Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Caracterización de adolescentes gestantes escolarizadas en instituciones educativas públicas de Bucaramanga, Colombia / Characterization of pregnant adolescents attending public educational institutions in Bucaramanga, Colombia / Caracterização de adolescentes gestantes escolarizadas em instituições educacionais públicas de Bucaramanga, Colômbia

Resumen Introducción El embarazo adolescente ha demostrado un comportamiento descendente en los últimos años en Colombia. Sin embargo, las cifras actuales evidencian que prevalece como una problemática de salud pública. Materiales y Métodos Se desarrolló un diseño descriptivo transversal que permitió caracterizar 48 adolescentes gestantes que estudiaban en el año 2014 y primer semestre de 2015 en 22 instituciones educativas públicas de Bucaramanga. Para la recolección de información se utilizó un instrumento adaptado del instrumento de salud del adolescente propuesto por el Centro de Estudios Económicos de la Universidad de los Andes. Se realizó validez del instrumento mediante evaluación de expertos. Se aplicó además Genograma, Ecomapa y APGAR familiar. Resultados Los casos de embarazo adolescente se presentaron con mayor frecuencia en instituciones educativas ubicadas en la zona norte de la ciudad de Bucaramanga especialmente en la comuna 1. La mayoría de las adolescentes recibieron información sobre sistemas reproductivos y relaciones sexuales a una edad promedio de 12 años por parte de sus madres y docentes. Un 70,4% de las participantes considera que falta información sobre educación sexual en los colegios. Un 23% de las gestantes adolescentes refiere agresión física y 12,5% violación. Se encontró un fuerte apoyo social de la gestante adolescente dado por las familias así como debilidad en las redes de apoyo comunitarias. Discusión La mayoría de las características personales, del contexto, y de las familias coinciden con los reportes de la literatura. Conclusiones El embarazo adolescente es una problemática vigente en las instituciones educativas públicas de Bucaramanga y requiere acciones concretas para su prevención y abordaje integral.

Abstract Introduction Adolescent pregnancy rates have decreased over the last years in Colombia. However, current statistics reveal that it keeps being a health public issue. Materials and Methods A descriptive cross-sectional study was conducted to characterize 48 pregnant adolescents studying in 2014 and the first semester of 2015 in 22 public educational institutions in Bucaramanga. An instrument adapted from the adolescent health instrument, which was proposed by the Center for Economic Studies at the Universidad de los Andes, was used to collect information. The instrument was validated through expert assessment. Genogram, eco-map and family Apgar score were also applied. Results Adolescent pregnancy cases were more frequent in educational institutions located in the northern part of Bucaramanga, especially in district 1. Most of the adolescents received information on reproduction systems and sexual relations at an average age of 12 from their mothers and teachers. 70.4% of the participants consider that there is a lack of information on sex education in schools. 23% of the pregnant adolescents reported physical aggression and 12.5% rape. There was strong social support to pregnant adolescents given by their families, as opposed to weaknesses found in the community support networks. Discussion Most personal, contextual and family characteristics coincide with literature reports. Conclusions Adolescent pregnancy is a current issue in public educational institutions in Bucaramanga that requires concrete actions for its prevention and comprehensive approach.

Resumo Introdução A gravidez adolescente já demonstrou um comportamento descendentes nos últimos anos na Colômbia. No entanto, as cifras atuais evidenciam sua prevalência como um problema de saúde pública. Materiais e Métodos Foi desenvolvido um estudo descritivo transversal que permitiu caracterizar 48 adolescentes gestantes que estudavam no ano 2014 e primeiro semestre de 2015 em 22 instituições educacionais públicas de Bucaramanga. Para a compilação da informação, foi utilizado um instrumento adaptado do instrumento de saúde do adolescente proposto pelo Centro de Estudos Econômicos da Universidade de los Andes. O instrumento foi validado mediante a avaliação de peritos. Além disso, foi aplicado um Genograma, um Ecomapa e um APGAR familiar. Resultados Os casos de gravidez adolescente se verificaram com maior frequência em instituições educacionais situadas na zona norte da cidade de Bucaramanga especialmente na comuna 1. A maioria das adolescentes receberam informação sobre sistemas reprodutivos e relações sexuais a uma idade média de 12 anos por parte de suas mães e docentes. Um 70,4% das participantes considera que falta informação sobre educação sexual nos colégios. Um 23% das gestantes adolescentes relata agressão física e 12,5% estupro. Verificou-se um forte apoio social da gestante adolescente dado pelas famílias bem como a fraqueza nas redes de apoio comunitárias. Discussão A maioria das características pessoais, do contexto, e das famílias coincidem com as informações da literatura. Conclusões A gravidez adolescente é uma problemática vigorante nas instituições educacionais públicas de Bucaramanga e precisa de ações concretas para sua prevenção e abordagem integral.

Pancreatoduodenectomía durante el embarazo por adenocarcinoma de ampolla de Vater y posterior resección de recurrencia ganglionar con buen resultado a corto y largo plazo / Pancreatoduodenectomy for ampullary adenocarcinoma and and re-intervention for ganglinonar recurrency

Mujer de 30 años con 13 semanas de su segunda gestación que se presentó con síntomas de anemia severa, hemorragia digestiva alta, dolor epigástrico y baja de peso. Mediante endoscopía alta se diagnosticó un adenocarcinoma bien diferenciado de ampolla de Vater. Se le practicó pancreato-duodenectomía a las 16 semanas de su embarazo sin complicaciones. Durante el seguimiento se identificó recurrencia ganglionar loco-regional 4 meses después por lo que se le realizó parto por cesárea a las 34 semanas con neonato saludable de 2500 gr. Se decidió reintervención para resección de enfermedad ganglionar la cual se realizó con éxito. Lleva 36 meses de seguimiento sin evidencia de recidiva de la enfermedad. Su hija ha tenido un desarrollo normal.

A 30 years old woman in the 13 week of her second pregnancy who had severe anemia, upper gastrointestinal bleeding and weight loss. She was given the endoscopic diagnosis of a well differentiated ampullary adenocarcinoma. She underwent a pancreato duodenectomy during the 16 week of pregnancy without complications. After 4 months of follow up we identified a ganglionar local recurrence so that´s why she underwent a cesarean in the 34 week of pregnancy. The product was a healthy 2500 gr. newborn. We decided a reoperation for the resection of the recurrence and it was carried out successfully. Currently the patient has 36 months of follow up without evidence of recurrence and her baby has a normal grow up.

Trastornos de la conducta alimentaria, embarazo y puerperio / Disorders of eating behavior, pregnancy and puerperium

Introducción: la mayoría de la evidencia muestra consecuencias negativas prenatales y posnatales para la madre y el producto en embarazadas y puérperas con trastornos de la conducta alimentaria. Objetivo: describir la evidencia acerca de las complicaciones físicas y psicológicas en el embarazo y puerperio en mujeres con trastornos de la conducta alimentaria. Metodología: se realizó una búsqueda bibliográfica de la evidencia sobre el embarazo y puerperio en mujeres con trastornos de la conducta alimentaria mediante las bases de datos Medline/PubMed. Resultados: el porcentaje de sintomatología compatible con trastornos de la conducta alimentaria en una muestra no clínica de mujeres embarazadas alcanza 23,4% y en ellas la historia previa o presente de trastornos de la conducta alimentaria (12%) surge como un significativo factor de riesgo (Odds ratio=14,7586) para la mantención de trastornos de la conducta alimentaria. Existen varias complicaciones físicas y psicopatológicas tanto maternas como fetales en mujeres con trastornos de la conducta alimentaria. Las pacientes anoréxicas muestran temores a la maternidad y preocupaciones sobre el peso corporal y la silueta y están muy expuestas a las recaídas posparto. Las pacientes bulímicas frecuentemente mejoran sus síntomas durante la gestación. Las mujeres sintomáticas previamente, empeoran sus trastornos de la conducta alimentaria en el embarazo. Conclusión: la cifra alcanzada para conductas anormales de alimentación supera ampliamente a la planteada para anorexia nerviosa y bulimia nerviosa, los que además reflejan tendencia a la cronicidad aún en el embarazo. Se requieren estudios adicionales que orienten apropiadamente a los profesionales de salud en la prevención, detección precoz y tratamiento de los trastornos de la conducta alimentaria en el embarazo y puerperio...

Introduction: most evidence shows negative pre and post natal consequences for the mother and the product in pregnant and puerperal women with eating disorders. Objective: to describe the evidence about physical and psychological complications in pregnant and puerperal women suffering from eating disorders. Method: Medline/Pubmed data bases were used to look for evidence on eating disorders in pregnant and puerperal women. Results: the percentage of symptomatology of eating disorders in a non clinical sample of pregnant women reaches 23.4% and a previous or present history (12%) of eating disorders in them emerges as a significant risk factor (Odds ratio=14.7586) for the maintenance of the eating disorders. There are several physical and psychopathological complications, both, maternal and fetal in women suffering from eating disorders. Anorectic patients show maternity fears and concerning about body weight and shape and they are very exposed to postpartum relapses. Bulimic patients frequently improve their symptoms during pregnancy. Previously symptomatic women worsen their symptoms during pregnancy. Conclusion: the percentage of pregnant women who displayed abnormal eating behaviors exceeds the rate described in literature for anorexia nervosa and bulimia nervosa. Besides, it reflects a tendency to be a chronic disease even in pregnancy. Additional studies are required to help health personnel to prevent, early detect and treat women with eating disorders in pregnancy and postpartum...

Clinical analysis of placental abruption in 180 cases complicating uteroplacental apoplexy in 58 cases / 中国综合临床

Objective To investigate the risk factors and outcomes of uteroplacental apoplexy complicating severe placental abruption in order to enhance the accuracy of early diagnosis and decrease the complication of mother and fetus.Methods A retrospective study of clinical data was conducted in 180 cases of placental abruption complicating uteroplacental apoplexy in 58 cases who delivered in the First Central Hospital of Tianjin from January 2007 to December 2011.Risk factors,clinical characteristics and outcomes were compared between the 58 cases complicating uteroplacental apoplexy (experimental group) and the other 122 cases without complicating uteroplacental apoplexy (control group).Results The incidence of placental abruption was 1.3％ (180/14 333),with the rate of uteroplacental apoplexy complicating placental abruption was 0.4％ (58/14 333) of all deliveries and 32.2％ (58/180) of all abruption cases.The duration of disease was significantly longer and the rate of placenta implanted on the posterior wall of uterus was significantly higher in the experimental group (9.14 ± 8.47) h; 63.9％ (23/36)) than in control group (5.88 ±4.31) h; 43.4％ (36/83)) (t =3.426,x2 =6.461 ; P ＜ 0.05).There were significant differences between the experimental group (12.1％,12.1％,13.8％ and 60.3 ％) and the control group (2.5 ％,2.5 ％,0.8％ and 11.5 ％) in postpartum hemorrhage,DIC,acute renal failure and stillbirth (x2 =6.919,6.919,13.929 and 47.388 respectively,P ＜ 0.05 or P ＜ 0.01).Conclusion Long duration of disease and posterior-wall placenta are risk factors for uteroplacental apoplexy complicating placental abruption which may lead to a poor maternal-fetal prognosis.

Surgical management of acute type A aortic dissection associated with pregnancy / 中华胸心血管外科杂志

Objective Acute type A aortic dissection associated pregnancy severely threatens the lives of both the mother and her ferus.We retrospectively reviewed our clinical experience with this life-threatening condition in six cases.Methods Between January 2007 and February 2012,6 women with acute type A aotic dissection associated pregnancy were treated by our group,with an average of 3 1 years (range 24 -37 weeks)and a mean gestation weeks of 24.5 (range,12 -38 weeks ).The etiology was Marfan syndrome in 4 cases and gestational hypertension in 2.The pathology was the modified Stanford type A3S in I case,A2C in 2 and A3C in 3.- Five patients were treated surgically and 1 medically.Surgical operations were performed under hypothermic cardiopulmonary bypass or deep hypothermic circulatory arrest,including Bentall procedure in 1case,Bentall + Sun's procedure in 2,ascending aortic replacement + Sun's procedure in 2.Results The woman treated medically and her fetus died from aortic rupture 9 days after admission.The cardiopulmonary bypass and cross clamp time and circulatory arrest time averaged 167 rninites(range,75 -210 minites) and 98 minites(range,83 - 145 minites) and 23.5minites(range,19 -27 minutes),respectively.Five patients treaed surgically survived the operation.Three fetuses survived rand two fetuses died.After a mean follow-up of 2.2 years (range,1 - 3.5 years ),5 patients were doing well.CT angiogram detected nonmal aortic and valvular structures,with no signs of distal dilation.Three babies were normal in development and neurocognitive functios.Conclusion Palients with aortic dissection associated with pregnancy should be operated on ugently and medical treatment carries high risks of aortic rupture and maternal and fetal death.Methods of surgical repair,peffusion techniques and delivery should be chosen based on the underlying aortic pathology and gestational age,so as to maximize the safety of the mother and her baby.

Educación de la sexualidad en función de prevenir el embarazo en las adolescentes / Sexual education as a function of pregnancy prevention in adolescents

Se realizó un estudio descriptivo y transversal de las adolescentes del Policlínico Universitario "Luis Augusto Turcios Lima", del municipio Pinar del Río que concurrieron a la consulta de regulación menstrual durante el período enero-junio del año 2011, con el objetivo de caracterizar la educación de la sexualidad en función de prevenir el embarazo. Se les aplicó una encuesta a los adolescentes con previo consentimiento de sus padres. El universo lo constituyeron 345 adolescentes, y se tomó una muestra probabilística simple de 200 que asistieron a este servicio. Los datos fueron procesados y analizados con medidas de frecuencias (porcientos) y se le aplicó la prueba de hipótesis. Los principales resultados fueron: las adolescentes con edades entre 14 a 16 años (66,7%) fueron las que con mayor frecuencia utilizaron el servicio, los amigos (39,5%) y los medios de difusión (30,5 %) son las vías principales por las cuales recibieron la información sobre el tema. Refieren que iniciaron las relaciones sexuales por las exigencias del otro miembro de la pareja y la presión de los amigos del grupo; el 55,5 % refleja no tener una percepción adecuada sobre los riesgos que representa el aborto y las causas principales: estar estudiando y no esperaba embarazarse y ser un método anticonceptivo con pocos riesgos y no tener información o ser escasa de cómo prevenir el embarazo. Existen dificultades en la educación de la sexualidad en función de prevenir el embarazo en las adolescentes.

A descriptive and cross-sectional study including female adolescents that attended to menstrual extraction (ME) service from January to July 2011 at "Luis Augusto Turcios Lima" University Polyclinic in Pinar del Rio municipality was conducted with the purpose of characterizing sexual education with respect to pregnancy prevention. A survey having a previous informed consent of their parents was applied. The target group was comprised of 345 female adolescents and a simple probabilistic sample of 200 adolescents attending to this service. Data were processed and analyzed using frequency measures (percentages) applying also a hypothesis tests. The main results were: female adolescents between 14-16 years old (66, 7%) showed the highest incidence using the service. Friends (39, 5%) and mass media (30, 5%) were the main ways to find information concerning the topic. With regard to the commencement of sexual relations they referred the demands of the couple or because of friends' pressure, and 55,5% reflected an inappropriate perception in relation to abortion risks. The principal causes that stimulate the use of this service were: the studies, a non-expected pregnancy, a contraceptive less-risky method, luck of information about pregnancy prevention as well, finding difficulties in sexual education concerning pregnancy prevention in female adolescents.

Estado nutricional y seguridad alimentaria en gestantes adolescentes: Pereira, Colombia, 2009 / Nutritional status and food safety in teenage pregnant women: Pereira, Colombia, 2009 / Estado nutricional e segurança alimentaria em gestantes adolescentes: Pereira, Colombia, 2009

Objetivo. Valorar estado nutricional y percepción de seguridad alimentaria, de gestantes adolescentes consultantes en Instituciones de la ESE Salud Pereira durante el año 2009. Metodología. Estudio descriptivo de corte transversal. Con un 95% de nivel de confianza, se seleccionó una muestra de 150 gestantes, entre las asistentes al control prenatal durante los meses abril a junio de2009. Se capacitaron cuatro encuestadores enfermeros profesionales. Se aplicó la encuesta y la Escala Latinoamericana y Caribeña de Seguridad Alimentaria. Se realizó valoración nutricional a partir de los registros en la historia clínica de biomarcadores e indicadores antropométricos y obstétricos. Se realizó análisis univariado y bivariado. Resultados. El 95% de las gestantes adolescentes eran de estratos I y II, el 59% con escolaridad secundaria incompleta, el 79% primigrávidas. El 21% tenía bajo peso pregestacional y el 45% bajo peso durante la gestación. El 15%mostró anemia. El 33% reportó infección urinaria. El 8.7% tenía riesgo de HIE. El 63.3% de las gestantes percibía algún grado de inseguridad alimentaria, que era severa en el 22.7% de los hogares. Conclusión. Se encontró una alta proporción de bajo peso pregestacional no compensado oportunamente. Debido al impacto de la seguridad alimentaria sobre la nutrición en el embarazo, su monitoreo debe ser incluido como una de las actividades básicas en la atención prenatal.

Objective. To assess the nutritional status and food safety perception of teenage pregnant women consulting in institutions from the ESE Salud Pereira during the year of 2009. Methodology. Descriptive transversal cut study. With a 95% confidence interaRT val, a sample of 150 pregnant women from the prenatal control assistants between April and June of 2009 were chosen. Four professional nurses were trained as interviewers. A survey and the Latin-American and Caribbean food security scale were applied. Nutritional assessment was performed from the biomarkers, anthropometric and obstetric indicators registered in the clinical history. A single variable and bivariate analysis was made. Results. 95% of the teenage pregnant women had socioeconomic status I and II, 59% hadn’t completed secondary education, 79% were primigravid, 21% had low weight before pregnancy and 45% low weight during pregnancy. 15% showed anemia. 33% reported urinary tract infection. 8.7% had PIH. 63.3% of the pregnant women perceived any degree of food insecurity which was severe in 22.7% of the homes. Conclusion. A high low weight before pregnancy ratio no opportunely compensated was found. Due to the food security impact over nutrition in pregnancy it’s monitoring should be included as one of the basic activities in the prenatal attention.

Objetivo. Valorizar estado nutricional e percepção de segurança alimentaria, de gestantes adolescentes consultados em Instituições da ESSE Saúde Pereira durante o ano 2009. Metodologia. Estudo descritivo de corte transversal. Com um 95% de nível de confiança, selecionou-se uma mostra de 150 gestantes, entre asassistentes ao controle pré-natal durante os meses abril a junho de 2009. Capacitaram-se quatro pesquisadores enfermeiros profissionais. Aplicou-se a enquete e a Escala Latino-americana e Caribenha de Segurança Alimentaria. Realizou-se valoração nutricional a partir dos registros na história clínica de bio-marcadores eindicadores antropométricos e obstétricos. Realizou-se análises uni-variado e bi-variado. Resultados. O 95% das gestantes adolescentes eram de estratos I e II, o 59% com escolaridade secundária incompleta, o 79% primi-grávidas. O 21% tinha sob peso progestacional e o 45% sob peso durante a gestação. O 15% mostrou anemia. O 33% reportou infecção urinária. O 8.7% tinha risco de HIE. O 63.3% das gestantes percebia algum grau de insegurança alimentaria, que era severa em 22.7% dos lares. Conclusõe. Encontrou-se uma alta proporção de baixo peso progestacional não compensado oportunamente. Devido ao impacto da segurança alimentaria sobre a nutrição na gravidez, sua monitoração deve ser incluído como uma das atividades básicas no atendimento pré-natal.

Protective effects and its mechanism of lipoxins on human umbilical vein endothelial cells under hypoxia / 中华妇产科杂志

Objective To investigate protective effects and mechanisms of lipoxinA4(LXA4)on human umbilical vein endothelial cells(HUVEC)under hypoxia in vitro.Methods The HUVEC culture were divided into groups as followed:added M199 cudture medium as normal contml groups,added CoCl2 to mimic hypoxia in vitro as hypoxia group and added different concentrations of LXA4(1,10,100 nmol/L)were added to the induced hypoxiai HUVEC as agents intervention group.Morphological changes of HUVEC were observed by using inverted phase contrast mieroscope.The influence of LXA4 on cell survival was investigated by methyl thiazolyl tetrazolium(MTT) assaying method after the treatment with different concentrations of LXA4 and 100 nmol/L lipoxinA4 according to different time(4,8,12 and 24 hours).The expression of von-willebrand factor (vWF) was detected by immunocytoehemistry method. The changes of cytosolic Ca2+ were measured by laser scanning confocal microscope. Results ( 1 ) Morphological changes:the cells under hypoxia lost its normal shapes and showed necrosis, while the cells cocuhured with 100 nmol/L LXA4 were normal appropriately. (2)Survival rate: the survival rates of HUVEC under hypoxia was (40. 1±3.9) % and increased to ( 52. 9 ± 1.4) %, (64. 1 ± 3. 3 ) %, ( 76. 6 ± 1.6) % respectively when added with LXA4 with concentration of 1,10, 100 nmol/L into culture medium. There was significant different survival rate when compared with that of hypoxia group. (3) The level of vWF: The expression of vWF was decreased with the increasing concentrations of LXA4 added into culture medium, the gray values were 203.9 ±0. 7 in 1 nmol/L,204.6 ±0. 9 in 10 nmoL/L,191.8 ±0. 5 in 100 nmol/L respectively, which reached statistical difference in comparison with that of hypoxia groups (P<0. 05). (4) Confocai analysis:the intracellular free Ca2+ concentrations of HUVEC were intensified with LXA4 treatment. Conclusions LXA4 plays an important role in keeping the normal shape of HUVEC under hypoxia, can enhance survival of hypoxial HUVEC and decrease the level of vWF in cytoplasm. The protective mechanism might be via decreasing mitochondria Ca2+ overload and increasing cytoplasm Ca3+ by nucleus Ca2+ transference.

Resistência à insulina durante a gestação e lactação de ratas wistar: influências sobre o metabolismo da glicose e da insulina na prole adulta / Insulin resistance during pregnancy and lactation in wistar rats: influence on glucose and insulin metabolism in the adult offspring

Diversos estudos observaram uma correlação entre doenças na idade adulta e o ambiente durante a vida fetal. O estudo realizado por Barker e colaboradores foi um dos primeiros a relatar a hipótese de um possível envolvimento do ambiente intra-uterino com o desenvolvimento de doenças cardiovasculares, mas os mecanismos responsáveis por esta associação ainda não são totalmente conhecidos. Estudos demonstraram uma associação entre baixo peso ao nascimento com resistência à insulina e intolerância à glicose na vida adulta. Recentemente, verificamos que o consumo de dieta hipossódica, conhecido modelo de resistência à insulina, durante a gestação e lactação está vinculado a menor sensibilidade à insulina na prole adulta. Visto que a presença de resistência à insulina durante a gestação leva a diversas alterações metabólicas na prole adulta, pode-se supor que a sobrecarga de sacarose, um modelo de resistência à insulina, durante a gestação e lactação influencie no desenvolvimento da prole. Assim, o objetivo do presente estudo foi verificar a repercussão da resistência à insulina, durante a gestação sobre a prole adulta. Para tanto, ratas Wistar foram alimentadas com dieta hipo (HO) ou normossódica (NR) suplementadas ou não com sacarose (NR+SAC - 20g/dL) ou maltodextrina (NR+MALTO - 20g/dL) desde a oitava semana de vida até o final da gestação e amamentação. Na prole resultante destes animais foi observado menor peso ao nascimento nos grupos HO, NR+SAC e NR+MALTO. Esta alteração resultou no desenvolvimento de maior insulinemia, pressão arterial e maior captação de glicose na prole de fêmeas das mães do grupo NR+SAC. Os machos apresentaram menor índice de adiposidade e maior expressão gênica renal dos componentes do sistema renina-angiotensina. Tais resultados nos permitem concluir que a sobrecarga de carboidratos durante a gestação e lactação está associada a alterações no peso ao nascimento e no metabolismo da insulina na idade adulta...

Many studies observed a correlation between diseases in adult subjects and the environment during the fetal life. Barker and coworkers hypothesized that there is a possible intrauterine enviroment association with cardiovascular diseases in adulthood. The mechanisms responsible for this association are still not very well known. Recently, we have verified that low-salt diet consumption, a well-known model of insulin resistance, during pregnancy and lactation is associated with a lower insulin sensitivity in the adult offspring. Since insulin resistance during pregnancy leads to many metabolic alterations in the adult offspring, we suppose that sucrose overload during pregnancy and lactation could influence the offspring development. The aim of this study was to verify the effects on adult offspring of insulin resistance during pregnancy and lactation. Female Wistar rats were fed low (LSD) and normal-salt diet (NSD) supplemented or not with sucrose (SUC - 20 g/dL) or maltodextrin (MALTO - 20 g/dL) until the end of pregnancy and lactation. Lower birth weight was observed in offspring of LSD, SUC and MALTO groups. Higher plasma insulin level, blood pressure and glucose uptake was detected in the adult SUC female offspring. SUC male offspring had lower adiposity index and higher gene expression of the renal renin-angiotensin components. These results show that carbohydrate overload during pregnancy and lactation is associated with alterations in birth weight and in insulin metabolism at adult life. It is possible that the maternal renin-angiotensin system activation by the carbohydrate overload is associated with alterations in the same system observed in the adult offspring.

A Clinical Study of Serous Retinal Detachment in Pregnancy-induced Hypertension

PURPOSE: This study was designed to determine the clinical progression of serous retinal detachment(RD) due to hypertensive choroidopathy in toxemia of pregnancy. METHODS: We diagnosed 437 preeclampsia and eclampsia patients in 9, 689 consecutive deliveries at the Chunchon Sacred Heart Hospital from January 1996 to December 2000, and found 35 cases of serous RD among them. We retrospectively studied the incidence, clinical characteristics of the patients, location, and shape of retinal pigment epithelium (RPE) lesions. RESULTS: Among the 9, 689 pregnant women, there were 429 cases (4.4%) of preeclampsia and 8 (0.08%) of eclampsia. Serous RD occurred in 32 cases of preeclampsia (7.5%), and 3 of eclampsia (38%). In the preeclampsia cases, there were 26 cases (81%) of severe type, and 6 (19%) of mild type. The mean age of serous RD patients was 29.53yrs. Twenty-two cases (63%) in the 35 cases of serous RD were primipara patients, and 13 (37%) were multipara. Twenty-two cases (63%) in 35 the serous RD patients featured binocular involvement. Reattachment of retina was attained in all cases of serous RD, with a mean recovery interval of 18 days. CONCLUSIONS: Serous retinal detachment induced by toxemia of pregnancy can occur in mild preeclampsia patients. Reattachment of retina was attained in all serous RD cases. These study results will provide assurance for the treatment of serous retinal detachment patients.

Fetal development and gestational weeks for triplets pregnancies and the comparison with singletons / 中华妇产科杂志

Objective To study the fetal developmental regulation and gestational weeks at labor for triplets pregnancies Methods To detect biparietal diameters and femoral length at different gestational weeks, record gestational weeks of labor and birth weights, and compare with those of singletons Results The fetal development of triplets slowed down from the beginning of the 28th gestational week compared with that of singletons (the mean difference was 2 1mm and 3 1 mm respectively, P

Effect of heparin on the ratio of peak systolic to least diastolic flow velocity of umbilical artery at second-trimester pregnancies / 中华妇产科杂志

ObjectiveTo evaluate the efficiency of heparin on the ratio of peak systolic to least diastolic flow velocity (S/D) of umbilical artery flow velocity waveforms at second-trimester pregnancies. MethodsSixty-seven pregnant women carrying 72 fetuses (5 twins) whose fetal umbilical artery flow S/D ratios were more than the 95~th percentage were divided into study and control groups. In study group, 35 women carrying 38 fetuses were treated with heparin at a dose of 6250 U or 12 500 U + 5% glucose 500 ml intravenously per day for a mean of (3.7?2.1)days, ranging from 1 to 10 days. In control group,another 32 women with 34 fetuses were treated regularly with dextran-40 500 ml and 10% glucose 500 ml + rooted salvia 30 ml; and 10% glucose 500 ml + 654-II 20 mg for a mean of (6.8 ?2.8) days, ranging from 3 to 14 days. After treatment the S/D ratios were re-examined, and compared between two groups. ResultsThe mean of decreased S/D ratios per day in heparin group and control group was 0.37(t=3.620, P

Measurement of Colloid Osmotic Pressure in Pregnancy Induced Hypertensive Patients / 대한마취과학회지

BACKGROUND: Pregnancy induced hypertension (PIH) is a common cause of maternal morbidity and death in late pregnancy. Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. However, the mechanisms that account for pulmonary edema have not been clarified. Mobilization of peripheral edema, excess fluid intake, myocardial dysfunction, and reduced plasma protein concentration are factors that have been postulated as contributing to the development of pulmonary edema in this syndrome. Colloid osmotic pressure is a principal regulator of capillary fluid exchange. METHODS: In a study of 50 normotensive and severe PIH patients who underwent cesarean section, peripartum plasma colloid osmotic pressure, serum albumin, and total serum protein were compared. RESULTS: Both groups exhibited significantly lower plasma colloid osmotic pressure in the postpartum period than that measured antepartum (p<0.05). The mean antepartum plasma colloid osmotic pressure in severe PIH patients was significantly lower than in normotensive subjects (p<0.05). CONCLUSIONS: We believe that serial COP measurments may be helpful to guide optimal fluid management in severe PIH patients.

Study on Pregnancy Outcomes after Transabdominal Cervico-Isthmic Cerclage before Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the effect of transabdominal cervicoisthmic cerclage before pregnancy among the patients who had poor obstetric outcome from previous failed transvaginal cervical cerclage and/or an anatomically defective cervix. STUDY DESIGN: A retrospective review of pre-conceptional transabdominal cervicoisthmic cerclage patients was conducted at Hanyang University Medical Center from 1989 to 1997, and analysis of the pregnancy outcomes after preconceptional transabdominal cervicoisthmic cerclage operation. RESULTS: The fifteen patients had 11 successful pregnancy outcomes. Two patients had two consecutive succesful pregnancies and repeat cesarean section deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage before pregnancy offers a high rate of fetal salvage with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.

Study on Pregnancy Outcomes after Transabdominal Cervico-Isthmic Cerclage during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Transabdominal cervico-isthmic cerclage(TCIC) may increase the fetal salvage rate and pregnancy outcome in selected women when poor obstetric outcome is related to previously failed transvaginal cervical cerclage and an anatomically defective cervix. Our purpose was to evaluate the outcomes after transabdominal cervicoisthmic cerclage during pregnancy. STUDY DESIGN: A retrospective review was done from patients who had been received transabdominal cervicoisthmic cerclage during pregnancy at Hanyang University Medical Center from October, 1989 to April 1997. The fetal salvage rate before and after post-conceptional transabdominal cervicoisthmic cerclage were compared and analysed. RESULTS: The seventy-eight patients had 95 successful pregnancies out of a total of 97. Thus the fetal salvage rate of TCIC during in pregnancy was 97.9 %. Of 78 patients, nineteen patients had the second succesful pregnancies and repeat cesarean deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage during pregnancy offers a high fetal salvage rate with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.

The management of the acute pancreatitis during middle or late stage of pregnancy / 中国普通外科杂志

Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.

Clinical charateristics of pregnancy-induced hypertensive mothers and their neonates

No abstract available.