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Resumen: El hígado graso agudo del embarazo es una de las alteraciones hepáticas con mayor mortalidad (cerca del 18%) presentes en la gestación, aunque es una patología poco frecuente: 1 de cada 7000 a 16.000 embarazos presenta muchas complicaciones y requiere un manejo inmediato para evitar la muerte de la gestante o del feto; sin embargo esta patología se puede enmascarar con la preeclampsia, que es otra patología hepática de mayor frecuencia, lo cual retrasa el manejo y aumenta el número de complicaciones. El objetivo de este artículo es realizar una búsqueda bibliográfica acerca del hígado graso agudo del embarazo e identificar los factores similares entre esta patología y la preeclampsia severa para lograr hacer un diagnóstico y manejo oportunos. Para ello se realizó una búsqueda sistemática en las bases de datos, PubMed, Science Direct, Medline, Embase, en junio de 2017; además, se seleccionaron artículos originales, reportes de casos y artículos de revisión, publicados en los últimos diez años. Abstract: Acute fatty liver of pregnancy (AFLP) is one of the liver disorders with the highest mortality rate (about 18%) during pregnancy, although it is rare: 1 in 7,000 to 16,000 pregnancies has many complications and requires immediate treatment to avoid the death of the pregnant woman or the fetus. However, this pathology can be masked by preeclampsia, which is another more frequent liver disease. This delays treatment and increases the number of complications. The aim of this article is to conduct a bibliographic search about AFLP and identify similar factors between this pathology and severe preeclampsia to make a diagnosis and provide treatment in a timely manner. For this, a systematic search was carried out in databases (PubMed, Science Direct, Medline, Embase) in June 2017. In addition, original articles, case reports, and review articles published in the last ten years were selected. Resumo: O fígado gorduroso agudo da gestação é uma das alterações hepáticas com mais mortalidade (cerca de 18 %) presentes na gravidez, embora seja uma patologia pouco frequente: 1 de cada 7.000 a 16.000 gestações apresenta muitas complicações e requer uma ação imediata para evitar a morte da gestante ou do feto. Contudo, essa patologia pode ser camuflada com a pré-eclâmpsia, que é outra patologia hepática de maior frequência, o que atrasa seu tratamento e aumenta o número de complicações. Nesse sentido, o objetivo deste estudo é realizar uma busca bibliográfica sobre o fígado gorduroso agudo da gestação e identificar os fatores semelhantes entre ele e a pré-eclâmpsia grave para poder fazer um diagnóstico e tratamento oportunos. Para isso, foi realizada uma busca sistemática nas bases de dados, PubMed, Science Direct, Medline, Embase, em junho de 2017, das quais foram selecionados artigos originais, relatos de caso e artigos de revisão, publicados nos últimos dez anos.

Resumen Introducción. El objetivo del estudio fue estimar los factores pronóstico asociados con el parto prematuro y otros resultados clínicos en mujeres embarazadas sometidas a apendicectomía en Colombia. Métodos. Se llevó a cabo un estudio retrospectivo de cohorte a partir de las bases de datos administrativos, que incluyó mujeres embarazadas afiliadas al sistema de salud contributivo en Colombia y sometidas a apendicectomía, entre enero de 2013 y noviembre de 2016. Se estimaron la tasa de parto prematuro, la tasa de mortalidad a los 30 días, el ingreso materno a la unidad de cuidados intensivos a 30 días, el reingreso de la madre a los 30 días y el bajo peso al nacer. Se utilizaron regresiones logísticas multivariadas para identificar estos tres factores pronóstico. Resultados. Se incluyeron 1.589 mujeres en el estudio. La edad media fue de 26,43 ± 5,79 años, el 17,94 % de las apendicectomías se practicaron en el tercer trimestre, el 6,10 % fueron apendicectomías laparoscópicas y el 22,03 % requirió drenaje por peritonitis. Las tasas de parto prematuro, mortalidad a 30 días, ingreso a la unidad de cuidados intensivos a 30 días, reingreso a los 30 días y bajo peso al nacer, fueron 12,08 %, 0,13 %, 9,75 %, 16,93 % y 3,34 %, respectivamente. La edad menor de 18 años, la apendicectomía en el tercer trimestre y el drenaje por peritonitis se asociaron con un mayor riesgo de parto prematuro. El índice de comorbilidad de Charlson, la apendicectomía en el tercer trimestre y el drenaje por peritonitis, se asociaron con un mayor ingreso materno a la unidad de cuidados intensivos. Conclusiones. La apendicectomía en el tercer trimestre y la apendicitis complicada, son factores pronóstico asociados a parto prematuro en mujeres colombianas embarazadas sometidas a apendicectomía. Abstract Introduction: The objective of the study was to estimate the prognostic factors associated with premature delivery and other clinical outcomes in pregnant women undergoing appendectomy in Colombia. Methods: A retrospective cohort study was conducted from the administrative healthcare records, which included pregnant women affiliated with the contributory health system in Colombia and undergoing appendectomy, between January 2013 and November 2016. The birth rate was estimated, premature delivery rate, the 30-day mortality rate, 30-day maternal admission to Intensive Care Unit (30-ICU), 30-day readmission (30-R-Adm), and low birth weight (LBW). Multivariate logistic regressions were used to identify these three prognostic factors. Results: 1589 women were included in the study. Mean age was 26.43 ± 5.79, 17.94% of the appendectomies were performed in the third trimester, 6.10% were laparoscopic appendectomies and 22% required peritonitis drainage. The Rates of premature delivery, 30-day mortality, 30-ICU, 30-R-Adm and LBW were 12%, 0.13%, 9.75%, 16.93% and 3.34%, respectively. Age under 18 years, appendectomy in the third trimester and peritonitis drainage were associated with an increased risk of premature delivery. Comorbidity Charlson Index, appendectomy in the third trimester and peritonitis drainage were associated with an increased maternal admission to ICU. Conclusions: Appendectomy in the third trimester and complicated appendicitis are prognostic factors associated with premature delivery in Colombian pregnant women undergoing to appendectomy.

Background Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. Objective The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. Material and methods An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. Clinical Cases The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. Conclusion The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour.