Pregnant Women In Labor Research Articles

Role of bacterial vaginosis in preterm labor - a prospective study

Objective: To study the incidence of bacterial vaginosis in pregnant women in preterm labor and in labor at term and the relation of bacterial vaginosis with preterm delivery, neonatal birth weight and puerperal sepsis. Material and Methods: This prospective case control study included 150 pregnant women. 100 pregnant women with singleton pregnancy between 28 to 36 weeks of pregnancy with preterm labor pains were selected randomly in study group and 50 pregnant women in labor at term ( >37 weeks) were enrolled in control group. Diagnosis of bacterial vaginosis was made by clinical criteria (Amsel’s criteria). The two groups were compared in regard to the presence of bacterial vaginosis. Pregnancy outcome variables assessed included gestational age at delivery, neonatal birth weight and puerperal sepsis. Results: In study group 38% women, while in the control group 16% women had bacterial vaginosis. This difference is statistically highly significant. ( p < .001). Out of 30 women with bacterial vaginosis in study group, 27 (90%) women delivered before 37 completed weeks, while only 10% delivered at term. Bacterial vaginosis was associated with low birth weight and was significantly associated with puerperal sepsis. Conclusion: Bacterial vaginosis in pregnancy is associated with adverse pregnancy outcomes including preterm labor, preterm delivery, low birth weight and puerperal sepsis. Thus screening for bacterial vaginosis in all pregnant women complaining of vaginal discharge and also in all patients with preterm labour is justifiable.

Hydrogen Sulfide Delays LPS-Induced Preterm Birth in Mice via Anti-Inflammatory Pathways.

A major cause of preterm labor in pregnant women is intra-amniotic infection, which is mediated by an inflammatory process. Hydrogen sulfide (H2S), a gaseous transmitter, has been implicated to be involved in inflammatory responses. We sought to investigate whether H2S affects infectious preterm birth using the mouse model of lipopolysaccharides (LPS)-induced preterm birth. Administration of LPS at 0.4 mg/kg with two injections intraperitoneally (i.p.) on gestational day 14.5 induced preterm labor. LPS significantly increased leukocyte infiltration in uterus, stimulated the expression of pro-inflammatory cytokines interleukin 1β (IL-1β), IL-6, tumor necrosis factor α (TNF-α), CCL2 and CXCL15 in myometrium. Administration of NaHS (i.p.) delayed the onset of labor induced by LPS in a dose-dependent manner. NaHS prevented leukocyte infiltration into intrauterine tissues and inhibited the production of pro-inflammatory cytokines in myometrium and decreased the levels of these cytokines in maternal circulation. H2S also decreased LPS-activated extracellular signal-regulated kinase (ERK) 1/2/ nuclear factor (NF)-κB signaling pathways in myometrium. This study provides new in vivo evidence for the roles of H2S in attenuating inflammation, and a potential novel therapeutic strategy for infection-related preterm labor.

Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.

ObjectivesTo compare the clinical effectiveness and cost‐effectiveness of labour induction methods.MethodsWe conducted a systematic review of randomised trials comparing interventions for third‐trimester labour induction (search date: March 2014). Network meta‐analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision‐tree model from a UK NHS perspective and calculated incremental cost‐effectiveness ratios, expected costs, utilities and net benefit, and cost‐effectiveness acceptability curves.Main resultsIn all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low‐dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra‐amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost‐effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low‐dose) misoprostol showed the highest probability of being most cost‐effective.ConclusionsFuture trials should be designed and powered to detect a method that is more cost‐effective than low‐dose titrated oral misoprostol.Tweetable abstractNew study ranks methods to induce labour in pregnant women on effectiveness and cost.

Lean Hospital; The Kanban System at Kemang Medical Care; An Improvement Approach for Reducing Lost Customer of Delivery Birth

Introduction – Kanban system is a card system that becomes markers. During its development, the kanban system experiences a number of variations. In the context of delivery system in hospital, delivery pack can be considered as a kanban. Delivery packs have complete data of patient information. They serve to monitor pregnant women in labor, childbirth, and the implementation of exclusive breastfeeding. By looking at the delivery packs, the doctor or midwife can determine the condition of mothers who give birth. Each card is stored in a pack in accordance with the estimated labor. This way, the doctor, midwife and mother can know the condition of pregnancy from time to time, including the danger signs of pregnancy and the risk of complications. the study sought to examine the performance of the delivery packs in customer retention in RSIA Kemang/Kemang Medical Care. Method – Researchers examined data on the number of patients maternity (SC and normal deliveries) in accordance with the estimated delivery using document analysis and report of medical record and audit results of kanban (delivery packs). The research sample was acquired in 6 (six) months from January to June 2015. The analysis was done by descriptive analytical design.Result – This study shows that the highest number of patients who gave birth happened in June 2015. In that month, there were 105 births, 19 of them did not have delivery packs. Even so, there were 96 patients who had delivery packs. It means that there are 10 patients with obstructed labor that did not have delivery records in the KMC. The evidence by the percentage of retention failures that goes up and down in the range of 6%-17%. There is failed retention as much as 11% every month. It means that in year 2015 and probably the year 2016, there are approximately 11% of patients KMC who do not want to give birth at the hospital, despite having the complete data of delivery packs.Discussion – The reasons which cause static retention may vary. They do not have to because of the low quality of services at KMC. They can be caused by KMC location which is far away from the patient when the patient is about to give birth. Indeed, KMC still have to improve the quality of service because if the consumer retention is seen as an indicator of quality of service. Conclusion - The use of delivery packs as a measuring tool of consumer retention shows the alternative benefits of kanban on hospital quality management system. This article gives examples of its use in hospitals KMC in Jakarta.

Oxidative stress during spontaneous vaginal delivery: comparison between maternal and neonatal oxidative status

Introduction: Spontaneous vaginal delivery inflicts a change in the redox status of the mother and the neonate. Hypoxia followed by reperfusion during powerful labour contractions causes increased generation of free radicals affecting the maternal oxidative status. The difference that exists between the extra uterine and intra uterine environment in the partial pressures of oxygen can induce free radical formation which affects the antioxidant mechanism of the neonate during vaginal delivery. The present study was aimed at quantifying the changes with respect to oxidative stress that occurs in uncomplicated laborin both the mother and newborn. Method: 20 singlet on term pregnant women in labour without any complications, delivered by spontaneous vaginal delivery were included in our study. Estimation of plasma MDA (Malondialdehyde) as a marker of lipid peroxidation and antioxidants like SOD (Superoxide dismutase), Total reduced Glutathione (GSH), and Glutathione Peroxidase (GPX) in hemolysate were performed using spectrophotometric method from cord blood and women in labour respectively. Result: The results showed significantly elevated plasma MDA in cord blood compared to maternal plasma MDA, before (P<0.001) and after delivery (P<0.001). Statistically significant higher GSH levels in the cord blood was observed compared to maternal GSH levels both before (P <0.05) and after delivery (P< 0.05). Maternal GPX level was significantly elevated when compared to cord (P< 0.05). However, SOD levels did not show any significant change. Conclusion: Vaginal delivery predisposes the neonate to increased oxidative stress when compared to maternal system which is reflected as an alteration in their antioxidant levels.

Resultados maternos y perinatales de la analgesia del parto

Objetivos: Determinar los resultados maternos y perinatales de la analgesia de parto. Diseño: Estudio observacional, descriptivo, de casos y controles. Institución: Servicio de Ginecología y Obstetricia, Hospital Docente Madre Niño San Bartolomé, Lima, Perú. Participantes: Gestantes en trabajo de parto. Métodos: Se revisó los datos de 400 gestantes (grupo I=controles; grupo II=casos), atendidas en el periodo septiembre a diciembre de 2013. Principales medidas de resultados: Resultados maternos y perinatales. Resultados: La media de edad en el grupo de casos fue 24,2+/-3,5 años, el peso fue 72,3+/-3,7 kg y la edad gestacional 38,6+/-1,2 semanas. A los 30 minutos, el nivel de dolor descendió significativamente (p &lt; 0,01) en el grupo de los casos, manteniéndose este descenso hasta el final de la dilatación. La dilatación completa para el grupo control se alcanzó a los 233 ± 28,7 minutos y a los 200,9 ± 29,5 minutos para el grupo de los casos, con una diferencia menor estadísticamente significativa. La duración del expulsivo para el grupo control fue 23,3 ± 5,3 minutos comparado con los casos de 27,5 ± 3,7, con una diferencia mayor estadísticamente significativa para el último grupo. Conclusiones: La analgesia de parto con bupivacaína–fentanil resultó un método eficaz para el alivio del dolor del parto cuando fue administrada en trabajo de parto bien establecido (dilatación 4 cm), acortando la duración de manera significativa y no interfiriendo con el reflejo de pujar. Aunque la duración del expulsivo fue significativamente mayor, no tuvo implicancia con la obtención de recién nacidos en buenas condiciones ni aumentó de manera significativa los partos instrumentados y las cesáreas.

The effects of acupressure on labor pains during child birth: randomized clinical trial.

ABSTRACTObjective: to analyze the effects of acupressure on the sanyinjiao point for pregnant women in labor at public maternity wards. Method: single-blind controlled clinical trial, randomly done employing a pragmatic profile. We selected 156 pregnant women in their ≥ 37 week/s, who had cervical dilations of ≥ 4 cm and with two or more contractions in 10 minutes. The pregnant women were randomly divided into three groups at a university hospital in the suburbs of Sao Paulo, Brazil, in order to receive either acupressure treatment, a placebo or participate as part of a control group. The acupressure was applied on the sanyinjiao point during the contractions for 20 minutes. Then the intensity of the pain was evaluated using the Visual Analogue Scale (VAS). Results: The averages for the pain measured using the VAS were not different for the three groups that were a part of the study (p-value=0.0929), however they were less in the acupressure groups immediately after receiving the treatment (p-value=<0.0001). This was also the case where the treatment lasted for 1 hour (p-value=0.0001). This was the case in comparison with placebo and control groups. Conclusion: the use of acupressure on the sanyinjiao point is a useful way to alleviate pain in a non-invasive manner. It can improve the quality of care given to pregnant women in labor. Register: RBR-9mhs8r.

Committee Opinion No 652

The U.S. Food and Drug Administration advises against the use of magnesium sulfate injections for more than 5-7 days to stop preterm labor in pregnant women. Based on this, the drug classification was changed from Category A to Category D, and the labeling was changed to include this new warning information. However, the U.S. Food and Drug Administration's change in classification addresses an unindicated and nonstandard use of magnesium sulfate in obstetric care. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine continue to support the short-term (usually less than 48 hours) use of magnesium sulfate in obstetric care for appropriate conditions and for appropriate durations of treatment, which includes the prevention and treatment of seizures in women with preeclampsia or eclampsia, fetal neuroprotection before anticipated early preterm (less than 32 weeks of gestation) delivery, and short-term prolongation of pregnancy (up to 48 hours) to allow for the administration of antenatal corticosteroids in pregnant women who are at risk of preterm delivery within 7 days.

Arnold-Chiari type I malformation with cervical syringomyelia in a pregnant woman in labor: case report and review of the literature

Arnold-Chiari type I malformation with cervical syringomyelia in a pregnant woman in labor: case report and review of the literature

Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries.

Gross examination of the placenta may provide useful insight into the aetiology of newborn and maternal complications. A review of literature revealed only a few epidemiological studies that determined the relationships between placental abnormalities, gestational age and occurrence of adverse outcome in babies of healthy pregnant women in our region. A prospective cross-sectional study was conducted at the Department of Obstetrics and Gynecology of University of Ilorin Teaching Hospital, between 1 st February and August 2013. Pregnant women in labour at ≥28 weeks' gestational age with singleton pregnancies were recruited. Gross examination of the placenta and umbilical cord after delivery were performed. Four hundred and twenty-eight singleton deliveries were studied. The average placental weight was 580.8 ± 130.6 g (range = 125-1500 g). The mean values of the umbilical cord length and width were 52.7 ± 10.5 cm and 1.96 ± 1.11 cm, respectively. Placental abnormalities occurred in 1.2%. The umbilical cord was centrally inserted in 290 (67.8%), marginally in 31% of cases. There was significant but weak positive correlation between the placental weight, birth weight and gestational age at 40 weeks (P ≤ 0.001, r = 0.356). Placental weight was directly related to birth weight (P < 0.0001, r = 0.244) and greater in babies with congenital abnormalities (P = 0.002). There was an association between placental parameters and foetal outcome at birth. Placental weight was positively correlated with birth weight, gestational age and occurrence of congenital abnormalities.

Vaginal colonization by group B streptococcus among pregnant women in the region of Marrakech

IntroductionLe streptocoque du groupe B est le principal agent impliqué dans les infections materno-fœtales, les septicémies et les méningites du nouveau-né à terme. L'objectif est de déterminer le taux de portage maternel du streptocoque du groupe B (SGB) à terme.MéthodesUn prélèvement vaginal a été réalisé de manière prospective chez 275 parturientes lors de l'entrée en salle d'accouchement sur une période de 06 mois.RésultatsLe taux de portage était de 20,2%. Le portage était variable en fonction de l’âge gestationnel, il constitue 57.5% entre 37 et 38 semaines d'aménorrhée. Aucun des facteurs de risque n'a était statistiquement prédictif du portage maternel du SGB.ConclusionLe dépistage doit être réalisé à partir de 37 semaines d'aménorrhée, et comme le portage est intermittent, un prélèvement négatif ne garantirait pas que le portage soit négatif à l'accouchement.

Correlation of Vitamin D and Body Mass Index in Term Normotensive and Pre -Eclamptic Women

INTRODUCTION: Obesity is associated with alteration in the vitamin D levels and has been related to vitamin D status. Lower vitamin D levels in higher BMI individuals may be secondary to an alteration in tissue distribution resulting from an increase in adipose mass. Therefore women with higher BMI need higher vitamin D supplementation as compared to women with BMI within normal range. &#x0D; MATERIAL AND METHOD: This was a case control study carried out in Department of Obstetrics and Gynaecology, ESIC-PGIMSR, New Delhi from August 2012-April 2014. A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated term normotensive pregnant women in labour while the study group comprised of term preeclamptic women in labour.In all the patients their BMI was analysed .Blood samples for vitamin D, serum calcium, serum phosphorus, serum parathormone, serum alkaline phosphatase levels were drawn and subsequently their levels were evaluated in cord blood; correlation studied between vitamin D &amp; BMI.&#x0D; RESULTS: The mean BMI was relatively higher in the study group (26.34 ± 4.12)kg/m2 than in the control group ( 24.24 ± 3.13)kg/m2. Thus in our study a prevalence of higher BMI was seen in patients of preeclampsia. When all the 100 women are being considered, median vitamin D levels were found to be higher (6.6ng/ml) in normal BMI patients (n=55) as compared to levels (5.6ng/ml) in patients with higher BMI(n=45).&#x0D; CONCLUSION: Vitamin D levels are related to maternal body mass index. Individuals with higher percentage body fat may require higher vitamin D intake to attain optimal 25(OH) D levels, compared with lean individuals and thereby may prevent pregnancy complications like Pre eclampsia.

Hemoglobina en recién nacidos por parto vaginal según clampaje precoz o tardío del cordón umbilical, a 2700 metros sobre el nivel del mar

Diversos estudios han demostrado que un clampaje tardío del cordón umbilical aumenta los niveles de hemoglobina de los recién nacidos. Objetivos: Evaluar si el clampaje tardío del cordón umbilical en neonatos a término muestra mayores valores de hemoglobina que cuando se realiza clampaje precoz, a 2700 msnm. Diseño: Investigación prospectiva, aleatorizada y doble ciego. Institución: Departamento de GinecoObstetricia, Hospital Regional de Cajamarca, Perú. Participantes: Recién nacidos y sus madres. Métodos: En enero de 2014, a 100 gestantes en trabajo de parto con gestación única, a término y sin otros factores de riesgo, se asignó al azar clampaje tardío (cuando dejó de latir el cordón umbilical 1 a 3 minutos) o clampaje precoz (alrededor de 10 segundos después del parto). Se midió el tiempo desde que aparecieron los hombros del bebé. Se procedió a sacar una muestra de sangre del talón derecho del recién nacido en 2 capilares y a las 6 horas de vida, y se analizó la hemoglobina, el hematocrito y grupo y factor Rh. Principales medidas de resultados: Nivel de hemoglobina. Resultados: Encontramos 91% de gestantes sin anemia y 9% con anemia; el grupo sanguíneo materno predominante fue el O+ en 86%. Se practicó clampaje tardío a 52 recién nacidos y clampaje precoz a 48. El 94% de los recién nacidos pesó entre 2 501 y 3 999 g, con Ápgar &gt;7 en el 100%. El tiempo en que dejó de latir el cordón umbilical fue 2,67+-0,28 minutos. En 100% de los neonatos con clampaje temprano el valor de la hemoglobina fue &lt;15 mg/dL y en el clampaje tardío el 71,1% presentó hemoglobina de 15,1 a 20,1 mg/dL, y 28,9% más de 20,1 mg/dL. No hubo diferencia significativa en los valores de hemoglobina de los recién nacidos sí la madre presentó o no anemia. Conclusiones: El clampaje tardío mostró mejores valores de hemoglobina en los neonatos. El tiempo medio en que dejó de latir el cordón fue 2,67 min y la anemia materna no influyó en la hemoglobina neonatal.

The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process.

The present research study was conducted with the objective of determining the effect of uterine and nipple stimulation on induction with oxytocin and the birth process. A randomized controlled experiment was conducted at the maternity ward of a state hospital located in the province of Sivas in Turkey. Three hundred ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to three groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. Statistical analyses were performed through the use of SPSS 14.0 software and included analysis of variance, Tukey's test, Dunnett's test, Tamhane's T2 test, and chi-square test. The study established statistically significant differences (p < .05) among the groups in terms of the average durations of the first, second and third phases of the action of birth, the status concerning delivery by C-section and the application of labor induction. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section. Nipple and uterine stimulation reduce the frequency of elective labor induction, the rate of relevant complications, and support normal vaginal birth by providing endogenous labor induction. Therefore, these interventions should be considered for pregnant women in labor.

Maternal and perinatal outcome in pregnancy with severe anaemia

Anemia is the most preventable cause of maternal and perinatal mortality and morbidity. This study was carried out to evaluate the maternal and perinatal outcome in pregnancy with severe anaemia. This hospitalized based study was carried out in randomly selected 260 pregnant women in labour . Patient were divided into Group – A ( Haemoglobin <7.0gm/dl , n=130 women ) and Group – B (Haemoglobin ≥ 11 gm/dl , n=130 women ) . Their maternal and perinatal outcome , mode of delivery , duration of labour and postpartum complications were noted and analyzed . The maternal and perinatal complications were 31% significantly more in Group – A than in Group – B , Preterm labour (42.31% v/s 15.38% ) , Preeclampsia ( 22.31% v/s 3.08% ) , Sepsis ( 10% v/s 0% ) , CHF (6.15% v/s 0% ) , Low birth weight (47.69% v/s 14.62% ) , Still birth (4.62% v/s 0% ) , IUGR (11.54% v/s 2.31% ) , Birth Asphxia ( 12.31% v/s 0% ) and Admission in NICU (43.08 % v/s 12.31% ) . There was no significant difference in maternal mortality and early neonatal death among both groups. Severe anaemia was associated with significantly more maternal and perinatal complications which mandates screening for nutritional deficiency anaemia in pregnant women and also to treat those cases to improve maternal and perinatal outcome .

Sufrimiento fetal y reanimación intrauterina; "Hasta el mejor de los tratamientos falla cuando se generaliza su uso sin un criterio adecuado y científico"

El sufrimiento fetal agudo es un grave problema que se presenta en aproximadamente el 15% de las gestantes en trabajo de parto, produciendo una mortalidad perinatal elevada o lesiones neurológicas irreversibles si no se actúa a tiempo. Es por ello que las gestantes en peligro de desarrollar insuficiencia úteroplacentaria o portadoras de enfermedades crónicodegenerativas que alteren su homeostasis, deben ser vigiladas cercanamente para buscar signos de posible deterioro del producto. Uno de los cambios más impresionantes en obstetricia ha sido el empleo de parámetros biofísicos y bioquímicos en la valoración del bienestar fetal, lo que ha permitido identificar a los productos de riesgo y orientar el tratamiento, lográndose así disminuir los problemas perinatales. El empleo del monitoreo electrónico fetal permite evaluar el estado del producto de riesgo en el periodo prenatal a través de una prueba de contracción, así como en el intraparto, ya que en la mayor parte de los casos, la actividad uterina es el factor desencadenante del sufrimiento fetal, al sumarse a las otras causas o factores predisponentes.

Un nuevo antiespasmódico en obstetricia: La asociación floroglucinol-trimetoxibenceno

Se han estudiado 150 pacientes en el Hospital Maternidad de Lima para apreciar clínicamente las variaciones del dolor con la asociación floroglucinol trimetoxibenceno, durante el parto y el puerperio. Se utilizaron las dosis de 120 mg. de floroglucinol y 40 mg. de trimetoxibenceno por vía oral en 75 pacientes con puerperio inmediato, 24 y 48 horas después y la vía endovenosa en 75 gestantes en trabajo de parto con la dosis de 40 mg. de floroglucinol y 40 mg. de trimetoxibenceno. Los resultados han sido: Disminución del dolor en el 66 % dentro de las primeras 24 horas para las pacientes que tomaron la droga inmediatamente después del parto, desapareciendo totalmente a las 48 horas del tratamiento En las pacientes con 24 horas de puerperio el dolor disminuyó en el 86 %, siendo total su efecto a las 48 horas y en las pacientes con 48 horas de puerperio la mejoría total se observó a las 24 horas. En las gestantes en trabajo de parto, el dolor disminuyó ostensiblemente en el 70 %. El 30 % restante no experimentó ninguna mejoría pese a que se aplicó una segunda dosis, sin ningún resultado positivo. Se pudo apreciar que después de aplicar la droga, la dilatación y el descenso de la presentación se realizó en tiempo menor que el previsto, en el 80%.

Uso de cuararizantes en la atención del parto

Se presenta la experiencia del autor con el uso de "Curare" en gestantes en trabajo de parto en el curso de 30 años. El autor indica que la ventaja del uso del curare durante la inducción de la anestesia está en que se puede administrar fácilmente una anestesia ligera poor inhalación en una paciente bien sedada, pudiéndose efectuar cualquier procedimiento quirúrgico obstétrico, incluyendo la aplicación del fórceps medio, en condiciones óptimas.

Circulating microparticles in umbilical cord blood in normal pregnancy and pregnancy with preeclampsia

Placenta microthrombi being one of the prevalent recurrent histological findings in women with preeclampsia (PE), it is reasonable to think that the study of coagulation alterations in cord blood could be more informative than that observed in maternal blood. The aim of the present study was to measure different subtypes of microparticles (MP) plasma levels in the maternal peripheral blood at labour and in the venous cord blood of pregnant women with PE compared to those in a group of women without PE. Thirty-two pregnant women in labour, 16 with and 16 without PE, were enrolled. Blood samples were collected immediately after delivery from cord blood and from maternal peripheral blood. Total, cellular-derived and tissue factor- bearing MP were analyzed using flow-cytometry. Procoagulant activity of MP was assessed using the STA® Procoag PPL assay. Total MP, platelet activated-derived (P-Selectin+), leukocyte-derived and TF+MP were higher in pregnancies complicated by PE as compared with normotensive women (p<0.05). Platelet-derived MP (CD61+) levels were lower in PE than in healthy women and no difference was found in endothelial-derived MP levels between the two groups. The PPL clotting time was significantly shorter in PE compared with controls. When only venous cord blood was analysed, all MP detected were significantly higher in PE than in healthy normotensive women (p<0.05). MP are very likely involved in the hypercoagulable and pro-inflammatory intravascular reactions during PE. Prospective studies in a larger population are needed to define the clinical meaning of MP measurement in the PE setting.

MISOPROSTOL VS OXITOCINA EN LA INDUCCIÓN DEL PARTO EN LA RUPTURA PREMATURA DE MEMBRANAS

OBJETIVO: Evaluar las características y complicaciones del trabajo de parto inducido con misoprostol intravaginal versus oxitocina endovenosa, en gestantes a término con ruptura prematura de membranas (RPM) sin evidencia de trabajo de parto espontáneo. DISEÑO: Estudio retrospectivo, descriptivo y comparativo. LUGAR: Servicio de Obstetricia del Hospital Loayza. MATERAIL Y MÉTODOS: Se revisó las historias clínicas de 92 gestantes a término con RPM, en condiciones para ser inducidas. Se evaluó los efectos de la oxitocina endovenosa en 49 pacientes (grupo 1], según protocolo, versus misoprostol intravaginal en 43 pacientes (grupo2), u dosis de 50 mg cada 4 horas hasta conseguir una dinámica uterina adecuada o alcanzar 300 mg. RESULTADOS: La inducción fue más exitosa en el grupo de misoprostol (74,4%) en comparación a oxitocina (61,2%), pero sin significación estadística (p= 0,18). El intervalo desde el inicio de la inducción hasta el parto fue significativamente menor en multíparas y con empleo de oxitocina (426,1 ± 208,4 min) que con misoprostol (621,9 ± 267,7) (p&lt;0,001). No hubo diferencia significativa en el tipo de parto, signos de sufrimiento fetal, distocia funicular y otras complicaciones en el parto y posparto. CONCLUSIONES: El misoprostol por vía intravaginal es una alternativa efectiva en la inducción del trabajo de parto en gestantes a término con RPM; en nuestro estudio no incrementó la tasa de cesáreas y las complicaciones maternas y neonatales fueron similares.