Abdomen agudo por torsión de masa anexial en tercer trimestre del embarazo, reporte de un caso y revisión de la literatura / Adnexal mass torsion as a cause of acute abdomen in the third trimester of pregnancy. Case report and review of the literature

Resumen INTRODUCCIÓN: Las masas anexiales en el embarazo son hallazgos fortuitos durante la gestación. Suelen diagnosticarse con la ecografía del primer trimestre. Su incidencia y curso clínico varían dependiendo de las semanas de embarazo. La complicación más común es la torsión con abdomen agudo. La incidencia de torsión va de 0.2 a 15%, con aumento durante el embarazo con masas de mayor tamaño. Son poco frecuentes durante el tercer trimestre del embarazo. Los cistoadenomas mucinosos son parte de los tumores epiteliales benignos más frecuentes del ovario; se consideran precursores de carcinomas mucinosos. CASO CLÍNICO: Paciente de 34 años, con antecedentes obstétricos de cuatro embarazos: dos partos y dos abortos, con 31 semanas de embarazo al ingreso al Hospital Universitario de la Samaritana de Colombia, justificado por un cuadro clínico de 18 horas de evolución consistente en: dolor abdominal intenso, tipo punzada, de predominio en la fosa iliaca y el flanco derechos. En la laparotomía se encontró un tumor ovárico con torsión, que se resecó. El estudio anatomopatológico reportó "tumor mucinoso de tipo endocervical con severos cambios por infarto". La evolución materno perinatal fue satisfactoria. CONCLUSIONES: El diagnóstico de torsión de masa anexial como causa de abdomen agudo en el tercer trimestre del embarazo es complejo pues requiere historia clínica, imágenes y estudios paraclínicos. El pronóstico materno-perinatal es bueno cuándo el tratamiento médico-quirúrgico es oportuno. Se requiere determinar el tipo de masa con estudios anatomopatológicos para continuar el tratamiento integral. El tumor mucinoso de ovario, tipo endocervical en masas torcidas de ovario, es raro.

Abstract BACKGROUND: Adnexal masses of pregnancy are incidental findings during pregnancy. They are usually diagnosed with first trimester ultrasound. Their incidence and clinical course vary depending on the weeks of pregnancy. The most common complication is torsion with acute abdomen. The incidence of torsion ranges from 0.2 to 15%, with an increase during pregnancy with larger masses. They are rare during the third trimester of pregnancy. Mucinous cystoadenomas are among the most frequent benign epithelial tumors of the ovary; they are considered precursors of mucinous carcinomas. CLINICAL CASE: 34-year-old female patient, with obstetric history of four pregnancies: two deliveries and two miscarriages, 31 weeks pregnant on admission to the Hospital Universitario de la Samaritana of Colombia, justified by a clinical picture of 18 hours of evolution consisting of: intense abdominal pain, stabbing type, predominantly in the right iliac fossa and flank. At laparotomy the torsion was found and resected. The anatomopathological study reported "mucinous tumor of endocervical type with severe infarction changes". Maternal perinatal evolution was satisfactory. CONCLUSIONS: The diagnosis of adnexal mass torsion as a cause of acute abdomen in the third trimester of pregnancy is complex as it requires clinical history, imaging and paraclinical studies. The maternal-perinatal prognosis is good when medical-surgical treatment is timely. It is necessary to determine the type of mass with anatomopathological studies to continue the integral treatment. Mucinous ovarian tumor, endocervical type in twisted ovarian masses, is rare.

¿Qué hay en común entre el hígado graso agudo del embarazo y la preeclampsia? Subdiagnóstico clínico de alta mortalidad / What is in Common Between Acute Fatty Liver of Pregnancy and Preeclampsia? Highly Mortal Clinical Sub-Diagnosis / O que tem em comum o fígado gorduroso agudo da gestação e a pré-eclâmpsia? Subdiagnóstico clínico de alta mortalidade

Resumen: El hígado graso agudo del embarazo es una de las alteraciones hepáticas con mayor mortalidad (cerca del 18%) presentes en la gestación, aunque es una patología poco frecuente: 1 de cada 7000 a 16.000 embarazos presenta muchas complicaciones y requiere un manejo inmediato para evitar la muerte de la gestante o del feto; sin embargo esta patología se puede enmascarar con la preeclampsia, que es otra patología hepática de mayor frecuencia, lo cual retrasa el manejo y aumenta el número de complicaciones. El objetivo de este artículo es realizar una búsqueda bibliográfica acerca del hígado graso agudo del embarazo e identificar los factores similares entre esta patología y la preeclampsia severa para lograr hacer un diagnóstico y manejo oportunos. Para ello se realizó una búsqueda sistemática en las bases de datos, PubMed, Science Direct, Medline, Embase, en junio de 2017; además, se seleccionaron artículos originales, reportes de casos y artículos de revisión, publicados en los últimos diez años.

Abstract: Acute fatty liver of pregnancy (AFLP) is one of the liver disorders with the highest mortality rate (about 18%) during pregnancy, although it is rare: 1 in 7,000 to 16,000 pregnancies has many complications and requires immediate treatment to avoid the death of the pregnant woman or the fetus. However, this pathology can be masked by preeclampsia, which is another more frequent liver disease. This delays treatment and increases the number of complications. The aim of this article is to conduct a bibliographic search about AFLP and identify similar factors between this pathology and severe preeclampsia to make a diagnosis and provide treatment in a timely manner. For this, a systematic search was carried out in databases (PubMed, Science Direct, Medline, Embase) in June 2017. In addition, original articles, case reports, and review articles published in the last ten years were selected.

Resumo: O fígado gorduroso agudo da gestação é uma das alterações hepáticas com mais mortalidade (cerca de 18 %) presentes na gravidez, embora seja uma patologia pouco frequente: 1 de cada 7.000 a 16.000 gestações apresenta muitas complicações e requer uma ação imediata para evitar a morte da gestante ou do feto. Contudo, essa patologia pode ser camuflada com a pré-eclâmpsia, que é outra patologia hepática de maior frequência, o que atrasa seu tratamento e aumenta o número de complicações. Nesse sentido, o objetivo deste estudo é realizar uma busca bibliográfica sobre o fígado gorduroso agudo da gestação e identificar os fatores semelhantes entre ele e a pré-eclâmpsia grave para poder fazer um diagnóstico e tratamento oportunos. Para isso, foi realizada uma busca sistemática nas bases de dados, PubMed, Science Direct, Medline, Embase, em junho de 2017, das quais foram selecionados artigos originais, relatos de caso e artigos de revisão, publicados nos últimos dez anos.

Hemorragia de la Segunda Mitad del Embarazo en el Hospital Provincial General Docente Riobamba, Chimborazo, Ecuador 2017 - 2018 / Antepartum hemorrhage in the Hospital Provincial General Docente Riobamba, Chimborazo, Ecuador 2017 - 2018

Introducción: la hemorragia obstétrica es la segunda causa más frecuente de mortalidad materna en el Ecuador, a pesar de ello, es un tema que se ha estudiado poco a nivel provincial y nacional. Objetivo: determinar la ocurrencia e identificar los factores de riesgo, manifestaciones clínicas y comorbilidades más frecuentes de la hemorragia de la segunda mital del embarazo. Métodos: estudio descriptivo, transversal, donde se analizaron las historias clínicas de las pacientes obstétricas con hemorragia de la segunda mitad del embarazo atendidas en el Hospital Provincial General Docente Riobamba (HPGDR) entre junio 2017 y junio 2018. Resultados: de un total de 3 460 pacientes obstétricas atendidas, 0.49% (n = 17) cumplieron los criterios de hemorragia en la segunda mital del embarazo, las cuales tuvieron una edad media de 29 años (desviación estándar = 7), una edad gestacional media de 36 semanas (desviación estándar = 5) y en su mayoría fueron multíparas. El desprendimiento de placenta normoinserta fue la principal patología causante de la hemorragia y el dolor abdominal el principal síntoma manifestado, en la mayoría no se observó otras comorbilidades obstétricas. Conclusión: se observó una baja ocurrencia de hemorragia de la segunda mitad del embarazo en el HGDR entre junio 2017 y junio 2018, siendo la causa más frecuente el desprendimiento de placenta normoinserta y el principal mitivo de consulta dolor abdominal.

Introduction: obstetric hemorrhage is the second most frequent cause of maternal mortality in Ecuador. Nevertheless, the topic has been little studied at a local and national level. Objective: to determine the ocurrence and identify the most frequent risk factors, clinical manifestations and comorbilities in antepartum hemorrhage. Methods: it is a descriptive, cross-sectional study, in which clinical histories of obstetric patients with hemorrhage of the second half of pregnancy were analyzed in the Hospital Provincial General Docente Riobamba (HGPDR) between June 2017 and June 2018. Results: from 3 460 obstetric patients attended, 0.49% (n = 17) met antepartum hemorrhage criteria. Women were in average 29 years old (standard deviation = 7), had an average gestational age of 36 weeks (standard deviation = 5) and were multiparous. Detachment of normoinserta placenta was the main cause of bleeding, abdominal pain was the most frequent symptom reported and in the majority of cases no obstetric comorbilities were observed. Conclusions: it was observed a low ocurrence of hemorrhage of the second half of pregnancy in the HGDR between June 2017 and June 2018. The mots common cause of the patology was detachment of normoinserta placenta and the most frequent complain reported was abdominal pain.

Asociación entre la ansiedad materna y el parto pretérmino en Lima, Perú / Association between maternal anxiety and preterm delivery in Lima, Peru

Introducción: el parto pretérmino se define como el parto antes de las 37 semanas. Se han establecido diversos factores desencadenantes, entre los cuales se encuentra la ansiedad. En Perú se han realizado pocos estudios en relación con el tema. Objetivo: determinar la asociación entre la ansiedad materna durante el tercer trimestre de embarazo y el desarrollo de parto pretérmino. Métodos: estudio de tipo cohorte prospectiva realizado en un hospital público de Lima-Perú, que incluyó a 247 gestantes (enero de 2014 a enero de 2015). Se evaluó a gestantes entre las semanas 28 y 35 de embarazo, durante la visita prenatal. Los datos perinatales se obtuvieron del libro de partos y de la historia clínica materna. El instrumento utilizado para medir la ansiedad fue la encuesta State Trait Anxiety Inventori (STAI). El análisis de datos se realizó mediante STATA versión 11.1. Resultados: la mediana de edad de las participantes fue 27, 68,1 por ciento fueron convivientes y 58 por ciento tuvieron secundaria completa. Se encontró una incidencia de parto pretérmino de 11,6 por ciento. En el análisis multivariado ajustado, se encontró un riesgo relativo de 1,23 (IC 95 por ciento: 0,57-2,65) para ansiedad de estado y un riesgo relativo de 0,97 (IC 95 por ciento: 0,45-2,06) para ansiedad de rasgo. En el análisis bivariado se encontró una asociación significativa con preeclampsia. Conclusión: Se recomienda realizar más estudios longitudinales para establecer mejor la asociación ansiedad materna - parto pretérmino(AU)

Introduction: preterm delivery is defined as delivery before 37 weeks of gestational age. Several triggering factors have been established, anxiety being one of them. Few studies on the subject have been conducted in Peru. Objective: determine the association between maternal anxiety during the third trimester of pregnancy and preterm delivery. Methods: a prospective cohort study was conducted at a public hospital in Lima, Peru, from January 2014 to January 2015. The study sample consisted of 247 pregnant women of 28-35 weeks of pregnancy. Evaluation was performed during prenatal visits. Perinatal data were obtained from the labor and delivery registry and the patients' medical records. The tool used to measure anxiety was the survey State Trait Anxiety Inventory (STAI). Data were analyzed with STATA version 11,1. Results: mean age of participants was 27 years; 68,1 percent cohabitated with their partners, and 58 percent had completed high school. Preterm delivery had an incidence of 11,6 percent. Adjusted multivariate analysis revealed a relative risk of 1,23 (95 percent CI 0,57-2,65) for state anxiety and ,.97 (95 percent CI 0,45-2,06) for trait anxiety. Bivariate analysis found a significant association with preeclampsia. Conclusion: anxiety during the third trimester of pregnancy was found to be a risk factor for preterm delivery. It is recommended to perform other longitudinal studies to more clearly determine the association between maternal anxiety and preterm delivery(AU)

Clinical study on bacterial condition in amniotic cavity in the third trimester of pregnancy / 中国综合临床

Objective To study bacterial conditions in amniotic cavity of the third trimester and the delivery. Methods Patients underwent cesarean section due to various reasons were randomly enrolled in the study. Ten ml aqua amnii taken from using aspesis were cultured and the bacteria were identified and tested for drug sensitivity. All patients were not treated with antibiotics before and during operation,conventional antibiotics treatnent was used after operation. The patients were divided into 3 groups based on their status: 34 cases of premature rupture of membrane ( PROM ), thirty-four cases of labor without PROM, and 27 cases of pregnancy without PROM. The positive rate, species , distribution and drug sensitivity of bacteria in the 3 groups were analyzed. Results The positive rate was 61.8% (21/34) in PROM ,52. 9% ( 18/34 ) in labor without PROM,11.1% (3/27)in pregnancy without PROM. The positive rates were significantly different among the 3 groups (x2 = 17.29 ,P =0.000). However, there was no significant difference between the labor without PROM group and the pregnancy without PROM group ( x2 = 0.541 , P = 0.462 ). Staphylococcus epidermidis was the most common isolated bacteria, following by staphylococcus aureas, streptococcus, colon bacillus, and pseudomonas. There were no significant differences of bacterial species between labor without PROM and pregnancy without PROM( x2 = 11.9,P =0.535 ). The relative higher positive rate in the labor without PROM and PROM indicated that they were important inducement of bacteria infection. There were no significant difference on positive rate and bacteria species distribution between the PROM and labor without PROM group,which suggested that up-bound along vagina to amniotic cavity was the most common route of infection. Sensitive antibiotics should be given to the patients of PROM and labor without PROM targeted at staphylococcus,streptococcus, colon bacillus and monad. Antibiotics such as Cephems, Penicillins and Clindamycin were sensitive to various bacteria and safe to both mother and baby, thus were recommended. Quinupristin, Vancomycin,Furantoin, Fusidic ,Teicoplanin, Amikacin and Meropenem were also sensitive to various bacteria, but due to their side effects and the principle of ladder antibiotics using, they were recommended as second line antibiotics. Conclutions Up-bound along vagina to amniotic cavity is the most common route of infection. For rupture of membrane and labor without PROM patients, antibiotics should be given, and strict aseptic technique,washing cavity and incision, using antibiotics after operation are necessary to prevent infection.

Autologous blood transfusion in the third trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVE: Preoperative autologous blood donation aims at avoiding the risks associated with exposure to allogenic blood and transfusion related diseases such as AIDS and hepatitis. While its use is frequent in adult patients with elective surgery, it is still uncommon in pregnant women because its safety has not been established for mother and fetus. The aim of this study is to determine the safety and utility of autologous blood donation in the third trimester of pregnancy. METHODS: In this study, sixteen pregnant women with placenta previa, Rh negative or huge myoma underwent 24 phlebotomies according to an autologous transfusion program. Phlebotomies were performed at an average gestational age of 36+4 weeks (range 34-41 weeks). Maternal vital sign and fetal heart rate were monitored before, during and after phlebotomy. Hematocrit was statistically evaluated by paired t-test. RESULTS: During the phlebotomy, there was no remarkable change in fetal heart rate except one case with temporary fetal tachycardia. Furthermore, changes in mean maternal diastolic blood pressure and pulse rate were not noted except one case with mild dizziness and diaphoresis. Change in mean maternal hematocrit between the initial donation and admission day for delivery was not statistically significant (P>0.05). The average interval from last donation to delivery was 9.8 day (2-20 day). Fetal outcomes were good in all cases. CONCLUSION: We concluded that preoperative autologous blood donation in pregnant woman in third trimester is safe for mother and fetus. So, if pregnant woman do not want to receive allogeneic transfusion, autologous blood transfusion might be the alternative method.