RESUMEN

Objetivo: Comparar la eficacia entre diferentes pautas de inducción médica empleadas para la interrupción del embarazo de segundo trimestre. Material y métodos: Análisis retrospectivo de 145 gestantes de 13 a 22 semanas que se expusieron a una interrupción mediante 4 métodos: 1) prostaglandina F2α intraamniótica y E2 endocervical; 2) prostaglandina E2 endocervical; 3) prostaglandina E1 vaginal y oral, y 4) prostaglandina E1 vaginal. Todos ellos seguidos de oxitocina. Resultados: La duración media de expulsión fue de 20,2 ± 7,6; 17,5 ± 8,2; 16,8 ± 8,7 y 12,6 ± 4,2 h, respectivamente. Las diferencias son estadísticamente significativas cuando se analiza la duración media de manera global (p = 0,02, ANOVA) y en no primigestas (p = 0,02, ANOVA). El porcentaje de expulsiones espontáneas antes de las 12 h fue del 5,5, el 31, el 32,5 y el 50%, respectivamente (p = 0,002, χ2). Únicamente aparecen fracasos y efectos secundarios graves (1 caso de coagulación intravascular diseminada) con la prostaglandina E2 endocervical. Conclusiones: La administración vaginal de prostaglandina E1 presenta una menor duración media de expulsión y una mayor tasa de expulsión espontánea a las 12 h

Objective: To compare the effectiveness of distinct medical induction regimens used for second trimester abortions. Materials and methods: We performed a retrospective review of 145 pregnancies between 13 and 22 weeks that underwent an induced abortion using four different methods: 1) intra-amniotic prostaglandin F2α and endocervical E2; 2) endocervical prostaglandin E2; 3) intravaginal and oral prostaglandin E1; and 4) intravaginal prostaglandin E1. All these methods were followed by oxytocin infusion. Results: The mean induction to abortion interval was 20.2 ± 7.6 h; 17.5 ± 8.2 h; 16.8 ± 8.7 h, and 12.6 ± 4.2 h, respectively. The differences were statistically significant when the mean interval was analyzed globally (p = 0.02, ANOVA) and in non-primigravidas (p = 0.02, ANOVA). The rate of successful abortions within 12 hours was 5.5%, 31%, 32.5% and 50%, respectively (p = 0.002 χ2 test). Surgical abortion and serious side effects (one case of disseminated intravascular coagulation) occurred only with prostaglandin E2. Conclusions: Vaginal administration of prostaglandin E1 resulted in a shorter mean induction to abortion interval and a higher rate of successful abortions within 12 hours

Asunto(s)

RESUMEN

STUDY OBJECTIVE: To test venous endothelial function in long-term climateric therapy with tibolone. DESIGN: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine (NE), bradykinin (BK), NG-monomethyl L-arginine (L-NMMA) and sodium nitroprusside (SNP). SETTING: Plethysmography and Menopause Units. University Hospital Valdecilla. Santander. Spain. PATIENTS: Eleven postmenopausal women having continuous treatment with oral tibolone (2.5 mg/day) for 6 months. INTERVENTIONS: Three plethysmography studies were made: at baseline, and at three and six months of treatment. MAIN OUTCOME MEASURES: Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of NE, BK, L-NMMA and SNP. RESULTS: (a) Baseline study: maximum dilation with BK was 54.2+/-10.2%. (b) Three-month study: BK dilation of 71.5+/-11.9%, with a significant increase of 17.3% (P=0.019) compared with baseline. (c) Six-month study: BK dilation of 77.5+/-11.9%, with a significant increase 23.3% (P=0.002) compared with baseline. Maximal vasodilation was reached with SNP in the three studies and L-NMMA infusion has a similar vasoconstrictor response in the three studies. CONCLUSIONS: Long-term climateric therapy with tibolone improves vein endothelium-dependent vasodilation suggesting a positive impact of this drug on endothelial function.

Asunto(s)

RESUMEN

To evaluate whether pregnant women become refractory to the effects of immersion, we studied 11 healthy women from 26 to 38 weeks' gestation, immersed in 34 degrees C shoulder-deep water for 4 or 5 consecutive days. The daily immersion diuresis showed no change throughout the study (p = 0.98: mean, 145 ml, 159 ml, 159 ml, 173 ml, 184 ml, day 1 through day 5, respectively). The range of urine volumes was broad, 35 to 675 ml, depending on the subject's degree of edema. Immersion produced a significantly larger diuresis compared with preimmersion values, 162 ml versus 110 ml. Maternal blood pressure and heart rate consistently fell during immersion, and this effect was maintained for each day studied. The subjects' hematocrit, hemoglobin, and total protein were unchanged from a preimmersion sample on day 1 to a postimmersion sample on the last day of the study. The results of this study indicate that pregnant women do not become refractory to the hemodynamic and diuretic effects of immersion.

Asunto(s)

RESUMEN

Sixty-one of 375 women with hypertension and preeclampsia in a 48-month period had thrombocytopenia. By postpartum day 3, 90% of these women had rising platelet counts, and by day 4, 59 of 61 women had counts greater than 100,000/mm3. The two exceptions had other pathologic conditions in addition to preeclampsia. Thrombocytopenia associated with preeclampsia should resolve by postpartum day 4.

Asunto(s)