| Journal: | Ginecología y obstetricia de México |
| Database: | PERIÓDICA |
| System number: | 000453665 |
| ISSN: | 0300-9041 |
| Authors: | Gómez García, Verónica1 Gallego De Largy, Cristina1 Llamazares Alonso, Anais1 Gómez Álvarez, Susana1 Ceballos Medina, Ana1 Vilares Calvo, Silvia1 |
| Institutions: | 1Hospital Universitario Marqués de Valdecilla, Area de Ginecología y Obstetricia, Santander, Cantabria. España |
| Year: | 2021 |
| Season: | Sep |
| Volumen: | 89 |
| Number: | 9 |
| Pages: | 715-720 |
| Country: | México |
| Language: | Español |
| Document type: | Artículo |
| Approach: | Caso clínico, descriptivo |
| Spanish abstract | ANTECEDENTES: El parto pretérmino es la principal causa de muerte neonatal (la tasa mundial de parto pretérmino se estima en 11%) y se relaciona con un aumento sustancial de la mortalidad perinatal y de la morbilidad neonatal a largo plazo, incluidos los déficits del desarrollo psicomotor. Debido a que la tasa de parto pretérmino sigue en aumento, la predicción, detección temprana y la identificación de embarazadas con alto riesgo de parto pretérmino es útil porque permite aumentar el control prenatal e indicar tratamientos preventivos, como el pesario cervical. CASO CLÍNICO: Paciente de 32 años, acudió a la consulta ordinaria de alto riesgo obstétrico debido a embarazo gemelar. Se objetivó la dinámica uterina irregular y la cervicometría de 11 mm con canalización. Se prescribió tratamiento tocolítico, maduración pulmonar fetal y se le colocó un pesario cervical. A las 33 semanas se finalizó el embarazo mediante cesárea urgente, por parto activo y segundo feto en podálica. Al extraer el pesario, antes de la cirugía, se advirtió la necrosis completa y el colgajo únicamente unido por un mínimo pedículo al labio anterior cervical. Nacieron dos varones con Apgar 9-9 y 6-9, respectivamente. Al finalizar la cirugía se revisó el canal cervical y se confirmaron los hallazgos; se procedió a la exéresis. La pieza se envió para estudio anatomopatológico. CONCLUSIONES: El pesario parece ser una alternativa terapéutica eficaz y sencilla para prevenir el parto pretérmino en embarazos gemelares, aunque no está exenta de complicaciones. La exploración mediante especuloscopia en la consulta podría ayudar a prevenirlas |
| English abstract | BACKROUND: Preterm labor is one of the most common causes (up to 11 %) of neonatal deaths worldwide. It is related to an increase of perinatal mortality and long-term neonatal mobility such as psychomotor development. Due to the increase of preterm delivery, it is of interest to predict and detect high risk pregnant women who would benefit from regular follow up and treatment such as cervical pessary. CASE PRESENTATION: A thirty-two-year-old pregnant woman who was seenby a high risk consult due to twin pregnancy. In one of the consultations, irregular uterine activity was detected as well as short cervical length (11 mm) and funneling. She was admitted to hospital for tocolysis, and two doses of glucocorticoids were given to aid lung maturation before delivery. Before she was discharged, a cervical pessary was inserted. She attended hospital in active labor at week 33 gestation. As the second fetus was in breech position, an urgent cesarean section was performed. Prior to the surgery, when removing the pessary, complete necrosis of the cervix was observed, leaving only a flap hanging from the cervix by a small pedicle from the anterior lip. Two live males were delivered, whose Apgar were 9-9 and 6-9. At the end of the surgery, the cervical channel was revised and the who cervix was excised and sent for histopathology study. FINDINGS: Cervical pessary is known as an efficient and easy prevention of preterm birth in twin pregnancies; however, it is associated with certain risks. It is important to examine the correct placement during follow up |
| Disciplines: | Medicina |
| Keyword: | Ginecología y obstetricia, Cirugía, Edad gestacional, Parto prematuro, Mortalidad perinatal, Pesario cervical, Cesárea |
| Keyword: | Gynecology and obstetrics, Surgery, Preterm delivery, Perinatal mortality, Cervical pessary, Cesarean section, Gestational age |
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