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Introduction: Cardiovascular diseases represent an important cause of morbidity and mortality during pregnancy, cardiomyopathy is notable as a syndrome of heart failure. Objective: To characterize patients with peripartum cardiomyopathy according to clinical and epidemiological variables of interest for the investigation. Methods: A descriptive and cross-sectional study of 18 patients with diagnosis of peripartum cardiomyopathy was carried out. They were assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from October, 2015 to December, 2022. Results: In the series there was a prevalence of patients over 35 years (32.6 average age), besides African descendant (50.0 %), chronic hypertension (44.4 %) and multiparity (8.9 %) as risk factors and the left ventricle failure as clinical manifestation. The ejection fraction of this ventricle was regularly diminished and the pharmacological treatment response was satisfactory in all the sample. Conclusions: Peripartum cardiomyopathy is of low incidence in this center; however, due to its seriousness, the early diagnosis and the specialized staff intervention are necessary to avoid complications. [ABSTRACT FROM AUTHOR]

Introduction: Gingivitis and periodontitis prevail in pregnant women and they are associated among other factors, with the gestational age, reason why an association between the periodontal deterioration and premature childbirth is suggested, which constitute health problems worldwide. Objective: To identify the frequency and seriousness of chronic inflammatory periodontal disease in newly-delivered women with premature childbirth. Methods: A descriptive and cross-sectional study of 250 newly-delivered women with premature childbirth of alive newborn and unique gestations was carried out; they were assisted in the maternal hospitals of Santiago de Cuba province, from 2018 to 2022. The analyzed variables were prevalence, type, seriousness and extension of the periodontal disease, depth and bleeding in the survey, as well as loss of clinical insertion. For the analysis of quantitative variables the mean, standard deviation and variation coefficient were used as summary measures; for the qualitative ones, the percentage was used. Results: Periodontal disease was found in 54.0 % of the patients, with a prevalence of gingivitis (31.0 %), most frequent in its moderated and generalized forms, as well as periodontitis (23.0 %), with superiority in the light and localized ways. Conclusions: The high frequency of periodontal diseases with advanced forms in the newly-delivered women demonstrates the importance of its prevention and control during pregnancy, due to its possible repercussion in prematurity.

Introduction: Preterm birth and low birth weight constitute a health problem worldwide, since they represent an important predictor of development and postnatal growth, as well as an indicator of newborn morbidity and mortality. Objective: To characterize mothers with preterm and low weight infants according to clinical and epidemiological variables. Methods: A descriptive, cross-sectional study was carried out from January to December, 2022, of 35 mothers with preterm and low weight infants, belonging to the East Area Teaching Polyclinic in Camagüey city. Age, nutritional state, risk classification, prenatal control, preconcepcional reproductive risk, multidisciplinary visits, diseases characteristic of pregnancy, birth state, detected deficiencies and causes were among the analyzed variables. Results: In the series there was prevalence of the 35 and over age group (25.7%), obesity (37.1%), high risk mothers (45.7%) who received among 8-14 prenatal controls, and bad obstetric history (31.4%). On the other hand, 22.9% of the mothers had low weight children and 31.4% preterm children; as long as there were difficulties in follow up due to absences (57.1%). Conclusions: The mothers presented unfavorable clinical and epidemiological characteristics, such as the 35 and over years, obesity, high risk, bad obstetric history and vaginal infection as a disease characteristic of pregnancy, which influenced the infants to be preterm or low weight, or both. [ABSTRACT FROM AUTHOR]

The case report of a 20 years pregnant woman is presented, who went to the maternal block emergency room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to run-down, nausea and diffuse discomfort. During the physical exploration sweaty and cold skin, tachycardia and jaundice were found. Diverse complementary exams were carried out and a hepatic disorder was verified, as well as low figures of glycemia. Acute fatty liver of pregnancy was diagnosed. After several days hospitalized with an unfavorable clinical course until getting to the critical state, the patient died due to multiple organ dysfunction syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth and low birth weight constitute a health problem worldwide, since they represent an important predictor of development and postnatal growth, as well as an indicator of newborn morbidity and mortality. Objective: To characterize mothers with preterm and low weight infants according to clinical and epidemiological variables. Methods: A descriptive, cross-sectional study was carried out from January to December, 2022, of 35 mothers with preterm and low weight infants, belonging to the East Area Teaching Polyclinic in Camagüey city. Age, nutritional state, risk classification, prenatal control, preconcepcional reproductive risk, multidisciplinary visits, diseases characteristic of pregnancy, birth state, detected deficiencies and causes were among the analyzed variables. Results: In the series there was prevalence of the 35 and over age group (25.7%), obesity (37.1%), high risk mothers (45.7%) who received among 8-14 prenatal controls, and bad obstetric history (31.4%). On the other hand, 22.9% of the mothers had low weight children and 31.4% preterm children; as long as there were difficulties in follow up due to absences (57.1%). Conclusions: The mothers presented unfavorable clinical and epidemiological characteristics, such as the 35 and over years, obesity, high risk, bad obstetric history and vaginal infection as a disease characteristic of pregnancy, which influenced the infants to be preterm or low weight, or both.

The case report of a 20 years pregnant woman is presented, who went to the maternal block emergency room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to run-down, nausea and diffuse discomfort. During the physical exploration sweaty and cold skin, tachycardia and jaundice were found. Diverse complementary exams were carried out and a hepatic disorder was verified, as well as low figures of glycemia. Acute fatty liver of pregnancy was diagnosed. After several days hospitalized with an unfavorable clinical course until getting to the critical state, the patient died due to multiple organ dysfunction syndrome.

Solidarity gestation is an assisted human reproductive technique intended for different or same sex couples and to single people with some infertility problems which prevent them from conceiving in a natural way. In this respect, the Cuba's Family Code clarifies that this procedure should only be carried out due to altruistic reasons and human solidarity, without any fees. Taking into account the above considerations, the topic was analyzed from different points of view, aimed at socializing this practice as a reproduction opportunity for Cuban families. [ABSTRACT FROM AUTHOR]

Solidarity gestation is an assisted human reproductive technique intended for different or same sex couples and to single people with some infertility problems which prevent them from conceiving in a natural way. In this respect, the Cuba's Family Code clarifies that this procedure should only be carried out due to altruistic reasons and human solidarity, without any fees. Taking into account the above considerations, the topic was analyzed from different points of view, aimed at socializing this practice as a reproduction opportunity for Cuban families. [ABSTRACT FROM AUTHOR]

Solidarity gestation is an assisted human reproductive technique intended for different or same sex couples and to single people with some infertility problems which prevent them from conceiving in a natural way. In this respect, the Cuba's Family Code clarifies that this procedure should only be carried out due to altruistic reasons and human solidarity, without any fees. Taking into account the above considerations, the topic was analyzed from different points of view, aimed at socializing this practice as a reproduction opportunity for Cuban families.

Se describe el caso clínico de una grávida de 26 años de edad y tiempo gestacional de 34,4 semanas, quien fue remitida del Hospital General de Rusape al Hospital Central de Harare, ambos en Zimbabwe, por presentar una hernia umbilical, que la aquejaba desde la infancia. La paciente había padecido ese volumen herniario en 3 embarazos anteriores, cuyos partos fueron normales. Luego de efectuar los estudios pertinentes, que demostraron el diagnóstico, y evaluar el caso en equipo multidisciplinario, se decidió practicar cesárea de urgencia. Durante el procedimiento quirúrgico se halló que todo el útero se encontraba dentro del saco herniario cubierto por el epiplón; se extrajo al recién nacido, el cual poseía buena vitalidad, índice de Apgar de 9-10 y peso de 2590 gramos; posteriormente, se resecó el tejido herniario redundante. La paciente evolucionó favorablemente en el período posoperatorio inmediato y recibió el alta hospitalaria a los 5 días.

Introduction: The development reached by teratology as science and the clinical observations made by the scientists, allowed to establish their principles, represented by a series of factors that determine the capacity of an agent to cause congenital dysfunctions, which are at the moment of great utility and importance in the training of health professional and rebound in the Infantile Maternal Care Program. Objective: To describe the teratogen agents associated with the appearance of congenital defects. Methods: A literatura review was carried out about the teratogen agents and their possible teratogenic effects in the LILACS, SciELO, Clinicalkey databases and Academic Google, as well as in the platform Virtual Library in Health. Results: The consequences of the exhibition to the teratogen depend, among other things, of the moment in which is the gestation process. There are multiple teratogen agents and some risk factors that frequently concomitan with them, for what should be considered in the primary prevention to diminish alterations and congenital defects for these environmental noxas. Final considerations: The knowledge of the effects of the agents teratogen allows to value the possible damage to the fetus.

Introduction: The development reached by teratology as science and the clinical observations made by the scientists, allowed to establish their principles, represented by a series of factors that determine the capacity of an agent to cause congenital dysfunctions, which are at the moment of great utility and importance in the training of health professional and rebound in the Infantile Maternal Care Program. Objective: To describe the teratogen agents associated with the appearance of congenital defects. Methods: A literatura review was carried out about the teratogen agents and their possible teratogenic effects in the LILACS, SciELO, Clinicalkey databases and Academic Google, as well as in the platform Virtual Library in Health. Results: The consequences of the exhibition to the teratogen depend, among other things, of the moment in which is the gestation process. There are multiple teratogen agents and some risk factors that frequently concomitan with them, for what should be considered in the primary prevention to diminish alterations and congenital defects for these environmental noxas. Final considerations: The knowledge of the effects of the agents teratogen allows to value the possible damage to the fetus. [ABSTRACT FROM AUTHOR]

The case report of a 26 years pregnant woman and gestacional age of 34.4 weeks is described, who was referred from General Hospital of Rusape to Harare Central Hospital, both in Zimbabwe, due to an umbilical hernia that afflicted her since the childhood. The patient had suffered from that hernial volume in 3 previous pregnancies whose childbirths were normal. After the pertinent studies that demonstrated the diagnosis, and evaluate the case in multidisciplinary team, it was decided to practice an emergency Cesarean section. During the surgical procedure it was found that the whole uterus was inside the hernial sack covered by omentum; the new born was extracted, who possessed good vitality, Apgar index 9-10 and 2590 grams weight; later on, the redundant hernial tissue was dried up. The patient had a favorable clinical course in the immediate postoperative period and she was discharged 5 days after. [ABSTRACT FROM AUTHOR]

Se presenta el caso clínico de una paciente de 27 años de edad con 17,2 semanas de embarazo, quien se encontraba en seguimiento por consulta de Ginecología del Hospital Provincial Ginecoobstétrico Mariana Grajales Coello de Santiago de Cuba por presentar un mioma uterino sintomático con cuadro doloroso abdominal agudo debido a una necrobiosis, lo cual obligó a la resolución quirúrgica urgente. La gestante evolucionó satisfactoriamente y a las 39 semanas se le realizó cesárea, sin complicaciones materno-fetales.

La enfermedad conocida como COVID-19 es causada por el virus SARS-CoV-2 y constituye una emergencia de la salud pública a escala global. Desde el informe sobre el primer caso en diciembre de 2019, en Whuan, provincia china de Hubei, la enfermedad se ha expandido rápidamente por el mundo y fue calificada como pandemia en marzo del presente año. El embarazo es un estado fisiológico que predispone a las mujeres a la infección viral. Más allá del impacto de la infección por la COVID-19 en una embarazada, existen preocupaciones relacionadas con el posible efecto sobre el resultado fetal y neonatal; por tanto, las gestantes constituyen un grupo que requiere atención especial en cuanto a prevención, diagnóstico y atención. En este trabajo se abordan aspectos relacionados con la infección por la COVID-19 y el embarazo.

Introducción: La educación sexual debe promover actitudes positivas hacia una sexualidad responsable y contribuir a adoptar una postura activa para prevenir riesgos en las personas que inician su vida sexual. Objetivo: Caracterizar las adolescentes con interrupciones de embarazo según variables seleccionadas. Método: Se realizó un estudio observacional, descriptivo y transversal de 16 356 adolescentes, a quienes se les interrumpió el embarazo, pertenecientes a la provincia de Santiago de Cuba, durante el quinquenio 2012-2016. Se analizaron las siguientes variables: edad, total de adolescentes a quienes se les interrumpió el embarazo según métodos y procederes, así como tipo de interrupción. Resultados: Del total de interrupciones de embarazos, 25,3 % correspondió a adolescentes. Predominó el grupo etario de 15-19 años. Estas adolescentes decidieron no continuar el embarazo en edad gestacional avanzada (8-12 semanas). Entre los 2 métodos utilizados tuvo mayor frecuencia la práctica del aborto, lo cual continúa siendo un problema de salud en este segmento poblacional. Conclusiones: Las adolescentes mostraron un porcentaje significativo del total de interrupciones del embarazo entre las mujeres que se encontraban edad fértil, con un predominio del grupo de 15 -19 años de edad; el método más utilizado fue el aborto.

Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized.

Introduction: Preterm labor is one of the main causes of neonatal morbidity and mortality whose origin is associated with the presence and interaction of factors related to the mother and her environment. Objective: To determine the risk factors associated with preterm labor in young mothers assisted in a Hospital of Lima, Peru. Methods: A non experimental, analytic and retrospective study of 32 mothers with preterm labor and 292 with term delivery (selected at random), was carried out from January to August, 2016 in the hospital center above mentioned. The chi-square test of Fisher test was used, as it was necessary, as well as the odds ratio (OR) with its confidence intervals of 95 %. Results: The social demographic factors as instruction, occupation and marital status were not related to preterm labor; as long as, antenatal factors (body mass index and history of preterm labor) were significantly associated and clinical factors (urinary tract infection, early rupture of membranes and preeclampsia) demonstrated a statistical association. Conclusions: The antenatal body mass index ≥25 kg/m2, history of preterm labor, urinary infection, early rupture of membranes and preeclampsia, significantly increased the risk of preterm labor. [ABSTRACT FROM AUTHOR]

The case report of a 27 years patient with 17.2 weeks of pregnancy is presented, who was in the Gynecology service follow up of Mariana Grajales Coello Gynecoobstetric Provincial Hospital in Santiago de Cuba presenting a symptomatic uterine myoma with acute abdominal pain due to a necrobiosis, which forced an urgent surgical solution. The pregnant woman had a favorable clinical course and a cesarean section was carried out at the 39 weeks of pregnancy without maternal-fetal complications. [ABSTRACT FROM AUTHOR]

The well-known disease COVID-19 is caused by SARS-CoV-2 virus and it constitutes an emergency of the public health at global scale. Since the report about the first case on December, 2019, in Whuan, Chinese province of Hubei, the disease has expanded quickly through the world and it was qualified as pandemic on March of the present year. Pregnancy is a physiological state that predisposes women to viral infection. Beyond the impact of the infection due to COVID-19 in a pregnant woman, there are concerns related to the possible effect on the fetal and neonatal result; therefore, the pregnant women constitute a group that requires special care as for prevention, diagnosis and care. Aspects related to the infection due to COVID-19 and pregnancy are approached in this work. [ABSTRACT FROM AUTHOR]

The case report of a 28 years patient is described, she was admitted to Tamara Bunke Bider Teaching Gynaecoobstetric Hospital in Santiago de Cuba at the 23.4 weeks of pregnancy with the objective of interrupting pregnancy, due to the specialists of the Provincial Center of Medical Genetics suggestion who had detected a fetal malformation (phocomelia of the upper limbs) in the echography of the second trimester. When the fetus was removed, a hysterectomy was carried out and the echographic diagnosis was confirmed. [ABSTRACT FROM AUTHOR]

Introduction: Sexual education should promote positive attitudes toward a responsible sexuality and contribute to adopt an active posture to prevent risks in people that begin their sexual life. Objective: To characterize the adolescents with pregnancy interruptions according to selected variables. Method: An observational, descriptive and cross-sectional study of 16 356 adolescents from Santiago de Cuba, who interrupted their pregnancy was carried out, from 2012 to 2016. The following variables were analyzed: age, total of adolescents who interrupted their pregnancy according to methods and procedures, as well as type of interruption. Results: Of the total of pregnancies interruptions, 25.3% corresponded to adolescents. The 15-19 age group prevailed. These adolescents decided not to continue the pregnancy in advanced gestational age (8-12 weeks). Among the 2 methods used the practice of abortion had a higher frequency, what is still a health problem in this sector of the population. Conclusions: The adolescents showed a significant percentage of the total of pregnancy interruptions among the women that were in fertility age, with a prevalence of the 15-19 age group; the most used method was abortion. [ABSTRACT FROM AUTHOR]

Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized. [ABSTRACT FROM AUTHOR]

Se describe el caso clínico de una paciente de 29 años de edad, con antecedente de prolapso de la válvula mitral, quien a los 16 días de parida se le diagnosticó trombosis venosa profunda ileofemoral del lado derecho y a los 15 días, aúncon tratamiento anticoagulante, comenzó con trombosis venosa profunda del lado izquierdo, así como también con cuadro clínico sugestivo de tromboembolismo pulmonar.Se concluyó como una enfermedad tromboembólica venosa, dada por la presencia de trombosis venosa profunda bilateral.No hubo oclusión de la vena cava inferior, los resultados de la ecografía Doppler fueron positivos en ambos miembros y la respuesta al tratamiento anticoagulante resultó adecuada

La enfermedad tromboembólica constituye un problema de salud que pone en riesgo la vida de miles de pacientes y en ella se encuentran relacionadas la trombosis venosa profunda y el tromboembolismo pulmonar. Su diagnóstico resulta difícil teniendo en cuenta que las manifestaciones clínicas y la mayoría de los medios para ello presentan limitaciones, de ahí la importancia de considerar de gran utilidad tanto los factores de riesgo como los test de probabilidad clínica para lograr un mejor enfoque; sin embargo, los cambios fisiológicos durante el embarazo favorecen la enfermedad y hacen más difícil el diagnóstico. Esta revisión tiene como objetivo ofrecer una información actualizada con vistas a orientar a la comunidad médica en el uso adecuado de estas herramientas y despertar en los obstetras la necesidad de trabajar con un modelo clínico predictivo, propio para el embarazo y puerperio

The case report of a 29 year-old patient is described with a pregnancy of 24 weeks and a history of chronic hypertension, so that she went to the emergency Department of "Tamara Bunke Bider" Teaching Gynecological and Obstetrical Hospital in Santiago de Cuba, due to her high values, migraine, epigastralgia and vomits. A overadded preeclampsia was diagnosed and, because of the worsening signs, it was decided to make a laparotomy. A hemoperitoneo and a rupture in hepatic right lobe were found, thus, a hepatic tamponing was carried out which was then retired. The patient required intensive cares in "Saturnino Lora Torres" Teaching Clinical-Surgical Provincial Hospital and the evaluation of a multidisciplinary team due to the emergence of complications: acute respiratory failure syndrome, abdominal wall abscess, hepatic abscess and presumed ileofemoral thrombosis. Her clinical course was favorable and she was discharged alive. [ABSTRACT FROM AUTHOR]

The case report of a 20 years nulliparous pregnant woman with history of intermittent, asymptomatic asthma is presented, who was admitted with an icteric syndrome in "Mariana Grajales Coello" Gynecoobstetric Hospital of Santiago de Cuba. After carrying out him the pertinent studies it was concluded that she presented a complicated hepatitis E, which required intensive cares; with the opportune diagnosis and the effective treatment her survival could be guaranteed. [ABSTRACT FROM AUTHOR]

Se describe el caso clínico de una embarazada de 17 años de edad, con diagnóstico de síndrome de Marfán desde la niñez, quien ingresó en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba a las 27 semanas de gestación, con valvulopatía mitral, aneurisma de la aorta abdominal y anemia ligera. Los resultados de la ecografía abdominal informaron que a 48 mm de la arteria mesentérica superior se observaba dilatación de la aorta con flujo de turbulencia en su interior. La paciente fue tratada desde el inicio con atenolol (25 mg diarios) y Betnesol®, para acelerar la madurez pulmonar del feto por el alto riesgo de parto pretérmino. Se le practicó la operación cesárea a las 37,2 semanas, la cual fue exitosa para el binomio madre-feto

Actualmente, las drogas como el alcohol y el tabaco constituyen un grave problema de salud,pues además de ocasionar trastornos psicológicos, están relacionadas con lesiones orgánicas que, en muchos casos, llegan a ser irreversibles. Se realizó esta comunicación breve para mostrar las principales malformaciones congénitas, entre ellas las fisuras labiopalatinas, provocadas por el uso de estas drogas durante la etapa de gestación

Se describe el caso clínico de una embarazada de 21 años de edad, con 28 semanas de gestación, de procedencia rural y aparente buen estado de salud, quien fue remitida desde su área de salud (municipio Songo- La Maya) hacia el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, por presentar vómitos y diarreas, con signos de deshidratación moderada, de manera que se le realizó test rápido de cólera cuyos resultados fueron positivos. La paciente fue ingresada en la Unidad de Cuidados Intensivos bajo tratamiento médico y epidemiológico, con lo cual evolucionó favorablemente y egresó de la institución 5 días después

Se presenta el caso clínico de una fémina de 44 años de edad, con 32 semanas de embarazo, la cual fuera ingresada en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, por presentar insuficiencia respiratoria aguda como consecuencia de una sepsis. La paciente fue tratada con cefalosporina de tercera generación y ventilación mecánica no invasiva, pero se mantuvieron las características gasométricas de hipoxemia y una mala reacción terapéutica, por lo que se requirió instrumentación de las vías respiratorias y soporte hemodinámico, sin lograr regresión del cuadro clínico, lo cual condujo a un paro cardiorrespiratorio y, con ello, a la muerte. La necropsia mostró un coriocarcinoma del endometrio con metástasis pulmonar

Las funciones de la reproducción humana y la enfermedad propia o asociada en la gestante, se identifican e interactúan en ella con frecuencia e impacto de diversa magnitud. Los autores de este informe decidieron evaluar el curso de la gestación, el parto y el posparto en 1 093 grávidas con diagnóstico confirmado de enfermedades crónicas no transmisibles -- hemoglobinopatías de tipo S, hipertensión arterial, cardiopatías, diabetes y anemias deficitarias --, así como algunos parámetros de interés en sus hijos; ambos tratados en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider", en el Centro de Cirugía Cardiovascular y en servicios diversos del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, durante el período 1985-2009. A tal fin fueron seleccionadas las variables: prevalencia, edad, paridad, estado nutricional de la madre (índice de masa corporal), índice de cesárea primitiva, partos pretérmino y postérmino, bajo y alto peso del recién nacido y estado nutricional del recién nacido (crecimiento retardado y crecimiento acelerado), para, finalmente, analizar la morbilidad neonatal y materna y la mortalidad perinatal y materna.

Labor induction is an elementary procedure in obstetrics that is applied in an important group of patients to successfully interrupt pregnancy due to maternal and perinatal risks. In this work, a new method that allows to approach with effectiveness the oxytocin response is briefly exposed, after the use of Misofar® in facilitator function to induce labor, shortening the latency in early break of membranes and conditioning the cervical structures in pregnant women with pre-eclampsia to obtain a better response. This new tool is at medical community disposal for the maternal and perinatal benefit. [ABSTRACT FROM AUTHOR]

A descriptive cross-sectional indication-prescription study of medications use, of 67 pregnant women with hipertensive disease during pregnancy, assisted in "Mariana Grajales Coello" Southern Maternal Hospital was carried out in Santiago de Cuba, from July, 2015 to June, 2016, aimed at characterizing methyldopa prescription in these patients. The use of this medicine prevailed in the case material in patients that had situations associated with the most serious forms of the disease, such as advanced age, nonpariity and hypertension history. The main difficulties corresponded to the combination of medicines with risk of methyldopa interactions and its use at a high dose. [ABSTRACT FROM AUTHOR]

A descriptive and cross-sectional study was carried out during 2014, aimed at exposing the direct and indirect costs related to the cesarean section. In the analysis the elements for a cost card were integrated such as: materials, manpower and other expenses; also, the breakdown of each of its components was made and it was obtained that the cost of a cesarean section without complications and with a duration of 30 minutes was $545.62. For the cesarean sections with these characteristics an approximate extrapolation of the expenses in the country for the same year was carried out. It was concluded that is necessary the strict control of this operation since the elevation of its indicator increases the costs that could be used in other necessities in the health system. [ABSTRACT FROM AUTHOR]

Se presenta el caso clínico de una gestante de 39 años de edad, quien fuera ingresada a las 22 semanas de gravidez en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, luego de ser remitida del Centro Provincial de Genética por el diagnóstico ecográfico prenatal de fibroelastosis endocárdica, confirmado en el Cardiocentro de esta provincia. Después de la interrupción del embarazo, sugerida en la consulta de Genética, se realizó la autopsia al feto y con el estudio hístico del ventrículo izquierdo se corroboró la miocardiopatía.

Se realizó un estudio analítico y observacional de tipo caso-control no pareado de 90 gestantes atendidas en los policlínicos universitarios "Camilo Torres Restrepo" y "Municipal" de Santiago de Cuba, desde junio de 2010 hasta igual mes de 2011, con vistas a determinar el grado de asociación causal entre algunos factores de riesgo cardiovascular y la enfermedad hipertensiva crónica. El grupo de los casos estuvo integrado por 30 embarazadas con hipertensión arterial crónica y el de los controles por 60; estas últimas con características biológicas similares, sin hipertensión, pero con el mismo grado de exposición. Se obtuvo que la malnutrición por exceso, el estrés mantenido y la dislipidemia fueron los factores de riesgo que mostraron mayor asociación causal con la hipertensión arterial crónicaAn analytical and observational unmatched case-control study including 90 pregnant women assisted in "Camilo Torres Restrepo" and "Municipal" university polyclinics in Santiago de Cuba was carried out from June of 2010 to the same month of 2011, with the objective of determining the degree of causal association between some factors of cardiovascular risk and the chronic hypertensive disease. The group of cases was formed by 30 pregnant women with chronic hypertension and that of controls was formed by 60; the last ones with similar biological characteristics, without hypertension, but with the same exposure degree. It was obtained that the excessive malnutrition, the maintained stress and dyslipidemia were the risk factors showing higher causal association with the chronic hypertension.

Los cambios en la estructura y función del aparato urinario que suceden durante el proceso reproductivo, son relevantes y garantizan la normalidad evolutiva de la preñez. Sin embargo, las complicaciones en el embarazo, parto y puerperio, además de las afecciones congénitas o adquiridas, pueden dañar la calidad de vida, e incluso la vida, del binomio madre-perinato. En esta revisión bibliográfica los autores describieron importantes aspectos del tema relacionados con la embriología, la anatomía, la fisiología, las modificaciones anatomofisiológicas, la exploración clínica y paraclínica y las enfermedades del tracto urinario. Asimismo, se consideraron la evolución del embarazo en la nefrópata, la estrecha correlación del riñón con la preeclampsia y la eclampsia, y las enfermedades crónicas no transmisibles de apreciable repercusión en la gestante (diabetes mellitus, hipertensión arterial crónica, hemoglobinopatías de tipo S rasgo S y enfermedades del colágeno). Finalmente, se reseñaron brevemente algunos elementos sobre los tumores renales en las embarazadas y los fundamentales medios terapéuticos como hemodiálisis, trasplante de riñón y trasplante de riñón y páncreas.The changes in the structure and function of the urinary system taking place during the reproductive process are outstanding and they guarantee the progressive normality of pregnancy. However, complications in the pregnancy, childbirth and puerperium, besides the congenital or acquired disorders, can damage the life quality, and even life, of the mother-perinate binomial. In this literature review the authors described important aspects of the topic related to the embryology, anatomy, physiology, and the anatomical and physiologic modifications, the clinical and paraclinical examinations and diseases of the urinary tract. Likewise, the progress of pregnancy in the pregnant woman with nephropathy, the closed correlation of kidney with preeclampsia and eclampsia, and chronic non-communicable diseases of considerable repercussion on the pregnant woman (diabetes mellitus, chronic hypertension, S trait-S hemoglobinopathies and diseases of the collagen) were considered. Finally, some elements on the renal tumors in the pregnant women and the fundamental therapeutic means as hemodyalisis, kidney and pancreas transplant, and kidney transplant were briefly pointed out.

Considerando que la infección intraútero es una de las causas más importantes de morbilidad y mortalidad perinatal, con esta revisión de la bibliografía se pretende ofrecer a los obstetras, algunos conocimientos sobre el síndrome de respuesta inflamatoria fetal, que permitan su identificación adecuada. Se incluyen, además, los aspectos de dicha entidad clínica relacionados con el parto pretérmino, la corioamnionitis y las complicaciones que dañan al producto de la concepción y al recién nacido, a corto y largo plazo, así como los medios de diagnóstico invasivos, menos invasivos y no invasivos, y la utilidad de la intervención temprana. Por último, se concluyó que la garantía de una atención multidisciplinaria posibilitará el logro de una reducción en la morbilidad y mortalidad perinatal, causadas por esta afección.Considering that intrauterine infection is one of the most important causes of perinatal morbidity and mortality, this literature survey is aimed at providing some knowledge of the fetal inflammatory response syndrome for obstetricians, which allows its adequate identification. Aspects of this clinical entity related to preterm delivery, chorioamnionitis and complications that damage the conceptus and the newborn in the short and long term are also included, as well as invasive, less invasive and non invasive diagnostic means and the usefulness of the early intervention. Finally, it was concluded that the guarantee of a multidisciplinary care will enable the achievement of a reduction in perinatal morbidity and mortality caused by this condition.

Se realizó una investigación longitudinal, prospectiva, de tipo casos y controles en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, durante 8 años, para medir el impacto que la afección cardíaca materna ha tenido sobre la salud, calidad de vida y sobrevida del perinato. Fueron agrupadas 113 gestantes con afecciones cardíacas (grupo de casos), identificadas de una población de 25 525 embarazadas atendidas en la institución durante este período de trabajo, y 226 no cardiópatas (grupo de control), seleccionadas en forma aleatoria entre las restantes grávidas, quienes a su vez crearon otras tantas unidades de estudio: fetos y recién nacidos. Las variables se evaluaron según clases establecidas y entre ellas figuraron: edad gestacional al diagnosticar la enfermedad y al parir, tipo de parto y puntaje de Apgar, sexo del producto de la concepción, peso y estado nutricional del recién nacido al nacimiento, morbilidad y mortalidad fetal y neonatal. En el análisis estadístico se estimó como criterio de significación el valor de p=0,05 y fueron comparados los indicadores de calidad. Finalmente, los autores consideraron como satisfactorios los resultados de la casuística.A longitudinal prospective case-control study was conducted in "Tamara Bunke Bider" Gyneco-Obstetric Teaching Hospital of Santiago de Cuba for 8 years to measure the impact of maternal heart disease on health, quality of life and survival of the perinate. Two groups were formed: 113 pregnant women with heart disease (case group) identified from a population of 25 525 pregnant women attending the institution during this working period, and 226 no cardiac patients (control group), randomly selected from the remaining pregnant women, who in turn formed other study groups: fetuses and newborns. The variables were evaluated according to classes established and among them were gestational age at diagnosis of the disease and at delivery, type of delivery and Apgar score, sex of the conceptus, weight and nutritional status of the newborn at birth, fetal and neonatal morbidity and mortality. In the statistical analysis the value of p= 0.05 was required as a significance criterion and quality indicators were compared. Finally, the authors considered the results of the cases as satisfactory.

Se realizó un estudio longitudinal y prospectivo, de casos y controles en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, durante un período de 8 años, con vistas a caracterizar a la gestante, parturienta y puérpera con alguna enfermedad cardíaca para lograr una asistencia médica diferenciada, ajustada a un protocolo de atención integral e interdisciplinario, diseñado a partir de experiencias previas logradas en otras pacientes con alto riesgo. Se agruparon 113 gestantes con diagnóstico clínico y confirmación paraclínica de afección cardíaca (casos) y 226 seleccionadas (controles) de un total de 25 412 embarazadas no cardiópatas. La clasificación se efectuó por medio de los criterios anatómicos de Carreras-Macías, la evaluación funcional de la Asociación de Cardiología de New York, los niveles de riesgo de muerte cardiológica de Clark y, finalmente, las categorías-tipo planteadas por este grupo de trabajo a tal fin. Los resultados han sido indudablemente satisfactorios y estimulantes, con un tratamiento integrado obstétrico-perinatológico, ya referido, y la asistencia cardiológica y cardioquirúrgica necesaria, ofrecida por el Cardiocentro del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de esta provincia.A longitudinal and prospective case-control study was carried out in "Tamara Bunke Bider" Gyneco-obstetric Teaching Hospital of Santiago de Cuba, during a period of 8 years, in order to characterize the pregnant woman or puerpera with some heart disease to achieve a differentiated care, adjusted to an interdisciplinary and comprehensive care protocol, designed from previous experience gained in other patients with high risk. One hundred and thirteen pregnant women with clinical diagnosis and paraclinical confirmation of heart disease (cases) were divided into groups and 226 (control) were selected from a total of 25 412 no cardiac pregnant women. The classification was performed by means of anatomical criteria of Carrera-Macías, functional assessment of New York Heart Association, the levels of risk of cardiac death of Clark and, finally, the type-categories raised by this working group for this purpose. The results are certainly satisfactory and encouraging, with the aforementioned comprehensive obstetric and perinatal treatment and necessary cardiac and cardiosurgical care offered by the Heart Center of "Saturnino Lora Torres" Clinical Surgical Teaching Hospital of this province.

Se presenta el caso clínico de una adolescente de 16 años de edad, con 37,8 semanas de embarazo, quien ingresó en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, por presentar manifestaciones neurológicas. Mediante la resonancia magnética efectuada se observó una imagen de posible aspecto tumoral en la zona temporoparietooccipital derecha, lo cual obligó a realizarle cesárea de urgencia. Luego se efectuó resonancia magnética contrastada, cuyos resultados confirmaron que se trataba de una heterotopia nodular difusa subependimaria y focal, asociada a hipoplasia de los hemisferios cerebral y cerebeloso derechos y del cuerpo calloso.The case report of a 16 year-old adolescent, with 37.8 weeks of pregnancy who was admitted to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital from Santiago de Cuba is presented, due to neurological manifestations. By means of magnetic resonance an image of possible tumoral aspect was observed in the right temporoparietooccipital area, which forced to carry out an emergent caesarean section. Then a contrasted magnetic resonance was made, which results confirmed that it was a focal and diffuse nodular subependymal heterotopy, associated with an hypoplasia of the right cerebral and cerebelous hemispheres and from the callous body.

Se efectuó un estudio descriptivo y transversal de 97 gestantes con enfermedad periodontal, atendidas en la Consulta Estomatológica del Hospital Docente "Ezequiel Miranda Díaz" del municipio de Julio Antonio Mella, desde octubre del 2009 hasta septiembre del 2010, para determinar el estado de salud del periodonto en estas, según algunas variables clinicoepidemiológicas. En la serie predominaron la anemia (36,1 %) y la hipertensión arterial crónica (22,7 %) como enfermedades asociadas, así como los estados de nutrición normopeso (45,3 %) y bajo peso (37,1 %) y el hábito de fumar (31,9 %). De manera general, la gingivitis constituyó la forma clínica sobresaliente, pues primó en 84,5 % de las embarazadas, sobre todo en aquellas con higiene bucal deficiente (61,8 %), lo cual mostró que la etapa de gravidez provoca una respuesta exagerada de los tejidos periodontales ante el daño y las alteraciones por agentes irritantes locales.A descriptive and cross-sectional study was conducted in 97 pregnant women with periodontal disease, attended at the dentist's office of «Ezequiel Miranda Díaz» Teaching Hospital in Julio Antonio Mella municipality, from October 2009 to September 2010, to determine the health status of periodontium in these women according to some clinical epidemiological variables. Anemia (36,1 %) and chronic hypertension (22,7 %) as associated diseases prevailed in the series, as well as normal weight nutritional statuses (45,3 %), low weight (37,1 %) and smoking habit (31,9 %). Overall, gingivitis was the marked clinical form, because it prevailed in 84,5 % of pregnant women, mainly in those with poor oral hygiene (61,8 %), which showed that the stage of pregnancy causes an exaggerated response of periodontal tissues to damage and alterations by local irritants.

El objetivo de esta investigación fue identificar en la adolescente primípara y su hijo un eventual patrón de riesgo, considerando las características de atención médica integral que recibe esta población en el país. Se realizó un estudio transversal y retrospectivo, de tipo casos y controles, integrado por una muestra de 207 unidades de análisis (69 casos y 138 controles), de 1 290 embarazadas en total. Entre las variables evaluadas figuraron: abortos provocados previos (= 2); afecciones diagnosticadas, asociadas con el embarazo; eventos dependientes de la gestación y otras. En el análisis estadístico se aplicó la razón de productos cruzados (RPC) u odds ratio (OR), con un intervalo de confianza (IC) de 95 %, así como la prueba de Ji al cuadrado, con p = 0,05 o menor. Las variables de asociación significativa y carácter causal fueron: anemias deficitarias en segundo y tercer trimestres, infección genital en primer trimestre y amenaza de parto pretérmino, en tanto los abortos (= 2) y las enfermedades del feto mostraron significación en sus asociaciones y carácter protector. Se identificó un patrón de riesgo de limitada complejidad para su manejo, con amplias opciones de modificación antes y después de la concepción y sin impacto negativo sobre la mortalidad maternoperinatal.The objective of this research was to identify a possible risk pattern in the primiparous adolescent and her child, taking into account the characteristics of comprehensive health care that this population receives in the country. A cross-sectional and retrospective case-control study was conducted in a sample of 207 analysis units (69 cases and 138 controls), of 1 290 pregnant women in total. Among the evaluated variables were earlier induced abortions (± 2); diagnosed conditions associated with pregnancy; pregnancy-dependent events and others. In the statistical analysis the odds ratio (OR) was used with a 95 % confidence interval (CI), as well as the chi-square test with p = 0,05 or lower. Variables of significant association and causal character were deficiency anemia in second and third trimesters, genital infection in first trimester and preterm labor, while abortions (± 2) and fetal diseases showed significance in their associations and protective character. A risk pattern of limited complexity for its use was identified, with extensive modification options before and after conception, and without negative impact on maternal perinatal mortality.

La enfermedad tromboembólica venosa constituye una causa importante de morbilidad y mortalidad en el período grávido puerperal, lo cual ha generado múltiples controversias en cuanto a su prevención y tratamiento. En este artículo se exponen las medidas preventivas y terapéuticas para tratar a mujeres con enfermedad tromboembólica en el embarazo y puerperio, para lo cual se detallan las medidas generales y el uso de antitrombóticos en la profilaxis de esta afección, así como también su utilización con fines terapéuticos. Se describen nuevos anticoagulantes, inhibidores directos de trombina y Anti/Xa, así como se exponen las modalidades de tratamiento quirúrgico, lo cual permitió como resultado introducir un protocolo de atención a la terapéutica de estas pacientes. Se concluye que si bien la profilaxis en población de riesgo es la piedra angular de la prevención, la anticoagulación eficaz constituye la herramienta básica para reducir la mortalidad.Venous thromboembolic disease is an important cause of morbidity and mortality in the pregnant-puerperal period, which has given rise to multiple controversies regarding its prevention and treatment. This article outlines the preventive measures and therapies to treat women with thromboembolic disease in pregnancy and puerperium, for which the general measures and the use of antithrombotics in the prophylaxis of this condition are detailed, as well as their use for therapeutics. New anticoagulants, direct thrombin inhibitors and Anti/Xa are described and the surgical treatment modalities are presented as well, allowing as a result to introduce a care protocol for treatment of these patients. It is concluded that although the risk population prophylaxis is the cornerstone of prevention, effective anticoagulation is the basic tool to reduce the mortality.

La enfermedad tromboembólica venosa es la primera causa no obstétrica de morbilidad materna, con un aporte importante a la mortalidad. En este artículo no solo se describen los factores de riesgo relacionados con esta entidad clínica en la gravidez vinculados a trombofilia, sino también con las afecciones previas de la gestación y los concernientes a embarazo y puerperio, así como los medios para su diagnóstico precoz, incluidas las principales manifestaciones clínicas y los mecanismos más fiables para confirmar la presencia de trombosis venosa profunda y tromboembolismo pulmonar. Sobre la base de lo anterior y de los valores del test de probabilidad se decidió agrupar los elementos favorecedores de su ocurrencia en 3 categorías: alto, mediano y bajo riesgo, con vistas a poder diagnosticar clínicamente con certeza su cuadro sintomático, adoptar la conducta médica expedita y emplear la profilaxis adecuada en cada caso.Venous thromboembolic disease is the first non-obstetric cause of maternal morbidity with an important contribution to mortality. In this article, not only risk factors related to this clinical disorder of gravidity involving thrombophilias are described, but also previous pregnancy conditions and those concerning pregnancy and puerperium as well as resources for its early diagnosis, including main clinical manifestations and the most reliable mechanisms to assure the presence of deep venous thrombosis and pulmonary thromboembolism. Taking into account all the aforementioned data and the probability test values, elements favoring its occurrence were grouped into three categories: high risk, mild risk, and low risk; thus, diagnosis can be clinically made having the certainty of the symptomatic chart, assuming a clear medical behavior, and applying the appropriate prophylaxis in each case.

Se utilizó un nuevo plan terapéutico para el alumbramiento activo, basado en el empleo de misoprostol por vía sublingual, con vistas a evaluar su eficacia y seguridad. Para ello se realizó un ensayo clínico pragmático de fase III con características específicas, que incluyó a gestantes tomadas como controles y tratadas según lo normado en ese caso, así como 2 grupos experimentales (1 y 2), en cuyas integrantes se empleó el proceder activo no invasivo propuesto para el estudio. La muestra quedó conformada por 600 pacientes atendidas en el Servicio de Partos del Hospital Ginecoobstétrico "Mariana Grajales Coello" de Santiago de Cuba desde junio de 2009 hasta igual mes de 2010. En los 2 últimos, tanto el tiempo de alumbramiento promedio como el volumen de sangrado calculado fueron menores que en el primero, de donde se concluyó que el misoprostol a las dosis y vía propuestas resultó ser más eficaz y seguro que la oxitocina.A new therapeutic plan was used for the active childbirth, based on sublingual misoprostol use, aimed at evaluating its effectiveness and safety. For this, a phase III pragmatic clinical trial was carried out with specific characteristics that included pregnant women taken as controls and treated according to the standards in that case, as well as 2 experimental groups (1 and 2) in whom the active and non invasive procedure proposed for the study was used. The sample was formed by 600 pregnant women assisted at the Childbirth Service of "Mariana Grajales Coello" Gynecological and Obstetrical Hospital in Santiago de Cuba from June, 2009 to the same month of 2010. In the 2 last groups, both the time of average childbirth and the volume of calculated bleeding were smaller than in the first one, and it was concluded that misoprostol at the doses and administration route proposed turned out to be more effective and safe than oxytocin.

Se realizó un estudio de 308 gestantes con hipertensión inducida por el embarazo: 77 casos y 231 controles; estas últimas grávidas supuestamente sanas, con vistas a determinar algunos factores de riesgo asociados a la ocurrencia de esa alteración. La investigación se efectuó en el Policlínico Universitario "José Martí Pérez" de Santiago de Cuba, de enero a diciembre de 2010. Se calculó la razón de productos cruzados y se aplicó la prueba de Ji al cuadrado de independencia. Entre los principales resultados sobresalió que los factores de riesgo biológicos estuvieron vinculados causalmente, exceptuando el precedente de enfermedades asociadas a la gravidez. También se estimó el riesgo atribuible en expuesto porcentual para identificar aquellos factores que al incidir sobre ellos, podría lograrse un mayor impacto, tales como: antecedentes familiares de hipertensión arterial y embarazo, malas condiciones obstétricas e inicio de la gestación malnutridas.A study of 308 pregnant women with pregnancy induced hypertension (77 cases and 231 controls; the latter were supposedly healthy) was carried out from January to December, 2010 in order to determine some risk factors associated with the occurrence of this disorder. Research was performed at "José Martí Pérez" University Polyclinic from Santiago de Cuba. Odds ratio was estimated and chi square test was applied. Among the main results prevailed that biological risk factors were causally related, except for the precedent of diseases associated with pregnancy. Risk difference was also estimated in the exposed percentage to identify those factors, such as pregnancy hypertension family history, poor obstetrical conditions, and initial malnourished pregnancy that, when influencing on them, a major impact would be achieved.

Se realizó una intervención comunitaria en 30 adolescentes de 15 a 19 años, pertenecientes al consultorio médico nr 15 del área de salud del Policlínico "Carlos Alberto Ortega Ortega" de Palma Soriano, provincia de Santiago de Cuba, desde octubre de 2009 hasta mayo de 2010, a fin de modificar o ampliar sus conocimientos sobre el embarazo precoz y caracterizar a la población objeto de estudio según variables de interés, para lo cual se impartió un programa de actividades distribuido en 9 sesiones de trabajo. Los resultados de la acción educativa, evaluados mediante la prueba de McNemar y con un nivel de significación de 0,05, fueron satisfactorios luego de impartidas las clases.A community intervention was carried out in 30 adolescents between 15 and 19 years, belonging to the physician's office number 15 from the health area of "Carlos Alberto Ortega Ortega" Polyclinic in Palma Soriano, Santiago de Cuba province, from October, 2009 to May, 2010, in order to modify or to increase their knowledge on the early pregnancy and to characterize the population under study according to variables of interest, for which a program of activities was delivered and distributed in 9 working sessions. The results of the educational action, evaluated by means of Mc Nemar test and with a significance level of 0,05, were satisfactory after classes were delivered.