Perinatologia y Reproduccion Humana最新文献

Polycystic ovary syndrome it is an endocrine-metabolic dysfunction and it is explained as a female functional hyperandrogenism. Associated to this, several systemic alterations are triggered, with one of these very important dysfunctions being the accumulation of visceral fat tissue. It has been demonstrated that the androgens and the increase of the free fatty acids, as observed in central type obesity, inhibit the hepatic action of insulin that results in compensatory hyperinsulinism secondary to insulin resistance. For this reason, patients with polycystic ovary syndrome present with diverse clinical, hormonal and metabolic characteristics, depending on their body fat and its distribution pattern. The classification into sub-groups can help to identify the systemic dysfunctions that each patient may have. One of these parameters is the phenotype associated with the body composition, which can be measured using the electrical impedance of the body fluids that helps to determine the distribution of the different components of the human body. For this reason, the study of the body composition should be now considered as part of the follow-up of patients with polycystic ovary syndrome, in order to determine the response to the treatments used in the correction of this systemic dysfunction.

Background

There are discrepancies around maternal pre-conception overweight and obesity and structural congenital heart disease (CHD). The worldwide prevalence of overweight and obesity has increased in women of reproductive age and this could have an impact on the health care of newborn babies.

Objectives

To estimate the risk for CHD associated with pre-conception maternal overweight and obesity in the study area.

Material and methods

A quantitative, analytical, and observational retrospective case-control and anonymised study was conducted on newborns babies with a CHD entered in the National Registry of Congenital Malformations (RENAC). They were compared against others without any malformations, in a proportion of 1:1 between 2011 and 2014.

Results

A total of 22 mother-infants pairs were included in the RENAC. According to the pre-conception BMI, the prevalence of overweight was 4/22, obesity 6/22, and normal weight 12/22. The distribution of other factors present between cases and controls was similar, with no significant differences. The distribution of CHD was similar in those with normal weight (12/22) and overweight and obesity (10/22), with no statistically significant differences. Compared with normal-weight women, the relative risk of CHD associated with maternal overweight and obesity was 1 (95% CI; 0.55-1.81) with an odds ratio of 1 (95% CI; 0.30-3.27). Septal defects were the most frequent CHD (Q21).

Conclusions

No significant relationship was found between pre-conception maternal overweight-obesity and CHD in our newborns.

Objective

To determine plasma adiponectin concentrations in obese and non-obese women with polycystic ovary syndrome (PCOS).

Materials and methods

A Case control study was conducted on women with a diagnosis of PCOS and age-matched healthy controls, with regular menstruation and normal ultrasound ovaries, were selected. Participants were divided into four groups (Group A: PCOS and obese; Group B: PCOS and non-obese; Group C: obese controls, and Group D: non-obese controls) according to body mass index (obese > 30 kg/m² and non-obese < 25 kg/m²). Concentrations of sexual hormones, sex hormone-binding globulin, serum glucose, insulin, and adiponectin, were measured.

Results

Obese and non-obese women with PCOS had higher luteinising hormone, follicle stimulating hormone, androstenedione, testosterone, and insulin levels compared to women in the obese and non-obese control group, respectively (P < .0001). Women with PCOS had a significantly lower concentration of adiponectin (Group A: 8.3 ± 1.6 ng/mL and Group B: 10.1 ± 1.4 ng/mL), compared with controls (Group C: 12.1 ± 2.8 ng/mL and Group D: 14.7 ± 2.6 ng/dL; P < .0001). It was observed that adiponectin concentrations had a positive and significant association with fasting blood glucose and insulin in PCOS women (P < .05).

Conclusion

There are significant differences in plasma adiponectin concentrations between obese and non-obese women with polycystic ovary syndrome and normal controls.

Background

Placenta accreta is a pathology that is associated with an elevated risk of haemorrhage, thus endangering the life of the obstetric patients. It is a public health problem, due to maternal morbidity and mortality.

There are multiple lines of management; however caesarean hysterectomy is the method of choice to resolve a pregnancy with placental accreta.

It is a procedure of high risk, even as a programmed surgery. The surgical and medical teams are challenged by the risk of massive haemorrhage and need to have rapid access to blood products to maintain haemostasis and haemodynamic balance.

Objective

To quantify blood loss, as well as the amount of blood derivatives used in patients in whom a caesarean hysterectomy was required due to placenta accreta.

Material and methods

A cross-sectional study was conducted that included patients that required a caesarean hysterectomy due to placenta accreta within a period of 4 years.

Results

A total of 106 cases of placenta accreta were studied, with 64.15% of the patients having a history of abortion and curettage, and 76.41% had at least 1 caesarean section. The mean blood loss was 2523.87 millilitres, with over 23.5% having a massive haemorrhage (> 3000 cc). Red blood cells transfusions were necessary in 68.98% of the cases. Fresh frozen plasma was given to 29.24% of the patients, and platelet concentrates were used in 6.6% of the cases.

Conclusions

Timely detection of placenta accreta in patients, an adequate surgical technique and experience, as well as the use of blood derivatives, are the cornerstones in the management of this disease.

The reduction in maternal mortality has been seen as a global priority over the past twenty years or so. Many countries, including Mexico, have been committed to developing strategies to meet the aims of the fourth Millennium Development Goal of the Nations United. The maternal mortality due to obstetric causes has shown a downward trend in Mexico in the last twenty years. However, an upward trend is observed when analysing maternal mortality due to indirect causes.

With the objective of contributing to the reduction of maternal mortality due to indirect causes, the Instituto Nacional de Perinatología has proposed the project of ‘High-Risk Reproductive Modules’. This consists in the application of a set of pre-conception care interventions, to be applied in Medical Units where women with serious illnesses receive medical attention, and who, on being adequately controlled and within reproductive age, become pregnant, with the pregnancy being a factor of poor prognosis for the patient.

The project is a strategy in the medical care of women within reproductive age with chronic or systemic diseases, which includes two fundamental objectives: 1) improvement of health care services, 2) improvement of the health of the population. The implementation of this project has the objective of contributing to the reduction of maternal mortality due to an indirect cause, and by using this strategy to reduce the existing gaps in health conditions among the population of our country.

The need to address and monitor patients minimally invasively, but more accurately, and thereby reducing the number of complications, has led to developing the concept of perfusion index over the years. The perfusion index reflects the peripheral vasomotor tone, due to the relationship of pulsatile and non-pulsatile waves through a pulse oximeter. The newborn, especially pre-term, have a number of features that make them more vulnerable to certain clinical situations, as such that the physiological response differs from that of other population groups. Hence, the main interest in this new tool, which would help in the understanding of the complex neonatal cardiovascular physiology and thus better interpret their response in order to make timely interventions. The following article presents the history and physiological basis that helped develop the perfusion index, as well as describing the most recent studies in the neonatal population.

Introduction

Retinophaty of prematurity (ROP) is a disease in which abnormal neovascularization develops in the retina and could be a cause of blindness.

Objective

To determine severe ROP prevalence.

Material and methods

In this retrospective, observational, descriptive, transverse study, we did a review of the clinical records of premature patients with < 34 weeks of gestation and a birth weight < 1,750 g, and neonates with a gestational age >34 weeks and birth weight > 1,750 g if they have risk factors for ROP. From 2005 to 2014, all the newborns were examined by a retinologist. ROP prevalence per year was determined, only the prevalence for severe ROP was compared because it requires treatment and has a high risk for blidness.

Results

One hundred forty-three newborns were included, 29 (20.2%) had severe ROP. When comparing for years there was a peak during 2005, with a descend in the prevalence of severe ROP in 2014, so in ten years there was a downward trend.

Conclusions

Severe ROP cumulated prevalence was 20.2%, similar to that observed in other latinoamerican countries. The high prevalence observed from 2005 to 2009, is explained because we examined patients refered from other institutions without screening programs for ROP. In 2010 we observed a descend in the prevalence, because only patient from our institution were included. From 2011 to 2014 we report none blind children with ROP.

Introduction

Preeclampsia is considered a maternal multisystemic disease mediated by injury to the endothelium, which could be modified by characteristics such as: age, obesity, and cardiovascular disease, among other factors.

Case report

The case is presented of a 33 year-old pregnant woman, who during her stay at Hospital General Regional, Lic. Emilio Sánchez Piedras, developed eclampsia and HELLP syndrome during hospital admission. She also progressed to kidney injury (AKIN 3), which required treatment with slow continuous renal replacement therapy (CRRT). She also acquired a hepatic subcapsular haematoma, diagnosed by abdominal tomography.

Conclusions

The use of CRRT is a novel treatment in pregnant or post-partum patients, who develop AKI, co-existing with fluid overload in the presence of anuria and haemodynamic instability problems, which increase maternal morbidity and mortality.

Objective

To determine the perinatal outcomes among Mexican women with singleton pregnancy and systemic lupus erythematosus.

Material and methods

Historical cohort study on women diagnosed with systemic lupus erythematosus, singleton pregnancy, prenatal care, and resolution between 2010 and 2015. The incidence of the following perinatal outcomes was calculated: pre-term birth, stillbirth, oligohydramnios, miscarriage, premature rupture of membranes, gestational hypertension, preeclampsia, intrauterine growth restriction, and congenital defects.

Results

A total of 122 women were included. The characteristics of the study population at admission and resolution were: maternal age 26.2 ± 6 years, maternal weight 63.4 ± 11.1 kg, body mass index 26 ± 3.9 kg/ m², number of gestations 1.9 ± 1.2, gestational weeks at admission 16.6 ± 6.5, gestational weeks at resolution 36.1 ± 3.4, neonatal weight 2,417-770 g. The incidence of adverse perinatal outcomes was: pre-term birth 41.8%, death 1.6%, oligohydramnios 6.6%, miscarriage 5.7%, premature rupture of membranes 9.8%, gestational hypertension 5.7%, preeclampsia 24.6%, early onset preeclampsia 15.6%, anaemia 23%, intrauterine growth restriction 14.7%, congenital defects 2.4%, and caesarean 78.2%.

Conclusions

Mexican women with systemic lupus erythematosus have high incidence of pre-term birth, preeclampsia, anaemia, early onset preeclampsia, intrauterine growth restriction, oligohydramnios and caesarean. Furthermore, the incidence of live births is among the highest reported in the literature.