Colposcopically Directed Biopsy Before Ablative Treatment Versus Direct Ablative Treatment in Patients With Cervical Oncogenic HPV.

Background/Aim: In the past, the standard of care for women with abnormal cervical cytology has been the performance of colposcopically guided biopsy, followed by conization or large loop excision of the transition zone (LLETZ) where biopsy revealed pre-cancerous or cancerous areas. More straightforward protocols are emerging which advocate performing LLETZ in all women with highly suspicious cytology, suspicious colposcopic impression, or the presence of high-risk oncogenic human papilloma virus (HPV) strains in their cervical swabs. This, theoretically, would reduce the rate of false-negative diagnoses, but at the price of overtreating a significant number of healthy women. Patients and Methods: We retrospectively analyzed cervical cancer screening protocols in two large cohorts of women with high-risk HPV. The study compared outcomes between patients undergoing a colposcopically directed biopsy before LLETZ (n=683) and those proceeding directly to LLETZ without a biopsy (n=136). The primary focus was to assess whether intervening biopsies would reduce unnecessary ablative procedures without compromising the detection of high-grade lesions. Results: The biopsy group had a high false-negative rate, with several high-grade lesions (CIN3) and a case of invasive cancer initially underdiagnosed. Conversely, the direct-to-LLETZ approach, while ensuring no high-grade lesions were missed, led to overtreatment of lower grade lesions. Conclusion: These findings raise concern about the reliance on biopsy results for treatment decisions. Neither protocol was entirely satisfactory, although the more aggressive one avoided the potentially life-threatening consequence of false-negative results. Further research is mandatory to accurately diagnose all cases requiring aggressive treatment, without subjecting healthy women to ablative treatments they do not need.

Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain.

BACKGROUND: The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS: Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS: The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS: In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.

Caso clínico: embarazo ectópico cervical, presentación de un caso clínico / Clinical case: cervical ectopic pregnancy, presentation of a clinical case

RESUMEN Antecedentes: El embarazo cervical es una forma rara del embarazo ectópico y representa < 1% de todos los embarazos ectópicos. Objetivo: Se presenta el caso de un embarazo ectópico cervical. Se realiza una revisión literaria sobre las diferentes opciones de manejo y tratamiento. Caso clínico: Mujer de 32 años en la semana 7+4 de embarazo en la que se objetiva un saco gestacional ístmico vascularizado, que ofrece dudas diagnósticas. Se establece el diagnóstico de embarazo ectópico cervical y se realiza un cerclaje por metrorragia. Conclusión: El embarazo ectópico cervical sigue siendo un reto importante en el campo del embarazo. El éxito del tratamiento conservador depende principalmente del diagnóstico precoz, lo que puede reducir las posibilidades de hemorragia grave y de histerectomía.

ABSTRACT Background: Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Objetive: The case of a cervical ectopic pregnancy is presented. A literary review is carried out on the different management and treatment options. Case report: A 32-year-old woman in week 7 + 4 of pregnancy in which is objetived a vascularized isthmic gestational sac, which ofeers diagnostic doubt. The diagnosis of ectopic cervical pregnancy is established and cercaclage is performed by metrorrhagia. Conclusion: Cervical ectopic pregnancy remains a major challenge in the field of early pregnancy. The success of conservative treatment depends primarily on early diagnosis, which may reduce the chances of severe bleeding and require a hysterectomy.

Mortalidad materna en España en el periodo 2010-2012: resultados de la encuesta de la Sociedad Española de Ginecología (SEGO) / Maternal mortality in Spain from 2010 to 2012: results of Spanish Society of Gynaecology Survey (SEGO)

Objetivo: la Sociedad Española de Obstetricia y Ginecología establece como uno de sus objetivos el conocer la tasa de mortalidad materna en España durante el periodo 2010-2012 y sus principales causas. Sujetos y Método: con este fin, la Sociedad Española de Obstetricia y Ginecología constituye un grupo de trabajo que elabora una encuesta que se remite a los 191 jefes de servicio de hospitales públicos y privados españoles. El análisis de los datos se llevó a cabo de forma confidencial, al igual que los nombres de los centros de los que procedían. Se llevó a cabo un procedimiento confidencial de los datos y su procedencia. Se cruzaron. Se analizan las causas obstétricas directas e indirectas de los datos con los publicados por el Instituto Nacional de Estadística. Resultados: respondieron 45 hospitales (23,56%). La encuesta representa el 18,9% de los recién nacidos en España en ese periodo. La tasa de mortalidad materna fue de 6,00/100.000 nacidos. Se consideró una subestimación del 48% de los datos registrados por el Instituto Nacional de Estadística. Las causas obstétricas directas representaron el 37,5%, siendo la hemorragia postparto la más importante. La causa obstétrica indirecta representó el 56,25%. El porcentaje de autopsias fue de 31%. Conclusiones: la tasa de mortalidad materna fue de 6/100.000 nacidos. El porcentaje de subestimación en las cifras oficiales se cifra en 48%. La causa obstétrica directa representó el 37,5%, siendo la hemorragia postparto las más frecuente. Se proponen medidas para mejorar esta información en nuestro país (AU)

Objectives: One of the aims of the Spanish Society of Obstetrics and Gynaecology is to determine the rate of maternal mortality and its main causes for the period 2010-2012. Subjects and methods: To do this, the Spanish Society of Obstetrics and Gynaecology formed a working group to draft a survey sent to 191 heads of obstetrics and gynaecology services in public and private hospitals. Analysis of the data and their origin was confidential. The data were crossed with those published by the Spanish National Statistics Institute. Direct and indirect obstetric causes were analysed. Results: Forty-five hospitals responded (23.56%). The survey represented 18.9% of newborns in Spain in that period. The maternal mortality ratio was 6/100.000 births. An underestimation of 48% was observed in relation to the data from the Spanish National Statistics Institute. Direct obstetric causes accounted for 37.5% of deaths, the most important being postpartum haemorrhage. Indirect obstetric causes accounted for 56.25%. The percentage of autopsies was 31%. Conclusions: The maternal mortality ratio was 6/100.000 births. The percentage of underestimation regarding official figures was 48%. Direct obstetric causes accounted for 37.5% of deaths, the most important cause being postpartum haemorrhage. Measures to improve this information in Spain are proposed (AU)

Rotura uterina completa en el intento de parto vaginal en gestantes con cesárea anterior / Complete uterine rupture in trial of labour after caesarean delivery

Objetivo: revisión de los casos de rotura uterina completa y su relación con el intento de parto vaginal en la cesárea anterior en el Hospital Universitario Marqués de Valdecilla. Sujetos y métodos: durante el periodo de estudio (2007-2013), se atendieron 27.008 partos, de los cuales 2.644 fueron en mujeres con cesárea anterior. Se produjeron un total de 5 roturas uterinas completas, todas ellas en las 2.198 mujeres con cesárea anterior que intentaron el parto vaginal. Resultados: la incidencia total de rotura uterina fue del 0,019%. Entre las gestantes con cesárea anterior fue del 0,19% y en el subgrupo que intentó el parto vaginal fue de 0,23%. Conclusión: todas las roturas uterinas se produjeron en las gestantes con cesárea anterior que intentaron el parto vaginal. En todos los casos se emplearon uterotónicos y en cuatro de ellos se observó un patrón cardiotocográfico característico (deceleraciones variables seguidas de bradicardia y ritmo silente o bradicardia mantenida) (AU)

Objective: To review of cases of complete uterine rupture and its association with trial of labour after caesarean delivery at the Marqués de Valdecilla University Hospital. Subjects and methods: During the study period (2007-2013), 27.008 births were attended, of which 2.644 were in women with a previous caesarean section. There were 5 complete uterine ruptures, all in the 2.198 women with a previous caesarean section who attempted vaginal birth. Results: The overall incidence of uterine rupture was 0.019%. The incidence was 0.19% in pregnant women with a previous caesarean and was 0.23% in the subgroup who attempted vaginal delivery. Conclusions: All uterine ruptures occurred in pregnant women with a trial of labour after caesarean delivery. Uterotonics were employed in all patients, with observation of a characteristic cardiotographic pattern (variable decelerations followed by bradycardia and silent rhythm or sustained bradycardia) in four of them (AU)