Reduction in the cesarean section rate in nulliparous patients after administration of intravenous propranolol

OBJECTIVE: A preliminary investigation to test the efficacy of intravenous propranolol in reducing the cesarean section rate in nulliparas in active labor and evaluate its effect on neonatal and maternal outcomes. METHODS: Fifty seven nulliparous patients admitted in active labor were randomly divided into two groups: a control group consisting of 23 patients, and a treatment group consisting of 34 patients given 2 mg of propranolol intravenously every 4 hours until delivery. Total length of labor, time from first administration of medication to delivery, incidence of cesarean section, APGAR scores, maternal and fetal morbidity were assessed. RESULTS: A total of 4 cesarean sections were performed in each group (11.7 per cent in the treatment group and 17.3 per cent in the control group). The rate of cesarean section due to dystocia was 6.25 and 13.6 per cent respectively (P = .367). Statistical significance was not reached due to the small number of subjects (students t test analysis). There was no increase in the incidence of low APGAR scores, intensive care unit admissions, abnormal heart rate patterns during labor, cesarean sections for fetal distress or maternal morbidity in the treated group. CONCLUSIONS: Intravenous administration of 2 mg of propranolol every four hours is safe and not associated to increased neonatal or maternal morbidity. A 50 per cent decrease in the incidence of cesarean sections can be documented among nulliparous patients treated with propranolol although the small numbers and overall low incidence of cesarean section in our population (14 per cent) did not permit these differences to reach statistical significance

Comparison of the endocervical brush and the endocervical curettage for the evaluation of the endocervical canal

OBJECTIVE: To evaluate and compare the efficacy in obtaining an adequate endocervical sampling using the endocervical brush and the endocervical curettage. METHODS: Analysis of the cytology and histology of samples obtained from patients referred to the University of Puerto Rico School of Medicine Tertiary Care Center Anaplasia Clinics for colposcopy due to an abnormal Pap smear having atypical cells or higher as classified according to the Bethesda System. All patients underwent evaluation of the endocervical canal with an endocervical brush and an endocervical curettage. RESULTS: Fifty three of fifty-eight patients had correlating endocervical brush Papanicolaou smear and endocervical curettage. Only five patients presented discrepancies. All endocervical brush samples had sufficient tissue for diagnosis. CONCLUSION: The endocervical curettage is operator dependent, is difficult to perform in patients with a stenotic cervical os or in menopausal patients. The endocervical brush is easier to use, malleable and has a lower processing cost. In view of these findings evaluation of the endocervix can be safely performed with the use of an endocervical brush. When used properly, the endocervical brush has a sensitivity of 90 per cent , a specificity of 92.1 per cent and a positive predictive value of 87.5 per cent

Misreporting of maternal mortality in Puerto Rico

La mortalidad materna (MM) continúa siendo un problema serio en muchos países desarrollados y sub-desarrollados. Se estima que existe un sinúmero de sub-registro en Estados Unidos de 20%, resultando esto en tasas que serán substancialmente mayores que las reportadas. La meta nacional de MM para el año 1990 ha sido fijada en 5/100,000, y se espera que se pueda llegar a dicha meta entre la población blanca pero no en las minorias. Puerto Rico registró una tasa de MM de 5/100,000 en 1975. Se sospechó que esta tasa tan baja se debió a un sub-registro, y se llevó a cabo un estudio para investigar esta posibilidad. Los resultados indicaron que existió un severo sub-registro en 1978 y 1979. Recientemente surgió la pre-ocupación que dicha situación continuase. Como no había evidencia que el registro había mejorado, el Departamento de Salud solicitó del Departamento de Obstetricia y Ginecología de la Escuela de Medicina de la Universidad de Puerto Rico y el Departamento de Salud Materno-Fetal que llecaran a cabo otro estudio para verificar los hallazgos. El estudio se basó en un estudio de expedientes médicos seleccionados correspondiendo a muertes de mujeres en edad reporductiva cuya causa de muerte, según codificados en el certificado de defunción, fueron consideradas como teniendo una alta probabilidad de ser un caso de sub-registro de muerte materna. Se decidió investigar las muertes del 1982, a ver si los resultados del estudio anterior habían causado algún impacto en el registro de MM rn Puerto Rico