Acretismo placentario focal tratado mediante embolización de arterias uterinas / Focal placenta accreta treated by uterine artery embolisation

El acretismo placentario es causa de hemorragia posparto y es una entidad que incrementa considerablemente la morbimortalidad materna. El diagnóstico anteparto es difícil. La embolización selectiva del vaso nutricio es una técnica conservadora que permite preservar el útero, y por lo tanto conservar la fertilidad. Presentamos el caso de una mujer con hemorragia puerperal, en el que se planteó el diagnóstico diferencial entre acretismo focal y malformación arterio-venosa uterina, que se trató exitosamente mediante embolización de arterias uterinas y posterior legrado, preservando fertilidad y consiguiendo nuevo embarazo posteriormente. Se evalúa la importancia de la interpretación de las imágenes para el diagnóstico, y la adaptación individual de los métodos terapéuticos y el manejo multidisciplinar

Placenta accreta can cause postpartum bleeding and has high maternal morbidity and mortality. Prenatal diagnosis is difficult. Selective embolisation of the uterine artery is a conservative technique that preserves the uterus and fertility. We present the case of a woman with puerperal bleeding, with a postulated differential diagnosis of focal placenta accreta and uterine arteriovenous malformation. Uterine artery embolisation and curettage successfully preserved fertility and the patient subsequently conceived again. We discuss the importance of image interpretation for correct diagnosis, the personalised adaptation of therapeutic methods and a multidisciplinary approach

Penfigoide gestacional / Pemphigoid gestationis

El penfigoide gestacional (PG) o herpes gestationis es una rara enfermedad cutánea autoinmune, que generalmente aparece en el segundo y tercer trimestre, y durante el puerperio, y que puede afectar al curso de la gestación y producir afectación neonatal. Presentamos el caso de una secundigesta con gestación gemelar y pénfigo gestacional. Se describe el proceso de diagnóstico, tratamiento y evolución

The pemphigoid gestationis or herpes gestationis is a rare autoimmune skin disease that occurs during the second or third trimester of pregnancy or in the immediate postpartum and which may affect the course of the pregnancy and cause neonatal pemphigoid gestationis. We present the case of a 40-year-old secudigravida with a twin pregnancy and pemphigoid gestationis. We describe the diagnostic process, treatment, and outcome

The effect of calcium supplementation on blood pressure in non-pregnant women with previous pre-eclampsia: An exploratory, randomized placebo controlled study.

BACKGROUND: Epidemiological findings suggest that the link between poverty and pre-eclampsia might be dietary calcium deficiency. Calcium supplementation has been associated with a modest reduction in pre-eclampsia, and also in blood pressure (BP). METHODS: This exploratory sub-study of the WHO Calcium and Pre-eclampsia (CAP) trial aims to determine the effect of 500mg/day elemental calcium on the blood pressure of non-pregnant women with previous pre-eclampsia. Non-pregnant women with at least one subsequent follow-up trial visit at approximately 12 or 24weeks after randomization were included. RESULTS: Of 836 women randomized by 9 September 2014, 1st visit data were available in 367 women of whom 217 had previously had severe pre-eclampsia, 2nd visit data were available in 201 women. There was an overall trend to reduced BP in the calcium supplementation group (1-2.5mmHg) although differences were small and not statistically significant. In the subgroup with previous severe pre-eclampsia, the mean diastolic BP change in the calcium group (-2.6mmHg) was statistically larger than in the placebo group (+0.8mmHg), (mean difference -3.4, 95% CI -0.4 to -6.4; p=0.025). The effect of calcium on diastolic BP at 12weeks was greater than in those with non-severe pre-eclampsia (p=0.020, ANOVA analysis). CONCLUSIONS: There is an overall trend to reduced BP but only statistically significant in the diastolic BP of women with previous severe pre-eclampsia. This is consistent with our hypothesis that this group is more sensitive to calcium supplementation, however results need to be interpreted with caution.