The review of 176 maternal deaths in the National Hospital Edgardo Rebagliati Martins (HNERM) of the Peruvian Institute of Social Security (LPSs) between 1958 and 1991 indicates that 71% were due to direct obstetric death, including 24% by infections 22% induced hypertension and 16% Bleeding-, was 16% indirect and 13% nonobstetric. The maternal mortality rate in the 33 years was 39 per 100 000 births Although the rate is relatively acceptable, deaths were mostly from preventable causes, requiring for you diminish a clearly defined institutional policy, care and management levels well implemented uniformly institutional protocols and manuals.

To examine the tendency of maternal mortality at one National Hospital of the Social Security Peruvian Institute. DESIGN: Epidemioloqic descriptive retrospective study of maternal deaths registered at our Hospital. SUBJECTS: 202 women that died during Pregnancy, delivery or postpartum, LOCATION: Department of Obstetrics and gynecology of Edgardo Rebagliati Martins National Hospital, SSPI. RESULTS: Direct obstetrical deaths represented 73,3% (1 48 cases), including 26,2% (53 cases) of pregnancy induced hypertension, 24,8% (50 cases) of infections, 14,9% (30 cases) of hemorrhage and 7,4% (15 cases) of other direct obstetrical causes. Indirect maternal death causes were 26,2% (53 cases) and non related 0,5% (1 case). Maternal mortality rate was 40,3/100000 l.n.b. CONCLUSIONS: Emphasis is placed on the importance of the study of maternal deaths, most of them preventable, so as to contribute ...

The amount of amniotic fluid is studied by measuring wells in millimeters high by ultrasonography in 300 normal pregnant women who were enrolled in different stages of pregnancy without complications, date of last normal menstruation precisada well, with only normal fetal development, no major malformations or delay growth and macrosomia, with apparently normal placentas without premature ripening. The well height during pregnancy ranged from an average of 32.5 mm. between 11 and 12 weeks to 61.3 mm. between 28 and 32 weeks, then remain more or less stationary values to 40 weeks. The maximum and minimum limits in the second half of pregnancy were 80 and 40 mm., Which corroborates in our results reported in other countries.

OBJECTIVE: To review cases of endometriosis found at laparoscopy or laparotomy in women evaluated for infertility or recurrent abortion. DESIGN; Descriptive retrospective cross-sectional study. MATERIALS AND METHODS: 675 women with infertility or recurrent abortion underwent laparotomy or laparoscopy. PLACE: Human Reproduction Service National Hospital Edgardo Rebagliati Martins EsSalud. RESULTS: The prevalence of endometriosis was 47% (317 patients), being more frequent in women between 30 and 39 years. Endometriosis was minimal in seven cases (2.2%), mild in 101 (31.9%), moderate in 128 (40.4%) and severe in 81 cases (25.6%). In 38 cases one or more endometriosis was found. The most frequent location was posterior fornix, uterosacral ligament and the ovarian surface. It is also found in chronic salpingitis 26% (81 cases), with hydrosalpinges in 20 cases. They hatched 55 patients (17.4%...

OBJECTIVE: To determine the incidence and risk factors for puerperal endometritis. DESIGN- Prospective, longitudinal, comparative, and observational study. LOCATION: Department of Obstetrics, Edgardo Rebagliati Martins National Hospital, PSSI. SUBJECTS: 3350 pregnant women who delivered at our Hospital. RESULTS: Puerperal endometritis occurred in 2,6% mainly in primiparae and great multiparae. Rupture of membranes over 6 hours appears as the most important risk factor, followed by cesarean section, prolonged labor, labor induction, number of vaginal examinations and infection of the urinary tract. Cultures grew mainly E. coli. CONCLUSION: Early detection of risk factors would preclude the installation of puerperal endometritis.

Advances in Contraception - New generation oral contraceptives, contraceptive Clinical experience with class 20 Surgical Contraception, Contraception and Breastfeeding.

The shock is a condition that causes inadequate perfusion of oxygenated blood to the cellular level. Recalling that the perfusion depends on three components, or the circulating blood volume, vascular channels and heart pump or other active components, the shock may occur when any of these components is affected. The shock caused by bacterial toxins resulting in disorders in which arterioles occurs, though not invariably, vasodilation.

Objective: To review the frequence and modality of presentation of chronic pelvic inflammatory disease in infertile patients. Design: retrospective observational transversal preliminarity clinical study in infertile women. Material: 121 women subjected to laparoscopy or laparotomy at the Human Reproduction Service of Edgardo Rebagliati Martins National Hospital, PPSI, in one year. Results: Chronic pelvic inflammatoy disease was found in 82 cases (68%), tubal obstruction in 59 (72%), adhesions in 47 (57%) chronic salpingitis in 9, hydrosalpinx in 15(18%) and phymosis in 3 cases (4%). We performed lysis of adhesions in 35 cases, lysis of fimbria in 33, salpingofimbriolysis in 45, fimbrionestomy in 10, salpingofimbriovariolysis in 6, tubal reimplant in 4 and other modalities in 17. Salpingoneostomy was performed for ectopic pregnacy in 3 cases. Conclusion: Chronic pelvic inflammatory diseas...

Objective: To determine the prevalence of asymptomatic bacteriuria in pregnant women. Design: Prospective, longitudinal, simple aleatory study of 123 pregnant women without urinary tract infection symptomatology attended as outpatients at the Rebagliati Hospital Department of Obstetrics. Asymptomatic bacteriuria was considered when two urine cultures were positive to the same microorganism. Results: Prevalence of asymptomatic bacteriuria was 15,4% and was found associated to increasing maternal age, multiparity, history of urinary tract infection, lower social and economical status and lesser gestational age, without statistical significance. Escherichia coli was found in 94,7% of positive cultures.

The uterus to placenta blood flow reduction would be the initial factor for preeclampsia, secondary to anomalous spiral uterine arteries invasion by the extravillous cytotrophoblastic cells, associated to both vascular tonus and immunologic and inflammatory balance local alterations, sometimes with genetic predisposition. There is endothelial cell dysfunction, dyslipidemia (especially hypertriglyceridemia), hyperinsulinemia, hyperleptinemia, antioxidant-prooxidant imbalance. Preeclampsia is an early pregnancy disease characterized by hypertension and proteinuria, expressed late in pregnancy. We still do not have a clinical useful test to predict preeclampsia. Combining both placental insufficiency and endothelial markers and PlGF y sFlT-1 serum or urinary levels in the first trimester is promising. Personal and familiar hypertension history is extremely important. Pregnant women with art...

Clinical histories of 38 pregmant diabetic patients seen at out Hospital between 1971 and 1980 were reviewed. Thirty-two per cent were between  35 and 39 year-old and 15 per cent over 40 years old. Only 13 per cent carried their first pregnancies, and 44 per cent had 6 gestations or more. Important past history included familiar diabetes (55 per cent) and bad obstetrical history. Current pregnancy was complicated by toxemia in 18 per cent of cases and by hydramnios in 5 cases. Cesarean section was performed in 50 per cent of diabetic mothers. Twenty-one per cent of their babies were born before 37 weeks of gestational age, and other 29 per cent were macrosomic. There were five stillborn infants and one neonatal death. We believe that both perinatal mortality and hydramnios may diminish if we bring blood sugar values down to within normal limits during pregnancy. 

Entre las causas de muerte materna directa, es decir, la muerte que resulta de complicaciones obstétricas del embarazo, parto y puerperio, una de las principales en el mundo es la preeclampsia/ eclampsia. 

Editorial

Premature ovarian failure is characterized by secondary amenorrhea affecting a woman before the age of 40, leading to hypoestrogenism, infertility, and consequences of premature menopause, such as osteoporosis, cardiovascular disease, neurovegetative alterations, and others. Follicular exhaustion is due to either follicles shortage or oocytes accelerated destruction. Main causes are genetic, autoimmune and iatrogenic. Among genetic causes Xq and Xp deletions, translocations, numeric aberrations (47,XXX, 45,X0), fragil X premutations are frequent. Type I and type II poliglandular insufficiency are important causes among autoimmune diseases. Iatrogenia may occur in surgery of the ovarios and Fallopian tubes and with oncologic treatment that destroys germinal cells in young women with breast cancer. Nowadays use of ovarian function and fertility preservation techniques are suggested. Once t...

Anales’ Editorial Committee has lost one of its most renowned staff members. Brilliant professor of our Faculty of Medicine, Carlos Alberto Battilana Guanilo (1945-2009) knew how to transmit knowledge and appeal audiences’ attention, either in young students or not so young contemporary fellows. He got his students interested in the paths of permanent learning and investigation. On the other hand, he committed distinguished physicians and professors to constitute and lead science-friendship interested groups. His vocation in teaching bound him to faculties of medicine and scientific academies and societies, where he coordinated courses and meetings that are pleasantly recalled. His scientific production was devoted to nephrology, immunology, cancer, medical treatment costs. His capacity of management and leadership present since being a student, allowed him to become regional directo...

La Facultad de Medicina realizó las VIII Jornadas Científicas Sanfernandinas, XI Jornadas de Investigación en Salud y XVIII Jornadas Sanfernandinas Estudiantiles correspondientes al año 2009, coincidiendo con la fecha de aniversario de creación de la Facultad de Medicina, el día 9 de setiembre de 1856, jornadas que anualmente crean grandes expectativas entre las autoridades, investigadores, docentes y alumnos. Previamente a las Jornadas, se brindó el curso ‘La clínica y el laboratorio en el diagnóstico de las enfermedades infecciosas y tropicales’ y el simposio ‘El ofidismo y el aracnoidismo: biología, clínica y tratamiento’. Las VIII Jornadas Sanfernandinas tuvieron como objetivos los actuales retos en salud, haciendo énfasis en aquellas infecciones emergentes y reemergentes y su impacto en un ambiente pluricultural, en donde se encuentra acentuada pobreza, educació...

El temario del presente número se inicia con tres trabajos relacionados a plantas con propiedades medicinales y que podrían tener aplicación práctica en nuestro medio, en el manejo de la úlcera gástrica y en la hipertensión arterial. La Copaifera officinalis, el árbol del diesel, es conocida por la producción masiva de oleoresina, principalmente compuesta por hidratos de carbono sesquiterpenos (1). El aceite de copaiba, producido por exudación del tronco de los árboles pertenecientes al género copaifera, ha sido utilizado por sus propiedades medicinales como antiiflamatorio, antitumor, balsámico (2), antiséptico urinario, enfermedades de la piel, úlceras, cicatrizantes de heridas. En el estudio experimental que publicamos, fue usado como citoprotector en estómago de ratas, con resultados comparables con los del omeprazol, ante la ligadura del píloro y administración de ...

Recurrent pregnancy loss study approach has been related to progress in genetics and molecular biology as well as better diagnosis methods. In this review we recall current knowledge on the etiology, diagnosis and treatment of recurrent pregnancy loss, as well as its repercussion in the couple with subfertility due to this cause.

El presente año 2009 se recuerda los 200 años del nacimiento de Charles Darwin (12 de febrero de 1809) y 150 años de la publicación “Sobre el origen de las especies mediante la selección natural, o la conservación de razas favorecidas en la lucha por la vida”. Coincidentemente, el mismo 12 de febrero de 2809 nació Abraham Lincoln, y a ambos les correspondió hacer el esfuerzo de modificar el estatus de hombres de color hasta ese momento considerados esclavos y diferentes al ser humano. Efectivamente, Darwin vivía disgustado y muy preocupado por la existencia de la esclavitud y al parecer esta angustia influyó en profundizar su idea de que hombres blancos y negros tenían un mismo origen (1) y, eventualmente, y más allá de esta concepción, de que las especies habían evolucionado a través de millones de años desde seres inferiores hasta la complejidad del ser humano

Durante la elaboración del presente número de Anales de la Facultad de Medicina, hemos tenido la grata novedad de que la Escuela Académica Profesional de Medicina Humana de San Fernando ha recibido el 16 de mayo una certificación de Acreditación de la Red Internacional de Evaluadores. La Red Internacional de Evaluadores (RIEV) fue creada como una respuesta a la necesidad de desarrollo y mejoramiento de la educación superior en el ámbito internacional, y con base en la experiencia de la praxis en evaluación-planeación y la trayectoria académica del grupo fundador, tanto en la Universidad Nacional Autónoma de México, UNAM, como en muy diversas instituciones, entre las que destacó la Unión de Universidades de América Latina y el Caribe, UDUAL, de la que surge la RIEV como organismo autónomo, a partir del trabajo continuado del Diplomado Latinoamericano en Evaluación Univers...