Mortalidad materna: Hospital Profesor Alejandro Posadas, Buenos Aires. Evolución 2003-2015 / Maternal mortality. Hospital Profesor Alejandro Posadas, Buenos Aires. Evolution 2003-2015

Revisamos las historias clínicas de las mujeres cuyo fallecimiento fue notificado como muerte materna entre agosto de 2003 y diciembre de 2015 en nuestro hospital y calculamos índices, tendencias y años de vida potencialmente perdidos. La información aportada por los certificados de defunción fue exigua. Un total de 52 casos cumplía con los criterios de muerte materna. Dos fueron muertes "incidentales" y dejaron siete huérfanos: una fue causada por embolia grasa por inyección de siliconas en mamas post-cesárea y la otra fue consecuencia de un femicidio que incluyó al feto de 24 semanas. De las 50 muertes maternas restantes, 11 fueron tardías (> 42 días post-parto). Las otras 39 ocurrieron durante el embarazo, parto y puerperio (≤ 42 días): 20 tuvieron causas obstétricas directas, 18 causas indirectas, y la causa de la restante fue indeterminada. La causa más frecuente de muerte fue el aborto séptico. Las muertes maternas directas presentaron como antecedentes más del triple de cesáreas y el doble de gestas que las indirectas, y dejaron el doble de huérfanos. La muerte por placenta accreta tuvo relación directa significativa con el número de cesáreas. El índice de mortalidad materna total varió entre 25 y 150 (media: 72) por 100 000 recién nacidos vivos en el período, con tendencia ascendente. Los años de vida potencialmente perdidos fueron 1576. Se destaca la necesidad de mejorar el sistema de registro de defunción y reforzar las medidas de prevención y asistencia a fin de disminuir la mortalidad materna en el área de influencia del hospital.

We reviewed the medical records of women with maternal death reported from August 2003 to December 2015 in the Posadas Hospital (Buenos Aires Province, Argentina), and calculated indexes, trends and years of potential life lost. A total of 52 cases fulfilled the criteria of maternal death. The information provided by death certificates was meager. Two deaths were incidental: one occurred post-caesarean section and was caused by fat embolism following liquid silicone breast injection, and the other was the consequence of femicide which involved also the 24-week fetus. Of the remaining 50 cases, 11 were late deaths (> 42 days postpartum). In 39 women, death occurred during pregnancy, childbirth, or puerperium up to 42 days: 20 were due to direct obstetric causes, and 18 to indirect, non-obstetric causes, the cause of the remaining death was not determined. The most frequent cause was septic abortion. Direct maternal deaths had had more than twice pregnancies, thrice caesarean sections, and orphaned twice as children as indirect deaths. Death caused by placenta accreta was directly related to the number of previous caesarean sections. Throughout the period, maternal mortality index varied between 25 y 150 (mean: 72) per 100 000 live births with ascending trend and 1576 years of potential life were lost. The study exposes the need to improve the death registration system and, most importantly, strengthen prevention and assistance measures to reduce maternal mortality in the area of influence of our hospital.

Coartación de aorta y su asociación con la patología mitral / Aortic Coartaction and its association with the mitral pathology

Coartaction of the aorta is characterized by a localized deformity narrowing the aortic lumen. The zone of coartaction is characteristically located beyond the origin of the left subclavian artery. Most of them are located in the zone of the posterior wall of the oposit aorta of the invertion of the ductus. The coartaction of the aorta amounts up to 5.1% of the congenital cardiac malformations and constitutes the eigth cardiac malformation in frequency; Is a malformation tipically associated with the Turner syndrome. The aims of this report were to describe and to analyze the mitral pathology and the clinicosonographic experience in patients with coarctation of the aorta associated to congenital mistral pathology during the last 10 years. An observtiona, descriptive and retrospective study was performed. The history of 103 patients with a diagnosis of coartaction of the aorta assisted in our Hospital were studied. All the patients were confirmed by color Doppler echocardiography. Assuming that the mitral pathology is a frequent association that affects strongly the morbi-mortality and the prognosis of such patients is an indisensable condition to investigate its presence in, front of a diagnosis of coartaction of the aorta (AU)

Compromiso cardiaco en pacientes con Mucopolisacaridosis tipo II (Enfermedad De Hunter) / Cardiac commitment in patients with type II Mucopolysaccharidosis. (Hunter's disease)

This report describes the cardiac involvement of patients with mucopolysaccharidoses Type II (Hunter disease). Mucopolysaccharidoses Type II are an uncommon group of about 50 rare inherited metabolic disorders, that result from defects in lysosomal dysfunction, usually as a consequence of deficiency of a single enzyme required for the metabolism of lipids, glycoproteins or so called mucoplysaccharides. Most of this diorders are autosomal recesively inherited such as Hunter syndrome Mucopolysacharidosis. Tuype II is a lisosomal storage disease caused by a deficiency of the lysosomal ensyme iduronate 2 sulfatase. its frequency is 1 to 100.000 to 150.000 male births; is farmore common in boys. Clinical, electrocardiographical and sonographical variables were determined. As a result 18 patients were evaluated; all the patients presented cardiac involvement. Color Doppler sonocardiogram was pathological in the 100% of the patients, and 4 of them, showed mitral/and or aortic, and 4 patients with miocardic hypoertrophy, and 1 patient, pulmonary hipertension. A clinical review is prsented, and a guide for management is detailed (AU)

Tendencia de edad gestacional y cambios en la práctica obstétrica en un período de 10 años / Gestational age trend and changes in obstetric practice in a period of 10 years

Introducción: La edad gestacional, definida como semanas de gestación completas, es el principal predictor de resultados perinatales. El monitoreo de las tendencias en la distribución de la edad gestacinal puede ser un indicador importante de los resultados de salud y desarrollo a largo plazo. Objetivos: Primario: Examinar la tendencia de la edad gestacional de los partos asistidos en el Servicio de Obstetricia del Hospital Nacional A. Posadas durante el período comprendido entre 2008-2017. Secundarios: Evaluar la tendencia en la edad gestacional según forma de inicio del parto. Determinar vía de finalización del embarazo según edad gestacional. Establecer complicaciones perinatales asociadas a la edad gestacional. Material y Métodos: Estudio observacional descriptivo y transversal. El relevamiento de datos se realizó a través del SIP. Criterio de inclusión: edad gestacional igual o mayor a 37 semanas. Criterios de exclusión: faltante de datos para la variable principal de interés. Las variables se presentan a través de medidas de frecuencia (%). Las comparaciones se realizaron con test Chi cuadrado/Fisher exact test según la conformación de la tabla de doble entrada. Se consideró un p valor<=0.05. Stata 12.0 Resultados: Durante el período de estudio se registraron 38977 nacimientos, de los cuales 28835 cumplieron con los criterios de inclusión. El mayor porcentaje de nacimientos se produjo a las 39 semanas, variando entre 27% (2008) y 35% (2016). Se encontró una disminución gradual de los nacimientos a las 40 semanas, siendo de 12% en 2008 y 6% en 2017. La edad gestacional más frecuente de finalización programada, hasta el 2014 la edad gestacional más frecuente fue 38 semanas (25%-33%) y a partir del 2015 se postergó a las 39 semanas (29%-37%). En cuanto a la vía de finalización, la prevalencia de partos vaginales fue mayor en todas las semanas, aumentando la frecuencia a mayor edad gestacional (p=0.001). Al analizar las complicaciones perinatales se encontró que la tasa de mortalidad perinatal fue en disminución hasta las 39 semanas, con una diferencia mayor a menor edad gestacional al comparar nacimientos programados y espontáneos (24.5%00 vs 13%00; 13%00 vs 7%00; y 4%00 vs 3%00 a las 37, 38 y 39 semanas respectivamente). El 39% de los nacimientos producidos a las 37 semanas de modo programaado requirieron ingreso a terapia intensiva neonatal, disminuyendo a 19% a las 38 y 14% a las 39 semanas. Conclusión: La distribución de la edad gestacional al término del embarazo ha cambiado en los últimos 10 años a expensas de un aumento de la finalización espntánea a las 39 semanas y a un cambio en la práctica obstétrica con respecto a la postergación de una semana en la finalización programada en aquellas mujeres con patologías materno fetales o cesáreas iterativas. Este cambio constribuye a disminuir la morbimortalidad perinatal ya que fue observado que a menos edad gestacional aumentó el ingreso a terapia intensiva neonatal luego del nacimiento programado, así como también contribuye a la disminución del gasto en salud (AU)

This article details trends of the gestational age and changes in the obstetrical practice during a 10 yr, period. We can define gestational age as weeks of complete gestation, as the main predictor of perinatal results. The monitoring of the trends in the distribution of the gestational age can be an important indicator of the results of the health and development in a long term. Objectives: Primary: to examine the tendency of the gestational age of the deliveries attended in our Hospital between 2008-2017. Secondary to evaluate the tendency of the gestational age according to the start of the delivery. To determine the route of ending of the pregnancy according to the start of the delivery. To determine the route of ending of the pregnancy according with the gestational age. To establish perinatal complications associated to the gestational age. With this study it is proposed to evaluate the tendency to the gestational age at the birth, in a 10-yr. period in our institution and if changes in the obstetric practice in that period influenced in it. In conclusion, the results obtained in this investigation, justify the change of behaviour in the programmed ending of the pregnancy, contributing to the decrease of the perinatal morbi-mortality, and in consecuence, to the diminishing of the waste in health (AU)

Detección prenatal de cardiopatías congénitas y factores relacionados. Experiencia en un hospital nacional / Prenatal detection of congenital cardiopathies and related factors. Experience in a national hospital

The authors present a estudy related to the prenatal detection of congenital heart diseases. The congenital anomalies (CA) are morphological or functional disorders of prenatal origin, present since the birth, even they can be detected later on, during their lifes. They constitute the second cause of infantile death in our country, following, prenatal diseases (prematurity, perinatal infections, etc.) The most severe CA have relevance for the health and require usually clinical a surgical treatment. Congenital cardiopaties (CC) are the most frequent and represent a great impact in the mobimortality both neonatal and pediatric. Foetal echocardiography is a sensitive and specific method of investigation for prenatal detection of cardiac malformations. Experience has shown that echocardiographic screening can demonstrate, the presence of probably various cardiac disease in the foetus as early as 18-20 th weeks of pregnancy. It is recommended that screening should be carried out as part of other forms of obstetric ultrasonic screening. Our aims were to analyze the characteristies of the pregnants at risk factors to CC. To determine the associated factors to the fetal pathology of the fetal electrocardiogram, and to correlate the postnatal diagnosis by cardiac echodoppler, which impoves neonate survival and reduces morbidity. The results obtained are detailed in the article (AU)

Experiencia en la colocación del DIUPP / Experience in the placement of the Diupp

Family planning is a key intervention to decrease the mortality rates and maternal morbidity, and neonatal mortality rates of children by mean of the preventiion of unwanted pregnancies, the same as pregnancies that happen very clsely to another previous one with little space between them. Several studies performed in different parts of the world have demonstrated adverse results related specially with the spaciament of the pregnancies. The risks are particularly higher with women wich get pregnant les after than a previous deliver, spontaneous abortion or induced abortion. The instrauterine device (ID) is a family planning higly efficacious with a prolongued action and reversible, that offers security to most postpartum women, including those who are still nursing. The primary aim of the present report was to determine the frequency in the placement of the DIUPP in our Obstetrical Department between 01/06/2017 and 30/06/2018, and in a second instance, to describe the method for placement of the DIUPP, to determine the curve of learning, to measure the rate of expulsion of the device, and to evaluate the conformity of the users of the method. Unplanned pregnancies have strongly increased, and for that circumstance, we believe that with new strategies, such as it is with the post-event anticonception, we can improve the reproducive health (AU)

Sindrome de corazón izquierdo hipoplásico: análisis de las características de una población en un hospital público / Hipoplastic left heart syndrome: analysis of the characteristics of a population in a public hospital

The authors present a study on prenatal diagnosis of hipoplastic left heart syndrome, and an analysis of the characteristics of a population in a public hospital. The hypoplastic left heart syndrome, and an analysis of the characteristics of a population in a public hospital. The hypoplastic left heart syndrome (HLHS) is a rare congenital heart deficit consisting in the hypodevelopment of the left ventricle, aortic valve, mitral valve and the ascendent aorta. Its incidence is 0,016% to 0.034% of the total of newborns alive. It represents between 1 - 3% of the whole congenital cardiopaties (cc). Its natural evolution is severe and it represents the greater cause of death by CC during the neonatal period. There is a predominance in males between the 55 to 67%. The etiology is multifactorial. Presents risk of recurrency between brothers, and because of that circumstance it could have genetical basis. The ais of this report were to analyze the clinical variables, electrocardiographis, echocardiographic and therapeutical, of a population with diagnosis fo HLHS. The incidence of HLHS in the population studied was 0.06% of life births. The results obtained are detailed (AU)

Características clínicas de pacientes pediátricos internados por Influenza A: comparación de dos subtipos virales (H1N1) y (H3N2) / Clinical characteristics of pediatric patients hospitalized due to Influenza A: comparison of two viral subtypes (H1N1 and H3N2)

Influenza is a respiratory disease ocasionated by influenza virus A and B. Is a disease with high morbi-mortality world-wide. Influenza produces an acute febrile respiratory illness with cough, headache and myalgias for 3-4 days, with simptoms that may persist for as long as 2 weeks. There are three types of influenza virsuses: A, B and C, of whom the type a has a higher ability to originate pandemias and is subclassified according to their surface antigens: hemaglutinine (H) and neuraminidase (N). Of the capacity of mutation that has the influenza virus and the consequent expression of different proteins, can modify its virulence. The transmission route is through direct contact with secretetory repirations. The transmission route is through direct contact with secretetory repirations. The incubation period is scant, between 12-72 hs. The aim of this study was to compare the clinical characteristics demographicals and evolutive of pediatric patients hospitalized because by Influenze A: subtypes H1N1 (pdm2009) and H3N2. An observative study was performed, retrospective, using data of hospitalizations of children during the years 2016 and 2017 with influenza A confirmed by laboratory. The study also, aimed to evaluate if the viral subtype constitutes a factor of risk, independent for complicated hospitalization (admission to intensive care and/or development of complications) in hospitalized children. The results obtained in the study are detailed in the paper. In conclusion, both viral subtypes affected mainly to children with risk factors. The viral subtype H1N1 was related with higher severety in hospitalized children. is of most importance to perform preventive works, specially in vulnerable groups, offering a good cover of immunizations. The clinical parameters arae commented (AU)

Intervenciones diagnósticas prenatales en un hospital público / Prenatal diagnostic interventions in a public hospital

The authors present a study of prenatal diagnostic interventions in a public hospital. The invasive prenatal diagnosis can be achieved by means of threee methods, aspirative punction of chorionic villous, extraction of amniotic fluid and fetal blood sample. Samples of chorionic villus are empoyed for citogenetic study, determination of the fetal cariotype or realization of a specific determination through technic FISH (Fluorescence in situ hybridization) or molecular genetics. Sample of amniotic fluid consists in the aspirative puncture under direct sonographic control of the amniotic cavity. During the period of the study, 9457 obstetric sonographies were performed with 121 genetic consultations of whom 46 resulted in invasive prenatal diagnostics. The results obtained are discussed (AU)

Nacimiento vertical en un Hospital de Alta Complejidad / Vertical delivery in a high complexity hospital

Introducción: La Organización Mundial de la Salud considera que las embarazadas no deben ser colocadas en posición horizontal durante el trabajo de parto, y que cada mujer debe decidir libremente la posición que quiere asumir durante el parto. Objetivos: Evaluar número de desgarros perineales y de episiotomía en mujeres que hayan elegido tener su segundo estadío del parto en forma vertical. Como objetivo secundario evaluar resultados perinatales como la duración del período expulsivo, hemorragia post parto y necesidad de transfusión, Apgar del recién nacido, ingreso a terapia neonatal, complicaciones puerperales y evaluar la experiencia materna. Material y métodos: Se llevó a cabo un estudio observacioal descriptivo y transversal desde octubre de 2012 a marzo de 2013 en el Hospital Nacional Profesor Alejandro Posadas. La población se identificó a partir de a revisión de historias clínicas de aquellas pacientes que decidieron tener su segundo estadío del parto en forma vertical. Las variables contínuas se presentarán como medida de tendencia central y sus dispersiones, las variabales categóricas con números absolutos y frecuencias. Se evaluará la experiencia materna a través de una encuesta utilizada como instrumento. Resultados: En el período de estudio se asistieron 24 nacimientos verticales. La población de estudio tiene una mediana de 28 años, multíparas con una mediana de 2 partos previos. No se encontró la necesidad de realizar episiotomías, el 9,1% de las pacientes tuvo desgarros prineales anteriores, el 37,5% del total de las pacientes tuvieron desgarros de segundo grado, en las pacientes con por lo enos un parto previo el 60% finalizó con periné indemne, no se encontraron desgarros de tercer y cuarto grado. No hubo recién nacidos con Apgar menor a 5 al inuto ni menor a 7 a los 5 minutos, no se encontraron hemorragias post parto ni necesidad de transfusiones sanguíneas. 2 neonatos ingresaron para control luego de las dos horas de vida por distress respiratorio a terapia intensiva neonatal. La experiencia materna fue calificada de "buena" a "muy buena" para el 95,2% de las mujeres encuestadas post parto. Conclusiones: Los datos obtenidos a través del presente estudio son de suma importancia ya que representan el primer análisis de resultados provenientes de nacimientos verticales dentro de nuestro servicio. El tamaño muestral no nos permite realizar análisis estadísticos ni conclusiones con respecto a las posibles riesgos ni beneficios del parto vertical con respecto a la posición supina, nuestros resultados más la evidencia bibliográfica existente nos permite continuar con este tipo de asistencia y con el desarrollo de otros diseños de investigación.

The aim of the present report was to evaluate the amount of perineal tears and of episiotomies in women that have chosen to have their second stage of parturition in a vertical form. As a secundary objective was the evaluation of perinatal results as the duration of the expulsve period, pospartum hemorrhage, transfusional rquires, Apgar score of the newborn, entrance to neonatal therapy, puerperal complications and evaluation of the maternal experience. Further studies will support new contributions with other designs of investigations

Niveles plaquetarios y marcadores de disfunción endotelial multiorgánica en síndrome HELLP / Platelet levels and multiorganic endothelial dysfunction markers in the Hellp Syndrome (Hemolysis, elevated liver enzimes, low platelets)

HELLP syndrome (hemolysis, elevated liver enzimes, low platelets count) is one of the major complications of the progression of thrombotic microangiopathies characterized by thrombocytopenia, hemolistic anemia and organic dysfunction. It can be found in between 0,5 - 0,9 % of all pregnancies, and between 4- 14 % in all those women who develop preeclampsia. The general objectives of this report were to describe the relationship existing between the platelet levls and the organic endothelial dysfunction because of the HELLP syndrome, and to determine the perinatal results, during the 10 yr. period of the study, in patients that were assited between 2007 and 2016.

Prevalencia de sífilis en embarazo adolescente / Syphilis prevalence in teenagers pregnant patients

The aim of this report was to determine the prevalence of syphilis in teenagers pregnant patients in the National Hospital "Alejandro Posadas" during the period between January 1st through December 31st 2016

Resultados perinatales del embarazo gemelar en un Hospital de Alta Complejidad / Perinatal results of twin pregnancy in a high complexity hospital

The objective of this study was to describe the epidemiology and the perinatal outcomes of twin pregnancy in the Maternal-Infantile Departament of the National Hospital "Alejandro Posadas". During the period studied there were 2825 births. The prevalence of twin pregnancies was 3.2% (N= 91). From the total of twin pregnancies, 88 were doubles and 3 were triples. It is postulated that the monochorial monovular twins constitutes a different clinical entity, because of a higher proportion of complicatioms, and that the adequate planification of the actions and working connected the perinatal team will improve the care process

Tumor maligno congénito. Síndrome de Pepper / Congenital malignant tumor: Pepper's Syndrome

Pepper's syndrome refers to a neuroblastoma originated in the adrenal glands that usually metastasizes to the liver with abdominal development and respiratory involvement because of thoracic compression. The metastasic tumors are usually infrequent with an unfavorable prognosis. The cases reported in the world literature are very few. The congenital form of neuroblastoma is uncommon. The aim of this report was to describe a typical clinical case of a new born who died because of a metastasic malignant tumor, comptible with a Pepper's syndrome

Frecuencia de desgarros perineales en pacientes primíparas con y sin episiotomía durante un parto vaginal / Frequency of perineal tears in primiparous patients with and without episiotomy during a vaginal birth

This report details the frequency of perineal tears in primiparous patients with and without episiotomy, curing a vaginal delivery. Episiotomy is the surgical incision on the perineum to enlarge the vaginal opening for obstetrical purposes during the birth process for widening the oulet of the birth canal to facilitate delivery. From the present study it becomes evident that the women submitted to restrictive episiotomy showed less anterior and posterior perineal tears comparing with those without the previous episiotomy. It is considered that the implementation of a restrictive episiotomy is a valid tool that should be used by qualified personal with experience in the technique and the repairment

Control prenatal ausente y resultados perinatales adversos / Absence of prenatal control and adverse perinatal reults

Objetivos: Primario: Evaluar asociación entre ausencia de control prenatal con bajo peso al nacer y prematuridad en nacimientos asistidos en el Hospital Posadas, 01/01/2012-31/12/2016. Secundarios: Establecer resultados maternos y otros resultados neonatales en mujeres con ausencia de control prenatal; determinar asociación entre control prenatal inadecuado con bajo peso al nacer y prematuridad, resultados maternos y otros resultados neonatales. Pacientes y método: Estudio observacional, analítico de cohorte. La población fue identificada a partir del SIP. Criterios de Inclusión: parto asistido en la institución. Criterios de exclusión: embarazo múltiple, abortos, control prenatal realizado en otra institución, número de controles mayor o igual a 5 de inicio tardío y/o sin estudios complementarios. La variable de exposición fue la ausencia de control prenatal. Las variables se presentan como medidas de frecuencia y tendencia central. Las comparaciones se realizaron con Fisher exact test, Chi 2 y T-test, p valor=<0.005. Para las variables principales se calcularon OR crudos, IC 95%. Se utilizó un modelo de regresión logística múltiple, calculándose OR ajustados, IC 95%. Se calculó un tamaño muestral de 500 pacientes. Resultados: En el período estudiado se registraron 17310 partos, de los que 3243 cumplieron con los criterios de inclusión, incluyendo 251 pacientes sin control prenatal, 812 con control inadecuado y 2180 con control adecuado. La prevalencia de control prenatal ausente fue de 1.45%. Comparado con el grupo control, el grupo con CPN ausente presentó más posibilidades de prematuridad (ORa=4.3 IC 95% [3.1-5.8]) y de bajo peso al nacer (ORa=4.1 IC 95%[2.9-5.8]). En el grupo con CPN inadecuado las posibilidades de prematuridad (ORa=2.4 IC 95% [2-3.5]) también se vieron aumentadas. Discusión: La ausencia de control prenatal representa un mayor riesgo de morbi-mortalidad perinatal. Por tal motivo se considera de suma importancia concientizar a la población sobre dicha problemática, ejerciendo acciones educativas y de prevención desde nuestro lugar como profesionales de la salud.

The aims of this report were to evaluate both the association between the absence of prenatal control with low weight at birth and prematurity in assisted deliveries, and to establish maternal results and other neionatal results in women with absence of prenatal control; and also to determine the association between inadequate antenatal care with low weight at birth and prematurity, maternal results and other neonatal results. As a conclusion we can asume that the inadequate antenatal care with absence of prenatal control is associated with a higher risk of adverse pregnancy outcomes and perinatal morbi-mortality, and for that motive, it is considered of main importance to conscientize the population with reference to such problematic.

Vía de finalización en pacientes con segunda inducción al trabajo de parto en el Hospital Nacional prof. A. Posadas / Postterm pregnancy in patients with second labour induction - Author's experience

The labour induction is an intervention to initiate artificially the uterine contractions to produce the effacement and dilatation of the uterine cervix until the child-birth is achieved. It is indicated when the benefit of the termination of the pregnancy for the mother and the child is greater than its continuation. It is perfored in more or less the 20 % of the women. In our institution the rate oscillates in around the 9 % of the cases. It is understand as an successful induction the termination of the labour through the vaginal delivery. The methods for labour induction more commonly used at present are mechanical and pharmacological. Between the first group we can find the Hamilton maneuver and the amniotomy. And between the pharmacologicals we find the oxytocine. These elements are considered in the article

Vía de finalización en inducciones de embarazos postérmino, según score de Bishop / Induction of postterm pregnancies according to Bishop score

Objetivo: Determinar la vía de finalización en embarazos pos término de mujeres que fueron internadas para inducción al trabajo de parto y establecer la relación entre la vía de finalización y Bishop de comienzo. Pacientes y métodos: Estudio Observacional, Descriptivo, Transversal, de 2013 a 2014. La población se identificó del SIP de aquellas pacientes con embarazo mayor a 41 semanas internadas para inducción. Test de Fisher exacto o Chi cuadrado para evaluar la siginficancia estadística p=0.05. Resultados: De 197 pacientes, la media fue de 24 años. El 21% comenzó la inducción con Bishop entre 0 y 3 puntos, 59.5% entre 4 y 6 puntos. 13 pacientes recibieron una segunda inducción tras la primera fallida. El 67.5% de las inducciones finalizaron por parto vaginal, 32.5% cesárea. De las mujeres con score 0-3 puntos el 61,5% finalizaron por cesárea, para el segundo grupo (Bishop 4-6) el 71.8% de las inducciones finalizó por parto vaginal, encontrándose una significancia estadística en estas relaciones, test de Fisher=0.000. Conclusiones: Podríamos relacionar el score de Bishop de comienzo de inducción con la vía de finalización y si bien se han encontrado gran porcentaje de partos vaginal con score de 4 en adelante, el 61.5% de las mujeres que pertenecían al grupo de 0-3 finalizaron por la vía quirúrgica por lo que podría recomendarse la maduración cervical previa inducción en este grupo de como estatregia para la reducción de la tasa de cesáreas en inducciones por 41 semanas.

The aim of this report was to present an evaluation of induction of postterm pregnancies according to the ´Bishop score in women admitted for labor induction. Labor induction is an intervention in order to iniciate artificially the uterine contractions to produce the effacement and the dilatation of the uterine cervix and to end with a birth. At present we have three main methods for induction, oxytocin, prostaglandins and amniotomy. The pregnancy chronologically prolongued refers to that simple gestation that reaches or overcomes the 294 days since the date of the last menstruation. It is known that the pregnancies chronologically prolongued are associated with a rise of the maternal and perinatal morbimortality, and therefore, since they are diagnosed. It is mandatory the management toward a minimization of the risks. For these reasons, it is recommended, in the case of a prolonged pregnancy, to consider beneficial to begin the parturition for security reasons for the mother and the fetus. ´These considerations are referred in the article

Manejo del acretismo placentario en Servicios de Obstetricia de hospitales de alta complejidad Aplicación de un Proyecto de atención integral multidisciplinario / PLACENTA ACCRETA: MANAGEMENT AT OBSTETRIC SERVICES IN HIGH COMPLEXITY HOSPITALS

Objetivo: El objetivo del estudio fue describir el manejo de los Trastornos Adherenciales de la Placenta en la Maternidad de alta complejidad recabando los datos tanto del servicio de Obstetricia del Hospital Nacional Profesor Alejandro Posadas y Hospital Naval Pedro Mallo Buenos Aires. Diseño: Estudio de tipo observacional, descriptivo y transversal. Análisis estadístico mediante Stata 12.0. Resultados: Durante el período comprendido entre enero de 2010 y diciembre de 2014 fueron atendidas 30 pacientes con trastornos adherenciales placentarios. La incidencia de acretismo placentario en ese periodo fue de 0.18 (30/16210 nacimientos). El 56.67% (17/30) de las cirugías fueron programadas con Hemodinamia. En el 96.67% (N=29) el resultado anátomo-patológico final fue Acretismo Placentario. Hubo un caso falso positivo. Cuatro casos presentaron complicaciones potencialmente graves "near miss". No se presentaron muertes maternas. Conclusiones: Los trastornos adherenciales placentarios se presentan como un nuevo desafío para los Servicios de Obstetricia por la aparición en forma "epidémica" de una enfermedad que era infrecuente. El manejo multidisciplinario es la clave para un correcto tratamiento. El Obstetra cumple el rol de coordinación del mismo, convocando a las diferentes especialidades. Será entonces, de capital importancia el aporte de todos para la correcta resolución de los casos.

The aim of the present report was to describe the management of the adherencial disorders of the placenta in a high complexity maternity. During the period between January 2010 and December 2014, 30 patients with placental adherencial disorders were assisted. The incidence of placenta accreta during that period, was 0.18 (30/16210 deliveries). The 96.67 % of surgeries were programmed with Hemodinamia. In the 96.67 % (N= 29) the final anatomo-pathological result was Placentary Accretism. There was a false positive case. Four cases presented complications potentially severe "near miss". None maternal deaths were observed in the survey. The placental adherencial disorders present as a new challenge for the Obstetric Services because of their apparition in an "epidemic" way of a disease that was unfrequent. The multidisciplinary management is the key for an adequate treatment. Obstetricians play a roll for coordination of the team, convoking the different specialities. There will be then, of great importance, the contribution of the totality for the proper resolution of the cases

Diagnóstico prenatal de cardiopatías congénitas / PRENATAL DIAGNOSIS OF CONGENITAL HEART DEFECTS FOR DETECTING CARDIAC MALFORMATIONS

Congenital heart defects or congenital cardiac malformations represent one of the major causes of death in children younger than 1 year. The incidence varies between 4 - 13 for each 1000 newborns. Represents the severe structural malformation of the higher prevalence worldwide. In the "Professor A. Posadas Hospital" during the year 2015, it was registered a frequency of congenital anomalies of 7,1 % , being in the first place the musculoskeletal malformations with 19,4 %, and in the second place we can find the cardiovascular manifestations with 18.1 %. It is important the prenatal diagnosis in order to carry out an assessment to their parents, to reach the birth in a high complexity center and in the possible case, to plan the possibility of performing a fetal therapy. There exists scientific evidence that proves that the prenatal diagnosis improves the neonatal survival, even being this anomalies the less diagnosticated during the prenatal period These considerations are discussed in the article.