Pregnancy outcomes in patients with portal cavernoma: A case series study.

OBJECTIVE: Non-cirrhotic portal vein cavernoma (PVC) is a cause of portal hypertension (PH) frequently affecting women of childbearing age. Cavernous transformation of the portal vein is frequently associated with prothrombotic disorders and often entails multiple hemodynamic changes, porto-collateral shunt development and thrombopenia, all of which can affect the course of pregnancy. Our aim was to evaluate the risk of PH-related complications and pregnancy outcomes in patients with PVC. METHODS: Retrospective case series study of patients with PVC undergoing pregnancy in a tertiary care hospital. RESULTS: Eight pregnancies fulfilled the eligibility criteria. All patients had a predisposing factor for PVC. One episode of variceal bleeding was reported at week 28. Six cesarean sections were scheduled to avoid labor while two urgent surgeries were indicated due to fetal distress and intrauterine growth restriction (IUGR). In all but one case, anticoagulation was prescribed after delivery. No hemorrhagic or thrombotic complications were reported. There were four cases of IUGR with no case of miscarriage or stillbirth. CONCLUSION: Pregnancy in patients with PVC has an overall favorable outcome albeit a higher risk of PH-derived complications, and IUGR may be expected. Hence, PVC must not be considered a contraindication for pregnancy although larger prospective studies are necessary.

Checklist: A Useful and Safe Tool for the Initiation of Care for Eutocical Vaginal Delivery.

The aim of this study is to present and analyze the vaginal delivery checklist as a safe and useful learning tool for first-year residents in the gynecology and obstetrics and midwifery specialties at different hospitals and to analyze the items that comprise it and the progress of the residents during the first 30 normal deliveries attended in a supervised manner. We present a descriptive, observational and prospective study in which 18 participants from different hospitals in Spain completed a checklist of skills in the first 30 births attended autonomously after learning its use in a simulation workshop. We collected a total of 329 of 330 checklists completed by 11 participants. In addition, the mean responses for each item contained on the checklist and the mean global progression of the participants were subsequently analyzed, detecting statistically significant differences using Student's t-test for paired data. During the data collection period between September 2020 and August 2021, a total of 329 checklists were analyzed. The global average of positive responses for the 30 questions contained on the checklist was 25.36 out of 30 points. The fulfillment of the different items was variable, with the lowest fulfillment of 2.18 points, although 73% of the items obtained a score greater than 25. A statistically significant difference in the mean compliance of the first five childbirths compared to the last five deliveries using the proposed checklist was obtained, with p < 0.01. In conclusion, knowing the importance of using a checklist to anticipate risk situations and reduce the number of adverse perinatal outcomes, we can say that, for first-year residents in gynecology and obstetrics attending a clinical simulation workshop in eutocic vaginal delivery, it may be interesting to have a tool, such as the checklist proposed in this study, that facilitates the learning process and the suitable progress of the participants.