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Objetivo. Presentar los resultados perinatales de dos pacientes con diagnóstico de sarcoma de Ewing y rabdomiosarcoma alveolar. Metodología. Se revisaron dos casos de pacientes con diagnóstico de sarcoma atendidas en el Instituto Nacional de Perinatología de la Ciudad de México. Resultados. Caso 1 femenino de 22 años, con embarazo de 23,0 semanas y tumoración en región glútea izquierda de 20 cm, dolor y dificultad para deambular. La radiografía de tórax informó múltiples nódulos pulmonares y la resonancia magnética, tumor en región glútea con compromiso extenso. El diagnóstico fue sarcoma de Ewing metastático en etapa IV. El manejo consistió en tratamiento sintomático con resolución del embarazo a las 28 semanas. Caso 2 femenino de 22 años con embarazo de 12,0 semanas y diagnóstico de síndrome medular metastásico. Se realizó descompresión T9-11. Se evidenció ausencia de frecuencia cardiaca fetal, por lo que se realizó manejo médico de aborto diferido.

Resumen Los edulcorantes no calóricos (ENC) son aditivos de alimentos que se utilizan para sustituir azúcares y potencialmente para reducir la ingesta energética. Existe un debate científico en torno a los beneficios reales de su uso. Los ENC son sustancias ampliamente evaluadas en la literatura científica. Su seguridad es revisada por las agencias regulatorias internacionales del campo de la salud. Los profesionales de la salud y los consumidores con frecuencia carecen de educación e información rigurosa, objetiva y sustentada en la evidencia científica y el juicio clínico sobre el uso de aditivos en los alimentos. Los ENC se han empleado como sustitutos de la sacarosa, en especial por las personas con diabetes mellitus y obesidad. Sin embargo, se han planteado inquietudes relacionadas con su posible asociación con el parto pretérmino y con su uso durante el embarazo y la lactancia, ante la posibilidad de consecuencias metabólicas o de otra índole en la madre o en el neonato. Este análisis de la evidencia en ginecología y obstetricia presenta una revisión que intenta responder a preguntas que habitualmente se hacen al respecto los profesionales de la salud y sus pacientes. En este documento se evalúan diversas publicaciones científicas bajo el tamiz de la medicina basada en la evidencia y del marco regulatorio para aditivos de alimentos con el fin dilucidar si el uso de ENC en las mujeres durante las etapas críticas del embarazo y la lactancia supone o no un posible riesgo. Abstract Non-nutritive sweeteners (NNS) are food additives that have been used as a possible tool to reduce energy and sugar intake. There is a scientific debate around the real benefits of their use. NNS are substances widely evaluated in the scientific literature. Their safety is reviewed by international regulatory health agencies. Health professionals and consumers often lack education and objective information about food additives based on the best scientific evidence. NNS have been used as a substitute for sucrose, especially by people with diabetes mellitus and obesity. However, concerns related to their possible association with preterm birth have been raised, and also with their use during pregnancy and lactation because of the possibility of metabolic or other consequences in both the mother and offspring. This analysis of the evidence in gynecology and obstetrics presents a review of the most commonly asked questions regarding this matter by health professionals and their patients. This document evaluates a diversity of scientific publications under the sieve of evidence-based medicine and the regulatory framework for food additives to elucidate whether the use of NNS in women in these critical stages of pregnancy and breastfeeding represents a potential risk.

Objective. To analyze the pattern of bone mineral density (BMD), serum concentrations of estradiol and calcium lev- els, dietary calcium, body mass index (BMI), and lactation in adolescents and adult women at 15, 90, and 365 postpartum days (ppd). Material and Methods. A prospective cohort study was conducted of 33 adolescents and 39 adult women. Anthropometric and dietetic evaluations were performed, as well as evaluations of bone mineral density in L2-L4 and femur neck. Estradiol concentrations and calcium serum levels were determined. Results. L2-L4 BMD increased by 16% in adolescents, and 3% in adult women from day 15 to 365 ppd. While age was associated with this change (β=13.779, EE=3.5, p=0.001), lactation was not (β=-0.705, EE=0.647, p=0.283). The adult women had a higher L2-L4 BMD at 15, 90, and 635 ppd (1.151 vs 0.978g/cm 2 , 1.195 vs 1.070g/cm 2 , 1.195 vs 1.123g/cm 2 , respectively) (p

Objective To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. Design Retrospective cohort study. Setting Level-three medical institution in Mexico City. Participants The study population comprised 1061 adolescent women aged 12–19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. Primary and secondary outcome measures The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (−), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. Results GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (−): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. Conclusions An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.

In recent years, in all Western societies has changed the paradigm of the physician-patient relationship. It has passed from the principle of beneficence and abscence of malificence to the patients autonomy, recognizing their sovereignty in making clinical decisions that directly affect them. Occasionally, this principle can clash with certain bioethical aspects of conscientious objection for health professionals and providers, primarily in the areas of contraception and abortion. We discussed aspects that support one or another attitude emphasizing issues relating to contraception and induced abortion and the access and use of contraceptive methods by adolescents recognized as "mature minors" to issues of sexuality, particularly in Spain and Mexico.

Luis Bahamondes,1 Josefina Lira-Plasencia,2 Ricardo Martin,3 Victor Marin,4 Maria Y Makuch1 1Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil; 2Instituto Nacional de Perinatología, México, DF, México; 3Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia; 4Hospital Central, Petróleos Mexicanos, México, DF, México Background: Unintended pregnancy is a public health problem and unmet medical need worldwide. It is estimated that in the year 2012, almost 213 million pregnancies occurred, and the global pregnancy rate decreased only slightly from 2008 to 2012. It was also estimated that 85 million pregnancies (40% of all pregnancies) were unintended and that 38% ended in an unintended birth. Objectives: To assess knowledge and attitudes of Latin American (LA) obstetricians and gynecologists (OBGYNs) regarding unintended pregnancies and aspects of combined oral contraceptive (COC) use. Methods: A survey was conducted during a scientific meeting about contraception in 2014, in which OBGYNs from 12 LA countries who provide attention in contraception were invited to respond to a multiple-choice questionnaire to assess their knowledge and attitudes regarding unplanned pregnancy and some aspects regarding COC use. Results: A total of 210 OBGYNs participated in the study. Their knowledge regarding COC failure was low. The participants reported they believed that their patients habitually forgot to take a pill and that their patients did not know what to do in these situations. They were aware of the benefits of COC use; however, they were less prone to prescribe COCs for the purpose of protecting against ovarian and endometrial cancer, and one-quarter of them had doubts about the association between COC use and cancer risk. Conclusion: The interviewed LA OBGYNs showed some flaws in terms of knowledge of COC failure rates and the non-contraceptive benefits and risks of COCs. To adequately counsel their patients regarding COC intake, OBGYNs must be updated regarding all aspects of COC use. Keywords: contraception, unintended pregnancy, benefits of oral contraceptives&nbsp

Due high rates of unplanned pregnancy and unsafe abortion in young women in Latin America intrauterine contraception, by its great contraceptive efficacy, should be offered by the public services of health in a more generalized way. However, some negative prejudices prevail over the perception of its benefits. The aim of this article was to explore the most relevant myths around this contraceptive method in Latin America and make a review of the literature to allay the fears of their use by young and nulliparous women.Descriptive and retrospective study. Search for information in Embase and PubMed with emphasis on clinical randomized studies, studies of cases and controls, meta-analyses and systematic reviews which show risks and benefits of intrauterine contraception.Evidence shows that intrauterine contraception has few contraindications for young women and nulliparous; for this reason it must be as an effective public health strategy to reduce unplanned pregnancies and unsafe abortions.We identified the major barriers to the use of intrauterine contraception in Latin America and evidence for each one of them in the bibliography. Doctors of first contact in health systems should now recognize that intrauterine contraception is safe and effective.

Although most teenagers know the consequences of the exercise of sexuality without protection, it is surprising that a percentage will be pregnant yet despite having received prior information.Explore some of the knowledge, beliefs and attitudes about sexuality in pregnant adolescents younger than 17 years.Exploratory, observational, cross-sectional and retrospective study with non-experimental design of a single specimen consisting of a questionnaire with the following questions: at what age did you have your first boyfriend?, at what age did you have your first sexual relationship?, did you receive information about sexuality?, do you think that the information that you received from sexuality was good, regular or bad?, did the information you received prepared you for the start of your sex life?, how was your first sexual relationship?, what were the reasons to start sexual activity?, where did you have your first sexual relation?158 patients with average age of 15.6 participated in the sample years and schooling of 8.8 years. Menarche occurred to the 11.5 years, one year later they had boyfriend and two years later the first intercourse. The 59.6% had a history that her mother also became pregnant as a teenager. The 94.3% received information about sexuality; 58.2% considered it good and 38.6% regular. Sexual life was started by curiosity and desire in 67.1% and referred it as pleasant and very enjoyable 80.9% of girls; 39.5% of them think that the bride and groom should not have no sexual relationship.Younger than 17 years pregnant teens enjoy their first sexual experience, they reach it by curiosity and desire, but they exercise it without protection, despite having knowledge of the consequences.

Long-term contraception, reversible, have shown high rates of effectiveness and long-term compliance, with few contraindications. However, despite that Mexico has a variety of reversible contraception, most women still using less effective options. The resulting health benefits of contraception are important because they prevent unintended pregnancy, reduce the number of abortions and the incidence of death and disability related to pregnancy and childbirth complications. The Committee for Reproductive Health and Sexual Rights of the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG) conducted a literature review to evaluate the use of long-term contraception reversible as an effective and accessible tool to reduce the incidence unintended pregnancy and its consequences.

Infection with human papillomavirus has increased dramatically in recent years. The highest prevalence rates are among adolescents and young women, reflecting changes in sexual behavior associated with biological factors in adolescent development. Adolescents who begin sexual activity early are at greater risk of precursor lesions and cervical cancer. There are adolescents with special circumstances, where no early decision should be delayed cervical cytology and in whom it is important to initiate consultations and periodic reviews with a preventive approach. Cervical cancer can be avoided when the diagnosis and treatment of precursor lesions is early. Despite efforts at sex education based on "safe sex" with the correct use of condoms has not been able to reduce the incidence of infections with human papillomavirus in adolescents. While better than nothing, condom use is not 100% reliable. Studies show that consistent and correct use provides protection against the human papillomavirus only 70%. In Mexico, reported an overall ratio of actual use of condoms from 24.6%. It is clear that the physician who provides care for adolescents plays a fundamental role in sex education. The key to future prevention of cervical cancer and its precursor lesions could be the vaccination.

Lira Josefina. Vocación de intelectual a través del estudio de los Cuadernos de la Realidad National. In: América : Cahiers du CRICCAL, n°9-10, 1992. Le discours culturel dans les revues latino-américaines, 1940-1970. pp. 325-336.

To analyze the pattern of bone mineral density (BMD), serum concentrations of estradiol and calcium levels, dietary calcium, body mass index (BMI), and lactation in adolescents and adult women at 15, 90, and 365 postpartum days (ppd).A prospective cohort study was conducted of 33 adolescents and 39 adult women. Anthropometric and dietetic evaluations were performed, as well as evaluations of bone mineral density in L2-L4 and femur neck. Estradiol concentrations and calcium serum levels were determined.L2-L4 BMD increased by 16% in adolescents, and 3% in adult women from day 15 to 365 ppd. While age was associated with this change (β=13.779, EE=3.5, p=0.001), lactation was not (β=-0.705, EE=0.647, p=0.283). The adult women had a higher L2-L4 BMD at 15, 90, and 635 ppd (1.151 vs 0.978 g/cm², 1.195 vs 1.070 g/cm², 1.195 vs 1.123 g/cm², respectively) (p0.003).Adolescents' BMD increased three times more than that of adult women. For all women, BMD was dependent of age and independent of lactation.

Benign cystic mesothelioma is an uncommon lesion of the peritoneum, occurring predominantly in women of reproductive age. The present case is a multitreated perimenopausal woman with lower urinary tract symptoms without clinical improvement despite the treatment, and pelvic pain with physical findings and radiology studies of a probable ovarian mass dependant tumoration, requiring protocolized exploratory laparotomy, finding a benign cystic mesothelioma. Despite the low incidence of this tumoration the gynecologist must be familiar with this disease, because of the high recurrence. Nowadays, steroid hormone receptors typification seems to play an important role to control the recurrence of this tumoration.

To describe the proportion of preterm delivery at pregnant adolescents clinic and their maternal, obstetric and fetal conditions other than spontaneous labor.Descriptive inside a cohort of consecutive cases. Preterm was defined from 20 to 36 full weeks. Maternal, obstetric and fetal conditions were defined if directly caused preterm labor or elective interruption; it was differentiated from spontaneous preterm labor.Preterm delivery rate was 10.8% (252/2326): 0.8% from 20 to 27 weeks (19/2326), 3.3% from 28 to 33 weeks (77/2326) and 6.7% from 34 to 36 weeks (156/2326). Spontaneous preterm labor presented in 39.3% (99/252); main conditions found were: rupture of the membranes 18.7% (47/252), preeclampsia-eclampsia 10.3% (26/252), twin pregnancy 10.3% (26/252), intrauterine growth restriction 5.6% (14/252) and congenital defects 5.6% (14/252). They were classified as: obstetric-type 34.9% (887252), fetal 25.4% (64/252) and maternal 0.4% (1/252). There was a 40.5% rate of vaginal delivery (102/252), with the use of forceps in 1 out of 5.At purpose-built clinics using evidence-based and problem oriented interventions, that are individually adapted and continuously up-dated, a non-risk comparable preterm delivery rate can be achieved at gestational ages with better neonatal prognosis.

The combined oral contraceptives are one of the most prescribed medicines. Across the years they have given to more than 60 million women of the whole world a suitable method for the highly reliable and effective natal control. The oral contraceptives are different from other medicines; principally they are not in use for controlling any disease and have the potential of giving advantages.To evaluate the control of the cycle, tolerability and acceptance of an oral contraceptive of ultralow dose with gestodene (60 microg) and ethinylestradiol (15 microg) in a population of healthy women from 18 to 35 years.The study included adult healthy women, all the users signed assent of informed before being included to the study and of the beginning of any procedure in agreement with the declarations of Helsinki and its amendments. Descriptive statistics was used for the demographic information and the comparison between the initial and final visits of the variables of efficiency. There was used the test (Proof) of ranges of Wilcoxon's sign for related samples.There were included 113 women. The average of age was 26.08 years (SD = 4.43), weight of 62.02 kg (SD = 11.13) and height of 159.20 cm (SD = 6.06). The distribution in four centers was: 32 in the University Hospital (Monterrey), 21 in the Country 2000 (Guadalajara), 30 in in the Medical Center La Mora (Aguascalientes) and 30 in Perinatology National Institute (Mexico City).The contraceptive efficiency of the combination of 15 microg of ethinylestradiol and 60 microg of gestodene has been demonstrated in previous studies. This study ratifies the international results of efficiency and tolerability.

To evaluate the perinatal outcomes within a pregnant cohort of adolescents aged 16 years and younger.Case review prospective study. All pregnant adolescents who attended to the Coordination for assistance of the adolescent patient from June 1998 to July 2003 were included.age, irrespective from antenatal care inside or outside of the Coordination and delivering inside the institution. Variables analyzed were: age, occupation, marital status, gestational age at first antenatal visit, number of antenatal visits, medical complications during pregnancy, gestational age on delivery, mode of delivery and contraceptive acceptance on discharge. Neonatal variables: weight at birth and intensive care admissions. Statistical analysis included descriptive measures.We identified 2723 pregnant adolescents, from whom only 2,315 met the inclusion criteria. Mean maternal age was 15.3 (SD 0.87). From the total 58% were single and 83.4% were households while only. Mean gestational age on first visit at the coordination was 24.26 (SD 6.79) weeks. The average number of antenatal visits was 4.78 (SD 3.99). The most frequent medical complications affected the genital and urinary tract, with a 54.2% of cervical and vaginal infections, and a 23.8% of urinary tract infections; anemia in 16.7%, threatened preterm delivery in 9.2% and pregnancy induced hypertension in 3.8%. From the total of cases the 79.1% presented with any morbidity. Mean gestational age concluded at 37.58 (SD 3.03), the preterm delivery rate was 15.4%. The most frequent way of delivery was vaginal with a 55.8% rate. On the neonatal outcomes, the mean birth weight was 2819.07 (SD 613.85). The contraceptive acceptance on the discharge was 98%.The adolescent pregnant has a high risk of suffering major complications, such as genital and urinary tract infections, anemia and preterm delivery.

To establish if there are differences on obstetric and perinatal outcomes between adolescents who are younger than 16 with young adults aging 20 to 24 years old.A double-cohort prospective and comparative study in 328 Mexican pregnant women. Cohort I included 153 pregnant adolescents younger than 16 years old and cohort II included 175 young adults aging 20 to 24 years old. Inclusion criteria for both groups were: healthy, singleton, primigravidas, with 4 or more antenatal care visits and delivery at institution.descriptive, t-test, chi-squared and Fisher's exact test.Cohort I: Mean age, 15 years old. Mean gestational age on first visit, 22.35 +/- 6.75 weeks. Morbidity was due mainly by vaginitis and vaginosis (p = 0.0001), urinary tract infection (p = 0.110) and anemia (p = 0.0001). Maternal weight on first visit was 54.11 +/- 9.11 (p = 0.001). In cohort II mean maternal age was 22 years old with a mean gestational age on first visit of 19.58 +/- 7.94 weeks. Main morbidity was: urinary tract infections, vaginitis-vaginosis and preeclampsia (p = 0.191). Mean maternal weight on first visit was 60.37 +/- 9.99. Gestational age on delivery and birth weight were not statistically different between newborns in each group.Pregnancy in adolescents should be considered of risk; nevertheless, adequacy in antenatal care provides good obstetric and perinatal outcomes.

To determine whether a pregnant adolescent whose weight-for-age is less than 90% is on the risk of delivering a baby who is small for gestational age.Six hundred and one adolescents aged 12-16 years, at 40 weeks of gestation were included. Body weight was measured at baseline with Mexican reference tables. Low maternal weight was considered less than 90%. Rate of small for gestational age at birth was determined for each group. Comparisons were made using chi2 and relative risks were estimated.The rate of small for gestational age among adolescents with low body weight was 16.1% (30/186), it differed significantly (36/415) from the others (8.7%). Relative risk for small for gestational age babies among adolescents with low body weight was 1.9 (95% CI, 1.2 - 2.9). An exploratory analysis suggests that this effect depends on gestational age.If body weight of a pregnant adolescent is to be evaluated in the absence of a previous record, tables by Arroyo can be used as reference; if body weight is less than 90%, then you have an indicator of perinatal risk.