RESUMEN
OBJECTIVE: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. METHODS: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to high-velocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. RESULTS: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. Immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. CONCLUSION: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound.
Asunto(s)
Traumatismos Abdominales/epidemiología , Complicaciones del Embarazo/epidemiología , Rotura Uterina/epidemiología , Útero/lesiones , Guerra , Heridas por Arma de Fuego/epidemiología , Heridas Penetrantes/epidemiología , Traumatismos Abdominales/cirugía , Cesárea , Femenino , Humanos , Recién Nacido , Laparotomía , Líbano/epidemiología , Embarazo , Complicaciones del Embarazo/cirugía , Estudios Retrospectivos , Rotura Uterina/cirugía , Heridas por Arma de Fuego/cirugía , Heridas Penetrantes/cirugíaRESUMEN
OBJECTIVES: The purpose of this study was to determine if antenatal sonographic determination of fetal ear length is a useful screening method for identification of fetuses with Down syndrome. METHODS: Ear length measurements were recorded in 418 fetuses undergoing ultrasound scanning between 20 and 28 weeks of gestation. Four trisomy 21 and six trisomy 18 fetuses were identified by karyotyping. The relationship between ear length and gestational age in the normal population was determined by linear regression analysis: expected ear length = -6.000 + 1.075 gestational age. The ability of measured-to-expected ear length cut-off ratios to discriminate between affected and non-affected fetuses was assessed. RESULTS: The mean ear length and measured-to-expected ear length ratios were significantly lower in the affected group as compared to the normal one. A measured-to-expected ear length ratio of less than 0.8 was 75.0% sensitive and 98.8% specific in detecting Down syndrome fetuses, and resulted in an 8.5% positive predictive value in the general population. CONCLUSIONS: This preliminary study suggests that antenatal ear length measurements might be a promising sonographic screening method for the detection of Down syndrome in the second trimester of pregnancy.
Asunto(s)
Cromosomas Humanos Par 18 , Síndrome de Down/diagnóstico por imagen , Oído/embriología , Enfermedades Fetales/diagnóstico por imagen , Trisomía/diagnóstico , Ultrasonografía Prenatal , Adulto , Síndrome de Down/epidemiología , Femenino , Enfermedades Fetales/epidemiología , Edad Gestacional , Humanos , Modelos Lineales , Edad Materna , Valor Predictivo de las Pruebas , Embarazo , Embarazo de Alto Riesgo , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To evaluate pregnancy outcome following uterine unification procedures in patients with uterine anomalies. METHODS: A retrospective survey included all abdominal metroplasty procedures performed on 43 patients at the American University of Beirut Medical Center between January 1, 1974 and December 31, 1991. Age at metroplasty, type of anomaly and surgical procedures, as well as preoperative and postoperative reproductive performance were all recorded. RESULTS: Forty (93%) out of 43 patients who underwent metroplasty had postoperative live births compared with five (12%) prior to surgery. The fetal wastage rate dropped from 93% pre- to 16% postoperatively. All seven patients with a history of primary infertility conceived and had live births. CONCLUSION: Our data suggest a remarkable improvement following abdominal metroplasty in patients with both typical and uncharacteristic preoperative reproductive performance.
Asunto(s)
Complicaciones Posoperatorias/etiología , Resultado del Embarazo , Útero/anomalías , Adulto , Femenino , Muerte Fetal/etiología , Muerte Fetal/prevención & control , Estudios de Seguimiento , Humanos , Recién Nacido , Infertilidad Femenina/cirugía , Embarazo , Estudios Retrospectivos , Útero/cirugíaRESUMEN
BACKGROUND: Very large cervical polyps are rarely reported. CASE: A giant cervical polyp, 17 x 10 x 5 cm, protruded through the vaginal introitus in a 27-year-old, sexually inactive woman. CONCLUSION: Although carcinomatous change occurs in 1.7% of cervical polyps, malignant degeneration did not occur in the six reported cases. Thus, biopsy of these tumors before excision may not be necessary.
Asunto(s)
Pólipos/patología , Neoplasias del Cuello Uterino/patología , Adulto , Biopsia , Femenino , Humanos , Leucorrea/etiología , Pólipos/complicaciones , Pólipos/cirugía , Cuidados Preoperatorios , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/cirugía , Hemorragia Uterina/etiologíaRESUMEN
Puerperal uterine inversion, a life threatening condition, is a true obstetrical emergency. Quick reanimation measures coupled with manual or surgical correction are the key to success in managing this rare condition.
Asunto(s)
Trastornos Puerperales , Enfermedades Uterinas , Enfermedad Aguda , Enfermedad Crónica , Urgencias Médicas , Femenino , Humanos , Incidencia , Trastornos Puerperales/clasificación , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiología , Trastornos Puerperales/terapia , Resucitación/métodos , Factores de Riesgo , Enfermedades Uterinas/clasificación , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/epidemiología , Enfermedades Uterinas/terapiaAsunto(s)
Coristoma/terapia , Pelvis , Bazo , Adulto , Coristoma/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , UltrasonografíaAsunto(s)
Traumatismos Abdominales , Complicaciones del Embarazo , Heridas Penetrantes , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/epidemiología , Traumatismos Abdominales/etiología , Traumatismos Abdominales/terapia , Femenino , Humanos , Mortalidad Materna , Neonatología/métodos , Obstetricia/métodos , Grupo de Atención al Paciente , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/terapia , Lesiones Prenatales , Traumatología/métodos , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/epidemiología , Heridas Penetrantes/etiología , Heridas Penetrantes/terapiaRESUMEN
Thoraco-amniotic shunting was performed in 51 singleton pregnancies for decompression and chronic drainage of fetal pleural effusions (n = 47), pericardial effusion (n = 1), or pulmonary cysts (n = 3). Five fetuses had chromosomal defects and in 4 the parents elected termination of pregnancy. All 18 non-hydropic fetuses and 14 of the 28 with hydrops survived. Thoraco-amniotic shunting is useful for diagnostic evaluation and treatment of fetuses with pathologic collection of intrathoracic fluid.
Asunto(s)
Amnios/embriología , Enfermedades Fetales/cirugía , Cirugía Torácica , Amnios/diagnóstico por imagen , Amnios/cirugía , Anastomosis Quirúrgica/instrumentación , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Malformación Adenomatoide Quística Congénita del Pulmón/embriología , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Femenino , Enfermedades Fetales/diagnóstico por imagen , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/embriología , Derrame Pericárdico/cirugía , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/embriología , Derrame Pleural/cirugía , Embarazo , Tórax/diagnóstico por imagen , Tórax/embriología , UltrasonografíaRESUMEN
Pelvic splenic ectopia is a very rare entity, often unsuspected preoperatively. We report a case of an ectopic spleen presenting as an adnexal mass in a middle-aged woman. Diagnosis was achieved intraoperatively, and confirmed pathologically. Pelvic ectopic spleen should be considered in the differential diagnosis of adnexal masses.
Asunto(s)
Enfermedades de los Anexos/diagnóstico , Coristoma/diagnóstico , Bazo/anomalías , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
During a 6-year period (1985-1990), blood karyotyping was performed in 44 fetuses with septated, bilateral, dorsal, cervical cystic hygromata. This condition constitutes a different entity from nuchal oedema. There were 33 (75%) chromosomal abnormalities, including Turner's syndrome (n = 31), trisomy 18 (n = 1) and trisomy 21 (n = 1). Congenital heart defects (CHD), mainly coarctation of the aorta, were present in 15 of the fetuses with Turner's and in 1 of the chromosomally normal fetuses. The incidence of CHD was higher in the fetuses with ultrasonographic evidence of moderate/severe hydrops (41%; 13 of 32 cases) than in those with mild or no hydrops (25%; 3 of 12 cases). Although both the biparietal diameter (BPD) and femur length (FL) were reduced in all fetuses, the FL to BPD ratio was below the 5th percentile in 29 of the 33 (88%) chromosomally abnormal fetuses, but in only 4 of the 11 (36%) chromosomally normal ones. In the chromosomally normal group, 3 of the fetuses had multiple pterygium syndromes, and in such cases the risk of recurrence may be high. In contrast, in the group of mutant chromosomal disorders with monosomy or trisomy, the risk of recurrence is in the order of 1%.
Asunto(s)
Aberraciones Cromosómicas/sangre , Enfermedades Fetales/genética , Neoplasias de Cabeza y Cuello/genética , Linfangioma/genética , Sistema Linfático/anomalías , Trastornos de los Cromosomas , Femenino , Sangre Fetal , Enfermedades Fetales/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/embriología , Humanos , Cariotipificación , Linfangioma/diagnóstico por imagen , Linfangioma/embriología , Sistema Linfático/diagnóstico por imagen , Embarazo , Ultrasonografía PrenatalRESUMEN
We report a postmortem cesarean section resulting in fetal survival, performed 25 minutes after maternal blast injury. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation represent important determinants of fetal survival. Improvement in maternal hemodynamic condition may potentially occur following the procedure. Postmortem cesarean section is advised in the event of fatal maternal trauma since it may result in fetal salvage.
Asunto(s)
Traumatismos por Explosión , Cesárea , Paro Cardíaco , Adulto , Muerte Súbita , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Factores de TiempoRESUMEN
A case of fibroepithelial polyp arising from the labium majus is described. The tumor measured 12 cm in its largest diameter and was connected to the left labium majus by a 12-cm pedicle. The microscopic examination showed hypocellular connective tissue and focal myxoid areas. One year following surgical excision, the patient did not manifest any signs of recurrence. This case is very unusual in that almost all reported vulvar fibroepithelial polyps are small and sessile.