[Active management of the premature membrane rupture in pregnancies of 34 to 37 weeks]. / Manejo activo de la rotura prematura de membranas en embarazos de 34 a 37 semanas.

BACKGROUND: Premature rupture of membranes is considered an obstetrical emergency since it has been associated with an increment of sepsis and maternal-fetal morbidity. For this reason, controversy exists among conservative and active management for the obstetrical resolution. OBJECTIVE: To determine if active management of premature rupture of membranes in pregnancy of 34 to 37 weeks diminishes the cesarean section incidence and the maternal-fetal morbidity. PATIENTS AND METHODS: Two groups of patients with pregnancy of 34 to 37 weeks and premature rupture of membranes were compared. Group I with active management was integrated by 42 cases that initiated inductoconduction at their admission to the hospital, and in group II, with 26 cases on the conservative management, medication was used to induce fetal pulmonary maturity and spontaneous delivery was expected. Descriptive statistics was carried out by means of the statistical package SPSS-10. RESULTS: The mean age of the patients was 27.2 +/- 5.8 years. Pregnancy resolution within the first 12 hours was 23.8% in group I and 11.5% in group II. Cesarean section in group I was made in 28.5% of the cases and in group II in 65.3% of them (p < 0.05). The most common indication for cesarean section in group I was stationary labor (16.5%) and in group II unfavorable cervical conditions (26.9%). Maternal and newborn hospital stay was greater in group II (p < 0.01). The most frequent maternal complication in both groups was decidual infection, with 4.7 and 15.3%, respectively. General maternal and neonatal morbidity was greater in group II. CONCLUSIONS: Conservative management of premature rupture of membranes, when pregnancy is equal or greater than 34 weeks, does not offer fetal benefits, increases the incidence of cesarean sections, the hospital stay and the cost of the medical attention.

[Therapeutic assessment of emergency cerclage. Analysis of a cases series]. / Evaluación terapéutica del cerclaje de urgencia. Análisis de una serie de casos.

BACKGROUND: Cervical incompetence is the incapacity of cervix to retain a pregnancy until term or until feasibility of the fetus. Patients present cervical enlargement without pain or contractions, vaginal strange sensation and membranes protrusion through most minimum degrees of enlargement. The cervical incompetence management can be rest in bed or cerclage. The emergency cerclage is carried out in patients with enlargement > or = 2cm with or without membranes prolapsus. OBJECTIVE: To evaluate the maternal and neonatal results of emergency cerclage with Espinosa-Flores modified technique in pregnancy from 13 to 28 weeks. PATIENTS AND METHODS: This series of cases was carried out as observational and prospective study, all patients with emergency cerclage and pregnancy from 13 to 28 weeks with cervical incompetence were included, during period of January 2000 to December 2003, in Gynecology and Obstetric Hospital from Medical Center La Raza, IMSS. Variables of study were gestational age at moment of cerclage, pregnancy prolongation, and maternal and neonatal complications. RESULTS: Ten patients were included, with age of 32.1 +/- 5.1 years. It was observed a mean prolongation of pregnancy 10 weeks after cerclage. The gestation was interrupted at 31.1 +/- 5.2 weeks. The most frequently complication was premature membranes rupture. Neonatal survival was 70%. CONCLUSIONS: The placement of emergency cerclage continuous being a therapeutic procedure to improve neonatal prognostic. The shortest prolongations of pregnancy were found in patients with greater enlargement (> or = 3cm) and who had membranes protrusion.

[Elaboration and validation of an index for preeclampsia diagnosis]. / Elaboración y validación de un indice para el diagnóstico de preeclampsia.

OBJECTIVE: To build a consistent and valid preeclampsia diagnosis index (IDP) for its Spanish acronyms. PATIENTS AND METHOD: The study was done in a Gyneco-Obstetrics Hospital and a Family Medicine Unit from March 2000 to February 2001. Fifty items were chosen from the literature, with a design to validate diagnostic tests, which were assessed by family doctors and gyneco-obstetricians in regard to their appearance and content validity. Concurrent criterion validity. Golden standard: Two gyneco-obstetricians diagnosed pre-eclampsia (hypertension and proteinuria). Simultaneously a family doctor (in an independent and blinded way) questioned, examined and recorded laboratory data of 219 preeclamptic patients and 251 non preeclamptic patients. RESULTS: Preeclampsia diagnosis index is an additive index with 21 clinical and paraclinical parameters weighted according to their individual diagnostic capacity. It has two parts: The first one with 82% (95%CI 80-84) sensitivity; 93% (95%CI 91-95) specificity; the second one with 86% (95%CI 83-89) sensitivity; 75% (95%CI 65-85) specificity. CONCLUSIONS: Preeclampsia diagnosis index is easily applied and has immediate results, which makes easier the physician's decisions.

[Usefulness of establishing diagnosis and severity of the most frequent signs and symptoms in preeclamptic patients]. / Utilidad para establecer diagnóstico y severidad de los síntomas y signos más frecuentes en la paciente preeclámptica.

OBJECTIVE: Our aim was to determine that signs and symptoms are tools in establishing diagnosis and severity of preeclampsia. MATERIALS AND METHODS: Our study design was prolective, comparative, cross-sectional for evaluation of diagnosis. Our sample included 408 patients. The study employed classification criteria of the American College of Obstetricians and Gynecologists. One blinded family physician interrogated and examined each patient. The sample included patients with recent diagnosis and without treatment. Patients with HELLP syndrome, eclampsia, and those in Intensive Care were excluded. Clinical signs evaluated included headache, Phosphenes, acuphenes, tinnitus, vomiting, epigastric pain, right hypochondrium pain, ecchymosis, hematomas,and hyperreactive reflexes. RESULTS: A total of 192 patients without preeclampsia, 63 with mild, and 153 with severe preeclampsia were included. Clinical manifestations were absent in 60, 21 and 8% respectively of patients in each group. Presence of three or more signs or symptoms had sensitivity of 60% (CI95% 53-67), specificity of 84% (CI95% 79-89), and positive likelihood ratio of 3.8 and negative, 0.48. Most usefulness data for diagnosis of preeclampsia are hyperreactive reflexes, phosphenes, acuphenes, right hypochondrium pain, and epigastric pain. CONCLUSIONS: The symptoms and signs taken alone are tools for evaluation of severity but not for detection of preeclampsia. There is necessary to develop new way for it's diagnosis during prenatal care.

[Clinical significance of the laboratory determinations in preeclamptic patients]. / Significado clínico de los resultados de laboratorio en las pacientes preeclámpticas.

OBJECTIVE: To determine the clinical significance and optimal cutting points of laboratory tests more frequently used in patients with pre-eclampsia of recent diagnosis. MATERIALS AND METHODS: We made an analytic cross-sectional study for evaluation of diagnostic test. Non probabilistic sampling. Sample size 400 patients. We used the American College of Obstetricians and Gynecologists criteria as gold standard. Laboratory personnel was blinded to the clinical classification of the patients. RESULTS: We studied 192 patients without pre-eclampsia, 63 with mild and 153 with severe pre-eclampsia. Hematocrits, prothrombin time, partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase and bilirubins did not show significative differences among groups. Platelets counting showed low sensitivity. Lactic dehydrogenase showed 71% sensitivity (65-85 CI95%), specificity 74% (68-80 CI95%) positive likelihood ratio 2.7 and negative 0.4. Uric acid showed sensitivity of 75% (69-81 CI95%) specificity 79% (73-85 CI95%) positive likelihood ratio of 3.5 and negative of 0.3. Seric creatinine with sensitivity of 81% (76-86 CI95%) specificity of 60% (53-67 CI95%) positive likelihood ratio of 2 and negative of 0.3. CONCLUSIONS: Seric uric acid, seric creatinine and lactic dehydrogenase are useful for diagnosis and severity classification of pre-eclampsia. Platelets counting is not useful for diagnosis but is useful for severity classification. In patients with thrombocytopenia prothrombin time is useful for severity classification.

[Is the high frequency of Caesarean sections in a highly specialized gyneco-obstetric hospital justifiable?]. / Se justifica la alta frecuencia de la cesárea en un Hospital Gineco-Obstétrico de alta especialidad?

OBJECTIVE: To determine if the high proportion of cesarean section performed at Obstetrics and Gynecology number 3 Hospital of the Medical Center "La Raza", IMSS (HGO3) is justified. MATERIAL AND METHODS: We carried out a cross sectional study of 300 patients who underwent cesarean section during a period of 35 consecutive days, from October to November 2001. We reviewed their clinical expedients and went to additional direct interrogatory. The studied variables were the number and indications of cesarean section; if they were programmed or urgent events and if the indication of surgery was related with perinatal outcome. RESULTS: We used descriptive statistics with frequencies and percentages in statistics program SPSS10. We found high incidence of prematurity (38.3%), pregestational and gestational maternal diseases (66%) and urgent indication of surgery (60.7%). CONCLUSION: The incidence of cesarean section in similar third level concentration hospitals in this country ranks from 20 to 40%. At HGO3 it was 72.51% in the last year (2001). This suggests that pregnancy comorbidity seen at this hospital, may be proportionally larger than in other similar units, because two thirds of patients had a high risk pregnancy and, if not, they had an obstetric or fetal justification for cesarean section in 80% of cases.