Efectos perinatales de la metformina en diabetes gestacional / Perinatal effects of metformin in gestational diabetes

Antecedentes: La diabetes gestacional es una condición en la que una mujer sin diabetes previa desarrolla intolerancia a la glucosa en cualquier momento del embarazo y puede o no resolverse al término de la gestación. La metformina, del grupo de las biguanidas, se considera manejo alternativo de la diabetes gestacional, incluido en el listado de los medicamentos esenciales por la OMS. El objetivo del presente fue identificar la incidencia de complicaciones obstétricas y perinatales en mujeres con diabetes gestacional que son sometidas a tratamiento con metformina. Material y método: Estudio transversal, con análisis comparativo de los resultados perinatales del tratamiento de diabetes gestacional. Donde el grupo 1 corresponde a pacientes que realizaron únicamente dieta y ejercicio y el grupo 2 a pacientes a las que además se les pautó metformina. Resultados: Fueron incluidas un total de 104 pacientes, edad materna promedio de 35 años, con ganancia ponderal de 10kg, media de peso al nacimiento de 3082 gramos. En el grupo 1 45,2%(n=47) con mayor ganancia ponderal materna y aumento en la incidencia de enfermedades hipertensivas del embarazo (9 casos de hipertensión gestacional y una preeclampsia con criterios de severidad); en contraste con el grupo 2, 54,8%(n=57) donde se reporta menor edad gestacional al nacimiento y un nacimiento pretérmino. Conclusiones: Con los resultados observados se demuestra que el uso de metformina para lograr el control metabólico de las pacientes con diabetes gestacional es una opción viable.(AU)

Background: Gestational diabetes is a condition in which a woman without previous diabetes develops glucose intolerance at any time during pregnancy, and may or may not be resolved at the end of gestation. Metformin, from the biguanide group, is considered as an alternative for the management of gestational diabetes, and is listed in essential drugs by the WHO. The objective of this study was to identify the incidence of obstetric and perinatal complications in women with gestational diabetes undergoing treatment with metformin. Material and method: A cross-sectional study was carried out, with comparative analysis of the perinatal outcomes of Gestational Diabetes treatment with lifestyle modification with and without metformin. Group 1 corresponded to patients who only performed exercise and diet, and Group 2 to patients who were also prescribed metformin. Results: A total of 104 patients were included. The mean maternal age was 35.05 years, with weight gain of 10kg. The mean birth weight was 3082 grams. Group 1, 45.2% (n=47) with greater maternal weight gain and increased incidence of hypertensive diseases of pregnancy (9 cases of gestational hypertension and 1 pre-eclampsia with severity criteria); in contrast to group 2, 54.8% (n=57) where 1 preterm birth and a lower gestational age at birth was reported. Conclusions: With the results observed, it is shown that the use of metformin to achieve metabolic control of patients with gestational diabetes is a viable option.(AU)

Diagnóstico ultrasonográfico de quiste ovárico fetal: reporte de caso / Ultrasound diagnosis of fetal ovarian cyst: Case report

Los quistes ováricos son los tumores abdominales más frecuentemente diagnosticados en los fetos femeninos, con una incidencia estimada de 1 en 1.000-2.600 embarazos. La probabilidad de malignidad es extremadamente baja y la asociación a malformaciones resulta excepcional. Se presenta un quiste ovárico en el diagnóstico ultrasonográfico prenatal, se observa por ecografía bidimensional en la región pélvica fetal una imagen anecoica con diámetro de 89mm y volumen de 242cc. El beneficio más importante es realizar un buen diagnóstico diferencial para así establecer un buen manejo del caso

Ovarian cysts are the most frequently diagnosed abdominal tumours in the female foetus, with an estimated incidence of 1 in 1,000-2,600 pregnancies. The probability of malignancy is extremely low and the association with malformations is exceptional. A case is presented of an ovarian cyst in the prenatal ultrasound diagnosis, with an anechoic image of 89mm diameter and 242cc of volume being observed in the fetal pelvic region with the two-dimensional ultrasound. The most important benefit is to make an optimal differential diagnosis in order to establish the treatment of the case

Diagnóstico prenatal de teratoma sacrococcígeo: reporte de un caso / Prenatal diagnosis of a sacrococcygeal teratoma: Case report

El teratoma sacrococcígeo es el tumor más común en recién nacidos, con incidencia reportada de uno por cada 40.000 nacidos vivos, habitualmente en fetos del sexo femenino, su mortalidad va del 15 al 35%, condicionada por el tamaño de la lesión, la extensión y el subtipo histológico. Se presenta un caso de teratoma sacrococcígeo diagnosticado en forma prenatal. En la región sacra se observó una imagen redondeada de bordes regulares, definidos, heterogénea, de 8,8×6,9×8,4cm, con un volumen de 266cc. El beneficio más importante es la prevención de distocias, por cesárea

Sacrococcygeal teratoma is the most common tumour found in newborns, with a reported incidence of one per 40,000 live births. It usually appears in female foetuses, with a mortality ranging from 15 to 35%, depending on the size of the lesion, extension, and histological subtype. The case is presented of a sacrococcygeal teratoma found in the prenatal diagnosis. It was observed in the sacral region as a rounded image with regular, defined, heterogeneous borders of 8.8×6.9×8.4cm, with a volume of 266cc. The most important action is the prevention of dystocia either by elective or emergency caesarean section

[Impact of prenatal steroids on morbimortality of eutrophic premature newborns]. / Impacto del uso de los esteroides antenatales sobre la morbimortalidad de neonatos prematuros eutróficos.

Although there is evidence that the use of prebirth steroids promote maturity of premature newborn, in the United States of America it has been estimated that only 50% of the women who have had a premature delivery (with babies with weight between 501 and 1500 g) have been treated with steroids. We analyzed the morbimortality and the need of assisted ventilation in 91 premature newborns with gestational age of less than 34 weeks and weight of 1,500 g or less. They were divided in two groups: one group included 50 newborns whose mothers received at least one full course of steroids and the other group included 41 newborns whose mothers did not receive it. Newborn pathologies, the need of assisted ventilation and the mortality were higher in the group that did not receive prebirth steroids. We conclude that the use of prebirth steroids diminishes the morbimortality of the premature newborn.

[The use of prostaglandins for labor conduction in its latent phase]. / Empleo de prostaglandinas para la conducción del trabajo de parto en su fase latente.

We wanted to know enprostil efficacy, an E2 prostaglandin analogous as a labor conductor in it's latent phase in term pregnancies. 188 patients were included, 52% received intracervical enprostil and 48% were treated with oxytocin. The labor evolution, resolution and complications were watch over. 15 patients (15.6%) of the study group required labor conduction with oxytocin because it was inhibited after peridural anesthesia. The main pregnancy resolution was vaginal via; only 6.3% of the study group subjected cesarean section against 10.3% of the witness group and the most frecuent indication was stationary dilation (1 and 8 cases respectively). The time of the latent phase and total labor was lower statistically in the study group. The observed complications were post-labor hemorrhage (3.1%), polysystolia (4.1%) and vomiting (5.2%), without significant difference with the witness group. We conclude that intracervical enprostil help cervical mature. shortenning latent phase and total labor, disminish oxytocin requeriment and cesarean incidence by cervical alterations without compromise maternal-fetal morbi-mortality.

[Genetic amniocentesis]. / Amniocentesis genética.

179 patients were studied by genetic amniocentesis (GA) in sessions of 3 punctures each. This was done in order to follow a prenatal diagnosis (PD) program and study amniotic fluid at the Hospital Regional 20 de Novembre (ISSSTE) between May 1983 and December 1987. The parameters taken were: age, indications, number of sessions, number punctures, echosonographic studies for gestational age, placental insertion, punction site, amniotic fluid volume, blood contamination, failures and handling of the patient. A low incidence of abortion is reported. We don't have cases of dripping of amniotic fluid or transvaginal haemorrhage. Multiple insertion of the needle and placental or vessel lesions of the cord, as causes of a fetal death are still argued if we have in mind avoiding chances; we didn't have those complications in our cases. The percent is low if there are not previous spontaneous abortions. 79% of the amniotic fluid samples were sent between the 15th and 17th weeks of pregnancy. For alpha fetus protein determination 12 and for biochemical studies 1, specially for beta-galactosidase level. This was done at the Biomedical Investigation Institute of the National Autonomous University of Mexico (in parents with generalized gangliosidosis GM1). Even though results were good, the technique has still risks and complications. An ultrasonic study of the procedures made by physicians with trustable experience is needed. Our country has the need to create more Prenatal Genetic Diagnosis Centers.