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Background: As the incidence of tuberculosis (TB) has increased worldwide, it is expected that pregnant women will acquire this infection more frequently. Mycobacterium tuberculosis infection during pregnancy may represent a risk for maternal and neonatal complications., Methods: We studied the perinatal events of 35 consecutive pregnancies complicated by TB from March 1990 to June 1998; 105 apparently healthy pregnant women were included as controls, matched in age, gestational age upon arrival at the Institute, and socioeconomic status. Frequency and type of neonatal complications were recorded. Relative risk (RR) with 95% confidence interval (CI) was calculated. To control potentially confounding variables, a stratified analysis was performed., Results: Seventeen (48.5%) tuberculous mothers had a pulmonary infection and 18 (51.5%), an extrapulmonar localization of the TB. The neonatal morbidity rate in children born to women with TB was 23% against 3.8% of the children of the control cohort (p <0.05). Average weight of newborn infants of tuberculous mothers was 2,859 +/- 78.5 g, while average weight at birth of control neonates was 3,099 +/- 484 g (p = 0.03). Newborns of women with TB had a higher risk of prematurity (RR 2.1; 95% CI 1-4.3), perinatal death (RR 3.1; 95% CI 1.6-6), and weight at birth less than 2,500 g (RR 2.2; 95% CI 1.1-4.9). Pulmonary localization of the TB and late start of the treatment in the mothers increase the risk of perinatal death and neonatal morbidity., Conclusions: Children born to women with TB have an increased risk of morbidity and mortality in the neonatal period.

Objective: To describe the experience of management of pregnant women complicated with rubella and to evaluate the perinatal outcome., Material and Methods: A total of 67 pregnant women with positive IgM test for rubella were studied in the period from January 1st, 1990 to October 31st, 1997. Sixty-six of these women were followed until the end of gestation, in 4 patients an elective abortion was performed and 1 patient had a molar pregnancy. The effects of rubella on gestation and on the product were evaluated in sixty-one of the patients. Anti-rubella IgM was determined at birth and positive infants were subjected to evaluation by echocardiogram, brainstem auditory evoked potentials (BAEP) and ophthalmological study., Results: Mean age of the patients was 24.7 +/- 5.5 years; 28 patients were primigravidae. Pregnancies were normal showing no complications due to the rubella episode. In 35 cases (52.2%), the viral infection occurred during the first trimester of pregnancy, in 23 cases (34.5%) during the second and in 9 (13.3%) during the third. Seventy-one percent of infants born to mothers infected during the first trimester of pregnancy were also infected, and 51.6% developed congenital rubella syndrome. The most frequent manifestations of CRS were: prematurity, low birth weight and alterations of the BAEP., Conclusions: In Mexico, rubella is still a cause of fetal damage, which shows the need for preventive strategies, such as universal vaccination, to avoid rubella infection during pregnancy.

Near 70 per cent of Mexican women infected by the Human Immunodeficiency virus (HIV) are between 15 and 44 years old, in this women sexual transmission are the most frequent route of infection. The objective of this article was to describe the obstetric course and perinatal repercussion of the HIV-Positive pregnant women with medical care at the Instituto Nacional de Perinatología, Mexico city between January 1994 to December 1996. Nineteen women were studied, sexual transmission was the route of infection in 16 of them. One had diagnostic criteria for AIDS, the others 18 had HIV asymptomatic infection. At delivery 18 a term products were born. The mean of the newborn weight was 3159 g. At moment of this report 4 children (22%) have been diagnosed as HIV infected, all of them dead during their first year of life.

Pregnant women infected with hepatitis B and C viruses pose a risk for infecting their newborn infants by vertical transmission. We studied 6,253 pregnant women aged 12-49 years for infection with hepatitis B (HBV) and C (HCV) viruses. Infection was diagnosed by measuring IgG antibodies against HBc, HBs, HBe, as well as IgM-HBc and HCV viral antigens with commercially available immunoassay kits. HBV infection was detected in 113 cases (1.8%), and prevalence was significantly higher (2.4%) in a group of women with a high-risk pregnancy who were attending a perinatology hospital than in healthy pregnant women (1.67%, p < 0.05). Infection with HBV was significantly higher in women older than 30 years old (p < 0.05). HBsAg was found in blood, colostrum and vaginal exudate of two pregnant women; HBsAg was detected in the gastric aspirate but not in the blood of the two newborn infants. HBeAg and IgM-HBc were not detected in any of the samples. DNA-HBV was detected in serum of seven women, and DNA-HBV was detected in the gastric aspirate of only one of the newborns. HCV infection was diagnosed in three out of 111 women with markers for HBV infection (2.7%), and in 6 out of 1,000 women without these markers (0.6%). Anti-HCV antibodies were found in the serum of six of their infants during up to six months of age. Infants were monitored for one year and none of them developed any sign of hepatic disease. These results suggest that special attention should be paid to women older than 30 years and with a high-risk pregnancy, as they are at a higher risk of HBV and HCV infections.

Objective: To determine the seroprevalence of hepatitis A, B, C and D virus infection among pregnant women attending a perinatal care hospital., Material and Methods: A prospective study was carried out to determine the seroprevalence of hepatitis A virus IgG antibodies (anti-HAV), hepatitis B virus markers (anti-HBcAg and HBsAg) and hepatitis C virus antibodies (anti-HCV) in pregnant women. In HBsAg positive cases. HBeAg and hepatitis D virus antibodies (anti-HDV) were investigated. All analyses were performed with the ELISA technique., Results: Of the 1500 pregnant women studied. 93.3% were positive for anti-HAV IgG. The HBsAg seroprevalence was 0.26% and anti-HCV seroprevalence was 0.53%. There were no patients with HBeAg or anti-HDV., Conclusions: A higher seroprevalence of HBsAg was found in this study than in other studies of pregnant Mexican women. We propose that HBsAg screening become a routine prenatal test.

Rabies infection in humans is still a major public health problem. A review of the literature shows 25 cases of pregnant human exposure to rabies virus. We report two patients with rabies exposure during the second and third trimester of pregnancy, that received immunization respectively with Vero cell vaccine and Fuenzalida vaccine. There were no repercutions in the products or in the mothers attributed to the prophylaxis, which appear safe when given during pregnancy. Because of the high likelihood of fatal disease following a rabid animal bite, this cases report supports the recommendation that pregnancy is not a contraindication to post-rabies exposure immunoprophylaxis.

Tetracyclines are antimicrobial agents that must be avoided during pregnancy. Metronidazole has showed to be carcinogenic in animals like mouse, but in humans this effect has not been proved. In developing countries the tuberculosis has a high prevalence, so tuberculosis in pregnant women isn't a rare event, all of this patient must receive antituberculosis agents. Of the extensive group of antiviral agents only few has proved clinical efficiency, of this acyclovir can be used during pregnancy with caution. At his moment there aren't sufficient information about the utility of zidovudine in pregnant women.

To start an active sexual activity at an earlier age and with a larger number of partners, has arousen the frequency of sexually transmitted diseases (STS). The teenagers are a group particularly affected. The objective of this article is to report the etiology of STD in a group of teenagers, out-patients at the Instituto Nacional de Perinatologia (INPer). The study includes 1360 patients at the clinic of STD at the INPer, 8.5 percent were less than 20 years old; 18.9 percent of them had previously a STD. The most frequent pathology was cervicovaginitis and the most frequently isolated pathogens were Candida sp, Gardnerella vaginalis and Ureaplasma urealyticum. There were no cases of gonorrhea. Three patients had Immunodeficiency Syndrome.

From January 1989 to February 1992, 19 pregnant women infected with human immunodeficiency virus (HIV) were attended at the Instituto Nacional de Perinatologia in Mexico City, all of them at the end of pregnancy as well as 15 of their offspring. Sexual transmission was found in 15 patients; the initial classification of 16 was CDC II, only one case with AIDS, and during pregnancy 2 cases changed their clinical status. Absolute CD4 count in 2 cases was lower 20%, None of 10 had positive VDRL and one case showed a positive PPD. All neonates were at term and eutrophics. During their first 3 months of life, 2 had an infectious disease and died. The serologic follow-up at the moment reports 3 having HIV infection (20%), 3 no HIV infection and 9 in study are sero-positive.

The objective of this paper was to evaluate, ultrastructurally the placental site, placenta, umbilical cord, embryonal tissues, and semen from 10 patients (5 females and 5 males), seropositive for the Human Immunodeficiency Virus. The tissue samples were processed by the routine techniques for electronic microscopy, and were examined with a Zeiss EM-10C Electronic, transmission microscope. Among the decidual cells of the placental site, macrophages were found, which contained vacuoles with particles similar to a virus, inside. Similar to virus, particles were found among microvilli of syncytiotrophoblast; it presented with a thick basal membrane and with calcifications. Hyperplasia of Hofbauer cells was seen, although there were not viral particles inside. In the membrane of fetal erythrocytes there particles, electron dense, possibly from viral origin. Viral particles were identified in the nuclei of endothelial cells of the brain and lung. In the semen budding areas were seen in immature spermatozoon; and similar particles were seen y spermatozoa, probable desquamation cells, and in seminal protein, in free form. It is concluded that the HIV may be transmitted via transplacental in very early stages of gestation. The hyperplasia of Hofbauer cells can be a response of local defense. And finally, the presence of viral particles in the different components of semen favor its transmission by sexual contact.

A prospective study to evaluate the prevalence of specific microorganisms in pregnant and nonpregnant women with cervicovaginitis attended at the Instituto Nacional de Perinatología, was done; Candida sp, Gardnerella vaginalis, Replasma urealitycum, Chlamydia trachomatis, Group B Streptococcus, Trichomonas vaginalis, Neisseria gonorrhoeae were investigated. Two hundred thirty four patients were studied, 105/234 (44.9%) pregnant and 129/234 (55.1%) nonpregnant women, with a mean age of 26.5 years (range 14 to 44 years). One hundred eighty one (77.5%) women had only one sexual partner. The most common microorganisms seen were Candida sp (31.6%), Gardnerella vaginalis (27.7) and Ureaplasma urealyticum (15.8%). Infection by Chlamydia trachomatis was documented in 9.8% of the population. Trichomonas vaginalis was identified in 1.7%, there was not any case of Neisseria gonorrhoeae infection. Candida sp and Ureaplasma urealyticum were founded more frequent in the pregnant women than nonpregnant women, 41.9% vs. 24.8% (p less than 0.01) and 20% vs. 12.4% (p less than 0.05) respectively. Group B Streptococci was isolated as a single agent in 4.8% in pregnant women. There were not found any pathogenic microorganisms in 29.9% of the cases, as a causal agent of symptomatic cervicovaginitis.

A prospective study was carried out in which quantitative clean-voided urine cultures, were obtained at the first clinic visit from 986 consecutive pregnant women, followed to delivery to assess the maternal and pediatric finding associated with maternal asymptomatic bacteriuria. Patients to be evaluated were divided in two groups: Treatment group (TG) with 42/46 patients that were treated with nitrofurantoin 100 mg a day during 10 days, and control group (CG) with 45/46 patients that were not treated. Patients who failed were given a second course of nitrofurantoin. The patients who remained infected were given further treatment (cephalexin). Primary treatment was successful in 85%, 10% more with the second course and 5% were failure treatment. There was a highly significant difference in the incidence of symptomatic bacteriuria (pyelonephritis), premature deliver, prematurity and other perinatal events in patients with persistent infection. Eradication of asymptomatic bacteriuria reduced the risk of pre-term deliveries and lower infant birth weights for gestational age.