[Emergency cerclage]. / Cerclaje du urgencia.

OBJECTIVE: To evaluate the maternal and fetal morbility as well as the odds and conditions of pregnancy when performing an emergency cerclage. MATERIAL AND METHODS: We performed a transversal, prospective and descriptive study of all the patients to which an emergency cerclage was performed in the Instituto Nacional de Perinatología between January 1, 1995 and December 31, 1996 having all the inclusion criteria. At such time 261 cerclages were performed in our Institute upon unique pregnancies being only 22 considered as emergency cerclages. We performed studies of their obstetrics background, their incidental as per their age group, complications during the inclusion for the technique used as well as restitution of fetal membranes, complications before, during and after surgery: as well as the time elapsed as from the inclusion of the cerclage to birth and the data of the new born. RESULTS: 21 patients had previous pregnancies and only one of them was her first one; only 6 of their children were alive. The average age was 29.5 +/- 3.8 years and the gestational average age of the inclusion of the procedure was of 18 +/- 2.6 weeks, having a cervical dilatation of 2.5 cm +/- 0.9 cm. In 10 patients we had to restitute fetal membranes. The long extended average time between the colocation of the cerclage and labor was 66.8 days (more than 9 weeks) and the 86.4% of the resolution was via vaginal. CONCLUSIONS: It was observed that with the inclusion of the urgency cerclage we were able to prolong gestation in around 66 days, in which the main indicator of the perinatal forecast was the presence of fetal membranes or if they were bulging through internal cervical os. In this type of patients there is a major risk of having preterm labor and infectious maternal morbility. Notwithstanding that we believe that it is not an ideal procedure, the urgency cerclage has a place in current obstetrics. Prior to performing this procedure, we will have to study the patient as well as to have an adequate neonatal service.

[Perinatal outcome in patients with meconial amniotic fluid in labor]. / Resultado perinatal en pacientes con líquido amniótico meconial durante el trabajo de parto.

PURPOSE: To evaluate the perinatal morbidity and mortality with the presence of meconial amniotic fluid. MATERIAL AND METHODS: Retrospective study of case review, performed from 1st of June 1995 to May 1997. The patients included were at delivery, with a pregnancy of 32 weeks or older and had meconial amniotic fluid. The variables analyzed were: motherhood age, pre-existing associated illness, resolution of the pregnancy, PSS interpretation, fetal weight, Apgar and final destiny of the product. RESULTS: Of the 432 patients the motherhood aged varied from 13 to 43 years old, mean 27.4; with a number of pregnancies from 1 to 10, mean 2.25. The gestational age went from 32.2 to 42.4 weeks. The fetal weight varied form 1025 to 5080 g. The Apgar grade mean was 7 at the first minute and 8 at the fifth. The pregnancy was interrupted by cesarean in 52.5%. Although there was not a significant difference with the arterial gas, the density of the amniotic fluid did determine the final destiny of the product. CONCLUSIONS: There is a relation between the presence of amniotic fluid and the Apgar grade; both determining the final destiny of the product. When the amniotic fluid had thick meconium the products had a greater morbidity.

Tendencias en la vía de interrupción del embarazo en el Instituto Nacional de Perinatología 1985-97 / Trends in the way of delivery at the Instituto Nacional de Perinatología 1985-97

Objetivo. Presentar la casuística en cuanto la resolución del embarazo a través de operación cesárea y la tasa de utilización de fórceps a lo largo de 13 años en el Instituto Nacional de Perinatología. Material y método. Se revisaron retrospectivamente todos los expedientes clínicos de los eventos obstétricos registrados entre el 1 de enero de 1985 y el 31 de diciembre de 1997. Se estableció el número total de nacimientos indicando si se trató de partos o cesáreas. en el caso de los nacimientos vaginales se resgistró si fueron instrumentados con fórceps. Resultados. El porcentaje de nacimientos atendidos por vía abdominal fue de 44.09 por ciento con un incremento anual de 1.85 por ciento. Por su parte de los partos vaginales en el 30.74 por ciento se aplicaron fórceps, en este caso el incremento anual correspondió a 2.54 por ciento

Embarazo abdominal recurrente: presentación de un caso / Recurrent abdominal pregnancy. a case presentation

Se informa de un caso de embarazo abdominal recurrente atendido en el Instituto Nacional de Perinatología de México, se comentan sus manifestaciones clínicas, diagnóstico y tratamiento. Se hace una revisión de la literatura