Disección aórtica aguda tipo A,una enfermedad catastrófica asociada al embarazo

Objective

To describe two fatal cases of type A acute aortic dissection associated with pregnancy.

Methods

We reviewed the medical records and autopsies of patients, and then identified some mechanisms linking this entity to pregnancy.

Results

Both deaths occurred in women aged less than 35 years at the end of gestation. One patient had aortic coarctation and bicuspid aortic valve, while the other had no risk factors.

Conclusion

Hemodynamic changes in the third trimester of pregnancy may be involved in the onset of this entity. Rapid diagnosis is essential to prevent its high associated mortality.     

Oligoamnios severo tras la administración de diclofenaco en el tercer trimestre de gestación

Objective

To describe the clinical findings in a case of severe fetal oligohydramnios associated with maternal ingestion of diclofenac, as well as to review the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy.

Subjects and methods

We present the case of a woman at 27 weeks of pregnancy with nephritic colic who developed acute oligohydramnios after receiving anti-inflammatory treatment.

Results

The oligohydramnios resolved after discontinuation of diclofenac.

Conclusions

NSAIDs should be used with caution during pregnancy due to possible adverse effects, including impaired renal function and premature constriction of the ductus arteriosus.     

Sífilis y embarazo: incidencia y evolución histórica en el área sur de Granada

Objective

To evaluate the prevalence of syphilis infection in pregnancy and the results of the management of this disease.

Material and methods

We performed a retrospective study of all cases of syphilis infection in pregnancy diagnosed and treated between January 1996 and December 2006 in the San Cecilio University Hospital in Granada.

Results

During the 11-year period studied, the overall incidence of syphilis infection in pregnancy was 2.42 × 10⁻⁰⁴ (seven cases), with three cases occurring in the final year.

Conclusions

In our area, the incidence of syphilis in pregnancy was higher than the average reported in other countries of a similar socioeconomic level (e.g. the USA with 1.1 × 100,000 pregnancies), possibly due to the increase in the immigrant population     

Evaluación del tratamiento médico del embarazo ectópico con metotrexato

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.     

Degeneración cerebelosa paraneoplásica en cáncer ginecológico: descripción de 3 casos

Background and objective

Paraneoplastic cerebellar degeneration (PCD) is a rare neurological complication that develops in patients with cancer and is associated with different antibodies. PCD associated with anti-Yo antibodies usually occurs in patients with gynecological cancer. There is no diagnostic method that would allow early detection and appropriate treatment.

Methods

We describe three patients who presented with subacute cerebellar dysfunction and positive anti-Yo antibodies. After diagnosis and treatment, the patients were monitored to evaluate persistence of the neurological syndrome.

Results

Imaging studies were performed when gynecologic cancer was suspected. In all patients, fluorodeoxyglucose-positron emission tomography/tomography computerized (FDG-PET/TC) was the only imaging test that led to suspicion of the primary lesion. Histological examination confirmed the diagnosis of ovarian carcinoma in two patients and carcinoma of the horn in the third patient. All patients underwent radical surgery and subsequent chemotherapy. Corticosteroids were administered with no improvement of the neurological syndrome in any of the patients.

Conclusion

Oncologic treatment does not improve neurological symptoms. FDG-PET/TC with fluorodeoxyglucose could be useful in cases of PCD in which conventional imaging tests do not identify the underlying malignancy.     

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.     

Éxito en el manejo conservador del acretismo placentario mediante embolización y metotrexato

Introduction

The incidence of placenta accreta has risen and this entity can cause postpartum hemorrhage, often requiring obstetric hysterectomy. There are, however, alternative conservative treatments to surgery.

Case report

A 38-year-old woman in her first pregnancy underwent manual removal of the placenta, with moderate hemorrhaging and subsequent curettage. The diagnosis was confirmed by ultrasound scan and magnetic resonance imaging. Selective embolization of the nutritional vessel was performed and methotrexate was administered. Three days after the embolization, the placental mass was expelled.

Conclusions

Selective embolization of a nutritional vessel and adjuvant treatment with methotrexate are conservative techniques that allow preservation of both the uterus and fertility. According to previous reports in the literature, the time interval between delivery and definitive placental expulsion was lower in our case than in other conservatively managed cases.     

Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino

Objective

To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies.

Material and methods

We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture.

Results

We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid.

Conclusions

Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy.     

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.     

Embarazo ectópico: de la cirugía de urgencia al tratamiento médico. Evolución de la terapéutica en nuestro centro

Objective

To analyze changing trends in the management of ectopic pregnancy in the previous 9 years.

Material and methods

We performed a retrospective study of 355 patients with ectopic pregnancy treated at the Virgen de las Nieves University Hospital from 1998 to 2006. We reviewed and analyzed changes in treatment trends over this 9-year period.

Results

Medical treatment was initiated in 139 patients (39.15%), with a failure rate of 10.07%. Surgery was performed in 230 women (60.85%). Of these, laparoscopy was performed in 121 and laparotomy in 109.

Conclusions

Laparoscopic surgery is currently the first-line therapeutic option in the management of tubal ectopic pregnancy. However, in the last few years, medical treatment has been shown to be safe and effective, allowing a less invasive approach.     

Malformación adenomatoide quística congénita pulmonar. Una entidad infrecuente

Objective

We want to stress an infrequent entity and his histipathological features.

Material and methods

It was a voluntary interruption of the pregnancy.

Resultados

The prognosis is poor due to the clinical characteristics and the frequent association with other malformations.

Conclusions

Cystic adenomatoid malformation of the lung is classified according to clinical and pathological criteria and the prognosis is ominous.     

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical

Objective

To present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature.

Subjects and methods

A primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed.

Results

A 3050 g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy.

Conclusions

Umbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed.     

Diagnóstico genético preimplantacional en un caso de una paciente portadora de una inmunodeficiencia combinada severa. Revisión crítica de este procedimiento en ciclos de FIV-ICSI

Objective

To perform a critical analysis from a clinical case of preimplantation genetic diagnosis (PGD).

Patients and methods

A patient is described who has a disease of genetic origin (severe combined immunodeficiency) in which PGD was of vital importance for her treatment.

Conclusions

PGD is a very important tool in assisted reproduction but its indications, except in monogenic diseases and those linked to sex, are still under debate.     

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.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

Vulvar Arteriovenous Malformation in a 16-Year-Old Girl

Background

Congenital arteriovenous malformations (AVMs) are infrequent but represent a serious medical challenge because of their unpredictable progression and high hemodynamic activity.

Poor prognosis in cycles following “genuine” empty follicle syndrome

Objectives

The aim of this study was to investigate the prognosis in future IVF cycles of patients with empty follicle syndrome (EFS).

Study design

EFS cases and their future cycles were reviewed. Clinical pregnancy rate per started cycle was taken as the primary outcome in assessing the future outcome in IVF treatment cycles.

Results

A total of 3023 patients underwent 5238 IVF treatment cycles. Twenty-six patients (1%) had a total of 58 (1%) cycles of EFS. Thirteen women went through 32 further IVF treatment cycles following the diagnosis of EFS, yielding only two clinical pregnancies, giving a clinical pregnancy rate of 6.25% per started cycle. In addition, four patients had recurrence in a total of 15 cycles.

Conclusions

The occurrence of EFS will indicate poor IVF success in subsequent IVF cycles. Patients with “genuine EFS” should be counselled about the outcome of their future IVF cycles.     

Inversión uterina puerperal

Introduction

Uterine inversion is a rare obstetric emergency that occurs during the third stage of labor

Objective

To describe the clinical, diagnostic and therapeutic characteristics and outcomes in patients with uterine inversion.

Material and methods

We performed a retrospective study of six patients with uterine inversion during the puerperium in the Hospital de Leon (Spain) in 2005.

Results

All inversions occurred in primiparous women with epidural anesthesia and instrumental delivery at term. Oxytocin was used in 83% during dilatation; the average duration of which was 6.5 hours. Diagnosis was mainly clinical except in one grade II inversion, which required ultrasonography and was resolved surgically. The remaining cases were resolved through manual reduction (83%). After the episode, hemoglobin levels were reduced by an average of 2.7 g/dl from prepartum levels, and only two patients required blood transfusion.

Conclusions

Factors predisposing to uterine inversion were hypotonic uterus, fundal implantation of the placenta, and placenta accreta. Sixty percent of all cases were caused by precipitous maneuvers including traction on the cord or improper fundal pressure. Diagnosis is essentially clinical. Although uncommon, uterine inversion will result in severe hemorrhage and shock if left unrecognized, leading to maternal death. Once a diagnosis is made, immediate measures must be taken to stabilize the mother. Manual manipulation should be attempted immediately to reverse the inversion. Tocolytics, such as ritrodine, magnesium sulphate and terbutaline, or halogenated anesthetics may be administered to relax the uterus and aid its reversal. Intravenous nitroglycerin is an alternative to tocolytics. Failure of reversion or recurrence requires surgical treatment.     

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura

Introduction

Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers).

Material and methods

This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Príncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available.

Discussion

PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome.

Conclusion

Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity.