ABSTRACT
En mujeres sintomáticas el embarazo empeora la enfermedad de Fabry, en un tercio de las asintomáticas aparecen entonces los síntomas. Hasta el momento, se han descrito 12 pacientes tratadas con terapia de reemplazo enzimático (TRE) durante el embarazo, sin evidencia de complicaciones asociadas o de compromiso fetal. Los altos niveles de LysoGB3 pueden implicar un mayor depósito de estos en la placenta e inducir un daño en sus vasos con el consiguiente riesgo de preeclampsia. Contrariamente a la práctica actual, la TRE no debe suprimirse. Se ha postulado el uso de hasta 2 mg/kg de peso galactosidasa-beta.(AU)
Pregnancy worsens the symptoms of Fabry's disease, and symptoms are developed in 1/3 of the asymptomatic women. So far, 12 patients treated with enzyme replacement therapy (ERT) during pregnancy have been described, with no evidence of associated complications or foetal compromise. The high levels of LysoGB3 may lead to a greater deposit of these in the placenta and induce vascular disease with the consequent risk of pre-eclampsia. Contrary to current practice, not only should ERT not be suppressed, but the use of up to 2 mg/kg of beta galactosidase weight is even postulated.(AU)
Subject(s)
Humans , Female , Young Adult , Inpatients , Physical Examination , Fabry Disease , Pregnancy , Pelvic Floor , Gynecology , UltrasonographyABSTRACT
Las técnicas de imagen cada vez son más utilizadas dentro de la medicina en general y de la ginecología en particular. La ecografía de suelo pélvico, a diferencia de la aplicación ecográfica en las otras subespecialidades ginecológicas, se encuentra bastante estandarizada y con planos de estudios definidos. Dependiendo del transductor utilizado y del modo de aplicación, se han descrito diferentes métodos ecográficos de valoración del suelo pélvico. De todos estos, el estudio transperineal es el más documentado para el diagnóstico de las disfunciones del suelo pélvico. Por ello, el objetivo de esta revisión es describir el método aplicado para realizar un estudio transperineal 2 D y 3-4D del suelo pélvico, describiendo los planos ecográficos necesarios.(AU)
Imaging techniques are increasingly used within medicine in general, and in gynaecology in particular. Pelvic floor ultrasound, unlike ultrasound application in the other gynaecological subspecialties, is fairly standardised and with defined study plans. Depending on the transducer used, and the mode of application, different ultrasound methods for evaluating the pelvic floor have been described. Of all these methods, the transperineal study is the most documented for the diagnosis of pelvic floor dysfunctions. Therefore, the objective of this review is to describe the method applied to perform a 2 D and 3-4D transperineal study of the pelvic floor, describing the necessary ultrasound planes.(AU)
Subject(s)
Humans , Pelvic Floor , Gynecology , Pelvic Floor/diagnostic imagingABSTRACT
BACKGROUND: The most common cause of anal sphincter injuries in women is vaginal birth. Endo-anal ultrasound is currently used for the diagnosis of anal sphincter defect. However, due to the inconvenience caused, it is not an applicable technique during the immediate post-partum. The aim of this study was to determine whether transperineal ultrasound in 3/4D is a useful diagnostic method for the assessment of anal sphincter during the immediate post-partum. MATERIAL AND METHODS: A prospective study was conducted on the vaginal deliveries performed between September 2012 and June 2013 in the Valme University Hospital (Seville). Obstetric and foetal parameters that could influence the onset of perineal tears were studied. The patients underwent a transperineal 3/4D ultrasound and a multislice study (48hours after birth). RESULTS: The study included 146 puerperal women. The sphincter complex was assessed in all of them during the immediate post-partum. External anal injuries were observed in 10.3% of the cases. In 8.2% of cases, the primary suture of the external anal sphincter was detected during ultrasound examination, and 2.1% of asymptomatic lesions were diagnosed only with post-partum ultrasound. None of the patients reported discomfort or pain. CONCLUSIONS: The 3-dimensional transperineal ultrasound is helpful in determining the primary repair of the anal sphincter during the immediate post-partum, with no discomfort for patients, as well as for establishing those early sphincter injuries that go unnoticed during vaginal delivery.