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One hundred and four patients who delivered after a previous cesarean section, at Hospital de Ginecoobstetricia de Garza García, N.L., from February 1, 1994 to January 31, 1995, were reviewed. The objective for this study was to know materno-fetal morbi-mortality at our hospital. Age, parity weeks of gestation, cause for previous section, delivery culmination, weight and Apgar of products, as well as, materno-fetal morbi-mortality, were analyzed. Average age group was 21 to 30 years with 68.5%. As to parity nulliparae predominated with 48.1%. As to weeks of gestation, the most frequent was 37 to 40 weeks, 85.5%. Previous section indication was: 1. Pelvic presentation, 2. Fetal stress, 3. Cefalo-pelvic disproportion, 4. Premature rupture of membranes, 5. Toxemia. As to deliveries outcome, there was dystocia in 86.5%, by profilactic low forceps application in 81.7%; and mid low in 4.8%. Eutocic delivery, 13.5%. Product weight was 3,000 to 3,500 g, with 51%. Apgar in 94 products was 8 and 9 at one minute. Maternal morbidity was 15.3% being most frequent vaginal tears. There was one case of uterine atonia, and one case of dura mater adverted puncture. There were no uterine dehiscence nor rupture. Perinatal morbidity was 5.6%. There was no perinatal death.

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263 cases of adolescent primipara at Hospital de Ginecoobstetricia, at Garza García. N.L. from January to December, 1995, were reviewed. two groups were formed, one of 12 to 15 years with 79 (30.1%); and the other one of 16 to 18 years, with 184 (69.9%), (p < 0.05). There were significant differences in both groups, with a greater proportion in the first group (p < 0.05), as to free union and preterm pregnancy; less prenatal control in the young ones with 31.6% against 23.3% in complications during pregnancy, more frequent the first group 36.7% and 28.8%; being more frequent, in both groups premature rupture of membranes, followed by anemia, toxemia and prolonged pregnancy. In pregnancy resolution, cesarean section showed a significant difference in both groups, being more frequent in the first group with 55.7% against 34.4% (p < 0.01) and the main indication was cephalopelvic disproportion with 32.9% and 16.8%. As to weight of products only 5% and 6.5% were subnormal; in the Apgar at one minute. it was slightly low in the first group with two deaths prepartum in the group two. Maternal morbidity was greater in the youth with 5% against 1%; There were no maternal deaths. Perinatal morbidity/mortality was 8.8% and 11.4%, predominating in both groups. Retardation of intrauterine growth, and in group two, congenital malformations and two deaths, fetal, prepartum. The contraceptive method used was Intrauterine device postpartum with a frequency of 81% against 72.2%. It is concluded that the adolescent primipara should be considered as high risk, as there is an increase in maternofetal morbidity, being more intense in the younger ones, and that a prenatal control, adequate, is of a great benefit.

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Six hundred and thirteen cases of Salinas forceps application at Hospital de Ginecoobstetricia de Garza García, N.L. from November 1992 to April, 1993, were reviewed. The largest patients group, 20 to 29 years of age with 54.5%; primiparae were predominant with 55.9%, the largest amount of applications in term products, 80.8%; elective forceps with 72.5%; low application with 83.0%; medium 2.5%; episiotomy, medium, right lateral in all the cases; epidural block anesthesia in all the patients, and only one complication 0.1%; most frequent position variety OIA with 50%; and the smaller OIP with 2.6%; 96.3% of products weighted more than 2,500 g; and 87.1% with Apgar 8-9 at one minute. Maternal morbidity, 30.1%; fetal morbidity, 6.1%, with one case with facial paralysis (0.1%) by medium forceps. There were no maternal deaths; 3 antepartum fetal deaths; none postpartum.

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Eighty six cases of perinatal mortality at Hospital de Ginecoobstetricia, Garza García, N.L. Subsecretaría Estatal, from january, 1992 to December, 1993, were reviewed. Perinatal mortality was 12.0 by one thousand births, less than in other reports. The highest incidence was in young patients, 20 to 29 years old, with 47.7% and with parity of 1 to 3, 80.2%; highest frequency in term pregnancies, 37 to 42 weeks, 39.6%; 35% of the products with weight over 2,500 g; and 65% with lesser weight; fetal death occurred most frequently during pre-partum, 55.8%, and less during intra-partum, 19.8%. Most frequent causes of peri-natal death were placental failure, 27.9% and fetal immaturity, with 24.4%. It is concluded that an adequate pre-natal control and delivery surveillance produce a diminution in fetal mortality.

PIP: A prospective study was conducted of the 86 perinatal deaths occurring at a woman's hospital in Garza Garcia, Nuevo Leon, between January 1992 and December 1993. The objective was to determine the frequency, causes, and patient groups at greatest risk of perinatal death. The perinatal mortality rate was 12.0/1000 live births. 47.7% of the mothers were aged 20-29; 24.4% each were 15-19 and 30-39 years old, and 3.5% were 40-42. 80.2% had 1-3 live births. The gestational age was 20-28 weeks and 29-36 weeks in 30.2% of cases each, and 37-42 weeks in 39.6%. 40.7% of the infants weighed 1000-2499 g, 27.9% weighed 2500-3999, and 24.4% weighed 500-999 g. 7.0% weighed over 4000 g. Birth weights ranged from 525 to 5000 g. 34 deliveries were eutocic, 31 were dystocic, and 21 were cesarean. 48 deaths were prepartum, 17 were intrapartum, and 21 were postpartum. 52 of the mothers had fewer than five prenatal visits and 34 had more than five. The cause of death was placental insufficiency in 24 cases, fetal immaturity in 21, umbilical problems in 15, and congenital malformations in 11. It was concluded that adequate prenatal care and monitoring of labor and delivery would result in a decreased perinatal mortality rate.

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This is a review of 209 cases of salpingochlasia by minilaparotomy, post-partum. Frequency was 13.2%. The larger group was 20 to 29 years of age, 52%; 14.3% were unmarried. Multiparae were most frequent, 52.2%. One previous section 3.5%; with four to six live children, 54%. No previous anticonceptive method, 91%; pre-natal control, 69%. With anemia, Hb less than 10 g, 11%, and only 3.5% required blood transfusion. Eutocic delivery, 89%. Ruptured membranes, before delivery, less than six hours, 97%. Anesthesia during delivery, 59.1%; it was epidural anesthesia, as well as for the salpingochlasia in 100%, without complications. The indication was completed parity in 100%, the technique mostly used was Pomeroy's in 77.3%. There were no pre, trans or post-operative complications. The interval between delivery and salpingochlasia in first 12 hours, 98% and from surgery to hospital discharge, 12 to 24 hours, 89.2%. Hospital stay was two days, 90%. Pomeroy's technique failure, 0.6% and for Kroener's, 2.1%. Two pregnancies occurred out of 1,238 months-woman observation.

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RESUMO

This is a review of 209 cases of salpingochlasia by minilaparotomy, post-partum. Frequency was 13.2%. The larger group was 20 to 29 years of age, 52%; 14.3% were unmarried. Multiparae were most frequent, 52.2%. One previous section 3.5%; with four to six live children, 54%. No previous anticonceptive method, 91%; pre-natal control, 69%. With anemia, Hb less than 10 g, 11%, and only 3.5% required blood transfusion. Eutocic delivery, 89%. Ruptured membranes, before delivery, less than six hours, 97%. Anesthesia during delivery, 59.1%; it was epidural anesthesia, as well as for the salpingochlasia in 100%, without complications. The indication was completed parity in 100%, the technique mostly used was Pomeroy's in 77.3%. There were no pre, trans or post-operative complications. The interval between delivery and salpingochlasia in first 12 hours, 98% and from surgery to hospital discharge, 12 to 24 hours, 89.2%. Hospital stay was two days, 90%. Pomeroy's technique failure, 0.6% and for Kroener's, 2.1%. Two pregnancies occurred out of 1,238 months-woman observation.

PIP: This is a review of 209 cases of salpingochlasia by postpartum mini laparotomy. 52% of the group were between 20-29 years of age and 14.3% were unmarried. 52.2% of the group were multipara. 3.5% had had a previous cesarean section and 54% had 4-6 live children. No previous contraceptive had been used by 91% of the population and 69% had used prenatal control. 11% had anemia with an Hb 10 g and only 3.5% required blood transfusions. A eutocic delivery was seen in 89% and 97% experienced ruptures membranes less than 6 hours before delivery. 59.1% of the women received epidural anesthesia during delivery without complications. The indication was that there was completed parity in 100% and the technique used most widely was the Pomeroy technique in 77.3%. There were no pre-, trans-, or postoperative complications. The interval between delivery and salpingochlasia was 12 hours for 98% of the group, and from surgery to hospital discharge 12-24 hours for 89.2%. 90% experienced a hospital stay of 2 days, 0.6% experienced Pomeroy techniques failure, and 2.1% experienced similar problems with the Kroener method. 2 pregnancies occurred out of 1238 woman-months of observation. (author's modified)

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