Relationship of aldosterone synthase gene (C-344T) and mineralocorticoid receptor (S810L) polymorphisms with gestational hypertension.

The extent of genetic influence in the aetiology of gestational hypertension has not been completely determined. The aim of this study was to analyse the relationship between aldosterone levels and the -344T/C polymorphism of the aldosterone synthase gene (CYP11B2) and to investigate the frequency of the S810L mutation of mineralocorticoid receptor (MR) in gestational hypertension. One hundred women with pregnancy-induced hypertension and 100 with normal pregnancy were studied to measure serum aldosterone and progesterone levels and for the genotypification of the -344T/C polymorphism of CYP11B2 gene and the S810L mutation of MR by RFLP-PCR and SSP, respectively. Serum aldosterone levels were reduced (<0.000001) and serum progesterone levels increased (<0.000001) in gestational hypertensive women as compared with normal pregnant women. The -344T/C of CYP11B2 genotypic frequencies were similar in the hypertensive and normotensive pregnant women. The 810L-mutated allele of MR was found in 12% of the hypertensive and 9.4% of the normotensive pregnant women. In contrast to the observations made in preeclampsia, the genotype of -344T/C of CYP11B2 was neither related with gestational hypertension nor with aldosterone levels at delivery. The frequency of the S810L mutation was similar in the hypertensive and normotensive women but higher than observed in other reports.

Actual use of the lactational amenorrhoea method.

OBJECTIVE: The lactational amenorrhoea method (LAM) is an effective contraceptive option in developing countries. Post-partum, of the women who accept to apply LAM, many never do. Our aim was to determine the actual use of LAM. METHODS: A group of 326 post-partum women who accepted LAM use were recruited. After 6 months, they were asked if they actually had applied the method or not. In a logistic regression analysis, nine socio-demographic and clinical variables were studied as predictors of actual LAM use. An alpha level was set at 0.05. RESULTS: Overall, of the 326 women, only 61 (18.7%) actually applied LAM. The mean duration of LAM use was 4.3 +/- 0.2 months. The main reason for not applying LAM was that women thought the method was ineffective (66.0%). The variable time of menses resumption emerged as a predictor of LAM use (p = 0.001). CONCLUSIONS: Despite post-partum acceptance, most women did not actually apply LAM. In our setting as well as in other developing countries, regular contacts with a health care provider could improve LAM use.

Postpartum contraceptive acceptance in León, Mexico: a multivariate analysis.

OBJECTIVES: The aim of the present study was to identify the reasons for the acceptance or rejection of contraceptive methods among postpartum women at the Hospital of Obstetrics and Gynecology in León, Mexico. METHODS: A prospective cross-sectional study of 1025 postpartum women was undertaken. Reasons for acceptance or refusal of contraceptives were registered in a written survey. Twelve sociodemographic variables were included as predictors in a logistic regression analysis; the acceptance or refusal was the dependent variable, and statistical significance was set at 0.05. RESULTS: There were 513 patients who accepted contraceptives (50.0%) and 512 (50.0%) who refused them. The main reasons for accepting contraceptives were definitive desire for no more children (17.0%) and satisfaction with previous contraceptive methods (21.5%). The main contraceptive methods chosen were intrauterine device (67.7%) and tubal sterilization (28.5%). Reasons for contraceptive refusal were husband's rejection (33.2%) and delaying contraceptive use until after finishing the postpartum period (31.8%). In the logistic regression model, the variables previous deliveries (p < 0.001), number of Cesarean sections (p < 0.001) and women's level of education (p < 0.02) were included as predictors of acceptance. CONCLUSIONS: Previous deliveries, previous Cesarean sections and women's level of education were significant in contraception acceptance. The rejection of contraceptives was mainly attributed to husbands.

[Factors influencing contraceptive acceptance or refusal in puerperium]. / Factores que influyen en la aceptación o rechazo de métodos anticonceptivos en el puerperio.

Throughout a cross-section observational descriptive study, 1,010 postpartum patients were included. Data were collected directly with a survey, and women were divided into two groups: 507 (50.20%) women who accept postpartum contraceptive use and 503 (49.80%) women, which did not accept postpartum contraceptive use. Variables with statistical significance related with postpartum contraceptive acceptance or refusal were: patient age (P < 0.05), marital status (P < 0.001), pregnancies number (P < 0.001), parity (P < 0.01), cesarean section number (P < 0.001) and previous contraceptive use (P < 0.001). Postpartum contraceptives more accepted were: intrauterine device (67.85%), and tubal section (28.20%). Main reasons for postpartum contraceptive acceptance were: desire of no more children (27.02%), satisfaction with previous contraceptive methods (21.4%) and gynecologist counseling during prenatal care and delivery room (18.55%). Main reasons for postpartum contraceptive refusals were: husband's rejection of postpartum contraceptive use (33.6%), and delay in postpartum contraceptive use after finishing postpartum (32.0%). It was concluded that according to presence of significant differences between both groups in some variables, these variables should be kept in mind by physicians in promoting contraceptive methods in a personalized manner during prenatal care. Likewise, owing to husband's rejection of postpartum contraceptive use is needed to incorporate the husbands systematically to the prenatal care and to try convincing them of accepting postpartum contraceptive use.

[Prediction of fetal wellbeing with Doppler flowmetric profile in pregnant hypertensive women]. / Predicción del bienestar fetal mediante el perfil flujométrico Doppler en embarazadas con hipertensión.

In order to evaluate the diagnostic accuracy of the Doppler ultrasonography profile in the assessment of fetal wellbeing in hypertensive pregnancies, 171 women at 36-42 week's gestation were included. A Doppler color ultrasound scanning was made and the score of the Doppler ultrasonography profile were correlated with the neonatal outcome, with one minute Apgar's score or admission to neonatal intensive care unit as main outcome. The Doppler ultrasonography profile includes: umbilical artery Doppler flow velocity waveforms, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. In 145 cases (84.7%) had gestational hypertension without proteinuria, 22 patients (12.9%) had chronic hypertension and only in 4 cases (2.4%) preeclampsia was found. In 101 patients (59%) a cesarean section was made, 66 cases delivered normally and 4 (2.4%) patients had complicated vaginal delivery. Scores of diagnostic tests were: sensitivity 44%, specificity 99%, positive predictive value 80% and negative predictive value 97%, with an average accuracy of 71.5%. The multiple logistic regression analysis with 5 parameters of the Doppler ultrasonography profile had a determination coefficient (R2 = 0.15125) P < 0.01, and umbilical artery Doppler flow velocity waveforms had a regression coefficient--31.3959 (P < 0.05). It was concluded that the Doppler ultrasonography profile is a test with high predictive values in assessing fetal wellbeing in hypertensive pregnancies and the umbilical artery Doppler flow velocity alone is a significant variable in the multiple logistic regression analysis.

[Evaluation of fetal well-being using a modified Doppler flowmetric profile]. / Valoración del bienestar fetal mediante el perfil flujométrico Doppler modificado.

Decreasing perinatal morbimortality rates still represents an essential objective of antenatal care, so better diagnostic test for detecting fetal well-being are needed. The aim of this study was to compare a modified Doppler Ultrasonography Profile (DUP) with the Manning Fetal Biophysical Profile (FBP). One hundred and thirty eight high risk pregnant women between 38 and 42 gestational age, were prospectively studied with the proposed technique. The modified DUP is a quick-easy method that included five variables: umbilical Doppler velocimetry, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. The modified DUP diagnostic accuracy was compared with FBP diagnostic accuracy and a logistical regression analysis was performed to find predictors of fetal well-being. The sensitivity, specificity, and positive and negative predictive values of DUP in predicting perinatal outcome were 28%, 97%, 40% and 96.2%, respectively. On the other hand sensitivity, specificity, and positive and negative predictive values of the FBP were: 20%, 91%, 11% and 95.6%, respectively. The 95% confidence intervals for sensitivity and specificity wore 20.7-25.2 and 94.5-99.4, for the modified DUP whereas were obtained for FBP 12.2-27.7 and 85.6-96.3. The concordance between evaluated tests was 89%, with a Kappa value of 0.80. The multivariate logistical analysis showed two predictor variables as significant in the modified DUP model (umbilical Doppler velocimetry, P < 0.05, and fetal growth pattern, P < 0.05) but in the FBP no parameter reached statistical significance. Although the modified DUP had better diagnostic values an overlapping was clearly found in 95% confidence intervals, therefore it was concluded that the modified DUP proposed had similar diagnostic accuracy as FBP and could be alternatively used for assessing fetal well-being in high-risk pregnancies.

[Color Doppler flowmetry values in fetuses with nuchal cord encirclement]. / Valores de flujometría Doppler color en fetos con circular de cordón.

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.

[Doppler flowmetric fetal indices in low-risk pregnancies]. / Indices de flujometría Doppler fetal en embarazos de bajo riesgo.

In order to measure the umbilical resistance and pulsatility Doppler indexes 60 pregnant women with low risk pregnancies were studied in a descriptive, observational and prospective study carried out at the Hospital de Gineco-Pediatria numero 48 del Instituto Mexicano del Seguro Social. Umbilical Doppler measurements were done of the fetal umbilical cord from the week 30 at the 40 of gestation. We carried out a total of 337 measurements and 178 (52.8%) corresponded to the resistance index and 159 (47.2%) to the pulsatility index. The average of the resistance index was 0.64 with a range average (average plus two standard deviations was 0.48-0.79) and the pulsatility index had an average value of 0.94 with an average range of 0.58-1.30. The percentil values of the resistance index were 0.52, 0.66 and 0.79 respectively in the percentil 5, 50 and 95 whereas the percentil values of the pulsatility index were 0.64, 0.94 and 1.28 respectively in the percentil 5, 50 and 95. The analysis of variance with the Bonferroni test for multiple comparisons showed that our found indexes can be applied from the week 31 to the 40 of gestation. Our findings are in according to reported by other authors and it should be kept in mind that the concept of normality of the Doppler velocimetry indexes is strictly statistical and that only its judicious use will offer the benefit to our pregnant patients to obtain products under good conditions of health.

[Maternal-fetal mortality in advanced age]. / Morbilidad y mortalidad materno fetal en embarazadas de edad avanzada.

In order to compare the maternal-fetal outcome in pregnant women of advanced age (bigger than 35 years old) with those smaller than 30 years. 268 pregnant women were studied that went for their control and attention of the childbirth, corresponding 134 patients of more than 35 years and 134 patients between 20-29 years (control group). Cases were excluded if presented confounding variables (smoking, obesity, multiparity and maternal illnesses associated to the pregnancy). Data of maternal-fetal morbimortality were written down both groups and they were analyzed by means of X2 test or Fisher exact test for assessing differences between the groups, P < 0.05 was considered statistically significant, with a power of 80%, with a delta of 12%. The only two variables that had statistical significant were the number of cesarean sections 66 (49.2%) in the group of older women against 43 (32%) in the control group (P < 0.01) and normal vaginal deliveries (45 cases in the study group and 80 cases in the control group (P < 0.001). The rest of the analyzed variables none had difference statistically significant between both groups and they are described next: Forceps delivery was documented in 6 patients of the older group and 4 of the control group; 7 abortions were observed in a group and 17 in the other group of patients; there were not maternal deaths in both groups. The premature rupture of membranes was presented in 22 cases of the study group and in 24 cases of the control group; 8 congenital anomalies were presented in women's of advanced age children and 2 in mother's of the group control children; admission to the unit of therapy intensive neonatal happened in 17 products of the study group and in 9 cases of the control group; there were 3 stillbirths in the women of advanced age and 1 stillbirth in the control group; 3 perinatal deaths were presented in the patients of advanced age and 2 cases in the control group, all these variables had a value of P greater than 0.05 (not significant). When controlling confounding variables that can influence in the increase of the maternal-fetal morbimortality, it was observed that the only two significant variables were smaller normal vaginal deliveries (P < 0.001) and higher number of cesarean sections (P < 0.01) in patients with advanced age, owing to most of them are subjected to cesarean section without evaluating the possibility to obtain the product by means of a childbirth, for what the indication of cesarean section should be revalued in advanced age multiparous pregnant and in case of not having factors of associated risk to attempt the birth for childbirth, reducing by this way the incidence of cesarean sections as well as the morbidity that this procedure may imply.

[Perinatal morbimortality associated with placental senescence]. / Morbimortalidad perinatal asociada a senescencia placentaria.

This is a prospective study in order to evaluate the association between placenta grade III changes and the neonatal outcome. A total of 370 patients divided into two groups were included: the case group included 182 patients with placenta grade III changes (placental senescence) and the control group included 188 cases with grade 0, I or II placenta. The patients with grade III placenta had more cases of oligohydramnios (37 vs 24%), cardiotocographic non reactive tests (35 vs 17 cases) and an elevated frequency of cesarean sections (83%), (P < 0.05). The newborns in both groups had not difference in birth weight and Apgar scores, but the senescence placental group had a higher incidence of meconium stained fluid (13 vs 8%, P < 0.05) and an increased admissions to special care nursery (17 vs 5 cases, P < 0.05). We concluded that our findings support that the placental senescence had a close association with the perinatal morbidity and we suggested a closer surveillance in these patients to improve the perinatal outcome.

[Ultrasonographic density of amniotic fluid and its correlation with fetal pulmonary maturity]. / Densidad ultrasonográfica del líquido amniótico y su correlación con la madurez pulmonar fetal.

In order to determine if the amniotic fluid density is correlated with fetal lung maturity, we carried out a prospective study in the Hospital de Gineco-Obstetricia del Centro Médico León del Instituto Mexicano del Seguro Social. One hundred and forty one patients with pregnancies between 13 and 41 gestation weeks were included. The amniotic fluid density was calculated by counting the level of echoes (free-floating particles) in the amniotic fluid. We found a significant correlation (P < 0.05) between the level of echoes and the gestation age, nevertheless, the correlation coefficient was very low (R = 0.28), therefore we concluded that this procedure is not a reliable predictor of fetal lung maturity.

[Ultrasonographic diagnosis of polyhydramnios and its association with congenital malformations]. / Diagnóstico ultrasonográfico de polihidramnios y su asociación con malformaciones congénitas.

We carried out a prospective study at the Hospital de Gineco-Obstetricia del Instituto Mexicano del Seguro Social, in León, Guanajuato in order to evaluate the association between polyhydramnios and fetal congenital anomalies. 200 women were included, 100 with polyhydramnios and 100 with normal amniotic fluid (control group). The diagnosis of polyhydramnios was made with ultrasound scanning using maximum vertical pocket technique and amniotic fluid index. The patients with polyhydramnios had an average maximum vertical pocket of 9.3 centimeters and amniotic fluid index of 27.0 centimeters. In patients with polyhydramnios 24 cases of congenital malformations were found, and none in patients with normal amniotic fluid (P < 0.01). The most common fetal anomalies were: esophageal atresia (25%), anencephaly (21%) and ductus arteriosus (21%). There were six perinatal deaths in the group of patients with polyhydramnios, five of them had congenital abnormalities, on the other hand in the control group there were no perinatal deaths (P < 0.01). Owing to the signifficative association between polyhydramnios and congenital anomalies, we suggest to reinforce the ultrasound evaluation in order to detect these abnormalities and to offer an early treatment and therefore a better prognosis to the fetus.

[Perinatal morbidity and mortality associated with fetal hypomotility]. / Morbimortalidad perinatal asociada a hipomotilidad fetal.

In a prospective study carried out in the Hospital de Gineco-Obstetricia, Centro Médico León, Instituto Mexicano del Seguro Social, 200 women with pregnancies 32-41 weeks, without risk factors, were included in order to evaluate the perinatal outcome in patients with decreased fetal movement. The sample was divided in two groups: 100 patients with decreased fetal movement (study group) and 100 patients with normal fetal movement (control group). The group of patients with decreased fetal movement had higher incidence of complications during delivery (only 35% had normal delivery), greater average of birth weight (3,412 g), more cases of meconium stained fluid (26%) and higher frequency of placental calcifications (29%) as compared with the control group (P < 0.01). In comparing newborn Apgar score and perinatal morbidity and mortality rates there were no statistical difference in both groups. It's concluded that antepartum fetal surveillance has a definite role in diminishing the morbidity and mortality rates in patients with decreased fetal movement.

[Clinical and ultrasonographic data in ectopic pregnancy]. / Datos clínicos y ultrasonográficos asociados al diasgnóstico de embarazo ectópico.

In order to evaluate the clinical and sonographic findings in 60 patients with ectopic pregnancy confirmed at laparotomy, we carried out a prospective study at the Hospital de Gineco-Obstetricia del Centro Médico León, Instituto Mexicano del Seguro Social. The patients were 28.17 years old, average. The ectopic pregnancy was more common in multiparous women (80%) than in nuliparous ones. The obstetric risk factors more frequent were abortion (26.6%) and use of intrauterine device (23.3%). The clinical sign reported most common was pelvic pain, referred in 48 patients (80%). Hemodynamic changes were detected in 21.6% of the cases. The ultrasound findings were seen in most of the patients and heterogeneous adnexal mass was observed in 91.6% of them, moreover intraperitoneal fluid was reported in 61.6% of the patients with ectopic pregnancy. The heterogeneous adnexal mass had a direct relationship with the diagnosis of ectopic pregnancy and had a correlation coefficient value R = 0.99 (P < 0.01). The ultrasonographic findings seen with transvaginal technique were similar than those obtained through transabdominal procedure. We conclude that ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.

[Diagnosis of ovum viability: comparative analysis between ultrasound and chorionic gonadotropin hormone]. / Diagnóstico de vitalidad ovular: análisis comparativo entre ultrasonido y hormona gonadotropina coriónica.

In a retrospective study carried out in the Hospital de Gineco-Obstetricia del Centro Médico León, Gto., Instituto Mexicano del Seguro Social, 61 patients were studied in order to compare the sensitivity and specificity values and the correlation coefficient between the hormonal assays (Human Chorionic Gonadotropin, HCG) and the ultrasound scanning. The qualitative concentrations of HCG had a sensitivity of 37.5% and a specificity of 100%. The levels of subunit beta of HCG had sensitivity of 25% and specificity of 100%. The whole correlation coefficient of the hormonal method (HCG) was R = 0.51 (P less than 0.01). The ultrasound monitoring had a sensitivity of 855 and specificity of 100%, with a correlation coefficient R = 0.88 (P less than 0.01). It was concluded that ultrasound scanning has a better sensitivity and higher correlation than human chorionic gonadotropin assays in the diagnosis of ovum vitality.

[Correlations between hyperprolactinemia and galactorrhea]. / Correlación entre hiperprolactinemia y galactorrea.

In a prospective study performed between January, 1989 to August, 1988, we evaluated the association between hyperprolactinemia and its clinical features. Of the 58 subjects included: 23 had hyperprolactinemia and 35 were controls. The most frequent clinical manifestations in hyperprolactinemic patients were galactorrhea (43.4%) and amenorrhea (17.3%) amenorrhea-galactorrhea syndrome was found in only 8.6% cases with hyperprolactinemia. We found a statistically significant correlation (R = 0.66, p less than 0.01) between serum prolactin levels and clinical symptoms in hyperprolactinemic patients.

[Elective appendectomy associated with cesarean section]. / Apendicectomía electiva asociada a cesárea.

A prospective study was conducted in 90 patients divided in two different groups: the first group included 45 labor patients operated of cesarean section and elective appendectomy, the second group included 45 labor patients operated of cesarean section without appendectomy (control group). The purpose was to evaluate if the elective removal of the appendix increase the postoperative morbidity. The most common indication of cesarean section was the mother-fetus disproportion (55.5%). The main type of uterine incision was the segmental transverse (over 90% of the cases). Appendectomy added 11.2 minutes to the operation time, as compared with the control group (p less than 0.01). There were 4 cases (8.8%) of decidual infection in the appendectomy group and 2 cases (4.4%) of decidual infection (one of these complicated with wound dehiscence) in the control group. Nevertheless there was not difference statistically significative in comparing the morbidity between the groups (p = 0.33). There were no complications directly attributable to elective appendectomy. It is concluded that the elective appendectomy does not increase the postoperative morbidity in labor patients undergoing cesarean section and it requires a good selection of patients to be appendectomized.

Personality profiles and socioeconomic factors in contraceptive use.

The correlation of contraceptive use with socioeconomic factors and personality profiles was examined in a sample of 3060 women by a questionnaire based on the diagnostic criteria of the DMS III. Use of safer contraceptives correlated with several socioeconomic factors, among them, the schooling of the wife had higher significance and explained most of the variance contained in other factors. Women unprotected did not show a distinct personality profile. Indices of compulsion and phobias were significantly different between groups of contraceptive use. Users of injectables showed higher scores of compulsion, whereas IUD users had higher scores of phobias. These results were interpreted to mean that personality profiles partially explain the preference for certain methods.