Invasión microbiana de la cavidad amniótica en la rotura de membranas de pretérmino: Resultados maternoneonatales y patología placentaria según microorganismo aislado / Outcome of microbial invasion of amniotic cavity in the preterm premature rupture of membranes

Background: Microbial invasion of amniotic cavity occurs in 30 to 50percent of patients with premature membrane rupture. Aim: To determine the outcomes associated with microbial invasion of the amniotic cavity (MIAC) in patients with preterm premature rupture of membrane (pPROM). Patients and methods: One hundred thirty four patients with preterm pPROM between 24 and 34 weeks of pregnancy, without clinical infection or labor, were studied. Cultures were obtained by transabdominal amniocentesis from the amniotic fluid and the lower genital tract. Four groups of MIAC were observed: MIAC1: due to S. agalactiae, F. nucleatum or H. influenzae as only etiologic agents, MIAC2: due to other bacteria, alone or mixed, MIAC3: due to U. urealyticum as only etiologic agent, MIAC0: No MIAC and no infection of the lower genital tract. Study patients received antibiotics and were managed expectantly until 35 weeks unless clinical chorioamnionitis developed or an amniotic fluid culture returned positive for S. agalactiae, F. nucleatum or H. influenzae. Results: Ninety six patients were enrolled: MIAC1 (n=11), MIAC2 (n=30), MIAC3 (n=19) and MIAC0 (n=36). Clinical chorioamnionitis was more common in patients with MIAC1 than those with MIAC3 (p<0.01) and those without infection (p<0.001). The admission to delivery interval was shorter in patients with MIAC1 (2.8 days) than those with MIAC3 (10.1 days, p<0.05) and those without infection (18 days, p<0.001). Delivery within 48 h and within 7 days of admission were also more frequent in patients with MIAC1 than in patients with MIAC3 (p<0.05) or those without infection (p<0.001). Newborns to mothers with MIAC1 had a higher frequency of infection (36percent), asphyxia (36percent), admission to neonatal ICU (100percent) and death (46prcent) than those of mothers with MIAC3 and those without infection. Birth weight was also significantly lower. Histological chorioamnionitis was more common in patients with MIAC1 than in patients with MIAC3 and those without infection. The rate of funisitis was higher in patients with MIAC1 than those without infection. Conclusions: In patients with preterm PROM, microbial invasion of the amniotic cavity by S. agalactiae, F. nucleatum or H. influenzae is associated with high frecuency of adverse maternal and neonatal outcomes and neonatal death.

Eficacia de la dexametasona en sindrome hellp

Después de la administración de dexametasona (vía EV en dosis de 10 mg. cada 12 horas) a una paciente de 26 semanas de gestación, hipertensa crónica con preeclampsia sobreagregada y síndrome Hellp, se aprecia estabilización y disminución de enzimas hepáticas (principalmente SGOT/AST), LDH y aumento de recuento de plaquetas, no observándose variaciones en los niveles de ácido úrico, creatinuria, proteinuria y calciuria.

Operación de Pereyra modificada con suspensión al ligamento de Cooper / Pereyra's modificated surgery with suspension of Cooper's ligament

Evaluación de una técnica quirúrgica para la corrección de prolapso genital e incontinencia de orina de esfuerzo, en 56 pacientes operadas con la técnica de Pereyra modificada con la suspensión al ligamento de Cooper, desde Octubre de 1996 a Septiembre de 1997. Se estudian 12 pacientes con seguimiento postoperatorio durante 9 meses, comprobándose que es una operación relativamente sencilla, con pocas complicaciones imputables al procedimiento y resultados satisfactorios de curación clínica de la incontinencia de orina de esfuerzo durante el período observado