[Maternal mortality at the Gynecologic-Obstetric Hospital of the Western National Medical Center, Mexico. A 12-year review]. / Mortalidad materna en el Hospital de Gineco-Obstetricia del Centro Médico Nacional de Occidente. Revisión de 12 años.

The aim of this study is to present the analysis of the leading causes of mortality found in all the cases of maternal death at the Hospital de Ginecobstetricia (HGO) and Hospital de Especialidades (HE) del Centro Médico Nacional de Occidente (CMNO), during a period of 12 years, to achieve a winder view and to find a solution to reduce maternal mortality (MM). We reviewed files and reports of the maternal mortality committee of 151 women who were hospitalized and died at the HGO and HE del CMNO in Gudalajara, Jalismo, México, between January first, 1985 and December 31, 1996. During this period the maternal death ratio was 64 per 100,000 live births. The main cause of maternal death was toxemia 25%, follow by hemorrhage 23%, pulmonary thromboembolism 16%, infection 13%, and anesthetic complications 6%. 73% were foreseen deaths and 23% were unforeseen deaths. At the patients arrival to the hospital 37% were avoidable deaths. 66% were direct obstetric deaths and 34% were avoidable deaths. 66% were direct obstetric deaths and 34% were indirects. In 50% of the cases the end of pregnancy was done by cesarean section. The professional responsibility existed in the 72% and the hospitalary in the 23%. We made an analysis related factors and we propose strategies to diminish the maternal mortality.

[Usefulness of prothrombin fragment 1 + 2 and fibrin dimer in the detection of hypercoagulation in obstetrical patients with thrombosis risk factors]. / Utilidad del fragmento 1 + 2 de protrombina y del dímero de fibrina en la detección de hipercoagulabilidad en pacientes obstétricas con factores de riesgo de trombosis.

We measured prothrombin 1 + 2 fragment (f1 + 2p) and dimer D (dD) in plasma from 100 pregnant women at high risk for thromboembolic disease (TED) and in 23 non-pregnant control. Measures of f1 + 2p were made by immunoassay analysis in 75 patients and dD by semiquantitative analysis of plate agglutination in 97 cases. F1 + 2p was significantly elevated in 85% of cases, but its levels was not predictive value for TED. Dimer D was not found in 40 cases, in 33 patients its values were between 500 and 1000 ng/ml. and in the other 24 cases were higher than 2000 ng/ml. Values higher than 1000 ng/ml. were founded in 78% of patients with history of TED, in 60% of cesarean section patients, in 37% of hypertensive patients and in the 23% of diabetic patients. Dimer D, that was higher than 500 ng/ml. in 59% of pregnant and puerperal patients, have predictive value for TED, because 25% of 24 patients that had dD higher than 2000 ng/ml. developed TED and/or coagulation anomalies suggestive of thrombotic activity. These findings were not found in the rest of patients (n 73) which had negative dD or less than 1000 ng/ml.

[Maternal mortality at the Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Review of 5 years]. / Mortalidad materna en el Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Revisión de 5 años.

This study was carried out in order to know the mortality rate and related factors at Hospital de Ginecobstetricia, Centro Médico de Occidente, and to analyze the problem and to propose solutions. The files and reports of the Maternal Mortality Committee, regarding 74 deaths in a five year period, were reviewed. The definitions and classification criteria proposed by tha International Federation of Gynecology and Obstetrics, were used. The average maternal death rate was 8.01 per 10,000 births. The main death causes were: hemorrhage, systemic hypertension, probable pulmonary thromboembolism and sepsis. Direct obstetrical deaths, were 82.4%; predictable deaths, 66.2%, and deaths on hospital arrival, 39.1%. There was professional liability in 66.2%, and hospital liability in 25.6%. These and other data, were analyzed and possible strategies to diminish maternal mortality, were proposed.

[Subcapsular hepatic hematoma in severe postpartum pre-eclampsia. Presentation of a case]. / Hematoma hepático subcapsular en preclampsia severa postparto. Presentación de un caso.

One of the known complications of the patient with preeclamptic or eclamptic disease is the subcapsular hepatic hematoma, caused mainly by the development of disseminated intravascular coagulation. When such hematoma ruptures to the abdominal cavity mortality is high. Nevertheless, there are reports of survival, depending on a prompt and accurate diagnosis and a prompt surgical approach. In this article, a case of a patient with a postpartum severe pre-eclampsia is presented. She was diagnosed as a HELLP syndrome complicated by a disseminated intravascular coagulation and a subcapsular hepatic hematoma by clinic and supported by lab and confirmed by ultrasound, who had a satisfactory outcome.

[Acute fatty liver in pregnancy. Presentation of a case]. / Hígado graso agudo del embarazo. Presentación de un caso.

Acute fatty liver of pregnancy (AFLP) is not a very frequent disease, of unknown etiology mainly present in the 3rd trimester of the pregnancy. Early diagnosis and treatment including interruption of pregnancy (delivery or caesarean section) had been the key for decreasing fetal-maternal morbidity-mortality in recent years. This paper analyzes a clinical report of a 30 years old woman suffering AFLP histologically confirmed admitted to our hospital two weeks after illness started and who died because of secondary complications which did not respond to management probably because it was too late.

Prevalence of antinuclear antibodies in patients with habitual abortion and in normal and toxemic pregnancies.

The prevalence of antinuclear antibodies (ANA) was investigated in the sera from patients with habitual abortion (HA) and in normal (NP) and toxemic pregnancies (TP). ANAs were more prevalent in patients with HA (30%) as compared with TP (15%) and the control group (6.6%). Only one patient, from the HA group, fulfilled four criteria for systemic lupus erythematosus (SLE). Most other patients with positive ANAs had some of the criteria for SLE, but none of the ANA negative patients had any of them. These studies suggest that there is a high prevalence of ANA in our group of women with HA and their identification may help to identify those patients who may eventually develop SLE which has been reported to be preceded in many women by repeated spontaneous abortions. In addition, immunological factors, at least in some cases, could play a role in the pathogenesis of HA.