PP078. Total antioxidant capacity in patients with pregnancy induced hypertension: Its relation to maternal and/or perinatal complications.

INTRODUCTION: Pregnancy-induced hypertension (PIH) is a major cause of maternal and perinatal mortality and morbidity, particularly in under-resourced countries, like Mexico. Studies on PIH have shown increased oxidative stress products such as malondialdehyde and decrease of total antioxidant capacity (TAC). In this research we measured one marker of oxidative stress (OS) the TAC in patients with PIH and we associated it with the development of maternal and/or fetal complications. OBJECTIVES: Determine whether the plasma level of total antioxidant capacity (as a marker of oxidative stress) influences the development of maternal and/or perinatal complications in patients with PIH. METHODS: A observational, analytical, clinical study was conducted in patients with gestational hypertension (GH), mild preeclampsia (MP), severe preeclampsia (SP) and normal pregnancy (NP) > or = 28weeks gestational age. Serum samples were collected and stored at -70°C until use for the determination of total antioxidant capacity. It was associated with the development of maternal and/or perinatal complications. RESULTS: TAC level in normotensive patients (NP) was mean of 2679 +/- 2014mEq/L while in hypertensive patients (GH, MP, SP) was on mean of 1502 +/-1340mEq/L (p<0.05), in the GH group was 1620 +/-1042mEq/L, in the MP group was 1977 +/-1865mEq/L, in the SP was 819 +/-305meq/L The mean TAC level in the 29 patients who had maternal and/or perinatal complications was 1521mEq/L, while in the 38 patients who showed no maternal and/or perinatal complications the mean was 2355mEq/L (p<0.05). Of the 29 patients who had complications 15 (52%) had greatly diminished TAC levels (less than 1000mEq/L), 9 (31%) had between 1000 and 2500mEq/L and only 5 (17%)>2500mEq/L. 72% (28/39) of PIH group had one or more maternal and/or perinatal complications, while only 1 patient (3.6%) of 28 patients with NP had one or more maternal and/or perinatal complications (p<0.05). CONCLUSION: Patients with decreased TAC level had a higher percentage of maternal and/or perinatal complications. Patients with PIH classified as mild preeclampsia, showing reduced TAC level should be in close observation as they have the risk of developing life-threatening complications since management is usually as outpatient.

[Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara]. / Intento de parto vaginal en 1000 pacientes con antecedente de una cesárea previa en el Antiguo Hospital Civil de Guadalajara.

Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

[Reduction of the number of cesarean sections from 28% to 13%: does it reduce or increase perinatal maternal mortality: the great doubt?]. / La reducción de cesáreas de 28 a 13% incrementa o no la mortalidad materna y perinatal; la gran duda?

According to the new trends related to decrease the cesarean section rates, we conducted our retrospective investigation in order to investigate if the decrease of the cesarean section from 28 to 13%, affect the perinatal mortality (before labor and during labor) and maternal mortality. The years included in this paper were 1990 and 1995. We justified our investigation because some professional in health, believe that the decrease of the cesarean section produce an increase of the maternal and perinatal mortality. In 1990 and 1995 this were our obstetric activity respectively: 1954 and 1504 cesarean section, 4899 and 9176 vaginal deliveries, 6893 and 10730 alive newborns, 172 and 199 perinatal deaths, and finally 9 and 11 maternal deaths. The comparative statistical analysis is as following: for perinatal mortality CHi2 8.00, p 0.004 and OR 1.33 (1.09-1.66) and for maternal mortality Chi2 0.34, P 0.56 and OR 1.30 (0.50-3.36). The risk of perinatal deaths increased in 1990. In relation to the maternal deaths, the risk of mortality didn't increase in 1995.

[How to reduce the number of cesarean sections?]. / Que hacer para reducir el número de cesáreas?

The cesarean section (C) frequency has increased dramatically as high as 62%. This situation has been producing a real preoccupation in all the world as well as in México. Documented bibliography about this subject, is unquestionable. We feel that at this time there is a lack of punctuals strategies in order to reduce the high frequency of C. Our communication analyzes this problem in relation to antecedents, evolution and integrated general strategies in order to reduce the C rates. Special analysis and comments involve amnioinfusion, trials for vaginal deliveries in case of previous cesarean section, prostaglandins, and external version. With these actions, at the Antiguo Hospital Civil de Guadalajara we have achieved 10.8% of C. rates, without any increase in fetomaternal morbility and/or mortality.

[Immunopathology of early abortion: current status]. / Inmunopatología del aborto temprano: lo actual.

We reviewed the bibliography concerning the roles involved in the immunological mechanism related to the etiology of miscarriage, pointing out the main theories specially related to the Major Histocompatibility Complex and TLX antigen all together are beginners of the antiidiotype reaction in order to avoid having a miscarriage. It is mentioned that the blocking antibodies, suppressor cells and interleukines arrest the citotoxic immune mechanism against the fetal allograft. The new therapeutic approach is mentioned.

[Acute kidney failure associated with the HELLP syndrome. A case report]. / Insuficiencia renal aguda asociada al síndrome de HELLP. Presentación de un caso.

A patient with 36 weeks' gestation with severe preeclampsia and HELLP syndrome associated to acute renal failure, was studied. Symptomatology, abnormal laboratories results and treatment, are emphasized. The haptoglobin level has been reported like sensitive marker of moderate hemolysis; it could permit an early diagnosis of HELLP syndrome. On the basis at physiopathology mechanism that were described, HELLP syndrome is susceptible of prevention in patients with high risk.

[Interleukins and pregnancy: a disputed reality]. / Interleukinas y embarazo: una realidad cuestionada.

We are reviewing information concerning to the role of interleukins (ILs) in labor and pregnancy; these substances produce the ignition of the arachidonic acid/prostaglandins cascade to induce labor, this process could be also activated by bacterial lipopolysaccharides in this case we could have preterm labor. The activity and production of IL-2 normally is inhibited, if it does not happen an abortion could result. IL-3 and stimulatory growth factors (SGFs) are implicated in the growth and development of the pregnancy, the alteration in the production of this IL could produce intrauterine growth retardation, both of this ILs are acting in the maternal fetal interface. We consider very important that the gynecologists and obstetricians should have more information about ILs related to normal and complicated pregnancy.

[The intensity of fetal movements vs. amnioscopy and cardiotocography in assessing fetal well-being]. / Intensidad de movimientos fetales vs. amnioscopia y cardiotocografía en la evaluación del bienestar fetal.

In 1989 at the Hospital Civil of Guadalajara we make a study with 100 patients with a term pregnancy, initial labor and alive fetus. At all women we practiced interrogatory about subjective intensity of fetal movements, amnioscopy and cardiotocographic registry and we compare results with Apgar score of the newborns at minute and five minutes. The fetal movements were normal in 91% of which 95.7% had Apgar score > or = 7 at minute and 98.9% Apgar score > or = 8 at five minutes; clear amniotic fluid in 75% of which 94.6% had Apgar score > or = 7 at minute and 100% had Apgar > or = 8 at five minutes and 94% with normal cardiotocographic registry of which 95.7% had Apgar score > or = 7 at minute and 100% had Apgar score > or = 8 at five minutes. In the distress fetal prediction, the best method was the cardiotocography and the worse was the meconial amniotic fluid. We conclude that the subjective intensity of fetal movements are similar in the well-being fetal prediction to the amnioscopy and cardiotocography and the physicians must use it in the obstetric care.

[Oxytocin. Use and abuse]. / Oxitocina. Uso y abuso.

From 1985 to 1988 we analyzed two hundred puerperas with term pregnancies and live newborns which pregnancy ended by vaginal route. One hundred of them received oxytocin during the labor and one hundred didn't receive it. The results showed that the use of oxytocin produces and increase in the cervical and vaginal tears; the Apgar score of the newborns was lower with a longer period in the incubator, and a high rate of complications regarding to respiratory distress and jaundice. These results were statistically significant according ti Chi square test with p less than 0.05.

[Eclampsia management at the Civil Hospital Medical Complex of Guadalajara]. / Manejo de la eclampsia en el Complejo Médico Hospital Civil de Guadalajara.

Prospectively from 1986 to 1988 we studied at the "Complejo Médico Hospital Civil de Guadalajara" 17 eclamptic patients treated with diazoxide besides magnesium sulfate, diazepam and dexamethasone. The average age was 25.4 years, the average gestational age was 33.5 weeks and the average dose of diazoxide was 210 mgs. In the 88.2% of the patients the general anesthesia was used. The average Apgar at minute was 6.6 and 8.8 at five minutes. The newborns average weight was 2,135 g. We had one maternal death (5.8%) and two perinatals demise (11.8%). The more frequent maternal complications were the blindness and oliguria postdelivery and the average maternal hospitalization was 5.7 days.