Nomograms of placental volumes according to gestational age and estimated fetal weight were constructed, generating reference values.

F etal heart rate (FHR) abnormalities can occur after the initiation of labor analgesia. Although combined spinalepidural (CSE) analgesia with opioids has been associated with a higher incidence of nonreassuring FHR tracings immediately after block placement than with epidural analgesia, the possible causes have not been confirmed. One hypothesis is that the rapid onset of pain relief creates an imbalance in maternal catecholamine levels leading to uterine hyperactivity. This prospective, randomized study compared the effects of CSE and traditional epidural (EPI) analgesia on uterine basal tone and their association with FHR abnormalities.Low-risk laboring patients with singleton, cephalic, full-term pregnancies who requested analgesia before 7 cm of cervical dilatation were enrolled. Of the 91 patients who were initially enrolled, 14 were excluded, primarily for cardiotocographic failure. Forty-one patients were randomly assigned to receive CSE and 36 to EPI analgesia. All received a 10 mL/kg bolus of lactated Ringer's solution prior to an intrathecal injection of 2.5 mg of 0.5% bupivacaine with 2.5 mg sufentanil in the CSE group or 12.5 mg 0.125% bupivacaine with sufentanil 12.5 mg in the EPI group. Patients were monitored with an intrauterine pressure transducer for at least 15 minutes before and 15 minutes after labor analgesia. FHR was monitored with an external transducer and tracings were evaluated by a blinded observer. Pain was assessed with a 10-cm visual analogue scale (VAS). Primary outcomes were the occurrence of prolonged decelerations or fetal bradycardia and an increase of Z10 mm Hg in basal uterine tone after analgesia. Oxytocin use, hypotension, and speed of pain relief were also recorded. Power analysis suggested that 84 parturients would have to be randomized to have an 85% chance of detecting a 30% difference in uterine basal tone of 10 mm Hg.The groups did not differ in maternal demographic characteristics. Uterine tone was elevated in 17 (41.5%) and 6 (16.7%) patients in the CSE and EPI groups, respectively (P = 0.18) in the first 15 minutes after analgesia. FHR abnormalities were present in 13 (31.7%) of patients in the CSE group compared with 2 (5.6%) in the EPI group (P<0.01). Of the 13 women with FHR abnormalities during the first 15 minutes of analgesia in the CSE group, 7 had bradycardia and 6 had prolonged decelerations. In the EPI group, one tracing showed a prolonged deceleration and another had bradycardia. FHR abnormalities associated with hypertonus occurred in 11 (26.8%) of the CSE group and 1 (2.8%) of the EPI group (P<0.01). Two women in the CSE group had maternal hypotension compared with none in the EPI group, not a significant difference. Hypertonus and nonreassuring FHR were resolved with hydration, suspension of oxytocin if used before analgesia, and maternal supplementation with oxygen. No patient required tocolysis and no emergency cesarean delivery was performed because of fetal distress. Mean pain relief on VAS was higher in the CSE group at all evaluations up to 20 ...

Mother-to-child transmission (MTCT) of HIV-1 has been significantly reduced with the use of antiretroviral therapies, resulting in an increased number of HIV-exposed uninfected infants. The consequences of HIV infection on the innate immune system of both mother-newborn are not well understood. In this study, we analyzed peripheral blood and umbilical cord blood (CB) collected from HIV-1-infected and uninfected pregnant women. We measured TNF-α, IL-10 and IFN-α secretion after the stimulation of the cells with agonists of both extracellular Toll-like receptors (TLRs) (TLR2, TLR4 and TLR5) and intracellular TLRs (TLR7, TLR7/8 and TLR9). Moreover, as an indicator of the innate immune response, we evaluated the responsiveness of myeloid dendritic cells (mDCs) and plasmacytoid DCs (pDCs) to TLRs that are associated with the antiviral response. Our results showed that peripheral blood mononuclear cells (PBMCs) from HIV-1-infected mothers and CB were defective in TNF-α production after activation by TLR2, TLR5, TLR3 and TLR7. However, the TNF-α response was preserved after TLR7/8 (CL097) stimulation, mainly in the neonatal cells. Furthermore, only CL097 activation was able to induce IL-10 and IFN-α secretion in both maternal and CB cells in the infected group. An increase in IFN-α secretion was observed in CL097-treated CB from HIV-infected mothers compared with control mothers. The effectiveness of CL097 stimulation was confirmed by observation of similar mRNA levels of interferon regulatory factor-7 (IRF-7), IFN-α and TNF-α in PBMCs of both groups. The function of both mDCs and pDCs was markedly compromised in the HIV-infected group, and although TLR7/TLR8 activation overcame the impairment in TNF-α secretion by mDCs, such stimulation was unable to reverse the dysfunctional type I IFN response by pDCs in the HIV-infected samples. Our findings highlight the dysfunction of innate immunity in HIV-infected mother-newborn pairs. The activation of the TLR7/8 pathway could function as an adjuvant to improve maternal-neonatal innate immunity.

Objectives: estimate the prevalence and track the risk factors associated with, Maternity blues (MB).Methods: a transversal study was performed with 113 women, on the tenth day of puerperium. The following instruments were used: Pitt Scale (1968), Stein (1980), Inventory for stressful life events by Holmes & Rahe (1967), and a questionnaire with sociodemographic and obstetric data.Results: the prevalence of MB was 32.7% according to the Stein scale. In the univariated analysis, civil status and tobacco use were associated with MB. Legally married women and nonsmokers showed a risk approximately 4 times lower of experiencing the problem.Conclusions: MB was very prevalent in this sample. Obstetricians must be aware of this condition which may be associated with postpartum depression.

Fetal echocardiography has recently caused an impact on the treatment of congenital heart disease and in the field of therapeutic, cardiological intervention. The present study reports on a case of critical aortic stenosis, diagnosed in utero at 27 weeks’ gestation, and in which balloon dilatation was attempted to improve the poor prognosis associated with this condition. Since the endocardium at this stage of development was apparently normal, this therapeutic intervention was attempted to avoid irreversible damage to the left ventricle. Although hydrops disappeared and the myocardium hypertrophied, endocardial fibroelastosis progressed and the neonate died within the first day of life, after surgical aortic valvotomy. More data are necessary to clarify whether endocardial fibroelastosis is really a consequence of high pressure in the left ventricle resulting from stenosis of the aortic valve or whether it is a disease, the progression of which is unavoidable once it takes hold.