Días de gestación ganados con diferentes técnicas de cerclaje en pacientes con insuficiencia cervical / Gestational days gained with different cerclage techniques in patients with cervical incompetence

Resumen OBJETIVO: Reportar la experiencia en la práctica de cerclajes con indicación profiláctica y terapéutica en pacientes con embarazo único o múltiple, con insuficiencia cervical. Además, informar los días de gestación ganados y comparar las técnicas quirúrgicas con los cerclajes. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo, comparativo y transversal efectuado entre enero de 2011 y enero de 2018. Criterios de inclusión: pacientes a quienes se efectuó un cerclaje y el embarazo finalizó en nuestra unidad. Variables de estudio: edad, IMC, embarazos, abortos, días de gestación ganados, días en que se efectuó el procedimiento quirúrgico, semanas de gestación cumplidas a la finalización del embarazo, tiempo quirúrgico, medicamentos (tocolíticos y antibióticos), complicaciones a partir del cerclaje hasta la finalización del embarazo. Para el análisis descriptivo se utilizó el paquete estadístico IBM SPSS (versión 22); la distribución se obtuvo con t de Student, se aplicó la prueba de normalidad Shapiro-Wilk y las variables con distribución normal se analizaron, comparativamente, con ANOVA y las de distribución anormal con la prueba Kruskal-Wallis. RESULTADOS: Se analizaron 37 casos en los que el cerclaje prolongó 116.14 ± 47.4 días la gestación, con finalización promedio del embarazo a los 246.41 ± 26.54 días. El cerclaje Shirodkar fue superior: prolongó la gestación 134.69 días con finalización del embarazo a las 36 ± 2 semanas. CONCLUSIONES: En pacientes con insuficiencia cervical el cerclaje es una opción para prolongar el embarazo. La técnica Shirodkar tuvo márgenes de mayor seguridad hasta la finalización del embarazo (más de 34 semanas). El comportamiento en embarazos múltiples es similar, por lo que en caso de insuficiencia cervical debe aplicarse.

Abstract OBJECTIVE: To report the experience in the practice of cerclages with prophylactic and therapeutic indication in patients with single or multiple pregnancy, with cervical incompetence. In addition, report the days of pregnancy gained, compare surgical techniques and cerclages in single and multiple gestations. MATERIALS AND METHODS: Retrospective, descriptive, comparative and cross-sectional study carried out between January 2011 and January 2018. Inclusion criteria: patients who had a cerclage and the pregnancy ended in our unit. Study variables: age, BMI, pregnancies, abortions, days of gestation earned, days in which they were placed, weeks of gestation completed at the end of pregnancy, surgical time, medications (tocolytics and antibiotics), complications from the placement of the cerclage until the end of pregnancy. For the descriptive analysis the statistical package IBM SPSS (version 22) was used; the distribution was obtained with Student's t test, the Shapiro-Wilk normality test was applied and the variables with normal distribution were analyzed, comparatively, with ANOVA and those with abnormal distribution with the Kruskal-Wallis test. RESULTS: 37 cases were analyzed in which the placement of cerclage prolonged 116.14 ± 47.4 days gestation, with an average termination of pregnancy at 246.41 ± 26.54 days. The Shirodkar cerclage was superior: it extended gestation 134.69 days with the end of pregnancy at 36 ± 2 weeks. CONCLUSIONS: In patients with cervical incompetence cerclages are an option to prolong pregnancy. The Shirodkar technique had higher safety margins until the end of pregnancy (more than 34 weeks). The behavior in multiple pregnancies is similar, so in case of cervical incompetence should be applied.

[Patients with inherited trombophilia and recurrent pregnancy loss: incidence]. / Pacientes con trombofilias hereditarias y pérdida gestacional recurrente: incidencia.

BACKGROUND: Inherited thrombophilia is a genetic tendency to suffer thrombotic events clinically evident at an early age, with frequent re- currences without apparent cause. In recent years thrombophilia has earned a place as a primary risk factor for abnormal pregnancy. OBJECTIVE: To determine the incidence of hereditary thrombophilia in patients with recurrent pregnancy loss. MATERIAL AND METHOD: A retrospective, linear and descriptive study was conducted at Clinic of Reproduction IMMUNOREP with patients treated from January 2007 to December 2012. The study included patients with a diagnosis of recurrent pregnancy loss and inherited thrombophilia with laboratory studies of thrombophilia including different genes: G1619A (factor V Leiden), R2 H1299R (factor V polymorphism), C677T (methylenetetrahydrofolate reductase enzyme polymorphism), A1298C (methylenetetrahydrofolate reductase enzyme mutation), G20210A (mutation of the prothrombin gene), V34L (factor XIII polymorphism), 455G > A (fibrinogen gene mutation), 4G/5G (plasminogen activator inhibitor) and a/b L33P (ribosomal polymorphism of methylenetetrahydrofolate reductase enzyme). RESULTS: 211 files were reviewed and only 10.4% of patients were negative for hereditary thrombophilia, a percentage that is consistent with the results of different series of studies in patients with unexplained recurrent pregnancy loss. The most prevalent genetic condition was 4G/5G (plasminogen activator inhibitor, 85.5%) in homozygous and heterozygous with 63.4% (120) and 22.4% (42), respectively. CONCLUSIONS: It was demonstrated the direct relationship between thrombophilia and recurrent pregnancy loss depending on whether the patient is heterozygous or homozygous for the disease.

Pregnancy and birth after assisted reproduction.

Pregnancy and birth after IVF has attracted much critical attention. Overall, pregnancy rates are about 30-40% with three transferred embryos. Abortion rates are high before 19 weeks of gestation, at 8% of established pregnancies, and ectopic pregnancies are regular occurrences. Pregnancy rates are highest (35%) in women aged 20-24 years, declining to 10% at and above age 40. The use of intracytoplasmic sperm injection (ICSI) and blastocyst transfer has transformed the establishment of pregnancies for couples with differing indications. High rates of implantation are achieved with blastocyst transfers, although many embryos die in vitro before this stage. Twins and triplets can result in up to 50% of pregnancies. Heterotopic pregnancies are rare. Abortion afflicts fetuses before 12 weeks (vanishing fetuses). Rates of spontaneous abortion can be as high as 50% with quadruplets and quintuplets, and may be even higher in cases of fetal aneuploidy. At birth, prematurity is high, especially with twins or higher multiple pregnancies. Fetal reduction is used to reduce multiple pregnancies for singletons. Ovarian hyperstimulation is a risk associated with multiple pregnancy.

[Embryonic quality in the use of urofolitropin vs recombinant FSH for in vitro fertilization]. / Calidad embrionaria en la utilización de urofolitropina vs FSH recombinante para fertilización in vitro.

There were no differences in both groups as tho the age of the patients; received doses of both types of FSH, nor HMG; but there was as to the amount of captured ovocytes, amount, and quality, embrionary, in special 1+ 2+ in favor of the group that received urofolitropine, specially under 35 years of age. In this study there was better qualy and amount, embrionary, obtained with the use of urofolitropine, as compared with FSH recombinant for in vitro fertilization.

[Comparison of 2 artificial insemination technics. (Sperm tubal perfusion and intrauterine insemination)]. / Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina).

In 1991 Kahn et al, described a method of intrauterine Insemination called Fallopian Tube Sperm Perfusion (FSP) using 4.0 ml for the insemination volume, unlike the classic Intrauterine Insemination (IIU) in which insemination volume is 0.5 ml. The aim of this study is to compare pregnancy rate per cycle in both technics. Between August 1993 and January 1994, 60 couples with infertility were studied, 131 ovarian stimulation cycles were done, 95 with IIU and 36 with PTE. 18 clinical pregnancies occurred, 11 with IIU and 7 with PTE, for a pregnancy rate per cycle of 11.5% for IIU and 19.4% for PTE. This result confirms the reports by Kahn. PTE represents a new possibility for the treatment of different etiology infertility.

Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina) / Comparison of two artificial insemination techniques-Sperm tubal perfusion and intrauterine insemination

En 1991 Kahn y col. describieron un método de inseminación intrauterina llamado Perfusión Tubárica de Esperma (PTE) utilizando un volumen inseminado de 4.0 ml, a diferencia de la Inseminación Intrauterina (IIU) clásica en la que el volumen inseminado es de 0.5 ml. El objetivo del estudio es comparar la tasa de embarazos de ambas técnicas. Durante un período comprendido entre agosto de 1993 a enero de 1994 se atendieron 60 pacientes con infertilidad se realizaron 131 ciclos de inducción de ovulación e inseminación intrauterina, 95 fueron con IIU y 36 con PTE. Se obtuvieron 18 embarazos clínicos, 11 con IIU y 7 con PTE, representando una tasa de éxito de 11.5 por ciento para la primera y de 19.4 por ciento para la segunda técnica. Estos resultados confirman los obtenidos por Kahn. La PTE representa una nueva posibilidad para el tratamiento de la infertilidad de diversas etiologías

[Retroperitoneal teratoma associated with primary neoplasm of the ovary. Presentation of a case]. / Teratoma retroperitoneal asociado a primario de ovario. Presentación de un caso.

The retroperitoneal teratomas are rare neoplasias that represent only 3.5% of all extragonadal teratomas. They generally appear in the first decade of life, and the incidence in adults is rare. We describe a rare case of extragodonal teratoma, not only because the patient is in the 7th decade of life, but also because of the localization and association of two epithelial cellular tumors of the ovary. We also describe the surgical and histopathological findings as well as an analysis of the frequence, clinical characteristics, diagnosis and treatment for this neoplasia.

[Comparative study of the human basophil degranulation test and total and specific IgE levels in schistosomiasis. 54 cases]. / Etude comparative du test dégranulation des basophiles humains et du dosage des IGE totales et spécifiques dans les schistosomoses. 54 cas.

In 54 patients (45 Africans and 9 West-Indians) we searched schistosomiasis and the presence of immunoglobulins E by different tests (total immunoglobulin E levels, measurement of specific IgE, human basophil degranulation test). In patients with an excretion of living eggs we observed 91.6% of positive responses for the II. B. D. T. and 100% for the specific IgE. In cases only identified by examination of rectal mucosa biopsy specimens showing apparently living eggs, we observed 75% and 87.5% of positive responses for the same tests. But in both categories of patients, the parasitological examination is the most important. Moreover the authors observed "false-positive" and "false negative" tests compared with the parasitological results and between the tests. It suggests that the best use of these is in case of very probable schistosomiasis without positive parasitological results.