Objectives: To determine the frequency of hemorrhage in the second half of pregnancy. Design: Descriptive study. Setting: Department of Obstetrics and Gynecology, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Pregnant women with second half hemorrhage. Methods: Review of 161 medical records from the Perinatal Information System of the Department of Gynecology and Obstetrics with diagnosis of hemorrhage of the second half of pregnancy in the period January 2008 through December 2009. Main outcome measures: Pregnant women characteristics and maternal and perinatal outcomes. Results: The 161 medical records analyzed represented 1.68% of obstetric care at the hospital. Age of women with hemorrhage of the second half of pregnancy was between 14 and 43 years with median 28 years; 62.7% (n = 101) had abruptio placentae, 34.8% (n = 56) placenta previa, and 2.5% (n = 4) uterine ru...

Objectives: To determine the quality of care and develop a continuous improvement of quality at the topic of Gynecology and Obstetrics of an emergency department. Design: Descriptive study. Setting: Hospital Nacional Cayetano Heredia Emergency department’s Obstetrics and Gynecology topic, Lima, Peru.  Participants: External users of the Obstetrics and Gynecology topic. Methodology: We determined the quality of care for external users; we designed a plan for continuous improvement of quality by the attitudinal problem of the doctor-patient relationship. We conducted a brainstorming session to build the Ishikawa diagram on "Attitude of staff that gives inadequate attention at the Gynecology and Obstetrics topic." A project for continuous quality improvement was developed. Main outcome measures: Quality of care and a continuous quality improvement project. Results: Of the 60 patients sur...

This review attempts to highlight the importance of acquired heart disease pathophysiology, clinical features, diagnosis and treatment during pregnancy and childbirth, so that both obstetricians and specialist consultation, especially the cardiologist, provide adequate advice to the patient in terms of maternal and infant prognosis.

OBJETIVE: To determine the incidence, demographic characteristics and complications of abortion in adolescents. MATERIALS AND METHODS: A descriptive, retrospective case series, held at the Cayetano Heredia National Hospital between 2000 and 2003. RESULTS Study type: From a total of 2222 abortions, 325 were adolescents. The incidence in adolescents was 14.7%. Most are concentrated in the age group of 17-19 years (73.6%). 59.4% interrupted their pregnancy before 17 weeks. The most common discharge diagnosis was incomplete abortion (67.1%); 12.8% agreed to have undergone abortion maneuvers and 9.4% had had a previous pregnancy. The most frequent complications were income 54.1% anemia and urinary tract infection 9.4%. CONCLUSION: The abortion occurred more frequently in late adolescence; the most common diagnosis was incomplete abortion and the most common complication of acute anemia.

Objective: To identify cost-opportunity that Hospital Nacional Cayetano Heredia (HNCH) presents for spontaneous normal vaginal deliveries. Design: Descriptive, transversal, observational study. Setting:Department of Gynecology and Obstetrics, Hospital Nacional Cayetano Heredia, Lima, Peru. Material: Clinical charts of patients attended for non complicated vaginal deliveries. Interventions: Clinical charts of 2 700 normal vaginal deliveries attended from January through December 2007 were reviewed and distributed according to mode of financing either by Sistema Integral de Salud (SIS) or by pocket payment; also SIS rejected cases were considered. Statistical analysis was done with commercial software. Main outcome measures: Shadow cost, costopportunity by SIS, pocket expense, cases rejected by SIS. Results: The total cost for spontaneous normal vaginal deliveries attended at HNCH was S/. ...

Objectives: To determine the frequency, admission diagnosis and case fatality rate of obstetrical/gynecological patients admitted to intensive care units (ICU). Design: Descriptive study. Setting: Department of Gynecology and Obstetrics and Intensive Care Units, Hospital Nacional Cayetano Heredia, Lima, Peru. Material: Medical records, ICU epicrisis and Perinatal Information System of all gynecological and obstetrical patients admitted to the ICU, from January 2008 through December 2009, were reviewed. Variables studied were maternal age, diagnosis at admission, ICU admission diagnosis, ICU stay, ICU interventions (mechanical ventilation, transfusions, inotropes use) and mortality. Main outcome measures: Outcome of patients admitted to UCI. Results: We analyzed 52 medical records representing 0,54 % of obstetrical interventions at the hospital. We reviewed 26 from year 2008, where age av...

Objectives: To determine the risk of preeclampsia in pregnant nulliparous women who presented early diastolic notch (EDN) or resistance index (RI) >0,58 during Doppler evaluation of the uterine arteries between the 24th and 26th weeks of pregnancy. Design: Cohort study. Setting: Cayetano Heredia National Hospital. Participants: Nulliparous pregnant women. Interventions: Between March 2002 and July 2003 126 pregnant nulliparous women with 24 and 26 weeks of gestation were studied by color Doppler velocimetry of the uterine arteries. We considered exposure when EDN or RI >0,58 were present. Covariables considered were maternal age, legal status, body mass index and placental location. Development of preeclampsia was considered as the final outcome. Main outcome measures: Presence of early diastolic notch or resistance index >0,58 by color Doppler velocimetry and relation with preeclampsia....

Objective: To determine the epidemiologic, clinical and surgical characteristics of patients with pelvic inflammatory disease. Design: Series of cases descriptive study. Setting: Gynecology Service, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Women with diagnosis of pelvic inflammatory disease. Interventions: Demographic data, gynecological history, clinical criteria and type of surgical intervention were studied in 199 patients with pelvic inflammatory disease during January 1999 through December 2005. Main outcome measures: Pelvic inflammatory disease characteristics. Results: The frequency of pelvic inflammatory disease was 3,2% with higher presence during the second and quarter decades of life. Most frequent demographic characteristics were cohabiting marital status (40,7%) and high school graduates (54,8%). Sexual activity was started at 18 years old average, and m...

Heart disease during pregnancy is the most common non-obstetric cause of maternal death. Current increase in mothers with congenital heart disease and decline in rheumatic heart disease carriers is noted due to reduction and control of rheumatic fever and advances in medical and surgical treatment of congenital heart disease;these girls reach reproductive age. This review highlights congenital heart disease diagnosis and treatment that requires multidisciplinary approach and management in order to obtain adequate maternal-perinatal outcomes.

OBJECTIVE: To obtain a nomogram that relations growth curve transverse fetal cerebellum with gestational age in normal pregnant. DESIGN: cross-sectional between March and July 2000, in the Department of Obstetrics and Gynecology, National Hospital Cayetano Heredia in Lima. MATERIALS AND METHODS: 198 pregnant women between 15 and 38 weeks of normal pregnancy were evaluated. Multiple fetal biometric measurements were performed to determine the gestational age, including the transverse diameter of the cerebellum. The data underwent a program of quadratic regression to the transverse diameter of the cerebellum. RESULTS: With the determination of the transverse diameter of the fetal cerebellum ultrasound, a nomogram is obtained for gestational age, being valid for estimation (R2 = 0.9511, P <0.0005). CONCLUSIONS: The ultrasonographic measurement of the transverse diameter of the fetal cerebel...

Objectives: To determine the frequency of hemorrhage in the second half of pregnancy. Design: Descriptive study. Setting: Department of Obstetrics and Gynecology, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Pregnant women with second half hemorrhage. Methods: Review of 161 medical records from the Perinatal Information System of the Department of Gynecology and Obstetrics with diagnosis of hemorrhage of the second half of pregnancy in the period January 2008 through December 2009. Main outcome measures: Pregnant women characteristics and maternal and perinatal outcomes. Results: The 161 medical records analyzed represented 1.68% of obstetric care at the hospital. Age of women with hemorrhage of the second half of pregnancy was between 14 and 43 years with median 28 years; 62.7% (n = 101) had abruptio placentae, 34.8% (n = 56) placenta previa, and 2.5% (n = 4) uterine ru...

Heart disease during pregnancy is the most common non-obstetric cause of maternal death. Current increase in mothers with congenital heart disease and decline in rheumatic heart disease carriers is noted due to reduction and control of rheumatic fever and advances in medical and surgical treatment of congenital heart disease;these girls reach reproductive age. This review highlights congenital heart disease diagnosis and treatment that requires multidisciplinary approach and management in order to obtain adequate maternal-perinatal outcomes.

This review attempts to highlight the importance of acquired heart disease pathophysiology, clinical features, diagnosis and treatment during pregnancy and childbirth, so that both obstetricians and specialist consultation, especially the cardiologist, provide adequate advice to the patient in terms of maternal and infant prognosis.

Objectives: To determine the frequency, admission diagnosis and case fatality rate of obstetrical/gynecological patients admitted to intensive care units (ICU). Design: Descriptive study. Setting: Department of Gynecology and Obstetrics and Intensive Care Units, Hospital Nacional Cayetano Heredia, Lima, Peru. Material: Medical records, ICU epicrisis and Perinatal Information System of all gynecological and obstetrical patients admitted to the ICU, from January 2008 through December 2009, were reviewed. Variables studied were maternal age, diagnosis at admission, ICU admission diagnosis, ICU stay, ICU interventions (mechanical ventilation, transfusions, inotropes use) and mortality. Main outcome measures: Outcome of patients admitted to UCI. Results: We analyzed 52 medical records representing 0,54 % of obstetrical interventions at the hospital. We reviewed 26 from year 2008, where age av...

Objective: To identify cost-opportunity that Hospital Nacional Cayetano Heredia (HNCH) presents for spontaneous normal vaginal deliveries. Design: Descriptive, transversal, observational study. Setting:Department of Gynecology and Obstetrics, Hospital Nacional Cayetano Heredia, Lima, Peru. Material: Clinical charts of patients attended for non complicated vaginal deliveries. Interventions: Clinical charts of 2 700 normal vaginal deliveries attended from January through December 2007 were reviewed and distributed according to mode of financing either by Sistema Integral de Salud (SIS) or by pocket payment; also SIS rejected cases were considered. Statistical analysis was done with commercial software. Main outcome measures: Shadow cost, costopportunity by SIS, pocket expense, cases rejected by SIS. Results: The total cost for spontaneous normal vaginal deliveries attended at HNCH was S/. ...

Objectives: To determine the quality of care and develop a continuous improvement of quality at the topic of Gynecology and Obstetrics of an emergency department. Design: Descriptive study. Setting: Hospital Nacional Cayetano Heredia Emergency department’s Obstetrics and Gynecology topic, Lima, Peru.  Participants: External users of the Obstetrics and Gynecology topic. Methodology: We determined the quality of care for external users; we designed a plan for continuous improvement of quality by the attitudinal problem of the doctor-patient relationship. We conducted a brainstorming session to build the Ishikawa diagram on "Attitude of staff that gives inadequate attention at the Gynecology and Obstetrics topic." A project for continuous quality improvement was developed. Main outcome measures: Quality of care and a continuous quality improvement project. Results: Of the 60 patients sur...

Objectives: To determine the risk of preeclampsia in pregnant nulliparous women who presented early diastolic notch (EDN) or resistance index (RI) >0,58 during Doppler evaluation of the uterine arteries between the 24th and 26th weeks of pregnancy. Design: Cohort study. Setting: Cayetano Heredia National Hospital. Participants: Nulliparous pregnant women. Interventions: Between March 2002 and July 2003 126 pregnant nulliparous women with 24 and 26 weeks of gestation were studied by color Doppler velocimetry of the uterine arteries. We considered exposure when EDN or RI >0,58 were present. Covariables considered were maternal age, legal status, body mass index and placental location. Development of preeclampsia was considered as the final outcome. Main outcome measures: Presence of early diastolic notch or resistance index >0,58 by color Doppler velocimetry and relation with pree...

OBJETIVE: To determine the incidence, demographic characteristics and complications of abortion in adolescents. MATERIALS AND METHODS: A descriptive, retrospective case series, held at the Cayetano Heredia National Hospital between 2000 and 2003. RESULTS Study type: From a total of 2222 abortions, 325 were adolescents. The incidence in adolescents was 14.7%. Most are concentrated in the age group of 17-19 years (73.6%). 59.4% interrupted their pregnancy before 17 weeks. The most common discharge diagnosis was incomplete abortion (67.1%); 12.8% agreed to have undergone abortion maneuvers and 9.4% had had a previous pregnancy. The most frequent complications were income 54.1% anemia and urinary tract infection 9.4%. CONCLUSION: The abortion occurred more frequently in late adolescence; the most common diagnosis was incomplete abortion and the most common complication of acute anemia.

OBJECTIVE: To obtain a nomogram that relations growth curve transverse fetal cerebellum with gestational age in normal pregnant. DESIGN: cross-sectional between March and July 2000, in the Department of Obstetrics and Gynecology, National Hospital Cayetano Heredia in Lima. MATERIALS AND METHODS: 198 pregnant women between 15 and 38 weeks of normal pregnancy were evaluated. Multiple fetal biometric measurements were performed to determine the gestational age, including the transverse diameter of the cerebellum. The data underwent a program of quadratic regression to the transverse diameter of the cerebellum. RESULTS: With the determination of the transverse diameter of the fetal cerebellum ultrasound, a nomogram is obtained for gestational age, being valid for estimation (R2 = 0.9511, P <0.0005). CONCLUSIONS: The ultrasonographic measurement of the transverse diameter of the fetal cere...

Objective: To determine the epidemiologic, clinical and surgical characteristics of patients with pelvic inflammatory disease. Design: Series of cases descriptive study. Setting: Gynecology Service, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Women with diagnosis of pelvic inflammatory disease. Interventions: Demographic data, gynecological history, clinical criteria and type of surgical intervention were studied in 199 patients with pelvic inflammatory disease during January 1999 through December 2005. Main outcome measures: Pelvic inflammatory disease characteristics. Results: The frequency of pelvic inflammatory disease was 3,2% with higher presence during the second and quarter decades of life. Most frequent demographic characteristics were cohabiting marital status (40,7%) and high school graduates (54,8%). Sexual activity was started at 18 years old average, and m...