Revista Cubana de Obstetricia y Ginecología

Minimum access surgery in the treatment of the tubo-peritoneal factor

Fifty operated patients, who had been previously diagnosed as infertile from peritoneal tube factor were studied. The objective of this study was to find out the efficiency of this type of surgery in treating peritoneal tube factor in relation to age, type of infertility, degree according to laparoscopic classification, associated factors, applied techniques, complications at pregnancies and type of delivery. A total number of 16 pregnancies were possible: 14 were eutopic (13 term pregnancies of which 10 were eutocic and 3 cesarean sections and 1 abortion) whereas 2 were ectopic. There were minimal complications and 32 % of these females got pregnant.

Behavior of obstetric hysterectomy: Results of 6 years

A retrospective observational and descriptive study was performed to identify the situation of obstetric hysterectomy in the period from 1997 to 2002 at “America Arias” teaching gynecological and obstetric hospital. A total number of 95 cases, including those patients who underwent this surgical procedure after hemorrhagic or infectious complications, were studied. The study considered underlying diseases and those associated to the group, criteria for intervention and transoperative and postoperative complications. We concluded that obstetric hysterectomy is a health problem in our hospital, which was on the rise in the studied period, with top level in the year 2001. Anemia and uterine myoma were the two most related conditions to this surgical intervention followed by gestational hypertensive disease. The predominant indication was uterine atony and the most frequent complication was anemia.

Vulvar Paget's disease: Apropos of a case

This paper presents the case of a patient aged 59 years-old, who went in October 2003 to the uterine neck pathology department in “América Arias” gynecological and obstetric hospital, with a diagnosis of Paget´s disease of the vulva. Her clinical, histological and pathological characteristics as well as the surgical treatment applied were underlined. Emphasis was made on the symptoms of this disease and its social impact.

Study of sexuality in women in the climacteric period

Se plantea que el climaterio en la población femenina se define como el paso de la fase reproductiva a la falta de reproducción y dura aproximadamente hasta los sesenta años. Por tanto, existe un tiempo en que esta sufre una disminución de la sexualidad debido a cambios endocrinos en parte, pero principalmente por factores socioculturales que los determinan. El objetivo de este trabajo es identificar las molestias biosicosociales que la vida cotidiana le causa a la mujer en relación con la sexualidad, para lo cual se realizó un estudio prospectivo en la consulta de climaterio del hospital universitario ginecoobstétrico de Guanabacoa y la muestra estuvo constituida por 280 mujeres. La disminución del deseo sexual, la incomprensión por parte de la familia, las pocas relaciones sexuales, la autoestima disminuida y la violencia sicológica fueron los factores de la vida cotidiana que más las afectan.

It was stated in this article that climaterium is defined in the female population as the shift from reproductive phase to lack of reproduction, which lasts approximately up to the age of 60 years. Therefore, there comes a time when sexuality in women is lowered partly due to endocrine changes, but mainly to social-cultural factors that determine it. The objective of this paper was to identify the biological, psychological and social inconveniences that daily life brings to the woman with respect to sexuality. To this end, a prospective study was carried out in a sample of 280 women seen at the climateric service department of the teaching gynecological-obstetric hospital located in Guanabacoa municipality. Waning sexual desire, misunderstanding on the part of the family, few sexual intercourses, low self-esteem and psychological violence were the factors in everyday life that affected these climateric women the most.

HIV/AIDS in pregnant women

Se realiza una revisión sobre la transmisión del VIH madre a hijo, conocidas como transmisión vertical, el estado actual de las medidas preventivas y su eficacia tanto en países desarrollados como en los llamados países en vías de desarrollo, además de la repercusión que esta afección tendrá en distintos indicadores de salud si no se toman medidas urgentes para evitarlo. Se actualizan las medidas que se deben indicar durante el embarazo, parto y puerperio, así como el tratamiento al recién nacido y la importancia de la supresión de la lactancia materna.

A review was made on the HIV mother-to-child transmission, also known as vertical transmission, the present situation of the preventive measures and their efficiency both in developed and developing countries in addition to the impact that this disease will have on the various health indexes if urgent appropriate steps are not taken to avoid it. An updating on the measures to be taken during pregnancy, labor and puerperium as well as the treatment to be given to the newborn and the importance of suspending breast feeding was provided.

Transient regional osteoporosis: A case report

Se presenta el caso de una paciente primigesta, la cual a partir de las 34 semanas de embarazo comenzó con dolor en la articulación coxofemoral izquierda y posteriormente la derecha, que se incrementó al punto de imposibilitarle la marcha, por lo que se le realizó cesárea a las 39 semanas. Posterior a la cesárea se comprueba que existe una osteopenia severa. Por el cuadro clínico presentado, los complementarios realizados y la recuperación total, se concluyó el diagnóstico de osteoporosis regional transitoria, entidad que aparece aun en gestantes sanas y con requerimientos de calcio considerados aceptables. La deambulación y la desaparición del dolor se lograron en un período de 3 meses.

This paper presents the case of a primigravid patient, who at 34 weeks of pregnancy began experiencing pain first in left coxofemoral joint and then in the right one. The pain got so intensive that made walking impossible for her, so it was decided to perform cesarean section at her 39 weeks of pregnancy. After the cesarean section, a severe osteopenia was detected. Owing to the clinical picture of the patient, the supplementary tests and her total recovery, it was concluded that the final diagnosis was transient regional osteoporosis, an entity that occurs even in healthy pregnant women with adequate calcium requirements. After three months, the patient could normally walk and the pain had disappeared.

Incidence of arterial hypertension in pregnants witch oligohydramnios

A retrospective longitudinal and descriptive study was undertaken to find out the incidence of both chronic and gestational blood hypertension on gestation of 28 weeks and over complicated with oligohydrammnios, and compare it with that of idiopathic oligohidramnios, at the gynecological and obstetric hospital of Guanabacoa municipality during 2 years (2002 and 2003). One hundred sixty four patients (sample) with oligohydramnios out of 200 cases diagnosed in this period (universe) were divided into two groups to be studied: one included 60 cases with high blood pressure and the other comprised 104 cases of idiopathic cause. Other types of causes were not included. The results showed that the main cause of oligohydramnios was idiopathic but HBP holds a significant position; the majority were considered as slight (ILA from4 to 5 cm) and they occur in term pregnancies in both groups, although in hypertensives, they increase preterm whereas in idiopathic cases, they occur mostly postterm. The number of cesarean sections performed as well as perinatal morbidity and mortality were slightly higher in hypertensive patients. It was concluded that high blood pressure plays an important role in the origin of oligohydramnios particularly in term pregnancies, however, idiopathic oligohydramnios are equally harmful in terms of perinatal outcomes and distocic labor. Likewise, a thorough research on the idiopathic cause of oligohydramnios and a prophylactic work to reduce blood hypertension were recommended.

Early neonatal mortality: Analysis of 15 years

Early neonatal mortality is a component of infant mortality and is mostly found in the first 24 hours after birth, generally accounting for 65 % of deaths in the first year of life. Cuba has a very low early neonatal mortality rate that is comparable to that of the developed countries (2.7 per 1000 live births in 2004). With the objective of studying the situation of these deaths at the institution, a retrospective cross-sectional descriptive study of all early neonatal deaths occurred from January 1 st, 1990 to December 31 st, 2005 was conducted in the teaching gynecological and obstetric hospital of Guanabacoa municipality. Such a study covered the 113 dead children out of a total number of 33 894 live births. The first cause of death in this period was infection; there has been no death from hyaline membrane disease since 1998. Low birthweight was not a health problem in our hospital. Emphasis was made on the arduous work done in preventing and controlling the causes of infant mortality, which allows showing the very good results attained by the hospital since no death from hyaline membrane disease, low birthweight or prematurity occurred in this period. However, it is important to continue taking actions to prevent neonatal sepsis.

Ectopic pregnancy surgical post-sterilization: Apropos of a case

Se realizó un estudio descriptivo retrospectivo de un caso ginecológico intervenido por acceso mínimo en el hospital ginecoobstétrico docente “Ramón González Coro” en el mes de septiembre del año 2004, por presentar un embarazo extrauterino, y luego en abril del año 2005 se repite una historia similar. Se realizó una revisión de su historia clínica, en la cual se refleja que después de estar ligada por laparascopia, presenta 2 cuadros consecutivos de embarazos ectópicos no complicados, utilizando para su diagnóstico además del cuadro clínico, la cuantificación de bHCG y la ecografía que confirmaron la sospecha. Si bien está descrito en la literatura este hecho, su incidencia en las mujeres cubanas es baja; es por esto que decidimos presentar el siguiente caso.

A retrospective descriptive study was performed on a gynecological case which underwent minimum access surgery at “Ramón González Coro” teaching gynecological and obstetric hospital in September, 2004 because she presented with extrauterine pregnancy, and then in April 2005, the same patient faced a similar condition. The review of her medical history revealed that after undergoing tubal ligation by the laparoscopic method, she presented with two consecutive uncomplicated ectopic pregnancies, which were diagnosed on the basis of clinical picture, bHCG quantification and sonography for confirmation. Taking into account that although this event is described in medical literature, the incidence on Cuban females is low, hence, we decided to make this case report.

Some ethical aspects of the prenatal diagnosis, the fetal medicine and therapy

El advenimiento del diagnóstico prenatal ha modificado radicalmente el manejo de los embarazos y de los resultados perinatales. La posibilidad de diagnosticar y tratar afecciones fetales antes del nacimiento ha determinado la aparición de dilemas bioéticos propios del diagnóstico prenatal, la terapia y la medicina fetales. Cuestiones como las enfermedades a incluir en programas de diagnóstico prenatal, la indicación del procedimiento invasivo, las alternativas en caso de diagnosticarse una afección fetal, el status moral del embrión y del feto, así como los posibles tratamientos al feto y sus repercusiones; se encuentran en el centro de grandes debates éticos que incluyen no solamente a los profesionales de la salud. El presente artículo expone una revisión de los principales aspectos de algunos de estos dilemas así como los puntos de vista de diferentes autores al respecto. Se concluye que los principios generales de la bioética deben servir de base para el análisis y la solución de los nuevos dilemas que han surgido en el campo del diagnóstico prenatal y la medicina materno-fetal.

The advent of prenatal diagnosis has dramatically changed the management of pregnancy and of perinatal outcomes. The possibility of diagnosing and treating fetal problems before birth has determined the emergence of bioethical dilemmas inherent to prenatal diagnosis, fetal therapy and medicine. Issues such as diseases to be included in the prenatal diagnosis program, the indication of an invasive procedure, the alternatives to be considered in case of a fetal problem diagnosis, the moral status of the embryo and the fetus, as well as possible therapies for the fetus and their impact are part of big ethical debates that not only include health professionals but other people as well. The present article set forth a review of the main aspects of some of these dilemmas and the viewpoints of several authors in this respect. It was concluded that the general principles of bioethics should serve as a basis for the analysis and solution of new controversies that have emerged in the field of prenatal diagnosis maternal-fetal medicine.