Uso del balón intrauterino en caso de inversión uterina recurrente / Use of the intrauterine balloon to manage recurrent uterine inversion

La inversión uterina es una urgencia obstétrica infrecuente pero importante. Su manejo debe ser escalonado con los objetivos de controlar la hemorragia, reponer el útero en la cavidad abdominal y prevenir la recurrencia.En caso de inversión recurrente se ha descrito la utilización de balón intrauterino para controlar la hemorragia y prevenir la reversión del útero, siendo un manejo conservador que permite mantener el potencial reproductivo y añade un uso adicional del balón intrauterino en la sala de partos.Exponemos un caso de inversión uterina grado III con posterior reinversión incompleta en una paciente tercípara de bajo riesgo tras un parto eutócico. Se realizó reposición uterina manual en paritorio, el alumbramiento manual y la administración de uterotónicos, evidenciándose una inversión uterina parcial o incompleta y hemorragia vaginal con repercusión hemodinámica materna. En quirófano, bajo anestesia general y relajación uterina, se realizó reposición uterina completa bajo visión ecográfica, se estabilizó a la paciente y se controló la hemorragia mediante sistema de taponamiento de doble balón.

Uterine inversion is an infrequent but serious obstetric emergency. Management of uterine inversion should be staggered to control postpartum haemorrhage, return the uterus to the abdominal cavity and prevent recurrent inversion. In cases of resistant inversion, the intrauterine balloon has been reported to control bleeding and prevent uterine reversal. This is conservative management, which maintains the reproductive potential of women and constitutes an additional use for the intrauterine balloon in the delivery room. We present a case of grade III uterine inversion with subsequent incomplete reinversion in a low-risk pregnancy after eutocic delivery. Manual uterine replacement and administration of uterotonics was performed in the delivery room, showing partial or incomplete uterine inversion, vaginal bleeding with maternal haemodynamic instability. In the operating room, under general anaesthesia and uterine relaxation, complete uterine replacement was performed under ultrasound guidance, the patient was stabilized, and bleeding was controlled using a double-balloon tamponade system.

Estrategia para disminuir la incidencia de cromosomopatías como parte de un screening universal en un hospital comarcal / Strategy to decrease the chromosomal defects as part of an Universal screening in a comarcal hospital in a rural community

Objetivos: Evaluar las opciones de cribado de cromosomopatías en un hospital comarcal sin disponibilidad de bioquímica del primer trimestre. Métodos: Estudiamos 909 gestantes, a 744 practicamos translucencia nucal (TN), a 494 screening bioquímico del segundo trimestre (SB 2ºT) y a 414 cribado secuencial (TN y SB 2ºT). La TN se valora según las pautas de la Fetal Medicine Foundation, los marcadores bioquímicos mediante electroquimioluminiscencia, y los cariotipos obtenidos mediante amniocentesis y biopsia corial (n=347). Resultados: 1. Al ser independientes nuestros marcadores, es posible realizar un screening secuencial. 2. En la población de alto riesgo ahorramos un 50% de amniocentesis con la TN y screening secuencial respecto al SB 2ºT, y en la población general las disminuímos a la tercera parte con el SB 2ºT y la TN con respecto a la edad materna. 3. Edad y TN muestran sensibilidad del 30% y 67%, respectívamente. Conclusión: La TN es un buen método de screening de cromosomopatías en nuestro medio

Objectives: The aim of this study is to evaluate the screening of cromosomal defects in a comarcal hospital, without the biochemical screening in the first trimester of pregnancy. Methods: We have studied 909 patients, 744 with nuchal translucency (NT), 494 biochemical screening in the second trimester (SB 2ºT) and 414 sequential screening (TN + SB 2ºT). NT has been estimated according to the patherns of Fetal Medicine Foundation, maternal serum markers with the electroquimioluminiscency technique,and the cariotipe was obtained with amniocentesis and corion villus sampling (n=347). Results: 1. The chromosomopaties markers are independents, so is possible to do a sequential screening. 2. In high risk population 50% less of amniocentesis were done with NT and sequential screening, rather than whith biochemical screening, and in the general population we decrease them to the third part using biochemical screening and NT compared to maternal age. 3. Maternal age and NT have a sensibility around 30% and 67%, respectively. Conclusion: NT is a good chromosomal abnormalities screening method in our hospital

Silver-Russell syndrome associated to Mayer-Rokitansky-Kuster-Hauser syndrome, diabetes and hirsutism.

We report an unusual association of two rare conditions, the Silver-Russell syndrome and the Mayer-Rokitansky-Küster-Hauser syndrome, with extra endocrine anomalies. A 15-year old Silver-Russell syndrome girl was referred to our Unit because of primary amenorrhea and hirsutism of adrenal origin. A thorough assessment confirmed previous diagnoses and revealed the presence of diabetes, hyperinsulinism and a complete Mayer-Rokitansky-Küster-Hauser syndrome with an ectopic localization of both ovaries. Although initial medical treatment was not unsatisfactory, future medical, psychological and social implications are expected.