Patrón menstrual y reserva ovárica en pacientes con salpingectomía y oclusión tubárica para esterilización definitiva / Menstrual pattern and ovarian reserve in patients undergoing to salpingectomy and tubal occlusion for definitive sterilization

Resumen Objetivo: Evaluar el patrón menstrual y la reserva ovárica mediante la determinación de FSH y conteo de folículos antrales en pacientes con salpingectomía y oclusión tubárica bilateral como métodos de esterilización definitiva. Material y métodos: Estudio prospectivo, longitudinal, comparativo, experimental, con asignación al azar, ciego simple, al que se incluyeron pacientes con deseos de esterilización definitiva como método anticonceptivo. Las pacientes se asignaron al azar a dos grupos, el primero con oclusión tubárica bilateral y el segundo con salpingectomía. A los seis meses posprocedimiento se evaluaron en forma ciega el patrón menstrual y la determinación sérica de hormona folículo estimulante (FSH) y el recuento de folículos antrales por ultrasonido transvaginal como marcadores de reserva ovárica. El análisis estadístico se llevó a cabo con t de Student para muestras independientes (comparación entre los grupos) y dependientes (comparación intragrupo) para comparación de medias y la prueba x2 para comparación de proporciones. Resultados: Se estudiaron 60 pacientes, 31 con oclusión tubárica bilateral y 29 con salpingectomía. Se registraron aumentos significativos en los días de sangrado menstrual con respecto a la basal después de la oclusión tubaria bilateral (p = .002) y salpingectomía (p = .008). No hubo diferencias entre oclusión tubárica bilateral y salpingectomía con respecto al tiempo quirúrgico para llevar a cabo la técnica de esterilización (p = .83), duración del ciclo menstrual (p = .35), duración de los días de sangrado menstrual (p = .40). Tampoco resultaron diferencias en las concentraciones séricas de FSH (p = 0.75) ni en el recuento de folículos antrales (p = .44) entre los grupos. Conclusiones: El patrón menstrual y la reserva ovárica son muy similares en pacientes con oclusión tubárica bilateral o salpingectomía. Ambas técnicas incrementan la duración del sangrado menstrual posterior al procedimiento. La salpingectomía implica un aumento ligero en el tiempo quirúrgico, sin diferencias en la frecuencia de complicaciones.

Abstract Objective: To evaluate the menstrual pattern and ovarian reserve in patients undergoing salpingectomy and bilateral tubal occlusion as definitive sterilization methods. Material and methods: A prospective, longitudinal, comparative, experimental, randomized, single blind study was carried out in patients with a desire for definitive sterilization as a contraceptive method. Patients were randomly assigned to perform bilateral tubal occlusion or salpingectomy. Six months after the procedure in each patient, the menstrual pattern and the serum determination of follicle stimulating hormone (FSH) and the antral follicle count were evaluated by transvaginal ultrasound as markers of ovarian reserve. The statistical analysis was carried out using the student's t-test for independent samples (comparison between groups) and dependent samples (intra-group comparison) for comparison of means and the x2 test for comparison of proportions. Results: Sixty patients were studied, 31 with bilateral tubal occlusion and 29 with salpingectomy. Significant increases were observed in the days of menstrual bleeding with respect to the baseline after bilateral tubal occlusion (p = .002) and salpingectomy (p = .008). No differences were observed between bilateral tubal occlusion and salpingectomy with respect to the surgical time to carry out the sterilization technique (p = .83), menstrual cycle duration (p = .35), duration of the days of menstrual bleeding (p = .40). No differences were observed in the serum levels of FSH (p = .75) nor in the antral follicle count (p = .44) between the groups. Conclusions: The menstrual pattern and the ovarian reserve are very similar in patients who undergo bilateral tubal occlusion and salpingectomy, although the two techniques increase the duration of menstrual bleeding after the procedure.

[Uterine leiomyomas during pregnancy and its impact on obstetric outcome]. / Miomas uterinos durante el embarazo y su repercusión en el resultado obstétrico.

BACKGROUND: The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman. OBJECTIVE: To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery. PATIENTS AND METHODS: We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome. RESULTS: The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p = 0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR = 2.9, 95% CI 1.2-7.6, p = 0.036). There were no differences in perinatal outcomes between the groups. CONCLUSIONS: Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.

[Risk factors associated with preeclampsia: case-control study]. / Factores de riesgo asociados con preeclampsia: estudio de casos y controles.

BACKGROUND: Preeclampsia is one of the most frequent and serious complication of pregnancy characterized by systemic perfusion reduction generated by vasospasm and activation of coagulation systems. OBJECTIVE: To evaluate the association between preeclampsia sociodemographics and obstetrics antecedents. MATERIAL AND METHOD: An unmatched case-control study was carried out in which all the clinical registries of patients with preeclampsia (cases: n = 196) assisted in the period 2003-2007 in the Hospital Civil of Culiacan, Sinaloa State of Mexico were analyzed. As controls the clinical registries of patients assisted during the same period were selected at random but that they didn't show up preeclampsia (n = 470). The association of preeclampsia with socioeconomic level, tobacco use, alcohol use, gynecologic and obstetric antecedents (sexual partners, pregnancies, deliveries and abortions number, prenatal control, contraceptive method) and previous pregnancy with preeclampsia were analyzed. RESULTS: There were not association between tobacco use (OR: 3.05; 95% CI: 0.81-11.48), beginning of sexual activity (p = 0.1509), number of sexual partners (OR: 1.23; 95% CI: 0.83-1.83; p = 0.3009) and sexual cohabitation less than 12 months (OR: 0.90; 95% CI: 0.63-1.27). The alcoholism (OR: 5.77; 95% CI: 1.48-22.53), socioeconomic level (p < 0.05), pregnancy previous with preeclampsia (RM:14.81; 95% CI: 1.77-123.85; p = 0.0006) were associated with preeclampsia. There were differences in the use of the contraceptive method between groups (p < 0.005). CONCLUSIONS: Preeclampsia was significantly associated with the alcoholism, low socioeconomic level and pregnancy previous with preeclampsia.

[Effect of post-abortion interpregnancy interval on obstetric and perinatal outcomes]. / Efecto del intervalo intergenésico postaborto en los resultados obstétricos y perinatales.

BACKGROUND: The interval between pregnancies is important because it allows the mother to recover after an obstetric event. OBJECTIVE: To evaluate if postabortion short interpregnancy intervals affect the obstetrics and perinatal outcome. MATERIAL AND METHODS: A cases and controls study was carried out. We studied 858 patients with a history of early pregnancy loss in the previous pregnancy, of which 286 were cases (interval postabortion < or = 6 months) and 572 controls (interval postabortion > 6 months). Abortion, preterm birth and perinatal outcomes: apgar < or = 7, morbidity, mortality, and weight of newborns were analyzed. RESULTS: The risk of abortion was similar in both groups (14.68% and 13.28%, for the cases and controls respectively (OR: 1.12; IC 95%: 0.75-1.69), and there were no differences in preterm birth (5.59% vs 8.21%; OR: 0.66; IC 95%: 0.37-1.19). Apgar was similar between the groups; there were not differences in the perinatal morbidity (RM: 0.77; IV 95%: 0.27-2.17; p = 0.8005), mortality (RM: 1.14; IC 95%: 0.33-3.94; p = 0.9145) and weight of the newborns between cases and control group. CONCLUSIONS: A short interpregnancy interval less than or equal to six months is not a risk factor for adverse obstetrical and perinatal outcome.

[Misoprostol and oxytocin for induction of cervical ripening and labor in patients with term pregnancy and premature membrane rupture]. / Misoprostol y oxytocina para inducción de madurez cervical y trabajo de parto en pacientes con embarazo a término y ruptura prematura de membranas.

OBJECTIVE: To evaluate the effect of the concurrent administration of intravaginal misoprostol and oxytocin for cervical ripening and labor induction on length labor, mode of delivery and perinatal outcomes. PATIENTS AND METHODS: One hundred seven patients with singleton pregnancy at term, vertex presentations, premature rupture of membranes and Bishop scores of < or = 4 were randomly assigned to receive one of three treatments: Group I: Intravenous oxytocin plus intravaginal misoprostol (n = 36); Group II: Intravenous oxytocin plus placebo intravaginal (n = 34); Group III: Intravaginal misoprostol plus intravenous placebo. The time interval from induction to beginning of the labor, from induction to delivery, mode of delivery and perinatal outcomes were measured. RESULTS: The mean time from induction to beginning of labor was different between the groups: Group I: 48.75 minutes, Group II: 107.50 minutes, Group III: 95.94 minutes (p = 0.0024). The mean time in minutes from induction to delivery was different between the groups: Group I: 359.83; Group II: 537.05; Group III: 474.54 (p < 0.05). The frequency of tachysystole, mode of delivery and perinatal outcomes were similar among the three groups. CONCLUSIONS: Oxytocin that is administered simultaneously with intravaginal misoprostol for cervical ripening and labor induction in patients with pregnancies at term, premature rupture of membranes and Bishop scores < 4 make the labor beginning quickly, significantly shortens induction to delivery times without affecting the mode of delivery and with no apparent adverse maternal and perinatal effects.