Perinatologia y Reproduccion Humana最新文献

Objective

To design a blood micro-culture using 200 to 300 μl of blood and compare it with the reference BACTEC peds plus/FTM BD^® blood culture.

Methods

Two batches of HEM-1 and HIM-3 blood micro-cultures, with different composition were prepared. They were quality controlled in the same way as that carried out in the BACTEC, which is the automated reference blood culture. A total of 98 samples taken from Neonatal Intensive Care Unit (NICU) patients with probable sepsis were studied and stratified into two groups. The first 48 samples that were inoculated into HIM-1 and BACTEC paediatric plates, and the second 50 samples in HIM-3 and in paediatric BACTEC plates.

Results

The microorganisms grown in HIM-1 and HIM-3 included: E. coli, K. pneumoniae, P. aeruginosa, and Enterococcus spp up to 10² CFU/ml (which is the minimum recovery concentration of the reference blood culture). Micro-blood cultures did not improve the growth of S. epidermidis, S. aureus and S. pneumoniae of 10² CFU/ml. For Gram negatives, a sensitivity of 80%, specificity of 96%, positive predictive value (PPV) of 80%, and negative predictive value (NPV) of 96%, were obtained.

Conclusions

HIM-1 and HIM-3 are adequate for the diagnosis of early neonatal sepsis in developing countries, mainly by Gram negative, but not for late sepsis, mainly by staphylococci. Compared to BACTEC they save a lot of blood sample.

Background

Multiple pregnancies, prematurity, low birth weight and intrauterine growth restriction are important risk factors for adverse neurodevelopmental throughout the world.

Material and methods

An observational, retrospective, and analytical study was conducted on a cohort of triplets born by different pregnancy methods. They were assessed using the Mayo Clinic neurological assessment, neurobehavioural evaluation, Bayley psychomotor assessment, human communication, and hearing and language at 2 years of life.

Results

A total of 82 sets of triplets were included in the analysis. In the neurological examination at two years, behavioural problems stand out, being 10.6% for spontaneous pregnancies. In the neurobehavioural assessment, 16% presented with a mild delay, 3.4% moderate, and severe delay only in 0.8%. The percentage for hearing loss in general was low, being superficial in one patient, with mild hearing loss in one, and another with profound hearing loss. The language for the entire sample was at a mean of 21.2 months. For the Bayley scale, the mean mental index was 83.6, and for the psychomotor index it was 82.7.

Conclusions

There were no statistical differences in relation to neurodevelopment and pregnancy methods. The only differences were found in the Bayley assessment for those born by ovulation inducers. The results of neurodevelopment in general were favourable. Cerebral palsy only occurred in 1.2%, with behavioural problems predominating in 6.8%.

In recent years, the incidence of congenital hypothyroidism has almost doubled; this is attributed to the increased number of premature births and multiple pregnancies, changes in the design of current neonatal screening programmes, and to the improvement in available laboratory techniques, which have allowed the detection of subtle forms of the disease.

Screening strategies vary according to the objectives of each programme and in recent decades, there has been controversy about: a) the ideal method of detection: TSH (thyrotropin), thyroxine (T4) or simultaneous T4 and TSH, b) the usefulness of the decrease in TSH cut-off in whole blood recently implemented and c) the need for re-screening among premature newborns with low birth weight, Down syndrome, and other high-risk populations.

Although the benefit of early treatment of severe cases of congenital hypothyroidism to prevent mental retardation is clear, most of the new cases detected with the new strategies are mild, such as transient and persistent neonatal hyperthyrotropinaemia, for which the usefulness of treatment in neurocognitive development has not been proven in randomized clinical trials. The objective of this article is to make a screening proposal in the Mexican population based on the current available evidence and to establish future research areas that help to resolve these controversies.

Introduction

The control of post-operative pain in the patient is essential to reduce the clinical and metabolic response that is generated secondary to stress.

Objective

To determine if the administration of analgesia at the end of surgery increases the time of presentation of the pain using the CRIES scale in post-operated bilateral inguinal hernia newborns.

Methods

A randomised double-blind clinical trial was conducted from November 2002 to August 2003, on premature newborn with corrected gestational age of ≥ 37 weeks. In all cases Regional anaesthesia with caudal block was used in all cases. At the end of the surgery, the patients were randomly assigned for analgesia at the end of the surgery. The drug used was nalbuphine at a dose of 100 μg/Kg.

Results

The gestational age at the time of surgery was 37.3 weeks. A value equal to or greater than 4 on the CRIES scale in the first assessment was observed in the study group at 219 minutes, while that in the control group was 147 minutes (P < .01). In the second assessment, a CRIES value of 4 or greater was observed in the study group at 531 minutes, while in the control group it was at 205 minutes (P < .001).

Conclusions

The period of well-being observed in the group of patients who were administered analgesia immediately at the end of the surgery was 531 minutes for an analgesic drug demand, being more than double the time in the control group.

Objective

To identify the attitudes of medical obstetrician-gynecologists (Ob-Gyn) and its association with the cesarean section rate.

Material and methods

We performed a cross-sectional multicenter survey research, 197 Ob-Gyn were surveyed from eight hospitals, between November 2010 and May 2011. Data analysis included descriptive statistics on the general characteristics of Ob-Gyn, We used the χ² test for bivariate analyses of categorical variables and logistic regression models to associate Ob-Gyn attitudes and percentage of births by cesarean section.

Results

The percentage of cesarean sections births expressed by Ob-Gyn surveyed was 59.2%. Ob-Gyn expressed a preference to delivery by cesarean section in 33.5%, 60.9% of the Ob-Gyn considered themselves skillful when attending cesarean deliveries compared against vaginal delivery. Thirty five percent of Ob-Gyn has scheduled a cesarean section for convenience, while 83.8% of Ob-Gyn said that women prefer cesarean births. In the regression model five variables are significantly associated with the Ob-Gyn that perform 30% or more of their cesarean deliveries, among these include: perception that vaginal are safer procedures than cesarean deliveries and that women have right to choose the type of delivery, whether vaginal or cesarean, with an OR = 4.7 and 7.5 respectively.

Conclusions

We have shown that attitudes of Ob-Gyn who are associated with cesarean section rate. These attitudes could be related with the increase of the cesarean births.

Objective

To analyze the Female Sexual Dysfunction Index and its relationship with biopsychosocial factors in Teno's female population from June 2014 to January 2015.

Methodology

Transversal, analytical and quantitative, non- experimental study of female users who attended gynaecological or family planning clinics in CESFAM Morza, Teno. Simple random sampling. In this study, The Graffar Scales, Rosenberg, Smilkstein, partner violence questionnaire and Rosen et al., were used to assess socioeconomic status, self-esteem, family functionality, type of conjugal violence and sexual function. The data was analyzed through Infostat software, 2015 version. A variance analysis (ANOVA) and a nonparametric variance analysis were performed using the Kruskal-Wallis test, considering a significance level of α=.05.

Results

305 women were studied. A (25.6+7.12) FSDI score was obtained. A 41.6% rate of sexual dysfunction and a 37% rate of desire disorder were observed in the women. Twelve point one percent of the women showed excitation difficulties, 9.5% lubrication problems, 63.3% orgasm disorder, 13.4% problems regarding sexual satisfaction, and 11.4% dyspareunia. The FSDI varied when it was related to self-esteem, couple violence, socioeconomic status and family structure.

Conclusions

There is a correlation between the FSDI and the biopsychosocial variables studied. Low self-esteem, overweight and obesity, family dysfunction and couple violence (physical, psychological and sexual) determine sexual dysfunction.

Hypertensive disorders of pregnancy are a major contributor to death and disability for pregnant women and their infants. The diagnosis of preeclampsia using blood pressure and proteinuria is of limited use because they are tertiary, downstream features of the disease. The angiogenic factors are secondary markers of associated placental dysfunction in preeclampsia, with known low or high plasma concentrations in the disease. The aim of our article was to describe a practical panel of biomarkers useful in the early diagnosis of preeclampsia. Our conclusion is that the placental growth facto and the soluble form of tyrosine kinase 1 could be considered the 2 biomarkers with the best predictive performance, since there are more studies that evaluate their usefulness.

Objective

This study is aimed at determining the serum and follicular fluid level of anti-Mullerian hormone, its quality, and relationship between anti-Mullerian hormone level with assisted reproductive technology (ART) success rates.

Method

In 50 infertile patients who underwent the ART cycle, follicular fluid and serum levels of anti-Mullerian hormone were measured on oocyte retrieval day. Patients were then divided into two groups of fertile and non-fertile.

Results

Pregnancy test result was positive in 13 and negative in 37 patients. Serum and follicular fluid level of anti-Mullerian hormone was higher among the first group than the second group (P < 0.05). Mean follicular fluid level of anti-Mullerian hormone was 5.12 and 4.23 among the first and second groups, respectively. Mean serum anti-Mullerian hormone level was 1.76 in the first group and 1.49 in the second group.

Conclusions

Higher level of anti-Mullerian hormone in serum and follicular fluid has a significantly positive correlation with the success rate in ART cycles and oocyte quality; therefore, anti-Mullerian hormone can be a positive predictor of ART success cycles.

Introduction

After congenital hydrocephalus, spinal dysraphisms represent the second cause of neurosurgical consultation within the National Institute of Perinatology ‘Isidro Espinosa de los Reyes’ in Mexico City (INPer). The objective of the present study is to establish the demographic and epidemiological characteristics of live newborns with neural tube defects, during the past year.

Material and methods

We carried out a descriptive, observational, retrospective study, including all live births within the Institute and diagnosis at discharge of cranial and/or spinal neural tube defects. The analysis is presented with descriptive statistics, using frequency tables, medians and ranges.

Results

Fifteen live births with neural tube closure defects were recorded, of which 3 had more than one defect other than the Chiari malformation, and 80% presented hydrocephalus. All the mothers reported adequate intake of folate. There was no history of relatives with dysraphisms or maternal consumption of anti epileptic drugs. One patient with a closed defect developed fistula and infectious ventriculitis as a surgical complication.

Conclusion

The number of cases attended in the INPer, due to neural tube defects, tripled compared to the previous year. The post natal care provided showed fewer complications than those reported in the literature, specifically infectious complications, due to timely multidisciplinary care and possibly due to the surgical closure of all open neural tube defects within the first 24 h.