Introducción: A pesar de los beneficios de la actividad física durante el embarazo, solo un 33 % de las embarazadas realiza ejercicio gestacional. Nuestro objetivo es determinar si la realización de actividad física previa al embarazo se relaciona con la práctica de ejercicio durante la gestación. Metodología: Se realizó un estudio descriptivo, observacional, transversal a un grupo de embarazadas que participaron de un programa de ejercicio durante la gestación. Se recabaron datos sobre su actividad física previa al embarazo utilizando el cuestionario PARmed-X. Resultados: Del total de mujeres que realizaron ejercicio durante el embarazo, un 52,6 % (n=10) no tenía antecedente de actividad física previa a la gestación. El análisis de asociación para la relación entre el ejercicio previo al embarazo y la práctica de actividad física durante la gestación arrojó un valor p = 0,102, sin alcanzar significancia estadística. Conclusiones: No se encontró una asociación significativa entre la práctica de ejercicio antes del embarazo y la actividad física durante la gestación. Sin embargo, un hallazgo relevante es que muchas mujeres que no realizaban ejercicio previamente comenzaron a hacerlo durante el embarazo al recibir información adecuada y comprender sus beneficios. Esto resalta el papel fundamental de la educación y el acceso a programas estructurados en la promoción de la actividad física gestacional. Es imprescindible desarrollar políticas públicas que promuevan el acceso universal, gratuito y equitativo a programas de ejercicio durante la gestación.

Since the creation of the National Integrated Health System, the crucial importance of equitable distribution of human health resources has been recognized to ensure quality care throughout the country. Improving the equitable distribution of human health resources remains an ongoing challenge for Uruguay. The decentralization of specialist training in rural areas of the country is a relevant issue to improve the equity and accessibility of the health system. Objective: To analyze the impact of the decentralization plan (2010-2024 period) of the training provided by the Academic Unit of Gynecology and Obstetrics A on the placement of professionals in rural areas of the country. Methodology: A cross-sectional observational study was conducted using a survey in June 2024, developed by the authors using Google Forms to collect data to meet the objective: origin, age, gender, children, place of residency training, year of admission, reasons for the choice of location after completing postgraduate studies, and place of professional practice. Results: A total of 134 responses were obtained from 135 residents who graduated during this period. Of the respondents, 61.2% trained in Montevideo, while 38.8% trained in rural areas. Of the residents who trained in rural areas, 70% settled in those areas. Among the 56 residents trained in rural teaching centers, 90% (51 residents) currently work in rural areas. Meanwhile, 62.8% of the specialists trained in Montevideo work exclusively in the capital, and 24.3% work both in Montevideo and rural areas. Conclusions: The decentralization plan for gynecology training has demonstrated the training capacity of public and private centers in rural areas of the country and has facilitated the placement of specialists, thereby addressing the need for specialized resources in the field.

Introduction: Uruguay had the highest cumulative rate of SARS-CoV-2 infections in the Americas and a mid-range position concerning mortality. The impact of the COVID-19 pandemic on fatality rates across different socioeconomic sectors has been generally underexplored. Objective: To compare mortality, fatality, and SARS-CoV-2 infection cases in the two subsectors of the healthcare system during 2020, 2021, and 2022 in Uruguay. Materials and methods: Data on the number of SARS-CoV-2 infections and deaths in Uruguay from 2020 to 2022, disaggregated by public and private healthcare subsectors, were requested from the Ministry of Public Health. Cumulative incidence, mortality, and fatality rates were calculated for each subsector by year. Results: During the analyzed years, annual cumulative incidence rates of COVID-19 in the public subsector were significantly lower compared to the private subsector. Regarding fatality, the proportion was significantly higher in the public subsector than in the private subsector across all years. Global analyses of the main risk factors for severe and fatal infections do not clearly show differences between the subsectors. Conclusions: From a rights-based perspective, unequal outcomes between the two subsectors represent a potential socio-health inequity. However, specific studies analyzing key healthcare variables in both subsectors are needed to confirm this inequity.

Ultrasound training for obstetrics and gynecology residents presents significant challenges. Variability in training programs and the lack of defined standards for competency assessment remain key issues, compounded by the limited capacity of clinical services to provide universal training. Since 2022, the Academic Unit of Gynecotocology "A" has implemented a pilot ultrasound training program for residents and postgraduate trainees. Objective: To assess the perception of residents and postgraduate trainees from the Academic Unit of Gynecotocology "A" regarding the impact of implementing a curricular ultrasound training program. Methodology: An observational, quasi-experimental, pre-poststudywithout a control group was conducted to evaluate the training program. Data were collected using a purpose-designed instrument developed specifically for this study, which had not undergone prior psychometric validation. Results: Atotal of 21 residentswere included: 8 from the firstyear, 6 from the second, and 7 from the third, with a median age of 29.6 years. Participants' perceptions were assessed regarding Level 1 ultrasound skills, including uterine and adnexal measurements, cervical length, diagnosis of intrauterine pregnancy, fetal biometry, and evaluation of amniotic fluid and placenta. The intervention demonstrated a statistically significant impact on self-perceived ultrasound competencies across all evaluated parameters (p < 0.001). Conclusions: The integration of structured ultrasound training programs into the obstetrics and gynecology residency curriculum enhances residents'

Introducción: La formación en ecografía para residentes de ginecología y obstetricia presenta desafíos significativos. La variabilidad en los programas de capacitación, la falta de estándares definidos para la evaluación de competencias es una dificultad a afrontar, sumado a la capacidad de los servicios para la formación universal. Desde 2022 se implementa en la UA Ginecotocología A un plan piloto de formación en ultrasonido para residentes y posgrados. El objetivo de este estudio fue determinar la percepción de residentes y posgrados de la UA Ginecotocológica “A” sobre el impacto de la aplicación de un programa de formación curricular en ultrasonido. Metodología: Se realizó un estudio observacional, cuasi-experimental, pre-post sin grupo control del programa de formación en ecografía mediante instrumento de recogida de datos, específicamente diseñada para este estudio, no validado previamente. Resultados: Se incluyeron 21 residentes, 8 de primero, 6 de segundo y 7 de tercero con una mediana de edad de 29,6 años. Se evaluó la percepción de los mismos en cuanto a las destrezas nivel 1 en ecografía, que incluyen: medición de útero, anexos y longitud cervical, diagnóstico de embarazo intrauterino, realización de biometría fetal así como evaluación de líquido amniótico y placenta. La intervención mostró un impacto estadísticamente significativo en la autopercepción de competencias ecográficas en todos los parámetros observados ( p < 0.001). Conclusiones: La incorporación de programas estructurados de formación en ecografía dentro del currículo de la especialidad en ginecología y obstetricia mejora la percepción de competencia por parte de los residentes, consolidándose como una herramienta educativa esencial para el desarrollo profesional.

Introducción: El bienestar médico ha cobrado relevancia en la atención de la salud, especialmente frente a la “epidemia de burnout”. Este estudio se propone evaluar la implementación y efectividad de un programa para mejorar el bienestar del personal de la Unidad Académica de Ginecología y Obstetricia A de la Facultad de Medicina de la Universidad de la República, Uruguay. Método: Se desarrolló un estudio descriptivo siguiendo un modelo lógico de evaluación de programas. Se implementó una estrategia organizacional focalizada en la identificación de factores de estrés y la promoción del bienestar. La intervención incluyó encuestas cualitativas, grupos focales y la conformación de un Equipo de Referentes de Bienestar (ERB), capacitado para guiar el proceso de mejora continua. Resultados: Se identificaron prioridades en las dimensiones de carga laboral y exigencias en el trabajo, eficiencia y recursos, comunidad en el trabajo, cultura organizacional e integración trabajo-vida personal. A lo largo del proceso, se implementaron acciones clave para mejorar el ambiente laboral y la efectividad del equipo. El compromiso de los líderes de la unidad y el trabajo colaborativo con consultores externos fueron fundamentales para el éxito del programa. Discusión: Las intervenciones organizacionales, aunque más complejas, parecen ser más efectivas en la promoción del bienestar. Los cambios alcanzados en esta etapa inicial sugieren un impacto positivo, aunque se requiere un seguimiento a largo plazo para asegurar la sostenibilidad de las mejoras. Conclusiones: La experiencia innovadora presentada ofrece una hoja de ruta para la mejora del bienestar del personal de salud en contextos académicos y asistenciales, destacando la importancia del liderazgo y colaboración en estos procesos.

In Uruguay there is an unequal distribution of doctors between the capital and the rest of the country, determining that patients must be referred to healthcare centers outside the area in which they reside. The ECHO (Extension for Community Healthcare Outcomes) Project seeks to improve access to specialized care for rural populations through the use of communication technologies, democratizing knowledge. Objective: to evaluate the results regarding professional competencies and skills in the participants of the ECHO teleclinics on gynecological cancer in Uruguay. Method: retrospective impact evaluation with baseline and impact line through a web census. Period: September 2020- May/2021. 22 variables were surveyed, 14 dependent indicators that measure self -perceptions of increased capabilities retrospectively based on a Likert scale of 5 values, and 8 independent indicators that address general aspects of the population. Taking into account that there is no normal distribution, the non -parametric Wilkoxon test is applied. Results: 36 responses were obtained. The results show that all pairs have a bilateral significance, being able to affirm that there is a significant difference between the capabilities before and after participation in the ECHO program. Conclusions: an improvement in the self -perception of the participants' capabilities was observed after the implementation of the ECHO teleclinics.

En mujeres privadas de libertad de Uruguay existe un déficit asistencial en Salud Sexual y Reproductiva. El objetivo del estudio es mejorar el ejercicio de los Derechos Sexuales y Reproductivos en mujeres privadas de libertad, brindando acceso a servicios ginecológicos integrales dentro de las cárceles. Estudio descriptivo retrospectivo, se incluyeron todas las mujeres privadas de libertad en cárceles uruguayas. La intervención consistió en una consulta clínica ginecológica integral, se abordaron aspectos de salud sexual y reproductiva con diagnóstico y tratamiento. Las consultas se realizaron en cárceles de Montevideo e interior. Se realizó la consulta clínica a 513 mujeres privadas de libertad (83% del total) en 800hs de atención médica y 640hs de gestión, con participación de 52 profesionales médicos. Se realizaron 401 colpocitologías oncológicas, 74 patológicas (18%). Se realizaron 108 Test Virus Papiloma Humano, 16 positivos para Alto Riesgo oncogénico (14%). Se realizaron 103 colposcopías y detectando 11 lesiones escamosas de alto grado, realizándose tratamiento quirúrgico. En anticoncepción se realizaron acciones específicas en 166 pacientes: 55 implantes subdérmicos; 27 Dispositivos Intrauterinos, 62 anticonceptivos orales y 23 inyectables. En 61 mujeres se brindaron preservativos masculinos y femeninos. Se desarrolló una intervención en salud sexual y reproductiva al 83% de las mujeres privadas de libertad de Uruguay con especial abordaje en prevención del cancer genitomamario y anticoncepción. Puede ser un insumo para el desarrollo de políticas públicas en esta población.

Introduction: Physician well-being has gained relevance in health care, especially in the face of the "burnout epidemic." This study aims to evaluate the implementation and effectiveness of a program to improve the well-being of the staff of the Academic Unit of Gynecology and Obstetrics A of the Faculty of Medicine of the University of the Republic, Uruguay. Method: A descriptive study was developed following a logical model of program evaluation. An organizational strategy focused on identifying stress factors and promoting well-being was implemented. The intervention included qualitative surveys, focus groups, and the formation of a Well-Being Referent Team (ERB), trained to guide the continuous improvement process. Results: Priorities were identified in the dimensions of workload, resources, community at work, organizational culture, and work- life balance. Throughout the process, key actions were implemented to improve the work environment and team effectiveness. The commitment of unit leaders and collaborative work with external consultants were fundamental to the success of the program. Discussion: Organizational interventions, although more complex, appear to be more effective in promoting well-being. The changes achieved at this initial stage suggest a positive impact, although long-term monitoring is required to ensure the sustainability of improvements. Conclusions: The innovative experience presented offers a roadmap for improving the well-being of health personnel in academic and healthcare contexts, highlighting the importance of leadership and collaboration in these processes.

Incarcerated women in Uruguay face a healthcare deficit in Sexual and Reproductive Health. The study's objective is to improve the exercise of Sexual and Reproductive Rights for incarcerated women by providing access to comprehensive gynecological services within prisons. This is a descriptive retrospective study. The target population was all incarcerated women in Uruguayan prisons. The intervention consisted of a comprehensive gynecological clinical consultation, addressing aspects of sexual and reproductive health with diagnosis and treatment. Consultations were conducted in prisons in Montevideo and other regions. Clinical consultations were conducted for 513 incarcerated women (83% of the total) over 800 hours of medical attention and 640 hours of management, with the participation of 52 medical professionals. A total of 401 oncological colpocytologies were performed, 74 of which were pathological (18%). Additionally, 108 Human Papillomavirus (HPV) tests were conducted, with 16 testing positive for high oncogenic risk (14%). 103 colposcopies were performed, detecting 11 high-grade squamous lesions, which were subsequently treated surgically. Specific contraception actions were taken for 166 patients: 55 subdermal implants, 27 intrauterine devices, 62 oral contraceptives, and 23 injectable contraceptives. Male and female condoms were provided to 61 women. A sexual and reproductive health intervention was developed for 83% of incarcerated women in Uruguay, with a special focus on the prevention of genital and breast cancer and contraception. This initiative can serve as a resource for the development of public policies targeting this population.

Placenta Accreta Spectrum is a condition associated with high morbidity and mortality. In recent years, there has been an increase in its incidence, highlighting its importance due to the rising rate of cesarean sections which is its main risk factor. A case is described of a 32-year-old patient with placenta accreta, diagnosed via ultrasound at 31 weeks of gestation. The surgery was meticulously planned with the team, including the placement of balloons in the hypogastric arteries and a double-J catheter, allowing for detailed intraoperative staging. In relation to the clinical case, a review and update of the pathology is carried out, emphasizing the detailed planning of the surgery and the approach in specialized teams.

Introduction: Reproductive justice is the ability of dividuals and societies to realize sexual and reproductive rights. On the contrary, reproductive injustice (RI) exposes the presence of risks to the developmental process during pregnancy and early childhood. Objective: To describe the evolution of a set of indicators related to reproductive justice in the Integrated National Health System (SNIS) of Uruguay over last 12 years and compare trends between the public and private subsectors. Methodology: A descriptive, retrospective study of set of indicators included in the Sustainable Development Goals (SDGs) and national health objectives was conducted. Maternal mortality ratio (MMR), incidence of preterm birth (PTB), low birth weight (LBW), congenital syphilis (CS) were analyzed in the public and private subsectors of the SNIS over the past years. Results: During the analyzed period the maternal mortality ratio has always been higher in the public subsector, except in the year 2015. The incidence of preterm birth during the period has ranged between 8.6% and 10%. It is higher in the public subsector, except some periods where it is higher in the private subsector. The incidence of low birth weight is always higher the public subsector, with its highest incidence in 2022 at 9.3. Congenital syphilis has always been higher the public subsector, ranging from 1.3 to 7.1, while in the private subsector, the values range from 0.2 to 0.6. Conclusions: The difference in these perinatal health indicators between the two healthcare subsectors in our country reflects that despite having an Integrated National Health System, there is a disparity that impacts the results of final and intermediate indicators, thus determining the existence of reproductive injustice.

El espectro acretismo placentario es una patología que cursa con una alta morbimortalidad, viéndose en los últimos años un incremento en su incidencia y cobrando relevancia por la tasa de cesáreas en aumento, siendo su principal factor de riesgo.Se describe el caso de una paciente de 32 años, portadora de acretismo placentario, diagnosticado mediante ecografía a las 31 semanas de edad gestacional, donde se logró planificar paso a paso la cirugía con equipo, colocando previo a la cirugía balones en arterias hipogástricas y catéter doble Jota, haciendo una estadificación intraoperatoria detallada.A propósito del caso clínico se realiza una revisión y actualización de la patología, enfatizando en la planificación detallada de la cirugía y el abordaje con equipos de referencia.

Introducción: la justicia reproductiva es la capacidad de las personas y las sociedades de poder concretar los derechos sexuales y reproductivos. Por el contrario, la injusticia reproductiva (IR) expone la presencia de riesgos para el proceso de desarrollo durante el embarazo y la primera infancia.Objetivo: describir la evolución de un conjunto de indicadores vinculados a la justicia reproductiva en el Sistema Nacional Integrado de Salud (SNIS) de Uruguay en los últimos 12 años y comparar las tendencias entre el subsector público y el subsector privado.Metodología: estudio descriptivo, retrospectivo, de un conjunto de indicadores incluidos en los objetivos de desarrollo sostenibles (ODS) y de los objetivos sanitarios nacionales. Se analizaron razón de mortalidad materna (MM), incidencia de parto pretérmino (PPT), bajo peso al nacer (BPN) y sífilis congénita (SC), en el subsector público y privado del SNIS, durante los últimos 12 años.Resultados: la razón de MM en el período de tiempo analizado ha sido siempre superior en el subsector público, salvo en el año 2015. La incidencia de PPT en el período de tiempo ha oscilado entre 8,6% y 10%. Ésta es superior en el subsector público, salvo en algunos períodos donde es mayor en el subsector privado. La incidencia de BPN es superior siempre en el subsector público, con su mayor incidencia en 2022, de 9,3. La SC siempre fue superior en el subsector público desde 1,3 a 7,1, mientras que en el subsector privado los valores van de 0,2 a 0,6.Conclusiones: la diferencia en estos indicadores de salud perinatal entre los dos subsectores de atención de nuestro país refleja que a pesar de contar con un SNIS, existe una disparidad que impacta sobre los resultados de indicadores finales e intermedios, determinando así la existencia de una IR.

Introduction: Cesarean delivery on maternal request, which occurs without maternal or fetal medical indication, has increased in recent years. Reasons for patients to request it have been described, such as emotional experiences, social norms, and the interrelationship with the healthcare team. Methodology: The objective was to determine possible determinants for cesarean request. An observational study was conducted with cases (patients who requested cesarean delivery without medical indication) and controls (spontaneous vaginal delivery), non-matched, in a 2:1 ratio. A pre-designed survey was used to determine possible determinants, including fear of childbirth through a W-DEQ adapted questionnaire, social support, concern for fetal-neonatal safety, and the influence of the treating physician. Results: A total of 171 patients were included. Among patients with cesarean delivery on maternal request, 52.5% reported choosing cesarean due to high concern for fetal-neonatal safety, 32.8% due to some influence from the treating physician, 31.7% due to its predictability (better home organization or the anxiety of uncertainty about the timing of delivery), and 42.6% due to personal concern about the consequences of vaginal delivery. The W-DEQ variable, categorized into tertiles, showed a statistically significant association for requesting cesarean delivery. Previous traumatic history showed an association of 4.17. Conclusions: The factors that influenced the decision to request a cesarean delivery were previous traumatic history, the influence of the treating physician, and the existence of tocophobia. What connects all these factors is that they are all modifiable.

En Uruguay existe una desigual distribución de médicos entre la capital y el resto del país, determinando que los pacientes deban ser referidos a centros asistenciales fuera del área en la que residen. El Proyecto ECHO (del inglés: Extension for Community Healthcare Outcomes) busca mejorar el acceso a atención especializada para poblaciones rurales mediante la utilización de tecnologías de la comunicación, democratizando el conocimiento. Objetivo: evaluar los resultados en lo referente a competencias y habilidades profesionales en los participantes de las teleclínicas ECHO sobre cáncer ginecológico en Uruguay. Método: evaluación retrospectiva de impacto con línea de base y línea de impacto mediante un censo vía web. Período: setiembre 2020- mayo/2021. Se relevaron 22 variables, 14 indicadores dependientes que miden autopercepciones sobre incremento de capacidades en forma retrospectiva a partir de una escala Likert de 5 valores y, 8 independientes que abordan aspectos generales de la población. Teniendo en cuenta que no hay una distribución normal se aplica el test no paramétrico de Wilkoxon. Resultados: se obtuvieron 36 respuestas. Los resultados, muestran que todos los pares tienen una significación bilateral, pudiendo afirmar que existe una diferencia significativa entre las capacidades previas y posteriores a la participación en el programa ECHO. Conclusiones: se objetiva una mejora en la autopercepción de las capacidades de los participantes luego de la implementación de las teleclínicas ECHO.

BackgroundThe mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality.ObjectiveTo analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic).MethodsA retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP).ResultsIn 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes.ConclusionsIn the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Objective: the main objective of the study was to as-sess the prevalence of anal cytology in women with a history of cervical intraepithelial neoplasia.Method: cohort transversal study conducted from May, 2018 until August, 2020 at Pereira Rossell Hos-pital. Two cohorts were studied, one of which included women with a diagnosis of cervical intraepithelial neo-plasia and the other one included healthy women who attended their routine follow up, in a 2:1 ratio. The total size of the sample was 205 patients, 135 of which were patients with cervical intraepithelial neoplasia (confidence interval being 95%), presuming a 10% pre-valence of anal pre-neoplasic lesions. The sample size of the control cohort was 70 patients as per the pre -de-fined ratio.Results: a association was found between the pre-sence of malignant lesions of the cervix and epithelial anomalies detected in the anal cytology, with a preva-lence coefficient of 1.77 (CI: 95%: 1,19 - 2,62) and odds ratio of 2,69 (1,36 - 5,30). No significant differen-ces were found between race, type of sexual relations-hips or smoking variables.Conclusions: our study concludes there is an asso-ciation between cervical intraepithelial neoplasia rela-ted to HPV and pathological anal screening.