Eutocic Delivery Research Articles

Motricidad fetal durante el segundo trimestre de gestación: estudio ecográfico longitudinal

IntroductionThe aim of this research is to contribute to knowledge of the normal spontaneous motor behavior of the human fetus during the second trimester of pregnancy. This study focuses on five patterns of spontaneous fetal movement: startle (S), axo-rhizomelic rhythmia (ARR), axial stretching (AS), general movement (GM), and diaphragmatic contraction (DC). MethodsA cohort of 13 subjects was followed up using 2D obstetrical ultrasound images at 12, 16, 20, and 24 weeks of gestation. As inclusion criteria, neonatal neurological examination and general movements after eutocic delivery at term were normal in all of the subjects, and their neuromotor and cognitive development until the end of pre-school age were also normal. ResultsAll these five motor patterns are present at the beginning of the 2nd gestational trimester, but their quantitative and qualitative traits are diverse according to gestational ages. The phasic, isolated or rhythmically repeated movements, S and ARR, are prominent at 12 and 16 weeks of gestation, and then their presence gradually diminishes. By contrast, tonic and complex AS and GM movements increase their presence and quality at 20 and 24 weeks. RAR constitute a particular periodic motor pattern not described in previous literature. Moreover, the incidence of DC is progressive throughout the trimester, in clusters of 2-6 arrhythmic and irregular beats. Fetal heart rate increases during fetal motor active periods. ConclusionsAll five normal behavioral patterns observed in the ultrasounds reflect the progressive tuning of motor generators in human nervous system during mid-pregnancy.

Tiempo de pinzamiento del cordón umbilical y complicaciones neonatales, un estudio prospectivo

ObjectiveTo assess the effects of early or late clamping of the umbilical cord in term newborns, assessing the levels of hemoglobin, hematocrit, and ferritin, and their correlation with some of the complications. Patients and methodsA prospective study of healthy newborns at term or born by dystotic or eutocic delivery in our hospital between May 2009 until May 2010. Patients were assigned according to the time of clamping, group 1 (<60seconds), group 2 (1 to<2minutes), and group 3 (2 to 3minutes). Laboratory tests were performed at birth and at 48hours of life, assessing the levels of hemoglobin, hematocrit, ferritin, and bilirubin. The risk of polycythemia, respiratory distress syndrome, neonatal phototherapy or admission to the Intensive Care Unit and the hospital stay, were evaluated. ResultsA total of 242 patients were included: group 1 (g1=80), group 2 (g2=31) y group 3 (g3=131). The background maternal and neonatal characteristics were similar in all sets. The first test showed significant differences in ferritin levels in those infants with delayed clamping (g1: 111 mg/dl, g2: 125 mg/dl, g3: 173 mg/dl; p<0.01). In the second analysis the values of hemoglobin (g1: 17.3 g/dl, g2: 18.9 g/dl, g3: 19.2 g/dl; p<0.01), hematocrit (g1: 53.4%, g2: 58%, g3: 59%; p<0.01) and ferritin (g1: 254 mg/dl, g2: 254.7 mg/dl, g3: 313 mg/dl; p = 0.008) were statistically higher in this group. As regards complications, a significant increase was observed in the number of cases of polycythemia symptoms in group 3. ConclusionsThe late cord clamping is associated with an increase in hematocrit, hemoglobin and ferritin at 48hours of life, as well as an increased risk of polycythemia present with symptoms.

Piometra por Streptococcus agalactiae tras parto vaginal eutócico. Presentación de un caso y revisión de la literatura

Objetivo: analizar un caso clínico de piometra por Streptococcus agalactiae tras parto vaginal. Revisar los factores de riesgo, el diagnóstico y el tratamiento de esta entidad.Materiales y métodos: se presenta el caso de una puérpera de 35 años con cuatro partos anteriores y parto vaginal diez días antes, quien consulta por sangrado genital abundante al Hospital Universitario San Cecilio de Granada (España) que realiza la atención obstétrico-ginecológica de la población sur de Granada y es centro de referencia de los Hospitales Básicos del Área Sanitaria Sur de la provincia. La ecografía transvaginal muestra cavidad uterina ocupada por contenido heterogéneo. Se practica legrado obteniéndose abundante material purulento, se hace diagnóstico de piometra y se instaura tratamiento antibiótico de amplio espectro. Cultivo positivo para Streptococcus agalactiae. Posteriormente presenta recidiva que precisa drenajes y tratamiento antibiótico intravenoso con clindamicina e imipenem, con buena evolución. Se realiza una búsqueda bibliográfica en las bases de datos: Pubmed, Cochrane y UpToDate utilizando los términos de búsqueda piometra posparto, endometritis posparto, Streptococcus agalactiae.Resultados: se encontraron 833 artículos en las bases de datos, de los cuales se seleccionaron 40 sobre casos de piometra o endometritis posparto en humanos incluyendo finalmente 14 artículos, 3 correspondieron a casos clínicos y 11 a revisiones del tema.Conclusiones: la aparición de piometra tras un La ecografía transvaginal muestra cavidad uterina parto vaginal eutócico es poco frecuente en humaocupada por contenido heterogéneo. Se practica nos, pero debe considerarse como posible entidad legrado obteniéndose abundante material purulen-etiológica en casos de fiebre puerperal con factores to, se hace diagnóstico de piometra y se instaura de riesgo asociados. El diagnóstico se basa en una tratamiento antibiótico de amplio espectro. Cultivo buena exploración clínica y ecográfica, y se debe positivo para Streptococcus agalactiae. Posteriormente instaurar de forma precoz un tratamiento antibiótico de amplio espectro y realizar drenaje del mismo.

Gestational diabetes in a multiethnic population of Spain: Clinical characteristics and perinatal outcomes

AimsTo compare clinical characteristics and perinatal outcomes between immigrant and Spanish women with gestational diabetes mellitus (GDM) in a multiethnic population of Barcelona and to identify factors independently associated with the development of large-for-gestational-age (LGA) infants. MethodsProspective study of women with GDM from five ethnic groups (Caucasian, South-Central Asian, Latin American, East Asian and Moroccan) at a single institution in Barcelona between 2004 and 2011. Maternal, gestational and newborn characteristics were recorded. ResultsThe cohort included 456 patients. In univariate analyses, Moroccan women had more frequently a pre-gestational body mass index (BMI)>25kg/m2 (76.4%, P=0.012), while East Asian women had lower BMI (23.41±2.79kg/m2, P<0.001), less need for insulin therapy (14.3%, P=0.013) and the highest rate of spontaneous labor (69.8%, P=0.014) and eutocic delivery (63.8%, P=0.032). Also, Latin American women had a higher rate of Cesarean section (52.9%, P<0.001) and LGA infants (28.6%, P=0.004), and their newborns had lower umbilical cord pH (7.23±0.06, P=0.005) and Apgar scores (9 [4–10], P<0.01) and a higher incidence of neonatal hypoglycemia (51.4%, P=0.045). Logistic regression analysis identified pre-gestational BMI (OR: 1.18; 95% CI: 1.09–1.27), pregnancy weight gain (OR: 1.19; 95% CI: 1.1–1.28) and insulin use during gestation (OR: 2.29; 95% CI: 1.09–4.82) as predictors of LGA infants. ConclusionsSignificant ethnic differences were found in clinical characteristics and perinatal outcomes of women with GDM. Latin American women had a higher frequency of adverse perinatal outcomes. Pregestational BMI, pregnancy weight gain and insulin use during pregnancy were independent predictors of LGA.

Psycho-Emotional Disorders in Women after Spontaneous bortion

Objective: To determine the frequency of women with spontaneous abortions that present psycho-emotional disorders. Design: Cross-sectional study using a face-to-face questionnaire. Setting: Postpartum area at a tertiary care referral hospital in Leon, Mexico. Participants: 210 postpartum women, divided into 105 women with spontaneous abortion, and 105 with eutocic deliveries (controls). Data collection: Women answered face-to-face the questionnaire Minnesota Multiphase Personality Inventory-2 (MMPI-2), applied one day after the abortion. Findings: the frequency of psycho-emotional disorders in women who presented abortion was (12.7%), which was higher compared with the controls (9.04%), P = 0.002, being significant the hysteria (6.6%), P = 0.021. Key conclusions: There is a higher frequency of psycho-emotional disorders in women who present an abortion, represented for hysteria. Implications for practice: It is recommended to supply psychological support to women who suffer a spontaneous abortion.

Evolución del porcentaje de episiotomía en un hospital comarcal entre los años 2003–2009. Factores de riesgo de los desgarros graves de periné

ObjectiveThe primary objective of this paper is to present the evolution of the episiotomy rate between the years 2003-2009, following a policy of restrictive use and its possible influence on the rate of severe lacerations and perinatal morbidity in the short term. MethodsThis is a retrospective study based on a cohort made up of women who gave birth in our hospital (9023 women). The valued parameters are: changes in the episiotomy rate, percentage of severe perineal tears according to the use of episiotomy or not. Normal vaginal deliveries versus instrumental ones and the type of instrumental delivery. Apgar score below 7 at five minutes. A multivariable logistic regression was performed in order to assess the relationship between risk factors and the incidence of severe tears. ResultsThe episiotomy rate ranged between 40.37% in 2003 and 8% in 2009, the downward trend was statistically significant. The rate of severe tears remained between 0.49% and 1.04% that change was not statistically significant. There was no significant variation in the rate of Apgar score less than 7 at 5minutes. The odds ratio (OR) of having a serious perineal tear is 2.99 (95% CI 1.47 to 6.05) in women who had an episiotomy compared with those that did not have it, the 2.40 (95% CI 1.16 to 4.99) in the instrumental delivery versus eutocic delivery and the 6.43 (95% CI 1.50 to 27.49) in forceps deliveries compared with vacuum deliveries. ConclusionsOver a period of 7 years the episiotomy rate was reduced by 80% without modifying the rate of serious perineal tears, and the short-term perinatal morbidity remained constant.

Pregnancy and Liver Transplant. Our experience

Introduction: Sexual and reproductive abnormalities are common in patients with terminal liver failure affecting up to 50% of them. However, these functions are recovered quickly after orthotopic liver transplantation (OLT). 80-90% of OLT woman in childbearing age recover menstrual few months after transplantation. The aim of our study is to analyze the impact of pregnancy in liver transplant patients at our center, as well as analyze the effect of immunosuppression on the fetus. Methods: We analyze a total of 1500 liver transplant patients from April 1986 to April 2011. Of these, 18 patients (1.2%) become pregnant during follow-up. Results: The most frequent causes of terminal liver failure in our study were: chronic parenchymal disease in 9 cases (50%), cholestatic disease in 3 cases (16.6%) fulminant hepatitis in 5 cases (27.7%) and metabolic disease in 1 case (5.5%). The average recipient age at the beginning of pregnancy was 21.2 years (±7.3). 88.8% of patients became pregnant over a year after liver trasplant. There was a total of 30 pregnancies in our study: 20 of them (66.6%) were newborn alive (NBA), 8 (26.6%) abortions and 2 (6%) fetal deaths. The most commonly immunosuppressor used during pregnancy was tacrolimus (75%) followed by cyclosporine (25%). There were no maternal deaths during pregnancy and the postpartum period. The most common maternal complications during pregnancy were: preeclampsia (15%), viral reactivation (15%), acute rejection during pregnancy (10%), infections (10%) and high blood pressure (HBP) (0.05%). The relationship between eutocic birth deliveries, assisted deliveries and caesarean were 8 (42%), 3 (16%) and 8 (42%) respectively. Six of 20 NBA (30%) were preterm deliveries, and 5 of them (25%) were attended by caesarean, rate which was significantly higher than term and post-term labor (p = 0.0498). Conclusions: We found no statistically significant differences between immunosuppression type and maternal complications, pregnancy duration and childbirth type. Although pregnancy is an important risk to take into account in liver recipients, according to the literature and our results we can conclude that get pregnant a year or more after liver transplantation is normally safe and has successful results.

A Case of Intravesical Migration of an Intrauterine Device Detected 14 Years Later

We report the case of a patient arrived because of urological symptoms characterized by terminal hematuria, strangury and dysuria due to migration into the bladder of an intrauterine contraceptive device (IUD) placed 14 years before and penetrated into the bladder with formation of lithiasis. These cases have already been described in literature, but the particular feature of this case is that the patient had been pregnant and had a eutocic delivery, she never voluntarily removed the IUD and nor was it found during a gynecologic laparoscopy. The patient underwent the surgical removal of the IUD and of the bladder stone, without detecting adjacent connective routes between uterus and bladder.

Hemorragia fetomaterna masiva con patrón cardiotocográfico sinusoidal. Presentación de un caso y revisión de la literatura

Introducción: la transfusión fetomaterna masiva (TFM) es una entidad con una elevada morbilidad y mortalidad fetal, suele cursar con una disminución en la percepción de los movimientos fetales por parte de la madre, y la presencia de un patrón cardiotocográfico sinusoidal fetal, asociado a la anemia fetal. No obstante, ambas situaciones tienen muy baja especificidad. Se presenta un caso clínico con el objetivo de revisar la exactitud del patrón sinusoidal en el diagnóstico de anemia fetal.Materiales y metodos: se presenta el caso de una gestante de 36 semanas que fue atendida en el Hospital Universitario La Paz (complejo hospitalario de tercer nivel que forma parte del conjunto de hospitales públicos en España), en la que tras presentarse un patrón cardiotocográfico no tranquilizador, se realizó una inducción del parto en el que las pruebas habituales de bienestar fetal resultaron insuficientes para el diagnóstico de sufrimiento fetal. Tras un parto eutócico se comprobó la presencia de una anemia neonatal grave, comprobándose la presencia de un gran volumen de sangre fetal en la sangre materna mediante el test de Kleihauer Betke. Se hace una revisión de los artículos publicados en los últimos 10 años en las base de datos Medline vía PubMed, en español e inglés.Conclusión: la monitorización fetal intraparto podría ser útil en el diagnóstico de la hemorragia fetomaterna masiva, aunque se deben hacer estudios más amplios para determinar la exactitud diagnóstica.

Seudoobstrucción aguda del colon posterior a parto vaginal eutócico

Acute colonic pseudo-obstruction is a poorly understood syndrome, characterized by the signs, symptoms and radiological pattern of large bowel obstruction without evidence of mechanical obstruction. We report the case of a 37-year-old pregnant woman who developed progressive abdominal distention and abdominal pain after a eutocic delivery. Plain abdominal X-ray showed a markedly dilated large bowel. Mechanical colonic obstruction was excluded with hypaque enema. Surgical exploration confirmed dilatation of the sigmoid colon with perforation. Partial colon resection was performed.

Reste-t-il une indication pour la radiopelvimétrie en cas d’utérus cicatriciel ?

To revalue the interest of X-ray pelvimetry and analyse our current management of patients with a previous caesarean delivery. Case-control retrospective study reviewing 418 case records of women with a scarred uterus: a study group of 206 parturients who delivered in 2002, when X-ray pelvimetry was the rule, compared with a control group of 212 parturients who delivered in 2007, without any X-ray pelvimetry. Outcomes of labour, influence of X-ray pelvimetry, indications of caesarean sections, rates of uterine rupture and neonatal well-being have been analysed. There was no significant difference between both groups concerning the outcomes of labour. The transverse pelvic diameter is positively correlated with an eutocic delivery and inversely correlated with the rate of caesarean section performed during labour because of obstructed labour. Measurements of the pelvis were unrelated neither to the risk of uterine rupture nor to the neonatal outcome. The risk of uterine rupture is significantly higher when an emergency caesarean section is required. Our study brings to light a complementary point of view about X-ray pelvimetry. Indeed, our results show that it could be useful in the following of a caesarean section for obstructed labour.

Diagnóstico de tuberculosis tubárica en el posparto

We present the case of a woman with fever of unknown origin, anemia and abdominal tenderness 10 days after a eutocic delivery. An ultrasound scan showed a large volume of free fluid. Surgery revealed a right tubo-ovarian abscess and abundant ascitic fluid in the abdominal cavity. Pathologic analysis demonstrated the presence of tuberculosis. Treatment was administered and maternal and neonatal outcomes were favorable. The difficulties of diagnosing tuberculosis in these patients are summarized.

Lipoprotein metabolism of pregnant women is associated with both their genetic polymorphisms and those of their newborn children

To explore whether the placenta contributes to the lipoprotein metabolism of pregnant women, we took advantage of the fact that placental proteins are encoded from the fetal genome and examined the associations between lipids of 525 pregnant women and the presence, in their newborns, of genetic polymorphisms of LPL and apolipoprotein E (APOE), two genes expressed in placenta. After adjustment for maternal polymorphisms, newborn LPL*S447X was associated with lower triglycerides (-21 +/- 9 mg/dl), lower LDL-cholesterol (LDL-C; -12 +/- 5 mg/dl), lower apoB (-14 +/- 4 mg/dl), higher HDL-C (5 +/- 2 mg/dl), and higher apoA-I (9 +/- 4 mg/dl) in their mothers; newborn LPL*N291S was associated with higher maternal triglycerides (114 +/- 31 mg/dl); and newborn APOE*E2 (compared to E3E3) was associated with higher maternal LDL-C (14 +/- 6 mg/dl) and higher maternal apoB (14 +/- 5 mg/dl). These associations (all P < 0.05) were independent of polymorphisms carried by the mothers and of lipid concentrations in newborns and were similar in amplitude to the associations between maternal polymorphisms and maternal lipids. Such findings support the active role of placental LPL and APOE in the metabolism of maternal lipoproteins and suggest that fetal genes may modulate the risk for problems related to maternal dyslipidemia (preeclampsia, pancreatitis, and future cardiovascular disease).

Gastrin levels in mothers and neonates at delivery in various perinatal conditions.

This study was designed to assess the variations of gastrin (Ga) serum levels in mothers and newborns at birth in some perinatal disorders. Ga levels were measured by RIA in maternal serum, amniotic fluid and cord sera of newborns in 55 cases with the following conditions: normal pregnancy and eutocic vaginal delivery (n = 8), repeat cesarean section (n = 10), and cardiotogographic register suggestive of fetal compromise (n = 15), cephalopelvic disproportion (n = 8), preeclampsia (n = 7) and postdate pregnancy (n = 7). Statistical analysis was performed by Mann-Whitney U test. Ga levels in cord sera of newborn and amniotic fluid in normal pregnancy and eutocic delivery were significantly higher (p < 0.02 and p < 0.01, respectively) than those found in patients with repeat cesarean operation. Serum Ga concentrations in women with postterm pregnancy were significantly higher (p < 0.02) than in women with prior cesarean section. Ga levels in amniotic fluid samples in the presence of suspected fetal compromise and postdate pregnancy were significantly higher (p < 0.001) than those observed in women who had repeat cesarean operation. Vaginal delivery and perinatal pathology may induce hypergastrinemia in both mother and neonate at birth.