Medicina
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Item Preeclampsia con signos de severidad, actualización de la teoría y manejo emergente.(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina., 2022-10-24) Escobar Lucio, Daniela Maribel; Tapia Ávila, Marco VinicioThis study consists of a systematic review of preeclampsia with signs of severity at the first level of care, to the medical personal, who in clinical practice have a lot of resource limitations. We uses databases such as: UptoDate, Springer, PubMed, WHO, PAHO, SciELO, ElSevier, Medline, Scopus, The Cochrane, ScienceDirect, among other journals that show publications of the last 2 years, in English or Spanish, were used. The theoretical framework details data on the pathophysiology of preeclampsia, the main clinical characteristics, possible systemic effects, current and alternative treatment for management in localities where intravenous medication is limited, or only oral medication is available. Clinical case review articles, letter to the editor, and articles prior to 2019 were excluded. The main importance is had prompt action by the doctor in the blue key code, following diagnostic, therapeutic, and prompt reference algorithms. The work concludes that the treatment of choice depends on the pharmacological availability of each hospital, taking into account the periodic review of the content of the regulatory obstetric code kits, as well as the experience of the doctor; Since not knowing about the pathophysiology of the disease, clinical manifestations, frequent complications, pharmacokinetics and pharmacodynamics, supposes an extra risk for the survival of the patient, it is necessary to avoid performing procedures without being completely sure of the action, and promptly refer to a nursing home of greater complexity while the patient is hemodynamically stable.Item Impacto de los factores ambientales en la aparición de preeclampsia grave (Revisión de la literatura)(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2022-09-01) Martínez Quinteros, Andrea Soledad; Belalcázar Sánchez, Yajaira Monserrath, DraPreeclampsia is a vascular placental pathology that affects around 5% of all pregnant women worldwide, characterized by the presence of high blood pressure and proteinuria from the 20th week of gestation. It represents the fourth cause of perinatal morbidity and mortality and, in turn, is one of the main causes of induced prematurity and intrauterine fetal growth restriction. Currently, climate change is a fact that must be taken into account within the risk factors in the development of various pathologies, which allows health professionals to develop skills and attitudes in the field of climate change. Seasonal and climatic factors seem to be involved in the development of this pathology, however, there are insufficient studies that examine all individual, socioeconomic and environmental factors, including the meteorological or climatic variant, as influential factors in the development of severe preeclampsia. The seasonality of preeclampsia has been observed at the time of delivery by different studies carried out in regions with different climatic and economic conditions. The present work will consist of a systematic review of the available bibliography in scientific journal publications with a good level of evidence of publications made in the last 10 years, in Spanish, English and French languages. Information will be collected from databases such as Medline, Intra Med, PubMed, The Cochrane, SciELO, Hyper Article en Ligne (HAL), BASE, Scinapse, Semantic Scholar, among others. In addition, bibliographic data and citations of scientific articles and degree works available in the virtual library of the Technical University of Ambato and in universities at an international level will be included, taking the line of research belonging to Human Health itself that corresponds to the Domain of Food Systems, Nutrition and Health of the Faculty of Health Sciences of the Technical University of Ambato.Item “Síndrome de hellp como complicación de preeclampsia”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Fernández Velasco, Diego Rodrigo; Tapia Ávila, Marco Vinicio Dr. Esp.Our current case is about a 21-year-old patient with no significant personal history, taking her first pregnancy with 37 weeks of gestation on admission and verbally referring at least 6 prenatal controls not confirmed due to loss of prenatal care card, the pregnant woman go to your local health house referring to headache and abdominal pain type contraction, place where to take vital signs blood pressure of 160/100 mmhg, and a new shot at 2 hours reporting the same figures, no changes are reported cervical, was diagnosed as a hypertensive disorder of pregnancy type severe preeclampsia with signs of severity more threat of preterm delivery, where they refer was established impregnation with magnesium sulfate with first dose of fetal lung maturation and is referred to health home of greater complexity level. It was evaluated in the emergency service of the General Hospital Latacunga where blood pressure of 125/77 mmHg was found without accompanying symptomatology to the obstetric examination was detected unique cephalic alive product with present movements with fetal heart rate of 140 bpm and uterine activity of 1/10 / 20 ", to the genital touch: posterior cervix with 1cm dilatation and 10% effacement. It was decided to enter the Gynecology and Obstetrics service with pregnancy diagnoses of 37 weeks for FUM + preeclampsia without signs of severity + early labor with a spontaneous evolution plan. At 48 hours after admission, he presented with severe headache, which was associated with pain in the epigastrium, presenting high arterial tension (155/98 mmHg) with regular uterine activity and pelvis not suitable for touch, in addition to laboratory tests that report, PLATELETS: 97 10 ^ 3 / Ul, TGO: 157.20 U / L, TGP: 97.00 U / L, LDH: 865 U / L; with which are added the diagnoses of: cephalopelvic disproportion maternal factor and Hellp syndrome type II secondary to preeclampsia with signs of severity, reasons why it is decided to terminate the pregnancy by caesarean section, due to risk of compromise of well-being fetal, with posterior fundic placenta with a 4x2 cm pediculated subserous myoma on the anterior uterine surface. After three days, responding favorably and improving the clinical picture, the discharge was decided with a medical appointment scheduling for control and monitoring of the case.Item “Pancreatitis aguda en el embarazo”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Obando Paredes, Jéssica Estefanía; Dr. Yépez Yerovi, Fabián EduardoLa pancreatitis aguda es una complicación rara en el embarazo la cual se presenta generalmente en el tercer trimestre de gestación, el 68% de los casos se debe a litiasis. La incidencia de pancreatitis aguda (PA) en el embarazo es de aproximadamente del 0,03 al 0,09%. Se describe el caso de una mujer de 31 años de edad, de 35.2 semanas de gestación que presenta dolor abdominal en epigastrio acompañadas de nauseas que llegan al vómito en reiteradas ocasiones, leucocitosis con desviación a la izquierda, amilasa y lipase elevadas, estudios de imagen TAC simple y contrastada de abdomen concluye pancreatitis aguda de tipo D por presentar áreas de necrosis de más del 50% de la superficie del páncreas con índice de severidad tomográfico alto, criterio de Balthazar 9/10, con lo que se establece el diagnóstico y se decide su ingreso hospitalario para complementar exámenes y realizar el manejo adecuado de la paciente e interrupción del embarazo por compromiso fetal. El diagnóstico diferencial debe establecerse con colecistitis aguda, apendicitis aguda, infarto mesentérico, embarazo ectópico complicado, hiperemesis gravídica, preeclampsia e hígado graso agudo, entre otras patologías. El diagnóstico se lo puede confirmar con la medición sérica de amilasa o lipasa, las que se van a encontrar elevadas. El tratamiento es similar al de las pacientes no embarazadas y fundamentalmente de soporte. Además, se debe realizar un estudio de la condición fetal por medio de ecografías y monitorización fetal.Item “Prevención primaria para la preeclampsia mediante la ingesta de alimentos ricos en calcio y administración por vía oral de este mineral durante el primer trimestre de gestación”(Medicina, 2014-11-01) Chiluiza Ramirez, Silvia Aracely; Castro Acosta, Norma del Carmen, Dra. Norma del CarmenThe said project was developed in the Health Center of San Andres, Canton Píllaro due to the need for a strategy that has been validated by WHO and several studies showing that the use of calcium reduces the incidence and even severity of preeclampsia (Recommendation grade a and B, respectively), a simple and useful strategy for a population susceptible to this disease, which in turn has the resources to take care of your health, therefore it is proposed use food and calcium supplement for the primary prevention of this disease and hence its complications , disease etiology is still unknown, also ignored by the affected population, not knowing it does not work, showing that educating the fertile female population pregnant women get positive results regarding health, ensuring the welfare of the mother and fetus , and while the health system extend preventive measures for this condition, it is necessary to provide the affected population tools at its disposal to combat it, then it is desirable to improve the food and only use the calcium supplement and complement. In conclusion to a cattle farm population, which ignored the usefulness of calcium and foods that have this mineral, it turned out that the intake of calcium-rich foods supplemented with 500 mg of carbonate chewable calcium helped reduce the incidence of preeclampsia 55 pregnant women aged 16-40 years, from 5 to 10 % indicating the wHO to 3.6%, which is the main benefit, as during the study only 2 of the participants developed mild preeclampsia.Item “Síndrome de hellp completo, secundario a preeclampsia grave”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Salazar Lizano, Darío Israel; Dr. Córdova Peñaloza, OpilioThis case is about a 22-year-old female patient with no relevant pathological history who is taking her first pregnancy (34 weeks), is treated in Emergency on 06/02/2017 for presenting approximately 24 hours before her admission Holocranial headache of moderate intensity accompanied by scotomas, espigastralgia and about 12 hours ago decrease her fetal movements, so go to a private doctor who recommends going to Provincial Ambato Hospital. Is evaluated in Emergency who decide her hospitalization to Gynecology and Obstetrics service with a diagnosis of Tonsillitis + Pregnancy of 33.5 weeks + Fetal Bradycardia Upon admission to Obstetrics and Gynecology, a patient is received with SCORE MAMA 4 without a strip, Arterial Blood Pressure: 100/60, Heart Rate: 74 bpm, Respiratory Rate: 22 rpm, Saturation: 94%, ultrasound scan, finding a single fetus, transverse , cephalic pole to the right, upper back, posterior fundic placenta Grade III, absence of heartbeat, for which they decide termination of pregnancy by high route, procedure that is performed under spinal anesthesia at one and a half hours after admission to obstetrics gynecology. During the procedure, a bladder catheter is placed to assess diuresis, which is not produced, cataloging it in this way with Acute Renal Insufficiency, for this reason Obstetrics Specialists request an assessment by the Intensive Care Unit (ICU), who value the patient and decide on treatment based on hydration and antibiotic therapy. In a new assessment by obstetrics gynecologist the patient is found with hepatic transaminase values and elevated LDH as well as coagulation times, and with alterations in abdominal ultrasound, and for this reason the specialists decided to initiate the protocol of hypertensive disease of pregnancy, Anuria is evidenced and a new assessment is requested by ICU who decide to enter the Intensive Care Unit for management of incomplete HELLP syndrome + renal failure and possible complications (07/02/2017). In intensive care room stayed controlled until 09/02/2017 where it is found that the patient has an increase in the production of each of their drains which were placed during the procedure of cesarean section. TAC Tóraco - Abdominal is performed where the presence of ascitic fluid + bilateral pleural effusion is evidenced, laboratory tests blood count, blood chemistry and EMO were altered and so a medical consensus is made among surgeons, gynecologists and intensivists who decide compensation of dyscrasia blood + anemia + expectant management due to the need for an eventual laparotomy. On 02/12/2017, the patient presented generalized tonic clonic movements, whereby phenobarbital 240 IV STAT was administered, maintaining arterial pressures between 160/100 - 120/70. However, there was an improvement in terms of urine production, as well as examinations of laboratory with slight improvement Patient evolves favorably and after 11 days of hospitalization in the ICU on 02/18/2017, it is decided to discharge and later be treated in the obstetric gynecology ward, presenting the following diagnoses: 1) late puerperium for fetal death, 2) complete HELLP, 3) Severe preeclampsia, 4) Acute hemorrhagic anemia, 5) Coagulopathy, 6) Eclampsia 7) Hepatic failure. In the Gynecology floor, the patient is managed according to the diagnoses given by the ICU by specialist doctors and on 04/03/2017 after 31 days of hospitalization and having been treated until all of her pathologies are resolved she is dischargedItem “Embarazo en una paciente con enfermedad renal crónica en hemodialisis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Chango Tituaña, María de los Angeles; Guacho Guacho, Juan Sebastián Dr.Chronic kidney disease is seen in approximately 4% of women in the reproductive stage, and includes both primary renal diseases and secondary to a systemic disorder. However, the association of advanced chronic kidney disease (ACKD) in stage 5D and gestation is an infrequent event, with a variable incidence. (1) We present the case of a 26-year-old female patient with a personal history of untreated hypertension (HTA) and primary glomerulopathy, which led to renal failure in stage 5D diagnosed one year ago in three-week treatment with hemodialysis. Within her gynecological-obstetric history: family planning method, her menstrual cycles were irregular; previous deeds: two, masculine, live births, without complications; gesta 3: current unknown date of last menstruation (FUM). Patient goes to nephrology control with obstetric echo that reports pregnancy of 15.1 weeks. Change of hemodialysis therapy is indicated to 5 times per week and it is immediately referred to the gynecology and obstetrics service where it carries out pregnancy uptake and subsequently goes to 2 more controls. At 31.1 weeks of gestation, she went to prenatal control, referring to headache and edema at the level of the lower limbs. She is admitted to the Obstetrics-Gynecology service where she stays hospitalized for 26 hours and receives antihypertensive treatment, pulmonary maturation and later is transferred from emergency to third level with a diagnosis of: Pregnancy of 31.2 weeks by Extrapolated Echo + Chronic Hypertension + Preeclampsia Sobreañadida + HELLP syndrome. In the third level, pregnancy is terminated by means of an emergency caesarean section, obtaining a live male product, which remains for 27 days in the neonatal care unit after which it passes away due to sepsis of early origin due to Streptococcus pneumoniaeItem “Histerectomia por atonía uterina secundaria a diagnóstico de preeclampsia”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-10-01) Albán Intriago, José Daniel; Salazar Faz, Fernando Abel Dr. Esp.Hypertensive Pregnancy Diseases are an important cause of maternal and fetal morbidity and mortality with a variable incidence according to the population studied, estimated in developing countries approximately 5 - 10%, being more frequent in the extremes of the population. Reproductive age. Every 3 minutes a woman dies in the world due to preeclampsia, being the main cause of maternal death in the world. We present a Clinical Case on a 43-year-old patient with Personal Pathology of Hypothyroidism, Father and Mother with Hypothyroidism and Type 2 Diabetes Mellitus, in addition to having Laparotomy Diagnosis, presents Gestas 2, Partos 0, Cesarea 0, Abortion 1 , Her date of last menstruation is 05/31/16, reason why she has a gestational age of 34.4s. Go to the External Consultation service of Gynecology of the Hospital IESS Ambato for presenting abdominal pain type contraction, of great intensity, frequently every 2 minutes; In addition, he refers to the physician who prescribes nifedipine and pulmonary maturation; At the time of the consultation to the table is added edema of lower and upper limbs, and nausea that does not reach vomit. At physical examination, vital signs are found within normal parameters, conscious, oriented, afebrile, hydrated, pycnical morphological biotype, normal head, preserved cardiopulmonary, globular abdomen, pregnant uterus, single product, AFU according to gestational age, presentation Cephalic, Left Back, FCF 152 bpm, Uterus Irritable, uterine activity of 2-3 contractions in 10 minutes, genital inguinal region: Genitalia of Nulliparous, no bleeding present; In extremities there is edema of lower limbs ++ / +++. Complementary Exams to Revenue report Leukocytosis accompanied by Neutrophilia, with Hemoglobin and Hematocrit within normal parameters.As a result, the patient is admitted to the Obstetrics and Gynecology Service at the IESS Ambato Hospital, with a diagnosis of Pregnancy of 34.4 weeks + Hypertensive Pregnancy Disorder. On her third day of patient hospitalization she referred to increase lower limb edema. Arterial pressure 140/80 mmHg, edematous facies + / +++, and in extremities bilaterally bilateral edema +++ / +++. Microalbuminuria and Proteinuria in 24-hour urine are performed which are positive. It is submitted to Cesarean Section by Preeclampsia, presenting in the transoperative Atonia Uterine and Adherence Syndrome. According to the Operative Part the findings were fibrotic wall, fluid in cavity of approximately 100 cc, pregnant uterus, clear amniotic fluid without lumps, female live newborn with APGAR and adequate weight, placenta accreta anterior and bleeding of 1000 cc; Posterior intervention is requested interconsultation to General Surgery because of continuous bleeding and hypovolemic shock performing Obstetric Hysterectomy and Exploratory Laparotomy; Finally enters the Intensive Care Unit of the Hospital IESS Ambato with diagnosis of Hypovolemic Shock, Obstetric Posthisterectomy for Uterine Hypotonia, Bleeding of 3rd period of Delivery, Adeherensiolisis by endometriosis grade IV and Preeclampsia, evolves favorably, and is discharged on day 17 Of February 2017.Item “Síndrome de hellp como complicación de preeclampsia”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-02-01) Betancourt Navas, Gina Elizabeth; Gavilanes Saenz, Víctor Patricio Dr. Esp.This case is about a 31 years old woman who was in her 33, 2 weeks gestation and 6 prenatal care, she attends to a medical center because of a tummy ache, irregular uterine activity, 120/80 blood pressure, any cervical alteration, this medical chart is cataloged as a threat of preterm birth, it was treated with uterus inhibitors and fetal lung maturity and is sent home. Four day later, she comes back having a severe headache, stomachache, 155/98 mmHg blood pressure, 500 mg/dl proteinuria, TGO: 485,20 U/L, TGP: 189,80 U/L, LDH: 952 U/L; she receives magnesium sulphate and was sent to a better medical center, where the doctor decide to end up the pregnancy time by a caesarian section in order to safe the baby´s life. They find out placental accretion and bleeding so they had to do a subtotal hysterectomy with globular packages transfusion and reinstate-ment with crystalloids. After two days, she shows ascites and pleural effusion that was treated with loop diuretics, having good results she was sent home.Item Embarazo + Pancreatitis Severa + Hipertensión Arterial Gestacional(2016-05-01) Gallegos Paredes, Manuel Humberto; Salazar Faz, Fernando Abel Dr.Acute pancreatitis (AP) during pregnancy is a rare cause of abdominal pain and, although rarely progresses to necrotizing form, it is a serious complication whose diagnosis often is difficult. There are many causal factors of AP during pregnancy; the most frequent is the gallstone disease of the bile duct, even though metabolic disorders such as hyperlipidemia may trigger it as well. Hypertension in pregnancy remains a major perinatal health problem worldwide. It is one of the biggest causes of premature birth, perinatal mortality and also figures among the leading causes of maternal death in both industrialized and developing countries. Statistical incidence ranges from 0.1 to 35%. The terminology used to refer to this disease has gone through altering. Currently the most widely accepted terms are pregnancy-induced hypertension, if it is not accompanied by proteinuria, and the term preeclampsia is used when proteinuria is present. Preeclampsia (PEE) is a multisystem disease of unknown causes that can manifest itself in the second half of pregnancy, childbirth or in the immediate postpartum period. It is characterized by an immunological- vascular maternal response, abnormal to the conceptus implantation. It is also manifested by an altered endothelial function which is represented by the activation of the coagulation cascade as well as an increase in the peripheral vascular resistance and platelet aggregation. The following case is of a female patient of 33 years of age, with a personal medical history of cholelithiasis diagnosed 7 months ago. The pacient´s gynecological and obstetric history does: G: 1 P: 0 C: 0 A: 0 HV. 0, LMP. 01/18/2015 and a gestational age of 35 weeks. The patient reports epigastric pain OF 9/10 VAS, around 24 hours ago. The pain was colicky, the same which radiated from the hemi-belt to the right dorsal region, with the apparent cause being the intake of a heavy meal. Patient reports presenting the same picture for 8 days which yielded with the intake of unspecified analgesics, the picture is accompanied by nausea that fails vomiting, anorexia, and generalized asthenia. For this reason, the patient is assisted in the emergency room of the IESS Hospital of Ambato, and after being assessed by medical specialists in surgery and gynecology, admission is decided, subsequently valuation to laboratory tests is required. Paraclinical tests showed elevated amylase and lipase amylase. AMYLASE 3322; LIPASE: 7823.1. In the physical examination; TA: 140/95 mm hg FC : 104 bpm FR: 17rpm T: 36.8 ° C Saturation O2: 94 %. Patient is conscious, oriented with time and space, dehydrated, conjunctives: slightly jaundiced, preserved cardiopulmonary. Abdomen: pregnant, epigastric pain, AFU: 32cm, negative uterine activity, single fetus, alive, head left oblique, FHR 140-150 bpm, fetal movements present. Inguinogenital region; external female genitalia: presence of urinary catheter with dark diuresis. Upper and lower extremities: symmetric. Presence of edema ++ / +++, proximal and distal pulses present. Tone strength and mobility preserved, no DTR. Because of the patient's clinical condition, admission to intensive care unit is decided. During the patient’s hospital stay, the patient presented thrombocytopenia, in addition to increased pancreatic enzymes making it a possible incomplete HELLP SYNDROME.