Giant luteinized follicular cyst of pregnancy / Cisto folicular luteinizado gigante da gestação

Functional cysts usually do not cause symptoms or require surgical intervention. We reported a 17-year-old primi-gravida, gestational age of 10 weeks and 2 days, and ultrasound showing anechoic cyst in the right parauterine re-gion without septa, with a larger diameter of 13.5cm, 632ml, and Doppler color without peripheral vascularization. The patient was oligosymptomatic during gestation. At 37 weeks and 6 days, gestation was interrupted, when the cyst had 2600 ml by ultrasonography. Fetal extraction was performed by cesarean delivery, and a large adnexal cyst visualized on the right was removed. The histopathological analysis of the surgical specimen revealed a cystic le-sion coated by luteinized cells with discrete hyperchromatic and slightly pleomorphic nuclei, with underlying fibrous stroma with sparse luteinized cells, characterizing a giant luteinized follicular cyst of pregnancy. The prevalence of ovarian masses in pregnancy is rare, usually not exceeding 5 cm in diameter, and disappearing spontaneously in the second trimester. The patient in the case report had a cyst of 632 ml, increasing in volume to 2600 ml at the time of delivery. Definitive preoperative diagnosis of ovarian masses is still difficult, and predictive criteria for malignancy include the use of tumor markers, ultrasound, and Doppler. The association of these tests should guide the clinician to define the best time for surgical intervention. The association of these tests should guide the clinician to define the best time for surgical intervention (AU)

Os cistos funcionais geralmente não causam sintomas ou requerem intervenção cirúrgica. Relatamos o caso de uma primigesta de 17 anos, idade gestacional de 10 semanas e 2 dias, e ultrassonografia mostrando cisto anecoico em região parauterina direita sem septos, com maior diâmetro de 13,5cm, volume 632ml e Doppler sem vascularização periférica. A paciente permaneceu oligossintomática durante a gestação. Com 37 semanas e 6 dias, a gestação foi interrompida, quando o cisto apresentava 2.600 ml pela ultrassonografia. A extração fetal foi realizada por cesaria-na, e um grande cisto anexial visualizado à direita foi removido. A análise histopatológica da peça cirúrgica revelou lesão cística revestida por células luteinizadas com núcleos discretamente hipercromáticos e levemente pleomór-ficos, com estroma fibroso subjacente com células luteinizadas esparsas, caracterizando cisto folicular luteinizado gigante da gravidez. A prevalência de massas ovarianas na gravidez é rara, geralmente não ultrapassam o diâmetro de 5 cm, e desaparecem espontaneamente no segundo trimestre. A paciente do relato de caso apresentou cisto de 632 ml, aumentando de volume para 2600 ml no momento do parto. O diagnóstico pré-operatório definitivo de massas ovarianas ainda é difícil, e os critérios preditivos de malignidade incluem o uso de marcadores tumorais, ultrassonografia e Doppler. A associação desses testes deve orientar o clínico para definir o melhor momento para a intervenção cirúrgica (AU)

Caracterización de adolescentes con aborto inducido en el Hospital Municipal de Libolo, Kwansa Sul, Angola / Characterisation of adoslescents with induced abortion in the Municipal Hospital of Libolo, Kwansa Sul, Angola

Se realizó un estudio descriptivo, observacional, de corte transversal, con el objetivo de caracterizar a las adolescentes con aborto inducido, que fueron ingresadas en la sala de maternidad del Hospital Municipal de Libolo, Kwansa Sul, en la República de Angola, desde noviembre de 2015 a diciembre de 2016. El universo de estudio estuvo constituido por las 103 adolescentes a las cuales se les realizó el diagnóstico de la patología antes mencionada. Las variables investigadas fueron edad, estado civil y complicaciones, como: sepsis, hemorragias, aborto incompleto y perforaciones. El grupo de edad más afectado fue el de 15 a 19 años. Las solteras tuvieron mayor predominio y la complicación más frecuente fue la sepsis. El aborto inducido en la adolescencia constituyó un problema de salud(AU)

A transversal observational descriptive study was carried out to characterise adoslcents with induced abortion that were hospitalized in the room of motherhood of the Municipal Hospital of Libolo, Kwansa Sul, in the Republic of Angola, from November 2015 to December 2016. The universe of study was of 103 adolescents positive to the diagnostic of the above-mentioned pathology. The variables investigated were age, civil state and complications as: sepsis, bleedings, incomplete abortion and perforation. The group of age more affected was the one of 15 to 19 years. The singles had greater predominance and the most frequent complications was the sepsis. The induced abortion in the adolescence is a problem of health(AU)

Vulnerabilidade na adolescência: Um relato decaso de tentativa de aborto e violência sexual / Vulnerability in adolescence: a case report of attempted abortion and sexual violence

INTRODUCTION: Abortion, even when provided by law in cases of sexual violence, continues to be practiced in an insecure way, since women who suffer violence are not reported or guarded by social, institutional or age vulnerability, as in adolescence. OBJECTIVE: Describe the clinical consequences of unsafe abortion, report this experience as well as sexual violence in situations of social and age vulnerability. METHODS: It is a clinical case report, with the consent of the patient, in the year 2016, of a 16-year-old female adolescent with a personal history of sexual violence by an intimate aggressor. Admitted to the health service with diagnosis of acute abdomen and induced abortion using antibiotic therapy. RESULTS: Laboratory tests revealed altered C reactive protein and presence of leukocytosis, ultrasound showed heterogenic mass, computed tomography showed presence of cylindrical foreign body in vaginal cavity, surgical interventions, sepsis, clinical complications (pulmonary thromboembolism) and prolonged hospitalization. CONCLUSION: The history of violence portrayed in this study reveals an attempt of abortion with self harm, revealing negative clinical repercussions and the health problems of the adolescent. This person has committed an abortion that does not fit into the abortion criteria provided by law. It also revealed the need for further discussion on the topic, highlighting health promotion practices against unsafe abortion.

INTRODUÇÃO: O aborto, mesmo quando previsto por lei nos casos de violência sexual, continua a ser praticado de maneira insegura, uma vez que as mulheres que experimentam essa violência não a relatam ou velam por vulnerabilidade social, institucional ou etária, como na adolescência. OBJETIVO: Descrever as consequências clínicas do aborto inseguro e relatar essa experiência vivenciada bem como a violência sexual em situações de vulnerabilidade social e etária MÉTODO: Trata se de relato de caso clínico, com consentimento da paciente, ocorrido no ano de 2016 de uma adolescente, sexo feminino, 16 anos com antecedente pessoal de violência sexual de agressor íntimo. Admitida em serviço de saúde com diagnóstico de abdome agudo e aborto induzido em uso de antibioticoterapia. RESULTADOS: Laboratoriais revelaram proteína C reativa alterada e presença de leucocitose, ultrassonografia apresentou massa heterogênica, tomográfica computadorizada evidenciou presença de corpo estranho cilíndrico em cavidade vaginal, intervenções cirúrgicas, infecções generalizadas, complicações clínicas. CONCLUSÃO: A história de violência retratada nesse estudo revela uma tentativa de aborto com autolesão, desvelando repercussões clínicas negativas e os agravos à saúde da adolescente. Esta que cometeu um aborto que não se insere nos critérios de aborto previsto por lei. Revelou ainda a necessidade de maior discussão sobre o tema, destacando as práticas de promoção da saúde contra o aborto inseguro.

Aborto séptico por Clostridium perfringens complicado con shock séptico / Septic abortion due to Clostridium perfringens complicated with septic shock

ANTECEDENTES: La sepsis por Clostridios es una entidad poco frecuente que conlleva una mortalidad del 8090% a pesar del tratamiento antibiótico y quirúrgico. A pesar de que la mayoría de los casos de septicemia secundaria a Clostridios se originan en el aparato genital femenino tras un aborto séptico, solo un pequeño porcentaje de abortos sépticos (1%) se siguen de septicemia. CASO CLÍNICO: Gestante de 15 semanas que acude a urgencias por rotura prematura de membranas pretérmino. Ante el deseo de la paciente se mantiene actitud conservadora con antibioterapia iv, produciéndose a las pocas horas el aborto de forma espontánea junto con aparición de signos de infección. Rápidamente la paciente evoluciona a sepsis grave, y ante la sospecha de aborto séptico se efectúa histerectomía. Tras la intervención ingresa en situación de shock séptico con insuficiencia renal, hepática y respiratoria. Durante el ingreso se confirma Clostridium perfringens como agente responsable del proceso séptico. Finalmente la paciente es dada de alta definitiva tras seis meses, una vez resueltas las alteraciones derivadas del proceso séptico.

BACKGROUND: Clostridial sepsis is a rare condition which carries a mortality of 80-90% despite antibiotic and surgical treatment. Although most cases of septicemia due to Clostridium are originated in female genital tract after septic abortion, only a small percentage of septic abortions (1%) are followed by septicemia. CLINICAL CASE: Our case is about a 15 weeks pregnant woman attended the emergency room for preterm premature rupture of membranes. Due to the desire of the patient we proceed conservative treatment with antibiotics iv, in the following few hours the abortion develops spontaneously along with signs of infection. Rapidly the patient progresses into a severe sepsis, due to suspected septic abortion, the patient is intervened urgently by hysterectomy. After the intervention she enters into septic shock state with respiratory, kidney and liver failure. During the admission Clostridium perfringens is confirmed as a causative agent for septic process. Finally the patient is discharge after six months once resolved all complications arising from septic process.

Caracterização morfológica e imuno-histoquímica de lesões em casos de aborto bovino bacteriano e viral no sul de Minas Gerais / Morphological and immunohistochemical characterization of the lesions in cases of bacterial and viral bovine abortion in southern Minas Gerais, Brazil

O presente estudo avaliou a participação de agentes bacterianos e virais em abortos em bovinos de propriedades rurais do sul de Minas Gerais. Foi realizada análise histopatológica e imuno-histoquímica dos casos de aborto recebidos pelo Setor de Patologia Veterinária da Universidade Federal de Lavras no período de 1999 a 2013. De 60 fetos analisados, em 30 (50%) foram observadas lesões microscópicas. Destes, oito apresentavam lesões compatíveis com infecção por agentes bacterianos e três apresentaram lesões sugestivas de agentes virais. Dos abortos bacterianos, um feto tinha lesões compatíveis com leptospirose, caracterizadas por icterícia e colestase, nefrite intersticial linfoplasmocítica e nefrose tubular. Sete fetos apresentaram pneumonia ou broncopneumonia purulenta; num deles havia também pleurite e peritonite fibrinosas; e em dois desses fetos houve imunomarcação para Brucella abortus. Dos três fetos com lesões sugestivas de aborto viral ocorreu imunomarcação anti-Herpesvírus bovino em um. Os resultados demonstram a ocorrência de abortos de origem bacteriana e viral na Região do estudo e que medidas profiláticas devem ser adotadas nas propriedades. O trabalho demonstra também que a imuno-histoquímica (IHQ); associada à histopatologia; é uma ferramenta útil e viável para o diagnóstico, especialmente quando provas microbiológicas e/ou sorológicas não estão disponíveis.

The paper evaluates the participation of bacterial and viral agents in bovine abortions in farms of southern Minas Gerais state, Brazil. Histopathological and immunohistochemical analysis was performed in aborted fetuses of cattle received by the Setor de Patologia Veterinária, Universidade Federal de Lavras, from 1999 to 2013. From 60 fetuses studied, 30 (50%) had microscopic lesions. From these, eight had lesions consistent with bacterial agents and three had lesions suggestive of viral agents. In the bacterial abortions, one fetus presented lesions compatible with leptospirosis, characterized by jaundice, cholestasis, lymphoplasmacytic intersticial nephritis, and tubular nephrosis. Seven fetuses had purulent pneumonia or bronchopneumonia and one of them had also fibrinous pleuritis and peritonitis; two of them presented positive immunostaining for Brucella abortus. One of the three fetuses with lesions of viral infection revealed positive imunostaining for bovine herpesvirus. The results showed that abortions of bacterial and viral origin occur in the Region of this study and prophylactic measures should be adopted on the farms. This study also demonstrates that immunohistochemistry associated with histopathology is a useful and viable tool for the diagnosis, especially when microbiological and/or serological tests are not available.

Sociodemographic and reproductive profile of women with abortion complications in hospital in Recife / Perfil sociodemografico e reprodutivo de mulheres com complicacoes por abortamento em hospital no Recife / Perfil sociodemografico y reproductivo de las mujeres con complicaciones de aborto en un hospital en recife

To describe the sociodemographic and reproductive characteristics of women with abortion complications in a tertiary hospital in the city of Recife. A cross-sectional study retrospectively analyzed 569 medical records and found 122 with abortion complications in 2008 to 2010 at Instituto de Medicina Integral Prof. Fernando Figueira. The frequency of abortion complications was 21.4%. The majority of women were between 20 and 35 years old, had eight or more years of schooling, were from Recife and the Metropolitan area, had no previous history of abortion and half of them were married. Among the complications, there was a high frequency of infection (77.0%), followed by the need for blood transfusion (15.6%). It was concluded that women in this study were young, with good education, living in an urban area. The main complication was infection and this could have contributed to abortion complications in maternal morbidity and mortality rates.

Este estudo objetivou descrever as características sociodemográficas e reprodutivas de mulheres com complicações de aborto em um hospital terciário na cidade de Recife. Estudo descritivo de corte transversal em que foram analisados, retrospectivamente, 569 prontuários de mulheres admitidas com diagnóstico de aborto, dos quais 122 continham registro de complicações no período de 2008-2010, no Instituto de Medicina Integral Prof. Fernando Figueira. A frequência de complicações de aborto foi de 21.4%. A maioria das mulheres tinha entre 20 e 35 anos, oito ou mais anos de estudo, era de Recife e região metropolitana e não tinha história de abortamento anterior; metade das mulheres era casada. Entre as complicações, houve frequência elevada de infecção (77.0%), seguida por necessidade de hemotransfusão (15.6%). Concluiu-se que as mulheres deste estudo eram jovens, com boa escolaridade e residiam em área urbana. A principal complicação foi infecção, evidenciando a contribuição das complicações do abortamento nos índices de morbimortalidade materna.

Describir las características sociodemográficas y reproductivas de las mujeres con complicaciones de aborto en un hospital de tercer nivel en la ciudad de Recife. Estudio descriptivo de corte transversal, donde se analizaron, retrospectivamente, 569 registros médicos, de los cuales se ha encontrado 122 mujeres con complicaciones de aborto durante el período 2008-2010, en el Instituto de Medicina Integral Prof. Fernando Figueira. La frecuencia de las complicaciones fue de un 21.4%. La mayoría de las mujeres tenía entre 20 y 35 años de edad y ocho o más años de escolaridad, vivían en la región metropolitana de Recife, no tenían antecedentes de aborto y la mitad de las mujeres estaban casadas. Entre las complicaciones, se registra con mayor frecuencia las infecciones (77.0%), seguido por la necesidad de transfusión de sangre (15.6%). Conclusión: las mujeres eran jóvenes, con buena educación y residentes en área urbana. La principal complicación fue la infección.

Listeriosis in the far South of Brazil: neglected infection?

Listeriosis is an under-diagnosed and under-reported infection; however, listeriosis is not a compulsorily notifiable disease in Brazil. We provide an overview of the rates of listeriosis in the United States of America (USA), Europe, Latin America, and Brazil during the past decade. We also report a case of miscarriage caused by listeriosis in which there was no suspicion of this infection. This overview and the case we report serve as reminders of the often-neglected threat of listeriosis and its potential to cause miscarriage while highlighting the necessity of recognizing listeriosis as a compulsorily notifiable disease in Brazil.

A Septic Abortion Caused by Candida glabrata Chorioamnionitis Following in Vitro Fertilization and Embryo Transfer / 대한내과학회지

Candida glabrata is a yeast that commensally colonizes the upper cervix and vagina and has low pathogenicity in immunocompetent hosts. Here we report a case of C. glabrata chorioamnionitis and septic abortion following in vitro fertilization and embryo transfer (IVF-ET). This case suggests that infection in the upper vagina and cervix should be considered prior to having IVF-ET. We encountered a rare case of C. glabrata chorioamnionitis and septic abortion; therefore, we report this case with a review of the literature.

Study of septic abortion cases at a tertiary centre of Uttarakhand.

Aim of this study was to evaluate the incidence, maternal morbidity & mortality, clinical features, management in cases of septic abortion in a tertiary centre. This study included 37 cases of septic abortion admitted during 5 years from January 2007 to January 2012 in the Department of obstetrics & Gynaecology in Government Medical College, Haldwani. All patients were evaluated with special reference to incidence, etiological factors, clinical features, surgery & maternal morbidity & mortality. The incidence of septic abortion was 1.08%. Common age group was between 26-30 years. Most of the cases were from lower socioeconomic status. Septic abortion following spontaneous abortion was present in 5 cases. Unwanted pregnancy was the indication for termination of pregnancy in 32 cases. 4 women were admitted in state of septic shock. 12 cases required lapratomy for drainage of pus, 3 had hysterectomy, 3 had resection anastomosis & uterus repair was done in 4 cases. Overall maternal mortality was 5 (13.5%).The incidence of illegal and septic abortion can be reduced by increasing awareness about family planning services and making legal abortion services easily available to the women and that too at a cheaper cost.

Reflections on the 24 years durability of an isolate tricuspid bovine pericardium IMC/Braile bioprosthesis / Reflexões sobre a durabilidade de 24 anos de uma bioprótese IMC/Braile de pericárdio bovino em posição tricúspide isolada

We were challenged by the experience of one patient reoperation for a bioprosthetic bovine pericardium degenerative stenosis, 24 years after implantation. This bioprosthesis was implanted due to tricuspid valve bacterial staphylococcal endocarditis after septic abortion.

Vivenciamos a experiência de reoperar uma paciente por estenose degenerativa de uma prótese biológica de pericárdio bovino, após 24 anos de implante. Essa prótese degenerada havia sido implantada devido à destruição da valva tricúspide por endocardite bacteriana estafilocócica após aborto séptico.

Factores de riesgo para hemorragia postaborto, estudio de casos y controles / Risk factors for post-abortion bleeding, case-control study

Objetivo: determinar los factores de riesgo para hemorragia grave en caso de aborto. Metodología: estudio de casos y controles, entre el primero de octubre de 2006 y el 31 de octubre de 2007, en la Unidad intermedia San Javier. Se analizaron 131 historias clínicas, 40 de los 45 casos de hemorragia postaborto del periodo y 91 controles obtenidas en forma aleatoria a partir del listado de los casos de aborto atendidos en igual periodo. Resultados: el principal factor para el desencadenamiento de una hemorragia grave postaborto es el hecho de tener un aborto séptico OR 8.5 (IC 95% 3.1-23). Otros factores que también contribuyen de manera significativa pueden ser: realizar un deficiente interrogatorio, ejecutar un deficiente examen físico, la subvaloración del cuadro clínico y el retraso en consultar. Conclusiones: es necesario detectar la infección de forma temprana en mujeres con aborto para iniciar un tratamiento oportuno. El hecho de realizar un interrogatorio minucioso y un examen físico detallado evitarían la subvaloración del cuadro clínico y sus consecuencias. Es importante aprender de los errores propios y ajenos y hacer una retroalimentación diaria con el fin de disminuir la frecuencia y las consecuencias negativas de las complicaciones obstétricas.

A Septic Abortion Caused by Campylobacter jejuni bacteremia / 대한내과학회지

Campylobacter jejuni was isolated from the blood of a 31-year-old woman who suffered a mid-trimester septic abortion with fever and headache. Histologically, evidence of septic abortion was found, with an intervillous abscess and acute villitis. Complete clinical recovery followed termination of the pregnancy and the use of antibiotics. C. jejuni is an unusual cause of septic abortion in humans. To our knowledge, no case has been reported in Korea.

A case of successful delivery after ultrasound guided hysteroscopic removal of intrauterine device with missing tail during early pregnancy / 대한산부인과내시경학회지

In case of intrauterine pregnancy with an intrauterine device (IUD), it is recommended to remove the device because of the increased risk of abortions, septic complications and premature delivery. But removal of intrauterine devices in early pregnancy remains a troublesome problem for both doctors and patients, especially when IUD threads are not visible at the external os. If the thread of the IUD is not visible, extraction with hysteroscopy and ultrasonic guidance is advised. But due to postoperative complications such as uterine rupture or bleeding and electrolyte imbalance, many doctors prefer not to perform the procedure. IUD removal is scarcely performed that there are only 2 successful cases which were reported in Korea until today. Recently we experienced a case of an early pregnant woman with IUD in whom thread was invisible at the cervical os and IUD removal was attempted and successfully performed by ultrasound guided hysteroscopy. Pregnancy was maintained without complications until 39th week and delivered healthy baby. So we report this case with the review of articles related.

Aborto infectado: epidemiologia, diagnóstico e conduta na urgência: [revisão] / Infected abortion: epidemiology, diagnosis and management in emergency: [review]

Abortamento é a expulsão ou extração de um produto da concepção sem sinais de vida com menos de 500 gramas ou 22 semanas de gestação. O aborto infectado ou séptico decorre da eliminação incompleta do ovo, do embrião ou da placenta, que mantém aberto o canal cervical, favorecendo a ascensão de bactérias da microbiota vaginal e intestinal à cavidade uterina. A real magnitude do abortamento é desconhecida devido à sua ilegalidade. No Brasil, há subnotificação de casos e complicações, pois nem todas as mulheres demandam assistência pós-abortamento. Ainda assim, os dados oficiais justificam a adoção de medidas preventivas e de promoção da saúde reprodutiva. O diagnóstico de aborto séptico deve ser considerado quando uma mulher na menacme apresentar atraso menstrual, sangramento vaginal, febre, dor hipogástrica e à mobilização do colo uterino. Exige tratamento imediato. Prefere-se a associação gentamicina/clindamicina.

Abortion is the expulsion or extraction of a product of conception, with no signs of life, with less than 500 grams or 22 weeks of gestation. Infected or septic abortion stems from partial removal of the egg, embryo or placenta, which keeps open the cervical channel, encouraging the rise of intestinal and vaginal bacteria to the uterine cavity. The real magnitude of abortion is unknown due to its illegality. In Brazil, there is underreporting of cases and complications because not all women require assistance in post-abortion care services. Still, official data justify the adoption of preventive measures and of reproductive healthÆs promotion. The diagnosis of septic abortion should be considered when a woman of childbearing age has missed period, vaginal bleeding, fever, hypogastric pain and pain by the cervix mobilization. It requires immediate treatment. The association of gentamicin/clindamycin is chosen.

unsafe abortion still a problem in Iraq?

According to the United Nations Population Fund [UNFPA] 2003 report, there is an increase in spontaneous and unsafe abortions in Iraq. However, there is no data on the exact number of unintended pregnancies that end in an illegally performed abortion. The current work presents an observational longitudinal study that was performed in Al Elwyia Maternity Teaching Hospital, throughout the year 2007. The relative frequency of unsafe abortions among all abortions treated in our hospital before 24 weeks of gestation for any indication during the year 2007, was 322/3100= 104/1000 abortions, with 95% confidence interval for prevalence [93-115]/1000 abortions. All those women had a direct interview with a special questionnaire and clinical examination which was conducted thereafter. Most of our patients, with unsafe abortions; [62.1%] were found to be between 20-30 years of age. [99.4%] were parous. The most common mode of termination was combined medical and surgical methods; done by health professionals other than doctors [87.0%]; with a confidence interval [83.3 - 90.7]. In [63.0%] of cases; the diagnosis of pregnancy was confirmed by ultrasound and abortion was confirmed to be illegal; mainly by history from the patient / husband and or relative companion in [91%], with a confidence interval [87.9 - 94.1]. Failed contraception used due to improper pill intake represented [53%] of cases. Decision for abortion was taken by the wife herself in [64%] and was due to financial reasons mainly. The most common presentation was septic abortion [86%] with a confidence interval [63.5 - 73.7]. [70.8%] who required 1 -3 units of blood transfusion. Unsafe abortion is still an ethical, religious and medical problem all over the world; including our country and the main determining factor for termination of pregnancy amongst those women appeared to be the fact that it was unwanted and/or unplanned; either because of inappropriate timing, the relationship itself, as well as social and economic implications which are important issues. Improper contraceptive use was an important contributing factor. In addition, misuse of Misoprostol, which became available over the counter for patients, midwifes and nurses, needs careful attention. There is a real need to update/upgrade our national family planning and the access to contraception policy, modifying this policy to meet our emerging social conditions

Trombosis de la vena ovárica: Factores de riesgo, diagnóstico y tratamiento / Ovarian vein thrombosis: risk factors, diagnosis and treatment

La trombosis de la vena ovárica es una complicación muy poco frecuente (0.002-0.05%), que se observa en mujeres que presentan un incremento en los factores de coagulación. La principal situación en la que es posible detectar esta complicación es el embarazo, aunque no es la única. Se describe el caso de una mujer de 31 años de edad, gestante de 16 semanas, que presenta un aborto espontáneo séptico complicado con una trombosis de la vena ovárica. Se aprovecha el caso clínico para revisar en la literatura los factores de riesgo, el diagnóstico y el tratamiento de esta inusual patología.

Ovarian vein thrombosis is an uncommon complication (0.002-0.05%) related to hypercoagulated status of women. The most frequent condition associated to ovarian vein thrombosis is pregnancy, but there are other possible causes. We present a case of a 31 year old pregnant woman at 16th week of gestation who had spontaneuos septic abortion complicated with an ovarian vein thrombosis. A discussion of risk factors, diagnostic and treatment options of ovarian vein thrombosis are presented.

Aborto inducido, séptico y shock séptico / Induced abortion, septic abortion and septic shock

El aborto provocado séptico en Chile estuvo por varias décadas dentro de las primeras causas de mortalidad materna, y en 1960 la tasa de mortalidad materna por aborto era de 107/100.000 NV. El desarrollo y progreso en diversas áreas de nuestro país, sumado a las políticas sanitarias implementadas gubernamentalmente, han logrado disminuir la mortalidad materna por aborto de manera muy significativa, siendo ésta de 0.8/100.000 NV en 2005 y manteniéndose estable y por debajo de 1.5/100.000 NV desde el 2001 en adelante. En el presente artículo se revisa y compara el perfil epidemiológico de la mujer que actualmente se realiza un aborto y además se aborda el diagnóstico y tratamiento médico desde la perspectiva gineco-obstétrica.

In Chile induced septic abortion was one of main causes of maternal death for several decades. In 1960 maternal mortality ratio (MMR) associated to abortion was 107 per 100.000 live births. Development an progress in a wide range of areas in addition to government’s family planning policies in our country have reduced the MMR associated to abortion significatively to 0.8 /100.000 live births in 2005 and have kept it under 1.5/100.000 live births since 2001. In this article we review and compare the epidemiologic profile of women who undergo an induced abortion and we approach to diagnosis and medical treatment from de gyneco-obstetric perspective.

Critical illness in obstetric patients requiring ICU admission: analysis of disease spectrum, interventions and clinical outcome

Critically ill obstetric patients represent an interesting group with unique characteristics, whose management is challenged by the presence of a fetus, an altered maternal physiology, and diseases specific to pregnancy. To review a series of critically ill obstetric patients admitted to our medical-surgical intensive care unit [ICU] to assess the spectrum of disease, required interventions, and maternal mortality, and to identify conditions associated with maternal death. This retrospectively designed cohort study comprised 365 patients [age, 26 +/- 8 years; mean gesta-tional age, 29 +/- 9 weeks] [mean +/- SD], constituting 2.8% of 13,000 ICU admissions. APACHE II score was 13 +/- 7, with 23% predicted mortality; SOFA score was 5 +/- 3; and TISS score at 24 h was 25 +/- 9. Forty-one percent of patients required mechanical ventilation. ARDS, shock, and organ dysfunction were present in 18.6%, 27%, and 49% of patients, respectively. Most patients [63%] were admitted postpartum, and 75% of admissions were of obstetric cause. Hypertensive disease [40%], major hemorrhage [17%], septic abortion [13.7%], and non-obstetric sepsis [13.2%] were the principal diagnoses. Maternal mortality was 11.5%, with multiple organ dysfunction syndrome [43%] and intracranial hemorrhage [38%] as main causes. There were no differences in death rate in patients admitted for obstetric and non-obstetric causes. Only 32% of patients received antenatal care, which was more frequent in survivors [33% Vs 6% non-survivors, p=0.014]. Although ARDS, organ failures, shock, and use of MV were extremely frequent in this population, maternal mortality remains within an acceptable range. APACHE II overpredicted mortality in these patients. Septic abortion is still an important modifiable cause of mortality. Efforts should concentrate in increasing antenatal care, which was clearly underprovided in these patients

Aborto séptico en el Hospital Dr. Adolfo Prince Lara 1977-2006 / Septic abortion at the Dr. Adolfo Prince Lara Hopsital 1977-2006

Determinar la incidencia del aborto séptico, características maternas y factores relacionados. Estudio retrospectivo, descriptivo y analítico de 9 529 abortos sucedidos durante 1997-2006, de los cuales 168 fueron sépticos. Hubo un aborto séptico por cada 57 abortos. Hospital "Dr. Adolfo Prince Lara", Puerto Cabello. El aborto séptico tuvo una incidencia 1,76 por ciento con rangos de 0,67 por ciento (1997) y 2,87 por ciento (2003), hay tendencia a cifras mayores en los últimos 5 años. Pacientes residentes urbanas eran 89 (52,98 por ciento), solteras 107 (63,70 por ciento), de 24 años y menos 94 (55,96 por ciento), con gestaciones entre II-V 118 (70,24 por ciento), edad de embarazo menor de 10 semanas 102 (60,72 por ciento), 8 pacientes (4,76 por ciento) tenían antecedente de ingesta de misoprostol. El diagnóstico fue fundamentalmente por clínica, ecografía y laboratorio en 106 casos (63,1 por ciento); grado séptico I (91,07 por ciento), tratadas con antibióticos y curetaje la mayoría 159 (94,64 por ciento), permanecieron hospitalizadas de dos o tres días el 58,93 por ciento, la mayor morbilidad fue anemia en un 71,16 por ciento. La mortalidad materna fue de 2,38 por ciento o una cada 42 abortos sépticos. El aborto séptico mostró una incidencia baja con una alta morbimortalidad, se asoció a factores socioconómicos. En consecuencia, deben incrementarse los programas preventivos de salud sexual y reproductiva y apoyo familiar.

To determine the incidence of septic abortion, maternal characteristics and related factors. Retrospective, descriptive and analytic study of 9 529 abortions happened during 1997-2006, from which 168 were septic. There was one septic abortion each 57 abortions. Hospital Dr. Adolfo Prince Lara, Puerto Cabello, Estado Carabobo. The septic abortion had an incidence of 1.76 percent with ranks of 0.67 percent (1997) and 2.87 percent (2003), with tendency to higher numbers in 5 last years. Were urban residents 89 patients (52.98 percent), unmarried 107 (63.70 percent), of 24 years and less 94 (55.96 percent), with gestations between II-V 118 (70.24 percent), age of pregnancy lower than 10 weeks 102 (60.72 percent), and history of misoprostol ingestion 8 patients (4.76 percent). Basicly the diagnostic was by clinical, ultrasound and laboratory in 106 cases (63.1 percent), septic abortion degree I 153 (91.07 percent), treatment with antibiotics and curettage 159 (94.64 percent), remaining hospitalized from 2 or 3 days 99 (58.93 percent), the greater morbidity was anemia 133 (71.16 percent). Maternal mortality 2.38 percent (4/168) or each for 42 septic abortions. The septic abortion showed a low incidence with an important morbid-mortality, is associated to social-economic factors. Consequently, the preventive programs of sexual and reproductive health and familiar support must be increased.