Complicaciones obstétricas y perinatales en pacientes con anemia / Obstetric and perinatal complications in anemic patients

Resumen OBJETIVO: Determinar la relación entre complicaciones obstétricas y perinatales con la anemia durante el embarazo. MATERIALES Y MÉTODOS: Estudio ambispectivo, observacional y transversal. Se incluyeron pacientes en trabajo de parto, con embarazo único, atendidas entre marzo y octubre de 2017 en el Hospital General Dr. Salvador Zubirán Anchondo, Chihuahua, Chih. Se excluyeron las pacientes con embarazo complicado por defectos congénitos, que hubieran recibido anticoagulantes, con diagnóstico médico de hemoglobinopatías, hemofilias, preeclampsia, síndrome de HELLP, partos instrumentados y distocias, diabetes gestacional, nefropatías, hepatopatías, tabaquismo y toxicomanías. Complicaciones valoradas: amenaza de aborto, amenaza de parto pretérmino, parto pretérmino, ruptura prematura de membranas, infección de vías urinarias, peso al nacer, valoración de Apgar al minuto y a los 5 minutos, hemorragia obstétrica. Se entrevistó a todas las pacientes para evaluar los antecedentes ginecoobstétricos y se tomó una muestra de sangre venosa para determinar: hemoglobina, hematocrito, cantidad de glóbulos rojos, volumen corpuscular medio, concentración de hemoglobina corpuscular media. Se registraron las mediciones antropométricas, valores de Apgar y complicaciones perinatales del expediente clínico. RESULTADOS: Se estudiaron 1051 pacientes divididas en dos grupos: con anemia (n = 172) y sin anemia (n = 879). Se consideró anemia a la hemoglobina menor de 11 g/dL o hematocrito menor de 33%. Se clasificaron de acuerdo con la OMS como: anemia leve 10-10.9 g/dL, moderada 7-9.9 g/dL y severa menos de 7.0 g/dL. La prevalencia de anemia fue de 16%. La anemia leve se identificó con mayor frecuencia 10% (n = 111), anemia moderada y severa 6% (n = 61). Las complicaciones maternas y neonatales no mostraron asociación con la anemia materna durante el embarazo. La hemotransfusión fue mayor en pacientes con anemia (9 vs 1%). CONCLUSIÓN: Se identificó anemia materna en 16% de los casos y se asoció con necesidad de transfusión de hemoderivados en el posparto o posquirúrgico de cesárea.

Abstract OBJECTIVE: Determinate the association between adverse perinatal outcomes and anemia in pregnant women. MATERIALS AND METHODS: Observational, prospective-retrospective and cross-sectional study. Including women in birth labor attended at Hospital General Dr. Salvador Zubirán Anchondo in Chihuahua City, during March to October 2017. Inclusion criteria considered women with single pregnancy. Exclusion criteria with present conditions: congenital deformities, use of anticoagulants, blood diseases, preeclampsia, HELLP syndrome, instrumental delivery with forceps, dystocia, maternal diabetes, kidney and liver diseases, use of tobacco and other drugs. Adverse perinatal outcomes included were: miscarriage risk, preterm labor, preterm birth, pre labor rupture of membranes, urinary infection, low birth weight, Apgar score at birth and after five minutes, obstetric hemorrhage. Patients were interviewed to evaluate obstetric background; blood venous sample was taken to determine haemoglobin, hematocrit, red blood cells number, medium corpuscular volume, medium corpuscular hemoglobin concentration. Birth data was registered from medical records. RESULTS: Two groups were integrated: with anemia (n=172) and without anemia (n=879). Patients with anemia were those with haemoglobin less than 11 g/dL or hematocrit less than 33% according World Health Organization anemia classification: mild 10-10.9 g/dL, moderate 7-9.9 g/dL and severe less than 7.0 g/dL. Anemia frequency was calculated in 16%, mild anemia frequency was 10% (111 patients), 6% moderate and severe anemia (n = 61). Both groups developed patients with adverse perinatal outcomes. Transfusion of blood products showed higher frequency in anemic patients (9% versus 1% control group). CONCLUSION: Anemia prevalence calculated in 16% associated with transfusion of blood products, during puerperium or after c-section period.

[Systemic lymphoma cells with T precursor condition of extreme female genital tract. A case report and literature review]. / Linfoma linfoblástico sistémico de células precursoras T con afección extrema del aparato genital femenino. Reporte de un caso y revisión de la bibliografía.

Primary female genital tract non Hodgkin's lymphoma is a rare presentation for a common disease in the childhood, and its classification as primary extranodal lymphoma is still controversial. There are a few cases reported as a primary precursor B-cell lymphoblastic lymphoma of the female genital tract, but there is not any case reported as primary precursor T-cell lymphoblastic lymphoma of the ovary in childhood. Herein we describe a 16 years old young woman with bilateral ovarian tumors, paraaortic lymphoadenophaty and disseminate disease to the female genital tract including extension of the tumor to neighboring organs like the omentum and the appendix. Exploratory laparatomy were performed with bilateral salpingo-oophorectomy, hysterectomy, omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy, pelvic washings and with biopsy of vaginal vault. The chemotherapy regimen comprised of CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone/Prednisolone) and methotrexate, 3 months later presents left facial hemiparesia follow by right facial hemiparesia, 7 months later presents more Central Nervous System (CNS) complications and apparently was complicated with acute lymphocitic leukemia and after 16 months from the diagnosis, following by a torpid evolution, the pacient finally died.

[Chorea gravidarum. A case report]. / Corea gravídica. Reporte de un caso.

Chorea gravidarum is an uncommon condition characterized by involuntary movements, speaking alterations and in the affective status during first trimester pregnancy, the incidence is 1 by each 2275 pregnancies, it is self limiting and resolves when the pregnancy ends, most of the cases are idiopathic and the rest is associated to the antiphospholipid syndrome, rheumatic fever, thyrotoxicosis, systemic lupus erythematosus, syphilis, Huntington disease or induced by drugs. The recurrences can occur in the subsequent pregnancies. The dopamine antagonists as the haloperidol and the chlorpromazine are useful to control the symptoms and are safe at lower doses. A 22 years-old patient, second pregnancy, without prenatal care, who was admitted to the labor at 36.1 weeks of gestation and psychosis of pregnancy presenting involuntary movements, dysnea and behavior disorder of three days evolution. The initial treatment was with diazepam, two days after the patient presented amniotic rupture without uterine activity, the pregnancy was interrupted by C- section and a male newborn was obtained. She had a favorable evolution during puerperium. She was discharged of the hospital four days later, having only abnormal movement in the right hand. Antistreptolysins antibodies of 333, PCR 1:80 and negative rheumatoid factor. She had four normal pregnancies more after, being the last the 10th of February of 2007.

[Umbilical cord rupture and vasa previa: a report of a case]. / Rotura del cordón umbilical y vasa previa: comunicación de un caso.

Vasa previa is a rare condition, frequently lethal, in which fetal blood vessels coming from the placenta or the umbilical cord cross the entrance of the childbirth channel before presentation. The abnormal blood vessels are result of a velamentous cord insertion or a placental alteration. It happens in 1:3000 births, with a high perinatal mortality. A 16 years-old primigest patient, at 34.6 week of gestation, was admitted to the labor, which has a good evolution, without any complication. A male new born was obtained without hearth rate or vitality, Apgar scale 0-0, weight 2800 grams, who presented an umbilical cord rupture 3 centimeters from its abdominal insertion, no where the fetal blood vessels are unprotected. It is necessary an adequate prenatal care, diagnosis and accurate management, to avoid the mortality by this rare clinical entity.

[Johnson and Toshach method utility for calculating fetal weight in term pregnancies within a second level hospital]. / Utilidad del método de Johnson y Toshach para calcular el peso fetal en embarazos de término en un hospital de segundo nivel.

OBJECTIVE: To evaluate the utility of the Johnson and Toshach's method to calculate the fetal weight before the birth in patients with term pregnancy. PATIENTS AND METHOD: A longitudinal, transversal and prospective study was done to analyze 244 patients between 37 to 41.6 weeks pregnancy, they were physically examinated and questionated, the body mass index was calculated and Johnson & Toshach method was used to calculate the fetal weight. The calculated weights with the formula were compared with the fetal weights measured at birth with t-Student's test to determine if significative difference exists (p < 0.05) between the medias of both groups. The data were classified in five categories according to the gestational age and the weights were compared using the Tukey's test to compare the statistic medias (p < 0.05). RESULTS: The category of the 39 to 39.9 gestational weeks of the study group is accounted for 29.5%, the calculated weight's media with the Johnson & Toshach method was of 3,292.88 g while the media of the real weights was of 3,273.13 g. There wasn not significative statistic difference between both groups with a variation of +/- 126 g. There is a correlation of 0.940 between the calculated weight and the real weight. The media of the weights calculated in the macrosomic products was of 4,252.5 g, and the media of the real weights was of 4,293.86 g, there is not significant statistic difference (p = 0.59). According to the gestational age, there was not significant difference. The 9.01% of the cases is represented by the macrosomic products (22) whose were obese in 77%. CONCLUSIONS: The Johnson and Toshach method is useful with a 95% confiability because there was not significant difference between the fetal weight measured and the weigth estimated by the formula, it is a non invasive method, of easy application that permits to detect fetal macrosomia with a variation of +/- 126 g (limit of variation stablished in the original technique is of +/- 240 g). We consider that the formula is useful to detect macrosomic products.