08:00 a 10:00 Sesion de Temas Libres Presentacion Oral
Coordinador : Soraya Reyno (Uruguay)
Coordinador : Jorge Hamer - Jefe de departamento de Ecografia y Diagnostico Prenatal CEGYR (Argentina) Ver CV • Egresado de la Facultad de Medicina de UBA. Promedio de la carrera 8.92. Diploma de honor.
• Residencia médica completa en Obstetricia y Ginecología CEMIC (Centro de Educación Médica e investigación Clínica “Dr. Norberto Quirno”.
• Ex médico interno de Obstetricia Policlínico Castex de San Martín, Pcia. de Bs. As.
• Docente adscripto de Obstetricia, Facultad de Medicina, UBA.
• Concurrente al Howard and Georgeanna Jones for Reproductive Medicine:y al Children hospital, División medicina materno fetal Eastern Virginia Medical School, Norfolk, USA.
• Miembro de la Asociación Médica Argentina (A.M.A).
• Miembro de la Sociedad Argentina de Ecografía y Ultrasonografía (SAEU).
• Especialista en Obstetricia y Ginecología. Ministerio de Salud Pública de la Nación.
• Medico Especializado en Ecografía General y Ultrasonografía. SAEU.
• Miembro adherente de la Sociedad de Obstetricia y Ginecología de BS. As.
• Miembro del American Institute of Ultrasoud in Medicine A.I.U.M.
• Miembro del International Society of Ultrasound in Obstetric & Ginecology.ISSUOG
• Jefe del Departamento de Ecografía de C.E.G.Y.R. Centro de estudios en ginecología y reproducción.
• Presidente de la Sociedad Argentina de Ecografía General y Ultrasonografia . SAEU (2001).
• Presidente del comité organizador del VIII Congreso Argentino de Ecografías septiembre del 2001.
• EX Medico de departamento de Obstetricia y Ginecología . Profesor asistente de la Unidad de Ultrasonografia, diagnostico prenatal y Medicina Materno Fetal del Centro. Medico Universitario Soroka. Universidad Ben Gurion del Neguev Beer Sheva Israel 2003/2004-04-07
• Jefe del Departamento de Ecografía y Diagnostico Prenata de C.E.G.Y.R. Centro de estudios en ginecología y reproducción.
• Miembro de SIADTP y SADITP
• Conferencista en multiples congresos y cursos en el area de Ultrasonografia Obstetrica y Ginecologica
Coordinador : Eduardo Castilla (Brasil) Ver CV Nombre Eduardo Enrique Castilla
Fecha de nacimiento 9 de octubre de 1933
Lugar de nacimiento Buenos Aires, Argentina
Libreta de enrolamiento 4.114.461 (BA-I)
Cedula de identidad 3.247.020 (PF)
Residencia permanente: RNE W-090869
Social Security Number 044-36-5484
Facultad de Ciencias Medicas, Universidad de Buenos Aires, Buenos Aires, Argentina, 27 de febrero de 1959
DOCTOR EN CIENCIAS
Escola Paulista de Medicina (UNIFESP-EPM) , Ministerio de Educacao e Cultura, Sao Paulo, Brasil, 22 de agosto de 1975
Académico Titular da Academia Brasileira de Ciências. Emposado em 6 de maio de 2008.
Académico Honorario Extranjero de la Academia Nacional de Medicina del Uruguay. Designado el 24 de julio de 2008.
Director del Centro de Genetica Medica, de la Secretaria de estado de Salud Publica y de la Asociacion de Facultades de Medicina de la Republica Argentina, por convenio. Dedicacion exclusiva. Con responsabilidad primaria sobre todas las actividades de investigacion, docencia y servicio de dicho Centro. Designado a tal fin por el Consejo Directivo, compuesto por las autoridades maximas de ambas instituciones del convenio. Periodo 21.03.69/21.03.74
Profesor colaborador doctor. Contratado por el Departamento de Genetica e Matematica Aplicada a Biologia, Facultade de Medicina, Universidade de Sao Paulo: USP, Ribeirao Preto, Brasil. Periodo 15.01.75/14.01.77
Profesor adjunto. Nombrado por el Departamento de Genetica, Instituto de Biologia, Universidade Federal de Rio de Janeiro:UFRJ, Brasil. Periodo 01.01.78/30.04.84
Jefe del Departamento de Genetica, Instituto de Biologia, Universidade Federal de Rio de Janeiro:UFRJ, Brasil. por eleccion del claustro. Periodo 04.08.81/31.12.81
Director a cargo ("Acting Director") del International Centre for Birth Defects, Roma, Italia, Periodo 01.01.93/30.09.94.
Director Estudio Colaborativo Latinoamericano de Malformaciones Congénitas: ECLAMC, del Centro Colaborador de la Organización Mundial de la Salud para la Prevención de las Malformaciones Congénitas, desde 1992.
Investigador de carrera, categoria "Superior", del Consejo Nacional de Investigaciones Cientificas y Tecnicas: CONICET, de Argentina, con lugar de trabajo en el CEMIC: Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires.
Investigador científico; CEMIC: Centro de Educación Médica e Investigaciones Clínicas; Dirección de Investigación; Buenos Aires; desde outubre 2008.
| Oral | Anesthesia
Feto-maternal outcome, epidural analgesia, and fetal occiput-posterior position
Anna Biasioli 1(*); Monica Della Martina 1(*); Giuliano Fabiani 1(*); Ambrogio P Londero 1(*); Paolo Nadbath 2(*); Teresa Dogareschi 2(*); Lorenza Driul 1(*); Diego Marchesoni 1(*)
1 - Clinic of Obsterics and Gynecology, University Hospital of Udine, Italy | (*) Italy
Objective. The fetal occiput-posterior position (OPP) is an important determinant for the progression of labour, delivery modality and different feto-maternal outcomes. The purpose of this study is to evaluate the association between OPP and epidural analgesia. Methods. A prospective case-control study was carried out among nullipara undergoing a labour at term with or without epidural analgesia. The fetal position was determined trough ultrasound examination in the three phases during labour, and verified at delivery. Data was analyzed trough R (version 2.7.0), using t-test, chi-square test, performing mono-variated and multi-variated logistic regression analysis. Results. 273 patients were recruited: 144 women who received epidural analgesia (52,7%) and 129 controls (47,3%). OPP prevalence at delivery was 11.7%, no significant difference was observed in terms of fetal position among cases and controls during the first phase of labour, while a higher OPP prevalence was noticed for cases at the beginning (21.5%vs10.1%) and at the end (16.7%vs 6.2%) of the second stage. A multivariate logistic regression confirmed the association between OPP and epidural analgesia (OR 3.6 IC 95% 1.507-8.771). Conclusions. The association between the fetal malposition and the analgesia seems to be explained by the pharmacological effect on the pelvic floor, and the increased OPP prevalence may contribute to the increased rate of operative deliveries, observed among women who receive epidural analgesia.
Keywords: epidural analgesia, fetal occiput-posterior position
| Oral | Genetics
Role of inflammation in preterm birth
Grazzia Rey 1(*); Silvana Pereyra 2(*); Tatiana Velazquez 2(*); Daniel Grasso 3(*); Bernardo Bertoni 2(*); Rossana Sapiro 4(*)
1 - CLinica Ginecologica B. Hospital de Clinicas. Facultad de Medicina. Universidad de la Republica | (*) Uruguay
Preterm birth (PTB) is a worldwide health problem and remains the leading cause of perinatal morbidity-mortality. The rate of PTB is currently 10% in Uruguay. Our group is investigating the association of diverse factors to PTB . We have collected epidemiological data and tissue samples from mothers and newborns. Toll Like Receptor 4 (TLR4) genetic variations of this population have been looked closely trying to associate SNPs to the commonly epidemiologic factors that contribute to PTB. Methods. We conducted a case-control study. Cases were 276 pretern neonates . Control subjects were 278 term neonates. DNA was extracted either from umbilical cords or from newborn cheek swabs by conventional methods. To detect TLR4 polymorphism, we used the PCR amplification strategy . Results. Young mothers that do not attend medical visits tend to have more preterm children than older ones.Education level did not affect the incidence of PTB. Smoking strongly associates to PTB. Hypertension, pregnancy bleeding, PPROM, IUGR were linked to preterm birth. This suggest the possibility of vasoconstriction and/or an altered liberation of cytokines as a common basis of the process that leads to premature labor. Since TLRs play a key role in those pathways and the AspGgly variation has been associated to a blunt response to TLR ligands, an association of the SNP was expected. PTB was not associated to the presence of TLR4 variations, an exception was the association between severe PTB, PROM and the presence of the AspGgly variation, suggesting possible differences between the pathogenesis of severe and moderate preterm birth. Interesting; infection wasn´t always present at detectable levels. Conclusions. Individual and ethnic differences exist both in the prevalence of infection related preterm birth and in the extent of immune responses to infection. Variability in immune responses may influence the different levels of susceptibility in women to preterm labor .
OBJECTIVE: to establish longitudinal reference ranges for fetal ultrasound biometry and growth parameters in twin pregnancies. METHODS: prospective longitudinal study involving uncomplicated twin pregnancies that underwent ultrasound examinations every 3 weeks. At each visit, biparietal diameter (BPD), occipitofrontal (OFD), head (HC) and abdominal (AC) circumferences and femur length (FL) measurements were obtained for each fetus. Estimated fetal weight, BPD/OFD, HC/AC and FL/AC ratios were also calculated. Multilevel regression analysis was performed on normalized data. RESULTS: Eight-hundred and seven ultrasound examinations were performed in 125 twin pregnancies between 14 and 38 weeks (6.5±1.4 scans/pregnancy). Regression analysis demonstrated a significant correlation for all variables according to gestational age. Reference values for the 5th, 10th, 50th, 90th and 95th percentiles were calculated for each gestational week. CONCLUSION: fetal growth in twin pregnancies should be assessed by ultrasound with appropriate longitudinal reference ranges.
OBJECTIVES: We investigated placental DNA methylation differences in the first trimester to understand epigenesis related to placentation, with an ultimate goal of applying this knowledge for understanding pathogenesis, developing predictive markers and treatments of perinatal complications that are due to placental insufficiency. METHODOLOGY: Villi were obtained from artificially aborted women after fetal heart beats were detected by ultrasonography. We extracted DNAs from villi using QIAamp® DNA Mini Kit and made DNA methylation profiles for 6 week and 10-11 weeks of gestation using Illumina HumanMethylation450 BeadChip®. They were compared between the two groups. The Institutional Review Boards at Showa University Hospital approved the study. RESULTS AND DISCUSSION: Before comparison, differences among individuals were minimized using criteria of IQR75. In consequence, 304,553 CpG sites (62.3%) were obtained as a dataset. Of these, 1,360 CpG sites on promoters were analyzed. Promoters were defined as oligonucleotides from 700bp upstream to 200bp downstream of the transcription start site. 844 sites (555 genes) were hypermethylated and 516 sites (342 genes) were hypomethylated in 10-11 weeks compared with 6 weeks. For some of these genes, we investigated gene expression using villi sample set same as previous DNA methylation study, and confirmed that there were differences of gene expression levels in particular genes between 6 weeks and 10-11 weeks. Therefore it is suggested that the changes of DNA methylation status in these genes from 6 weeks to 10-11 weeks may influence gene expression. Normal placentation may require changes of DNA methylation status in some specific genes that work for placentation. CONCLUSIONS: It is suggested that DNA methylation in villi is related to placentation and some perinatal complications such as preeclampsia and fetal growth retardation may be caused by such an epigenetic alteration as villi DNA in early gestation.
Keywords: DNA methylation, villi, first trimester, placentation
| Oral | Obstetrics
Improving Outcomes by Reducing Elective Deliveries Before 39 Weeks of Gestation
Leslie Altimier 1(*)
1 - Mercy Hospital Anderson | (*) USA - United States of America
Elective delivery before 39 weeks´ gestation is associated with significant neonatal morbidity. In 2005, after an intense analysis of the Family Birth Center (FBC), the overall induction rate and elective induction rate of < 39 weeks´ gestation was at an alarming 26.4 % and 12.1 % respectively. Newly developed elective induction guidelines required patients to have completed 39 0/7 weeks of gestation and to have a Bishop score of at least 8 for nulliparas and 6 for multiparas. In 2007, outcomes including total induction rate, elective induction rate for less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and Special care Nursery (SCN) unanticipated admissions of infants 34 0/7 - 36 6/7 weeks´ gestation (late preterm infants) were compared to these same measures in 2005. The study was a retrospective chart audit of all deliveries between January 2005 and December 2007. From 2005 - 2007, the overall induction rate dropped from 24.6 % to 24.1 % in 2006, and 22.1 % in 2007 (P=.59) and the percentage of elective inductions between 36 0/7 and 38 6/7 weeks´ gestation dropped from 12.1 % in 2005 to 9.7 % in 2006, and 1.97 % in 2007 (P<.001). The number of infants between 36 0/7 and 38 6/7 weeks´ gestation that were electively induced and admitted to the SCN decreased from 67 in 2005, to 51 in 2006, and 39 in 2007 (P<.001). Admissions to SCN following elective primary cesarean sections and elective repeat cesarean sections decreased. Neonatal transports to a higher level III facility went from 26 in 2005 to 20 in 2006, and 14 in 2007. Staff education and the implementation of elective induction guidelines can contribute towards decreasing the overall prematurity rate. This improvement not only optimizes medical outcomes, but it can minimize health care resources and costs.
Keywords: Induction, Late Preterm, Special Care Nursery, Elective Delivery, Elective Induction
| Oral | Imaging
Partial agenesis of the corpus callosum - prenatal diagnosis
A 32-year-old primigravida was refferd to evaluate a fetal intracranial cyst after routine ultrasound examination at 34 weeks of gestation. The first and second trimester screening was normal. Fetal biometry was appropriate for dates. Midline interhemispheric cyst measuring 21x25mm was visualized. According to standard policy fetal head examination was performed transabdominally in the axial, coronal and sagital planes and after that vaginal sonography was done. The posterior portion of corpus callosum was absent, the splenium was missing. The corpus callosum also was a thin. The cavum septi pellucidi was present. There was no abnormalities of the cerebellum-posterior fossa complex. In coronal section the frontal horns of the lateral ventricles were not separated more than usual, there were no ventriculomegaly. No other abnormality was detected. A possible diagnosis of partial agenesis of the corpus callosum was considered. At 39 weeks cesarean section produced a female infant, 2860gr weight , with Apgar scores of 9 at 1 minute and 9 at 5 minutes. The baby looked normal at general inspection.. Ultrasonic examination confirmed midline inter hemispheric cyst. MR of the head confirmed partial agenesis of the corpus callosum. Chromosomal analysis revealed 46,XX. The corpus callosum may be imaged antenatally by targeted sonography from the midtrimester and has become part of expert fetal scanning.
Keywords: corpus callosum, agenesis, prenatal diagnosis
| Oral | Genetics
Noninvasive Prenatal Diagnosis of Fetal Aneuploidy by Massively Parallel Sequencing of Maternal Plasma DNA
High throughput sequencing technology has been rapidly adopted for clinical practice, whiles cell free DNA in maternal plasma was demonstrated to be abundant and promising potential as material for prenatal diagnosis. Massively parallel sequencing of plasma DNA was ascertained to be accurate and sensitive in giving definite prenatal diagnosis in several studies though it’s more likely to be present as a tool for prenatal screening. Here, we recruited plasma DNA of 5268 pregnant women was sequenced with Illumina GAⅡx/HiSeq 2000 to detect chromosome abnormal of fetus. In order to improve the sensitivity a new statistics model based on unique reads bin was established for determining fetal aneuploidiesand gender, when the t-value was <-4 the aneuploidy fetus was diagnosed. About 3.28 ~5.02 million 35bp sequence tags was obtained for each sample, We successfully identiﬁed 62 cases of trisomy 21 (Down syndrome), 40 cases of trisomy 18 (Edward syndrome), three case of trisomy 13 (Patau syndrome), 13 cases of sex chromosome abnormal, in a cohort of karyotyping cases the sensitivity and specificity of the aneuploidy fetus detection was 100% and 100%, respectively. Since the cost of massively parallel sequencing declined dramatically, prenatal diagnosis by this new technology could be complementary to the standard karyotyping, or even a substitution of serum screening tests. The massively parallel sequencing also could be lighted to detect other chromosome abnormal diseases such as Mendelian diseases and microdeletions/duplications related diseases for non-invasive prenatal diagnosis.
Objectives: A short cervix in a pregnancy complicated by TTTS and LASER treatment has been shown to be an independent risk factor for preterm birth (PTB) putting survival at risk. We aimed for identification of patients whose risk for spontaneous abortion or extremely PTB is increased so the effort of LASER therapy must be considered inappropriate. Methods: 196 patients who underwent LASER therapy for TTTS in 2004-2007 were included. All women’s cervical lengths (CL) on transvaginal ultrasound (TVS) and cervical colonization patterns were analyzed 24h before LASER. All received a single dose of 1g Cefazolin i.v. during the procedure. We investigated the association between an abnormal smear and prematurely losing the pregnancy. Results: 16 women (RR=8.2%) lost both fetuses by miscarriage or extremely PTD leading to immediate neonatal death. CL (total n=182) were significantly shorter in those who aborted. However, there were outliers, i.e. 7 women with a CL of <20 mm, who later gave birth to at least one survivor. Smear results were attributed to 3 groups: local standard flora (1), bacterial vaginosis or other (2) and (3) presence of fetopathic microorganisms. Of 190 smears, 79 were classified as normal (1), 111 as abnormal (63x group 2, 48x (3)). There was no association between an abnormal smear (group 2+3) before LASER and pregnancy loss (OR 0,8; p=0.53): a questionable association between being GBS+ at baseline (n=16) and later loss (OR 1,77; p=0.48) will undergo further investigation. Conclusion: TVS can identify patients at risk for pregnancy loss better than cervical smears. There is no reason to deny LASER treatment to any woman with TTTS not in labor on the basis of an abnormal smear or a short cervix.
The addition of hPL cell free fetal RNA as a marker of placental dysfunction improves prediction rates of PE at the first trimester of gestation.
Alejandra Perez 1(*); Javier Caradeux 1(*); Ramon Serra 1(*); Maria Jose Torres 1(*); Jose Galaz 1(*); Ignacio Valenzuela 1(*); Francisco Valenzuela 1(*); Horacio Figueroa Diesel 1(*); Sebastian Illanes 1(*)
1 - Fetal Medicine Unit, Department of Obstetrics & Gynecology. Universidad de los Andes. Santiago, Chile | (*) Chile
Introduction: Multiparametric models for PE prediction during early gestation using maternal history and parameters, IPAut, MAP and endothelial biomarkers reach good prediction rates. The objective of this study was to evaluate if the addition of hPL cell free fetal mRNA (hPL cffmRNA) as a placental dysfunction marker improves this results. Method: Total mRNA was purified with MasterPure Complete DNA&RNA purification kit (Epicentre Biotechnologies) from 50uL of plasma extracted at 11-14 weeks of gestation. Reverse transcription PCR was done with ImProm-II Reverse Transcription System (Promega) and 3ul of cDNA were used in RT-qPCR for hPL. qPCR conditions were as follow: initial denaturation 95°C for 2 min, followed by 45 cycles of 94°C for 20s, annealing of 60°C for 20s and elongation and acquisition at 72°C por 20s. Results in copies/ul were used in the multiple regression analysis for PE prediction. A predictive model for PE at 11-14 weeks was developed using history of hypertension, Diastolic blood pressure, IPAut, Sflt-1 and hPL cffmRNA. Results: hPL cffmRNA levels at 11-14 weeks are lower in patients that would develop PE, without reaching statistical significance (Figure 1A).. Multiple regression analysis shows PE detection rate of 83.33% with 5% of false positives, and LR+ 20.7 (Figure 1B). Hosmer and Lemeshow analysis verified that the algorithm adjust data and explain the 92% of variation between themselves. Conclusion: The addition of hPL cffmRNA to the multiparametrics models, improves prediction rates.
10:30 a 12:30 Sesion de Temas Libres Presentacion Oral
Coordinador : Pedro Beltran - INSTITUTO DE MEDICINA MATERNO FETAL, MEXICO (México) Ver CV CURRICULUM VITAE
NOMBRE: PEDRO ABEL BELTRAN PEÑALOZA
DIRECCION CONSULTORIO: AVE. HIDALGO 1828 PTE. CONS 02, COLONIA OBISPADO, MONTERREY NUEVO LEON, CP. 64060
TELEFONO 83 48 29 09
TITULOS O GRADOS ACADEMICOS DE ESPECIALIZACION
ESPECIALIDAD EN GINECOLOGIA Y OBSTETRICIA
INSTITUCION: INSTITUTO MEXICANO DEL SEGURO SOCIAL, HOSPITAL DE GINECOOBSTETRICIA NO. 4 “ DR. LUIS CASTELAZO AYALA”
UNIVERSIDAD QUE AVALA LA ESPECIALIZACION: UNIVERSIDAD NACIONAL AUTONOMA DE MEXICO
EMBARAZO DE ALTO RIESGO Y ECOSONOGRAFIA
INSTITUCION: HOSPITAL DE GINECOOBSTETRICIA NO. 23 DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL “ DR. IGNACIO MORONES PRIETO”
PERIODO: 1 DE JULIO DE 1992 AL 31 DE DICIEMBRE DE 1992
TERAPIA INTENSIVA EN GINECOOBSTETRICIA
INSTITUCION: HOSPITAL DE GINECOOBSTETRICIA NO. 23 DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL “ DR. IGNACIO MORONES PRIETO”
ADIESTRAMIENTO EN SERVICIO
PERIODO: 1 DE ENERO DE 1999 AL 30 DE JUNIO DE 1999
METHODIST HEALTHCARE OF SAN ANTONIO, TEXAS
ROTATION IN THE PHYSICIAN EXCHANGE PROGRAM
11 AL 27 DE NOVIEMBRE 2002
HOMOLOGACIÓN MINISTERIO DE CIENCIA E INNOVACIÓN
DIRECCIÓN GENERAL DE UNIVERSIDADES
HOMOLOGACIÓN CON CREDENCIAL TITULO UNIVERSITARIO OFICIAL ESPAÑOL DE LICENCIADO EN MEDICINA
25 FEBRERO 2009, MADRID ESPAÑA
CONSEJO DE ESPECIALIDAD:
CERTIFICADO. CONSEJO MEXICANO DE GINECOLOGIA Y OBSTETRICIA
26 DE NOVIEMBRE DE 1994. MEXICO DISTRITO FEDERAL
NO DE CERTIFICADO 1284
19 JULIO 1999
NO DE CERTIFICADO 660
THE AMERICAN COLLEGE OF OBSTETRICIANS AND GINECOLOGISTS
31DEDICIEMBRE DE 2002
NIVELES I Y II
ADIESTRAMIENTO EN SERVICIO MEDICINA MATERNO-FETAL HOSPITAL MATERNO INFANTIL “CARLOS HAYA” MÁLAGA ESPAÑA
NIVELES I Y II SOCIEDAD ESPAÑOLA DE ECOGRAFÍA
INSTITUTO DE MEDICINA MATERNO FETAL
HOSPITAL DE GINECOLOGÍA Y OBSTETRICIA DE MONTERREY
PROFESOR ADJUNTO RESIDENCIA DE MEDICINA PERINATAL
HOSPITAL DE GINECOLOGÌA Y OBSTETRICIA DE MONTERREY
PROFESOR TITULAR MÓDULO MEDICINA FETAL I
2002 A LA 2010
COORDINADOR TITULAR. ALUMNOS DEL INTERNADO DE PREGRADO
UNIVERSIDAD NACIONAL AUTONOMA DE MEXICO
HOSPITAL DE GINECOOBSTETRICIA NO. 23 DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL
CICLO ENERO/ DICIEMBRE DE 1993
CICLO ENERO/ DICIEMBRE DE 1994
CICLO ENERO/ DICIEMBRE DE 1995
CICLO ENERO/ DICIEMBRE DE 1996
CICLO ENERO /DICIEMBRE DE 1997
CICLO ENERO/ DICIEMBRE DE 1998
CICLO ENERO/ DICIEMBRE DE 1999
CATEDRATICO CLINICO ADJUNTO. INTERNADO DE PREGRADO
UNIVERSIDAD DE MONTEMORELOS
1 DE JULIO DE 1994 AL 30 DE JUNIO DE 1999
PROFESOR DE CIENCIAS CLINICAS UNIVERSIDAD DE MONTERREY
INTERNADO DE PREGRADO ROTACION POR GINECOOBSTETRICIA
PROFESOR TITULAR MÒDULO METODOLOGIA DE LA INVESTIGACIÒN
CENTRO DE GINECOLOGÌA Y OBSTETRICIA DE MONTERREY
SOCIEDADES MEDICAS A LAS QUE PERTENECE
ASOCIACION DE MEDICOS EX- RESIDENTES Y RESIDENTES DEL HOSPITAL DE GINECOOBSTETRICIA NO. 1/ 4 “ DR. LUIS CASTELAZO AYALA”
INSTITUTO MEXICANO DEL SEGURO SOCIAL
SOCIEDAD DE GINECOLOGIA Y OBSTETRICIA DE MONTERREY
MIEMBRO ACTIVO DESDE MARZO DE 1994
ASOCIACION DE GINECOOBSTETRICIA Y MEDICINA PERINATAL DE NUEVO LEON AC
MIEMBRO ACTIVO DESDE MARZO DE 1994
PRESIDENTE PERIODO 2001
1ER. VOCAL PERIODO 2002
COLEGIO DE MEDICOS CIRUJANOS DEL ESTADO DE NUEVO LEON AC
MIEMBRO ACTIVO DESDE FEBRERO DE 1996
PRESIDENTE COLEGIO DE GINECOLOGÍA Y OBSTETRICIA DE MONTERREY
PERIODO ENERO- DICIEMBRE 2009
MÉDICO STAFF INSTITUTO DE MEDICINA MATERNO FETAL, MONTERREY NUEVO LEÒN
PROFESOR DE LA ESPECIALIDAD, CENTRO DE GINECOLOGIA Y OBSTETRICIA DE MONTERREY
INSTITUCION DONDE PRESTA SUS SERVICIOS ACTUALMENTE
CENTRO DE INVESTIGACIÓN EDUCATIVA Y FORMACIÓN DOCENTE
INSTITUTO MEXICANO DEL SEGURO SICIAL
PROFESOR DE TIEMPO COMPLETO
Coordinador : Jorge Decaro (Uruguay)
Coordinador : Peter Chedraui (Ecuador) Ver CV Peter Chedraui, MD, MSc, actualmente es Director del Instituto de Biomedicina y Laboratorio de Biología Molecular de la Universidad Católica de Santiago de Guayaquil, Ecuador. Es Profesor de Obstetricia y Ginecología en la misma Universidad. Es Jefe de la Unidad de Labor y Parto de Embarazo de Alto Riesgo del Hospital Gineco-Obstétrico Enrique C. Sotomayor. Miembro de varias Sociedades Científicas Internacionales con más de 70 publicaciones internacionales arbitradas. Actualmente es presidente de la Sociedad Ecuatoriana de Menopausia (Filial Guayas). Ha obtenido múltiples asignaciones de apoyo para investigación de la Universidad Católica, de la Industria Farmacéutica local e Internacional, de Fundaciones privadas e Internacionales. Es un activo investigador y colaborador de de otras Universidades de América Latina, Europa y EEUU. Sus intereses primarios de investigación versan sobre el embarazo en la adolescente y la biología molecular y fisiopatología de la preeclampsia, el parto pretérmino y su impacto en la salud femenina adulta. Además es un estudioso de la epidemiología de la menopausia y temas de cuidados de la salud en las diversas etapas de la vida reproductiva de la mujer.
Selección de publicaciones internacionales:
1: Fernández-Alonso AM, Valdera-Simbrón CJ, Fiol-Ruiz G, Rodríguez-Sánchez F, Chedraui P, Pérez-López FR. First trimester serum levels of 25-hydroxyvitamin D, free β-human chorionic gonadotropin, and pregnancy-associated plasma protein A in Spanish women. Gynecol Endocrinol. 2011; In press.
2: Pérez-López FR, Fernández-Alonso AM, Ferrando-Marco P, Salmerón-González MD, Dionis-Sánchez EC, Fiol-Ruiz G, Chedraui P. First Trimester Serum 25-Hydroxyvitamin D Status and Factors Related to Lower Levels in Gravids Living in the Spanish Mediterranean Coast. Reprod Sci. 2011; In press.
3: Chedraui P, Jaramillo W, Pérez-López FR, Escobar GS, Morocho N, Hidalgo L. Pro-inflammatory cytokine levels in postmenopausal women with the metabolic syndrome. Gynecol Endocrinol. 2010; In press.
4: Salazar-Pousada D, Arroyo D, Hidalgo L, Pérez-López FR, Chedraui P. Depressive Symptoms and Resilience among Pregnant Adolescents: A Case-Control Study. Obstet Gynecol Int. 2010;2010:952493.
5: Chedraui P, Lockwood CJ, Schatz F, Buchwalder LF, Schwager G, Guerrero C, Escobar GS, Hidalgo L. Increased plasma soluble fms-like tyrosine kinase 1 and endoglin levels in pregnancies complicated with preeclampsia. J Matern Fetal Neonatal Med. 2009;22:565-70.
6: Teran E, Chedraui P, Racines-Orbe M, Vivero S, Villena F, Duchicela F, Nacevilla L, Schwager G, Calle A. Coenzyme Q10 levels in women with preeclampsia living at different altitudes. Biofactors. 2008;32:185-90.
7: Díaz J, Chedraui P, Hidalgo L, Medina M. The clinical utility of fetal fibronectin in the prediction of pre-term birth in a low socio-economic setting hospital in Ecuador. J Matern Fetal Neonatal Med. 2009;22:89-93.
8: Teran E, Chedraui P, Vivero S, Villena F, Duchicela F, Nacevilla L. Plasma and placental nitric oxide levels in women with and without pre-eclampsia living at different altitudes. Int J Gynaecol Obstet. 2009;104:140-2.
9: Chedraui P. Pregnancy among young adolescents: trends, risk factors and maternal-perinatal outcome. J Perinat Med. 2008;36:256-9.
10: Medina M, Moya W, Hidalgo L, Calle A, Terán E, Chedraui P. Molecular identification of endocervical Chlamydia trachomatis infection among gestations at risk for preterm birth in Ecuador. Arch Gynecol Obstet. 2009;279:9-10.
11: Chedraui P, Van Ardenne R, Wendte JF, Quintero JC, Hidalgo L. Knowledge and practice of family planning and HIV-prevention behaviour among just delivered adolescents in Ecuador: the problem of adolescent pregnancies. Arch Gynecol Obstet. 2007;276:139-44.
12: Chedraui PA, Hidalgo LA, Chávez MJ, San Miguel G. Determinant factors in Ecuador related to pregnancy among adolescents aged 15 or less. J Perinat Med. 2004;32:337-41.
| Oral | Genetics
PERINATAL AND MATERNAL OUTCOME IN WOMEN – CARRIERS OF LEIDEN AND PROTHROMBIN MUTATION IN HETEROZYGOUS CONFIGURATION.
Tomáš Binder 1(*); Blanka Vavrinkova 2(*)
1 - Dep.OB/GYN 2nd Medical School Charles Uni and Teaching Hospital Motol | (*) Czech Republic
Methodology: Since Jan. 2003 to Dec. 2010 we assessed the incidence of serious late pregnancy complications (preterm labor, IUGR, stilbirth, preeclampsia and HELLP syndrome) during the course of pregnancy, labor and puerperium in 25 836 pregnant women. 473 (group A) of them were asymptomatic and 502 (group B) were symptomatic carriers of FV – Leiden or FII – prothrombin mutation in heterozygous configuration. All asymptomatic women got the prophylaxis with LMWH post partum and during puerperium. The LMWH administration in symptomatic women usually started with the second half of pregnancy.. Results: The incidence of serious late pregnancy complications was significantly higher in group B (20%) compared with group A (8 %) and healthy controls (7,4%). We didn’t encounter any thrombembolic event in group A, in group B we registered 8 (1,6%) cases and in controls 18 (0,07%) cases. Conclusions: Asymptomatic carriage of FV-Leiden or F II- prothrombin mutation in heterezygous configuration is posing only a mild risk factor for developing DVT and is not associated with significantly higher risk of serious late pregnancy complications. The prophylaxis with LMWH during pregnancy is not routinely indicated. The risk of late pregnancy complications and thrombofilic events in symptomatic carriers of FV-Leiden and FII- prothrombin mutation remain statistically higher ( p < 0, 001) despite the prophylaxis with LMWH. The project was supported by IGA MZ CR NS9905-3
Different ways of nutritional supplementation are being advised by physicians during pregnancy, but there is a lack of literature focused on its metabolical results. Methodology: We compare three different kind of patients between the 25 and 27th week of gestation. One group of 46 single pregnancies, one group of 38 spontaneous twin pregnancies and another group of 32 twin pregnancies after using assisted reproduction tecniques. We compare the levels of LDL, HDL-cholesterol, tryglicerides, serical folic acid, Vit B12, homocysteine, Haemoglobine, creatinine and platelets. In order to look for the differences and the effect of supplementation with folic acid, Vit. B12 and iron in these patients. Results and discussion: The levels of tryglicerides were higher in both groups of twin pregnacies (p>0,0001), but the levels of cholesterol remain similar. Folic acid concentrations were higher in the groups of twin pregnancies (p<0,001). The rest of levels studied were similar in the 3 gropups. Conclusions: We conclude that the supplementation following the ACOG recommendations seems to be effective in controlling the values of LDL, HDL-cholesterol, serical folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Only the levels of tryglicerides appear unaffected by the supplementation and can be related with the higher incidence of preeclampsia and cholestasis seemed among twin pregnancies.
Methodology: Since June 2008 till Dec 2010 we prospectively monitored the changes in hemocoagulatory parametres ( Fbg, protein S, protein C, antitrhombin III, D dimers and F VIII) in 49 asymptomatic carriers, 48 carriers with positive history of DVT or PE and in 50 healthy women. Asymptomatic carriers got the prophylaxis with LMWH post partum and during the whole course of puerperium. Symptomatic carriers started with the prophylactic dose of LMWH usually in the middle of their pregnancy, continuing throughout the puerperium. Results: We have not encounter any statistically significant differences in the changes of the values in fingrinogen, protein S, protein C, antithrombin III and factor VIII. The average value of D dimers directly before labor was statistically significantly higher in both groups of mutations carriers. This significant difference provably lasts during the first post partum week. When we analyzed each group, we found 20% of individuals from asymptomatic carriers and 40 % of individuals from symptomatic carriers compared with 7,l% of individuals from a healthy group of women. Conclusion: The carriage of FV Leiden and FII phrotrombin mutation is not associated with different changes of hemocoagulatory parameters compared with pregnant non carriers, with exceptions of D dimer-values prior to labor and first week post partum. Post partum DVT prophylaxis with LMWH covering the whole puerperium is fully indicated in these women. LMWH in prophylactic dose does not significantly influence the value of D dimers. The project was supported by IGA MZ CR NS9905-3
Venous thromboembolism (VTE) remains one of the leading direct causes of maternal deaths in developed countries. Knowledge of the absolute and relative risk of first VTE in and around pregnancy is therefore crucial in identifying when to commence and cease thromboprophylaxis in women who would benefit most from such intervention. METHODOLOGY: We used data from the Health Improvement Network (THIN), an electronic primary care database containing prospective records (including all pregnancies) from women aged 15-44 years old from the United Kingdom between 1987 and 2004. Women experiencing their first VTE event were identified, and the risks of VTE during antepartum and postpartum periods were compared with those outside pregnancy using a Poisson regression model adjusted for age and calendar period. RESULTS AND DISCUSSION: Among 972,683 women in our cohort there were 207,327 live birth pregnancies. The overall risk of VTE compared with the risk outside pregnancy was much higher in the postpartum (Hazard ratio (HR) =11.9 95% CI, 9.8-14.5; absolute risk (AR) 228/100,000 person-years) than antepartum (HR=3.5, 2.8-4.3; AR=65/100,000 person-years). Within antepartum, the third trimester conveyed a higher risk (HR=6.1,4.7-7.9) than both the first (HR=1.6,0.9-2.8) and second (HR=2.1,1.3-3.4) trimester. The first 6 weeks was the period of highest risk during postpartum (HR =22.8,18.6-28; AR=417/100,000 person-years), with the peak occurring in the first 3 weeks. Within postpartum periods specifically, women aged 35 years and over had a modest excess absolute rate of VTE (1.6 per 1000 person-years) when compared to women aged 25-34 years. No effect on VTE risk with increasing age was seen during antepartum periods. CONCLUSIONS: Women are at highest risk of VTE in the third trimester of pregnancy and in the first 6 weeks postpartum. Our results have implications for modifying current recommendations for VTE prophylaxis in pregnancy and the puerperium in both the UK and other countries.
Keywords: pregnancy, venous thrombosis, cohort study
| Oral | Obstetrics
Evaluation of fetal red blood cells for passage of the maternal circulation during afterbirth by Kleihauer Betke test
Luciano Marcondes Machado Nardozza 1(*); Jaqueline Brandão Mazzola 1(*); Carla Delascio Lopes 1(*); Daniela Meleti 2(*); Alan Roberto Hatanaka 1(*); Edward Araujo Júnior 1(*); Antonio Fernandes Moron 1(*)
1 - Universidade Federal de São Paulo | (*) Brazil
OBJECTIVES: The aim of this study is to evaluate the passage of fetal erythrocytes into the circulation during maternal uterine emptying with and without flow of blood from the umbilical cord. METHODS: Experimental, analytical, prospective, controlled, comprising 50 patients, randomized into two groups, with group (A) of 25 mothers who had before Afterbirth of umbilical blood drained spontaneously in its entirety without the cord clamping and the group (B) of 25 mothers who had the umbilical cord clamped immediately after birth and the fetus during the entire handling the placenta. The evaluation of the passage of fetal red blood cells to the maternal circulation was performed using the Kleihauer-Betke test. We analyzed only those patients in whom delivery occurred at term and vaginally. RESULTS: There was a failure of the method in 13 slides (26%), and 5 in group A and 8 in group B. After reviewing the slides valid by Kleihauer-Betke test, we found no statistical differences of fetal maternal hemorrhage between the two groups (p> 0.05). CONCLUSION: Handling the placenta without clamping the umbilical cord was not beneficial in decreasing the passage of fetal erythrocytes in maternal circulation by Kleihauer Betke test.
Purpose: The aim of this study was to evaluate the passage of fetal red blood cells to the maternal circulation, after invasive obstetric procedures, through the Kleihauer Betke test, flow cytometry and by measurement of maternal serum α-fetoprotein level. Methods: This prospective descriptive study with patients submitted to amniocentesis, cordocentesis, chorionic villus sampling (CVS), amniotic drainage and ventriculo-amniotic shunt, performed for karyotype analysis, treatment of hydrocephalus and polyhydramnios and to assess fetal lung maturity. Maternal blood samples were collected before and 60 minutes after the invasive obstetric procedure, to search for fetal erythrocytes, using the Kleihauer Betke test, flow cytometry and serum α-fetoprotein measurement. Results: Ten invasive obstetric procedures were performed. The mean age of the patients was 29.2 years and the mean gestational age was 29.6 weeks. The procedures were: five amniocentesis, two cordocentesis, one CVS, one ventriculo-amniotic shunt and one amniotic drainage with cephalocentesis. The indications for the procedures were: karyotype analysis in five patients, fetal lung maturity assessment in two patients, polyhydramnios drainage in one patient, fetal hydrocephalus shunt in one patient and polyhydramnios drainage related to hydranencephaly in one patient. Regarding the path of puncture, 3 procedures were accomplished through the placenta and 7 apart from it. All punctures were well succeeded at the first attempt. There was no significant increase of fetal erythrocyte quantity in maternal blood samples, using the Kleihauer Betke test. After a cordocentesis, a significant increase of fetal erythrocytes was detected by means of flow cytometry and serum α-fetoprotein measurement. Conclusion: Invasive obstetric procedures during prenatal care are safe when performed by experienced professionals using adequate techniques, with minimal chance of passage of fetal erythrocytes for fetal compartment.
Alcohol use during pregnancy act over the mother, foetus and child all along his life. There are not programs in Uruguay to prevent alcohol use during pregnancy or for treating alcohol addicted pregnant women. Two previous studies have been performed with this study group using ethanol biomarkers, in meconium and umbilical cord, and surveys, but with no final results in relation to which is the most accurate biomarker. Biomarker Peth in Blood spot shows ethanol use during last three weeks. Objectives. To investigate the prevalence of alcohol consumption during pregnancy through the use of surveys and a third biomarker, diversifying methodologies in order to extend the quality of the evaluation Methods Survey on 250 postpartum women coincidental sample, all cases between 05/07/09 and 06/20/09. Biomarkers :GCMS for tobacco in meconium and ucord. For alcohol in meconium: FAEE. In UmbilicalCord and blood spot:Phosphatidylethanol (PEth) Results: SES lower /low 7.4% , upper/ low 81 %, media 11.6% .Age 14 to 45 mean 25 . No.of controls 9 .Newborn morbidity 11.4%Birth weight 2500 grams or less 8.0% ALCOHOL CONSUMPTION: once in a lifetime 98.4%. media starting age 10 years old During pregnancy : once a week 5.0%, each 15 days 5.4%, once a month 16.9%, once to three times during pregnancy 59.7% Any amount Survey 52.9% , FAEE meconium 58 %, PETH in UCord 78.5% in bloodspot 86.1%% Information from medical doctors to mothers were on alcohol 33.5 % CONCLUSIONS Prevalence of drug and alcohol consumption is high. . Biomarker for ethanol in Ucord show higher positive results than in mecoium. Information for alcohol is unsatisfactory Surveys and biomarkers are good methodologies when measuring consumption and blood spot as a new biomarker extends the quality of the research. More strategies for specific populations should be planned.
Keywords: Alcohol, Pregnancy, Biomarker
| Oral | Obstetrics
TWIN GESTATIONS: PERINATAL ASPECTS IN A FEDERAL UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL: 11 YEARS OF CARE.
Tayanna Bortoluzzi Nazário da Cruz 1(*); Mario Julio Franco 2(*); Michele Birckholz Rocha 2(*); Alberto Trapani Júnior 2(*); Leisa Beatriz Grando 2(*)
1 - Universidade Federal de Santa Catarina | (*) Brazil
Introduction: The considerable increase in the number of multiple pregnancies in recent decades, added to the specific perinatal problems related to twins as high risk pregnancies, has encouraged us to seek knowledge about the outcomes in our community. Objective: to analyze the occurrence of twin pregnancy in our University Hospital for 11 years (January, 1998 to december, 2009) and describe maternal and neonatal outcomes. Methods: retrospective study of Hospital Universitário da Universidade Federal de Santa Catarina, including the following variables: prevalence of twins; maternal age; number of prenatal consultations; prematurity rates; corionicity and amnionicity, route of delivery, fetal presentations at delivery; fetal gender; birthweight; APGAR scores; lenght of hospital stay and existence of congenital anomalies. Results: We studied 260 pairs of twins, 7 triplets and 1 quadruplet born in this period (248 female and 296 males), being 206 cesarean sections, 2 cases of c-section after vaginal birth of the first twin and 60 vaginal deliveries. The first twin was cephalic in 184 pregnancies. Maternal age ranged between 14 and 45 years, the average being 26.8. Mean gestational age at time of delivery was 34 weeks. 143 monochorionic pregnancies were observed and, of these, 34 were monoamniotic. The average birth weight was 2109g for the first twin and 2055g for the second twin. The APGAR score of 8 was evidenced in 139 twins in the first minute. Of pregnancies evaluated, 216 presented some complication during the prenatal period, being the premature labor the most common and urinary tract infection as a close second. Major malformations were detected in 18 fetuses and there were 43 fetal deaths and one maternal death. Conclusions: The rates of twins in our sample is the same from literature. Our outcomes show the need for rank these gestations always as high risk, giving judicious monitoring and care.
Keywords: Twin Gestations, perinatal outcomes
14:30 a 16:30
Coordinador : Dolores Montes Varela (Argentina)
Coordinador : Teresita Leis (México)
Coordinador : Corazón Almirante (Filipinas) Ver CV Corazon Yabes Almirante MD MSc PhD Perinatal-Neonatology-Pediatric Gynecology Center, Philippine Children's Medical Center Tel. 632 924 0855, Tel/ Fax.632 372 3356 Educational Attainment: M.D. University of the Philippines, Residency in OB GYN: UP PGH, MSc:and DSc U Zagreb, POSTGRAD COURSES: WHO Perinatology Scholar Beth Israel H Boston MA, UTZ in Med, WHO Coordinating Center for UTZ, Zagreb, Erich Saling Inter Univ Sch for the Study of Patho Physio of Pregnancy, Ian Donald School of Med UTZ 1989, First Teaching Conference. on Women's Health Univ. of London 1993, Career Executive Board - Executive Leadership Program 2000, Current Position: Center Chief. Perinatal-Neonatology-Pediatric Gyne Center, PCMC. Pres. Pediatric and Adolescent Gynecology Soc of the Phil, School Director: Ian Donald School of Med UTZ, Philippine Br. Chairman and Convenor Q.C. Perinatal Council, Founding Pres and Board of Director Philippine Soc UTZ in Clinical Med (PSUCMI), Founding Pres. Fetus as a Patient Inst. Phil. Board of Director: World Association of Perinatal Medicine, International Society Fetus as a Patient,, Member of Editorial Board: J. of UTZ in OB and Gyn Donald School, Board Member: Kaisahang Buhay Foundation (KBF), Tanglaw Pansambayanan Foundation, Member: N. Y. Academy of Science, American Academy for the Advancement of Science, Vice Pres for External Affairs. Newborn Screening Society of the Phil. Pres Foundation for Filipino Adolescents, President QC Medical Women's Research Foundation, AWARDS&CITATIONS: Mar 8,2011 WIN Outstanding Service Award 100th year Women's Day Celebration, National Acad of Sc & Tech, Outstanding Book Award: ATLAS OF PEDIATRIC AND ADOLESCENT GYNECOLOGY, 2010: Outstanding member Q.C. Medical Society, 2010 Outstanding consultant PCMC 2009: PMA Most Outstanding Member (PSUCMI), 2007 William Liley Award In PERINATAL MEDICINE by Internat'l Soc. Fetus as a Patient, 2006- Q.C. Gov't Recognition for: establishing: Q.C. Perinatal Council in 1986, 1st Perinatal Medical Services Cooperative in the Country in 1998, First Filipino Woman President of Organization Gestosis in 1995. 2005 - Outstanding Philippine Doctors (OPD) Jaycee-WHO-DOH Award, 1999 - UPAA Outstanding Professional Award in Medicine for pioneering work in the fields of Perinatal Medicine, Ultrasound and Women's Health,1999 -National Centennial Commission Women's Sector Award for pioneering work in the field of Medicine,1997 FIGO Award - for Outstanding Service for the Promotion of Women's Health, 1997- HAMIS (Health Management and Information System) Silver Award for QC Perinatal Council,1991 - QC Health Dept - Award for Maternal and Child Health Program, 1988 Goodwill Industries. Award for livelihood program of the disabled. 1982 - Most Outstanding member of PMWA, QC. BOARD CERTIFICATIONS: Medical Board 1961, Phil Ob Gyn Soc Board1969, Philippine College of Surgeons 1974, Magnitude Test Battery for Career Executive Services 1998, Career Executive Service Eligibility 1999, International Federation of Pediatric and Adolescent Gynecology (IFEPAG) 2003, BOOKS: Primer on Women's Health 1993, Increasingly Safe and Successful Pregnancies Elsevier1996, Atlas of Pediatric and Adolescent Gynecology 2009, Chapters of Books: Kurjak and Chervenak Embryo as a Patient 2001, Karyotype of Abortus diagnosed as early embryo demise & anembryonic pregnancy, Chervenak, Kurjak and Papp The Fetus as a Patient , the Evolving Challenge. Fetal Macrosomia: Prediction, Timing and Mode of Delivery 2002, Blickstein and Keith: Multiple Pregnancy 2006. Multiple births in the Philippines. PAPERS: 95 Scientific papers, articles published in peer reviewed journals, presented in international and Philippine fora on Women’s Health; High Risk Pregnancies; UTZ of fetus, child & mother; Gynaecologic problems of newborn and child. Preserving mother earth, teen pregnancy
| Oral | Obstetrics
Fetal heart rate parameters and perinatal outcomes in fetuses with nuchal cords
Jeong Kyu Hoh 1(*); Moon Il Park 1(*)
1 - Hanyang University Hospital | (*) Korea, Republic of
Aim: The purpose of this study was to compare and analyze differences in antepartal fetal heart rate (FHR) parameters during pregnancy, and pregnancy outcomes, in normal fetuses and fetuses with nuchal cord (NC). Methods: We surveyed all non-stress test (NST) data acquired using a computerized FHR analysis system at Hanyang University Hospital between 2005 and 2008, and selected 150 cases which had NC. NSTs were performed between 37 and 42 weeks of gestation. Subjects were divided into three groups by the number of NCs; no NC and normal (n=300), single (n=124), and multiple NCs (n=26). Neonatal outcomes were compared, and FHR parameters analyzed using computerized fetal monitoring system. Results: FHR variability, with respect to amplitude (AMP) and mean minute range (MMR), was lower in the multiple NCs group than in the normal group (18.04±0.38 vs 14.54±1.10 bpm, P=0.0207; 55.69±1.22 vs 44.35±3.41 msec, P=0.0145, respectively). There were no other statistically significant differences of FHR parameters between the three groups. Baby weight was significantly lower in the multiple NCs group than the normal group (3,317±24 vs 3,054±55; P=0.0008), and there were no other significant differences between the groups. Conclusions: Computerized analysis of FHR would be helpful to assess fetal status especially in cases of multiple NC. Multiple NC may be a subliminal risk factor for the babies even though they present no complications at delivery.
Background The thymus is the central organ of the adaptive immune system responsible for induction of tolerance. Intact immune tolerance between fetus and mother is pivotal for healthy pregnancy. Breakdown of feto-maternal tolerance is believed to result in preeclampsia, the most common pregnancy related disease. In preeclampsia the maternal adaptive immune system undergoes specific changes, which are different from the physiological processes associated with healthy pregnancy. Whether preeclampsia also affects the fetal immune system is difficult to investigate, due to limited access to the fetus. We hypothesized that if preeclampsia affects the fetal adaptive immune system this might be associated with changes in thymic growth. Methods and Findings This was a case control study with 55 preeclamptic and 121 healthy control pregnancies, matched for maternal age, parity, fetal gestational age and smoking. Fetal thymus size was measured on ultrasound images taken at 17-21 weeks gestation. Two examiners measured all thymuses independently, blinded to pregnancy outcome (Pearson r=0.7, p=0.0001). Fetal thymus diameter was measured as the greatest width perpendicular to a line connecting sternum and spine. Thymuses were smaller in preeclamptic pregnancies as compared with healthy controls (preeclampsia: 16.2mm, 95% CI 15.28-17.19; controls: 18.4mm, 95% CI 17.78-18.93; p<0.0001). Multivariate analysis revealed increased fetal thymus size decreases the risk of developing preeclampsia (OR: 0.754; 95% CI: 0.656-0.867), independent of fetal and maternal anthropometric measures. There was no correlation between the onset or severity of preeclampsia and fetal thymus size. Conclusions This is the first study to show that fetal thymus growth is reduced before the clinical onset of preeclampsia and precedes any described fetal anomalies or maternal immunological changes associated with preeclampsia. We suggest that the fetal adaptive immune system is either passively affected by maternal processes preceding clinical preeclampsia or is actively involved in initiating preeclampsia in later pregnancy.
Introduction: Hypertensive disorders during pregnancy are an important issue in global public health. It is current the leading cause of maternal mortality in Brazil. Objective: To assess the effect of physical exercise using stationary bicycle through blood pressure (BP) and heart rate (HR) measurements, incidence of preeclampsia (PE) and quality of life (QoL) survey in pregnant women with chronic high blood pressure (CHB), previous preeclampsia pregnancies or both factors associated. Methodology: This randomized clinical trial (preliminary) enrolled 52 pregnant women presenting CHB, previous PE experience or both. Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and randomly allocated to the study or non-interventional group. Women at the study group performed physical exercise using stationary bicycle (horizontal bench model) during 20 min, once a week. The HR was maintained at 20% above resting heart rate and up to 140 bpm. BP and HR measurements were evaluated before and after exercise. The non-intervention group followed regular prenatal routine with weekly returns for HR and BP measurements. Both groups fulfilled the QoLsurvey (SF-36 questionnaire) at three times: between 12 and 20 weeks; 28 and 32 weeks and 36 and 41 weeks of gestation. Significance was assumed as p<.5%. Results: No statistical differences was observed between groups on BP and HR. BP at the end of the study on the interventional group was significantly lower compared to pre-study BP. Pregnant women in both groups presented worse scores in some QoL domains along pregnancy; however, there was no significant differences when the scores were compared between the groups trough the study. Conclusion: Pregnant women at risk for preeclampsia development who did physical exercise using stationary bicycle did not present HR and BP changes and also did not develop preeclampsia; however,presented worse Qol, as expected with pregnancy evolution.
Keywords: Preeclampsia, Physical Exercise, Blood Pressure, Heart Rate, Quality of Life
| Oral | Obstetrics
Outcome and long–term prognosis of children by the double Shirodkar cerclage with fibrin sealing for preterm premature membrane rupture (pPROM)
[Objective] In 1979, Genz firstly reported a technique known as the fibrin sealing using fibrin adhesive in the uterine cervix for the treatment of pPROM cases. We developed our original technique to treat pPROM cases using a double Shirodkar cerclage with fibrin sealing. In this study, we investigated its effectiveness and long-term prognosis of children. [Methodology] We focused on 25 membrane rupture cases from 15th to 30th of gestation during from 1997 and 2005 who delivered at our hospital and who could be followed up for 5 years. We examined cervical dilatation and length, leukocyte counts, diameter of amniotic fluid pocket prior to the operation, and we investigated whether these factors were associated with the duration of pregnancy and long-term prognosis of children. [Ｒｅｓｕｌｔｓ and Discussion] The duration of the maintenance of pregnancy for all the cases was 62.8 ± 48.7 days. Out of the 28 cases that included twin fetuses, there were 26 surviving cases. The ratio of the average duration of pregnancy and duration of pregnancy falling short by 10 days was 17.0 ± 15.3, 40% when preoperative amniotic fluid pocket was less than 1 cm, as against 79.7 ± 48.7, 5.3% when it was more than 1 cm. The amniotic fluid volume was found to be related to the duration of pregnancy. Additionally, the duration of pregnancy was observed to be short when the preoperative leukocyte count was above 14,000 and when preoperative bleeding was observed. [Conclusion] Our original technique to treat pPROM cases using a double Shirodkar cerclage with fibrin sealing was found to be apparently effective. However, we also found that there are poor prognostic factors including less amniotic fluid volume, high level of leukocyte count and the existence of bleeding preoperatively. Children can be improved by this technique if we consider the appropriateness.
Objetive: The aim of this study was to compare the metabolic profile between two groups of pregnant women between 30 – 34 weeks all of whom had Gestational Diabetes Treated Group (n=42 Glibenclamide) and Diet Group (n=97) Methods: We conducted a prospective analysis of 139 women with singleton pregnancies and gestacional Diabetes Mellitus . The diagnostic was made according the Chilean recommendations. All the women were provided with standard nutritional instructions and evaluated one week after enrolment.. The primary outcome measured was good glycemic control (Fasting 60 – 90 mg/dl Postprandial 90 – 120 mg/dl). Women that do not meet criteria was assigned to receive Glibenclamide. Metabolic profile was evaluated 4 weeks after enrolment Results: There were no significant differences between groups in terms of maternal weight or BMI at the moment of enrolment. Women of Glibenclamide group was significant older than diet. Fasting and post prandial glycemia was significant higher in Glibenclamide Group. Hb A1C was 5,49 (diet) v/s 5,76 respectively . Total Cholesterol was 240,3 mg/dl v/s 227,7 mg/dl (p < 0,05), HDL was 63,2 mg/dl v/s 59,9 mg/dl (n/s), LDL was 135,4 mg/dl v/s 124,6 mg/dl (p < 0,05) and TGC was 235,6 mg/dl v/s 226,9 mg/dl (n/s). There were not statistically significant differences in the neonatal outcomes Results: In our experience Glibenclamide improve the metabolic profile in women with Gestational Diabetes
OBJECTIVE: The purpose of this study was to evaluate the fetal mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: Ongoing case-control study, setting at Hospital Carlos Van Buren of Valparaiso, tertiary level center, in Chile between January to May of 2011. Fetal echocardiography was performed for women with ICP and control subjects. Clinical and demographics characteristics were compared between groups. RESULTS: Fifteen women with ICP and 10 control subjects were enrolled. There is no clinical differences between the cases and control subjects. The PR interval average in ICP patients was 134 (117 – 158) and in control subjects was 120 (118 - 138) msec. The difference was significantly higher in fetuses with ICP than in control fetuses (P 0.004). We found two cases of First degree Heart Block. One of them was confirmed postnatally, and was followed by the pediatric cardiology unit. CONCLUSION: The ICP is a condition asociated with clinical pruritus, a rise in the bile acid concentration, and unexplained fetal demise. Although the exact mechanism of fetal death that is associated with ICP is unknown, there is evidence to suggest that it may be related to a fetal cardiac failiure. In these investigation we can demonstrate that the fetal cardiac conduction system is altered in fetuses of patients with ICP. To determine if this alteration is related to the fetal cardiac event in the patients with ICP is necessary to follow further investigations.
Keywords: cholestasis intrahepatic of pregnancy, pr mechanical interval, First degree Heart Block, fetal echocardiography
| Oral | Obstetrics
Penicillin G pharmacokinetics profile during antepartum GBS prophylaxis – A PRELIMINARY REPORT
Santiago Scasso 1(*); Joel Laufer 1(*); Grisel Rodriguez 1(*); Claudio Sosa 1(*); Justo Alonso 1(*); Leonel Briozzo 2(*)
The CDC recommends penicillin G as first line treatment for GBS carriers during labor. However, the fact that Penicillin G should be administered at least four hours before delivery for maximum effectiveness is based on limited data. Most of the pharmacologic research involving the dosage of penicillin were obtained in non-pregnant patients and only indirectly addressed tissue levels. OBJECTIVE: The purpose of this study was to determine Penicillin G pharmacokinetics profile during intrapartum GBS prophylaxis (IAP). Evaluating the time necessary to achieve and maintain bactericidal concentrations of penicillin in fetal serum, amniotic fluid and maternal vaginal GBS status vs time. STUDY DESIGN: Prospective cohort study in the largest maternity unit in Uruguay - Pereira Rossell Hospital – with around 8,500 deliveries per year. As we published previously GBS colonization rate is estimated in 17.3% and it was determined that 100 % of isolates susceptible to Penicillin (MIC 0.1 micrograms/mL). In this current study we proposed to collect cord blood samples at the time of delivery (vaginal and C-section) and amniotic fluid (in C-section) to determine the Penicillin G levels through high-performance liquid chromatography analyses. RESULTS: Table 1 (attached). CONCLUSION: Penicillin G levels were found to exceed the minimal bactericidal concentration reported in the literature (0.5-2.0 µg/ml ) during the 4 hours interval. In our sample, the initial concentration level is estimated in 12.9 µg/ml with a clearance of 0.04 µg/ml per minute. However, we could not find a relationship between time of IAP and penicillin levels in amniotic fluid. This preliminary report will be completed with the profile of GBS rectovaginal culture status before starting intrapartum antibiotic prophylaxis and at two and four hours after initial antibiotics.
Introduction: Recent evidence suggests that delaying cord clamping is of benefit to newborns. While current recommendations and the intended practice in our institution state that clamping should be performed beyond the first minute there might be variables affecting compliance. Objectives: Evaluate the timing of umbilical cord clamping (UCC) in term newborns. Population: Full term newborns born at Clínica y Maternidad Suizo Argentina between 11/2008 and 11/2010. Methods: An observation of a convenience sample of deliveries was performed. Neonatologists in every delivery were unaware of the study. On admission the mothers signed a general consent allowing the confidential and anonymous use of data from their charts for research. The protocol was approved by the local Research Ethics Committee. Results:427 deliveries were analyzed, GA was 39±1w and BW was 3283±444g (Mean±SD); 335 (78.3%) were c-sections and 93 (21,7%) vaginal deliveries, in 88% the positioning of the infant after birth was at the level of the placenta. Cord blood was collected for stem cells in 58 cases (13.5%). The timing of UCC was 48±19 seconds. In 58 (13.6%) it was < 30s, in 292 (68.4%) between 30-60s, in 63 (14.8%) between 60-90s and in 14 (3.3%) >90s. Comparing c-sections and vaginal deliveries timing was 48±1s vs. 55±3s (p<0.01). When cord blood was collected timing was 41.4±15s vs 49.1±20s (p<0.01). Conclusions: UCC was performed later in our institution than in previous local reports. However, the timing was shorter than recommended specially in association with c-section and stem cell collection. We speculate that the diffusion of the recommendations within the institution and the presence of a neonatologist at every delivery may have contributed to the relative delay in UCC. Our results show, nevertheless, that modifying established practices is a complex task and that in order to improve compliance new strategies should be considered.
| Oral | Obstetrics
BLOOD FLOW IN FETAL RENAL ARTERIES IN SEVERE PREECLAMPTIC AND NORMOTENSIVE HEALTHY PREGNANT WOMEN
Yolimar Navarro-Briceño 1(*); Carlos Briceño-Perez 2(*); Joel Santos-Bolivar 1(*); Eduardo Reyna-Villasmil 1(*); Jorly Mejia-Montilla 1(*); Nadia Reyna-Villasmil 1(*)
1 - Hospital Central "Dr. Urquinaona" | (*) Venezuela
OBJECTIVE: To compare the blood flow of fetal renal arteries in severe preeclamptic and healthy normotensive pregnant women. METHODS: A sample was of 30 severe preeclamptic women (group A) and 30 healthy normotensive pregnant women (group B) with single pregnancies over 30 weeks of gestation was selected. Pulsatility and resistance index of uterine, umbilical, fetal middle cerebral and fetal renal arteries were measured. RESULTS: There were not significant differences in maternal age, gestational age and newborn weigth (p = ns). Patients of group A showed significant higher values of pulsatility and resistance index in uterine and umbilical arteries with significant lower values of both measurements for fetal middle cerebral artery compare with pregnant women of goup B (p = 0.0001). Severe preeclamptic women showed values of pulsatility and resistance index of fetal renal artery significantly higher than patients in group B (p = 0.0001). Fetal renal artery pulsatility index showed a significant correlation with pulsatility index of uterine artery (p = 0.011) and fetal middle cerebral artery (p < 0.007).Fetal renal artery resistance index presented a correlation with resistance index of three vesels (p < 0,05). CONCLUSION: Severe preeclamptic women have blood flow alterations of fetal renal arteries when compared to healthy normotensive pregnant women.
Coordinador : Germán Campos Pérez - Universidad Austral de Chile (Chile) Ver CV Prof. Dr. Germán Campos, born in Chile the year 1949.
Undergraduated studies at the University of Concepción (Chile), and graduated as a Medical Doctor in 1974.
Residence in Obstetrics & Gynecology at the Faculty of Medicine of the Universidad Austral de Chile from 1974 to 1977.
Post-doctoral research training in Fetal and Reproductive Physiology at the Postgraduated School of Obstetrics and Gynecology, Auckland University, New Zealand, at the laboratory of Prof. GC Liggins from 1978 to 1981.
Academic career at the Faculty of Medicine, Universidad Austral de Chile since 1974. At present is full Professor of Obstetrics & Gynecology and Head of the Institute of Obstetrics & Gynecology.
Research interest and publications: Prostaglandins and initiation of labor, fetal lung physiology and at present leading a research group focused on prevention of preterm birth.
Coordinador : Lawrence D. Longo (Estados Unidos)
| Oral | Perinatology
ARE ANTENATAL STEROIDS (AS) INDICATED IN SEVERE INTRAUTERINE GROWTH RESTRICTED (IUGR) FETUSES?
George Mitsiakos 1(*); Lajos Kovacs 1(*); Apostolos Papageorgiou 1(*)
1 - McGill University, Department of Neonatology, Jewish General Hospital, Montreal | (*) Canada
BACKGROUND: Antenatal Steroids (AS) have been shown to enhance fetal maturation in preterms and to improve outcome. The efficacy of AS in severe IUGR infants is questionable due to already high circulating endogenous steroids and the potential harm to the brain and cardiovascular system (CVS). AIM: To evaluate the efficacy of AS in premature infants with severe IUGR. METHODOLOGY: The electronic data of all infants born 24 to 31 6/7 wks of GA and with a BW ≤ 3rd percentile was analyzed. We compared the outcome of whose who received 2 doses of AS (Group A) vs those who did not receive (Group B). RESULTS: Out of 1565 neonates, 212(13.5%) infants had severe IUGR. Group A of 130 infants, with mean GA 28±2.4 wks and BW 789±213gms was compared to Group B of 82 infants with GA of 28±2.6 wks and BW 779±215gms. Comparison of outcomes between the two groups is indicated in table 1. CONCLUSIONS: In severe IUGR, AS did not improve the neonatal outcome of infants born between 24 and 31 6/7 wks of gestation, with the exception of better cord pH and 5 min Apgar. In view of the potential cerebral and CVS risks associated with high circulating steroids, the indications for AS in such a population need to be re-evaluated.
Introduction: Adverse outcomes of pregnancy or labour, can often by their consequences, seriously damage relationship of trust developed up to then between a female patient and a doctor and in most difficult cases have an epilogue in court.Paper objective: Perceive the complexity of the problem of an adverse outcome of pregnancy or labour, as well as its medicolegal and ethical aspects in the light of possible consequences for the mother and baby, as well as for the doctor himself. Discussion: Even besides a doctrinal approach, best intentions, excellent level of education, as well as the exceptional progress of methods of diagnostics, it is possible for an adverse outcome of pregnancy or labour to occur. An adverse outcome of pregnancy can sometimes be caused by a mere combination of cirucumstances or by a complete abscence of cooperation from mother, but it can also be a result of an inadequate pregnancy managment or an incorrect assessment of labour. In all cases when a pregnancy and labour do not end favourably for the patient or her baby, it is of exceptional importance that doctor who managed the pregnancy or performed the delivery as well as the institution in which he works do not close the doors on the patient or her relatives for conversation and provide sufficient explanation in order to try to resolve such cases without a court epilogue, which has been proven possible in Bosnian and Herzegovinian(B&H) circumstance. Conclusion: In future an increasing number of lawsuits regarding adverse outcomes of pregnancy or labour can be expected in B&H. That is why it will also be necessary, apart from an adequate approuch to a patient, a highly professional and ethical attitude during examinations, pregnancy managment and at the conclusion of labour itself, to develop mechanisms of protection of perinatologists in B&H.
Keywords: pregnancy, labour, adverse outcome
| Oral | Psycho-social - bioethical
Psychoactive substance use during pregnancy-BPS
Pablo Putti 1(*); Raquel Magri 2(*)
1 - Instituto de Prevision Social - BPS | (*) Uruguay
Justification: The self-consumption may be underestimated. The possibility of studying several biomarkers to detect drug use in different stages of pregnancy such as meconium, umbilical cord and a drop of blood. Tobacco consumption, alcohol and other drugs is also linked to information that mothers receive from the health team. Objectives: Principal: determine the nature and magnitude of consumption to reduce neonatal mortality and maternal morbidity and risk factors. Specific: Determine 1. consumption patterns according to socio-cultural context 2. prevalence of reported and biological testing. 3. levels of information (and understanding) given in relation to the influence of drugs during pregnancy Methodology: Show coincidental, not random. Number counted: 249 cases Universe: Postpartum women 16 to 41 years, and signed informed consent Results: Base: Total sample Perinatology Unit (BPS) 2009 Age (average) 24.28 Prevalence According to: Survey Meconium Umbilical Cord Heel drop of blood Tobacco: 38.8% 40.2% 40.0% 42.0% Alcohol 53.9% 58.0% 78.5% 86.1% Caffeine 98.0% 98.0% 98.0% 98.0% Tran./antidep. 6.5% 10.0% 10.0% 10.0% Marihuana 0.4% Cocaine 0.4% “Pasta Base” 0.8% Amphetamines 1.2% Opium / morphine / heroin 0.0% Ecstasy 0.0% CONCLUSIONS: The prevalence of drug and alcohol consumption is high. Biomarker for ethanol in umbilical show more positive results in meconium. The survey and biomarkers are good methodologies in measuring consumption, and drops of blood as a new biomarker improves the quality of research. Information to pregnant women about alcohol is unsatisfactory. Population strategies should be planned to reverse this situation starting point for these preliminary studies with the support of government agencies involved.
OBJECTIVE: To compare concentrations of interleukin-18 in preeclamptic patients and healthy normotensive pregnant women. METHOD: a total of 100 patients were selected. Fifty preeclamptic patients were selected as cases (group A) and a control group selected for having same age and body mass index to study group that consisted in 50 healthy normotensive pregnant women. Blood samples were recollected in all patients before labor and immediately after diagnosis in group B to determine interleukin-18 concentrations. RESULTS: There were not significant differences in relation to maternal age, gestation age and body mass index at the moment of getting the sample (p = ns). There was significant statically difference in interleukin-18 concentrations between patients in control group (group A; 38.6 +/- 6.5 pg/ml) and patients in control group (group B; 32.2 +/- 8.5 pg/ml; p < 0.05). There was a moderate, positive and significant correlation with values of systolic blood pressure (r = 0.341; p < 0.05) and with values of diastolic blood pressure (r = 0.408; p < 0.05). CONCLUSIONS: Preeclamptic patients presented significantly higher concentrations of interleukin-18 when compared with healthy normotensive pregnant women.
Keywords: Interleukin-18, Preeclampsia, Pregnancy
| Oral | Obstetrics
Salbutamol used as tocolytic in cases of non-reassuring fetal status during labor.
Soledad Bottaro 1(*); Diego Greif 1(*); Maria Fernanda Gómez 1(*); Verónica Fiol 1(*); María Fernanda Nozar 1(*); Fernanda Corpas 1(*); Leonel Briozzo 1(*)
1 - Clínica Ginecotocológica A, Facultad de Medicina UdelaR. Centro Hospitalario Pereira Rossell | (*) Uruguay
Intrapartum fetal hypoxia is a subject of health impact, because asphyxia remains a leading cause of perinatal morbidity and mortality worldwide. In Pereira Rossell Hospital (PRH) the prevalence of suspected fetal hypoxia (SFH) is between 3 and 4%. The current recommendation in case of SFH is fetal intrauterine resuscitation with tocolysis prior to birth. The drug used was fenoterol, but given its discontinuation in the country, salbutamol is being used. The aim of this study is to analyze the first cases of fetal intrauterine resuscitation using this drug in the PRH. METHODOLOGY Descriptive, observational study. Population: all cases in which SFH is diagnosed using electronic fetal heart rate monitoring, and fetal intrauterine resuscitation is done with salbutamol (starting dose: 10 mcg/min). The data were fed into an art form, assessing maternal and perinatal outcomes. RESULTS AND DISCUSSION Study period: between 14 april and 24 may, 2011. Total number of births: 836. SFH was diagnosed in 22 cases, equivalent to a prevalence of 3%. In 54% of cases the diagnosis was made in the first stage, bradycardia being the most common pattern (54%). In 82% of cases uterine contractility was decreased or abolished. Fetal heart rate pattern improved in 23% and normalized in 50% of cases. Dose increase of salbutamol was required in 36% of cases. Neonatal outcomes: acidosis in the umbilical artery was found in 3 cases. 3 newborns were admitted to the NICU. Maternal outcomes: in 5 cases it was verified tachycardia. In one case, evaluation of intrapartum hemorrhage was subjectively greater than usual. CONCLUSIONS Salbutamol is effective in achieving tocolysis in cases of SFH, with no severe maternal side effects. It would be important to conduct a prospective study to evaluate its efficacy as other parenteral tocolytic like atosiban.
Transdisciplinary work is a system of health care practiced in the Department of Prenatal Medicine of UP (under the social security system BPS). It implies that each member of the Health Team incorporates and applies in his/her work the different knowledge of the diverse disciplines for the benefit of patients. The techniques currently offered by obstetrics not only focus on the pregnant woman but make parents consider the “fetus” as a patient. Those techniques thus involve a change in the approach that has prevailed so far. Psychologists and social workers contribute an overview of the situation with the acknowledgment of non-verbal messages. Communication goes through different stages and vulnerability pervades all the players. Reporting bad news is a process in which all players give themselves "permission" to express the emotions aroused by the event. The participation of non-medical professionals contributes to the acceptance of those emotions as well as to provide a better quality care. Pregnancy with a baby with congenital pathology, or the increased risk of having it as a consequence of his/her background is an extremely stressful event which makes the parents become highly vulnerable; they could even remain in a state of shock for some time. For that reason they need support, contention, and to reverse the potential future effects on the link with their baby or their other children, and their environment. The expression of the emotions aroused by the diagnosis and the medical information that surrounds it is the beginning of a process more generally called "mourning" for the normal baby they had expected. The success of the interdisciplinary work is outstanding when comparing our patients with those who have faced these dramatic situations without having gone through the system we propose.
Keywords: Transdisciplinary, emotions, fetus, non-verbal messages, state of shock
| Oral | Perinatology
Perinatal mortality in Paysandu- Uruguay in the 1995-2009 period
Col: Dres. E. Laluz, M. López, R. Medina, W. Acuña, G. Tacain, C.Alonso, A. Lodeiros, L. Martínez, A. Tomas, C. Rial, S. Correa.
We analysed the perinatal mortality in Paysandú in the 1995-2009 period. In Uruguay during the 1999-2009 period, the natality decreased 13% while in Paysandú it decreased 30%. Perinatal mortality at MSP in the moveable five year period 1995-2003 showed a progressive decreased from 16 ‰ to 11‰ while from 2003 to 2009 the perinatal mortality is established at 12‰ Perinatal mortality at COMEPA in the moveable five year period 1995-2009 decreased constantly , reaching in the last moveable five year period the excellent value of 5,7‰ like its seen at first world countries. In the moveable five year period 1995-2009 in Paysandú the perinatal mortality decreased from 18‰ to 10‰. This shows an 8 ‰ improvement in all the period. Perinatal Mortality in Paysandú since 1979 to 2009 has shown excellent results decreasing from 49 ‰ to 8,4 ‰. Perinatal Mortality in Uruguay during the five year period 2002-2006 was 14‰, which improved in the similar previous period 1,7‰. At 2009 it was 13,5 ‰. Perinatal mortality in Paysandú analyzed with the moveable five year period 1995-2009 was 10‰ which is a very good result because is under the country´s average. Several actions in technology, service creation, increase in human resources in the health team as well as continuous medical education and university teaching and infrastructure implementation were determining conditions for good perinatal results.
Keywords: Perinatal Mortality, Paysandú, Uruguay
| Oral | Obstetrics
Preterm Premature Rupture of Membranes: a Management Dilemma?
Corazon Almirante 1(*)
1 - Philippine Children;s Medical Center | (*) Philippines
When membranes rupture before term and is confirmed by history, pooling of fluid in vagina on examination, nitrazine paper test and transperineal ultrasound , one is confronted with options in order to achieve optimum perinatal outcome. to give or not to give antibiotics 2) immediate or expectant management detection of intra-amniotic infection A review of random controlled trials in Cochrane Pregnancy and Childbirth Groups Trial Register (April 29,2010) 22 trials, comparing antibiotics use and placebo showed significant reduction in chorioamnionitis, reduction in number of babies born in 48 hours and reduced neonatal infection but the question is what is the long term effect and what antibiotic to use. Cochrane Database System Review, March 17,2010; 7 trials,compared outcome of immediate and expectant delivery. There is insufficient evidence to give clinical practise guidelines on benefits and harms of immediate and expectant management for Women with PPROM A study done at the Perinatal Center, Philippine Children's Medical Center showed that glucose levels determined from vaginal pool (Amniotic Fluid)of 37 patients with PPROM to predict intra-amniotic infection showed a sensitivity of 92% and specificity of 87%. This was compared to Amniotic fluid Gram Stain, sensitivity 88% and specificity77%; Histopath of placenta sensitivity 8% and specificity 85%, Clinical Signs of infection sensitivity 83% and specificity 87% Positive culture was obtained in 57% PPROM cases.Rapid and sensitive diagnosis of intra-amniotic infection is extremely important to assure proper and timely treatment.
Keywords: PPROM, intra-amniotic infection, Glucose Level in Amniotic Fluid, Histopath, Culture and Sensitivity