ABSTRACT
BACKGROUND: Pulmonary embolism is a serious and sometimes mortal complication of pregnant and puerperal women. Pulmonary embolism diagnosis can be difficult. In Mexico, it causes between 2.5 and 16% of maternal mortality. OBJECTIVES: To estimate the incidence of pulmonary embolism, to identify most frequently risk factors that contribute to the presence of pulmonary embolism as an obstetrical complication and to determine clinical characteristics and specific diagnostic tests in hospitalized patients at the Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social. MATERIAL AND METHODS: We conducted a cross-sectional study from January 1st 1997 to December 31st, 2002. We identified 30 patients with pulmonary embolism confirmed by ventilation-perfusion scan. RESULTS: Incidence of 4.7 cases per 10,000 pregnancies was found. Most frequently, risk factors were varicose veins in lower extremities (0.045), previous thromboembolic event (0.030) and pre-eclampsia/eclampsia (0.05). Cesarean section was present in 85% of the cases with pulmonary embolism during puerperium. The most common clinical findings were: dyspnea (100%), chest pain (63%), tachycardia (93%) and tachypnea (93%). Sinus tachycardia (93%) and S1 Q3 T3 were the electrocardiogram findings most commonly observed. 83% of the patients showed abnormalities in chest radiography. 100% presented altered blood values. Mortality rate was of 6.6%. CONCLUSION: Diagnosis of pulmonary embolism should be based on risk factors and clinical findings. Basic laboratory and scan are essential. Early diagnosis and treatment significantly reduce mortality rates.
Subject(s)
Pregnancy Complications, Cardiovascular/epidemiology , Pulmonary Embolism/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Incidence , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pulmonary Embolism/diagnosis , Risk FactorsABSTRACT
Se presenta un estudio retrospectivo realizado en la unidad de cuidados intensivos del nuevo Hospital Civil de Guadalajara con paciente que desarrolló preeclampsia severa y síndrome HELLP, 70 pacientes de las cuales 30 desarrollaron insuficiencia renal aguda, de éstas 25 fueron catalogadas como necrosis tubular aguda y cinco con necrosis cortical bilateral. Todas las pacientes (30) con insuficiencia renal aguda presentaron hipertensión arterial severa, además de depleción de volumen plasmático circulante con un promedio de PVC de 6 cm de agua (en 20 pacientes), los promedios de urea de 64.2 mg/dl y creatinina 4.2 mg/dl. Seis pacientes del grupo fallecieron, tres por hemorragia cerebral, dos choque hipovolémico y una paciente por falla multisistémica. La causa del desarrollo de insuficiencia renal aguda se debe a disminución del volumen circulante, endoteliosis glomerular y vasoconstricción severa
