ABSTRACT
OBJECTIVES: Vaginal and endocervical infections are considered a global health problem, especially after recent evidence of their association with preterm delivery and other adverse obstetric outcomes. Still, there is no consensus on the efficacy of a screening strategy for these infections in the first trimester of pregnancy. This study evaluated their prevalence and whether screening and treatment resulted as effective in reducing pregnancy and perinatal complications. METHODS: A single-center prospective observational study was designed; a sample size of 400 first-trimester pregnant women was established and they were recruited between March 2016-October 2019 at the Puerta de Hierro University Hospital (Spain). They were screened for vaginal and endocervical infections and treated in case of abnormal flora. Pregnancy and delivery outcomes were compared between abnormal and normal flora groups by univariate analysis. RESULTS: 109 patients had an abnormal flora result (27.2%). The most frequently detected infection was Ureaplasma urealyticum (12.3%), followed by Candida spp. (11.8%), bacterial vaginosis (5%), Mycoplasma hominis (1.2%) and Trichomonas vaginalis (0.8%). Patients with abnormal flora had a 5-fold increased risk of preterm premature rupture of membranes (5.3% vs. 1.1% of patients with normal flora, Odds Ratio 5.11, 95% Confidence Interval 1.20-21.71, p = 0.028). No significant differences were observed regarding preterm delivery or neonatal morbidity. CONCLUSIONS: Considering the morbimortality related to prematurity and that the results of our study suggest that the early treatment of abnormal flora could improve perinatal outcomes, the implementation of a screening program during the first trimester should be considered.
ABSTRACT
Objective: To assess the incidence of cervical stenosis in women treated with conization and to identify risk factors for its occurrence. To determine the rate of medical and surgical complications due to conization. Methods: We performed a retrospective study of 113 women who underwent conization over a 1-year period at Hospital Universitario Puerta de Hierro Majadahonda in order to evaluate the frequency of and factors involved in cervical stenosis. Cervical stenosis was defined as a narrowing that prevented the insertion of a 3-mm endocervical curette through the endocervical canal. Univariate analysis was used to identify predictors of cervical stenosis. Statistical significance was set at 0.05. Results: A total of 14 patients were diagnosed with cervical stenosis (12.4%). The risk of cervical stenosis was greater when conization was performed in menopausal women (p = 0.047), when it was performed with laser excision (p = 0.046), when the height of the cone was ≥ 20 mm (p = 0.013), and when the ectocervical margins of the cone were affected by dysplasia after conization (p = 0.038). The variables age, previous treatment of cervical intraepithelial neoplasia (CIN), smoking, parity, human papillomavirus, histologic classification of CIN, postoperative bleeding, and second conization were not associated with an increased risk of cervical stenosis. Conclusions: The main risk factors for cervical stenosis were menopausal status, laser excision, cone height ≥ 20 mm, and involvement of exocervical surgical margins
Objetivo: Evaluar la incidencia de estenosis cervical en mujeres tratadas mediante conización e identificar factores de riesgo en su desarrollo. Determinar la tasa de complicaciones médico-quirúrgicas derivadas de la conización. Material y métodos: Estudio retrospectivo en el que se revisó una cohorte de 113 pacientes a las que se había realizado una conización a lo largo del año anterior en el Hospital Universitario Puerta de Hierro Majadahonda para evaluar la frecuencia y factores implicados en la estenosis cervical. La estenosis cervical se definió como el estrechamiento cervical que impide el paso de una microlegra endocervical de 3 mm de diámetro a través del canal endocervical. Se utilizó un análisis univariante para identificar factores predictores de estenosis. El nivel de significación se fijó en 0,05. Resultados: Se diagnosticaron 14 casos de estenosis cervical (12.4%). El riesgo de estenosis cervical fue mayor cuando la conización se realizó en mujeres menopaúsicas (P = 0,047), cuando se realizó conización con láser (P = 0,046), cuando la altura del cono fue ≥ 20 mm (P = 0,013) y cuando los márgenes exocervicales quedaron afectos tras las conización (P=0.038). Las variables edad, tratamiento previo de neoplasia intraepitelial cervical (CIN), tabaquismo, paridad, virus del papiloma humano (VPH), clasificación histológica de CIN, sangrado postoperatorio y reconización no demostraron aumentar el riesgo de estenosis cervical. Conclusiones: Las variables estado menopáusico, láser, altura del cono ≥ 20 mm y la afectación del margen exocervical fueron los principales factores de riesgo para la estenosis cervical
