Percretismo placentario con invasión de vejiga y recto

ResumenAntecedentesEl percretismo placentario puede llevar a hemorragia obstétrica masiva, descompensación del estado hemodinámico y finalmente a la muerte. Con relación al tratamiento, la histerectomía obstétrica total de inicio se encuentra universalmente aceptada; sin embargo, el surgimiento de nuevas técnicas de abordaje, como la angioembolización de arterias uterinas y el uso de agentes quimioterapéuticos como el metotrexato, con el objetivo de disminuir las complicaciones asociadas, son alternativas también descritas en la literatura.Caso clínicoPaciente femenina de 28 años de edad, multigesta, gesta 4, partos 2, cesárea una, que cursó con embarazo de 28.4 semanas por ultrasonografía del segundo trimestre, es diagnosticada de percretismo placentario con invasión vesical y rectal, mediante resonancia magnética. Ingresa bajo protocolo de manejo multidisciplinario y secuencial, cuyos componentes fueron cesárea con placenta in situ, embolización selectiva de arterias uterinas inmediatamente posterior a cesárea, quimioterapia semanal con metotrexato por 4 dosis y, finalmente, histerectomía obstétrica, previa ligadura bilateral de arterias hipogástricas. El resultado fue favorable, ya que la paciente egresó en buenas condiciones generales, sin presentar hemorragia ni otras complicaciones durante el tratamiento.ConclusionesEl manejo protocolizado y secuencial, que incluye embolización selectiva de las arterias uterinas inmediatamente posterior a la cesárea con placenta in situ, quimioterapia con metotrexato de forma semanal y, finalmente, histerectomía obstétrica precedida de ligadura bilateral de las arterias hipogástricas es una alternativa terapéutica a considerar en casos de percretismo placentario.AbstractBackgroundPlacenta percreta may lead to massive obstetric haemorrhage, haemodynamic decompensation, and ultimately death. Total obstetric hysterectomy is universally accepted as treatment; however, the emergence of new techniques such as the uterine artery angioembolisation approach, and the use of chemotherapy agents such as methotrexate, are alternatives also described in the literature.Clinical caseA 28 year-old patient, in her fourth gestation, with a previous history of 2 vaginal and 1 caesarean birth 4, in her 28.4 week of pregnancy, by second trimester ultrasound, was diagnosed with placenta percreta with bladder and rectal invasion using magnetic resonance imaging. Multidisciplinary and sequential treatment included: Caesarean with placenta in situ, uterine artery embolisation immediately after caesarean, chemotherapy with methotrexate weekly for 4 doses, and finally obstetric hysterectomy after bilateral hypogastric artery ligation. The outcome was favourable and the patient was discharged in good general condition.ConclusionsThe protocoled and sequential management including selective embolization immediately after caesarean section with placenta in situ, weekly chemotherapy with methotrexate and obstetric hysterectomy, preceded by bilateral ligation of the hypogastric arteries, is a therapeutic alternative to be considered in cases of placenta percreta

Nitazoxanide against COVID-19 in three explorative scenarios

to describe the results of treating COVID-19 positive patients with nitazoxanide in three clinical settings: pregnancy/puerperium, hospitalized patients in an Internal Medicine Service and in an ambulatory setting. Methodology: This was a prospective follow-up and report of COVID-19 cases in three different situations, pregnant women, hospitalized patients receiving medical attention in an Internal Medicine Service and ambulatory patients residing in Toluca City, and Mexico City. Results: The experience with a first group of 20 women, pregnant (17) or in immediate puerperium (3) was successful in 18 cases with two unfortunate deaths. The five cases treated in an Internal Medicine service showed a positive outcome with two patients weaned from mechanical ventilation. Of the remaining 16 patients treated in an ambulatory setting, all got cured. Nitazoxanide seems to be useful against SARS-CoV-2, not only in an early intervention but also in critical condition as well as in pregnancy without undesired effects for the babies. As an adjunctive therapy budesonide was used that seems to contribute to the clinical improvement. Conclusions: Nitazoxanide could be useful against COVID-19 as a safe and available regimen to be tested in a massive way immediately

COVID-19 y atención a embarazadas en el consultorio

The pregnant woman does not seem to be more vulnerable than the general population, however, it can be said that there is not much data or it is scarce, and that the physiological changes and the immune response of patients are similar to that of pregnant women. When a pregnant patient infected with COVID-19 is identified in the general office, her gynecologist or intensivist should be consulted, depending on her conditions. The pregnant patient can go through different situations and it should be considered that she can reach intensive care if preventive measures are not enough. Obstetric assessment must always be individual and the prenatal control that is carried out must be oriented with a risk approach, early identification of risk factors and comorbidities of both the mother and the fetus.La mujer embarazada aparentemente no parece ser más vulnerable que la población en general; sin embargo, se puede decir que no hay muchos datos o son escasos, y que los cambios fisiológicos y la respuesta inmune de los pacientes son similares a la mujer embarazada. Cuando se identifica a una paciente en este estado contagiada por COVID-19 en el consultorio general, debe consultarse a su ginecólogo o intensivista, dependiendo de sus condiciones. La paciente puede pasar por diferentes situaciones y se debe considerar que puede llegar a cuidados intensivos si las medidas preventivas no son suficientes. La valoración obstétrica debe ser siempre de forma individual y el control prenatal que se hace debe ser orientado con un enfoque de riesgo, identificar de manera temprana factores de riesgo y comorbilidades tanto de la madre como del feto

Environmental Nanoparticles Reach Human Fetal Brains

Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8–15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8–15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences

Maternal Consumption of Non-Nutritive Sweeteners during Pregnancy Is Associated with Alterations in the Colostrum Microbiota

Non-nutritive sweeteners (NNSs) provide a sweet taste to foods and beverages without significantly adding calories. Still, their consumption has been linked to modifications in adult’s and children’s gut microbiota and the disruption of blood glucose control. Human milk microbiota are paramount in establishing infants’ gut microbiota, but very little is known about whether the consumption of sweeteners can alter it. To address this question, we sequenced DNA extracted colostrum samples from a group of mothers, who had different levels of NNS consumption, using the Ion Torrent Platform. Our results show that the “core” of colostrum microbiota, composed of the genera Bifidobacterium, Blautia, Cutibacteium, Staphylococcus, and Streptococcus, remains practically unchanged with the consumption of NNS during pregnancy, but specific genera display significant alterations, such as Staphylococcus and Streptococcus. A significant increase in the unclassified archaea Methanobrevibacter spp. was observed as the consumption frequency of NNS increased. The increase in the abundance of this archaea has been previously linked to obesity in Mexican children. NNS consumption during pregnancy could be related to changes in colostrum microbiota and may affect infants’ gut microbiota seeding and their future health