[Prenatal diagnosis of isolated otocefalia. Usefulness of three-dimensional ultrasound]. / Diagnóstico prenatal de otocefalia aislada. Utilidad de la ecografía tridimensional.

Otocephaly is a rare and lethal congenital malformation characterized by the presence of agnathia, microstomia, aglossia and synotia. Despite its frequent association with severe malformations, diagnosis in the few published cases is usually made at III trimester. In this case, three-dimensional ultrasound scan was performed in a Chinese primigravida with no remarkable personal nor familiar history since mandible was difficulty visualized with two-dimensional sonography at 21 weeks of gestation. Multiplanar and rendering mode showed the typical cervicofacial features of otocephaly without associated malformations. After parental counselling, they opted for termination of pregnancy and necropsy confirmed our prenatal findings. Our case shows the usefulness of three-dimensional ultrasound in assessing fetal cervicofacial pathology. Volumetric capture allows a delayed study of fetal anatomy and multiplanar mode offers the reconstruction of views whose achivement is difficult with conventional 2D ultrasound. Surface rendering provides excellent spatial vision and enables parents to understand the severity of the malformation thus helping with their decisions.

Apendicitis y gestación / Appendicitis and pregnancy

Objetivo: Analizar los casos de apendicitis en gestantes diagnosticados en nuestro centro, valorando las características clínicas, analíticas, anatomopatológicas, evolutivas y terapéuticas de éstas, comparándolas con no gestantes, así como su pronóstico perinatal. Pacientes y métodos: Estudio retrospectivo descriptivo de 13 casos de apendicitis durante la gestación diagnosticados en nuestro centro entre 2002 y 2006. Resultados: El síntoma más frecuente fue el dolor abdominal, siguiéndole en frecuencia náuseas y vómitos. La mayor parte de las pacientes no presentaron fiebre ni leucocitosis > 20.000 leucocitos/ml, pero sí desviación a la izquierda. Todos los casos diagnosticados de apendicitis gangrenosa correspondieron a pacientes con cuadros de 24 h o más de evolución y, excepto uno, todos presentaron fiebre. Conclusiones: Los signos y síntomas, así como las modificaciones analíticas, de la apendicitis aguda, durante la gestación pierden sensibilidad y especificidad, dificultando y retrasando su diagnóstico y tratamiento, aumentando el riesgo de complicaciones (AU)

Objective: To analyze cases of appendicitis during pregnancy diagnosed in our center. Clinical, laboratory, histologic and therapeutic characteristics were examined and compared with those in nonpregnant women. Perinatal outcomes were also evaluated. Patients and methods: We performed a retrospective, descriptive study of 13 cases of appendicitis during pregnancy diagnosed in our center between 2002 and 2006. Results: The most frequent symptom was abdominal pain, followed by nausea and vomiting. Fever and leukocytosis with more than 20,000 cells/ mm3 were infrequent findings but granulocytosis (left shift) was common. All patients with a diagnosis of gangrenous appendicitis had symptoms for more than 24 hours and all except one had fever. Conclusions: The clinical and laboratory signs caused by appendicitis during pregnancy lose their sensitivity and specificity, hampering and delaying diagnosis and treatment and increasing the risk of complications (AU)

Técnica de B-Lynch en el control de la hemorragia posparto / The B-Lynch suture technique to control postpartum hemorrhage

Objetivo: Revisar la seguridad, eficacia y resultados a corto y medio plazo de la técnica descrita por B-Lynch en 6 casos de atonía uterina y hemorragia posparto refractarios al tratamiento médico convencional. Sujetos y métodos: Estudio retrospectivo descriptivo de 6 casos de atonía uterina en los que se realizó la técnica de B-Lynch en nuestro centro entre 2004 y 2006. Resultados: En todos casos en los que se aplicó se consiguió resolver el problema hemorrágico preservando la integridad uterina. A medio plazo no se constataron problemas ginecológicos atribuibles a la técnica. Conclusiones: La técnica de B-Lynch, a pesar de su reciente aplicación, ha demostrado ser una técnica efectiva, rápida y segura en el tratamiento de la atonía uterina, evitando las complicaciones y dificultades de otros tratamientos. Son necesarios más estudios así como un seguimiento a largo plazo de las pacientes, para conocer las consecuencias de la técnica en la fertilidad

Objectives: To analyze the safety, efficacy and short- and long-term outcomes of the B-Lynch suture technique in six cases of uterine atony that were unresponsive to uterotonic drugs. Subjects and methods: We performed a retrospective, descriptive study of six cases of uterine atony in which the B-Lynch suture technique was applied in our center between 2004 and 2006. Results: In all patients, the B-Lynch suture technique controlled bleeding and preserved the uterus. No mid-term gynecologic problems due to the technique were found. Conclusions: Despite being a novel procedure, the B-Lynch suture technique has proved to be effective, quick and safe in the treatment of uterine atony and avoids the complications and difficulties associated with other treatments. Further studies as well as long-term patient follow-up are required to determine the effects of this technique on fertility