Aníbal Nieto

Lack of benefits of left tilt in emergent cesarean sections: A randomized study of cardiotocography, cord acid-base status and other parameters of the mother and the fetus

OBJECTIVE To assess the benefits of performing the cesarean section in lateral tilt during active labor. SETTING University Hospital. PATIENTS 204 unselected women undergoing cesarean section (21.1% fetal distress, 45.6% cephalo-pelvic disproportion, 26.0% induction failure, 7.4% abnormal presentation) under general (86.8%) or spinal anesthesia (13.2%). DESIGN Randomized study. INTERVENTION During anesthesia induction and cesarean section 103 women were in partial left lateralization (20 degrees), whereas the remaining 101 remained in the supine position. MAIN OUTCOME MEASURES Internal cardiotocography during cesarean section. Umbilical artery acid-base analysis. Newborn evaluation. Maternal hemodynamic parameters. RESULTS Fetal heart rate during cesarean section was similar in both groups, except for a baseline heart rate which was slightly higher in the lateral tilt group (137.5 +/- 19.2 vs 131.1 +/- 20). The umbilical artery pH values, as well as pCO2, base deficit, CO3H and oxygen saturation were similar in both groups. The pO2 value was significantly lower in the lateral tilt group (14.03 +/- 6.04 Hg mm vs 16.02 +/- 7.65). Newborn evaluation was similar in both groups. The blood pressure and heart rate of the mother during the cesarean section were also similar in both groups. CONCLUSIONS No benefits were found in performing cesarean section in left lateral tilt.

Intrauterine growth retardation and plasma fatty acids in the mother and the fetus

BACKGROUND Assessing the relationship between plasma fatty acids, specially polyunsaturated fatty acids in the mother and the fetus and intrauterine growth retardation (IUGR) in an apparently well-nourished population. DESIGN Case-control intrapartum analysis. SETTING Academic tertiary hospital. PATIENTS, PARTICIPANTS There were 17 IUGR newborn cases (23 mothers) and 34 newborn control cases (46 mothers). MAIN OUTCOME MEASURE Eleven fatty acids were blindly analysed in plasma by means of gas chromatography. RESULTS Percentage values of eicosapentaenoic acid among mothers from the IUGR group were significantly higher than controls, whereas stearic absolute values were significantly reduced. On the other hand there were no differences in percentage values nor in absolute values regarding the 11 fatty acids analysed in newborn infants. CONCLUSION In an apparently well-nourished population IUGR is not associated with an alteration in plasma fatty acids on the fetal side. However, on the maternal side some imbalance in eicosapentaenoic and stearic acids were found which will require further study.

Multivariate analysis of determinants of fetal growth retardation

OBJECTIVE To analyse the relative effect of the risk factors related to fetal growth retardation (FGR) in the central area of Spain. STUDY DESIGN This is a case-control survey of 370 full-term gestations. Of the 370 women, 185 were diagnosed with intrauterine growth retardation, and 185 were in the normal group. All came from a central region of Spain. We took into account 25 possible risk factors. RESULTS In the FGR group we found 12 risk factors with statistical significance in the univariate analysis (tobacco, drugs, low pre-pregnancy weight, low maternal height, little gestational weight gain, excessive physical activity during pregnancy, low socioeconomic status, low educational level, unmarried, urinary infection, mothers haematological changes, and previous infertility). After the multiple logistic regression analysis, five factors were shown to exist as independent risks (tobacco: OR, 23.50; 95% CI, 3.01-183.18; P < 0.01; low pre-pregnancy weight: OR, 4.01; 95% CI, 2.14-7.51; P < 0.001; low socioeconomic status: OR, 2.91; 95% CI, 1.72-4.90; P < 0.001; little gestational weight gain: OR, 2.52; 95% CI, 1.21-5.22; P < 0.05; and urinary infection: OR, 3.83; 95% CI, 1.49-9.87; P < 0.01). CONCLUSIONS (i) Tobacco, low pre-pregnancy weight and low socioeconomic status are the three main cause-effect factors of relative importance in our sanitary zone for FGR. (ii) Disproportionate FGR is related more to older mothers and maternal previous illness than to the proportionate FRG.

Increased tissue concentrations of arachidonic acid in umbilical artery and placenta in fetal growth retardation

Objective. To compare the fatty acid phospholipid composition of the umbilical artery and the placenta in cases of fetal growth retardation (FGR) and of normal growth, as well as in symmetric and asymmetric FGR.

Intrauterine growth retardation: fluctuation of fetal pH measured between beginning and at the completion of labor

UNLABELLED The aim of this study was to evaluate the fluctuation of fetal pH in blood samples taken at the beginning of labor and at the moment of birth as related to intrauterine growth retardation syndrome. This is a prospective follow-up of term gestations, of which 41 were diagnosed as intrauterine growth retardation (IUGR) and 61 as normal ones. pH was measured in scalp blood sample at the beginning of the labor and in umbilical artery right after birth in both groups respectively. The rate of decrease of pH value in relation to duration of labor was determined for each case. Our results are: 1) Lower baseline pH were found in the IUGR group (pH 7.32 vs 7.34, p < 0.01), lower arterial blood pH at birth/.23 +/- 0.08 vs 7.27 +/- 0.08, p < 0.05). 2) Faster decrease of the pH during the labor (0.019 unit/hour vs 0.012, p < 0.05) as related to IUGR. CONCLUSION IUGR fetuses are more acidotic at the beginning of the labor, and the rate of decrease of the fetal pH per unit of time during the labor is faster at least in a theoretical situation nevertheless it will require more studies if any practical applications are thought of.

Fetal cardiotocography and acid-base status during cesarean section

OBJECTIVE To assess the fetal well-being during cesarean section, in relation to the previous fetal condition. DESIGN Observational study. SETTING University Hospital. PATIENTS PARTICIPANTS: 204 women undergoing cesarean section (203 intrapartum cesarean sections): 177 with general anesthesia and 27 with spinal anesthesia. MATERIAL AND METHODS We compared the fetal heart records of the last 30 min before cesarean section (during the first stage of labor) with those during cesarean section. Scalp blood analysis 30 min before the beginning of anesthesia induction was compared with umbilical artery analysis at delivery. MAIN OUTCOME MEASURES Cardiotocography. Acid-base analysis. Apgar scores. RESULTS During cesarean section there was a reduction in uterine activity, an increase in silent tracings and a decrease in late decelerations. Umbilical artery pH was lower than scalp pH (7.23+/-0.06 vs 7.30+/-0.06). Oxygen saturation was also lower (14.43+/-8.58% vs 18.99+/-8.4%). The values of pCO2 and of base deficit were higher. During cesarean section low values of modified Fischer scores were associated with low pH values of umbilical artery and low Apgar scores. CONCLUSION Silent tracings appearing during cesarean section usually do not indicate fetal distress. Poor intracesarean fetal heart tracings were associated with worse indicators of neonatal well-being. Although umbilical pH were lower than scalp values, when the correction described in the literature was applied, the difference was of little clinical relevance. It is concluded that anesthesic, pharmacological and surgical events have slight repercussion in fetal well being. However, in a few cases fetal heart monitoring during cesarean section could detect otherwise undiagnosed cases of transient acidemia or depression in the fetus.

Evaluation of gestrinone after surgery in treatment of endometriosis.

OBJECTIVE The clinical and histological efficacy of gestrinone in the treatment of endometriosis was evaluated. METHODS A prospective study was performed with longitudinal follow-up of 4 years duration (minimum) for each patient. Twenty-five cases of endometriosis were treated with gestrinone (as a drug of choice or associated with other local surgical treatment) during 6 months. RESULTS The total or partial response to pain was induced with treatment in 19 of the 20 cases (95%), and posttreatment pregnancies were induced in 3 of the 9 cases of infertility (33.3%). The global clinical efficacy was as follows: none (n = 5, 20%), poor (n = 2, 8%), moderate (n = 2, 8%), good (n = 3, 12%) and excellent (n = 13, 52%). The pretreatment American Fertility Society score was 23.1 +/- 3.8 points (2-58) and that after treatment (re-examination) 7.8 +/- 3.7 points (0-52), p < 0.01. Global histological efficacy (n = 17) results were as follows: none (23.6%), poor (0%), moderate (5.8%), good (35.3%) and excellent (35.3%). CONCLUSIONS Gestrinone is presented as a drug with an efficacy comparable to other pharmacological agents currently available in the medical treatment of endometriosis. Adequate posology and acceptable effectiveness were also observed.