Resilience, Perceived Stress, and Depressed Mood in Women Under in Vitro Fertilization Treatment.

It has been suggested that women who display higher resilience levels may have less psychological distress during IVF. The aim of this study was to evaluate how infertile women deal with perceived stress, depressed mood, and sleep disturbances at the first IVF attempt and after one or more negative IVF outcomes depending on their level of resilience. An observational, cross-sectional study was carried out in a sample of 207 infertile women undergoing IVF procedures. The participants completed the short version of the Connor-Davidson Resilience Scale (CD-RISC), the short version of the European Spanish Version of Perceived Stress Scale (PSS-10), the Center of Epidemiologic Studies Depression Scale (CESD-10), and the Jenkins Sleep Scale (JSS). The relationship between CD-RISC scores ranked according to percentiles and mean PSS-10 scores revealed that women with strong resilience had lower perceived stress. After splitting the sample according to CD-RISC percentiles, differences were observed only at the first IVF attempt and the observed protective effect of high resilience scores appears to disappear following a negative IVF outcome. Women with high resilience are less likely to suffer from perceived stress or depressed mood during their first IVF attempt, this protective effect appears to be lost after a negative outcome.

Transvaginal Ultrasound-Guided Fine-Needle Aspiration of Adnexal Cysts With a Low Risk of Malignancy: Our Experience and Recommendations.

OBJECTIVES: The purpose of this study was to assess the effectiveness of ultrasound (US)-guided aspiration for the management of low-risk adnexal cysts. METHODS: A longitudinal cohort of women with a low-risk adnexal cyst who underwent transvaginal US-guided aspiration from January 2012 to April 2018 were included. All procedures were performed on an outpatient basis, without anesthesia, sedation, or antibiotics. The posttreatment follow-up protocol included transvaginal US at 3 and 12 months. Potential risk factors for recurrence (ie, age, menopausal status, comorbidities, symptoms, cyst diameter, incomplete emptying, and location) were analyzed by multiple logistic regression. RESULTS: A total of 156 patients were included. The median (interquartile range) cyst diameter was 66 (58-80) mm. Fifty-seven (36.5%) cases were resolved by US-guided aspiration. The median follow-up time was 556.5 (344-1070.25) days. The complication rate of the procedure was 2.6% (n = 4), with 3 cases of a major complication due to a pelvic abscess and 1 case of a minor complication due to self-limited vaginal spotting. A larger cyst size (odds ratio, 1.01; 95% confidence interval, 1.04-1.07; P = .002) and an older age (odds ratio, 1.01; 95% confidence interval, 1.03-1.05; P = .007) at diagnosis were independent factors related to recurrence. CONCLUSIONS: Based on the low resolution rate, US-guided aspiration is not an effective option for the treatment of low-risk adnexal cysts. Risk factors associated with recurrence were age and cyst size at diagnosis. Larger randomized studies are necessary to assess predictive factors for cyst recurrence.

Dispositivos intratubáricos Essure(R) asociados a dolor pélvico crónico y endosalpingiosis / Essure(R) intratubal devices associated with crhonic pelvic pain and endosalpingiosis

El término endosalpingiosis hace referencia a la presencia de epitelio ciliado glandular tubárico en cualquier localización ectópica. Junto a la endocervicosis y endometriosis, son entidades clínicas relacionadas por su origen embriológico común tras una diferenciación no maligna del sistema mulleriano secundario. Para algunos autores comparten los mismos mecanismos etiopatogénicos, incluyendo la teoría de la implantación secundaria a cirugía pélvica previa. Presentamos un caso clínico de dolor pélvico crónico y endosalpingiosis en paciente portadora de dispositivos intratubáricos Essure(R) y la resolución del cuadro tras la extracción endoscópica de los mismos (AU)

Endosalpingiosis refers to the presence of tubal-type ciliated glandular epithelium in ectopic locations. Together with the endocervicosis and endometriosis, they are clinical entities related by common embryological origin after not malignant differentiation of the secondary müllerian system. For some authors they share the same ethiopatogenyc mechanisms, including the theory of implantation secondary to pelvic previous surgery. We report a clinical case of chronic pelvic pain and endosalpingiosis in patient with Essure(R) intratubal devices and the resolution of this patology after the endoscopic removal of the same ones (AU)

Recuperación del parto vaginal de nalgas y versión cefálica externa / Reintroduction of vaginal breech delivery and external cephalic version

Objetivo. Se analizan retrospectivamente los resultados obstétricos y neonatales de la aplicación de un protocolo de parto vaginal de nalgas tras 10 años de su abandono. Métodos. Las pacientes eran derivadas a una unidad específica en la semana 36 donde se les ofrecía una versión cefálica externa. Si la presentación de nalgas persistía, eran seleccionadas para intento de parto vaginal si cumplían los siguientes criterios: a) peso fetal estimado 2.500-3.600g; b) nalgas puras o completas; c) cabeza fetal no hiperextendida, y d) pelvis clínicamente adecuada. El progreso del parto requería: a) primer estadio ≥1cm/h; b) segundo estadio 90 min para el descenso pasivo de las nalgas y una hora de pujos activos, y c) se estableció la disponibilidad de experto localizado. Resultados. Se encontró a 93 pacientes con presentación de nalgas única y viva tras la aplicación de la versión cefálica externa. En 69 (73,4%) se indicó una cesárea electiva, y 24 (26,6%) fueron candidatas para parto vaginal, 19 de las cuales lo lograron (20,1%). La tasa de cesáreas por esta indicación se redujo significativamente del 5,7% en 2009 a 2,02% (p<0,001). No se observó ningún resultado fetal adverso (muerte fetal, test de Apgar<7 en 5 min, pH de la arteria umbilical < 7 o traumatismos fetales). Conclusiones. El cumplimiento de los criterios anteparto e intraparto y la disponibilidad de expertos localizados hacen posible un parto vaginal seguro. La aplicación combinada de versión e intento de parto vaginal reduce la tasa de cesáreas por presentación de nalgas(AU)

Objective: To review the obstetric and neonatal outcomes of the application of an updated vaginal breech delivery protocol 10 years after this practice had been discontinued. Methods: Breech presentations were referred to a dedicated breech unit at 36 weeks where the external cephalic version was offered. If breech presentation persisted, the patients were selected to undergo attempted vaginal delivery if the following criteria were met: a) estimated fetal weight of 2.500-3.600 g; b) frank or complete breech presentation; c) absence of hyperextension of the fetal head; and d) a clinically adequate pelvis. Intrapartum criteria included: a) progression of labor of 1 cm/hour in the first hour; b) In the second stage, 90 minutes were allowed for adequate descent of the breech, and 1 hour of active pushing, and c) the availability of an on-call expert. Results: A total of 93 patients showed single live pregnancies in breech presentation after external cephalic version. Sixty-nine patients (73.4%) underwent elective prelabor cesarean delivery, and 24 (26.6%) progressed to attempted vaginal breech delivery, which was successful in 19 (20.1%). Cesarean indications for breech presentation were reduced from 5.7% in 2009 to 2.02% after the application of external cephalic version and vaginal breech delivery (P<.001). We observed no fetal deaths, no Apgar test at 5 minutes of less than 7, no umbilical artery pH of less than 7, and no fetal injuries. Conclusions: . When antepartum and intrapartum criteria are met, vaginal breech delivery is safe. The availability of an on-call expert allows vaginal breech delivery to be safely performed. The combination of external cephalic version and vaginal breech delivery decreases the cesarean rate for breech presentation(AU)