Ciencias de la Salud
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Item Placenta previa oclusiva total con signos de acretismo secundaria a cirugía uterina anterior(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2020-10-01) Salazar Urrutia, Pamela de los Angeles; Belalcazar Sánchez, Yajaira MonserrathDra.The placenta previa is defined as the total or partial insertion of the placenta in the lower segment of the uterus. It is considered responsible for 20% of bleeding in the 3rd trimester, the 3rd cause of blood transfusion in the last stage of gestation and the 2nd cause of radical hysterectomy. It is more frequently associated with older women, a previous caesarean section, induced or spontaneous abortions. The case of a 43-year-old female patient with a surgical history of a previous caesarean section is described. She is in her third 35.1-week pregnancy due to chronological FUM, diagnosed with total occlusive placenta previa and placental accretion confirmed by MRI and obstetric ultrasound. Prior to admission, she presented with contraction-type abdominal pain that radiated to the lumbar region accompanied by small amount of dark bleeding, which is why admission to the Ambato Provincial Teaching Hospital was assessed and the pregnancy was planned to end at 36 weeks. Cesarean section is scheduled at 36 weeks due to the diagnosis of total occlusive Placenta previa with signs of placental accreta. As a complication of the surgical act, a uterine uterine atony is observed, so a total abdominal hysterectomyItem “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 Útero de Couvelaire y Óbito Fetal tras desprendimiento Normoplacentario en embarazo de 31.5 semanas(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Pérez Salazar, Carlos Andrés; Castro Acosta, Norma del Carmen Dra. Esp.Female patient of 31 years old, who is in her second pregnancy, currently 31.5 weeks of pregnancy with no medical or family history of importance, who has about 6 hours ago abdominal pain, cramping, located in the lower abdomen and irradiated region lumbar, high intensity +++ / +++ (hand intensity from 0 to three crosses), its accompanied by vaginal bleeding, glittering red in small quantities, why go to health center where evaluating Quero and refer to emergency service HPDA so it is entered the service of Gynecology and Obstetrics. With a Pregnancy diagnosed of 31.5 weeks + placental abruption + fetal death, so that emergency caesarean section was performed, finding a womb Couvelaire more stillbirth procedure continues with Hysterectomy, the service is requested interconsultation Intensive Care who value and enter that area, diagnosed with hypovolemic shock, Hysterectomy, placental abruption, renal failure.