Expresión de ACE2 en cerebro durante el desarrollo y susceptibilidad de infección cerebral por SARS-COV-2 / ACE2 expression in the brain during development and susceptibility to brain infection by SARS-COV-2

Resumen La pandemia COVID-19 se extendió por todo por a la enorme capacidad del coronavirus SARS-CoV-2 para transmitirse entre humanos. El COVID-19 es una amenaza para la salud pública mundial. La entrada de este virus en las células se ve muy facilitada por la presencia de la enzima convertidora de angiotensina 2 (ACE2) en la membrana celular. Hoy en día no tenemos un conocimiento preciso de cómo se expresa este receptor en el cerebro durante el desarrollo humano y, como consecuencia, no sabemos si las células neurales en desarrollo son susceptibles de ser infectadas a través de la transmisión de madre a feto. Revisamos en este artículo los conocimientos sobre la expresión de ACE2 en el cerebro humano en desarrollo, con especial atención a la etapa fetal. Esta etapa corresponde al periodo de formación de la corteza cerebral. La posibilidad de infección por SARS-CoV-2 durante el periodo fetal puede alterar el desarrollo normal de la corteza cerebral. Así pues, aunque se han publicado pocos casos demostrando la transmisión vertical de la infección por SARS-CoV-2, el gran número de jóvenes infectados puede representar un problema sanitario que necesite seguimiento, por la posibilidad de que se originen alteraciones cognitivas y anomalías en el desarrollo de los circuitos corticales, que pueden representar predisposición a padecer problemas mentales a lo largo de la vida.

Abstract The COVID-19 pandemic spread around the world due to the enormous transmission of the SARS-CoV-2 among humans. COVID-19 represents a threat to global public health. The entry of this virus into cells is greatly facilitated by the presence of angiotensin-converting enzyme 2 (ACE2) in the cell membrane. Today we do not have a precise understanding of how this receptor expresses in the brain during human development and, as a consequence, we do not know whether neural cells in the developing brain are susceptible to infection. We review the knowledge about ACE2 expression in the developing human brain, with special attention to the fetal stage. This stage corresponds to the period of the cerebral cortex formation. Therefore, SARS-CoV-2 infection during the fetal period may alter the normal development of the cerebral cortex. Although few cases have been published demonstrating vertical transmission of SARS-CoV-2 infection, the large number of infected young people may represent a problem which requires health surveillance, due to the possibility of cognitive alterations and abnormalities in the development of cortical circuits that may represent a predisposition to mental problems later in life.

Which social, gestational and mental health aspects are associated to maternal-fetal attachment? / Quais aspectos sociais, gestacionais e de saúde mental materna estão associados ao apego materno-fetal?

Abstract Objectives: this study aimed to explore a set of factors associated with lower maternal-fetal attachment (MFA) in pregnant women. Methods: this is a cross-sectional study corresponding to the second wave of a cohort study with a population-based sample of pregnant women in the South of Brazil. The maternal-fetal attachment scale (MFAS) was used to measure MFA. Bivariate analysis was performed using the t-test and ANOVA. The variables that presented p<0.20 were taken for multivariate analysis, through linear regression, in order to control possible confounding factors. Results: a total of 840 pregnant women were included. Pregnant women who had lower MFA means were those who did not live with a partner (B=-3.8 [CI95%=-6.0; -1.7]), those between the first and second trimester of pregnancy (B=-4.3 [CI95%=-5.9; -2.6]), those who did not have support from their mother during pregnancy (B=-2.4 [CI95%=-4.6; -0.2]), and those with depressive symptoms (B=-4.9 [CI95%=-7.4; -2.5]). Conclusions: the results showed that a higher MFA it is associated with an adequate support network during pregnancy, better maternal mental health, and with an advanced pregnancy. Early evaluation of MFA and effort to promote an adequate prenatal bond, focusing on maternal psychological and emotional aspects are strongly suggested.

Resumo Objetivos: explorar um conjunto de fatores associados ao menor apego materno-fetal (AMF) em gestantes. Métodos: trata-se de um estudo transversal, correspondente à segunda fase de um estudo de coorte com uma amostra de base populacional de gestantes no sul do Brasil. Foi utilizada a Escala de Apego Materno-Fetal (EAMF) para medir o AMF. A análise bivariada foi realizada através do teste t e ANOVA. As variáveis que apresentaram p<0,20 foram levadas para análise multivariada, por meio de regressão linear, a fim de controlar possíveis fatores de confusão. Resultados: foram incluídas 840 gestantes. As gestantes que apresentaram menores médias de AMF foram aquelas que não moravam com um companheiro (B=-3,8 [IC95%=-6,0; -1,7]), que estavam entre o primeiro e o segundo trimestre de gestação (B=-4,3 [IC95%=-5,9; -2,6]), que não tiveram o apoio da mãe durante a gestação (B=-2,4 [IC95%=-4,6; -0,2]) e que apresentaram sintomas depressivos (B=-4,9 [IC95%=-7,4; -2,5]). Conclusões: os resultados mostraram que um maior AMF está associado a presença de uma rede de apoio adequada na gravidez, melhor saúde mental materna e a uma gestação avançada. A avaliação precoce do AMF e a promoção de um vínculo pré-natal adequado, com foco nos aspectos psicológicos e emocionais maternos são fortemente sugeridos.

Hemorragia materno-fetal posterior a amniocentesis y cordocentesis

Objetivo . Comparar la frecuencia y cantidad de hemorragia materno-fetal posterior a la amniocentesis y cordocentesis. Diseño . Estudio de casos y controles. Métodos . Gestantes con embarazos simples sin anomalías fetales sometidas a amniocentesis para determinación del cariotipo fetal (16 a 20 semanas de gestación) o cordocentesis (20 a 30 semanas de embarazo) en el periodo de enero de 2017 a mayo de 2022. Principales medidas de estudio. Características generales del procedimiento, resultados de la prueba de Kleihauer-Brown-Betke y concentraciones séricas de alfafetoproteína materna. Resultados . La muestra del estudio fue de 305 pacientes. La amniocentesis se realizó en 165 mujeres y la cordocentesis en 140 casos. La hemorragia materno-fetal de novo se observó en 8 pacientes (4,8%) después de la amniocentesis y en 41 pacientes (29,3%) después de la cordocentesis. Las concentraciones de alfafetoproteína sérica aumentaron en 24 casos (14,5%) después de la amniocentesis y en 55 casos (39,3%) después de la cordocentesis (p < 0,05). Luego de la cordocentesis se observó mayor volumen promedio de hemorragia maternofetal, elevación de valores individuales de volumen e incrementos significativos en la hemorragia materno-fetal severa (más de 5 mL de eritrocitos fetales) y de pérdida del volumen sanguíneo fetoplacentario total (p < 0,05). Conclusión . Estos resultados muestran que tanto la amniocentesis como la cordocentesis aumentan el riesgo de hemorragia materno-fetal. Sin embargo, la amniocentesis guiada por ecografía tiene menor riesgo de producir hemorragia y la isoinmunización Rh resultante, comparada con la cordocentesis.

Objective : To compare the frequency and amount of maternal-fetal hemorrhage following amniocentesis and cordocentesis. Design : Case-control study. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Pregnant women with singleton pregnancies without fetal anomalies undergoing amniocentesis for fetal karyotyping (16-20 weeks' gestation) or cordocentesis (20- 30 weeks' pregnancy) in the period January 2017-May 2022. Main study outcomes: General characteristics of the procedure, Kleihauer-Brown-Betke test results, and maternal serum alpha-fetoprotein concentrations. Results : The study sample was 305 patients. Amniocentesis was performed in 165 women and cordocentesis in 140 cases. De novo maternal-fetal hemorrhage was observed in 8 patients (4.8%) after amniocentesis and in 41 patients (29.3%) after cordocentesis, de novo maternalfetal hemorrhage was observed in 8 patients (4.8%). Serum alpha-fetoprotein concentrations increased in 24 cases (14.5%) after amniocentesis and in 55 cases (39.3%) after cordocentesis (p < 0.05). After cordocentesis, higher mean maternalfetal hemorrhage volume, elevation of individual volume values and significant increases in severe maternal-fetal hemorrhage (more than 5 mL of fetal erythrocytes) and total fetoplacental blood volume loss were observed (p < 0.05). Conclusion : These results show that both amniocentesis and cordocentesis increase the risk of maternal-fetal hemorrhage. However, ultrasound-guided amniocentesis has a lower risk of producing hemorrhage and resulting Rh isoimmunization compared to cordocentesis.

Apego materno-fetal e transtornos psiquiátricos em gestantes com fetos malformados / Maternal-fetal attachment and psychiatric disorders in pregnant women with malformed fetuses

OBJETIVO: Determinar a prevalência e os fatores associados aos sintomas de ansiedade e depressão e ao apego materno-fetal em gestantes com diagnóstico de malformações congênitas. MÉTODOS: Estudo prospectivo de corte transversal realizado durante o período de dezembro/2019 a março/2020. Foram incluídas 77 gestantes com diagnóstico de malformação fetal atendidas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) e excluídas aquelas < 18 anos e as que sabiam o diagnóstico da malformação há menos de três semanas. Aplicou-se um questionário com variáveis sociodemográficas e clínicas, além da Escala Hospitalar de Ansiedade e Depressão e da Escala de Apego Materno-Fetal. Para análise estatística, foi aplicado o modelo de regressão logística multivariado com nível de significância de 5%. RESULTADOS: Entre as gestantes, 46,8% possuíam sintomas ansiosos e 39%, depressivos, sendo o apego materno-fetal médio em 54,5% e alto em 45,5%. Antecedentes de ansiedade e depressão e não possuir religião foram associados a maior risco de sintomas de ansiedade e depressão, e saber da malformação há ≥ 10 semanas associou-se apenas ao risco de ansiedade e ter gestação múltipla associou-se apenas ao risco de depressão. O apego materno-fetal não foi associado a ansiedade ou depressão. CONCLUSÃO: Observou-se alta prevalência de sintomas ansiosos e depressivos em gestantes com fetos malformados, além da presença de apego materno-fetal médio/alto em todas pacientes, porém sem associação com os transtornos psiquiátricos estudados. Diante disso, urge a necessidade da criação de novas linhas de cuidado voltadas à saúde mental dessas mulheres.

OBJECTIVE: To determine the prevalence and factors associated with anxiety and depression symptoms and maternal-fetal attachment in pregnant women diagnosed with congenital malformations. METHODS: Prospective cross-sectional study conducted from December/2019 to March/2020. Seventy-seven managers with a diagnosis of fetal malformation attended at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and those under 18 years of age who did not know the diagnosis of malformation in less than 3 weeks were excluded. Applicable to a questionnaire with clinical and sociodemographic variables, in addition to the Hospital Anxiety and Depression Scale and Maternal- -Fetal Attachment Scale. For statistical analysis, the multivariate logistic regression model was applied with a 5% significance level. RESULTS: Among pregnant women, 46.8% had anxiety symptoms and 39% depressive symptoms, with average maternal-fetal attachment at 54.5% and high at 45.5%. History of anxiety and depression and cannot use religion have been associated with an increased risk of anxiety and depression, whereas malformation saber for ≥ 10 weeks, associated only with risk of anxiety and multiple pregnancy only in depression. Maternal-fetal attachment was not associated with anxiety or depression. CONCLUSION: If there is a high prevalence of anxious and depressive symptoms in pregnant women with malformed fetuses, in addition to the presence of medium maternal-fetal/high attachment in all patients, with no association with the studied psychiatric disorders. Therefore, request the creation of new lines of care aimed at the mental health of these women.

COVID-19: aspectos relacionados a la susceptibilidad genética y defectos congénitos / COVID-19: Aspects of genetic susceptibility and congenital defects

RESUMEN Introducción: la COVID-19 (acrónimo del inglés c oronavirus disease 2019) es una enfermedad infecciosa de reciente descripción, causada por el SARS-CoV-2, sin tratamiento efectivo. La identificación de variantes genéticas que intervienen en la respuesta a la COVID-19; así como la posibilidad de trasmisión materno-fetal del SARS-CoV-2 no solo permitirán ampliar los conocimientos sobre su fisiopatología; sino además estratificar los grupos de la población, y según su riesgo, implementar medidas preventivas y tratamientos personalizados, incluida la prioridad en el uso de vacunas. Objetivo: describir aspectos relacionados con la susceptibilidad genética y defectos congénitos en la COVID-19. Material y Métodos: se realizó una investigación tipo revisión bibliográfica; para identificar los documentos que se revisarían se consultó la base bibliográfica PubMed/Medline, incluyendo los trabajos del 2019 y 2020. Se incluyó publicaciones recomendadas por expertos, preferiblemente publicados en los últimos 10 años; luego de una valoración cualitativa, se realizó una síntesis. Desarrollo: están descritas mutaciones de los genes: ACE2, ACE1, TMPRSS2, TLR7, así como haplotipos HLA asociadas a la susceptibilidad genética a la COVID-19. Variantes de los genes: SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 y XCR1; así como de los que codifican para el receptor de la Vitamina D y las citoquinas pro inflamatorias (como las IL-1, IL-6, IL-12, IFN-γ, y TNT-α), pudieran también estar relacionadas con un incremento de la susceptibilidad al SARS-CoV-2. Ante la posibilidad de trasmisión vertical de la COVID-19 y su posible papel teratogénico, las embarazadas constituyen un grupo de riesgo. Conclusión: variantes genéticas humanas son factores de susceptibilidad genética al virus SARS-CoV-2, que puede ser causa de defectos congénitos(AU)

ABSTRACT Introduction: COVID-19 (acronym for Coronavirus Disease 2019) is a recently described infectious disease caused by SARS-CoV-2, without effective treatment. Identification of genetic variants involved in the response to COVID-19 as well as the possibility of maternal-fetal transmission of SARS-CoV-2 will not only allow us to expand our knowledge of the pathophysiology of COVID-19, but also stratify population groups according to their risks in order to implement preventive measures and personalized treatments, including the priority in the use of vaccines. Objective: To describe aspects related to congenital defects and genetic susceptibility to the SARS-CoV-2 virus. Material and Methods: A bibliographic review was carried out. Medline and PubMed bibliographic databases were searched. Studies published between 2019 and 2020 were included as well the ones recommended by experts, preferably published within the last 10 years. After qualitative evaluation, synthesis was made. Development: Mutations in ACE2, ACE1, TMPRSS2, TLR7 genes, as well as HLA haplotypes associated with genetic susceptibility to COVID-19 are described. Variants in the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1 and in those codifying vitamin D receptor and proinflammatory cytokines (IL-1, IL-6, IL-12, IFN-γ, and TNF-α) could be related to an increased susceptibility to SARS-CoV-2. Due to the risk of vertical transmission of COVID-19 and its possible teratogenic effect, pregnant women are included in the risk group. Conclusion: Human genetic variants are factors of genetic susceptibility to the SARS-CoV-2 virus which may cause congenital defects(AU)

Neonatal infection and passive acquisition of serum total IgG and reactive with Streptococcus B, anti-LPS of Klebsiella spp and Pseudomonas spp antibodies in twins

SUMMARY OBJECTIVE To describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella spp, and anti-lipopolysaccharide of Pseudomonas spp in the umbilical cord of newborn(NB) twins and to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood. METHODS A prospective cross-sectional study of a cohort of NB twins admitted during the period of 20 months. Patients with malformations and mothers with infection were excluded. Variables analyzed: gestational age(GA); birth weight(BW); antibody concentrations in umbilical cord blood; infection episodes. We used the paired Student t-test, Spearman correlation, and generalized estimation equation. RESULTS 57 pairs of twins were included, 4 excluded, making the sample of 110 newborns. GA=36±1.65weeks and BW=2304.8±460g(mean±SD). Antibody concentrations in twins(mean±SD): total IgG=835.71±190.73mg/dL, anti-StreptococcusB IgG=250.66±295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas spp IgG=280.04±498.66 AU/mL and anti-lipopolysaccharide of Klebsiella spp IgG=504.75±933.93 AU/mL. There was a positive correlation between maternal antibody levels and those observed in newborns(p <0.005). The transplacental transfer of maternal total IgG and anti-LPS Pseudomonas IgG antibodies was significantly lower at NB GA <34 weeks(p <0.05). Five newborns were diagnosed with an infection. Infants with infection had significantly lower total IgG concentration(p <0.05). CONCLUSION This study showed a positive correlation between maternal and newborn antibodies levels. In infants younger than 34 weeks there is less transfer of total IgG and anti-LPS Pseudomonas IgG. The highest incidence of infection in the newborn group who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother.

RESUMO OBJETIVOS Descrever o título de anticorpos IgG total e específico anti-Streptococcus B, anti-lipopolissacarídeos(LPS) de Klebsiella e Pseudomonas no cordão umbilical em gêmeos e analisar a possível associação entre os títulos desses anticorpos e a ocorrência de infecção. MÉTODOS Estudo prospectivo transversal de uma coorte de recém-nascidos (RN) gemelares em 20 meses. Excluídos: malformação, infecção congênita ou materna. Variáveis estudadas: idade gestacional(IG); peso de nascimento(PN); título de anticorpos e episódios de infecção. Foram utilizados testes t-Student pareado, correlação de Spearman e equações de estimação generalizadas. RESULTADOS Elegíveis 59 pares de gêmeos, excluídos 4 e incluídos 55 pares (n=110RN). A IG foi 36±1,65semanas e o PN foi 2304,8±460g (média±DP). Concentrações de anticorpos dos RN(média±DP): IgG total=835,71±190,73 mg/dL, IgG anti-Streptococcus B=295,1±250,66 UA/mL, IgG anti-LPS Pseudomonas=280,04±498,66 UA/mL e IgG anti-LPS Klebsiella=504,75± 933,93UA/mL. Houve correlação positiva entre níveis de anticorpos maternos e aqueles observados nos RN (p<0,005). A transferência transplacentária de anticorpos maternos IgG total e IgG anti-LPS Pseudomonas foi significativamente menor em RN IG < 34semanas (p<0,05). Foram diagnosticados 5 RN com infecção. Os RN que apresentaram infecção tinham concentração de IgG total significativamente menor (p<0,05). CONCLUSÕES Na população estudada existe correlação entre os anticorpos maternos e os níveis de anticorpos no RN. Nos gêmeos menores que 34 semanas há menor transferência de IgG total e IgG anti-LPS Pseudomonas. Nos RN com infecção a concentração de IgG total é significativamente menor, o que demonstra a maior vulnerabilidade e risco de infecção dessa população e a importância da imunidade passiva transferida pela placenta.

Desenlaces maternos y neonatales relacionados con edad materna avanzada / Maternal and neonatal outcomes in advanced maternal age

Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas de edad avanzada. MATERIALES Y MÉTODOS: Estudio de dos cohortes, prospectivo y retrospectivo efectuado con base en la información de expedientes clínicos de pacientes atendidas en el Complexo Hospitalario Universitario de Ourense entre 2017 y 2018. Se establecieron dos cohortes: la cohorte A con edad mayor o igual a 40 años y la cohorte B con edad menor de 40 años. Se realizaron pruebas paramétricas y no paramétricas para determinar la asociación potencial entre las variables de estudio (χ2, t de Student, U de Mann-Whitney). RESULTADOS: Las pacientes de la cohorte A (n = 207) tuvieron significación estadística: índice de masa corporal mayor al inicio del embarazo (p = 0.028), mayor cantidad de embarazos previos (p = 0.001), a expensas de mayor cantidad de abortos (p < 0.001), estados hipertensivos del embarazo (p = 0.03), prematurez (p = 0.009), retraso en el crecimiento intrauterino (p = 0.006), macrosomía fetal (p = 0.04), inducciones (p < 0.001), cesáreas programadas o intraparto y hemorragia posparto (p = 0.001). No se encontraron diferencias en la paridad, amenorrea al parto, diabetes pregestacional-gestacional, peso fetal medio, Apgar, pH de la arteria umbilical y cantidad de recién nacidos con requerimiento de ingreso a la unidad de Neonatología. CONCLUSIONES: La edad materna avanzada es un factor de riesgo importante de morbilidad materna y perinatal. La mayor tasa de complicaciones descritas refleja la importancia del control exhaustivo del embarazo y vigilancia periparto minuciosa.

Abstract OBJECTIVE: To describe the maternal and perinatal results in pregnant women with advanced age. MATERIALS AND METHODS: A cohort study was conducted with prospective follow-up and retrospective data collection of the Clinical History of the University Hospital Complex of Ourense between 2017 and 2018. Two cohorts were established, cohort A with age greater than and equal to 40 years and the cohort B with age under 40 years. Parametric and non-parametric tests were performed to determine the potential association between the study variables (Chi-Square, Student's T, Mann-Whitney U). RESULTS: The cohort A patients (n = 207) presented with statistical significance: body mass index higher at the beginning of pregnancy (p = 0.028), higher number of previous pregnancies (p = 0.001), but at the expense of a higher number of abortions (p <0.001), hypertensive states of pregnancy (p = 0.03), prematurity (p = 0.009), intrauterine growth retardation (p = 0.006), fetal macrosomia (p = 0.04), inductions (p < 0.001), of both scheduled and intrapartum caesarean sections and postpartum hemorrhage (p = 0.001). No differences were found in parity, amenorrhea at delivery, pregestational / gestational diabetes, mean fetal weight, Apgar score, umbilical artery pH and number of newborns who required admission to the Neonatal Unit. CONCLUSIONS: Advanced maternal age is an important risk factor for maternal and perinatal morbidity. The higher rate of complications described reflects the importance of thorough pregnancy control and careful peripartum surveillance.

Percepción del dolor durante el trabajo de parto. Una revisión de los factores involucrados / Pain perception during labor. A review of factors

The pain experimented by women during the labor is considered as one of the most important, significative and stressing events in the life of a woman. It is widely known than labour is the caused of severe pain. Our purpose is to review the aspects related to the experience of acute pain of patients in labor, related to the normal physiology in this process and to describe different variables that can modify it. From the evidence we conclude that perception of pain is subjective and variable, and it is influenced or modified for multiple factors, by past living experiences or transmitted through generations, by socio-cultural environment and individual expectative in front of this event, also by psychological, clinical, biochemical and genetic factors that predispose to experience a different perception of its severity. This information seems relevant to us for a better comprehension of pain during the labor and for developing strategies that would allowed a relief in a more effective way helping the maternal-fetal welfare and a better experience of maternity, especially during labor.

El dolor experimentado por mujeres durante el trabajo de parto es considerado uno de los eventos más importantes, significativos e intensos en la vida de una mujer. Es ampliamente conocido que el trabajo de parto es causa de un dolor severo. Nuestro propósito es revisar los aspectos relacionados a la experiencia del dolor agudo en las pacientes en trabajo de parto, en cuanto a la fisiología normal de este proceso y describir diferentes variables que pueden modificarlo. Desde la revisión bibliográfica concluimos que la percepción del dolor es subjetiva y variable, y está influenciada o modificada por múltiples factores, por las experiencias pasadas vividas o transmitidas entre generaciones, por el entorno sociocultural y las expectativas individuales ante este evento, también por factores psicológicos, clínicos, bioquímicos y genéticos que predisponen a experimentar una percepción diferente en cuanto a su severidad y significado. Esta información nos parece relevante para una mejor compresión del dolor en el parto y para desarrollar estrategias que permitan su alivio de manera más efectiva, contribuyendo al bienestar materno-fetal y a una mejor experiencia de la maternidad, especialmente durante el trabajo de parto.

Maternal, fetal and neonatal heart rate and heart rate variability in Holstein cattle / Frequência cardíaca e variabilidade da frequência cardíaca materna, fetal e neonatal em bovinos da raça Holstein

The aim of this study was to describe the normal values for maternal, fetal and neonatal heart rate (HR) and heart rate variability (HRV) indexes in the time domain (standard deviation of beat-to-beat interval - SDNN; root mean square of successive beat-to-beat differences - RMSSD) and the frequency domain (low frequency - LF; high frequency - HF; relationship between low and high frequency - LF/HF) in 23 Holstein cows, 23 fetuses and 18 neonates during the perinatal period. HR and HRV were calculated by fetomaternal electrocardiography (ECG). Fetomaternal measurements were taken six times prepartum (between days 234 and 279 of pregnancy) and measurements were taken in neonates six times after calving (after birth and five times weekly). HR, time and frequency domain were analyzed. No significant changes in maternal, fetal beat-to-beat interval (RR interval) or HR were found. In maternal variables, SDNN decreased significantly from 38.08±2.6ms (day 14 before calving) to 23.7±2.5ms (day 1 after calving) (p<0.05), but the RMSSD did not change significantly. HR and RR interval of calf differed statistically from the day before delivery (163±7.5bpm; 381±24.2ms) to the day after calving (131±5bpm; 472±16.2ms). Time variables (SDNN and RMSSD) and the frequency-domain variables (LF and HF) were significantly different (p<0.05) between fetal and neonatal stages. Reductions in the values of SDNN and RMSSD can reflect a sympathetic dominance. After calving, the increase in HF and decrease in LF variables can indicate activation of the vagal nerve followed by heart and respiratory modulation.(AU)

O objetivo deste estudo foi descrever os valores normais para os índices de frequência cardíaca (FC) materna, fetal e neonatal e de variabilidade da frequência cardíaca (VFC) no domínio do tempo (desvio padrão do intervalo batimento a batimento, SDNN; raiz quadrada média de sucessivas diferenças de batimento a batimento, RMSSD) e do domínio da frequência (baixa frequência, LF; alta frequência, HF; relação entre baixa e alta frequência, LF/HF) em 23 vacas Holandesas, 23 fetos e 18 neonatos durante o período perinatal. A FC e a VFC foram calculadas por eletrocardiografia materno-fetal. As medidas materno-fetais foram realizadas seis vezes antes do parto (entre os dias 234 e 279 de gestação) as medidas neonatais foram realizadas seis vezes após o parto (um dia após nascimento e semanalmente, durante cinco semanas). FC, e variáveis no domínio do tempo e de frequência foram analisadas. Não foram encontradas alterações significativas na FC e no intervalo de batimento para batimento (intervalo RR) materno e fetal. Nas variáveis maternas, o SDNN diminuiu significativamente de 38,08±2,6ms (dia 14 antes do parto) para 23,7±2,5ms (dia 1 após o parto) (p<0,05), mas o RMSSD não alterou significativamente. A FC e o intervalo e RR do bezerro diferiram estatisticamente a partir de um dia antes do parto (163±7,5bpm, 381±24,2ms) até o dia seguinte ao parto (131±5bpm, 472±16,2ms). As variáveis de tempo (SDNN e RMSSD) e as variáveis de domínio de frequência (LF e HF) foram significativamente diferentes (p<0,05) entre os momentos fetal e neonatal. As reduções nos valores de SDNN e RMSSD podem refletir domínio simpático. Após o parto, o aumento da HF e a diminuição das variáveis LF podem indicar a ativação do nervo vagal seguido de modulação cardíaca e respiratória.(AU)

Primary lower segment caesarean section in multipara: materno-fetal outcomes

Background: All-natural birth has a purpose and a plan; who would think of tearing open the chrysalis as the butterfly is emerging? Who would break the shell to pull the chick out?” ~ Marie Mongon. It is of particular interest, in light of increased incidence of abdominal delivery throughout the country and in the world, to judge the validity of this procedure when used for the first time in the multipara.Methods: All the cases of Primary caesarean delivery in multipara over a period of 18 months were studied with regards to the indication, associated risks factors, and perinatal morbidity and mortality. The primary objective of the study was to find out the status of primary Lower Segment Caesarean Section (LSCS) in multipara in tertiary care center.Results: The overall incidence of LSCS was 30.7%. The incidence of Primary LSCS in multipara was 23.4%. The most common indication of LSCS was Foetal Distress i.e. 40.8%. Almost all caesarean sections were done in Emergency (99.2%). 12.3% of patients underwent PPH intra-operatively with 0.7% patient requiring Obstetric hysterectomy. Majority of the neonates were admitted in NICU for Respiratory Distress (30%). Major cause of Post-operative morbidity was wound gape seen in 10.8% patients.Conclusions: The fact that a multipara has had one or more vaginal deliveries should be regarded as an optimistic historical fact, not as diagnostic criteria for spontaneous delivery of the pregnancy at hand. Hence a multiparous woman in labour requires the same attention as that of primigravida and may still require a caesarean section for safe delivery. Good antenatal and intrapartum care and early referral will help reduce the maternal and perinatal morbidity.

Hypertriglyceridemia and adverse outcomes during pregnancy / Hipertrigliceridemia y consecuencias adversas en el embarazo

Abstract Introduction: During pregnancy, levels of maternal serum triglycerides increase as a physiological adaptation mechanism to meet the needs of the developing fetus. However, although an excessive increase has been associated with preeclampsia, macrosomia and preterm delivery, the levels from which measurements should be taken in each trimester to prevent complications have not been established conclusively. Objective: To review the physiopathology, effects on mother and child, expected values in each trimester and therapeutic interventions in maternal hypertriglyceridemia. Materials and methods: A review was made based on a search of articles in the ScienceDirect, Pubmed, Scopus, LILACS, Cochrane and SciELO databases, with the terms: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications in English and its equivalents in Spanish. Results: 59 articles met the search criteria and responded to the objectives. Conclusions: The limited amount and the great variability of the data indicate the need to carry out further research to establish the normal triglycerides ranges during the three trimesters of pregnancy and to determine risks and effective interventions before pregnancy in order to reduce maternal and child morbidity and mortality.

Resumen Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones. Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional. Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español. Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos. Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.

Morbilidad, mortalidad y repercusiones perinatales en pacientes con hipertensión arterial pulmonar / Morbimortality and perinatal result in patients with pulmonary arterial hypertension

Resumen Objetivo: Determinar la morbilidad, mortalidad y las repercusiones perinatales de pacientes con hipertensión arterial pulmonar atendidas en la unidad de cuidados intensivos de un centro médico de tercer nivel. Materiales y métodos: Estudio observacional, retrospectivo, transversal y descriptivo que incluyó a pacientes embarazadas con hipertensión arterial pulmonar atendidas en la unidad de cuidados intensivos entre los años 2013 a 2016. Se revisaron los expedientes clínicos para conocer sus datos generales, la morbilidad y mortalidad y las repercusiones perinatales. Para el análisis estadístico se utilizó estadística descriptiva (media, mediana, desviación estándar, rango) con el programa SPSS 17. Resultados: Se estudiaron 12 pacientes de 27.2 ± 7.2 años, con antecedente de dos partos, 35.5 ± 6.4 semanas de embarazo; tiempo trascurrido desde el ingreso al hospital hasta la finalización del embarazo 3.8 ± 0.7 días, con estancia en la unidad de cuidados intensivos de 1.7 ± 1.2 días. El embarazo se interrumpió, por deterioro agudo de la clase funcional materna, en 5 de 12 casos, concluyeron en cesárea 10 de 12 casos. Se aplicó anestesia con bloqueo peridural a 10 de 12 y fallecieron 2 de 12 pacientes. Se obtuvieron 12 recién nacidos y un aborto de 14 semanas. De éstos 6 de 12 requirieron cuidados críticos y 1 falleció. La media de hipertensión arterial pulmonar fue 60.5 ± 18.0 mmHg, y se diagnosticó síndrome de Eisenmenger en 7 de 12, con predominio de persistencia del conducto arterioso en 4 de 12. Se utilizó sildenafilo en 2 de 12, fármacos cardiovasculares en 3 de 12 y ventilación mecánica en 3 de 12. Conclusiones: Si bien la morbilidad fue elevada no así la mortalidad materno-fetal, quizá como consecuencia del tratamiento en la unidad de cuidados intensivos.

Abstract Objective: To determine morbimortality and perinatal result in pregnant patients with pulmonary arterial hypertension attended in an Intensive Care Unit of a third-level medical center. Materials and method: Observational, retrospective, cross -sectional and descriptive study including 12 pregnant patients with pulmonary arterial hypertension treated in Intensive Care Unit from 2013- 2016. Morbidity, mortality and perinatal outcome were studied using a review of medical records. For statistical analysis, descriptive statistics (mean, median, standard deviation, range) with SPSS 17 program were used. Results: We studied 12 patients of 27.2 ± 7.2 years, with a history of two births, gestational age of 35.5 ± 6.4 weeks; time elapsed from admission to hospital to delivery care 3.8 ± 0.7 days with a stay in the intensive care unit of 1.7 ± 1.2 days. Pregnancy was interrupted, due to acute deterioration of maternal functional class, in 5/12 cases, 10/12 cases were completed in caesarean section. Anesthesia with epidural block was applied to 10/12 and 2/12 patients died. Twelve newborns with prematurity were obtained; of these, 6/12 required critical care and 1 died. The mean pulmonary arterial hypertension was 60.5 ± 18.0 mmHg, and Eisenmenger's syndrome was diagnosed in 7/12, with predominance of patent ductus arteriosus in 4/12. Sildenafil was used in 2/12, cardiovascular drugs in 3/12 and mechanical ventilation in 3/12. Conclusion: Morbidity was high but not maternal-fetal mortality, probably due to the effect of treatment in Intensive Care Unit.

Ultrastructure of bovine placenta during all gestational period / Ultraestrutura de placenta bovina durante todo o período gestacional

Placentas from pregnant cows with different gestation periods were used. Placental fragments of all groups were processed and evaluated by transmission electron microscopy. After fragment analysis, bovine placenta was observed to be epitheliochorial type in early pregnancy, becoming progressively sinepiteliocorial at the beginning of the second trimester. There are no ultrastructural evidences of inflammation in the region of caruncles throughout gestation, despite the invasion of caruncle proper lamina by trophoblast cells. However, throughout pregnancy and especially at the end, there were evident signs of cell degeneration in both trophoblast and the uterine epithelium. The active trophoblast cells intensely phagocytize cellular debris. There are complex interdigitations between the surface of the trophoblast and the uterine epithelium, which is related to the increase of the exchange surface between mother and fetus. At the end of pregnancy, interdigitations disappear, favoring the detachment and expulsion of the placenta after birth.(AU)

Foram utilizadas placentas de vacas abatidas em frigorífico com diversos tempos gestacionais. Fragmentos de placentomo de todos os grupos foram processados e avaliados em microscopia eletrônica de transmissão. Após análise dos fragmentos, observou-se que a placenta bovina é do tipo epiteliocorial no início da gestação, tornando-se sinepiteliocorial progressivamente a partir do início do segundo mês de gestação. Não existem evidências ultraestruturais de inflamação na região das carúnculas durante toda a gestação, apesar da invasão da lâmina própria caruncular por células trofoblásticas. No entanto, durante toda a gestação e em especial ao seu final, foram observados sinais evidentes de degeneração celular, tanto do trofoblasto como do epitélio uterino. As células trofoblásticas ativas fagocitam intensamente os debris celulares originados dessas degenerações. Existem complexas interdigitações entre a superfície do trofoblasto e do epitélio uterino, o que estaria relacionado com o aumento da superfície de troca entre mãe e feto. Ao final da gestação, praticamente desaparecem essas interdigitações, favorecendo o descolamento e a expulsão da placenta após o parto.(AU)

Listas de chequeo: crisis en Obstetricia / Checklists: obstetric crisis

Introducción: Las crisis en la atención de la paciente obstétrica son eventos pocos frecuentes, pero de presentarse requieren de un manejo rápido y adecuado. Actualmente hay evidencia que las listas de chequeo pueden contribuir a un mejor desenlace. Objetivo: Confeccionar una herramienta adaptada a la realidad del Uruguay que nos sirva de ayuda cognitiva frente a una situación de crisis en la población obstétrica. Métodos: El grupo de trabajo decidió cuáles era las listas de chequeo que iban a conformar el manual. Para las confección de las mismas se tuvo en cuenta las realizadas por Ariadne Labs. En cada uno de los temas se valoró la bibliografía actualizada y la evidencia de la misma. Resultados: Se realizaron 11 listas de chequeo de crisis en obstetricia, las cuales se adaptaron a los tratamientos y fármacos disponibles en nuestro país. Las mismas pueden ser descargadas en forma gratuita. Discusión y conclusiones: Luego de analizar la literatura disponible que apoya el uso de las listas de chequeo y concluye que su uso permite un mejor desenlace frente a una crisis. Dicha herramienta es una más junto con las ya existentes que puede ser de gran ayuda en una situación de crisis, pero que por sí sola no cambia el desenlace. Se presentó un manual de emergencias obstétricas con contenido claro, actualizado y adaptado a nuestro país.

Introduction: Crisis in patients in obstetrical care are unlikely events. If they occur, it is required to deal with them promptly and skillfully. Nowadays, there is evidence that checklists can help to achieve a better outcome. Objective: To create a tool suitable for the Uruguayan circumstances. This tool will provide cognitive aid in situations of crisis in the obstetric population. Methods: The work group decided on the checklists to be included in the handbook. Checklists made by Ariadne Labs were taken into consideration. Throughout all stages of this work, updated bibliography and scientific evidence were considered. Results: Eleven checklists were made on patients with obstetric crisis. These were created given the treatments and drugs available in Uruguay, moreover, they can be downloaded free of charge. Discussion and conclusions: After careful study of the available papers that supports the use of checklists, they conclude that the use of these, provide a better outcome when dealing with a crisis. In addition, there are many existing tools extremely beneficial in this situation. However, the use of checklist in isolation is not enough to guarantee a positive result. A handbook of obstetric emergency was presented featuring a clear and updated content, which is suitable to this country reality.

Immunophenotyping of leukocytes in bovine placenta / Imunofenotipagem de leucócitos na placenta bovina

Lymphocytes and macrophages are the main white cells involved in fetal-maternal tolerance. Little is known about these leukocytes in bovine placenta, such as the quantity and location of these cells. Thus, the objective of this study was to identify lymphocyte and macrophage populations in bovine placenta using specific markers and flow cytometry. This study analyzed samples of placentomes and intercaruncular regions of cows in the three quarters of pregnancy. In the placentomes, during the first quarter of pregnancy, mean percentage of labeled CD3+ cells was 2.34%; CD8+, 1.28%; CD14+, 1.66%; and CD335+, 0.96%. For the intercaruncular region, percentage of CD3+ cells was 0.71%; CD8+, 1.63%; CD14+, 2.81%; and CD335+, 2.81%. In the second quarter, placentomes showed 0.94% CD3+ cells; 0.77% CD8+; 0.72% CD14+; and 0.51% CD335+. In the intercaruncular region, percentage of labeled CD3+ cells was 0.50%; CD8+, 1.81%; CD14+, 2.64%; and CD335+, 0.51%. In the third quarter, placentomes showed labeling of 0.88% CD3+; 0.66% CD8+; 1.06% CD14+; and 0.74% CD335+ cells. In the intercaruncular region, percentage of labeled CD3+ cells was 0.19%; CD8+, 2.23%; CD14+, 2.43%; and CD335+, 0.16%. The results showed that there was a greater immunomarking of leukocytes CD3+ and CD335+ in the placentome when compared to the intercaruncular region during the third trimester. It can be concluded that leukocytes populations in bovine placenta is reduced, probably because of the syndesmochorial characteristic of bovine placenta. This represents a significant barrier for the immunological system of the mother, sharply decreasing the exposure of the conceptus to the mother's immune system.(AU)

Linfócitos e macrófagos são os principais leucócitos envolvidos na tolerância materno-fetal. Pouco se sabe sobre esses leucócitos na placenta bovina, como por exemplo, a quantidade e localização dessas células. Assim, o objetivo desse estudo foi identificar populações de linfócitos e macrófagos na placenta bovina utilizando marcadores específicos e citometria de fluxo. Este estudo analisou amostras de placentônios da região intercaruncular de bovinos nos três trimestres da gestação. No primeiro trimestre, nos placentônios, a porcentagem média de células CD3+ foi 2,34%; CD8+, 1,28%; CD14+, 1,66%; e CD335+, 0,96%. Na região intercaruncular, a porcentagem de células CD3+ foi 0,71%; CD8+, 1,63%; CD14+, 2,81%; e CD335+, 2,81%. No segundo trimestre, os placentônios apresentaram 0,94% de células CD3+; 0,77% de CD8+; 0,72% de CD14+e 0,51% de CD335+. Na região intercaruncular, a porcentagem de células CD3+ foi 0,50%; CD8+, 1,81%; CD14+, 2,64%; e CD335+, 0,51%. No terceiro trimestre, os placentônios apresentaram 0,88% de células marcadas CD3+; 0,66% de CD8+; 1,06% de CD14+ e 0,74% de CD335+. Na região intercaruncular, a porcentagem de células CD3+ foi 0,19%; CD8+, 2,23%; CD14+, 2,43% e CD335+, 0,16%. Os resultados mostraram que a imunomarcação de leucócitos na região do placentônio foi maior do que na região intercaruncular no terceiro trimestre. Concluiu-se que a população de leucócitos CD3+ e CD335+ na placenta bovina está reduzida, provavelmente devido à sua característica sindesmocorial. Essa característica representa uma barreira significante para o sistema imunológico da mãe, o que diminui drasticamente a exposição do concepto ao sistema de defesa da mãe.(AU)

Infección por virus del Zika en el embarazo, impacto fetal y neonatal / Zika virus infection in pregnancy, fetal and neonatal impact

Zika virus (ZV) is an arbovirus transmitted by Aedes aegypti and A. albopictus. The neurotropic profile of this virus is known since 1952. The main finding related to ZV in America is microcephaly. Two hypotheses are tested on its involvement in the central nervous system: its neurotropic feature and the direct effect of ZV on the placenta. Malformations and clinical findings on fetal development comprise congenital Zika syndrome. RT-PCR and serology (IgM) are useful for definitive diagnosis. However, we should keep in mind first that the viremia in pregnant women can stay for a longer period of time, and second, a positive IgM for Zika should be properly interpreted in an endemic area to other flavivirus. It is suggested to be part of TORCHS-Z complex the ZV infection in endemic areas.

El virus del Zika (VZ), arbovirus, es transmitido por Aedes aegypti y A. albopictus. Desde 1952 se conoce su perfil neurotrópico. El principal hallazgo relacionado con la infección en las Américas, es la microcefalia. Dos hipótesis se plantean sobre su afectación en el sistema nervioso central: su característica neurotrópica per se, y el efecto directo del virus sobre la placenta. Las malformaciones y hallazgos clínicos sobre el desarrollo fetal conforman el síndrome de Zika congénito. La reacción de polimerasa en cadena-transcriptasa reversa (RPC-TR) y serología (IgM) son útiles para el diagnóstico definitivo; sin embargo, debe tenerse en cuenta, primero, que la viremia en las mujeres embarazadas puede permanecer por un período más prolongado y segundo, que una IgM positiva para Zika, debe ser adecuadamente interpretada en un medio endémico para otros flavivirus. Se propone a la infección por el VZ, en zonas endémicas, como parte del complejo TORCHS-Z.

¿Siente dolor el feto?

Objetivo: Analizar una variedad de estudios publicados sobre el dolor fetal. Desde hace más de un siglo, investigadores clínicos y básicos han estudiado la posibilidad de que el feto sienta dolor. Este tema ha aumentado en relevancia debido al uso creciente de técnicas invasivas para diagnóstico y tratamiento fetal, y además por ser sustrato social de confrontación entre partidarios y adversarios del aborto. La pregunta fundamental es si el sistema nociceptivo del feto adquiere un desarrollo neurobiológico suficiente como para generar la experiencia mental que llamamos dolor. En el presente artículo, comenzamos con las etapas del desarrollo del sistema nociceptivo humano. Luego abordamos los aspectos éticos. Seguidamente discutimos si las manifestaciones conductuales, hormonales, hemodinámicas y electroencefalográficas del feto son evidencia de que ya tiene una mente y es capaz de sentir dolor. Conclusiones: No parece probable que el feto sienta dolor antes de la semana 20 de gestación; quizás pueda comenzar a sentir dolor entre las semanas 22 y 26. Sea cual sea la respuesta definitiva a la pregunta fundamental planteada más arriba, ante abordajes invasivos del feto, es recomendable usar analgesia o anestesia.

Objective: To analyze a variety of published studies on fetal pain. For a long time now, clinical and basic researchers have dealt with the question of whether the fetus is able to feel pain. The relevance of this subject has augmented in view of the increasing use of invasive techniques for fetal diagnosis and treatment, and also because of social strife between advocates and adversaries of abortion. The fundamental question here is whether the fetal nociceptive system has reached sufficient development for generating the mental experience that we call pain. We start with the developmental stages of the human nociceptive system. Then we approach the ethics of the problem. We further discuss whether the behavioral, hormonal, hemodynamic and electroencephalographic manifestations of a fetus are evidence for a mind capable of feeling pain. Conclusions: It seems unlikely that a fetus feels pain before week 20 of gestation; the fetus might be able to start feeling pain at weeks 22-26. We finally conclude that, whatever the answer to the fundamental question posed above, upon invasive approaches to the fetus the use of analgesia or anesthesia is recommended.

Imunofenotipagem dos linfócitos positivos para indoleamina 2, 3 dioxigenase (IDO) em cultura de células de placenta bovina / Phenotyping of the indoleamine 2, 3 dioxygenase (IDO) positive lymphocytes in bovine placental cell culture

A gestação é um estado fisiológico que exige adaptações imunológicas para que transcorra normalmente. Nesse período a mãe e o feto apresentam uma relação imunológica, ou seja, a interface materno fetal. A enzima indoleamina 2,3 dioxigenase (IDO) desempenha um papel importante na tolerância materno fetal, por ser responsável pela metabolização do triptofano, impedindo por diversas vias a proliferação principalmente de linfócitos TCD8. Diversos tipos celulares estão presentes na interface materno fetal e vários deles podem expressar a IDO. Os leucócitos com perfil Th1 produzem uma citocina conhecida: o interferon γ que estimula a expressão da IDO em vários tipos celulares. Os linfócitos são divididos em subpopulações de acordo com sua função e fenótipo. Seus tipos incluem linfócitos T, linfócitos B e as células natural killer (NK). Hormônios também atuam nesse processo a progesterona que exerce função determinante sobre a resposta imunológica materna podendo alterar o prognóstico gestacional e o estrógeno essencial para a tolerância materno fetal e manutenção da prenhez. Dessa maneira este trabalho tem por objetivo principal identificar os linfócitos presentes na placenta bovina em cultivo que expressam IDO (linfócitos T, linfócitos B e células NK), frente a estimulação por progesterona, estrógeno e interferon γ nas diversas fases gestacionais utilizando a citometria de fluxo. Segundo os resultados no período de 67,5 a 77, 5 dias com a adição de interferon γ a expressão da enzima IDO aumentou discretamente nos linfócitos TCD3, TCD4, e diferente dos linfócitos T CD8 apresentaram uma elevada expressão da enzima (4,48 ± 2,12 - 8,65± 4,91)....

Pregnancy is a physiological state that requires immune adaptation in order to be successfully carried on. During this period, mother and fetus establish an immune tolerance status at the maternal fetal interface. Indoleamine 2,3-dioxygenase (IDO) plays an important role in maternal-fetal tolerance by metabolizing tryptophan, impairs by several pathways, mainly T CD8 cells proliferation. Several cell types are present in the maternal fetal interface and several of them can express IDO. Leucocytes with Th1 produce a cytokine known as interferon γ that stimulates the expression of IDO in several cell types. Lymphocytes are divided into sub-populations according to their function and phenotype: T lymphocytes, B lymphocytes and natural killer cells (NK). Hormones also involved in this process where progesterone exerts decisive role on maternal immune response that may change gestational outcome and estrogen is essential for fetal maternal tolerance and maintenance of pregnancy. Therefore, the main objective of this study was to identify lymphocytes in the bovine placental cell culture that are sensitive to progesterone, estrogen and interferon γ, IDO expression in various gestational stages using flow cytometry. According to the results in the gestational period from 67.5 to 77.5 days with the addition of interferon γ expression IDO was slightly increased in TCD3 lymphocytes, CD4, and differently from the other T cells CD8 displayed an higher expression of the enzyme (4.48±2.12 to 8.65±4.91)...

Comportamiento de las células asesinas naturales, las dendríticas y los macrófagos, en el embarazo / Behavior of the natural killer cells, dendritic cells and macrophages in pregnancy

La implantación de un embrión semialogénico en el útero materno constituye una paradoja inmunológica y es uno de los fenómenos que abre más interrogantes dentro del campo de la Inmunología. Mientras que en un determinado momento se consideró que la interfase materno-fetal era un sitio inmunológicamente privilegiado, hoy se sabe que ocurre un reconocimiento del feto semialogénico por el sistema inmune de la madre. Sin embargo, a pesar de este reconocimiento inmunológico se han descubierto varios mecanismos que pueden explicar el porqué la madre no rechaza al feto antigénicamente diferente. Estos mecanismos incluyen, tanto factores fetales como factores locales maternos, donde están incluidos los elementos de la respuesta inmunitaria adaptativa e innata. En este trabajo se hace referencia a la importante función que desempeñan las células asesinas naturales, las células dendríticas y los macrófagos en el embarazo(AU)

The implantation of a semiallogenic embryo in the womb is an immunological paradox and is one of the phenomena that open more questions in the field of immunology. While at one point it was considered that the maternal-fetal interface was an immunologically privileged site, now it is known that a fetus semiallogenic recognition by the immune system of the mother occurs. However, despite this immune recognition several mechanisms have been discovered that may explain why the mother does not reject the fetus antigenically different. These mechanisms include both fetal factors and local maternal factors, where the elements of innate and adaptive immune response are included. In this paper we refer to the important role of natural killer cells, dendritic cells and macrophages in pregnancy(AU)

Diseño e implementación de una unidad de medicina materno fetal / Design and implementation of a unit of maternal fetal medicine

Uno de los grandes desafíos de la obstetricia actual, es transitar desde una maternidad tradicional a una maternidad diseñada e implementada como una unidad de gestión clínica. Si bien la determinación del riesgo de las pacientes obstétricas se mantiene en el tiempo, adaptándose a los nuevos conocimientos y la capacidad de intervención, la estructura y funcionamiento de las maternidades está cambiando, desarrollándose la medicina materno fetal y la medicina fetal, para abordar patologías obstétricas y materno fetales, o patologías fetales o feto placentarias primarias o patologías médicas que puedan complicar la gestación y en forma indirecta al feto. De ahí la importancia de utilizar una metodología que permita transformar nuestras maternidad en unidades de gestión clínica, que puedan responder efectiva, eficaz y eficiente a la problemática actual en el campo obstétrico. En gestión clínica aplicada, se han utilizado distintos modelos para realizar esta transformación. Uno de ellos, el modelo AMPHOS, nos ha parecido conveniente para el diseño e implementación de unidades de medicina materno-fetal. El modelo AMPHOS cuenta con 7 módulos, los 2 primeros de resorte de la dirección de los establecimientos, en especial de la mejoría de sus procesos. Los módulos siguientes se refieren al desarrollo de las unidades de medicina materno-fetal, mientras que el módulo 7 y final representa la vinculación de la institución con su respectiva unidad de medicina materno-fetal, que a través de dirección por objetivos y la firma de compromisos de gestión, pudiera operacionalizar los acuerdos para lograr su desarrollo.

One of the great challenges of the present obstetrics, is turn from a traditional maternity hospital to a maternity designed and implemented as a clinical management unit. While determining the risk of obstetric patients is maintained over time, adapting to new knowledge and intervention capacity, the structure and operation of maternity wards is changing, developing maternal-fetal medicine and fetal medicine, to address obstetrical and maternal-fetal pathologies or fetal pathologies or primary fetal placental pathologies or medical conditions that may complicate gestation and the fetus in a indirect way. Hence the importance of using a methodology to transform our maternity in management clinical units that can respond effectively, efficiently and effectively to the current problems in the obstetrical field. In applied clinical management, different models have been used to perform this transformation. One of them, the AMPHOS model, it seemed suitable for design and implementation on maternal fetal medicine units. The AMPHOS model has 7 modules, the first 2 spring the direction of the establishments, especially improving their processes. The following modules refer to the development of maternal fetal medicine units, while module 7 and final, represents the binding of the institution with their respective medical maternal-fetal unit, that through management by objectives and management firm commitments, could operationalize the agreements to achieve its development.