The value of serial cervical length measurements for the prediction of threatened preterm labour

Objectives

To assess the predictive performance of cervical length measurement at presentation and 24 h later in women with symptoms of preterm labour.

Study design

Cervical length was measured transvaginally at presentation and 24 hours later in 122 women presenting with threatened preterm labour between 23 and 33 + 6 gestational weeks.

Results

Six women delivered within 1 week of presentation. The sensitivity and specificity of a cervical length <15 mm at admission for delivery within one week was 83.3 and 95.8%, respectively. A reduction of >20% in cervical length 24 h after admission predicted 50% of preterm deliveries within 1 week, with a specificity of 92.7%; in combination with cervical length at presentation it did not improve the prediction. The same was observed for birth before 32 weeks (N = 9) and birth before 35 weeks (N = 15).

Conclusions

Women with threatened preterm labour and a cervical length of <15 mm at presentation are at high risk of delivering preterm. Cervical change in the following 24 hours does not seem to improve the prediction.     

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino

Objective

To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound.

Material and methods

We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n = 112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits.

Results

Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group.

Conclusions

Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient.     

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.     

Velocimetría Doppler del flujo sanguíneo de la arteria uterina y riesgo de muerte perinatal en preeclámpsicas

Objective

To determine the association between Doppler velocimetry values of uterine artery blood flow with the risk of perinatal death in preeclamptic patients.

Materials and method

We selected 80 patients with a diagnosis of preeclampsia. Preeclamptic patients were divided into those with perinatal deaths and those without. The variables analyzed were the pulsatility index, the resistance index, and the systolic/diastolic flow ratio of the uterine arteries.

Results

There were no differences in maternal age, height or weight between preeclamptic patients with or without perinatal deaths (p = ns), or between gestational age at the time of Doppler ultrasound and systolic and diastolic blood pressure (p = ns). The pulsatility index (1.206 ± 0.140) and resistance index (0.684 ± 0.098) of the uterine arteries were significantly higher in women with perinatal deaths than in those without (1.113 ± 0.109 and 0.605 ± 0.116, respectively; P<.05). No significant differences were found in mean values of the systolic/diastolic flow ratio of the uterine arteries (p = ns).

Conclusion

A high value of the pulsatility index and resistance index of the uterine arteries on Doppler velocimetry in preeclamptic patients is associated with an increased risk of perinatal death.     

Concentraciones del factor de necrosis tumoral alfa en preeclámpticas y embarazadas normotensas sanas

Objective

To compare tumor necrosis factor-alpha concentrations 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 tumor necrosis factor-alpha 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). Significant differences were found in tumor necrosis factor-alpha concentrations in group A (9.7±4.6 pg/ml) and patients in group B (5.5±1.6 pg/ml; p < 0.05), and a moderate, positive and significant correlation was found with mean systolic (r=0.433; p < 0.05) and diastolic (r=0.412; p < 0.05) blood pressure.

Conclusions

Tumor necrosis factor-alpha concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

Factores etiopatogénicos de la prematuridad en el hospital universitario Sant Joan de Déu de Barcelona

Objective

To determine the rate of preterm births in 2010 at the Sant Joan de Déu University Hospital in Barcelona, and classify them according to the main cause by using a mapping algorithm to establish the main etiological causes of preterm birth.

Subjects and methods

All preterm births at less than 37 weeks’ gestation occurring in the Sant Joan de Déu University Hospital in 2010 (n = 396) were reviewed and assigned to a group according to their primary etiology.

Results

The preterm birth rate was 9.8%. Inflammatory causes accounted for 36% of all preterm births followed by idiopathic causes (29%). In preterm deliveries of multiple gestations, inflammatory causes accounted for 44%.

Conclusions

Inflammatory causes are the main etiology of preterm births and are more common in multiple gestations.     

Ensayo clínico aleatorizado para evaluar la efectividad de dos vías de administración de hierro,oral e intravenosa,en el tratamiento de la anemia ferropénica posparto

Objective

To compare the effect of treatment with oral and intravenous iron in postpartum iron deficiency anemia.

Material and method

Thirteen women with hemoglobin values of 7-10 g/dl and ferritin values of < 15 microgram/l at 24 h postdelivery were randomized in two groups: one group received intravenous iron (two doses of 200 mg ferrous sucrose) on days 2 and 4 after labor and the other group received standard treatment with oral ferrous sulphate 200 mg twice daily for 6 weeks.

Results

By day 7, ferritin levels were significantly higher (p = 0.002) in the group treated with intravenous iron (298.3 ± 159,1 μg/l) than in that treated with oral iron (21.3 ± 9.4 μg/l). By day 14, differences between these two groups were also detected (123.7 ± 65.1 μg/l in the intravenous iron group and 24.6 ± 9.3 μg/l in the oral iron group, p = 0.004). Hemoglobin and hematocrit levels increased in both groups on days 7, 14 and 42 with no statistically significant differences. Adverse effects were detected in the oral iron group only (29%, n = 2), although all were mild.

Conclusions

Intravenous iron could be an alternative in the treatment of postpartum iron deficiency anemia, especially in patients who are unable to tolerate or who reject oral formulations.     

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.     

Ejercicio físico y los resultados del embarazo

Introduction

The beneficial effects of physical exercise on health in general are well known. However, less is known about the effects of exercise on the highly important process of pregnancy. The greatest uncertainty concerns whether both processes —exercise and pregnancy— can coexist, without maternal-fetal conflicts and without altering pregnancy outcome. Currently, an increasing number of women wish to continue some form of exercise during pregnancy.

Objective

To determine the influence of moderate aerobic exercise in the second and third trimesters of pregnancy on pregnancy outcome.

Material and method

We performed a randomized, controlled, open trial in 142 pregnant women. There were 72 women in the treatment group and 70 on the control group. The maternal variables studied were gestational age, weight gain, oral glucose load (O'Sullivan's test), type of delivery, hemoglobin level before delivery, and mean blood pressure during the course of pregnancy. The fetal variables studied were birth weight, length, head circumference, Apgar test at 1 and 5 min, and umbilical cord pH value.

Results

No statistically significant differences were found between the two groups (p < 0.05). However, in the treatment group (exercise), mean (± SD) maternal weight gain (11.4 ± 3.7 kg) and birth weight (3165.3 ± 431.8 g) were lower than in the control group (12.3 ± 3.3 kg and 3307.4 ± 474.2 g).

Conclusion

Moderate aerobic exercise during the second and third trimesters of pregnancy seems not to alter pregnancy outcomes.     

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.     

Efectos de un programa de ejercicio físico supervisado sobre la estructura cardiaca durante la gestación. Ensayo clínico aleatorizado

Objective

To analyze the safety of aerobic exercise for the cardiovascular system in pregnant women, and to assess improvement in the cardiovascular system.

Subjects and methods

A randomized clinical trial was designed. Data collection was performed at weeks 20 and 34 of gestation. At week 20, 45 women were studied in the exercise (EG), of which 35 completed the study. There were 14 pregnant women in the control group (CG) in week 20, of which nine completed the study.

Results

At week 20 there were improvements in body mass index (EG: 25.1.±.4.3/CG: 27.9 ± 4.5) (P=.04), and in systolic blood pressure (EG: 104.7 ± 10.9/CG: 112 .5 ± 11.3) (P=.02). In the CG there was concentric hypertrophy (N = 2; 14.3%). At week 34, the EG had a higher stroke volume (EG: 52.33 ± 10.42/GC: 43.69 ± 9.48) (P=.03).

Conclusion

Aerobic exercise during pregnancy is safe for the cardiovascular system and even improves some parameters.     

Influencia de la edad y de las técnicas de reproducción asistida en nuestros resultados obstétricos y perinatales

Objective

To evaluate the influence of age ≥ 40 years and ART in our obstetric and perinatal outcomes.

Material and methods

Retrospective study of 14805 singleton pregnancies in our Institute from January 1, 2000 to December 31, 2006. We compared obstetric and perinatal outcome between: Age group: women ≥ 40 years (N = 557) vs. group of women < 40 years (N = 14248); ART group < 40 years: ART pregnancies (N = 1150) vs. spontaneous pregnancies (N = 13098); ART group ≥ 40 years: ART pregnancies (N = 126) vs. spontaneous pregnancies (N = 431).Results: Age ≥ 40 years is significantly associated with preterm birth under 34 weeks (odds ratio [OR] = 2.148 [1.237-3.730]), gestational diabetes (OR = 2.25 [1.799-2.815]), placenta previa (OR = 3.346 [1.516-7.386]), caesarean delivery (OR = 1.831 [1.539-2.177]), and peripartum hysterectomy (OR = 6.414 [1.359-2.177]). In the ART group < 40 years assisted conception (ART) is significantly associated with preterm birth under 37 (OR = 1.67 [1.337-2.088]) and 34 weeks (OR = 1.8 [1.162-2.822]), with gestational diabetes (OR = 1.5 [1.273-1.844]), pre-eclampsia (OR = 2.1 [1.456-3.164]), placenta previa (OR = 5.29 [2.973-9.437]), choriamniotic infection (OR = 3.8 [1.029-14.072]), caesarean delivery (OR = 1.5 [1.346-1.737]) and low birth weight ≤ 2500 g. (OR = 1.67 [1.329-2.114]) and ≤ 1500 g. (OR = 2.44 [1.442-4.135]). In the ART group ≥ 40 years we only find a significantly increased rate of caesarean delivery (OR = 1.76 [1.183-2.635]) in ART group vs. spontaneous pregnancy group.

Conclusions

Age ≥ 40 years increases the risk of adverse obstetric outcome. ART increase the risk of adverse obstetric and perinatal outcome in the group < 40 years, but not in the group of women aged 40 years and older, probably due to the small size of the sample.     

Concentraciones de interleucina-15 en preeclámpticas y embarazadas normotensas sanas

Objective

To compare interleukin-15 concentrations 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 50 normotensive pregnant women with a similar age and body mass index to the study group were selected as controls (group B). Blood samples were collected before labor in all patients and immediately after diagnosis in group B to determine interleukin-15 concentrations.

Results

There were no significant differences in maternal age, gestational age or body mass index at sample extraction (p = ns). Interleukin-15 concentrations were significantly higher in patients in the study group (group A; 3.21 ± 0.79 pg/ml) than in those in the control group (group B; 2.26 ± 0.24 pg/ml; p < 0.05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = 0.584; p < 0.05) and diastolic blood pressure values (r = 0.589; p < 0.05).

Conclusions

Interleukin-15 concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

Efectos del butil bromuro de hioscina-oxitocina u oxitocina intravenosos en la duración del parto de embarazos a término

Objective

To compare the effects of intravenous hyoscine butylbromide-oxytocin or oxytocin on the duration of labor in term pregnancies.

Method

Ninety patients were selected and randomly assigned to receive intravenous hyoscine butylbromide-oxytocin (n = 45) or intravenous oxytocin (n = 45). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1 hour after drug administration and the interval between the onset of labor and delivery.

Results

There were no significant differences between the two groups in maternal age, gestational age, or Bishop score at drug administration (p = ns). No significant differences were observed in the duration of the first, second or third phases of labor between the two groups (p = ns). No significant differences were found between the groups in Apgar scores at 1 and 5 minutes (p = ns). No maternal adverse effects were observed or reported due to the use of hyoscine-butylbromide or oxytocin.

Conclusion

The effect of hyoscine butylbromide-oxytocin on the duration of labour in term pregnancies is similar to that of oxytocin. The drug does not alter Apgar score or produce maternal adverse effects.     

Concentraciones de quimiocina RANTES en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of chemokine RANTES in pre-eclampsia patients and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. We included 50 pre-eclamptic patients as cases (group A) and a control group of 50 healthy normotensive women with the same age and body mass index as the study group (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine RANTES concentrations.

Results

There were no significant differences in maternal age, gestational age, or body mass index when the samples were taken (P = ns). RANTES concentrations showed statistically significant differences between cases (group A; 2484.6 ± 113.7 pg/mL) and controls (group B; 2002.8 ± 62.6 pg/mL; P < .05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = .283; P < .05) and with diastolic blood pressure values (r = .322; P < .05).

Conclusions

Chemokine RANTES concentrations were significantly higher in pre-eclampsic patients than in healthy normotensive pregnant women.     

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.     

Proteína C reactiva y homocisteína en menopáusicas tratadas con tibolona

Objective

To determine modifications in C-reactive protein and homocysteine in postmenopausal women who used tibolone.

Materials and methods

We selected a sample of 45 postmenopausal women treated with a 2.5-mg dose of tibolone daily for 6 months. Serum concentrations of C-reactive protein and homocysteine were measured.

Results

C-reactive protein concentrations were significantly increased after 6 months of treatment (0.51 ± 0.29 mg/dl at baseline compared with 0.95 ± 0.34 mg/dl after treatment; P<.05). Homocysteine concentrations were significantly reduced after 6 months of treatment (10.16 ± 1.45 picomol/L) compared with initial values (10.95 ± 1.87 picomol/L; P<.05).

Conclusions

After 6 months of use, tibolone significantly increased C-reactive protein concentrations and reduced homocysteine concentrations.     

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.     

Concentraciones de interleucina-6 en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of interleukin-6 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 interleukin-6 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). No significant differences were found in interleukin-6 concentrations in the group A (31.4±3.5 pg/ml) and patients in group B (25.2±5.7 pg/ml; p<0.05), but a moderate, positive and significant correlation was found with mean systolic (r=0.489; p<0.05) and diastolic (r=0.518; p<0.05) blood pressure.

Conclusions

Interleukin-6 concentrations were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

The use of cervical length and change in cervical length for prediction of spontaneous preterm birth in asymptomatic twin pregnancies

Objective

To assess the association between cervical length (CL) and change of CL over two measurements and preterm birth (PTB) at <32 weeks in asymptomatic twin pregnancies.

Study design

This study was undertaken in the multiple pregnancy antenatal clinic at the Security Forces Hospital (SFH), a tertiary care hospital in Riyadh, Saudi Arabia, between November 2005 and October 2010. This study involved 420 women with asymptomatic twin gestations, but only 209 unselected patients completed the study and met the inclusion criteria. All patients had a CL measurement by transvaginal ultrasound at 20–23 weeks, and a second CL measurement was done within 3–5 weeks of the initial measurement. Patients were classified into two groups, group A with significant shortening of CL, and group B without significant shortening of CL. Comparisons between the groups were performed using a chi-square test or a Fisher exact test for categorical variables, whereas Student's t-test or Wilcoxon's rank-sum test was used for continuous variables. We employed ROC curves to compare the diagnostic accuracy of actual cervical length and percent change in cervical length in predicting preterm birth events. All analyses were performed using the SAS/STAT software.

Results

There were 35 (16.7%) patients whose CL shortened by ≥25% (group A), and 174 (83.3%) whose CLs either did not shorten or shortened by <25% (group B). Preterm birth at <28, <30, <32, and <34 weeks gestation was higher in group A than in group B even if the CL was >25 mm. The use of CL shortening was superior, but not statistically significantly, to the use of CL for the prediction of PTB at <32 (P = 0.0524) and <34 weeks (P = 0.281), but CL was preferred for the prediction of PTB at <28 (P = 0.037) and <30 weeks (P = 0.0457).

Conclusion

The test of two CL measurements, the first between 20 and 23 weeks gestation and another CL measurement 3–5 weeks later, with a difference of ≥25%, is a good predictor for preterm birth in asymptomatic twin pregnancies, even if the CL is >25 mm.