[Comparison of Doppler flowmetry in brachial artery in Mexican postmenopausal women with and without symptoms]. / Comparación de la flujometria doppler de la arteria braquial en mujeres posmenopáusicas mexicanas con y sin sintomas vasomotores.

BACKGROUND: Brachial artery doppler fluxometry permits to evaluate the endothelial function in a non-invasive way. OBJECTIVE: To know the effect of vasomotor symptoms in brachial artery flux ultrasonographic parameters in Mexican postmenopausal women. MATERIAL AND METHODS: A prospective study was done including postmenopausal women divided into two groups: I) without hot-flushes and II) with hot-flushes. To all them Doppler fluxometry was done. The pulsatility index resistance index and arterial diameter were determined previous and after the hyperemic stimulus. The intensity of vasomotor symptoms (hot-flushes, throbs and sweatings) was determined using an analog visual scale; and the number of each one of them was determined. For statistical analysis Student t test for independent and paired samples was used. Correlation analysis was done between age, time since menopause, hot flushes, throbs and sweating with pulsatility index, resistance index and arterial diameter previous and after hyperemic stimulus. RESULTS: Thirty patients were divided into two groups of 15 women each. No differences were found between the groups neither in age, anthropometric variables, pulsatility index, resistance index nor arterial diameter neither before nor after hyperemic stimulus; only there was a statistically significant increase in arterial diameter after hyperemic stimulus in group I (p < 0.001). In group I a positive correlation was found between age and baseline resistance index and in group II between baseline resistance index and the number of throbs per week. CONCLUSION: Women with hot-flushes have a healthier endothelium.

Comparison of brachial artery vascular responses among postmenopausal women receiving different doses of tibolone.

OBJECTIVE: To compare the effects of low and conventional doses of tibolone in brachial artery flux parameters among postmenopausal women. METHODS: Between March 2011 and September 2012, 24 postmenopausal women attending Gynecology and Obstetrics Hospital Luis Castelazo Ayala, Mexico City, for hormone replacement therapy were consecutively recruited. The women were alternately assigned to receive a daily dose of either 2.5mg (n=11) or 1.25mg (n=13) of oral tibolone. Before and after treatment, all women underwent a brachial artery Doppler ultrasound. The arterial diameter was measured, and the pulsatility index (PI) and the resistance index (RI) were calculated. A hyperemic stimulus was then induced and these parameters were measured again. RESULTS: Among the 24 women, the time since menopause ranged from 16 to 24 months, and the median treatment duration was 3 months. Both groups showed a significant increase in arterial diameter after treatment. There was no significant difference between the groups in arterial diameter, PI, and RI. The arterial diameter after hyperemic stimulus was significantly lower after treatment than before treatment in both groups. CONCLUSION: Low and conventional doses of tibolone induced similar changes in brachial artery flux parameters among postmenopausal women.

[Umbilical artery Doppler velocimetry and adverse perinatal outcome in severe pre-eclampsia]. / Velocimetría Doppler de la arteria umbilical y resultado perinatal adverso en preeclampsia severa.

BACKGROUND: Abnormal placentation is a main preeclampsia characteristic. Its cause is a maternal spiral veins trophoblastic invasion failure, which conditions vascular resistances raise and uterus-placental perfusion decrease. OBJECTIVE: To determine the relationship between umbilical artery Doppler waveform and adverse perinatal outcome in patients with severe preeclampsia. PATIENTS AND METHOD: A prospective, observational and transversal study was done to analyze patients between 27 to 33 weeks of gestation with expectant management of severe preeclampsia from January 2004 to January 2006. Umbilical artery velocimetry studies were performed at least once a week by means of pulsed Doppler equipment with a 3.5 MHz transducer. Only the results of the last Doppler examination performed within 7 days of delivery were considered in the correlation with perinatal outcomes. The indications for delivery were maternal or fetal (non reassuring nonstress test or biophysical profile < or = 4). An abnormal Doppler velocimetry was defined as pulsatility index being higher than percentile 95 for gestational age, or absent or reversed end diastolic velocity waveforms in umbilical artery. The statistical analysis was done with chi2 test and Student t test. RESULTS: There were included 43 patients in this study. Twenty-two (52%) had an abnormal Doppler umbilical artery pulsatility index and 21 (49%) obtained a normal umbilical artery waveform. In the first group 13 (59%) had a positive end diastolic velocities with elevated pulsatility index values, end diastolic velocities were absent in seven cases (32%) and reversed in two cases (9%). Neonates with abnormal pulsatility index had a lower birth weight (1,174 vs 1,728 g), lower Apgar score at 5 minutes, higher admission to the neonatal intensive care unit (86.4 vs 43%), and significant neonatal morbidity compared with those with normal velocimetry (p < 0.05). There were no perinatal deaths with normal umbilical Doppler waveform. There were six perinatal deaths in the abnormal Doppler velocimetry. Two cases occurred with positive end diastolic velocity (15%), two cases with absent end diastolic velocity (28%) and two deaths with reversed flow of the umbilical artery (100%). CONCLUSION: An abnormal Doppler umbilical artery waveform is associated with poor perinatal outcome and is a strong predictor of perinatal mortality.

Urinary prolactin as a reliable marker for preeclampsia, its severity, and the occurrence of adverse pregnancy outcomes.

CONTEXT: It has been proposed that preeclampsia may result from of an imbalance in angiogenic factors. Although prolactin (PRL) is mainly related to lactation, it is also involved in other biological functions, including angiogenesis. OBJECTIVE: Our objective was to determine the relationship among preeclampsia, serum and urinary PRL (uPRL) levels, and excretion of antiangiogenic PRL fragments in urine. STUDY DESIGN: Using a cross-sectional design, uPRL and serum PRL levels, and the presence of PRL isoforms were determined in 546 pregnant women: 207 healthy pregnant, 124 with gestational hypertension, 48 with mild preeclampsia, and 167 with severe preeclampsia (sPE). RESULTS: uPRL concentrations were significantly (P < 0.001) higher in preeclampsia (11.99 ng/mg creatinine) than in healthy pregnancy (0.20 ng/mg creatinine) and gestational hypertension (0.19 ng/mg creatinine), and were even higher in sPE compared with mild preeclampsia (21.20 vs. 2.77 ng/mg creatinine, respectively; P < 0.001). Antiangiogenic PRL fragments (14-16 kDa) were detected in 21.6% of urine samples from women with sPE but in none from other groups. Patients with hemolysis, elevated liver enzymes, low platelet count syndrome, and/or eclampsia, placental abruption, acute renal failure, and pulmonary edema exhibited highest uPRL concentrations (P < or = 0.028) and frequency of antiangiogenic PRL fragments in urine (P < or = 0.036). High-serum PRL levels were associated with sPE independently of gestational age, proteinuria, and prolactinuria (P = 0.032). CONCLUSIONS: Preeclampsia is characterized by increased uPRL excretion. uPRL concentrations and their isoforms appear to be suitable markers to assess the severity of preeclampsia and occurrence of adverse outcomes. PRL and and/or its isoforms might be involved in the pathophysiology of preeclampsia.

Utilidad de la prueba sin estrés en la preeclampsia / Utility of nonstress test (NST) in preeclampsia

Introducción. La preeclampsia es una causa importante de morbimortalidad perinatal, por tanto, es necesario dentro del manejo integral una adecuada vigilancia fetal. Objetivo. Evaluar la utilidad de la prueba sin estrés (PSS) en pacientes con preeclampsia. Materiales y método. Se incluyeron embarazos de 28 semanas o más, complicados con preeclampsia, a los que se les efectuó una PSS 24 horas antes de la resolución de la gestación. La población estudiada se dividió en dos grupos: preeclampsia leve y severa, agrupándose cada uno de acuerdo a las semanas de gestación en 28 - 31, 32 - 34 y = 35. El resultado perinatal adverso fue definido por la presencia de líquido amniótico meconial, oligohidramnios, Apgar menor de 7 a los 5 minutos en gestaciones mayores de 34 semanas, restricción del crecimiento intrauterino y muerte perinatal. Resultados. Se analizaron 147 pacientes con preeclampsia leve y 103 con preeclampsia severa. No hubo ningún caso de óbito. La sensibilidad de la PSS fue baja, tanto para la forma leve (39 por ciento), como para la severa (63 por ciento). El valor predictivo positivo fue igualmente bajo (66 y 45 por ciento, respectivamente) en ambos grupos. La especificidad y el valor predictivo negativo fueron altos para el grupo de preeclampsia leve (89 y 73 por ciento) y severa (64 y 78 por ciento), respectivamente. Conclusiones. La PSS es una prueba preparto importante, sin embargo, debido a su baja sensibilidad no debe ser usada como única prueba de vigilancia fetal.

Morbimortalidad materna en síndrome de HELLP / Maternal morbidity and mortality in HELPP

Objetivo. Describir la morbimortalidad materna asociada a embarazos complicados con síndrome de HELLP. Diseño. Se realizó un estudio prospectivo, descriptivo del 01 de enero de 1998 al 31 de marzo de 2000 en pacientes con síndrome de HELLP que ingresaron a nuestro Hospital. La población estudiada se dividió en tres grupos de acuerdo con la clasificación de Mississippi. Resultados. Se analizaron 170 casos, de los cuales 156 (92 por ciento) ocurrieron anteparto y 14 (8 por ciento) posparto. En cuanto a la edad gestacional, 15 casos (9 por ciento) se presentaron antes de la semana 27 de gestación, 112 (66 por ciento) entre las semanas 28 a 36, y 43 (25 por ciento) al término del embarazo. Las principales complicaciones fueron insuficiencia renal (13.5 por ciento), desprendimiento prematuro de placenta normoinserta (6.6 por ciento), neumonía (3 por ciento), hematoma hepático (2.3 por ciento), edema pulmonar (2.3 por ciento), coagulación intravascular diseminada (1.7 por ciento) y hemorragia cerebral (1.2 por ciento). La mortalidad materna fue de 4.7 por ciento (ocho pacientes), de las cuales siete ocurrieron en la clase I y una en la clase II. Seis muertes (75 por ciento) se asociaron a eclampsia. Ochenta y cinco por ciento de la morbimortalidad materna se presentó en pacientes con cuenta plaquetaria < 50,000 mm3 (clase I). Conclusiones. Existe un incremento progresivo de la morbimortalidad materna conforme la cifra de plaquetas disminuye y pasa de la clase III a la clase I. Setenta y cinco por ciento de la mortalidad materna se asoció a eclampsia. El diagnóstico temprano puede mejorar el pronóstico y resultado materno de este síndrome.