<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412020000700010</article-id>
<article-id pub-id-type="doi">10.24245/gom.v88i7.3944</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Fascitis necrosante genital posterior a parto instrumentado: reporte de un caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Genital necrotizing fasciitis after operative vaginal delivery: A case report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Espinosa-García]]></surname>
<given-names><![CDATA[Carlos Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivera-Medina]]></surname>
<given-names><![CDATA[Ernesto Rodolfo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez-Colorado]]></surname>
<given-names><![CDATA[Esther Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramírez-Isarraraz]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gorbea-Chávez]]></surname>
<given-names><![CDATA[Viridiana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Granados-Martínez]]></surname>
<given-names><![CDATA[Verónica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Perinatología Isidro Espinosa de los Reyes  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Perinatología Isidro Espinosa de los Reyes  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Nacional de Perinatología Isidro Espinosa de los Reyes  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto Nacional de Perinatología Isidro Espinosa de los Reyes servicio de Urología Ginecológica ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Instituto Nacional de Perinatología Isidro Espinosa de los Reyes  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<volume>88</volume>
<numero>7</numero>
<fpage>488</fpage>
<lpage>497</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412020000700010&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412020000700010&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412020000700010&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  ANTECEDENTES:  La fascitis necrosante es una infección rara del tejido subcuta&#769;neo y la fascia que rápidamente puede complicarse y poner en riesgo la vida; por esto siempre debe tenerse en mente la posibilidad de este diagnóstico.  OBJETIVO:  Describir un caso raro de fascitis necrosante genital aparecida luego de un parto instrumentado.  CASO CLI&#769;NICO:  Paciente primigesta, de 30 años, con antecedente de infección vaginal por Ureaplasma. El parto instrumentado tuvo lugar a las 39 semanas; se reparó la episiotomía medio-lateral derecha, sin complicaciones, y se dio de alta del hospital a las 48 horas. Al quinto día de puerperio acudió a Urgencias por dolor perineal intenso y fiebre. Durante la auscultación se encontró un hematoma perineal y glúteo derecho, con eritema alrededor, indurado y con crepitación vaginal, con secreción hematopurulenta fétida. Reportes de laboratorio: leucocitosis y anemia. Los cultivos de la herida reportaron infección polimicrobiana. El ultrasonido pélvico evidenció dos colecciones debidamente delimitadas en planos dérmicos y musculares. Se indicó tratamiento con antibióticos de amplio espectro, lavado quirúrgico y desbridamiento quirúrgico diario durante 5 días. Después, se inició la terapia de cierre asistido por vacío (VAC) durante 7 días hasta lograr la granulación. Se continuó con lavados quirúrgicos durante 5 días más. El día 18 posparto se cerró la herida sin complicaciones. A la sexta semana de seguimiento la herida había cicatrizado, sin dolor, ni incontinencia fecal o urinaria: solo hipoestesia de la cicatriz, pero con evolución satisfactoria.  CONCLUSIO&#769;N:  Lo ideal es establecer el diagnóstico lo más temprano posible para disminuir la morbilidad y mortalidad, ofrecer inmediatamente atención multidisciplanaria que permita conseguir los mejores desenlaces quirúrgicos e incrementar la supervivencia.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  BACKGROUND:  Necrotizing fasciitis is a rare infection of the subcutaneous tissue and the fascia that is rapidly progressive and deadly, requiring early and aggressive surgical debridement to decrease mortality. The objective of this study was to describe a rare case of genital necrotizing fasciitis after operative vaginal delivery.  CLINICAL CASE:  A 30 years old primiparous woman with a history of vaginal infection by Ureaplasma. Instrumented delivery was attended at 39 weeks, repairing right mid-lateral episiotomy without complications and discharge after 48 hours. On the fifth day of the puerperium she went to the emergency department for severe perineal pain and fever, finding perineal hematoma and right gluteus with erythema around, indurated and with vaginal crepitation with fetid hemato-purulent secretion. The laboratories reported leukocytosis and anemia, wound cultures showed polymicrobial infection and pelvic ultrasound diagnosed 2 well-defined collections in dermal and muscular planes. Management was initiated with broad-spectrum antibiotics plus washing and daily surgical debridement for 5 days. Subsequently, it was placed with VAC therapy for 7 days until granulation was achieved; and then, surgical washes were continued for 5 more days. On the 18th day, the wound was closed without complications. In her sixth week of follow-up she has a scarred wound, without pain or fecal or urinary incontinence; only refers to hypoesthesia of the scar, but with satisfactory evolution.  CONCLUSION:  The ideal is to establish the diagnosis as early as possible to decrease morbidity and mortality, immediately offer multidisciplinary care that allows the best surgical outcomes to be achieved, and increases survival.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Fascitis necrosante]]></kwd>
<kwd lng="es"><![CDATA[tejido subcutáneo]]></kwd>
<kwd lng="es"><![CDATA[fascia]]></kwd>
<kwd lng="es"><![CDATA[desbridamiento quirúrgico]]></kwd>
<kwd lng="es"><![CDATA[Ureaplasma]]></kwd>
<kwd lng="es"><![CDATA[episiotomía]]></kwd>
<kwd lng="es"><![CDATA[descarga]]></kwd>
<kwd lng="es"><![CDATA[perineal]]></kwd>
<kwd lng="en"><![CDATA[Necrotizing fasciitis]]></kwd>
<kwd lng="en"><![CDATA[Subcutaneous tissue]]></kwd>
<kwd lng="en"><![CDATA[Fascia]]></kwd>
<kwd lng="en"><![CDATA[Debridement]]></kwd>
<kwd lng="en"><![CDATA[Vaginal]]></kwd>
<kwd lng="en"><![CDATA[Old Primiparous Women]]></kwd>
<kwd lng="en"><![CDATA[Ureaplasma]]></kwd>
<kwd lng="en"><![CDATA[Episiotomy]]></kwd>
<kwd lng="en"><![CDATA[Discharge]]></kwd>
<kwd lng="en"><![CDATA[Perineal]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tabares-Trujillo]]></surname>
<given-names><![CDATA[MK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Postpartum vulvar necrotizing fasciitis]]></article-title>
<source><![CDATA[Ginecol Obstet Mex]]></source>
<year>2014</year>
<volume>82</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>54-63</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Patel]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A rare case report of vulvar necrotizing fasciitis in a healthy patient]]></article-title>
<source><![CDATA[Int J Surg Case Rep]]></source>
<year>2017</year>
<volume>35</volume>
<page-range>103-5</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Althunayyan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Karamitosos]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fournier's gangrene in an obese female in third trimester of pregnancy]]></article-title>
<source><![CDATA[Saudi Med J]]></source>
<year>2018</year>
<volume>39</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>415-8</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gallup]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2002</year>
<volume>187</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>305-10</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Faro]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Faro]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Necrotizing Soft-tissue infections in obstetric and gynecologic patients]]></article-title>
<source><![CDATA[Clin Obstet Gynecol]]></source>
<year>2012</year>
<volume>55</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>875-87</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gadler]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Recognizing Fournier's Gangrene in the Emergency Department]]></article-title>
<source><![CDATA[Adv Emerg Nurs J]]></source>
<year>2019</year>
<volume>41</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>33-8</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhou]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fournier's Gangrene with septic shock and multiple organ dysfunction syndrome]]></article-title>
<source><![CDATA[Int J Low Extrem Wounds]]></source>
<year>2019</year>
<volume>18</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>94-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Soto-Sánchez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fournier's gangrene caused by Streptococcus anginosus, a rare etiologic agent]]></article-title>
<source><![CDATA[Rev Gastroenterol Méx]]></source>
<year>2018</year>
<volume>83</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>348-50</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chernyadyev]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fournier's Gangrene Literature Review and clinical cases]]></article-title>
<source><![CDATA[Urol Int]]></source>
<year>2018</year>
<volume>101</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>91-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Almarzouqi]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fatal necrotizing fasciitis following episiotomy]]></article-title>
<source><![CDATA[Case Rep Surg]]></source>
<year>2015</year>
<volume>2015</volume>
<page-range>562810</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nikolaou]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Necrotizing fasciitis complicating pregnancy a case report and literature review]]></article-title>
<source><![CDATA[Case Rep Obstet Gynecol]]></source>
<year>2014</year>
<volume>2014</volume>
<page-range>505410</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Courtney-Brooks]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vulvar necrotizing soft tissue infection a review of a multi-disciplinary surgical emergency and management in the modern era]]></article-title>
<source><![CDATA[Gynecol Oncol Case Rep]]></source>
<year>2013</year>
<volume>5</volume>
<page-range>6-9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lynch]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Maternal death from postpartum necrotizing fasciitis arising in an episiotomy A case report]]></article-title>
<source><![CDATA[Infect Dis Obstet Gynecol]]></source>
<year>1997</year>
<volume>5</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>341-4</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nikolaou]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Necrotizing fasciitis complicating pregnancy a case report and literature review]]></article-title>
<source><![CDATA[Case Rep Obstet Gynecol]]></source>
<year>2014</year>
<volume>2014</volume>
<page-range>505410</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Anaya]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Necrotizing soft-tissue infection Diagnosis and management]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2007</year>
<volume>44</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>705-10</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Topdagi Yilmaz]]></surname>
<given-names><![CDATA[EP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of vacuum-assisted closure in massive puerperal genital hematoma]]></article-title>
<source><![CDATA[Obstet Gynecol Sci]]></source>
<year>2019</year>
<volume>62</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>186-9</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aviki]]></surname>
<given-names><![CDATA[EM]]></given-names>
</name>
<name>
<surname><![CDATA[Posthuma Batalden]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vacuum-Assisted Closure for Episiotomy Dehiscence]]></article-title>
<collab>G del Carmen M.Berkowitz LR</collab>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2015</year>
<volume>126</volume>
<page-range>530-3</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
