[
    {
        "page": 1,
        "title": "ACRETISMO PLACENTARIO",
        "body": "<div>\n\n<meta charset=\"utf-8\" \/><b style=\"font-weight:normal\" id=\"docs-internal-guid-c0560038-7fff-01f4-5bf1-26e97798081c\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">ACRETISMO PLACENTARIO<\/span><\/p><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">(Trastornos del espectro de la adherencia placentaria)<\/span><\/p><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">DEFINICI\u00d3N<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">El acretismo placentario se refiere a una <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">implantaci\u00f3n an\u00f3mala de la placenta<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">, en la cual <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">las vellosidades cori\u00f3nicas invaden parcial o totalmente el miometrio<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">, en lugar de quedar restringidas al sitio de la decidua basal.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Clasificaci\u00f3n<\/span><\/p><ol style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Placenta acreta:<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> invasi\u00f3n <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">superficial<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> del miometrio (\u224875% de casos).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Placenta increta:<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> invasi\u00f3n <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">profunda<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> dentro del miometrio.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Placenta percreta:<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> penetraci\u00f3n <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">a trav\u00e9s del miometrio<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> hasta la serosa e incluso \u00f3rganos adyacentes (vejiga, intestino).<\/span><\/p><\/li><\/ol><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">EPIDEMIOLOG\u00cdA<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Incidencia: en aumento debido al incremento de ces\u00e1reas.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Antes 1:2500, ahora hasta 1:272 partos.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Responsable de hemorragias obst\u00e9tricas graves, histerectom\u00eda periparto y mortalidad materna.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">FACTORES DE RIESGO<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Ces\u00e1rea previa<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: principal factor de riesgo.<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">El riesgo aumenta proporcionalmente con el n\u00famero de ces\u00e1reas:<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"3\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">1 ces\u00e1rea + placenta previa \u2192 riesgo ~3%.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"3\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">\u22653 ces\u00e1reas + placenta previa \u2192 riesgo &gt;60%.<\/span><\/p><\/li><\/ul><\/ul><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Placenta previa (concomitante)<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: presente en &gt;80% de los casos de AIP.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cirug\u00edas uterinas previas: miomectom\u00eda, legrado, ablaci\u00f3n endometrial.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Edad materna avanzada.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cicatrizaci\u00f3n uterina previa.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Defectos endometriales (como en Asherman).<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">FISIOPATOLOG\u00cdA<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">P\u00e9rdida de la <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">decidua basal<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> y de la <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">capa de Nitabuch<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">, que normalmente act\u00faan como barreras a la invasi\u00f3n trofobl\u00e1stica.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Esto permite que las vellosidades cori\u00f3nicas penetren el miometrio y m\u00e1s all\u00e1.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">En percreta, puede haber invasi\u00f3n a \u00f3rganos p\u00e9lvicos, particularmente vejiga.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">CL\u00cdNICA<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Muchas veces <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">asintom\u00e1tica<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> y se detecta por ecograf\u00eda.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Puede presentarse como <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">hemorragia posparto grave<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> si no fue diagnosticada antes del parto.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Complicaciones:<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Sangrado profuso intraoperatorio.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Invasi\u00f3n a vejiga: hematuria, disuria.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Aton\u00eda uterina, rotura uterina previa al trabajo de parto.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Retenci\u00f3n placentaria.<\/span><\/p><\/li><\/ul><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">DIAGN\u00d3STICO<\/span><\/p><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Ecograf\u00eda transvaginal con Doppler color (m\u00e9todo de elecci\u00f3n)<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Signos ecogr\u00e1ficos:<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">P\u00e9rdida de la zona hipoecoica retroplacentaria.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Presencia de <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">lagunas vasculares placentarias<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> (espacios anecoicos irregulares).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Adelgazamiento o ausencia del miometrio subyacente.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Vascularizaci\u00f3n aberrante en el segmento uterino inferior.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Extensi\u00f3n placentaria m\u00e1s all\u00e1 de la serosa.<\/span><\/p><\/li><\/ul><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Resonancia magn\u00e9tica (RM)<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Complementaria en casos dudosos.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">\u00datil para definir <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">profundidad y extensi\u00f3n<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> de la invasi\u00f3n (especialmente percreta).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Ayuda en planificaci\u00f3n quir\u00fargica, particularmente si hay sospecha de invasi\u00f3n vesical.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">CONDUCTA Y MANEJO<\/span><\/p><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Planificaci\u00f3n<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Requiere <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">centro especializado<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> con experiencia en cirug\u00eda gineco-obst\u00e9trica compleja.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Programar el parto entre <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">34-36 semanas<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> (idealmente 35+0\u201335+6) con maduraci\u00f3n pulmonar fetal previa.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Preparaci\u00f3n:<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cirujano gineco-oncol\u00f3gico o perinat\u00f3logo entrenado.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Anestesi\u00f3logo con experiencia.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Banco de sangre disponible.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cirujano general o ur\u00f3logo si se sospecha invasi\u00f3n a \u00f3rganos.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Consentimiento informado amplio.<\/span><\/p><\/li><\/ul><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">V\u00eda del parto<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Ces\u00e1rea cl\u00e1sica<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> (incisi\u00f3n corporal del \u00fatero), preferida para evitar incidir placenta.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Evitar incisi\u00f3n sobre la placenta.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Manejo quir\u00fargico<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Histerectom\u00eda total inmediata sin intentar extracci\u00f3n placentaria.<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">T\u00e9cnica m\u00e1s segura y est\u00e1ndar de manejo.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Courier New',monospace;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Menor riesgo de hemorragia masiva que intentar conservar el \u00fatero.<\/span><\/p><\/li><\/ul><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Otras estrategias (seleccionadas)<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Dejar placenta in situ + metotrexato + seguimiento con hCG:<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> riesgo de infecci\u00f3n, sangrado, fracaso.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Resecci\u00f3n segmentaria uterina<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> con reconstrucci\u00f3n: alternativa en percreta focal.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Embolizaci\u00f3n arterial uterina<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> preoperatoria: variable beneficio.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">COMPLICACIONES<\/span><\/p><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Maternas<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Hemorragia masiva.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Choque hipovol\u00e9mico.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Coagulopat\u00eda.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Lesi\u00f3n de vejiga o ur\u00e9ter.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Infecci\u00f3n, sepsis.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Necesidad de transfusi\u00f3n masiva.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Histerectom\u00eda de emergencia.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mortalidad materna (aunque menor con diagn\u00f3stico prenatal adecuado).<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Fetales<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Prematuridad iatrog\u00e9nica.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Sufrimiento fetal por sangrado agudo.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Morbilidad neonatal asociada a prematuridad.<\/span><\/p><\/li><\/ul><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">PRON\u00d3STICO Y CONSEJER\u00cdA<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mortalidad materna \u2193 si hay <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">diagn\u00f3stico prenatal<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> y planificaci\u00f3n adecuada.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Importancia de <\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">controles prenatales precoces<\/span><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> y evaluaci\u00f3n cuidadosa en mujeres con ces\u00e1rea previa + placenta previa.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Riesgo de recurrencia elevado en futuros embarazos si se conserva el \u00fatero.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:10pt;font-family:'Noto Sans Symbols',sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.3900000000000001;margin-bottom:8pt\" role=\"presentation\"><span style=\"font-size:12pt;font-family:Calibri,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">En casos conservadores, seguimiento estricto con ecograf\u00eda, hCG y evaluaci\u00f3n cl\u00ednica frecuente.<\/span><\/p><\/li><\/ul><\/b>\n<br \/><\/div>",
        "footer": "P\u00e1gina 1"
    }
]