RESUMO

OBJECTIVE: To evaluate the association between the severity of climacteric symptoms (CS) and orgasmic dysfunction (OD), controlled by demographic, clinical, and partner variables. METHODS: We carried out a secondary analysis of a multicenter Latin American cross-sectional study that surveyed sexually active women 40 to 59 years old. We assessed CS (global, somatic, psychological, or urogenital domains) and OD. Also, we explored clinical variables and partner sexual conditions. We performed logistic regression models with nonparametric bootstrap resampling to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: We included data of 5,391 women in the analysis. Regarding CS, 24.8%, 10.8%, 28.4%, and 32.9% had respectively severe symptoms according to total, somatic, psychological, and urogenital domain scores of the Menopause Rating Scale. OD was found in 25.4% of women. The adjusted model (including menopausal status and partner sexual dysfunction) showed that severe CS increased the odds of OD (aOR = 2.77; 95% CI: 2.41-3.19 [total Menopause Rating Scale score]; aOR = 1.65; 95% CI: 1.37-2.00 [somatic domain]; aOR = 2.02; 95% CI: 1.76-2.32 [psychological domain] and aOR = 3.89; 95% CI: 3.40-4.45 [urogenital]). CONCLUSIONS: Severe CS were associated with OD independently of demographic, clinical, and partner variables. Severe urogenital symptoms had the strongest association.

Assuntos

RESUMO

Multiple small studies have suggested that women with pre-eclampsia present elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6). However, little is known regarding the source of this CRP and IL-6 increase. Therefore, the aim of this study was to evaluate the relationship between CRP and IL-6 levels with pre-eclampsia considering different confounding factors. Using data from a large Colombian case-control study (3,590 cases of pre-eclampsia and 4,564 normotensive controls), CRP and IL-6 levels were measured in 914 cases and 1297 controls. The association between maternal serum levels of CRP and IL-6 with pre-eclampsia risk was evaluated using adjusted logistic regression models. Pre-eclampsia was defined as presence of blood pressure ≥140/90 mmHg and proteinuria ≥300mg/24 h (or ≥1 + dipstick). There was no evidence of association between high levels of CRP and IL-6 with pre-eclampsia after adjusting for the following factors: maternal and gestational age, ethnicity, place and year of recruitment, multiple-pregnancy, socio-economic position, smoking, and presence of infections during pregnancy. The adjusted OR for 1SD increase in log-CRP and log-IL-6 was 0.96 (95%CI 0.85, 1.08) and 1.09 (95%CI 0.97, 1.22), respectively. Although previous reports have suggested an association between high CRP and IL-6 levels with pre-eclampsia, sample size may lack the sufficient power to draw robust conclusions, and this association is likely to be explained by unaccounted biases. Our results, the largest case-control study reported up to date, demonstrate that there is not a causal association between elevated levels of CRP and IL-6 and the presence of pre-eclampsia.

Assuntos

RESUMO

BACKGROUND: Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population. MATERIALS AND METHODS: Design: A case-control study. Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012. Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls. Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy. Main Outcomes Measures: Odds ratio for pre-eclampsia. RESULTS: After adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy. CONCLUSIONS: Maternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.

Assuntos

RESUMO

Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.

Assuntos

RESUMO

OBJECTIVE: To evaluate associations between anxiety and severe impairment of quality of life (QoL) in Latin American postmenopausal women. METHODS: This was a secondary analysis of a multicenter cross-sectional study among postmenopausal women aged 40 to 59 from 11 Latin American countries. We evaluated anxiety (The Goldberg Depression and Anxiety Scale), and QoL (Menopause Rating Scale [MRS]), and included sociodemographic, clinical, lifestyle, and anthropometric variables in the analysis. Poisson family generalized linear models with robust standard errors were used to estimate prevalence ratios (PRs) and 95% CIs. There were two adjusted models: a statistical model that included variables associated with the outcomes in bivariate analyses, and an epidemiologic model that included potentially confounding variables from literature review. RESULTS: Data from 3,503 women were included; 61.9% had anxiety (Goldberg). Severe QoL impairment (total MRS score ≥17) was present in 13.7% of women, as well as severe symptoms (MRS subscales): urogenital (25.5%), psychological (18.5%), and somatic (4.5%). Anxiety was independently associated with severe QoL impairment and severe symptoms in the epidemiological (MRS total score: PR 3.6, 95% CI, 2.6-5.0; somatic: 5.1, 95% CI, 2.6-10.1; psychological: 2.8, 95% CI, 2.2-3.6; and urogenital: 1.4, 95% CI, 1.2-1.6) and the statistical model (MRS total score: PR 3.5, 95% CI, 2.6-4.9; somatic: 5.0, 95% CI, 2.5-9.9; psychological: 2.9, 95% CI, 2.2-3.7; and urogenital: 1.4; 95% CI, 1.2-1.6). CONCLUSIONS: In this postmenopausal Latin American sample, anxiety was independently associated with severe QoL impairment. Hence, screening for anxiety in this population is important.

Assuntos

RESUMO

BACKGROUND: Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE: To determine the use of MHT and perceived related risks among gynecologists. METHODS: A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS: A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION: Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.

Assuntos

RESUMO

BACKGROUND: The prevalence of obesity increases during female mid-life and although many factors have been identified, data from Latin America is lacking. OBJECTIVE: To assess factors related to obesity among middle-aged women and determine the association with depressive symptoms, sedentary lifestyle and other factors. METHODS: A total of 6079 women aged 40-59 years of 11 Latin American countries were asked to fill out the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index and a general questionnaire containing personal socio-demographic data, anthropometric measures and lifestyle information. Obesity was defined as a body mass index (BMI) ≥30 kg/m(2). RESULTS: Obesity was observed in 18.5% and sedentary lifestyle in 63.9%. A 55.5% presented vasomotor symptoms, 12.2% had severe menopausal symptoms and 13.2% used hormone therapy for the menopause. Prevalence of depressive symptoms was 46.5% and anxiety 59.7%. Our logistic regression model found that significant factors associated to obesity included: arterial hypertension (OR: 1.87), depressive symptoms (OR: 1.57), sedentary lifestyle (OR: 1.50) diabetes mellitus (OR: 1.34), higher number of individuals living at home (OR: 1.31), sleep problems (OR:1.22), anxiety (OR: 1.21), having a stable partner (OR: 1.20), parity (OR: 1.16) and vasomotor symptoms (OR:1.14). A lower risk for obesity was found among women using hormonal contraceptives (OR: 0.69). CONCLUSION: Obesity in middle-aged women is the consequence of the interaction of multiple factors. It was associated to hypertension, depressive symptoms, sedentary lifestyle, climacteric symptoms and other factors.

Assuntos

RESUMO

BACKGROUND: Few studies have addressed the impact of menopausal symptom severity over quality of life (QoL) in Latin American women with different ethnics. OBJECTIVE: To assess menopausal symptom severity and the QoL among postmenopausal Colombian women with three different ethnicities. METHOD: Data of healthy naturally occurring postmenopausal Hispanic, indigenous and black women aged 40-59 years who participated in a cross-sectional study filling out the Menopause Rating Scale (MRS) and a general questionnaire was analysed. RESULTS: A total of 579 women were included, 153 Hispanic, 295 indigenous and 131 Afro-descendent. Hispanic women had an average age of 55.3 +/- 3.3 years. Indigenous and black women were less educated than the Hispanic ones (2.2 +/- 1.8 and 4.6 +/- 4.4 vs. 6.4 +/- 3.5 years, p < 0.0001). Hispanic women displayed lower total MRS scores (better QoL) when compared to indigenous and black women. Urogenital scoring was worse among indigenous women compared to Hispanic and black women. Black women presented higher MRS psychological and somatic scorings than Hispanic and indigenous women. After adjusting for confounding factors, indigenous and black women continued to display a higher risk for impaired QoL, total MRS score > 16 (OR: 3.11, 95% CI: 1.30-7.44 and OR: 5.29, 95% CI: 2.52-11.10, respectively), which was significantly higher among indigenous women due to urogenital symptoms (OR: 102.75, 95% CI: 38.33-275.47) and black women due to psychological (OR: 6.58, 95% CI: 3.27-13.27) and somatic symptoms (OR: 3.88, 95% CI: 1.83-8.22). CONCLUSION: In this postmenopausal Colombian series, menopausal symptoms in indigenous (urogenital) and black (somatic/psychological) women were more severe (impaired QoL) when compared to Hispanic ones.

Assuntos

RESUMO

OBJECTIVE: The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument. METHODS: The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out. RESULTS: Mean +/- SD age of surveyed women was 49.0 +/- 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of them presented SD (FSFI total score 48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare. CONCLUSIONS: The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.

Assuntos

RESUMO

BACKGROUND: Several studies indicate that quality of life (QoL) is impaired in middle aged women. Assessment of QoL using a single validated tool in Latin American climacteric women has not been reported to date at large scale. OBJECTIVE: The Menopause Rating Scale (MRS) was used to assess QoL among middle aged Latin American women and determine factors associated with severe menopausal symptoms (QoL impairment). METHODS: In this cross-sectional study, 8373 healthy women aged 40-59 years, accompanying patients to healthcare centres in 18 cities of 12 Latin American countries, were asked to fill out the MRS and a questionnaire containing socio-demographic, female and partner data. RESULTS: Mean age of the entire sample was 49.1+/-5.7 years (median 49), a 62.5% had 12 or less years of schooling, 48.8% were postmenopausal and 14.7% were on hormonal therapy (HT). Mean total MRS score (n=8373) was 11.3+/-8.5 (median 10); for the somatic subscale, 4.1+/-3.4; the psychological subscale, 4.6+/-3.8 and the urogenital subscale, 2.5+/-2.7. The prevalence of women presenting moderate to severe total MRS scorings was high (>50%) in all countries, Chile and Uruguay being the ones with the highest percentages (80.8% and 67.4%, respectively). Logistic regression determined that impaired QoL (severe total MRS score > or =17) was associated with the use of alternatives therapies for menopause (OR: 1.47, 95% CI [1.22-1.76], p=0.0001), the use of psychiatric drugs (OR: 1.57, 95% CI [1.29-1.90], p=0.0001), attending a psychiatrist (OR: 1.66, 95% CI [1.41-1.96], p=0.0001), being postmenopausal (OR: 1.48, 95% CI [1.29-1.69, p=0.0001]), having 49 years or more (OR: 1.24, 95% CI [1.08-1.42], p=0.001), living at high altitude (OR: 1.43, 95% CI [1.25-1.62, p=0.0001]) and having a partner with erectile dysfunction (OR: 1.69, 95% CI [1.47-1.94, p=0.0001]) or premature ejaculation (OR: 1.34, 95% CI [1.16-1.55, p=0.0001]). Lower risk for impaired QoL was related to living in a country with a lower income (OR: 0.77, 95% CI [0.68-0.88], p=0.0002), using HT (OR: 0.65, 95% CI [0.56-0.76], p=0.0001) and engaging in healthy habits (OR: 0.59, 95% CI [0.50-0.69], p=0.0001). CONCLUSION: To the best of our knowledge this is the first and largest study assessing QoL in a Latin American climacteric series with a high prevalence of impairment related to individual female and male characteristics and the demography of the studied population.

Assuntos

RESUMO

BACKGROUND: Increased frequency and severity of menopausal symptoms have been associated to black race. However, this situation has not been described in any Latin American population. OBJECTIVE: Compare frequency and severity of menopausal symptoms among Afro and non-Afro Hispanic Colombian climacteric women. METHODS: In this cross-sectional study, healthy Afro and non-Afro-Colombian women aged 40-59 years were asked to fill out the Menopause Rating Scale (MRS) questionnaire in order to compare symptom frequency and intensity. RESULTS: A total of 578 women were surveyed (201 Afro-Colombian and 377 non-Afro-Colombian). Mean age of the whole sample was 47.9+/-5.9 years (median 47), with no differences among studied groups in terms of age, parity, and hormone therapy (HT) use. Intensity of menopausal symptoms, assessed with the total MRS score, was found to be significantly higher among Afro-Colombian women (10.6+/-6.7 vs. 7.5+/-5.7, p=0.0001), which was due to higher somatic and psychological subscale scores. In this group, the frequency of somatic symptoms, heart discomfort and muscle and joint problems, was found to be higher than in non-Afro-Colombian women (38.8% vs. 26.8% and 77.1% vs. 43.5%, respectively, p<0.05); equally, all items of the psychological subscale (depressive mood, irritability, anxiety and physical exhaustion) were also found to be higher among black women. On the other hand, compared to black women non-Afro-Colombian ones presented more bladder problems (24.9% vs. 14.9%, p=0.005). After adjusting for confounding factors, logistic regression analysis determined that black race increased the risk for presenting higher total MRS scorings (OR: 2.31; CI 95%: 1.55-3.45, p=0.0001). CONCLUSION: Despite the limitations of this study, as determined with the MRS Afro-Colombian women exhibited more impaired quality of life (QoL) when compared to non-Afro-Colombian ones, due to a higher rate and severity of menopausal somatic and psychological symptoms.

Assuntos

RESUMO

BACKGROUND: Inappropriate activation of the renin-angiotensin system may play a part in the development of preeclampsia. An insertion/deletion polymorphism within the angiotensin-I converting enzyme gene (ACE-I/D) has shown to be reliably associated with differences in angiotensin-converting enzyme (ACE) activity. However, previous studies of the ACE-I/D variant and preeclampsia have been individually underpowered to detect plausible genotypic risks. METHODS AND FINDINGS: A prospective case-control study was conducted in 1,711 unrelated young pregnant women (665 preeclamptic and 1,046 healthy pregnant controls) recruited from five Colombian cities. Maternal blood was obtained to genotype for the ACE-I/D polymorphism. Crude and adjusted odds ratio (OR) and 95% confidence interval (CI) using logistic regression models were obtained to evaluate the strength of the association between ACE-I/D variant and preeclampsia risk. A meta-analysis was then undertaken of all published studies to February 2006 evaluating the ACE-I/D variant in preeclampsia. An additive model (per-D-allele) revealed a null association between the ACE-I/D variant and preeclampsia risk (crude OR = 0.95 [95% CI, 0.81-1.10]) in the new case-control study. Similar results were obtained after adjusting for confounders (adjusted per-allele OR = 0.90 [95% CI, 0.77-1.06]) and using other genetic models of inheritance. A meta-analysis (2,596 cases and 3,828 controls from 22 studies) showed a per-allele OR of 1.26 (95% CI, 1.07-1.49). An analysis stratified by study size showed an attenuated OR toward the null as study size increased. CONCLUSIONS: It is highly likely that the observed small nominal increase in risk of preeclampsia associated with the ACE D-allele is due to small-study bias, similar to that observed in cardiovascular disease. Reliable assessment of the origins of preeclampsia using a genetic approach may require the establishment of a collaborating consortium to generate a dataset of adequate size.

Assuntos

RESUMO

OBJECTIVE: To assess the age at menopause (AM) in Latin America urban areas. DESIGN: A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis. RESULTS: The mean age of the entire sample was 49.4 +/- 5.5 years. Mean educational level was 9.9 +/- 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P < 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P < 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P < 0.001) were more prone to an earlier onset of menopause. CONCLUSIONS: The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause.

Assuntos

RESUMO

Si bien están disponibles desde hace muchos años los anticonceptivos orales de sólo progestina o minipíldora, son poco conocidos y menos prescritos o recomendados que los anticonceptivos orales combinados. Los anticonceptivos orales de sólo progestina, por estar libres de estrógenos tienen un papel importante y un definido sitial en la anticoncepción hormonal contemporánea. A las primeras progestinas: etinodiol, linestrenol y noretisterona, se agregó el norgestrel, luego el levnorgestrel y posteriormente el desogestrel. Recientemente la drospirenona está siendo evaluada. Desde siempre la minipíldora de levonorgestrel tiene su asiento único dentro de la anticoncepción oral hormonal en la lactancia, mientras que la minipíldora de desogestrel, sin perder dicho espacio, puede también ser recomendada más allá de la lactancia, por su capacidad inhibitoria de la ovulación. Esta capacidad igualmente se ha observado con la administración de tabletas que sólo incluyen drospirenona. El propósito de la presente revisión es orientar al profesional de la salud, para que identifique y puntualice las diferencias, así como las similitudes entre minipíldora y anticonceptivos orales combinados. Por la inocuidad clínica y los beneficios observados, los anticonceptivos orales de sólo progestins deben considerarse en el momento de la consejería contraceptiva.

Assuntos

RESUMO

Polymorphisms in the endothelial NO synthase (eNOS) gene have been evaluated as risk factors for preeclampsia. However, data from small studies are conflicting. We assessed whether eNOS genotypes alter the risk of preeclampsia in a population in which the incidence of this disorder is high. A total of 844 young pregnant women (322 preeclamptic and 522 controls) were recruited from 5 cities. Genotyping for the Glu298Asp, intron-4 and -786T-->C polymorphisms in the eNOS gene was conducted. Multivariate odds ratios (ORs) were obtained to estimate the association of individual polymorphisms and haplotypes with preeclampsia risk. No increase in the risk of preeclampsia for the intron-4 or -786T-->C polymorphisms was observed under any model of inheritance. In contrast, in women homozygous for the Asp298 allele, the adjusted OR for preeclampsia was 4.60 (95% confidence interval [CI], 1.73 to 12.22) compared with carriers of the Glu298 allele. After a multivariate analysis, carriage of the "Asp298-786C-4b" haplotype was also associated with increased risk of preeclampsia (OR, 2.11 [95% CI, 1.33 to 3.34]) compared with carriers of the "Glu298-786T-4b" haplotype. The eNOS Glu298Asp polymorphism and the Asp298-786C-4b haplotype are risk factors for preeclampsia.

Assuntos

Assuntos

RESUMO

El embarazo en la adolescencia a todas luces un evento traumático e inesperado para las y los jóvenes, sus familias y la sociedad en general. Esta problemática se viene incrementando y son muchos los factores de riesgo que requieren ser analizados y trabajados para prevenirlos. Diversas evaluaciones y observaciones en el país sustentan que la mayoría de los embarazos en adolescentes no son deseados. Un parto a edad temprana puede deteriorar a acortar la vida de la adolescente y establecer una práctica reproductiva perjudicial a su salud y a la de sus hijos. No se conoce la cuantificación real del embarazo en la adolescencia, lo que podemos medir es la maternidad en la adolescencia. El embarazo y la maternidad en la adolescencia suele llevar al abandono escolar, falta de educación, pérdida en la capacidad de contribuir con independencia económica. Existe poca preparación en el personal de salud para hacer frente a los problemas psico-sociales de las adolescentes en embarazo

Assuntos

RESUMO

El prolapso genital es una condición frecuente en la práctica clínica, definido como el descenso de las estructuras genitales y/o elementos relacionados con él, por debajo del nivel que normalmente ocupan. La fascia endopélvica une los órganos a las paredes pélvicas, mientras los músculos del piso pélvico, cierran la pelvis y elevando los órganos, evitan la distención de los ligamentos aponeuróticos. 102 pacientes que fueron ingresadas al Hospital Universitario de Cartagena con prolapso genital son estudiadas. Edades: 32-80 años. X=55.8+o- 12.3 años. 74.5 por ciento tenían prolapso Grado III. La paridad promedio fue de 7 partos y ninguna era nulípara. El tipo de prolapso más frecuente fue el cistorectocele, seguido del prolapso genital total. El 30.2 por ciento de las cirugías ginecológicas que se realizan en este Hospital son procedimientos por corrección del prolapso genital. No se presentaron accidentes intraoperatorios y las complicaciones a los 30 días post-quirúrgicas fueron del 11.8 por ciento. La estancia hospitalaria fue de 3-8 días. El origen de los transtornos del piso pélvico se considera multifactorial, dándose gran valor al traumatismo obstétrico y más recientemente a los estados hipoestrogénicos post-menopáusicos. Hacen falta más estudios para precisar la influencia de los estados nutricionales y la tendencia familiar en el prolapso genital

Assuntos

RESUMO

El embarazo en adolescentes es un problema con implicaciones psíquicas, sociales y médicas. En la Matenidad"Rafael Calvo", Cartagena, Colombia en el año de 1994 se atendieron 12.416 partos, siendo 3.161 pacientes (25.4 por ciento) menores de 20 años: estando en adolescencia temprana 57 (1.8 por ciento) y en adolescente tardía 3.104 (98.2 por ciento). Se comparan los resultados obstétricos de la atención a las adolescentes tempranas con los de 180 maternas adultas. La edad promedio de las adolescentes fue 13.9 años de edad. En ellas se presentó mayor frecuencia de : parto pretémino y parto post-término, ruptura prematura de membranas, hipertensión inducida por el embarazo, hemorragia post-parto, contractilidad uterina alterada y retardo en el crecimiento intrauterino, aunque las diferencias no fueron estadísticamente significativas. El bajo peso al nacer fue más frecuente en adolescentes, y la diferencia si fue estadísticamente significativa, con un riesgo relativo 2 veces mayor. La presentación fetal, los desgarros perineales maternos, la talla y el apgar de los neonatos fue similar en ambos grupos. El embarazo en la adolescencia se debe prevenir, y ello se consigue con una correcta educación en salud reproductiva, incluida en un amplio y adecuado programa de educación sexual

Assuntos

RESUMO

La incompetencia cervical es una causa relativamente poco frecuente de pérdida gestacional, que se considera se ha sobrediagnósticado, más sin embargo es una importante razón para aborto repetido en el segundo trimestre de la gestación. El diagnóstico debe sustentarse en los antecedentes obstétricos y tratar de evidenciar su existencia de forma preconcepcional para simultáneamente descartar otras causas de pérdidas repetidas. Alcanzada la gestación y de forma temprana debe realizarse cerclaje cervical, utilizando técnica de Shirodkar o McDonald, que se presentan iguales ratas de supervivencia fetal e iguales ratas de complicaciones. En nuestra experiencia hemos tenido buenos resultados con Técnica de McDonald y seda en forma de trenza, como material de sutura, pasando la rata de supervivencia fetal del 10 por ciento pre-cerclaje al 88 por ciento post-cerclaje. En aquellos pacientes en que no se pueden realizar cerclaje cervical, se recomienda cerclaje cérvico-istmico vía abdominal

Assuntos