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1.
Femina ; 50(1): 61-64, 20220131. ilus
Article in Portuguese | LILACS | ID: biblio-1358222

ABSTRACT

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)


Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiology
2.
Femina ; 49(5): 309-313, 20210531. ilus
Article in Portuguese | LILACS | ID: biblio-1290569

ABSTRACT

Introdução: A gravidez heterotópica é um fenômeno obstétrico muito raro em concepções espontâneas no qual gestações tópica e ectópica coexistem. O diagnóstico é difícil, mas, se realizado precocemente, o prognóstico é favorável. Descrição do caso: Paciente do sexo feminino, de 35 anos de idade, admitida com quadro de dor abdominal e pequeno sangramento vaginal. Diagnosticada precocemente e tratada cirurgicamente por gravidez heterotópica naturalmente concebida. Como resultado, a gravidez tópica seguiu sem intercorrências. Conclusão: Esse caso enfatiza a necessidade de considerar esse diagnóstico diferencial e analisar clínica e ecograficamente as características globais da pelve, mesmo na ausência de fatores de risco em gestações tópicas.(AU)


Introduction: Heterotopic pregnancy (HP) is a rare obstetric phenomenon in spontaneous conceptions in which intrauterine and ectopic pregnancies coexist. The diagnosis is difficult, but, if performed early, the prognosis is favorable. Case description: A 35-year-old woman was admitted with abdominal pain and light vaginal bleeding. She was early diagnosed and surgically treated for a naturally conceived heterotopic pregnancy. As a result, the intrauterine pregnancy went on healthily. Conclusion: This case emphasizes the need to regard HP as a differential diagnosis and analyze the global pelvis characteristics both clinically and in ultrasound scans, even in the absence of risk factors when dealing with intrauterine pregnancies.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Pregnancy Complications/diagnostic imaging , Pregnancy, Tubal/surgery , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Heterotopic/surgery , Pregnancy, Heterotopic/diagnostic imaging , Uterine Hemorrhage/complications , Fertilization
3.
Revista Digital de Postgrado ; 10(1): 275, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147596

ABSTRACT

El hígado graso del embarazo es una patología poco frecuente en la especialidad obstétrica, cuyo diagnóstico se realiza basado en los criterios de Swansea, muchas veces es un diagnóstico que se realiza por exclusión; usualmente se presenta entre las semanas 30 y 35 del embarazo, y la cura definitiva se realiza con la interrupción expedita del mismo; con una tasa de recuperación casi del 100% si se realiza la interrupción oportuna y una tasa de mortalidad materno fetal actual del 10%. Es importante estar atentos a la ganancia ponderal de la embarazada durante el control prenatal, la epigastralgia, y los signos clínicos asociados a hipoglicemia(AU)


Fatty liver of pregnancy is a rare pathology in obstetrics, whose diagnosis is made based on the Swansea criteria, many times it is a diagnosis that is made by exclusion; It usually occurs between weeks 30 and 35, and the definitive cure is carried out with the expeditious interruption of pregnancy; with a recovery rate of almost 100% if timely interruption is made and a current maternal-fetal mortality rate of 10%. It is important to be attentive to the weight gain of the pregnant woman during prenatal control, epigastric pain, and clinical signs associated with hypoglycemia


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/diagnosis , Fatty Liver/diagnosis , Pregnancy Complications/surgery , Pregnancy Trimester, Third , Cesarean Section , Acute Disease , HELLP Syndrome/diagnosis , Diagnosis, Differential , Fatty Liver/surgery , Fatty Liver/complications , Hypoglycemia/diagnosis , Jaundice/complications , Jaundice/diagnosis
4.
Rev. cuba. obstet. ginecol ; 45(3): e486, jul.-set. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093660

ABSTRACT

Introducción: Los fibromas uterinos, también conocidos como miomas o leiomiomas son los tumores benignos más frecuentes de la porción superior del aparato genital femenino; pueden alcanzar gran tamaño y generalmente no requieren de tratamiento quirúrgico durante el embarazo. La prevalencia del mioma en el embarazo es desconocida. El manejo quirúrgico se reserva solo para los miomas complicados. Objetivo: Mostrar un caso al que se realizó la miomectomía de un gran fibroma suberoso sintomático coexistente con un embarazo de 21 semanas, debido a que no es frecuente su realización en la práctica médica. Presentación de caso: Paciente de 41 años, nulípara, de 21 semanas de gestación, con síntomas compresivos dados por vómitos, molestias digestivas e intolerancia al decúbito supino, afectada por un gran mioma, que fue sometida a miomectomía. La paciente evolucionó satisfactoriamente. Acudió a consultas prenatales cada 15 días hasta las 39,6 semanas, en que se le realizó la cesárea electiva obteniéndose un recién nacido de buen peso y Apgar. Conclusiones: La miomectomía durante el embarazo es un proceder quirúrgico seguro y eficiente con altas tasas de éxito. La discusión del caso es esencial y debe ser realizada por un equipo multidisciplinario, con experiencia probada en cirugía ginecológica(AU)


Introduction: Uterine fibroids, also known as myomas or leiomyomas are the most frequent benign tumors of the upper portion of the female genital tract. They can reach large size and generally do not require surgical treatment during pregnancy. The prevalence of myoma in pregnancy is unknown. Surgical management is reserved only for complicated myomas. Objective: To report a case in which the myomectomy was performed to a large symptomatic suberose fibroid coexisting with a 21-week pregnancy, which is not frequent in medical practice. Case report: A 41-year-old nulliparous patient, 21 weeks pregnant had compressive symptoms due to vomiting, digestive discomfort and intolerance to the supine position. She underwent myomectomy because she was affected by a large myoma. The patient evolved satisfactorily. She was followed up at prenatal consultations every 15 days until 39.6 weeks, when she had an elective caesarean section, resulting a newborn of good weight and Apgar. Conclusions: Myomectomy during pregnancy is a safe and efficient surgical procedure with high success rates. Case discussion is essential and should be carried out by a multidisciplinary team, with proven experience in gynecological surgery(AU)


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/surgery , Cesarean Section/methods , Uterine Myomectomy/methods
5.
Rev. méd. Chile ; 147(8): 1078-1081, ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058646

ABSTRACT

Acute pancreatitis during pregnancy is uncommon and usually associated with gallstones. However other etiologies must be considered. We report a 24 years old woman with a 32 weeks pregnancy consulting for abdominal pain, nausea and vomiting. She had elevated lipase and amylase levels, a corrected serum calcium of 13.1 mg/dl and a serum phosphate of 1.6 mg/dl. A magnetic resonance colangiopancreatography showed an enlarged pancreas with inflammatory changes and a normal Wirsung duct. A parathyroid nodule was found on cervical ultrasonography. The patient was treated initially with cinacalcet with partial response. A parathyroidectomy was performed at 39 weeks of pregnancy with a good maternal and fetal evolution.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pancreatitis/etiology , Pregnancy Complications/etiology , Hypercalcemia/complications , Pancreatitis/surgery , Pancreatitis/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Pregnancy Complications/surgery , Adenoma/diagnostic imaging , Abdominal Pain/etiology , Parathyroidectomy/methods , Treatment Outcome , Cholangiopancreatography, Magnetic Resonance/methods
6.
Rev. cuba. obstet. ginecol ; 45(2): e454, abr.-jun. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093647

ABSTRACT

La reducción embrionaria es la interrupción selectiva del desarrollo de uno o varios fetos en el primer trimestre del embarazo. El embarazo gemelar se presenta aproximadamente en uno de cada 100 nacimientos y se considera como una entidad con alto riesgo materno y fetal. Los embarazos múltiples tienen un impacto mayor en los sistemas de salud, debido a la mayor frecuencia de complicaciones. La rotura prematura de membranas causa aproximadamente el 40 por ciento de los partos pretérmino y, como consecuencia, aportan un 10 por ciento de la mortalidad perinatal según la Sociedad Española de Ginecología y Obstetricia. En este caso clínico se observó que una actitud expectante con los pertinentes controles ecográficos (índice del líquido amniótico), analíticos (recuento leucocitario y reacción en cadena de la polimerasa) y clínicos (frecuencia cardiaca y temperatura) pueden llevar a una buena evolución posnatal que justificó al menos en esta ocasión, una actitud conservadora(AU)


Embryonic reduction is the selective interruption of the development of one or several fetuses in the first trimester of pregnancy. Twin pregnancy occurs in approximately one in every 100 births. It is considered an entity with high maternal and fetal risk. Multiple pregnancies have greater impact on health systems due to the higher frequency of complications. Premature rupture of membranes causes approximately 40 percent of preterm births and, consequently, it contributes 10 percent of perinatal mortality according to the Spanish Society of Gynecology and Obstetrics. In this clinical case it was observed that an expectant attitude with the relevant ultrasound (index of amniotic fluid), analytical (leukocyte count and polymerase chain reaction) and clinical (heart rate and temperature) controls can lead to good postnatal evolution, justified at least on this occasion, a conservative attitude(AU)


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/surgery , Progesterone/therapeutic use , Pregnancy Reduction, Multifetal/methods , Pregnancy, Twin/genetics , Pregnancy Complications/genetics
7.
Einstein (Säo Paulo) ; 17(3): eRC4570, 2019. graf
Article in English | LILACS | ID: biblio-1011990

ABSTRACT

ABSTRACT Vesicouterine fistula is a rare condition. Its incidence, however, has been increasing due to the higher incidence of cesarean sections. The presence of a live fetus inside the bladder who passed through a vesicouterine fistula is an extremely rare situation. We report a case of woman who underwent two previous cesarean sections, was referred to a hospital due to mild pelvic pain and genital bleeding. At the moment, physical examination was normal. Ultrasound scan revealed a gestational sac inserted into the anterior wall of the uterus, with a living fetus of approximately 13 weeks, with active body movement and normal heart rate inside it. The fetal abdomen, around the waist, was stuck at the opening of a vesicouterine fistula, so that the fetal head and trunk were entirely into the bladder cavity, while lower limbs remained at the uterine cavity. Laparotomy was performed, the fistulous tract was excised, the fetus (without heart beating) was removed on opening the bladder, and the uterine cavity was emptied. The defects in the bladder and uterus were repaired. The postoperative period was uneventful. A live fetus inside the urinary bladder is a rare condition the continuation of pregnancy is unlikely and the vesicouterine correction can be made by the time of surgical intervention.


RESUMO A fístula vesicouterina é uma condição rara. Sua incidência, no entanto, vem aumentando, devido à maior incidência de cesáreas. A presença de feto vivo dentro da bexiga por meio de uma fístula vesicouterina constutui situação extremamente rara. Relatamos o caso de uma mulher com duas cesarianas anteriores encaminhada para o hospital devido à dor pélvica leve e sangramento genital. Na hospitalização, o exame físico estava normal. A ultrassonografia revelou saco gestacional inserido na parede anterior do útero com feto vivo de aproximadamente 13 semanas, com movimento corporal ativo e frequência cardíaca normal. O abdômen fetal, ao redor da cintura, estava preso na abertura de uma fístula vesicouterina de modo que a cabeça e o tronco fetais estavam totalmente dentro da cavidade da bexiga, enquanto os membros inferiores permaneciam na cavidade uterina. A laparotomia foi realizada, o trajeto fistuloso foi excisado, o feto (que estava sem batimento cardíaco) foi removido ao abrir a bexiga, sendo a cavidade uterina esvaziada. Além disso, foram reparados os defeitos na bexiga e no útero. O pós-operatório transcorreu sem intercorrências. Feto vivo dentro da bexiga é uma condição rara, e a continuidade da gravidez é improvável, sendo que a correção vesicouterina pode ser feita no momento da intervenção cirúrgica.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/surgery , Urinary Bladder Fistula/surgery , Pregnancy Complications/etiology , Pregnancy Complications/diagnostic imaging , Uterine Diseases/surgery , Uterine Diseases/etiology , Uterine Diseases/diagnostic imaging , Magnetic Resonance Imaging , Cesarean Section/adverse effects , Ultrasonography , Urinary Bladder Fistula/etiology , Urinary Bladder Fistula/diagnostic imaging , Laparotomy
8.
Rev. bras. cir. plást ; 33(3): 423-427, jul.-set. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-965628

ABSTRACT

Introdução: A incidência de queimaduras em gestantes não é bem estabelecida na literatura mundial, mas estima-se que varie entre 3% e 7%. Os cuidados da gestante queimada representam um grande desafio com impacto significante nos resultados e prognóstico materno-fetais. Relato de Caso: No presente estudo relatamos dois casos de gestantes vítimas de queimaduras que foram tratadas na unidade de tratamento de queimaduras na Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), uma no primeiro trimestre e a outra no terceiro trimestre. Conclusão: Em ambos os casos, as gestantes receberam tratamento especializado para queimaduras em conjunto com acompanhamento clínico da equipe da obstetrícia, com boa evolução materno-fetal.


Introduction: The incidence of burns involving pregnant women is not well established in the literature, but is estimated to be between 3% and 7%. The management of burns in pregnancy represents a great challenge with significant impact on outcomes and maternal-fetal prognosis. Case Report: In the present study, we report two cases of pregnant burn victims who were treated in the burn unit in the Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP). One patient was treated in the first trimester and the other in the third trimester. Conclusion: In both cases, the pregnant women received specialized treatment for burns in conjunction with clinical follow-up by the obstetrics team, with good maternal-fetal outcomes.


Subject(s)
Humans , Female , Adult , Pregnancy Complications/surgery , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/rehabilitation , Transplantation/methods , Wounds and Injuries , Hypovolemia/diagnosis , Fetus/surgery , Patients , Burn Units , Pregnancy , Pregnancy, High-Risk
9.
Braz. j. med. biol. res ; 51(7): e7315, 2018. tab, graf
Article in English | LILACS | ID: biblio-889116

ABSTRACT

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically women's kidney health on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state in which acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. Various autoimmune and other conditions are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we know and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.


Subject(s)
Humans , Female , Pregnancy , Kidney Diseases/etiology , Kidney Transplantation , Renal Dialysis , Women's Health , Kidney Diseases/surgery , Kidney Diseases/therapy , Pregnancy Complications/surgery , Pregnancy Complications/therapy , Sex Factors
10.
Rev. chil. obstet. ginecol. (En línea) ; 82(4): 408-415, oct. 2017. tab
Article in English, Spanish | LILACS | ID: biblio-899923

ABSTRACT

INTRODUCCION La histerectomía obstétrica es procedimiento de urgencia para resolver una situación grave, su incidencia es de 5 a 15 por cada 1000 eventos obstétricos OBJETIVO GENERAL Determinar la frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México. METODOLOGIA Estudio descriptivo, transversal y retrospectivo en el periodo de Enero de 2014 a Diciembre del 2016, se incluyeron todos los casos de histerectomía posterior a un evento obstétrico, se estudiaron: edad, paridad, vía de interrupción del embarazo, antecedente de cesárea previa, indicaciones y complicaciones de la histerectomía, ingreso al servicio de terapia intensiva y mortalidad, el análisis se realizó con estadística descriptiva. RESULTADOS Durante el periodo de estudio, se atendieron 37 308 eventos obstétricos, efectuándose histerectomía obstétrica a 153 pacientes que representan el 0.57%, es decir, una HO por cada 243 embarazos. La edad promedio de quienes se les efectuó la histerectomía fue de 34 años de edad, siendo más frecuente en el grupo de mayores de 35 años, que habían tenido dos o tres embarazos previos. El antecedente de cesárea previa fue del 69.2%. La vía de interrupción del embarazo actual fue de cesárea en el 72.1%. La principal indicación fue la atonía uterina en 51 casos (33.3%). La complicación más frecuente fue la anemia aguda en el 83%. Hubo 1 muerte materna (0.6%). CONCLUSIONES La Histerectomía obstétrica es una cirugía de urgencia, por lo que se deben de identificar durante el control prenatal los factores asociados a las principales indicaciones de esta complicación.


INTRODUCTION Obstetric Hysterectomy (OH) is an emergency procedure to solve a life threatening condition, and its incidence is 5 to 15 per 1000 obstetric events. GENERAL OBJETIVE To determine the frequency and factors related with obstetric hysterectomy at a secondary hospital in Mexico. METHODOLOGY Descriptive, cross-sectional and retrospective study from January 2014 to December 2016 including all hysterectomy cases due to an obstetric event. Factors such as Age, number of deliveries, abortions, and previous cesarean sections, admission to the Intensive care unit, surgical indications, complications and mortality because of hysterectomy were analyzed thru descriptive statistics. RESULTS 37 308 obstetric events were registered and 153 were treated with Obstetric Hysterectomy representing 0.57% of the total, meaning one OH per every 243 pregnancies. The average age of those who had a hysterectomy was 28.5 years, and the procedure had its peak at the group of age older than 35 years who had had two or more pregnancies. The history of previous cesarean section was 39.2%. In 72.1% the pregnancy was terminated with a cesarean section. The main indication for hysterectomy was Uterine Atony in 33.3% (51 cases). The most frequent complication was acute anemia in 83%. There was a maternal death (0.6%). CONCLUSIONS Obstetric Hysterectomy is an emergency surgery, there are related factors that must be identified during the prenatal control to avoid this complication.


Subject(s)
Humans , Female , Adult , Young Adult , Pregnancy Complications/surgery , Hysterectomy/statistics & numerical data , Parity , Cesarean Section/statistics & numerical data , Incidence , Cross-Sectional Studies , Retrospective Studies , Age Distribution , Emergencies , Hysterectomy/adverse effects , Mexico
11.
Gac. méd. boliv ; 39(2): 88-90, dic. 2016. ilus, graf, map, tab
Article in Spanish | LILACS, LIBOCS | ID: biblio-953619

ABSTRACT

OBJETIVO: describir las principales causas de morbilidad y mortalidad materna por preeclampsia en la Unidad de Cuidados Intensivos Maternos (UCIM) del Hospital Materno Infantil Germán Urquidi (HMIGU). MÉTODOS: un total de 47 pacientes con diagnóstico de Preeclampsia que ingresaron a Cuidados Intensivos Maternos del Hospital Materno Infantil German Urquidi fueron registrados de Enero a Diciembre de 2015, a quienes se realizó un estudio observacional y prospectivo. La morbimortalidad es evaluada y descrita. RESULTADOS: la preeclampsia y sus complicaciones constituyen las principales causas de ingreso a Cuidados Intensivos Maternos del Hospital Materno Infantil German Urquidi con un 44%. La distribución diagnóstica de las principales complicaciones fue: HELLP (57%), eclampsia (48%), lesión renal aguda (19%), CID (8,5%), ACV (6,38%) y edema agudo pulmonar (2,1%) (Tabla 2). La mortalidad materna asociada a esta patología fue de 6,38 % (1 paciente con eclampsia, 1 paciente con edema agudo pulmonar y 1 paciente con CID) (Figura 2). La estancia media en la UCIM fue de 3,55 2,17 días (Tabla 3). CONCLUSIONES: la primigestación sigue siendo un factor prevalente (48%), tal y como se ha descrito en otros trabajos. La preeclampsia de inicio precoz (menor a 34 semanas) es predominantemente relevante dentro la historia natural de la enfermedad con un 51,4%. Las principales complicaciones y su prevalencia se aproximan a los descritos por Malvino 2012 y Briones 2013. La vigilancia y monitorización de estas pacientes en Cuidados Intensivos puede detectar de forma precoz la aparición de complicaciones con un beneficio secundario sobre la morbimortalidad. Por el bajo número de pacientes tomadas como muestra, no se pueden extraer conclusiones válidas referentes a la mortalidad.


OBJECTIVE: to describe the main causes of maternal morbidity and mortality due to preeclampsia in the Maternal Intensive Care Unit (UCIM) of the Hospital Materno Infantil Germán Urquidi (HMIGU). METHOD: a total of 47 patients diagnosed with Preeclampsia admitted to the Intensive Care Maternal and Child Hospital German Urquidi Maternal were recorded from January to December of 2 015, to whom a prospective observational study was conducted. Morbidity and mortality is assessed and described. RESULTS: eclampsia and its complications are the leading causes of admission to Intensive Care Maternal and Child Hospital German Urquidi Maternal and 44%. The diagnostic distribution of major complications was: HELLP (57%), eclampsia (48%), acute kidney injury (19%), CID (8, 5 %), stroke (6,38%) and acute pulmonary edema (2,1%) (Table 2). Maternal mortality associated with this disease was 6,38 % (1 patient with eclampsia, 1 patient with acute pulmonary edema and 1 patient with DIC) (Figure 2). The average length of stay in the MICU was 3,55 2,17 days (Table 3). CONCLUSIONS: the primigestación remains a prevalent factor (48%), as described in other works. Early-onset preeclampsia (less than 34 weeks) is predominantly relevant in the natural history of disease with 51,4%. The main complications and its prevalence approach described by Malvino 2012 and 2013 Briones surveillance and monitoring of these patients in intensive care can detect early onset of complications with a secondary benefit on morbidity and mortality. For the low number of patients taken as a sample, no valid conclusions can be drawn concerning mortality.


Subject(s)
Female , Pregnancy , Adult , Pregnancy Complications/surgery , Pre-Eclampsia , Pre-Eclampsia/diagnosis , HELLP Syndrome/diagnosis
12.
Rev. chil. obstet. ginecol ; 81(3): 223-228, jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-788913

ABSTRACT

El síndrome de Hallermann-Streiff es una rara entidad asociada a hipoplasia del tercio inferior de la cara, determinando así una vía aérea de difícil manejo. Se presenta el caso de una mujer de 21 años con ese síndrome, acondroplasia, escoliosis severa e infección respiratoria los días previos a la interrupción exitosa de su embarazo mediante cesárea. El manejo requirió una cuidadosa evaluación preoperatoria y disponibilidad inmediata de dispositivos alternativos para el manejo de la vía aérea en caso necesario. La gravidez, así como ciertas comorbilidades asociadas, aumentan la posibilidad de una intubación fallida con morbi-mortalidad secundaria importante, dado ello, es necesaria la preparación e implementación de algoritmos atingentes para el manejo de la vía aérea en casos como el presentado.


The Hallermann-Streiff syndrome is a rare entity associated to hypoplasia of the lower third of the face, determining a difficult airway management. We report the case of a 21 years female with this syndrome, achondroplasia, severe scoliosis and respiratory infection at the days prior to the interruption of her preg-nancy by cesarean section. Her management required a carefully preoperative evaluation and availability of alternative devices to secure her airway. Pregnancy and certain comorbidities increase the chance of a failed intubation with severe secondary morbidity and mortality, given this, the correct preparation and implementation of difficult airway algorithms in pregnancy if it’s necessary.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pregnancy Complications/surgery , Hallermann's Syndrome/complications , Pregnancy Complications/etiology , Pregnancy Outcome , Cesarean Section , Pregnancy, High-Risk , Airway Management , Intubation
14.
Rev. Nac. (Itauguá) ; 8(1): 3-9, jun 2016.
Article in Spanish | LILACS, BDNPAR | ID: biblio-884693

ABSTRACT

Introducción: una de cada 50 mujeres presentará durante su embarazo dolor abdominal potencialmente quirúrgico y una de cada 600 mujeres embarazadas requerirá de cirugía abdominal no obstétrica durante el embarazo. Objetivos: determinar la frecuencia y características demográficas y clínicas de patologías quirúrgicas durante el embarazo en pacientes internadas en el Hospital Nacional del año 2010 al 2014. Metodología: diseñoobservacional, descriptivo, retrospectivo de corte trasversal. Población estudiada: gestantes y/o puérperas atendidas en el Hospital Nacional con diagnóstico de patologías quirúrgicas durante los años 2010-2014. Muestreo no probabilístico según criterio. Resultados: se hallaron 76 mujeres (0,5%) con patologías quirúrgicas, la edad media fue 27 ± 6,2 años. La litiasis vesicular y la apendicitis aguda fueron las más frecuentes. La media de edad gestacional fue 28 ± 9,4 semanas. Las complicaciones fueron abdomen agudo y pancreatitis aguda, requiriendo cirugía 39 (51,3%) pacientes. Conclusiones: la frecuencia de patologías quirúrgicas fue menor al 1%, las patologías biliares y apendiculares fueron las más frecuentes.


Introduction: One in 50 women during pregnancy will potentially present surgical abdominal pain and one of every 600 pregnant women will require nonobstetric abdominal surgery during pregnancy. To determine the frequency and types of surgical pathologies during pregnancy in patients hospitalized in the HNI from 2010 to 2014. Methodology: observational, descriptive, retrospective study population crosscut: population studied pregnant and / or postpartum women treated at the National Hospital with a diagnosis of surgical pathologies during the years 2010-2014, no probabilistic sampling according to criteria. Results: 76 (0.5%) with surgical pathologies, median age were found: 27 ± 6.2 years, Cholelithiasis and acute appendicitis were the most frequent. Median gestational age was 28 ± 9.4 weeks. The complication were acute abdominal patology and acute pancreatitis, requiring surgery 39 (51.3%) patients. Conclusions: The frequency of surgical pathologies were less than 1%, biliary and appendicular pathology were the most frequent.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Young Adult , Pregnancy Complications/surgery , Pancreatitis/surgery , Appendicitis/surgery , Cross-Sectional Studies , Retrospective Studies , Cholecystitis, Acute/surgery , Ileus/surgery , Jaundice, Obstructive , Hernia, Inguinal/surgery , Abdomen, Acute/surgery
15.
Rev. Assoc. Med. Bras. (1992) ; 61(2): 170-177, mar-apr/2015. tab, graf
Article in English | LILACS | ID: lil-749015

ABSTRACT

Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial. .


Introdução: suspeita de apendicite é a indicação mais comum de cirurgia para condições não obstétricas durante a gravidez e ocorre em cerca de 1:500 a 1:635 gestações por ano. Ocorre com mais frequência no segundo trimestre da gestação. A apendicite aguda é o problema cirúrgico geral mais comum encontrado durante a gravidez. Método: revisão de literatura com pesquisa de artigos científicos por meio dos unitermos “apendicite aguda” e “gestação” nas bases de dados PubMed, Lilacs/SciELO, Scopus, Biblioteca Cochrane e Uptodate. Resultados: as manifestações clínicas da apendicite são semelhantes às de mulheres não grávidas; no entanto, pode ocorrer a apresentação não clássica, o que pode dificultar o diagnóstico, devendo ser subsidiado por exames de imagem. Discussão: o diagnóstico clínico deve ser fortemente suspeitado em mulheres grávidas com achados clássicos, como dor abdominal que migra para o quadrante inferior direito. O principal objetivo da imagem é reduzir atrasos na intervenção cirúrgica decorrentes da incerteza diagnóstica. Um objetivo secundário é o de reduzir, mas não eliminar, a taxa de apendicectomia negativa. O diagnóstico diferencial de suspeita de apendicite aguda inclui patologias geralmente consideradas em pessoas não grávidas. Conclusão: o exame de imagem de primeira escolha é a ultrassonografia, podendo-se utilizar a ressonância nuclear magnética quando aquela não for conclusiva, e, em último caso, a tomografia computadorizada. O tratamento indicado permanece sendo a apendicectomia por laparotomia, uma vez que a viabilidade da cirurgia videoassistida ainda permanece controversa. .


Subject(s)
Female , Humans , Pregnancy , Appendicitis , Pregnancy Complications , Acute Disease , Appendicitis , Appendicitis/surgery , Magnetic Resonance Imaging , Pregnancy Complications , Pregnancy Complications/surgery , Tomography, X-Ray Computed
16.
Gut and Liver ; : 672-678, 2015.
Article in English | WPRIM | ID: wpr-216101

ABSTRACT

BACKGROUND/AIMS: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. METHODS: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. RESULTS: A total of 10 ER-CPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. CONCLUSIONS: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.


Subject(s)
Adult , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Endosonography/adverse effects , Female , Fetus , Humans , Obstetric Surgical Procedures/adverse effects , Pancreatic Diseases/surgery , Pregnancy , Pregnancy Complications/surgery , Pregnancy Outcome , Retrospective Studies , Young Adult
19.
Hosp. Aeronáut. Cent ; 9(2): 132-5, 2014. ilus
Article in Spanish | LILACS | ID: lil-776832

ABSTRACT

La rotura espontanea de vasos uterinos es una rara causa de abdomen agudo hemorrágico durante el embarazo y una complicación potencialmente mortal. Las manifestaciones clínicas son: dolor abdominal súbito, shock hipovolémico y caída de hematocrito. Objetivos: Presentación de causa infrecuente de abdomen agudo hemorrágico. Reporte de Caso: Se presenta un caso de una mujer de 36 años primigesta, con embarazo de 27 semanas, con abdomen agudo, sin antecedentes traumáticos y signos de shock hipovolémico. Ecografía abdominal con líquido libre en cavidad. En laparotomíaexploradora se halla laceración de vena uterina derecha, se realiza hemostasia directa y cesárea de urgencia por bradicardia fetal severa. Discusión: Debe realizarse un correcto diagnóstico diferencial dado que el tratamiento de la rotura espontanea de los vasos uterinos es el manejo urgente del shock hipovolémico y la intervención quirúrgica a la brevedad...


Spontaneous rupture of uterine vessels is a rarecause of acute abdomen bleeding during pregnancy and apotentially fatal complication.Clinical manifestations include sudden abdominal pain,hypovolemic shock and fall of hematocrit.Objectives: Introducing rare cause of acute abdomen bleeding.Case Report: We presents case of a woman aged 36 with 27weeks pregnancy (first one), acute abdomen, without traumatichistory WITH signs of hypovolemic shock. Abdominal ultrasoundwith free fluid in the cavity. At laparotomy we found laceration ofthe right uterine vein, performing direct hemostasis andemergency cesarean for severe fetal bradycardia.Discussion: We have to make sure of doing a correct differentialdiagnosis because the treatment of spontaneous rupture of theuterine vessels is urgent for management of hypovolemic shockand surgery should be performed promptly...


Subject(s)
Humans , Adult , Female , Abdomen, Acute/surgery , Abdomen, Acute/epidemiology , Pregnancy Complications/surgery , Uterine Rupture/surgery
20.
West Indian med. j ; 62(2): 158-160, Feb. 2013. ilus
Article in English | LILACS | ID: biblio-1045612

ABSTRACT

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.


Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.


Subject(s)
Humans , Female , Pregnancy , Adult , Ovarian Cysts/surgery , Pregnancy Complications/surgery , Laparoscopy/methods , Torsion, Mechanical , Ligaments/surgery , Ovarian Cysts/complications , Adnexal Diseases/surgery , Adnexal Diseases/complications
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