Riesgo de complicaciones maternas y perinatales en mujeres con coartación aórtica. Estudio de casos y controles / Risk of maternal and perinatal complications in women with aortic coarctation. Case- control study

Resumen OBJETIVO: determinar los riesgos maternos y perinatales en mujeres con coartación aórtica. MATERIAL Y MÉTODO: estudio de casos y controles de pacientes atendidas en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes para control prenatal entre 2011-2016. Se estimó la razón de momios para complicaciones maternas (preeclampsia, hemorragia, hipertensión y proteinuria) y fetales (restricción del crecimiento intrauterino, prematurez y Apgar bajo). RESULTADOS: se estudiaron 13 casos: en éstos, la hemorragia posparto fue de 5.7 (p=0.2) RM 3.8 (IC 95%: 0.31-46.9); preeclampsia de 11.4 (p=0.1), RM 4.4 (IC 95%: 0.6-28.8); hipertensión de 14.3 (p=0.35), RM 2.8 (IC 95%: 0.59-13.3) y proteinuria de 14.4 (p=0.09), RM 3.9 (IC 95%: 0.75-20). Restricción del crecimiento intrauterino 8.6 (p=0.09), RM 6.3 (IC 95%: 0.5-68.4). El embarazo se interrumpió a las 35.1 ± 6.1 semanas (p=0.05); 27% (6 de 13 casos) con prematurez y 27.7% (6 de 22 controles), no hubo diferencias estadísticas en el puntaje Apgar. CONCLUSIÓN: la coartación aórtica en las embarazadas incrementa la morbilidad; la principal limitación de este estudio fue el número reducido de casos; de ahí que se requieran investigaciones con mayor cantidad de casos, que permitan llegar a conclusiones más sólidas.

Abstract OBJECTIVE: Determine maternal and perinatal risk in women with aortic coarctation. MATERIAL AND METHOD: A study of cases and controls in women admitted in the period 2011- 2016 during antenatal care was performed. 13 cases were found. We calculated OR for maternal complications such as preeclampsia, bleeding, hypertension and proteinuria; fetal and intrauterine growth restriction, prematurity and Apgar. RESULTS: Maternal morbidity for postpartum hemorrhage was 5.7 (p=0.2), OR 3.8 (CI 95% 0.31-46.9), 11.4 preeclampsia (p=0.1), OR 4.4 (CI 95% 0.6-28.8), 14.3 hypertension (p=0.35), OR 2.8 (CI 95% 0.59-3.13), proteinuria, 14.4 (p=0.09) OR 3.9 (CI 95% 0.75- 20). Growth restriction 8.6 (p=0.09), OR 6.3 (CI 95% 0.5- 68.4). Gestational age of 35.1 ± 6.1 SDG interruption (p=0.05), with 27% (6 of 13 cases) with prematurity and 27.7% (6 of 22 controls), no statistical differences in the Apgar score. CONCLUSION: Pregnant women who present with coarctation of the aorta, there is an increase in morbidity as has been demonstrated in previous publications; however, the main limitation of the study is the low number of cases and requires further research.

[Cholecystectomy during pregnancy]. / Colecistectomía durante el embarazo.

UNLABELLED: Cholecystectomy during pregnancy happens to be the second most common cause of laparotomy. The reported incidence of the procedure is I of every 1250 to 12,500 pregnancies. We have done a retrospective study from january 1989 to december 1994, at Instituto Nacional de Perinatología, having 35,080 deliveries registered, four of them with reported cholecystectomy during pregnancy. The average of maternal age resulted in 20.2 years, varying from 16 to 23 years. Three patients were multigravidas, and just one primigravida. Gestational age at the time of diagnosis and surgery was reported in 17 to 23.4 weeks. We found one twin pregnancy, and that two patients had history of chronic colecistitis. In the 100% of cases laparotomy and cholecystectomy was done, with preterm labor as the most frequent complication. There were 3 fetal loss in study and only 2 pregnancies were delivered at term. DISCUSSION: In this review the estimated frequency of cholecystectomy was 1 of 8780 deliveries, being the second cause of quirurgical treatment during pregnancy, after appendicectomy. There were reported 50% fetal deaths, and no severe maternal complications.

[Appendicitis during pregnancy]. / Apendicitis durante el embarazo.

Acute appendicitis es the most common cause of lapparotomy during pregnancy. The differential diagnosis in the pregnant woman becomes a challenge due to the anatomic changes that take place during the maternal adjustment to pregnancy. We have done a retrospective study between january 1989 and december 1994, at Instituto Nacional de Perinatologia. We found in that period of time 35,080 deliveries reported and 4 cases of acute appendicitis during pregnancy. The maternal age was between 16 and 42 years old, 26 years in average. Three patients were in the 3 trimester at the time of diagnosis, and the most important clinical sign was found to be diffuse abdominal pain. In 3 cases diagnosis was attributed to obstetric pathology rather than appendicitis in first place. Laparotomy and appendicectomy was done to all patients, with on block hysterectomy in only one case, having this particular patient an abscess as a postquirurgical complication. Just one case reported a healthy newborn delivered at term. It is obvious that early diagnosis and quirurgical treatment are important factors for the mother and the fetus prognosis. Appendicectomy as well as cholecystectomy are the two most common causes of laparotomy during pregnancy.

Phenytoin serum concentration monitoring during pregnancy and puerperium in Mexican epileptic women.

Phenytoin serum concentrations were evaluated in 88 epileptic women at different stages of pregnancy and 40 women during postnatal periods. In addition, concentrations were determined from the umbilical cords of 27 neonates. On average, the dose of phenytoin was increased by 130 +/- 54 mg in 67% of the patients in order to control seizures. In 76% of the women during pregnancy and 95% in the postnatal periods, dose adjustment was achieved for the control of the seizures. Therapeutic clinical concentrations ( < 9.9 micrograms/ml) were found in 64% of the patients, with an average of 7.2 +/- 1.8 micrograms/ml during pregnancy and 6.2 +/- 2 micrograms/ml in 90% of the women during the postnatal period. The average phenytoin concentration reached with doses of 100, 200, 300, 400 and 500 mg were 3.3, 5.7, 8.4, 10.8, and 14.1 microliters/ml, respectively, without statistically significant differences among the pharmacokinetic parameters measured during pregnancy, between pregnancy and the postnatal period. The proportion between fetal and maternal phenytoin concentration was 0.37 +/- 0.28. Hydantoin fetal syndrome was seen in 8% of the neonates, without a statistically significant difference among patients with or without seizures. No relation was found between the concentration of phenytoin during pregnancy and the hydantoin fetal syndrome. The study shows that low concentrations of phenytoin can control seizures during pregnancy and the postnatal period and the need to relate serum phenytoin concentrations with the clinical state of pregnant women who suffer seizures.