Complications of transvaginal radiofrequency ablation of fibroids: A 5-year experience.

Introduction: Transvaginal radiofrequency ablation is a relatively noninvasive approach for the treatment of fibroids in patients who do not wish to undergo conventional surgery. Information on potential complications of this novel technique is very scarce. Methods: Retrospective, descriptive, epidemiological study of 115 patients who underwent transvaginal radiofrequency ablation of fibroids and for whom complications were recorded. Results: We performed 115 transvaginal radiofrequency ablation procedures, we recorded a total of 11 complications (9.6%; 95% CI, 3.8-14.8). Of these, 8 (7.0%) were classified as Clavien-Dindo type I, 1 (0.9%,) as type II, and 2 (1.7%) as type IIIb (severe). No other complications were recorded in a year follow-up. Conclusion: Transvaginal radiofrequency ablation is a treatment option that makes it possible to treat fibroids that are difficult to manage using other techniques. Few associated complications have been described, and most of them are mild.

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas.

STUDY OBJECTIVE: Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. DESIGN: Prospective case series. SETTING: Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. PATIENTS: The participants were 59 patients with myomas. INTERVENTIONS: Transvaginal radiofrequency ablation. MEASUREMENTS AND MAIN RESULTS: The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. CONCLUSION: Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Associations of Vitamin D Deficiency, Parathyroid hormone, Calcium, and Phosphorus with Perinatal Adverse Outcomes. A Prospective Cohort Study.

Vitamin D deficiency during pregnancy has been linked to perinatal adverse outcomes. Studies conducted to date have recommended assessing interactions with other vitamin D-related metabolites to clarify this subject. We aimed to evaluate the association of vitamin D deficiency during early pregnancy with preterm birth. Secondary outcomes included low birth weight and small for gestational age. Additionally, we explored the role that parathyroid hormone, calcium and phosphorus could play in the associations. We conducted a prospective cohort study comprising 289 pregnant women in a hospital in Granada, Spain. Participants were followed-up from weeks 10-12 of gestation to postpartum. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, and phosphorus were measured within the first week after recruitment. Pearson's χ2 test, Mann-Whitney U test, binary and multivariable logistic regression models were used to explore associations between variables and outcomes. 36.3% of the participants were vitamin D deficient (<20 ng/mL). 25-hydroxyvitamin D concentration was inversely correlated with parathyroid hormone (ρ = -0.146, p = 0.013). Preterm birth was associated with vitamin D deficiency in the multivariable model, being this association stronger amongst women with parathyroid hormone serum levels above the 80th percentile (adjusted odds ratio (aOR) = 6.587, 95% CI (2.049, 21.176), p = 0.002). Calcium and phosphorus were not associated with any studied outcome. Combined measurement of 25-hydroxyvitamin D and parathyroid hormone could be a better estimator of preterm birth than vitamin D in isolation.

Accuracy of fetal sex determination on ultrasound examination in the first trimester of pregnancy.

PURPOSE: The aim of this study was to evaluate the feasibility and success rate of sex determination on transabdominal sonographic examination at 11-13 weeks' gestation and to identify factors influencing accuracy. METHODS: In this prospective observational evaluation of 672 fetuses between 11 weeks' and 13 weeks + 6 days' gestational age (GA), we determined fetal sex according to the angle of the genital tubercle viewed on the midsagittal plane. We also analyzed maternal, fetal, and operator factors possibly influencing the accuracy of the determination. RESULTS: Fetal sex determination was feasible in 608 of the 672 fetuses (90.5%), and the prediction was correct in 532 of those 608 cases (87.5%). Fetal sex was more accurately predicted as the fetal crown-rump length (CRL), and GA increased and was less accurately predicted as the maternal body mass index increased. A CRL greater than 55.7 mm, a GA more than 12 weeks + 2 days, and a body mass index below 23.8 were identified as the best cutoff values for sex prediction. None of the other analyzed factors influenced the feasibility or accuracy of sex determination. CONCLUSIONS: The sex of a fetus can be accurately determined on sonographic examination in the first trimester of pregnancy; the accuracy of this prediction is influenced by the fetal CRL and GA and by the maternal body mass index. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:272-277, 2016.

Parto operatorio fallido / Failed operative vaginal delivery

La tasa de parto vaginal instrumental está disminuyendo en todos los países desarrollados a costa de un aumento generalizado de la tasa de cesáreas. El parto operatorio vaginal fallido es una situación indeseada por los obstetras, que puede conllevar en algunas ocasiones un aumento de la morbilidad materno-fetal y en casos extremos un aumento de la mortalidad fetal. Estos riesgos pueden minimizarse o evitarse mediante una evaluación individualizada de cada gestante, feto y situación clínica, aplicando los protocolos recomendados por las sociedades científicas para la realización de un parto instrumental y abandonando la vía vaginal en el momento adecuado, sin prolongar el número de intentos o sin aumentar la intensidad de la tracción realizada. La experiencia en parto operatorio vaginal es imprescindible, debiéndose abandonar dicho procedimiento ante la inseguridad del obstetra (AU)

Globally, the rate of instrumental vaginal delivery is declining in all developed countries at the expense of a general increase in the rate of cesarean sections. Failed operative vaginal delivery is an undesirable situation for all obstetricians and can sometimes lead to increased maternal and fetal morbidity and, in extreme cases, to fetal mortality. These risks can be minimized or avoided through individualized assessment of each patient, fetus, and clinical situation by using the protocols recommended by scientific societies to perform instrumental delivery and abandoning the vaginal route at the appropriate moment without extending the number of attempts or increasing the intensity of the traction performed. Experience of vaginal surgery is essential, and the procedure should be abandoned whenever the obstetrician feels uncertain (AU)

Inseminación artificial intrauterina en mujeres con síndrome de ovario poliquístico resistentes al citrato de clomifeno / Intrauterine insemination in women with polycystic ovary syndrome and clomiphene citrate resistance

Objetivo: Evaluar los resultados del tratamiento mediante inducción de la ovulación con gonadotropinas e inseminación artificial intrauterina (IAC-IU) realizados en mujeres con síndrome de ovario poliquístico (SOP) resistentes al citrato de clomifeno (CC). Material y métodos: Estudio observacional retrospectivo de 462 ciclos de inducción de la ovulación con IAC-IU en mujeres diagnosticadas de SOP resistentes al tratamiento con CC. Resultados. La tasa de embarazo clínico fue del 11,9% por ciclo iniciado y del 14,74% por inseminación, finalizando en aborto el 45,45% de los embarazos. El porcentaje acumulativo efectivo de embarazo a término por ciclo iniciado fue del 8% al primer ciclo y del 10,23% por inseminación, manteniéndose en el 26,15% a partir del quinto ciclo y en 32,24% a partir de la quinta inseminación. Se canceló el 19,26% de los ciclos. Conclusiones: La IAC-IU es un método útil en mujeres con SOP resistentes al CC, con resultados similares a los obtenidos con otras indicaciones. Estas pacientes presentan altas tasas de aborto del primer trimestre y de cancelación de ciclo. Esta elevada tasa de aborto debe dar lugar al desarrollo de una línea de investigación que logre encontrar la pauta que disminuya la pérdida reproductiva (AU)

Objective: To evaluate the results of ovulation induction cycles with gonadotropins and intrauterine insemination (IUI) carried out in women with polycystic ovary syndrome (POS) resistant to clomiphene citrate. Material and methods: We performed an observational retrospective study of 462 ovulation induction cycles with IUI in women with SOP and clomiphene citrate resistance. Results: The clinical pregnancy rate was 11.9% per cycle initiated and 14.74% per insemination and 45.45% of the pregnancies terminated in abortion. The effective accumulative percentage of term pregnancies per cycle initiated was 8% for the 82 first cycle and 10.23% for insemination, increasing to 26.15% from the fifth cycle and to 32.24% from the fifth insemination. A total of 19.26% of the cycles was cancelled. Conclusions: IUI is a useful method in women with SOP who are resistant to clomiphene citrate, with similar results to those obtained with other indications. These patients have high abortion and cycle cancellation rates. The high abortion rate should prompt research into ways of reducing reproductive loss (AU)

Características epidemiológicas de una población de mujeres posmenopáusicas con osteopenia y osteoporosis: importancia de la dieta mediterránea / Epidemiological characteristics of a population of postmenopausal women with osteopenia and osteoporosis: importance of the Mediterranean diet

Objetivos: Conocer la distribución de los factores de riesgo asociados con la osteoporosis posmenopáusica en la población española. Pacientes y métodos: Estudio observacional multicéntrico de 1.779 mujeres posmenopáusicas. En función del diagnóstico densitométrico, se dividieron en 3 grupos: a) 450 mujeres con osteoporosis; b) 766 con osteopenia, y c) grupo control formado por 479 mujeres con valores de densidad mineral ósea normal. Resultados: Los factores de riesgo conocidos de osteoporosis se presentan en nuestras pacientes con similar distribución que en otros estudios. Además, se observa un efecto protector de la dieta basada en alimentos vegetales, junto al consumo moderado de alcohol, pescado y productos lácteos. Conclusión: Se confirmó la importancia de los factores de riesgo conocidos de osteoporosis. Además, en nuestra población se identificó el papel protector de la ingesta abundante de los alimentos que se incluyen en la llamada dieta mediterránea (AU)

Objective: To determinate the distribution of risk factors for osteoporosis in a Spanish population of postmenopausal women. Patients and methods: An observational multicenter study was carried out in 1779 postmenopausal women. The women were divided into three groups depending on the results of densitometry: 450 women with osteoporosis, 766 women with osteopenia, and 479 controls. Results: The distribution of known risk factors for osteoporosis in our patients was similar to that in other studies. Moreover, a protective effect of a diet based on vegetables, fish, dairy products, and moderate alcohol intake against developing osteoporosis was found. Conclusions: Our study confirms the importance of known risk factors for osteoporosis. Moreover, in our population, the beneficial effects of moderate alcohol ingestion and abundant intake of food included in the Mediterranean diet is identified (AU)