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Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The prevalence of cervicovaginal infections during pregnancy has been associated with adverse perinatal outcomes however, the actual approach used for diagnosis is not effective. The aim of this study was to compare the diagnosis of vaginal infections in pregnant women using clinical, molecular diagnostic and traditional microbiological culture in a pilot study, to determine the prevalence and association with the development of preterm labor., Materials and Methods: We performed a nested cross-sectional study composed by 54 women in a cohort of pregnant women in Mexico City. Cervicovaginal infections were evaluated by clinical methods, microbiology culture and a commercially available molecular biology test., Results: Prevalence of cervicovaginal infections during pregnancy was estimated between 28% and 50% according to methodologies. Considering the clinical diagnosis of preterm labor as the gold standard, all diagnostic tests were poor as predictors of preterm labor., Conclusion: Traditional approaches to establish the significance of cervicovaginal infection in pregnancy are exhausted, so be sought new ways to understand this complex relationship. Meanwhile it is recommended to continue to use traditional methods to identify infections during pregnancy in both knowledge of new methods aimed at understanding these relationships are sophisticated.

Background: Twin pregnancies (TP) have shown a greater risk of adverse perinatal outcomes than singletons have. However, there is still no consensus about whether the TP achieved by assisted reproduction techniques (ART) have worse perinatal outcomes compared with TP achieved spontaneously., Objective: Compare the incidence of adverse perinatal outcomes (preterm birth, premature rupture of membranes, gestational diabetes, pregnancy-induced hypertension, anemia, weight and destination of the newborn) in Mexican women with TP achieved spontaneously vs those with TP achieved by ART., Methods: Historical cohort study with two sample groups: group 1, women with TP achieved spontaneously, and group 2, women with TP achieved by ART. Women with TP achieved by TRA were matched 1:1 with women with EG achieved spontaneously for age, weeks of gestation, chorionicity and body mass index at admission to prenatal care. Adverse perinatal outcomes were compared between the two groups and the odds ratio (OR) had a 95% confidence interval., Results: There were 57 women per group. Baseline characteristics were similar in both groups except for nulliparity (38.6% in group 1 vs 82.5% in group 2 (p < 0.0001)). In group 2 there was a higher incidence of pregnancy-induced hypertension (group 1 (19.3%) vs. group 2 (42.1%), OR 2.5 (95% CI 1.07-5.8)). Newborns in group 2 were admitted to nursery more often than those in group 1 (49.1% vs. 35.1% OR 1.7 IC 95% 1.04-3.04). There was no difference in other adverse perinatal outcomes., Conclusions: Mexican women with TP achieved by ART had higher risk of pregnancy-induced hypertension compared to women with TP achieved spontaneously.

Background: Studies have shown that breast infiltrating ductal carcinoma develops from precursor lesions or pre-invasive. It is accepted that the risk of invasive ductal carcinoma increased slightly in hyperplasia, but especially in cases of atypical hyperplasia and intraductal carcinoma., Objectives: To evaluate and compare the nodal status between ductal breast cancer with in situ component (group 1) or without it (group 2)., Material and Method: Descriptive and retrospective study that included 454 ductal breast cancers. Data concerning clinical and pathological variables was collected. All data was compared between both groups., Results: Among all cases, 176 (38.8%) showed positive lymph nodes, 136 patients (39.5%) from group 1 and 40 cases (36.4%) from group 2. Among group 1 cases, high-grade subgroup showed higher positive lymph node rate (82 cases, 55.4%) than the extensive in situ carcinomas subgroup (84 cases, 49.7%). Both of them had a significant higher rate than group 2 cases (p = 0.003 y p = 0.028, respectively). Moreover, the low-grade in situ carcinomas without cellular necrosi had positive lymph nodes just in 30 cases (24%), significantly lower (p = 0.034) than group 2., Conclusions: We did not find overall statistical differences between groups depending on in situ associated component. But when we analyzed in situ subgroups, we found differences with higher positive lymph node rate in high grade carcinomas and extensive in situ carcinomas subgroups, while lower affectation rates were observed in low grade carcinomas (without cellular necrosis), compared to the group of breast cancers without in situ component associated.

Background: The human labor is an inflammatory process invading leukocytes modulated by gestational tissues. The local increase of cell adhesion molecules (CAMs) promotes the permanence of these leukocytes in the coriodecidua. Gestational tissues express ICAM-1, while circulating leukocytes expressing its ligand Mac-1., Objective: To analyze, first, if the expression of CAMs in the fetal membranes is associated with progress of gestational age, and second, the expression of CAMs on circulating leukocytes in the uterus (placenta)., Material and Method: original and closed study conducted at the Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes (Mexico City). We included samples from healthy women between 15 and 44 years of age with term pregnancies (> or =37 weeks gestation)., Results: Real time PCR analysis showed that the expression of CAMs in the fetal membranes remained constant before labor. ICAM3 and ICAM1 tended to increase during labor, while ICAM2, VCAM1, SELE and SELP decrease with advancing gestational age. Placental leukocytes showed a clear increase in the expression of ITGAM (Mac-1) during labor., Conclusions: These results show that the maternal-fetal interface expresses a specific combination of CAMs during labor, including ICAM1, ICAM-3 and Mac-1. The expression of these molecules could promote the retention of leukocytes in the local tissues to modulate the local inflammatory microenvironment during human labor.

The uterine rupture is a catastrophic obstetric complication. The main risk factor is an antecedent of uterine surgery, usually caesarean. It is reported the case of a 39-years-old patient with 37 week-pregnancy and polyhydramnios, without surgical antecedents, whose was not in labor and developed complete rupture of the lateral face of the uterus, which was spontaneous, without previous uterine scar and with a unusual outcome.

Objective: To evaluate the secretion of interleukin 6 (IL-6) in cervicovaginal fluid in a pseudocohort that emulates the evolution of the labor., Material and Method: Samples of cervicovaginal fluid of patients with 20 to 40 weeks of gestation were taken, patients were classified in 5 strata of the development of the labor. Each stratum reflects the progressive activation of the uterine activity and the cervical changes. To each sample was made determination of IL-6 by means of the system Multiplex. The samples of patient with infection data were eliminated., Results: 173 samples were included distributed in each one of the five strata. Basal secretion exists of IL-6 to the cervicovaginal fluid along the gestation, that doesn't modify until the active labor appears. Only when the uterine activity is manifested in form to regulate and effective, very significant increase is documented in the concentration of the IL-6 in the cervicovaginal fluid., Conclusions: The IL-6 it is a proinflammatory cytokine that increases in a specific way in the moment in that the effective uterine activity begins, thus, it is an excellent candidate to be evaluated as marker presage of the event of normal labor and preterm.

Background: Physical and structural chorioamniotic membranes integrity is due to a precise process of synthesis and degradation of collagen; surrounding collagenolitic activity raises during labor, what leads to a structural loss and mechanical resistance weakening, the main cause of its rupture under physiological and pathological conditions. Understanding of its three-dimensional structure is essential to characterize normal and pathological labor., Objective: To analyze three-dimensional structure of human chorioamniotic membranes at gestational term., Material and Methods: Descriptive study to analyze the distribution of collagens type I, II and IV in human chorioamniotic membranes at term (37 to 40 gestational weeks) without labor by means of confocal and electronic scan microscopy., Results: Cells' amnios shapes a homogeneous epithelium without a close intercellular contact (classic epithelium) what may contribute to transmembranal diffusion molecules' transport. Amnios connective tissue is too a complex fibrilar net of type I collagen, structurally supported by type IV collagen. On the contrary, corion has a great amount of cells in close contact, with a few fibers of type I and II collagen, and almost none of type IV collagen cells., Conclusion: Three-dimensional analysis of chorioamniotic membranes connective tissue, particularly amnios, allows to understand the main role of type IV collagen on supporting its structure, as well as collagenolitic enzymes in its degradation and rupture under normal and pathological conditions.

Background: The rise of cholagenolitic activity in fetal membranes, associated to premature rupture, have been related to abnormal activity of the extracellular matrix metalloproteinases discharged to the extracellular space as inactive enzymes that have to be activated to selectively degrade its components., Objective: To analyze the functional properties of leukocytes subpopulations coming from the placental circulation., Material and Methods: Biomedical experimental study in which placental and outlying blood leukocytes were cultivated during 96 hours, from women with pregnancy to term without labor. Leukocytes subpopulations were stained by flow cytometry. Culture media were analyzed with zymography and enzymatic activity profile was evaluated in presence of proteases inhibitors., Results: Placental leukocytes are composed of T-, NK- and B-lymphocytes, and monocytes; it was documented a progressive increase of inactive MMP-9 secretion (92 kDa), accompanied by an 82 kDa form MMP-9 activation since 48 hours. Enzymatic profile mainly showed metalloproteasas., Conclusions: Placental blood leukocytes showed functional capacities different from those that circulate in pregnant women's outlying circulation. Placental leukocytes, mainly T-lymphocytes, are characterized by the specific capacity to secrete and activate MMP-9; an enzyme that participates in fetal membranes degradation. It suggests that in placental surroundings are recruited cells specialized in labor changes induction.

Background: Physiological and pathological membrane rupture is a complex phenomenon with different biochemical processes; it is known that collagenolitic activity rises and collagen content diminishes within term tissue membranes in comparison to preterm membranes. Identification of these processes within rupture mechanism allows to suggest that fetal membranes and decidua can respond to biochemical and mechanical stimulus alike, and to produce mediators that degrade matrix of intracellular membranes., Objective: To identify simultaneously, whit a soluble microarray, different matrix metalloproteinases in extracts from amniochorion of pregnancies at term and preterm., Patients and Methods: Biomedical experimental study where amniochorion explants were obtained from four women groups. Group 1: at term with spontaneous labor; group 2: at term without labor; group 3: at term with premature rupture of membranes, and group 4: preterm labor. Explants were cultured for 24 h and then homogenated in their own culture media to obtain cell free extracts. MMP were identified in these extracts using a soluble microarray for MMPs that included: MMP-1, -2, -3, -7, -8, -9, -12 and -13., Results: MMP-8 and -2 were the enzymes most abundant in all the extracts of amniochorion. However, the concentration of MMP-8 in the extracts of group 3 (PROM) was significantly greater in comparison with the extracts of groups 1 and 2 (p = 0.01). The MMP-8 also was in greater concentration in the extracts of group 4 (preterm labor) in comparison with in the extracts of group 1 (p = 0.01)., Conclusion: Activation of cellular processes that lead to the degradation of connective tissue in the MCA under physiological conditions seems to defer in originating tissues from cases with PROM or preterm labor, and this activation is characterized by an increase in the concentration of MMP-8.

Objectives: To develop a method to isolate cells of human citotrophoblast and to assess its invading and differentiation capacity., Type of Study: Experimental biomedical., Materials and Method: Citotrophoblasts of healthy placentas of full-term pregnancies were isolated by digestion with dispase and purification in a density gradient. The purity by immunoreactivity to citokeratin 7 and the invasiveness of the cells of citotrophoblast in Matrigel were evaluated. The enzymatic activity was determined through zimography and hCG secreted was quantified by means of ELISA. The expression of alpha 1 and alpha 5 integrins was evaluated by immunohistochemistry., Results: Citotrophoblasts with a purity of 97% were obtained; they differentiated themselves, in a spontaneous way, to a syncytium after four days. There was a growing production of hCG. Maximum invasiveness of citotrophoblasts ocurred the first two days, when their phenotype was mononuclear and coincided with the secretion of pro-MMP-9, and then it diminished according with the culture time. Immunoreactivity to the alpha 1 and alpha 5 integrins was observed in citotrophoblast cells with mononuclear phenotype. This immunoreactivity was lower in cells with phenotype of syncytium., Conclusions: It was created an in vitro model that replicates events of the early development of the placenta. These events resemble the invasion and differentiation phase of the citotrophoblast. This model has potential utility in the study of the mechanisms of damage in preeclampsia.

Objective: At the end of pregnancy, a complex signaling network of cytokines, chemokines and proteic effector molecules is started. Due to such complexity, this network is very difficult to analyze. The aim of the present study was to evaluate the effectiveness of an antibody-based proteomic analysis method to distinguish the simultaneous presence of different molecules in biological samples., Material and Method: Amniochorion explants were obtained from women at term with spontaneous labor (n = 4) and subjected to cesarean section without labor (n = 4). Explants were cultured for 24 h and then homogenated in their own culture media to obtain cell free extracts. Chemokines were identified in these extracts using a commercial array for chemokines that included: eotaxin, eotaxin 2, 1-309, IL-8, IP-10, MCP-1, MCP-2, MIG, MIP-1alpha, MIP-1beta, MIP-1delta and RANTES., Results: All the included chemokines were found in amniochorion extracts, being IL-8 the most abundant. However, once labor is present, all chemokines tend to appear in greater concentrations than those from non-in-labor tissues, except for RANTES, which disappeared when labor began., Conclusion: This methodological approach shows that amniochorion from term pregnancies secrete chemokines with a characteristic qualitative profile during labor. This approach would allow the fast evaluation of potential markers of this phenomenon in physiologic or pathologic conditions.

Objective: Human corioamniotic membranes, or their equivalent in the rat, function as selective barrier during gestation and their rupture is part of the mechanisms implied in the labor. Molecular mechanisms carried out in this process are unknown., Type of Study: Experimental animal model., Material and Methods: Corioamniotic membranes (obtained at the beginning of the labor) of rats with programmed and synchronous pregnancies were analized. The coexistence and distribution of metalloproteinase of extracellular-3 matrix (estromelisine) in these tissues were determined., Results: Secretion and tissue location of metalloproteinase of extracellular-3 matrix in fetal membranes were identified for the first time. Metalloproteinase of extracellular-3 matrix was immunolocated in the compact layer of the amnion and its secretion (by the membranes) was confirmed through electrophoresis, zimography and Western blot. By confocal microscopy it was verified that metalloproteinase of extracellular-3 matrix is located in the same places of that of extracellular-9 matrix., Conclusions: Rupture of corioamniotic membranes relates to the expression and local activity of the metalloproteinases of extracellular matrix. The coexistence of metalloproteinase of extracellular-3 matrix in the amnion of the rat has been identified; this element is added to the biochemical process of rupture, since metalloproteinase of extracelular-3 matrix is an activator of that of extracellular-9 matrix. It is possible that the physiological function of this enzyme is implied, of a main way, in the process of rupture of corioamniotic membranes during the childbirth.

Objective: To identify whether soluble products from choriodecidual blood cells stimulated with group B streptococci (GBS) induce connective tissue degradation in human amniochorion., Material and Methods: Blood samples from choriodecidual compartment were collected by direct aspiration from placental cotyledons draining blood and represent local circulating cells. Samples were divided into two aliquots: one was stimulated with GBS (1 X 10(6) CFU/mL) and the other was kept free of bacteria as negative control. After overnight incubation, plasmas were separated. Chorioamnion explants were stimulated with 10% plasma for 12h at 37 degrees C in 5% CO2. MMP-9 proteolytic activity was measured in the supernatants by gelatin-zymography and IL-1beta and TNF-alpha were quantified by ELISA. Distribution of the collagenous fibrils in explants was examined by electron microscopy., Statistical Analysis: three independent experiments on duplicate were carried out and the statistical significance of experimental differences between groups was assessed with ANOVA test., Results: MMP-9, IL-1beta and TNF-alpha production was significantly higher in supernatants from explants co-cultured with choriodecidual plasma from blood previously infected with GBS, compared with control plasma. Accompanying extensive changes of connective tissue arrangement confirm induction of extracellular matrix degradation., Conclusions: Choriodecidual plasma from blood stimulated with GBS is enriched with biochemical signals that enhance the MMP-9, IL-1alpha and TNF-beta production by amniochorion. These findings suggest that local circulating cells are capable to act in response to GBS choriodecidual infection through extracellular matrix degradation and the consequent rupture of membranes.

Objective: To identify whether soluble products from choriodecidual blood cells stimulated with group B streptococci (GBS) induce connective tissue degradation in human amniochorion., Material and Methods: Blood samples from choriodecidual compartment were collected by direct aspiration from placental cotyledons draining blood and represent local circulating cells. Samples were divided into two aliquots: one was stimulated with GBS (1 x 10(6) CFU/mL) and the other was kept free of bacteria as negative control. After overnight incubation, plasmas were separated. Chorioamnion explants were stimulated with 10% plasma for 12h at 37 degrees C in 5% CO2. MMP-9 proteolytic activity was measured in the supernatants by gelatin-zymography and IL-1beta and TNF-alpha were quantified by ELISA. Distribution of the collagenous fibrils in explants was examined by electron microscopy., Statistical Analysis: three independent experiments on duplicate were carried out and the statistical significance of experimental differences between groups was assessed with ANOVA test., Results: MMP-9, IL-1beta and TNF-alpha production was significantly higher in supernatants from explants co-cultured with choriodecidual plasma from blood previously infected with GBS, compared with control plasma. Accompanying extensive changes of connective tissue arrangement confirm induction of extracellular matrix degradation., Conclusions: Choriodecidual plasma from blood stimulated with GBS is enriched with biochemical signals that enhance the MMP-9, IL-1beta and TNF-alpha production by amniochorion. These findings suggest that local circulating cells are capable to act in response to GBS choriodecidual infection through extracellular matrix degradation and the consequent rupture of membranes.

Objective: To identify a specific microenvironment in direct contact with fetal membranes where effector molecules acumulate, aiming to degrade the components of its extracellular matrix during labor., Type of Study: Experimental, analytic, longitudinal and prospective., Materials and Methods: Blood samples were collected from maternal, fetal and choriodecidual compartments, and mononuclear cells were isolated. Part of these cells was stained with antibodies to determine leukocyte subpopulations by flow cytometry. The other part was cocultured for 12 h with amniochorion explants. After coculture, MMP-9 was identified on the mononuclear cells by immunofluorescence. IL-1beta and TNF-alpha were determined in the supernatants by ELISA. Three independent experiments were carried out with duplicates and analyzed with Mann-Whitney's U test., Results: Although there were no significant differences in the mononuclear cell subpopulations from the three compartments, MMP-9 production was higher in choriodecidual cells than in those of the maternal and fetal compartments. Furthermore, IL-1beta and TNF-alpha were significantly more abundant in cocultures with choriodecidual cells compared with the other two compartments., Conclusions: During labor, choriodecidual cell subpopulations are not phenotypically different from those of the maternal or fetal compartments, but they are regarding MMP-9 production, which suggests that the environment surrounding chorioamniotic membranes enhances the synthesis of this enzyme, thus promoting degradation of connective tissue.

Premature membrane rupture (PMR) is one of the most serious public health problems in the world, ocurring in 10% of all pregnancies. PMR has important adverse effects on maternofetal morbidity-mortality, as it has been estimated that it accounts on the whole for 70% and 40% of neonatal morbidity and mortality, respectively. PMR treatment is empirical, as its aetiology is unknown and its physiopathogenic description has just been initiated. This work analyzes the possibility of documenting functional differences in human chorio-amnios, comparing the zone where rupture most frequently occurs in PMR with some other distant chorio-amnionic zones and with equivalent zones of fetal membranes obtained from nine month pregnancies which have not undergone labor. The membrane zone which was nearest to the cervical os was identified and marked to be analyzed later for extracellular matrix metalloprotease (MMP) activity, histology and topographical MMP distribution. The MMP expression was quantitatively determined in explant culture media from membrane fragments using specific immuno-enzymatic essays (ELISA) and zymography. In addition, immuno-histochemistry methods were used to reveal MMP expression in the different tissues. This methods allowed us to show the existence of a decreasing MMP activity gradient, with the greatest value corresponding to the zone nearest to the cervical os in the membranes obtained from PMR cases. In membranes obtained from cesarean operations no characteristic pattern was documented and values were always lower than those obtained for PMR tissues. We conclude that there is a chorio-amnionic zone in which connective tissue degradation is specifically induced and which coincides with the membrane zone in contact with the cervical os.

Introduction: Endometriosis constitutes the growth of endometrial tissue in a place other than the uterine cavity. Its etiopathogenesis is unknown, although there is some evidence associating it with the decrease of cytotoxic activity in the immunological system., Objective: Evaluating the relationship between the development of ectopic endometrial tissue and the immunological status, and enumerating lymphocyte subpopulations and cytokine synthesis in T lymphocytes, using a murine endometriosis model., Methodology: Spleen lymphocytes isolated from two study groups of 10 female mice of the Balb/c strain that had been submitted to the surgical implantation of autologous endometrial tissue in the peritoneal cavity, and sacrificed after 5 (group I) and 8 (group II) weeks, were incubated--or not--with PMA/lonomicine. Lymphocyte T numbers and their cytokine production were determined by flow cytometry., Results: A lower dispersion of the ectopic tissue growth value was observed in group II (24% vs. 42%). A smaller population of cytotoxic T lymphocytes and a greater IL-4 production in the stimulated cells of the study group (p < 0.05) were observed, as compared to the control group., Conclusions: The presence of endometrial tissue in the uterine cavity decreases the amount of cytotoxic T lymphocytes and increases IL-4 production in total T lymphocytes, suggesting a modulation of the systemic immunological response to TH-2.

Objective: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery., Design: Cohorts. REFERENCE FRAME: Instituto Nacional de Perinatología, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa, México., Patients: Four hundred and sixty eight patients attending prenatal control and delivery care., Interventions: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated., Measurements: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study., Results: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001)., Conclusions: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Objective: To characterize the effect of IL-1 beta, on connective tissue metabolism in a human chorioamniotic membrane tissue culture (CAM)., Type of Study: Experimental, in an in vitro model., Material and Methods: CAM explants obtained from cesarean sections were cultured. The presence of local infection was excluded by microbiological methods. An XTT viability essay of the explants was carried out. Explants were stimulated with different doses of IL-1 beta within a 0-10 ng/mL range. After the stimulation, protein content was measured, MMP-9 production was determined by zymography, and each explant was divided in two parts: one was used for collagen measurement and the other analyzed by electronic microscopy., Results: CAMs kept adequate viability and functionality. IL-1 beta stimulation produced an increase in the amount of MMP-9 expressed, as determined by the zymography method with a maximum effect 36 hours after stimulation. Collagen content decreased in a progressive manner after IL-1 beta stimulation and reached its minimum after 36 hours. The characteristic pattern of collagen fibers gradually lost its organization, and could not be observed any more after 36 hours., Conclusions: The information presented here allows us to conclude that IL-1 beta is capable of inducing an enzymatic expression affecting connective tissue, thus confirming its participation in membrane degradation processes under inflammatory conditions.

Unlabelled: Even though endometriosis represents a reproductive health problem of the greatest importance due to the fact that it is one of the most common benign gynecological conditions, its aetiology is still unknown. The most accepted hypothesis is the one proposed by John Sampson, suggesting that the endometrial cells and tissues derived from menstrual flow during uterine scaling reach the peritoneum through the tubes by reversed flow and, under the specific conditions of the peritoneal microenvironment, they are able to implant and proliferate in an ectopic manner. Some evidence shows that the number and activation of macrophages are increased in the peritoneal medium of women with endometriosis. It is known that the activation of this cell group leads to a greater synthesis of diverse molecules associated with this condition., Objective: Evaluating the association between the nitric oxide (NO) synthesis induction capacity of the peritoneal fluid, the percentage of cooperative T lymphocytes and NK cells present in the peritoneal medium of women with different stages of endometriosis, as compared to fertile and healthy women. We also tried to find the correlation between the concentration of TNF-alpha identified in the peritoneal fluid of both groups with the NO synthesis induction that was carried out. Material and methods. The study group was formed by women with endometriosis (WEN) from the National Institute of Perinatology, and the control group was formed by patients attending the Family Planning Clinic of the Northeast Regional Unit (Culiacán, Sin.) (HFW). A NO synthesis induction was performed using lymphocytes stimulated with peritoneal fluid from WEN and HFW in order to measure the concentration of cooperative T lymphocytes and NK cells, the TNF-alpha of the peritoneal fluid was also measured., Results: The NO synthesis induction capacity of peritoneal fluid observed with lymphocytes from a culture was greater than the one presented by healthy women., Conclusion: Nitric oxide was recently described as a potent inhibitor of effector cytotoxic activity associated to the immunological response of cooperative T lymphocytes of the TH-1 type promoting cytotoxic activity on different cell strains. Evidence suggests that NO inhibits INF-alpha synthesis, the later being a potent proliferation and cytotoxic activity inducer in NK cells, cytotoxic T lymphocytes, and cooperative T lymphocytes. A role of NO as a regulator of NK cell activity has also been described.

Recurrent spontaneous abortion of unidentified cause or idiopatic is an important problem of reproduction health. In this study, the study has been started of one of the mechanisms that could act in the pathology of human pregnancy. The general hypothesis proposed, is that in the case of patients with recurrent spontaneous abortion of non identified cause (RSA) there are phenomenons in the materno/fetal/placentary means that manifest themselves in harm to the functionality and/or vitality of placentary tissue. The hypothesis was consistent with the finding of massive activation of cellular death in all the cases with RSA studied in this work.

Neonato preterm birth (before 37 pregnancy weeks) account more than 80% perinatal deaths not attributable to congenital malformations. Preterm and term labor full mechanisms are unknown at present. Proinflammatory cytokinesis direct participation have been involved in the phenomena by several experimental evidence. The study's aim was to determine TNF-alpha and IL-1 beta concentration at maternal, fetal and fetal-maternal vascular compartments in women with term and preterm delivery and in women at term childbirth without labor. TNF-alpha and IL-1 beta concentration were determinated by commercial immunoassay. TNF-alpha concentration showed a tendency to be in more proportion at fetal and fetal-maternal compartments in preterm and term childbirth groups versus TNF-alpha concentration in term group without labor at same places. IL-1 beta concentration showed same tendency of increase than TNF-alpha in preterm and term childbirth groups, but alone at fetal-maternal compartment. Statistical difference were not documented at any compartment or group compared. Data allow to identify fetal-maternal compartments as target places where TNF-alpha and IL-1 beta were synthesized. Gradient concentration synthesis of cytokinesis allows to intend fetus as TNF-alpha initial producer.

Background: The molecular mechanisms of chorioamniotics membranes rupture during labor are relationated with a group of enzymes named metalloproteinases of extracellular matrix (MMP), the production of these enzymes are elevated in premature rupture of membranes. The collagenase IV (molecular weight 92 kDa) is induced in specific form during both events. We unknown the regulatory mechanisms to these enzymes in the chorioamnios., Objective: To determine the presence of apoptosis and expression of (MMP-) in human chorioamnios during the labor and premature of the fetal membranes., Material and Methods: The gel lysis using zimography was determined in membranes of 1) Labor, 2) Cesarean section, 3) PRM. The analysis of DNA fragmentation in situ and DNA of the membranes was studied. Using immunohistochemistry techniques was identified MMP-9., Results: It was observed increase of gel lysis in stracts with PRM and labor in comparation with cesarean section. In all the specimens were found apoptotics cells, however, they were scareces, abundance or very abundance in cesarean section specimens, labor or PRM respectively. The fragmentation in situ was confirmed in specimens of DNA. The immunohistochemistry showed positively to MMP-9 in labor and PRM specimens, and not in cesarean section specimens. The MMP-9 immunorreactivity was extensive in PRM and only was found apoptosis., Conclusions: The results demonstrate that apoptosis and expression-activity of MMP-9 can be associated to membranes rupture during labor and lysis, the same explanation may be true for the increased expression of MMP-9 in PRM both phenomena seems to have a sequence.

The tumoral necrosis factor alfa (TNF-alpha) has been characterized as a signal contained in chorioamniotic membrane with premature rupture of membrane complicated with infection, inducing enzymes that degrade extracellular matrix components in fetal membranes. This cytocine is normally produced of immune system cells as a response to contact with infectious agents, and its identification is a direct molecular nexus between inflammatory response and development of premature rupture of membranes.

Matrix metallo proteinases (MMP) are the physiological mediators of collagen degradation and its participation in physiopathogenesis of premature rupture of membranes has been suggested by our group. With the idea of defining if some MMP become active active in a coordinated way with labor in fetal membranes, we analyzed enzymatic activity and immunoreactive protein present in extracts of amnion and chorion. It was possible to identify the presence of MMP-9 in extracts of membranes obtained during cesarean sections, without labor, although its activity/quantity was faintly detectable. Instead, extracts of fetal membranes obtained during active labor showed large activity/quantity of this MMP. With a monoclonal antibody, it was possible to show that the active form of MMP-9 could only be found in samples with labor. MMP-9 and its messenger RNA, were localized by immunohistochemistry and in situ hybridization in amniotic epithelium, in some fibroblasts of the compact layer and in trophoblast-like cells in chorion. It is concluded that: 1. Activity and quantity of MMP-9 increase selectively associated to labor; and 2. That this enzyme is expressed by different cellular populations of fetal membranes.

Some studies have shown an association between vitamin C disposability (Vit C), and the development of premature rupture of membranes (RPM). However, vitamin C role in the metabolism of collagen upon chorioamnion tissue, has not been analyzed. In this study the effect of modulation with different vit C concentrations in culture cells derived from human amnion, was analyzed. Vit C concentrations were used in order to cover physiological range (29.0 micrograms/ml). After stimulation the cells media were analyzed for enzymatic activity of metalloproteinases with extracellular matrix (MMP), and relative quantity of MMP-1, MMP-2 and MMP-9, was quantified, by immune transference, using monospecific polyclonal antibodies. The activity, as well as protein decreased in amniotic cells media, in a direct way as to vit C concentration, so, at the highest used concentrations (100 micrograms/ml), the least MMP activity/quantity, was obtained. These results show a finding not described until now, which permits to establish a direct connection between vit C availability and increase in collagen degradation. According to results, the less availability of vit C, the greater degradation of collagen, which should lead to a mechanical support loss and eventual fetal membranes rupture.

Experimental proofs are presented, that involve the participation of the metalloproteinases family, of extracellular matrix in the genesis of premature rupture of membranes. The expression of this group of enzymes, which presents in normal conditions of labor appears in the RPM without relation with gestational age. This phenomenon is not presented as an isolated example of participation of metalloproteinases in events related to labor and delivery, as is very well known its participation in maturation of uterine cervix preceding product expulsion, and that consists in similar mechanisms to the ones now chosen for the maturation of fetal membranes. The working hypothesis in pathologic conditions, implies, then, the activation of a normal system in an inadequate moment that results in premature rupture of membranes.