Medicina

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    Placenta previa oclusiva total con signos de acretismo secundaria a cirugía uterina anterior
    (Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2020-10-01) Salazar Urrutia, Pamela de los Angeles; Belalcazar Sánchez, Yajaira MonserrathDra.
    The placenta previa is defined as the total or partial insertion of the placenta in the lower segment of the uterus. It is considered responsible for 20% of bleeding in the 3rd trimester, the 3rd cause of blood transfusion in the last stage of gestation and the 2nd cause of radical hysterectomy. It is more frequently associated with older women, a previous caesarean section, induced or spontaneous abortions. The case of a 43-year-old female patient with a surgical history of a previous caesarean section is described. She is in her third 35.1-week pregnancy due to chronological FUM, diagnosed with total occlusive placenta previa and placental accretion confirmed by MRI and obstetric ultrasound. Prior to admission, she presented with contraction-type abdominal pain that radiated to the lumbar region accompanied by small amount of dark bleeding, which is why admission to the Ambato Provincial Teaching Hospital was assessed and the pregnancy was planned to end at 36 weeks. Cesarean section is scheduled at 36 weeks due to the diagnosis of total occlusive Placenta previa with signs of placental accreta. As a complication of the surgical act, a uterine uterine atony is observed, so a total abdominal hysterectomy
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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