[External version in pelvic presentation]. / Versión externa en presentación pélvica.

We made a prospective, population-based study of external version attempt in the department of obstetrics at Hospital, Clínica y Maternidad Conchita A.C. at Monterrey, N.L. 45 patients were enrolled with diagnosis of breech presentation. We tested the hypothesis to determined the average of success and how this procedure can reduce the primary C section rate. Of the 45 patients, 48.9% were primiparous, we had success in the external version in 27 patients (60%), 81.4% had vaginal delivery and 18.6% C section. During the study the incidence of primary C section in breech presentation shown low rates from 15.3% to 9.3%. We did'nt have complications in the procedure. With these results, we concluded that the attempt of external version is more safety and had less risks for the mother and fetus that breech delivery, and we can reduced the primary C section rate for this indication.

[Mammary tumor puncture with fine needle]. / Punción de tumoraciones mamarias con aguja fina.

Breast cancer is the second malignant tumor that affects women in our population. The fine needle biopsy is a sensitive and specific technique. The purpose for this study was to show our experience at our institution. The fine needle biopsy was performed in 22 patients with diagnosis of breast tumor; all were surgically treated. In all the cases the initial cytology showed a high correlation with final histology findings. There were no complications. It was concluded that with an adequate fine needle biopsy technique, results correlate well with histopathologic study, with high sensitivity and specificity. This technique is easy to perform, with a low cost, and it may be considered as an useful tool in the study of patients with breast tumors.

[Incidence of fetal macrosomia: maternal and fetal morbidity]. / Incidencia de macrosomía fetal. Morbilidad materna y fetal.

The macrosomia is an obstetric eventuality associated to high maternal-fetal morbidity-mortality. This assay was planned in order to know the incidence of macrosomia in our institution, the relation between vaginal and abdominal deliveries and the fetal-maternal morbidity we reviewed 3590 records and we found 5.6% incidence of macrosomia in the global obstetric population. There was 58% of vaginal deliveries, 68% of the newborn were male. The main complications were in the C. sections, 2 laceration of the hysterectomy, and 2 peroperative atonias. In the vaginal deliveries, the lacerations of III and IV grade were 9 of each grade. The main fetal complications were 5 slight to severe asphyxia and 4 shoulder dystocias. This assay concludes that the macrosomia in our service is similar to the already published ones, a 42% were C. section and the maternal-fetal morbidity was low.

[Syringomyelia and pregnancy. A case report]. / Siringomielia y embarazo. Informe de un caso.

This report refers to the case of a 39-year-old woman, fourth gestation, who during her first pregnancy developed neurologic deficit of the left hand, which slowly progressed getting to affect during seven years, all the left upper extremity and the right hand. During this time, she had two abortions, and between the third and fourth pregnancies, because of the clinical suspicion, laboratory tests were done, finding by electromyography, lesion of anterior process of spinal chord at cervical level. During this fourth pregnancy, neurologic deficit increased and it was decided to interrupt pregnancy by cesarean section under epidural block at 38 weeks of gestation. According to our knowledge this syringomyelia case and pregnancy, is the first one reported in our country.

[Care of the delivery following a cesarean section]. / Atención del parto después de operación cesárea.

A retrospective study to determine the risks of normal delivery after cesarean section, was done. The inclusion criteria were found in 116 patients in six years covering the study. All the patients were permitted normal delivery and none received ocitocin. Sixty six patients accomplished delivery, which corresponds to 57%. In the rest of patients cesarean section was performed. The probability of ending in delivery was associated to women with three or more gestas. But cephalo-pelvic disproportion and fetal suffering, were associated to greater probability of ending in cesarean section. There was no dehiscence of uterine scar. It is concluded that with well established requisites it is possible to resolve by delivery with a great degree of confidence, at least 50% of cases with previous section.

[Labor induction with an unfavorable cervix by the modified Krause method]. / Inducción del parto con cervix desfavorable con el método de Krause modificado.

When delivery induction with an unfavorable cervix, is required, the traditional conduct has been to use oxitocin and more recently prostaglandins as gel. The purpose of this report is to communicate the experience of a prospective work with a group of 48 patients with amenorrhea from 16 to 42.5 weeks of gestation with an unfavorable cervix. The idea was to modify cervical features in order to facilitate delivery induction in patients with the following diagnosis: 1, Prolonged pregnancy in 32 patients. 2. Severe pre-eclampsia in seven. 3. High blood pressure in five. 4. Intrauterine growth retardation in four. All the patients were evaluated with a Bishop index of three or less. The procedure consisted of introduction of a No. 14 or 16 Foley catheter through the cervical canal, filling the balloon with 30 ml, and simultaneous application of intravenous oxitocin controlled with an infusion pump. Cervical maturation was seen in all the patients, time was from 2 to 24 hours. In all the cases Bishop's index was greater than five after the procedure. Delivery via was vaginal in 26 patients, and cesarean section in 22. There were no infectious complications, nor other type in women nor in newborns. It was concluded that despite criticism, this procedure has shown to be useful, dependable, to mature the cervix, its is available for all gyneco-obstetricians and easy to carry out.

Inducción del parto con cervix desfavorable con el método de Krause modificado / Delivery induction with unfavorable cervix with modified Krause's method

Cuando se requiere la inducción del parto con una cervix desfavorable, lo tradicional ha sido utilizar la oxitocina endovenosa y más recientemente las prostaglandinas en su forma de gel. El propósito de este informe es comunicar la experiencia de un trabajo prospectivo en un grupo de 48 pacientes con amenorrea entre 36 y 42.5 semanas de gestación con un cérvix desfavorable. La finalidad fue modificar las características cervicales para facilitar la inducción del parto en pacientes que tenían los siguientes diagnósticos: 1. Embarazo prolongado en 32 pacientes. 2. Pre-eclampsia severa en siete. 3. Hipertensión arterial en cinco, y 4. Retardo en el crecimiento intrauterino en cuatro. A todas las pacientes se les evaluó con un índice de Bishop de tres o menos. El procedimiento consistió en la introducción de una sonda de Foley No. 14 o 16 a través del canal cervical, llenado el balón con 30 ml. y aplicación simultánea de oxitocina endovenosa controlado con una bomba de infusión. La maduración del cervix se observó en todas las pacientes, oscilando el tiempo necesario entre 2 y 24 horas. En todos los casos el índice de Bishop fue mayor de cinco después del procedimiento. La vía de nacimiento fue vaginal en 26 pacientes y en 22 por operación cesárea. No se observaron complicaciones infecciosas ni de otra naturaleza en madres ni en los recién nacidos. Se concluye que a pesar de las críticas, este procedimiento ha mostrado ser útil, confiable, para madurar el cervix, al alcance de cualquier Gineco-Obstetra y fácil de realizar

[Premature membrane rupture: morbidity-mortality in pregnancies under 36 weeks]. / Ruptura prematura de membranas morbi-mortalidad en embarazos menores de 36 semanas.

The incidence of premature rupture of membranes in pregnancies of 36 weeks or less, in relation to the total births (3,796) is 1.3%; in relation to pregnancies less than 36 weeks (49 cases) 21.5%, and in pregnancies of less than 34 weeks (17 cases) of 0.47%. Infectious mortality was 2.2%. There was no maternal mortality. Cesarean section incidence was 43%. Neonatal infectious morbidity was present in 16.3%. Neonatal mortality on 4/30 cases was 13.0%; global mortality at two years was 5/30 cases, 17.0%.

[Prophylactic use of antibiotics in cesarean section]. / Uso profiláctico de antibióticos en operación cesárea.

The objective of this investigation was to determine the effectiveness of ampicillin administration as a prophylactic regime in patients undergoing cesarean section. A double blind randomized study compared a long course of ampicillin (7 days) to a short course of ampicillin (three doses) to placebo. Thirty one patients were included in the placebo group and sixty patients in the drug groups. Only one patient in the placebo group and one in the drug group developed infectious morbidity. There was no significant difference (p less than 0.001) between the placebo and ampicillin groups.

[Our experience with the Krause method in the Clínica y Maternidad Conchita]. / Nuestra experiencia con el método de Krause en la Clínica y Maternidad Conchita.

PIP: The author reports on his experience with the Krause method of pregnancy termination at the "Conchita" Maternity Clinic in Mexico during a period of 13 years, from 1955 to 1968. The following indications are accepted as legitimate and justify use of this method: dead retained ovum, hydatidiform mole, fetal death, and such complications in pregnancy as isoimmunization to the Rh factor, diabetes mellitus, gravidic toxemia, chronic hypertension. 149 patients were studied, of whom 9 had hydatidiform mole, 29 had induced delivery, and 111 had retained dead ovum. The technique and stages of the procedure are described in detail and the results are summarized in 4 tables. The technique is described as simple and requiring few instruments. Results are considered satisfactory, although the method involves some serious dangers. Brief reference is made to other methods of interrupting pregnancy, such as dilatation and curettage, hysterectomy, the injection of hypertonic solution into the uterine cavity and the perfusion of intravenous oxytoxin.^ieng