Biomedical subjects

A Fortuny

Publications and source records attributed to A Fortuny.

At least 55 records · Page 3Linked to original sources

PubMed1996

Reversed end-diastolic umbilical artery velocity in two cases of trisomy 18 at 10 weeks' gestation.

Doppler velocimetry of the umbilical artery was carried out during routine ultrasound examinations performed immediately before either chorionic villus sampling (n = 383) or genetic amniocentesis (n = 649) in 1032 women referred for prenatal diagnosis at our institution, between 10 and 18 weeks of gestation. Reversed end-diastolic flow was detected in only two cases (0.19%), both of which were affected by trisomy 18. The diagnosis was made at 10 weeks' gestation and, to our knowledge, these are the earliest records of this pathological Doppler pattern. Although a possible relationship with early abnormal placentation remains to be established, the finding of reversed end-diastolic velocities in the umbilical artery in the first trimester of pregnancy may be an early sign of karyotype abnormality.

Adult↗

PubMed1996

Does the use of contraception reduce the risk of pregnancy-induced hypertension?

To estimate the impact of the exposure to spermatozoa on the risk of developing pregnancy-induced hypertension, the duration of sexual cohabitation with the father and the use of contraceptive methods were evaluated among 113 primigravid women with pregnancy-induced hypertension and 109 age- and parity-matched controls. The duration of unprotected sexual cohabitation was approximately 50% shorter in women with pregnancy-induced hypertension (2.3 versus 4.7, P < 0.0001), regardless of the contraceptive method previously used. However, the duration of oral contraception use was similar in cases and controls (22.1 versus 23.4 months). Also, of the total group of women who developed pregnancy-induced hypertension, 85.5% (97) became pregnant during the first 3 months of unprotected sexual intercourse in comparison with 54.1% (59) in the control group (P < 0.0001). Results suggest that the risk of pregnancy-induced hypertension in primigravidae is reduced with duration of sexual cohabitation, and therefore with exposure to paternal spermatozoa. However, the protective effect of exposure is not achieved while using oral contraceptives. Considering the present options for nulliparous women, contraception does not appear to be a viable public health policy to reduce the risk of pregnancy induced hypertension.

Adult↗

PubMed1996

Umbilical artery pulsatility index in early pregnancies with chromosome anomalies.

OBJECTIVE: The aim of our study was to obtain measurements of the umbilical artery pulsatility index in pregnancies before invasive procedures for prenatal diagnosis, to investigate its potential prognostic value in predicting chromosomal abnormalities. DESIGN: A prospective study. PARTICIPANTS: Nine hundred and twenty-four consecutive women with singleton pregnancies between 10 and 18 weeks of gestation who underwent chorionic villus sampling (n = 385) or genetic amniocentesis (n = 539). All Doppler measurements were obtained by a single investigator before the invasive procedure. Pregnancies where structural malformations were detected by ultrasound were excluded. RESULTS: Twenty-six fetuses with chromosomal anomaly, including 12 with trisomy 21, were diagnosed. Using the 90th centile in umbilical artery pulsatility index values as a cut-off for trisomy 21 the detection rate was 66.6%, with a specificity of 90.4% and a positive predictive value (defined as the proportion of unaffected individuals with positive results, l-specificity) of 8.8%. However, with this cut-off the false positive rate was 9.6%. All 19 chromosomally normal pregnancies in which a fetal loss occurred after the procedure had a normal umbilical artery pulsatility index before it was carried out. CONCLUSIONS: These preliminary data suggest that trisomic fetuses have an abnormally increased umbilical artery pulsatility index in early pregnancy. Because the number of cases is too small to draw any firm conclusions, the use of a single measurement for screening purposes needs to be confirmed by further investigation and the clinical significance of reference curves of normal values in the detection of pathological conditions has still to be determined. The potential of umbilical artery pulsatility index as an additional parameter along with others previously established for Down's syndrome screening, such as nuchal oedema, needs to be explored further.

Abortion, Induced↗

PubMed1996

Plasma lipids, lipoproteins and apolipoproteins in hirsute women.

OBJECTIVE: To determine whether lipid alterations in hirsute women are due to excessive androgen, low estrogen or to a combination of these abnormalities. DESIGN: Cross sectional study. PATIENTS: Forty-five hirsute women between 15 and 39 years of age. MAIN OUTCOME MEASURES: FSH, LH, 17beta-estradiol, PRL, testosterone, androstenedione, triglycerides and apolipoproteins A-I and B. RESULTS: Testosterone was correlated with triglycerides (r: 0.76, p<0.01), HDL (r: -0.61, P<0.01) and LDL (r: 0.50, p<0.05). Both HDL (r: 0.66, p<0.01) and LDL (r: -0.57, p<0.01) were correlated with estradiol. Total cholesterol was also correlated with estradiol (r: -0.52, p<0.05). Cross adjusted correlations revealed that, after adjusting for estradiol, lipids were associated with testosterone and that estradiol was also correlated with lipids when adjusted for testosterone. CONCLUSION: The results suggest that altered lipids in women with hyperandrogenism could result from independent effects of androgens and estrogens.

Adolescent↗

PubMed1996

Variation in lipid levels during pregnancy in women with different types of hypertension.

OBJECTIVES: To evaluate the levels of serum lipids (cholesterol and triglycerides) in pregnant women with different types of hypertension, at the first, second and third trimesters of pregnancy. METHODS: Cholesterol and triglyceride levels at the first, second and third trimesters of gestation were recorded for 115 women with hypertension during pregnancy, and 115 healthy pregnant women matched for age and body mass index. Cases were classified as having mild gestational hypertension (25), severe gestational hypertension (15), mild preeclampsia (20), severe preeclampsia (20), chronic hypertension (20), and superimposed preeclampsia (15). RESULTS: Cholesterol levels were not statistically different between cases and controls in any form of hypertension. At 20 and 34 weeks' gestation, triglyceride levels were significantly higher than controls in women with severe gestational hypertension, mild and severe preeclampsia, and superimposed preeclampsia, but not in mild gestational hypertension or chronic hypertension. The significant elevation in triglycerides was already present at 10 weeks in mild and severe preeclampsia. CONCLUSIONS: The data suggest that the alterations in lipid metabolism observed in preeclampsia are already present at the first trimester of pregnancy. Women with severe gestational hypertension presented a pattern of triglycerides similar to that of preeclamptic women, but mild gestational hypertension resembled chronic hypertension in this respect. This supports the concept that, although in many cases gestational hypertension represents latent essential hypertension, some of these women, probably the most severe cases, present with true pregnancy-induced hypertension, or nonproteinuric preeclampsia.

Adult↗

PubMed1996

Effects of progestogen on lipids, lipoproteins and apolipoproteins during transdermal estrogen replacement therapy with and without medroxyprogesterone acetate.

OBJECTIVE: To assess whether the effects on plasma lipids and lipoproteins after oophorectomy differ in patients who receive transdermal estrogen replacement therapy (ERT) with and without progestin. STUDY DESIGN: Twenty-five healthy, normal-weight, regularly menstruating women who underwent hysterectomy and bilateral oophorectomy for benign diseases received, for one year, transdermal therapeutic systems containing estradiol with daily delivery of 50 micrograms cyclically for 24 days per month plus 2.5 mg/d of oral medroxyprogesterone acetate (MPA) sequentially for the last 12 days of each cycle. After the first year the patients ceased to take MPA. We determined the levels of cholesterol (CHOL), high density lipoprotein (HDL)-CHOL, low density lipoprotein (LDL)-CHOL, triglycerides (TG) and apolipoproteins (apo) A-I and B prior to oophorectomy, one month after surgery and during the 6th and 12th months on estrogen plus progestogen substitution and during the 18th and 24th months without progestogen addition. RESULTS: After oophorectomy, the patients showed increases in LDL, apo-B and atherogenic index, whereas after hormone replacement therapy the patients exhibited falls in plasma LDL, apo-B and atherogenic index and increases in HDL and apo A-I. No significant changes in total CHOL were observed after surgery or treatment, and TG were decreased. Plasma levels of lipids and lipoproteins during estrogen replacement therapy (ERT) without MPA were not significantly different from those observed during ERT plus MPA. CONCLUSION: Changes in lipids induced by transdermal ERT were not affected by low doses of MPA.

Administration, Cutaneous↗

PubMed1995

Rapid fetal karyotype from cystic hygroma and pleural effusions.

Fluid from pleural effusion (n = 2) and cystic hygroma (n = 7) was obtained from eight fetuses, between 13 and 32 weeks of pregnancy at the time when a conventional prenatal diagnosis procedure was carried out. As these fluids contain lymphocytes, they were processed like peripheral blood. A karyotype was obtained in 4 days in both cases of pleural effusion and in four out of seven samples of cystic hygroma. An abnormal karyotype was detected in three of the four samples of cystic hygroma: two trisomies 21 and a monosomy X. Different parameters were evaluated in order to predict the feasibility of obtaining a cytogenetic diagnosis. Our data showed that if the amount of fluid obtained was > or = 4 ml and the initial lymphocyte count (ILC) was > 0.2 x 10(6) cells/ml, a cytogenetic diagnosis was possible from an initial concentration of cultured lymphocytes (ICCL) of > 0.06 x 10(6) cells/ml.

Body Fluids↗

PubMed1995

Chorionic villus sampling by biopsy forceps. Results of 1580 procedures from a single centre.

The results of a prospective series of 1580 chorionic villus sampling (CVS) procedures using biopsy forceps are presented. Most of the procedures (1442), including 11 sets of twins, were performed by the transcervical approach (TC-CVS), using a curved-shank thin forceps, and 138 by the transabdominal approach (TA-CVS), using a trocar-guided straight thin forceps. The mean gestational age for TC-CVS was 10.9 weeks, and in 233 cases (16 per cent) the procedure was carried out between the 12th and 14th weeks. The mean gestational age for TA-CVS was 16.7 weeks. The major indication for CVS was advanced maternal age (92.7 per cent in the TC and 91.8 per cent in the TA approach), and indications for abnormal ultrasound findings were more common in the TA approach (4.5 per cent) than in TC-CVS (0.07 per cent). Although sampling was apparently accomplished in all the procedures, in 3.1 per cent of the TC-CVS and 2.2 per cent of TA-CVS procedures, the samples were less than 1 mg after dissection. A cytogenic report was obtained in 96.1 per cent of the TC-CVS and 90.6 per cent of the TA-CVS. Maternal serum alpha-fetoprotein (MSAFP) was measured before and after TC-CVS and the post-CVS MSAFP was positively correlated with the sample weight. Second-trimester amniocentesis following CVS was required in 5.2 per cent (TC-CVS) and 6.5 per cent (TA-CVS), due to the failure to obtain a cytogenetic report or diagnostic confirmation. The follow-up to the 20th week was 100 per cent by ultrasound scan, and 88.6 per cent from the 21st week to 1 week after delivery. Fetal loss rates within 2 weeks of the procedure were 1.7 per cent (TC-CVS) and 0.8 per cent (TA-CVS) and total fetal loss accumulated to 1 week after delivery was 4.6 per cent (TC-CVS) and 5.9 per cent (TA-CVS). Factors found to increase significantly fetal loss in the TC-CVS series were maternal age and the collection of very small samples, but not the number of forceps insertions.

Adult↗

PubMed1995

Prevalence and clinical significance of anticardiolipin antibodies in pregnancies complicated by parvovirus B19 infection.

Anticardiolipin antibodies were measured in 60 pregnant women with acute parvovirus B19 infection. Test results for eight (13.3 per cent) women were positive for anticardiolipin antibody. Six of these eight women became negative later, yielding a prevalence of anticardiolipin antibodies of 3.3 per cent (2/60) 6 months after acute parvovirus B19 infection. Anticardiolipin antibody positivity was not associated with an increased risk of abortion, fetal death, or maternal complications. This study suggests that there is an elevated frequency of anticardiolipin antibodies in pregnant women with acute parvovirus B19, probably representing an epiphenomenon. However, this is not associated with an adverse maternal or perinatal outcome.

Antibodies, Anticardiolipin↗

PubMed1995

Biochemical and Doppler predictors of poor perinatal outcome in a fetus with four umbilical vessels.

Unexpected elevation of maternal serum alpha-fetoprotein (MSAFP) in women with anti-phospholipid syndrome has already been described as a predictor of fetal death. In this report we present a case of a pregnant woman with elevated second trimester MSAFP, in which Doppler ultrasound at 28 weeks suggested very poor fetal prognosis. A cesarean section was performed, but 2 days later the infant died due to distress. The only remarkable feature at post-mortem study was the finding of four vessels in the umbilical cord. Conventional investigation of the mother led us to the diagnosis of a primary anti-phospholipid syndrome. The finding of such an association should alert clinicians to the increased risk of fetal death. Precocious Doppler ultrasound examination may be the elective non-invasive technique to monitor such high risk fetuses.

Adult↗

PubMed1995

First-trimester nuchal edema as a marker of aneuploidy.

Targeted ultrasonographic screening for nuchal fluid accumulation during the first trimester (9-13 weeks) seems to be a recommendable method for the detection of Down's syndrome and other chromosomal anomalies in pregnant women. It compares favorably with current methods of maternal serum screening performed during the second trimester. Using a 4-mm cut-off value, the detection rate of aneuploidy among our population was found to be 57.1%, with a false-positive rate of 0.7% and a positive predictive value of 72.7%. Chromosomal analysis should be considered for fetuses with nuchal translucency equal to or greater than 4 mm in the first trimester.

Adolescent↗

PubMed1995

The influence of the site of Doppler recording on umbilical artery pulsatility index during the first trimester.

The aim of our study was to determine the pulsatility index (PI) of the umbilical artery velocity waveform obtained from the fetal insertion, the placental insertion and a free floating loop of the umbilical cord. This was a prospective study involving 60 consecutive singleton pregnancies undergoing ultrasound examination between 10 and 13 weeks' gestation. Doppler measurements were obtained transvaginally from the placental and the fetal abdominal insertion, and from a free floating loop of umbilical cord. Chromosomal abnormalities and structural malformations detected by ultrasound were excluded. A multi-way analysis of variance did not show significant differences between the measurements of umbilical PI at the different sites of the umbilical cord and Pearson's coefficient showed an excellent correlation between them. No significant intra- and interobserver differences were found. In conclusion, measurements of Doppler velocimetric indices of the umbilical artery during the first trimester are not influenced by the recording site and these recordings are reproducible at this stage of gestation.

Adult↗

PubMed1995

The incidence of human parvovirus B19 infection during pregnancy and its impact on perinatal outcome.

A prospective study of parvovirus B19 infection during pregnancy was conducted at a large teaching hospital in Barcelona, Spain. Women (1610) who were < 28 weeks pregnant at enrollment were screened for parvovirus infection. The prevalence of IgG positivity was 35.03% (564/1610). The incidence of acute infection during pregnancy was 3.7% (60/1610). There were five abortions among the B19-infected women but only one was caused by parvovirus, as assessed by histologic examination and polymerase chain reaction assay. The incidence of fetal loss caused by parvovirus was, therefore, 1.66% (1/60). The remaining 55 pregnancies were uneventful, and at 1 year of age, none of the infants had serious abnormalities. The incidence of vertical transmission of infection was estimated at 25%. This study provides evidence that although acute parvovirus infection may occur relatively commonly during pregnancy, an adverse fetal outcome is a rare complication.

Adult↗

PubMed1995

Schistosomiasis: an unusual cause of tubal infertility.

A case report of a Nigerian woman having an unusual cause of tubal infertility is presented. On histological examination of the Fallopian tube, ova of Schistosoma haematobium enclosing living miracidia were found in the smooth muscle layer of the Fallopian tube and its mesosalpinx. Mechanisms of tubal involvement are analysed. The case indicates the need to consider schistosomiasis as a possible aetiological factor in patients with tubal infertility coming from areas where the disease is endemic.

Adult↗

PubMed1995

Circulating hormone levels in menopausal women receiving different hormone replacement therapy regimens. A comparison.

OBJECTIVE: To measure and compare plasma levels of sex hormones after the administration of different hormone replacement therapy (HRT) regimens. STUDY DESIGN: Ninety women with natural menopause were randomized into this comparative study. Eighty-five women completed one year of follow-up. Patients were randomly assigned to five groups. The first received 0.6 mg/d of conjugated equine estrogen (CEE) cyclically (n = 15). The second received 50 micrograms/d of transdermal estradiol (E2) cyclically (n = 17), and the third received 0.6 mg/d of CEE continuously (n = 17). All these groups also received 2.5 mg of medroxyprogesterone acetate (MPA) sequentially for the last 12 days of HRT, while the fourth therapy group received 0.625 mg/d of CEE and 2.5 mg/d of MPA continuously (n = 19). The fifth group constituted a treatment-free control group (n = 22). Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2, estrone (E1), prolactin (PRL), testosterone (T), androstenedione (A4), dehydroepiandrosterone sulfate (DHEA-S) and sex hormone binding globulin (SHBG) were determined prior to HRT and during the last week of the 6th and 12th months of HRT, between days 21 and 24 of estrogen administration. RESULTS: After HRT we found decreases in FSH, LH and PRL levels, increases in E2, E1 and SHBG, and no modifications in T, A4 and DHEA-S plasma levels. There were no significant differences between the treatment groups in FSH, LH, E2, PRL, T, A4 or DHEA-S. E1 and SHBG were significantly higher in the groups with oral HRT. CONCLUSION: All the observed changes in hormone levels are to be expected after HRT except for the decrease in PRL levels. Finally, although MPA dosage was not the focus of the present study, our results suggest that the dosage of 2.5 mg/d of MPA in sequential regimens is clearly inadequate to protect the endometrium from hyperplastic changes.

Adult↗

PubMed1995

Postmenopausal hormone replacement therapy with low-dose medroxyprogesterone acetate. Endometrium, plasma lipids, lipoproteins and apolipoproteins.

Several studies have demonstrated that the use of estrogens in postmenopausal women has a protective effect against cardiovascular disease; however, this beneficial effect may be counteracted when concomitant progestogens are administered. We investigated the influence of hormone replacement therapy (HRT) with lower doses of medroxyprogesterone acetate (MPA) (2.5 mg/d) on the endometrium and on the plasma levels of lipids, lipoproteins and apolipoproteins. All the studied HRT regimens induced favorable changes in the levels of plasma lipids, lipoproteins and apolipoproteins, which may play an important role in the prevention of cardiovascular disease. The dosage of 2.5 mg/d of MPA is clearly inadequate to protect the endometrium from hyperplastic changes with sequential regimens, but probably this dosage is safe when MPA is administered continuously.

Adult↗

PubMed1994

Body stalk anomaly associated with maternal cocaine abuse.

A case of body stalk anomaly diagnosed prenatally by ultrasound during the 24th week of pregnancy in a cocaine abusing mother is presented. Accurate visualization of the fetal organs was difficult due to the severe oligohydramnios caused by premature rupture of membranes, probably related to the cocaine use. The sonographic findings were an omphalocoele, fetal attachment to the placenta, kyphoscoliosis, and absence of a floating umbilical cord. The prenatal diagnosis of the syndrome and the possible relationship with cocaine abuse are discussed.

Abdominal Muscles↗

PubMed1994

The prevalence of cocaine abuse during pregnancy in Barcelona.

The aim of our study was to determine the prevalence of cocaine abuse, by means of positive urine toxicology screens or targeted questionnaire, among women in labor at our hospital. The prospective study included 1773 women who delivered consecutively in our institution. All of them underwent a standardized questionnaire including drug use and demographic data. Urine samples were obtained during labor. Urine toxicology screens for cocaine and its metabolites, opiates, and ethanol were performed by enzyme multiplied immunoassay technique. Information was coded in order to maintain anonymity. Among the 1773 women in labor we screened, the mean age was 27.8 years and the overall prevalence of a positive questionnaire for cocaine was 0.3% and a positive urine toxicology was 0.8%. Results by drug and by demographic items are analysed. There was a substantial denial of cocaine use among the toxicologically positive patients, since only 43% of them referred its use at any time during pregnancy, in conclusion, the use of illicit drugs is common among pregnant women in our institution, but cocaine does not seem to be as prevalent as it is in the USA, while in the labor room most women with a positive test do not refer the use of the drug. Urine toxicology screening increases the rate of detection of substance abuse in this population of women. These studies are necessary to target educational programs among pregnant women.

Adult↗