Efectividad y seguridad de nifedipino solución vs. nifedipino cápsulas para la amenaza de parto pretérmino. Estudio retrospectivo / Effectiveness and safety of nifedipine solution vs. nifedipine capsules in threatened preterm labor. A retrospective study

Objetivo: analizar la efectividad y seguridad de nifedipino solución comparado con nifedipino cápsulas en el tratamiento de la amenaza de parto prematuro (APP). Métodos: estudio retrospectivo, unicéntrico, en mujeres con APP, tratadas con nifedipino como tocolítico de primera elección, entre enero de 2012 y diciembre de 2015. Se distribuyeron en dos cohortes, según recibieron nifedipino cápsulas o nifedipino solución. Se analizaron las características obstétricas al ingreso, dosis de tocolítico administrado, prolongación de parto y reacciones adversas. Resultados: no hubo diferencias significativas en cuanto a la prolongación de parto de 48 horas y 7 días. La dosis total utilizada de nifedipino fue menor en solución que en cápsulas (mediana 75 mg; IQR: 125 vs. 120 mg; IQR: 140), respectivamente. Un menor número de mujeres presentó uno o más efectos adversos en nifedipino solución frente a cápsulas (12,1% vs. 37,3 %; p = 0,010). Conclusiones: nifedipino solución mostró eficacia similar a nifedipino cápsulas, pero con un menor número de efectos secundarios (tales como hipotensión y taquicardia) (AU)

Objecti ve: To analyze the effectiveness and safety of nifedipine oral solution compared with nifedipine oral capsules as tocolytic agent in pregnant women with threatened preterm labor (TPL). Methods: Single-center retrospective study was performed in women with TPL treated with nifedipine as a tocolytic of first choice, between January 2012 and December 2015. There were two cohorts: patients who received nifedipine capsules and patients who received nifedipine oral solution. Results: Obstetric characteristics, total tocolytic doses administered prolongati on of pregnancy and adverse reacti ons were analyzed. There were no significant differences for the prolongation of pregnancy to 48 hours and to 7 days. The total tocolytic dose used was lower for nifedipine oral soluti on than for nifedipine capsules (median 75 mg; IQR: 125 vs. 120 mg; IQR: 140) respectively. The incidence of adverse events was significantly lower on nifedipine solution group than on nifedipine capsules group (12.1% vs. 37.3%; p = 0.010). Conclusions: Nifedipine solution showed similar effectiveness to nifedipine capsules but with less secondary effects (AU)

Alternativas terapéuticas para la tocólisis en el manejo de la amenaza de parto pretérmino / Therapeutic alternatives for the tocolysis in the management of the threatened preterm labour

La amenaza de parto pretérmino (APP) es una urgencia obstétrica que, en ausencia de intervención, desemboca en un parto prematuro. Detener la APP y prolongar la gestación todo lo posible permite trasladar a la gestante a un centro apropiado, administrar los cuidados necesarios y conceder un mayor periodo de maduración al feto, esencial para reducir la morbimortalidad asociada al parto prematuro. El empleo de tocolíticos al inicio de este proceso es esencial. En este artículo se revisa el escenario clínico y la información sobre los tocolíticos actualmente autorizados en España, dos de ellos por vía intravenosa (ritodrina y atosibán) y otro por vía oral (nifedipino solución oral) (AU)

Threatened preterm labour is an urgent obstetric condition leading to a preterm birth in the absence of medical intervention. Intervention must focus on stopping birth progression in order for the patient and the fetus be administered an adequate medical care, providing a temporal window for fetus´ maturation. This medical management is aimed to reduce the morbimortality associated to preterm birth. This manuscript consists of a review of the toclytics of more extended use in our context. Currently, three drugs are authorised as tocolytics in Spain: ritodrine and atosiban (intravenous) and nifedipine (oral solution) (AU)

Resultados perinatales en amenazas de parto prematuro con colonización endocervical por Ureaplasma urealyticum / Perinatal results in threatened preterm labor related to Ureaplasma urealyticum colonization

Objetivo. Valorar los resultados perinatales en embarazadas con episodios de amenaza de parto prematuro y colonización concomitante por Ureaplasma urealyticum detectada mediante cultivos endocervicales. Material y métodos. Entre enero del 2002 y diciembre del 2003 se incluyeron un total de 72 mujeres con uno o más episodios de amenaza de parto prematuro entre las 24 y 36,6 semanas de gestación, en cuyo ingreso se realizó un cultivo endocervical para micoplasmas genitales. Criterios de exclusión: embarazos múltiples, rotura prematura de membranas previa a la amenaza de parto prematuro. Se compararon los resultados perinatales entre las pacientes con y sin colonización concomitante por U. urealyticum. Resultados. Al comparar el grupo de mujeres con cultivo endocervical positivo a U. urealyticum (30 pacientes) y el grupo con cultivo negativo (42 pacientes) no se encontraron diferencias estadísticamente significativas respecto a la edad materna, la nuliparidad, la longitud cervical o el test de Bishop. La edad gestacional en el momento del parto fue muy similar en ambos grupos, así como los resultados perinatales. No se observó ningún caso de corioamnionitis ni sepsis neonatal. Discusión. En mujeres con episodios de amenaza de parto prematuro, la positividad del cultivo endocervical para U. urealyticum al ingreso no se asocia a mayor riesgo de parto pretérmino ni aumenta la morbilidad perinatal (AU)

Objective. To assess the perinatal results in pregnant women with threatened preterm labor and detection of Ureaplasma urealyticum by endocervical culture. Material and methods. Seventy-two pregnant women with at least one episode of preterm labor between 24 and 36.6 weeks of pregnancy from January 2002 to December 2003 were included in our study. An endocervical culture for genital mycoplasmas was performed at admission. Exclusion criteria consisted of multiple pregnancy and premature rupture of membranes prior to the episode of threatened preterm labor. Perinatal results were compared in women with positive and negative cultures to U. urealyticum. Results. There were 30 women with a U. urealyticum-positive culture and 42 women with a U. urealyticum-negative culture. There were no statistically significant differences in maternal age, nulliparity rate, cervical length or Bishop's score. Gestational age at delivery and perinatal results were highly similar in the two groups. There were no cases of chorioamnionitis or neonatal sepsis. Discussion. In women admitted to hospital for threatened preterm labor, detection of U. urealyticum in endocervical culture at admission is not related to an increased risk of preterm birth or with increased perinatal morbidity (AU)

Treatment with amniopatch of premature rupture of membranes after first-trimester chorionic villus sampling.

OBJECTIVE: To assess the amniopatch procedure when premature rupture of membranes occurs after first-trimester chorionic villus sampling (CVS). STUDY DESIGN: From May 2001 to June 2004, the amniopatch procedure was offered in cases of premature rupture of membranes after CVS when severe oligohydramnios was present (largest vertical pocket < 2 cm) and persistent (more than 1 week). RESULTS: The amniopatch was placed in five pregnancies at 12-18 weeks of gestation, resulting in amniotic fluid restoration in all but one pregnancy. In three pregnancies, fetal demise was observed at 1, 2 and 36 days after the procedure. The last procedure resulted in a healthy newborn. CONCLUSION: Although the amniopatch restored normal amniotic fluid levels in all cases, 4 of the 5 cases resulted in fetal demise.

Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy.

BACKGROUND: Pre-eclampsia and/or fetal death have increased sharply in HIV-infected pregnant women receiving HAART. METHODS: The occurrence of pre-eclampsia or fetal death was analysed in women who delivered after at least 22 weeks of gestation for all women (January 2001 until July 2003) and for HIV-infected women (November 1985 until July 2003). RESULTS: In 2001, 2002 and 2003, the rates per 1000 deliveries of pre-eclampsia and fetal death, respectively, remained stable in all pregnant women at 25.4, 31.9 and 27.7 (P = 0.48) and 4.8, 5.8, and 5.0 (P = 0.89) (n = 8768). In 1985-2000 (n = 390) to 2001-2003 (n = 82), rates per 1000 deliveries in HIV-infected women rose from 0.0 to 109.8 (P < 0.001) for pre-eclampsia and from 7.7 to 61.0 (P < 0.001) for fetal death. In all pregnant women, factors associated with pre-eclampsia or fetal death were multiple gestation [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI), 2.3-5.6; P < 0.001], HIV infection (adjusted OR, 4.9; 95% CI, 2.4-10.1; P < 0.001), multiparity (adjusted OR, 0.76; 95% CI, 0.58-0.98; P = 0.040) and tobacco smoking (adjusted OR, 0.65; 95% CI, 0.46-0.90; P = 0.010). The use of HAART prior to pregnancy (adjusted OR, 5.6; 95% CI, 1.7-18.1; P = 0.004) and tobacco smoking (adjusted OR, 0.183; 95% CI, 0.054-0.627; P = 0.007) were risk factors in HIV-infected women. CONCLUSIONS: HIV infection treated with HAART prior to pregnancy was associated with a significantly higher risk for pre-eclampsia and fetal death.

Awareness of the use of folic acid to prevent neural tube defects in a Mediterranean area.

OBJECTIVES: The risk of neural tube defects (NTDs) is decreased in women who take folic acid during the periconceptional period. The main objective of our study was to evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects in a Mediterranean area. STUDY DESIGN: A retrospective study was performed from 1 July to 30 November 2000. One thousand consecutive women who delivered in our hospital were interviewed during the immediate postpartum period about their knowledge of neural tube defects and folic acid intake before and during pregnancy. RESULTS: Most women (85.7%) referred not having been specifically informed about the need to take folic acid to prevent neural tube defects although approximately half of the women (50.6%) were in fact, aware of the need for folic acid intake. Eight percent (8.1%) of the women took folic acid before conception but only 6.9% did so during the effective period from 4 weeks before conception to 4 weeks after conception. Logistic regression analysis showed that awareness of the need to take folic acid together with having had preconceptional counselling and knowledge of NTDs were the strongest variables related to the fact of having taken folic acid during the correct period. CONCLUSIONS: Although the population is aware of the need to take folic acid, the real impact of the present recommendations is almost negligible. Information in primary care and preconceptional counselling to specifically inform patients about the need to take folic acid to prevent NTDs seem to be crucial to improve the final intake of folic acid during the protective period.