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.

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.

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.

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.

Indirect effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are difficult to calculate. Fear of intrahospital infection has led to a decrease in the use of emergency services and the performance of elective procedures. Several low- and middle-income countries have seen the number of institutional deliveries reduced, even in the absence of a follow-up program for home births. We present the case of a patient with adequate prenatal care and an institutional delivery plan who, due to the SARS-CoV-2 pandemic, chose to have a home delivery with unsafe conditions. The lack of supervision by health personnel and the absence of an immediate consultation plan facilitated the presentation of postpartum hemorrhage and poor neonatal results. Little attention has been paid during the pandemic to pregnant women who decide to have their birth at home. A broad discussion is necessary in this regard, to regain the confidence of the population and strengthen institutional births, or to strengthen midwife-assisted home births programs. Patients’ fear to acquiring SARS-CoV-2 infection inside hospitals is a factor that must be taken into account in prenatal care programs.

Indirect effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are difficult to calculate. Fear of intrahospital infection has led to a decrease in the use of emergency services and the performance of elective procedures. Several low- and middle-income countries have seen the number of institutional deliveries reduced, even in the absence of a follow-up program for home births. We present the case of a patient with adequate prenatal care and an institutional delivery plan who, due to the SARS-CoV-2 pandemic, chose to have a home delivery with unsafe conditions. The lack of supervision by health personnel and the absence of an immediate consultation plan facilitated the presentation of postpartum hemorrhage and poor neonatal results. Little attention has been paid during the pandemic to pregnant women who decide to have their birth at home. A broad discussion is necessary in this regard, to regain the confidence of the population and strengthen institutional births, or to strengthen midwife-assisted home births programs. Patients’ fear to acquiring SARS-CoV-2 infection inside hospitals is a factor that must be taken into account in prenatal care programs.