Search

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 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.

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.

To search for differences in the frequency of thyroid peroxidase antibodies (TPO-Ab) among 150 pregnant Mexican women who were healthy, had type 2 diabetes mellitus (DM), or had gestational diabetes mellitus (GDM).Fifty healthy women, 50 women with type 2 DM, and 50 women with GDM were studied at delivery. In addition, 142 of their offspring were included in the study. TPO-Ab were determined by enzyme immunoassay, and total triiodothyronine, free thyroxine, and thyroid-stimulating hormone (thyrotropin) were measured by radioimmunoanalysis.TPO-Ab wereor = 70 U/mL (negative) in 50% of the healthy women and in 60% and 60% of women with type 2 DM and GDM, respectively (no significant difference). TPO-Ab were 71 to 250 U/mL (slightly positive) in 40% of healthy women and in 30% and 34% of women with type 2 DM and GDM, respectively (no significant difference). TPO-Ab wereor =251 U/mL (strongly positive) in 10% of healthy women and in 10% and 6% of women with type 2 DM and GDM, respectively. One healthy woman had subclinical hypothyroidism, and the rest were euthyroid. The newborn offspring of these Mexican women were euthyroid and had similar frequencies of TPO-Ab (all had TPO-Ab250 U/mL).(1) The frequency of TPO-Abor =251 U/mL was similar in pregnant Mexican women with GDM in comparison with those who were healthy or had type 2 DM. (2) The similar high frequencies of slightly positive TPO-Ab in the three groups of pregnant women can partially be explained by the existence of an ethnic factor, the very strong family history of DM in a substantial percentage of them, and the use of a more sensitive and specific assay for detection of TPO-Ab.

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.

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.

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.

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.

Abdominal pregnancy is a rare condition representing 1-2% of all pregnancies; early diagnosis is difficult, but the challenge is the advanced pregnancy with adequate clinical condition for conservative management. There are few cases in which conservative management can improve, even though when the abdominal pregnancy is secondary to ruptured interstitial localization. A case of secondary (interstitial) abdominal pregnancy with conservative management and post-operative eventful for the mother and fetus is discussed.

There is an increasing incidence of type 2 diabetes mellitus (DM) among adolescents (especially females), and the serum glucose concentrations in pregnant women25 years during a 3-h oral glucose tolerance test (3-h OGTT) seem to be lower than those of pregnant women25 years. Among 115 Mexican pregnant adolescents (18 years) we analyzed their serum glucose concentrations during: a) 1-h 50-g glucose challenge test (GCT) performed at 24-28 weeks of gestation (n = 103) or at 29-35 weeks of gestation (n = 12); b) A standard 3-h OGTT performed 3-5 days later. Eight adolescents had an abnormal GCT, three of whom also had an abnormal 3-h OGTT. Sixteen adolescents (13 with previously normal GCT) had an abnormal 3-h OGTT, 15 classified as GGI and one as gestational DM (GDM). Serum glucose concentrations in adolescents with GGI were higher than in adolescents with normal 3-h OGTT: a) at 60 and 120 min during the 3-h OGTT (p0.001); and b) when expressed as the area under the glucose curve (p0.001). Adolescents with GGI had serum glucose concentrations during the 3-h OGTT similar to adult, non-diabetic pregnant Mexican women. It is suggested that GGI in pregnant adolescents may represent an early sign of a future deterioration in glucose metabolism, leading to a higher risk for GDM in future pregnancies and/or type 2 DM in adulthood. Thus, the current criteria to diagnose GDM in adults may not completely apply to adolescents, especially in ethnic groups with high risk for glucose abnormalities and considering the frequency of multiparous adolescents, especially in developing countries.

To evaluate the maternal morbidity inor = 16 year old pregnant teenagers.A prospective study of the reviewed cases was carried out from June 1998 to May 1999. All pregnant teenagers which attended the Coordination for the Attention of the Teenage Patient and whose pregnancy came to term during the study period were included. The following variables were analyzed: maternal age, preexisting related diseases, number of pregnancies, number of prenatal control medical visits and the time at which these were started, and maternal morbidity secondary to pregnancy.Two hundred and ninety six of 330 case were included. The average maternal age was 15.1 years old (10-16 range); 68.9% had finished middle school; 82.2% were housekeepers, and 61.4% were single. Prenatal control was initiated in the 2nd trimester by 50.7% of them, while 39.5% started it in the 3rd trimester and the remaining 9.8% in the 1st trimester. The most frequent previous pathologies were: bronchial asthma (2.5%), drug addiction (2%), hypothyroidism (2%), cardiopathy (1.5%). The most common complications during pregnancy: urinary system infections (20.4%), anemia (9.8%), threats of premature labour (9.8%), premature membrane rupture (9%), hypertensive disease induced by pregnancy (3.2%), delayed intrauterine growth (2.4%) and fetal malformation (2.4%). About 44.1% of the pregnancies were interrupted by cesarean section, 35.6% by eutochia and 20.3% by instrumented labour. The most frequent complications during the puerperium were: tearing of the canal of the cervix (7%), decidual endometritis (3.3%), dehiscence of surgical wounds (2.7%), and pyelonephritis (1.6%).The pregnant teenager is a "special" patient form the biopsychosocial point of view, thus, she must be managed by a multidisciplinary team, with special emphasis in the problems analyzed in this study.

To evaluate the perinatal morbidity and mortality with the presence of meconial amniotic fluid.Retrospective study of case review, performed from 1st of June 1995 to May 1997. The patients included were at delivery, with a pregnancy of 32 weeks or older and had meconial amniotic fluid. The variables analyzed were: motherhood age, pre-existing associated illness, resolution of the pregnancy, PSS interpretation, fetal weight, Apgar and final destiny of the product.Of the 432 patients the motherhood aged varied from 13 to 43 years old, mean 27.4; with a number of pregnancies from 1 to 10, mean 2.25. The gestational age went from 32.2 to 42.4 weeks. The fetal weight varied form 1025 to 5080 g. The Apgar grade mean was 7 at the first minute and 8 at the fifth. The pregnancy was interrupted by cesarean in 52.5%. Although there was not a significant difference with the arterial gas, the density of the amniotic fluid did determine the final destiny of the product.There is a relation between the presence of amniotic fluid and the Apgar grade; both determining the final destiny of the product. When the amniotic fluid had thick meconium the products had a greater morbidity.

To evaluate the maternal and fetal morbility as well as the odds and conditions of pregnancy when performing an emergency cerclage.We performed a transversal, prospective and descriptive study of all the patients to which an emergency cerclage was performed in the Instituto Nacional de Perinatología between January 1, 1995 and December 31, 1996 having all the inclusion criteria. At such time 261 cerclages were performed in our Institute upon unique pregnancies being only 22 considered as emergency cerclages. We performed studies of their obstetrics background, their incidental as per their age group, complications during the inclusion for the technique used as well as restitution of fetal membranes, complications before, during and after surgery: as well as the time elapsed as from the inclusion of the cerclage to birth and the data of the new born.21 patients had previous pregnancies and only one of them was her first one; only 6 of their children were alive. The average age was 29.5 +/- 3.8 years and the gestational average age of the inclusion of the procedure was of 18 +/- 2.6 weeks, having a cervical dilatation of 2.5 cm +/- 0.9 cm. In 10 patients we had to restitute fetal membranes. The long extended average time between the colocation of the cerclage and labor was 66.8 days (more than 9 weeks) and the 86.4% of the resolution was via vaginal.It was observed that with the inclusion of the urgency cerclage we were able to prolong gestation in around 66 days, in which the main indicator of the perinatal forecast was the presence of fetal membranes or if they were bulging through internal cervical os. In this type of patients there is a major risk of having preterm labor and infectious maternal morbility. Notwithstanding that we believe that it is not an ideal procedure, the urgency cerclage has a place in current obstetrics. Prior to performing this procedure, we will have to study the patient as well as to have an adequate neonatal service.

pregnancy within 1 year was documented in 34.3% of patients with an average time from pregnancy loss to conception of 141.6 70.1 days. Of those that were compliant with follow up, 31% experienced repeat pregnancy within 1 year compared to 36.4% of those that did not comply with follow up, although this was not statistically significant (p1⁄40.64). Incidence of rapid repeat pregnancy did not differ based on age, gravity, parity, race, type of insurance, diagnosis, or contraception plan. Conclusions: Compliance with ED follow up from first trimester pregnancy loss among this urban adolescent population was poor and rapid repeat pregnancy rates were high. Poor compliance with follow up was associated with higher rates of repeat pregnancy within 1 year although the sample size was not large enough to show a statistically significant difference. The high rates of rapid repeat pregnancy following first trimester loss in the urban adolescent population is evidence that greater effort in providing resources for follow up and contraception to these young women after an ED encounter is of critical importance.