ABSTRACT
Very long fusiform gram-negative bacilli were observed after Gram staining of amniotic fluid from a 36-year-old multigravida woman. At 24 hours, pure, abundant growth of smooth, gray, only slightly convex catalase-positive and oxidase-negative colonies measuring about 2 mm were observed. Growth was greater in anaerobic than in aerobic conditions. The bacterium was identified as Leptotrichia trevisanii by matrix-assisted laser desorption ionization time of flight mass spectrometry. Ampicillin and gentamicin were prescribed for chorioamnionitis, and vaginal prostaglandins were administered to terminate the pregnancy. The patient remained afebrile throughout 48 hours and was discharged. Microscopic examination of the placenta revealed severe acute chorioamnionitis with a maternal inflammatory response and abundant bacillary-shaped microorganisms. To our knowledge, this isolate constitutes the first reported case of chorioamnionitis caused by L. trevisanii.
Subject(s)
Chorioamnionitis/microbiology , Fusobacteriaceae Infections/microbiology , Leptotrichia/isolation & purification , Pregnancy Complications/microbiology , Adult , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Female , Fusobacteriaceae Infections/drug therapy , Gentamicins/administration & dosage , Humans , Leptotrichia/drug effects , Leptotrichia/genetics , Leptotrichia/physiology , Pregnancy , Pregnancy Complications/drug therapy , Spectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationABSTRACT
OBJECTIVE: To evaluate if ultrasound variables at term are associated with the mode of delivery in women with previous cesarean section (PCS). METHODS: This was a prospective study of singleton pregnant women who planned a trial of vaginal birth after cesarean delivery. Cervical length, posterior cervical angle, head-perineum distance, and estimated fetal weight were measured at 37-39 weeks of gestation. RESULTS: One hundred forty-four pregnancies were examined and vaginal delivery was achieved in 98 women (73%). Logistic regression analysis identified cervical length, head-perineum distance, age, previous vaginal delivery, previous cesarean for dystocia, and Bishop score as predictors of vaginal delivery. Combining ultrasound and clinical parameters, two models for risk scoring that differ in the variable Bishop score or cervical length were constructed. The AUC of these models was 0.867 and 0.855, respectively. CONCLUSIONS: In women with a PCS, measurement of cervical length and head-perineum distance at term is associated with the mode of delivery. A combination of clinical and sonographic parameters at term can predict the likelihood of vaginal delivery.
Subject(s)
Cervix Uteri/physiology , Delivery, Obstetric/methods , Fetal Weight/physiology , Labor Presentation , Term Birth , Trial of Labor , Adult , Cervical Length Measurement , Female , Humans , Odds Ratio , Pregnancy , Pregnancy Outcome , Prospective Studies , ROC Curve , Regression Analysis , Risk Assessment , Sensitivity and Specificity , Ultrasonography, Prenatal/methods , Vaginal Birth after CesareanABSTRACT
El síndrome de insensibilidad a los andrógenos se caracteriza por la presencia de cariotipo 46,XY, fenotipo femenino y presencia de gónadas masculinas. Es la tercera causa más frecuente de amenorrea primaria, tras la disgenesia gonadal y la ausencia congénita de vagina (síndrome de Mayer-Rokitansky-Küster-Hauser). Se trata de una entidad de interés por su relevancia en la identificación sexual y por su posible asociación con tumores malignos de las gónadas masculinas, que hace necesario un correcto diagnóstico y tratamiento quirúrgico. En este artículo se describen dos casos de síndrome de insensibilidad a los andrógenos, con su estudio clínico-genético y tratamiento, así como su seguimiento (AU)
Androgen insensitivity syndrome is characterized by the presence of external female phenotype, 46,XY karyotype and intraabdominal testes. This syndrome is the third most frequent cause of primary amenorrhea, after gonadal dysgenesis and congenital absence of the vagina (Mayer-Rokitansky-Küster-Hauser syndrome). Androgen insensitivity syndrome is of interest due to its role in sexual identification and its possible association with malignant tumors of the male gonads, which require an accurate diagnosis and surgical treatment. We present two cases of androgen insensitivity syndrome. The results of the clinical and genetic examinations, as well as the treatment and follow-up of these two patients, are discussed (AU)
