Gestación heterotópica espontánea

Heterotopic pregnancy is the combination of intrauterine and ectopic pregnancy. This potentially fatal condition rarely occurs in spontaneous conception cycles and consequently its diagnosis requires a high index of suspicion. We report a case of heterotopic pregnancy in a 30-year old primipara with no known risk factors who presented with acute abdominal pain due to a spontaneous heterotopic pregnancy. The ectopic pregnancy was resected via laparoscopy. After surgery, the intrauterine pregnancy was uneventful.     

Papel de la inseminación intrauterina en la era de la fertilización in vitro

Intrauterine insemination is a low-complexity assisted reproduction technology in which previously washed sperm are deposited in the uterine cavity with ovarian stimulation. This invasive technique is well accepted by patients and achieves cumulative pregnancy rates similar to those obtained in a single cycle of more complex assisted reproduction techniques. We compared two methods of assisted reproduction: in vitro fertilization and intrauterine insemination in relation to their effectiveness and cost. We conclude that intrauterine insemination is the first-line treatment in male factor infertility without severe disruption or unexplained infertility; pregnancy can be achieved with 3 to 6 cycles in a high percentage of these cases at lower cost and with lower risk of multiple pregnancy than with in vitro insemination. We did not consider other techniques, such as intracytoplasmic sperm injection, which is also indicated for the treatment of male factor infertility, since this technique requires greater technical and human resources, thus precluding comparison.     

Gestación heterotópica en inseminación artificial

We report a case of heterotopic pregnancy, which is of interest due to its low incidence and the serious complications that can ensue when diagnosis is delayed. Most of the heterotopic pregnancies described occurred after in vitro fertilization techniques. These pregnancies are less frequent after artificial insemination and are exceptional in spontaneous pregnancies. Our objective is to emphasize the increase in this type of pregnancy in the last few years due to assisted reproduction techniques and to highlight the importance of early diagnosis.     

Gestación heterotópica en un embarazo espontáneo

Heterotopic pregnancy consists of simultaneous intra and extrauterine pregnancy. The incidence is low in spontaneous pregnancies, but these pregnancies are more common when assisted reproductive technologies are used; therefore, diagnosis requires a high index of suspicion. We report the case of a 34-year-old woman with no history of interest and a spontaneous pregnancy, who presented with spotting and hypogastralgia. An ultrasound scan showed an intrauterine gestational sac and left adnexal mass consistent with ectopic pregnancy. As a heterotopic pregnancy was suspected, laparoscopic salpingectomy and curettage of the miscarriage were performed. Pathological analysis confirmed the diagnosis.     

Gestación heterotópica espontánea

Heterotopic pregnancy is a rare clinical condition in which several pregnancies can coexist inside and outside the uterus. In recent years, the incidence of heterotopic pregnancy has increased due to assisted reproductive techniques. A high index of suspicion may help in the early diagnosis and appropriate treatment of this entity. We report a case of spontaneous heterotopic gestation in a 35-year-old woman who developed both an extra- and an intrauterine pregnancy diagnosed by ultrasound 10 weeks after the onset of amenorrhea.     

Feto acardio en gestación gemelar a término

Twin reversed arterial perfusion sequence (TRAP) is a serious complication of monochorionic twin pregnancies, in which one twin perfuses the other twin (an acardiac fetus) via large arterio-arterial and veno-venous anastomoses.We report a case of monochorionic twin pregnancy at term, in which the second twin was an acardiac fetus with only an undeveloped lower limb and rudimentary colonic tissue. The first twin was born healthy, a very rare outcome in this entity as the pump twin usually shows distinct degrees of cardiac overload, leading to intrauterine death from heart failure in more than 50% of cases.     

Incarceración y torsión uterina en gestante

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed.     

Embarazo abdominal secundario tras una esterilización tubárica

The ectopic pregnancy appears in the 10-12% of cases after tubal sterilization and it is usually located in the tube. 1% of ectopic pregnancies are abdominal and the implantation in omentum is a rare condition with only 16 described cases. According to Studdiford, they can be classified as primary or secondary depending on whether they are originated or not in the peritoneal cavity. We present the case of a secondary abdominal pregnancy located in omentum, in a woman with previous tubal sterilization, which has not been described to date; one is an abdominal pregnancy with origin in a tubal abortion, since trofoblastic invasion does not exist in omentum and there are remains of the same tissue in the right tube.     

Decidualización peritoneal y embolización de arterias uterinas en la hemorragia puerperal tras cesárea

Deciduosis peritonei consists of the presence of decidua in the peritoneal surface and develops during pregnancy due to the effect of progesterone. The typical lesions are highly vascularized and immunohistochemical studies are required to exclude a diagnosis of malignancy. Selective arterial embolization is a conservative procedure to treat postpartum hemorrhages with minimal side effects and allows fertility to be preserved. We present a case of severe deciduosis peritonei identified during a cesarean section in a patient who subsequently required embolization of the uterine arteries due to a postpartum hemorrhage.     

Saco y pseudosaco. Su importancia en el diagnóstico diferencial ecográfico de la gestación ectópica

We report the case of a pregnant woman who presented to the emergency department with slight vaginal bleeding in the first trimester of pregnancy. The the differential diagnosis between eutopic, heterotopic and tubal ectopic pregnancy was hampered by the presence of an intrauterine pseudosac. The clinical course was complicated by spontaneous rupture of a tubal ectopic pregnancy, which required curettage and laparotomic salpingectomy. The postoperative outcome was favorable.     

Análisis de los factores de influencia sobre el resultado de 500 ciclos de inseminación intrauterina homóloga

Objective

To evaluate the results and analyse different factors influencing pregnancy rate using homologous intrauterine insemination.

Subjects and methods

Retrospective analysis of 500 homologous intrauterine insemination cycles in 183 infertile couples. Only one insemination per stimulated ovarian cycle was performed in patients with: mild endometriosis, ovulatory factor, male subfertility or unexplained infertility. We studied female age, duration of infertility, stimulation protocol, number of cycle, number of preovulatory follicles, motile sperm count and endometrial thickness related to pregnancy rate.

Results

Pregnancy rate per couple was 24% and per intrauterine insemination 9%, 11% was multiple pregnancies. Best outcome has been got in women younger than 37 years (P=.048) and in cycles with more than one preovulatory follicle. Other studied factors did not have influence in homologous intrauterine insemination outcome.

Conclusions

Female age is a prognostic factor for homologous intrauterine insemination with poor outcome in women older than 38 years. Cycles with more than one preovolatory follicle have better outcome. No differences in pregnancy rate have been achieved with motile sperm count over 1.5 millions/0.3 ml.     

Fiebre Q y gestación

Q fever is a zoonosis with worldwide distribution caused by Coxiella burnetii. There are two phases of the disease: an acute phase after the initial exposure and another chronic phase, months or years after the primary infection. The prevalence is unknown, since the signs are often subclinical, leading to underestimation of the number of cases in pregnant women. Q fever during pregnancy increases fetal morbidity and mortality and can cause spontaneous abortions, intrauterine growth restriction, oligohydramnios, intrauterine fetal death and threatened preterm birth. Obstetric complications are more frequent and severe if the disease is contracted during the first trimester of gestation. Pregnancy could be a risk factor for chronic Q fever, with maternal endocarditis being the most common diagnosis. Long-term cotrimoxazole therapy avoids placental infection and possible fetal effects, and protects the pregnant patient from chronic Q fever.     

Gestación heterotópica espontánea. Diagnóstico ecográfico y tratamiento laparoscópico

Heterotopic pregnancy is defined as a simultaneous intrauterine and extrauterine pregnancy. It is a rare event, which appears with major frequency in patients submitted to assisted reproductive technologies (ARTs).     

Gestación heterotópica espontánea. Diagnóstico ecográfico precoz y asintomático

Heterotopic pregnancy is a potentially fatal situation that rarely occurs in a natural conception. Diagnosis in the absence of symptoms is even more exceptional. Furthermore, due to the low index of suspicion of heterotopic pregnancy in natural conceptions, the incidence of serious clinical complications (hemoperitoneum, tubal rupture, acute abdomen) is greater in this group of patients.We report the case of a 33-year-old primigravida with a spontaneous pregnancy who attended her first prenatal visit at 6 weeks and 3 days of amenorrhea. The patient was asymptomatic. Vaginal ultrasound scan showed two gestational sacs, an intrauterine sac and an extrauterine sac next to the right ovary. A laparoscopic right salpingectomy was performed to remove the ectopic pregnancy. A healthy neonate was delivered at 38 weeks’ gestation without complications.Heterotopic pregnancy can be diagnosed after spontaneous conception, even in asymptomatic patients. It is important to carry out routine examination of the adnexae in the first ultrasound scan to exclude ovarian disease and diagnose (or exclude) the presence of asymptomatic heterotopic pregnancy.     

Embarazo heterotópico espontáneo en pacientes con antecedente de embarazo gemelar familiar: 2 casos

Heterotopic pregnancy is the coexistence of an intrauterine pregnancy with an extrauterine pregnancy. There are two types: induced (associated with in vitro fertilization techniques, representing 1:1000 to 1:1,500 pregnancies) or spontaneous (1: 20,000 to 1: 80.000 pregnancies). Causal factors for spontaneous heterotopic pregnancies include pelvic inflammatory disease, use of hormonal or intrauterine devices, previous pelvic surgery and ectopic pregnancy. We report two cases of spontaneous heterotopic pregnancy in patients with a family history of twins.     

Tratamiento conservador del adenocarcinoma de endometrio. Obtención de dos gestaciones con recién nacidos sanos

We present the case of a 30-year-old childless woman who was diagnosed with a well-differentiated endometrial adenocarcinoma. The patient chose conservative treatment consisting of megestrol and hysteroscopic resection. After this treatment, a normal pregnancy ensued, followed by contraception with an intrauterine device (IUD) delivering levonorgestrel for 18 months. After removal of the IUD, a second normal pregnancy occurred. After the second pregnancy, the patient had no desire for more children and a total hysterectomy with bilateral salpingo-oophorectomy was performed. We discuss the ethical, diagnostic and therapeutic dilemmas posed by this case, including the possibility of progression and patient death.     

Enanismo tanatofórico: presentación de un caso

Thanatophoric dwarfism or dysplasia constitutes a rare malformation of the skeletal system that usually causes prenatal demise. Although there are two clinical forms, some alterations such as short and horizontal ribs, deformities of the thorax and short, curved femurs usually occur together. We describe a case of thanatophoric dwarfism prenatally diagnosed in the Municipal Center of Genetics of the Isle of Youth (Cuba). The parents were given genetic counselling and decided to interrupt the pregnancy. The diagnosis was confirmed by pathological analysis.     

Rotura espontánea de la vena renal izquierda materna durante la gestación

Retroperitoneal hemorrhage is a very rare event, especially during pregnancy, and is associated with high morbimortality for both the mother and fetus. The cause is usually traumatic, but these hemorrhages can occur spontaneously, which further hampers their diagnosis. Presenting symptoms are abdominal pain and maternal hypovolemic shock, with rapid fetal compromise. We present a case of maternal retroperitoneal hemorrhage, which occurred at week 35 of pregnancy due to spontaneous rupture of the left renal vein, although the first manifestation was placental abruption.     

Síndrome de bridas amnióticas: caso clínico y revisión del tema

Amniotic band syndrome is a set of congenital birth defects consisting of constriction rings and limb or digit amputations, associated with the presence of amniotic bands. The incidence of this complication is low and its occurrence is sporadic. This syndrome usually causes constriction rings in the distal end of limbs or digits, which, in severe cases, can lead to complete amputation of the limbs or other malformations. Only 29-50% of cases are diagnosed prenatally. We report the case of a patient with an ultrasonographic diagnosis of amniotic band syndrome in week 12 of pregnancy.     

Embarazo ectópico primario en epiplón. Reporte de caso

Abdominal pregnancy occurs in one out of 10,000 deliveries. Omental ectopic pregnancy is the least common of these pregnancies and diagnosis is generally made during laparotomy. We report the case of a 28-year-old woman, secundigesta, secundípara, who presented with menstrual delay, cutaneous-mucosal pallor, and severe abdominal pain. During laparotomy, the presence of omentum was observed in the pelvis and uterus. Both adnexa were normal. A tumor was found on the inferior border of the omentum. The tumor was removed and partial omentectomy was performed. A primary omental ectopic pregnancy was diagnosed.