Estados hipertensivos del embarazo y complicaciones materno-perinatales en el Hospital Regional De Ciudad del Este

Introducción: Los estados hipertensivos del embarazo son un conjunto de patologías que puede producir muerte o discapacidad crónica en las madres, en los fetos y recién nacidos. Objetivo: Determinar la frecuencia de los estados hipertensivos del embarazo y las complicaciones materno-perinatales en el Hospital Regional de Ciudad del Este. Materiales y métodos: Estudio transversal descriptivo con muestreo no probabilístico. Se estudiaron a todas las mujeres embarazadas con estados hipertensivos del embarazo o asociado al mismo que tuvieron eventos obstétricos en el Hospital Regional de Ciudad del Este en los años 2018 al 2020. Los datos fueron analizados en el Software Stata 12.0. Resultados: Se estudiaron a 7056 pacientes. Se encontraron 11,9% participantes con estados hipertensivos del embarazo, 55,3% con mayor frecuencia entre los 20 a 35 años, el 71,3% tuvieron control prenatal de mala calidad, se encontraron el 42,8% con preeclampsia. El 65,2% terminaron por cesárea, 27,8% Síndrome de HELLP, el 1,4% presentaron requerimiento de terapia intensiva y 0,6% muerte materna. Con respecto a las complicaciones perinatales se encontraron bajo peso al nacer en 30,2% y muerte del 2%. Conclusión: Se registró alta frecuencia de estados hipertensivos del embarazo con alto porcentaje de complicaciones, mala calidad de control prenatal. Entre las complicaciones perinatales más frecuentes fueron el bajo peso al nacer y la más grave es la muerte.

Introduction: Hypertensive states of pregnancy are a set of pathologies that can cause death or chronic disability in mothers, fetuses and newborns. Objective: To determine the frequency of hypertensive states of pregnancy and maternal-perinatal complications at the Regional Hospital of Ciudad del Este. Materials and methods: Descriptive cross-sectional study with non-probability sampling. All pregnant women with hypertensive states of pregnancy or associated with pregnancy who had obstetric events at the Regional Hospital of Ciudad del Este in the years 2018 to 2020 were studied. The data were analyzed in Stata 12.0 software. Results: A total of 7056 patients were studied. 11.9% of participants had hypertensive states of pregnancy, and among them, 55.3% were found to be more frequent from 20 to 35 years of age, 71.3% had poor prenatal care, and 42.8% had preeclampsia. 65.2% of the participants ended up with cesarean delivery, 27.8% had HELLP syndrome, 1.4% required intensive care and 0.6% ended in maternal death. Regarding perinatal complications, low birth weight was found in 30.2%, and death at birth in 2%. Conclusion: A high frequency of hypertensive states of pregnancy with a high percentage of complications and poor quality of prenatal control was registered. One of the most common perinatal complications were low birth weight, and the most serious was death.

Factores de riesgo de complicaciones perinatales en el embarazo de adolescentes / Risk factors for perinatal complications in adolescent pregnancy

Resumen OBJETIVO: Identificar los factores asociados que condicionan complicaciones perinatales en las adolescentes embarazadas. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo, efectuado en adolescentes embarazadas atendidas en el Hospital General de la Zona 6, Ciudad Juárez, Chihuahua, entre marzo de 2020 y marzo de 2021. Se evaluaron las complicaciones perinatales que se clasificaron en: maternas durante el embarazo, trabajo de parto y puerperio. Y perinatales en el neonato. También se tomaron en cuenta los antecedentes obstétricos (embarazos, partos, cesáreas, abortos y complicaciones). Se utilizó la prueba de χ2 y en las variables estadísticamente significativas se llevó a cabo regresión logística. RESULTADOS: Se evaluaron 287 expedientes clínicos y se encontró asociación estadísticamente significativa entre las complicaciones perinatales y los embarazos sin control prenatal. El 49.8% de las adolescentes tuvieron complicaciones perinatales durante el embarazo, 24.4% en el trabajo de parto y el 0.3% en el puerperio, mientras que el 25.4% no experimentó complicaciones. CONCLUSIONES: Es evidente que la falta total o parcial de control prenatal, aunada al hecho de ser multigesta, soltera, consumir alcohol, vivir con los padres y encontrarse en la adolescencia temprana fueron factores de riesgo de complicaciones perinatales en el embarazo. En esta etapa de la vida el embarazo se asocia con diversos factores sociodemográficos que favorecen las complicaciones perinatales.

Abstract OBJECTIVE: To identify the associated factors that condition perinatal complications in pregnant adolescents. MATERIALS AND METHODS: Retrospective, case series study conducted in pregnant adolescents attended at the Hospital General de la Zona 6, Ciudad Juárez, Chihuahua, between March 2020 and March 2021. Perinatal complications were evaluated and classified as: maternal during pregnancy, labor and puerperium. And perinatal complications in the neonate. Obstetric history (pregnancies, deliveries, cesarean sections, abortions and complications) was also taken into account. The test of 2 was used and logistic regression was performed for statistically significant variables. RESULTS: A total of 287 clinical records were evaluated and a statistically significant association was found between perinatal complications and pregnancies without prenatal control. 49.8% of the adolescents had perinatal complications during pregnancy, 24.4% in labor, and 0.3% in the puerperium, while 25.4% experienced no complications. CONCLUSIONS: It is evident that the total or partial lack of prenatal control, together with the fact of being multigestational, single, consuming alcohol, living with parents and being in early adolescence were risk factors for perinatal complications in pregnancy. At this stage of life, pregnancy is associated with various sociodemographic factors that favor perinatal complications.

Prevalencia de la infección por Chlamydia trachomatis y su potencial impacto perinatal en pacientes chilenas / Prevalence of Chlamydia trachomatis infection and a potential perinatal impact in Chilean patients

Resumen Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. Según datos de la Organización Mundial de la Salud, su prevalencia se estima alrededor de 4,2% en mujeres. Es una infección silente; sin embargo, puede desarrollar complicaciones en la fertilidad o durante el embarazo. El objetivo de esta revisión es describir la prevalencia de C. trachomatis en estudios recientes en Chile, que utilicen para su detección reacción de polimerasa en cadena (RPC), revisar las posibles complicaciones perinatales asociadas, conocer las recomendaciones de tamizaje en gestantes en otros países y discutir la necesidad de incluir en nuestro país un programa de tamizaje prenatal.

Abstract Chlamydia trachomatis is the most frequent bacterial sexually transmitted disease around the world. Estimated prevalence by WHO is 4,2% for women. Most cases are asymptomatic, but complications in fertility and during pregnancy are possible. The aim of this review is to describe the prevalence of C. trachomatis in Chilean studies using polymerase chain reaction (PCR) for detection, to describe the possible perinatal complications, to know recommendations about pregnancy screening in other countries, and to discuss the possibility of implementing in Chile.

Nudos verdaderos del cordón Umbilical. Presentación de tres casos. Maternidad de Ouargla. 2017-2018, Argelia / True knots of the umbilical cord. Presentation of three cases. Ouargla Maternity. 2017-2018, Algeria / Verdadeiros nós do cordão umbilical. Apresentação de três casos. Ouargla Maternity. 2017-2018, Argélia

RESUMEN Introducción: los nudos verdaderos del cordón umbilical son poco frecuentes y ocurren entre 0.3-1.3 % de todos los embarazos. La tasa de mortalidad fetal antes del parto oscila entre 4 a 10 veces mayor con relación a los embarazos con cordones umbilicales normales. Presentación de caso: caso 1 paciente de 39 años de edad G3 P (1eut y 1 ces) A0, obesa, edad gestacional de 39.3 semanas, que asiste al Hospital con contracciones uterinas de 3/10 minutos, buena intensidad, presentación alta, cefálica y la frecuencia cardiaca fetal(fcf) de 164/minutos, cesárea anterior hace 2 años, signo de más, con cuello uterino permeable 1cm, grueso y membranas intactas. Caso 2: paciente que ingresa en el Hospital con 41 años de edad, obesa, con G5 P4 A0, Edad gestacional de 40, 4 semanas, el último parto ocurrió hace 6 años, posee contracciones 2/10 minutos y fcf de 160/minutos, con desaceleraciones tardías en los registros cardiotocográficos (CTG), dilatación de 2cms con membranas intactas y el cuello grueso y rígido. TA: 140/80, en hipertensa crónica y tratamiento con metildopa 250mg c/6hrs. Caso 3: paciente que ingresa con 39 años de edad, 41 semanas de gestación, G6 P5 A0, obesa, el último parto se realizó con la aplicación de fórceps con apgar bajo, hace 3 años, lleva tratamiento con metildopa 500mg cada 8 horas por ser una hipertensa crónica; ingresó con tensión arterial de 120/80, se queja de dolores bajo vientre. Discusión: dentro de los factores de riesgos planteados en la aparición de los nudos verdaderos del cordón umbilical se constató: la hipertensión arterial crónica en los tres pacientes, dos multíparas, tres con edad igual o mayor a 39 años y todos con cordones mayores a 60cms. La longitud normal del cordón es de (30cms a 60cms). Se plantea como riesgo de desarrollar nudos del cordón, con cordones mayores a 80cms. Conclusiones: no hubo complicaciones para la salud de los neonatos.

ABSTRACT Introduction: true umbilical cord knots are rare and occur between 0.3-1.3 % of all pregnancies. The fetal mortality rate before delivery ranges from 4 to 10 times higher than in pregnancies with normal umbilical cords. Case presentation: case 1 39-year-old patient G3 P (1 eut and 1 ces) A0, obese, gestational age of 39.3 weeks, who attends the Hospital with uterine contractions of 3/10 minutes, good intensity, high presentation, cephalic and fetal heart rate (fcf) of 164 / min, previous cesarean section 2 years ago, plus sign, with a patent cervix 1cm, thick and intact membranes. Case 2: patient admitted to the Hospital at 41 years of age, obese, with G5 P4 A0, gestational age of 40, 4 weeks, the last delivery occurred 6 years ago, has contractions 2/10 minutes and fcf of 160 / minutes, with late decelerations in the cardiotocographic recordings (CTG), dilation of 2 cm with intact membranes and a thick and stiff neck. BP: 140/80, in chronic hypertensive and treatment with methyldopa 250mg every 6hrs. Case 3: patient who was admitted with 39 years of age, 41 weeks of gestation, G6 P5 A0, obese, the last delivery was performed with the application of forceps with low apgar, 3 years ago, has been treated with methyldopa 500mg every 8 hours for be a chronic hypertensive; she was admitted with a blood pressure of 120/80, she complains of pain in the lower abdomen. Discussion: among the risk factors raised in the appearance of true umbilical cord knots, it was found: chronic arterial hypertension in the three patients, two multiparous, three with age equal to or greater than 39 years and all with cords greater than 60 cm. The normal length of the cord is (30cms to 60cms). It is posed as a risk of developing knots in the cord, with cords greater than. Conclusions: there were no complications for the health of the neonates.

RESUMO Introdução: os nós verdadeiros do cordão umbilical são raros e ocorrem entre 0,3-1,3% de todas as gestações. A taxa de mortalidade fetal antes do parto varia de 4 a 10 vezes maior do que em gestações com cordão umbilical normal. Apresentação do caso: caso 1 paciente G3 P, 39 anos (1 eut e 1 ces) A0, obesa, idade gestacional de 39,3 semanas, que chega ao Hospital com contrações uterinas de 3/10 minutos, boa intensidade, apresentação elevada, frequência cardíaca cefálica e fetal (fcf) de 164 / min, cesárea anterior há 2 anos, sinal positivo, com colo pérvio 1cm, membranas espessas e íntegras. Caso 2: paciente que dá entrada no Hospital com 41 anos de idade, obeso, com G5 P4 A0, idade gestacional de 40,4 semanas, último parto há 6 anos, contrações 2/10 minutos e fcf de 160 / minutos, com desacelerações tardias nos registros cardiotocográficos (CTG), dilatação de 2 cm com membranas íntegras e pescoço grosso e rígido. PA: 140/80, em hipertensos crônicos e tratamento com metildopa 250mg a cada 6h. Caso 3: paciente que deu entrada com 39 anos, 41 semanas de gestação, G6 P5 A0, obesa, último parto realizado com aplicação de fórceps com baixo apgar, há 3 anos, tratou com metildopa 500mg a cada 8 horas para ser hipertenso crônico; Foi internado com pressão arterial de 120/80, com queixa de dores na região abdominal inferior. Discussão: entre os fatores de risco levantados no aparecimento de nós verdadeiros do cordão umbilical, encontrou-se: hipertensão arterial crônica nos três pacientes, dois multíparos, três com idade igual ou superior a 39 anos e todos com cordões maiores que 60 cm. O comprimento normal do cabo é (30 cms a 60 cms). É considerado risco de desenvolvimento de nós no cordão, com cordões maiores que 80cms. Conclusões: não houve complicações para a saúde dos neonatos.

Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.

Base excess as a prognostic factor determining the perinatal outcome

Background: Umbilical cord blood gas assessment seems to be the most objective determination of fetal metabolic condition at the time of birth and can be used to assess the perinatal outcome of the baby. In the early stage of an impaired placental circulation, hypoxemia and hypercapnia result in a decrease in pH with BD maintained normal (respiratory acidemia), whereas if the hypoxic process develops into a sustained anaerobic metabolism the BD rises secondary to lactic acidosis and consumption of buffer.Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India, in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.Results: In present study, there was a significant difference between the 2 groups in terms of BE, BE being highest in the group without complication. There was a moderate negative correlation between duration of NICU stay (days) and BE (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of BE with the median BE (mmol/L) being highest in the group not requiring resuscitation. At a cutoff of BE (mmol/L) <-17.5, it predicts complications with a sensitivity of 71.4%, and a specificity of 88.2%.Conclusions: Hence cord blood base excess can be used as a prognostic factor in determining the perinatal outcome.

Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Assessment of maternal and perinatal outcome in cases of prolonged pregnancy in a tertiary healthcare institute: a cross sectional observational study

Background: Prolonged pregnancy has always been regarded as a high‑risk condition because perinatal morbidity and mortality is known to rise. The interest in postdatism (just beyond expected date of delivery) has been recent and the management is controversial, more so with the advent of sonography providing information about placental aging and amount of amniotic fluid.  The aim of the present retrospective study was to analyze the outcome of pregnancies which crossed the expected date of delivery.Methods: The present study was a cross sectional observational study, conducted between April 2018 to September 2018, among 90 cases presented with post dated pregnancy under the department of obstetrics and gynecology, in a tertiary medical teaching institute in Maharashtra.Results: Maximum number of cases, i.e., 22.22% indications were meconium stained liquor with fetal distress, in 18.51% cases indications were failure of induction, in 22.22% indications were nonreactive NST, in 17.61% cases indications were CPD.Conclusions: It was concluded that prolonged pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR.

Maternal and perinatal outcome following assisted reproductive technology in a tertiary care centre: a retrospective study

Background: Infertility is a major issue and a source of social and psychological suffering for many couples. Introduction of assisted reproductive technology (ART) leads to great relief for couples nowadays.Methods: Present study was a retrospective study conducted at K.E.M hospital, a major tertiary care hospital after approval of the institutional ethics committee. A retrospective analysis of maternal and perinatal outcome of 30 cases of ART conception from the year 2014 to 2018 was done.Results: The mean age of women enrolled into present study was 37.6 years and most common age group was 30-50 years. The main cause of infertility was unexplained (40%), other causes were female factor (33.33%), male factor (16.67%) and combined (10%). 63.33% pregnancies were singleton and 36.67% twin gestations. The most common complication seen was preterm labour (43.33%). The other complications were preeclampsia/eclampsia (33.33%), gestational hypertension, renal failure, gestational diabetes, cardiomyopathy, hepatic failure, HELLP syndrome and DIC. 60% patients had caesarean section and 40% had vaginal delivery.90.24% neonates had 5-minute Apgar score of more than or equal to 7 and 9.76% had score less than 7. There were 4 stillbirths accounting for 9.76% and out of live births,75.68% babies required NICU admission. There were 5 neonatal deaths (12.2%) and perinatal death rate was 21.95%.Conclusions: ART is associated with a variety of maternal and perinatal complications. Couples should therefore be counseled about these risks while offering them ART as a mode of conception.

Complicaciones perinatales asociadas al embarazo en adolescentes de Atacames / Perinatal complications associated with pregnancy in adolescents from Atacames

Introducción: Las complicaciones perinatales en adolescentes embarazadas es un gran problema de salud pública, los riesgos en las madres adolescentes determinan el aumento en la morbi-mortalidad materna y un incremento de 2 a 3 veces la mortalidad neonatal. Objetivo: Determinar las complicaciones perinatales en adolescentes embarazadas en el servicio de emergencia del hospital Juan Carlos Guasti, de la ciudad de Atacames, entre enero y junio del 2016. Métodos: Estudio no experimental, cuantitativo de corte transversal y correlacional, los datos fueron obtenidos de las historias clínicas, partes diarios del servicio de emergencia, libros de registros de partos, legrados y cesáreas, los que fueron tabulados, analizada y representada en gráficos y tablas. Resultados: Se determinó que de las 69 embarazadas adolescentes que presentaron complicaciones perinatales, el 28 por ciento fue por abortos y el 23 por ciento se hospitalizaron por: amenaza de aborto, amenaza de parto prematuro, infección de vías urinarias, oligoamnios y ruptura prematura de membrana, entre otras. La histerectomía y hemorragia postparto que correspondió al 1 por ciento. En los recién nacidos, el 12 por ciento presentó complicaciones, siendo el 6 por ciento distrés respiratorio. Conclusiones: El aborto fue la principal complicación presentada en las embarazadas, seguido por otras como la ruptura prematura de membrana, amenaza de aborto, infección de vías urinarias, desproporción céfalo pélvica, sufrimiento fetal, antecedentes patológicos personales, entre otras(AU)

Introduction: Perinatal complications in pregnant adolescents is a major public health concern. The risks in adolescent mothers determine the increase in maternal morbidity and mortality and an increase of 2 to 3 times neonatal mortality. Objective: To determine the perinatal complications in pregnant adolescents in the emergency service of Juan Carlos Guasti Hospital, in the city of Atacames, between January and June 2016. Methods: Non-experimental, quantitative, cross-sectional and correlational study; data were obtained from clinical records, daily emergency service reports, birth records, cesareans, and cesarean sections, which were tabulated, analyzed and represented in graphs and boards. Results: It was determined that of the 69 pregnant adolescents who presented perinatal complications, 28 percent were abortions and 23 percent were hospitalized for threat of abortion, threat of premature birth, urinary tract infection, oligohydramnios and premature membrane rupture, among other. Hysterectomy and postpartum hemorrhage corresponded to 1 percent. In newborns, 12 percent presented complications, 6 percent being respiratory distress. Conclusions: Abortion was the main complication presented in pregnant women, followed by others such as premature rupture of the membrane, threatened abortion, urinary tract infection, cephalic pelvic disproportion, fetal distress, personal pathological history, among others(AU)

Progress in diagnosis and treatment of twin-twin transfusion syndrome / 中华实用儿科临床杂志

Twin-twin transfusion syndrome is the specific complication in monochorionic diamnionic twin pregnancy with the higher morbidity and mortality.Now,the progress in the clinical manifestation,complications,diagnosis and treatment of the twin-twin transfusion syndrome are introduced,in order to arouse clinicians to put importance on the diagnosis of chorion and amnion,specially monochorion,and provide help for the early management and intervention of twin pregnancy.

El sobrepeso y la obesidad como factores de riesgo para la preeclampsia / Overweight and obesity as risk factors in preeclampsia

Introducción: la preeclampsia es un trastorno multisistémico que se caracteriza por una invasión anormal del trofoblasto y que tiene entre sus factores de riesgo la obesidad. Objetivo: determinar la relación entre la obesidad y la preeclampsia como desencadenantes de complicaciones maternas y perinatales. Métodos: se realizó un estudio descriptivo de corte transversal de casos y controles en el Hospital Docente Ginecobstétrico de Guanabacoa desde 2014 hasta 2015. El universo quedó constituido por las 101 pacientes con diagnóstico de preeclampsia que concluyeron el embarazo. El grupo control lo integraron 96 pacientes que no desarrollaron la enfermedad en una muestra tomada de forma aleatoria. Se utilizó la prueba de chi cuadrado con corrección de Yate o la prueba exacta de Fisher para hacer comparaciones entre grupos. Resultados: se estudiaron 197 pacientes, 101 con preeclampsia (51,3 por ciento) y 96 controles sin preeclampsia (48,7 por ciento). Del total de pacientes, 86,1 por ciento presentó preeclampsia con elementos de agravamiento. El índice de masa corporal fue significativamente mayor entre las pacientes con preeclampsia que en el grupo control (p= 0,002). Hubo proporción de obesidad entre las pacientes con preeclampsia (48,5 por ciento de ellas con ganancia exagerada de peso. La preeclampsia se relacionó significativamente con las complicaciones maternas o perinatales combinadas (64,8 por ciento vs. 46,2 por ciento; p= 0,029). Conclusión: el incremento del índice de masa corporal influye en el riesgo de preeclampsia y esta a su vez en los adversos resultados maternos y perinatales(AU)

Introduction: preeclampsia is a multisystem disorder that is characterized by an abnormal invasion of the trophoblast and obesity is among its risk factors. Objective: determine the relationship between overweight and hypertensive disease that develops during pregnancy. Methods: across-sectional descriptive study of cases and controls was performed at the G-O teaching Hospital in Guanabacoa from 2014 to 2015. The universe consisted of the 101 patients diagnosed with preeclampsia who completed their pregnancy. The control group was composed of 96 patients who did not develop the disease in a sample taken at random. The chi square test with Yate correction or the Fisher exact test was used to make comparisons between groups. Results: 197 patients were studied, 101 with preeclampsia (51.3 percent) and 96 controls without preeclampsia (48.7 percent). Out of the total number of patients, 86.1percent presented preeclampsia with aggravating factors. Body mass index was significantly higher among patients with preeclampsia than in the control group (p= 0.002). There was a proportion of obesity among patients with preeclampsia (48.5 percent of them with an exaggerated weight gain. Preeclampsia was significantly associated with combined maternal or perinatal complications (64.8 percent vs. 46.2 percent, p= 0.029). Conclusion: the increase in body mass index influences the risk of preeclampsia and this, in turn, in adverse maternal and perinatal outcomes(AU)

"Clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of ""two-child policy""" / 中华临床感染病杂志

Objective To investigate the clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of two-child policy.Methods A total of 173 women with chronic hepatitis B virus infection in a subsequent pregnancy were enrolled from Hangzhou Xixi Hospital, among whom 91 cases were before implementation of the policy (from January to August 2015, control group), and 82 cases were after policy implementation (from March to December 2016, study group).The clinical data including basic information, pregnancy complications, postpartum complications, delivery mode and perinatal complications were retrospectively analyzed,t test or χ2 test was used for comparison between the two groups.Results There were significant differences in proportion of age>35 years (31.71% vs.16.48%,χ2=5.528), frequency of abortion(3.2±0.3 vs.1.3±0.4,t=5.723), fertility interval with first pregancy[(57.8±21.4)months vs.(40.4±16.6)months,t=6.691],rate of assisted reproduction(14.63% vs.5.49%,χ2=4.066),proportion of abnormal liver function(13.41% vs.4.40%,χ2=4.618),antiviral treatment during pregnancy (34.14% vs.19.78%,χ2=4.561) and proportion of HBV DNA loads >105IU/mL(35.36% vs.20.88%,χ2=4.515)between study group and control group (all P<0.05).The incidences of gestational hypertension(12.20% vs.3.30%), gestational diabetes mellitus(14.63% vs.5.49%),placenta previa(9.76% vs.2.20%),placental implantation(3.66% vs.0), hydramnio (12.20% vs.3.30%), fetal distress (14.63% vs.5.49%) and preterm birth(14.63% vs.5.49%)were also statistically significant between two groups (χ2=4.914, 4.066, 4.524, 3.838, 4.914, 4.066 and 4.066,all P<0.05).The incidence of cesarean section again(50.00%), postpartum hemorrhage(14.63%)and postpartum anemia(19.51%) were significantly higher in the study group than that in the control group(35.16%,4.40% and 8.79%,χ2=3.892, 5.387 and 4.149,all P<0.05).Compared with the control group, the incidence of low birth weight(14.63% vs.5.49%), neonatal asphyxia(19.51% vs.6.59%)and neonatal HBV infection rate(15.85% vs.6.59%)were higher in the study group (χ2=4.066, 6.486 and 3.883,all P<0.05).Conclusions The clinical characteristics of re-pregnant women with chronic hepatitis B virus infection are more complex and suffer greater risk of pregnancy, so antenatal care should be further reinforced after the comprehensive implementation of two-child policy.

Maternal and neonatal perinatal outcomes in pregnancies after in vitro fertilization and natural pregnancy: a systematic: a meta analysis / 重庆医学

Objective To systematically evaluate maternal perinatal complications and neonatal outcomes after in vitro fertili zation and embryo transplantation(IVF-ET).Methods The computer retrieval was performed on the databases of PubMed,Cochrane library,EMbase,CNKI,Wanfang and Chinese biomedical literature database.The articles on the comparison between IVF and natural pregnancy were included.The RevMan5.3 software was adopted to conduct the meta analysis.Results Twenty-three articles conforming to the requirements were included,including 1 312 651 cases,among them 113 044 cases were IVF and 1 199 607 cases were naturalpregnancy.IVF mother's age was larger than that of natural pregnancy,while the gestational weeks were smaller than those of natural pregnancy,the newborn birth weight was lighter than that of natural pregnancy(P＜0.05);the probability of pregnancy-induced hypertension (PIH),placenta previa,postpartum hemorrhage and gestational diabetes mellitus (GDM) occurrence in IVF mother were higher than that of natural pregnancy (P＜0.05);the rate of multiple and cesarean section in IVF mothers were higher than that of natural pregnancy (P＜0.05);the occurrence rates of small for gestational age(SGA),low birth weight infants,stillbirth and premature in IVF were higher than those of natural pregnancy (P＜0.05).Conclusion The maternal perinatal complications in IVF are higher than those of natural pregnancy,and the birth outcomes in IVF are worse than those of natural pregnancy.

Impact of Maternal Nutrition Management During Pregnancy on Perinatal Outcome, in One of the Pilot area of Gyeonggi-do Province

PURPOSE: Proper management of nutrition or health care for pregnant women is known to have better perinatal outcomes for maternal and neonatal health. In this study, we investigated the effect of regular medical and nutritional counseling provided to pregnant women for improved-results for mother and neonates. METHODS: Thirty-five pregnant women participated in the study and received information on nutrition management via telephone or e-mail every four weeks until childbirth. The nutrition management program comprised proper diet, low-salt diet, low-sugar diet, breast-feeding preparation, and provision of a healthy menu according to their pregnancy trimesters. We categorized them by their degree of participation into a “low participation group” that formed the control group, and a “high participation group” as the study group. RESULTS: No significant differences were found in maternal age, and body mass index between the two groups at the time of enrollment in the study. Post-natal exclusive breast feeding rate was significantly higher in the high participation group (62%) than in the low participation group (32%) (p<0.05). In the neonatal results, gestational age at birth and neonatal birth weight were significantly higher in the high participation group than in the low participation group (p<0.05). Neonatal complication rate, neonatal admission rate to intensive care unit, rate of low birth weight, Apgar score at 1 and 5 minutes, as well as the rate of transient tachypnea were higher in the low participation group, but lacked any statistically significant difference. CONCLUSION: Collaborative nutrition management with obstetricians and nutritionists is helpful in achieving better perinatal outcomes.

Desenlaces maternos, fetales y perinatales de las gestantes con diabetes en manejo con bomba de insulina en el Hospital Universitario San Ignacio / Maternal, fetal and perinatal outcomes of pregnant women with diabetes on insulin pump management at the Hospital Universitario San Ignacio

Antecedentes: La diabetes en el embarazo se asocia a un incremento considerable en la morbimortalidad materna, fetal y perinatal. Objetivo: Determinar los desenlaces maternos, fetales y perinatales de las gestantes con diagnóstico de diabetes pre gestacional en manejo con bomba de insulina en el Hospital Universitario San Ignacio. Método: Estudio de corte transversal en 24 gestantes con diagnóstico de diabetes en manejo con bomba de insulina quienes asistieron a control por Endocrinología y Alto Riesgo Obstétrico en el Hospital Universitario San Ignacio, entre Septiembre de 2009 y Diciembre de 2015. Resultados: La complicación materna más frecuente fue la hipoglicemia sintomática (50%), en segundo lugar los trastornos hipertensivos asociados al embarazo (45,8%). Las complicaciones neonatales más frecuentes fueron el síndrome de dificultad respiratoria del recién nacido (37,5%) y la hiperbilirrubinemia (37,5%). La hemoglobina glicosilada mayor del 6% se relacionó con el 71% de pacientes con macrosomía fetal. Conclusiones: La bomba de infusión de insulina representa una estrategia relativamente nueva dentro de los protocolos de manejo de diabetes pre gestacional y embarazo. Representaría una opción de manejo segura y fácil para el control de la glicemia en pacientes con indicaciones precisas.

Background: Diabetes in pregnancy is associated to a considerable increase in the maternal, fetal and perinatal morbidity and mortality. Objective: Determine the maternal, fetal and perinatal outcomes of patients with pre gestational diabetes being treated with insulin pump at Hospital San Ignacio. Methods: Cross-sectional study of 24 patients diagnosed with diabetes being treated with insulin pump who assisted to controls made by Endocrinology and Obstetrical High-Risk units at Hospital San Ignacio from September 2009 to December 2015. Results: The most common maternal complication was symptomatic hypoglycemia (50%) followed by hypertensive disorders of pregnancy (45.8%). Most common neonatal complications were respiratory distress syndrome (37.5%) and hyperbilirubinemia (37.5%). Glycosylated hemoglobin higher than 6% was related with 71% of patients who developed fetal macrosomia. Conclusions: The insulin infusion pump is a relatively new strategy management of pre gestational diabetes and pregnancy. Representing a safe and easy option for glycemic control in patients with precise indications.

Frecuencia de obesidad y su relación con algunas complicaciones maternas y perinatales en una comunidad indígena / Obesity frequency and its relationship with some maternal and perinatal complications in a native community

Antecedentes: La obesidad representa un alto riesgo tanto para la madre en el momento del embarazo, como para su descendencia.Objetivo: determinar la frecuencia de obesidad pregestacional, y su relación con algunas complicaciones maternas y perinatales en una comunidad indígena.Métodos: se realizó un estudio descriptivo transversal con 166 gestantes en la comunidad de la etnia miskita de El Muelle, municipio Puerto Cabezas, Nicaragua, durante el año 2013. El dato primario se obtuvo de las historias clínicas obstétricas, que se le confeccionó a cada una de ellas para su seguimiento en el puesto de salud.Resultados: 40 de las gestantes (24,1 por ciento), iniciaron el embarazo con obesidad. De ellas, 26 (15,6 por ciento), con obesidad grado I; 10 (6,1 por ciento) con grado II, y 4 (2,4 por ciento) con grado III. En general, el 87,5 por ciento de las embarazadas con obesidad pregestacional presentaron alguna complicación materna o perinatal; mientras en las no obesas se observaron en el 59,5 por ciento (OR: 4,76, IC: 1,74-12,96, p= 0,0011). La obesidad elevó significativamente el riesgo de presentar diabetes mellitus gestacional (OR: 5,03, IC: 2,03-12,4, p= 0,0002), macrosomía (OR: 8,06, IC: 2,56-25,36, p= 0,0001) y cesárea (OR: 5,13, IC: 1,53-17,22, p= 0,0040).Conclusiones: la frecuencia de obesidad en la población obstétrica de la comunidad indígena de El Muelle es elevada e incrementa el riesgo de complicaciones maternas y perinatales como la diabetes mellitus gestacional, la macrosomía y la cesárea(AU)

Background: Obesity represents a high risk both for the mother at the time of pregnancy and for her offspring.Objective: to determine the frequency of pregestational obesity and its association to maternal and perinatal complications in a native community.Methods: a descriptive cross-sectional study was conducted in 166 pregnant women from the Miskita ethnic community called El Muelle located in Puerto Cabezas, Nicaragua in 2013. The primary data was taken from their obstetric clinical histories that had been prepared for each of them for the follow-up at the health post.Results: forty of the pregnant women (24.1 percent) started their pregnancy as obese persons. Twenty six (15.6 percent) had 1st degree obesity; 10 (6.1 percent) with 2nd degree and four (2.4 percent) had 3rd degree. Generally speaking, 87.5 percent of the pregnant women with pregestational obesity presented with some maternal or perinatal complication whereas this situation was observed in 59.5 percent of non-obese women (OR: 4.76, CI 1.74-12.96, p= 0.0011). Obesity significantly increased the risk of gestational diabetes mellitus (OR: 5.03, CI: 2.03-12.4, p= 0.0002), macrosomy (OR: 8.06, CI: 2.56-25.36, p= 0.0001) and cesarean section (OR: 5.13, CI: 1.53-17.22, p= 0.0040).Conclusions: obesity frequency in the obstetric population of El Muelle native community is high and increases the risk of maternal and perinatal complications such as gestational diabetes mellitus, macrosomy and cesarean section delivery(AU)

Study on the peri-puerperium outcome and associated factors of patients with primary Sj?grenˊs syndrome / 中华风湿病学杂志

Objective To analyze the peripartum complications,frequency of neonatal abnormalities and the associated factors in patients with primary Sj?grenˊs syndrome (SS). Methods The chart of 39 patients with primary SS who were admitted to the hospital for delivery were retrospectively reviewed. The clinical data, obstetrical outcome and the frequency of neonatal abnormalities as well as the possible associated factors were analyzed. Results There were 76 pregnancies and 41 deliveries among these 39 patients. Two patients (5%) had pregnancy-related hypertension, 1 (3%) had gestational diabetes and 1 (3%) had eclampsia. Twenty-eight(72%) patients had at least one episode of complication. In which, 27(68%) were induced abortion, 2 (5%) were premature birth, 6 (21%) were amniotic fluid volume abnormalities, 2 (5%) were post-partum bleeding, 5 (13%) were premature rupture of membrane, 6 (21%) were intra-uterine distress and 3 (8%) had intra-uterine growth retardation. Fetal abnormality was detected in 7(18%) patients, in which 3 fetus (8%) died before delivery, 2 fetus (5%) were small than gestational age and 2 (5%) had fetal deformity. Compared to the reports in the literature, the rate of abortion and fetal death was higher, but the rate of growth retardation , induced abortion was lower. Conclusion The frequency of peri-partum complication and fetal abnormality is increased in patients with primary SS. Pregnancies in patients with primary SS should beclosely monitored by rheumatologists.

Clinical factors affecting the timing of delivery in twin pregnancies

OBJECTIVE: To investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications. METHODS: A retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks' gestation (group A), between 32 and 35+6 weeks' gestation (group B), and over 36 weeks' gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group. RESULTS: In group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14). CONCLUSION: Proper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks' gestation, and may decrease maternal and perinatal complications.

Valor predictivo del índice de líquido amniótico en las complicaciones neonatales / Predictive value of amniotic fluid index in neonatal complications

Determinar el valor predictivo del índice de líquido amniótico en las complicaciones neonatales. Se seleccionaron 120 embarazadas en las que se evaluó el valor del índice de líquido amniótico, complicaciones neonatales y eficacia diagnóstica. Las pacientes fueron divididas según el punto de corte del índice de líquido amniótico (grupo A: índice de líquido amniótico menor de 60 mm y grupo B índice de líquido amniótico igual o mayor a 60 mm). Servicio de Obstetricia y Ginecología. Hospital Central “Dr. Urquinaona”. Maracaibo. Estado Zulia. Las pacientes del grupo A presentaron una duración mayor del trabajo de parto y recién nacidos con menos peso al nacer que las pacientes del grupo B (P < 0,05). Con respecto a las complicaciones perinatales, la frecuencia de recién nacidos con sufrimiento fetal y con puntuación de Apgar menor o igual de 6 puntos al minuto fue estadísticamente superior en las pacientes del grupo A comparado con aquellas del grupo B (P < 0,05). El valor de corte de 60 mm en la predicción de sufrimiento fetal tiene una sensibilidad del 22,2 por ciento, especificidad del 96,4 por ciento, valor predictivo positivo del 72,3 por ciento y valor predictivo negativo del 74,3 por ciento; en la predicción de puntuación de Apgar menor o igual de 6 puntos al minuto tiene una sensibilidad del 25,0 por ciento, especificidad del 96,4 por ciento, valor predictivo positivo del 69,2 por ciento y valor predictivo negativo del 74,7 por ciento. El índice de líquido amniótico tiene valor en la predicción de sufrimiento fetal y puntuación de Apgar

To determine the predictive value of amniotic fluid index in perinatal complications. One hundred and twenty patients were selected. Amniotic fluid index, perinatal complications and diagnostic accuracy was evaluated. Patients were divided according to cut-off point of amniotic fluid index (group A: amniotic fluid index less than 60 mm and group B amniotic fluid index same or higher than 60 mm). Servicio de Obstetricia y Ginecologia. Hospital Central “Dr. Urquinaona”. Maracaibo. Estado Zulia. Patients in group A presented a longer labor and there newborns had less weight than those of patients in group B (P < 0.05). In relation to perinatal complications, the frequency of fetal distress and Apgar Score less than 6 points at minute was statically superior in patients of group A compared with those in group B (P < 0.05). The cut-off value of 60 mm for prediction of fetal distress has a sensivity of 22.2 percent, specificity of 96.4 percent, positive predictive value of 72.3 percent and negative predictive value of 74.3 percent; in the prediction of Apgar score equal or less than 6 points at minute had a sensivity of 25.0 percent, specificity of 96.4 percent, positive predictive value of 69.2 percent and negative predictive value of 74.7 percent. Amniotic fluid index has a value for prediction of fetal distress and Apgar score