RESUMO

Intrauterine fetal transfusion is currently the therapy of choice in cases of severe anti-D isoimmunisation. However, its efficacy is reduced in patients with early severe hydrops fetalis due to the technical difficulties in performing this procedure before 20 weeks' gestation. The purpose of this study was to determine whether early onset of high-dose gammaglobulin therapy followed by intrauterine transfusions (IUTs) is more effective than IUTs alone in the treatment of very severe isoimmunised fetuses. The population studied in this retrospective clinical research was assigned to one of the following two groups: 1) Gamma group: 30 patients receiving gammaglobulin therapy before 21 weeks' gestation and IUTs after 20 weeks; or 2) IUT group: 39 patients receiving IUT treatment starting at a gestational age of 20-25 weeks. Both groups were statistically similar regarding history of perinatal deaths and anti-D antibody titers. The number of hydropic fetuses at the first IUT and of fetal deaths were significantly higher in the IUT than in the Gamma group. No significant differences were observed between the groups in fetal hematocrit at first IUT and at birth. However, the percentage of severely anemic fetuses was higher in the IUT group. Fetal mortality rate was 36% less in the Gamma group. Our results suggest that high-dose gammaglobulin therapy followed by IUTs may improve fetal survival in these severe cases. Further randomised clinical trials are needed to confirm these results.

Assuntos

RESUMO

The purpose of this study was to determine the degree of agreement among different frequencies of blood pressure measurements (FoM) in 24-hour ambulatory blood pressure monitoring (ABPM) in their ability to obtain useful clinical information. ABPM records were obtained with a Del Mar IV Avionics device from 49 hospitalised preeclamptic women with a FoM of 7 per hour (high-FoM). With these records, we simulated two sets of data as if measurements had been recorded at a rate of 1 measurement per hour (low-FoM) and of 2 per hour (medium-FoM). Diastolic blood pressure > 89 mmHg defined hypertension and > 109 mmHg, severe hypertension The median and 25th and 75th centiles for the differences in hypertensive rate detected (expressed as percentage points) between lowFoM vs. high-FoM was 0.00 (- 3.4-3.00) and between medium-FoM vs. high-FoM,- 1.04 (- 3.7-1.5). The agreement in the detection of severely affected patients was 85% (CI 95%: 74-96) between low-FoM and high-FoM and 87% (CI 95%: 77-98), between medium-FoM and high-FoM. Average blood pressure was similar in the three FoMs studied at day-time and night-time. We did not find any strong argument to perform ABPM at a high-FoM. Lower FoM are more comfortable for the patient and could reduce equipment deterioration, while providing equivalent information to that supplied by high-FoM.

RESUMO

Our aim was to assess the effectiveness of neonatal treatment of Rh hemolytic disease with high-dose intravenous immunoglobulin (HDIVIG), in reducing neonatal hemolysis. A total of 40 neonates born to isoimmunized Rh negative women were studied. The population was randomized into 2 groups: Group 1 received IVIG 800 mg/kg/day for 3 days, plus phototherapy; and Group 2 received only phototherapy. No significant difference was observed between the groups in the severity of either the antenatal and neonatal disease, mode of delivery, mean birthweight, gestational age at delivery, proportion of preterm deliveries, 1 minute Apgar Score, days of phototherapy, and presence of neonatal cholestasis. Group 1 babies showed a significantly decreased duration of hospitalization, less hemolysis, and a less marked increase in bilirubin levels on the first day of life than Group 2 newborns. Therefore, Group 1 neonates received less treatment with transfusions (exchange-transfusions and/or simple blood treatment with transfusions) than those in Group 2. Our data suggest that the frequency of transfusional therapy can be reduced by combining conventional phototherapy with HDIVIG. Further studies are needed to determine the optimum timing and dosages of neonatal HDIVIG treatment.

Assuntos

RESUMO

The efficacy of misoprostol (a PGE1 analog) for induction of labor at term was compared with oxytocin by means of an open and randomized study in 153 pregnant women. A vaginal tablet containing 50 mcg of misoprostol was placed intravaginally in 78 women, the remaining 75 patients received i.v. oxytocin (2-32 mU/min). Bishop's score at the entry of the trial was similar in both groups. Delivery within 24 hours was achieved in 85.7% of the patients induced with misoprostol and in 64% of the patients infused with oxytocin (p < 0.05). Mean induction to delivery interval was significantly shorter in the misoprostol group (552 +/- 211 min; mean =SD) in comparison with that of the oxytocin group (745 +/- 292 min; mean +/- SD) (p < 0.05). The probability of still being pregnant at 24 hours (Life table analysis) was 14% (misoprostol group) and 26% (oxitocyn group). The difference was also statistically significant (p < 0.01). No undesirable side effects were observed in any of the patients, however, polisystoly (> 5 contractions in 10 min) was more frequently observed in the patients induced with misoprostol (24.6% vs 13.3%; p = NS). Cesarean section rate was higher in the oxytocin-induced patients (25.3%) than in the misoprostol-induced women (3.8%) (p < 0.05). The main cause of cesarean section was failure to progress in labor in both groups of patients. Neonatal outcome was good in both groups and there were no differences with respect to birthweight or to Apgar scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Assuntos

RESUMO

La adolescente embarazada representa para el médico una doble responsabilidad: la gestación en un organismo inmaduro y el riesgo psicosocial. En nuestro Hospital, la tasa de embarazos es de 160 por ciento. Esta gran incidencia responde a la pobre situación socieconómica, coexistente con el desempleo y la falta de educación. Muchas jóvenes encuentran dificil incorporarse al sistema de atención prenatal clásico. En nuestro Hospital un equipo multidisciplinario atiende a la adolescente para lograr una continuidad en el cuidado y el compromiso con su gestación. En nuestra casuística no hemos observado aumento de la prematurez, con una incidencia para los adultos de 9 por ciento y para los menores de 17 años de 9,7 por ciento. Tampoco hubieron diferencias en la incidencia de bajo peso al nacer, 10,9 por ciento en las mayores y 11 por ciento en las menores. La duración del trabajo de parto fue similar en adolescentes y adultas. Tampoco encontramos mayor incidencia de otros tipos de distancia. Respecto a la forma de terminación, la incidencia de cesáreas fue 21,6 por ciento en las adultas, y 16 por ciento en las adolescentes, duplicando la incidencia de fórceps, en las menores a la de las adultas. Nuestra función como equipo de Salud es brindarle a la joven la oportunidad de iniciar su maternidad en las mejores condiciones, permitiéndole desarrollar su potencial afectivo hacia ese hijo por venir

Assuntos

RESUMO

La adolescente embarazada representa para el médico una doble responsabilidad: la gestación en un organismo inmaduro y el riesgo psicosocial. En nuestro Hospital, la tasa de embarazos es de 160 por ciento. Esta gran incidencia responde a la pobre situación socieconómica, coexistente con el desempleo y la falta de educación. Muchas jóvenes encuentran dificil incorporarse al sistema de atención prenatal clásico. En nuestro Hospital un equipo multidisciplinario atiende a la adolescente para lograr una continuidad en el cuidado y el compromiso con su gestación. En nuestra casuística no hemos observado aumento de la prematurez, con una incidencia para los adultos de 9 por ciento y para los menores de 17 años de 9,7 por ciento. Tampoco hubieron diferencias en la incidencia de bajo peso al nacer, 10,9 por ciento en las mayores y 11 por ciento en las menores. La duración del trabajo de parto fue similar en adolescentes y adultas. Tampoco encontramos mayor incidencia de otros tipos de distancia. Respecto a la forma de terminación, la incidencia de cesáreas fue 21,6 por ciento en las adultas, y 16 por ciento en las adolescentes, duplicando la incidencia de fórceps, en las menores a la de las adultas. Nuestra función como equipo de Salud es brindarle a la joven la oportunidad de iniciar su maternidad en las mejores condiciones, permitiéndole desarrollar su potencial afectivo hacia ese hijo por venir (AU)

Assuntos

RESUMO

The present study was developed to verify whether a reduction in phospholipid concentration could increase the activated partial thromboplastin time (APTT) sensitivity to detect lupus anticoagulant (LA) during pregnancy. The authors studied 38 pregnant women (10 normal subjects and 28 patients with associated clinical complications) and 40 nonpregnant control subjects. Tests to detect LA, including APTT, platelet neutralization procedure (standard APTT), the kaolin clotting time, the diluted Russell viper venom test neutralized by lysed platelets, and factor assays, were performed. Positive results were found in 5 of 28 pregnant women with associated clinical complications. The APTT, using three different phospholipid concentrations (standard and more diluted cephalin), was performed on plasma samples and on its 1:1 mixture with normal plasma. The behavior of standard and diluted APTT was similar in negative LA pregnant women and nonpregnant control subjects. The mean values showed nonsignificant differences. Four of five pregnant women with positive LA findings had a prolonged APTT, which was not corrected by the addition of normal plasma using standard conditions. When diluted phospholipids were used, only one of them had a prolonged APTT that was corrected by the addition of normal plasma. Therefore, the highest sensitivity (80%) and specificity (100%) of the APTT to detect LA in pregnant women were obtained using the standard conditions.

Assuntos

RESUMO

The antihypertensive effect, tolerability, and influence on placental and fetal circulation of cadralazine, a 6-substituted derivative of 3-hydrazinopyridoxine structurally related to hydralazine, was assessed in 46 preeclamptic patients in the third trimester of pregnancy and with diastolic blood pressure of 100-120 mm Hg after 24 hours of bed rest. Patients who fulfilled the inclusion criteria at the initial report (24-48-hour run-in period after hospitalization) entered the titration period. During titration, cadralazine was administered at an initial dose of 5 mg once a day; if after 3 days diastolic blood pressure was still above 90 mm Hg, 5 mg more was added for another 3 days, and so forth, until the maximum dose (20 mg once a day) was reached. Patients who did not lower diastolic blood pressure below 90 mm Hg were considered nonresponders; those who achieved the desired diastolic level (responders) entered the maintenance period, which lasted until delivery. Eight patients delivered during the titration period (premature discontinuation group). A significant decrease in systolic and diastolic blood pressures was observed between the initial report and the titration period. During titration, there were 27 responders (71%) and 11 nonresponders. One of the responders was lost to follow-up. Cadralazine proved to be effective in lowering blood pressure levels; in the group of responders, a mean diastolic reduction of 20% was observed. This significant decrease was not affected by the diastolic blood pressure increase observed at the end of gestation. No adverse effects from the drug were observed on fetal development or immediate postnatal adaptation to stress during labor, and only mild maternal side effects were detected (headache).

Assuntos

RESUMO

The value of intravenous immunoglobulin (IVIG) in the treatment of 24 severely Rh-sensitized pregnant women was studied. IVIG was infused at a daily dose of 0.4 g/kg maternal body weight for 4-5 consecutive days, and was administered again 15-21 days later until delivery, depending on the evolution of the hemolytic disease. Our population was divided into 3 groups according to the time of onset of therapy: group 1 (n = 8), before 20 weeks' gestation; group 2 (n = 7), 20-28 weeks, and group 3 (n = 9), after 28 weeks. Initial mean anti-D level was significantly higher in group 1 (25.9 +/- 12.9 IU/ml) than in the other 2 groups, whose mean values were, however, higher than 10 IU/ml. Amniotic-fluid total bilirubin levels before the onset of therapy were pathologic, and in 55% of the cases they coincided with zone 3 of Liley's chart. Hydrops fetalis at the onset of treatment accounted for the only 3 fetal deaths in groups 1 and 2. None of the fetuses developed hydrops during treatment. Six of the 9 neonates in group 3 were depressed at birth (1-min Apgar below 7). However, at 5 min only 1 newborn showed an Apgar below 7. Mean birth weight was over 2,500 g in all the cases. Neonatal hematological condition in group 2 (50% of the babies required only phototherapy) was better than in the other 2 groups (transfusional therapy). There was a significant fall in maternal anti-D titers and intrauterine hemolysis after IVIG treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Assuntos

RESUMO

Twenty-four hour noninvasive, automatic and ambulatory control of blood pressure (BP) was carried out on 11 normotensive pregnant women in the third trimester of pregnancy with a Del Mar Avionics Model 1978 Pressurometer III System at 7.5 min intervals during 24 h. The patients kept a detailed record of their activities during those 24 h. BP increased from 9 AM to a peak between 7 and 10 PM. Mean (+/- SD) waking and sleeping values were 110.56 +/- 6.68 mm Hg and 96.5 +/- 10.01 mm Hg, respectively, for systolic BP, and 71.41 +/- 5.35 mm Hg and 62.82 +/- 5.47 mm Hg, respectively, for diastolic BP. There was a significant difference in systolic and diastolic BP between sleeping hours and waking hours. We believe that 24-h control of BP behavior in normotensive pregnant women allows us to adequately diagnose hypertensive disease in pregnancy.

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