SARS-CoV-2 infection in early first-trimester miscarriages: a prospective observational study.

RESEARCH QUESTION: Is there an association between SARS-CoV-2 infection and first-trimester miscarriage? DESIGN: This multicentre prospective study included a cohort of women with first-trimester miscarriages registered consecutively by seven Spanish hospitals where universal PCR screening for SARS-CoV-2 infection was implemented with both miscarriages and deliveries. The incidence of SARS-CoV-2 infection among women with first-trimester miscarriages was compared with the rate registered in women on admission to the delivery ward within the same time frame using a mixed-effects Poisson regression analysis, considering 'hospital' as random effect. The characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses. RESULTS: A total of 301 miscarriages were registered, 11 (3.7%) to SARS-CoV-2 infected and 290 to non-infected women. In the same time frame as the miscarriages, 1936 deliveries were registered, 44 [2.3%] of them were SARS-CoV-2 infected. No differences in terms of SARS-CoV-2 infection incidence were observed between infected miscarriages and infected deliveries (P = 0.233). Regarding the differences observed between miscarriages in SARS-CoV-2 positive and negative women, more inevitable miscarriages occurred in the group of infected women (36.4% versus 16.5% in non-infected women; P = 0.004), and there was greater surgical management of miscarriages (27.3% versus 8.2% in non-infected women; P = 0.036), probably in line with the greater number of inevitable miscarriages observed in this group. CONCLUSIONS: No association between SARS-CoV-2 infection and risk of first-trimester miscarriage was observed; however, the type of miscarriage seems to differ between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

Dehiscencia de cúpula vaginal tras histerectomía laparoscópica: a propósito de un caso / Vaginal vault dehiscence after total laparoscopic hysterectomy: A propos of a case

La dehiscencia de cúpula vaginal tras histerectomía total con evisceración de intestino delgado a través de la misma es una complicación rara y, aún más si cabe, en las mujeres premenopáusicas. El manejo adecuado incluye diagnóstico precoz y tratamiento quirúrgico y la combinación de abordaje abdominal y vaginal puede facilitar la reparación. Presentamos el caso de una paciente premenopáusica con prolapso de intestino delgado a través de dehiscencia de cúpula vaginal 7 meses después de histerectomía total (AU)

Vaginal vault dehiscence after total hysterectomy with small bowel prolapse through the vagina is a rare complication, especially in premenopausal women. Appropriate management includes early diagnosis and surgical treatment. The combination of an abdominal and vaginal approach may facilitate repair. We present the case of a premenopausal woman with prolapse of the small bowel through vaginal cuff dehiscence 7 months after total laparoscopic hysterectomy (AU)

Útero unicorne con cuerno rudimentario no comunicante en la adolescencia / Unicornuate uterus with noncommunicating rudimentary horn in adolescence

El útero unicorne es una rara malformación uterina que resulta del desarrollo anormal de uno de los conductos de Müller. Se manifiesta habitualmente con dismenorrea, dispareunia y dolor pélvico que aparece pocos meses después de la menarquia, aunque existen casos de presentación tardía o asintomática. Los médicos deben tener en cuenta la importancia de esta rara anomalía congénita del aparato genital femenino, especialmente poco después de la menarquia porque sin un diagnóstico y tratamiento precoz, las pacientes pueden desarrollar endometriosis, infertilidad, y complicaciones graves. Presentamos el caso de una paciente de 15 años con dolor pélvico crónico originado por un útero unicorne con un cuerno rudimentario no comunicante (AU)

Unicornuate uterus is a rare uterine anomaly resulting from the abnormal development of one of the Müllerian ducts. This abnormality usually manifests with dysmenorrhea, dyspareunia and pelvic pain appearing a few months after menarche, although there are late or even asymptomatic presentations. Clinicians should be aware of the importance of this rare congenital anomaly of the female genital tract, especially when symptoms occur shortly after menarche, because without early diagnosis and treatment, patients carrying this anomaly may develop endometriosis, infertility, and severe complications. We report the case of a 15-year-old girl with chronic pelvic pain caused by a unicornuate uterus with a noncommunicating rudimentary horn (AU)

Torsión anexial como causa de abdomen agudo en una paciente adolescente / Adnexal torsion as cause of acute abdomen in an adolescent

El abdomen agudo debido a torsión anexial en la adolescencia es una entidad poco frecuente. La variación en la presentación clínica es una de las principales razones por las que el diagnóstico es frecuentemente equivocado en un primer momento. Cuando no podemos excluir la torsión anexial, deberíamos realizar una laparoscopia diagnóstica. Presentamos un caso de torsión ovárica y tubárica en una mujer de 15 años con dolor abdominal agudo en cuadrante inferior izquierdo, que fue tratado mediante cirugía laparoscópica (AU)

Acute abdomen due to adnexal torsion in adolescence is rare. One of the main reasons this diagnosis is frequently missed at first presentation is the diverse clinical presentation. When ovarian torsion cannot be excluded, diagnostic laparoscopy should be performed. We present a rare case of ovarian and fallopian torsion in a 15-year-old girl who presented with acute lower left abdominal pain and was treated by laparoscopic surgery (AU)

Presentación tardía de lesión ureteral secundaria a cirugía laparoscópica / Late presentation of ureteral injury secondary to laparoscopic surgery

Presentamos el caso de una mujer de 32 años que acude a urgencias por distensión abdominal a los dos meses de la realización de anexectomía derecha por endometriosis pélvica vía laparoscópica. En la ecografía se visualiza abundante líquido ascítico, que tras punción aspiración con aguja fina es informado como sugerente de orina. El TAC abdominopélvico informa de fístula en uréter pélvico derecho con fuga de contraste y ascitis masiva secundaria. La fístula ureteroperitoneal con ascitis secundaria es una complicación infrecuente de la cirugía laparoscópica ginecológica, sin embargo cuando sucede tiene serias implicaciones en términos de morbilidad. El manejo depende del momento del diagnóstico; la etiología, longitud y localización de la lesión; y el estado clínico de la paciente(AU)

We present the case of a 32-year-old woman who presented to the emergency service complaining of abdominal distension 2 months after laparoscopically-assisted right oophorectomy for pelvic endometriosis. Ultrasound examination revealed abundant ascitic fluid. Fine-needle aspiration biopsy suggested the fluid to be urine. Computed tomography scan of the abdomen and pelvis showed a retroperitoneal fistula with contrast leak and secondary massive ascites. Ureteroperitoneal fistula with secondary ascites is a rare complication in gynecological laparoscopic practice but can cause serious morbidity. Management depends on the timing of diagnosis, etiology, the length and location of the injury, and the patient's clinical status(AU)

Bloqueo aurículo-ventricular completo fetal de causa inmune / Immune-mediated complete fetal Atrioventricular block

Se presenta un caso de bloqueo aurículo-ventricular completo (BAVC) de causa inmune en el que destaca un buen resultado perinatal al implantar marcapasos al nacimiento, a pesar de la alta morbimortalidad reflejada en la literatura. El diagnóstico se realiza mediante ecografía, al visualizar bradicardia fetal persistente con disociación aurículo-ventricular y en ausencia de otras alteraciones estructurales y de patología infecciosa (AU)

We report one case of congenital heart block with a good perinatal outcome after a pacemaker implant at birth, despite the high morbidity and mortality of this condition reported in the literatura (AU)