Complicaciones obstétricas en gestantes trabajadoras / Obstetric complications in pregnant workers

Objetivo: Determinar el riesgo de complicaciones obstétricas en gestantes trabajadoras atendidas en la Maternidad" Dr. Armando Castillo Plaza" de Maracaibo, estado Zulia. Métodos: Investigación comparativa, con diseño no experimental y transeccional, que incluyó 100 gestantes trabajadoras (casos) y 100 no trabajadoras (controles); evaluándoseles el riesgo de presentar complicaciones obstétricas como preeclampsia, prematuridad, bajo peso al nacer y malformaciones congénitas. Resultados: Prevalecieron trabajadoras de los servicios y vendedores de comercio y mercado(31%) y ocupaciones elementales (20%), contratadas (74%),con antigüedad entre 2-5 años (56%), trabajo en bipedestación (62%), alta-media demanda física o mental (73% y 57%,respectivamente), alta demanda laboral (51%), alta satisfacción laboral (68%), y expuestas a riesgos ergonómicos como esfuerzo físico pesado (51,8%). Se encontró que 44% de las pacientes presentaron alguna complicación obstétrica, aunque en las trabajadoras hubo mayor número de complicaciones que en las no trabajadoras, la presencia de cualquier complicación fue similar y no mostró diferencias significativas (41% vs. 47%,respectivamente; OR [IC95%]= 0,783 [0,447 ­ 1,371]; p>0,05). Aunque no constituyó un factor de riesgo, sólo el parto pretérmino predominó en las gestantes trabajadoras, aunque nore (10% vs. 1%; OR [IC95%]= 0,090 [0,011 - 0,724]; p= 0,009);mientras que la presencia de preeclampsia ocurrió mayormente en las no trabajadoras (8% vs. 16%, respectivamente; OR[IC95%]= 2,191 [0,892 ­ 5,381]; p> 0,005), representando el no tener la condición laboral un factor protector para no presentar preeclampsia, aunque no significativo. Conclusión:La condición laboral no genera mayor riesgo de presentar complicaciones en las gestantes(AU)

Aim: To determine the risk of obstetric complications in workers pregnant women attending at the Maternity "Dr.Armando Castillo Plaza" in Maracaibo, Zulia state. Methods: Comparative research, with non experimental and transactional design. We included 100 pregnant workers (cases) and 100 non-workers (controls); evaluated the risk of showed any obstetric complications such as preeclampsia, premature birth, low birth weight and birth defects. Results: Prevailed service workersand sales persons and market (31%) and elementary occupations(20%), employed (74%), with between 2-5 years old (56%),work in a standing position (62%), high-average physical ormental demand (73% and 57%, respectively), high labor demand(51%), high job satisfaction (68%) and exposed to ergonomicrisks as heavy physical exertion (51.8%). It was found that 44%of patients had some obstetric complication, although workersthere were more complications than non-workers, the presenceof any complications was similar and showed no differencesignificant (41% vs. 47%, respectively; OR [95% CI] = 0.783[0.447 to 1.371]; p> 0.05). Although was not representing a riskfactor, only preterm birth predominated in pregnant workers(10% vs. 1%; OR [95% CI] = 0.090 [0.011 to 0.724]; p =0.009); while the presence of preeclampsia occurred mostlyin non-workers (8% vs. 16%, respectively; OR [95% CI] =2.191 [0.892 to 5.381]; p> 0.005), representing not havethe employment status a protective factor for preeclampsia,although not significant. Conclusion: The employment statusdoes not create further risk of complications in pregnant women

An observational study of effect of Mullerian anomalies on pregnancy

Background: Mullerian anomalies occur in approximately 3-4% of fertile and infertile women, 5–10% of women with recurrent early pregnancy loss, and up to 25% of women with late first or second-trimester pregnancy loss or preterm delivery. However, due to low prevalence rate and asymptomatic course of the anomalies, Mullerian anomalies remain underdiagnosed and often overlooked as a possible cause of recurrent pregnancy failures, preterm deliveries, IUGR and low birth weight.Methods: Total of 30 cases of Mullerian anomalies with pregnancy, prior diagnosed or incidental during LSCS, were studied for complications during pregnancy, history of gynecological complaints and rate of diagnosis with routine imaging technique.Results: Septate uterus was the most common anomaly seen in this study (36.6%).56.6% were diagnosed incidentally during LSCS despite the fact 26.6% of cases had history of 2 or more abortions and 30% had some or other gynecological complaints previously. 10% of pregnancies ended in abortions, 20% had preterm delivery, 36.6% had malpresentations and there was case of rupture uterus (03.3%).Conclusions: Mullerian anomalies are often asymptomatic or have subtle gynecological symptoms which are often missed by both patient and gynecologists. It is observed that due to the asymptomatic course of Mullerian anomalies, invasive nature of HSG and lack of 1.5 Tesla MRI at many institutes leads to low rate of diagnosis of Mullerian anomalies. Pregnancy with Mullerian anomalies often have preterm delivery, IUGR and malpresentation, so, require proper counselling and close monitoring during antenatal period.

An Observational Study on Uterine Myoma in Search of Factors Contributing to its Symptoms

Introduction: Uterine fibroid, the most common benign tumor,contributes significantly on quality of life if symptomatic.The study evaluates the factors which possibly contribute tothe symptoms. Objective: To identify the parameters whichpossibly play a role in symptoms of myoma.Material and Methods: An observational study on 48 subjectsafter taking written informed consent selected randomly fromwomen of reproductive age group attending at GynaecologyOut Patient Department.Results: Different age groups had comparable incidencesof fibroids. Most of the patients complained of Menorrhagia(54.2%). Metrorrhagia was complained in 6.2%, dysmenorrheain 10.4% patients, infertility and pain abdomen each wascomplained in 14.6% subjects. Most of the study subjectshad myoma of 14-week of gestation (39.6%) and 31.2% had16-week size myoma. The commonest location is found tobe fundo-anterior (33.3%), type is intramural (54.2%). Mostfibroids had volume of 95.1-125 cc (54.2%). One or twomyomas are more common than three or more myomas.Conclusion: Myoma is common in reproductive ages andthroughout the reproductive period incidences in differentage groups are comparable. Commonest symptom of myomais menorrhagia. Most myomas had volume of 95.1-125 cc,situated in fundo-anterior position, are of intramural type.Most myomas, if present as an abdominal lump, are of 14-week gravid uterus size. One or two myomas in uterus aremore common than number of myomas more than that

Role of Emergency Hysterectomy in Modern Obstetrics.

A retrospective study was done to estimate prevlance, indications and complications of emergency hysterectomy done for various obstetric indications over two years was carried out. There were 37549 confinements during study period from April 2006 to Aug 2008. Out of this 27213 (72.4%) delivered vaginally and 10336 (27.5%) by Cesarean section. 80 emergency hysterectomies were done, incidence being 2.13 /1000 births. Mean age was 30.5 years. Majority (75%) were from rural areas. Maximum cases were para 2-4. Most common indication for emergency hysterectomy was uterine rupture (40%) followed by atonic PPH (28.75%). Placenta previa (9%). Secondary PPH (6.25%), broad ligament hematoma (6.2%) placenta accreta &increta (2%).fibroid with bleeding (3.7%). Couvelaire uterus (2.1%) and obstructed labour with septicemia (1.2%). Majority of uterine rupture cases were late referrals from rural areas. Out of 32 cases of rupture uterus 20 were with previous LSCS and 12 were multipara. Maternal mortality was 2.5% and the cause of death was related to irreversible shock and DIC. Identification of high risk cases, early referral and procedures like internal illiac artery ligation can reduce the incidence of Emergency Hysterectomy.