[Transabdominal cerclage in the management of cervical incompetence]. / Cerclaje transabdominal en el manejo de la incompetencia cervical.

The Transabdominal Cerclage in the Cervical Incompetence. The purpose of this study was to assess the transabdominal cerclage indications at the Instituto Nacional de Perinatología. A retrospective study was carried on in order to evaluate fetal outcome in all patients with transabdominal cerclages. Since 1997 seven transabdominal cerclages were performed. The primary indication was unsuccessful previous vaginal cerclage. All seven patients delivered at term. The rate of live births before the procedure was 5.2% compared to 85.8% after the transabdominal cerclage. There was one still birth a the gestational of 37.2 in a woman with preeclampsia. Five newborns were small for gestational age. In our study the transabdominal cerclage, under strict indications, offers a high fetal survival rate with a minimum of complications in patients with a poor obstetric history due to cervical incompetence and unsuccessful vaginal cerclage.

[Tumor necrosis factor-alpha and interleukin-1 beta in maternal, fetal and retroplacental intravascular compartments at term and preterm labor]. / Factor de necrosis tumoral-alpha e interleucina-1 beta en los compartimentos intravascular materno, fetal y retroplacentario en parto a término y pretérmino.

Neonato preterm birth (before 37 pregnancy weeks) account more than 80% perinatal deaths not attributable to congenital malformations. Preterm and term labor full mechanisms are unknown at present. Proinflammatory cytokinesis direct participation have been involved in the phenomena by several experimental evidence. The study's aim was to determine TNF-alpha and IL-1 beta concentration at maternal, fetal and fetal-maternal vascular compartments in women with term and preterm delivery and in women at term childbirth without labor. TNF-alpha and IL-1 beta concentration were determinated by commercial immunoassay. TNF-alpha concentration showed a tendency to be in more proportion at fetal and fetal-maternal compartments in preterm and term childbirth groups versus TNF-alpha concentration in term group without labor at same places. IL-1 beta concentration showed same tendency of increase than TNF-alpha in preterm and term childbirth groups, but alone at fetal-maternal compartment. Statistical difference were not documented at any compartment or group compared. Data allow to identify fetal-maternal compartments as target places where TNF-alpha and IL-1 beta were synthesized. Gradient concentration synthesis of cytokinesis allows to intend fetus as TNF-alpha initial producer.

[Cesarean section: science or anxiety? Eleven years of institutional experience]. / Operación cesárea: ciencia o ansiedad? Once años de experiencia institucional.

The increasing rise of cesarean section rate invites to analyze its indications. The present study was done from 1985 to 1995, which means 11 years of study with 38,407 cases. Frequency and clinical indications were analyzed. As to births, frequency was 40.6%. Main causes were: Iterative section 38.2%; cephalopelvic disproportion 28.1%; pelvic presentation, 23.4%; hypertensive disease in pregnancy 16.3%; and acute fetal suffering, 10.9%. The careful observation of indications in every institution, may produce better reasons for reducing such high indexes.

[Incidence of pelvic-genital static disorders in patients with urinary incontinence]. / Frecuencia de trastornos de estática pelvigenital en pacientes con incontinencia urinaria.

Urogenital prolapse in patients with urinary incontinence, was studied. Retrospective and analytic study was made in the Clínica de Urología Ginecológica del Instituto Nacional de Perinatología, 121 patients with urinary incontinence were included, urogenital prolapse was evaluated (urethrocele I, II, III. cistocele I, II, III). 117 patients had urogenital prolapse (96.6%), 53 had cistocele I, 46 cistocele II, 11 cistocele III. 19 patients had urethrocele 1, 54 urethrocele II, 35 urethrocele III and 13 no urethrocele. According with the type of urinary incontinence, 72 patients had urinary stress incontinence, 41 mixed urinary incontinence, 8 with urge incontinence. Patients with urinary stress incontinence show greater frequency of cistocele I, urethrocele II. 13 patients had low urethal close pressure.

[HELLP syndrome. 7-year experience at the National Institute of Perinatology]. / Síndrome Hellp. Siete años de experiencia en el Instituto Nacional de Perinatología.

We studied 36 patients with Hellp syndrome and her newborn during seven years in the National Institute of Perinatology (INPer). The objective of this study is show the epidemiology and clinic features, unite diagnostic criteria and classification, furthermore establish morbidity and mortality maternal and perinatal. The 44.6% (16/36) was type I, and 55.6% (20) was type II. The average of pregnancies was 3. The 38.9% (14/36) received regular prenatal control. Both types were more common in patients with preterm pregnancies, between 28-36 weeks. The patients with severe preeclampsia and eclampsia were more common. The cases with type I had more complications and stayed on hospital more time. The maternal mortality was 5.55%. Perinatal outcomes were unsatisfactory, with high incidence of asphyxiated newborn. The newborn of patients with type I had more severe complications and stayed more time on the hospital. The perinatal mortality was 32.43%.

Neurobehavioral deficits after low level lead exposure in neonates: the Mexico City pilot study.

Gestation age and ability of the baby to self-quiet and to be consoled during the first 30 days of life decrease when mother's blood lead levels rise from 36 weeks of pregnancy to birth of child. These effects appear to be independent of the absolute lead levels of mother and child (N = 42). Since pre- and perinatal stress predicts higher maternal birth lead, further work could determine the relative contributions of undetected stress during pregnancy and elevated lead levels upon subsequent development. Several cases, not included in the statistical analyses, showed associations between cord leads greatly elevated over maternal leads and poor outcome.