[Klippel-Trenaunay syndrome and pregnancy. Case report]. / Síndrome de Klippel-Trenaunay y embarazo. Comunicación de un caso.

The Klippel-Trenaunay syndrome is a rare congenital disorder consisting of: cutaneous vascular nevi, varicose veins or venous malformations and hypertrophy of soft tissue and bone, affecting one or more limbs. The morbidity of the disease is associated with vascular anomalies. Pregnancy is discouraged because this rare disease puts a pregnant woman in an increased obstetric risk, due to pregnancy can exacerbate complications. The pregnancy has been reported rarely in patients with Klippel-Trenaunay syndrome, although the incidence is unknown. Until 2006 there have been only 17 reported cases of pregnancy in patients with Klippel-Trenaunay syndrome in the literature in English. We report the case of the second pregnancy of 22 years old woman with this disease.

[Modification to surgical technique of cesarean hysterectomy]. / Modificación a la técnica quirúrgica de cesárea-histerectomía.

BACKGROUND: Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality. OBJECTIVES: To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique. PATIENTS AND METHOD: Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care. RESULTS: Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group. CONCLUSIONS: The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.

[Placenta percreta with bladder invasion. Case report]. / Placenta percreta con invasión a la vejiga. Reporte de un caso.

We report a case of a 30-year-old woman, who had two previous caesarean sections, attended for the first time at 18 weeks of gestation. Pelvic ultrasonography and color Doppler imaging showed a placenta percreta invading the urinary bladder. A caesarean section was carried out at 27th week of gestation for preterm premature rupture of membranes. Placental tissue was firmly attached to the anterior surface of the bladder. A cesarean hysterectomy was performed with bilateral anterior internal iliac artery ligation before hysterectomy was finished. The bladder was repaired, leaving a suprapubic catheter.