Inserción de balones intraarteriales ilíacos previa a la realización de cesárea ante la sospecha de acretismo placentario / Iliac artery occlusion balloons for suspected placenta accreta during cesarean section

La hemorragia masiva obstétrica continúa siendo una de las causas principales de morbimortalidad materna. Deben identificarse cuáles son los factores de riesgo asociados a esta enfermedad para adoptar un correcto plan terapéutico y disponer de los recursos necesarios. Se presenta un caso en el que se insertaron balones intraarteriales ilíacos previamente a la realización de la cesárea ante la sospecha de un acretismo placentario. Se describe el tratamiento perioperatorio y se analizan las distintas opciones terapéuticas con sus ventajas e inconvenientes, desde el uso de protocolos de administración de hemoderivados y factores procoagulantes y otras maniobras de control de la hemorragia, hasta la realización de histerectomía (AU)

Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy (AU)

[Iliac artery occlusion balloons for suspected placenta accreta during cesarean section]. / Inserción de balones intraarteriales ilíacos previa a la realización de cesárea ante la sospecha de acretismo placentario.

Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy.

Descripción de un caso de síndrome de cirugía fallida de espalda, estimulación medular y embarazo / Failed back surgery, spinal cord stimulation and pregnancy: presentation of a case

La estimulación medular constituye una terapia básica en el tratamiento de síndromes de dolor crónico como el síndrome de dolor regional complejo, el dolor crónico de espalda, la angina refractaria o algunas enfermedades vasculares periféricas cuando no responden a otras modalidades terapéuticas conservadoras o menos agresivas. El empleo precoz de esta técnica en las afecciones mencionadas hace posible su uso en mujeres jóvenes, en edad fértil y con deseo de maternidad. Se presenta el caso de una paciente de 33 años, embarazada 4 meses después de haber sido sometida a una estimulación de cordones posteriores, y se revisa la actitud ante esta situación y las recomendaciones a seguir llegado el momento de finalizar la gestación(AU)

Spinal cord stimulation is increasingly used to manage chronic pain syndromes, such as complex regional pain syndrome, chronic back pain, refractory angina pectoris or peripheral vascular diseases, which are unresponsive to other common less aggressive treatment methods. The early use of this technique in the aforementioned diseases makes it suitable in young women of childbearing age and who wish to become pregnant. We report the case of a 33-year-old woman who became pregnant 4 months after having undergone posterior cord stimulation, and we review the approach to this situation and the perioperative management during the perinatal period(AU)

Hemorragia obstétrica masiva en una paciente con placenta pércreta / Massive obstetric haemorrhage in a patient with placenta percreta

Presentamos el caso de una paciente de 38 años con diagnóstico prenatal de placenta previa. Al iniciar la cesárea programada se evidenció una placenta pércreta. Tras un sangrado masivo incoercible a pesar de haberse realizado una histerectomía de urgencia, fue necesario embolizar los vasos mediante radiología intervencionista, evolucionando posteriormente sin incidencias(AU)

We present a case of a 38 year-old patient with prenatal diagnosis of placenta praevia. When the elective caesarean began it was found a placenta accreta. In spite of an emergency hysterectomy, embolisation using interventional radiography was needed after a massive obstetric haemorrhage. The post-operative period progressed without incidents(AU)

[Failed back surgery, spinal cord stimulation and pregnancy: presentation of a case]. / Descripción de un caso de síndrome de cirugía fallida de espalda, estimulación medular y embarazo.

Spinal cord stimulation is increasingly used to manage chronic pain syndromes, such as complex regional pain syndrome, chronic back pain, refractory angina pectoris or peripheral vascular diseases, which are unresponsive to other common less aggressive treatment methods. The early use of this technique in the aforementioned diseases makes it suitable in young women of childbearing age and who wish to become pregnant. We report the case of a 33-year-old woman who became pregnant 4 months after having undergone posterior cord stimulation, and we review the approach to this situation and the perioperative management during the perinatal period.

[Massive obstetric haemorrhage in a patient with placenta percreta]. / Hemorragia obstétrica masiva en una paciente con placenta pércreta.

We present a case of a 38 year-old patient with prenatal diagnosis of placenta praevia. When the elective caesarean began it was found a placenta accreta. In spite of an emergency hysterectomy, embolisation using interventional radiography was needed after a massive obstetric haemorrhage. The post-operative period progressed without incidents.

Colocación de filtro de cava por trombosis venosa profunda durante el embarazo / No disponible

No disponible

[Analysis of the causes for increases in the length of stay in the Recovery Unit of La Paz Maternity Hospital in 2008]. / Análisis de las causas de prolongación de la estancia en la Unidad de Reanimación del Hospital Maternal La Paz en el año 2008.

OBJECTIVE: To establish the spectrum of diseases in the obstetric patient that involves an increase in the length of stay in the Recovery Unit of a specialist Maternity Hospital. To analyse the severity of these conditions as regards the means required for their resolu-tion, as well as to identify the factors that influence on post-operative morbidity in the obstetric patient. MATERIAL AND METHODS: All the case histories of all the patients admitted to the Maternity Hospital Recovery Unit during the year 2008 were reviewed. Those who required a lon-ger stay than usual were selected, which included, those with more than 6hours after a caesarean, and all admissions made during pregnancy, or after dilation and curettage or partum. RESULTS: Out of a total of 10419 births delivered in 2008, 3000 obstetric patients were ad-mitted to the Maternity Hospital Recovery Unit, of which 285 (9.5%) required critical care. The most frequent cause of increased length of stay was obstetric haemorrhage, followed by hypertensive states of pregnancy. No patients died in this Unit in the year 2008. CONCLUSIONS: The number of patients who had an increased length of stay in the Mater-nity Hospital Recovery Unit is similar to the percentage of patients who are admitted to Intensive Care Units in countries such as Canada or the United Kingdom, but our Unit had a lower death rate in the year evaluated. The main causes are obstetric haemorrhage and hypertensive states of pregnancy, thus patients with risk factors for developing these complications must be observed closely and monitored.

Análisis de las causas de prolongación de la estancia en la Unidad de Reanimación del Hospital Maternal La Paz en el año 2008 / Analysis of the causes for increases in the length of stay in the Recovery Unit of La Paz Maternity Hospital in 2008

Objetivo: Establecer el espectro de enfermedades de la paciente obstétrica que implican la estancia prolongada en la unidad de reanimación de un hospital maternal monográfico; analizar la gravedad de dichas alteraciones en función de las medidas requeridas para su resolución, así como identificar los factores que influyen en la morbilidad del postoperatorio de la paciente obstétrica. Material y métodos: Se revisan todas las historias clínicas de todas pacientes que ingresaron en la Unidad de Reanimación del Hospital Universitario Maternal La Paz durante el año 2008, y se selecciona a las que requirieron un ingreso más largo de lo habitual, es decir, más de 6 h tras una cesárea y todo ingreso que se produjera durante la gestación o tras un legrado o el parto. Resultados: De un total de 10.419 nacimientos que se produjeron en 2008, 3.000 pacientes obstétricas pasaron por la Unidad de Reanimación del Hospital Maternal, de las que 285 (9,5%) necesitaron cuidados críticos. La causa más frecuente de la estancia prolongada fue la hemorragia obstétrica, seguida de los estados hipertensivos del embarazo. Ninguna paciente obstétrica falleció en esta unidad en 2008. Conclusiones: La cifra de pacientes que tuvieron que prolongar su estancia en la Reanimación del Hospital Maternal es similar al porcentaje de pacientes graves obstétricas que ingresan en unidades de cuidados intensivos de países como Canadá o Reino Unido, pero con una mortalidad menor en nuestro servicio en el año evaluado. Las principales causas son la hemorragia obstétrica y los estados hipertensivos del embarazo. Por ello, se debe vigilar y monitorizar a las pacientes con factores de riesgo de sufrir estas complicaciones(AU)

Objective: To establish the spectrum of diseases in the obstetric patient that involves an increase in the length of stay in the Recovery Unit of a specialist Maternity Hospital. To analyse the severity of these conditions as regards the means required for their resolution, as well as to identify the factors that influence on post-operative morbidity in the obstetric patient. Material and methods: All the case histories of all the patients admitted to the Maternity Hospital Recovery Unit during the year 2008 were reviewed. Those who required a longer stay than usual were selected, which included, those with more than 6 hours after a caesarean, and all admissions made during pregnancy, or after dilation and curettage or partum. Results: Out of a total of 10 419 births delivered in 2008, 3000 obstetric patients were admitted to the Maternity Hospital Recovery Unit, of which 285 (9.5%) required critical care. The most frequent cause of increased length of stay was obstetric haemorrhage, followed by hypertensive states of pregnancy. No patients died in this Unit in the year 2008. Conclusions: The number of patients who had an increased length of stay in the Maternity Hospital Recovery Unit is similar to the percentage of patients who are admitted to Intensive Care Units in countries such as Canada or the United Kingdom, but our Unit had a lower death rate in the year evaluated. The main causes are obstetric haemorrhage and hypertensive states of pregnancy, thus patients with risk factors for developing these complications must be observed closely and monitored(AU)

Fracaso hepático en una paciente con hígado graso aguso del embarazo / No disponible

No disponible

Analysis of protein chromatographic profiles joint to partial least squares to detect adulterations in milk mixtures and cheeses.

To prevent possible frauds and give more protection to companies and consumers it is necessary to control that the types of milk used in the elaboration of dairy products correspond to those appearing in their label. Therefore, it is greatly interesting to have efficient, quick and cheap methods of analysis to identify them. In the present work, the multivariate data are the protein chromatographic profiles of cheese and milk extracts, obtained by high-performance liquid chromatography with diode-array detection (HPLC-DAD). These data correspond to pure samples of bovine, ovine and caprine milk, and also to binary and ternary mixtures. The structure of the data is studied through principal component analysis (PCA), whereas the percentage of each kind of milk has been determined by a partial least squares (PLS) calibration model. In cheese elaborated with mixtures of milk, the procedure employed allows one to detect 3.92, 2.81 and 1.47% of ovine, caprine and bovine milk, respectively, when the probability of false non-compliance is fixed at 0.05. These percentages reach 7.72, 5.52 and 2.89%, respectively, when both the probability of false non-compliance and false compliance are fixed at 0.05.

Tratamiento de anemia aguda grave por hemorragia vaginal en la testigo de Jehová: a propósito de dos casos / Treating severe acute anemia due to vaginal bleeding in the Jehova’s Witness: a report of 2 cases

Los Testigos de Jehová (TJ) no aceptan la transfusiónsanguínea ni la administración de derivados hemáticosdebido a sus creencias religiosas. En situaciones de anemiaextrema, con riesgo vital para el paciente, si ésterechaza la transfusión puede producirse un grave conflictoético y legal, enfrentándose el principio de autonomíadel paciente, que implica la libertad para rechazaro aceptar un tratamiento médico, y el deber delmédico de salvaguardar la vida del paciente utilizandotodos los medios a su alcance. Presentamos dos casos deanemia grave, uno por menorragia y otro por hemorragiapuerperal, en mujeres TJ. Debemos conocer los tratamientosalternativos a la transfusión de hemoderivados(en nuestras dos pacientes fueron eficaces), y sabercómo actuar ante una situación crítica inesperada eneste tipo de pacientes. En la menorragia, el tratamientohormonal es efectivo cuando la mujer quiere preservarla fertilidad y evitar la cirugía (ablación endometrial ehisterectomía); en la hemorragia postparto refractariaal tratamiento conservador, la embolización selectiva delos vasos sangrantes puede evitar la necesidad de actitudesterapéuticas más agresivas como la histerectomíaobstétrica(AU)

For reasons of religious belief, Jehova’s Witnesses donot accept blood transfusions or the infusion of bloodproducts. In situations in which severe, life-threateninganemia develops, patient refusal to receive a transfusioncan create serious ethical and legal problems. Theprinciple of patient autonomy, which implies the freedomto accept or reject treatment, comes into conflict with thephysician’s obligation to safeguard the patient’s life usingall means possible. We report 2 cases of severe anemia inJehova’s Witnesses. One was due to menorrhagia and theother to postpartum bleeding. The physician should beaware of alternatives to infusion of blood products andknow how to cope with an unexpected critical event inthese patients. The measures we took were effective in ourpatients. In the case of menorrhagia, hormone treatmentis effective when the woman wishes to preserve the abilityto conceive and avoid surgery (endometrial ablation andhysterectomy). In postpartum bleeding refractory toconservative treatment, selective embolization of bleedingvessels may make it unnecessary to resort to moreaggressive treatment, such as obstetric hysterectomy(AU)

Cesárea urgente en paciente con malformación arteriovenosa / No disponible

No disponible

Observational study of continuous spinal anesthesia with the catheter-over-needle technique for cesarean delivery.

BACKGROUND: Few studies have assessed the efficacy and safety of continuous spinal anesthesia in obstetrics, although placement of a catheter in the intrathecal space theoretically offers advantages in these patients. METHODS: Ninety-two women scheduled for elective cesarean delivery using continuous spinal anesthesia with the catheter-over-needle technique (22- or 24-gauge Spinocath) were included in the study. The doses of local anesthetic used, hemodynamic variables, use of ephedrine and other drugs, and incidence of complications such as technical failure and postdural puncture headache (PDPH) were recorded. RESULTS: The mean (+/-SD) dose of hyperbaric bupivacaine used was 8.2+/-1.8 mg. The incidence of hypotension was 30% and the mean total dose of ephedrine was 4+/-7 mg. The continuous spinal anesthetic technique failed in 18 women (20%). The overall incidence of post-dural-puncture headache was 29%; 18% of patients with post-dural-puncture headache required a blood patch. CONCLUSIONS: Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice.

[Treating severe acute anemia due to vaginal bleeding in the Jehovah's Witness: a report of 2 cases]. / Tratamiento de anemia aguda grave por hemorragia vaginal en la testigo de Jehová: a propósito de dos casos.

For reasons of religious belief, Jehova's Witnesses do not accept blood transfusions or the infusion of blood products. In situations in which severe, life-threatening anemia develops, patient refusal to receive a transfusion can create serious ethical and legal problems. The principle of patient autonomy, which implies the freedom to accept or reject treatment, comes into conflict with the physician's obligation to safeguard the patient's life using all means possible. We report 2 cases of severe anemia in Jehova's Witnesses. One was due to menorrhagia and the other to postpartum bleeding. The physician should be aware of alternatives to infusion of blood products and know how to cope with an unexpected critical event in these patients. The measures we took were effective in our patients. In the case of menorrhagia, hormone treatment is effective when the woman wishes to preserve the ability to conceive and avoid surgery (endometrial ablation and hysterectomy). In postpartum bleeding refractory to conservative treatment, selective embolization of bleeding vessels may make it unnecessary to resort to more aggressive treatment, such as obstetric hysterectomy.