ABSTRACT
Material y Métodos: estudio observacional retrospectivo que compara 704 gestaciones conseguidas tras técnicas de reproducción asistida en el periodo 2008-2012 (grupo estudio), con 2.507 gestaciones espontaneas (grupo control). Resultados: mayor riesgo de gestaciones múltiples en el grupo estudio 24,3% contra 1% del grupo control p < 0,001 RR 25,5 (17,3-37,6). El parto fue a las 37,79 semanas en grupo estudio y 38,99 grupo control p < 0,001. Manteniéndose las diferencias en gestaciones únicas con una media de 38,5 en grupo estudio y 39 en grupo control p < 0,001. Niños prematuros en grupo estudio 23,2%, contra 6,2% grupo control p < 0,001 RR 4,5 (3,6-5,8). Reduciéndose a la mitad el riesgo relativo cuando solo comparamos gestaciones únicas. Cesarea en 52% gestaciones por técnicas de reproducción asistida, contra 18,6% en gestaciones espontaneas p < 0,001 RR 2,85 (2,56-3,22). Manteniéndose diferencias comparando gestaciones únicas 15,6% en grupo estudio y 18,3% grupo control. No encontramos diferencias en el sexo del recién nacido. La tasa de bajo peso al nacer también fue mayor en grupo estudio 23,8% contra 7,97% grupo control p < 0,001 RR 3,6 (2,8-4,5); manteniéndose diferencias en gestaciones únicas con 11% recién nacido de bajo peso contra 5,8% p < 0,001 RR 2 (1,46-2,8). Malformaciones congénitas mayor en grupo control 9,45% respecto grupo estudio 3,69%. Conclusiones: la gestación tras técnicas de reproducción asistida presenta 25 veces más riesgo de gestación múltiple; las madres son 5 años más añosas; 4,5 veces más riesgo de tener un parto pretérmino; 2 veces mayor si comparamos gestaciones únicas; 3 veces más de tener recién nacido de bajo peso, el doble si comparamos gestaciones únicas; cesárea en más del doble tanto gestaciones únicas como en total gestaciones (AU)
Material and Methods: Retrospective observational study comparing outcomes of 704 pregnancies after assisted reproductive techniques 2008-2012 (study group), with 2507 spontaneous pregnancies (control group). Results: There are difference in outcome between assisted reproductive techniques (study group) and naturally conceived pregnancies (control group). We found differences in increased risk of multiple pregnancies in the study group 24.3% to 1% of control group p < 0.001 RR 25.5 (17.3-37.6). Mean weeks in which the delivery occurred study group was 37.79 and 38.99 in the control group p < 0.001. Maintaining differences when only singleton pregnancies compared with an average of 38.5 in the study group and control group 39 weeks p < 0.001. In the study group are at higher risk of preterm birth with 23.2% versus 6.2% control group, p < 0.001 RR 4.5 (3.6-5.8). Reduced to half the relative risk when compared only single pregnancies. Cesarean was performed in 52% of pregnancies by assisted reproductive techniques, while it was 18.6% incidence of spontaneous pregnancies p < 0.001 RR 2.85 (2.56-3.22). He maintained even comparing differences singleton pregnancies in both groups with 15.6% in the study group and 18.3% control group. Without differences in sex of newborns. The rate low birth weight was also higher in the study group 23.8% vs control group 7.97% p < 0.001 RR 3.6 (2.8-4.5); maintaining differences in single pregnancies with 11% low birth weight against 5.8%, study group against control group, p < 0.001 RR 2 (1.46-2.8); Although increased incidence of congenital malformations in the control group 9.45% from 3.69% in the study group. Conclusions: These results suggest that assisted reproductive techniques is associated with increased risk of multiple pregnancy, delivery preterm, higher risk of low birth weight (< = 2500g), and more cesarean section. The increased risk of preterm, low birth weight, and cesarean persisted in singleton pregnancies (AU)
Subject(s)
Humans , Female , Pregnancy , Reproductive Techniques, Assisted , Evaluation of Results of Therapeutic Interventions/methods , Evaluation of Results of Therapeutic Interventions/trends , Fertilization in Vitro/methods , Retrospective Studies , 28599 , Infant Mortality/trends , Perinatal Care/methodsABSTRACT
After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.
ABSTRACT
La sospecha clínica, el diagnóstico rápido y un abordaje multidisciplinar son fundamentales para mejorar la morbimortalidad de las pacientes con hematoma subcapsular hepático. El tratamiento de esta entidad abarca desde la conducta expectante bajo vigilancia clínica y radiológica, la embolización de las arterias hepáticas o la cirugía en caso de inestabilidad hemodinámica, persistencia de sangrado o incremento del dolor. Presentamos el caso de un síndrome de HELLP posparto complicado con un hematoma subcapsular hepático y que se resolvió exitosamente con embolización de la arteria hepática derecha (AU)
To improve morbidity and mortality in patients with subcapsular liver hematoma, clinical suspicion, a rapid diagnosis and multidisciplinary treatment are fundamental. The treatment of this complication includes expectant management with clinical and radiological observation, embolization of the hepatic arteries, and surgical treatment if there is hemodynamic instability, persistent bleeding or increasing pain. We report a case of postpartum HELLP syndrome that was complicated by a subcapsular liver hematoma, successfully treated by embolization of the right hepatic artery (AU)
Subject(s)
Humans , Female , Adult , HELLP Syndrome/diagnosis , HELLP Syndrome/therapy , Embolization, Therapeutic/methods , Uterine Artery Embolization/methods , Hematoma/complications , HELLP Syndrome , Indicators of Morbidity and Mortality , /methods , Angiography/methodsABSTRACT
Objetivo. Comparar el tiempo medio de expulsión de dos protocolos de misoprostol vaginal en abortos de segundo trimestre. Material y métodos. Estudio retrospectivo de 281 casos entre enero de 2000 y diciembre de 2005 (protocolo A: 800mg/24h) y junio de 2007 y diciembre de 2008 (protocolo B: 400mg/4h). Se recogió como variable principal el tiempo de expulsión. Resultados. El tiempo medio de expulsión fue similar para los dos protocolos (19,7h para el A y 17,7h para el B). Tampoco encontramos diferencias significativas en cuanto a las tasas de expulsión a las 12, 24 y 48h. El efecto adverso observado con mayor frecuencia fue la fiebre, siendo más frecuente en el protocolo B. No hubo efectos adversos mayores como rotura uterina o hemorragia severa. Conclusiones. No existen diferencias significativas entre los dos protocolos en cuánto a tiempo medio de expulsión fetal, aunque sí mayor porcentaje de fiebre en el protocolo B (AU)
Objective. To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination. Material and methods. We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800mg /24h) and between June 2007 and December 2008 (regimen B: 400mg /4h). Induction-expulsion time was taken as the main outcome. Results. The mean expulsion time was similar in both regimens (19.7h for A and 17.7h for B). No significant differences were found in the expulsion rate at 12, 24 and 48h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed. Conclusions. No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B (AU)
Subject(s)
Humans , Female , Pregnancy , Clinical Protocols , Misoprostol/therapeutic use , Abortion, Threatened/diagnosis , Abortion, Threatened/therapy , Pregnancy Trimester, Second , Fever/complications , 28640/methods , Mifepristone/therapeutic use , Fever/etiology , Fever/therapy , Retrospective Studies , Prenatal Diagnosis/methods , Prenatal Diagnosis/trends , Indicators of Morbidity and Mortality , 28599 , Oxytocin/therapeutic useABSTRACT
Presentamos un caso de donovanosis genital en una gestante cuyo diagnóstico fue dificultoso dada la baja incidencia de esta enfermedad en nuestro país. La donovanosis o granuloma inguinal es una infección de transmisión sexual, causa de úlcera genital crónica no dolorosa. Es una enfermedad endémica en países tropicales y subtropicales. Debido al aumento de la inmigración procedente de estas zonas y al turismo sexual a países endémicos, estamos asistiendo a un aumento de esta patología infecciosa poco prevalente hasta ahora en nuestro medio (AU)
We report a case of genital donovanosis in a pregnant woman, whose diagnosis was difficult because of the low incidence of this disease in our country. Donovanosis or granuloma inguinale is a sexually transmitted infection that causes chronic genital painless ulceration. It is an endemic disease in tropical and subtropical countries. Due to the increase of immigration coming from these countries and sexual tourism in endemic countries, we are witnessing an increase in this infectious disease not very prevalent in our country until now (AU)
Subject(s)
Humans , Female , Adult , Granuloma Inguinale/complications , Granuloma Inguinale/diagnosis , Granuloma Inguinale/therapy , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Azithromycin/therapeutic use , Diagnosis, Differential , Acquired Immunodeficiency Syndrome/complications , Doxycycline/therapeutic use , Ciprofloxacin/therapeutic use , Erythromycin/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
La displasia mesenquimal placentaria (DMP) es una anomalía vascular que presenta una baja incidencia (0,02%) y se caracteriza por una placentomegalia con múltiples vesículas en grano de uva en el examen ecográfico. El diagnóstico diferencial principal es la mola hidatiforme parcial, pero la DMP coexiste con feto viable. Se asocia a crecimiento intauterino restringido (CIR), muerte fetal y, en el 30% de los casos, síndrome de Beckwith-Wiedemann. El diagnóstico de sospecha de la DMP es ecográfico, pero el diagnóstico definitivo lo dará el estudio anatomopatológico. Presentamos 2 casos de DMP, cuyo diagnóstico no se realizó hasta el análisis histológico, que cursaron con resultados perinatales diferentes, así como una revisión bibliográfica de la displasia mesenquimal placentaria (AU)
Placental mesenchymal dysplasia (PMD) is a vascular abnormality with a very low incidence (0.02%) that is characterized by placentomegaly with multiple grapelike vesicles on ultrasound examination. The main differential diagnosis of PMD is partial hydatidiform mole. However, in contrast to a partial mole, PMD can coexist with a viable fetus. PMD is associated with fetal growth restriction, fetal demise and Beckwith-Wiedemann syndrome in 30% of cases. The suspected diagnosis is based on ultrasound examination, but the final diagnosis of PMD is made by histological analysis. We present two cases of PMD which were diagnosed at necroscopy and which had distinct outcomes. A literature review of placental mesenchymal dysplasia is also provided (AU)
