Trombosis de los senos venosos cerebrales en una gestante en el primer trimestre de embarazo

Cerebral venous thrombosis is an uncommon disease during pregnancy. In 25-40% of cases, the etiology is unknown. Risk factors are infectious diseases, pregnancy, puerperium, dehydration, oral contraception use, hypercoagulative states, tumors,and traumatism.     

Trombosis de la vena ovárica con extensión a la vena cava inferior en el posparto

Ovarian vein thrombosis is a complication that can appear during the postpartum period or after pelvic surgery. This complication is a rare but serious entity requiring early diagnosis and treatment and should be suspected in patients with fever and acute abdominal pain at the beginning of the postpartum. Imaging diagnosis with contrast computed tomography remains the gold standard. Administration of broad-spectrum antibiotics and heparin therapy produces immediate clinical improvement.     

Trombosis de vena ovárica y vena cava inferior asociada a endometritis en el puerperio

Ovarian vein thrombosis is a rare and severe puerperal complication that usually manifests as fever and abdominal pain in the puerperal period and is more frequent in women who have undergone cesarean section. There is an associated high risk of pulmonary embolism and thus early diagnosis and treatment are required. We report the case of a 30-year-old woman with pelvic pain and fever in the puerperal period. Computed tomography scan revealed ovarian vein thrombosis extending to the inferior vena cava. Endometritis was also diagnosed. The patient received dalteparin and antibiotics. Ovarian vein thrombosis should be included in the differential diagnosis of fever in the postpartum period.     

Trombosis del seno venoso cerebral en gestante con síndrome de Job

Cerebral venous sinus thrombosis is uncommon. Pregnancy is a major risk factor for the development of this entity. We report the case of a patient with Job’s syndrome and protein C and S deficiency who developed cerebral venous sinus thrombosis and dural fistula at 36 weeks’ gestation. After heparinization, the treatment of choice, pregnancy termination to eliminate the prothrombotic status and embolization of the dural fistula were required to obtain complete remission of the neurological symptoms.     

Disección espontánea aguda de la arteria coronaria durante el puerperio

The pathogenesis of pregnancy-related spontaneous coronary artery dissection (SCAD) has not yet been fully elucidated. Eighty percent of SCAD cases occur in women. One third of cases are observed during pregnancy or the postpartum. Most cases occur in the puerperium. We present the case of a 26-year-old woman (gesta 2, para 1), who reported chest pain radiating to her back and left arm 4 hours after delivery. Coronary angiography showed a normal left coronary system and extensive dissection of the right coronary artery. The patient was treated pharmacologically and later underwent surgical bypass of the affected coronary vessel.     

Evolución clínica y paraclínica de 9 embarazos en 4 pacientes con enfermedad de Gaucher tipo 1 en el servicio de hematología de un hospital docente asistencial

Objectives

To describe the clinical presentation and course in a group of pregnant women with Gaucher disease type 1.

Subjects and methods

Pregnant women admitted to our hematology service with a medical diagnosis of Gaucher disease type 1.

Results

All patients were classified as high risk. We describe 9 pregnancies in 4 patients: 7 were on enzyme replacement therapy before the pregnancy and continued to receive this therapy throughout the pregnancy; 1 patient discontinued therapy 8 months previously and had a hematological exacerbation.

Conclusions

Pregnancy should not be contraindicated in patients with stable disease. Enzyme replacement therapy should not be interrupted or suspended because it decreases complications.     

Cribado de parto pretérmino en el primer trimestre de la gestación

First-trimester combined screening for preterm delivery and the early initiation of preventive strategies in high-risk patients can effectively reduce preterm delivery rates.     

Teratoma inmaduro de ovario en la gestación

Ovarian tumors are estimated to occur in about 1 in 1000 pregnancies; of these, 3% are malignant. Most patients are clinically asymptomatic and the masses are usually detected in a routine abdominal examination during the second trimester of pregnancy. The management of these ovarian masses depends on their etiology and clinical findings. Surgical intervention is required when malignancy is suspected. Neoadjuvant chemotherapy is also indicated. Fertility conserving surgery should be attempted.     

Trombosis de la arteria cerebral media en un neonato afectado de déficit de proteína C

Stroke is an important cause of mortality and chronic neurological morbidity in children. Perinatal stroke has been defined as a cerebrovascular event occurring between 28 weeks of fetal life and the 28^th postnatal day. The most common manifestation of stroke is neonatal seizures but this entity may also be asymptomatic until months after birth when asymmetry of reach and grasp, failure to reach developmental milestones, or postnatal seizures can develop. Improvements in neuroimaging and its availability have increased the diagnosis and awareness of perinatal stroke in newborns and infants with neurological symptoms. Obstetricians are responsible for monitoring pregnancies at high thromboembolic risk, but rarely consider the effect this has on the fetus or newborn. We present the case of a newborn with perinatal stroke associated with protein-C deficiency.     

Resultados de la aplicación de la técnica SNOLL versus tumorectomía guiada con arpón en el cáncer de mama

Objective

To compare the results of the SNOLL technique with those of wire-guided lumpectomy in the treatment of breast cancer.

Material and methods

A retrospective study conducted in the Breast Pathology Unit of the Vigo University Hospital from May 2010 to February 2012.

Results

We studied 73 patients. The SNOLL technique was used in 34 women and wire-guided lumpectomy in 39. In both groups, the most common histological type was infiltrating ductal carcinoma (94% and 64.1%, respectively, P=.005). In the intraoperative study, 55.3% of tumors in the SNOLL group and 44.7% of those in the wire-guided group were found to touch the surgical margin. The rate of margin extension in the same intervention was higher in the SNOLL group (P=.160). The reoperation rate for margin extension was 0% in the SNOLL group and 13% in the wire-guided group (P=.57). In the final surgical specimen, the mean disease-free margin was 7.21 mm in the SNOLL group and 4.66 mm in the wire-guided group (P=.01).

Conclusions

The re-excision rate was similar in the two groups. The SNOLL technique allows a greater margin of safety.     

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas

Objective

To evaluate the mode of delivery and maternal morbidity associated with pregnancies ending at 41 weeks.

Material and methods

We designed a retrospective cohort study. The mode of delivery and maternal complications of 230 pregnancies ending at 41 weeks were compared with those in 234 pregnancies ending between 37 and 40 weeks at the Miguel Servet University Hospital in 2005.

Results

Women delivering at 41 weeks had an increased risk of membrane sweep, unfavorable Bishop score at admission, induction and longer duration of labor. These increases were also seen in the rates of operative vaginal delivery (25.6 vs 17.6%, p < 0.001) and cesarean section (21.7 vs 8.5%, p < 0.001).

Conclusions

The rates of maternal peripartum complications increase as pregnancy reaches 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction.     

Tratamiento de la hemorragia uterina posparto mediante taponamiento mecánico con balón intrauterino

Objective

To demonstrate the usefulness of uterine balloon tamponade in postpartum hemorrhage.

Material and methods

Five term pregnancies with postpartum hemorrhage were studied. The criterion for balloon placement was persistent bleeding despite pharmacological treatment.

Results

Balloon placement was successful in 100% of the patients. The mean decrease in hemoglobin was 3.2 g/dl (range: 1-5) and an average of three units of packed red blood cells per patient were required (range: 0-6). The mean volume of saline solution per balloon was 312 ml (range: 160-420) and the mean duration of treatment was 22 hours (range: 12-30).

Conclusions

Uterine balloon tamponade is an efficient method to control postpartum hemorrhage. Training is not required for the application of this technique, which can obviate the need for surgery. Because of its ease of use and reasonable cost, this method can be used in any hospital setting.     

Eficacia de la suplementación con L-arginina sobre la respuesta a la quimioterapia neoadyuvante en pacientes con cáncer de mama

Background

Breast cancer is the first cause of mortality from malignant neoplasms among women in Mexico. Neoadjuvant chemotherapy has a reported efficacy of approximately 70%; however, patients with inadequate response must undergo additional coadjuvant methods that negatively affect their quality of life. High concentrations of nitric oxide have shown cytotoxic and tumoricidal effects, thus favoring an adequate response to antineoplastic treatment. L-arginine is a nitric oxide precursor and therefore supplementation with this substance can augment nitric oxide synthesis and consequently its plasma concentration.

Objectives

To evaluate the efficacy of L-arginine supplementation in response to neoadjuvant chemotherapeutic treatment.

Materials and methods

We conducted a randomized clinical trial in which 30 g of L-arginine was administered in each neoadjuvant chemotherapy cycle. Plasma nitrite concentrations were determined before and after supplementation, as well as tumoral size before the start of antineoplastic treatment and after its completion. A chi-square test was performed to evaluate the association between the supplementation and adequate treatment response; plasma nitrites were evaluated by performing Student's T-tests.

Results

Forty-five patients were assessed, of whom 21 had an adequate response to antineoplastic treatment. No statistically significant association was found between supplementation and adequate response. Nitrite concentrations in plasma were significantly increased (p < 0.05) in patients receiving the supplement than in those who receiving placebo.

Conclusions

L-arginine supplementation can modulate nitric oxide synthesis and thus elevate plasma nitrite concentrations. However, this supplementation is not associated with an adequate response to neoadjuvant treatment; indeed, in this study, treatment response was lower than that reported in the literature, probably because the antineoplastic therapy was not tailored to specific tumoral characteristics.     

Extracción de DIU mediante histeroscopia en la gestación precoz: nuestra experiencia en 4 casos

Objectives

To evaluate the utility and effectiveness of hysteroscopic retrieval of intrauterine devices (IUDs) in early pregnancy.

Subjects and methods

We followed-up four pregnant women with IUDs with retracted tails removed by hysteroscopy before 10 weeks of pregnancy from 2003 to 2005.

Results

After hysteroscopy, pregnancy course was successful in three women, without complications that could be attributed to the procedure. There was one abortion due to rupture of fetal membranes at 15 weeks’ gestation.

Conclusions

The application of hysteroscopy in pregnancy has always been limited. In all patients, a possible optic nerve lesion in the fetus should be evaluated. This technique should not be performed after the 10th week of pregnancy. In most patients, pregnancy continues without complications after IDU removal.     

Vacunación antigripal en la embarazada

Objective

To describe influenza vaccination coverage in pregnant women and analyze whether influenza vaccination in these women confers protection in their neonates in the first months of life.

Material and methods

Three hundred sixteen neonates were followed-up during an epidemic season. An epidemiologic survey was performed in mothers, which included their influenza vaccination status. In all patients with symptoms compatible with respiratory infection, fortnightly telephone calls and nasopharyngeal aspiration were performed and virological diagnosis was obtained.

Results

A total of 5.7% of the cohort had been vaccinated against influenza during pregnancy and 17.4% of the same sample had been vaccinated in the previous season. The only factors significantly influencing vaccination were vaccination in the previous season (OR: 11.35 [7-31]) or in cohabitants (OR: 19.9 [6.7-59.5]). No cases of influenza virus were detected.

Conclusions

The percentage of pregnant women vaccinated against influenza is very low. Information could improve these results. No conclusions can be drawn on the study hypothesis.     

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.     

Influencia de la visita puerperal temprana en la detección y evolución de la depresión posparto

Objectives

The aim of this study was to determine the influence of early postpartum home visits in reducing the incidence of puerperal depression in our environment.

Material and methods

A total of 430 patients with uncomplicated pregnancy and delivery were randomized to two homogeneous groups (one group receiving an early postpartum home visit and a control group). The hospital anxiety and depression scale was used to assess puerperal depression at 7 and 30 days.

Results

At 7 days, 10.2% of the patients had a positive score for puerperal depression. At 30 days, the incidence of puerperal depression was lower in the group receiving an early home visit (0.9%) than in the control group (3.7%).

Conclusion

The incidence of postpartum depression in our setting was similar to the expected incidence. Early postpartum home visits seem to be useful in detecting this disorder and in reducing symptoms.     

Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección

Objectives

To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection.

Subjects and methods

Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II^® test, histological study, and analysis of other sexuallytransmitted diseases.

Results

Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman’s lifetime was significantly associated with HPV infection (χ² for trend: 4.187; p = 0.0407).

Conclusions

Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman’s lifetime.     

Impacto de la introducción en el primer trimestre del cribado combinado de trisomía 21 en la tasa de procedimientos invasivos

Objective

To study the impact of introducing first-trimester combined Down syndrome screening on invasive prenatal testing for prenatal diagnosis, together with the criteria change from 35 to 38 years old as the indication for obtaining the fetal karyotype.

Material and methods

A retrospective population-based study was carried out of invasive tests for prenatal diagnosis performed at the Cabueñes Hospital in Gijón (Spain). A first period from 31-1-2004 to 30-1-2006 (without the screening program) was compared with a second period from 31-1-2006 to 30-1-2008 (with the screening program). During the second period the impact of screening (31-1-2006 to 30-1-2007) was differentiated from that linked to changing the maternal age criteria to 38 years old as the indication for invasive testing (31-1-2007 to 30-1-2008).

Results

During the second period there was an overall reduction of 31.2% in invasive testing; 21.6% was exclusively attributable to first-trimester combined Down syndrome screening. In expectant mothers aged 35 or more at delivery, the number of amniocentesis performed in the second period was reduced by 30.74%; this tendency was maintained for pregnant women aged 38 years or more, showing a reduction of 25.92%. In the second period, 30% of the expectant mothers aged 38 years or more chose to have an invasive test due to their age compared with 61.53% in the first period.

Conclusions

First-trimester combined Down syndrome screening had a major impact on invasive testing, increasing its efficiency and, moreover, allowing detection rates to be improved.