Relación entre el polimorfismo g-238a del factor de necrosis tumoral alfa y la pérdida gestacional recurrente / Relation of polymorphism g-238a of tumor necrosis factor alpha with recurrent pregnancy loss

Resumen OBJETIVO: Determinar si existe asociación entre los polimorfismos G-308A (rs1800629) y G-238A (rs361525) del promotor del factor de necrosis tumoral alfa y la pérdida gestacional recurrente. MATERIALES Y MÉTODOS: Estudio observacional, transversal, descriptivo de casos y controles llevado a cabo entre enero de 2020 y diciembre de 2021 en el Hospital de la Mujer de Aguascalientes y en el Laboratorio de Virología e Ingeniería Genética de la Universidad Autónoma de Aguascalientes. Se estudiaron pacientes con pérdidas gestacionales recurrentes y sin éstas, con embarazo normal (controles). RESULTADOS: Se estudiaron 300 pacientes: 150 con pérdida gestacional recurrente y 150 con embarazo normal (controles). Se encontraron 19 pacientes (12.6%) con pérdida gestacional recurrente primaria y 131 (87.4%) con pérdida gestacional recurrente secundaria. Las pacientes con pérdida gestacional recurrente tuvieron, significativamente, mayor edad (28 ± 6.43 en comparación con 26 ± 6.07 años; p = 0.006), más abortos (mediana de 2 en comparación con 0; p = 0.049) y menos semanas de gestación (13.18 ± 12.51 en compoaración con 34.55 ± 10.99; p = 0.0001) que las pacientes del grupo control. De los diferentes modelos genéticos, ninguno demostró un incremento significativo de riesgo para G-308A (rs1800629); sin embargo, para G-238A (rs361525) los modelos heterocigoto (RM 4.36, IC95%: 1.2-15.78; p = 0.012) y dominante (RM 4.36, IC95%: 1.42-13.36; p = 0.005) sí mostraron un aumento de probabilidad. En el análisis multivariado ninguna variable clínica demostró significación estadística. CONCLUSIÓN: En el grupo estudiado, el polimorfismo G-238 A (rs361525) del gen TNF-α mostró asociación con la pérdida gestacional recurrente, no así el polimorfismo G-308A (rs1800629).

Abstract OBJECTIVE: To determine if there is an association between polymorphisms G-308A (rs1800629) and G-238A (rs361525) of the tumor necrosis factor alpha (TNF-α) with the presence of recurrent pregnancy loss in patients treated at the Women's Hospital of the City of Aguascalientes. MATERIALS AND METHODS: An observational, case-control study was conducted in 150 patients with recurrent pregnancy loss and 150 patients with normal pregnancies. Different clinical variables were studied and the polymorphisms of the TNF-α tumor gene, G-308A (rs1800629) and G-238A (rs361525). Were genotyped by restriction fragment length polymorphism (RFLP) reaction and the prevalences of the genotypes between both groups was compared, as well as the Odds ratios (OR) of the genotypes and mutated alleles using various genetic models. Multivariate analysis was performed to determine the effect of clinical variables and the presence of these polymorphisms. RESULTS: Patients with recurrent pregnancy loss were significantly older, had more miscarriages and a lower gestational age than those in the control group. For the G-308A (rs1800629) polymorphism, no significant difference was observed in the prevalences between both groups. For G-238A (rs361525) the prevalence was 6.7% for patients and 1.7% for women with normal pregnancies, with a statistically significant difference (p = 0.004). None of the different genetic models showed a significant increase for G-308A (rs1800629), however, for G-238A (rs361525) the heterozygous (OR 4.36, 95%IC: 1.2-15.78; p=0.012) and dominant (OR 4.36, 95%IC: 1.42-13.36, p=0.005) models did show an increase in said probability. In the multivariate analysis, no clinical variable showed statistical significance. CONCLUSION: The G-238A (rs361525) polymorphism of the tumor necrosis factor alpha gene shows an association, and a higher risk of recurrent pregnancy loss in our population.

Índice neutrófilo-linfocito, relación plaquetas-linfocito y distribución de la anchura del eritrocito en pacientes con preeclampsia / Neutrophil-to-lymphocyte ratio, plateletto- lymphocyte ratio, and erythrocyte width distribution. and erythrocyte width distribution in patients with preeclampsia

Resumen OBJETIVO: Comparar el índice neutrófilo-linfocito, la relación plaquetas-linfocito y la distribución de la anchura del eritrocito de mujeres con preeclampsia con o sin criterios de severidad y los de mujeres sin ésta. MATERIALES Y MÉTODOS: Estudio retrospectivo, de casos y controles, efectuado en mujeres con y sin preeclampsia atendidas entre enero y diciembre de 2019. RESULTADOS: Se estudiaron 70 mujeres con preeclampsia y 70 con embarazo sin esta complicación. El índice neutrófilo-linfocito fue significativamente mayor en las mujeres con preeclampsia (4.11 ± 2.76; IC95%: 3.47-4.75) que en las mujeres sin esta complicación (2.99 ± 1.6; IC95%: 2.62-3.36; p = 0.004), similar a la relación plaquetas-linfocitos (117.61 ± 47.53; IC95%:106.48-128.24 vs 97.64 ± 43.67; IC95%: 87.41-107.87; p = 0.006) y para la distribución de la anchura del eritrocito (14.46 ± 1.9; IC95%: 14.02-14.9 vs 13.56 ± 1.38; IC95%: 13-13.72; p = 0.0002). Ninguno de estos parámetros logró discriminar entre las pacientes con preeclampsia con o sin criterios de severidad. CONCLUSIÓN: Un índice neutrófilo-linfocito ≥ 5.1 y una relación plaquetas-linfocito ≥ 113.1 son capaces de discriminar de manera adecuada entre preeclampsia con o sin criterios de severidad.

Abstract OBJECTIVE: To compare the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and erythrocyte width distribution, of women with preeclampsia with or without severity criteria and those of women without. MATERIALS AND METHODS: Retrospective case-control study in 70 women with preeclampsia and 70 with normal pregnancy between January and December 2019. RESULTS: Seventy women with preeclampsia and 70 with pregnancy without this complication were studied. The neutrophil-lymphocyte ratio was significantly higher in women with preeclampsia (4.11 ± 2.76; 95%CI: 3.47-4.75), than in women with normal pregnancies (2.99 ± 1.6; 95%CI: 2.62-3.36; p = 0.004); which is similar for the platelet-lymphocyte ratio (117.61 ± 47.53, 95%CI: 106.48-128.24 vs 97.64 ± 43.67; 95%CI: 87.41-107.87; p = 0.006) and for the distribution of the width of the erythrocyte; (14.46 ± 1.9, CI95%: 14.02-14.9 vs 13.56 ± 1.38; CI95%: 13-13.72; p = 0.0002). None of these parameters was able to discriminate between patients with preeclampsia with or without severity criteria. A neutrophil-lymphocyte ratio ≥ 5.1 discriminates between women with a normal pregnancy and those with preeclampsia with or without severity criteria [area under the curve of 0.746, (95%CI: 0.664-0.827)], sensitivity 42%, specificity 91%, positive predictive value 82%, negative predictive value 60% and Odds Ratio 7.1 (95%CI: 2.7-18.6, p = 0.001). The platelet-lymphocyte ratio ≥ 113.4 can discriminate between women with a normal pregnancy and preeclampsia with or without severity criteria, with an area under the curve of 0.617 (95% CI 0.525-0.709). CONCLUSION: A neutrophil-lymphocyte ratio ≥ 5.1, and a platelet-lymphocyte ratio ≥ 113.1 are able to adequately discriminate between patients with normal pregnancy and those with preeclampsia with or without severity criteria.

Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes.

Background Extreme maternal morbidity is defined as "events that potentially threaten the life of a pregnant woman during pregnancy, childbirth or the puerperium, but that due to a medical intervention the patient does not die", and this is an indicator of health quality at the hospital and demographic level. Objective The aim of this study was to determine the prevalence of extreme maternal morbidity in the Women´s Hospital of Aguascalientes, Mexico. Material and methods A retrospective cross-sectional study was conducted under the criteria of the World Health Organization and the Latin American Federation of Obstetrics and Gynecology Societies for the definition of extreme maternal morbidity to determine the prevalence of near miss morbidity, between January 1 and December 31, 2016. Results We found 165 cases of extreme maternal morbidity; no maternal death was registered during the study year. The extreme maternal morbidity rate was 0.016 and 16.69 per 1000 live births; the ratio of extreme maternal morbidity cases / obstetric admissions was 11.07. The prevalence of extreme maternal morbidity was 1.6%. The main causes of extreme maternal morbidity were hypertensive disorders (57%), obstetric hemorrhage (29%), sepsis (1%) and other (13%). Conclusion Extreme maternal morbidity in our institution had a similar prevalence to that reported in other countries and was mainly caused by hypertensive disorders.

[Association between early miscarriage and Chlamydia trachomatis infection in Aguascalientes, Mexico]. / Asociación entre aborto temprano e infección por Chlamydia trachomatis en Aguascalientes, México.

Background: Chlamydia trachomatis infection in women has been strongly associated with early membrane rupture and pre-term labor; however, the evidence linking Chlamydia trachomatis infection and early miscarriage is inconsistent. Objective: To determine if there is an association between Chlamydia trachomatis infection and early abortion in a group of women from Aguascalientes, Mexico. Material and methods: 108 early abortion product samples were analyzed using polymerase chain reaction technique, along with 42 samples that belonged to 42 patients with a normal pregnancy, in order to determine the presence of Chlamydia trachomatis. The strength of association between early abortion and Chlamydia trachomatis infection was measured with odds ratio (OR) and 95% confidence intervals (95% CI). A value of p < 0.05 was considered statistically significant. Results: Chlamydia trachomatis infection was positive in 39 of 150 patients (26%), in 37 of 108 women with early abortion (34%) and in two of 42 of women with uneventful control pregnancies (4.7%) (p = 0.002). We observed a positive association between the risk of early miscarriage and Chlamydia trachomatis infection (OR = 10.42, 95% CI, 2.39 45.54, p = 0.002). Conclusions: We found a higher frequency of Chlamydia trachomatis infection than the one previously reported in our country, and a higher risk of early abortion for Chlamydia trachomatis infection (10.42) in pregnant women, which suggests the necessity of including the molecular study of this pathogen in women in prenatal control.

Introducción: la infección por Chlamydia trachomatis es un factor de riesgo bien establecido en pacientes con ruptura prematura de membranas y parto prematuro; sin embargo, su papel en el riesgo de aborto temprano es incierto. Objetivo: determinar si existe asociación entre la presencia de infección por Chlamydia trachomatis y aborto temprano en un grupo de mujeres de Aguascalientes, México. Material y métodos: se estudiaron muestras de 108 productos de aborto temprano y 42 pacientes con embarazo normal mediante reacción en cadena de la polimerasa de punto final para determinar la presencia de Chlamydia trachomatis. Se evaluó la magnitud de la asociación entre aborto temprano e infección por este microrganismo con razón de momios (RM) e intervalos de confianza al 95% (IC 95%). Un valor de p < 0.05 se consideró significativo. Resultados: se encontró Chlamydia trachomatis en 39 de las 150 pacientes (26%), en 37 de 108 mujeres con aborto temprano (34.2%) y en dos de 42 mujeres con embarazo normal (4.7%) (p = 0.002). Se observó asociación positiva del riesgo de aborto temprano e infección por Chlamydia trachomatis con RM de 10.42, IC 95%: 2.39 45.54, p = 0.002. Conclusiones: encontramos una frecuencia de infección por Chlamydia trachomatis más elevada que la reportada previamente en nuestro país y un riesgo significativamente mayor de aborto temprano en mujeres embarazadas con esta infección (10.42), lo que sugiere la necesidad de incluir el estudio molecular de este patógeno en mujeres en control prenatal.

Incidence of intraepithelial fallopian tube neoplasias in mexican women over 40 years of age that underwent elective hysterectomy.

AIMS: The incidence of intraepithelial neoplasia in the fallopian tubes of women over 40 years of age who had undergone elective hysterectomy was assessed at the Aguascalientes Women's Hospital. METHODS: An observational, prospective, descriptive study was carried out at the Aguascalientes Women's Hospital on female patients over 40 years of age who underwent elective hysterectomy between July and October 2017. In these 4 months, 85 patients underwent elective hysterectomy. RESULTS: In this study, 85 patients who received a hysterectomy for non-oncological reasons were analyzed. Salpinx alterations compatible with intraepithelial neoplasia in the Fallopian tubes were found in 2.4% of the patients studied. CONCLUSIONS: The incidence of intraepithelial neoplasia in the fallopian tubes of high-risk patients at the Aguascalientes Women's Hospital is 2.4%. Prophylactic salpingectomy is a simple procedure and has the potential to decrease the risk of high-grade ovarian cancer. In premenopausal patients, total abdominal hysterectomy with bilateral salpingectomy should be the procedure most often performed.

Utilidad y eficacia de la clasificación de Robson para disminuir la tasa de cesáreas / Utility and efficacy of Robson's classification to reduce the rate of cesareas

Resumen Objetivo: Evaluar la eficacia y utilidad de la clasificación de Robson en la reducción de la práctica de cesáreas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y de corte transversal efectuado en pacientes de nivel socioeconómico medio y bajo atendidas entre enero y diciembre de 2016 en un hospital de segundo nivel. Para clasificar a las pacientes, según sus características obstétricas, se aplicó el modelo de Robson. Resultados: Se estudiaron 374 pacientes embarazadas; de ellas 91 (24.3%) terminaron la gestación mediante cesárea. Los grupos de Robson con mayor contribución al porcentaje de cesáreas fueron: grupo 1 con 50.5%, grupo 2 con 29.8% y grupo 10 con 8.7%. El grupo 5 reportó que 62.7% de los embarazos terminaron mediante parto. El 89.8% de las pacientes ingresó con trabajo de parto espontáneo. Las principales indicaciones de cesárea fueron, en el grupo 1, trabajo de parto estacionario; en el grupo 2, cesárea iterativa y en el grupo 10, feto pretérmino. Conclusiones: La aplicación del modelo de clasificación de Robson es útil y práctica para identificar los grupos de pacientes en los que es posible disminuir el porcentaje de cesáreas.

Abstract Objective: Evaluate the effectiveness and usefulness of the Robson classification to reduce the practice of cesarean sections. Materials and methods: Observational, descriptive, retrospective and cross section was made in patients of medium and low socioeconomic status attended between January and December 2016 in a second level hospital. For classify the patients, according to their obstetric characteristics, the model of Robson was applied. Results: 374 pregnant patients were studied; in 91 (24.3%) the pregnancy ended by caesarean section. The Robson groups with the greatest percentage contribution of caesarean sections were: group 1 with 50.5%, group 2 with 29.8% and group 10 with 8.7%. Group 5 reported that 62.7% of pregnancies ended by delivery; 89.8% of the patients was admitted with spontaneous labor. The main Cesarean indications were, in group 1, stationary labor; at group 2, iterative caesarean section and group 10, preterm fetus. Conclusions: The application of the Robson classification model is useful and practice to identify groups of patients in who it is possible to decrease the percentage of cesareans.

Hematoma subcapsular hepático en síndrome de HELLP: reporte de dos casos / Hepatic subcapsular hematoma in HELLP syndrome. Report of 2 cases

Resumen OBJETIVO Reportar el tratamiento clínico-quirúrgico y en la unidad de cuidados intensivos obstétricos de dos pacientes con síndrome de HELLP y hematoma subcapsular hepático. CASO CLINICO A Paciente de 29 años en curso de las 36.1 semanas de embarazo, con ausencia de movimientos fetales, choque hipovolémico, desprendimiento prematuro de placenta normoinserta y óbito. Hemoperitoneo de 2000 mL y hematoma subcapsular del lóbulo hepático izquierdo. Se le colocó un empaquetamiento Miculicz durante 48 horas. Permaneció en la unidad de cuidados intensivos durante nueve días. Reporte de tomografía axial computada de hematoma subcapsular hepático. CASO CLINICO B Paciente de 15 años, con embarazo de 38.6 semanas, dolor epigástrico y lumbar, bradicardia fetal y síndrome de HELLP. Hemoperitoneo de 300 cc, feto de 2400 g, Apgar 1-5, desprendimiento de placenta del 100%, hematoma hepático subcapsular contenido por el ligamento triangular sin necesidad de empaquetamiento. Atención en la unidad de cuidados intensivos obstétricos durante tres días. Reporte de tomografía axial computada de hematoma hepático subcapsular. CONCLUSIÓN El síndrome de HELLP puede originar complicaciones hepáticas graves, como: rotura hepática o hematoma subcapsular roto o no roto. La mortalidad es de 18 a 86% en caso de rotura del hematoma. Las pacientes deben tratarse en hospitales de tercer nivel. La intervención temprana, la atención multidisciplinaria, el soporte hemodinámico y el seguimiento con estudios de imagen son decisivos para reducir su elevada morbilidad y mortalidad.

Abstract OBJECTIVE Report clinical-surgical management and in the Obstetric Intensive Care Unit of the HELLP Syndrome and hepatic subcapsular hematoma of two clinical cases. CLINICAL CASE A 29 years of age, 36.1 weeks of gestation, absence of fetal movements, hypovolemic shock, premature detachment of normoinserta placenta, stillbirth. Hemoperitoneum finding of 2000 mL and subcapsular hematoma of the left hepatic lobe; Miculicz packaging is placed for 48 hours. Management in the Obstetric Intensive Care Unit for 9 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CLINICAL CASE B 15 years of age, 38.6 weeks of gestation, pain in the hypogastrium and lumbar region, fetal bradycardia and HELLP syndrome; hemoperitoneum finding of 300 cc, product of 2,400 gr, Apgar 1-5, placental abruption of 100%, hepatic subcapsular hematoma contained by triangular ligament without the need for packaging. Management in the Obstetric Intensive Care Unit for 3 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CONCLUSION The HELLP syndrome can present serious hepatic complications such as ruptured hepatic or subcapsular hematoma. Mortality is 18 to 86% in case of hematoma rupture. They require management in highly complex centers. Early intervention, multidisciplinary management, hemodynamic support and follow-up with imaging studies are essential to reduce their high morbidity and mortality.