Incidence of obstetric anal sphincter injuries according to the type of forceps used in the Mexican population.

OBJECTIVE: This study describes the frequency of obstetric anal sphincter injuries (OASIS) in patients after instrumental delivery according to the type of forceps used. METHODS: A retrospective comparative cohort study was conducted on patients who underwent instrumental delivery from January 2017 to April 2022. The primary outcome was the presence of OASIS following delivery. Patients were categorized into Cohort A if only rotation forceps were used, Cohort B for only traction forceps, and Cohort C if both types were used sequentially. Statistical analysis was performed with SPSS (IBM, New York, NY) with χ2, Fisher's exact, and analysis of variance testing. A P-value <0.05 was considered significant. RESULTS: OASIS occurred in 45 of 328 instrumental deliveries. OASIS after rotation forceps occurred in 12.9% (n = 8) of cases, after traction forceps in 13.2% (n = 34), and after sequential use of rotation and traction forceps in 37.5% (n = 3) of cases (p = 0.141). An odds ratio (OR) of 0.91 (95% confidence interval [CI] 0.40-2.08) for OASIS was obtained with the use of rotation forceps, 0.81 (95% CI 0.38-1.70) for traction forceps, and 3.97 (95% CI 0.91-17.2) for the sequential use of rotation and traction forceps. CONCLUSION: There were no significant differences in the presence of OASIS comparing traction and rotation forceps. A non-significant trend of higher OASIS following the sequential use of traction and rotation forceps was observed.

Clitoromegalia: quiste epidermoide de clítoris / Clitoromegaly: epidermal cyst of clitoris

Objetivo: Describir un caso de clitoromegalia en una mujer perimenopáusica. Lugar: Centro de Tercer Nivel de Atención. Intervenciones: Resonancia magnética, ultrasonido pélvico, marcadores tumorales, clitoroplastia con resección quirúrgica de quiste epidermoide. Resultados: Clitoroplastia más resección de tumor epidermoide con preservación de la anatomía y sensibilidad. Conclusión: Paciente femenina de 52 años, sin antecedentes de trauma pélvico, quien desarrolló un caso inusual de clitoromegalia sin dolor u otros síntomas, además de un notorio crecimiento tumoral en los últimos cuatro años en el cual la malignidad fue descartada. Hay pocos casos de quistes epidermoides en ausencia de trauma o mutilación de genitales reportados en la literatura; generalmente son solitarios, de crecimiento lento y asintomáticos, localizados usualmente en la piel, el cuello o el tronco del clítoris. El procedimiento realizado fue una clitoroplastia con resección del quiste epidermoide, en el cual se ha preservado tanto la anatomía como la sensibilidad sin complicaciones después de seis meses de seguimiento.

Objective: Describe a case of clitoromegaly in a perimenopausal female. Setting: Third Level Attention Center. Interventions: Magnetic resonance imaging, pelvic ultrasound, tumoral markers, clitoroplasty with surgical extirpation of epidermal cyst. Results: Clitoroplasty with surgical extirpation of epidermal cyst and preservation of the anatomy and sensitivity. Conclusions: A 52 years old female patient without history of pelvic trauma who developed an unusual case of clitoromegaly without pain nor any symptoms besides notorius tumor growing over past four years in which malignancy was discarded. There are very few epidermal cyst cases in the absence of trauma or genitalia mutilation reported in literature; they are usually solitary tumors, with slow growing and asymptomatic. Usually localized in clitoral scalp, neck or trunk. The performed procedure was a clitoroplasty with extirpation of an epidermal cyst, where has been well preserved the anatomy and sensitivity, without any complication after six months follow up.

[Asynchronous birth in twin pregnancy. Literature review and case report]. / Nacimiento asincrónico en embarazo gemelar. Revisión de la bibliografia y reporte de un caso.

BACKGROUND: The incidence of multiple pregnancy has grown, some of these cases are attributed to assisted reproduction techniques, with the consequent increase of maternal-fetal morbidity. There have been few reported cases of delayed interval delivery with different perinatal outcomes. This is a case report of a double twin pregnancy with delayed delivery of the second fetus after birth of the first one within 15.5 weeks of pregnancy, and the second one birth at 38.4 weeks, 158 days after the first one. Reported diagnosis, treatment and perinatal outcomes. CONCLUSIONS: The mean reported time to extend the pregnancy after the evacuation of the first one is 7 to 153 days. In this case the pregnancy was held 158 days, more than in the rest of the reported cases, maybe due to gestational delivery age of the first fetus (15.5 weeks) compared to fetuses of 20 to 28 weeks reported in the literature. The approach of these specific cases must be individualized. There have been no trials enough so we can't know with certainty which treatment is the best of all.