搜索结果：Revista chilena de obstetricia y ginecologia

The benefits of hormonal replacement therapy are widely known. In spite of this, the proportion of women under treatment is low. The study aims to evaluate the amount of knowledge that patients have, about menopause, and how it influences compliance with therapy. In our study, 494 women attending the outpatient's clinic of Hospital Barros Luco-Trudeau were interviewed; 93.5% considered that menopause has adverse effects upon health; 87.9% believes that it produces emotional disturbances; 55.1% bone-related and 40.9% cardiac problems. Sixty six point eight percent of the consulted women know that there is a treatment for menopause. Half of the women interviewed had consulted the physician specifically for this reason; however, only one third are or were under treatment. Obesity, hirsutism and cancer are considered to be the main secondary effects to treatment. Patients who have not received hormone therapy have a much lower degree of knowledge about menopause than the treated ones, and amongst the latter, those who abandon treatment have less information than the ones that remain under treatment. As a conclusion, we may say that our patients have information about menopause and also that they attend to the physician's office for this reason. The knowledge about the matter and related beliefs influence both adherence to and compliance with therapy.

The purpose of this study was to compare the pregnancy outcome and the growth and development of infants of adolescent and older mothers in a Latin American setting in which young mothers received aggressive prenatal care, and in which breast feeding behavior of all women was strongly encouraged and recorded. Our hypothesis was that the generally higher rates of low birth weight and neonatal complications among infants of Chilean adolescents would be eliminated by an aggressive protocol of prenatal care. Data on prenatal care, gestation, birth and infant growth and development were extracted retrospectively from the medical records of 200 low socioeconomic status para I patients, all of whom received care by the same hospital team. The sample included 50 women ages 14-16, 50 women 17-19, and 100 women 20-24.

Pregnancy is marked by changes and cardiovascular adaptations that are important for the maintenance and growth of the placenta and fetus. During this period, the uterine vascular adaptations manifest changes that can be classified as short or long term and they related to adaptations for vasodilation, angiogenic or remodeling. Estrogen and the classical estrogen receptors (ERs), ER-α and ER-β, have been shown to be partially responsible for facilitating this dramatic increase in uterine blood flow needed during pregnancy. This literature review discusses the basis for structural diversity and functional selectivity of ERs by estrogen, the role of ERs on the genomic and non-genomic effects in endothelial cells of uterine arteries (UAEC). These themes integrate scientific knowledge about the molecular regulation of UAEC to maintain the physiological increase in uteroplacental perfusion observed during normal pregnancy. El embarazo está marcado por cambios y adaptaciones cardiovasculares que son importantes para el crecimiento y mantenimiento de la placenta y el feto. Durante este periodo, las adaptaciones vasculares uterinas manifiestan cambios clasificados como de corto o largo plazo los cuales están relacionados con adaptaciones vasodilatadoras, angiogénicas o de remodelación. El estrógeno y los receptores estrogénicos clásicos (REs), RE-α y RE-β, han demostrado ser parcialmente responsables por facilitar el incremento dramático en el fluido sanguíneo uterino necesario durante el embarazo. En ésta revisión bibliográfica se discuten la base estructural para la diversidad y selectividad funcional de los REs por el estrógeno, el papel de los REs sobre los efectos genómicos y no-genómicos en células endoteliales de arterias uterinas (CEAU). Estos temas integran el conocimiento científico sobre la regulación molecular de CEAU para mantener el incremento fisiológico en la perfusión útero-placentaria observada durante un embarazo normal.

We reviewed 1.178 benign tumors treated between 1981/93 among which 39 appeared with a Phylodes Tumors diagnosis, disregarding 5 of them because they did not have a precise description and histologic classification, studying 34 proved cases which represented 2.89% of all benign tumors; if we add 89% cancers in these years, we have 2.074 and the relation becomes 1.64% of the total. We found 22 benign phylodes (64.7%) 7 border line (20.5%) and 5 malignant (14.8%) whose clinic, histologic and evolutive characteristics are presented in this paper.

Estrogen and classical estrogen receptors (ERs), ER-α and ER-β, have been shown to be partially responsible for short and long term uterine endothelial adaptations during pregnancy. The molecular and structural differences, together with the various effects caused by these receptors in cells and tissues, suggest that their function varies depending upon estrogen and estrogen receptor signaling. In this review, we discuss the role of estrogen and its classic receptors in the cardiovascular adaptations during pregnancy and the expression of ERs in vivo and in vitro in the uterine artery endothelium during the ovarian cycle and pregnancy, while comparing their expression in arterial endothelium from reproductive and non-reproductive tissues. These themes integrate current knowledge of this broad scientific field with various interpretations and hypothesis that related estrogenic effects by either one or both ERs. This review also includes the relationship with vasodilator and angiogenic adaptations required to modulate the dramatic physiological increase to the uteroplacental perfusion observed during normal pregnancy. El estrógeno y los receptores estrogénicos clásicos (REs), RE-α y RE-β, han demostrado ser parcialmente responsable por las adaptaciones endoteliales uterinas durante el embarazo al corto y largo plazo. Las diferencias moleculares y estructurales, junto con los diferentes efectos causados por estos receptores en las células y los tejidos, sugieren que su función varía dependiendo de la manera en la cual el estrógeno se comunica con sus receptores. En ésta revisión bibliográfica se discuten la función del estrógeno y sus receptores clásicos en las adaptaciones cardiovasculares durante el embarazo y la expresión de los Res in vivo e in vitro en el endotelio de la arteria uterina durante el ciclo ovárico y el embarazo, a la vez comparado con la expresión en endotelio arterial de tejidos reproductivos y no reproductivos. Estos temas integran el conocimiento actual de este amplio campo científico con interpretaciones e hipótesis diversas relacionadas con los efectos estrogénicos mediados bien sea por uno o los dos REs. Esta revisión también incluye la relación con las adaptaciones vasodilatadoras y angiogénicas requeridas para modular el dramático incremento fisiológico en la perfusión útero-placentaria observada durante un embarazo normal.

Two hundred biopsy reports with uterine myoma histopathological diagnosis were studied 67% of the cases were between 41-50 years of age. Premenopausic patients showed an average number of myomas almost three times higher than the postmenopausic women. The most frequent myoma were those within the walls with a size less than 2 cm. Chronic inespecific cervixitis was the most frequent finding in the cervix pathology, with in 1.5% of the cases. In 2 cases (1%) endometrial adenocarcinoma was found. In 60.5% of the cases one or both tubes and ovaries were removed neither case had malignant alterations. In 51 cases (25.2%) the myoma presented some type of degeneration, the most frequent being the cellular type, 16 out of 200, which represented 8% of the cases; it was considered as presarcomatose type. Presurgical clinical behavior is discussed considering the analysis of these figures and the perspectives of the conservative treatment with the use of new no ablative technique.

Danazol is a synthetic steroid, derived from 17-alpha ethinyltestosterone and it is used primarily in the treatment of endometriosis. It effectiveness is due to a reversible hypoestrogenic and hyperandrogenic state, which lead to atrophy of the ectopic endometrial tissue. A prospective study was undertaken in 14 women of child-bearing age with laparoscopically confirmed pelvic endometriosis to evaluate the alterations produced in bone and lipid metabolism after a six month treatment with Danazol. Laboratory evaluation included: bone mineral density, urine hydroxiproline/creatinine and calcium/creatinine ratios, lipid profile, bone isoenzyme of alkaline phosphatases and plasma estradiol. A significant decrease in plasma estradiol levels was observed (p < 0.001). Decrease in HDL cholesterol and increase in LDL cholesterol levels were statistically significant after 3 and 6 months of medication (p < 0.001), but the lipoproteins returned to normal levels three months after discontinuing Danazol. The bone isoenzyme of alkaline phosphatases showed a progressive increase (p < 0.001) and there were no significant variations in the hydroxyproline/creatinine and calcium/creatinine ratios. The osteodensitometry remained unchanged at 6 months of therapy. We conclude that, even though Danazol produces hypoestrogenism and hyperandrogenism, the markers of bone loss did not change, it has no negative effect on bone mineral density, and the transient worsening of the lipid profile that it causes is reversible on discontinuation of medication.

We present a newborn with a malformation in the central nervous system that isn't frequent, the ininencephaly: this consist in the absence of the squamous part of the occipital bone, exaggerated cervical-thoracic retroflexion, high raquischisis, and with other malformations. Died at half hour, by global insufficiency respiratory due lug hypoplasia, verify by necropsies. In the Clinic Hospital of the University of Chile the incidence is 1 in 40,000 life newborn. We review the prevent of the nerval tube defect with the use of folic acid in the diet of the future woman who is going to became pregnant.

The ultrasound detection of corpus luteum in the midluteal phase of ovulatory cycles was associated with significantly higher levels of plasma progesterone, opposed to those patients where a corpus luteum could not be identified. The hormone level was directly proportional no the number of corpora lutea seen. However, only 33.3% o patients with no corpus luteum visible were found to have suboptimal plasma progesterone levels (< 10 ng/ml).

Four bladder-amniotic shunts were done in three fetuses with megacystis. The procedure was successful in all cases on the first attempt. The interval between the shunt insertion and delivery was range from three to twenty eight days. Pulmonary and renal damage were irreversible in two fetuses. Spontaneous abortion occurred with the third fetus which had multiple malformations. We believe that selection of candidates for such procedures should be improved. Early diagnosis and referral to high technology centers will increase clinical experience.

We have investigated the prevalence of antibodies against Toxoplasma gondii, Trypanosoma cruzzi, Hepatitis B virus, cytomegalovirus, rubella virus, and human immunodeficiency virus in 139 adolescent pregnant women and in their high risk newborn children. The methods employed were the Sabin and Feldman reaction, complement fixation reaction, ELISA, and xenodiagnostic 30.9% of the pregnant group were seropositive for T. gondii, both mothers and newborns were IgM-negative. Two mothers (1.4%) presented anti T. cruzii antibodies, and one newborn child had circulating parasites. Related to the virological studies, 93.5% of the population were anti CMV antibodies positive and all their newborns were IgM (-) 90.6% of the adolescents were rubella positive and one was seropositive to VIH. We conclude that the prevalence found in this group of adolescent pregnant women are not significantly different to the one reported for the general pregnant women population.

To determine the existence of any change in the blood flow velocity indexes in patients with cholestasis of pregnancy, we studied a total of 51 pregnant women, (normal n = 15; anicteric cholestasis n = 21 and icteric cholestasis n = 15). There was no significant change in the parity, maternal age, gestational age, birth weight and in the apgar score among the groups. There was also no significant change in any of the blood flow indexes determined in the uterine artery, umbilical artery and fetal cerebral artery. We conclude that there are no significant changes in blood flow velocity indexes determined by doppler blood flow analysis in patients with cholestasis of pregnancy.

Between 1988-1922, data of the nutritional status of pregnant women seen in the Santiago Metropolitan Health Service were analyzed. Underweight (22.2%), normal weight (47.2%), overweight (19.7%) and Obese (15.4%). Four thousand five hundred fifty five pregnant women were studied. Underweight 1136, normal weight 1219, overweight 1100 and obese 1100. Underweight was significantly more frequent in the patients less than 20 years old while overweight and obese was significantly more frequent in the patients over 30 years old. Hypertension (2.6%) was the only significant morbidity factor in the obese group. The overweight and obese groups had earlier menarche, while the obese group had shorter periods. The obese group were associated most frequently with higher parity (75.1%), stillbirth (4.6%), spontaneous abortion (19.5%), induced abortion (3.1%) and high obstetric risk (33.2%). In the normogram used, the underweight patients are abnormally represented at the start of pregnancy. The obese group gained less weight proportionally during pregnancy (overweight and obese 42.8%, underweight and normal 34.7%). The obese group presented more frequently with hypertension (20.4%) and diabetes (0.7%), while the obstetric complications occurred more frequently in the underweight (6.3%). The underwent group had more anemia (45.4%) and premature labor (12.3%). Cesarean section was performed more frequently in the obese group (33.1% versus 21.3% of all the other groups combined. The neonatal birthweight was in direct proportion to the maternal weight, measured by various methods. It is worth noting the importance of microelements in the milk ingestion of the pregnant patients and the influence on their weight.

In order to assess the relationship between echographic endometrial thickness and pattern and the probability of clinical pregnancy and delivery we analyzed retrospectively 51 cycles of IFV-ET. Patients were classified in three categories of endometrial thickness: < 9 mm, 9.1-11 mm and > 11 mm and in two types of endometrial pattern: type 1 (non triple line) or type 2 (triple line). The average endometrial thickness of patients who got pregnant and those who did not was 11.8 +/- 1.8 mm and 10.6 +/- 1.7 mm respectively (p = NS). There were no clinical pregnancies in patients with endometrial thickness < 9 mm (p < 0.01). The average endometrial thickness in patients with endometrial pattern type 1 and type 2 was 11.1 +/- 1.2 mm and 10.9 +/- 1.9 mm respectively (p = NS). Patients who presented type 2 endometrial pattern (n = 39) produced eleven clinical pregnancies (28.2%) and those with type 1 (n = 2) only one clinical pregnancy (8.3%), which ended in spontaneous abortion (p < 0.01). When both variables, thickness and pattern, were considered together, patients with endometrial pattern type 2 and thickness > 11 mm had a probability of clinical pregnancy and of delivery of 43.8% and 25%, respectively, who is statistically significant (p < 0.03). We conclude that endometrial thickness and pattern, taken together, offer a valuable prognostic value for the outcome of an IVF-ET cycle.

The menstrual characteristics, FSH, LH, estradiol and progesterone levels of 21 women were measured before and one month after sterilization by tubal ligation. No statistical differences were found.

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A case of patient that during a cesarean section, a dark zone of the Omentum was biopsied, and informated as melanosis. Then appeared a cystic mass in the left ovary, and an ooforectomy was performed, resulting a Primary Malignant melanoma.

We show our experience in the diagnostic and management of 19 pregnancies with absent or reverse diastolic blood flow velocity (ARFV) in the umbilical artery. The presence of ARFV was a rare condition (2.2% of the high risk patients), and it was associated with a poor prognosis shown by the high percentage of fetuses SGD (small for gestational age) (63.2%), malformations and hydrops fetalis (26%) and asphyxiated fetuses, giving a final perinatal mortality rate of 36.8%. In 8 cases (42.1%) the termination or pregnancy was delayed for at least 48 hours, allowing in some cases the administration of corticosteroid. There were significant differences when comparing the groups of survivors and non survivors in relation to the gestational age at the moment of delivery (33.1 +/- 3.4 vs 28.6 +/- 3.8 weeks), malformations (8.3 vs 57.1%) and C-section (91.7 vs 42.9%). Finally, we conclude that the presence of ARFV in the umbilical artery is associated with a critical fetal condition and termination of pregnancy should be considered. In this decision the gestational age and fetal and maternal well being ought to be taken into account when choosing the best moment and route of delivery.

A uterine smooth muscle tumor belonging to the category of unknown malignant potential in a 20-year-old woman is reported. The major axis of the tumor was 5 cm, and the tumor was soft and homogeneous. Histologically, it was composed of cellular groups, arranged in an epithelioid pattern, with hyaline bands dissecting the groups, moderate nuclear hyperchromasia and pleomorphism, and mitotic index of 2 per 10 high power fields; the tumor had infiltrating margins and tumoral vascular invasions were found. Immunohistochemically, the tumor was positive for vimentin, and negative for keratins, desmin, actin, and S 100 protein. Epithelioid smooth muscle tumors of the uterus should be classified as tumors of unknown malignant potential under the following conditions: if they are larger than 5 cm, if they show at least moderate cellular pleomorphism, if their mitotic index is at least 1 per 10 high power fields, or if they show cellular necrosis. The present immunohistochemical findings suggest more a fibroblastic than a smooth muscle cell origin of this neoplasm.