COVID-19 y embarazo: caso clínico de presentación crítica, inflamación placentaria y transmisión vertical fetal demostrada / COVID-19 and pregnancy: clinical case of critical presentation, placental inflammation and demonstrated fetal vertical transmission

ANTECEDENTES: La pandemia global de COVID-19 llega al continente americano en marzo del año 2020 y en menos de dos meses reúne a más de la mitad de los casos a nivel global. OBJETIVO: Caso clínico de una mujer embarazada con una presentación crítica de COVID-19 y embarazo a las 25 semanas de gestación, en el contexto del peak de la pandemia en Chile en el otoño del año 2020. CASO CLÍNICO: El 20 de junio de 2020, una mujer de 34 años, con 25 semanas de embarazo, es trasladada desde Hospital de San Bernardo a Clínica Las Condes en Santiago, Chile, con un cuadro de 10 días de evolución de COVID-19, que evoluciona a una situación crítica con insuficiencia respiratoria severa. Ingresa a unidad de cuidados intensivos para ventilación mecánica. Las imágenes de radiología simple y de tomografía axial computarizada de tórax demuestran una neumopatía bilateral con imágenes características opacidades en vidrio esmerilado, asociado a engrosamiento intersticial, imágenes descritas previamente como características para COVID-19. La paciente permanece en unidad de cuidados intensivos en ventilación mecánica por siete días, con evolución favorable posterior, mejoría del cuadro séptico y alta después de 22 días de hospitalización. El parto ocurre en forma espontánea a las 38 semanas, la madre y el recién nacido evolucionan en buen estado general. El examen histopatológico placentario demuestra compromiso inflamatorio vellositario y los exámenes de anticuerpos en sangre del recién nacido demuestran la presencia de anticuerpos del tipo IgG e IgM. Se trata de uno de los pocos casos demostrados reportados de transmisión transplacentaria vía sanguínea de SARS-CoV-2 de la madre al recién nacido.

BACKGROUND: The global COVID-19 pandemic reaches the American continent in March 2020 and in less than two months it brings together more than half of the cases globally.OBJECTIVE: The clinical case of a 25-week pregnant woman with a critical presentation of COVID-19 and pregnancy at 25 weeks of gestation, is presented in the context of the peak of the pandemic in Chile in the fall of 2020. CLINICAL CASE: On June 20, 2020, a 34-year-old woman, 25 weeks pregnant, is transferred from Hospital de San Bernardo to Clinica Las Condes in Santiago, Chile, with a ten-day evolution of a COVID-19 that evolves to critical with severe respiratory failure. She is admitted to the intensive care unit for mechanical ventilation. Chest computerized axial tomography images demonstrate bilateral pneumopathy with characteristic images of ground-glass opacities, associated with interstitial thickening, images previously described as characteristics for COVID-19. The patient remains in the intensive care unit on mechanical ventilation for seven days, with subsequent favorable evolution, improvement of the septic condition, and discharge after 22 days of hospitalization. Delivery occurs at 38 weeks, the mother and the newborn evolve in good general condition. The placental histopathological examination demonstrates villous inflammatory involvement, and the newborn's blood tests show the presence of IgG and IgM antibodies. It is one of the few reported cases of transplacental transmission of SARS-CoV-2 from the mother to the newborn.

Lesiones placentarias en embarazos de madre adolescente en una maternidad pública de Argentina / Placental lesions during teenage pregnancy in a public maternity of Argentina

INTRODUCCIÓN: En Argentina, el 18,3% de los recién nacidos vivos son hijos de madres menores de 20 años. El embarazo adolescente está asociado a una mayor incidencia de resultados perinatales adversos. El estudio histopatológico de la placenta ayuda a especificar etiologías y a predecir la recurrencia de las patologías perinatales. OBJETIVO: Determinar el peso de la placenta y sus lesiones en madres adolescentes, y estimar el riesgo en comparación con madres adultas jóvenes. MÉTODOS: Se estudiaron 50 placentas de madres adolescentes (n=18 de ≤16 años y n=32 de 17-19 años) y 101 de adultas jóvenes (20 a 29 años) atendidas en el Hospital Materno Infantil Ramón Sardá de Buenos Aires. Las placentas fueron examinadas macro y microscópicamente según técnicas convencionales. RESULTADOS: No se encontraron diferencias entre los pesos placentarios de los tres grupos. La mitad de las placentas tenían una o más lesiones con un leve predominio en las de adolescentes (p=0,327). En ≤16 años las lesiones placentarias ascendieron al 77,78% (14/18; IC 95%: 54-91), mientras que entre 17 y 19 años el valor fue del 34,3% (11/32; IC 95%:20-51) (OR 2,26; IC 95%: 1,32-3,38; p=0,003) y de 41,5% para las jóvenes adultas (42/101; 95% CI: 32-51; a 1.87 (IC 95%: 1.33-2.62;p=0.004) y 0,83 (IC 95%: 0.49-1.41; p=0.469) de riesgo crudo para ambos grupos de adolescentes en comparación con las adultas. El riesgo ajustado de presentar lesiones placentarias fue cuatro veces mayor en las adolescentes de hasta 16 años que en las madres adultas (p=0,018). CONCLUSIONES: No hubo diferencias en el peso placentario, mientras que la edad de hasta 16 años se asoció independientemente con importantes lesiones placentarias

INTRODUCTION: In Argentina, 18.3% of live newborns are from mothers younger than 20 years. Adolescent pregnancy is associated with an increase of adverse perinatal outcomes. Placental histopathological examination helps identify etiologies and predict recurrence of perinatal pathologies.OBJECTIVE: To determine placental weight and lesions in adolescent mothers, and to estimate the risk compared with young adult mothers. METHODS: The study included 50 placentas from adolescent mothers (n=18 from ≤16 years and n=32 from 17-19 years) and 101 from young adult mothers between 20 and 29 years of age attending the Sardá Maternityin Buenos Aires. Placentas were subjected to macroscopic and microscopic examination according to conventional methods. RESULTS: No differences were found between the placental weights of the three groups. In half of examined placentae one or more lesions were present, with a slight prevalence in adolescents (p=0.327). In ≤16 years placental lesions represented 77.78 %(14/18; 95% CI: 54-91), while the value was 34.3% for 17-19 years (11/32; 95% CI: 20-51) (OR 2.26; 95% CI: 1.32-3.38;p=0.003) and 41.5% for young adults (42/101; 95% CI: 32-51; a 1.87 (IC 95%: 1.33-2.62; p=0.004) and 0.83 (IC 95%:0.49-1.41; p=0.469) crude risks of both adolescents’ groups compared with adults, respectively. Adjusted risk for placental lesions was four times higher in adolescents up to 16 years of age than in adult mothers (p=0.018). CONCLUSIONS: No differences were found in placental weights, while adolescents up to 16 years of age have a higher risk of placental lesions

Impaired gestational glucose tolerance. Its effect on placental pathology

The aim of this study was to investigate several macroscopic and microscopic features of placenta in cases with impaired gestational glucose tolerance. Seventy-five gm World Health Organization criteria for the diagnosis of gestational diabetes and impaired gestational glucose tolerance were followed during the period June 1999 through to June 2000, at the Maternity Hospital of Kuwait. Macroscopic and microscopic examinations of 95 placentas were carried out. Sixty-five were from the control patients and 30 were from cases with impaired gestational glucose tolerance. Mean maternal age, maternal weight and parity was significantly higher in the impaired gestational glucose tolerance [IGGT] group compared to the control group. Mean birth weight of the baby was significantly higher in the IGGT group compared to the control group. Mean placental weight and the percentage of the cesarean delivery was higher in the IGGT group but did not reach the level of significance. There was no significant association between the microscopic features of the placenta in the control and IGGT groups. Impaired gestational glucose tolerance is related to increased neonatal and placental weight, which may lead to a higher number of cesarean deliveries, stressing the similarity between impaired gestational glucose tolerance and gestational diabetes mellitus. More stringent criteria may be necessary to define gestational diabetes. Microscopic features of placenta both in the control and IGGT groups did not show any significant difference

Anticardiolipin antibodies in women with recurrent abortion

The present study sought to determine whether the level of anticardiolipin antibodies in women with recurrent abortion differed from that in the general population. Enzyme-linked immunosorbent assay was used for detection of anticardiolipin antibodies in a group of 26 patients defined as habitual aborters [at least three consecutive spontaneous abortions], and in a control group of 26 patients each of whom had had at least one live birth without pregnancy wastage. A high level of anticardiolipin antibody activity was detected among 19.23% of the habitual aborters but in none of the controls, indicating an association between anticardiolipin antibody level and habitual abortion

Modificación del perfil lipídico de la placenta humana por efecto de la desnutrición materna moderada / Modification of lipidic profile of human placenta by effects of moderate maternal undernutrition

The lipid composition of human placenta phospholipids, coming from 9 undernourished women that gave birth to low weight newborns and 9 well norished women, was analyzed using gas-liquid chromatography. Phospholipids of placentas coming from undernourished women, when compared to well nourished women, had significantly lower amounts of w-6 and w-3 fatty acids (40.1 ñ 1.5 vs 42.4 ñ 1.4 and 6.0 ñ 0.7 vs 7.1 ñ 1,3 per cent respectively). The calculated mean melting point was higher in placentas coming from undernourished women. In these women, the low content of polyunsaturated fatty acids and its replacement by short chain fatty acids was not able to balance the high mean melting points. The relative deficiency of essencial fatty acids, the low saturation index and the high mean melting point of undernourished women's placental phospholipids, may suggest a lower membrane fluidity and a subnormal essencial fatty acid content of fetal organs, that are essencial for normal growth and development

Enfermedad trofoblastica gestacional

La presente revisión trata de la enfermedad trafoblástica gestacional haciendo referencia a los tumores de origen placentario que se derivan del tejido epitelial coriónico. Se describe la clasificación según la OMS, resaltando ls sintomatología clásica de esta patología, así como también los métodos de laboratorio más utilizados como son: La ecosonografía, La dosificación de HCG. Gamagrafía, TAC, estudios de histopatología, medición de alfa feto proteínas dosificación de calcio calmodulina y de CAMP-A quinasa, por último se revisan los esquemas terapéuticos más usados hoy en día.

Matabolismo energético durante el desarrollo de la placenta en ratas: efecto de la desnutrición materna crónica / Energy metabolism during placental development in rats-effect of chronic maternal malnutrition

Se estudió el efecto de la desnutricion crónica materna en el metabolismo enerético durante el desarrollo de la placenta en ratas y su relación con el crecimiento fetal. Ratas hembras vírgines de la cepa Wistar se sosmetieron a la restricción de una dieta con 25% de caseína, desde la pubertad y durante la preñez. Los resultados revelaron que la desnutrición materna disminuye significativamente la actividad de adenilato kinasa expresada pr gramo de DNA, y aumenta significativamente el contenido de adenina nucleótidios (ATP y ADP) en la placenta, cerca del término de la preñez. Se postula que el aumento significativo de la carga energética (ATP + 1/2 ADP:/ ATP + AMP) de la placenta de ratas desnutridas, es el resultado de una inhibición de los sistemas que utilizan ATP para procesos de síntesis de macromoléculas y transporte activo de sustratos en las últimas etapas de la gestación. Ello coincide con la significativa disminución del crecimiento fetal en esa etapa

Placentite hematogênica em mäes chagásicas / Hematogenous placentitis in chagasic mothers

Foram estudadas 135 placentas de mäes chagásicas que näo transmitiram sua infecçäo ao feto. Em apenas uma destas placentas, encontrou-se parasitismo associado a discreta vilosite, crônica e focal. Em outras 24 placentas, observou-se apenas vilosite, na ausência de parasitismo, determinando uma freqüência de 17,9% de vilosite de causa ignorada. Comparou-se esta freqüência com a de um grupo controle, composto de placentas de mäes näo-chagásicas. A diferença observada foi, estatisticamente, näo significante

Infecçäo ovular por Candida albicans / Intrauterine infection by Candida Albicans

A gestaçäo desponta como fator predisponente ao crescimento de leveduras. Entretanto, a prevalência de vulvo-vaginite por Candida albicans é bastante variável na literatura, provavelmente em decorrência da diversidade de metodologia empregada em sua identificaçäo. A despeito dos elevados índices de afecçäo genital, a infecçäo ovular pela Candida é esporádica. Quando presente é grave, sendo possivelmente o fator determinante da elevada taxa de mortalidade perinatal, nestes casos. O acometimento fetal pode ser cutâneo ou generalizado, culminando com o óbito intra-uterino ou neonatal. A via ascendente é a mais provável, na fisiopatologia da infecçäo ovular, mesmo estando íntegras as membranas corioâmnicas. Tem sido citada a correlaçäo entre candidíase ovular e a presença de DIU na cavidade uterina