Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation.

INTRODUCTION: This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical-practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations. MATERIALS AND METHODS: This was a quasi-experimental pre-post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020-2021 and 2021-2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives. RESULTS: Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020-2021 academic year and 80.6% of students in the 2021-2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical-practical knowledge (improvement mean = 1.38 and 1.21 in 2020-2021 and 2021-2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points. CONCLUSIONS: Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.

Atosiban versus ritodrine as tocolytics in external cephalic version.

OBJECTIVE: To assess the efficacy of atosiban versus ritodrine as tocolytics in external cephalic version (ECV). MATERIALS AND METHODS: A prospective comparative trial was carried out in a tertiary hospital. 430 women with singleton breech pregnancies ≥36 weeks were recruited for ECV, 215 with ritodrine and 215 with atosiban as tocolytic agents. The efficacy, complications and perinatal outcomes were compared between both groups. The associations between variables were analyzed using the chi-square test (χ2) (qualitative), Student's t test (quantitative, parametric) or Mann-Whitney test (nonparametric). Statistical significance was established as p < .05. RESULTS: The overall ECV success rate was 47.9% (206/430), 46.0% in the atosiban group (99/215) and 49.8% in the ritodrine group (107/215). This difference showed no statistical significance (p = .440). A higher rate of uterine contractions after the maneuver was observed in the atosiban group (34.4 versus 22.8%; p = .008), but without clinical relevance. Perinatal outcomes were similar in both groups, with no significant differences. CONCLUSION: Atosiban and ritodrine showed similar efficacy as tocolytic agents in ECV, with no differences in complications and perinatal outcomes between these two agents.

Permeability of the amniotic membranes to the natural vanilla molecule.

Purpose: We studied natural vanilla permeability through amniotic membranes.Methods: We studied natural vanilla permeability through amniotic membranes obtained from 45 spontaneous normal deliveries at term. The ferric chloride test (FeCL3) was used to determine the presence or absence of phenols in a given sample. Vanilla is a polyphenol so it gives a reaction to FeCL3 with an intense color change. The diffusion of the vanilla was checked by dropping ferric chloride solution on the gauze once the membranes are lifted with care to avoid contamination. If vanilla has passed through the membranes the distilled water papers would change from an initial ferric yellow in the drops toward a marked gray/greenish color on the papers (positive test).Results: In all cases, the swabs were stained, all the membranes in both directions were permeable to the whole vanilla molecule.Conclusions: This experiment allows us to reevaluate the importance of molecular diffusion through the amniotic membranes with no placental metabolism existing between maternal and fetal environment.

Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid.

OBJECTIVE: To determine the intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid (MSAF). STUDY DESIGN: In a retrospective cohort study of all singleton deliveries over a period of one year (2015) in a tertiary hospital, we compared different degrees of MSAF (yellow, green and thick) to clear amniotic fluids, and analysed in each group maternal, intrapartum and neonatal variables as well as umbilical cord blood gas analysis. RESULTS: Of the 3590 deliveries included, 503 (14%) had MSAF. The incidence of MSAF rises with gestational age at delivery, reaching 20.7% in gestations above 41 weeks compared to 4.3% below 37 weeks. As the amniotic fluid staining progresses we found a higher proportion of intrapartum fevers (p < 0.001), pathological fetal heart rate patterns (p < 0.05), operative vaginal deliveries and cesarean sections (p < 0.001), as well as the need for advanced neonatal resuscitation (p < 0.001). There was also a correlation between MSAF and low Apgar scores at five minutes (p < 0.001) and fetal-neonatal mortality (p < 0.001) but there was not a higher proportion of neonatal intensive care admissions (p > 0.05). We have observed a similar distribution of umbilical artery pH ranges in all groups (p > 0.05). CONCLUSIONS: MSAF was associated with an increase in the rate of pathological fetal heart rate patterns, intrapartum fevers, operative vaginal and cesarean section deliveries, need for neonatal resuscitation, low Apgar scores and higher fetal-neonatal mortality. Moreover, we found that the risks increase as the staining and consistency of the amniotic fluid evolves so it should alert the obstetrician and paediatrician to the potential adverse outcomes.

Diagnosis of a defect in the uterine wall using 3D ultrasound in the 16th week of gestation.

The 3D volumetric transabdominal study with rendering mode is a very useful tool to perform a detailed study of the uterine wall, and it allows us to create a safe and early strategy during pregnancy in uterine dehiscences, as we show in this case in the 16th week of gestation.

Manejo de la hiponatremia asociada a trastornos hipertensivos del embarazo / Management of hyponatremia associated with hypertensive disorders of pregnancy

La hiponatremia severa es una complicación poco frecuente de los trastornos hipertensivos en la gestación. Actualmente existen pocos casos publicados en la literatura, sin embargo resulta fundamental tener en cuenta este trastorno ante una paciente con preeclampsia. Presentamos dos casos de hiponatremia asociada a trastornos hipertensivos en pacientes gestantes, en los que la clínica y la analítica mejoraron rápidamente tras realizar el diagnóstico e iniciar un tratamiento adecuado, con remisión completa tras el parto (AU)

Severe hyponatremia is a rare complication of hypertensive disorders in pregnancy. Few cases have been reported in the literature. However, it is important to consider this disorder in patients with preeclampsia. We present two cases of hyponatremia associated with hypertensive disorders in pregnant women. Rapid clinical and analytical improvement was observed after diagnosis and appropriate treatment with complete remission following delivery (AU)

Accurate Diagnosis of Severe Hypospadias Using 2D and 3D Ultrasounds.

The hypospadias is the most common urogenital anomaly of male neonates but the prenatal diagnosis of this is often missed before birth. We present the prenatal diagnosis of a severe penoscrotal hypospadias using 2D and 3D ultrasounds. 3D sonography allowed us the best evaluation of the genitals and their anatomical relations. This ample detailed study allowed us to show the findings to the parents and the pediatric surgeon and to configure the best information about the prognosis and surgical treatment.

Resultados perinatales y manejo de las pacientes con seroconversión para toxoplasma durante la gestación / Perinatal outcomes and management of patients with seroconversion to toxoplasma during gestation

Objetivo: conocer los resultados perinatales obtenidos en las pacientes con seroconversión para toxoplasma durante la gestación. Material y Métodos: estudio retrospectivo descriptivo de las gestaciones con seroconversión para toxoplasma durante el embarazo, entre los años 2004 y 2012. Las variables estudiadas hicieron referencia a las características gestacionales, serológicas y perinatales. El tratamiento de los datos se realizó con el programa estadístico SPSS versión 18 paraWindows. Resultados: la población a estudio englobó un total de 139 gestantes, de las cuales un 85% presentó la seroconversión para toxoplasma en el primer trimestre, el 11% en el segundo y el 4% restante en el tercer trimestre.Se realizó un análisis en tres grupos según el resultado de la avidez de la inmunoglobina G: débil (32%), intermedia (17%) y fuerte (50%). Sólo se registró un caso de toxoplasmosis neonatal, correspondiente al grupo de avidez débil, donde el recién nacido presenta actualmente una pérdida auditiva de tipo conductivo de 20 dB en el oído izquierdo y de 10 dB en el oído derecho. Conclusión: los resultados perinatales no son peores en las pacientes con seroconversión para toxoplasma durante la gestación. La tasa de transmisión vertical en nuestro centro fue baja (AU)

Objective: To determine the perinatal results obtained in patients with toxoplasma seroconversion during pregnancy. Material and Methods: Retrospective descriptive of pregnancies with toxoplasma seroconversion during pregnancy, between 2004 and 2012. Studied variables referred to gestational characteristics, serological and perinatal. The data processing was performed using SPSS version 18 for Windows. Results: The study population encompassed a total of 139 pregnant women, of which 85% had seroconversion for toxoplasma in the first quarter, 11% in the second and the remaining 4% in the third quarter. Analysis wasperformed in three groups according to the result of the inmunoglobulin G: weak (32%), intermediate (17%) and strong (50%). Only one case of neonatal toxoplasmosis, corresponding to the avidity weak group, where currently newborn.This Conductive hearing loss of 20 dB in the left ear and 10 dB in the right ear. Conclusion: Perinatal outcomes were not worse in patients with toxoplasma seroconversion during gestation. The vertical transmission rate at our center was low (AU)

In utero gratification behaviour in male fetus.

Fetal masturbation has been described previously once in utero but only as a description of an action. Masturbation is well described in infancy and early childhood when they discover that this practice can give them pleasure. Our letter proves that it could begin in utero as a 'gratification behaviour'. We have shown this pattern clearly by using a volumetric rendering mode study. © 2016 John Wiley & Sons, Ltd.

Resultados perinatales asociados a las gestantes infectadas por el virus de la inmunodeficiencia humana en el Complejo Hospitalario Universitario de Vigo / Perinatal outcomes in HIV-positive pregnant women in the Complejo Hospitalario Universitario de Vigo

Introducción: la infección por el virus de la imnunodeficiencia humana (VIH) tiene gran repercusión sobre la reproducción desde el momento de la concepción, por el riesgo de la transmisión sexual, hasta la posible infección del recién nacido. Por ello, es primordial combatir la transmisión vertical durante el embarazo en toda mujer gestante infectada por este virus. Objetivo: conocer la tasa de transmisión vertical, así como estudiar los resultados perinatales asociados a las gestantes infectadas por el VIH en el Complejo Hospitalario Universitario de Vigo. Material y métodos: se realizó un estudio descriptivo retrospectivo de la población gestante afectada por el VIH desde enero de 2000 hasta enero de 2014. Definimos para el estudio variables maternas, gestacionales, intraparto y neonatales. El tratamiento estadístico de los datos fue realizado con el programa SPSS20 para Windows. Resultados: la población estudiada fue de 100 gestantes seropositivas. El 50% presentó coinfección por el virus de la hepatitis C (VHC) y el 9% por el virus de la hepatitis B (VHB). El 98% de las pacientes recibió tratamiento antirretroviral durante el embarazo, el 97% profilaxis intraparto con zidovudina y el 98% de recién nacidos tratamiento antirretroviral desde el nacimiento. El 45% de los casos cumplió criterios para un parto vaginal. Finalmente, el 28% fueron partos eutócicos y el 4%, instrumentados; en el 13% restante se indicó cesárea urgente intraparto. La transmisión materno-fetal fue del 0%. Conclusión: protocolizar el manejo gestacional y neonatal en las pacientes seropositivas frente al VIH ha permitido obtener un importante descenso en su tasa de transmisión vertical (AU)

Introduction: Human Immunodeficiency Virus (HIV) infection has a major impact on reproduction that includes the risk of sexual transmission at conception and even possible infection of the newborn. Consequently, it is essential to combat vertical transmission during pregnancy in all HIV-infected pregnant women. Objective: The objective of this study was to determine the rate of vertical transmission and perinatal outcomes in HIV-infected pregnant women attended at the University Hospital of Vigo. Material and methods: A retrospective descriptive study was conducted in HIV- pregnant women from January 2000 to January 2014. Maternal, gestational, intrapartum and neonatal variables were defined for the study. The statistical analysis of the data was carried out with SPSS version 20 for Windows. Results: The study population consisted of 100 HIV-seropositive pregnant women. Fifty percent were coinfected with the hepatitis C virus (HCV) and 9% with the hepatitis B virus (HBV). Most (98%) of patients received antiretroviral therapy during pregnancy, 97% received intrapartum prophylaxis with zidovudine and 98% of newborns received antiretroviral treatment from birth. Forty-five percent of the patients met the criteria for vaginal delivery. Delivery was normal in 28% and instrumental in 4%, while intrapartum emergency caesarian section was required in the remaining 13%. Maternal-fetal transmission was 0%. Conclusion: Protocolizing gestational and neonatal management in HIV-seropositive patients significantly decreased the rate of vertical transmission (AU)

Trombosis venosa cerebral recurrente en el embarazo / Recurrent cerebral venous thrombosis in pregnancy

La trombosis venosa cerebral es una enfermedad poco frecuente, pero de pronóstico potencialmente grave. Debido a los cambios hemostáticos durante la gestación, es una patología que puede asociarse al embarazo. Presenta un amplio rango de signos y síntomas. El diagnóstico y tratamiento precoz mejoran el pronóstico. Presentamos el caso de una mujer de 30 años, que en la semana 8 de gestación acude a Urgencias por cefalea intensa y cuya resonancia magnética reveló una trombosis venosa cerebral. La paciente presentó un segundo episodio en la semana 33, a pesar del correcto tratamiento anticoagulante recibido.

Cerebral venous thrombosis is a rare disease, but with a potentially serious prognosis. It is a condition that can be associated with pregnancy because of the hemostatic changes during gestation. It has a wide range of signs and symptoms. Early diagnosis and treatment improve prognosis. We report the case of a 30-year-old woman, at week 8 of pregnancy, who came to the emergency department for severe headache and whose magnetic resonance imaging revealed a cerebral venous thrombosis. The patient had a second episode at week 33, despite correct anticoagulation received.

Secuencia TRAP. Diagnóstico diferencial con gemelo muerto / Twin reverse arterial perfusion (TRAP) sequence. Differential diagnosis with intrauterine demise of one twin

La secuencia TRAP (twin reverse arterial perfusion) está presente en el 1% de las gestaciones gemelares monocoriales. Presentamos un caso de secuencia TRAP poco convencional en el que el gemelo acardias está bien formado, identificándose en él estructuras craneales y cardiacas. El diagnóstico diferencial entre fenómeno TRAP y gemelo muerto intraútero se hizo a partir de otros signos ecográficos de sospecha, como la presencia de una arteria umbilical única, un higroma dorsal y el cordón corto. El diagnóstico de certeza se consiguió mediante Doppler, que demostró la presencia de la anastomosis arterio-arterial y el flujo reverso en el gemelo «muerto». Consideramos que la existencia de un fenómeno TRAP debe tenerse en cuenta ante el diagnóstico ecográfico de gestación monocorial con muerte de uno de los gemelos. El pronóstico y manejo de la gestación va a diferir en ambos casos. La presencia de estructuras craneales y corazón no excluye el diagnóstico de TRAP (AU)

TRAP sequence occurs in 1% of monochorionic twin pregnancies. We present an atypical case of TRAP sequence in which the acardiac twin was properly formed and the cranial and cardiac structures could be identified. The differential diagnosis between TRAP phenomenon and intrauterine death of one twin was performed on the basis of other suspicious ultrasound signs, such as the presence of a single umbilical artery, a dorsal hygroma, and a short cord. The definitive diagnosis was established by Doppler, which showed an arterio-arterial anastomosis and reverse flow in the dead twin. We believe that the presence of a TRAP phenomenon should be taken into account in cases of ultrasound diagnosis of a monochorionic pregnancy with intrauterine demise of one twin. The finding of cranial structures and heart does not exclude a diagnosis of TRAP (AU)

Estudio ecográfico 2D y 3D del segmento inferior en gestante con cesárea anterior / Ultrasonographic study of the inferior uterine segment in a pregnant woman with previous cesarean section

La rotura uterina es una complicación potencial y grave en el intento de parto vaginal en mujeres con una cesárea anterior. El adelgazamiento del segmento inferior es la clave. Existe una correlación inversa entre el grosor del segmento y el riesgo de dehiscencia de la cicatriz. Presentamos el caso de una gestante en la que se detectó en la semana 24 una disminución del grosor de la cicatriz de 2mm. Se realizó un seguimiento con ecografía 2D y estudios complementarios 3D/4D. El grosor del segmento se mantuvo estable hasta la semana 34, cuando se apreció un adelgazamiento de hasta 0,7mm en la zona más debilitada. Se realizó una cesárea programada. La exploración mediante proyecciones 3D con volúmenes de alta resolución permite analizar la situación real del segmento. La medición ecográfica del segmento durante la exploración del tercer trimestre puede ayudar a identificar las gestantes con cesárea anterior y riesgo de rotura uterina (AU)

Uterine rupture is a potential and serious complication of any attempt at vaginal delivery in women with a previous cesarean section. The key is narrowing of the inferior uterine segment. There is an inverse correlation between the thickness of the segment and the risk of scar dehiscence. We present the case of a pregnant woman in whom a 2mm decrease in scar thickness was observed at week 24 of pregnancy. The patient was monitored with 2D ultrasound and supplementary 3D/4D studies. The thickness of the segment remained stable until week 34, when narrowing of up to 0.7mm was observed in the weakest area. An elective caesarean section was performed. Examination through 3D views with high resolution volumes allows accurate evaluation of the status of the segment. Ultrasonographic measurement of the inferior segment during the third trimester can help to identify pregnant women with a previous cesarean section and risk of uterine rupture (AU)

Response of the foetal pupil to vibro-acoustic stimulation: a foetal attention test.

BACKGROUND: The iris regulates the intensity of light that stimulates the retina. The pupils dilate also in response to mental activities as sign of attention. We hypothesized that the response of the foetal pupil to vibro-acoustic stimulation (VAS) reflects foetal attention. AIMS: To determine whether the changes in the foetal pupil produced by vibroacoustic stimulation is a sign of foetal attention. STUDY DESIGN: We studied sonographically the pupils and iris of 151 foetuses between 27 and 41 weeks of gestation, using maximum ultrasonic zoom. SUBJECTS: 160 human foetuses between the 27th and the 41st week of gestation. OUTCOME MEASURES: The diameters of the pupil and iris were compared before and after VAS. RESULTS: At baseline, the pupils were miotic. We observed a response to VAS, manifest as a prominent pupillary dilatation in all foetuses. At all gestational ages, the percent increase in pupillary diameter was ≥57% (mean 87%; range: 57-135%). CONCLUSIONS: VAS dilated the foetal pupil. Sonographic assessment of the foetal pupil provided important insights in the development of foetal neurological functions.

Rotura uterina anteparto: importancia diagnóstica de la ecografía obstétrica / Antepartum uterine rupture: diagnostic importance of obstetric ultrasound

La rotura uterina es un fenómeno poco frecuente pero que puede tener graves consecuencias para la vida materna y fetal. Nuestro equipo presenta una rotura uterina espontánea en una gestante de 37 semanas antes del inicio del trabajo de parto. La ecografía obstétrica fue clave en el diagnóstico y se mostró más resolutiva que las imágenes de la ecografía abdominal y de la resonancia magnética. La realización inmediata de una laparotomía obtuvo como resultado un recién nacido sano y permitió la reparación uterina. En la exhaustiva anamnesis posterior, el único factor de riesgo encontrado fue el antecedente de dos legrados en gestaciones anteriores (AU)

Uterine rupture is an uncommon event but can cause serious damage to both the mother and fetus. We report a case of spontaneous uterine rupture in a 37-week pregnant woman that occurred before the onset of labor. Obstetric ultrasound was the key to diagnosis, providing information not given by abdominal ultrasound or magnetic resonance imaging. Early laparotomy allowed a healthy newborn to be delivered and the uterine defect to be corrected. Subsequently, an exhaustive history was taken, revealing the antecedent of two curettages performed in two previous pregnancies as the only risk factor for this complication (AU)

Piomioma tras aborto de segundo trimestre de gestación / Pyomyoma after miscarriage in the second trimester of pregnancy

El piomioma es una patología muy poco frecuente pero con elevada morbimortalidad. La evolución clínica subaguda y la inespecificidad de los síntomas, junto con su baja incidencia, dificultan un diagnóstico temprano.Se presenta un caso de shock séptico secundario a un piomioma tras un aborto en el segundo trimestre de gestación, donde la evolución tórpida del cuadro febril, a pesar de un tratamiento antibiótico de amplio espectro, condujo a la realización de una histerectomía.La existencia de signos de infección en una paciente con miomas y una historia reciente de instrumentación uterina hace necesario descartar la presencia de un piomioma (AU)

Pyomyoma is a rare disease but carries high morbidity and mortality. Because of the non-specific nature of the symptoms, subacute course of the disease and its low incidence, early diagnosis is difficult. We report a case of septic shock due to pyomyoma after a miscarriage in the second trimester of pregnancy. Because of the torpid clinical course –despite the use of a broad-spectrum antibiotic– hysterectomy was performed. When there are signs of infection in a patient with myomas and a recent history of uterine instrumentation, the presence of a pyomyoma must be excluded (AU)

Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino / Amnioinfusion in premature rupture of membranes in preterm pregnancies

Objetivo: Valorar la posibilidad de la amnioinfusión en la rotura prematura de membranas en gestaciones pretérmino como medida terapéutica. Material y métodos: Se practicaron amnioinfusiones vía transabdominal seriadas en 2 pacientes con una rotura prematura de membranas pretérmino. La solución de Ringer lactato se administró por punción abdominal. Resultados: Se realizaron amnioinfusiones seriadas hasta aproximadamente la semana 23.a. A partir de ese momento, ambos casos mantuvieron un líquido amniótico normal durante el resto de la gestación. Conclusión: La amnioinfusión transabdominal es una opción terapéutica en la rotura prematura de membranas en gestaciones pretérmino

Objective: To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies. Material and methods: We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture. Results: We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid. Conclusions: Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy

Diagnóstico prenatal de un quiste esplénico fetal mediante ultrasonografía 4D / Prenatal diagnosis of a fetal splenic cyst through 4D ultrasonography

El quiste esplénico es una rara entidad que pocas veces se diagnostica antenatalmente en la ecografía, y se han descrito muy pocos casos en la bibliografía. Se presenta un caso de un quiste esplénico fetal diagnosticado mediante ecografía en la semana 20 de gestación, su evolución prenatal y seguimiento posterior, que incluye la exploración mediante ultrasonografía 4D, así como una revisión de la etiología, el diagnóstico prenatal, las complicaciones y las estrategias de manejo

Congenital splenic cyst is an uncommon pathology which is diagnosed very infrequently in the antenatal study of the fetus. There are very few cases antenatally diagnosed described in literature. We show a fetal cyst spleen diagnosed by ultrasonography at 20 weeks of gestation. We show its prenatal evolution with 4D ultrasonography and its postnatal study. The aetiology, prenatal diagnosis, complications and management strategies are discussed