SUMMARY OBJECTIVE: Deep pelvic endometriosis is the most common cause of chronic pelvic pain and infertility. Guidelines proposed standardized approaches for the diagnosis of deep pelvic endometriosis with ultrasonography and magnetic resonance imaging; however, knowing the reasons for discrepancy is crucial. We aimed to analyze the agreement between ultrasonography and magnetic resonance imaging for deep pelvic endometriosis findings and provide potential pitfalls and reasons for discordant findings. METHODS: The study group consists of consecutive patients with deep pelvic endometriosis diagnosed on pelvic (n=1) or transvaginal ultrasonography (n=34) who underwent noncontrast pelvic magnetic resonance imaging. The agreement between the ultrasonography and magnetic resonance imaging was assessed using the prevalence and bias-adjusted kappa statistics. Potential pitfalls and reasons for discordant findings were presented. RESULTS: The study group consisted of 35 patients with deep pelvic endometriosis. The mean age was 39.5±6.2 years. The most common site of involvement was the rectosigmoid colon (n=34, 97.1%), followed by endometrioma/hemorrhagic cyst (n=32, 91.4%). There was a perfect agreement for endometrioma/hemorrhagic cyst (100%), almost perfect agreement for bladder involvement (PABAK=0.886), and moderate agreement for other sites. The number of uterosacral ligament involvement was lower with ultrasonography than with magnetic resonance imaging. However, due to the impact of gas signals on magnetic resonance imaging imaging, the number and boundaries of rectosigmoid deep pelvic endometriosis were better defined with ultrasonography. CONCLUSION: The agreement between ultrasonography and magnetic resonance imaging for deep pelvic endometriosis findings varies according to the sites of involvement. Ultrasonography and magnetic resonance imaging are not standalone diagnostic techniques but are complementary to each other. We provided potential diagnostic pitfalls.

ABSTRACT Introduction: The cerclage and cervical pessary represent therapeutic options in the prevention of preterm childbirth. Objective: To characterize pregnant women with criteria for cerclage realization and placement of cervical pessary. Methods: A descriptive and cross-sectional study was carried out on 62 pregnant women with cerclage criteria or cervical pessary, belonging to 28 de Septiembre University Polyclinic in Santiago de Cuba who were referred by the Basic Team of Health to the provincial service of prematurity, from November, 2022 to August, 2023. The analyzed variables were: age, educational level, prematurity risk factors in obstetrics, cervical modifications observed in transvaginal echography, evaluation in provincial prematurity service, cerclage realization or placement of cervical pessary and reason of the non performance of these interventions. Results: In the case material there was a prevalence of pregnant women over 30 years (51.6 %) and pre-university educational level (43.5 %). It was observed a higher prevalence of patients with induced abortions (76.4 %), index of cervical consistency among 5-10 percentile and with open internal cervical orifice (40.0 %, respectively). The most frequent preventive procedure was the cervical cerclage. The negativism of pregnant women was the main cause for not using cerclage and cervical pessary. Conclusions: The cerclage and cervical pessary criteria identified in pregnant women allowed to evaluate the risk of preterm childbirth, what facilitated to determine the necessity of both procedures in prenatal care.

RESUMEN Introducción: El cerclaje y el pesario cervical representan opciones terapéuticas en la prevención del parto pretérmino. Objetivo: Caracterizar a las gestantes con criterios para la realización de cerclaje y colocación de pesario cervical. Métodos: Se llevó a cabo un estudio descriptivo y transversal de 62 gestantes con criterios de cerclaje o pesario cervical, pertenecientes al Policlínico Universitario 28 de septiembre de Santiago de Cuba, quienes fueron remitidas por el Equipo Básico de Salud a la consulta provincial de prematuridad, en el periodo comprendido desde noviembre de 2022 hasta agosto de 2023. Entre las variables analizadas figuraron: edad, nivel educacional, factores de riesgo de prematuridad en obstetricia, modificaciones cervicales observadas en ecografía transvaginal, evaluación en consulta de prematuridad provincial, realización de cerclaje o colocación de pesario cervical y causal de la no ejecución de estas intervenciones. Resultados: En la casuística primaron las gestantes mayores de 30 años de edad (51,6 %) y el nivel educacional preuniversitario (43,5 %). Se observó una mayor prevalencia de las pacientes con abortos inducidos (76,4 %), índice de consistencia cervical entre 5-10 percentil y con orificio cervical interno abierto (40,0 %, respectivamente). El procedimiento preventivo más frecuente resultó ser el cerclaje cervical. La negatividad de las embarazadas fue la principal causa para no utilizar el cerclaje y el pesario cervical. Conclusiones: Los criterios de cerclaje y pesario cervical identificados en las gestantes permitieron evaluar el riesgo de parto pretérmino, lo que facilitó determinar la necesidad de ambos procedimientos en la atención prenatal.

RESUMO Introdução: O tumor de Krukenberg compreende um tumor metastático raro e agressivo que faz parte dos diagnósticos diferenciais das massas ovarianas. Origina-se principalmente do trato gastrointestinal, especialmente do estômago e cólon. Sua sobrevida mediana ao diagnóstico é de 16 meses. Relato do caso: Paciente de 35 anos, hígida, queixava-se de dor abdominal baixa e dispareunia há um ano, com ultrassonografia transvaginal evidenciando massa extensa em ovário esquerdo. Por meio da investigação, foi realizada colonoscopia revelando adenocarcinoma de retossigmoide. A avaliação posterior compreendeu a análise do painel genético cujo resultado foi negativo e a revelação de metástase no fígado, no peritônio e no ovário, este último denominado tumor de Krukenberg. Após tratamento envolvendo quimioterapia, cirurgias de retossigmoidectomia com linfadenectomia e salpingo-oforectomia bilateral, cirurgias de citorredução peritoneal e de metastasectomia hepática, as duas últimas associadas à quimioterapia intraperitoneal hipertérmica, encontra-se assintomática, com qualidade de vida e em remissão completa cinco anos após o diagnóstico. Conclusão: Relatar o caso de tumor de Krukenberg com tempo de remissão mais prolongado do que o descrito em literatura, possivelmente pelas terapias combinadas utilizadas e perfil molecular favorável.

RESUMEN Introducción: El tumor de Krukenberg es un tumor metastásico raro y agresivo que forma parte del diagnóstico diferencial de las masas ováricas. Se origina principalmente en el tracto gastrointestinal, especialmente en el estómago y el colon. Su mediana de supervivencia al momento del diagnóstico es de 16 meses. Informe del caso: Paciente sana de 35 años, que consultó por dolor abdominal bajo y dispareunia de un año de evolución, con ecografía transvaginal que mostró masa extensa en ovario izquierdo. A través de la investigación, se realizó una colonoscopía que reveló un adenocarcinoma rectosigmoideo. La evaluación posterior incluyó el análisis del panel genético, cuyo resultado fue negativo y la revelación de metástasis en hígado, peritoneo y ovario, este último denominado tumor de Krukenberg. Luego de un tratamiento que incluyó quimioterapia, cirugías de rectosigmoidectomía con linfadenectomía y salpingooforectomía bilateral, cirugía de citorreducción peritoneal y metastasectomía hepática, estas dos últimas asociadas a quimioterapia intraperitoneal hipertérmica, la paciente se encuentra asintomática, con calidad de vida y en remisión completa a cinco años del diagnóstico. Conclusión: Se reporta un caso de tumor de Krukenberg con tiempo de remisión mayor al descrito en la literatura, posiblemente debido a las terapias combinadas utilizadas y al perfil molecular favorable.

ABSTRACT Introduction: Krukenberg tumor is a rare and aggressive metastatic tumor that is part of the differential diagnosis of ovarian masses. It originates mainly from the gastrointestinal tract, especially the stomach and colon. Its median survival at diagnosis is 16 months. Case report: A 35-year-old healthy patient complained of lower abdominal pain and dyspareunia for one year, with a transvaginal ultrasound showing an extensive mass in the left ovary. Through the investigation, a colonoscopy was performed revealing rectosigmoid adenocarcinoma. The subsequent evaluation included analysis of the genetic panel, the result of which was negative, and the revelation of metastases in the liver, peritoneum, and ovary, the latter called Krukenberg tumor. After treatment involving chemotherapy, rectosigmoidectomy with lymphadenectomy and bilateral salpingo-oophorectomy, peritoneal cytoreduction, and hepatic metastasectomy surgeries, the latter two associated with hyperthermic intraperitoneal chemotherapy, the patient is asymptomatic, with quality of life and in complete remission five years after diagnosis. Conclusion: Case report of Krukenberg tumor with a longer remission time than described in the literature, possibly due to the combined therapies used and favorable molecular profile.

Abstract Objective: In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents the imbalance between the production of reactive oxygen species and their detoxification. Total Antioxidant and Oxidant Status, and Oxidative Stress Index levels are the main oxidative stress markers. This study investigated the effects of oxidative stress markers on infertility etiology, embryo quality, and success of In vitro fertilization. Methods: Before enrolling in the ICSI-ET cycle, participants had their FSH and LH levels assessed on the second day of the cycle. The ovarian degrees of the participants were evaluated by transvaginal ultrasonography. Participants underwent controlled ovarian stimulation using the GnRH antagonist protocol. TV-USG and serial E2 measurements were performed at appropriate intervals to follow follicular development. Follicle sizes, quantity, and endometrial thickness were recorded. Total Antioxidant and Oxidant Status, and Oxidative analyses were conducted using Rel Assay Diagnostics Assay Kits. Results: The average number of total oocytes in the participants was 10.25±6.66, and the average of mature M2 stage oocytes was 6.71±3.72. The average number of fertilized oocytes was 4.65±2.81. Fertilization rates were calculated as approximately 54.75±25.58%. A statistically significant positive correlation was found between embryo quality and serum Total Antioxidant Status levels (p=0.004). Similarly, a significant positive correlation was observed between embryo quality and follicular Total Antioxidant Status values (r = 0.42, p = 0.01). Conclusion: This study concluded that oxidative stress markers affect certain stages of the IVF treatment process.

ABSTRACT Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2–5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access. Materials and Methods Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure. Results Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up. Conclusions Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm).

Abstract Uterine prolapse is a common pathology in the female population as longevity increases. If we take into account the concomitant rectal prolapse that these patients may have, we see a not very high frequency, although both are part of the disorders of the pelvic floor, combined surgical treatment may be a valid option to improve the quality of life of these patients. We present the results of 3 patients who underwent transvaginal hysterectomy and Delorme operation in a single procedure with satisfactory results.

Resumen El prolapso uterino es una patología frecuente en la población femenina a medida que aumenta la longevidad, si tomamos en cuenta el prolapso rectal concomitante que pueden tener estas pacientes, vemos una frecuencia no muy alta, si bien ambos forman parte de los trastornos del piso pélvico, el tratamiento quirúrgico combinado puede ser una opción válida para mejorar la calidad de vida de estas pacientes. Presentamos los resultados de 3 pacientes sometidas a histerectomía transvaginal y operación de Delorme en un solo tiempo con resultado satisfactorio.

Resumen La neoplasia ginecológica más frecuente son los leiomiomas uterinos, tumores benignos hormonodependientes que se generan del músculo liso del miometrio. Presentan una alta incidencia en mujeres en edad reproductiva entre la cuarta y quinta década de la vida y suelen disminuir con la menopausia. Generalmente son asintomáticos, pero a menudo se pueden acompañar de dismenorrea, metrorragia o infertilidad. El estudio inicial para su caracterización es la ecografía transvaginal; sin embargo, la resonancia magnética tiene un alto valor diagnóstico, ya que permite una evaluación más específica sobre el tipo, ubicación y número de leiomiomas, así como también permite identificar el tipo de degeneración y diferenciar entre leiomiomas y sus lesiones imitadoras. El objetivo principal de este manuscrito es abordar las principales características en resonancia magnética entre los distintos tipos de degeneración leiomiomatosa, siendo esta una causa de posible dolor abdominal y pélvico agudo.

Abstract The most common gynecological neoplasm is uterine leiomyomas, these are benign hormone-dependent tumors that are generated from the smooth muscle of the myometrium. They have a high incidence in women of reproductive age between the fourth and fifth decades of life and usually decrease with menopause. They are generally asymptomatic, but can often be accompanied by dysmenorrhea, metrorrhagia, or infertility. The initial study for its characterization is transvaginal ultrasound, however, magnetic resonance imaging has a high diagnostic value since it allows a more specific evaluation of the type, location and number of leiomyomas, as well as allowing the identification of the type of degeneration and differentiation. between leiomyomas and their mimic lesions. The main objective of this manuscript is to address the main characteristics in magnetic resonance between the different types of leiomyomatous degeneration, this being a cause of possible acute abdominal and pelvic pain.

Abstract Objective This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.

Abstract Background Pelvic Congestion Syndrome is an important cause of pelvic pain in adult women, leading to reduced quality of life, absenteeism from work, anxiety, depression, and sexual disorders. Objectives To evaluate the response to endovascular treatment for pelvic varicose veins using foam sclerotherapy and outline the profile of patients with this diagnosis followed up at the Hospital das Clínicas Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Brazil. Methods Based on review of medical records, this retrospective descriptive study analyzes the profile and response of patients undergoing endovascular treatment for pelvic varicose veins by foam sclerotherapy. The variables analyzed include age, weight, height, body mass index, parity, pelvic pain complaints, ultrasound criteria comparing the diameter of pelvic vessels before and after the procedure, and presence of venous reflux on transvaginal Doppler ultrasound. Results The sample of patients analyzed had an average age of 43.3 years old, a mean of 2.95 gestations, and a mean BMI of 25.37kg/m2. Ultrasound assessment after the intervention indicated a statistically significant reduction (p-value < 0.005) in the caliber of the parauterine vessels, with mean diameters of 6.34 mm on the right and 7.26 mm on the left before the procedure and 4.37 mm and 4.56 mm respectively afterwards. Conclusions Foam sclerotherapy reduced the caliber of pelvic varicose veins in the study sample. The results were similar to those of other endovascular treatment methods for this comorbidity. Further prospective studies to assess the response to this intervention are necessary to establish it as an effective option for treatment of pelvic congestion syndrome.

Resumo Contexto A síndrome de congestão pélvica (SCP) é uma importante causa de dor pélvica em mulheres adultas, levando à redução da qualidade de vida, abstenção no trabalho, ansiedade, depressão e distúrbios sexuais. Objetivos Avaliar a resposta ao tratamento endovascular por escleroterapia com espuma para varizes pélvicas e traçar o perfil das pacientes com esse diagnóstico acompanhadas no Hospital das Clínicas Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo. Métodos Com base na revisão de prontuários, este estudo descritivo retrospectivo analisa o perfil e a resposta das pacientes submetidas ao tratamento endovascular de varizes pélvicas por escleroterapia com espuma. As variáveis analisadas incluem idade, peso, altura, índice de massa corporal (IMC), paridade, queixa de dor pélvica e critérios ultrassonográficos, comparando o diâmetro dos vasos pélvicos pré e pós-procedimento, e a presença de refluxo venoso ao Doppler transvaginal. Resultados As pacientes analisadas tinham em média 43,3 anos, 2,95 gestações e IMC de 25,37kg/m2. A avaliação ultrassonográfica após intervenção indicou uma redução estatisticamente significativa (valor de p < 0,005) do calibre dos vasos parauterinos, com diâmetro médio de 6,34 mm à direita e 7,26 mm à esquerda antes do procedimento e, respectivamente, 4,37 mm e 4,56 mm após o procedimento. Conclusões A escleroterapia com espuma reduziu o calibre das varizes pélvicas na amostra estudada, com resultados semelhantes aos de outras modalidades de tratamento endovascular dessa comorbidade. A realização de mais estudos prospectivos para avaliação da resposta a essa intervenção se faz necessária para firmá-la como uma opção eficaz para o tratamento da SCP.

SUMMARY OBJECTIVE: The objective of this study was to describe the single-surgeon experience on transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension in patients with severe prolapse who had concomitant vaginal hysterectomy. METHODS: A total of 53 patients with severe uterine prolapse who underwent vaginal hysterectomy and transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension between January 2021 and March 2023 were included in the study. Operation time, intraoperative and postoperative complications, de novo urinary continence, and duration of hospitalization were obtained from the patient records. Initial postoperative follow-up visits were scheduled for the first week of the month. Patients were followed up yearly, and they had the opportunity to reach the surgical team at any time. Symptomatic prolapse beyond the hymen is defined as recurrence. RESULTS: Patients had a mean age of 61.7 years ±7.7 SD. All patients received bilateral opportunistic salpingectomy and salpingo-oophorectomy. The total operation time was 162±31 min, with transvaginal natural orifice transluminal endoscopic surgery taking 32.3±5.37 min. There were no intraoperative complications. 12 patients had recurrence; 8 anterior, 3 apical, and 1 posterior prolapse. The mean recurrence time was 11.5 months (range 5–23 months). The reoperation rate was 13.2% (n:7). Three of the patients had obliterative vaginal surgery, three of the patients had anterior, and one patient had posterior repair. Overall failure of apical surgical procedure was 5.6%. Two patients had de novo incontinence postoperatively. CONCLUSIONS: Transvaginal natural orifice transluminal endoscopic surgery uterosacral ligament suspension is a feasible technique to treat severe pelvic organ prolapse with promising results for short-term efficacy and safety in patients who had concomitant vaginal hysterectomy. Longer follow-up periods are needed to evaluate the long-term efficacy profile of transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension.

ABSTRACT Purpose: This study investigated the hypothesis of early dehiscence of hysterorrhaphy as the initial stage of post-cesarean uterine scar defects, examining the possible influence of barbed suture in this process. Methods: This longitudinal, prospective, double-blind study included 54 pregnant women with no history of cesarean section, randomized into two suture groups: #0 polyglactin or #1 barbed PDS threads. Sutures were continuous, unlocked, involved the entire myometrium in a single layer, and included the endometrium. Tridimensional transvaginal ultrasonography was performed on the second day postpartum to investigate scar dehiscence and measure its maximal width. Results: The groups had 29 and 25 participants, respectively. Ages: 18–37 (mean 25.80 ± standard error of the mean 0.69) years old. Groups were homogeneous for labor duration, cervical thickness, edge-to-os distance, retroversion, amniotic sac rupture, and additional hemostatic sutures required. Uterine retroversion accounted for 7.4% of cases. Dehiscence was observed in 68.5% (3.98 ± 0.57 mm). The only factor correlating (positively) with dehiscence width was myometrial thickness, whether proximal or distal. Conclusions: Suture type had no influence on early dehiscence, which occurred at the same rate as published niche formation rates. Tridimensional ultrasound proved effective for evaluating dehiscence.

SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Resumen Introducción : el tratamiento de la insuficiencia cervical es el cerclaje cervical. Pese a este tratamiento el riesgo de parto prematuro persiste elevado en mujeres con insuficiencia cervical. La mejor forma y utilidad del seguimiento ecográfico de mujeres cercladas es desconocida. El objetivo de esta revisión fue evaluar la capacidad pronóstica de la ecografía transvaginal para predecir riesgo de parto prematuro luego de un cerclaje cervical. Materiales y métodos : realizamos una revisión sistemática de la literatura incluyendo estudios que evaluaran el valor pronóstico de la ecografía transvaginal luego de un cerclaje cervical, para predecir parto prematuro. Resultados : incluimos 14 estudios en la revisión. El parámetro más frecuentemente asociado con parto prematuro fue la longitud cervical posterior al cerclaje, aunque con capacidad predictiva moderada. El punto de corte para definir pacientes en riesgo varió entre 15-28 mm. Conclusión : la longitud cervical disminuida posterior a un cerclaje se asocia con mayor riesgo de parto prematuro. No se ha establecido un valor de corte único ni la utilidad clínica del seguimiento ecográfico de mujeres cercladas.

Abstract Introduction : The management of cervical insufficiency involves a cervical cerclage. Despite this treatment, patients with cervical insufficiency remain at high risk of preterm delivery. The best method and utility of ultrasound monitoring for women with cervical cerclage is unknown. The objective of this revision was to evaluate the prognostic performance of ultrasonographic cervical assessment to predict preterm labor after a cervical cerclage. Material and methods : We conducted a systematic literature review, including studies that assessed the prognostic value of transvaginal ultrasound after cervical cerclage in predicting premature birth. Results : We included 14 studies in our review. The most frequently evaluated parameter was cervical length after the cerclage, although with only moderate predictive capacity. The length used to define prognosis varied from 15 to 28 mm. Conclusion : Short cervical length after a cerclage is associated with a higher risk of preterm delivery. A single cutoff value and the clinical utility of ultrasound monitoring for women with cervical cerclage have not been established.

Abstract Vaginal cuff dehiscence (VCD) and evisceration are rare but potentially severe complications of hysterectomy, with a significant risk for patient morbimortality. The authors report a case of transvaginal small bowel evisceration in a 91-year-old woman, 8 years after a hysterectomy, identified after the occurrence of a fall. Immediate manual bowel reduction and VCD correction were performed in the operating room. On the 3rd postoperative day, her intestinal transit was restored and seven days after surgery she developed acute pulmonary edema, which caused her death.

Resumo A deiscência da cúpula vaginal e a evisceração são complicações raras, mas potencialmente graves da histerectomia, com risco significativo de morbimortalidade da paciente. Os autores relatam um caso de evisceração transvaginal de intestino delgado numa mulher de 91 anos, 8 anos pós-histerectomia, identificada após uma queda. A redução manual do intestino e a correção da cúpula vaginal foi realizada no bloco operatório. Ao 3.º dia pós-operatório, o trânsito intestinal estava restabelecido e 7 dias após cirurgia, ela desenvolveu edema agudo do pulmão, o que provocou a sua morte.