Use of Contraceptive Methods Among Women in the General Population and Female Gynecologists in Spain: the ELEGIAN Survey.

Background: The contraceptive preferences of obstetricians and gynecologists (OB/GYNs) are thought to influence the contraceptive counseling they provide. The purpose of this study was to assess contraceptive preferences of OB/GYNs and women in the general population (WGP) in the current Spanish contraceptive scenario. Materials and Methods: Anonymous online survey of 100 OB/GYNs and 1,217 WGP aged 23-49 years. Results: WGP were younger (35.3 ± 7.3 vs. 37.9 ± 6.2 years, respectively) and less likely to have stable partners (64.7% vs. 84.0%) and children (49.1% vs. 62.0%) (all p < 0.05 vs. OB/GYNs). Seventy-nine percent versus 82%, respectively, used contraceptive methods, with condoms used most frequently by WGP (37% vs. 22% by OB/GYNs; p < 0.05) and pills by OB/GYNs (26% vs. 21% by WGP; p > 0.05). Intrauterine devices (IUDs) were more frequently used by OB/GYNs (20% vs. 5%; p < 0.05), especially the levonorgestrel-releasing intrauterine devices (LNG-IUDs) (18% vs. 2.6%; p < 0.05). The highest-rated methods were condoms among WGP and LNG-IUDs among OB/GYNs. Effectiveness was the most valued attribute of contraceptive methods for both. Reasons related to convenience were the main reason for choosing IUDs. OB/GYNs prescribed the contraceptive method in 40% of cases. Conclusions: Our study reveals differences between female OB/GYNs and WGP in contraceptive methods use and rating. The use of LNG-IUDs was much higher among OB/GYNs.

The Effect of Virtual Reality on the Reduction of Pain in Women with an Indication for Outpatient Diagnostic Hysteroscopy: A Randomized Controlled Trial.

Background: The cognitive distraction caused by Virtual Reality (VR) seems to cause a decrease both in pain and its perception as in the time spent thinking about possible pain, among anxiety about hysteroscopy procedure. The main objective of this investigation was to evaluate the efficacy of virtual reality for pain relief during outpatient hysteroscopy. Method: A total of 83 patients underwent outpatient diagnostic hysteroscopy in a single-centre, open-label, randomized control trial. Overall, 180 women with medical indication for an outpatient diagnostic hysteroscopy were randomized. Ten were excluded due to the impossibility of entering the endometrial cavity caused by a cervical canal that was not permeable, and 15 did not tolerate the pain at the beginning and during the procedure, excluding themselves from the final model. Finally, 154 were analysed per protocol to use VR (n = 82, study group) or standard treatment (n = 72, control group) assessing the differences between both groups by reduction in pain using Visual Analogue Scale score (VAS: 0-10 cm) and clinical data (arterial pressure, heart rate, and oxygen saturation) at the end of hysteroscopy, at 15 and 30 min after hysteroscopy. Results: Women with VR outpatient diagnostic hysteroscopy experienced less pain at final (VAS score 2.451 vs. 3.972, standard mean difference (SMD) -1.521, 95% CI -2.601 to -0.440; p = 0.006), at 15 min (VAS 1.769 vs. 3.300, SMD -1.531, 95% CI -2.557 to -0.504; p = 0.004), and at 30 min (VAS 1.621 vs. 2.719, SMD -1.099, 95% CI -2.166 to -0.031; p = 0.044) after the ending of the hysteroscopy, compared with no VR. Conclusions: The use of VR during outpatient diagnostic hysteroscopy proved effective in the reduction of pain in this randomized control trial. It shows wide potential role in ambulatory gynaecologic procedures to avoid repeating tests, perform surgeries without anaesthesia, and the use of medication and its side effects.

Personalized Sentinel Node Mapping in Endometrial Cancer by the Indocyanine Green Implementation as Single Tracer: A Case Control Study.

The main objective was to analyze the rate of bilateral sentinel lymph node (SLN) detection in endometrial cancer using indocyanine green (ICG) as a unique tracer compared to Technetium99 + ICG. As secondary objectives, we analyzed the drainage pattern and factors that might affect the oncological outcomes. A case-control ambispective study was carried out on consecutive patients at our center. Data on the SLN biopsy with ICG collected prospectively were compared to retrospective data on the use of a double-tracer technique including Technetium99 + ICG. In total, 194 patients were enrolled and assigned to both groups, in which the group with both tracers (controls) included 107 (54.9%) patients and the ICG-alone group (cases) included 87 (45.1%) patients. The rate of bilateral drainage was significantly higher in the ICG group (98.9% vs. 89.7%; p = 0.013). The median number of nodes retrieved was higher in the control group (three vs. two nodes; p < 0.01). We did not find survival differences associated with the tracer used (p = 0.85). We showed significant differences in terms of disease-free survival regarding the SLN location (p < 0.01), and obturator fossa retrieved nodes showed better prognosis compared to external iliac. The use of ICG as a single tracer for SLN detection in endometrial cancer patients seemed to obtain higher rates of bilateral detection with similar oncological outcomes.

Catastrophic antiphospholipid syndrome during pregnancy.

Catastrophic antiphospholipid syndrome (CAPS) is an uncommon and the most severe form of antiphospholipid syndrome (APS). A 33-week pregnant patient with Klippel-Trenaunay syndrome, past SARS-CoV-2 infection and type I fetal growth restriction with shortening of the fetal long bone was diagnosed in our center with a probable CAPS. Cesarean section was performed four days after the diagnosis due to the torpid evolution of the patient. Clinical improvement was noted a few days later and the mother and baby were discharged within a week. We review the current literature on CAPS during pregnancy and provide an updated view.

Prolapsed cervical myoma during pregnancy.

Prolapsed submucosal myomas during pregnancy are uncommon, and few cases of patients undergoing vaginal myomectomy during pregnancy have been reported. In our center, a 13 weeks pregnant patient with prolapsed cervical myoma was diagnosed. Because of intermittent vaginal bleeding, surgery was scheduled at 13 weeks and 5 days of pregnancy. A vaginal myomectomy was performed. The postoperative course was uneventful. Cervical leiomyomas and prolapsed submucosal leiomyomas in pregnancy are rare clinical entities, and the literature is comprised of only case reports. We reviewed the current literature in regard to prolapsed cervical leiomyomas in pregnancy and provide an updated vision of the literature.

Immunogenicity, transplacental transfer of pertussis antibodies and safety following pertussis immunization during pregnancy: Evidence from a randomized, placebo-controlled trial.

BACKGROUND: Pertussis immunization during pregnancy is recommended in many countries. Data from large randomized controlled trials are needed to assess the immunogenicity, reactogenicity and safety of this approach. METHODS: This phase IV, observer-blind, randomized, placebo-controlled, multicenter trial assessed immunogenicity, transplacental transfer of maternal pertussis antibodies, reactogenicity and safety of a reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap) during pregnancy. Women received Tdap or placebo at 27-36 weeks' gestation with crossover ≤ 72-hour-postpartum immunization. Immune responses were assessed before the pregnancy dose and 1 month after, and from the umbilical cord at delivery. Superiority (primary objective) was reached if the lower limits of the 95% confidence intervals (CIs) of the pertussis geometric mean concentration (GMC) ratios (Tdap/control) in cord blood were ≥ 1.5. Solicited and unsolicited adverse events (AEs) and pregnancy-/neonate-related AEs of interest were recorded. RESULTS: 687 pregnant women were vaccinated (Tdap: N = 341 control: N = 346). Superiority of the pertussis immune response (maternally transferred pertussis antibodies in cord blood) was demonstrated by the GMC ratios (Tdap/control): 16.1 (95% CI: 13.5-19.2) for anti-filamentous hemagglutinin, 20.7 (15.9-26.9) for anti-pertactin and 8.5 (7.0-10.2) for anti-pertussis toxoid. Rates of pregnancy-/neonate-related AEs of interest, solicited general and unsolicited AEs were similar between groups. None of the serious AEs reported throughout the study were considered related to maternal Tdap vaccination. CONCLUSIONS: Tdap vaccination during pregnancy resulted in high levels of pertussis antibodies in cord blood, was well tolerated and had an acceptable safety profile. This supports the recommendation of Tdap vaccination during pregnancy to prevent early-infant pertussis disease. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT02377349.

Effectiveness of nonhormonal products for the treatment of women with vaginal atrophy / Efectividad de productos no hormonales para el tratamiento de las mujeres con atrofia vaginal

Objective: To describe the clinical progress of women with vaginal atrophy who receive nonhormonal treatment. Material and methods: Single-center retrospective longitudinal observational descriptive study in postmenopausal women aged 45-60 years with symptoms of vaginal atrophy who required nonhormonal treatment. Results: We included 98 women with a mean (SD) age of 54.6 (3.2) years and a mean time of 5.6 (3.0) years without menstrual periods. Of these, 63.3% were treated with hyaluronic acid and Centella asiatica cell lysate and the other 36.7% with glycerin and polycarbophil. The vaginal maturation index improved significantly after 3 months of treatment with hyaluronic acid and Centella asiatica: the parabasal cell count declined (-8.4%; 95%CI, -10.6 to -6.2; p=0.001) and the intermediate cell count increased (3.6%; 95%CI, 2.0-5.3; p=0.001), as did that of superficial cells (4.8%; 95%CI, 3.8-5.7; p=0.001). In addition, all symptoms and signs of vaginal atrophy improved after 3 months with treatment with hyaluronic acid and Centella asiatica lysate. There was no significant change in the vaginal maturation index or in symptoms and signs after 3 months of treatment with glycerin and polycarbophil. Conclusions: Three months of nonhormonal treatment with hyaluronic acid and Centella asiatica lysate significantly improved the vaginal maturation index

Objetivo: describir la evolución clínica de mujeres con atrofia vaginal que reciben un tratamiento no hormonal.Material y métodos:estudio descriptivo observacional retrospectivo longitudinal unicéntrico en mujeres posmenopáusicas de 45 a 60 años con síntomas de atrofia vaginal que hubieran requerido tratamiento no hormonal. Resultados: se incluyeron 98 mujeres con una edad media de 54,6 ± 3,2 años y un tiempo medio sin menstruación de 5,6 ± 3,0 años. El 63,3% de las mujeres eran tratadas con ácido hialurónico y lisado celular de centella asiática y el 36,7% con glicerol y policarbofil. El índice de maduración vaginal fue significativamente mejor tras tres meses de tratamiento con ácido hialurónico y lisado de centella asiática: descienden las células parabasales (-8,4%, IC95% (-10,6 - -6,2), p=0,001) y aumentan las intermedias (3,6%, IC95% (2,0 - 5,3), p=0,001) y las superficiales (4,8%, IC95% (3,8 - 5,7), p=0,001). Además, se redujeron todos los síntomas y signos de atrofia vaginal tras 3 meses con el tratamiento con ácido hialurónico y lisado de centella asiática. No se encontraron cambios tras tres meses de tratamiento con glicerol y policarbofil en el índice de maduración vaginal y de los síntomas y signos. Conclusiones: El tratamiento no hormonal con ácido hialurónico y lisado de centella asiática mejora significativamente el índice de maduración vaginal y los síntomas y signos de atrofia vaginal tras tres meses de tratamiento

Hysteroscopy: endometrial vascular dystrophy / Histeroscopia: ¿distrofia vascular endometrial?

Objective: The objective of the study was to analyze cases of endometrial vascular dystrophy in the Hysteroscopy Unit of Hospital Clínico San Carlos, Madrid, Spain. Review: We reviewed a total of 7,658 hysteroscopies carried out in the unit during 2011-May 2017. We identified a total of 8 cases and analyzed both the hysteroscopy and the histopathology data. Conclusion: The condition known as endometrial vascular dystrophy does not comprise vascular disorders, but rather involves tortuous secretory glands (normal) filled with retained blood. We can find no explanation for this phenomenon

Objetivo: el objetivo del trabajo es analizar los casos de "Distrofia Vascular Endometrial" encontrados en la unidad de histeroscopias del Hospital Clínico de San Carlos (UCM). Material y métodos: se revisan un total de 7.658 histeroscopias, practicadas en la unidad durante el periodo de tiempo comprendido entre 2011- mayo de 2017. Se analizan las histeroscopias, así como el estudio histopatológico e histoquimico de los 8 casos de DVE encontrados. Resultados: se encuentran un total de 8 casos de DVE, totalmente documentados con videos, desechándose otros casos que no están documentados. Conclusión: los autores llegan a la conclusión de que la llamada Distrofia Vascular Endometrial, no está constituida por alteraciones vasculares, sino que se trata de glándulas secretoras tortuosas (normales) pero llenas de sangre retenida y material de secreción. No encuentran explicación a este fenómeno

Papel actual del acetato de ulipristal en el tratamiento de los síntomas asociados a los miomas uterinos / Current role of ulipristal acetate in the management of uterine fibroids

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Acetato de ulipristal después del proceso de la Agencia Europea del Medicamento. ¿Qué ha sucedido y cuál es la visión actual? / Ulipristal acetate after the process of the European Medicines Agency. What has happened and what is the current vision?

Los miomas uterinos son tumores benignos en la pared miometrial del útero. El acetato de ulipristal fue autorizado en la Unión Europea por primera vez el 23 de febrero de 2012; desde entonces, se han tratado con él unas 765.000 mujeres. Durante estos años de uso se han reportado algunos escasos cuadros de lesión hepática, lo que ha supuesto un análisis exhaustivo de los análisis clínicos previos. Presentamos una evaluación de los estudios realizados con el fármaco respecto a su seguridad y a los estudios reportados en la Agencia Europea del Medicamento, así como nuestro punto de vista sobre estos hallazgos, los beneficios del tratamiento y las implicaciones en la práctica clínica

Uterine fibroids are benign tumours within the uterine wall affecting women. Ulipristal acetate was first authorized in the European Union on 23 February 2012, with a post-marketing exposure estimated to be more than 765,000 patients so far. During the post-marketing experience, sporadic cases of liver injury and hepatic failure were reported. A detailed review of the clinical trials carried out in the development of Ulipristal acetate was undertaken to further assess the liver safety data reported during the clinical trials. The experts present an evaluation of the liver safety findings observed during the clinical development and during the evaluation from the European Medicines Agency, and their views on the role of these findings in predicting the occurrence of drug-induced liver injury, the benefits of the treatment and the implications to the current clinical practice

Percepción de los ginecólogos sobre la situación actual de los dispositivos intrauterinos durante el consejo contraceptivo en España para distintos perfiles de usuaria / Perception of gynecologists on the current situation of intrauterine devices during contraceptive advice in Spain for different user profiles

Objetivo: comunicar las percepciones de ginecólogos españoles sobre el uso del dispositivo intrauterino en distintos perfiles de usuaria. Materiales y métodos: estudio transversal descriptivo. 94 ginecólogos de diferentes regiones de España cumplimentaron un cuestionario sobre la situación del dispositivo intrauterino durante el consejo contraceptivo. Las valoraciones fueron consensuadas en una reunión nacional. Resultados: un 73% de los ginecólogos se manifestaron de acuerdo en recomendar los dispositivos intrauterinos en mujeres nulíparas. Sin embargo, solo un 52% declaró prescribirlo en ese perfil con frecuencia. Asimismo, un 93% de los participantes mostró acuerdo para afirmar la existencia de ideas preconcebidas sobre el dispositivo intrauterino y un 79% para afirmar que una mayor accesibilidad aumentaría su recomendación. Conclusiones: se sugiere incluir los distintos tipos de dispositivos intrauterinos durante el consejo contraceptivo según el perfil de cada usuaria, independientemente de edad o paridad, y preferiblemente los hormonales en mujeres candidatas (AU)

Objective: To communicate the perceptions of Spanish gynecologists about the use of intrauterine devices in different user profiles. Materials and methods: Cross-sectional descriptive study. 94 gynecologists answered a questionnaire related to the current situation of intrauterine devices in contraceptive counseling. Answers and considerations were validated in a national meeting. Results: 73% of gynecologists showed their agreement to recommend intrauterine devices to nulliparous women. However, only 52% declared to often prescribe these methods to these users. In addition, 93% of participants agreed to describe the existence of preconceived notions about intrauterine devices, and 79% agreed to declare that better accessibility would increase intrauterine devices prescription rates. Conclusions: Considering all intrauterine devices types during contraceptive counseling was advised, giving preference to hormone-based methods in the appropriate women. Acknowledging the different user profiles was also recommended, regardless of age and parity (AU)

Mesothelial-to-mesenchymal transition as a possible therapeutic target in peritoneal metastasis of ovarian cancer.

Peritoneal dissemination is the primary metastatic route of ovarian cancer (OvCa), and is often accompanied by the accumulation of ascitic fluid. The peritoneal cavity is lined by mesothelial cells (MCs), which can be converted into carcinoma-associated fibroblasts (CAFs) through mesothelial-to-mesenchymal transition (MMT). Here, we demonstrate that MCs isolated from ascitic fluid (AFMCs) of OvCa patients with peritoneal implants also undergo MMT and promote subcutaneous tumour growth in mice. RNA sequencing of AFMCs revealed that MMT-related pathways - including transforming growth factor (TGF)-ß signalling - are differentially regulated, and a gene signature was verified in peritoneal implants from OvCa patients. In a mouse model, pre-induction of MMT resulted in increased peritoneal tumour growth, whereas interfering with the TGF-ß receptor reduced metastasis. MC-derived CAFs showed activation of Smad-dependent TGF-ß signalling, which was disrupted in OvCa cells, despite their elevated TGF-ß production. Accordingly, targeting Smad-dependent signalling in the peritoneal pre-metastatic niche in mice reduced tumour colonization, suggesting that Smad-dependent MMT could be crucial in peritoneal carcinomatosis. Together, these results indicate that bidirectional communication between OvCa cells and MC-derived CAFs, via TGF-ß-mediated MMT, seems to be crucial to form a suitable metastatic niche. We suggest MMT as a possible target for therapeutic intervention and a potential source of biomarkers for improving OvCa diagnosis and/or prognosis. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Acetato de ulipristal 5 mg (Esmya(R)) como primera opción en el manejo terapéutico de los miomas uterinos sintomáticos / Ulipristal acetate 5 mg (Esmya(R)) as the first option for the treatment of uterine myomas

Introducción: los miomas uterinos son un viejo problema médico, con una elevada incidencia en la población femenina y que suponen un número importante de consultas en ginecología. En la actualidad contamos con nuevas alternativas terapéuticas. Objetivo: proporcionar un enfoque basado en la mejor evidencia disponible de las opciones actuales de tratamiento médico para los miomas uterinos. Métodos: se realizó una búsqueda bibliográfica en las bases de datos, Medline PubMed, Embase, Cochrane, Ovid-Hinari, Scielo, Bireme y Lilacs. Resultados: se revisaron 112 artículos y se seleccionaron 21, los cuales estaban relacionados directamente con el tema. Hay múltiples opciones terapéuticas que han sido usadas para el tratamiento de la miomatosis. Los agonistas de la hormona liberadora de gonadotropina eran los únicos medicamentos aprobados por la Food and Drug Administration para la disminución del volumen de los miomas, con indicación pre-quirúrgica; sin embargo presentan muchos efectos secundarios. Los moduladores selectivos de receptores de progesterona se postulan como una opción útil en el tratamiento de los miomas. Conclusión: la literatura muestra que hay evidencia de que el acetato de ulipristal 5 mg puede ser usado para el manejo exclusivamente médico de pacientes con miomatosis, especialmente para tratar los síntomas asociados y mejorar su calidad de vida. La importancia para el ginecólogo radica, principalmente, en el hecho de que cualquier tratamiento quirúrgico sobre el útero puede tener un impacto negativo directo sobre el pronóstico reproductivo de la paciente, además de no estar exento de posibles complicaciones (AU)

Background: Uterine fibroids are a high-prevalent medical issue involving an important impact on gynecology consultations. Currently, new alternative medical therapies are available. Objetives: To know the best current evidence about the different options in the management of uterine myomas. Methods: A bibliographic search was performed in Medline PubMed, Embase, Cochrane, Ovid-Hinari, Scielo, Bireme y Lilacs. Results: We reviewed 112 articles and selected 21, which were directly related to the topic. We found multiple choices of treatment in case of uterine myomas. Selective progesterone receptor modulators are postulated as a useful option in the treatment of fibroids. Conclusion: The literature shows evidence that ulipristal acetate 5 mg can be used for exclusively medical management of patients with uterine fibroids, especially to treat associated symptoms and improve their quality of life. It should be acknowledged that any surgical procedure on uterus could have a direct negative impact on patient’s reproductive prognosis, as well as other relevant complications (AU)

¿Es el dispositivo Epi-no(R) una herramienta de prevención de las lesiones perineales de origen obstétrico? / Is the Epi-no(R) trainer a device to prevent perineal trauma?

Introducción: la fisioterapia del suelo pélvico previa al parto, es una herramienta para la prevención de lesiones perineales de origen obstétrico. Objetivo: estudiar la utilidad de la fisioterapia del suelo pélvico, como el masaje perineal y los ejercicios con el dispositivo Epi-no(R), en las lesiones de origen obstétrico. Material y métodos: se realiza un estudio unicéntrico, nacional, prospectivo, observacional comparativo de tres brazos de 332 pacientes: grupo A (129): pacientes grupo control; grupo B (103): pacientes que realizan ejercicios de masaje perineal; grupo C (100): pacientes que realizan ejercicios con el dispositivo Epi-no(R). Resultados: se demostró que a mayor número de Epi-no(R) alcanzado, menor fue la tasa de episiotomías y mayor la tasa de perinés íntegros, p < 0,001 para ambas. El grupo Epi-no(R) tuvo menor tiempo de expulsivo frente al grupo masaje y grupo control (p = 0,043). Las pacientes del grupo Epi-no(R) tuvieron menor tasa de partos instrumentales (28%), frente al grupo masaje (35,9%) y grupo control (50,4%) (p = 0,002). Se encontraron menores tasas de episiotomías en el grupo Epi-no(R) (37%) frente al grupo de masaje (55,3%) y grupo control (69%), (p < 0,001). También se demostró mayor tasa de perinés íntegros en el grupo Epi-no(R) (32%), frente al grupo masaje (8,7%) y grupo control (2,3%), p < 0,001. No se demostraron diferencias estadísticamente significativas en el peso, perímetro cefálico, test de Apgar ni pH fetal entre los diferentes grupos. Conclusión: se considera de gran eficacia en la preparación al parto, la utilización de dispositivos instrumentales de ayuda al entrenamiento de los músculo pélvicos, como el Epi-no(R). Además, sus efectos se complementan de manera satisfactoria con terapias como el masaje perineal. Los ejercicios con el dispositivo Epi-no(R) tienen beneficios sobre las lesiones del periné como la episiotomía y los desgarros frente al grupo control y grupo masaje perineal (AU)

Introduction: Pelvic floor antenatal physiotherapy is a technique to prevent perineal trauma during childbirth. Objective: To study the efficacy of the perineal massage and Epi-no(R) device to prevent perineal trauma. Material and methods: We performed a comparative single-center, national, prospective, observational study of 332pacientes: group A (129): control group; group B (103): perineal massage group; grupo C (100): Epi-no(R) device group. Results: The study showed a significant reduction in the rate of episiotomies in the Epi-no(R) group (37%) compared to massage group (55.3%) and control group (69%). Higher rate of intact perineum was also shown in the Epi-no(R) group (32%), compared to massage group (8.7%) and control group (2.3%), p < 0.001. Patients from Epi-no(R) group had a significant reduction in the duration of the second stage of labour than patients from perineal massage group and control group. We also found that Epi-no(R) group had lower rates of instrumental deliveries (28%), compared to massage group (35.9%) and control group (50.4%) (p = 0.002). No statistically significant differences in fetal outcomes as fetal APGAR scores and fetal pH, between groups were demonstrated. Conclusion: The Epi-no(R) device device is beneficial in decreasing perineal damage during vaginal delivery. Training with Epi-no(R) device decreases episiotomy rates and increases intact perineum outcomes (AU)

Anticoncepción con métodos reversibles de larga duración / No disponible

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Tumoraciones mesenquimales de músculo liso uterino de potencial incierto: revisión anatomopatológica y pronóstica de un caso clínico / Uterine smooth-muscle tumors of uncertain malignant potential: histopathological findings and outcome in a clinical case

Los STUMPs (tumoraciones mesenquimales de músculo liso uterino de potencial incierto) son tumoraciones infrecuentes, que pertenecen a las tumoraciones mesenquimales de músculo liso uterino. Estas tumoraciones no pueden definirse ni como totalmente benignas ni malignas. Presentamos un caso clínico de una paciente de 27 años que consultó por sensación de plenitud, aumento del perímetro abdominal y polaquiuria de 6 meses de evolución. Ecográficamente se visualizó una masa intramural-subserosa de 9 cm en fondo uterino, con sospecha de degeneración hialina, que fue extirpada quirúrgicamente. El estudio anatomopatológico reveló el diagnóstico de tumoración muscular lisa de potencial maligno incierto, variante epiteloide. Conclusión. Los STUMPs se diagnostican anatomopatológicamente, siendo este proceso complejo y requiriendo, en gran número de ocasiones, técnicas inmunohistoquímicas para conseguir un diagnóstico y pronóstico más preciso. El tratamiento es quirúrgico, pudiendo realizar una histerectomía o bien, siendo más conservadores, la exéresis de la tumoración, ya que la mayoría tienen un comportamiento benigno (AU)

Uterine smooth-muscle tumours with unusual growth patterns represent an histologically heterogeneous and uncommon group of uterine smooth-muscle tumours that cannot be diagnosed as either benign or malignant.We report the case of a 27year-old woman who consulted for a 6-month history of bladder fullness sensation, abdominal distension and polaquiuria. Transvaginal ultrasound showed a 9cm intramural mass at the uterine fundus that was surgically excised. The anatomopathological diagnosis of uterine smooth-muscle tumour with growth pattern, epithelioid variant, was reported. Conclusions: The diagnosis of uterine smooth-muscle tumours may create great challenges for the pathologist who classifies these tumours by their histological features. The immunohistochemical staining may be helpful to establish their behaviour and prognosis. The clinical management remains a dilema and surgical treatment of choice has not been well defined, due to their uncertain clinical behaviour. Most of these tumours have a benign clinical course but these patients should receive long-term follow-up (AU)

El ductus venoso es un buen marcador de rescate en los riesgos intermedios del cribado combinado / Ductus venosus is a good rescue marker in the intermediate riskcategory after combined screening

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Trombosis de la arteria cerebral media en un neonato afectado de déficit de proteína C / Perinatal stroke associated with protein-C deficiency

Los accidentes cerebrovasculares (ACV) son una causa frecuente de mortalidad y morbilidad neurológica crónica en niños. El ACV perinatal se define como aquel que ocurre entre la semana 28 de gestación y los 28 días de vida. Se suele manifestar en forma de convulsiones en las primeras semanas de vida, aunque puede permanecer asintomático hasta meses después del parto, cuando aparecen alteraciones en la lateralidad de la función motora fina, fallo al alcanzar los hitos del desarrollo o convulsiones. Gracias a la mejora de los métodos diagnósticos de imagen, esta patología se ha incluido como diagnóstico diferencial en los recién nacidos con sintomatología neurológica. Los obstetras se encargan del seguimiento de los embarazos de alto riesgo trombótico, pero rara vez tienen en cuenta el efecto de este riesgo en el feto o en el recién nacido. Se presenta un caso de ACV perinatal asociado a déficit de proteína C (AU)

Stroke is an important cause of mortality and chronic neurological morbidity in children. Perinatal stroke has been defined as a cerebrovascular event occurring between 28 weeks of fetal life and the 28th postnatal day. The most common manifestation of stroke is neonatal seizures but this entity may also be asymptomatic until months after birth when asymmetry of reach and grasp, failure to reach developmental milestones, or postnatal seizures can develop. Improvements in neuroimaging and its availability have increased the diagnosis and awareness of perinatal stroke in newborns and infants with neurological symptoms. Obstetricians are responsible for monitoring pregnancies at high thromboembolic risk, but rarely consider the effect this has on the fetus or newborn. We present the case of a newborn with perinatal stroke associated with protein-C deficiency (AU)