El embarazo y los efectos que produce en la salud de las mujeres VIH positivas / Pregnancy and the effects it produces on the health of HIV positive women

INTRODUCCIÓN: Existen 35 millones de casos de infección por el virus de la inmunodeficiencia humana (VIH) en el mundo, y de ellos, 15 millones corresponden a mujeres en edad fértil. El embarazo en las mujeres seropositivas genera efectos relevantes que afectan la condición psicosocial y física. Los cambios que genera el embarazo en una mujer VIH positiva se relacionan con resultados perinatales adversos, como hemorragia posparto, sepsis puerperal, parto prematuro y mortalidad. OBJETIVO: Conocer los efectos físicos y psicosociales que tiene el embarazo en la evolución de la mujer portadora del VIH. MÉTODO: Revisión narrativa. Se realiza un análisis de contenido de fuentes primarias obtenidas mediante búsqueda en las bases de datos CINAHL, PubMed y SciELO. La búsqueda abarcó un periodo de 10 años, en idioma español e inglés. Para la presente investigación se incluyen 22 artículos, de los que se consideraron las secciones de resultados y conclusiones. RESULTADOS: Se seleccionaron inicialmente 318 artículos y 22 fueron elegibles para su inclusión. En esta revisión se plantean tres dimensiones de análisis psicosocial, fisiopatología y características clínicas, y tratamiento farmacológico. La literatura evidencia un efecto psicológico negativo en la población de estudio, y en cuanto al tratamiento se manifiesta un escaso porcentaje de eventos adversos frente a la terapia antirretroviral, por lo que los beneficios superan los riesgos. CONCLUSIONES: Las tres dimensiones planteadas se relacionan entre sí, definiendo los efectos del embarazo en mujeres VIH positivas y lo que conlleva esta condición en la salud de la madre. Se identificaron diversos problemas que afectan la salud de las mujeres seropositiva que se embarazan. Sin embargo, estas mujeres pueden embarazarse siguiendo un tratamiento óptimo, con atenciones de salud en periodos regulares, evitando así la mayoría de los efectos que pueden afectar su salud.

INTRODUCTION: There are 35 million cases of human immunodeficiency virus (HIV) worldwide, 15 million correspond to women of childbearing age. This pregnancy condition in seropositive women generates relevant effects that affect the psychosocial and physical condition. The changes generated by pregnancy in an HIV positive woman are related to adverse perinatal results such as postpartum hemorrhage, puerperal sepsis, premature delivery and mortality. OBJECTIVE: To know the physical and psychosocial effects that pregnancy has on the evolution of women with HIV. METHOD: Narrative review. Content analysis of primary sources obtained through searches in the CINAHL, PubMed and SciELO databases is performed. The search was carried out within a 10-year range, in Spanish and English. For the present investigation 22 articles are included. The sections for the analysis were results and conclusions. RESULTS: 318 articles were initially selected, 22 articles were eligible for inclusion. In this review, three dimensions of psychosocial analysis, pathophysiology and clinical characteristics, and pharmacological treatment are proposed. The literature shows the negative psychological effect in the study population, in terms of treatment there is a low percentage of adverse events compared to ART, so the benefits outweigh the risks. CONCLUSIONS: The three dimensions raised are related to each other, defining the effects of pregnancy in HIV positive women and what the condition entails on the mothers health. Various problems were identified that affect the health of an HIV-positive woman who becomes pregnant. However, these HIV positive women can become pregnant, following optimal treatment, with regular health care, thus avoiding most of the effects that can affect her health.

Prevención de la transmisión maternoinfantil del virus de la hepatitis B. directrices sobre la profilaxis con antivirales en el embarazo / Prevention of mother-to-child transmission of hepatitis B virus. guidelines on antiviral prophylaxis in pregnancy

Según estimaciones de la Organización Mundial de la Salud (OMS), en el 2015 257 millones de personas en el mundo tenían la infección crónica por el virus de la hepatitis B (VHB) y 900 000 fallecieron a causa de ella, en la mayor parte de los casos de cirrosis o carcinoma hepatocelular. La mayoría de las defunciones asociadas con el VHB en personas adultas obedecen a infecciones contraídas al nacer o en los cinco primeros años de vida. En mayo del 2016, la Asamblea Mundial de la Salud aprobó la Estrategia mundial del sector de la salud contra las hepatitis víricas 2016-2021, en la que se hace un llamado a eliminar las hepatitis virales como amenaza de salud pública ­definida como una reducción de 90% de la incidencia de infecciones y una reducción de 65% de la mortalidad­ para el 2030. La eliminación de la infección por el VHB como amenaza de salud pública conlleva la necesidad de reducir la prevalencia del antígeno de superficie del virus de la hepatitis B (HBsAg) a menos de 0,1% en los niños de 5 años de edad. Esta meta se puede lograr mediante la vacunación de todos los recién nacidos contra la hepatitis B y otras intervenciones orientadas a prevenir la transmisión maternoinfantil del VHB

Manejo anestésico de la paciente de urgencia embarazada / Pregnant patient in emergency

Laparoscopic apendicectomy posterior fossa surgery in the sitting position in a pregnant patient with cerebellopontine angle meningioma. A review is made of those anatomical and physiological changes that occur during pregnancy, that may affect anesthesia administration. Emphasis is made in upper airway, respiratory function, cardiovascular and gastrointestinal systems. Pharmacokinetic and pharmacodynamic changes that are relevant to the administration of general and regional anesthesia are described. The most suitable time for surgery is discussed and is concluded that elective surgery must not be performed during pregnancy and it should be postponed until after delivery. In some cases, immediately after, such as tubal sterilization, and others, after normalization of physiological parameters. A remark is made regarding teratogenicity: Although there is a well-known effect of anesthetic drugs on cell formation, mitosis and DNA synthesis (which participate in cell differentiation and organogenesis), any significant change in function or morphology of a child, secondary to a prenatal treatments (such as, anesthetic management) may eventually affect the outcome. Finally, recommendations are made regarding the anesthetic techniques of choice. There is not a single optimal technique for all cases but becomes clear that maintaining maternal oxygenation and uteroplacental flow are the key. Whichever technique is chosen, it is paramount to avoid hypoxemia and acidosis, maintaining normocarbia and normothermia, treating hypotension aggressively; however, in general when a regional technique is feasible, its use is preferable.

La apendicectomía laparoscópica es la cirugía más frecuente durante el embarazo. El Colegio Americano de Obstetras y Ginecólogos (ACOG), sugiere que es importante contactar a un obstetra antes de realizar la cirugía. Se hace una revisión de los cambios anatómicos y fisiológicos que ocurren durante el embarazo más relacionados con la administración de anestesia, especialmente en la vía aérea superior, en la función respiratoria, en el sistema cardiovascular y a nivel gastrointestinal. Se describen los cambios farmacológicos, farmacocinéticos y farmacodinámicos implicados con la administración de anestesia general y regional. Se discute el momento más adecuado para la realización de una cirugía: una cirugía electiva no debe realizarse durante el embarazo, sino que debe postergarse hasta después del parto; algunas inmediatamente después, como la esterilización tubaria y otras, después que los parámetros fisiológicos hayan vuelto a la normalidad. Se hace una referencia a la teratogenocidad, que no solo es el efecto de las drogas usadas en anestesia que pudieran afectar la formación celular, mitosis y síntesis de ADN, que participan en la diferenciación celular y la organogénesis, sino a cualquier cambio significativo en la función o morfología de un niño, secundario a algún tratamiento prenatal (en este caso, el manejo anestésico). Finalmente, se recomienda una técnica anestésica: no existe una única técnica óptima en la medida de que se mantenga la oxigenación materna y el flujo uteroplacentario. Cualquiera sea la técnica elegida, lo importante es evitar la hipoxemia y la acidosis, mantener la normocarbia y la normotermia, y tratar de manera agresiva la hipotensión arterial; sin embargo, en términos generales, cuando es posible, se prefiere una técnica regional.

Perfil de pacientes em idade reprodutiva tratadas por epilepsia / Profile of patients in reproductive age treated by epilepsy

Objetivo: Descrever o perfil de pacientes em idade reprodutiva internadas por epilepsia nas regiões brasileiras em 5 anos, elucidando os riscos promovidos por ela durante a gravidez e abordando o gerenciamento do quadro. Métodos: Pesquisa e análise de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), acerca das internações em mulheres em idade reprodutiva (10 a 49 anos) por epilepsia, avaliando a ocorrência, de acordo com faixa etária, etnia e região do Brasil, no período de janeiro de 2012 a dezembro de 2016. Resultados: No total, foram notificadas 42.204 internações de mulheres em idade reprodutiva associadas à epilepsia, estando a maior parte delas (22,66%) na faixa de 20 a 29 anos e na de 40 a 49 anos (22,59%). O Sudeste correspondeu a 43,01% do total de casos (18.152), seguido pela Região Sul, com 9.456 registros (22,4%), e pelo Nordeste (8.245; 19,53%). A etnia mais atingida foi a de brancas (15.804; 37,44% dos atendimentos) e pardas (12.200; 28,9%). Conclusão: O planejamento da gravidez em mulheres epilépticas contribui para redução dos riscos tanto maternos quanto fetais, pois permite ao prescritor e à gestante pesar quais os benefícios e os malefícios de cada terapia anticonvulsivante disponível. Vale lembrar que uma abordagem individualizada da paciente epiléptica grávida por equipe multidisciplinar se faz necessária para melhorar os desfechos e prevenir internações por crises convulsivas. (AU)

Objective: To describe the profile of female patients in childbearing age hospitalized due to epilepsy in the Brazilian regions in 5 years, elucidating the risks it causes during pregnancy, and addressing the management of the condition. Methods: Research and analysis of data provided by the Informatics Department of the Unified Health System (DATASUS), concerning hospitalizations of women of childbearing age (10-49 years) due to epilepsy, evaluating the occurrence according to age, ethnicity and the region in Brazil, from January 2012 to December 2016. Results: A total of 42,204 admissions of women of childbearing age due to epilepsy were reported, with most of them in the age group from 20 to 29 years old (22,66%), and in the 40-49 age group (22.59%). The Southeast Region accounted for 43.01% of the total number of cases (18,152), followed by the South Region, with 9,456 records (22.4%), and the Northeast (8,245 - 19.53%). The most affected ethnic group was the white one (15,804; 37,44% of the admissions) and brown one (12,200; 28,9%). Conclusion: Pregnancy planning in epileptic women contributes to both maternal and fetal risk reduction, since it allows the prescriber and the pregnant woman to weigh the benefits and harms of each available anticonvulsant therapy. It is worth remembering that an individualized, multidisciplinary approach of the epileptic pregnant patient is necessary to improve the outcomes, and to prevent hospitalizations due to seizures. (AU)

Ácido fólico y embarazo, ¿beneficio o riesgo? / Folic acid and pregnancy, benefit or risk?

RESUMEN El consumo de ácido fólico se ha relacionado con la disminución en la incidencia de malformaciones congénitas y deficiencias obstétricas, pero existen criterios de que no siempre su uso tiene los efectos favorables esperados para la madre y su descendencia. Con el objetivo de estructurar los presupuestos teóricos que sustentan el beneficio y el riesgo del consumo de ácido fólico para el embarazo, se realizó una búsqueda sobre el tema consultándose 37 referencias bibliográficas actualizadas. El ácido fólico ostenta dos grandes funciones en el organismo: la síntesis y reparación de los ácidos nucleicos, así como la síntesis del aminoácido metionina a partir de la homocisteina, esta última, al acumularse en el organismo se asocia a defectos congénitos y enfermedades crónicas del adulto. A partir de estos aspectos se corrobora que su consumo antes y durante el embarazo es beneficioso pues previene defectos del tubo neural, algunas cardiopatías congénitas, hendiduras bucofaciales, síndrome de Down, desórdenes del espectro autista, infecciones obstétricas, preeclampsia, hemorragia uterina, desprendimiento abrupto de la placenta, retardo del crecimiento intrauterino y prematuridad. El consumo excesivo de más de 5 mg/día se ha asociado a anemia por deficiencia de vitamina B12, déficit de zinc, crecimiento intrauterino retardado y prematuridad; en modelos animales acelera la transformación maligna de tumores existentes. Se concluye que el ácido fólico contribuye a preservar una embriogénesis y placentación normal y no se han demostrado efectos adversos por su uso, pero debe ser consumido en la dosis adecuada y por prescripción médica.

ABSTRACT Acid folic intake has been related to the decrease in the incidence of congenital malformations and obstetric deficiencies but there are criteria about folic acid not always achieving the expected favorable results for mothers and their descendants. A search on the theme was carried out with the objective of structuring the theoretical assumptions upholding the benefit and risk of folic acid intake for pregnancy. 37 updated bibliographic references were consulted. The folic acid has two main functions in the organism: nucleic acids´ synthesis and repair, and also the synthesis of the methionine amino acid from homocystein; when the last one accumulates in the organism, it is associated to congenital defects and adults´ chronic diseases. Beginning from these aspects, it is stated that the intake before and after pregnancy is beneficial because it prevents defects of the neural tube, some congenital deficiencies, oral facial clefts, Down syndrome, autism spectrum disorders, obstetric infections, preeclampsia, uterine hemorrhage, sudden placental abruption, intrauterine grow retardation and prematurity. The excessive intake of more than 5 mg/d has been associate to anemia due vitamin B12 deficiency, zinc deficiency, intrauterine retarded grow and prematurity; in animal models it speeds up the malignant transformation of existent tumors. The authors arrived to the conclusion that folic acid contributes to preserving a normal embryogenesis and placentation, and that no adverse effects have been demonstrated, nevertheless it should be taken in adequate doses and for medical prescription.

Avaliação toxicológica da exposição à Cannabis e cocaína na gravidez em cordão umbilical humano: validação de método analítico e prospecção de biomarcadores proteicos de toxicidade / Toxicological assessment of Cannabis and cocaine exposure during pregnancy in human umbilical cord tissue: analytical method validation and prospection of protein biomarkers related to fetotoxicity

O abuso de drogas atinge aproximadamente 35 milhões de pessoas em todo planeta, sendo um problema alarmante em decorrência de graves danos à saúde, como a dependência química e intoxicações fatais. No Brasil, o número de usuários tem crescido principalmente para o consumo de produtos da Cannabis e cocaína, drogas amplamente consumidas, inclusive entre mulheres em período gestacional, trazendo à tona um novo grupo de risco. A exposição gestacional a drogas de abuso está diretamente relacionada a malformações fetais e complicações de saúde para mãe e bebê nos períodos pré- e pós-natal. Tradicionalmente, a avaliação toxicológica da exposição é realizada pela detecção da droga parental e de seus produtos de biotransformação em matrizes materno-fetais por meio de métodos bioanalíticos. Entretanto, estes ensaios não fornecem informações acerca dos impactos fisiológicos ocasionados pela exposição, deixando uma lacuna no que tange às informações sobre os mecanismos e moléculas subjacentes envolvidos em processos de toxicidade. Desse modo, o desenvolvimento de análises toxicológicas mais robustas utilizando tecnologia de ponta, que possam comprovar o uso drogas e também elucidar aspectos de toxicidade é de suma importância, pois auxiliam na compreensão do impacto biológico relativo à exposição humana a xenobióticos. Neste trabalho foram desenvolvidos ensaios bioanalíticos, utilizando o tecido do cordão umbilical para a avaliação da exposição in utero à canabinoides. Foi desenvolvido e validado método QuECheRS adaptado como preparo de amostra, no qual etapas simultâneas de extração e hidrólise alcalina de canabinoides são alcançadas, utilizando cromatografia em fase gasosa acoplada a espectrômetro de massas para detecção de delta-9-tetraidrocanabinol (THC), canabinol (CBN), 11-hidroxi-delta-9-tetraidrocanabinol (11-OHTHC) e 11-nor-9-carboxi-tetrahidrocanabinol (THC-COOH). Também foram desenvolvidas metodologias utilizando LC-MS/MS e Trapped Ion Mobility Mass Spectrometry para análise de proteoma de cordão umbilical humano em diferentes regiões, no intuito de identificar biomarcadores proteicos relativos à fetotoxicidade do uso de drogas na gravidez. Até o presente momento, QuECheRS é utilizado pela primeira vez como abordagem bioanalítica para avaliação de drogas ilícitas em matrizes teciduais materno-fetais e mostrou-se satisfatório para detecção de produtos da Cannabis. Nos ensaios proteômicos, foram identificados potenciais biomarcadores de fetotoxicidade, como as moléculas ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A, em tecidos expostos à Cannabis e/ou cocaína. Tais macromoléculas estão correlacionadas a malformações embriogênicas e complicações de saúde na vida intra-uterina. As metodologias desenvolvidas neste trabalho podem ser úteis para uma melhor avaliação da toxicidade do uso de drogas na gravidez, fornecendo novas pistas sobre a exposição e/ou efeitos tóxicos significativos considerados na avaliação de risco

Drug abuse affects approximately 35 million people worldwide and can be considered a significant burden on society due to severe health problems, e.g. drug addiction and fatal poisonings. In Brazil, the number of users has been growing related to Cannabis and cocaine products, drugs widely used, including among women in gestational period, bringing up a new risk group. Gestational exposure to drugs of abuse is directly related to fetal malformations and health complications for mother and babies in the pre- and postnatal periods. Traditionally, toxicological assessment of exposure is performed by detecting the parent drug and its biotransformation products in maternal-fetal matrices using bioanalytical methods. However, these assays do not provide information about the physiological impacts caused by exposure, leaving a lack of information about the pathways and molecules involved in toxicity processes. Thus, the development of robust toxicological analyzes using cutting-edge technologies in order to prove drug use and also elucidate aspects of toxicity is very important, as they help in understanding the biological impact of human exposure to xenobiotics. Herein, bioanalytical methods using umbilical cord tissue to assess in utero exposure to cannabinoids were developed. A QuECheRS method was developed fully validated as a sample preparation technique for simultaneous extraction and alkaline hydrolysis of cannabinoids, using gas chromatography coupled to mass spectrometry to detect the analytes delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), 11-hydroxydelta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH). LC-MS/MS based proteomics and Trapped Ion Mobility Mass Spectrometry were also developed in order to identify protein biomarkers related to fetotoxicity of drug use in pregnancy. Our works represents the first use of QuECheRS for evaluation of illicit drugs in maternal-fetal tissue and was suitable for detection of Cannabis products. In the proteomic assays, potential biomarkers of fetotoxicity were identified in the exposed tissues, such as ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A. These proteins are related to embryogenic malformations and health complications in intrauterine life. The methodologies developed in this project may be useful for a better assessment of the toxicity of drug use in pregnancy, providing new clues about exposure and/or significant toxic effects that should be considered in the risk assessment

Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications / Interações medicamentosas em terapia intensiva materna: prevalência, fatores e medicamentos de risco

ABSTRACT Objective: To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications. Methods: An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05). Results: A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam. Conclusion: The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.

RESUMO Objetivo: Caracterizar as interações medicamentosas potenciais graves em terapia intensiva materna, e determinar sua frequência, os fatores e os medicamentos de risco associados à ocorrência dessas interações. Métodos: Estudo observacional e longitudinal executado entre dezembro de 2014 a dezembro de 2015, conduzido em uma unidade de terapia intensiva materna. Foram coletados dados clínicos e identificadas interações medicamentosas potenciais graves de gestantes admitidas. As interações medicamentosas foram caracterizadas quanto ao tipo, à prevalência e à taxa de exposição. Um modelo multivariado de regressão logística foi utilizado para identificação de fatores associados à ocorrência de interações medicamentosas potenciais graves e os medicamentos implicados (p<0,05). Resultados: Um total de 95,1% das pacientes foi exposto a, no mínimo, uma interação medicamentosa potencial, com 91,7% delas envolvidas com interações medicamentosas potenciais moderadas e 33,9% com as interações graves. As pacientes ficaram expostas, em média, em 69,2% dos dias que estiveram sob terapia intensiva. Os principais medicamentos implicados em interações medicamentosas de maior gravidade foram sulfato de magnésio, metoclopramida, propranolol e diazepam. Conclusão: As interações medicamentosas potenciais graves ocorreram na maioria das pacientes avaliadas. Aproximadamente um terço das interações foram graves e levaram à maior exposição por um longo período de internação. Maior número de fármacos prescritos e uso prévio domiciliar de medicamentos elevam a ocorrência de interações medicamentosas potenciais graves.

Combined low dose aspirin and 17 alpha hydroxyl progesterone versus 17 alpha hydroxyl progesterone alone study in pregnancy: a randomized clinical trial for prevention of spontaneous preterm birth

Background: Preterm birth: defined as any live birth occurring through the end of the last day of the 37th week [259th day] following the onset of the last menstrual period. Low-dose aspirin [LDA] has been noted to reduce the preterm birth [PTB] rate in multiple meta-analyses of the preeclampsia [PreE] prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB versus reductions in preterm premature rupture of membranes [PPROM] or spontaneous PTB. In the Maternal-Fetal Medicine Unit [MFMU] high-risk aspirin [HRA] study, a near significant decrease in PTB was found despite no effect on preeclampsia. The objective of this study was to assess the impact of LDA on indicated PTB, spontaneous PTB, and PPROM PTB in the MFMU HRA study population

Aim of the work: This study aim to assess the efficacy of 17 alpha hydroxyl progesterone and low dose aspirin in reducing the rate of preterm birth in pregnant women at this risk

Patients and Methods: Study type: A double blinded randomized placebo controlled clinical trial

Study settings: This study conducted at outpatient clinic of Ain Shams University Maternity Hospital

Time of the study: The study was held from August 2016 to November 2017

Results: Data was analyzed according to the intention-to-treat principle. In a total 400 women whom recruited in the study, 160 were excluded. So we ended in to 240 women whom randomized and allocated in to 2 groups to intervention. Primary outcome measure was preterm birth. The most important secondary outcome is a composite of poor neonatal outcome [including bronchopulmonary dysplasia [BPD], periventricular leucomalacia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity [ROP], sepsis and perinatal death].There was no statistically significant difference between both groups as regarding to age, gravidity, parity, body mass index, mean cervical length, and number of previous preterm labor. There was no significant difference between two groups as regard preterm premature rupture of membranes [P.PROM].There was no significant difference between two groups as regard time of delivery there was no significant difference between both groups in Need for NICU admission, neonatal birth weight, APGAR score, fetal complications [RDS, jaundice, BPD, HIE, NEC, bleeding, sepsis or even neonatal death].Long term neurodevelopmental complications was not conducted at this study as it needs more time.In maternal complications there was no significant difference between both groups

Conclusion: Further randomized controlled trials with larger sample size should be done to demonstrate the efficacy of low dose Aspirin in prevention of preterm labor and its complications

Consumo de tabaco, alcohol y marihuana según autodeclaración en mujeres que tuvieron su parto en el Centro Hospitalario Pereira Rosell (mayo 2013-abril 2014) / Smoking, alcohol and marijuana consumption in a self-report by women who delivered their babies at the Pereira Rossell Hospital Center (May 2013- April 2014)

Introducción: la prevalencia del consumo de drogas entre las mujeres que quedan embarazadas es probable que sea similar al de la población general, lo que puede resultar en una alta exposición fetal durante el primer trimestre, etapa más vulnerable con respecto al neurodesarrollo y organogénesis(¹).Objetivo: conocer la prevalencia de consumo de tabaco, alcohol, marihuana y derivados de cocaína durante el embarazo, según el autorreporte en mujeres que tuvieron su parto en el Centro Hospitalario Pereira Rossell.Material y método: se realizó un estudio descriptivo de tipo transversal, analítico, durante el período de un año. Los datos fueron recabados a partir de una encuesta protocolizada realizada a mujeres durante el puerperio inmediato y se recolectaron datos de la historia clínica.Resultados: se entrevistaron 319 mujeres. La mayoría eran mayores de 18 años (83,65%) con una media de 24,67 años; el embarazo no había sido planificado en 182 casos (57%). Declararon haber fumado tabaco alguna vez durante el embarazo 136 mujeres (42,63%), la mayor parte de las que abandonaron el hábito lo hicieron en el primer trimestre. Declararon consumo de alcohol en el embarazo 76 mujeres (23,82%), 5 (1,5%) reportaron consumo de marihuana durante el embarazo. Declararon consumir cocaína y pasta base de cocaína 3 (0,94%) y 3 (0,94%), respectivamente.Conclusiones: la sustancia que se consume con mayor frecuencia en el embarazo es el tabaco seguido en frecuencia por el alcohol. Un elevado porcentaje de embarazos no planificados puede determinar una mayor exposición a hábitos previos durante el primer trimestre de gestación, período de máxima vulnerabilidad para el desarrollo fetal.

Abstract Introduction: prevalence of drug use in women who get pregnant is likely to be similar to that of the general population, what may result in a high exposure of fetus during the first trimester, the most vulnerable stage with regards to neurodevelopment and organogenesis. Objective: to learn about the prevalence of smoking, alcohol, marijuana and cocaine derivatives during pregnancy, according to a self report by women who delivered their babies at the Pereira Rossell Hospital Center. Methods: we conducted a descriptive study,The data transversal and analytical during one year. The data were collected by means of a protocolized survey to women during the immediate puerperium and data was taken from the medical record. Results: 319 women were surveyed. Most women were older than 18 years old (83.65%) with an average of 24.67 years old; pregnancy had not been planned in 182 cases (57%). 136 women declared to have smoked during pregnancy (42.63%), most of those who quit the habit did it in the first trimester. 76 women declared to have drunk alcohol during pregnancy (23.825), 5 (1.5%) reported marijuana consumption during pregnancy. Three women declared they had consumed cocaine and 3 to have consumed coca paste (0.94 and 0.94 respectively). Conclusions: the substance that is more widely used during pregnancy is tobacco, followed by alcohol. A high percentage of unwanted pregnancies may determine a higher exposure to previous habit during the first trimester of pregnancy, when fetus are most vulnerable.

Resumo Introdução: a prevalência do consumo de drogas entre as mulheres que ficam grávidas provavelmente é similar ao da população em geral, o que pode causar uma alta exposição fetal durante o primer trimestre, etapa em que o feto é mais vulnerável com relação ao neurodesenvolvimento e a organogênese(¹). Objetivo: conhecer a prevalência do consumo de tabaco, álcool, maconha e derivados da cocaína durante a gravidez, de acordo com a auto declaração de mulheres cujos partos foram realizados no Centro Hospitalario Pereira Rossell. Material e método: foi realizado um estudo descritivo de tipo transversal, analítico, durante o período de um ano. Os dados foram coletados em entrevistas protocolizadas realizadas a mulheres durante o puerpério imediato e também foram coletados dados do prontuário das pacientes. Resultados: foram entrevistadas 319 mulheres. A maioria tinha mais de 18 anos (83,65%) com una media de 24,67 anos; a gravidez não havia sido planejada em 182 casos (57%). Declararam haver fumado tabaco alguma vez durante a gestação 136 mulheres (42,63%) sendo que a maior parte das que abandonaram o hábito o fez durante o primeiro trimestre. 76 mulheres (23,82%) declararam consumo de álcool durante a gravidez e 5 (1,5%) de maconha. 3 (0,94%) informaram consumir cocaína e 3 (0,94%) seus derivados (crack). Conclusões: a substância consumida com maior frequência durante a gravidez é o tabaco seguido pelo álcool. Uma porcentagem alta de gestações não planejadas pode determinar uma maior exposição a hábitos prévios durante o primeiro trimestre de gestação, período de máxima vulnerabilidade para o desenvolvimento fetal.

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

Tabaco y salud infantil: un aspecto no suficientemente valorado / Cigarette smoking and child health: an issue that has not yet been assessed enough

La campaña que se desarrolla en Uruguay contra el consumo de tabaco enfatiza sobre los efectos nocivos que produce el cigarrillo en la salud de la población adulta que fuma y en fumadores pasivos. La disminución de afecciones cardiovasculares como el infarto de miocardio y del cáncer de pulmón ha mostrado resultados alentadores en relación a la disminución del número de consumidores, si bien aún no se ha logrado el descenso esperado. La campaña enfoca varios aspectos dirigidos a la presentación de los envoltorios, el precio, pero la que ha mostrado mejores resultados ha sido el consejo personal brindado en los consultorios a fumadores, en especial a embarazadas. Desde hace casi una década han surgido publicaciones que demuestran aspectos de la morbilidad infantil asociada al uso de tabaco por mujeres gestantes. En la etapa prenatal se han evidenciado alteraciones del desarrollo del aparato respiratorio, bajo peso al nacer, parto prematuro así como propensión al aborto. Otras investigaciones han observado que un hogar con fumadores, especialmente durante los primeros meses de la vida del niño constituye un ambiente hostil, negativo para lograr condiciones de sueño seguro, práctica que se describe asociada a la disminución del riesgo a sufrir el síndrome de la muerte súbita del lactante. Es evidente que el consumo de tabaco constituye también un problema real para la salud de la población infantil especialmente aquellos más vulnerables. Los pediatras y médicos que atienden niños podrán promover consejos sobre crianza saludable aconsejando a la madre sobre condiciones para sueño seguro y que evite los fumadores intradomiciliarios.

In Uruguay the tobacco control campaign emphasized the adverse effects of smoking for the adult population as well as secondhand smoking. A reduction in cardiovascular diseases and lung cancer has been achieved, although not as much as expected. The campaign addressed the appearance of cigarette boxes and the price of the product. But what proved the most useful resource was the advice given to pregnant women. In the last decade many articles on the consequences of smoking during pregnancy have been published. Fetal loss, low birth weight and preterm delivery have been widely accepted as consequences of maternal smoking. After birth, smoking near the infant is a risk factor for sudden infant death syndrome. Pediatricians, neonatologists and general practitioners that care for infants and children, should advice mothers and family on smoking and health.

Abnormalities of digestive tract innervation in rat fetus treated with ethylenethiourea / Anomalias da inervação do trato digestório de fetos de ratas expostas à etilenotioureia

PURPOSE: The pathophysiology of abnormalities associated with myenteric plexus lesions remains imperfectly understood. Such abnormalities have been correlated with subocclusive intestinal conditions in children with Hirschsprung's disease, cases of chronic constipation and, postoperatively, in cases of anorectal anomalies. This study evaluated abnormalities of the myenteric plexus in fetus from female rats that received ethylenethiourea. METHODS: Female rats were exposed to ethylenethiourea on the 11th day of pregnancy (experimental group) or to 0.9 percent physiological solution (control group). Abnormalities were only found in the experimental group. The digestive tract muscle layer was analyzed morphometrically and changes to the frequencies of nerve plexus cells and interstitial cells of Cajal were evaluated, using hematoxylin-eosin, S-100 protein, neuron-specific enolase and C-Kit, respectively. RESULTS: Muscle and skeletal abnormalities were observed in 100 percent, anorectal anomalies in 86 percent, absent tail in 71 percent, short tail in 29 percent, duodenal atresia in 5 percent, esophageal atresia in 5 percent and persistent omphalomesenteric duct in 5 percent. Histopathological analysis showed a thinner muscle layer associated with lower frequencies of ganglion cells and interstitial cells of Cajal, in all gastrointestinal tract. CONCLUSION: Severe nerve plexus abnormalities associated with muscle layer atrophy were observed throughout the gastrointestinal tract in newborn rats exposed to ethylenethiourea.

OBJETIVO: As anomalias associadas a lesões dos plexos mioentéricos permanecem sem plena compreensão da sua fisiopatologia. Alterações nos plexos nervosos têm sido correlacionadas com quadros suboclusivos intestinais em crianças portadoras de doença de Hirschsprung, em constipação crônica e no pós-operatório de anomalias anorretais. Este estudo avaliou as anomalias do plexo mioentérico em fetos de ratos fêmea que ingeriram etilenotioureia (ETU). MÉTODOS: Ratos fêmea foram expostos no 11º dia de gestação a ETU 1 por cento no Grupo Experimento e a solução fisiológica 0,9 por cento no Grupo Controle. Foram observadas anomalias apenas no Grupo experimento, sendo realizada morfometria da camada muscular e avaliadas alterações da frequência celular nos gânglios do plexo mioentérico e nas células intersticiais de Cajal (CIC) utilizando hematoxilina-eosina, P S-100, Enolase Neurônio Específica e C-KIT. RESULTADOS: Foram observadas anomalias musculoesqueléticas (100 por cento), anorretais (86 por cento), ausência de cauda (71 por cento), cauda curta (29 por cento), atresia duodenal (5 por cento), atresia esofágica (5 por cento) e conduto onfalomesentérico persistente (5 por cento). A análise histopatológica mostrou adelgaçamento da camada muscular associada às alterações da frequência das células ganglionares e das CIC em todos os segmentos do trato gastrointestinal. CONCLUSÃO: Foram observadas alterações graves nos plexos nervosos associadas ao adelgaçamento da camada muscular de todo o trato gastrointestinal nos fetos expostos a ETU.

Estudio retrospectivo sobre las posibles complicaciones maternofetales de la exposición a cabergolina / Retrospective Study of any potencial Adverse Effects of Cabergoline on Pregnancy and Embryofetal Development

Objetivos: Estimar la frecuencia de complicaciones maternofetales en mujeres que se embarazaron durante el tratamiento con cabergolina (CAB). Estimar la frecuencia de patología detectada posnacimiento en los niños producto de dichos embarazos. Material y métodos: Estudio retrospectivo y multicéntrico de 86 embarazos en 78 mujeres con hiperprolactinemia idiopática (7) o tumoral (44 micro y 27 macro), en tratamiento con CAB en el momento de la concepción. Edad: 20 a 45 años; PRL inicial: 30 a 1429 ng/ml; duración del tratamiento previo al embarazo 1 a 120 meses; dosis: 0.125 a 4 mg/semana. El rango de exposición embriofetal a la CAB fue de 3 a 27 semanas, el 96.39% de las pacientes la recibió durante el primer trimestre y el 3.61% hasta el segundo. Resultados: No hubo complicaciones mayores durante el embarazo. Se registraron 7 abortos espontáneos (8.1%) y 75 partos, de los cuales 49 fueron vaginales y 26 cesáreas. Se registraron 69 recién nacidos, 63 fueron a término y 6 pretérmino (8.8%), ninguno bajo peso para la edad gestacional. En 3 (5.2%) recién nacidos se observó: 1 malformación mayor (Síndrome de Down) y 2 menores (hernia umbilical e inguinal). Se obtuvo seguimiento de 42 recién nacidos; se diagnosticó epilepsia refractaria en uno y un trastorno generalizado del desarrollo en otro. No se halló una mayor frecuencia de complicaciones en los embarazos ni en los recién nacidos expuestos a CAB que en la población normal. Sería necesario mayor número de pacientes para concluir sobre la seguridad de CAB durante el embarazo.

Objectives: To assess the rate of any potential adverse effects on pregnancy and embryo-fetal development in women who became pregnant under treatment with cabergoline (CAB). To follow up medical data of children who were born from mothers exposed to Cab in early weeks of gestation. Material and methods: Observational, retrospective and multicenter study on 86 pregnancies in 78 women with idiopathic or tumoral hyperprolactinemia. All patients were under Cab at conception. The average age was 29 (range: 20-45). Pituitary images at diagnosis showed 44 microadenomas, 27 macroadenomas and 7 were normal. Serum PRL at baseline was between 30 and 1429 ng/ml. Duration of therapy before pregnancy ranged from 1 to 120 months. Maternal and fetal exposure to cabergoline and doses ranged from 0.125 to 4 mg/week. The mean serum PRL level under which patients achieved pregnancy was 17 ng/ml. Fetal exposure ranged from 3 to 27 weeks; 96.39% of patients received CAB during the first trimester of pregnancy and 3.61% until the second one. Results: No significant complications during pregnancy were found. Seven women (8.1%) had spontaneous abortions. Term deliveries were recorded in 63/69, preterm in six (8.8%), none of them with low weight for gestational age. Neonatal abnormalities were observed in 3 (5.2%): 1 major (Down syndrome) and 2 minor malformations (umbilical and inguinal hernia). Two out of 42, developed abnormalities during the follow- up, one of them was a refractory epilepsy during the second month of life, the other presented a Pervasive Developmental Disorder diagnosed in the third year of life. Conclusion: No significantly higher frequency of complications was found in pregnancies and/or offspring exposed to CAB than in normal population. Larger series of patients are needed to asses the safety.

effect of maternal selenium supplementation on pregnancy outcome and the level of oxidative stress in neonates

Pregnancy is regarded as a condition which is usually accompanied by oxidative stress. This study was undertaken to investigate the effect of maternal selenium supplementation during gestation on the level of oxidative stress in neonates and the pregnancy outcome. In this double-blind trial, 179 primigravid pregnant women in the first trimester of pregnancy were randomly assigned to receive 100 micro g of selenium [Se group] or a placebo [control group] per day until delivery. The level of oxidative stress and serum selenium concentration was determined in the maternal and umblical cord sera of the subjects. Oxidative stress was measured by means of a novel assay of prooxidant-antioxidant balance [PAB]. The incidence of any pregnancy complications and outcomes was also evaluated in all neonates, being fully examined and followed up until 45 days. Although maternal selenium concentration was significantly higher in the Se group [p<0.001], there was no statistically significant differences in the umblical cord selenium content between the two groups. Selenium supplementation was not associated with any significant decrease in PAB values in the Se group. The incidence of neonatal complications and outcomes did not differ significantly between the groups. Maternal selenium supplementation during pregnancy was safe but was not associated with a significant change in the extent of oxidative stress in neonates

Arrest of preterm labour by nitroglycerine patch

Preterm labour and delivery before 37 weeks of gestation is a major cause of perinatal morbidity and mortality. To delay preterm delivery, we need a tocolytic agent which is uterospecific with few fetomaternal side effects and which can significantly improve perinatal outcome. Since long the search for such a tocolytic agent that is effective and safe for both the mother and fetus has been frustrating. Recently attention has focused on the use of Nitroglycerine, a nitric oxide donor in the treatment of preterm labour as it has a uterine smooth muscle relaxant properties. This study was conducted to assess the effectiveness of nitroglycerine patches in the treatment of preterm labour. Quasi - Experimental study was conducted in Obstetrics and Gynaecology Department of Abbasi Shaheed Hospital in Karachi. Duration of study was from March2005 to March2006. Women in preterm labour with alive singleton pregnancy, uterine contractions of at least 1 in 10 minutes, intact membranes and cervical dilatation of no more than 2 cm were recruited. Women with premature rupture of membranes, ante partum hemorrhage, hypotension, and chorioamnionitis were excluded from the study. Those women who fulfilled inclusion criteria were included in the study. History and examination were done at the time of admission and baseline observations were made. Nitroglycerine patch delivering 10mg/24 hours was applied on abdominal skin and if needed another 10mg patch applied after 1 hour. After 24 hours previous patches replaced with a new patch for next 24 hours. During treatment two doses of Inj. Dexamethasone were given for fetal lung maturity. Efficacy of transdermal patches were measured in terms of cessation of uterine contractions, cervical dilatation of not more than 2 cms, allowing prolongation of pregnancy for at least 48 hours without significant maternal side effect like headache, nausea, tachycardia and hypotension. Data was analyzed on SPSS version 10.0. 60 patients were enrolled in the study. Mean maternal age was 24.60 +/- 2.25 and mean parity was found to be 1.96 +/- 1.96. Out of them 47 [78.3%] had cessation of uterine contractions for more than 48 hours where as 13 [21.6%] failed to stop contracting. Progressive cervical dilatation of more than 2 cms was found in 29 [48.3%] in less than 48 hours, where as in 31 [51.6%] cervical dilatation remained same after 48 hours. Pregnancy was prolonged for more than 48 hours in 40 [66.6%] patients and 20 [33.3%] delivered in less than 48 hours P = 0.0098. Headache was present in 17[28.3%], nausea 7 [11.6%], tachycardia 8 [13.3%] and hypotension in 3[5%] patients. Transdermal Nitroglycerine Patches were effective tocolytic agents allowing prolongation of pregnancy for at least 48 hours

case of fetal valproate syndrome with new features expanding the phenotype

Fetal valproate syndrome [FVS] is a well-recognized constellation of dysmorphic features, and neurodevelopmental retardation that results from prenatal exposure to the anticonvulsant valproic acid. In this report, we describe a case with typical features of FVS. A 23-year-old lady with post-traumatic epilepsy controlled by sodium valproate [Depakene] 500 mg twice daily throughout pregnancy as monotherapy, gave birth to a female baby with facial features characteristic of FVS, and severe radial ray reduction. She also had wide-spaced nipples and short neck, features not described before. Sodium valproate, a widely used anticonvulsant and mood regulator, is a well-recognized teratogen that can result in severe limb deformities, craniosynostosis, neural tube defects and neurodevelopmental retardation. Therefore, we recommend that valproic acid must be avoided during pregnancy, as new generation of anticonvulsant drugs have emerged into the market