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Objetivo: la Sociedad Española de Obstetricia y Ginecología establece como uno de sus objetivos el conocer la tasa de mortalidad materna en España durante el periodo 2010-2012 y sus principales causas. Sujetos y Método: con este fin, la Sociedad Española de Obstetricia y Ginecología constituye un grupo de trabajo que elabora una encuesta que se remite a los 191 jefes de servicio de hospitales públicos y privados españoles. El análisis de los datos se llevó a cabo de forma confidencial, al igual que los nombres de los centros de los que procedían. Se llevó a cabo un procedimiento confidencial de los datos y su procedencia. Se cruzaron. Se analizan las causas obstétricas directas e indirectas de los datos con los publicados por el Instituto Nacional de Estadística. Resultados: respondieron 45 hospitales (23,56%). La encuesta representa el 18,9% de los recién nacidos en España en ese periodo. La tasa de mortalidad materna fue de 6,00/100.000 nacidos. Se consideró una subestimación del 48% de los datos registrados por el Instituto Nacional de Estadística. Las causas obstétricas directas representaron el 37,5%, siendo la hemorragia postparto la más importante. La causa obstétrica indirecta representó el 56,25%. El porcentaje de autopsias fue de 31%. Conclusiones: la tasa de mortalidad materna fue de 6/100.000 nacidos. El porcentaje de subestimación en las cifras oficiales se cifra en 48%. La causa obstétrica directa representó el 37,5%, siendo la hemorragia postparto las más frecuente. Se proponen medidas para mejorar esta información en nuestro país (AU)

Objectives: One of the aims of the Spanish Society of Obstetrics and Gynaecology is to determine the rate of maternal mortality and its main causes for the period 2010-2012. Subjects and methods: To do this, the Spanish Society of Obstetrics and Gynaecology formed a working group to draft a survey sent to 191 heads of obstetrics and gynaecology services in public and private hospitals. Analysis of the data and their origin was confidential. The data were crossed with those published by the Spanish National Statistics Institute. Direct and indirect obstetric causes were analysed. Results: Forty-five hospitals responded (23.56%). The survey represented 18.9% of newborns in Spain in that period. The maternal mortality ratio was 6/100.000 births. An underestimation of 48% was observed in relation to the data from the Spanish National Statistics Institute. Direct obstetric causes accounted for 37.5% of deaths, the most important being postpartum haemorrhage. Indirect obstetric causes accounted for 56.25%. The percentage of autopsies was 31%. Conclusions: The maternal mortality ratio was 6/100.000 births. The percentage of underestimation regarding official figures was 48%. Direct obstetric causes accounted for 37.5% of deaths, the most important cause being postpartum haemorrhage. Measures to improve this information in Spain are proposed (AU)

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OBJECTIVE: To identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks. STUDY DESIGN: Analysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period. RESULTS: Most claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment. CONCLUSION: OG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.

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OBJETIVO: El objetivo de este trabajo es analizar los resultados obtenidos en nuestro centro en pacientes seleccionadas, con factores de riesgo de recidiva del prolapso genital. MÉTODOS: Serie de casos que incluye un total de 76 pacientes intervenidas, desde Julio del 2005 hasta Diciembre del 2009, de prolapso genital severo, con factores de riesgo de recidiva del prolapso genital. RESULTADOS: En el grupo Prolift® anterior se detectan, durante el seguimiento, 3 casos (6.8%) de recidiva sintomática del prolapso y 6 casos (13.6%) de aparición de prolapso de otro compartimento. En el grupo Prolift® posterior no se produce ningún caso de recidiva, pero existen 2 (10,52%) casos de prolapso de otro compartimento. En el caso del Prolift® total existen 2 (16.6%) casos de recidiva sintomática del prolapso. En cuanto a la urgencia miccional de novo: existen un total de 4 (5.33%) casos. 3 de ellos pertenecientes a la malla Prolift® anterior y 1 a la malla Prolift® total. No hemos detectado ningún caso de dolor, pélvico o en los puntos de inserción de la malla, severo que haya obligado a la reintervención por persistencia del mismo. CONCLUSIONES: El uso de mallas en la cirugía reconstructiva del suelo pélvico, en pacientes seleccionadas, con factores clínicos de riesgo de recidiva, es una buena opción de tratamiento para evitar o intentar disminuir las tasas de recidiva o reintervención descritas en la actualidad(AU)

OBJECTIVE: The aim of this paper is to analyze the results obtained in pelvic floor surgery using a non-absorbable mesh in selected patients with risk factors of recurrent prolapse. METHODS: Case series including a total of 76 patients who were surgically treated for severe genital prolapse from July 2005 to December 2009, with risk factors for recurrence of genital prolapse. RESULTS: We detected 3 cases (6.8%) of symptomatic prolapse recurrence and 6 cases (13.6%) of prolapse of another compartment in the anterior Prolift® group. In the posterior Prolift® group there were no recurrences but there were 2 cases (10.52%) of prolapse of another compartment. In the total Prolift® group, there were 2 cases (16.6%) of symptomatic prolapse recurrence. As for de novo urgency, there were a total of 4 cases (5.33%), 3 in the anterior Prolift® group and 1 in the total Prolift ® group. We did not detect any case of severe pain in the pelvis or mesh insertion points that required reoperation due to persistence. CONCLUSIONS: The use of mesh in pelvic floor reconstructive surgery in selected patients with risk factors for recurrence is a good treatment option to prevent or attempt to reduce the recurrence or reoperation rates currently described(AU)

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OBJECTIVE: The aim of this paper is to analyze the results obtained in pelvic floor surgery using a non-absorbable mesh in selected patients with risk factors of recurrent prolapse. METHODS: Case series including a total of 76 patients who were surgically treated for severe genital prolapse from July 2005 to December 2009, with risk factors for recurrence of genital prolapse. RESULTS: We detected 3 cases (6.8%) of symptomatic prolapse recurrence and 6 cases (13.6%) of prolapse of another compartment in the anterior Prolift® group. In the posterior Prolift® group there were no recurrences but there were 2 cases (10.52%) of prolapse of another compartment. In the total Prolift® group, there were 2 cases (16.6%) of symptomatic prolapse recurrence. As for de novo urgency, there were a total of 4 cases (5.33%), 3 in the anterior Prolift® group and 1 in the total Prolift® group. We did not detect any case of severe pain in the pelvis or mesh insertion points that required reoperation due to persistence. CONCLUSIONS: The use of mesh in pelvic floor reconstructive surgery in selected patients with risk factors for recurrence is a good treatment option to prevent or attempt to reduce the recurrence or reoperation rates currently described.

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La vasa previa es una situación que se produce cuando vasos fetales intramembranosos aberrantes, procedentes de la placenta o del cordón umbilical, atraviesan el orificio cervical interno y se sitúan por delante de la presentación fetal. Su incidencia es de 1/2.000-1/3.000 embarazos, y la mortalidad perinatal asociada es del 52-66%, aproximadamente. La reducción de esta elevada mortalidad se basa en su diagnóstico prenatal. Exponemos a continuación el caso clínico de una gestante, con controles obstétricos correctos, que acude a urgencias a las 34,5 semanas por rotura prematura de membranas, objetivándose un líquido amniótico hemático y bradicardia fetal severa, por lo que se realiza una cesárea urgente, naciendo una niña con anemia severa, que ingresa en la unidad de neonatología, presentando buena evolución posterior. Presentamos también una revisión de la literatura de los años 1980 al 2008, a través de Medline, usando las palabras «vasa previa» (AU)

Vasa previa is a condition in which the intramembranous fetal blood vessels within the placenta or umbilical cord cross the internal os and become trapped between the fetus and the opening of the birth canal. The incidence of this entity varies from 1/2000 to 1/3000 pregnancies and the associated perinatal mortality rate has been reported to be as high as 52-66%. Reduction of this high perinatal mortality depends on prenatal diagnosis. We report the case of a pregnant woman with no abnormalities in antenatal visits who presented to the emergency service at 34.5 weeks of pregnancy due to premature rupture of membranes, at which time blood-stained amniotic fluid and severe fetal bradycardia were noted. An emergency cesarean section was performed. A female neonate was delivered with severe anemia. The neonate was admitted into the neonatology unit and subsequent outcome was favorable. We also provide a review of the literature published between 1980 and 2008 using Medline, with the key words "vasa previa" (AU)

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INTRODUCTION: Single-incision devices for the treatment of stress urinary incontinence (SUI) have been introduced in the last few years. We report a comparison between Obturator Tension-free vaginal tape (TVT-O) and Contasure-Needleless (C-NDL). METHODS: One hundred and fifty-eight women with primary SUI were scheduled to receive TVT-O or C-NDL and follow-up during the first year. Epidemiological information, complications, blood loss, and pain level were recorded. We also analyze stress test and quality of life. RESULTS: Sixty-three (87.5%) C-NDL presented a negative stress test, compared with 54 (90%) of TVT-O (p value 0.015 for non-inferiority test). Sandvik Severity Index was 0 in 75.4% in the C-NDL group and 87.3% in the TVT-O (p < 0.015). Complication rate and degree of satisfaction were similar in both groups. Statistically, there were differences (p = 0.012) in postoperative pain in the TVT-O group. CONCLUSIONS: C-NDL provides similar outcomes as TVT-O after 1-year follow-up. It is necessary that long-term data confirm our results.

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La endometriosis de pared abdominal es inusual y prácticamente siempre se presenta adyacente a las incisiones quirúrgicas por procesos invasivos previos de la cavidad abdominal, con una incidencia máxima del 0,03-0,4% poscesárea y un intervalo de aparición después de la cirugía de 1 a 20 años en la mayoría de los casos. Se presenta como una masa o nódulo relacionado con la cicatriz, que suele asociarse a dolor cíclico. El diagnóstico definitivo es histológico, mediante ecografía, tomografía computarizada y punción-aspiración con aguja fina como métodos complementarios. El tratamiento de elección consiste en la extirpación quirúrgica de piel, tejido adiposo, músculo y peritoneo con una recuperación cercana al 100%; se considera útil el tratamiento adyuvante con análogos de la hormona liberadora de gonadotropina, ya que reducen el tamaño de la tumoración, facilitando que la exéresis de la fascia afectada no sea tan amplia y así evitar la necesidad del uso de mallas. Presentamos un caso clínico de una mujer de 34 años que, después de una segunda cesárea y con antecedente de endometriosis intrapélvica, fue diagnosticada de endometrioma sobre la incisión de Pfannestiel. Discutimos la sintomatología, el diagnóstico y el tratamiento de esta afección (AU)

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years. The clinical presentation of the disease is a palpable mass near surgical scars, usually associated with cyclic pain. The hallmark in the diagnosis of endometriosis is histology. Ultrasonographic examination, computed tomography and fine-needle aspiration biopsy can be helpful. The treatment of choice is wide local excision with a recovery rate of nearly 100%. Adjuvant treatment with GnRH analogues is used to reduce the size of the mass, thus facilitating fascial excision to avoid synthetic mesh placement. We present a case of cutaneous scar endometriosis occurring in the site of a second cesarean section scar in a 34-year-old woman with a prior history of intrapelvic endometriosis. The clinical findings, diagnosis and treatment of this disease are discussed (AU)

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OBJECTIVES: To evaluate the differences in results and complications between retropubic and obturator TVT. METHODS: Descriptive prospective study including 245 patients who underwent retropubic TVT and 90 obturator TVT after the diagnosis of stress urinary incontinence by means of clinical history, physical examination and urodynamic tests. Continence outcomes and Intraoperative/post operative complications were recorded. RESULTS: There were intraoperative complications in 12.65% of the retropubic TVT and 1.11% of the obturator TVT (p = 0.002). Immediate post operative complications appeared in 24.5% of the retropubic TVTs and 12.2% of the obturator TVTs: severe anemia (0.4 vs. 1.1%), inguinal pain (1.2 vs. 4.4%), hematoma (1.6 vs. 0%), urinary tract infection (12.2 vs. 4.4%), and acute urinary retention (8.9 vs. 2.2%) (p = 0.018). Complications during follow-up: partial exteriorization of the mesh (0.81 vs. 1.11%) and de novo urgency incontinence (9.38 vs. 4.44%) (p = 0.031). Post operative results were similar for both groups: 90.2% vs. 91.1% cured (p = 0.046), improvement in 8.2% vs. 6.7% (p = 0.18) and failure in 1.6% vs. 2.2% (p = 0.57). CONCLUSIONS: The obturator TVT seems to be preferable to retropubic TVT because it offers a lower complications rate without differences in post operative results in the short-term.

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Objetivo: Valorar diferencias respecto a resultados y complicaciones entre TVT® retropúbico y obturador. Métodos: Estudio descriptivo prospectivo; 245 pacientes con TVT®-retropúbico y 90 con TVT®-obturador diagnosticadas de incontinencia urinaria de esfuerzo mediante historia clínica, exploración y urodinamia. Se recogen complicaciones intraoperatorias y postoperatorias además de los resultados de continencia urinaria. Resultados: Complicaciones intraoperatorias en el 12.65% de TVT®-retropúbico y en el 1.11% de TVT®-obturador (p=0.002). Complicaciones durante el postoperatorio inmediato en el 24.5% de TVT®-retropúbico y en el 12.2% de TVT®-obturador : anemia severa (0.4 vs 1.1%), dolor inguinal (1.2 vs 4.4%), hematoma (1.6 vs 0%), infección urinaria (12.2 vs 4.4%) y retención urinaria (8.9 vs 2.2%) (p=0.018). Complicaciones durante el seguimiento: exteriorización parcial de malla (0.81 vs 1.11%) e incontinencia de urgencia de novo (9.38 vs 4.44%) (p=0.031). Resultados postquirúrgicos similares para ambos grupos: “curación” 90.2% vs 91.1% (p=0.046), “mejoría” 8.2% vs 6.7% (p=0.18) y “fracaso” 1.6% vs 2.2% (p=0.57). Conclusiones: TVT®-obturador parece ser preferible a TVT®-retropúbico al ofrecer una menor tasa de complicaciones sin existir diferencias en cuanto a resultados postquirúrgicos a corto plazo (AU)

Objectives: To evaluate the differences in results and complications between retropubic and obturator TVT. Methods: Descriptive prospective study including 245 patients who underwent retropubic TVT and 90 obturator TVT, after the diagnosis of stress urinary incontinence by means of clinical history, physical examination and urodynamic tests. Continence outcomes and Intraoperative/post operative complications were recorded. Results: There were intraoperative complications in 12.65% of the retropubic TVT and 1.11% of the obturator TVT (p = 0.002). Immediate post operative complications appeared in 24.5% of the retropubic TVTs and 12 .2% of the obturator TVTs: severe anemia (0.4 vs. 1.1%), inguinal pain (1.2 vs. 4.4%), hematoma (1.6 vs. 0%), urinary tract infection (12.2 vs. 4.4%), and acute urinary retention (8.9 vs. 2.2%) (p = 0.018). Complications during follow-up: partial exteriorization of the mesh (0.81 vs. 1.11%) and de novo urgency incontinence (9.38 vs. 4.44%) (p = 0.031). Post operative results were similar for both groups: 90.2% vs. 91.1% cured (p = 0.046), improvement in 8.2% vs. 6.7% (p = 0.18) and failure in 1.6% vs. 2.2% (p = 0.57). Conclusions: The obturator TVT seems to be preferable to retropubic TVT because it offers a lower complications rate without differences in post operative results in the short-term (AU)

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