Physical examination-indicated cerclage in twin pregnancies compared with singleton pregnancies.

OBJECTIVE: The aim of this study was to compare pregnancy outcomes of physical examination-indicated cerclage in twin and singleton pregnancies with bulging membranes. METHODS: All women with bulging membranes in the second trimester of pregnancy who were admitted to La Fe University and Polytechnic Hospital from January 2009 to January 2022 were included. A total of 128 participants were enrolled, 102 singleton pregnancies and 26 twin pregnancies. All patients underwent an amniocentesis to rule out intra-amniotic inflammation (IL-6 < 2.6 ng/mL). Cerclage was placed in the absence of intra-amniotic inflammation. RESULTS: Compared with singleton gestations, twin pregnancies displayed a significantly higher prevalence of nulliparity and assisted reproductive techniques. The incidence of intra-amniotic inflammation/infection was similar in both groups (68.62% in singleton vs. 65.38% in twin pregnancies). The average gestational age of delivery without cerclage in singleton gestations was 23.83 weeks (95% CI 22.82-24.84) and in twin pregnancies, it was 23.69 weeks (95% CI 21.8-25.57). The average gestational age at delivery among patients with cerclage was 37.27 weeks (95% CI 35.35-39.19) in singleton gestations and 36 weeks (95% CI 33.51-38.63) in twin pregnancies, with no significant differences. Time from diagnosis to delivery in patients with IL-6 < 2.6 ng/mL was 79.88 days, and in those with IL > 2.6 ng/mL was 10.87 days. Gestational age at delivery was significantly higher in both singleton and twin pregnancies with cerclage, compared with those without cerclage (log-rank p < .001). CONCLUSIONS: Singleton and twin pregnancies with bulging membranes behave similarly when cerclage is placed in the absence of intraamniotic inflammation/infection.

Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control / Periodontal disease and gestational diabetes mellitus: a case-control study

Antecedentes: Los estudios que relacionan la enfermedad periodontal (EP) y la diabetes mellitus gestacional (DMG) no son concordantes. Nuestro objetivo principal es evaluar la posible asociación entre la EP y la DMG. Además, analizamos los factores de riesgo para la DMG en nuestra muestra. Métodos: Participaron 180 gestantes, 90 con DMG y 90 controles, del Hospital La Fe de Valencia. Se pasó un cuestionario y realizo un examen periodontal, valorándose los siguientes parámetros: número de dientes, índices de placa y sangrado al sondaje, profundidad de sondaje (PS) y nivel de inserción de clínica (NIC). La periodontitis se definió según criterios de la CDC-AAP. Resultados: Las DMG tuvieron mayor valor promedio de PS (p = 0,001) y NIC (p = 0,028). Un 74,4% de las pacientes con DMG presentaron inflamación gingival vs. 57,8% de las no diabéticas. La periodontitis fue más prevalente en las pacientes con DMG (p < 0,05). La edad materna, el nivel de estudios y la presencia de periodontitis son factores independientes de riesgo para la DMG (OR = 1,16, IC 95% 1,07 a 1,25, p < 0,001), (OR = 0,37, IC 95% 0,19 a 0,72, p < 0,005) y (OR = 2,79, IC 95% 1,40 a 5,59, p < 0,005), respectivamente. Conclusiones: Los resultados sugieren que las embarazadas con diabetes gestacional asocian más enfermedad periodontal que aquellas sin dicha enfermedad gestacional. En nuestra muestra el riesgo de DMG puede estimarse a partir de la periodontitis, la edad y el nivel de estudios.(AU)

Background: Studies linking periodontal disease (PD) and gestational diabetes mellitus (GDM) are not consistent. Our main objective is to evaluate the possible association between PD and GDM. We also analysed the risk factors for GDM in our sample. Methods: 180 pregnant women participated, 90 with GDM and 90 controls, from Valencia's Hospital La Fe. A questionnaire was completed and a periodontal examination was performed, assessing the following parameters: number of teeth, plaque and bleeding on probing indices, probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to the criteria of CDC-AAP. Results: The GDM group had a higher mean value of PD (p = .001) and CAL (p = .028). Of the patients with GDM, 74.4% had gingival inflammation compared to 57.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < .05). Maternal age, educational level and periodontitis are independent risk factors for GDM (OR = 1.16, 95% CI 1.07 to 1.25, p < .001), (OR = .37, 95% CI .19 to .72, p < .005) and (OR = 2.79, 95% CI 1.40 to 5.59, p < .005) respectively. Conclusions: The results suggest that pregnant women with gestational diabetes have more associated periodontal disease than those without gestational diabetes. In our sample, the risk for GDM can be estimated from periodontitis, age, and educational level.(AU)

Tumor trofoblástico del lecho placentario: reporte de un caso / Placental site trophoblastic tumour: A case report

El tumor trofoblástico del lecho placentario es una afección muy infrecuente que forma parte del grupo de las neoplasias trofoblásticas gestacionales. Se origina generalmente tras un aborto o gestación normal a partir de la proliferación patológica del trofoblasto intermedio extravelloso, que puede ocurrir en meses o años tras la gestación. Su presentación clínica habitual es el sangrado uterino anómalo, la amenorrea y unos niveles de β-hCG bajos, en contra de lo que ocurre con el coriocarcinoma o la mola invasiva. El tratamiento de elección es la histerectomía junto con linfadenectomía pélvica. Es particularmente resistente a la quimioterapia, y un 30% de las pacientes presentan metástasis al diagnóstico. Se presenta un caso clínico de un tumor trofoblástico del lecho placentario diagnosticado en nuestro centro en julio de 2018, en una paciente con infertilidad que tras 3 abortos espontáneos comenzó con unos niveles de β-hCG bajos, pero en meseta y con tendencia al alza. Se aborda el enfoque diagnóstico y terapéutico que recibió, así como la evolución hasta la actualidad.(AU)

Placental site trophoblastic tumour (PSTT) is a very rare pathology that is part of the group of gestational trophoblastic neoplasia (GTN). It generally develops after a nonmolar abortion or term pregnancy from the pathological proliferation of extravillous intermediate trophoblast that can occur months or years after gestation. Its usual clinical presentation is abnormal uterine bleeding, amenorrhoea, and low levels of β-hCG, in contrast to choriocarcinoma or invasive mole. The treatment of choice is hysterectomy along with pelvic lymphadenectomy. It is particularly resistant to chemotherapy and 30% of patients present metastatic disease on diagnosis. A clinical case of PSTT diagnosed at our centre in July 2018 in a patient with infertility who, after 3 spontaneous abortions, debuted with low levels of β-hCG but on a plateau and with an upward trend. The diagnostic and therapeutic approach she received is addressed, as well as the evolution to date.(AU)

Trombosis venosa ovárica posparto: una causa inusual de fiebre puerperal / Postpartum ovarian venous thrombosis: An unusual cause of puerperal fever

La trombosis de la vena ovárica posparto es una complicación rara e impredecible y que requiere un alto índice de sospecha clínica, cuyo diagnóstico y manejo precoces son esenciales, requiriendo un abordaje multidisciplinar, para evitar cirugías innecesarias y posibles complicaciones graves. Su presentación clínica habitual suele ser fiebre persistente y dolor abdominal, generalmente en la primera semana posparto. Revisamos 3 casos clínicos representativos, diagnosticados en nuestro centro entre 2014 y 2019, abordando los factores predisponentes, diagnóstico, manejo y evolución de estas pacientes.(AU)

Postpartum ovarian vein thrombosis is a rare and unpredictable complication that requires a high index of clinical suspicion. Its early diagnosis and management, with a multidisciplinary approach, are essential in order to avoid unnecessary surgeries and possible serious complications. Its usual clinical presentation is often persistent fever and abdominal pain, generally in the first week postpartum. A report is presented on three representative cases that were diagnosed in our centre between 2014 and 2019, presenting predisposing factors, diagnosis, management, and outcome of these patients.(AU)

Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity.

OBJECTIVE: To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. METHODS: This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. RESULTS: Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = -0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH-21st fetal weight centiles instead of BW (log odds, -0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR). CONCLUSION: Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Prenatal Ultrasound Diagnosis of a Cyst of the Oral Cavity: An Unusual Case of Thyroglossal Duct Cyst Located on the Tongue Base.

We describe a case of a lingual thyroglossal duct cyst diagnosed prenatally by ultrasound at 26 weeks of gestation. The follow-up ultrasound scans revealed no changes in the cyst measurement. Surgical treatment was performed without any complication 72 hours after delivery with good results.

Craneosinostosis: diagnóstico intraútero y evolución posnatal / Craniosynostosis: Intrauterine diagnosis and postnatal outcome

La craneosinostosis conlleva la fusión precoz de una o varias suturas craneales, generando un desarrollo anormal de la bóveda craneal, asociado hasta en un 20% a síndromes genéticos. Conllevan buen pronóstico si son corregidas en los primeros meses de vida, disminuyendo así secuelas estéticas y cognitivas. Presentamos, basándonos en un caso clínico, el diagnóstico prenatal, manejo obstétrico y la mala evolución neonatal de un feto afecto de síndrome de Crouzon

Craniosynostosis is defined as early fusion of one or more cranial sutures, resulting in abnormal development of the skull, associated with genetic syndromes in up to 20%. The prognosis is good if the cranial sutures are corrected in the first months of life, reducing esthetic and cognitive sequels. We present the prenatal diagnosis, obstetric management and poor neonatal outcome of a fetus with Crouzon syndrome

Utilidad de la ecografía del primer trimestre en el diagnóstico de la pentalogía de Cantrell: a propósito de un caso / Utility of first trimester ultrasound on prenatal diagnosis of Cantrell's pentalogy: a case report

Presentamos el seguimiento de un caso clínico de pentalogía de Cantrell detectado en la ecografía del primer trimestre. Se trata de una paciente de 33 años, G2C1, sin antecedentes médicos de interés. Acude en su semana 13 + 2 para ecografía del primer trimestre. La ecografía se informó como feto único con una longitud céfalo-nalga de 50,1 mm y una translucencia nucal de 7,5 mm. Se observa masa cardiopulmonar extracorpórea, diagnosticándose de ectopia cordis, megavejiga, afectación renal bilateral y pies zambos, etiquetándose al feto como portador de la pentología de Cantrell. La paciente solicitó interrupción voluntaria del embarazo. La anatomía patológica describió feto con peso y talla adecuados a edad gestacional, que presentaba por la cara anterior extrofia visceral, identificándose tanto corazón como paquete intestinal y vejiga. Por tanto, el uso de la ecografía del primer trimestre no solo permite el diagnóstico de la viabilidad fetal y la datación de la edad gestacional, sino que hoy en día permite también el diagnóstico de patología malfomativa estructural sin necesidad de esperar a la ecografía de la semana 20 para la toma de decisiones. Con este trabajo pretendemos describir la utilidad de la ecografía de primer trimestre en el diagnóstico de patología morfológica, tratando en nuestro caso la pentalogía de Cantrell(AU)

We report the case of a 33 year old patient, G2P1, who presented with a Pentalogy of Cantrell in the first trimester ultrasound scan (13+2 weeks). The ultrasound shows a single pregnancy, with CRL of 51.1 mm and nuchal translucency of 7.5 mm that has a toracic mass diagnosed as ectopia cordis, a megabladder, bilateral renal malformation and clubfoot, being diagnosed of Pentalogy of Cantrell. The patient asked for abortion. Pathology analysis described a fitus adequate for gestational age with midline toraco-abdominal defect with evisceration of heart, intestines and bladder. Therefore, the use of first trimester ultrasound scan permits not only the diagnosis of fetal viability and gestational age, but also the diagnosis of fetal structural defects with no need for waiting for the 20th week allowing early decision making. The will of this report is to describe the use of first trimester ultrasound for the diagnosis of structural defects, in this case the Pentalogy of Cantrell(AU)

Sludge amniótico como marcador ecográfico en una gestación gemelar con parto diferido del segundo gemelo / No disponible

La presencia del sludge amniótico (sedimento amniótico) es un factor de mal pronóstico obstétrico asociado a parto pretérmino con el aumento de la morbimortalidad perinatal que esto conlleva. Por otra parte, la prevalencia de gestaciones múltiples ha aumentado en los últimos años. Este tipo de gestaciones presentan un mayor riesgo de parto pretérmino, presentándose este en ocasiones en edades gestacionales muy tempranas. Generalmente el parto del primer gemelo suele ir seguido del parto del segundo gemelo en un intervalo corto de tiempo no siendo habitual que este intervalo se prolongue durante días o incluso semanas. Presentamos el caso de una gestación gemelar con parto diferido del segundo gemelo donde en el transcurso de su seguimiento encontramos el sludge amniótico en la valoración ecográfica (AU)

The presence of amniotic fluid sludge is a marker of poor obstetric prognosis because of its association with preterm delivery, which carries greater perinatal morbidity and mortality. The prevalence of multiple pregnancies has increased in the last few years. These pregnancies are at risk of preterm delivery, which sometimes occurs at very preterm gestational ages. Delivery of the (..) (AU)

Embarazo ectópico sobre cicatriz de cesárea previa. Caso clínico / Ectopic cesarean scar pregnancy. A case report

El embarazo ectópico sobre la cicatriz de una cesárea previa es una entidad muy poco frecuente y que se acompaña de complicaciones potencialmente muy graves. Sin embargo, debido a la baja frecuencia de su aparición, no existen unas pautas claras para su tratamiento, existiendo diferentes pautas de actuación tanto médicas como quirúrgicas. Presentamos un caso de una paciente con embarazo ectópico sobre cicatriz de cesárea previa diagnosticada mediante ecografía transvaginal y tratada mediante histerectomía total por vía abdominal, ya que la paciente no tenía deseo genésico (AU)

Ectopic cesarean scar pregnancy is a very rare process that has the potential forvery severe complications. However, due to the low frequency of this entity, there are no clearprotocols for its treatment and many different treatment plans, both medical and surgical, arecurrently applied.We report the case of a patient with an ectopic pregnancy in a previous cesarean scar, diagnosedby transvaginal ultrasound scan and treated by total abdominal hysterectomy, since thepatient did not wish to preserve her fertility (AU)

Embarazo ectópico ovárico: a propósito de un caso / Ovarian ectopic pregnancy: a case report

La localización ovárica es una forma poco frecuente de embarazo ectópico y supone el 3,3% de todos ellos. Se presenta un caso en una mujer 28 años que consultó por metrorragia y dolor hipogástrico a los 14 días de la retirada de un DIU, con la sospecha diagnóstica de embarazo ectópico. Tras empeorar clínicamente se realiza una laparoscopia en la que se aprecia un embarazo ectópico ovárico izquierdo que confirma la anatomía patológica. Se ha revisado la literatura médica respecto a esta infrecuente localización de la gestación, sobre todo desde el punto de vista del diagnóstico diferencial (AU)

Ovarian pregnancy is an infrequent form of ectopic pregnancy, constituting 3.3% of all ectopic pregnancies. We report the case of a 28-year-old woman who presented with metrorrhagia and hypogastric pain 14 days after removal of an intrauterine device. The initial diagnosis was ectopic pregnancy. Clinical deterioration indicated the need for surgical management. Laparoscopic findings revealed a left ovarian ectopic pregnancy, which was confirmed by pathological study of the specimen. We review the literature on this uncommon localization, with special emphasis on its differential diagnosis (AU)

Derrame pleural fetal. Etiología, manejo y pronóstico / Fetal pleural effusion. Etiology, management and prognosis)

Introducción. El derrame pleural fetal (DPF) es una entidad rara que puede amenazar la viabilidad fetal. El objetivo es revisar el DPF analizando su etiología, manejo y pronóstico.Métodos. Estudio retrospectivo de 16 casos de DPF de16.971 partos (0,094%) realizados en el Hospital Maternal La Fe en el período 2003-2006. Se valora la etiología, manejo, uso de técnicas invasivas, forma de parto y evolución neonatal.Resultados. La edad gestacional media del diagnósticofue 25±1 semanas (14-38), y la de finalización del embarazo fue 28±1 semanas (rango: 16-39). El DPF asoció hidrops en 8 casos (50%), ascitis en 14 casos (87,5%), cardiopatías 5 casos (31,25 %) y polihidramnios en 6 casos (37,5 %). La amniocentesis demostró aneuploidía en 3 casos (18,75%). El sexo fue varón en 12 casos, hembra en 3 y ambiguo en 1 (p<0,05). De las 16 gestaciones: 2 fueron abortos tardíos y 2 interrupciones voluntarias del embarazo (IVE). Sólo en 12 casos se controló la gestación, desapareciendo el DPF en 3 casos (25%). La finalización de la gestación fue: 7 cesáreas(58 %), y 5 partos vaginales (42 %). Solo en 5 casos (41%) hubo recién nacidos vivos, los 3 casos de desaparición y 2 casos sin desaparición. La tasa de mortalidad durante el embarazo fue del 58,3% y perinatal del 66,6%.Conclusiones. El derrame pleural fetal se asocia a unaalta morbimortalidad perinatal, siendo más frecuente en varones. Son factores de buen pronóstico la reabsorción durante la gestación y la finalización tardía

Introduction. Fetal pleural effusion (FPE) is an uncommoncondition that is life-threatening to the fetalviability. This study has aimed to review FPE, analyzingetiology, management and prognosis.Methods. Retrospective study (2003-2006) of 16 FPEfrom among 16,971 deliveries (0.094%) performed in theMaternity Hospital La Fe. Etiology, management, use ofinvasive techniques, delivery method and neonatal outcomewere studied.Results. Mean gestational age at diagnosis was 25±1(14-38) weeks, and gestational age at delivery was 28±1(16-39) weeks. FPE was associated to hydrops in 8 cases(50 %), ascitis 14 cases (87.5 %), heart disease 5 cases(31.25%), polyhydramnias 6 cases (37.5%). The amniocentesis showed aneuploidy in 3 cases (18.75%). Gender was male in 12 case, female in 3 and ambiguous in one (p<0.05). Among 16 pregnancies, 2 were late miscarriages and 2 Voluntary Termination of Pregnancy. The pregnancies were controlled in only 12 cases, the FPE disappearing in 3 cases (25%). The end of the pregnancy was by cesarean section in 7 (58%) and vaginal deliveries in 5 (42%). There were live newborns in only 5 cases (41%) (5/12), 3 cases of disappearance and 2 without disappearance. Mortality rate in pregnancy was 58.3% and perinatal mortality rate was 66.6%.Conclusions. Fetal pleural effusion is associated to ahigh perinatal morbidity-mortality, this being more frequent in males. Good prognostic factors are reabsorption during pregnancy of late birth

Cribado de trisomía 21 en el primer trimestre mediante el test combinado. Valoración de su efectividad / First trimester combined screening test for trisomy 21. Effectiveness evaluation

Introducción. Valorar la efectividad del cribado combinado del primer trimestre del síndrome de Down en términos de tasa de detección (TD) y tasa de falsos positivos (TFP). Pacientes y métodos. Estudio retrospectivo de 6.269gestantes con fetos únicos cribadas en el Hospital La Fe de Valencia entre 2003-2005. El punto de corte fue de 1/270. Se revisaron los cariotipos obtenidos de los métodos invasivos y de sangre periférica de recién nacidos del período correspondiente. Resultados. En nuestro estudio el porcentaje de mujeresmayores de 35 años representó el 11,23% de la poblaciónasistida. La tasa de cribados positivos fue del 2,98%. Seha obtenido una TD del 90% y una TFP del 3%. Conclusiones. La estimación del riesgo para identificarpacientes de alto riesgo de aneuploidías mediante el cribado combinado que se está utilizando en nuestro hospital en el primer trimestre de la gestación se ha mostrado aplicable, eficaz y eficiente

Objective. To asses the effectiveness of first trimestercombined screening test for prenatal detection ofDown’s syndrome, in terms of detection rate (DR) andfalse positive rate (FPR).Subjects and methods. Retrospective study on 6,269of pregnant women with screening test carried out atHospital La Fe in Valencia between 2003-2005. We haveincluded only gestation with unique fetuses. Cut-off value was 1/270 to consider pregnancies in high risk ofaneuploidy. Karyotypes of invasive methods and peripheralblood of the corresponding period have been reviewed.Results. Our study showed that women older 35 yearsof the attended population represented 11.23%. The positive screening rate was 2.98%. A detection rate for trisomy 21 of 90% has been obtained and a false positiverate of 3%.Conclusions. The estimation of risk by mean of thecombined first trimester test used in our Hospital hasshown applicable, effective and efficient to identify patients at high risk of aneuploidies

Estrategia para disminuir la incidencia de cromosomopatías como parte de un screening universal en un hospital comarcal / Strategy to decrease the chromosomal defects as part of an Universal screening in a comarcal hospital in a rural community

Objetivos: Evaluar las opciones de cribado de cromosomopatías en un hospital comarcal sin disponibilidad de bioquímica del primer trimestre. Métodos: Estudiamos 909 gestantes, a 744 practicamos translucencia nucal (TN), a 494 screening bioquímico del segundo trimestre (SB 2ºT) y a 414 cribado secuencial (TN y SB 2ºT). La TN se valora según las pautas de la Fetal Medicine Foundation, los marcadores bioquímicos mediante electroquimioluminiscencia, y los cariotipos obtenidos mediante amniocentesis y biopsia corial (n=347). Resultados: 1. Al ser independientes nuestros marcadores, es posible realizar un screening secuencial. 2. En la población de alto riesgo ahorramos un 50% de amniocentesis con la TN y screening secuencial respecto al SB 2ºT, y en la población general las disminuímos a la tercera parte con el SB 2ºT y la TN con respecto a la edad materna. 3. Edad y TN muestran sensibilidad del 30% y 67%, respectívamente. Conclusión: La TN es un buen método de screening de cromosomopatías en nuestro medio

Objectives: The aim of this study is to evaluate the screening of cromosomal defects in a comarcal hospital, without the biochemical screening in the first trimester of pregnancy. Methods: We have studied 909 patients, 744 with nuchal translucency (NT), 494 biochemical screening in the second trimester (SB 2ºT) and 414 sequential screening (TN + SB 2ºT). NT has been estimated according to the patherns of Fetal Medicine Foundation, maternal serum markers with the electroquimioluminiscency technique,and the cariotipe was obtained with amniocentesis and corion villus sampling (n=347). Results: 1. The chromosomopaties markers are independents, so is possible to do a sequential screening. 2. In high risk population 50% less of amniocentesis were done with NT and sequential screening, rather than whith biochemical screening, and in the general population we decrease them to the third part using biochemical screening and NT compared to maternal age. 3. Maternal age and NT have a sensibility around 30% and 67%, respectively. Conclusion: NT is a good chromosomal abnormalities screening method in our hospital

Obstetric significance of anti-Jr(a) antibody.

The first case in the English-language medical literature of anti-Jr(a) antibody during pregnancy in a Spanish woman is described. The few reported cases to date about this issue are reviewed, with advice as to an obstetric guideline to follow for pregnant women with this antibody.

Diagnóstico prenatal de un aneurisma Galeno / Prenatal diagnosis of an aneurism of the vein of Galen

El aneurisma de la vena de Galeno es una malformación arterio-venosa rara del sistema nervioso central que tiene mal pronóstico. El diagnóstico prenatal puede mejorar el pronóstico. Presentamos el diagnóstico prenatal de un caso de aneurisma de la vena de Galeno mediante la utilización de Doppler color (AU)

Pharmacological and biochemical study on the effects of selective phosphodiesterase inhibitors on human term myometrium.

This study was aimed at evaluating the in vitro effects of phosphodiesterase inhibitors and beta2-adrenoceptor agonists on spontaneous contractions of human term myometrium. Rolipram, RP 73401 (3-cyclopentyloxy-N-(3,5(-dichloro-4-pyridil)-4-methoxybenzamide) and Ro 20-1724 (1-4-(3-butoxy-4-methoxybenzyl)-2-imidozolidinone) (phosphodiesterase 4 inhibitors) inhibited spontaneous myometrial contractions (Emax approximately 100%; pD2 of 6.80+/-0.28, 6.84+/-0.32 and 6.31+/-0.03, respectively). Salbutamol and formoterol were less effective (Emax=40+/-6% and 35+/-12%, respectively) than phosphodiesterase 4 inhibitors to reduce myometrial contractility. Inhibitors of phosphodiesterase 3 (milrinone and siguazodan) and 5 (zaprinast) were marginally effective. Rolipram (10-30 nM) and siguazodan (0.1 microM) potentiated the response to salbutamol (Emax=75+/-12%, 88+/-8% and 73+/-12% and pD2=6.51+/-0.20, 6.93+/-0.29 and 6.48+/-0.16, respectively). Sodium nitroprusside (pD2=6.76+/-0.29) and theophylline (pD2=5.15+/-0.22) were effective inhibitors of myometrial contractions. Chromatographic separation of phosphodiesterase isoenzymes demonstrated that phosphodiesterase 4 is predominant but other phosphodiesterase isoenzymes were also identified. In conclusion, phosphodiesterase 4 inhibitors alone or combined with beta2-adrenoceptor agonists have potential interest as tocolytic agents.