Objective: To ascertain that social and emotional deprivation of the mother is associated with fetal growth restriction, fetal death, preterm birth and congenital defects. Materials and Methods: We retrieved the maternal and perinatal outcome from the Informatic Perinatal System of all pregnancies with antenatal care whose delivery occurred between January 1, 1992 and December 31, 2001. Three groups of patients with social and emotional deprivation were included: 1) single women (n=1285), 2) teenage women with absent prenatal care (APC), (n=2131), and 3) primigravid with stature lower than 160 cm (n=35722). Maternal and perinatal outcome were compared with: 1) women living with sexual partner (n=5550), 2) teenage women with prenatal care (n=7644), and 3) primigravids taller than 159 cm (n=5264). Odds ratio and 95% confidence interval (CI) were calculated. Results: Single women presented ...

Objetive: To determine healthy neonates birthweight born from healthy Lima pregnant women without obstetrical complications. Materials and Methods: A retrospective, analytic and transversal study was conducted. Maternal and perinatal data was retrieved from the Department of Obstetrics/Gynecology and Pediatrics Database at Hospital Nacional Docente Madre-Niño San Bartolome from January 1, 1991 through December 31, 1999. Healthy singleton pregnant women 20 to 30 years old, BMI 20 to 25 kg/mt2 , without obstetrical complications, with a difference ± 2 weeks between last menstrual period and gestational age by physical assessment of the healthy living neonate were selected. Results: Birthweights of 5,443 healthy neonates in Lima [50th percentile [10th percentile- 90th percentile]) at 35, 36, 37, 38, 39, 40, 41, and 42 gestational weeks were 2640 (2346-3356), 2850 (2430- 3344), 3100 (2688-...

Objetive: To ascertain whether the use of uterine compression suture (B-Lynch technique) during a cesarean section with uterine atony decreases the amount of blood loss and prevents postpartum hysterectomy. Material and Methods: Retrospective study of all the cesarean section deliveries complicated by uterine atony from January 1, 1990 through December 31, 2003 at San Bartolome Hospital in Lima. The standard management of uterine atony included uterine massage, use of uterotonic agents (ocytocin, prostaglandins), uterine/hypogastric artery ligature and, finally, postpartum hysterectomy. Maternal and Infant clinical charts were reviewed and variables were entered into a computer system analysis (SPSS version 10). Results: Forty six cases were identified: B-Lynch technique was used in 30 cases and the standard method in 16 cases. There was no difference in maternal characteristic between b...

El tamaño fetal es un indicador de bienestar fetal y, al mismo tiempo, predictor del desarrollo de enfermedades crónicas posterior al parto. Es, por lo tanto, necesario conocer los valores de normalidad del crecimiento fetal intrauterino. De un total de 18,615 partos simples registrados en el Hospital San Bartolomé de Junio de 1990 a Marzo de 1995, sólo 5,399 (29%) gestantes menores de 35 años, sanas y sin complicación obstétrica tuvieron un recién nacido sano. No fue considerado sano un recién nacido menor de 34 semanas de edad gestacional. Los valores del peso al nacer en los percentiles 10, 50 y 90 fueron similares a los informados en otros países. La variación del peso fetal entre las razas ha dependido principalmente del ambiente, donde la pobreza y la ignorancia han influido poderosamente. Ambas, a través de la desnutrición crónica, han alterado por generaciones la ta...

OBJECTIVE: To establish the values of head circumference (PC) of a group of healthy newborns Lima children of women who had healthy singleton pregnancies. DESIGN: Retrospective, analytical and transversal study. MATERIALS AND METHODS: Based on maternal and perinatal data from the Department of Obstetrics and Pediatrics National Teaching Hospital Mother-Child "San Bartolome" between January 1, 1991 and December 31, 1999 (SIP) was reviewed. Singleton pregnancies of women between 20 and 30 years, with BMI between 20 and 25 km / m2 was selected healthy without obstetric complications, with difference ± 2 weeks between EG FUR and physical examination of the living and healthy newborn. RESULTS: The sound in Lima (50th percentile (10th percentile-90th percentile)) 5443 head circumference of newborns (NB) at weeks 36,36,37,38,39,40,41 and 42 were 33 (31-35 ), 33 (31-35), 34 (32 to 35.5), 34 (32...

To determine the prevalence and risk factors of placental abruption (DPP). MATERIALS AND METHODS: l) of January 1, 1980 to December 31: A study retrospectioo DPP all cases that occurred in the National Teacher San Bartolomé Mother-Child Hospital in Lima for 19 years, was conducted in two periods 1989; 2) l January 1991 to December 31, 1999, a retrospective analysis of the perinatal information DPP cases registered in the Perinatal Information System (SIP) of the hospital was performed. DPP diagnosis was performed by macroscopic visualization of a blood clot in the maternal face of the placenta inserted into the upper uterine segment. RESULTS: The DPP occurred in 0.4% of pregnancies (464/107 854). Risk factors associated with the DPP were: genetic and / or hereditary (poor reproductive history: previous stillbirth 28% (129/464), preterm delivery before 9% (26/284)); emotional (multiparit...

OBJECTIVES: To determine pregnancy complicated by arterial hypertension pathogenic factors. DESIGN: Retrospective clinical study. SETTING: Hospital Nacional Docente Madre-Niño San Bartolome, Lima.PARTICIPANTS: Women with pregnancies complicated by arterial hypertension. INTERVENTIONS: The hospital’s perinatal information technology system was reviewed from January 1991 through December 2006 in order to determine the prevalence of pregnancies complicated by arterial hypertension, to establish associated factors and describe its natural history. MAIN OUTCOME MEASURES: Pregnancy arterial hypertension prevalence and conditioning factors. RESULTS: Pregnancy arterial hypertension prevalence was 8,6% (8 506/98 956). Preeclampsia and eclampsia represented 95% (8 085/8 506) of these cases, preeclampsia prevalence was 8,5% and eclampsia, 0,11%. Preeclampsia and eclampsia conditioning factors we...

The prevalence of gestational diabetes mellitus (GDM) reaches 2% by screening a Peruvian pregnant population. Performing standard Oral glucose tolerance test (OGTT) on 17540 Peruvian pregnant women with risk factors for diabetes at San Bartolome’s Hospital in Lima, the prevalence of GDM was 3,8%, it represented 1% of all pregnancies with antenatal care and 0,5% of all the deliveries attended over that period 95% of GDM were gestational diabetes (DG) and 5% pregestational diabetes (DPG). Fasting blood sugar over 79 mg1dL (4,5 mM/L) could have diagnosed GDM at the first visit with 93% sensitivity and 80% of specificity and is more sensitive to identify pregnancies at increased risk than OGTT using National Diabetes Data Group’s Criteria. We advocate to perform OGTT in pregnancies without diabetes risk factor at 20-26 weeks of gestation using 1 glucose/kg weight, considering as normal: ...

During normal pregnancy, the cytotrophoblast becomes their epithelial phenotype to endothelial phenotype (termed pseudo-vasculogenesis) and invade the maternal spiral arteries. This physiological transformation myometrial spiral arteries increases blood flow and nutrient supply to the fetus at the end of the first quarter. Vascular, such as vascular endothelial growth factor (VEGF), placental growth factor (PIGF), the tyrosine kinase-1 soluble fms-like receptor (sFlt1) factors involved in this process. At the origin of circulating angiogenic proteins involved preeclampsia. Furthermore, serum from women with preeclampsia reduced the viability of the trophoblast, which is related to changes in the sensitivity of trophoblast to Fas-mediated apoptosis, which could be mediated by proinflammatory cytokines, which have been found increased in patients with preeclampsia. In preeclompsia, there i...

OBJECTIVE: To determine the consequences of asymptomatic bacteriuria. MATERIAL AND METHODS: Prospective, comparative study of 3,602 pregnant women belonging to the Epidemiologic Surveillance Program of Glucose Intolerance in the Woman and Infant at San Bartolomé Hospital, Lima, from june 1990 through December 1994. RESULTS: 720 (20%) presented significant bacteriuria. From other 1.432 selected pregnant females without urinary symptom and with prenatal control, 304 (21,1) presented aymptomatic bacteriuria. Compared with the general pregnant population, asyimptomatic bacteriuria was three times more frequent inpregnant women that had of urinary tract infection before current gestation. Compared with non bacteriuric pregnant females, those with bacteriuria presented significant ferropenic anemia, arterial hipertension, premature rupture ofmembranes, pretem delivery, perineal condiloma peri...

Although there is no doubt that it is necessary to improve the pregravid nutritional status or indicate caloric supplements since early in pregnancy in undernourished woman, it is also important to avoid excessive nutrients during pregnancy in normal and overweight women. Should there exist familiar predisposition to develop arterial hypertension, dyslipidemia or diabetes mellitus, these women will develop such diseases during pregnancy with catastrophi, consequences to the mother and her infant. The excesive weight gain after each delivery will cause obesity with the subsequent risk of developing the above diseases early in life. Mother’s nutritional habits is transmitted to progeny in pregnancy which added to the environmen will determine the development of chronic diseases by generations. Therefore, it is imperative to keep an appropiate maternal nutrition as a key for health in pre...

OBJECTIVE. To ascertain the maternal and fetal variables that predict fetopelvic disproportion (FPD). SETTING. Hospital Nacional Docente Madre-Niño San Bartolome, Lima, Peru. DESIGN. Clinical retrospective study. Participants. Pregnant women with labor second stage arrest and birth by cesarean section. INTERVENTIONS. Retrospective study of our Perinatal Data Base from January 1, 1991 to December 31, 1999. Fetopelvic disproportion (FPD) was defined as labor arrest during 2 hours in nulliparous and 1 hour in multiparous women at the second stage of labor and delivery of the baby was by cesarean section. Logistic regression (LR) and ROC analysis were performed. MAIN OUTCOME MEASURES. FPD prevalence and associated conditions. RESULTS. The prevalence of FPD was 1,28% (583/45,386). As compared with women without FPD, women with FPD significantly presented lower stature –less than 160 cm–,...

OBJECTIVE: To establish the values of head circumference (PC) of a group of healthy newborns Lima children of women who had healthy singleton pregnancies. DESIGN: Retrospective, analytical and transversal study. MATERIALS AND METHODS: Based on maternal and perinatal data from the Department of Obstetrics and Pediatrics National Teaching Hospital Mother-Child "San Bartolome" between January 1, 1991 and December 31, 1999 (SIP) was reviewed. Singleton pregnancies of women between 20 and 30 years, with BMI between 20 and 25 km / m2 was selected healthy without obstetric complications, with difference ± 2 weeks between EG FUR and physical examination of the living and healthy newborn. RESULTS: The sound in Lima (50th percentile (10th percentile-90th percentile)) 5443 head circumference of newborns (NB) at weeks 36,36,37,38,39,40,41 and 42 were 33 (31-35 ), 33 (31-35), 34 (32 to 35.5), 34 (32...

To determine the prevalence and risk factors of placental abruption (DPP). MATERIALS AND METHODS: l) of January 1, 1980 to December 31: A study retrospectioo DPP all cases that occurred in the National Teacher San Bartolomé Mother-Child Hospital in Lima for 19 years, was conducted in two periods 1989; 2) l January 1991 to December 31, 1999, a retrospective analysis of the perinatal information DPP cases registered in the Perinatal Information System (SIP) of the hospital was performed. DPP diagnosis was performed by macroscopic visualization of a blood clot in the maternal face of the placenta inserted into the upper uterine segment. RESULTS: The DPP occurred in 0.4% of pregnancies (464/107 854). Risk factors associated with the DPP were: genetic and / or hereditary (poor reproductive history: previous stillbirth 28% (129/464), preterm delivery before 9% (26/284)); emotional (multiparit...

OBJECTIVE. To ascertain the maternal and fetal variables that predict fetopelvic disproportion (FPD). SETTING. Hospital Nacional Docente Madre-Niño San Bartolome, Lima, Peru. DESIGN. Clinical retrospective study. Participants. Pregnant women with labor second stage arrest and birth by cesarean section. INTERVENTIONS. Retrospective study of our Perinatal Data Base from January 1, 1991 to December 31, 1999. Fetopelvic disproportion (FPD) was defined as labor arrest during 2 hours in nulliparous and 1 hour in multiparous women at the second stage of labor and delivery of the baby was by cesarean section. Logistic regression (LR) and ROC analysis were performed. MAIN OUTCOME MEASURES. FPD prevalence and associated conditions. RESULTS. The prevalence of FPD was 1,28% (583/45,386). As compared with women without FPD, women with FPD significantly presented lower stature –less than 160 cm–,...

During normal pregnancy, the cytotrophoblast becomes their epithelial phenotype to endothelial phenotype (termed pseudo-vasculogenesis) and invade the maternal spiral arteries. This physiological transformation myometrial spiral arteries increases blood flow and nutrient supply to the fetus at the end of the first quarter. Vascular, such as vascular endothelial growth factor (VEGF), placental growth factor (PIGF), the tyrosine kinase-1 soluble fms-like receptor (sFlt1) factors involved in this process. At the origin of circulating angiogenic proteins involved preeclampsia. Furthermore, serum from women with preeclampsia reduced the viability of the trophoblast, which is related to changes in the sensitivity of trophoblast to Fas-mediated apoptosis, which could be mediated by proinflammatory cytokines, which have been found increased in patients with preeclampsia. In preeclompsia, there i...

OBJECTIVES: To determine pregnancy complicated by arterial hypertension pathogenic factors. DESIGN: Retrospective clinical study. SETTING: Hospital Nacional Docente Madre-Niño San Bartolome, Lima.PARTICIPANTS: Women with pregnancies complicated by arterial hypertension. INTERVENTIONS: The hospital’s perinatal information technology system was reviewed from January 1991 through December 2006 in order to determine the prevalence of pregnancies complicated by arterial hypertension, to establish associated factors and describe its natural history. MAIN OUTCOME MEASURES: Pregnancy arterial hypertension prevalence and conditioning factors. RESULTS: Pregnancy arterial hypertension prevalence was 8,6% (8 506/98 956). Preeclampsia and eclampsia represented 95% (8 085/8 506) of these cases, preeclampsia prevalence was 8,5% and eclampsia, 0,11%. Preeclampsia and eclampsia conditioning factors we...

Introduction: Post partum depression and gender based violence are very common disorders in women; the importance of early diagnosis and prompt treatment is to avoid future consequences in women, newborns and the family. Objectives: To determine the association between post partum depression and gender based violence. Design: Exploratory cross-sectional. Place: Hospital Nacional Docente Madre Niño San Bartolome, Lima, Peru. Participants: Post partum women. Interventions: We applied a sociodemographic data and delivery card, the Edinburgh scale, revised inventory predictors of post partum depression and an instrument for detection of gender based violence to 100 women 1 to 12 months post partum. Data analysis was conducted using odds ratio tests, Chi-square and Fisher exact test. Main outcome measures: Association between post partum depression and gender based violence. Results: The rat...

Objetive: To establish values for neonatal ponderal index (PI) in a group of healthy fetuses born from healthy singleton pregnant women at Lima, Peru. Materials and Methods: A retrospective, analytic and transversal study was conducted. Maternal and perinatal data from January 1, 1991 through December 31,1999 was retrieved from the Department of Obstetrics/Gynecology and Pediatrics Database at Hospital Nacional Docente Madre-Niño “San Bartolome”. Healthy singleton pregnant women between 20 and 30 years old, BMI between 20 and 25 kg/m2 , without obstetrical complications, with a difference ± 2 weeks between last menstrual period and gestational age by physical assessment of a live-healthy neonate were selected. PI was defined as birthweight in grams x 100/ [crown-heel length]3 . Results: The PI [50th percentile (10th percentile- 90th percentile)] in 5,443 Lima healthy neonates at 35...

Obejetive: To identify the etiopathogenic factors associated to both fetal and neonatal deaths in Lima, Peru. Materials and methods: Retrospective study of all the cases of fetal death over 20 weeks gestation and neonatal death before 28 days of life that underwent autopsy and histopathologic study, in order to identify the cause of perinatal death. Settings: Hospital San Bartolomé in Lima, between January 1, 1996 and December 31, 2000. Results: The prevalence of fetal death was 1,68% (508/30125) and neonatal death 1,44% (434/30125). All fetal deaths and 58,8% (255/434) of the neonatal deaths underwent autopsy. Among 508 fetal deaths, 92 (18%) presented signs of autolysis that did not allow appropiate identification of the etiopathogenic process. Fetal death was associated to prematurity (60,5%), nutricional/vascular defect (78,1%), social privation (60,8%), congenital anomaly (14,6%) a...