Physical examination-indicated cerclage in twin pregnancies compared with singleton pregnancies.

OBJECTIVE: The aim of this study was to compare pregnancy outcomes of physical examination-indicated cerclage in twin and singleton pregnancies with bulging membranes. METHODS: All women with bulging membranes in the second trimester of pregnancy who were admitted to La Fe University and Polytechnic Hospital from January 2009 to January 2022 were included. A total of 128 participants were enrolled, 102 singleton pregnancies and 26 twin pregnancies. All patients underwent an amniocentesis to rule out intra-amniotic inflammation (IL-6 < 2.6 ng/mL). Cerclage was placed in the absence of intra-amniotic inflammation. RESULTS: Compared with singleton gestations, twin pregnancies displayed a significantly higher prevalence of nulliparity and assisted reproductive techniques. The incidence of intra-amniotic inflammation/infection was similar in both groups (68.62% in singleton vs. 65.38% in twin pregnancies). The average gestational age of delivery without cerclage in singleton gestations was 23.83 weeks (95% CI 22.82-24.84) and in twin pregnancies, it was 23.69 weeks (95% CI 21.8-25.57). The average gestational age at delivery among patients with cerclage was 37.27 weeks (95% CI 35.35-39.19) in singleton gestations and 36 weeks (95% CI 33.51-38.63) in twin pregnancies, with no significant differences. Time from diagnosis to delivery in patients with IL-6 < 2.6 ng/mL was 79.88 days, and in those with IL > 2.6 ng/mL was 10.87 days. Gestational age at delivery was significantly higher in both singleton and twin pregnancies with cerclage, compared with those without cerclage (log-rank p < .001). CONCLUSIONS: Singleton and twin pregnancies with bulging membranes behave similarly when cerclage is placed in the absence of intraamniotic inflammation/infection.

Trombosis venosa ovárica posparto: una causa inusual de fiebre puerperal / Postpartum ovarian venous thrombosis: An unusual cause of puerperal fever

La trombosis de la vena ovárica posparto es una complicación rara e impredecible y que requiere un alto índice de sospecha clínica, cuyo diagnóstico y manejo precoces son esenciales, requiriendo un abordaje multidisciplinar, para evitar cirugías innecesarias y posibles complicaciones graves. Su presentación clínica habitual suele ser fiebre persistente y dolor abdominal, generalmente en la primera semana posparto. Revisamos 3 casos clínicos representativos, diagnosticados en nuestro centro entre 2014 y 2019, abordando los factores predisponentes, diagnóstico, manejo y evolución de estas pacientes.(AU)

Postpartum ovarian vein thrombosis is a rare and unpredictable complication that requires a high index of clinical suspicion. Its early diagnosis and management, with a multidisciplinary approach, are essential in order to avoid unnecessary surgeries and possible serious complications. Its usual clinical presentation is often persistent fever and abdominal pain, generally in the first week postpartum. A report is presented on three representative cases that were diagnosed in our centre between 2014 and 2019, presenting predisposing factors, diagnosis, management, and outcome of these patients.(AU)

Sludge amniótico como marcador ecográfico en una gestación gemelar con parto diferido del segundo gemelo / No disponible

La presencia del sludge amniótico (sedimento amniótico) es un factor de mal pronóstico obstétrico asociado a parto pretérmino con el aumento de la morbimortalidad perinatal que esto conlleva. Por otra parte, la prevalencia de gestaciones múltiples ha aumentado en los últimos años. Este tipo de gestaciones presentan un mayor riesgo de parto pretérmino, presentándose este en ocasiones en edades gestacionales muy tempranas. Generalmente el parto del primer gemelo suele ir seguido del parto del segundo gemelo en un intervalo corto de tiempo no siendo habitual que este intervalo se prolongue durante días o incluso semanas. Presentamos el caso de una gestación gemelar con parto diferido del segundo gemelo donde en el transcurso de su seguimiento encontramos el sludge amniótico en la valoración ecográfica (AU)

The presence of amniotic fluid sludge is a marker of poor obstetric prognosis because of its association with preterm delivery, which carries greater perinatal morbidity and mortality. The prevalence of multiple pregnancies has increased in the last few years. These pregnancies are at risk of preterm delivery, which sometimes occurs at very preterm gestational ages. Delivery of the (..) (AU)