ABSTRACT
Resumen OBJETIVO: dar a conocer a los ginecoobstetras un documento donde pueda consultarse, a la luz de los estudios más recientes y con la mejor evidencia en la fisiopatología, prevalencia y significado clínico de los miomas uterinos, así como la mejor evidencia posible acerca de las diversas modalidades de tratamiento. METDOLOGÍA: estudio retrospectivo efectuado por los miembros del Comité de expertos de la Asociación Mexicana de Medicina de la Reproducción, empleando los artículos publicados entre los años 2000 a 2016 en Pubmed y que en el resumen contuvieran los MeSH: leiomyomatosis uterus, leiomyoma, leiomyomatosis uterine, leiomyomatosis uterine in pregnancy. La calidad de la evidencia y la formulación de las recomendaciones se realizaron con la metodología establecida por el sistema GRADE. RESULTADOS: se incluyeron 97 artículos en los que se encontró que la prevalencia en mujeres en edad reproductiva es variable, según la edad (20 a 80%). En la mayoría el diagnóstico se establece entre los 35 y 54 años. Para el tratamiento existen varias opciones con distintos porcentajes de eficacia. CONCLUSIONES: queda de manifiesto la evidencia de la eficacia de varios medicamentos indicados para el control de los síntomas y para mejorar la calidad de vida de las pacientes. En la comparación entre acetato de leuprolide y acetato de ulipristal no se encontraron que originaran síntomas vasomotores, ni disminuyeran la masa ósea. En relación con el último se vislumbra la posibilidad de evitar la cirugía, aunque aún se requiere más investigación a este respecto.
Abstract OBJECTIVE: To make known to the gynecological obstetricians a document where they can be consulted, in the light of the most recent studies and with the best evidence on the pathophysiology, prevalence and clinical significance of uterine fibroids, as well as the best possible evidence about the various treatment modalities. METDOLOGY: A retrospective study carried out by the members of the Committee of experts of the Mexican Association of Reproductive Medicine, using the articles published between 2000 and 2016 in Pubmed and that in the abstract contained MeSH: leiomyomatosis uterus, leiomyoma, Leiomyomatosis uterine, leiomyomatosis uterine in pregnancy. The quality of the evidence and the formulation of the recommendations were made using the methodology established by the GRADE system. RESULTS: 97 articles were included in which the prevalence was found to be variable, according to age (20 to 80%) in women of reproductive age. In most, the diagnosis is established between 35 and 54 years. There are several treatment options with different percentages of effectiveness. CONCLUSIONS: Evidence of the efficacy of several medications indicated for the control of symptoms and to improve the quality of life of the patients is evident. In the comparison between leuprolide acetate and ulipristal acetate, they were not found to cause vasomotor symptoms or to decrease bone mass. Regarding the latter, the possibility of avoiding surgery is envisaged, although more research is still needed in this regard.
ABSTRACT
During one year, 104 term products were in fetal presentation. Cesarean was done in 75%, and most frequent indications were, deflexionated head (24.2%); previous section 24.2%; head hyperextension 12.8%. Section was done only in 14.4% of product with the requisites for vaginal delivery. There were two neonate al deaths among the ones by vaginal via; one due to major congenital malformations. Corrected neonatal mortality was 34.4 for 1000 alive products. Severe perinatal asphyxia was in 0.76% in vaginal birth and in 0.38% of cesarean products; and difference was not statistically significant. Maternal morbidity was 20.3% in cesarean and 0% for vaginal delivery. In the cases with pelvic presentation, well selected for vaginal delivery, fetal morbidity was not significantly increased, and maternal morbidity decreases importantly. In selected patients and with well trained physicians for this purpose, vaginal delivery is a good option.
Subject(s)
Breech Presentation , Cesarean Section , Decision Making , Female , Humans , Infant, Newborn , PregnancyABSTRACT
Post-cesarean-section endometritis therapy usually combines an intravenous administered antibiotic followed, once fever has remitted, by an oral or intramuscular course of 7-10 days of the same antibiotic. From November 1993 to May 1994 and trying to reduce the length of the treatment we conducted a randomized, comparative study between the conventional post-C-section endometritis treatment used at the Hospital Central Militar (long course) and a short parenteral treatment with the same antibiotics. Thirty one patients were randomized in the short course group and 32 in the long course group. Only in the long course group there was a patient with persistence of infection after ten days of antibiotic treatment (p > 0.05). The short course regimen brought additional advantages as reduction in treatment days as well as discomfort for the intramuscular administration of antibiotics. This observation suggests that a short course of antibiotics based on the patient's clinical response is a safe and less expensive alternative in the treatment of post-C-section endometritis.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cesarean Section/adverse effects , Endometritis/drug therapy , Administration, Oral , Adult , Drug Administration Schedule , Endometritis/etiology , Female , Humans , Injections, Intramuscular , Postoperative Complications/drug therapy , Pregnancy , Retrospective Studies , Time FactorsABSTRACT
Male sexual differentiation in based upon at least two factors; testosterone and the müllerian inhibitor factor. The absence of the latter produces a rare form of male pseudohermaphroditism, the persistence of the Müllerian duct syndrome. The case of a phenotypically male patient in whom surgery to correct bilateral cryptorchidism was performed is presented. The operatory findings included the presence of uterus and fallopian tubes which were removed. The right atrophic tes was removed and the left was fixated. Literature regarding etiology, clinical presentation, diagnosis and treatment is presented.
