Helicobacter pylori seropositivity: its correlation with vomiting disorders during pregnancy

To evaluate the relationship between Helicobacter pylori [H. pylori] infection and vomiting disorders during pregnancy. Helicobacter pylori IgG antibodies were determined in three groups of pregnant women by ELISA. Group I included 25 pregnant women with hyperemesis gravidarum [HG], group II included 60 pregnant women with emesis gravidarum [EG] and group III included 60 asymptomatic pregnant women [NP] of matched age and parity. The percentage of IgG seropositivity and the mean IgG liter in each group were determined and analysed. El-Minia University Hospital. The prevalence of seropositivity for H. pylori IgG antibodies among patients with [HG] [21 out of 25 = 84%] was higher than those with [EG] [34 out of 60 = 56.67%] and also higher than that in asymptomatic pregnant women [32 out of 60 = 53.33%]. This difference was statistically significant [P < 0.05]. Also the mean liter in the first group was [55.64 +/- 7.2 Au/ml] compared to [40.41 +/- 18.2 Au/ml] and [31.52 +/- 11.34 An/ml] in the second and third groups respectively. This difference in the mean titer was statistically significant [P < 0.05]. Helicobacter pylori infection appears to be significantly associated with [HG] and accordingly, serologic testing for this infection will be of great help in the management of these patients

Nausea and vomiting of pregnancy: an evolutionary hypothesis

Nausea and vomiting of pregnancy, "morning sickness", is a common contemporary complaint. Many pregnant patients note alterations in smell and taste which can precipitate "morning sickness", symptoms that characterize early gestation. Epidemiologic studies suggest that pregnancies accompanied by "morning sickness" have better outcomes than asymptomatic pregnancies. The intimate connection between immunogenetic identity, chemoidentity, and chemocommunication by olfactory mechanisms suggests a relationship between maternal symptoms and maternal accommodation of paternal antigens contained in the fetoplacental unit. Most mammalian species utilize olfaction to reduce inbreeding and thus do not require an intimate placental connection between mother and fetus. The evolution of Homo sapiens included prolonged periods of small, genetically homogeneous foraging groups which limited selection of genetically heterogeneous mates. Adaptation to this circumstance included a reduction of olfactory precision in mate selection and a more intimate association between mother and fetus, the hemochorial placenta

Hepatopatía del embarazo / Hepatopathies of pregnancy

Se analizan las hepatopatías propias del embarazo, según las últimas investigaciones y por la experiencia del Departamento de Anatomía Patológica del Hospital Central de San Luis Potosí. Tales entidades son: el hígado graso, la hiperemesis gravídica, la preeclampsia y eclampsia y la colestesis del embarazo. Se estima que el estado eclámtico es capaz de dar manifestaciones clínicas, de laboratorio o estructurales, absolutamente variables, que llevan a juzgarse como dependientes al hígado graso, al síndrome HELLP y a algunos casos de colestasis. A su vez, la colestasis del embarazo, genéticamente determinada, debe difundirse de la asociada a la eclampsia o determinada por drogas u otras causas. Similarmente, la hiperemesis gravídica puede ser primaria, aunque rara u obedecer a causas neurológicas; es capaz también de producir disfunción hepática ligera. finalmente, se ubican los padecimientos anteriores dentro del esquema clásico fisiopatológico de las ictericias.

Alteraciones hepáticas durante el embarazo

During pregnancy, biochemical evaluation of the liver is affected in many significan ways. Alkaline phosphatase increases in the third trimester and rapidly returns to the normal limits after delivery. This increase is clearly secondary to the placental isoenzyme. AST and ALT are usually normal and GGTP doens't changes significantly. Hepatic flow remains unchanged and estrogen levels increase leading to several metabolic and cutaneous changes, such as hepatic palms and systemic vasodilatation. Liver diseases that occur during pregnancy can be classified as follows: a) Entities exclusive of pregnancy, b) Pregnancy associated diseases, and c) Previous liver diseases. The first group included: 1. Cholestasis of pregnancy, described mainly in Scandinavian and Chilean women and characterized by pruritus in the third trimester, biochemical evidence of cholestasis, increased frequency of cholelitiasis and fetal problems. The entity usually recurs in other pregnancies or during exposure to estrogens. Prognosis is good and the patient improves rapidly after delivery. Several reports have shown that s-Adenosyl-Methionine can be effective. 2) Hyperemesis gravidarum, characterized by protacted vomiting associated to significant malnutrition. Liver function tests are usually abnormal and the liver biopsy shows no specific changes. Prognosis is usually good and most of the patients improved spontaneously. 3) Acute fatty liver, is one of the causes of liver failure during the third trimester and is associated with a very high maternal mortality. Clinically the patient presents with encephalopathy, biochemical evidence of liver failure and microvesicular fat in the liver...