Changes in circulating levels of carboxymethyllysine, soluble receptor for advanced glycation end products (sRAGE), and inflammation markers in women during normal pregnancy.

Objective: To determine the circulating levels of insulin, Nε-carboxymethyllysine (CML), soluble receptor for advanced glycation end products (sRAGE), and markers of inflammation and oxidative stress (OS) in maternal and umbilical cord blood in a cohort of healthy women with normal pregnancy.Methods: We conducted an observational longitudinal study in a group of women (n = 31; age range 18-39 years) with healthy pregnancy starting at 30 weeks of gestation and finishing at the time of delivery. We collected weight and height in the participants and their neonates and calculated body mass index (BMI). Blood from each patient was collected at 30th week of pregnancy and at delivery when a sample of cord blood was also obtained. Glucose, lipid profile, CML, sRAGE, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), highly sensitivity C-reactive protein (hsPCR), and insulin were determined. The study was approved by the University of Guanajuato Institutional Ethics Committee.Results: All pregnancies reached term (mean gestational time 38.9 ± 0.83 weeks) and there were no maternal complications. Mean age was 27.6 years. Lipid profile values were higher in the group compared with our values in nonpregnant women. During pregnancy, levels of insulin increased (p < .0006), CML (p < .0001) and sRAGE (p < .01) decreased, levels of MDA did not change, while those of TNF-α and hsPCR tended to increase. In the neonates, we found lower levels of CML (p < .003), hsPCR (p < .004), and insulin (p < .004) and higher levels of sRAGE (p < .013) and TNF-α (p < .022) compared to their mothers at delivery. In the total group, we found association of CML of the mother at baseline with the CML (p < .0006) and MDA (p < .002) in neonates, while maternal sRAGE at the end of pregnancy was associated with CML (p < .004) of their neonates.Conclusions: Our study confirms that normal pregnancy is accompanied by insulin resistance (IR) and significant increase in lipid profile, and demonstrates that circulating levels of CML and sRAGE decreased significantly at the end of pregnancy. The lack of association between the course of insulin levels and those of CML probably results from the predominant role of placental factors in the pathogenesis of IR in pregnancy. sRAGE levels in the neonates are markedly increased compared to their mothers suggesting a placental origin of this compound which may have a protective effect on the fetus since sRAGE restricts Advanced glycation end product (AGE) effects and may exert anti-inflammatory effects.

11 beta-hydroxysteroid dehydrogenase 2 promoter methylation is associated with placental protein expression in small for gestational age newborns.

Small for gestational age infants have greater risk of developing metabolic diseases in adult life. It has been suggested that low birth weight may result from glucocorticoid excess in utero, a key mechanism in fetal programming. The placental enzyme 11-beta hydroxysteroid dehydrogenase type 2 (11ß-HSD2, HSD11B2 gene) acts as a barrier protecting the fetus from maternal corticosteroid deleterious effects. Low placental 11ß-HSD2 transcription and activity have been associated with low birth weight, yet the mechanism regulating its protein expression is not fully understood. In the present study we aimed to analyze 11ß-HSD2 protein expression in placentas of adequate and small for gestational age (AGA and SGA, respectively) newborns from healthy mothers, and to explore whether 11ß-HSD2 protein expression could be modulated by DNA methylation. 11ß-HSD2 protein levels were measured by western blot in placental biopsies from term AGA and SGA infants (n=10 per group). DNA methylation was profiled both globally and in the HSD11B2 promoter by liquid chromatography with UV detection and methylation-specific melting curve analysis, respectively. We found lower placental 11ß-HSD2 protein expression and higher HSD11B2 promoter methylation in SGA compared to AGA. Promoter methylation was inversely correlated with both protein expression and, importantly, birth weight. No changes in global placental methylation were found. In conclusion, lower 11ß-HSD2 protein expression is associated with higher HSD11B2 promoter methylation, correlating with birth weight in healthy pregnancy. Our data support the role of 11ß-HSD2 in determining birth weight, providing evidence of its regulation by epigenetic mechanisms, which may affect postnatal metabolic disease risk.

[Association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios]. / Asociación de la flujometría Doppler con la evolución perinatal en pacientes con oligohidramnios.

BACKGROUND: Oligohydramnios is sometimes associated with poor perinatal outcome. Our aim was to determine the association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios. METHODS: We carried out a prospective cross-sectional study that included 130 patients with pregnancy between 30 to 41 weeks of gestation; we compared the measurement of the resistance index in the umbilical artery by Doppler flowmetry and the measurement of amniotic fluid in patients with oligohydramnios. A follow-up of patients after birth was made, recording the Apgar score and whether they required special attention. The data were analyzed using descriptive statistics and we calculated the sensitivity, specificity, accuracy, and predictive values of the tests. RESULTS: Sensitivity, specificity and accuracy were obtained for oligohydramnios associated to perinatal death and for five-minute Apgar, with results of 100, 0, 50 % and 0, 0, 0 % respectively. The resistance index of umbilical artery related to perinatal death had sensitivity, specificity and accuracy of 100, 96 and 98 %, while in the Apgar were 0, 95 and 47.5 %, respectively. CONCLUSIONS: Doppler flowmetry of the umbilical artery showed a higher sensitivity, specificity and accuracy to diagnose perinatal death than the measurement of oligohydramnios and the Apgar score.

Introducción: el oligohidramnios en ocasiones se asocia a mala evolución perinatal. El objetivo fue determinar la asociación de la flujometría Doppler con la evolución perinatal en pacientes con oligohidramnios. Métodos: se realizó un estudio transversal en el que se analizaron 130 pacientes con embarazo de 30 a 41 semanas con oligohidramnios; se comparó la medición del índice de resistencia de la arteria umbilical por flujometría Doppler y la medición del líquido amniótico. Se hizo un seguimiento postnatal en el que se registró el Apgar y si los pacientes ameritaron cuidados especiales. Se utilizó estadística descriptiva y se calculó la sensibilidad, especificidad, exactitud y los valores predictivos de las pruebas. Resultados: para el oligohidramnios en muerte perinatal se obtuvo sensibilidad, especificidad y exactitud de 100, 0 y 50 %; y para Apgar de 0, 0 y 0 %, respectivamente. El índice de resistencia de la arteria umbilical referente a la muerte perinatal tuvo sensibilidad, especificidad y exactitud de 100, 96 y 98 %, en tanto que en el Apgar los valores fueron de 0, 95 y 47.5 %, respectivamente. Conclusiones: la flujometría Doppler de la arteria umbilical mostró mayor sensibilidad, especificidad y exactitud que la medición del oligohidramnios y la prueba de Apgar para diagnosticar muerte perinatal.

[Results of the application of modified Hamilton scale in the diagnosis of maternal anxiety during immediate puerperium]. / Resultados de la aplicación de la escala de Hamilton modificada en el diagnóstico de ansiedad materna durante el puerperio inmediato.

BACKGROUND: Anxiety during pregnancy is a risk factor of maternal and fetal morbidity with adverse results in newborn at short and long term. OBJECTIVE: To determine, with the modified Hamilton Anxiety Scale, the level of anxiety at the immediate postpartum and its association with maternal and fetal morbidity. MATERIAL AND METHOD: A cross-sectional study including 384 patients at the immediate postpartum to whom modified Hamilton Anxiety Scale was applied to determine the level of anxiety and its association with maternal factors and fetal and neonatal morbidity. Data were analyzed with statistical logistic regression analysis; an alpha value was set at 0.05. RESULTS: One hundred thirty-five patients had anxiety associated at immediate postpartum, the significant factors were scholarship (p = 0.0034), number of pregnancies (p = 0.0001), occupation (p = 0.0001). Women with anxiety had more frequency of threatened abortion (p = 0.0061), preterm labor (p = 0.0001), neonatal sepsis (p = 0.0123) and transient tachypnea of the newborn (p = 0.0016). CONCLUSIONS: A significant percentage of pregnant women had anxiety at immediate postpartum. Women with anxiety suffer more frequently maternal and fetal morbidity. It is recommended the opportune identification of this disorder in order to avoid the repercussion in the neonatal care.

[Prevalence of postpartum impaired glucose tolerance after gestational diabetes]. / Prevalencia de alteraciones en la tolerancia a la glucosa postparto en pacientes con diabetes gestacional previa.

BACKGROUND: gestational diabetes mellitus (GDM) affects 2 to 10% of pregnancies and it has been postulated as a variant of type 2 diabetes mellitus (DM2) because they share a similar pathophysioiogy. Approximately in 90% the carbohydrate intolerance resolves after pregnancy, however after 5 to 16 years after delivery women will have a risk of 17 to 63% to the development of type 2 diabetes mellitus. OBJECTIVE: to determine the frequency of postpartum impaired glucose tolerance in women with previous GDM. MATERIAL AND METHODS: 125 patients with diagnosis of GMD were included, general data were captured, type of control during pregnancy and complications occurred. The women were instructed to undergo a postpartum oral glucose tolerance test of 75 g and 2 h, 6 weeks after their delivery date and they were classified into five groups: normal patients, type 2 diabetes mellitus, impaired glucose tolerance, impaired fasting glucose and combined both. RESULTS: after follow up 13 women (10.4%) were diagnosed as DM2; 14 patients (11.2%) were classified as glucose intolerance; 16 (12.8%) were catalogued with impaired fasting glucose; 6 (4.8%) had both disorders; and 76 (60.8%) were diagnosed as healthy women. CONCLUSIONS: the detection with a postpartum oral glucose tolerance test is necessary for the identification of the various types of disorders of the carbohydrate metabolism including DM2.

[Comparison of isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy]. / Isosorbide y dinoprostona en inducción del trabajo de parto.

BACKGROUND: it has been suggested that nitric oxide generators, such as isosorbide dinitrate, may be an alternative to mimic the effects of signal transduction mechanisms leading to cervical ripening, without affecting uterine contractility. OBJECTIVE: to compare the isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy. MATERIAL AND METHODS: in a randomized controlled blinded clinical trial, we studied 66 patients divided into 2 groups: 33 patients were given 20 mg of isosorbide dinitrate and to the other 33 were administered 0.5 mcg of dinoprostone; in both groups the drugs were administered vaginally each 6 h and at maximum 3 times. It was carried out a cardiotocographic study in order to determine the presence or absence of uterine activity and to exclude disorders of the fetal heart frequency; it was performed a vaginal examination to assess cervical conditions determining the Bishop score at 0, 6 and 12 h. RESULTS: there were no differences between the groups in the determinations of mean arterial pressure, maternal heart frequency, fetal heart frequency and Bishop score registered at 6 y 12 h followed the drugs administration. The time of delivery was 20.7 +/- 1.8 h in the group of women treated with dinoprostone; and 16.3 +/- 1.4 h in women treated with isosorbide dinitrate (p=0.032). The cost was higher in women treated with dinoprostone ($560 vs $12, respectively, p=0.001). There was no difference between the groups related to: frequency of meconium stained liquid (p=1.000), mode of delivery by caesarean section (p=0.918), Apgar score at 1 minute (p=0.764) and 5 minutes (p=0.294) and mother discharged with healthy baby (p=1.000). CONCLUSIONS: the isosorbide dinitrate is associated with lower duration of labor compared with dinoprostone. There was no difference in the maternal-fetal outcome by using whatever drug.

Prevalence of violence against pregnant women and associated maternal and neonatal complications in Leon, Mexico.

OBJECTIVES: to determine the prevalence of violence against women and associated maternal and neonatal complications in a developing country setting. DESIGN: cross-sectional study using a face-to-face questionnaire. SETTING: postpartum area at a tertiary care referral hospital in Leon, Mexico. PARTICIPANTS: 1623 postpartum women. DATA COLLECTION: women were recruited at 24-72 h post partum. The diagnosis and severity of violence were assessed using a modified questionnaire based on the Index of Spouse Abuse and Severity of Violence against Women Scale. FINDINGS: of 1623 women, 711 (43.8%) were diagnosed with violence during pregnancy; 563 (79.1%) experienced mild violence and 148 (20.9%) experienced severe violence. Of the women who experienced violence, 72.9% experienced psychological violence, 15.8% experienced physical violence and 11.3% experienced sexual violence. Maternal complications were higher in women who experienced violence (30.2% vs 23.6%, p = 0.004). Women who experienced sexual violence had more maternal complications (43.2%), and women who experienced psychological violence had more neonatal complications (54.2%). KEY CONCLUSIONS: violence during pregnancy is quite common in the study setting. Maternal complications are higher in women who experience violence during pregnancy. The type of violence has different effects on maternal and neonatal health. IMPLICATIONS FOR PRACTICE: it is recommended that pregnant women who are experiencing violence should be identified during antenatal care to avoid maternal or neonatal complications.

[Prevalence of maternal sadness and its associated factors]. / Prevalencia de tristeza materna y sus factores asociados.

BACKGROUND: Frequently occur emotional changes during pregnancy and postpartum. These changes can produce feelings of sadness, anxiety, or fear. In most women, these feelings called "maternity blues" or "baby blues" disappear quickly, if they do not disappear or worsen, they are catalogued as postpartum depression. OBJECTIVE: To determine the prevalence of maternity blues and the associated factors. MATERIAL AND METHOD: In a cross-sectional study, women at immediate postpartum were recruited. It was applied face-to face the Edinburgh test for determining maternity blues. Other registered data were: maternal age, education level, parity, death sons, history of depressive episodes, sleeping disorders, and if the pregnancy was planned or unplanned. The statistical analysis included arithmetic mean, percentages, Chi2, Student t test; and logistic regression analysis for determining the associated factors with the maternity blues. An alpha value was set at 0.05. RESULTS: Overall 1,134 women, 21 of them (1.8%) were diagnosed as maternity blues. The significant factors associated with maternity blues were: the history of death sons, p < 0.002; depressive episodes, p < 0.001; and sleeping disorders, p < 0.003. CONCLUSION: The frequency of maternity blues is low in our population. The associated factors with this disease should be identified during antenatal care in order to offer special care to these women, in order to avoid the complications associated with this entity.

[Progression of gestational hypertension to chronic hypertension]. / Evolución de hipertensión gestacional a hipertensión crónica.

BACKGROUND: The gestational hypertension is the most frequent cause of hypertension during the pregnancy. The gestational hypertension is a provisional diagnosis only during the pregnancy; it is unknown the number of women with gestational hypertension who progress to chronic hypertension. OBJECTIVE: To determine the number of women with gestational hypertension who progress to chronic hypertension. MATERIAL AND METHODS: A cohort prospective study was carried out; we includedl96 patients with the diagnosis of gestational hypertension at the time of the interruption of the pregnancy; after 12 weeks, a follow up appointment was scheduled in order to measure the blood pressure and to determine how many patients progressed to chronic hypertension. The data were analyzed with arithmetic mean, standard error and percentage values. For the comparison of variables, the Chi2 test and a logistic regression analysis were used; an alpha value was set at 0.05. RESULTS: Thirteen patients (6.6%) with diagnosis of gestational hypertension progressed to chronic hypertension. It was found that advanced age (p = 0.007), high body mass index (p = 0.013) and the antecedent of hypertensive disease in a previous pregnancy (p = 0.048) were significantly associated with the progression to chronic hypertension. CONCLUSIONS: The overweight, advanced maternal age and the antecedent of hypertensive disorder in a previous pregnancy are the variables associated with the progression from gestational hypertension to chronic hypertension.

Prevalence of HIV antibodies in pregnant women with increased risk for AIDS.

The prevalence of Human immunodeficiency virus (HIV) antibodies in pregnant women varies widely between industrialized and developing countries. There is a lack of information about the status of HIV-infected pregnant women with increased risk for AIDS. Our objective was to determine the prevalence of HIV antibodies in pregnant women with increased risk at the Hospital of Obstetrics and Gynecology of the Mexican Institute of Social Security, Leon, Mexico, from December 18, 2003, through February 28, 2006. In a cross-sectional study, 2,257 pregnant women with at least one risk factor for AIDS were recruited. In these women, a sample of blood to determine HIV antibodies was taken. There were two women with positive HIV antibodies; therefore, the HIV seroprevalence was 0.8 per 1,000. Of the two HIV-positive women, one of them had a history of chronic sexually transmitted diseases; she was married to a man who was working outside of our country for about 10 months, and also he had tattoos. The other HIV-positive woman had a history of chronic sexually transmitted diseases, and her husband had intercourse with different women. The risk factors of use of tattoos, migration to foreign countries, and use of injectable drugs were more frequent among the male partners than in the pregnant women (P < .001). We concluded that in our country as well as in other developing countries, the prevalence of HIV antibodies in pregnant women with risk factors is low but still present. Because a significant number of risk factors for AIDS also were found in their male partners, HIV testing should be performed in all pregnant women as well as in their male partners.

[Predictive value of Doppler fluxometry of umbilical and middle cerebral arteries with the perinatal outcomes in fetus with intrauterine growth restriction]. / Valor predictivo de la flujometría Doppler de las arterias umbilical y cerebral media con los resultados perinatales en fetos con restricción del crecimiento intrauterino.

OBJECTIVE: To determine the predictive value of the Doppler fluxometry of the umbilical artery and middle cerebral artery with the perinatal outcome in fetuses with intrauterine growth restriction. MATERIAL AND METHODS: We carried out a cross-sectional study. There were included 220 pregnant women with diagnosis of intrauterine growth restriction. We carried out in these women Doppler fluxometry of umbilical artery and middle cerebral artery. It was followed the perinatal outcome of the newborns. We used student's t test for comparing the fluxometry indexes; and logistic regression analysis to determine its association with the perinatal outcome. An alpha value was set at 0.05. RESULTS: The fluxometry indexes of the umbilical artery were abnormal in all the cases of intrauterine growth restriction. The fluxometry indexes of the middle cerebral artery were abnormal in a small number of fetuses with perinatal complications. In the logistic regression analysis the fluxometry index of the umbilical artery was significant in order to predict bad perinatal outcome, in the other hand, the middle cerebral artery was not significant. The perinatal complications diagnosed were: distress respiratory syndrome (37.2%) necrotizing enterocolitis (6.2%) and sepsis (6.2%). CONCLUSIONS: The Doppler fluxometry of the umbilical artery have better predictive value than the middle cerebral artery for predicting bad perinatal outcome. We recommend the assessment of umbilical artery as first choice in order to determine the well-being in fetuses with intrauterine growth restriction.

Weight gain in preterm infants following parent-administered Vimala massage: a randomized controlled trial.

Massage has been proposed as a way of facilitating development and growth of newborns through its effects on increasing blood flow, heart rate, digestion, and immunity. Massage might increase basal metabolism and nutrient absorption through endocrine effects such as increase in insulin and adrenaline and decrease in cortisol. Preliminary studies have suggested significant impact on weight gain with shortening of in-hospital stays of up to 6 days. We compared weight gain among preterm infants receiving Vimala massage plus usual care versus usual care alone. A randomized controlled trial was conducted. Sixty clinically stable preterm newborns with a corrected gestational age of 30 to 35 weeks receiving enteral nutrition in the hospital nursery were included. Half of them were assigned at random to receive Vimala massage twice daily for 10 days plus usual nursery care; the others received usual nursery care. Weight, head circumference, caloric intake, and nutritional method were recorded daily. Group characteristics were compared with analysis of variance, T test, and chi (2) test as appropriate. There were no differences between groups in gender, gestational age, initial weight, head circumference, and caloric intake and type of nutrition at baseline. Infants receiving massage had a larger weight gain versus the control group since the third day (188.2 +/- 41.20 g/kg versus 146.7 +/- 56.43 g/kg, P < 0.001). Hospital stay was shorter in infants receiving massage and usual nursery care (15.63 +/- 5.41 days versus 19.33 +/- 7.92 days, P = 0.03). The addition of parent-administered Vimala massage to usual nursery care resulted in increased weight gain and shorter hospital stay among clinically stable preterm newborns.

Ghrelin in small-for-gestational age (SGA) newborn babies: a cross-sectional study.

BACKGROUND: Small-for-gestational newborn babies may have long-term metabolic consequences. Among the main hormones possibly involved in foetal growth regulation are the IGFs, IGFBPs and the recently described ghrelin. OBJECTIVE: To examine the levels of desacyl-ghrelin, IGF-1, IGFBP-1 and IGFBP-3 in children Small-for-gestational age (SGA) and children adequate-for-gestational age (AGA). DESIGN: This was a cross-sectional and comparative study. SUBJECTS: We included 40 children SGA and 40 children AGA. MEASUREMENTS: Blood sample was taken a week after birth and measuring hormonal levels were done by ELISA. RESULTS: SGA babies had lower IGF-1, IGFBP-3 and leptin levels, but higher ghrelin and IGFBP-1 levels. Birth weight was associated independently with ghrelin and IGFBP-1 (negatively) and IGFBP-3 (positively). Ghrelin circulating levels were associated negative and independently with IGFBP-3 and triglycerides in the mother. CONCLUSIONS: We interpreted these findings to indicate that diminished body weight in newborns induce different adaptive signals, some of them mediated by IGF-1/IGFBP-3, ghrelin or by IGFBP-1. This regulation is congruent with the proposed role of ghrelin to adaptation to under-nutrition favouring lipid accumulation. CONCyTEG grant number 05-16-K117-028.

[Placental histopathological changes in gestational hypertension]. / Alteraciones histopatológicas placentarias en la hipertensión gestacional.

BACKGROUND: Preeclampsia develops after a partial disorder in the process of placental formation, perhaps due to a deficiency of the trophoblast invasion by its spiral arteries and acute aterosis in its miometrial segments. It has not been reported if these changes also appear in placentas of women with gestational hypertension without proteinuria. OBJECTIVE: To describe histopathological changes in the placenta of patients with hypertensive disorders during pregnancy. MATERIAL AND METHODS: Cross-sectional study carried out in 138 patients divided into three groups: 46 with normotensive pregnancy (A group or control), 46 with gestational hypertension (group B), and 46 with preeclampsia (group C). There were registered sociodemographic and clinical variables; and the histopathological study of the placenta was performed. Mean, standard error and percentages were used. We calculated analysis of variance for comparing groups and linear regression for determining correlation between histopathological changes and blood pressure (it was assigned an alpha value of 0.05). RESULTS: There were more histopathological changes in groups of gestational hypertension and preeclampsia compared with controls (p < 0.01). Most frequent changes in all groups were: sincitial hyperplasia and fibrin deposits around the villi. There was correlation between histopathological changes and blood pressure (r= 0.27, p <0.01). CONCLUSION: There are more histopathological changes in placentas of women with hypertensive disease; number of histopathological changes is correlated with the severity of hypertension.

[Risk factors associated to female infertility]. / Factores de riesgo asociados con infertilidad femenina.

BACKGROUND: Incidence of female infertility is growing worldwide and the its rate varies from 10 to 20%. It has been reported diverse risk factors associated with this medical complication. OBJECTIVE: To identify the risk factors with significant association with female infertility. MATERIAL AND METHODS: A case-control study was carried out. There were included 440 patients, divided into 220 women with primary or secondary female infertility (cases) and 220 women without infertility recruited at mediate postpartum (controls). Twenty sociodemographic and clinical risk factors for female infertility were analyzed. Statistical analysis was performed with percentages, arithmetic media, standard error, Student t test and chi squared. An alpha value was set at 0.05. RESULTS: There were 6 factors with statistical significance: advanced age (p < 0.001), elevated body mass index (p < 0.001), age of onset of sexual activity (p < 0.001), prior pelvic surgeries (p < 0.001), and presence of stress (p < 0.001). Other risk factors such as smoking, chemical and radiological treatments, pelvic inflammatory disease, exercise, contraceptive use, alcohol intake, drugs, coffee, solvents, glue and insecticides, were not significant. CONCLUSIONS: There are clinical and demographic risk factors associated with female infertility. Them identification in women at reproductive age could diminish the frequency of female infertility and, thus, avoid them consequences.

[Correlation between Doppler fluxometry of middle cerebral artery/umbilical and non stress test as methods of antepartum fetal surveillance]. / Correlación entre la flujometría Doppler de la arteria cerebral media/umbilical y la prueba sin estrés como métodos de vigilancia fetal antes del parto.

OBJECTIVE: To determine the correlation between Doppler fluxometry of middle/umbilical cerebral artery and the non-stress test as methods of antepartum fetal surveillance. PATIENTS AND METHODS: We made a cross-sectional study. There were included 161 patients with high risk pregnancies. We carried out the non-stress test and the middle/umbilical cerebral artery resistance index in these women. Apgar score and perinatal outcome of the newborns were registered. Correlation coefficient as well as the sensitivity, specificity and predictive values of the tests were calculated. RESULTS: For the non-stress test in perinatal death, a sensitivity of 0% and a specificity of 84% were obtained; for Apgar at five minutes, sensitivity was 50% and specificity was 85%. In relation to perinatal death, the middlelumbilical cerebral artery resistance index has a sensitivity and specificity of 100 and 91%, respectively; for Apgar score at five minutes, the values were 100 and 92%, respectively. Correlation coefficient for the middle/umbilical cerebral artery resistance index and the non-stress test was -0.257 (p = 0.0009). CONCLUSION: We found a correlation between the middle/umbilical cerebral artery resistance index and the non-stress test. This index had more sensitivity and specificity for diagnosing perinatal death and Apgar score, for this reason we recommend it as a first choice method of antepartum fetal surveillance.

[Major and multiple birth defects in newborns of women attended in a tertiary care hospital]. / Defectos congénitos mayores y múltiples en neonatos de mujeres atendidas en un hospital de tercer nivel.

OBJECTIVE: To identify the frequency and type of major and multiple birth defects in live newborns of pregnant women attending at a tertiary care hospital. PATIENTS AND METHODS: A cross-sectional study was carried out during one year. There were included pregnant women who delivered neonates with a single major birth defect, or three minor birth defects, or one single major birth defect with two minor birth defects. A control group matched for sex without birth defects was included. We registered data of the mother, pregnant, newborn outcome and perinatal deaths caused by birth defects. RESULTS: Overall 17,546 pregnant women were included. There were 98 live newborns with birth defects (5.5 per 1000 live newborns). The most frequent birth defects were heart diseases (15.3%), gastrointestinal malformations (14.2%) and specific genetic syndromes (13.2%). Ten (13.2%) perinatal deaths were registered caused by birth defects. There were no difference between the groups in relation to maternal age, occupation, administered medications and number of appointments in antenatal care. Thirteen birth defects were diagnosed antenatal by ultrasound scanning. CONCLUSION: Since the repercussion of birth defects in the families and in hospital centers, it is important the collaborative work of a multidisciplinary team for diagnosing and treating these complications. These actions will contribute to enhance the outcome of the mother and newborn.

Antenatal dexamethasone and renal vascular resistance in preterm infants.

OBJECTIVE: To compare vascular resistance, renal volume and insulin levels in preterm infants with and without antenatal steroids. METHODS: We studied 61 preterm infants (37 with (group A) and 24 without antecedent of antenatal steroids (group B)). We measured insulin levels at birth in cord blood samples. Ultrasound measurements to evaluate renal arteries resistance index and renal volume were performed during the first 72 h of birth. RESULTS: Preterm infants from group A tended to have lower weight and gestational age than those from group B. Resistance index in renal arteries was lower in preterm infants with steroid therapy compared with group B (right renal artery 0.73 vs. 0.80; P=0.001, and left renal artery 0.75 vs. 0.79; P=0.01, respectively). Renal volume and insulin levels were not different between the groups. In the multiple regression analysis for factors associated with resistance index of renal arteries, only antenatal steroids use was included in the model (R2=0.13; P=0.003 and R2=0.10; P=0.01 for left and right renal arteries, respectively). CONCLUSION: Antenatal dexamethasone in preterm infants during the first 72 h of birth seems to decrease resistance index in renal arteries without affecting renal volume and insulin levels.

Efficacy and renal toxicity of one daily dose of amikacin versus conventional dosage regime.

This study assessed the efficacy and renal toxicity of one daily dose of amikacin versus several doses in infected full-term newborns. A clinical trial was conducted with 120 patients who were divided into two groups: group A (n = 60), infants who received amikacin 20 mg/kg/d in one dose; and group B (n = 60), infants who received amikacin 10 mg/kg/d every 12 hours. Both groups also received ampicillin 100 mg/kg/day. Blood levels of amikacin, urinary beta(2)-microglobulin (beta(2)-m), serum creatinine (SCr), and glomerular filtration rate (GFR) were measured in each patient. No significant difference was found in demographic characteristics as well as in their beta(2)-m, SCr, and GFR levels. Infection was resolved in 96% for infants of group A and 91% for group B ( P = 0.254). Renal toxicity was present in 20 versus 31.6%, respectively ( P = 0.211). In both groups no significant difference was found in peak amikacin levels, whereas trough levels were higher for group B ( P = 0.004). No significant difference was found in efficacy or renal toxicity in either group. We recommend using amikacin in one daily dose. It could diminish the manipulation of intravenous access, reducing the risk of nosocomial infections.

Risk factors of maternal death in Mexico.

BACKGROUND: One of the United Nations' Millennium Development Goals for 2015 is to reduce the maternal mortality ratio by three fourths. Ninety-nine percent of maternal deaths occur in developing countries, and the World Health Organization encourages investigations in these settings to determine the risk factors of maternal deaths. Our aim was to identify these risk factors in a hospital-based study in Mexico. METHODS: The study was conducted at the Hospital of Obstetrics and Gynecology at the Mexican Institute of Social Security in Leon, Guanajuato, Mexico, from January 1, 1992, to March 31, 2004. Women were divided into groups of 110 individuals who had died during pregnancy, delivery, or postpartum, and 440 women who survived the postpartum period. We used a logistic regression analysis to find the significant risk factors for maternal deaths. Odds ratios with 95% t confidence intervals were estimated. RESULTS: The maternal mortality ratio was 47.3 per 100,000 live births. The main causes of death were hemorrhage (30.9%), preeclampsia/eclampsia (28.2%), and septic shock (10.9%). Six factors were significantly associated with maternal death: age (OR = 1.09, 95% CI = 1.00-1.18), marital status (OR = 16.2, 95% CI = 1.3-196.1), number of antenatal visits (OR = 1.3, 95% CI = 1.0-1.6), preexisting medical conditions (OR = 23.3, 95% CI = 6.6-81.6), obstetric complications in previous pregnancies (OR = 28.3, 95% CI = 4.9-163.0), and mode of delivery (OR = 1.6, 95% CI = 1.0-2.4). CONCLUSIONS: Socioeconomic, medical, and obstetric risk factors are associated with maternal deaths in Mexico.