Cirugía

URI permanente para esta comunidadhttps://hdl.handle.net/11441/10999

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Predictive Model for the Diagnosis of Uterine Prolapse Based on Transperineal Ultrasound
(MDPI, 2022) García Mejido, José Antonio; Ramos Vega, Zenaida; Fernández Palacín, Ana; Borrero González, Carlota; Valdivia, Maribel; Pelayo Delgado, Irene; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
We want to describe a model that allows the use of transperineal ultrasound to define the probability of experiencing uterine prolapse (UP). This was a prospective observational study involving 107 patients with UP or cervical elongation (CE) without UP. The ultrasound study was performed using transperineal ultrasound and evaluated the differences in the pubis–uterine fundus distance at rest and with the Valsalva maneuver. We generated different multivariate binary logistic regression models using nonautomated methods to predict UP, including the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver. The parameters were added progressively according to their simplicity of use and their predictive capacity for identifying UP. We used two binary logistic regression models to predict UP. Model 1 was based on the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient [AUC: 0.967 (95% CI, 0.939–0.995; p < 0.0005)]. Model 2 used the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver, age, avulsion and ballooning [AUC: 0.971 (95% CI, 0.945–0.997; p < 0.0005)]. In conclusion, the model based on the difference in the pubis– uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient could predict 96.7% of patients with UP.
Type of levator ani muscle avulsion as predictor for the disappearance of avulsion
(Wiley, 2020) García Mejido, José Antonio; Sáinz Bueno, José Antonio; Universidad de Sevilla. Departamento de Cirugía
Objectives The objective of our study was to establish whether the type of levator ani muscle (LAM) avulsion diagnosed 6 months after delivery influences the integrity of the LAM at 1 year after delivery and determine its influence on the levator hiatus area. Study Design This observational prospective cohort study included 192 primiparous women with vaginal delivery. Transperineal ultrasound examinations were performed at 6 months and 1 year postpartum. Levator hiatus measurements (anteroposterior diameter, transverse diameter, and area) were performed in the plane of minimal dimensions. Complete avulsion was defined based on maximum contraction in multislice mode. Type I LAM avulsion was present when most lateral fibers of the pubovisceral muscle were observed at its insertion at the pubic level (the arch of the elevator remained intact). Type II LAM avulsion was defined as a complete detachment of the pubovisceral muscle from its insertion at the pubic level. Results In total, 192 patients were recruited after delivery; 48 patients were diagnosed with complete LAM avulsion, and 13 patients with avulsion did not attend the second ultrasound follow-up at 1 year after delivery. Thirty-five patients with complete LAM avulsion were included in the study. At 6 months after delivery, 51 LAM avulsions were observed in 35 patients (including bilateral LAM avulsion in 16 cases), of which 54.9% were right avulsions and 45.1% left avulsions. Furthermore, 11 (five right and six left) were type I LAM avulsions at the 6-month assessment, and all of these had disappeared 1 year after delivery. However, none of the type II LAM avulsions (23 right and 17 left) observed at 6 months had disappeared at the second ultrasound examination. There were no differences between the LAM areas detected at the first and second ultrasound examinations (10.2 ± 3.3 vs 9.3 ± 1.8; P = .404). Conclusions The type of LAM avulsion observed at 6 months after childbirth predicts LAM persistence at 1 year postpartum.

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Examinando Cirugía por Materia "3D Transperineal ultrasound"