Marcos J. Cuerva

Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position.

To evaluate the hypothesis that intrapartum ultrasound (ITU) measurements, including the angle of progression (AOP), progression distance (PD) and head direction (HD), can predict complicated forceps delivery in non‐occiput posterior deliveries.

The sexual health approach in postmenopause: The five-minutes study

OBJECTIVES To determine whether actively addressing sexuality in a gynaecological consultation with menopausal patients improves the diagnosis of sexual problems. STUDY DESIGN A multi-centre analytical cross-sectional study was conducted at 12 Spanish hospitals. In gynaecological consultations the usual medical histories were taken, except that, initially, issues relating to sexuality were omitted, unless the patients raised them. Then, after 5min, gynaecologists offered the possibility of talking about sexuality and asked about possible sexual problems. Main outcome measures Observed prevalence of sexual problems. RESULTS A total of 256 postmenopausal women participated in the study. Of them, 12.1% reported a sexual problem during the first 5 minutes of the interview. The prevalence of patients with a sexual problem increased by 35.9% (from 12.1% to 48.0%) when they were asked about sexuality after 5min (p<0.0001). The main factors associated with having a sexual problem were genitourinary syndrome of menopause (GSM) and having a stable sexual partner. CONCLUSIONS Asking postmenopausal women about sexuality in gynaecological consultations is an important tool that increases the number of diagnoses of sexual problems. Gynaecologists should routinely ask about sexuality.

Teaching childbirth with high-fidelity simulation. Is it better observing the scenario during the briefing session?

Abstract The design of optimal courses for obstetric undergraduate teaching is a relevant question. This study evaluates two different designs of simulator-based learning activity on childbirth with regard to respect to the patient, obstetric manoeuvres, interpretation of cardiotocography tracings (CTG) and infection prevention. This randomised experimental study which differs in the content of their briefing sessions consisted of two groups of undergraduate students, who performed two simulator-based learning activities on childbirth. The first briefing session included the observations of a properly performed scenario according to Spanish clinical practice guidelines on care in normal childbirth by the teachers whereas the second group did not include the observations of a properly performed scenario, and the students observed it only after the simulation process. The group that observed a properly performed scenario after the simulation obtained worse grades during the simulation, but better grades during the debriefing and evaluation. Simulator use in childbirth may be more fruitful when the medical students observe correct performance at the completion of the scenario compared to that at the start of the scenario. Impact statement What is already known on this subject? There is a scarcity of literature about the design of optimal high-fidelity simulation training in childbirth. It is known that preparing simulator-based learning activities is a complex process. Simulator-based learning includes the following steps: briefing, simulation, debriefing and evaluation. The most important part of high-fidelity simulations is the debriefing. A good briefing and simulation are of high relevance in order to have a fruitful debriefing session. What do the results of this study add? Our study describes a full simulator-based learning activity on childbirth that can be reproduced in similar facilities. The findings of this study add that high-fidelity simulation training in childbirth is favoured by a short briefing session and an abrupt start to the scenario, rather than a long briefing session that includes direct instruction in the scenario. What are the implications of these findings for clinical practice and/or further research? The findings of this study reveal what to include in the briefing of simulator-based learning activities on childbirth. These findings have implications in medical teaching and in medical practice.

Intrapartum ultrasound prior to Kristeller maneuver: an observational study

Abstract Objectives: To evaluate the accuracy of criteria followed by obstetricians when performing a Kristeller maneuver in cases of prolonged second stage of labor. Methods: In this prospective observational study, the station of the fetal head was measured using the angle of progression (intrapartum ultrasound) just prior to the intervention of the managing obstetrician in 52 women with prolonged second stage of labor. The managing obstetricians were blinded to the sonographic results. The decision of performing a Kristeller maneuver was taken by the obstetricians based on digital palpation and their experience. Delivery mode, Apgar score, umbilical artery pH value, episiotomy, perineal tears, bleeding, and time to delivery were recorded. Results: Kristeller maneuver was performed in 36/52 (69.2%) cases. There were no significant differences between the Kristeller and the non-Kristeller group regarding the angle of progression. There were no significant differences between both groups with respect to delivery mode, perineal tears, episiotomy, bleeding, Apgar score, and umbilical artery pH value. Conclusions: Our study failed to define any criteria followed by obstetricians when performing a Kristeller maneuver in cases of prolonged second stage of labor. There was no relation between the angle of progression and the decision to perform a Kristeller maneuver.

Impact of oocyte donation on obstetric and perinatal complications in twin pregnancies

Abstract Aim: To evaluate obstetric and perinatal outcomes of twin pregnancies obtained after in vitro fertilization with donated oocytes. Methods: This is a case-control study comparing 50 women with twin pregnancies after oocyte donation (OD) and 50 women after in vitro fertilization with autologous oocytes. Clinical records were reviewed and obstetric and perinatal outcome variables including rates of preeclampsia, gestational diabetes, pregnancy-induced hypertension, preterm delivery, premature rupture of membranes, cesarean delivery, birth weight, Apgar score, pH test were compared. Results: Women in the OD group were significantly older than those in the AO group (mean 40.8 versus 36 years old, p < .001). There were a higher risk of preeclampsia (OD 24% versus AO 8%), cesarean delivery (OD 90% versus AO 66%), and preterm birth before 37 weeks (OD 52% versus AO 32%). After adjustment for maternal age, only the risk of preterm birth remained significantly higher (OR 3.2 (1.15–8.86); p = .025). Comparing neonatal outcomes, there were no differences in birth weight, pH or Apgar score at birth. Conclusions: Twin pregnancies after OD are associated with a higher risk of preterm birth before 37 weeks of gestation. However, this did not translate into increased rate of adverse perinatal outcomes.

Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

The aim of this study was to test the hypothesis that transperineal ultrasound can be used to decide whether to admit a pregnant woman due to labor.

Labor induction just after external cephalic version with epidural analgesia at term

OBJECTIVE To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. MATERIALS AND METHODS This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. RESULTS ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). CONCLUSION Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient.

Efficacy of an intimate hygiene wash solution on the global symptoms of acute vulvovaginitis in menopause women

Results: Women between the ages of 49 and 66 answered the questions. We discovered an age-related decrease in sexual interest and activity, which can be attributed to physical health problems associatedwith ageing and decreased levels of sexual hormones in both sexes. 12% of women reported no sexual desire and 17% felt reduced sexual desire, which is completely comparable to published data. Almost one in three women was found to be taking antihypertensive drugs and almost a quarter of women were taking painkillers. 6.3% of women were taking thyroid medication, 5.9% antidepressants and6.2% sedatives.While anti-diabetic drugs, antihypertensive drugs, analgesics and thyroid had no effect on libido, women who were taking sedatives or antidepressants showed a predictable decrease in their desire for sex. 17% of women were smokers, 20% smoked in the past and 61% were non-smokers. Smoking did not show to affect sexual desire. One third of women under 55 years and almost 40% over 61 years reported dryness of the vagina. Women with a dry vagina had a statistically significant lower sexual desire. Conclusions: Lesser sexual desire was present in women with signs of atrophic vaginitis and women with some medications.