Selección de la curva de referencia del índice de pulsatilidad de las arterias uterinas entre las 24 y 40 semanas de gestación para una institución de salud en Lima, Perú / Uterine artery pulsatility index reference chart selection between 24 and 40 weeks of gestational age for a health institution in Lima, Peru / Uterine artery pulsatility index reference chart selection between 24 and 40 weeks of gestational age for a health institution in Lima, Peru

RESUMEN La evaluación de la resistencia en las arterias uterinas es empleada para identificar a las gestantes con placentación inapropiada, que las pone en riesgo de desarrollar preeclampsia, restricción de crecimiento intrauterino (RCIU) y otras manifestaciones de insuficiencia placentaria. Objetivo. Identificar cuál de las curvas de referencia del índice de pulsatilidad de las arterias uterinas (IPAUt) publicadas coinciden con nuestros datos institucionales. Métodos. Estudio retrospectivo, transversal, en el que se obtuvo 2 031 evaluaciones del índice de pulsatilidad de las arterias uterinas en 1 753 gestantes. La resistencia promedio de las arterias uterinas fue comparada con las curvas de referencia publicadas por Gomez, Weichert y Limay. Resultados. El IPAUt tuvo una débil pero significativa correlación negativa (r=0,16) con la edad gestacional (EG), entre las 24 y 40 semanas. El 6,5%, 7,5% y 15% de nuestras mediciones superaron el percentil 95 de las curvas de Weichert, Limay y Gomez, respectivamente. Conclusiones. El índice de pulsatilidad promedio de las arterias uterinas en nuestra población se ajustó mejor a la curva de referencia de Weichert. Se requieren estudios prospectivos para validar este hallazgo clínico.

ABSTRACT Uterine artery resistance is assessed to detect inadequate placentation in pregnant women, that increases the risk to develop preeclampsia, intrauterine growth restriction and other complications associated with placental insufficiency. Objective: To identify the uterine arteries pulsatility index (UtAPI) reference chart that best fits our institutional data. Methods: Retrospective, cross-sectional study that evaluated 1 753 single pregnancies; 2 031 UtAPI measurements of the uterine arteries were obtained. Mean UtAPI was compared with the reference charts published by Gomez, Limay and Weichert. Results: There was a mild but significant (r=0.16) negative correlation between UtAPI and gestational age between 24 and 40 weeks of gestation; 6.5%, 7.5% and 15% of our measurements were above the 95 centile of respectively Weichert, Limay and Gomez reference charts. Conclusions: In our population, the UtAPI distribution fitted best with Weichert reference chart. More prospective studies are needed to validate this clinical finding.

Uterine artery doppler in screening for preeclampsia and fetal growth restriction / Doppler das artérias uterinas no rastreamento para pré-eclâmpsia e restrição do crescimento fetal

Abstract Objective To perform a comprehensive review of the current evidence on the role of uterine artery Doppler, isolated or in combination with other markers, in screening for preeclampsia (PE) and fetal growth restriction (FGR) in the general population. The review included recently published large cohort studies and randomized trials. Methods A search of the literature was conducted usingMedline, PubMed, MeSH and ScienceDirect. Combinations of the search terms "preeclampsia," "screening," "prediction," "Doppler," "Doppler velocimetry," "fetal growth restriction," "small for gestational age" and "uterine artery" were used. Articles in English (excluding reviews) reporting the use of uterine artery Doppler in screening for PE and FGR were included. Results Thirty articles were included. As a single predictor, uterine artery Doppler detects less than 50% of the cases of PE and no more than 40% of the pregnancies affected by FGR. Logistic regression-based models that allow calculation of individual risk based on the combination of multiple markers, in turn, is able to detect ~ 75% of the cases of preterm PE and 55% of the pregnancies resulting in small for gestational age infants. Conclusion The use of uterine artery Doppler as a single predictive test for PE and FGR has poor accuracy. However, its combined use in predictive models is promising, being more accurate in detecting preterm PE than FGR.

Resumo Objetivo Realizar revisão da literatura científica acerca do uso do Doppler das artérias uterinas, de forma isolada ou em combinação com outros marcadores, no rastreamento para pré-eclâmpsia (PE) e restrição do crescimento fetal (RCF) na população geral. A revisão incluiu estudos de coorte e ensaios clínicos randomizados recentemente publicados. Métodos Realizou-se uma pesquisa da literatura nas bases de dados Medline, PubMed, MeSH e ScienceDirect. Diferentes combinações dos termos "preeclampsia," "screening," "prediction," "Doppler," "Doppler velocimetry," "fetal growth restriction," "small for gestational age" e "uterine artery" foram utilizadas. Artigos eminglês, (excluindo-se artigos de revisão) em que o Doppler das artérias uterinas é reportado como ferramenta no rastreamento para PE e RCF foram incluídos. Resultados Trinta artigos foram incluídos. Como teste preditivo isolado, o Doppler das artérias uterinas tem sensibilidade inferior a 50% na detecção de casos de PE e inferior a 40% para identificação de gestações afetadas por RCF. Modelos matemáticos preditivos baseados em equações de regressão logística que permitem o cálculo de risco individual, por sua vez, são mais promissores, permitindo a detecção de 75% dos casos de PE pré-termo, e 55% das gestações que resultarão emparto de recém-nascidos pequenos para a idade gestacional. Conclusão O uso do Doppler das artérias uterinas tem baixa acurácia na identificação de gestações afetadas por PE e RCF. No entanto, seu uso combinado com outros marcadores é mais promissor, apresentando maior acurácia para detecção de PE do que para RCF.

Pinzamiento vaginal de arterias uterinas de pacientes con hemorragia obstétrica primaria / Vaginal impingement of the uterine arteries in patients with primary obstetric hemorrhage

Resumen ANTECEDENTES: El pinzamiento vaginal de las arterias uterinas es una técnica eficaz para detener la hemorragia obstétrica; actúa como un torniquete que contiene la pérdida hemática. OBJETIVO: Analizar los casos de pacientes a quienes se efectuó pinzamiento Zea. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, transversal y retrospectivo efectuado en pacientes atendidas en el Hospital de la Mujer de Aguascalientes entre los meses de enero a diciembre de 2016 a quienes se aplicó pinzamiento vaginal de las arterias uterinas con técnica Zea para control de la hemorragia obstétrica. RESULTADOS: Se encontraron 83 expedientes de pacientes con diagnóstico de hemorragia posparto primaria y se analizó el caso de 22 en quienes se ejecutó el pinzamiento Zea. El 63.9% tenía entre 20 y 34 años de edad (media de 25.3 años), 78% fueron embarazos a término. Los factores de riesgo asociados fueron: segundo embarazo, preeclampsia, diabetes gestacional, anemia, trabajo de parto prolongado, parto precipitado y tratamiento con sulfato de magnesio. El tiempo del pinzamiento tuvo una media de 6.3 horas. La diferencia promedio entre la hemorragia al aplicar el pinzamiento y la hemorragia total fue de 311 mL. CONCLUSIÓN: La incidencia de hemorragia posparto fue de 0.8%, menor a la reportada en la bibliografía. La técnica Zea es una opción efectiva para el control de la hemorragia obstétrica.

Abstract BACKGROUND: Vaginal impingement of the uterine arteries is an effective technique to stop obstetric hemorrhage; acts as a tourniquet that contains blood loss. OBJECTIVE: To analyze the cases of patients who underwent Zea impingement. MATERIALS AND METHODS: Observational, descriptive, cross-sectional and retrospective study carried out on patients treated at the Hospital de la Mujer de Aguascalientes (Mexico) between January and December 2016, who underwent vaginal clamping of the uterine arteries using the Zea technique for obstetric hemorrhage control. RESULTS: 83 cases of patients diagnosed with primary postpartum haemorrhage were found and the case of 22 in whom the Zea impingement was performed was analyzed. 63.9% were between 20 and 34 years of age (mean of 25.3 years), 78% were full-term pregnancies. The associated risk factors were: second pregnancy, preeclampsia, gestational diabetes, anemia, prolonged labor, precipitated delivery and treatment with magnesium sulfate. The impingement time had an average of 6.3 hours. The average difference between the bleeding when applying the impingement and the total hemorrhage was 311 mL. CONCLUSION: The incidence of postpartum hemorrhage was 0.8%, lower than that reported in the literature. The Zea technique is an effective option for the control of obstetric hemorrhage.

Monochorionic twin delivery after conservative surgical treatment of a patient with severe diffuse uterine adenomyosis without uterine rupture

A 31-year-old nulliparous woman with severe diffuse uterine adenomyosis, which replaced nearly the whole uterine myometrium, visited our hospital due to severe dysmenorrhea, menorrhagia, and a desire to have a baby. The patient had a history of two spontaneous abortions. Laparotomic adenomyomectomy with transient occlusion of uterine arteries (TOUA) was performed safely and the patient tried in vitro fertilization and achieved a intrauterine twin pregnancy after recovery time of the operation. At 31+6 weeks of gestation, a male neonate baby weighing 1,620 g and a male neonate baby weighing 1,480 g were born by transverse lower segment cesarean delivery. There was no complication after the operation. The babies were discharged after receiving routine neonatal intensive care for neonatal respiratory distress syndrome. Adenomyomectomy with TOUA technique would be an option for conservative surgical treatment in patients with severe diffuse whole uterine adenomyosis. This is the first report of twin pregnancy after diffuse whole uterine adenomyomectomy with TOUA.

Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries

There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding.

Correlación de las curvas Doppler de arterias uterinas con el desarrollo puberal de los genitales internos de niñas y adolescentes: experiencia en un servicio de imagenología pediátrico / Correlation of uterine artery Doppler patterns and the development of the internal genitalia of girls and adolescents: experience in a pediatric imaging department

Ultrasound allows evaluate in girls, the internal genitals development and their follow up during puberty. Doppler of the uterine arteries (UA) has demonstrated be a complementary parameter to detect the onset of puberty. Objective: To show through our experience, the correlation between the internal genital development and the Doppler of UA morphology in girls and adolescents. We analyzed in 84 ultrasounds (US); uterine morphology and the relation body/cervix, endometrial thickness, ovarian volume and the pattern of Doppler UA. We obtained a relationship between the anatomic changes usually studied and the patterns of the Doppler UA, since childhood to puberty. Conclusion: The diastolic flow changes in the UA can be complementary for the diagnosis of the degree of puberty.

El ultrasonido permite la evaluación del desarrollo de los genitales internos en las niñas y seguimiento a través de la pubertad. La curva del Doppler de arterias uterinas (AU) ha demostrado ser un parámetro complementario en la detección del inicio de la pubertad.Objetivo: mostrar la correlación del desarrollo de los genitales internos, con la morfología de las curvas Doppler de AU en niñas y adolescentes a través de nuestra experiencia. Analizamos en 85 ultrasonidos (US); morfología uterina, relación cuerpo/cervix, grosor endometrial, volumen ovárico y morfología de la curva del Doppler de AU. Constatamos una asociaciónentre los cambios morfológico estudiados habitualmente con los distintos patrones de las curvas del Doppler desde la niñez a la pubertad. Conclusión: Los cambios en el flujodiastólico de las arterias uterinas permiten complementar el diagnóstico del grado de progreso de la pubertad.

Repercussões da cicatriz uterina resultante de cesariana prévia na dopplervelocimetria das artérias uterinas entre 26 e 32 semanas / Repercussions of previous cesarean uterine scar at uterine arteries Doppler velocimetry between the 26th and 32nd gestational weeks

OBJETIVO: Avaliar as repercussões da cicatriz uterina na dopplervelocimetria das artérias uterinas, entre 26 e 32 semanas, em gestantes primíparas com uma cesariana prévia, considerando quando esta foi realizada fora (cesárea eletiva) ou durante o trabalho de parto. MATERIAIS E MÉTODOS: Estudo prospectivo transversal em 45 gestantes, divididas em três grupos: 17 gestantes com cicatriz prévia resultante de cesariana eletiva (grupo A); 14 gestantes com uma cicatriz prévia oriunda de cesariana executada em trabalho de parto (grupo B); 14 gestantes cujo único parto anterior foi realizado por via vaginal (grupo C). A dopplervelocimetria das artérias uterinas foi realizada pela via abdominal. Foram calculados as médias, medianas e desvios-padrão (DP) para cada grupo em estudo. Em relação ao índice de pulsatilidade, a comparação dos grupos foi conduzida pelo teste não paramétrico de Kruskal-Wallis. RESULTADOS: Os valores médios do índice de pulsatilidade no grupo A variaram de 0,60 a 1,60 (média: 0,90; DP: 0,29), no grupo B, de 0,53 a 1,43 (média: 0,87; DP: 0,24), e no grupo C, de 0,65 a 1,65 (média: 1,01; DP: 0,37); p = 0,6329. CONCLUSÃO: Não houve repercussões da cicatriz de cesariana prévia na dopplervelocimetria das artérias uterinas avaliadas de 26 a 32 semanas de gestação.

OBJECTIVE: To evaluate the possible repercussions of the previous cesarean scar at uterine arteries Doppler velocimetry between the 26th and 32nd gestational weeks. MATERIALS AND METHODS: Prospective cross-sectional study including 45 women between 11 and 14 weeks of gestation, divided into three groups: 17 pregnant women with uterine scar resulting from a previous elective cesarean section (group A); 14 with uterine scar resulting from a previous cesarean section performed during labor (group B); and 14 pregnant women with a single previous vaginal delivery (group C). Uterine arteries Doppler velocimetry was performed with transabdominal approach. Means, medians and standard deviation (SD) were calculated for each group in the study. The groups comparison regarding pulsatility index was performed with the non-parametric Kruskal-Wallis test. RESULTS: In group A, the pulsatility index ranged from 0.60 to 1.60 (mean: 0.90; SD: 0.29), in group B, from 0.53 to 1.43 (mean: 0.87; SD: 0.24), and in group C, from 0.65 to 1.65 (mean: 1.01; SD: 0.37); with p = 0.6329. CONCLUSION: No repercussion of previous cesarean scar was observed at uterine arteries Doppler velocimetry performed in the period between the 26th and 32nd gestational weeks.

Ligadura vaginal de arterias uterinas en hemorragia postparto: técnica simple, rápida y efectiva / Vaginal ligature of uterine arteries in patients with postpartum hemorrhage

La metrorragia posparto es una de las complicaciones más graves de la obstetricia con importante morbi-mortalidad materna. La ligadura de las arterias uterinas forma parte de la cadena de procedimientos terapéuticos. Esta comunicación muestra una paciente con hemorragia posparto tratada con ligadura vaginal de arterias uterinas, con cese del sangrado y recuperación de la paciente sin complicaciones.

Postpartum hemorrhage is one of the most serious obstetrics complications with significant maternal morbidity and mortality. Uterine arteries ligature is part of the chain of therapeutic procedures. This communication presents a patient with postpartum hemorrhage treated with vaginal uterine arteries ligature with cessation of bleeding after the intervention and recovery without complications.

Embolización arterial de miomas uterinos: resultados morfológicos y funcionales a corto y mediano plazo / Uterine fibroid embolization: morphologic and functional results at short-to-medium term

Introducción: Los miomas uterinos son los tumores sólidos más frecuentes del aparato genital femenino. En un alto porcentaje son asintomáticos, pero cuando se acompañan de sangrado uterino anormal, dolor o síntomas de compresión, se debe aplicar un tratamiento. La Embolización Arterial Uterina (EAU) se presenta como una alternativa al tratamiento quirúrgico. Objetivo: El objetivo de este trabajo es medir la eficacia de la EAU como tratamiento de la miomatosis sintomática a corto y mediano plazo, evaluar la seguridad y comparar los resultados con otros tratamientos. Material y Método: Se realizó un estudio prospectivo de 28 pacientes seleccionadas entre diciembre de 2000 y abril de 2005, cuya edad promedio era 41 años y que presentaban miomatosis sintomática, con alteraciones en el sangrado menstrual y deseos de conservación del útero. Las EAU fueron realizadas con partículas de polivinil alcohol de 500 a 1000 μm. A todas se les hizo un seguimiento posterior mayor de 2 años. Resultados: En 27 pacientes, el alta médica se otorgó a las 24 horas post EAU. Una paciente permaneció internada por la persistencia de dolor pelviano y una se reinternó por la misma causa a las 48 horas post procedimiento. Todas las pacientes reanudaron sus actividades rutinarias a los 7 ± 4 días post embolización. No se presentaron complicaciones. Luego de un seguimiento de 6 meses, el 100 % de las pacientes se manifestaron satisfechas con el procedimiento. Conclusión: La EAU es una excelente alternativa a los tratamientos clásicos y una opción terapéutica para las pacientes portadoras de miomas uterinos sintomáticos.

Introduction: Uterine myomas are the most frequent solid tumours of the female reproductive system. In a high percentage of cases patients are asymptomatic; however, when clinical manifestations occur such as abnormal uterine bleeding, pain or compressive symptoms, some kind of therapy must be initiated. Uterine artery embolization (UAE) is an alternative to conventional surgical therapy. Purpose: The objective of this study was to evaluate the usefulness of UAE as treatment for symptomatic myomatosis at short and intermediate term, to evaluate the safety of this technique and to compare its results with other alternative treatments. Material and methods: Prospective study of 28 selected patients who underwent UAE from December 2000 to April 2005 and followed up until April 2008 whose average age was 41 years. All the patients presented with symptomatic myomatosis with menstrual bleeding disorders. All the patients desired to keep their uterus. The embolizing material was polyvinyl alcohol particles of 500-1000 μm. Results: Twenty seven patients were discharged 24 hours after the UAE. One patient remained hospitalized 12 more hours and 1 was readmitted 48 hours after the procedure, both due to pelvic pain. All the patients returned to their usual activities 7 + days after the UAE. None of the patients presented complications. All the patients remained satisfied with the results of the procedure at the 6-month control. Conclusion: UAE is an outstanding alternative to conventional treatment, with high technical success and safety. It should be considered for patients with symptomatic uterine myomas.

Application of Blocking Ascending Branch of Uterine Arteries in Operation of Hysteromyomas Rejecting by Laparoscope / 医学研究杂志

Objective To investigate blocking ascending branch of uterine arteries in operation of hysteromyomas rejecting by laparoscope.Methods 60 petients(except cervix myoma,intraligamentary myoma,submucosa myoma),randomly devided to reseach group(30 cases)and control group(30 cases).Blocking ascending branch of uterine arteries before rejecting hysteromyomas by laparoscope in reseach group,directly rejecting hysteromyomas by laparoscope in control group.The volumes of blood loss in operation,the duration of operation,postoperative recovery(Time of passing flatus,wound healing,length of stay)were compared between two groups.During the follow-up months,observing hysteromyoma recidivism and improvement of menstruation.Results All patient were rejected hysteromyomas by laparoscope.The volumes of blood loss in research group were less than that in control group(P0.05),All wounds were well healed in both groups,the rate of hypermenorrhea improvement was 100%(26/26)in research group,but That in control group was 80%(16/20),There was significant difference between two group.Conclusions Blocking ascending branch of uterine arteries may obviously decrease the volumes of blood loss in operation of hysteromyomas rejecting by laparoscope,It presents rapider convalescence,higher rate of symptom improvement and less complication operation.

The Effects of Verapamil and Nifedipine on Isolated Human Uterine Arteries / 대한마취과학회지

Isometric tension was recorded in uterine arterial ring preparation contracted by potassium (60 mM) and norepinephrine(1.8 X 10(-7) M). With pretreatment of various concentrations of nifedipine(2.9 x 10(-9) ~2.9 X10(-7) M) and verapamil(2.2 X 10(-7) -2.2 X 10(-5) M), the relaxation was dose-dependent and inhibitory effects of both agents were more marked on the potassium than norepinephrine-evoked contraction. After immersion of the arterial preparation in calcium-free solution, the potassium-evoked contraction was decreased to 21+/-4.1%(mean+/-SEM) of the response in normal Krebs solution and norepinephrine-evoked contraction to 26+/-3.8%. The responses to both agents were completely restored when the calcium concentration was increased to 4.0 mM. Pretreated nifedipine(2.9 x 10(-7) M) in calcium-free solution depressed the potassium-evoked contraction to 7.3+/-1.6% and norepinephrine-evoked contraction to 12+/-3.7%. In addition of calcium(0-4.0mM), the potassium-evoked contraction increased to 30+/-4.6% and that by norepinephrine to 45+/-5.4%. Pretreated verapamil(2.2 X 10(-5) M) in calcium-free solution depressed the potassium-evoked contraction to 14+/-3.6% and norepinephrine-evoked contraction to 18+/-3.3%. In addition of calcium(0-4.0mM), the potassium-evoked contraction increased to 41+/-4.2% and that by norepinephrine to 57+/-4.7%. It was concluded that nifedipine and verapamil relaxed KC1 contracted ring in the presence of external calcium and relaxed norepinephrine contracted ring in both the presence and absence of external calcium. These findings suggest that calcium antagonists interfere with the release of calcium from intracellular sites as well as with the slow inward current of calcium.

Clinical Observation on Xiaozheng Decoction in the Treatment of Endometriosis:A Report of 46 Cases / 中医杂志

0.05). In the improvement of irregular menstruation, lumbosacral discomfort and morbid leucorrhea, the effect of the treatment group was significantly superior to that of the control group (P0.05). The hemodynamic indices of uterine arteries in the treatment group was significantly improved after treatment (P