Evolución de pacientes con lesión renal aguda secundaria a complicaciones obstétricas tratadas con terapia de reemplazo renal continua / Evolution of patients with acute kidney injury secondary to obstetric complications treated with continuous renal replacement therapy / Evolução de pacientes com lesão renal aguda secundária a complicações obstétricas tratadas com terapia renal substitutiva contínua

Resumen: Introducción: La lesión renal aguda asociada al embarazo o complicaciones obstétricas (PR-AKI) es una enfermedad que ocurre por múltiples etiologías, de la cual poco se ha estudiado, estimándose una mortalidad de 4.3%. Objetivo: Analizar la evolución de las pacientes con lesión renal aguda secundaria a complicaciones obstétricas (PR-AKI) que recibieron terapia de reemplazo renal continua (TRRC) en la Unidad de Cuidados Intensivos del Hospital de la Mujer de Morelia, Michoacán. Material y métodos: Estudio retrospectivo, longitudinal, descriptivo. Se realizó una revisión de expedientes de pacientes que requirieron TRRC secundario a complicaciones obstétricas durante enero de 2013 a diciembre de 2019. Se aplicó la prueba t de Student, considerando los resultados estadísticamente significativos si p < 0.05. Resultados: Se incluyeron 13 pacientes que requirieron TRRC. La edad promedio de las pacientes fue de 26.18 años. Los criterios de TRRC fueron tener AKI grado 2 o 3 y RIFLE etapa lesión o fracaso; potasio ≥ 6.5 mEq/L; urea ≥ 150 mg/dL; índice urinario ≤ 0.5 mL; pH < 7.10 y HCO3 ≤ 20 mEq/L; SCr ≥ 2.4 mg/dL; sobrecarga hídrica > 10%; BUN > 30 mg/dL. Conclusiones: La incidencia de mujeres que requieren TRRC es de 3.2 casos/100 complicaciones obstétricas. Noventa y dos por ciento de las pacientes tuvieron recuperación de la función renal, mientras que la progresión a enfermedad renal crónica dependiente de otras modalidades de terapia de sustitución renal fue de 8%.

Abstract: Introduction: Acute kidney injury associated with pregnancy or obstetric complications (PR-AKI) is a disease that occurs due to multiple etiologies of which little has been studied, with an estimated mortality of 4.3%. Objective: To analyze the evolution of patients with acute kidney injury secondary to obstetric complications (PR-AKI) who received continuous renal replacement therapy (CRRT) in the Intensive Care Unit of the Hospital de la Mujer de Morelia, Michoacán. Material and methods: Retrospective, longitudinal, descriptive study. A review of the records of patients who required CRRT secondary to obstetric complications was carried out during January 2013-December 2019. The Student's t test was applied, considering the statistically significant results if p < 0.05. Results: Thirteen patients who required CRRT were included. The mean age of the patients was 26.18 years. The CRRT criteria were: AKI grade 2 or 3 and RIFLE stage injury or failure and potassium ≥ 6.5 mEq/L; urea ≥ 150 mg/dL; urinary index ≤ 0.5 mL; pH < 7.10 and HCO3 ≤ 20 mEq/L; SCr ≥ 2.4 mg/dL; water overload > 10%; BUN > 30 mg/dL. Conclusions: The incidence of women requiring CRRT is 3.2 cases/100 obstetric complications. Ninety-two percent of the patients had recovery of renal function while the progression to chronic kidney disease dependent on other modalities of renal replacement therapy was 8%.

Resumo: Introdução: A lesão renal aguda associada à gravidez ou complicações obstétricas (PR-LRA) é uma doença que ocorre por múltiplas etiologias das quais pouco tem sido estudada, com mortalidade estimada em 4.3%. Objetivo: Analisar a evolução de pacientes com lesão renal aguda secundária a complicações obstétricas (PR-LRA) que receberam terapia renal substitutiva contínua (TRRC) na Unidade de Terapia Intensiva do Hospital da Mulher de Morelia, Michoacán. Material e métodos: Estudo retrospectivo, longitudinal, descritivo. Uma revisão dos prontuários de pacientes que necessitaram de TRRC secundária a complicações obstétricas foi realizada durante janeiro de 2013-dezembro de 2019. Foi aplicado o teste t de Student, considerando os resultados estatisticamente significativos se p < 0.05. Resultados: Incluíram-se 13 pacientes que necessitaram de TRRC. A média de idade dos pacientes foi de 26.18 anos. Os critérios de TRRC foram ter IRA grau 2 ou 3 e lesão ou falha no estágio RIFLE; potássio ≥ 6.5 mEq/L; ureia ≥ 150 mg/dL; índice urinário ≤ 0.5 mL; pH < 7.10 e HCO3 ≤ 20 mEq/L; SCr ≥ 2.4 mg/dL; sobrecarga hídrica > 10%; BUN > 30 mg/dL. Conclusões: A incidência de mulheres que necessitam de TRRC é de 3.2 casos/100 complicações obstétricas. 92% dos pacientes tiveram recuperação da função renal enquanto a progressão para doença renal crônica dependente de outras modalidades de terapia renal substitutiva foi de 8%.

Factores de riesgo asociados al parto pretérmino en madres jóvenes atendidas en un hospital de Perú / Risk factors associated with preterm labor in young mothers assisted in a hospital of Peru

Introducción: El parto pretérmino es una de las principales causas de morbilidad y mortalidad neonatal, cuyo origen está asociado con la presencia e interacción de factores relacionados con la madre y su entorno. Objetivo: Determinar los factores de riesgo asociados con el parto pretérmino en madres jóvenes atendidas en un Hospital de Lima, Perú. Métodos: Se realizó un estudio no experimental, analítico y retrospectivo de 32 madres con parto pretérmino y 292 a término (seleccionadas aleatoriamente), desde enero hasta agosto de 2016 en el mencionado centro hospitalario. Se utilizó la prueba de Ji al cuadrado o test de Fisher, según fue necesario, así como el odds ratio (OR) con sus intervalos de confianza al 95 %. Resultados: Los factores sociodemográficos como la instrucción, la ocupación y el estado conyugal no estuvieron relacionados con el parto pretérmino; en tanto, los pregestacionales (índice de masa corporal y antecedente de parto pretérmino) se asociaron significativamente y los clínicos (infección del tracto urinario, rotura prematura de membranas y preeclampsia) demostraron asociación estadística. Conclusiones: El índice de masa corporal pregestacional ≥25 kg/m2, el antecedente de parto pretérmino, la infección urinaria, la rotura prematura de membranas y la preeclampsia, incrementaron significativamente el riesgo de parto pretérmino.

Introduction: Preterm labor is one of the main causes of neonatal morbidity and mortality whose origin is associated with the presence and interaction of factors related to the mother and her environment. Objective: To determine the risk factors associated with preterm labor in young mothers assisted in a Hospital of Lima, Peru. Methods: A non experimental, analytic and retrospective study of 32 mothers with preterm labor and 292 with term delivery (selected at random), was carried out from January to August, 2016 in the hospital center above mentioned. The chi-square test of Fisher test was used, as it was necessary, as well as the odds ratio (OR) with its confidence intervals of 95 %. Results: The social demographic factors as instruction, occupation and marital status were not related to preterm labor; as long as, antenatal factors (body mass index and history of preterm labor) were significantly associated and clinical factors (urinary tract infection, early rupture of membranes and preeclampsia) demonstrated a statistical association. Conclusions: The antenatal body mass index ≥25 kg/m2, history of preterm labor, urinary infection, early rupture of membranes and preeclampsia, significantly increased the risk of preterm labor.

Neonatal and Maternal Clinical Characteristics of Late Preterm Births: Single Center Data

PURPOSE: Recently, the number of late preterm infants are increasing, and they are prone to have many clinical problems. The purpose of this study is to emphasize the importance of perinatal care for the late preterm infants and their mothers. METHODS: Total admitted numbers of late preterm infants were 547 (from 464 mothers) and of term infants were 1,514 (from 1,470 mothers) in NICU, at Chonnam National University Hospital January 2014~December 2015. Maternal and neonatal mortality rate were calculated in the total admitted numbers. Exclusion criteria were death or transfer during admission, congenital anomaly, and etc. The enrolled numbers of late preterm infants were 493 (from 418 mothers) and of term infants were 1,167 (from 1,123 mothers). Retrospective chart review was conducted. In mothers, demographics, underlying illness, and obstetric complication, and in newborns, demographics, hospital days and morbidity were compared between late preterm group and term group. RESULTS: Maternal mortality rate was not different. However, neonatal mortality rate was higher in late preterm infants. In mothers of late preterm group, there was no difference in demographic characteristics, but the rates of autoimmune disease and obstetric complication were higher. In infants of late preterm group, body size was smaller, artificial conception and C-section rate were higher, and one and five-minute Apgar scores were lower, and hospital duration was longer. And the incidence of respiratory distress, transient tachypena of newborn, intraventricular hemorrhage and metabolic abnormalities were higher, but the incidence of meconium aspiration syndrome was lower compare to the term infant group. CONCLUSIONS: Maternal mortality was not different. However, neonatal mortality was higher in late preterm infants. In late preterm group, the mothers had higher rate of autoimmune disease and obstetric complication, and the infants had higher morbidity compare to the term group. When the obstetrician decides on delivery time in high risk pregnancy, maternal medical condition and neonatal outcome should be considered.

Maternal morbidity and near miss associated with maternal age: the innovative approach of the 2006 Brazilian demographic health survey

OBJECTIVE: To study the prevalence of potentially life-threatening maternal conditions and near miss in Brazil according to maternal age. METHODS: A secondary analysis of the 2006 Brazilian demographic health survey database using a validated questionnaire to evaluate maternal morbidity with a focus on age extremes. The study included 5,025 women with at least 1 live birth in the 5-year reference period preceding their interviews. Three age range periods were used: 15-19 years (younger age), 20-34 years (control), and 35-49 years (advanced maternal age). According to a pragmatic definition, any woman reporting eclampsia, hysterectomy, blood transfusion, or admission to the intensive care unit during her pregnancy/childbirth was considered a near-miss case. The associations between age and severe maternal morbidity were further assessed. RESULTS: For the 6,833 reported pregnancies, 73.7% of the women were 20-34 years old, 17.9% were of advanced maternal age, and only 8.4% were of younger age. More than 22% of the women had at least one of the complications appraised, and blood transfusion, which was more prevalent among the controls, was the only variable with a significant difference among the age groups. The overall rate of maternal near miss was 21.1 per 1000 live births. There was a trend of higher maternal near miss with increasing age. The only significant risk factor identified for maternal near miss was a lower literacy level among older women. CONCLUSIONS: There is a trend towards worse results with increasing age. The investigation of the determinants of maternal near miss at the community level using an innovative approach through a demographic health survey is an example suggested for under-resourced settings. .

Consideraciones prácticas sobre la hemorragia en el periparto / Practical considerations on hemorrhage during peripartum

La hemorragia de origen obstétrico constituye la primera causa de morbilidad y mortalidad maternas en la región de las Américas y el mundo, con el sangrado posparto como su forma de presentación más común. La presente revisión ha perseguido actualizar la información disponible sobre prevención, diagnóstico precoz e intervención temprana en lo que respecta al tratamiento médico o quirúrgico del riesgoso proceso, a fin de que apoye a la comunidad científica de esta disciplina en la toma de decisiones, contribuya a lograr un mejor control de esa contingencia negativa en las féminas y disminuya el número de madres fallecidas por complicaciones del embarazo, parto o puerperio, como la mencionada al inicio de esta síntesis.

Hemorrhage of obstetric origin constitutes the first maternal morbidity and mortality cause in the region of the Americas and of the world, with the postpartum bleeding as its most common form of presentation. The present review has been aimed at updating the available information on prevention, early diagnosis and intervention concerning medical or surgical treatment of the risky event, so that it supports the scientific community of this discipline in the decision making process, contributes to achieve a better control of this negative disorder in the females and diminishes the number of dead mothers due to complications of pregnancy, delivery or puerperium, as the one mentioned at the beginning of this synthesis.

Influence of positive serum thyroid peroxidase antibody on pregnancy outcomes / 中华内分泌代谢杂志

ObjectiveTo investigate the influence of positive serum thyroid peroxidase antibody (TPOAb) on pregnancy outcomes in biochemically euthyroid women during gestation.MethodsFrom July 2006 to December 2010,in the prenatal care unit all pregnant women,who had no medical and family history of thyroid diseases,underwent thyroid function screening.Serum TPOAb was tested among those pregnant women with euthyroidism.Pregnancy outcomes,including obstetric complications,neonate birth weight,and Apgar score,were compared between 185 TPOAb positive women and 1417 TPOAb negative women.ResultsCompared with TPOAb negative women,it was more frequent for TPOAb positive women to suffer from various obstetric complications.The prevalences of umbilical cord entanglement ( 18.9％ vs 12.9％,RR =1.47,95％ CI 1.06-2.03,P＜0.05 ),threatened premature delivery or abortion (3.8％ vs 1.0％,RR =3.83,95％ CI 1.57-9.37,P＜0.05 ),intrauterine growth retardation (5.4％ vs 0.8％,RR =6.96,95％ CI 3.00-16.17,P＜0.01 ),and neonatal pneumonia ( 4.9％ vs 1.3％,RR =3.83,95％ CI 1.75-8.40,P＜0.01 ) in the group of TPOAb positive women were higher than those in the group of TPOAb negative women.Apgar score of those newborns whose mothers had positive TPOAb was 9.27 ±1.13 at one minute and 9.44 ± 1.09 at five minutes,being lower than that of the TPOAb negative group (9.49 ±0.69 and 9.68 ±0.52,both P＜0.01 ).The rate of newborns with Apgar score at 7 or less by 5 min in group with positive TPOAb was higher than that of group with negative TPOAb ( 1.6％ vs 0.1％,RR =11.49,95 ％ CI 1.93-68.31,P＜ 0.05 ).ConclusionsThese results indicate that pregnant women with normal thyroid function but positive TPOAb may be liable to increase risk of serious pregnancy outcomes,such as threatened premature delivery or abortion,intrauterine growth retardation,and a lower Apgar score in neonatal.

AKT1 Gene Polymorphisms and Obstetric Complications in the Patients with Schizophrenia

OBJECTIVE: We performed a genetic association study with schizophrenic patients to investigate whether the V-akt murine thymoma viral oncogene homolog 1 (AKT1) gene plays a role in obstetric complications. METHODS: One-hundred-eighty patients with schizophrenia (male, 113; female, 67) were included. All patients fulfilled DSM-IV criteria for schizophrenia. Obstetric complications were measured by the Lewis scale. Prenatal and perinatal information was retrospectively collected from the patients' mothers. We selected six single nucleotide polymorphisms (SNPs) for the AKT1 gene: SNP1 (rs3803300), SNP2 (rs1130214), SNP3 (rs3730358), SNP4 (rs 1130233), SNP5 (rs2494732), and SNPA (rs2498804). The genotype data were analyzed for an association with the Lewis total score in terms of allele, genotype, and haplotype distribution. RESULTS: The mean total Lewis scores were 1.30+/-1.61 for males and 1.54+/-1.87 for females. Higher total score tended to be correlated with an earlier age of onset of schizophrenia in females. In the total sample, no SNP was associated with obstetric complications. However, the additional analyses for male and female subgroups found a significant association between SNPA and SNP4 and Lewis score in females (p=0.02 for SNPA, p=0.04 for SNP4). The SNP5-SNPA haplotype showed a positive association with obstetric complications (p=0.03) in the female patient group. CONCLUSION: We found an association between SNPs in the AKT1 gene and total Lewis score measuring obstetric complications in female patients with schizophrenia. Because these findings did not survive a correction for multiple testing, the significance should be interpreted carefully and replication studies are required.

Normal Obstetric Outcome in Neurofibromatosis-1 Complicating Pregnancy.

Neurofibromatosis (NF), a genetic disorder, has increased risk of obstetric complications as well as aggravation of maternal disease. However, here is a case of Neurofibromatosis associated with normal obstetric outcome despite the aggravation of dermatological lesions.

Real situation of obstetric complications in the community in some communes of Hoai Duc district, Ha Tay province

Background: Obstetric complications always are the risk factors which impact on pregnant women, especially no having care and treatment on time. Objectives: (1) To determine the rate of obstetric complications in some communes of Hoai Duc district, Ha Tay province. (2) To identify some factors which may have impact obstetric complications in the community. Subjects and method: Conducting a cross \ufffd?sectional survey with 363 women randomly chosen for sampling from the list of 1.530 women of reproductive age having terminated their pregnancy dressed for a six \ufffd?month period (from 1 October 2004 to 31 March 2005) in 10 communes of Hoai Duc district, Ha Tay province. Results: The obstetric complications rate was 9.9%. Obstetric complications recorded under the research often had the following forms: hemorrhage (94.4%), infection and pre \ufffd?eclampsia/eclampsia, each of them (2.8%). obstetric complications regularly happened with women of over 40 years old (20%). Those complications were closely linked to vaginal bleeding symptom during pregnant period with p<0.05. Conclusion: Obstetric complication rate was 9.9%, mostly hemorrhage. There was close relation between obstetric complication with vaginal bleeding symptom during pregnant period.

A clinical analysis of the non-diabetic factors and fetal macrosomia / 医学研究生学报

Objective: To analyze the clinical characteristics of non-diabetic fetal macrosomia and their mothers.Methods: A retrospective case control study design was used to analyze 149 cases of non-diabetic fetal macrosomia and their mothers with the normal oral glucose tolerance test(OGTT) by comparison with 166 randomly included newborns of normal birth weight.Results: More cases of non-diabetic fetal macrosomia were found in the male neonates.The body weight,height,FL and BPD averaged significantly higher in the macrosomia group than in the control,and so did the body weight,height,uterus height,abdominal circumference and gestational age of the mothers.The rates of cesarean section and other obstetric complications were also higher in the macrosomia group.Conclusion: Different from the diabetic macrosomic fetus,the non-diabetic macrosomic fetus is a normal one,the incidence of which is associated with mothers'excessiver pregnancy nutrition as well as with genetic factors.

A Study of Obstetric Complications and Minor Physical Anomalies in Sibling and Sporadic Schizophrenics / 신경정신의학

The authors hypothesized that sporadic schziophrenic patients had more chances of receiving environmental insults during the fetal neural development compared with familial schizophrenics. We tested our hypothesis by comparing obstetric complications(OCs), minor physical anomalies(MPAs) and other clinical features, and examining the correlation between OCs and MPAs in schziophrenic patients who had one or more sibling with schizophrenia(sibling group) and sporadic schizophrenics(sporadic group) and normal controls. OCs were evaluated by the scale of Lewis, and MPAs were measured by the Waldrop scale. There were no significant differences in OCs and MPAs between schizophrenic and control groups. Sporadic group had significantly higher fetal distress, total Waldrop score and Waldrop score for mouth than sibling group. And there was a tendency that the number of subjects having the Waldrop score over 4 points was greater in the sporadic group. No significant correlation was observed between OCs and MPAs. The scores of initial psychopathology and post-treatment functioning were much higher in the sporadic group, but the other clinical features showed no differences. Although male patients had more OCs than female patients in sibling group, no sex differences were observed as a whole. Our results suggest that, if the methodological weakness were complemented, OCs and MPAs would be useful tools in the search for the cause of schizophrenia.