Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension.

The purpose of this study is to compare the levels of maternal serum pregnancy-associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6-0.9) and GH groups (0.5 IQR: 0.3-1.4) compared to the PE group (1.06 IQR: 0.66-1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08-1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59-0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66-1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.

Placenta previa: risk factors and impact on maternal and neonatal morbidity and mortality in Bogotá, Colombia / Placenta previa: factores de riesgo e impacto en la morbimortalidad materno-perinatal en Bogotá, Colombia

Abstract Introduction: Placenta previa can cause bleeding during the second half of pregnancy and may compromise the health of both the mother and the fetus. Knowing the associated risk factors allows for the early identification of pregnant women at high risk of placenta previa. Objective: To describe the risk factors for placenta previa in a sample of pregnant women treated in Bogotá D.C., Colombia, as well as their maternal and perinatal morbidity and mortality. Materials and methods: Retrospective descriptive study. 17 pregnant women diagnosed with placenta previa and admitted to the High Obstetric Risk Unit of a tertiary care hospital between 2013 and 2017 were included. Medical records were reviewed to collect data on risk factors for placenta previa and clinical and sociodemo-graphic characteristics. In the descriptive analysis, means and standard deviations and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Results: The most frequent risk factors were >4 pregnancies (64.70%), maternal age >35 years (29.41%), and history of miscarriage (29.41%). Maternal morbidity was higher than fetal morbidity: three patients required transfusion of blood products, and another underwent a subtotal hysterectomy, while no perinatal complications were reported, with the exception of one stillbirth. Conclusions: A history of miscarriage, >4 pregnancies, and maternal age >35 years were the most frequent risk factors. Furthermore, the degree of maternal-perinatal complications did not depend on the type of placenta previa. Knowing which pregnant women are at higher risk of placenta previa as a result of the early identification of these risk factors allows for a better clinical approach, reducing morbidity and mortality rates in both the mother and the child.

Resumen Introducción. La placenta previa puede causar hemorragias en la segunda mitad del embarazo que pueden llegar a comprometer la salud materno-perinatal. Conocer los factores de riesgo asociados permite identificar tempranamente gestantes con alto riesgo de placenta previa. Objetivo. Describir los factores de riesgo de placenta previa en una muestra de gestantes atendidas en Bogotá D.C., Colombia, así como su impacto en la morbimortalidad materno -perinatal. Materiales y métodos. Estudio descriptivo retrospectivo. Se incluyeron 17 gestantes diagnosticadas con placenta previa que ingresaron entre 2013 y 2017 a la Unidad de Alto Riesgo Obstétrico de un hospital de tercer nivel. Se revisaron las historias clínicas para recolectar datos sobre factores de riesgo y características clínicas y sociodemográficas. En el análisis descriptivo, para las variables cuantitativas se calcularon medias y desviaciones estándar y para las cualitativas, frecuencias absolutas y relativas. Resultados. Los factores de riesgo más frecuentes fueron haber tenido >4 embarazos (64.70%), edad materna >35 años (29.41%) y aborto previo (29.41%). La morbilidad materna fue mayor que la fetal: 3 pacientes requirieron transfusión de hemoderivados y en otra fue necesario realizar histerectomía subtotal, mientras que no se reportaron complicaciones perinatales, a excepción de un mortinato. Conclusiones. Haber tenido >4 embarazos, tener una edad materna >35 años y el antecedente de aborto fueron los factores de riesgo más frecuentes; además, el grado de las complicaciones materno-perinatales fue independiente del tipo de placenta previa. Saber cuáles son las gestantes con mayor riesgo de presentar esta condición mediante la identificación temprana de estos factores permite brindarles un mejor abordaje clínico, lo que permitirá disminuir la morbimortalidad del binomio madre-hijo.

Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses / Comportamento dos marcadores genéticos na triagem durante o primeiro trimestre de gravidez em fetos euploides

Abstract Objective This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses. Methods This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05. Results We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of β subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A. Conclusion Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.

Resumo Objetivo Este estudo tem como objetivo descrever o comportamento do rastreamento de cromossomopatias em fetos euploides. Métodos Trata-se de um estudo prospectivo descritivo com 566 pacientes, entre 11 e 14 semanas de gestação. A associação entre a ultrassonografia e as variáveis sorológicas foi estudada. Para as variáveis quantitativas foi utilizado o teste de Spearman; para as qualitativas com variáveis quantitativas foi utilizado o teste U de Mann-Whitney e para as variáveis qualitativas foi aplicado o teste X2. A significância foi fixada em p ≤ 0,05. Resultados Constatou-se que a idade gestacional tem correlação com o ducto venoso, translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana, proteína plasmática A associada à gravidez e fator de crescimento placentário; há também correlação entre a história de abortos e o osso nasal. Além disso, correlacionamos o índice de massa corporal com translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. A idade materna foi relacionada com fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. Conclusão Nosso estudo demonstra pela primeira vez o comportamento dos marcadores bioquímicos e ultrassonográficos de triagem de cromossomas durante o primeiro trimestre em fetos euploides na Colômbia. Nossa informação é consistente com a referência de valores internacionais. Além disso, mostram-se as relações das diferentes variáveis com as características maternas para determinar as variáveis capazes de ajudar no desenvolvimento de um processo de rastreamento durante o primeiro trimestre com alta taxa de detecção.

Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses.

OBJECTIVE: This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses. METHODS: This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05. RESULTS: We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of ß subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of ß subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of ß subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A. CONCLUSION: Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.

OBJETIVO: Este estudo tem como objetivo descrever o comportamento do rastreamento de cromossomopatias em fetos euploides. MéTODOS: Trata-se de um estudo prospectivo descritivo com 566 pacientes, entre 11 e 14 semanas de gestação. A associação entre a ultrassonografia e as variáveis sorológicas foi estudada. Para as variáveis quantitativas foi utilizado o teste de Spearman; para as qualitativas com variáveis quantitativas foi utilizado o teste U de Mann-Whitney e para as variáveis qualitativas foi aplicado o teste X2. A significância foi fixada em p ≤ 0,05. RESULTADOS: Constatou-se que a idade gestacional tem correlação com o ducto venoso, translucência nucal, fração livre da subunidade ß da gonadotrofina coriônica humana, proteína plasmática A associada à gravidez e fator de crescimento placentário; há também correlação entre a história de abortos e o osso nasal. Além disso, correlacionamos o índice de massa corporal com translucência nucal, fração livre da subunidade ß da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. A idade materna foi relacionada com fração livre da subunidade ß da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. CONCLUSãO: Nosso estudo demonstra pela primeira vez o comportamento dos marcadores bioquímicos e ultrassonográficos de triagem de cromossomas durante o primeiro trimestre em fetos euploides na Colômbia. Nossa informação é consistente com a referência de valores internacionais. Além disso, mostram-se as relações das diferentes variáveis com as características maternas para determinar as variáveis capazes de ajudar no desenvolvimento de um processo de rastreamento durante o primeiro trimestre com alta taxa de detecção.

First trimester placental growth factor in maternal blood and placenta related disorders.

OBJECTIVE: To describe and compare the placental growth factor levels at first trimester in patients that developed preeclampsia, gestational hypertension, IUGR and in those patients without impaired placentation diseases. METHODS: Observational study based on a prospective cohort of 422 pregnant women. PlGF values were compared between the different groups (preeclampsia, intrauterine growth restriction (IUGR), gestational hypertension or normal group-patients without impaired placentation diseases). RESULTS: The 85.3% (n = 360, 95% CI = 81.9-88.7) had a normal pregnancy, 7.6% (n = 32, 95% CI = 5.1-10.1) had preeclampsia, 3.8% (n = 16, 95% CI = 2.0-5.6) had IUGR and 3.3% (n = 14, 95% CI = 1.6-5.0) had gestational hypertension. The median level of PlGF for preeclampsia (0.76) and IUGR (0.75) were lower than gestational hypertension (0.82) and normal group (1.02). The groups of preeclampsia >34 weeks (0.76), preeclampsia <37 weeks (0.73), and preeclampsia ≥37 weeks (0.77), were significantly lower than the normal group. The sensitivity and specificity of PlGF for impaired placentation diseases is 65% and 64.9%, respectively. CONCLUSION: It was found in this study that PlGF has significantly lower levels in gestational hypertension than normal pregnancies, in concordance with the other impaired placentation diseases. Additionally, a better comparison of the PlGF values was obtained when separating early onset of preeclampsia <37 weeks and late-onset of preeclampsia 37≥ weeks of gestations.

Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high-risk population.

AIM: To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. METHODS: This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. RESULTS: For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. CONCLUSION: Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.

Preventive measures to avoid vertical transmission in untreated pregnant women with HIV/AIDS.

The HIV/AIDS during pregnancy has high morbidity and mortality, without optimal prevention and treatment. The advanced stage cases are found in developing countries due to late detection, but, also in developed countries due to immigration; therefore, the professionals should know the management steps for these patients. The implementation of specific interventions can reduce vertical transmission incidence until 1%-8%. It is presented a case of a pregnant woman with AIDS detected during first hospitalisation, due to a ventilatory failure by opportunistic germs; at the delivery the specific interventions were implemented, being able to eliminate vertical transmission to the newborn. This article explains the four main aspects to be considered for reducing vertical transmission (detection of HIV, viral load levels-CD4 lymphocyte count, way and moment of childbirth and antiretroviral therapy) and shares experiences of the management of an advanced case, in order to help professionals to handle these cases and its complications.

Correlación entre características físicas neonatales y maternas con el recuento total de células nucleadas y de células cd34+ por microlitro en sangre de cordón umbilical / Correlation between neonatal and maternal physical characteristics with total nucleated cell count and cell count per microliter cd34+ in cord blood / Correlação entre características físicas neonatais e maternas com a contagem total de células nucleadas e células cd34 + por microlitro no sangue do cordão umbilical

Introducción: La sangre de cordón umbilical (SCU) ha sido reconocida como una fuente de células madre hematopoyéticas. Múltiples estudios han sido realizados con el propósito de determinar variables maternas y neonatales que afecten el volumen, el recuento total de células nucleadas y de células CD34+. El presente estudio correlaciona variables maternas y neonatales con el recuento total de células nucleadas y de CD34+ medidas en μL (microlitro). Materiales y Métodos: Estudio correlacional en el que se analizaron 50 muestras de sangre de cordón umbilical de gestantes atendidas en dos IPS, una de Bogotá y otra de Ubaté, (Cundinamarca), durante un período de 7 meses del año 2013. La selección de estas muestras fue basada en un muestreo no probabilístico. Se calculó el coeficiente de correlación de Pearson con su respectiva significancia estadística entre las variables cuantitativas de la madre y del neonato, y el volumen, el recuento de células CD34+ y el recuento total de células nucleadas por μL. Resultados: Se encontró correlación positiva entre la longitud del cordón y el recuento total de células nucleadas. Así mismo entre el volumen inicial de la muestra y el recuento total de células nucleadas y el recuento de células CD34+ en μL y en mL (mililitro). Discusión: Múltiples estudios se han desarrollado entorno a la búsqueda de variables maternas y neonatales que afectan la calidad de la muestra. En Colombia no se habían descrito las correlaciones encontradas en el presente estudio. Es por ello, que el desarrollo de nuevos estudios con diseños analíticos será enriquecedor.

Background: The cord blood has been recognized as a source of hematopoietic stem. Multiple studies have been conducted in order to determine maternal and neonatal variables that affect the volume, total nucleated cell count and CD34+ cells. This study correlated maternal and neonatal variables with the total nucleated cell count and CD34+ cells measured by μL. Materials and methods: Correlational study in which 50 samples of umbilical cord blood were analyzed of pregnant women at two health institutions, one at Bogotá and the other one at Ubaté, Cundinamarca, for a period of seven months of 2013. The selection of these samples was based on a non-probability sample. The Pearson correlation coefficient was calculated with their respective statistical significance between quantitative variables of mother and newborn, and the volume, the count of CD34+ cells and the total nucleated cell count measured by μL. Results: Positive correlation between the length of the umbilical cord and the total nucleated cell count was found. Similarly, correlation between total nucleated cell count with the initial volume and count of CD34+ cells in μL and mL was found. Discussion: Several studies have been conducted around to look maternal and neonatal variables that affect the sample quality, however, the Colombian literature has not described the correlation found in this study, so it requires the development of new research with designs of analytical studies to establish associations between the variables described.

Introdução: O sangue do cordão umbilical (SCU) tem sido reconhecido como uma fonte de células-tronco hematopoiéticas. Vários estudos têm sido realizados com a finalidade de determinar as variáveis maternas e neonatais que afetam o volume e a contagem total de células nucleadas e células CD34+. O presente estudo correlaciona as variáveis maternas e neonatais com a contagem total das células nucleadas e células CD34+ medidas em μL (microlitro). Materiais e métodos: Estudo correlacional no que 50 amostras de sangue do cordão umbilical de mulheres grávidas atendidas em dois IPs foram analisadas, uma em Bogota e outra em Ubaté (Cundinamarca), durante um período de 7 meses do ano 2013. A seleção destas amostras foi baseada em uma amostragem não probabilística. O coeficiente de correlação de Pearson foi calculado com a respectiva significância estatística entre variáveis quantitativas da mãe e do recém-nascido, assim como o volume, a contagem de células CD34 + e contagem total de células nucleadas por μL. Resultados: Correlação positiva foi encontrada entre o comprimento do cordão e a contagem total de células nucleadas. Também entre o volume da amostra inicial e contagem total de células nucleadas e contagem de células CD34+ em μL e em mL (mililitro). Discussão: Vários estudos têm sido desenvolvidos em torno da busca de variáveis maternas e neonatais que afetam a qualidade da amostra. Na Colômbia não tinham sido descritas as correlações encontradas no presente estudo. É por esta razão que será gratificante o desenvolvimento de novos estudos com desenhos analíticos.