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Objective: Our study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy., Study Design: Transperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data., Results: In the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm 2 for cesarean sections, compared to 16.2 ± 2.7 cm 2 for vaginal deliveries with an OR of 0.57 (0.34-0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35-0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60-1.00, 95% CI)., Conclusion: The hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate whether administration of analgesic medication one hour before undergoing office hysteroscopy decreased pain and other side effects., Study Design: A prospective randomized study was carried out in 200 patients who underwent office hysteroscopy from November 2011 until May 2012. 100 patients received 1000 mg paracetamol and 600 mg ibuprofen one hour before the procedure and 100 did not receive any medication., Results: We observed significant differences (p = 0.013) regarding the occurrence of non-pain side effects, 6% in the non-medicated group and none of the patients in the medicated group. The main pain score was always slightly higher in the group receiving no medication, though there was no statistically significant difference when compared to the medicated group., Conclusion: Administration of 1 g paracetamol and 600 mg ibuprofen one hour prior to office hysteroscopy decreased statistically the occurrence of non-pain side effects such as nausea, emesis, and hypotension. No differences in pain scores were observed., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Many women experience menorrhagia episodes resistant to medical treatment requiring definitive surgical treatment., Objective: To analyze the effectiveness of hysteroscopic endometrial resection versus Novasure system., Material and Methods: A descriptive and retrospective study comparing 20 patients who underwent endometrial ablation with Novasure vs 20 patients who underwent hysteroscopic endometrial resection. We analyzed the indication, age, time of surgery, the incidence of complications, satisfaction at 3, 6 and 12 months and technical failure., Results: No significant differences were found in terms of failure to complete the technique, and satisfaction at 3, 6 and 12 months. But significant differences regarding the mean operation time, which was reduced to 15 minutes among Novasure system patients. This could influence the total costs of the procedure., Conclusion: There were no significant differences between the two methods in terms of efficacy and safety; however, the final costs seem to be higher for the Novasure system.

Background: The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida., Objective: To determine the different risk factors for urinary incontinence after a twin pregnancy., Patients and Methods: 331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence., Results: The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058)., Conclusions: The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.