Medicina

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Author: search.filters.author.Barragán Quishpe, Fanny Gabriela

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    Óbito Fetal y Shock Hipovolémico Secundario a Desprendimiento Normoplacentario
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Barragán Quishpe, Fanny Gabriela; Mera Ramos, Gerardo Vinicio Dr.
    Placental abruption or placental abruption refers to bleeding in the decidual-placental interface that causes the release of partial or total placental, the main clinical findings are bleeding associated with abdominal pain or severe and persistent dorsal, sustained uterine contraction and signs of suffering fetal.6 In many cases the source of bleeding is a small blood vessel or feto-placental vessel breaks, where the result is that the decidual progressively dissected hematoma formed, leaving a thin layer in contact with the maternal face the placenta and the rest remains attached to the myometrium, the detached part of the placenta is unable to exchange gases and nutrients, when the remaining fetoplacental unit is not able to compensate for this loss, is compromised. In 5% of pregnancies occur bleeding before delivery and 1.2% are abruption.6-8 The placental abruption is an important cause of morbidity and mortality maternal and perinatal. The perinatal mortality rate is approximately 20%. In Ecuador according to the Ecuadorian Institute of Statistics and Censuses in 2013 3.23% of maternal deaths was caused by the placental abruption.12 The main risk factors are a history of abruption, hypertensive disorders of pregnancy, advanced maternal age, multiparity, premature labor and premature rupture of membranes due to inflammation or sudden decompression of the uterus, alcohol, snuff and cocaine among otros.15 The following case describes a female patient 25 years old with surgical history, two previous cesareans with no medical history of importance and gynecological and obstetrical history: menarche at age 11, regular menstrual cycles for 5 days, beginning the sexual life 15, pregnang: 3 (with the current) vaginal: 0 cesareans: 2 abortions: 0, course with urinary tract infection in pregnancy, with last menstrual period (LMP): 05 / Aug / 2015. Current Gestation: Pregnancy 39.2 weeks LMP, the patient comes aforementioned Health Center La Mana by dark red vaginal bleeding present in moderate amount, no odor, no apparent cause of approximately 12 hours of evolution followed by abdominal pain contraction type, progressive intensity that radiates lumbar region of about 3 hours of evolution, along with signs and symptoms of hypovolemic shock due to haemorrhage (tachycardia, hypotension and generalized pallor), with this clinical picture is received in gynecologic Emergencies Provincial General Hospital in Latacunga, he decided to send him to proceed with cesarean surgery is performed showing dead male product and complete abruption. The blood loss is offset by the administration of crystalloid, colloid, packed red blood cells and plasma. As a complication of surgery presents difficult control of hemostasis upper right pedicle, difficult removal of the cervix, friable tissue, uterine atony, subtotal hysterectomy is performed. In its evolution at 24 hours post-surgery blood count which draws attention hemoglobin 7.4 mg / dl and hematocrit of 23.2%, which is why they decide to spend two more packed red blood cells is performed. The patient remained hospitalized for seven days, recovering their hemoglobin which reached the fourth day, hemodynamically stable without symptoms or signs of possible complications are decided high. So we can say that the patient predisposing risk factors that could cause abruption being multiparity, smoking and alcoholism and the failure in planning and antenatal care unit primary care found. Within the management of hemorrhagic shock we can say that was indicated to restore blood volume to the patient agrees to set standards.
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    Óbito Fetal y Shock Hipovolémico Secundario a Desprendimiento Normoplacentario
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Barragán Quishpe, Fanny Gabriela; Mera Ramos, Gerardo Vinicio Dr.
    Placental abruption or placental abruption refers to bleeding in the decidual-placental interface that causes the release of partial or total placental, the main clinical findings are bleeding associated with abdominal pain or severe and persistent dorsal, sustained uterine contraction and signs of suffering fetal.6 In many cases the source of bleeding is a small blood vessel or feto-placental vessel breaks, where the result is that the decidual progressively dissected hematoma formed, leaving a thin layer in contact with the maternal face the placenta and the rest remains attached to the myometrium, the detached part of the placenta is unable to exchange gases and nutrients, when the remaining fetoplacental unit is not able to compensate for this loss, is compromised. In 5% of pregnancies occur bleeding before delivery and 1.2% are abruption.6-8 The placental abruption is an important cause of morbidity and mortality maternal and perinatal. The perinatal mortality rate is approximately 20%. In Ecuador according to the Ecuadorian Institute of Statistics and Censuses in 2013 3.23% of maternal deaths was caused by the placental abruption.12 The main risk factors are a history of abruption, hypertensive disorders of pregnancy, advanced maternal age, multiparity, premature labor and premature rupture of membranes due to inflammation or sudden decompression of the uterus, alcohol, snuff and cocaine among otros.15 The following case describes a female patient 25 years old with surgical history, two previous cesareans with no medical history of importance and gynecological and obstetrical history: menarche at age 11, regular menstrual cycles for 5 days, beginning the sexual life 15, pregnang: 3 (with the current) vaginal: 0 cesareans: 2 abortions: 0, course with urinary tract infection in pregnancy, with last menstrual period (LMP): 05 / Aug / 2015. Current Gestation: Pregnancy 39.2 weeks LMP, the patient comes aforementioned Health Center La Mana by dark red vaginal bleeding present in moderate amount, no odor, no apparent cause of approximately 12 hours of evolution followed by abdominal pain contraction type, progressive intensity that radiates lumbar region of about 3 hours of evolution, along with signs and symptoms of hypovolemic shock due to haemorrhage (tachycardia, hypotension and generalized pallor), with this clinical picture is received in gynecologic Emergencies Provincial General Hospital in Latacunga, he decided to send him to proceed with cesarean surgery is performed showing dead male product and complete abruption. The blood loss is offset by the administration of crystalloid, colloid, packed red blood cells and plasma. As a complication of surgery presents difficult control of hemostasis upper right pedicle, difficult removal of the cervix, friable tissue, uterine atony, subtotal hysterectomy is performed. In its evolution at 24 hours post-surgery blood count which draws attention hemoglobin 7.4 mg / dl and hematocrit of 23.2%, which is why they decide to spend two more packed red blood cells is performed. The patient remained hospitalized for seven days, recovering their hemoglobin which reached the fourth day, hemodynamically stable without symptoms or signs of possible complications are decided high. So we can say that the patient predisposing risk factors that could cause abruption being multiparity, smoking and alcoholism and the failure in planning and antenatal care unit primary care found. Within the management of hemorrhagic shock we can say that was indicated to restore blood volume to the patient agrees to set standards.