Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases.

The relationship between events occurring during intrauterine development and later-life predisposition to long-term disease, has been described. The fetus responds to excess intrauterine exposure to high levels of corticosteroids, modifying their physiological development and stopping their growth. Fetal exposure to elevated levels of either endogenous (alterations in fetal hypothalamic-pituitary-adrenal axis) or synthetic corticosteroids, is one model of early-life adversity; to developing adult disease. At the molecular level, there are transcriptional changes in metabolic and growth pathways. Epigenetic mechanisms participate in transgenerational inheritance, not genomic. Exposures that change 11ß-hydroxysteroid dehydrogenase type 2 enzyme methylation status in the placenta can result in transcriptional repression of the gene, causing the fetus to be exposed to higher levels of cortisol. More precise diagnosis and management of antenatal corticosteroids for preterm birth, would potentially decrease the risk of long-term adverse outcomes. More studies are needed to understand the potential roles of factors to alter fetal corticosteroid exposure. Long-term infant follow-up is required to determine whether methylation changes in placenta may represent useful biomarkers of later disease risk. This review, summarize recent advances in the programming of fetal effects of corticosteroid exposure, the role of corticosteroids in epigenetic gene regulation of placental 11ß-hydroxysteroid dehydrogenase type 2 enzyme expression and transgenerational effects.

Histerectomía obstétrica: análisis de 15 años / Obstetric hysterectomy: analysis of 15 years

Determinar la incidencia, factores asociados y repercusiones de la histerectomía obstétrica. Estudio retrospectivo, descriptivo, analítico y transversal que incluyó 50 pacientes sometidas a histerectomía obstétrica en 64293 casos obstétricos, durante un período de 15 años (del 01 de agosto de 1993 al 31 de julio de 2008). Departamento de Obstetricia y Ginecología. Hospital Nuestra Señora de Chiquinquirá. Maracaibo, Venezuela. La incidencia de histerectomía obstétrica fue 0,07 por ciento (1 HO por 1 285 casos obstétricos). Fue más frecuente en mujeres entre 25-29 años (26 por ciento), IV gestas (34 por ciento), para 3 (26 por ciento), con control prenatal (63,33 por ciento), embarazos de 37-41semanas (56 por ciento), poscesárea (46 por ciento), histerectomía tipo total (86 por ciento), indicadas por atonía uterina (38 por ciento), complicadas con anemia (88 por ciento), ameritaron transfusión sanguínea (84 por ciento) y duraron <7 días de hospitalización (56 por ciento). Hubo 8 muertes maternas (16 por ciento) y la tasa de mortalidad materna ajustada fue 792 por 10000 nacidos vivos. Hubo 9 abortos (18 por ciento), 15 muertes fetales (30 por ciento) y la tasa de mortalidad perinatal fue 129 por 1000 nacidos vivos. En la población estudiada, la histerectomía obstétrica fue poco frecuente, más comúnmente indicada por trastornos hemorrágicos y tuvo cifras de morbilidad y mortalidad materna elevadas

To determine the incidence, associated factors and repercussions of obstetric hysterectomy. Retrospective, descriptive, analytic and transversal study that included 50 obstetric hysterectomies (OH) in 64293 obstetrics cases, during fifteen years (from August 1st, 1993 to July 31th, 2008). Department of Obstetrics and Gynecology. Our Lady of Chiquinquira Hospital. Maracaibo, Venezuela. The incidence of OH was 0.07 percent (1 OH by 1285 obstetric cases). It was more frequent in women between 25-29 years (26 percent), IV gestations (34 percent), para 3 (26 percent), prenatal care (63,33 percent), pregnancies 37-41 weeks (56 percent), after cesarean section (46 percent), total hysterectomy (86 percent), uterine atony as mean indication (38 percent), complicated with anemia (88 percent), blood transfusion (84 percent) and discharged home <7 days length of stay (56 percent). There were 8 maternal deaths (16 percent) and adjusted maternal mortality rate was 792 by 10000 live births. There were 9 abortions (18 percent), 15 fetal deaths (30 percent) and adjusted perinatal mortality rate was 129 by 1000 live births. Obstetric hysterectomy in the studied population, was not frequent, commonest indicated by hemorrhagic disorders and there were high maternal morbidity and mortality

[Vaginal leiomyoma]. / Leiomioma vaginal.

Vaginal leiomyomas are rare benign tumors. This is a case report with menstrual and urinary difficulties and vaginal mass with inner urethral meatus and hymen displacement. Miccional cystourethrography showed a posterior displaced, comprised and elongated urethra. Excretory urography and pelvic sonogram were normal. Preurethral enucleation extirpation with no complications was practiced. Current literature is reviewed.

Placenta percreta / Placenta percreta

La placenta adherida al miometrio es muy rara. Varía entre 1:500 y 1:93 000 partos. La placenta percreta es el tipo menos común. Es importante porque las complicaciones pueden ser mortales. La ruptura uterina anterior es más frecuente que la posterior. En la literatura inglesa, entre 1899 y 1999, sólo se reportaron menos de 50 casos con hemoperitoneo. En Venezuela se han descrito 6 placentas percretas. En esta nota clínica se reporta un caso de placenta percreta con rotura uterina posterior, hemoperitoneo e invasión a epiplón.

Embarazo ístmico-cervical con invasión a región vésico-uterina / Isthmic cervical ectopic pregnancy with vesical uterine invasion

El embarazo ectópico cervical es muy raro. Entre 1978 y 1994, sólo se reportaron 120 casos en la literatura inglesa. En Venezuela se han descrito 4. En esta nota clínica se reporta un caso de embarazo ísmico-cervical con invasión a región vésico-uterina