Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Objective. To determine the association between caesarean sections and the Acute bronchial obstructive syndrome (SOBA) in patients 12 to 36 months of age hospitalized at Vitarte-MINSA Hospital during 2017-2019. Material and methods. An analytical retrospective study of cases and controls was carried out. The population studied were 12 to 36-month-old patients hospitalized during 2017-2019, consisting of 306 children, 102 cases and 204 controls (1:2). The source of data collection was the medical history where the following variables are recorded: age, sex, caesarean section, APGAR, gestational age, breastfeeding, vaccination, overcrowding and siblings.  Results. The study population consisted mainly of 1-year-old children (53.27%) of female sex (52.29%). Caesarean section represents 41.18% of births and the association with the development of SOBA (OR = 2.50; 95% CI = 1.51-4.15; p <0.001) in comparison with vaginal delivery. Similarly, there is an association between breastfeeding (OR = 0.42; 95% CI = 0.23-0.78; p = 0.006), vaccination (OR = 0.56; 95% CI = 0.33-0, 94; p = 0.027) and overcrowding (OR = 1.77; 95% CI = 1.04-3.01; p = 0.034); however, there was no statistical difference between age (p = 0.343; 95% CI = 0.62-1.18%), sex (p = 0.871; 95% CI = 0.42-1.29), gestational age (p = 0.164; 95% CI = 0.71-1.06), APGAR (p = 0.685; 95% CI = 0.73-1.23) and siblings (p = 0.357; 95% CI = 0.89-1.39). Conclusion. Cesarean delivery is associated with the development of SOBA. Present a 2 times greater risk of suffering if born by caesarean section.

Objective: To determine the factors associated with hyperemesis gravidarum and acute stress reaction in pregnant women with hyperemesis gravidarum hospitalized at the National Maternal Perinatal Institute during 2021. Materials and Methods: This research corresponds to an analytical, observational, case-control study, where the medical records of pregnant patients hospitalized for hyperemesis gravidarum attended by the psychology service who presented an acute stress reaction meeting the inclusion and exclusion criteria were collected. An analysis of frequencies and percentages of the different variables and a multivariate analysis were performed to find the significant factors (p<0.05) and the calculation of the Odds Ratio (OR) with a confidence level of 95%; this model was evaluated using multiple logistic regression. Results: A relationship was found between pregnancy planning (p<0.044, β=0.957 and OR=2.6047) and nausea rejection (p<0.028, β=1.774 and OR=5.893) in pregnant women with hyperemesis gravidarum. A direct relationship was found between the acute stress reaction in pregnant women with hyperemesis gravidarum, with respect to pregnancy loss (p<0.043, β=0.933 and OR=2.542) and hospitalization in the COVID-19 area (p<0.010, β=1.467 and OR=4.335); and inversely, regarding the acceptance of the pregnancy (p<0.014, β=-1.515 and OR=0.220). Conclusion: Two variables were found to be associated with the presence of hyperemesis gravidarum (pregnancy planning and the rejection of nausea). The acute stress reaction was related to two factors associated with the patients (gestational loss and pregnancy acceptance) and one associated with the pandemic (hospitalization in Covid-19 area) which explain 32% of the variance.

Mr. EditorDuring the pandemic, the maternal mortality rate has increased, especially in underdeveloped countries, where one in three pregnant women with COVID-19 could not access the intensive care unit (ICU); therefore, 35% of pregnant women died and the measures to prevent COVID-19 infection had an impact in limiting the complete control of pregnant women (1). This pandemic had a significant impact on maternal mortality worldwide. In some countries there was an increase in the maternal mortality rate, such as Uganda with 6.5%, Mexico 26.2%, India 34.4% and Kenya 8.5% (2). In Latin America, Honduras had the highest mortality rate, while Peru was in fifth place, with a 50% increase (3). In Peru, maternal mortality had an unequal presence, according to the region, since before the pandemic, the regions that reported the highest mortality rates were Amazonas, Ucayali, Madre de Dios and Loreto; while during the pandemic, the departments that reported the highest incidence of maternal mortality were Lima, La Libertad, Piura, Cajamarca, Puno, which together accounted for 65.8% of all deaths during this time (4). On the other hand, the main change in the causes of maternal mortality as a result of the COVID-19 pandemic was the gradual rise of indirect causes such as respiratory diseases, COVID-19, among others; displacing direct causes such as hypertensive disorders and obstetric hemorrhage, which before the pandemic were the predominant causes at the national level (5). However, during the first months of 2022, 68.3% of the total maternal mortality occurred due to direct causes and 31.7% due to indirect causes, with similarities observed from the second semester of 2021 (6). In conclusion, since maternal mortality represents a serious public health problem, it is of interest to know aspects related to maternal mortality in Peru, which occurred in the context of the COVID-19 pandemic, and to use these experiences in future similar scenarios where the public health of pregnant women is involved.

Objective. To determine the association between temperature and blood glucose level at discharge in exclusively breastfed term newborns from the Joint Hosting Service of the National Maternal Perinatal Institute. Materials and methods. Analytical, observational, prospective, case-control study. The group of cases consisted of 70 neonates with hypothermiaand the group of controls consisted of 140 neonates with normothermia, from the Joint Hosting Service E of the National Maternal-Perinatal Institute. The newborn who met the inclusion criteria was recruited and, with the informed consent of the mother, the newborn’s temperature, blood glucose and weight were taken. Results. The average length of life was 51.02 for the case group and 49.97 hours of life in the control group. The average temperature was 36.31°C in the casegroup and 36.9°C in the control group. Regarding glycemia in the case group the average was 56.33 mg/dL and in thecontrol group 63.5mg/dL, both with a p < 0.00. The measure of association between the two variables was an OR of 2.57with a 95% CI of (1.26-5.16) which was statistically significant. Conclusions. Neonates with hypothermia had lower mean blood glucose than neonates with normothermia, such difference was statistically significant.

Liver rupture is a serious complication of pregnancy with high morbidity and mortality, it is frequently related to preeclampsia; exceptionally it can occur in a pregnant woman without preeclampsia or HELLP syndrome. There is a case of a pregnant woman without preeclampsia or previous liver disease who develops a liver rupture in the puerperium, she is promptly diagnosed and surgically managed. The patient evolved favorably.

Introduction. Cervical ectopic pregnancy is a challenge both in diagnosis and in its treatment. Hysterectomy is no longer the most widely used treatment, with medical and minimally invasive treatments being the most widely used. Objective. To describe the efficacy of the Shirodkar-type cervical cerclage in the management of cervical pregnancy. The study. It is presented a case series treated at the Instituto Nacional Materno Perinatal in pregnant women attended between 2015 and 2021. The modified Shirodkar cervical cerclage technique was performed for hemostatic purposes, so that it allows us to aspirate the gestational sac contained in the cervical canal, preventing bleeding. Finding. Six cases of cervical ectopic pregnancy were treated with the modified Shirodkar technique, all of them successfully, since the embryonic tissue contained in the cervical canal was evacuated, controlling post-evacuation bleeding, not requiring additional treatments or hysterectomy. Conclusion. The evaluation of this series of cases allows us to conclude that the modified Shirodkar-type cervical cerclage technique, in the treatment of cervical ectopic pregnancy, it is effective in controlling the potential bleeding that can occur after the evacuation of embryonic tissue located in the cervical canal, as well as avoid additional treatments or hysterectomy.  

Se estima que a nivel mundial cada año nacen antes de las 37 semanas 15 millones de niños. Esto equivale a más de 1 de cada 10 nacimientos. Cada año fallecen aproximadamente un millón de niños como consecuencia de las complicaciones del nacimiento prematuro1. Los recién nacidos prematuros nacen antes de completarse las 37 semanas de gestación. De acuerdo con la edad gestacional pueden ser extremadamente prematuros (menos de 28 semanas), muy prematuro (de 28 a 32 semanas) y prematuro entre moderado y tardío (de 32 a 37 semanas)2. En el Perú nacen 30,000 niños antes de las 37 semanas. La tasa de nacimientos prematuros en el país está en ascenso y es disímil según la fuente de información utilizada, ENDES reporta 23%, OMS 8.8%, y el sistema de registro del certificado de nacido vivo–MINSA (CNV), 7%, con un promedio anual de 30,000 nacimientos prematuros según CNV y más de 2000 defunciones anuales notificadas al sistema de vigilancia de CDC3.

Durante el 2021 y el 2022 la mortalidad materna en el Perú tuvo un incremento del 45% y un 63% respecto al  2019, de tal manera que hubo un retroceso de 13 años en los avances que se tenían en la reducción de la mortalidad materna en el país.1 La pandemia por COVID desnudó graves problemas en el sistema de salud como la precariedad del primer nivel de atención, que debió ser la primera barrera de contención de la pandemia en las gestantes, y sin embargo se caracterizó por una pérdida de la capacidad resolutiva en los establecimientos I-3 y I-4, al no tener la capacidad resolutiva para brindar la atención prenatal y el parto institucional, debido a la falta de recursos humanos, principalmente debido a que el personal de salud, asistencial y administrativo, tuvieron que dejar de trabajar por ser personal de riesgo frente a la pandemia.

Background. Acute placental uterine vascular insufficiency is a cause of adverse fetal outcome in fetuses with failure to reach their growth potential and are born at an appropriate weight for gestational age. Clinical case. A 24-year-old patient, 37 weeks gestational age, went to the National Maternal Perinatal Institute of Lima, Peru, for reporting little vaginal bleeding. In the clinical evaluation, a BP of 90/60 mmHg, uterine height 32 cm, fetal heartbeat was found in 152. At ultrasound evaluation, a fetus of 2902 grams (34 Hadlock percentile) was reported 1 hour after admission, a Profile Fetal biophysicist 6/8 due to decreased body movements, 11cm amniotic fluid index, grade III posterior fundic placenta, Middle Cerebral Artery Doppler of the 1.18, umbilical artery Doppler of the 0.56, ductus venosus Doppler 0.26 and Aortic Isthmus with absent diastole. The contraction stress test 3 hours after admission was scored 5 points with decreased fetal movements, decreased variability and absent accelerations. An emergency caesarean section was indicated obtaining a 2846 gr male newborn, size 47.5 cm, Apgar 8-9. Meconial fluid with a dark bloody appearance was found. At the parenchymal section, hairy infarcts: recent 10% and old 5%. Hypoplastic chorionic villi with wide intervillous spaces. Conclusions. Integrated surveillance of AEG growth fetuses allows to be detected those at risk of adverse outcome from acute placental insufficiency.

Objective: To determine the influence of a brief stress reduction program in health workers of the National Maternal and Perinatal Institute during the COVID-19 pandemic. Materials and Methods: This research corresponds to a quasi-experimental study, which consist of the elaboration and application of a brief stress reduction program in workers of the Puericulture area of the INMP. The population consisted of 45 workers, 30 of whom complied with the inclusion criteria for the pilot study, from which a sample of 15 participants was distributed, by convenience, for the experimental group and 15 for the control group. The Depression, Anxiety and Stress Scale (Dass21) was applied at the beginning of the investigation and after concluding the program. The analysis of frequencies and percentages of the variable, analysis of adjusted goodness of fit to the normal curve, and Student's t-tests for correlated samples (p<0.05) pre and post intragroup test with a confidence level of 95% were carried out. Results: Significant differences were found in the experimental group in their pre and post treatment measures respectively in the variables Stress (T=5.20, p<0.001, D=0.742, Mean Dif=3.00); Anxiety (T=3.15, p<0.007, D=0.414, Mean Dif=2.20) and Depression (T=3.97, p<0.001, D=0.426, Mean Dif=3.97) reducing the averages of these variables after the application of the pilot program. Conclusion: The brief program for stress reduction is effective for stress reduction, and due to the fact that in its sessions cognitive behavioral strategies for the improvement of mental health were trained, indicators of anxiety and depression present in the sample were reduced in a secondary way.