RESUMO
BACKGROUND: Advances in technology and the specialized training of gynecologists in ultrasound have led to an increase in fetal diagnoses. Congenital cystic adenomatoid malformation (CCAM) is of particular interest because of its difficulty in predicting the disease evolution. OBJECTIVE: To review the cases of prenatal diagnosis of CCAM during the last five years in our hospital, and to analyze their evolution as a consequence of its diagnosis. PATIENTS AND METHODS: Retrospective study that reviewed the cases of CCAM between 2005 and 2010 treated in our hospital. We evaluated gestational age, type of CCAM and evolution in at least the first 12 months. RESULTS: Twenty-one cases were diagnosed (1 for every 2,660 deliveries in our hospital of reference), 3 of them with CCAM type 1 (14.3%), 8 with type 2 (38.1%) and 10 with type 3 (47.6%). Two patients proceeded with a medical interruption of pregnancy; in 11 patients lesions were stable, in eight they disappeared and one fetus suffered severe mediastinal shift with little healthy lung, and died during the first postpartum week. Four of eight cases in which the image disappeared were considered free of disease after birth. Of the 19 cases in which pregnancy was not interrupt, 15 had mediastinal shift and 6 did not; in five of them (83.3%), the image disappeared and only one remained stable. The lesion disappeared in only three cases of the 13 who had mediastinal shift (p < 0.01). Lobectomies were necessary in 8 of 19 cases, four are considered free of the disease and seven are still in follow-up. CONCLUSION: Congenital cystic adenomatoid malformation is a condition in which the council is extremely complex, but most cases evolved favorably. Severe complications such as hydrops are described in up to 25% of all CCAM.
Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos RetrospectivosRESUMO
BACKGROUND: The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida. OBJECTIVE: To determine the different risk factors for urinary incontinence after a twin pregnancy. PATIENTS AND METHODS: 331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence. RESULTS: The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058). CONCLUSIONS: The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.
Assuntos
Parto Obstétrico/métodos , Incontinência Fecal/epidemiologia , Gravidez Múltipla , Transtornos Puerperais/epidemiologia , Incontinência Urinária/epidemiologia , Adulto , Peso ao Nascer , Cesárea , Estudos Transversais , Parto Obstétrico/efeitos adversos , Episiotomia , Incontinência Fecal/etiologia , Feminino , Humanos , Incidência , Recém-Nascido , Pessoa de Meia-Idade , Forceps Obstétrico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Transtornos Puerperais/etiologia , Inquéritos e Questionários , Gêmeos , Incontinência Urinária/etiologia , Adulto JovemRESUMO
Gastrointestinal stromal tumors are the commonest stromal tumors of the digestive tract. Even though, the incidence is aproximately 10 to 20 cases per million people and year. More than 90% of these tumors take place in patients over 40, and the median age is 63. Its diagnosis during pregnancy is extremely rare. There are less than 10 cases reported in literature about gastrointestinal stromal tumors diagnosed during pregnancy. We describe the case of a patient who was diagnosed of gastrointestinal stromal tumor during her first pregnancy due to massive lower digestive bleeding and the fetus died. She underwent a small bowel resection and cesarean section delivery. Afterwards, she was controlled by obstetricians, digestive surgeons and oncologists. The following two pregnancies were normal, and six years since the diagnosis she is asymptomatic. Even if they are extremely rare tumors during pregnancy, it is very important knowing their diagnosis and multidisciplinary treatment; also very important is knowing their prognostic factors and the different possible treatments.