Spontaneous hemoperitoneum in pregnancy: report of two cases

The condition known as spontaneous hemoperitoneum in pregnancy (SHiP) is characterized by an accumulation of fluid in the abdominal cavity and a vague collection of symptoms. Specifically, intrauterine pregnancy increases the chance of death for both the mother and the fetus, making SHiP a potentially lethal illness when it coexists. Here, we discuss two cases of spontaneous hemoperitoneum in pregnancy that resulted from placenta accreta spectrum and endometriosis, and happened in the second and third trimesters, respectively.

Maternal and perinatal outcome in placenta previa

Background: Placenta previa is a serious and life-threatening pregnancy complication characterized by bleeding originating from the placental site located in the lower uterine segment. This condition typically occurs during the latter half of pregnancy when the lower uterine segment undergoes stretching.Methods: This study is a retrospective observational study of total 30 cases of placenta previa from October 2022 to February 2024 at the department of obstetrics and gynecology at SVP Hospital, tertiary center, western Ahmedabad. All women with placenta previa included in this study except patients suffering from any other bleeding disorder. These women were analyzed with age, parity, gestational age, past history of bleeding, clinical features at presentation, blood transfusion, period of gestation at time of delivery, mode of delivery and perinatal outcome.Results: In present study 30 cases were taken. Majority were registered 66.7% (20), age group between 21 to 30 year patients 87% (26), multiparous 73.4% (22) patients. Most common risk factor is caesarean section 20% (6) followed by D&E 16.6% (5). Common complications include 33.33% (10) postpartum haemorrhage.Conclusions: Placenta previa is a major risk factor for adverse maternal and perinatal outcome. Good antenatal care, early diagnosis, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and nicu services can improve maternal and neonatal outcome in high risk cases.

A rare case of retained placenta in a young primigravida with no known risk factors; managed by manual removal of the placenta under general anaesthesia

A retained placenta is suspected when there is failure of expulsion of the placenta even after 30 minutes of delivery of the fetus. Retained placenta is a common cause of PPH and, hence, a significant cause of maternal mortality and morbidity in developing countries. Thus, early intervention is necessary to prevent this post-delivery of the baby. We present a case of retained placenta in a young primigravida with oligohydramnios with fetal horse horseshoe-shaped kidney and a foetal echogenic bowel loop. Her clinical findings and investigations were not significant at the time of admission. She was induced with dinoprostone gel intra-cervically and delivered via vaginal route. There was failure of expulsion of the placenta even after 30 minutes of delivery of the baby. Inj. syntocin 5 units were given via the umbilical cord. In the event of this failure, the patient was shifted inside the OT, and manual removal of the placenta was done under general anaesthesia f/b evacuation retained bits of placental membranes with ovum forceps under USG guidance. Retained placenta can lead to severe PPH and its consequences in the postpartum period. Thus, it requires timely intervention to prevent PPH and reduce maternal mortality and morbidity. Cases of retained placenta can occur even in the absence of any known identified risk factors and should be managed in a tertiary care centre with OT facilities.

Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort

Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

El embarazo gemelar monocorial desde la perspectiva de la teoría de la complejidad / Monochorionic twin pregnancy from the perspective of the theory of complexity

En la práctica, es muy frecuente asociar las gestaciones gemelares monocoriales (MC) con embarazos complejos o complicados, utilizando ambos términos en forma intercambiable. Sin embargo, no lo son; el dinamismo es protagonista en los sistemas complejos, pero no en los complicados. Para entender a la embarazada con una gestación MC como un sistema complejo, primero se desarrollarán las características principales de los embarazos MC; su placenta es una de las principales responsables de los problemas. Luego se analizará el embarazo MC desde la complejidad, identificando las características del sistema y sus complicaciones como propiedades emergentes.

In practice, it is very common to associate monochorionic (MC) twin pregnancies with complex or complicated pregnancies, using both terms interchangeably. However, these are not synonyms; dynamism is the protagonist in complex systems, but not in complicated ones. In order to understand a MC pregnancy as a complex system, it is necessary to first look into its main characteristics. The placenta is one of the main sources of problems. Then, the MC pregnancy has to be analyzed from the perspective of complexity, identifying the system characteristics and its complications as emergent properties.

An unusual case of retained placenta managed by hysterotomy

When the placenta does not expel after 30 minutes of delivery of fetus it is said to be retained. It can be a cause of post-partum haemorrhage. It may result from poor uterine contractions. The most common source of a trapped placenta is from a partial closure of the cervix and/or a contracted lower uterine segment. We present an unusual case of a retained placenta trapped in a myometrial sacculation at the left angular region of the uterus.

Case series on placenta accreta spectrum disorder and its management

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it抯 massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. We report here a series of 5 cases of placenta accreta spectrum and their management at our centre. With all due pre-op preparedness and anticipation of complications. All 5 cases had good maternal and fetal outcome. In 3 cases hysterectomy was required and 2 cases uterus could be preserved.

Manejo expectante de amniocele en paciente con espectro de placenta accreta: reporte de caso / Expectant management of amniocele in a patient with placenta accreta: a case report

Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.

Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.

A cross sectional study of indications and complications of primary cesarean section at District Hospital Patiala

Background: Caesarean section is one of the major oldest surgical procedure that has been performed all over world to save life of mother and fetus. The steadily increasing global rates of caesarean section have become one of the most debated topics in maternity care, as its prevalence has increased alarmingly in recent years. The aim is to assess the indications and complications of primary caesarean section in primigravida and multigravida.Methods: A cross sectional study carried out over a period of 1 year from April 2022 to March 2023, among 300 pregnant women from labour room in Mata Kaushalya District Hospital, Patiala by simple random sampling method.Results: Majority 54.7% of cesarean section were of primigravida and 45.3% were of multigravida. Maximum number of caesareans was between 26-30 yrs of age group. 68% women underwent emergency caesarean section and 32% underwent elective caesarean section. 6% underwent caesarean section at <37 weeks gestational age, maximum 83%caesarean section were at 37- 40 weeks gestational age and 11% caesarean section were at >40 weeks gestational age. Among primigravida, majority 35%were fetal distress, 24.29% CPD, malpresentation and malposition were 6.77%, 5.08% NPOL, 3.38% were placenta previa, 2.25% were IUGR, 3/177 (1.69%), severe oligohydroamnios 1.69%, preeclampsia and 1/177 (0.56%) were abruptio placenta. Among multigravida women 41.46% had most common indication was fetal distress, 2.43% had non progress of labour, 14.63% had malpresentations and malpositions.Conclusions: The proportion of primigravida undergoing primary Caesarean delivery was much more than multigravida. However, complications related to primary CS was much higher in multigravida.

Amnios con cobertura antibiótica: eficacia en pacientes sometidas a conización / Amnions with antibiotic coverage: efficacy in patients undergoing conization

Objetivo: Comparar la evolución de la cicatrización en pacientes en quienes se aplicó amnios con cobertura antibiótica, con otro grupo en que no se aplicó, posterior a la realización de conización cervical en la consulta de patología cervical del Hospital Central de San Cristóbal, entre febrero y mayo de 2023. Métodos: Estudio experimental, comparativo, aleatorizado, longitudinal. Incluyó 66 pacientes, aleatorizadas en dos grupos: grupo 1 (control): no se aplicó el amnios (n = 30/45,5 %) y grupo 2 (experimental): se aplicó el amnios tratado con antibióticos (n = 36/54,5 %). La investigadora preparó, en quirófano, el amnios de placentas obtenidas por cesárea o parto vaginal. Se obtuvo consentimiento informado de donantes y receptoras. Resultados: Al día 14, ninguna paciente del grupo 1 presentaba epitelización. En el grupo 2, una paciente (2,7 %) tenía 50 % de epitelización y 35 (94,6 %) habían alcanzado el 100 % (p < 0,001). La epitelización fue total en 13,3 % del primer grupo y 94,6 % del segundo (Odds Ratio de 227 (IC 95 %: 24,0 a 2157,0; p < 0,001). No hubo ningún caso de infección cervical. Cinco pacientes (16,7 %) del grupo 1 y una del grupo 2 (2,8 %) presentaron ectopias (p = 0,051). No hubo asociación entre epitelización completa o parcial y características clínicas (p ˂ 0,05). Conclusión: El amnios con cobertura antibiótica se asocia a mejor evolución de la cicatrización en pacientes con conización cervical. Se comprobó su eficacia como terapéutica médica al ser aplicada sobre la herida operatoria(AU)

Objective: To compare the evolution of healing in patients in whom amnion with antibiotic coverage was applied, with another group in which it was not applied, after cervical conization performed in cervical pathology consultations of the San Cristobal Central Hospital, between February and May 2023. Methods: Experimental, randomized, longitudinal comparison. It included 66 patients, randomly divided into two groups. Group 1: in which amnion was applied (n = 36/54.5 %); Group 2: no treatment (n = 30/45.5%). The researcher prepared the amnions of placentas obtained by cesarean section or vaginal delivery, in the operating room. Informed consent was obtained from both donors and recipients. Results: On day 14, none of the patients in the group 1 had epithelialization. In the group 2, one patient (2.7%) had 50% epithelialization and 35 (94.6%) had reached 100% (p < 0.001). Epithelialization was total in 13.3% of the first group and 94.6% of the second group (Odds Ratio of 227 (95% CI: 24.0 to 2157.0; p < 0.001). There were no cases of cervical infection. Five patients (16.7%) in the group 1 and one in the group 2 (2.8%) had ectopias (p = 0.051). There was no association between complete or partial epithelialization and clinical characteristics (p ˂ 0.05). Conclusion: Amnion with antibiotic coverage is associated with better healing outcomes in conized patients. Its effectiveness as a medical therapy was proven when placed on the surgical wound(AU)

Peripartum hysterectomy: prospective observational study in a tertiary care centre of north India

Background: Emergency peripartum hysterectomy is a vital surgical procedure performed at the time of vaginal or caesarean delivery or in the immediate postpartum period in cases of intractable postpartum haemorrhage unresponsive to other conservative measures. Such hemorrhage may be due to atonic uterus, uterine trauma, coagulation disorders, abnormal placentation, not treatable by conservative measures.Methods: This study was conducted for a time period of 1.5 years from March 2016 to September 2017, in the department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India. All such patients in our hospital were included in this study. The incidence, risk factors, age, parity, gestational age, indications for performing hystrectomy, pre and post-operative complications were studied.Results: The incidence was 3.2/1000 deliveries. The average age of the patients in our study was 31.18±2.80 years. Most patients were delivered at gestation of 37-38 weeks (61.17%). Among the patients undergoing peripartum hysterectomy 87.38% had caesarean delivery and 12.62% had vaginal delivery. The commonest indication of peripartum hystrectomy in our study was abnormal placentation (67.96%) with accreta accounting for most of these cases (53.40%).Conclusions: The incidence of peripartum hystrectomy in our centre has increased with time, which can be accounted by increase in the rate of caesarean sections over time which has led to the emergence of morbidly adherent placentation as the commonest risk factor for peripartum hysterectomy.

Alteraciones de la placenta y sus anejos en muestras procedentes de muertes fetales. Cienfuegos, 2021-2023

Fundamento la placenta humana es un misterio. El diagnóstico anatomopatológico cobra importancia en la búsqueda de factores en los que se pueda trabajar para evitar las muertes fetales. Objetivo determinar las alteraciones macroscópicas y microscópicas de la placenta y sus anejos en especímenes procedentes de muertes fetales. Métodos se realizó un estudio descriptivo, retrospectivo y trasversal, en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en el período comprendido entre 2021 y 2023. Fueron analizadas 58 placentas y sus anejos, recibidos en el departamento de Anatomía Patológica. Se estudiaron las alteraciones macroscópicas y microscópicas de la placenta. Resultados tuvieron mayor representación las placentas y cordones anormalmente pequeños (24,14 % y 63,79 % respectivamente); la inserción marginal del cordón (36,21 %), las rupturas, las torciones (8,62 %), los quistes (6,90 %), el edema (77,59 %), la necrosis fibrinoide (72,41%), las vellosidades inmaduras, la villitis (43,10 %), el excesivo número de nudos sincitiales (3,48 %), la esclerosis fibromuscular (20,69 %), la presencia de fibrina (82,76 %), la funisitis (29,31%), la esclerosis fibromuscular (20,69 %) y la corioamnionitis (31,03 %). Conclusiones los resultados evidenciaron predominio de las alteraciones microscópicas, como son la fibrina, la necrosis fibrinoide y el edema. Teniendo en cuenta estos factores, se podrán tomar las medidas necesarias para evitar una muerte fetal.

Foundation the human placenta is a mystery. The anatomopathological diagnosis becomes important in the search for factors that can be worked on to avoid fetal deaths. Objective to determine the macroscopic and microscopic alterations of the placenta and its annexes in specimens from fetal deaths. Methods a descriptive, retrospective and cross-sectional study was carried out at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, from 2021 to 2023. 58 placentas and their annexes, received in the Pathological Anatomy Department, were analyzed. Macroscopic and microscopic alterations of the placenta were studied. Results abnormally small placentas and cords were more represented (24.14 % and 63.79 % respectively); marginal cord insertion (36.21 %), ruptures, twists (8.62 %), cysts (6.90 %), edema (77.59 %), fibrinoid necrosis (72.41 %), immature villi, villitis (43.10 %), excessive number of syncytial knots (3.48 %), fibromuscular sclerosis (20.69 %), the presence of fibrin (82.76%), funisitis (29.31 %), fibromuscular sclerosis (20.69 %) and chorioamnionitis (31.03 %). Conclusions the results showed a predominance of microscopic alterations, such as fibrin, fibrinoid necrosis and edema. Taking these factors into account, the necessary measures can be taken to avoid fetal death.

Desarrollo embriológico e importancia clínica de la membrana amniótica: revisión narrativa de literatura / Embryological development and clinical significance of the amniotic membrane: narrative literature review

La membrana amniótica (MA), ubicada en el lado interno de la placenta fetal, ha sido objeto de múltiples investigaciones para intentar dilucidar su papel embriológico y su potencial celular terapéutico. Actualmente las limitaciones del estudio en fetos humanos hacen que parte de su funcionamiento sea una incógnita, sin embargo algunos estudios clínicos y básicos nos dan luz sobre su papel en la médica moderna. Se realizó una revisión bibliográfica de la literatura desde 1960 hasta 2022, empleando bases de datos como PubMed, SciELO y Scopus, siendo incluidos un total de 50 artículos y dos textos de embriología. El objetivo de esta revisión narrativa fue sintetizar la información sobre la angiogénesis y su importancia clínica. La información recopilada permitió evidenciar que las propiedades de curación de la piel del feto se deben a factores intrínsecos del feto, y a que las células epiteliales amnióticas humanas poseen una diferenciación similar a las células madre embrionarias, con la capacidad de diferenciación similar al de las células mesenquimales, resaltando su importancia clínica por sus características regenerativas. En conclusión, el desarrollo embrionario humano sigue siendo relativamente inexplicable, pero su conocimiento ha permitido grandes avances, que podrían ser útiles en terapias de regeneración, reparación de tejidos y órganos lesionados.

The amniotic membrane, located on the inner side of the fetal placenta, has been the subject of multiple investigations to try to elucidate its embryological role and its therapeutic cellular potential. Currently, the limitations of the study in human fetuses mean that part of its functioning is unknown, however, some clinical and basic studies shed light on its role in modern medicine. A bibliographic review of the literature was carried out from 1960 to 2022, using databases such as PubMed, SciELO and Scopus, including a total of 50 articles and two embryology texts. The objective of this narrative review was to synthesize information on angiogenesis and its clinical importance. The information collected made it possible to show that the healing properties of the fetal skin are due to intrinsic factors of the fetus, and that human amniotic epithelial cells have a differentiation similar to embryonic stem cells, with the differentiation capacity similar to that of mesenchymal cells, highlighting their clinical importance due to their regenerative characteristics. In conclusion, human embryonic development remains relatively inexplicable, but its knowledge has allowed great advances, which could be useful in regeneration therapies, repair of injured tissues and organs.

Conservative management in case of placenta accreta followed by hysterectomy

With a rise in number of caesarean sections we are also seeing an increase in the adherent placenta that form a part of placenta accreta spectrum. Early identification and appropriate management and monitoring is very important in these patients as they can have hemorrhage that can cause significant maternal and fetal morbidity and mortality. This is a case of conservative management of a woman with placenta accreta spectrum, use of uterine artery balloon ligation to decrease the intra-operative blood loss, leaving placenta in situ, methotrexate therapy and follow up of the patient that ultimately led to hysterectomy. It highlights the importance of managing these women in adequately equipped center with the required expertise and intensive care support and multidisciplinary management to improve patient care leading to good maternal and fetal outcome.

Fetal outcome of placenta accreta spectrum disorder patients admitted at Cumilla medical college hospital

Background: Placenta accreta spectrum disorder (PASD) is a complex obstetric condition associated with significant maternal and fetal morbidity and mortality. Despite its increasing global prevalence, there is limited research focusing on the fetal outcomes of PASD patients, particularly in Asian populationsMethods: This observational study was conducted at Cumilla medical college hospital over 18 months, starting from January 2022. A total of 60 patients diagnosed with PASD were included, following specific inclusion and exclusion criteria. Data were collected on sociodemographic characteristics, antenatal care, presenting complaints, and fetal outcomes.Result: The study found that 90% of the participants had live births, while 10% experienced intrauterine death. Among the live births, there was a nearly equal distribution between low and normal birth weights. The sociodemographic distribution was diverse, with the majority of participants falling within the age range of 21-30 years. Half of the participants received regular antenatal care, and antepartum hemorrhage was the most common presenting complaint.Conclusions: The study provides valuable insights into the fetal outcomes of PASD patients, with a notably high rate of live births. The findings also highlight the importance of regular antenatal care and early diagnosis in managing PASD effectively. The study serves as a foundation for future research aimed at improving both maternal and fetal outcomes in PASD.

A retrospective analysis of obstetric hysterectomy in a tertiary center over one year

Background: Obstetric hysterectomy is a lifesaving procedure in a setting of life-threatening obstetrical hemorrhage. There is and increasing need of obstetric hysterectomy due to rising cases of caesarean sections and morbidly adherent placenta. We aimed to study the incidence, indications and fetomaternal outcome of obstetric hysterectomy. Various risk factors are discussed which may be helpful in reducing maternal and neonatal morbidity.Methods: A one year hospital based retrospective study involving detailed medical records of patients who underwent obstetric hysterectomy between 1st April 2022 and 31st march 2023.Results: The overall incidence of obstetric hysterectomy was 0.2% in this study with majority of patients in the 20-25-year age group, and patients who were 2nd and 3rd para comprised of the maximum number. The indication identified in this study were morbidly adherent placenta followed by atonic PPH and caesarean scar ectopic. The major risk factors noted were previous LSCS in 60% and morbidly adherent placenta in 53.3% patients. Of the 15 patients, 60% underwent total while 40% underwent subtotal hysterectomy. ICU admission, fever and coagulopathy were the leading post op complications. There was one case of maternal death noted and one case each of intrauterine death and perinatal mortality.Conclusions: Obstetric hysterectomy is the last resort to intractable bleeding and hence an important lifesaving procedure. The feto-maternal outcome depends on timely decision, surgical techniques and stringent post op monitoring of these patients.

Embarazo pretérmino intrabdominal exitoso: Reporte de caso / Successful intrabdominal preterm pregnancy: A case report

RESUMEN Introducción: El embarazo ectópico es toda gestación, en la que el sitio de implantación del óvulo fecundado se localiza fuera de la cavidad endometria y representa el 1.4 % de estos. Caso clínico: Paciente de 28 años con dos cesáreas previas, sometida a salpingoclasia durante la última intervención. La paciente ingresó al hospital con presión arterial de 180/130 mm Hg, no respondió a tratamiento médico y presentó falla en la progresión de trabajo de parto, por lo que se decidió interrupción por operación cesárea. Durante la cirugía, se observó un pequeño útero con embarazo extrauterino adherido a la serosa del ciego, el colon ascendente y el apéndice. Se obtuvo un producto femenino pretérmino vivo; la madre cursó con evolución favorable y sin complicaciones posoperatorias. Conclusión: La presentación del embarazo abdominal ectópico es rara, por lo que un control prenatal adecuado por personal capacitado puede orientar a la sospecha diagnóstica. La madre y la recién nacida no presentaron ninguna complicación, a pesar de ser un embarazo abdominal avanzado y la inserción multifocal de la placenta. Se resalta la importancia del manejo oportuno y multidisciplinario cuando se enfrentan embarazos con curso anormal para la mejor evolución de la madre y del producto.

ABSTRACT Introduction: Ectopic pregnancy is any gestation in which the implantation site of the fertilized egg is located outside the endometrial cavity. Abdominal ectopic pregnancy represents 1.4% of these. Case report: 28-year-old patient with two previous cesarean sections; bilateral tubal obstruction during the last operation. The patient was admitted to the hospital with blood pressure of 180/130 mm Hg that did not respond to medical treatment and not progression to labor so it was decided to interrupt the pregnancy by cesarean section. During surgery, a small uterus with extrauterine pregnancy was observed adhered to the serosa of the cecum, ascending colon, and appendix. A live preterm female product was obtained; the mother had a favorable evolution and no postoperative complications. Conclusion: Ectopic pregnancies are rera. An adequate prenatal control by well trained personnel is essential for an accurate diagnosis. The mother and the newborn did not present any complication. It is very important to have and accurate an opportune diagnosis so trained personnel can offer an adequate management.

Ultrasonic risk model for predicting invasiveness of placenta accreta spectrum disorders / 中国医学影像技术

Objective To explore the value of a risk model established based on ultrasonic features for predicting invasiveness of placenta accreta spectrum disorders(PAS).Methods Data of 133 PAS patients were retrospectively analyzed.According to being invasive PAS or not,the patients were divided into invasive group(n=63)and non-invasive group(n=70).PAS-related ultrasonic features and distance between the lower margin of placenta and internal os of cervix(D value)were compared between groups.Univariate logistic regression and the receiver operating characteristic(ROC)curve were used to define the optimal cut-off value of figure of ultrasonic features for identifying invasiveness of PAS,then a dichotomous variable of the above figure was created.Multivariate logistic regression was performed to detect whether the dichotomous variable of the above figure and D were the independent impact factors for identifying invasiveness of PAS,and the risk prediction model was constructed.Results Among 12 PAS-related ultrasonic features,the detection rates of 10 features,including interruption or disappearance of retroplacental clear zone,thinner myometrium,lacunae,thickened placenta,cervix involvement,interrupted or disappeared bladder wall,feeding vessels of lacunae,bridge vessels,as well as hypervascularity of uteroplacental interface and between uterus and bladder in invasive group were higher than those in non-invasive group(all P＜0.05),while those of lumpy contour and placental bulge were not significantly different between groups(both P＞0.05).In invasive group,anterior placenta mainly located on the anterior wall and multiple PAS-related ultrasonic features were more common.Multiple ultrasonic features and smaller D value were both independent risk factors for identifying invasiveness of PAS(both P＜0.05).The prediction model for identifying invasiveness of PAS was logit(P)=-0.717+1.551 × Positivemultiple ultrasonic features-0.216 × D value,with the area under curve(AUC)of 0.905.Conclusion Multiple PAS-related ultrasonic features and shorter distance of the lower margin of placenta to the internal os of cervix were independent risk factors for identifying invasiveness of PAS.The constructed risk model was effective for predicting invasiveness of PAS.

Effects of permanent placental injury due to severe acute respiratory syndrome coronavirus 2 infection during pregnancy on the feto-placental circulation: a cross-sectional study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of permanent placental injury due to a severe acute respiratory syndrome coronavirus 2 infection during pregnancy on feto-placental circulation. METHODS: In this cross-sectional study, 83 pregnant women with planned deliveries were divided into two groups according to their severe acute respiratory syndrome coronavirus 2 infection statuses during pregnancy. Their demographic parameters, obstetric histories, and prenatal risks were evaluated. A prenatal fetal Doppler ultrasound examination was performed for all participants, and umbilical artery and middle cerebral artery Doppler parameters were obtained. Postpartum placentas were examined for pathological findings under appropriate conditions. All placentas were evaluated according to the Amsterdam consensus criteria. Mann-Whitney U test, Student's t-test, and chi-square test were used for comparisons. RESULTS: Demographic parameters were statistically similar, except that they were borderline significant for gestational weeks at delivery (p=0.044). In the pathological examination of the placenta, regardless of the trimester of exposure to viral infection, perivillous fibrin deposition and villus dystrophic calcification were more common in group 2 (p=0.016 and p=0.048, respectively) than in group 1. In the prenatal Doppler examination between the groups, no statistically significant difference was found for all of the umbilical artery pulsatile index, middle cerebral artery pulsatile index, and cerebro-placental ratio values. CONCLUSION: Severe acute respiratory syndrome coronavirus 2 infection during pregnancy causes an increase in perivillous fibrin deposition and villus dystrophic calcification in the placenta. Placental injury caused by the severe acute respiratory syndrome coronavirus 2 virus does not affect fetal Doppler parameters.

Descripción de los factores contribuyentes a las muertes secundarias a trastornos hipertensivos asociados al embarazo en Antioquia, Colombia (2012-2020) / Description of the contributing factors to deaths secondary to hypertensive disorders associated with pregnancy in Antioquia, Colombia (2012-2020)

Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.

Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.