[Comparison of obstetric and perinatal results of childbirth vertical position vs. childbirth supine position]. / Comparación de resultados obstétricos y perinatales del parto en postura vertical versus supina.

BACKGROUND: Vertical position is an option to delivery to which several advantages have been attributed. This research exposes its related findings. OBJECTIVE: To compare obstetric and perinatal outcomes between supine and vertical position at delivery. PATIENTS AND METHOD: We performed a randomized double-blind study including healthy women assigned to the supine or upright posture (vertical) during labor with complications following the delivery in the puerperium stage. The variables evaluated were: blood loss, pain in the second period of labor and immediate postpartum, duration of the second period of labor, perineal and vaginal tears, need to forceps implement, accommodation in position and perinatal outcome. RESULTS: 164 patients were randomized into two groups, the vertical position (I) and the supine position (II). The losses were 5.4%, and the Caesarean rate was of 4.6%. Difference was found only for vaginal tears in the vertical posture, with a relative risk of 1.4 (CI 1.1-3.2), and shortening of the second period with a significant difference of 10 minutes on average (p < 0.05). CONCLUSIONS: The upright posture during childbirth provides no improvement in perinatal outcomes and fewer obstetric conditions. It shortens the second period of labor, but it is a risk factor for vaginal tears. The best position for birth is which offers more comfort to the patient.

[Skene cyst: report of a case and review of the literature]. / Quiste de Skene: reporte de un caso y revisión de la bibliografía.

Paraurethral cyst or Skene cysts are rare at any age but particularly in newborns. In infants typically present as cystic formations, raised similar to a dermoid cyst. The treatment is established based on the findings, pathology and the age of the patient may be observational, puncture the cyst or surgical. We present a newborn with acute renal failure secondary to skene's cysts.

[Mayer-Rokitansky-Küster-Hauser syndrome. A report of two cases]. / Síndrome de Mayer-Rokitansky-Küster-Hauser: reporte de dos casos y revisión de la bibliografía.

The Mayer-Rokitansky-Kuster-Hauser is a rare congenital anomaly characterized by lack of vaginal and uterine development variable and normal ovaries. It results from agenesis or hypoplasia Müller duct system. Cervicovaginal agenesis as part of the complex syndrome, is even rarer. We report two cases: adolescent patient with primary amenorrhea, cervicovaginal agenesis and chronic pelvic pain, and a 28-year-old patient with primary amenorrhea, congenital absence of uterus and vagina.

[Transverse vaginal septum in the upper part of the vagina and pregnancy]. / Tabique vaginal transverso superior parcial y embarazo.

Transverse vaginal septum is a congenital Mullerian malformation resulting from a failure of the fusion or canalization of the urogenital sinus and the Müllerian ducts. It may cause hematocolpos, dyspareunia and infertility in adult patients. In some cases, it is associated with congenital malformations such as coarctation of the aorta or atrial septal defects. A case of a transverse vaginal septum identified during a vaginal check-up of a 39-week pregnant patient during labour is reported. A cesarean surgery was performed with no complications. Septal defect was diagnosed due to heart murmur. It was decided to treat the transverse vaginal septum as soon as the puerperium was over. The patient left the hospital after proper response to treatment.

[Placenta accreta: a surgical alternative that can save lives]. / Acretismo placentario: una alternativa quirúrgica que puede salvar vidas.

The placenta accreta is the second leading cause of obstetric hemorrhage, which often require the implementation of emergency obstetric hysterectomy increased morbidity and mortality. We present a surgical alternative to hysterectomy obstetric allowed us to reduce to zero until our rate of maternal deaths from obstetric hemorrhage. Improving surgical times, associated morbidity, without altering perinatal outcomes.

[A surgical alternative for placenta accreta]. / Una alternativa quirúrgica para acretismo placentario.

The placenta accreta is the second leading cause of obstetric hemorrhage in the world. In many occasions it is necessary to make an obstetric hysterectomy, a circumstance that increases morbidity, and maternal mortality. Communicates a surgical alternative to hysterectomy obstetric that has enabled us to reduce until the time to zero our rate of maternal deaths by obstetric hemorrhage, in addition to reducing the surgical time and the associated morbidity, without changing the perinatal outcome.

[Urethral myomas: report of two cases and literature review]. / Miomas uretrales: reporte de dos casos y revisión de la bibliografía.

Leiomyomas of the bladder and urethra are extremely rare. Depending on their location and size, they can produce diverse clinical manifestations. At urethral level in particular, formed near the vaginal wall, symptoms include recurrent urinary tract infections, voiding dysfunction, foreign body sensation, heaviness and dyspareunia. We present two cases of urethral leiomyomas, one expressed during pregnancy, which resolved successfully with surgical resection without damage to the urinary tract and no recurrence so far.

[Partial molar pregnancy. A case report and literature review]. / Embarazo molar parcial: reporte de un caso y revisión de la bibliografía.

We report the case of a 17 year old patient with partial molar pregnancy and coexistent live fetus of 13 gestational weeks diagnosed by ultrasound, which required the termination of pregnancy for maternal decompensation.

[Extreme maternal morbidity in the Hospital General Dr. Aurelio Valdivieso, Oaxaca Health Services]. / Morbilidad materna extrema en el Hospital General Dr. Aurelio Valdivieso, Servicios de Salud de Oaxaca.

BACKGROUND: Obstetric Morbidity Extreme (OME) is a promising addition to the investigation of maternal deaths and is used for the evaluation and improvement of maternal health services is defined as a severe obstetric complication that threatens the life of the pregnant woman and requires urgent medical intervention to prevent death of the mother. OBJECTIVE: To identify association between diseases and obstetric morbidity Extreme. MATERIAL AND METHOD: Transversal review analytical records. We searched for codes related to conditions that could cause extreme obstetric morbidity and the indirect causes that might cause it. RESULTS: The prevalence of OME 21 per 1000 newborns, diseases with greater association were eclampsia, liver failure and preeclampsia yielded the highest OR and statistical significance, the association of OME derived from surgery despite having a high prevalence in the analysis showed no association, in the same way if other variables showed association but had no significance and confidence intervals are below the unit that is the case of renal failure, metabolic failure and blood transfusion. CONCLUSIONS: The OME is caused by group entities specific disease (FLASOG) in most cases such as preeclampsia, eclampsia and obstetric hemorrhage.

Tratamiento conservador del embarazo ectópico con metotrexate / Conservativetreatmen of ectopic pregnancy with metotrexate

El embarazo ectópico (E.E.) tratado por los métodos tradicionales significa siempre pérdida de aproximadamente 50 por ciento de la capacidad de fertilidad de la paciente. El diagnóstico temprano permite el tratamiento conservador con metotrexate (MTXE), el cual tiene como ventaja preservar la salpinge afectada y su función. Se hizo detección temprana de E.E. no roto en 11 casos con los siguientes parámetros: cuadro clínico, ultrasonografía (Us) (útero vacío, masa anexial y líquido libre; anillo anexial o embrión extrauterino); determinación cuantitativa de fracción beta de gonadotropina coriónica (HGC b) y observación laparoscópica, al reunirse las siguientes características: embarazo tubario no mayor de 30 mm, serosa tubárica integra, falta de sangrado activo y visualización de toda la cavidad pélvica. Se aplicaron 12.5 mg de MTXE intrasacular por vía laparoscópica en ocho pacientes y tres por laparotomía. El control posterior al procedimiento fue: vigilancia estrecha por ocho días, Us. diario y determinación de HGC b en dos ocasiones, 10 pacientes evolucionaron en forma satisfactoria, dos de las cuales requirieron dosis adicional de MTXE parenteral a 0.5 mg/kg y Factor Citovorum a 0.1 mg/kg/4 días. Las conclusiones obtenidad son: 1) El tratamiento conservador con MTXE puede realizarse siempre que se reúnan las condiciones establecidas anteriormente. 2) El seguimiento de la paciente debe ser estrecho, y por el costo elevado de la determinación c/3er día de HGC b puede auxiliarse de la Us. Se practicó histerosalpingografía en cinco pacientes a los seis mese del procedimiento, observándose permeabilidad tubaria. Una paciente dio a luz por vía vaginal a un producto de término un año después, practicándose posteriormente laparoscopia de segunda mirada a los 40 días postparto, encontrándose restitución anatómica de la trompa afectada y se consideró ser la de la fertilización ya que la otra estaba ocluida totalmente por un hidrosalpix a otra paciente de embarazo cornual se le practicó laparoscopia de segunda mirada seis meses después encontrando restitución anatómica y funcional completa. Se espera obtener más experiencias con la acumulación de más casos, con este mismo protocolo.