Relación entre grosor endometrial medido ecográficamente y riesgo de cáncer de endometrio en mujeres posmenopáusicas: Un estudio observacional de centro único / Relationship between ultrasound-measured endome-trial thickness and risk of endometrial cancer in postmenopausal women. A single-center observa-tional study

Introducción: El cáncer de endometrio es la patología oncológica más frecuente en la posmeno-pausia, asociada a hemorragia uterina anormal. Diferentes estudios han encontrado relación significativa entre el grosor endometrial aumentado y el riesgo de cáncer de endometrio. El objetivo del presente estudio fue medir la asociación entre estas variables y realizar pruebas diagnósticas en un centro de referencia regional en Guayaquil-Ecuador. Metodología: El presente estudio analítico, se realizó en el Hospital Ginecológico ­ Obstétrico ­ Pediátrico Universitario de la ciudad de Guayaquil-Ecuador de enero a diciembre del 2018, con una muestra no probabilística, se incluyeron mujeres posmenopáusicas con sangrado uterino y engrosamiento endometrial igual o mayor a 3 milímetros al estudio ecográfico transvaginal y fueron sometidas a legrado con reporte histopatológico. La variable dependiente fue presencia histológica de neoplasia endometrial, la variable independiente fue el grosor endometrial ecográfico. Resultados: El análisis incluyó 148 pacientes, con una edad promedio de 57.9 ± 5.4 años. Obesidad en 22 casos (10.9%), diabetes tipo 2 en 20 casos (9.95%) e hipertensión en 11 casos (5.47%). Fueron 19 casos con cáncer de endometrio y 129 casos con hiperplasia endometrial. El promedio del grosor endometrial fue de 3.560 ± 0.49969 mm. El grosor >3.5 mm OR 54.03 (IC 95% 3.19-914.34) P=0.0057. La sensibilidad del 100%, especificidad 58.1%, valor predictivo positivo de 26.0%, exactitud de 63.5%. Conclusión: La sensibilidad de la medición del grosor endometrial >3.5 mm como predictor de cáncer endometrial en mujeres postmenopáusicas sintomáticas es alta, sin embargo no tiene una buena especificidad y valor predictivo positivo lo que limitan su uso clínico.

Introduction: Endometrial cancer is the most frequent oncological pathology in postmenopause and is associated with abnormal uterine bleeding. Different studies have found a significant relationship between increased endometrial thickness and the risk of endometrial cancer. This study aimed to measure the association between these variables and perform diagnostic tests in a regional reference center in Guayaquil, Ecuador. Methodology: This analytical study was carried out at the University Pediatric-Obstetric-Gynecological Hospital of the city of Guayaquil-Ecuador from January to December 2018, with a nonprobabilistic sample, including postmenopausal women with uterine bleeding and endometrial thickening equal to or greater than 3 millimeters to the transvaginal ultrasound study who were subjected to curettage with a histopathological report. The dependent variable was the histologicalence of endometrial neoplasia; the independent variable was the ultrasound endometrial thickness. Results: The analysis included 148 patients, with a mean age of 57.9 ± 5.4 years. Obesity was observed in 22 cases (10.9%), type 2 diabetes in 20 cases (9.95%), and hypertension in 11 cases (5.47%). There were 19 cases of endometrial cancer and 129 cases of endometrial hyperplasia. The mean endometrial thickness was 3.560 ± 0.49969 mm. Thickness >3.5 mm OR 54.03 (95% CI 3.19-914.34) P=0.0057. The sensitivity was 100%, the specificity was 58.1%, the positive predictive value was 26.0%, and the accuracy was 63.5%. Conclusion: The sensitivity of measuring endometrial thickness >3.5 mm as a predictor of endo-metrial cancer in symptomatic postmenopausal women is high; however, it does not have reasonable specificity or positive predictive value, which limits its clinical use.

Sangrado Uterino Anormal: hallazgos ecográficos / Abnormal Uterine Bleeding: ultrasound findings

Describir los hallazgos ecográficos de las pacientes que acudieron por sangrado uterino anormal al servicio de Ginecología y Obstetricia del Hospital Dr. Domingo Luciani durante el período enero 2021 a enero 2022. Métodos: Estudio observacional-descriptivo, de tipo retrospectivo. Muestra no probabilística e intencional, integrada por 99 pacientes. Variables involucradas: edad, raza, paridad, antecedentes personales, ciclo menstrual, duración del período menstrual, fecha última de menstruación, uso de algún medicamento, método anticonceptivo y hallazgos ecográficos. Resultados: Los hallazgos ecográficos evidenciaron diferentes causas que explican el sangrado uterino anormal de las pacientes que integraron la muestra de estudio; las tres más frecuentes fueron: miomatosis uterina, sangrado uterino anormal por leiomioma o por endometrio, sangrado uterino anormal tipo L y tipo E(AU)

Objective: To describe the ultrasound findings ofpatients who came for abnormal uterine bleeding to theGynecology and Obstetrics service of the Dr. Domingo LucianiHospital during the period January 2021 to January 2022.Methods: This was an observational-descriptive, retrospectivestudy. The sample was non-probabilistic and intentional,consisting of 99 patients. The data were collected in an Excelsheet for analysis to determine their percentage frequencyaccording to the variables involved: age, ethnicity, parity,personal history, menstrual cycle, duration of menstrual period,last date of menstruation, use of some medication, contraceptivemethod and ultrasound findings. Results: The ultrasoundfindings showed different causes to explain the abnormal uterinebleeding of the patients who made up the study sample; however,the three most frequent were: uterine myomatosis, sangradouterino anormal tipo L y tipo E(AU)

Sangrado genital por cuerpo extraño en niñas prepuberales: a propósito de un caso / Genital bleeding caused by foreign body in prepubertal girls: a case report

El sangrado genital en niñas prepúberes es un signo poco frecuente y siempre requiere determinar su causa. Se necesitan una detallada anamnesis y examen físico, con el conocimiento adecuado de la anatomía uroginecológica, y, en muchos casos, estudios de imágenes y exámenes complementarios, para arribar al diagnóstico. Se presenta el caso de una niña de 7 años con sangrado genital, cuyo examen físico y estudios complementarios fueron poco concluyentes, y que requirió un procedimiento invasivo para su resolución. (AU)

Genital bleeding in prepubertal girls is a rare sign and always requires determining its cause. A detailed history and physical examination are needed, with adequate knowledge of urogynecological anatomy, and in many cases, imaging studies and complementary tests, to arrive at the diagnosis. We present the case of a 7-year-old girl with genital bleeding, whose physical examination and complementary studies were inconclusive, requiring an invasive procedure for its resolution. (AU)

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Zoom sur le cancer du col utérin chez les adolescentes à Kananga au Kasaï-Central, en République Démocratique du Congo / NA

Introduction. Le cancer du col de l'utérus (CCU) demeure un problème majeur de santé publique et il est le quatrième cancer le plus répandu chez les femmes à l'échelle mondiale. L'objectif est de contribuer à l'améliorationde niveau de connaissance des adolescentes sur le cancer du col utérin dans la ville de Kananga.Matériel et méthodes.Il s'agit d'une étude transversaledescriptive sur le cancer du col utérin, réalisée dans la ville de Kananga et dont l'étude était basée sur l'interview de 436 Adolescentes selon un échantillonnage à plusieurs degrés, dans les Aires de Santé de la Zone de Santé Urbaine de Kananga.Résultats. La moyenne d'âge des répondantes était de 17,7 ± 1,2 ans. Le niveau de connaissances sur le cancer du col utérin s'est révélé inadéquat chez presque toutes les participantes (90%). Les signes couramment connus étaient le saignement vaginal (80,3%), dyspareunie (4,8%) et règles prolongés (2,3%). Le sexe était pratiqué dans55,5% des adolescents alors que 70,9% savaient l'existence du lien entre le cancer du col utérin et les infections sexuellement transmissible (IST). Les connaissances sur lesfacteurs de risque de survenu du cancer du col étaient: la consummation de tabacdans 31,9% et le rapport sexuel précoce dans 25,5%; la pratique du dépistage était observée dans 0,2% des cas et 37,2% d'adolescentes connaissaient que toutes les femmes étaient prédisposées de développer la pathologie.Conclusion.Le niveau de connaissances de cancer du col utérin s'est révélé inadéquat chez les adolescents et nécessité des campagnes destinées à sensibiliser d'avantage toutes les femmes en particulier et le public de la ville de Kananga en général au sujet de ce cancer du col utérin

MRI and Transvaginal Ultrasound Findings of Atypical Polypoid Adenomyoma: A Case Report / 中国医学科学杂志(英文版)

Atypical polypoid adenomyoma (APA) is an uncommon type of polypoid characterized by fibroid stroma and endometrial glands. It occurs mostly in premenopausal women and rarely in postmenopausal women with irregular vaginal bleeding. In our current case, a 76-year-old woman presented with irregular vaginal bleeding. The final pathological diagnosis of the mass was APA. APA is not easy to diagnose before surgery. On the one hand, there was no obvious particularity in imaging features and clinical features, especially for uncomfortably identifying endometrial cancer. On the other hand, APA has a pedicle, attaching to any part of the uterine cavity, which can cause pseudocoel between the mass with the uterine cavity wall. So, when it comes to getting the pathological tissue in the absence of hysteroscopy, it is easy to access to the pseudocoel and obtain endometrial tissue rather than the pathological tissue of the mass. Therefore, preoperative imaging examination is of great significance diagnosis way of thinking to clinicians for APA. In the meantime, pathological tissue of APA can be obtained by hysteroscopy in visual conditions.

Rotura uterina: da suspeita ao tratamento / Uterine rupture: from suspicion to treatment

A rotura uterina durante a gravidez ou trabalho de parto é uma grave complicação obstétrica ainda responsável por elevada morbimortalidade materna e perinatal. É importante o diagnóstico diferencial de outras hemorragias da segunda metade da gravidez, como o descolamento prematuro da placenta e a placenta prévia. O diagnóstico é feito baseado em uma associação de sinais bem comuns da rotura uterina. O tratamento sempre é cirúrgico, mas varia de acordo com a classificação da emergência. A prevenção é realizada por meio da atenção obstétrica cuidadosa e com implementação das boas práticas de assistência ao parto.(AU)

Uterine rupture during pregnancy or labor is a serious obstetric complication still responsible for high maternal and perinatal morbidity and mortality. Differential diagnosis of other hemorrhages in the second half of pregnancy, such as placental abruption and placenta previa, is important. The diagnosis is made based on an association of very common signs of uterine rupture. Treatment is always surgical but varies according to the classification of the emergency. Prevention is carried out through careful obstetric care and the implementation of good childbirth care practices.(AU)

Abnormal Uterine Bleeding in Adolescence: When Menarche Reveals other Surprises / Hemorragia uterina anormal na adolescência: Quando a menarca revela outras surpresas

Abstract Introduction Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described. Clinical case A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severemenstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma. Discussion Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.

Resumo Introdução A hemorragia uterina anormal é mais frequente na adolescência. Apesar de maioritariamente de etiologia não estrutural, pode dever-se a qualquer causa descrita. Caso clínico Adolescente de 12 anos, sem antecedentes pessoais relevantes, com menarca há 1 mês, observada no serviço de urgência por hemorragia menstrual grave com agravamento progressivo e repercussão hemodinâmica com necessidade de suporte transfusional. Foi colocada a hipótese de disfunção ovulatória fisiológica associada a eventual coagulopatia desconhecida previamente e foi instituído tratamento médico. Por ausência de resposta a tratamento médico, foi submetida a observação sob sedação e aspiração uterina que evidenciou tratar-se de um Linfoma de Burkitt. Discussão Apesar de as causas estruturais, e particularmente as neoplasias, do foro ginecológico ou não, serem uma causa rara de hemorragia uterina anormal nesta faixa etária, elas devem ser levadas em consideração potenciando assim um tratamento mais célere e adequado.

Métodos de estudio de pacientes con sangrado uterino posmenopáusico: recomendaciones prácticas / Study methods of patients with postmenopausal uterine bleeding: practical recommendations

Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Hematometra y hematocervix en paciente postmenopáusica: reporte de caso / Hematometry and hematocervix in postmenopausal patient: case repor

El hematometra es la retención de sangre en el útero y comúnmente se presenta en mujeres jóvenes con anomalías mullerianas pero puede aparecer también en mujeres postmenopausicas por causas secundarias como traumas, tumores, terapia de remplazo hormonal, estenosis cervical, entre otras. En esta presentación de caso interesante se describe una mujer postmenopáusica bajo terapia de remplazo hormonal. Dicha mujer inicia con hemorragia uterina anormal por lo que se le realiza ultrasonido evidenciando hematómetra y hematocervix. Como método diagnóstico y terapéutico de la hemorragia postmenopáusica se le realiza histerectomía abdominal en la cual la patología evidencia leiomiomatosis uterina con endometrio secretor

Hematometra is the retention of blood in the uterus and commonly occurs in young women with Mullerian abnormalities but can also appear in postmenopausal women due to secondary causes such as trauma, tumors, hormone replacement therapy, cervical stenosis, among others. In this presentation an interesting case is described a postmenopausal woman under hormone replacement therapy. She said woman began with abnormal uterine bleeding, so an ultrasound was performed showing hematometer and hematocervix. As a method diagnosis and treatment of postmenopausal hemorrhage, abdominal hysterectomy is performed in which the pathology shows uterine leiomyomatosis with secretory endometrium

A scary complication: single-center study on management and outcome of cesarean scar pregnancy

Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Uterine rescue in high-risk gestational trophoblastic neoplasia treated with ema-co by uterine arteries embolization due to arteriovenous malformations / Resgate uterino em neoplasia trofoblástica gestacional de alto risco tratada com EMA-CO por embolização de artérias uterinas devido a malformações arteriovenosas

Abstract Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral

Resumo Mola hidatiforme completa (MHC) é um tipo raro de gravidez, na qual 15 a 20% dos casos podem desenvolver neoplasia trofoblástica gestacional (NTG). O diagnóstico de NTG deve ser feito o mais cedo possível, pelo monitoramento semanal do hCG sérico após esvaziamento uterino. Relatamos o caso de uma paciente primigesta, de 23 anos de idade, com MHC, sem vigilância de hCG após esvaziamento uterino. Dois meses depois, a paciente compareceu na emergência com sangramento vaginal, sendo encaminhada ao Centro de Doenças Trofoblásticas do Hospital São Paulo, onde foi diagnosticada com NTG de alto risco, estádio e score de risco III:7 de acordo com a The International Federation of Gynecology and Obstetrics/Organização Mundial de Saúde (FIGO/OMS). O exame ultrassonográfico revelou útero aumentado com uma massa heterogênea constituída pormúltiplos vasos volumosos invadindo e desestruturando o miométrio. A paciente evoluiu com piora progressiva do sangramento vaginal após quimioterapia com o regime etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Ela foi submetida a transfusão de sangue e embolização das artérias uterinas devido aos episódios graves de hemorragia vaginal, com completo controle do sangramento. O hCG atingiu valor negativo após o terceiro ciclo, havendo regressão completa da vascularização uterina anômala, assim como recuperação da anatomia uterina. O tratamento em um centro de referência permitiu o manejo adequado, principalmente no que se refere à embolização das artérias uterinas através da punção percutânea da artéria femoral, que foi crucial para evitar a histerectomia, permitindo a cura da NTG e a manutenção da vida reprodutiva.

Cervical heterotopic pregnancy: A case report / 中南大学学报(医学版)

Heterotopic pregnancies are rare and difficult to be diagnosed early. A patient with combined intrauterine pregnancy and cervical pregnancy was admitted in Qingdao Municipal Hospital in 2019. The patient complained of abnormal vaginal bleeding after menopause and was misdiagnosed as simple intrauterine pregnancy. She underwent artificial abortion and suffered intraoperative hemorrhage. To stop bleeding, she received the treatment of uterine artery embolization immediately. Afterwards, cervical residual pregnancy tissues started necrosis, blood β-human chorionic gonadotropin level and the cervix appearance gradually returned to normal. This report suggests that cervical heterotopic pregnancy inclines to be mis diagnosed. Correct diagnosis should be made as soon as possible. Selective uterine artery embolization is an effective measure to prevent and treat massive bleeding.

Systematic review and Meta-analysis on efficacy and safety of Gongxuening Capsules in treatment of abnormal vaginal bleeding after medical abortion / 中国中药杂志

To systematically evaluate the efficacy and safety of Gongxuening Capsules in the treatment of abnormal vaginal bleeding after medical abortion. CNKI, Wanfang, SinoMed, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to comprehensively collect the clinical randomized controlled trials(RCTs) of Gongxuening Capsules for treatment of abnormal vaginal bleeding after medical abortion from the establishment of the databases to October 10, 2020. Literature screening, data extraction and quality evaluation were conducted independently by two system reviewers according to the inclusion and exclusion criteria. Cochrane Handbook bias risk assessment tool was used for the literature methodology quality evaluation, RevMan 5.3 software was used for Meta-analysis, and the evidence quality of outcomes was evaluated by the evidence quality grading system(GRADE). A total of 16 RCTs were inclu-ded. The results of Meta-analysis showed that as compared with the western medicine treatment alone, the addition of Gongxuening Capsules to the western medicine treatment can reduce the amount of vaginal bleeding(RR=1.23, 95%CI[1.19, 1.27], P<0.000 01), shorten vaginal bleeding time(RR_(≤15 d number of people)=1.39, 95%CI[1.31, 1.48], P<0.000 01; MD_(number ofdays)=-1.20, 95%CI[-1.66,-0.74],P<0.000 01). However, there was no obvious advantage in abortion effect(RR=1.02, 95%CI[0.99, 1.06], P=0.14) and menstrual recovery(MD=-0.35, 95%CI[-0.96, 0.25], P=0.25). The results of GRADE showed that the grading level was low for vaginal bleeding volume and vaginal bleeding time, and extremely low for abortion effect and mens-trual recovery. In terms of safety, 16 studies reported adverse events. Only one study showed no adverse events and the rest showed transient nausea, vomiting, stomach burning, upper abdominal discomfort and other gastrointestinal symptoms. The results show that the addition of Gongxuening Capsules to the application of western medicine in treatment of drug abortion can reduce the amount of vaginal bleeding and shorten vaginal bleeding time, but the abortion effect and menstrual recovery have no obvious advantages. The use of Gongxuening Capsules helps to achieve less adverse reactions and higher safety. Due to the small sample size of the included studies and many methodological quality problems, no conclusions with clinical guidance value can be obtained. Large sample-zise, high-qua-lity randomized controlled trials are still needed for further verification.

Gestação heterotópica espontânea: relato de caso com diagnóstico e manejo oportunos / Spontaneous heterotopic pregnancy: a case report with appropriate diagnosis and management

Introdução: A gravidez heterotópica é um fenômeno obstétrico muito raro em concepções espontâneas no qual gestações tópica e ectópica coexistem. O diagnóstico é difícil, mas, se realizado precocemente, o prognóstico é favorável. Descrição do caso: Paciente do sexo feminino, de 35 anos de idade, admitida com quadro de dor abdominal e pequeno sangramento vaginal. Diagnosticada precocemente e tratada cirurgicamente por gravidez heterotópica naturalmente concebida. Como resultado, a gravidez tópica seguiu sem intercorrências. Conclusão: Esse caso enfatiza a necessidade de considerar esse diagnóstico diferencial e analisar clínica e ecograficamente as características globais da pelve, mesmo na ausência de fatores de risco em gestações tópicas.(AU)

Introduction: Heterotopic pregnancy (HP) is a rare obstetric phenomenon in spontaneous conceptions in which intrauterine and ectopic pregnancies coexist. The diagnosis is difficult, but, if performed early, the prognosis is favorable. Case description: A 35-year-old woman was admitted with abdominal pain and light vaginal bleeding. She was early diagnosed and surgically treated for a naturally conceived heterotopic pregnancy. As a result, the intrauterine pregnancy went on healthily. Conclusion: This case emphasizes the need to regard HP as a differential diagnosis and analyze the global pelvis characteristics both clinically and in ultrasound scans, even in the absence of risk factors when dealing with intrauterine pregnancies.(AU)

Diagnostic accuracy of a hysteroscopic score for the detection of endometrial cancer in patients with postmenopausal bleeding and endometrial thickening / Exactitud diagnóstica de una escala histeroscópica para la detección de cáncer endometrial en pacientes con sangrado posmenopáusico y engrosamiento endometrial

RESUMEN Objetivo: evaluar la exactitud diagnóstica del sistema de puntaje histeroscópico de cáncer endometrial. Materiales y métodos: estudio de exactitud diagnóstica ensamblado en estudio transversal, que incluyó pacientes con sangrado posmenopáusico y engrosamiento endometrial mayor o igual a 5 mm, a quienes se practicó histeroscopia, cuyo resultado se comparó con la biopsia endometrial como patrón de oro diagnóstico, en dos hospitales de alta complejidad. Se midieron variables sociodemográficas, clínicas, puntaje de evaluación histeroscópica y resultado histopatológico de tejido endometrial. En el análisis se estimó sensibilidad, especificidad, razones de probabilidades y área bajo la curva con sus respectivos intervalos de confianza. Resultados: con una prevalencia del cáncer endometrial del 9 %, el sistema de evaluación por histeroscopia mostró una sensibilidad de 75 % (IC 95 %: 30,1-95,43), especificidad de 95,1 % (IC 95 %: 83,9- 98,7), una razón de probabilidades positiva de 15,38 (IC 95 %: 3,55-66,56), una razón de probabilidades negativa de 0,26 y un área bajo la curva del 85 %. Conclusión: el sistema de evaluación endometrial histeroscópico estandarizado mostró una sensibilidad aceptable para hacer la tamización en pacientes con sangrado posmenopáusico y engrosamiento endometrial (≥ 5 mm). Se requiere la realización de estudios con un mayor tamaño muestral que permitan hacer una estimación más precisa de las características operativas de este sistema de evaluación histeroscópico para la detección de cáncer endometrial.

ABSTRACT Objective: To assess the diagnostic accuracy of hysteroscopic scores in endometrial cancer. Materials and methods: Diagnostic accuracy study assembled within a cross-sectional study that included patients with postmenopausal bleeding and endometrial thickening greater than 5 mm in whom hysteroscopy was performed and then compared with endometrial biopsy as the diagnostic gold standard, in two high complexity hospitals. Clinical, sociodemographic variables, as well as hysteroscopic scores and the results of endometrial tissue histopathology were measured. Sensitivity and specificity, likelihood ratios and area under the curve with their respective confidence intervals were estimated in the analysis. Results: With a 9 % prevalence of endometrial cancer, the hysteroscopic assessment system was shown to have 75 % sensitivity (95 % CI; 30.1- 95.43), 95,1 % specificity (95 % CI; 83.9-98.7), a positive likelihood ratio of 15.38 (95 %; CI 3.55- 66.56), a negative likelihood ratio of 0.26 and area under the curve of 85 %. Conclusion: The standardized hysteroscopic assessment system was found to have an acceptable sensitivity for screening in patients with postmenopausal bleeding and endometrial thickening (≥ 5 mm). Further studies with larger sample sizes are required in order to arrive at a more precise estimation of the operational characteristics of the hysteroscopic assessment system for the detection of endometrial cancer.

Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016 / Seguridad y aceptabilidad del sistema intrauterino liberador de levonorgestrel 52 mg en mujeres con hemorragia uterina anormal en un centro de atención ambulatoria en bogotá, colombia, 2012-2016

RESUMEN Objetivo: describir la seguridad y aceptabilidad del uso del sistema intrauterino liberador de levonorgestrel de 52 mg en mujeres con hemorragia uterina anormal. Materiales y métodos: cohorte retrospectiva en la que se incluyeron mujeres de 18 años o más con diagnóstico de hemorragia uterina anormal, reporte por ultrasonido de tamaño uterino entre 6 y 10 cm de longitud y cavidad endometrial uniforme en toda su longitud, independiente de alteración estructural, a quienes se les colocó para tratamiento el sistema intrauterino liberador de levonorgestrel de 52 mg, en el periodo de 2012 hasta 2016 Se realizó un muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas basales, así como la percepción de la hemorragia por parte de la paciente y la frecuencia de falla, amenorrea, necesidad de histerectomía y eventos adversos, con seguimiento a 12 meses. Se aplicó estadística descriptiva. Resultados: se evaluaron 200 pacientes, hubo una percepción de mejoría subjetiva del volumen de sangrado y de la frecuencia de incapacidad laboral o asistencia a urgencias. El 90 % de las pacientes registró amenorrea y el 6 % eventos adversos. Conclusiones: el sistema intrauterino liberador de levonorgestrel de 52 mg es una alternativa segura para el manejo de la hemorragia uterina anormal en mujeres con úteros de tamaño normal y sin alteraciones submucosas del endometrio. Se requieren estudios aleatorizados en el medio local para evaluar su efectividad y eficiencia respecto a otras alternativas de manejo.

ABSTRACT Objective: To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. Materials and methods: Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. Results: Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. Conclusions: The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.