bachelorThesis
Conducta obstétrica en multípara de 30 años de edad con embarazo a término más placenta previa oclusiva total.
Autor
Zambrano Sevillano, Nicole Andrea
Institución
Resumen
Placenta previa is a rare pathology but it increases with the rate of cesarean sections. In placenta previa, the centimeters of insertion of the placenta towards the OCI are taken into account to decide the route of delivery. So, the loss of thickness of the basal layer of the endometrium causes the placenta to fix abnormally in the lower uterine segment. The causes of this are diverse such as trophoblastic, uterine, placental factors, advanced age, history of placenta previa, previous cesarean sections, curettage assisted reproductive technique among others. This pathology is associated with placental accrete mainly due to previous cesarean sections, in which there is a lack of the decidua basalis and a deficiency in the development of Nitabush’s membrane. The diagnosis is based on a routine abdominal ultrasound at weeks 18 and 24, and a transvaginal ultrasound at weeks 35 to 36 confirm this pathology and a Doppler ultrasound on suspecting placental accreta. It is usually characterized by painless transvaginal bleeding (hemorrhage), it usually occurs from the second half of pregnancy, involving serious complications in pregnancy such as childbirth and even death, if not managed in time. In the following research work, laboratory test, obstetric ultrasounds, diagnoses, and follow-up of the patient are reported. Placenta previa is a rare pathology but it increases with the rate of cesarean sections. In placenta previa, the centimeters of insertion of the placenta towards the OCI are taken into account to decide the route of delivery. So, the loss of thickness of the basal layer of the endometrium causes the placenta to fix abnormally in the lower uterine segment. The causes of this are diverse such as trophoblastic, uterine, placental factors, advanced age, history of placenta previa, previous cesarean sections, curettage assisted reproductive technique among others. This pathology is associated with placental accrete mainly due to previous cesarean sections, in which there is a lack of the decidua basalis and a deficiency in the development of Nitabush’s membrane. The diagnosis is based on a routine abdominal ultrasound at weeks 18 and 24, and a transvaginal ultrasound at weeks 35 to 36 confirm this pathology and a Doppler ultrasound on suspecting placental accreta. It is usually characterized by painless transvaginal bleeding (hemorrhage), it usually occurs from the second half of pregnancy, involving serious complications in pregnancy such as childbirth and even death, if not managed in time. In the following research work, laboratory test, obstetric ultrasounds, diagnoses, and follow-up of the patient are reported. La placenta previa es una patología poco frecuente pero que se incrementa con la tasa de cesáreas. En la placenta previa los centímetros de inserción de la placenta hacia el OCI se toman en cuenta para decidir la vía de parto. De manera que la pérdida de grosor de la capa basal del endometrio hace que la placenta se fije anormalmente en el segmento uterino inferior. Las causas de esta son diversas como factores trofoblásticos, uterinos, placentarios, edad avanzada, antecedentes de placenta previa, cesáreas anteriores, legrados, técnica de reproducción asistida entre otros. Esta patología se llega a asociar a acretismo placentario principalmente por cesáreas anteriores, en la que existe una carencia de la decidua basal y deficiencia en el desarrollo de la membrana de Nitabuch. El diagnóstico se basa en ecografía abdominal de rutina en semanas 18 y 24, y de realizar ecografía transvaginal a las semanas 35 a 36 para confirmar esta patología y en sospecha de acretismo placentario una ecografía Doppler. Por lo general se caracteriza por sangrado transvaginal indoloro (hemorragia), que suele presentarse desde la segunda mitad de la gestación, implicando complicaciones graves en el embarazo como el parto e incluso la muerte, si no se maneja a tiempo. En el siguiente trabajo de investigación se reporta exámenes de laboratorio, ecografías obstétricas, diagnósticos y seguimiento de la paciente.