Schwannoma Con Una Localización Cervical Infrecuente En Un Paciente Pediátrico: Reporte De Caso / Schwannoma With A Non-Frequent Location In Pediatric Patient. Case Report

Resumen Los schwannomas son tumores usualmente benignos, de crecimiento lento y generalmente propios de adultos. Son muy raros en la población pediátrica y su diagnóstico requiere un alto índice de sospecha clínica. Se presenta el caso de un paciente de sexo masculino de 9 años con historia de una masa cervical asintomática, sin otros antecedentes clínicos relevantes. La escisión total de la masa fue posible e histopatología confirmó el diagnóstico de schwannoma. El paciente se recuperó completamente, con excelente pronóstico. Es necesario tener presente a los schwannomas en el diagnóstico diferencial en casos de masas cervicales en pacientes pediátricos.

Abstract Schwannomas are usually benign, slow-growing tumors, usually found in adults. They are very rare in the pediatric population and their diagnosis requires a high index of clinical suspicion. We present the case of a 9-year-old male patient with a history of an asymptomatic cervical mass, with no other relevant clinical history. Total excision of the mass was possible, and histopathology confirmed the diagnosis of schwannoma. The patient recovered completely, with excellent prognosis. It is necessary to keep in mind schwannomas in the differential diagnosis in cases of cervical masses in pediatric patients.

Predictors of perinatal outcomes and economic costs for late-term induction of labour.

OBJECTIVE: We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. MATERIALS AND METHODS: We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. RESULTS: A very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77-6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43-24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09-0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was €3465.56 (95% confidence interval [CI], 3339.53-3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis. CONCLUSION: The cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling.

Economic implications of labor induction.

OBJECTIVE: To assess health service costs associated with labor induction according to different clinical situations in a tertiary-level hospital. METHODS: In a prospective study, individual patient cost data were assessed for women admitted for induction of labor at a tertiary hospital in Spain between November 1, 2012, and August 31, 2013. The costs of labor induction were estimated according to maternal and neonatal outcomes, method of delivery, cervical condition at admission, and obstetric indication. Direct costs including professional fees, epidural, maternal stay, consumables, and drugs were calculated. RESULTS: Overall, 412 women were included in the final cost analysis. The mean total cost of labor induction was €3589.87 (95% confidence interval [CI] 3475.13-3704.61). Cesarean delivery after labor induction (€4830.45, 95% CI 4623.13-5037.58) was significantly more expensive than spontaneous delivery (€3037.45, 95% CI 2966.91-3179.99) and instrumental vaginal delivery (€3344.31, 95%CI 3151.69-3536.93). The total cost for patients with a very unfavorable cervix (Bishop score <2; €4283.47, 95% CI 4063.06-4503.88) was almost double that for women with a favorable cervix (€2605.09, 95% CI 2327.38-2837.58). Labor induction for hypertensive disorders of pregnancy was the most expensive obstetric indication for induction of labor (€4347.32, 95% CI 3890.45-4804.18). CONCLUSION: Following the induction of labor, a number of patient- and treatment-related factors influence costs associated with delivery.

Amniotic fluid sludge as a marker of intra-amniotic infection and histological chorioamnionitis in cervical insufficiency: a report of four cases and literature review.

Amniotic fluid sludge (AFS) is defined as the presence of particulate matter in the amniotic fluid in close proximity to the cervix. Although its prevalence is known to correlate with the risk of preterm delivery, initial reports describe a strong association between AFS and microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis. However, AFS is also present in uncomplicated pregnancies, and its prevalence appears to increase with gestational age. Recent evidence debates the usefulness of AFS as a marker of early preterm delivery risk. We present four cases with AFS diagnosed by transvaginal ultrasound at admission for cervical insufficiency between 20 and 24 weeks of gestation, with confirmed lower genital tract and intra-amniotic infections by amniocentesis and histological chorioamnionitis and funisitis. Our findings reinforce the presence of AFS as a useful marker of MIAC, chorioamnionitis and funisitis that increase the likelihood of preterm delivery at an extreme gestational age.

Cervix assessment for the management of labor induction: reliability of cervical length and Bishop score determined by residents.

AIM: To evaluate the reliability of two techniques of cervical ripeness assessment at the beginning of labor induction, as assessed by inexperienced observers. METHODS: A total of 120 women were prospectively studied at admission for labor induction. Two independent physicians examined consenting women successively but separately. One experienced consultant and one of the six first-year obstetrics residents composed the pairs of observers. The trainees had very limited prior experience with cervical ultrasound scan or evaluating Bishop score. Cervical length and Bishop score were evaluated according to standard methodology. Reliability was described by intraclass correlation coefficients (ICC) and coefficients of variation (COV). Ultrasound cervical length was plotted according to the Bland-Altman method. RESULTS: The median Bishop score and mean cervical length were similar for all observers. Ultrasound cervical length and Bishop score were highly reliable when evaluated by first-year residents. Ultrasound cervical length showed the highest interobserver agreement, with ICC values over 0.9 and COV values of approximately 10% or less for all trainees. The Bishop score was also reliable, but with lower ICC and higher COV values. CONCLUSION: Bishop score and ultrasound cervical length examination for the management of labor induction are accurate and easy to learn by inexperienced first-year residents. However, cervical length showed higher reliability than the Bishop score.

[Conservative management of cervical ectopic pregnancy]. / Tratamiento conservador de la gestación ectópica cervical.

BACKGROUND: Cervical ectopic pregnancy is a rare type of ectopic pregnancy (less than one percent of all ectopic pregnancies). OBJECTIVE: Assess the efficacy of the treatment options available. MATERIAL AND METHODS: Retrospective study of the cervical ectopic pregnancies treated in our hospital from January 2005 to December 2011. RESULTS: Three patients were diagnosed cervical ectopic pregnancy in our hospital during that period, that is, an incidence of 1.7 per 10,000 gestations. The main symptom was a moderate-to-severe genital hemorrhage. In two of the cases a single dose of 50 mg/cm2 methotrexate was administered, and in the third one, curettage and uterine arterial embolization were performed. Histerectomy was not necessary in either of the cases. CONCLUSION: Conservative management of cervical ectopic pregnancy is an effective and safe option.

Low-risk pregnancy at 41 weeks: when should we induce labor?

OBJECTIVE: To study the perinatal outcome according to whether labor was induced or not, when a low-risk pregnancy reached 41 weeks of gestation. METHODS: A quasi-experimental study of 11492 low-risk singleton pregnancies was designed. A total of 1,721 patients (15.0%) women met the study criteria, were informed about the risks and benefits and gave their informed consent, of whom 629 (36.5%) were planned for induction soon after the 41 weeks (287-289 days). RESULTS: An intention-to-treat analysis was performed. The proportion of small-for-gestational age babies was lower in the early-induced labor cohort (10.5% versus 15%; p = 0.008). This cohort showed an increased hospital stay (4.54 versus 3.80 days; p < 0.001), and a higher rate of requiring delivery by caesarean section (31.1% versus 19.8%;p < 0.001), including the need for caesarean section for failed induction (21.8% versus 11%;p < 0.001). Three stillbirths occurred in the group followed expectantly, whereas no stillbirths were seen in the early induction group. CONCLUSIONS: Induction of labor for prolonged pregnancy in low-risk patients soon after the 41 weeks, reduces the proportion of small-for-gestational age babies, but increases the mean hospital stay as well as the need for delivery by caesarean section, including that for failed induction.