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Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8-15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8-15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences.
RESUMO
Resumen: OBJETIVO: Revisar la bibliografía más reciente para valorar y sintetizar los aspectos más importantes relacionados con las repercusiones del hipotiroidismo y su asociación con infertilidad en la mujer en edad reproductiva. METODOLOGÍA: Estudio de investigación documental consistente en la búsqueda en las bases electrónicas de PubMed y Google Scholar (1993-2018) con las palabras clave: hipotiroidismo subclínico, hipotiroidismo, disfunción tiroidea, hipofunción tiroidea, enfermedad de tiroides subclínica, pérdida de embarazo, aborto y embarazo; escritos en español e inglés y estudios retrospectivos publicados en libros de texto. RESULTADOS: Se incluyeron 39 documentos y se seleccionaron los de mayor relevancia científica y epidemiológica. El hipotiroidismo afecta a las mujeres en edad reproductiva con prevalencia de 0.4-0.5% para el evidente y 2-8% para el subclínico, este último puede resultar en infertilidad femenina y pobres desenlaces reproductivos. CONCLUSIÓN: El hipotiroidismo es una enfermedad que afecta más a las mujeres que a los hombres, con mayor incidencia en la etapa fértil. El diagnóstico y tratamiento oportuno mejoran el pronóstico de la fertilidad, embarazo y vida del recién nacido.
Abstract: OBJECTIVE: To review the most recent bibliography to assess and synthesize the most important aspects in relation to the repercussions of hypothyroidism and its association with infertility in women of reproductive age. METHODOLOGY: Documentary research study carried out based on the search in PubMed and Google Scholar; from the years 1993 to 2018 with the keywords: subclinical hypothyroidism, hypothyroidism, thyroid dysfunction, thyroid hypofunction, subclinical thyroid disease, pregnancy loss, abortion and pregnancy in Spanish and English and retrospective study in textbooks. RESULTS: 39 documents were included, selecting the ones with the highest scientific and epidemiological relevance. Hypothyroidism affects women of reproductive age with a prevalence of 0.4-0.5% for the obvious and 2-8% for the subclinical, the latter can result in female infertility and poor reproductive results. CONCLUSION: Hypothyroidism is a pathology that affects women, with a higher incidence in the fertile stage. A timely diagnosis and treatment improve the prognosis of fertility, pregnancy and life of the newborn.
RESUMO
Resumen: ANTECEDENTES: Las malformaciones müllerianas son un grupo de alteraciones congénitas que resultan del inadecuado desarrollo de los conductos de Müller durante la embriogénesis. El 25% de las mujeres con malformaciones müllerianas tiene problemas obstétricos. La rotura espontánea del útero didelfo durante el embarazo es un accidente poco frecuente y de difícil diagnóstico. La importancia del estudio de estas malformaciones radica en las posibilidades diagnósticas y terapéuticas, además del pronóstico reproductivo de las pacientes. CASO CLÍNICO: Paciente de 27 años, acudió a consulta por dolor abdominal intenso súbito. A la exploración física se encontraron: tensión arterial de 90-50 mmHg, palidez cutáneo-mucosa, hipotensión e hipotermia, abdomen doloroso, fondo uterino no delimitable y datos de irritación peritoneal; cuello uterino cerrado, sin sangrado transvaginal. En la ecografía: feto único extrauterino, con ausencia de actividad cardiaca, de 21.2 semanas de gestación y líquido libre en la cavidad abdominal. La laparotomía exploradora reportó: útero didelfo con ruptura uterina, por lo que se procedió a la metroplastia de Strassman, con resultados satisfactorios. CONCLUSIÓN: Aún con la escasa frecuencia de estos casos siempre será conveniente tenerlos en mente en el diagnóstico diferencial de mujeres embarazadas que en el segundo trimestre manifiestan dolor abdominal. Este caso sirve como precedente para la atención y tratamiento temprano, con la intención de evitar complicaciones, como la ruptura uterina.
Abstract: BACKGROUND: Mullerian malformations are a group of congenital pathologies resulting from from an inadequate development of the Mullerian ducts during embryogenesis. The 25% of women with mullerian malformations have obstetric problems. Spontaneous rupture of the didelphys uterus during pregnancy is a rare and difficult- to- diagnose accident. The fundamental importance of the study of these malformations lies in the various diagnostic and therapeutic possibilities employed, in addition to the improvement in the reproductive prognosis of the patients. CLINICAL CASE: 27-year-old patient, who starts suddenly with severe abdominal pain. She arrives at the emergency department with blood pressure of 90/50 mmHg, pale-mucous paleness, coldness, hypotension and hypothermia, painful abdomen, non-delimitable uterine fundus, with data of peritoneal irritation; closed cervix, without transvaginal bleeding. On ultrasound: single extrauterine fetus, with absence of cardiac activity, 21.2 weeks, presence of free fluid in abdominal cavity. An exploratory laparotomy is performed by finding a didelphys uterus with uterine rupture and a Strassman metroplasty is performed. CONCLUSION: Despite the low frequency of the clinical case presented, we believe that it should be considered in the differential diagnosis of pregnant women with abdominal pain in the second trimester. Likewise, we consider it important to make it known to contribute to early approach and treatment, avoiding complications such as uterine rupture.
