Incisión Fúndica Uterina con Histerectomía y Ligadura de Arterias Hipogástricas para manejo de Placenta Previa con Acretismo: A propósito de un caso / Uterine Fundic Incision with Histerectomy and Hypogastric Artery Ligation for Placenta Previa Management with Acretism: About a Case

La placenta previa con acretismo es una patología con alta morbimortalidad que puede ser diagnosticada en el tercer trimestre del embarazo mediante estudios de imagen, lo que permite programar su resolución mediante cesárea. Se presenta un caso clínico de una paciente femenina de 40 años que cursaba un embarazo de 36,5 semanas con placenta previa oclusiva total con signos de acretismo determinados por ecografía y resonancia magnética nuclear. Considerando el riesgo de hemorragia se programó la cesárea mediante incisión fúndica del útero y al no desprenderse espontáneamente la placenta se realizó ligadura de arterias hipogástricas bilateral e histerectomía obstétrica, dicha cirugía se realizó sin complicaciones ni necesidad de transfusión sanguínea o ingreso de la paciente a terapia intensiva

The placenta previa with acretism is a pathology with high morbimortality that can be diagnosed in the third trimester of pregnancy by image, which allows to program its resolution by caesarean section. A clinical case of a 40-year-old female patient presenting a 36.5-week pregnancy with total occlusive placenta with signs of accretion determined by ultrasound and resonance is presented, considering the risk of hemorrhage, a caesarean section was scheduled by means of a uterine fundal incision and at the placenta is not spontaneously detached, bilateral hypogastric artery ligation and obstetric hysterectomy are performed. This surgery is performed without complications or the need for blood transfusion or admission of the patient to intensive therapy

Corioangioma gigante de la placenta con buenos resultados perinatales / Giant Placenta Chorioangioma with Good Perinatal Outcomes

El corioangioma fue descrito por primera vez en 1798 por Clarke. Este es un tumor no trofoblástico de la placenta, constituye una entidad poco usual y se reporta en 1 por ciento de las placentas examinadas microscópicamente, con evidencia clínica en aproximadamente 1:3 500 a 1:9 000 nacimientos. Presentamos el caso de una paciente de 21 años, con una historia obstétrica de embarazos 2, abortos 1, que es valorada en servicio de emergencias con embarazo a término con corioangioma gigante de la placenta. El ultrasonido muestra una imagen redondeada hipoecogénica que se interpreta como: cotiledón placentario aberrante. Se le realizó cesárea y se observa una tumoración redondeada en borde placentario con presencia de una red vascular evidente en su superficie. El ultrasonido es el medio que más favorece el diagnóstico, sobre todo el Doppler. La detección precoz y oportuna de esta afección permite la vigilancia fetal y la prevención de las complicaciones(AU)

Clarke first described Chorioangioma in 1798. This is a placenta non-trophoblastic tumor; it is an unusual entity and is reported in 1 percent of the placentas examined microscopically, with clinical evidence in approximately 1: 3 500 to 1: 9 000 births. We present the case of a 21-year-old patient, with an obstetric history of two pregnancies and one abortions, who is evaluated in emergency services with full-term pregnancy with giant placenta chorioangioma. Ultrasound shows a rounded hypoechoic image that is interpreted as aberrant placental cotyledon. A caesarean section was performed and a rounded tumor was observed on the placental border with the presence of an evident vascular network on the surface. Ultrasound is the way that most favors diagnosis, especially Doppler. Early and timely detection of this condition allows fetal monitoring and prevention of complications(AU)

Spontaneous necrosis of a giant placental chorioangioma: case report / Necrose espontânea de um corioangioma placentário gigante: relato de caso

Chorioangiomas are the most common benign placental tumors, with an estimated prevalence of 1%. Whilst small chorioangiomas usually remain asymptomatic and are of no clinical significance, larger tumors (>4cm) can be associated with a variety of complications, ranging from fetal anemia to in-utero demise in up to 40% of cases. Despite size being a major determinant for the risk of complications, the degree of the chorioangioma's vascularity also seems to play a role. In fact, in selected cases, occluding the tumors vessels (e.g. with alcoholic instillation) appears to improve the prognosis due to the subsequent tumor ischemia. We present the case of a 40-year-old woman who at 29 weeks was found to have a large placental hypervascular mass (93mm×66mm) and polyhydramnios, with an elevated peak systolic volume in the middle cerebral artery. She was given corticosteroids for fetal lung maturation, and throughout her admission both the volume of amniotic fluid stabilized and the peak systolic volume in the middle cerebral artery normalized, with changing of the ultrasonographic characteristics of the chorioangioma, with apparent progressive necrosis. At 34 weeks, a large subchorionic hematoma was found and, due to the risk of impending placental abruption, we opted to deliver by cesarean section, with a favorable outcome.(AU)

Corioangiomas são os tumores placentários benignos mais comuns, com uma prevalência estimada de 1%. Embora pequenos corioangiomas geralmente permaneçam assintomáticos e não tenham significância clínica, tumores maiores (> 4cm) podem estar associados a diversas complicações, que variam de anemia fetal até a morte intraútero em até 40% dos casos. Ainda que o tamanho do tumor seja um determinante principal para o risco de complicações, o grau da vascularidade do corioangioma também parece desempenhar um papel importante. De fato, em casos selecionados, a oclusão dos vasos tumorais (por exemplo, através de instilação de álcool) parece melhorar o prognóstico devido à subsequente isquemia tumoral. Apresentamos o caso de uma mulher de 40 anos a qual, com 29 semanas de gestação, apresentava grande massa hipervascular placentária (93×66mm) e poli-hidrâmnio, com elevação do peak systolic volume in the middle cerebral artery. Ela recebeu corticosteroides para a estimulação da maturação pulmonar fetal e durante a sua internação o volume de líquido amniótico foi estabilizado e o peak systolic volume in the middle cerebral artery normalizado, com mudança nas características ultrassonográficas do corioangioma, com necrose progressiva aparente. Com 34 semanas de gestação, observou-se a presença de hematoma subcoriônico de grande porte e, devido ao risco de descolamento prematuro da placenta, optou-se por parto cesariano, com desfecho favorável.(AU)

[Effect of oral morphine consumption on lacunas development in ten day placenta pregnant wistar rats]

Previous studies indicated that morphine consumption during pregnancy could inhibit embryos development. Present study further evaluated the effects of oral morphine consumption on the placenta lacunas development in ten day pregnant Wistar rats. Female Wistar rats [W: 170-200 gr] were used in the present study. Experimental group were received morphine [0.05 mg/ml of tap water] after one night coupling with male rats for mating. On the day 10th of pregnancy, the pregnant animals were killed with chloroform and the placentas and uterus were removed surgically and fixed in 10% formalin for twenty days. The fixed placentas were processed and stained by H and E method and evaluated for their development. Thickness of layers, surface area of lacuna, as well as the number of cells in both maternal and fetal parts of the placentas was assessed by light microscopy. Our results indicated that the layer thickness of fetal portion and surface area of lacuna of the fetal and maternal portion of placenta reduced in experimental group. In addition, maternal portion layer thickness and cell number of the fetal and maternal portion of placenta increased in the experimental group. Our results showed that oral morphine consumption could inhibit natural function of placenta lacuna and fetal cell development

Fisiopatologia da pré-eclâmpsia / Pathophysiology of preeclampsia

A pré-eclâmpsia é uma complicação da gravidez que ocorre no terceiro trimestre de gestação e é específica da gravidez humana. Ela é secundária a uma disfunção placentária, a qual é responsável pela liberação na circulação materna de diversas substâncias responsáveis por ativação e até lesão do endotélio materno, tendo como consequências hipertensão arterial, nefropatia glomerular e aumento da permeabilidade vascular. Trabalhos recentes têm permitido melhor compreensão da fisiopatologia desta patologia, com a esperança de desenvolver novos instrumentos de detecção e possíveis perspectivas terapêuticas. Este artigo ilustra os mecanismos fisiopatológicos da revascularização uterina defeituosa, da disfunção placentária e da disfunção endotelial que ocorrem no decurso da pré-eclâmpsia.

Caracterização da fusão caruncular em gestações naturais e de conceptos bovinos clonados / Characterization of the caruncular fusion in gestations of natural and cloned bovine conceptuses

O objetivo deste trabalho foi comparar as fusões carunculares em gestações de conceptos não clonados (CNC) e conceptos clonados (CC). Os CNC foram divididos segundo o período de gestação em Grupo I (2-3 meses, n=9), Grupo II (4-6 meses, n=9), Grupo III (7-8 meses, n=10) e Grupo IV (9 meses, n=7). Os CC formaram o Grupo V (9 meses, n=4). As carúnculas foram observadas macroscopicamente (número e dimensões: comprimento, largura e altura), microscopicamente e submetidas à análise estatística (5 por cento de significância). Observaram-se três tipos de fusões carunculares macroscópicas: ovais (morfologicamente normais); duas carúnculas adjacentes unidas e do tipo lobuladas, caracterizadas por regiões com várias carúnculas unidas apresentando falsa fusão ou deformação do parênquima caruncular. O comprimento das carúnculas foi de 1,55±0,57; 2,45±0,55; 4,66±2,00 e 5,72±1,90cm para os Grupos I, II, III e IV, respectivamente. Quanto à altura, as carúnculas apresentaram um crescimento linear durante a gestação e foram de 0,40±0,15; 0;57±0,21; 1,00±0,48 e 1,80±0,91cm, para os respectivos Grupos I, II, III e IV. A largura das carúnculas foi semelhante entre os Grupos I e II (0,97±0,30 e 1,42±0,71cm) e os Grupos III e IV (2,68±1,22 e 3,52±1,16cm). Quando o Grupo V foi comparado ao Grupo IV, as carúnculas do Grupo V apresentaram maior comprimento (5,72±1,90 vs. 7,88±2,13cm) e largura (3,52±1,16 vs. 4,93±1,46cm), porém foram semelhantes em altura (1,80±0,91 e 2,25±0,67cm). Verificou-se que em gestações de CC, as carúnculas apresentaram maior desenvolvimento que em gestações de CNC. As carúnculas fusionadas apresentaram medidas estatisticamente semelhantes às isoladas em todos os parâmetros e grupos. Sob microscopia de luz, observou-se a formação de um eixo estromal, da base da carúncula ao ápice da fissura fusional, de constituição histológica semelhante ao estroma endometrial. Também foram ineditamente definidos três formatos microscópicos: fusão propriamente ...

The objective of the study was to compare the characteristics of the caruncular fusion in gestations of non-cloned and cloned conceptuses. The non-cloned conceptuses were divided according to the gestation period: Group I (2 to 3 months; n=9), II (4 to 6; n=9); III (7 to 8; n=10) and IV (9 n=7). The cloned conceptuses formed the Group V: 9 months; n=4. The caruncles were observed macroscopically (number and dimensions: length, width and height), microscopically and submitted to statistical analysis (5 percent of significance). We observed three types of macroscopic caruncular fusions: oval (morphologically normal); two united adjacent caruncles and the lobulated type, characterized by regions with several united caruncles presenting a false fusion or deformation of the caruncular parenchyma. The length of the caruncles was 1.55±0.57; 2.45±0.55; 4.66±2.0 and 5.72±1.90cm for the groups I, II, III, IV respectively. As for the height, the caruncles presented a lineal growth during the gestation: 0.40±0.15; 0.57±0.21; 1.0±0.48 and 1.80±0.91cm, for the respective groups I, II, III and IV. The width of the caruncles was similar between the groups I and II (0.97±0.30 e 1.42±0.71cm) and the groups III and IV (2.68±1.22 and 3.52±1.16cm). When the group V was compared to the IV, the caruncles of the group V presented a larger length (5.72±1.90 vs. 7.88±.13cm) and width (3.52±1.16 vs. 4.93±1.46cm), however they were similar in height (1.80±0.91 and 2.25±0.67cm). We verified that in gestations of cloned conceptuses the caruncles presented a larger development than in gestations of non-cloned conceptuses. The fusioned caruncles presented measurements statistically similar to the isolated ones in all the parameters and groups. Under light microscopy, we observed the formation of a stromal axis from the basis of the caruncle to the apex of the fusional fissure, with the histological constitution similar to the endometrial stroma. Three microscopic shapes ...

Síndrome de Ballantyne: caso clínico / Ballantyne syndrome: a case report

Se describe un caso de síndrome de Ballantyne de una paciente de 33 años con embarazo de 33 semanas quien consultó por presentar edema en miembros inferiores, cefalea y escotomas. La ecografía fetal demostró la presencia de feto único en presentación cefálica, edema de cuero cabelludo, hidronefrosis, gran cantidad de líquido en cavidad abdominal y torácica fetal acompañado de compresión del corazón y los pulmones hacia la columna vertebral, realizándose el diagnóstico de hidrops fetal. Se realizó cesárea por sufrimiento fetal agudo obteniendo un recién nacido con edema generalizado. El examen patológico de la placenta confirmó el diagnóstico por la presencia de vellosidades hidrópicas e inmadurasAU)

A case of Ballantyne syndrome is described in a 33 years-old patient with a 33 weeks pregnancy who consulted for presenting lower limbs edema, headache and blurred vision. Fetal ultrasonography showed the presence of cephalic unique fetus, scalp edema, hydronephrosis, large amount of fluid in fetal abdominal and thoracic cavities accompanied with hearth and lungs compression to spinal cord, diagnosing fetal hydrops. Cesarean section was performed due to acute fetal distress obtaining a newborn with generalized edema. Pathological examination of placenta confirmed the presence on hydropic and immature placental villi

Changes of human placental alkaline phosphatase and acid phosphatase in prolonged pregnancy

The current study aims to investigate the pattern of distribution of alkaline and acid phosphatases in the placentas of prolonged pregnancies compared to that in those delivered at term. In addition, it also aims to determine whether the studied enzyme changes of prolonged pregnancy placentas represent a continuum that may begin before 42 week's gestation. This study examined placentas obtained from 220 non-hypertensive, non-diabetic, non-smoker, Rh[+] singleton pregnant women who delivered at Al-Batool Maternity Teaching hospital in Mosul city in over a period of two months extending from August 1[st] to September 30[th] 2005. These women were classified according to their accurately assigned gestational age into three groups: Group 1; includes women who delivered between 38-41 weeks of gestation [n=100], Group 2; includes women who delivered between 41-42 weeks of gestation [n=60], and Group 3; includes those who delivered beyond 42 weeks [n=60]. All placental sections of the three study groups were stained using alkaline phosphatase stain [Gomons method-cobalt] and acid phosphatase stain [Gomons method-lead]. The placentas of group I showed a moderate to marked reaction to alkaline phosphatase stain in the syncytiotrophoblasts with a very weak reaction in the villous stroma, and a moderate reaction in the maternal decidua; however, they showed a very weak reaction to acid phosphatase stain in both syncytiotrophoblasts and the villous stroma. Placentas in group 2 and 3 showed a marked reaction to alkaline stain in the syncytiotrophoblasts, while the villous stroma and the maternal decidua showed a moderate reaction with further decrease in the activity of acid phosphatase in both syncytiotrophoblasts and the villous stroma. Negative reaction to acid phosphatase stain was noticed in the maternal decidua in all groups. Prolonged pregnancy placentas showed increased alkaline phosphatase activity and reduction in acid phosphatase activity. In addition, the studied placental enzyme changes of prolonged pregnancies [including alkaline phosphatase and acid phosphatase] represent a continuum that may begin before 42 weeks gestation as most of these enzymatic changes are associated with pregnancies extended between 41-42 weeks

Stereological study of mice placental barrier after protein malnutrition

Investigations have been carried out on the effect of maternal protein free diet on the placenta of laboratory mice of Balb/C strain. The thickness of placental barrier was measured. Placental weight, fetal weight, fetal numbers were also calculated and histological study was also done. Animal husbandry and the day of conception were arranged. Pregnant mice were dissected at days [12[th], 14[th], and 18[th]] of gestation. Thirty placentas from mice on protein free diet and fifteen placentas from mice on control diet, were taken, stained by haematoxylin and eosin and examined under light microscope with screen. The following results are subsequently obtained: 1.Reduction in fetal number and weight of mice after protein malnutrition, in comparison to their control at the same stage of gestation. 2.Reduction in placental weight of mice after protein malnutrition, in comparison to their control at the same stage of gestation. 3. Reduction in the thickness of trophoblastic layers of placental barrier in mice after protein malnutrition, which are measured by using light microscope with screen and scientific ruler. 4.Morphological changes showed thin placental barrier, with basophilic cytoplasm and degenerated nuclei. Areas of degeneration infiltrated with phagocytic cells with increase in the number and size of blood vessels were seen. These changes may affect the placental function, which may be the main cause of decrease in fetal weight [intra uterine growth retardation], placental weight and fetal number

Fatores maternos e resultados perinatais no descolamento prematuro da placenta: comparação entre dois períodos / Maternal factors and perinatal results in placental abruption: a comparative study of two periods

OBJETIVOS: comparar o perfil dos fatores maternos, aspectos clínicos e os resultados perinatais no descolamento prematuro da placenta (DPP), em dois períodos. MÉTODOS: avaliação retrospectiva dos casos de DPP ocorridos entre 01 de janeiro de 1994 e 31 de dezembro de 1997 (período 94-97), e entre 1 de abril de 2001 e 31 de março de 2005 (período 01-05), em gestações únicas com peso do recém-nascido superior a 500 g e idade gestacional acima da 20ª semana. Foram analisados os fatores: idade materna, cor, antecedentes obstétricos, pré-natal, rotura prematura de membranas, intercorrências clínicas e/ou obstétricas, sangramento, tônus uterino, malformação fetal, tipo de parto, hemoâmnio e complicações maternas (histerectomia, atonia uterina, CIVD, insuficiência renal aguda e morte materna), e os resultados perinatais. RESULTADOS: no período 94-97, foram realizados 7692 partos e o DPP ocorreu em 0,78 por cento (60 casos), e, no período 01-05, foram 8644 partos com 0,59 por cento (51 casos) de DPP (sem diferença significativa). Observou-se diferença significativa entre os períodos 94-97 e 01-05 em relação à média do número de gestações (3,5±2,4 e 2,6±1,8; p=0,04), não realização de pré-natal (13,3 e 2,0 por cento; p=0,03) e intercorrências maternas (38,3 e 64,7 por cento; p=0,01). Não foram observadas diferenças significativas quanto ao sangramento, à alteração no tônus e aos resultados perinatais, entre os períodos, verificando-se apenas maior proporção de hemoâmnio no período 94-97 que no 01-05 (28,3 e 11,8 por cento, p=0,03). CONCLUSÕES: apesar dos avanços da obstetrícia, as complicações maternas e os resultados perinatais foram semelhantes nos períodos analisados. A gravidade e a imprevisibilidade do fenômeno alertam para a prevenção e controle adequados diante dos fatores associados ao DPP, na abordagem desta doença.

PURPOSE: to compare the maternal factors, clinical aspects and perinatal results in placental abruption during two periods. METHODS: retrospective analysis of placental abruption cases that occurred from January 1, 1994 through December 31, 1997 (period 94-97), and from April 4, 2001 through March 3, 2005 (period 01-05), in singleton delivery with birthweight higher than 500 g and after 20 weeks of gestation. The following factors were analyzed: maternal age, previous obstetric history, prenatal care, premature rupture of membranes, obstetric and/or clinical intercurrent events, vaginal bleeding, uterine tonus, fetal anomaly, mode of delivery, hemoamnion and maternal complication (hysterectomy, uterine atony, disseminated intravascular coagulation, acute renal failure, and maternal death), and the perinatal results. RESULTS: the rate of placental abruption was 0.78 percent (60 cases) in the period 94-97 (n=7692 deliveries), and 0.59 percent (51 cases) in the period 01-05 (n=8644 deliveries), without significant difference. A significant difference was observed between the periods 94-97 and 01-05 regarding mean number of previous gestations (3.5±2.4 and 2.6±1.8, p=0.04), patients without prenatal care (13.3 and 2.0 percent, p=0.03) and maternal intercurrences (38.3 and 64.7 percent, p=0.01). No significant difference was observed related to vaginal bleeding, tonus abnormalities and perinatal results, between the periods, but a higher proportion of hemoamnion in 94-97 was found when compared to 01-05 (28.3 and 11.8 percent, p=0.03). CONCLUSIONS: in spite of obstetrical advances, maternal complications and perinatal results were similar in the analyzed periods. The severity and the unexpected results emphasize the importance of prevention and adequate control of associated factors, when this pathology is approached.

Amadurecimento precoce da placenta avaliada pela ultra-sonografia e prognóstico perinatal / Early placental maturation evaluated by ultrasound and perinatal prognosis

OBJETIVO: descrever os resultados maternos e perinatais das gestações com amadurecimento precoce da placenta detectado pela ultra-sonografia. MÉTODOS: realizou-se estudo retrospectivo, descritivo, tipo série de casos, com comparação de grupos. Foram incluídas 146 gestantes, internadas entre janeiro de 2000 e dezembro de 2002 e em cujo prontuário constavam diagnóstico de amadurecimento precoce da placenta (presença de placenta grau II antes da 32ª semana de gestação ou grau III, antes da 35ª semana de gestação) e descrição das condições materno-fetais. Foram excluídas gestantes com diagnóstico de: amniorrexe prematura, gravidez múltipla, forma aguda de descolamento prematuro de placenta normoinserida e malformação fetal. As complicações clínico-obstétricas foram: doenças hipertensivas, redução do crescimento intra-uterino, alterações do volume de líquido amniótico, infecções, diabete materno, anemia falciforme, soropositividade para HIV, drogadição, litíase renal, epilepsia e asma brônquica. Pelos prontuários, foram identificadas 106 gestantes com complicações clínico-obstétricas (Gcom) e 40, sem essas complicações (Gsem). Para comparação entre os grupos, empregaram-se os testes de chi2 e exato de Fisher, ao nível de significância de 0,05. RESULTADOS: o grupo Gcom apresentou maior freqüência de oligoâmnio (27,3 por cento), restrição de crescimento intra-uterino (44,3 por cento) e cesárea antecedente ao trabalho de parto (36,8 por cento). Comparado ao grupo Gsem, o Gcom caracterizou-se por maior incidência de óbitos fetais, prematuros (58,8 versus 40 por cento), menor índice de Apgar de 5° minuto, peso ao nascer <2.500 g (67,9 versus 40 por cento), recém-nascidos pequenos para a idade gestacional (39,2 versus 10 por cento) e intercorrências mais graves. CONCLUSÕES: o prognóstico perinatal não dependeu do amadurecimento precoce da placenta, mas sim da presença de complicações clínico-obstétricas maternas.

PURPOSE: to describe perinatal and obstetric characteristics of pregnant women with ultrasonographic early placental aging. METHODS: using a retrospective, descriptive, series of cases, with group comparison, the authors analyzed the data of 146 pregnant women, whose diagnosis of placental early aging (presence of grade II placenta before 32 gestational weeks or grade III, before 35 gestational weeks), and maternal-fetal conditions had been recorded in the medical charts at the "Maternidade Prof. Monteiro de Moraes", Recife, Pernambuco Brazil, from January 2000 to December 2002, where they had been attended as inpatients. The exclusion criteria were diagnoses of: premature amniorrhexis, multiple pregnancies, acute premature detachment of a normally located placenta, and fetal malformation. The clinical and obstetric complications were: hypertensive diseases, intrauterine growth restriction, changes of amniotic fluid volume, infections, maternal diabetes, falciform anemia, HIV seropositivity, drug addiction, renal lithiasis, epilepsy and bronchial asthma. In the medical records, 106 pregnant women were identified as having clinical and obstetric complications (Gwith group) and 40 as not having any of these complications (Gwithout group). For group comparisons, chi2 and exact Fisher statistical tests were used, with significance level of 0.05. RESULTS: Gwith group was associated with higher incidence of oligoamnion (27.3 percent), intrauterine growth restriction (44.3 percent) and caesarean section prior to labor (36.8 percent). Compared to Gwithout, the Gwith group was characterized by high incidence of: fetal death, prematurity (58.8 percent versus 40 percent), lower 5th minute Apgar index, birth weight less than 2.500g (67.9 percent versus 40 percent); small body size for gestational age (39.2 percent versus 10 percent) and more severe intercurrents events. CONCLUSIONS: perinatal prognosis does not depend upon placental early aging, but...

Displasia mesenquimática placentaria / Placental mesenchymal dysplasia

Reportamos el primer caso en Chile de displasia mesenquimática placentaria que coexistió con un feto sano y cuyo curso clínico demostró un exitoso resultado perinatal. Se revisa la literatura y se definen las claves del diagnóstico diferencial.

Anatomical aspects of the placenta of the sloth, Bradypus variegatus, Schinz, 1825

Sloth plows euterians mammals, belonging to the order Edentata, sub-order Xenarthra, infra-order Tardigrada, family Bradipodidae, which comprehend three specimen, Bradypus tridadctylus, Bradypus variegates and Bradypus torquatus. They plows few work found in the literature related to the anatomy of the placenta of this specimen. The material used in this research was consisted of 3 placentas of Bradypus variegatus of adult females (Briton, 1941) original of the Forests of the City of Recife and Zone of the Forest of the State of Pernambuco with average weight 4,2 Kg. Placentas were fixed in buffered glutaraldehyed 4 per cent, pH 7,4, 0,1M and processed goes optical microscopy. Macroscopically was observed that the placenta of the sloth is composed of discoidal lobes and had the fundal position of the uterine cavity. The fetal membranes identified were chorium, applied on the uterine surface and, amnion adherent to inner face of chorium. In the specimen examined presented vestige of allantois sack and vitelline sack in these gestational phase. Anatomically, placenta of Bradypus variegatus could be classified like chorium-amniotic. Microscopic analysis of the placenta showed endothelial cells of maternal vessel hypertrophied and fetal components without cellular limits identified. The fetal tissue presented an epithelioid aspect with fetal vessel surrounded to connective tissue and epithelioid cells or next to maternal vessel. According our description, Placenta of Bradypus variegatus could be classified microscopically in syndesmochorial and endotheliochorial

El proceso de calcificación en la placenta humana / The process of calcification in human placental

Con el propósito de conocer el inicio del proceso de la calcificación placentaria y su evolución fueron analizadas con microscopía electrónica de transmisión, histoquímica de v.Kossa para calcio y microscopía electrónica de barrido muestras de placa basal procedentes de embarazo prolongado. Vesícula de matríz no fueron vistas. Densos agregados de minerales parecen fusionarse y formar gránulos cada vez mayores en la degeneración fibrinoide intracelular del sincitio, en células de placa basal, matríz extracelular, estroma vellositario y barrera placentaria. Glóbulos rojos, fibrina, fibrinoide y colágena son posibles núcleadores de cristales de hidroxiapatita. Gránulos que crecen para formar pequeños filamentos, barras y cuerpos tridimencionales irregulares, se ocacionan unos a otros por aposión para formar depósitos minerales en cualquier lugar de la placa basal. Vellosidades que se impregnan uniformemente de estos depósitos se fusionan y forman áreas de infartación calcificada. En conclusión, los resultados presentan imágenes del inicio y desarrollo de la calcificación distrófica

Presencia de IgG-Anti-helicobacter pylori en mujeres embarazadas y muestras sanguineas de cordon umbilical / The prevalence of IgG anti.H.pylori in pregnant women and serum samples from umbilical cord blood

En 50 sueros obtenidos de sangre venosa de mujeres embarazadas, sin afecciones gastroduodenales, y 50 muestras de sangre cordón umbilical, se analizó la presencia de IgG-anti H.pylori. En el 54 por ciento de las madres, se observaron títulos de IgG anti H.pylori. Todas las muestras de cordón umbilical obtenidas durante el parto del grupo de mujeres seropositivas para H.pylori. El 46 por ciento de las madres fueron negativas para IgG antio H.pylori al igual que las muestras apareadas obtenidas de cordón umbilical. Estos resultados sugieren que existe una transmisión de anticuerpos IgG anti.pylori a través de la barrera placentaria lo cual contribuye a la protección de los recién nacidos en contraer la infección con H.pylori. En la población pediátrica estudiada en edades comprendidas entre 10 meses y 10 años, se determinó la presencia de IgG anti H.pylori en un 62.5 por ciento de los niños, el 37.5 por ciento de esta población infantil fue seronegativa para H.pylori (P<0.0001)(

Amputación prenatal del pie en un recién nacido causado por bridas amnióticas / Amputation of a newborns's foot caused by amniotic bands

Introducción. Secundario a la ruptura del amnios, pequeños filamentos de éste pueden anudar estructura en desarrollo produciendo: constricciones anulares, pseudosindactilia, amputaciones intrauterinas y constricción del cordón umbilical. Este patrón de malformación conocido como secuencia de bridas amnióticas es en la mayoría de los casos de etiología desconocida. El riesgo de recurrencia es insignificante. Caso clínico. Se informa el caso de un recién nacido pretérmino, obtenido por cesárea debido a sufrimiento fetal agudo, en quien se encontró el pie derecho amputado incrustado en las membranas placentarias. Además, los dedos segundo, tercero y cuarto de la mano izquierda se observaron amputados a nivel de la articulación interfalángica distal. Conclusiones. Se considerá importante comunicar este caso de secuencia de bridas amnióticas en el cual se encontró el pie derecho amputado unido a las membranas fetales. Este caso ilustra la importancia de evaluar en forma sistemática la placenta ya que de otra manera este diagnóstico podría pasar inadvertido

Coagulation status and fibrinolytic activity in normal and abnormal pregnancy: case control study

Haemostatic and fibrinolytic activity changes during normal pregnancy particularly at the time of the placental separation. This study was designed to detect the changes in fibrinogen, plasminogen and factor XIII; and fibrin degradation products [FOPs], antiplasminogen and for the first time the "D-dimer" in different types of pregnancy associated complications. Twenty seven patients with aberrations of the pregnancy during first and second trimester and 26 patients with hypertensive disorders of pregnancy were compared to the 36 normal pregnancies. Plasminogen, fibrinogen and factor XIII showed a significant reduction in both abnormal groups compared to the normal pregnancy. The FOPs, antiplasminogen and the D-dimer, on the other hand showed a significant increase. These findings suggest using some of these parameters in early diagnosis of placental-associated abnormalities of the pregnancy

21 years statistic of perinatal mortality in a private hospital

21 years statistics of perinatal mortality at Baqai Medical College Hospital along with maternal and foetal factors are discussed. A comparison of booked and non-booked cases is also done. In conclusion some recommendations to reduce perinatal mortality in the community are suggested