Tumor neuroectodérmico recidivante. A propósito de un caso y revisión bibliográfica / Recurrent neuroectodermal tumor. A case report and literatura review

Resumen ANTECEDENTES: La relación entre cáncer y embarazo supone 0.07% de las complicaciones gestacionales. Cuando estas situaciones coinciden el tratamiento del tumor se dificulta. El tumor neuroectodérmico primitivo es una neoplasia relacionada con el sarcoma de Ewing y su incidencia es excepcional durante el embarazo. CASO CLÍNICO: Paciente de 34 años, con 36.3 semanas de embarazo, que ingresó a la unidad hospitalaria por dolor abdominal irradiado al miembro inferior derecho. A la exploración física se palpó una tumoración de gran dimensión en la fosa iliaca derecha. La ecografía abdominal objetivó una imagen compatible con un mioma. La resonancia magnética reportó una masa de 16 x 13 x 17 cm, retroperitoneal, paravertebral, coincidente con tumor neuroectodérmico, sarcoma y tumor neurogénico. La paciente tuvo parto eutócico, sin administración de analgesia epidural, del que nació una niña de 2950 g, con Apgar 8-9. Se efectuó una biopsia por aspiración con aguja gruesa, que reportó un tumor neuroectodérmico primitivo. El tratamiento consistió en quimioterapia con protocolo VAC (vincristina, dactinomicina y ciclofosfamida [14 ciclos]) y adriamicina (6 a 8 ciclos de inducción). Actualmente padece dolor neuropático en la pierna derecha y permanece en rehabilitación, con tratamiento médico. CONCLUSIONES: Los tumores neuroectodérmicos primitivos son neoplasias excepcionales durante el embarazo. Se requieren estudios complementarios para conocer la relación exacta entre este tipo de tumores y el embarazo, y de esta forma establecer el protocolo de tratamiento adecuado.

Abstract BACKGROUND: The relationship between cancer and pregnancy accounts for 0.07% of gestational complications. This aspect makes treatment difficult and has a negative impact on pregnant patients. The primitive neuroectodermal tumor is a neoplasm related to Ewing's sarcoma and its incidence is exceptional during pregnancy. CLINICAL CASE: A 34-year-old patient, 36.3 weeks pregnant, who was admitted to the hospital unit due to abdominal pain radiating to the right lower limb. Physical examination revealed a large tumor in the right iliac fossa. The abdominal ultrasound showed an image compatible with a myoma. Magnetic resonance imaging revealed a mass of 16 x 13 x 17 cm, retroperitoneal, paravertebral, coinciding with neuroectodermal tumor, sarcoma and neurogenic tumor. The patient had eutocic delivery, without administration of epidural analgesia, from which a girl of 2950 g was born, and Apgar 8/9. An aspiration biopsy was performed with a thick needle, which reported a primitive neuroectodermal tumor. The treatment consisted of chemotherapy with VAC protocol (vincristine, dactinomycin and cyclophosphamide [14 cycles]) and adriamycin (6 to 8 induction cycles). He currently suffers from neuropathic pain in the right leg and remains in rehabilitation, with medical treatment. CONCLUSIONS: Primitive neuroectodermal tumors are exceptional neoplasms during pregnancy. Complementary studies are required to know the exact relationship between this type of tumors and pregnancy, and in this way establish the appropriate treatment strategy.

Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants.

The use of long-acting contraceptive methods is on the rise. The aim of this study was to describe the main variables (effectiveness, tolerability, menstrual bleeding) associated with the use of subdermal contraceptive implants and to investigate the influence of age on these variables. This was a descriptive, retrospective, observational study of 221 cases of contraceptive implants inserted at a Spanish hospital between 2006 and 2015. The mean age of implant users was 31.2 ± 7.5 years. Effectiveness was 100% and good tolerability was recorded for 86.5%. Infrequent bleeding was the most common bleeding pattern, followed by amenorrhoea. Of the 221 implants inserted, 47.5% were removed. The main reasons were expiration (54.3%) and discomfort due to bleeding alterations and other adverse effects (25.7%). Nulliparity and weight gain were significantly associated with an increased probability of implant removal. This study shows that implants were highly effective, safe and well-tolerated in our population. The age of users had no influence on any of the study variables analysed. Impact Statement What is already known on this subject? Subdermal contraceptive implants are long-acting reversible contraceptives which are both safe and effective. What do the results of this study add? The age of users had no influence on any of the study variables analysed. Nulliparity and weight gain were significantly associated with an increased probability of implant removal. What are the implications of these findings for clinical practice and/or further research? Subdermal contraceptive implants were a safe and effective long-acting progestin contraceptive method for women from all age groups in our series because no significant age-related differences were observed for the tolerability, vaginal bleeding patterns, the effectiveness, the adverse effects or any other variables.

Síndrome de obstrucción congénita de vía aérea superior: diagnóstico prenatal / Congenital high airway obstruction syndrome: prenatal diagnosis

Introducción: el síndrome de obstrucción congénita de la vía aérea superior (CHAOS) es una condición infrecuente que consiste en el estrechamiento severo u obstrucción completa de la vía aérea superior, de pronóstico nefasto en ausencia de intervención, y con hallazgos ecográficos característicos que conducirán al diagnóstico. Caso clínico: gestante en semana 20.3 que acude a la ecografía morfológica donde se evidencia pulmones aumentados de tamaño, hiperecongénicos, dilatación del árbol traqueobronquial, aplanamiento diafragmático y compresión cardiaca. Asocia ascitis e hidramnios. Con todo ello, se establece el diagnóstico del síndrome de obstrucción congénita. Discusión: el correcto diagnóstico prenatal del síndrome de obstrucción congénita, con hallazgos ecográficos constantes, es esencial para optimizar el manejo gestacional y planificar el tratamiento. La cesárea EXIT y la cirugía endoscópica se proponen entre las alternativas terapéuticas disponibles en la actualidad. Es imprescindible identificar la causa de la obstrucción, así en algunos casos muy seleccionados, la fetoscopia puede ser curativa. No obstante, la morbilidad y mortalidad en la mayor parte de casos es alta (AU)

Background: Congenital high airway obstruction syndrome is a rare life-threatening condition. It is characterized by severe narrowing or complete obstruction of the upper airway, grim prognosis in absence of intervention, and with characteristic sonographic findings that lead to diagnosis. Clinical case: Pregnant in week 20.3 that goes to the routine ultrasound that demonstrated enlarged echogenic lungs, dilated tracheobronchial tree, flattened diaphragms and cardiac compression. It associates fetal ascites and polyhydramnios. In all, the diagnosis established is congenital high airway. Discussion: The accurate prenatal diagnosis of congenital high airway, with constant sonographic findings, is essential to optimize gestational management and treatment planning. EXIT procedure and endoscopic surgery are proposed among the therapeutic alternatives available today. It is essential to identify the cause of the obstruction, as fetoscopy can be curative in some highly-selected cases. However, morbidity and mortality are high in most cases (AU)

Hernia de pared abdominal como complicación de la laparoscopia / Abdominal wall hernia as a complication of laparoscopy

El presente artículo nos muestra un caso clínico que ilustra una de las complicaciones de la cirugía laparoscópica, la hernia abdominal. Presentamos el caso de una paciente anticoagulada a la que se le realiza una laparoscópia, el postoperatorio se complica con un cuadro de dolor abdominal y vómitos, y dado que presentaba una masa violácea en la zona de incisión del trocar izquierdo, nos planteamos un diagnóstico diferencial con un hematoma de pared abdominal. El objetivo de este artículo es mostrar la importancia del diagnóstico diferencial de hernia abdominal, en pacientes con múltiples patologías y tratamientos, así como de su diagnóstico temprano. La hernia abdominal es una complicación reparable pero sobre todo prevenible, por lo que es importante revisar las diferentes técnicas quirúrgicas que pueden conseguir una disminución de su incidencia (AU)

This article reports a clinical case that illustrates one of the complications of laparoscopic surgery, abdominal hernia. We present the case of a patient receiving anticoagulant therapy who underwent laparoscopy. The postoperative period was complicated by abdominal pain and vomiting. Because the patient had a purplish mass in the area of the left trocar incision, we carried out a differential diagnosis with an abdominal wall hematoma. The aim of this article is to illustrate the importance of the differential diagnosis of abdominal hernia in patients with multiple diseases and treatments, as well as its early diagnosis. Abdominal hernia is a complication that can be repaired but, most importantly, it can be prevented. It is therefore important to review the different surgical techniques that can decrease their incidence (AU)

[Spontaneous hemoperitoneum and clear cell tumor of ovary]. / Hemoperitoneo espontáneo y carcinoma ovárico de células claras.

UNLABELLED: Hemoperitoneum is a rare cause of acute abdomen, which is usually due to liver, spleen, hematologic and vascular causes. We should consider gynecological origin in women in reproductive age, being a rare etiology in postmenopausal. CLINICAL CASE: We report the case of a spontaneous hemoperitoneum in a postmenopausal woman as the first manifestation of an ovarian tumor, with exceptional pathological lineage: clear cell carcinoma. Hemoperitoneum is a suspected diagnosis before clinical symptoms of hypovolemic shock and acute abdomen, with decrease in hemoglobin. To treating underlying cause, which in this case was surgical, it's important the clinical suspect and the appropriate hemodynamic support of the patient. Despite the resolution of the acute, it is particularly important the subsequent clinical monitoring of the patient by the peculiarities of this type of tumors.

Muerte fetal anteparto. Duelo perinatal / Antepartum stillbirth. Perinatal bereavement

Introducción. La muerte fetal intrauterina es una de las situaciones más difíciles de enfrentar en la práctica obstétrica diaria. Esta condición es bien caracterizada como un duelo. Especial énfasis debe ser otorgado al apoyo psicológico brindado especialmente a la madre. Sujetos y métodos. Se presenta el caso clínico de una primigesta de 40 semanas diagnosticada de muerte fetal anteparto. Ilustramos las etapas del duelo y su manejo clínico. Conclusiones. Consideramos interesante establecer protocolos y directrices bien planificadas sobre el cuidado de la madre y de la pareja durante la pérdida gestacional (AU)

Introduction. Intrauterine fetal death is one of the most difficult situations to face in daily obstetric practice. This condition is well characterized as a bereavement. Special emphasis should be given to the provision of psychological support, especially to the mother. Subjects and methods. We report the case of a primigravida at 40 weeks of pregnancy who was diagnosed with an antepartum stillbirth. We illustrate the stages of grief and their clinical management. Conclusions. Protocols and guidelines should be designed for the care of the mother and her partner during pregnancy loss (AU)

[Non-surgical management of rectovaginal fistula: a case report]. / Tratamiento no quirúrgico de la fístula rectovaginal. A propósito de un caso.

BACKGROUND: The rectovaginal fistula is a rare disease whose treatment is extremely difficult. OBJECTIVE: To present the expectant management of rectovaginal fistula as an alternative to surgery for those cases in which the surgical risk is not an acceptable option. CLINICAL CASE: We report the case of a rectovaginal fistula in an 85-year-old woman with significant comorbidity that avoided the performance of any surgical technique. CONCLUSION: In patients whose surgical risk does not exceed the benefits, non-surgical management would be an option of treatment of rectovaginal fistula.

Síndrome de Herlyn-Werner-Wunderlich / Herlyn-Werner-Wunderlich syndrome

Presentamos el caso de una paciente de 18 años que consultó por oligomenorrea, flujo menstrual maloliente y dolor pélvico tipo cólico. Ante la sospecha de alteración menstrual por defecto en el tracto de salida se realizó ecografía ginecológica y resonancia magnética con el resultado de útero doble, hemivagina obstruida o ciega derecha acompañado de agenesia renal derecha, síndrome Herlyn-Werner-Wunderlich. Tras el diagnóstico se realizó escisión del septo y drenaje de las colecciones que suprimen la sintomatología de la paciente mejorando la capacidad reproductiva (AU)

We report the case of an 18-year-old woman who consulted for oligomenorrhea, chronic pelvic pain and malodorous vaginal discharge. Ultrasonography and magnetic resonance imaging demonstrated uterus didelphys with right-sided hematometrocolpos and absent right kidney (Herlyn-Werner- Wunderlich syndrome). The patient underwent resection of the septum and drainage of collections, with complete symptom resolution (AU)

[Diagnosis and treatment of hemophilia A acquired during postpartum ]. / Diagnóstico y tratamiento de hemofilia A adquirida durante el posparto.

Acquired hemophilia A is a truly exceptional hemorrhagic diathesis, that consists of the emergence of polyclonal autoantibodies (inhibitor) IgG-type (subclasses 1 and 4, in most cases) against the coagulant function of the circulating factor VIII, which acts in the domains C2, A2 and A3 of the molecule, thus interfering their interaction with the factor IXa, the phospholipids and the Von Willebrand factor. Its morbidity and mortality are high, but nevertheless its low incidence (1-1.5 cases per million population per year) is the most frequent autoimmune disorder. This paper reports the clinical case of two patients; the first one, 36 years old, who the tenth day of postpartum required re-entry due to a diagnosis of hematoma of the abdominal wall that was surgically drained twice. The patient of case 2 was 39 years old and at six days of postpartum went to the emergency room due to bleeding, she was underwent to curettage and therapeutic transfusion of 3 UCH. Because of the persistence of bleeding, which was not possible to control with medical treatment and conservative measures, therapeutic hysterectomy was performed, with blood transfusion later. Due to the hemorrhagic complications of this condition and the serious clinical consequences derived from them, it is important to establish an early diagnosis; it is therefore critical to know the existence of this very rare disease to be able to avoid its consequences.

Embolización de las arterias uterinas como alternativa de tratamiento para miomas uterinos. Experiencia en 60 pacientes / Uterine artery embolization as an alternative treatment for uterine fibroids. Experience in 60 patients

Introducción. Los miomas uterinos son los tumores sólidos benignos más comunes del aparato genital femenino. La embolización de las arterias uterinas (EAU) se presenta como una alternativa al tratamiento quirúrgico. Objetivo. Evaluar la eficacia de EAU en el manejo de los miomas sintomáticos. Establecer la tasa de éxito y evaluar la seguridad de la técnica mediante la detección de complicaciones durante el procedimiento y con posterioridad al mismo. Material y métodos. Estudio retrospectivo bicéntrico de 60 pacientes sometidas a EAU desde el año 2000 hasta el 2011 en H. General de Albacete y H. Puerta de Hierro de Madrid. Resultados. El éxito clínico de la técnica se demostró en 41 de los 60 casos (tasa de éxito global del 68% a los 4 años de seguimiento). En 7 de los 60 casos (11,6%) se presentaron complicaciones como síndrome postembolización, dolor e isquemia transitoria del 1.er y 2.° dedo del pie, que cedieron sin mayor complicación con tratamiento médico. Conclusión. La EAU es un tratamiento eficaz en mujeres con miomas sintomáticos, mostrando una alta seguridad y un bajo índice de posibles complicaciones menores (AU)

Introduction. Uterine fibroids are the most common benign solid tumors of the female genital tract. Uterine artery embolization (UAE) is presented as an alternative to surgical treatment. Objective. To evaluate the efficacy of UAE in the management of symptomatic fibroids, establish the success rate, and evaluate the safety of the technique by detecting complications during the procedure. Material and methods. A retrospective dual-center study was performed in 60 patients undergoing UAE from 2000 to 2011 in Albacete and the Puerta de Hierro General Hospital in Madrid. Results. The clinical success of the technique was demonstrated in 41 of the 60 patients (overall success rate of 68% at 4 years of follow-up) Complications occurred in 7 of the 60 patients (11.6%), consisting of embolization syndrome and transient ischemic pain in the first and second, which resolved with medical treatment and without further complications. Conclusion. UAE is an effective treatment for women with symptomatic fibroids, showing high reliability and a low rate of minor complications (AU)

Obstrucción intestinal en un caso de endometriosis extragenital / Intestinal obstruction in a case of extragenital endometriosis

Presentamos un caso insospechado de obstrucción intestinal secundario a endometriosis. Analizamos los síntomas clínicos, las claves diagnósticas y el diagnóstico diferencial de esta inusual localización de endometriosis (AU)

We present an unsuspected case of acute ileal obstruction due to endometriosis. We analyze the clinical symptoms, the diagnostic clues, and the differential diagnosis of this unusual location of endometriosis (AU)

Púrpura trombótica trombocitopénica versus síndrome de HELLP: un reto diagnóstico durante la gestación / Thrombotic thrombocytopenic purpura versus hellp syndrome: a diagnostic challenge during pregnancy

La trombocitopenia es una alteración relativamente frecuente durante la gestación. Varias entidades patológicas pueden presentarse con este dato de laboratorio. Entre ellas, destacamos la púrpura trombótica trombocitopénica (PTT) y el síndrome de HELLP (hemólisis, elevación de enzimas hepáticas y trombocitopenia). Ambas entidades, en ocasiones, pueden ser muy difíciles de diferenciar cuando se producen durante el embarazo, y su manejo y tratamiento difieren enormemente. Por ello es necesario conocerlas y realizar un correcto diagnóstico diferencial, ya que el diagnóstico erróneo de cualquiera de ellas puede tener consecuencias muy graves, incluso la muerte de la paciente y del producto de la concepción (AU)

Thrombocytopenia is relatively frequent during pregnancy and can occur in a range of syndromes. Among these, particular attention should be paid to thrombotic thrombocytopenic purpura (TTP) and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). It can be difficult to differentiate between these conditions during pregnancy, and their management and complications may differ widely. It is therefore essential to recognize their causes and perform a correct differential diagnosis, particularly in light of their possible serious consequences, which include maternal and/or fetal death (AU)

Meningitis puerperal por estreptococo del grupo B / Puerperal meningitis by group B streptococcus

Fundamento y objetivo: Describir un cuadro clínico poco habitual como es la meningitis puerperal por Streptococcus agalactiae (S. agalactiae). Paciente y método: Presentamos una meningitis puerperal por S. agalactiae, una rara forma de infección en una puérpera sana y con una presentación atípica. Resultados: Se expone ampliamente el caso clínico, así como los procedimientos realizados en el diagnóstico diferencial y su tratamiento. Se compara con los casos de meningitis publicados en la bibliografía, y como en estos, se realiza un diagnóstico precoz y un inicio rápido del tratamiento antibiótico. Conclusión: La meningitis por S. agalactiae es un proceso infrecuente en el período puerperal, que requiere de un diagnóstico y tratamiento precoces, de los cuales dependerá el pronóstico de la paciente (AU)

Background and objective: To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae). Patient and method: We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation. Results: We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment. Conclusion: Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis AU)

Carcinosarcoma en trompa uterina / Carcinosarcoma of the fallopian tube

Objetivo: Describir los hallazgos clínicos y las características patológicas en un caso clínico de carcinosarcoma en la trompa de Falopio. La particularidad y la peculiaridad del carcinosarcoma en la trompa de Falopio inspiran la presentación de este caso. Sujetos y métodos: Se presenta un caso clínico de una mujer de 51 años que se inicia con dolor abdominal y que ilustra el difícil diagnóstico y manejo de los tumores müllerianos mixtos malignos por lo insidioso de su presentación clínica y su agresiva presentación. Resultados: Actualmente, la paciente presentada en el caso clínico continúa estable y asintomática después de 31 meses desde el diagnóstico. Conclusiones: El tumor mülleriano mixto en la trompa de Falopio es una afección extremadamente rara y difícil de diagnosticar. El esquema terapéutico continúa sin definir, por eso, nuevas líneas de investigación debieran ser abiertas respecto del mejor manejo y tratamiento en estos casos (AU)

Objective: To describe the clinical findings and pathological characteristics in a case of carcinosarcoma of the Fallopian tube. This report was prompted by the particularity and peculiarity of this entity. Subjects and methods: We report the case of a 51-year-old woman who presented with abdominal pain. This case illustrates the difficult diagnosis and management of mixed malignant müllerian tumors due to their insidious and aggressive clinical presentation. Results: The patient is currently stable and asymptomatic 31 months after diagnosis.Conclusions: A mixed mu¨llerian tumor of the Fallopian tube is extremely rare and difficult to diagnose. There are no established recommendations on treatment and consequently new lines of research should be pursued on the optimal management and treatment of these patients (AU)

[Puerperal meningitis by group B streptococcus]. / Meningitis puerperal por estreptococo del grupo B.

BACKGROUND AND OBJECTIVE: To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae). PATIENT AND METHOD: We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation. RESULTS: We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment. CONCLUSION: Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis.

In vitro maturation, fertilization, embryo development & clinical outcome of human metaphase-I oocytes retrieved from stimulated intracytoplasmic sperm injection cycles.

BACKGROUND & OBJECTIVES: The major cause of fertilisation failure after ICSI is failure of the oocyte to initiate the biochemical processes necessary for activation. This inability could be ascribed to cytoplasmic immaturity of those gametes even if they had reached nuclear maturity. The activation of a mature oocyte is characterised by release from metaphase II (MII) arrest and extrusion of the second polar body, followed by pro-nuclear formation. The aim of this study was to evaluate the fate of in vitro matured (IVM) metaphase I (MI) oocytes subjected to intracytoplasmic sperm injection (ICSI) at different time intervals after extrusion of the first polar body (1PB) in in vitro fertilization (IVF) cycles. METHODS: A total of 8030 oocytes were collected from 1400 ICSI cycles, 5504 MII at the time of cumulus retrieval. Four hundred eight metaphase II (MII) (27.1%) matured to MII after in vitro culture for 2-26 h and 5389 sibling MII in the moment of oocyte denudation were injected. On the other hand, 49 ICSI cycles containing only MI oocytes at retrieval were injected at three different time intervals after reaching the MII. The intervals were as follows: 2-6 h (n=10), 8-11 h (n=4) and 23-26 h (n=10). Fertilization and development potential were evaluated in both studies. RESULTS: Fertilization, embryo cleavage and quality were significantly lower in IVM MI compared to MII at time of denudation. Pregnancy rate was higher in group MII. Pregnancy was achieved in three embryo transfers when ICSI was performed within 2-6 h (group I) and 8-11 h (group II) after PB extrusion. One pregnancy was obtained in group I and a healthy neonate was born. INTERPRETATION & CONCLUSIONS: Immature oocytes from women whose ovaries have been stimulated could be matured, fertilized by ICSI, cleaved in vitro and to give rise to a live birth. However, the developmental competence of embryos derived from immature oocytes is reduced, compared with sibling in vivo matured oocytes. Further, human IVM oocytes need between 2-6h after the 1PB extrusion to complete its maturation.

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical / Hypoxic-ischemic encephalopathy following a spontaneous umbilical cord hematoma

Objetivo. Exponer el caso de una gestante que presentó un hematoma espontáneo de cordón umbilical, así como revisión de la literatura. Sujetos y métodos Primigesta, sin antecedentes de interés, con control gestacional normal, que ingresó por fase latente de parto. La MNE fue no satisfactoria, realizándose una cesárea de urgencia. Resultados. Nacimiento de una mujer de 3.050g, Apgar 1/3, que ingresó en la UCI y fue dada de alta con diagnóstico de encefalopatía hipóxico-isquémica. Conclusiones. La presencia de un patrón de monitorización fetal no satisfactorio debe alertar hacia la patología de cordón umbilical, debiéndose revisar este histológicamente (AU)

Objective. To present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature. Subjects and methods. A primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed. Results. A 3050g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy. Conclusions. Umbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed (AU)

Incarceración y torsión uterina en gestante / Incarceration and uterine torsion in a pregnant woman

La torsión uterina es un evento raro, más aún cuando se produce en ausencia de embarazo. Se define como una rotación de más de 45° sobre el eje longitudinal uterino, y habitualmente tiene lugar a lo largo de la transición entre cuerpo y cérvix. En 2 tercios de los casos se produce hacia el lado derecho. Normalmente, está causada por la presencia de una condición anormal o patología que afecta al útero y/o a las estructuras adyacentes. Las manifestaciones clínicas pueden ser agudas, crónicas, o incluso un cuadro asintomático, constituyendo entonces un hallazgo intraoperatorio. La confirmación diagnóstica se realiza únicamente durante la realización de la laparotomía. La congestión de vasos en el ligamento ancho y la colocación anterior de los ovarios, hacen que la histerotomía baja realizada habitualmente en la cesárea no pueda realizarse en determinadas situaciones, optando por una histerotomía clásica en la superficie posterior del útero (AU)

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed (AU)

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro / Sperm DNA fragmentation in relation to seminal parameters and outcome of in vitro fertilization/intracytoplasmic sperm injection

Objetivo. Analizar la relación existente entre el grado de fragmentación del ADN espermático y los parámetros seminales, la edad del varón y los resultados del ciclo de FIV-ICSI. Sujetos y métodos. Cuarenta y tres pacientes sometidos a tratamientos de FIV-ICSI. La edad media de los varones fue 35,62±4,87 años. En este estudio prospectivo analizamos la fragmentación del ADN espermático mediante la técnica de SCSA (sperm chromatin structure assay) y los parámetros seminales clásicos (concentración, movilidad y morfología espermática). Los parámetros del ciclo de FIV-ICSI analizados fueron: tasa de fecundación, calidad embrionaria, tasa de embarazo, tasa de gestación y tasa de aborto. Resultados. La fragmentación del ADN está relacionada con un descenso en la movilidad progresiva de la muestra en fresco (p=0,000) y capacitada (p=0,041). También observamos un descenso en la movilidad progresiva de la muestra en fresco (p=0,034) y en la calidad del ADN espermático (p=0,043) en pacientes de mayor edad. No observamos relación entre la fragmentación y la tasa de fecundación, calidad embrionaria, tasa de embarazo y tasa de aborto. Conclusiones. El grado de fragmentación del ADN está inversamente correlacionado con la movilidad progresiva de la muestra seminal en fresco. La fragmentación del ADN no es útil como predictor del resultado del ciclo de FIV-ICSI, pero sí podría ser útil como herramienta diagnóstica ya que añade información al análisis seminal básico. Su valoración podría resultar de utilidad en determinados pacientes, como aquellos que presentan esterilidad idiopática. La calidad espermática del varón se ve afectada por el aumento en la edad(AU)

Objective. To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Subjects and methods. The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62±4.87 years and that of women was 33.88±3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates. Results. DNA fragmentation was negatively correlated with progressive motility (p=0.000) of fresh and capacitated (p=0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p=0.034) and worse sperm DNA quality (p=0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates. Conclusions. DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age(AU)

Inversión uterina total: reposición mediante expresión manual del cuerpo uterino por vía laparotómica / Complete uterine inversion: manual repositioning after laparotomy

La inversión uterina es una de las complicaciones más graves que pueden suceder en la tercera etapa del parto. Presentamos el caso de una gestación que finaliza en un parto eutócico, objetivando una inversión uterina total, que no se puede resolver por vía vaginal precisando abordaje laparotómico. La inversión se reduce mediante presión manual del cuerpo uterino hasta que el fondo uterino queda totalmente repuesto. La evolución posterior de la paciente es favorable. Hemos realizado una revisión de la literatura científica analizando la incidencia, factores de riesgo, clasificación, clínica y opciones terapéuticas relacionadas con dicha complicación (AU)

Uterine inversion is one of the most life-threatening obstetric emergencies that can occur during the third stage of labor. We present a case of acute complete uterine inversion following a vaginal birth. Manual vaginal manipulation was unsuccessful and surgical reduction by laparotomy was required. During the repositioning procedure, manual pressure was applied to the uterine body until the fundus reached its anatomic position. Subsequent patient outcome was favourable. A review of the literature was performed, focusing on the epidemiology, risk factors, classification, clinical findings and management of this complication (AU)