ABSTRACT
Post-partum haemorrhage (PPH) is a major cause of maternal mortality, according to the WHO. Early PPH occurs in 5% to 15% of births. In 80% of cases, uterine atonia is the cause. We describe a case of uterine necrosis following uterine artery embolization (UAE). due to PPH. The patient was a 37-year-old woman who had a normal delivery after her second pregnancy, but experienced haemorrhage due to uterine atonia that failed to respond to drugs. She underwent UAE with Spongostan® with no complications. The peri-partum period was normal. At 16 days, she consulted due to recurrence of fever. Magnetic resonance imaging confirm the diagnosis of uterine necrosis. Abdominal hysterectomy was performed.
Subject(s)
Necrosis , Postpartum Hemorrhage/therapy , Uterine Artery Embolization/adverse effects , Uterus/pathology , Adult , Female , Humans , Hysterectomy , Magnetic Resonance Imaging , Postpartum Hemorrhage/etiology , Pregnancy , Uterine InertiaABSTRACT
Resumen ANTECEDENTES: El parto pretérmino es una causa importante de morbilidad y mortalidad materno-fetal. El pesario cervical es un método eficaz para prevenir el parto pretérmino en pacientes con cuello uterino corto. CASO CLÍNICO: Paciente de 38 años, de 34.3 semanas de embarazo, que acudió a consulta por hidrorrea y dolor abdominal. Entre sus antecedentes ginecoobstétricos refirió la colocación de un pesario de Arabin a partir de la semana 20 del embarazo, por diagnóstico de cuello uterino corto (14 mm). La exploración médica reveló: cuello uterino cerrado y formado, con desgarro de 2 cm en la cara posterior uterina, indicándose cesárea de urgencia. Cinco minutos después tuvo aumento importante de dolor abdominal, objetivándose la cabeza fetal en IV plano de Hodge, por lo que se decidió la asistencia mediante parto en el área quirúrgica. Nació un varón de 2045 g, con Apgar 9/10, que ingresó al área de neonatología. Posteriormente se comprobó el desgarro ístmico-cervical, de aproximadamente 7 cm, con prolongación ascendente medial de 4 cm, que se suturó sin contratiempos. El puerperio inmediato y tardío transcurrieron con normalidad. Un año después del parto la paciente se encuentra en excelente estado de salud. CONCLUSIÓN: La rotura uterina en pacientes con pesario es una complicación extremadamente rara. Hasta la fecha no existe un esquema de tratamiento óptimo. Se prefiere una conducta conservadora, sobre todo si existe deseo reproductivo, e individualizar cada caso.
Abstract BACKGROUND: Preterm delivery is an important cause of maternal-fetal morbimortality. The cervical pessary is an effective method to prevent preterm birth in patients with short cervix. CLINICAL CASE: A 38-year-old patient, 34.3 weeks pregnant, attended the clinic due to hidrhorea and abdominal pain. Among his gynecological and obstetric history he referred to the placement of Arabin pessary from week 20 of pregnancy, by diagnosis of short cervix (14 mm). The medical examination revealed: Cervix closed and formed, with a 2 cm tear in the posterior uterine side, indicating an emergency caesarean section. Five minutes later, there was a significant increase in abdominal pain, with the fetal head being seen in the IV plane of Hodge. Therefore, it was decided to assist with delivery in the surgical area. A newborn male, 2045 g, was obtained with Apgar 9 / 10, who entered the neonatology area. Subsequently, the isthmic-cervical tear, of approximately 7 cm, with a medial ascending extension of 4 cm, which was sutured without incident, was confirmed. The immediate and delayed puerperium proceeded normally. One year after the obstetric event, the patient is in excellent health. CONCLUSIONS: Uterine rupture associated to pessary is an extremely rare complication. To date there is no optimal treatment scheme. A conservative behavior is preferred, especially if there is a reproductive desire, and each case is individualized.
ABSTRACT
Introducción: el síndrome de obstrucción congénita de la vía aérea superior (CHAOS) es una condición infrecuente que consiste en el estrechamiento severo u obstrucción completa de la vía aérea superior, de pronóstico nefasto en ausencia de intervención, y con hallazgos ecográficos característicos que conducirán al diagnóstico. Caso clínico: gestante en semana 20.3 que acude a la ecografía morfológica donde se evidencia pulmones aumentados de tamaño, hiperecongénicos, dilatación del árbol traqueobronquial, aplanamiento diafragmático y compresión cardiaca. Asocia ascitis e hidramnios. Con todo ello, se establece el diagnóstico del síndrome de obstrucción congénita. Discusión: el correcto diagnóstico prenatal del síndrome de obstrucción congénita, con hallazgos ecográficos constantes, es esencial para optimizar el manejo gestacional y planificar el tratamiento. La cesárea EXIT y la cirugía endoscópica se proponen entre las alternativas terapéuticas disponibles en la actualidad. Es imprescindible identificar la causa de la obstrucción, así en algunos casos muy seleccionados, la fetoscopia puede ser curativa. No obstante, la morbilidad y mortalidad en la mayor parte de casos es alta (AU)
Background: Congenital high airway obstruction syndrome is a rare life-threatening condition. It is characterized by severe narrowing or complete obstruction of the upper airway, grim prognosis in absence of intervention, and with characteristic sonographic findings that lead to diagnosis. Clinical case: Pregnant in week 20.3 that goes to the routine ultrasound that demonstrated enlarged echogenic lungs, dilated tracheobronchial tree, flattened diaphragms and cardiac compression. It associates fetal ascites and polyhydramnios. In all, the diagnosis established is congenital high airway. Discussion: The accurate prenatal diagnosis of congenital high airway, with constant sonographic findings, is essential to optimize gestational management and treatment planning. EXIT procedure and endoscopic surgery are proposed among the therapeutic alternatives available today. It is essential to identify the cause of the obstruction, as fetoscopy can be curative in some highly-selected cases. However, morbidity and mortality are high in most cases (AU)
Subject(s)
Humans , Female , Pregnancy , Prenatal Diagnosis/instrumentation , Airway Obstruction/congenital , Cardiac Tamponade/complications , Cardiac Tamponade , Indicators of Morbidity and Mortality , Amniocentesis/methods , Polyhydramnios/diagnosis , Sexual Health , Larynx/abnormalitiesABSTRACT
Fundamento y objetivo: Describir un cuadro clínico poco habitual como es la meningitis puerperal por Streptococcus agalactiae (S. agalactiae). Paciente y método: Presentamos una meningitis puerperal por S. agalactiae, una rara forma de infección en una puérpera sana y con una presentación atípica. Resultados: Se expone ampliamente el caso clínico, así como los procedimientos realizados en el diagnóstico diferencial y su tratamiento. Se compara con los casos de meningitis publicados en la bibliografía, y como en estos, se realiza un diagnóstico precoz y un inicio rápido del tratamiento antibiótico. Conclusión: La meningitis por S. agalactiae es un proceso infrecuente en el período puerperal, que requiere de un diagnóstico y tratamiento precoces, de los cuales dependerá el pronóstico de la paciente (AU)
Background and objective: To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae). Patient and method: We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation. Results: We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment. Conclusion: Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis AU)
Subject(s)
Humans , Female , Streptococcal Infections/diagnosis , Meningitis, Bacterial/diagnosis , Streptococcus agalactiae/pathogenicity , Postpartum Period , Anti-Bacterial Agents/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVE: To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae). PATIENT AND METHOD: We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation. RESULTS: We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment. CONCLUSION: Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis.
Subject(s)
Meningitis, Bacterial/microbiology , Puerperal Disorders/microbiology , Streptococcal Infections/microbiology , Streptococcus agalactiae/isolation & purification , Adult , Amoxicillin/therapeutic use , Ceftriaxone/therapeutic use , Dexamethasone/therapeutic use , Diagnosis, Differential , Early Diagnosis , Female , Humans , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Pregnancy , Puerperal Disorders/diagnosis , Puerperal Disorders/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Vancomycin/therapeutic useABSTRACT
El embarazo ectópico se presenta en el 10-12% de los casos tras una esterilización tubárica y suele localizarse en la trompa. El 1% de los embarazos ectópicos son abdominales y la implantación en el epiplón es una rara entidad (sólo se han descrito 16 casos). Según Studdiford, pueden clasificarse como primarios o secundarios en función de que se originen o no en la cavidad peritoneal. Presentamos el caso de un embarazo abdominal secundario, localizado en el epiplón, en una mujer con esterilización tubárica previa, aspecto no relacionado hasta la fecha en ninguna publicación. Se trata de un embarazo abdominal con origen en un aborto tubárico, puesto que no hay invasión trofoblástica del epiplón y hay restos del mismo tejido en la trompa derecha
The ectopic pregnancy appears in the 10-12% of cases after tubal sterilization and it is usually located in the tube. 1% of ectopic pregnancies are abdominal and the implantation in omentum is a rare condition with only 16 described cases. According to Studdiford, they can be classified as primary or secondary depending on whether they are originated or not in the peritoneal cavity. We present the case of a secondary abdominal pregnancy located in omentum, in a woman with previous tubal sterilization, which has not been described to date; one is an abdominal pregnancy with origin in a tubal abortion, since trofoblastic invasion does not exist in omentum and there are remains of the same tissue in the right tube
