Pacientes con morbilidad obstétrica grave de acuerdo con la Organización Mundial de la Salud, atendidas en un hospital de alta especialidad (2010-2016) / Patients with severe obstetric morbidity, according to the World Health Organization, atended at the high specialty hospital (2010 to 2016)

Resumen OBJETIVO: Estimar la morbilidad obstétrica grave y mortalidad materna en el Hospital Juárez de México. MATERIALES Y MÉTODOS: Estudio retrospectivo y transversal efectuado para evaluar los registros de pacientes con morbilidad obstétrica grave y la mortalidad materna, de acuerdo con los criterios de la OMS, atendidas en el Hospital Juárez de México de 2010-2016. Se analizaron las variables relacionadas con el diagnóstico, insuficiencia o disfunción orgánica y las intervenciones asociadas con el tratamiento. Se calculó la tasa de morbilidad materna extrema y obstétrica grave (Near Miss/total de embarazadas). Se utilizaron medidas de tendencia central y de dispersión. RESULTADOS: Se registraron 137 casos de morbilidad obstétrica grave y 26 de muerte materna. La mortalidad promedio fue de 5.78% y el índice de mortalidad de 0.415. Las principales causas de morbilidad materna grave y mortalidad fueron: hemorragia obstétrica, hipertensión asociada con el embarazo y sepsis. Se observó un incremento en los casos de morbilidad materna grave y disminución de la mortalidad materna en el periodo estudiado. CONCLUSIÓN: Se sugiere establecer un comité de evaluación y análisis de pacientes con morbilidad obstétrica grave para mejorar la calidad de atención y tratamiento, y disminuir la tasa de mortalidad materna.

Abstract OBJECTIVE: To determine how many cases of severe obstetric morbidity and maternal mortality were presented in 2010-2016, at the Hospital Juárez de México. MATERIALS AND METHODS: A retrospective, cross-sectional, observational study was carried out in cases of severe obstetric morbidity and maternal death were included according, to WHO criteria, attended in the Hospital Juárez de México from 2010-2016,. We included variables related to the diagnosis, with the organic failure or dysfunction and the interventions related to the management. The extreme maternal morbidity rate was calculated; obstetric (Near miss / Total pregnant). Measures of central tendency and dispersion were used. RESULTS: A total of 137 cases of severe obstetric morbidity and 26 of maternal deaths were registered. The mortality rate on average was 5.78% and death rate .415. The main causes of severe maternal morbidity and mortality were obstetric haemorrhage, hypertension associated with pregnancy and sepsis. There was an increase in cases of severe maternal morbidity and decrease in maternal death in the period studied. CONCLUSION: We suggest the establishment of a committee to evaluate and analyze cases of severe obstetric morbidity to improve the quality of care and treatment for this group of pregnant women, to reduce maternal death.

[Profile dipper/non-dipper in patient with severe preeclampsia, eclampsia and HELLP syndrome during pregnancy and puerperium]. / Perfil dipper-no dipper en pacientes con preeclampsia severa, eclampsia y síndrome de Hellp durante el embarazo y puerperio.

BACKGROUND: Blood pressure (BP) has a circadian rhythm, decreases at night and increases in the morning (dipper), have been observed in patients with impaired in this profile, increased at night and lower in the morning (no dipper) have increased cardiovascular risk. Preeclampsia-eclampsia complicates about 7% of pregnancies, preeclampsia is known to reverse the normal circadian cycle of the BP. OBJECTIVE: To determine the profile dipper/non-dipper in patients with severe preeclampsia, eclampsia and HELLP syndrome patients in Intensive Care and Obstetrics Hospital Juárez of México. MATERIAL AND METHODS: 15 patients were reviewed, 10 with severe preeclampsia, 4 with HELLP syndrome and 1 eclampsia, systolic, diastolic, mean and pulse PA were analyzed during the day/night and pregnancy/postpartum. Using ratios pregnancy day/night pregnancy, puerperium day/night postpartum dipper/non-dipper profile is determined RESULTS: Maternal age 30 ± 6.34 years, 7 primiparous (46%) 8 multiparous (54%), pregnancy was 31.67 ± 4.59 weeks. In all but two results in the ratio of pulse pressure during pregnancy was not the result dipper raiser and did not change during the postpartum period. CONCLUSION: in all patients during pregnancy profile was observed no dipper no change during the postpartum period. The established treatment did not modify this result. So it is appropriate to establish strategies to change this behavior and try to get the patient to regain normal circadian BP rhythm.

[Surgical correction of vaginal agenesis]. / Corrección quirúrgica de la agenesia vaginal.

BACKGROUND: Vaginal agenesis is a rare congenital disorder. It requires surgical management and still it is not defined universally. The surgical resolution of the pure vaginal agenesis, through fasciocutaneous pudendal thigh flaps, has few complications and allows the copulative function in normal conditions. OBJECTIVE: To assess the results of the vaginal agenesis surgical management. PATIENTS AND METHODS: From January 1996 to January 2005 we identified 33 patients with Müllerian duct and urogenital sinus disorders; eight of them had vaginal agenesis diagnosis. All the patients were subject to: complete medical history, karyotype study, determination of a complete gynecological profile, pelvic ultrasound, excretory urography, and, in some acute cases of hematometra or hematosalpinx, to an intervention with two surgical equipments: one of them used for the hematic collection emptiness of the internal genitals and the other one to solve the mechanical obstruction of vaginal agenesis. In some cases the study was completed through diagnostic laparoscopy. RESULTS: In our series six patients had functional uterus. When we made the surgical intervention we tried to make the uterus tunelization in the neovagina through the use of a Foley catheter. Nevertheless, they continued with symptoms of cyclical pelvic pain and chronic hematometra. One of the patients was exposed to total abdominal hysterectomy without bilateral oophorectomy, and in two more we are planning to make the same procedure in a short term. CONCLUSIONS: Fasciocutaneous pudendal thigh flaps technique is easy, safety and reliable, and it allows the creation of a neovagina in only one surgical time.

[Medical treatment of unruptured ectopic pregnancy]. / Tratamiento médico del embarazo ectópico no roto.

BACKGROUND: Ectopic pregnancy is the implantation of fertilized ovum on any tissue other than the endometrial lining of the uterus. OBJECTIVE: To evaluate the effectiveness and safeness of methotrexate in the treatment of unruptured ectopic pregnancy. MATERIALS AND METHODS: From January 2000 to October 2002 five patients were diagnosed with unruptured ectopic pregnancy in Hospital Juarez de Mexico. The inclusion criteria were: hemodynamic stability, gestational sac of < 40 mm, serum beta-hCG concentration < 15,000 mIU/L and future fertility desire. Systemic methotrexate was administered as an intramuscular injection of 50 mg. Evaluation was based on transvaginal ultrasonography, beta-hCG levels and hysterosalpingography. RESULTS: Five patients with unruptured ectopic pregnancy were treated with methotrexate. Successful rate, after one or two injections, was 100% (5 patients). The size of ectopic pregnancy as estimated by ultrasonographic was 33.33 mm. Negligible plasma beta-hCG values were reached 45.6 +/- 19.85 days after the time of treatment. Ultrasonographic scanning demonstrated progressive disorganization and the gestational sac disappeared at 134 days after treatment. There were no adverse effects from the chemotherapy. In 3 of 4 women who underwent hysterosalpingography following treatment, patency of the affected tube was observed. Three women experienced an intrauterine pregnancy spontaneously in the methotrexate group. CONCLUSIONS: Systemic methotrexate treatment is safety and effective in the treatment of unruptured ectopic pregnancy, for woman with future desire of fertility and if it has unruptured, conservative treatment using methotrexate is an excellent choice.

Tratamiento conservador del embarazo ectópico intersticial y endometriosis con metotrexato y cloruro de potasio por vía laparoscópica y manejo complementario con nafarelina nasal. Informe de un caso y revisión de la literatura / Conservative treatment of ectopic interstitial pregnancy and endometriosis with methotrexate and potassium chloride by laparoscopic aproach and complementary treatment with nafarelin (nasal). Presentation of one case and literature review

Se presenta el caso de una paciente de 30 años de edad con esterilidad secundaria, opsomenorrea b de 56 días, dolor a la movilización cervical, tumoración en anexo izquierdo, sub unidad b de gonadotrofina criónica humana (GCH) de 112 mUI/mL, ultrasonido transvaginal con flujo vascular trofoblástico con actividad cardiaca compatible con gestación ectopia.La laparoscopia confirma el diagnóstico de embarazo ectópico intersticial izquierdo, realizándose salpingocentesis con metotrexato y cloruro de potasio (KCI). Como hallazgos se encuentra endometriosis severa. Durante el control postoperatorio los niveles séricos de sub unidad b de GCH sé negativizaron en 28 días; el tratamiento continuo durante cuatro meses con nafarelina. La laparoscopia histeroscopia de segunda mirada (second look) mostró resolución completa de la gestación ectópica, mejoría en 1 endometriosis y permeabilidad tubaria bilateral.

La laparoscopia en el Instituto Nacional de Perinatología: análisis de 738 casos / The laparoscopy at the National Institute of Perinatology: analysis of 738 cases

Se revisan 738 casos de laparoscopias llevadas a cabo en el Instituto Nacional de Perinatología de 1983 a 1987. El análisis de los datos informó una preponderancia de las indicaciones diagnósticas sobre las terapéuticas, sin embargo, éstas últimas han incrementado su realización en los últimos meses revisados. La indicación más frecuente para la elaboración del procedimiento es la evaluación de la esterilidad femenina. El análisis comparativo de los hallazgos histerosalpingográficos y laparoscópicos demostró un porcentaje de correlación de 72.72% a 78.35%. Se comenta la utilidad de la laparoscopia en diversas patologías pélvicas, así como los mecanismos precautorios para evitar complicaciones