Medicina

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    Preeclampsia Asociada a Vasa Previa
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Pineda Vaca, Vanessa Tatiana; Mena Villarroel, Luis Byron Dr.
    The Preeclampsia is defined as the appearance of hypertension and proteinuria after the week 20 of the pregnancy. It is in the habit of accompanying of edema in low members but the presence is not necessary of these to be diagnosed. It is an own disease of the pregnancy of which they can treat the symptoms, but only he recovers with the ending of the same one, can cause serious complications both for the woman and for the fetus. The previous vasa is a rare reason of hemorrhage of the third quarter of the pregnancy, in which blood glasses from the placenta intervene between the presentation and the cervical internal orifice. It is a question of a pathology that in most cases is not diagnosed during the pregnancy but she is looked specifically, being responsible for a high mortality perinatal that ranges between 60 % to 90 %, according to different bibliographical sources. There presents a case of one 38-year-old feminine patient, with pregnancy of 31 weeks diagnosed by ultrasound scan, there comes for migraine holocraneana of moderate intensity sharp type that it increases with the activity, accompanied of bled vaginal, does +/-24 hours in few quantity red sparkling color, 20 hours ago it recounts decrease of foetal movements, 12 hours ago abdominal pain adds constant type of moderated to great intensity located in upper abdomen, there is realized ultrasound scan in which there is demonstrated previous occlusive partial placenta and to rejecting vasa previous, there is demonstrated in the foetal electronic monitoring commitment of the foetal well-being, by what emergency Caesarean is realized being the only alive fetus premature baby deposited to neonatalogy, in this clinical case the association was looking between preeclampsia and vasa previous that on not having been it also was discarding it, at the same time one was determining the factors of risk as well as the diagnosis and treatment of the pathologies treated in the topic.
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    Placenta Previa Increta como causa de Hemorragia Obstétrica
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Cupueran Limachi, Carolina Estefanía; Remache Cevallos, Héctor Rodrigo Dr. Especialista
    Placenta previa is defined as the total or partial insertion of the placenta in the lower segment of útero. La incidence is estimated to be 1 in every 200 pregnancies to term and varies throughout the world. It seems to have increased relative to the increasing rate of births cesárea. It is classified as complete, partial and marginal, depending on how the placenta covers the opening endocervical. According to the degree of penetration of abnormal placentation three types are recognized: accreta, increta, percreta. We present the case of female patient of 33 years old that causes pregnancy 22 weeks 5 days with reproductive background of sharp curettage 3 years ago. Go to the emergency room to present in moderate vaginal bleeding, bright red, with clots, accompanied by crampy abdominal pain located in lower abdomen. Enter hemodynamically stable. An ultrasound trace is reported total occlusive placenta previa. It remains hospitalized for about 3 months in the HPDA, at 35.3 weeks outpatient reports crystal clear liquid in small quantities, positive crystallography. Patient with uterine activity sporadic transfer is decided by lack of physical space to IESS in Ambato with a pregnancy of 35.3 weeks LMP + premature rupture of membranes 48 hours of evolution + previa low set + fetal distress, is valued and decide their intervention performing a caesarean surgical segmental abdominal hysterectomy + bilateral + adnexectomy. Post-surgical patient remains in recovery of 35.3 weeks + increta placenta previa, pregnancy patient is discharged in good general condition. Histopathological confirms increta placenta. Early prenatal approach through non-invasive diagnostic imaging provides useful information on the commitment and extension in the evaluation of patients with risk factors for placenta accreta. Ultrasonography is the method of choice, leaving magnetic resonance imaging and the study as a confirmatory histopathology as the gold standard definitive diagnosis and image. The only safe and proper method of delivery for placenta previa is a cesarean delivery. It is essential in all hospitals that treat obstetric patients evaluate and implement strategies to achieve a significant reduction in maternal morbidity and mortality. The ideal is to have a contingency plan on therapeutic conduct to follow, so that each case must be individualized. However, there are specific conditions of these high-risk pregnancies that require rapid decision-making, which should ideally be carried out in highly complex centers with highly trained professionals’ health to optimize final results thus reducing the maternal risks fetal.
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    Acretismo Placentario
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) Buenaño González, Ricardo Andrés; Mera Ramos, Gerardo Vinicio Dr.
    Placenta accreta is a broad term that encompasses the conditions in which the placenta, in histopathological terms, can be accreta, increta or percreta. Being able to distinguish between these entities in clinical situations, is not easy. It remains a challenge even after diagnosis, except when the uterus is removed and subjected to pathological examination. Percreta placenta is the most serious placentas for their great invasion, and is associated with high maternal morbidity compared with other varieties. The case of a patient of 36 years old with a history of antiphospholipid antibodies and stillbirths syndrome occurs, is in her sixth pregnancy of 28.6 weeks and is diagnosed sonographically total occlusive placenta previa and placenta accreta. It is particularly treated with heparin and low molecular weight ASA. Prior to admission, heavy bleeding genital glittering red so it is transferred to Provincial Teaching Hospital Ambato, where diagnoses are confirmed. She underwent emergency caesarean with pregnancy diagnostics 28.6 weeks + Total occlusive placenta previa bleeding + antiphospholipid antibody síndrome + accretism + anticoagulated patient. As a complication of surgery percreta placenta is seen to vegija invasion, parametrial and cervix, so the total obstetric hysterectomy is performed without adnexectomy; hallo posteriormene is complicating bilateral ureteral ligation developing acute renal failure. Therefore it was necessary bilateral ureteral reimplantation, which yields box renal failure, and patient evolves favorably
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    Enfermedad Trofoblástica Gestacional: Mola Hidatiforme Parcial
    (Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) Capuz Cisneros, Fernanda Estefanía; Salazar Faz, Fernando Abel Dr.
    Gestational trophoblastic disease, included a focal hydatidiform changes are characterized by hydropic degeneration of chorionic villi and trophoblastic hyperplasia, comprising: hydatidiform mole (partial and complete), invasive mole, gestational trophoblastic neoplastic, placental site trophoblastic tumor and choriocarcinoma. Dropsy histologically diffuse stromal edema characteristically avascular chorionic villus, whose diameter ranges from 0.1 to 3 cm is evident; thus acquiring the morphology of bands and clusters of vesicles that give the appearance of "Bunch of Grapes", are harmless while other vascular placental villi with fetal circulation. In the 75% of molar pregnancies are complete, with androgenetic diploid chromosome complement; the remaining 25% belongs to the partial hydatidiform mole with triploid chromosome complement regular or sporadic cases. So in the 45% of these women with a partial mole arrived at 28 weeks of gestation, of which 70% lived on. Therefore it is essential to the realization of cytogenetic study and high resolution ultrasonography. The present clinical case is a female patient 26 years old, FUM: July 5, 2015 (unreliable), gestational age 14 weeks echo made the September 28, 2015, which reports: Pregnancy 14 weeks + single fetus alive + partial placental hydropic degeneration (partial mole), In hospitalization she received two doses of Misoprostol is imposed to perform curettage, but on the evidence of a live fetus and apparently normal amniocentesis decided to perform more genetic study, with a genetic result of 46XX. At 29 weeks gestation, is again entering in hospital with diagnostic of initial labor of part + low amniotic liquid + early rupture of membranes 36 hours of evolution, so it was decided to terminate the pregnancy by cesarean, we got a RN active, female, minute Apgar 8 and five minutes of born 9, weight: 1105 g, size: 35.5 cm, head circumference: 25.5 cm, and a posterior fundic placenta with characteristics of partial mole, tubal ligation is performed. Monitoring BHCG quantitative is done in progressive decline and good prognosis in the future.