RESUMEN
Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case.
Asunto(s)
Colon Sigmoide/patología , Parto Obstétrico/efectos adversos , Hematoma/etiología , Femenino , Hematoma/diagnóstico por imagen , Humanos , Pelvis/diagnóstico por imagen , Peritoneo/diagnóstico por imagen , Peritoneo/patología , Embarazo , Tomografía Computarizada por Rayos XRESUMEN
Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of cervical incompetence is low and the best prophylactic option is progesterone administration.
Asunto(s)
Cuello del Útero/diagnóstico por imagen , Cuello del Útero/patología , Nacimiento Prematuro/diagnóstico por imagen , Ultrasonografía/métodos , Cerclaje Cervical , Medición de Longitud Cervical , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
True umbilical cord knot appears to be a relatively common complication that occurs in 0.3%-1.3% of all pregnancies and it is correlated with an increased incidence of SGA infants, premature birth, need for neonatal intensive care and fetal death. The aim of the article was to evaluate the incidence of the true umbilical cord knot in the University Emergency Hospital, Bucharest, for a period of 5 years and its association with premature birth, low birth weight, low Apgar score at 1 minute and the need for neonatal intensive care. By reviewing the total number of women who delivered in this unit between January 1st 2011 and December 31st 2015, the percentage of the diagnosis antepartum and intrapartum, the outcome of these pregnancies, and the reflection of this condition on the fetal status, were evaluated. During 5 years, 133 (0.71%) of 18.500 deliveries were diagnosed with true umbilical cord knot, only 16 (0.08%) cases were diagnosed by ultrasound antepartum. The mean maternal age was 34.3 years. About 30% of the studied cases (39) presented this condition at the third delivery or more. A personal history for diabetes corresponded to 27 cases (20.3%). From our database, it resulted that only 12 fetuses (10.5%) required neonatal intensive care and presented an Apgar score lower than 7 at 1 minute. Prenatal diagnosis of a true umbilical cord knot is rarely encountered and sonography skills are needed. Complementary methods such as color Doppler and 3D HD Flow are reliable for the diagnostic when true umbilical cord knots are suspected after a 2D scan. Several risk factors can guide the expectancy, such as advanced maternal age, polyhydramnios, multiparty or diabetes.
Asunto(s)
Complicaciones del Embarazo/diagnóstico por imagen , Ultrasonografía Prenatal , Cordón Umbilical/patología , Adulto , Puntaje de Apgar , Femenino , Muerte Fetal/etiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Mortalidad Prematura , Embarazo , Cordón Umbilical/diagnóstico por imagenRESUMEN
Paraovarian cysts are a rare pathology, constituting 10-20% of the adnexal masses. The origin can be represented by paramesonephric ducts (Hydatid cysts of Morgagni), vestiges of mesonephric ducts also represented by mesothelium, or neoplastic (cystadenomas or cystadenofibromas) that are mostly benign. Borderline or malignant paraovarian tumors are encountered less often. This article presents a case of paraovarian cyst in a 37-year-old patient, with a history of 2 pregnancies, completed by cesarean. The patient sought medical attention for an asymptomatic voluminous ovarian cyst, detected in a routine ultrasound scan. Laboratory tests and tumor markers were within normal limits. Transvaginal ultrasound and color Doppler revealed a cystic adnexal mass with 10 cm transonic, smooth, homogeneous content, avascular walls with no internal papillary projections, with a "hyperechoic line" sign of delimitation from the ovarian capsule, mostly visible when the adnexa was mobilized. The diagnostic and curative laparoscopic surgery was successful, followed by a quick recovery. The histopathological exam confirmed the benignity and the origin of the paraovarian cyst. The case was discussed in the context of the literature review concerning this pathology, drawing attention to the real possibility of differentiating ovarian from paraovarian cysts by ultrasound.