Retrospective Study of First Trimester Metrorrhagia: Pregnancy Follow-Up and Relationship with the Appearance of Gestational Complications.

Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. Materials and Methods: We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. Results: The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). Conclusions: Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.

Diagnosis and gestational follow-up in a patient with Herlyn-Werner-Wünderlich syndrome, a case report.

OBJECTIVE: Herlyn-Werner-Wünderlich syndrome (HWW) is a rare congenital malformation of the urogenital tract due to a fusion failure in the Müllerian ducts. This anomaly consists of a didelphus uterus with obstructed hemivagina and sometimes associated with ipsilateral renal agenesis. The treatment of choice is surgical, it consists of a simple procedure of resection of the vaginal septum and drainage of the obstructed hemivagina and retained collections. CASE REPORT: We report the case of a pregnancy in a 37-year-old woman with SHWW without resection of the vaginal septum. CONCLUSIONS: The early detection is important due to the possible associated complications. Women with uterine defects are subject to an increased risk of complications in pregnancy and childbirth. Therefore, each case must be treated individually.

[Results following an action protocol in patients with severe pelvic inflammatory disease]. / Resultados tras un protocolo de actuación en pacientes con diagnóstico de enfermedad inflamatoria pélvica grave.

BACKGROUND: Pelvic inflammatory disease is manifested by a broad spectrum of genital tract infections that include: endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. This disease is associated with evidence of inflammation of the lower genital tract. OBJECTIVE: To evaluate the subgroup of patients with a diagnosis of acute pelvic inflammatory disease requiring hospitalization after implementation of the protocol for action in the patient with suspected pelvic inflammatory disease. MATERIAL AND METHODS: Retrospective analysis conducted between January and December 2011 in a cohort of patients diagnosed with severe pelvic inflammatory disease after implementation of a hospital protocol for suspected patients with this condition. Patients who met the diagnostic criteria of Centers for Disease Control and Prevention (CDC) and required hospitalization were considered with severe pelvic inflammatory disease. In all cases the same complementary tests were conducted and the same antibiotic protocol was prescribed. RESULTS: We included 38 patients and found a statistically significant relationship between the IUD and mixed gram-negative flora etiologic agent (p < 0.05). There was a negative correlation (Pearson correlation coefficient -0.334) between elevated leukocyte at the time of admission and the need for surgery. CONCLUSIONS: In cases of severe pelvic inflammatory disease IUD is associated with gram-negative mixed flora infection. The normal or moderately elevated concentrations of leukocytes were correlated with failure of medical treatment.

El himen imperforado como urgencia en ginecología. Caso clínico y revisión de la literatura / Imperforate hymen as a gynecological emergency: case report and literature review

El himen imperforado se presenta en aproximadamente una de cada 2.000 mujeres. Es la causa congénita más común de obstrucción del flujo genital y, por lo general, no suele presentar síntomas hasta la pubertad. Presentamos el caso de una adolescente de 13 años que acudió a nuestro servicio de urgencias refiriendo dolor abdominal y metrorragia. La exploración física reveló un himen íntegro y abombado por el que empezaba a drenar sangre oscura. La ecografía transabdominal era sugestiva de hematocolpos y hematometra. La paciente recibió tratamiento quirúrgico y la evolución postoperatoria fue favorable (AU)

Imperforate hymen occurs in approximately 1 out of every 2000 females. This entity is the most common congenital cause of genital outflow obstruction and does not usually cause symptoms until puberty. We present the case of a 13-year-old girl who attended the emergency department complaining of abdominal pain and metrorrhagia. Physical examination revealed an imperforate and bulging hymen beginning to drain dark blood. Transabdominal ultrasonography was suggestive of hematocolpos and hematometra. The patient was treated surgically and the postoperative outcome was favorable (AU)

Luteoma estromal ovárico como causa de virilización en la mujer posmenopáusica / Ovarian stromal luteoma as a cause of postmenopausal virilization

Objetivo. Se presenta el caso de una paciente diagnosticada luteoma estromal de ovario con efecto virilizante. Material y métodos. Mujer de 67 años que presenta cuadro de virilización. A pesar de que no fue posible detectar mediante pruebas de imagen ningún tumor productor de andrógenos, se decidió someter a la paciente a una histerectomía y doble anexectomía debido a la fuerte sospecha clínica y analítica de un tumor productor de andrógenos de origen ovárico. Resultados. El estudio anatomopatológico de la pieza quirúrgica demostró la presencia de un luteoma estromal de ovario como causa del cuadro de virilización que presentaba la paciente. Conclusiones. El luteoma estromal de ovario es una rara neoplasia ovárica que se presenta habitualmente en mujeres posmenopáusicas y puede comenzar con síntomas virilizantes o derivados de un ambiente hiperestrogénico. En un 20% de los casos, se diagnostica como un hallazgo incidental (AU)

Objective. We report the case of a patient diagnosed with a stromal luteoma of the ovary with a virilizing effect. Material and methods. A 67-year-old woman presented with symptoms of virilization. Although no androgen-producing tumor was detected on imaging tests, the patient underwent hysterectomy and double oophorectomy due to strong clinical and laboratory suspicion of an androgen-producing tumor of the ovary. Results. Pathologic study of the surgical specimen showed the presence of an ovarian stromal luteoma causing the patient's virilization. Conclusions. Ovarian stromal luteoma is a rare ovarian neoplasm that usually occurs in postmenopausal women and may present as virilization or hyperestrogenism. In 20% of cases, the diagnosis is incidental (AU)

Hemorragia fetomaterna masiva con patrón cardiotocográfico sinusoidal: presentación de un caso y revisión de la literatura / Massive fetomaternal hemorrhage with cardiotocographic sinusoidal rhythm: a case presentation and literature review

Introducción: la transfusión fetomaterna masiva (TFM) es una entidad con una elevada morbilidad y mortalidad fetal, suele cursar con una disminución en la percepción de los movimientos fetales por parte de la madre, y la presencia de un patrón cardiotocográfico sinusoidal fetal, asociado a la anemia fetal. No obstante, ambas situaciones tienen muy baja especificidad. Se presenta un caso clínico con el objetivo de revisar la exactitud del patrón sinusoidal en el diagnóstico de anemia fetal. Materiales y metodos: se presenta el caso de una gestante de 36 semanas que fue atendida en el Hospital Universitario La Paz (complejo hospitalario de tercer nivel que forma parte del conjunto de hospitales públicos en España), en la que tras presentarse un patrón cardiotocográfico no tranquilizador, se realizó una inducción del parto en el que las pruebas habituales de bienestar fetal resultaron insuficientes para el diagnóstico de sufrimiento fetal. Tras un parto eutócico se comprobó la presencia de una anemia neonatal grave, comprobándose la presencia de un gran volumen de sangre fetal en la sangre materna mediante el test de Kleihauer Betke. Se hace una revisión de los artículos publicados en los últimos 10 años en las base de datos Medline vía PubMed, en español e inglés.Conclusión: la monitorización fetal intraparto podría ser útil en el diagnóstico de la hemorragia fetomaterna masiva, aunque se deben hacer estudios más amplios para determinar la exactitud diagnóstica...

Introduction: massive fetomaternal transfusion (MFT) is an entity having high fetal morbidity and mortality; it usually involves the mother’s reduced perception of fetal movements and the presence of a cardiotocographic fetal sinusoidal rhythm, associated with fetal anemia. However, both situations have very low specificity. A clinical case is presented here to arouse interest in reviewing the precision of the sinusoidal rhythm when diagnosing fetal anemia. Materials and methods: the case of a 36-weeks pregnant mother is presented; she attended La Paz teaching hospital (a third-level hospital forming part of the Spanish public hospital system). After presenting a non-reassuring cardiotocographic heart rate pattern, birth was induced in which the usual fetal wellbeing tests proved insufficient for diagnosing fetal suffering. The presence of serious neonatal anemia was shown following a eutocic delivery, the Kleihauer-Betke test proving the presence of a large volume of fetal blood in the mother’s blood. Articles published in both Spanish and English during the last 10 years in the Medline database were reviewed via PubMed. Conclusion: intradelivery fetal monitoring could be useful in diagnosing massive fetal-maternal hemorrhage, even though broader studies should be carried out for determining diagnostic precision...