RESUMO
AIM: To develop a combined predictive model for preterm and term pre-eclampsia (PE) during the first trimester of pregnancy. METHODS: This investigation was a nested case-control study in singleton pregnancies at the Maternal-Fetal Medicine Unit, University of Chile Hospital. A priori risks for preterm and term PE were calculated by multivariate logistic regression analyses. Biophysical markers were log10 -transformed and expressed as multiples of the median. A multivariate logistic regression analysis was used to estimate a combined predictive model of preterm and term PE. Detection rates at different cut-off points were determined by a receiver operator curve analysis of a posteriori risks. RESULTS: First trimester mean arterial pressure and uterine artery Doppler pulsatility index were significantly higher in women who develop PE than in the unaffected group. The detection rate of preterm PE based on maternal characteristics and biophysical markers was 72% at a 10% false-positive rate, corresponding to a cut-off risk of 1 in 50. The detection rate for term PE was 30% at a 10% false-positive rate. CONCLUSION: Preterm PE can be predicted by a combination of maternal characteristics and biophysical markers. However, first trimester screening is less valuable for term PE.
Assuntos
Pressão Arterial/fisiologia , Pré-Eclâmpsia/diagnóstico , Artéria Uterina/diagnóstico por imagem , Adulto , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico por imagem , Pré-Eclâmpsia/fisiopatologia , Gravidez , Primeiro Trimestre da Gravidez , Prognóstico , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de PulsoRESUMO
AIM: We aimed to assess the use of metformin (MTF) in the prevention of gestational diabetes mellitus (GDM) in patients with pregestational insulin resistance (PIR). METHODS: A double blind, multicenter, randomized trial was carried out in patients with a history of PIR and pregestational MTF treatment. Groups were allocated either to MTF 1700 mg/day or placebo. Patients were recruited between 12+0 and 15+6 gestational weeks, and treatment was extended until week 36. A multiple logistic regression analysis was applied to determine the relation between the use of metformin and the development of GDM. RESULTS: One hundred and forty one patients were randomized (68 patients in the MTF group and 73 in the placebo group). A total of 30 patients withdrew from the study during follow-up. Administration of MTF was not associated with a decrease in the incidence of GDM as compared to placebo (37.5% vs 25.4%, respectively; P = 0.2). Moreover, MTF administration was associated with a significant increase in drug intolerance as compared to placebo (14.3% vs 1.8%, respectively; P = 0.02). CONCLUSION: The use of MTF is not effective in prevention of GDM in populations with PIR. The use of MTF shows a significantly higher frequency of drug intolerance than placebo.
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Diabetes Gestacional/prevenção & controle , Hipoglicemiantes/farmacologia , Resistência à Insulina , Metformina/farmacologia , Falha de Tratamento , Adulto , Método Duplo-Cego , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Metformina/administração & dosagem , Metformina/efeitos adversos , GravidezRESUMO
OBJECTIVE: The aim of this article is to assess the use of the anterior cervical angle (ACA) as a predictor of spontaneous preterm delivery (sPTD) at 20+0-24+6 weeks of gestation in an unselected population. METHODS: We conducted a nested case-control study that included 93 women who later delivered spontaneously <34 weeks of gestation and 225 controls. The ACA was assessed retrospectively on all selected images using ImageJ® software. The concordance correlation coefficient was determined for the assessment of interobserver variability. Continuous variables were adjusted by maternal characteristics and expressed as the z-score or multiples of the expected normal median (MoM) of the unaffected group. Logistic regression analysis was used to evaluate whether any maternal characteristics and ultrasound variables were significantly associated with sPTD <34 weeks. RESULTS: ACA z-score values were significantly greater in women who later delivered <34 weeks compared to controls (ACA z-score = 1.32 ± 0.57 vs. -0.09 ± 0.35; p = 0.035). The best prediction of sPTD <34 weeks was provided by a model that combined cervical length (CL) MoM, ACA z-score and maternal characteristics. For a fixed false-positive rate of 10%, the detection rate for this model was 37.6%. CONCLUSION: A model combining maternal history, CL and ACA at 20+0-24+6 weeks of gestation can predict approximately 40% of the severe preterm births.
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Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/diagnóstico por imagem , Segundo Trimestre da Gravidez , Nascimento Prematuro/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez/fisiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND/AIMS: Current evidence has tried to extrapolate the use of the protein:creatinine ratio (PCR) in a single urine sample as a rapid diagnostic tool for preeclampsia (PE). The present study addresses the effectiveness of the PCR in the differential diagnosis of the pregnancy hypertensive disorder (PHD). METHODS: This is a prospective study conducted on patients admitted during 1 year with a diagnosis of PHD. These pregnant women were assessed for the correlation between the 24-hour test and the PCR to detect significant proteinuria. A ROC curve was made to determine the PCR cutoff value that would offer the best positive predictive value (PPV) as an early predictor of global and severe PE. RESULTS: A total of 72 patients with 24-hour proteinuria and PCR were studied (49 with PE). A significant correlation between the quick and the deferred sampling was observed (r = 0.60; p < 0.001). The ROC analysis showed a PCR of 0.36 as the best cutoff value for the diagnosis of global PE (PPV 96.4%; false-positive rate 4.4%; AUC 0.8802) and a cutoff value of 4.58 (sensitivity: 100%; PPV 87.5%; false-positive rate 3.5%; AUC 0.9805) as the best cutoff for the diagnosis of severe proteinuria. CONCLUSIONS: PCR proved to be an effective test for the differential diagnosis of PHS.
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Creatinina/urina , Pré-Eclâmpsia/urina , Proteinúria/urina , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , UrináliseRESUMO
AIM: To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE). METHODS: Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis. RESULTS: Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p < 0.05) and hypothyroidism (5.0 vs. 1.6%, p < 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p < 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not. CONCLUSION: Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.
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Índice de Massa Corporal , Diabetes Gestacional/epidemiologia , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Resistência à Insulina/fisiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Gravidez , Distribuição Aleatória , Fatores de Risco , Ultrassonografia Pré-Natal , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/fisiopatologiaRESUMO
BACKGROUND/AIMS: The evidence regarding the utility of assessing first-trimester adiponectin (ApN) serum levels in early prediction of preeclampsia (PE) and fetal growth restriction (FGR) is contradictory. This study aims to determine the role of maternal serum ApN levels as an early predictor of PE and FGR. METHODS: A prospective case-control study among a pregnant population who attended their 11- to 14-week ultrasound scan at the University of Chile's Clinical Hospital's Fetal Medicine Unit. We included patients who developed PE or FGR (10 cases per group) and 35 healthy controls. We determined ApN levels in blood samples from these 55 patients using a commercial ELISA kit and assessed the relationship of ApN levels with variables like development of PE, FGR, weight at birth and maternal BMI. RESULTS: There were no significant differences among first-trimester ApN serum levels in the groups. Average concentrations were 8, 6.8 and 10.8 ng/ml for the control, PE and FGR groups, respectively. CONCLUSION: In our study, maternal serum ApN levels were not useful in predicting subsequent development of PE and FGR. However, maternal serum ApN concentration adjusted by BMI was significantly higher during the first trimester in women who later developed FGR.
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Adiponectina/sangue , Retardo do Crescimento Fetal/sangue , Pré-Eclâmpsia/sangue , Primeiro Trimestre da Gravidez/sangue , Adolescente , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
Impetigo Herpetiformis is a high-risk gestational skin disease that represents a risk for both the mother and offspring. Its management is based on multisystemic support and maternal steroid therapy. When these measures are insufficient to control the disease, the association of ciclosporine to the treatment has been proposed. We report a 24 year-old woman with a 16 weeks pregnancy, that presented with Impetigo Herpetiformis. The disease was refractory to the use of steroids, the patient had a metabolic decompensation and a dehydration with electrolyte imbalance. Therefore, treatment with ciclosporine was initiated and a rapid regression of the lesions was observed. Gestation was maintained, with a good perinatal outcome.
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Ciclosporina/uso terapêutico , Dermatite Herpetiforme/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Impetigo/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Feminino , Humanos , Gravidez , RecidivaRESUMO
Se presenta el informe original de la primera epidemia de poliomielitis paralítica que ocurrió en México, de la cual se cumplen 50 años ahora, en 1996. La descripción pormenorizada del brote que hacen los autores traduce la labor dedicada de un grupo de médicos salubristas y clínicos, que identificaron con oportunidad un comportamiento en ese entonces anormal, de una enfermedad considerada exótica en México en esos años. Por desgracia fue el inicio de una endemia importante y mas de 9 mil casos se notificaron en los siguientes diez años, aunque algunos estudios indican que la incidencia pudo haber sido de tres a cinco veces mayor. Cincuenta años después de este brote que aquí se relata, se ha logrado erradicar la circulación del poliovirus salvaje en México y con ello la virtual erradicación de este importante flagelo de la humanidad, la poliomielitis paralítica
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Humanos , Masculino , Feminino , Pré-Escolar , Adolescente , Surtos de Doenças/história , História da Medicina , Poliomielite/história , MéxicoRESUMO
Se presenta el informe original de la primera epidemia de poliomielitis paralítica que ocurrió en México, de la cual se cumplen 50 años ahora, en 1996. La descripción pormenorizada del brote que hacen los autores traduce la labor dedicada de un grupo de médicos salubristas y clínicos, que identificaron con oportunidad un comportamiento en ese entonces anormal, de una enfermedad considerada exótica en México en esos años. Por desgracia fue el inicio de una endemia importante y mas de 9 mil casos se notificaron en los siguientes diez años, aunque algunos estudios indican que la incidencia pudo haber sido de tres a cinco veces mayor. Cincuenta años después de este brote que aquí se relata, se ha logrado erradicar la circulación del poliovirus salvaje en México y con ello la virtual erradicación de este importante flagelo de la humanidad, la poliomielitis paralítica(AU)
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Surtos de Doenças/história , Poliomielite/história , História do Século XX , México , Saúde Pública/históriaRESUMO
Se destaca la importancia del sueño en la salud del hombre, y se presenta una visión de algunas patologías que ocurren por su privación. Incluye un análisis sobre la ocurrencia de perturbación de sueño en pacientes hospitalizados en servicios de medicina y cirugía de una clínica de Santiago de Chile del área médico quirúrgica, de allí se deriva la elaboración de un programa educativo. Está dirigido al personal de salud, cuyo propósito apunta al mejoramiento de las condiciones ambientales para tratar y prevenir alteraciones de sueño en los pacientes
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Fases do Sono , Privação do Sono , Sono , Sono REM , Transtornos do Sono-Vigília , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/prevenção & controleRESUMO
Se efectúa estimulación vibroacústica intraparto a pacientes cuya monitorización externa de la frecuencia fetal resultó patológica. Se correlaciona el resultado de ésta estimulación con Apgar, presencia de meconio y pH de cordón umbilical. Se concluye que en relación al pH, la estimulación vibroacústica tiene una sensibilidad de 83,3%, una especificidad de 81,3%y un valor predictivo positivo de 62,5%. Se recomienda el uso de estimulación vibroacústica en aquellos casos en que la monitorización sea patológica y no se pueda utilizar monitorización interna ni se pueda obtener pH de cuero cabelludo fetal, para asegurar el buen estado fetal