Punción intrasacular ecoguiada de metotrexato como tratamiento en embarazos ectópicos con embrión.

Objetivo: evaluar la eficacia y seguridad del tratamiento médico mediante punción intrasacular ecoguiada de 50 mg de MTX en gestaciones ectópicas con embrión no complicadas asociado a 50 mg/m2 de MTX sistémico. Material y métodos: estudio de casos y controles retrospectivo de los casos de embarazos ectópicos con embrión tratados con 50 mg de MTX intrasacular mediante punción ecoguiada asociado a 50 mg/m2 de MTX sistémico realizados en la Unidad de Medicina Materno Fetal del Hospital Universitario Miguel Servet, desde el 1 de enero de 2007 hasta el 31 de diciembre de 2018. Resultados: de las 60 gestaciones ectópicas incluidas, el protocolo de MTX intrasacular y sistémico fue efectivo en el 73.3% de las pacientes. Ninguno de los ectópicos localizados a nivel cervical o abdominal precisó cirugía de rescate. Seis (85.7%) de los 7 ectópicos cornuales se resolvieron mediante el protocolo combinado. El 25% precisó más de una dosis de MTX sistémico para conseguir una disminución de los valores de β-HCG y un 5% de las pacientes recibieron dos punciones por persistencia de latido cardiaco a las 24 horas de la primera punción. No se encontraron diferencias estadísticamente significativas en las tasas de éxito del tratamiento conservador en función de la clínica, características ecográficas o analíticas de las pacientes. Conclusiones: la punción intrasacular de MTX puede ser una alternativa eficaz y segura de tratamiento conservador de la gestación ectópica con embrión. Las características clínicas, ecográficas o analíticas maternas no deberían suponer una contraindicación a la hora de proponer el tratamiento médico en este tipo de embarazos en mujeres hemodinámicamente estables. En localizaciones en las que la cirugía supone una dificultad técnica, el uso del tratamiento conservador podría disminuir las tasas de morbi-mortalidad que conlleva una técnica más invasiva.<br /

Hemoptysis as the first symptom in the diagnosis of metastatic choriocarcinoma in the third trimester of pregnancy: A case report

Introduction: Choriocarcinoma is a rare neoplasm (1/40000 pregnancies). In the context of a viable pregnancy, the incidence is even lower (1/160000). Case report: A woman in her second pregnancy was admitted at 31 + 6 weeks of gestation with hemoptysis and abnormal vaginal bleeding. Numerous placental venous lakes, bilateral pulmonary nodules and a pleural effusion were found. Pleural fluid ß-HCG levels were elevated and a brain-chest-abdominal-pelvic CT scan led to the diagnosis of a high-risk gestational trophoblastic neoplasm. A caesarean section at 32 + 1 weeks of gestation was performed. Six cycles of an EMA-CO chemotherapy regime were administered. ß-HCG levels normalized after 3 cycles. Placental histopathology confirmed the presence of a gestational choriocarcinoma. Conclusion: Choriocarcinoma is a highly aggressive tumor. In high-risk tumors, combination chemotherapy is the first-line treatment, offering high remission rates. Treatment response is evaluated by monitoring blood ß-HCG levels, which should be long-term

Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage

We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon’s failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENT What is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out. What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion. What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible