The Peruvian Journal of Gynecology and Obstetrics

Seventy years of the Peruvian Journal of Gynecology and Obstetrics

Alfredo Guzmán — Mon, 07 Apr 2025 00:00:00 +0000

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.

Wernicke's encephalopathy secondary to hyperemesis gravidarum

Mon, 07 Apr 2025 00:00:00 +0000

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.

Prenatal diagnosis and postnatal management of fetal ovarian cyst

Jorge Luis Minchola Vega, Rider Guerrero Campos — Mon, 07 Apr 2025 00:00:00 +0000

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.

Impact of obesity on women's health

Adolfo Rechkemmer, Santiago Cabrera Ramos — Mon, 07 Apr 2025 00:00:00 +0000

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.

Obesity in pregnancy

Santiago Cabrera Ramos — Mon, 07 Apr 2025 00:00:00 +0000

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.

Obesity and menopausal transition

Eliana Ojeda-Lazo, Juan Enrique Blümel — Mon, 07 Apr 2025 00:00:00 +0000

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.

Obesity and its impact on reproductive medicine

Adolfo Rechkemmer — Mon, 07 Apr 2025 00:00:00 +0000

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 and gynecological cancer

Oscar Galdos Kajatt, Roxana Cárdenas de Galdos, Gino Venegas Rodriguez — Mon, 07 Apr 2025 00:00:00 +0000

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.

Clinical, radiological and histopathological correlation in breast lesions: 10 years of experience

Mon, 07 Apr 2025 00:00:00 +0000

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.

Characteristics of Extreme Maternal Morbidity at the Regional Hospital of Ayacucho, Peru, 2021-2023

Mon, 07 Apr 2025 00:00:00 +0000

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.

Comparison between clinical-ultrasound and pathological tumor size in breast cancer. Descriptive study

Oscar Alejandro Bonilla Sepúlveda — Mon, 07 Apr 2025 00:00:00 +0000

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.

Ovarian reserve and pregnancy prognosis in in vitro fertilization

Mon, 07 Apr 2025 00:00:00 +0000

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.