[Perinatal results in patients with chronic hypertension at the National Institute of Perinatology]. / Resultados perinatales en pacientes con hipertensión arterial sistémica crónica en el Instituto Nacional de Perinatología.

There are many causes of Chronic Hypertension, and all can be present in pregnant women. The literature reports an incidence between 1-3%. The prognosis usually is favorable, if we have an excellent control of blood pressure along pregnancy. But the risks like abruptio placentae, fetal demise or fetal growth restriction have a greater incidence than in the health population, furthermore the superimposed preeclampsia increase notably the perinatal morbidity. The objective of this study is to determine the perinatal outcomes in women with chronic hypertension in the Instituto Nacional de Perinatología. In the study we included 66 patients with chronic hypertension with age between 21-45 years old, and 54.4% had an age between 30-40 years. The evolution time of hypertensive disease was 5 years or less principally (71.2% of the patients).

[Determination of the tumor necrosis factor in the peritoneal fluid of gynecologic patients with intraperitoneal infections and endometriosis]. / Determinación del factor de necrosis tumoral en líquido peritoneal de pacientes ginecológicas con infecciones intraperitoneales y endometriosis.

Tumor necrosis factor (TNF-alpha) is a cytokine which can be found in peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response of inflammatory disorder and infections diseases. The cytotoxic effect of this cytokine could be participating in the pathology of different gynecologic problem and be accountable of the high immunological response and damage on the tubal epithelium. The objective of this study was determinate the presence of TNF-alpha in PF of endometriosis patients, fallopian tube occlusion (FTO) and PID and their correlation with different isolated bacteria. Ten mililiter PF were collected and cultured in antificial medium and Mc Coy culture cells for isolation of acrobic, and anaerobic bacteria and Chlamydia trachomatis from 73 patients by laparoscopy. The TNF-alpha activity was determined by L-929 cells endometriosis, 30 PID and 4 had miomas and adherences. The 50.7% of patients were cultive positive, fom these, 31.5% were PID. Chlamydia trachomatis (16%) was the most frecuenty isolated bacteria in these patients. 59.4% of FTO patients displayed TNF-alpha activity. However, only 4% showed positive isolation, in conclusion the detection of TNF-alpha could be useful in active infectious and inflammatory diseases in patients which not present simptomatologic characteristic of these illnesses and plus being attended at for sterility clinical as a result of their incapacity to get pregnant.

[Trends of perinatal mortality at the National Institute of Perinatology]. / Tendencias de la mortalidad perinatal en el Instituto Nacional de Perinatología.

The purpose of this study is to address the yearly fetal, neonatal, crude death rates observed at the Instituto Nacional de Perinatología from 1987 through 1997, and the specific death rates for birth weight, gestation age, cause of death, avoidability, and structure and process failures as proxy to quality of medical care. Data come from death certificates following the WHO criteria which includes the maternal medical history, pregnancy follow up, birth attendance, newborn characteristics, autopsy findings, microbiological results, basic cause of death (of both maternal and fetal/neonatal origin), death avoidability, and structure and process issues. The death certificates were analyzed by the Perinatal Mortality Committee and registered into a computerized database. The fetal mortality rate during 1987 was 17.67 per 1000 births, whereas in 1997 it was 21.5 per 1000 births. There was an increasing tendency from 1987 to 1992, with the highest rate being 34.13 during 1992. After 1992 this rate shows a decreasing tendency. The neonatal mortality rate decreased from 42.82 in 1987 to 17.34 per 1000 live births in 1997. The highest rates were observed among the newborns with the lowest birth weights and at the youngest gestational ages. The most frequent cause of death of maternal origin, in both fetal and neonatal deaths, was premature rupture of membranes. As for the most frequent fetal cause of death was antepartum hypoxia, and among neonatal deaths prematurity and immaturity. The percentage of avoidable perinatal deaths has declined dramatically from 27% in 1987 to less than 10% in 1996. Perinatal mortality at the Instituto Nacional de Perinatología has decreased during the period under assessment, due to the reduction of the neonatal mortality rate. Improving the quality of medical care focusing mainly on process issues will help lowering avoidable mortality rates.

[Cholecystectomy during pregnancy]. / Colecistectomía durante el embarazo.

UNLABELLED: Cholecystectomy during pregnancy happens to be the second most common cause of laparotomy. The reported incidence of the procedure is I of every 1250 to 12,500 pregnancies. We have done a retrospective study from january 1989 to december 1994, at Instituto Nacional de Perinatología, having 35,080 deliveries registered, four of them with reported cholecystectomy during pregnancy. The average of maternal age resulted in 20.2 years, varying from 16 to 23 years. Three patients were multigravidas, and just one primigravida. Gestational age at the time of diagnosis and surgery was reported in 17 to 23.4 weeks. We found one twin pregnancy, and that two patients had history of chronic colecistitis. In the 100% of cases laparotomy and cholecystectomy was done, with preterm labor as the most frequent complication. There were 3 fetal loss in study and only 2 pregnancies were delivered at term. DISCUSSION: In this review the estimated frequency of cholecystectomy was 1 of 8780 deliveries, being the second cause of quirurgical treatment during pregnancy, after appendicectomy. There were reported 50% fetal deaths, and no severe maternal complications.

[Appendicitis during pregnancy]. / Apendicitis durante el embarazo.

Acute appendicitis es the most common cause of lapparotomy during pregnancy. The differential diagnosis in the pregnant woman becomes a challenge due to the anatomic changes that take place during the maternal adjustment to pregnancy. We have done a retrospective study between january 1989 and december 1994, at Instituto Nacional de Perinatologia. We found in that period of time 35,080 deliveries reported and 4 cases of acute appendicitis during pregnancy. The maternal age was between 16 and 42 years old, 26 years in average. Three patients were in the 3 trimester at the time of diagnosis, and the most important clinical sign was found to be diffuse abdominal pain. In 3 cases diagnosis was attributed to obstetric pathology rather than appendicitis in first place. Laparotomy and appendicectomy was done to all patients, with on block hysterectomy in only one case, having this particular patient an abscess as a postquirurgical complication. Just one case reported a healthy newborn delivered at term. It is obvious that early diagnosis and quirurgical treatment are important factors for the mother and the fetus prognosis. Appendicectomy as well as cholecystectomy are the two most common causes of laparotomy during pregnancy.

[En block hysterectomy. Institutional experience of 6 years]. / Histerectomía en bloque. Experiencia institucional de seis años.

On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.

[Usefulness of fresh wet mount examination in the diagnosis of vaginal candidiasis]. / Utilidad del examen en fresco para el diagnóstico de candidiasis vaginal.

A prospective study was done at the Clinic for Sexually Transmitted Diseases of the Department of Infectology, Instituto Nacional de Perinatología, Mexico City, in order to validate the fresh wet mount examination as a confirmatory test for vaginal candidiasis. Ninety six patients with cervico-vaginal infection were included, 22 of them had clinical candidiasis (22.9%). The fresh wet mount examination showed the presence of yeast and/or pseudomycelium in all 2 samples (100%). The presence of Candida in the cultures was confirmed in 18 of the 22 specimens (81.8). Negative in 71/96 (73.9%) (Three cultures were not processed). The fresh wet mount examination had a sensitivity of 100% and a specificity of 94.8%. The positive predictive value was 88.8% while the negative predictive value was 100%. It can be concluded that the fresh wet mount examination is very recommendable, useful, economic and easy to practice at the physician's office for the confirmation of vaginal candidiasis.

[Utility of the Papanicolaou smear in the diagnosis of bacterial vaginosis]. / Utilidad del frotis de Papanicolaou en el diagnóstico de vaginosis bacteriana.

In 200 studied patients there was a sensitivity of 49% and specificity of 100%; bacterial vaginosis incidence was 17.7%; the probability of false negatives was 73%. So, Papanicolaou's smear is not an adequate method for bacterial vaginosis diagnosis, but the negative result, excludes the possibility of disease.

Validacion clinica de las pruebas cardiotocograficas anteparto. / Clinical value of cardiotocographic antepartum tests

Se hace una revision historica referente a la inquietud que en la practica de la obstetricia se ha tenido para conocer el estado del feto, especialmente en los embarazos de riesgo elevado, hasta llegar al estado actual de conocimientos y recursos tecnologicos. Se analiza la experiencia de los autores con 200 registros de pruebas sin stress y de tolerancia a la ocitocina con objeto de determinar tanto su sensibilidad y especificidad, como su excludibilidad y diagnosticabilidad, concluyendose lo siguiente: la especificidad mayor que la sensibilidad en ambas pruebas, las cuales se ven influenciadas por la prevalencia de la enfermedad que se estudie. La prueba de tolerancia a la ocitocina en la que se emplean todos los elementos de juicio tiene mayor diagnosticabilidad que la prueba sin stress y en lo que se refiere a la excludibilidad practicamente no existe diferencia entre las dos pruebas