Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.

Leiomiosarcoma primario vaginal en el embarazo. A propósito de un caso / Primary vaginal leiomyosarcoma in pregnancy. About A case

RESUMEN Los sarcomas primarios de vagina son extremadamente raros especialmente durante la gestación. Se presenta el caso de una gestante de 25+2 semanas que acude a urgencias con clínica de sangrado vaginal objetivándose a la exploración una formación nodular dependiente de pared vaginal derecha. Dada la clínica se reseca en quirófano con el hallazgo histopatológico de leiomiosarcoma. A la gestante se le realiza sin incidencias una cesárea en la semana 34 de gestación, previa maduración pulmonar fetal, completándose en el puerperio inmediato el estudio de extensión sin encontrarse ningún hallazgo relevante. Finalmente, se somete a la paciente a una histerectomía y salpinguectomía bilateral con preservación ovárica. El seguimiento y los controles sucesivos de la gestante en los meses posteriores muestran ausencia de enfermedad.

ABSTRACT Primary sarcomas of the vagina are extremely rare, especially during pregnancy. We report a case of a 25-week-pregnant who came to emergency room complaining of vaginal bleeding. Pelvic examination revealed a globular mass located on the right vaginal wall. Given the persistent bleeding, resection of the mass was performed. The specimen was sent to pathology and confirmed to be a leiomyosarcoma. At 34-weeks of pregnancy after fetal lung maturation a cesarean section is done. It was completed the extension study during immediate postpartum without any relevant finding. Finally, she had a totally hysterectomy and bilateral salpingectomy with ovarian preservation. Clinical follow-up over the following months shows no evidence of disease.

Dolor abdominal en puerperio. Perforación uterina y formación de pseudoquiste peritoneal / Abdominal pain in the puerperium. Uterine perforation and peritoneal pseudocyst formation

Debido al número creciente de la tasa de cesáreas, el riesgo de rotura uterina probablemente aumentará. La mayoría aparecen intraparto, siendo más raro un diagnóstico durante el postparto. Se presenta el caso de una mujer de 35 años de edad con antecedente de cesárea anterior hace 4 años que acude a urgencias con un cuadro de dolor abdominal y empeoramiento del estado general, tras parto instrumental 2 semanas antes (AU)

Due to increasing rate of cesarean deliveries, the risk of uterine rupture would probably rise. Most of them appear during labour, being less common a postpartum period diagnosis. Our case report describes a 35-year-old woman with previous caesarean section 4 years ago, who goes to emergency services with abdominal pain and poor performance status after having an instrumental delivery 2 weeks before (AU)