Neumotórax espontáneo bilateral en primigestante adolescente, reporte de un caso / Spontaneous bilateral pneumothorax in a primigestant adolescent, a case report

El neumotórax espontáneo es una patología extremadamente rara durante la gestación. Se define como la presencia de aire dentro de la cavidad pleural que puede generar principalmente dolor torácico y disnea. Esta patología tiene unas bajas incidencia y prevalencia en el embarazo, pero es relevante por una alta tasa de recurrencia, con un buen pronóstico para la madre y el feto si es tempranamente diagnosticada y oportunamente manejada. Se relaciona con factores de riesgo como las maniobras de Valsalva efectuadas durante el trabajo de parto, además de con comorbilidad como el tabaquismo, y con el biotipo longilíneo, entre otros, por lo que son muy importantes una adecuada anamnesis y la evaluación de la exploración física. El obstetra debe sospecharlo ante la clínica de dolor torácico asociado a disnea en gestantes en el trabajo de parto y el parto, y tenerlo en cuenta como diagnóstico diferencial. Es de vital importancia tener un manejo multidisciplinario compuesto por ginecoobstetra, internista, neumólogo y neonatólogo, incluido el apoyo por una unidad de cuidado intensivo para evitar complicaciones materno-perinatales que se puedan asociar al neumotórax espontáneo.

Spontaneous pneumothorax is an extremely rare pathology during pregnancy. It is defined as the presence of air inside the pleural cavity that can mainly generate chest pain and dyspnea. This pathology has a low incidence and prevalence in pregnancy, but a high rate of recurrence with a good prognosis for the mother and the fetus if it is diagnosed early and managed early. It is related to risk factors such as Valsalva maneuvers performed during labor, in addition to comorbidities such as smoking, longilinear biotype, among others, so it is very important to have an adequate history and evaluation of the physical examination. The obstetrician must be attentive to chest pain symptoms associated with dyspnea in pregnant women during labor and delivery, suspect this pathology and take it into account as a differential diagnosis. It is vitally important to have a multidisciplinary management composed of the gynecologist-obstetrician, internist, pulmonologist, neonatologist, including the support of an intensive care unit to avoid maternal-perinatal complications that may be associated with spontaneous pneumothorax.

Factores de riesgo perinatal asociados al trastorno del espectro autista y al síndrome de Rett / Perinatal risk factors associated with autistic spectrum disorder and the Rett syndrome

Resumen El propósito de este proyecto fue identificar los factores de riesgo perinatal asociados al trastorno del espectro autista (TEA) y al síndrome de Rett y compararlos entre sí, estando enmarcado dentro de un estudio de tipo descriptivo. Para esta investigación se utilizó una unidad de análisis conformada por 421 historias clínicas, de las que 377 fueron de TEA y 44 de Rett, a las cuales se les aplicó un instrumento especializado en identificar factores de riesgo perinatales llamado Cuestionario Materno de Riesgo Perinatal (CMRP), con el que se encontró una gran prevalencia de niños nacidos por cesárea y que las ocupaciones de sus padres estaban relacionadas con los cuidados requeridos por el trastorno. Esta identificación de factores servirá para la toma de precauciones a nivel clínico médico y a nivel de prevención de los riesgos asociados al trastorno del espectro autista y el síndrome de Rett.

Abstract The purpose of this project was to identify the perinatal risk factors associated with Autism Spectrum Disorder (ASD) and Rett Syndrome and compare them to each other, being framed within a descriptive study; For this research, an analysis unit consisting of 421 medical records was used, of which 377 were from ASD and 44 from Rett, to which a specialized instrument was applied to identify perinatal risk factors called the Maternal Perinatal Risk Questionnaire (MPRQ ), which found a high prevalence of children born by caesarean section and that their parents' occupations were related to the care required by the disorder. This identification of factors will serve to take precautions at the medical clinical level and at the level of prevention of the risks associated with Autism Spectrum Disorder and Rett Syndrome.

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

La atención primaria en salud. La experiencia peruana

Alma Ata is still in force in those experiences of comprehensive health care from all and for all that some countries have managed to implement, especially in the rural areas with populations affected by exclusion and poverty. Peru has several of them that find their roots in experiences previous to the 1978 Conference. It is interesting to confirm that many of these were initially dedicated to the care of pregnant women and newborns, and then they have translated their lessons learned to the care of the whole population.

Alma Ata sigue vigente en aquellas experiencias de Cuidado Integral de la Salud por todos y para todos que algunos países han logrado implementar, sobre todo en zonas rurales con poblaciones afectadas por la exclusión y la pobreza. El Perú detenta varias de ellas, que incluso encuentran sus raíces en experiencias previas a la Conferencia de 1978. Es interesante confirmar que muchas de estas se abocaron primero a la atención de las gestantes y recién nacidos, y luego han trasladado sus lecciones aprendidas al cuidado de toda la población.

Embarazo en pacientes con lesión medular / Pregnancy in patients with spinal cord injury

ANTECEDENTES: Las gestaciones en pacientes con daño medular representan un reto para la obstetricia. Las complicaciones más frecuentes son las infecciones de las vías respiratorias y de las vías urinarias, y la más grave la hiperreflexia autonómica. El parto vaginal es posible en lesiones por debajo de T5, pero por encima de ese nivel, la imposibilidad de percibir las contracciones, de identificar el trabajo de parto y realizar pujos lleva a la necesidad de una cesárea programada. OBJETIVO: Exponer nuestra experiencia y revisar el manejo más adecuado de la embarazada parapléjica. MÉTODOS: Estudio retrospectivo en el periodo 2003-2014. Hubo 10 pacientes con 24 gestaciones: 6 abortos espontáneos, un 1 aborto inducido, quedando para el análisis 17 gestaciones (1 embarazo gemelar). La evaluación es independiente a la etiología o localización de la lesión. Se analiza las complicaciones perinatales y maternas. Resultados: La edad media fue 33 años. La edad gestacional media al parto fue 37 semanas: 12 de término (70,59%), 4 de pretérmino (23,53%) y una desconocida (5,88%). Hubo 10 cesáreas (58,82%) y 7 partos vaginales (41,18%). Peso medio neonatal de 2940 g, ninguno con retraso de crecimiento intrauterino. CONCLUSIONES: Nuestra experiencia muestra una alta tasa de prematuridad y de cesáreas, pero con buenos resultados maternos y perinatales, que hace permisible que estas pacientes puedan cumplir su deseo genésico, superando su discapacidad.

BACKGROUND: The pregnancies in patients with spinal cord injury represent a challenge for obstetrics. The most common complications are infections of the respiratory and urinary tract, and the most severe is the autonomic hyperreflexia. Vaginal delivery is possible in lesions below T5, but above that level the inability to perceive contractions, to identify labor and perform straining leads to the need for a scheduled cesarean. OBJECTIVE: To describe our experience and review the most appropriate management of paraplegic pregnant. Methods: Retrospective study in the period 2003-2014. There were 10 patients with 24 pregnancies: 6 spontaneous abortions, 1 induced abortion, leaving 17 for analysis pregnancies (one twin pregnancy). The evaluation is independent of the etiology or location of the lesion. Perinatal and maternal complications were analyzed. RESULTS: The mean age was 33 years. The mean gestational age at delivery was 37 weeks: 12 to term (70.59%), 4 preterm deliveries (23.53%) and one unknow. There were 10 cesarean sections (58.82%) and 7 vaginal deliveries (41.18%). Average birth weight of 2940 g, none with intrauterine growth restriction. CONCLUSIONS: Our experience shows a high rate of prematurity and cesarean section, but with good maternal and perinatal outcomes, which makes it permissible for these patients can fulfill their procreative desire, overcoming his disability.

Outcome of caesarean section under spinal versus epidural for women with pre-eclampsia.

Background: Pre-eclampsia is a major cause of maternal and perinatal mortality worldwide. Women with pre-eclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress and prematurity. Objective: To compared the outcome of Cesarean section for pre-eclampsia using sub-arachnoid block and epidural anesthesia Methods: The present retrospective study was carried out in one of the tertiary care hospital of Bareilly district from Jan.2011 to July 2013. Unit of study were all the women with preeclampsia who underwent caesarean section for delivery under spinal or epidural anaesthesia and their babies. chi squire test and student t-test test were applied for statistical analysis. Results: There was no significant difference between two groups in overall maternal mortality (0.0% vs 2.4%, p>0.05), perinatal mortality (5% vs 7.1%, p>0.05), Apgar score less than 7 at 1 minute (25% vs 21%, p,0.05)and Apgar score less than 7 at 5 minute (5% vs 14.3%). Conclusion: no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with preeclampsia who had epidural and those that had spinal anaesthesia.

A retrospective study of the outcome of cesarean section for women with pre-eclampsia under spinal versus epidural anaesthesia in hospital of Northern India.

Back ground: Pre-eclampsia is a major cause of maternal and perinatal mortality worldwide. Women with pre-eclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress and prematurity. Objective: To compared the outcome of Cesarean section for pre-eclampsia using sub-arachnoid block and epidural anesthesia Methods: The present retrospective study was carried out in one of the tertiary care hospital of Bareilly district from Jan.2011 to July 2013. Unit of study were all the women with preeclampsia who underwent caesarean section for delivery under spinal or epidural anaesthesia and their babies. chi squire test and student t-test test were applied for statistical analysis. Results: There was no significant difference between two groups in overall maternal mortality (0.0% vs 2.4%, p>0.05), perinatal mortality (5% vs 7.1%, p>0.05), Apgar score less than 7 at 1 minute (25% vs 21%, p,0.05)and Apgar score less than 7 at 5 minute (5% vs 14.3%). Conclusion: no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with preeclampsia who had epidural and those that had spinal anaesthesia.

Resultados maternos-perinatales de pacientes con preeclampsia / Maternal-perinatal outcome of patients with pre-eclampsia

Introducción: la preeclampsia es la complicación médica más frecuente del embarazo, en Cuba se ha encontrado una incidencia entre el 5 y el 10 %, y constituye una de las primeras causas de morbilidad materna y perinatal. Objetivo: caracterizar el comportamiento de los resultados maternos-perinatales en pacientes con diagnóstico de preeclampsia. Métodos: se realizó un estudio observacional analítico de casos y controles en el período comprendido entre el 1ro. de enero del 2008 y el 31 de diciembre de 2009 en el Hospital Ginecobstétrico "Eusebio Hernández" de La Habana. Se consideraron como casos las pacientes con diagnóstico previo de preeclampsia (172) y como controles las que no tuvieran este diagnóstico (7 916). Resultados: la mayoría de las gestantes estuvieron incluidas en los rangos de edades comprendidos entre 20 y 34 años. Los factores de riesgo que con más frecuencia se observaron en las pacientes con preeclampsia fueron la nuliparidad (82,5 %) y la edad materna extrema (26,7 %). La cesárea se utilizó con mayor frecuencia entre las pacientes preeclámpticas (59,3 %), además presentaron 5,5 veces más probabilidades de presentar parto pretérmino. Conclusiones: las pacientes con diagnóstico de preeclampsia en las que se utilizó el sulfato de magnesio presentaron una probabilidad casi 21 veces menor de desarrollar una eclampsia. Las complicaciones materno-perinatales más frecuentes fueron la preeclampsia grave, el hematoma retroplacentario, peso inferior a los 1 500 g y la enfermedad por membrana hialina en el recién nacido.

Introduction: pre-eclampsia is the most common medical complication of pregnancy. In Cuba, an incidence of 5-10 % was found and it is one of the leading causes of maternal and perinatal morbidity. Objective: to characterize the behavior of maternal-perinatal outcome in patients with pre-eclampsia. Methods: an observational study of cases and controls was conducted from January 1st. January 2008 to 31 December 2009, at Eusebio Hernández OB/GYN Hospital in Havana. We considered as cases, 172 patients with previous diagnosis of pre-eclampsia and as controls, 7916 patients who did not have this diagnosis. Results: most of the pregnant women were included in the age range 20-34 years. The most frequent risk factors observed in patients with pre-eclampsia was nulliparity (82.5 %) and extreme maternal age (26.7 %). Cesarean section was used more frequently in pre-eclamptic patients (59.3 %), also the likelihood of having preterm labor was 5.5 times more in these patients. Conclusions: the likelihood of developing eclampsia was almost 21 times less in patients with pre-eclampsia, who used magnesium sulfate. The most common perinatal and maternal complications were severe pre-eclampsia, retroplacental hematoma, weighing bellow 1 500 g, and hyaline membrane disease in the newborn.

Factores de accesibilidad relacionados con muerte perinatal / Factors of accessibility realated to perinatal death

Introducción: Objetivo Describir diferencias de factores relacionados con accesibilidad a servicios de salud, entre un grupo de mujeres que tuvieron parto en instituciones prestadoras de servicios de salud de Bucaramanga, cuyos productos sufrieron muerte perinatal y otro grupo con productos vivos, procedentes de Lebrija Santander año 2004. Materiales y métodos: estudio de caso descriptivo, retrospectivo. De 15 muerte perinatal reportadas, sólo 7 cumplían criterios de inclusión. Por cada muerte perinatal, se seleccionaron por conveniencia, 3 madres con niños vivos. Las variables estudiadas, mediante frecuencia absoluta y relativa, fueron: Características de la madre, del niño, Oportunidad, Percepción de atención, Funcionalidad, Costos. Resultados: 6 muerte perinatal previsibles, 1 no previsible. 3 pertenecían al régimen subsidiado, 1 al contributivo, 3 no aseguradas. Se observó, falta de oportunidad para remisión de madres e intervención del parto. Mujeres con 3 ó más controles, presentaron mayor frecuencia relativa de muerte perinatal. También se observó insatisfacción en la percepción de atención, en 3 aspectos estudiados, en 3 niveles de atención...

Introduction: Objective: To describe differences of factors related with accessibility to health’s services among a group of women which had childbirth in lender institutions of health’s services of Bucaramanga city whose products suffered perinatal death and another group with alive products, coming from Lebrija Santander year 2004. Materials and methods: An study descriptive, retrospective case. Of 15 reported perinatal death, 7 only completed inclusion criterion. By each perinatal death were selected by convenience, 3 mothers with alive children. The studied variables, by means of absolute and relative frequency were: Characteristic of the mother, of the boy, Opportunity, Perception of attention, Functionality and Costs. Results: 6 foregone perinatal death, 1 not foregone. 3 belonged to the subsidized régime, 1 to the revenue, 3 non insureds. It was observed, opportunity lack for mothers’ remission and intervention of the childbirth. Women with 3 or more controls, presented bigger relative frequency of perinatal death. Dissatisfaction was also observed in the perception of attention, in 3 studied aspects, in 3 levels of attention...