[Relationship between domestic violence during pregnancy and risk of low weight in the newborn]. / Relación entre la violencia familiar durante el embarazo y el riesgo de bajo peso en el recién nacido.

OBJECTIVES: To determine the prevalence and characteristics of domestic violence before and during pregnancy, and its impact on obstetrical and perinatal outcomes, as well as to identify the main variables associated to domestic violence during pregnancy. PATIENTS AND METHODS: From August to September 2004, 288 consecutive women in the puerperium period were screened for a cross-sectional study in the Hospital General Dr. Manuel Gea Gonz6lez. The Abuse Assessment Screen and the IPPF screening instrument were used to measure emotional and physical abuse during pregnancy. Outcome data included miscarriage, cesarean delivery, gestational age, birth weight and Apgar score. Odds ratios and 95% confidence intervals were calculated to measure the associations between maternal characteristics, perinatal outcome and violence. RESULTS: The prevalence of domestic violence during pregnancy was 39.24%. Emotional abuse was the most prevalent type before and during pregnancy (94.71 and 96.46%, respectively) whereas the frequency of physical and sexual decreased during pregnancy. Domestic violence 12 months before pregnancy increased risk of low birth weight (OR: 1.69; 95% CI: 1.01-2.81), and miscarriage (OR: 2.09; 95% CI 1.14-3.83). The exposure to domestic violence anytime before pregnancy (OR: 3.13; 95% CI 1.48-6.63) and 12 months before pregnancy (OR: 12.79; 95% CI 6.38-25.6) increased risk of domestic violence during pregnancy. CONCLUSIONS: Violence before and during pregnancy is common and is associated with adverse maternal and perinatal outcomes. There is a critical need to include a routine screening in the obstetric and gynecologic services and to provide medical and social services.

[Domestic violence: an approach from gynecology and obstetrics]. / Violencia familiar: una aproximación desde la ginecología y obstetricia.

Violence against women represents a serious violation of women's human rights and has been recognized as a clinical and public health problem, independently of nationality, ethnicity, cultural norms and socioeconomic status. One of the most common forms of violence against women is that perpetrated by an intimate male partner. The intimate partner violence has short-term and long-term negative health consequences, which provoke a poor quality of life with high use of health services, and even the suicide and homicide of women. Specifically, abuse during pregnancy is associated with sexually transmitted diseases, anemia, first and second trimester bleeding, less than optimal weight gain, deleterious perinatal outcomes (low birth weight, miscarriage, and fetal distress) and maternal or infant deaths. The purpose of this review is to emphasize the serious health consequences of the partner violence, and to compile the studies that have measured violence during pregnancy, particularly in Latin America.

[Attitudes and hierarchy of medical values in a gynecology and obstetrics department]. / Actitudes y jerarquía de valores en un servicio de ginecología y obstetricia.

BACKGROUND: The current practice of medicine is suffering a deep crisis of values due to the process of super-specialization, marketing tendencies, growing and the practice of a defensive medicine. OBJECTIVE: To examine the attitudes and hierarchy of medical values in undergraduate students, residents and faculty physicians in an obstetrics and gynecology department. MATERIAL AND METHODS: A descriptive, open, observational and transversal study was done, in which a questionnaire including a demographic data-record and 22 questions related to values and attitudes was applied to 29 individuals belonging to the medical staff of the gynecology and obstetrics service at Hospital General Dr. Manuel Gea Gonzalez. RESULTS: Medical knowledge, honesty and respect were consistently mentioned as the most emphasized characteristics across the examination. Benevolence and compassion were frequently indicated in undergraduate students, but not in third year residents and specialists. Respect for the right of individual patients to make their own choices about their health care, in some doctors, is a problematic issue. CONCLUSIONS: The teaching of professionalism is important in residency training and is expected to be an equal partner in the triad of knowledge, skills and values.

[Current concepts of venous thromboembolism and anticoagulation during pregnancy]. / Conceptos actuales en tromboembolismo venoso y anticoagulación durante el embarazo.

The pregnancy is a physiologic state with an elevated risk for thromboembolic complications. Clinical diagnosis and many diagnostic tests are less accurate in pregnant than in nonpregnant patients. The principal indications for anticoagulation during pregnancy include treatment and prophylaxis of deep vein thrombosis and pulmonary embolism, and prevention of pregnancy loss in women with antiphospholipid antibodies. However, the use of anticoagulants may produce complications in the fetus, as well as in the mother. This paper provides recommendations for the safe use of anticoagulants during pregnancy.