Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: randomised controlled trial.

OBJECTIVE: To test the hypothesis that a relative deficiency in L-arginine, the substrate for synthesis of the vasodilatory gas nitric oxide, may be associated with the development of pre-eclampsia in a population at high risk. DESIGN: Randomised, blinded, placebo controlled clinical trial. SETTING: Tertiary public hospital in Mexico City. PARTICIPANTS: Pregnant women with a history of a previous pregnancy complicated by pre-eclampsia, or pre-eclampsia in a first degree relative, and deemed to be at increased risk of recurrence of the disease were studied from week 14-32 of gestation and followed until delivery. INTERVENTIONS: Supplementation with a medical food-bars containing L-arginine plus antioxidant vitamins, antioxidant vitamins alone, or placebo-during pregnancy. MAIN OUTCOME MEASURE: Development of pre-eclampsia/eclampsia. RESULTS: 222 women were allocated to the placebo group, 228 received L-arginine plus antioxidant vitamins, and 222 received antioxidant vitamins alone. Women had 4-8 prenatal visits while receiving the bars. The incidence of pre-eclampsia was reduced significantly (χ(2) = 19.41; P < 0.001) in women randomised to L-arginine plus antioxidant vitamins compared with placebo (absolute risk reduction 0.17 (95% confidence interval 0.12 to 0.21). Antioxidant vitamins alone showed an observed benefit, but this effect was not statistically significant compared with placebo (χ(2) = 3.76; P = 0.052; absolute risk reduction 0.07, 0.005 to 0.15). L-arginine plus antioxidant vitamins compared with antioxidant vitamins alone resulted in a significant effect (P = 0.004; absolute risk reduction 0.09, 0.05 to 0.14). CONCLUSIONS: Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia. Supplementation with L-arginine plus antioxidant vitamins needs to be evaluated in a low risk population to determine the generalisability of the protective effect, and the relative contributions of L-arginine and antioxidant vitamins to the observed effects of the combined treatment need to be determined. Trial registration Clinical trials NCT00469846.

[Analysis of the perinatal results of the first five years of the functioning of a clinic for pregnant teenagers]. / Análisis de los resultados perinatales de los primeros cinco años del funcionamiento de una clínica de atención para adolescentes embarazadas.

OBJECTIVE: To evaluate the perinatal outcomes within a pregnant cohort of adolescents aged 16 years and younger. PATIENTS AND METHODS: Case review prospective study. All pregnant adolescents who attended to the Coordination for assistance of the adolescent patient from June 1998 to July 2003 were included. INCLUSION CRITERIA: age, irrespective from antenatal care inside or outside of the Coordination and delivering inside the institution. Variables analyzed were: age, occupation, marital status, gestational age at first antenatal visit, number of antenatal visits, medical complications during pregnancy, gestational age on delivery, mode of delivery and contraceptive acceptance on discharge. Neonatal variables: weight at birth and intensive care admissions. Statistical analysis included descriptive measures. RESULTS: We identified 2723 pregnant adolescents, from whom only 2,315 met the inclusion criteria. Mean maternal age was 15.3 (SD 0.87). From the total 58% were single and 83.4% were households while only. Mean gestational age on first visit at the coordination was 24.26 (SD 6.79) weeks. The average number of antenatal visits was 4.78 (SD 3.99). The most frequent medical complications affected the genital and urinary tract, with a 54.2% of cervical and vaginal infections, and a 23.8% of urinary tract infections; anemia in 16.7%, threatened preterm delivery in 9.2% and pregnancy induced hypertension in 3.8%. From the total of cases the 79.1% presented with any morbidity. Mean gestational age concluded at 37.58 (SD 3.03), the preterm delivery rate was 15.4%. The most frequent way of delivery was vaginal with a 55.8% rate. On the neonatal outcomes, the mean birth weight was 2819.07 (SD 613.85). The contraceptive acceptance on the discharge was 98%. CONCLUSIONS: The adolescent pregnant has a high risk of suffering major complications, such as genital and urinary tract infections, anemia and preterm delivery.

[Quantification of perinatal risk in Mexican adolescents: consequences of maternal low weight]. / Cuantificación del riesgo perinatal en adolescentes mexicanas: consecuencias del bajo peso materno.

OBJECTIVE: To determine whether a pregnant adolescent whose weight-for-age is less than 90% is on the risk of delivering a baby who is small for gestational age. PATIENTS AND METHOD: Six hundred and one adolescents aged 12-16 years, at 40 weeks of gestation were included. Body weight was measured at baseline with Mexican reference tables. Low maternal weight was considered less than 90%. Rate of small for gestational age at birth was determined for each group. Comparisons were made using chi2 and relative risks were estimated. RESULTS: The rate of small for gestational age among adolescents with low body weight was 16.1% (30/186), it differed significantly (36/415) from the others (8.7%). Relative risk for small for gestational age babies among adolescents with low body weight was 1.9 (95% CI, 1.2 - 2.9). An exploratory analysis suggests that this effect depends on gestational age. CONCLUSIONS: If body weight of a pregnant adolescent is to be evaluated in the absence of a previous record, tables by Arroyo can be used as reference; if body weight is less than 90%, then you have an indicator of perinatal risk.

[Perinatal implications of pregnancy in adolescent women]. / Implicaciones perinatales del embarazo en la mujer adolescente.

OBJECTIVE: To establish if there are differences on obstetric and perinatal outcomes between adolescents who are younger than 16 with young adults aging 20 to 24 years old. PATIENTS AND METHOD: A double-cohort prospective and comparative study in 328 Mexican pregnant women. Cohort I included 153 pregnant adolescents younger than 16 years old and cohort II included 175 young adults aging 20 to 24 years old. Inclusion criteria for both groups were: healthy, singleton, primigravidas, with 4 or more antenatal care visits and delivery at institution. STATISTICAL ANALYSIS: descriptive, t-test, chi-squared and Fisher's exact test. RESULTS: Cohort I: Mean age, 15 years old. Mean gestational age on first visit, 22.35 +/- 6.75 weeks. Morbidity was due mainly by vaginitis and vaginosis (p = 0.0001), urinary tract infection (p = 0.110) and anemia (p = 0.0001). Maternal weight on first visit was 54.11 +/- 9.11 (p = 0.001). In cohort II mean maternal age was 22 years old with a mean gestational age on first visit of 19.58 +/- 7.94 weeks. Main morbidity was: urinary tract infections, vaginitis-vaginosis and preeclampsia (p = 0.191). Mean maternal weight on first visit was 60.37 +/- 9.99. Gestational age on delivery and birth weight were not statistically different between newborns in each group. CONCLUSIONS: Pregnancy in adolescents should be considered of risk; nevertheless, adequacy in antenatal care provides good obstetric and perinatal outcomes.

[Maternal morbidity in adolescent pregnancy]. / Morbilidad materna en la adolescente embarazada.

OBJECTIVE: To evaluate the maternal morbidity in < or = 16 year old pregnant teenagers. MATERIAL AND METHODS: A prospective study of the reviewed cases was carried out from June 1998 to May 1999. All pregnant teenagers which attended the Coordination for the Attention of the Teenage Patient and whose pregnancy came to term during the study period were included. The following variables were analyzed: maternal age, preexisting related diseases, number of pregnancies, number of prenatal control medical visits and the time at which these were started, and maternal morbidity secondary to pregnancy. RESULTS: Two hundred and ninety six of 330 case were included. The average maternal age was 15.1 years old (10-16 range); 68.9% had finished middle school; 82.2% were housekeepers, and 61.4% were single. Prenatal control was initiated in the 2nd trimester by 50.7% of them, while 39.5% started it in the 3rd trimester and the remaining 9.8% in the 1st trimester. The most frequent previous pathologies were: bronchial asthma (2.5%), drug addiction (2%), hypothyroidism (2%), cardiopathy (1.5%). The most common complications during pregnancy: urinary system infections (20.4%), anemia (9.8%), threats of premature labour (9.8%), premature membrane rupture (9%), hypertensive disease induced by pregnancy (3.2%), delayed intrauterine growth (2.4%) and fetal malformation (2.4%). About 44.1% of the pregnancies were interrupted by cesarean section, 35.6% by eutochia and 20.3% by instrumented labour. The most frequent complications during the puerperium were: tearing of the canal of the cervix (7%), decidual endometritis (3.3%), dehiscence of surgical wounds (2.7%), and pyelonephritis (1.6%). CONCLUSIONS: The pregnant teenager is a "special" patient form the biopsychosocial point of view, thus, she must be managed by a multidisciplinary team, with special emphasis in the problems analyzed in this study.

Morbilidad materna en la adolescente embarazada / Maternal morbidity in adolescent pregnancy

OBJECTIVE: To evaluate the maternal morbidity in < or = 16 year old pregnant teenagers. MATERIAL AND METHODS: A prospective study of the reviewed cases was carried out from June 1998 to May 1999. All pregnant teenagers which attended the Coordination for the Attention of the Teenage Patient and whose pregnancy came to term during the study period were included. The following variables were analyzed: maternal age, preexisting related diseases, number of pregnancies, number of prenatal control medical visits and the time at which these were started, and maternal morbidity secondary to pregnancy. RESULTS: Two hundred and ninety six of 330 case were included. The average maternal age was 15.1 years old (10-16 range); 68.9 had finished middle school; 82.2 were housekeepers, and 61.4 were single. Prenatal control was initiated in the 2nd trimester by 50.7 of them, while 39.5 started it in the 3rd trimester and the remaining 9.8 in the 1st trimester. The most frequent previous pathologies were: bronchial asthma (2.5), drug addiction (2), hypothyroidism (2), cardiopathy (1.5). The most common complications during pregnancy: urinary system infections (20.4), anemia (9.8), threats of premature labour (9.8), premature membrane rupture (9), hypertensive disease induced by pregnancy (3.2), delayed intrauterine growth (2.4) and fetal malformation (2.4). About 44.1 of the pregnancies were interrupted by cesarean section, 35.6 by eutochia and 20.3 by instrumented labour. The most frequent complications during the puerperium were: tearing of the canal of the cervix (7), decidual endometritis (3.3), dehiscence of surgical wounds (2.7), and pyelonephritis (1.6). CONCLUSIONS: The pregnant teenager is a "special" patient form the biopsychosocial point of view, thus, she must be managed by a multidisciplinary team, with special emphasis in the problems analyzed in this study.

[Perinatal outcome in patients with meconial amniotic fluid in labor]. / Resultado perinatal en pacientes con líquido amniótico meconial durante el trabajo de parto.

PURPOSE: To evaluate the perinatal morbidity and mortality with the presence of meconial amniotic fluid. MATERIAL AND METHODS: Retrospective study of case review, performed from 1st of June 1995 to May 1997. The patients included were at delivery, with a pregnancy of 32 weeks or older and had meconial amniotic fluid. The variables analyzed were: motherhood age, pre-existing associated illness, resolution of the pregnancy, PSS interpretation, fetal weight, Apgar and final destiny of the product. RESULTS: Of the 432 patients the motherhood aged varied from 13 to 43 years old, mean 27.4; with a number of pregnancies from 1 to 10, mean 2.25. The gestational age went from 32.2 to 42.4 weeks. The fetal weight varied form 1025 to 5080 g. The Apgar grade mean was 7 at the first minute and 8 at the fifth. The pregnancy was interrupted by cesarean in 52.5%. Although there was not a significant difference with the arterial gas, the density of the amniotic fluid did determine the final destiny of the product. CONCLUSIONS: There is a relation between the presence of amniotic fluid and the Apgar grade; both determining the final destiny of the product. When the amniotic fluid had thick meconium the products had a greater morbidity.

Evaluación comparativa de la densidad mineral ósea en mujeres mexicanas entre el osteodensitómetro de rayos X y de ultrasonido / Comparative evaluation of mineral bone density in mexican women with osteodensimeter of X ray and ultrasound

Con el cambio en el estilo de vida de la mujer se ha incrementado el tabaquismo, el consumo de bebidas con cafeína y el sedentarismo, por lo cual se intensifican los factores de riesgo y se favorece la descalcificación, constituyendo un problema de salud pública por el aumento en la incidencia de fracturas osteoporóticas conforme avanza la edad, sobre todo en la mujer posmenopáusica, la cual lleva a una mayor morbimortalidad secundaria a esta entidad, siendo una causa importante de discapacidad física, afectando en forma directa el bienestar psicoemocional de la mujer. Con el desarrollo de la tecnología, cada vez se cuenta con equipos de diagnóstico más sensibles y específicos para detectar la descalcificación en estas mujeres; se utilizaron dos métodos de osteodensitometría, uno a través de rayos X, y otro a través de ultrasonido en 138 mujeres en la etapa de la posmenopausia con un promedio de índice de masa corporal de 29. Se compararon ambos resultados de densidad ósea, puntuación de T, con osteopenia y osteoporosis. Se realizó doble densitometría a las 138 pacientes de columna lumbar con equipo DEXA, y de calcáneo con equipo DTU-one, por el mismo técnico, calculando la diferencia del puntaje de T en el doble estudio.

Complicaciones asociadas al uso de amniocentesis diagnóstica en la segunda mitad del embarazo, realizada con o sin guía ultrasonográfica continua / Complications associated with the utilization of diagnostic amniocentesis with or without guided continuous ultrasound performed in the second half of pregnancy

Objetivo: Identificar las complicaciones secundarias a la realización de amniocentesis diagnóstica (AD) cuando se realiza con y sin guía ultrasonográfica continua. Material y métodos: En el periodo de 1990 a 1997, se evaluaron un total de 473 amniocentesis, realizadas a 165 mujeres embarazadas (2.8 procedimientos por paciente). De las cuales, 197 se realizaron sin guía ultrasonográfica continua y 276 con guía ultrasonográfica continua. Se identificaron como complicaciones mayores a aquellas que llevaron a la finalización del embarazo: ruptura prematura de las membranas corioamnióticas, hemorragia transvaginal y contracciones uterinas no controladas. Se consideraron complicaciones menores a aquellas que se presentaron dentro de las primeras 72 horas posteriores al procedimiento y que no llevaron a la terminación del embarazo: repetición del número de punciones, contaminación hemática del líquido amniótico obtenido en la muestra, actividad uterina corregida y goteo de sangrado transvaginal. El análisis estadístico se realizó a partir de la diferencia de proporciones utilizando la prueba de c2. Resultados: En el grupo sin guía ultrasonográfica continua se incluyeron un total de 197 procedimientos, realizados en 68 mujeres embarazadas (2.9 procedimientos por caso). Se observaron un total de 62 complicaciones (31.5 por ciento): 5 mayores (2.5 por ciento) y 57 menores (28.9 por ciento). En el grupo con guía ultrasonográfica continua se incluyeron 276 procedimientos realizados en 97 mujeres embarazadas (2.8 procedimientos por caso). Se observo un total de 22 complicaciones (7.9 por ciento): 2 mayores (0.7 por ciento) y 20 menores (7.2 por ciento). La diferencia entre proporciones dio un valor de Ji cuadrada de 86.435, con un valor de p menor de 0.0001 Conclusiones: El uso de guía ultrasonográfica en la aplicación de procedimientos invasivos para el diagnóstico fetal, disminuye en forma importante los riesgos hacia el feto. La posibilidad de que se presente alguna complicación que lleve a la terminación del embarazo con un procedimiento sin guía ultrasonográfica es de 3 a 4 veces mayor. Se recomienda la utilización rutinaria del ultrasonido en la guía de procedimientos diagnósticos del estado fetal.

Choque en obstetricia. Experiencia intitucional / Shock in obstetrics. institucional experience

El estado de choque es uno de los problemas más difíciles a los que se puede enfrentar el ginecoobstetra. Una de las principales causas de choque es la hemorragia, problema que se presenta con cierta frecuencia en la obstetricia. Se realizó una investigación retrospectiva descriptiva en el Instituto Nacional de Perinatología desde el mes de enero de 1992 al mes de mayo de 1996. Se incluyeron todas las pacientes que ingresaron a la terapia intensiva con diagnóstico de choque. Se encontraron 90 casos con diagnóstico de choque, de los cuales 82 correspondieron al tipo hipovolémico y 8 al tipo séptico. El promedio de edad fue 32.2 años y la edad gestacional entre 6.2 a 41.4 semanas. Se encontraron 71 pacientes sin patología de base, 9 con enfermedad hipertensiva asociada, infertilidad o esterilidad en 2, miomatosis uterina en 2, diabetes mellitus en 2 y otras enfermedades en 5 casos. La causa más frecuente de choque hipovolémico fue el acretismo placentario (40 casos), seguido de alteraciones del tono uterino (37 casos), embarazo ectópico en 7 casos, ruptura o perforación uterina en 4 casos y laceraciones del canal del parto en 2 casos. La pérdida hemática estimada varió desde 2200 ml a 6500ml. La presión arterial mínima registrada tuvo un rango de 40/20 mmHg hasta 90/60 mmhg. El tratamiento médico se basó en la utilización de cristaloides, concentrados eritrocitarios y expansores del plasma en 73 casos (81.1 por ciento). Al grupo restante se agregaron además de lo anterior coloides, crioprecipitados y plaquetas. Un total de 76 pacientes requirió histerectomía total abdominal y 5 casos con histerectomía total y ligadura de hipogástricas, salpingectomía en 5 pacientes y reparación de ruptura o de perforación uterina en 3. Se presentó un promedio de tiempo quirúrgico de 2 horas con 33 minutos. Las complicaciones observadas fueron 7 casos con absceso de cúpula, 2 con coagulopatía de consumo, una lesión vesical, una oclusión intestinal y una fístula vesicovaginal. El promedio de estancia fue de 5 días. La causa más frecuente de choque en obstetricia es la hemorragia para el tipo hipovolémico, seguido del choque séptico. En cuanto al manejo de las pacientes en estado de choque, la reposición volumétrica y restitución de la oxigenación son las metas principales, así como la oportuna intervención y rápida decisión de una cirugía radical que evitará el mayor deterioro de la paciente y la mortalidad materna

Eficacia de Sulbactam/Ampicilina en la profilaxis de infecciones postquirúrgicas en gineco-obstetricia: estudio abierto comparativo / Eficacy of sulbactam/Ampicillin in prophylaxis of post-surgical infections in gyneco-obstetries. open comparative study

Se llevó a cabo un estudio multicéntrico, abierto, comparativo, de distribución al azar, para conocer el efecto como profiláctico de infecciones post-quirúrgicas en gineco-obstetricia, de la combinación de Sulbactam/Ampicilina vs. la no adminstración del fármaco. Se incluyeron 100 pacientes, 50 en cada grupo, a las que se le practicó tipo de cirugía gineco-obstetricia. Las pacientes en el grupo de Sulbactam/Ampicilina recibieron el fármaco en dosis de 0.5/1.0 g, por vía intravenosa en el momento del acto quirúrgico, lo cual se repirió 6 horas después. En este grupo no hubo ninguna infección post-quirúrgica, mientras que en el grupo que no recibió medicamento profiláctico se presentaron 4 casos de infección post/quirúrgica. Se concluye que la combinación de Sulbactam/Ampicilina es eficaz como tratamiento profiláctico en este tipo de cirugía además de ser bien tolerado y fácil de administrar

Hemorragia peri-intraventricular en neonatos de pretermino con peso inferior a 1,000g., y su posible relación con la vía de nacimiento / Peri-intraventricular hemorrhage in newborns of pre-term with weight less than 1,00g. and its possible relatronship with via of delivery

Se presenta el estudio de ultrasonido cerebral en 20 neonatos de pretérmino con peso igual o inferior a 1,00g. Se dividieron en dos grupos: 15 nacidos por via vaginal y 5 nacidos por operación cesárea. Se encontró una frecuencia mayor de hemorragia cerebral en los recién nacidos de pretérmino obtenidos por vía vaginal en comparación con los extraídos por intervención cesárea. Se comentan las diversas causas por las que el cerebro del producto de pretérmino es más vulnerable a la hemorragia. El cambio de conducta para el nacimiento de productos de pretérmino debe esperar la sanción del tiempo y estudios más controlados sobre el tema

Morbimortalidad en la paciente lúpica embarazada / Morbimortality in pregnant lupus patient

Se estudiaron los expedientes de 14 pacientes con diagnóstico certero de lupus eritematoso sistémico (LES) asociado al embarazo, en el periodo comprendido entre noviembre de 1986 a julio de 1988 en el Hospital Regional "20 de Noviembre", del ISSSTE. Se evaluaron las siguientes variables: edad materna, edad de inicio del LES, critérios del lupus que presentaban las pacientes en la fase aguda de la enfermedad, antecedentes ginecoobstétricos, atención prenatal, semanas de gestación, estudios de laboratorio, tratamiento anteparto transporto y postparto, datos del recién nacido y complicaciones maternas. El 50% de las pacientes tenían antecedentes de aborto, hubo un alto porcentaje de partos pretérmino (42.85%); 71.42% de las pacientes cursaron con hipertensión arterial; 64.31% tuvo anemia; el tratamiento fue a base de corticoides y fármacos antihipertensivos; se encontró una relación significativa entre los valores de complemento hemolítico disminuido y peso del producto