Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged.

BACKGROUND: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. OBJECTIVE: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). METHODS: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). RESULTS: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. CONCLUSIONS: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Impact of mitigation measures against the COVID 19 pandemic on the perinatal results of the reference maternity hospital in Uruguay.

INTRODUCTION: Social consequences of pandemics, impacts on perinatal results, especially those who are the most vulnerable. OBJECTIVE: Determine effect of mitigation measures of the COVID 19 pandemic on perinatal results in the maternity hospital of the Pereira Rossell Hospital Center (CHPR). METHODS: A retrospective cross-sectional cohort study, with a comparative analysis of the semesters of March 15-30 September 2019 versus the same period in 2020 based on three variables low birth weight (LBW), preterm birth (PB), and small for gestational age (SGA). RESULTS: Incidence of PB (14.5%), LBW (12%) and SGA (6.9%) was higher in the 2020 semester during COVID 19 pandemic compared to the same period of 2019 (12.2%; 9.8%; 5.5%). PB showed a statistically significant increase of 21% in our hospital. CONCLUSION: Mitigation measures of the COVID 19 pandemic, aggravate the effects of the global syndemic on the reproductive process of the social sectors most violated in their rights.

Effect of the unfavorable maternal-fetal environment cause by mitigation measures of the covid-19 pandemic in the public maternity of reference of Uruguay.

INTRODUCTION: The mitigation measures to face the health emergency due to the COVID 19 pandemic generated a deep economic, social, and psychological crisis at the community level. This effect is greater in the people, who are the most violated in their rights. In relation to the social crisis and gender perspective, women are particularly affected by the pandemic. Given the disadvantaged situation of women socially, economically, and politically, their self-care is diminished. OBJECTIVE: To identify whether there is an association between the classic risk factors for prematurity and fetal growth restriction and the increase in these pathologies in the period March-September 2020, in a maternity hospital that assists women from low resources. MATERIALS AND METHODS: A retrospective study, with a comparative analysis of the periods between 15 March and 30 September 2019 and the same period in 2020. The data were obtained from an electronic clinical database. The prevalence of preterm birth and small-for-gestational age newborn was analyzed. Indicators available in the database that reflect maternal conditions that lead to an unfavorable maternal environment were selected and they were classified into categories. RESULTS: In the period of 2019, 3225 births were registered and in the period of 2020, 3036 births. In the 2019 period, 12.2% of prematurity was evidenced, while in the 2020 period, 14.5% (RR = 1.19, IC 95% = 1.05-1.35, p = .005). In relation to PEG 5.5% in the first period versus 6.9% in the second (RR = 1.26, CI 95% = 1.04-1.53, p = .01). No increases were found in the indicators that are traditionally related to the etiologies proposed to explain the increase in prematurity and small-for-age gestational, there was no evidence of an increase in inflammatory or vascular conditions. CONCLUSION: The economic, psychological and social crises, in the 1st semester of the health emergency, seriously affected the social determinants of the health of pregnant women who use the Public Maternity of reference in Uruguay. This situation is at the base of the poor perinatal results in the period of the maximum mediated mitigation of the pandemic.

Behaviors of Turkish pregnant women towards gestational diabetes screening.

OBJECTIVES: Although gestational diabetes is the most common metabolic disease in pregnancy some pregnant women still refuse to undergo oral glucose tolerance test (OGTT). The purpose of this study was to evaluate the behavior of pregnant women undergoing OGTT, and to compare perinatal results between women who undergo and refuse OGTT. METHODS: This retrospective cohort study was performed by evaluating the data of Izmir Katip Celebi University Gynecology and Obstetrics outpatient clinic between 2012-2017. Data of 2079 pregnant were evaluated retrospectively. Among 373 women who refused OGTT were evaluated as the study group, while remaining 1706 women who underwent OGTT were considered as the control group. The groups were compared with regard to perinatal results. RESULTS: Sixty-two point four percent of the group who refused OGTT had a C-section, while 56.3% of the control group had a C-section (p<0.05). Intrauterine growth retardation, fetal distress, amniotic fluid pathologies, macrosomia, gestational hypertension and perinatal death were slightly higher in pregnant women who did not undergo OGTT compared to the control group, however, the difference was not statistically significant. CONCLUSION: Maternal complications and poor pregnancy results were found slightly higher in pregnant women who refused OGTT. These results might be explained by assuring glycemic control in pregnant women who refused OGTT by a series of fasting and postprandial blood sugar measurements in our center.

Freeze-all en reproducción asistida

Los avances en los protocolos de vitrificación y los resultados obtenidos tras la transferencia de embriones congelados han dado lugar a una versión distinta de los ciclos estándar de reproducción asistida: los ciclos freeze-all. Independientemente de su uso frente a las indicaciones más comunes (progesterona elevada, riesgo de hiperestimulación, entre otros), este nuevo concepto hoy representa una práctica habitual en muchas clínicas siendo aplicado a todas las pacientes. En este artículo analizaremos los distintos factores que pudieron haber contribuido a este cambio de política y la evidencia científica en relación al tema. Basados en esta evidencia concluiremos si las clínicas deberían cambiar su forma de trabajo pasando de transferencias de embriones frescos a solo transferencia de embriones congelados o si deberíamos mantener el protocolo estándar.

Breakthroughs in vitrification protocols and the results obtained after frozen embryo transfer have resulted in a different version of the assisted reproduction standard cycles: the "freeze-all" cycles. Regardless of their use beyond the usual indications (elevated progesterone, risk of hyperstimulation, among others), this new concept currently represents a common practice in many institutions and is applied to all patients. In this article, we will discuss the various factors that may have contributed to this change in policy and the scientific evidence for this topic. Based on this evidence, we will conclude if clinics should change their way of working from fresh embryo transfers to only transfer frozen embryos, or if we should maintain the standard protocol.

Comparación resultados perinatales en gestantes con y sin alteración de doppler de acm en fetos de crecimiento normal / Comparison of perinatal outcomes in pregnant women with and without alteration of acm Doppler in normal growth fetuses

Objetivo:Comparar los resultados perinatales en gestantes cony sinalteración de Doppler de la arteria cerebral mediaen fetos de crecimiento normal. Hospital Niño Jesús, Barranquilla,periodo julio 2017 ­abril 2018.Materiales y métodos: Se presenta un estudio analítico prospectivounicentrico, diseñado con el objetivo de comparar los resultados perinatales en gestantes con y sin alteración de Dopplerde la arteria cerebral media en fetos de crecimiento normal. Hospital Niño Jesús, Barranquilla, periodo julio 2017 ­abril 2018.Resultados:Muestra compuesta por un total de 200 pacientes, 180 pacientes que no presentaron alteración de Doppler de la arteria cerebral media con media en su percentil de 47.6 ± 25.0 y 20 pacientes cuyo percentil estuvo por debajo de 5 con media de 3.5 ± 1.0, no se encontraron diferencias significativas respecto a aumento de resultados perinatales adversos en ninguno de los grupos de estudio, la tasa de cesárea Aumento de la tasa de cesárea OR: 5.5 p: 0.001.Conclusiones:no existen diferencias estadísticamente significativas al comparar los resultados perinatales de las gestantes con y sin alteración de Dopplerde la arteria cerebral media en fetos de crecimiento normal, se evidencio un aumento estadísticamente significativo en la tasa de cesáreas en el grupode arteria cerebral media alterada

Objective:To compare the perinatal results in pregnant women with and without Doppler alteration of the middle cerebral artery in fetuses of normal growth. Hospital Niño Jesús, Barranquilla, period July 2017 -April 2018.Materials and methods: We present a unicentric prospective analytical study, designed with the aim of comparing perinatal outcomes in pregnant women with and Doppler alteration of the middle cerebral artery in normal growth fetuses. "Hospital Niño Jesús, Barranquilla", period July 2017 -April 2018.Results:Sample composed of a total of 200 patients, 180 patients who did not present a Doppler alteration of the middle cerebral artery with a percentage of 47.6 ± 25.0 and 20 patients whose percentage was below 5 with an average of 3, 5 ± 1.0. there are no differences between the results of the study results, Increase in the OR: 5.5 p: 0.001.Conclusions: there are no statistically significant differences when compared with the perinatal results of pregnant women with and without Doppler alteration of the cerebral middle artery in fetuses of normal growth, a statistically significant increase in the rate of cesarean sections in the cerebral artery group was evidenced altered media

Resultados maternos y perinatales en gestantes diabéticas que requirieron tratamiento insulínico / Maternal and Perinatal Outcomes in Diabetic Pregnant Women Who Required Insulin Treatment

Introducción: la diabetes mellitus representa un factor de riesgo para la mujer embarazada y un problema de salud para el producto. Objetivos: identificar los resultados maternos y perinatales en gestantes diabéticas que recibieron tratamiento insulínico. Métodos: se realizó una investigación de desarrollo, descriptiva, transversal en el Hospital Ginecobstétrico Mariana Grajales de Villa Clara, Cuba desde enero de 2013 hasta diciembre de 2014. La muestra quedó conformada de manera no probabilística por 111 pacientes diabéticas gestacionales y pregestacionales con tratamiento insulínico. Resultados: predominó la diabetes gestacional (58 por ciento de los casos) respecto a la pregestacional (42 por ciento). El primer grupo alcanzó un buen control metabólico. La mayoría de las pacientes tuvo recién nacidos con peso de 2 500 gr a 4 199 gr, presentándose la macrosomía fetal solo en 17,1 por ciento del total de pacientes. Los trastornos hipertensivos y la infección vaginal fueron las complicaciones maternas de más representatividad. La complicación perinatal con mayor incidencia fue el parto pretérmino, aunque sin significación estadística. Conclusiones: hubo predominio de la diabetes mellitus gestacional en más de la mitad de la muestra. Este grupo resultó ser el de mejor control metabólico respecto a la pregestacional. Los trastornos hipertensivos y la infección vaginal fueron las complicaciones más representativas y el parto pretermino resulto de mayor incidencia en la muestra. Predominaron los recién nacidos de peso adecuado(AU)

Introduction: Diabetes mellitus represents a risk factor for pregnant women and a health problem for the offspring. Objectives: Identify maternal and perinatal outcomes in diabetic pregnant women who received insulin treatment. Methods: A descriptive, cross-sectional research was conducted at Mariana Grajales Gyneco-Obstetric Hospital in Villa Clara, Cuba from January 2013 to December 2014. A hundred-eleven (11) gestational and pre-gestational diabetic patients with insulin treatment non-probabilistically formed the sample. Results: Gestational diabetes predominated (58 percent of cases) compared to pre-gestational diabetes (42 percent). The first group achieved good metabolic control. The majority of the patients had newborns weighing 2 500 g to 4 199 g, with fetal macrosomia only in 17.1 percent of the total patients. Hypertensive disorders and vaginal infection were the most representative maternal complications. The most frequent perinatal complication was preterm delivery, although there was no statistical significance. Conclusions: There was a predominance of gestational diabetes mellitus in more than half of the sample. This group turned out to be the one with the best metabolic control with respect to pre-gestational control. Hypertensive disorders and vaginal infection were the most representative complications and preterm birth resulted in a higher incidence in the sample. The newborns of adequate weight predominated(AU)

Resultados maternos y perinatales en gestantes diabéticas que requirieron tratamiento insulínico / Maternal and Perinatal Outcomes in Diabetic Pregnant Women Who Required Insulin Treatment

Introducción: la diabetes mellitus representa un factor de riesgo para la mujer embarazada y un problema de salud para el producto. Objetivos: identificar los resultados maternos y perinatales en gestantes diabéticas que recibieron tratamiento insulínico. Métodos: se realizó una investigación de desarrollo, descriptiva, transversal en el Hospital Ginecobstétrico Mariana Grajales de Villa Clara, Cuba desde enero de 2013 hasta diciembre de 2014. La muestra quedó conformada de manera no probabilística por 111 pacientes diabéticas gestacionales y pregestacionales con tratamiento insulínico. Resultados: predominó la diabetes gestacional (58 por ciento de los casos) respecto a la pregestacional (42 por ciento). El primer grupo alcanzó un buen control metabólico. La mayoría de las pacientes tuvo recién nacidos con peso de 2 500 gr a 4 199 gr, presentándose la macrosomía fetal solo en 17,1 por ciento del total de pacientes. Los trastornos hipertensivos y la infección vaginal fueron las complicaciones maternas de más representatividad. La complicación perinatal con mayor incidencia fue el parto pretérmino, aunque sin significación estadística. Conclusiones: hubo predominio de la diabetes mellitus gestacional en más de la mitad de la muestra. Este grupo resultó ser el de mejor control metabólico respecto a la pregestacional. Los trastornos hipertensivos y la infección vaginal fueron las complicaciones más representativas y el parto pretermino resulto de mayor incidencia en la muestra. Predominaron los recién nacidos de peso adecuado(AU)

Introduction: Diabetes mellitus represents a risk factor for pregnant women and a health problem for the offspring. Objectives: Identify maternal and perinatal outcomes in diabetic pregnant women who received insulin treatment. Methods: A descriptive, cross-sectional research was conducted at Mariana Grajales Gyneco-Obstetric Hospital in Villa Clara, Cuba from January 2013 to December 2014. A hundred-eleven (11) gestational and pre-gestational diabetic patients with insulin treatment non-probabilistically formed the sample. Results: Gestational diabetes predominated (58 percent of cases) compared to pre-gestational diabetes (42 percent). The first group achieved good metabolic control. The majority of the patients had newborns weighing 2 500 g to 4 199 g, with fetal macrosomia only in 17.1 percent of the total patients. Hypertensive disorders and vaginal infection were the most representative maternal complications. The most frequent perinatal complication was preterm delivery, although there was no statistical significance. Conclusions: There was a predominance of gestational diabetes mellitus in more than half of the sample. This group turned out to be the one with the best metabolic control with respect to pre-gestational control. Hypertensive disorders and vaginal infection were the most representative complications and preterm birth resulted in a higher incidence in the sample. The newborns of adequate weight predominated(AU)

Resultados perinatales de las pacientes con anemia a la captación del embarazo (enero 2015-diciembre 2016) / Perinatal Outcomes of Patients with Anemia at the Beginning of Pregnancy (January 2015-December 2016)

Introducción: la anemia durante el embarazo se produce como resultado de deficiencias nutricionales y constituye un problema de salud. Es una de las afecciones coincidentes con más frecuencia en el embarazo. Objetivo: describir los resultados perinatales en pacientes con diagnóstico de anemia en el momento de la captación del embarazo. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo, en 543 pacientes con anemia atendidas en la consulta de nutrición del Hospital Ginecobstétrico Eusebio Hernández Pérez de La Habana, Cuba, desde enero de 2015 hasta diciembre de 2016. La recolección de la información se realizó mediante entrevista, examen físico, las investigaciones diagnósticas realizadas y las historias clínicas. Resultados: casi la mitad de las pacientes estuvieron representadas por las adolescentes y las mayores de 35 años (45,4 por ciento). Las multíparas iniciaron la gestación con anemia para un 36,6 por ciento. Las nulíparas presentaron infecciones durante el embarazo para un 59,2 por ciento. El 83,9 por ciento de las pacientes con partos anteriores tenían un periodo intergenésico corto. El parto antes del término y el recién nacido con bajo peso al nacer estuvo presente en 15,4 por ciento. No hubo mortalidad materno-fetal. Hubo tres muertes neonatales precoces. Conclusiones: la multiparidad y el período intergenésico corto fueron antecedentes frecuentes en las gestantes con anemia en la captación. La prematuridad y el bajo peso al nacer fueron bajas y no se produjeron muertes maternas ni fetales. La mortalidad perinatal fue a expensas de los recién nacidos menores de siete días(AU)

Introduction: Anemia during pregnancy occurs as a result of nutritional deficiencies and is a health problem. It is one of the most frequently encountered conditions in pregnancy. Objective: Describe the perinatal outcomes in patients with anemia at the beginning of pregnancy. Methods: An observational, descriptive, longitudinal and prospective study was conducted in 543 patients with anemia treated at the nutrition clinic of the Eusebio Hernández Pérez Ginecobstetric Hospital, Havana, Cuba, from January 2015 to December 2016. The collection of information was made through interview, physical examination, diagnostic investigations and clinical records. Results: Almost half of the patients were represented by adolescents and those over 35 (45.4 percent). The multiparous women started gestation with anemia (36.6 percent). Nulliparous women had infections during pregnancy (59.2 percent).83.9 percent of the patients with previous deliveries had short intergenic period. Preterm birth and low birth weight newborns were present in 15.4 percent. There was no maternal-fetal mortality but only three early neonatal deaths. Conclusions: Multiparity and short intergenic period were frequent antecedents in pregnant women with anemia at the beginning of pregnancy. Prematurity and low birth weight incidence were low and there were no maternal or fetal deaths. Perinatal mortality was at the expense of infants younger than seven days(AU)

Resultados perinatales de las pacientes con anemia a la captación del embarazo (enero 2015-diciembre 2016) / Perinatal Outcomes of Patients with Anemia at the Beginning of Pregnancy (January 2015-December 2016)

Introducción: la anemia durante el embarazo se produce como resultado de deficiencias nutricionales y constituye un problema de salud. Es una de las afecciones coincidentes con más frecuencia en el embarazo. Objetivo: describir los resultados perinatales en pacientes con diagnóstico de anemia en el momento de la captación del embarazo. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo, en 543 pacientes con anemia atendidas en la consulta de nutrición del Hospital Ginecobstétrico Eusebio Hernández Pérez de La Habana, Cuba, desde enero de 2015 hasta diciembre de 2016. La recolección de la información se realizó mediante entrevista, examen físico, las investigaciones diagnósticas realizadas y las historias clínicas. Resultados: casi la mitad de las pacientes estuvieron representadas por las adolescentes y las mayores de 35 años (45,4 por ciento). Las multíparas iniciaron la gestación con anemia para un 36,6 por ciento. Las nulíparas presentaron infecciones durante el embarazo para un 59,2 por ciento. El 83,9 por ciento de las pacientes con partos anteriores tenían un periodo intergenésico corto. El parto antes del término y el recién nacido con bajo peso al nacer estuvo presente en 15,4 por ciento. No hubo mortalidad materno-fetal. Hubo tres muertes neonatales precoces. Conclusiones: la multiparidad y el período intergenésico corto fueron antecedentes frecuentes en las gestantes con anemia en la captación. La prematuridad y el bajo peso al nacer fueron bajas y no se produjeron muertes maternas ni fetales. La mortalidad perinatal fue a expensas de los recién nacidos menores de siete días(AU)

Introduction: Anemia during pregnancy occurs as a result of nutritional deficiencies and is a health problem. It is one of the most frequently encountered conditions in pregnancy. Objective: Describe the perinatal outcomes in patients with anemia at the beginning of pregnancy. Methods: An observational, descriptive, longitudinal and prospective study was conducted in 543 patients with anemia treated at the nutrition clinic of the Eusebio Hernández Pérez Ginecobstetric Hospital, Havana, Cuba, from January 2015 to December 2016. The collection of information was made through interview, physical examination, diagnostic investigations and clinical records. Results: Almost half of the patients were represented by adolescents and those over 35 (45.4 percent). The multiparous women started gestation with anemia (36.6 percent). Nulliparous women had infections during pregnancy (59.2 percent).83.9 percent of the patients with previous deliveries had short intergenic period. Preterm birth and low birth weight newborns were present in 15.4 percent. There was no maternal-fetal mortality but only three early neonatal deaths. Conclusions: Multiparity and short intergenic period were frequent antecedents in pregnant women with anemia at the beginning of pregnancy. Prematurity and low birth weight incidence were low and there were no maternal or fetal deaths. Perinatal mortality was at the expense of infants younger than seven days(AU)

Resultados perinatales en la preeclampsia con signos de gravedad / Perinatal results in severe pre-eclampsia

OBJETIVO: Determinar los resultados perinatales en pacientes con preeclampsia con signos de gravedad. MÉTODOS: Se realizó un estudio descriptivo retrospectivo de los resultados perinatales en la preeclampsia con signos de gravedad en el hospital Docente Ginecoobstétrico Eusebio Hernández en el período de tiempo comprendido entre el 1º de enero de 2008 al 31 de diciembre de 2008. El universo de trabajo estuvo constituido por el total de puérperas y la muestra por las 61 pacientes que ingresaron en la sala de cuidados perinatales que se le diagnosticó preeclampsia con signo de gravedad. Se estudiaron las siguientes variables: causa de cesárea primitiva en la cesárea con signo de gravedad, morbilidad materna, morbilidad perinatal, y mortalidad perinatal. Previo consentimiento informado se realizó una encuesta que incluyó las variables estudiadas mediante un muestreo sistemático. Se revisaron, además, las historias clínicas de las pacientes. RESULTADOS: El mayor número de cesáreas primitivas fue por malas condiciones cervicales con un 18,03 por ciento, la mayor morbilidad materna fue la hemorragia posparto con 18,03 por ciento, la morbilidad perinatal que predominó fue la enfermedad de membrana hialina y la infección, asimismo hubo dos muertes neonatales, una por enfermedad de membrana hialina y otra neonatal tardía por sepsis. CONCLUSIONES: El mayor número de nacimientos se obtuvo mediante la cesárea primitiva por malas condiciones cervicales. La principal morbilidad materna fue la hemorragia posparto; la infección y la enfermedad de membrana hialina obtuvieron el mayor porcentaje de morbimortalidad perinatal(AU)

OBJECTIVE: To determine the perinatal results obtained in patients with a severe pre-eclampsia. METHODS: A retrospective and descriptive study was conducted on the perinatal results obtained in patients with a severe pre-eclampsia in the Eusebio Hernández Gynecology-Obstetrics Teaching Hospital from January 1, 2008 to December 31, 2008. Work universe included the total of puerperants and the sample included 61 patients admitted in the perinatal care service diagnosed with severe pre-eclampsia. Following variables were studied: cause of original severe cesarean section, mother mortality, perinatal morbidity and perinatal mortality. With the previous informed consent a survey was made including the study variables by systematic sampling. Also, we analyzed the patient's medical records. RESULTS: The greater figure of original cesarean section was due to poor cervical conditions with the 18.03 percent, the greater and predominant mother morbidity was the hyaline membrane disease and another late due to sepsis. CONCLUSIONS: The greater number of births was by original cesarean section due to the poor cervical conditions. The main mother morbidity was the postpartum hemorrhage; the infection and hyaline membrane disease had the higher percentage of perinatal mortality and morbidity(AU)

Resultados perinatales en la preeclampsia con signos de gravedad / Perinatal results in severe pre-eclampsia

OBJETIVO: Determinar los resultados perinatales en pacientes con preeclampsia con signos de gravedad. MÉTODOS: Se realizó un estudio descriptivo retrospectivo de los resultados perinatales en la preeclampsia con signos de gravedad en el hospital Docente Ginecoobstétrico Eusebio Hernández en el período de tiempo comprendido entre el 1º de enero de 2008 al 31 de diciembre de 2008. El universo de trabajo estuvo constituido por el total de puérperas y la muestra por las 61 pacientes que ingresaron en la sala de cuidados perinatales que se le diagnosticó preeclampsia con signo de gravedad. Se estudiaron las siguientes variables: causa de cesárea primitiva en la cesárea con signo de gravedad, morbilidad materna, morbilidad perinatal, y mortalidad perinatal. Previo consentimiento informado se realizó una encuesta que incluyó las variables estudiadas mediante un muestreo sistemático. Se revisaron, además, las historias clínicas de las pacientes. RESULTADOS: El mayor número de cesáreas primitivas fue por malas condiciones cervicales con un 18,03 por ciento, la mayor morbilidad materna fue la hemorragia posparto con 18,03 por ciento, la morbilidad perinatal que predominó fue la enfermedad de membrana hialina y la infección, asimismo hubo dos muertes neonatales, una por enfermedad de membrana hialina y otra neonatal tardía por sepsis. CONCLUSIONES: El mayor número de nacimientos se obtuvo mediante la cesárea primitiva por malas condiciones cervicales. La principal morbilidad materna fue la hemorragia posparto; la infección y la enfermedad de membrana hialina obtuvieron el mayor porcentaje de morbimortalidad perinatal

OBJECTIVE: To determine the perinatal results obtained in patients with a severe pre-eclampsia. METHODS: A retrospective and descriptive study was conducted on the perinatal results obtained in patients with a severe pre-eclampsia in the Eusebio Hernández Gynecology-Obstetrics Teaching Hospital from January 1, 2008 to December 31, 2008. Work universe included the total of puerperants and the sample included 61 patients admitted in the perinatal care service diagnosed with severe pre-eclampsia. Following variables were studied: cause of original severe cesarean section, mother mortality, perinatal morbidity and perinatal mortality. With the previous informed consent a survey was made including the study variables by systematic sampling. Also, we analyzed the patient's medical records. RESULTS: The greater figure of original cesarean section was due to poor cervical conditions with the 18.03 percent, the greater and predominant mother morbidity was the hyaline membrane disease and another late due to sepsis. CONCLUSIONS: The greater number of births was by original cesarean section due to the poor cervical conditions. The main mother morbidity was the postpartum hemorrhage; the infection and hyaline membrane disease had the higher percentage of perinatal mortality and morbidity

Cardiopatía y embarazo / Hearth disease and pregnancy

La cardiopatía es la causa más frecuente de muerte materna indirecta en el mundo y se espera que el número de gestantes con cardiopatía crezca en los próximos años. La prevención de las complicaciones cardiovasculares constituye un objetivo primordial del sistema de salud. Este hospital como Centro Provincial de Referencia de Cardiopatía y Embarazo tiene elaborado un protocolo para la asistencia de este grupo de pacientes. OBJETIVO: describir los resultados materno- perinatales logrados con la aplicación del protocolo asistencial. MÉTODOS: se realizó un estudio descriptivo, prospectivo y de corte transversal durante el período de enero de 2004 a diciembre de 2008 en el servicio de Obstetricia del Hospital General Dr. Juan Bruno Zayas Alfonso, con una muestra de 435 gestantes cardiópatas. RESULTADOS: el 76,8 por ciento de las cardiopatías fueron adquiridas, predominando el grado funcional I así como las cardiopatías de bajo riesgo. La complicación cardiovascular más frecuente fue la insuficiencia cardiaca, con el 2,3 por ciento. Dentro de la morbilidad perinatal representaron el mayor porcentaje la restricción del crecimiento fetal (4,6 por ciento) y el parto pretérmino (3,4 por ciento). La mortalidad materna fue de 0,2 por ciento y la mortalidad perinatal de 1,6 por ciento. CONCLUSIONES: los resultados maternos y perinatales logrados con el protocolo asistencial pueden evaluarse de satisfactorios

Heart disease is the more frequent indirect maternal death cause at world scale and it is possible that the cardiopath pregnant figures increase in a future. Cardiovascular complication prevention is an essential objective of health system. Our hospital as Hearth disease and Pregnancy Reference Provincial Center has designed a protocol for assistance of this patient group. OBJECTIVE: to describe the maternal-perinatal results achieved applying the healthcare protocol. METHODS: a cross-sectional, prospective and descriptive study was made from January, 2004 to December, 2008 in Juan Bruno Zayas general Hospital including a sample of 435 cardiopaths. RESULTS: the 76,8 percent of heart diseases were of acquired type, with a predominance of I functional degree, as well as the low risk heart diseases. The more frequent cardiovascular complication was the heart insufficiency for a 2,3 percent. Included in perinatal morbidity was the great percentage of fetal development restriction (4,6 percent) and preterm labor (3,4 percent). Maternal mortality was of 0,2 percent and perinatal mortality of 1,6 percent). CONCLUSIONS: maternal and perinatal results achieved using healthcare protocol may be assessed as satisfactory