Incidencia de hemorragia obstétrica en el primer trimestre del embarazo en adolescentes de 14 a 16 años en el Hospital Matilde Hidalgo de Procel de mayo a noviembre del 2013
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2013
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Obstetricia
Resumen
Las alteraciones en la evolución del embarazo son relativamente frecuentes y el sangrado es el síntoma clínico más importante. El aborto es la más frecuente de las patologías de la
gestación y alrededor de 15% de los embarazos reconocidos clínicamente, terminan en abortos espontáneos. Las causas pueden ser maternas y fetales, siendo las más frecuentes las congénitas. Existen varias formas de presentación clínica y las que continúan su evolución terminan en aborto completo o incompleto, el tratamiento en el primer caso es observación y, en el segundo, el vaciamiento uterino. En general el aborto es una entidad clínica que evoluciona sin mayores complicaciones maternas; sin embargo, cuando el aborto es provocado, el riesgo de muerte materna es tan elevado, que en los países donde el aborto es ilegal, constituye la primera causa de muerte materna.
En el embarazo ectópico la implantación embrionaria ocurre fuera del endometrio que recubre la cavidad uterina. Su frecuencia ha aumentado en los últimos años; sin embargo, todavía sigue siendo una complicación poco frecuente.
La parte más difícil de su manejo la constituye el diagnóstico precoz y, a pesar de la gran cantidad de métodos que existen, todavía hay casos en los que se manifiesta en la forma aguda de hemorragia intrabdominal que, a menos que se someta a tratamiento quirúrgico de inmediato, puede producir la muerte materna. También se puede hacer un tratamiento quirúrgico conservador por laparotomía o laparoscopia, si se reúnen ciertas condiciones. El tratamiento con salpingectomía es inevitable en casos en los que el diagnóstico es tardío.
Las enfermedades del trofoblasto incluyen un amplio grupo de condiciones benignas o malignas que ocurren en las mujeres en edad reproductiva, en las cuales existe degeneración del tejido derivado del corion con abundante producción de HCG, cuyo genoma es fundamentalmente paterno y que responden extraordinariamente bien a la quimioterapia. Existen cuatro formas de presentación: la mola hidatidiforme completa, la parcial, el coriocarcinoma y el tumortrofoblástico del lecho placentario. El tratamiento consiste en el vaciamiento uterino, seguido de quimioterapia, preferible-mente con MTX. Debido a la posibilidad de recurrencia y de metástasis, la paciente debe evitar el embarazo, por lo menos durante un año, durante el cual es sometida a un estricto seguimiento para evaluar la evolución de la enfermedad.
The alterations in the evolution of the pregnancy are relatively frequent and bleeding is the most important clinical symptom. Abortion is the most frequent of the pathologies of pregnancy and about 15% of clinically recognized pregnancies end in spontaneous abortion. The causes may be maternal and fetal, being the most frequent congenital diseases. Almost all the abortions that take place before the week 8 are product of eggs with aberrant genetic anomalies, due to an error in the meiosis I or II, either maternal or paternal. There are several forms of clinical presentation, and who continue their evolution leads to abortion complete or incomplete, the treatment in the first case is observation and, in the second, the contradic- uterine horizontally. In general the abortion is a clinical entity that evolves without major maternal complications; however, when the abortion is caused, the risk of maternal death is so high, that in countries where abortion is illegal, it is the leading cause of maternal death. In an ectopic pregnancy the embryo implantation occurs outside the endometrial lining of the uterine cavity. Their frequency has increased in recent years; however, it is still a rare complication. The most difficult part of its management by early diagnosis and, in spite of the large number of methods that exist, there are still many cases in which manifests itself in the acute form of intrabdominal hemorrhage that, unless it is submitted to surgical treatment immediately, you can produce the maternal death. If the diagnosis is early you can make a medical treatment based on MTX, and leucovorin. You can also make a conservative surgical treatment by laparotomy or laparoscopy, if certain conditions are met. Treatment with salpingectomy is inevitable in cases where the diagnosis is delayed. Diseases of the trophoblast include a large group of benign or malignant tumors that occur in women of reproductive age, in which there is degeneration of the tissue derived from the co-Orion with abundant production of HCG, whose genome is essentially that paternal and respond extremely well to the chemotherapy. There are four forms of presentation: the complete hydatidiform mole, the partial, choriocarcinoma and tumortrofoblastico placental bed. The treatment consists in the uterine emptying, followed by chemotherapy, preferable-mind with MTX treatment.
The alterations in the evolution of the pregnancy are relatively frequent and bleeding is the most important clinical symptom. Abortion is the most frequent of the pathologies of pregnancy and about 15% of clinically recognized pregnancies end in spontaneous abortion. The causes may be maternal and fetal, being the most frequent congenital diseases. Almost all the abortions that take place before the week 8 are product of eggs with aberrant genetic anomalies, due to an error in the meiosis I or II, either maternal or paternal. There are several forms of clinical presentation, and who continue their evolution leads to abortion complete or incomplete, the treatment in the first case is observation and, in the second, the contradic- uterine horizontally. In general the abortion is a clinical entity that evolves without major maternal complications; however, when the abortion is caused, the risk of maternal death is so high, that in countries where abortion is illegal, it is the leading cause of maternal death. In an ectopic pregnancy the embryo implantation occurs outside the endometrial lining of the uterine cavity. Their frequency has increased in recent years; however, it is still a rare complication. The most difficult part of its management by early diagnosis and, in spite of the large number of methods that exist, there are still many cases in which manifests itself in the acute form of intrabdominal hemorrhage that, unless it is submitted to surgical treatment immediately, you can produce the maternal death. If the diagnosis is early you can make a medical treatment based on MTX, and leucovorin. You can also make a conservative surgical treatment by laparotomy or laparoscopy, if certain conditions are met. Treatment with salpingectomy is inevitable in cases where the diagnosis is delayed. Diseases of the trophoblast include a large group of benign or malignant tumors that occur in women of reproductive age, in which there is degeneration of the tissue derived from the co-Orion with abundant production of HCG, whose genome is essentially that paternal and respond extremely well to the chemotherapy. There are four forms of presentation: the complete hydatidiform mole, the partial, choriocarcinoma and tumortrofoblastico placental bed. The treatment consists in the uterine emptying, followed by chemotherapy, preferable-mind with MTX treatment.
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Embarazo, Aborto, Hemorragia, Adolescente, Hospital Materno Infantil Dra. Matilde Hidalgo de Procel, Cantón Guayaquil, Ecuador, Primer trimestre del embarazo