Showing papers in "Revista Peruana de Ginecología y Obstetricia in 2015"
TL;DR: To determine the perinatal characteristics of pregnant adolescent women, a retrospective, descriptive study with a focus on women in their 20s and 30s is needed.
Abstract: OBJECTIVE: To determine the perinatal characteristics of pregnant adolescent women. DESIGN: Retrospective, descriptive study. SETTING: Edgardo Rebagliati Martins National Hospital, EsSalud, a teaching hospital. MATERIALS AND METHODS: We analyzed all deliveries attended in adolescents from January 2000 through December 2004. RESULTS: There were 443 deliveries in adolescents, average age 18,3 years, 16,3% of them (72) 17 year-old or less, and 83,7% (471) between 18 and 19 years. It was the first pregnancy in 81,3%, preterm delivery occurred in 17,1%, cesarean-section rate was 41,5%; 84,4% of the newborns weighed between 2500 and 3999 g and 12% less than 2500 g. CONCLUSIONS: Preterm delivery and perinatal mortality were higher in adolescents than in the hospital general pregnant population, mainly in the 17 year-old or less adolescent, becoming the higher risk group. Vaginal delivery was more frequent in the adolescent, but the incidence of cesarean- section increased in the adolescent 17 year-old or less in comparison with the 18 and 19 year-old.
30 citations
TL;DR: An updated review on the modifications and adaptation of the maternal organism to pregnancy, emphasizing their repercussions on complications during pregnancy is presented.
Abstract: We present an updated review on the modifications and adaptation of the maternal organism to pregnancy, emphasizing their repercussions on complications during pregnancy. We also consider to know these modifications for therapeutic adjustments in case we need to administer medicines and drugs during the pregnancy.
20 citations
TL;DR: The concept of bioethics is born in Seattle early in the sixties when a non-medical committee was created to decide who had preference for hemodialysis and Beauchamp and Childress introduce the concept of non-maleficency.
Abstract: Background. It is considered that the concept of bioethics is born in Seattle early in the sixties when a non-medical committee was created to decide who had preference for hemodialysis. Term bioethics is given by the North American oncologist Potter in 1970. In 1974 the USA Congress creates a commission to elaborate ethical directives and protect rights of persons participating in research studies. Belmont´s report appears in 1978, one of the first documents written on bioethics, where autonomy, beneficent professional practice and justice are recognized. In 1979 Beauchamp and Childress introduce the concept of non-maleficency. Principles of bioethics. Principle of autonomy: is the obligation to observe each individual’s values and personal options in such basic decisions concerned. Principle of beneficence: is the obligation to do well. Principle of non-maleficence: is respect to the human being integrity, ever more relevant with technical and scientific advances. Principle of justice: is the equitable division of charges and benefits in vital wellbeing, avoiding access discrimination to sanitary resources. Role of gynecologists and obstetricians. To try equitable access to health services by women independently from age, race, marital, socioeconomical or religious status, recognizing sexual and reproductive rights an integral part of human rights.
19 citations
TL;DR: Hoy en día, la maternidad segura se debe enfocar como un problema de salud pública y de derechos humanos, aceptando that todas las mujeres son sujetos de dereChos e individuos with dignidad.
Abstract: Quisiera empezar la redacción de este capítulo tomando las palabras que Alicia Yamín escribe en su reciente publicación: \"La muerte materna representa una enorme discriminación de género en el Perú\" -y en el mundo. \"Hoy en día, la maternidad segura se debe enfocar como un problema de salud pública y de derechos humanos, aceptando que todas las mujeres son sujetos de derechos e individuos con dignidad\".
18 citations
TL;DR: Advanced maternal age represented an independent risk factor for medical and obstetric complications and the recognition of such factors is important for the reduction of perinatal morbidity and mortality in this group of patients.
Abstract: Objective: To determine whether maternal age 35 years or older is an independent risk factor for maternal and perinatal complications. Design: Case-control, comparative study. Setting: Arzobispo Loayza National Hospital, Lima, Peru, III level teaching hospital. Participants: One hundred and sixty six 35 years or older pregnant women were compared with 324 pregnant women less than 35 years old. These patients were randomly selected of those attended in 2005. Mantel-Haenszel x2 statistics was used to compare age specifically, with P< ,05 considered statistically significant. Main outcome measures: Multiple logistic regression analysis was used to evaluate the association between maternal age and outcome variables, controlling for possible confounding factors. Results: Advanced maternal age was independently associated with abnormal fetal presentation during labor (OR 1,05; 95% IC 1,01, 1,10), cesarean section due to third trimester bleeding (OR 1,05; 95% IC 1,01, 1,09), preterm delivery (OR 1,08; 95% IC 1,02, 1,14), chronic hypertension (OR 1,03; 95% IC 1,01, 1,05), recurrent abortion (OR 3,09; 95% IC 1,49, 6,43), and grand multiparty (OR 10,34; 95% IC 3,46, 30,93). The prevalence of gestational diabetes was higher in the cases. Perinatal mortality rate, 7 or lower 5-minute Apgar score, low-birth-weight and puerperal morbidity were not influenced by maternal age. Conclusions: After correcting for confounding factors the advanced maternal age represented an independent risk factor for medical and obstetric complications. The recognition of such factors is important for the reduction of perinatal morbidity and mortality in this group of patients.
16 citations
TL;DR: Maternal mortality rate continues being high in Peruvian hospitals and hemorrhage is the most important cause, followed by pregnancy induced hypertension.
Abstract: OBJECTIVE: To update rate and causes of maternal death at Peruvian hospitals. DESIGN: A Self Evaluation Manual was elaborated and 31 hospitals were selected 7 in Lima and Callao and 24 in the different regions of Peru. The Self Evaluation Manual was previously sent to the hospitals and a report was requested. A technical team had scheduled visits to each hospital and met with the board of directors. Registry information of the three previous years was obtained and processed with the V2, 6 Fox Pro Program. RESULTS: Seventeen hospitals to the coast, 10 to the mountains and 4 to the jungles; 25 were from the Ministry of Health, 3 from the Peruvian Institute of Social Security, 2 were integrated hospitals with origin in both institutions and 1 was aprivate hospital. Previous year total deliveries were 100 063; 66,6% with 1 or moreprenatal controls; only 43,6% had had 4 or more controls; there were 20,5% cesareansection and 2,2% instrumental deliveries; 15,4% abortions, 6,7% low weight newborn babies and 4,3% low Apgar newborns. There were 349 maternal deaths in 155 797 live newborn delivered during the three years before the survey, with a rate of 224,04 per thousand live newborns. Lima’s rate was 120,14 and in the rest of the country it was 255,66. Coast hospitals rate was 147,11, in the mountains 145,36 and in the jungles 728,00. Integrated hospitals presented a higher rate and the rate was higher in the smallest and largest hospitals. Direct causes were responsible of 84,5% of deaths and indirect causes of 15,5%. Among direct causes, hemorrhage was the most frequent, followed by pregnancy induced hypertension. CONCLUSION:Maternal mortality rate continues being high in Peruvian hospitals and hemorrhage is the most important cause.
14 citations
Ipas1
TL;DR: Misoprostol is a pharmacological agent that exists and is commercialized in Latin America and its use in Obstetrics continues spreading and there have been few specific initiatives to restrain access to it but there have also been very few initiatives to facilitate its access.
Abstract: Objective: To update information on misoprostol obstetrical use in order to determine availability mapping in Latin America and the Caribbean countries. Design: Survey type study. setting: Latin America and the Caribbean countries. Participants: Public and private sources. Methodology: A survey semiestructured format was elaborated and sent to key Latin America and the Caribbean informers. They consulted different public and private sources in each country. Answers were ncorporated in a database to obtain frequencies of each variable studied. main outcome measures: Misoprostol trademarks, content and availability. Results: Misoprostol is obtained in different trademarks in Latin America and the Caribbean, usually in 200 μg oral tablets presentations and only one is presented as 25, 50, 100 y 200 μg vaginal tablets. Few presentations associate misoprostol to an antiinflammatory. There are 17 laboratories that produce the drug and Pfizer is the laboratory with more presence in these countries. Only four available presentations are generic and 35 specific. Medical prescription is usually obligatory, but the drug can be obtained without prescription. Pharmacies and drugstores are in charge of distribution, but it can be found in hospitals, private hospitals, pharmacies and informal market. Cost varies from one country to another and is exorbitant in countries where it is obtained backstreet. Usually regulations establish the drug is for gastrointestinal use; though in 12 countries some obstetrical indications are accepted, mainly labor induction. There have been few specific initiatives to restrain access to misoprostol but there have also been very few initiatives to facilitate its access. Notwithstanding the great publication production on misoprostol around the world, very few have been written in the region. conclusions: Misoprostol is a pharmacological agent that exists and is commercialized in Latin America and its use in Obstetrics continues spreading.
14 citations
TL;DR: The intrapartum risk factors most important constituted premature rupture of membranes, fetal distress and dysfunctional labor and the incidence of Caesarean sections in all high-risk pregnant women was 35 .6 %.
Abstract: 1632 pregnant women attended by the author, 437 (26.7%) had obstetric risk and 186 (11 .4%) of intrapartum risk. Those with obstetric risk in the pre natal, 32% had medical problems (varicose veins, pulmonary tuberculosis, urinary tract infections, Rh negative, endocrinopathies) and 40% major obstetric history (caesarean section, multiparity. The intrapartum risk factors most important constituted premature rupture of membranes, fetal distress and dysfunctional labor. While only 13.7% of the population studied had her baby by Caesarean section, the incidence of Caesarean sections in all high-risk pregnant women was 35 .6 %. There was a 52% of puerperal infection in the second group. the perinatal mortality was 27% N .V. in the general population and 64% N .V. at high risk.
14 citations
TL;DR: Bacterial vaginosis is the most common vaginal infection among reproductive age women from Quilmana City, representing at least one third of such infections.
Abstract: Objective: To evaluate the prevalence of bacterial vaginosis in women of a rural population with vaginal discharge. Design: Prospective, transversal, analytical study. Material and Methods: Vaginal secretion samples were taken from 100 patients with vaginal discharge, and microbiologic analysis and Amsel‘s criteria for bacterial vaginosis diagnosis were applied. Results: Bacterial vaginosis was found in 33% of patients that fulfilled at least 3 of the 4 Amsel‘s criteria, candidiasis in 15%, trichomoniasis in 4% and mixed culture in 5%. Clue cells and the amine test allowed us to identify the largest percentage of patients with bacterial vaginosis; likewise, the presence of clue cells alone, clue cells + odor and odor + pH had high positive and negative predictive value. Vaginal discharge sensitivity is low. Conclusions: Bacterial vaginosis is the most common vaginal infection among reproductive age women from Quilmana City, representing at least one third of such infections. Diagnosis can be done in ambulatory clinical practice applying only two of the Amsel’s criteria, like amine test plus vaginal secretion pH.
13 citations
TL;DR: Gender violence is very frequent among women attended at reproductive health services, and problem detection is not difficult when the questionnaire used in this research is applied.
Abstract: Objective: To determine gender based violence prevalence in reproductive health services users and to motivate heath protessionals to detect these cases using an easy questionnaire. DESIGN: Survey type transversal descriptive study. Material and Methods: Two hundred and ninety-eight reproductive health services users at three Lima hospitals, between May and July 2002. Study searched for history of psychological, physical and sexual violence as well as sexual abuse during childhood. Time of violence and the relation between aggressor and the victim were identified. Data was processed with EpiInfo at the Campinas-Brasil University and Inppares. Results: Sixty-one per cent of the women interviewed accepted being victims of some type of violence, including emotional violence 54%, physical violence 32,2%, sexual violence 21, 1 % and childhood sexual violence 19, 1 %. Main aggressors were de current partner or the ex-husband, and the near family members were responsible for childhood sexual aggression. Conclusion: Gender violence is very frequent among women attended at reproductive health services. Problem detection is not difficult when the questionnaire used in this research is applied.
13 citations
TL;DR: An update on the epidemiology of preeclampsia is presented and it is shown that women who develop preeClampsia during pregnancy are at higher risk of future diabetes mellitus, hypertension and cardiovascular complications.
Abstract: Preeclampsia is a complication of pregnancy characterized by inadequate placentation, resultant ischemia and failure of several maternal organs. Preeclampsia is one of the most serious conditions in pregnancy and a leading cause of maternal and perinatal morbidity and mortality. Various risk factors and some protective factors have been reported associated to preeclampsia. Finally, women who develop preeclampsia during pregnancy are at higher risk of future diabetes mellitus, hypertension and cardiovascular complications. In this article an update on the epidemiology of preeclampsia is presented. Keywords: Preeclampsia, prevalence, risk factors, protective factors, complications, maternal mortality, perinatal mortality.
TL;DR: Pregnant women who present risk factors found in this and other studies should be controlled carefully in order to reduce the incidence and complications of this hypertensive disorder.
Abstract: OBJECTIVE: To identify risk factors for preeclampsia in Peruvian women. Design: Prospective case control clinical study. SETTING: Materno Perinatal Institute and Dos de Mayo Hospital between August 1997 and January 1998. MATERIAL AND METHODS: One hundred eighty-seven preeclampsic women were compared with 193 normotensive pregnant women. Cases were matched to controls regarding Inaternal age and gestational age. Potential associated factors were analyzed using univariated analysis and then logistic regression to adjust to confounders. RESULTS: Pre eclampsia was associated to primiparity but only by univaried analysis (OR. 1,86, IC95: 1,2-3,0). History of a previous pregnancy complicated with preeclampsia was the main risk factor associated to preeclampsia (OR: 9,7. IC95%: 3,4-27,3). Obesity was marginally associated to preeclampsia (OR: 2,1. IC95%: 0,8-5,4) and there was a marginally significative lineartrend (p = 0, 056) for preeclampsia risk as BMI increases. CONCLUSION: Preeclampsia is correlated to several risk factors. Pregnant women who present risk factors found in this and other studies should be controlled carefully in order to reduce the incidence and complications of this hypertensive disorder.
TL;DR: Only urinary infection and large for gestational age were more common in adolescents, and perinatal maternal complication is a very important one in adolescents under 16 factor in late adolescence.
Abstract: Objectives: To identify the main maternal and perinatal complications in primiparous adolescents, when compared with a control group. Design: Observational, analytical, case-control. Location: Obstetrics and Gynecology Service, Hospital Nacional Sergio E. Bernales, teaching hospital. Participants: primigravid Adolescents. Interventions: He divided the population {on two homogeneous groups of 162 participants each, randomly selected and distributed by age in case group (10-19 years old) and control (20-29 years). Main outcome measures: Complications in pregnancy. Results: The mean age of the adolescents was 17.5 years, 61.2% had not completed secondary school, only 8.6% were students, 83% housewife. 71% of couples of teenagers teen was of age. The teens had less prenatal care than adults, 83% versus 89%, although with p> 0.05. The most common complication was urinary teen infection (p = 0.00). Numericamnete, there was a higher incidence of anemia, preeclampsia, premature rupture of membranes, bone dystocia funicular dystocia, placental senescence, prolonged labor and prolonged expulsion, puerperal infection and retention of afterbirth; but no statistically significant differences compared to the control group. Cesarean section was also more frequent in the control group compared to the group of teenagers, but with p> 0.05. The condition of the newborn large for gestational age was the only commplicacion, with p> 0.05. Conclusions: Only urinary infection and large for gestational age were more common in adolescents. Perinatal maternal complication is a very important one in adolescents under 16 factor. In late adolescence, they seem much more important and greater impact various factors psychological and social.
TL;DR: The frequency and seriousness of these complications rise as the disease worsens, and as such convulsions have to be prevented and treatment of the disease must be timely, with well established protocols and complete use of drug doses, such as magnesium sulfate.
Abstract: Objectives: To identify maternal and perinatal complications of preeclampsia and eclampsia. Design: Cross sectional study of 359 cases of pregnant women with preclampsia and eclampsia and their products, diagnosed from July 1 1997 to June 30 1998 at Maria Auxiliadora Hospital. Clinical records were reviewed and maternal and perinatal complications were determined. Frequencies were introduced in a double entry table and compared to a control group consisting of the remaining patients without this disease. A value of p < 0,05 was considered significant. Results: In the five-year interval preeclampsia increased significatively from 7,0% to 10,6%, whereas eclampsia decreased from 0,8% to 0,4%. Maternal complications related to death were HELLP syndrome, DIC, hepatic subcapsular hematoma rupture and cerebral hemorrhage. Perinatal complications were neonatal depression, small for gestational age, neonatal depression and asphyxia, respiratory distress and prematurity. Conclusions: Maternal and newborn complications as a result of preeclampsia and eclampsia occur frequently. The frequency and seriousness of these complications rise as the disease worsens, and as such convulsions have to be prevented and treatment of the disease must be timely, with well established protocols and complete use of drug doses, such as magnesium sulfate.
TL;DR: The probable reasons for non-improvement in maternal mortality rate at a Peruvian Social Security National Hospital are discussed and measures that may contribute to decrease maternal deaths are emphasized, including obstetrical attention with quality and warmth, better reference and improvement of the hospital obstetrical equipment.
Abstract: Objective: To determine maternal mortality rate tendency at a Peruvian Social Security National Hospital during the 44 years of existence. Design: Epidemiological descriptive retrospective study of maternal deaths registered at our Hospital from 1958 through 2002. Subjects: Two hundred and thirty-three women that died during pregnancy, delivery or postpartum. Setting: Department of Obstetrics and Gynecology, Edgardo Rebagliati-Martins National Hospital, EsSalud. Results: Direct obstetrical deaths represented 71,7% (167 cases) of all deaths, including 27,0% (63 cases) of pre-eclampsia-eclampsia cases, 23,2% (54 cases) infections, 14,6% (34 cases) hemorrhage and 6,9% (16 cases) other direct obstetrical causes. Indirect obstetrical causes represented 27,9% (65 cases) and non-related causes 0,4% (1 case). Maternal mortality rate was 42,61100 000 live-newborns, rate unchanged for the past 12 years but for a slight increase in indirect causes. Conclusions: We discuss the probable reasons for non-improvement in maternal mortality rate at our Hospital and emphasize on measures that may contribute to decrease maternal deaths, including obstetrical attention with quality and warmth, better reference and improvement of the hospital obstetrical equipment.
TL;DR: In this study of MINSA Peruvian hospitals preeclampsia incidence and maternal and neonatal morbidity and mortality were similar to findings in the literature, and were related to social and age factors.
Abstract: Objectives: To determine preeclampsia (PE) and eclampsia (E) maternal characteristics in Peruvian hospitals and influence on mother and neonate. Design: Observational, analytical, cross-sectional type study. Setting: Hospitals of the Ministry of Health of Peru. Participants: Pregnant women with or without preeclampsia and eclampsia (PE/E) and their newborns. Methods: Perinatal Information System SIP 2000 data of 310 795 pregnant women and their 314 078 newborns attended at 28 MINSA hospitals during 2000-2006 were analyzed. Data analysis was done using SPSS 14.0 and Epi Info 6.0 statistical packages. Main outcome measures: Maternal and neonatal characteristics and influence of PE/E. Results: From all pregnant women 295 075 did not have PE/E (94.9%) and 15 720 had PE/E (5.1%) [preeclampsia 14 993 (4.8%) and eclampsia 727 (0.24%)]. Significant preeclampsia-associated factors were maternal age 35 or over, multiple pregnancy, abruptio placentae, and abdominal delivery; factors associated to eclampsia were age less than 20, single state, illiteracy/low level of education, multiple pregnancy abruptio placentae, and cesarean section. Significant findings in newborns of PE/E mothers were low birthweight for gestational age, low Apgar score needing resuscitation, and newborn weight less than 2 500 at discharge. More maternal and neonatal deaths occurred in eclampsia in relation to pregnant women without PE/E or with non-convulsive preeclampsia. Conclusions: In this study of MINSA Peruvian hospitals preeclampsia incidence and maternal and neonatal morbidity and mortality were similar to findings in the literature, and were related to social and age factors. It is necessary to continue determining evolution of this fearsome complication of pregnancy in Peru. Keywords: Preeclampsia, eclampsia, Peruvian pregnant women, maternal mortality, neonatal mortality.
TL;DR: The relationship between pregnancy and inflammation as determined by cytokine expression profile and the trophoblast endocrine function is recalled.
Abstract: We present an update on placental physiology and placenta as a barrier, from maternal uterus modifications- a process known as decidualization, implantation and trophoblast invasion, until the placental barrier is established; we explain the different mechanisms of mother-child transfer with emphasis in the transport molecules. Finally we recall the relationship between pregnancy and inflammation as determined by cytokine expression profile and summarize the trophoblast endocrine function.
TL;DR: Rupture of membranes over 6 hours appears as the most important risk factor, followed by cesarean section, prolonged labor, labor induction, number of vaginal examinations and infection of the urinary tract.
Abstract: OBJECTIVE: To determine the incidence and risk factors for puerperal endometritis. DESIGN- Prospective, longitudinal, comparative, and observational study. LOCATION: Department of Obstetrics, Edgardo Rebagliati Martins National Hospital, PSSI. SUBJECTS: 3350 pregnant women who delivered at our Hospital. RESULTS: Puerperal endometritis occurred in 2,6% mainly in primiparae and great multiparae. Rupture of membranes over 6 hours appears as the most important risk factor, followed by cesarean section, prolonged labor, labor induction, number of vaginal examinations and infection of the urinary tract. Cultures grew mainly E. coli. CONCLUSION: Early detection of risk factors would preclude the installation of puerperal endometritis.
TL;DR: New proposed theories on the pathophysiology of preeclampsia are discussed and genetic and angiogenic aspects of preeClampsia will be reviewed.
Abstract: Preeclampsia is one of the most frequent and serious disorders of pregnancy. It is a significant contributor of maternal and perinatal mortality worldwide. An important amount of research has been devoted in the research of preeclampsia in the recent years; nonetheless, its pathophysiology is yet to be completely understood. In this review, we will discuss new proposed theories on the pathophysiology of preeclampsia. Genetic and angiogenic aspects of preeclampsia will be reviewed elsewhere in this issue. Keywords: placental ischemia, endothelial dysfunction, nitric oxide, oxidative stress, endoplasmic reticulum stress, Chlamydia pneumoniae, fetuin-A
TL;DR: There were significant differences in newborns at term birth weight in the five cities studied, and male babies were heavier than female babies at different altitudes.
Abstract: Objectives: To determine birth weight at different levels of altitude and relation with sex of newborns. Design: Descriptive and retrospective study. Settings: Lima, Arequipa, Cusco, Puno and Cerro de Pasco EsSalud hospitals. Participants: Normal term neonates. Interventions: Birth weight of 19 543 normal neonates at term from normal singleton pregnancies recorded between 2001 to 2005 by the Peruvian Social Health Security Perinatal Information System database were analyzed in the cities of Lima (150 m), Arequipa (2 340 m), Cuzco (3 400 m), Puno (3 830 m) and Cerro de Pasco (4 340 m). Main outcome measures: Weight and sex of newborns. Results: There were significant differences in newborns at term birth weight in the five cities studied (p < 0.05). History of abortions, and current cesarean sections and sex of newborns were similar in all groups. Conclusions: Difference in mean birth weight at term was around 55 g in the first four cities, but increased between Puno and Cerro de Pasco in about 250 g. Significant reduction in birth weight occurred over 2 340 m and much more over 4 000 m. Male babies were heavier than female babies at different altitudes.
TL;DR: In this article, the advantages of vertical childbirth over supine confinement were evaluated in 160 pregnant women who had either vertical or supine childbirth and found that the women perceived vertical birth as faster, more comfortable and less painful; they enjoyed seeing their babies being born.
Abstract: OBJECTIVE: To determine the advantages of vertical childbirth over supine confinement. DESIGN: Observational, comparative and cross sectional study. SETTING: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru, a medical residency hospital. Participants: Pregnant women who had either vertical or supine childbirth. INTERVENTIONS: We studied 160 women from June 2006 through June 2007; 80 had vertical delivery and 80 supine childbirth. Main outcome measures: Time of delivery, uterine bleeding volume, episiotomy need, complications, maternal perception. RESULTS: Time for third stage of labor was shorter in vertical versus supine confinement (11,39 versus 19,48 minutes respectively). Average bleeding volume was similar in both groups (300 mL and 296,74 mL respectively). Considering the use and non-use of post partum oxytocin, significant higher bleeding volume was encountered when oxytocin was not used in both groups. Kristeller’s maneuver was hardly necessary for vertical delivery (1,3%) but it was performed in 16 patients with supine childbirth (20%). Episiotomy need was less for vertical delivery (26,5% and 56,3 respectively). Instrumental delivery was required in two supine childbirth cases (1 vacuum, 1 output forceps). There was one case of vaginal hematoma and one postpartum hemorrhage with supine childbirth, with no statistical significance. There were more vaginal superficial tears in the vertical delivery group when episiotomy was not done (83% and 60% respectively). Mothers perceived vertical birth as faster, more comfortable and less painful; they enjoyed seeing their babies being born (96,3% vs. 42,5% respectively) and vertical childbirth was recommended by most women from both groups (81,9% of the 160 women). CONCLUSIONS: Vertical delivery offers significant advantages compared to supine confinement with shorter third stage of labor, less pain, more comfort, and most rewarding.
TL;DR: The pregnant woman 35 or older has high reproductive risk and requires good preconception counseling, prenatal care with a focus on risk and disposal of fetal malformations, institutionalized childbirth and maternal and perinatal monitoring pre-, intra- and post-partum.
Abstract: OBJECTIVES: To determine the risk for birth and perinatal morbidity and mortality in the elderly mother pregnant. DESIGN: Retrospective clinical study of cross section. MATERIALS AND METHODS: Pregnant Women 35 years or older treated at the San Juan de Dios Hospital in Callao, between January 1990 and December 1991. birth outcomes and maternal and perinatal morbidity and mortality with the pregnant minor is compared 35 treated at the same time. RESULTS: Of 10 445 deliveries, 744 were for anosas pregnant women (7.7%). There were significantly more births anosas dystocic in pregnant women (19.2% vs 10.6%), including breech presentations (7.3%), transverse (0.9%) and other rare (0.6%), having served more vaginal breech births (6.1% vs 2%); the incidence of caesarean sections was 11%. The cesareada previous cesarean was the most common cause in both groups. The maternal mortality rate was 397 per 100 000 live births in most pregnant women and 41 per 100 000 live births in the less than 35 years, unlike statistical significance. In the elderly mother, perinatal mortality was due more often to severe asphyxia (30%), prematurity (16.6%) and congenital malformations (13.3%), the rate of perinatal mortality in aged pregnant was 39, 7 per 1000 live births, and under 35 years 24.8 per 1,000 live births, a statistically significant difference. The overall perinatal mortality rate was 27.8 per 1,000 live births. CONCLUSIONS: The pregnant woman 35 or older has high reproductive risk and requires good preconception counseling, prenatal care with a focus on risk and disposal of fetal malformations, institutionalized childbirth and maternal and perinatal monitoring pre-, intra- and post-partum.
TL;DR: The epidemiology, risk factors, diagnosis and treatment of vaginal infections, including candidiasis, are reviewed.
Abstract: Vaginal infections are important cause of consultation as the only symptom or accompanied by other problems of different relevance. Depending on investigation series candidiasis represents the first or second place in the differential diagnosis of the different causes of vulvovaginal disturbances and vaginal discharge. In this article we review the epidemiology, risk factors, diagnosis and treatment.
TL;DR: Third trimester hemorrhage, preterm rupture of membranes, acute fetal distress, preeclampsia and twin pregnancy were risk factors for preterm birth.
Abstract: OBJETIVE: To determine the risk factors of preterm birth. DESIGN. Case control study. Setting: Maternal Perinatal Institute during the first trimester of 1996. MATERIAL AND METHODS: One hundred and sixty-five patients with preterm birth and 330 controls. RESULTS: The absence of prenatal control (OR= 14,4 and P < 0,01), born in the highland (OR= 2,26; P= 0, 001) and jungle (OR= 3,33; P= 0, 013), living in a poverty district (OR= 2,52; P= 0,05), previous preterm births (OR= 1,62; P< 0,05), obstetrical diagnosis of third trimester hemorrhage (OR= 17,33; P= 0, 00001), preterm rupture of membranes (OR= 7,29; P = 0,000001), acute fetal distress (OR= 3,63; P= 0, 005), breech presentation (OR=2,89; P= 0,021), preeclampsia (OR=1,92; P= 0,05) and twin pregnancy (OR= 2,26; P= 0, 09) were risk factors for preterm birth. CONCLUSION: Third trimester hemorrhage, preterm rupture of membranes, acute fetal distress, preeclampsia and twin pregnancy were risk factors forpreterm birth.
TL;DR: The most frequent indications for cesarcan delivery were cephalopelvic disproportion, fetal distress, previous cesarean section and breech presentation, and the main complications were puerperal endometritis and surgical wound infection.
Abstract: OBJECTIVE.- To determine the main indications and complications of cesarean deliveries. MATERIAL AND METHODS.- Retrospective study that reviewed the clinical and perinatal histories of 109 patients who underwent cesarean section at Oxapampas General Hospital trom January 2001 to December 2002. Maternal and neonatal variables were analyzed using percentage and frequency tables. RESULTS: The cesarean delivery rate was 25,7%, The majority of the patients were between 20 and 35 years-old (56,9%), had primary education (35,8%), were not married (54,%) and had a term pregnancy (77,6%). The most frequent indications forcesarean delivery were cephalopelvic disproportion (21,1%), fetal distress (20,2%), previous cesarean section (11,9%), and breechpresentation (9,296). Seven patients (6,3%)presented puerperal morbidity and endometritis and surgical wound infection were the most frequent complications (28,6%). There were no maternal deaths. The perinatal mortality rate was 8,7 deaths per 1000 births. CONCLUSIONS.- The cesarean delivery rate was 25,7%. The most frequent indications for cesarcan delivery were cephalopelvic disproportion, fetal distress, previous cesarean section and breech presentation. The main complications were puerperal endometritis and surgical wound infection.
TL;DR: The incidence of maternal complications and newborn are higher in pregnant teen in pregnant women of 19-30 years of age, and these complications are more common at altitude than sea level.
Abstract: OBJECTIVES: To determine the factors that have contributed to pregnancies occur in adolescence, and the characteristics and risks of the same height in a population. DESIGN: Retrospective descriptive study of 423 medical records in Jauja-Junin (3375 m) between January and June 1996. RESULTS: The incidence of early pregnancies in adolescents (under 16 years) was 5.4% between late adolescence ( 16 to 19 years) and 21.3% among pregnant women aged 19 to 30 years 73.3%. increased incidence of celibacy, unemployment, abortion, preeclampsia, preterm delivery and low birth weight in pregnant adolescent early as in the late was found; and increased incidence of celibacy, unemployment, stillbirth, caesarean section, preeclampsia, eclampsia, preterm delivery, postpartum and neonatal abnormal pathology in pregnant women between 16 and 19 years than in the 19 to 30 years. He had no prenatal more than 80% of pregnant women in the three study groups. CONCLUSIONS: The incidence of maternal complications and newborn are higher in pregnant teen in pregnant women of 19-30 years of age. Also, these complications are more common at altitude than sea level.
TL;DR: Antiangiogenic phenomena and their relation with the fetus may be crucial in clarifying this unanswered question of early-onset preeclampsia and the possibility that these are two different diseases.
Abstract: Significant differences between preeclampsia manifestations before (early-onset) and after 34 weeks (late-onset) raise the possibility that these are two different diseases. This hypothesis is strengthened based on genetic, epidemiological and placental differences. However, recent studies show the possibility of temporal continuity between both clinical phenotypes. In this context antiangiogenic phenomena and their relation with the fetus may be crucial in clarifying this unanswered question. Keywords: Early-onset preeclampsia, late-onset preeclampsia, antiangiogenic imbalance
TL;DR: Risk factors identified by ENDES at population level and by SIP at hospital level are complemented, the latter with higher predictive value por perinatal mortality.
Abstract: OBJECTIVE: To identify Peruvian perinatal mortality risk factors at both population level (ENDES) and hospital level (SIP) and to determine their predictive value. DESIGN:Epidemiologic, analytical, case-control study using information from both the National Survey of Demography and Health (ENDES) and the Perinatal Computer System (SIP) of 9 hospitals of the Ministry of Health corresponding to the year 2000. MATERIAL AND METHODS: The study included mothers with gestations more than 28 weeks or newborns weight above 1000g. We used rate per thousand births, odds ratio (OR) with 95% confidence intervals, population attributable risk percentage (RAP%), logistical and curved regression ROC (receiving operating characteristic). RESULTS: The rate of perinatal mortality in Peru in the year 2000 was 23, 1 per thousand births according to ENDES, similar to the 22,9 rate of the hospital study. ENDES risk factors were rurality (OR= 1,5), altitude > 3000 masl (OR= 1,7), language different to spanish (OR= 1,8), agriculture occupation (OR= 1,6), low scholarship (OR= 1,5), short intervals between pregnancies (OR=4,7) and domiciliary childbirth (OR= 1,8), being the three last susceptible of control. The hospital risk factors were: mountain region (OR= 2,l), altitude>3000 mas1 (OR= 1,8), low scholarship (OR= 2,3), old maternal age (OR= 1,6), previous fetal death (OR= 1,9), short pregnancy interval period (OR= 4,5), multiparity (OR= 1,9), absence of prenatal control (OR= 2,l), anomalous presentation (OR= 4,3), maternal and neonatal pathology (OR= 2,4 and 56,7), low birthweight (OR= 9,8), prematurity (OR= 5,6), intrauterine malnutrition (OR= 5,5), low Apgar score at one and 5 minutes (OR= 4,3 and 46,6); the last seven were factors susceptible of control. Three ENDES risk factors-short interval between pregnancies, altitude> 3000 masl and absence or inadequate prenatal control- had low predictive value (62%); at hospital level predictive value was 96% with low birthweight, prematurity, newborn depression, neonatal morbidity and multiparity. CONCLUSIONS.- Risk factors identified by ENDES at population level and by SIP at hospital level are complemented, the latter with higher predictive value por perinatal mortality. We recommend the inclusion of hospital information in future ENDES.
TL;DR: Gender based violence is very frequent in the pregnant population attended at Lima's South Cone obstetrical services and is associated with higher maternal and perinatal pathology frequency and higher per inatal mortality.
Abstract: Objective: To recail abuse prevalence against women attended at Lima's South Cone obstetrical services and to establish association between violence and both maternal and perinatal pathology and perinatal mortality. Design: Analytical retrospective cohort investigation. Setting: Maria Auxiliadora Hospital and Cesar Lopez Silva Mother and Child Hospital, Villa El Salvador. Participants: Hospitalized puerperal women. Interventions: Between March and november 2005 we applied a survey to 7333 puerperal women before discharge from the hospital in order to identify the presence of violence against women. Answers were classified in three groups: without violence (30,7%), with violence history (37,4%) and with violence during this pregnancy (31,9%). Wereviewed the perinatal clinical history in each case and verified demographic variables as well as maternal and perinatal complications. We also determined both fetal or neonatal deaths. Data was processed in Epi Info V.6. in order or examine differences, we applied X2 and student t and we considered statistically significant when p<0,05. Main outcome measures: Violence during pregnancy, obstetrical and neonatal complications. Results: In the violence during pregnancy group the higher frequency of obstetrical and neonatal complications was significant, as well as higher perinatal mortality. Conclusions: Gender based violence is very frequent in the pregnant population attended at lima's South Cone and is associated with higher maternal and perinatal pathology frequency and higher perinatal mortality.
TL;DR: Bacterial vaginosis-induced risk for abortion and puerperal endometritis requires prompt diagnosis and treatment and requires prompt treatment, according to the authors.
Abstract: Objectives: To determine the risk of pregnancy complications by untreated bacterial vaginosis. Design: Retrospective study of historical cohort. Materials and Methods: Clinical histories were reviewed at the time of delivery for diagnosis of bacterial vaginosis in the first prenatal control. Results: One hundred thirty pregnant women with bacterial vaginosis did not complete their treatment and 447 pregnant women did not have bacterial vaginosis. There was no significant differences in maternal age, parity, history of vaginal discharge, presence of vaginal secretion, birth weight and route of delivery between the groups. Pregnant women with bacterial vaginosis had more risk of abortion (RR 4,185; p = 0, 01) and endometritis (RR 2,441; p = 0, 034). Risk for preterm delivery, chorioamnionitis, premature rupture of membranes and low birth weight was not significant. Conclusions: Bacterial vaginosis-induced risk for abortion and puerperal endometritis requires prompt diagnosis and treatment.