Ensayo clínico controlado de la influencia del entrenamiento aeróbico en la tolerancia al ejercicio y los síntomas depresivos en primigestantes colombianas

Introduction

Depression in pregnancy affects almost 60% of pregnant women and several studies have shown that aerobic exercise can reduce depressive symptoms by increasing physical capacity. However, this effect has not been determined in pregnancy.

Objective

To evaluate the influence of aerobic training on exercise tolerance and depressive symptoms in Colombian nulliparous pregnant women.

Materiales and methods

We carried out a simple controlled trial in 80 nulliparous pregnant women, between 16 and 20 weeks of pregnancy, randomized to two groups. 1) The control group continued their usual activities, with no specific exercise regime. 2) The intervention group performed aerobic training between 50% and 65% of their maximal heart rate for 50 minutes, three times a week for 12 weeks. Exercise tolerance was assessed using the 6-minute walk test and symptoms of depression were assessed by the Center for Epidemiological Studies Depression Scale (CES-D) at baseline and immediately after the 3-month intervention.

Results

The mean age was 21 ± 3 years and gestational age was 18 ± 2 weeks. Seventy-four women completed the study. After the intervention, participants who exercised had a higher exercise tolerance, measured by the 6-minute walk test, and a greater reduction in depressive symptoms than the control group, as measured by the CES-D scale, P<.05.

Conclusions

A supervised 3-month program of primarily aerobic exercise during pregnancy reduces depressive symptoms and improves exercise tolerance. These results provide new evidence of the benefits of exercise in preventing maternal depression.     

Éxito del tratamiento de las infecciones urinarias en gestantes tratadas con cefditoren pivoxilo vs. amoxicilina

Objectives

To compare the efficacy of cefditoren pivoxil versus amoxicillin in the treatment of urinary tract infections (UTI) and to evaluate the rate of reinfection and of maternal-fetal complications in both groups.

Material and methods

We performed a cohort study in pregnant women with a diagnosis of UTI in the Vall d’Hebron Hospital from January, 2010 to June, 2010. Diagnosis, follow-up and subsequent evaluation of the mother and infant were performed in both groups.

Results

We included 300 pregnant women diagnosed with a UTI: 150 patients received oral cefditoren pivoxil (400 mg/12 hours for 5 days) and 150 women received amoxicillin. No demographic differences were observed between the two groups. Disappearance of the infection was confirmed in 150 patients in the cefditoren pivoxil group versus 67% of those in the amoxicillin group (P=.03). Both the reinfection rate and the frequency of pyelonephritis were higher in the amoxicillin group [17.3% versus 4.6% (P=.02) and 40.6% vs 2.6% (P=.01) respectively]. There were no differences in hospital stay (2.4 days vs 2.5 days). Adverse effects were observed in 1.33% (two patients) in the cefditoren pivoxil group versus 0% in the amoxicillin group.

Conclusions

In this study, cefditoren pivoxil produced a higher cure rate and a lower reinfection and pyelonephritis rate than did amoxicillin. Cefditoren pivoxil might be a therapeutic alternative in pregnant women with UTI. Further studies are needed to confirm these results.     

Epidemiología de las estrías gravídicas en España

Objective

To assess the influence of different factors on the presence of striae prior to pregnancy as well as the development of new lesions during and after pregnancy.

Subjects and methods

An observational epidemiologic study was carried out on the prevalence and incidence of striae gravidarum and stretch marks in pregnant women. Data from 519 pregnant women were registered, including obstetric history, family history of striae gravidarum, weight prior to pregnancy, skin type, Fitzpatrick skin phototype, and current use of body creams and lotions. A multivariate analysis was used to determine the factors associated with the incidence of striae gravidarum during current pregnancy.

Results

The prevalence of pre-pregnancy stretch marks was 85.5%, mainly observed in patients with a first pregnancy (OR = 2.6), body mass index ≥ 25 (OR = 2.2), and family history of striae gravidarum (OR = 2.1). The overall incidence of striae gravidarum during pregnancy was 36.8% and most of these patients had a body mass index ≥ 25 (OR = 2.2) and were younger (< 30 years old; OR = 1.9). Risk analysis of all the variables registered indicated a higher risk of striae gravidarum in women who were overweight prior to pregnancy (OR = 1.8), those aged under 30 years (OR = 2.4), and those with previous pregnancies (OR = 4.3).

Conclusions

Prevention of striae gravidarum should be recommended in all cases, with special emphasis on younger women and those who are overweight or obese due to their higher risk for the development of these marks during pregnancy.     

Hemopatías malignas en el embarazo

Objective

To analyze the incidence of hematological malignancies, their obstetric and medical management, and maternal and perinatal outcomes in pregnant women.

Subjects and methods

Medical histories were reviewed, and all cases of women diagnosed with hematologic malignancies during pregnancy from 2000 to 2005 were analyzed.

Results

We found five cases (two leukemias and three lymphomas, two of which were Hodgkin's disease), in distinct trimesters of pregnancy. The women consulted mainly because of B symptoms. Blood tests and histological data were highly variable. In all patients, complete remission was achieved after proper staging and treatment.

Conclusions

Pregnancy does not alter the development of hematological malignancies. Long-term disease-free survival is similar in both pregnant and non-pregnant women with the same disease.     

Pronóstico y resultados en pacientes diagnosticadas de endometriosis a las que se les ha realizado por primera vez una cirugía conservadora por dolor o esterilidad

Objective

To analyze clinical outcomes in patients with suspected endometriosis undergoing conservative surgery. Pain reduction, pregnancy rates, and reinterventions were analyzed.

Material and methods

Patients with suspected endometriosis and symptoms of pain or infertility undergoing conservative surgery for the first time were included (n = 128). Exclusion criteria consisted of incomplete medical histories and interventions indicated for reasons other than pain or infertility.

Results

Surgery was indicated for pain in 70.3% and for infertility in 29.7%. A total of 32.5% of the patients had pain at the first postsurgical visit, 42.5% at 6 months and 58.3% at 1 year. Reintervention was performed in 11.29%. Among reinterventions for pain, there was a higher percentage of intestinal symptoms before surgery (P=.07), as well as episodes of abdominal pain requiring hospital care (P=.08); a higher proportion of these patients had pain in the first visit (P=.05) and at 1 year (P=.03) than patients not undergoing reintervention. Postsurgical medical treatment was less frequent in patients undergoing reintervention (P=.11). Among patients undergoing surgery for infertility, pregnancy was achieved in 65.8%.

Conclusions

Pain was less frequent in the first postsurgical visit than in subsequent visits. Among patients undergoing reintervention for pain, there was a higher percentage of intestinal symptoms and episodes of abdominal pain requiring hospital care prior to the intervention. Pain at the first visit and at 1 year are factors of poor prognosis for reintervention. Patients undergoing reintervention for pain less frequently required postsurgical medical treatment. More than half of patients with interfertility and endometriosis achieved spontaneous pregnancy after surgery.     

Estudio observacional,transversal, de una muestra representativa de las mujeres españolas en edad fértil,sobre los cuidados,hábitos y promoción de la salud previamente y durante el embarazo: Estudio GESTMUJER

Objective

To identify the use of folic acid and other vitamins in Spanish women of fertile age before and during pregnancy.

Material and method

A representative survey of 1020 Spanish women aged 15 to 49 years was carried out in March 2013.

Results

Only one quarter of Spanish women planned their pregnancies and,as a result, only 28.6% of women took folic acid before becoming pregnant.

Conclusions

There is a lack of information about the role and importance of folic acid to prevent neural tube defects. Institutional campaigns are needed to promote both pregnancy planningand the use of vitamin supplements before and during pregnancy.     

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting

Objective

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings.

Methods

A prospective cross-sectional study was undertaken involving women with (n = 105) and without (n = 105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby–Bauer disk diffusion.

Results

Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P < 0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin.

Conclusion

For the first 48 hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course.     

Impacto de la edad materna avanzada en las complicaciones obstétricas y perinatales de las gestaciones gemelares

Objective

To evaluate the pregnancy and perinatal outcomes of twin gestations in women aged 35 or older.

Material and methods

We designed a retrospective cohort study. Maternal complications, mode of delivery and perinatal outcomes were compared in 229 women who delivered at age 35 or older and in 374 women who delivered at age less than 35 years. The computerized database and medical records of pregnant women attending the Miguel Servet University Hospital from January 2001 to December 2007 were retrospectively reviewed.

Results

Older women had an increased risk of conceptions after assisted reproductive techniques (p > 0.001), dichorionic pregnancies (p > 0.001) and gestational diabetes (p = 0.007; 95% CI: 1.119-3.19). There was no significant association between older maternal age and an increased incidence of preterm labor, premature rupture of membranes, fetal growth restriction, cesarean delivery or perinatal mortality.

Conclusion

Based on our data and previous studies, advanced maternal age in twin pregnancies does not seem to significantly increase obstetric complications or adverse perinatal results.     

Efecto de las hormonas sexuales sobre las concentraciones de homocisteína en preeclámpticas y embarazadas normales

Objective

To establish the effects of sexual hormones on plasma homocysteine concentrations in preeclamptic and normotensive pregnant women.

Methods

There were two groups: group A consisted of 35 preeclamptic patients and group B of 35 normotensive pregnant women used as controls. Blood samples were collected before labor in both grops and immediately after diagnosis in group A. Concentrations of testosterone, free testosterone, dehidroepiandrosterone sulphate, androstenodione, estradiol and homocysteine were measured.

Results

There were statistically significant differences in gestational age, the presence of proteinuria, birthweight and systolic and diastolic blood pressure (p < 0.05). Testosterone, free testosterone and dehidroepiandrosterone sulphate were significantly higher in group A than in group B (P<.05). Estradiol concentrations were significant lower in the group A than in group B (P<.05). Strong positive and significant correlations were found between testosterone, dehidroepiandrosterone sulphate and free testosterone and a moderate negative correlation was found between estradiol and plasma homocysteine concentrations (P<.05).

Conclusions

In preeclamptic and normotensive pregnant women, plasma homocysteine concentrations are positively affected by testosterone, dehidroepiandrosterone sulphate and free testosterone and are negatively affected by estradiol.     

Estudio de la integridad del ADN espermático en relación con la calidad seminal y los resultados del ciclo de fecundación in vitro

Objective

To establish the relationship between the degree of sperm DNA fragmentation and seminal parameters, male age and outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Subjects and methods

The sample consisted of 43 couples undergoing IVF/ICSI. The mean age of men was 35.62 ± 4.87 years and that of women was 33.88 ± 3.95 years. We prospectively analyzed sperm DNA fragmentation from each patient by the Sperm Chromatin Structure Assay (SCSA) and correlated the findings with seminal parameters (volume, concentration, progressive motility and morphology), IVF/ICSI outcomes and male age. IVF/ICSI outcome was evaluated by measuring the fertilization rate, embryo quality and the pregnancy and miscarriage rates.

Results

DNA fragmentation was negatively correlated with progressive motility (p = 0.000) of fresh and capacitated (p = 0.041) semen. Older patients had a significantly lower percentage of progressive motility in fresh seminal samples (p = 0.034) and worse sperm DNA quality (p = 0.043). There were no significant differences between the fragmentation rate and fertilization rate, embryo quality, and the pregnancy and miscarriage rates.

Conclusions

DNA fragmentation is inversely correlated with progressive motility in fresh seminal samples. DNA fragmentation does not predict the IVF/ICSI outcome but screening for sperm DNA damage may provide useful information in the diagnosis of idiopathic male infertility. Seminal quality is affected by increasing male age.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

Concentraciones de interferón gamma en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of interferon-gamma in patients with preeclampsia and healthy normotensive pregnant women.

Material And Methods

One hundred patients were selected. Fifty preeclamptic patients were selected as cases (group A) and 50 healthy pregnant women with a similar age and body mass index to patients in group A were selected as controls (group B). Blood samples for interferon-gamma determination were collected in all patients before labor and immediately after diagnosis in the study group.

Results

There were no significant differences in maternal age, gestational age or body mass index at sample collection (p=ns). Statistically significant differences were found between groups in mean values of systolic and diastolic blood pressure (p<0.05). Interferon-gamma concentrations were significantly higher in group A (75.5±27.7 pg/ml) than in group B (54.2±29.6 pg/ml, p<0.05) and there was a slight, positive and significant correlation with values of systolic blood pressure (r=0.383; p<0.05) and diastolic blood pressure (r=0.259; p<0.05).

Conclusion

Interferon-gamma concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

Resultados obstétricos en cribado combinado de las aneuploidías en el primer trimestre superior al corte con resultado de amniocentesis con cariotipo fetal normal

Introduction

To evaluate whether there are adverse pregnancy outcomes in pregnant women with a risk index above the cut-off point in first-trimester screening for fetal chromosomal abnormalities and an amniocentesis result of normal fetal karyotype in a sample of pregnant women attending our clinic at the beginning of pregnancy.

Subjects and methods

We performed a case-control study. A series of patients who underwent first-trimester combined screening as part of antenatal care between January 2009 and January 2010 were selected.

Results

Of the maternal complications registered during the pregnancy, gestational diabetes was more frequent among cases.

Conclusions

The incidence of the remaining complications analyzed (intrauterine restricted growth, preeclampsia, oligoamnios) was similar in the two groups. In most of the pregnant women, delivery occurred after 37 weeks through the vaginal route.     

¿Ingieren suficiente calcio nuestras gestantes?

Objective

To quantify calcium intake in a group of pregnant Spanish women.

Material and methods

A total of 115 pregnant women were evaluated in a prospective observational study. Dietary information was prospectively collected from pregnant women at 15 and 28 weeks’ gestation using 7-day food records. Daily calcium intake throughout pregnancy, as well as differences between rural and urban populations, were analyzed.

Results

The mean calcium intake was 930.60 ± 300.71 mg/day (range, 345-1,462) at 15 weeks’ gestation and 1,083.03 ± 330.59 mg/day (range, 274-2,150) at 28 weeks’ gestation. In 76.8% of the respondents, dietary calcium intake was below the recommended daily intake for pregnant women in Spain. No significant differences were found between early and late pregnancy or between rural and urban populations.

Conclusions

Dietary calcium intake is deficient in a high percentage of pregnant women in Spain.     

Análisis de la relación entre riesgo gestacional y ansiedad materna

Objective

To evaluate levels of maternal anxiety in third trimester pregnancies according to pregnancy risk, classified as low, medium and high-risk/very high-risk.

Patients and methods

We performed an observational, analytical and cross-sectional study of anxiety levels in 174 pregnant women followed-up in our hospital. Levels of both state anxiety and trait anxiety were evaluated in the three groups of pregnant women.

Results

Of the 174 participants in the study, 98 (56.3%) had low risk pregnancies, 40 showed medium risk (23%) and 36 (20.7%) had high risk or very high risk pregnancies. We obtained a mean of 32.8 points for state anxiety and of 27.3 points for trait anxiety. Mean anxiety levels scores were 44.1 points in the high/very high risk group, 33 points in the medium risk group, and 28.5 points in the low risk group, with statistically significant differences (P = .0001 for the high risk group and P = .038 for the medium risk pregnancies). A significant correlation was found between trait anxiety and state anxiety (P = .0001). Statistically significant differences were observed in anxiety related to the number of children (P = .0001).

Conclusions

In pregnant women, anxiety levels were higher than average levels in the general population. Anxiety levels increased in accordance with greater risk in the pregnancy. The greater the number of children the mother already had the lower her anxiety level.     

Campaña de lucha contra el cáncer de cuello uterino en Guinea-Bissau. Estudio de las citologías de un trimestre

Objective

To study 300 cytologies from a single trimester, within a campaign against uterine cervical cancer in Guinea-Bissau.

Design

We compared 300 cytologies from Guinea-Bissau with 880 cytologies performed in a single month in autochthonous women attending our hospital for vaginal infections and cervical lesions.

Results

Significant differences between women in Guinea-Bissau and autochthonous women were found in Trichomonal infection (2% versus 0,34%, respectively; P < .001) and in low-grade squamous intraepithelial lesions (2% versus 0,68%, respectively; P = .05). One case of cervical cancer was detected in a 75-year-old multiparous woman. The mean number of deceased children in these women was 2 (range 1-8).

Conclusions

To avoid both cervical cancer and neonatal mortality, a permanent program for the early detection of cervical cancer in Guinea-Bissau is clearly needed, together with family planning, prenatal care and obstetric assistance.     

Adecuación de la profilaxis antibiótica en el parto por cesárea

Objective

To evaluate compliance with a protocol for antibiotic prophylaxis in cesarean sections and its influence on the incidence of surgical wound infection.

Patients and methods

A prospective cohort study was carried out to assess compliance with our antibiotic prophylaxis protocol. Percentages of compliance and the cumulative incidence of infection were calculated. The effect of compliance with the protocol for antibiotic prophylaxis on surgical wound infection was estimated with the relative risk.

Results

We included 680 patients. Overall compliance with the protocol was 95.7%. The most frequent cause of lack of compliance was the time of administration (96.6%). The cumulative incidence of infection was 2.5% and there was no association between compliance with the protocol and the infection rate (RR = 4.5; 95% CI: 0.55-38.4; P>.05).

Conclusions

Compliance with the protocol for antibiotic prophylaxis was high. The cumulative incidence of surgical wound infection was low and was unrelated to antibiotic prophylaxis.     

Concentraciones de gonadotropina coriónica humana en pacientes preeclámpticas y embarazadas normotensas sanas

Objective

To compare chorionic gonadotrophin concentrations in preeclamptic and healthy normotensive pregnant women.

Subjects and methods

One hundred patients were selected. Fifty preeclamptic patients were selected as cases (group A) and 50 healthy pregnant women with a similar age and body mass index to patients in group A were selected as controls (group B). Blood samples for chorionic gonadotrophin determination were collected in all patients before labor and immediately after diagnosis in the study group.

Results

There were no significant differences in maternal age, gestational age or body mass index at sample collection (P=NS). Statistically significant differences in chorionic gonadotrophin concentrations were found between patients in group A (47.661+/- 18.124 mUI/mL) and patients in group B (27.459 +/- 13.329 mUI/mL; P<.05). There was a moderate, positive and significant correlation with values of systolic blood pressure (r = 0.493; P<.05) and values of diastolic blood pressure (r = 0.504; P<05).

Conclusions

Chorionic gonadotrophin concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

Anticoagulación en gestantes portadoras de prótesis mecánicas

Objective

To study distinct anticoagulation regimens in pregnant women with prosthetic heart valves.

Subjects and methods

We performed a systematic review of the literature to determine the required levels of anticoagulation prophylaxis, timing of the introduction of oral anticoagulation and its substitution by heparins, and the maternal and fetal risks associated with different anticoagulation regimens.

Results

A target international normalized ratio (INR) of 2.5-3.5 should be achieved. Although consensus on the heparin of choice is lacking, heparin dose requirements should be based on anti-factor Xa levels (around 1.0 U/mL) or activated partial thromboplastin time (aPTT) (2-3 times control value). The risk of thrombosis in heparin-treated patients is approximately 7%, while the incidence of heparin embryopathy ranges from 1.6-7.4%. The switch from oral anticoagulation to heparin should be made no later than at weeks 35-36 of pregnancy.

Conclusions

The nticoagulation therapy of choice in the first trimester of pregnancy cannot currently be established. Prospective and randomized studies are required to determine the advisability of one treatment over the other