[Gynecologic laparoscopy at the ABC Hospital. Analysis of 882 cases]. / "Laparoscopia ginecológica en el Hospital ABC. Análisis de 882 casos".

The objective was to evaluate the indications and clinical evolution of patients treated with laparoscopy. Eight hundred eighty two women undergoing conventional laparoscopy for gynecological pathology, patients were not preselected, preoperative and postoperative data were registered retrospectively. Main indications to perform laparoscopy were dismenorrhea and infertility. Endometriosis and pelvic adhesions were the most frequent findings detected in the study subjects. Endoscopic treatment resulted in minimal complications and short postoperative stay. As conclusion classic laparoscopy is a safe and efficacious technique for treatment gynecological pathology.

[Conservative laparoscopic treatment of bilateral ectopic pregnancy. 2 case reports and review of the literature]. / Tratamiento laparoscópico conservador del embarazo ectópico bilateral. Informe de dos casos y revisión de la literatura.

Ectopic pregnancy is a frequent clinic entity, with an incidence from 4.5 to 16.8 for 1000 pregnancies. The frequency of ectopic pregnancy has been triplicated in the last years, mainly owed to increase of sexual transmitted diseases, increase in salpinges' surgery and in assisted reproductive medicine. The ectopic pregnancy is also the most frequency cause of maternal death during the first trimester of pregnancy. The frequency of bilateral tubal ectopic pregnancy is extremely rare, it is reported from 1:125 to 1:1580 of all ectopic pregnancies. The first case of bilateral tubal ectopic pregnancy was reported n 1918 by Bledsoe. In Mexico, Molina described the first case in 1993, with conservative laparoscopic treatment. Two clinic cases are presented of bilateral ectopic pregnancy, treated conservatively by laparoscopy. The first one with background of sterility because of anovulation, receiving treatment with menotropins for ovarian hyperstimulation, the other one. In the second case, was a spontaneous pregnancy, in a patient with a history of several pelvic surgeries. In this case a bilateral salpingostomy was realized. In both cases was demonstrated chorionic villi by histopathology. These cases are a model of nature to evaluate the real utility of several diagnostic and therapeutic methods which are available nowadays for the treatment of ectopic pregnancy.

[Recurrent fetal death and antiphospholipid antibody syndrome. A case report]. / Muerte fetal repetida y síndrome de anticuerpos antifosfolípidos. Presentación de un caso.

Antiphospholipid Antibodies has been associated with severe maternal and fetal sequels, like recurrent miscarriage, death, intrauterine growth retardation, pregnancy-induced hypertensive disease, thromboembolic phenomena and thrombocytopenia. Pathogenesis has been explained reporting that IgG from women with antiphospholipid antibodies increases placenta thromboxane production without affecting prostacyclin production, which conducts to thrombosis of placenta uterus junction. In 1982, it was suggested for the first time low doses of aspirin and prednisone for treatment of recurrent fetal death associated to this syndrome, heparin therapy was reported in 1984, recommended a doses of 15,000 U/day during first pregnancy trimester and 20,000 U/day posteriorly. The objective of this report, is the description a clinic case of a patient with recurrent fetal death and antiphospholipid antibodies syndrome, discussing a prenatal and obstetric treatment model, including diagnosis and final therapeutic, which includes the participation of some other specialists, the national experience in diagnosis and treatment is initial, and also because it has been reported a rate of fetal death in those patient with no treatment, almost of 90%. The importance of identify this syndrome is not based on its prevalence but on its maternal complications and that it is a cause of fetal death potentially treatable.

[HELLP syndrome. Severe consequence of hypertensive disease induced by pregnancy]. / Síndrome de HELLP. Consecuencia severa de enfermedad hipertensiva inducida por el embarazo.

A descriptive, transversal retrospective study was performed, to determine the prevalence of HELLP syndrome among patients with Pregnancy-Induced Hypertension (PIH), who were admitted into the Gynecology and Obstetrics Service the American British Cowdray Hospital in Mexico City, since July 1992 to June 1995. We detected a total or 11 patients who had the diagnostic parameters proposed by Sibaí, those were 11.8% of all the patients with PIH. The medial gestational age was 33 weeks (range from 30 to 39) The mean tensional levels were 170/ 107 mm Hg, in base of platelet count, nine patients were classified as Class I (82%) and two in Class II (18%), the medial peak levels of transaminases and bilirubins was reached 40 hours and that of lactic deshidrogenase 60 hours after the diagnosis was established, while the minimum levels of hematocrit and platelets were at 48 and 57 respectively. The mean weight of the neonates was 1,655 g, the maternal mortality rate was 9% and the perinatal 8.3%, the diagnosis of HELLP syndrome was established before delivery in 40% of the cases and after that in 60%, puerperal HELLP may occur more frequently that is believed. Point out the importance of early detection of this clinic entity in order to establish an opportune and efficient treatment which improves maternal and fetal prognosis.

[Laparoscopic treatment of dermoid cyst. First report in Mexico]. / Tratamiento laparoscópico de quiste dermoide. Primer informe en México.

The laparoscopic treatment of adnexal masses has been controversial; however, the study of the case with the judicious use of the laboratory and ultrasound permit the laparoscopic approach of the most of the adnexal masses, including the dermoid cyst or mature cystic teratomas, and offer to the patient the benefits of the laparoscopic surgery with low morbidity. However, it should be do it in medical centers with the human and technics recourse need it for the performance. It present the first report in Mexico of laparoscopic treatment in contrast with a group of patients with laparotomy. The results of this study, are in conformity with the reports on the literature and suggest the initial laparoscopic approach of the dermoid cyst.

[HELLP syndrome. Critical state. Current concepts]. / Síndrome de HELLP. Estado crítico real. Conceptos actuales.

The HELLP syndrome is an English acronym, for describing patients with Pregnancy Induced Hypertension (PIH), who also has hemolysis, elevated hepatic enzymes and low platelets, its presence is associated with a frequency of maternal mortality from 5 to 25% and when it is associated with hepatic rupture it increases to 35% and a perinatal one from 30 to 60%. It is present in 2 to 12% among women with PIH. Its etiology has not been elucidated completely, the base of its pathophysiology is an unbalance in prostanoid metabolism which conduces to generalize vasopasm with the subsequent endothelial damage and platelets activation. Sibaí describes the diagnostic parameters of the syndrome. Its initial treatment is the hemodinamic stabilization of the maternal status and the evaluation of fetal well-being for decide whether immediate delivery is indicated. HELLP appears in the puerperium in 30% of the cases. There are both maternal and perinatal severe complications, and a recurrence risk of a 4 to 27%. We emphasize the importance of early detection of the syndrome which improves maternal-fetal prognosis.

[HELLP syndrome as manifestation of pre-eclampsia decompensation during puerperium. 2 case reports]. / Síndrome de Hellp como manifestación de descompensación de la preeclampsia durante el puerperio. Presentación de dos casos.

Two extreme cases of pregnancy-induced hypertension with puerperal HELLP syndrome are presented and the literature is review. HELLP is an English acronym, for describing the preeclamptic or eclamptic patient, who also has hemolysis, elevated hepatic enzymes and low platelets. Its etiology has not been elucidated, but it has been accepted the theory of dysequilibrium in prostanoid metabolism. It has an incidence of 5 to 15% among patients with pregnancy-induced hypertension. Maternal mortality is about 10 to 28% and neonatal of 40%. Owing to fatal complications, treatment consist of interrupting pregnancy. Point out the importance of early detection of this clinic entity, which improves maternal-fetal prognosis.

[Endometriosis. Analysis of laparoscopic findings at the A.B.C. (American-British Cowdray) Hospital]. / Endometriosis. Análisis del hallazgo laparoscópico en el Hospital A.B.C.

Endometriosis approximately affects 10 to 15% of premenopausic women. Diagnosis mainly is made by laparoscopy. We revised all the laparoscopies which were made in labor service at the American British Cowdray Hospital from July 1st 1989 to June 30th 1994 in order to evaluate the incidence of endometriosis in the institution. They were made from 882 laparoscopies done, in 447 cases (50.68%) endometriosis was the main finding, this was similar to the reports published by other authors. The group of age mainly affected was from 20 to 29 years-old. Sterility was found in 53% of these patients, slightly above the results in other series. The 85% of the cases were in hospital for less than 24 hours. Complications were in 7% of them, none required a laparotomy, however.

[Ehlers-Danlos syndrome in pregnancy. Report of a case and review of the literature]. / Síndrome de Ehlers Danlos y embarazo. Presentación de un caso y revisión de la literatura.

The Ehlers Danlos Syndrome is a hereditary alteration of connective tissue, characterized by hyperelastic joints, tissues, and skin. The papers about the obstetric and gynecological aspects of Ehlers Danlos syndrome is mostly anecdotical and much has not originated from obstetricians and gynecologists. The complications are important for the feto-material binomial. The case presented here is related with a 39.1 of gestation associated with Ehlers Danlos syndrome, and a description of antenatal period, labor and delivery is done. Literature revision and possible relation with obstetrical care and pregnancy resolution in commented.

[Perinatal impact of multiple pregnancy at the ABC Hospital]. / Impacto perinatal del embarazo múltiple en el Hospital ABC.

Multiple pregnancy is a special event that requires a particular care because of maternal morbi-mortality, as well as fetal one, which is increased. The incidence of this event at the ABC Hospital is similar to what is reported in the literature; there is maternal morbidity and fetal morbi-mortality very low, mainly in products older than 32 weeks of gestation. Early diagnosis as well as the adequate prenatal control and pregnancy resolution by cesarean section, diminish maternal and fetal complications. Neonatal Care Unit is necessary for a better product surveillance.