A primigravida with a twin pregnancy presented acute abdominal pain and hypovolemic shock at 33 weeks of gestation. Ultrasound examination revealed the absence of fetal heartbeat in one fetus and serious bradycardia in the other without echographic signs of placental abruption. Immediate laparotomy revealed massive hemoperitoneum resulting from spontaneous rupture of right uterine vessels. Two demised fetuses were delivered by cesarean section and hemostasis was accomplished. According to the literature reported, endometriosis may be involved in the rupture of these vessels.

A pregnant woman can present medical pathologies similar to a woman who is not pregnant. However, the clinical features of some pathologies and the diagnostic or therapeutic process might be altered due to changes produced by pregnancy and the presence of the foetus. In some cases this can limit the diagnostic methods or the therapies to be applied. This article sets out the digestive and cardiovascular pathologies, pathologies of the nervous system and dermatoses of greatest relevance due to their frequency or severity, which might be encountered in an emergency consultation. It also offers a practical approach for the initial handling and the prognosis for the mother and the foetus.

Hypertensive states of pregnancy are a set of disorders that occur during gestation whose common nexus is hypertension. They must be given special emphasis due to their implication in maternal and neonatal morbidity and mortality. A classification is made of the different hypertensive states, with special emphasis placed on preeclampsia. This article defines the symptoms and signs of the disease and a differential diagnosis is made amongst diseases that must be ruled out. It is important to identify expectant mothers with preeclampsia, and it is of even greater importance in such cases to rule out some criterion of seriousness, as this will enable a different management to be carried out. The article includes the indications and the moment when the pregnancy finalises. Similarly, it details the controls that must be made if an expectant management is chosen for the benefit of the premature baby. The different anti-hypertensive therapeutical options are detailed, as well as the prophylactic treatment of eclampsia with magnesium sulphate. Because of their intrinsic interest, we draw special attention to the HELLP syndrome and to eclampsia as complications. The treatment and conduct that must be followed in gestation is described.

Hypertensive states of pregnancy are a set of disorders that occur during gestation whose common nexus is hypertension. They must be given special emphasis due to their implication in maternal and neonatal morbidity and mortality. A classification is made of the different hypertensive states, with special emphasis placed on preeclampsia. This article defines the symptoms and signs of the disease and a differential diagnosis is made amongst diseases that must be ruled out. It is important to identify expectant mothers with preeclampsia, and it is of even greater importance in such cases to rule out some criterion of seriousness, as this will enable a different management to be carried out. The article includes the indications and the moment when the pregnancy finalises. Similarly, it details the controls that must be made if an expectant management is chosen for the benefit of the premature baby. The different anti-hypertensive therapeutical options are detailed, as well as the prophylactic treatment of eclampsia with magnesium sulphate. Because of their intrinsic interest, we draw special attention to the HELLP syndrome and to eclampsia as complications. The treatment and conduct that must be followed in gestation is described.

La hemorragia es una de las causas más frecuentes y potencialmente más graves en la consulta de urgencias durante la gestación. En esta revisión hemos realizado un enfoque global para el manejo de una gestante que acude a urgencias por un sangrado vaginal, y posteriormente de manera más específica el manejo de algunas de las entidades más frecuentes de la hemorragia obstétrica. En cuanto a las hemorragias del primer trimestre se ha hecho mayor hincapié en el manejo del aborto, puesto que otras entidades que también son frecuentes se valoran de manera específica en otros capítulos. En el segundo trimestre se ha realizado una revisión de tres entidades que abarcan el mayor porcentaje de hemorragias en ese periodo, como son la placenta previa, el desprendimiento prematuro de placenta normalmente inserta y la rotura uterina. Hemos valorado en cada una de ellas la etiopatogenia, la actitud diagnóstica y el manejo de la forma más sistemática posible. Palabras clave. Hemorragia en la gestación. Amenaza de aborto. Placenta previa. Desprendimiento prematuro de placenta. Rotura uterina.