[Maternal mortality decrease at IMSS, 2000-2005. As a result of specific actions or by chance?]. / El descenso de la mortalidad materna en el IMSS, 2000-2005. ¿Azar o resultado de acciones específicas?

OBJECTIVE: to assessment the epidemiological characteristics and evolution of maternal hospital deaths at Instituto Mexicano del Seguro Social (IMSS) on the years 2000-2005 and to analyze a possible relation with a specific program to reduce it, starting in 2001. METHODS: we collected and studied data about 253 and 144 hospital maternal deaths between 2000 and 2005, respectively. We compared rates, causes, type of obstetrical death, age, parity, history of prenatal care and preventability at admission in hospitals were the women died. Data about live births in were obtained from the official Information Medical System of IMSS. The analysis was made with descriptive statistical measures and values of chi(2). RESULTS: the maternal mortality rate fell by 30.8 %, as result of a decline from 39 per 100,000 live births in 2000, to 27 in 2005; the proportion of direct obstetric deaths showed a reduction from 77.1 to 66.7 %; all the specific-age mortality rates felt too, but with some variability. Preeclampsia-eclampsia, hemorrhages and abortion were responsible for more of 50 % of total deaths in both years compared. We did not observe significant changes in other variables. CONCLUSIONS: the reduction in general rate of hospital maternal mortality, in percentage of direct obstetric causes of death and specific-age rates were chronologically coincidental with the development of a program to increase opportunity and quality of obstetric care at the whole institution. The results let us think there is a possible cause-effect relation. It is imperative to conduct a more long-term observation to confirm this epidemiological phenomenon.

[Low dose estrogens and synthetic estrogens. Options for hormone replacement therapy in climacteric women]. / Estrógenos a dosis bajas y estrógenos de síntesis. ¿Opciones para el reemplazo hormonal en el climaterio?

A significant increase for cardiovascular disease and breast cancer risks was found in the Women's Health Initiative study in 2002, for current users of conjugated equine estrogens in the habitual dose of 0.625 mg for hormone replacement therapy (HRT) for treating menopausal symptoms. This unexpected finding has caused new-found interest in the world to determine if the use of low-dose estrogens or synthetic estrogens can be useful and safer. At present, there is no scientific evidence about the reduction of such risks with the use of low-dose estrogens. Current medical information has showed that HRT is effective to treat climacteric syndrome and to prevent postmenopausal osteoporosis. In addition, HRT reduces significantly the frequency and severity of vaginal bleeding. Currently the Climacteric and Menopause Program at the Instituto Mexicano del Seguro Social only considers the use of conjugated equine estrogens at the standard dose (0.625 mg). The purpose of this paper is to present some results about use of low-dose estrogens and points of view about synthetic estrogens found in current medical literature. This review aims at contributing to the analysis a possible future use of this type of hormone treatment within the institutional program with the goal of giving safer options to clinicians in managing women with menopausal symptoms.

[Knowledge, experience and behavior at climacteric and menopause stages among family medicine female users at IMSS]. / Conocimientos, experiencias, y conductas durante el climaterio y la menopausia en las usuarias de los servicios de medicina familiar del IMSS.

OBJECTIVE: To identify knowledge, experiences and behaviors of climacteric and menopause women users of family medicine services of Instituto Mexicano del Seguro Social (IMSS). METHODS: A descriptive study that included a 37 questions survey about climacteric and menopause was conducted in a national representative sample of 4162 women aged 45 to 59 years between September 2004 and January 2005. The analysis was made by using descriptive statistics and chi2. RESULTS: 82.9 % Of women knew about menopause or its significance; 82.1 % identified hot flushes as a climacteric symptom; 46.1 % knew about pharmacologic treatment and 25.6 % knew about postmenopausal complications such as osteoporosis. Only 26.6 % mentioned preventive measures as physical exercise or consumption of food with high calcium content. Their main information sources were media communication. Mean age at menopause was 46.8 years old; 57.7 % had symptoms at interview and 18.4 % were taking pharmacologic treatment, mainly (53.3 %) hormones. 11.1 % of treated women had had side effects. 10.7 % had received pharmacologic treatment and 39.4 % had withdrawn from medication either for medical indications or for side effects (23 %). CONCLUSIONS: Knowledge about climacteric was scarce and obtained from non-medical sources; use of pharmacological treatment and preventive behavior was low. We recommended reinforcing the information and education about treatment and favorable life styles by health personal.

[Estrogen treatment in climacteric and postmenopause after 2002. Can it still be prescribed?]. / Tratamiento con estrógenos en el climaterio y la posmenopausia después de 2002. Aún puede prescribirse?

Preliminary results of the American study called Women's Health Initiative starting in July 2002, showed an increase in some health risks, such as coronary disease, stroke, invasive breast cancer and dementia in 2003, in postmenopausal users of replacement hormonal therapy (HRT) with conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). These results were opposed to those found in many observational studies in previous years. Although some benefits like significant reduction in number of osteoporotic fractures were demonstrated too, these results caused an enormous change in medical criteria for prescription and time of usage of HRT during the climacteric and postmenopausal periods in the whole world. The publication of complementary information in subsequent years to date, related to other sections or branches of Women's Health Initiative, such as only-estrogens users, which showed no increase of the above mentioned results, confirm the importance of continuing analysis of Women's Health Initiative results, as well as the need to do more research about HRT, with the purpose to get a better understanding about risks and benefits. This paper is a review of the most important results of Women's Health Initiative published to date, with comments about the hypothesis and possibilities to explain them, with the purpose of spreading in a realistic way the state of knowledge in the usage of HRT and increase the information of family physicians in Instituto Mexicano del Seguro Social, who are the first contact for medical care in these periods of their lives and help them to take clinical decisions.

[Strategy of provision and assessment of preventive health services]. / Estrategia de prestación y evaluación de servicios preventivos.

This paper describes the strategy of provision and assessment of preventive health services that the Mexican Institute of Social Security (IMSS) established in 2002 and that for social communication purposes, was called PREVENIMSS. The strategy is composed by five programs: Children's Health, Adolescents' Health, Women's Health, Men's Health and Seniors' Health. The objectives of these programs are the following: to provide a group of actions to promote and protect health, according to their age, sex and risk factors; to incorporate new preventive actions in order to face demographic and epidemiologic transition; to promote the participation of population in health care; to integrate provision of preventive services in family medicine clinics, and to broaden their coverage and impact. The modernization process of the statistical information system is also described in this paper. It included several aspects, such as the establishment of an automated record of preventive actions, which allowed the generation of relevant and timely information to measure the coverage and both national and local impacts.

[ENCOPREVENIMSS 2003. Reproductive health]. / Encoprevenimss 2003. 7. Salud reproductiva.

OBJECTIVE: to analyze the current situation of some aspects of reproductive health in population covered by the Mexican Institute of Social Security (IMSS), based on the results of the National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS) 2003. MATERIAL AND METHODS: we collected and analyzed data on fertility, contraceptive practice and prenatal and puerperal care. For this purpose, we made specific files as follows: 5823 adolescents from 15 to 19 years old, 16,275 men from 20 to 59 years old and 16 866 women from 20 to 49 years old, of the total sample of 79,797 questionnaires of ENCOPREVENIMSS 2003. RESULTS: the specific fertility rate in adolescent females was registered in 40 live births for every thousand women in this age group. About 70% of men and 41.7% of women said they used some kind of contraceptive method in their first intercourse. The prevalence of contraceptive use among female adolescents was 56% and among women from 20 to 49 years old, it was 76.5%, with the largest proportions of definitive or high-continuity contraceptive methods: 50.1% for tubal occlusion and 19.9% for intrauterine device. Global fertility rate for the whole population covered by IMSS was 2.56. Prenatal care coverage was 97.1% in adolescents and 98.2% in women from 20 to 49 years old. CONCLUSIONS: the data of ENCOPREVENIMSS 2003 confirm a high prevalence of contraceptive use in female population covered by IMSS, very similar to what was observed in other national surveys and in the population covered by IMSS. Besides, women attending IMSS show a reduction of fertility that gets them closer to demographic replacement rates.

[Maternal mortality at the Mexican Institute of Social Security, from 1991 to 2005. A period of changes]. / Mortalidad materna en el IMSS, 1991-2005. Un periodo de cambios.

OBJECTIVE: to describe and analyze the levels, tendency, causes and preventability of maternal mortality occurred at hospitals of the Mexican Institute of Social Security (IMSS) in the period 1991-2005, in order to identify possible strategies and activities to get a faster reduction of this problem. MATERIAL AND METHODS: 3553 maternal deaths registered in medical units of IMSS between 1991 and 2005. This period was divided in two: from 1991 to 1997 and from 1998 to 2005, for comparison purposes. The analysis was made based on the conclusions reached by the Institutional Committees of Maternal Mortality Studies and the classification and codification according to the criteria of the 9th and 10th revisions of the International Disease Classification. The information on live births was obtained from the institutional information system named "Population and Services". RESULTS: in the fifteen-year studied period, the maternal mortality rate in hospitals decreased from 45.3 to 27 for every 100,000 live births (40.4%). The main causes of maternal death (preeclampsia-eclampsia, obstetrical hemorrhages, pulmonary tromboembolism) did not show any important changes in percentage values, even when the direct obstetric and specific rates for causes did show a reduction. By age groups, the highest maternal mortality rate was registered for women older than 35; the lowest one corresponded to adolescents. More than the third part of cases was considered as potentially preventable at admission in medical units. CONCLUSIONS: we identified that maternal mortality at IMSS hospitals tended to decrease in the analyzed period, particularly faster in the last 6 years. This was attributed to a better quality of medical care and timeliness in the use of medical services by population.

[Maternal mortality in the IMSS: an analysis from the perspective of mortality and lethality]. / Mortalidad materna en el IMSS: un análisis desde la perspectiva de la morbilidad y la letalidad.

OBJECTIVE: To assess the incidence of hospital maternal mortality in the population covered by the Mexican Institute of Social Security (IMSS) from 2000 to 2003, utilizing the rates of the main causes of morbidity and lethality, in order to gain a better understanding of this epidemiological picture. METHODS: We collected information from 3,357,346 hospital deliveries and 832 maternal deaths that occurred in the medical units of the IMSS during the above-mentioned years. For the specific analysis of mortality, morbidity and lethality, deliveries and deaths with diagnoses of mild preeclampsia, severe preeclampsia, eclampsia, placenta previa, postpartum hemorrhage, chorioamnionitis and puerperal sepsis were selected, based on the criteria of International Diseases Classification, Tenth Revision. For statistical differences we used the chi(2). RESULTS: Maternal mortality registered a reduction of 25.1% (39 x 100,000 live births in 2000 and 29.2% in 2003). Morbidity increased by 6.6%. Morbidity and lethality caused by preeclampsia, obstetrical hemorrhages and puerperal sepsis (56.7% of the total deaths) showed a significant decrease in most cases. Specific morbidity showed no changes. CONCLUSIONS: We observed a decrease in the rate of hospital maternal mortality during the years of the study, linked to a reduction in lethality of these three main causes. This epidemiological picture may demonstrate the optimal quality in obstetrical care, because no reported changes in morbidity levels were registered.

[Maternal mortality at the Mexican Institute of Social Security (IMSS). Initial results from a reduction intervention strategy]. / Mortalidad materna en el IMSS. Resultados iniciales de una intervención para su reducción.

OBJECTIVE: To analyze the preliminary results of a medical manager intervention to improve the quality of medical care during pregnancy, delivery and puerperium, on the maternal mortality rates in population covered by the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: We selected the 14 administrative delegations of IMSS that showed the highest rates and absolute numbers of maternal deaths in the years 1999 to 2001. Within this group, the manager medical staff developed activities for medical training of family physicians and gynecologists, to improve medical resources, to achieve a better coordination among medical services, to adequate reference of obstetrical complications to higher-level hospitals, and for monitoring of maternal mortality committees operation. The other 23 IMSS administrative delegations were used as controls. RESULTS: Maternal mortality rates fell down from 40.7 to 28.2 per 100,000 live births among the delegations included in the strategy (mean reduction 30.7%). Among the control delegations maternal mortality rate fell down 1.5% only (32.3 to 31.8 per 100,000 live births). A similar phenomenon was observed for the absolute number of maternal deaths, with a reduction of 36.7% and 8.4%, respectively. CONCLUSIONS: The improving intervention was associated with a noticeable reduction in the maternal mortality rate. It is necessary a long-term observation to confirm a cause-effect relationship.

[Fractures in postmenopausal women in the IMSS: frequency and costs of hospital care]. / Fracturas en mujeres postmenopáusicas en el IMSS: frecuencia y costos de su atención hospitalaria.

OBJECTIVE: To analyze the frequency and costs of hospitalary care due to fractures in postmenopausal period occurred in Instituto Mexicano del Seguro Social (IMSS). MATERIAL AND METHOD: Study about hospitalary discharges in IMSS, among 2000-2001, with diagnosis of hip, distal forearm and vertebral fractures, with an analysis by sex and age groups. To estimate hospitalary costs, we utilized the data of Grupos Relacionados de Diagnóstico (GRD) used in IMSS. The cost for each case was $46,965.30 mexican pesos ($5,101.63 U.S.D.). RESULTS: It were registered 22,157 (8.2%) were fractures of the selected types. Of this number, 15,925 ocurred in persons of 50 years and more y 11,084 (69.6%) in postmenopausal women. The mentioned fractures were more frequent in men before 50 years with a proportion of 1.9 to 1. This proportion changed from 2 to 1 in women after 50 years. These differences were statistically significant. The cost of hospitalary care of hip fracture in postmenopausal women was $336,658.097 mexican pesos ($36' 593,271 U.S.D.) in the two years of the study. CONCLUSION: It is convenient to make costs-benefits evaluation about preventive resources, as widespread use of HRT, to reduce the frequency of fractures in postmenopausal women, due its high actual costs of hospitalary care.

[Causality and hospital perinatal mortality trend at the Mexican Institute of Social Security, 1998-2002]. / Causalidad y tendencia de la mortalidad perinatal hospitalaria en el Instituto Mexicano del Seguro Social, 1998-2002.

OBJECTIVE: To analyze levels, trend and causes of hospital perinatal mortality at the Instituto Mexicano del Seguro Social (IMSS) during the 5 years from 1998 to 2002 to identify magnitude and related factors in our population and discuss some technical bases and epidemiologic aspects for planning strategies to contribute to its reduction. MATERIAL AND METHODS: Descriptive study on the death certificates of 39,994 cases of perinatal deaths distributed among 19,108 fetal deaths of 28 weeks and more of gestation and 20,886 neonatal deaths 7 to days of life that occurred in IMSS hospitals during the reference period. With this information and the data on total births, dead or live from the official information system of our Institution, we established annual rates for the entire IMSS, including administrative regions and zones of medical services. We also generated 5-year cumulated numbers for frequencies and rates of perinatal death causes in the IMSS, using the codes of Tenth Revision of the International Diseases Classification. RESULTS: Hospital perinatal mortality at the IMSS showed a reduction from 1998 (13 per 1,000 births) to 2002 (11.4 per 1,000 births). That trend was observed in the four administrative regions and in the majority of number of medical services zones, but with many differences in levels. It was similar in proportions of fetal (47.8%) and neonatal deaths (52.2%). Two thirds of fetal mortality was linked to maternal complications during pregnancy and labor. A similar proportion of neonatal deaths was due to premature birth and its complications.

[Training experience in climacteric and menopause among physicians of the IMSS]. / Una experiencia de capacitación sobre climaterio y menopausia entre médicos del IMSS.

OBJECTIVE: To analyze the level of knowledge concerning climateric and menopause among family physicians and gynecologists and obstetricians of the Instituto Mexicano del Seguro Social (IMSS), after a training process in institutional technical guidelines and in educational content for population. We also analyze possible changes in frequency of medical attention for climateric and menopause in the first level of medical care. MATERIAL AND METHODS: Prospective and descriptive study on 1) results of the knowledge evaluation by means of 23 questions with multiple answers, and 2) analysis of rates of medical care for menopausal and perimenopausal disturbances (N95 code, X Revision, IDC) from 1995 to 2000. RESULTS: The percentage of correct answers prior to training was 62.2 for family physicians and 65.9 for gynecologists and obstetricians; after training, 79.3 and 81.4, respectively. Both groups had on increase in knowledge levels (p < 0.001) but there were no differences among them. An increase was registered in medical care rates for menopausal and perimenopausal disturbances in the group from 45 to 64 years of age in the period from 1995 to 2000. CONCLUSIONS: All physicians had on increase in knowledge on climateric and menopause issues but without differences among them, probably because the care of this health problem is referred to specialized services and as well as to more attention on other more frequent problems in women's health. In addition, we did not find changes yet in the rates of medical attentions attributable to training and information to population.

Una experiencia de capacitación sobre climaterio y menopausia entre médicos del IMSS / Training experience in climacteric and menopause among physicians of the IMSS

OBJECTIVE: To analyze the level of knowledge concerning climateric and menopause among family physicians and gynecologists and obstetricians of the Instituto Mexicano del Seguro Social (IMSS), after a training process in institutional technical guidelines and in educational content for population. We also analyze possible changes in frequency of medical attention for climateric and menopause in the first level of medical care. MATERIAL AND METHODS: Prospective and descriptive study on 1) results of the knowledge evaluation by means of 23 questions with multiple answers, and 2) analysis of rates of medical care for menopausal and perimenopausal disturbances (N95 code, X Revision, IDC) from 1995 to 2000. RESULTS: The percentage of correct answers prior to training was 62.2 for family physicians and 65.9 for gynecologists and obstetricians; after training, 79.3 and 81.4, respectively. Both groups had on increase in knowledge levels (p < 0.001) but there were no differences among them. An increase was registered in medical care rates for menopausal and perimenopausal disturbances in the group from 45 to 64 years of age in the period from 1995 to 2000. CONCLUSIONS: All physicians had on increase in knowledge on climateric and menopause issues but without differences among them, probably because the care of this health problem is referred to specialized services and as well as to more attention on other more frequent problems in women's health. In addition, we did not find changes yet in the rates of medical attentions attributable to training and information to population.

El cáncer cervicouterino: el médico familiar frente al problema / Cervical cáncer: the family physician confronts the problem

El cáncer cervicouterino constituye en la actualidad uno de los más importantes problemas de salud de la mujer, ya que representa la segunda causa más frecuente de muerte por neoplasias malignas en el género femenino; se diagnostica cerca de medio millón de casos nuevos por año en todo el mundo, particularmente entre los grupos de población con bajo nivel socioeconómico. Para 1997 en el Instituto Mexicano del Seguro Social (IMSS), esta enfermedad también ocupó el segundo lugar como causa de muerte por cáncer en la mujer y registró una tasa de 4.5 por 100 mil derechohabientes, por lo que se ha considerado como una de las prioridades en salud pública para esta institución y ha motivado la instrumentación de un programa integral para su prevención, identificación y control, con el fin de modificar favorablemente el perfil epidemiológico. Ya que el programa mencionado hace énfasis particular en la prevención primaria y secundaria del cáncer cervicouterino -esta última mediante citología cervical-, en el presente trabajo se revisan los criterios más aceptados en la actualidad para la evaluación médica y las acciones por realizar ante resultados anormales de la prueba de papanicolaou, así como los factores causales y propiciadores del carcinoma del cérvix, con el fin de proporcionar al médico familiar elementos técnicos simplificados para aplicarlos en su labor educativa y asistencial en la práctica clínica cotidiana.

Prevención y tratamiento del parto pretérmino: lo nuevo acerca del viejo problema / Prevention and treatment o premature birth: what's new about an old problem

El nacimiento pretérmino, que ocurre aproximadamente en uno de cada diez embarazos, origina una elevada proporción de la mortalidad y morbilidad perinatales en todo el mundo. Aunque no se dispone de cifras confiables para México, en el Instituto Mexicano del Seguro Social tuvo una frecuencia de 6 por ciento en el quinquenio 1989 a 1993 y representó la causa básica de 53.3 por ciento de la mortalidad perinatal informada en 1998, cuya tasa fue de 659.5 por 100 mil nacidos vivos. Estos datos confirman la gran trascendencia de ese problema de salud. En virtud de lo anterior, en el presente trabajo se revisa la información científica más reciente con respecto a la etiopatogenia, factores de riesgo, asociación con infecciones del tracto genitourinario, recursos disponibles para el diagnóstico preclínico, y los criterios más empleados en los últimos años para la prevención y tratamiento, con el fin de formular planteamientos que contribuyan a actualizar y uniformar los protocolos de atención de este problema en el país.

Mortalidad materna por ruptura hepática: experiencia de 15 años en el IMSS / Maternal mortality due to hepatic rupture: 15 years of experience at the IMSS

Aunque poco frecuente, la ruptura hepática durante el estado grávido puerperal constituye una de las complicaciones más graves de la enfermedad hipertensiva aguda en la gestación. La elevada mortalidad materna y perinatal que la acompaña obedece al diagnóstico tardío, y a que aparece en pacientes con síndrome de HELLP o manifestaciones de disfunción orgá-nica múltiple características de la preeclampsia-eclampsia. Debido a su carácter de emergencia quirúrgica grave, la mayoría de las comunicaciones sobre ella señala casos aislados y discute los criterios diagnósticos y terapéuticos, pero se ocupa menos de los aspectos relacionados con el comportamiento epidemiológico y la prevención, los cuales son de gran importancia en países como México, donde es relativamente frecuente la preeclampsia-eclampsia. En el presente estudio, transversal y descriptivo, se analizan 79 muertes maternas por ruptura hepática ocurridas en un periodo de 15 años en unidades hospitalarias del Instituto Mexicano del Seguro Social, con el propósito de contribuir a caracterizar el perfil epidemiológico en el país y brindar elementos prácticos para la identificación de las pacientes en riesgo y las posibles estrategias para la prevención de esa complicación.

Estrógenos equinos vs. estrógenos esterificados en el climaterio y menopausia: la controversia llega a México / Equine estrogens vs. esterified estrogens in the climateric and menopause the controversy arrives in Mexico

Existe controversia con respecto a si los efectos y beneficios de los estrógenos esterificados pueden ser similares a los informados para los equinos, ya que su composición química y su biodisponibilidad son distintas porque carecen de delta 8,9 dehidroestrona y se absorben y alcanzan con mayor rapidez las concentraciones plasmáticas máximas.Pese a lo anterior, en Estados Unidos de Norteamérica y en otros países, los estrógenos esterificados se han comercializado para su empleo en el tratamiento del síndrome climatérico y la prevención de la osteoporosis postmenopáusica, con base en la farmacopea de ese país, aunque no ha sido autorizada por la Food and Drug Administration (FDA) ninguna versión genérica de estrógenos conjugados.En virtud de que en el Instituto Mexicano del Seguro Social (IMSS) y en otras dependencias del sector salud de México, a partir del año 2000 se han empezado a utilizar estrógenos esterificados en lugar de estrógenos equinos, para el tratamiento médico en el climaterio y la menopausia, se revisa la información actualizada con respecto a farmacología, composición, uso clínico y costos de los estrógenos conjugados, con el fin de orientar la toma de decisiones en la selección y adquisición de este tipo de fármacos por las instituciones mexicanas de salud.

Experiencias y conocimientos sobre climaterio y menopausia en mujeres de la ciudad de México / Experience and knowledge of the climacterium and menopause in women in Mexico city, Mexico

Objetivo: Investigar experiencias y conocimientos sobre climaterio y menopausia, en mujeres derechohabientes del Instituto Mexicano del Seguro Social (IMSS), con el fin de obtener información para planear estrategias educativas que incrementen la demanda de atención en estos periodos.Material y métodos: estudio transversal y descriptivo mediante encuestas, en una muestra aleatoria simple de 495 mujeres de 50 a 59 años, usuarias de los servicios de medicina familiar en el Distrito Federal, representativa de esta población y ámbito con un nivel de confianza del 95 por ciento.Resultados: La edad promedio a la menopausia fue de 47.8 años. Los síntomas más frecuentes fueron bochornos (70.9 por ciento), depresión (60.2 por ciento), insomnio (53.5 por ciento) e irregularidades menstruales (37.8 por ciento); 51.1 por ciento de las mujeres solicitaron atención médica; solo 12.1 por ciento estaba recibiendo actualmente tratamiento, que consistía en hormonales en 81.6 por ciento.Alguna vez habían usado tratamiento 14.9 por ciento de las encuestadas, hormonales en 87.8 por ciento. El 83.8 por ciento de las mujeres conocía los síntomas del climaterio; 90.1 por ciento a la osteoporosis como una complicación postmenopáusica y 37.2 por ciento declaró saber del riesgo de enfermedad cardiovascular.La prevención de la osteoporosis y de la enfermedad coronaria la asociaron con calcio y ejercicio, pero solo 1 por ciento con el uso de hormonales.Conclusiones: Existe aceptable información sobre climatérico y osteoporosis postmenopáusica, pero menor en cuanto a enfermedad cardiovascular. La información declarada parece ser producto de la información comercial por medios masivos de comunicación más que de la educación en salud que proporcionan las instituciones.

Indicaciones y justificación de las cesáreas en el Instituto Mexicano del Seguro Social / Indication and justification for cesarean surgery at the Instituto Mexicano del Seguro Social (IMSS)

Objetivo: debido a la elevada frecuencia de cesáreas en el IMSS, se realizó un estudio para conocer indicaciones y justificación.Material y método: estudio transversal y retrospectivo en una muestra al azar simple nacional de 3,232 cesáreas entre junio de 1997 y junio de 1999. Resultados: las indicaciones más frecuentes fueron desproporción cefalopélvica (29.6 por ciento), cesárea previa (20.9 por ciento), sufrimiento fetal agudo (14.1 por ciento), cesárea iterativa (11.9 por ciento) y ruptura prematura de membranas (10.7 por ciento). En casos de desproporción cefalopélvica (DCP) el peso promedio de los productos al nacer fue 3,430g., 70.6 por ciento tenía contractilidad irregular y 21.7 por ciento recibió oxitocina; 78.2 por ciento tuvieron membranas íntegras y dilatación cervical de 4 cm o menor. En los casos de cesárea previa y DCP, el peso de los recién nacidos fue de 3,425 g; 81.7 por ciento de las pacientes tenían contractilidad irregular y 4.8 por ciento recibieron oxitocina. En las cesáreas por sufrimiento fetal agudo, 94.9 por ciento de los productos tuvieron Apgar de 8 o más a los 5 minutos.Conclusión: las indicaciones de cesárea en el IMSS son similares a lo informado en México y el mundo, pero con los datos existentes en los expedientes clínicos de este estudio, en la mayoría de los casos no se justifican.