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Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas. Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones. Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos. Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología.

Resumen El proposito de este caso, es reportar la experiencia y los resultados obtenidos en el manejo de una gestante con 21 semanas de embarazo que desarrolla choque cardiogenico secundario a taquicardia supraventricular en el primer embarazo con resultados perinatales desfavorables, quien es manejada con ablacion y marcapasos ventricular. Posteriormente, en presencia del manejo descrito, requiere manejo de su segundo embarazo con buenos resultados maternos y neonatales. Debido al enorme impacto en morbimortalidad y a la dificultad en la toma de decisiones, es necesario que el manejo de esta enfermedad se realice por un equipo multidisciplinario en un centro hospitalario de alta complejidad.

El 87 % de las empresas activas en Antioquia son de índole familiar, aporte significativo a los sectores de la economía nacional. Pero, la ausencia de un protocolo adecuado para tomar decisiones financieras, no les permite alcanzar su madurez económica. Este trabajo comprendió el análisis de los principales obstáculos en el proceso de toma de decisiones financieras a través del estudio de dos casos empresariales, para identificar los factores que inciden en su proceder frente a temas financieros; a través de una metodología cualitativa bajo el método analítico e inductivo. Ambos casos analizados arrojan, en los indicadores de rentabilidad, liquidez y diagnóstico, tendencias bajistas, incluso negativas, que reflejan inadecuadas prácticas de administración en decisiones con criterios subjetivos, conocimientoempírico y satisfacción de necesidades según la oportunidad del negocio, que dificultan el control de los costos y gastos, la conversión de ventas en utilidad y el retorno del capital invertido al inversionista. 87% of the companies active in Antioquia are of a family nature, a signifi­cant contribution to the sectors of the national economy. But, the absence of an adequate protocol to make financial decisions, does not allow them to reach their economic maturity. This work includes the analysis of the main obstacles in the financial decision-making process through the study of two business cases, to identify the factors that influence their actions in relation to financial issues; through a qualitative methodology under the Analytical and inductive method. Both analyzed cases show, in the indi­cators of Profitability, Liquidity and Diagnosis, bearish tendencies, even negative ones, that reflect inadequate management practices in decisions with subjective criteria, empirical knowledge and satisfaction of needs according to the business opportunity that hinder the control of costs and expenses, the conversion of sales into profits and the return of the capital invested to the investor.

BACKGROUND Surgical site infections (SSIs) are a known cause of morbidity and mortality; however, evidence related to management of SSIs during pregnancy is sparse. CASE A 26-year-old female patient with an adnexal cystic lesion underwent laparotomy at 19 weeks of pregnancy. She experienced a late SSI 10 days after initial surgery, necessitating surgical debridement. She was treated with multiple surgical interventions for wound irrigations and wound closure assisted by a negative pressure wound therapy. CONCLUSION Negative pressure wound therapy was used for treatment of an SSI during pregnancy without causing premature delivery or requiring a cesearan section.

Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who receive...

OBJECTIVE To compare the outcomes of women with postpartum hemorrhage (PPH) refractory to initial management and in a state of hypoperfusion between management with a non-pneumatic anti-shock garment (NASG) and Bakri balloon and management with other surgical interventions. METHODS A retrospective observational descriptive study of women with PPH and hemorrhagic shock who were treated at a high complexity obstetric unit in Columbia between 2011 and 2017. Clinical records were reviewed and women were divided in two groups by clinical management. Group 1 women were managed with surgical interventions; group 2 women were managed with NASG plus a Bakri balloon. RESULTS Overall, 142 women were treated for PPH, with 69 in group 1 and 73 in group 2). There were differences between group 1 and group 2 in the degree of hypovolemic shock (shock index: 1.1 vs 0.9, P=0.02), indicators associated with hypoperfusion (lactic acid, 2.9 vs 1.9 mmol/L, P=0.001), and frequency of transfusion of blood components (68% vs 44%, P

Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development...

We describe intraoperative and postdischarge outcomes of a case series after the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA) during elective cesarean delivery in pregnant women with morbidly adherent placenta (MAP). We furthermore performed a systematic review and meta-analysis to investigate the safety and effectiveness of the use of REBOA during elective cesarean delivery in pregnant women with MAP.Descriptive case series of REBOA (December 2015 to June 2017) used during elective cesarean delivery in pregnant women with MAP. The systematic review was conducted following PRISMA guidelines. We included studies involving pregnant women with a diagnosis of MAP who underwent an elective cesarean delivery with prophylactic REBOA placement. A meta-analysis was performed to assess the overall amount of transfusions and intraoperative hemorrhage of REBOA compared to NO-REBOA cases.A total of 12 patients with MAP underwent elective cesarean delivery with REBOA deployment. The median (interquartile range) of packed red blood cells transfused during the first 24 hours following surgery was two units (0-3.5). The median (interquartile range) of intraoperative blood loss was 1,500 mL (900-2,750). At 28 days, all patients were alive, and no adverse outcomes were observed. Four articles were included in the systematic review and meta-analysis. These articles included a total of 441 patients. Quantitative synthesis (meta-analysis) found that the use of REBOA as prophylaxis for the prevention of major hemorrhage was associated with a lower amount of intraoperative hemorrhage (in milliliters) (weighted mean difference, -1,384.66; 95% confidence interval, -2,141.74 to -627.58) and lower requirements of blood products transfusions (in units) (weighted mean difference, -2.42; 95% confidence interval, -3.90 to -0.94).We provide clinical data supporting the use of REBOA in the management of pregnant women with MAP undergoing elective cesarean delivery. Our findings demonstrate the feasibility of REBOA as a prophylactic intervention to improve outcomes in women at risk of catastrophic postpartum hemorrhage.Therapeutic study, level V; Systematic Review, level IV.

Objective To compare the characterization of an obstetric population diagnosed with sepsis using systemic inflammatory response syndrome (SIRS) criteria and sepsis-related organ failure assessment (SOFA). Methods The present retrospective observational descriptive study was conducted at a fourth-level clinic in Colombia among pregnant women who met the inclusion criteria (two SIRS criteria plus infection) between January 1, 2015, and December 31, 2016. Patients with systemic compromise were admitted to the high-complexity obstetric unit (HCOU), whereas those with multiorgan dysfunction were admitted to the intensive care unit (ICU). The SIRS scale was deemed positive if all four criteria were met. A SOFA score of at least 2 was considered a positive result. Results The study included 688 patients. The SIRS test at admission was positive among 431 patients (62.6%); 279 (64.7%) in the HCOU group and 152 (35.2%) in the ICU group. The SOFA test at admission was positive in 69 (38.5%) of 179 patients with complete data. The concordance-measured using the κ statistic-between SIRS and SOFA was low (0.016). Conclusion Using the SIRS scale could promote early sepsis management by identifying patients who require admission to the HCOU or ICU; however, low concordance between the SIRS and SOFA results suggested a need to create diagnostic scales specifically for the obstetric population.

This chapter deals with the problem of gender violence, especially in Chilean Aymara women. The aim of the study is to make a diagnosis of the indices and forms of domestic violence against women on the basis of gender in a sample of Aymara women from the urban area in the Arica and Parinacota Region (Chile). The chapter assumes the definition of intrafamiliar violence, according to the formulation adopted by Chilean legislation, as a complex and multi-determined phenomenon, which happens in the context of a culture and certain social relationships that support and make it possible. In this sense, it is one of the most dramatic manifestations of discrimination experienced by women because of their sexual condition. It is conceptualized as any form of physical, psychological-emotional, sexual, and/or economic abuse, which happens within the couple relationship, regardless of the legality of the bond. The chapter deals with the description of conditions and ways of life of the Aymara ethnic group, from socio-demographic, economic, and public health indicators that may be related to these women's perceptions concerning their situation in view of the intrafamiliar violence phenomenon. The research is a quantitative and qualitative multimethod design. The qualitative side of this study consists of group discussions in which the object of the research is analyzed through an outline ad hoc. The quantitative side of the research consists of the application of two standardized scales of domestic violence (WASTT and ISA).