Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Introduction

Clinical case

Conclusion

Introduction

Symptoms and Clinical Findings

Diagnosis, Therapeutic Intervention, and Results

Conclusion

Introduction

An isthmocele is a disruption of the myometrium that creates a cavity at the level of the hysterorrhaphy because of an impaired cicatrization from a previous caesarean section. In addition to several obstetric and fertility complications, it is possible the presence of retained products of conception inside it. We present the case of an isthmocele without previous cesarean section, with retained products of conception and a placental site nodule.

Symptoms and clinical findings

We present a clinical case of a 32-year-old woman, with no history of previous cesarean section, who consulted due to the presence of latent hypogastric pain. After the initial examination and hysteroscopy, the presence of an isthmocele with retained products of conception was revealed.

Therapeutic interventions

After laparoscopic correction of the isthmocele, the anatomopathological findings showed the presence of a placental site nodule, a benign entity whose atypical variant is related to epithelioid trophoblastic tumor, which is the rarest form of gestational trophoblastic tumor.

Results

After the surgical procedure, the patient remains asymptomatic and without any additional treatment.

Objective

To evaluate the effectiveness of parecoxib vs. dexketoprofen, in combination with paracetamol, as additional analgesia in patients receiving neuraxial morphine for postoperative pain relief in cesarean section.

Methods

A total of 380 patients scheduled for a cesarean section received neuraxial morphine for pain management. After the procedure, they were randomized to receive, as additional analgesia, 1 g of paracetamol intravenously every 6 h in combination with either 40 mg of parecoxib intravenously every 12 h or 50 mg of dexketoprofen intravenously every 8 h. A Visual Analog Scale (VAS) was used for evaluation of pain intensity at 12 and 24 h post-operative. Also, the need for additional analgesics, the time (h) required to start patient mobilization and the presence of adverse effects were recorded.

Results

No statistical differences were found between groups in pain intensity, using the VAS-Pain score at 12 h [(Parecoxib vs. Dexketoprofen): 2.76(4.03) vs 2.97(4.34); p = 0.39)], at 24 h [(Parecoxib vs. Dexketoprofen): 2.47(4.62) vs 2.84(5.20); p = 0.11)] or in the need for additional analgesics at 12 h [(Parecoxib vs. Dexketoprofen): 4.21% vs 5.79%; RR = 0.73, 95% CI: 0.33 to 1.77; p = 0.31)] or at 24 h [(Parecoxib vs. Dexketoprofen): 5.79% vs 4.21%; RR = 1.38, 95% CI: 0.57 to 3.34; p = 0.31)]. There were no differences in mobilization time or in the development of adverse effects.

Conclusion

There are no differences concerning the effectiveness of parecoxib vs. dexketoprofen, in combination with paracetamol as additional analgesia in patients receiving neuraxial morphine, for postoperative pain relief in cesarean section.

Background

Postpartum depression can lead to situations in new mothers that affect baby care, impacting their feeding by reducing adherence to exclusive breastfeeding. Therefore, it is important to identify the factors associated with this condition.

Objective

To determine which sociodemographic factors are associated with postpartum depression in postpartum women at a Peruvian hospital.

Materials and methods

Observational, cross-sectional, and analytical research.

Design

Case-control research design.

Site

Regional Hospital of Ica-Peru.

Participants

A total of 173 cases (postpartum women at risk of postpartum depression) were studied and compared with 173 controls (postpartum women without risk of postpartum depression). All participants were surveyed between the months of May and October 2022, 15 to 30 days after delivery.

Interventions

Survey.

Main measures

Edinburgh Postnatal Depression Scale to obtain the metric of the dependent variable, and a general data sheet to obtain independent variables. The cutoff point for the Edinburgh Scale was ≥ 13.

Results

The prevalence of postpartum depression was 18.8% (95% CI = 16.3-21.3). The associated factors were: Age under 20 years OR: 2.2 (95% CI: 1.4-3.4) p = 0.001. Higher education level OR: 4.5 (95% CI: 2.8-7.0) p = 0.000. Single marital status OR: 4.4 (95% CI: 2.8-6.9) p = 0.000. Poor relationship with partner OR: 3.9 (95% CI: 2.4-6.1) p = 0.000. Use of Psychotropic drugs OR: 2.7 (95% CI: 1.7-4.4) p = 0.000. Complications during labor OR: 2.6 (95% CI: 1.6-4.3) p = 0.000. Cesarean delivery OR: 3.3 (95% CI: 2.1-5.1) p = 0.000. History of COVID-19 infection during pregnancy OR: 2.7 (95% CI: 1.7-4.2) p = 0.000. Employment status OR: 3.2 (95% CI: 2.1-5.0) p = 0.000.

Conclusion

Postpartum depression is associated with sociodemographic variables in the patient's environment that require timely intervention to reduce negative effects on both the mother and the child.

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Introduction

Paratubal cysts, commonly benign and incidentally found during hysterectomy or salpingectomy, are often termed “hydatid cysts of Morgagni.” While most are benign, borderline and malignant subtypes are rare. This report presents an unusual case of synchronous malignancies involving an endometrioid adenocarcinoma and a paratubal borderline serous tumor, emphasizing the need for careful examination of paratubal cysts.

Main symptoms and/or clinical findings

A 61-year-old postmenopausal woman presented with two months of vaginal bleeding and lower abdominal pain. Elevated CEA and CA 19-9 levels were noted. Ultrasonography showed thickened endometrium and moderate pyometra, and MRI revealed a lesion in the upper endometrium involving the myometrium without extrauterine extension. An endometrial biopsy indicated endometrial intraepithelial neoplasia.

Main diagnoses, therapeutic interventions, and outcomes

The patient underwent a staging laparotomy, bilateral salpingo-oophorectomy, hysterectomy, and pelvic lymphadenectomy. Histopathology confirmed endometrioid adenocarcinoma (FIGO grade II, stage IB) and identified a left paratubal cyst with borderline serous tumor features. Immunohistochemical analysis supported these findings. The post-operative period was uneventful, and the patient remains under follow-up with no signs of recurrence or metastasis.

Conclusion

This case underscores the importance of thorough examination of paratubal cysts. The rare coexistence of endometrioid adenocarcinoma with a borderline serous paratubal tumor highlights the necessity for detailed histopathological and immunohistochemical evaluation in synchronous malignancies. Such meticulous examination ensures accurate diagnosis and appropriate management, potentially enhancing patient outcomes.

Preeclampsia is a gestational disorder that associates arterial hypertension and organic disfunction and can have adverse consequence to both mother and fetus in the short term. The main factor implicated in its pathogenesis is an anormal placentation leading to endothelial dysfunction, as well as to the dysregulation of physiological pathways. Last evidence suggests that preeclampsia can also lead to long-terms outcomes, such an increase incidence of chronic disease, renal dysfunction and increased cardiovascular risk. This paper reviews the long-term cardiovascular consequences, their pathogenesis and the implications for clinical practice.

Introduction

Mosaicism due to duplication of chromosome 1q is recognized as a cytogenetic anomaly, characterized by low frequency and few cases reported in the literature.

Clinical findings

In this case, we present a primigravida patient at 24 weeks of pregnancy, with a fetus displaying abnormal ultrasound findings. These include ventriculomegaly, micrognathia, hypotelorism, and associated diaphragmatic hernia.

Primary diagnoses

Amniocentesis was performed, and karyotype analysis revealed a prenatal diagnosis of mos 46,XY,dup(1)(q23q44)[19]/46,XY[41] mosaicism. Subsequently, the patient experienced preterm delivery with early perinatal demise.

Therapeutic interventions and outcomes

Due to the lack of evidence regarding fetal therapy and the prenatal diagnosis of this condition, postnatal assessment was awaited for appropriate therapeutic management. Subsequently, the patient had preterm delivery with early perinatal death.

Conclusion

Heterogeneity of findings is observed to depend on the size and location of the chromosomal alteration, and factors such as the concurrent development of diaphragmatic hernia are associated with a poorer prognosis and higher rates of mortality due to the degree of pulmonary hypoplasia.