Do induced twin pregnancies influence the obstetric and neonatal results of multiple births born before 32 weeks? Comparison to spontaneous gestation

PURPOSE: To compare obstetric outcomes of induced preterm twin births (under 32 weeks gestation) with those spontaneously conceived. METHODS: Prospective study of twin pregnancies (25 induced and 157 spontaneously conceived) developed over a period of 16 years in a tertiary obstetric center. Demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were compared. RESULTS: The analysis of obstetrical complications concerning urinary or other infections, hypertensive disorders of pregnancy, gestational diabetes, fetal malformations, intrauterine fetal death, intrauterine growth restriction and intrauterine discordant growth reveal no significant statistical differences between the two groups. First trimester bleeding was higher in the induced group (24 versus 8.3%, p=0.029). The cesarean delivery rate was 52.2% in spontaneous gestations and 64% in induced gestations. Gestational age at delivery, birth weight, Apgar scores at first and fifth minutes, admissions to Neonatal Intensive Care Unit and puerperal complications show no statistically significant differences between the two groups. These results were independent of chorionicity and induction method. CONCLUSION: The mode of conception did not influence obstetric and neonatal outcomes. Although induced pregnancies have higher risk of first trimester bleeding, significant differences were not observed regarding other obstetric and puerperal complications and neonatal results.

Markers of insulin resistance and sedentary lifestyle are predictors of preeclampsia in women with adverse obstetric results

Some thrombophilias and severe preeclampsia may increase the risk for preterm deliveries and fetal death due to placental insufficiency. Our objective was to evaluate clinical and laboratory data as predictors of preeclampsia in a population of mothers with 3rd trimester fetal losses or preterm deliveries. In a longitudinal retrospective study, 54 consecutive women (age range: 16 to 39 years) with normotensive pregnancies were compared to 79 consecutive women with preeclampsia (age range: 16 to 43 years). Weight accrual rate (WAR) was arbitrarily defined as weight gain from age 18 years to the beginning of pregnancy divided by elapsed years. Independent predictors of preeclampsia were past history of oligomenorrhea, WAR &gt;0.8 kg/years, pre-pregnancy or 1st trimester triglyceridemia &gt;150 mg/dL, and elevated acanthosis nigricans in the neck. In a multivariate logistic regression model, two or more predictors conferred an odds ratio of 15 (95%CI [5.9-37]; P < 0.001) to develop preeclampsia (85% specificity, 73% sensitivity, c-statistic of 81 �� 4%; P < 0.0001). Clinical markers related to insulin resistance and sedentary lifestyles are strong independent predictors of preeclampsia in mothers with 3rd trimester fetal losses or preterm deliveries due to placental insufficiency. Women at risk for preeclampsia in this particular population might benefit from measures focused on overcoming insulin resistance.

PAPP-A y ��-hCG libre como predictores de preeclampsia y bajo peso al nacer en una poblaci��n latina

Introducci��n: La Preeclampsia ocurre entre el 2-7% de los embarazos. Previos estudios han sugerido la asociaci��n entre los niveles alterados de PAPP-A y la ��-hCG libre con el desarrollo de Preeclampsia (PE) y/o Bajo Peso al Nacer (BPN). Metodolog��a: El dise��o del estudio es de Prueba Diagn��stica con enfoque de casos y controles. Las mediciones s��ricas de PAPP-A y la ��-hCG libre, fueron realizadas entre la semana 11-13.6 d��as durante 2 a��os. Resultados: La cohorte incluy�� 399 pacientes, la incidencia de PE fue de 2,26% y de BPN fue de 14.54%. El punto de corte del percentil 10 fue MoM PAPP-A: 0,368293 y MoM ��-hCG libre: 0,412268; la especificidad en PE leve fue de 90,5 y para BPN de 90. Los MoM de la ��-hCG libre, la edad y el peso materno se comportan como factores de riesgo, mientras que mayores valores de MoM de la PAPP-A y mayor n��mero de partos factores de protecci��n. Para el BPEG severo la edad materna y la paridad se comportan como factores de riesgo, mientras que un aumento promedio de los valores de los MoM de la PAPP-A y la ��-hCG libre, como factores de protecci��n en el desarrollo de BPEG Severo. Conclusiones: Existe una relaci��n significativa entre los valores alterados de PAPP-A y de ��-hCG libre, valorados a la semana 11 a 13 con la incidencia de Preeclampsia y de Bajo Peso al nacer en fetos cromos��micamente normales, mostrando unos niveles significativamente m��s bajos a medida que aumentaba la severidad de la enfermedad.

��ndice de pulsatilidad de arteria cerebral media como predictor para desenlaces desfavorables en fetos peque��os para la edad gestacional

Introducci��n: La aparici��n de vasodilataci��n aislada de la arteria cerebral media en fetos peque��os para la edad gestacional sin otros cambios en el doppler puede interpretarse como fisiol��gica o podr��a ser la manifestaci��n inicial de una restricci��n de crecimiento intrauterino de inicio tard��o. Se pretende evaluar la asociaci��n de la disminuci��n del ��ndice de pulsatibilidad de la arteria cerebral media, como predictor de desenlaces perinatales adversos, en fetos con bajo peso para edad gestacional. Metodolog��a: Se realiz�� un estudio de cohorte anal��tica de temporalidad hist��rica para determinar si el hallazgo de disminuci��n de la pulsatibilidad en el doppler de arteria cerebral media se asocia con el pron��stico perinatal adverso, en fetos peque��os para edad gestacional mediante un muestreo no probabil��stico. Resultados: Se recolectaron un total de 325 flujometr��a doppler de fetos peque��os para edad gestacional. El riesgo de parto pret��rmino fue RR 2.6 IC95% 1.6-4.1, de hospitalizaci��n fue RR 1.4 IC95%1.1-1.9 y de muerte fue 2.1 IC95%1.5-3.2 cuando hay ��ndice de pulsatilidad alterada en la arteria cerebral media. La regresi��n log��stica mostr�� que el riesgo de desenlaces desfavorables con alteraciones en la arteria cerebral media fue de RR 4.2 IC95% 2.5-7.1 ajustado por edad materna, edad gestacional y bajo peso al nacer. Discusi��n Los pacientes expuestos presentan mayor riesgo de desenlaces desfavorables con diferencias significativas, no as�� en otros estudios publicados. El presente estudio muestra asociaciones significativas que debe ser evaluada con estudios m��s amplios.

Relaci��n del ingreso en primer trimestre al control prenatal y el n��mero de controles prenatales con el desenlace de prematurez en reci��n nacidos de mujeres afiliadas a una EPS en la ciudad de Bogot�� quienes finalizaron su gestaci��n entre abril y septiembre del 2003.

Con este estudio se espera proporcionar informaci��n real para la toma de decisiones que fortalezcan las pol��ticas de promoci��n y prevenci��n en la organizaci��n y similares, determinando y dando respuesta a la pregunta de investigaci��n que se plantea as��: ��Cu��l es la relaci��n del ingreso en primer trimestre a control prenatal, el numero de controles prenatales y la aplicaci��n de la estrategia para vigilar la aparici��n y manejo de las infecciones urinarias y vulvovaginitis (estrategia PVTS) con la prematurez de los reci��n nacidos de gestantes afiliadas al r��gimen contributivo de Cafesalud EPS que finalizaron su gestaci��n en los meses comprendidos entre abril y septiembre del 2003 en la ciudad de Bogota?.

Hipotensi��n arterial y variabilidad de la frecuencia cardiaca en pacientes embarazadas llevadas a cesarea bajo anestesia raqu��dea

INTRODUCCION La hipotensi��n arterial por anestesia raqu��dea en embarazadas llevadas a ces��rea es frecuente y delet��rea para la madre y el feto, sin que a la fecha exista una herramienta cl��nicamente ��til para predecirla. La variabilidad de la frecuencia cardiaca es una medida que estima la actividad del sistema nervioso aut��nomo y algunos estudio iniciales indican una posible utilidad como herramienta predictiva de hipotensi��n arterial en esta poblaci��n. METODOLOGIA Se realiz�� un estudio observacional descriptivo para examinar el comportamiento de la variabilidad de la frecuencia cardiaca, medida como raz��n de Baja frecuencia/Alta frecuencia, con un punto de corte de 2.5 tomada con un reloj POLAR RS800CX, en una poblaci��n de pacientes con embarazo a t��rmino llevadas a ces��rea, en un hospital de tercer nivel en Bogot��- Colombia entre Febrero y Abril del 2015. RESULTADOS El estudio incluy�� 82 pacientes. Se determin�� que la raz��n Baja frecuencia/Alta frecuencia mayor a 2,5 era poco frecuente en nuestra poblaci��n (15.85%), y su asociaci��n no fue significativa. DISCUSION El presente estudio demostr�� que la asociaci��n entre la presencia de hipotensi��n y un ��ndice Baja frecuencia/Alta frecuencia con punto de corte de 2.5 no es significativo para nuestra poblaci��n de mujeres con embarazo a t��rmino llevadas a ces��rea con anestesia espinal. Seg��n los resultados se sugieres un punto de corte de 1.6 como punto de partida para la realizaci��n de nuevos estudios que permitan validar este valor.

Influ��ncia da aboragem cir��rgica (laparotomia versus vedeolaparoscopia na gesta����o : estudo experimental em coelhas

Objetivo: Estudar a influ��ncia de duas abordagens cir��rgicas na evolu����o da gesta����o de coelhas prenhes. Delineamento: Estudo experimental e controlado. M��todo: Sessenta coelhas brancas, da ra��a Nova Zel��ndia (Oryctolagus cuniculus), prenhes, foram divididas em tr��s grupos de estudo: controle (n=20), laparotomia (n=20) e videolaparoscopia (n=20). Os tr��s grupos, ap��s anestesia intravenosa e intuba����o orotraqueal, foram submetidos a duas diferentes abordagens cir��rgicas (laparotomia exploradora e videolaparoscopia diagn��stica) e acompanhados at�� o momento do parto. Foram feitas observa����es referentes �� dura����o da gesta����o, da mortalidade fetal e do peso dos l��paros vivos. Foram coletadas amostras de sangue arterial, no per��odo pr�� e p��s-operat��rio, para an��lise gasom��trica e medidas do hemat��crito e da hemoglobina das coelhas. Resultados: A dura����o da gesta����o (31,6 �� 0,99 vs. 31,8 �� 1,8 vs. 31,3 �� 2,24 dias), a taxa de mortalidade fetal (1,0 �� 2,5 vs. 1,9 �� 2,7 vs. 1,4 �� 2,0) e o peso dos l��paros vivos no primeiro dia de vida (48,7 �� 11,3 vs. 51,5 �� 11,9 vs. 48,3 �� 8,2 g) nos grupos C, L e V, respectivamente, n��o apresentaram diferen��as estat��sticas significativas entre os grupos de estudo (p>0,05). Nas an��lises das amostras sang����neas, quando comparado as diferen��as entre o pr�� e o p��s-operat��rio entre os grupos L e V, respectivamente, foram encontradas diferen��as com relev��ncia estat��stica (p>0,05) em rela����o ��s medidas do hemat��crito (34,4 �� 3,1 e 33,1 �� 2,8 vs. 34,2 �� 3,2 e 30,3 �� 3,7), do pH (7,4 �� 0,1 e 7,4 �� 0,1 vs. 7,5 �� 0 e 7,3 �� 0,1), do paCO2 ( 30,8 �� 5,1 e 40,7 �� 8,2 vs. 32 �� 3,7 e 53,5 �� 18,4), mas sem relev��ncia cl��nica. Conclus��o: A evolu����o da gesta����o das coelhas prenhes submetidas a abordagens videolaparosc��pica e laparot��mica n��o mostrou diferen��a entre os grupos, estando ambas as t��cnicas indicadas no per��odo gestacional de coelhas quando se fizer necess��rio.

Transplacental transmission of Toxoplasma gondii in reinfected pregnant female canines

Twelve pregnant female canines, naturally infected with Toxoplasma gondii, were reinfected with T. gondii: three (GI) received tachyzoites subcutaneously (1.0 x 107), three (GII) were orally inoculated with oocysts (1.5 x 104), and six (GIII) were kept as a nonreinfected control group. All the reinfected female canines (GI and GII) miscarried or presented fetal death, while only one GIII female presented a stillborn in a litter of four pups (P < 0.01). Fever, lymphoadenopathy, miscarriage, and fetal death were the main clinical alterations observed. The highest serological titers detected through the indirect fluorescence antibody test (IFAT) were 1,024 (GI) and 4,096 (GII). In group III, the titers ranged between 64 and 256. By bioassays in mice, T. gondii was isolated in 17 organs of the reinfected adult canines, in 11 of the control group, and in 20 of the neonates. Positive immunostaining of cysts and/or tachyzoites were observed in 26 canine tissues (14 from GI and GII and ten from GIII). The agent was detected by immunohistochemistry in the encephalon of a neonate and in the spinal cord of a stillborn, thus, confirming that T. gondii infected canine fetuses, provoking miscarriages, even in bitches that presented primoinfection.

Glargine vs. NPH insulin therapy in pregnancies complicated by diabetes: An observational cohort study

Aims: The effects of glargine insulin therapy in pregnancies are not well established. We compared maternal and neonatal outcomes of women with pregestational and gestational diabetes treated with glargine or NPH insulin.Methods: A prospective cohort study was conducted analyzing outcomes from 56 women with pregestational and 82 with gestational diabetes treated with either insulin regimen.Results: Comparisons were performed among 138 women: 56 with pregestational and 82 with gestational diabetes. In relation to maternal complications, worsening of retinopathy and nephropathy, preeclampsia, micro and macroalbuminuria, and all kinds of hypoglycemia were found higher in women with pregestational diabetes NPH-treated vs. glargine-treated. In women with gestational diabetes NPH-treated, it was observed increased incidence of prepregnancy and new-onset pregnancy hypertension, micro and macroalbuminuria, as well as mild and frequent hypoglycemia, compared to glargine-treated. Among the neonatal outcomes, 1-min Apgar score <7, necessity of intensive care unit and fetal death in pregestational, while jaundice and congenital malformations in gestational diabetes, respectively, were more frequently observed in infants born to NPH-treated, compared to glargine-treated.Conclusions: Glargine use during pregnancy from preconception through delivery, showed to be safe since it is associated with decreased maternal and neonatal adverse outcomes compared with NPH insulin-treated patients. (C) 2010 Elsevier B.V. All rights reserved.

Clinical, parasitological and obstetric observations in pregnant bitches with experimental toxoplasmosis

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Insulinoterapia, controle glic��mico materno e progn��stico perinatal - Diferen��a entre o diabetes gestacional e o cl��nico

PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher's exact test and Goodman's test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m 2 (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.

Absence of Wharton's jelly: case report

There are few reports in the literature of the absence of Wharton's Jelly. Here we report the seventh case in a primigravida, 22 years old, admitted after vaginal delivery of stillborn. The umbilical cord have a long segment with disruption of cord structures and the three blood vessels were completely separated from each other, with a minimum amount of Wharton's jelly remaining around each vessel. The absence of Wharton' jelly is associated with fetal distress, intrauterine growth restriction, and fetal death. Quantitative/qualitative studies of Wharton's jelly represent an open field of research for possible correlations with obstetric conditions and fetal deaths.

Infec����es parasit��rias na gravidez: preval��ncia e auto medica����o com plantas medicinais na regi��o de Araraquara -S��o Paulo - Brasil

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Principais complica����es perinatais da obesidade e do sobrepeso pr��-gestacionais

Objetive: The goal of this review is to discuss the evidence regarding the impact of pre-pregnancy overweight and obesity on perinatal outcomes. Data Collection Method: We conducted a search for articles in the Medline, PubMed and Scielo databases covering the past 5 years, and reviewed the bibliographical references contained in the articles selected. Articles were selected by subjective evaluation in terms of methodology, sample size and year of publication. Summary of evidence: We found strong evidence linking excess weight before pregnancy with the development of birth defects, fetal and neonatal deaths and macrosomia,. Conclusions: Excess weight in the pre-pregnancy is an important risk factor for the health of the fetus, whose importance increases because it is a modifiable risk factor.