[Obstetric hemorrhage control Bakri balloon]. / Control de la hemorragia obstétrica con balón de Bakri.

BACKGROUND: Obstetric hemorrhage is the second leading cause of maternal death in Mexico. Intrauterine tamponades are a valuable resource for the limitation of bleeding. OBJECTIVE: Analyze the success rate of the Bakri balloon in the control of obstetric hemorrhage and calculate the fill volume with clinical parameters. MATERIAL AND METHODS: Descriptive, retrospective and observational study Subjects were included who presented refractory hemorrhage on administration of uterotonics (postpartum, caesarean section, post-caesarean section, and post-miscarriage); a Bakri balloon was inserted with epidural anesthesia. The procedure was considered successful where there was immediate cessation of hemorrhage without recurrence. The fill volume in milliliters (FV) was analyzed with a linear regression that included gestational age in weeks (GA) and neonatal weight in grams (NW). RESULTS: The study included 35 subjects: 20 postpartum (57.1%), 10 caesarean and post-caesarean section (28.5%), and 5 post-miscarriage (14.2%). Use of the Bakri balloon was successful in 33 cases (94.2%). Unsuccessful cases involved subinvolution of the placental site and placenta accreta. Fill volume correlated with gestational age (r=0.50, p=0.001) and with neonatal weight (r=0.47, p=0.002). The linear regression equation for calculation of the fill volume is FV = 150 + (4.3 x GA) + (0.03 x NW), (p = 0.003). CONCLUSION: Use of the Bakri balloon is safe, simple, and effective; we encountered no adverse reactions in this study. The procedure can be carried out after delivery or miscarriage or during or after a caesarean section.

[Adverse perinatal outcomes in Mexican women with twin pregnancy achieved by assisted reproduction techniques vs. spontaneous twin pregnancies]. / Resultados perinatales adversos en mujeres mexicanas con embarazos gemelares por reproducción asistida vs. gemelares espontáneos.

BACKGROUND: Twin pregnancies (TP) have shown a greater risk of adverse perinatal outcomes than singletons have. However, there is still no consensus about whether the TP achieved by assisted reproduction techniques (ART) have worse perinatal outcomes compared with TP achieved spontaneously. OBJECTIVE: Compare the incidence of adverse perinatal outcomes (preterm birth, premature rupture of membranes, gestational diabetes, pregnancy-induced hypertension, anemia, weight and destination of the newborn) in Mexican women with TP achieved spontaneously vs those with TP achieved by ART. METHODS: Historical cohort study with two sample groups: group 1, women with TP achieved spontaneously, and group 2, women with TP achieved by ART. Women with TP achieved by TRA were matched 1:1 with women with EG achieved spontaneously for age, weeks of gestation, chorionicity and body mass index at admission to prenatal care. Adverse perinatal outcomes were compared between the two groups and the odds ratio (OR) had a 95% confidence interval. RESULTS: There were 57 women per group. Baseline characteristics were similar in both groups except for nulliparity (38.6% in group 1 vs 82.5% in group 2 (p < 0.0001)). In group 2 there was a higher incidence of pregnancy-induced hypertension (group 1 (19.3%) vs. group 2 (42.1%), OR 2.5 (95% CI 1.07-5.8)). Newborns in group 2 were admitted to nursery more often than those in group 1 (49.1% vs. 35.1% OR 1.7 IC 95% 1.04-3.04). There was no difference in other adverse perinatal outcomes. CONCLUSIONS: Mexican women with TP achieved by ART had higher risk of pregnancy-induced hypertension compared to women with TP achieved spontaneously.

Abordaje diagnóstico del cáncer de mama en el Instituto Nacional de Perinatología / Diagnostic approach of breast cancer in the National Institute of Perinatology

El cáncer de mama en la mujer ocupa el primer lugar como causa de muerte por cáncer en México, desde 2006. El diagnóstico tardío implica que el tratamiento sea más costoso, doloroso y con menor posibilidad de curación. Objetivo: Analizar el abordaje diagnóstico utilizado en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, en pacientes con diagnóstico de cáncer de mama. Material y métodos: Se realizó un estudio observacional, retrolectivo, transversal y descriptivo, de enero de 2004 a diciembre de 2010. Se incluyeron 54 pacientes de entre 29 y 85 años de edad; el motivo de la consulta fue presentar algún síntoma. El principal síntoma fue la tumoración mamaria, con un promedio de evolución de 8.4 meses; 84% presentaba lesión palpable; en 82.4% de los casos se realizó mastografía, y en 80.4%, ultrasonido. El diagnóstico definitivo de cáncer de mama se realizó mediante biopsia, en un tiempo promedio de 3.8 meses; en el 37% de los casos se realizó examen transoperatorio, el tipo histológico más frecuente fue el ductal infiltrante en 67.4%; se realizó el diagnóstico en estadio II en 46.3%. Al comparar la estadificación clínica con la patológica, el tamaño tumoral y ganglionar coincidieron en 64.7 y 59.5%, respectivamente. Conclusiones: El cáncer de mama constituye hoy una gran amenaza, y es uno de los desafíos más importantes para los profesionales de la salud de la mujer. Por lo tanto, el ginecoobstetra tiene un papel fundamental en la atención, diagnóstico y tratamiento de las enfermedades de la mama en la mujer.

The breast cancer is the first cause of death among cancers in Mexico, since 2006. Late diagnosis means that treatment is more expensive, painful, and has less chance of cure. Objective: Analyze the diagnostic approach done by the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Material and methods: A retrolective, observational, descriptive, cross sectional study was done, from January 2004 to December 2010. 54 patients, between 29 to 85 years of age were studied. The most important symptom to request consultation was tumor of the mammary gland, with an evolution of 8.4 months. 84% of the cases had a palpable lesion. Mastography was done in 82.4% of the cases and ultrasound in 80.4%. The final diagnosis of breast cancer, was done through biopsy in an average of 3.8 months, and in 37% of the cases an intraoperatory study was done. The histological type most seen was the ductal infiltrative, in 67.4% of the cases. The stage at the time of diagnosis was II, in 46.3% of the cases. Comparing clinical staging with pathological tumor size and nodal agreed 64.7 and 59.5% respectively. Conclusions: Therefore the OB-GYN has a key role in addressing the diagnosis and treatment of breast diseases in women.

Bladder rupture caused by postpartum urinary retention.

BACKGROUND: Postpartum bladder rupture is an uncommon surgical emergency and a diagnostic challenge. CASE: A primigravida delivered a healthy newborn without complications at 39.4 weeks of gestation. The patient was admitted 80 hours postpartum with abdominal pain, oliguria, hematuria, and pain that worsened during the previous 4 hours. An inserted Foley catheter drained only a small amount of urine, and serum creatinine was elevated (3.5 mg/dL). A laparotomy was performed and revealed a 10-cm hole in the urinary bladder. The bladder was repaired and the patient was discharged 15 days after surgery. The follow-up cystoscopy revealed adequate healing of the bladder. CONCLUSION: Urinary retention can lead to serious complications, including bladder rupture. Postpartum bladder rupture due to urinary retention should be ruled out if there is a history of abdominal pain, oliguria, and elevated of serum creatinine.

[Vitamin C decreases MMP-9 synthesis induced by hydrogen peroxide in an in vitro chorioamniotic membrane model]. / La vitamina C disminuye la síntesis de MMP-9 inducida con peróxido de hidrógeno en un modelo de estudio in vitro de membranas corioamnióticas.

OBJECTIVE: To evaluate the hydrogen peroxide ability to induce the synthesis of matrix metalloproteinase-9 (MMP-9) in an in vitro chorioamniotic membrane model. MATERIAL AND METHODS: An experimental, transversal, analytic and prospective study was made. From amniotic membranes (n = 13) of term labour pregnant women chorionic and chorioamniotic explants were prepared; these were stimulated with hydrogen peroxide [200 mcM]. A group of explants were cultured with vitamin C, 48 hours prior to the hydrogen peroxide stimulus. Twenty-four hours after hydrogen peroxide stimulus the supernatants were collected and metalloproteinase-9 production was determined by zymography methods. RESULTS: Hydrogen peroxide induced the synthesis of metalloproteinase-9 in chorionic and chorioamniotic membranes. When chorionic and chorioamniotic membranes were cultured with vitamin C prior to the hydrogen peroxide stimulus, the MMP-9 production diminished (p < 0.05; Dunn's method). CONCLUSIONS: Hydrogen peroxide induced the synthesis of metalloproteinase-9 in chorionic and chorioamniotic membranes. When chorionic and chorioamniotic membranes were cultured with vitamin C, 48 hours prior to peroxide hydrogen stimulus, the metalloproteinase-9 production diminished with statistical significance.

The predominant Th1 cytokine profile in maternal plasma of preeclamptic women is not reflected in the choriodecidual and fetal compartments.

OBJECTIVE: Human pregnancy disorders such as preeclampsia are thought to involve variations in cytokine levels. It has been proposed that, in preeclamptic women, a balance favoring the Th1-type over the Th2-type cytokine profile determines local or systemic immunologic responses to pregnancy and that this may cause defective placental implantation and placental ischemia, which activate systemic endothelial cells. The purpose of this study was to determine whether cytokine expression differs in the maternal, choriodecidual, and fetal compartments, and between women with or without preeclampsia. METHODS: Plasma concentrations of interferon gamma (IFNgamma), interleukin (IL)-2, IL-4, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) in samples obtained from maternal peripheral blood (MPB), choriodecidual (CD), and fetal cord (FC) blood compartments of 17 women with preeclampsia and in 15 normotensive women. Intracellular concentrations of IFNgamma and IL-2 in T lymphocytes were assessed by flow cytometry. RESULTS: Plasma IFNgamma concentrations in both MPB and CD compartments were significantly higher in preeclamptic than in normotensive women. Maternal plasma IL-4 concentration was significantly lower in preeclamptic than in normotensive women. Intracellular IFNgamma and IL-2 concentrations did not differ significantly between preeclamptic and normotensive women. CONCLUSIONS: The dominant Th1-type over Th2-type cytokine profile is evident in MPB, but not in the CD and FC blood compartments. This might reflect the complex cytokine networks in the fetal-placental interface and might involve trophoblasts or decidual and endothelial cells, which could account for the increased plasma IFNgamma concentration and T-helper cell number.

Cerclaje de urgencia: experiencia institucional / Emergency cerclage: institutional experience

Introducción: Determinar la frecuencia de utilización del cerclaje de urgencia en nuestro medio y analizar la efectividad del procedimiento evaluado a través del resultado perinatal. Material y métodos: Se realizó la evaluación de 87 casos con cerclaje de urgencia, aplicados y resueltos en el Instituto Nacional de Perinatología (INPer) de enero de 1998 a enero del 2001; mediante un estudio observacional, descriptivo y retrospectivo. Resultados: Se encontró una sobrevida neonatal de 86 por ciento, habiendo utilizado en la mayoría de los casos la técnica Espinosa Flores modificada (70 por ciento) vs. McDonald. Las complicaciones resultaron menores, predominando la infección genitourinaria; en tanto los promedios encontrados fueron: colocación 19 ñ 2, retiro 34.6 ñ 5, resolución 35.1 ñ 5 semanas y semanas ganadas 16 ñ 6. El borramiento cervical fue el factor de riesgo más importante para el parto pretérmino RM 3.9 (IC 95 por ciento 1.30-11.81). Conclusiones: La frecuencia de utilización del cerclaje de urgencia fue baja; sin embargo, existe evidencia clínica a favor de su utilidad en nuestro medio, dada la alta sobrevida neonatal y baja morbimortalidad materno-fetal.