Prediction of an effective cervical ripenning in the induction of labour using vaginal dinoprostone.

To develop a predictive model for successful cervical ripening in women that undergo induction of labour by means of a vaginal prostaglandin slow-release delivery system (Propess®).  Prospective observational study on 204 women that required induction of labour between February 2019 and May 2020 at "La Mancha Centro" hospital in Alcázar de San Juan, Spain. The main variable studied was effective cervical ripening (Bishop score > 6). Using multivariate analysis and binary logistic regression, we created three initial predictive models (model A: Bishop Score + Ultrasound cervical length + clinical variables (estimated fetal weight, premature rupture of membranes and body mass index)); model B: Ultrasound cervical lenght + clinical variables; and model C: Bishop score + clinical variables) to predict effective cervical ripening. All three predictive models obtained (A, B and C) presented good predictive capabilities, with an area under the ROC curve ≥ 0.76. Predictive model C, composed of the variables: gestational age (OR 1.55, 95% CI 1.18-2.03, p = 0.002), premature rupture of membranes (OR 3.21 95% CI 1.34-7.70, p = 0.09) body mass index (OR 0.93, 95% CI 0.87-0.98, p = 0.012), estimated fetal weight (OR 0.99, 95% CI 0.99-1.00, p = 0.068) and Bishop score (OR 1.49 95% CI 1.18-1.81, p = 0.001), is presented as the model of choice with an area under the ROC curve of 0.76 (95% CI 0.70-0.83, p < 0.001). A predictive model composed of the variables: gestational age, premature rupture of membranes, body mass index, estimated fetal weight and Bishop score upon admission presents good capabilities in predicting successful cervical ripening following administration of prostaglandins. This tool could be useful in making clinical decisions with regard to induction of labour.

Use of Vaginal Dinoprostone (PGE2) in Patients with Premature Rupture of Membranes (PROM) Undergoing Induction of Labor: A Comparative Study.

Purpose: To evaluate the effect and safety of vaginal dinoprostone in pregnant women with PROM who undergo induction of labor (IoL). Materials and Methods: Prospective observational study conducted at La Mancha Centro hospital from 1 February 2019, to 30 August 2020. Obstetric and neonatal variables of 94 pregnant women with PROM who underwent IoL with vaginal dinoprostone were analyzed, and the results were compared with 330 patients without PROM who also underwent IoL. Bivariate and multivariate analyses were performed using binary and multiple linear regression. Results: A total of 424 women were included in this study. A greater response to cervical ripening (Bishop score > 6) with PGE2 was observed in the PROM group (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.50−4.99, p = 0.001), as well as a shorter total duration of IoL (mean difference (MD) 2823.37 min (min), 95% CI 1257.30−4389.43, p < 0.001). Cesarean sections were performed in 28.7% (n = 27) of patients in the PROM group vs. 34.2% (n = 113) of patients in the non-PROM group, with no significant differences (OR 0.87%, 95% CI 0.47−1.60, p = 0.652). There were no significant differences in changes in the cardiotocographic record (CTG), postpartum hemorrhage (PPH), uterine rupture, or adverse neonatal outcomes between the two groups. Conclusions: The use of vaginal dinoprostone in pregnant women undergoing IoL with PROM is safe for the mother and the fetus, shortens the total delivery time, and does not increase the risk of cesarean section compared with pregnant women undergoing IoL without PROM.

Study of amniotic fluid in pregnant women infected with SARS-CoV-2 in first and second trimester. Is there evidence of vertical transmission?

COVID-19 is a respiratory disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effects of this infection on fetal development and whether there is vertical transmission are currently unknown. We present two cases of pregnant women with COVID-19 infection during the first and second trimester of gestation in which a PCR study of SARS-CoV-2 in amniotic fluid extracted by amniocentesis is performed to try to determine if there is vertical transmission. In both cases, the PCR result was negative. This fact could support the absence of vertical transmission when the infection occurs in these quarters. It would be advisable to carry out more extensive studies to be able to make this statement safely.

Induction of Labor with Vaginal Dinoprostone (PGE2) in Patients with a Previous Cesarean Section: Obstetric and Neonatal Outcomes.

BACKGROUND: Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. OBJECTIVE: To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. MATERIALS AND METHODS: A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. RESULTS: A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68-2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. CONCLUSIONS: The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.

Variability and associated factors in the management of cord clamping and the milking practice among Spanish obstetric professionals.

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11-0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41-23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.

COVID-19 infection in symptomatic pregnant women at the midpoint of the pandemic in Spain: a retrospective analysis.

OBJECTIVES: Determine the strengths and weakness of a symptomatic screening for COVID-19 in pregnant women. Analyze the clinical presentation, management, and outcomes. DESIGN: Descriptive retrospective observational study. SETTING: Mancha-Centro Hospital (Spain). MATERIAL AND METHODS: Population: Symptomatic pregnant women with confirmed diagnosis of COVID-19. Between the 12th of March and 17th of April 2020, all the symptomatic pregnancies were screened with diagnostic test for SARS-CoV-2. Data collection was done by reviewing the medical records and telephone interviews. MAIN OUTCOME MEASURES: Clinical characteristics, management, treatment, and obstetric and neonatal outcomes. RESULTS: Twenty patients with positive COVID-19 diagnostic test out of thirty-four suspected. The most common symptoms were fever (70%), cough (65%) and myalgia (35%). A unique symptom of presentation in 20% of cases. COVID-19 pneumonia was diagnosed in 30% by chest X-ray and one case had pulmonary embolism associated diagnosed by CT-Scan. Thromboprophylaxis was indicated in 16 out of 20 patients. Eight women finished their pregnancy during the observation period. Type of birth: 25% natural birth, 12.5% assisted vaginal delivery and 62.5% caesarean section. We had three severe cases, two of them with intensive care support. All neonates had negative test for COVID 19 infection. CONCLUSIONS: We recommend universal screening of all pregnant woman for COVID-19 during the pandemic because of the limits of the symptomatic screening seen in this studio and the ratio of asymptomatic pregnancies with positive test for COVID-19 recently published.

Variability of Clinical Practice in the Third Stage of Labour in Spain.

Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12-0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13-2.18) and worked in a hospital that attended >4000 births per year (ORa: 7.95 CI: 4.02-15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour (p < 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors.

Evaluation of the results of end-of-pregnancy protocols in diabetic pregnant women / Evaluación de los resultados de dos protocolos de finalización de la gestación en gestantes diabéticas

Objective: The objective of our study was to compare perinatal outcomes in 2 cohorts; one from before and one from after the implementation of a new protocol for the care of pregnant diabetic woman. Material and methods: We performed a retrospective study on 262 pregnant women diagnosed with pregestational or gestational diabetes in whom labor was induced. Results: Diabetes went from being the second reason for induction to the third reason, with a statistically sig-nificant increase in the duration of gestation in favor of the second cohort. The percentage of premature births was lower, as was that of low-birth-weight newborns. Conclusions: There are no quality studies in the literature that indicate guidelines to be followed for the monito-ring and treatment of diabetic pregnant women. In our hospital, induction rates improved after implementation of the protocol

Objetivo: el objetivo de nuestro estudio fue comparar los resultados perinatales en dos cohortes; antes y después de la implantación de un nuevo protocolo de asistencia a la gestante diabética. Material y métodos: se llevó a cabo un estudio sobre dos cohortes retrospectivas formadas por un total de 262 gestantes con diagnóstico de diabetes pregestacional o gestacional a las que se les indujo el parto .Resultados: las inducciones por diabetes pasaron de constituir el segundo motivo de inducción al tercer motivo con un aumento estadísticamente significativo de duración de la gestación a favor de la cohorte del protocolo 2. Se observó con un menor porcentaje de partos prematuros; así como un menor porcentaje de recién nacidos de bajo peso Conclusiones: en la literatura no aparecen estudios de buena calidad que marquen las directrices a realizar en el seguimiento y tratamiento de la gestante diabética. En nuestro hospital se han mejorado las tasas de inducción con el nuevo protocolo establecido

Oxytocin discontinuation after the active phase of induced labor: A systematic review.

BACKGROUND: Oxytocin is the most widely used drug in the induction of labor, but it could have potential adverse effects that derive from uterine hyperstimulation. AIM: To determine the benefits and drawbacks of oxytocin continuation versus oxytocin discontinuation after the active phase of induced labor. METHODS: We systematically searched Pubmed, EMBASE, Scopus, ClinicalTrials.gov and Cochrane Library Plus until October 2017, for randomized controlled trials comparing oxytocin continuation with oxytocin discontinuation when the active phase of labor is reached were included. Data was collected by three reviewers and quality of the included studies assessed using the methodology recommended in the Cochrane Handbook. StatsDirect software was used to calculate risk ratios for binary variables and weighted mean differences for continuous variables. A fixed-effects or random-effects model was used as appropriate. RESULTS: Nine studies were selected including 1538 women, 774 in the oxytocin continuation group and 764 in the oxytocin discontinuation group. The incidence of cesarean sections (14.3% vs. 8.6%; relative risk, 1.67; 95% confidence interval: 1.25-2.23), uterine hyperstimulation (12.4% vs. 4.7%; relative risk, 2.59; 95% confidence interval: 1.70-3.93) and nonreassuring fetal heart rate (19.2% vs.12.5%; relative risk, 1.55; 95% confidence interval: 1.18-2.02) were significantly higher in the oxytocin continuation group. An increase in the duration of the second stage of labor in the oxytocin discontinuation group was observed (pooled mean difference, -7.03; 95% confidence interval: -9.80 to -4.26). CONCLUSIONS: After the active phase of induced labor, oxytocin continuation increases the risk of cesarean section, uterine hyperstimulation and alterations to the fetal heart rate.

Predictive model for risk of cesarean section in pregnant women after induction of labor.

PURPOSE: To develop a predictive model for risk of cesarean section in pregnant women after induction of labor. METHODS: A retrospective cohort study was conducted of 861 induced labors during 2009, 2010, and 2011 at Hospital "La Mancha-Centro" in Alcázar de San Juan, Spain. Multivariate analysis was used with binary logistic regression and areas under the ROC curves to determine predictive ability. Two predictive models were created: model A predicts the outcome at the time the woman is admitted to the hospital (before the decision to of the method of induction); and model B predicts the outcome at the time the woman is definitely admitted to the labor room. RESULTS: The predictive factors in the final model were: maternal height, body mass index, nulliparity, Bishop score, gestational age, macrosomia, gender of fetus, and the gynecologist's overall cesarean section rate. The predictive ability of model A was 0.77 [95% confidence interval (CI) 0.73-0.80] and model B was 0.79 (95% CI 0.76-0.83). The predictive ability for pregnant women with previous cesarean section with model A was 0.79 (95% CI 0.64-0.94) and with model B was 0.80 (95% CI 0.64-0.96). For a probability of estimated cesarean section ≥80%, the models A and B presented a positive likelihood ratio (+LR) for cesarean section of 22 and 20, respectively. Also, for a likelihood of estimated cesarean section ≤10%, the models A and B presented a +LR for vaginal delivery of 13 and 6, respectively. CONCLUSION: These predictive models have a good discriminative ability, both overall and for all subgroups studied. This tool can be useful in clinical practice, especially for pregnant women with previous cesarean section and diabetes.

Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal / Variability in the rate of episiotomies and its relation to severe perineal tears and neonatal morbility

Objetivo Determinar la variabilidad en la práctica de episiotomías entre matronas y su relación con la aparición de desgarros perineales tipo III-IV, así como sus repercusiones sobre la morbilidad neonatal. Método Cohortes históricas sobre 2.366 partos eutócicos con feto vivo único, mayor o igual a 37 semanas de gestación y 18 matronas del Hospital la Mancha-Centro de Alcázar de San Juan durante los años 2009, 2010 y 2011. Las variables principales fueron la incidencia de episiotomías, desgarros perineales y morbilidad neonatal. Resultados La variabilidad en la práctica de la episiotomía osciló entre el 19,5 y el 50,1% entre las 18 matronas a estudio, con una tasa promedio del 34,9% (824). Al agrupar por intervalo, el 22,1% (524) presentaba una tasa ≤ 25%, el 26,1% (621) entre el 26-35%, el 38% (898) entre el 36-44% y el 13,7% (323) una tasa ≥ 45%, observándose homogeneidad entre los grupos para todos los factores de confusión. No se observó asociación estadística entre mayores tasas de episiotomías y pH de arteria umbilical < 7,10, puntuaciones de apgar a los 5 min < 7 y grado de reanimación neonatal tipo III y IV. Tampoco encontramos asociación entre tasa de episiotomías con integridad perineal y desgarros tipo III-IV. ConclusiónLa variabilidad en la tasa de episiotomías es alta y no se relaciona con la mayor presencia de desgarros tipo III y IV, ni mayor morbilidad neonatal. No se justifican tasas mayores del 25% de episiotomías para prevenir el trauma perineal ni la pérdida de bienestar fetal (AU)

Objective: To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity. Method: A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in «Mancha-Centro» Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity. Results: The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524)had a rate of ≤ 25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323)a rate of ≥ 45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery <7.10, Apgar score after 5 min <7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears. Discussion: The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being (AU)

[Differences in cesarean sections between spontaneous and induced labour]. / Diferencias en el número de cesáreas en los partos que comienzan espontáneamente y en los inducidos.

BACKGROUND: The induction of labour (IOL) may be associated with complications for pregnant women. The aim was to assess the differences in the number of caesarean sections between spontaneous or induced labour. METHODS: Historical groups from 841 women with induced labour and 2,534 women with an spontaneous onset of labour over a three- year period (from 2009 to 2011). They were carried out in "Mancha Centro" Hospital (Alcázar de San Juan). It was used a multivariate analysis through binary logistic regression to control confounding variables. RESULTS: The prevalence of IOL was 22,9%. The most frequent indications were: Premature Rupture of Membranes (22,7%), bad- controlled Diabetes (22,5%). It was reported a relation between induced labour and cesarean section risk due to parity (nulliparous OR= 2.68, IC 95%: 2.15- 3.34 and multiparous OR= 2.10, IC 95%: 1.72- 2.57). Postterm pregnancy (37,1%), pathological monitor (35.3%) and hypertensive diseases of pregnancy (34%) reported the highest risks of cesarean section. The IOL was related to other factors: a long- time length first -stage of labour (OR= 6.00; IC 95%: 4.02- 8.95), use of epidural analgesia (OR= 3.10; IC 95%: 2.24- 4.29) and blood transfusion needs (OR= 3.33; IC 95%: 1.70- 9.67). CONCLUSION: Independently of parity, The IOL increases the risk to: have a longer duration first- stage, use epidural analgesia, need a blood transfusion and have a cesarean section. This relation is stronger when induction is due to postterm pregnancy, pathological monitor or hypertensive diseases. No relation was found among induced labour and second- stage duration, episiotomy, perineal tears, excessive blood loss or uterine rupture.

Relation between induced labour indications and neonatal morbidity.

PURPOSE: To assess the main neonatal morbidity results in relation to induced labour indications. METHODS: Historical groups from a total of 3,817 deliveries over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan) formed the study group. All programmed and non-avoidable caesarean sections and pregnancies under 35 weeks were excluded. The main variable result was a neonatal morbidity variable made up of the Apgar score after 5 min, pH of umbilical artery <7.10 and the neonatal need for resuscitation type III-V. Multivariate analysis was used to control confounding variables. RESULTS: The incidence of induced labour was 22.6 % (862). The highest indication was premature rupture of membranes for more than 12 h 22.8 % (190), poorly controlled diabetes 22.6 % (189) and oligoamnios 16.2 % (135). The rate of pH lower than 7.10 was 2.8 % (22), the rate of the Apgar score lower than 7 after 5 min was 0.2 % (2) and the neonatal need for resuscitation type III-IV was 5.7 % (48) for induced labour. The relation between induced labour and neonatal morbidity indicators were not statistically significant. 10.1 % (4) of induced labour for suspected intrauterine growth restriction and 8.6 % (10) of postterm pregnancies required neonatal resuscitation type III-IV. DISCUSSION: No relation was found between induced labour and the neonatal morbidity indicators. The highest neonatal risk indicator is when a intrauterine growth restriction, hypertensión/preeclampsia or a postterm pregnancy is suspected.

Diferencias en el número de cesáreas en los partos que comienzan espontáneamente y en los inducidos / Differences in cesarean sections between spontaneous and induced labour

Fundamentos: La inducción del parto (IDP) puede estar asociada a mayores complicaciones para la mujer gestante. El objetivo de este trabajo fue determinar las diferencias en el número de cesáreas entre partos espontáneos y partos inducidos. Métodos: Cohortes históricas sobre un total de 841 inducciones y 2.534 partos espontáneos realizados entre 2009 y 2011 en el Hospital "Mancha-Centro" de Alcázar de San Juan. Se empleó análisis multivariante por medio de regresión logística binaria para control de la confusión. Resultados: La prevalencia de IDP fue del 22,9%, presentándose como indicaciones más frecuentes la rotura prematura de membranas (RPM) de más de 12 horas (22,7%) y diabetes mellitus mal controlada con un 22,5%. Se observó relación entre inducción y riesgo de cesárea tanto en mujeres nulíparas (OR= 2,68; Intervalo de confianza [IC] 95%: 2,15-3,34) como en multíparas (OR=2,10; [IC] 95%:1,72-2,57). La indicación con mayor riesgo de cesárea fue la gestación cronológicamente prolongada (GCP) (37,1%) seguida del registro cardiotográfico (RCTG) patológico (35,3%) y estados hipertensivos del embarazo (EHE) (4,0%). La IDP también se relacionó con la mayor duración de la dilatación (OR=6,00; IC 95%:4,02-8,95), empleo de epidural (OR=3,10;IC95%: 2,24-4,29) y necesidades de transfusión sanguínea (OR=3,33; IC %:1,70-5,67). Conclusiones: La IDP es un factor de riesgo para una mayor duración de la dilatación, empleo de analgesia epidural, necesidad de transfusión sanguínea y de cesárea tanto en mujeres nulíparas como en multíparas, especialmente en las indicaciones de gestación cronológicamente prolongada, registro cardiotocográfico patológico y estados hipertensivos del embarazo. No se encontró relación con la duración del período expulsivo, la práctica de episiotomía, desgarros, sangrado excesivo y rotura uterina (AU)

Background: The induction of labour (IOL) may be associated with complications for pregnant women. The aim was to assess the differences in the number of caesarean sections between spontaneous or induced labour. Methods: Historical groups from 841 women with induced labour and 2,534 women with an spontaneous onset of labour over a three- year period (from 2009 to 2011). They were carried out in "Mancha Centro" Hospital (Alcázar de San Juan). It was used a multivariate analysis through binary logistic regression to control confounding variables. Results: The prevalence of IOL was 22,9%. The most frequent indi- cations were: Premature Rupture of Membranes (22,7%), bad- controlled Diabetes (22,5%). It was reported a relation between induced labour and cesarean section risk due to parity (nulliparous OR= 2.68, IC 95%: 2.15- 3.34 and multiparous OR= 2.10, IC 95%: 1.72- 2.57). Postterm pregnancy (37,1%), pathological monitor (35.3%) and hypertensive diseases of preg- nancy (34%) reported the highest risks of cesarean section. The IOL was related to other factors: a long- time length first -stage of labour (OR= 6.00; IC 95%: 4.02- 8.95), use of epidural analgesia (OR= 3.10; IC 95%: 2.24- 4.29) and blood transfusion needs (OR= 3.33; IC 95%: 1.70- 9.67). Conclusion: Independently of parity, The IOL increases the risk to: have a longer duration first- stage, use epidural analgesia, need a blood transfusion and have a cesarean section. This relation is stronger when induction is due to postterm pregnancy, pathological monitor or hyperten- sive diseases. No relation was found among induced labour and second- duration, episiotomy, perineal tears, excessive blood loss or uterine rupture (AU)

[Variability in the rate of episiotomies and its relation to severe perineal tears and neonatal morbility]. / Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal.

OBJECTIVE: To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity. METHOD: A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity. RESULTS: The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery<7.10, Apgar score after 5 min<7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears. DISCUSSION: The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.

Efectividad del doble test bioquímico como prueba de cribado de síndrome de Down en el segundo trimestre / Effectiveness of the double test in screening for Down syndrome in the second trimester of pregnancy

Para determinar la población de riesgo de síndrome de Down a la que debe recomendarse realizar una te ́cnica invasiva para obtener un cariotipo fetal existen varias pruebas de cribado. En nuestro centro se realiza con el cribado del primer trimestre (edad materna + - translucencia nucal +b-HCG + PAPP-A). Cuando éste no es posible, se realiza el doble test (AFP+b- HCG) como cribado de segundo trimestre. Los resultados del doble test en nuestro centro son insatisfactorios ya que tenemos una tasa de detección del 0%, con una tasa de falsos positivos del 7,7%. Por ello consideramos que es necesaria la utilización de otros criterios alternativos para la selección de las mujeres de riesgo de síndrome de Down en el segundo trimestre (AU)

Several screening tests are available to identify the population at risk of Down syndrome. This population should then be recommended to undergo an invasive technique to obtain a fetal karyotype. In our hospital, screening is done by the combined test (maternal age + nuchal translucency + b subunit of human chorionic gonadotropin [b-HCG] + pregnancy- associated plasma-A [PAPP-A]) during the first trimester of pregnancy. When this test is not feasible, we request the double test (alpha-fetoprotein [AFP] + b-HCG) as a second trimester screening test. The results of the double test in our hospital were unsatisfactory because the detection rate was 0% with a false positive rate of 7.7%. Therefore, we believe alternative criteria should be used to select women at risk of having a child with Down syndrome in the second trimester (AU)

Cirugía laparoscópica con puerto único: ampliación del espectro de utilización / Single port laparoscopic surgery: Widening the spectrum of use

No disponible

Agenesia lumbosacra. Expresión del síndrome de regresión caudal / Lumbosacral agenesis. Caudal regression syndrome expresión

La agenesia lumbosacra es una malformación congénita muy infrecuente que forma parte del síndrome de regresión caudal. Presentamos un caso diagnosticado como agenesia lumbosacra en nuestra consulta de diagnóstico prenatal durante el segundo trimestre de gestación. No se presentaron malformaciones asociadas, el cariotipo fetal fue normal y la gestante carecía de antecedentes de interés. La pareja se acogió al derecho de interrupción legal del embarazo (AU)

Lumbosacral agenesis is an uncommon condition which is part of the caudal regression syndrome. We report a case de lumbosacral agenesis detected by ultrasound in the second trimester of gestation. The fetus was not presenting other malformations. The fetal karyotype was normal and the pregnant woman did not have precedents of interest. The parents decide to abort (AU)

Validez de la histeroscopiay de la biopsia endometrial en el diagnóstico diferencial de las hiperplasias / Validity of hysteroscopy and endometrial biopsy in the differential diagnosis of endometrial hyperplasias

Objetivo: Analizar la validez de la aplicación de la histeroscopia y de la biopsia endometrial en el diagnóstico diferencial entre el grupo de hiperplasias de endometrio sin atipias y el grupo de hiperplasias que presentó atipias en nuestro medio.Pacientes y métodos: Estudio descriptivo transversal que analiza los casos diagnosticados como hiperplasia de endometrio por histología en nuestra unidad de histeroscopia entre los años 2000 y 2007. Comprende 121 hiperplasias de un total de 4.808 histeroscopias realizadas.Resultados: La sensibilidad y la especificidadde la biopsia endometrial para el diagnóstico histológico definitivo en los casos de cirugíafueron del 72 y el 83%.La sensibilidad y la especificidad de la correlación entre el diagnóstico histeroscópico y el grupo de hiperplasia diagnosticado por biopsia endometrial fueron del 45,8 y del 95,8%. La sensibilidad aumentó hasta el 59% cuando consideramos la histología de la pieza quirúrgica.Conclusiones: La histeroscopia, como método aislado, presenta una moderada sensibilidad y una muy alta especificidad en el diagnóstico de las hiperplasias con atipias. La biopsia endometrial dirigida, como prueba diagnóstica, tiene mayor sensibilidad pero menor especificidad que la histeroscopia para el diagnóstico diferencial entre los dos grupos de hiperplasia considerados (AU)

Objective: To evaluate the usefulness of hysteroscopy and endometrial biopsy in the differential diagnosis of atypical endometrial hyperplasia and endometrial hyperplasia without atypias.Patients and methods: Descriptive cross-sectional study that analyses the cases of endometrial hyperplasia diagnosed in our Hysteroscopic Unit between the years 2000 and 2007. The study includes 121 hyperplasias out of 4808 hysteroscopies performed.Results: The sensitivity and specificity of the endometrial biopsy for the definitive histological lesiodiagnosiswas 72% and 83% in the surgery cases.The sensitivity and specificity of the correlation between the hysteroscopic diagnosis and the group of hyperplasia diagnosed by endometrial biopsy was 45.8% and 95.8%. The sensitivity increased to 59% when we take into account the histology of the surgical specimen.Conclusions: Hysteroscopy, as an isolated method of diagnosis, has a moderate sensitivity and high specificity in the diagnosis of atypical endometrial hyperplasia. The endometrial biopsy has higher sensitivity but lower specificity than hysteroscopy in the diagnosis of atypical endometrial hyperplasia (AU)