;A. Alonso Calvete ,&nbsp;L. Núñez Remiseiro ,&nbsp;M. Fernández Paz","doi":"10.1016/j.gine.2024.101002","DOIUrl":"10.1016/j.gine.2024.101002","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101002"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441298","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":"Diagnostic rentability of IOTA models for differentiating between benign and malignant complex adnexal masses","authors":"A. Rodríguez Pérez ,&nbsp;A. Caruso ,&nbsp;M. Pantoja Garrido ,&nbsp;I. Rodríguez Jiménez ,&nbsp;A. Polo Velasco ,&nbsp;J.J. Fernández Alba","doi":"10.1016/j.gine.2024.101000","DOIUrl":"10.1016/j.gine.2024.101000","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic accuracy of the <em>International Ovarian Tumor Analysis (IOTA)</em> 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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>One hundred thirty five malignant masses (45%), one hundred forty benign (46.7%) and twenty five border line (8.3%) were included.</div><div>LR1 and LR2 models, and ADNEX were applicable to all lesions; however, in 72 lesions (24%), the simple rules were inconclusive.</div><div>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%.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101000"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528478","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":"Bases fisiológicas, técnicas y principales indicaciones de preservación de la fertilidad en la paciente oncológica","authors":"Y. Barral ,&nbsp;M. Vidal ,&nbsp;S. Peralta ,&nbsp;L. Magnano","doi":"10.1016/j.gine.2024.101005","DOIUrl":"10.1016/j.gine.2024.101005","url":null,"abstract":"<div><div>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 (<em>random start</em>), 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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101005"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528477","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":"Uso de plasma rico en plaquetas en el campo de la reproducción humana asistida","authors":"P. Luque González ,&nbsp;M. Pineda Mateo ,&nbsp;J. Rodríguez Sánchez-Reyman","doi":"10.1016/j.gine.2024.101016","DOIUrl":"10.1016/j.gine.2024.101016","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101016"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722615","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":"Violencia obstétrica: primera, segunda y tercera víctima","authors":"L. Guillén Vargas ,&nbsp;E.M. Aragoneses Tiburcio ,&nbsp;M.J. Galván León ,&nbsp;J.M. Martínez-Sánchez","doi":"10.1016/j.gine.2024.101001","DOIUrl":"10.1016/j.gine.2024.101001","url":null,"abstract":"","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101001"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437902","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":"Management of thoracic neuropathic pain with an ESP block in a pregnant patient","authors":"L. Arce Gálvez ,&nbsp;R.E. Valencia Gómez ,&nbsp;A. Ceballos Vejarano ,&nbsp;J. Daes Mora ,&nbsp;D.A. Méndez Vega","doi":"10.1016/j.gine.2024.101004","DOIUrl":"10.1016/j.gine.2024.101004","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Clinical case</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101004"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422618","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":"Diagnóstico de cáncer renal metastásico en gestante a través de lesiones cutáneas: descripción de un caso clínico","authors":"A. Ramírez Castán ,&nbsp;M.J. Cuerva González ,&nbsp;J.L. Bartha Rasero","doi":"10.1016/j.gine.2024.100999","DOIUrl":"10.1016/j.gine.2024.100999","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Symptoms and Clinical Findings</h3><div>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.</div></div><div><h3>Diagnosis, Therapeutic Intervention, and Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 100999"},"PeriodicalIF":0.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423093","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}