[Scuba diving and pregnancy. A case report and review of the literature]. / Buceo y embarazo. Informe de un caso y revisión de la literatura.

The number of women in childbearing age participating in SCUBA dividing is increasing. Some dives during first trimester before pregnancy is confirmed. The preoccupation of both parents, is that the child could have any damage in the embryonal stage. This is a review of the literature and we present one case of a patient 28 years old with one immersion of 25 meters, at 28 days of gestation. The child did not present any congenital deformity at birth and his growth and development in the eighteen months have been normal.

[Clinical trial of a new suction system for uterine curettage. Preliminary report]. / Experiencia clínica de un nuevo sistema de succión para legrado uterino. Reporte preliminar.

PIP: Uterine curettage was done on 60 patients aged 16-40, mostly with parity over 6. Indications were incomplete abortion, and 1 case of hydatiform mole. The procedure was performed with a new plastic cannula, very flexible and with a blunt tip, and with a diameter going from 4 to 10 mm. With such a tool, uterine perforations are reduced to a minimum, and the possibility of choosing among different sizes makes dilatation of the cervix easy and painless. Bleeding was minimal and hospitalization necessary only in a few cases; anesthesia was used on 50 patients. It is imperative that, to avoid complciatiics, the procedure be performed by a skilled physician.^ieng

[Usefulness of the flame test in the diagnosis of premature rupture of fetal membranes]. / Utilidad de la prueba de la flama en el diagnóstico de ruptura prematura de membranas fetales.

A prospective, experimental and comparative study, was carried out at the Labor Service and Perinatology Service at Gyn-Ob Division, Regional Hospital "20 de Novembre" ISSSTE, Mexico City, during the period from September 1st, 1987 to September 1st., 1988. The objective was to demonstrate usefulness of the Flame Test in the diagnosis of premature rupture of membranes (PRM). A total of 116 samples from patients randomly selected, in four groups (3 controls and one problem group), were studied. The test was used in comparison with crystallography. Age, gesta, parity, abortion and cesarean section, and birth's via, as well as the antecedent of use of anticonceptives, were studied. Twenty six samples in Group I, 10 in Group II, 40 in Group III and 40 in Group IV, were obtained. The statistical method of X,2 was used, and a statistically significant difference (p.05), was obtained, with a sensitivity of 97.8%, and specificity of 100%, a predictive value of 100%, and security of 98% for the test. It's concluded that the Flame test is useful in the diagnosis of PRM, with a low cost, a high sensitivity, and a similar specificity to the reported one by others.

[Alternative management of iron deficiency anemia in pregnancy and puerperium]. / Manejo alternativo de la anemia ferropénica en el estado grávido-puerperal.

An open, observative, prospective, follow-up study was performed in 80 obstetric patients at the 20 de novembre Hospital in Mexico city between november 1986 and august 1987. There were two groups: 40 pregnant patients (between 15 and 35 weeks of pregnancy), and 40 puerperants (between 1st and 6th day or puerperium), both groups had confirmed diagnosis of iron deficiency anaemia; iron-deficiency was estimated upon haemoglobin level, patients body weight and obstetric status. After that, diluted dextran-iron was infused intraveously, six weeks after iron infusion the patients were evaluated. Haemoglobin, haematocrit and red blood cell levels showed a significant rise. Abnormalities observed in the blood smear decreased; 10% of the patients in both groups showed slight secondary reactions, which were self-limited or subside with medical therapy.

[The use of prostaglandins for labor conduction in its latent phase]. / Empleo de prostaglandinas para la conducción del trabajo de parto en su fase latente.

We wanted to know enprostil efficacy, an E2 prostaglandin analogous as a labor conductor in it's latent phase in term pregnancies. 188 patients were included, 52% received intracervical enprostil and 48% were treated with oxytocin. The labor evolution, resolution and complications were watch over. 15 patients (15.6%) of the study group required labor conduction with oxytocin because it was inhibited after peridural anesthesia. The main pregnancy resolution was vaginal via; only 6.3% of the study group subjected cesarean section against 10.3% of the witness group and the most frecuent indication was stationary dilation (1 and 8 cases respectively). The time of the latent phase and total labor was lower statistically in the study group. The observed complications were post-labor hemorrhage (3.1%), polysystolia (4.1%) and vomiting (5.2%), without significant difference with the witness group. We conclude that intracervical enprostil help cervical mature. shortenning latent phase and total labor, disminish oxytocin requeriment and cesarean incidence by cervical alterations without compromise maternal-fetal morbi-mortality.

[Proposed normal values for alpha fetoprotein in maternal serum for the detection of neural tube closure defects and Down syndrome. Preliminary study]. / Propuesta de valores normales de alfa fetoproteína (AFP) en suero materno para la detección de defectos en el cierre del tubo neural (DCTN) y síndrome de Down (SD). Estudio preliminar.

To establish a normal range of alpha fetoprotein in maternal serum (AFP sm) in the population at the "20 de Noviembre" Hospital in Mexico City, there were studied 46 patients with a normal pregnancy confirmed with ultrasonography between 16 to 18 week of gestation. The 97 determinations of AFPsm were made by radioimmunoanalysis. The multiples of the median (MoM) were 2.16 al 16th weeks, 2.33 a 17th week 2.43 al 18th week of pregnancy. Now the methods to determine abnormalities in the product and the genetics studies are proposed only to the patients considered high risk (older than 35 years old, previous malformed son or family history of those abnormalities). AFPsm and the establishment of normal range allow us to amplify the study to every pregnant woman and to determine those malformations in the pregnant women of low risk which represents about 90-95% of DCTN and about 80% of SD.

[Cesarean section: science or anxiety? Eleven years of institutional experience]. / Operación cesárea: ciencia o ansiedad? Once años de experiencia institucional.

The increasing rise of cesarean section rate invites to analyze its indications. The present study was done from 1985 to 1995, which means 11 years of study with 38,407 cases. Frequency and clinical indications were analyzed. As to births, frequency was 40.6%. Main causes were: Iterative section 38.2%; cephalopelvic disproportion 28.1%; pelvic presentation, 23.4%; hypertensive disease in pregnancy 16.3%; and acute fetal suffering, 10.9%. The careful observation of indications in every institution, may produce better reasons for reducing such high indexes.

[Tumor necrosis factor-alpha and interleukin-1 beta in maternal, fetal and retroplacental intravascular compartments at term and preterm labor]. / Factor de necrosis tumoral-alpha e interleucina-1 beta en los compartimentos intravascular materno, fetal y retroplacentario en parto a término y pretérmino.

Neonato preterm birth (before 37 pregnancy weeks) account more than 80% perinatal deaths not attributable to congenital malformations. Preterm and term labor full mechanisms are unknown at present. Proinflammatory cytokinesis direct participation have been involved in the phenomena by several experimental evidence. The study's aim was to determine TNF-alpha and IL-1 beta concentration at maternal, fetal and fetal-maternal vascular compartments in women with term and preterm delivery and in women at term childbirth without labor. TNF-alpha and IL-1 beta concentration were determinated by commercial immunoassay. TNF-alpha concentration showed a tendency to be in more proportion at fetal and fetal-maternal compartments in preterm and term childbirth groups versus TNF-alpha concentration in term group without labor at same places. IL-1 beta concentration showed same tendency of increase than TNF-alpha in preterm and term childbirth groups, but alone at fetal-maternal compartment. Statistical difference were not documented at any compartment or group compared. Data allow to identify fetal-maternal compartments as target places where TNF-alpha and IL-1 beta were synthesized. Gradient concentration synthesis of cytokinesis allows to intend fetus as TNF-alpha initial producer.

[Genetic amniocentesis]. / Amniocentesis genética.

179 patients were studied by genetic amniocentesis (GA) in sessions of 3 punctures each. This was done in order to follow a prenatal diagnosis (PD) program and study amniotic fluid at the Hospital Regional 20 de Novembre (ISSSTE) between May 1983 and December 1987. The parameters taken were: age, indications, number of sessions, number punctures, echosonographic studies for gestational age, placental insertion, punction site, amniotic fluid volume, blood contamination, failures and handling of the patient. A low incidence of abortion is reported. We don't have cases of dripping of amniotic fluid or transvaginal haemorrhage. Multiple insertion of the needle and placental or vessel lesions of the cord, as causes of a fetal death are still argued if we have in mind avoiding chances; we didn't have those complications in our cases. The percent is low if there are not previous spontaneous abortions. 79% of the amniotic fluid samples were sent between the 15th and 17th weeks of pregnancy. For alpha fetus protein determination 12 and for biochemical studies 1, specially for beta-galactosidase level. This was done at the Biomedical Investigation Institute of the National Autonomous University of Mexico (in parents with generalized gangliosidosis GM1). Even though results were good, the technique has still risks and complications. An ultrasonic study of the procedures made by physicians with trustable experience is needed. Our country has the need to create more Prenatal Genetic Diagnosis Centers.

[Ultrasonic measurement of the cerebellum in the newborn infant as a prognostic index of gestational age. (A preliminary study)]. / Medición del cerebelo por ultrasonido en el neonato como índice predictivo de edad gestacional. (Estudio preliminar).

This paper studies if cerebellum measurement by ultrasound is a point of prognostic value for evaluation of gestational age. Ninety-nine neonates of different age of gestation, were studied. Ultrasonographic study of the cerebellum was done in all the cases during the first 24 hours of life. It is suggested that the cerebellum measurement may be one indicator more for the evaluation of gestational age, and therefore of value to identify the products with growth disturbances.

[AIDS and pregnancy]. / SIDA y embarazo.

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.

[Norplant: a 3-year experience of the National Institute of Perinatology in Mexico]. / Norplant: experiencia de tres años en el Instituto Nacional de Perinatología.

We present the experience from Instituto Nacional de Perinatología (INPer) with the use of subdermal contraceptive implants Norplant from 1995 to 1997. The purpose was to Know the sociodemographic characteristics and evaluate contraceptive efficacy, adverse effects and tolerance on the users of Norplant. We carried out a prospective, observational trial in the Family Planning Clinic, during the period january 1o, 1995 through december 31, 1997. Women with desire of long term hormonal contraception, and without contraindications for the use of progestins were eligible for the study. The follow up consisted in visits every 6 months, and in some cases we obtain the information by telephonic interviews. One hundred an two women were included in the study; the median age of the subjects was 21.6 years, the median number of pregnancies were 2.0. In 53% of the subjects an obstetric risk factor was present such as adolescence (25.5%), social (8.8%), and others. Seventy-four women were followed up, and accumulated 1,064 months of observation. (Average 14.4 months). Menstrual irregulaties (83%), and headache (30%) were the most frequent adverse effects. The continuity rate was 81%, and during the study no pregnancy was observed. The principal causes for the extraction of the implants were menstrual irregulaties and headache. The contraceptive subdermal implants Norplant, constitutes and excellent choice because of its high efficacy, safety and good tolerance.

[Dilated myocardiopathy and pregnancy. Report of 3 cases and review of the literature]. / Miocardiopatía dilatada y embarazo. Informe de tres casos y revisión de la literatura.

Pregnancy in association with dilated cardimyopathy is considered to be a rare entity. The incidence is unknown. The dilated cardiomyopathies (DCM) are defined as diseases of the cardiac muscle without a known cause. Three pregnancies with DCM are reported. In this article the possible hazzards of pregnancy and DCM are discussed, including a review of the literature concerning to diagnosis and management is present.

[Balance of the TH1/TH2 immune response in the materno-fetal interphase in normal and preterm pregnancy. Preliminary results]. / Balance de la respuesta inmune TH1/TH2 en la interfase materno-fetal de pacientes con embarazo normal y pretérmino. Resultados preliminares.

The subpopulations don's speak directly of the answers Th1 or Th2 in the compartment, as the are only reflexion of prevalent citocines in the microenvironment: However. It is important its exploration to the taken as starting point of this project.

[Initial experience with a minidose of methotrexate in the management of unruptured ectopic pregnancy]. / Experiencia inicial con un esquema de minidosis única de metotrexate para el manejo de embarazo ectópico no roto.

Methotrexate has been used in the conservative management of ectopic pregnancy with good results. Due to its great afinity for the trophoblast it was decided to try unique doses of 50 mg i.m. independently of the body surface. Fifteen patients were studied with ectopic pregnancy by ultrasound and hCG in series that didn't require confirmatory laparoscopy. The ectopic pregnancies broken and/or decompensated were discarded. Average gestational age was 6.1 weeks; the maximal dimention of the sacs was 36.8 mm average; the values for hCG average were 6440 mU/ml and the maximal time of negativization was 52 days. One patient required laparoscopy and salpingostomy, lineal, for inminent rupture 24 hour after methotrexate, the other 14 presented with complete remission. There were no colateral effects. From the 15 patients, in 6 tubal permeability was confirmed by laparoscopy or HSG, being positive in 6 patients, it has not been evaluated, two patients with resolved pregnancy, and other on course (two of them with one salpinx). The proposed management seems to be useful in ectopic pregnancy with success, equivalent to surgical management, and other programs of medical management, with out side effects and with greater easiness of administration.

[Manual intrauterine aspiration om the treatment of molar pregnancy]. / Aspiración manual endouterina para el tratamiento del embarazo molar.

Thirty six cases of molar pregnancy treated by Manual Vacuum Aspiration (MVA) were reviewed in the Instituto Nacional de Perinatología from January 1st to october 31, 1997. Molar pregnancy rate was 2.3 per 1000 pregnancies. Sixty percent of the cases occurred in women aged 20-30 years old. Previous molar pregnancy was the most frequent risk factor found, it was present in 44.5% of the cases. The mean gestational age was 12.6 weeks. Peridural blocking was used for anesthesia de 86.1% of the cases, in the remainder general anesthesia was used. MVA was performed by different surgeons, following the technique that has been previously reported. Twelve women received sharp curettage immediately after MVA. There were tree women with bleeding complications (1000 cc or more), one case needed blood transfusion. In two cases the evacuation was incomplete. Seven cases became persistent trophoblastic disease. The histopathologic report was consistent with complete molar pregnancy la more than 90% of the cases. Oral contraceptives were selected by 66.7% of the women after the evacuation. It was concluded that MVA is a safe and effective method for the evacuation of molar pregnancy.

[Trends of perinatal mortality at the National Institute of Perinatology]. / Tendencias de la mortalidad perinatal en el Instituto Nacional de Perinatología.

The purpose of this study is to address the yearly fetal, neonatal, crude death rates observed at the Instituto Nacional de Perinatología from 1987 through 1997, and the specific death rates for birth weight, gestation age, cause of death, avoidability, and structure and process failures as proxy to quality of medical care. Data come from death certificates following the WHO criteria which includes the maternal medical history, pregnancy follow up, birth attendance, newborn characteristics, autopsy findings, microbiological results, basic cause of death (of both maternal and fetal/neonatal origin), death avoidability, and structure and process issues. The death certificates were analyzed by the Perinatal Mortality Committee and registered into a computerized database. The fetal mortality rate during 1987 was 17.67 per 1000 births, whereas in 1997 it was 21.5 per 1000 births. There was an increasing tendency from 1987 to 1992, with the highest rate being 34.13 during 1992. After 1992 this rate shows a decreasing tendency. The neonatal mortality rate decreased from 42.82 in 1987 to 17.34 per 1000 live births in 1997. The highest rates were observed among the newborns with the lowest birth weights and at the youngest gestational ages. The most frequent cause of death of maternal origin, in both fetal and neonatal deaths, was premature rupture of membranes. As for the most frequent fetal cause of death was antepartum hypoxia, and among neonatal deaths prematurity and immaturity. The percentage of avoidable perinatal deaths has declined dramatically from 27% in 1987 to less than 10% in 1996. Perinatal mortality at the Instituto Nacional de Perinatología has decreased during the period under assessment, due to the reduction of the neonatal mortality rate. Improving the quality of medical care focusing mainly on process issues will help lowering avoidable mortality rates.