Knowledge and Opinion of Obstetrician-Gynecologists and Midwives Regarding Complementary and Alternative Medicine in Spain.

The objective of this article is to present the results from a cross-sectional survey carried out to assess and compare knowledge, attitudes, and beliefs of the obstetrician-gynecologists and midwives, regarding a set of complementary and alternative therapies in the area of the Corredor del Henares in Spain. The results show a high percentage of acceptance regarding complementary and alternative therapies in the field of obstetrics and gynecology, and more than half of the Spanish professionals of reproductive health would like to learn more about these therapies.

Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth.

OBJECTIVE: After an obstetric trauma, a non-negligible number of postpartum women complain of perineal pain and dyspareunia. These symptoms clearly diminish their quality of life. Many treatment options have been suggested, such as oral analgesia, local anaesthetic, or steroid injections… Regretfully, none of these have yet demonstrated their efficacy with the validated trials. The objective of this review is to retrospectively evaluate the response to vaginal infiltrations into the trigger points (where the vaginal/perineal examination sets off the maximum intensity of pain) combining local anaesthetic and corticosteroids. METHODS: Our goal is to detect women who complain of sexual disfunction and perineal pain 2 and 6 months after childbirth. All reviewed cases correspond to vaginal deliveries made between June 2016 and April 2017. Trigger points were detected through a vaginal examination. Patients with moderate-to-severe perineal pain were determined using a visual analogue score (VAS 0-10). We suggested a treatment of vaginal infiltration specifically into the trigger points. Patients underwent local injections with a combination of mepivacaine hydrochloride 2% (8 ml) and betamethasone acetate (2 ml). RESULTS: Twenty-seven women were treated with vaginal injections directly into the trigger points. Seven of them [7/27 (25.92%)] were treated 2 months after delivery and experienced complete recovery of their perineal pain 4 months after the treatment. Those who first chose conservative treatment [20/27 (74.08%)] were also assessed 6 months after giving birth. This group continued to suffer the same symptoms and they then subsequently underwent vaginal injections. As well as the first group, these women experienced complete recovery of their perineal pain after treatment. No side effects have been registered so far. CONCLUSION: Women treated with vaginal injection into the trigger points improved in a fast and effective way. It seems to be a well-tolerated and safe option for women with moderate-to-severe pain.

Perfil de pacientes con mutación BRCA y cáncer de mama / Profile of patients with BRCA-positive breast cancer

Objetivo. Estudiar el perfil de las pacientes con cáncer de mama y mutación BRCA1 o BRCA2. Material y métodos. Se realizó un estudio retrospectivo entre 2010 y 2016 de 28 pacientes con cáncer de mama, que presentó mutación BRCA1 o BRCA2. Se excluyeron aquellos resultados considerados negativos, no informativos o variantes de significado incierto. Se diseñó una base de datos para recogida de los mismos al presentarse en el comité de tumores del Servicio de Ginecología. Se analizaron diferentes variables epidemiológicas, del tumor, del tratamiento, seguimiento y de medidas preventivas. Se han valorado también los diferentes subtipos moleculares basándose en los marcadores inmunohistoquímicos. Resultados. Se estudió a 28 pacientes, 11 BRCA1, 17 BRCA2. Se clasificaron en los diferentes subtipos (11 luminal B, 9 triple negativo [TN], 7 luminal A, 1 HER2). La edad media ± desviación estándar al diagnóstico fue de 41,50±2,26 (24-65) años, con una mediana de 38,50 años. Las cirugías reductoras de riesgo fueron solicitadas en 22 (78,57%) pacientes; en 10 (35,71%) casos optaron por cirugía de la mama contralateral mediante mastectomía profiláctica, en 5 (17,85%) casos solo demandaron cirugía profiláctica de los ovarios, realizándose mediante laparoscopia salpingooforectomía bilateral y en las restantes 7 (25%) se realizaron ambas técnicas. Conclusión. Las mutaciones BRCA representan un bajo pero importante número dentro de los cánceres de mama por su alta penetrancia. Los subtipos más frecuentemente asociados a dichas mutaciones han sido los clasificados como luminal B en primer lugar, seguidos de TN. La realización de cirugías reductoras de riesgo ha sido demandada por un elevado porcentaje de nuestras pacientes (AU)

Objective. to study patients with breast cancer and BRCA 1 and / or 2 mutations. Material and methods. We performed a retrospective study of 28 patients with breast cancer and BRCA 1 and/or 2 mutations between 2010 and 2016. Patients were excluded if their results were negative, non-informative or variants of uncertain significance. A database was designed to gather information on patients appearing in the Tumour Committee of the Gynaecology Service. Distinct epidemiological variables, tumour characteristics, treatment and preventive measures were analysed. The different molecular subtypes were also evaluated, based on immunohistochemical biomarkers. Results. We studied 28 patients, 11 with BRCA1 and 17 with BRCA2. Tumours were classified into subtypes (11 luminal B, 9 triple negative (TN), 7 luminal A, 1 HER2). The mean age at diagnosis was 41.50+2.26 (24-65) years, with a median age of 38.50 years. Risk-reducing surgeries were requested in 22 (78.57%) patients: 10 patients (35.71%) opted for prophylactic contralateral mastectomy, 5 patients (17.85%) required prophylactic ovarian surgery performed through bilateral salpingo-oophorectomy by laparoscopy, and in the remaining 7 (25%) both techniques were performed. Conclusion. BRCA mutations represent a small but important number of tumours within breast cancers because of their high penetrance. The subtypes most frequently associated with these mutations were firstly luminal B followed by TN. Risk-reducing surgery was requested by a high percentage of our patients (AU)

[Postpartum left ovarian vein thrombosis: case report and literature review]. / Trombosis de vena ovárica izquierda posparto: revisión de la bibliografía basada en un caso clínico.

BACKGROUND: Ovarian Vein Thrombosis is an uncommon complication of the puerperium. Its unspecific clinical presentation and its low incidence make it difficult to diagnose. CASE REPORT: A 36-year-old pregnant woman has a vaginal delivery at 39+2 weeks of gestation and develops left lumbar pain irradiated to the left iliac fossa. She is diagnosed of left ovarian vein thrombosis by sonography and TC and receives anticoagulant treatment. DISCUSSION: A high index of suspicion is the key to a correct diagnosis and treatment. Confirmation with modern imaging methods is crucial for the diagnosis and treatment nowadays. CONCLUSION: The best results and lower rate of complications are achieved with an early diagnosis and anticoagulant treatment.

Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study.

STUDY OBJECTIVE: To show the decrease in pain and better tolerance to inhalation analgesia with a 50% equimolar mixture of nitrogen protoxide and oxygen in hysteroscopic polypectomy compared with paracervical anesthesia and a control group. DESIGN: One hundred six patients scheduled for office hysteroscopy and polypectomy were divided into the following 3 groups: the control group, the nitrous oxide group, and the paracervical infiltration group. Patients were assigned sequentially (Canadian Task Force classification II-1). SETTING: The study took place in a hysteroscopy outpatient clinic under the supervision of a gynecologist and 2 nurses trained to cooperate in the trial. PATIENTS: One hundred six women from Area III of Madrid Community, Spain, who had been diagnosed with endometrial polyps at a gynecology office and were scheduled for office hysteroscopy and polypectomy agreed to participate in the study. INTERVENTIONS: Patients in group 1 (control group) received no treatment. Group 2 received inhaled nitrous oxide and group 3 paracervical infiltration with 1% lidocaine. MEASUREMENTS AND MAIN RESULTS: Pain was assessed using the visual analog scale (0-10). Pain perceived by patients was lower in the nitrous Oxide group (mean: 3.55 ± 0.60, median: 3) versus the control group (mean: 5.49 ± 1.88, median: 6, p < .05) and the paracervical infiltration group (mean: 4.22 ± 1.73, median: 5). Tolerance to pain, assessed by the medical staff using qualitative variables, was bad for the control group, very good for the nitrous oxide group, and good for the paracervical infiltration group (p < .05). There were no complications in 82% of the patients in the nitrous oxide group, whereas in the paracervical infiltration group, there were complications in more than 50% of the patients. No severe complications occurred. CONCLUSION: Nitrous oxide is a safe and effective analgesic technique for polipectomy office hysteroscopy compared with the paracervical infiltration and control groups.

Health related quality of life improvement in breast cancer patients: secondary outcome from a simple blinded, randomised clinical trial.

OBJECTIVE: To determine the effectiveness of an early physiotherapy intervention for the prevention of secondary lymphoedema on health-related quality of life in women who also received an education program after breast cancer surgery. METHODS: One hundred and fifty three women diagnosed with unilateral breast cancer (stage I-II) treated with breast surgery, which included axillary lymph-node dissection, from Hospital Príncipe de Asturias, Alcalá de Henares, Madrid (Spain) were randomly assigned into two groups. Subjects in early physiotherapy group (n = 76) received a physiotherapy intervention combined with a therapeutic education program; women in the control group (n = 77) received only the therapeutic education program. Both interventions were delivered by two different physiotherapists of Physiotherapy in Women's Health Research Group at Physiotherapy Department of Alcala University. Health related quality of life was measured with EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires in 5 assessments: after surgery just before group interventions started (A1), after the 3-week group interventions finished (A2); and a follow-up period in 3 (A3), 6 (A4) and 12 (A5) months after surgical intervention. RESULTS: Greater change in quality of life was observed for early physiotherapy group arm compared to control group, although no strong statistical evidence was found (p > .05) for most of the dimensions except for physical function and social function areas (p < .003). CONCLUSIONS: The control group with therapeutic education program reported a clear improvement in the perception of quality of life. Adding early physiotherapy to the therapeutic education program did not show statistically significant changes in the global score or in most of the dimensions, but showed an improvement in the physical and social dimensions.

Rotura de cuerno uterino rudimentario en gestación de 22 semanas. A propósito de un caso y revisión de la literatura / Rupture of a rudimentary uterine horn at 22 weeks of pregnancy: A propos of a case and review of the literature

El útero unicorne con cuerno rudimentario es una anomalía mulleriana rara con una alta incidencia de complicaciones obstétricas que afecta al 4,5% de las mujeres. La gestación albergada en él ocurre en uno de cada 76.000 embarazos con un riesgo de rotura uterina de un 50-80% y ocurre normalmente a final del segundo trimestre del embarazo. El diagnóstico precoz reduce la morbimortalidad, pero la sensibilidad diagnóstica por ecografía es solo del 30%, dada la baja prevalencia de la enfermedad. Presentamos el caso de una gestante de 22 semanas, con cesárea previa, con abdomen agudo y shock hipovolémico por rotura de un cuerno rudimentario uterino (AU)

Unicornuate uterus with rudimentary horn is a rare Müllerian anomaly with a high incidence of obstetric complications, affecting 4.5% of women. Pregnancy located in the rudimentary horn occurs in 1 in 76,000 pregnancies with a risk of uterine rupture of 50-80%. Rupture usually occurs at the end of the second trimester of pregnancy. Early diagnosis reduces morbidity and mortality, but ultrasound diagnosis has a sensitivity of only 30%, due to the low prevalence of this entity. We report the case of a woman at 22 weeks of pregnancy with a previous cesarean delivery, who presented with acute abdomen and hypovolemic shock due to a ruptured rudimentary horn (AU)

Linfoma primario de cérvix: gestación tras tratamiento conservador / Primary lymphoma of the cervix: pregnancy after conservative treatment

El cérvix representa una rara localización de linfomas, con una incidencia del 0,41-0,6% de linfomas extranodales. El síntoma de inicio suele ser el sangrado vaginal, siendo diagnosticado en biopsia. No existe tratamiento estándar debido a su baja incidencia. La cirugía supone la pérdida irreversible de capacidad reproductiva. Este caso apoya la posibilidad de un manejo conservador de linfoma primario de cérvix con quimioterapia y RT si la enfermedad está localizada y se desea preservar el potencial genésico de la paciente. Sin embargo, las técnicas de criopreservación de ovocitos, embriones o transposición de tejido ovárico deberían ser planteadas previo al tratamiento, debido al mal pronóstico de este sobre la fertilidad en pacientes jóvenes (AU)

The cervix is a rare localization of lymphomas, with an incidence of 0.41- 0.6% of extranodal lymphomas. The initial symptom is usually vaginal bleeding. Diagnosis is made by biopsy. There is no standard treatment due to the low incidence of this tumor. Surgery causes irreversible loss of reproductive capacity. We report a case that illustrates the possibility of conservative treatment of primary cervical lymphoma with chemotherapy and radiotherapy in local disease if the patient wishes to preserve her reproductive ability. However, the techniques of ovocyte preservation or embryo or ovarian tissue transposition should be considered before treatment, due to its negative effects on fertility in young women (AU)

Hemofilia A adquirida posparto: guía de diagnóstico y tratamiento a raíz de un caso clínico / Postpartum adquired A Hemophilia: guide to diagnosis and treatment apropos of a case report

La hemofilia A adquirida (HAA) posparto es una entidad extremadamente infrecuente (100 casos descritos en la literatura) y potencialmente grave. Se caracteriza por la aparición de anticuerpos antifactor viii (FVIII) circulante, que producen clínica hemorrágica en el puerperio, sin afectar al feto. Por lo general, los anticuerpos desaparecen espontáneamente en las primeras semanas o meses y no se reproduce en gestaciones posteriores. Pese a que el retraso en el diagnóstico puede ser fatal, la HAA posparto presenta buena respuesta al tratamiento procoagulante e inmunosupresor, siendo de mejor pronóstico que otras causas de hemofilia A. Por esta razón, ante síntomas como metrorragia incoercible sin causa obstétrica que lo justifique y signos como pruebas de coagulación alteradas, debemos sospechar esta enfermedad y realizar las pruebas diagnósticas de confirmación para instaurar sin demora el tratamiento sintomático y etiológico (AU)

Postpartum acquired hemophilia A is an extremely rare (100 cases in the literature) and potentially serious disease. Anti-circulating factor viii (FVIII) antibodies develop in the puerperium, leading to hemorrhagic symptoms without fetal danger. In general, the antibodies disappear spontaneously in the first few weeks or months after delivery and do not recur in subsequent pregnancies. Even though a delay in diagnosis can be fatal, postpartum hemophilia A has a good response to treatment and a better prognosis than other causes of hemophilia A. Consequently, it is important to suspect this disease in the presence of symptoms such as intractable vaginal bleeding without underlying obstetric disorders and signs such as abnormal coagulation tests. The correct diagnostic tests must be carried out to establish symptomatic and etiologic treatment without delay (AU)

Miofibroblastoma mamario en paciente posmenopáusica / Breast myofibroblastoma in a menopausal woman

El miofibroblastoma mamario suele aparecer en pacientes posmenopáusicas. Es una tumoración unilateral, no dolorosa, móvil y de crecimiento lento, que no suele presentar márgenes invasivos, a diferencia del caso que presentamos. Las características típicas y el estudio histológico e inmunohistoquímico son la clave para excluir el carcinoma como diagnóstico. El tratamiento de elección es la tumorectomía, siendo la recurrencia una entidad poco frecuente que sí tuvo lugar en nuestro caso (AU)

Breast myofibroblastoma usually develops in postmenopausal patients and is a unilateral, painless and mobile tumor. Growth is slow and, unlike the case presented here, the margins are not usually invasive. The key features to exclude a diagnosis of cancer are thetypical characteristics of breast myofibroblastoma and histological and immunohistochemical studies. Although the tumor recurred in our case, the preferred treatment is tumorectomy because there is a low rate of recurrence (AU)

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura / Update of primary breast lymphomas: a case series and literature review

Introducción. Los linfomas primarios de mama (LPM) son un rarísimo proceso patológico maligno de la mama que se puede confundir fácilmente con un carcinoma de mama. El conocimiento de esta entidad nos permitirá un abordaje diagnóstico-terapéutico correcto de los pocos casos que encontramos (0,04-0,5% de cánceres de mama). Material y métodos. Esta actualización se basa en un estudio analítico retrospectivo sobre la serie de casos recogida en el Hospital Príncipe de Asturias y una exhaustiva revisión de la literatura ginecológica y oncológica. Discusión. Los LPM son una entidad cuyo diagnóstico es prácticamente indistinguible del carcinoma de mama, por su similar distribución por edad, clínica e imagen radiológica. Solo la histología permite diferenciarlos. El tratamiento más eficaz es el combinado, basándose en la quimioterapia (siendo el régimen CHOP-R el más utilizado). La cirugía y radioterapia tienen un papel secundario. La evolución de la enfermedad es muy variable, desde la diseminación precoz a la remisión completa, teniendo gran importancia los factores pronósticos de los linfomas. Un diagnóstico precoz es fundamental para mejorar el pronóstico de esta enfermedad. Conclusión. Los LPM suponen un reto diagnóstico-terapéutico por su baja prevalencia. Las pautas de tratamiento no están consensuadas y su evolución es muy variable. Es necesario un estudio más profundo para lograr unificar criterios y conocimientos sobre esta enfermedad (AU)

Introduction: Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers). Material and methods: This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Prý´ncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available. Discussion: PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome. Conclusion: Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity (AU)

Cultural adaptation and validation of the Pelvic Floor Distress Inventory short form (PFDI-20) and Pelvic Floor Impact Questionnaire short form (PFIQ-7) Spanish versions.

OBJECTIVE: To develop a linguistically adapted and psychometrically validated Spanish version of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire Short Forms (PFDI-20 and PFIQ-7) to assess symptoms and quality of life in Spanish women with pelvic floor disorders. STUDY DESIGN: Cross-cultural linguistic adaptation was performed following the translation-backtranslation method in 30 native Spanish-speaking women with pelvic floor disorders to obtain PFDI-20 and PFIQ-7 Spanish versions. The psychometric properties were evaluated in 114 women with pelvic floor disorders. We calculated the reliability with the intraclass correlation coefficient and Cronbach's alpha coefficient, the validity with Spearman coefficient, the feasibility with the response rate and the filling time, and the ceiling and floor effects. RESULTS: Spanish versions of the PFDI-20 and PFIQ-7 achieved good semantic, conceptual, idiomatic and content equivalence. Concerning the psychometric validation, internal consistency was high with Cronbach's alpha coefficient of 0.837 (p<0.001) for PFDI-20 and 0.967 (p<0.001) for PFIQ-7. The test-retest reliability was 0.644 (p<0.001) for the PFDI-20 and 0.786 (p<0.001) for the PFIQ-7. Good construct validity was found with questionnaires: SF-12, EPIQ and ICIQ-SF. The average administration time was 10.1 (5.8)min for the PFDI-20, and 7.5 (4.7)min for the PFIQ-7. A ceiling effect was detected in the PFIQ-7 (25.4%). CONCLUSIONS: The PFDI-20 and PFIQ-7 Spanish versions showed semantic, conceptual, idiomatic and content equivalence with the original versions. Both instruments are reliable, valid and feasible to evaluate symptoms and quality of life in Spanish women with pelvic floor disorders.

Urinoma prenatal y función renal posnatal / Prenatal urinoma and postnatal renal function

El urinoma es orina extravasada, contenida por la fascia de Geroto; ecográficamente es una imagen econegativa entre el riñón y la fascia renal, sin continuidad con el sistema pielocalicial ni el parénquima. Diagnosticamos un urinoma a las 24 semanas de gestación, que fue regresando y desapareció a la 28 semana; en el control posnatal objetivamos riñón displásico. Revisamos 40 casos, objetivando en un 80,6% de estos una afectación de la función renal ipsolateral. Son factores de mal pronóstico en la función renal posnatal feto femenino, aparición de urinoma en el segundo trimestre, estenosis de la unión ureteropélvica, regresión intraútero y visualización de riñón displásico(AU)

Urinoma consists of extravasated urine contained by Gerota's fascia. On ultrasound examination, this entity appears as an echo-negative image between the kidney and the renal fascia without continuity with the ureteropelvic junction or the renal parenchyma. We diagnosed a urinoma in a woman at 24 weeks of pregnancy, which was totally resorbed and disappeared at 28 weeks of pregnancy; in the postnatal stage, a dysplastic kidney was found. We reviewed 40 cases and found ipsilateral kidney involvement in 80.6% of cases. Poor prognostic factors for postnatal kidney function were female fetus, diagnosis in the second trimester, ureteropelvic junction stenosis, intrauterine resorption and visualization of a dysplastic kidney(AU)

Endometriosis vesical aislada recidivante con repercusión renal / Recurrent isolated bladder endometriosis with renal involvement

La endometriosis vesical aislada es muy infrecuente y la aparición secundaria de hidronefrosis es un hecho escasamente descrito. La manifestación clínica más frecuente es el síndrome miccional cíclico y, en menor medida, la menuria. El método más sensible para su diagnóstico es la cistoscopia. Actualmente, el tratamiento que más se aplica es la resección transuretral con el uso posterior de análogos de la hormona liberadora de la hormona luteinizante(AU)

Isolated bladder endometriosis is very uncommon. A finding of secondary hydronephrosis has barely been described in the literature. The most common symptom is urethral syndrome and, to a lesser extent, menouria. The most sensitive diagnostic test for bladder endometriosis is cystoscopy. Currently, the most widely used treatment is transurethral resection, with subsequent ovarian suppression with luteinizing hormone-releasing hormone analogues(AU)

Síndrome hiperhemolítico en gestante con drepanocitosis: desenlace fatal / Hyperhemolytic syndrome in a pregnant woman with sickle cell disease: fatal outcome

La drepanocitosis es una enfermedad caracterizada por la presencia de una hemoglobina anómala. Afecta principalmente a la raza negra. Su diagnóstico y su tratamiento en la gestante son de vital importancia, ya que puede tener repercusiones fatales tanto para la madre como para el feto. Presentamos el caso de una gestante de raza negra con drepanocitosis, el manejo de la patología y desenlace del mismo (AU)

Sickle cell disease is characterized by the presence of abnormal hemoglobin. This entity primarily affects the black population. Diagnosis and treatment of sickle cell disease in pregnant women is essential as outcome can be fatal for both mother and fetus. We report the case of a pregnant black woman with sickle cell disease. The management and outcome are discussed (AU)

Cáncer epidermoide de mama: una entidad que se debe estudiar / Squamous cell carcinoma of the breast. An entity to be studied

El carcinoma epidermoide de mama es un tumor maligno de la mama con un comportamiento muy agresivo debido a su rápida diseminación sistémica y local. Posee rasgos ecográficos y mamográficos bastante específicos, presentándose en la mayoría de los casos como un quiste complicado. Se trata de un tumor con escasa respuesta a los tratamientos convencionales, por lo que presenta un pronóstico poco favorable. Nosotros presentamos 3 casos de pacientes diagnosticadas y tratadas en nuestro centro con unos resultados similares al del resto de series (AU)

Squamous cell carcinoma of the breast is a highly aggressive malignant tumor with rapid local and systemic spread. In most patients, the ultrasonographic and mammographic features are fairly specific, and the disease usually manifests as a complicated cyst. This tumor shows poor response to conventional treatment and prognosis is unfavorable. We present three cases of squamous cell carcinoma in patients diagnosed and treated in our center. Outcomes were similar to those in other series (AU)

Tratamiento médico de la gestación ectópica cervical: nuevos avances / Medical management of cervical ectopic pregnancies: new developments

Presentamos un caso de gestación ectópica cervical con tratamiento conservador satisfactorio. Se trató mediante inyecciones sistémicas de metotrexato, que resultaron inicialmente efectivas, aunque posteriormente apareció cuadro hemorrágico genital severo que precisó dilatación y legrado cervical para su resolución, no siendo necesario ningún tipo de actitud terapéutica radical (AU)

We report a case of cervical ectopic pregnancy with successful conservative treatment. The patient was treated with systemic methotrexate injections, which initially proved effective. However, severe genital bleeding subsequently developed, requiring cervical dilation and curettage for resolution. A radical change in the therapeutic approach was not required (AU)

Aplicaciones de la histeroscopia guiada por ecografía / Role of ultrasound-guided hysteroscopy in resolving the complications of curettage in a malformed uterus

Presentamos el caso clínico de una paciente de 35 años, diagnosticada de un útero bicorne unicollis, que fue derivada a nuestro centro para legrado evacuador de un aborto diferido de 9 semanas. Durante el legrado, la cavidad que alberga la gestación se colapsa y se recurre a la histeroscopia guiada por ecografía 2D para evacuar la gestación. Gracias a dicha técnica, se alcanza el diagnóstico de útero septo completo bicorne y unicollis, se logra evacuar la gestación y se reseca el septo que separa ambos hemiúteros. Siete meses tras la intervención, la paciente logra de nuevo una gestación (AU)

We report the case of a 35-year-old woman, diagnosed with a bicornuate unicollis uterus, who was admitted to our hospital for curettage following a missed miscarriage at 9 weeks. During curettage, the cavity containing the pregnancy collapsed and 2D ultrasound-guided hysteroscopy was used to evacuate the fetal remains. Based on this technique, a diagnosis of bicornuate and complete septum uterus was reached. Resectoscopy was used to perform the curettage and to remove the septum. Seven months later, the patient became pregnant again (AU)