Preeclampsia and eclampsia cause significant morbidity and mortality for mothers and neonates in Peru. Recent studies have suggested that secretion excess of a naturally occurring anti-angiogenic molecule of placental origin (soluble fmslike tyrosine kinase-1 - sFlt-1, or sVEGFR-1) may contribute to the pathogenesis of preeclampsia. sFlt-1 acts by antagonizing two pro-angiogenic molecules –vascular endothelial growth factor (VEGF) and placental growth factor (PLGF). Abnormalities in the angiogenic balance have been proposed as having a major role in the molecular cascade leading to proteinuria, hypertension, and endothelial dysfunction. Further evidence supports the hypothesis that angiogenic balance is crucial for differentiation and invasion of cytotrophoblasts. The abnormal placentation and the accompanying hypoxia may, in turn, result in more sFlt-1 production, thus leading to a vi...

We show how diabetes mellitus complicates pregnancy and what are the risks these patients and their newborns are exposed to. For this purpose the experience of Hospital San Bartolomé was revised. From January 1972 to December 1989, 56,347 pregnant women attended for pre-natal care, 11,298 (20%) women had diabetes risk factors and underwent oral glucose tolerance (OGIT) according to conventional criteria 538 patients were identified as pregnancy complicated by diabetes (GDM). Mean age was 31 y.o. (DS ± 6,5). 525 GDM (97,6%) were gestational diabetes (GD) and 13 (2,4%) pregestational diabetes (PGD). These latter were older than GD (p<0,05). 54 patients were lost (10%) and did riot deliver at the hospital. GDM women had significant maternal and perinatal complications in comparison to the total pregnant population (p<0,005). Considering abnormal plasma fasting glucose ³ 80 mg/dl (4,5 mM/...

Diabetes mellitus is a state of impaired glucose tolerance, caused by inadequate or ineffective insulin secretion action thereof. This altered metabolic state may worsen during pregnancy because pregnancy causes changes in metabolism of carbohydrates, fats and proteins that can aggravate diabetes in patients with a genetic predisposition for the disease.

Fetal macrosomia has been traditionally defined based on an arbitrary birthweight. However, fetal macrosomia is currently defined as a large for gestational age infant (>90 percentil) because of increased perinatal risk. This prospective investigation performed at San Bartolome's Hospital in Lima, Peru, included 1697 pregnant women from June 1990 to June 1993. 278 pregnant women had large infants (LGA) and 1 336 had normal sized infants. The predictor factors for LGA were: excessive weight gain (70%), male fetal sex (77%), placental width > 4 cm (74%), age over 30 years old (41,7%), obesity (33,5%), previous large infant (27%), fasting blood sugar > 79 mg/cIl (21,6%), 2h  post  prandial glucose > 110 mg/dl (20,7%), height > 160 cm (20%), familial diabetes (13,7%) and anemia (10, 1 %). The predictable maternal complications were: excessive weight gain, anemia, threatened abortion, place...

651 pregnant women at 26 to 36 weeks gestation were tested 1 hour with 50 g oral load of glucose (Test 50 g). They are passing the threshold of greater than or equal 130 mg / dl in plasma were suspicious of Gestational Diabetes (SDG). You're were subsequently tested oral glucose tolerance (OGTT) stop the diagnosis of gestational diabetes mellitus (BG) according to the criteria of the National Diabetes Data Group. The age of pregnant women was 26.3 ± 6.4 years (mean ± SD), range 16-45 years. 310 pregnant women (47.6%) did not have any risk factors for diabetes mellitus. 57 pregnant women (8.7%) were SDG. 32 (4.9%) underwent OGTT, resulting DG 24 patients (3.7%). There was no significant difference in the incidence of BG in people with risk factors and those that had not. The sensitivity of the test was 50 g of 88.9% and specificity of 95.2%. There were 3 DG not detected by the test; so ...

Preeclampsia and eclampsia cause significant morbidity and mortality for mothers and neonates in Peru. Recent studies have suggested that secretion excess of a naturally occurring anti-angiogenic molecule of placental origin (soluble fmslike tyrosine kinase-1 - sFlt-1, or sVEGFR-1) may contribute to the pathogenesis of preeclampsia. sFlt-1 acts by antagonizing two pro-angiogenic molecules –vascular endothelial growth factor (VEGF) and placental growth factor (PLGF). Abnormalities in the angiogenic balance have been proposed as having a major role in the molecular cascade leading to proteinuria, hypertension, and endothelial dysfunction. Further evidence supports the hypothesis that angiogenic balance is crucial for differentiation and invasion of cytotrophoblasts. The abnormal placentation and the accompanying hypoxia may, in turn, result in more sFlt-1 production, thus leading to a vi...

Preeclampsia and eclampsia cause significant morbidity and mortality for mothers and neonates in Peru. Recent studies have suggested that secretion excess of a naturally occurring anti-angiogenic molecule of placental origin (soluble fmslike tyrosine kinase-1 - sFlt-1, or sVEGFR-1) may contribute to the pathogenesis of preeclampsia. sFlt-1 acts by antagonizing two pro-angiogenic molecules –vascular endothelial growth factor (VEGF) and placental growth factor (PLGF). Abnormalities in the angiogenic balance have been proposed as having a major role in the molecular cascade leading to proteinuria, hypertension, and endothelial dysfunction. Further evidence supports the hypothesis that angiogenic balance is crucial for differentiation and invasion of cytotrophoblasts. The abnormal placentation and the accompanying hypoxia may, in turn, result in more sFlt-1 production, thus leading to a vi...

Diabetes mellitus is a state of impaired glucose tolerance, caused by inadequate or ineffective insulin secretion action thereof. This altered metabolic state may worsen during pregnancy because pregnancy causes changes in metabolism of carbohydrates, fats and proteins that can aggravate diabetes in patients with a genetic predisposition for the disease.

We show how diabetes mellitus complicates pregnancy and what are the risks these patients and their newborns are exposed to. For this purpose the experience of Hospital San Bartolomé was revised. From January 1972 to December 1989, 56,347 pregnant women attended for pre-natal care, 11,298 (20%) women had diabetes risk factors and underwent oral glucose tolerance (OGIT) according to conventional criteria 538 patients were identified as pregnancy complicated by diabetes (GDM). Mean age was 31 y.o. (DS ± 6,5). 525 GDM (97,6%) were gestational diabetes (GD) and 13 (2,4%) pregestational diabetes (PGD). These latter were older than GD (p<0,05). 54 patients were lost (10%) and did riot deliver at the hospital. GDM women had significant maternal and perinatal complications in comparison to the total pregnant population (p<0,005). Considering abnormal plasma fasting glucose ³ 80 mg/dl (4...

Fetal macrosomia has been traditionally defined based on an arbitrary birthweight. However, fetal macrosomia is currently defined as a large for gestational age infant (>90 percentil) because of increased perinatal risk. This prospective investigation performed at San Bartolome's Hospital in Lima, Peru, included 1697 pregnant women from June 1990 to June 1993. 278 pregnant women had large infants (LGA) and 1 336 had normal sized infants. The predictor factors for LGA were: excessive weight gain (70%), male fetal sex (77%), placental width > 4 cm (74%), age over 30 years old (41,7%), obesity (33,5%), previous large infant (27%), fasting blood sugar > 79 mg/cIl (21,6%), 2h  post  prandial glucose > 110 mg/dl (20,7%), height > 160 cm (20%), familial diabetes (13,7%) and anemia (10, 1 %). The predictable maternal complications were: excessive weight gain, anemia, threatened ...

651 pregnant women at 26 to 36 weeks gestation were tested 1 hour with 50 g oral load of glucose (Test 50 g). They are passing the threshold of greater than or equal 130 mg / dl in plasma were suspicious of Gestational Diabetes (SDG). You're were subsequently tested oral glucose tolerance (OGTT) stop the diagnosis of gestational diabetes mellitus (BG) according to the criteria of the National Diabetes Data Group. The age of pregnant women was 26.3 ± 6.4 years (mean ± SD), range 16-45 years. 310 pregnant women (47.6%) did not have any risk factors for diabetes mellitus. 57 pregnant women (8.7%) were SDG. 32 (4.9%) underwent OGTT, resulting DG 24 patients (3.7%). There was no significant difference in the incidence of BG in people with risk factors and those that had not. The sensitivity of the test was 50 g of 88.9% and specificity of 95.2%. There were 3 DG not detected by the test; so ...

A propósito de la reciente promulgación de la Resolución Ministerial N.º 486-2014/Minsa, que aprueba la guía técnica nacional para el aborto terapéutico, se ha generado un gran debate al respecto. Como un aporte a la discusión, se presenta una revisión sobre las definiciones y tipos de aborto, para luego centrarse en el denominado ‘aborto terapéutico’ y explorar las  dificultades que existen para definirlo. Finalmente, sepresentan algunas observaciones a esta Guía técnica emitida por el Minsa. Se concluye que el término ‘aborto terapéutico’ es anacrónico y contradictorio porque el aborto no es un tratamiento que asegure mejorar la salud de la mujer ni la del niño. El término apropiado debería ser ‘interrupción del embarazo por razones médicas’.

Blood samples in the rasting state were drawn rrom 1,560 non diabetic Peruvan pregnant women at 26 to 36 weeks or gestatlon in order to establish a normal range für fasting serum glucose in pregnancy (ortho-tolouidine method) and to examine whether maternal-fetal prognosis differs when maternal fasting blood sugar (FBS) values are beyond this range. The 3rd, 50th and 95th percentiles were SO, 67, 80 and 85 mg/dl, respectively. Pregnant women with diabetes risk factors had mean serum glucose values higher titan pregnant women without such risk factors significantly. Follow up was completed on 1,415 (90.7%) of the pregnancies and 1,043 (67%) of the newborns. Maternal FDS showed a positive association to diabetes rlsk factors, pregnancy complicatlons, feto-pelvic disproportion, shoulder dystocia, operative deliveries and perinatal morbidity and mortality. A significant increase In the mate...

Objetivo: Describir la frecuencia de los factores condicionantes de la enfermedad y la muerte en la mujer y el niño en un hospital materno infantil de la ciudad de Lima. Material y Métodos: Estudio descriptivo y analítico de los embarazos únicos ocurridos en el Hospital de Bartalomé de Lima desde el primero de enero de 2001 hasta el 31 de diciembre de 2009. Se obtuvo la información clínica y demográfica de la gestante y su niño por nacer de la base de los datos del Sistema Informático Perinatal de Departamento de Gineco-obstetricia y pediatría del Hospital. Los factores condicionantes de la enfermedad y la muerte humana fueron clasificados de la siguiente forma: 1) Anatómico: Talla materna <156cm, ruptura prematura de membranas fetales y defecto anatómico del niño, 2) Malnutrición: Índice de masa corporal (IMC) >24.9kg/m2 IMC<18.5 kg/m2 y Hemoglobina<11gr/dl; ...

Objetivo: Describir la frecuencia de los factores condicionantes de la enfermedad y la muerte de la mujer y el niño en un hospital materno infantil de la ciudad de Lima. Material y Métodos: Estudio descriptivo, retrospectivo y analítico de los embarazos únicos ocurridos en el Hospital San Bartolomé de Lima desde el 1 de enero de 2001 hasta el 31 de diciembre de 2009. Se obtuvo la información clínica y demográfica de la gestante y su niño por nacer de la base de datos del Sistema Informático Perinatal del Departamento de Gineco-obstetricia y pediatría del Hospital. Los factores condicionantes de la enfermedad y la muerte humana fueron clasificados de la siguiente forma: 1) Anatómica: Talla materna <156cm, ruptura prematura de membranas fetales y defecto anatómico del niño, 2) Malnutrición: índice de masa corporal (IMC)>24.9kg/m2, IMC<18.5kg/m2 y hemoglobina <11...

El ser humano nace con una percepción innata de la eternidad de la vida y una conciencia de la lucha entre el bien y el mal, donde el mal simboliza enfermedad y muerte; y el bien, salud y esperanza en la vida eterna. La frase "no existen enfermedades, sino enfermos" refleja una visión centrada en la persona humana, no solo en la enfermedad, y tiene raíces en la historia médica peruana y mundial.Antes de la escritura, los médicos peruanos conocían las propiedades de plantas medicinales y desarrollaron procedimientos de intervención, especialmente en el cuidado de mujeres embarazadas que se emplean en la actualidad. La llegada de la escritura y la educación occidental retrasó la incorporación de estos conocimientos, debido a prejuicios coloniales. Sin embargo, gracias al espíritu misericordioso de profesores peruanos y extranjeros, se formaron generaciones de médicos peruanos q...

El estudio HAPO incluyó 25 505 embarazos únicos en 9 países que se sometieron a una prueba de tolerancia oral a la glucosa de 2 horas con 75 g de glucosa (PTOG) en semana 24 a 32 de gestación. En el 2010, el Grupo Internacional de Asociaciones del estudio de la diabetes y el embarazo (IADPSG) reportó que el diagnóstico de hiperglicemia en el embarazo podía establecerse empleando los valores en ayunas, 1 y 2 horas post PTOG asociados a 1.75 veces mayor riesgo sobre la media de los efectos adversos del estudio HAPO, los cuales correspondieron a glicemia en ayunas ≥ 92 mg/dl, glicemia 1 hora ≥ 180 mg/dL y glicemia 2 horas ≥ 153 mg/dl. Aunque la PTOG en el estudio HAPO se realizó desde la semana 24 a 32 de embarazo, la Organización Mundial de la Salud en el 2013 recomendó emplear estos valores para diagnóstico de la hiperglicemia en el embarazo fuera de ese periodo del embar...

Introduction: Fetal macrosomia is a risk factor for metabolic disorder and obesity in childhood and adulthood. Objectives: To determine nutritional status and metabolic disorders of children with history of fetal macrosomia in Tacna. Design: Prospective, descriptive and longitudinal study. Institution: Hipolito Unanue Hospital, Tacna, Peru. Patients: Fifty children 8 to 10 year-old born at Hipolito Unanue Hospital of Tacna, with history of birth weight over 4 500 grams were studied. Children with chronic diseases predisposing to overweight or obesity were excluded. Interventions: The nutritional status was assessed by current body mass index (BMI) according to age using World Health Organization charts; blood pressure was measured in millimeters of mercury and fasting serum sample was obtained for enzymatic methods analysis to assess glucose, triglycerides, total cholesterol, HD...

Este libro sobre crecimiento intrauterino y neonatal en el Perú y sus implicancias en salud pública, es el resultado de una estrecha cooperación entre las Facultades de Medicina de la Universidad Nacional Jorge Basadre Grohmann de Tacna y la Universidad Nacional Mayor de San Marcos, con el financiamiento del Instituto Nacional de Salud para estudios de crecimiento intrauterino en el Perú. El propósito es presentar patrones de crecimiento intrauterino propios del país para una adecuada clasificación del estado nutricional de nuestros recién nacidos y su consecuente prevención de la malnutrición intrauterina y crecimiento postnatal del recién nacido de muy bajo peso.

Introduction: Fetal macrosomia is a risk factor for metabolic disorder and obesity in childhood and adulthood. Objectives: To determine nutritional status and metabolic disorders of children with history of fetal macrosomia in Tacna. Design: Prospective, descriptive and longitudinal study. Institution: Hipolito Unanue Hospital, Tacna, Peru. Patients: Fifty children 8 to 10 year-old born at Hipolito Unanue Hospital of Tacna, with history of birth weight over 4 500 grams were studied. Children with chronic diseases predisposing to overweight or obesity were excluded. Interventions: The nutritional status was assessed by current body mass index (BMI) according to age using World Health Organization charts; blood pressure was measured in millimeters of mercury and fasting serum sample was obtained for enzymatic methods analysis to assess glucose, triglycerides, total cholesterol, HD...