RESUMO
OBJECTIVES: Genital tract lacerations are responsible for potentially serious postpartum hemorrhage (PPH), and are often underestimated. The objective of this study was to analyze the characteristics of genital tract lacerations associated with severe PPH in a reference center. PATIENTS AND METHODS: All women transferred for treatment of PPH due to genital tract lacerations between January 2008 and April 2011 were included in this observational study. Two populations of patients with genital tract lacerations were defined : patients with "complex" lesions and patients with "simple" genital tract laceration. RESULTS: Forty-four patients were treated for PPH associated with genital tract lacerations. The average age of patients was 30.6 years (17-41 years). All the patients had a vaginal delivery, combined with an instrumental in 70.5% of cases. With the exception of one patient, all patients had a revision of the cervix and vagina before the transport in our Institution. Twenty nine patients (70.7%) had received a suture of genital tract in their maternity. In our Hospital, the patient having a "simple" genital tract lesion received in 54.5% of cases medical drugs alone against 33.3% for patients with complex genital tract lacerations. In 39.4% of cases an embolization was necessary for the group of patients with complex genital tract lacerations against 9.1% in the simple genital tract lesion group. DISCUSSION AND CONCLUSION: Genital tract lacerations are a serious cause of HDD. Their management should be multidisciplinary combining appropriate and timely decisions (resuscitation, embolization and/or surgery). The sequence of these treatments depends on the clinical condition of the patient and justifies a transfer to a referral center.
Assuntos
Genitália Feminina/lesões , Lacerações/complicações , Hemorragia Pós-Parto/etiologia , Adolescente , Adulto , Feminino , Humanos , Lacerações/diagnóstico , Lacerações/terapia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemAssuntos
Doença Diverticular do Colo/diagnóstico por imagem , Embolia Aérea/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Transtornos Puerperais/diagnóstico por imagem , Doenças do Colo Sigmoide/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Colectomia , Doença Diverticular do Colo/cirurgia , Embolia Aérea/cirurgia , Seguimentos , Humanos , Ileostomia , Masculino , Veias Mesentéricas/cirurgia , Veia Porta/cirurgia , Transtornos Puerperais/cirurgia , Doenças do Colo Sigmoide/cirurgia , Tromboflebite/cirurgia , Trombose/cirurgiaRESUMO
PURPOSE: To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. RESULTS: The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). CONCLUSION: Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.
Assuntos
Síndrome Coronariana Aguda/complicações , Angina Pectoris/complicações , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
Parvovirus B19 infection during pregnancy is at risk of adverse fetal outcome. The risk is increased if maternal infection occurs during the first two trimesters, but may also happen during the third trimester. Adverse first and third trimester fetal outcome were recently highlighted by polymerase chain reaction (PCR) viral DNA detection. Parvovirus does not seem to be a significant teratogen. Infection during pregnancy can cause severe fetal anaemia and nonimmune hydrops fetalis. Cardiac tropism of the virus can cause myocarditis and aggravate the cardiac failure. Follow up of in utero anaemia is based upon the middle cerebral artery peak systolic flow velocity evaluation and treatment is based upon cordocentesis transfusion.