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BACKGROUND Fetal smallness affects 10% of pregnancies. These fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight (EFW) and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37-38 weeks. On the other hand, the classification using angiogenic factors (AF) seems to have a lower false positive rate. Here we present a protocol for the GRAFD trial, which compares the management of small fetuses at term using AF or Doppler. OBJECTIVE The primary objective is to demonstrate that classification based on AF is not inferior to EFW and Doppler to detect fetuses at risk of adverse perinatal outcomes. METHODS This is a multicentre, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1,030 singleton pregnancies with an EFW ≤10th percentile at 36+0 to 37+6 weeks will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio (sFlt-1/PlGF) ≥38 will be classified as fetal growth restriction (FGR), otherwise as small for gestational age (SGA). In both arms, FGR will be delivered at ≥37 weeks and SGA at ≥40 weeks. We will assess the differences between groups calculating the relative risks (RR) and their 95% confidence intervals. RESULTS The study is in the recruitment and data collection phase. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences by the end of 2022 or in early 2023. CONCLUSIONS The AF-based protocol may reduce the number of pregnancies with classified as FGR without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities. CLINICALTRIAL NCT04502823

Resumen Los tumores del estroma gastrointestinal (GIST) del tabique rectovaginal son entidades muy poco frecuentes, que cuando aparecen plantean grandes dificultades por su escasa sospecha diagnostica. En la mayoria de los casos, se suelen confundir con leiomiomas o leiomiosarcomas, por su consistencia y tamano similar, por lo que desempena un papel clave el analisis histologico e inmunohistoquimico a la hora de planificar el abordaje terapeutico de estas pacientes. Presentamos el caso de una paciente de 75 anos con un tumor GIST en el tabique rectovaginal, a la que se realizo reseccion total de la lesion y posterior tratamiento con Glivec ® (mesilato de imatinib).

Resumen Objetivo Estudiar la patologia vulvar de las pacientes en edad menopausica remitidas a una unidad del tracto genital inferior (UCTI). Material y metodos Estudio observacional y descriptivo de las pacientes menopausicas con patologia vulvar remitidas a la UTGI del Hospital General Universitario de Alicante entre enero de 2000 y diciembre de 2007. Se evaluaron las patologias mas frecuentes, el tipo de lesion, la localizacion, el diagnostico y el tratamiento. Resultados Se estudio a 189 pacientes mayores de 55 anos; 68 (36%) presentaban patologia vulvar. El liquen escleroso fue la mas frecuente (46%), con prurito como sintoma principal (64%) y localizado principalmente en los labios mayores. El tratamiento instaurado con mas frecuencia fueron los corticoides de alta potencia (64%). Conclusiones La patologia vulvar mas frecuente en las pacientes menopausicas de nuestra UTGI es el liquen escleroso, que se presenta habitualmente como prurito. Los corticoides de alta potencia fueron el tratamiento mas efectivo.

ObjectiveThe purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer.Study DesignThis was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves.ResultsAfter a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach.ConclusionsThe laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.