RESUMO
El embarazo en la anemia drepanocítica (AD) es considerado una situación de alto riesgo por la alta incidencia de la morbimortalidad materno-fetal. En Cuba, el programa de atención integral a las embarazadas se incluye desde el nivel primario de salud y la captación se realiza antes de las 12 sem de gestación y los partos son institucionales. Todas las embarazadas con AD en La Habana son atendidas en el Instituto de Hematología e Inmunología (IHI) por un equipo multidisciplinario y los partos se realizan en el Servicio de Obstetricia del Hospital General Docente Enrique Cabrera . Desde enero del año 2000 hasta diciembre del 2009, 68 embarazadas con AD fueron atendidas por un equipo multidisciplinario. La frecuencia de las consultas fue quincenal hasta las 32 sem de la gestación y posteriormente semanal hasta la sem 36 en que fueron ingresadas; el embarazo se interrumpió en la semana 38. Las pacientes que presentaron algún evento fueron hospitalizadas y en ellas la interrupción se realizó en la semana 36 si el feto era viable. El bienestar fetal fue evaluado desde la semana 28 cada 2 semana hasta el nacimiento. No se realizaron transfusiones ni exanguinotransfusiones profilácticas y solo fueron indicadas según los criterios del equipo médico tratante; 16 pacientes recibieron transfusiones de glóbulos y la exanguinotransfusión se realizo en 4, todas en el tercer trimestre del embarazo. En 47 pacientes se realizó cesárea y siempre por indicación obstétrica; 17 recién nacidos tuvieron bajo peso pero solo uno tuvo un conteo de Apgar bajo. Ocurrieron 2 muertes fetales y una neonatal; se reportó una muerte materna
Pregnancy in women with sickle cell disease (SCD) is a high-risk situation associated with increased incidence of maternal and fetal morbidity and mortality. In Cuba, the maternal care program includes the primary level and the gestational age at booking is before the 12 week of gestation and all deliveries are institutional. All pregnant women with SCD in La Habana are attended at the Institute of Hematology and Immunology (IHI) by a multidisciplinary team and labor takes place at the obstetrics service of the General Hospital next to the IHI. From January 2000 to December 2009, 68 pregnant women with SCD were attended in labor; the frequency of the visits is every two weeks from gestational age at booking until week 32 of pregnancy and weekly until week 36 when they are hospitalized, in week 38 induction of labor is made. Patients were hospitalized upon the appearance of any event and in such cases induction of labor was made in week 36, if fetus was mature. The fetal well-being was evaluated starting from week 28 and every two weeks until childbirth. Non prophylactic blood transfusion or prophylactic exchange transfusions were indicated as this depends on the criteria of attending team; only 16 patients presented alert signs of requiring blood transfusion, 4 requiring blood exchange transfusions. All these procedures were carried out in the third trimester of pregnancy; 47 patients required caesarea indicated by the obstetrician; 17 newborns were underweight but only one with low apgar score. Two fetal deaths occurred and one new born had early neonatal death. Only one maternal death was reported
Assuntos
Humanos , Feminino , Gravidez , Assistência Integral à Saúde/métodos , Complicações do Trabalho de Parto/prevenção & controle , Complicações do Trabalho de Parto/sangue , Traço Falciforme/complicações , Traço Falciforme/prevenção & controle , Traço Falciforme/sangue , Saúde Materno-InfantilRESUMO
OBJETIVO: evaluar los cambios en la pérdida estimada de sangre y tasas de Hemorragia Posparto [HPP] derivados del entrenamiento en el Manejo Activo de la Tercera Etapa del Parto [MATED] en cinco Clínicas Materno Infantiles del departamento de Yoro, Honduras. METODOLOGÍA: durante nueve meses, el equipo de investigación enseña las habilidades sobre la pérdida estimada de sangre, establece una tasa base para la HPP y enseña el manejo activo de la tercera etapa del parto. En cada nacimiento se registran la pérdida estimada de sangre, los resultados para la madre y el neonato, así como el uso calculado de Oxitocina en el periodo posnatal. Los datos obtenidos se analizan estadísticamente con SPSS descriptivo, prueba-T y Chi-cuadrado. RESULTADOS: el periodo de estudio previo al entrenamiento en MATEP incluye 178 casos, el periodo posterior al entrenamiento incluye 392 casos. La pérdida estimada de sangre durante el periodo previo es de 109 ml en promedio, comparado con 81 ml en promedio que se obtiene durante el periodo posterior al entrenamiento (p=.004). En la fase previa y posterior a/ entrenamiento, el uso de Oxitocina en el periodo posparto es de 99.5%, aunque en el 17% de los casos reportados la administración de Oxitocina se realiza después de la expulsión de la placenta. Después del entrenamiento en MATER la tasa de hemorragia posparto disminuye del 7.3% al 3.8%, dato que no es estadísticamente significativo.
AIM: evaluate the changes in estimated blood loss and Post Partum Hemorrhage [PPH] rates with dissemination of Active Management of Third Stage of Labor [AMTSL] training to five Clinicas Materno Infantiles in the state of Yoro, Honduras. METHODS: over a nine month period, the research team utilized a two part training module to first teach the skills of estimated blood loss to establish a baseline rate for PPH and then in the second phase teach skills of active management of third stage labor. Estimated blood loss, outcomes for mother and neonate as well as the use and timing of Oxytocin in the postpartum period were recorded for each birth for the research team. The collected data were analyzed with SPSS for descriptive, t-test and chi-square statistics. RESULTS: pre-AMTSL training period N= 178, post AMTSL training N=392. Estimated blood loss pre-AMTSL training was a mean of 109 ml compared with post-training period of 81ml (p=.004). The use of Oxytocin in the postpartum period was 99.5% in both pre and post AMTSL training, though 17% of the cases reported Oxytocin administration after delivery of the placenta. The postpartum hemorrhage rate decreased from 7.3% to 3.8% after the AMTSL training, but was not statistically significant. CONCLUSION: AMTSL training reduced estimated blood loss though did not significantly change PPH rates in this study. Use of Oxytocin postpartum has become a regular component of care provided.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Ocitocina/administração & dosagem , Hemorragia Pós-Parto/enfermagem , Hemorragia Pós-Parto/tratamento farmacológico , Parto/sangue , Honduras , Complicações do Trabalho de Parto/sangueRESUMO
The objective was to describe the relationship between concentration of serum nonesterified fatty acids (NEFAs) at calving and the incidence of periparturient disorders in Chilean Holstein dairy cows (Bos taurus). The study was conducted at two dairies (central Chile) with 700 milking cows each and similar management. Between July 2006 and March 2007, 350 cows were selected, and concentrations of serum NEFAs were determined at calving. The incidence of milk fever (MF), retained fetal membranes (RFMs), metritis, and clinical mastitis from calving to 100 d in lactation were consistently recorded. The relationship between concentration of serum NEFAs at calving and the incidence of periparturient diseases was determined using logistic regression. The main explanatory variable was concentration of serum NEFAs at calving. The incidence of MF, RFM, metritis, and mastitis was 5.4%, 15.6%, 10.8%, and 14.4%, respectively. There was no association between concentration of NEFAs at calving and the incidence of these conditions when the median value of NEFAs (0.9 mEq/L) was used as a cutoff. However, when the 75th percentile (1.2 mEq/L) was used as the cutoff, cows with values <1.2 mEq/L were 0.45 and 0.32 times as likely to develop clinical mastitis and MF, respectively, compared with cows with values >or=1.2 mEq/L. When the 90th percentile (1.6 mEq/L) was used as a cutoff, cows with values <1.6 mEq/L were 0.25 times as likely to develop clinical mastitis compared with cows with values >or=1.6 mEq/L. As a continuous variable, for every 0.1 mEq/L increment in NEFAs at calving, cows were 1.11 times more likely to experience clinical mastitis. In conclusion, cows with NEFA concentrations >or=1.2 mEq/L had a higher incidence of clinical mastitis and MF than that of cows with values <1.2 mEq/L.
Assuntos
Doenças dos Bovinos/sangue , Ácidos Graxos não Esterificados/sangue , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Feminino , Incidência , Mastite Bovina/sangue , Mastite Bovina/epidemiologia , Complicações do Trabalho de Parto/sangue , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/veterinária , Paresia Puerperal/sangue , Paresia Puerperal/epidemiologia , Parto , Gravidez , Análise de Regressão , Fatores de RiscoRESUMO
OBJECTIVE: To study maternal complication associated to delivery and the puerperium period in pregnancies affected by von Willebrand's disease. METHODS: Chart data of all the pregnant women with diagnosis of von Willebrand disease were retrospectively reviewed. All cases with von Willebrand's disease that had given birth at this institution, between March 2001 and August 2007, were analyzed. The following variables were investigated: mode of delivery, hemorrhage complications during delivery and postpartum, maternal blood exams and perinatal results. Variables were studied descriptively, using absolute and relative frequencies, means, medians and standard deviations. RESULTS: 13 pregnancies of eight women with the disease were reviewed. During this sane period, there were 13,037 deliveries in the institution, resulting in an incidence of 0.1%. Six women (75%) were type 1 disease and, two (25%) were type 2. The last Factor VIIIc activity presented a mean value of 98.5%. A Cesarean section was performed in nine pregnancies, with epidural anesthesia in seven. Delivery complication occurred in two cases: one presented placental abruption and a Cesarean was performed. The other, presented postpartum hemorrhage in the first day and required reposition with factor VIII. Two cases received factor VIII before Cesarean section. Fetal growth restriction was detected in five pregnancies (38.5%). Mean birth weight was of 2676 grams and one case presented 1st minute Apgar score below seven. CONCLUSION: Delivery in patients with von Willebrand disease has a favorable evolution when specific assistance is provided. In these pregnancies,fetal growth should be monitored.
Assuntos
Complicações do Trabalho de Parto/sangue , Hemorragia Pós-Parto/sangue , Complicações Hematológicas na Gravidez/sangue , Doenças de von Willebrand/complicações , Índice de Apgar , Peso ao Nascer/fisiologia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Fator VIII/administração & dosagem , Fator VIII/análise , Feminino , Retardo do Crescimento Fetal/diagnóstico , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Adulto Jovem , Doenças de von Willebrand/sangueRESUMO
OBJETIVO: Analisar as complicações maternas associadas ao parto e puerpério, bem como os resultados perinatais, em gestantes portadoras da doença de von Willebrand. MÉTODOS: Foram analisados os prontuários de todas as gestantes com diagnóstico de doença de von Willebrand, cujo parto foi realizado nesta instituição no período compreendido entre março de 2001 e agosto de 2007. Foram investigadas características relativas à via de parto, incidência de complicações hemorrágicas no parto e no puerpério imediato, perfil dos exames laboratoriais maternos e resultados perinatais. As variáveis foram estudadas descritivamente, calculando-se freqüências absolutas e relativas, médias, medianas e desvios padrão. RESULTADOS: Foram revisadas 13 gestações em oito pacientes portadoras da doença. No período ocorreram 13.037 partos na instituição, perfazendo incidência de 0,1 por cento. Seis pacientes (75 por cento) apresentavam o tipo 1 da doença, e duas (25 por cento) o tipo 2. No terceiro trimestre, a média da atividade do fator VIIIc foi de 98,5 por cento. A cesárea foi realizada em nove casos (69 por cento), cuja anestesia foi do tipo raquidiana em sete casos. Como complicação do parto, um caso evoluiu com descolamento prematuro da placenta e foi realizada a cesárea. Um caso apresentou sangramento no primeiro pós-parto, necessitando reposição do fator VIII. Em dois casos foi realizada a reposição profilática do fator VIII antes da cesárea. A restrição do crescimento fetal ocorreu em cinco casos (38,5 por cento). O peso dos RNs apresentou média de 2676 gramas e um caso (7,8 por cento) apresentou Apgar de 1º minuto inferior a sete. CONCLUSÃO: O parto em gestantes com diagnóstico de doença de von Willebrand tem evolução favorável quando cuidados são tomados procurando oferecer assistência específica. O crescimento fetal deve ser monitorizado nessas gestantes.
OBJECTIVE: To study maternal complication associated to delivery and the puerperium period in pregnancies affected by von Willebrand's disease. METHODS: Chart data of all the pregnant women with diagnosis of von Willebrand disease were retrospectively reviewed. All cases with von Willebrand's disease that had given birth at this institution, between March 2001 and August 2007, were analyzed. The following variables were investigated: mode of delivery, hemorrhage complications during delivery and postpartum, maternal blood exams and perinatal results. Variables were studied descriptively, using absolute and relative frequencies, means, medians and standard deviations. RESULTS: 13 pregnancies of eight women with the disease were reviewed. During this sane period, there were 13,037 deliveries in the institution, resulting in an incidence of 0.1 percent. Six women (75 percent) were type 1 disease and, two (25 percent) were type 2. The last Factor VIIIc activity presented a mean value of 98.5 percent. A Cesarean section was performed in nine pregnancies, with epidural anesthesia in seven. Delivery complication occurred in two cases: one presented placental abruption and a Cesarean was performed. The other, presented postpartum hemorrhage in the first day and required reposition with factor VIII. Two cases received factor VIII before Cesarean section. Fetal growth restriction was detected in five pregnancies (38.5 percent). Mean birth weight was of 2676 grams and one case presented 1st minute Apgar score below seven. CONCLUSION: Delivery in patients with von Willebrand disease has a favorable evolution when specific assistance is provided. In these pregnancies,fetal growth should be monitored.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Complicações do Trabalho de Parto/sangue , Hemorragia Pós-Parto/sangue , Complicações Hematológicas na Gravidez/sangue , Doenças de von Willebrand/complicações , Índice de Apgar , Peso ao Nascer/fisiologia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Fator VIII/administração & dosagem , Fator VIII/análise , Retardo do Crescimento Fetal/diagnóstico , Resultado da Gravidez , Adulto Jovem , Doenças de von Willebrand/sangueRESUMO
In obstetric patients transfusion is a common procedure, it has many advantages but it also has severe risks. Since the observation that human immunodeficiency virus (HIV) infection is transmitted by transfusion, the number of preventive measures to reduce the infectious diseases transmission by this procedure has increased. The microorganisms that can be transmitted through transfusion include: human T lymphotropic virus (HTLV) I and II, hepatitis B virus, hepatitis C virus, hepatitis D virus, hepatitis G virus, HIV, cytomegalovirus, Treponema pallidum, Barucella sp, Toxoplasma gondii, Plasmodium sp, and Trypanosoma cruzi. The most important measure for reduce transfusion risks is the appropriate and careful use of this procedure. This article review transfusion's indication, describe the infectious diseases commonest transmitted by transfusion and analyze the preventive measures to put in practice.
Assuntos
Doenças Transmissíveis/transmissão , Complicações do Trabalho de Parto/sangue , Hemorragia Pós-Parto/terapia , Complicações na Gravidez/sangue , Reação Transfusional , Infecções Bacterianas/sangue , Infecções Bacterianas/transmissão , Doenças Transmissíveis/microbiologia , Doenças Transmissíveis/virologia , Feminino , Infecções por HIV/sangue , Infecções por HIV/transmissão , Humanos , Complicações do Trabalho de Parto/cirurgia , Gravidez , Complicações na Gravidez/cirurgia , Viroses/sangue , Viroses/transmissãoRESUMO
La transfusión es una práctica frecuente en las pacientes obstétricas; el empleo de la sangre puede salvar la vida de una paciente, pero no está exento de riesgos, de los cuales la transmisión de infecciones es uno de los más importantes. A partir de la identificación de la transmisión del virus de la inmunodeficiencia humana (VIH) por vía de la transfusión, a nivel mundial se ha incrementado el número de medidas preventivas para eliminar el riesgo de transmisión de enfermedades infecciosas por esta vía. Los microorganismos que se pueden transmitir por enfermedades infecciosas por esta vía. Los microorganismos que se pueden transmitir por enfermedades infecciosas por esta vía. Los microorganismos que se pueden transmitir por transfusión incluyen: virus linfotrópicos humanos de células T (HTLV) y II, VIH, virus de hepatitis B, virus de hepatitis C; virus de hepatitis D, virus de hepatitis G, citomegalovirus, Treponema pallidum, Brucella sp, Plasmodium sp, Toxoplasma gondii y Trypanosoma cruzi. La medida más importante para reducir los riesgos que conlleva la transfusión es el uso adecuado y cauteloso de la misma. El presente artículo revisa las indicaciones de la transfusión, describe las infecciones más comunes asociadas a este procedimiento y analiza las medidas de prevención a poner en práctica
Assuntos
Humanos , Feminino , Gravidez , Infecções Bacterianas/sangue , Infecções Bacterianas/transmissão , Doenças Transmissíveis/microbiologia , Doenças Transmissíveis/transmissão , Doenças Transmissíveis/virologia , Infecções por HIV/sangue , Infecções por HIV/transmissão , Complicações do Trabalho de Parto/sangue , Complicações do Trabalho de Parto/cirurgia , Hemorragia Pós-Parto/terapia , Complicações na Gravidez/sangue , Complicações na Gravidez/cirurgia , Transfusão de Sangue/efeitos adversosRESUMO
Se presenta el primer estudio venezolano sobre primigestas maduras, que comprende 241 mujeres de 35 o más años (rango 35 a 46, promedio 37,7 años), estudiadas en dos períodos de 6 años, con intervalo de 15 años entre ellos. Se encontró un aumento significativo (p<0,05) de estas gestantes en el segundo sexenio. Hubo mayor incidencia de presentaciones viciosas (podálicas 8,3 por ciento y hombro 0,9 por ciento ) y embarazo gemelar (0,93 por ciento ) que en la población general. Hubo más patología obstétrica en el segundo lapso (p<0,05 por ciento ) que en el primero. La incidencia de cesárea se incrementó de 46,7 por ciento en el primer lapso a 58,7 por ciento en el segundo, sin mejoría del estado de los neonatos. Los nacidos en el primer lapso presentaron mayor peso y talla que los del segundo. Hubo predominio de fetos hembras. Se detectó malformación congénita en el 0,83 por ciento por mil. La mortalidad perinatal global fue de 23 mil. No hubo mortalidad materna
Assuntos
Gravidez , Adulto , Pessoa de Meia-Idade , Humanos , Feminino , Gravidez , Mortalidade Perinatal , Complicações do Trabalho de Parto/sangue , Cesárea/tendências , Idade MaternaRESUMO
There is enough evidence that prolactin (PRL), like many other pituitary hormones, is composed by multiple forms that differ from each other by size charge. Although they can be seen in the pituitary glands of a variety of species, their biological significance, identity and chemical nature still remain poorly understood. Recently, a new syndrome characterized by normal ovarian function in the presence of sustained hyperprolactinemia has been reported by our group. In these women, highly abnormal percentages of serum big big PRL have been consistently demonstrated. This observation suggests that big big PRL is immunologically similar, but biologically less active than monomeric or little PRL. In this study we have determined then molecular size heterogeneity of immunoreactive PRL in serum and amniotic fluid from two ovulatory hyperprolactinemic subjects (subjects A and B) who had, under non-pregnant conditions, large amounts of serum big big PRL, throughout different stages of parturition. Control subjects consisted of two women at the end of pregnancy in whom PRL species demonstrated a normal size distribution (subjects C and D). Mean basal levels of PRL were the highest in subjects A and B and remained constant during labor. In the control subjects a remarkable decline in PRL levels was observed during the periparturitional period. This pattern of PRL release was not correlated with changes in steroid hormone concentrations. The relative proportions of PRL size variants throughout delivery showed no apparent changes in all four subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Líquido Amniótico/química , Hiperprolactinemia/metabolismo , Ovário/metabolismo , Complicações na Gravidez/metabolismo , Prolactina/química , Adulto , Córion/metabolismo , Estradiol/sangue , Feminino , Humanos , Hiperprolactinemia/fisiopatologia , Peso Molecular , Complicações do Trabalho de Parto/sangue , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/metabolismo , Período Pós-Parto/sangue , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações Neoplásicas na Gravidez/metabolismo , Progesterona/sangue , Prolactina/análise , Prolactina/metabolismo , Prolactinoma/complicações , Prolactinoma/metabolismoRESUMO
In a prospective study, levels of interleukin-1 beta (IL-1 beta), interleukin-6) (IL-6), and tumor necrosis factor (TNF) were measured in a blind fashion in cord blood plasma from 92 neonates by specific immunoassays, and were correlated with the clinical courses of the infants, including type of delivery and perinatal complications. Plasma IL-1 beta concentration was undetectable in infants born by normal vaginal delivery or elective cesarean section but was significantly increased in infants born after induced vaginal deliveries (142 +/- 68 pg/ml) or urgent cesarean section (290 +/- 21 pg/ml; both p less than 0.05 compared with normal deliveries). The IL-1 beta levels were elevated in infants with severe perinatal complications (282 +/- 116 pg/ml; p less than 0.001), whereas TNF and IL-6 levels were not related to these complications. Infants with isolated perinatal infectious complications had elevated levels of plasma IL-6 compared with those of sick neonates without infection (p less than 0.001). In contrast, TNF plasma levels and IL-1 beta production by cord blood leukocytes were decreased in infants with infectious complications alone (both p less than 0.05). These studies suggest that the levels of IL-1 beta, IL-6, and TNF in the cord plasma relate differentially to clinical complications in the perinatal period.
Assuntos
Parto Obstétrico/métodos , Sangue Fetal/química , Infecções/sangue , Interleucina-1/análise , Interleucina-6/análise , Complicações do Trabalho de Parto/sangue , Fator de Necrose Tumoral alfa/análise , Feminino , Humanos , Infecções/epidemiologia , Interleucina-1/biossíntese , Interleucina-6/biossíntese , Masculino , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Estudos Prospectivos , Radioimunoensaio , Fatores de Risco , Fator de Necrose Tumoral alfa/biossínteseRESUMO
Serum total cholesterol (TCHO) and tryglyceride (TG) levels were determined in paired maternal and umbilical cord serum from 120 full-term deliveries at the University Hospital of the West Indies. The median cord serum TG level was found toPbe 0.74 mmol/l, which is much higher than the levels of 0.34-0.52 mmol/l in the studies reprted so far. On the other hand, cord serum TCHO levels of 1.91 mmol/l, and maternal TG and TCHO levels of 1.84 mmol/l and 5.60 mmol/l respectively are within the range of values reported in the literature. Cord serum hypertriglyceridaemia was seen in 7 newborns, all of whom had at least one kind of perinatal stress. A significant elevation of cord serum TG was seen in infants who suffered neonatal jaundice. Further studies are needed to confirm our findings to elucidate their significance (AU)