Doppler ultrasound evaluation in preeclampsia.

BACKGROUND: Worldwide preeclampsia (PE) is the leading cause of maternal death and affects 5 to 8% of pregnant women. PE is characterized by elevated blood pressure and proteinuria. Doppler Ultrasound (US) evaluation has been considered a useful method for prediction of PE; however, there is no complete data about the most frequently altered US parameters in the pathology. The aim of this study was to evaluate the uterine, umbilical, and the middle cerebral arteries using Doppler US parameters [resistance index (RI), pulsatility index (PI), notch (N), systolic peak (SP) and their combinations] in pregnant women, in order to make a global evaluation of hemodynamic repercussion caused by the established PE. RESULTS: A total of 102 pregnant Mexican women (65 PE women and 37 normotensive women) were recruited in a cases and controls study. Blood velocity waveforms from uterine, umbilical, and middle cerebral arteries, in pregnancies from 24 to 37 weeks of gestation were recorded by trans-abdominal examination with a Toshiba Ultrasound Power Vision 6000 SSA-370A, with a 3.5 MHz convex transducer. Abnormal general Doppler US profile showed a positive association with PE [odds ratio (OR) = 2.93, 95% confidence interval (CI) = 1.2 - 7.3, P = 0.021)], and a specificity and predictive positive value of 89.2% and 88.6%, respectively. Other parameters like N presence, RI and PI of umbilical artery, as well as the PI of middle cerebral artery, showed differences between groups (P values < 0.05). CONCLUSION: General Doppler US result, as well as N from uterine vessel, RI from umbilical artery, and PI from umbilical and middle cerebral arteries in their individual form, may be considered as tools to determine hemodynamic repercussion caused by PE.

No association between polymorphisms/haplotypes of the vascular endothelial growth factor gene and preeclampsia.

BACKGROUND: Preeclampsia (PE) is the first worldwide cause of death in pregnant women, intra-uterine growth retardation, and fetal prematurity. Some vascular endothelial grown factor gene (VEGF) polymorphisms have been associated to PE and other pregnancy disturbances. We evaluated the associations between VEGF genotypes/haplotypes and PE in Mexican women. METHODS: 164 pregnant women were enrolled in a case-control study (78 cases and 86 normotensive pregnant controls). The rs699947 (-2578C/A), rs1570360 (-1154G/A), rs2010963 (+405G/C), and rs25648 (-7C/T), VEGF variants were discriminated using Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) methods or Taqman single nucleotide polymorphism (SNP) assays. RESULTS: The proportions of the minor allele for rs699947, rs1570360, rs2010963, and rs25648 VEGF SNPs were 0.33, 0.2, 0.39, and 0.17 in controls, and 0.39, 0.23, 0.41, and 0.15 in cases, respectively (P values > 0.05). The most frequent haplotypes of rs699947, rs1570360, rs2010963, and rs25648 VEGF SNPs, were C-G-C-C and C-G-G-C with frequencies of 0.39, 0.21 in cases and 0.37, 0.25 in controls, respectively (P values > 0.05) CONCLUSION: There was no evidence of an association between VEGF alleles, genotypes, or haplotypes frequencies and PE in our study.

[Prenatal diagnosis ovarian cyst with an amputation at three months of age. A case report]. / Diagnóstico prenatal de quiste de ovario con torsión y amputación a los tres meses de edad. Reporte de un caso.

UNLABELLED: In the neonate the pelvic masses regularly are usually benign until in 87%, those of ovarian origin most is of cystic and benign origin. CLINIC CASE: Of a pregnant of 26 years of age, primigesta, was detected to the fetus during the 24 weeks of gestation an abdominal cyst in pelvic hole of 3.5 diameter cm, non motive. The pregnancy culminated for caesarean operation, feminine product was obtained with weight when being born 3.400 kg. They were practiced 3 ultrasounds: when being born, to the month and two months of age, finding ovary cyst with the same characteristics. To the 3 months it is observed in 4th control ultrasound that the cystic image was no longer in pelvic hole, but it liberates in abdominal cavity for what decides to make exploratory laparotomy, where is a cyst of free amputated ovary in abdominal cavity of 3.5 x 4 diameter cm. The pathology results reported an ovary with necrosis areas and content cystic saculado.

[A 35 year period review of the perinatal mortality in a gynecology-obstetric unit]. / Mortalidad fetal, neonatal y perinatal en un hospital de ginecoobstetricia. Revisión de 35 años.

OBJECTIVE: To estimate the perinatal mortality rates over a 35 year period in neonates 22 weeks' gestation or above 500 g at birth until seven days postdelivery. METHODS: Data was obtained from medical records and the fetal death (FD) and neonatal death (ND) certificates. RESULTS: There were 889 282 deliveries (D) with 10,178 FD (11.2/1000 D) and 10,126 ND [11.3/1000 live newborns (LNB) with a significant reduction from 1972 to 2006 of 57 % in fetal mortality rate (p <0.0001) and 18.8 % in neonatal mortality rate (p <0.01). We registered 8081/10,126 (79.84 %) neonates who died from 0 to 6 days (9.2/1000 LNB). The overall perinatal mortality rate was 20.5/1000 D, with a 48.4 % significant reduction from 1972 to 2006 (p < 0.0001), 27.8/1000 ND, a 13.5/1000 ND respectively. We observed 4161 immature neonates (0.47 %); 55,340 premature newborns (6.2 %) and 9055 twin pregnancies (1 %). CONCLUSIONS: The fetal, neonatal and perinatal mortality rates were below the national media and presented a significant decrease from 1972 to 2006, more accentuated in fetal mortality rate (57 %) and perinatal mortality rate (48.4 %).

[Comparison of two educational strategies in teacher formation courses]. / Comparación de dos modalidades educativas en diplomados de formación docente.

OBJECTIVE: To compare the achievement of promotional strategies on the participation in two educational modalities for the development of skills for the elaboration of the knowledge (SSEK) in courses of teacher formation (TF). METHODS: A quasi-experimental design was performed in four courses of TF with similar contents and strategies with seven students each one. As independent variable the presence and semipresence modalities were considered. In order to measure the development of the SSEK reliable; a validated instrument were used. RESULTS: No significant differences were found among or between evaluations before and after interventions in the four groups. The students of the semipresencial course well as the presence advanced significantly in the development of the aptitudes and educative posture according to Wilcoxon test. CONCLUSIONS: Both modalities increase the SSKE to development therefore represents an option for medical education in health professionals.

[Relation between fresh plasma administration and morbidity in patients with HELLP syndrome]. / Relación entre la administración de plasma fresco y morbilidad en pacientes con síndrome HELLP.

INTRODUCTION: HELLP syndrome is a complication of severe preeclampsia; its incidence goes from 0.1 to 0.6% of pregnancies, and causes complications in 4% of patients. OBJECTIVE: To evaluate frozen fresh plasma administration to prevent pregnancy complications in patients with HELLP syndrome. PATIENTS AND METHODS: Retrospective, comparative and non-randomized study. Patients with HELLP syndrome were divided in two groups: first one (n=23) was treated with fresh frozen plasma (10 mL/kg/day), and second one (n=29) with dexamethasone. Complications, dialysis requirement, hospital stay, and mortality were compared (chi2 test was used). RESULTS: Group 1 (n=23) had nine patients with HELLP syndrome type I, and 14 with type II. Group 2 (n=29) had 20 cases with HELLP syndrome type I, and nine with type II. Most frequent complication in group 1 was acute renal failure (22%), and hospital stay was 4.5 days. Group 2 had 13 patients with acute renal failure, three with pulmonary edema, one with cerebral edema, one with hepatic fracture, and one with placenta detachment. Hospital stay was from 8 to 30 days (p < 0.002). There were no maternal deaths in both groups. CONCLUSIONS: Fresh frozen plasma meaningfully reduces (43%) complications, hospital stay, and hemodialysis requirement (45%) in patients with HELLP syndrome.

[Ambulatory treatment of prolonged pregnancy with prostaglandin E2 gel]. / Embarazo de 41 semanas o mayor. Manejo ambulatorio con gel de prostaglandina E2.

BACKGROUND: the rutinary labor induction with prostaglandin E2 (PGE2) in pregnancy at 41 weeks has showed a fetal benefit without an increase in maternal morbidity or cesarean delivery. OBJECTIVE: to show that the ambulatory management of prolonged pregnancy with PGE2 gel decreases the cesarean delivery and prenatal morbidity rates. METHODS: quasiexperimetal study of patients with an accurate dated pregnancy of 41 weeks and beyond were analyzed. The women were divided in two groups of 196 each one. In the treated group, the endocervical application of PGE2 was followed by cardiotocographic control. If there was no reason to interrupt the pregnancy they were evaluated twice a week. Perinatal outcomes, mode of delivery and indications for cesarean section were assessed in both groups. RESULTS: there was a decrease in rate of cesarean delivery in treated group, 43 % versus 54 % in control group (p < 0.05). Apgar score at 1 and 5 minute showed no difference, but there were two intrauterine deaths in control group. The indications for cesarean surgery were the same in both groups and there was a case of tachysystole in each one. CONCLUSION: we concluded that decrease in the rate of cesarean deliveries without increments of fetal and maternal morbidity in this study, point to a secure management choice with PGE2 in ambulatory patients.

Uso de metformina en el embarazo / Metformin use during pregnancy

La utilización de metformina en pacientes con diabetes gestacional (DG) ha mostrado efectos benéficos al disminuir la resistencia a la insulina y no relacionarse con teratogénesis, pero no ha sido evaluado su efecto sobre la morbilidad perinatal al utilizarlo desde las primeras semanas del embarazo. Objetivo: Demostrar que la administración de metformina desde el inicio del segundo trimestre del embarazo en pacientes obesas con diabetes gestacional (OG) disminuye la macrosomía y morbilidad neonatal. Diseño: Estudio cuasiexperimental. Lugar: Departamento de Medicina Materno-Fetal, Universidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social. Participantes: Pacientes con diagnóstico de DG. Intervenciones: Se obtuvo del archivo del Hospital los datos de pacientes con diagnóstico de DG, cursando embarazos de 17 o menos semanas de gestación al inicio del tratamiento e índice de masa corporal de 30 o mayor. Se formó 2 grupos: el de casos, con 34 pacientes, a quienes se administró únicamente metformina durante todo el embarazo, debido a que no aceptaron el tratamiento con insulina, y el grupo control, formado por 40 pacientes, quienes utilizaron diversos esquemas de insulina. Principales medidas de resultados: Resultados perinatales, vía de nacimiento, asociación con estados hipertensivos y progresión a diabetes tipo 2 en el puerperio. Resultados: Encontramos disminución de la macrosomía en el grupo tratado con metformina, una (2 por ciento), en relación al de insulina, 6 (15 por ciento), pero no fue estadísticamente significativo (p mayor que 0,05). Se obtuvo resultados similares con la morbilidad neonatal, la asociación con estados hipertensivos y la progresión a diabetes tipo 2. Conclusiones: Aunque clínica, pero no estadísticamente significativos, se obtuvo mejores resultados con el uso de metformina; éste representa una alternativa segura y con fiable en el manejo de pacientes obesas con DG que no aceptan el tratamiento con insulina.

Metformin therapy in gestational diabetes (GD) has beneficial effects on insulin resistance and does not appear to be teratogenic; but the use effect in early pregnancy on perinatal morbidity has not been studied. Objective: To assess that metformin therapy initiated early in pregnancy in obese women with GO reduces macrosomia and neonatal morbidity. Design: Quasiexperimental study. Setting: Department of Maternal Fetal Medicine, high specialty medical university, Social Security Mexican Institute. Participants: Patients with diagnosis of GD. Interventions: We examined the records of women with GD, 17 or less weeks of pregnancy and a body mass index equal or more than 30 when they started therapy. They were divided in two groups: metformin group (women treated only with metformin throughout pregnancy because they did not accept to use insulin, n = 34) and insulin group (women who received only insulin treatment, n = 40). Perinatal outcomes, mode of delivery, development of gestational hypertension and type 2 diabetes were assessed. Main outcome measures: Perinatal results, birth type, association with hypertensive states and progression to type 2 diabetes in the postpartum. Results: There was a decrease in macrosomia in the metformin group, 1 (2 per cent) vs. 6 (15 per cent) in the insulin group, but this difference was not significant (p more than 0/05). Results in neonatal morbidity and gestational hypertension and type 2 diabetes development were similar. Conclusions: Even though results with metformin therapy were not statistically better, it represents a safe management alternative in patients with GD and obesity who do not accept insulin use.

[Prenatal diagnosis of pentalogy of Cantrell associated to bilateral cleft lip. A case report]. / Diagnóstico prenatal de la pentalogía de Cantrell concomitante con labio hendido bilateral. Reporte de un caso.

The pentalogy of Cantrell is a rare congenital syndrome characterized by deficiency of the anterior diaphragm and defects of abdominal wall, the pericardium, the lower sternum, as well as congenital intracardiac abnormalities. It has usually a poor prognosis, but most cases have had incomplete variants of this syndrome, so it is important to make a prenatal diagnosis to determine the size of the wall defect and to establish a multidisciplinary management. Less than 90 cases have been reported in the world literature. There are no casuistic or even treatment criteria in Latin America. A case of a newborn in whom was suspected this pentalogy associated to bilateral cleft lip by an ultrasound examination at 25 week of gestation is described. We also comment on diagnostic aspects, as well as anatomopathological, therapeutic, and prognostic characteristics.