Inicio de un síndrome de Guillain-Barré durante la gestación

We present the case of a pregnant woman who developed severe Guillain-Barré syndrome in the third trimester and who required admission to the intensive care unit of the referral hospital for suspected disease progression. No clinical improvement was observed. Because the onset of diaphragm paralysis was suspected and the fetus was in the podalic position, emergency cesarean was performed. Given the rarity of onset of Guillain-Barré syndrome in pregnancy, we review this entity to improve knowledge of maternal and fetal management.     

Síndrome coronario agudo durante la gestación

Acute coronary syndrome in women aged less than 40 years old is uncommon and is even less frequent during pregnancy. However, the incidence of this syndrome can be expected to increase because associated risk factors, such as increased age at pregnancy, are becoming increasingly frequent.     

Obstrucción intestinal durante la gestación

The present study describes three cases of intestinal obstruction in chronological order treated in our service in the last year. Although the reported symptoms were highly similar in all three patients, outcomes were very different. The interest of these cases lies in the low incidence of this complication during pregnancy and its high morbidity and mortality. Early diagnosis is essential to improve survival.     

Diagnóstico ecográfico de quistes del cordón umbilical en el primer trimestre de la gestación

Although umbilical cord cysts are a relatively frequent entity they cannot be considered a nonpathological sonographic finding. In the first trimester pregnancies the prevalence of umbilical cord cysts has been reported about 3%. Sometimes are associated to other chromosomal and/or structural abnormalities. If they are persistent and progressive in the size, could restrict the fetal sanguineous flow.     

Prevención de la hemorragia posparto en una gestante afectada de síndrome de Hermansky-Pudlack

Hermansky-Pudlak syndrome is a multisystemic disease with autosomal recessive inheritance, mainly characterized by oculo-cutaneous albinism and impaired platelet aggregation. We describe the follow–up and end of pregnancy in a 30-year-old woman with this syndrome, as well as the measures carried out during labor to avoid bleeding complications due to platelet dysfunction. The pregnancy ended at 38.2 weeks through vaginal delivery, without epidural anesthesia and good maternal and fetal outcome.     

Síndrome ELLP,un diagnóstico diferencial complicado

HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count) is a thrombotic microangiopathy of pregnancy. This syndrome may be incomplete, with manifestations of only a few of its parameters: EL (elevated liver enzymes), ELLP (elevated liver enzymes and thrombocytopenia) and LP (thrombocytopenia alone). ELLP syndrome is a difficult differential diagnosis in which the main causes of thrombocytopenia in pregnancy and other diseases must be excluded. In current clinical practice, the management of ELLP is similar to that of complete HELLP syndrome. However, maternal and fetal morbidity is lower in ELLP syndrome, which may suggest the need to evaluate different protocols for these two variants of the same disease.     

Absceso primario de psoas diagnosticado durante la gestación

Primary psoas abscess is a rare infection that can be a diagnostic challenge, particularly when the patient is pregnant. We describe a case of primary psoas abscess during pregnancy and its clinical manifestations, diagnosis and treatment.     

Neumotórax espontáneo durante la gestación

Spontaneous acute pneumothorax during pregnancy is extremely rare. A diagnosis of pneumothorax should be excluded in any pregnant women experiencing chest pain and dyspnea and must be confirmed radiographically. Treatment is the same as in non-pregnant women. Prognosis is generally good for both the mother and the fetus. We describe two cases of spontaneous pneumothorax during pregnancy with favorable maternal and perinatal outcomes.     

Entrecruzamiento de cordones en la gestación gemelar monocorial monoamniótica

Monochorial monoamniotic twins are at high risk of fetal death due to the general complications seen in multiple gestations, as well as those specific to this type of pregnancy. The most severe complication in these pregnancies is fetal death due to cord entanglement, which occurs in almost all cases.Early ultrasonographic diagnosis and intensive prenatal surveillance are essential for the early detection of cord entanglement and the prevention of fetal death.The need for in-hospital management and the exact gestational age for delivery continue to generate controversy in the literature.     

Evaluación del índice proteína-creatinina en orina aislada para la predicción de proteinuria significativa durante la gestación

Introduction

Diagnosis and follow-up of preeclampsia requires measurement of proteinuria and the gold standard for this evaluation is the 24-hour collection. However, this collection is cumbersome, time consuming and delays clinical diagnosis. The purpose of this study is assess the diagnostic performance of the spot urine protein/creatinine (P/C) ratio to predict the absence or presence of significant proteinuria (≥ 300 mg per 24 hours) among outpatient pregnant women with suspected or previous diagnosis of preeclampsia.

Material and methods

The P/C ratio was calculated in 106 single voided urine samples, obtained after the completion of the 24-hour collection, from 66 outpatient pregnant women admitted to the Maternal Fetal Care Unit at our Hospital to follow-up of hypertension gestational. Correlation between the spot urine P/C ratio with the 24-hour urine protein excretion was calculated. Receiver operator characteristic (ROC) curves analysis was used to evaluate the diagnostic performance and to determinate the best cutoff to predict the absence or presence of significant proteinuria.

Results

Significant proteinuria on 24 hour collection urine was identified in 31 urines from 22 pregnant women. There was a significant correlation between the spot urine P/C and 24-hour urine protein excretion (r_Spearman = 0,658, p = 0,01). ROC curves analysis revealed an area under the curve for spot P/C ratio of 0,838, greater than urine dipstick (0,629). No single P/C ratio cutoff was appropriate to rule-out or predict significant proteinuria; however, use of dipstick and spot urine P/C ratio, with two cutoffs, 120 mg/g to predict the absence of significant proteinuria and 240 mg/g to confirm it, clasiffied correctly 44,3% of urines and avoided the collection of 24 hours urine in 51% of the cases.

Conclusions

Spot urine P/C ratio, in conjunction with dipstick urianalysis, is a useful test in the initial screen for rule-out and predict significant proteinuria in outpatient pregnant women with hypertensive pregnancy or preeclampsia, but it should not be used as an alternative to 24-hour total protein evaluation in midrange P/C ratio, requiring a full 24-hour urine for accurate results.     

Colitis ulcerosa asociada a la infección por citomegalovirus durante la gestación

Ulcerative colitis is an inflammatory bowel disease characterized by intermittent flares of disease activity. Exacerbations have been associated with cytomegalovirus superinfection. We report the case of a pregnant woman who experienced a severe flare, producing toxic megacolon. Cytomegalovirus infection during this flare was subsequently confirmed. Maternofetal transmission of the virus occurred and the fetus showed the lesions characteristic of this infection.     

Manejo conservador de un hematoma subcapsular hepático en un síndrome de HELLP

To improve morbidity and mortality in patients with subcapsular liver hematoma, clinical suspicion, a rapid diagnosis and multidisciplinary treatment are fundamental. The treatment of this complication includes expectant management with clinical and radiological observation, embolization of the hepatic arteries, and surgical treatment if there is hemodynamic instability, persistent bleeding or increasing pain. We report a case of postpartum HELLP syndrome that was complicated by a subcapsular liver hematoma, successfully treated by embolization of the right hepatic artery.     

Lesión urológica compleja y gestación. Técnica de Mitrofanoff

We report the case of a 31-year-old primigravida who had sustained irreversible urethral damage in a traffic accident 11 years previously. The lesion required the application of Mitrofanoff's technique, consisting of the creation of a catheterizable urinary conduit from the urinary bladder to the abdominal wall (the cecal appendix is generally used). In addition to routine prenatal care, monthly urine cultures were performed, revealing recurrent urinary tract infections, which were resolved with oral antibiotics.     

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.     

Rotura de cuerno uterino rudimentario en gestación de 22 semanas. A propósito de un caso y revisión de la literatura

Unicornuate uterus with rudimentary horn is a rare Müllerian anomaly with a high incidence of obstetric complications, affecting 4.5% of women. Pregnancy located in the rudimentary horn occurs in 1 in 76,000 pregnancies with a risk of uterine rupture of 50-80%. Rupture usually occurs at the end of the second trimester of pregnancy. Early diagnosis reduces morbidity and mortality, but ultrasound diagnosis has a sensitivity of only 30%, due to the low prevalence of this entity.     

Cribado de aneuploidía en gestación gemelar: resultados de la aplicación del test combinado

Objective

To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin pregnancies with one or two affected fetuses. To compare the value of markers according to chorionicity and the mode of conception.

Material and methods

Retrospective study including 161 twin pregnancies. Maternal serum fß-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risk of trisomy 21 was calculated in each fetus using the Combined Test. In monochorionic pregnancies, the single risk for the pregnancy was obtained with the largest NT. An invasive diagnostic procedure was offered when the risk was 1:250 or more in one or both of the fetuses.

Results

All trisomy 21 pregnancies were identified (three pregnancies and four fetuses) by the combined testfor a false-positive rate of 6.4% of pregnancies and 3.5% of fetuses. The median fß-hCG level, expressed in MoM, was 1.72 and the median PAPP-A level was 2.01. The median NT was 1.05 MoM. Both fß-hCG and PAPP-A levels were significantly decreased in monochorionic pregnancies and PAPP-A was significantly decreased in pregnancies resulting from assisted reproduction. No significant differences were observed in NT measurement between monochorionic and dichorionic fetuses or between those conceived naturally or by assisted reproduction.

Conclusions

The combined test shows high sensitivity and specificity in screening for trisomy 21 in twin pregnancies. The differences obtained in the biochemical markers according to chorionicity or the mode of conception require confirmation in further studies with a larger number or cases.     

Pronóstico perinatal y materno de la gestación múltiple en función del protocolo intraparto

Objectives

To evaluate maternal and fetal outcomes of multiple pregnancy according to route of delivery.

Material and methods

We performed a retrospective study of all twin deliveries in the previous 5 years and evaluated the route of delivery, especially in the final year. The information was recorded with Microsoft EXCEL and was analyzed with the statistical program SPSS 12.0 for Windows.

Results

The mean gestational age was 35.3 weeks. Route of delivery was through cesarean section in 59.8%. The mean interval between twins was 7.82 minutes when the first twin was delivered vaginally. Neonatal morbidity was found in 49%, and was higher in the second twin and in preterm deliveries.

Conclusions

Multiple pregnancies are associated with a large number of maternal and perinatal complications, as well as with a greater number of cesarean sections. Consequently, correct intrapartum management is required to reduce neonatal morbility as far as possible.     

Corioamnionitis subclínica: un reto diagnóstico. A propósito de un caso

Diagnosis of subclinical chorioamnionitis in patients with premature rupture of membranes in preterm gestation is a challenge. If intraamniotic infection is ruled out by amniocentesis, it is not clear–in the expectant management of the pregnancy and until the fetus has reached a gestational age allowing active management–when the test should be repeated, or whether it should be repeated. In the case reported herein, expectant management of pregnancy was adopted after intra-amniotic infection had been excluded by amniocentesis. However, because of changes in the number of leukocytes and an increase in acute phase reactants in the absence of infection at another site, we decided to repeat the test. Despite early diagnosis of subclinical chorioamnionitis, fetal involvement had already occurred due to the inflammation-infection process. It is therefore essential to obtain an early maternal serum marker of intra-amniotic infection.     

Hiperemesis gravídica complicada con síndrome de Korsakoff

Hyperemesis gravidarum is seen as the most serious form of vomiting during pregnancy. It was described in the medical literature in the 18th century as a cause of maternal death due to starvation, a not uncommon event until the 20th century. Nowadays maternal death is unusual.