Factores de riesgo predisponentes al desarrollo de preeclampsia y eclampsia en el embarazo / Risk factors for the development of preeclampsia and eclampsia in pregnancy

Resumen La preeclampsia es una patología de origen desconocido, de alta incidencia en la salud materna y neonatal. Caracterizada como una hipertensión gestacional grave multisistémica a partir de las 20 semanas de gestación hasta el parto y posparto, siendo de los trastornos más prevalentes en el mundo y la principal causa de muerte materna en Ecuador durante 2022. El objetivo fue realizar una revisión bibliográfica respecto de los factores de riesgo que predisponen preeclampsia en embarazadas. Mediante una revisión bibliográfica de estudios correspondientes a factores predisponentes al desarrollo de preeclampsia y eclampsia en embarazadas cuyos resultados se enfocaron a pacientes adultas diagnosticadas con dichas patologías mediante estrategia PICO, aplicando criterios de inclusión y exclusión. La preeclampsia conlleva una diversidad de factores de riesgo familiares patológicos como preeclampsia previa, hipertensión o enfermedades renales, diabéticas y obesidad; otros factores incluyen: edad, raza, embarazos gemelares, multiparidad, progenitores de distinta índole. Los factores significativos para presentar la enfermedad fueron en su mayoría factores ginecoobstétricos donde destacaron multiparidad, edad, obesidad, malnutrición, hipertensión previa y factores hereditarios.

Abstract Preeclampsia is a condition of unknown origin, with a high incidence in maternal and neonatal health, characterized as a severe multisystemic gestational hypertension from the 20th week of gestation until childbirth and postpartum. Among the most prevalent disorders worldwide, in Ecuador was the main cause of maternal death during 2022. The objective was to conduct a literature review regarding risk factors that predispose pregnant women to preeclampsia. Through a literature review of studies corresponding to predisposing factors for the development of preeclampsia and eclampsia in pregnant women, whose results were focused on adult patients diagnosed with said pathologies through the PICO strategy, applying inclusion and exclusion criteria. Preeclampsia involves a variety of pathological familial risk factors such as prior preeclampsia, hypertension, renal diseases, diabetes, and obesity; other factors include age, race, twin pregnancies, multiparity, and diverse parental lineage. The significant factors for presenting the disease were mostly gynecobstetric factors, prominently multiparity, age, obesity, malnutrition, prior hypertension, and hereditary factors.

Tendencia de cesáreas en entidades privadas de la provincia de Buenos Aires, Argentina (2017-2021) / Cesarean section trends in private entities in the province of Buenos Aires, Argentina (2017-2021)

Resumen OBJETIVO: Evaluar las tasas de cesárea en la finalización de embarazos registrados en el sector privado de la Obra Social de la provincia de Buenos Aires (Instituto de Obra Médico Asistencial) entre los años 2017 a 2021. MATERIALES Y MÉTODOS: Estudio analítico y descriptivo de cesáreas registradas en el Sistema de Modulación Centro Único de Auditoría y Fiscalización IOMA (CUAFI) de las 13 regiones sanitarias de la provincia de Buenos Aires. Se describen los porcentajes de cesárea por año y por región sanitaria. RESULTADOS: Se registraron 75,244 partos únicos. En el año 2017 el porcentaje de cesáreas se incrementó de 69.0% (12,600 cesáreas de 18,258 partos) a 73.6% (8,232 cesáreas de 11,180 partos) en 2021. Los mayores porcentajes de cesárea se registraron en la Región IV (83.6%), la Región XIV (81.7%) y Región X (78.9%). CONCLUSIÓN: El alto porcentaje de cesáreas registrado y el incremento en los últimos años muestra la necesidad de diseñar intervenciones para reducir su tasa. Será importante contar con información de sus indicaciones y explorar intervenciones destinadas al personal de salud y a las mujeres para reducir su práctica.

Abstract OBJECTIVE: To evaluate the rates of caesarean section in the termination of pregnancies registered in the private sector of the Obra Social of the province of Buenos Aires (Instituto de Obra Médico Asistencial) between 2017 and 2021. MATERIALS AND METHODS: Analytical and descriptive study of caesarean sections registered in the Modulation System of the IOMA Single Audit and Control Centre (CUAFI) of the 13 health regions of the province of Buenos Aires. The percentages of caesarean sections per year and per health region are described. RESULTS: 75,244 singleton deliveries were registered in the private sector of the Instituto de Obra Médico Asistencial. In 2017, the percentage of caesarean sections increased from 69.0% (12,600 caesarean sections out of 18,258 deliveries) to 73.6% (8,232 caesarean sections out of 11,180 deliveries) in 2021. The highest caesarean section rates were recorded in Region IV (83.6%), Region XIV (81.7%) and Region X (78.9%). CONCLUSION: The high percentage of caesarean sections recorded and the increase in recent years shows the need to design interventions to decrease the rate. It is important to have information on the indications for caesarean section and to explore interventions aimed at health personnel and women to reduce the rate.

Biometry and pathological ultrasound findings in multiple pregnancies / Características ecográficas y hallazgos patológicos en embarazos múltiples

Resumo Objectives: to determine the prevalence of pathological findings according to the type of chorionicity in pregnancies in two institutions in Bogotá, Colombia. Methods: descriptive, retrospective, cohort study. Biometric variables were calculated, and pathological findings were evaluated according to the type of chorionicity in multiple pregnancies. Statistical characterization was performed with absolute frequencies, calculation of relative frequencies in qualitative variables, standard deviation measures, median and interquartile range. In addition, a descriptive analysis of the information was carried out. Results: 528 studies were carried out in 141 pregnant women, 98.5% (n = 139) twins and 1.4% (n = 2) triplets. A prevalence of 35.4% of fetal complications was calculated. The most frequent was fetal growth restriction (p=0.37). According to each type of chorionicity, fetal growth restriction was presented in 50% (1/2) of the trichorionics, 16.6% (7/42) of the monochorionics, and 11.3% (11/97) of the dichorionics. Conclusion: fetal growth restriction was the most common finding, both in trichorionics, monochorionics and dichorionics pregnancies.

Resumen Objetivos: el objetivo del estudio fue determinar la prevalencia de los hallazgos patológicos ecográficos en embarazos múltiples de acuerdo con la corionicidad en dos instituciones en Bogotá-Colombia. Métodos: estudio de cohorte, descriptivo, retrospectivo. Las variables biométricas realizadas y los hallazgos patológicos se evaluaron de acuerdo con el tipo de embarazo gemelar. Se realizó caracterización estadística con frecuencias absolutas, cálculo de frecuencias relativas en variables cualitativas, medidas de desviación estándar, mediana y rango intercuartílico. Además, se realizó análisis descriptivo de la información. Resultados: se realizaron 528 estudios en 141 gestantes, encontrando 98,5% (n=139) gemelares y 1,4% (n=2) triples. Se calculó una prevalencia de 35,4% de complicaciones fetales siendo más frecuente la restricción del crecimiento fetal (p=0,37). Según la corionicidad, esta complicación se presentó en 50% (1/2) de los tricoriónicos, 16,6% (7/42) de los monocoriónicos y 11,3% (11/97) de los dicoriónicos. Conclusión: la restricción del crecimiento fetal fue el hallazgo más común en los embarazos múltiples en la población estudiada.

Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women / Fatores associados com o nível de atividade física e a prática de exercício em gestantes de alto risco

Abstract Objective To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. Methods A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. Results Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81±81.84 METs), followed by work-related activities (40.77±84.71 METs). Only 19.3% women exercised during pregnancy (4.76±12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR=29.8; 95% CI 4.9-117.8). Nulliparity (OR=3.1; 95% CI 1.0-9.1), low levels of anxiety (OR=3.6; 95% CI 1.2-10.7), and unemployment (OR=4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. Conclusion Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

Resumo Objetivo Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. Métodos Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes comidade entre de 18 e 40 anos; feto único e comidade gestacional (IG) até 38 semanas.O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. Resultados Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81±81.84 METs), seguidas pelas atividades ocupacionais (40.77±84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76±12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR=29,8; IC 95% 4,9-117,8) . Nuliparidade (OR=3,1; IC 95% 1,0-9,1), baixos níveis de ansiedade (OR=3,6; IC 95% 1,2-10,7) e não trabalhar na gestação (OR=4,8; IC 95% 1.1-19,6) foram associados à prática de exercício físico durante a gestação. Conclusão A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Labor interventions in low- and high-risk parturients in a university hospital

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.

Perfil epidemiológico dos nascidos de mães adolescentes com gestações repetidas em um hospital de referência na cidade de Blumenau/SC, no período de janeiro de 2007 a dezembro de 2011 / Epidemiological profile of children of adolescent mothers with repeat pregnancies at a referral hospital in Blumenau between january 2007 and december 2011

Introdução: No mundo, por ano, cerca de 10% do total de partos são de adolescentes. No Brasil, 26,75% são filhos de mães adolescentes. A reincidência da gestação ocorre em 22,9%. A gestação na adolescência apresenta maiores complicações, resultando em maior morbimortalidade. Objetivos: Avaliar o perfil epidemiológico dos recém-nascidos de mães adolescentes com gestações recorrentes em hospital de referência para gestação de alto risco na cidade de Blumenau/SC, no período de janeiro de 2007 a dezembro de 2011. Métodos: Estudo descritivo, retrospectivo e documental. Resultados: Foram identificadas 1684 gestantes adolescentes, sendo a idade média ao parto de 16,9 (± 1,17). Destas, 105 engravidaram pela segunda vez e 6 pela terceira vez durante a adolescência. Foi possível a aplicação do questionário em 42 adolescentes com gestação recorrente. O peso do RN na primeira gestação apresentou-se menor que nas demais. Na análise do Apgar do primeiro e do quinto minuto, houve diferença significativa (p<0,001), sendo que o Apgar > 6 ocorreu 76% das vezes na primeira gestação, 88% na segunda e 93% na terceira. Discussão: Contrariamente à literatura, demonstraram-se desfechos favoráveis quanto ao peso do nascimento, Apgar no primeiro e quinto minuto de vida, além de demonstrar uma melhora desses índices ao longo das gravidezes subsequentes. Conclusão: Este estudo foi realizado em uma cidade com elevado IDH e boas condições de vida, além de contar com amplo acesso à saúde. Assim, os resultados obtidos devem ser interpretados com ressalvas e mais estudos são necessários sobre o tema.

Introduction: Each year, around 10% of all births worldwide are to adolescents. In Brazil, around 26.75% of the population was born to adolescent mothers. Pregnancy recurrence occurs in 22.9% of the cases. Adolescent pregnancies present greater complications, resulting in higher morbidity and mortality. Objectives: To assess the epidemiological profile of newborns to adolescent mothers with repeat pregnancies at a referral hospital for high-risk pregnancies in Blumenau between January 2007 and December 2011. Methods: This is a descriptive, retrospective, and documental study. Results: We identified 1,684 pregnant teenagers whose mean age at delivery was 16.9 (± 1.17) years. Of these, 105 were pregnant for the second time and 6 were pregnant for the third time in adolescence. We were able to apply the questionnaire to 42 adolescents with repeat pregnancies. The weight of newborns of first pregnancies was lower than that for other pregnancies. First- and fifth-minute Apgar scores presented significant differences (p<0.001), and Apgar scores > 6 were observed in 76% of first pregnancies, 88% of second pregnancies, and 93% of third pregnancies. Discussion: In contrast with the literature, favorable outcomes of birth weight and first- and fifth-minute Apgar scores were observed in our sample, and these indices were improved in subsequent pregnancies. Conclusion: This study was performed in a city with a high human development index and good life conditions, as well as broad access to health care. Therefore, the obtained results should be interpreted with caution and more studies on this subject are required.

A STUDY ON FETO-MATERNAL OUTCOME IN A POSTDATED PREGNANCY

BACKGROUND: The objective of the study is to find out the fetal and maternal complications in post dated pregnancy. This is a prospective observational study. METHODS: Patients who have completed 40weeks of gestational age, meeting the inclusion criteria. RESULTS: Of 100 cases 74(74%) cases were under 20 to 25 years, majority cases were primigravida (66%), overall caesarean rate was 36%, Meconium-stained liquor with fetal distress was the most common indication for LSCS 9(25 %). Fetal distress was the most common fetal complications, number of induced labor is 71.4% at 41 weeks 1 day to 42 weeks CONCLUSION: In our study we concluded that prolonged pregnancy was associated with significant risk of perinatal complications like fetal distress, meconium aspiration syndrome and IUGR. There was significantly increased risk of obstetric complications like oligohydramnios, perineal tear, atonic PPH and shoulder dystocia.

Embarazo cornual de 31 semanas con ruptura uterina. Reporte de caso / 31-week cornual pregnancy with uterine rupture. A case report

Resumen ANTECEDENTES: El embarazo cornual es un reto diagnóstico debido a que la capacidad de estiramiento del miometrio hace que la manifestación sea tardía y con alta mortalidad debido al riesgo de choque hemorrágico que llega a suceder, incluso, hasta en un tercio de las pacientes. OBJETIVO: Hacer hincapié en la importancia del adecuado control prenatal para el diagnóstico oportuno de embarazo ectópico y la consecuente disminución de complicaciones asociadas. CASO CLÍNICO: Paciente primigesta, de 20 años de edad, originaria y residente de Guadalupe, Nuevo León. Sin antecedentes heredofamiliares o personales médicos o quirúrgicos relevantes. Ingresó a la sala de urgencias de Obstetricia con un cuadro de choque hipovolémico y 31 semanas de embarazo. En la revisión la cavidad abdominal se encontró con un embarazo cornual izquierdo, con ruptura uterina y acretismo placentario. Por lo anterior, se procedió a la histerectomía obstétrica, salpingectomía bilateral y ooforectomía izquierda, con reporte de 1000 mL de hemoperitoneo. La evolución posquirúrgica fue satisfactoria. CONCLUSIONES: El embarazo cornual debe sospecharse en toda mujer con amenorrea, dolor abdominal y sangrado transvaginal, con búsqueda intencionada de los hallazgos ultrasonográficos de cavidad uterina vacía, saco coriónico separado por lo menos 1 cm desde el borde lateral de la cavidad uterina, capa del miometrio delgada (menos de 5 mm) que rodea el saco gestacional y signo de la línea intersticial (visualización de una línea ecogénica que se extiende desde la cavidad endometrial hasta la región cornual, contigua al saco gestacional). El diagnóstico temprano de estos embarazos evita complicaciones y afectaciones al futuro obstétrico.

Abstract BACKGROUND: Cornual pregnancy is a diagnostic challenge because the stretching capacity of the myometrium makes the manifestation late and with high mortality due to the risk of hemorrhagic shock that occurs in up to one third of patients. OBJECTIVE: To emphasize the importance of adequate prenatal care for the timely diagnosis of ectopic pregnancy and the consequent reduction of associated complications. CLINICAL CASE: Primigestation patient, 20 years old, native, and resident of Guadalupe, Nuevo Leon. No relevant heredofamilial or personal medical or surgical history. She was admitted to the obstetrics emergency room with hypovolemic shock and 31 weeks of pregnancy. On examination the abdominal cavity was found to have a left cornual pregnancy, with uterine rupture and placental accretism. Therefore, obstetric hysterectomy, bilateral salpingectomy and left oophorectomy were performed, with a report of 1000 mL of hemoperitoneum. The postoperative evolution was satisfactory. CONCLUSIONS: Cornual pregnancy should be suspected in any woman with amenorrhea, abdominal pain and transvaginal bleeding, with purposeful search for ultrasonographic findings of empty uterine cavity, chorionic sac separated at least 1 cm from the lateral border of the uterine cavity, thin myometrial layer (less than 5 mm) surrounding the gestational sac, and interstitial line sign (the visualization of an echogenic line extending from the endometrial cavity to the cornual region, contiguous with the gestational sac). The early diagnosis of these pregnancies avoids complications and affects the future obstetrician.

Dental anxiety and its influencing factors among pregnant women in Shanghai / 口腔疾病防治

Objective @#To investigate the incidence of dental anxiety in pregnant women and its influencing factors. @*Methods @# A total of 2 638 pregnant women in Shanghai were included in this study. Data on demographic and social factors, oral health behaviors and the number of teeth were collected. Participants completed the modified dental anxiety scale (MDAS), and an MDAS score greater than 12 was defined as a dental anxiety disorder. An electronic data capture system (EDC) was used to establish a database, and SPSS 22.0 was used to analyze the degree of anxiety and its influencing factors.@*Results@# A total of 2 638 valid questionnaires were received. The incidence of dental anxiety in pregnant women was 34.9%. The results of a univariate analysis showed that the prevalence of dental anxiety in pregnant women (P<0.001) and MDAS score decreased (P<0.05) with increasing age, annual family income, educational level, frequency of cleaning, frequency of brushing and number of teeth. Conversely, the prevalence of dental anxiety in pregnant women (P<0.05) and MDAS score increased (P<0.05) as the number of pregnancies and gingival bleeding increased. Logistic analysis showed that education level “college” (P = 0.003) and “bachelor and above” (P<0.001), frequency of dental cleaning “semiannually or annually” (P = 0.021) and “biennial” (P<0.001), and frequency of brushing “twice a day” (P<0.001) were significantly associated with dental anxiety in pregnant women and were protective factors (OR<1). The frequency of gingival bleeding “Sometimes”(P<0.001) and the number of teeth “≤ 27” (P<0.001) were also significant risk factors for dental anxiety in pregnant women (OR>1).The results of a negative binomial regression analysis of MDAS showed that the frequency of dental cleaning and the number of teeth were significantly associated with dental anxiety. The frequency of dental cleaning "semiannually or annually" (P<0.001) was a protective factor (OR<1) for pregnant women's dental anxiety. The number of teeth ≤27 (P<0.001) was a risk factor (OR>1) for dental anxiety in pregnant women.@*Conclusion@#Educational level, teeth cleaning frequency, teeth brushing frequency, gingival bleeding, and the number of teeth influence dental anxiety in pregnant women. To effectively reduce the prevalence of dental anxiety, dentists should attach great importance to it in clinical practice and enhance pregnant women's awareness of oral hygiene maintenance by disseminating relevant health care knowledge.

Comparison of hematological parameters between single and twin pregnancies in Dorper ewes during gestation, lambing, and postpartum / Comparação dos parâmetros hematológicos entre ovelhas Dorper de gestação simples e gemelar durante a prenhez, parto e pós-parto

ABSTRACT: The hematopoietic system changes during the pregnancy to carry fetal development and maternal needs. This study compared the hematological parameters between ewes with single and twin pregnancies during gestation, delivery, and postpartum. The experiment was conducted on 60 healthy pregnant Dorper ewes that were divided into two experimental groups: Group 1 (G1), with single pregnancies (n=30), and Group 2 (G2), with twin pregnancies (n=30). Blood samples were collected from all ewes at different times: immediately before fixed-time artificial insemination (AI); on day 30, 90, 120, 130, and 140 of pregnancy; immediately after delivery; and at 24h and 48h postpartum. Statistical analysis compared the two groups at different times (P<0.05). Mild, normocytic, and hypochromic anemia was detected in all ewes from AI time and throughout pregnancy from both groups, but did not prove to be of clinical relevance. In the peripartum stage (from the 140th day of pregnancy to 48h postpartum), the ewes with twin pregnancies (G2) exhibited higher erythrogram values and neutrophil:lymphocyte ratio than did ewes with single pregnancies (G1). This indicated a greater hematopoietic adaptation in the body during the development of two fetuses. Except for the eosinophil numbers, all leukogram parameters were influenced by pregnancy in a similar way in both groups, and was characterized mainly by leukocytosis with neutrophilia during peripartum due to the high presence of endogenous cortisol at delivery. Thus, these findings showed that pregnancy was a stressful physiological event that increased the leukocyte count with a slight alteration in the erythrogram of Dorper ewes.

RESUMO: O sistema hematopoiético sofre mudanças durante a gestação para atender o desenvolvimento fetal e as necessidades maternas. Este estudo comparou os parâmetros hematológicos entre ovelhas com gestação simples e gemelar durante a prenhez, parto e pós-parto. O estudo foi realizado em 60 ovelhas Dorper prenhes, saudáveis, divididas em dois grupos experimentais: Grupo 1 (G1) com gestação simples (n = 30); e Grupo 2 (G2) com gestação gemelar (n = 30). Amostras de sangue foram colhidos de todas as ovelhas em diferentes momentos: imediatamente antes da inseminação artificial em tempo fixo (IA); nos dias 30, 90, 120, 130 e 140 de gestação; imediatamente após o parto; e às 24h e 48h pós-parto. A análise estatística comparou os dois grupos nos diferentes momentos (P < 0,05). Anemia leve, normocítica e hipocrômica foi detectada desde a IA e ao longo da gestação, nas ovelhas de ambos os grupos, mas não houve relevância clínica. Na fase periparto (do 140º dia de gestação às 48h pós-parto), as ovelhas com gestação gemelar (G2) mostraram valores do eritrograma e proporção neutrófilos: linfócitos mais elevados do que as ovelhas com gestação simples (G1). Isso indicou maior adaptação hematopoiética da ovelha para o desenvolvimento de dois fetos. Com exceção do número de eosinófilos, todos os parâmetros do leucograma foram influenciados pela gestação de forma semelhante em ambos os grupos, e foi caracterizada principalmente por leucocitose com neutrofilia no periparto devido ao alto nível de cortisol endógeno no parto. Assim, os achados mostraram que a gestação foi um evento fisiológico estressante que aumentou a contagem de leucócitos com leve alteração no eritrograma de ovelhas Dorper.

Gynecological/Obstetric Background and Rheumatoid Arthritis: A Cross-sectional Study in Brazilian Patients / Antecedentes ginecológicos/obstétricos e artrite reumatoide: Um estudo transversal em pacientes brasileiros

Abstract Objective To study a sample of rheumatoid arthritis (RA) patients for their gynecological/obstetric history and compare them to controls to determine their influences on number of pregnancies, menarche, menopause and reproductive years following RA onset. Methods This is a cross-sectional study of 122 RA patients and 126 controls. Patients and controls were questioned about age of menarche, age of menopause, number of pregnancies and abortions. Reproductive years were calculated as the difference between age at menopause and age at menarche. For comparison, we used the Mann-Whitney, unpaired t, chi-squared, and Spearman tests. The adopted significance was 5%. Results In the RA patients with disease beginning in the postmenopausal years, the period of reproductive years (age at menopause - age of menarche) showed a positive correlation with age at disease onset (rho=0.46; 95% confidence interval [CI]=0.20- 0.55 with p=0.0008). The number of pregnancies was higher in patients with postmenopausal disease onset when compared with those with premenopausal disease onset (median of 3 with interquartile range [IQR]=2-4 versus median of 2 with IQR=1-3; p=0.009), and RA patients had more pregnancies than controls (p=0.0002). Conclusion The present study shows that, in our population, the duration of reproductive years and the number of pregnancies are linked to the onset of RA.

Resumo Objetivo Estudar uma amostra de pacientes com artrite reumatoide (AR), com investigação da história ginecológica e obstétrica, comparando-a com controles, visando conhecer suas influências no número de gestações, menarcas, menopausa e anos reprodutivos no início da AR. Métodos Trata-se de um estudo transversal de 122 pacientes com AR e 126 controles. Pacientes e controles foram questionados sobre idade da menarca, idade da menopausa, número de gestações e abortos. Os anos reprodutivos foram calculados com a diferença entre a idade da menopausa e a idade da menarca. Para comparação, foram utilizados Mann Whitney, Teste t não pareados, Teste qui-quadrado e teste de Spearman. A significância adotada foi de 5%. Resultados Nas pacientes comAR e início da doença na pós-menopausa, o período de anos reprodutivos (idade da menopausa - idade da menarca) apresentou correlação positiva com a idade de início da doença (rho=0,46; intervalo de confiança de 95% [IC95%]=0,20-0,55 com p=0,0008). O número de gestações foi maior nas pacientes cominício da doença no período pós-menopausa quando comparadas às pacientes em pré-menopausa (mediana de 3 comintervalo interquartil [IIQ]=2-4 versusmediana de 2 com IIQ=1-3; p=0,009). Nas pacientes com AR, foi observado ummaior número de gestações do que no grupo controle (p=0,0002). Conclusão O presente estudo mostra que, em nossa população, a diminuição dos anos reprodutivos e o alto número de gestações estão relacionados ao surgimento da AR.

A scary complication: single-center study on management and outcome of cesarean scar pregnancy

Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Correlation analysis of platelet antibody between adverse pregnancy and the number of pregnancies / 中国输血杂志

【Objective】 To analyze the testing results of platelet antibody in peripheral blood of 266 pregnant women, so as to explore the correlation of platelet antibody between adverse pregnancy and the number of pregnancies. 【Methods】 A total of 266 pregnant women, admitted to Shaanxi Provincial People′s Hospital, were selected for platelet antibody detection. They were divided into two groups according to history of adverse pregnancy, and the positive rate of platelet antibody between two groups was compared. They were divided into group A (1 pregnancy), group B (2 pregnancies) and group C (≥3 pregnancies) in parallel, and the positive rate of platelet antibody among three groups was compared 【Results】 The yield rate of platelet antibody in groups with and without adverse pregnancy was 31.81% vs 14.86%, showing statistical significance(P<0.05). The yield rate of platelet antibody of Group A, B and C was 9.09%, 21.62% and 23.65%, respectively, with The significant differences(P<0.05). The statistical analysis of inter-group χ2 test demonstrated a linear trend between the number of pregnancies and platelet antibodies yielding(χ2=7.056, P<0.05). 【Conclusion】 Platelet antibody was correlated with adverse pregnancy, and the yield rate of platelet antibody in the group with adverse pregnancy was higher than that in the group without adverse pregnancy. There was a linear trend between platelet antibodies yielding and the number of pregnancies. The yield rate of antibodies gets higher as the number of pregnancies increased. Taking platelet antibody test as a routine test during pregnancy is conducive to the early detection of clinical adverse pregnancy, as well as the early prevention, early detection and early intervention of fetal/neonatal homoimmune thrombocytopenic purpura and other diseases.

Recurrent ectopic pregnancies with secondary infertility: a case report

Infertility is defined as 1 year of unprotected sexual intercourse without pregnancy. It is further classified as primary and secondary. Secondary infertility is one in which prior pregnancy not necessarily live birth has occurred. Pelvic infections as a cause for infertility are seen in 12% cases while genital tuberculosis contribute 10-15%. Various studies have well established a relationship between subclinical infection and infertility with the two most potential pathogens being: Chlamydia trachomatis and mycoplasma species. Authors are presenting two cases one of a 30yr female, P0+5, with class 2 obesity with previous three ectopic pregnancies with LSO done 1 year back i/v/o left ruptured ectopic now presenting with secondary infertility for 1 year and another case of a 21 years female, P0+2, with previous two ectopic with LSO done 2 years back now presenting with infertility. These cases emphasize that infections are important causes for recurrent ectopic pregnancies and infertility.

Hysteroscopic treatment of cervical pregnancy: case report

Of ectopic pregnancies, cervical implantation pregnancy is an exceptional entity, corresponding to less than 1% of ectopic pregnancies. With an incidence calculated at 1: 2500 to 1: 12,000 pregnancies. The risk factors for cervical pregnancy are the same as for other ectopic pregnancies. This entity, a difference from tubaric pregnancy where bleeding is within the peritoneal cavity, the main risk is incoercible vaginal bleeding, which usually ends in a hysterectomy, which limits the reproductive future of patients. There are currently no established criteria for candidates for medical versus surgical treatment. This case reports a case of cervical ectopic pregnancy, treated with Methotrexate, and culminating with hysteroscopy resection.

Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Prevalence of teenage pregnancy in 2015–2016 and its obstetric outcomes compared to nonteenage pregnancy at Hospital Tuanku Ja’afar Seremban (HTJS), Negeri Sembilan, Malaysia: A retrospective case-control study based on the national obstetric registry

@#Objective: To determine the prevalence of teenage pregnancy and compare its obstetric and perinatal outcomes with those of non-teenage pregnancy. Method: This retrospective hospital-based case-control study was conducted in the Department of Obstetrics and Gynaecology in Hospital Tuanku Ja’afar Seremban. The study made use of the Malaysian National Obstetric Registry (NOR) records of teenage pregnant women aged 11–19 at Hospital Tuanku Ja’afar Seremban over a 12-month period between May 2015 and May 2016 (n=164). Socio-demographic profiles, obstetric outcomes, and perinatal outcomes were detailed for each pregnant woman. The results were compared to a control group of 169 pregnant women aged 20–30 who also delivered in hospital Tuanku Ja’afar Seremban during the same period. The aim of this study was to assess the obstetric outcomes of teenage pregnancy and to compare them with those of the control group. A chi-squared test was used to identify the statistical significance of the relationship between teenage pregnancy rates and obstetric outcomes. Results with p <0.05 was considered statistically significant. Results: The prevalence of teenage pregnancy was 2.8%. The mean age of the teenage group was 17.9; that of the control group was 26.4. Teenage mothers had a significantly higher risk of anemia (p<0.05), episiotomy (p<0.001), preterm labor (p<0.001), and delivering low-birthweight babies (p<0.001). There were no significant differences between the two groups in mode of delivery, antenatal complications, birth outcomes, APGAR scores at 5th minute, or neonatal complications. Conclusion: The prevalence of teenage pregnancy in this study is relatively low but is associated with an increased risk of some perinatal complications. The primary care physician’s role is pivotal in educating adolescents on sexual health, providing continual care in hospitals, and empowering teenagers in their reproductive health decisions.

Influencia de factores no médicos para el nacimiento por cesárea en un hospital privado / Influence of non-medical factors for cesarean birth in a private hospital

Resumen: OBJETIVO: Encontrar los factores no médicos que intervienen en el criterio del obstetra para elegir que la vía de nacimiento sea por parto o cesárea. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo, observacional y analítico, efectuado en pacientes atendidas entre 2016 y 2019 en el Hospital Ángeles Lomas, con más de 24 semanas de embarazo y que lo terminaron mediante parto o cesárea. Criterio de exclusión: embarazos múltiples. Variable dependiente: nacimiento por parto o cesárea. Variables independientes: sexo del obstetra, consultorio en el mismo hospital o externo, disponibilidad de asistente médico, mes del año, día de la semana y periodo vacacional. RESULTADOS: Se incluyeron 3906 nacimientos, 1495 cesáreas (38.3%) y 2411 partos (61.7%). Se observó mayor riesgo de cesárea, con significación estadística en: nacimientos atendidos por obstetras externos (OR = 3.81; IC95%: 3.07-4.73), nacimientos atendidos por obstetras del mismo hospital sin asistente médico (OR = 1.75; IC95%: 1.48-2.08), obstetras mujeres (OR = 2.55; IC95%: 2.06-3.16), abril vs diciembre (OR = 1.44; IC95%:1.04-1.98) y miércoles vs domingos (OR = 1.55; IC95%:1.14-2.05). Se registraron más cesáreas en el periodo prevacacional vs vacacional (OR = 1.51; IC95%: 0.94-2.43) sin diferencia estadísticamente significativa. CONCLUSIONES: Existen factores no médicos que aumentan la frecuencia de cesárea. Los relacionados con el obstetra incluyen: no tener el consultorio en el mismo hospital y carecer de asistente médico.

Abstract: OBJECTIVE: To find the non-medical factors that intervene in the obstetrician's criteria for choosing a birth canal or Cesarean section. MATERIALS AND METHODS: Transversal, retrospective, observational and analytical study carried out on patients attended between 2016 and 2019 at Hospital Ángeles Lomas (Mexico City), with more than 24 weeks of pregnancy and who finished it by vaginal delivery or cesarean section. Exclusion criterion: Multiple pregnancies. Dependent variable: birth by delivery or cesarean section. Independent variables: sex of the obstetrician, office in the same hospital or outside, availability of medical assistant, month of the year, day of the week and vacation period. RESULTS: 3906 births, 1495 cesarean sections (38.3%) and 2411 deliveries (61.7%) were included. A higher risk of cesarean section was observed, with statistical significance in: births attended by external obstetricians (OR = 3.81; CI95%: 3.07-4.73), births attended by obstetricians at the same hospital without a physician's assistant (OR = 1. 75; CI95%: 1.48-2.08), female obstetricians (OR = 2.55; CI95%: 2.06-3.16), April vs. December (OR = 1.44; CI95%:1.04-1.98) and Wednesday vs More cesarean sections were recorded in the pre-vacation vs. vacation period (OR = 1.51; IC95%: 0.94-2.43) with no statistically significant difference. CONCLUSIONS: There are non-medical factors that increase the frequency of cesarean section. Those related to the obstetrician included: not having the office in the same hospital and not having a medical assistant.

Frecuencia de episiotomías en un hospital de tercer nivel / Frequency of episiotomy in a third-level hospital

OBJETIVO: Determinar la frecuencia y correlación de las episiotomías y desgarros en pacientes con parto eutócico. MATERIALES Y MÉTODOS: Estudio observacional y retrospectivo efectuado en el Hospital General Universitario de Alicante en dos periodos: 1) 2008-2012 y 2) 2013-2018. Se incluyen los partos eutócicos de embarazos únicos, a término, en presentación cefálica. Variables de estudio: episiotomía, desgarro, edad, semanas de embarazo, paridad, inducción del parto, cesárea anterior, analgesia regional, peso y sexo del recién nacido. Los resultados se expresan en porcentaje, coeficiente de correlación y las variables implicadas con razón de momios (RM). RESULTADOS: La tasa de episiotomía entre el periodo 1 vs el 2 disminuyó de manera muy importante: de 42.3 a 32.8%; [p < 0.001; RM: 0.81 (0.78-0.84)]. En cambio, el porcentaje de desgarros aumentó: de 42.7 a 50.8%; (p < 0.001; RM: 1.16[1.13-1.20]). El coeficiente de correlación fue de -0.91. Uno de los factores de riesgo asociados con la episiotomía fue la edad menor de 35 años, con RM de 1.25; IC95%: 1.16-1.35; p < 0.001, pero fue un factor protector de desgarros con RM de 0.76; IC95%: 0.71-0.81; p < 0.001. CONCLUSIONES: La tendencia de la episiotomía es decreciente, mientras que la de desgarro es inversamente proporcional. No se encontraron diferencias en la tasa de desgarro de III y IV grado.

Abstract OBJECTIVE: To determine the frequency and correlation of episiotomies and tears of patients with eutocic deliveries. MATERIALS AND METHODS: Observational and retrospective study carried out at the Hospital General de Alicante, Spain, in two periods: 1) 2008-2012 and 2) 2013-2018. Eutocic deliveries of single pregnancies, at term, in cephalic presentation are included. Study variables: episiotomies, tear, age, weeks of pregnancy, parity, labor induction, previous caesarean section, regional analgesia, weight and sex of the newborn. The results are expressed as a percentage, correlation coefficient and the variables involved with odds ratio. RESULTS: The episiotomy rate between period 1 vs. 2 decreased very significantly: 42.3% vs 32.8%; [p <0.001; OR: 0.81 (0.78-0.84)]. In contrast, the percentage of index tears: 42.7% vs 50.8%; (p <0.001; OR: 1.16 [1.13-1.20]). The correlation coefficient was -0.91. Regarding risk factors associated with episiotomy, one of them was the age under 35 years with an OR (95% CI): 1.25 (1.16-1.35; p <0.001), but it was a OR protective factor (95% CI): 0.76 (0.71-0.81; p <0.001) for the appearance of tears. CONCLUSIONS: The tendency in the realization of episiotomies is decreasing, while the tendency of the appearance of tears is inversely proportional. No differences were found in the tear rate of III and IV grade.

Duplicación de imagen ultrasonográfica de feto único intrauterino que emula un gemelo inexistente: reporte de un caso / Ultrasonographic image duplication of an intrauterine unique fetus mimicking non-existing twin: case report

Resumen ANTECEDENTES: En Obstetricia, las imágenes en espejo son artefactos ecográficos infrecuentes que, potencialmente, pueden confundirse con embarazos heterotópicos y propiciar errores diagnósticos e intervenciones iatrógenas. Estas imágenes ficticias se generan por la existencia de una superficie reflectora como, por ejemplo, el intestino distendido o la vejiga repleta. CASO CLÍNICO: Paciente de 39 años, con embarazo por fertilización in vitro, que asiste a evaluación ecográfica del primer trimestre. En la ecografía de rutina a las 11 semanas se observó una imagen en espejo y en la resonancia magnética: útero gestante con una estructura retrouterina hipoecoica, sin feto en el interior. La imagen ecográfica en espejo volvió a reproducirse en el tercer trimestre. El embarazo llegó a término y finalizó por vía abdominal, sin que pudieran demostrarse las estructuras que se advirtieron en la resonancia magnética. CONCLUSIONES: Las imágenes en espejo se han reportado en ultrasonidos de diversas localizaciones pero pocos en la Obstetricia. Todo hizo suponer que la superficie reflectora fue la estructura hipoecoica retrouterina observada, transitoriamente, en la resonancia magnética.

Abstract BACKGROUND: In obstetrics, ultrasonic artifactual mirror images are infrequent, but potentially dangerous since they can be mistakenly interpreted as heterotopic pregnancies, precluding diagnostic errors and iatrogenic interventions. These images require a reflection surface such as dilated bowl or plenty bladder to be generated. OBJECTIVE: We report a first trimester scan ghost twin, diagnosed since first trimester of pregnancy. CLINICAL CASE: 39-year-old patient, with pregnancy due to in vitro fertilization, who attends ultrasound evaluation of the first trimester. Routine ultrasound at 11 weeks showed a mirror image and magnetic resonance imaging: a pregnant uterus with a hypoechoic retrouterine structure, with no fetus inside. The ultrasound mirror image reproduced again in the third trimester. The pregnancy came to an end and ended by abdominal route, without being able to demonstrate the structures that were noticed on the MRI. CONCLUSION: Very few reports of obstetric ultrasound mirror images have been reported. We hypothesize that the transient retrouterine hypoecogenic structure observed by MRI was the reflective surface that create the ghost twin image.