RESUMEN
La enfermedad de Chagas en zonas no endémicas, como nuestro país, se adquiere fundamentalmente por transmisión vertical. La prevalencia de la enfermedad en embarazadas latinoamericanas oscila entre el 0,7 y el 54% en función del país de origen, la procedencia rural o la edad de la madre, situándose la tasa de transmisión vertical entre el 5 y el 6%. Se sabe que el tratamiento en fases precoces y en concreto en el niño < 15 años tiene altas tasas de curación y parece que el tratamiento de la embarazada tras el parto podría prevenir la transmisión en otros embarazos. Todo ello justificaría el diagnóstico y tratamiento precoz de esta entidad en ambos grupos. En este documento se exponen las recomendaciones actuales de diagnóstico y tratamiento de la enfermedad en el niño y la embarazada. Estas recomendaciones han sido elaboradas por un grupo de trabajo formado por especialistas en Enfermedades Infecciosas, Microbiología Clínica, Ginecología y Pediatría (AU)
Congenital transmission of Chagas disease now occurs in areas where the disease is non-endemic, and also from one generation to another. According to epidemiological data from Latin America, the prevalence of the disease in pregnant women is 0.7%-54%, and the prevalence of vertical transmission is around 5%-6%.Congenital T. cruzi infection is an acute infection in newborns that should be treated with anti-parasitic therapy. The treatment of pregnant women could also have an impact on the control of the disease. This article has been prepared following the recommendations suggested by a group of experts in Infectious Diseases, Microbiology, Gynaecology and Paediatrics (AU)
Asunto(s)
Humanos , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/terapia , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pautas de la Práctica en Medicina , Complicaciones Infecciosas del EmbarazoRESUMEN
OBJECTIVE: To analyze the clinical situations that leads us to carry out curettage after cesarean section, the ultrasound prior surgery, intraoperative, and pathological findings. METHODS: A retrospective study of all cases of postpartum curettage after cesarean section in a level 3 maternity unit. RESULTS: There were 42 curettages to women with cesarean sections (1.6% of all cesarean sections). The indications for curettage were: fever: 21, methrorraghia: 11, and residual trophoblastic tissue: 10. In the previous ultrasound, all indicated curettages for retained trophoblastic tissue showed it, and in a lower proportion those indicated for fever (66.6%) or methrorraghia (22.2%). A total of fourteen curettages (35%) were performed without suspect image of retained tissue, and in all cases the surgeon described to obtain small amount of tissue. From material submitted to pathologic evaluation trophoblastic tissue was found in 64.7%, and there were no differences as curettage indication. CONCLUSIONS: When the previous ultrasound do not showed retained tissue, the surgeon did not remove retained material. When extracted there were always in small amounts. Therefore, it could be concluded that after cesarean section the curettage should be indicated only in the presence of evident ultrasound image of retained products.
Asunto(s)
Cesárea/métodos , Legrado/métodos , Trastornos Puerperales/cirugía , Cesárea/efectos adversos , Endometritis/etiología , Endometritis/cirugía , Femenino , Humanos , Retención de la Placenta/diagnóstico , Retención de la Placenta/etiología , Retención de la Placenta/cirugía , Hemorragia Posparto/etiología , Hemorragia Posparto/cirugía , Periodo Posparto , Embarazo , Trastornos Puerperales/etiología , Estudios RetrospectivosRESUMEN
El caso que se presenta es el de una mujer joven, cuyo diagnóstico de diabetes monogénica por mutación del gen de la glucocinasa, en el tercer embarazo, planteó un cambio en la actitud terapéutica respecto a susgestaciones previas. Se hace, asimismo, un breve repaso de la literatura sobre las implicaciones obstétricas de las pacientes gestantes condiabetes mellitus MODY 2 (AU)
We report the case of a young woman who was diagnosed with monogenic diabetes caused by a glucokinase gene mutation during the third trimester of pregnancy,r equiring a change in treatment plan in comparison with her previous pregnancies. We also discuss the implications for obstetric management in patients with maturity onset diabetes of the young, type2 (MODY-2) (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Diabetes Gestacional/metabolismo , Diabetes Mellitus Tipo 2/genética , Reacción en Cadena de la Polimerasa , MutaciónRESUMEN
We report the case of a young woman who was diagnosed with monogenic diabetes caused by a glucokinase gene mutation during the third trimester of pregnancy, requiring a change in treatment plan in comparison with her previous pregnancies. We also discuss the implications for obstetric management in patients with maturity onset diabetes of the young, type 2 (MODY-2).