Objective: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM).Study design: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals.Inclusion criteria: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery.Results: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA(1c)) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude.Conclusions: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

En una encuesta realizada por la Sección de Medicina Perinatal de la SEGO, se ha podido comprobar que durante el año 2006, la tasa de episiotomías en los partos eutócicos fue del 54,08% y en los partos instrumentales del 92,62%.

El embarazo implantado sobre la cicatriz de una cesárea anterior constituye la localización más infrecuente de los embarazos ectópicos y, posiblemente, es una de las más peligrosas por el riesgo de rotura uterina y hemorragia que comporta. Se trata de una entidad rara, con pocos casos publicados en la bibliografía mundial y en la que el diagnóstico diferencial puede llegar a ser muy dificultoso. La incertidumbre en los criterios diagnósticos y en su pronóstico hace que no exista hoy un consenso aceptado sobre cuál es la mejor opción terapéutica.

Cesarean section scar pregnancy is the rarest of ectopic pregnancy locations. It is a dangerous condition because of the risk of uterine rupture and excessive hemorrhage. The diagnostic criteria and prognosis are uncertain. The differential diagnosis can be difficult and there is no consensus on which treatment is preferred. However, the interest on this pathology is increasing and there is a recently publication with a 18 cases. We report a case of a woman with previous cesarean section who was previously false diagnosed of complete abortion. The diagnosis of pregnancy implanted into a cesarean section scar was made based on ultrasonographic criteria: the uterine cavity appeared empty and an image compatible with trophoblast tissue was located between the bladder and the anterior uterine wall. An increased peritrophoblastic blood supply was demonstrated by Doppler examination showing high velocity and low resistance flow. An MRI confirmed the diagnosis. The patient was treated successfully with intramuscular methotrexate and the follow-up was performed with ultrasound examination and monitoring b-HCG levels. New studies confirm that cesarean section scar pregnancies are more common than previously thought. The prognosis appears to be much better when the diagnosis is made in the first trimester.

El síndrome de transfusión feto-fetal (STFF) es una complicación que se presenta en un 10-15% de las gestaciones gemelares monocoriales biamnióticas. Es una afección exclusiva de este tipo de gemelaridad y se caracteriza por la presencia de anastomosis arteriovenosas cuyo flujo unidireccional no está equilibrado por otras conexiones vasculares y, por consiguiente, se produce la secuencia oligoamnios-hidramnios. La afección fetal es debida a una hipovolemia del gemelo donante y a una hipervolemia del gemelo receptor

Morphofunctional study of umbilical cords from pregnancies complicated by preeclampsia shows both activation and lesion of endothelium. The cellular findings in umbilical cords from pregnancies complicated by preeclampsia can be summarized as: (i) higher number of cells with secretion bladders and increase in the number and size of both secretion bladders and microvilli-like protrusions; (ii) increase in collagen, fibrin, fibronectin and lipidic vesicles in the vessel wall; (iii) vacuolization of endothelial cells; (iv) presence of lipidic vacuoles and lipophages in the vessel wall; (v) erosion and disorganisation of the endothelium that exposes extracellular proteins to the blood flow. Endothelial cell cultures from preeclamptic pregnancies show kinetic disorders and cell detachment. The results confirm that an endothelial cell lesion occurs in preeclampsia and this cellular disorder can be reproduced in vitro.

To assess coagulation activation and endothelial cell injury in normotensive and pre‐eclamptic pregnant women, a comparision was made of plama levels of tissue factor, fibronectin, fibrinopeptide A and D‐dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre‐eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D‐dimer were found in pre‐eclampsia women. Moreover, the ratio fibrinopeptide A:D‐dimer was much greater in the pre‐eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre‐eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsir coagulation pathway in pre‐eclampsia. The increase of fibrinopeptide A:D dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre‐eclampsia.

Morphofunctional study of umbilical cords from pregnancies complicated by preeclampsia shows both activation and lesion of endothelium. The cellular findings in umbilical cords from pregnancies complicated by preeclampsia can be summarized as: (i) higher number of cells with secretion bladders and increase in the number and size of both secretion bladders and microvilli-like protrusions; (ii) increase in collagen, fibrin, fibronectin and lipidic vesicles in the vessel wall; (iii) vacuolization of endothelial cells; (iv) presence of lipidic vacuoles and lipophages in the vessel wall; (v) erosion and disorganisation of the endothelium that exposes extracellular proteins to the blood flow. Endothelial cell cultures from preeclamptic pregnancies show kinetic disorders and cell detachment. The results confirm that an endothelial cell lesion occurs in preeclampsia and this cellular disorder can be reproduced in vitro.

Objective: To evaluate the plasma levels of coagulation and fibrinolysis parameters in the third trimester of gestation and on the third day after delivery.Methods: Normal pregnant women (n = 65), pregnant women with essential hypertension (n = 10), pregnant women with gestational hypertension without proteinuria (n = 13), and pregnant women with preeclampsia (n = 12) formed the study population. Coagulation and fibrinolysis parameters were estimated using commercial tests. Antithrombin III, thrombin-antithrombin III complexes, heparin cofactor II(HCII), protein C, protein S, tissue plasminogen activator, D-dimer, and plasminogen activator inhibitors levels in uncomplicated pregnancies and in hypertensive pregnancies were determined.Results: No differences were found in coagulation inhibitor levels between normal, chronic essential hypertension, and gestational hypertension groups. However, preeclamptic women showed lower levels of antithrombin III and heparin cofactor II. The concentration of thrombin-antithrombin III was higher in hypertensive disorders, mainly in preeclampsia, than in normal pregnancy. No differences were found in the levels of tissue plasminogen activator and plasminogen activator inhibitors type 1 and type 2 in the normal pregnancy, chronic essential hypertension, and gestational hypertension groups. However, preeclamptic women had higher tissue plasminogen activator and lower plasminogen activator inhibitor type 2 levels.Conclusion: The finding that HCII levels were decreased only in the preeclamptic group shows its potential utility in the diagnosis of preeclampsia.

A fetal goiter was detected by ultrasonography in a woman receiving potassium iodide. After this medication was discontinued at 29 weeks, a fetal hypothyroidism was confirmed by cordocentesis, and two doses of levothyroxine were administered by amniocentesis. At 34 weeks repeated cordocentesis showed fetal euthyroidism and ultrasonography shrinkage of the goiter. Growth and development were normal at 1 year. (J Pediatr 1998;133:147-8.)

The objective of this article is to evaluate the plasma levels of coagulation and fibrinolysis parameters in the third trimester of gestation and 72 hr postdelivery. Antithrombin III (ATIII), thrombin-antithrombin III complexes (TAT), heparin cofactor II (HCII), protein C (PC), protein S (PS), tissue plasminogen activator (t-PA), D-dimer, and plasminogen activator inhibitors (PAI-1 and PAI-2) levels in uncomplicated pregnancies and in pregnancies complicated by intrauterine growth retardation (IUGR) have been determined. Normal pregnant women (n = 63) and women whose was complicated by IUGR (n = 10) formed the study population. Coagulation and fibrinolysis parameters were estimated using commercial tests. There were no differences in ATIII, HCII, and PS levels between normal and IUGR pregnancies. TAT, t-PA, and D-dimer levels were higher in IUGR pregnancy than in the uncomplicated pregnancy group. PAI-1 and PAI-2 were found depressed in IUGR pregnancy when compared with normal pregnancy. Changes in coagulation and fibrinolytic systems occur in plasma of women with pregnancies complicated by IUGR. The results suggest an activation of the coagulation system in pregnancies complicated by IUGR. Reduced PAI-2 and high TAT levels correlate with birth weight. In IUGR pregnancies a hypercoagulative state with hyperfibrinolytic compensatory mechanisms is suggested.

The changes in coagulation and fibrinolysis parameters during pregnancy, delivery and 3 days after delivery were evaluated in normotensive and gestational diabetes pregnant women. Normal pregnant women (n = 60) and pregnant women with gestational diabetes (n = 15) formed the study population. Coagulation and fibrinolysis parameters were estimated using commercial tests. Antithrombin III, thrombin-antithrombin III complexes, heparin cofactor II, protein C, protein S, tissue plasminogen activator, (t-PA) D-dimer and plasminogen activator inhibitor(PAI-1 and PAI-2) activities in normal and gestational diabetes pregnancies were determined. Thrombin-antithrombin III complexes increased and coagulation inhibitors decreased in gestational diabetes. Plasminogen activator inhibitors remained unchanged and t-PA levels increased in gestational diabetes.