Interstitial pregnancy rupture at 15†weeks of pregnancy.

Ectopic pregnancy occurs when the developing blastocyst becomes implanted outside the uterine cavity. Interstitial pregnancy is a rare type, representing 2-3%, of all ectopic pregnancies. It is located outside the uterine cavity in the segment of the fallopian tube that penetrates the muscular layer of the uterus. Therefore, it is a difficult and challenging diagnosis. We report a case of a 19-year-old girl who was admitted to our emergency department because of a ruptured interstitial pregnancy at 15 weeks of gestation.

[Transobturator tapes for stress urinary incontinence treatment: middle-term results]. / Fitas suburetrais transobturadoras na incontinência urinária de esforço feminina: resultados a médio prazo.

INTRODUCTION: Minimal invasive surgical treatment of female stress urinary incontinence with suburethral transobturator tapes is completely accepted nowadays. The purpose of this study is to evaluate the efficacy and security of these suburethral tapes, comparing the outside-in to the inside-out approach. MATERIAL AND METHODS: We performed a retrospective study of 298 patients with stress urinary incontinence diagnosis that were submitted to transobturator surgery between 2003 and 2006. From these patients 113 women underwent outside-in approach and 185 patients had inside-out approach. RESULTS: The mean-age of the patients was 57.2 +/- 10.3 years-old and 69.1% were in the post-menopausal period. Mean parity was 2.2 +/- 1.1. The outside-in approach was performed more frequently in association with other(s) pelvic floor surgery(ies) (83.2% versus 37.8% for the inside-out technique). The mean follow-up duration was of 14.35 +/- 13.75 months in those patients who had a transobturator outside-in technique and of 11.79 +/- 10.39 months in the inside-out group. In respect to the efficacy, results were identical in the two groups with cure and cure or improvement rates respectively of 76.9% and 92.9% in the outside-in group and of 82.7% and 93.5% in the inside-out group (differences not significative). Regarding mean procedure duration, when it was performed isolated, we had a significant lower duration in patients submitted to inside-out technique (14.77 +/- 5.37 minutes versus 21.21 +/- 7.48 minutes, p < 0.05). The post-operative rates of de novo urge incontinence and mesh erosions were identical in the two groups, however microporous tapes had more erosions than macroporous ones (p < 0.05). DISCUSSION AND CONCLUSIONS: The transobturator suburethral tapes are effective and safe for the stress urinary incontinence treatment. We had elevated cure and improvement rates with no significant differences in regard to performed procedure. The inside-out technique is significantly associated to a lower operative duration.

Lupus and pregnancy--15 years of experience in a tertiary center.

This retrospective study was designed to evaluate the outcome of pregnancies in women diagnosed with systemic lupus erythematosus (SLE) followed in a tertiary fetal-maternal center. Data were collected from clinical charts between January 1993 and December 2007, with a total of 136 pregnancies (107 patients). Mean maternal age was 29 years, with the vast majority of patients being Caucasian. Most patients were in remission 6 months prior to pregnancy (93%) and the most frequently affected organs were the skin and joints. Renal lupus accounted for 14% of all cases. Twenty-nine percent of patients were positive for at least one antiphospholid antibody (aPL) and nearly 50% had positive SSa/SSb antibodies. All patients with positive aPL received low-dosage aspirin and low-molecular-weight heparin (LMWH). There were no pregnancy complications in more than 50% of cases and hypertensive disease and intrauterine growth restriction were the most common adverse events. There were 125 live births, one neonatal death, eight miscarriages, and three medical terminations of pregnancy. Preterm delivery occurred in 25% of pregnancies. Our results are probably the conjoined result of a multidisciplinary approach together with a systematic management of SLE pregnancies, with most patients keeping their prior SLE medication combined with low-dosage aspirin and LMWH in the presence of aPL.

[Pregnancy and antiphospholipid antibodies in systemic lupus erithematosus patients: an outcome evaluation]. / Gravidez e anticorpos antifosfolípidos em doentes com lúpus eritematoso sistémico: uma avaliação do prognóstico.

BACKGROUND AND AIMS: Antiphospholipid antibodies (APLAs) have been associated with pregnancy loss and other obstetric complications, such as pre--eclampsia, fetal growth restriction and preterm delivery. Systemic lupus erythematosus (SLE) patients frequently present APLAs and secondary antiphospholipid syndrome. The purpose of this work is to evaluate pregnancy outcome in SLE patients with and without APLAs. MATERIAL AND METHODS: Retrospective analysis of 136 gestations in women with SLE diagnosis previous to pregnancy that underwent surveillance in our maternity from 1993 to 2007. Patients with and without APLAs were considered separately. Maternal age, obstetric history, SLE activity and nephropathy, present pregnancy evolution, gestational age at delivery, mode of delivery, birth weight and hypertensive complications were identified. RESULTS: 28% (38) of pregnant SLE patients had APLAs. From these patients, 28.9.8% had past history of second and/or third trimester fetal losses, against 6.12% in patients without APLAs (p<0.05). Evaluation of present pregnancy outcome revealed, for APLAs positive patients, a significant higher rate of non-successful pregnancy (8.1% vs 2.1%, p<0.05). Analysis of mean birth weight and intrauterine growth restriction rates revealed no significant differences related to APLAs presence. Mean gestational age at delivery was 36.9 weeks for both groups with identical preterm delivery rates. Cesarean section was the mode of delivery for 47% and 44.1% of the patients, in APL patients and others, respectively. CONCLUSIONS: SLE patients with APLAs had more spontaneous abortions and worse obstetric history, with no other significant differences in perinatal and obstetric outcome.