Perinatologia y Reproduccion Humana最新文献

Infertility affects between 8-15% of general population of reproductive age. The term refers to the inability of couples to achieve pregnancy after one year of unprotected sexual activity. The male factor is solely responsible in 20%, and 30-40% with the couple.

The initial evaluation of the male reproductive situation is the seminogram, which is considered as a key assessment tool.

Several conditions may be associated with infertility in men, such as endocrine-metabolic diseases such as hypogonadism, hyperprolactinaemia, dysthyroidism, dyslipidaemia, alterations glucose and insulin alteration, central obesity, or to the group of parameters called metabolic syndrome (MS). Obesity contributes to development of hypertension, dyslipidaemia and insulin resistance.

The aim of our review was to find documents that showed the impact of the association between waist circumference and insulin resistance in semen parameters as a possible origin of male infertility. The search for information was conducted in Medline, ScienceDirect, and Scopus. The terms used for the basic search were: obesity, abdominal circumference, insulin resistance, male infertility, semen, semen parameters.

There are studies documenting the deleterious effect of obesity and insulin resistance in female fertility. Some performed in men suggest harmful effects on their reproductive potential.

Semen anomalies are found in obese men with insulin resistance, but still require further studied to assess the association between them. The literature reports semen anomalies associated with obesity that are still to be elucidated.

Objective

To establish the prognostic usefulness of cervical length values in the second trimester using transperineal ultrasound for the prediction of preterm delivery.

Material and methods

A case-control study was conducted on a sample of 613 pregnant women attending the Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Group A consisted of 52 patients who had preterm deliveries and group B 561 pregnant women who had term deliveries, and considered as controls. An evaluation was made of the general characteristics of the patients, as well as of the cervical length values measured by transperineal ultrasound.

Results

The mean gestation age at the time of measuring the cervical length by transperineal ultrasound was 25.7 ± 1.2 weeks in group A, and 26.0 ± 1.1 weeks in group B (P = ns). There were no significant differences in maternal age, body mass index and history of preterm labour (P = ns). Values of cervical length measured by transperineal ultrasound were higher in group A (3.2 ± 0.4 centimetres) than in group B (4.0 ± 0.4 centimetres; P < .0001). A cut-off value of 3.5 centimetres had a value under curve of 0.88 with a sensitivity of 71.1%, specificity of 86.8%, and positive predictive value of 33.3%, and negative predictive value of 97.0%. Diagnostic accuracy was of 85.9%.

Conclusion

Cervical length in second trimester by transperineal ultrasound could be a useful tool for the prediction of preterm delivery.

Persistent pulmonary hypertension of the newborn is the result of an abnormal adaptation to the perinatal circulatory transition. Persistent pulmonary hypertension of the newborn is a syndrome noted for its sustained elevation of the pulmonary vascular resistance, decreased lung perfusion, and continued right to left shunting of blood through the foramen ovale and ductus arteriosus. Respiratory failure in the neonate is frequently complicated by persistent pulmonary hypertension of the newborn. Nitric oxide has been shown to be efficient in its treatment, and inhaled nitric oxide is the only agent approved by the FDA for use in neonates with persistent pulmonary hypertension of the newborn, and, should always be the first-line treatment. In this article a review is presented of the evidence for the use of inhaled nitric oxide in the persistent pulmonary hypertension of the newborn.

Introduction

The large majority (95%) of monochorionic-monoamniotic twins have arterio-venous placental anastomoses that allow blood to transfuse from one to the other. Without treatment, both babies are affected.

Material and methods

A retrospective analysis was performed on the outcomes of 55 monochorionic-monoamniotic twin pregnancies, complicated by twin to twin transfusion syndrome, and treated with laser coagulation in the Instituto Nacional de Perinatología (INPer) in Mexico City, from January 1999 to July 2014. Data was obtained from clinical charts. Percentages, means, and standard deviations were calculated for the descriptive analysis. The Student t-test was used to compare quantitative variables, and χ² test for qualitative ones, using SPSS v. 20 software.

Results

There were 48 live babies, 38 stillbirths, and 20 continued their treatment outside the INPer. Survival is related to the Quintero stage at the time of treatment: stage I (83%), II (35%), III (67.5%), and IV (50%). Mean gestational age at laser coagulation was 23.3 weeks. A caesarean section was used for 93.7% of the deliveries at 31.2 weeks (56 days post-treatment). The mean birth weight was 1399.8 g. There was a statistical difference in haematocrit values between donors (45 ± 10.6) and recipients (48.9 ± 11.2) (P < .001). Complications were: hydrops (4%), necrotising enterocolitis (4%), and thrombosis (2%). The main morbidities were retinopathy (14%), bronchopulmonary dysplasia (10%), and neurodevelopmental deficit (14.5%).

Conclusions

Survival and outcomes of twin to twin transfusion syndrome patients are related to the Quintero stage and gestational age. Therefore, early detection and treatment improve both prognosis and quality of life.

Objective

To establish the usefulness of measuring aminotransaminases in vaginal fluid in the diagnosis of premature rupture of membranes.

Material and methods

A study was conducted on 270 pregnant women who were seen in obstetrics emergency department of the Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. They were divided into two groups, consisting of patients with premature rupture of membranes (group A), and pregnant women with intact membranes (group B) considered as controls. General characteristics, values of aminotransferases in vaginal fluid, and diagnostic efficacy were evaluated.

Results

Gestational age at the time of determining aminotransferases in vaginal fluid was 28.2 ± 7.2 weeks in group A, and 27.5 ± 7.3 weeks in group B (P = ns). There were no significant differences in other general characteristics (P = ns). Patients in group A showed significant higher concentrations of alanine transferase and aspartate transaminase in vaginal fluid compared with pregnant women in group B (P < .05). Alanine transferase showed an area under the curve value of 0.88. A cut-off point of 2 IU/L showed a sensitivity of 82.9%, specificity of 92.5%, positive predictive value of 91.8%, and negative predictive value of 84.4%. Aspartate transaminase showed an area under the curve value of 0.81. A cut-off point of 13 IU/L showed an area under the curve value of 0.96, with a sensitivity of 60.0%, specificity of 94.0%, positive predictive value of 91.0%, and negative predictive value of 70.1%.

Conclusions

Measurement of aminotransferases concentrations in vaginal fluid is a useful diagnosis tool for premature rupture of membranes.

Menopause is the cessation of menses as a result of loss of ovarian follicular activity. The period before menopause and the first year after menopause is known as peri-menopause. Post-menopause is defined as the years after menopause, regardless of whether it was induced or spontaneous. Due to increased life expectancy in Mexican women, as many reach the average age of menopause at 45-59 years, they spend a significant part of their lives in post-menopause. It has been observed that psychiatric disorders are more common in women than in men, and that peri-menopause is a stage when the risk of psychological symptoms increases, as well as the risk of major depression and anxiety disorders. It must be determined when anxiety arises as a normal state in response to specific daily stress provoking situations, or whether anxiety starts to present itself irrationally as part of a psychiatric disorder. In this review we present data on anxiety during menopausal transition. Reference is also made to general anxiety disorder and panic disorder, due to their high prevalence in women during menopausal transition, probably attributed to hormonal changes during this stage.

Background

The World Health Organisation uses the term “near miss” to describe medical and obstetric events - whether during pregnancy, childbirth or the following 42 days after the end of the pregnancy - in which the mother survived, but almost lost her life (extreme maternal morbidity). In the case of our country, cases of extreme maternal morbidity are not adequately recorded.

Objective

To analyse the texts of International Law (declarations, treaties and agreements) related to maternal health, to determine the standards by which Mexico must comply.

Materials and methods

The authors analyse various texts of International Law, as well as the standards set by the World Health Organization and the Millennium Development Goals in relation to extreme maternal morbidity.

Results

There is a significant need for Mexico to comply with the guidelines and standards set by the World Health Organization and the Pan American Health Organization in relation to maternal morbidity, as these guidelines are part of International Law. Mexico has ratified, accepted and signed several international treaties, many of which involve commitments directly related to maternal health.

Conclusions

Appropriate monitoring, not only of maternal mortality, but also of maternal morbidity and severe or extreme maternal morbidity, are part of the practices that our country must undertake in order to have a proper fulfilment of international commitments in maternal health.

In 1885, Louis-Victor Marcé estimated that for every thousand births, between one and two women suffer a psychotic breakdown during the puerperal period; this rate remains the same. Despite the extensive history of studies of puerperal psychological disorders, more precisely postpartum psychosis, there is currently no consensus on its aetiology or nosography.

The aim of this article is to perform a historical and clinical review of the debate on the diagnosis, aetiology, and interpretation of acute psychosis breakdown triggered during the puerperal period, in order to provide a general panorama of this pathology; a pathology that is gaining more and more interest in psychiatry, psychology, and gynaecology.

Exposure to synthetic oxytocin (SOT) during labour and delivery is currently associated with a low prevalence of the practice of exclusive breastfeeding (EBF).

Objective

To compare levels of exposure to synthetic oxytocin during labour and delivery, and breastfeeding at 2 months post-partum.

Method

A quantitative, descriptive, prospective observational pilot study was conducted on a sample of 19 mothers, users of the Chilean public health system, during 2014-2015. Bio-socio-demographic and perinatal variables were recorded, as well as exposure to SOT during delivery. Breastfeeding details were gathered using a questionnaire. A descriptive univariate and bivariate analysis was performed using SPSS v19 software. The study was approved by the Research Ethics Committee of the health service involved, and participation was by prior informed consent.

Results

The mean age of mothers was 27 years old, literate, with a stable partner, and good social support and functional families. The prevalence of EBF was 63.15%. The exposure to SOT was 52.63%, and of these, 60% practised EBF. Exclusive breastfeeding was also practised by 50% of the women exposed to spinal anaesthesia. Dose and exposure time to SOT, as well as information on the benefits of breastfeeding, did not influence EBF. The expectations of breastfeeding for 6 months had a 100% consistency with maintaining EBF.

Discussion

It was not possible to determine whether exposure to SOT influenced EBF. However, it was observed that exposure to spinal anaesthesia and caesarean section could lead to lower EBF.