The early diagnosis of breast cancer, the prevention of cervical cancer, the control of low-risk pregnancy, the prevention of pelvic floor pathology or family planning are some of the processes that Primary Care assumes in its portfolio of services. To give them continuity with the assistance in Specialized Care, share new knowledge derived from research and integrate them into daily clinical practice in a coordinated way, lhe Fundación Jiménez Díaz has celebrated, one more year, this time in online format, its Gynecology and Obstetrics for Primary Care Conference.
“Primary professionals are excellent highly qualified doctors who dedicate a lot of time daily to studying but, due to their dynamics and scope of work, it is very difficult for them to keep up to date with all the advances in health care”, he explains Dr. Manuel Albi, head of the Department of Obstetrics and Gynecology of the Jiménez Díaz Foundation and member of the Scientific Committee organizing the conference. “For this reason, with this course, which is now in its fourth edition,” he adds, “we update our knowledge on these shared aspects of the specialty and we organize patient referral circuits between both levels of care.”
As the control of pregnancy and the early diagnosis of breast cancer are topics that always require updating, in addition to this virtual meeting, lThe Jiménez Díaz Foundation has an e-consultation program that allows direct consultation between both levels of care (integrated in the Electronic Medical Record) to solve problems in the day-to-day of patients. Likewise, regular meetings are held with the midwives of the Primary Care teams aimed at optimizing obstetric care.
Control of pregnancy and early diagnosis of breast cancer
One of the issues that most concern women today is Covid-19 and the compromise it can entail for pregnancy. In this sense, the specialist indicates, “the general risk for pregnant women is low. However, it is possible that they have more respiratory complications than women who are not pregnant and that these are more serious ”. In addition, it is important to note that pregnant diabetic women are also at increased risk of severe disease due to Covid-19, and a higher likelihood of preterm delivery and cesarean section have been reported.
Regarding breast cancer, the results of the cases detected under the age of 50 years or above the 67 treated in the Gynecology and Obstetrics Service of the Madrid hospital in the last four years were presented, which, fortunately, “represent a small percentage of all breast cancers ”, says Dr. Albi, emphasizing that self-examination is convenient in this group of women who are left out of screening programs. “If not, at the time of diagnosis they tend to be larger”, aim.
Induction of labor and caesarean section
Currently, elective induction of labor at 39 weeks is considered as an effective, safe and well-accepted way for pregnant women to end the pregnancy that, as explained by the gynecologist, “consists of preparing, ‘ripening’ the cervix with medication, then stimulating uterine contractions with oxytocin”. Although the results in terms of the percentage of caesarean sections are very positive, it implies a possibly excessive medicalization of a physiological process such as childbirth.
As for cesarean section, “none is better than a natural delivery,” warns Dr. Albi. But, in the event that vaginal delivery is impossible or is contraindicated, and there are no risk factors that could cause maternal and fetal well-being to be lost during the intervention, the hospital currently has a natural cesarean section program, that optimizes the humanization of cesarean section.
“It does not intend at all to replace childbirth with cesarean section,” he emphasizes, qualifying: “The term natural cesarean section would be almost an oxymoron, we should speak of caesarean section participated by women. In any case, it is about reducing the impact that the need for a cesarean section has for any pregnant woman, as well as for her partner, since it allows a greater and more active participation of both in childbirth ”.
“In our center, we perform caesarean sections attended by women when they are scheduled caesarean sections in gestations greater than 37 weeks. Also, and already during childbirth, when there is a failure in its proper progression and it has been confirmed that vaginal delivery is impossible ”, adds the specialist.
Anticipating loss of fertility
On the last 30-40 years has changed our way of life and there has been a considerable delay in the age of motherhood with respect to the ideal to seek a pregnancy, which is around 20-29 years. The absence of a partner, work reasons, economic restrictions or the simple passage of time “robs” women, consciously or unconsciously, their opportunities to be mothers.
As the decade of the 30s progresses, and especially after 35, the number of follicles and the quality of intrafollicular oocytes decrease, in such a way that, after 40, reproductive success rates are casualties both spontaneously and when using assisted reproductive techniques. “In this sense, the anti-Müllerian hormone (AMH) – explains Dr. Albi-, is an indicator of the number of oocytes available at each age and helps to measure the ovarian reserve”. It decreases over the years and its decline is the earliest marker of ovarian aging. For this reason, it is the responsibility of health professionals to clearly inform society of the detrimental effect of age on female fertility ”, he concludes.