[Uterine prolapse and pregnancy. A case report]. / Prolapso uterino y embarazo. Reporte de un caso.

Uterine prolapse associated with pregnancy is rare today. The case of a 34-year-old woman whose pregnancy ended at 39 weeks and analyzed with those reported in the literature is presented.

[Prevalence of osteopenia and osteoporosis in postmenopausal women and its relation to risk factors]. / Prevalencia de osteopenia y osteoporosis en mujeres posmenopáusicas y su relación con factores de riesgo.

BACKGROUND: Degenerative diseases are becoming more frequent in adults due to the increase in the average life, among them osteoporosis is with one prevalence higher in women mainly due to the lack of estrogen after menopause. OBJECTIVE: Estimate the prevalence of osteoporosis and osteopenia by effectuate a bone densitometry in postmenopausal women and analyze the possible relationship with some recognized risk factors. MATERIAL AND METHODS: Cross-sectional study with 389 patients analyzing the following variables: age; index of body mass and time of treatment with hormone replacement therapy, crossing the information with the result of bone densitometry. RESULTS: A prevalence rate similar to that reported in our country was obtained. We found that patients with overweight have one higher percentage of osteopenia and osteoporosis than normal weight, which is contrary to what was reported in literature. Also contrary to expectations, untreated patients occupy a higher percentage without bone disorders, while in the leading hormone therapy the lesser percentage was for those whit osteoporosis. We found no differences in terms of age. CONCLUSIONS: Early diagnosis provides an excellent opportunity to address these problems but we must not forget that the best treatment is prevention from an early age.

[Metabolic disorders in women during climacterium]. / Trastornos metabólicos de mujeres en el climaterio.

BACKGROUND: As part of preventive medicine climacteric and menopause clinics should identify the chronic-degenerative diseases that accompany this stage of women and which are increasing as the age increases. OBJECTIVE: To dentify following chronic degenerative diseases that occur during climacteric: diabetes, hypertension, obesity and dyslipidemia. MATERIAL AND METHODS: A descriptive and transversal study was performed with 688 patients in the clinic of the climacteric and menopause, 98 were removed for failing to comply with all the requirements that included: determining serum glucose and lipids, weight, height, diameter of waist and hip. Controls were done every three to four months forming two groups: menopause and perimenopause. RESULTS: The average age of menopause was 47.5 years, in which predominated the chronic degenerative diseases, highlighting the overweight and obesity (66%), dyslipidemia (59%), hypertension (22%) and diabetes (19%). CONCLUSION: The gynecologist must be attentive to identify early risk factors for chronic degenerative diseases from the reproductive stage.

[Cesarean birth: justifying indication or justified concern?]. / Operación cesárea: Indicación justificante o preocupación justificada?

BACKGROUND: Caesarean section is the most common surgery performed in all hospitals of second level of care in the health sector and more frequently in private hospitals in Mexico. OBJECTIVE: To determine the behavior that caesarean section in different hospitals in the health sector in the city of Aguascalientes and analyze the indications during the same period. MATERIAL AND METHOD: A descriptive and cross in the top four secondary hospitals in the health sector of the state of Aguascalientes, which together account for 81% of obstetric care in the state, from 1 September to 31 October 2008. Were analyzed: indication of cesarean section and their classification, previous pregnancies, marital status, gestational age, weight and minute Apgar newborn and given birth control during the event. RESULTS: were recorded during the study period, 2.964 pregnancies after 29 weeks, of whom 1.195 were resolved by Caesarean section with an overall rate of 40.3%. We found 45 different indications, which undoubtedly reflect the great diversity of views on the institutional medical staff to schedule a cesarean section. CONCLUSIONS: Although each institution has different resources and a population with different characteristics, treatment protocols should be developed by staff of each hospital to have the test as a cornerstone of labor, also request a second opinion before a caesarean section, all try to reduce the frequency of cesarean section.

[Giant ovarian cyst and pregnancy. Case report and literature review]. / Quiste gigante de ovario y embarazo. Reporte de un caso y revisión de la bibliografía.

Ovarian tumors represent approximately 30% of genital tumors, being the most frequent the germ and the epithelial tumors. During pregnancy the incidence of ovarian cysts is less than 5%, and they are almost always benign. Giant cysts have a frequency of less than 1%. A giant cyst in a primigravida 20 years, 15 weeks pregnant and the evolution of the same case is reported.

[Rating the quality of care offered to women who underwent hysterectomy]. / Valoración de la calidad de la atención ofrecida a mujeres a quienes se realizó histerectomía.

BACKGROUND: In recent years emerged as a primary need, the evaluation of the services offered to get better quality in them. Health systems are subject to these assessments. OBJECTIVE: To assess the quality of care provided to patients who underwent hysterectomy, since the reference of the family physician, until discharge by the gynecologist. We analyzed the diagnostic results in the short and long-term, patient satisfaction and gynecologist satisfaction, regarding the conditions for offering services. PATIENTS AND METHOD: Retrospective study including 118 patients who underwent hysterectomy and were analyzed the following aspects: history, diagnoses and outcomes. Cross-sectional surveys were also conducted to obtain the satisfaction of patients and the physicians who performed the surgeries. RESULTS: The satisfaction of patients was confirmed, in contrast to the opinion of gynecologists who expressed dissatisfaction with the resources they have. There was discrepancy between diagnosis, planned surgery and the procedure performed, however, the clinical results were adequate. CONCLUSIONS: At present, any institution should periodically evaluate the services it provides to implement measures and procedures commensurate with their population and resources and invite users to participate in internal decision making and provide the opportunity to become an evaluator to generate a culture of self-improvement and continuous improvement in all involved.

[Pregnancy and labor activity: is there really risk?]. / Embarazo y actividad laboral: realmente existe riesgo?

BACKGROUND: In the last decades the participation of women in the family economy has increased causing in theory a higher risk for reproduction. OBJECTIVE: To investigate whether labor negatively influences the course and culmination of pregnancy in women workers. PATIENTS AND METHOD: Descriptive and comparative cross-sectional survey made in the Hospital General de Zona núm. 2, of the Instituto Mexicano del Seguro Social, in Aguascalientes city (Mexico), which included 154 working patients and a control group of 154 not working patients selected by pairs. The study period was from 1 February to 31 March 2010. The following variables were analyzed: age, marital status, education degree, occupation, pregnancy number, queries, weight increase, obstetric complications, obstetric event, family planning method after the obstetric event; sex, weight and gestational age of the newborn, years of labor and weekly hours labored. RESULTS: There are significant differences in favor of working women according to the background; while in progress and resolution of pregnancy there is virtually no difference. CONCLUSION: Work does not imply an increased obstetric complication or neonatal morbidity risk.

[Demographic impact of cesarean section]. / Repercusión demográfica de la operación cesárea.

BACKGROUND: in the vital statistics the cesarean section is a cause that makes reference to births and deaths. OBJECTIVE: to analyze the frequency of the cesarean section, the changes brought about in the rates of maternal, perinatal mortality and of natality, and their relation with reliable contraceptive methods. PATIENTS AND METHOD: retrospective study realized with the dices of patients of the Coordination of Reproductive Health of the Mexican Institute of the Social Insurance (IMSS) of the state of Aguascalientes (Mexico). The births were registered majors of 20 weeks of gestation, the maternal and perinatal deaths from 1990 to 2007 in the hospitals of the IMSS in Aguascalientes. The rate of cesarean calculated by means of the registry of the number of the same realized per year and they were divided between the total of vaginal and abdominal births, and the result multiplied percent. RESULTS: 201,563 obstetrical events were registered, of which 145,106 corresponded to vaginal childbirths and 56,457 abdominal ones. With these data a global rate of cesarean section of 28% was obtained, with 201,182 new born alive ones and 2,618 perinatal ones. The acceptance of the tubary bilateral occlusion maintained a constant increase during the period of study, like the intrauterine device. The acceptance from the bilateral occlusion was completely different tubary during the cesarean one, in comparison with the childbirth. CONCLUSION: the long term results show positive influence in the reduction of the rate of natality.

[Sociodemographic characteristics of users of the contraceptive implant releasing etonogestrel]. / Características sociodemográficas de las usuarias del implante anticonceptivo liberador de etonogestrel.

BACKGROUND: The search for options for contraception has always led to the development of increasingly effective methods and safe and, above all, varied for those with any contraindication to always find a viable alternative. OBJECTIVE: To know the sociodemography characteristics the users of implants liberating contraceptive of etonogestrel and the effects in the 24 following months to its application. MATERIAL AND METHODS: A cross-sectional descriptive study was made in 207 users of implants liberating of etonogestrel during 24 months in the Aguascalientes Delegation of IMSS through a structured questionnaire. The Statistic Program v 7 for the capture, data processing and analysis of were used. RESULTS: The group of more frequent age was of 25-29 years; the majority had at least secondary, lived in the urban middle, were married and catholic; 48.6% were dedicated to the home; 1.2% of the pairs did not work; 82.6% had a weekly sex at least; 84.3% had 1 to 2 children; 66.3% wished more children; 95.9% of the pairs approved the method; 29:6% referred a not planned previous pregnancy ; 72.1% used some contraceptive method previously; 36.6% referred bad experience with the previous method; 41.9% requested implants by comfort; 90:1% received information of the method but only 73.8% knew the indirect effect; 86.6% would recommend it; 11.6% left the method by undesirable effects of which the main one was the irregular bled one, whereas 33.1% did not present/display any indirect effect and no patient became pregnant during the time of study. CONCLUSIONS: It subdermal implant is a contraceptive alternative adapted by its effectiveness, its tolerance and the high rate of continuity, finding like basic characteristics of the users: young woman, with acceptable educative and economic level, low parity and desires of future fertility.

[Influence of Caesarean section on familial planning]. / Influencia de la operación cesárea en la planificación familiar.

The Caesarean section is commonly related to the effects it produces in maternal and perinatal morbidity and mortality; however, little has been studied about the influence that C-Section exerts in familiar planning. This cross-sectional study analyzes the relationship between the rate of Caesarean section during 19 years and the rates of natality, of maternal mortality, and perinatal mortality, as well as the accepted contraceptive methods during such surgical procedure.

[Socio-demographic impact of 15 years of family planning]. / Impacto sociodemográfico de 15 años de planificación familiar.

Familiar planning is an important branch of the preventive medicine that can have a great impact on the health of the humanity. The present study is an evaluation by a cross section of the effects obtained by the program of familiar planning during a period of 15 years in the Aguascalientes Delegation of the Mexican Institute of the Social Security, establishing therefore a diagnosis and identifying elements that can contribute in the suitable planning of strategies to improve the quality of the attention and to respond to social and health necessities of the population.

[Non-puerperal uterine inversion. Report of a case]. / Inversión uterina no puerperal. Comunicación de un caso.

Non-puerperal uterine inversion is extremely rare. We report a case associated with leiomyoma. It is presented the case of a multiparous of 46 year-old for presenting severe vaginal bleeding, pelvic pain and strange body vaginal sensation. The diagnosis was uterine myoma in abortive phase. An abdominal hysterectomy was performed to find a complete uterine inversion. This report represents an anecdotal case of non-puerperal uterine inversion successfully treated surgically.

[Maternal mortality. A challenge of the new millennium]. / Mortalidad materna. Un reto del nuevo milenio.

Maternal mortality is a principal concern of the contemporary society because of consequence to generate since the most cases to be about young woman and healthy, whose death be able to avoid. This study analyzed the cases registered in Aguascalientes delegation of IMSS during ten years with purpose to find strategy for to salve. The case fatality rate was average of 26.1 x 100,000 alive births. The principal causes was the obstetric hemorrhages; preeclampsia and lung thrombosis. The greater percentage was in woman aged between 25-39 years and multiparous. Most of 50% doing appropriate prenatal control. A greater percentage was pregnancy of term with 77.4 a live births and 59% performed cesarean sections. 93% was through the puerperium. Only 20% was to classify as treatment inappropriate and inopportune and 74% was maternal mortality foreseeable. Some type responsibility existed in 38.7%.

Valor real del ultrasonido en ginecología / Actual value of ultrasound in ginecology

Con el fin de determinar la certeza diagnóstica en la patología ginecológica mas frecuente susceptible de tratamiento quirúrgico en forma programada o urgente se analizaron 104 casos durante un período de nueve meses, en los cuales se realizó de manera independiente un diagnóstico clínico, ultrasonográfico y quirúrgico, para finalmente compararlos con el diagnóstico histopatológico, obteniendo la sensibilidad, especificidad y valores predictivos para cada uno de los procedimientos y en cada una de las patologías mas frecuentes

Impacto económico de las infecciones nosocomiales / Economical impact of nosocomial infections

Se llevó a cabo un estudio retrospectivo, analítico y descriptivo, de los casos de infección nosocomial del Hospital General de Zona 1, del IMSS, en la ciudad de Aguascalientes, Ags. Durante los últimos cinco años y teniendo como objetivos: encontrar la incidencia, casos más frecuentes, tratamientos y costos de atención, tanto en el Hospital General, como en el servicio de Ginecología y Obstetricia. También se realizó un cálculo de gastos para el año de 1995 con base en los resultados obtenidos, mostrando el gran impacto económico, social y laboral, al que conducen estas complicaciones.