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1.
Anna Maroto Jorge CostaBibiana Morillas Maria GrimauRamón Cos Manuel CoronaYolanda Canet 《Progresos de Obstetricia y Ginecología》2012
Introduction
Placental accreta has increased because of the greater use of prior uterine surgery, especially cesarean section. Treatment has evolved from a radical surgical approach to conservative management.Case report
A woman at 26.1 weeks of pregnancy was admitted to hospital because of premature rupture of membranes. Three days after a cesarian section was performed for suspected fetal distress, we observed placenta accreta. A fragment of placenta was left in the cornual bed. Given the absence of bleeding, an expectant attitude was adopted. Subsequent follow-up showed no abnormalities. Ultrasound and hysteroscopic monitoring showed a progressive reduction of placental size until its disappearance at 5 months postpartum.Discussion
The optimal management of placenta accreta remains controversial in the literature. In selected cases, we should offer the possibility of conservative treatment, reducing morbidity and preserving the fertility of the patient. 相似文献2.
Mariona Rius Rogelio Cruz Raquel Mula Virginia Borobio Arturo Pereira Antoni Borrell 《Progresos de Obstetricia y Ginecología》2012
Objective
To assess the clinical application of non-invasive methods in the management of alloimmunization from 2006 to 2010.Subjects and methods
Seventy pregnancies with risk of fetal anemia were studied by fetal middle cerebral artery peak systolic velocity (MCA-PSV). The efficacy of MCA-PSV was compared between the first, second and third transfusions. Prenatal testing of fetal RHD blood group using maternal blood was performed in pregnancies followed-up in our center.Results
Fetal blood sampling was performed in 22 pregnancies; of these, fetal transfusion was carried out in 20. Detection rates and the false-positive rate of MCA-PSV in the prediction of severe or moderate fetal anemia were 89% and 15% in pregnancies with no previous transfusions, 100% and 41% in patients with one previous transfusion, and 40% and 24% when more than one transfusion was performed.Conclusion
MCA-PSV has high sensitivity when there is one previous fetal transfusion but its specificity is lower. 相似文献3.
Almudena Pérez Quintanilla Gloria Costa MartínezMar Ramírez Mena Isabel Campo GestoVicente Furió Bacete José Antonio Vidart Aragón 《Progresos de Obstetricia y Ginecología》2010
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. 相似文献
4.
Y. José Gutiérrez J.M. Campillos MazaE. Cruz Guerreiro S. Castan Mateo 《Clínica e investigación en ginecología y obstetricia》2014
Pregnancies complicated by hydramnios are at increased risk of both maternal and fetal complications. Amnioreduction can restore normal amniotic pressure, thus increasing maternal comfort and prolonging pregnancy by limiting the risk of preterm labor and rupture of membranes. We present our experience in the management of two patients with severe polyhydramnios who were treated with amnioreduction. 相似文献
5.
Jesús Joaquín Hijona Elósegui Miguel Calero RojasAna Contreras Rodríguez M. del Carmen Toledano MonteroCarmen Pallarés Ayuso Juan Manuel Torres Martí 《Progresos de Obstetricia y Ginecología》2008
Cervical pregnancy is a rare form of ectopic pregnancy with a high risk of hemorrhage. Early diagnosis is an important prognostic factor for survival and preserved fertility in these patients. We present the case of a patient diagnosed with cervical ectopic pregnancy in her seventh week of gestation. The therapeutic management was conservative and involved the combination of systemic and intra-amniotic methotrexate Because of the lower associated morbidity and mortality and the possibility of maintaining the patient’s fertility, conservative treatment is a viable therapeutic approach in cases such as that presented herein. 相似文献
6.
M. Jesús Cancelo Hidalgo José Luis Neyro Bilbao Carlos Zorzo Ferrer Jon Andoni Mieza Arana 《Progresos de Obstetricia y Ginecología》2008
Uterine myoma is the most common nonmalignant pelvic tumor in women, occurring in 30%. Menorrhagia, pelvic pain, hypogastric distress, infertility and rapid growth are indications for hysterectomy. Uterine artery embolization has been proposed as a therapeutic alternative for menorrhagia caused by uterine myoma. 相似文献
7.
L. Sánchez-Hidalgo C. López de la ManzanaraA. Alpuente R.A. GarridoL. Sánchez-Hipólito A. González-López 《Clínica e investigación en ginecología y obstetricia》2012
Objectives
To evaluate the efficacy of medical treatment with methotrexate in ectopic pregnancy.Material and methods
We performed a prospective observational study of the use and effectiveness of medical treatment with methotrexate in patients diagnosed with ectopic pregnancy in the Ciudad Real University General Hospital from 2008 to 2009. A single intramuscular dose was administered in patients who met the inclusion criteria. Medical treatment was considered to have failed when surgery was required. We analyzed the economic costs of medical and surgical treatment.Results
We diagnosed 63 cases of ectopic pregnancy. Forty patients (63.5%) were treated with methotrexate, and 23 women (36.5%) who did not meet the criteria for inclusion in the protocol for medical treatment were treated surgically (laparoscopic salpingectomy). Among patients who received methotrexate, 30 (82.5%) required only one dose and 10 (17.5%) required two doses. Methotrexate treatment was successful in 30 patients (75%) and failed in 10 (25%), who underwent a laparoscopic salpingectomy. The cost per case of medical treatment was 580 €, which was less than the cost of laparoscopic surgical treatment (3,465.8 €).Conclusions
Methotrexate treatment of ectopic pregnancy in selected patients is as effective as the standard treatment with laparoscopy with less cost and with high acceptance by patients. 相似文献8.
Carme Merced Andrea GascónLucía Berlanga María GoyaLuis Cabero 《Progresos de Obstetricia y Ginecología》2013
Objectives
To compare the efficacy of cefditoren pivoxil versus amoxicillin in the treatment of urinary tract infections (UTI) and to evaluate the rate of reinfection and of maternal-fetal complications in both groups.Material and methods
We performed a cohort study in pregnant women with a diagnosis of UTI in the Vall d’Hebron Hospital from January, 2010 to June, 2010. Diagnosis, follow-up and subsequent evaluation of the mother and infant were performed in both groups.Results
We included 300 pregnant women diagnosed with a UTI: 150 patients received oral cefditoren pivoxil (400 mg/12 hours for 5 days) and 150 women received amoxicillin. No demographic differences were observed between the two groups. Disappearance of the infection was confirmed in 150 patients in the cefditoren pivoxil group versus 67% of those in the amoxicillin group (P=.03). Both the reinfection rate and the frequency of pyelonephritis were higher in the amoxicillin group [17.3% versus 4.6% (P=.02) and 40.6% vs 2.6% (P=.01) respectively]. There were no differences in hospital stay (2.4 days vs 2.5 days). Adverse effects were observed in 1.33% (two patients) in the cefditoren pivoxil group versus 0% in the amoxicillin group.Conclusions
In this study, cefditoren pivoxil produced a higher cure rate and a lower reinfection and pyelonephritis rate than did amoxicillin. Cefditoren pivoxil might be a therapeutic alternative in pregnant women with UTI. Further studies are needed to confirm these results. 相似文献9.
Laura Costa Jordi Costa Joan Falcó Patricia Bermudez Joan Perandreu Laia Ribot Ángel López-Muñiz Yolanda Canet 《Progresos de Obstetricia y Ginecología》2009
Objective
To evaluate the mid-term outcomes and patient satisfaction following UAE in women with symptomatic leiomyomata, as well as to assess safety treatment.Material and methods
Prospective study of 90 patients from Sabadell Hospital between December 2002 and October 2006.Data were collected using a questionnaire and was later introduced in a specific database. Statistical analysis of data was carried out using SPSS 15.0.All patients went on a 2-year follow-up after UAE, including clinical, laboratory and diagnostic imaging examinations.Symptoms were scored as successful, improvement, unchanged or worsened. Adverse events were noted following the Society of Interventional Radiology's classification. Patients were also asked about their satisfaction.The need of an eventual hysterectomy or the persistence of symptoms was considered to be a treatment failure.Results
The improvement of symptoms occurred in 90,7% of all the embolized women. We had to perform a second embolization in 4 cases, and a hysterectomy in 6 cases.6 months later, null vascularisation or hypovascularisation of the myoma was observed in 92.8% of women. Over two years, the average volume reduction of the dominant myoma was 76.3%.The rate of major complications was 12.7%. Patient satisfaction for the procedure was 90.2%.Conclusions
Uterine artery embolization is an effective treatment for women with symptomatic uterine leiomyomata, being well accepted by the patients in the mid-term follow-up. 相似文献10.
L. Costa A. López-Muñiz J. Costa J. Falcó J. Perandreu R. Cos N. Prat 《Progresos de Obstetricia y Ginecología》2007
We present 2 cases of spontaneous transcervical expulsion of myoma after uterine artery embolization as a primary treatment of leiomyomata, which produced symptom improvement. Subsequent follow-up was performed with hysteroscopy and magnetic resonance imaging. 相似文献
11.
Antonio Martín GutiérrezBelén Garrido Luque Luís García MartínLaura Benítez Toledo José C. Maañón di Leo 《Progresos de Obstetricia y Ginecología》2011,54(7):379-382
Objective
To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate.Subjects and methods
Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1 mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment.Results
Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability.Conclusions
Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective. 相似文献12.
Jennifer Rovira Pampalona Laura Cusiné LópezIsabel Aznar García Tamara García GrandalJ. Carlos Mateu Pruñonosa Irene Mora HervásPere Brescó Torras 《Progresos de Obstetricia y Ginecología》2011,54(12):634-636
Cornual pregnancy is very rare, with an incidence of 2-4% of ectopic pregnancies. As with tubal pregnancy, treatment options include surgery, medical therapy or a combination of both. Currently, there are also other treatment options that are effective. We report a case of cornual pregnancy treated with hysteroscopic resection followed by laparoscopic review, which can be an effective treatment option. 相似文献
13.
M. Fasero Laiz Pluvio Coronado MartínJavier García Santos Francisco Ros BerruezoCarlota Ruesta Teran Almudena Pérez Quintanilla 《Progresos de Obstetricia y Ginecología》2010
Three cases of cervical ectopic pregnancy treated medically are described. The first case with selective uterine artery embolization and methotrexate dose single, the second case with selective uterine artery embolization and methotrexate dose multiple, and the third case intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat was necesary, before selective uterine artery and methotrexate dose unique. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. The diagnostic and therapeutic methods are discussed and the literature is reviewed. 相似文献
14.
Guadalupe Aguarón Benítez Marco Arones CollantesRocío Moreno Selva Jessica Nogueira GarcíaGaspar González de Merlo 《Progresos de Obstetricia y Ginecología》2013
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. 相似文献
15.
Borja Rivero Mikel Gorostidi Daniel Andia Enrique Izaguirre Javier Diez Carlos Pérez José Ignacio Olabarri Aloña Elorza José Ramón Serrano Emerson Murua 《Progresos de Obstetricia y Ginecología》2010
Objective
The main objective of this study was to evaluate the conization technique used in Basque Country hospitals and to determinate the most appropriate place to perform this procedure (outpatient clinic or operating room) by evaluating pain, early and late complications and histological results.Materials and methods
We selected 232 patients with a cytologic and colposcopic diagnosis of cervical dysplasia requiring surgical cervical conization between September 2006 and July 2007 in eight public hospitals of the Basque Country.Results
A total of 94.8% of conizations were performed with long loop excision of transformation zone (LLETZ) and, exceptionally, with cold knife conization. Local anesthesia was used in tertiary hospitals and regional anesthesia in county hospitals. Pain tolerance in outpatient conization with LLETZ under local anesthesia was excellent. In Hospital Donostia, pain was scored on a visual analogue scale and low scores were achieved, in accordance with the high degree of satisfaction obtained with the procedure. Conization margins depended on the grade of dysplasia rather than on the technique. There were few early complications and even fewer late complications.Conclusion
The LLETZ method performed under local anesthesia in the outpatient clinic is very well tolerated by patients and has few complications. Consequently, this option is a valid alternative to conization under general or regional anesthesia. The LLETZ technique provides multiple advantages for the patient and health service due to its lower cost, without medical disadvantages, and satisfactory tolerance. 相似文献16.
J. de la Rosa M.V. San Román M. López L. Oleaga T. Ibáñez 《Progresos de Obstetricia y Ginecología》2006
Objective
Evaluation of feability of magnetic resonance (MRI) in the assessment of the grade of myometrial invasion in endometrial carcinoma in our service.Material and method
Retrospective study about pelvic MRI (dynamic, intravenous contrast media with gadolinium) sistematically made in the presurgical study of endometrial carcinoma in our service. 123 MRI were made in many other patients diagnosed of endometrial carcinoma between the year 2000-2004, both included. Afterwards, the results were contrasted with the histologic studies of the surgical piece.Results
In 112 of the 123 neoplasms studied there was myometrial invasion valorated in the anatomopathologic study (paraffin sections). The MRI presented concordance with the histology in 101 cases, the positive predictive value (PPV) was 97% and although the negative predictive value (NPV) was 38.8%, the corrected negative predictive value (cNPV) was 87.5%.Conclusions
Pelvic magnetic resonance with intravenous contrast media is a good technique to leave out deep myometrial invasion in endometrial carcinoma (cNPV: 87.5%), but its value is lower when pretending to asses superficial myometrial invasion (NPV 38,8%).When the uterine miomas are associated to endometrial carcinoma the specificity (25%) and the cNPV (14%) endure a great descent. 相似文献17.
Yasmina José Gutiérrez Álvaro Alvir AlvaroJosé Manuel Campillos Maza Pilar Garrido FernándezBelén Rodríguez Solanilla Sergio Castán Mateo 《Progresos de Obstetricia y Ginecología》2011,54(5):257-260
Abdominal pregnancy is a rare form of ectopic pregnancy and is associated with high maternal and fetal morbidity and mortality. The diagnosis of this entity is difficult and is generally delayed. We report the case of a patient with an abdominal pregnancy diagnosed by transvaginal ultrasound in the first trimester of pregnancy. The patient was treated with methotrexate until complete resolution. We provide a review of the literature on the risk factors, diagnostic tests and therapeutic options for abdominal pregnancy. 相似文献
18.
Ricardo Savirón Cornudella Cristina Martínez PayoElisa Díaz de Terán Martínez-Berganza Inés Tamarit DegenhardtEnrique Iglesias Goy 《Progresos de Obstetricia y Ginecología》2006
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. 相似文献
19.
Objectives
To assess a clinical intervention protocol for aspiration curettage based on a nonstandard procedure for presurgical evaluation, continuous ultrasonographic monitoring, and performance of the process in an outpatient room.Subjects and methods
We reviewed 1,600 surgical procedures carried out in our hospital according to our protocol. Surgical times, the complication rate and patient satisfaction were analyzed.Results
The mean surgical time was 6.88 minutes. There were five surgical complications (0.3%). Medical complications occurred in 39 patients (2.4%). Dilatation was easy in 97.8%, difficult in 1.7% and very difficult in 0.6%. Tolerance to the technique was considered as excellent or good by 96.8% of the patients.Conclusions
Assessment of the clinical intervention protocol in obstetric aspiration curettage is safe, effective and quick. 相似文献20.
Ana Belén Partal Lorente María del Carmen Pallarés AyusoSilvia Pérez López María José Campos PinelVicente Maldonado Ezequiel Juan Torres Martí 《Progresos de Obstetricia y Ginecología》2011,54(6):306-309
We present a case of cervical ectopic pregnancy diagnosed in the sixth week of gestation. The speed of diagnosis and good clinical status of the patient allowed conservative treatment to be applied. Two doses of systemic methotrexate were required to decrease human chorionic gonadotrophin (βHCG) values followed by the use of intrasaccular methotrexate due to the persistence of the ultrasound image.Medical treatment with systemic and/or intrasaccular methotrexate is a highly effective measure to achieve low morbidity. This option allows more aggressive techniques to be reserved for patients unresponsive to this treatment or those with complications. 相似文献