Parto y puerperio durante la pandemia por COVID-19: experiencia de las pacientes y frecuencia de prematuridad / Childbirth and puerperium during the COVID-19 pandemic: patient experience and frequency of prematurity

Objetivo: Evaluar la percepción de las madres que tuvieron su parto durante la pandemia COVID en relación a la obligación de no recibir visitas en su puerperio, y cuantificar la frecuencia de prematuridad que otros centros del mundo mostraron que se redujo durante la pandemia. Método: Estudio observacional retrospectivo con encuestas realizadas entre el 1 de septiembre y el 31 diciembre 2020, y análisis de estadísticas locales de la Unidad de Maternidad y Neonatología. Resultados: Sobre el 90% de las madres que contestaron la encuesta afirmó haber descansado mejor y preferir un retorno a las visitas con horarios reducidos. La frecuencia de prematuridad se redujo significativamente en nuestra institución (8,08% entre 2014 y 2019 vs. 1,6% en 2020). Conclusiones: La mayoría de las puérperas prefiere un horario reducido para visitas en el posparto. Este hallazgo y la caída en la frecuencia de prematuridad obligan a reflexionar sobre nuestro cuidado prenatal actual.

Objective: To evaluate the perception of mothers who gave birth during the COVID pandemic in relation to the obligation not to receive visits during the puerperium, and to quantify the frequency of prematurity that other centers in the world showed decreased during the pandemic. Method: Retrospective observational study with surveys conducted between September 1st and December 31, 2020, and analysis of local statistics from the Maternity and Neonatal Unit. Results: Over 90% of the mothers who answered the survey stated that they had rested better and preferred a return to visits with reduced hours. The frequency of prematurity was signficantly reduced in our institution ((8.08% between 2014 and 2019 vs 1.6% in 2020). Conclusions: Most postpartum women prefer a reduced schedule for pospartum visits. This finding and the drop in the frequency of prematurity force us to reflect on our current prenatal care.

Profile of women affected with premature childbirth and neonatal outcomes / Perfil de mulheres acometidas por parto prematuro e desfechos neonatais

Abstract Objectives: to describe the profile of women affected with premature childbirth and neonatal outcomes at a referral maternity in the city of Fortaleza-CE, Brazil. Methods: descriptive and retrospective documentary type study, with a quantitative approach, carried out from January to December, 2017, with 253 medical records of women who had premature childbirth in a referral maternity. Results: the average age was 28, with the prevalence of women living in a stable union, graduated from high school and without formal work. The gestational mean average was three pregnancies, gestational age of 34 weeks and three days, and six prenatal consultations, starting in the first trimester. The major intercurrence was pre-eclampsia. In relation to the neonatal data, there was a prevalence of male newborns, with an average of 2.251 kg and a score of seven on the 1-minute Apgar and eight on the 5-minute Apgar. Newborns in going to a hospital accommodation after childbirth and in room air, spending an average of 12.71 days in the hospital. Conclusion: in this case of this research, knowing the woman's profile and the outcomes in premature newborns is useful to encourage public policies and reduce the sequelae on mother and baby

Resumo Objetivos: descrever o perfil de mulheres acometidas por parto prematuro e os desfechos neonatais em maternidade de referência, na cidade de Fortaleza-CE, Brasil. Métodos: estudo do tipo documental, descritivo, retrospectivo, com abordagem quantitativa, realizadode janeiro a dezembro de 2017, com 253 prontuários de mulheres que tiveram parto prematuro em maternidade de referência. Resultados: média de idade de 28 anos, com prevalência de mulheres vivendo em união estável, ensino médio completo, sem trabalho formal. A média gestacional foi de três gravidezes, idade gestacional de 34 semanas e trêsdias e seis consultas de pré-natal, iniciando no primeiro trimestre. A maior intercorrência foi a pré-eclâmpsia. Relacionado aos dados neonatais, houve prevalência de recém-nascidos do sexo masculino, com média de 2,251 quilos e escore sete no Apgar do 1º minuto e oito, no Apgar do 5º minuto. Recémnascidos indo para alojamento conjunto após o parto e em ar ambiente, tendo passado, em média, 12,71 dias internados. Conclusões: no caso da pesquisa, conhecer o perfil dessa mulher e os desfechos do recém-nascido prematuro é útil para estimular as políticas públicas e diminuir as sequelas para mãe e bebê.

Relación entre características sociodemográficas, obstétricas y psicosociales con el desenlace del parto prematuro en un hospital de alta complejidad / Relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature delivery in a highly complex hospital

INTRODUCCIÓN: La prematuridad es un grave problema de salud pública por la morbilidad, la mortalidad y los costos a ella asociados. OBJETIVO: Evaluar la relación entre las características sociodemográficas, obstétricas y psicosociales con el desenlace de parto prematuro frente a partos de término en el Hospital Guillermo Grant Benavente de Concepción, Chile, entre el segundo semestre de 2016 y el primer semestre de 2017. MÉTODO: Estudio cuantitativo, observacional, de tipo caso-control. La muestra la constituyeron 84 mujeres con parto prematuro y 85 con parto de término. Se utilizó un cuestionario de elaboración propia y la escala de Evaluación Psicosocial Abreviada (EPsA). El estudio fue aprobado por el comité ético científico. Se realizó análisis bivariado, con un nivel de significancia a = 0,05. Los datos se analizaron con el software estadístico SPSS v.25.0. RESULTADOS: No hubo diferencias en los antecedentes sociodemográficos (edad, nivel socioeconómico, estado civil y escolaridad) entre ambos grupos. Solo las mujeres con parto prematuro mantenían en mayor porcentaje que las gestantes de término un trabajo remunerado (43,4% vs. 25,9%). El estado nutricional y el antecedente de parto prematuro previo no se asociaron a un nuevo parto antes de las 37 semanas. La interrupción por cesárea fue significativamente más frecuente en las gestaciones de pretérmino que en el grupo control (p = 0,0377). CONCLUSIONES: En la población estudiada, las características sociodemográficas de las gestantes no tuvieron relación con el desenlace prematuro de la gestación. Algunos factores biomédicos se relacionan significativamente con este riesgo. Es necesario evaluar la pertinencia de aplicar escalas psicosociales en esta población y enfocar los esfuerzos para promover el control preconcepcional en mujeres con antecedentes de parto prematuro o comorbilidad.

INTRODUCTION: Prematurity is a serious public health problem due to morbidity, mortality and associated costs. OBJECTIVE: To evaluate the relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature birth versus term births at the Guillermo Grant Benavente Hospital in Concepción, Chile, between the second semester of 2016 and the first semester of 2017. METHOD: Quantitative, observational case-control study. The sample consisted of 85 women with premature delivery and 85 with term delivery. A self-elaborated questionnaire and Abbreviated Psychosocial Assessment scale (EPsA) were used. The study was approved by the scientific ethics committee. Bivariate and multivariate analysis was performed, with a level of significance a = 0.05. The data were analyzed with the statistical software SPSS v.25.0. RESULTS: There were no differences between the sociodemographic antecedents (age, socioeconomic level, marital status and education) between both groups. Only women with preterm birth had a higher percentage of paid work than full-term pregnant women (43.4% vs. 25.9%). Nutritional status and a history of previous preterm birth were not associated with a new delivery before 37 weeks. Interruption by cesarean section was significantly more frequent in preterm pregnancies than in the control group (p = 0.0377). CONCLUSIONS: In the studied population, the sociodemographic characteristics of the pregnant women were not related to the premature outcome of pregnancy. Biomedical factors are significantly related to this risk. It is necessary to evaluate the relevance of applying psychosocial scales in this population and to focus efforts to promote preconception control in women with a history of preterm birth and/or comorbidities.

Evolución y costes de la prematuridad por indicación médica en un hospital de tercer nivel / Evolution and costs of the medically indicated preterm birth in a tertiary care university hospital

INTRODUCCIÓN Y OBJETIVO: Analizar la evolución y los costes de los partos prematuros iatrogénicos en un hospital universitario de tercer nivel. MÉTODOS: Estudio de cohortes retrospectivo de los partos con edad gestacional comprendida entre 24 y 36+6 semanas en dos periodos temporales: 2001-2005 y 2011-2016. Se identificaron los partos prematuros por indicación médica o iatrogénicos (PPI). Se analizaron variables demográficas y de resultado. Los costes se calcularon mediante el grupo relacionado con el diagnóstico (GRD) de cada ingreso. RESULTADOS: Se obtuvo una muestra de 620 partos prematuros iatrogénicos. La tasa de prematuridad global se mantuvo estable en 9%. La tasa de prematuridad iatrogénica experimentó un incremento relativo del 9,7%. Entre las pacientes con un PPI se apreció un incremento en la edad materna de 27,7 a 32,9 años, de la obesidad (32,2% a 55,5%) y del uso de técnicas de reproducción asistida (6% a 11,1%). Preeclampsia y retraso del crecimiento (CIR) fueron las principales causas de PPI, en los que se incrementó la tasa de cesáreas de 66,9% a 78%, la estancia media de 7,8 días a 9,6 y el coste por paciente de 3.068,6 a 7.331,9 euros. CONCLUSIONES: Se observa un aumento de PPI en el segundo periodo, manteniéndose la prematuridad global. Los cambios demográficos podrían explicar este incremento. Estos cambios están implicados en la fisiopatología de la preeclampsia y el CIR y en el aumento de su incidencia. La prevención primaria y secundaria de esas complicaciones podría reducir la incidencia y los costes de la prematuridad iatrogénica.

INTRODUCTION AND OBJECTIVES: To evaluate the incidence, evolution, causes and costs of premature births (PB) due to medical indication (iatrogenic) in a tertiary care university hospital METHODS: Retrospective cohort study of all deliveries with gestational age between 24 and 36+6 weeks, in two periods 2001-2005 and 2011-2016. Iatrogenic births were identified. Clinical, epidemiological, diagnostic and economic variables were analysed. RESULTS: A sample size of 620 iatrogenic deliveries was obtained. We found a 9.7% relative increase in iatrogenic prematurity rate in the second period as well as an increase in maternal age from 27.7 to 32.9, obesity from 32.2% to 55.5% and the use of assisted reproductive techniques from 6% to 11.1%. Preeclampsia and intrauterine growth restriction were found to be the main causes of iatrogenic premature delivery. In these cases the rates of cesarean section increased from 66.9% to 78%. The average stay per patient and the cost calculated by diagnosis related group (DRG) also showed a statistically significant increase from 7.8 days and 3,068.6 euros to 9.6 days and 7,331.9 euros. CONCLUSIONS: We observed an increase in iatrogenic prematurity in the second period despite the unchanged rate of spontaneous PB. Demographic changes in the population, as well as an increase in obstetric related conditions, seem to be responsible for this increase. Primary and secondary prevention of clinical characteristics may reduce the incidence and costs derived from this type of prematurity.

Parto prematuro en pacientes COVID-19 en Hospital San Juan de Dios / Premature delivery in COVID-19 patients at San Juan de Dios Hospital

INTRODUCCIÓN Y OBJETIVO: La pandemia por SARS-CoV-2 afecta a las embarazadas con diferentes manifestaciones clínicas; una de ellas es el parto prematuro. El objetivo del presente estudio es caracterizar a las embarazadas con COVID-19 que tuvieron su parto y determinar la razón de aumento de parto prematuro en este grupo en comparación con aquellas que no presentaban la enfermedad. MÉTODOS: Estudio observacional de cohorte retrospectivo donde se incluyeron pacientes embarazadas entre abril y junio del año 2020 en la Maternidad del Hospital San Juan de Dios. Se seleccionaron aquellas que tuvieron su parto y se evaluaron los datos demográficos y médicos, antecedentes obstétricos, información respecto al parto, antecedentes del recién nacido y características de la enfermedad por COVID-19. RESULTADOS: Entre las pacientes COVID-19 un 16.9% tuvo parto prematuro, alcanzando un OR de 1,79 (0,76-3,84 IC 95%) respecto a aquellas sin la enfermedad que, aunque no significativo, evidencia tendencia. Entre las que cursaron con COVID-19 severo todas tuvieron parto prematuro, con un OR significativo (>= 7.84 IC 95%) en comparación con aquellas con cuadro leve o negativas a COVID-19. Un 10.1% de los recién nacidos de madres COVID-19 requirió reanimación neonatal, mientras que en las negativas fue de un 5.5%. CONCLUSIONES: Entre las pacientes COVID-19 se observo una tendencia a aumento del riesgo de parto prematuro respecto a aquellas sin la enfermedad, siendo significativo el aumento del riesgo en aquellas que cursaban con síntomas y aún más significativo si presentaban enfermedad severa.

INTRODUCTION AND OBJECTIVES: The SARS-CoV-2 pandemic has affected pregnant women with different clinical manifestations, one of them premature labor. The objective of this study is to characterize the pregnant patients with COVID-19 who had their delivery and to determine the risk of preterm delivery in this group compared to those who did not have the disease at the Maternity Department in San Juan de Dios Hospital, and determine what the rate of premature delivery is. METHODS: Retrospective observational cohort study where pregnant patients were included between April and June of 2020 at the Maternity Department in San Juan de Dios Hospital. Patients who had their delivery were selected and demographic and medical data, obstetric history, information regarding delivery, newborn history and characteristics of COVID-19 disease were evaluated. RESULTS: Among COVID-19 positives, a 16.9% had premature labor, reaching a nonsignificant OR 1.79 (0.76-3.84 95% CI) compared to those COVID-19 negative. Among those with severe COVID-19, all had preterm birth, with a significant OR (>=7.84 95% CI) compared to those with mild symptoms or COVID-19 negative. 10.1% of newborns of COVID-19 mothers required neonatal resuscitation, while, in the negative ones it was 5.5%. CONCLUSIONS: Among COVID-19 patients, a trend towards increased risk of preterm birth was observed compared to those without the disease, with the increased risk being significant in those with symptoms and even more significant if they had severe disease.

La paradoja de la inmigración: las madres haitianas y latinoamericanas en Chile / The Immigration Paradox: Haitian and Latin American Mothers in Chile

Introducción: Existe información internacional sobre las diferencias en parto prematuro y peso al nacer para madres migrantes de diferentes etnias originarias. El objetivo de este trabajo es evaluar parto prematuro y peso al nacer de madres de nacionalidad diferente, cuyos partos ocurrieron en Chile. Materiales y métodos Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile. Se incluyeron los recién nacidos del período Septiembre 2012 a Diciembre 2016. Se evaluaron los datos perinatales básicos, parto prematuro, bajo peso al nacer y su relación con la edad gestacional de nacidos de madres chilenas y de otras nacionalidades. Resultados En el periodo estudiado hubo 1.048490 nacimientos, de los cuales 50995 son de madres extranjeras. El porcentaje de nacidos antes de 37 semanas en madres de Bolivia, Colombia, Ecuador, Perú y Venezuela es entre un 4.8 y 7.3 %, versus 8% en madres chilenas. Los percentiles 10 para el peso al nacer entre 30 y 40 semanas para madres chilenas y Haitianas (en paréntesis) expresados en gramos: 1045 (1102), 1195 (1160), 1360 (1370), 1550 (1503), 1750 (1508), 2000 (1669), 2235 (1982), 2500 (2237), 2810 (2607), 2970 (2710), 3080 (2858). Los z-score de madres Haitianas fueron significativamente menores después de las 35 semanas. Conclusiones La paradoja de la inmigración se verifica en la experiencia nacional, con tasas de natalidad prematuras y bajo peso al nacer más favorables para las madres extranjeras en comparación con las mujeres chilenas y con sus países de origen. Las madres afro-caribeñas tuvieron nacimientos con peso menor, en edades gestacionales donde se toman decisiones frecuentes, con diferencias de hasta un 20 % entre las 35- 37 semanas.

SUMMARY The immigration paradox: Haitian and Latin American mothers in Chile Introduction There is international information on the differences in preterm birth and birth weight for migrant mothers of different ethnicities. The objective is to evaluate prematurity and birth weight of mothers of different national origin, whose deliveries occurred in Chile. Materials and methods The national database of the Department of Informatics of the Ministry of Health of Chile was used. Newborns from the period of September 2012 to December 2016 were included. Basic perinatal data, preterm birth, low birth weight and their relationship with the gestational age of babies born to mothers of local origin and other nationalities were evaluated. Results 1,048,490 births, 50,995 foreign mothers were studied. The percentage of those born before 37 weeks of mothers from Bolivia, Colombia, Ecuador, Peru, and Venezuela is between 4.8 and 7.3%, compared to nationals with 8%. The 10th percentiles for birth weight from 30 to 40 weeks for Chilean and Haitian mothers (in parentheses) were (g): 1045 (1102), 1195 (1160), 1360 (1370), 1550 (1503), 1750(1508 ), 2000 (1669), 2235 (1982), 2500 (2237), 2810 (2607), 2970 (2710), 3080 (2858). The z-scores of Haitian mothers were significantly lower. Conclusions The immigration paradox is verified in the national experience, with preterm birth rates and low birth weight more favorable to foreign mothers compared to chileans Afro-Caribbean mothers had births with a lower weight, at gestational ages where relevant decisions are made, with differences of up to a 20% between 35-37 weeks.

Perfil de gestantes acometidas de parto prematuro em uma maternidade pública / Profile of the pregnant women affected by preterm birthing a public maternity hospital / Perfil de la mujer embarazada de trabajo afectada prematura en una maternidad pública

Objetivo: Caracterizar o perfil das gestantes acometidas de parto prematuro; descrever as complicações do parto prematuro; identificar o número de óbitos por parto prematuro. Método: Pesquisa retrospectiva; transversal com abordagem quantitativa; realizada em uma maternidade pública, a amostra que representou a população constituiu-se de 300 prontuários de gestantes com parto prematuro. Pesquisa aprovada pelo Comitê de Ética; sob CAAE nº 47429315.1.0000.5210. Resultados: Faixa etária predominante foi 14 a 19 anos 26,38%; escolaridade ensino médio (56,68%); situação conjugal casada (38,11%); ocupação do lar (48,21%); raça não registrada (99,67%); local de moradia zona rural (57,00%). Maior incidência de complicações dentro das variáveis; foram pré-eclâmpsia (28,66%); amniorrexe prematura (17,26%). Causa maior de óbito: Pré-eclâmpsia. Conclusão: Destaca-se que pré-eclâmpsia foi o agravo que causou o maior número de óbitos nas mulheres investigadas; esse dado evidencia as estatísticas alarmantes; confirmando que as doenças hipertensivas ocupam o primeiro lugar como causa de morte materna no Brasil

Objetivo: Caracterizar el perfil de parto prematuro afectaba a lãs mujeres embarazadas; describir lãs complicaciones Del nacimiento prematuro; identificar el número de muertes debidas al parto prematuro. Método: Estudio retrospectivo; cruzar com un enfoque cuantitativo; realizado em un hospital público, La muestra que representa la población constaba de 300 historias clínicas de mujeres embarazadas com trabajo de parto prematuro. De investigacióna probado por el Comité de Ética, La opinión Nº 1.175.971. Resultados: Rango de edad predominante fue de 14 a 19 años 26,38%; educación secundaria (56,68%); estado civil casada (38,11%); ocupación de la casa (48,21%); No raza registrado (99,67%); lugar de residencia, rural (57.00%). Mayor incidencia de complicaciones en las variables y preeclampsia (28,66%); ruptura prematura de membranas (17,26%). Principal causa de muerte: La pre-eclampsia. Conclusión: Es de destacar que La preeclampsia fue La lesión que causo el mayor número de muertes investigadas em lãs mujeres; estos datos pone de manifiesto las estadísticas alarmantes; lo que confirma que lãs enfermedades hipertensivas ocupan el primer lugar como causa de muerte materna en Brasil

Objective: Herein, our goal has been to characterize the pregnant women profile that experienced preterm birth. Moreover, describe the complications of preterm birth, and also to identify the number of deaths due to preterm birth. Methods: It is a retrospective cohort study with a quantitative approach, whichwas carried out in a public maternity hospital. The sample that represented the population consisted of 300 medical records of pregnant women with preterm birth. The research was approved by the Ethics Committee under the Legal Opinion No. 1,175,971. Results: The predominant age group was from 14 to 19 years old (26.38%); high school education (56.68%); married (38.11%); housekeeper (48.21%); unregistered race (99.67%); rural area as residence place (57.00%). The following were the higher incidence of complications within the variables: pre-eclampsia(28.66%) and premature amniorrexis (17.27%). The major cause of death was pre-eclampsia. Conclusion: It should be noted that pre-eclampsia caused the highest number of deaths in the women investigated and this fact shows the alarming statistics, confirming that hypertensive diseases occupy the first place as cause of maternal death in Brazil

Premature childbirth: pregnant women's characteristics of a population in the South area of São Paulo / Parto prematuro: características das gestantes de uma população da zona sul de São Paulo

Abstract Objectives: to identify the characteristics of pregnant women who had premature child-birth (PPT) in the South region of São Paulo city. Methods: a cross-sectional observational study with a data collection of 122 medical files on pregnant women who had PPT in 2013. The collected data were analyzed by a statistical package, Graphpad Prism 6. As for the variables that were shown to be significant in the multivariate regression, an analysis was performed in a dichotomous form by odds ratio. Results: the mean age of the pregnant women was 24.9 years old. Of the 122 pregnant women, 34.4% were included in the age group considered to be at risk by the Ministry of Health. The predominant race was mixed (46.2%). 41.8% were high school graduates. Regarding to personal background, the history on urinary infection was mostly mentioned (37.5%). In relation to family history regarding clinical conditions, 43% had diabetes history and 61% had hypertension. As for gynecological history, 37.5% reported having dysmenorrhea during menstrual cycles. Multivariate analysis was performed and found that particularly hypertension and dysmenorrhea were the most significant. Conclusions: Regarding to women´s risk factors for premature childbirth, the most determining factor was dysmenorrhea, followed by hypertension.

Resumo Objetivos: identificar as características das gestantes que tiveram parto prematuro (PPT) na região sul da cidade de São Paulo. Métodos: estudo observacional transversal com coleta de dados de 122 prontuários de gestantes que tiveram PPT em 2013. Os dados coletados foram analisados pelo pacote estatístico Graphpad Prism 6. Para as variáveis que se mostraram significantes dentro da regressão multivariada foi feita análise de forma dicotômica por meio odds ratio. Resultados: a média de idade das gestantes foi de 24,9 anos. Das 122 gestantes, 34,4% estavam na faixa etária considerada de risco pelo Ministério da Saúde. A raça predominante foi parda (46,2%). 41,8% finalizaram o ensino médio. Em relação aos antecedentes pessoais, o que mais se destacou foi o histórico de infecção urinária (37,5%) . Em relação aos antecedentes familiares em relação à condições clínicas, 43% possuíam antecedentes com diabetes e 61% com hipertensão arterial. Quanto aos antecedentes ginecológicos, 37,5% relataram apresentar dismenorreia durante os ciclos menstruais. Ao ser realizada análise multivariada, foi verificado que a hipertensão arterial e principalmente a dismenorreia foram as mais significantes. Conclusões: em relação aos fatores de risco das mulheres para parto prematuro das mulheres, a dismenorreia foi o fator mais determinante, seguido de hipertensão arterial.

Asociación entre la ansiedad materna y el parto pretérmino en Lima, Perú / Association between maternal anxiety and preterm delivery in Lima, Peru

Introducción: el parto pretérmino se define como el parto antes de las 37 semanas. Se han establecido diversos factores desencadenantes, entre los cuales se encuentra la ansiedad. En Perú se han realizado pocos estudios en relación con el tema. Objetivo: determinar la asociación entre la ansiedad materna durante el tercer trimestre de embarazo y el desarrollo de parto pretérmino. Métodos: estudio de tipo cohorte prospectiva realizado en un hospital público de Lima-Perú, que incluyó a 247 gestantes (enero de 2014 a enero de 2015). Se evaluó a gestantes entre las semanas 28 y 35 de embarazo, durante la visita prenatal. Los datos perinatales se obtuvieron del libro de partos y de la historia clínica materna. El instrumento utilizado para medir la ansiedad fue la encuesta State Trait Anxiety Inventori (STAI). El análisis de datos se realizó mediante STATA versión 11.1. Resultados: la mediana de edad de las participantes fue 27, 68,1 por ciento fueron convivientes y 58 por ciento tuvieron secundaria completa. Se encontró una incidencia de parto pretérmino de 11,6 por ciento. En el análisis multivariado ajustado, se encontró un riesgo relativo de 1,23 (IC 95 por ciento: 0,57-2,65) para ansiedad de estado y un riesgo relativo de 0,97 (IC 95 por ciento: 0,45-2,06) para ansiedad de rasgo. En el análisis bivariado se encontró una asociación significativa con preeclampsia. Conclusión: Se recomienda realizar más estudios longitudinales para establecer mejor la asociación ansiedad materna - parto pretérmino(AU)

Introduction: preterm delivery is defined as delivery before 37 weeks of gestational age. Several triggering factors have been established, anxiety being one of them. Few studies on the subject have been conducted in Peru. Objective: determine the association between maternal anxiety during the third trimester of pregnancy and preterm delivery. Methods: a prospective cohort study was conducted at a public hospital in Lima, Peru, from January 2014 to January 2015. The study sample consisted of 247 pregnant women of 28-35 weeks of pregnancy. Evaluation was performed during prenatal visits. Perinatal data were obtained from the labor and delivery registry and the patients' medical records. The tool used to measure anxiety was the survey State Trait Anxiety Inventory (STAI). Data were analyzed with STATA version 11,1. Results: mean age of participants was 27 years; 68,1 percent cohabitated with their partners, and 58 percent had completed high school. Preterm delivery had an incidence of 11,6 percent. Adjusted multivariate analysis revealed a relative risk of 1,23 (95 percent CI 0,57-2,65) for state anxiety and ,.97 (95 percent CI 0,45-2,06) for trait anxiety. Bivariate analysis found a significant association with preeclampsia. Conclusion: anxiety during the third trimester of pregnancy was found to be a risk factor for preterm delivery. It is recommended to perform other longitudinal studies to more clearly determine the association between maternal anxiety and preterm delivery(AU)

Asociación de nivel bajo de PAPP-A en primer trimestre con resultados obstétricos adversos / Association of low PAPP-A level in the first trimester with adverse obstetric outcomes

ANTECEDENTES: La PAPP-A es una proteína utilizada en obstetricia de forma rutinaria para el cribado de aneuploidías de primer trimestre. En los últimos años se está conociendo más acerca de su papel en la función placentaria. Diversos estudios están mostrando una asociación entre un nivel bajo de PAPP-A y distintos eventos obstétricos. OBJETIVO: Establecer una asociación entre PAPP-A baja y eventos obstétricos adversos. MÉTODO: Estudio retrospectivo de casos y controles anidado en una cohorte. Se han recogido las gestaciones únicas con PAPP-A inferior a percentil 5 en primer trimestre durante 2 años. Se ha recogido de la misma cohorte un grupo control, en proporción 2:1. Se compara mediante análisis estadístico la incidencia de eventos obstétricos adversos de cada grupo. RESULTADOS: Se incluyó un total de 285 pacientes en el grupo de casos y 570 pacientes en el grupo control. Se observó un aumento significativo en el grupo de casos de la incidencia de prematuridad, restricción del crecimiento, hipertensión gestacional y diabetes gestacional. Se ha correlacionado la PAPP-A baja con varios eventos obstétricos adversos, incluyendo prematuridad (OR 4,27), diabetes gestacional (OR 2,40), restricción del crecimiento (OR 2,36) e hipertensión gestacional (OR 2,22). No se observó relación con el resto de eventos obstétricos adversos. CONCLUSIÓN: Un nivel de PAPP-A bajo se asocia con aumentos significativos de prematuridad, diabetes gestacional, restricción del crecimiento e hipertensión gestacional.

BACKGROUND: PAPP-A is a placental protein used in obstetrics as a first trimester marker in aneuploidy screening. In the last few years we are knowing more about its placental function. Some studies are showing a association between low PAPP-A and obstetrical adverse events. AIM: Establish an association between low PAPP-A an obstetrical adverse events. METHOD: This is a retrospective nested case-control study. We identified each singleton pregnancy with a normal phenotype and a low PAPP-A (under percentile 5) in the last 2 years, and match it with a control group of the same population in a 2:1 proportion. It was compared the incidence of each obstetrical adverse outcomes with statistical analysis. RESULTS: We found 285 patients in the case group and match it with 570 patients from control group. It was observed a significative increase in the incidence of prematurity, intrauterine growth restriction, gestational hypertension and gestational diabetes. A low PAPP-A level was correlated with some obstetrical adverse events, like prematurity (OR 4.27), gestational diabetes (OR 2.40), intrauterine growth restriction (OR 2.36) and gestational hypertension (OR 2.22). We observe no correlation with the rest of outcomes. CONCLUSIONS: A low PAPP-A level is related with significative increases of prematurity, gestational diabetes, intrauterine growth restriction and gestational hypertension.

Epidemiología de la prematuridad, sus determinantes y prevención del parto prematuro / Epidemiology of prematurity, its determinants and prevention of preterm birth

La prematuridad es un grave de problema de salud pública por la gran morbilidad y mortalidad que generan, además, de los elevados costos económicos y sociales que ocasiona su atención. A nivel mundial, aproximadamente uno de cada diez neonatos nacen prematuros. Sus determinantes son múltiples. En el parto prematuro están involucrados además de los determinantes biológicos, los que son responsabilidad del sector salud y los que son responsabilidad del estado, como son los determinantes políticos, ambientales, sociales y económicos. Es por ello que la prevención y el tratamiento de la prematuridad debe ser una política pública obligada para todas las naciones, e involucra a muchos actores. Las estrategias empleadas para prevenir y tratar al parto prematuro son amplias y van desde los cuidados preconcepcionales, hasta la atención del parto y del neonato en el periodo postnatal.

Prematurity is a serious public health problem by the high morbidity and mortality also generated high economic and social costs caused by its staff. Globally, about one in ten infants born prematurely. Its determinants are numerous. In preterm birth are involved in addition to biological determinants, which are the responsibility of the health sector and which are the responsibility of the state, such as political, environmental, social and economic determinants. That is why prevention and treatment of prematurity should be a public policy required for all nations, and involves many actors. The strategies used to prevent and treat premature birth are spacious and range from preconception care, to care delivery and newborn in the postnatal period.

Epidemiología de la prematuridad y sus determinantes, en una población de mujeres adolescentes y adultas de Colombia / Epidemiology of prematurity and its determinants in a population of adolescent and adult women in Colombia

Antecedentes: La prematuridad es considerada actualmente una prioridad en salud pública para algunos países. Objetivo: Describir la prevalencia del parto prematuro y sus determinantes, en una población de gestantes adolescentes y adultas, que tuvieron su único o último parto en la Fundación Hospital San José de Buga, Colombia, entre los años 2010 a 2015. Métodos. Estudio de casos y controles realizado con 11.881 neonatos mujeres adolescentes y adultas. Los datos fueron analizados en Stata® 11.0, empleando para variables cuantitativas, mediana o promedio y sus medidas de dispersión, comparadas mediante pruebas t, Ranksum, ANOVA o Kruskal Wallis, de acuerdo a su distribución y para variables categóricas; medidas de frecuencia absolutas y relativas, comparadas mediante Pruebas de Chi2 o exacta de Fisher. Para estimar las asociaciones empleamos Odds Ratio con sus intervalos de confianza de 95% y para el análisis multivariado la regresión logística. La significancia estadística fue definida como un valor p<0,05. Resultados. La prevalencia de prematuridad fue 11,4%. Después del análisis multivariado, los determinantes asociados a prematuridad fueron etnia indígena-afrocolombiana o mulato, número de controles prenatales igual o inferior a 6, periodo intergenésico inferior a 2 años, embarazo múltiple, preeclampsia, oligohidramnios, restricción del crecimiento intrauterino y hemorragia del tercer trimestre (incluye desprendimiento prematuro de placenta). Conclusiones. La prematuridad es el resultado de una compleja red de determinantes individuales, sociales, culturales y gestacionales que interactúan, por lo que para su prevención se debe no sólo trabajar en medidas de salud, sino en elaboración de políticas y planes de acción integral.

Background: Prematurity is currently considered a public health priority for some countries. Objective: To describe the prevalence of preterm birth and its determinants in a population of adolescent and adult mothers who had their sole or last delivery in the Fundación Hospital San José de Buga, Colombia, between 2010-2015. Methods: Case-control study conducted with 11,881 infants adolescent and adult women. The data were analyzed in Stata 11.0, using quantitative, medium or average and dispersion measures variables compared using t tests, Ranksum, ANOVA or Kruskal Wallis, according to distribution and for categorical variables, frequency measurements absolute and relative, compared with Chi2 tests or Fisher exact. To estimate associations employ odds ratio with confidence intervals of 95% and multivariate analysis logistic regression. Statistical significance was defined as p <0.05. Results: Prematurity prevalence was 11.4%. After multivariate analysis, the determinants associated with prematurity were indigenous-Afro-Colombian or mulatto ethnicity, number of prenatal visits equal to or less than 6, less than two years intergenesic period, multiple pregnancy, preeclampsia, oligohydramnios, IUGR and bleeding of the third quarter (includes abruption). Conclusions: Prematurity is the result of a complex network of individual, social, cultural and gestational determinants that interact, so that prevention is due not only work on health measures, but in developing policies and plans integral action.

Impacto do monitoramento telefônico de gestantes na prevalência da prematuridade e análise dos fatores de risco associados em Piracicaba, São Paulo, Brasil / Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, São Paulo State, Brazil / Impacto del monitoreo telefónico de mujeres embarazadas en la prevalencia de partos prematuros y análisis de factores de riesgo asociados en Piracicaba, São Paulo, Brasil

Resumo: Objetivou-se verificar o impacto do monitoramento telefônico na prevalência da prematuridade e identificar os fatores de risco associados ao parto prematuro através de estudo transversal, de universo de gestantes monitoradas nos anos de 2010, 2011 e 2012 (n = 2.739). Utilizou-se estimação de modelos de regressão logística múltipla hierarquizada, considerando permanência no modelo p ≤ 0,05. A prevalência de prematuridade foi de 8,34% nas gestantes monitoradas e de 10,18% nas não monitoradas (p = 0,0058), sendo inversamente proporcional ao número de monitoramentos (p < 0,0001). As variáveis associadas foram: idade materna menor que 19 anos, antecedentes de dois ou mais filhos mortos, gestação múltipla, diabetes e hipertensão arterial, menor número de monitoramentos telefônicos, atividades laborais em pé e/ou carga de peso, fumo, número de consultas pré-natal, sem ultrassonografia, diabetes gestacional, gravidez múltipla e anomalia fetal. Com custos baixos, a estratégia demonstrou ser efetiva na redução da ocorrência do parto prematuro.

Abstract: This study aims to assess the impact of a telephone monitoring service on prevalence of prematurity and to analyze associated risk factors using data on 2,739 pregnant women. Estimation was based on hierarchical multiple logistic regression, with p ≤ 0.05 for variables to remain in the model. Prevalence of preterm birth was 8.34% in monitored pregnant women and 10.18% in unmonitored women (p = 0.0058). Prevalence of preterm birth was inversely proportional to the number of monitoring calls (p < 0.0001). Variables associated with prematurity were maternal age < 19 years, history of death of two or more children, multiple pregnancy, diabetes, hypertension, fewer monitoring calls, extended standing or lifting heavy weights at work, smoking, fewer prenatal visits, no ultrasound examination, gestational diabetes, multiple pregnancy, and fetal abnormality. This low-cost strategy proved effective for reducing the preterm birth rate.

Resumen: Este estudio tuvo como objetivo evaluar el impacto de monitoreo telefónico en la prevalencia de los partos prematuros y de los factores de riesgo asociados con el parto prematuro a través de un estudio transversal con datos de 2.739 mujeres embarazadas en Piracicaba, São Paulo, Brasil. Se utilizó la estimación de modelos de regresión logística múltiple jerárquica, considerando permanecer en el modelo de p ≤ 0,05. La prevalencia de parto prematuro era 8,34% en las mujeres embarazadas monitoreadas y 10,18% en sin control (p = 0,00058), siendo inversamente proporcional al número de monitoreo (p < 0,0001). Las variables asociadas fueron: edad materna de 19 años, una historia de dos o más niños muertos, embarazo múltiple, diabetes e hipertensión, menos monitoreo telefónico, actividades industriales a pie y/o con peso/carga, tabaquismo, menos visitas prenatales, sin ultrasonido, diabetes gestacional, embarazo múltiple y anormalidad fetal. Con menores costes, la estrategia resultó una medida eficaz para reducir la incidencia de parto prematuro.

Conocimiento de médicos de 2 hospitales peruanos sobre la relación entre enfermedad periodontal y alteraciones sistémicas / Knowledge of physicians, from 2 peruvian hospitals on the relationship between periodontal and systemic diseases

Objetivo: Determinar el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares, en médicos de 2 hospitales peruanos. Material y método El presente estudio, transversal y descriptivo, se desarrolló entre abril y mayo de 2014 e incluyó un total de 77 médicos, 39 del Hospital Belén de Trujillo y 38 del Víctor Lazarte Echegaray (Trujillo, Perú), a quienes se les aplicó un cuestionario, sometido previamente a validación por expertos y análisis de confiabilidad (Alfa de Cronbach = 0,605). Resultados El nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en un 57,1 por ciento y regular en un 41,6 por ciento de los médicos evaluados. No se encontraron diferencias con respecto a la especialidad médica (p = 0,348) ni al tiempo de ejercicio profesional (p = 0,403). Conclusión Los resultados permiten concluir que el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en el 57,1 por ciento de los médicos de los hospitales Belén y Víctor Lazarte Echegaray de Trujillo, Perú, 2014.

Objective: To determine the level of knowledge of physicians from two Peruvian hospitals on the relationship between periodontal and systemic diseases. Methods This cross-sectional and descriptive study was conducted between April and May 2014 and included a total of 77 physicians, 39 from Hospital Belen de Trujillo and 38 from Hospital Victor Lazarte Echegaray (Trujillo, Peru). They were given a questionnaire that was previously submitted for validation by experts and reliability analysis (Cronbach's alpha = 0.605). Results The level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent and moderate in 41.6 percent of physicians who responded. No differences were found as regards medical specialty (P = .348) or professional experience (P = .403). Conclusion The results suggest that the level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent of physicians from Victor Lazarte Echegaray and Belen hospitals in Trujillo, Peru, in 2014.

Prematuros tardíos: estudio clínico retrospectivo de sus causas y consecuencias / Late preterm infants: a retrospective clinical study of their causes and consequences

ANTECEDENTES: Los niños nacidos entre las 34 0/7 y 36 6/7 semanas se denominan prematuros tardíos (PT), constituyen 5-7% de los nacidos y poseen mayor morbimortalidad que los niños de término. OBJETIVO: Analizar las causas de partos PT en nuestra institución. Comparar morbilidad neonatal de nacidos PT y de término. MÉTODOS: Estudio de cohorte retrospectivo. Se revisan registros de nacimientos entre enero de 2009 y diciembre de 2012 identificando los nacidos vivos entre las 34 0/7 y 36 6/7 y entre las 39 0/6 y 40 6/7 semanas. Se identifica grupo clínico de parto prematuro al que pertenecen. Se compara frecuencia de resultados perinatales de nacidos PT y de término completo. RESULTADOS: En el período estudiado nacieron 8.890 niños vivos. Tasa de partos PT fue 7,49% (n = 666). El 64,11% fue por causa idiopática o asociado a rotura de membranas y 35,89% por indicación médica. Dentro del grupo de indicaciones médicas un 19,25% de interrupciones no están basadas en evidencia y ninguna puramente electiva. Los PT, comparados con niños de término, tienen más riesgo de hospitalización y morbilidad neonatal; este riesgo es mayor a menor edad gestacional. CONCLUSIONES: En nuestro hospital 1 de cada 5 PT pudo haber nacido a una edad gestacional mayor, lo que podría haber evitado los riesgos perinatales asociados. Se sugiere que las instituciones de salud analicen las causas de interrupciones del embarazo en el grupo de PT, lo que podría ser un indicador de calidad obstétrica.

BACKGROUND: Children born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants. Represent 5 to 7% of live births and they are at higher risk of morbidity and mortality than term infants. OBJECTIVE: To analyze causes of late preterm births in our institution. To compare neonatal morbidity in late-preterm and term infants. METHODS: A retrospective cohort study. Birth records between January 2009 and December 2012 were reviewed identifying live births between 34 0/7 and 36 6/7 and between 39 0/6 and 40 6/7 weeks of gestation. Clinical group of preterm labor to which they belong was identified. Frequency of perinatal outcomes of late-preterm and term infants were compared. RESULTS: In the period under study there were 8890 live birth. The late-preterm birth rate was 7.49% (n = 666); 64.11% of them was idiopathic in cause or associated with rupture of membranes and 35.89% was for medical indication. In the group of medical indications 19.25% of the interruptions were not based on evidence and none were purely elective. Late-preterm infants have higher risk of hospitalization and neonatal morbidity than term infants; this risk is higher at earlier gestational ages. CONCLUSIONS: In our hospital 1 in 5 late-preterm birth could have been born at higher gestational age, preventing perinatal risks. It is suggested that health institutions analyze causes of interruption of pregnancy in the late-preterm group, which could constitute an indicator of obstetric quality.

Eficácia da progesterona na prevenção do trabalho de parto prematuro gemelar: revisão sistemática / Progesterone efficacy for twin preterm labor prevention: a systematic review

Este estudo teve como objetivo realizar uma revisão sistemática de ensaios clínicos randomizados que analisaram a eficácia do uso da progesterona em reduzir o parto pré-termo na gravidez gemelar no período de 1994 até 2014. Segundo critérios pré-estabelecidos, foram incluídos dez artigos, com um total de 3.432 gestantes de gêmeos randomizadas para tratamento com progesterona versus placebo ou nenhum tratamento, entre os quais somente um estudo demonstrou algum benefício, mas com amostragem muito pequena. Concluímos, com o presente estudo, que as evidências não comprovam a eficácia da progesterona na prevenção de parto prematuro gemelar, em geral. São necessários estudos com maior número de gestantes gemelares que tenham fatores de risco para parto prematuro, tais como aquelas com colo curto e/ou história de parto prematuro prévio.

The goal of our study was to make a systematic review of randomized controlled trials that analyzed the efficacy of progesterone to reduce preterm birth in twin pregnancies published from 1994 to 2014. According to predetermined criteria, ten studies were included, with a total of 3,432 pregnant woman with twins randomized either to treatment with progesterone versus placebo or no treatment, among which only one study showed benefits, but with a very small sample. We conclude, from this study, that there is no evidence that progesterone prevents twin preterm birth, in general. More studies, that focus the use of progesterone in high risk twin pregnancies, such as short cervix or/and preterm birth history, are required.

Gravidez na adolescência: análise de fatores de risco para baixo peso, prematuridade e cesariana / Teenage pregnancy: analysis of risk factors for low birth weight, prematurity and cesarean delivery

O objetivo do estudo foi analisar possíveis associações entre a faixa etária materna até 16 anos, com o peso e a idade gestacional do recém-nascido, assim como a ocorrência de cesaria na. Estudo transversal com dados das Declarações de Nascidos Vivos/DN obtidos através do Sistema Nacional de Nascidos Vivos/SINASC, de Feira de Santana, Bahia, Brasil, no período 2006 a 2012. Nas análises, utilizou-se regressão logística, em razão de odds (OR) e intervalo de confiança de 95 %, medindo a força de associação entre variáveis, ajustadas aos fatores de confundimento. Os Recém Nascidos de baixo peso e de peso insuficiente mostraram associação significante com a faixa etária materna (< 16 anos); e interação estatística do pré-natal inadequado e cesariana; em gestantes adolescentes com idade abaixo de 16 anos, a cesariana mostrou associação significante com estado civil solteira (OR 1,24), pré-natal inadequado (OR 1,58) e Recém Nascidos de baixo peso (OR 1,34). Os dados sugerem que múltiplos fatores podem interferir no tipo de parto e resultado gestacional de adolescentes em idade muito precoce, apontando a importância de investimentos em políticas e ações direcionadas a esse grupo, considerado de alta vulnerabilidade aos agravos gestacionais e perinatais.

The scope of the study was to analyze possible associations between maternal age under 16 years and the weight and gestational age of the newborn child, as well as the occurrence of cesarean delivery. A cross-sectional study was conducted using data of Live Birth Certificates/DN from the National System of Live Births/SINASC in Feira de Santana, State of Bahia, Brazil, in the 2006-2012 period. In the analyses, logistic regression for the odds ratio (OR) and a confidence interval of 95% was used, measuring the strength of association between variables adjusted for confounding factors. Newborns (NB), with low birth weight and underweight, revealed a significant association with maternal age (< 16 years) and statistical interaction of inadequate prenatal care and cesarean delivery. In teenage pregnancy under the age of 16 years, cesarean delivery showed a significant association with single marital status (OR 1.24), inadequate prenatal care (OR 1.58) and newborns with low weight (OR 1.34). The data suggest that multiple factors may interfere with the type of delivery and pregnancy outcome of adolescents at an early age, pointing to the importance of investment in policies and actions directed at this group considered highly vulnerable to perinatal and pregnancy complications.

A ausência do eco glandular endocervical e a presença de sludge no líquido amniótico podem ser consideradas imagens ultrassonográficas preditivas de parto prematuro? / Absent cervical gland area and amniotic fluid sludge may be considered predictive ultrasound images of preterm birth?

A prematuridade ainda é um grande desafio para a Obstetrícia, sendo considerada a principal causa de morbidade e mortalidade neonatal, com repercussões importantes na infância. Apesar dos avanços da medicina, ainda falhamos muitas vezes em predizer e prevenir o parto prematuro. Novos marcadores surgem a cada dia na tentativa de melhorar o arsenal médico para a predição da prematuridade, entre eles a ausência do eco glandular endocervical e o sludge no líquido amniótico, vistos em avaliações ultrassonográficas transvaginais. Para avaliar os estudos disponíveis sobre esses novos métodos, este estudo de revisão da literatura pesquisou nas bases de dados MEDLINE, PubMed, SciELO, LILACS e Biblioteca Cochrane os descritores "cervical gland area", "amniotic fluid sludge", "sludge", "preterm", "preterm labor" e "preterm birth" e selecionou 12 artigos com base em sua relevância e metodologia. Apesar de vários estudos publicados sugerirem a aplicação desses marcadores, é difícil comparar os resultados apresentados, pois as populações avaliadas são muito diferentes, a casuística ainda é pequena e faltam avaliações com melhor nível de evidência. Até que se consiga realmente comprovar o benefício do uso isolado desses marcadores, podemos associar os métodos propostos com os já utilizados, como fibronectina fetal e comprimento cervical, para tentar diminuir o número de partos prematuros em nossa prática médica. (AU)

Prematurity is still a challenge for Obstetrics, considered the leading cause of neonatal and childhood deaths worldwide, with serious repercussions in childhood. Despite advances in medicine, yet we often fail to predict and prevent preterm birth. New markers appear every day in an attempt to improve the medical arsenal for predicting prematurity, including two sonographic markers: the absence of cervical gland area and amniotic fluid sludge, seen in transvaginal sonographic evaluations. To evaluate the available studies on these new methods, this literature review study searched the databases MEDLINE, PubMed, SciELO, LILACS and the Cochrane Library the following descriptors: "cervical gland area", "amniotic fluid sludge", "sludge", "preterm", "preterm labor" e "preterm birth" and selected 12 articles based on their relevance and methodology. Despite all the published studies suggest the application of these markers, it is difficult to compare the results because the populations evaluated are very different, the sample is still small and we still lack reviews with best level of evidence. Until we can actually prove the benefit of using these markers separately, we can associate the proposed methods with the ones already used, such as fetal fibronectin and cervical length, in an attempt to reduce the number of premature births in our practice.(AU)

Caracteristicas epidemiologicas de la prematures. Hospital Materno Neonatal de Córdoba 2013 / Epidemiological characteristics of prematurity. Maternal and Neonatal Hospital of Cordoba 2013

Determinar las características epidemiológicas vinculadas a la aparición de la prematurez. Material y Método: La población se conformó por las madres de los recién nacidos cuya edad gestacional dada por método Capurro sea 35 semanas o menos internados en el Hospital Materno Neonatal de la ciudad de Córdoba entre el 1 de marzo y el 5 de julio del año 2013, que aceptaron voluntariamente participar en el presente estudio y que firmaron la carta de consentimiento informado Dada la magnitud de la población, no se trabajó con muestra alguna Los datos se recolectaron mediante la técnica de entrevista utilizándose como instrumento el cuestionario Los datos de las variables en estudio, volcados en soporte magnético, fueron analizados mediante la versión actualizada del programa: Stadistic Package for Social Science (software estadístico SPSS) y ordenados en tablas frecuenciales simples y de contingencia que facilitan el entrecruzamiento de variables. Conclusiones: Se demostraron factores de riesgo prevenibles vinculados a la aparición de prematurez: 30% de adolescentes, nivel de instrucción alcanzado: básica, vulnerabilidad social con 45,3% de NBI,80% de desempleo,20% de necesidad de terapia psicológica, 16% de violencia doméstica, 38% sin prácticas anticonceptivas, antecedente de 28% de prematuro previo, estados carenciales: anemia 28% e insuficiente ganancia de peso 27%, alta incidencia de fumadoras (25%), de diabetes gestacional 5,3% y Preeclampsia 30,7%No se encontró asociación estadísticamente significativa ente planificación del embarazo y situación social desfavorable, podría deberse a patrones socio culturales. Sugerencias: Implementación del correspondiente programa de prevención en este grupo vulnerable. Asegurar control prenatal de calidad en embarazos posteriores...

To determine the epidemiology related to the occurrence of prematurity. Methods: The population was formed by mothers of newborns whose gestational age given by Capurro method is 35 weeks or less admitted to the Maternal and Neonatal Hospital of Cordoba city between March 1 and July 5 year 2013, who volunteered to participate in this study and signed the informed consent letter Given the magnitude of the population, not sample worked with some Data were collected by interview technique used as an instrument the questionnaire The data of the study variables, focused on magnetic media, were analyzed using the updated version of the program: Stadistic Package for Social Science (SPSS statistical software) and arranged in simple tables and contingency frecuenciales that facilitate cross-linking of variables Conclusions: We demonstrated preventable risk factors related to the occurrence of prematurity: 30% of teenagers, basic educational attainment, social vulnerability NBI 45.3%, 80% unemployment, 20% of need for psychological therapy, 16 % of domestic violence, 38% no contraceptive practices, 28% a history of previous preterm deficiency conditions: anemia 28% and insufficient weight gain of 27%, a high incidence of smokers (25%) of 5.3% and gestational diabetes Preeclampsia 30.7% No statistically significant association was found pregnancy planning agency and social disadvantage, could be due to socio-cultural patterns Suggestions: Implementing prevention program for this vulnerable group. Ensure quality prenatal care in subsequent pregnancies...