RESUMEN
Amniotic fluid embolism is a relatively rare clinical entity and with difficult medical recognition. However, it is the second leading cause of maternal mortality. We report here the case of a 32-year-old patient who underwent elective caesarean section complicated by an amniotic fluid embolism with cardiac arrest. The presence of a major disseminated intravascular coagulation favored the occurrence of a retroperitoneal hematoma of iatrogenic origin on attempt of femoral venous catheterization and that of hemoperitoneum on bleeding of an hepatic adenoma. The diagnostic of amniotic fluid embolism was confirmed by the presence of amniotic cells in the bronchoalveolar lavage. The patient survived without sequelae.
Asunto(s)
Adenoma/terapia , Coagulación Intravascular Diseminada/complicaciones , Embolia de Líquido Amniótico/etiología , Paro Cardíaco/etiología , Hemoperitoneo/terapia , Complicaciones Intraoperatorias/terapia , Neoplasias Hepáticas/terapia , Adulto , Líquido del Lavado Bronquioalveolar/citología , Cateterismo Periférico , Cesárea , Coagulación Intravascular Diseminada/terapia , Embolia de Líquido Amniótico/terapia , Femenino , Vena Femoral , Paro Cardíaco/terapia , Hemoperitoneo/complicaciones , Humanos , Enfermedad Iatrogénica , Recién Nacido , Embarazo , Embarazo Gemelar , Espacio Retroperitoneal , Resultado del TratamientoRESUMEN
Laparoscopic sacrocolpopexy is one of the gold standards of pelvic organ surgery. However, this intervention is associated with long operation duration. One of the steps of this intervention (peritoneal closure) can be shortened using several methods of suturing (e.g. staples). Recently, a self-anchoring barbed suture has been described for wound closure. The goal of this initial feasibility study was to describe the use of the barbed suture (V-Loc™) in peritoneal closure during laparoscopic sacrocolpopexy.
Asunto(s)
Implantes Absorbibles , Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía , Peritoneo/cirugía , Técnicas de Sutura , Suturas , Femenino , HumanosRESUMEN
OBJECTIVES: Three-dimensional (3D) Doppler quantification within the uteroplacental unit could be of great help in understanding and screening for pre-eclampsia and intrauterine growth restriction. Yet the correlation between 3D Doppler indices and true blood flow has not been confirmed in vivo. The aim of this study was to evaluate this correlation in a pregnant sheep model. METHODS: A blood flow quantitative sensor and a controllable vascular occlusion system were placed around the common uterine artery in seven sheep in late pregnancy, while all the other arterial supplies were ligated. Several occlusion levels were applied, from 0 to 100%, simultaneously with 3D Doppler acquisitions of several placentomes, using standardized settings. Each placentome was analyzed using VOCAL™ (Virtual Organ Computer-aided AnaLysis) software. The correlation between true blood flow and Doppler indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) was evaluated, together with measurement reproducibility. RESULTS: Forty-eight acquisitions were analyzed. All 3D Doppler indices were significantly correlated with true blood flow. Higher correlations were observed for VI and VFI (r = 0.81 (0.74-0.87), P < 0.0001 and r = 0.75 (0.67-0.82), P < 0.0001) compared with FI (r = 0.53 (0.38-0.64) P < 0.0001). Both intra- and interobserver reproducibility were high, with intraclass correlation coefficients of at least 0.799. CONCLUSION: This is the first in-vivo experimental study confirming a significant correlation between true blood perfusion and quantitative 3D Doppler indices measured within the uteroplacental unit. These results confirm the potential usefulness of 3D Doppler ultrasound for the assessment of placental vascular insufficiency both in clinical cases and in a research setting.
Asunto(s)
Placenta/diagnóstico por imagen , Circulación Placentaria/fisiología , Arteria Uterina/diagnóstico por imagen , Animales , Femenino , Imagenología Tridimensional , Placenta/irrigación sanguínea , Embarazo , Flujo Sanguíneo Regional/fisiología , Oveja Doméstica , Ultrasonografía Doppler , Ultrasonografía Prenatal , Arteria Uterina/fisiopatologíaRESUMEN
OBJECTIVES: To determine the interest and simplicity of 3D ultrasound for the 3-month check in place of the recommended routine radiologic in a general gynecology practice. PATIENTS AND METHOD: Twenty-five patients had routine radiologic and transvaginal 3D ultrasound (Voluson 730 Expert) 3 months after placement of Essure micro-insert. RESULTS: Twenty-one 3D acquisitions were realized. In all cases, the micro-insert are easily visualized. Ideally, the echogenic micro-insert appears in the cornuale portion of the fallopian tube. The relationship between the micro insert and the uterine cavity is well documented. CONCLUSION: Easy-to-use, good reproducibility, absence of radiation, make the 3D ultrasound an interesting alternative for the 3-month check. The coronal view gives a directly exploitable document for the surgeon.
Asunto(s)
Prótesis e Implantes , Esterilización Reproductiva/instrumentación , Esterilización Tubaria/instrumentación , Vagina/anatomía & histología , Vagina/diagnóstico por imagen , Adulto , Trompas Uterinas/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional/métodos , Persona de Mediana Edad , Radiografía , UltrasonografíaRESUMEN
A 25-year-old woman gravida 0 was seen for haemoperitoneum secondary to spontaneous avulsion of a uterine leiomyoma. It is a life-threatening complication. A myomectomy was performed. Through a case, we report a revue of the literature of haemoperitoneum complicating uterine leiomyoma.
Asunto(s)
Hemoperitoneo/etiología , Leiomioma/complicaciones , Neoplasias Uterinas/complicaciones , Adulto , Femenino , Hemoperitoneo/cirugía , Humanos , Leiomioma/cirugía , Rotura/etiología , Rotura/cirugía , Neoplasias Uterinas/cirugíaRESUMEN
We report a case of intrapericardial teratoma following in utero demise at 29 weeks with nonimmune hydrops. The diagnosis was strongly suggested by ultrasound findings and confirmed by fetopathology. The mechanism whereby intrapericardial teratomas may lead to hydrops and death is massive pericardial effusion responsible for compressive tamponade. When prenatal diagnosis is performed before this stage, in utero interventions can obtain decompression, and the birth can be planned with rapid and appropriate management of the neonate.