Maternal Diaphragmatic Hernia Correction During Pregnancy

Congenital diaphragmatic hernia consists of a defect in the embryonic development of the diaphragm that allows the passage of the abdominal viscera into the thoracic cavity,its diagnosis during pregnancy is quite rare.We present the case of a 31-year-old woman,with 23 weeks of gestation,who consulted for epigastric pain,nausea,and repetitive emetic episodes,without improvement with the medication provided.Due to the intense abdominal pain,a computed tomography of the abdomen and thorax was performed where the 28 mm defect was found at the left diaphragmatic level with protrusion of the gastric fundus to the thoracic cavity.She was taken to surgical management by laparoscopy with abdominal and thoracic approach,with a successful result and without maternal perinatal complications.Although the integrity of the diaphragmatic suture could be feared in relation to the increase in intraabdominal pressure due to uterine growth,the evolution of our patient and previous reports show that postoperative complications are not frequent.Successful vaginal delivery has even been described in some reports.Diaphragmatic hernias diagnosed during pregnancy are quite rare.We suggest that the optimal management of them during pregnancy is immediate surgical correction in case of persistent symptoms,more studies are needed to establish firm recommendations on the management of this pathology.

How Learning from Trauma Benefits the Obstetric Population?Damage Control Surgery

The recent implementation of trauma-validated damage control strategies in severe postpartum hemorrhage proves the importance of interdisciplinary management in the obstetric patient.Massive hemorrhage control techniques and damage control surgery are clear examples of how learning from trauma can benefit the obstetric population.Currently,most obstetric programs do not include training in this type of interventions.Nevertheless,it has been shown that these interventions are useful in the management of severe postpartum hemorrhage.The aim of this article is to introduce the application of damage control surgery principles in the management of massive obstetric hemorrhage.We propose to include appropriate training and the implementation of damage control surgery in obstetric management protocols.The prompt application of damage control principles can be considered in patients with persistent hemodynamic instability despite control of the source of bleeding.

Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum:Why Is This Technique Still Performed?

Introduction The major complication of placenta accreta spectrum(PAS)disorder is massive bleeding;therefore,multiple vascular interventions have been described to prevent or treat pelvic bleeding.Ligature of the internal iliac arteries(IIAs)was published more than 130 years ago,and although research relating to the physiology of this procedure has demonstrated poor vascular control over the last few decades,2-this technique has evolved into an established technique known as endovascular IIA balloon occlusion.

Cesarean Scar Pregnancy with Iniencephaly and Progression to Placenta Accreta Due to Early Management Rejection

To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean section and scar resection shortly after diagnosis.2 The final decision regarding management depends on the patient's choice,medical advice,the fertility desire,and the social,religious and emotional background that should also be taken into account.