Valoración de la musculatura pélvica mediante ecografía transperineal 3-D tras parto vaginal mediante vacuum

Falta resumen y palabras clav

Re: The evolution of levator ani muscle trauma over the first 9 months after vaginal birth

The disappearance of levator ani muscle(LAM) avulsions has given rise to two theories that try to justify the disappearance of LAM avulsion over time (diagnostic errors or possible natural healing process of LAM avulsion). It is difficult to confirm one of these two theories in a study.There are two types of LAM avulsion. Type I injury is limited to individual portions of the pubovisceral muscle with parts of the muscle missing, while the levator arch remains intact. Type II injury consists of detachment of the catenary shaped levator arch from the pubic bone due to excessive tension created in this region during vaginal delivery, with loss of the normal architecture of the lateral pelvic wall due to the loss of this union.These lesions have also been diagnosed by transperineal ultrasound. LAM type I avulsion assessed at 6 months postpartum was shown to disappear one year postpartum. Type II LAM avulsion diagnosed 6 months after delivery persisted one year postpartum. They did not observe the appearance of new lesions (type I and type II LAM avulsion) between the exploration carried out at 6 months and the modification at one year postpartum. Currently, the vast majority of studies that refer to the number of LAM after instrumented delivery ultrasound examination was performed up to 6 months after delivery. This would make us doubt whether the figures for permanent LAM avulsion in operative delivery are correct. Therefore, research should be needed to resolve this issue and clarify the evolution of LAM avulsion after postpartum

Differential diagnosis of posterior compartment prolapse using transperineal ultrasound

Pelvic organ prolapse (POP) of the posterior compartment encompasses various conditions that may have similar clinical presentation, including obstructed defecation and presence of a bulge in the vagina. Management of posterior compartment POP requires accurate diagnosis of the underlying pathology to provide the correct treatment. Currently, transperineal ultrasound is used to diagnose significant descent of the posterior compartment defined as downward displacement of the rectal ampulla ≥ 15 mm below the pubic symphysis1. In addition to detecting posterior compartment POP, ultrasound may also allow differentiation between pathologies that affect the posterior compartment, including rectocele, combined rectoenterocele, enterocele and rectal intussusception2. Here we illustrate the differential diagnoses of posterior compartment POP based exclusively on transperineal ultrasound imaging

Torsión anexial sin patología ovárica en gestante del primer trimestre

La torsión anexial durante el embarazo es una entidad muy poco frecuente y casi siempre ocurre en el contexto de una masa anexial. Es importante establecer el diagnóstico mediante ecografía y en caso de duda se recomienda la utilización de laparoscopia diagnóstica para realizar el tratamiento lo más precozmente posible.Adnexal torsion during pregnancy is a rare entity and usually occurs in the context of an increase in the mass of the annex. It is important to establish the diagnosis by ultrasound and in case of doubt we recommend the use of diagnostic laparoscopy for treatment as early as possible

Resolution of hydrops fetalis caused by atrioventricular block: good postnatal evolution with terbutaline treatment

Introduction: Complete atrioventricular block (CAVB) is rarely seen, as it occurs in only 1:11 000 to 1:20 000 newborns. There is a serious risk of mortality in CAVB, mainly in those cases associated with hydrops, fetal cardiac frequency ≤ 55 beats/minute, and pre mature delivery. Case Report: Case of complete atrioventricular block with a poor prognosis (hydrops fetalis and foetal cardiac frequency < 5 beats/minute) caused by anti-La and anti-Ro antibodies. Intrauterine symptoms improved after treatment with terbutaline, permit ting foetal viability and successful postnatal treatment with a cardiac pacemaker. Discussion: In case of complete atrioventricular block of cause autoimmune with poor prognosis should be treated with positive inotropic drugs, anticholinergics or b-mimetic in the attempt to maintain adequate ventricular frequency, and thus prevent hydrops fetalis from occurring

Lipomatous variant of angiomyofibroblastoma of the vulva: A case report

Introducción: La variante lipomatosa del angiomiofibroblastoma de vulva es un tumor mesenqui mal infrecuente con pocos casos descritos en la literatura. Es un tumor benigno de crecimiento lento cuya importancia reside en su diagnóstico correcto, diferenciándolo del angiomixoma agresivo, ya que tienen un manejo distinto. Caso clínico: Paciente mujer de 33 anos ˜ de edad con una tumoración en la región vulvar de meses de evolución. En la exploración se visualizaba una tumoración enrojecida en el labio mayor izquierdo de 7 cm de diámetro, no dolorosa y móvil. Se realizó una tumorectomía vulvar y el análisis anatomopatológico determinó que se trataba de un angiomiofibroblastoma variante lipomatosa. La paciente evolucionó correctamente tras el postoperatorio, encontrándose en periodo libre de enfermedad. Conclusiones: La variante lipomatosa del angiomiofibroblastoma de vulva es un tumor benigno de buena evolución cuya importancia clínica reside en el diagnóstico diferencial con el angio mixoma agresivo vulvar, ya que su tratamiento quirúrgico conservador y su buen pronóstico a largo plazo difiere del presentado por el angiomixoma agresivoBackground: The lipomatous variant of angiomyofibroblastoma of the vulva is a rare mesenchy mal tumour; only a few cases have been reported to date. It is a slow-growing benign tumour whose importance lies in its correct diagnosis differentiating it from aggressive angiomyxoma which requires a different clinical management. Case report: A 33-year-old female patient presented with a tumour in the vulvar region of several months evolution. On examination a painless, mobile, red tumour, 7 cm in diameter, was found in the left labia. Vulvar lumpectomy was performed and histopathology showed it to be a lipomatous variant angiomyofibroblastoma. The patient made a good post-operative recovery and is free of disease. Conclusions: The lipomatous variant of angiomyofibroblastoma of the vulva is a benign tumour of good evolution and long-term prognosis which requires only conservative surgical treat ment. Its clinical significance lies in the importance of differentiating it from aggressive vulvar angiomyxoma

What is your diagnosis? Illustrated case number 15

Referido al caso iconográfico número 15. Afectación hepática debida a infección fetal congénita por citomegalovirus

Caso iconográfico número 15. Afectación hepática debida a infección fetal congénita por citomegalovirus

Afectación hepática debida a infección fetal congénita por citomegalovirus

Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse

Objectives: Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. Materials and methods: We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. Results: For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). Conclusions: There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP

Aplicabilidad de la ecografía transperineal en 3/4D para el diagnóstico de lesiones del esfínter anal durante el posparto inmediato.

The most common cause of anal sphincter injuries in women is vaginal birth. Endo-anal ultrasound is currently used for the diagnosis of anal sphincter defect. However, due to the inconvenience caused, it is not an applicable technique during the immediate post-partum. The aim of this study was to determine whether transperineal ultrasound in 3/4D is a useful diagnostic method for the assessment of anal sphincter during the immediate post-partum. A prospective study was conducted on the vaginal deliveries performed between September 2012 and June 2013 in the Valme University Hospital (Seville). Obstetric and foetal parameters that could influence the onset of perineal tears were studied. The patients underwent a transperineal 3/4D ultrasound and a multislice study (48hours after birth). The study included 146 puerperal women. The sphincter complex was assessed in all of them during the immediate post-partum. External anal injuries were observed in 10.3% of the cases. In 8.2% of cases, the primary suture of the external anal sphincter was detected during ultrasound examination, and 2.1% of asymptomatic lesions were diagnosed only with post-partum ultrasound. None of the patients reported discomfort or pain. The 3-dimensional transperineal ultrasound is helpful in determining the primary repair of the anal sphincter during the immediate post-partum, with no discomfort for patients, as well as for establishing those early sphincter injuries that go unnoticed during vaginal delivery