Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices.

OBJECTIVE: To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. METHODS: This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free ß human chorionic gonadotrophin (ß-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. RESULTS: 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. CONCLUSIONS: Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

[Construction of model for calculating and recording neonatal weight percentiles]. / Construcción de un modelo de cálculo y registro del percentil de peso neonatal.

OBJECTIVES: To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results. MATERIAL AND METHODS: A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children. RESULTS: Optimal weight model: 3,311.062+68.074 *sex+143.267 *GE40 -13.481 *GE40(2) - 0.797 *GE40(3)+sex* (5.528 *GE40 - 0.674 *GE40(2) - 0.064 *GE40(3)). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was "almost perfect" (κ=0.866, κ=0.872, and κ=0.876 (P<.001), respectively), and between our model and that proposed by Figueras it was "substantial" (κ=0.720, P<.001). CONCLUSIONS: The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles.

First-trimester screening for large-for-gestational-age infants.

OBJECTIVES: To examine the relationship between newborn birth weight and first-trimester uterine artery (UtA) pulsatility index (PI), maternal characteristics, serum pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (ß-hCG) and fetal nuchal translucency (NT) thickness. We also examined the results of screening for large-for-gestational-age (LGA) neonates by an integrated first-trimester approach incorporating these parameters. METHODS: We evaluated maternal characteristics, fetal NT, PAPP-A, free ß-hCG and UtA-PI in 2097 singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Linear models based on quasi Akaike's Information Criterion were used to determine the best predictive model for fetal birth weight. The patient-specific risk of delivering an LGA infant was derived from multiple logistic regression analysis and the performance of screening was determined by receiver-operating characteristics curve analysis. RESULTS: The best predictive models for fetal birth weight included UtA-PI, PAPP-A, NT, parity, maternal age, smoking status, weight, height and free ß-hCG. In pregnancies delivering LGA newborns compared with non-LGA pregnancies, PAPP-A and NT thickness were significantly increased (P = 0.016 and 0.001, respectively) and UtA-PI was significantly decreased (P = 0.011). A combination of maternal factors with PAPP-A, fetal NT and UtA-PI identified 34.4% of LGA newborns for a false-positive rate of 10%. CONCLUSIONS: This study showed an association between newborn birth weight and maternal factors, and first-trimester PAPP-A, ß-hCG, fetal NT and UtA-PI. Together, these factors can be used to identify over a third of pregnancies that will deliver LGA infants.

Fetal and neonatal habituation in infants of diabetic mothers.

OBJECTIVE: To evaluate whether maternal diabetes alters the habituation ability of fetuses and newborns. STUDY DESIGN: Two nonrandomized clinical trials were performed. First, we studied prenatal fetuses of women with pregestational diabetes, and control subjects matched for gestational age, and then we studied infants of diabetic mothers (IDM) and control subjects matched for gestational age and mode of delivery. Fetus and newborns were stimulated with vibroacoustic stimulus. RESULTS: In fetuses of diabetic mothers, the ability to habituate was lower, and the habituation rate was higher than in control subjects to all habituation tests. In the neonatal period, ability to habituate was lower (59% vs 100%; P< .001), and the habituation rate was higher (18 [14-21] vs 4 [1.2-6.8]; P< .001) in the IDM than in the control infants. We found a significant negative correlation between maternal glycosylated hemoglobin in each trimester of pregnancy and habituation ability in IDM. CONCLUSIONS: Fetuses and infants of diabetic mothers have impaired habituation ability, which is related to the degree of maternal metabolic control.

Persistence of fetal memory into neonatal life.

OBJECTIVES: To test the hypothesis that fetal memory persists into the neonatal period. STUDY DESIGN: Forty-one newborns that had been repeatedly stimulated by using fetal vibroacoustic stimulation were compared with 31 controls. The same vibroacoustic stimulator was used for both fetal and neonatal stimulation tests. For the neonatal test the stimulus was applied against the mastoid of the newborn with the interposition of a specifically designed solid-liquid interface to simulate intrauterine conditions. Student's t-test was used. RESULTS: Neonatal habituation rate (the number of consecutive stimuli applied before a baby stopped responding) was significantly higher in those newborns who had not participate in the fetal habituation study (7.0+/-5.4 stimuli) than in those who had (4.1+/-4.1 stimuli), p=0.01. CONCLUSIONS: Newborns who were stimulated in utero habituated earlier than those who had not previously experienced the stimulation. These results suggest that fetal memory persists into neonatal life.

Estados de comportamiento fetal en gestantes con diabetes pregestacional y gestacional / Fetal behavioral states in pregestational and gestational diabetic pregnancies

Objetivo. Valorar las características de los estados de comportamiento fetal en gestantes con diabetes tipo 1 y gestacional. Material y método. Se estudia una muestra constituida por 3 grupos de 20 gestantes cada uno: grupo 1, controles; grupo 2, gestantes con diabetes tipo 1, y grupo 3, gestantes con diabetes gestacional. Se realizó un estudio comparativo que valoró: la actividad ocular, los movimientos corporales y la frecuencia cardíaca fetal, objetivados por ecografía y cinetocardiotocografía. Se cuantificó el tiempo consumido por los fetos en los diferentes estados de comportamiento, la estabilidad conductual y el número de cambios de estado a las 36-37, 38 y 39 semanas de gestación. Resultados. Los fetos de las gestantes con diabetes tipo 1 presentaron una menor duración de los períodos de sueño profundo (significativa a las 38 semanas), una prolongación de los estados de incoordinación, un mayor número de cambios transicionales (significativo a las 39 semanas) y una incapacidad global para establecer estados de comportamiento estables (significativa a las 36-37 y 38 semanas). La diabetes gestacional condicionó alteraciones similares, si bien las diferencias con el grupo control no alcanzaron significación estadística. Conclusiones. La diabetes materna condiciona alteraciones en las características de los estados de comportamiento fetal (AU)

Objective. To evaluate the characteristics of fetal behavioral states in pregestational and gestational diabetic pregnancies. Material and method. We compared the results obtained in a control group consisting of 20 physiological pregnancies with 20 type 1 diabetic pregnancies and 20 gestational diabetic pregnancies. Ocular activity, body movements and patterns of fetal cardiac frequency on ultrasound and kinetocardiotocography were simultaneously recorded. The time spent by the fetuses in behavioral or coincident states, ability to establish stable behavioral states and behavioral stability were evaluated at weeks 36-37, 38 and 39 of pregnancy. Results. Fetuses in the type 1 diabetic group spent less time in quiet sleeping rate (significant at 38 weeks), more time in states of behavioral incoordination, and showed a greater number of changes in state (significant at 39 weeks) than control group fetuses. Fetuses in the type 1 diabetic group also showed an overall inability to establish stable behavioral states (significant at weeks 36-37 and 38). Fetuses in the gestational diabetes group showed similar alterations, but differences with the control group were not statistically significant. Conclusions. Type 1 diabetes is associated with a lesser fetal ability to establish stable behavioral states (AU)

[Antenatal care in immigrants]. / Control de gestación en inmigrantes.

The phenomenon of immigration has had an impact on the health care of the population. The immigrant population in Spain today represents approximately 8% of the total population. The majority of this population proceeds from countries with low income, and its origin and distribution is diverse. The immigrant population is characterised by its being young and healthy, and with a capacity to adapt to changes, but its social, economic and labour conditions are frequently insecure and favour vulnerability to disease. In spite of the number of immigrants of the male sex being globally higher than that of women, the percentage of immigrants of the female sex is growing. This increase of the female immigrant population has resulted in the appearance of specific health care needs, especially with respect to sexual and reproductive health. To which we must add a substantial increase in pathologies prevalent in the countries of origin, such as anaemia, tuberculosis, malnutrition, haemoglobinopathies, consanguinity, hypocalcaemia, hepatitis B and/or C, sexually transmitted infections, infectious diseases transmitted by arthropods, such as Chagas disease and other parasitoses, as well as genital mutilations. The aim of this article is to analyse the factors that make it difficult to control gestation in the immigrant population, as well as to establish guidelines for acting in antenatal care consultations. Insistence is placed on health education and prevention during pregnancy, and consideration is given to the appearance of rare diseases related to some of these groups.

Control de gestación en inmigrantes / Antenatal care in immigrants

El fenómeno de la inmigración ha supuesto un impacto en la atención a la salud de la población. En España la población inmigrante representa hoy en día, aproximadamente el 8% de su población total. Esta población en su mayoría procede de países de baja renta, y su procedencia y distribución es diversa.La población inmigrada se caracteriza por ser joven, sana, y con capacidad de adaptación a los cambios, pero sus condiciones sociales, económicas y laborales, con frecuencia son precarias y favorecen la vulnaribilidad a la enfermedad. A pesar de que el número de inmigrantes de sexo varón es globalmente superior al de mujeres, el porcentaje de inmigrantes de sexo femenino es cada vez mayor. Este incremento de población inmigrante femenina trae como consecuencia la aparición de necesidades específicas en atención sanitaria, sobre todo en lo que a su salud sexual y reproductiva se refiere. A esto debemos añadir un incremento sustancial de patologías, prevalentes en los países de origen como la anemia, tuberculosis, desnutrición, hemoglobinopatías, co-sanguinidad, hipocalcemia, hepatitis B y/o C, infecciones de transmisión sexual, enfermedades infecciosas transmitidas por artrópodos como enfermedad de Chagas y otras parasitosis, así como mutilaciones genitales.El objetivo de este capítulo es analizar los factores que dificultan el control de la gestación en la población inmigrante, así como establecer pautas de actuación en la consulta de control de gestación, insistiendo en la educación sanitaria y la prevención durante el embarazo, considerando la aparición de enfermedades poco comunes, relacionadas con algunos de estos colectivos

The phenomenon of immigration has had an impact on the health care of the population. The immigrant population in Spain today represents approximately 8% of the total population. The majority of this population proceeds from countries with low income, and its origin and distribution is diverse. The immigrant population is characterised by its being young and healthy, and with a capacity to adapt to changes, but its social, economic and labour conditions are frequently insecure and favour vulnerability to disease. In spite of the number of immigrants of the male sex being globally higher than that of women, the percentage of immigrants of the female sex is growing. This increase of the female immigrant population has resulted in the appearance of specific health care needs, especially with respect to sexual and reproductive health. To which we must add a substantial increase in pathologies prevalent in the countries of origin, such as anaemia, tuberculosis, malnutrition, haemoglobinopathies, consanguinity, hypocalcaemia, hepatitis B and/or C, sexually transmitted infections, infectious diseases transmitted by arthropods, such as Chagas disease and other parasitoses, as well as genital mutilations. The aim of this article is to analyse the factors that make it difficult to control gestation in the immigrant population, as well as to establish guidelines for acting in antenatal care consultations. Insistence is placed on health education and prevention during pregnancy, and consideration is given to the appearance of rare diseases related to some of these groups

Base de datos perinatales nacionales del año 2000 / National perinatal database 2000

National perinatal database 2000 (AU)

Extrofia vesical corregida complicada por un prolapso uterino recidivante asociado y embarazo / Corrected vesical extrophy complicated by recurrent uterine prolapse associated to pregnancy

El embarazo en pacientes con antecedentes de extrofia vesical corregida quirúrgicamente se ha descrito en la bibliografía y se ha asociado con un riesgo incrementado de infecciones urinarinas, hidronefrosis, incontinencia urinaria o prolapso genital. No existe un criterio uniforme en cuanto a la vía del parto en estas gestantes. Se presenta el primer caso de una extrofia vesical corregida mediante uretorisgmoidostomía y complicada por un prolapso uterino que a su vez se trató quirúrgicamente mediante la suspensión sacra del útero con cincha de goretex. El prolapso recidivó, asociándose un rectocele y en esta situación la paciente consiguió un embarazo espontáneo que cursó de forma fisiológica y finalizó con el nacimiento a término, mediante cesárea, de un niño sano (AU)

Estados de comportamiento intraútero en los hijos de madres con diabetes tipo 1 / Fetal behavioral states in type 1 diabetic pregnancies

Objetivo: Establecer la posible existencia de diferencias en el desarrollo neurológico fetal, valorado mediante el análisis de las características de los estados de comportamiento, de los fetos de madres diabéticas. Material y método: Se comparan los resultados obtenidos en un grupo control, constituido por 15 gestantes con embarazo fisiológico, y un grupo problema, formado por 15 gestantes con diabetes tipo 1. La edad gestacional en el momento del estudio fue 37 y 41 semanas. A lo largo de 60 min se registraron simultáneamente la actividad ocular, los movimientos corporales y los patrones de frecuencia cardíaca fetal mediante ecografía y cinetocardiotocografía. Se valoran el tiempo consumido por los fetos en los diferentes estados de coincidencia o de comportamiento, la capacidad para establecer estados de comportamiento estables y el número de cambios de estado (estabilidad conductual).Resultados: El tiempo consumido por los fetos en estado de sueño profundo (F1) es significativamente menor en el grupo de hijos de madres diabéticas a las 38 semanas de gestación. La duración de los períodos de incoordinación conductual (F5) es, en cambio, superior en este grupo, siendo la diferencia estadísticamente significativa con respecto al grupo control a las 36-37 semanas. El número de cambios de estado es mayor en los fetos de madres diabéticas que en los controles. Conclusiones: La diabetes tipo 1 se asocia con una menor capacidad para establecer estados de comportamiento estables en los fetos de madres diabéticas. (AU)

Valor del test de estimulación vibroacústica como prueba de bienestar fetal / Vibroacustic stimulation as fetal well-being test

Muchos autores han informado del uso de la estimulación vibroacústica fetal como un método para mejorar la eficacia de la monitorización fetal no estresante sin modificar el valor predictivo de la prueba. Este estímulo altera el comportamiento fetal y la frecuencia cardíaca. La información disponible sugiere que la exposición del feto a la estimulación vibroacústica es clínicamente segura. Desde el punto de vista experimental, la estimulación vibroacústica ofrece la oportunidad de evaluar cómo responde el feto al ambiente externo. Serán precisas nuevas investigaciones para determinar la frecuencia optima, duración, intensidad y tipo de estímulo más útil (AU)

Base de datos perinatales nacionales de 1998 / National perinatal database 1998

No disponible

[Neurosensory defects secondary to neonatal hyperbilirubinemia]. / Defectos neurosensoriales secundarios a hiperbilirrubinemia neonatal.

Effects to medium and long term of neonatal hyperbilirubinemia (BI less than or equal to 16.8 mg%) on acoustic and visual sensorial systems have been studied on two groups: a) group I, 20 jaundiced term and 5 jaundiced preterm newborns, 21 of term treated with phototherapy, b) group II, 15 term and 10 preterm newborns. At the age of 9-10 years the following data were analyzed: Anthropometrics, psychometrics, audiologic and ophthalmologic. Statistic analysis of results obtained on the differences that have been studied do not show statistic differences between problem and control series (p greater than 0.05) except for audiological parameters. A higher incidence of hypoacusia was found in group I (p less than 0.05). It is concluded that neonatal hyperbilirubinemia (BI less than or equal to 16.8 mg%) has not any side-effects at medium and long term on the visual area, but it produces hypoacusia.