[Fetal fibronectin and cervical length as early predictors of preterm labor]. / Fibronectina fetal y longitud cervical como predictores tempranos de parto pretérmino.

UNLABELLED: BACGROUND: preterm birth is a major obstetric problem that contributes to 70% of perinatal mortality. OBJECTIVE: to determine the sensitivity, specificity and predictive values of fetal fibronectin and cervical length as predictors of preterm birth in the HGR No. 36, Puebla. MATERIAL AND METHODS: observational, prospective. comparative study. Pregnant women were included between 24 and 33 weeks amenorrhea and diagnosis of preterm labor. Quik Chek Kit was used to detect fibronectin using qualitative methods, and then subjected to measurement of cervical length with endovaginal ultrasound. Patients with a positive result or both proceeded to start treatment. To calculate sensitivity, specificity and predictive values were used odds ratios and Fisher exact test for statistical analysis. RESULTS: of 66 patients 34% reported positive fibronectin with a sensitivity and PPV of 92% and 77% compared with the assessment of 27% of patients with short cervical length at 55% and 88% respectively. 28% had two positive marker (fibronectin/cervical length), the sensitivity, specificity and positive and negative predictive values increased significantly (86%, 100%, 93%, 100%). The average time between birth positive test was observed at 21 days. Risk factors for preterm delivery were found: patients under 25 years (P:0.0009), primigravida (P:0.0057), genitourinary infection (P:0.0001). CONCLUSION: the double marker fibronectin / cervical length is useful for determining patients at risk of preterm delivery because of its high specificity and NPV, ideal for easy handling and low cost.

[Comparison of maternal and perinatal outcomes in the conservative treatment preterm premature membrane rupture between the use of erythromycin and clindamycin]. / Comparación de resultados maternos y perinatales en el tratamiento conservador de la rotura prematura de membranas pretérmino entre el uso de eritromicina y clindamicina.

BACKGROUND: premature rupture of membranes occurs between 5 and 15% of pregnancies, of these, 10% occurs at term and preterm 2 to 3.5%. OBJECTIVE: To compare maternal and perinatal outcomes from the use of erythromycin or clindamycin in women with preterm premature rupture of membranes with conservative treatment at the Regional General Hospital No. 36. PATIENTS AND METHODS: comparative, prospective, randomized study conducted at the Regional General Hospital No. 36 of the Instituto Mexicano del Seguro Social, Puebla. The most common risk factors were cervical infections (55%) and urinary tract infection (55%). A history of premature rupture of membranes in pregnancy was reported in 12.5% of patients. Group A was prescribed erythromycin and group B, standard-dose clindamycin, these were the independent variables. Maternal outcomes (deciduoendometritis and chorioamnionitis) and perinatal (respiratory distress syndrome, necrotizing enterocolitis and sepsis) were the dependent variables. Fisher exact test was applied to the results of the study. RESULTS: about perinatal outcome, sepsis was expressed more frequently in the clindamycin group (60%) compared with erythromycin (35%). The occurrence of respiratory distress syndrome was similar in both groups, 70 and 75% respectively. For necrotizing enterocolitis, 25 and 5%. Maternal alterations as chorioamnionitis occurred in 20% of patients in group A and 5% in group B. Endometritis results were similar in both groups. CONCLUSIONS: comparing the maternal and perinatal outcomes with conservative management of premature rupture of membranes, results were better in the group treated with erythromycin. It is not possible to prove it statistically because of the sample size.

[Comparison of dinoprostone (ovules and gel) to achieve cervical ripening in patients with term pregnancy that occurs with premature membranes rupture]. / Comparación de dinoprostona (óvulos y gel) en la maduración cervical en embarazo de término con rotura prematura de membranas.

BACKGROUND: Premature rupture of membranes is a normal occurrence of labor and can occur before or after the onset of contractions. The clinical factors associated with premature rupture of membranes include: low socioeconomic status, low body mass index, prior preterm pregnancies, smoking, sexually transmitted infections and urinary tract, conization, cervical cerclage and amniocentesis. OBJECTIVE: To evaluate whether prolonged release of the vaginal insert of PGE2 is superior to dinoprostone gel to achieve cervical ripening in patients with term pregnancy that occur with premature rupture of membranes. MATERIAL AND METHOD: Randomized clinical trial in the surgical unit of play in a period of 6 months, with an estimated sample of 50 patients was randomized by block table. After assessment confirming rupture of membranes, Bishop Score and meeting inclusion criteria, group A was applied PGE2 intracervical gel 0.5 mg with a maximum of 3 doses, every 6 hours. Group B was administered at vaginal insert of PGE2 single dose for 24 hours, the patient was left to sleep 30 minutes cardio toco-monitoring chart for at least 2 hours after application. RESULTS: The average time to maturity was 310.59 minutes with a standard deviation of 198.7 and concluded that there was no significant difference between the onset of uterine activity and the onset of labor among the prolonged release dinoprostone and alternatives such as the gel cervical for cervical ripening. CONCLUSIONS: Either this is a good choice to ripen the cervix in patients with term pregnancy and premature rupture of membranes.