Trombosis del seno cavernoso en gestantes: a propósito de un caso / Thrombosis of the cavernous sinus in pregnant women: case report

La trombosis de senos venosos cerebrales es una entidad poco frecuente. Puede presentarse con clínica de cefalea, nauseas, vómitos, fiebre, déficits neurológicos focales y incluso el coma. La etiología es multifactorial siendo uno de los factores causantes los estados de hipercoagulabilidad. El embarazo y el puerperio, fisiológicamente, son estados procoagulantes. Presentamos el caso de una gestante de 32 años de 9 semanas que fue ingresada por un cuadro de nausea acompañado de una intensa cefalea, por lo que fue remitida al Servicio de Neurología. La resonancia magnética con angiografía reveló una trombosis de senos venosos cerebrales. Fue tratada con infusión bomba de heparina no fraccionada con mejoría en los síntomas. Tras el parto, prosiguió el tratamiento anticoagulante con heparina de bajo peso molecular a dosis profilácticas durante 6 semanas. En conclusión, resulta muy importante que se produzca un correcto y precoz diagnóstico para el pronóstico de esta enfermedad por lo que debe considerarse esta entidad dentro del diagnóstico diferencial de cefalea intensa en pacientes gestantes

Cerebral venous sinus thrombosis is a rare entity. It can present with symptoms of headache, nausea, vomiting, fever, focal neurological deficits and even coma. The etiology is multifactorial, being one of the factors causing hypercoagulability states. Pregnancy and the puerperium, physiologically, are procoagulant states. We present the case of a pregnant woman of 32 years of 9 weeks who was admitted for a nausea episode accompanied by an intense headache, for which she was referred to the Neurology Service. Magnetic resonance imaging with angiography revealed a cerebral venous sinus thrombosis. It was treated with infusion of unfractionated heparin pump with improvement in symptoms. After delivery, the anticoagulant treatment with low molecular weight heparin at prophylactic doses during 6 weeks. In conclusion, it is very important that there is a correct and early diagnosis for the prognosis of this disease so this entity should be considered within the differential diagnosis of severe headache in patients pregnant women

Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons.

OBJECTIVES: To ascertain the risk factors for imminent delivery and infection in pregnant women with premature rupture of membranes (PPROM) before 34 weeks of gestation, evaluate maternal and fetal outcomes and identify obstetric factors for determining which patients meet the criteria for home follow-up. METHODS: Medical charts of all women with PPROM admitted to the Vall d'Hebron Hospital (HVH) between January 2006 and December 2010 were retrospectively reviewed. RESULTS: During the study period, 216 women were admitted with a diagnosis of PPROM <34 weeks of gestation with a singleton, live, structurally-normal fetus. Mean gestational age at delivery was 31 weeks. Sixty-two patients (28.7%) delivered before 28 weeks and 76 of the infants (35.2%) had birth weight <1,500 g. Overall, 202 infants (93.5%) survived to be discharged home. On stratifying by gestational age at PPROM diagnosis, prognosis was better when PPROM occurred near to term. Gestational age at delivery was increased in pregnant women with no oligohydramnios, no shortened cervix and with negative endocervical and vaginal cultures at PPROM diagnosis (33 weeks of gestation) vs. pregnant women with positive cultures at admission (27 weeks), oligohydramnios at admission (28 weeks) and shortened cervix (26 weeks). This difference was statistically significant (p = 0.005). CONCLUSIONS: Protective factors for PPROM could be normal AFI, cervical length >25 mm and negative cultures at PPROM diagnosis. These factors could permit home follow-up of this group of patients.