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(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.

To evaluate if ultrasound variables at term are associated with the mode of delivery in women with previous cesarean section (PCS).This was a prospective study of singleton pregnant women who planned a trial of vaginal birth after cesarean delivery. Cervical length, posterior cervical angle, head-perineum distance, and estimated fetal weight were measured at 37-39 weeks of gestation.One hundred forty-four pregnancies were examined and vaginal delivery was achieved in 98 women (73%). Logistic regression analysis identified cervical length, head-perineum distance, age, previous vaginal delivery, previous cesarean for dystocia, and Bishop score as predictors of vaginal delivery. Combining ultrasound and clinical parameters, two models for risk scoring that differ in the variable Bishop score or cervical length were constructed. The AUC of these models was 0.867 and 0.855, respectively.In women with a PCS, measurement of cervical length and head-perineum distance at term is associated with the mode of delivery. A combination of clinical and sonographic parameters at term can predict the likelihood of vaginal delivery.

Analysis of the cervical cancer screening activity in the National Health System of Catalonia has identified a cytological coverage at 3 years of 40.8%, an interval of 2.4 years between Pap smears and a loss to follow-up of 50% at 3 years in women aged 25-65 years old. The introduction of human papillomavirus testing in the management of women with cytological results of atypical squamous cell of undetermined significance and as an adjunct to cytology in women with a history of inadequate screening has facilitated the management and detection of women at risk of developing cervical intraepithelial neoplasia grade 2 or worse (CIN2 + ). Human papillomavirus testing has demonstrated high sensitivity and specificity at 3 years in the detection of CIN2 + and was substantially superior to cytology. Furthermore, it had good inter-laboratory reproducibility and was easy to perform in routine situations. The use of uniform protocols and the extensive availability of software tools have allowed comprehensive and reliable assessment across Catalonia. The protocol has been complemented with educational interventions for healthcare professionals and regular monitoring of all activities. We conclude that the introduction of organized screening programs and human papillomavirus testing among women older than 30 years can greatly enhance efforts for the secondary prevention of CC in Catalonia.

Resumen Introduccion El acretismo placentario ha aumentado debido al incremento de la cirugia uterina previa (en particular las cesareas). La conducta ha evolucionado de un abordaje quirurgico radical a un tratamiento conservador. Caso clinico Gestante de 26,1 semanas que ingreso por rotura prematura de membranas. A los 3 dias se realizo una cesarea por riesgo de perdida de bienestar fetal apreciando acretismo placentario, dejando un fragmento en el lecho cornual. Dada la ausencia de sangrado se decidio adoptar una conducta expectante. El control clinico posterior fue correcto. Los seguimientos ecografico e histeroscopico observaron una reduccion progresiva del tamano placentario desapareciendo a los 5 meses posparto. Discusion El manejo optimo de la placenta acreta sigue siendo discutido en la literatura medica. En casos seleccionados, deberiamos ofrecer la posibilidad de realizar un tratamiento conservador, reduciendo la morbilidad y preservando la fertilidad de la paciente.

Androgen insensitivity syndrome is characterized by the presence of external female phenotype, 46,XY karyotype and intraabdominal testes. This syndrome is the third most frequent cause of primary amenorrhea, after gonadal dysgenesis and congenital absence of the vagina (Mayer-Rokitansky-Kuster-Hauser syndrome). Androgen insensitivity syndrome is of interest due to its role in sexual identification and its possible association with malignant tumors of the male gonads, which require an accurate diagnosis and surgical treatment. We present two cases of androgen insensitivity syndrome. The results of the clinical and genetic examinations, as well as the treatment and follow-up of these two patients, are discussed.

Resumen Objetivo Comparar el tiempo medio de expulsion de dos protocolos de misoprostol vaginal en abortos de segundo trimestre. Material y metodos Estudio retrospectivo de 281 casos entre enero de 2000 y diciembre de 2005 (protocolo A: 800 μg/24 h) y junio de 2007 y diciembre de 2008 (protocolo B: 400 μg/4 h). Se recogio como variable principal el tiempo de expulsion. Resultados El tiempo medio de expulsion fue similar para los dos protocolos (19,7 h para el A y 17,7 h para el B). Tampoco encontramos diferencias significativas en cuanto a las tasas de expulsion a las 12, 24 y 48 h. El efecto adverso observado con mayor frecuencia fue la fiebre, siendo mas frecuente en el protocolo B. No hubo efectos adversos mayores como rotura uterina o hemorragia severa. Conclusiones No existen diferencias significativas entre los dos protocolos en cuanto a tiempo medio de expulsion fetal, aunque si mayor porcentaje de fiebre en el protocolo B.

We report a case of genital donovanosis in a pregnant woman, whose diagnosis was difficult because of the low incidence of this disease in our country. Donovanosis or granuloma inguinale is a sexually transmitted infection that causes chronic genital painless ulceration. It is an endemic disease in tropical and subtropical countries. Due to the increase of immigration coming from these countries and sexual tourism in endemic countries, we are witnessing an increase in this infectious disease not very prevalent in our country until now.

Resumen La displasia mesenquimal placentaria (DMP) es una anomalia vascular que presenta una baja incidencia (0,02%) y se caracteriza por una placentomegalia con multiples vesiculas en grano de uva en el examen ecografico. El diagnostico diferencial principal es la mola hidatiforme parcial, pero la DMP coexiste con feto viable. Se asocia a crecimiento intauterino restringido (CIR), muerte fetal y, en el 30% de los casos, sindrome de Beckwith-Wiedemann. El diagnostico de sospecha de la DMP es ecografico, pero el diagnostico definitivo lo dara el estudio anatomopatologico. Presentamos 2 casos de DMP, cuyo diagnostico no se realizo hasta el analisis histologico, que cursaron con resultados perinatales diferentes, asi como una revision bibliografica de la displasia mesenquimal placentaria.

La sospecha clinica, el diagnostico rapido y un abordaje multidisciplinar son fundamentales para mejorar la morbimortalidad de las pacientes con hematoma subcapsular hepatico. El tratamiento de esta entidad abarca desde la conducta expectante bajo vigilancia clinica y radiologica, la embolizacion de las arterias hepaticas o la cirugia en caso de inestabilidad hemodinamica, persistencia de sangrado o incremento del dolor. Presentamos el caso de un sindrome de HELLP posparto complicado con un hematoma subcapsular hepatico y que se resolvio exitosamente con embolizacion de la arteria hepatica derecha

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment.Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies.Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event.Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction.Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

IntroductionThe fetus is most vulnerable to severe iodine deficiency and hypothyroidism during pregnancy. The effects of mild iodine deficiency and subclinical hypothyroidism are poorly known. The present study assesses the association between thyroid hormones (TH)s and urinary iodine concentration (UIC) in healthy pregnant women and the birth weight of their children.MethodsAbout 657 pregnant women were recruited in Sabadell and followed until delivery. The association between THs during the first trimester, UIC during the first and third trimesters, and birth weight was studied in 557, 251, and 528 mother–newborn pairs respectively, using linear and logistic regression models adjusted for potential confounders. Only 239 women had all the data available (thyroid function and UIC at the first and third trimesters). Six percent of newborns were classified as small for gestational age (SGA).ResultsThe median UIC was 95 and 104 μg/l during the first and third trimesters respectively. Women with the third trimester UICs between 100 and 149 μg/l had lower risk of having an SGA newborn than women with UICs below 50 μg/l (adjusted OR (95%CI): 0.15 (0.03–0.76). There was no significant reduction in SGA among mothers with higher UICs. Lower free thyroxine and higher TSH levels during the first trimester were not associated with birth weight or SGA. Nevertheless, the analyses were repeated including only those women with all the data available, and high TSH levels became statistically significantly associated with lower birth weight and higher risk of SGA.ConclusionsThe present study suggests that iodine status during pregnancy may be related to prenatal growth in healthy women.

Background: High-risk human Papillomavirus infection is a necessary factor for cervical squamous intraepithelial lesions and invasive cervical cancer. In HIV-1-infected women, HPV infection is more prevalent and a higher risk of cervical cancer has been identified. We aimed to calculate the prevalence of infection by HR-HPV, determine the factors associated with this infection and abnormal cytology findings and to describe the history of cervical cancer screening in HIV-1-infected women. Methods: We enrolled 479 HIV-1-infected women from the PISCIS cohort. Each patient underwent a gynecological checkup, PAP smear, HPV AND Hybrid capture, HPV genotyping, and colposcopy and biopsy, if necessary. We applied questionnaires to obtain information on sociodemographic, behavioral, clinical, and cervical screening variables. We present a cross-sectional analysis. Results: Median age was 42 years. The prevalence of HR-HPV infection was 33.2% and that of high-grade squamous intraepithelial lesions (HSIL) was 3.8%. The most common genotypes were 16(23%), 53(20.3%), and 52(16.2%). The factor associated with HR-HPV infection was age < 30 years (odds ratio[OR], 2.5; 95% confidence interval[CI], 1.1-5.6). The factors associated with the presence of HSIL or low-grade squamous intraepithelial lesions (LSIL) were CD4T-lymphocyte count < 200cells/mm(3) versus > 500cells/mm(3) (OR, 8.4; 95% CI, 3.7-19.2), HIV-1 viral load > 10,000copies/mL versus < 400copies/mL (OR, 2.1; 95% CI, 1.0-4.4), and use of oral contraceptives (OR, 2.0; 95% CI, 1.0-3.9). Sixty percent of HIV-1-infected women had had one Pap smear within the last 2 years. Conclusions: The high prevalence of HPV infection and cervical lesions in the HIV-1-infected population in Catalonia, as well as the low coverage and frequency of screening in this group, means that better preventive efforts are necessary and should include vaccination against HPV, better accessibility to screening programs, training of health care professionals, and specific health education for HIV-1-infected women.