Relations of neuropeptide Y and heme oxygenase-1 expressions with fetal brain injury in rats with intrahepatic cholestasis of pregnancy

Abstract Purpose: To investigate the relations of neuropeptide Y (NPY) and heme oxygenase-1 (HO-1) expressions with fetal brain injury in rats with intrahepatic cholestasis of pregnancy (ICP). Methods: Sixty rats pregnant for 15 days were randomly divided into experimental and control groups. The ICP model was established in experimental group. On the 21st day, the blood biochemical test, histopathological examination of pregnant rat liver and fetal brain tissues and immunohistochemical analysis of fetal rat brain tissues were performed. Results: On the 21st day, the alanineaminotransferase, aspartate aminotransferase and total bile acid levels in experimental group were significantly higher than control group (P<0.01). Compared with control group, there was obvious vacuolar degeneration in pregnant rat liver tissue and fetal brain tissue in experimental group. NPY expression in fetal brain tissue was negative in control group and positive in experimental group. HO-1 expression in fetal brain tissue was strongly positive in control group and positive in experimental group. There was significant difference of immunohistochemical staining optical density between two groups (P<0.01). Conclusion: In fetal brain of ICP rats, the NPY expression is increased, and the HO-1 expression is decreased, which may be related to the fetal brain injury.

Metabolomics applied to maternal and perinatal health: a review of new frontiers with a translation potential

The prediction or early diagnosis of maternal complications is challenging mostly because the main conditions, such as preeclampsia, preterm birth, fetal growth restriction, and gestational diabetes mellitus, are complex syndromes with multiple underlying mechanisms related to their occurrence. Limited advances in maternal and perinatal health in recent decades with respect to preventing these disorders have led to new approaches, and "omics" sciences have emerged as a potential field to be explored. Metabolomics is the study of a set of metabolites in a given sample and can represent the metabolic functioning of a cell, tissue or organism. Metabolomics has some advantages over genomics, transcriptomics, and proteomics, as metabolites are the final result of the interactions of genes, RNAs and proteins. Considering the recent "boom" in metabolomic studies and their importance in the research agenda, we here review the topic, explaining the rationale and theory of the metabolomic approach in different areas of maternal and perinatal health research for clinical practitioners. We also demonstrate the main exploratory studies of these maternal complications, commenting on their promising findings. The potential translational application of metabolomic studies, especially for the identification of predictive biomarkers, is supported by the current findings, although they require external validation in larger datasets and with alternative methodologies.

Altered Tregs and oxidative stress in pregnancy associated lupus

Abstract Aim SLE is a systemic autoimmune disease generally affecting woman in the reproductive age. It is associated with an altered level of Tregs and oxidative stress while an increase in Tregs, and different antioxidant mechanisms to combat oxidative stress are essential for successful pregnancy. Hence, this study aims to determine the level of CD4+ and CD8+ Tregs and oxidative stress in pregnant lupus patients. Methods Ten healthy and 10 pregnant lupus volunteers from the North Indian population, within the age group of 20-30 years were enrolled in the study. All the patients were non-smokers, non-alcoholics and were not associated or undergoing therapy for any other disease. They had a SLEDAI of 37.4 ± 7.32 with 5.2 ± 1.93 years of disease duration. Oxidative stress was determined by measuring the enzyme activity of anti-oxidant enzymes (catalase, superoxide dismutase and glutathione peroxidase) and the level of reduced glutathione and lipids peroxidised, spectrophotometrically. Flowcytometry was performed for immunophenotyping to determine CD8+ and CD4+ Tregs. Results Elevated CD8+ Tregs and diminished CD4+ Tregs were observed in pregnant lupus patients. Oxidative stress was significantly increased as the activities of anti-oxidant enzymes and level of reduced glutathione was considerably diminished. There was a substantial increase in the amount of lipids peroxidised. Conclusion Pregnant lupus patients undergo considerable level of oxidative stress in comparison to healthy pregnant woman. The decreased level of CD4+ Tregs and an increase in CD8+ Tregs might be another important factor responsible for pregnancy associated complications. Hence, lupus leads to alterations in the necessary conditions for a successful pregnancy, which might eventually cause higher mortality, morbidity and associated complications.

Rotura hepática asociada a hipertensión arterial crónica y preeclampsia sobreañadida / Liver rupture associate with chronic hypertension and overadded preeclampsia

Se describe el caso clínico de una paciente de 29 años de edad con gestación de 24 semanas y antecedentes de hipertensión arterial crónica, que acudió al Servicio de Urgencias del Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba, por presentar cifras tensionales elevadas, cefalea, epigastralgia y vómitos. Se diagnosticó una preeclampsia sobreañadida y, por los signos de agravamiento, se decidió efectuar laparotomía. Se halló hemoperitoneo y una rotura en lóbulo derecho hepático, de modo que se realizó taponamiento hepático, que luego se retiró. La paciente requirió cuidados intensivos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres y la evaluación de un equipo multidisciplinario debido a la aparición de complicaciones: síndrome de insuficiencia respiratoria aguda, absceso de pared abdominal, absceso hepático y presunta trombosis ileofemoral. La evolución fue favorable y egresó viva.

The case report of a 29 year-old patient is described with a pregnancy of 24 weeks and a history of chronic hypertension, so that she went to the emergency Department of Tamara Bunke Bider Teaching Gynecological and Obstetrical Hospital in Santiago de Cuba, due to her high values, migraine, epigastralgia and vomits. A overadded preeclampsia was diagnosed and, because of the worsening signs, it was decided to make a laparotomy. A hemoperitoneo and a rupture in hepatic right lobe were found, thus, a hepatic tamponing was carried out which was then retired. The patient required intensive cares in Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital and the evaluation of a multidisciplinary team due to the emergence of complications: acute respiratory failure syndrome, abdominal wall abscess, hepatic abscess and presumed ileofemoral thrombosis. Her clinical course was favorable and she was discharged alive.

Effect of non-surgical periodontal therapy on the degree of gingival inflammation and stress markers related to pregnancy

Abstract Objectives The purpose of this study was to determine the impact of nonsurgical periodontal therapy considering the salivary stress-related hormone and cytokine levels in the gingival crevicular fluid (GCF) on pregnant and nonpregnant women. Material and Methods Thirty non-pregnant (control group) and 30 pregnant women (test group) that met the study inclusion criteria were chosen. Only participants with gingivitis were included. Clinical data and samples of GCF and saliva were collected at baseline and after periodontal therapy. The levels of interleukin-1 beta (Κ-1β) and IL-10, and concentration of salivary chromogranin A (CgA) hormone were analyzed by enzyme-linked immunosorbent assay (ELISA). The repeated measures analysis of variance was used for intragroup and intergroup analyses. Results A major decrease in the gingival inflammation was observed in both groups after periodontal therapy (p<0.05). Periodontal treatment decreased the level of IL-1β in GCF (p<0.05) in control group, but no statistical difference was determined for GCF IL-1β in the test group. However, after periodontal therapy, the CgA hormone concentration was reduced in both groups (p<0.05). However, there was no difference in salivary CgA concentration, GCF IL-10 levels, and perceived stress scale (PSS)-10 between the groups (p>0.05). Conclusions Within the limitations of this study, periodontal therapy significantly improved the periodontal status and stress level. In addition, the severity of the gingival inflammation during pregnancy was related to stress. However, further studies will be needed to substantiate these early findings.

Alterações metabólicas e inflamatórias na gestação / Metabolic and inflammatory changes in pregnancy

Em gestantes, ocorrem alterações hormonais, metabólicas e hematológicas, fisiologicamente importantes. As alterações metabólicas observadas estão associadas ao aumento do efeito hepático da progesterona, estradiol e lactogênio placentário nesse período. Estrogênios são conhecidos por aumentar a produção de colesterol VLDL e diminuir a atividade da lipase hepática. Nesse grupo de mulheres, notase também um aumento do número de neutrófilos e monócitos para a circulação periférica, notadamente em gestantes com pré-eclampsia, tendo como consequência produção e secreção da mieloperoxidase. Assim, torna-se importante determinar quais alterações metabólicas e inflamatórias estão relacionadas com a gestação, para auxiliar no diagnóstico e prognóstico de doenças cardiovasculares futuras nesta população. Além dos fatores de risco, esta revisão aponta novos biomarcadores, tais como a mieloperoxidase, capacidade antioxidante total do soro, marcadores inflamatórios e proteína plasmática A.(AU)

In pregnant women, hormonal, metabolic and hematologic physiologically important changes occur. The metabolic changes observed are associated with increased hepatic effect of estradiol, progesterone and placental lactogen during this period. Estrogens are known to increase production of VLDL cholesterol and decrease the activity of hepatic lipase. In this group of women, we can note an increased number of neutrophils and monocytes into the peripheral circulation, especially in pregnant women with pre-eclampsia, resulting in production and secretion of myeloperoxidase. Thus, it becomes important to determine which metabolic and inflammatory changes are related to pregnancy, to assist in the diagnosis and prognosis of future cardiovascular disease in this population. In addition to the risk factors, this review shows new biomarkers such as myeloperoxidase, total antioxidant capacity of serum, inflammatory markers and plasma protein A.(AU)

Consumo de alcohol antes y durante la gestación en Argentina: prevalencia y factores de riesgo / Alcohol consumption before and during pregnancy in Argentina: prevalence and risk factors

OBJETIVO: Caracterizar el consumo de alcohol de mujeres argentinas antes y durante la gestación e identificar los factores asociados con ese consumo y con los cambios relacionados con la gestación. MÉTODOS: Estudio observacional transversal. Se entrevistaron mujeres puérperas atendidas en dos centros de atención perinatal de la ciudad de Santa Fe, Argentina. Se recabó la información sociodemográfica de las participantes y datos de su consumo de alcohol, entre otros. Se realizó un análisis descriptivo de las prevalencias de consumo y se identificaron los factores asociados con los patrones de consumo de alcohol mediante análisis de medidas repetidas. RESULTADOS: De las 614 participantes, 75,2% había consumido al menos un trago (unidad estándar) de alcohol durante la gestación y 83,3% lo había hecho durante el último año; 15,1% reconoció haber tenido al menos un evento de consumo excesivo episódico (5 tragos o más) durante la gestación y 27,6% durante el año anterior a la gestación. Solo 30,6% de las mujeres manifestó haber hecho algún cambio en el consumo durante el último año; de ellas, 55,6% disminuyó el consumo y 41,8% dejó de beber. Las mujeres que mostraron mayor consumo de alcohol antes y durante la gestación informaron mayor consumo de sus parejas, fumaban y tenían actitudes más permisivas respecto al consumo de alcohol durante la gestación. CONCLUSIONES: En Argentina, se requiere un plan de prevención específico para reducir el consumo de alcohol en las mujeres embarazadas, ajustado a las características del consumo en el contexto local, con intervenciones que incluyan a las parejas y se focalicen en las mujeres más jóvenes, las que consumen tabaco y las que tienen actitudes más permisivas respecto al consumo de alcohol.

OBJECTIVE: Describe alcohol consumption by Argentine women before and during pregnancy and identify the factors associated with consumption- and pregnancy-related changes. METHODS: Cross-sectional observational study. Women were interviewed after giving birth and receiving care at two perinatal health care centers in Santa Fe, Argentina. Sociodemographic information, data on their alcohol use, and other information were obtained from the participants. A descriptive analysis of consumption prevalence rates was made and the factors associated with patterns of alcohol use were identified by means of repeated measure analysis. RESULTS: Of the 614 participants, 75.2% had had at least one alcoholic drink (standard unit) during pregnancy and 83.3% had done so in the previous year; 15.1% admitted having at least one episode of binge drinking (five or more drinks) during pregnancy and 27.6% in the year prior to pregnancy. Only 30.6% of the women said they had made any change in consumption during the previous year; of those, 55.6% reduced their consumption and 41.8% stopped drinking. Women who consumed the most alcohol before and during pregnancy reported higher consumption by their partners, smoked, and had more permissive attitudes about alcohol use during pregnancy. CONCLUSIONS: A specific prevention plan is required in Argentina to reduce alcohol use in pregnant women, adjusted to local patterns of use, with interventions that include couples, and focused on the youngest women, those who use tobacco, and those who have more permissive attitudes about alcohol use.

Alterações dermatológicas na gravidez: revisão da literatura / Skin changes in pregnancy: literature review

Durante o período gestacional ocorrem profundas alterações imunológicas, metabólicas, endócrinas e vasculares, que são responsáveis por alterações cutâneas, fisiológicas e patológicas. O objetivo deste artigo foi verificar as alterações dermatológicas que ocorrem durante a gravidez. Para isso, foi realizada uma revisão da literatura, de artigos publicados entre 1982 e 2013, indexados no PubMed e SciELO. Em relação a pele, os achados indicam que as alterações gestacionais são divididas em: alterações fisiológicas gestacionais, dermatoses específicas e dermatoses alteradas na gestação. Este apanhado engloba as características clínicas e o prognóstico das alterações fisiológicas da pele durante a gravidez, as dermatoses influenciadas pela gravidez e as dermatoses específicas da gravidez.(AU)

During pregnancy, deep immunological, metabolic, endocrine and vascular changes responsible for physiological and pathological skin changes occur. The objective of this paper was to check the skin changes that occur during pregnancy. For this, a literature review of articles published between 1982 and 2013, indexed in PubMed and SciELO was performed. Regarding the skin, the findings indicate that gestational changes are divided into gestational physiologic changes, specific skin diseases and skin conditions changed during pregnancy. This overview covers the clinical features and prognosis of physiological skin changes during pregnancy, dermatoses affected by pregnancy specific dermatoses of pregnancy.(AU)

Maternal obesity and late effects on offspring metabolism / Obesidade materna e efeitos tardios sobre o metabolismo da prole

Objective : The aim of this study was to evaluate the late effects of maternal obesity induced by lesion of the ventromedial hypothalamus on offspring metabolism.Materials and methods : Thirty days after the bilateral lesion of the ventromedial hypothalamus, female rats were mated and divided into 2 groups of pregnant animals: Control (C) – false lesion (sham) and Obese (OB) – lesion. Three months after that, with the groups of mothers, offspring were divided into control and obese animals that received a normocaloric diet (C-N and OB-N), and control and obese animals that received a hypercaloric diet (C-H and OB-H). At 120 days of age, the animals were euthanized and their carcasses, feces and food were submitted to calorimetric analysis to determine energy balance and body composition.Results : During the growth period, offspring from obese mothers showed higher values of body weight and food intake than controls. Obese animals showed higher body weight gain and gross food efficiency than control animals in adulthood. The hypercaloric diet led to increased metabolizable energy intake, percentage of absorbed energy and energy expenditure in both groups. Body composition was only affected by the association of hypercaloric diet and maternal obesity that led to increased body fat.Conclusions : Maternal obesity has led to the development of later overweight in offspring, suggesting fetal programming. According to the trend presented, it is believed that the prolonged intake of hypercaloric diets in adult animals may, as an additional effect, induce worsening of the overweight induced by maternal obesity. Arq Bras Endocrinol Metab. 2014;58(3):301-7.

Objetivo Avaliar os efeitos tardios da obesidade materna induzida por lesão do núcleo ventromedial do hipotálamo sobre o metabolismo da prole. Trinta dias após a lesão bilateral do hipotálamo ventromedial, ratos fêmeas foram colocadas para acasalar e divididas em dois grupos de animais gestantes: Controle (C) – falsa lesão e Obeso (OB) – lesionados. Três meses após o nascimento, de acordo com os grupos das mães, os filhotes foram divididos em animais controle e obesos que recebiam dieta normocalórica (C-N and OB-N) e animais controle e obesos que recebiam dieta hipercalórica (C-H and OB-H). Aos 120 dias de idade, os animais foram eutanasiados e as carcaças, fezes e ração foram submetidas à análise calorimétrica para determinação do balanço energético e composição corporal.Resultados Durante o período de crescimento, os filhos de mães obesas mostraram maiores valores de peso corporal e ingestão alimentar que animais controle. Os animais obesos apresentaram maiores valores de ganho de peso corporal e eficiência metabólica que os animais controle quando adultos. A dieta hipercalórica levou ao aumento da energia metabolizável, percentagem de energia absorvida e gasto energético para ambos os grupos. A composição corporal foi somente afetada pela associação da dieta hipercalórica com a obesidade materna que levou ao aumento da gordura corporal.Conclusões : A obesidade materna levou ao sobrepeso tardio na prole, sugerindo uma programação fetal. Pela tendência apresentada, acreditamos que a ingestão prolongada de dietas hipercalóricas em animais adultos possa induzir uma piora no quadro de sobrepeso induzido pela obesidade materna. Arq Bras Endocrinol Metab. 2014;58(3):301-7.

Hipertiroidismo y embarazo / Hyperthyroidism and pregnancy

El hipertiroidismo constituye la enfermedad tiroidea más frecuente de la gestación. Su diagnóstico puede ser algo difícil por los cambios fisiológicos que ocurren durante el embarazo, ambos se acompañan de bocio, hipermetabolismo y circulación hiperdinámica. La dificultad para ganar peso a pesar de mantener el apetito y la taquicardia en reposo (más de 90 latidos/minuto) son los signos más sugestivos. La causa más común (80-85 por ciento) es la enfermedad de Graves, de etiología autoinmune, que aparece con mayor frecuencia en el primer trimestre y el posparto, y puede agravarse si existen niveles elevados de gonadotropina coriónica durante el primer trimestre. El hipertiroidismo manifiesto afecta al curso del embarazo con consecuencias adversas para la madre y el feto. La determinación de niveles elevados de tiroxina y triyodotironina libres es el estudio diagnóstico confirmatorio. El empleo de los antitiroideos de síntesis es la terapia de elección, y se sugiere emplear la dosis mínima necesaria para controlar el hipertiroidismo y mantener a la paciente eutiroidea, lo cual se logra mediante un seguimiento clínico y de la función tiroidea cada 4 o 6 semanas. La lactancia se permite en madres que ingieren dosis de 200 mg/día de propiltiuracilo o 20 mg/día de metimazol(AU)

Hyperthyroidism is the most common thyroid disease in pregnancy. Diagnosing is somewhat difficult because of the physiological changes in pregnancy; it is accompanied with goiter, hypermetabolism and hyperdynamic circulation. Difficulties in gaining weight in spite of keeping appetite and tachycardia value at rest (over 90 beats per minute) are the most suggestive signs. The most common cause (80 to 85 percent of cases) is Graves' disease of autoimmune etiology, which occurs more frequently in the first trimester of pregnancy and after the childbirth, and may become more severe if there are high levels of chorionic gonadotropin during the first trimester of pregnancy. Manifest hyperthyroidism affects the course of pregnancy and has adverse effects for the mother and the fetus. The determination of high levels of free thyroxine and triiodothyronine is the confirmatory diagnostic test. The use of synthesis antithyroid medication is the therapy of choice. The minimal necessary dose is recommended to control hyperthyroidism and to keep the patient in euthyroid state, and this is achieved with clinical and thyroid function follow-up every 4 to 6 weeks. The breast-feeding is allowed in mothers taking a 200 mg/day dose of propylthiouracil or 20mg/day of methimazole(AU)

Disfunções miccionais no período gestacional e puerperal / Voiding dysfunctions in gestational and postpartum periods

Os autores fazem uma revisão da literatura sobre as alterações anatômicas e funcionais que ocorrem no trato urinário durante a gestação, assim como discorrem sobre as disfunções miccionais mais prevalentes no período gravídico e puerperal, seus diagnósticos e tratamentos. Anatomicamente, ocorre um aumento nas dimensões renais, dilatação no sistema coletor urinário, aumento da mobilidade do colo vesical e da excreção renal. Fatores hormonais (progestágenos) também influenciam em tais modificações. Fisiologicamente, há um aumento da frequência urinária e noctúria. A incontinência urinária na gestação é preditiva do seu aparecimento no período puerperal. Urodinamicamente, há um aumento dos valores volumétricos da bexiga na cistometria; no estudo fluxo/pressão, há um aumento do comprimento uretral funcional, da pressão de fechamento uretral e uretral máxima, assim como no fluxo máximo e médio urinário na fluxometria

The authors have performed a literature review about the anatomic and functional changes that occur in the urinary system during pregnancy, as well as they have discussed about the most prevalent voiding dysfunctions in gestational and postpartum periods, their diagnosis and treatments. Anatomically, it is expected an increase of: renal dimensions, dilation of urinary collecting system, bladder neck mobility, and renal excretion. Hormonal factors (progesterone) are also influencing such modifications. Physiologically, there is an increase of the urinary frequency and nocturia. Urinary incontinence during pregnancy is predictive of its beginning during postpartum period. When performing urodynamics, there is an increase of bladder volumetric values during cystometry and urethral closure pressure, maximum urethral pressure and functional urethral length are increased in flow/pressure study, as well as the maximum and mean urinary flow during fluxometry

Serum lipid levels in pregnancies complicated by preeclampsia / Concentrações séricas de lipídeos em gestações com complicações de pré-eclâmpsia

CONTEXT AND OBJECTIVE: Pre-eclampsia is a disorder that occurs only during pregnancy. Postpartum changes relating to lipid metabolism may contribute towards the endothelial lesions observed in preeclampsia. Thus, the aim of the present study was to evaluate the lipid profile among patients who present preeclampsia and correlate these parameters with 24-hour proteinuria. DESIGN AND SETTING: Cross-sectional analytical study including 77 pregnant patients seen at Hospital Dório Silva. METHODS: This study involved 42 women with preeclampsia and 35 healthy pregnant women in the third trimester of pregnancy as controls. Blood samples were obtained from all the patients, and the serum levels of triglycerides, total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and very low density lipoproteins (VLDL) were determined. Cases and controls were matched for maternal age, gestational week and body mass index. RESULTS: The VLDL and triglyceride values from the women with preeclampsia were significantly higher than those of the healthy women. There was a positive correlation between increased proteinuria and higher VLDL and triglyceride levels in patients with preeclampsia. CONCLUSION: Among the patients with preeclampsia, higher VLDL and triglyceride levels were positively correlated with proteinuria. These observations indicate that the pregnant women who presented elevated lipid levels were more susceptible to cardiovascular disorders and, consequently, pre-eclampsia.

CONTEXTO E OBJETIVO: A pré-eclâmpsia é um distúrbio que ocorre apenas durante a gravidez e as alterações pós-parto relacionadas ao metabolismo lipídico podem contribuir para a lesão endotelial observada nessa afecção. Assim, o objetivo do presente estudo foi avaliar o perfil lipídico em pacientes que apresentaram pré-eclâmpsia e correlacionar estes parâmetros com a proteinúria de 24 horas. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, incluindo 77 pacientes grávidas atendidas no Hospital Dório Silva. MÉTODOS: Este estudo envolveu 42 mulheres com pré-eclâmpsia e 35 gestantes saudáveis no terceiro trimestre de gravidez como controle. Amostras de sangue foram obtidas de todas as pacientes e os níveis séricos de triglicérides, colesterol total, lipoproteínas de baixa densidade (LDL), lipoproteínas de alta densidade (HDL) e lipoproteínas de muito baixa densidade (VLDL) foram determinados. Casos e controles foram pareados por idade materna, semana gestacional e índice de massa corporal. RESULTADOS: Os valores de VLDL e triglicérides, obtidos de mulheres com pré-eclâmpsia foram significativamente maiores quando comparados com mulheres saudáveis. Houve uma correlação positiva entre o aumento da proteinúria e concentrações elevadas de VLDL e triglicérides, em pacientes com pré-eclâmpsia. CONCLUSÃO: Nas pacientes com pré-eclâmpsia foram observadas as maiores concentrações de VLDL e os níveis de triglicérides estão correlacionados positivamente com proteinúria. Estas observações indicam que as mulheres grávidas que apresentam níveis elevados de lipídios, são mais suscetíveis a doenças cardiovasculares e, consequentemente, a pré-eclâmpsia.

Correlação entre a fração inspirada de oxigênio, a pressão parcial de oxigênio materno e a pressão parcial de oxigênio fetal durante parto cesáreo em gestações normais / Correlación entre la fracción inspirada de oxígeno, la presión parcial de oxígeno materno y la presión parcial de oxígeno fetal durante el parto por cesárea en embarazos normales / Correlation between the inspired fraction of oxygen, maternal partial oxygen pressure, and fetal partial oxygen pressure during cesarean section of normal pregnancies

JUSTIFICATIVA E OBJETIVOS: Apesar das alterações na função pulmonar, a oxigenação materna se mantém nas anestesias regionais para obstetrícia. Mesmo assim, nessas situações, o fornecimento de oxigênio suplementar para a mãe é prática disseminada. A principal justificativa é a boa oxigenação fetal; entretanto, não há devida comprovação. Este estudo prospectivo e com distribuição randômica das pacientes teve o objetivo de testar a hipótese da existência ou não de correlação entre hiperóxia materna e elevação de parâmetros gasométricos fetais na cesariana eletiva. MÉTODO: Foram estudadas vinte pacientes grávidas, submetidas à raquianestesia, através de gasometrias arteriais, com diferentes frações inspiradas de oxigênio e correlacionadas com a gasometria fetal. RESULTADOS: O aumento da fração inspirada de oxigênio materno não se correlacionou com o aumento da pressão parcial de oxigênio fetal. CONCLUSÕES: A indução de hiperóxia materna através de oxigenoterapia suplementar não foi capaz de aumentar a pressão parcial de oxigênio no feto. Não houve modificação nos parâmetros gasométricos fetais, mesmo em caso de mudança desses parâmetros na parturiente, induzidos pela hiperóxia durante a cesariana sob raquianestesia.

BACKGROUND AND OBJECTIVES: Despite changes in pulmonary function, maternal oxygenation is maintained during obstetric regional blocks. But in those situations, the administration of supplementary oxygen to parturients is a common practice. Good fetal oxygenation is the main justification; however, this has not been proven. The objective of this randomized, prospective study was to test the hypothesis of whether maternal hyperoxia is correlated with an increase in fetal gasometric parameters in elective cesarean sections. METHODS: Arterial blood gases of 20 parturients undergoing spinal block with different inspired fractions of oxygen were evaluated and correlated with fetal arterial blood gases. RESULTS: An increase in maternal inspired fraction of oxygen did not show any correlation with an increase of fetal partial oxygen pressure. CONCLUSIONS: Induction of maternal hyperoxia by the administration of supplementary oxygen did not increase fetal partial oxygen pressure. Fetal gasometric parameters did not change even when maternal parameters changed, induced by hyperoxia, during cesarean section under spinal block.

JUSTIFICATIVA Y OBJETIVOS: A pesar de las alteraciones en la función pulmonar, la oxigenación materna se mantiene en las anestesias regionales para obstetricia. Pero incluso así, en esas situaciones, el suministro de oxígeno suplementario para la madre se practica en forma diseminada. La principal justificación es la buena oxigenación fetal, sin embargo, no existe la debida comprobación al respecto. Este estudio prospectivo y con distribución randómica de las pacientes, tuvo el objetivo de comprobar la hipótesis de la existencia o no de una correlación entre la hiperoxia materna y la elevación de los parámetros gasométricos fetales en la cesárea por elección.? MÉTODO: Se estudiaron veinte pacientes embarazadas, sometidas a la raquianestesia, a través de gasometrías arteriales, con diferentes fracciones inspiradas de oxígeno y correlacionadas con la gasometría fetal. RESULTADOS: El aumento de la fracción inspirada de oxígeno materno no se correlacionó con el aumento de la presión parcial de oxígeno fetal. CONCLUSIONES: La inducción de hiperoxia materna a través de la oxigenoterapia suplementaria, no fue capaz de aumentar la presión parcial de oxígeno en el feto. No hubo modificación en los parámetros gasométricos fetales, incluso en el caso del cambio de esos parámetros en la parturiente, inducidos por la hiperoxia durante la cesárea bajo raquianestesia.

Fatores relacionados à insulinoterpia no diabete melito gestacional / Factors related to Insulin therapy on gestational diabetes mellitus

Objetivo: Avaliar as características das gestantes que necessitaram de insulinoterapia para o tratamentodo Diabete Gestacional. Métodos: Estudo retrospectivo descritivo. Foramselecionadas 231 gestantes com Diabete Gestacional, no período de janeiro de 2004 até julho de 2006, divididas em dois grupos, um que necessitou de insulinoterapia para controle glicêmico (n=78) e outro que utilizou apenas dietoterapia (n=173).Resultados: 33,8% das gestantes utilizaram insulina. A idade materna (p<0,01) e o número de gestaçõesanteriores (p<0,01) foram maiores no grupo que utilizou insulina, e a idade gestacional de início do tratamento(p=0,02) foi menor neste grupo. O índice de massa corporal, ganho de peso durante a gestação, as glicemiano teste de tolerância oral à glicose com 75 gramas não apresentaram diferença (p>0,05). Conclusão: As gestantes com idade elevada, maior número de gestações anteriores e com chegada mais precoce ao serviço são as que mais necessitaram insulina para controle glicêmico.

Purpose: To evaluate the characteristics of pregnant patients who required insulin therapy for Gestational Diabetes management. Methods: A descriptive retrospective study. Were chosen 231 pregnant woman with Gestational Diabetes, on period of January 2004 to July 2006, divided into two groups, one which required insulin therapy for glucose control (n=78) and another group that used only diet control (n=173). Results: 33,8% of patients used insulin. Maternal age (p<0,01) and number or previous pregnancies (p<0,01) were higher in the group using insulin and gestational age at start of treatment (p=0,02) was lower. Body mass index, weight gain during pregnancy, glucose on oral glucose tolerance test with 75 grams did not show difference (p>0,05). Conclusion: older pregnant patients, those withhigher number of previous pregnancies and earlier beginning of management were those who most needed insulin for glucose control.

Hypothyroid state reduces calcium channel function in 18-day pregnant rat uterus.

Hypothyroidism significantly reduced the mean amplitude and increased the mean frequency of spontaneous rhythmic contractions in 18 day pregnant rat uterus. Nifedipine (10(-12)-10(-9) M) and diltiazem (10(-10)-10(-6) M) caused concentration related inhibition of the myogenic responses of the uterine strips obtained from both pregnant and hypothyroid state. However, nifedipine was less potent (IC50:2.11 x 10(-11) M) in pregnant hypothyroid state as compared to pregnant control (IC50: 3.1 x 10(-12) M). Similarly, diltiazem was less potent (IC50: 3.72 x 10(-9) M) in inhibiting the uterine spontaneous contractions in hypothyroid than in pregnant rat uterus (IC50:5.37 x 10(-10) M). A similar decrease in the sensitivity to nifedipine and diltiazem for reversal of K+ (100 mM)-induced tonic contraction and K(+)-stimulated 45Ca2+ influx was observed with these calcium channel antagonists in uterus obtained from hypothyroid pregnant rats compared to the controls. Nifedipine-sensitive influx of 45Ca(2+)-stimulated either by K+ (100 mM) or by Bay K8644 (1,4-dihydro-2,6-methyl-5-nitro-4-[2'-(trifluromethyl)phenyl]-3-pyridine carboxylic acid methyl ester) (10(-9) M) was significantly less in uterine strips from hypothyroid rats compared to controls. The results suggest that the inhibition of uterine rhythmic contractions may be attributable to a reduction in rat myometrial Ca2+ channel function in the hypothyroid state.

Polimorfismos gênicos da metilenotetrahidrofolato redutase, cistationina beta-sintetase e metionina sintase: associação a perdas fetais recorrentes e níveis séricos de vitamian B12, folatos e hemocisteína / Polymorphisms of metilenotetrahidrofolato reductase gene, cystathionine beta-synthase and methionine synthase: association with recurrent fetal losses and serum vitamian B12, folate and hemocisteína

A patogênese dos abortos espontâneos envolve interação complexa de diversos fatores genéticos e ambientais. A homocisteína é um aminoácido envolvido em diversos processos metabólicos incluindo metilação e sulfuração, sendo que as concentrações plasmáticas de homocisteína são determinadas por fatores nutricionais, como a ingestão de folatos e vitamina BI2, e de variações na atividade de enzimas decorrentes da presença de polimorfismos gênicos. Atualmente, a elevação da homocisteína plasmática e a deficiência de folatos e vitamina BI2 têm sido associadas a problemas obstétricos, incluindo o aborto espontâneo recorrente. O objetivo deste trabalho foi investigar associações entre os polimorfismos presentes em genes responsáveis pela síntese de proteínas envolvidas no metabolismo da homocisteína e seus substratos e ocorrência de aborto espontâneo recorrente. Foram investigados os polimorfismos C677T e A1298C no gene da enzima metilenotetrahidrofolato redutase (MTHFR); o polimorfismo A2756G no gene da enzima metionina sintase (MS) e a inserção 844ins68 no gene da enzima cistationina beta sintetase (CBS), utilizando o técnica de PCR - RFLP. Os níveis séricos de homocisteína, vitamina BI2 e folatos foram determinados pela técnica de quimioluminescência. As freqüências a1élicas dos po1imorfismos entre 89 mulheres com história de abortos recorrentes e 150 controles foram de 19,1 por cento e 19,6 por cento, respectivamente, para o polimorfismo C677T da MTHFR; 20,8 por cento e 26,0 por cento, respectivamente,para o polimorfismo A1298C da MTHFR; 14,2 por cento e 21,9 por cento, respectivamente, para o polimorfismo A2756G da MS; e 16,4 por cento e 18,0 por cento, respectivamente, para a inserção 844ins68 da CBS. No presente estudo não foram encontradas diferenças significativas entre as freqüências dos polimorfismos nos grupos de mulheres investigadas.