Prácticas y experiencias de violencia obstétrica y gineco-obstétrica como violencia de género en Chile

Objetivo Describir la experiencia de mujeres que han sufrido violencia obstétrica y gineco-obstétrica en Chile. Métodos Estudio cualitativo en el que participaron 34 mujeres entre 18 y 60 años que experimentaron algún tipo de violencia (obstétrica o gineco-obstétrica) en Chile. Se emplearon entrevistas en profundidad. El análisis se realizó siguiendo los procedimientos del análisis temático. Resultados La violencia obstétrica es un proceso que marca las relaciones de poder médico en distintos niveles: desde lo procedimental hasta el trato que se tiene con las propias mujeres. Esto puede provocar en ellas diversos estados emocionales y psicológicos catalogados como negativos y traumáticos. Discusión La violencia obstétrica y gineco-obstétrica es una dimensión de la violencia de género, pues representa cómo la mujer ha sido instrumentalizada en los procedimientos y atenciones médicas. Se evidencia la necesidad de profundizar en las relaciones de poder médico y en las prácticas gineco-obstétricas para la generación de políticas que protejan los derechos reproductivos y sexuales de las mujeres.

Objective To describe the experience of women who have suffered obstetric and gynecological violence in Chile. Methods Using a qualitative methodology, this study involved the participation of 34 women aged between 18 and 60 years who have experienced some form of violence (obstetric or gynecological violence) in Chile. In-depth interviews were conducted, and subsequently, the analysis was carried out following the procedures of thematic analysis. Results Obstetric violence is a process that marks medical power relations at different levels, from the procedural to the treatment of the women themselves, provoking diverse emotional and psychological states that are associated as negative and traumatic. Discussion Obstetric and gynecological violence is a dimension of gender-based violence as far as it represents how women have been instrumentalized in medical procedures and care. It is evident that there is a need to go deeper into medical power relations and gynecological-obstetric practices in order to generate policies that protect women's reproductive and sexual rights.

Altura uterina versus ecografía obstétrica para detectar macrosomía fetal. Hospital San Juan de Kimbiri, Perú

RESUMEN Fundamento Aunque la ecografía obstétrica es ampliamente utilizada en los niveles primario y secundario de salud para la detección de macrosomía fetal, la altura uterina también puede resultar útil, sobre todo, en contextos sanitarios desprovistos de equipamiento tecnológico. Objetivo determinar la correlación entre altura uterina versus ecografía obstétrica y el diagnóstico de macrosomía fetal. Métodos estudio descriptivo, correlacional, en madres no diabéticas de partos a término con neonatos macrosómicos, realizado en un hospital público del Valle de los ríos Apurímac, Ene y Mantaro, Perú. Las variables del estudio: edad materna, índice de masa corporal pregestacional, número de embarazos, edad gestacional al parto, y vía del parto. Se emplearon los coeficientes de correlación Rho de Spearman, y Pearson, ambos con intervalos de confianza al 95 % y error del 5 %. Resultados la estimación del peso fetal y la macrosomía se correlacionaron con la altura uterina (R Pearson 0,05). Entre las características maternas asociadas a neonatos macrosómicos, se hallaron la obesidad pregestacional (Rho = 0,009) y la condición de multigesta (Rho = 0,04). La estimación del peso fetal mayor a 4000 g tuvo mayor porcentaje de acierto (26,3 %) por ecografía obstétrica. Conclusión la ecografía obstétrica mostró mayor correlación que la altura uterina con el diagnóstico de macrosomía fetal.

ABSTRACT Background Although obstetric ultrasound is widely used at primary and secondary health levels for the detection of fetal macrosomia, uterine height can also be useful, especially in health contexts lacking technological equipment. Objective to determine the correlation between uterine height versus obstetric ultrasound and the diagnosis of fetal macrosomia. Methods descriptive, correlational study in non-diabetic mothers of full-term deliveries with macrosomic neonates, carried out in a public hospital in the Valley of the Apurímac, Ene and Mantaro rivers, Peru. The study variables: maternal age, pre-pregnancy body mass index, number of pregnancies, gestational age at delivery, and route of delivery. Spearman's Rho and Pearson's correlation coefficients were used, both with 95% confidence intervals and 5% error. Results Fetal weight estimation and macrosomia correlated with uterine height (Pearson's R 0.05). Among the maternal characteristics associated with macrosomic neonates, pregestational obesity (Rho = 0.009) and multigestational condition (Rho = 0.04) were found. The estimation of fetal weight greater than 4000 g had a higher percentage of success (26.3%) by obstetric ultrasound. Conclusion obstetric ultrasound showed a higher correlation than uterine height with the diagnosis of fetal macrosomia.

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

SUMMARY OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

RESUMO OBJETIVO Este estudo tem como objetivo investigar as causas do diagnóstico equivocado na avaliação da patência tubária por meio da ultrassonografia de contraste histerosalpingo em tempo real transvaginal (TVS RT-3D-HyCoSy), a fim de melhorar a eficiência diagnóstica das TVS RT-3D-HyCoSy. MÉTODOS Um total de 162 ovidutos em 83 pacientes da infertilidade foi examinado por TVS RT-3D-HyCoSy. Esses resultados foram comparados com o padrão ouro para estudos de tintura laparoscópica, e os casos diagnosticados erroneamente foram analisados. RESULTADOS TVS RT-3D-HyCoSy revelaram que 68 ovidutos foram desobstruídos e 94 ovidutos foram obstruídos. Os resultados para os 144 ovidutos estavam em consonância com o padrão ouro, enquanto que aqueles para os 18 ovidutos, não. A taxa de acurácia do TVS RT-3D-HyCoSy foi de 88,9%, e a taxa de erro de diagnóstico foi de 11,1%. As principais causas de erro de diagnóstico incluíram contraponto e difusão do meio de contraste, espasmo do oviduto, forma ou posição anormal do oviduto, adesão pélvica e má operação de imagem. CONCLUSÃO TVS RT-3D-HyCoSy pode bem avaliar a patência tubária, e compreender e melhorar a causa do erro de diagnóstico. Além disso, a eficiência diagnóstica do TVS RT-3D-HyCoSy ainda pode ser melhorada.

Evaluation of different magnetic resonance imaging contrast materials to be used as dummy markers in image-guided brachytherapy for gynecologic malignancies / Avaliação do uso de diferentes agentes de contraste em ressonância magnética como fontes falsas em planejamentos de braquiterapia guiados por imagem

Abstract Objective: To identify a contrast material that could be used as a dummy marker for magnetic resonance imaging. Materials and Methods: Magnetic resonance images were acquired with six different catheter-filling materials-water, glucose 50%, saline, olive oil, glycerin, and copper sulfate (CuSO4) water solution (2.08 g/L)-inserted into compatible computed tomography/magnetic resonance imaging ring applicators placed in a phantom made of gelatin and CuSO4. The best contrast media were tested in four patients with the applicators in place. Results: In T2-weighted sequences, the best contrast was achieved with the CuSO4-filled catheters, followed by saline- and glycerin-filled catheters, which presented poor visualization. In addition (also in T2-weighted sequences), CuSO4 presented better contrast when tested in the phantom than when tested in the patients, in which it provided some contrast but with poor identification of the first dwell position, mainly in the ring. Conclusion: We found CuSO4 to be the best solution for visualization of the applicator channels, mainly in T2-weighted images in vitro, although the materials tested presented low signal intensity in the images obtained in vivo, as well as poor precision in determining the first dwell position.

Resumo Objetivo: Encontrar um material de contraste que possa ser utilizado como fonte falsa em imagens de ressonância magnética. Materiais e Métodos: Foram feitas imagens de ressonância magnética de cateteres preenchidos com seis meios de contraste conhecidos: água, glicose 50%, soro fisiológico, óleo de oliva, glicerina, solução aquosa de sulfato de cobre (CuSO4) (2.08 g/L), inseridos em aplicadores de sonda e anel compatíveis com tomografia computadorizada/ressonância magnética colocados em um objeto simulador de gelatina e CuSO4. Os materiais com melhores respostas foram testados em quatro pacientes que utilizaram os aplicadores. Resultados: Os cateteres preenchidos por CuSO4 apresentaram melhor visualização em sequências T2, seguidos pelos cateteres com solução de soro fisiológico e glicerina, que apresentaram visualização insatisfatória. O CuSO4 apresentou bom contraste em sequências T2 quando testado em objeto simulador e em pacientes, porém com uma identificação insatisfatória da primeira posição de parada possível para fonte, principalmente no anel. Conclusão: O CuSO4 se mostrou a melhor solução para visualização dos canais dos aplicadores, principalmente em sequências T2 in vitro, mas os materiais testados apresentaram baixo sinal nas imagens de ressonância magnética in vivo e uma precisão insatisfatória para identificação da primeira parada de fonte possível.

Utilize the simplified POP-Q system in the clinical practice of staging for pelvic organ prolapse:comparative analysis with standard POP-Q system / 中华妇产科杂志

Objective To determine the association between simplified pelvic organ prolapse quantification system (S-POP-Q) and the standard pelvic organ prolapse quantification system (POP-Q) in describing pelvic organ prolapse. Methods This was an observational study. From Jan. 2010 to Jan. 2014, 256 subjects with pelvic floor disorder symptoms underwent two exams: a POP-Q exam and a S-POP-Q exam. For the S-POP-Q system, vaginal segments of the exam were defined using points Ba, Bp, C, and D. For the POP-Q system vaginal segments of the exam were defined using points Aa, Ba, Ap, Bp, C, and D. The inter-system consistency between the overall ordinal stages, the anterior vaginal wall stages, the posterior vaginal wall stages, the cervix stages, the posterior fornix or vaginal cuff stages from each two kind of exam were compared. Results The Kendall tau-b correlation coefficient for overall stage was 0.81, the Kendall tau-b correlation coefficients were 0.81, 0.81, 0.85, 0.88 for the anterior vaginal wall, for the posterior vaginal wall, for the cervix, for the posterior fornix or vaginal cuff, respectively. Conclusion There is almost perfect association between S-POP-Q and POP-Q in describing pelvic organ prolapse.

Relação entre a contagem de eritroblastos no sangue do cordão umbilical e os resultados obstétricos e neonatais em fetos pequenos para a idade gestacional e com Doppler de artéria umbilical normal / Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal dopplervelocimetry of umbilical artery

OBJETIVO: Avaliar resultados obstétricos e neonatais em gestantes com fetos pequenos para a idade gestacional após 35 semanas segundo a contagem de eritroblastos (EB) no sangue de cordão umbilical.MÉTODOS: A contagem de EB por 100 leucócitos no sangue do cordão umbilical foi obtida de 61 gestantes com fetos pequenos para a idade gestacional e Doppler umbilical normal. Estas foram divididas em 2 grupos: EB≥10 (grupo estudo, n=18) e EB<10 (grupo controle, n=43). Resultados obstétricos e neonatais foram comparados entre os grupos. Para a análise estatística, foram utilizados teste do χ2e t de Student, com nível de significância adotado de 5%.RESULTADOS: A média±desvio padrão de EB por 100 leucócitos foi de 25,0±13,5 para o grupo estudo e de 3,9±2,2 para o grupo controle. Os grupos EB≥10 e EB<10 não diferiram estatisticamente em relação à idade materna (24,0 versus 26,0 anos), primiparidade (55,8 versus 50%), comorbidades (39,5 versus 55,6%) e idade gestacional no parto (37,4 versus 37,0 semanas). O grupo EB≥10 apresentou maior taxa de cesárea (83,3 versus 48,8%, p=0,02), sofrimento fetal (60 versus 0%, p<0,001) e pH<7,20 (42,9 versus11,8%, p<0,001). O peso de nascimento e o percentil de peso para a idade gestacional foram significativamente menores no grupo EB≥10 (2.013 versus 2.309 g; p<0,001 e 3,8 versus 5,1; p=0,004; respectivamente). Não houve nenhum caso de Apgar de 5º minuto abaixo de 7.CONCLUSÃO: A contagem de EB acima de 10 por 100 leucócitos no sangue do cordão umbilical foi capaz de identificar maior risco de parto cesárea, sofrimento fetal e acidose de nascimento em fetos pequenos para a idade gestacional com dopplervelocimetria de artéria umbilical normal.

PURPOSE: To analyze the obstetrical and neonatal outcomes of pregnancies with small for gestation age fetuses after 35 weeks based on umbilical cord nucleated red blood cells count (NRBC).METHODS: NRBC per 100 white blood cells were analyzed in 61 pregnancies with small for gestation age fetuses and normal Doppler findings for the umbilical artery. The pregnancies were assigned to 2 groups: NRBC≥10 (study group, n=18) and NRBC<10 (control group, n=43). Obstetrical and neonatal outcomes were compared between these groups. The χ2 test or Student's t-test was applied for statistical analysis. The level of significance was set at 5%.RESULTS: The mean±standard deviation for NRBC per 100 white blood cells was 25.0±13.5 for the study group and 3.9±2.2 for the control group. The NRBC≥10 group and NRBC<10 group were not significantly different in relation to maternal age (24.0 versus 26.0), primiparity (55.8 versus 50%), comorbidities (39.5 versus55.6%) and gestational age at birth (37.4 versus 37.0 weeks). The NRBC≥10 group showed higher rate of caesarean delivery (83.3 versus 48.8%, p=0.02), fetal distress (60 versus 0%, p<0.001) and pH<7.20 (42.9 versus11.8%, p<0.001). The birth weight and percentile of birth weight for gestational age were significantly lower on NRBC≥10 group (2,013 versus 2,309 g; p<0.001 and 3.8 versus 5.1; p=0.004; respectively). There was no case described of 5th minute Apgar score below 7.CONCLUSION: An NRBC higher than 10 per 100 white blood cells in umbilical cord was able to identify higher risk for caesarean delivery, fetal distress and acidosis on birth in small for gestational age fetuses with normal Doppler findings.

Diagnostic value of random spot urine albumin/creatinine ratio in women with hypertensive disorders complicating pregnancy / 天津医药

Objective To explore the correlation of random spot albuminuria to creatinine ratio (ACR) and 24 h uri?nary protein, and the diagnostic value of ACR in women with hypertensive disorders complicating pregnancy (HDCP). Meth?ods A total of 584 women with HDCP (169 with gestational hypertension, 205 with mild pre-eclampsia, 173 with severe pre-eclampsia and 37 with chronic hypertension) and 2 038 normal pregnant women were included in this study. Changes of ACR, 24-h urinary protein and other biochemical indicators were compared between groups. Bivariate correlation analysis was used to analyze the relationship between ACR, 24-h urinary protein and other biochemical indicators. Receiver operat?ing characteristic curve (ROC) was used to analyze the sensitivity, specificity and optimal cut off value of ACR for predicting HDCP. Results (1)There were significantly higher levels of ACR, 24-h urinary protein, blood urea nitrogen (BUN), serum creatinine (Cr), uric acid (UA), total cholesterol (TC) and low density lipoprotein cholesterol (LDL) and significantly lower val?ues of platelet (PLT), serum albumin and total protein in women with severe preeclampsia than those of other groups ( P <0.05). (2) There were positive correlation between ACR and 24-h urinary protein, BUN, Cr, UA, D-dimer, TC, LDL (P <0.05). (3) The optimal cut off value of ACR for predicting gestational hypertension, mild preeclampsia, severe preeclampsia (24-h urinary protein≥2 g,≥5 g) were 1.44, 10.48, 39.84, 94.91 g/mol separately. Conclusion There is positive correla?tion between ACR and 24 hour urinary protein. ACR can be used for diagnosing and estimating the severity degree of hyper?tensive disorders complicating pregnancy.

Fatores associados ao falso diagnóstico pré-natal da restrição de crescimento fetal / Factors associated with false diagnosis of fetal growth restriction

OBJETIVO: Descrever os fatores relacionados ao falso diagnóstico de restrição de crescimento fetal (RCF). MÉTODOS: Foram incluídas 48 gestantes encaminhadas ao nosso serviço com suspeita de RCF, não confirmada após o nascimento. Estas foram comparadas ao grupo de gestantes com RCF confirmada e foram descritas características relacionadas a esses falso-positivos. Os dados foram analisados utilizando-se o programa Statplus para Mac(r), versão 5.8. Os resultados obtidos no estudo foram divididos em variáveis categóricas e contínuas para análise. Para comparação entre proporções, foi aplicado o teste do χ2 ou o teste exato de Fisher. O nível de significância foi estabelecido em p<0,05 para todos os testes. RESULTADOS: As gestantes com falso diagnóstico de restrição de crescimento fetal apresentavam as seguintes características: chegaram ao serviço em idade gestacional mais precoce (média de 32,8 semanas); entre 2 e 6 exames de ultrassonografia antes da matrícula no hospital terciário (média 3,8); foram submetidas à ultrasonografia até a 12ª semana em apenas 25% dos casos; tinham medida da altura uterina normal em 66,7% dos casos; foram submetidas a pelo menos 1 ultrassonografia com percentil normal em 52,1% dos casos; tinham a última ultrassonografia (média de 36 semanas) com percentil médio de 18; foram submetidas em média a 5 exames de ultrassonografia e 4,6 exames de vitalidade após ingressarem no serviço. CONCLUSÃO: O falso diagnóstico da RCF envolve custos hospitalares altos e demanda maior de especialistas. Deve-se valorizar a medida da altura uterina, por meio de exame físico cuidadoso e confirmar esse diagnóstico com a ultrassonografia nas últimas semanas de gestação, antes que a conduta ...

PURPOSE: The aim of this study was to analize and describe some characteristics related to a false diagnosis of intrauterine growth restriction (IUGR). METHODS: We retrospectively included 48 pregnant women referred to our service with a suspected diagnosis of IUGR that was not confirmed after birth and we compared them to another group with confirmed IUGR. We then analyzed the characteristics of the false-positive results. The results of the study were divided into continuous and categorical variables for analysis. The χ2test or Fisher exact test was applied to compare proportions. The level of significance was set at p<0.05 for all tests. RESULTS: In our sample, pregnant women with a false diagnosis of IUGR had the following characteristics: they were referred earlier (mean gestational age of 32.8 weeks); were submitted to 2 to 6 ultrasound examinations before been registered in our service; in 25% of cases ultrasound examination was performed before 12 weeks; in 66.7% of cases the symphysis-fundal height measurement was normal; in 52.1% of cases they had at least 1 sonographic exam above the 10th percentile; on average, the last ultrasound examination (performed on average at 36 weeks) was above the 18th percentile; the women were submitted to a mean number of 5 ultrasound examinations and to a mean number of 4.6 vitality exams. CONCLUSION: The false diagnosis of IUGR involves high hospital costs and higher demand for specialists. The symphysis-fundal height measurement must be valued, and the diagnosis of IUGR must be confirmed with ultrasonography in the last weeks of pregnancy before any obstetric management is taken. .

Significance of symptom and physical sign to diagnosis of deeply infiltrating endometriosis / 中华妇产科杂志

Objective To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Methods Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE.The pain symptoms and gynecological physical signs were recorded detail,and the correlation with diagnose of DIE were analyzed.Results (1) The significance of pain symptoms:the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and OR,95％ CI of each pain symptom were:dysmenorrhae (90.5％,37.2％,59.6％,79.3％,5.66,3.46-9.28),chronic pelvic pain (35.2％,82.6％,67.4％,55.4％,2.58,1.70-3.91),dyspareunia (46.2％,80.6％,70.7％,59.6％,3.56,2.39-5.32),dyschezia (51.0％,73.7％,66.5％,59.5％,2.91,2.00-4.24),respectively.(2) Pelvic physical examination:the sensitivity,specificity,PPV and NPV of each physical sign were:fixed uterine:73.6％,71.2％,79.5％,64.0％; fixed ovarian cyst:94.1％,20.3％,63.3％,70.0％; uterosacral ligaments nodule:47.1％,97.5％,96.6％,54.9％; uterosacral ligaments nodule with tenderness:81.7％,75.0％,83.1％,73.2％; rectovaginal septum nodule:32.2％,100.0％,100.0％,49.4％; rectovaginal septum nodule with tenderness:32.2％,100.0％,100.0％,49.4％; blue nodule in posterior vaginal forni:14.9％,100.0％,100.0％,43.7％.Conclusions In the symptoms,the dysmenorrheal has the highest sensitivity and NPV for the diagnosis.And chronic pelvic pain has the highest specificity,and dysparaunia has the highest PPV for the diagnosis.In pelvic vaginal examination,fixed uterine,fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness,the blue lesion on posterior fornix have the strong significance for DIE.So record the symptom detail and careful digital vaginal examination,especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.