A crucial point in the management of pelvic inflammatory disease (PID) is to determine the most appropriate treatment for each case. Usually the initial management is outpatient. But depending of the severity hospitalization might be required. Taking into account the polimicrobial nature of this entity, antibiotic therapy will be broad spectrum and the election will be directed to the most frequent microbes. Treatment should not only be directed to the acute process eradication but to the prevention of its complications, such as chronic pelvic pain, infertility and ectopic pregnancy, which can be avoided or minimized if a precocious, aggressive and broad coverage is done. The most severe forms of pelvic inflammatory disease presentation are tubo-ovarian abscess and pelvic abscess. Treatment of these pathologies has varied on time from a very radical conduct in the pre-antibiotic era to a...

Ovarian tumors occur mostly during the reproductive stage. Of women and therefore constitutes one of the problems most common that the gynecologist has to deal with in their daily practice. Approximately 10% of these tumors will need surgical treatment To be resolved.

Diagnostic laparoscopy is routinely done in the infertile couple initial evaluation and as diagnostic method of tubal pathology and other intrapelvic causes of infertility. In many centers this procedure is accepted as a final procedure in the infertility work up before the couple is subjected to treatment. However, lately its real value has been questioned and there has been a growing tendency to bypass diagnostic laparoscopy in case of a normal histerosalpingography and treat infertility by intrauterine insemination (IIU) or in vitro fertilization (FIV). Currently it is not clear when we should perform diagnostic laparoscopy in the infertility work up. This review analyzes available evidence to assess the role of diagnostic laparoscopy in the infertile couple work up and its repercussion in infertility treatment, and when laparoscopy intervention should be performed in women undergoing...

Intrauterine insemination is the first treatment option in the infertile couple in patients with unexplained infertility, minimal and mild endometriosis, subfertility for cervical factor, or subfertility for mild male factor. But its effectiveness has been questioned for the low success rates and probable risks as multiple pregnancy and ovarian hyperestimulation syndrome. Nevertheless it continues being a widely used technique due to its simplicity and low cost, advantages over in vitro fertilization. IVF provides better success rates and the possibility of only one embryo transfer and subsequent transfer of frozen embryos, thus decreasing the risks despite being more expensive. This review tries to establish what is intrauterine insemination status at present, if it continues being in forcé and if it has a place in the infertile couple treatment or it will be withdrawal due to IVF.

Intrauterine insemination is the first treatment option in the infertile couple in patients with unexplained infertility, minimal and mild endometriosis, subfertility for cervical factor, or subfertility for mild male factor. But its effectiveness has been questioned for the low success rates and probable risks as multiple pregnancy and ovarian hyperestimulation syndrome. Nevertheless it continues being a widely used technique due to its simplicity and low cost, advantages over in vitro fertilization. IVF provides better success rates and the possibility of only one embryo transfer and subsequent transfer of frozen embryos, thus decreasing the risks despite being more expensive. This review tries to establish what is intrauterine insemination status at present, if it continues being in forcé and if it has a place in the infertile couple treatment or it will be withdrawal due to IVF.

Diagnostic laparoscopy is routinely done in the infertile couple initial evaluation and as diagnostic method of tubal pathology and other intrapelvic causes of infertility. In many centers this procedure is accepted as a final procedure in the infertility work up before the couple is subjected to treatment. However, lately its real value has been questioned and there has been a growing tendency to bypass diagnostic laparoscopy in case of a normal histerosalpingography and treat infertility by intrauterine insemination (IIU) or in vitro fertilization (FIV). Currently it is not clear when we should perform diagnostic laparoscopy in the infertility work up. This review analyzes available evidence to assess the role of diagnostic laparoscopy in the infertile couple work up and its repercussion in infertility treatment, and when laparoscopy intervention should be performed in women undergoing...

A crucial point in the management of pelvic inflammatory disease (PID) is to determine the most appropriate treatment for each case. Usually the initial management is outpatient. But depending of the severity hospitalization might be required. Taking into account the polimicrobial nature of this entity, antibiotic therapy will be broad spectrum and the election will be directed to the most frequent microbes. Treatment should not only be directed to the acute process eradication but to the prevention of its complications, such as chronic pelvic pain, infertility and ectopic pregnancy, which can be avoided or minimized if a precocious, aggressive and broad coverage is done. The most severe forms of pelvic inflammatory disease presentation are tubo-ovarian abscess and pelvic abscess. Treatment of these pathologies has varied on time from a very radical conduct in the pre-antibiotic era to a...

Endometriosis is undoubtedly one of the most enigmatic diseases in gynecology and in the medical profession. Its pathogenesis remains unknown, and its presentation is bizarre as there are women with endometriosis who have pain and/or infertility and other women with endometriosis do not suffer of either pain or infertility; also, many aspects on its handling remain controversial, including the treatment of endometrioma. Different medical and surgical treatments have been proposed with varying results, but perhaps the surgical treatment of ovarian endometrioma is most controversial. The relationship between endometrioma and infertility has always been manifest, and the treatment of choice has been surgical, with evidence of increased fertility following surgery. With the advent of in vitro fertilization (IVF) doubts appeared about the real benefit of surgery to improve fertility in women ...

Bleeding and venous thromboembolism (VTE) are among the five most common causes of morbidity and mortality in pregnant women worldwide. This review describes the current evaluation and management of the obstetric causes of postpartum hemorrhage (PPH) – the leading cause of maternal mortality in our country in recent years prior to the pandemic, as well as the diagnosis and management of hematologic conditions which can cause or worsen PPH, such as autoimmune thrombocytopenia, von Willebrand disease, and thrombotic microangiopathies. It also describes the role of the antiphospholipid syndrome and inherited thrombophilias as predisposing factors of recurrent pregnancy loses and VTE, and the current recommendations for the prevention of both complications. One of the objectives of this Review is to emphasize the importance of a collaborative multidisciplinary approach for the successful m...

Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo cola...

Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo cola...