Mola hidatiforme parcial en gestante de 17 semanas con preeclampsia / Partial hydatiform mole at 17 weeks’ gestation in a woman with preeclampsia

Objetivo. Presentar un caso de mola hidatiforme parcial (MHP) que comienza con un cuadro de preeclampsia a las 17 semanas de gestación, y revisar los datos relativos al diagnóstico y manejo de esta patología. Caso clínico. Paciente que ingresa por cuadro grave de preeclampsia. El estudio ecográfico y citogenético ponen de manifiesto una MHP. Se realiza evacuación uterina por vía abdominal y seguimiento posterior de la paciente hasta la resolución del proceso. Discusión. La MHP suele manifestarse por metrorragia del primer trimestre; no suelen identificarse anomalías fetales específicas aunque casi siempre existe un crecimiento fetal retardado. Raramente comienza con un cuadro de preeclampsia de aparición precoz, como en el caso que se presenta. Su diagnóstico prenatal se basa en la ecografía, determinaciones seriadas de HCG y cariotipo fetal, si bien el diagnóstico de certeza es histológico. Es considerada una enfermedad localizada que normalmente se resuelve con la evacuación uterina, sin embargo en algunos casos da lugar a una enfermedad trofoblástica persistente. Conclusión. El diagnostico de la MHP debe ser tenido en cuenta en los cuadros de preeclampsia que comienzan precozmente (AU)

Objectives. To report a case of partial hydatidiform mole presenting as preeclampsia at 17 weeks of gestation and to review the data on the diagnosis and management of this entity. Case Rrport. The patient was admitted for severe preeclampsia. Ultrasound and cytogenetic studies revealed a partial hydatiform mole. Abdominal uterine evacuation was performed and the patient was monitored until the process resolved. Discussion. Partial hydatiform mole usually manifests as first-trimester metrorrhagia. This entity is not generally associated with specific fetal anomalies, but retarded fetal growth is almost always present. These moles rarely present with a picture of early-onset preeclampsia, as in the present case. Diagnosis is based on ultrasound, human chorionic gonadotropin (HCG) measurements and fetal karyotype, although the definitive diagnosis is histological. Partial hydatiform mole is considered a localized disease that usually resolves with uterine evacuation. However, in some patients, there can be persistent trophoblastic disease. Conclusion. Diagnosis of partial hydatiform mole should be taken into account in patients with early onset preeclampsia (AU)

Edema vulvar masivo en preeclampsia severa / Massive vulvar edema in severe preeclampsia

Presentamos el caso clínico de una gestante, diabética pregestacional, que en la semana 22 de gestación presenta una preeclampsia severa con edema masivo agudo de la vulva y un edema agudo de pulmón. Se realiza una revisión bibliográfica, mediante búsqueda informática, en el sistema de Medline, de los trabajos publicados relacionados.El edema vulvar agudo en una gestante puede ser predictor de graves complicaciones, lo que nos obliga a una vigilancia intensa. En nuestra paciente se tuvo que terminar la gestación mediante cesárea en la semana 26, debido a las graves complicaciones maternas

We report the case of a pregnant woman with pregestational diabetes who developed severe preeclampsia in week 22 of pregnancy culminating in acute massive edema of the vulva and acute edema of the lung. A Medline search was performed to identify published studies related to this topic. Acute vulvar edema in pregnancy can be predictive of serious complications and consequently intense monitoring is mandatory. In our patient, Cesarean delivery was performed at week 26, due to serious maternal complications

Two sets of monozygotic twins after intracytoplasmic sperm injection and transfer of two embryos on day 2.

OBJECTIVE: To report a case of quadruple gestation (two sets of monozygotic twins) after intracytoplasmic sperm injection (ICSI) and transfer of two embryos. DESIGN: Case report. SETTING: Tertiary clinical and academic medical center. PATIENT(S): Thirty-four-year-old patient who underwent an ICSI cycle. INTERVENTION(S): After 7 years of primary sterility for andrologic subfertility, the patient underwent an ICSI cycle, with transfer of two embryos on day 2. MAIN OUTCOME MEASURE(S): Transvaginal sonogram performed at the 36th day of gestational age showed a quadruple gestation (dichorionic-quadramniotic). RESULT(S): After receiving extensive counseling, the couple decided to proceed to a nonselective reduction of a set of monozygotic twins. Final outcome was complete loss of pregnancy. CONCLUSION(S): Several factors have been involved in the etiopathogenesis of monozygotic twins in assisted reproductive technology: maternal age, extended embryo culture and in vitro culture condition, blastocyst-stage transfer, ICSI, and assisted hatching. One of the most important objectives in assisted reproductive technology is to reduce the multiple-gestation rate; therefore, it is necessary to determine the optimum number of embryos to be transferred in each case. In addition, couples must be informed that monozygotic-twin pregnancies could be an important complication in IVF-ICSI cycles.