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1.
ARS med. (Santiago, En línea) ; 48(3): 62-70, 30 sept. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1512554

ABSTRACT

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.


Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

2.
Article in English | IMSEAR | ID: sea-183180

ABSTRACT

Cough remains one of the chief complaints for which patients seek medical attention. It has been estimated that at least 25% of chronic cough cases are caused by multiple, simultaneous causes. Cough is also an important presenting feature of a number of extrapulmonary conditions, such as cardiac diseases, upper airway diseases, gastroesophageal reflux diseases and neurological/ psychological conditions. The diagnosis of extrapulmonary causes of cough is quite challenging and the management is complicated by poor treatment response if underlying etiological mechanisms are overlooked. The intention of this article is to highlight the importance and consequences of nonpulmonary etiologies of cough such as drug-induced vocal cord dysfunction, gastroesophageal reflux disease, laryngeal reflux and neuropathic disorders and to discuss about management strategies for each etiology.

3.
Article in English | IMSEAR | ID: sea-183070

ABSTRACT

Cough is considered as a single most common complaint for which patients globally seek medical attention. A multitude of allergic etiologies contribute to the development of chronic cough in adults, which makes the diagnosis and treatment quite challenging. Allergic cough is a distinct entity where there is no respiratory obstruction and there is presence of a family history, past history and/or concomitant allergic conditions. Sensitivity to allergens is readily demonstrable by skin testing. It is also characterized by a therapeutic response to epinephrine and a periodic nature. The intention of this article is to highlight the common causes of chronic dry cough associated with allergic diseases, to differentiate allergic cough from various other causes of chronic cough associated with asthma syndromes (which include related airway disorders like ‘classic’ asthma [cough-variant asthma], nonasthmatic eosinophilic bronchitis and atopic cough) and to discuss its management strategies.

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