Ginecología y obstetricia de México
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Case Reports
[Post-cesarean necrotizing fasciitis. Bacterial synergism, or mixed infection of the soft tissues?].
It has been demonstrated recently that most of the disemminated infections of the dermis, necrotizing fascitis included are due to a mix bacteria infection working sinergistically, demonstrated by clinical studies as well as in experimental animals. Treatment based on wide spectrum antibiotics and extensive debridement of the necrotic tissue performed by a team of several specialists have diminished mortality to 10%. We report a case of necrotizing fasciitis following a cesarean section in the absence of risk factors. We discuss risk factors, classification, etiology, diagnosis and therapy in light of the current knowledge.
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Severe genital hemorrhage in women is almost always present during puerperal pregnancy status. Thus, bearing in mind the hemodynamic and metabolic changes which appear physiologically during gestation: hypovolimia, hemodilution, tachycardia, and modification showing in blood coagulation factors and in electrocardiogram, is of paramount importance. In this article, a four-type genital bleeding classification based on the extent of blood loss is presented. ⋯ Class III and class IV correspond to hypovolemic shock and call for intensive care. The need for the availability of all necessary material resources and the participation of a multidisciplinary team are emphasized. The author also emphasized the preservation of the fetus' life-while inside the uterus-whenever this be feasible.
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The septic shock has a low frequency in the gynecologic-obstetric patients, nevertheless several obstetric conditions like: septic abortion, chorioamnionitis or puerperal infections can be complicated with this syndrome. The infections cause near 20% of the maternal deaths. Because the high morbidity and mortality of the patients with septic shock is necessary to have an actual knowledge of its pathogenesis and treatment. ⋯ Many studies had showed the importance of the bacterial endotoxin and the tumoral necrosis factor as mediators of septic shock. The treatment include: control of the infectious process, restoration of tissue perfusion pressure, restoration of blood volume, use of inotropic agents and general support measures. The role of monoclonal antibodies against endotoxin in the management of Gram-negative sepsis is still ignored, but there are several studies that support its use.
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In view of the illegal status induced abortion, it is difficult to determine the degree to which it is practiced. In our country there are a great inconsistency in the statistics on the number of abortions and the number of maternal deaths due to this cause. ⋯ The treatment consist on antimicrobial agents and early surgery. A reduction on the number of illegal abortions will decrease significantly the number of septic abortion's cases.
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Randomized Controlled Trial Clinical Trial
[Management of severe pre-eclampsia/eclampsia. Comparison between nifedipine and hydralazine as antihypertensive agents].
The objective was to compare the fetal and maternal effects between parenteral hydralazine and sublingual nifedipine used like antihypertensive drugs in the management of severe preeclampsia. Study design was prospective, comparative, longitudinal, randomized clinical trial. It was carried out at Centro Medico Nacional IMSS Torreon, Coah. ⋯ The only difference observed in this study was the Apgar of neonates whose mothers received hydralazine, that was significatively lesser than the Apgar of neonates whose mothers received nifedipine. Both medicaments are a good alternative as antihypertensive drugs in severe preeclampsia. Neonates whose mothers received Nifedipine had a higher Apgar.