[Comparison of isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy]. / Isosorbide y dinoprostona en inducción del trabajo de parto.

BACKGROUND: it has been suggested that nitric oxide generators, such as isosorbide dinitrate, may be an alternative to mimic the effects of signal transduction mechanisms leading to cervical ripening, without affecting uterine contractility. OBJECTIVE: to compare the isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy. MATERIAL AND METHODS: in a randomized controlled blinded clinical trial, we studied 66 patients divided into 2 groups: 33 patients were given 20 mg of isosorbide dinitrate and to the other 33 were administered 0.5 mcg of dinoprostone; in both groups the drugs were administered vaginally each 6 h and at maximum 3 times. It was carried out a cardiotocographic study in order to determine the presence or absence of uterine activity and to exclude disorders of the fetal heart frequency; it was performed a vaginal examination to assess cervical conditions determining the Bishop score at 0, 6 and 12 h. RESULTS: there were no differences between the groups in the determinations of mean arterial pressure, maternal heart frequency, fetal heart frequency and Bishop score registered at 6 y 12 h followed the drugs administration. The time of delivery was 20.7 +/- 1.8 h in the group of women treated with dinoprostone; and 16.3 +/- 1.4 h in women treated with isosorbide dinitrate (p=0.032). The cost was higher in women treated with dinoprostone ($560 vs $12, respectively, p=0.001). There was no difference between the groups related to: frequency of meconium stained liquid (p=1.000), mode of delivery by caesarean section (p=0.918), Apgar score at 1 minute (p=0.764) and 5 minutes (p=0.294) and mother discharged with healthy baby (p=1.000). CONCLUSIONS: the isosorbide dinitrate is associated with lower duration of labor compared with dinoprostone. There was no difference in the maternal-fetal outcome by using whatever drug.

Prevalence of violence against pregnant women and associated maternal and neonatal complications in Leon, Mexico.

OBJECTIVES: to determine the prevalence of violence against women and associated maternal and neonatal complications in a developing country setting. DESIGN: cross-sectional study using a face-to-face questionnaire. SETTING: postpartum area at a tertiary care referral hospital in Leon, Mexico. PARTICIPANTS: 1623 postpartum women. DATA COLLECTION: women were recruited at 24-72 h post partum. The diagnosis and severity of violence were assessed using a modified questionnaire based on the Index of Spouse Abuse and Severity of Violence against Women Scale. FINDINGS: of 1623 women, 711 (43.8%) were diagnosed with violence during pregnancy; 563 (79.1%) experienced mild violence and 148 (20.9%) experienced severe violence. Of the women who experienced violence, 72.9% experienced psychological violence, 15.8% experienced physical violence and 11.3% experienced sexual violence. Maternal complications were higher in women who experienced violence (30.2% vs 23.6%, p = 0.004). Women who experienced sexual violence had more maternal complications (43.2%), and women who experienced psychological violence had more neonatal complications (54.2%). KEY CONCLUSIONS: violence during pregnancy is quite common in the study setting. Maternal complications are higher in women who experience violence during pregnancy. The type of violence has different effects on maternal and neonatal health. IMPLICATIONS FOR PRACTICE: it is recommended that pregnant women who are experiencing violence should be identified during antenatal care to avoid maternal or neonatal complications.

[Prevalence of maternal sadness and its associated factors]. / Prevalencia de tristeza materna y sus factores asociados.

BACKGROUND: Frequently occur emotional changes during pregnancy and postpartum. These changes can produce feelings of sadness, anxiety, or fear. In most women, these feelings called "maternity blues" or "baby blues" disappear quickly, if they do not disappear or worsen, they are catalogued as postpartum depression. OBJECTIVE: To determine the prevalence of maternity blues and the associated factors. MATERIAL AND METHOD: In a cross-sectional study, women at immediate postpartum were recruited. It was applied face-to face the Edinburgh test for determining maternity blues. Other registered data were: maternal age, education level, parity, death sons, history of depressive episodes, sleeping disorders, and if the pregnancy was planned or unplanned. The statistical analysis included arithmetic mean, percentages, Chi2, Student t test; and logistic regression analysis for determining the associated factors with the maternity blues. An alpha value was set at 0.05. RESULTS: Overall 1,134 women, 21 of them (1.8%) were diagnosed as maternity blues. The significant factors associated with maternity blues were: the history of death sons, p < 0.002; depressive episodes, p < 0.001; and sleeping disorders, p < 0.003. CONCLUSION: The frequency of maternity blues is low in our population. The associated factors with this disease should be identified during antenatal care in order to offer special care to these women, in order to avoid the complications associated with this entity.

Prevalence of HIV antibodies in pregnant women with increased risk for AIDS.

The prevalence of Human immunodeficiency virus (HIV) antibodies in pregnant women varies widely between industrialized and developing countries. There is a lack of information about the status of HIV-infected pregnant women with increased risk for AIDS. Our objective was to determine the prevalence of HIV antibodies in pregnant women with increased risk at the Hospital of Obstetrics and Gynecology of the Mexican Institute of Social Security, Leon, Mexico, from December 18, 2003, through February 28, 2006. In a cross-sectional study, 2,257 pregnant women with at least one risk factor for AIDS were recruited. In these women, a sample of blood to determine HIV antibodies was taken. There were two women with positive HIV antibodies; therefore, the HIV seroprevalence was 0.8 per 1,000. Of the two HIV-positive women, one of them had a history of chronic sexually transmitted diseases; she was married to a man who was working outside of our country for about 10 months, and also he had tattoos. The other HIV-positive woman had a history of chronic sexually transmitted diseases, and her husband had intercourse with different women. The risk factors of use of tattoos, migration to foreign countries, and use of injectable drugs were more frequent among the male partners than in the pregnant women (P < .001). We concluded that in our country as well as in other developing countries, the prevalence of HIV antibodies in pregnant women with risk factors is low but still present. Because a significant number of risk factors for AIDS also were found in their male partners, HIV testing should be performed in all pregnant women as well as in their male partners.

[Placental histopathological changes in gestational hypertension]. / Alteraciones histopatológicas placentarias en la hipertensión gestacional.

BACKGROUND: Preeclampsia develops after a partial disorder in the process of placental formation, perhaps due to a deficiency of the trophoblast invasion by its spiral arteries and acute aterosis in its miometrial segments. It has not been reported if these changes also appear in placentas of women with gestational hypertension without proteinuria. OBJECTIVE: To describe histopathological changes in the placenta of patients with hypertensive disorders during pregnancy. MATERIAL AND METHODS: Cross-sectional study carried out in 138 patients divided into three groups: 46 with normotensive pregnancy (A group or control), 46 with gestational hypertension (group B), and 46 with preeclampsia (group C). There were registered sociodemographic and clinical variables; and the histopathological study of the placenta was performed. Mean, standard error and percentages were used. We calculated analysis of variance for comparing groups and linear regression for determining correlation between histopathological changes and blood pressure (it was assigned an alpha value of 0.05). RESULTS: There were more histopathological changes in groups of gestational hypertension and preeclampsia compared with controls (p < 0.01). Most frequent changes in all groups were: sincitial hyperplasia and fibrin deposits around the villi. There was correlation between histopathological changes and blood pressure (r= 0.27, p <0.01). CONCLUSION: There are more histopathological changes in placentas of women with hypertensive disease; number of histopathological changes is correlated with the severity of hypertension.

Risk factors of maternal death in Mexico.

BACKGROUND: One of the United Nations' Millennium Development Goals for 2015 is to reduce the maternal mortality ratio by three fourths. Ninety-nine percent of maternal deaths occur in developing countries, and the World Health Organization encourages investigations in these settings to determine the risk factors of maternal deaths. Our aim was to identify these risk factors in a hospital-based study in Mexico. METHODS: The study was conducted at the Hospital of Obstetrics and Gynecology at the Mexican Institute of Social Security in Leon, Guanajuato, Mexico, from January 1, 1992, to March 31, 2004. Women were divided into groups of 110 individuals who had died during pregnancy, delivery, or postpartum, and 440 women who survived the postpartum period. We used a logistic regression analysis to find the significant risk factors for maternal deaths. Odds ratios with 95% t confidence intervals were estimated. RESULTS: The maternal mortality ratio was 47.3 per 100,000 live births. The main causes of death were hemorrhage (30.9%), preeclampsia/eclampsia (28.2%), and septic shock (10.9%). Six factors were significantly associated with maternal death: age (OR = 1.09, 95% CI = 1.00-1.18), marital status (OR = 16.2, 95% CI = 1.3-196.1), number of antenatal visits (OR = 1.3, 95% CI = 1.0-1.6), preexisting medical conditions (OR = 23.3, 95% CI = 6.6-81.6), obstetric complications in previous pregnancies (OR = 28.3, 95% CI = 4.9-163.0), and mode of delivery (OR = 1.6, 95% CI = 1.0-2.4). CONCLUSIONS: Socioeconomic, medical, and obstetric risk factors are associated with maternal deaths in Mexico.

Mexican women's reasons for accepting or declining HIV antibody testing in pregnancy.

OBJECTIVE: To determine pregnant women's reasons for accepting or declining the HIV test in Leon, Mexico. DESIGN: A cross-sectional study using a face-to-face questionnaire. SETTING: The antenatal clinic at a tertiary-care referral hospital in Leon, Mexico. PARTICIPANTS: 1184 pregnant women. DATA COLLECTION: Reasons for accepting or declining the HIV antibodies test, socio-economic characteristics and risk factors for HIV were recorded. Blood samples were obtained from women who accepted to be tested, and positive serologies to HIV on duplicate enzyme-linked immunosorbent assay testing were confirmed by Western Blot assay. FINDINGS: 1009 (85.2%) women accepted the HIV antibodies test. The main reason for accepting it was that women felt the test could be beneficial to their babies (45.1%). The two main reasons for rejecting the HIV antibodies test were that women felt the test was unnecessary because their husbands did not have sexual intercourse with other women (32.6%), and because they did not have permission from their husbands for accepting the test (23.5%). None of the women tested positive for HIV antibodies (0 per 1009). KEY CONCLUSIONS: The reasons for accepting the HIV test were similar to those reported in developed countries. One important reason for declining the test was that women did not have their husband's permission. IMPLICATIONS FOR PRACTICE: The acceptance rate for HIV testing in pregnant women could be improved by counselling men on the value of their wives being tested in pregnancy.

[Risk factors associated with dystocic delivery]. / Factores de riesgo asociados con el parto distócico.

BACKGROUND: the dystocic delivery is a frequent complication and its perinatal repercussions vary from minor lesions to severe brain damage. It has been reported diverse factors associated with this medical complication. OBJECTIVE: to identify the risk factors with significant association with dystocic delivery. MATERIAL AND METHODS: a case-control study was carried out. There were included 750 patients, divided into 250 women with dystocic deliveries (cases) and 500 women with eutocic deliveries (controls). Demographic and clinical variables were registered. The statistical analysis was performed with percentages, arithmetic media, standard deviation, Student t test, chi2 and logistic regression analysis. An alpha value was set at 0.05. RESULTS: the factors with statistical significance were: advanced age (p < 0.001), major patient's height (p < 0.001), major new born's weight (p = 0.009), lower parity (p < 0.001), and prolonged duration of labor (p = 0.04). Other variables such as number of pregnancies, previous cesarean sections, spontaneous abortions, weight of the patient, weight earned during pregnancy, number of medical appointments during antenatal care, previous dystocic delivery, and premature rupture of the membranes, were not significant. CONCLUSIONS: there are clinical and demographic risk factors associated with dystocic delivery. To identify this risk factors during the antenatal care could diminish the frequency of dystocic deliveries and therefore to avoid the associated maternal-fetal complications.

[Maternal and fetal morbidity related to delayed antenatal work incapacity]. / Morbilidad materno fetal relacionada con el aplazamiento de la incapacidad laboral prenatal.

OBJECTIVE: To determine if there is higher maternal fetal morbidity associated to delayed antenatal work incapacity. PATIENTS AND METHOD: A case-control study was carried out, including 220 pregnant workers. They were divided into 110 women who delayed their antenatal work incapacity (cases) and 110 women who took it on time (controls). Sociodemographic and clinical data, which included maternal fetal morbidity, were registered. Results were analyzed by percentage values and arithmetic mean. Differences between groups were evaluated with Student's t test, chi square test, or exact test of Fisher. An alpha value was set at 0.05. RESULTS: There were 48 (43.6%) women who had antenatal complications in the group of cases and 27 (24.5%) in the controls, p= 0.004. The most common complication in the cases was preterm labor (29.1%), and in the controls was threatening of spontaneous abortion (55.5%). Other significant variables were: higher maternal age in the cases group (32.2 vs 22.5 years, p < 0.001), and lower number of antenatal visits (8.2 vs 9.5, p < 0.001). CONCLUSIONS: We conclude that there is higher maternal morbidity in women who delayed their antenatal work incapacity. It is recommended to give this incapacity according to present normative.

[Prevalence of Streptococcus agalactiae colonization in pregnant women at term]. / Prevalencia de colonización por Streptococcus agalactiae en mujeres con embarazo a término.

OBJECTIVE: To determine the prevalence of colonization by Streptococcus agalactiae in pregnant women at term. MATERIAL AND METHODS: We carried out a cross-sectional study. Four hundred thirty three pregnant patients at term without data of cervicovaginitis were included. We processed vaginal and rectal swabs with hisopo placed in the Stuart middle of transport. They were inoculated on blood agar with nalidixic acid and gentamicine incubating itself by duplicate on Todd-Hewitt broth. The samples with suggestive result were reincubating to detect suspicious Streptococcus using the CAMP test, for final identification. Some clinical variables were included as age, gravidity, parity, abortions, cesarean sections, and vaginal infections during pregnancy. RESULTS: We found two patients with positive result for Streptococcus agalactiae in vaginal swabs that represented a prevalence of 0.46%; in those cases therapeutic measures were provided for both mother and newborn. The mean age for patients was 27 years. The median value for gravidity was 2, for parity was 1; and for spontaneous abortions and cesarean sections were 0, respectively. In our studied women 77.8% of them referred previous unspecified vaginal infections. CONCLUSIONS: In our setting the prevalence of Streptococcus agalactiae colonization in pregnant women at term is low. Due to morbidity associated to this infection, it is suggested the specific research of this microorganism both in pregnant women and in their newborns.

Multivariate analysis of risk factors for stillbirth in Leon, Mexico.

BACKGROUND: To identify sociodemographic and clinical risk factors for antenatal fetal death in a developing country setting. METHODS: A case-control study was carried out, including 753 women: 251 had a stillbirth (cases) and 502 had a healthy live birth (controls). Stillbirths were considered as antenatal fetal death after 21 weeks of gestation. Seventeen sociodemographic and clinical risk factors for stillbirth were analyzed. Statistical analysis. Student's t-test or the Mann-Whitney U-test for continuous data and the chi2-test or Fisher's exact test for categorical variables were used. Logistic regression analysis was used to find significant predictors for stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS: Three risk factors were significant in the logistic regression model: maternal age (OR 1.04, 95% CI 1.00-1.08), antenatal care (OR 0.1, 95% CI 0.0-0.2) and umbilical cord complication (OR 5.8, 95% CI 3.2-10.2). The whole model had a determination coefficient of 0.280, with a chi2-value of 246.2 (p < 0.001). CONCLUSIONS: In our setting antenatal care should be considered as the cornerstone in the prevention of stillbirth. With adequate antenatal care both women with advanced maternal age and umbilical cord complication could be identified. This finding could be useful for developing as well as developed country settings to avoid the occurrence of stillbirth.

[Risk factors for stillbirth]. / Factores de riesgo y muerte fetal anteparto.

BACKGROUND: Antenatal fetal death is one of the most devastating complications of pregnancy. OBJECTIVE: To identify socio-demographic and clinical risk factors for antenatal fetal death. MATERIAL AND METHODS: A case-control study was carried out. Five hundred women were included: Two hundred fifty patients had a stillbirth (cases) and 250 women had a healthy live birth (controls). Stillbirths were considered as antenatal fetal death after 20 weeks of gestation. Seventeen socio-demographic and clinical risk factors for stillbirth were analyzed. Statistical analysis included: Student t test or Mann-Whitney U test for continuous data, and Chi-square or Fisher exact test for categorical variables. Multiple logistic regression analysis (backward stepwise procedure) was used to find significant predictors for stillbirth. Odds ratio (OR) with 95% confidence intervals (95% CI) were calculated. It was set an Alfa level of 0.05. RESULTS: Six risk factors were significant in the final logistic regression model: Age (OR 1.07, 95% CI 1.03-1.1), smoking habits (OR 9.1, 95% CI 1.07-78.0), placental abruption (OR 51.9, 95% CI 6.8-393.9), cord entanglement (OR 5.0, 95% CI 2.5-9.7), nulliparity (OR 1.3, 95% CI 1.1-1.5) and antenatal care (OR 0.1, 95% CI 0.08-0.4). The whole model had a determination coefficient R2 = 0.234 (p < 0.001). CONCLUSIONS: We developed a predictive model for antepartum fetal death appropriate at our population. The six significant risk factors for stillbirth could be diagnosed early during pregnancy. The antenatal care could be considered the cornerstone for the prevention of antenatal fetal death.

[Association between insulin resistance and pregnancy induced hypertension. Case-control study]. / Asociación entre resistencia a la insulina y la hipertensión inducida por el embarazo. Estudio de casos y controles.

OBJECTIVE: To evaluate the association between insulin resistance and the pregnancy induced hypertension. METHODS: One hundred sixty pregnant patients were studied in the third trimester: 46 patients with preeclampsia, 34 patients with gestational hypertension and 80 healthy patients (controls). Socio demographic data were collected and the body mass index was calculated as well as the insulin resistance was evaluated through the homeostasis model assessment. Three logistic regression analyses were made: First with all the patients who developed any form of pregnancy induced hypertension, the second with patients who developed gestational hypertension and the third regression with patients who developed preeclampsia. RESULTS: The variables that had statistical significance (P < 0.05) were number of pregnancies, parity, familiar incomes, and body mass index. The insulin resistance did not have statistical significance in any of the logistic regression analyses. CONCLUSION: The insulin resistance assessed in the third trimester of the pregnancy did not have association with the pregnancy induced hypertension and we recommend to carry out further investigations with prospective design and assessing insulin resistance calculating the homeostasis model assessment during all the pregnancy to evaluate this possible association.

Factores que influyen en la aceptación o rechazo de métodos anticonceptivos en el puerperio / Factors influencing postpartum contraceptive acceptance or refusal

Mediante un estudio descriptivo, observacional y transversal se estudiaron 1,010 pacientes que ingresaron para la atención de su evento obstétrico. Se recabaron los datos mediante interrogatorio directo a pacientes en su puerperio inmediato y se dividieron para su análisis en 507 pacientes que sí aceptaron métodos anticonceptivos (50.20 por ciento) y el otro grupo correspondió a 503 pacientes (49.80 por ciento) que rechazaron los métodos anticonceptivos propuestos por el personal hospitalario. Las variables con significancia estadística relacionadas con la aceptación o rechazo de los métodos anticonceptivos fueron: edad de Ia paciente (P < 0.05), el estado civil (P < 0.001), el número de gestas (P < 0.001), partos previos (P < 0.01), número de cesáreas (P < 0.001) y el uso previo de algún anticonceptivo (P < 0.001). Los métodos anticonceptivos más utilizados en el puerperio fueron el dispositivo intrauterino (67.85 por ciento), y la salpingoclasia (28.20 por ciento). Los motivos más frecuentes para la aceptación de métodos anticonceptivos fueron: paridad satisfecha (27.02 por ciento), eficacia de métodos usados previamente (21.49 por ciento) y consejos del ginecólogo durante el control prenatal y sala de labor (18.55 por ciento). Los motivos más importantes asociados con el rechazo de anticonceptivos fueron: causas atribuibles al esposo (33.6 por ciento), y diferimiento en la utilización de anticonceptivos hasta después del puerperio (32.0 por ciento). Se concluye que debido a la presencia de variables significativas entre ambos grupos de pacientes, estas variables se deben tener en cuenta para promover los métodos anticonceptivos en forma individualizada por los médicos del control prenatal, el cual es un periodo propicio para remarcar las ventajas de los métodos. Asimismo, debido a las causas de rechazo de anticonceptivos que son atribuibles al esposo, es necesario incorporar de manera sistemática su participación en el control prenatal para convencerlo de las ventajas de los diferentes métodos y de esta manera incrementar la frecuencia de aceptación de anticonceptivos dentro del periodo del puerperio.

Indices de flujometría Doppler fetal en embarazos de bajo riesgo / Fetal Doppler celocimetry indexes in low risk pregnant women

Mediante un estudio descriptivo, prospectivo y observacional realizado en el Hospital de Gineco-Pediatría número 48 del Instituo Mexicano del Seguro Social se estudió a 60 pacientes con embarazos de bajo riesgo con el objetivo de medir mediante ultrasonido Doppler los índices de resistencia y pulsatilidad del cordón umbilical fetal desde la semana 30 a la 40 de gestación. Se realizaron en total 337 mediciones, de las cuales 178 (52.8 por ciento) correspondieron al índice de resistencia y 159 mediciones (47.2 por ciento) al índice de pulsatilidad. La media aritmética del índice de resistencia fue 0.64 con un rango promedio (media ñ 2 desviaciones estándar de 0.48-0.79) y el índice de pulsatilidad tuvo un valor promedio de 0.94 con un rango de 0.58-1.30. Los valores percentilares del índice de resitencia fueron 0.52, 0.66 y 0.79 respectivamente en la percentila 5, 50 y 95. El análisis de varianza con la prueba de comparación múltiple de Bonferroni mostró que los valores encontrados pueden aplicarse desde la semana 31 a la 40 de gestación. Nuestros hallazgos concuerdan con los informados por otros autores y sólo se aprecian diferencias mínimas de los valores informados en nuestras mediciones, y se debe tener en cuenta que el concepto de normalidad de los índices flujométricos Doppler referidos es estrictamente estadístico y que sólo su juiciosa utilización brindará el beneficio a nuestras pacientes embarazadas para obtener productos en buenas condiciones de salud