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.

Walking Promotion in Pregnancy and Its Effects on Insomnia: Results of Walking_Preg Project (WPP) Clinical Trial.

Introduction: Insomnia is a frequent condition during pregnancy. The aim of this study was to assess if a walking promotion program from the 12th Gestational Week (GW) of pregnancy helps to prevent insomnia and improve the quality of sleep at third trimester. Materials and Methods: A prospective, randomized, and controlled trial was conducted with 270 pregnant women divided into 3 groups in parallel: maximum intervention group, I1 (pedometer and goal of 10,000 steps/day), minimum intervention group, I2 (pedometer without a goal), and control group (no intervention). All groups received recommendations about physical activity in pregnancy. A structured interview was performed at 13th, 20th, and 32nd GW, collecting pedometer mean steps/day, Athens Insomnia Scale (AIS), and Pittsburgh questionnaire (PSQI). Lineal regression models were conducted to determine the association between mean steps/day at 31st GW and AIS or PSQI score. Results: At 19th GW, groups I1 and I2 reached a mean of 6267 steps/day (SD = 3854) and 5835 steps/day (SD = 2741), respectively (p > 0.05). At 31st GW mean steps/day was lower for I2 (p < 0.001). Insomnia and poor sleep quality prevalence increased through pregnancy, but no differences between groups, within trimesters, were found (p > 0.05). Lineal regression showed no association between the average steps/day at third trimester of pregnancy and AIS and PSQI scores. Conclusions: Our walking promotion program based on pedometers did not help to prevent insomnia in the third trimester of pregnancy.

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.

Maternal obesity and the risk of group B streptococcal colonisation in pregnant women.

The aim of the study was to test if maternal obesity and being overweight are independent risk factors for rectovaginal Group B Streptococcus (GBS) colonisation in pregnancy and for early onset GBS disease in the neonate. A case-control study of 9877 deliveries was conducted. The obese gravidas were significantly more likely to be colonised by GBS when compared with non-obese gravidas (22.7% versus 17.5%, P < .001). Obese gravidas were still 33% more likely than non-obese women to test positive for GBS after adjusting for the perinatal factors (adjusted OR 1.33 [95% CI 1.12-1.56]). The risk of early onset GBS disease was not calculated due to its very low incidence. The conclusion is that maternal obesity is a significant risk factor for GBS colonisation at term. Impact statement What is already known on this subject? Group B Streptococcus (GBS) is as an important cause of perinatal mortality and morbidity if prophylaxis is not performed. Intrapartum antibiotics are given if the carrier status is positive or unknown, provided that the risk factors are present. What do the results of this study add? Maternal obesity is a significant and independent risk factor for GBS colonisation at term. What are the implications of these findings for clinical practice and/or further research? Maternal obesity may be considered as a risk factor that should be taken into account in strategies for reducing GBS disease in neonates.

Hysterectomy in women with obesity: complications related to surgical site.

BACKGROUND: The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. METHODS: Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. RESULTS: Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. CONCLUSIONS: In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

Dispositivo intrauterino migrado a cavidad abdominal: características clínicas, diagnóstico y manejo / Intraabdominal migration of intrauterine devices: characteristics, diagnosis and treatment options

OBJETIVO: Describir las características clínicas, los factores predisponentes, complicaciones y la actitud terapéutica en pacientes con DIU migrado a cavidad abdominal. Material y MÉTODOS: Se analizaron de manera retrospectiva 17 casos de DIU migrado diagnosticados en el Hospital Universitario Virgen de las Nieves de Granada (España) entre 2002 y 2012. RESULTADOS: En 8 casos (47,1 %) el diagnóstico se hizo en el primer mes, mientras que en 5 (29,5 %) el diagnóstico se realizó transcurridos más de 4 años tras la implantación. El 35,2 % presentaron dolor abdominal, sin embargo el 52,9 % estaban asintomáticas y el diagnóstico se realizó de manera casual o tras un embarazo. Se llevó a cabo una extracción quirúrgica en todos los casos y fue realizada sin complicaciones mediante una laparoscopia en 15 pacientes, mientras que dos precisaron una laparotomía. CONCLUSIONES: La mayoría de las perforaciones uterinas por un DIU se inician durante la inserción por lo que debemos recomendar un examen pélvico exhaustivo, con una ecografía de control tras el primer mes de la inserción. Así mismo, si aparece dolor abdominal en estas pacientes se debe realizar una ecografía para descartar la perforación uterina. Nuestra recomendación ante un DIU fuera de la cavidad uterina es la extracción por laparoscopia en todos los casos

OBJECTIVE: To describe the clinical characteristics, predisposing factors, complications and surgical treatment options of patients with intraabdominal, mislocated intrauterine devices (IUD). MATERIAL AND METHODS: We retrospectively analyzed 17 cases of migrated IUD diagnosed at Virgen de las Nieves Hospital of Granada, Spain between 2002 and 2012. RESULTS: 8 cases (47,1 %) were diagnosed within the first month post-insertion and 5 of them (29,5 %) were diagnosed after more than 4 years. 35.2 % of the patients suffered abdominal pain, however 52,9 % were asymptomatic and the diagnosis was made by chance or as a result of pregnancy. A surgical extraction was performed in all cases. 15 patients were managed by laparoscopy without complications, whereas laparotomy was required in two. CONCLUSIONS: Most of the uterine perforations by an IUD are initiated during the insertion; therefore, a thorough pelvic examination with an ultrasound control after the first month should be carried out. Likewise, in carriers of IUD with abdominal pain an ultrasound should be made to rule out uterine perforation. Our recommendation when a migration of an IUD takes place is a laparoscopic extraction in all cases

Perinatal outcomes with isolated oligohydramnios at term pregnancy.

AIMS: To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid. METHODS: A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status. RESULTS: Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA. CONCLUSION: The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

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.

Perinatal outcomes in singleton pregnancies with a single umbilical artery.

OBJECTIVE: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders. METHODS: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes. RESULTS: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH. CONCLUSION: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery.