Protocolo para el manejo de placenta percreta con cesárea, embolización uterina e histerectomía diferida / Protocol for the management of percrete placenta with cesarean, uterine embolization, and deferred hysterectomy

Introducción. El objetivo de este artículo fue dar a conocer el protocolo institucional del manejo de la placenta percreta como un procedimiento varias horas después de la cesárea, con embolización de arterias placentarias de forma selectivas, previo a la práctica de la histerectomía, y presentar los resultados. Métodos. Estudio de serie de casos, donde se evaluaron las pacientes con placenta percreta, manejadas durante un año en un hospital de cuarto nivel de complejidad en la ciudad de Bogotá, D.C., Colombia. Se efectuó cesárea fúndica y se dejó la placenta in situ, 48 a 72 horas después se realizó embolización ultra selectiva y luego de 2 a 3 días se procedió a practicar la histerectomía vía abdominal. Resultados. Se evaluaron 5 pacientes, con paridad de 3,8 embarazos promedio, con diagnóstico de placenta percreta. El tiempo promedio de espera entre la embolización y la histerectomía fue de 1,6 días. No se presentaron complicaciones asociadas a la embolización, ni morbimortalidad materno fetal. Los volúmenes de sangrado en promedio durante la histerectomía de cada paciente fueron de 1160 ml. Conclusión. Existen datos limitados sobre el tratamiento óptimo del acretismo placentario. La sospecha diagnóstica permite planificar de forma favorable el manejo intraparto y, es por ello, que el surgimiento de nuevas técnicas, como la embolización de arterias placentarias, constituyen alternativas para un manejo más seguro de las pacientes.

Introduction. The objective of this article was to present the institutional protocol for the management of percrete placenta as a procedure several hours after cesarean section, with selective embolization of placental arteries, prior to the practice of hysterectomy, and to present the results. Methods. Case series study, where patients with percrete placenta were evaluated, managed for 1 year in a hospital of fourth level of complexity in the city of Bogotá, Colombia. A fundic cesarean section was performed and the placenta was left in situ, 48 to 72 hours later an ultra-selective embolization was performed, followed by an abdominal hysterectomy after 2 to 3 days.Results. Five patients with a diagnosis of placenta percreta were evaluated; mean wait time between embolization and hysterectomy was 1.6 days. There were no complications associated with embolization, or maternal-fetal morbidity and mortality. Average bleeding volumes during hysterectomy for each patient were 1160 ml. Conclusion. There are limited data on the optimal treatment of percrete placenta. Diagnostic suspicion allows for a favorable planning of intrapartum management and, for this reason, the emergence of new techniques, such as placental artery embolization, constitute alternatives for a safer management of patients.

Placenta mórbidamente adherente asociada a malformaciones congénitas: reporte de caso / Morbidly adherent placenta associated with congenital malformations: a case report

INTRODUCCIÓN: Las alteraciones en la placentación son causa importante de morbilidad materna y neonatal y, en ocasiones, de mortalidad. La literatura científica menciona la posible asociación entre acretismo placentario y alteraciones en los parámetros bioquímicos para aneuploidía, sin descripciones de casos en que coincidan estos dos hallazgos. OBJETIVO: Este es un reporte de caso de una gestante con placenta percreta y producto con trisomía 13 REPORTE DE CASO: Gestante de 34 años, gesta 4 cesáreas 2, abortos 1, vivos 2, con embarazo de 20.4 semanas, sin antecedentes de importancia, con hallazgos en ecografía de iii nivel de alteraciones morfológicas en el sistema nervioso central, onfalocele, malformación cardiaca y deformidades en miembros. Con doppler de placenta que evidencia placenta mórbidamente adherida variedad percreta; hallazgos ecográficos confirmados con el estudio anatomopatológico. CONCLUSIONES: La trisomía 13 es una condición genética que debido a las múltiples malformaciones asociadas se considera incompatible con la vida, la placenta mórbidamente adherida se ha asociado con morbimortalidad neonatal y fetal, la no evidencia en la literatura de estas dos condiciones asociadas puede ser debido a la interrupción temprana de las gestaciones en las que se confirma el primer diagnóstico.

BACKGROUND: Alterations in placentation are an important cause of maternal and neonatal morbidity and, sometimes, deaths. The scientific literature mentions the possible association between placental accreta and alterations in the biochemical parameters for aneuploidy, without descriptions of cases in which these two findings coincide. OBJECTIVE: This is a case report of a pregnant woman with placenta percreta and trisomy 13, in which an ultrasound and pathological analysis were made. The use of keywords, in different databases, did not yield information that directly comply with these associations. CASE REPORT: A 34-year-old pregnant woman, G4C2A1V2 with a 20.4-week pregnancy, without significant medical records, with findings at III level ultrasound of morphological alterations of the central nervous system, omphalocele, cardiac malformation and limb deformities. Also, with placental Doppler that evidences morbidly adhered placenta variety percreta; ultrasound findings confirmed with the pathological study. CONCLUSION: The morbidly adhered placenta has been associated with neonatal and fetal mortality, in which some of the identified causes of fetal death are congenital anomalies. This way this case report allows for the first time to describe the association of placental accreta with aneuploidy, type trisomy 13, demonstrated by the morphological alterations of the pathological and karyotype study.

Thick “Swiss Cheese” Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Retenção de placenta e endometrite subclínica: prevalência e relação com o desempenho reprodutivo de vacas leiteiras mestiças / Retained placenta and subclinical endometritis: prevalence and relation with reproductive performance of crossbred dairy cows

Objetivou-se avaliar os efeitos do tipo de parto (eutócico vs. distócico) e do período do ano (chuvoso vs. seco) sobre a prevalência de retenção de placenta (RP) e de endometrite subclínica (ES), verificar a relação entre as duas patologias, e os efeitos dessas sobre a taxa de descarte, o período de serviço (PS) e número de IA/concepção. A RP foi avaliada no primeiro dia pós-parto (DPP). A citologia endometrial foi realizada entre 30 e 80 DPP, considerando positivos casos contendo acima de 5% de neutrófilos. Os dados foram analisados por regressão logística e análise de variância no programa Minitab (P<0,05). A prevalência de RP foi de 14,93% (69/462) e de ES de 27,49% (127/462). Foi detectada tendência de efeito (P=0,10) da RP sobre a prevalência da ES. Partos distócicos aumentaram a prevalência de RP e vacas que pariram nos meses chuvosos tiveram maior prevalência de ES (P<0,05). A RP elevou a taxa de descarte (P<0,05), a duração do período de serviço (P<0,05) e o número de IA por concepção (P<0,05), enquanto a ES não afetou essas variáveis (P>0,05). Conclui-se que a retenção de placenta tende a ser um fator de risco para endometrite subclínica, distocia predispõe à retenção de placenta e partos ocorridos no período chuvoso aumentam os casos de endometrite subclínica. Há um impacto negativo na eficiência reprodutiva de vacas leiteiras mestiças acometidas por retenção de placenta.(AU)

This study aimed to evaluate the effects of type of calving (eutocic vs. dystocic), season of the year (rainy vs. dry) on retained placenta (RP) and subclinical endometritis (SE) prevalence, to verify the relation between these diseases, as well as its effects on culling rate, days open and number of AI/conception. Retention of fetal membranes was recorded on first day postpartum. Endometrial cytology was performed between 30 and 80 days in milk (DIM) and positive cases were considered ≥5% neutrophils. Data were analysed by logistic regression and analysis of variance on Minitab program (P<0.05). The prevalence of RP was 14.93% (69/462) and of SE was 27.49% (127/462). A tendency of effect of RP on SE prevalence was detected (P=0.10). Dystocia increased RP prevalence (P<0.05). Cows that calved during rainy months had greater SE prevalence (P<0.05). RP increased culling rate (P<0.05), calving to conception interval (P<0.05) and number of AI/conception (P<0.05), although SE occurrence did not affect these variables (P>0.05). In conclusion, RP tended to be a risk factor for SE, dystocia is a predisposing factor for RP and calvings that happens during rainy period increases SE. There is a negative impact on reproductive efficiency of crossbred dairy cows that had retained placenta.(AU)

Impacto econômico da retenção de placenta em vacas leiteiras / Economic impact of retained placenta in dairy cows

Aproximadamente 75% das doenças em vacas leiteiras acontecem no primeiro mês após o parto e esses problemas têm sua origem associada ao sistema imune e ao consumo de alimentos duas a três semanas antes do parto. Doenças relacionadas ao trato reprodutivo como, por exemplo, retenção de placenta pode afetar a eficiência reprodutiva assim como a produção de leite. Os efeitos das doenças nos processos fisiológicos dos animais se transformam em impactos econômicos passíveis de serem mensurados. Objetivou-se avaliar o impacto econômico da retenção de placenta em um rebanho composto de 900 vacas em lactação. O diagnóstico de retenção de placenta foi definido como presença da placenta 24 horas após o parto. Foi utilizado um banco de dados no estudo, do qual foram extraídas as seguintes informações: ano de parição, época de parição, ordem de lactação, presença da placenta 24 horas após o parto, e número de doses de sêmen por gestação. Para cálculo do impacto econômico foram considerados os custos diretos (tratamento, mão de obra, redução da produção de leite e descarte de leite durante o período de tratamento) e indiretos (aumento do período de serviço, aumento do número de doses de sêmen e aumento do risco de descarte). Os valores médios relacionados aos custos foram obtidos junto ao veterinário responsável pela propriedade com referência ao ano de 2009 para que os cálculos fossem realizados. O custo total por ocorrência de retenção de placenta em vacas primíparas no período de chuva e seca foi de US$51,8 e em vacas multíparas foi de US$70,6 e US$87,9 nas épocas de seca e de chuvas, respectivamente. A retenção de placenta apresentou custo para a propriedade no período avaliado de US$8.878,0 ou 19.666 litros de leite. A retenção de placenta apresentou impacto econômico importante na propriedade leiteira nas condições avaliadas.(AU)

Approximately 75% of diseases in dairy cows occur in the first month after parturition and these problems have their origin associated with the immune system and food consumption two to three weeks before parturition. Diseases related to the reproductive tract, such as retained placenta, can affect reproductive efficiency as well as milk production. The effects of diseases on the physiological processes of animals become economic impacts that can be measured. The objective of this study was to evaluate the economic impact of retained placenta on a herd of 900 lactating cows. The diagnosis of placental retention was defined as presence of the placenta 24 hours postpartum. A database was used in the study, from which the following information was extracted: placenta presence 24 hours after calving, year of calving, calving season, and number of semen doses per gestation. In order to calculate the economic impact, the direct costs (treatment, labor, reduction of milk production and milk discharge during the treatment period) and indirect costs (increase in the service period, increase in the number of semen doses and increase of the risk of disposal). The average values related to the costs were obtained from the veterinarian responsible for the property with reference to the year 2009 for the calculations to be carried out. The total cost per occurrence of placenta retention in primiparous cows in the rainy and dry season was US$51.8 and in multiparous cows was US$70.6 and US$87.9 in times of drought and rain, respectively. Retention of placenta presented a cost for the property in the evaluated period of US$8,878.0 or 19,666 liters of milk. Retention of placenta presented a significant economic impact on milk production under the conditions evaluated.(AU)

Cytological endometritis in dairy cows: diagnostic threshold, risk factors, and impact on reproductive performance

We determined the threshold proportion of polymorphonuclear leukocytes (PMNs) for a diagnosis of cytological endometritis (CEM), the risk factors for this condition, and its impact on reproductive performance in dairy cows. Uterine cytology was performed on 407 Holstein cows 4 weeks postpartum to determine the proportions of endometrial cells and PMNs. A receiver operator characteristics curve was used to determine the threshold above which the PMN proportion affected the likelihood of cows conceiving by 200 days postpartum. The optimal threshold was ≥ 14% PMN (sensitivity, 31.3%; specificity, 81.7%; p < 0.05). The farm identity, retained placenta (odds ratio [OR] = 1.87), and septicemic metritis (OR = 3.07) were risk factors for CEM (p < 0.05). Cows with CEM were less likely to resume cyclicity (OR = 0.58) and to conceive by 200 days postpartum (hazard ratio = 0.58). Cows with CEM tended (p < 0.1) to be less likely to become pregnant after their first insemination (OR = 0.65) and to require a greater number of inseminations per conception (2.3 vs. 2.2). In conclusion, a PMN threshold of 14% defined the presence of CEM at 4 weeks postpartum. The farm, retained placenta, and septicemic metritis were risk factors for CEM, which reduces subsequent reproductive performance.

Comparação entre vacas puras Holandês e mestiças Holandês x Jersey quanto à sanidade, imunidade e facilidade de parto / Comparison between Holstein and Holstein × Jersey crossbred cows for health, immunity and easy calving

O cruzamento com a raça Jersey vem sendo utilizado principalmente como alternativa para o aumento da concentração de sólidos do leite em rebanhos puros Holandês, sendo a capacidade de produção desses animais conhecida em diversos estudos. Entretanto, ainda existem limitadas informações sobre diversos fatores relevantes para a tomada de decisão e para o manejo de rebanhos cruzados, tais como resistência a doenças e facilidade de parto, sendo esta a motivação do presente trabalho, o qual objetivou avaliar a sanidade, a imunidade e a facilidade de parto de vacas mestiças Holandês x Jersey em relação a vacas puras Holandês. Foram analisados dados de dificuldade de parto, duração da gestação, retenção de placenta, indicadores sanguíneos para doenças metabólicas pós-parto (cetose e paresia puerperal hipocalcêmica) e de imunidade obtidos em vacas mestiças Holandês x Jersey e puras Holandês durante o período de um ano. O grupamento genético não afetou a facilidade de parto (P=0,4376), a retenção de placenta (P=0,7074) e a duração da gestação (P=0,2812). Vacas mestiças apresentaram maiores concentrações de gamaglobulinas (1,776 contra 1,456g/dL) e de proteína total (7,019 contra 6,525g/dL). Quanto à concentração de ß-hidroxibutirato (BHBA), ocorreu diferença somente no dia do parto, com valores mais altos para as vacas mestiças (0,580 contra 0,427mmol/L). Observou-se diferença entre grupamentos genéticos para concentração de cálcio iônico (P=0,082), com vacas mestiças apresentando concentração mais baixa (3,92 contra 4,3 mg/dL). Conclui-se que vacas mestiças apresentam melhor performance em indicadores de imunidade e pior nos indicadores de cetose e paresia puerperal hipocalcêmica no pós-parto em relação às puras Holandês. O cruzamento não aumenta o risco de distocia em vacas inseminadas com touros Holandês.(AU)

The crossbreed with the Jersey breed has been used mainly as an alternative to increasing the concentration of milk solids in Holstein herds, the production capacity of these animals having become the focus of several studies. However, there is still limited information on many relevant factors for decision-making and management of crossbreed herds, such as disease resistance and ease of calving, and this is the motivation for this work, which aimed to evaluate the health, immunity and calving difficulty in Holstein x Jersey crossbred cows compared to pure Holstein cows. Data from calving difficulty, retained placenta, gestation length, blood indicators for postpartum metabolic diseases (ketosis and hypocalcemic puerperal paresis) and immunity in a herd composed by crossbreeds and Holstein cows during one year was analyzed. The genetic groups did not affect ease of calving (P = 0.4376), retained placenta (P = 0.7074) and gestation length (P=0.2812). Crossbred cows had higher concentrations of gammaglobulins (1.776 versus 1.456g/dL) and total protein (7.019 versus 6.525g/dL). For the concentration of BHBA, differences occurred only at calving, with higher values for crossbred cows (0.580 versus 0.427mmol/L). Difference was observed between genetic groups for concentration of ionized calcium (P = 0.082), with crossbred cows presenting lower concentrations (3.92 versus 4.3mg/dL). In conclusion, crossbred cows have superior performance compared to Holstein cows for immunity indicators and lower for hypocalcemic puerperal paresis and ketosis indicators on the day of calving. Crossbred cows do not have an increased risk of dystocia in relation to pure Holstein cows when mated with Holstein bulls.(AU)

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

OBJECTIVE: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. MATERIALS AND METHODS: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. RESULTS: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. CONCLUSION: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Alterações patológicas do sistema genital de cutias (Dasyprocta aguti Linnaeus, 1758) fêmeas criadas em cativeiro / Pathological changes of the genital system of agoutis (Dasyprocta aguti Linnaeus, 1758) females bred in captivity

Este artigo apresenta relatos de sete distintas patologias de origem reprodutiva ainda não descritas em cutias (Dasyprocta aguti Linnaeus, 1758) fêmeas, que afetaram a fertilidade ou resultaram na morte do animal. Descreveu-se a natureza, a localização e a frequência das alterações patológicas macroscópicas e histológicas dos órgãos que compõem o sistema reprodutivo de cutias fêmeas, criadas sob condições de cativeiro no semiárido do Brasil. Foram avaliados através do exame anatomopatológico o aparelho reprodutivo de trinta e nove cutias mortas naturalmente e encaminhadas ao Laboratório de Patologia Veterinária, no período de fevereiro de 2010 a maio de 2015. Destas, constatou-se alterações patológicas no sistema reprodutivo de 10 (25,6 %). No total, 13 alterações foram observadas, sendo que, em alguns animais haviam a coexistência de mais de uma alteração. Assim, as alterações patológicas encontradas foram: endometrite (n=4; 30,8%), piometra (n=3; 23%), retenção de placenta (n=2; 15,4%), maceração fetal (n=1; 7,7%), mumificação fetal (n=1; 7,7%), parto distócico (n=1; 7,7%) e ovários afuncionais (n=1; 7,7%).(AU)

This paper presents seven distinct reports diseases with reproductive origins that are not yet described in females agoutis (Dasyprocta aguti Linnaeus, 1758), affecting fertility or resulted in the animal's death. The nature, location and frequency of macroscopic and histological pathological changes of the organs that compose the reproductive system of female agoutis, created under conditions of captivity in the semiarid region of Brazil, are described in this article. Were evaluated by pathological examination of the reproductive tract of thirty-nine naturally dead agoutis and sent to the Veterinary Pathology Laboratory in February 2010 to May 2015. From these, it was found pathological alterations in the reproductive system of 10 (25.6%). A total of 13 abnormalities were observed, and in some animals had the coexistence of more than one alteration. Thus, the pathological changes were: endometritis (n=4, 30.8%), pyometra (n=3; 23%), retained placenta (n=2; 15.4%), fetal maceration (n=1, 7.7%), fetal mummification (n=1, 7.7%), dystocia (n=1, 7.7%) and afuncionais ovary (n=1, 7.7%).(AU)

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Deficiências minerais em vacas em lactação da bacia leiteira do município de Rondon do Pará, estado do Pará / Mineral deficiencies in lactating cows from the dairy basin of Rondon do Pará, Brazil

Realizou-se um estudo das deficiências minerais em vacas em lactação de rebanhos leiteiros pertencentes a 13 propriedades da bacia leiteira do município de Rondon do Pará, estado do Pará. Foram determinados os níveis de fósforo (P) no osso, e os níveis de cobre (Cu), cobalto (Co), selênio (Se) e zinco (Zn) no fígado de 47 vacas leiteiras no 2º terço da lactação. Estas amostras foram coletadas por meio de biópsias realizadas no terço superior da 12a costela do lado direito e no bordo caudal do lobo caudado do fígado, respectivamente. Os rebanhos eram formados por animais mestiços (Holandes x Zebu), mantidos em sistema de produção extensivo em pastos de Brachiaria brizantha cv Marandu e recebiam suplementação mineral. A mistura mineral em 12 propriedades era do tipo comercial, dita "completa", acrescida de quantidades de NaCl acima do recomendado pelos fabricantes em dez propriedades. Em sete propriedades as misturas minerais eram fornecidas em cochos sem cobertura e em oito, o fornecimento da mistura mineral não era realizado diariamente. Em 11 propriedades, havia históricos clínicos condizentes com deficiências minerais nos rebanhos. Nessas fazendas a retenção de placenta e a osteofagia foram as alterações mais relatadas. Após as análises minerais observou-se deficiência de P em cinco propriedades, de Co em três propriedades, de Se em nove propriedades e de Zn em dez propriedades. Conclui-se que ocorre a deficiência de P, Co, Se e Zn; a suplementação mineral realizada na maioria das propriedades não atendeu as exigências diárias de P, Se e Co, baseadas no consumo estimado de 30 g de NaCl/animal/dia; os cochos pouco adequados ou inadequados para a suplementação, assim como o fornecimento inconstante das misturas minerais possivelmente contribuíram para a deficiência de um ou mais minerais.

A study of mineral deficiencies was performed in lactating cows from dairy herds belonging to 13 farms of Rondon do Pará, state of Pará, Brazil. We determined the levels of phosphorus (P) in the bone and levels of copper (Cu), cobalt (Co), selenium (Se) and zinc (Zn) in the liver of 47 dairy cows in lactation 2. The samples were collected by means of biopsies taken on the top third of the 12th rib of the right side and the caudal edge of the caudate liver lobe, respectively. The herds were composed of crossbred (Holstein x Zebu) cattle, kept in extensive production system on Brachiaria brizantha cv. Marandu pasture and received mineral supplementation. The mineral mixture on 12 farms were commercial type, called "full" and the owners added a quantity of salt above the manufacturer's recommendations on ten farms. The mineral mixtures were provided in troughs without covering on seven farms and on other eight, providing of the mineral mix was not performed daily. On 11 farms there were clinical histories consistent with mineral deficiencies in livestock, and placenta retention and osteophagia were the most frequently reported ones. The results of chemical analysis showed deficiency of P on five farms, of Co on three farms, of Se on nine farms and of Zn on ten farms. It is concluded that the mineral supplementation performed on the farms do not supply the daily demands of P, Se and Co, based on the estimated daily consumption of 30g of NaCl per animal; the little adequate or inadequate troughs for proper supplementation, as well as inconstant supply of mineral mixtures contribute to the deficiency of one or more minerals.

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma / Tomografia computadorizada de múltiplos detectores no estadiamento pré-operatório do adenocarcinoma gástrico

Objective: To evaluate the role of multidetector computed tomography in the preoperative investigation of tumor invasion depth and lymph node and metastatic involvement according to the TNM classification, in patients with gastric adenocarcinoma. Materials and Methods: Fifty-four patients with biopsy-confirmed gastric cancer underwent preoperative staging with 64-channel multidetector computed tomography. Two independent radiologists analyzed the images and classified the findings. Sensitivity, specificity, accuracy and overall accuracy were calculated for each observer. The interobserver agreement was also evaluated. Results: The accuracy in the classification of categories T ranged from 74% to 96% for observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for both observers. The weighted kappa index was 0.75, consistent with a significant interobserver agreement. The accuracy in the classification of lymph node involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82% for observer 2. The evaluation of metastatic involvement showed an overall accuracy of 89.6% for both observers. Conclusion: 64-channel multidetector computed tomography demonstrated clinically relevant accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion depth (T category) and metastatic involvement (M category). .

Objetivo: Avaliar a tomografia computadorizada com múltiplas fileiras de detectores na análise pré-operatória da profundidade de invasão tumoral, acometimento linfonodal e metastático, de acordo com a classificação TNM, em pacientes com adenocarcinoma gástrico. Materiais e Métodos: Cinquenta e quatro pacientes com câncer gástrico foram submetido a estadiamento pré-operatório com tomografia computadorizada de 64 canais de detectores. Dois radiologistas analisaram, independentemente, as imagens e classificaram os achados. A sensibilidade, especificidade, acurácia e acurácia global para cada avaliador foram calculadas. A concordância interobservador também foi avaliada. Resultados: A acurácia na classificação das categorias T variou entre 74% e 96% para o observador 1 e entre 80% e 92% para o observador 2. A acurácia global foi 70% para ambos os observadores. O kappa ponderado foi 0,75, consistente com uma concordância interobservador substancial. A acurácia na classificação do acometimento linfonodal (categoria N) variou entre 55% e 79% para o observador 1 e entre 73% e 82% para o observador 2. A avaliação do acometimento metastático mostrou acurácia global de 89,6% para ambos os observadores. Conclusão: A tomografia computadorizada com 64 canais de detectores demonstrou acurácia clinicamente relevante no estadiamento pré-operatório do adenocarcinoma gástrico em relação à profundidade de invasão e acometimento metastático. .

Retained placenta accreta after a first-trimester abortion manifesting as an uterine mass

Placenta accreta during the first trimester of pregnancy is rare. Only a few cases of placenta accreta manifesting as a uterine mass have been published. Most patients with placenta accreta present with vaginal bleeding during or after pregnancy. This report describes a patient with placenta accreta that caused vaginal bleeding three years after a first trimester abortion. The patient had regular menstruation for three years after the abortion. Initially endometrial cancer or a uterine myoma with degeneration was suspected. This is the first report of a placenta accreta detected as a uterine mass long after a first trimester abortion with delayed vaginal bleeding.

Utilização de minerais iônicos ou complexos orgânicos de minerais no pré-parto de vacas Holandesas / Use of ionic minerals or organic mineral complexes in the dry period of Holsteins cows

Os efeitos do uso de minerais complexados durante o pré-parto sobre a ocorrência de retenção de placenta foram avaliados em 135 vacas Holandesas de dois ou mais partos: grupo mineral iônico (69 animais) e grupo mineral complexado (66 animais). Em 55 desses animais foram também avaliadas as concentrações séricas da imunoglobulina G (IgG), Zn, Cu e a qualidade do colostro. O experimento foi realizado em delineamento inteiramente ao acaso, em arranjo em parcelas subdivididas. As concentrações séricas de IgG e dos microminerais foram avaliadas por análise de variância, sendo utilizados, respectivamente, os testes de Duncan e Fisher. A taxa de erro α admitida foi de 7%. Não foram observadas diferenças entre os grupos para ocorrência de retenção de placenta, qualidade do colostro, concentrações séricas de Zn e IgG (P>0,07), sendo observada diferença para a concentração de Cu (P<0,07). As concentrações de IgG foram diferentes nas semanas pré-parto avaliadas (P<0,07).

The effects of the use of complex minerals on the occurrence of retained placenta during pre-partum were valued on 135 Holstein cows from two or more deliveries. The animals were divided in two groups: ionic mineral (69 animals) and complexed mineral (66 animals). In 55 of these animals serum concentrations of imunoglobulin G (IgG), Zn and Cu and colostrum quality were also evaluated. The experiment was conducted in complete randomized split-plot design, serum IgG and trace minerals were evaluated by analysis of variance and used, respectively, Duncan's test and Fisher. The α error rate of 7% was accepted. There were no differences between groups for the occurrence of retained placenta, colostrum quality and serum concentrations of Zn and IgG (P>0.07), a difference was observed for Cu (P<0.07) concentrations. The IgG concentrations were different on the weeks pre partum evaluated (P <0.07).

Prophylaxis of retained fetal membranes in dairy cattle

This study aimed to evaluate the effect of usage some drugs to avoid retention of placenta [fetal membranes] in dairy cattle. This study was carried out in private dairy farm. The age of cows ranged between 2-5 years. The animals were divided randomly into 2 groups. First group [20 cows] to study the effect of vitamin E and Selenium injection for [re-partum prophylaxis of RFM. Second group [30 cows] to study the effect of Oxytocin or Methyl ergometrine injection for post-partum prophylaxis of RFM. The results indicated that using vitamin E and Selenium injection pre-partum reduced the incidence percentage of retention of fetal membranes also the usage of Methergin or Oxytocin injection immediately post-partum reduced the incidence of retention of fetal membranes and improved the reproductive performance in dairy cattle

[Comparing intravenous oxytocin Vs. rectal misoprostol for third-stage management after second-trimester medically induced abortion]

Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin, ergots, and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination. In this randomized clinical trial, 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 microg of rectal misoprostol to manage the third stage of labor. In this study, the frequency of placenta retention was significantly [P=0.034] lower in the misoprostol group [n=3, 7.5%] compared with oxytocin group [n=10, 25%]. The average duration of placenta delivery was significantly lower in the misoprostol group [7.95 min Vs. 19.22 min, respectively; P=0.015]. Decreases in hemoglobin concentration was not significantly different between the two groups. Generally, management of the third stage of labor in second-trimester abortions could reach a better outcome, regarding lower risks of placenta retention and duration of delivery, if rectal misoprostol is administered instead of intravenous oxytocin

Survey on fertility of retained placenta and abomasal displacement cows after single or twin births in dairy cows in Korea / 대한수의학회지

Calving records of Holstein dairy cows from 2005 to 2010 comprising Goyang and Paju cities herd with 2,362 calving events representing 240 twin births were used to evaluate the effect of abomasal displacement and retained placenta after single or twin births on fertility. In retained placenta cows, the period of twin pregnancy (mean 270.5 days) was shorter than that of single pregnancy (mean 274.8 days), however first artificial insemination period (twin: mean 107.4 days, single: mean 92.0 days), non-pregnant period (twin: 154.8 days, single: 132.2 days), and number of insemination (twin: mean 2.00 times, single: mean 1.87 times) of twin pregnancy were increased as compared with single pregnancy. In abomasal displacement cows, first artificial insemination period (twin: mean 122.9 days, single: mean 106.0 days), non-pregnant period (twin: 172.4 days, single: 152.0 days), and number of insemination (twin: mean 2.16 times, single: mean 1.89 times) of twin pregnancy were increased as compared with single pregnancy. The prevalence of complication such as retained placenta, abomasal displacement with single or twin births increased first artificial insemination period, non-pregnant period, and number of insemination period.

Hemorragia pós-parto / Postpartum hemorrhage

O sangramento pós-pato é causa importante de mortalidade materna no Brasil e no mundo. A sua principal prevenção inclui o manejo ativo do terceiro do parto. O tratamento medicamentoso mediante o uso de ocitocina, prostaglandinas e metilergonovina é a primeira escolha, sendo eficaz na grande maioria das vezes. Nos casos em que haja necessidade cirúrgica, procedimentos conservados visam preservar o futuro reprodutivo da paciente, nem sempre conseguido. Nesta revisão, abordamos as principais situações com as quais o obstetra deve estar habituado a fim de permitir imediata identificação do quadro, exato reconhecimento da causa e terapia clinica e cirúrgica adequadas.

Retained placenta: still a cause of maternal morbidity and mortality in a Nigerian semi-urban population

Retained placenta is associated with morbidity and mortality when left untreated. This study was done to determine the occurrence of retained placenta in our setting as well as to ascertain the possible risk factors, morbidities and mortality. This was a retrospective review of all cases of retained placenta over a three year period [March 2005 to March 2007]. There were 3542 deliveries, and of which 64 cases were of retained placenta. The incidence of retained placenta was 1.8% of all deliveries with a higher incidence in unbooked patients and a case fatality of 3.12%.The commonest complication was postpartum haemorrhage in 51[79.68%] of cases with blood transfusion rate of 47%. Complications associated with retained placenta could be reduced by adequate utilisation of health care facilities manned by skilled attendants; availability of blood transfusion services as well as effective and safe anaesthesia