Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections / Ruptura prematura das membranas fetais pré-termo: associação com fatores sociodemográficos e infecções geniturinárias maternas

OBJECTIVE: tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94), with lower level of schooling (PR = 2.43), age > 29 years (PR = 2.49), and smokers (PR = 2.04). It was also associated with threatened miscarriage (PR = 1.68) and preterm labor, (PR = 3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. .

OBJETIVO: o objetivo deste estudo foi verificar a ocorrência da ruptura prematura das membranas fetais pré-termo em gestações únicas e sua associação com fatores sociodemográficos maternos e infecções geniturinárias autorreferidas. MÉTODOS: estudo transversal de base populacional onde foram incluídas todas as mães dos recém-nascidos dos partos únicos ocorridos no ano de 2010, com peso ao nascer igual ou superior a 500 gramas, residentes no município. As puérperas foram entrevistadas nas duas maternidades da cidade. Foram considerados casos as gestantes que perderam líquido amniótico antes da internação hospitalar e cujo tempo de gestação fosse inferior a 37 semanas. Foi realizada análise estatística por níveis, para controle de fatores de confusão por meio da regressão de Poisson. RESULTADOS: das 2.244 mulheres elegíveis para o estudo, 3,1% apresentaram ruptura prematura das membranas fetais pré-termo, a qual foi mais frequente, após ajuste, nas mulheres de menor nível econômico, razão de prevalência (RP) de 1,94, menor escolaridade, RP de 2,43, com idade superior a 29 anos, RP de 2,49 e tabagistas, RP de 2,04. Também esteve relacionada com ameaça de aborto, RP de 1,68, e de trabalho de parto pré-termo, RP de 3,40. Não houve associação com infecção urinária materna ou presença de corrimento genital. CONCLUSÕES: o desfecho foi mais frequente nas puérperas com menor escolaridade, mais pobres, mais velhas e tabagistas, assim como naquelas com histórico de ameaça de abortamento e trabalho de parto prematuro. Estes fatores devem ser considerados na sua abordagem preventiva, diagnóstica e terapêutica. .

Factores asociados al desprendimiento prematuro de placenta en gestantes atendidas en el Hospital Docente Madre Niño San Bartolomé durante el periodo 2008-2012 / Factors associated with abruptio placentae in pregnant women attended at the Teaching Hospital Mother Child San Bartolome during the period 2008-2012

Determinar los factores asociados al Desprendimiento prematuro de placenta en gestantes atendidas en el Hospital Docente Madre Niño San Bartolomé durante el periodo 2008-2012. Metodología: Estudio de tipo observacional, analítico comparativo, retrospectivo y transversal. Se estudió a 39 pacientes gestantes con desprendimiento prematuro de placenta (DPP) y 21 gestantes como grupo comparativo que no tenían DPP. Para determinar las diferencias de medias de las variables cuantitativas se utilizó las pruebas t de student y para determinar la relación entre variables y los factores asociados se usó las pruebas de Chi-cuadrado y Odds ratio. Resultados: La edad promedio de las pacientes con sospecha de desprendimiento prematuro de placenta es de 23.1±5.3 años, teniendo en su mayoría entre 19 a 35 años (75 por ciento), la mayoría son sólo convivientes (71.7 por ciento) de educación secundaria (96.7 por ciento). El grupo etario de las pacientes no está relacionado significativamente con el diagnóstico de desprendimiento prematuro de placenta (p=0.562), de la misma forma el estado civil de las pacientes no está relacionado significativamente con el DPP (p=0.067), tampoco 10 está el grado de instrucción de las pacientes (p=0.291). De los factores médicos obstétricos se observó que existe diferencia entre los peso y talla promedios entre gestantes con y sin DPP (p<=0.001) y (p=0.038) respectivamente. No se ha encontrado asociación significativa de las gestantes con DPP con la paridad (p=0.49), control prenatal (p=0.075), tipo de gestación (0.495), índice de masa corporal (0.131). Con respecto a los factores maternos conductuales no se detectó ningún caso con hábitos nocivos. Referente a los otros factores estudiados sólo la ausencia de la desproporción céfalo pélvica tiene relación significativa (p=0.002) con la presencia del DPP. La prevalencia del desprendimiento prematuro de placenta en el periodo 2008 a 2012 es de 39 / 60 casos que cumplieron los criterios...

To determine the factors associated with abruptio placentae in pregnant women at the Mother Child Teaching National Hospital San Bartolome during the period 2008-2012. Methodology: Observational, comparative, retrospective, transversal study. The sample was 39 pregnant patients with diagnosis of abruptio placentae and 21 pregnant patients without that diagnosis. To determine the mean differences of quantitative variables, the T-student test was used, and to determine the relationship between variables and the factors associated the chi-square test and Odds ratio were used. Results: The average age of patients with suspected abruptio placentae was 23.1 years, the majority was between 19-35 years (75 per cent), most were just cohabiting (71.7 per cent), secondary education (96.7 per cent). The age group of patients was not significantly associated with the diagnosis of abruptio placentae (p=0.562), likewise the marital status of patients was not significantly related with DPP (P=0.067), Likewise the marital status of the patients was not significantly associated to the DPP (p = 0.067), nor the level of education (p=0.291). Of obstetric medical factors that were significantly associated with patients with or without a diagnosis of abruptio placentae were the weight (p<=0.001) and height (p=0.038), there was also no significant association with parity (p=0.49), prenatal care (p=0.075), type of pregnancy (0.495) and body mass index (0.131). Regarding maternal behavioral factors, no harmful habit was detected. As for the other factors studied, only the absence of cephalopelvic disproportion had significant relationship (p=0.002) with the presence of the DPP. The prevalence of abruptio placentae in the period 2008 to 2012 was 39 cases of the 60 cases that met the inclusion and exclusion criteria. Conclusions: The only factor related with the diagnosis of abruptio placentae showing a significant association (p=0.002) factor was cephalo pelvic disproportion...

Factores predictivos maternos de ruptura prematura de membranas en gestantes con parto a término, atendidas en el Hospital Nacional Dos de Mayo, durante el año 2013 / Maternal predictors factors of premature rupture of membranes in pregnant women with labor at term, attended at the National Hospital Dos de Mayo, during the year 2013

Determinar los factores maternos predictores para Ruptura Prematura de Membranas a término en pacientes atendidas en el Hospital Nacional Dos de Mayo durante el año 2013. Metodología: Estudio observacional de tipo analítico caso y control, retrospectivo, de corte transversal. La muestra estuvo compuesta por 204 pacientes, distribuidos en 2 grupos: Grupo Caso: gestantes con RPM (102) y Grupo Control: gestantes sin RPM (102). Para el análisis descriptivo se empleó medidas de tendencia central y de dispersión; así como, frecuencias absolutas y relativas. Para el análisis bivariado de las variables cuantitativas se utilizó "t" de student y para las variables cualitativas se empleó la prueba del Chi-cuadrado y OR, y para determinar los predictores se aplicó análisis multivariante: Regresión logística. Resultados: Entre las características generales de las pacientes, el promedio de edad de las gestantes con ruptura prematura de membrana (RPM) fue 23,4±6,2 años y las gestantes sin RPM fue 25,9±7,7 en donde se observó diferencia significativa (p=0.011). La mayoría de pacientes con y sin ruptura prematura de membranas tenían entre 20 a 35 años, las edades de ambos grupos fueron similares (p=0.110); el grado de instrucción hasta nivel primaria se observó en el 12,7 por ciento de las gestantes con RPM y 3,9 por ciento en las gestantes sin RPM, en el análisis presentó diferencia significativa (p=0.023). Más de la mitad de pacientes con y sin ruptura de membrana presentó controles prenatales insuficientes. El control prenatal no estuvo relacionado con la presencia de RPM (p=0.400). Entre los factores maternos asociados al riesgo de presentar ruptura prematura de membranas, fueron: el antecedente de RPM (OR=4.9, IC=1.02-22.9), la infección del tracto urinario (OR=1.9, IC=1.08-3.6) y el periodo intergenésico (OR=1.8, IC=1.02-3.3). Los resultados multivariantes de estimadores predictivos más significativos fueron: la infección del tracto urinario (p<0.001), OR=1.9...

To determine maternal predictor factors for Premature Rupture of Membranes at term in patients treated at the Dos de Mayo National Hospital in 2013. Methodology: Observational, analytic case-control, retrospective and cross- sectional study. The sample consisted of 204 patients, divided into 2 groups: Group Case: pregnant with PRM (102) and Control Group: pregnant without PRM (102). For the descriptive analysis, measures of central tendency and dispersion were used, as well as absolute and relative frequencies. For bivariate analysis of quantitative variables, student "t" test was used; and for qualitative variables, the chi-square test and OR were used, and to determine the predictors was applied multivariate analysis: Logistic Regression. Results: Among general characteristics of the patients, the average age of pregnant women with premature rupture of membranes was 23.4±6.2 years and pregnant without PRM was 25.9±7.7, there was significant difference (p=0.011). The majority of patients with and without premature rupture of membranes were between 20 and 35 years old, the ages of both groups were similar (p=0.110); primary level education was observed in 12.7 per cent of pregnant women with RPM and 3.9 per cent in pregnant women without PRM, the analysis showed a significant difference (p=0.023). More than half of patients with and without had inadequate prenatal care. The prenatal care was not related with PRM (P=0.400). Among the maternal factors associated with risk of premature rupture of membranes, were: history of RPM (OR=4.9, CI=1.02-22.9), urinary tract infection (OR=1.9, CI=1.08-3.6) and intergenesic periods (OR=1.8, CI=1.02-3.3). The multivariate results of predictive estimators most significant were: urinary tract infection (p<0.001), OR=1.9, CI=(1.07-3.6) and interpregnancy period (p<0.001), OR=1.8, CI=(1.00-3.2). Conclusions: The main significant maternal predictor factors for premature rupture of membranes were: urinary tract...

Repercusiones materno neonatales de rotura prematura de membranas pretérmino en pacientes atendidas en el Hospital Regional de Pucallpa - 2011 / Effects maternal and neonatal of the premature rupture of membranes, preterm labor in patients treated in Regional Hospital Pucallpa - 2011

OBJETIVO: Este estudio estuvo dirigido a determinar las repercusiones maternas neonatales de la ruptura prematura de membranas pretérmino del Hospital Regional de Pucallpa, durante Enero-Diciembre del 2011. MATERIALES y METODOS: Estudio observacional, analítico de casos y controles. RESULTADOS: Se estudiaron 109 pacientes con RPM. La incidencia de RPM es de 4.65 por ciento. Terminación de parto: cesárea en 33.9 por ciento (37), p=0,018800 OR:1,61 (1,08-2,42), y un 11 por ciento (12) se encuentra < a las 28 semanas, (p=0,000001 OR: 12,99 (6,46-26,1)), Sin CPN p=0,000382, OR: 2,34 (1,45-3,80), control prenatal inadecuado (de 1-3 CPN) p=0,002611 OR: 1,87 (1,24-2,83), CPN adecuado >4 en 48.6 por ciento (53), p=0,000000 OR:0,33 (0,23-0,49), En el caso de la edad gestacional al nacer, 78 por ciento (89) era prematuros leves (34 a 37 semanas) (p=0,000003 OR: 52,40 (31,72-86,5)), 10 por ciento (9) eran de prematuridad moderada (30 a 34 semanas), p=0,000048 OR: 3,77 (1,90-7,49); Hallazgos obstétricos asociados: en 10.1 por ciento (11) tuvieron Oligohidramnios severo en 11 (10.1 por ciento), p=0,000001 OR: 7,82 (3,93-15,58), podálico en 6.4 por ciento (7), p=0,001579 OR: 3,40 (1,52-7,60), preeclampsia severa en 2.8 por ciento (3), Mortalidad en 12 prematuros (11 por ciento) p=0,000001 OR: 8,25 (4,24-16,05). CONCLUSION: Se encontró estadísticamente significativa con un valor de p<0.05, en el grupo de prematuridad leve, edad gestacional < de 28 semanas, Mortalidad en el recién nacido, Oligohidramnios, recién nacido en presentación podálico, prematuridad moderada, Madre sin control prenatal, control prenatal inadecuado < de 3 controles, Los casos de RPM en el Hospital de Pucallpa, son más del tipo de prematuridad leve, y la mortalidad se asocia a prematuros de bajo peso al nacer.

OBJECTIVE: This study was aimed to determine the effects of neonatal maternal premature rupture of membranes Pucallpa Regional Hospital during January to December 2011. MATERIALS AND METHODS: A retrospective descriptive study, correlational. RESULTS: We studied 109 patients with RPM. RPM incidence is 4.65 per cent. Termination of birth: caesarean section 33.9 per cent (37), P=0.018800 OR: 1.61 (1.08 to 2.42), and 11 per cent (12) is < at 28 weeks (p=0.000001 OR 12.99 (6.46 to 26.15)), No CPN p=0.000382, OR: 2.34 (1.45 to 3.80), inadequate prenatal care (from 1-3 CPN) p=0.002611 OR: 1.87 (1.24 to 2.83), appropriate CPN>4 in 48.6 per cent (53), P=0.000000 OR: 0.33 (0.23-0.49) in the case of gestational age at birth, 78 per cent (89) was mild preterm (34-37 weeks) (p=0.000003 OR: 52.40 (31.72 to 86.56)), 10 per cent (9) were of moderate prematurity (30-34 weeks), p=0.000048 OR: 3.77 (1.90 to 7.49) associated obstetric Findings: 10.1 per cent (11) had severe in 11 Oligohidramnios (10.1 per cent)., p=0.000001 OR: 7.82 (3.93 to 15.58), breech in 6.4 per cent (7), P=0.001579 OR: 3.40 (1.52 to 7, 60), severe preeclampsia in 2.8 per cent (3), mortality in 12 infants (11 per cent) p=0.000001 OR: 8.25 (4.24 to 16.05). CONCLUSION: We found statistically significant with a p-value <0.05, in the group of mild prematurity, gestational age <28 weeks, mortality in newborn, oligohydramnios, newborn baby in breech presentation, moderate prematurity, Mother without prenatal care, inadequate prenatal care <3 controls, RPM cases at the Hospital of Pucallpa, are mild prematurity rate, and mortality associated with premature low birth weight.

Relación del bajo peso al nacer con la sepsis vaginal: its relation to the low-birth weight / Vaginal sepsis: its relation to the low-birth weight

INTRODUCCIÓN: El bajo peso al nacer constituye uno de los principales problemas obstétricos actuales pues está relacionado con más del 75 por ciento de la mortalidad perinatal. Las infecciones del tracto genital se asocian a numerosas complicaciones como aborto espontáneo, elevada morbimortalidad, bajo peso al nacer, endometritis posparto y secuelas en los neonatos sobrevivientes. OBJETIVO: Conocer la relación del bajo peso al nacer con la sepsis vaginal en el área de salud del policlínico Este del municipio Camagüey, durante el trienio 2007-2009. MÉTODOS: Se realizó un estudio descriptivo, transversal, acerca de la relación del bajo peso al nacer con la sepsis vaginal en el área de salud. El universo estuvo conformado por los 1 151 nacidos vivos en el periodo y se tomó como muestra los 55 niños que nacieron con peso inferior a 2 500 g, independientemente de la edad gestacional, aplicándoles a las madres un cuestionario (previo consentimiento informado) que contenía las variables: presencia de sepsis, tipo de germen, rotura prematura de membranas y modificaciones cervicales durante el embarazo. RESULTADOS: El 72,72 por ciento de las madres tuvieron en algún momento del embarazo sepsis vaginal, el germen más frecuente fue la trichomonas vaginalis con el 50,90 por ciento; el 52,5 por ciento de las gestantes aunque tenían sepsis vaginal no presentaron modificaciones cervicales. CONCLUSIONES: Las tres cuartas partes de las gestantes tuvieron sepsis vaginal, más de la mitad de las gestantes que tuvieron sepsis vaginal presentaron rotura prematura de membranas

INTRODUCTION: The low-birth weight is one of the major current obstetric problems since it is related to with more than the 75 percent of the perinatal mortality. The genital tract infections are associated with many complications including the spontaneous abortion, a high morbidity and mortality, the low-birth weight, postpartum endometritis and the sequelae in surviving neonates. OBJECTIVE: To know the relationship between the low-birth weight and vaginal sepsis in a health area of the East polyclinic of Camag³ey municipality from 2007-2009. METHODS: A cross-sectional and descriptive study was conducted to know the relationship between the low-birth weight and vaginal sepsis in the above mentioned health area. Universe included 1 151 newborns during the period taking like sample a group of 55 children weighing less than 2 500 g, independently of the gestational age, applying to mothers a questionnaire (previous informed consent) including the following variables: presence of sepsis, type of germen, an premature rupture of membranes and cervical modifications during pregnancy. RESULTS: The 72.72 percent of mothers had during any moment of pregnancy vaginal sepsis, the more frequent germ was the Trichomonas vaginalis with the 50.90 percent; the remainder 52.5 percent although despite the presence of vaginal sepsis had not cervical modifications. CONCLUSIONS: The three quarter of pregnant women had vaginal sepsis, more than half with this type of sepsis also had a premature rupture of membranes

Muerte fetal: evento actual / Fetal death: current event

El objetivo fue estudiar la mortalidad fetal, conocer su frecuencia, determinar características maternas, condiciones obstetricas y factores relacionados. Es un estudio observacional, descriptivo de 347 muertes fetales sucedidas entre 2005-2009. Para el mismo lapso se registraron 17406 nacimientos en el Departamento de Obstetricia y Ginecología. Hospital "Dr. Adolfo Prince Lara". Puerto Cabello-Estado Carabobo. La mortalidad fetal para el período fue 19,94 por mil nacidos o 1 por cada 50 nacimientos. Hubo predominio de pacientes de 24 años y menos (40,35%), en antecedentes familiares destacó la hipertensión arterial (18,44%) y diabetes e hipertensión arterial crónica (9,8%), en los personales la hipertensión arterial (17,58%). El diagnóstico de ingreso fue feto muerto 47,26%, rotura prematura de membrana 14,7% y patología hipertensiva 14,12%. No realizaron control prenatal 48,7%; eran multigestas 43,24%, con edad de embarazo menor igual 36 semanas 70,03%, y resuelto en parto vaginal 77,52%. Predominaron los fetos masculinos (57,06%), con peso menor igual 2500 g (75,5%) y talla menor igual 49 cm (65,13%). El factor de muerte directo conocido prevaleciente en 178 casos fue la insuficiencia placentaria (36,52%), desencadenada principalmente por patología hipertensiva; seguida de patología hemorrágica placentaria (25,28%), liderizada por desprendimiento normoplacentario. La tasa de mortalidad fetal se encuentra elevada, por lo cual se recomienda una estrategia de atención precoz del embarazo, enfatizar control de las patologías relacionadas: hipertensivas, diabetes, prematurez y hemorragias placentarias. La vigilancia intra-parto debe ser rutinaria, en especial en estas patologías

The objetive wasto study fetal mortality, to know its impact, to determine the maternal characteristics, obstetric conditions and related factors. It is an observational descriptive study of 347 fetal death accurred between 2005-2009. For the same period there were 17406 birth in the Department of Obstetrics and Gynecology Hospital "Dr. Adolfo Prince Lara". Puerto Cabello, Estado Carabobo. Fetal mortality for the period was 1994 per thousand births or 1 per 50 births. Most of them were patients of 24 years or less (40.35%), with family history of hypertension (18.44%) and diabetes and cronic arterial hypertension (9.8%); and personal history of hypertension (17.58%). The admission diagnosis was stillbirth 47.26%, premature rupture of membranes 14.7%, and hypertension disease 14.12%. No prenatal care 48.7%, were multiparous 43.24%. with gestational age < igual 36 weeks 70.03%. and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weight < igual 36 weeks 70.03, and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weightv< igual 2.500 g (75.5%) and heidht < igual 49 cm (63.13%). The known factor of prevalent direct death in 178 cases was placental insufficiency (36.52%), mosthy triggered by hipertensive pathology, , followed by placental hemorrhage (25.28%), lead by placental abruption. The fetal mortality rate is high, so it is recommended a strategy of early attention of pregnancy, and stress control of related conditions: hypertensive disorders, diabetes, pematurity and placental bleeding, Intrapartum monitoring should be routine, especially in these conditions

Enfermedad periodontal como factor de riesgo para presentar resultados perinatales adversos / Periodontal disease as a risk factor for the adverse perinatal outcomes

Objetivo: Determinar si la enfermedad periodontal (EP) es un factor de riesgo que pudiera ejercer alguna influencia en la presentación de resultados perinatales adversos en la población general. Método: Estudio prospectivo de cohorte, en el cual se incluyeron 282 pacientes que acudieron al Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo León, México, para atención del parto. Se realizó examen dental clasificándolas como sanas o enfermas. Para el análisis estadístico se utilizó estadística descriptiva, medidas de tendencia central y de dispersión, X² y riesgo relativo (RR) para establecer asociación entre la enfermedad periodontal y las variables de estudio. Resultados: La incidencia de EP fue de 15 por ciento. La edad promedio de 22,1 años. El RR para parto prematuro fue 0,67 (IC 95 por ciento 0,19-2,33; p=0,81), preeclampsia 1,17 (IC 95 por ciento 0,45-3,02; p=0,35), ruptura prematura de membranas 0,842 (IC 95 por ciento 0,80-0,88; p=0,76), bajo peso al nacer 0,85 (IC 95 por ciento 0,33-2,51; p=0,71). Conclusión: En nuestro estudio no encontramos asociación entre pacientes con enfermedad periodontal y resultados perinatales adversos.

Objective: To determine the relationship between maternal periodontal disease and the development of adverse perinatal outcomes. Methods: A prospective cohort study was performed; 282 patients were included, who were assisted for their birth delivery at the Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico. A dental examination was done classifying them as healthy or sick. A descriptive and statistic study was done looking for the association between periodontal disease and the variables of the study were compared using X² and relative risk. Results: The incidence of periondontal disease was 15 percent. The average age was 22.1 years. The risk ratio for preterm delivery was 0.67 (CI 95 percent 0.19-2.33; p=0.81), preeclampisa 1.17 (CI 95 percent 0.45-3.02; p=0.35), premature rupture of membranes 0.842 (CI 95 percent 0.80-0.88; p=0.76), low birthweight 0.85 (CI 95 percent 0.33-2.51; p=0.71). Conclusion: No significant association was seen between periodontal disease and the adverse perinatal outcomes.

Riesgo de complicaciones perinatales en embarazadas con periodontitis moderada y severa, en la ciudad de Córdoba. Argentina / Risk for adverse pregnancy outcome in a population with moderate and severe periodontal disease in Córdoba. Argentina

Objetivo: Evaluar en nuestro medio a las Periodontitis Moderadas a Severas (PM/S) en embarazadas como factores de riesgo de prematuridad (PP), ruptura prematura de membranas (RPM) y bajo peso al nacer (BPN). Método: Este estudio de cohorte, observacional y prospectivo involucró a 66 embarazadas en las semanas 24 a 30 de gestación, sin patologías sistémicas diagnosticadas, asistidas en dos hospitales universitarios de Maternidad y Neonatología de la ciudad de Córdoba, Argentina. Las pacientes fueron incorporadas al Grupo 1 ó de Cohorte expuesta al riesgo (CE) y Grupo 2 ó Cohorte no expuesta al riesgo (CNE) según presentaran o no PM/S en no menos de 4 sitios ubicados en diferentes cuadrantes de la boca. Fueron considerados los siguientes indicadores clínicos: índice de Placa Bacteriana (Pb); índice Gingival (IG); Profundidad de Sondaje (PS) y Nivel de Inserción Clínica (NIC) e"3 mm. Posteriormente, fueron recolectados los datos perinatales a partir de las historias clínicas de acuerdo con el sistema informático perinatal SIP (CLAP-OPS/OMS) y sometidos a los análisis estadísticos correspondientes. Resultados: Veintiún pacientes (n=21) conformaron el Grupo 1 ó CE; veintitrés mujeres (n=23) el Grupo 2 ó CNE y 22 embarazadas debieron ser excluidas por razones médicas. El 13.6 por ciento del total de pacientes, presentó su parto antes de las 37 semanas de gestación (PP). El Odds Ratio hallado para prematuridad fue de 6.06 (IC 95 por ciento; 5.86 - 7.76); para RPM, 2.8 (IC 95 por ciento; 1.81 - 4.39) y con respecto al BPN no se hallaron diferencias en la población estudiada. Conclusión: En la población analizada, las Periodontitis maternas moderadas a severas constituyen un verdadero factor de riesgo para PP y para RPM; por el contrario las mismas parecerían no tener influencia sobre los nacimientos de bajo peso.

Objectives: To evaluate moderate to severe Periodontitis (M/SP) in pregnant women as a risk factor for preterm birth (PTB), premature rupture of membranes (PROM) and low birth weight (LBW). Method: This observational and prospective cohort study involved 66 pregnant women between weeks 24 and 30 of gestation, without diagnosed systemic pathologies, attending at the Maternal and Neonatology University Hospital, Cordoba, Argentina. The patients were integrated into Group 1 or Cohort exposed to risk (CER) and Group 2 or Cohort not exposed to risk (CNER) according to whether they showed or not moderate to severe PD in no less than 4 points situated in different quadrants of the mouth. The following clinical indicators were considered: Dental Plaque Index (DP); Gingival index (GI); Periodontal Depth (PD) and Clinical Attachment Level (CALe"3 mm). Later, the perinatal data was collected from the medical records, according to the Perinatal informatic system, Latin American Center of Perinatology and Human Development-Panamerican Health Organization/WHO) and submitted to under proper statistical analyses. Results: Group 1 or CER comprised twenty-one patients (n=21); Group 2 or CNER comprised twenty-three women. 22 pregnant women had to be excluded due to medical reasons. 13.6 percent of the patients gave birth before the 37th week of gestation (PTB). The Odds Ratio for prematurity was 6.06 (CI 95 percent; 5.86 - 7.76); 2.8 for PROM (CI 95 percent; 1.81 - 4.39) and no differences were found concerning LBW among the population studied. Conclusion: In the population of patients studied, moderate to severe PD in pregnant women constitute a real risk factor for premature birth as well as for premature rupture of membranes; on the other hand, these diseases would not seem to affect low birth weight.

Procedimiento de escisión electro-quirúrgica por asa térmica y riesgo de parto prematuro: una revisión sistemática de la literatura / Loop electrosurgical excision procedure and risk of preterm delivery: a literature review

Antecedentes: A diferencia de la conización cervical por cono frío, no se ha podido demostrar una clara asociación entre el procedimiento de escisión electro-quirúrgica por asa térmica (LEEP) y el riesgo de parto prematuro. Objetivo: Análisis crítico de la literatura científica, en relación al riesgo de presentar un parto prematuro en pacientes que han sido sometidas a LEEP, y los resultados materno-perinatales asociados. Búsqueda sistemática en múltiples bases de datos. Resultados: Se encontraron sólo tres artículos que cumplían los criterios de inclusión, los cuales son incluidos en esta revisión. De éstos, el primero muestra que el LEEP no aumenta el riesgo de parto prematuro ni de recién nacidos de bajo peso. El segundo evidencia un aumento del riesgo de rotura prematura de membranas y parto prematuro secundario a esto, pero no de parto prematuro espontáneo. Sin embargo, el tercero, señala que el LEEP se asocia en forma significativa a riesgo aumentado de parto prematuro, parto prematuro secundario a rotura prematura de membranas y recién nacidos de bajo peso. Los tres estudios son de cohortes retrospectivas, lo cual les otorga un nivel de evidencia de tipo 2b. Conclusión: La evidencia indica que la excisión de la zona de transformación a través del uso de LEEP está asociada a un pequeño, pero real incremento del riesgo de presentar un parto de pretérmino.

Background: Unlike cold-knife conization, studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). Objective: Critical analysis of the literature to establish if the LEEP treatments increase risk of preterm delivery and its influence in maternal-perinatal results. Results: Only three studies were filling the inclusion criteria. The first study does not show that LEEP treatment increase risk of preterm delivery and low birth weight. The second study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, but not spontaneous preterm delivery. Nevertheless, the third study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, spontaneous preterm delivery and low birth weight. The three studies are based in retrospective cohorts, which grant them a level of evidence of type 2b. Conclusion: The evidence indicates that loop excision of the transformation zone by LEEP is associated with a small but real increase the risk of preterm delivery.

"Después de la tormenta sobreviene la calma": hipertensión inducida por el embarazo y desprendimiento seroso de la retina: angiografía fluoresceínica evolutiva / Calm follows storm: pregnant induced hypertension and serous retinal detachment: sequential fluorescein angiography

El desprendimiento seroso de la retina es una rara complicación de la hipertensión inducida por el embarazo. Se ha reportado en 1% a 2% de pacientes con eclampsia severa siendo usualmente bilateral. En esta condición, la isquemia coroidea inducida por el vasoespasmo suele ser severa y es la responsable de la ruptura de la barrera hematorretiniana externa y del desprendimiento. La mayoría de los pacientes obtienen recuperación espontánea en el curso de pocas semanas sin secuelas visuales, quedando como evidencia cambios pigmentarios residuales en el epitelio pigmentario de la retina. En una secuencia de angiografías fluoresceínicas del fondo ocular de una embarazada de 31 años mostramos la historia natural de la complicación

Serous retinal detachment is an unusual complication of the hypertensive disorder in pregnancy. It has been reported in 1% to 2% of patients with severe preeclampsia and 10% with eclampsia and is usually bilateral. In this condition choroidal ischemia induced by vasospasm may be severe compromising the retinal-pigmentary epithelium barrier and resulting in serous retinal detachment. Most patients with retinal detachment in pregnancy-induced hypertension have had full spontaneous resolution within a few weeks, and they did not have any visual sequelae but residual pigmentary changes of the retinal pigment epithelium. The natural history of the condition is shown in sequential fluoresce in angiography studies in a 31 year-old pregnant patient

Aplicabilidade da amnioinfusão na oligodramnia / Applicability of amnioinfusion to oligodramnios

A aplicabilidade da amnioinfusão na oligodramnia tem sido relatada por diversos autores, entretanto, suas indicações são controversas. Sabe-se que a adequada quantidade de líquido na cavidade amniótica é essencial para o desenvolvimento fetal. Neste particular, a amnioinfusão poderia melhorar o prognóstico materno-fetal. Entretanto, este procedimento está associado a: corioamnionite, descolamento prematuro de placenta e parto pré-termo. A amnioinfusão tem importância na realização de exames ultra-sonográficos, por permitir melhor visibilização das estruturas do feto durante o exame ultra-sonográfico, facilitando o diagnóstico de malformações fetais. Os autores fazem atualização sobre a aplicabilidade da amnioinfusão na oligodramnia.

Cervical Length and the Risk of Microbial Invasion of the Amniotic Cavity in Women with Preterm Premature Rupture of Membranes

The aims of this study were to determine whether sonographically measured cervical length is of value in the identification of microbial invasion of the amniotic cavity in women with preterm premature rupture of membranes (PPROM) and to compare its performance with maternal blood C-reactive protein (CRP), white blood cell count (WBC), and amniotic fluid (AF) WBC. This prospective observational study enrolled 50 singleton pregnancies with PPROM. Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of CRP and WBC at the time of amniocentesis. AF obtained by amniocentesis was cultured and WBC determined. The prevalence of a positive amniotic fluid culture was 26% (13/50). Patients with positive amniotic fluid cultures had a significantly shorter median cervical length and higher median CRP, WBC, and AF WBC than did those with negative cultures. Multiple logistic regression indicated that only cervical length had a significant relationship with the log odds of a positive AF culture. Transvaginal sonographic measurement of cervical length is valuable in the identification of microbial invasion of amniotic cavity in women with PPROM. Cervical length performs better than AF WBC, maternal blood CRP, and WBC in the identification of a positive amniotic fluid culture.

The clinical and microbiological correlates of premature rupture of membranes.

Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.

Spontaneous reseal of ruptured membranes after genetic amniocentesis.

BACKGROUND: Rupture of membranes is an uncommon complication of genetic amniocentesis. The risk of ruptured membranes is reported as 1-1.2%. CASE: Genetic amniocentesis complicated by ruptured membranes was diagnosed in a 31-year-old woman. The membranes resealed after 48 hours with conservative management and the pregnancy ended with a favorable outcome. CONCLUSION: Spontaneous reseal of ruptured membranes after genetic amniocentesis can occur with conservative management and end with a favorable pregnancy outcome.

Comparação entre conduta ativa com ocitocina e conduta expectante na rotura prematura de membranas em gestaçöes a termo / Comparison between active management with oxytocin and expectant management for premature rupture of membranes at term

Objetivos: comparar, em uma populaçäo de gestantes brasileiras com rotura prematura de membranas a termo (RPM-TI), as condutas expectante ou ativa com ocitocina. Métodos: ensaio clínico prospectivo, randomizado e multicêntrico, avaliando as variáveis relativas ao tempo para o início do trabalho de parto e tempo de internaçäo hospitalar materna e neonatal. Foram selecionadas 200 gestantes com RPM-T, atendidas em quatro instituiçöes públicas do estado de Säo Paulo de novembro de 1995 a fevereiro de 1997. As pacientes foram divididas aleatoriamente em dois grupos de conduta: ativa, com induçäo do trabalho de parto com ocitocina iniciando até 6h de RPM, e expectante, aguardando-se o início espontâneo do trabalho de parto por um período máximo de 24h. Os dados foram analisados com o auxílio dos programas Epi-Info e SPSS-PC+, utilizandos-se os testes estatísticos do X², t de Student e Log-rank. Resultados: indicam que as diferenças entre a utilizaçäo da conduta ativa com ocitocina e a conduta expectante dizem respeito ao maior tempo necessário no grupo de conduta expectante para o início do trabalho de parto e parto, além da maior proporçäo de mulheres e recém-nascidos com internaçäo superior a três dias. Conclusöes: o tempo entre a admissäo e o parto, o período de latência e o tempo entre a rotura das membranas e o parto foram maiores quando se adotou conduta expectante.