[Amniotic fluid embolism]. / Embolia de líquido amniótico.

The amniotic fluid embolism continues to be an unusual, but catastrophic situation, with high mortality. With a complex pathophysiology, it leads to cardiovascular collapse and disseminated intravascular coagulation. The immediate cardiopulmonary resuscitation and monitoring in an Intensive Care Unit with a multidisciplinary team are essential aspects in the management of this situation.

Intravaginal glyceryl trinitrate and dinoprostone for cervical ripening and induction of labor.

OBJECTIVE: This study was undertaken to evaluate the efficacy and safety of intravaginal administration of glyceryl trinitrate plus dinoprostone versus dinoprostone, for cervical ripening and induction of labor. STUDY DESIGN: A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted among 196 singleton low-risk nullipara women with term pregnancies and unfavorable cervices who were randomly assigned to receive intravaginal glyceryl trinitrate plus dinoprostone or placebo plus dinoprostone. The main outcome variables were time from application to active phase of labor and to delivery. Secondary outcomes were change in Bishop score, fetal and maternal morbidity, and incidence of cesarean deliveries. RESULTS: The interval from application of the initial dose to the beginning of active phase of labor was 868 +/- 582 and 1136 +/- 692 minutes (P = .004) and from initial dose to delivery was 1339 +/- 826 and 1620 +/- 975 minutes (P = .03) for the glyceryl trinitrate and placebo groups, respectively. There were no significant differences in Bishop score change, cesarean section rate, and in the incidence of hypersystole and hyperstimulation. The incidence of tachysystole was significantly lower in the glyceryl trinitrate group (4% vs 15%, P < or = .02). No maternal and neonatal adverse effects were noted. CONCLUSION: The association of glyceryl trinitrate with dinoprostone is more effective than dinoprostone alone for labor induction in low-risk patients at term with unfavorable cervices.

[Corticosteroid therapy for patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)]. / Corticoterapia na Síndrome de HELLP (hemólise, enzimas hepáticos elevados e trombocitopenia).

OBJECTIVE: To evaluate the influence of the therapy with high-dose corticoids on the clinical and laboratory evolution of HELLP syndrome. STUDY DESIGN: We reviewed all the cases of pregnancy complicated with HELLP, admitted to the Garcia de Orta Hospital from 1993 to 2000. We compared the patients without corticosteroid therapy or with a standard corticosteroid regimen for promotion of fetal lung maturation--group 1, with the patients who received dexamethasone (10 mg intramuscular every 12 hours)--group 2. RESULTS: Out of 48 patients, 13 were included on group 1 and 35 on group 2. The time from admission to delivery was longer for the group on dexamethasone (3.7+/-4.5 days) compared to the group without (1.8+/-2.4). There was a significant improvement in the symptom of epigastric pain (P<0.05) and in the laboratory findings--platelets (P<0.000), liver enzymes (P<0.000) and lactic dehydrogenase (P<0.001), in the dexamethasone group. The number of caesarean deliverys was similar on both groups (group 1--46% and group 2--48%). The use of regional anesthetic techniques for delivery, was higher on group 2--66% (23 of 35) compared with group 1--15% (2 of 13), P=0.006. There was no significant difference in the maternal morbidity or number of blood transfusions. Perinatal mortality was associated with prematurity, and similar in the two groups. CONCLUSIONS: This study confirms the positive influence of the high-dose corticosteroid therapy on HELLP syndrome.

Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony.

OBJECTIVE: To demonstrate the usefulness of a new method of applying compressive sutures to treat postpartum bleeding secondary to uterine atony. METHODS: Multiple sutures were applied longitudinally and transversally around the uterus of 7 women with postpartum uterine atony and postpartum bleeding. RESULTS: The procedure was successful in all cases. CONCLUSION: Compressive sutures of the uterus were effective in treating uterine atony with postpartum bleeding. LEVEL OF EVIDENCE: III.

[Burch colposuspension]. / Colpopexia de burch.

OBJECTIVE: This study was undertaken to evaluate the subjective success rates, and complications, of Burch colposuspension. DESIGN: A retrospective review. SAMPLE: Fortynine women undergoing surgery - Burch colposuspension - for genuine stress incontinence, between 1994 and 2000, were reviewed. METHODS: Choice of surgical procedure was made on the basis of clinical and urodynamic findings and physician preference. The subjective cure rate was determined by means of historical report and defined as no or occasional stress or urge incontinence (< one episode per week). Clinical follow-up started six weeks after the surgical procedure and continued for one to seven years. RESULTS: Thirty-six (73.5%) of the 49 women submitted to Burch colposuspension were subjectively cured of the stress urinary incontinence and three (6,1%) had improvement with mainly urge incontinence, while ten (19.2%) operations failed (n= 52). CONCLUSION: Burch colposuspension is an effective and safe procedure for women with urinary stress incontinence (even after retropubic continence surgery).