Pregestational body mass index and risk of maternal adverse events. / Índice de masa corporal pregestacional y riesgo de eventos adversos maternos.

BACKGROUND: In women of reproductive age, pregestational overweight and/or obesity could result in negative outcomes for both, mother and child. OBJECTIVE: To investigate the association between pregestational body mass index (PBMI) and maternal adverse outcomes (MAO) during childbirth, in women assisted during 2014, in a public hospital in Mérida, Yucatán, Mexico. MATERIAL AND METHODS: 427 pregnant women assisted during childbirth were consecutively included, identifying among them those who did not have any MAO (n = 137), whose demographic and clinical data, including PBMI, were compared with those who did have at least one MAO (n = 290). Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using a binary logistic regression model (LRM). RESULTS: 33% had normal PBMI, and 37% had obesity. Urgent cesarean section was the most frequent MAO (58.8%). According to the LRM, schooling (secondary school level, OR: 0.56; 95% CI: 0.34-0.94), primigravidae ( OR: 6.88; 95% CI: 3.37-12.58), and secondigravidae women (OR: 5.57; 95% CI: 3.04-10.24), the number of prenatal visits (≥ 5, OR: 3.49; 95% CI: 1.54-7.91), and PBMI (overweight, OR: 0.41: 95% CI: 0.23-0.72) were identified as clinically and statistically significant. CONCLUSIONS: Women with overweight were at low risk for MAO, while schooling (secondary school level) reduced risk by 44%, being a primigravidae or a secondigravidae increased risk more than 6 and 5 times, respectively. Paradoxically, prenatal visits (≥ 5 medical visits) increased risk more than 3 times.

INTRODUCCIÓN: En la mujer en edad reproductiva, el sobrepeso y la obesidad pregestacional pueden ser adversos a los resultados de la gestación, tanto para la madre como para el producto. OBJETIVO: Investigar la asociación entre el índice de masa corporal pregestacional (IMCP) y los eventos adversos maternos (EAM) durante el nacimiento del producto, en gestantes atendidas en un cuatrimestre de 2014, en un hospital público de Mérida, Yucatán, México. MATERIAL Y MÉTODOS: Se incluyeron 427 gestantes y se identificaron las que no tuvieron ningún EAM (n = 137), cuyos datos demográficos y clínicos, incluido el IMCP, fueron comparados con los del grupo que tuvo alguno (n = 290). Se obtuvieron razones de momios (RM) e intervalos de confianza del 95% (IC 95%) con un modelo de regresión logística binario (MRL). RESULTADOS: El 33% de la muestra tenía IMCP normal, el 30% tenía sobrepeso y el 37% presentaba obesidad pregestacional. Fue la operación cesárea urgente el EAM más frecuente (58.8%). El MRL identificó como significativamente asociados a los EAM la escolaridad secundaria (RM: 0.56; IC 95%: 0.34-0.94), ser primigesta (RM: 6.88; IC 95%: 3.37-12.58), ser secundigesta (RM: 5.57; IC 95%: 3.04-10.24), el número de visitas prenatales (≥ 5, RM: 3.49; IC 95%: 1.54-7.91) y el IMCP (sobrepeso, RM: 0.41; IC 95%: 0.23-0.72). CONCLUSIONES: Tener sobrepeso pregestacional redujo el riesgo de EAM hasta un 59%, la educación secundaria lo redujo un 44%, ser primigesta lo incrementó más de seis veces, ser secundigesta lo incrementó más de cinco veces y tener ≥ 5 visitas prenatales paradójicamente lo incrementó más de tres veces.

Hemostatic profile in patients with and without postpartum hemorrhage / Perfil hemostático en pacientes con y sin hemorragia obstétrica posparto

Background: The association between coagulation profile and postpartum hemorrhage (PH) is still debated. Objective: To determine the association between hemostatic profile and PH in women with cesarean operation (CO). Methods: We included 92 patients with PH (cases) and 184 without (controls), patients were attended during 2014, at one hospital of the Instituto Mexicano del Seguro Social in Mérida, Yucatán. Demographic, clinical and laboratory data including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLC), and fibrinogen concentration were compared among cases and controls using a binary logistic regression model (LRM), from which odd ratios (OR), and 95% confidence intervals (95% CI), were obtained. Results: According to the bivariate comparison, in the LRM categorical data such as parity, any type of hypertensive comorbidity, type of anesthesia, and categorized aPTT (< 38 vs. ≥ 38 seconds), and one continuous variable (gestational age) were included. Having some hypertensive comorbidity (OR 3.55, 95% CI: 1.95-6.47), type of anesthesia (regional anesthesia, OR 0.27, 95% CI: 0.13-0.55) and aPTT (< 38 seconds, OR 0.26, 95% CI: 0.10-0.66) were all statistically significant. Categorized PT, platelet count and fibrinogen concentration, were not statistically significant. Conclusions: In this sample, having some hypertensive comorbidity increased risk of PH more than three times, while regional anesthesia and aPTT < 38 seconds reduced risk in 73% and 74%, respectively. Neither platelet count, nor fibrinogen concentration, or the PT categories modified risk of PH.

Introducción: la asociación entre el perfil hemostático y la hemorragia obstétrica posparto (HO) es controversial. Objetivo: determinar la asociación entre el perfil hemostático y la HO en pacientes con operación cesárea (OC). Métodos: se incluyeron 92 pacientes con HO (casos) y 184 sin HO (controles), atendidas durante 2014 en un hospital del Instituto Mexicano del Seguro Social de Mérida, Yucatán. Diversas variables, incluyendo la cuenta plaquetaria, el tiempo de protrombina (TP), el tiempo de tromboplastina parcial activado (TTPa) y el fibrinógeno plasmático, fueron comparadas entre casos y controles, mediante un modelo de regresión logística del que se obtuvieron razones de momios (RM) e intervalos de confianza de 95% (IC 95%). Resultados: con base en el análisis univariado se incluyeron en el modelo la paridad, comorbilidad hipertensiva (hipertensión crónica, preeclampsia, eclampsia), tipo de anestesia y el TTPa categorizado (< 38 frente a ≥ 38 segundos) y la edad gestacional (como dato continuo), resultando significativamente diferentes la presencia de comorbilidad hipertensiva (RM 3.55, IC 95%: 1.95-6.47), el tipo de anestesia (regional, RM 0.27, IC 95%: 0.13-0.55) y el TTPa (< 38 segundos, RM 0.26, IC 95%: 0.10-0.66). Conclusiones: en esta muestra, tener comorbilidad hipertensiva incrementó más de tres veces el riesgo de HO, la anestesia regional lo redujo en 73% y el TTPa < 38 segundos lo redujo en 74%. Ni el TP, ni la cuenta plaquetaria modificaron el riesgo.

[Chronic low back pain and associated risk factors, in patients with social security medical attention: A case-control study]. / Lumbalgia crónica y factores de riesgo asociados en derechohabientes del IMSS: Estudio de casos y controles.

BACKGROUND: Chronic low back pain (CLBP) is frequently seen in the orthopedic outpatient consultation. The aim of this paper is to identify risk factors associated with CLBP in patients cared for during the year 2012, at a General Hospital belonging to Instituto Mexicano del Seguro Social, in Yucatán, Mexico. METHODS: Data of 95 patients with CLBP (cases) was compared with data of 190 patients without CLBP (controls) using a binary logistic model (BLM), from which odd ratios (OR) and 95 % confidence intervals (95 % CI) were obtained. RESULTS: School level, body mass index (BMI) as a continuous variable, story of heavy weight lifting, some types of comorbidities and dyslipidemia, were identified as statistically significant in the bivariate analysis (p ≤ 0.05 each). In a second step, secondary school level (OR 0.25, 95 % CI: 0.08-0.81), dyslipidemia (OR 0.26, 95 % CI: 0.12-0.56), heavy weights lifting (OR 0.22, 95 % CI: 0.12-0.42), and BMI (OR 1.22, 95 % CI: 1.12-1.32) were all identified by the BLM as statistically significant. CONCLUSIONS: In this sample, secondary school level, dislipidemia and heavy weights lifting reduced the risk of CLBP, while the BMI increased the risk.

Introducción: la lumbalgia crónica (LC) es un padecimiento frecuente en el ámbito de la Ortopedia. El objetivo de este trabajo es identificar los factores de riesgo asociados a LC en pacientes atendidos durante 2012, en un Hospital General del Instituto Mexicano del Seguro Social, en Yucatán, México. Métodos: se identificaron de la consulta externa de Ortopedia 95 casos y 190 controles, comparando entre grupos diversos datos demográficos y clínicos mediante modelo de regresión logístico (ML) binario del que se obtuvieron las razones de momios (RM) y los intervalos de confianza de 95 % (IC 95 %). Resultados: fueron incluidos en el ML la escolaridad, el índice de masa corporal (IMC, como variable continua), la manipulación de objetos pesados, la presencia de comorbilidad y de dislipidemia, siendo identificados como estadísticamente significativas: el nivel secundaria de la escolaridad (RM 0.25, IC 95 %: 0.08 a 0.81), la dislipidemia (RM 0.26, IC 95 %: 0.12 a 0.56), la manipulación de objetos pesados (RM 0.22, IC 95 %: 0.12 a 0.42) y el IMC (RM 1.22, IC 95 %: 1.12 a 1.32). Conclusiones: la escolaridad secundaria, la ausencia de dislipidemia y no manipular objetos pesados redujeron el riesgo de LC, mientras que la obesidad lo incrementó.

[Perioperative risk factors associated with allogeneic blood transfusion in patients with hip fracture surgery]. / Factores de riesgo asociados a hemotransfusión alogénica en pacientes con cirugía de cadera.

BACKGROUND: The aim of this article is to identify risk factors associated with allogeneic blood transfusion (ABT) in patients undergoing hip surgery during 2008-2009, at a General Hospital, in Yucatán, Mexico. METHODS: Data of patients who received at least one package of allogeneic blood either before, during, or after hip surgery, (cases, n = 118), was compared against that of patients having the same type of surgery, but not transfused with an ABT (controls, n =138). Logistic regression analysis was carried on in estimating associations. Odd Ratios (OR) and 95 % confidence intervals (95 % CI), were applied when appropriate. RESULTS: Bleeding grater than or equal to 400 ml during surgery (vs < 400 ml, OR 5.68, 95% CI 2.5-12.9, p = 0.007), and having pre surgical hemoglobin (Hb) concentration < 11 g/dL (vs = 11 g/dL, OR 2.86, 95% CI 1.5-5.6; p = 0.001) were both, associated with ABT. Duration of surgery, the femoral segment involved, the surgical procedure and the postsurgical Hb, were all excluded. CONCLUSION: Bleeding grater than or equal to 400 ml during surgery and having pre surgical Hb concentration < 11 g/dL were both, associated with increased risk of receiving an ABT.

Introducción: el objetivo es identificar los factores de riesgo asociados a la hemotransfusión alogénica en pacientes con cirugía de cadera realizada en un hospital general citadino, durante 2008 y 2009. Métodos: fueron considerados como casos 118 pacientes que recibieron sangre alogénica en el pre, el trans o en el postquirúrgico inmediato, y como controles 138 pacientes que tuvieron el mismo tipo de cirugía, pero no fueron hemotransfundidos. La relación entre variables se investigó utilizando un modelo de regresión logística del que se obtuvieron la razón de momios (RM) y los intervalos de confianza (IC) de 95 %. Resultados: se identificaron como factores de riesgo: el sangrado transquirúrgico mayor o igual a 400 ml (frente a < 400 ml, RM 5.68, IC 95 % 2.5 a 12.9, p = 0.007) y la concentración prequirúrgica de hemoglobina < 11 g/dL (frente a = 11 g/dL, RM 2.86, IC 95 % 1.5 a 5.6; p = 0.001); pero no la duración de la cirugía, el segmento femoral intervenido, la técnica quirúrgica ni la Hb postquirúrgica. Conclusiones: el sangrado transquirúrgico mayor o igual a 400 ml y la Hb prequirúrgica < 11 g/dL incrementaron el riesgo de hemotransfusión alogénica.

Risk factors associated with symptomatic hypoglycemia in type 2 diabetes mellitus patients.

OBJECTIVE: To identify risk factors associated with symptomatic hypoglycemia (SH) (< or = 72 mg/dL) in patients with type 2 diabetes mellitus (t2DM) treated at a general hospital during July 2003 to December 2004. MATERIAL AND METHODS: Ninety four t2DM patients (incident cases) with a primary diagnosis of SH matched with 188 t2DM patients (incident controls) with a diagnosis other than hypoglycemia were included in a case-control study. Demographic and clinical variables entered into an automated binary logistic regression model from which odds ratio (OR) and 95% confidence intervals (95% CI) for variables with a p value < 0.05 were obtained. RESULTS: The binary logistic model determined that age had a "protective" effect, while duration of t2DM, educational level (Illiteracy-primary education, OR 3.7, [95% CI 1.4 to 10]; p = 0.009), attending physicians' specialty (family physician, OR 2.8, [1.02 to 7.9]; p = 0.04), chronic renal failure presence (OR 3.0, [1.2 to 7.7]; p = 0.01), antihyperglycemic treatment (combined therapy, OR 5.2, [2.3 to 11.8]; p < 0.01), fasting (OR 19.8, [9.1 to 43.1]; p < 0.001) and history of hypoglycemia (OR 2.9, [1.3 to 6.5]; p = 0.01) were all risk factors associated with SH. The variable "exposure to polypharmacy" was excluded from the logistic model (OR 4.86; [0.7 to 35.1]; p = 0.11). CONCLUSIONS: According to our results, physicians should be cognizant of the possibility that the odds of SH might be increased when treating patients with t2DM fulfilling factors, such as those identified in this investigation.

[Knowledge and application level of the Ramsay Scale by Mexican nurses specialized in intensive care]. / Conocimiento y nivel de aplicación de la escala de Ramsay por parte de enfermeras mexicanas especialistas en cuidados intensivos.

INTRODUCTION: Among the intensive care specialized nursing staff, knowing the sedation level of the patient under their responsibility is of crucial importance. The present study evaluated the knowledge that nurses specialized in intensive care (NSIC) have on the Ramsay Scale (RS) and the way in which they apply it. MATERIAL AND METHODS: Those personnel who were developing their activity in the intensive care units (ICU) of four public hospitals of the cities of Merida, Yucatan, Mexico were enrolled during May 2003. The information was obtained by applying an expressly designed questionnaire that contained both demographic endpoints (age, years of experience as NSIC and type of ICU) and those related with the RS (clinical components that it evaluates, operative definitions, frequency of use per week or day). 95% (95% CI) confidence intervals were applied and odds ratio (OR) was used to determined the likelihood of the event. RESULTS: Of the 60 nurses interviewed, 75% did not know the RS. Age was a significant factor associated with its knowledge, since 11 of 23 with an age equal to or less than 38 years (47.8%) and 4 of 37 over 38 years (10.8%) knew what it evaluated (OR of 4 for the group of lower age, 95% CI 1.5 to 12.3, p = 0.002). Of 15 NSIC who knew what it evaluated, 9 (60%) also knew its operative definitions, and stated that they applied it adequately per day. CONCLUSIONS: In this sample, there is an elevated percentage of NSIC who did not know the RS. Age was the factor associated with lack of knowledge.

Conocimiento y nivel de aplicación de la escala de Ramsay por parte de enfermeras mexicanas especialistas en cuidados intensivos / Knowledge and application level of the Ramsay scale by Mexican nurses specialized in intensive care

Introducción. Conocer el nivel de sedación del paciente a su cargo, entre el personal de enfermería especialista en cuidados intensivos, es de crucial importancia. El presente estudio evaluó el conocimiento que enfermeras especialistas en cuidados intensivos (EECI) tienen acerca de la escala de Ramsay (ER) y la forma en que la aplican. Material y métodos. Se incluyó personal que durante mayo de 2003 desarrolló su actividad en unidades de cuidados intensivos (UCI) de 4 hospitales públicos de la ciudad de Mérida (Yucatán, México). La información se obtuvo co la aplicación de un cuestionario diseñado ex profeso que contenía tanto variables demográficas (edad, años de experiencia como EECI y tipo de UCI) como relacionadas con la ER (componentes clínicos que evalúa, definiciones operativas, frecuencia de uso por semana y por día). Se aplicaron intervalos de confianza (IC) del 95% y se utilizó razón de momios (RM) para determinar la probabilidad del evento. Resultados. De 60 enfermeras entrevistadas, un 75% no conocía la ER. La edad fue un factor significativo asociado con su conocimiento, pues 11 de 23 (47,8%) con edad igual o menor de 38 años y 4 de 37 (10,8%) mayores de 38 años sabían qué evalúa (RM de 4 para el grupo de menor edad; IC del 95%, 1,5-12,3; p = 0,002). De 15 EECI que sabían qué evalúa, 9 (60%) también conocían sus definiciones operacionales, y refirieron que la aplicaban adecuadamente por día. Conclusiones. En esta muestra, un elevado porcentaje de EECI no conocía la ER. La edad fue el factor asociado con su desconocimiento

Introduction. Among the intensive care specialized nursing staff, knowing the sedation level of the patient under their responsibility is of crucial importance. The present study evaluated the knowledge that nurses specialized in intensive care (NSIC) have on the Ramsay Scale (RS) and the way in which they apply it. Material and methods. Those personnel who were developing their activity in the intensive care units (ICU) of four public hospitals of the cities of Merida, Yucatan, Mexico were enrolled during May 2003. The information was obtained by applying an expressly designed questionnaire that contained both demographic endpoints (age, years of experience as NSIC and type of ICU) and those related with the RS (clinical components that it evaluates, operative definitions, frequency of use per week or day). 95% (95% CI) confidence intervals were applied and odds ratio (OR) was used to determined the likelihood of the event. Results. Of the 60 nurses interviewed, 75% did not know the RS. Age was a significant factor associated with its knowledge, since 11 of 23 with an age equal to or less than 38 years (47.8%) and 4 of 37 over 38 years (10.8%) knew what it evaluated (OR of 4 for the group of lower age, 95% CI1.5 to 12.3, p = 0.002). Of 15 NSIC who knew what it evaluated, 9 (60%) also knew its operative definitions, and stated that they applied it adequately per day. Conclusions. In this sample, there is an elevated percentage of NSIC who did not know the RS. Age was the factor associated with lack of knowledge

[Abnormal pre-surgical tests and their association with tramp-surgical hemorrhagic complication in elective surgery]. / Pruebas de coagulación prequirúrgicas anormales y su asociación con complicación hemorrágica transquirúrgica, en cirugía electiva.

MAIN OBJECTIVE: To determine whether abnormal preoperative coagulation tests (PCT) are related to trans-surgical bleeding complication (TSBC) during elective surgical procedures. MATERIAL AND METHODS: Adult patients, undergone some elective surgical procedure in a tertiary care medical center, in Merida, Yucatan, Mexico in whom TSBC was looked for, were selected in a non-random fashion and included. TSBC was considered when bleeding in the surgical bed was > or =300 ml. Prothrombin time (PT) and partial thromboplastin time (PTT) were the PCT measured and compared against TSBC. To analyze data, inferential statistics was used. RESULTS: Eighty four males (49%) and 86 females (51%), were included. PT, PTT or both were requested to 100% of the them. PT was prolonged in 26 (15%), and PTT was prolonged in 14 (8%) patients. TSBC was documented in 30 patients (18%), although among those with and without bleeding, neither PT averages difference (P=0.76), nor PTT averages difference (P= 0.83), were statistically significant. In comparing TSBC and its relationship to abnormal PCT, again neither PT nor PTT were associated with bleeding (Fisher's exact tests for each: P= 0.41 and P= 1.0, respectively). CONCLUSION: In this sample, abnormal PCT were not associated with TSBC.

Pruebas de coagulación prequirúrgicas anormales y su asociación con complicación hemorrágica transquirúrgica, en cirugía electiva / Abnormal Pre-Surgical Tests and Their Association with Tramp-Surgical Hemorrhagic Complication in Elective Surgery

Objetivo: determinar si existe asociación entre pruebas de coagulación prequirúrgicas (PCP) anormales y el desarrollo de hemorragia transquirúrgica (HTQ), en cirugía electiva. Material y métodos: durante el año 2002 se seleccionaron en forma no probabilística a pacientes > 18 años intervenidos quirúrgicamente en un hospital de tercer nivel de atención médica en Mérida, Yucatán en los que se buscó HTQ. Ésta se dio cuando la hemorragia en el lecho quirúrgico fue > 300 ml. Las PCP medidas fueron el tiempo de protrombina (TP) y el tiempo de tromboplastina parcial (TTP). Los datos se analizaron con estadística inferencial. Resultados: TP o TTP fue solicitado a 100% de los pacientes; el primero estuvo prolongado en 26 (15%) y el segundo en 14 (8%). Los eventos hemorrágicos se documentaron en 30 casos (18%). Entre aquellos con o sin hemorragia, los valores promedio del TP o del TTP no fueron significativamente diferentes (P= 0.76 y P= 0.83, respectivamente). Asimismo, las PCP anormales, tampoco se asociaron significativamente con la presencia de HTQ (Prueba exacta de Fisher con P> 0.05 para cada una). Conclusión: en este grupo de pacientes las PCP anormales, no se asociaron con HTQ.

Main objective: To determine whether abnormal preoperative coagulation tests (PCT) are relatedto trans-surgical bleeding complication (TSBC) during elective surgical procedures. Material and methods. Adult patients, undergone some elective surgical procedure in a tertiary care medical center, in Merida, Yucatan, Mexico in whom TSBC was looked for, were selected in a non-random fashion and included. TSBC was considered when bleeding in the surgical bed was >300 ml. Prothrombin time (PT) and partial thromboplastin time (PTT) were the PCT measured and compared against TSBC. To analyze data, inferential statistics was used. Results: Eighty four males (49%) and 86 females (51%), were included. PT, PTT or both were requested to 100% of the them. PT was prolonged in 26 (15%), and PTT was prolonged in 14 (8%) patients. TSBC was documented in 30 patients (18%), although among those with and without bleeding, neither PT averages difference (P=0.76), nor PTT averages difference (P=0.83), were statistically significant. In comparing TSBC and its relationship to abnormal PCT, again neither PT nor PTT were associated with bleeding (Fisher's exact tests for each: P= 0.41 and P= 1.0, respectively). Conclusion: In this sample, abnormal PCT were not associated with TSBC.

Intoxicación aguda por plaguicidas / Acute poisoning from pesticides

Objetivo. Describir la epidemiología de la intoxicación aguda por plaguicidas (IAP) en el Hospital General O'Horán de Mérida, Yucatán, México. Material y métodos. Se revisaron los expedientes de 33 pacientes =13 años, tratados en una unidad de cuidados intensivos (UCI), entre 1994 y 1998. Se recopilaron variables demográficas y clínicas relevantes, y se aplicó estadística descriptiva. Resultados. En la población estudiada predominó el sexo masculino (82 por ciento) del medio rural (70 por ciento), y la edad media fue de 34 ñ 15.8 años. El intento de suicidio fue causa frecuente de IAP (79 por ciento), y en 33 por ciento de los casos la intoxicación se produjo por la utilización de organofosforados. La mortalidad fue de 12 por ciento. Conclusiones. La IAP fue baja entre los sujetos del medio rural, por lo que los resultados de este estudio parecen no reflejar la realidad del problema. Es importante añadir que los plaguicidas son utilizados con relativa frecuencia para el intento de suicidio.

Epidemiología de la preeclampsia-eclampsia en el Hospital General O'Horán: epidemiología de la preeclampsia-eclampsia de una muestra, en Yucatán / Epidemiology of preeclampsia-eclampsia at Hospital General O'Horán

Se describe la epidemiología de la preeclampsia-eclampsia (P-E) en el Hospital General O'Horán (HGOH) de la ciudad de Mérida, Yucatán entre 1995 y 1998. Se incluyeron pacientes egresadas con diagnóstico de P-E en las que se midieron variables demográficas y clínicas que se analizaron con estadística descriptiva. Fueron 143 pacientes, 58 (41 por ciento) con preeclampsia y 85 (59 por ciento) con eclampsia, con edad promedio de 24.4 ñ 7.3 y del medio rural en su mayoría (76 por ciento). La escolaridad de 79 por ciento fue hasta primaria. Fueron casadas 75 por ciento. El inicio de actividad sexual promedio fue de 18.8 ñ 4.3 años. Veintisiete por ciento cursó sin control prenatal. Fueron primigestas (55 por ciento) y nulíparas (52 por ciento). La edad gestacional al momento de presentar P-E tuvo mediana de 38 semanas. Se observaron complicaciones en 30 por ciento. El tiempo de estancia en la UCI tuvo mediana de dos días. La mortalidad del grupo fue de 5 por ciento. P-E fue frecuente en mujeres de nivel socioeconómico bajo control prenatal irregular. La evolución intrahospitalaria fue adecuada en la mayoría y la mortalidad baja