Streptococcus agalactiae: prevention and vaccine development.

Streptococcus agalactiae, group B Streptococcus (SGB), is the most important cause of morbi-mortality among newborn population, and an important pathogen among immunossupressed adult patients. Despite the advances in the treatment and prevention of neonatal infections as a consequence of implementation of national and international recommendations for prevention of infection, there are still some improvements for the final control of the disease. In this sense, the vaccination against SGB could be an effective measure for the prevention of disease in those cases where intrapartum prophylaxis is not useful and in adult patients with risk factors for invasive infection due to SGB. This review summarizes the efforts made until now in order to establish the control of the infection, and brings some information on the current state-of-the art of vaccines against SGB, in which different strategies in their design have been used.

Prevención del tromboembolismo venoso durante el embarazo y el puerperio en Atención Primaria y Especializada / Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care

Tras reseñar que existen una serie de factores de riesgo de enfermedad tromboembólica venosa durante la gestación, se hace hincapié en que la prevención primaria y el tratamiento de esta grave entidad durante el embarazo y el puerperio son esenciales para reducir la morbimortalidad materna. Las heparinas de bajo peso molecular constituyen el anticoagulante de elección en el embarazo. Su prescripción puede hacerla tanto el médico de Atención Primaria como el hematólogo y el obstetra. En cuanto a cuándo prescribirlas, se presenta un protocolo de aplicación tanto en Atención Primaria como Especializada, multidisciplinar, basado en la bibliografía existente al respecto, en el que se indica que los trastornos de hipercoagulabilidad, asociados a algunos de los factores de riesgo, obligan a hacer tromboprofilaxis con heparina de bajo peso molecular durante todo el embarazo y el puerperio (AU)

After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented (AU)

[Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care]. / Prevención del tromboembolismo venoso durante el embarazo y el puerperio en Atención Primaria y Especializada.

After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented.

Hemorragia subaracnoidea y embarazo / Subarachnoid hemorrhage and pregnancy

La incidencia de hemorragia subaracnoidea (HSA) parece aumentar durante el embarazo y origina un amplio grupo de problemas a resolver tales como la realización de pruebas de imagen con protección radiológica, la viabilidad del feto, la finalización del parto, el manejo neuroanestésico, los fármacos a utilizar y la decisión de intervención neuroquirúrgica. El diagnóstico y el tratamiento precoz de la HSA es fundamental para obtener buenos resultados tanto para la madre como para el feto y evitar complicaciones. Se exponen 3 casos de hemorragia intracraneal de aparición espontánea durante el embarazo que se registraron en el Hospital Virgen de las Nieves de Granada durante los años 2008-2010 (AU)

The incidence of subarachnoid hemorrhage increases during pregnancy and involvesa wide range of activities and issues such as the performance of imaging tests with radiological protection, assessment of fetal viability, termination of pregnancy, the patient’s anesthetic management, the drugs to be used, and neurosurgical intervention. Early diagnosis and treatment of this event are essential to obtain favorable outcomes for the mother and fetus and to avoid complications. We describe three cases of intracranial hemorrhage with spontaneous onset during pregnancy registered at the Virgen de las Nieves’ Hospital between 2008 and 2010 and provide a review of the topic (AU)

Rotura uterina en paciente con feto muerto anteparto y lupus eritematoso sistémico / Uterine rupture in a patient with intrauterine demise and systemic lupus erythematus

El Lupus Eritematoso Sistémico (LES) es una enfermedad autoinmune de causa desconocida que puede afectar a cualquier aparato o sistema del organismo ocasionando gran variedad de síntomas. Esta enfermedad es más frecuente en las mujeres en edad reproductiva. Secundigesta de 32 años diagnosticada de LES y mutación del gen del factor xii de la coagulación que recibe tratamiento con prednisona a baja dosis y heparina de bajo peso molecular. La gestación cursa sin hallazgos de interés hasta la semana 32 y 5 días, cuando la gestante nota ausencia de movimientos fetales y se evidencia óbito fetal. Se ingresa a la paciente y se inicia inducción del parto con misoprostol en dos dosis de 50 mcg separadas 4 horas; tras las que se inicia el parto. Se instaura analgesia epidural y finalmente se extrae mediante ventosa obstétrica un feto varón de 1.630 g sin anomalías aparentes. Tras el alumbramiento se produce sangrado profuso que no cesa y se evidencia rotura uterina de gran magnitud que precisa cierre laparotómico (AU)

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology that can affect any device or system in the body, causing a wide variety of symptoms. This disease is more frequent in women of reproductive age. We report the case of a 32-year-old secundigesta diagnosed with SLE and a mutation in the gene encoding coagulation factor XII, who received treatment with low-dose prednisone and low-molecular weight heparin. The pregnancy was uneventful until week 32 and 5 days, when the patient noted the absence of fetal movements and fetal death was detected. The woman was admitted to hospital for labor induction with two 50mg doses of misoprostol at a 4-hour interval. The mother received epidural analgesia and finally a 1630g boy with no anomalies was extracted through the use of an obstetric vacuum. After the birth, profuse continuous bleeding occurred and a large uterine rupture requiring laparotomic closure was detected (AU)

Influencia de la analgesia epidural en la saturación arterial fetal de oxígeno durante el período de dilatación / Influence of epidural analgesia on fetal oxygen saturation during labor

Objetivo: Valorar la influencia de la analgesia vía epidural en la saturación de oxígeno fetal (SpO2) intraparto y los patrones de frecuencia cardíaca fetal. Material y métodos: Se realizó un estudio prospectivo con 50 gestantes a las que, durante el período de dilatación, se les administró analgesia por vía epidural, y que fueron monitorizadas mediante cardiotocografía y pulsioximetría fetal a través de una sonda Nellcor FS-14®. Resultados: El valor de SpO2 preepidural fue del 48,5 ± 7,8%. Durante los primeros 15 min postepidural se obtuvo la cifra de 47,4 ± 9,7 (p = NS), y la significación estadística se alcanzó a partir de los 30min posteriores a su instauración. En un 76% de los casos aparecieron alteraciones del registro cardiotocográfico en los primeros 120 min tras la perfusión analgésica. Conclusiones: La disminución de la saturación arterial de oxígeno a partir de los 30 min postepidural puede estar relacionada con la administración de analgésicos por vía epidural (AU)

Objective: To evaluate the influence of maternalepidural analgesia on fetal oxygen saturation (SpO2) and fetal heart rate (FHR) patterns during labor. Material and methods: We performed a prospective study in 50 pregnant women. During labor, epidural analgesia was administered and the women were monitored by means of cardiotocography (CTG) and fetal pulse oximetry, using a Nellcor FS-14® sensor. Results: The mean SpO2 value before analgesia administration was 48.5 ± 7.8%. During the first 15 minutes after administration, this value was 47.4 ± 9.7 (p: NS). A statistically significant decrease in SpO2 was found 30 minutes after initiation of epidural analgesia in 76 % of the patients, alterations in the CTG appeared during the first 120 minutes after maternal epidural analgesia. Conclusions: The decrease in SpO2 30 minutes after administration of epidural analgesia could be influenced by the use of epidural analgesic drugs (AU)

Parto prematuro e inmigración / Preterm delivery and immigration

Introducción: La prematuridad es la principalcausa de morbimortalidad perinatal. Existeun amplio espectro de factores de riesgo, algunosde ellos con mayor frecuencia en la poblacióninmigrante.Material y métodos: Estudio retrospectivode la incidencia de prematuridad, factores relacionadoscon el control de embarazo, parto ymorbilidad perinatal en un grupo de inmigrantesy otro de mujeres con nacionalidad española.Resultados: La incidencia de parto pretérminofue ligeramente superior en la población inmigrantesin alcanzar significación. La principaldiferencia entre ambos grupos fue el inadecuadocontrol prenatal observado en el grupoinmigrante y una menor utilización de la anestesiaepidural.Discusión: Aunque los factores asociados alparto prematuro son más frecuentes en poblacióninmigrante, la incidencia de parto prematuroy los resultados perinatales obtenidos eneste estudio son similares en ambos grupos

Introduction: Preterm delivery is the first;;obstetric factor associated to perinatai morbimortality.;;There are many risk factors, most of;;them with a high incidence in immigrant population.;;Patients and method: Retrospective study;;of preterm delivery incidence, factors related to;;pregnancy survelilance, labor and perinatal;;morbidity in an immigrant group and another;;of spanish nationality pregnant women.;;Results: Preterm delivery was slightly higher;;in immigrant population without statistical significance.;;The main difference between two;;groups was inadequate prenatal surveillance in;;immigrant group and a lesser use of epidural;;analgesia.;;Comment: Although factors related to preterm;;delivery are frequent in immigrant population,;;preterm delivery incidence and perinatal;;outcome are similar in both groups

Influencia del orden al nacimiento en el resultado perinatal de los partos gemelares / Effect of birth order on perinatal outcome of delivery in twin pregnancies

Se plantea como objetivo conocer la influenciadel orden al nacimiento en el resultado obstétricode los gemelos, analizando variables relacionadascon el parto. Se estudian retrospectivamente266 parejas de gemelos, valorando elpH y el test de Apgar al nacimiento.El primer gemelo presenta mejores resultadosperinatales. Las variables que influyen sobrelas diferencias de pH son: intervalo de tiempoal nacimiento, diferencia de peso entre ambosgemelos y el peso medio. En el Indice de Apgaral minuto influyen la diferencia de peso ylas interacciones del tiempo de gestación con elpeso medio y la diferencia de peso. El test alquinto minuto se ve influido por la diferenciade peso y el peso medio.Existen diferencias en el resultado neonatalentre las parejas de gemelos, siendo la variableque muestra una influencia más constante, ladiferencia de peso entre ambos fetos

The objective of the study was to investigate;;the effect of birth order on obstetric outcome of;;twin pregnancies, analyzing delivery-related;;variables. 266 pairs of twin babies were studied;;retrospectively, recording umbilical cord blood;;pH and Apgar score at birth.;;The first twin had a better perinatal outcome.;;Variables that led to cord blood pH differences;;were: Time interval in twin delivery,;;weight difference between twins, and mean fetal;;weight. 1 minute Apgar score differences;;are related to weight difference between twins;;and intereactions between gestational age, mean;;fetal weight and weight difference between;;twins. 5 minutes Apgar score was influenced by;;weight difference between twins and mean fetal;;weight. There were differences in neonatal;;outcome between twins, and the variable that;;show a more constant influence is weight difference;;between twins

The influence of maternal erythrocyte deformability on fetal growth, gestational age and birthweight.

The increase in blood viscosity during pregnancy reduces maternal-fetal blood flow, which can lead to fetal hypoxia and acidosis. These factors have been related to a reduction in fetal growth and to premature births. We carried out a longitudinal study of 36 normal-term gestations at different stages of the pregnancy. We analyzed the erythocyte deformability, the intraerythocyte viscosity and the plasma viscosity in the mother, as well as the relation of these parameters to fetal growth (biparietral diameter (BPD) and length of the femur), birthweight, gestational age at birth and the Agpar score. The results obtained were as follows: from weeks 25 to 36 of pregnancy (30.9 (SD 2 weeks)) there occurs a significant increase in maternal erythocyte rigidity (p < 0.05) (despite the compensatory decrease in intracellular viscosity). This increase is very significantly related to the fetal biparietral diameter (r = -0.50, p < 0.01), the length of the fetal femur (r = -0.48, p < 0.02), gestational age at birth (r = -0.73, p < 0.0001, birthweight (r = -0.63, p < 0.001) and the Agpar score 5 minutes after birth (r = 0.67, p < 0.001). Our conclusions are that the reduction in erythocyte deformability (which we attribute to alterations in the fluidity or elasticity of its membrane) and the factors that increase the aggregation capacity of the red cells (modulators of blood viscosity and of blood flow in the placental intervillous space) are risk factors for reduced fetal growth, lower birthweight and lower gestational age at birth. By avoiding maternal hematocrit levels higher than 36% we could improve uteroplacental perfusion, fetal growth and perinatal results.

Changes in erythrocytic deformability and plasma viscosity in neonatal ictericia.

We studied 45 full-term newborns divided into 3 groups. Group 1: 17 newborns with bilirubin <10 mg/dL; Group 2: 18 newborns with hemolytic ictericia (bilirubin 11-20 mg/dL) and Group 3: 10 newborns with moderate hemolytic ictericia needing exchange transfusion. The following were studied: erythrocytic deformability, plasma viscosity, plasmatic osmolarity, seric bilirubin, bilirubin/albumin ratio, free fatty acids and corpuscular volume of the erythrocytes. In full-term newborns, the following are risk factors for increased erythrocytic rigidity: neonatal hemolytic illness (p = 0.004, odds ratio: 7.02), increases in total bilirubin (p = 0.02, odds ratio: 4.3) and increases in the bilirubin/albumin ratio (p = 0.025, odds ratio: 4.25). Furthermore, the most important risk factor for high plasma viscosity is also neonatal hemolytic illness (p = 0.01, odds ratio: 2.30). The role of total bilirubin is also important (p = 0.09, odds ratio: 2.10), while that of the bilirubin/albumin ratio (p = 0.012, NS) is less so. The greater the hemolysis, the greater the erythrocytic rigidity and plasma viscosity (p < 0.01). In full-term newborns with moderate ictericia, hemolytic illness and increases in the bilirubin/albumin ratio are accompanied by rheological alterations that could affect cerebral microcirculation and cause a neurological deficit not exclusively related to the levels of bilirubin in plasma.

Lipoproteins in pregnant women before and during delivery: influence on neonatal haemorheology.

AIMS: To investigate whether the lipid profile of pregnant women during parturition differs from the profile at previous stages of pregnancy and to determine the effects of maternal lipid changes on fetal or neonatal haemorheology. METHODS: Sixty pregnant women were studied, divided into two groups. Group 1 contained 30 women of mean age of 27 (SD 3) years and gestational age > 38 weeks in whom delivery had not yet begun; all these pregnancies followed an uncomplicated course and there was no evidence of any fetal pathology from previous obstetric examinations. All the women reached term and birth weight was 3340 (350) g. Group 2 contained women of mean age 26 (4) years, in whom delivery was ongoing, all of whose pregnancies reached term. The following variables were determined in all cases: total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), free fatty acids and phospholipids, and apoprotein A (apo-A) and apoprotein B (apo-B). Serum and plasma viscosity was measured with a capillary viscosimeter. RESULTS: The apo-B/apo-A and HDL/apo-A ratios increased during delivery, indicating that in pregnant women these atherogenic indices are raised during delivery compared with previous gestational stages. Significant correlation coefficients were obtained between maternal lipids (triglycerides, total cholesterol, LDL, total cholesterol/HDL, and LDL/HDL) and plasma viscosity in the neonate. CONCLUSIONS: Plasma atherogenic indices increase progressively until birth. These changes have implications for neonatal haemorheology because they cause an increase in plasma viscosity.