Placental levels of essential and non-essential trace element in relation to neonatal weight in Northwestern Spain: application of generalized additive models.

Adequate gestational progression depends to a great extent on placental development, which can modify maternal and neonatal outcomes. Any environmental toxicant, including metals, with the capacity to affect the placenta can alter the development of the pregnancy and its outcome. The objective of this study was to correlate the placenta levels of 14 essential and non-essential elements with neonatal weight. We examined relationships between placental concentrations of arsenic, cadmium, cobalt, copper, mercury, lithium, manganese, molybdenum, nickel, lead, rubidium, selenium, strontium, and zinc from 79 low obstetric risk pregnant women in Ourense (Northwestern Spain, 42°20'12.1″N 7°51.844'O) with neonatal weight. We tested associations between placental metal concentrations and neonatal weight by conducting multivariable linear regressions using generalized linear models (GLM) and generalized additive models (GAM). While placental Co (p = 0.03) and Sr (p = 0.048) concentrations were associated with higher neonatal weight, concentrations of Li (p = 0.027), Mo (p = 0.049), and Se (p = 0.02) in the placenta were associated with lower newborn weight. Our findings suggest that the concentration of some metals in the placenta may affect fetal growth.

Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain.

OBJECTIVES: Antenatal exposure to organic pollutants is a leading public health problem. Meconium is a unique matrix to perform prenatal studies because it enables us to retrospectively evaluate fetal exposure accumulated during the second and third trimester. The aim of the present study was to evaluate associations between organic pollutant levels in meconium and birth weight in NW Spain. METHODS: In this study, we quantify the concentrations of 50 organic pollutants together with the total values of the most important chemical groups in meconium using gas chromatography coupled to tandem mass spectrometry. RESULTS: Organochlorine pesticides, polychlorinated biphenyls and polybrominated diphenyl ethers were detected with the highest levels in meconium from small for gestational age newborns. It was estimated that several congeners were statistically significant (p<0.05). However, organophosphorus pesticides attained higher concentrations in newborns with an appropriate weight. CONCLUSIONS: The occurrence of transplacental transfer can be confirmed. Prenatal exposure to organic pollutants was associated with a decrease in birth weight and, therefore, organic pollutants could have an impact on fetal growth. Nevertheless, these results need validation in larger sample sized studies.

Association between placenta concentrations polybrominated and polychlorinated biphenyls and gestational diabetes mellitus: a case-control study in northwestern Spain.

Exposure to persistent organic pollutants begins in uterine life. The study was conducted to evaluate associations between gestational diabetes mellitus and the presence of persistent organic pollutants in placenta samples. They were derived from a birth cohort study in Ourense (NW Spain). Selective pressurized liquid extraction methodologies were used to determine targeted persistent organic pollutants in placenta samples. Cleanup of extracts was performed by solid-phase extraction using EZ-POP cartridges and detection by gas chromatography coupled to tandem mass spectrometry. Statistical calculations were performed by comparing the values obtained in the case and control groups. Statistical significance was considered as p < 0.050. Results: The concentrations of several congeners of polybrominated diphenyl ethers (PBDE) and polychlorinated biphenyls (PCB) presented lower levels in the placentas of expectant mothers with gestational diabetes mellitus when comparing them to the control cohort. This difference was statistically significant. It was revealed that this association was independent of obesity, age, parity, amenorrhoea at birth, or a family history of diabetes mellitus. To the best of our knowledge, this paper reported an inverse relationship between PBDE and PCB levels in placenta and gestational diabetes mellitus for the first time. We believe this may open a door to future studies in this field.

Hemorragia posparto secundaria o tardía / Secondary postpartum haemorrhage

Introducción: la hemorragia posparto secundaria puede estar asociada a entidades poco conocidas, pero con capacidad para incrementar la morbimortalidad materna, por lo cual es necesario su conocimiento con el fin de instaurar las medidas terapéuticas oportunas. Objetivo: conocer la incidencia de la hemorragia posparto secundaria (HPS), los factores de riesgo, así como la prevalencia de las principales entidades implicadas en esta patología. Material y métodos: estudio descriptivo, observacional y retrospectivo, mediante el análisis poblacional de las pacientes hospitalizadas con el diagnóstico de HPS, en el Complexo Hospitalario Universitario de Ourense, en el periodo comprendido entre 2004 y el 31 de marzo de 2014. El criterio de selección se realizó de acuerdo con la definición de la OMS de la HPS: 'sangrado uterino excesivo que ocurre entre las 24 horas y las 12 semanas posteriores al parto'. Resultados: la incidencia de HPS fue del 0,29%. Esta enfermedad se asocia con mayor frecuencia al antecedente de parto vaginal en el actual episodio. La causa más prevalente de HPS fue la retención de restos placentarios, la cual representó el 75,51% del total de casos. El tratamiento realizado con mayor frecuencia fue el legrado evacuador (77,55%). Hasta en el 14% de los casos se asocia con anemia severa que requiere transfusión sanguínea. Conclusiones: la principal causa de la HPS es la retención de restos placentarios. Existen otras causas menos frecuentes y menos conocidas, pero con un alto potencial de generar morbimortalidad (AU)

Background: Secondary postpartum hemorrhage may be associated with little known entities but with ability to increase maternal mortality and morbidity by which its knowledge is necessary in order to establish appropriate therapeutic measures. Objective: To determine the incidence of secondary postpartum hemorrhage (HPS), risk factors, and the prevalence of the main entities involved in this pathology. Material and methods: Descriptive and retrospective study using the population analysis of patients hospitalized with the diagnosis of HPS in the University Hospital Complex of Ourense, in the period between 2004 and March 31, 2014. Inclusion criteria was the WHO’s definition for HPS: 'excessive uterine bleeding from 24 hours to 12 weeks after childbirth'. Results: The incidence of HPS was 0.29%. This entity is more strongly associated with previous vaginal deliveries in the current episode. The most prevalent cause of HPS was retained placental remnants, representing 75.51% of all cases. The treatment most frequently performed was evacuator curettage (77.55%). Severe anemia is observed in 14% of the women requiring blood transfusion. Conclusions: The principal cause of the HPS is placental retention. There are other less common and less well-known causes but with a high potential for morbidity and mortality (AU)

[Risk factors of evolution of postpartum hemorrhage towards severe postpartum hemorrhage: A case-control study]. / Factores de riesgo de la evolución de la hemorragia posparto a hemorragia posparto severa: estudio de casos y controles.

OBJECTIVE: To describe the incidence and risk factors for evolution of postpartum haemorrhage towards severe. MATERIAL AND METHODS: Epidemiologic, observational, analytical, case-control study was done from total data of deliveries in Complexo Hospitalario de Ourénse between January 1st 2004 and June 30th 2014. Mann-Whitney U test was used to determine the differences between cases and controls. The statistical analyses were made with the informatic programs Spss 15.0 y Epidat 3.0. We considered statistical significance for p < 0.05. RESULTS: The initial size of the sample was 17,116 deliveries from which we selected 150 patients with the diagnosis of postpartum haemorrhage. The incidence for HPSe form all deliveries was 3.3% reaching 36% of the total of postpartum haemorrhages. 79.63% of HPSe showed symptoms withing the first 24h postpartum, but we found that 20.37% debuted as secondary postpartum haemorrhages. BMI ≥ 35, hypertensive gestational manifestations, labor's second phase ≥ 120 minutes and weight at birth > 4000 g presented statistical significance as risk factor for evolution to severe postpartum haemhorrage. The relative risk for evolution towards HPSe was 2.81 for instrumental delivery and 3.55 for cesarean section. The most prevalent etiology was uterine atony. CONCLUSION: The incidence of HPSe in our hospital is low, as well as secondary maternal mortality. The major risk factor for the appearance of the clinical symptoms is cesarean section, followed, in less proportion by instrumental delivery. It is possible for the HPSe to make its appearance delayed after delivery, usually secondary to infrequent and non well-known clinical presentations.

[Perinatal outcomes of twin pregnancies conceived through in vitro fertilization versus spontaneous]. / Resultados perinatales de las gestaciones gemelares concebidas mediante fecundación in vitro versus espontáneas.

OBJECTIVE: Determine maternal and fetal characteristics of in vitro fertilization twin pregnancies in comparison with spontaneous twin pregnancies. MATERIAL AND METHODS: Retrospective historical cohort study between 2011 and 2013. Statistical analysis was performed with SPSS 15.0 program and Epidat 3.0. A value of p<0.05 was considered statistically significant. RESULTS: 96 twin pregnancies met inclusive criteria with an incidence of 2.01%, of which 54.16% were spontaneous twin pregnancies and 45.83% in vitro fertilization twin pregnancies. Mean maternal age at delivery was higher in vitro fertilization twin pregnancies (p=0.004). The primigravidae were more frequent in vitro fertilization twin pregnancies group (p<0.001). Monochorionic pregnancies percentage was superior in spontaneous pregnancies (p=0.009). Amenorrhea at delivery was not a significant difference between cohorts (p=.9). Preterm rate was superior in spontaneous twin pregnancies group (p=0.003). However, "great preterm deliveries" were higher in in vitro fertilization twin pregnancies (p<0.001). Significant differences were not observed in fetal presentation at delivery, first-born child birth-weight or intrauterine growth retardation between the two groups. Nevertheless, the mean birth-weight of second-born spontaneously conceived twins was higher than second-born twins of the in vitro fertilization conceived group (p=0.027). Gestational pathology presented the same distribution in both cohorts. There was no significant difference in the mode of delivery between the two groups. Total perinatal mortality rate was 20,83%o and comprised 2 first born twins and 2 second born twins. Three of the stillbirths came from the spontaneous pregnancies group and one from the in vitro fertilization group. CONCLUSIONS: Perinatal death was secondary to stillbirths, which we found higher in spontaneously conceived twin pregnancies due to higher number of monochorionic pregnancies.