Complications of transvaginal radiofrequency ablation of fibroids: A 5-year experience

Introduction: Transvaginal radiofrequency ablation is a relatively noninvasive approach for the treatment of fibroids in patients who do not wish to undergo conventional surgery. Information on potential complications of this novel technique is very scarce. Methods: Retrospective, descriptive, epidemiological study of 115 patients who underwent transvaginal radiofrequency ablation of fibroids and for whom complications were recorded. Results: We performed 115 transvaginal radiofrequency ablation procedures, we recorded a total of 11 complications (9.6%; 95% CI, 3.8-14.8). Of these, 8 (7.0%) were classified as Clavien-Dindo type I, 1 (0.9%,) as type II, and 2 (1.7%) as type IIIb (severe). No other complications were recorded in a year follow-up. Conclusion: Transvaginal radiofrequency ablation is a treatment option that malees it possible to treat fibroids that are difficult to manage using other techniques. Few associated complications have been described, and most of them are mild

Walking Promotion in Pregnancy and Its Effects on Insomnia: Results of Walking_Preg Project (WPP) Clinical Trial

Insomnia is a frequent condition during pregnancy. The aim of this study was to assess if a walking promotion program from the 12th GestationalWeek (GW) of pregnancy helps to prevent insomnia and improve the quality of sleep at third trimester. Materials and Methods: A prospective, randomized, and controlled trial was conducted with 270 pregnant women divided into 3 groups in parallel: maximum intervention group, I1 (pedometer and goal of 10,000 steps/day), minimum intervention group, I2 (pedometer without a goal), and control group (no intervention). All groups received recommendations about physical activity in pregnancy. A structured interview was performed at 13th, 20th, and 32nd GW, collecting pedometer mean steps/day, Athens Insomnia Scale (AIS), and Pittsburgh questionnaire (PSQI). Lineal regression models were conducted to determine the association between mean steps/day at 31st GW and AIS or PSQI score. Results: At 19th GW, groups I1 and I2 reached a mean of 6267 steps/day (SD = 3854) and 5835 steps/day (SD = 2741), respectively (p > 0.05). At 31st GW mean steps/day was lower for I2 (p < 0.001). Insomnia and poor sleep quality prevalence increased through pregnancy, but no differences between groups, within trimesters, were found (p > 0.05). Lineal regression showed no association between the average steps/day at third trimester of pregnancy and AIS and PSQI scores. Conclusions: Our walking promotion program based on pedometers did not help to prevent insomnia in the third trimester of pregnancy.FIBAO (Fundacion para la Investigacion Biosanitaria de Andalucia Oriental-Alejandro Otero) PI-0350-201

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.Fundacion Publica Andaluza para la Investigacion Biosanitaria (FIBAO - IBS) PI-0350-201

Complicaciones de la histerectomía en función de su vía de abordaje y otros factores

La histerectomía es la cirugía ginecológica más frecuente tras la cesárea, con millones de procedimientos realizados anualmente en el mundo, y puede realizarse por vía vaginal, laparoscópica o abdominal. Cada vía de abordaje tiene consideraciones especiales para la paciente, relativas a la vuelta a la actividad diaria, duración de la hospitalización, tiempo operatorio, viabilidad técnica y riesgo de lesión intraoperatoria. Existe un consenso general de que la histerectomía vaginal (HV) es la que se asocia a mejores resultados, con un número menor de complicaciones y mejor coste-efectividad. De este modo, la mayoría de organizaciones nacionales e internacionales afirman que de ser posible la vía de elección para la extirpación del útero, en patología benigna debe ser la vía vaginal. En caso de que la HV no fuese posible, bien por un acceso vaginal limitado, por un gran tamaño uterino o por la existencia de adherencias pélvicas, la vía recomendada sería la laparoscópica. Por otro lado, esta vía de abordaje parece que presenta un tiempo operatorio superior respecto a la histerectomía abdominal (HA) y un riesgo mayor de presentar una lesión del tracto urinario, complicaciones que no son tan acentuadas si se llevan a cabo por cirujanos con experiencia en laparoscopia. También hay un amplio consenso en dejar la vía abdominal como última opción y debe realizarse sólo cuando la HV o histerectomía laparoscópica (HL) no fuesen posibles para manejar la situación clínica de la paciente o cuando las instalaciones no pudiesen apoyar un procedimiento específico. Dado el gran número de histerectomías que se realizan en nuestro medio por las tres distintas vías de abordaje, se ha propuesto la realización de este estudio para conocer y dar respuesta a las siguientes preguntas de investigación: ¿Cuál es la frecuencia de complicaciones de la histerectomía en cada vía de abordaje (vaginal, abdominal y laparoscópica) en nuestro centro? ¿Ha variado la frecuencia de cada vía a lo largo de los años? ¿Existen otras variables que se asocien a las complicaciones en este procedimiento quirúrgico?.Tesis Univ. Granada.Programa Oficial de Doctorado en Medicina Clínica y Salud Públic

Maternal obesity and the risk of group B streptococcal colonisation in pregnant women

The aim of the study was to test if maternal obesity and being overweight are independent risk factors for rectovaginal Group B Streptococcus (GBS) colonisation in pregnancy and for early onset GBS disease in the neonate. A case-control study of 9877 deliveries was conducted. The obese gravidas were significantly more likely to be colonised by GBS when compared with non-obese gravidas (22.7% versus 17.5%, P < .001). Obese gravidas were still 33% more likely than non-obese women to test positive for GBS after adjusting for the perinatal factors (adjusted OR 1.33 [95% CI 1.12–1.56]). The risk of early onset GBS disease was not calculated due to its very low incidence. The conclusion is that maternal obesity is a significant risk factor for GBS colonisation at term.Impact statement What is already known on this subject? Group B Streptococcus (GBS) is as an important cause of perinatal mortality and morbidity if prophylaxis is not performed. Intrapartum antibiotics are given if the carrier status is positive or unknown, provided that the risk factors are present. What do the results of this study add? Maternal obesity is a significant and independent risk factor for GBS colonisation at term. What are the implications of these findings for clinical practice and/or further research? Maternal obesity may be considered as a risk factor that should be taken into account in strategies for reducing GBS disease in neonates

Complications of laparoscopic gynecologic surgery.

Journal Article;BACKGROUND AND OBJECTIVES To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. METHODS A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. RESULTS Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. CONCLUSION Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.This research was supported by the Department of Obstetrics and Gynecology, Hospital Universitario Virgen de las Nieves, Granada, Spain.Ye