Influential factors of adverse pregnancy outcome in women with subchorionic hematoma / 中国基层医药

Objective:To investigate the influential factors of adverse pregnancy outcomes in women with subchorionic hematoma.Methods:A total of 101 women with subchorionic hematoma who received treatment in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to June 2020 were included in this study. They were divided into a control group and an adverse pregnancy outcome group according to whether there was an adverse pregnancy outcome. The epidemiological characteristics, hematoma characteristics observed on ultrasound images, and pregnancy outcomes were compared between the two groups.Results:There was no significant difference in the number of women who used assisted reproductive technology between the control and adverse pregnancy outcome groups [6 (8.0%) vs. 8 (30.7%), χ2 = 8.38, P = 0.004]. There was a significant difference in hematoma volume between adverse pregnancy outcome and control groups [(4.12 ± 0.61) mL vs. (6.36 ± 0.87) mL, t = 6.73, P = 0.009]. There was a significant difference in the number of patients who had obstetric complications between control and adverse pregnancy outcome groups [11 (14.7%) vs. 16 (61.5%), χ2 = 21.66, P = 0.001]. There was a significant difference in the number of patients who had hematomas located at the edge of the placenta between the control and adverse pregnancy outcome groups [15 (20.0%) vs. 12 (46.2%), χ2 = -4.81, P = 0.001]. Conclusion:Women who use assisted reproductive technology for pregnancy, have obstetric complications, or have a subchorionic hematoma with hematoma at the edge of the placenta are more likely to experience a miscarriage. Therefore, women of childbearing age should actively treat the primary disease and be alert to the occurrence of placental abruption.

Abruptio placentae y trombofilia hereditaria / Abruptio placentae and hereditary thrombophilia / Abruptio placentae e trombofilia hereditária

Resumen: El abruptio placentae o desprendimiento prematuro de placenta normoinserta se define como el desprendimiento parcial o completo de la placenta normalmente implantada que ocurre antes del parto en embarazos mayores a 20 semanas. Entidad de elevada morbimortalidad (75%). La pato-fisiología es multifactorial, disminución de la invasión trofoblástica de las arterias espirales, disfunción endotelial y activación anormal de la coagulación a nivel de la interface materno-fetal. Es controversial si la trombofilia hereditaria contribuye a este proceso y de ser así como lo haría. Se realiza una revisión del tema con recomendaciones de estudio y tratamiento en pacientes que tienen esta patología.

Abstract: Abruptio placentae or premature detachment of the normoinserted placenta is defined as partial or complete detachment of the normally implanted placenta that occurs before delivery in pregnancies greater than 20 weeks. Entity with high morbidity and mortality (75%). The pathophysiology is multifactorial, decreased trophoblastic invasion of the spiral arteries, endothelial dysfunction and abnormal activation of coagulation at the level of the maternal-fetal interface. It is controversial whether and if hereditary thrombophilia contributes to this process. A review of the subject is carried out with study and treatment recommendations in patients who have this pathology.

Resumo: O descolamento da placenta ou descolamento prematuro da placenta normoinserida é definido como o descolamento parcial ou completo da placenta normalmente implantada que ocorre antes do parto em gestações com mais de 20 semanas. Entidade com alta morbimortalidade (75%). A fisiopatologia é multifatorial, diminuição da invasão trofoblástica das artérias espirais, disfunção endotelial e ativação anormal da coagulação ao nível da interface materno-fetal. É controverso se e se a trombofilia hereditária contribui para esse processo. É feita uma revisão do assunto com recomendações de estudo e tratamento em pacientes portadores dessa patologia.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Application of low molecular weight heparin plus low dose aspirin in preventing twin pregnancy with preeclampsia high risk factors / 中国基层医药

Objective To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.Methods From January 2013 to December 2017,the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment .The observation group(n=53) used LMWH plus LDA to prevent preeclampsia ,while the control group ( n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups .Results The incidence of severe preeclampsia in the observation group(5.7％) was lower than that in the control group (18.9％)(χ2 =4.296,P<0.05),and there was statistically significant difference in the delivery time between the two groups (χ2 =7.993,P<0.05).While the incidence of preeclampsia ,placental abruption,postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P >0.05).The proportion of NICU transferred fetus in the observation group(18.3％) was lower than that in the control group (30.7％)(χ2 =4.289,P<0.05).There were no statistically significant differences in perinatal mortality and neonatal asphyxia ( all P >0.05 ).Conclusion Compared with using the LDA alone , LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies;at the same time,it also can delay the delivery time and reduce the rate of NICU transferred.

Application of low molecular weight heparin plus low dose aspirin in preventing twin pregnancy with preeclampsia high risk factors / 中国基层医药

Objective@#To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.@*Methods@#From January 2013 to December 2017, the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment.The observation group(n=53) used LMWH plus LDA to prevent preeclampsia, while the control group(n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups.@*Results@#The incidence of severe preeclampsia in the observation group(5.7%) was lower than that in the control group(18.9%)(χ2=4.296, P<0.05), and there was statistically significant difference in the delivery time between the two groups(χ2=7.993, P<0.05). While the incidence of preeclampsia, placental abruption, postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P>0.05). The proportion of NICU transferred fetus in the observation group(18.3%) was lower than that in the control group(30.7%)(χ2=4.289, P<0.05). There were no statistically significant differences in perinatal mortality and neonatal asphyxia(all P>0.05).@*Conclusion@#Compared with using the LDA alone, LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies; at the same time, it also can delay the delivery time and reduce the rate of NICU transferred.

Assessment of Second and Third Trimester Vaginal Bleeding with Final Outcome of Pregnancy: A Prospective cohort Study

Background: Vaginal bleeding at any stage of pregnancy is an alarming event. As it is estimated that approximately one fifth of pregnancies are accompanied by vaginal bleeding, The present study was carried out to investigate the relationship between second and third trimester vaginal bleeding and the outcome of pregnancy. Methods: This prospective cohort study population comprises of 150 pregnant women who were booked at the antenatal clinics and presented with complaints of bleeding or spotting per-vaginum in the second and third trimester. These patients were on continuous follow up till their final outcome of pregnancy. Results: Out of 100 cases of second trimester bleeding per vaginum, pregnancy continued in 84 cases. Subjects of second trimester with vaginal bleeding have been clinically diagnosed with threatened abortion in 84% patients, missed abortion (08%) followed by incomplete (06%) and complete (02%) abortion. Placenta previa was the leading cause of the vaginal bleeding both in second and third trimester vaginal bleeding subjects 26% and 21%. Forty-eight second trimester cases and 26% of third trimester cases had repeated episode of bleeding. The vaginal and caesarean delivery rate (majority of them were at term) were 33%, 51% and 36%,64% respectively in cases of second & third trimester bleeding groups. Conclusion: The overall prognosis of the patients who present in second and third trimester with history of bleeding per vaginum is favorable. At the same time physicians should be aware of the adverse outcomes that are associated with second and third trimester bleeding and remain alert for signs of these complications

Perinatal outcomes in abruptio placenta

Background: Abruptio placentae is an obstetric emergency where placenta completely or partially separates before delivery of the baby. It occurs approximately in one in 120 deliveries. It is an important cause of perinatal morbidity and mortality.Methods: This was a prospective hospital-based study design conducted over a period of 2 years, in the Department of Obstetrics and Gynecology at a tertiary care hospital in Mumbai comprising of 60 cases.Results: The incidence of abruption placentae in Present study is 0.51%. Authors had perinatal mortality in 6.6% of the cases. Out of 60 cases, 2 deaths occurred in utero. Out of the remaining 58 cases, 24 babies needed NICU care, out of them, 22 went home alive and 2 had neonatal deaths. Perinatal morbidity in the form of hyperbilirubinemia, CNS depression, septicemia, neonatal anemia and neonatal DIC were noted.Conclusions: High incidence of perinatal mortality in abruptio placentae is because of increased number of still births. In our studies, the perinatal mortality is 6.6% as compared to all other studies. This decline in perinatal mortality is due to improved obstetric care and excellent NICU facilities which are required for a majority of the cases.

Clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption / 中国基层医药

Objective@#To explore the clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption.@*Methods@#From January 2015 to December 2017, 120 patients with placental abruption in the Maternal and Child Health Hospital of Zhoushan were selected as observation group.120 healthy pregnant individuals were selected as control group.They all received the color Doppler ultrasound and detection of serum CA125 and AFP levels.The clots checking on the surface of placenta post-delivery was conducted at the same time.The statistical analysis was set up to compare two groups according to those tests from the lab reports.@*Results@#The levels of serum CA125 and AFP were higher in the observation group compared with those in the control group.In details, the CA125[(69.1±8.9)U/mL]and AFP[(279.8±41.3)μg/L] levels in placental abruption grade Ⅲ were significantly higher than those in gradeⅡ[CA125(61.6±9.4)U/mL, AFP(234.9±46.2)μg/L] and gradeⅠ[CA125(52.2±8.9)U/mL, AFP(205.7±43.1)μg/L](all P<0.01). The positive predictive values of placental abruption by the color Doppler ultrasound alone was 46.7%.The combination of the color Doppler ultrasound with serum CA125 was 81.7%.The combination of the color Doppler ultrasound with serum AFP was 78.3%.The combination of those three tests was increased up to 90.8%, which was the best pre-diagnosis compared to the color Doppler ultrasound alone and the other two combinations(χ2=11.67, P<0.01). The detective rate of combination of the color Doppler ultrasound with serum CA125 and AFP was higher than the other two combinations(χ2=12.56, 12.64, all P<0.01).@*Conclusion@#The levels of serum CA125 and AFP are positively correlated with placental abruption.The combination tests using the color Doppler ultrasound and both serum CA125 and AFP is a novel and sensitive method as to pre-diagnose high risk placental abruption during pregnancy.

Ultrasonographic features and pregnancy outcomes of placental abruption / 中国医学影像技术

Objective: To investigate the ultrasonic features of placental abruption (PA) and its outcomes of pregnancy. Methods: Prenatal ultrasonic data of 132 pregnant women diagnosed as PA after delivery were collected, and the ultrasonic findings and pregnancy complications were analyzed. Results: PA was detected with ultrasonography in 48 patients while misses in 84 patients, the detection rate was 36.36% (48/132), and the missed diagnosis rate was 63.64% (84/132). Ultrasound showed placental thickening in 29 cases, intraplacental abnormal echo in 16, retroplacental abnormal echo in 9, placental marginal abnormal echo in 6, abnormal echo at placental fetal surface in 4, abnormal echo between uterine wall and amniotic membrane in 2, abnormal echo in amniotic cavity in 7 cases. The main complications of PA included cesarean section, uterine placental stroke, disseminated intravascular coagulation, postpartum hemorrhage, premature birth, severe neonatal asphyxia and even perinatal death. The incidences of complications in pregnant women with PA detected with ultrasound were higher than those in pregnant women with PA missed with ultrasound (all P<0.05). Conclusion: Prenatal ultrasonic detection rate of PA is low, and the pregnancy outcomes of pregnant women with PA detected with ultrasound is relatively poor.

Clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption / 中国基层医药

Objective To explore the clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption.Methods From January 2015 to December 2017,120 patients with placental abruption in the Maternal and Child Health Hospital of Zhoushan were selected as observation group. 120 healthy pregnant individuals were selected as control group.They all received the color Doppler ultrasound and detection of serum CA125 and AFP levels.The clots checking on the surface of placenta post-delivery was conducted at the same time. The statistical analysis was set up to compare two groups according to those tests from the lab reports.Results The levels of serum CA125 and AFP were higher in the observation group compared with those in the control group.In details,the CA125[(69.1 ± 8.9) U/mL] and AFP[(279.8 ± 41.3) μg/L] levels in placental abruption grade Ⅲ were significantly higher than those in gradeⅡ[ CA125 ( 61.6 ± 9.4 ) U/mL, AFP ( 234.9 ± 46.2)μg/L] and gradeⅠ[ CA125 (52.2 ± 8.9) U/mL,AFP(205.7 ± 43.1) μg/L] ( all P<0.01).The positive predictive values of placental abruption by the color Doppler ultrasound alone was 46.7%.The combination of the color Doppler ultrasound with serum CA125 was 81.7%.The combination of the color Doppler ultrasound with serum AFP was 78.3%.The combination of those three tests was increased up to 90.8% ,which was the best pre-diagnosis compared to the color Doppler ultrasound alone and the other two combinations(χ2 =11.67,P<0.01).The detective rate of combination of the color Doppler ultrasound with serum CA125 and AFP was higher than the other two combi-nations(χ2 =12. 56, 12. 64, all P <0. 01 ). Conclusion The levels of serum CA125 and AFP are positively correlated with placental abruption.The combination tests using the color Doppler ultrasound and both serum CA125 and AFP is a novel and sensitive method as to pre-diagnose high risk placental abruption during pregnancy.

Disección espontánea de la arteria descendente anterior en gestante con desprendimiento prematuro de placenta normoinserta: reporte de caso / Case report spontaneous descending artery dissection in pregnant woman with premature placental abruption

La patología coronaria no es frecuente dentro de la población joven. El diagnóstico en la paciente obstétrica no es fácil dado los cambios fisiológicos que esta población presenta. La disección espontánea de una arteria coronaria es una afección muy poco frecuente que puede ser causa de isquemia miocárdica y asociarse a un síndrome coronario agudo. Se trata del caso de una paciente de sexo femenino de 38 años cursando 33 semanas de gestación, la cual presentó un síndrome coronario agudo con elevación del segmento ST, por una disección coronaria, desprendimiento prematuro de placenta normo inserta (DPPNI) y óbito fetal.

Coronary disease is infrequent among young population. Diagnosis in the obstetric population is not easy, due to the physiological changes that this population presents. Spontaneous coronary artery dissection, not a frequent medical condition, can be a cause of myocardial ischemia and be associated with and acute coronary syndrome. We present the case of a 38-year-old female patient, at 33 weeks gestation, who presented an acute coronary syndrome with ST segment elevation, caused by coronary artery dissection. This syndrome was accompanied with abruptio placentae and fetal death.

Evaluation of the Maternal & Perinatal Outcome in Abruptio Placentae in Reference to Coagulation Profile

Background:Maternal mortality is an important indicator of a woman’s health. Even though MMR has reduced dramatically death from hemorrhage remains prominent even in developed countries. Abruptio placentae is an acute obstetrical emergency. Methods: This study was done in the Department of Obstetrics and Gynecology Government Medical College and Rajindra Hospital Patiala to assess clinical and coagulation profile of patients presenting with abruptio placentae and analyze maternal and fetal outcome. Result: A total of 73 patients with abruptio placentae were studied, giving an incidence of 3.09%.Of these 76.7% patients were in the age group of 21-30 years. (60%) were either nulliparous or primiparous. (65.75%) patients belonged to rural area with no regular antenatal checkup. The 90.41% patients belong to lower socio- economic status and 56% were iIIiterate. The mean gestational age in our study was 34.5 weeks and classical presentation of bleeding per vaginum associated with pain was seen in 54.7%. Most common associated risk factor found to be hypertension (58.9%), followed by PROM (13.7%) and trauma (2.74%). Conclusion: The main complications observed were shock, DIC and PPH. There was only one maternal death in our series; Mode of delivery was Vaginal in 53 Cases (72.60%) and LSCS in 20 (27.40%) Perinatal mortality was observed in 40 patients (54.79%).

Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis / Idade materna avançada e sua associação com placenta prévia e descolamento placentário: uma metanálise / Edad materna avanzada y su asociación con placenta previa y desprendimiento de la placenta: un metanálisis

This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.

Este estudo teve como objetivo investigar a existência e magnitude da associação entre idade materna avançada (AMA) e ocorrência de placenta prévia (PP) e descolamento placentário (DP) entre mulheres nulíparas e multíparas, por meio de uma revisão sistemática e meta-análise. Nós pesquisamos artigos publicados entre 1º de janeiro de 2005 e 31 de dezembro de 2015, em qualquer idioma, nos seguintes bancos de dados: PubMed, Scopus, Web of Science e LILACS. As mulheres foram agrupadas em duas categorias de idade: até 34 anos e 35 anos ou mais. A Escala Newcastle-Ottawa foi utilizada para avaliar a qualidade metodológica dos estudos. Uma meta-análise foi realizada para os desfechos PP e DP, usando um modelo de meta-regressão para encontrar possíveis covariáveis associadas à heterogeneidade entre os estudos e o teste de Egger para avaliar o viés de publicação. O protocolo desta revisão sistemática foi registrado no sistema PROSPERO (CRD42016045594). Vinte e três estudos preencheram os critérios e foram incluídos na meta-análise. Para ambos os resultados, um idade mais avançada aumentou a magnitude da associação, e PP (OR = 3,16, IC95%: 2,79-3,57) foi mais fortemente associado com AMA do que DP (OR = 1,44, IC95%: 1,35-1,54). Ao estratificar por paridade, não houve diferença entre nulíparas e multíparas de idade materna avançada para os desfechos de PP e DP. Nossa revisão forneceu evidências de baixa qualidade para ambos os resultados, uma vez que abrange estudos observacionais com alta heterogeneidade estatística, diversidade de populações, sem controle de fatores de confundimento em vários casos e viés de publicação. No entanto, os intervalos de confiança eram pequenos e há um gradiente dose-resposta, bem como uma grande amplitude de efeito para o PP.

Este estudio tuvo como objetivo investigar la existencia y la magnitud de la asociación entre la edad materna avanzada (AMA) y la aparición de placenta previa (PP) y desprendimiento de la placenta (DP) entre mujeres nulíparas y multíparas, mediante una revisión sistemática y un metanálisis. Se realizaron búsquedas en los artículos publicados entre el 1º de enero de 2005 y el 31 de diciembre de 2015, en cualquier idioma, en las siguientes bases de datos: PubMed, Scopus, Web of Science y LILACS. Las mujeres se agruparon en dos categorías de edad: hasta 34 años y 35 años o más. La Escala Newcastle-Ottawa se utilizó para evaluar la calidad metodológica de los estudios. Se realizó un metanálisis para los resultados de PP y DP, utilizando un modelo de metarregresión para encontrar posibles covariables asociadas con la heterogeneidad entre los estudios y la prueba de Egger para evaluar el sesgo de publicación. El protocolo de esta revisión sistemática se registró en el Sistema PROSPERO (CRD42016045594). Veintitrés estudios cumplieron los criterios y se incluyeron en el metanálisis. Para ambos resultados, una edad más avanzada aumentó la magnitud de la fuerza de asociación, y PP (OR = 3,16, IC95%: 2,79-3,57) se asoció más fuertemente con AMA que DP (OR = 1,44, IC95%: 1,35-1,54). Cuando se estratificó por paridad, no hubo diferencia entre las mujeres nulíparas y las multíparas consideradas mayores para los resultados de PP y DP. Nuestra revisión proporcionó pruebas de muy baja calidad para ambos resultados, ya que abarca estudios observacionales con alta heterogeneidad estadística, diversidad de poblaciones, ausencia de control de los factores de confusión en varios casos y sesgo de publicación. Sin embargo, los intervalos de confianza fueron pequeños y existe un gradiente de dosis-respuesta, así como una gran magnitud de efecto para PP.

Evolución y aspectos ecográficos del desprendimiento crónico de placenta / Evolution and ultrasound aspects of chronic placental abruption

El desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.

Chronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.

Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011 / Factores de riesgo asociados con el desarrollo de asfixia perinatal en neonatos en el Hospital Universitario del Valle, Cali, Colombia, 2010-2011

Abstract Introduction: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. Objective: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Materials and methods: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Results: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Resumen Introducción: La asfixia perinatal constituye una de las principales causas de morbilidad y mortalidad perinatal en el mundo, tiene factores de riesgo modificables y genera altos costos para los sistemas de salud. Objetivo: Determinar los factores de riesgo asociados al desarrollo de asfixia perinatal en recién nacidos en el Hospital Universitario del Valle, Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio de casos incidentes y controles concurrentes. Los casos se definieron como neonatos con asfixia perinatal moderada a grave, de edad de gestación mayor o igual a 36 semanas, que requirieron reanimación avanzada y presentaron, al menos, una de las siguientes condiciones: alteraciones neurológicas tempranas, falla orgánica múltiple o aparición de un evento centinela. Los controles se definieron como neonatos sin diagnóstico de asfixia, nacidos hasta con una semana de diferencia con respecto al caso y de edad de gestación comparable. Se excluyeron los pacientes con malformaciones congénitas mayores y síndromes. Resultados: Se estudiaron 56 casos y 168 controles. El desprendimiento prematuro de la placenta (odds ratio, OR=41,09; IC95% 4,61-366,56), un trabajo de parto con fase expulsiva prolongada (OR=31,76; IC95% 8,33-121,19), no usar oxitocina (OR=2,57; IC95% 1,08-6,13) y ser madre soltera (OR=2,56; IC95% 1,21-5,41) fueron factores de riesgo para el desarrollo de asfixia perinatal en la población bajo estudio. En las madres de los casos se encontraron dificultades sociales en mayor proporción. Conclusiones: Se recomienda un control adecuado y una vigilancia apropiada del trabajo de parto, hacer un estricto partograma, y una búsqueda activa, de manera que cada mujer embarazada tenga un adecuado control prenatal y reciba apoyo social.

Avaliação dos fatores associados aos resultados neonatais no descolamento prematuro de placenta / Evaluation of factors associated with neonatal outcomes in placental abruption

O descolamento prematuro de placenta (DPP), apesar de ter baixa prevalência, é uma das principais causas de morbimortalidade perinatal. Fatores maternos estão associados a sua ocorrência e podem influenciar a vitalidade fetal e relação entre o peso do recém-nascido/idade gestacional. Avaliar a associação entre fatores maternos e resultados neonatais presente em gestantes com DPP. Estudo transversal que revisou prontuários digitalizados de 62 mulheres que interromperam a gestação por DPP, num hospital público de São José, entre Agosto/2010 e Novembro/2012. Informações demográficas, clínico-obstétricas e perinatais coletadas, foram digitadas no Excel e exportadas para o software Stata versão 10, onde foram analisadas de forma descritiva e bivariada através da prova exata de Fisher e o Odds Ratio (OR). A significância estatística está representada pelo valor de p < 0,05 e intervalo de Confiança de 95%. Estudo aprovado pelo Comitê de Ética em Pesquisa do Hospital Regional de São José. A prevalência de DPP foi de 0,4% e predominou em mulheres entre 20 e 30 anos, com parto prematuro, primíparas, sem aborto prévio. A maioria não tinha características clínicoobstétricas de risco para DPP. A maior parte dos recém-nascidos apresentaram Apgar alto em primeiro e quinto minuto, era pequena para idade gestacional e não sofreu morte intraútero ou neonatal. Ao associar prematuridade e baixo Apgar de primeiro minuto, observou-se significância estatística (p=0,03), com OR=5,5 (IC95% 1,0-29,9). Nenhuma variável materna teve relação com peso do recémnascido/idade gestacional. Apenas a baixa idade gestacional apresenta influência significativa sobre baixo Apgar de primeiro minuto (p=0,03) em pacientes com DPP.

Abruptio placentae (AP), despite its low prevalence, is a major cause of perinatal morbidity and mortality. Maternal factors are associated with its occurrence and may influence the fetal vitality and the relationship between fetal weight and gestational age. To evaluate the association between maternal factors and neonatal outcomes in women with AP. Cross-sectional study which reviewed digitized records of 62 women who interrupted pregnancy by AP, at a public hospital in São José, between August/2010 and November/2012. Collected demographic, clinical-obstetric and perinatal informations were entered in Excel and exported to software Stata version 10, where they were analyzed descriptively and through bivariate Fisher's exact test and Odds Ratio (OR). Statistical significance is represented by the value of p < 0.05 and confidence interval of 95%. This study was approved by Ethics Committee in Research of Regional Hospital of São José. The AP's prevalence was 0.4% and it was more common in women between the ages of 20 and 30, with premature birth, primiparous, without previous abortion. Most of them had no clinical and obstetric risk's characteristics for AP. Most newborns had a high Apgar at one and five minutes, were small for gestational age and did not have intrauterine or neonatal death. There was statistically significant when associating prematurity and low Apgar score at first minute (p=0.03), and OR=5.5 (CI95% 1,0-29,9). There was none maternal variable between fetal weight and gestational age. Only prematurity has significant influence on first minute Apgar score (p=0.03) in patients with AP.

Útero de Couvelaire: relato de caso / Couvelaire uterus: a case report

O descolamento prematuro da placenta (DPP) é importante causa de hemorragia na gestação, sendo responsável por grande aumento na morbimortalidade materna e fetal. O diagnóstico é principalmente clínico, mas os achados laboratoriais e de imagem podem ser utilizados para apoiar o diagnóstico clínico. O DPP representa desafio em Obstetrícia ao promover graves consequências à mãe-filho, assim como por ter suaetiologia definida de forma incompleta. O objetivo deste estudo foi discutir os aspectos mais relevantes do DPP, enfatizando a importância do exame clínico completo associado ao método de ultrassonografia obstétrica no auxílio ao diagnóstico.

Premature placental separation (PPS) is a major cause of bleeding in pregnancy and responsible for a large increase in maternal and fetal morbidity and mortality. The diagnosis is mainly clinical; however, laboratory and imaging findings can be used to support the clinical diagnosis. PPS represents a challenge in Obstetrics because it promotesserious consequences to mother-child and have incomplete defined etiology. The objective of this study was to discuss the most relevant aspects of PPS emphasizing the importance of a complete clinical examination associated with the obstetric ultrasound method as a diagnostic aid.

Maternal and fetal outcome among abruptio placentae cases at a rural tertiary hospital in Karnataka, India: a retrospective analysis.

Background: Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. The Diagnosis was confirmed on the presence of retroplacental clot, which was used to estimate the amount of bleeding and severity of abruption. Patients were managed according to the fetal and maternal conditions and ultrasonography. Methods: The study was carried out for a period of two years from 1st July 2012 to 30th June 2014. The study population included all cases presenting with ante partum hemorrhage to the Department of Obstetrics and Gynecology during the study period. Subjects selected for the study were all cases diagnosed as having abruptio placentae. Results: Total number of women admitted in labor ward between 1st July 2012 to 30th June 2014 was 4956. Among these 138 had abruption placenta. Majority of patients were in the age group 25-30 years. Incidence was higher in multi-parous. Spontaneous vaginal delivery was the mode in most patients (~74%). Major maternal complication seen was Shock, followed by postpartum hemorrhage, altered coagulation profile and renal failure. Eighty four (62.3%) women delivered alive babies while 52(37.7%) were stillborn. Out of these 86 alive born babies four died in early neonatal period due to prematurity. Overall perinatal mortality was 40.5%. Conclusion: In our setup, frequency of abruptio placenta is comparable with local and international literature. Abruptio placenta is associated with high rate of maternal and fetal morbidity and mortality, Because of this association, the conditions predisposing it should be carefully evaluated in order to reduce the occurrence of placental abruption. Unfortunately neither accurate prediction nor prevention of abruption is possible at the present time. Despite advances in medical technology, the diagnosis of abruption is still a clinical one.

Clinical manifestation of preeclampsia complicated with placental abruption and its treatment measure / 中国基层医药

Objective To study the clinical manifestation of preeclampsia complicated with placental abrup-tion and its treatment measures.Methods 160 patients with placenta abruption were selected,and the patients with preeclampsia complicated with placental abruption were selected as the study group(70 cases),and the patients with non preeclampsia complicated with placental abruption were selected as the control group(90 cases).The clinical manifestations,infant outcome and treatment measures of the two groups were compared.Results When the disease attack of the study group often accompanied with vaginal bleeding,but few had symptoms of abdominal pain,the main symptoms of the control group was vaginal bleeding and abdominal pain.The occurrence rate of abdominal pain of the two groups had statistically significant difference(4.3%vs 92.2%,χ2 =11.032,P0.05);The incidence of neonatal asphyxia of the two groups had no significant difference(56.6%vs 55.6%,P>0.05);The perinatal mortality of the two groups had sta-tistically significant difference(31.7%vs 11.1%,P0.05).Conclusion The clinical manifestation of preeclampsia was not typical,with a greater harm to the fetus and perinatal infant,operation to termination of pregnancy is the main method for treatment of preeclamp-sia complicated with placenta abruption.

Intervenções obstétricas no parto pré-termo: revisão da literatura e atualização terapêutica / Obstetric interventions in preterm birth: a literature review and therapeutic update

A prematuridade constitui-se em tema de grande repercussão em saúde pública e individual. Persiste como a maior causa de morbimortalidade perinatal e suas consequências envolvem efeitos imediatos e tardios potencialmente graves. Existe ainda grande limitação na identificação precoce dos casos de trabalho de parto pré-termo quanto à adoção de medidas capazes de prevenir suas complicações, entretanto, muitos avanços foram obtidos em função de como melhor oferecer assistência àgestante e ao recém-nascido, além da difusão de centros de terapia intensiva neonatal. Esta revisão objetiva apresentar as medidas terapêuticas capazes de minimizar as consequências do parto pré-termo. Devem ser empregadas, sempre que houver indicação, as medicações para tocólise, maturação pulmonar fetal, neuroproteção e prevenção de infecções, uma vez que qualquer intervenção capaz de melhorar o prognóstico fetal possui forte impacto social, psicológico e financeiro nas famílias afetadas por esse problema.

Prematurity is an important theme that impacts greatly both public and individual health. It is still the highest cause of morbimortality in the perinatal period and its consequences include potentially severe immediate and late effects. Although there are still severe limitations to the early identification of preterm labor as well as in the measures to avoid complications, many advances have been made in terms of assistance topregnant mothers and neonates, including more widespread neonatal intensive care centers. This review aims to present therapeutic measures that can minimize the consequences of preterm delivery. Whenever indicated, medication for tocolysis, fetus lung maturation, neural protection, and infection prevention must be prescribed, given that any intervention capable of improving fetal prognosis has relevant social, psychological and financial impact on affected families.