Prevalence and clinical usefulness of antiphospholipid and anticofactor antibodies in different Spanish preeclampsia subsets.

OBJECTIVE: To study the prevalence and clinical usefulness of antiphospholipid antibodies in different preeclampsia subsets. DESIGN: Observational cross-sectional study. SETTING: Tertiary teaching hospital. PATIENTS: Ninety-nine women with preeclampsia versus 83 healthy pregnant women as controls. INTERVENTIONS: We analysed anticardiolipin IgG/IgM, anti-ß(2)glycoprotein IgG/IgM, antiphosphatidylserine IgG/IgM, antiAnnexin-A5 IgG/IgM, and lupus anticoagulant. MAIN OUTCOME MEASURE: Comparison of antiphospholipid antibody positivity between groups. RESULTS: Antiphospholipid antibody prevalence was 14.14% in the study group vs. 7.23% in controls. Excluding antiAnnexin-A5-positive women, overall antiphospholipid prevalence was 13.19% vs. 3.61% (p = 0.034). Only IgM-anticardiolipin positivity showed significant differences between preeclampsia group and controls (8.1% vs. 1.20%, p = 0.041). Comparing a severe preeclampsia subset vs. controls, we obtained these significant results: for two or more positive antiphospholipid tests: 9.09% vs. 1.20 (p = 0.037); IgM-anticardiolipin 10.91% vs. 1.20% (p = 0.016); IgG/IgM-anti-ß(2)glycoprotein-I 10.91% vs. 1.90% (p = 0.016), IgM-anti-ß(2)glycoprotein-I 9.09% vs.1.20 (p = 0.037). When comparing early-onset preeclampsia vs. controls we found IgM-anticardiolipin 11.11% vs. 1.20% (p = 0.029). CONCLUSIONS: Prevalence of antiphospholipid antibodies in preeclampsia patients is twice that in healthy pregnant women. Multipositive aPL test, IgM-anticardiolipin and IgM-anti-ß(2)glycoprotein-I isotypes showed an association with severe and early-onset preeclampsia. Larger studies are needed to establish the usefulness of antiphospholipid tests as risk markers for severe and early onset preeclampsia.

Consideraciones actuales sobre la prevención de la transmisión vertical del estreptococo β - hemolítico del grupo B / Current considerations on the prevention of vertical transmission of group B beta´hemolytic streptococcus

La sepsis bacteriana del neonato es un síndrome clínico caracterizado por signos de infección sistémica acompañados de bacteriemia. Denominamos infección neonatal de transmisión vertical aquella que es transmitida por la madre al feto o al recién nacido (RN) durante el embarazo, el parto el período neonatal. Las bacterias implicadas son las que se encuentran en el canal del parto que en su mayoría son de baja virulencia, pero ocasionalmente pueden infectar a la madre o al RN. Actualmente el principal agente de infección bacteriana de transmisión vertical es el Streptococcus agalactiae (estreptococo β – hemolítico del grupo B) (EGB), siendo menos frecuente la infección por Escherichia coli y otros bacilos gran negativos y se suele observar, sobre todo, en RN prematuros y de muy bajo peso (AU)

Neonatal bacterial sepsis is a clinical syndrome characterized by signs of systemic infection accompanied by bacteriemia. Neonatal infection due to vertical transmission refers to that which is transmitted by the mother to the fetus or to the newborn (NB) during the pregnancy, delivery and neonatal period. The bacterias involved are those found in the delivery canal, which mostly have low virulence, but they may sometimes infect the mother or NB. Currently the primary agent of vertical transmission bacterial infection is the Streptococcus agalactiae (group B β-hemolytic streptococcus) (EGB) infection by Escherichia coli and other gram negative bacilli being less frequent and it is generally observed, above all, in premature very low weight NB (AU)

La cesárea / Caesarean section

En los últimos años estamos viviendo un aumento en la tasa de cesáreas. Por ello realizamos una valoracion de suó distintas indicaciones médicas y paramédicas con el fin de intentar acercarnos a tomar las decisiones que supongan un mayor beneficio materno-fetal. La cesárea a demanda supone uno de los aspectos más polémicos en este momento

In the past 20 years we are attending to a continuous increase in the rate of caesarean section. Because of this we try to analize the different clinical and non clinical indications for caesarean section in order to decide the best for mother and fetus. Moreover we discuss the actual controversy of caesarean section “on maternal request”

Presentación podálica / Breech presentation

El parto de nalgas plantea uno de los principales problemas al ginecólogo hoy en día. Dada la actual tendencia a asistirlo mediante cesárea, se revisan en este capítulo las posibles vías del parto de nalgas que presentan una menor morbilidad y mortalidad materna y perinatal, tanto en partos pretérmino como a término, únicos o múltiples. Sometemos a valoración la utilidad de la versión externa en la actualidad así como la importancia de la experiencia del obstetra en la decisión sobre la actitud a tomar

Breech delivery is one of the principal problems in the actual gynaccology. Nowadays gynaecologists tend to practice caesarean section in breech presentations. In this article we try to review delivery ways that present lower mother and perinatal morbidity and mortality in preterm as well as term pregnancies and single or multiple pregnancies. Moreover we try to study the utility of external podalic version and underline the importance of obstetric experience when deciding the way of delivery

Biopsia corial transabdominal en el primer trimestre: resultados en 803 casos con seguimiento neonatal / Transabdominal chorion villi sampling in the first trimester: results in 803 cases with neonatal follow-up

Fundamentos: La biopsia corial transabdominal se ha empleado en algunos grupos como una técnica de elección para el diagnóstico prenatal en el primer trimestre. Objetivo: Estudiar la seguridad y fiabilidad de la biopsia corial transabdominal mediante aspiración con aguja en el primer trimestre. Pacientes y métodos: Estudio prospectivo. Pacientes con indicación para estudio prenatal mediante biopsia corial, feto único y edad gestacional comprendida entre las 9 y las 12 semanas. Resultados: Las indicaciones más frecuentes para la biopsia corial fueron el estudio del cariotipo (82,19 per cent) y de enfermedades mendelianas (17,81 per cent).Se obtuvo material con una punción en el 95,98 per cent de los casos. El porcentaje de discrepancias fue del 1,9 per cent. Hubo un 15,2 per cent de pérdidas gestacionales totales de las cuales un 10 per cent correspondió a anomalías cromosómicas y génicas. La tasa de pérdidas gestacionales incluyendo muertes perinatales en fetos con estudio normal fue del 5 per cent. Conclusiones: La biopsia corial transabdominal es una técnica fiable y segura en nuestro medio (AU)

Aceptación de la amniocentesis como técnica invasiva para estudio del cariotipo fetal / Acceptance of amniocentesis as an invasive technique for fetal karyotiping

Objetivo: Estudiar el grado de aceptación de la amniocentesis y sus diferencias en función de la indicación entre las pacientes con riesgo secundario a la edad y riesgo secundario al cribado bioquímico. Métodos: Se incluyó a las gestantes referidas a la unidad de diagnóstico prenatal para estudio de cariotipo fetal durante un período de 7 años. Las pacientes fueron clasificadas en dos grupos según la indicación: grupo I (edad) y grupo II (cribado indicativo). Resultados: Se incluyó a 9.227 mujeres: 4.859 con la indicación de edad materna y 4.368 con indicación por cribado bioquímico. Rechazaron la amniocentesis 176 gestantes en el grupo I (el 3,62 per cent; intervalo de confianza (IC) del 95 per cent, 3,35-3,89 per cent) y 152 mujeres en el grupo II (el 3,48 per cent; IC del 95 per cent, 3,32-3,75 per cent). Tras un período de reflexión, reconsideraron su decisión 21 pacientes en el grupo I (12 per cent) y 22 en el grupo II (14 per cent). Conclusiones: La tasa de aceptación de la amniocentesis en nuestro centro fue del 96,92 per cent (IC del 95 per cent: 96,74-97,1 per cent). (AU)

Strategies for the modification of risk factors in gynecological cancers.

Strategies to modify risk for female or gynecological cancers will vary with our knowledge of the epidemiology, etiology, and specific molecular mechanisms for each individual cancer. In general, cancer preventive strategies have been divided into primary and secondary prevention with primary prevention directed toward the causative factors for a disease. Secondary prevention is classically used in cervical cancer cytology screening programs and is essentially an attempt to identify individuals in a population with preclinical phases of the disease where intervention will impact mortality the most. A vast literature has evolved regarding the epidemiology of most of the common cancers in women. While the specific molecular mechanisms are not completely understood at this time knowledge of contributing factors for many of these tumors is well known. The association of cigarette smoking with lung cancer has been well established and the increasing rates of lung cancer, particularly in women, are directly linked to the increasing number of female smokers in the population. Indeed in many western countries lung cancer deaths have overtaken breast cancer as the most common cause of death from malignant disease in women. Excessive sun exposure without adequate skin protection is another lifestyle activity that is related to the high incidence of skin cancer in certain areas. Epidemiologically, cervical cancer has been studied extensively with the current data indicating a causal role of exposure to human papillomavirus (HPV), particularly at an early age in this disease. Hereditary breast and ovarian cancer syndromes are well understood and as more information on human genomics becomes available a clear understanding of the underlying molecular mechanisms of these diseases will be possible and hopefully will result in effective strategies for their control. Unfortunately, in spite of the vast knowledge that is available regarding risk factors for many of these malignancies we have been unable to influence effective lifestyle changes that could substantially reduce the risk of these malignancies in our population. Increased efforts in education, research, and commitment--both financial and educational--are required by governments and other social organizations.

Acute fatty liver of pregnancy.

Acute fatty liver of pregnancy can produce a great variety of complications. Of these, infections are important. We describe two cases, one of them complicated with uterine sepsis. Both gave evidence of the necessity for multidisciplinary treatment, which reduces the maternal-fetal morbidity and mortality produced by this disease.

[Evaluation of three rapid methods for intrapartum detection of group B streptococcus]. / Evaluación de tres técnicas rápidas para la detección intraparto del estreptococo del grupo B.

OBJECTIVE: The goal of this study was to evaluate three methods for rapid group B streptococcus (GBS) intrapartum vaginal detection. MATERIALS AND METHODS: In 330 women, at risk of delivering an infant with GBS disease, vaginal exudates were collected and a culture performed. The following rapid tests were also performed: 1) Equate Strep B immunoassay in 133 samples. 2) Icon Strep B immunoassay in 192 samples. 3) Co-agglutination with Phadebact Strep B, with a previous incubation (> 4 hours) of the vaginal swabs in Lim Group B Strep broth, in 88 samples. In some patients, two of these methods were performed simultaneously. RESULTS: GBS was detected in 37 women (11.2%) by culture. The sensitivity of Equate Strep B was 47%, Icon Strep B was 35% and co-agglutination with Phadebact Strep B was 38%. The specificity was 91%, 99% and 100% for each one of these methods. PPV 44%, 90% and 100%, respectively and NPV 92%, 91% and 90%, respectively. CONCLUSION: In conclusion, none of these methods was shown sensitive enough to be used for the routine detection of GBS. Therefore, in order to know the GBS carrier status and prevent its vertical transmission, the practice of vaginal culture during late pregnancy is mandatory.

[Characteristics of group b streptococcus vertical transmission]. / Características de la transmisión vertical madrefeto del estreptococo del grupo B.

OBJECTIVE: The goal of this study was to compare the characteristics of group B streptococcus (GBS) or Streptococcus agalactiae vertical transmission in woman, receiving or not intrapartum. antimicrobial prophylaxis, at risk of delivering an infant with GRS disease. MATERIALS AND METHODS: The study included 330 women, with risk factors for delivering an infant with GBS disease. The vaginal GBS colonization was studied by conventional culture. A clinical and microbiological follow-up was done in both women and neonates. RESULTS: GHS was detected in 37 women (11.2%). Among these, 21 (56.8%) received intrapartum antibiotics and 16 (43.2%) did not. Forty-one neonates were born from these 37 women. Of these, 11 showed signs of infection (3 with positive blood culture and 8 with blood culture negative for GBS) and 2 presented an asymptomatic bacteremia A GBS neonatal infection (with positive blood culture) was produced in 4.8% of newborns from mothers who received intrapartum antibiotics versus 25% of newborns from mothers who did not receive intrapartum antibiotics. However, this difference was not significant nor was the difference between external colonization by GBS between these two groups of newborns. On the contrary, significant differences were found in the percentage of clinically suspected sepsis (with negative blood cultures), which was more frequent among newborns from mothers without intrapartum antibiotics (30.4% vs 5.6%). A good correlation between the intensity of vaginal colonization and the incidence of microbiologically demonstrated sepsis, suspected sepsis an asymptomatic bacteremia in the newborn was found. CONCLUSION: In conclusion, in order to minimize the vertical transmission of GBS, the most efficient strategy seems to be to offer antibiotic prophylaxis to women identified as GBS carriers, since the antibiotic administration to women with "obstetric risks" often means that it is impossible that two hours elapse between antibiotic administration and delivery, resulting in the loss of efficacy of this second strategy.