Obstetric outcomes after treatment for cervical intraepithelial neoplasia: six years of experience.

OBJECTIVE: : The purpose of this study was to assess the effect of cervical conization on subsequent pregnancy and delivery outcomes. MATERIALS AND METHODS: : A retrospective case-control study was performed in patients who underwent conization from 2000 to 2005 and had a subsequent delivery. Two case controls were matched for each case studied. The obstetric outcomes of the 2 groups were compared. A subsequent analysis comparing the 2 excisional techniques used was performed. RESULTS: : The study population group included 87 women (29 cases and 58 controls). Overall, the mean gestation age at delivery (38 vs 39 wk, p = .003), prevalence of preterm birth (20.7% vs 5.2%, p = .025), mean birth weight (3,035 vs 3279 g, p = .018), and low birth weight (20.7% vs 1.7%, p = .02) were statistically different among the cases and controls.In the study group (n = 29), large loop excision of the transformation zone was used in 62% (n = 18) and laser was used in 38% (n = 11) of the cases. There was no significant difference in the medium depth of the excised tissue, the prevalence of preterm birth, low birth weight, and the cesarean delivery rate between the 2 techniques. CONCLUSIONS: : Despite the small number of cases, this study indicates that excision of the transformation zone is associated with an increased risk of overall preterm delivery and low-birth weight infants in subsequent pregnancies. No significant difference was found between the 2 cervical excision procedures.

Advanced abdominal pregnancy in a spontaneous heterotopic pregnancy.

Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy as the form of the ectopic component, outside the context of assisted reproduction, is an even more unusual and perilous diagnosis with very few cases reported in the literature. We report such a case in a 34-year-old multipara, with no known risk factors for ectopic pregnancy. The pregnancy was initially misdiagnosed and managed as a dichorionic gestation, complicated with fetal demise of one of the twins. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The abdominal pregnancy was subsequently managed via laparotomy with no complications.

[Warfarin hipersensitivity: how to deal with it?]. / Hipersensibilidade à varfarina: que abordagem?

The authors report a clinical case of warfarin hypersensitivity noticed when a patient, with thromboembolic risk, was submitted to warfarin. She was found to be heterozigotic to -1639G>A (gene VKORC1) and homozygotic to 1075A>C (genotype CYP2C9*3/*3). In this article the warfarin pharmacodinamics and its role over Vitamin K is revisited. It includes some suggested indications for investigating genetic polymorphisms, in order to avoid complications associated with warfarin.