RESUMEN
Iatrogenic ureteral lesions may occur after any pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of this injury. We conducted a retrospective study of six patients with iatrogenic ureteral lesions following gynecologic or obstetric surgery whose data were collected in the Department of Urology in Kairouan on a period of 4 years (2012-2016). The average age of our patients was 46 years. They were all multiparous. Clinical symptoms were variable depending on the type of lesion. Intravenous urography is very useful for diagnosis. It was performed in 4 cases showing abnormalities. Treatment was based on the insertion of a catheter in one case and on 5 uretero-vesical reimplantations. The postoperative course was marked by a nephrectomy. Iatrogenic ureteral lesions have become a rarity. They are correlated with the degree of medicalization in the country. Gynecological and obstetric surgery is the main cause of iatrogenic ureteral lesions. Prognosis is conditioned by early diagnosis and the anatomic condition of the ureter.
Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Uréter/lesiones , Enfermedades Ureterales/etiología , Adulto , Diagnóstico Precoz , Femenino , Humanos , Persona de Mediana Edad , Nefrectomía/métodos , Complicaciones Posoperatorias/diagnóstico , Pronóstico , Estudios Retrospectivos , Túnez , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/epidemiologíaRESUMEN
The delivery of a macrosomic infant is a relatively common situation. It can put mother and fetus at high risk. The main maternal complications are the increase in cesarean rates, postpartum hemorrhage and cervicovaginal traumatic lacerations. The main fetal complication is shoulder dystocia increasing the risk of brachial plexus. The objective was to identify risk factors and maternal-fetal complications associated with fetal macrosomia. Comparative retrospective study conducted at Kairouan University Hospital maternity unit in 2010. We compared a group of 820 cases of macrosomic infants to a control group of 800 cases of infants born in the same period of time. During the study period we collected clinical data of 820 macrosomic cases on a total of 7.495 deliveries, corresponding to a total incidence of 10.94%. Several factors predisposing to fetal macrosomia were highlighted: Maternal age> 35 years was present in 28.5% of cases; Maternal obesity was found in 45% of cases; A personal history of macrosomia was noted in 28,8% of cases; Prolonged pregnancies > 41 weeks of amenorrhoea was noted in 35.6% of cases; Multiparity was found in 47% of cases. Maternal complications were essentially postpartum hemorrhage: 71 cases and genital traumas: 24 cases. Perinatal complications were dominated by shoulder dystocia: 27 cases (3.3%). Traumatic postpartum complications were found in 11.6%.
Asunto(s)
Macrosomía Fetal/etiología , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Trastornos Puerperales/epidemiología , Adulto , Femenino , Macrosomía Fetal/etnología , Hospitales Universitarios , Humanos , Masculino , Edad Materna , Embarazo , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , TúnezRESUMEN
Cerebral thrombophlebites are rare but life-threatening conditions (1/5000 births). Pregnancy and postpartum are predisposing factors: clinical presentation vary and may be misleading, dominated by headaches, convulsions and neurological deficits but showing no specific features. Physical examination often generates informations unavailable and misleading because cerebral thrombophlebites share symptoms with other affections. A definitive diagnosis can be made only neuroradiologically. Brain MRI is currently the reference method; it allows visualization of the venous thrombus and its evolution. The treatment of cerebral thrombophlebites is essentially medical based on anticoagulant drugs. We here report four cases with post partum cerebral thrombophlebites. The aim of our study and review of the literature is to highlight the importance of early diagnosis and adequate therapy.