Medicina
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Item Embarazo Ectópico Abdominal y Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Aucapiña Rodríguez, Luz Cecilia; Gavilanes Sáenz, Víctor Patricio Dr.The abdominal ectopic pregnancy is an exceptional anomaly that represents 1% of ectopic pregnancies; it is associated with high morbidity and mortality, maternal and fetal. The risk of maternal mortality is 7 to 8 times greater than a tubal pregnancy and it is 90 ectopic times greater than an intrauterine pregnancy. This is a pathology of difficult diagnosis that, in many cases, belatedly established and it is considered an obstetric emergency. Female patient of 23 years old who presents an abdominal pain of 2 months evolution and amenorrhea of approximately 17 weeks, she is admitted to Hospital General Puyo by abdominal pain in study and hypovolemic shock, βHCG is performed with positive result and eco FAST showing free liquid in abdominal cavity and an appearance of embryo outside the uterine cavity with movement, so it is considered a probable accident ectopic pregnancy. On physical examination is hypotensive, tachycardic with generalized pallor, Algic facies, oral mucosal semihumid. An Emergency exploratory laparotomy with identification of abdominal ectopic pregnancy, salpingectomy, right oophorectomy, partial omentectomy is performed. Also, compensation with blood products for trans-surgical cardiovascular instability is indicated. The patient is transferred to intensive therapy to control and manage cardiovascular. Presenting a satisfactory evolution and at 17 hours of admission she is discharged to continue handling by gynecology and obstetrics where she remains hospitalized 2 days and sent homeItem Shock Hipovolémico Secundario a Hemorragia Obstétrica por Inversión Uterina en Sala de Partos(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Toalombo Eugenio, Graciela Estefanía; González Guevara, Laura Catalina Dra. ESP.Postpartum hemorrhage, mostly caused by uterine atony is the most common preventable cause of maternal mortality worldwide, and the second leading cause of maternal death in Ecuador. 4-6 Among the causes of postpartum hemorrhage is uterine inversion, a rare and serious complication that occurs in the third stage of labor, has an incidence of 1: 20,000 -1: 25,000 partos.13 This case is a female patient of 22 years old, born in Santo Domingo and living in Puyo, without personal pathological or family history of importance, is in her second pregnancy of 40.1 weeks last menstrual period (LMP), during his pregnancy was hospitalized for threatened preterm delivery more urinary tract infection. Go to gynecological emergencies present labor decided to send him to proceed to cefalovaginal birth, left in spontaneous evolution, resulting in childbirth at three hours and forty-five minutes, I received newborn anthropometric parameters of a newborn macrosomia with good general condition, in the period lasts more than 30 minutes delivery by retained placenta, is extracted manually incompletely, the vaginal touch incomplete uterine inversion palpating under short general anesthesia review is done and reduced manually uterus with maneuver Johnson, curettage and Bakri balloon placement is done. Patient signs of moderate hypovolemic shock with a loss of approximately 2000 milliliters blood crystalloid solutions so more globular packages are administered and plasma cool to recover blood volume; warrants admission to ICU, hypovolemic shock is persistent, a new uterine inversion, which is determined with the help of relaxation and bleeding, the conditions of the user warrant mechanical ventilatory support invasive, remains under observation without ruling hysterectomy evidence . Remains in ICU for 3 days thereafter to monitor their discharge is decided by the department of gynecology where it is kept under observation without improving clinical symptoms or signs of possible complications and decides high. In its evolution goes for outpatient control being in good general condition.