Evaluación de la salud sexual femenina en la consulta de Ginecología / Evaluation of female sexual health in routine gynaecological practice

Antecedentes: La disfunción sexual en la mujer es un problema multicausal y multidimensional, poco estudiado en la consulta de Ginecología. El objetivo de este trabajo fue estimar la calidad de vida sexual mediante el test de Índice de Función Sexual Femenina en las mujeres que acudieron a la consulta de Ginecología e identificar qué variables se asociaban a esta. Material y métodos: Estudio observacional descriptivo que incluye a las pacientes que acudieron a la consulta de Ginecología entre marzo y agosto 2019. Las pacientes rellenaron anónimamente el test de Índice de Función Sexual Femenina y se recogieron variables sociodemográficas y clínicas. Para establecer las características que pudieron estar asociadas con la calidad de la salud sexual se elaboró un modelo de regresión lineal múltiple. Resultados: Del total de pacientes encuestadas un 39,4% presentaban disfunción sexual con un valor medio del test de 27,2. Si excluimos pacientes que no tenían relaciones en el momento de la encuesta, este porcentaje descendió al 19,2%. La variable que más descendió el valor del Índice de Función Sexual Femenina fue la menopausia. Asimismo la edad y el tener 3 o más hijos también disminuyó el valor del test. Por el contrario, los estudios universitarios mejoraron significativamente el resultado de dicho test. Conclusiones: La disfunción sexual femenina es un problema multifactorial. Dado que afecta de forma significativa la salud global de las mujeres, se hace patente la necesidad de abordar la problemática en las consultas de Ginecología de manera real y eficaz.(AU)

Background and objective: Female sexual dysfunction is a multicausal and multidimensional pathology, often underestimated in gynaecology care. The aim of this study was to estimate the quality of sexual life using the Female Sexual Function Index test in women who attended the gynaecology practice and to identify which variables were associated with sexual dysfunction. Material and methods: Descriptive observational study that includes patients who attended routine gynaecology care between March and August 2019. The patients filled out the Female Sexual Function Index anonymously and sociodemographic and clinical variables were collected. To establish the characteristics that could be associated with the quality of sexual health, a multiple linear regression model was developed. Results: Of the total of patients surveyed, 39.4% presented sexual dysfunction with a mean value of 27.2. After excluding patients without sexual intercourse at the time of the survey, this percentage dropped to 19.2%. Menopause was the variable that most lowered the Female Sexual Function Index value. Likewise, age and having 3 or more children also decreased the test score. Nevertheless, having a university education significantly improved womeńs sexual health. Conclusions: Female sexual dysfunction is a multifactorial problem that greatly affects women's well-being. It is important to assess this problem in routine gynaecology care in order to improve female sexual and global health.(AU)

Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial.

BACKGROUND: Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy. METHODS: Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software. DISCUSSION: promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.

Implicaciones obstétricas de los tratamientos escisionales de cérvix por lesiones premalignas / Excisional treatment for cervical dysplasia and obstetrics outcomes

Objetivo: Analizar los resultados obstétricos en mujeres con antecedente de tratamiento escisional de cérvix y si existen diferencias en los mismos según la técnica de conización empleada: LEEP (procedimiento de escisión cervical con asa de diatermia) o LLETZ (escisión de la zona de transformación [TZ] con asa de diatermia). Material y métodos: Estudio observacional retrospectivo en el que se han incluido las conizaciones realizadas entre 2007 y 2014 y las siguientes variables: edad materna, paridad, tabaquismo, parto, aborto, intervalo entre la conización y el parto, tipo de parto, rotura prematura de membranas pretérmino (RPMP), edad gestacional y peso del recién nacido. Grupo control: 100 pacientes que habían quedado gestantes en el mismo periodo de tiempo. Resultados: Cincuenta y tres (7,9%) pacientes quedaron gestantes tras la conización, de estas 4(7,5%) abortaron y 49(92,5%) tuvieron un parto. Se observó mayor tasa de prematuridad (18 vs. 8%, p=0,049) y de RPMP (22,4 vs. 3%, p=0,001) en el grupo de conización. En relación a la técnica empleada, hubo más casos de prematuridad en el grupo de LEEP frente al de LLETZ (25 vs. 10,5%), RR=1,7 (IC 95%:1,1-2,9), no encontrando diferencias en cuanto a la RPMP y el bajo peso. Por otro lado, también se observó mayor proporción de cesárea en el grupo de conización frente al control (38,8 vs. 20%) (57%-LEEP vs. 5,3%-LLETZ, p=0,013). Discusión: Es importante hacer un manejo conservador en mujeres con deseos genésicos y lesiones cervicales premalignas y seleccionar correctamente a las pacientes candidatas a conización. Cuando se utilizó LEEP los resultados obstétricos (en términos de prematuridad y RPMP) son peores frente a las gestantes en las que se realizó LLETZ

Objective: The aim of our study was to analyse the obstetric outcomes in women with a history of excisional treatment for cervical intraepithelial neoplasia and whether there were differences according to the methods of treatment used (loop electrosurgical excision procedure [LEEP] vs. large loop excision of the transformation zone [LLETZ]). Material and methods: A retrospective cohort study was conducted on patients who underwent conization between 2007 and 2014. Outcome measures included maternal age, parity, smoking, childbirth, abortion, interval between conization and delivery, mode of delivery, preterm prelabour rupture of the membranes (PPROM), gestational age and birth weight. A group of 100 patients who had been pregnant during the same period was used as a control group. Results: 53 (7.9%) patients became pregnant after conization, resulting in 4 (7.5%) miscarriages and 49 (92.5%) deliveries. Increased rate of preterm deliveries (18 vs. 8%, p=.048) and PPROM (22.4 vs. 3%, p=.001) was observed in the conization group. According to technique used, there were more cases of prematurity in the LEEP group against LLETZ (25 vs. 10.5%), RR=1.7 (95% CI: 1.1-2.9), no differences were found in PPROM and low weight. On the other hand, a higher proportion of caesareans was also observed in the conization group versus the control group (38.8 vs. 20%) (57%: LEEP vs. 5.3%: LLETZ, p=.013). Discussion: Conservative management and appropriate selection of candidates for conization are important in women with premalignant cervical lesions who wish to become pregnant. Worse results were observed in LEEP group (preterm delivery and PPROM) compared to women who underwent LLETZ

Effect of surgeon's experience on complications from laparoscopic hysterectomy.

OBJECTIVE: To analyze the effect of learning in two surgeons on complications and conversion to laparotomy during total and subtotal laparoscopic hysterectomy. MATERIAL AND METHODS: We analyzed retrospectively 236 total and subtotal laparoscopic hysterectomies done by two surgeons from the time they first performed the procedure. The interventions were classified in three groups based on the surgeon's experience: the first 75 hysterectomies ("novice period"), the subsequent 75 hysterectomies ("intermediate"), and the subsequent 86 hysterectomies ("routine period"). RESULTS: Patient's characteristics changed as surgeons gained experience, with more complex operations (greater obesity, previous surgery and malignant disease) becoming more frequent. During the second group of operations when surgeons had an intermediate level of experience, the risk of major complications decreased (adjusted odds ratio: 0.28, 95% confidence interval: 0.10-0.85), as did the risk of type III complications of Clavien-Dindo classification (adjusted odds ratio 0.15, 95% confidence interval: 0.03-0.93). However, the percent rate of conversion to laparotomy remained stable in the second (intermediate experience) group. In the third group, after the surgeons had performed 150 procedures and when the risk of any type of complication was lowest, the risk of conversion to laparotomy decreased compared to the routine group. CONCLUSIONS: The surgeon's experience in performing laparoscopic hysterectomy plays an essential role in the decrease in the risk of complications, and this finding supports the importance of providing appropriate training for residents and gynecologists to enable them to perform this procedure with an optimal degree of competence and safety.

Prevención del tromboembolismo venoso durante el embarazo y el puerperio en Atención Primaria y Especializada / Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care

Tras reseñar que existen una serie de factores de riesgo de enfermedad tromboembólica venosa durante la gestación, se hace hincapié en que la prevención primaria y el tratamiento de esta grave entidad durante el embarazo y el puerperio son esenciales para reducir la morbimortalidad materna. Las heparinas de bajo peso molecular constituyen el anticoagulante de elección en el embarazo. Su prescripción puede hacerla tanto el médico de Atención Primaria como el hematólogo y el obstetra. En cuanto a cuándo prescribirlas, se presenta un protocolo de aplicación tanto en Atención Primaria como Especializada, multidisciplinar, basado en la bibliografía existente al respecto, en el que se indica que los trastornos de hipercoagulabilidad, asociados a algunos de los factores de riesgo, obligan a hacer tromboprofilaxis con heparina de bajo peso molecular durante todo el embarazo y el puerperio (AU)

After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented (AU)

[Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care]. / Prevención del tromboembolismo venoso durante el embarazo y el puerperio en Atención Primaria y Especializada.

After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented.

Resultados perinatales en función de 3 criterios diagnósticos de diabetes gestacional / Perinatal outcomes according to 3 diagnostic criteria for gestational diabetes

Objetivo: Comparar la frecuencia de efectos perinatales adversos en función de 3 criterios diagnósticos de diabetes gestacional (DG). Material y métodos: Estudio prospectivo. Las gestantes se clasificaron en 3 categorías: DG según los criterios del NDDG (tratadas), criterios de Carpenter y Coustan e Hyperglycemia and Adverse Pregnancy Outcomes (no tratadas). Se comparó el riesgo de recién nacidos prematuros, macrosomías, grandes para edad gestacional y el tipo de parto entre los grupos. Resultados: Las gestantes con DG presentan mayor frecuencia de resultados perinatales adversos. Las gestantes con criterios Hyperglycemia and Adverse Pregnancy Outcomes no se diferencian significativamente de la población no diabética, mientras que aquellas con criterios de Carpenter y Coustan muestran mayor riesgo de macrosomías y grandes para edad gestacional; OR de 7,14 (1,76-29,96) y 5,84 (1,75-19,52) respectivamente. Sin embargo, no se encuentran diferencias en otras variables obstétricas como la prematuridad o el tipo de parto

Objective: To compare the frequency of adverse perinatal effects according to 3 diagnostic criteria for gestational diabetes (GD). Material and methods: We conducted a prospective study in which pregnant women were categorized according to the following criteria: NDDG (treated), Carpenter-Coustan and Hyperglycemia and Adverse Pregnancy Outcomes (untreated). We compared the risk of preterm infants, fetal macrosomia, large for gestational age infants and type of delivery among the study groups. Results: Women with GD showed a higher frequency of adverse perinatal outcomes. Women with Hyperglycemia and Adverse Pregnancy Outcomes criteria showed no significant difference with non-diabetics. Women with Carpenter-Coustan criteria showed an increased frequency of fetal macrosomia and large for gestational age infants, OR 7.14 (1.76-29.96) and 5.84 (1.75-19.52), respectively. There were no differences among the study groups in other obstetric variables such as prematurity or type of delivery

Úlcera vulvar aguda o de Lipschütz: comparación de 2 casos clínicos / Acute vulvar ulcer or Lipschütz ulcer: comparison of two clinical cases

Se presentan 2 casos clínicos referentes a pacientes prepúberes con un cuadro clínico caracterizado por la aparición de úlceras vulvares asociadas con síntomas sistémicos y orofaríngeos en los días anteriores a la aparición de dichas úlceras. Se intenta ahondar en la importancia del diagnóstico diferencial entre las diferentes enfermedades infecciosas de transmisión sexual, siendo de vital importancia descartar la posibilidad de abusos sexuales en estas pacientes. La aparición de la úlcera vulvar aguda es rara, a menudo es infradiagnosticada por su baja incidencia y su difícil diagnóstico. Aunque es un cuadro autolimitado, el tratamiento temprano es importante para minimizar la sintomatología que se deriva. El diagnóstico se basa en la clínica y la exclusión de otras causas responsables de la aparición de úlceras vulvares. El tratamiento se fundamenta en la administración de antiinflamatorios y/o antipiréticos. También pueden administrarse anestésicos locales tópicos. La mayoría de las pacientes pueden tratarse de forma ambulatoria pero en ocasiones requieren ingreso para sondaje vesical, debido a la imposibilidad para la micción derivada del dolor que esto ocasiona

We present the cases of two prepubertal girls with a clinical picture characterized by systemic and oropharyngeal symptoms a few days before the appearance of vulvar ulcers. We aim to highlight the importance of performing a differential diagnosis among distinct sexually-transmitted diseases and of excluding the possibility of sexual abuse in these patients. The development of acute vulvar ulcer is rare and this entity is often underdiagnosed because of its low incidence and difficult diagnosis. Although this process is self-limiting, early treatment is important to minimize symptoms. Diagnosis is based on clinical findings and the exclusion of other causes of genital ulcers. Treatment is based on the administration of anti-inflammatory and/or antipyretic agents. Local topical anesthetics can also be used. Most patients can be treated as outpatients. If urination is impossible due to pain, hospital admission may be required for catheterization