Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage.

We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.

Uterocervical angle at 20 weeks: A promising predictor of spontaneous preterm birth in twin pregnancies.

OBJECTIVE: To compare the performance of uterocervical angle (UCA) and cervical length (CL) measurement at 20 weeks of pregnancy for prediction of spontaneous preterm birth (sPTB) in twin pregnancies. STUDY DESIGN: We conducted a retrospective cohort study of 424 twin pregnancies who delivered in our center from October 2014 to December 2018 and who underwent transvaginal ultrasound between 19+0-22+0 weeks to measure CL during routine second trimester scan. Recorded ultrasound images of CL were reassessed to evaluate UCA. Medical and obstetric data were also collected for statistical analysis. RESULTS: A total of 424 women were included. The rates of sPTB rate below 28, 32 and 34 weeks of gestation were 2.8 %, 5.4 % and 10.4 %, respectively. ROC curves showed a better area under the curve (AUC) for UCA at all gestational ages compared with CL (AUC for sPTB <28 weeks 0.902 (p < 0.001) vs 0.620 (p 0.175); AUC for sPTB <32 weeks 0.740 (p 0.001) vs 0.620 (p 0.058); AUC for sPTB <34 weeks 0.676 (p 0.001) vs 0.632 (p 0.047). UCA > 120 degrees was significantly associated with sPTB <28 weeks (p < 0.001; OR 39.17; CI 4.81-319.23; NPV, 99.65 %), <32 weeks (OR 4.23; p 0.002) and <34 weeks of gestation (OR 2.66; p 0.01). CONCLUSION: In our study, an UCA > 120 degrees allowed to identify those women with twin pregnancies at risk of sPTB and performed better than CL measurement.

Ultrasound-guided intrasacular injection of methotrexate in the management of ectopic pregnancies with embryo. A 12 year experience report in a tertiary hospital.

OBJECTIVE: To evaluate the efficacy and safety of combined-therapy with ultrasound guided intrasacular injection of 50 mg of methotrexate (MTX) and a 50 mg/m2 dose of systemic MTX in uncomplicated ectopic pregnancies with ultrasonographic evidence of embryonic structures in the gestational sac. STUDY DESIGN: We designed a retrospective study including 60 patients to assess the efficacy of combined MTX treatment and to determine which clinical or ultrasonographic variables could be associated with successful medical treatment. Failed medical treatment was defined when surgery was needed. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study. RESULTS: Medical approach was effective in 73.3 % of patients. MTX treatment was successful in 32 (68.1 %) out of 47 tubal pregnancies None of the 4 cervical or 2 abdominal pregnancies required surgery. Six (85.7 %) out of 7 cornual pregnancies were successfully treated. No statistically significant differences were found in the success rates according to clinical data, ultrasound or analytic characteristics of women. CONCLUSION: Combined MTX therapy could be an effective and safe alternative in ectopic pregnancies with embryo in hemodynamically stable women. Clinical, ultrasound or analytic characteristics of patients should not entail a contraindication. In locations where surgery implies a technical difficulty, this option may decrease morbimortality rates frequently associated to a more invasive alternative.

Hemoptysis as the first symptom in the diagnosis of metastatic choriocarcinoma in the third trimester of pregnancy: A case report.

INTRODUCTION: Choriocarcinoma is a rare neoplasm (1/40000 pregnancies). In the context of a viable pregnancy, the incidence is even lower (1/160000). CASE REPORT: A woman in her second pregnancy was admitted at 31 + 6 weeks of gestation with hemoptysis and abnormal vaginal bleeding. Numerous placental venous lakes, bilateral pulmonary nodules and a pleural effusion were found. Pleural fluid ß-HCG levels were elevated and a brain-chest-abdominal-pelvic CT scan led to the diagnosis of a high-risk gestational trophoblastic neoplasm. A caesarean section at 32 + 1 weeks of gestation was performed. Six cycles of an EMA-CO chemotherapy regime were administered. ß-HCG levels normalized after 3 cycles. Placental histopathology confirmed the presence of a gestational choriocarcinoma. CONCLUSION: Choriocarcinoma is a highly aggressive tumor. In high-risk tumors, combination chemotherapy is the first-line treatment, offering high remission rates. Treatment response is evaluated by monitoring blood ß-HCG levels, which should be long-term.

Tratamiento con drenaje percutáneo ecoguiado de hematomas vesicouterinos postcesárea complicados. Experiencia en 4 casos / Treatment with ultrasound-guided percutaneous drainage of complicated post-cesarean vesicouterine hematomas. Experience in 4 cases

Resumen ANTECEDENTES: Los hematomas vesicouterinos sobreinfectados son una rara complicación de la histerotomía segmentaria transversa. La acumulación de sangre entre la pared posterior de la vejiga y el segmento uterino facilita la proliferación de microorganismos patógenos. Cuando el tratamiento antibiótico falla deben plantearse técnicas invasivas para su resolución, entre las que destaca el drenaje percutáneo ecoguiado. CASOS CLÍNICOS: Se exponen 4 casos de mujeres que, después de la cesárea, iniciaron con descenso del hematocrito, fiebre (3 casos) y cuadro pseudooclusivo (1 caso). Con base en la ecografía se estableció el diagnóstico de hematoma vesicouterino sobreinfectado. Después de la falla del tratamiento con antibióticos se propuso el drenaje percutáneo ecoguiado. Se observó mejoría clínica en todos los casos de forma significativa. El cultivo del material drenado orientó al tratamiento antibiótico específico. La evolución de las pacientes fue satisfactoria. CONCLUSIONES: El drenaje percutáneo ecoguiado permite evacuar el contenido hemático, obtener suficiente muestra para el cultivo y aportar información del microorganismo patógeno concreto. Además, es una técnica efectiva, menos invasiva que la cirugía y se asocia con escasas complicaciones.

Abstract BACKGROUND: Infected bladder-flap hematomas are a rare complication after a lower uterine segment caesarean section. This blood collection located in the space between the posterior bladder wall and the lower uterine segment allows microorganism proliferation. When the treatment with antibiotics fails, invasive techniques are considered, such as ultrasound percutaneous drainage. CLINICAL CASE: We present 4 cases of women whom, after the performance of a cesarean section, began with a decrease in hemoglobin levels, spiking fevers in 3 cases and pseudo-occlusive symptoms in the other one. With an ultrasound examination, the diagnosis of infected bladder-flap hematomas were achieved. After the failure of the antibiotics treatment, an ultrasound percutaneous drainage was performed. As a result of the evacuation of the collection, the clinical situation improved significantly. Culture of the sample obtained permitted to establish a more effective antibiotic treatment. CONCLUSIONS: Ultrasound percutaneous drainage allows not only the evacuation of the blood collection to obtain a sample for culture, but also provides information about the presence of a specific microorganism. Moreover, it is a highly efficient technique, less invasive than surgery which presents few complications.

Sexual assault in gynecology emergency departments: patient profile and associated factors / Agresiones sexuales en Urgencias de Ginecología: perfil de la paciente y factores relacionados

Objective: To study the characteristics of patients attended for sexual assault in the Emergency Department of Miguel Servet Maternity Hospital. Material and methods: Descriptive cross-sectional study of sexual assaults managed between October 2016 and April 2018 at Miguel Servet Maternity Hospital. Results: We attended 52 cases of sexual assault in 50 women. Patients were generally young women with an average age of 28 years (24% were minors), had been assaulted by penetration (57.7%) by a single assailant (80.8%), and had received no observable physical lesions on the genitals (86.5%) or other parts of the body (65.4%). Fifty percent of the assaults took place during the weekend, and 63.5% of the patients came to the emergency department within 24 hours of the incident. In 75% of cases, the women reported the assault to the police. In 48% of cases, the patient did not undergo serology testing after visiting the emergency department; of those who did, 81% did not undergo repeat testing 3 months later. Conclusions: We observed a lack of agreement between the overall rate of sexual assault and the number of patients who came to the Emergency Department for this reason. Patients were mostly young, with no secondary physical lesions, and had been assaulted by penetration by a single assailant. Patients' adherence to medical indications was poor. Appropriate coordination between health workers, the police, and forensic experts is essential for appropriate management of sexual assaults are

Objetivo: estudiar las características de las pacientes atendidas en el Servicio de Urgencias del Hospital Maternal Miguel Servet por agresión sexual. Material y métodos: estudio descriptivo de las agresiones sexuales entre octubre de 2016 hasta abril de 2018 en el Hospital Maternal Miguel Servet. Resultados: se atendieron 52 urgencias de 50 pacientes diferentes. El perfil de la paciente fue: mujer joven, con una edad media de 28 años (el 24% fueron menores de edad), mediante penetración (57,7%), por un agresor único (80,8%) y sin lesiones físicas objetivables en genitales (86,5%) ni otras partes del cuerpo (65,4%). El 50% de agresiones se produjeron durante el fin de semana y el 63,5% acudió al Servicio de Urgencias en las primeras 24 horas tras la agresión. El 75% denunció los hechos a la policía. El 48% de las pacientes no se realizó serologías tras la visita al Servicio de Urgencias, y de las que lo hicieron, el 81% no repitió la determinación a los 3 meses. Conclusiones: existe una discordancia entre la tasa de agresión sexual global y el número de mujeres que acudió a Urgencias por este motivo. Las pacientes fueron en su mayoría jóvenes, sin lesiones físicas secundarias y agredidas mediante penetración por un agresor único. Fue observada una baja adherencia a las indicaciones médicas por parte de las pacientes. Una adecuada coordinación entre profesionales sanitarios, policía y especialistas en Medicina Legal y Forense es fundamental para un correcto manejo de la situación