Evidence of brain injury in fetuses of mothers with preterm labor with intact membranes and preterm premature rupture of membranes.

BACKGROUND: Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. OBJECTIVE: This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. STUDY DESIGN: In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. RESULTS: Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non-intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8-37.6), 35.3 mm (interquartile range, 31.2-39.6), and 35.0 mm (interquartile range, 31.3-38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5-19.6), 17.2 mm (interquartile range, 16.0-18.9), and 17.1 mm (interquartile range, 15.7-19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59-0.81], 0.71 mm2 [interquartile range, 0.63-0.82], and 0.78 mm2 [interquartile range, 0.71-0.91], respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth-to-biparietal diameter ratios were 0.14 [interquartile range, 0.12-0.16], 0.14 [interquartile range, 0.13-0.16], and 0.16 [interquartile range, 0.15-0.17], respectively [P<.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07-0.12], 0.11 [interquartile range, 0.09-0.14], and 0.11 [interquartile range, 0.09-0.14], respectively [P=.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4-21,098.8], 8397.7 pg/mL [interquartile range, 3682.1-17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1-3209.3], respectively; P<.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0-4883.5], 1070.3 pg/mL [interquartile range, 365.1-1463.2], and 74.8 pg/mL [interquartile range, 44.7-93.7], respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54-3.88], 0.965 ng/mL [interquartile range, 0.59-2.07], and 0.24 mg/mL [interquartile range, 0.20-0.28], respectively; P=.002). CONCLUSION: Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.

Lung Inflammatory Phenotype in Mice Deficient in Fibulin-2 and ADAMTS-12.

Interaction between extracellular matrix (ECM) components plays an important role in the regulation of cellular behavior and hence in tissue function. Consequently, characterization of new interactions within ECM opens the possibility of studying not only the functional but also the pathological consequences derived from those interactions. We have previously described the interaction between fibulin2 and ADAMTS-12 in vitro and the effects of that interaction using cellular models of cancer. Now, we generate a mouse deficient in both ECM components and evaluate functional consequences of their absence using different cancer and inflammation murine models. The main findings indicate that mice deficient in both fibulin2 and ADAMTS12 markedly increase the development of lung tumors following intraperitoneal urethane injections. Moreover, inflammatory phenotype is exacerbated in the lung after LPS treatment as can be inferred from the accumulation of active immune cells in lung parenchyma. Overall, our results suggest that protective effects in cancer or inflammation shown by fibulin2 and ADAMTS12 as interactive partners in vitro are also shown in a more realistic in vivo context.

Intra-amniotic infection and/or inflammation is associated with fetal cardiac concentric hypertrophy and diastolic dysfunction in preterm labor and preterm prelabor rupture of membranes.

BACKGROUND: Preterm delivery is associated with cardiovascular remodeling and dysfunction in children and adults. However, it is unknown whether these effects are caused by the neonatal consequences of preterm birth or if these are already present in utero. OBJECTIVE: We evaluated fetal cardiac morphology and function in fetuses of mothers admitted for preterm labor or preterm prelabor rupture of membranes and the association of these changes with the presence of intra-amniotic infection and/or inflammation. STUDY DESIGN: In this prospective cohort study, fetal echocardiography and amniocentesis were performed at admission in singleton pregnant women with preterm labor and/or preterm prelabor rupture of membranes between 24.0 and 34.0 weeks' gestation with (intra-amniotic infection and/or inflammation group, n=41) and without intra-amniotic infection and/or inflammation (non-intra-amniotic infection and/or inflammation, n=54). Controls (n=48) were outpatient pregnant women without preterm labor or preterm prelabor rupture of membranes. Intra-amniotic infection was defined by a positive amniotic fluid culture or positive 16S ribosomal RNA gene. Intra-amniotic inflammation was defined by using the amniotic fluid interleukin-6 cutoff levels previously reported by our group being >1.43 ng/mL in preterm prelabor rupture of membranes and >13.4 ng/mL in preterm labor. Fetal cardiac morphology and function was evaluated using echocardiography, and troponin-I and N-terminal pro-brain natriuretic peptide concentrations were measured in amniotic fluid from women with preterm labor or preterm prelabor rupture of membranes and compared with 20 amniotic fluid Biobank samples obtained for reasons other than preterm labor or preterm prelabor rupture of membranes or cardiac pathology. The data were adjusted for the estimated fetal weight below the 10th percentile and for preterm prelabor rupture of membranes at admission and also for gestational age at amniocentesis when amniotic fluid biomarkers were compared. RESULTS: From 2018 to 2021, 143 fetuses were included; 95 fetuses were from mothers admitted with a diagnosis of preterm labor or preterm prelabor rupture of membranes, and among those, 41 (28.7%) were in the intra-amniotic infection and/or inflammation group and 54 (37.8%) were in the non-intra-amniotic infection and/or inflammation group. A total of 48 (33.6%) fetuses were included in the control group. Fetuses with preterm labor and/or preterm prelabor rupture of membranes had signs of subclinical cardiac concentric hypertrophy (median left wall thickness of 0.93 [interquartile range, 0.72-1.16] in the intra-amniotic infection and/or inflammation group; 0.79 [0.66-0.92] in the non-intra-amniotic infection and/or inflammation group; and 0.69 [0.56-0.83] in controls; P<.001) and diastolic dysfunction (tricuspid A duration 0.23 seconds [0.21-0.25], 0.24 [0.22-0.25], and 0.21 [0.2-0.23]; P=.007). Systolic function was similar among groups. Higher values of amniotic fluid troponin I (1413 pg/mL [927-2334], 1190 [829-1636], and 841 [671-959]; P<.001) and N-terminal pro-brain natriuretic peptide were detected (35.0%, 17%, and 0%; P=.005) in fetuses with preterm labor or preterm prelabor rupture of membranes when compared with the control group. The highest N-terminal pro-brain natriuretic peptide concentrations were found in the intra-amniotic infection and/or inflammation group. CONCLUSION: Fetuses with preterm labor or preterm prelabor rupture of membranes showed signs of cardiac remodeling and subclinical dysfunction, which were more pronounced in those exposed to intra-amniotic infection and/or inflammation. These findings support that the cardiovascular effects observed in children and adults born preterm have, at least in part, a prenatal origin.

A multivariable prediction model for intra-amniotic infection in patients with preterm labor and intact membranes including a point of care system that measures amniotic fluid MMP-8.

OBJECTIVES: Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0 weeks using clinical, sonographic and biochemical biomarkers. METHODS: From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0 weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019-2020, n=49) and validation cohort (2021-2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results. RESULTS: During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10 % had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95 % confidence interval: 0.860-0.995) with a sensitivity of 75 %, specificity of 93.3 %, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort. CONCLUSIONS: In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes.

Immunohistochemical detection of PIEZO1 and PIEZO2 in human digital Meissner´s corpuscles.

BACKGROUND: The cutaneous end organ complexes or cutaneous sensory corpuscles are specialized sensory organs associated to low-threshold mechanoreceptors. Mechano-gated proteins forming a part of ion channels have been detected in both the axon and terminal glial cells of Meissner corpuscles, a specific cutaneous end organ complex in the human glabrous skin. The main candidates to mechanotransduction in Meissner corpuscles are members of the Piezo family of cationic ion channels. PIEZO2 has been detected in the axon of these sensory structures whereas no data exists about the occurrence and cell localization of PIEZO1. METHODS: Skin samples (n = 18) from the palmar aspect of the distal phalanx of the first and second fingers were analysed (8 female and 10 males; age range 26 to 61 26-61 years). Double immunofluorescence for PIEZO1 and PIEZO2 together with axonal or terminal glial cell markers was captured by laser confocal microscopy, and the percentage of PIEZOs positive Meissner corpuscles was evaluated. RESULTS: MCs from human fingers showed variable morphology and degree of lobulation. Regarding the basic immunohistochemical profile, in all cases the axons were immunoreactive for neurofilament proteins, neuron specific enolase and synaptophysin, while the lamellar cells displayed strong S100P immunoreactivity. PIEZO1 was detected co-localizing with axonal markers, but never with terminal glial cell markers, in the 56% of Meissner corpuscles; weak but specific immunofluorescence was additionally detected in the epidermis, especially in basal keratinocytes. Similarly, PIEZO2 immunoreactivity was found restricted to the axon in the 85% of Meissner corpuscles. PIEZO2 positive Merkel cells were also regularly found. CONCLUSIONS: PIEZO1 and PIEZO2 are expressed exclusively in the axon of a subpopulation of human digital Meissner corpuscles, thus suggesting that not only PIEZO2, but also PIEZO1 may be involved in the mechanotransduction from low-threshold mechanoreceptors.

Acid-Sensing Ion Channels' Immunoreactivity in Nerve Profiles and Glomus Cells of the Human Carotid Body.

The carotid body is a major peripheral chemoreceptor that senses changes in arterial blood oxygen, carbon dioxide, and pH, which is important for the regulation of breathing and cardiovascular function. The mechanisms by which the carotid body senses O2 and CO2 are well known; conversely, the mechanisms by which it senses pH variations are almost unknown. Here, we used immunohistochemistry to investigate how the human carotid body contributes to the detection of acidosis, analyzing whether it expresses acid-sensing ion channels (ASICs) and determining whether these channels are in the chemosensory glomic cells or in the afferent nerves. In ASIC1, ASIC2, and ASIC3, and to a much lesser extent ASIC4, immunoreactivity was detected in subpopulations of type I glomus cells, as well as in the nerves of the carotid body. In addition, immunoreactivity was found for all ASIC subunits in the neurons of the petrosal and superior cervical sympathetic ganglia, where afferent and efferent neurons are located, respectively, innervating the carotid body. This study reports for the first time the occurrence of ASIC proteins in the human carotid body, demonstrating that they are present in glomus chemosensory cells (ASIC1 < ASIC2 > ASIC3 > ASIC4) and nerves, presumably in both the afferent and efferent neurons supplying the organ. These results suggest that the detection of acidosis by the carotid body can be mediated via the ASIC ion channels present in the type I glomus cells or directly via sensory nerve fibers.

Factors related to inhibition of lactation by pharmacological means at birth in a Spanish referral hospital (2011-2017) / Factores relacionados con la inhibición de la lactancia por medios farmacológicos al nacer en un hospital de referencia español (2011-2017)

Objective: To describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline. Method: We assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017. Results: IL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period. Conclusions: Factors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them. (AU)

Objetivo: Describir las características maternas, neonatales y del embarazo relacionadas con la inhibición de la lactancia (IL) con cabergolina. Método: Se evaluaron 20.965 ocasiones de inicio de lactancia, según los registros obstétricos del Hospital Clínic de Barcelona (2011-2017). Resultados: La IL disminuyó durante el periodo de estudio del 8,78% al 6,18% (odds ratio[OR]: 0,93 anual; intervalo de confianza del 95% [IC95%]: 0,90-0,95). Las mujeres con menor nivel educativo (OR: 2,5; IC95%: 2,0-3,0), las madres que viven en áreas más deprivadas (OR: 1,08 por 10 puntos extra sobre 100; IC95%: 1,04-1,12), las fumadoras (OR: 2,2; IC95%: 1,9-2,6), las que tienen más hijos (OR: 1,2 por cada hermano; IC95%: 1,1-1,3), los nacimientos prematuros (OR: 1,8; IC95%: 1,4-2,3), los nacimientos múltiples (OR: 1,6; IC95%: 1,2-2,1) y los embarazos de mayor riesgo (OR: 1,3 por punto de riesgo; IC95%: 1,2-1,4) tuvieron una mayor prevalencia de IL. Respecto a las mujeres nacidas en España, la IL fue menor que en las demás mujeres, con la excepción de las nacidas en China (OR: 7,0; IC95%: 5,7-8,6). Estas desigualdades se mantuvieron durante el periodo de estudio. Conclusiones: Los factores relacionados con el bajo nivel socioeconómico y la mala salud tuvieron más probabilidades de estar asociados con la IL. El uso de cabergolina disminuyó durante el periodo de estudio, mientras que las desigualdades se mantuvieron. Tener en cuenta estas desigualdades es el primer paso para abordarlas. (AU)

Evaluación del efecto de un estabilizador del microbioma vaginal sobre los resultados maternos y neonatales en mujeres con rotura prematura de membranas pretérmino / Evaluation of the effect of a vaginal microbiome stabilizer on maternal and neonatal outcomes in women with premature rupture of preterm membranes

Objetivo: evaluar, en mujeres con rotura prematura de membranas pretérmino, si un estabilizador del microbioma vaginal disminuye el riesgo de corioamnionitis clínica, aumenta la latencia al parto y reduce la morbimortalidad materna y neonatal. Sujetos y métodos: estudio de cohortes retrospectivo. Entre 2011-2014 se trató con Geliofil® vaginal a mujeres con rotura prematura de membranas entre las 24,0-29,6 semanas que estaban bajo antibioterapia de amplio espectro. Se compararon los resultados maternos y neonatales con un grupo histórico de características similares (2008-2011). Resultados: veinticinco mujeres fueron tratadas con Geliofil® y veinticuatro pertenecieron al grupo no tratado. El porcentaje de corioamnionitis clínica (32% vs. 33,3%), la edad gestacional al parto (media (desviación estándar)-30,3 (3,4) vs. 30,3 (3,1) semanas) y la latencia al parto (4,4 (5,1) vs. 4,3 (4,1) semanas) fueron similares en ambos grupos. No hubo diferencias en la morbimortalidad materna ni neonatal. Conclusión: el uso de Geliofil® no mejoró los resultados maternos ni neonatales en mujeres con rotura prematura de membranas Pretérmino (AU)

Objective: To evaluate if a vaginal ecosystem stabilizer, Geliofil®, administered to women with preterm prelabour rupture of membranes decreases the occurrence of clinical chorioamnionitis, increases latency to delivery and decreases maternal and neonatal morbimortality. Subjects and methods: Retrospective cohort study. From 2011-2014, vaginal Geliofil® was added to broad-spectrum antibiotic therapy of singleton pregnancies with diagnosis of preterm prelabour rupture of membranes between 24.0 and 29.6 weeks. Maternal and neonatal outcomes were compared with a historical group with similar characteristics (2008-2011). Results: Twenty-five women were treated with Geliofil® and 24 were included in the historic group. No differences were observed between groups in relation to gestational age at delivery (mean (standard deviation)-30.3 (3.4) vs. 30.3 (3.1) weeks), latency to delivery (4.4 (5.1) vs. 4.3 (4.1) weeks) or the occurrence of clinical chorioamnionitis (32% vs. 33.3%), respectively. Moreover, no differences were found in other maternal or neonatal outcomes evaluated. Conclusion: Geliofil®, as a vaginal ecosystem stabilizer, does not improve maternal or neonatal morbimortality in women with preterm prelabour rupture of membranes (AU)

Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

Introduction: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed.Objectives: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage.Methods: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed.Results: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs).Conclusions: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

Introdução: a ancoragem ortodôntica é um dos aspectos mais desafiadores da Ortodontia. A prevenção de movimentos dentários indesejados poderia resultar em um tratamento ortodôntico mais seguro e menos complexo. Recentemente, foram publicadas várias revisões de literatura sobre os efeitos de diferentes substâncias na fisiologia do tecido ósseo e os efeitos colaterais clínicos na Ortodontia. Porém, os efeitos da aplicação local dessas substâncias no grau de movimentação dentária ortodôntica não foram avaliados.Objetivos: o objetivo da presente pesquisa foi analisar a evidência científica publicada na literatura sobre os efeitos de diferentes substâncias na ancoragem ortodôntica.Métodos: a literatura foi sistematicamente revisada utilizando-se as bases de dados PubMed/Medline, Scopus e Cochrane, de 2000 a 31 de julho de 2014. Os artigos foram selecionados, de maneira independente, por dois pesquisadores diferentes, tendo como base critérios de inclusão e exclusão previamente estabelecidos, com um índice Kappa de concordância de 0,86. A qualidade metodológica dos artigos revisados foi analisada.Resultados: a estratégia de pesquisa identificou 270 artigos; 25 artigos foram selecionados após a aplicação dos critérios de inclusão e exclusão, mas apenas 11 foram qualificados para a análise final. As substâncias envolvidas na ancoragem ortodôntica foram divididas em três grupos principais: osteoprotegerina (OPG), bisfosfonatos (BFs) e outras substâncias (OSs).Conclusões: diferentes substâncias são capazes de alterar o ciclo de remodelação óssea, influenciando na função dos osteoclastos e, portanto, na movimentação dentária. Sendo assim, essas substâncias podem ser utilizadas para promover o máximo de ancoragem e prevenir movimentos indesejados. A OPG foi a substância mais eficaz no bloqueio da ação dos osteoclastos, reduzindo os movimentos indesejados.

Resultados perinatales en amenazas de parto prematuro con colonización endocervical por Ureaplasma urealyticum / Perinatal results in threatened preterm labor related to Ureaplasma urealyticum colonization

Objetivo. Valorar los resultados perinatales en embarazadas con episodios de amenaza de parto prematuro y colonización concomitante por Ureaplasma urealyticum detectada mediante cultivos endocervicales. Material y métodos. Entre enero del 2002 y diciembre del 2003 se incluyeron un total de 72 mujeres con uno o más episodios de amenaza de parto prematuro entre las 24 y 36,6 semanas de gestación, en cuyo ingreso se realizó un cultivo endocervical para micoplasmas genitales. Criterios de exclusión: embarazos múltiples, rotura prematura de membranas previa a la amenaza de parto prematuro. Se compararon los resultados perinatales entre las pacientes con y sin colonización concomitante por U. urealyticum. Resultados. Al comparar el grupo de mujeres con cultivo endocervical positivo a U. urealyticum (30 pacientes) y el grupo con cultivo negativo (42 pacientes) no se encontraron diferencias estadísticamente significativas respecto a la edad materna, la nuliparidad, la longitud cervical o el test de Bishop. La edad gestacional en el momento del parto fue muy similar en ambos grupos, así como los resultados perinatales. No se observó ningún caso de corioamnionitis ni sepsis neonatal. Discusión. En mujeres con episodios de amenaza de parto prematuro, la positividad del cultivo endocervical para U. urealyticum al ingreso no se asocia a mayor riesgo de parto pretérmino ni aumenta la morbilidad perinatal (AU)

Objective. To assess the perinatal results in pregnant women with threatened preterm labor and detection of Ureaplasma urealyticum by endocervical culture. Material and methods. Seventy-two pregnant women with at least one episode of preterm labor between 24 and 36.6 weeks of pregnancy from January 2002 to December 2003 were included in our study. An endocervical culture for genital mycoplasmas was performed at admission. Exclusion criteria consisted of multiple pregnancy and premature rupture of membranes prior to the episode of threatened preterm labor. Perinatal results were compared in women with positive and negative cultures to U. urealyticum. Results. There were 30 women with a U. urealyticum-positive culture and 42 women with a U. urealyticum-negative culture. There were no statistically significant differences in maternal age, nulliparity rate, cervical length or Bishop's score. Gestational age at delivery and perinatal results were highly similar in the two groups. There were no cases of chorioamnionitis or neonatal sepsis. Discussion. In women admitted to hospital for threatened preterm labor, detection of U. urealyticum in endocervical culture at admission is not related to an increased risk of preterm birth or with increased perinatal morbidity (AU)

Parto diferido del segundo gemelo / Delayed-interval delivery in twin pregnancy

La incidencia de embarazos múltiples se ha incrementado en los últimos años. Las pacientes con embarazos múltiples están en riesgo de parto prematuro con una alta asociación a mortalidad y morbididad perinatal. El parto del primer gemelo en una gestación múltiple va normalmente seguido por el parto del siguiente en un corto periodo. Es raro observar un intervalo prolongado entre el parto de los dos fetos de un embarazo múltiple. Nosotros reportamos 7 casos de embarazos múltiples con un parto diferido del segundo gemelo. Basándonos en nuestra experiencia y en la revisión de la literatura, concluimos que el parto diferido del segundo gemelo en edades gestacionales extremas, con un control exhaustivo de las condiciones fetales y maternas, está recomendado para mejorar la supervivencia y disminuir la morbilidad en el segundo gemelo (AU)

The incidence of multiple pregnancies has increased in the last few years. Patients with multiple pregnancies are at risk of preterm delivery associated with high perinatal mortality and morbidity. Delivery of the first twin in a multiple gestation is usually followed by delivery of the second twin shortly thereafter. A prolonged interval between delivery of the fetuses in a multiple pregnancy is infrequent. We report seven cases of multiple pregnancies with delayed- interval delivery of the second twin. On the basis of our experience and a review of the literature, we conclude that delayed delivery of the second twin in very preterm gestational ages, with careful observation of fetal and maternal status, is recommended to improve survival and decrease morbidity in the second twin (AU)