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BACKGROUND: There are 3 treatment options for placenta accreta spectrum: cesarean delivery with hysterectomy, expectant management, and uterine-sparing surgical techniques. One-step conservative surgery is the most extensively described conservative surgical technique, and it has extensive evidence supporting its usefulness; however, few groups apply it, most likely because of the misconception that it is a complex procedure that requires extensive training and is applicable to only a few patients. OBJECTIVE: This study aimed to evaluate the clinical outcomes of patients undergoing one-step conservative surgery in 4 placenta accreta spectrum reference hospitals and provided detailed steps for successfully applying this type of surgery. STUDY DESIGN: This was a multicenter, descriptive, prospective study that described the outcomes of patients with placenta accreta spectrum treated in 4 reference hospitals for this condition. The patients were divided into those managed with one-step conservative surgery and those managed with cesarean delivery and hysterectomy. RESULTS: Overall, 75 patients were included. One-step conservative surgery was possible in 85.3% of placenta accreta spectrum cases (64 patients). Intraoperative staging and placenta accreta spectrum topographic classification allowed for the selection of one-step conservative surgery candidates. The clinical outcomes of the 2 groups were similar, except for the frequency of transfusions (81.8% in the cesarean delivery and hysterectomy group vs 67.2% in the one-step conservative surgery group) and vascular interventions (27.3% in the cesarean delivery and hysterectomy group vs 4.7% in the one-step conservative surgery group), which were both higher in patients who underwent hysterectomy. In addition, the operation time was shorter in the one-step conservative surgery group (164.4 minutes vs 216.5 minutes). CONCLUSION: One-step conservative surgery is a valid procedure in most patients with placenta accreta spectrum. It is an applicable technique even in scenarios with limited resources. However, its safe application requires knowledge of the topographic classification and the application of intraoperative staging.

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Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG.Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups.Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2.Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days.Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.

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Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development of expertize in all obstetric centers. We evaluated the results obtained from a multidisciplinary approach in patients with PA in a Latin American hospital.Methods: The study included patients with prenatal suspicion or intraoperative diagnosis of PA, before and after initiating a set of interdisciplinary and institutional interventions, with the aim of achieving better outcomes.Results: From December 2011 to December 2017, 62 patients with prenatally or intraoperatively suspected PA underwent surgery. The first 30 women (Group A), admitted until April 2016 and before any changes in the management protocol, had a longer hospital stay and surgery time, higher newborn hospitalization, and greater use of general anesthesia, compared to the 20 patients from Group B, who were admitted during the last 20 months of the observation period. A total of 12 women with late and intraoperative diagnosis, under no institutional protocol, showed greater blood loss and more frequent red blood cell transfusions.Conclusions: The expertize of the multidisciplinary team responsible for managing women with PA is associated with better clinical outcomes.

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BACKGROUND: Surgical site infections (SSIs) are a known cause of morbidity and mortality; however, evidence related to management of SSIs during pregnancy is sparse. CASE: A 26-year-old female patient with an adnexal cystic lesion underwent laparotomy at 19 weeks of pregnancy. She experienced a late SSI 10 days after initial surgery, necessitating surgical debridement. She was treated with multiple surgical interventions for wound irrigations and wound closure assisted by a negative pressure wound therapy. CONCLUSION: Negative pressure wound therapy was used for treatment of an SSI during pregnancy without causing premature delivery or requiring a cesearan section.

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Introduction: Postpartum hemorrhage is a world-leading cause of morbidity and mortality. Lacerations are the second most frequent cause. Early management with appropriate treatment is essential to obtain adequate outcomes; the endovascular occlusion of pelvic vessels is among the management options. Objective: To describe the management experience with the arterial embolization of pelvic vessels. Materials and methods: We conducted a retrospective case series study based on the institutional registry of Fundación Valle del Lili (Cali, Colombia), which included patients with postpartum hemorrhage admitted between January 1st, 2011 and October 31st, 2016. Results: Out of 430 patients diagnosed with PPH, 11 were subject to embolization of pelvic vessels. Within our group, 10 patients had a vaginal delivery with severe vaginal lacerations; most of them (9 cases, 82%) were referred from other lower-complexity institutions after 20.5 hours. Occlusion was more frequent in the superior vaginal and the internal pudendal arteries. No patients showed complications associated with the procedure and only 2 showed recurrent bleeding while 3 required a hysterectomy, but no deaths occurred. Conclusion: Percutaneous management is a safe and effective third-line method for difficult-management bleedings control in patients with postpartum hemorrhage after a severe perineal tear. These results are similar to case reports published in the worldwide literature available to date.

Introducción. La hemorragia posparto es la primera causa de morbimortalidad materna en el mundo y las laceraciones son la segunda causa en frecuencia. Su tratamiento temprano y apropiado es clave para obtener buenos resultados, y la oclusión endovascular de los vasos pélvicos se cuenta entre las opciones terapéuticas. Objetivo. Describir la experiencia del tratamiento con la 'embolización' (sic) arterial de los vasos pélvicos. Materiales y métodos. Se trató de un estudio retrospectivo del tipo de serie de casos basado en el registro institucional de la Fundación Valle del Lili, Cali, Colombia, en el que se incluyeron las pacientes con hemorragia posparto atendidas entre el 1º de enero del 2011 y el 31 de octubre del 2016. Resultados. De las 430 pacientes con diagnóstico de hemorragia posparto, 11 fueron sometidas a la 'embolización' de los vasos pélvicos. De este grupo, 10 pacientes tuvieron parto vaginal con laceraciones vaginales complejas, y la mayoría (9 casos, 82 %) fue remitida por otras instituciones de menor complejidad después de 20,5 horas. Las arterias ocluidas frecuentemente fueron la vaginal superior y la pudenda interna. Ninguna paciente presentó complicaciones asociadas al procedimiento y solo dos presentaron sangrado recurrente. Tres pacientes requirieron histerectomía y ninguna murió. Conclusión. El manejo percutáneo es un método de tercera línea, seguro y efectivo para el control de los sangrados de difícil manejo en las pacientes con hemorragia pospartopor desgarros perineales complejos. Estos resultados son similares a los reportados en la literatura científica mundial disponible hasta la fecha.

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Resumen Introducción. La hemorragia posparto es la primera causa de morbimortalidad materna en el mundo y las laceraciones son la segunda causa en frecuencia. Su tratamiento temprano y apropiado es clave para obtener buenos resultados, y la oclusión endovascular de los vasos pélvicos se cuenta entre las opciones terapéuticas. Objetivo. Describir la experiencia del tratamiento con la 'embolización' (sic) arterial de los vasos pélvicos. Materiales y métodos. Se trató de un estudio retrospectivo del tipo de serie de casos basado en el registro institucional de la Fundación Valle del Lili, Cali, Colombia, en el que se incluyeron las pacientes con hemorragia posparto atendidas entre el 1º de enero del 2011 y el 31 de octubre del 2016. Resultados. De las 430 pacientes con diagnóstico de hemorragia posparto, 11 fueron sometidas a la 'embolización' de los vasos pélvicos. De este grupo, 10 pacientes tuvieron parto vaginal con laceraciones vaginales complejas, y la mayoría (9 casos, 82 %) fue remitida por otras instituciones de menor complejidad después de 20,5 horas. Las arterias ocluidas frecuentemente fueron la vaginal superior y la pudenda interna. Ninguna paciente presentó complicaciones asociadas al procedimiento y solo dos presentaron sangrado recurrente. Tres pacientes requirieron histerectomía y ninguna murió. Conclusión. El manejo percutáneo es un método de tercera línea, seguro y efectivo para el control de los sangrados de difícil manejo en las pacientes con hemorragia posparto por desgarros perineales complejos. Estos resultados son similares a los reportados en la literatura científica mundial disponible hasta la fecha.

Abstract Introduction: Postpartum hemorrhage is a world-leading cause of morbidity and mortality. Lacerations are the second most frequent cause. Early management with appropriate treatment is essential to obtain adequate outcomes; the endovascular occlusion of pelvic vessels is among the management options. Objective: To describe the management experience with the arterial embolization of pelvic vessels. Materials and methods: We conducted a retrospective case series study based on the institutional registry of Fundación Valle del Lili (Cali, Colombia), which included patients with postpartum hemorrhage admitted between January 1st, 2011 and October 31st, 2016. Results: Out of 430 patients diagnosed with PPH, 11 were subject to embolization of pelvic vessels. Within our group, 10 patients had a vaginal delivery with severe vaginal lacerations; most of them (9 cases, 82%) were referred from other lower-complexity institutions after 20.5 hours. Occlusion was more frequent in the superior vaginal and the internal pudendal arteries. No patients showed complications associated with the procedure and only 2 showed recurrent bleeding while 3 required a hysterectomy, but no deaths occurred. Conclusion: Percutaneous management is a safe and effective third-line method for difficult-management bleedings control in patients with postpartum hemorrhage after a severe perineal tear. These results are similar to case reports published in the worldwide literature available to date.

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BACKGROUND: Neuroleptic malignant syndrome (NMS) is a serious complication associated with the use of drugs that affect dopaminergic system neurotransmission. The occurrence of NMS during pregnancy or gestation is considered a life-threatening obstetric emergency. CASE: We are reporting the first case in Latin America of NMS in one pregnant women with acute psychotic episode. One day after starting with antipsychotic therapy, she developed a fever higher than 39.0 °C with tachycardia, tachypnea, generalized muscle rigidity and somnolence, with creatine kinase (CPK) levels evidencing a result of 2800 U/L. She was treated successfully with levetiracetam, biperiden and quetiapine. DISCUSSION: A search in PubMed, Embase and Ovid from 1988 to 2016 resulted in seven cases reported in either pregnant or puerperal women. In general, NMS resolves within 3-14 days; most NMS cases reported during pregnancy have involved the use of haloperidol (5 case reports) which is concordant with this report. The obstetric results were good in cases reported, only two women showed signs, among them: hyperemesis gravidarum and preterm delivery. Most of the pregnant women who had NMS presented other associated comorbidities, being mostly of infectious origin. In other investigations, it has been affirmed that NMS can become lethal in adults; however, in our search for pregnant women with this disease, no associated mortality was found. CONCLUSIONS: NMS is seen infrequently during pregnancy. The clinical diagnosis requires high suspicion by the examiner. It is important that obstetricians timely recognize the condition.

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PURPOSE: Report the results obtained following the implementation of an OCC (Obstetric Critical Care) model. MATERIALS AND METHODS: This is an observational prospective study in obstetric population with high complexity illness attended in a safety and quality model of attention in a specific unit supporting the concept of obstetric critical care. Records were used as the primary source for collecting information, using the standards of the Center for Clinical Research. RESULTS: In a 5-year period, 10,956 patients were admitted. About 51% had diseases that were not exclusive to pregnancy, 91% were admitted while pregnant and, from all births, 46% were by vaginal delivery. 1685 (19%) patients met the criteria for Near Miss Maternal Mortality (NMMM). Forty-three patients died, which represented a mortality rate of 0.49% of the total of hospitalized patients. CONCLUSIONS: The implementation of an OOC model, security models, and an institutional support system improve the quality of care in the obstetric services of reference hospitals in developing countries.

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BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.

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The aim of this study was to determine the prevalence of toxoplasma antibodies among pregnant women in Cali, Colombia. In 2005, 955 pregnant women were tested for IgG and IgM antibodies and sociodemographic information was collected. Their average age was 25.1 years, overall IgG seroprevalence 45.8% (95% CI: 41.8%, 48.2%), IgM 2.8% (95% CI: 1.5%, 3.6%). Seroprevalence increased significantly with age, 39.0% in 14 to 19 years to 55.3% in 30 to 39 years (P = 0.001). There was a significant trend toward a higher seroprevalence in the lower socioeconomic strata (SES) (low: 49.0%, high: 29%, P = 0.004). The increase in seroprevalence by age was more significant in the lower socioeconomic strata (P = 0.002). Our results suggest a higher prevalence when compared with those of the national 1980 (33-37.6%) survey. In contrast to reports from other regions of the world, Cali has not seen a decrease in T. gondii seroprevalence over the past 25 years.

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