Showing papers in "Ginecología y obstetricia de México in 2010"

[Risk factors associated with preeclampsia: case-control study].

Abstract: BACKGROUND: Preeclampsia is one of the most frequent and serious complication of pregnancy characterized by systemic perfusion reduction generated by vasospasm and activation of coagulation systems. OBJECTIVE: To evaluate the association between preeclampsia sociodemographics and obstetrics antecedents. MATERIAL AND METHOD: An unmatched case-control study was carried out in which all the clinical registries of patients with preeclampsia (cases: n = 196) assisted in the period 2003-2007 in the Hospital Civil of Culiacan Sinaloa State of Mexico were analyzed. As controls the clinical registries of patients assisted during the same period were selected at random but that they didnt show up preeclampsia (n = 470). The association of preeclampsia with socioeconomic level tobacco use alcohol use gynecologic and obstetric antecedents (sexual partners pregnancies deliveries and abortions number prenatal control contraceptive method) and previous pregnancy with preeclampsia were analyzed. RESULTS: There were not association between tobacco use (OR: 3.05; 95% CI: 0.81-11.48) beginning of sexual activity (p = 0.1509) number of sexual partners (OR: 1.23; 95% CI: 0.83-1.83; p = 0.3009) and sexual cohabitation less than 12 months (OR: 0.90; 95% CI: 0.63-1.27). The alcoholism (OR: 5.77; 95% CI: 1.48-22.53) socioeconomic level (p < 0.05) pregnancy previous with preeclampsia (RM:14.81; 95% CI: 1.77-123.85; p = 0.0006) were associated with preeclampsia. There were differences in the use of the contraceptive method between groups (p < 0.005). CONCLUSIONS: Preeclampsia was significantly associated with the alcoholism low socioeconomic level and pregnancy previous with preeclampsia.

Comparison of laparoscopic vs. laparotomy treatment in ovarian teratomas

Abstract: BACKGROUND Benign cystic teratoma is one of the most common benign tumors of the ovary, according to international series represents between 44 and 62% of all ovarian tumors diagnosed in women younger than 40 years. OBJECTIVES To evaluate and compare the efficacy and safety between laparoscopy and laparotomy in the management of ovarian teratomas, as well as the recurrence between both techniques. MATERIALS AND METHOD Retrospective, clinical series study involving 169 cases of ovarian teratomas operated at the Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes in the period comprehended between 2000-2008. The cases were divided into the ones solved by laparoscopy, corresponding to group 1 (102 cases) and 67 cases solved by laparotomy, corresponding to group 2. RESULTS Group 1 (laparoscopic approach) consisted of 102 patients (60.3%), and group 2 (laparotomy approach) had 67 patients (39.7%). Surgical bleeding: 55.7 +/- 21.4 mL vs. 91.6 +/- 29.2 mL (p < 0.0001), hospital stay: 1.6 +/- 0.57 vs. 2.7 +/- 0.42 days (p < 0.0001), surgical time: 110.3 +/- 27.2 vs. 83.6 +/- 26.9 minutes (p < 0.0001), teratoma size: 7.2 +/- 2.3 vs. 11.5 +/- 4.2 cm (p < 0.0001) in groups 1 and 2, respectively. Teratoma rupture had 57.8% incidence (59 cases) in group 1, and 16.4% in group 2 (11 cases). Laparoscopy was a risk factor for broken open for ovarian cyst (OR: 6.9; CI 95%: 3.3-14.8). Not a single case was complicated by chemical peritonitis in any study group. CONCLUSIONS Laparoscopic approach to teratomas is a safe and efficient procedure, it does not increase complications in comparison to the laparotomy approach; it presents less bleeding and short hospital stay, offering a quick recovery.

Frequency of symptoms of the climacteric syndrome

Abstract: BACKGROUND Menopause is the descent in circulating estrogens that manifests clinically for the climacteric symptoms. These symptoms motivate the patient to consult to the physician. OBJECTIVE To know which are the symptoms that motivate women in the climacteric to begin hormonal therapy. MATERIAL AND METHOD Atransverse study was settled, 692 patients from the menopause cohort of Endocrine Research Unit, Centro Medico Nacional, IMSS participated. All patients signed the letter of informed consent. Complete clinical evaluation and taking samples of veined blood for the hormonal determinations of LH, FSH and estradiol were carried out. The approach of evaluation of the clinical symptoms was made with the scale of Greene that values six components: psychological, anxiety, depression, somatic, vasomotor and sexual, which quantifies the presence and intensity of the climacteric symptoms. RESULTS The four main symptoms that accompany the climacteric are: hot flushes, irritability, edginess and sickness. With the registered symptoms, the punctuation of the components in the scale of Greene showed a bigger frequency statistically with difference significant (p < 0.05) for the vasomotor and the depressive component compared with the rest of the components that integrate all the symptoms. CONCLUSIONS Hot flushes and irritability are the symptoms found in the first time interview, also these are presented in more than half of the patients, therefore these symptoms can be considered as main cause to begin hormonal therapy. In accordance with the scale of Greene that allowed us to evaluate the symptoms in integrated form, the sexual component was a smaller frequency, maybe to that great number of patient does not dare to comment the sexual dysfunctions. However, at the moment has a wide therapeutic arsenal and forms of administration of estrogen therapy that have demonstrated to have a clinical-benefic effect for the control of the climacteric symptoms.

Risk factors associated with maternal mortality in the State of Morelos, Mexico

Abstract: Antecedentes : la mortalidad materna es un problema de salud publica. Las causas de la mortalidad materna estan directamente relacionadas con la accesibilidad, la oportunidad de las intervenciones, los costos y la calidad de los servicios obstetricos y perinatales. Objetivo: describir las caracteristicas de las muertes maternas y analizar los factores de riesgo relacionados con estas en el estado de Morelos. Material y metodo : estudio epidemiologico, transversal, observacional, descriptivo, retrospectivo de 94 casos de muertes maternas registradas en los servicios de salud de Morelos, entre 2000 y 2004. Se compararon las caracteristicas de las muertes maternas hospitalarias y no hospitalarias. Resultados : de las 94 muertes maternas, 81.9% se clasificaron como hospitalarias (66.7% en hospitales publicos) y 13.8% como no hospitalarias. 73 (77.6%) de las muertes ocurrieron durante el puerperio. La mayoria de las mujeres no contaba con algun servicio me- dico (76.7%). Hubo 77 casos (81.9%) de muerte materna directa y 12 (18.1%) indirecta. El riesgo de muerte materna no hospitalaria en mujeres de 35 a 40 anos de edad fue tres veces mayor, con estudios de primaria incompleta o ninguno de 10.9 y no tener derecho a servicio medico 3.6 veces. Conclusiones: la mayor cantidad de muertes fueron hospitalarias, las causas principales fueron: trastornos hipertensivos del embarazo, parto y puerperio y hemorragia obstetrica y eventos relacionados con la calidad de los servicios de salud. Es necesario desarrollar pro- gramas de control del embarazo mas eficientes, con un enfoque de riesgo materno-infantil

Intracytoplasmic morphologically selected sperm injection (IMSI) vs intracytoplasmic sperm injection (ICSI) in patients with repeated ICSI failure

Abstract: Antecedentes : la inyeccion intracitoplasmica de espermatozoides (ICSI) es altamente efectiva para el control de la infertilidad por factor masculino. Los espermatozoides seleccionados para inyeccion intracitoplasmica pueden tener alteraciones estructurales indetectables a 400x, como: vacuolas nucleares, disminuyendo tasas de embarazo e implantacion. Los estudios recientes demuestran que con la inyeccion intracitoplasmica de espermatozoides morfologicamente seleccionados (IMSI), a mayor magnificacion (> 6,600x), se incrementan las tasas de embarazo e implantacion en pacientes con falla repetida a ICSI. Objetivo : comparar los resultados de la inyeccion de espermatozoides moviles seleccionados con examen morfologico organelar (MSOME) para IMSI, con la ICSI en pacientes con falla repetida a ICSI. Pacientes y metodo : estudio prospectivo, observacional y de cohortes. A partir del 1 de febrero de 2010 se administro inyeccion intra- citoplasmica de espermatozoides morfologicamente seleccionados a las parejas con al menos dos ciclos fallidos de inyeccion intracito- plasmica de espermatozoides, y analizamos los primeros 30 ciclos en pacientes menores de 38 anos con buena reserva ovarica. Este grupo de estudio se comparo con los ultimos 30 ciclos de inyeccion intracitoplasmica de espermatozoides realizados antes de esa fecha, en pacientes con caracteristicas clinicas similares. La inyeccion intracitoplasmica de espermatozoides morfologicamente seleccionados se realizo con una magnificacion de 7,676 aumentos para evaluacion y seleccion espermatica. Resultados : los grupos tuvieron caracteristicas clinicas similares. La tasa de gestacion con inyeccion intracitoplasmica de espermatozoi- des morfologicamente seleccionados fue mejor que con inyeccion intracitoplasmica de espermatozoides (63 vs 50%); la diferencia no fue significativapara el tamano de la muestra

Pandemic Influenza Caused by A(H1N1) in Pregnant Women

Abstract: La pandemia de influenza causada por el A(H1N1), que se inicio en Mexico en 2009 y que persiste todavia aunque con tasas de morbilidad y mortalidad muy reducidas, no tuvo las repercusiones de las pandemias de influenza que la precedieron en el siglo XX, porque los paises miembros de la Organizacion Mundial de la Salud se anticiparon a preparar todo lo necesario para combatirla desde 1997, ano en el que ese organismo internacional emitio una voz de alarma y sugirio esa preparacion, en virtud de que el virus de la influenza aviar H5N1 estaba sufriendo mutaciones geneticas y se estaba creando un nuevo subtipo de virus que ya habia causado defunciones de seres humanos. La informacion oportuna de la OMS permitio crear estrategias para proteger a la mayoria de la poblacion mundial y, particu- larmente, a los grupos mas vulnerables, entre ellos las mujeres embarazadas. En este grupo, en efecto, las complicaciones pulmonares y en especial los cuadros de neumonia, obligan a la hospitalizacion de las pacientes con mucha mayor frecuencia y elevan las tasas de mortalidad perinatal. Los signos y sintomas de la influenza estacional (invernal), y los de la influenza A(H1N1), en mujeres gestantes, son siempre mas agudos, y por su gravedad obligan a tratamientos mas intensos. No obstante su gravedad, no obligan a hospitalizar a todas las pacientes, ni tampoco a comprobar con examenes de laboratorio complejos la existencia del virus A(H1N1). A todas las enfermas se les debe clasificar, por sus signos y sintomas, de acuerdo con la escala de Triage, y su hospitalizacion solo debe efectuarse cuando despues de un aislamiento estricto en su domicilio, su cuadro clinico empeora, o se complica alguna enfermedad cronica debilitante preexistente (diabetes, VIH-SIDA, cardiopatia, asma, obesidad morbida, etc.). Segun la escala en la que se haya clasificado a la paciente debe aislarse en su domicilio e iniciar

[Prenatal diagnosis by amniocentesis. Clinical and cytogenetic experience in 1,500 cases].

Abstract: BACKGROUND: Genetic amniocentesis is performed in Mexico 25 years ago but only few works have been published. OBJECTIVE: To analyze clinical and cytogenetic findings in consecutive patients submitted to genetic amniocentesis. MATERIAL AND METHOD: An analysis was made of the clinical features, amniocentesis results and pregnancy outcome in 1500 consecutive cases of genetic amniocentesis. RESULTS: Sixty-eight fetuses with chromosomopathy (4.5%) were detected and two, with an inborn error of metabolism. The most frequent abnormalities were trisomy 21 (32 cases), trisomy 18 (10 cases), trisomy 13(6 cases), 45,X (6 cases), 47,XXY (4 cases). Pregnancy outcome is known in 474 patients (32%). There were five fetal losses (1%). Of the 68 cases with chromosomopathy, the outcome is known in 45, of which, 29 (64%) decided to have an abortion while 16 (35%) continued the pregnancy, six had a spontaneous abortion or perinatal death and ten had an alive new born. Among fetuses with normal or balanced karyotype and normal ultrasound, 11 out of 419 (2.6%) had congenital anomalies. Two of them had a condition known to be related with epigenetic regulation, (Russell Silver and Angelman syndrome). CONCLUSIONS: Amniocentesis is a reliable and low risk method. Cytogenetic findings in this series are similar to those reported in the literature. Most patients with fetal disease decided to have an abortion. The finding of two patients with a condition related with abnormal epigenetic regulation suggests that the magnitude of this risk remains to be defined.

Rotura espontánea de variz uterina durante la gestación. Descripción de dos casos y revisión bibliográfica

Abstract: Spontaneous uterine venous rupture is a very rare condition (1/10,000 pregnancies). The etiology is still unknown, and it is associated with an increased of venous pressure. The rupture especially occurs on third trimester. The most frequent site of the rupture is the broad ligament. Maternal mortality has decreased to 4% but the perinatal mortality rate is still as high as 31%. The presenting symptoms are commonly unspecific. Clinical presentations are usually hypovolemic shock signs with severe abdominal pain and reduction in hemoglobin levels. In view of these findings an exploratory laparotomy is usually necessary as well as the adequate blood and fluid replacement. Two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture are reported. Both cases have different evolution. In the first case the evolution was favorable. It wasn't necessary the vein suture because of the bleeding ended by compression. In the second case the diagnostic took place after the fetal death and it was required the vein suture. This rare condition has to be taken into account to de the differential diagnosis in a pregnant woman with severe abdominal pain.

[Klippel-Trenaunay syndrome and pregnancy. Case report].

Abstract: The Klippel-Trenaunay syndrome is a rare congenital disorder consisting of: cutaneous vascular nevi, varicose veins or venous malformations and hypertrophy of soft tissue and bone, affecting one or more limbs. The morbidity of the disease is associated with vascular anomalies. Pregnancy is discouraged because this rare disease puts a pregnant woman in an increased obstetric risk, due to pregnancy can exacerbate complications. The pregnancy has been reported rarely in patients with Klippel-Trenaunay syndrome, although the incidence is unknown. Until 2006 there have been only 17 reported cases of pregnancy in patients with Klippel-Trenaunay syndrome in the literature in English. We report the case of the second pregnancy of 22 years old woman with this disease.

[No-scalpel vasectomy. Profile of acceptance and results].

Abstract: Background: Men have few effective methods for birth control The surgical method vasectomy is highly safe and effective although in Mexico represents only 24% of all contraceptive methods used Objective: To determine the characteristics complications and results of the men who requested and underwent no-scalpel vasectomy in the Instituto Nacional de Perinatologi­a Isidro Espinosa de los Reyes in Mexico Material and method: Retrospective cohort study with data of clinical records of men who underwent no-scalpel vasectomy from 2003 to 2007 Sociodemographic and clinical variables and complications reported as well as espermatobioscopy data were included Descriptive analysis was performed of different variables and chi squared test between proportions Results: A total of 596 no-scalpel vasectomies were performed The average age was 365 years and 134 of schooling 869% were married with 96 years of union Socioeconomic status was as follows: medium (25%) middle high (201%) and high (247%) The 943% of men requested the no-scalpel vasectomy because of satisfied fertility and 57% by morbidity in his couple The complications were as follows: epididymitis (22%) mild haematoma (15%) and contact dermatitis (02%) The surgical complications were significantly more frequent for the group with varicocele compared with the normal men group (p < 005) Azoospermia was achieved in 991% of men at 18 weeks after the no-scalpel vasectomy Early recanalization occurred in 05% of men There were no pregnancies Conclusions: The profile of men who requested no-scalpel vasectomy was in a great proportion healthy in the fourth decade of life with high school or greater satisfied fertility and high socioeconomic status No-scalpel vasectomy is a method of fertility planning very effective with low morbidity

Trombofilia genética y marcadores de activación endotelial en pacientes con preeclampsia

Abstract: Antecedentes : la coexistencia constante de trombosis en pacientes con preeclampsia sugiere que la funcion del endotelio podria ser un mediador determinante en su patogenesis Objetivo : determinar la asociacion entre marcadores de trombofilia genetica, activacion endotelial y preeclampsia Material y metodo : estudio prospectivo de casos y controles para determinar la existencia del factor V de Leiden, protrombina G20210A y metilentetrahidrofolato reductasa C677T, resistencia a la proteina C activada y concentraciones sericas del factor de von Willebrand, receptor sFlt1 en mujeres con preeclampsia (n = 28) y comparar esos valores con los de pacientes embarazadas sanas (n = 41) Resultados : se observo una alta frecuencia alelica de la metilentetrahidrofolato reductasa C677T (050) Aun en ausencia del factor V de Leiden se observaron diferencias notables en la prevalencia de resistencia a la proteina C activada y de concentraciones anormales de sFlt1 entre el grupo de pacientes con preeclampsia homocigotas para el alelo C677T y las controles (72 vs 10%, p < 0008 y 636 vs 10%, p < 005, respectivamente) Las mujeres con dos o mas pruebas anormales, incluida la homocigocidad para el alelo C677T, tuvieron un riesgo mayor de padecer preeclampsia que las que tuvieron una o ninguna (RM: 315; IC: 11-902) Conclusion : el polimorfismo C677T del gen de metilentetrahidrofolato reductasa tiene una alta prevalencia y se asocia con marcadores de trombosis y activacion endotelial en mujeres mexicanas con preeclampsia

Atención de la resistencia a la insulina en el síndrome de ovarios poliquísticos

Abstract: Polycystic ovary syndrome (PCOS) constitutes the main cause of anovulatory sterility with a near occurrence to 7 %. The PCOS have not a constant hormonal profile, for it has been necessary the employment of approaches like those of Rotterdam to establish the presence of this dysfunction. A surprising discovery was the demonstration of the effect of the insulin on the ovary, that which modified the concept of the specificity in the action of the insulin on certain tissues, therefore a resistance stage to the action of insulin induces a compensatory hyperinsulinism to try to stimulate all the tissues, but in secondary form increases the dysfunction of the ovarian steroidogenesis. There are drugs known as "insulin sensitizers", used in the treatment of certain forms of diabetes mellitus, among those are metformin and tiazolidinediones (roziglitazone and pioglitazone), recently a compound has been used with formulation of amino acids and oligoelements (Diamel) that neutralizes the free radicals reestablishing the intracellular signs of the insulin at cellular level. It is important to guide that long term without correct the PCOS could have back effect since the insulin resistance is associates to a higher risk of increasing impaired glucose, diabetes, dyslipidemia, atherosclerosis and vascular disease. Therefore, preventive measures should be implemented that at present time are to the reach.

Defectos congénitos asociados con translucencia nucal aumentada

Abstract: Antecedentes : la translucencia nucal es un tamiz para trisomia 21 que ha demostrado asociacion con otras alteraciones cromosomicas, sindromes geneticos y defectos congenitos. Objetivo : evaluar el resultado perinatal de los pacientes con translucencia nucal igual o mayor al percentil 95, durante el tamiz ultrasonografico del primer trimestre y del cariotipo fetal. Material y metodo : serie de casos en la que se evaluaron fetos con translucencia nucal igual o mayor al percentil 95 mediante cariotipo fetal, ultrasonido estructural en el segundo trimestre, ecocardiografia fetal y valoracion genetica al nacimiento, atendidos en el servicio de Genetica del Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes. Resultados : a 48 fetos con translucencia nucal igual o mayor al percentil 95 se les evaluo el cariotipo, que fue normal en 39 (81%) casos y anormal en 9 (19%) casos; de ellos, tres padecian trisomia 21, tres monosomia X, dos trisomia 18 y uno 47,XYY. De los pacientes con cariotipo normal, en 13 (33%) se detectaron anomalias por ultrasonido del segundo trimestre; de ellos, 12 tuvieron defectos congenitos mayores entre los que se observaron cinco casos con datos de cardiopatia corroborados por ecocardiografia anormal. De los 26 fetos con cariotipo y ultrasonido normal, solo dos tuvieron defectos menores. Conclusiones : el incremento de la translucencia nucal se asocia frecuentemente con anomalias cromosomicas y diversos defectos con- genitos, principalmente cardiopatias y sindromes geneticos. Nuestros resultados concuerdan con lo publicado en la bibliografia respecto a la importancia del seguimiento integral de todos los pacientes con translucencia nucal aumentada, aun cuando muestren cariotipo normal, debido al riesgo de sufrir otros defectos congenitos o sindromes

Prevalence and complications of monochorionic diamniotic twin pregnancy

Abstract: Antecedentes : los embarazos gemelares monocoriales-biamnioticos tienen alto riesgo de sindrome de transfusion feto-fetal, restriccion selectiva del crecimiento intrauterino y alteraciones estructurales. Objetivo : reportar los embarazos gemelares monocoriales atendidos en el departamento de Medicina Materno Fetal del Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes en los anos 2008-2009, y describir la fisiopatologia de sus complicaciones. Material y metodo : la corionicidad se corroboro con base en las caracteristicas de la membrana interfetal. Se identificaron los casos con sindrome de transfusion feto-fetal y restriccion selectiva del crecimiento intrauterino, y se clasificaron segun su gravedad. Ademas, se buscaron de forma dirigida las alteraciones estructurales en uno o ambos gemelos. Resultados : se registraron 34 embarazos gemelares (monocoriales-biamnioticos). De estos, 20 tuvieron sindrome de transfusion feto-fetal, seis con estadio de gravedad moderado y 14 con estadio severo. Cuatro casos tuvieron restriccion selectiva del crecimiento intrauterino, todos ellos muy afectados. Cuatro embarazos tenian una alteracion estructural, dos con cardiopatia, uno con un defecto urologico y otro con un defecto en el tubo neural. Seis embarazos gemelares monocoriales-biamnioticos no tuvieron complicaciones. Conclusiones: el embarazo gemelar monocorial-biamniotico justifica la vigilancia cercana con revision anatomica detallada y evaluacion hemodinamica de las arterias umbilicales y los ductos venosos de ambos gemelos

Prevalencia de tristeza materna y sus factores asociados

Abstract: Antecedentes: durante el embarazo y el puerperio son frecuentes los cambios emocionales que pueden ocasionar sentimientos de tristeza, ansiedad o temor. En la mayoria de las mujeres, estos sentimientos denominados “tristeza materna” o baby blues desaparecen rapidamente, si no ocurre asi o empeoran se catalogan como depresion postparto. Objetivo: determinar la prevalencia de tristeza materna y sus factores asociados. Material y metodo: estudio transversal en el que se captaron mujeres durante el puerperio inmediato. Mediante interrogatorio directo se aplico la escala de Edimburgo para determinar tristeza materna. Otros datos registrados fueron: edad, escolaridad, embarazos, hijos muertos, episodios de depresion, antecedentes de alteraciones del sueno y si el embarazo fue planeado. El analisis estadistico incluyo media aritmetica, valores porcentuales, prueba de la ji al cuadrado y de la t de Student; y analisis de regresion logistica para determinar los factores asociados con la tristeza materna. Se asigno un valor alfa de 0.05. Resultados: de 1,134 mujeres, 21 (1.8%) tuvieron diagnostico de tristeza materna. Los factores significativos relacionados con esta fueron: el antecedente de hijos muertos, p < 0.002; episodios de depresion, p < 0.001; y alteraciones en el sueno, p < 0.003. Conclusiones: la frecuencia de tristeza materna es baja en nuestra poblacion. Los factores asociados con este padecimiento pueden iden- tificarse durante el control prenatal para proporcionar atencion especial a estas mujeres, y asi prevenir las complicaciones resultantes. Palabras clave: tristeza materna, depresion postparto, embarazo

[Eclampsia, obstetric hemorrhage and heart disease as a cause of maternal mortality in 15 years of analysis].

Abstract: BACKGROUND: It has been described that 70% of all maternal deaths are provoked by obstetrical hemorrhage infections abortions hypertension and delivery dystocies. Poverty social exclusion low level education and violence are important causes of maternal mortality. OBJECTIVE: To establish the changes in the maternal mortality in a term of 15 years in a hospital of assistance obstetrical complicated. MATERIAL AND METHOD: A retrospective and descriptive study in which the number and causes of obstetrical death was analyzed occurred from 1991 to 2005. The comparison was done by five-year periods using descriptive statistics to analyze frequency of results. RESULTS: The number of maternal deaths was 105 97 and 42 by each one of the three five-year periods the mortality rate x 10000 decreased from 28.7 to 16.4 in the last quinquennium and was found from 6.1 just including the last year. In the first and second quinquennia the eclampsia occupied the first place as cause of death followed by the hemorrhage and the infections. In the third quinquennium the eclampsia also occupied the first place with a rate of 8.6 followed by the cardiopathy (2.3) and the infections (1.9) but the hemorrhage with a rate of 1.5 was displaced to the fourth place. CONCLUSIONS: The maternal mortality has diminished in a general way; the eclampsia has occupied the first place as cause of death from 1991 to 2005. The death by obstetrical hemorrhage has diminished in important form possibly due to the specific groups of medical attention by modules which has also helps the decrease of mortality by other causes. The increment of the deaths by cardiopathy should be considered as a possibility of risk associate undoubtedly to the present style of life from our society.

Histerectomía total laparoscópica: estudio descriptivo de la experiencia institucional con 198 casos

Abstract: BACKGROUND Total laparoscopic hysterectomy is a useful surgery in current gynecology, specially, in cases where abdominal access is indicated. Total laparoscopic hysterectomy performance has increased in recent years. OBJECTIVE To analyze the clinical characteristics and surgical variables of patients undergoing laparoscopic total hysterectomy for benign disease, performed at the Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, between 2007 and 2009. MATERIAL AND METHOD Retrospective, longitudinal and descriptive study. Medical records of all patients with a noncancer diagnosis underwent laparoscopic hysterectomy were reviewed, at the Instituto Nacional de Perinatologia, between January 1, 2007 and December 31, 2009. RESULTS 594 hysterectomies were performed, of which 37.3% were by laparoscopic surgery, within these 89.1% were through the total laparoscopic hysterectomy technique. Surgical indications were 58.6% for fibroids, 23.2% abnormal uterine bleeding and 18.2% for adenomiosis. Studied variables revealed an average surgical time of 139 + 66.9 min (range: 75-225 min), average surgical bleeding of 119.7 +/- 60.5 mL (50-350 mL), average uterine longitude of 12.4 +/- 2 cm (8-16 cm), average uterine weight 222.7 +/- 113.8 g (90-860 g), and average hospital stay of 2.3 +/- 0.5 days (2-4 days), all of these results within the range reported in the literature. CONCLUSIONS Previous surgical interventions were observed as complications risk factors, 162 (81%) patients had previous surgeries, 29% with 2 c-sections, 20% with 3 or more and 27% had other non-obstetrical interventions. This technique is safe and reliable, it does not replace the vaginal access and with adequate training and equipment it may be performed in an efficient manner with satisfactory results in our population.

Detection of human papillomavirus types 16 and 18 in semen samples from patients in an assisted reproduction program

Abstract: BACKGROUND The infection with human papillomavirus (HPV) represents a serious health problem in the world This is because are associated with cervical cancer development in when HPV of high-risk type 16 and 18 are involved A genital infection by these virus types are normally asymptomatic in the male and an infection to sexual partner is possible OBJECTIVE The objective of the present is the detection of HPV-16 and HPV-18 in semen samples from patients included in an assisted reproduction protocol MATERIAL AND METHOD Semen samples were obtained from 149 patients that are included in an assisted reproduction protocol in our institution Semen was examined according with WHO criteria and detection of HPV-16 and HPV-18 was realized with real time PCR protocol with commercial kits Also, conventional histology techniques were used to assess spermatozoo morphology and leukocyte count RESULTS 149 semen samples were analyzed from patients with an age average 3727 (22-56 age) The 5618% present oligozoospermic and take into account all patients, 5973% was positive for HPV-16 (2956%), HPV-18 (1611%) or both (1409%) The infection with HPV-16 was more frequent in both oligozoospermic and normozoospermic patients In this latter, a minus abnormal spermatic cells and leukocytes were found in regard to oligozoospermic patients CONCLUSIONS There is an important percentage off human asymptomatic male subjects that present in your semen a positive result for high risk papillomavirus This is very important for the sexual partner because this represent a problem for public health that most be in attention

Efecto del intervalo intergenésico postaborto en los resultados obstétricos y perinatales

Abstract: Antecedentes: el intervalo entre embarazos es importante porque permite a la madre recuperarse luego de un evento obstetrico. Objetivo: evaluar la repercusion del intervalo intergenesico postaborto menor o igual a seis meses en los resultados obstetricos y perinatales. Material y metodo : estudio de casos y controles efectuado en 858 pacientes con antecedente de perdida gestacional temprana en el embarazo previo, de las que 286 tuvieron un intervalo intergenesico corto < 6 meses (casos) y 572 un intervalo intergenesico mayor de seis meses (controles). Se evaluo como resultado obstetrico la frecuencia del aborto y el nacimiento pretermino y como resultados perinatales: apgar < 7, morbilidad y mortalidad perinatales y peso del recien nacido. Resultados : la frecuencia de aborto fue similar entre los grupos con 16.6% en los casos y 13.2% en los controles (RM: 1.12; IC 95%: 0.75-1.69; p = 0.6486); no hubo diferencias en la frecuencia de nacimiento pretermino, que se presento en 5.59% de los casos y en 8.21% de los controles (RM: 0.66; IC 95%: 0.37-1.19; p = 0.2115). El apgar a los cinco minutos fue menor o igual a siete y similar entre los grupos (RM: 1.18; IC 95%: 0.70-2.00; p = 0.6335). La morbilidad (RM: 0.77; IC 95%: 0.27-2.17; p = 0.8005) y mortalidad (RM: 1.14; IC 95%: 0.33-3.94; p = 0.9145) perinatales y el peso de los recien nacidos al nacimiento fueron similares entre los grupos. Conclusion: un intervalo intergenesico corto postaborto menor o igual a seis meses no es un factor de riesgo para un resultado obstetrico y perinatal adverso

Factores sociodemográficos y obstétricos asociados con nacimiento pretérmino

Abstract: Antecedentes: el nacimiento pretermino es la mayor causa de morbilidad y mortalidad neonatal y responsable de 75 a 90% de las muertes neonatales no relacionadas con malformaciones congenitas. Objetivo : evaluar la asociacion entre nacimiento pretermino y factores de riesgo sociodemograficos y obstetricos. Material y metodo : estudio retrospectivo, comparativo, longitudinal y observacional en el que se analizaron los registros clinicos de nacimientos pretermino (casos prevalentes: n = 748) atendidos del 2001 al 2006 en el Hospital Civil de Culiacan, Sinaloa, Mexico. Los controles se seleccionaron al azar de los registros clinicos de pacientes con nacimientos a termino (n = 755). Se analizo la asociacion de nacimiento pretermino con factores sociodemograficos (edad, medio socioeconomico, tabaquismo, alcoholismo, inicio de vida sexual, numero de parejas sexuales) y obstetricos (embarazos, partos, abortos, cesareas, control prenatal, sangrado transvaginal en la primera mitad del embarazo, antecedente de parto pretermino e intervalo posaborto y posparto, rotura prematura de membranas, anemia e in- feccion urinaria). Resultados : en los casos, el nivel socioeconomico bajo se asocio menos con parto pretermino que en los controles (81.9% vs 86.4%; RM: 0.71; IC 95%: 0.5-0.9; p = 0.0191). El nacimiento pretermino se asocio con: sangrado transvaginal en el primer trimestre (RM : 31.06; IC 95%: 7.5-127.6; p < 0.05), antecedente de parto pretermino (RM : 9.33; IC 95%: 2-59.1; p = 0.0006), intervalo posparto igual o menor de un ano (RM: 1.79; IC 95%: 1.2-2.5; p = 0.0021), rotura prematura de membranas (RM : 9.24; IC 95%: 6.1-13.9; p < 0.05) e infeccion urinaria (RM: 3.72; IC 95%: 2.1-6.4, p < 0.05). No se demostro asociacion con el resto de las variables analizadas. Conclusion : el nacimiento pretermino se asocio, significativamente, con el nivel socioeconomico bajo, sangrado transvaginal en la primera mitad del embarazo, nacimiento

[Extreme maternal morbidity in the Hospital General Dr. Aurelio Valdivieso, Oaxaca Health Services].

Abstract: Antecedentes : la morbilidad obstetrica extrema es un prometedor complemento a la investigacion de muertes maternas que se utiliza para evaluar y mejorar los servicios de salud materna. Se trata de una complicacion obstetrica severa que pone en riesgo la vida de la mujer embaraza y que requiere una intervencion medica urgente para prevenir la muerte de la madre. Objetivo : identificar las principales determinantes de la morbilidad obstetrica extrema en el Hospital General Dr. Aurelio Valdivieso, Ser- vicios de Salud de Oaxaca. Material y metodo : estudio observacional, transversal, de revision de expedientes de tipo analitico. Se buscaron los codigos relacionados con los padecimientos que pudieron originar la morbilidad obstetrica extrema y las causas indirectas que pudieron ocasionarla. Resultados : la prevalencia de morbilidad obstetrica extrema fue de 2.1%. Las comorbilidades mas frecuentes fueron: eclampsia, insu- ficiencia hepatica y preeclampsia que dieron la razon de momios y la significacion estadistica mas altas. La asociacion de morbilidad obstetrica extrema derivada de la intervencion quirurgica, a pesar de tener una prevalencia alta, se mostro como un factor protector. Hubo otras variables asociadas pero no tuvieron significacion y sus intervalos de confianza estuvieron por debajo de la unidad, como sucedio con la insuficiencia renal y metabolica y la transfusion sanguinea. Conclusiones : la morbilidad obstetrica extrema tuvo una prevalencia similar a la reportada en otros paises. Casi siempre la originan enfermedades especificas (FLASOG): preeclampsia, eclampsia y hemorragia obstetrica. Las enfermedades del grupo de insuficiencia organica fueron menos frecuentes pero su asociacion con la morbilidad obstetrica externa fue mas significativa. Las agrupadas en el rubro de intervencion no tuvieron

Pregnancy and tetralogy of Fallot with and without surgical correction

Abstract: La tetralogia de Fallot es la mas comun de las lesiones cardiacas congenitas cianoticas. Aunque el embarazo en pacientes con tetralogia de Fallot corregido generalmente tiene una evolucion satisfactoria, puede haber complicaciones cardiovasculares maternas. Objetivo : comunicar nuestra experiencia en el seguimiento y tratamiento de 16 embarazos en 14 mujeres con tetralogia de Fallot. Pacientes y metodo : estudio prospectivo realizado en 16 embarazos de 14 pacientes con tetralogia de Fallot, que acudieron a los ser- vicios de Cardiologia y Embarazo de Alto Riesgo del Hospital de Gineco-Obstetricia del Centro Medico Nacional de Occidente, de enero de 1997 a enero de 2010. Nueve mujeres tenian correccion quirurgica total y cinco no. Todas recibieron protocolo de estudio completo y pruebas de bienestar fetal. Resultados : la hemoglobina y el hematocrito fueron significativamente mas altos en el grupo sin correccion quirurgica, quienes tambien tenian menor saturacion de oxigeno y dilatacion del ventriculo derecho. De los 16 embarazos, 5 terminaron por via vaginal, el resto por cesarea. Los hijos de madres cianoticas tuvieron una terminacion prematura del embarazo, menor peso al nacer y Apgar levemente deteriorado. No hubo muertes maternas ni neonatales, tampoco malformacion cardiaca en los recien nacidos. Conclusiones : son mayores los riesgos para la madre y su hijo en las pacientes con tetralogia de Fallot no corregida y en las operadas con lesiones residuales importantes. La mayor repercusion anatomica se correlaciono significativamente con hemoglobina mayor y menor saturacion de oxigeno, que son los factores de riesgo mas importantes para resultados adversos fetales

Comparación de los síntomas del climaterio entre mujeres perimenopáusicas de la Ciudad de México y las de una comunidad zapoteca del estado de Oaxaca

Abstract: Antecedentes : el sindrome climaterico que acompana a la posmenopausia se ha estudiado en diferentes culturas, con distintos hallazgos entre ellas. Objetivo : comparar las diferencias en la aparicion del sindrome climaterico en mujeres del medio urbano y del medio rural. Material y metodo : estudio transversal en el que se valoraron los sintomas del climaterio con la escala SUMEVA, previamente validada, en dos grupos de mujeres perimenopausicas. El Grupo 1 se integro con mujeres indigenas de habla zapoteca, de San Ildefonso Villa Alta, Oaxaca y el Grupo 2 con mujeres de la Ciudad de Mexico que acudieron a la consulta de ginecologia endocrina de la Unidad Medica de Alta Especialidad del Hospital de Ginecoobstetricia Luis Castelazo Ayala. Para el analisis estadistico se utilizaron medidas de tendencia central y de dispersion. La comparacion de las variables continuas entre los grupos se realizo con la prueba de la t Student y para las discontinuas con la χ 2 . Resultados : la media de la calificacion obtenida con la escala SUMEVA fue de 42.3 ± 31.2 para las mujeres rurales y 63.7 ± 48.6 para las mujeres de la Ciudad de Mexico (p < 0.04). Cuando se analizaron los sintomas por separado, fueron significativamente mas intensos en el grupo de mujeres de la Ciudad de Mexico. Conclusion : las mujeres perimenopausicas de la Ciudad de Mexico experimentaron los sintomas climatericos con mayor intensidad que las del medio rural, hecho que puede estar influido por el estilo de vida en la cultura occidental

Combined hormonal contraception in cycles artificially extended

Abstract: OBJECTIVE: To compare the bleeding patterns satisfaction and tolerability of 3 different contraceptive in an extended regimens in the service of Family Planning of the North Central Hospital of PEMEX. MATERIAL AND METHODS: Healthy adult women with desire of contraception for one year (N 120) were randomly assigned to receive oral contraceptive drospirenone/ethinyl E2 (group1) the norelgestromin/ethinyl E2 transdermal patch (group 2) and vaginal ring etonogestrel/ ethinyl E2 (group 3) in an extended regimen (42 consecutive days 1 hormone-free week). Study assessments were conducted at scheduled visits at the time of initial screening at baseline after 1 3 6 and 12 months. Subjects recorded menstrual associated symptoms bleeding data and completed satisfaction questionnaires. Subjects and investigators provided overall assessments of the regimens. RESULTS: Extended use of 3 different contraceptive resulted in fewer bleeding days in every group (66.6% 55% and 58.3% P 0.0024) and less mastalgia and menstrual pain. Subjects were highly satisfied with three regimens (93.3% 96.6% and 91.6% P 0.00421). Although not mayor adverse events were reported with this regimen there was an increase in spotting days; it decreased with each successive cycle of therapy. Efficacy and safety were similar to those reported for traditional cycle. CONCLUSION: Extended-contraceptive regimen delays menses and reduces bleeding a profile that may be preferred by women who seek flexibility with their contraceptive method.

[Alpha-fetoprotein as an early predictor of adverse perinatal outcome].

Abstract: Background The alpha-fetoprotein (AFP) is a glycoprotein, which is produced by the human fetus. Previous studies have shown associations between elevated AFP levels and an increased risk of adverse perinatal outcomes. Objective To determine if abnormal AFP levels are associated with adverse perinatal outcomes. The AFP concentrations were calculated as Multiples of the medians (MoM). Patients and method A prospective cohort study, including 283 pregnant women, the maternal serum concentration of AFP was determined between 15 and 20 weeks of pregnancy, and the pregnancy was followed until term, when we search for the perinatal outcomes. The study was made in the Instituto Nacional de Perinatologia, in Mexico City, from August 2007 to January 2008. For the analyses, the AFP concentrations were calculated as Multiples of the medians (MoM). Results The threshold of 1.5 MoM increases the risk for preterm delivery (RR: 1.77, IC 95%: 1.04-3.03), abruption placentae (RR: 3.67, IC 95%: 1.59-8.49), placenta accreta (RR: 3.67, IC 95%: 1.59-8.49) and for intrauterine growth restriction (RR: 2.86, IC 95%: 1.74-4.68) There was a weak relation between AFP concentration and birth weight (r = -0.12, p = 0.047) and no correlation with pregnancy weeks at birth. Conclusions There is a relation between adverse perinatal outcome and abnormal AFP levels. The evidence of an increase in the AFP concentration in fetuses without congenital defects should alert de clinician about the possibility of other adverse perinatal outcomes and those results must be included in the prenatal risk assessment.

Rotura uterina por acretismo placentario

Abstract: La rotura uterina durante el embarazo es una de las complicaciones mas graves, que aumenta la morbilidad y mortalidad materna y fetal. La rotura uterina por placenta percreta es rara. Comunicamos el caso de una paciente de 39 anos, con embarazo de 16.3 semanas por ultrasonido, quien ingreso por dolor abdominal de 48 horas de evolucion, de predominio en la region hipogastrica, que durante su evolucion padecio afectacion hemodinamica y aumento del dolor abdominal. Por ultrasonido se observo liquido libre en la cavidad abdominal. Mediante la laparotomia se encontro el utero perforado con producto y placenta libres en la cavidad abdominal. Se realizo histerectomia obstetrica y se confirmo el diagnostico de rotura uterina por placenta percreta

Prevalencia de condiloma acuminado en mujeres que acuden a detección oportuna de cáncer cérvico uterino en un primer nivel de atención

Abstract: Antecedentes : la incidencia y prevalencia de la enfermedad de trasmision sexual se han estimado con base en la informacion contenida en los diferentes bancos de datos, aunque cada una de esas fuentes tiene limitaciones. Objetivo : evaluar la prevalencia anual de condiloma acuminado genital en las mujeres que acuden a deteccion oportuna de cancer cervicouterino. Material y metodo : estudio prospectivo, transversal y observacional realizado en la clinica de primer nivel de atencion Zaragoza del Sistema de Transporte Colectivo Metro de la Ciudad de Mexico; de enero del ano 2000 a junio del 2009. Se incluyeron todas las pacientes que acudieron a deteccion oportuna de cancer cervicouterino. Resultados : en 3,232 citologias cervicovaginales se detectaron 106 casos de condiloma acuminado genital confirmados por clinica y biopsia, lo que dio una prevalencia anual de 3.2%. La mayor cantidad de casos por prevalencia por edad fue entre 30 y 34 anos, con tasa de 21.6%. Discusion : la prevalencia de infeccion por virus del papiloma humano varia en las diferentes regiones del mundo; suele alcanzar valores de 20 a 30% en mujeres de 20 a 24 anos de edad y posteriormente disminuye a 3 a 10% en mujeres mayores de 30 anos. Conclusion : es importante establecer medidas encaminadas a prevenir el contagio, exhortando a la poblacion adolescente de hombres y mujeres a tener una sexualidad responsable

Potential treatment of infertility with second ejaculate

Abstract: OBJECTIVE: To compare the changes that occurs in the spermatic parameters when a second ejaculate is obtained in the first 60 minutes in patients with a different seminal quality. MATERIAL AND METHOD: Infertile patient from andrology service were asked to provide a second sample within 1 hours of the first. All the patients had poor semen characteristics in volumen, density, motility or total motile cells. RESULTS: The patients were divided in subgroup; hipospermia (n = 75), oligospermic (n = 46), asthenospermic (n = 111) and teratospermic (n = 157). A benefic effect from a second ejaculate sample was observed in patients with asthenosperia, oligospermic and a total motile sperm count less than 10 million (p < 0.05). CONCLUSIONS: The second ejaculate must be considered as an alternative in some infertile patients that are looking for an spontaneous pregnancy or in patients that will require an assisted reproductive techniques and have poor seminal parameters.