The Effect of Early Oxytocin Augmentation

Antimicrobial Prophylaxis for Cesarean

EXPOSICION EMBARAZO ECTOPICO DRA QUISPE

EMBARAZO ECTOPICO mr3 patricia.ppt

A PROPOSITO DE LA EXPOSICION

Pemphigoid Gestationis: Early Onset and Blister Formation Are Associated with Adverse Pregnancy Outcomes

C-C. Chi; S-H. Wang; R. Charles-Holmes; C. Ambros-Rudolph; J. Powell; R. Jenkins; M. Black; F. Wojnarowska

• Abstract and Introduction
• Patients and Methods
• Results
• Discussion

Abstract and Introduction

Abstract

Background: It is unclear whether clinical features of pemphigoid gestationis (PG), such as timing of onset and severity, may affect pregnancy outcomes or whether the adverse outcomes in pregnancies complicated by PG are related to or worsened by systemic corticosteroid treatment.
Objectives: To evaluate the associations of adverse pregnancy outcomes with clinical features, autoantibody titre of PG, and systemic corticosteroid treatment.
Methods: We conducted a retrospective cohort study recruiting 61 pregnancies complicated by PG from the St John's Institute of Dermatology database which enrolled cases from dermatologists across the U.K., and two tertiary hospitals in the U.K. and Taiwan. Outcome measures included gestational age at delivery, preterm birth, birthweight, low birthweight (LBW, i.e. birthweight < 2500 g), small-for-gestational-age (i.e. birthweight below the 10th percentile for gestational age), fetal loss, congenital malformation, and mode of delivery.
Results: After controlling for maternal age and comorbidity, decreased gestational age at delivery was significantly associated with presence of blisters (P = 0.017) and disease onset in the second trimester (P = 0.001). Reduced birthweight was significantly associated with disease onset in the first and second trimesters (P = 0.030 and 0.018, respectively) as was also LBW [adjusted odds ratio (95% confidence interval) 13.71 (1.22-154.59) and 10.76 (1.05-110.65), respectively]. No significant associations of adverse pregnancy outcomes with autoantibody titre or systemic corticosteroid treatment were found.
Conclusions: Onset of PG in the first or second trimester and presence of blisters may lead to adverse pregnancy outcomes including decreased gestational age at delivery, preterm birth, and LBW children. Such pregnancies should be considered high risk and appropriate obstetric care should be provided. Systemic corticosteroid treatment, in contrast, does not substantially affect pregnancy outcomes, and its use for PG in pregnant women is justified.

Introduction

Pemphigoid gestationis (PG) is a rare autoimmune dermatosis that occurs in 1 : 50 000 pregnancies.^[1] PG is characterized by an intensely pruritic eruption of erythematous papules, plaques and blisters. The lesions frequently appear first in the periumbilical area before spreading to other parts of the torso and limbs. PG often occurs in the second and third trimesters of gestation, but can also begin in the postpartum period.^[1] The diagnosis of PG can be confirmed by direct immunofluorescence showing linear deposition of complement (C3) and occasionally IgG along the basement membrane zone (BMZ).^[1] A circulating IgG1 autoantibody (PG factor) against the BMZ may also be found by indirect immunofluorescence.^[2] A significant increase in adverse pregnancy outcomes including preterm birth and small-for-gestational-age, and a reduction in birthweight have been found in pregnancies complicated by PG.^[3-5]

Systemic corticosteroid treatment (usually starting at 30-40 mg prednisolone per day) is required to control PG in a third to a half of affected women.^[2,4,5] However, compared with the unexposed controls, a higher rate of adverse pregnancy outcomes such as preterm birth and miscarriage as well as a decrease in gestational age at delivery and birthweight has been demonstrated in pregnant women receiving systemic corticosteroid treatment for allergy, asthma, inflammatory bowel disease or other indications.^[6,7] To date, it has been unclear whether clinical features of PG, such as timing of onset and severity, may affect pregnancy outcomes or whether the adverse outcomes in pregnancies complicated by PG are related to or worsened by systemic corticosteroid treatment.

The objective of this study was to evaluate the associations of adverse pregnancy outcomes with clinical features of PG (including trimester of onset, extensive involvement, and presence of blisters), PG autoantibody titre, and systemic corticosteroid treatment.

GRACIAS HYPOCRATES

CREACIONES-GRATUITAS

CREACIONES-PA

GRACIAS AL AEEM CLAVES DE LAS REVISTAS

Esta sección de la página está dedicada a brindar acceso a las principales bases de datos y revistas más prestigiosas que abarcan los temas de Medicina y ramas afines. Cualquier sugerencia sobre algún recurso que crean que sea de utilidad es bien recibida.

AccessMedicine



ACP Medicine



Acta Médica Costarricense
Registro Gratuito


BMJ
rah//rah


Chest
ottawa//chest


eMedicine
5456


Harrison en Español
uvalencia//medicine


HINARI


InformaWorld
torrey1//admin1


IngentaConnect
mscpchn:shr//zhongkang
malayamys:shr//pantai
bidstgri//ibsst7


JAMA
sutter/library


MDConsult
Enlace directo (dar click en open generic account)



New England Journal of Medicine
ninowilson//ab920ef6
feralta//123456


OVID

Enlace directo
Enlace directo


Oxford Journals
countess /// postgradlibrary


Sage Publisher
uitmlib2//welcome


SpringerLink
etx557nw//xky696an
_;4 [Q1 ktp836te//tjf373uz

permite ingresar múltiples usuarios simultaneamente


UpToDate

Sindrome de Ovario Poliquístico (SOP)

Este sindrome (conjunto de signos y síntomas) es cada día más frecuente entre la población femenina en edad reproductiva; aunque fue descrito hace muchos años, fue en 1985 cuando su diagnóstico ecográfico llegó a ser aceptado.
En 2003 se establecieron los criterios diagnósticos: 1) Disfunción menstrual, que consiste en menstruaciones irregulares, esporádicas o ausentes debido a la falta de ovulación. 2) Signos de hiperandrogenismo. Los andrógenos son las hormonas masculinas (así como los estrógenos son las femeninas). Todas las mujeres tenemos ambos tipos de hormonas, sin embargo en esta patología existe un desequilibrio por lo que hay un exceso de hormonas masculinas originando signos como hirsutismo, que es la presencia excesiva de vellos en diversas áreas del cuerpo como en el rostro, región pública, brazos etc. , también es común el acné. 3) Ovarios de apariencia ecográfica poliquística (ver foto).
Ahora bien, sabiendo esto, ¿qué implicaciones puede traer este Sindrome y cuáles son sus manifestaciones? La mayoría de las pacientes con SOP presentan infertilidad debido a que no ovulan por el desequilibrio hormonal, recordemos que el ovocito maduro debe salir del ovario para ser fecundado (esto es ovulación); también podemos encontrar con mucha frecuencia resistencia a la insulina (esta hormona es muy importante para el metabolismo de los carbohidratos), es decir, los órganos no responden a la acción de esta hormona y por eso es que las pacientes pueden presentar niveles de glucosa altos como si fueran diabéticas; también es sumamente común la obesidad, aumentando el riesgo de enfermedades cardiovasculares y de Diabetes Mellitus tipo 2.
Y, ¿cúal es el tratamiento? En vista de que este sindrome consiste en tantas alteraciones, es comprensible que el tratamiento incluya múltiples medicamentos y recomendaciones, también es necesario saber si la paciente tiene deseos de fertilidad o no. Si existe obesidad y/o alteración de la insulina es necesaria la ayuda de un nutricionista y de medicamentos que regulen la alteración del metabolismo de los carbohidratos. Si hay hirsutismo se puede indicar algún antiandrogénico (algunos anticonceptivos tienen esta propiedad) y por supuesto es necesario realizar ejercicio diario para mejorar todos estos síntomas y disminuir el riesgo de patología cardiovascular. En conclusión, aunque es una patología difícil de tratar, es posible llegar a encontrar un equilibrio hormonal y también es posible lograr la concepción, pero por supuesto los medicamentos no son milagrosos, es necesaria la perseverancia y el buen control por parte del médico y de la paciente.
Si sospechas que tienes SOP acude al ginecólogo, con una ecografía pélvica y exámenes de sangre es posible llegar al diagnóstico.

News

Swine Flu public information

Your help required! We are surveying UK Fellows and Members on their understanding of the use of the flu vaccine during pregnancy. Please take a few minutes to complete this survey.

BJOG release: New study on the

cause of early preterm birth

An exploratory study to be published in BJOG: An International Journal of Obstetrics and Gynaecology, has shown that women going into early preterm labour (before 34 weeks gestation) have low-levels of progesterone in their saliva as early as 24 weeks, and that moreover, these levels fail to rise during pregnancy in the normal way. This offers the possibility of developing a simple, non-invasive test to identify women at increased risk of delivering early.

TOG release: A call for awareness on pregnancy, abortion and domestic violence

A new paper to be published in The Obstetrician & Gynaecologist (TOG) examines the relationship between abortion and domestic violence. The authors call for greater awareness about domestic violence, and underline the need to support women seeking to terminate unwanted pregnancies associated with intimate partner violence.

Libro del mes

Clinical Obstetrics and Gynaecology (2nd edition)

£35.39
£32.39 (10% discount) to all Online Bookshop customers

Bookshop

VER ESTO IMPORTANTE ACOG

http://acog-buenosaires-section.org/bas/

LIBROS IMPORTANTES DE LA ESPECIALIDAD

ME4012 Obstetricia

• Rang's and Dale's Pharmacology (6ta ed) Parte única
• Obstetrics: Normal and Problem Pregnancies (Gabbe) Parte única
• Handbook of Obstetrics and Ginecology (Benson's & Pernoll) Parte única
• Clinical Obstetrics: The fetus and the Mother Parte única
• Practical Obstetrics and Ginecology for the General Practitioner Parte única
• Obstetrics (Williams, 22 ed) Parte única
• Dewhurst's Textbook of Obstetrics and Ginecology Parte única
• Danfort's Obstetrics and Ginecology Parte única
• Current Diagnosis and Treatment in Obstetrics and Ginecology Parte única