RESUMO
An unusual case of self-inflicted cesarean section with maternal and child survival is presented. No similar event was found in an Internet literature search. Because of a lack of medical assistance and a history of fetal death in utero, a 40-year-old multiparous woman unable to deliver herself alone vaginally sliced her abdomen and uterus and delivered her child. She was transferred to a hospital where she underwent repair of the incisions and had to remain hospitalized. Mother and child survived the event. Unusual and extraordinary measures to preserve their offspring sometimes moves women to extreme decisions endangering their own lives. Social, educational, and health measures should be instituted all over the world, particularly in rural areas of developing countries, to avoid such extreme events.
Assuntos
Cesárea , Comportamento Materno , Resultado da Gravidez , Comportamento Autodestrutivo , Adulto , Cesárea/psicologia , Feminino , Humanos , Comportamento Materno/psicologia , Gravidez , Comportamento Autodestrutivo/psicologiaRESUMO
Ectopic pregnancy (EP) treated by traditional methods, signifies an approximate lose of fertility capacity of the patient, of 50%. The early diagnosis allows conservative treatment with metotrexate (MTXE), with the objective of preserving the affected tube (salpynx) and its function. Early detection of EP, intact, was done, in 11 cases, with the following parameters: clinical picture, ultrasonography (Us) (empty uterus, adnexial mass and free fluid; adnexial ring or extrauterine embryo); quantitative determination of beta fraction of chorionic gonadotropin (CGH b) and laparoscopic observation, when the following characteristics were met: tubal pregnancy, no greater than 30 mm, intact tubarian serosa, lack of active bleeding and visualization of all pelvic cavity. MTXE 12.5 mg, intrasacularly via laparoscopy in eight patients, and three by laparotomy. The ulterior control of the procedure was: careful surveillance during eight days, Us daily and CGH b in two occasions; ten patients evolutionated satisfactorily, two of them required additional dosis of MTXE, parenterally, 0.5 mg/kg and citovorum factor, 0.1 mg/kg/4 days. The obtained conclusions are: 1. Conservative treatment with MTXE may be carried out provided the conditions established before, are met. 2. The patient's follow up must be precise and because of the high cost of the determination every third day of CGH b, Us may be used. Hysterosalpingography was done in five patients after six months of the procedure, and tubal permeability was seen.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Metotrexato/uso terapêutico , Gravidez Tubária/tratamento farmacológico , Adulto , Testes de Obstrução das Tubas Uterinas , Feminino , Fertilidade/efeitos dos fármacos , Seguimentos , Humanos , Laparoscopia , Gravidez , Gravidez Tubária/diagnóstico por imagem , Radiografia , UltrassonografiaRESUMO
The usefulness of ultrasonography in IUD insertion and control, was evaluated. A follow up of IUD localization, placed at the end of puerperium and in non puerperal patients, was done. The copper T IUD 200 was used, and was placed in 50 patients. Ultrasonographic study was done right after IUD placement, at one month and at three months; uterine longitudinal sections, as well as transversal ones, for adequate localization of IUD; data were taken for control and followup. There were no IUD expulsion, pregnancy, or uterine perforation. Conclusions were: 1. Ultrasonography is useful for IUD control. 2. IUD placement at the hospital is adequate. 3. There were no complications. 4. Alterations produced by IUD insertion are more frequent during the first month, and very scarce at third month. 5. Dysmenorrhea was most frequent after IUD insertion. 6. Echosonographic control of IUD is the most accurate method in order to know its localization within the uterine cavity.
Assuntos
Dispositivos Intrauterinos de Cobre , Útero/diagnóstico por imagem , Adolescente , Adulto , Estudos de Avaliação como Assunto , Feminino , Humanos , UltrassonografiaRESUMO
PIP: The results of a prospective study of postpartum sterilization by laparoscopy with silastic ring application are presented. 300 patients at a regional hospital in Oaxaca, Mexico, were studied. The majority of patients were under 30 years of age, had more than 3 children, and had between 1 and 6 years of primary education. Sterilization was performed approximately 38 hours postpartum. Verres and Thouy needles were used; the average volume of carbon dioxide used was 2 liters. In 17 patients a 2nd puncture was required to apply pneumoperitoneum. Some modifications of the technique to facilitate this procedure are described. There were few surgical difficulties. Complications included 2 failures of the procedure, 3 tubal lacerations, and 1 small hematoma of the mesosalpinx; 2 of these complications were resolved by laparotomy and 4 by laparoscopy. The pregnancy rate was 0.66% (2 cases). Patients were discharged 24 hours after the procedure; there was no increase in the patients' length of hospitalization. The authors conclude that laparoscopic sterilization using silastic rings should be considered by hospitals where demand for postpartum sterilization is high because it does not increase morbidity or mortality, it requires only small modifications of traditional laparoscopic technique, and postoperative pain is minimal.^ieng
Assuntos
Esterilização Tubária/métodos , Adulto , Feminino , Humanos , Laparoscopia , Período Pós-Parto , GravidezRESUMO
Se presentan los resultados de un estudio prospectivo de esterilizacion en postparto por laparoscopia con aplicacion de anillos de silastic, en el servicio de Ginecoobstetricia del Hospital "Dr. Aurelio Valdivieso" de Oaxaca, Oax., en 300 casos; el mayor numero de pacientes tenia menos de 30 anos, mas de tres hijos y el nivel de educacion predominante fue del 1o. al 6o.ano de primaria; el promedio de horas de puerperio fue de 38 horas se uso la aguja de Verres y Thouy, el volumen de CO2 promedio fue de dos litros: en 17 casos se recurrio a una segunda puncion en hipocondrio izquierdo para aplicar el neumoperitoneo. Se senalan algunas modificaciones de la tecnica para facilitar este procedimiento. Hubo pocas dificultades quirurgicas y las complicaciones fueron las seguientes; dos fallas del procedimiento, tres desgarros de trompa y un pequeno hematoma de mesosalpinx, se resolvieron con laparotomia (dos) y cuatro por laparoscopia. El indice de embarazos fue de 0.66 por ciento (dos casos) no hubo modificaciones de dia estancia paciente, el alta fue a las 24 horas del procedimiento. Se insiste en las modificaciones de la tecnica, se reviso la bibliografia del tema y se recomienda como util el procedimiento.Finalmente una evaluacion correcta sera cuando se tenga mas experiencia al respecto