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The aim of this study was to identify the bacteria causing neonatal septicemia in a neonatal intensive care unit (NICU) in León, Nicaragua and its relation with bacteria isolated from the environment at the NICU. Our data showed that 74% (34/46) of the bacteria related to newborns with septicemia were Gram-negative and highly resistant to beta-lactams (>85%) and aminoglycosides (80%), leading to treatment failure in 10 neonates with fatal outcome. Although, the prevalence of Gram-positive bacteria (26%) was lower than Gram-negative bacteria, Staphylococcus epidermidis was related to the death of three newborns. No clonal similarity was found among Enterobacter cloacae , Escherichia coli and Serratia liquefaciens isolated from the neonates with septicemia and the NICU environment. However, in order to improve the outcome for neonates with septicemia, infection control practices and appropriate empirical therapy should be considered to reduce the high prevalence of extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria isolated from neonates with septicemia (80%) and from the NICU environment (34%).

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Information relative to the frequency of vaginal delivery and cesarean section in adolescent population is limited and contradictory. Some publications refer that cesarean section is practiced more frequently in adolescents than in adults, because teenagers have a biological immaturity and a less medical control during pregnancy; but others show that frequency of cesarean section and vaginal delivery is very similar in adolescents as in adults. The reason of this contradiction is the fact that all studies compare general populations, with or without sistemic pathologies, and with or without obstetric antecedents. Therefore, the authors of this paper consider that if they compare adolescent and adult populations in their first pregnancy and without sistemic pathologies, the frequency of cesarean section and vaginal delivery should be the same in the two groups of women. To confirm their hypothesis, the authors collected original data from 121 adolescent women in their first pregnancy, seventeen years old or younger, without sistemic pathology, attended in the Instituto Nacional de Perinatología, and they compared them with original data collected from 121 adult women also in their first pregnancy, between 20 to 27 years old, without sistemic pathology, attended in the same institution and during the same period. The authors concluded that there were not statistical differences between the two groups in relation to the number of prenatal care visits; the weeks of pregnancy at the time of delivery; the indications of the different obstetric procedures to resolve the delivery; and in the perinatal mortality. Nevertheless, there were differences with high statistical significance between the number of vaginal deliveries and the number of cesarean sections; in fact, the cesarean section was performed more frequently in adult women. The authors considered that in the population of adolescents they studied, the age by itself was not a risk factor; furthermore, it is necessary to perform other studies to confirm and to explain why the cesarean section was performed more frequently in the adult population.

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We present the experience from Instituto Nacional de Perinatología (INPer) with the use of subdermal contraceptive implants Norplant from 1995 to 1997. The purpose was to Know the sociodemographic characteristics and evaluate contraceptive efficacy, adverse effects and tolerance on the users of Norplant. We carried out a prospective, observational trial in the Family Planning Clinic, during the period january 1o, 1995 through december 31, 1997. Women with desire of long term hormonal contraception, and without contraindications for the use of progestins were eligible for the study. The follow up consisted in visits every 6 months, and in some cases we obtain the information by telephonic interviews. One hundred an two women were included in the study; the median age of the subjects was 21.6 years, the median number of pregnancies were 2.0. In 53% of the subjects an obstetric risk factor was present such as adolescence (25.5%), social (8.8%), and others. Seventy-four women were followed up, and accumulated 1,064 months of observation. (Average 14.4 months). Menstrual irregulaties (83%), and headache (30%) were the most frequent adverse effects. The continuity rate was 81%, and during the study no pregnancy was observed. The principal causes for the extraction of the implants were menstrual irregulaties and headache. The contraceptive subdermal implants Norplant, constitutes and excellent choice because of its high efficacy, safety and good tolerance.

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Manual vacuum aspiration (MVA) is a method proposed for uterine evacuation in cases of incomplete abortion, using a syringe of plastic material to produce negative pressure. With this technique, we treated 122 cases of different types of abortion at The Instituto Nacional de Perinatología, and results obtained were compared with those of 126 women treated with standard dilation and curettage (D&C). The sociodemographic characteristics of the two groups were similar. Molar pregnancy and blind ova were more frequent in cases treated with MVA. Types of anesthesia used were similar in both groups with the exception of 10 cases of MVA, that received paracervical block. Four surgical complications occurred, one of hemorrhage in each group and two cases of incomplete evacuation in the MVA group. Histopathological examinations using morphometric techniques showed similar proportions, of fetal parts, villi, decidua, myometrial cells and blood clots for both groups. It was concluded that MVA is as effective and safe as D&C, it is easy to perform, and is not associated with important complications. It can be used as an advantageous option for the evacuation of molar pregnancy.

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Material and methods used to assess the epidemiology of puerperal infection (PI) in the National Institute of Perinatology (Mexico) between 1984 and 1990, are described. We observed that the general rate of PI ranged between 1.6 and 3.1; post-cesarean section posed a higher risk of infection than vaginal partum. Endometritis, associated with cesarean section, was the most frequent form of PI and gram positive flora was the most frequently found etiological agent. In general terms, we found that the rate of PI remained constant through the years of study, even when there was a significant increase in the practice of cesarean operations. Finally, we emphasize the need for the standardization of clinical norms used to assess the epidemiology of infection events. Standard norms will allow health-service institutions to compare results, observe tendencies, predict changes and take preventive actions.

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PIP: High-risk in reproduction is the major health problem in the developing world, responsible for the high incidence of morbidity and mortality rates caused mostly by high fertility rates and the frequency of complications in pregnancy. Therefore, preventing high-risk pregnancies should become the principal objective of all maternal and child health programs worldwide. Unfortunately, both women and physicians continue ignoring symptoms during pregnancy that should be diagnosed as high-risk. A major constraint remains the lack of family planning (FP) services; only 39% (1,500 million) of populations in developing countries as against 65% (800 million) of those in developed countries have access to FP. Added to this problem are people's rejection of FP because of religious, psychological or social pressures, without any information on the dangers of having high-risk pregnancies. The responsibility should be placed on institutions and health practitioners that suspect women who are in high-risk categories and these women should be informed about the risks of future pregnancies.^ieng

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