[Gynecological care to children and adolescents. Twelve-year experience at National Pediatrics Institute, Mexico]. / Atenció ginecológica a niñas y adolescentes. Doce años de experiencia en el Instituto Nacional de Pediatría.

BACKGROUND: In major regions of the world, the importance of gynecological care to children and adolescents has been recognized. There are multiple publications, journals and associations dedicated to this purpose. In Mexico, it has not been the case. OBJECTIVE: The aim of this publication is to raise awareness to the medical community about the importance of sub specialized gynecological care to children and adolescents. MATERIAL AND METHODS: Retrospective study. The number of office evalu- ations issued by the Department of Gynecology of the National Institute of Pediatrics (INP) from January 1, 2002 to December 31, 2013 were counted. Results were grouped by age groups. Group 1: 1 year or less. Group 2: 2 to 9 years. Group 3: 10 to 18 years. The major causes of morbidity were analyzed by groups and in general. RESULTS: In the 12 year period reported, 21,190 girls granted gynecological consultation: 15.2% were first consultations (n = 3,221), 74.76% subsequent consultations (n = 15,842) and 10.04% evaluations and interconsultations (n = 2,127). The yearly average was 1,766 consultations. From 2002 to 2005, two certififyed obstetrician-gynecologists (OB-GYN) worked in the Departament, with the subsecuent increase in the number of attentions; 2005 was the year with the highest productivity (2,265). From 2006, only one OB-GYN continued laboring, and the number of visits decreased gradually. 2013 was the year with fewer productivity (1,351). The main causes of morbidity were: abnormal uterine bleeding (26.48%), inflammatory conditions of vagina and vulva (13.58%), dysmenorrhea (12.31%); which occupied 52.37% of the total (10,404 / 19,867). 81% of the patients corresponded to group 3 (17,079/21,190). To a younger patient, corresponded a smaller number of visits. CONCLUSION: It is required to institute the subspecialty of Child and Adolescent Gynecology in Mexico and to establish Services formed by subspecialists in this matter in the top pediatric hospitals of the country.

[Scientific evidence on the legalization of abortion in Mexico City]. / Evidencias científicas en torno a la legalización del aborto en la Ciudad de México.

BACKGROUND: On April 24 2007, abortion before 12 weeks became legal in Mexico City. The arguments for this decision were: diminish the maternal morbidity and mortality, avoid a "severe health problem" and accomplish the women's physical, mental and social well being. OBJECTIVE: To analyze the scientific evidences that support or reject this arguments. MATERIAL AND METHOD: Retrospective study realized by bibliographic search of electronic data basis and Internet portals of interested groups. RESULTS: Mexico is considered by the World Health Organization, one of the countries in the world with low maternal mortality rates (<100/100,000 live births). The main causes are: preeclampsia-eclampsia, pregnancy related hemorrhage, complications of pregnancy, delivery and puerperium, and other causes (92.2 to 93.1%). In 2007, the Health Services of Mexico City reported 11 deaths (0.03% of the total maternal deaths) associated with "non-spontaneous abortion". In the hospitals of the Mexican Institute of Social Security, maternal deaths as consequence of induced abortions were, approximately, three every year. The evidences used as arguments in favor of abortion come from studies performed in Sub-Saharan African countries, which do not apply to Mexico. DISCUSSION: The scientific evidences show that induced abortion has important psychological sequels in women, a higher frequency of illegal drug abuse, alcoholism, child abuse, low birth weight in the following pregnancy, greater risk of subsequent miscarriage and greater mortality rate. CONCLUSIONS: There are no scientific evidences to support the arguments used for the legal approval of abortion in Mexico City.

[Fetal cardiac rhabdomyoma as a rare cause of hydrops fetalis. A report of a case]. / Rabdomioma cardiaco fetal como causa rara de hydrops fetalis. Reporte de un caso.

Cardiac tumors are rare entities at any age. The reported incidence in fetal echocardiograms is 0.17%. This case report presents the detection of a cardiac rhabdomyoma in a 27.5 weeks of gestational age (WGA) fetus during a routine sonogram. Treatment with terbutaline, as a cardiac inotropic and chronotropic agent, was started because of fetal bradichardia of 86 beats per minute, as well as fetal lung maturity inductors. At 30 WGA furosemide was added because of fetal hydrops. At 32 WGA a cesarean section was performed. The fetal development at the time of birth was in accordance to the gestational age, the newborn weight was 1,820 g and the Apgar score was 1-0, at one and five minutes after delivery. The newborn died immediately after the interruption of the umbilical circulation, because of a 90% obstruction of the left ventricular cavity caused by the tumor. The present case is an evidence of the utility of a medical treatment in a severely ill fetus, that allowed it to continue with its normal development for four weeks after the diagnosis and opens the possibility for fetal medical therapy in the future for similar cases.

[Gynecological clinical study in girls and adolescent victims of sexual abuse]. / Estudio clínico ginecológico en niñas y adolescentes que sufrieron abuso sexual.

In spite of a very important under-registration, sexual abuse represents a social and public health problem worldwide. In Mexico, estimated prevalence of sexual abuse in women is 17.3%, half of them in youngsters under 15 years old. Most of cases have a late gynecological evaluation, due to a delay in a formal complaint. Gynecologist or pediatrician are the specialists who most frequently perform the genital examination of girls suspected of sexual abuse, due to this a complete knowledge of the topic is necessary in order to make an accurate diagnosis, register the physical findings and give prompt medical and psychological treatment as well as follow up to the patient. Despite the low risk of acquiring a sexually transmitted infection, it is important to evaluate the use of prophylactic treatment and the prevention of unwanted pregnancy with emergency contraception. Big efforts are being made by preventive programs on sexual abuse, sexually transmitted infections and unwanted pregnancy, all of which are serious problems in Mexican children and youths, and should constitute a fundamental part of the public politics on sexual health.

Utilidad de dos pruebas para el diagnóstico presuntivo rápido en infección de vías urinarias y embarazo / Usefulness of two tests for the diagnosis, presuntive and quick, in urinary infection and pregnancy

Se estudiaron a 60 pacientes que acudieron al Servicio de Urgencias del INPer, refiriendo sintomatología de IVU. Se les realizó toma de urocultivo y detección de nitritos y estearasa leucocitaria en orina con la tira reactiva Multistix 10 SG (R). Se tomó como grupo testigo a 20 pacientes obstétricas de primera vez, sin sintomatología de IVU bajo la misma metodología. En el grupo de estudio se informaron 34 urocultivos negativos, 9 urocultivos contaminados y 17 urocultivos positivos, con una semsibilidad y especificidad de 94 por ciento para la prueba de nitritos y de 64 por ciento y 100 por ciento, respectivamente, para la prueba de estearasa leucocitaria. En el grupo testigo se observaron dos urocultivos contaminados, 13 negativos y 5 positivos a un microorganismo. La sensibilidad fue de 100 por ciento y la especificidad de 92 por ciento para la prueba de nitritos; y de 40 por ciento y 100 por ciento respectivamente para la estearasa leucocitaria.