Association of leptin receptor expression in placenta and peripheral blood mononuclear cell with maternal weight in birth outcomes.

INTRODUCTION: The pregnancy period represents the most intense period of growth and development. Pre-pregnancy weight influences weight gain during pregnancy. Leptin is a hormone mainly derived from white adipose tissue, during pregnancy leptin is also produced by the placenta. It has been suggested that the effects of placental leptin on the mother may contribute to endocrine-mediated alterations in energy balance; a dysregulation in leptin levels or its receptors may lead to poor birth outcomes. Therefore, the main goal of the present study was to analyze the differences in birth outcomes by maternal weight with the expression level of leptin receptor in maternal peripheral blood mononuclear cell (PBMC) and placental tissue. METHODS: Women with full-term gestation and its offspring were enrolled. Total RNA from maternal PBMC and placenta was obtained to perform the analysis of expression of the leptin receptor (LEPR) gene trough real-time PCR technique. Data were analyzed using one-way ANOVA or Mann-Whitney u test when applicable. Pearson correlation coefficient was used to determine the relationship between continuous variables (Stata v.13); p ≤ 0.05 was considered statistically significant. RESULTS: No statistically significant differences were found between LEPR expression level and the BMI studied groups in maternal PBMC and placental tissue. Interaction between gestational weight gain (GWG) and LEPR in maternal PBMC explain in a 32% the variability of the newborn weight. CONCLUSIONS: LEPR expression level in maternal PBMC correlates with newborn measurements independent from sex. GWG can affect fetal development by increasing fetal birth weight.

[Operative morbidity of the hidrodisección with epinefrina during the surgery for prolapse of pelvic organs]. / Morbilidad operatoria de la hidrodisección con epinefrina en la cirugía del prolapso de órganos pélvicos.

Objetive: To assess the effect of the hydrodissection on operative morbidity and operative time in patients undergoing vaginal surgery for pelvic organ prolapse. Material and methods: Experimental, prospective, longitudinal, comparative, randomized study: randomized controlled clinical. Randomly, 44 patients were assigned to receive management hydrodissection with epinephrine (Group 1= 22) or not hydrodissection (Group 2= 22) prior to the start of the surgical procedure. The variables analyzed were operative morbidity (defined as infection, hematoma and surgical postoperative bleeding requiring transfusion) and surgical time required to complete the procedure. Results: The average age was 58.1 years (± 9.3) in the group of hydrodissection and 63.0 years (± 10.6) in the group without hydrodissection (p = .111). The frequency of postoperative complications was similar enters both groups (p> .05) presenting only one case of postoperative hematoma in Group 1 and none in Group 2. The operative bleeding was significantly lower in the hydrodissection group (240.9 ± 111.9 mL) compared with the group of non hydrodissection (324.1 ± 104.9 mL). No significant difference in operative time was found (p = 0.67) compared with 135.5 (± 22.6) minutes in Group 1 and 139.3 (± 32.5) minutes. Conclusion: Hydrodissection with epinephrine compared with non Hydrodissection significantly reduces operative bleeding but no differences in operative morbidity and operative time in patients undergoing vaginal surgery in the management of pelvic organ prolapse.

[Prophylactic appendectomy with invagination during cesarean section]. / Apendicectomía profiláctica con técnica invaginante durante la operación cesárea.

OBJECTIVE: To evaluate the impact of the prophylactic appendectomy acComplished during cesarean section about postoperative morbidity. METHODS AND MATERIALS: Fifty-nine patients with pregnancy at term and had a cesarean section were randomized in two groups: Group I: Twenty-nine patients subjected to cesarean section as well as prophylactic appendectomy with invaginant technic and Group II: Thirty patients subjected just to cesarean section. The analyzed variables were: surgical time, hospitable stay and postoperative morbidity. RESULTS: Surgical time were similar between two groups (means: 56.75 min vs. 53.96 min to group I and II). The means of the hospitable stay was 29.98 hours (SD +/- I 1.81) and 27.72 hours (SD +/- 6.91) to Group I and II respectively, without significant differences statisTIcally between the groups. There were no postoperative morbidity in any group. CONCLUSIONS: Cesarean section plus prophylactic appendectomy with invaginant technic is an easy and safe procedure to be performed. It does not produce postoperative morbidity, besides it does not increase surgical time and hospitable stay.

[Evolution and quality of care during labor and delivery in primiparous patients who underwent early obstetrical analgesia]. / Evolución y calidad de la atención del trabajo de parto en pacientes primigestas sometidas a analgesia obstétrica temprana.

Evaluations of labor and delivery progress and care quality in primiparous patients that receive obstetric analgesia by peridural way at the beginning of the active phase, was done. One-hundred-twenty-nine patients at the beginning of the active phase of the labor were randomized into two groups: Group I: Sixty-six patients that received obstetric analgesia by peridural way and Group II: Sixty-three patients did not receive analgesia by any way. Length of the cervical dilation and effacement, and expulsive period, cervical dilation rate per hour, delivery type, labor experience and perinatal outcomes were measured. The length means of the cervical dilation and effacement was 177.7 (SD +/- 89.0) and 296.0 (SD +/- 114.5) minutes to Group I and II respectively (p < 0.005). Cervical dilation rate was 2.74 and 1.6 centimeters per hour to Group I and II respectively (p < 0.05). The length of the expulsive period was 36.54 minutes (SD +/- 21.7) to Group I and 42.57 minutes (SD +/- 16.15) to Group II (p > 0.05). Labor experience was referred like very painful in the 9% and 100% to Group I and II respectively (p < 0.05). The perinatal outcomes and method of delivery were similar between two groups. Obstetric analgesia administered by peridural way at the beginning of the active phase of the labor significantly reduce the dilation and effacement period and whole labor, without modify the expulsive period length. It does not inhibit the uterine activity and improvement the care quality of the labor.

[Perinatal conditions of newborns of adolescent mothers in the state of Sinaloa, Mexico]. / Condiciones perinatales en recién nacidos de madres adolescentes del estado de Sinaloa, México.

UNLABELLED: The objective was to compare perinatal conditions of newborns and obstetric complications between a group of adolescent mothers and one of adult mothers. It is a retrolective comparative survey, at the General Hospital "Bernardo J. Gastelum" SSA and General Hospital IMSS, Sinaloa, Mexico. PATIENTS: 10634 clinical records of patients in labour at obstetric unit from 1990 to 1994. A randomized sample of 215 adolescent pregnant patients and 215 adult pregnant patients were selected and the following data were analysed regarding to the mother: age, pregnancy outcome and obstetric complications; in regard to the newborn: gender, weight, height, cefalic circumference and Apgar score. The mean adolescent mother's age was 16 years, and 25 in adult mothers; mean adolescent mother newborn birthweight was 3.297 SD 0.414 kg. and in adult mothers was 3.393 SD 0.591 kg. (p = 0.09), adolescent mothers newborns with Apgar score less than 7 at first minute was 20% and 5% for adult mothers newborns. Statistically significant difference was observed (p = 0.02). There were not statistically significant differences between the groups in obstetric outcome and complications, birthweight. It was concluded that pregnancy in adolescence it's not a risk factor for the mother and the newborn.

[Cervical labor induction with prostaglandin E2 in patients with fetal death]. / Maduración cervical con prostaglandina E2 en pacientes con feto muerto.

The objective was to compare the effectiveness and efficacy of prostaglandin E2 (prepidil gel) plus oxitocin with that of intravenous oxitocin in the treatment of delivery induction in patients complicated with fetal death. Fifteen patients received prepidil gel plus oxitocin and 15 patients oxitocin. In the treatment group only one dosage of 0.5 ng in 2 ml of prepidil gel was administered intracervically and simultaneously oxitocin by intravenous infusion, dosage was increased 2 mUI/min every 30 minutes. In the control group only intravenous oxitocin was administered at the same dosage. The mean duration in hours of delivery in the treatment group was 13.1 +/- h and in the control group was 30.9 +/- 9.1 h. There were statistically significant differences between the groups in reduction of delivery duration (p = 0.0007). It is concluded that prostaglandin E2 plus oxitocin provide better short-term outcomes than oxitocine treatment and gave more short periods of labor in patients with fetal death.

[Evaluation of ultrasound as a diagnostic test in nuchal encirclement by the umbilical cord during labor]. / Validación del ultrasonido como prueba diagnóstica para circular de cordón durante el trabajo de parto.

A comparison was made of ultrasonographic diagnosis of fetal nuchal encirclement by the umbilical cord versus the gold standard in pregnant, women at labor. 114 pregnant women at labor were studied. On admission to the labor and delivery room, each patient underwent an abdominal ultrasonographic evaluation for the identification of nuchal encirclement by the umbilical cord and the diagnosis by ultrasound was compared versus direct visualization of the umbilical cord at the moment of delivery or cesarean section (gold standard). Of the 114 patients studied, the prevalence of nuchal cord diagnosed by ultrasound was 20.1%. The diagnostic test had a sensitivity of 80% (CI 95%: 72.66-87.34), specificity of 96% (CI 95%:92.91-99.09), and positive and negative predictive values of 87% and 94% respectively. The accuracy of the test was 92%. Analysis of the discordances by the McNemar's test was not significative between obstetric ultrasound and the gold standard (p = 0.7236). The likelihood ratios were 20 and 0.20 for a positive and a negative results respectively. The ultrasonographic study during labor for diagnosis of nuchal encirclement by the umbilical cord had a high specificity (96%), and this advantage permit it to be utilized like screening test for the identification of high risk pregnancies with nuchal cord.