[Immediate response team. 59 cases with obstetric hemorrhage]. / Equipo de respuesta inmediata, análisis de 59 casos con hemorragia obstétrica.

BACKGROUND: The lack of diagnosis as well as an appropriate medical and/or surgical treatment, due to an inefficient work team, contributes to the mortality associated to obstetric hemorrhage. The aim of this article is to analyze 59 cases in which the immediate response team (ERI) was implemented in patient with obstetric hemorrhage. METHODS: Retrospective/prospective, observational, traverse and descriptive study in which 59 cases with obstetric hemorrhage and their attention by means of ERI. RESULTS: 59 patients with the diagnosis of obstetric hemorrhage were studied. The mean age of patients was 30.2 ± 6.8 years. The main reason that originated the obstetric hemorrhage, was abruption placenta followed by uterine atony. The place in which where the ERI was more frequently implemented was the expulsion room and in 93.2 % of the cases the doctor was who begin it. In 71.2 % it was not necessary to transfuse globular package. Only one surgery was carried out in 52.5 % of the cases and two in 28.8 %. The 90.1 % of women didn't pass to intensive care unit, 8.5 % went in, and 1.7 % was transferred. CONCLUSIONS: According to the results obtained in this study the application of ERI was in a correct, integrated and standardized way.

Introducción: la falta de diagnóstico como de tratamiento médico y/o quirúrgico adecuado debido a un equipo ineficiente de trabajo contribuye a la mortalidad asociada a hemorragia obstétrica. El objetivo fue analizar 59 casos en los que se implementó el equipo de respuesta inmediata (ERI) en pacientes con hemorragia obstétrica. Métodos: estudio retrospectivo/prospectivo, observacional, transversal. Se analizaron 59 casos con hemorragia obstétrica y su atención por medio del ERI. Resultados: se captaron 59 pacientes con diagnóstico de hemorragia obstétrica. La media de la edad de las pacientes fue 30.2 ± 6.8 años. El motivo principal que originó la hemorragia obstétrica fue el desprendimiento prematuro de placenta normoinserta seguido por la atonía uterina. El sitio donde más frecuentemente se implementó el ERI fue la sala de expulsión y en 93.2 % de los casos el médico fue quien inicio el ERI. En 71.2 % no fue necesario transfundir paquete globular. Se realizó una cirugía en el 52.5 % de los casos y dos en 28.8 %. El 90.1 % de las mujeres no pasaron a la unidad de cuidados intensivos, 8.5 % ingresó a UCIA y 1.7 % se trasladó. Conclusiones: De acuerdo a los resultados obtenidos en este estudio, la aplicación del ERI fue de forma correcta, integrada y uniforme.

[Atypical preeclampsia: case report]. / Preeclampsia atípica. Reporte de un caso.

BACKGROUND: Preeclampsia that occurs at < 20 weeks of gestation is rare and has been usually reported with molar or hydropic degeneration of the placenta and antiphospholipid syndrome. CASE REPORT: To describe the clinical presentation of atypical preeclampsia of a patient of 37 years old at her first gestation who developed this entity at 18.5 weeks of gestation. She had history of pre-existing hypertension and infertility. This pregnancy was obtained through in vitro fertility. She reported a severe headache and was admitted to our hospital secondary to elevated blood pressure of 160/110 mm Hg. The laboratory evaluation revealed platelet count 51,000, alanine aminotransferase of 331 UI/L, aspartate aminotransferase of 285 UI/L, lactate dehydrogenase 421 UI/L and urinalysis with +2 proteinuria, soluble fms-like tyrosine kinase-1/placental growth factor ratio 895.5. The diagnosis of chronic hypertension and superimposed preeclampsia and incomplete HELLP syndrome was supported. After termination of pregnancy, the patient improved rapidly. She was discharged home on postoperative day 7 with a blood pressure of 120/70 mm Hg with normal laboratory. CONCLUSIONS: Clinicians should consider the diagnosis of preeclampsia and HELLP syndrome before 20 weeks of gestation in women presenting with clinical or laboratory abnormalities consistent with this disease.

[Progression of gestational hypertension to preeclampsia]. / Evolución de hipertensión gestacional a preeclampsia.

BACKGROUND: 15 to 25% of patients with gestational hypertension progress to preeclampsia. OBJECTIVE: To determine the number of patients with gestational hypertension who developed preeclampsia. MATERIALS AND METHODS: Observational prospective comparative and longitudinal study realized between november 2010 to december 2012. We included pregnant patients diagnosed with mild gestational hypertension who were followed during pregnancy to observe the progression to preeclampsia. We compared the clinical features of each group among those who developed and not the disease. RESULTS: We included a total of 146 patients, of whom 36 (25%, IC 95% 17.7-31.7%) progress to preeclampsia. In this group 3 (8%) developed mild preeclampsia and 33 (92%) severe preeclampsia, of which 8 (24%) account HELLP syndrome. The remaining 110 patients (75%), did not develop preeclampsia. From 12 (8%) patients with gestational age < to 28 weeks, 7 (58%) developed preeclampsia, 46 (31%) patients between 28-33 weeks, 12 (26%) evolved into preeclampsia, 39 (27%) patients between 34-36 weeks, 11 (28%) progressed to preeclampsia and finally 49 (34%) with pregnancy > 37 weeks, 6 (12%) developed to preeclampsia. When comparing these groups we found that a lower gestational age was more frequent the progression to preeclampsia (p < 0.004). The onset of gestational hypertension before 28 weeks was significantly associated with the progression of preeclampsia (OR 5.1 IC 95% 1.5-17.2). The weight of infants and gestational age was lower in children of women who developed the disease in comparison that those who did not (p < 0.001). There were no significance differences between both groups in relation with body mass index, maternal age, parity and antecedent of preeclampsia. CONCLUSIONS: The progression of gestational hypertension into preeclampsia appreciated in one of each four patients. The progression of gestational hypertension in preeclampsia was more common in preterm pregnancy. Most of the patients developed the severe form of the disease.

[Eclampsia, obstetric hemorrhage and heart disease as a cause of maternal mortality in 15 years of analysis]. / Eclampsia, hemorragia obstétrica y cardiopatía como causa de mortalidad materna en 15 años de análisis.

BACKGROUND: It has been described that 70% of all maternal deaths are provoked by obstetrical hemorrhage, infections, abortions, hypertension and delivery dystocies. Poverty, social exclusion, low level education and violence are important causes of maternal mortality. OBJECTIVE: To establish the changes in the maternal mortality in a term of 15 years in a hospital of assistance obstetrical complicated. MATERIAL AND METHOD: A retrospective and descriptive study, in which the number and causes of obstetrical death was analyzed, occurred from 1991 to 2005. The comparison was done by five-year periods using descriptive statistics to analyze frequency of results. RESULTS: The number of maternal deaths was 105, 97 and 42 by each one of the three five-year periods, the mortality rate x 10,000 decreased from 28.7 to 16.4 in the last quinquennium and was found from 6.1 just including the last year. In the first and second quinquennia the eclampsia occupied the first place as cause of death, followed by the hemorrhage and the infections. In the third quinquennium the eclampsia also occupied the first place with a rate of 8.6, followed by the cardiopathy (2.3) and the infections (1.9), but the hemorrhage with a rate of 1.5 was displaced to the fourth place. CONCLUSIONS: The maternal mortality has diminished in a general way; the eclampsia has occupied the first place as cause of death from 1991 to 2005. The death by obstetrical hemorrhage has diminished in important form, possibly due to the specific groups of medical attention by modules, which has also helps the decrease of mortality by other causes. The increment of the deaths by cardiopathy should be considered as a possibility of risk, associate undoubtedly to the present style of life from our society.

[Usefulness of a clinical questionnaire for screening osteopenia and osteoporosis in post-menopausal women]. / Utilidad de un cuestionario clínico en la detección de osteopenia y osteoporosis en la posmenopausia.

BACKGROUND: The prevalence of osteoporosis in post-menopausal women (PMW) is 30 %, and bone densitometry (BD) is the gold standard. This is not recommended as a screening test because of its cost. Instead, the SCORE index (Simple Calculated Osteoporosis Risk Estimation) is proposed. The objective is to determine the sensitivity and specificity of this test in the population and the optimization of BD. METHODS: The SCORE Index is a pre-screening questionnaire; it was used in PMW to compare with BD, registering the total score of the questionnaire, densitometry diagnosis, the fracture risk and the site of osteoporosis. The sensitivity and specificity of SCORE Index and chi(2) of Mantel-Hanszel were calculated. RESULTS: We studied 201 patients, mean age 55.70 years. Osteoporosis was recognized in 22.8 %, osteopenia in 68.3 % and 8.9 % was normal. The sensitivity of the SCORE index was 87 % (95 % CI = 77-97) and specificity was 34.6 % (95 % CI = 27-42) with p = 0.000. A positive probability quotient of 1.33 (95 % CI = 1.1-1.7). CONCLUSIONS: Osteoporosis is a frequent disease in PMW. It is mandatory to have cheap and easy-tools which can detect osteoporosis cases.

[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.

[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.

[Sacropexy with abdominal fascia in treatment of vaginal prolapse vault of menopausal women]. / Sacropexia con fascia de recto abdominal en el tratamiento del prolapso de la cúpula vaginal.

INTRODUCTION: Vaginal vault prolapsed is a rare complication, with a frequency from 0.2 to 1% after hysterectomy, which is presented due to a bad surgical technique in fixation of the vault suspension elements, as well others factors as the multiparity, menopause, chronic lungs disease, obesity, smoking and weak physical activity. There are many techniques reported to correct this pelvic disease, although the conventional sacropexy has been established for abdominal way, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of muscle rectos. OBJECTIVE: This descriptive and clinical study was carried out in a group of patient with vaginal vault prolapsed, with the objective to know the results and experience of this correction with the surgical technique of sacropexy utilizing abdominal fascia. MATERIAL AND METHODS: 32 menopausal patient with mean age of 53.9 years, 5 gestations, as well as index of Quetelet of 26.2, were studied, a following of a year was carried out. In these women the main symptom were the sensation of vaginal strange body and subsequently urinary incontinence of effort. Moreover, considering to all group the mean in presentation of the vaginal vault prolapsed after hysterectomy was of 7.7 years, with surgical time of 129 minutes and bled of 172 milliliters. RESULTS. The 97.5% of the patient returned to its sexual life without difficulties and only one referred dyspareunia. Post-surgical complications were not presented and only a patient presented vault prolapsed again (0.31%). CONCLUSIONS: With this results we can consider that the sacropexy with abdominal fascia is a good technique for the correction of the vaginal vault prolapsed in healthy menopausal women with regular sexual activity and then is a natural material who cause not any.