[Chronic high blood pressure in 110 pregnant women]. / Hipertensión arterial crónica en 110 mujeres embarazadas.

BACKGROUND: Hypertension is associated with increased maternal and fetal mortality and morbidity. While there is consensus that severe hypertension should be treated, antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial. OBJECTIVE: To evaluate clinical course, and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease, under strict control of maternal hypertension (target dBP of 85-89 mmHg). PATIENTS AND METHODS: We conducted a prospective cohort study of 110 pregnant women with mild chronic hypertension without other disease; clinical course was classified in three groups: stable condition, exacerbation of hypertension and superimposed preeclampsia. We compare maternal and perinatal outcomes; statistical comparisons were performed by ANOVA test. Relative risk (RR) was calculated for adverse perinatal outcomes. RESULTS: Atotal of 110 women were included, mean maternal age was 33 +/- 5.8 years. There were 78 (71%) women with stable condition, 26 (24%) with exacerbation of hypertension and 6 (5%) with superimposed preeclampsia (PE). Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age (SGA) babies than women with stable condition and exacerbation. Delivery route was vaginal in 45 patients (40%) while 65 patients (60%) underwent cesarean section in order to avoid fetal distress. CONCLUSIONS: Results demonstrated that fetuses in the stable condition group (strict control) did not have worst outcomes than those in the other groups. This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy.

[Pulmonary thromboembolism in obstetrics]. / Tromboembolia pulmonar en obstetricia.

BACKGROUND: Pulmonary embolism is a serious and sometimes mortal complication of pregnant and puerperal women. Pulmonary embolism diagnosis can be difficult. In Mexico, it causes between 2.5 and 16% of maternal mortality. OBJECTIVES: To estimate the incidence of pulmonary embolism, to identify most frequently risk factors that contribute to the presence of pulmonary embolism as an obstetrical complication and to determine clinical characteristics and specific diagnostic tests in hospitalized patients at the Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social. MATERIAL AND METHODS: We conducted a cross-sectional study from January 1st 1997 to December 31st, 2002. We identified 30 patients with pulmonary embolism confirmed by ventilation-perfusion scan. RESULTS: Incidence of 4.7 cases per 10,000 pregnancies was found. Most frequently, risk factors were varicose veins in lower extremities (0.045), previous thromboembolic event (0.030) and pre-eclampsia/eclampsia (0.05). Cesarean section was present in 85% of the cases with pulmonary embolism during puerperium. The most common clinical findings were: dyspnea (100%), chest pain (63%), tachycardia (93%) and tachypnea (93%). Sinus tachycardia (93%) and S1 Q3 T3 were the electrocardiogram findings most commonly observed. 83% of the patients showed abnormalities in chest radiography. 100% presented altered blood values. Mortality rate was of 6.6%. CONCLUSION: Diagnosis of pulmonary embolism should be based on risk factors and clinical findings. Basic laboratory and scan are essential. Early diagnosis and treatment significantly reduce mortality rates.

[Medically indicated preterm birth. Maternal and fetal consequences]. / Nacimiento pretérmino por indicación médica. Consecuencias maternas y fetales.

One of the principal challenges of obstetrics is to reduce the percentage of perinatal mortality. Preterm birth is considered the main cause of neonatal morbidity and mortality. Preterm birth by medical indication, is a condition rarely documented in medical literature, but it requires analysis to determine the effect in perinatal health. In a third care hospital setting, a prospective study was performed on 154 pregnant women that delivered preterm babies between 25 and 36 weeks of gestation. The Relative Risk (RR) was obtained to compare the association between the medical indication of the preterm birth, the use of fetal pulmonary maturants, type of delivery, the health status of the newborn at birth and hospital discharge. The main causes of preterm birth by medical indication were: premature rupture of membranes, preeclampsia, intrauterine growth retardation and fetal distress. Neonatal mortality was 13%. The rate of cesarean section was higher than expected. Despite the various types of delivery, there were no significant differences between mortality, length of hospital stay or hospital complications. The probability of death to preterm born was explained to gestational age and was not modified for medical decision to interrupt pregnancy.

Mortalidad materna en el Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Revisión de 5 años / Maternal mortality at Hospital de Ginecobstetricia, Centro Médico de Occidente IMSS. Five years review

El objetivo del presente trabajo fue conocer la mortalidad y aspectos relacionados, en el Hospital de Ginecobstetricia del Centro Médico de Occidente IMSS y hacer un análisis de la problemática y proponer alternativas de solución. Se revisaron los expedientes e informes del Comité de Mortalidad Materna de 74 muertes ocurridas en un lapso de cinco años. Se emplearon las definiciones y criterios de clasificación propuestos por la Federación Internacional de Ginecología y Obstetricia. La tasa de muerte materna promedio fue de 8.01 X 10,000 nacidos vivos. Las principales causas de muerte fueron hemorragia, hipertensión arterial, probable tromboembolia pulmonar y sepsis. 82.4%fueron muertes directas, 66.2%fueron previsibles, y al ingreso al hospital, 39.1%. La responsabilidad profesional existió en 66.2%y la hospitalaria en 25.6%. Se hace el análisis de éstos y otros datos y se plantean posibles estrategias para disminuir la mortalidad materna.

Alteraciones de coagulación en la paciente eclámptica / Coagulation alterations in the eclamptic patient

La toxemia del embarazo puede cursar con alteraciones hematolpógicas graves que pueden poner en peligro la vida de la madre y del producto. El objetivo del presente estudio fue describir las alteraciones de la coagulación en la paciente con eclampsia y señalar su relación con la presencia de sangrados anormales y eventos trombóticos; para ello se efectuó un estudio retrospectivo, en un lapso de cuatro años, en 46 de 70 pacientes eclámpticas que reunieron los criterios de inclusión, determinándose cuantificación de plaquetas, tiempo de protombina, tiempo de trombina, tiempo de tromboplastina parcial, fibrinógeno y productos de degradación de fibrina en algunos casos, así como presencia de sangrados anormales y eventos trombóticos. Se encontró que más de 50% de las pacientes eclámpticas cursaron con alteraciones en las plaquetas, tiempos de coagulación practicados y fibrinógeno. La trombociopenia moderada y la elevación de los productos de degradación de fibrina fueron en forma aislada de dos únicos factores que se correlacionaron significativamente con la presencia de sangrados anormales; así mismo, existió hemorragia en forma significativa cuando se presentaron en la paciente eclámptica cuatro o más alteraciones de la hemostasia contriuyentes de ella. No existió correlación significativa entre las plaquetas y pruebas de coagulación con la aparición de eventos trombóticos. La edad, número de embarazos y edad gestacional no guardaron relación con la presencia de sangrados o trombosis. La detección temprana de las alteraciones de la hemostasia señaladas deberían servir como alarma para el inicio e un tratamiento oportuno y prevención e sangrados anormales.