Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants.

The use of long-acting contraceptive methods is on the rise. The aim of this study was to describe the main variables (effectiveness, tolerability, menstrual bleeding) associated with the use of subdermal contraceptive implants and to investigate the influence of age on these variables. This was a descriptive, retrospective, observational study of 221 cases of contraceptive implants inserted at a Spanish hospital between 2006 and 2015. The mean age of implant users was 31.2 ± 7.5 years. Effectiveness was 100% and good tolerability was recorded for 86.5%. Infrequent bleeding was the most common bleeding pattern, followed by amenorrhoea. Of the 221 implants inserted, 47.5% were removed. The main reasons were expiration (54.3%) and discomfort due to bleeding alterations and other adverse effects (25.7%). Nulliparity and weight gain were significantly associated with an increased probability of implant removal. This study shows that implants were highly effective, safe and well-tolerated in our population. The age of users had no influence on any of the study variables analysed. Impact Statement What is already known on this subject? Subdermal contraceptive implants are long-acting reversible contraceptives which are both safe and effective. What do the results of this study add? The age of users had no influence on any of the study variables analysed. Nulliparity and weight gain were significantly associated with an increased probability of implant removal. What are the implications of these findings for clinical practice and/or further research? Subdermal contraceptive implants were a safe and effective long-acting progestin contraceptive method for women from all age groups in our series because no significant age-related differences were observed for the tolerability, vaginal bleeding patterns, the effectiveness, the adverse effects or any other variables.

Síndrome de obstrucción congénita de vía aérea superior: diagnóstico prenatal / Congenital high airway obstruction syndrome: prenatal diagnosis

Introducción: el síndrome de obstrucción congénita de la vía aérea superior (CHAOS) es una condición infrecuente que consiste en el estrechamiento severo u obstrucción completa de la vía aérea superior, de pronóstico nefasto en ausencia de intervención, y con hallazgos ecográficos característicos que conducirán al diagnóstico. Caso clínico: gestante en semana 20.3 que acude a la ecografía morfológica donde se evidencia pulmones aumentados de tamaño, hiperecongénicos, dilatación del árbol traqueobronquial, aplanamiento diafragmático y compresión cardiaca. Asocia ascitis e hidramnios. Con todo ello, se establece el diagnóstico del síndrome de obstrucción congénita. Discusión: el correcto diagnóstico prenatal del síndrome de obstrucción congénita, con hallazgos ecográficos constantes, es esencial para optimizar el manejo gestacional y planificar el tratamiento. La cesárea EXIT y la cirugía endoscópica se proponen entre las alternativas terapéuticas disponibles en la actualidad. Es imprescindible identificar la causa de la obstrucción, así en algunos casos muy seleccionados, la fetoscopia puede ser curativa. No obstante, la morbilidad y mortalidad en la mayor parte de casos es alta (AU)

Background: Congenital high airway obstruction syndrome is a rare life-threatening condition. It is characterized by severe narrowing or complete obstruction of the upper airway, grim prognosis in absence of intervention, and with characteristic sonographic findings that lead to diagnosis. Clinical case: Pregnant in week 20.3 that goes to the routine ultrasound that demonstrated enlarged echogenic lungs, dilated tracheobronchial tree, flattened diaphragms and cardiac compression. It associates fetal ascites and polyhydramnios. In all, the diagnosis established is congenital high airway. Discussion: The accurate prenatal diagnosis of congenital high airway, with constant sonographic findings, is essential to optimize gestational management and treatment planning. EXIT procedure and endoscopic surgery are proposed among the therapeutic alternatives available today. It is essential to identify the cause of the obstruction, as fetoscopy can be curative in some highly-selected cases. However, morbidity and mortality are high in most cases (AU)

Muerte fetal anteparto. Duelo perinatal / Antepartum stillbirth. Perinatal bereavement

Introducción. La muerte fetal intrauterina es una de las situaciones más difíciles de enfrentar en la práctica obstétrica diaria. Esta condición es bien caracterizada como un duelo. Especial énfasis debe ser otorgado al apoyo psicológico brindado especialmente a la madre. Sujetos y métodos. Se presenta el caso clínico de una primigesta de 40 semanas diagnosticada de muerte fetal anteparto. Ilustramos las etapas del duelo y su manejo clínico. Conclusiones. Consideramos interesante establecer protocolos y directrices bien planificadas sobre el cuidado de la madre y de la pareja durante la pérdida gestacional (AU)

Introduction. Intrauterine fetal death is one of the most difficult situations to face in daily obstetric practice. This condition is well characterized as a bereavement. Special emphasis should be given to the provision of psychological support, especially to the mother. Subjects and methods. We report the case of a primigravida at 40 weeks of pregnancy who was diagnosed with an antepartum stillbirth. We illustrate the stages of grief and their clinical management. Conclusions. Protocols and guidelines should be designed for the care of the mother and her partner during pregnancy loss (AU)

Síndrome de Herlyn-Werner-Wunderlich / Herlyn-Werner-Wunderlich syndrome

Presentamos el caso de una paciente de 18 años que consultó por oligomenorrea, flujo menstrual maloliente y dolor pélvico tipo cólico. Ante la sospecha de alteración menstrual por defecto en el tracto de salida se realizó ecografía ginecológica y resonancia magnética con el resultado de útero doble, hemivagina obstruida o ciega derecha acompañado de agenesia renal derecha, síndrome Herlyn-Werner-Wunderlich. Tras el diagnóstico se realizó escisión del septo y drenaje de las colecciones que suprimen la sintomatología de la paciente mejorando la capacidad reproductiva (AU)

We report the case of an 18-year-old woman who consulted for oligomenorrhea, chronic pelvic pain and malodorous vaginal discharge. Ultrasonography and magnetic resonance imaging demonstrated uterus didelphys with right-sided hematometrocolpos and absent right kidney (Herlyn-Werner- Wunderlich syndrome). The patient underwent resection of the septum and drainage of collections, with complete symptom resolution (AU)

[Diagnosis and treatment of hemophilia A acquired during postpartum ]. / Diagnóstico y tratamiento de hemofilia A adquirida durante el posparto.

Acquired hemophilia A is a truly exceptional hemorrhagic diathesis, that consists of the emergence of polyclonal autoantibodies (inhibitor) IgG-type (subclasses 1 and 4, in most cases) against the coagulant function of the circulating factor VIII, which acts in the domains C2, A2 and A3 of the molecule, thus interfering their interaction with the factor IXa, the phospholipids and the Von Willebrand factor. Its morbidity and mortality are high, but nevertheless its low incidence (1-1.5 cases per million population per year) is the most frequent autoimmune disorder. This paper reports the clinical case of two patients; the first one, 36 years old, who the tenth day of postpartum required re-entry due to a diagnosis of hematoma of the abdominal wall that was surgically drained twice. The patient of case 2 was 39 years old and at six days of postpartum went to the emergency room due to bleeding, she was underwent to curettage and therapeutic transfusion of 3 UCH. Because of the persistence of bleeding, which was not possible to control with medical treatment and conservative measures, therapeutic hysterectomy was performed, with blood transfusion later. Due to the hemorrhagic complications of this condition and the serious clinical consequences derived from them, it is important to establish an early diagnosis; it is therefore critical to know the existence of this very rare disease to be able to avoid its consequences.

Carcinosarcoma en trompa uterina / Carcinosarcoma of the fallopian tube

Objetivo: Describir los hallazgos clínicos y las características patológicas en un caso clínico de carcinosarcoma en la trompa de Falopio. La particularidad y la peculiaridad del carcinosarcoma en la trompa de Falopio inspiran la presentación de este caso. Sujetos y métodos: Se presenta un caso clínico de una mujer de 51 años que se inicia con dolor abdominal y que ilustra el difícil diagnóstico y manejo de los tumores müllerianos mixtos malignos por lo insidioso de su presentación clínica y su agresiva presentación. Resultados: Actualmente, la paciente presentada en el caso clínico continúa estable y asintomática después de 31 meses desde el diagnóstico. Conclusiones: El tumor mülleriano mixto en la trompa de Falopio es una afección extremadamente rara y difícil de diagnosticar. El esquema terapéutico continúa sin definir, por eso, nuevas líneas de investigación debieran ser abiertas respecto del mejor manejo y tratamiento en estos casos (AU)

Objective: To describe the clinical findings and pathological characteristics in a case of carcinosarcoma of the Fallopian tube. This report was prompted by the particularity and peculiarity of this entity. Subjects and methods: We report the case of a 51-year-old woman who presented with abdominal pain. This case illustrates the difficult diagnosis and management of mixed malignant müllerian tumors due to their insidious and aggressive clinical presentation. Results: The patient is currently stable and asymptomatic 31 months after diagnosis.Conclusions: A mixed mu¨llerian tumor of the Fallopian tube is extremely rare and difficult to diagnose. There are no established recommendations on treatment and consequently new lines of research should be pursued on the optimal management and treatment of these patients (AU)

Oligoamnios severo tras la administración de diclofenaco en el tercer trimestre de gestación / Severe oligohydramnios after diclofenac administration in the third trimester of pregnancy

Objetivo. Describir los hallazgos clínicos en un caso de oligoamnios fetal severo asociado a la administración materna de diclofenaco, así como revisar los efectos de los antiinflamatorios no esteroideos (AINE) durante la gestación. Sujetos y métodos. Presentamos un caso clínico que ilustra la complicación descrita en una gestante de 27 semanas con un cólico nefrítico, que desarrolló oligoamnios agudo tras la terapia antiinflamatoria. Resultados. Resolución del oligoamnios tras la supresión de diclofenaco. Conclusiones. El uso de AINE debe realizarse con precaución durante la gestación por sus posibles efectos adversos, entre los que destaca la alteración de la función renal y el cierre prematuro del ductus arterioso (AU)

Objective. To describe the clinical findings in a case of severe fetal oligohydramnios associated with maternal ingestion of diclofenac, as well as to review the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy. Subjects and methods. We present the case of a woman at 27 weeks of pregnancy with nephritic colic who developed acute oligohydramnios after receiving anti-inflammatory treatment. Results. The oligohydramnios resolved after discontinuation of diclofenac. Conclusions. NSAIDs should be used with caution during pregnancy due to possible adverse effects, including impaired renal function and premature constriction of the ductus arteriosus (AU)