BACKGROUND: The extraction of the myoma after laparoscopic resection can be done by: direct extraction, standard intra-abdominal morcellation, electric morcellation, extraction by posterior colpotomy or by minilaparotomy. Most of these options generally require placement of a 10-12 mm trocar and / or enlargement of the skin incision and fascia for tissue removal; In addition to the aesthetic disadvantages, it represents clinical implications such as the risk of incisional hernias. CLINICAL CASES: We present 3 cases of patients with diagnosis of myomatosis of large elements, the smallest being 7 cm and the largest being 15 cm, in greater diameter, after the laparoscopic myomectomy the extraction of the complete surgical piece is performed through posterior colpotomy, presenting a favorable postoperative recovery, without associated symptoms. CONCLUSIONS: The transvaginal extraction through posterior colpotomy represents a safe and effective alternative for the extraction of surgical pieces, the elasticity of the vagina allows the safe extraction of large pieces, avoiding the use of the morcellator and its possible risks; It also avoids expanding the abdominal incisions, associating to less postoperative pain, faster recovery and better cosmetic results. The vaginal route is a safe option with minimal risk of complications, and with better postsurgical results compared to the other options in laparoscopic surgery.
BACKGROUND: It is possible that the hyperinflammatory state in pregnant patients with COVID-19 is associated with hypoxic lesions in the placenta, which induce a clinical and biochemical picture similar to that of preeclampsia and HELLP syndrome. CLINICAL CASE: 40-year-old patient, with a history of primary infertility, with 33.1 weeks of pregnancy achieved by in vitro fertilization and embryo transfer. She was admitted to the emergency department due to hypertensive crisis accompanied by respiratory distress, hemolysis, hyperbilirubinemia and increased lactate dehydrogenase, elevated liver enzymes, thrombocytopenia and proteinuria. It was decided to terminate the pregnancy due to a suspected diagnosis of HELLP syndrome and probable acute pulmonary edema secondary to preeclampsia, with severity criteria. During the immediate postpartum period, chest CT scan showed pulmonary changes due to SARS-CoV-2 pneumonia, CORADS classification 5. During her stay in intensive care, she experienced clinical and biochemical improvement and was discharged on the sixth day after hospitalization. CONCLUSION: In this case we found similarity of the clinical picture and biochemical alterations of SARS-CoV-2 with preeclampsia and HELLP syndrome. To avoid in treatment and complications associated with late diagnosis it is important to establish the differential diagnosis.
OBJECTIVE: To present cases of pregnant women with COVID-19 and preeclampsia that showed torpid evolution and unfavorable outcomes. As well as a review of the literature to know the prevalence of both pathologies and their similarities, to be able to differentiate them and to evaluate the most appropriate management. MATERIALS AND METHODS: An electronic search was performed in databases, finding 120 articles, of which a total of 33 articles were included for the literature review. RESULTS: We report four cases of patients diagnosed with COVID-19 infection and preeclampsia who presented torpid evolutions with complications such as eclampsia, stroke, HELLP syndrome, acute kidney injury, DIC, pneumonia, maternal death and fetal death. This shows that pregnant women with these two pathologies can present severe complications where morbidity and risk of death are high. CONCLUSIONS: The presence of preeclampsia and COVID-19 represents a diagnostic challenge due to similar clinical, laboratory and pathophysiology data. PCR testing should be considered for all women with high-risk pregnancies and those presenting with symptoms suggestive of preeclampsia to avoid delay in diagnosis. © 2021 Asociacion Mexicana de Ginecologia y Obstetricia. All rights reserved.
Resumen ANTECEDENTES: La neoplasia gestacional trofoblástica es un tumor raro, derivado de la gestación que procede de un desarrollo anormal del tejido trofoblástico. Incluye cuatro variedades, entre las que se encuentra la mola invasiva y el coriocarcinoma. Puede tener diferentes grados de proliferación; el diagnóstico diferencial es decisivo porque influye directamente en el tratamiento. Las molas premalignas suelen tratarse con legrado uterino, las malignas requieren tratamiento sistémico con mono o poliquimioterapia. Paciente de 13 años, hospitalizada debido a un cuadro de vómitos y dolor abdominal. Durante el internamiento se le practicaron estudios complemen-tarios: determinación de la fracción β de la gonadotropina coriónica humana ( β -hCG) y tomografía axial computada para plantear el diagnóstico diferencial. El diagnóstico definitivo lo aportó la biopsia obtenida mediante legrado. El tratamiento se basó en la poliquimioterapia. En la actualidad está en remisión completa de la enfermedad. CONCLUSIONES: Resulta imprescindible detectar lo más temprano posible la gestación anómala, entender perfectamente su evolución e importancia de la anticoncepción mientras se trata y la enfermedad desaparece y minimizar la cantidad de pacientes que deben recibir quimioterapia. Abstract BACKGROUND: Gestational trophoblastic neoplasia is a rare tumor that originates from pregnancy and it develop from anormal proliferation of trophoblastic tissue. It includes four varieties, including invasive mole and choriocarcinoma. They can present different degrees of proliferation, being essential differential diagnosis since it directly influences the treatment. Premalignant moles are usually treated by suction curettage while malignant forms require systemic therapy with mono or polychemotherapy. OBJECTIVE: Report the case, paying special attention to the differential diagnosis and treatment used, analyzing the reasons why polychemotherapy is established and de-scribing the different possible options, based on current scientific evidence. CLINICAL CASE: We present the case of an invasive mola in a 13-year-old patient hospitalized by vomiting and abdominal pain. During this period, complementary techniques such as the determination of the β fraction of the human chorionic gonado- tropin ( β -hCG) or computed tomography (CT) are required to establish the differential diagnosis. Finally, the definitive diagnosis is provided by the biopsy obtained by curet- tage. Treatment is instituted with the pattern of polychemotherapy being, currently, with complete remission of the disease. CONCLUSIONS: Thus, it is essential to detect anomalous gestation early, to understand perfectly the evolution of this entity, the importance of contraception during its resolu-tion, and to minimize patients susceptible to chemotherapy.
BACKGROUND: Chagas disease is a zoonosis caused by Trypanosoma cruzi, a parasite endemic to Latin America. Children become infected by contact with vectors or by congenital transmission. CLINICAL CASE: Illiterate indigenous patient, 32 years old, from the rural area of western Colombia, with a history of 7 pregnancies and 6 deliveries, the current pregnancy with 29.5 weeks determined by the third trimester ultrasound, without prenatal controls, with preterm labor and severe oligohydramnios. The pregnancy ended by cesarean section, without complications and the birth of a girl who weighed 1290 g. At 50 days of life, he developed hemodynamic instability, respiratory distress, mucocutaneous pallor and fever with a diagnosis of sepsis of undetermined origin. Extension studies reported: positive microhematocrit parasitaemia for Trypanosoma cruzi, with amastigotes in the cerebrospinal fluid. Diagnosis: Chagasic meningoencephalitis. CONCLUSIONS: The vertical transmission of Chagas disease is low; congenital transmission is responsible for the progressive appearance of the disease in endemic and non-endemic areas. In pregnant women, it is important to include screening for Trypanosoma cruzi infection, as part of the prenatal control test suite .
de arterias uterinas; cesárea; histerectomía. Abstract BACKGROUND: Obstetric genitourinary fistulas can cause as a complication of uter- ine artery embolization due to necrosis of the uterus and/or bladder. Vaginal surgical treatment is a less invasive option with success rates of up to 84.12%. CLINICAL CASE : A 40-year-old woman who came with a pregnancy of 35 5/7 weeks and placenta accreta, which was managed with uterine arteries embolization and obstetric hysterectomy after caesarean section. At 3 weeks she had vaginal urine loss; by physical examination and with support of dye test, cystoscopy and retrograde cys-tography, obstetric vesicovaginal fistula was diagnosed. After the improvement of the inflammatory process, vaginal fistulectomy was performed with modification of the Latzko technique. Its postoperative evolution was satisfactory and without recurrence of the fistula during the follow-up in the outpatient clinic. CONCLUSION: This is the fifth case of post-embolization bladder necrosis reported in the literature. The favorable resolution of this case allows us to conclude that vaginal fistulectomy is a viable and safe alternative in the surgical treatment of this type of obstetric fistulas.
OBJECTIVE: To determine the genetic mutations in hereditary pattern breast cancer and demonstrate whether there is a significant association between the most common in the Mexican population and the risk of suffering it. MATERIALS AND METHODS: Cross-sectional and observational study conducted at the Hospital Angeles México in coordination with the National Institute of Genomic Medicine. Inclusion criteria: patients with breast cancer and one or more first-degree relatives affected by this disease and patients with ovarian cancer. Exclusion criteria: patients without a history of breast or ovarian cancer, or with a family member in the protocol. The RT2 Profiler plate rearrangement technique was used for Master-Mix Quantinova probe PCR kit. The SPSS version 22 program and Epi Info version 7 were used for the statistical analysis. RESULTS: 39 patients with an average age of 53.2 ± 12.1 years were studied. Pro- gesterone and estrogen receptors showed no difference between groups. There was a statistical difference, and CONCLUSION: The data obtained show that in the Mexican population the BRCA2 has a higher incidence in hereditary cancer, at an age of earlier onset and greater nuclear grade at the time of diagnosis.
OBJECTIVE: To determine the diagnostic performance of the FullPIERS model as a predictor of perinatal complications in patients with preeclampsia from a public hospital in Northwest Mexico. MATERIALS AND METHODS: Retrospective study, for the evaluation of a proper diagnosis, performed in patients with diagnosis of preeclampsia attended at a secondlevel public hospital between October 2018 and February 2019. Inclusion criteria: sufficient data to introduce them into the FullPIERS calculator (saturation of oxygen, platelet retreat, creatinine, aspartate, transaminases and the existence of dysnea). Exclusion criteria: patients with previous diagnosis of acute, pulmonary or renal liver diseases. It is compared to the percentage of the ingrowth risk of each patient versus the number of patients with complications. Calculated: sensitivity, specificity and predictive values of the model. RESULTS: If 100 patients were studied with preeclampsia: 11 with positive results according to the Full PIERS calculator (over 5% risk), and 7 out of 11 were true. For Ingrid América Cazarez-Ávalos, Demnsi García-Benavente, Cinthia Nallely Toledo-Lorenzo, Jaime Guadalupe Valle-Leal, Diego Misael López-Valenzuela Recibido: junio 2019 Aceptado: noviembre 2019 1 Departamento de Ginecología y Obstetricia. 2 Departamento de Educación e Investigación en Salud. Hospital General Regional 1, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México. Correspondencia Jaime Guadalupe Valle Leal Valle_jaime1@hotmail.com Este artículo debe citarse como Cazarez-Ávalos IA, García-Benavente D, Toledo-Lorenzo CN, Valle-Leal JG, López-Valenzuela DM. Desempeño diagnóstico del modelo FullPIERS como predictor de complicaciones perinatales en pacientes con preeclampsia. Ginecol Obstet Mex. 2020 enero;88(1):1-7. https://doi .org /10.24245/gom. v88i1.3253 Diagnostic performance of FullPIERS model as predictor of perinatal complications in patients with preeclampsia. Ginecología y Obstetricia de México
