Ernesto Fabre

Perinatal mortality in twin pregnancy: An analysis of birth weight-specific mortality rates and adjusted mortality rates for birth weight distributions

The objective of this study is to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of twin and single births. It is based on a survey which was carried out in 22 Hospital Centers in Spain in 1980, and covered 1,956 twins born and 110,734 singletons born. The FMR in twins was 36.3/1000 and 8.8/1000 for singletons. The ENMR in twins was 36.1/1000 and 5.7/1000 for singletons. The PMR in twins was 71.1/1000 and 14.4/1000 for singletons. When birthweight-specific PMR in twin and singletons births are compared, there were no differences between the rates for groups 500-999 g and 1000-1499 g. For birthweight groups of 1500-1999 g (124.4 vs 283.8/1000) and 2000-2999 g (29.6 vs 73.2/1000) the rates for twins were about twice lower than those for single births. The PMR for 2500 g and over birthweight was about twice higher in twins than in singletons (12.5 vs 5.5/1000). After we adjusted for birthweight there was a difference in the FMR (12.6 vs 9.8/1000) and the PMR (19.1 vs 16.0/1000, and no difference in the ENMR between twins and singletons (5.9 vs 6.4/1000), indicating that most of the differences among crude rates are due to differences in distribution of birthweight.

Efecto del ácido levofolínico sobre las concentraciones de homocisteína plasmática en la mujer joven y sana en la consulta preconcepcional

Fundamento El aumento de la homocisteina plasmatica total (tHcy) es un factor de riesgo para los defectos del tubo neural. Se estudia el efecto de la suplementacion con acido levofolinico (l,5-formil-tetrahidrofolico) sobre los valores de la tHCy plasmatica en la mujer en edad reproductiva. Pacientes y metodo Treinta mujeres sanas de 18 a 35 anos recibieron 5 mg/dia de acido levofolinico por via oral durante 30 dias. La tHcy y los folatos intraeritrocitarios se determinaron antes de la suplementacion (dia 0), los dias 2, 5, 10 y 30 durante el tratamiento, y 30 (dia 60) y 60 dias (dia 90) despues de finalizado. La tHcy plasmatica se determino por inmunoanalisis de polarizacion de fluorescencia (coeficiente de variacion [CV] intraanalisis e interanalisis Resultados La tHCy plasmatica disminuye a partir del segundo dia de tratamiento (dia 0 frente a 2: media de la diferencia, –1,24 μmol/l; intervalo de confianza [IC] del 95%, –0,84 a –1,63; p Conclusiones El acido levofolinico provoca un descenso temprano, intenso y persistente de las concentraciones de tHcy plasmatica.

Perinatal mortality in term and post-term births.

Our aim was to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of post-term and term births, 2) to examine trends in the incidence and perinatal mortality rates of post-term and term births. We used data from Spanish Perinatal Mortality Survey of 1980, 1986, 1989 and 1992. The data include 40,863 post-term births (42 weeks and over) and 517,060 term births (37-41 weeks). Perinatal mortality rates of post-term and term births were compared. The incidence of post-term births was 7.3%. The relative risk (RR) of FMR for post-term compared to term births was 1.1 (95% confidence interval [CI] 0.9-1.3), of ENMR was 1.6 (95% CI 1.4-2.0) and of PMR was 1.3 (95% CI 1.1-1.5). From 1980 to 1992 there was a significant reduction in the incidence of post-term births (8.1% vs 5.0%), in the FMR (4.5/1000 vs 1.9/1000), ENMR (4.3/1000 vs 2.0/1000) and PMR (8.7/1000 vs 3.9/1000) of post-term births. There was no significant difference in the FMR between post-term and term in each year studied. Post-term births had a significantly higher ENMR and PMR than term births in 1980, and they were equivalent from 1983 to 1992. The incidence of post-term births, its FMR, ENMR and PMR have been significantly reduced during the whole period studied.

Use of Drugs in Pulmonary Medicine in Pregnant Women

Lung diseases that are frequently seen in young people, such as bronchial asthma, pneumonia, and tuberculosis, occur with comparable prevalence in pregnant women. Their treatments do not greatly differ from those used in the nonpregnant state. However, pharmacokinetics of these drugs undergo changesduetothephysiologicvariationsinducedbypregnancythatwemust consider. On the other hand, some drugs used for lung disease have a teratogenic potential and thus carry a risk for the fetus. In this article, we review the drugs most commonly used for the treatment of respiratory diseases in pregnancy and lactation and discuss the current data of their possible effects on the fetus and neonate. Asthma is the most common potentially serious medical disease complicating pregnancy and should be treated as aggressively in pregnant women as in nonpregnant women, because the perceivedrisktothefetuscausedbypharmacologic therapyismuchlessthan theriskofuncontrolledasthmaandtheresultinghypoxia.Antepartumpneumonia and tuberculosis require prompt evaluation and empiric antimicrobial therapy. The clinician must choose antimicrobial agents considering efficacy as well as safety for both mother and fetus. Among the agents for antithrombotic therapy, heparin is the anticoagulant of choice during pregnancy. Data on the use of low molecular weight heparins are encouraging, but clinical experience with these agents is still limited. Oral anticoagulant therapy should be avoided because of its teratogenic potential and increased risk of fetal complications, and the use of thrombolytic agents must be limited to life-threatening situations.

Effect of folates (levofolinic acid) treatment on homocysteine plasma levels in a group of healthy young women distributed by C677T genotypes of the MTHFR polymorphism

Objectives: The aim of the study was to investigate the Bcl-2 and Bax expression in endometriotic and adenomyotic tissues. Study Methods: 56 tissue samples were collected during gynecological surgery and confirmed by histology to have 25 endometriosis and 31 adenomyosis. The Bcl-2 and Bax expression were investigated by immunochemical staining and electron microscopy. Results: The difference of Bcl-2 positive protein between endometriosis and adenomyosis was not significant. No significant difference was found between Bcl-2 expression and the proliferative and secretory phase of the cycle in women with endometriosis. The difference of Bax positive protein between endometriosis and adenomyosis was not significant. In addition, no significant differences were found between the various phases of the cycle. We have found strong inverse correlation between the expression of Bcl-2 and Bax in endometriosis than in adenomyosis. Conclusion: Our results suggest that the pathogenesis of ovaria endometriosis is different from this of adenomyosis and the persistent Bcl-2 and Bax expression during both phases of the cycle in ovarian endometriotic tissues may have important implications for the survival and proliferation of the ectopic endometrial tissue.