Papers by Alfredo Perales
Clínica e Investigación en Ginecología y Obstetricia, Mar 1, 2011
Mucocele apendicular; Cistoadenoma ovárico; Laparoscopia Resumen El mucocele apendicular es una p... more Mucocele apendicular; Cistoadenoma ovárico; Laparoscopia Resumen El mucocele apendicular es una patología infrecuente y de difícil diagnóstico. Se presenta el caso de una paciente de 48 años con historia de dolor en fosa ilíaca derecha (FID), intervenida por un diagnóstico de sospecha de cistadenoma de ovario derecho, con diagnóstico intraoperatorio de mucocele apendicular.
Journal of Cardiovascular Pharmacology, Jun 1, 1994
Journal of Obstetrics and Gynaecology, Apr 1, 2013
confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show a... more confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show any features of complete mole as was expected, as the molar placenta gradually resolved. A decrease in the size of molar portion of placenta on USS has been reported in the literature (Lee et al. 2010) but not complete disappearance, which makes our case unique. So far in the literature, about 63 cases of live births in CHMF cases have been reported. Th e estimated live birth rate is around 35 – 40% (Sebire et al. 2002; Dolapcioglu et al. 2009). Th e risk of developing pre-eclampsia is reported from 19% to 26% and is indicative of a poor outcome (Wee and Jauniaux 2005). Th e risk of PTD is reported to be higher (33 – 57%) in CHMF cases compared with a complete mole (Massardier et al. 2009). It appears that continuation of pregnancy is not a risk factor for development of PTD, as the rates did not diff er between women undergoing elective 1st trimester termination and those who continued pregnancy (Sebire et al. 2002). In conclusion, in CHMF, we can expect the molar part to either become quiescent or resorb allowing the pregnancy to continue or to grow extensively leading to severe maternal and fetal complications. Formerly, most of them were terminated but recently, this approach has started to change. Continuation of pregnancy can be recommended aft er careful counselling of the couple with close antenatal and postnatal surveillance.
Ultrasound in Obstetrics & Gynecology, Dec 1, 2021
Objective To assess the efficacy of vaginal progesterone for the prevention of preterm birth and ... more Objective To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. Methods This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth < 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk
Transfusion Medicine, Jun 1, 2007
Clinical and Experimental Obstetrics & Gynecology, Jun 10, 2017
The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mo... more The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mole gestation caused a placenta previa; with a posterior preterm premature rupture of membranes (PPROM) and ending in the 28 th week of gestation due to acute chorioamnionitis, obtaining a live preterm newborn.
Acta Obstetricia et Gynecologica Scandinavica, Feb 1, 2010
Objective. To assess the efficacy of the cervical phosphorylated insulin-like growth factor bindi... more Objective. To assess the efficacy of the cervical phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) in combination with cervical length measurement for the prediction of preterm delivery. Design. Observational prospective study. Setting. University Hospital, Spain. Sample. A total of 276 women between 24 and 34 weeks gestational age complaining of uterine contractions and intact membranes. Methods. Transvaginal scan to assess cervical length and cervical swabs for pIGFBP-1 detection. Main outcome measures. Prevalence of preterm delivery within 48 hours and 7 days, delivery at < 32, < 34 weeks, admission-to-delivery interval by cervical length and the presence of pIGFBP-1. Results. The prevalence of preterm delivery at < 34 weeks was 14.1% (39/276) and 7.6% (21/276) at < 32 weeks. Cervical pIGFBP-1 was positive in 38.7% (107/276), whereas cervical length < 15 mm was present in 7.2% (20/276) and was > 30 mm for 64.8% (179/276) of the women. The presence of a positive pIGFBP-1 appeared useful for prediction of delivery before 32 (likelihood ratio (LR) = 2.21, confidence interval (CI): 1.63-3.00) and 34 weeks (LR = 1.76, CI: 1.25-2.41), respectively. Receiver operating characteristic curves were significant for cervical length and pIGFBP-1 for prediction of delivery at < 34 weeks, < 32 weeks, < 48 hours and < 7 days. Combining pIGFBP-1 and cervical length had a median interval that was shorter when both were positive as compared to only one positive or both negative, but the CIs overlapped. Conclusions. Both cervical length measurement and pIGFBP-1 are useful for prediction of spontaneous preterm delivery. A pIGFBP-1 positive result associated with cervical length does not improve preterm delivery prediction rates.
American Journal of Obstetrics and Gynecology, Apr 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Computational and Mathematical Methods in Medicine, 2014
Electrohysterography (EHG) is a noninvasive technique for monitoring uterine electrical activity.... more Electrohysterography (EHG) is a noninvasive technique for monitoring uterine electrical activity. However, the presence of artifacts in the EHG signal may give rise to erroneous interpretations and make it difficult to extract useful information from these recordings. The aim of this work was to develop an automatic system of segmenting EHG recordings that distinguishes between uterine contractions and artifacts. Firstly, the segmentation is performed using an algorithm that generates the TOCO-like signal derived from the EHG and detects windows with significant changes in amplitude. After that, these segments are classified in two groups: artifacted and nonartifacted signals. To develop a classifier, a total of eleven spectral, temporal, and nonlinear features were calculated from EHG signal windows from 12 women in the first stage of labor that had previously been classified by experts. The combination of characteristics that led to the highest degree of accuracy in detecting artifacts was then determined. The results showed that it is possible to obtain automatic detection of motion artifacts in segmented EHG recordings with a precision of 92.2% using only seven features. The proposed algorithm and classifier together compose a useful tool for analyzing EHG signals and would help to promote clinical applications of this technique.
The Journal of Urology, May 1, 2005
We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bond... more We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure for the surgical treatment of stress urinary incontinence in women. A total of 65 patients diagnosed with stress urinary incontinence underwent a transobturator suburethral tape procedure with a fusion welded, nonwoven, nonknitted polypropylene mesh, with or without a central silicone coated section, at our institution. All women were followed and if vaginal erosion was diagnosed, cystoscopy and vaginoscopy were performed, the mesh was partially or completely removed and, if necessary, posterior cough test and urodynamic study were performed. Of the 65 patients 9 (13.8%) were diagnosed with vaginal erosion at the vaginal incision during a relatively long postoperative period (mean 290 days). All presented with vaginal discharge and 1 had a severe complication (obturator abscess). Complete mesh removal was necessary in 8 patients and only 2 (22%) had recurrent stress urinary incontinence. A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).
Progresos de Obstetricia y Ginecología, Jun 1, 1998
Revista chilena de obstetricia y ginecología, 2015
Las gestaciones en pacientes con daño medular representan un reto para la obstetricia. Las compli... more Las gestaciones en pacientes con daño medular representan un reto para la obstetricia. Las complicaciones más frecuentes son las infecciones de las vías respiratorias y de las vías urinarias, y la más grave la hiperreflexia autonómica. El parto vaginal es posible en lesiones por debajo de T5, pero por encima de ese nivel, la imposibilidad de percibir las contracciones, de identificar el trabajo de parto y realizar pujos lleva a la necesidad de una cesárea programada. Objetivo: Exponer nuestra experiencia y revisar el manejo más adecuado de la embarazada parapléjica. Métodos: Estudio retrospectivo en el periodo 2003-2014. Hubo 10 pacientes con 24 gestaciones: 6 abortos espontáneos, un 1 aborto inducido, quedando para el análisis 17 gestaciones (1 embarazo gemelar). La evaluación es independiente a la etiología o localización de la lesión. Se analiza las complicaciones perinatales y maternas. Resultados: La edad media fue 33 años. La edad gestacional media al parto fue 37 semanas: 12 de término (70,59%), 4 de pretérmino (23,53%) y una desconocida (5,88%). Hubo 10 cesáreas (58,82%) y 7 partos vaginales (41,18%). Peso medio neonatal de 2940 g, ninguno con retraso de crecimiento intrauterino. Conclusiones: Nuestra experiencia muestra una alta tasa de prematuridad y de cesáreas, pero con buenos resultados maternos y perinatales, que hace permisible que estas pacientes puedan cumplir su deseo genésico, superando su discapacidad.
Clínica e Investigación en Ginecología y Obstetricia, Nov 1, 2010
Angioma cavernoso intracraneal; Embarazo; Convulsiones; Malformación vascular cerebral Resumen Lo... more Angioma cavernoso intracraneal; Embarazo; Convulsiones; Malformación vascular cerebral Resumen Los angiomas cavernosos intracraneales son malformaciones vasculares que raramente se presentan durante la gestación. El estado fisiológico del embarazo podría agravar su comportamiento al aumentar su crecimiento, por presentar sangrados recurrentes o por la aparición de nuevas lesiones. Las crisis comiciales son la manifestación clínica más común de las malformaciones cavernosas, seguidas de los déficits neurológicos focales, la cefalea y las hemorragias agudas. En la mujer gestante, estos síntomas deben ser diferenciados de la preeclampsia-eclampsia. Presentamos el caso de una mujer gestante en la que se diagnosticó un angioma cavernoso intracraneal de novo durante el embarazo.
Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for mo... more Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for monitoring uterine dynamics. Bipolar recordings of EHG have proven to provide valuable information to predict labor. Recently it has been stated that uterine EHG bursts could also be identified in Laplacian recordings on abdominal surface. Taking into account that Laplacian potential technique permits to acquire more localized electrical activity than conventional recordings; these recordings could also be helpful for deducing uterine contraction efficiency. The aim of this paper is to examine the feasibility of Laplacian potential EHG recording for labor prediction and to compare it with monopolar recordings. To this purpose, a total of 42 EHG recordings were acquired from women of similar gestational age: 29 antepartum patients, and 13 patients in labor. Then linear and non-linear classifiers have been implemented using EHG burst parameters as input features. Experimental results show significant differences in temporal and spectral parameters in both monopolar and Laplacian potential recordings between the two groups. In addition, support vector machine based classifier achieved an accuracy of 93% for labor prediction for monopolar recordings, 92% for bipolar recordings and 91% for Laplacian potential.
Journal of Obstetrics and Gynaecology, Jan 20, 2016
Journal of Sensors, Nov 15, 2019
Pharmacological agents are often used to induce labor. Failed inductions are associated with unne... more Pharmacological agents are often used to induce labor. Failed inductions are associated with unnecessarily long waits and greater maternal-fetal risks, as well as higher costs. No reliable models are currently able to predict the induction outcome from common obstetric data (area under the ROC curve (AUC) between 0.6 and 0.7). The aim of this study was to design an early success-predictor system by extracting temporal, spectral, and complexity parameters from the uterine electromyogram (electrohysterogram (EHG)). Different types of feature sets were used to design and train artificial neural networks: Set_1: obstetrical features, Set_2: EHG features, and Set_3: EHG+obstetrical features. Predictor systems were built to classify three scenarios: (1) induced women who reached active phase of labor (APL) vs. women who did not achieve APL (non-APL), (2) APL and vaginal delivery vs. APL and cesarean section delivery, and (3) vaginal vs. cesarean delivery. For Scenario 3, we also proposed 2-step predictor systems consisting of the cascading predictor systems from Scenarios 1 and 2. EHG features outperformed traditional obstetrical features in all the scenarios. Little improvement was obtained by combining them (Set_3). The results show that the EHG can potentially be used to predict successful labor induction and outperforms the traditional obstetric features. Clinical use of this prediction system would help to improve maternal-fetal well-being and optimize hospital resources.
Bone Marrow Transplantation, Feb 1, 2003
The use of cord blood (CB) for transplantation has increased greatly in recent years. The collect... more The use of cord blood (CB) for transplantation has increased greatly in recent years. The collection strategy is the first step in collecting good-quality CB units. There are two main techniques for collecting CB from the umbilical vein: in the delivery room while the placenta is still in the uterus by midwives and obstetricians or in an adjacent room after placental delivery by CB bank trained personnel. In this study, the benefits and disadvantages between the two different CB collection strategies were evaluated, in order to improve CB bank methodology. Valencia CB bank maintains the two different collection strategies. CB was obtained from 569 vaginal and 70 caesarean deliveries and obstetrical and clinical charts were reviewed. Before processing CB units, volume was calculated and samples were drawn for cell counts. After processing and before cryopreservation samples were drawn for cell counts, CD34+cell analysis, viability, clonogenic assays and microbiology were drawn directly from the bags. We compared the efficiency of the two collection techniques. Obstetric data and umbilical CB were obtained from 569 vaginal (264 collected in utero and 305 collected ex utero) and 70 caesarean deliveries. The proportion of excluded CB units before processing was 33% for vaginal ex utero, 25% for vaginal in utero and 46% for caesarean deliveries. Differences were statistically significant. For vaginal deliveries a larger volume and a higher number of nucleated cells, percentage of CD34+ cells and colony-forming units (CFUs) were harvested in the in utero collection group. There was no statistical difference between CB collected after placental expulsion from vaginal and caesarean deliveries. Comparison between all vaginal and caesarean deliveries did not show any difference. We conclude that the mode of collection influences the haematopoietic content of CB donations. Collection before placental delivery is the best approach to CB collection and allows optimisation of CB bank methodology. Caesarean deliveries seem to contain similar progenitor content to vaginal deliveries.
Ultrasound in Obstetrics & Gynecology, Mar 1, 2017
Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a... more Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix an updated meta-analysis of individual patient data
Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta.... more Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta. Appropriate depth of placental invasion is needed to support a healthy pregnancy; shallow invasion is associated with the development of severe preeclampsia (sPE). Maternal contribution to sPE through failed decidualization is an important determinant of placental phenotype. However, the molecular mechanism underlaying the in vivo defect linking decidualization to sPE is unknown. Here, we discover the footprint encoding this decidualization defect comprising of 166 genes using global gene expression profiling in decidua from women who developed sPE in a previous pregnancy. This signature allowed us to effectively segregate samples into sPE and control groups. Estrogen receptor 1 (ESR1) and progesterone receptor B (PGR-B) were found highly interconnected with the dynamic network of defective decidualization fingerprint. ESR1 and PGR-B gene expression and protein abundance were remarkably...
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Papers by Alfredo Perales