Insuficiencia cardiaca aguda secundaria a estenosis mitral reumática durante el puerperio / Puerperal acute heart failure secondary to mitral stenosis. Case report / Insuficiência cardíaca aguda secundária à estenose mitral reumática durante puerpério

Resumen: Las cardiopatías complican 4% de los embarazos y 60% son por valvulopatías reumáticas; la más común es la estenosis mitral. Por esta razón, reportamos el caso de una puérpera en apariencia sana con embarazo normoevolutivo que debutó con falla cardiaca derecha. Se integró el diagnóstico de estenosis mitral grave por enfermedad reumática, la cual se estabilizó de manera precoz para realizar de forma externa corrección quirúrgica. Aunque en la actualidad la prevalencia de enfermedades reumáticas ha disminuido, la estenosis mitral sigue siendo la valvulopatía más común en las embarazadas y es una entidad potencialmente mortal si no se lleva el control adecuado.

Abstract: Heart disease complicates 4% of pregnancies, and rheumatic valve diseases make up 60% of these cases. The most common one is mitral stenosis. We present the case of a healthy puerperal woman with a non-complicated pregnancy who begin with pulmonary edema and acute heart failure. She was diagnosed with severe mitral stenosis with rheumatoid etiology, which was stabilized for external surgical correction. Although the prevalence of rheumatoid diseases has decreased, mitral stenosis remains the most common valve disease in pregnant women and is life-threatening without proper control.

Resumo: As cardiopatias complicam 4% das gestações e 60% são decorrentes de valvopatias reumáticas, sendo a mais comum a estenose mitral. Por esse motivo, relatamos o caso de uma puérpera aparentemente saudável com gestação normoevolutiva, que debutou com insuficiência cardíaca direita, integrando o diagnóstico de estenose mitral grave por doença reumática, que se estabilizou precocemente para realizar correção cirúrgica externa. Embora atualmente a prevalência de doenças reumáticas tenha diminuído, a estenose mitral ainda é a doença valvular mais comum em mulheres grávidas e é uma entidade potencialmente fatal se não for adequadamente controlada.

Embarazo ectópico intersticial asociado a técnicas de reproducción asistida y ligadura tubaria bilateral. Reporte de caso / Interstitial Pregnancy associated to assisted reproductive techniques. Case report

Antecedentes: Sólo 2,4% de los embarazos ectópicos se desarrollan en la región intersticial de la trompa, la cual tiene un diámetro de 0,7 mm y 1-2 cm de largo, su ubicación anatómica causa que el embarazo ectópico se diagnostique tardíamente, y como se encuentra en la rama ascendente de la arteria uterina, predispone un riesgo de hemorragia, asociado a una tasa de mortalidad de 5,2%, en contraste con otras variedades de embarazo ectópico tubario. Descripción del caso: Presentamos el caso clínico de una paciente de 32 años con infertilidad primaria de 5 años de evolución, con antecedentes de endometriosis severa. La paciente fue tratada con fertilización in vitro después de la supresión hipofisaria con acetato de leuprolide, hiperestimulación ovárica controlada con FSH recombinante, captura de 8 ovocitos con adecuada fertilización, transferencia embrionaria (2 embriones); treinta y dos días después de la transferencia de embriones, en el examen ecográfico se reporta: saco gestacional de 18 mm, embrión de 8,2 mm y masa heterogénea anexial izquierda de 16x15 mm. Se le realiza salpingectomia en porción cornual por laparoscopia y estudio histopatológico que reporta embarazo ectópico. La paciente cursó postoperatorio normoevolutivo y sin complicaciones. Conclusiones: el embarazo ectópico es una complicación de las técnicas de reproducción asistida y el embarazo intersticial es una forma rara de embarazo tubario que implica un reto diagnóstico y es potencialmente mortal por el riesgo de hemorragia masiva, la evidencia de un embarazo intersticial merece una intervención rápida para evitar situaciones que amenacen la vida (AU)

2.4 % of ectopic pregnancies develop in the interstitial region of the tube. It has a diameter of 0.7 mm and 1.2 cm length, anatomic location causes a late diagnosed, it’s in the ascending branch of the uterine artery predisponding a risk of hemorrhage, has a mortality rate of 5.2%, in contrast to traditional tubal pregnancy. Case Report: Patient is 32 years with primary infertility of 5 years of evolution, history of severe endometriosis she was treated in vitro fertilization after pituitary suppression with leuprolide acetate. For ovarian hyperstimulation was used recombinant FSH. Were captured 8 eggs, which were suitable for fertilization All fertilized eggs. Pre-embryos were transferred at stage 2 11 C 2 + and blastocyst. Thirty-two days after embryo transfer, ultrasonographic examination is performed where 18-mm gestational sac, embryo of 8.2 mm and heterogeneous left adnexal mass of 16x15 mm. Were admitted for diagnostic and operative laparoscopy, the laparoscopic procedure was performed with 30 degree angle with the tripolar energy use for coagulation and exeresis of the uterine horn. The histopathologic result was left cornual pregnancy. The patient developed normally in early postoperative period, and leaving the next day in proper clinical status. Conclusion: ectopic pregnancy is a complication of assisted reproduction techniques and interstitial pregnancy is a rare form of tubal pregnancy involving a diagnostic challenge and is life-threatening because of the risk of massive bleeding , evidence of an interstitial pregnancy deserves a quick intervention avoid life-threatening situations (AU)

[Atipical uremic hemolityc syndrome in pregnancy]. / Síndrome urémico hemolítico atípico en el embarazo.

Atypical haemolytic uraemic syndrome is one of the main variants of thrombotic microangiopathy, and is characterized by excessive complement activation in the microvasculature. It is also characterised by the clinical triad; non-immune haemolytic anaemia, thrombocytopenia, and acute renal failure. In addition, 60% of patients have mutations in the genes encoding complement regulators (factor H, factor I, membrane cofactor proteins, and thrombomodulin), activators (factor B and C3), as well as autoantibodies against factor H. Multiple factors are required for the disease to manifest itself, including a trigger and gene mutations with adequate penetration. Being one of the differential diagnoses of preeclampsia- eclampsia and HELLP syndrome means that the clinician must be familiar with the disease due to its high mortality, which can be modified with early diagnosis and comprehensive treatment.

[Ovarian ectopic pregnancy with little common clinical presentation. A case report and bibliographical review]. / Embarazo ectópico ovárico con presentación clínica poco común. Reporte de caso y revisión de la bibliografía.

UNLABELLED: Ovarian ectopic pregnancy is only 3% of all ectopic, with an incidence of 1:7,000-40,000. In the last 10 years, it has been a rise in incidence. Most patients have vaginal bleeding, abdominal pain and shock data. Less than 300-400 cases are reported in the literature. CASE: We present the case of a woman with ovarian ectopic pregnancy of 12 weeks of gestation, who have not suggestive clinical signs and whose diagnosis was incidental despite having a regular prenatal ultrasound. CONCLUSION: Ovarian pregnancy is a rare presentation; diagnosis is difficult and often suggested by clinical data, when clinical data fail, more studies are needed to integrate the diagnosis.