RESUMEN
We report two women who presented with a recurrent, mildly painful, bluish nodule in the umbilicus. Both patients complained of local tenderness and occasional bleeding that increased during menstruation. Neither patient had had previous pelvic surgery. Excision of the lesions revealed a primary umbilical endometriosis; in one case, a simultaneous laparoscopy showed a pelvic endometriosis. We review the current literature and discuss the possible etiopathogenesis and when a laparoscopy is indicated to diagnose a concomitant pelvic endometriosis. Umbilical endometriosis is a very rare disease but should be considered in the differential diagnosis of umbilical lesions.
Asunto(s)
Endometriosis/patología , Laparoscopía , Ombligo , Adulto , Endometriosis/diagnóstico , Femenino , Hemorragia/etiología , Humanos , Ciclo Menstrual , Persona de Mediana EdadRESUMEN
INTRODUCTION: Increasing evidence has demonstrated that intravaginal misoprostol (PGE1) is more effective in labor induction than dinoprostone (PGE2). Several studies have demonstrated that the administration of PGE1 instead of PGE2 reduces the induction-to-delivery interval. However, it has not been fully investigated on which phase of birth the activity of PGE1 is stronger than that of PGE2. We undertook this study to investigate whether the activity of the two prostaglandins are different over time during the induction-to-delivery interval. MATERIAL AND METHODS: 155 patients undergoing induction of labor with 50 micrograms intravaginal PGE1 were compared with 174 patients treated with 3 mg PGE2. In both groups the procedure was repeated 6, and 24 hours after the first dose until labor was achieved. Induction-to-initiation of labor time, duration of labor stages, induction-to-delivery time, mode of delivery, maternal and neonatal morbidity and changes in Bishop score were compared. RESULTS: Demographic characteristics, indications for induction, mode of delivery, fetal weight, maternal and neonatal morbidity and duration of the labor stages were similar between the groups. A significant difference was found in terms of: induction-to-initiation of labor interval (7.37 h [1-68] vs. 11.25 h [1-74], p < 0.01) and induction-to-delivery interval (11.5 h [2.5-89] vs. 14.4 h [2.7-94], p < 0.05). The Bishop score at the time of the second administration was significantly different from that at admission in the PGE1 group compared to the PGE2 group [PGE1: 4.8 +/- 2/5.6 +/- 1.9, p < 0.0005; PGE2: 3.9 +/- 2/4.2 +/- 1.4, p = 0.09]. This effect of PGE1 remained significant after correction for various explanatory variables. CONCLUSIONS: The stronger effect of PGE1 is the consequence of a faster cervical ripening, which in turn leads to a quicker achievement of active labor. DISCUSSION: Intravaginal PGE1 compared to PGE2 reduces significantly the induction-to-delivery time.
Asunto(s)
Extracción Obstétrica , Trabajo de Parto Inducido , Misoprostol , Administración Intravaginal , Adulto , Dinoprostona , Femenino , Humanos , Recién Nacido , Estudios Retrospectivos , Suiza , Factores de TiempoRESUMEN
Maternal thrombocytopenia is a frequent finding in pregnancy. The clinically important causes of maternal thrombocytopenia in pregnancy are gestational thrombocytopenia and autoimmune thrombocytopenia. We report a case of refractory idiopathic thrombocytopenic purpura by a 30-year-old pregnant woman, gravida 3, para 2, successfully treated with high dose corticosteroids and immune globulins.
Asunto(s)
Complicaciones Hematológicas del Embarazo/diagnóstico , Púrpura Trombocitopénica Idiopática/diagnóstico , Adulto , Cesárea , Diagnóstico Diferencial , Femenino , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Recién Nacido , Metilprednisolona/administración & dosificación , Recuento de Plaquetas , Prednisona/administración & dosificación , Embarazo , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Complicaciones Hematológicas del Embarazo/inmunología , Tercer Trimestre del Embarazo , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Púrpura Trombocitopénica Idiopática/inmunologíaRESUMEN
OBJECTIVE: To investigate whether the amount of Wharton's jelly in non-malformed fetuses with a single umbilical artery is different from that of fetuses with a normal umbilical cord. METHODS: We evaluated patients with singleton pregnancies, non-malformed fetuses and single umbilical artery undergoing sonographic evaluation at a gestational age ranging from 19 to 41 weeks' gestation. The cross-sectional areas of the umbilical cord and of the umbilical vessels were measured. The amount of Wharton's jelly was calculated by subtracting from the total cross-sectional area of the umbilical cord the areas of the artery and of the vein. The umbilical cord cross-sectional area, the umbilical artery and vein areas as well as the amount of Wharton's jelly were plotted on previously published nomograms. RESULTS: Twenty-two patients met the inclusion criteria. The umbilical cord cross-sectional area was within the normal range in 20 (90.1%) cases. The umbilical artery and vein areas were above 2 standard deviations from the mean in 20 cases and in 11 cases (50%), respectively. The amount of Wharton's jelly was below 2 standard deviations from the mean in all cases. An abnormal insertion of the umbilical cord (marginal, velamentous) was present in five cases (22.7%). CONCLUSIONS: A reduction of Wharton's jelly is frequently present in cases of single umbilical artery. The increased perinatal morbidity and mortality observed in cases of single umbilical artery, even in the absence of congenital or chromosomal abnormalities, could be in part the consequence of a reduced amount of Wharton's jelly.
Asunto(s)
Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Cordón Umbilical/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , EmbarazoRESUMEN
We report the rare combination of a monoamniotic twin pregnancy with giant uterine leiomyomas in a 33-year-old para 0, gravida 1. Considering the restricted capacity of uterine expansion during pregnancy and the known complications associated with myomas, as well as the elevated morbidity and mortality of monoamniotic twin pregnancies, we opted for a medically indicated abortion at 12 weeks' gestation. After abortion the patient developed fever and abdominal pain. In differential diagnosis we considered endomyometritis and necrosis of the myomas. Despite adequate conservative treatment the symptoms persisted and myomectomy was performed in view of the patient's desire to maintain fertility.
Asunto(s)
Aborto Eugénico , Leiomioma/diagnóstico , Imagen por Resonancia Magnética , Complicaciones Neoplásicas del Embarazo/diagnóstico , Embarazo Múltiple , Neoplasias Uterinas/diagnóstico , Adulto , Femenino , Humanos , Leiomioma/cirugía , Embarazo , Complicaciones Neoplásicas del Embarazo/cirugía , Primer Trimestre del Embarazo , Embarazo de Alto Riesgo , Neoplasias Uterinas/cirugía , Útero/patología , Útero/cirugíaRESUMEN
Based on the Inventory of Interpersonal Problems (IIP), the IIP-PD and the IIP-C screening scales were developed to distinguish personality disorder (PD) from non-PD and Cluster C from other PD, respectively, in a clinic population. Two studies were conducted to determine (a) validity and reliability of these IIP scales for PD screening in a nonclinical population, (b) specificity of IIP-C for identifying Cluster C, and (c) usefulness of the IIP scales for screening Cluster A. College students were screened using the IIP scales (Study 1, N = 454, Study 2, N = 87). High and low scorers completed PD-related questionnaires in Study 1 and a clinical interview for PD symptomatology in Study 2. Results indicated strong test-retest reliability, internal consistency, and factorial, convergent, and external validity. The scales tapped a common deficit in interpersonal relatedness, with some distinction between externalizing and internalizing dimensions, respectively, and both scales were positively and significantly associated with schizotypal traits. In conclusion, the IIP-PD and IIP-C are useful and valid screening instruments for identifying any versus no PD in nonclinical populations.
Asunto(s)
Tamizaje Masivo/métodos , Trastornos de la Personalidad/diagnóstico , Inventario de Personalidad , Psicometría/métodos , Adolescente , Adulto , Anciano , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/psicología , Reproducibilidad de los Resultados , Trastorno de la Personalidad Esquizotípica/psicología , Estados UnidosRESUMEN
OBJECTIVE: To determine if carbon dioxide laser conization of the cervix is a risk factor for preterm delivery in subsequent gestations and to evaluate whether there is any relationship between cone height and duration of pregnancy. METHODS: Patients of fertile age who had carbon dioxide laser conization were followed for reproductive events. Cases were matched one-to-one with controls for known risk factors for preterm delivery. Pregnancy duration, rate of preterm birth, and mode of delivery were studied. Parametric and nonparametric tests were used for statistical analysis. Logistic regression analysis and Cox proportional hazard modeling were used to investigate the relationship between cone height and subsequent preterm delivery. RESULTS: Sixty-four women with singleton pregnancies after carbon dioxide laser conization and 64 controls were included in the study. Overall, no difference was found in the rate of preterm delivery and duration of pregnancy. However, women with cone height of at least 10 mm had a higher rate of preterm delivery than either those with cone height less than 10 mm (five of 23 versus one of 41, P = .01) or the controls (five of 23 versus three of 64, P < .05). Cone height of at least 10 mm remained significant in predicting the occurrence of preterm delivery and the duration of pregnancy after adjusting for known risk factors (odds ratio 11.1, P < .05). CONCLUSION: Cone height of at least 10 mm is an independent risk factor for the duration of pregnancy and for the occurrence of preterm delivery in the subsequent gestation.
Asunto(s)
Conización/efectos adversos , Conización/métodos , Terapia por Láser/efectos adversos , Trabajo de Parto Prematuro/etiología , Resultado del Embarazo , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Adulto , Dióxido de Carbono , Estudios de Casos y Controles , Femenino , Humanos , Modelos Logísticos , Oportunidad Relativa , Embarazo , Modelos de Riesgos Proporcionales , Factores de Riesgo , Sensibilidad y Especificidad , Análisis de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: To determine the prevalence of fetal acidemia associated with regional anesthesia for elective cesarean delivery in healthy paturients with uncomplicated singleton term pregnancies. METHODS: This was an epidemiologic study using the data base of the Swiss obstetric study group (Arbeitsgemeinschaft Schweizerischer Frauenkliniken). After the exclusion of cases with extraneous factors that may have affected the health of the neonate, we analyzed the umbilical artery pH, Apgar score, and other neonatal outcome measures after cesarean delivery with reference to the anesthetic technique. RESULTS: From 1985 to 1994, 327,763 deliveries, including 40,858 (12.47%) by cesarean, were registered in the data base. Of these, 5806 patients fulfilled the study criteria. The study population included 1002 spinal, 2155 epidural, and 2649 cases of general anesthesia. The frequency of fetal acidemia (pH less than 7.10) was significantly increased in the spinal-anesthesia group (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.73, 8.01) and in the epidural group (OR 2.39; 95% CI 1.42, 4.04) compared with the general-anesthesia group. CONCLUSION: The rate of fetal acidemia is significantly increased after regional anesthesia. This risk must be judged in light of the risks inherent with general anesthesia.
Asunto(s)
Anestesia de Conducción , Cesárea , Enfermedades Fetales/sangre , Enfermedades Fetales/epidemiología , Enfermedades Metabólicas/sangre , Enfermedades Metabólicas/epidemiología , Adulto , Intervalos de Confianza , Procedimientos Quirúrgicos Electivos , Femenino , Sangre Fetal/química , Humanos , Concentración de Iones de Hidrógeno , Persona de Mediana Edad , Oportunidad Relativa , Embarazo , Prevalencia , Suiza/epidemiologíaRESUMEN
A 49-year-old woman presented with a uterine tumour with solid and cystic parts. Extension of the tumour into the broad ligament was noted at the operation with wormlike plugs of tumour within the veins. The histological diagnosis of intravenous leiomyomatosis was evident. The disease turned out to be far advanced: a long continuous intraluminal mass extending from the iliac veins to the right ventricle made a second operation with thoracotomy and laparotomy mandatory. Postoperative follow-up showed so far, 1.5 years after operation, no evidence of recurrence. Intravenous leiomyomatosis is a very uncommon finding. Though it is histologically a benign smooth-muscle tumour, the biological behaviour with intravenous growth which may involve the right side of the heart, is quite aggressive. About 100 cases were reported in the literature; in no case could the diagnosis be made before surgery.
Asunto(s)
Leiomiomatosis/patología , Neoplasias Uterinas/patología , Útero/irrigación sanguínea , Neoplasias Vasculares/patología , Femenino , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Vena Ilíaca/patología , Vena Ilíaca/cirugía , Leiomiomatosis/cirugía , Persona de Mediana Edad , Reoperación , Neoplasias Uterinas/cirugía , Neoplasias Vasculares/cirugía , Venas/patologíaRESUMEN
In a patient with elevated serum alpha-fetoprotein a little haemangioma of the umbilical cord is diagnosed by ultrasound in the 21st week of pregnancy. So far only nine reports exist of prenatal diagnosed haemangiomas of the cord. Severe complications like rupture, cord haematoma, non-immune hydrops fetalis and polyhydramnions as well as a perinatal mortality of 35% have been reported. Therefore, intensive surveillance during pregnancy is mandatory.
Asunto(s)
Hematoma/diagnóstico por imagen , Ultrasonografía Prenatal , Cordón Umbilical/diagnóstico por imagen , alfa-Fetoproteínas/metabolismo , Adulto , Femenino , Hematoma/sangre , Humanos , Recién Nacido , Masculino , Placenta/diagnóstico por imagen , Embarazo , Segundo Trimestre del EmbarazoRESUMEN
Faculty administration of a magnesium infusion in the 32nd week of a twin-pregnancy caused a life-threatening situation. Oxygen mask ventilation, calcium i.v. and forced diuresis rapidly improved the condition of the patient and thus prevented any sequelae for mother and children.
Asunto(s)
Sobredosis de Droga/terapia , Sulfato de Magnesio/envenenamiento , Trabajo de Parto Prematuro/prevención & control , Embarazo Múltiple , Tocólisis , Adulto , Cuidados Críticos , Relación Dosis-Respuesta a Droga , Sobredosis de Droga/sangre , Femenino , Humanos , Recién Nacido , Sulfato de Magnesio/administración & dosificación , Sulfato de Magnesio/farmacocinética , Errores de Medicación , Trabajo de Parto Prematuro/sangre , Embarazo , ResucitaciónAsunto(s)
Aberraciones Cromosómicas/genética , Síndrome de Down/genética , Hidropesía Fetal/genética , Sistema Linfático/anomalías , Síndrome de Turner/genética , Ultrasonografía Prenatal , Aborto Eugénico , Trastornos de los Cromosomas , Síndrome de Down/diagnóstico por imagen , Femenino , Humanos , Hidropesía Fetal/diagnóstico por imagen , Recién Nacido , Linfocele/diagnóstico por imagen , Linfocele/genética , Embarazo , Segundo Trimestre del Embarazo , Síndrome de Turner/diagnóstico por imagenRESUMEN
We present the second published case of an ovarian cancer in Ovarian Remnant Syndrome. Only explorative laparotomy confirms the diagnosis. Conservative treatment is often without success and may conceal the diagnosis of a malignant process.
Asunto(s)
Cistadenocarcinoma/patología , Endometriosis/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Ováricas/patología , Ovariectomía , Complicaciones Posoperatorias/patología , Cistadenocarcinoma/cirugía , Endometriosis/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Neoplasias Ováricas/cirugía , Complicaciones Posoperatorias/cirugía , Adherencias TisularesRESUMEN
A 32 year old I P II G with preexisting diabetes insipidus was treated with 1-(3-mercaptopropionic acid)-8-d-arginine vasopressin (DDAVP) during pregnancy. An otherwise normal pregnancy was marked only with an excessive weight increase. A healthy girl was delivered by secondary cesarean section at term. Postoperative the mother developed a water intoxication accompanying oxytocin-infusion. During nursing the diabetes insipidus improved significantly whereby DDAVP doses could be reduced to 20-10 percent. We suppose an overreaction to endogene oxytocin with an antidiuretic effect.
Asunto(s)
Desamino Arginina Vasopresina/administración & dosificación , Diabetes Insípida/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Administración Intranasal , Cesárea , Femenino , Humanos , Recién Nacido , Oxitocina/efectos adversos , Complicaciones Posoperatorias/etiología , Embarazo , Intoxicación por Agua/inducido químicamente , Equilibrio Hidroelectrolítico/efectos de los fármacosRESUMEN
Spontaneous rupture of the vaginal vault is a rare event. Patients at risk are postmenopausal. Very often they show symptoms of an enterocele or have been operated before vaginally. Treatment is always by surgery. Whether it can be done vaginally or by laparotomy, depends on the local situation. To prevent recurrence, a double closure of the lesion is necessary, often combined with colpocleisis, colpectomy, sacropexie or obliteration of the "cul-de-sac".
Asunto(s)
Enfermedades Intestinales/cirugía , Prolapso Uterino/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Intestino Delgado/cirugía , Prolapso , Rotura Espontánea , Técnicas de Sutura , Vagina/cirugíaRESUMEN
In a casuistic report we describe sinusoidal heart rate pattern in severe feto-maternal-transfusion. Hypoxia, acidosis and fetal anaemia have to be excluded, when sinusoidal heart rate pattern is registrated.