Amniotic fluid sludge as a marker of intra-amniotic infection and histological chorioamnionitis in cervical insufficiency: a report of four cases and literature review.

Amniotic fluid sludge (AFS) is defined as the presence of particulate matter in the amniotic fluid in close proximity to the cervix. Although its prevalence is known to correlate with the risk of preterm delivery, initial reports describe a strong association between AFS and microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis. However, AFS is also present in uncomplicated pregnancies, and its prevalence appears to increase with gestational age. Recent evidence debates the usefulness of AFS as a marker of early preterm delivery risk. We present four cases with AFS diagnosed by transvaginal ultrasound at admission for cervical insufficiency between 20 and 24 weeks of gestation, with confirmed lower genital tract and intra-amniotic infections by amniocentesis and histological chorioamnionitis and funisitis. Our findings reinforce the presence of AFS as a useful marker of MIAC, chorioamnionitis and funisitis that increase the likelihood of preterm delivery at an extreme gestational age.

[Conservative management of cervical ectopic pregnancy]. / Tratamiento conservador de la gestación ectópica cervical.

BACKGROUND: Cervical ectopic pregnancy is a rare type of ectopic pregnancy (less than one percent of all ectopic pregnancies). OBJECTIVE: Assess the efficacy of the treatment options available. MATERIAL AND METHODS: Retrospective study of the cervical ectopic pregnancies treated in our hospital from January 2005 to December 2011. RESULTS: Three patients were diagnosed cervical ectopic pregnancy in our hospital during that period, that is, an incidence of 1.7 per 10,000 gestations. The main symptom was a moderate-to-severe genital hemorrhage. In two of the cases a single dose of 50 mg/cm2 methotrexate was administered, and in the third one, curettage and uterine arterial embolization were performed. Histerectomy was not necessary in either of the cases. CONCLUSION: Conservative management of cervical ectopic pregnancy is an effective and safe option.

Low-risk pregnancy at 41 weeks: when should we induce labor?

OBJECTIVE: To study the perinatal outcome according to whether labor was induced or not, when a low-risk pregnancy reached 41 weeks of gestation. METHODS: A quasi-experimental study of 11492 low-risk singleton pregnancies was designed. A total of 1,721 patients (15.0%) women met the study criteria, were informed about the risks and benefits and gave their informed consent, of whom 629 (36.5%) were planned for induction soon after the 41 weeks (287-289 days). RESULTS: An intention-to-treat analysis was performed. The proportion of small-for-gestational age babies was lower in the early-induced labor cohort (10.5% versus 15%; p = 0.008). This cohort showed an increased hospital stay (4.54 versus 3.80 days; p < 0.001), and a higher rate of requiring delivery by caesarean section (31.1% versus 19.8%;p < 0.001), including the need for caesarean section for failed induction (21.8% versus 11%;p < 0.001). Three stillbirths occurred in the group followed expectantly, whereas no stillbirths were seen in the early induction group. CONCLUSIONS: Induction of labor for prolonged pregnancy in low-risk patients soon after the 41 weeks, reduces the proportion of small-for-gestational age babies, but increases the mean hospital stay as well as the need for delivery by caesarean section, including that for failed induction.

Efecto del ácido levofolínico sobre las concentraciones de homocisteína plasmática en la mujer joven y sana en la consulta preconcepcional / Effects of levofolinic acid on plasma homocysteine concentrations in healthy and young women in preconceptional care

FUNDAMENTO: El aumento de la homocisteína plasmática total (tHcy) es un factor de riesgo para los defectos del tubo neural. Se estudia el efecto de la suplementación con ácido levofolínico (l,5-formil-tetrahidrofólico) sobre los valores de la tHCy plasmática en la mujer en edad reproductiva. PACIENTES Y MÉTODO: Treinta mujeres sanas de 18 a 35 años recibieron 5 mg/día de ácido levofolínico por vía oral durante 30 días. La tHcy y los folatos intraeritrocitarios se determinaron antes de la suplementación (día 0), los días 2, 5, 10 y 30 durante el tratamiento, y 30 (día 60) y 60 días (día 90) después de finalizado. La tHcy plasmática se determinó por inmunoanálisis de polarización de fluorescencia (coeficiente de variación [CV] intraanálisis e interanálisis < 8 por ciento) y el ácido fólico intraeritrocitario, mediante inmunoanálisis quimioluminiscente (CV intraanálisis e interanálisis < 5 por ciento). RESULTADOS: La tHCy plasmática disminuye a partir del segundo día de tratamiento (día 0 frente a 2: media de la diferencia, -1,24 µmol/l; intervalo de confianza [IC] del 95 por ciento, -0,84 a -1,63; p < 0,001). El descenso máximo (32,3 por ciento) se observa a los 30 días (media de la diferencia, -2,72 µmol/l; IC del 95 por ciento, -2,20 a -3,24; p < 0,001). Tras finalizar el tratamiento el efecto hipohomocisteinémico persiste el día 60 (media de la diferencia, -2,67 µmol/l; IC del 95 por ciento, -2,07 a -3,26; p < 0,001) y 90 (media de la diferencia, -1,49 µmol/l; IC del 95 por ciento, -0,94 a -2,03; p < 0,001). La respuesta fue mayor cuando la tHcy plasmática fue de 9 µmol/l o más. CONCLUSIONES: El ácido levofolínico provoca un descenso temprano, intenso y persistente de las concentraciones de tHcy plasmática (AU)