Sylvia Elena Totsuka Sutto

By Leonel García Benavides, Diego Hernández Molina, Jessica L. Barajas Vega, Sylvia E. Totsuka Sutto, Fernando Grover Paéz, Francisco J. Hernández Mora, Ernesto J. Ramírez Lizardo, Sara Pascoe Gonzalez, David Cardona Müller and Ernesto G. Cardona Muñoz

Preeclampsia (PE) is the leading cause of preterm birth by medical indication when associated with premature detachment of placenta normoinserta, and Intrauterine growth restriction (IUGR) is associated with high perinatal morbidity and mortality and long-term sequelae. The main problem of PE is threefold: the diagnostic difficulty, the complicated interrelationship of the pathophysiological processes, and the vulnerability of the maternal-fetal binomial to the therapeutic interventions. The approach for management with PE is preventing its late occurrence in pregnancy. The key to preventing PE is knowledge of the factors that trigger the pathophysiological processes that culminate in the presentation of PE. Understanding the developmental characteristics of the placenta in pregnancy at high risk for PE is essential for understanding the pathophysiology and developing strategies for prevention. When deciding that the population of study is a group of pregnant women, the first ethical criteria that need to be reviewed are those aimed at the protection of the fetus. There are no specific guidelines on how to assess fetal well-being during pregnancy routinely in the clinic, and this deficiency is shifted to clinical research with pregnant women.

Part of the book: Clinical Trials in Vulnerable Populations

By Leonel García Benavides, Diego Hernández Molina, Jessica L. Barajas Vega, Sylvia E. Totsuka Sutton, Fernando Grover Paéz, Francisco J. Hernández Mora, Ernesto J. Ramírez Lizardo, Sara Pascoe Gonzalez, David Cardona Müller and Ernesto G. Cardona Muñoz

Preeclampsia (PE) is a disorder that occurs during pregnancy, it has an estimated worldwide prevalence of 5–8%, being one of the leading causes of maternal and perinatal morbidity and mortality. Currently, different diagnostic criteria exist, however, due to its complexity; the clinical presentation that makes up this syndrome could make its presence unclear. The pathophysiology of PE has been recently postulated and divided into three processes: inadequate uterine remodeling, placental dysfunction and maternal endothelial dysfunction. Despite the advances in the treatment of PE, the outcome of the medical interventions has failed to decrease the morbidity and mortality of this disease. The main reason might be the multifactorial origin of pathogenic processes that lead to the development of PE. That is why treatment is focused on the prevention of PE in patients that might present the risk before developing it late in pregnancy. The knowledge of the pathophysiological factors that trigger the processes that culminate in the presentation of PE, is key for prevention of this disease. However, the origin of these processes is poorly understood. It may be attributed to the ethical considerations that come with the study of these population of patients compared with the study of non-pregnant women.

Part of the book: Obstetrics

By Leonel Garcia Benavides, Sylvia Elena Totsuka Sutto, Leonel Garcia Valdes, Simon Q. Rodríguez Lara, Guillermo Ramos Gallardo, Ana Rosa Ambriz Plascencia and Miriam Méndez del Villar

The combination of surgical procedure (open or endoscopic techniques), rehabilitation and antioxidant therapy (Alpha lipoic acid, curcumin) is superior to monotherapies in the prognosis and recovery of patients with this pathology. The prescription of these medications by their mechanisms of action should be allocated prior to decompression surgery and should continue receiving medication during the rehabilitation time. Clinical and electrophysiological follow-ups are required to verify the improvement.

Part of the book: Essentials of Hand Surgery