Epidermólisis bulosa distrófica recesiva en mujer embarazada. Reporte de caso / Recessive dystrophic epidermolysis bullosa in pregnant women. Case report

Resumen INTRODUCCIÓN: La epidermólisis bulosa engloba a un grupo de enfermedades caracterizadas por una fragilidad extrema de la piel y membranas mucosas, consecuencia de la formación de ampollas posterior a un traumatismo mínimo. Hay tres tipos principales de epidermólisis. Se comunica el caso para hacer notar las implicaciones del cuidado al momento del nacimiento, y las consideraciones anestésicas. CASO CLÍNICO: Paciente de 25 años en su segundo embarazo con epidermólisis bulosa distrófica recesiva. El nacimiento fue electivo mediante cesárea, con anestesia regional. CONCLUSIONES: Debe tenerse especial cuidado durante las intervenciones terapéuticas a fin de evitar la formación de bulas o exacerbar las existentes. Las fuerzas de fricción son más dañinas que las de compresión. La planeación multidisciplinaria es necesaria para un desenlace sin complicaciones.

Abstract BACKGROUND: Epidermolysis bullosa encompasses a group of diseases characterized by extreme fragility of the skin and mucous membranes, resulting in the formation of blisters after minimal trauma; There are three main types of epidermolysis. The case is presented to highlight the implications of care both at the time of birth, as well as anesthetic considerations. CLINICAL CASE: A 25-year-old patient in her second pregnancy with recessive dystrophic epidermolysis bullosa. The birth was elective by caesarean section under regional anesthesia. CONCLUSIONS: Special care must be taken during therapeutic interventions to avoid the formation of bullae or exacerbate those already present. Friction forces are more damaging than compression forces. Multidisciplinary planning is necessary for a smooth outcome.

Síndrome de Klippel Trenaunay y embarazo. Reporte de tres casos / Klippel-Trenaunay syndrome and pregnancy. Report of three cases

Resumen ANTECEDENTES: El síndrome de Klippel Trenaunay es una enfermedad congénita rara, caracterizada por malformaciones capilares y venosas, sobrecrecimiento de miembros y en algunos casos malformaciones linfáticas. Quienes lo padecen tienen un riesgo incrementado de hemorragia y tromboembolismo. CASOS CLÍNICOS: Tres pacientes primigestas con diagnóstico de síndrome de Klippel Trenaunay con complicaciones del embarazo que finalizaron mediante cesárea con el nacimiento de sus hijos sanos, de término, en todos los casos. CONCLUSIONES: Las embarazadas y con síndrome de Klippel-Trenaunay tienen un riesgo significativo de que sus síntomas se agraven, de tener hemorragia durante el nacimiento y de eventos tromboembólicos, incluso después del nacimiento. La atención individualizada y multidisciplinaria ayudará a mitigar las complicaciones asociadas y a conseguir desenlaces óptimos.

Abstract BACKGROUND: Klippel Trenaunay syndrome is a rare congenital disease characterized by capillary and venous malformations, limb overgrowth and in some cases lymphatic malformations. Sufferers have an increased risk of hemorrhage and thromboembolism. CLINICAL CASES: Three primigravid patients diagnosed with Klippel Trenaunay syndrome with pregnancy complications that were terminated by cesarean section with the birth of their healthy, full-term children in all cases. CONCLUSIONS: Women with Klippel-Trenaunay syndrome and pregnancy are at significant risk for aggravation of their symptoms, hemorrhage during birth, and thromboembolic events, even after birth. Individualized, multidisciplinary care will help mitigate associated complications and achieve optimal outcomes.

Desenlaces perinatales, en un centro de tercer nivel de México de pacientes con colestasis intrahepática del embarazo / Perinatal outcomes of patients with intrahepatic cholestasis of pregnancy in a third level center in Mexico

Resumen OBJETIVO: Describir la atención, tratamiento, desenlaces perinatales y complicaciones asociadas con la colestasis intrahepática del embarazo. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo y observacional de pacientes embarazadas, con diagnóstico de colestasis intrahepática atendidas en el Instituto Nacional de Perinatología entre los meses de enero de 2016 a diciembre de 2020. Se evaluaron las características obstétricas, los datos demográficos, clínicos, bioquímicos y de tratamiento, la finalización del embarazo y los desenlaces perinatales. RESULTADOS: Se analizaron 67 casos de colestasis intrahepática que arrojaron una incidencia de 0.57%. La edad promedio de las pacientes fue 29.0 ± 6.8 años, 30 de 67 eran primigestas, 12 tuvieron el antecedente de colestasis intrahepática en el embarazo previo y 7 de óbito. El inicio de la enfermedad fue en el tercer trimestre en 41 de 67 pacientes. En los estudios de bioquímica 32 de 67 tuvieron valores de ácidos biliares entre 10 y 39 μM/L; 12 de las 67: 40-99 μM/L y 23 más de 100 (μM/L). Se administró tratamiento con ácido ursodesoxicólico a 63 de 67 y ante la falta de respuesta se agregó rifampicina. El promedio de semanas de gestación fue 35.6 ± 2.0 semanas con peso promedio de 2397 ± 572 g. Se encontró líquido amniótico con meconio en 10 neonatos y restricción del crecimiento en 20 de 67; se registraron 2 óbitos. CONCLUSIONES: Este es el primer estudio efectuado en México que describe la incidencia de la enfermedad y se utiliza la determinación de los ácidos biliares para establecer el diagnóstico. Los desenlaces perinatales coinciden con lo reportado en la bibliografía.

Abstract OBJECTIVE: To describe the care, treatment, perinatal outcomes and complications associated with intrahepatic cholestasis of pregnancy. MATERIALS AND METHODS: A retrospective and observational case series study of pregnant patients with a diagnosis of intrahepatic cholestasis seen at the National Institute of Perinatology between January 2016 and December 2020. Obstetric characteristics, demographic, clinical, biochemical and treatment data, pregnancy termination and perinatal outcomes were evaluated. RESULTS: Sixty-seven cases of intrahepatic cholestasis were analyzed, yielding an incidence of 0.57%. The mean age of the patients was 29.0 ± 6.8 years, 30 of 67 were primigravidases, 12 had a history of intrahepatic cholestasis in the previous pregnancy and 7 had an abortion. The onset of the disease was in the third trimester in 41 of 67 patients. In biochemistry studies 32 of 67 had bile acid values between 10 and 39 μM/L; 12 of 67: 40-99 μM/L and 23 more than 100 (μM/L). Treatment with ursodeoxycholic acid was administered to 63 of 67 and rifampicin to 4 patients. The mean number of weeks of gestation was 35.6 ± 2.0 weeks with a mean weight of 2397 ± 572 g. Amniotic fluid with meconium was found in 10 neonates and growth restriction in 20 of 67; there were 2 recorded abortions. CONCLUSIONS: This is the first study carried out in Mexico in which the incidence of the disease is described, and the determination of bile acids is used to establish the diagnosis. Perinatal outcomes coincide with those reported in the literature.

Sarcomas durante el embarazo: reporte de dos casos y revisión de la literatura / Sarcomas in pregnancy: Report of two cases and literature review / Sarcomas in pregnancy: Report of two cases and literature review

RESUMEN 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.

ABSTRACT Objective: To present the perinatal results of two patients diagnosed with Ewing's sarcoma and alveolar rhabdomyosarcoma. Methodology: Two cases of patients with a diagnosis of sarcoma treated at the National Institute of Perinatology in Mexico City were reviewed. Results: Case 1, a 22-year-old female, with a 23.0-week pregnancy and a 20-cm tumor in the left gluteal region, pain and difficulty walking. The chest radiograph revealed multiple pulmonary nodules and the magnetic resonance imaging revealed a tumor in the gluteal region with extensive involvement. The diagnosis was stage IV metastatic Ewing sarcoma. Management consisted of symptomatic treatment with resolution of the pregnancy at 28 weeks. Case 2, a 22-year-old female with a 12.0-week pregnancy and a diagnosis of metastatic spinal cord syndrome. T9-11 decompression was performed. Absence of fetal heart rate was evidenced, so medical management of deferred abortion was performed.

Edulcorantes no calóricos en la mujer en edad reproductiva: documento de consenso / Non-caloric sweeteners in women of reproductive age: a consensus document

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

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

[Non-caloric sweeteners in women of reproductive age - A consensus document]. / Edulcorantes no calóricos en la mujer en edad reproductiva: documento de consenso.

INTRODUCTION: 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.

INTRODUCCIÓN: 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.

Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis.

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.

[Contraception and bioethics: between the conscience objection and the autonomy principle]. / Anticoncepción y bioética: entre la objeción de conciencia y el principio de autonomía.

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.

Knowledge and attitudes of Latin American gynecologists regarding unplanned pregnancy and use of combined oral contraceptives.

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.

[Myths and realities of the long-term reversible contraceptives]. / Mitos y realidades de los anticonceptivos reversibles de larga duración.

BACKGROUND: For a woman uses contraception acceptance not only required but also the possibility of minimal or no side effects, comfort and tranquility of their safety. There are women who find it inconvenient not taking the pill daily, but for many other yes, what follows that notwithstanding their safety, do not suit the need of women. IUDs have reached high fees clinical efficacy and safety for use in any group of women, including gilts. METHODOLOGY: A search for original articles and systematic reviews published in the last ten years in the PubMed database, specifically study reversible long-term hormonal contraception was made. They were included in the various search engines, the words: Long-Acting Reversible Contraception, intrauterine contraceptive method, contraceptive implants and intrauterine, myths About IUDs, and others. We selected the highest level of evidence and documents were analyzed and 76 of these myths and realities were located around the long-term contraception. CONCLUSIONS: There are too many myths accepted as paradigms and perceptions about IUDs, especially about its indication to nulliparous women, who do not stand by the scientific evidence. The clinical efficacy of intrauterine contraception in nulliparous women is equal in multiparous; though probably more painful insertion in the former, but not harder.

[Reversible long-duration contraceptives: an efficient strategy to reduce non-planned pregnancies]. / Anticonceptivos de larga duración reversibles: una estrategia eficaz para la reducción de los embarazos no planeados.

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.

[The pregnant adolescent: information, beliefs and attitudes toward sexuality]. / La adolescente embarazada: información, creencias y actitudes hacia la sexualidad.

BACKGROUND: 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. OBJECTIVE: Explore some of the knowledge, beliefs and attitudes about sexuality in pregnant adolescents younger than 17 years. PATIENTS AND METHOD: 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? RESULTS: 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. CONCLUSIONS: 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.

[Benign peritoneal cystic mesothelioma as differential diagnose of an ovarian dependant tumor. Case report and review of the literature]. / Mesotelioma quistico peritoneal benigno como diagnóstico diferencial de tumor dependiente del ovario. Comunicación de un caso y revisión bibliográfica.

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.

[Causes of preterm delivery among adolescent mothers]. / Causas de nacimiento pretérmino entre madres adolescentes.

OBJECTIVE: To describe the proportion of preterm delivery at pregnant adolescents clinic and their maternal, obstetric and fetal conditions other than spontaneous labor. PATIENTS AND METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

[Analysis of the perinatal results of the first five years of the functioning of a clinic for pregnant teenagers]. / Análisis de los resultados perinatales de los primeros cinco años del funcionamiento de una clínica de atención para adolescentes embarazadas.

OBJECTIVE: To evaluate the perinatal outcomes within a pregnant cohort of adolescents aged 16 years and younger. PATIENTS AND METHODS: 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. INCLUSION CRITERIA: 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. RESULTS: 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%. CONCLUSIONS: The adolescent pregnant has a high risk of suffering major complications, such as genital and urinary tract infections, anemia and preterm delivery.

[Quantification of perinatal risk in Mexican adolescents: consequences of maternal low weight]. / Cuantificación del riesgo perinatal en adolescentes mexicanas: consecuencias del bajo peso materno.

OBJECTIVE: 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. PATIENTS AND METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

[Perinatal implications of pregnancy in adolescent women]. / Implicaciones perinatales del embarazo en la mujer adolescente.

OBJECTIVE: 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. PATIENTS AND METHOD: 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. STATISTICAL ANALYSIS: descriptive, t-test, chi-squared and Fisher's exact test. RESULTS: 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. CONCLUSIONS: Pregnancy in adolescents should be considered of risk; nevertheless, adequacy in antenatal care provides good obstetric and perinatal outcomes.

[Conservative management of secondary ectopic abdominal pregnancy. Case report with literature review]. / Manejo conservador del embarazo ectópico abdominal secundario (intersticial). Informe de un caso y revisión de la literature.

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.