Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies. METHODS: This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests. RESULTS: We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively). CONCLUSION: All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.

Accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS: This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS: No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION: The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.

Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study.

BACKGROUND: Maximum decrease of blood pressure and number of minutes of hypotension were independently associated with umbilical arterial pH. However, the impact of hypotension considering the duration of it on umbilical arterial pH is unknown. METHODS: Pregnant women aged ≥ 20 years who delivered a baby at full-term via a cesarean delivery under a single-shot spinal anesthesia between January 2017 and March 2019 were included. The main outcome was to predict umbilical arterial pH, based on the value of the time integral of hypotension. Patient demographics, patient comorbidities, and intraoperative data, including the total dose of ephedrine and phenylephrine by fetal delivery and cumulative duration of maternal hypotension, were evaluated. Maternal hypotension was reflected as a decrease in systolic arterial pressure and mean arterial pressure to < 80% of baseline values. The systolic arterial pressure and mean arterial pressure were independently included in a multiple regression analysis along with all other explanatory factors to predict the umbilical arterial pH. RESULTS: Of the 416 eligible patients, 381 were enrolled. When including the systolic arterial pressure or mean arterial pressure in the model, emergency cases, the total dose of ephedrine, hypertensive disorders of pregnancy, and systolic arterial pressure or mean arterial pressure values were found to be significant predictive factors of umbilical arterial pH. CONCLUSION: Our results suggest that an elevated time integral of maternal hypotension may have a negative impact on umbilical arterial pH. Therefore, to minimize the risk of fetal acidosis, maternal hypotension should be prevented with the consideration of vasopressors selection.

Células madre mesenquimatosas y sus diferentes usos / Mesenchymal stem cells and their different uses

Introducción: las células madre mesenquimatosas (CMM) se diferencian de diversos tipos celulares para la regeneración de tejidos, esta característica sumada con la versatilidad del antígeno leucocitario humano (HLA) representan una eficaz alternativa para el tratamiento de enfermedades con tejidos deteriorados. Se pueden obtener a partir de médula ósea, cordón umbilical (CU) y sangre fetal. Objetivo: analizar los tipos de diferenciación de las CMM, sus métodos de extracción y su relación con bancos de sangre de cordón umbilical (BSCU), a fin de demostrar la eficacia de las CMM, en patologías que impliquen alteración de algún tejido u órgano. Metodología: se revisaron varias publicaciones en español e inglés en Pubmed, Clinicalkey y Science Direct; desde 2013 hasta 2020. Se usaron los términos sangre fetal, células madre mesenquimatosas, trasplante de Células Madre de Sangre del Cordón Umbilical y bancos de sangre. Con dicha información se redactó un panorama amplio sobre las células mesenquimales y como estas participan en diversas áreas de la salud, con un énfasis importante en sus usos terapéuticos y lo referente a de donde provienen. Conclusión: a través de la pluripotencialidad de las CMM, se han podido emplear en múltiples patologías pues reestablece tejidos o líneas celulares exitosamente. Así mismo, los recursos para su obtención son claves en la tolerancia de los pacientes, por lo cual una gran opción para su obtención es el CU, que actualmente cuenta con bancos exclusivos para esto. (AU)

Introduction: mesenchymal stem cells (MSC) differentiate into multiple cell types for tissue regeneration, this characteristic added with the versatility of human leukocyte antigen (HLA) represent an effective alternative for the treatment of diseases with damaged tissues. They can be obtained from bone marrow, umbilical cord (UC), and fetal blood. Objetive: analyze the types of differentiation of MSC, their extraction methods and their relationship with umbilical cord blood banks (UCBB), in order to demonstrate the efficacy of MSC, in pathologies that involve alteration of a tissue or organ. Methodology: several publications in Spanish and English in Pubmed, Clinicalkey and Science Direct were reviewed; from 2013 to 2020. The terms fetal blood, mesenchymal stem cells, Umbilical Cord Blood Stem Cell transplantation and blood banks were used. With this information, a broad overview of mesenchymal cells and how they participate in various areas of health was drawn up, with an important emphasis on their therapeutic uses and where they come from. Conclusion: through the pluripotentiality of MSC, they have been used in multiple pathologies as it successfully re-establishes tissues or cell lines. Also, the resources for obtaining it are key in the tolerance of patients, which is why a great option for obtaining it is the UC, which currently has exclusive banks for this.

Massive Fetomaternal Hemorrhage Remote from Term: Favorable Outcome after Fetal Resuscitation and Conservative Management.

Fetomaternal hemorrhage (FMH) is a rare condition that requires early diagnosis and appropriate treatment due to its potentially severe consequences. We report a case of massive FMH presenting as decreased fetal movement, fetal hydrops, and intracranial hemorrhage at 24 weeks. Treatment considerations were made and amniocentesis, fetal blood sampling, and fetal blood transfusion via cordocentesis were performed. Recurrent FMH required subsequent fetal transfusion 2 days later. Surveillance was continued twice weekly until the patient delivered a viable infant at 38 weeks after spontaneous labor. Recurrent FMH was unpredictable due to its unclear etiology and absence of precipitating events, however close surveillance proved effective.

Técnica quirúrgica vascular integral avanzada (VIVA) aplicada en pacientes con placenta previa anormalmente adherida con feto in situ / Advanced integral vascular surgical technique (AIVS) applied in patients with placenta previa adhered abnormally with in situ fetus

Resumen OBJETIVO: Describir la técnica quirúrgica vascular integral avanzada (VIVA) aplicada en pacientes con placenta previa anormalmente adherida, con feto in situ. MATERIALES Y MÉTODOS: Estudio prospectivo y descriptivo de serie de casos efectuado en pacientes atendidas en el Hospital de Especialidades del Niño y la Mujer de Querétaro, y en el Hospital Materno Celaya, entre enero y junio de 2017, con placenta previa anormalmente adherida en quienes se practicó la técnica quirúrgica vascular integral avanzada. Los datos se analizaron con estadística descriptiva y medidas de tendencia central. Parámetros de estudio: edad materna, edad gestacional al momento de la interrupción del embarazo, tiempo y sangrado quirúrgico estimado, concentración de hemoglobina y hematocrito pre y posquirúrgicos; pacientes que requirieron "biocirugía", ingreso a unidad de cuidados intensivos obstétricos y tiempo de estancia intrahospitalaria. Variables perinatales: Capurro al nacimiento, peso del neonato, calificación de Apgar y gasometría del cordón umbilical. RESULTADOS: Se registraron 16 pacientes, todas se intervinieron en un solo procedimiento quirúrgico, sin necesidad de reintervención, con sangrado quirúrgico promedio objetivado con hemoglobina pre y posquirúrgica, sin indicación de ingreso a la unidad de cuidados intensivos obstétricos, con adecuada evolución posquirúrgica y sin morbilidad neonatal asociada. CONCLUSIÓN: La técnica quirúrgica vascular integral avanzada (VIVA) es un procedimiento seguro, accesible, asequible y disponible; debe integrarse un equipo médico-quirúrgico adecuadamente organizado.

Abstract OBJECTIVE: To describe the advanced integral vascular surgical technique (AIVS) applied in patients with placenta previa adhered abnormally with in situ fetus. MATERIALS AND METHODS: Prospective and descriptive study presenting a series of cases, carried out in patients with abnormally attached placenta previa to whom the advanced integral vascular surgical technique was applied, attended at the Hospital of Specialties of the Child and the Woman of Querétaro, and Hospital Maternal Celaya, between January and June 2017. Using descriptive statistics of central tendency, maternal variables were analyzed such as: maternal age, gestational age at the time of the interruption of the obstetric event, time and estimated surgical bleeding, hemoglobin concentration and pre and post hematocrit postsurgical patients who required "biosurgery", admission to obstetric intensive care unit and intrahospital stay; perinatal variables: Capurro at birth, neonatal weight, Apgar score and umbilical cord blood gas. RESULTS: 16 patients were registered. All the patients were operated on in a single surgical event, with no need for reoperation, with average surgical bleeding objectified with pre- and postoperative hemoglobin, without indication of admission to the Obstetric Intensive Care Unit, with adequate postoperative evolution and perinatal outcomes without associated neonatal morbidity. CONCLUSION: The advanced integral vascular surgical technique (AIVS) is a safe, accessible, affordable and available technique, having to integrate a properly organized medical surgical team.

Effect of ultrafiltration on placental-fetal blood flow in pregnancy of woman undergoing chronic hemodialysis.

INTRODUCTION: Patient who was undergoing hemodialysis (HD) thrice weekly usually gain 1 to 4 kg of weight in interdialytic period, mainly due to fluid accumulation by ingestion of water. Ultrafiltration (UF) during HD will be need to remove fluid excess to avoid severe medical complications secondary to fluid overload. However, in pregnant woman UF can increase the episodes of intradialytic hypotension which may lead to placental ischemic injury and predispose to fetal distress. There is little information about safe fluid amount withdrawn by UF during pregnancy. METHODS: We prospectively study by obstetric Doppler ultrasonography the fluxometric parameters: pulsatility index (PI) and resistance index (RI) of fetal middle cerebral, uterine, and umbilical artery obtained at the beginning and the end of HD session, the acute and chronic effect of UF on placenta and fetus blood flow, as well as the fetal outcome in 1 pregnant woman on chronic HD. FINDINGS: We did not observe any acute harmful effect on fetal middle cerebral, placental and umbilical artery blood flow when UF rate of 2.1 ± 0.04 L (6 < 8 mL/h/kg) during HD session, no significant statistical difference was observed when compared PI and RI before and after UF and also when we compared these data with reference value on normal pregnancy to the same gestational age. DISCUSSION: UF rate of 6 < 8 mL/h/kg during HD did not bring any acute harmful effect on fetal middle cerebral, placental, and umbilical blood flow and the UF rate of 1.4 6 0.4 L (< 6 mL/h/kg) / HD session that was done in all others HD during pregnancy was safe, without any chronic fetal deleterious effect. Obstetric Doppler ultrasonography is a simple and noninvasive method to fetal follow-up and can aid to determine safe UF rate in pregnant women during gestation.

Evaluación de umbrales mínimos de celularidad en unidades de sangre de cordon umbilical en el Instituto Nacional Materno Perinatal del Perú / Evaluation of minimum thresholds of cellularity in units of umbilical cord blood at Instituto Nacional Materno Perinatal in Peru

RESUMEN Con el objetivo de evaluar criterios mínimos de celularidad de las unidades de sangre de cordón umbilical (USCU) según los estándares NETCORD en el Instituto Nacional Materno Perinatal de Lima, Perú, se realizó un estudio transversal que incluyó 100 USCU; se determinó el volumen, el recuento de células nucleadas totales (CNT) por hematología y el número de células CD34+ totales, así como también la viabilidad celular, por citometría de flujo. Se encontró que el 56% de las USCU no cumplen los umbrales mínimos de celularidad para ser criopreservadas en un banco de sangre de cordón umbilical. Se encontró, además, que las USCU de recién nacidos de mayor peso y de sexo femenino presentan mayor volumen y recuentos de células. En conclusión, es necesario considerar estas variables para optimizar la colecta de las USCU y obtener mayores recuentos de células que permita almacenar unidades de alta calidad en un futuro banco de sangre de cordón umbilical en Perú.

ABSTRACT A cross-sectional study that included 100 units of umbilical cord blood (UCB) was conducted to evaluate the minimum criteria of cellularity in UCB units, according to NetCord standards at Instituto Nacional Materno Perinatal in Lima, Peru. The volume, total count of nucleated cells by hematological tests and total number of CD34+ as well as cell viability by flow cytometry were determined. The study revealed that 56% of UCB units do not fulfill the minimum criteria of cellularity to be cryopreserved in an umbilical cord blood bank. Furthermore, the UCB units of newborns who weighed more and were female had a higher volume and cell count. In conclusion, these variables must undoubtedly be considered to optimize the collection of UCB units and obtain greater cell counts that enable the storage of high-quality units in a future umbilical cord blood bank in Peru.

Good practices in collecting umbilical cord and placental blood / Boas práticas para a coleta de sangue de cordão umbilical e placentário / Buenas prácticas para la recolección de sangre del cordón umbilical y de la placenta

Abstract Objective: to identify the factors related to the quality of umbilical cord and placental blood specimens, and define best practices for their collection in a government bank of umbilical cord and placental blood. Method: this was a descriptive study, quantitative approach, performed at a government umbilical cord and placental blood bank, in two steps: 1) verification of the obstetric, neonatal and operational factors, using a specific tool for gathering data as non-participant observers; 2) definition of best practices by grouping non-conformities observed before, during and after blood collection. The data was analyzed using descriptive statistics and the following statistical software: Statistica(r) and R(r). Results: while there was a correlation with obstetrical and neonatal factors, there was a larger correlation with operational factors, resulting in the need to adjust the professional practices of the nursing staff and obstetrical team involved in collecting this type of blood. Based on these non-conformities we defined best practices for nurses before, during and after blood collection. Conclusion: the best practices defined in this study are an important management tool for the work of nurses in obtaining blood specimens of high cell quality.

Resumo Objetivos: identificar fatores relacionados à qualidade das amostras do sangue de cordão umbilical e placentário e definir boas práticas para sua coleta em um banco público de sangue de cordão umbilical e placentário. Método: pesquisa descritiva, abordagem quantitativa, realizada em um banco público de sangue de cordão umbilical e placentário, desenvolvida em duas etapas: 1) verificação dos fatores obstétricos, neonatais e operacionais, obtidos por coleta em instrumento próprio e observação não participante; 2) definição das boas práticas, por meio do agrupamento de não-conformidades observadas antes, durante e após a coleta do sangue. Os dados foram analisados por meio da estatística descritiva, utilizando-se dos softwares Statistica(r) e R(r). Resultados: houve correlação da influência dos fatores obstétricos e neonatais em menor escala quando comparados aos fatores operacionais, resultando na necessidade de readequar a prática profissional do enfermeiro e da equipe obstétrica envolvida no processo da coleta desse tipo de sangue. A partir das não-conformidades foram definidas boas práticas para o enfermeiro antes, durante e após a coleta. Conclusão: as boas práticas definidas neste estudo são importante ferramenta gerencial para o trabalho do enfermeiro na obtenção de amostras de sangue com alta qualidade celular.

Resumen Objetivos: identificar factores relacionados a la calidad de las muestras de la sangre del cordón umbilical y de la placenta y definir buenas prácticas para su recolección en un banco público de sangre del cordón umbilical y de la placenta. Método: investigación - descriptiva, abordaje cuantitativo, realizada en un banco público de sangre - del cordón umbilical y de la placenta, desarrollada en dos etapas: 1) verificación de los factores obstétricos, neonatales y operacionales, obtenidos por recolección con instrumento propio y observación no participante; 2) definición de las buenas prácticas, por medio del agrupamiento de no-conformidades observadas antes, durante y después de la recolección de la sangre. Los datos fueron analizados por medio de la estadística descriptiva, utilizando los softwares Statistica(r) y R(r). Resultados: hubo correlación de la influencia de los factores obstétricos y neonatales en menor escala cuando comparados a los factores operacionales, resultando en la necesidad de readecuar la práctica profesional del enfermero y del equipo obstétrico que participa en el proceso de la recolección de ese tipo de sangre. A partir de las no-conformidades fueron definidas buenas prácticas para el enfermero antes, durante y después de la recolección. Conclusión: las buenas prácticas definidas en este estudio son importante herramienta administrativa para el trabajo del enfermero en la obtención de muestras de sangre con alta calidad celular.

Hemoglobina en recién nacidos por parto vaginal según clampaje precoz o tardío del cordón umbilical, a 2 700 metros sobre el nivel del mar

Diversos estudios han demostrado que un clampaje tardío del cordón umbilical aumenta los niveles de hemoglobina de los recién nacidos. Objetivos: Evaluar si el clampaje tardío del cordón umbilical en neonatos a término muestra mayores valores de hemoglobina que cuando se realiza clampaje precoz, a 2700 msnm. Diseño: Investigación prospectiva, aleatorizada y doble ciego. Institución: Departamento de GinecoObstetricia, Hospital Regional de Cajamarca, Perú. Participantes: Recién nacidos y sus madres. Métodos: En enero de 2014, a 100 gestantes en trabajo de parto con gestación única, a término y sin otros factores de riesgo, se asignó al azar clampaje tardío (cuando dejó de latir el cordón umbilical 1 a 3 minutos) o clampaje precoz (alrededor de 10 segundos después del parto). Se midió el tiempo desde que aparecieron los hombros del bebé. Se procedió a sacar una muestra de sangre del talón derecho del recién nacido en 2 capilares y a las 6 horas de vida, y se analizó la hemoglobina, el hematocrito y grupo y factor Rh. Principales medidas de resultados: Nivel de hemoglobina. Resultados: Encontramos 91 % de gestantes sin anemia y 9% con anemia; el grupo sanguíneo materno predominante fue el O+ en 86%. Se practicó clampaje tardío a 52 recién nacidos y clampaje precoz a 48. El 94% de los recién nacidos pesó entre 2 501 Y 3 999 g, con Ápgar > 7 en el 100%. El tiempo en que dejó de latir el cordón umbilical fue 2,67+-0,28 minutos. En 100% de los neonatos con clampaje temprano el valor de la hemoglobina fue <15 mg/dLy en el clampaje tardío el 71,1 % presentó hemoglobina de 15,1 a 20,1 mg/dL, y 28,9% más de 20,1 mg/dL. No hubo diferencia significativa en los valores de hemoglobina de los recién nacidos sí la madre presentó o no anemia. Conclusiones: El clampaje tardío mostró mejores valores de hemoglobina en los neonatos. El tiempo medio en que dejó de latir el cordón fue 2,67 min y la anemia materna no influyó en la hemoglobina neonatal.

Several studies have shown that late cord clamping in creases levels of hemoglobin in newborns. Objectives: To determine whether delayed umbilical cord clamping in term infants show higher hemoglobin levels than early clamping, investigation performed at 2700 m.a.s.l. Design: Prospective, randomized, double blind study. Setting: Gynecology and Obstetrics Department, Hospital Regional de Cajarnarca, Peru. Participants: Newborns and their moth­ ers. Methods: In january 2014, 100 pregnant women in labor with singleton pregnancies at term and without other risk factors were randomized to delayed clamping (when the umbilical cord stopped beats in 1-3 minutes) or early clamping (about 1 O seconds after birth). Time was measured starting when baby shoulders appeared. A blood sample from the right newborn's heel was obtained and placed in 2 capillaries, at birth and also at 6 hours of life; hemoglobin, hematocrit, and group and Rh factor were analyzed. Main outcome measures: Hemoglobin levels. Results: Ninety-one per cent of pregnant women did not have anemia and 9% had anemia; maternal blood group was 0+ in 86%; 94% of newborns weighed 2 501-3 999 g, Apgar >7 was found in all newborns. Late clamping was done in 52 infants and early clamping in 48. The umbilical cord stopped beating at 2.67+-0.28 minutes. In 100% of infants with early clamping hemoglobin value was <15 mg/dL, and in late clamping 71.1 % had hemoglobin 15.1­ 20.1 mg/dL and 28.9% over 20.1 mg/dL. There was no significant difference in newborn hemoglobin values whether the mother presented anemia or not. Conclusions: Late clamping resulted in better neonatal hemoglobin values. Average time for the umbilical cord stopping beats was 2.67 mino Maternal anemia did not affect neonatal hemoglobin at 2 700 m.a.s.l.

Celularidade do sangue de cordão umbilical de gestantes hipertensas: estudo caso-controle / Cellularity of the umbilical cord blood of hypertensive pregnant women: a case control study / Celularidad de la sangre de cordón umbilical de gestantes hipertensas: estudio caso-control

OBJETIVO(S): analisar a relação entre celularidade do sangue do cordão umbilical e placentário de gestantes hipertensas e não hipertensas. MÉTODO: estudo caso-controle, com abordagem quantitativa, amostra de 73 gestantes, no período de março a setembro de 2011. Os dados fazem parte do estudo aprovado pelo Comitê de Ética em Pesquisa sob o protocolo de número 126/10. RESULTADOS: foi concluído que 80% das bolsas de sangue de cordão umbilical e placentário coletados de gestantes com hipertensão arterial apresentaram celularidade ≥5 x 108, quantidade adequada no total de células nucleadas, atendendo aos critérios estabelecidos pela Resolução 56. CONCLUSÃO: os resultados contribuíram para a identificação de fatores que possibilitam a obtenção de um quantitativo adequado de células tronco-hematopoiéticas, resultando no aumento do número de transplantes de células tronco-hematopoiéticas no Brasil.

AIM: To analyze the relationship between the cellularity of placental and umbilical cord blood of hypertensive and non-hypertensive pregnant women. METHOD: This is a case-control study that used a quantitative approach. The sample consists of 73 pregnant women and it was conducted from March to September 2011. The data are part of the study approved by the Research Ethics Committee under protocol number 126/10. RESULTS: It was found that 80% of the Umbilical Cord and placental blood bags collected from pregnant women with hypertension presented cellularity ≥5 x 108. This is the appropriate amount in relation to the totality of nucleated cells, given the criteria established by Resolution 56. CONCLUSION: The results contributed to the identification of factors that make it possible to obtain an adequate number of hematopoietic stem cells, resulting in the increased number of hematopoietic stem cell transplantation in Brazil.

OBJETIVO(S): analizar la relación entre celularidad de la sangre del cordón umbilical y placentario de gestantes hipertensas y no hipertensas. MÉTODO: estudio caso-control, con abordaje cuantitativo, muestra de 73 gestantes, en el período de marzo a septiembre de 2011. Los datos hacen parte del estudio aprobado por el Comité de Ética en Investigación bajo el protocolo de número 126/10. RESULTADOS: fue concluido que 80% de las bolsas de sangre de cordón umbilical y placentario colectados de gestantes con hipertensión arterial presentaron celularidad ≥5 x 108, cantidad adecuada en el total de células nucleadas, atendiendo a los criterios establecidos por la Resolución 56. CONCLUSIÓN: los resultados contribuyeron para la identificación de factores que posibilitan la obtención de un cuantitativo adecuado de células madre-hematopoyéticas, resultando en el aumento del número de trasplantes de células madre-hematopoyéticas en Brasil.

Controversias legales y éticas respecto a la sangre del cordón umbilical / Legal and ethical controversies regarding a umbilical cord blood

Hasta hace relativamente escaso tiempo, la sangre del cordón umbilical, era desechada por considerarse material biológico inservible. Actualmente este material biológico se ha transformado en un recurso sanitario de primer orden, al tiempo que en un potencial objeto lucrativo. Cerca del 75 % de los bancos de sangre de cordón umbilical existentes en el mundo son de carácter público y no lucrativos, los cuales procuran un servicio para el beneficio común, aunque también almacenan sangre de cordón para el uso familiar en el caso de un riesgo conocido en una específica familia. El 25% restante son bancos privados comerciales, de uso autólogo, cuyo propósito es un servicio a la conservación de células de sangre de cordón para el beneficio propio de sus “exclusivos” clientes. Las consecuencias recientes de las actividades de extracción, conservación y aplicación de la sangre del cordón umbilical, han contribuido a reavivar el interés social en torno a la preservación en los bancos privados y/o públicos y con ello las derivadas cuestiones éticas y legales. En el presente artículo de revisión se exponen las posiciones y discrepancias en torno a la creación de bancos de sangre de cordón umbilical privados, y la ausencia de legislación específica. Igualmente se trata de mostrar la falta de argumentos sólidos, de carácter ético que sustenten la utilidad de los bancos de sangre de cordón umbilical para uso autólogo y son establecidos criterios en defensa de los bancos públicos...

Until relatively short time, umbilical cordon blood was discarded due to biological material was deemed unusable. Currently this biological material has become in a health resource of first order, while in a potential object lucrative. Around 75% of the umbilical cord blood banks in the world, are publics and nonprofit, which seek a service for the common benefit, though umbilical cord blood is also stored for family use in the case of a known risk in a specific family. The remaining 25% are private commercial banks, for autologous use, a service whose purpose is to conserve cord blood cells for the benefit of their own “exclusive” clients. The recent impact of the extraction, preservation and application of umbilical cordon blood activities, have helped to revive social interest around the preservation in private banks and/or public ones and thus the ethical and legal issues arising. In this review article, we try to expose positions and disagreements over the establishment of private umbilical cord blood bank, and the absence of specific legislation. We also try to show the lack of solid and ethical arguments that support utility of umbilical cord blood banks for autologous use and we establish criteria in defense of public banks...

Association between maternal and fetal factors and quality of cord blood as a source of stem cells.

OBJECTIVES: To comparatively analyze maternal and fetal factors and quality markers of blood samples in a public umbilical cord blood bank. METHOD: This is a cross-sectional descriptive study that revisited 458 records of donations from September 2009 to March 2013 at the Hemocentro de Santa Catarina. The means of markers were used to define cutoff points for the quality of cord blood. RESULTS: Most donations came from women with ages between 18 and 29 years (62.8%), gestational age≥40 weeks (55.2%), vaginal delivery (51.3%), primiparous (41.4%), and with male newborns (54.4%) weighing between 3000 and 3499g (41.8%). The volume of the donations ranged from 71.6 to 275.2mL, the total nucleated cell count ranged from 4.77×10(8) to 31.0×10(8) cells and CD34(+) cells ranged from 0.05 to 1.23%. There were statistically significant differences in the volume with respect to gestation age>38 weeks (p-value=0.001), cesarean section (p-value<0.001) and birth weight>3500g (p-value<0.001). The total nucleated cell count was positively affected by cesarean section (p-value=0.022) and birth weight>3500g (p-value<0.001). There was no statistically significant difference between the variables and the percentage of CD34(+) cells. CONCLUSIONS: Delivery route and birth weight influence the volume of cord blood and the total nucleated cell count. Gestational age influences only the volume of cord blood.

Association between maternal and fetal factors and quality of cord blood as a source of stem cells

Objectives: To comparatively analyze maternal and fetal factors and quality markers of blood samples in a public umbilical cord blood bank. Method: This is a cross-sectional descriptive study that revisited 458 records of donations from September 2009 to March 2013 at the Hemocentro de Santa Catarina. The means of markers were used to define cutoff points for the quality of cord blood. Results: Most donations came from women with ages between 18 and 29 years (62.8%), gestational age ≥ 40 weeks (55.2%), vaginal delivery (51.3%), primiparous (41.4%), and with male newborns (54.4%) weighing between 3000 and 3499 g (41.8%). The volume of the dona- tions ranged from 71.6 to 275.2 mL, the total nucleated cell count ranged from 4.77 × 108 to 31.0 × 108 cells and CD34+ cells ranged from 0.05 to 1.23%. There were statistically significant differences in the volume with respect to gestation age > 38 weeks (p-value = 0.001), cesarean section (p-value < 0.001) and birth weight > 3500 g (p-value < 0.001). The total nucleated cell count was positively affected by cesarean section (p-value = 0.022) and birth weight > 3500 g (p-value < 0.001). There was no statistically significant difference between the variables and the percentage of CD34+ cells. Conclusions: Delivery route and birth weight influence the volume of cord blood and the total nucleated cell count. Gestational age influences only the volume of cord blood. .

A capacitação dos enfermeiros e o processo da coleta do sangue do cordão umbilical e placentário: o caso da Maternidade Escola da UFRJ / The training of nurses and the process of umbilical and placental cord blood collection: the case of the UFRJ Maternity School

Introdução: O sangue de cordão umbilical age como ligação entre a placenta e o feto durante a gestação e contém células-tronco que podem ser utilizadas como fonte de células-tronco hematopoéticas em transplantes. Objetivo geral: Analisar a capacitação dos enfermeiros para o processo da coleta SCUP, considerando os aspectos relevantes para a caracterização da Maternidade Escola/UFRJ como posto de coleta. Objetivos específicos: 1- Traçar a caracterização das potenciais doadoras de sangue de cordão e placentário na Maternidade Escola da UFRJ. 2- Descrever a capacitação dos enfermeiros no processo da coleta do sangue de cordão umbilical e placentário na Maternidade Escola da UFRJ. 3 - Avaliar a capacitação dos enfermeiros para o processo da coleta do sangue do cordão umbilical e placentário. 4 Elaborar um programa de educação e capacitação dos enfermeiros para o processo da coleta do sangue do cordão umbilical e placentário para a Maternidade Escola da UFRJ. Método: A primeira fase da pesquisa para atender o objetivo de traçar a caracterização das potenciais doadoras de sangue de cordão e placentário na Maternidade Escola da UFRJ utilizou a metodologia do estudo de caso, as fases seguintes se caracterizaram pela abordagem da pesquisa-ação, com dados descritivos realizada com 20 enfermeiros em uma Maternidade Escola pública do Rio de Janeiro. Para a coleta de dados utilizamos várias fontes de informações (pesquisa documental, entrevistas, observação participativa) para assegurar as diferentes perspectivas dos participantes e por outro, obter várias medidas do mesmo fenômeno. Os dados foram coletadas no período de janeiro de 2014 a novembro de 2015. Para atender a análise e tratamento quantitativos os dados foram tabulados em uma planilha do programa MS Excel® e analisados por meio de estatística descritiva. Para os objetivos qualitativos foram realizados uma análise descritiva de frequência e porcentagem para cada um dos itens dos instrumentos de coleta de dados aplicados, como também através da descrição da percepção subjetiva contidas nos questionários. A pesquisa observou os preceitos éticos contidos na resolução na resolução 466/2012. Aprovado com o número do parecer: 722.172 em 18/07/2014. Resultados: Considerando os critérios de qualificação 73,8% (n=404) aptas para a doação do SCUP, enquanto que nos critérios de desqualificação 89% (n=490) aptas. Apontaram que 62,5% (n=345) das pacientes da maternidade-escola estariam aptas para a doação do sangue do cordão umbilical e placentário, dependendo do seu consentimento. A oficina teórica teve um efeito positivo e significativo no aprendizado para os participantes da pesquisa. As oficinas práticas da CSCUP aconteceram no período de setembro a novembro de 2015, foram realizadas no centro obstétrico da ME/UFRJ, totalizando 18 oficinas e houve a participação de 20 enfermeiros participantes da pesquisa, nesse período foram coletadas 87 bolsas do SCUP. Após o término das oficinas práticas os enfermeiros participantes se sentiram aptos para realizarem a coleta SCUP. Conclusão: A Maternidade-Escola da UFRJ tem aptidão para ser posto de CSCUP com um grande diferencial: que os enfermeiros devidamente capacitados da instituição poderão realizar as coletas SCUP. Houve aprimoramento dos conhecimentos para enfermeiros em relação ao processo da coleta do sangue do cordão umbilical e placentário. A pesquisa possibilitou elaborar um programa de educação de capacitação para a coleta SCUP contribuindo para que as outras maternidades públicas com perfil de posto de coleta também possam usar este programa como modelo para capacitar os enfermeiros no processo de CSCUP. Assim as instituições poderão ser mais um posto de coleta SCUP

Introduction: The umbilical cord blood acts as a connection between the placenta and the fetus during pregnancy. It contains stem cells and can be used as a source for hematopoietic stem cell transplantation. General objective: To analyze the training of nurses for the process of UCB collection, considering specific aspects of the hospital Maternidade Escola/UFRJ as a collection station. Specific objectives: 1 - To outline the profile of potential placenta and cord blood donors at UFRJ´s Maternidade Escola hospital. 2 ­ To define nurses' training in the placental and umbilical cord blood collection process at UFRJ´s Maternidade Escola hospital. 3 ­ To assess nurses' training in the placental and umbilical cord blood collection process at UFRJ´s Maternidade Escola hospital. 4 ­ To elaborate a training program for nurses in the placental and umbilical cord blood collection process at UFRJ´s Maternidade Escola hospital. Method: The objective of the first phase of the research is to outline the profile of potential placenta and cord blood donors at UFRJ´s Maternidade Escola hospital using the case study methodology. The following stages resorted to the action research methodology, with descriptive data conducted with 20 nurses at the public Hospital Maternidade Escola in Rio de Janeiro. Several sources of information were used to collect data (documentary research, interviews, participant observation) in order to establish the participants' different perspectives, and also get multiple measures of the same phenomenon Data were collected in the period from January 2014 to November 2015. To present the quantitative analysis and treatment data were tabulated in a MS Excel® spreadsheet and analyzed using descriptive statistics. For qualitative objectives it was developed a descriptive analysis of frequency and percentage for each of the items of data collection instruments used. The description of the subjective perception in the questionnaires was also used. The research followed the ethical principles of the Resolution 466/2012. Accredited with the opinion number: 722.172 in 07/18/2014. Results: Considering the qualification criteria 73.8% (n = 404) were suitable for donation of UCB, while as per the disqualification criteria it was 89% (n = 490). It was indicated that 62.5% (n = 345) of the maternity hospital patients would be able to donate placenta and umbilical cord blood, depending on their consent. The theoretical workshop had a positive and significant effect on the survey participants' learning curve. UCB practical workshops took place from September to November 2015 at the ME/ UFRJ's obstetric center. 20 nurses participating in the research attended 18 workshops, collecting a total 87 UCB bags. Nurses that attended the practical workshops felt able to perform the UCB collection. Conclusion: UFRJ's Maternidade Escola hopsital is suited to be a UCB collection point with a significant advantage: the institution's properly trained nurses can conduct the UCB collections. Nurses' knowledge in the placenta and umbilical cord collection process improved. The research made it possible to draw up a training education program for UCB collection contributing to other public hospitals with a collection point profile, which can also use this program as a model to train nurses in UCB collection process. Thus these institutions may become another UCB collection point

Introducción: La sangre del cordón umbilical actúa como conexión entre la placenta y el feto durante el embarazo. Ésta contiene células madre y se puede utilizar como fuente de células madre en trasplantes hematopoyéticos. Objetivos generales: Analizar la capacitación de enfermeros en el proceso extracción de SCUP, teniendo en cuenta las características particulares del hospital Maternidade Escola/UFRJ como puesto de extracción. Objetivos específicos: 1. Determinar el perfil de los potenciales donantes de sangre de cordón umbilical y placenta en el hospital Maternidade Escola de la UFRJ.; 2 ­ describir el tipo de entrenamiento de enfermeros en el proceso de extracción de sangre de cordón umbilical y placenta; 3 ­ evaluar la formación de enfermeros en el proceso de extracción de sangre de cordón umbilical y placenta; 4 ­ elaborar un programa de entrenamiento de enfermeros en el proceso de extracción de sangre de cordón umbilical y placenta en el hospital Maternidade Escola de la UFRJ. Método: La primera fase de la investigación tiene el objetivo de determinar el perfil de los potenciales donantes de sangre de cordón umbilical y placenta en el hospital Maternidade Escola de la UFRJ mediante la metodología de estudio de caso. Las fases siguientes utilizan el proceso de investigación-acción, con datos descriptivos sobre 20 enfermeros en el Hospital Maternidade Escola de Río de Janeiro. Para recoger datos se utilizaron diversas fuentes de información (investigación documental, entrevistas, observación participante) para asegurar la representación de las diferentes perspectivas de los participantes y, asimismo, obtener múltiples medidas de un mismo fenómeno. Los datos fueron recolectados en el período comprendido entre enero de 2014 y noviembre de 2015. Los datos de análisis y tratamiento cuantitativos fueron tabulados una planilla de MS Excel® y analizados mediante estadística descriptiva. Para los objetivos cualitativos se llevo a cabo un análisis descriptivo de la frecuencia y porcentaje para cada uno de los instrumentos de recolección de datos usados, incluyendo también la descripción de percepción subjetiva en los cuestionarios. La investigación siguió los principios éticos de la Resolución 466/2012. Aprobado con el número de opinión: 722.172 del 18/07/2014. Resultados: Teniendo en cuenta los criterios de calificación un 73,8% (n = 404) son aptas para donación de SCUP, mientras que según los criterios de descalificación un 89% (n = 490) son aptas. Se indicó que el 62,5% (n = 345) de los pacientes del Maternidade Escola sería capaz de donar sangre de cordón umbilical y placenta, dando su consentimiento. El taller teórico tuvo un efecto positivo y significativo en el aprendizaje de los participantes en la investigación. Los talleres prácticos de colección SCUP se llevaron a cabo desde septiembre hasta noviembre de 2015 en el centro obstétrico del ME/UFRJ. Se realizaron un total de 18 talleres con la asistencia de 20 enfermeros que participaron en la investigación. Durante este período se recolectaron 87 bolsas de SCUP. Al finalizar los talleres prácticos los enfermeros que participaron se sentían capaces de realizar la extracción de SCUP. Conclusión: El hospital Maternidade Escola de la UFRJ tiene la capacidad de ser un puesto de extracción de SCUP con un gran diferencial: que los enfermeros de la institución debidamente capacitados podrán realizar las extracciones de SCUP. El conocimiento de los enfermeros sobre el proceso de extracción de sangre de cordón umbilical y placenta mejoró. La investigación ha permitido elaborar un programa de formación para la extracción de SCUP pudiendo contribuir con otros hospitales públicos que tengan el perfil de punto de extracción y que también puedan utilizar este programa como modelo para capacitar a sus enfermeros en el proceso de extracción de SCUP. De esta manera las instituciones pueden tornarse otro puesto de extracción de de SCUP

Boas práticas para a coleta de sangue de cordão umbilical e placentário: atuação do enfermeiro / Good practices for umbilical and placental cord blood collection: nurses' performance

Objetivos: O objetivo geral deste estudo foi definir as boas práticas para a coleta de sangue de cordão umbilical e placentário (SCUP) em um Banco Público de SCUP (BPSCUP) da Rede BrasilCord, enquanto que os objetivos específicos foram descrever a atuação do enfermeiro em um BPSCUP da Rede BrasilCord; identificar os fatores que influenciam no volume e celularidade de amostras de SCUP em um BPSCUP da Rede BrasilCord; investigar as causas de descartes de amostras de SCUP em um BPSCUP da Rede BrasilCord; estabelecer o padrão de descarte de amostras de SCUP em um BPSUP da Rede BrasilCord. Método: Pesquisa de intervenção de abordagem quantitativa, realizada com 50 doadoras de SCUP e 14 profissionais da equipe de obstetrícia, em uma unidade de coleta externa de um BPSCUP do Sul do Brasil. A coleta de dados ocorreu no período de abril de 2013 a agosto de 2014, pela análise documental, observação não-participante (12 horas e 50 minutos no total) e diário de campo. Os dados foram tabulados em planilha eletrônica do Excell® e pelos softwares estatísticos R® e Statistica®, sofrendo ajustes de normalidade não-paramétrica, considerando 5% como nível de significância. Resultados: Foram identificadas como influências no volume e celularidade do SCUP, os fatores obstétricos peso placentário (rs=0,382923, p=0,006057; rs=0,339155, p=0,015978) e características do cordão umbilical quanto ao calibre (p=0,0051, p= 0,0095) e fluxo sanguíneo (p=0,00001, p=0,00001); os fatores neonatais peso do recém-nato (rs=0,362558, p=0,009667) e os fatores operacionais volume e celularidade (rs=0,873151, p=0,000000), características do cordão umbilical quanto ao aspecto (p=0,0003, p=0,0001), secção inadequada do segmento do cordão umbilical (p=0,00054, p=0,0005), excesso de pressão manual durante a dequitação placentária por tração controlada (p=0,0004, p=0,0004), ruptura ou laceração do segmento do cordão umbilical (p=0,021, p=0,036), desclampeamento do segmento de cordão umbilical por esquecimento do profissional (p=0,0007, p=0,024), desclampeamento do segmento do cordão umbilical para esvaziamento placentário (p=0,024), desclampeamento do segmento do cordão umbilical para coleta de tipagem sanguínea (p=0,006), sequencia de clampeamentos no segmento do cordão umbilical (p=0,036) e tempo entre coleta, transporte e processamento de amostras de SCUP (p=0,0355, p=0,0233). O padrão de descartes das amostras foi estabelecido pelos fatores obstétricos e neonatais identificados. As boas práticas para a coleta de SCUP foram definidas a partir da descrição da atuação do enfermeiro em BPSCUP e das não-conformidades encontradas baseadas nos fatores operacionais de influencia no volume e celularidade de SCUP e foram validadas com profissionais da equipe obstétrica da instituição. Conclusão: As boas práticas para a coleta de SCUP definidas neste estudo surgem como uma importante ferramenta gerencial para o trabalho do enfermeiro de BPSCUP na perspectiva da obtenção de volume e celularidade adequadas para o suprimento de amostras de alta qualidade celular para o BPSCUP. Desta forma, a atuação do enfermeiro em um serviço de ponta, de alta complexidade, visa atender às necessidades da demanda dos TCTH advindos do SCUP à inúmeros candidatos, principalmente crianças, contribuindo para a melhoria da qualidade do SCUP armazenado nos BPSCUP.

Objectives: This study aims to define the best practices for umbilical cord and placental blood (UCPB) collecting in a umbilical cord blood and placental public bank (UCPPBB) of BrasilCord network, while the specific objectives were to describe the nurse's role in a UCPPBB of BrasilCord network; identify the factors that influence the volume and cellularity of samples UCPB in a UCPPBB of BrasilCord network; investigate the causes of discharges of samples UCPB in a UCPPBB BrasilCord network; setting standards for disposal of samples UCPB in a UCPPBB BrasilCord Network. Method: Intervention quantitative research, performed with 50 donors and 14 UCPB professional obstetrics team in an external unity collection of a UCPPBB in the South of Brazil. Data collection realized between April 2013 and August 2014, by documentary analysis, non-participant observation (12 hours and 50 minutes in total) and a field journal. The data were tabulated in a spreadsheet and the Excell® and the statistical software R® and the Statistica®, suffering adjustments nonparametric normality, considering 5% level of significance. Results: We identified the influence on the volume and cellularity of the UCPB linked obstetric factors like a placental weight (rs=0.382923, p=0.006057; rs=0.339155, p=0.015978) and characteristics of the umbilical cord as size (p=0.0051, p=0.0095) and blood flow (p=0.00001, p=0.00001); neonatal factors newborn weight (rs=0.362558, p=0.009667) and operational factors volume and cellularity (rs=0.873151, p=0.000000), characteristics of the umbilical cord in appearance (p=0,0003, p=0.0001), inadequate section of the umbilical cord (p=0.00054, p=0.0005) manual excess pressure for blood placental expulsion by a controlled traction (p=0.0004, p=0.0004), rupturing or lacerating the umbilical cord (p=0.021, p=0.036) segment unclamping the umbilical cord segment through forgetfulness professional (p=0.0007, p=0.024), unclamping the umbilical cord segment for placental deflating (p=0.024), unclamping the umbilical cord segment for collecting blood type (p=0.006), the sequence of clamping umbilical cord (p=0.036) and related time for collection, transportation and processing of samples UCPB (p=0.0355, p=0.0233). The discharges pattern of the samples were established by identified obstetric and neonatal factors. Best practices for UCPB collecting were defined from description of the nurse works in UCPPBB and non-conformities found based on operational factors influencing the volume and cellularity of UCPB and were validated by a professional obstetric staff. Conclusion: The best practices of UCPB collecting, defined in this study, emerged as an important management tool for the job of UCPB nurse, prospect of obtaining volume and suitable for the supply of high quality samples for UCPPBB cell cellularity. Thus, the nurses work in a rush service with a high complexity, which aims to meet the needs of the demand arising from UCPB HSCT for many candidates, especially children, contributing to improve the quality of UCPB stored in UCPPBB.

Gases en sangre de arteria umbilical de neonatos a término en altura / Umbilical artery blood gases of term neonates at altitude

Con el objetivo de determinar los valores normales de gases en sangre en la arteria umbilical de neonatos a término a 3400 m de altitud se hizo un estudio transversal, realizado en la sangre de la arteria umbilical de 300 neonatos a término, adecuados para la edad gestacional y cuyo parto se dio entre enero de 2010 a diciembre de 2011 en el Hospital Nacional Adolfo Guevara Velazco de EsSalud (Cusco, Perú). Se encontró que la media del pH de neonatos sanos a término fue de 7,33 ± 0,07, los valores para los percentiles 5 y 95 fueron 7,18 y 7,40 respectivamente. En conclusión, se han construido las tablas con los percentiles 5 al 95 para el pH, pO2, pCO2, SO2, p50, exceso de bases y HCO3, de la arteria umbilical de neonatos a término a 3400 m de altitud.

In order to determine the normal values of arterial blood gases in the umbilical artery of term infants at 3400 m altitude, a cross-sectional study was conducted. It was performed in the umbilical artery blood of 300 term infants, with an adequate gestational age and whose birth took place between January 2010 and December 2011 at the Essalud National Hospital Adolfo Guevara Velazco (Cusco, Peru). It was found that the average pH of healthy term infants was 7.33 ± 0.07; the values for percentiles 5 and 95 were 7.18 and 7.40 respectively. Tables with the 5th and 95th percentiles for pH, pO2, pCO2, SO2, p50, base excess and HCO3 of the umbilical artery of term infants at 3400 m altitude are provided.

Malformações do sistema nervoso central e a presença da mutação C677T-MTHFR no sangue fetal / Central nervous system malformations and the presence of the MTHFR-C677T mutation in fetal blood

OBJETIVO: Avaliar a associação entre as malformações do sistema nervoso central (SNC) e a mutação C677T-MTHFR no sangue fetal. MÉTODOS: Foi realizado um estudo caso-controle que comparou a presença da mutação C677T-MTHFR entre 78 fetos com malformações de SNC e 100 fetos morfologicamente normais. O DNA genômico foi extraído e purificado do sangue fetal utilizando o Wizard® Genomic DNA Purification Kit (Promega Corp., Madison, WI, USA), de acordo com o protocolo do fabricante. A reação em cadeia da polimerase (PCR, na sigla em inglês) foi realizada para a detecção da mutação C677T-MTHFR termolábil. A análise estatística descritiva foi realizada usando o teste exato de Fisher e o γ² e o teste de Wilcoxon foi utilizado para a análise univariada. Uma análise de regressão logística foi realizada para identificar as variáveis preditoras de malformações do SNC fetal. RESULTADOS: Os casos e controles foram similares quanto às características maternas, incluindo idade e paridade. A mutação C677T-MTHFR foi detectada em 20 casos (25,6%) e em 6 controles na forma heterozigota (OR 10,3; IC95% 3,3-32,2) e em 6 casos (7,7%) e em 1 controle na forma homozigota (OR 12,3; IC95% 1,3-111,1), e essas diferenças foram estatisticamente significativas. CONCLUSÃO: A presença da mutação C677T-MTHFR no sangue fetal foi consistente com maior risco de malformações de SNC, tanto na forma heterozigota quando homozigota.

PURPOSE: To evaluate the association between central nervous system (CNS) malformations and the C677T-MTHFR mutation in fetal blood. METHODS: A case-control study was conducted to compare the MTHFR-C677T mutation detected in 78 fetuses with CNS malformations and with 100 morphologically normal fetuses. Genomic DNA was extracted and purified from fetal blood using the Wizard® Genomic DNA Purification Kit (Promega Corp., Madison, WI, USA) according to manufacturer's protocol. The polymerase chain reaction (PCR) was used to assay the thermolabile MTHFR-C677T mutation. The γ² and the Fisher's exact tests were used for descriptive analysis and the Wilcoxon test was used for univariate analysis. Logistic regression analysis was performed to identify which variables were predictors of CNS malformation. RESULTS: Cases and controls were similar regarding maternal characteristics such as age and number of deliveries and abortions. The MTHFR-C677T mutation was detected in 20 cases (25.6%) and in 6 controls in its heterozygous form (OR 10.3; 95%CI 3.3-32.2) and in 6 cases (7.7%) and in 1 control in its homozygous form (OR 12.3; 95%CI 1.3-111.1), and the differences were statistically significant. CONCLUSION: The presence of the MTHFR-C677T mutation in fetal blood was consistent with a higher risk of CNS malformations, both in the heterozygous and homozygous forms.

Plomo en sangre de cordón umbilical de neonatos nacidos en un hospital del norte de Lima / Lead in umbilical cord blood of neonates born in northern Lima

Con el objetivo de describir la concentración de plomo en sangre de cordón umbilical (SCU) de recién nacidos (RN) hijos de mujeres primíparas residentes en la zona norte de Lima (Perú) se realizó un estudio transversal en el Hospital Nacional Cayetano Heredia entre julio de 2011 a diciembre de 2012. Se incluyeron 100 RN hijos de madres primigestas, que tenían un tiempo mínimo de residencia de 5 años en la zona norte de Lima. Se midió plomo en SCU de los RN por el método de adsorción atómica. Se encontró que 30% de los RN tuvieron nivel de plomo en SCU considerados de riesgo incrementado (= 3,0 µg/dL); en el 16% de los casos se encontró niveles tóxicos de plomo en SCU (= 5 µg/dL). Se concluye que existe un gran porcentaje de neonatos contaminados con plomo entre los RN de madres primigestas residentes en la zona norte de Lima.

The aim of this study was to describe the concentration of lead in umbilical cord blood (UCB) of neonates born from primiparous women who live in northern Lima. A cross sectional study was carried out at Cayetano Heredia National Hospital, from July 2011 to January 2012. 100 neonates born from primiparous women who lived in northern Lima in the previous 5 years or more were included. Umbilical cord lead levels were measured by the atomic adsorption method, and the demographic information and risk factors of the neonates were filled in a patient record designed to this purpose. 30% of the neonates had concentration of lead in UCB that was considered as increased risk (= 3,0 µg/dL), 16% of the cases had had toxic concentration of lead in UCB (= 5 µg/dL). We conclude that there are a high percentage of neonates contaminated with lead in the northern Lima.

Análise dos resultados maternos e fetais dos procedimentos invasivos genéticos fetais: um estudo exploratório em Hospital Universitário / Analysis of fetal and maternal results from fetal genetic invasive procedures: an exploratory study at a University Hospital

OBJETIVO: Caracterizar as indicações das gestantes que procuraram o serviço de Medicina Fetal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo para realização de procedimentos invasivos diagnósticos e avaliar os resultados dos cariótipos fetais e de suas gestações. MÉTODOS: Estudo observacional retrospectivo das gestantes que realizaram biópsia de vilo corial (BVC), amniocentese e cordocentese no período de fevereiro de 2005 a dezembro de 2009. Não foram incluídos outros procedimentos diagnósticos ou procedimentos terapêuticos. O resultado da gestação foi obtido através de consulta de prontuário eletrônico e/ou físico e/ou contato telefônico. RESULTADOS: Foram realizados 713 procedimentos (113 BVC, 340 amniocenteses e 260 cordocenteses). A principal indicação para a realização dos procedimentos invasivos foi a presença de alterações estruturais nos fetos, seguido por valores aumentados da translucência nucal e pela idade materna avançada. O cariótipo fetal esteve alterado em 186 casos (26,1%). A trissomia do cromossomo 18 foi a aneuploidia mais comum, seguida pela trissomia do 21, a monossomia do X e a trissomia do cromossomo 13. Ocorreram 4,9% de abortamento, 25,7% de natimortos e 13% de neomortos. Oito gestantes optaram pela interrupção judicial, e 99% das gestantes cujos fetos não apresentavam malformação e que apresentavam cariótipo fetal normal tiveram nativivos.

OBJECTIVE: To characterize the indications of pregnant women who sought the Fetal Medicine Services of the Hospital das Clínicas, at the Medical School of the Universidade de São Paulo for performing invasive diagnostic procedures, and to evaluate the results of fetal karyotypes and their pregnancies. METHODS: A retrospective and observational study on pregnant women who underwent chorionic villus sampling (CVS), amniocentesis, and cordocentesis in the period from February, 2005 to December, 2009. Other diagnostic or therapeutic procedures were not included. The result of pregnancy was obtained by consulting patient electronic records, medical records, and/or telephone call. RESULTS: 713 procedures were performed (113 CVS, 340 amniocenteses, and 260 cordocenteses). The main indication for performing invasive procedures was the presence of structural changes in fetuses, followed by increased values of nuchal translucency, and advanced maternal age. Fetal karyotype was altered in 186 cases (26.1%). The 18 trisomy was the commonest aneuploidy followed by the 21 trisomy, X monosomy, and 13 trisomy. There were 4.9% cases of miscarriage, 25.7% cases of stillborn infants, and 13% cases of neonatal deaths. Eight pregnant women opted for legally induced abortion. 99% of pregnant women whose fetuses did not present abnormalities and presented normal fetal karyotype had infants who were born alive.