Molecular detection of Chlamydia trachomatis and semen quality of sexual partners of infertile women.

Chlamydia trachomatis is considered as the bacterium that is more sexually transmitted as cause of male urethritis, epididymitis, orchitis and infertility. A total of 116 semen samples of men whose couples are infertile women were analysed. The quality of the semen was measured by standard procedures recommended by WHO while C. trachomatis was detected by the PCR assay. Thirty-seven semen samples were positive for C. trachomatis (31.9%). Regarding semen analysis, no different values were observed between positive and negative samples to C. trachomatis. However, the presence of leucocytes and erythrocytes suggests an inflammatory process; however, these were high in negative samples to C. trachomatis. Furthermore, an association between low seminal volume at 1, 5 ml and the positivity to C. trachomatis was observed (OR=2, 1; CI95 % 1,16-3,07). The total semen volume is a contribution by the various accessory glands (this reflects the secretory activity of the glands); a low semen volume could be due to an obstruction of the ejaculatory duct or infection of accessory glands by C. trachomatis. More studies are necessary to identify the causes of a reduced semen volume.

[Factors associated with acceptance of postpartum tubal ligation among HIV-infected women]. / Factores asociados a la aceptación de salpingoclasia posparto entre mujeres infectadas por el VIH.

OBJECTIVE: To identify the factors associated with the acceptance of tubal ligation after childbirth among HIV-infected patients. MATERIAL AND METHODS: A case-control study was conducted from March 1988 to February 1999, at Mexico's National Institute of Perinatology (INPer), in 72 HIV-positive pregnant women. Cases were 49 women who accepted postpartum tubal ligation after childbirth, and controls were 23 women who refused this birth control method. Data collected for each patient were demographic characteristics, sexual and reproductive history, and HIV status. Statistical analysis consisted of descriptive measures, Chi 2 or Fisher's exact test for categorical variables, and Student's t test for continuous variables. Odds ratios (OR) with 95% CI were used to compare groups and potential confounders were assessed by stratified analysis with the Mantel-Haenszel method. RESULTS: The patients' mean age was 25.5 +/- 5.5 years. The median gestation period was 27 weeks (range 7 to 40 weeks); 16 women (22.2%) had no prenatal care visits at INPer. The median time of HIV positivist awareness was 9 months (range 1 to 108). Variables associated with acceptance of tubal ligation were: having a prior childbirth (OR 11.1, 95% CI 3.4 to 36), pregnancy care from 1995 onward (OR 4.7, 95% CI 1.7 to 13.3), and having given birth to an HIV-infected child (OR 4.6, 95% CI 1.05 to 23.1). Stratified analysis showed no modification of the strength of association of these variables with acceptance of tubal ligation. CONCLUSIONS: A prior childbirth was the most important predictor of tubal ligation acceptance. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Demographic and clinical profile of human immunodeficiency virus-infected postpartum women who undergo sterilization.

The decision of human immunodeficiency virus (HIV)-infected women to accept a contraceptive method has implications related to the prevention of HIV infection to their children. A case-control study was performed in 57 HIV seropositive pregnant women with prenatal care and delivery at the National Institute of Perinatology, Mexico City. Thirty-five cases were women who accepted postpartum sterilization and twenty-two controls were women who refused this method. The acceptance of tubal occlusion was statistically more frequent in multiparous women, and in those with previous children infected with HIV. The antecedent of at least one previous pregnancy had an association with the acceptance of tubal occlusion with an OR of 11.2 (CI 95% 2.9 to 42.9); having at least one previous child HIV-infected had an OR of 4.6 (CI 95% 1.3 to 23.1). The stratified analysis did not show modification of the association strength between previous pregnancy and the precedent of previous children HIV-infected with the acceptance of sterilization.

[Measles and pregnancy. Evolution and management]. / Sarampión y embarazo. Evolución y manejo.

Measles is a highly infectious disease. In Mexico, nevertheless the postvaccine era, continue being an endemic disease. It has been described that measles increase the maternal mortality, because pregnant women have a more severe clinical course of the disease; measles also has negative repercussion on pregnancy, increasing the frequency of premature labor. We report two pregnant women complicated with measles, both of them had a clinical course of the disease and they didn't have obstetric or neonatal complications.

Tuberculosis of the female reproductive tract: effect on function.

OBJECTIVE: To discuss the clinical presentation and consequences of genital tuberculosis (GTB), a known cause of infertility. Although it appears to be a rare entity, usually secondary to a primary site of infection by Mycobacterium tuberculosis, its true incidence is not known owing, in part, to inadequate diagnostic procedures, particularly in less developed areas of the world. PATIENTS AND METHODS: We present our experience with 25 cases of genital TB. Of these woman, 21 were seen for infertility; 3 were postmenopausal with uterine hemorrhage, and 1 was admitted with an acute abdomen. All women were treated medically and/or surgically. RESULTS: Only five women were found to be suitable for artificial insemination. Two of the women became pregnant but aborted. CONCLUSIONS: The incidence of genital TB may be higher than one might imagine, based on the lack of reports in the literature, and may account for a significant amount of female infertility.

PIP: During 1988-93, in Mexico City, the National Institute of Perinatology diagnosed 25 cases of female genital tuberculosis. Their age ranged from 21 to 42 years. The diagnostic procedures used to detect these cases included laparoscopy, PPD skin test reaction, hysterosalpingography (HSG), culture of tissue and fluid samples, and histopathological examination of tissue biopsies. 16% had a history of tuberculosis. 39.1% had a history of contact with a relative with tuberculosis. Three women were postmenopausal and suffered from uterine bleeding; they underwent a hysterectomy. 17 of 21 women who went on to infertility studies had suffered infertility for 2-14 years. HSG revealed abnormalities in 95.2%, especially bilateral tubal occlusion (57.1%) and deformity of the uterine cavity (54.5%). Mycobacterium tuberculosis was isolated in 4 women, all of whom had fluid in the pelvic cavity. 14 of the 16 patients who underwent the PPD skin test had an induration larger than 10 mm in diameter. 68% of the 19 patients who underwent endometrial biopsy had granulomas consistent with tuberculosis. All the women received antibiotics to treat female genital tuberculosis. Five of the 17 patients referred for infertility evaluation underwent in vitro fertilization and embryo transfer. Two of these women became pregnant but later suffered a spontaneous abortion. The other 3 women never conceived. These findings indicate that the incidence of female genital tuberculosis may be higher than expected and may be responsible for a substantial amount of female infertility. Pregnancy occurs when female genital tuberculosis is detected at an early stage and when no irreversible anatomical pathology is evident. Thus, it is important to determine the existence of tuberculosis early in cases of infertility and to begin therapy immediately.

[Comparison of the therapeutic efficacy of the piperacillin/tazobactame combination vs. ampicillin and gentamycin in in the management of post-cesarean endometritis]. / Comparación de la eficacia terapéutica de piperacilina/tazobactam vs ampicilina más gentamicina en el tratamiento de endometritis poscesárea.

Traditionally obstetric infections have been treated with combination antimicrobial agents that provide coverage against aerobic and anaerobic bacteria commonly found in these infections. New antibiotics may be a monotherapy alternative for this type of infections. The objective of the study was to compare the efficacy of the agent piperacillin/tazobactam against ampicillin plus gentamicin in the treatment of postcesarean endometritis. By randomized way 14 patients were enrolled in the piperacillin/tazobactam group and 42 in the ampicillin-gentamicin group. A favorable clinical response occurred in 78.6% of piperacillin/tazobactam patients and 88.1% of ampicillin and gentamicin patients (p = NS). There was no statistically significant difference in the times to recovery and days of hospitalization between the two groups. The combination piperacillin/tazobactam did not show advantage towards the standard treatment, so combination antimicrobial agent continue been the optimal approach to the management of obstetric infection.

[Ceftriaxone vs. cefazolin in obstetrical surgical prevention]. / Ceftriaxona vs. cefazolina en la profilaxis quirúrgica obstétrica.

The cesarean section is associated with a high incidence of puerperal infections. The antibiotic prophylaxis in obstetric surgery may reduce infectious complications, nevertheless antibiotic prophylaxis only has proved to be effective in women with risk factors for the occurrence of infection. We made a comparative study of the prophylactic efficacy of the ceftriaxone a single dose versus cefazolin three doses, in women with risk factor for infection. There were enrolled 100 patients, 50 in each group. Six percent of the ceftriaxone group patients developed puerperal infections while 12% of the cefazolin group women developed this complication. The statistic analysis don't show difference between the groups. We consider the single dose prophylactic schema is better because its application is easier, administration is safety and reduces the risk of adverse reactions.

[Course of pregnancies complicated by viral hepatitis]. / Evolución de los embarazos complicados con hepatitis viral.

It has been described that viral hepatitis is the most frequent cause of jaundice in the pregnant women. In this article we present clinical cases of hepatitis in pregnancy and review the new knowledge about the perinatal repercussion of this association. Hepatitis A is rare in pregnant women and has not a significant perinatal risk. Hepatitis B virus (HBV) can be transmitted from mother to child by transplacental way or at born. Between 40 to 80 per cent of the children infected by this route will develop chronic hepatitis, so the infants of HBsAg carrier mothers must be immunized at birth. The perinatal transmission of hepatitis C virus has been proved but the repercussion in the fetus or newborn is unknown. Hepatitis D virus can only be transmitted from mother to child together with HBV. Hepatitis E has been associated with a mortality from 10 to 40 per cent in pregnant women and with an increase in the preterm pregnancy.

[The behavior and perinatal impact of viral hepatitis in pregnancy]. / Comportamiento y repercusión perinatal de la hepatitis viral en el embarazo.

The association between viral hepatitis and pregnancy is not common, nevertheless it has been described that hepatitis is the most frequent cause of jaundice in pregnant women. In this article the current knowledge on the perinatal repercussions of the different types of viral hepatitis are reviewed. Hepatitis A is rare during pregnancy and is not associated with perinatal risk. Hepatitis B virus (HBV) can be transmitted transplacentally, 20 per cent of the children infected by this route will develop liver cirrhosis or carcinoma in the adult age, so the infants of HBsAg carrier mothers must be immunized at born. The perinatal transmission of hepatitis C virus has been proved but the repercussion in the fetus or newborn is unknown. Hepatitis D virus can only be transmitted from mother to child together with HBV. Hepatitis E has been associated with a mortality of 10 to 40 per cent in pregnant women.

[Complications and treatment of cholera during pregnancy]. / Complicaciones y tratamiento del cólera durante el embarazo.

Since 1961 cholera has spread in many countries reaching a pandemic form. Since 1991 Mexico has been involved in this pandemia. Near 20% of all cases of cholera in our country happen in fertile women, so the possibility of the association between cholera and pregnancy is high. We present the case of a pregnant woman, who during her third trimester presented a episode of cholera, developing premature labor. Furthermore is revised the medical literature about the general principles of the management of cholera, and the association between pregnancy and the intestinal infection.

[Chorioamnionitis as a cause of jaundice during pregnancy]. / Corioamnioitis como causa de ictericia durante el embarazo.

A clinical case of a pregnant patient with chorioamniotis and E. coli sepsis during the third trimester, whose principal clinical symptom was an icteric syndrome, is presented. Jaundice during pregnancy represents many etiologic possibilities, nevertheless the most frequent causes are hepatic or biliary tract diseases, some systemic illness like infections or eclampsia can be associated to this syndrome. It is proposed that, although is not a common cause, chorioamniotis must be considered between the causes of jaundice during pregnancy.