Causas de muerte fetal: Un revisión de 38 pacientes / Causes associated to fetal death: A review study of 38 women

INTRODUCCIÓN: La pérdida del embarazo que ocurre tras las veinte semanas de gestación, se denomina muerte fetal (MF); es un evento que causa un gran impacto psicoemocional en la pareja afectada. La literatura médica afirma que, en casi la mitad de estos casos, no hay una causa conocida. Las causas principales están relacionadas son: síndrome antifosfolípido obstétrico (SAF), otras alteraciones inmunológicas (OIA), otros factores que pueden causar infarto placentario por coagulación, rotura prematura de membranas, preeclampsia y trombosis en la circulación útero-placentaria. MÉTODOS: Revisamos cuidadosamente la historia clínica y los estudios inmunológicos de una cohorte de 38 pacientes que han sufrido MF. RESULTADOS: Treinta y ocho pacientes (edades 36-42 años) fueron estudiadas. En más de la mitad de los pacientes (57 %) se diagnosticó SAF. El hipotiroidismo autoinmune (26 %), el anticuerpo antinuclear (24 %) comprendió el grupo de OIA. Once de 38 pacientes mostraron diferentes mutaciones de trombofilias. La hiperhomocisteinemia estuvo presente en el 53 % de los pacientes. CONCLUSIÓN: Las alteraciones inmunológicas y la trombofilia se asociaron con una proporción significativa de nuestros casos de MF. El diagnóstico de las causas evitables es necesario para evitar complicaciones obstétricas en embarazos futuros

INTRODUCTION: Pregnancy loss that occurs after the twenty weeks of gestation, termed foetal death (FD), is a rare event of pregnancy causing great psycho-emotional impact on the affected couple. Medical literature states that in nearly half of these cases, there is no known cause. Leading, causes are related to obstetric antiphospholipid syndrome (APS), other immunological alterations (OIA), other factors that may cause clotting placental infarction, premature rupture of membranes, preeclampsia, and thrombosis in the utero-placental circulation with subsequent FD. METHODS: We carefully reviewed the complete medical records and immunological studies of a cohort of 38 patients that have suffered FD. RESULTS: Thirty-eight patients (ages 36 - 42 years) were studied. In more than half of the patients (57%) APS was diagnosed. Autoimmune hypothyroidism (26%), antinuclear antibody (24%) comprised the group of OIA. Eleven out of 38 patients showed different thrombophilia mutations. Hyperhomocysteinemia was present in 53% of patients. CONCLUSION: Immunological alterations and thrombophilia were associated with a significant proportion of our FD cases. Diagnosis of preventable causes of FD is necessary in order to avoid any obstetric complications in future pregnancies

Effects of oral ciprofloxacin on aerobic gram-negative fecal flora in patients with cirrhosis: results of short- and long-term administration, with daily and weekly dosages.

BACKGROUND/AIMS: Selective intestinal decontamination has been proposed to prevent spontaneous bacterial peritonitis in cirrhosis. Because of the cost of antibiotics and the development of resistant bacteria, we have evaluated the effect of different schemes and doses of oral ciprofloxacin on aerobic gram-negative fecal flora in cirrhotic patients. METHOD: Twenty-nine cirrhotic patients were allocated to four groups to receive: Group 1: 500 mg/day for 2 weeks (six patients); Group 2: 1000 mg twice a week for 2 weeks (six patients); Group 3: 1000 mg once a week for 2 weeks (six patients); and Group 4: 1000 mg once a week for 12 weeks (11 patients). Quantitative analysis of the gram-negative fecal flora was performed before and 1 and 2 weeks after initiation of treatment in patients in Groups 1, 2 and 3 and before and 4, 8 and 12 weeks after initiation of treatment in patients in Group 4. RESULTS: Complete eradication of gram-negative bacilli was observed in four of six patients in Group 1. In contrast, only one patient eradicated gram-negative bacilli in Group 2 and Group 3. In long-term administration of ciprofloxacin (Group 4), only two of 11 patients had persistent eradication of gram-negative bacilli. Four patients developed E. coli resistant to ciprofloxacin (one of them associated to resistant Klebsiella). No patient developed bacterial infection during the study period. CONCLUSION: Oral ciprofloxacin administered in a weekly dose is ineffective in selective intestinal decontamination. Different mechanisms, including the emergence of ciprofloxacin-resistant organisms, could account for this failure. Therefore, our results suggest that weekly administration of ciprofloxacin is not useful in preventing spontaneous bacterial peritonitis.