The Peruvian Journal of Gynecology and Obstetrics
The Peruvian Journal of Gynecology and Obstetrics (Revista Peruana de Ginecologia y Obstetricia) is the official publication of the Peruvian Society of Obstetrics and Gynecology. Its purpose is to disseminate knowledge about gynecology, obstetrics, human reproduction and other topics related to women among its members and professionals of the specialty and related specialties and health professionals in general. The Peruvian Journal in Gynecology and Obstetrics is published quarterly in four issues that comprise, our journal is peer-reviewed and indexed in: LIPECS, LATINDEX, IMBIOMED, REDALYC, DOAJ, HINARI, REDIB, SciELO, DIALNET, ESCI Web of Science, MIAR.
Sociedad Peruana de Obstetricia y Ginecología
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Immunology of pregnancy and vaccination: importance, recommended vaccines, and appropriate timing of administration
During pregnancy, the maternal immune system dynamically adapts, balancing tolerance to paternal-fetal antigens with active protection against pathogens. Maternal immunization is a fundamental public health strategy that provides protection to pregnant women, fetuses, and newborns. During pregnancy, the risk of morbidity and mortality associated with vaccine-preventable diseases increases. Maternal immunization takes advantage of the mother's natural ability to generate antibodies that cross the placenta (immunoglobulin A (IgG), which is secreted in breast milk). Inactivated vaccines, such as those recommended for pertussis (Tdap), influenza, and COVID-19, have been shown to be safe and effective during pregnancy. However, vaccine coverage is low in many regions, driven primarily by vaccine hesitancy and concerns about safety for the infant. Healthcare professionals play a key role in improving uptake through clear and proactive communication.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
I am grateful to the Peruvian Society of Obstetrics and Gynecology for conferring upon me the great honor of writing this profile, which I am sure will not be easy given the significance of Dr. José Pacheco’s life for Peruvian medical science, as he has devoted his entire professional career to the advancement of Peruvian obstetrics and gynecology.
The history of fetal medicine and surgeryin Peru gives meaning to the eternity oflife
Human beings are born with an innate perception of the eternity of life and an awareness of the struggle between good and evil, where evil symbolizes illness and death, and good symbolizes health and hope for eternal life. The phrase “there are no illnesses, only sick people” reflects a vision centered on the human person, not just on the illness, and has its roots in Peruvian and global medical history. Before the advent of writing, Peruvian doctors knew the properties of medicinal plants and developed intervention procedures, especially in the care of pregnant women, which are still used today. The arrival of writing and Western education delayed the incorporation of this knowledge due to colonial prejudices. However, thanks to the compassionate spirit of Peruvian and foreign teachers, generations of Peruvian doctors were trained who now offer high-quality fetal care, comparable to that of developed countries. Modern medicine, especially in fetal surgery, depends on interdisciplinary work based on trust, respect, and collaboration between professionals, families, and communities, following international medical protocols. The healing power of the physician lies in their faith in life and in understanding the laws that sustain it, acting in cooperation with the family and respecting human dignity. Only with knowledge of the factors that affect health before pregnancy can we transform the environment into a healthier one, thus continuing the legacy of the ancient Peruvian inhabitants.
Influenza and pregnancy: Impact ofinfection and benefits of vaccination
The influenza virus causes acute respiratory infections seasonally every year and has historically been responsible for pandemics that have resulted in high morbidity and mortality in various periods. Pregnant women and women in the postpartum period constitute an important risk group for complications arising from influenza infection. These complications can occur in the mother (pneumonia, hospitalization), the fetus (congenital anomalies), or represent adverse pregnancy outcomes (fetal death, premature birth, low birth weight). Inactivated influenza vaccines have proven to be an effective and safe tool in preventing influenza-related complications in pregnant women and infants, with their main benefit being the prevention of infections and reduction in hospitalization rates for pregnant women and infants during the first months of life. These benefits are greater when vaccination occurs during the third trimester of pregnancy and appear to be restricted to the first 4 months of the infant's life. It is recommended that pregnant women be vaccinated before the start of the peak influenza season, regardless of the trimester of pregnancy.
Tdap vaccine and pregnancy. Why is itimportant? Safety and efficacy of thevaccine
Pertussis (Bordetella pertussis) is a highly contagious respiratory disease that poses a significant threat to infants under six months of age, in whom clinical manifestations may be atypical and complications severe or fatal, including apnea, pneumonia, encephalopathy, and death. Despite the availability of effective vaccines for decades, pertussis continues to be a public health problem, with recurring epidemic cycles. Since the childhood vaccination schedule is not completed until six months of age, newborns and infants remain vulnerable. Tdap vaccination during pregnancy has been shown to be an effective and safe strategy for preventing the disease at this stage. Administering the vaccine between 20 and 36 weeks of gestation—preferably at least two weeks before delivery—ensures adequate transplacental transfer of antibodies, conferring passive protection to the newborn. Numerous observational studies and meta-analyses have shown significant reductions in hospitalizations, severe illness, and mortality in infants born to vaccinated mothers. Likewise, no significant maternal, obstetric, or neonatal risks have been observed. Nor has maternal vaccination been shown to clinically interfere with the infant's immune response after receiving their own vaccination schedule. Vaccination coverage among pregnant women in Peru is still suboptimal, highlighting the need for health personnel to commit to recommending and implementing this intervention in every pregnancy as an integral part of prenatal care.
COVID-19 and the impact of the vaccine onmaternal health during pregnancy: safetyand efficacy
Introduction. During the COVID-19 pandemic, pregnant women were one of the most affected populations, with a significant increase in the risk of complications and mortality. Objectives. To review the evidence on the safety and efficacy of COVID-19 vaccines in pregnant women and analyze their impact on maternal morbidity and mortality globally and in Peru. Methods. A narrative review of the scientific literature published in international databases and official public health reports was conducted, focusing on observational studies, systematic reviews, and relevant clinical guidelines. Results. COVID-19 vaccines, especially mRNA vaccines, have demonstrated a favorable safety profile during pregnancy, with no association with spontaneous abortion, congenital malformations, or preterm birth. They also showed significant efficacy in preventing severe disease and maternal mortality. In Peru, the inclusion of pregnant women in the national vaccination plan in 2021 was associated with a marked reduction in maternal mortality attributed to COVID-19. Conclusions. COVID-19 vaccination in pregnant women is a key public health tool with proven benefits in reducing maternal morbidity and mortality. Its implementation should continue to be a priority in pandemic and epidemic outbreak contexts.
The changes that occur in the immune system during pregnancy make the pregnant woman more susceptible to illness, or to the illness being more severe, or to causing severe fetal effects due to certain infections; thus increasing the risk of complications such as premature birth, low birth weight, neonatal infections, etc., making pregnancy one of the most vulnerable periods in terms of maternal, fetal, and neonatal morbidity and mortality.
SMAD2/SMAD3 as a regulatory axis inthe pathogenesis and progression ofendometrial cancer and their responses tohormonal therapy
Endometrial cancer stands out as the most common gynecological tumor in industrialized nations. It's crucial to thoroughly understand its molecular processes, particularly in hormone-dependent cases that often exhibit treatment resistance. Research attention has focused on SMAD2/SMAD3, crucial proteins in the transforming growth factor beta signaling pathway. These proteins are fundamental for cellular development and proper functioning, encompassing proliferation and differentiation. However, their role in cancer is ambivalent: they act as tumor inhibitors in the early stages and promote invasion and metastasis in later stages. Various studies reveal that SMAD2/SMAD3 are essential for endometrial stability, and their alteration directly contributes to tumor progression. Furthermore, they interact with estrogen and progesterone, altering the response to hormonal therapies. This interaction is vital for creating new therapeutic targets and predictive biomarkers that improve the approach to endometrial cancer. The objective of this review is to analyze the role of SMAD2/SMAD3 as a regulatory axis in the pathogenesis and progression of endometrial cancer, and their influence on responses to hormonal therapy, with the aim of identifying new therapeutic targets and predictive biomarkers.
Successful laparoscopic management in aheterotopic tubal pregnancy
Heterotopic pregnancy is defined as the coexistence of an intrauterine and an ectopic gestation. It is an exceptional event in spontaneous conceptions, although assisted reproductive techniques have significantly increased its incidence. Clinical manifestations are often nonspecific, making diagnosis challenging; however, transvaginal ultrasound is considered the method of choice for early detection. Early recognition and timely management of the ectopic pregnancy are essential to preserve maternal health and optimize perinatal outcomes, as they allow for the adequate progression of the intrauterine gestation while reducing associated complications. We present the case of a 27-year-old woman with no known risk factors, diagnosed at 8 weeks with heterotopic pregnancy following spontaneous conception. She underwent laparoscopic salpingectomy, with histopathological confirmation. The intrauterine pregnancy evolved favorably and was carried to term, culminating at 40 weeks in a vaginal delivery of a healthy newborn, with favorable maternal outcomes.
We present the case of a pregnant woman in her third trimester who was referred for management of a fetal cervical tumor with a risk of airway obstruction during delivery. The importance of prenatal referral for fetal cervical tumors and the need for a multidisciplinary approach to ensure optimal management were vital in this case. Fetal magnetic resonance imaging (MRI) plays a crucial role in assessing tumor extent and surgical planning. Although fetal cervical rhabdomyosarcoma is rare, its inclusion in the differential diagnosis is essential for appropriate treatment. Successful management of fetal cervical tumors that threaten the airways requires timely and coordinated intervention, with priority given to referring these cases to centers with medical teams trained to perform procedures such as EXIT surgery and chemotherapy, which contributes to a better prognosis for both the mother and the newborn.
Omphalocele, or exomphalos, is a congenital malformation of the midline of the abdomen involving herniation of abdominal contents at the base of the umbilical cord, limited by a membrane. It is rare and predominantly affects males. Early diagnosis of this pathology is currently possible, and ruling out other associated pathologies as well as markers of chromosomal abnormalities is essential for the prognosis of the fetus. We present a case of giant omphalocele with multidisciplinary management at the Belén de Trujillo Hospital, a tertiary care facility. Neonatology, pediatric surgery, and anesthesiology departments participated in the case, which was very important for a good outcome.
Non-diabetic ketoacidosis due tostarvation in a pregnant woman withdengue
Non-diabetic ketoacidosis in pregnant women is a rare complication, but it is potentially serious and often difficult to diagnose because blood glucose levels are normal. We present the case of a pregnant woman in her second trimester with dengue infection. After initial management, she developed metabolic acidosis and ketonuria due to oral intolerance secondary to the viral infection. With adequate fluid therapy, the patient's clinical condition improved, supporting the diagnosis.
Outpatient management of uncomplicatedectopic pregnancy with oral methotrexate
Background. Ectopic pregnancy is a significant cause of maternal morbidity in the first trimester. Although intramuscular methotrexate is the standard medical treatment, the oral route has emerged as an alternative in outpatient settings with logistical limitations. Objective. To describe the experience in the outpatient management of uncomplicated ectopic pregnancy with oral methotrexate in a gynecological center. Materials and methods. Observational, descriptive, and retrospective study. Ten patients were included, all treated with oral methotrexate (1 mg/kg every 8 hours for two days). Results. The mean age was 27.8 years (range 21–35). All patients met the criteria for early response (>15% decrease on day 4 and <50 mIU/mL on day 7) and achieved complete β-hCG negativization during follow-up, without adverse events or need for additional doses or surgery. Conclusions. Outpatient use of oral methotrexate was effective and safe in selected patients.
Breast and cervical cancer screening inPeru in 2022
Introduction: Cervical and breast cancer are the most common cancers in our country. Early detection is essential to initiate timely treatment, due to their high morbidity and mortality. In Peru, the performance of screening tests (mammography and Pap smears) has increased; however, they still remain below the latest recommendations. Objectives: To determine the frequency of Pap smears and mammograms in women in Peru in 2022 and the sociodemographic variables with which they were correlated. Methods: Observational, descriptive, correlational, and secondary study of the National Demographic and Family Health Survey (ENDES) database of 2022. which interviewed 18,243 women aged 15 to 97 years. Results: 5,636 participants answered the mammography questions (age: 51.9 +/- 8.8 years), and 13,021 answered the Pap smear (PAP) questions (age: 38.6 +/- 10.5 years). Women aged 70 and over were the most likely to receive mammography; and those aged 35 to 44 were the most likely to receive Pap smears. A total of 62.4% had had their last mammogram more than two years prior to the survey, and 29.1% had had their Pap smear more than three years prior. Conclusions: By 2022, 23.7% and 78.5% of women had undergone mammography and Pap smear tests at some point in their lives, respectively. A statistically significant relationship was found between the performance of these tests and age, education, and level of instruction.
Pioneering experience in roboticgynecological surgery in Peru: initialresults with the Da Vinci XI System –Clínica Internacional San Borja
Introduction: Robotic-assisted gynecologic surgery offers advantages in submillimetric precision, 3D visualization, and enhanced instrument articulation over conventional laparoscopy. In June 2024, Clínica Internacional San Borja implemented the Da Vinci Xi system, marking the beginning of this technique in Peru. Objectives: To describe the demographic characteristics, diagnoses, intraoperative findings, and surgical outcomes in the initial series of patients undergoing robotic gynecologic surgery. Methods: A retrospective descriptive study was conducted from June to December 2024. Surgical reports and clinical records from 24 patients were analyzed for age, diagnosis, procedure type, operative time, estimated blood loss, and hospital stay. Results: Median age was 41.7 years. The most common diagnosis was uterine leiomyoma (83.3%). A total of 25 procedures were performed, mainly hysterectomies (58.3 %) and myomectomies (33.3 %). Mean operative time was 180.7 minutes, with a mean blood loss of 101 mL. No major complications or conversions occurred. The average hospital stay was 2 days. One patient conceived following robotic surgery. Conclusions: This initial experience with the Da Vinci Xi system supports the safety and effectiveness of robotic gynecologic surgery for complex cases, with satisfactory outcomes and minimal morbidity, advocating for its integration into national clinical practice.
Gestational diabetes and risk ofobstructive sleep apnea in the thirdtrimester
Introduction: Physiological changes during pregnancy predispose women to complications such as gestational diabetes (GD) and obstructive sleep apnea (OSA). Recent studies suggest a possible relationship between the two conditions in the third trimester; however, this relationship has not yet been sufficiently explored in local contexts. Objective: To evaluate the association between gestational diabetes (GD) and the risk of obstructive sleep apnea (OSA) in third-trimester pregnant women. Methods: An observational, cross-sectional study included 152 pregnant women with ≥28 weeks' gestational age. OSA risk was assessed using the Epworth, STOP-BANG, and Mallampati scales, while the presence of GD was determined using the IADPSG criteria. Crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals were calculated. Results: A significant association was observed between the risk of OSA and gestational diabetes (cPR = 1.465) as well as with hyperglycemia (cPR = 2.03). After the adjusted analysis, only hyperglycemia showed a significant association (aPR = 1.985). Conclusion: The risk of OSA was significantly associated with hyperglycemia in pregnancy, suggesting a possible relationship with alterations in glycemic metabolism.
Transperineal ultrasound findings inpatients with stress urinary incontinencein the Department of Gynecology andObstetrics of a public hospital in 2024
Introduction: Stress urinary incontinence is common. Diagnostic aids are needed to provide objective data to optimize therapeutic strategies. Transperineal ultrasound can be used to evaluate patients with stress urinary incontinence. Objectives: To describe the transperineal ultrasound findings using measurement of urethral neck descent (BND), posterior urethrovesical angle (β angle) at rest and with de Valsalva maneuver, and the presence of bladder neck funneling in patients reporting stress urinary incontinence. Methodology: A descriptive, prospective, cross-sectional study. Transperineal ultrasound measurements were made of bladder neck descent (BND), posterior urethrovesical angle (β angle), and the presence of bladder neck funneling in patients reporting stress urinary incontinence. Results: A total of 52 patients were included. The mean bladder neck descent (BND) was 10.19 ± 5.2 mm. The mean resting posterior urethrovesical angle (β angle) was 129.27 ± 41.46°. The mean Valsalva posterior urethrovesical angle (β angle) was 129.67 ± 38.01°. Bladder neck funneling was present in fourteen (14) of the 52 patients. Conclusion: Transperineal ultrasound provides objective data for the evaluation of patients with stress urinary incontinence. Further studies with an analytical design are needed to evaluate transperineal ultrasound in the evaluation of stress urinary incontinence.
Politics refers to the art, doctrine, or practice of governing states, promoting citizen participation, and exercising power as needed to safeguard the common good within society (Wikipedia). Therefore, in matters of health, political decision-making holds particular significance, as it entails ensuring the optimal protection of population health. This requires promotional, preventive, and therapeutic actions guided by policies grounded in the best available evidence derived from scientific research, academia, medical societies, and public and private institutions. Governments compile this evidence and disseminate it through their governing bodies, ministries, or national health systems.
Obesity is a growing public health problem and its association with some chronic diseases, including some types of cancer, mainly breast cancer and endometrial cancer, is increasingly clear. In this review we analyze some mechanisms of this relationship, such as: aromatization in fatty tissue, insulin resistance, chronic inflammation and immune dysfunction.
Simposio - Obesidad y Salud Reproductiva
Obesity and its impact on reproductive medicine
Obesity has a negative impact on reproductive health, with a higher incidence of anovulation, menstrual disorders and infertility. The increase in adipose tissue is associated with insulin resistance and hyperinsulinemia, reduction in sex hormone binding globulin levels, and hyperandrogenemia. There is an increase in pro-inflammatory adipokines and a decrease in adiponectins. Female obesity is associated with ovulatory dysfunction, lower ovarian response to ovulation inducers, decreased oocyte quantity and quality, and alteration in endometrial receptivity. Likewise, a decrease in the live birth rate has been reported in in vitro fertilization treatments, and an increase in the frequency of abortions. Male obesity increases the incidence of erectile dysfunction and alterations in sperm quality. Diet, exercise, and medical therapy have been shown to be effective. Bariatric surgery is an alternative in cases of body mass index greater than 40, and achieves a rapid and effective weight reduction, with improvement in metabolic parameters; it is recommended to postpone pregnancy in women for at least one year after surgery. Bariatric surgery significantly reduces the risk of fetal macrosomia, pregnancy-associated hypertension, and gestational diabetes. However, it increases the risk of maternal anemia and small-for-gestational-age newborns.
Obesity is a chronic multifactorial disease influenced by biological, psychological, and environmental determinants, with a higher prevalence in women. It is associated with chronic inflammation, metabolic disturbances, and an increased risk of cardiovascular diseases and cancer. In postmenopause, the hormonal changes characteristic of this stage affect body composition and energy metabolism, promoting an increase in visceral adiposity. Oestrogen decline favours fat redistribution towards the abdomen, which increases insulin resistance and the prevalence of metabolic syndrome. This process is accompanied by a reduction in resting energy expenditure and lean mass, without significant variations in body mass index (BMI). It is important to emphasise that body fat distribution is a more accurate predictor of cardiometabolic risk than BMI. Additionally, obesity influences the menopausal transition, exacerbating symptoms such as hot flushes, sleep disorders, and sexual dysfunction, as well as increasing the risk of urinary incontinence, sleep apnoea, and cognitive impairment, partly due to systemic inflammation induced by adipokines. Moreover, obesity also increases the risk of cancer, particularly endometrial and breast cancer, as it is associated with greater exposure to endogenous oestrogens. Given the increase in life expectancy, a growing number of women will spend a significant portion of their lives in postmenopause, a stage in which obesity is highly prevalent. This underscores the need to address obesity as a priority public health issue due to its impact on quality of life and the risk of chronic diseases.
The pathophysiology of obesity includes adipose tissue dysfunction, alterations in adipokine secretion and chronic inflammation, which contribute to insulin resistance. During pregnancy, this increases the risk of complications such as gestational diabetes, preeclampsia, miscarriage, premature delivery and fetal death. In addition, obesity is linked to an increased risk of cesarean section, anesthetic complications, postoperative infections and venous thromboembolism. Management of obesity in this setting focuses on behavioral and lifestyle interventions, limiting excessive weight gain. The use of weight-reducing medications is contraindicated, while bariatric surgery may be an option if performed in the preconceptional state.
Throughout history, obesity has been perceived in different ways, sometimes as a symbol of health and prosperity, and sometimes as a disease. Nowadays, there is consensus in considering it as a chronic disease characterized by excessive fat accumulation and linked to cardiovascular diseases, diabetes and pregnancy complications. It is most commonly diagnosed by means of the Body Mass Index (BMI). BMI often does not accurately reflect the problem. For this reason, other methods such as Bioelectrical Impedance Analysis (BIA) and Dual Energy X-ray Absorptiometry (DXA) have been proposed. Anthropometric parameters such as skinfold thickness and mid-arm circumference are also used. Obesity is a global public health problem whose prevalence has been increasing in recent decades. In Peru, it is estimated that two-thirds of women of reproductive age have a BMI ≥ 25. There are genetic and environmental factors involved in the development of obesity. The metabolic changes associated with obesity are reviewed, including hyperinsulinemia and hyperandrogenism, increased leptin and other pro-inflammatory adipokines, and decreased adiponectin. Obese women have a higher risk of developing insulin resistance, type 2 diabetes mellitus, dyslipidemia, coronary heart disease and high blood pressure. The prevalence of menstrual irregularities due to anovulation and infertility increases, with a lower rate of live births in in vitro fertilization (IVF) treatments, and an increase in the abortion rate. Postmenopausal women tend to gain weight, due to hormonal changes and less physical activity, with a preferential increase in visceral fat. In obese women, the risk of breast, endometrial and ovarian cancer increases. Obese pregnant women have a higher risk of developing gestational diabetes and preeclampsia, fetal macrosomia and congenital anomalies. It is important to prevent obesity with early education programs regarding the short- and long-term medical consequences of obesity, and the promotion of healthy lifestyles. Treatment includes diet and exercise, and medical and surgical management options.
Seventy years of the Peruvian Journal of Gynecology and Obstetrics
In September 1955, the first issue of the Revista Peruana de Ginecología y Obstetricia (RPGO) was published, official publication of the Sociedad Peruana de Obstetricia y Ginecología (SPOG) under the Presidency of Dr. Eduardo Aguila Pardo, being Director de la RPGO, as he was named the Editor, Dr. Lucas Molina Navia and co-Director Dr. Victor M. Bazúl.
Prenatal diagnosis and postnatal management of fetal ovarian cyst
Los quistes de ovario en el feto son las tumoraciones que se detectan con mayor frecuencia en la etapa prenatal. Se diagnostican ecográficamente durante el tercer trimestre a nivel abdominal como una imagen anecogénica, unilocular, en la que puede estar presente el signo del ‘quiste hijo’. Se debe realizar el diagnóstico diferencial con otras lesiones quísticas intraabdominales. El tamaño del quiste, las características ecográficas y la presencia de síntomas o complicaciones serán los determinantes para el manejo perinatal, en la que se incluye el manejo conservador, la aspiración prenatal del quiste y la cirugía posnatal. Se comunica el caso de una gestante de 30 semanas con feto femenino que presentó un quiste abdominal dependiente de anexo que en el transcurso de sus controles ecográficos mostró un incremento en el tamaño y un cambio en el patrón ecográfico. Durante la etapa posnatal requirió de un manejo quirúrgico vía laparoscópica, con evolución favorable y seguimiento por consultorio externo sin complicaciones.
Wernicke's encephalopathy secondary to hyperemesis gravidarum
We report the case of a 32-year-old multigestational woman with 18 weeks of gestation hospitalized for hyperemesis gravidarum. She was admitted with signs of dehydration, weight loss (8.8%) and suffered fetal loss. There was evidence of impaired consciousness, horizontal and vertical nystagmus and ataxia. A brain tomography without contrast showed no alterations. Wernicke's encephalopathy was diagnosed and thiamine was replaced, with a slow and favorable evolution.
Ovarian reserve and pregnancy prognosis in in vitro fertilization
Introduction: The woman’s age and ovarian reserve are the most important factors in fertility treatment. Ovarian reserve can be calculated through antral follicle count (AFC) with vaginal ultrasound, providing valuable information on the pregnancy prognosis in assisted reproduction. Objective: To define the significance of AFC in the pregnancy prognosis in in vitro fertilization. Methods: Retrospective observational study in which the clinical records of 508 infertile patients who underwent in vitro fertilization at the Centro de Fertilidad y Ginecología del Sur from December 2005 to April 2024 were reviewed. The clinical pregnancy rate in women with AFC ≥ 5 and in those with AFC < 5 is analyzed and compared with the differences found according to age. Results: The clinical pregnancy rate in women with AFC ≥ 5 was 35.2%, while it was 14.3% in women with AFC < 5 (p = 0.0236), and was 41.9% in patients < 35 years and 27.2% in those ≥ 35 years (p = 0.0005). Differences in clinical pregnancy rate are more transcendent when considering AFC rather than age (Odds Ratio: 3.3 versus 1.9, respectively). Conclusions: Patients with AFC < 5 have three times lower clinical pregnancy rate in IVF than those with greater ovarian reserve.
Comparison between clinical-ultrasound and pathological tumor size in breast cancer. Descriptive study
Introduction: Clinical evaluation of tumor size in the TNM classification is an integral part of the diagnosis of breast carcinoma. The surgical decision depends largely on the clinical stage. Objective: To determine the concordance between the clinical- ultrasound and pathological size of invasive breast carcinoma. Materials and methods: Observational, retrospective study. Surgical pathology and ultrasound reports of patients with invasive breast carcinoma were reviewed. Data from 271 cases were included. Concordance was defined as a size difference equal to or less than 5 mm. Demographic and clinical data were collected and analyzed using descriptive statistics. Results: Concordance between clinical and pathological tumor size was 30.8% (n: 73), and ultrasound was 52.9% (n: 18). The mean clinical size was 33 mm (SD: 17.4), ultrasound was 11.3 mm (SD: 6.8) and pathological was 22.2 mm (SD: 14.4). The Student t test showed a significant difference in clinical measurement (t= 7.5 mm, 95% CI 7.33 - 12.5; p: 0.000), Pearson correlation (r: 0.224; p: 0.001) and ultrasound measurement (t: 3.83 mm, 95% CI 2.27 - 7.40; p: 0.001), Pearson correlation (r: 0.342; p: 0.048). There were significant clinical-pathological differences by clinical stages. Conclusions: In the sample studied, it was found that the clinical and ultrasound measurement of tumor size had a low correlation with the pathological tumor size, clinically there was a tendency to overestimate and ultrasound to underestimate, affecting the clinical classification (TNM) for tumor size.
Characteristics of Extreme Maternal Morbidity at the Regional Hospital of Ayacucho, Peru, 2021-2023
Extreme maternal morbidity (EMM), according to WHO, is a condition in which a woman nearly almost loses her life due to complications during pregnancy, childbirth, or the postpartum period. This rate is higher in low- and middle-income countries. Although maternal mortality has declined in Peru, the EMM is not fully described, underlining the importance of its analysis to improve maternal health services. Objective: To describe EMM in the Regional Hospital of Ayacucho, Peru, between June 2021 and June 2023, and to analyze key indicators to improve maternal care. Materials and methods: An observational, retrospective, cross-sectional study was conducted with 100 cases of EMM. Socio-demographic data, obstetric characteristics, pathological history and interventions were assessed using epidemiological surveillance forms and formulas to calculate the EMM, maternal mortality ratio and other metrics. Results: The mean age of the patients was 28 years, mostly cohabiting women with secondary education. The most frequent criteria for EMM were severe hypoxia (50%) and cardiovascular compromise (39%). HELLP syndrome (30%) and postpartum hemorrhage (22%) were the most common complications. The EMM was 19.4 per 1,000 live births and the maternal mortality ratio was 5.75 per 100 cases of EMM. Conclusions: The EMM in Ayacucho (2021-2023) reveals severe complications mainly in young women with low educational level. It is crucial to implement effective prevention and management strategies to reduce its incidence and improve obstetric outcomes.
Clinical, radiological and histopathological correlation in breast lesions: 10 years of experience
Introduction: Breast cancer remains a global public health problem. It is estimated that its incidence will increase in the coming years. It is important to evaluate screening studies in breast clinics through indicators in order to obtain an adequate clinical, imaging and histopathological correlation. Objectives: To evaluate the correlation between clinical, radiological and histopathological studies in women who underwent breast cancer screening tests over a 10-year period. Methods: A cross-sectional, descriptive, retrospective cohort study was conducted using the records of a referral center from June 2013 to June 2023, of women who underwent breast cancer screening. In those who underwent biopsy, the samples were analyzed at our institution. Results: The records of 6 754 women who met the inclusion criteria were analyzed, where the average age of the study population was 50.7 years. It was recorded that 73.2% of the studies were categorized BI-RADS 2 and the majority of the participants were asymptomatic. Of those 551 women who received a BI-RADS >4 mammogram, 226 (41%) had a malignant result. Conclusions: Mammography has been shown to be the only imaging tool that has managed to have an impact on mortality. There are modalities, such as tomosynthesis, that have increased the performance of this test. It is valid to use new technologies to maintain quality standards in the studies.