Comparison of hemodynamic, biochemical and hematological parameters of healthy pregnant women in the third trimester of pregnancy and the active labor phase.

BACKGROUND: Pregnancy is accompanied by several hemodynamic, biochemical and hematological changes which revert to normal values after labor. The mean values of these parameters have been reported for developed countries, but not for Mexican women. Furthermore, labor constitutes a stress situation, in which these factors may be altered. It is known that serologic increase of heat shock protein (Hsp) 70 is associated with abnormal pregnancies, presenting very low level in normal pregnant women. Nevertheless, there are no studies where these measurements are compared in healthy pregnant women at their third trimester of pregnancy (3TP) and the active labor phase (ActLP). METHODS: Seventy five healthy Mexican pregnant women were included. Hemodynamic, biochemical and hematological parameters were obtained in all cases, and serum Hsp70 levels were measured in a sample of 15 women at 3TP and at ActLP. RESULTS: Significant differences were found in most analysis performed and in Hsp70 concentration at 3TP as compared to ActLP, however all were within normal range in both conditions, supporting that only in pathological pregnancies Hsp70 is drastically increased. CONCLUSION: Results obtained indicate that 3TP and ActLP have clinical similarities in normal pregnancies, therefore if abnormalities are found during 3TP, precautions should be taken before ActLP.

[Relationship between domestic violence during pregnancy and risk of low weight in the newborn]. / Relación entre la violencia familiar durante el embarazo y el riesgo de bajo peso en el recién nacido.

OBJECTIVES: To determine the prevalence and characteristics of domestic violence before and during pregnancy, and its impact on obstetrical and perinatal outcomes, as well as to identify the main variables associated to domestic violence during pregnancy. PATIENTS AND METHODS: From August to September 2004, 288 consecutive women in the puerperium period were screened for a cross-sectional study in the Hospital General Dr. Manuel Gea Gonz6lez. The Abuse Assessment Screen and the IPPF screening instrument were used to measure emotional and physical abuse during pregnancy. Outcome data included miscarriage, cesarean delivery, gestational age, birth weight and Apgar score. Odds ratios and 95% confidence intervals were calculated to measure the associations between maternal characteristics, perinatal outcome and violence. RESULTS: The prevalence of domestic violence during pregnancy was 39.24%. Emotional abuse was the most prevalent type before and during pregnancy (94.71 and 96.46%, respectively) whereas the frequency of physical and sexual decreased during pregnancy. Domestic violence 12 months before pregnancy increased risk of low birth weight (OR: 1.69; 95% CI: 1.01-2.81), and miscarriage (OR: 2.09; 95% CI 1.14-3.83). The exposure to domestic violence anytime before pregnancy (OR: 3.13; 95% CI 1.48-6.63) and 12 months before pregnancy (OR: 12.79; 95% CI 6.38-25.6) increased risk of domestic violence during pregnancy. CONCLUSIONS: Violence before and during pregnancy is common and is associated with adverse maternal and perinatal outcomes. There is a critical need to include a routine screening in the obstetric and gynecologic services and to provide medical and social services.

[Advances in hormonal contraception]. / Adelantos en anticoncepción hormonal.

This review provides an update regarding newer options in hormonal contraception that include the progestin-releasing intrauterine system, the contraceptive patch and ring, the single rod progestin-releasing implant, extended and emergency oral contraception and recent advances in hormonal male contraception. These methods represent a major advancement in this field, allowing for the development of more acceptable, safety and effective birth control regimens.

[Pregnancy induced hypertension risk factors in diabetes mellitus pregnant women]. / Factores de riesgo para hipertensión inducida por el embarazo en mujeres con diabetes mellitus gestacional.

BACKGROUND: Relation between gestational diabetes mellitus and pregnancy-induced hypertension increases significantly the maternal and perinatal morbidity and mortality risk. OBJECTIVE: The purpose of this study was to investigate the risk factors for pregnancy-induced hypertension in women with gestational diabetes mellitus. MATERIAL AND METHODS: In this case-control study, were compared a total of 90 women with gestational diabetes mellitus according to absence (controls, n = 60) or presence (cases, n = 30) of pregnancy-induced hypertension in terms of demographic data, previous reproductive history, maternal and neonatal characteristics. Odds ratios and 95 percent confidence intervals were calculated to estimate the effects of individual factors on the risk of pregnancy-induced hypertension. RESULTS: In our study, the body mass index in cases was greater than controls (35.70 +/- 8.7 vs. 31.17 +/- 5.2). In addition, pregnancy-induced hypertension in a previous pregnancy was the only factor associated with an increased risk of recurrent hypertension (OR = 4.52, IC95%: 1.02-20.03). CONCLUSIONS: Women with gestational diabetes mellitus and pregnancy-induced hypertension in a previous pregnancy require more surveillance for to prevent or achieve an early diagnosis and treatment of hypertension, and if the woman is overweight, she should be offered advice on life style adjustment for to avoid maternal and perinatal complications.

[Domestic violence: an approach from gynecology and obstetrics]. / Violencia familiar: una aproximación desde la ginecología y obstetricia.

Violence against women represents a serious violation of women's human rights and has been recognized as a clinical and public health problem, independently of nationality, ethnicity, cultural norms and socioeconomic status. One of the most common forms of violence against women is that perpetrated by an intimate male partner. The intimate partner violence has short-term and long-term negative health consequences, which provoke a poor quality of life with high use of health services, and even the suicide and homicide of women. Specifically, abuse during pregnancy is associated with sexually transmitted diseases, anemia, first and second trimester bleeding, less than optimal weight gain, deleterious perinatal outcomes (low birth weight, miscarriage, and fetal distress) and maternal or infant deaths. The purpose of this review is to emphasize the serious health consequences of the partner violence, and to compile the studies that have measured violence during pregnancy, particularly in Latin America.

[Factors related to the diagnosis of HELLP syndrome in patients with severe preeclampsia]. / Factores relacionados con el pronóstico del síndrome HELLP en mujeres con preeclampsia grave.

BACKGROUND: Each year, around 50,000 women die from preeclampsia-eclampsia worldwide. Thus, hypertensive disorders during pregnancy are public health problems in both developed and developing countries. OBJECTIVE: To identify prognosis factors associated with HELLP syndrome in patients with severe preeclampsia. MATERIAL AND METHODS: A retrospective, observational, cross-sectional, and analytical study was carried out. It included patients that suffered from severe preeclampsia, with and without HELLP syndrome. They were hospitalized at the Division of Obstetrics Dr. Manuel Gea González General Hospital, from January 1st, 1995 to January 1st, 2000 (study group). Only clinical files of patients with severe preeclampsia, without convulsions, HELLP syndrome, or who had not died during the days spent at the hospital were included in the control group; within at least 72 subsequent hours to the pregnancy termination. The connection of HELLP syndrome with the following variables was assessed in the control group: gestational age, maternal age, infant formula, prenatal control, hypertensive disorder history, headache, tinnitus, phosphen, nausea, vomiting, epigastric pain, edema, hyperreflexia, blood pressure values, hepatic biometry, platelet count, blood chemistry with hepatic function. RESULTS: Right upper quadrant or epigastric pain was the most important independent prognosis factor. There were significant differences in the admission laboratory values between those with HELLP syndrome and those without acute complications of preeclampsia. CONCLUSIONS: Although the contribution of right upper quadrant or epigastric pain to the risk status of a pregnant patient is difficult to quantify, it can be used to assess whether the patient is at high risk for development of HELLP syndrome.

Factores pronósticos asociados a la progresión de preeclampsia a eclampsia / Prognostic factors associated to progression of preeclampsia to eclampsia

Este estudio fue realizado para determinar el valor pronóstico de diferentes hallazgos clínicos y de laboratorio en la progresión de preeclampsia severa a eclampsia. La presencia de náusea y vómito, así como las concentraciones séricas de glucosa >105 mg/dL, creatinina >1 mg/dL, aspartato amino transferasa > 35 Ul/L, alanina amino transferasa > 40 Ul/L y lactato deshidrogenasa > 450 Ul/L constituyen variables asociadas al avance de preeclampsia a eclampsia. Esta información puede ser de utilidad en la toma de decisiones del clínico referente al manejo individualizado de estas pacientes.