[Vaginal birth after cesarean. A safe option?]. / Parto después de cesárea una opción segura?

OBJECTIVE: To compare the beginning and evolution of labor variables such as demographic characteristics, obstetric and perinatal outcomes of patients with vaginal birth after cesarean (VBAC). MATERIAL AND METHODS: Observational, retrospective and retro elective trial purposes of comparative analysis, were divided into groups by the onset of labor; spontaneously versus induction and by the labor evolution; spontaneously versus conduction. Being analyzing by Student's T and Fisher test. RESULTS: According the ACOG criteria. 136 patients with prior cesarean section were eligible to labor. The indications of previous cesarean have a trend of a non-recurring etiology, being the elective cesarean section the most common. Regarding the onset, 78% was spontaneous and 22% had an induction. Comparing the demographic characteristics it stands a greater number of deliveries, history of vaginal delivery, a higher Bishop score, fetal weight estimated lower and higher intergenesic period. As a perinatal prognosis, the study has shown be safe with a positive outcome. Conclusions:Vaginal birth after cesarean is safe, that should be offered to all women with a low transverse incision, with an intergenesic period greater than 18 months, whit a singleton pregnancy, in a cephalic presentation, with an appropriate fetal weight, and without obstetric contraindications of vaginal delivery.

[Congenital cystic adenomatoid malformation of the lung, intrauterine diagnostic and treatment. A case report and literature review]. / Enfermedad adenomatoidea quística pulmonar, diagnóstico y manejo intrauterino. Reporte de un caso y revisión bibliográfica.

The use of prenatal ultrasonography has improve the detection of fetal abnormalities, which affects the perception about the natural history and evolution of them, changing the management of the fetus and neonate. Today, it is possible to perform an early prenatal diagnosis, and be treated even intrauterine with high rates of success. Such is the case of Congenital Cystic Adenomatoid Malformation (CCAM), characterized by abnormal proliferation and dilatation of the terminal structures of the airway, generating multiple cysts of diferent sizes and locations. The CCAM can be asymptomatic until adulthood, but sometimes it is presented as an adverse perinatal outcome, manifested with ascites, hydrothorax, hydrops and hypoplasia of the affected lung. We report a case of a pregnant women, 32-year-old, diagnosed on the 18 week pregnancy by ultrasound Type 3 Congenital Cystic Adenomatoid Malformation disease. Treated with an intrauterine intervention percutaneous fetal sclerotherapy successfully.

[Atypical preeclampsia and perinatal success: a case report]. / Preeclampsia atípica y éxito perinatal: reporte de caso.

Preeclampsia is a multi systemic syndrome of variable severity, pregnancy specific, consequence of an abnormal vascular response to placentation, with increase in peripheral vascular resistance, stimulation of platelet aggregation, activation of the coagulation cascade, and endothelial dysfunction. In the majority of cases, it will present with gestational hypertension and proteinuria, after 20 weeks, nevertheless, in other cases, it has presented as an atypical form (with absence of hypertension and/or proteinuria) behaving like severe preeclampsia. We report the case of a patient, 32 year old primigravida, with a 26.6 weeks gestation, that comes to the office with postprandial projectile vomiting. At the time of admission, she presents with sudden headache, phosphenes, and tinnitus, associated to epigastric pain, with a blood pressure of 110/70 mmHg; fetal heart rate of 146 bpm, normal lower limbs and reflexes. The Complete Blood Count and liver function tests are within normal values, urinalysis with proteinuria. Normal hepatic ultrasound. Obstetric ultrasound; with fetal measurements of 2.6 weeks below, with flattening of the growth curve, Doppler flowmetry with an increase in placental resistance and oligohydramnios. Given the clinical manifestations compatible with severe preeclampsia, magnesium sulfate, and antenatal corticosteroid therapy are initiated, and abdominal termination of pregnancy is decided. A female newborn is obtained, of 595 g, Apgar 4/7. On immediate puerperium, she presents with an increase in blood pressure of 150/90 mmHg, discharged with normal blood pressure 96 hours later. The newborn girl was discharged when she reached a weight of 2000 g. Today, she is neurologically unimpaired.

[Ductus arteriosus aneurysm. Case report and review of the literature]. / Aneurisma de conducto arterioso: reporte de un caso y revisión de la bibliografía.

The saccular or fusiform dilatation of the ductus arteriosus is called aneurysm (DAA). It is diagnosed in the second trimester during a structural ultrasound. Even though the reported incidence is 2.2%, it remains infrequent, because it is not searched routinely. The pathogenesis is uncertain, resulting from an increase on the circulating blood volume thus in the cardiac afterload, associated to a thinning of the vessel wall, for an inadequate intima development. Ductus arteriosus aneurysm can be classified according by their diameter as small (<7 mm.) and large (> or =8 mm). The smaller commonly closes spontaneously in 70% of the cases, unlike the larger one, they are associate in a greater number of complications, such as thrombosis, embolism, infection, compression effects of adjacent structures and spontaneous rupture. The absence of spontaneous closure, according to the symptoms and possible complications, a neonatal surgical closure should be considered. We report a case of a 35-year-old patient, diagnose on the 35 week pregnancy, a ductus arteriosus aneurysm by ultrasound with an image of the three vessels performed communicating, saccular dilatation of 7-8 mm. and a turbulent Doppler flow.

[Placental acretism, a repercussion of modern obstetrics]. / Acretismo placentario, una de las repercusiones de la obstetricia moderna.

The evolution of obstetrics has led us to beneficial discoveries, and to new pathologies. The increase of cesarean section is due to elective cesarean section and cesarean section on maternal request, which have increased in popularity over the last past few years. Without condemning them, we have to take into account the benefits, as well as the complications that may arise from them, leading us to pathologies that were not frequent before, such as placental acretism, which today, is the second cause of obstetric hemorrhage worldwide. For us to be able to counteract the potential complications, it is important to have a multidisciplinary team that allows us to decrease maternal and neonatal death, starting with primary prevention, capable of identifying risk factors, so as to be able to make an early diagnosis. Today, imaging studies have described suggestive markers of acretism at early gestational age, such as 8.4 to 14.2 weeks, allowing us a wide range of time for decision making. In the majority of cases, it is required to perform an obstetrical hysterectomy as a definitive treatment, which is a real challenge for medical skills. Nevertheless, conservative treatment with limited evidence, with uterotonics, and uterine artery embolization, has proved useful. When set on a scale, the risks and benefits of an elective, or maternal request cesarean section, we can understand why we have concluded that, in absence of maternal or fetal indications, natural delivery is the best way to resolve pregnancy.

[Occupational disability during pregnancy and lactation]. / Incapacidad laboral durante el embarazo y la lactancia.

Historically, women have been known for their role as housewives and were held responsible for children's education. This has changed throughout the years, and they have modified their role in our society. Nowadays, in developed countries, 50% of the working population is represented by women of reproductive age. An important number of these women end up pregnant, and most of them are willing to keep theirjobs after delivery. This is the main reason why pregnancy should not compromise their employment or economic stability. Several international treaties have been signed to defend women, improve their health and reduce child mortality. Even when most countries have developed measures to protect and defend maternity, there is still, a strong difference comparing legislations in this matter, between developed and non-developed countries like Mexico. This is why it is essential to get to know and analyze the main legal dispositions and regulations about maternity issues and protection. We must be aware of the differences in legislation between Mexico and other countries that might influence our own country secondary to sociocultural, commercial and financial exchange. There have been clear and evident improvements related to women's health and maternity matters in the past 15 years. These include longer periods of rest after delivery and making the employer responsible for financing maternity leave.

Sorter de citometría de flujo: repercusiones en los indicadores clave de rendimiento de un laboratorio de reproducción asistida / Flow cytometry sorter: results in the key performance indicators of an assisted reproductive technology

Resumen OBJETIVO: Evaluar si la manipulación de gametos con sorter de citometría de flujo repercute negativamente en los indicadores clave de rendimiento de un laboratorio de reproducción asistida. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo, llevado a cabo en parejas a quienes se efectuó fecundación in vitro mediante inyección intracitoplasmática de espermatozoides (ICSI), con selección espermática, mediante un sorter de citometría de flujo, para selección de sexo. El estudio se efectuó en el New Hope Fertility Center de Guadalajara y Ciudad de México, de junio de 2014 a agosto de 2017. Los resultados se compararon con un grupo control seleccionado al azar. Se evaluaron los indicadores decisivos de rendimiento (KPI´s); tasa de fecundación normal, anormal (1PN, ≥ 3 PN) y fallida; tasa de degeneración posterior a ICSI; tasas de segmentación o división, blastocisto, implantación (segmentación y blastocisto) y recién nacido. Se utilizó la prueba t de Student para dos muestras y se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se evaluaron 150 ciclos. Grupo 1: ICSI con selección espermática y sorter de citometría de flujo (n = 40); Grupo 2: ICSI sin sorter de citometría de flujo (n = 110). Los indicadores clave de rendimiento del grupo 1 disminuyeron; se reportaron tasas de fecundación fallida de 1.6%, blastocisto 17.4%, implantación en la segmentación 10%, implantación en blastocisto 14.2% y de recién nacido 14.5%. CONCLUSIONES: La manipulación de gametos con sorter de citometría de flujo reportó un efecto negativo en los indicadores clave de rendimiento del laboratorio de reproducción asistida, específicamente en las tasas de blastocisto, implantación de blastocisto y de recién nacido.

Abstract OBJECTIVE: To evaluate if the manipulation of gametes with a flow cytometry sorter has a negative effect on the key performance indicators (KPI´s). MATERIALS AND METHOD: Descriptive and retrospective analysis, in couples undergoing In a Vitro Fertilization (IVF) by ICSI, with sperm selection, using a flow cytometry sorter for sex selection. The study was conducted at the New Hope Fertility Center in Guadalajara and Mexico City, from June 2014 to August 2017. The results were compared with a randomly group without a flow cytometry sorter. KPI´s were evaluated; normal fertilization rate, abnormal (1PN, ≥3 PN), failed fertilization, ICSI damage rate, cleavage rate, blastocyst development rate, implantation rate (cleavage and blastocyst-stage) and live birth rate. A Student's t-test was made for two samples considering significant differences with p < 0.05. RESULTS: 150 cycles were evaluated. Group 1: ICSI with sperm selection by a flow cytometry sorter (n = 40); Group 2: ICSI without sperm selection (n = 110). Observing with statistical significance a decreased of the KPI´s of Group 1: failed fertilization rate (1.6%), blastocyst development rate (17.4%), implantation rate (cleavage-stage) (10%), implantation rate (blastocyst-stage) (14.2%) and live birth rate (14.5%). CONCLUSIONS: The manipulation of gametes with the flow cytometry sorter, has a negative effect on the assisted reproductive technology KPI´s; specifically, in the blastocyst rate, blastocyst implantation rate and live birth rate.

Relación entre hallazgos radiológicos e inmunofenotipos tumorales de pacientes con cáncer de mama / Relationship between radiological findings and immunophenotyped in breast cancer

Resumen OBJETIVO: Evaluar la relación entre los hallazgos radiológicos e inmunofenotipos tumorales de pacientes con cáncer de mama. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y transversal, efectuado en el Hospital ABC de la Ciudad de México, entre 2013 y 2017. Se incluyeron pacientes con diagnóstico de cáncer de mama establecido por biopsia percutánea o escisional, que contaran con estudios de inmunohistoquímica e imagen (mastografía, ultrasonido o ambos). Para evaluar la relación entre las características morfológicas de las lesiones observadas en los estudios radiológicos y el inmunofenotipo se utilizó la prueba de χ2. RESULTADOS: Se registraron 182 pacientes. En cuanto a las características de las lesiones se encontró relación significativa entre las masas de morfología irregular con bordes espiculados y las calcificaciones agrupadas con tumores luminales, y entre las calcificaciones de morfología amorfa con los tumores luminales A y las pleomórficas finas con los tumores luminales B. CONCLUSIÓN: Existe relación entre los hallazgos morfológicos por imagen y el inmunofenotipo de los tumores mamarios. Es importante que el médico radiólogo especialista en imagen mamaria conozca esta relación, con la finalidad de proporcionar información de la inmunohistoquímica al momento del estudio diagnóstico de imagen.

Abstratc OBJECTIVE: Establish if there is a relationship between the radiological findings and the immunophenotype of breast cancer. MATERIALS AND METHODS: An observational, cross-sectional, retrospective study realized at the ABC Medical Center, over a period of 4 years, that included patients diagnosed with breast cancer performed by percutaneous or excisional biopsy, with an immunohistochemical study and images (mammography and/or ultrasound). The relationship between the morphological characteristics of the lesions observed in the radiological studies and the immunophenotyped was studied by means of the χ2 test. RESULTS: We included 182 patients, among the characteristics of the lesions we found a significant relationship between the masses of irregular morphology with spiculate edges and the calcifications grouped with luminal tumors; calcifications of amorphous morphology with luminal A and pleomorphic fine tumors with luminal B. CONCLUSION: The results suggest that there is a relationship between the morphological findings by imaging and the immunophenotype of mammary tumors.

Valor de la cuenta folicular antral como predictor de éxito en ciclos de fertilización in vitro / Value of the antral follicular count as a predictor of success in in vitro fertilization cycles

Resumen ANTECEDENTES: La asociación entre pruebas de reserva ovárica y respuesta a la estimulación está debidamente establecida aunque su capacidad para predecir embarazo clínico y recién nacido vivo es limitada. OBJETIVO: Evaluar la utilidad clínica de la cuenta folicular antral para predecir embarazo clínico y recién nacido vivo. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en el Instituto Nacional de Perinatología, entre 2011 y 2016 en ciclos de fertilización in vitro en fresco. Se incluyeron pacientes con diagnóstico de infertilidad a quienes se efectuó, in vitro, transferencia de embriones en fresco. Variables de estudio: edad, cuenta folicular antral, concentración basal de FSH y cantidad de ovocitos capturados. Se elaboró un modelo de regresión logística. Para el análisis estadístico se utilizó el programa Statistic Package for Social Sciences (SPSS). Se consideró significativa la probabilidad de error alfa menor de 5%. RESULTADOS: Se analizaron 923 ciclos de fertilización in vitro. La cuenta folicular antral tiene predicción para detectar embarazo clínico con un área bajo la curva ROC de 0.59 y para recién nacido vivo de 0.57. El número óptimo con mayor porcentaje de embarazo clínico (9%) y recién nacido vivo (10.4%) tuvo cuenta folicular antral ≥ 8. CONCLUSIONES: Cuando la cuenta folicular antral es más o menos mayor de 8 folículos se espera mayor cantidad de embarazos clínicos y de recién nacidos.

Abstract BACKGROUND: The association between ovarian reserve test and ovarian response is well established, however, its ability to predict clinical pregnancy and the live birth is limited. OBJETIVE: Evaluate the clinical usefulness of the antral follicle count (AFC) to predict clinical pregnancy and live newborn. MATERIALS AND METHODS: Retrospective cohort study was made. In fresh IVF cycles, performed at INPer between 2011-2016. Including patients diagnosed with infertility, who underwent in vitro fertilization with fresh embryo transfer. The study variables were age, antral follicle count, basal FSH concentration and number of oocytes captured. A binary logistic regression model was performed. Statistical Package for Social Sciences (SPSS) was used for the statistical analysis. The probability of error alpha <5% was considered significant. RESULTS: A total of 923 in vitro fertilization cycles were included. The antral follicle count has a prediction for clinical pregnancy (ABC 0.59) and live birth (ABC 0.57). The optimal cut-off value with the highest percentage of clinical pregnancy (9%) and live birth (10.4%) was presented with a CFA ≥ 8. A higher pregnancy rate is reported when there is a follicular count above ≥8 follicles. CONCLUSIONS: It is expected the highest number of clinical pregnancy and live birth when the antral follicle count is for ≥8 follicles.