[Non-immunologic hydrops. Report of 2 cases]. / Hidrops no inmunológico. Informe de dos casos.

UNLABELLED: Non immune hydrops is an uncommon entity, it is observed in one per 2,000 to 3,500 alive birth. It can be idiopathic or secondary to different pathologies, the most important examples are: congenital malformations, cromosompathies or viral infections. OBJECTIVE: To show our therapeutic and diagnostic experience in two cases of non immune hydrops. STUDY DESIGN: To present a case of spontaneous reversion of non immune hydrops secondary to parvovirus B 19 infection and other case secondary to congenital cardiopathy. RESULTS: We found spontaneous reversion of a case of non immune hydrops due to a parvovirus B 19 infection and infant was normal but the infant with congenital cardiopathy died ten minutes after birth. CONCLUSIONS: Two of the most important causes of non immune hydrops are cardiopathies and infections, specially parvovirus which is responsible of poor perinatal outcome but there is a remote possibility of spontaneous reversion because it is important to make a specific diagnose and to make the expected management.

[The induction of fetal lung maturity in pre-eclampsia]. / Inducción de madurez pulmonar fetal en preeclampsia.

The consensus of the world literature shows that the prematurity is the first cause of perinatal morbidity and mortality. In this period several are the complications to short and long term that they can be presented, but seems be that it is the respiratory distress syndrome (RDS) the principal cause of this problems. This syndrome is frequent in the neonate of mothers with severe preeclampsia of early appearance in which exists the need of interruption the pregnancy. There are some articles, that show that preeclampsia by itself or the steroids given antenatally to the mother may accelerated the fetal lung maturity. The objective of the present study was analyze the behavior of the phospholipids responsible for the fetal lung maturity in amniotic fluid, with the administration of steroids to mothers with preeclampsia, and its correlation with the presentation of the RDS in the RDS in the newborn. 31 patients were included in the study, all of them with severe preeclampsia without complications, between 28 and 33 weeks of pregnancy. Twenty one patients received 12 mg of betametasone i.m. in 2 doses one each day (Group 1) and 10 patients who did not receive the steroid (Group 2). All the births were by cesarean section, amniocentesis was done during this procedure. The relation L/E > or = were observed in 81% of the patients of group 1. In the group 2 the relation L/E < or = 2 were observed in 80% of the cases. The RDS was present in 47% of the neonates in Group 1 and in 100% of the group that did not receive betametasone (p 0.004). The perinatal mortality (20%) was present only in the that did not receive betametasone. The findings of the present paper shows that the administration of betametasone in patients with severe preeclampsia accelerated the fetal lung maturity more the disease in consequence the frequency and severity of the RDS were less.

[Maternal mortality from eclampsia. A 5-year experience]. / Mortalidad materna por eclampsia. Cinco años de revisión.

UNLABELLED: Eclampsia is the most important cause of maternal mortality in our hospital. The main purpose of the present study was to define the main clinical, social and demographic profiles of the pregnant women at risk of fatality due to eclampsia. Of a total 71 maternal deaths that took place our hospital from January 1991 to December 1995, 37 cases were due to eclampsia, and they are the subject of the present analysis. RESULTS: The fatalities due to eclampsia represented 52.1% of the total mortality. The average age of these women were 26 years, 46% were primigravid and 20% were chronically hypertensive. Eclampsia was diagnosed at an average of 33 weeks gestation. The most important clinical signs were: severe headache, vomiting and convulsions. Systolic blood pressure on admission was 160 mm Hg with an average of 110 mm Hg for the diastolic figure. Proteinuria greater that 3 g/L was present in 45% of the cases. Signs of hemolysis, a platelet count below 100,000 mm3 and liver involvement with increased levels of amino-transferases. CONCLUSIONS: The pregnant women likely to die from eclampsia seems to be relatively older, multipara, with underlying chronic hypertension, with early onset of the clinical picture, and with multisystemic manifestations of the disease, mainly in the hematologic, hepatic and neurologic territories.

[Presence of fetal fibronectin in cervico-vaginal secretion as predictor of premature labor]. / Presencia de fibronectina fetal en secreción cérvico-vaginal como predictor de parto pretérmino.

The objective of this article is to correlate a new biochemical method called fetal fibronectin (fFN) found in cervico-vaginal secretions (CVS) in pregnant woman with the presence or not of preterm labor. In this paper the patients studied had pregnancies of 24 up to 37 weeks of pregnancy. The were free of symptoms and without risk factors for preterm labor. The cervico-vaginal specimen was taken with special equipment designed for this purpose (Adeza Biomedical Collection Kit). The laboratory processed this for immunoassay. A positive fFN was considered above 0.05 microgram/dl. There were 263 patients enrolled for this study. Of these 232 had fFN negative (89%) and 31 were positive (12%). The weeks of gestation at birth were 38.6 for the negative group and 34.4 for the positive group (p < 0.0001). Only 5 neonates from the negative group were born before 37 weeks of gestation (2.2%) and in the positive fFN group this occurred in 22 case (71%) (p < 0.0001). The average weight at birth for the negative fibronectin group was 3152 g. for the positive group (p < 0.0001). The neonatal morbidity was more frequent and respiratory distress syndrome was more severe in the positive fibronectin group in comparison with the negative fFN with a significant p. The same tendency was observe with the Apgar score < 7 at 1 and 5 minutes (more frequent in the positive group) (p < 0.0001). The was one neonatal death in the negative group (0.43%) and 5 in the positive group (16%) p = 0.0001. The sensibility and positive predicitive value of positive fFN for the prediction of preterm labor was 81.4 and 71 respectively and the specificity and negative predictive value for negative fFN was 96.1 and 97.8. Finally the RR for prematurity when the fFN was positive on SCV was 32.9. The presence fFN in cervical-vaginal secretion between 24 and 37 weeks of gestation seems to be a good indicator of preterm labor. In this study positive results correlate with less weeks of pregnancy and lees weight at birth. Also with higher with more morbidity and mortality. These findings give the obstetrician a better chance of an opportune diagnosis with adequate treatment and improve perinatal results.

[Reliability of optic density at 650 nm in determining lung maturity in children of diabetic mothers]. / Confiabilidad de la densidad óptica a 650 nm en la determinación de madurez pulmonar en el hijo de madre diabética.

The Diabetes Mellitus is the pathology that frequently is associated to the pregnancy and it is responsible for perinatal mobility specially by the respiratory distress syndrome since exists delay in the conversion of myoinositol-phosphatidyl inositol-phosphatidyl glycerol. To demonstrate the reliability of the DO tho 650 nm with standard of 20 in the determination of fetal lung maturity of the infant of diabetic mother. There were included 143 patient with pregnancy > or = 37 weeks with amenorrhea reliable and gestational age confirmed by ultrasound, of those 94 corresponded to gestational Diabetes Mellitus, 49 to pregestational (46 non insulin-dependent and 3 insulin-dependent). In all of them amniotic fluid studies was perform at 37 week and the resolution of the pregnancy was when DO to 650 nm showed fetal lung maturity. It was found a correlation among the DO to 650 nm of 20 and absence of RDS in 130 cases (true positive); there were seven cases with immaturity results by DO that they did not express RDS (false negative) and six cases with results that showed immaturity by DO and there were manifestations of RDS (true negative). We did not find results of false positive. The frequency of RDS was of 4.9% with a positive predictive value of the 100% an negative predictive value of 46%, a specificity of 100% and a sensitivity of 94%. An interesting finding was the fact that six cases true negative cases had poor maternal metabolic control of different degrees. For our results can be deduced that DO to 650 nm with standard of .20 it is reliable for the diagnosis of fetal lung maturity in the pregnancies complicated with Diabetes Mellitus, in addition to be an easy elaboration test and low cost.

[Predictive value of fetal pulmonary maturity tests in pregnancy of diabetic mothers]. / Valor predictivo de las pruebas de madurez pulmonar fetal en la paciente diabética embarazada.

Respiratory distress syndrome is a common morbidity in a infants of diabetic mother however there is a controversy in the literature about apparition of lung maturity in this infants. However this reports have not got a control group. Lung maturity tests were prospectively studied, obtained by amniocentesis at 37 weeks of gestation, in 47 patients: twenty diabetics (studied group) and 27 healthy pregnant women (control group). All the pregnancies were solved by cesarean section. The values of lung maturity tests were related to presence of respiratory morbidity in neonates (respiratory distress syndrome: RDS). Five of 49 infants had some kind of respiratory morbidity. The incidence of RDS was 10.2%. Four of 5 infants with RDS belonged to the diabetic group, which gives us an incidence of 20% versus only one of the 29 healthy infants (3.7%). This difference is statistically significant, p < 0.0001. Four infants had false positive lung maturity tests (Od, L/S), three of them (two with severe metabolic meladjustment) occurred in the study group, with alteration of L/S ratio (3/20 = 15%). There was no false positive in PG (specificity 100%) in both group. The 3 lung maturity tests had a specificity of a hundred per cent in the control group). This study shows that the presence of PG in amniotic fluid of diabetic pregnant women confirms maturity with a very low risk to develop RDS. Finally, when the metabolic control of the diabetic is not appropriate, the L/S ratio may give false positive results in 15% of cases, which is quite important.

[Value of the amniotic fluid rate in premature membrane rupture: prognosis of infection]. / Utilidad del índice del líquido amniótico en la ruptura prematura de membranas: Pronóstico de infección.

The presence of oligohydramnios evaluated by accumulation or major pool technique in pre-term PMR is strongly correlated with maternal and perinatal infection. The objective of this study is to evaluate the usefulness of amniotic fluid volume rate (AFVR) in prediction of maternal and fetal-neonatal infection in patients with PMR before 37 weeks. Thirty patients with PMR were prospectively studied. AFVR was done in all the patients at the time of arrival and they were managed conservatively. None of them had utero-inhibitors and only antibiotics were used after chord clamping. In absence of intrauterine infection corticotherapy was allowed. The results of AFVR were correlated with maternal infection (chorioamnioitis) and perinatal (possible neonatal sepsis or neonatal sepsis). Twenty three out of 30 patients (76.6%) had a AFVR less than or equal to 5.0 cm. (Oligohydramnios) and seven (30.4%) showed a greater rate than 5.0 cm. The earliest pregnancy was 26.5 weeks and the greatest 34.4 weeks. Out of the total of patients 13 (43.3%) had chorioamnioitis and all correspond to the group with AFVI smaller or equal to 5.0 cm. In the group with oligohydramnios were 15 neonates (65.2%) with neonatal infection (six possible sepsis and nine neonatal sepsis). All neonates with positive cultures also corresponded to the group with smaller AFVR; the comparison among the cases with oligohydramnios with infection and the ones that had normal AFVR without infection has statistical significance (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Preeclampsia in pregnancy. Importance of reclassification]. / Preeclampsia en el embarazo. Importancia de la reclasificación.

It is difficult to determine the etiology of hypertension during pregnancy on the basis of clinical criteria alone. The purpose of the present study is to emphasize the impact of the postpartum reclassification of the hypertensive disorders in gestation. One hundred and fifty eight patients with an initial diagnosis of preeclampsia were prospectively studied. The follow-up included a reclassification of their hypertensive disorder at 4, 8 and 12 weeks postpartum. Such reclassification was based on renal function test and values of blood pressure. Among 158 patients, 118 had an initial diagnosis of preeclampsia during pregnancy, and only in 39 cases (33%) such diagnosis was confirmed postpartum. At the time of reclassification the rest of the patients belonged to the following conditions: gestational hypertension without proteinuria 35%, chronic hypertension 16%, nephropathy (7 with renal biopsy) 11%, and 4% with chronic hypertension and superimposed preeclampsia. There was no significative difference in perinatal morbidity between patients with chronic and gestational hypertension. A total of 10% of perinatal mortality rate was found. We concluded that the reclassification postpartum of the hypertensive disorders in pregnancy is essential to avoid errors in diagnosis and to establish adequate maternal and perinatal outcomes in future pregnancies.

[Correlation of creatine phosphokinase blood level with prenatal fetal heart rate as a prognostic factor in tissue hypoxia]. / Correlación del nivel sanguíneo de creatin fosfoquinasa con los registros de la frecuencia cardiaca fetal anteparto, como un predictor clínico de hipoxia tisular.

The presence of a high serum activity of the creatinine phosphokinase enzyme (CPK) could be the result of an hypoxic tissue event. The existence of an ominous fetal heart rate tracing is a reliable method which indicates the presence of an hypoxic state in variable degrees. Thirty-five pregnancies between 34 and 41 weeks of gestation were prospectively studied to correlate both, CPK activity and cardiotocography, with perinatal morbidity and mortality. All the patients had antepartum fetal heart rate testing and pregnancy was terminated by cesarean section within seven days to the last fetal heart tracing. As soon as the baby was born, we took an umbilical cord sample to measure CPK activity and a second sample was also taken at 36 hours of life. All the neonates had pediatric, neurologic, electrocardiographic and sonographic evaluation within their 48 hours of extrauterine life. Two groups were created: Group A included 14 neonates with normal cardiotocographic tracings (control group) and Group B had 21 infants with abnormal tracings (study group). We found an elevated serum CPK activity with statistic significance in the next three conditions: a) In the sample at 36 hours of life when compared to the cord sample in the control group, p less than 0.001; b) In the neonatal sample at 36 hours of age when compared to the cord sample in the study group, p less than 0.001; c) In the neonates of the study group compared to the neonates of the control group at 36 hours of extrauterine life, p less than 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transient myocardial ischemia in newborn babies with perinatal asphyxia (hypoxic cardiomyopathy)]. / Isquemia miocárdica transitoria en el recién nacido con asfixia perinatal (miocardiopatía hipóxica).

A prospective study in 76 newborn with perinatal asphyxia searching for myocardial ischemia was carried out. The disease was found in 51% of the patients. With electrocardiogram, myocardial enzymes, X ray and clinical manifestations the diagnosis was elaborated. No difference in the sex was present, the mean of gestational age was 35 weeks, and with mean birth weight 2,216 g, respiratory distress was present in all the people; only 20.5% developed heart failure and two had heart murmurs; 61.5% showed cardiomegaly. The creatine kinase MB isoenzyme at twelve hours after birth was raised in most of the patients. Respiratory distress syndrome was the principal diagnosis in 38%; hypoxic ischemic encephalopathy and peri-intraventricular hemorrhage was present in 50 and 33% of the patients, respectively. Mortality rate was 33%. Also a comparative study in the infants with and without myocardial ischemia was carried out appearing significative difference in: 1. Cardiomegaly, 2. Hypoxic-ischemic encephalopathy and 3. Creatine kinase MB isoenzyme.

[Biophysical profile in prolonged pregnancy. Another alternative of fetal surveillance]. / Perfil biofísico en el embarazo prolongado. Otra alternativa de vigilancia fetal.

The value of the biophysical profile scoring to predict occur-rate perinatal outcome in prolonged pregnancy, was assessed. 60 patients with the diagnosis of prolonged pregnancy were included in this prospective clinical trial. A fetal biophysical profile score, described by Manning and modified by Johnson, was recorded in all these patients. There were 40 cases (66%) with normal profile scoring 3 of which had a feature considered as perinatal morbidity (specificity 94.8%). In contrast, from 20 cases with abnormal profile scores, 18 (90%) had abnormal perinatal findings (sensitivity 85.7%). The false positive and negative rates were low, 10 and 7.5% respectively, and the global predictive value of this test was 90%. In our study the amniotic fluid volume was the profile variable most able to identify a compromised fetus and the second with the highest specificity. Although we had a high cesarean section rate, (71%), we suggest that with normal profile scores (greater than or equal to 8) and normal amniotic fluid volume, the fetal biophysical profile may be an accurate test in the evaluation of the fetal condition in this obstetric complication.

[Biophysical profile in prolonged pregnancy. Another alternative to fetal monitoring]. / Perfil biofísico en el embarazo prolongado. Otra alternativa de vigilancia fetal.

The value of the biophysical profile scoring to predict accurate perinatal outcome in prolonged pregnancy, was assessed. 60 patients with the diagnosis of prolonged pregnancy were included in this prospective clinical trial. A fetal biophysical profile score, described by Manning and modified by Johnson, was recorded in all these patients. There were 40 cases (66%) with normal profile scoring 3 of which had a feature considered as perinatal morbidity (specificity 94.8%). In contrast, from 20 cases with abnormal profile scores, 18 (90%) had abnormal perinatal findings (sensitivity 85.7%). The false positive and negative rates were low, 10 and 7.5% respectively, and the global predictive value of this test was 90%. In our study the amniotic fluid volume was the profile variable most able to identify a compromised fetus and the second with the highest specificity. Although we had a high cesarean section rate, (71%), we suggest that with normal profile scores (greater than or equal to 8) and normal amniotic fluid volume, the fetal biophysical profile may be an accurate test in the evaluation of the fetal condition in this obstetric complication.

[Sinusoid pattern. Perinatal consequences]. / Patrón sinusoidal. Repercusión perinatal.

This is a review of 7,203 antepartum fetal heart rate recordings. It was found that the sinusoidal pattern is rare for fetal heart rate, which is seen more frequently in patients with severe Rh isoimmunization, that is easily identified, and it may lead to interruption; in its incomplete form will allow to evaluate the cases totally, as it'bit a severe fetal condition.

[Fetal growth in prolonged pregnancy]. / Crecimiento fetal en el embarazo prolongado.

Posterm pregnancy still is a topic full of controversies in many aspects, such as diagnosis, perinatal risk and management. This paper suggests that a great number of fetuses from prolonged pregnancies, still grow after term, secondary to a persistent and adequate placental function; it's demonstrated, by comparing the distribution of newborn weights between term and posterm pregnancies. In the posterm group a significant increase in the incidence of hypertrophic newborns, is found. Dismature newborns, products of the placentary insufficiency in posterm pregnancy, although the point of interest of obstetricians, pediatricians and perinatologists because of its high rates of morbimortality, constitute a minority in comparison with fetus of posterm pregnancies with high newborn weights. It is possible that fetal hypertrophy by it self may be another cause of morbimortality in posterm pregnancies (because of dystocias, prolonged labor, altered fetopelvic relations, increased rates of cesarean sections, and others) that must be determined in future longterm, prospective analysis.

Purpura trombocitopenica idiopatica y embarazo. Uso de corticoesteroides para prevenir la purpura neonatal. / Idiopathic thrombocytopenic purpura and pregnancy. Use of corticosteroids to prevent neonatal purpura

En recien nacidos de madres con purpura trombocitopenica idiopatica se puede presentar purpura neonatal como resultado del paso de anticuerpos antiplaquetarios a traves de la placenta; la principal complicacion puede ser la hemorragia intracraneana. Los metodos que se han propuesto para evitar o prevenir esta complicacion no han mostrado ser utiles en estudios amplios. En 32 pacientes embarazadas con purpura trombocitopenica idiopatica se administro prednisona a dosis bajas una a dos semanas antes y durante el parto.Otras 14 pacientes no recibieron corticoesteroides. En los recien nacidos cuyas madres recibieron prednisona la mediana de la cuenta de plaquetas, inmediatamente despues del parto, fue de 181 x 10 elevado 9 x 1; em cambio, en el grupo que no recibio corticoesteroides, fue de 108 x 10 elevado 9 x 1; (p, < 0.001). Ademas en solo el 21% de los recien nacidos cuyas madres recibieron esteroides se presento purpura en comparacion con el 66% de quienes no lo recibieron