Is mid-trimester cervical length screening effective for reduction of threatened preterm labor?

OBJECTIVE: To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS: A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS: We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION: The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.

Análisis de la tasa de cesáreas en el Hospital Universitario Cruces (Vizcaya) mediante el empleo de la clasificación de Robson / Use of the Robson 10-group classification to assess cesarean section rates in Cruces Hospital (Vizcaya)

OBJETIVO: valorar la frecuencia de las cesáreas realizadas en nuestro hospital empleando la clasificación estandarizada de Robson e identificar qué indicaciones son las que más contribuyen a la tasa global de cesáreas en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo, observacional sobre el total de cesáreas realizadas en el Hospital Universitario Cruces en un periodo de tres años (2015-2017). Para la inclusión de las gestantes en algunos de los 10 grupos de Robson hemos tenido en cuenta la paridad, edad gestacional, inicio del parto, presentación fetal y el número de fetos. RESULTADOS: durante este tiempo se han atendido un total de 15.112 partos; de los que 1.935 fueron cesárea (12,80%). El grupo que mayor incidencia tiene sobre el total de cesáreas realizadas es el grupo 2 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto inducido o cesárea antes del inicio del trabajo de parto) con una tasa del 30,64%, seguido del grupo 1 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto espontáneo) con un 19,22%. Al margen del grupo 9 (que incluye las cesáreas en presentaciones transversas), los grupos con un mayor porcentaje de cesáreas son el 6 (nulíparas, gestación única, presentación podálica) y 7 (multípara, gestación única, presentación podálica, incluidas las gestantes con cesárea anterior) con un 56,83% y 54,54% respectivamente. CONCLUSIONES: la clasificación de Robson es una buena herramienta para auditar clínicamente la tasa de cesáreas. Es fácil de implementar y permite evaluar el impacto del cambio en el manejo para cambiar dicha tasa. En nuestro centro, la protocolización adecuada de la atención a las presentaciones podálicas, gestaciones múltiples y cesáreas anteriores representa el mayor reto

OBJECTIVE: To apply the Robson 10-group classification system to identify which indications are the ones that contribute most to the cesarean section rate in our hospital. MATERIAL AND METHODS: A historical cohort study was performed on women who delivered in a 3-year period (2015-2017) at the Cruces University Hospital. Five parameters (parity including previous cesarean, gestational age, labor onset, fetal presentation, and plurality), identifiable on presentation for delivery, were used to classify all women included into 1 of 10 groups. The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed, and the distribution of other outcomes was calculated for each Robson group. RESULTS: Of 15,112 deliveries, 1,935 (12.80%) were cesarean sections. Robson groups 1 (30.65%) and 3 (29.91%) (spontaneous term births) were the largest groups. Robson group 2 (single cephalic nulliparous women full-term, induced labor or cesarean section antepartum) and group 1 (single cephalic nulliparous women full-term in spontaneous labor) were the major contributors to the overall cesarean rate at 30.64% and 19.22% respectively. Besides group 9 (transverse lie), groups with higher cesarean rates are 6 (single breech, nulliparous) and 7 (single breech, multiparous, including previous cesarean section), with 56.83% and 54.54% respectively. CONCLUSIONS: The Robson classification is a good tool to clinical audit cesarean section rates. Is easy to implement and interpret and allows to evaluate the impact of changes in management that may alter these rates. In our hospital breech presentations, multiple pregnancy and previous cesarean section are the main challenges

Melanoma multifocal del tracto genital femenino / Multifocal melanoma of the female genital tract

El melanoma maligno del tracto genital femenino es una enfermedad multifocal a un trastorno de los melanocitos de las mucosas. Esto justifica su alta tasa de recurrencias a pesar de las resecciones quirúrgicas radicales con márgenes libres. Presentamos el caso de una paciente con melanomas malignos en vulva, vagina y cérvix, acompañados de melanosis del área genital (AU)

Malignant melanoma of the genital tract is a multifocal disease resulting from a disorder of melanocytes within the mucosa, which explains the high recurrence rate after radical excision with free margins. We report the case of a patient with malignant melanoma of the vulva, vagina and cervix, associated with genital melanosis (AU)

Melanosis vaginal asociada a melanoma primario de vulva / Benign vaginal melanosis associated to primary melanoma of the vulva. Case report

Presentamos un caso de melanosis vaginal asociada a melanoma de vulva en una mujer de69 años. Las dos lesiones pigmentarias surgen en la paciente de forma independiente y sin relaciónaparente. La mujer había sido tratada quirúrgicamente por un melanoma maligno primitivode vulva con invasión a nivel IV de Clark y metástasis en una adenopatía inguinal. La lesión demelanosis vaginal se desarrolló tres años después de la vulvectomía radical. Además de la descripcióndel caso se realiza una revisión de la literatura y se comenta sus posibles implicacionesclínico-patológicas

A case of vulvar melanosis associated with primary vulvar melanoma in a 69 yr. old caucasianwoman is reported the two pigmentary lesions became manifest in the patient independentlyand had no apparent relationship. Firstly, the patient was treated by radical vulvectomy for a primitivevulvar melanoma, Clark’s stage IV with metastasis in an inguinal adenopathy. Three yearsafter vulvectomy the patient developed the benign vaginal melanosis. A review of the literatureand a discussion and comments on the clinico-pathological implications between both entitiesare included in this paper

Melanosis vaginal asociada a melanoma primario de vulva / Benign vaginal melanosis associated to primary melanoma of the vulva. Case report

Presentamos un caso de melanosis vaginal asociada a melanoma de vulva en una mujer de 69 años. Las dos lesiones pigmentarias surgen en la paciente de forma independiente y sin relación aparente. La mujer había sido tratada quirúrgicamente por un melanoma maligno primitivo de vulva con invasión a nivel IV de Clark y metástasis en una adenopatía inguinal. La lesión de melanosis vaginal se desarrolló tres años después de la vulvectomía radical. Además de la descripción del caso se realiza una revisión de la literatura y se comenta sus posibles implicaciones clínico-patológicas

A case of vulvar melanosis associated with primary vulvar melanoma in a 69 yr. old Caucasian woman is reported the two pigmentary lesions became manifest in the patient independently and had no apparent relationship. Firstly, the patient was treated by radical vulvectomy for a primitive vulvar melanoma, Clark’s stage IV with metastasis in an inguinal adenopathy. Three years after vulvectomy the patient developed the benign vaginal melanosis. A review of the literature and a discussion and comments on the clinico-pathological implications between both entities are included in this paper