Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

Proceso de enfermería a embarazada con infección de vías urinarias y amenaza de aborto / A Nursing Process for a Pregnant Woman with Urinary Tract Infection and Threatened Miscarriage

Introducción: La infección de vías urinarias es recurrente en el embarazo y generadora de complicaciones. Objetivo: Presentar un plan de cuidados enfermero a una mujer con diagnóstico infección de vías urinarias y amenaza de aborto Métodos: Caso clínico de paciente admitida en unidad de Ginecología y Obstetricia del Hospital General de Teziutlán, Puebla, México, durante 2019. Siguiendo la lógica del proceso de enfermería, la valoración se fundamentó en los patrones funcionales de salud de Marjory Gordon. Fueron utilizadas las terminologías normalizadas de enfermería: Diagnósticos (NANDA.int). Resultados (NOC) e Intervenciones (NIC). Resultados: Se identificaron cuatro diagnósticos de enfermería: deterioro de la eliminación urinaria, gestión ineficaz de la propia salud, disposición para mejorar la nutrición y riesgo de alteración de la díada materno/fetal, este último diagnóstico principal. Además, un Resultado NOC (Conocimiento: Control de Infección), cuatro indicadores y la escala de nunca a siempre demostrado; cuatro Intervenciones NIC, con 19 actividades. La evaluación transitó desde 12 (puntuación inicial) a 19 (puntuación final), de 20 como puntuación diana. Conclusión: La integración de las taxonomías NANDA, NIC, NOC y los patrones funcionales de salud de Marjory Gordon permitió diseñar el plan de cuidado de la embarazada, fueron articulados diagnósticos, resultados e intervenciones de enfermería que favorecieron la relación enfermera-paciente-contexto sociocultural, para llevar el cuidado hasta una concepción sistémica que permita el seguimiento y control de la embarazada(AU)

Introduction: Urinary tract infection is recurrent in pregnancy and causes complications. Objective: To present a nursing care plan provided to a woman with a diagnosis of urinary tract infection and threatened miscarriage. Methods: Clinical case of a patient admitted to the gynecology and obstetrics unit of General Hospital of Teziutlán (Puebla, Mexico) during 2019. Following the logic of the nursing process, the assessment was based on Marjory Gordon's functional health patterns. The standard nursing terminologies were used: diagnostics (NANDA-I), outcomes (NOC) and interventions (NIC). Results: Four nursing diagnoses were identified: deterioration of urinary elimination, ineffective self-health management, willingness to improve nutrition, and risk for alterations in maternal-fetal dyad, the latter being the main diagnosis. In addition, a NOC outcome (knowledge: infection control), four indicators and the never-to-always scale upon demonstration, as well as four NIC interventions, with nineteen activities, were obtained. Evaluation ranged from twelve (initial score) to nineteen (final score), with twenty as target score. Conclusion: The integration of the NANDA, NIC and NOC taxonomies together with the Marjory Gordon's functional health patterns allowed the design of the pregnant woman's care plan, with an articulation between nursing diagnoses, outcomes and interventions, which favored the nurse-patient-sociocultural context relationship, up to considering care based on a systemic conception that allows monitoring and control of the pregnant woman(AU)

Causas de internación en sector de Alto Riesgo en el Hospital Materno Neonatal "Eloisa Torrent de Vidal" en el período Enero a Junio del año 2019 / Causes of hospitalization in the High Risk sector at the "Eloisa Torrent de Vidal" Maternal and Neonatal Hospital in the period January to June 2019

Denominamos embarazo de "alto riesgo" a la gestación en la cual el pronóstico materno y/o fetal es potencialmentesubóptimo en comparación a un embarazo de bajo riesgo. Se estima que el 20% de los embarazos se correspondecon esta denominación y son responsables del 80% de los resultados perinatales adversos.Los objetivos del estudio fueron, conocer los motivos de internación de las embarazadas en el sector de Alto Riesgo, conocer la frecuencia de las patologías obstétricas y no obstétricas que llevan a la internación en alto riesgo, y analizarla asociación de patologías al ingreso. Estudio descriptivo, transversal. Se realizó la revisión de los registros de ingresos enla guardia del Servicio de Tocoginecología en el periodo de enero a junio del año 2019,se identificaron aquellaspacientes que fueron internadas en el sector de alto riesgo y el diagnóstico que la motivó.Los datos recabados fueron volcados en una planilla de Excel, a partir de la cual fueron representados mediantegráficos con sus respectivos porcentajes.El total de internaciones fue de 623 y las patologías más frecuentes fueron: en primer lugar,la amenaza de partoprematuro con 24,5%, seguida de aborto con 14%, síndromes hipertensivos con 13,2%, diabetes (DBT) y riesgo de saludfetal con 9,1%. Durante los seis meses del estudio podemos afirmar que la causa más frecuentemente asociada a internación en el alto riesgo fue la prematurez. El segundo motivo más prevalente fue Aborto. El Síndromehipertensivo se halla en el tercer lugar en frecuencia semestral. En cuarto lugar se encuentran Diabetes y Riesgo de salud fetal, los cuales obtuvieron el mismo porcentaje semestral

The prevent miscarriage effects of Yun Kang oral liquid on threatened abortion rat induced by kidney deficiency and luteum inhibition / 中国应用生理学杂志

OBJECTIVE@#Yun Kang oral liquid is a listed proprietary Chinese Medicine. To further evaluate its efficacy, this experiment established a kidney deficiency and luteum inhibition threatened abortion rat model to observe the effects of Yun Kang oral liquid.@*METHODS@#Sixty pregnant rats were randomly divided into normal control group (NC), model group (MG), dydrogesterone group (DT, 3.02 mg/kg), and Yun Kang oral liquid low-dose group (YK-L, 4 ml/kg), medium dose group (YK-M, 6 ml/kg), high dose group (YK-H, 9 ml/kg), 10 in each group. On the first day of pregnancy, each administration group was treated with the test drug at the prescribed dose every morning, and the NC group and the MG group were given an equal volume of purified water for 10 days; the rats were intragastrically administrated every afternoon, except for the NC group. In addition, the other groups were intragastrically administered with hydroxyurea at a dose of 450 mg/kg for 9 days, and mifepristone was administered at a dose of 4.0 mg/kg on the 10th day. On the 9th day of pregnancy, behavioral signs such as back temperature, grasping force, pain threshold, and autonomic activity were measured in each group. On the 11th day of pregnancy, blood was collected from the abdominal aorta in each group to determine serum levels of estradiol (E) , progesterone (P) and thromboxane B (TXB) . Ovary and fetal uterus were removed, the number and diameter of embryos were observed, and the ovary and uterus indexes were calculated.@*RESULTS@#Compared with the NC group, the back temperature, grip, pain threshold, number of spontaneous activities, number of embryos, embryo diameter, uterus index and serum E, P, TXB levels in the MG group were decreased significantly (P＜0.05, 0.01). Compared with the MG group, the back temperature, grasping force, number of embryos, embryo diameter and serum E and P levels were increased significantly in each dose group (P＜0.05, 0.01); the pain threshold, autonomic activity, and uterus index of YK-M and YK-H group were increased significantly (P＜0.05); serum level of TXB in YK-H group were increased significantly (P＜0.05).@*CONCLUSION@#Yun Kang oral liquid has a clear kidney-filling effect on rats with threatened abortion caused by kidney deficiency-luteal suppression. The mechanism may be related to raising serum E, P, TXB levels, improving kidney deficiency and improving embryo quality.

Effect on immune factors and serum CA125 in patients of threatened abortion in early pregnancy complicated with subchorionic hematoma treated with auricular acupuncture combined with dydrogesterone / 中国针灸

OBJECTIVE@#To evaluate the therapeutic effect of auricular acupuncture combined with dydrogesterone for threatened abortion in early pregnancy complicated with subchorionic hematoma.@*METHODS@#A total of 80 patients were randomized into an observation group and a control group, 40 cases in each one. In the control group, dydrogesterone was taken orally twice a day, 10 mg a time until 12-week into pregnancy. In the observation group，auricular acupuncture was applied at penqiang (TF), pizhixia (AT), shen (CO), xin(CO), gan (CO), jiaogan (AH) and neifenmi (CO) on the basis of the control group, the auricular points on both sides were used alternatively. The auricular points were replaced every 3 days with 1 day break, totally 3 weeks (20 days) were required. Before treatment and after 10, 20 days of treatment, the percentage of helper T lymphocyte (Th) and inhibitory T lymphocyte (Ts), ratio of Th and Ts and serum level of CA125 were compared in the two groups. The areas of subchorionic hematoma and gestational sac were evaluated by B ultrasound. The therapeutic effect in the two groups were compared.@*RESULTS@#The effective rate in the observation group was 80.0% (32/40), which was superior to 65.0% (26/40) in the control group (<0.05). After 10, 20 days of treatment, the percentage of Th and ratio of Th and Ts were lower than before treatment, the percentage of Ts were increased in the two groups (<0.01). After 20 days of treatment, the percentage of Th and ratio of Th and Ts in the observation group were lower than the control group (<0.01), the percentage of Ts was higher than the control group (<0.01). After 10, 20 days of treatment, the serum levels of CA125 were reduced compared before treatment in the two groups (<0.01), and the serum levels of CA125 in the observation group were lower than the control group (<0.01). After 10, 20 days of treatment, the ratio of subchorionic hematoma area and gestational sac area in the observation group was lower than the control group (<0.01).@*CONCLUSION@#Auricular acupuncture combined with dextroprogesterone can improve the effective rate of patients with threatened abortion in early pregnancy complicated with subchorionic hematoma, regulate immune factors, promote the hematoma absorption, and has a better synergistic effect with dextroprogesterone.

Adjuvant therapy of acupoint catgut embedding for threatened abortion after in vitro fertilization-embryo transfer: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of acupoint catgut embedding on miscarriage prevention and pregnancy outcome in patients with threatened abortion after in vitro fertilization-embryo transfer (IVF-ET).@*METHODS@#Sixty cases of patients with threatened abortion after IVF-ET were randomly divided into an observation group and a control group, 30 cases in each group. The patients in the control group were treated with intramuscular injection of progesterone (40 mg) once every day, while the patients in the observation group, on the basis of the treatment of control group, were treated with catgut embedding at Geshu (BL 17), Ganshu (BL 18), Shenshu (BL 23), Pishu (BL 20), Weishu (BL 21), Xuehai (SP 10), Diji (SP 8) and Fuliu (KI 7), once every two weeks, six times as a course of treatment. The treatment was given until 12 weeks into pregnancy. The level of serum human chorionic gonadotropin (HCG), estradiol (E) and progesterone (P) before and after treatment was recorded; the TCM syndrome score before and after treatment was compared; the successful pregnancy rate and spontaneous abortion rate after treatment were observed in the two groups.@*RESULTS@#Compared before treatment, the scores of TCM syndrome in both groups were reduced after treatment (both <0.01), and score in the observation group was superior to that in the control group (<0.05). After treatment, the clinical efficacy in the observation group was superior to that in the control group (<0.05). After treatment, the hormone levels (β-HCG, E, P) in both groups were increased steadily; the hormone levels in 6-week pregnancy, 8-week pregnancy and 10-week pregnancy were significantly higher than those in 4-week pregnancy (all <0.05); except the levels of P and β-HCG in 10-week pregnancy, the hormone levels in the observation group were superior to those in the control group (all <0.05). After treatment, the early abortion rate was 16.7% (5/30) in the observation group, which was lower than 33.3% (10/30) in the control group (<0.01); the pregnancy rate was 96.0% (24/25) in the observation group, which was higher than 80.0% (16/20) in the control group (<0.01).@*CONCLUSION@#Acupoint catgut embedding is effective for preventing threatened abortion, which could significantly reduce the spontaneous abortion rate, improve the pregnancy success rate, regulate hormone levels in patients after IVF-ET.

Embarazo ectópico en cicatriz de cesárea previa / Ectopic cesarean scar pregnancy

El embarazo localizado dentro de una cicatriz de cesárea previa es el menos frecuente de los embarazos ectópicos y no existe un tratamiento estándar. Se presenta el caso de una paciente de sexo femenino de 36 años de edad, derivada de la Unidad de ultrasonografía con reporte ecográfico de embarazo de 9,4 semanas, saco gestacional de implantación baja con signos de inserción placentaria anormal en la zona de la cicatriz por histerorrafia (acretismo-percretismo precoz total).

The ectopic cesarean scar pregnancy is the less frequent of the ectópics pregnancies and a treatment standard doesn't exist. We report the case of a patient of feminine sex 36 years old, derived of the ultrasonography unit with report of pregnancy of 9,4 weeks, sack gestacional of low installation with signs of abnormal insert of placenta in the area of the scar cesarean (precocious placenta acreta).

Niveles séricos de la progesterona en las gestantes con amenaza de aborto espontáneo y embarazo normal en el Centro Médico Naval CMST / Serum levels of progesterone levels in pregnant women with threatened spontaneous abortion and normal pregnancy at the Medical Center Naval CMST

INTRODUCCION: La progesterona es el principal esteroide secretado por el cuerpo lútea y es vital para el desarrollo de la gestación. Hasta la fecha, en muchas instituciones como el Centro Médico Naval, dan progesterona a toda mujer con amenaza de aborto, sin previa justificación de niveles bajos de progesterona, tampoco existen estudios locales publicados que docén progesterona en la amenaza de aborto espontáneo comparándolo con las que llevan un embarazo normal. MATERIAL y METODOS: Se realizó un estudio transversal-analítico, comparativo en base a la ficha de datos clínicos y de laboratorio de un grupo de gestantes con el diagnóstico clínico de Amenaza de aborto y otro grupo con el diagnóstico de Embarazo normal, atendidas en los servicios de emergencia y consultorios externos del Centro Médico Naval "CMST", con una gestación entre 5 a 13 semanas corroborada por ecografía transvaginal, durante el periodo comprendido entre agosto del 2012 y marzo del 2013. Se seleccionaron los datos de edad, paridad, número de abortos anteriores, progesterona sérica, nivel de hormona gonadotrofina coriónica sub unidad Beta (Beta hCG), y además en el grupo de gestantes con amenaza de aborto se tomó las variables de sangrado por vía vaginal y dolor pélvico. RESULTADOS: Durante el periodo comprendido entre agosto de 2012 a marzo de 2013 se lograron obtener 152 registros válidos para nuestro análisis en ambos grupos; de los cuales 80 (52.6 por ciento) correspondían a gestantes con Amenaza de aborto y 72 (47.4 por ciento) con embarazo Normal. La edad promedio de nuestra población fue 28.3 años, el promedio de la semana de gestación fue 7.6 semanas, el promedio del nivel sérico de progesterona fue 22.9 ng/ml (17.68 y 28.6 ng/ml, del grupo con Amenaza de aborto y embarazo Normal respectivamente). Los porcentajes de niveles séricos de progesterona: <14, entre 14 y 25 y >=25 ng/mI, fueron 42.5 por ciento, 37.5 por ciento y 20 por ciento en las gestantes con amenaza de aborto...

INTRODUCTION: Progesterone is the principal steroid secreted by the corpus luteum and is vital for the development of pregnancy. To date, in many institutions such as the Naval Medical Center, give progesterone to women with threatened abortion, without justification of low progesterone levels, there are no published local studies that measure progesterone in threatened spontaneous abortion compared with that has a normal pregnancy. MATERIALS AND METHODS: We performed a cross-sectional study - analytical, comparative profile based on clinical data and laboratory of a group of pregnant women with the clinical diagnosis of threatened abortion and another group with the diagnosis of normal pregnancy, treated in the emergency services and outpatient Naval Medical Center "CMST" with a gestation from 5 to 13 weeks confirmed by transvaginal ultrasound during the period between August 2012 and March 2013. We selected data on age, parity, number of previous abortions, progesterone serum level of human chorionic gonadotropin Beta subunit (hCG Beta), and also in the group of pregnant women with threatened abortion variables took vaginal bleeding and pelvic pain. RESULTS: During the period from August 2012 to March 2013 were achieved for 152 valid records for our analysis in both groups, of which 80 (52.6 per cent) were pregnant women with threatened abortion and 72 (47.4 per cent) with Pregnancy Normal. The average age of our population was 28.3 years, the average week of gestation was 7.6 weeks, the mean serum progesterone IeveI was 22.9 ng/mI (17.68 and 28.6 ng/mI, the group threatened abortion and pregnancy Normal respectively). The percentages of serum progesterone IeveIs: <14, 14 to 25 and >=25 ng/mI were 42.5 per cent, 37.5 per cent and 20 per cent in pregnant women with threatened abortion, respectiveIy. In pregnant women with normal pregnancy values were 2.8 per cent, 52.8 per cent and 44.4 per cent, respectively. The percentages of progesterone serum IeveIs...

Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion

Vaginal sonograghy and serial beta-hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase [CPK] in blood. assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and beta-hCG divided into 3 groups [N=37]: tubal pregnancy [1], threatened abortion [2] and normal pregnancy [3]. Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Mean total CPK level were 96.27 +/- 63.9 u/lit [group 1], 55.37 +/- 14.1 u/lit [group 2] and 48.94 +/- 19.2 u/lit [group 3] and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62 +/- 5.2 u/lit, 17.32 +/- 6.9 u/lit, and 15.1 +/- 4.7 u/lit, respectively which was not significant. It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy

Ameaça de aborto: conduta baseada em evidências / Threatened miscarriage: conduct based on evidences

A ameaça de aborto é definida como sangramento vaginal, geralmente indolor, que ocorre na primeira metade da gravidez com concepto vivo sem dilatação cervical. Muitas intervenções são utilizadas para a ameaça de aborto espontâneo. Quando uma causa específica é identificada, o tratamento direcionado pode reduzir taxas de abortamento. No entanto, na maioria dos casos, a fisiopatologia permanece desconhecida. Intervenções inespecíficas como repouso no leito e ausência de relações sexuais, apesar de comumente aconselhadas pelos médicos, não têm comprovação de benefício. A didrogesterona, um derivado progestínico, parece reduzir o risco de abortamento. Esta revisão mostra a qualidade das evidências científicas e o grau de recomendação das várias condutas para o tratamento da ameaça de aborto, concluindo que ainda é necessário realizar outros ensaios clínicos maiores, placebo-controlados e randomizados sobre o tratamento da ameaça de aborto para definir a eficácia da maioria das intervenções

Threatened miscarriage is defined as a vaginal bleeding, usually painless, which occurs in the first half of viable pregnancy without cervical dilatation. Many interventions are used for threatened and recurrent miscarriage. When a specific cause is identified, directed treatment may reduce miscarriage rates. However, in the majority of cases, the pathophysiology remains unknown. Unspecific interventions, as bed rest and avoidance of sexual intercourse, though commonly advised, are of no proven benefit. Dydrogesterone, a progesterone derivative, may further reduce miscarriage rates. This review shows the scientific evidence and classification quality of several interventions for the treatment of threatened miscarriage. Larger, randomized and controlled trials on the treatment of threatened miscarriage are needed to support the majority of the interventions

Relation of serum estradiol and progesterone levels with abortive anticipation in pregnant women with fetal irritability and vaginal bleeding / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the serum levels of estradiol (E2) and progesterone (P) in patients with the auras of threatened abortion (ATA), i.e., fetal irritability and vaginal bleeding, and the relation with prognosis.</p><p><b>METHODS</b>Chinese medicine syndrome of 598 pregnant women with ATA consulted in authors' hospital were differentiated into 5 types, 151 patients of Shen-deficiency type; 151 of Pi-Shen deficiency type; 36 of qi-blood insufficiency type, 235 of blood-heat type, and 25 of traumatic injured type. Their serum levels of E2 and P at the 5th to 13th gestation week were monitored by competitive chemiluminescnet enzyme immunoassay. And the outcome of pregnancy, continued or defeated, was observed.</p><p><b>RESULTS</b>(1) From the 7th gestation week on, serum E2 level in women with continued pregnancy (CP) increased continuously, showed a higher value than that at the previous week (P < 0.05), and was higher than that in women with defeated pregnancy (DP) of same gestation age (P < 0.05). (2) Serum P level was not different in CP women at various gestation age (P > 0.05), but from the 7th week on, it was higher in CP women than in DP women of same gestation age (P < 0.05). (3) The comparison of serum E2 in CP versus DP of women with Shen-deficiency type or Pi-Shen deficiency type was identical to that in CP versus DP of all women enrolled.</p><p><b>CONCLUSIONS</b>Serum levels of E2 and P in women with ATA at 5th to 13th gestation weeks were obtained. The 7th week of pregnancy is the critical period of pregnancy development, a comparative high E2 levels and its sustained and steady elevation indicates the good-ending of pregnancy with fetal irritability and vaginal bleeding. The Chinese medicine syndrome presented in women with ATA is dominantly the Shen-deficiency type. The variation of serum E2 is one of the important material foundation in pregnancy with fetal irritability and vaginal bleeding of Shen-deficiency type.</p>

Incidencia de Amenaza de Parto Pretérmino en el Hospital de Quillacollo, durante los meses de Marzo, Abril y Mayo de la gestión 2009 (Hospital de Quillacollo - Villa Moderna) / Incidence of preterm labor in Quillacollo Hospital during the months of March, April and May 2009 management (Quillacollo Hospital - Villa Moderna)

Durante los meses mencionados asistieron 268 pacientes con complicaciones durante el embarazo de los cuales el 69,9% corresponde a hemorragias de la primera mitad, un 5,2% eclampsia û preeclampsia. Las complicaciones de la segunda mitad del embarazo: Placenta previa con 7,4%, desprendimiento de placenta y otros con 3,7%. Pacientes con Amenaza de Parto Pretérmino en un porcentaje de 10,8 representando a 29 pacientes; es la población que se estudió con mayor detalle.De un total de 29 pacientes registradas con Amenaza de Parto Pretérmino en el hospital de Quillacollo, en el gráfico # 2 se observa que el mes de marzo hubo una incidencia de 13,7% y el mes de mayo 51,6%, estos porcentajes muestran que fue aumentando gradualmente la incidencia. Estas pacientes asistieron al hospital de Quillacollo por diferentes circunstancias como ser referidas de los diferentes centros de salud que pertenecen a la Red de Quillacollo y algunas por presentar sintomatología de Amenaza de Parto Pretérmino.Se puede observar que el porcentaje mayor de la población de mujeres que asistieron al servicio de dilatantes corresponde al grupo de 21 a 25 años de edad con 34,4%, con un porcentaje de 6,8% las mujeres de 31 a 35 años.

Conforme va avanzando la edad va disminuyendo el porcentaje de Amenaza de Parto Pretérmino. La mayor incidencia de Amenaza de Parto Pretérmino ocurre en primigestas con un porcentaje de 41,3% y en mujeres con 4º gestas con 13,7%. Estos datos coinciden con las causas, que la mayoría de las mujeres padecen de infección del tracto urinario, ya que durante la gestación la mujer es más suceptible a contraer las mismas por diferentes causas.Se observa que el 58,6% de mujeres con Amenaza de Parto Pretérmino realizaron de 1 a 3 controles prenatales y algunas pacientes realizaron 7 a 8 controles prenatales en un porcentaje de 13,7%. Tomando en cuenta que toda mujer durante su gestación (nueve meses) debe realizar cuatro controles prenatales, más aun si es un embarazo de alto riesgo. Se observó que el 62% de mujeres con Amenaza de Parto Pretérmino se presenta durante las 31 a 37 semansa gestacionales, en pacientes con 22 a 25 semanas gestacionales un 17,2%. En muchos de estos casos se logra evitar el parto pretérmino con las medidas de prevención que se realiza en el hospital de Quillacollo.La causa principal para la Amenaza de Parto Pretérmino es la infección del tracto urinario alta con un porcentaje de 34,4%, seguida de infecciones del tracto urinario baja con un 24,1%, en muchas ocasiones con dos causas como ser ruptura prematura de membranas y oligohidramnios con 20,6%; en un porcentaje de 10,3% pacientes con ruptura prematura de membranas, de igual forma con polihidramnios. Como ya se mencionó anteriormente la causa con mayor porcentaje son las infecciones del tracto urinario durante el embarazo, lo cual nos concientiza para educar a la población sobre los cuidados durante el embarazo y cuan importantes son los controles prenatales.

Se observa que las pacientes internadas con Amenaza de Parto Pretérmino en el servicio de obstetricia del hospital de Quillacollo se quedaron entre 1 a 3 dias en un porcentaje de 68,9% y un 10,3% por 6 días o más; la mayoría de éstas dejaron el servicio por alta médica y algunas referidas a tercer nivel. Durante su permanencia en el hospital de las mantuvo en reposo absoluto, con úteroinhibición, maduración fetal, monitoreando constantemente la frecuencia cardiaca materna y fetal, la dinámica uterina y el sangrado transvaginal.

Effect of Chinese herbal treatment on Th1- and Th2-type cytokines, progesterone and beta-human chorionic gonadotropin in early pregnant women of threatened abortion / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the clinical effects of Prescription Zhuyun-III (ZYIII) on early pregnant women diagnosed as threatened abortion, and its mechanism in immunity and endocrine by determining serum Th1- and Th2-type cytokines, progesterone, and beta-human chorionic gonadotropin (beta-HCG).</p><p><b>METHODS</b>The treatment group comprised 30 early pregnant women diagnosed as threatened abortion of deficiency syndrome of Pi, Shen, or both. The control group consisted of 20 normal early pregnant women of similar gestational age. Patients in the treatment group were administered with ZYIII for 4 weeks. Peripheral blood samples were collected pre- and post-treatment from both the treatment and the control groups. Serum Th1-type cytokine [interleukin-2 (IL-2)] and Th2-type cytokine [interleukin-10 (IL-10)] were determined by flow cytometry, and serum progesterone and beta-HCG were determined by ELISA.</p><p><b>RESULTS</b>(1) The treatment was effective in 26 and ineffective in 4 patients of the treatment group. Therefore, the cure percentage was 86.67%. (2) In the treatment group before the treatment, IL-2 was significantly higher, IL-10 tended to be less, and the Th1/Th2 balance shifted toward Th1 compared with those in the control group. (3) After the treatment, IL-2 was decreased, IL-10 was increased, and IL-2/IL-10 was decreased. Both progesterone and beta-HCG were increased. Changes of progesterone were positively correlated with changes of IL-10, whereas changes of beta-HCG were negatively correlated with changes of IL-2.</p><p><b>CONCLUSIONS</b>Our study suggests that ZYIII has an evident function of protecting the fetus, and one of its mechanisms is inhibiting the secretion of Th1 cytokines, promoting the secretion of Th2 cytokines, and recovering the pathological shift of the Th1/Th2 balance. The other possible mechanism is increasing serum progesterone and beta-HCG concentrations. Moreover, there are some correlations between the above two effects.</p>

Comparison of pregnancy prognosis by surgical management for Adnexal mass in pregnancy / 대한산부인과학회지

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.

Comparison of pregnancy prognosis by surgical management for Adnexal mass in pregnancy / 대한산부인과학회지

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.

As intercorrências durante a gestação e suas conseqüências sobre o peso do recém-nascido / Intercurrencies during pregnancy and their consequences on the weight of the newborn

Objetivo: verificar se as intercorrências presentes na gestação aumentam as chances da mãe ter uma criança com baixo peso ao nascer (BPN). Metodologia: trata-se de um estudo de casos e controles, realizado no período de abril a novembro de 2003, no município de Rio Grande/RS. A coleta de dados ocorreu a través de um questionário aplicado a 547 mães que deram à luz nas maternidades dos dois hospitais deste município. Resultados: a presença de hipertensão arterial transitória ou crônica durante a gestação e a ameaça de aborto durante a gravidez atual associaram-se positivamente com o desfecho estudado (p = 0,008 e p = 0,01, respectivamente), aumentando o risco da mãe ter um recém-nascido de BPN (RO = 3,77; IC95 por ciento 1,40-10,17eRO=6,27;IC95 por ciento 1,53-25,76, respectivamente). Conclusões: conclui-se que uma das medidas de prevenção das intercorrências durante a gestação e, conseqüentemente, do BPN, é prestar uma assistência pré-natal diferenciada para as gestantes de risco e de alto risco.

Ultrasonographic characteristics in patients clinically diagnosed with threatened abortion.

OBJECTIVE: To determine ultrasonographic appearances in pregnant women clinically diagnosed with threatened abortion. DESIGN: Cross-sectional study. MATERIAL AND METHOD: Seven hundred and seventy six pregnant women clinically diagnosed with threatened abortion and receiving ultrasonographic examination were enrolled Data on ultrasonographic characteristics were obtained from records at the Maternal-fetal Medicine unit. Pregnancy outcomes were reviewed from medical records. RESULTS: The ultrasonographic findings demonstrated 328 (42.3%) viable pregnancy, 178 (22.9%) embryonic death, 176 (22.7%) anembryonic pregnancy, 25 (3.2%) incomplete abortion, 24 (3.1%) complete abortion, seven (0.9%) molar pregnancy, four (0.5%) ectopic pregnancy, and 34 (4.4%) inconclusive finding. Two hundred and sixty viable pregnancies were available for follow-up and revealed that 229 (88.1%) eventually delivered while 31 (11.9%) ended up with abortion. The two groups were not significantly different regarding age, parity, history of abortion, and gestational age at diagnosis. CONCLUSION: Ultrasonographic findings in patients clinically diagnosed with threatened abortion demonstrated viable pregnancy in nearly half of the cases. Transvaginal ultrasonography is useful in establishing definite diagnosis and appropriate treatment among these patients.

The fetus protection effects of Zhixue Baotai Decoction on women of early threatened abortion with dark area surrounding pregnancy sac / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the fetus protection effects of Zhixue Baotai Decoction (ZBD) on women of early threatened abortion with dark area surrounding pregnancy sac.</p><p><b>METHODS</b>The 105 patients with early threatened abortion, in whom vaginal bleeding was shown already, were randomly assigned to the treatment group and the control group, who were treated respectively with ZBD and progesterone to protect fetus. The efficacy of treatment was evaluated by dynamic monitoring of serum hormone and B-ultrasonic examination.</p><p><b>RESULTS</b>Among the 54 cases in the treatment group the fetus was protected successfully, showing a fetus protecting rate of 81.5%; while among the 51 cases in the control group, the protection was effective in 22 cases (43.1%), the success rate in the former was better (P<0.01). The dark area was absorbed in 16 out of 19 cases (84.2%) in the treatment group, while in the control group absorption occurred only in 6 out of 17 (35.3%).</p><p><b>CONCLUSION</b>The effect of ZBD is superior to that of progesterone in treating women of early threatened abortion with dark area surrounding pregnancy sac.</p>