[Usefulness of stress-free test in preeclampsia]. / Utilidad de la prueba sin estrés en la preeclampsia.

INTRODUCTION: Poor perinatal outcome in patients with preeclampsia has been reported. This significant risk reinforces the importance of fetal evaluation. OBJECTIVE: The purpose of this study was to evaluate the utility of the nonstress test (NST) in preeclampsia. STUDY DESIGN: Criteria for inclusion in this report comprised pregnancies complicated by preeclampsia of longer than 28 weeks of gestation delivered 24 hours of final NST. The study population were divided into mild and severe preeclampsia. Each of the latter two groups was further subdivided into three subgroups by gestational age at 28-31, 32-34 and > 35 weeks. Measurements of adverse perinatal outcome included meconium staining, oligohydramnios, five-minute Apgar score less than 7 beyond 34 weeks of gestational age, intrauterine growth retardation, and perinatal death. RESULTS: A total of 250 patients with preeclampsia were analyzed, among these 147 with mild and 103 with severe disease. There were no stillbirths. Sensitivity of the NST was low ranged from 39% (mild preeclampsia) to 63% (severe disease). Its positive predictive value was equally low (66 and 45%) respectively. Specificity was quite high in both groups (89 and 64%). Its negative predictive value was 73% for mild disease and 78% for severe preeclampsia. CONCLUSION: The NST is an important test in antepartum care but based on its low sensitivity should not be considered as a stand alone test.

[Maternal morbidity and mortality in HELLP Syndrome]. / Morbimortalidad materna en síndrome de HELLP.

OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

[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.

[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.

[Maternal and perinatal morbidity-mortality in pregnant women with renal transplant]. / "Morbimortalidad materna y perinatal en pacientes embarazadas con trasplante renal".

The outcome of 32 pregnancies in renal allograft recipients is reported. The mean age at the time of conception was 27.3 years (range, 20 to 37) with an average interval of 47 months from the time of transplantation to conception (range, 2 to 163). Twenty-nine patients received the graft from a living related donor, one from a living no related donor an 2 from cadaver donors. All patients continued their immunosuppressive regimen during pregnancy and only 6 patients were taking cyclosporine A. Hypertension during pregnancy was observed in 10 patients (31%), superimposed preeclampsia in 4 (14%), preterm labor in 4 (14%) and premature rupture of membranes in 2 (7%). Twenty-eight pregnancies resulted in 28 liveborn infants and there were 4 miscarriages. Cesarean section was performed in 17 cases and 11 had vaginal delivery. Intrauterine growth retardation was observed in 4 cases (14%), fetal distress in 2 (7%) and one neonatal death due to multiple malformations. There was not significative impairment of renal function in this group.

[Management of refractory autoimmune thrombocytopenic purpura during pregnancy, Review of the literature and report of three cases]. / Manejo de la púrpura trombocotopénica autoinmune refractaria durante el embarazo. Revisión de la literatura e informe de tres casos.

The immune thrombocytopenic purpura (ITP) is an immunological disease associated with pregnancy; it is difficult to control when there is not an adequate response to the treatment mainly with prednisone (refractory). When this problem occurs there are other ways to treat it: monthly pulses of dexamethasone (oral or intravenously), administration of gamma globulin or anti D and occasionally to perform a splenectomy. Three cases of refractory ITP and pregnancy are presented using different treatment in each case: Case 1 hyperimmune gammaglobulin; case 2 platelets by transfusion and in case number 3 monthly dexamethasone oral pulses. In the case treated with hyperimmune gammaglobulin the maternal response was acceptable but neonatal demise occurred due to hemorrhage; in the treated with platelets transfusion, there were maternal and fetal deaths; the best results were obtained with the administration of dexamethasone monthly, in this way we were able to reach the term of the pregnancy with good results for mother and neonate. The importance of early diagnosis is imperative and initiating the adequate treatment that according to our results would be dexamethasone pulses; the use of hyperimmune gammaglobulin in restricted due to high cost, and the platelets transfusion would be indicated only in cases of severe thrombocythopenia, imminence of hemorrhage or if a surgical procedure has to be done. An extensive review of the literature is done.

[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)

[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.

[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.

[Procoagulant properties of the amniotic fluid. IV. The acceleration time of thromboplastin in the amniotic fluid in pathologic pregnancy]. / Propiedades procoagulantes del líquido amniótico. IV. El tiempo de aceleración de tromboplastina en líquido amniótico en el embarazo patológico.

With the purpose of know the behaviour of the thromboplastic acceleration time in amniotic fluid, there were analized 390 amniotic fluids, 241 from normal pregnancies and 149 from abnormal pregnancies, of these, 52 from diabetic women, and 97 from hypertensive women. It was found an important increase in T.A.T. with the progress of pregnancy and their usefulness as fetal lung maturity test. It was concluded, that this method is easy, cheap, and highly specific, so it can be the first election test for determination of fetal lung maturity in low resources Obstetric Centers.

[Cardiotocography in intrauterine growth retardation]. / Cardiotocografía en retardo en el crecimiento intrauterino.

Fifty seven cases of intrauterine growth retardation were analyzed at the Department of Perinatal Medicine, "Luis Castelazo Ayala" Hospital, IMSS. The main purpose of the study was to establish the usefulness of cardiotocography in the decision of pregnancy interruption. The patients were divided in three groups in relation to the last non stress test made before delivery (reactive, non reactive, non reactive, non reactive with declarations). It is concluded that cardiotocography is a useful procedure for the surveillance of these fetuses and it was found a good correlation between progressively ominous traces and fetal condition at birth.

PIP: Early diagnosis, adequate follow-up, and determination of the ideal moment for delivery are fundamental aspects of management of intrauterine growth retardation. This study evaluates the usefulness of cardiotocography in follow-up such cases and in the identification of the best moment for delivery. 57 cases of intrauterine growth retardation were studied at the Department of Perinatal Medicine of a Mexican Institute of Social Security hospital in Mexico City between July 1986-June 1987. The 57 cases were divided into 3 groups based on the results of the most recent nonstress test made 72 hours or less before delivery. Group 1 consisted of 15 cases with reactive tests, group 2 of 17 cases with nonreactive tests, and group 3 of 25 cases of nonreactive tests with decelerations. In group 1 there were no histories of previous complicated pregnancies. In group 2 there were 3 cases of low birth weight and 7 of preterm birth in previous pregnancies. In group 3 there were 3 cases of low birth weight, 2 of preterm birth in previous pregnancies. In group 3 there were 3 cases of low birth weight, 1 of preterm birth, 5 of stillbirth and 1 neonatal death. 77.1% of the 57 mothers were hypertensive, 5.2% had cardiopathies, and 1.7% each had lupus erythematosus, prolonged pregnancy, and hyperparathyroidism. There was no associated pathology in 12.2% of cases. There were 13 caesareans and 2 vaginal deliveries in group 1, with a fetal indication for cesarean in 3 cases. In group 2 there were 13 caesareans and 4 vaginal deliveries, with 9 maternal and 4 fetal indications for cesarean. 24 of 25 deliveries in group 3 were cesarean, with fetal indications in 22 cases and both fetal and maternal indications in 2 cases. The nonstress test was the basic criterion for the indication in group 3. The average birth weight and gestational age respectively were 1798 g and 37.2 weeks for group 1, 1681 g and 36.5 weeks for group 2, and 1551 g and 37 weeks for group 3. The average Apgar score at the minute of birth was 6.8 for group 1, 6.6 for group 2l, and 5.1 for group 3. There were 3 fetal deaths, 2 in group 2 including 1 case of anencephaly and 1 which occurred 48 hours after a recommendation for cesarean following a deterioration in the nonstress test. 1 death in group 3 followed a misinterpreted nonstress test. 4 neonatal deaths included 1 in group 1 from septicemia probably acquired in the nursery and 3 in group 3 attributed to cerebral hemorrhage. The results indicate that the presence of spontaneous decelerations in the fetal heart beat strongly suggest fetal compromise, and are an alarm signal in case of intrauterine growth retardation. The nonstress test is a useful tool in such cases.