RESUMO
Resumen ANTECEDENTES: ante un dolor pélvico intenso en una paciente embarazada, durante el parto o puerperio inmediato, debe considerarse la posibilidad de diástasis de la sínfisis del pubis, que es una afección poco frecuente e infradiagnosticada que puede resultar muy dolorosa e invalidante porque daña considerablemente la calidad de vida. A la exploración física se advierte: dolor intenso en la sínfisis púbica, que puede irradiarse hacia la zona lumbar o ambos muslos. Para establecer el diagnóstico definitivo es necesaria una prueba de imagen que muestre una separación entre ambas ramas ≥ 10 mm. En función de la clínica y el grado de separación puede optarse por un tratamiento conservador o, bien, por una intervención quirúrgica con osteosíntesis y estabilización del anillo pélvico. CASO CLÍNICO: paciente que luego de un parto eutócico experimentó dolor pélvico intenso e incapacidad para la deambulación y sedestación. Con base en la imagen radiográfica antero-posterior de la pelvis se estableció el diagnóstico de diástasis severa de la sínfisis del pubis, con afectación de la articulación sacroiliaca. El tratamiento fue quirúrgico, con buena evolución posterior. CONCLUSIONES: las formas leves de esta afección son infradiagnosticadas. El retraso en el diagnóstico y tratamiento implica dolor residual y empeora el pronóstico de la enfermedad. Es importante tener en mente este diagnóstico a la hora del diagnóstico diferencial de dolor pélvico en una paciente embarazada o puérpera.
Abstract BACKGROUND: In the presence of severe pelvic pain in a pregnant patient, during childbirth or the immediate puerperium, it is necessary to consider the possibility of a diastasis of the pubic symphysis. It is a rare and underdiagnosed pathology that can be very painful and invalidating and seriously worsens the quality of life. Physical examination shows intense pain at the level of the pubic symphysis that can radiate towards the lower back or both thighs. Definitive diagnosis requires an image test showing a separation between the two pubic bones ≥10 mm. Depending on symptomatology and the degree of separation, it is possible a conservative treatment or surgery, with osteosynthesis and stabilization of the pelvic ring. CLINICAL CASE: Patient who experienced intense pelvic pain and incapacity for ambulation and sedation after a eutocic delivery for ambulation and sedestation. After an anteroposterior radiograph of the pelvis, a severe diastasis of the pubic symphysis was diagnosed with affectation of the sacroiliac joint and required surgical treatment with a favourable evolution. CONCLUSIONS: Mild forms of this condition are underdiagnosed. Delay in diagnosis and treatment involves residual pain and worsens the prognosis of the disease. It is important to keep this diagnosis in mind at the time of the differential diagnosis of pelvic pain in a pregnant or puerperal patient.
RESUMO
El polihidramnios severo es una complicación de la gestación que incrementa el riesgo de resultados desfavorables de tipo materno y fetal. La realización de un amniodrenaje en estos casos puede restablecer una presión normal del líquido amniótico mejorando el bienestar materno y prolongando la gestación al disminuir el riesgo de parto pretémino y rotura prematura de membranas. Presentamos nuestra experiencia en el manejo de 2 pacientes, con polhidramnios severo, que fueron tratadas mediante la técnica de amniodrenaje
Pregnancies complicated by hydramnios are at increased risk of both maternal and fetal complications. Amnioreduction can restore normal amniotic pressure, thus increasing maternal comfort and prolonging pregnancy by limiting the risk of preterm labor and rupture of membranes. We present our experience in the management of two patients with severepolyhydramnios who were treated with amnioreduction
Assuntos
Humanos , Feminino , Gravidez , Poli-Hidrâmnios/terapia , Sucção/métodos , Líquido Amniótico , Complicações na Gravidez/terapia , Estudos RetrospectivosRESUMO
Objetivo: Analizar los resultados perinatales de nuestro hospital en fetos en presentación podálica en gestaciones únicas a término comparando partos vaginales y por cesárea. Material y métodos: Se incluyen todos los fetos vivos anteparto en gestaciones únicas, en presentación de nalgas entre las semanas 37 a 41+ 6 días de gestación nacidos entre el 1 de julio de 2006 y el 1 de septiembre de 2010. Comparamos los resultados perinatales en función del parto por cesárea o vía vaginal. Resultados No se objetivaron diferencias en cuanto a la puntuación en el test de Apgar a los 5 min < 7, pH de cordón al nacimiento < 7, déficit de bases y ácido láctico, ingreso en UCI neonatal, ni en las muertes perinatales. Conclusiones: Cuando se cumplen los criterios materno-fetales adecuados y se dispone de personal médico cualificado, puede ser correcto plantear un parto de nalgas vía vaginal, obteniéndose buenos resultados perinatales
Objective: To analyze the perinatal results in our hospital comparing vaginal delivery and cesarean section in breech presentation singleton pregnancies at term. Material and Methods: All live ante-partum singleton fetuses in breech presentation, at 37 to41+6 weeks and days who delivered between July 2006 and August 2010 were included in the study. We compared perinatal results between cesarean section and vaginal delivery Results: There were no differences in Apgar score at 5 minutes < 7, pH umbilical cord < 7,base deficits and lactate, neonatal intensive care unit admission or perinatal mortality. Conclusions: With appropriate maternal and fetal conditions and a qualified medical team, a breech vaginal delivery could be propose obtaining good perinatal outcomes
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Resultado da Gravidez/epidemiologia , Apresentação Pélvica/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto , Cesárea/estatística & dados numéricos , Índice de Apgar , Cordão Nucal/epidemiologiaRESUMO
Objective: To compare maternal morbidity before and after implementation of a postpartum hemorrhage (PPH) protocol that included misoprostol. Methods: A retrospective analysis was performed using data from 34 631 deliveries recorded at a Spanish hospital between January 1, 2007, and December 31, 2014. The PPH protocol was implemented in 2009 and included use of misoprostol and the Bakri balloon. Results: The pre-implementation and post-implementation groups comprised 9394 and 25 237 women, respectively. Women in the pre-implementation group tended to have lower hemoglobin levels than did those in the post-implementation group: 811 (8.6%) versus 1349 (5.3%) for levels less than 90 g/L, and 272 (2.9%) versus 497 (2.0%) for levels less than 80 g/L (both P<0.001). Implementation of the PPH protocol was also associated with a decrease in the frequency of postpartum hysterectomies owing to uterine atony (0.11 cases per 1000 deliveries vs 0.53 cases per 1000 deliveries for the pre-implementation group; P=0.063). Pregnancy length, maternal age, neonatal weight at delivery, multiple pregnancy, previous cesarean delivery, parity, operative vaginal delivery, induced labor, cesarean delivery, and not using the PPH protocol were found to predict postpartum anemia in the multivariate analysis (all P<0.001). Conclusion: Implementation of the PPH protocol decreased rates of postpartum anemia and postpartum hysterectomy owing to uterine atony. (AU)
Assuntos
Misoprostol , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/sangue , Hemorragia Pós-Parto/epidemiologia , Inércia Uterina , Estudos Retrospectivos , Parto Obstétrico , HisterectomiaRESUMO
204 cases of invasive carcinoma of the uterine cervix seen in the period 1972-1985 are studied. The incidence was higher from 50 to 69 years of age and maximum during the last years of the decade of the fifties. It was verified that the early beginning of sexual intercourse increases the number of cases and the age of presentation, and also that invasive uterine cervix cancer is more common in women with 3 or more pregnancies, while the incidence decreases in women with 1 or 2 pregnancies and specially in nulliparous virgins.
Assuntos
Neoplasias do Colo do Útero/epidemiologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Paridade , EspanhaRESUMO
The combined use of colposcopy and cytology allows the diagnosis of 98.39 per cent of the cases of invasive cervical carcinoma.
Assuntos
Neoplasias do Colo do Útero/patologia , Colposcopia , Feminino , Humanos , Invasividade Neoplásica , Esfregaço VaginalRESUMO
CIN I and CIN II can be treated by colposcopy-guided biopsy. Control examinations must be made every six months. Persistence of a CIN II lesion is an indication for conization. Some CIN III cases can be treated by conization, but considering the frequency of residual lesions and insufficient conization, a total hysterectomy is a safer procedure.