Acretismo placentario: un diagnóstico emergente. Abordaje quirúrgico no conservador / Placental accreta: an emerging diagnosis. Approach non-conservative surgical

RESUMEN El espectro de acretismo placentario es un fenómeno infrecuente del embarazo cuya incidencia ha aumentado considerablemente y que está caracterizado por el anclaje anormal de las vellosidades coriónicas al miometrio, lo cual aumenta la morbi-mortalidad materna durante la resolución quirúrgica. Según las capas uterinas comprometidas, serán clasificadas como placenta acreta (contacta miometrio), increta (penetra miometrio) y percreta (compromete todo el miometrio y/o eventualmente órganos adyacentes), siendo su mayor factor de riesgo: la cesárea anterior y la placenta previa. En este artículo se realizó una revisión bibliográfica abarcando definiciones, diagnóstico y las nuevas tendencias en manejo quirúrgico no conservador propuesto en la nueva guía de la Federación Internacional de Ginecología y Obstetricia publicada en 2018 y elaborando una discusión respecto a ellas.

SUMMARY Placenta accreta spectrum is an uncommon phenomenon of pregnancy whose incidence has increased considerably over time and is characterized by the abnormal anchoring of the chorionic villi to the myometrium, which increases maternal morbidity and mortality during surgical resolution. According to the compromised uterine layers, they will be classified as placenta accreta (contacts myometrium), increta (penetrates myometrium) and percreta (compromises the entire myometrium and / or possibly adjacent organs), being previous caesarean section and placenta previous its major risk factor. In this review, we included definitions, diagnosis, and the new topics in non-conservative surgical management developed by the International Federation of Obstetrics and Gynecolgy published in 2018, and developing a discussion of the topic.

A rare case of leiomyosarcoma of cervix and challenges in its management: a case report and brief review of literature.

Leiomyosarcoma of cervix is an aggressive and rare tumour of the cervix with poor prognosis. Management plan differs greatly from other common cervical malignancies. A 38 year old multiparous lady presented with a large circumferential cervical tumour which was diagnosed as leiomyosarcoma of cervix on cervical biopsy. It was a surgical challenge. Patient underwent pre-operative ureteric stenting followed by exploratory laparotomy with hysterectomy with bilateral salphingo-oophorectomy. Surgical difficulties were encountered due to deep impaction of tumour in pelvis and altered anatomy due to the bulk of tumour. Retrograde approach was taken and pouch of Douglas was opened before clamping the mackenrodts and the uterus was bisected and debulking of tumour done simultaneously to facilitate the surgery. Post operatively patient received chemotherapy (Vincristine, adriamycin and cyclophosphamide) followed by radiotherapy. Patient developed vesicovaginal fistula and liver metastasis nine months post- surgery. She received second line of chemotherapy (gemcitabine and docetaxel) after which she was lost to follow up.