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M Zambrana Castañeda

Publications and source records attributed to M Zambrana Castañeda.

5 recordsLinked to original sources
PubMed2000

[Repeat cesarean section: a necessary procedure?].

The purpose of this study was to identify the clinical indications for the repeated cesarean section (RCS). In order to determine if the indication was an absolute or a relative one and to establish if it was justified. This is a cross sectional study of all patients with a previous cesarean delivery who underwent a RCS from January 1996 to December 1997 at the National Institute of Perinatology. Multiple pregnancies were excluded. According to the indication two groups were identified: those with an absolute indications and those with a relative one. In order to assess the differences between both groups data were analyzed through chi square test or Fisher's Exact test. During the study period there were 5,545 cesarean deliveries, 664 were RSC (11.9%). Only 641 of the RCS complied with the inclusion criteria for the study. Average maternal age was 30 years. More than half the patients under study (57.2%) did not have any pathological condition during pregnancy, and the rest (42.7%) had at least one (preeclampsia, diabetes mellitus/gestational, chronic hypertension). Indications for the previous cesarean section were absolute in 25.9% and relative in 74.1% (p = 0.0006). Indications for the RCS were also predominantly relative (70.7%), with only 29.3%) absolute (p = 0.0001). The main RCS indications were: elective (20.1%) cephalopelvic disproportion (17.8%), preeclampsia (15.4%), fetal distress (8%). Trial for vaginal delivery was undertaken in 65.4% of the absolute indications group and in 36.9% of the relative indications group (p = 0.0001). Low Apgar one minute and five minute scores were more frequent among the absolute indications group (p = 0.03 and p = 0.01 respectively). Newborns having had an absolute cesarean delivery indication entered the National Intensive Care Unit more frequently (53.6%) than those with relative indications (46.4%) (p = 0.001). The main indication for RCS in our hospital were relative, and thus it is possible to reduce the cesarean rate through a thorough assessment of all cases with a previous cesarean section, and by giving a delivery trial of all this patients.

Adolescent↗
PubMed2000

[Within the limits of viability: the dilemma of the obstetrician. A 5-year experience at a perinatal care center].

The study was performed in order to establish the obstetric factors that influence survival of newborns whose birth weight is under 1000 g. All medical records of babies with such birth weight, born alive at the Instituto Nacional de Perinatología in Mexico City during the period from 1991 to 1996 were revised. Babies with congenital malformations, cromomosomopathies or those who after birth were referred to another medical center were excluded. Survival status was used to form two study groups: those who were discharged alive and those who died during their hospital stay. Different obstetric conditions on management were compared between these two groups. Statistical Analysis was performed through t-test, chi square or exact Fisher's test. Two hundred and ninety two cases were included out of 294. Sixty nine (25.4%) survived while 203 (74.6%) died during their hospitalization. Several obstetric conditions were found to have statistical differences between survivors (S) and non survivors (NS): cervical dilatation on admittance to hospital (1.6 cm among S and 2.7 among NS), cervical dilatation prior to resolution (3.3 cm S vs 4.9 cm NS), gestational age (28.3 vs 27 weeks). Newborn conditions also showed significant statistical differences as in birth weight (867.1 vs 795.5 g), 1 minute Apgar (4.1 vs 2.5), and 5 min Apgar (6.9 vs 5). Use of antepartum steroids showed a striking difference between groups while duration of labor, usage of oxitocin and way of delivery showed no statistical differences. Gestational age (over 28 weeks), birth weight (above 867 g) and the use of antepartum steroids are of extreme importance in the survival status of babies born weighting less than 1000 g.

Cross-Sectional Studies↗
PubMed2000

[Acute fatty liver of pregnancy. Report of a case and review of the literature].

Acute Fatty Liver of Pregnancy. The acute fatty liver of pregnancy (AFLP) is an uncommon entity, potentially fatal, which affects women during the last quarter of pregnancy. It is characterized by a prodromic period of symptoms followed by jaundice, hepatic failure, clotting disorders and fatty infiltration of the liver, evident through hepatic biopsy. The incidence ranks from 1 to 20 thousand births, and it is more frequent among women with multiple pregnancies. We report the case of a 29-year-old patient, with multiple pregnancy 33 to 34 weeks of gestation, blood pressure values of 140/90 mmHg, 160,000/dL platelets, PT 25.6 seconds, TPT 64.7 seconds, blood glucose 52 mL/dL, creatinine 2.1 mg/dL, uric acid 11.9 mg/dL, lactic dihydrogenase 1063 U/l, GPT 220 U/l, AF 1172 U/l, total bilirubin 8.4 mg/dL, proteinuria 30 mg/dL. A cesarean section was practiced after correcting the coagulation disorders. The first twin was a male with birth weight of 2,070 g, APGAR 8-9; the second twin was a female fetal death weighting 2,050 g. Hepatic biopsy confirmed the diagnosis. The cause of AFLP is unknown. The frequency among multiple pregnancies is higher. Almost half of the cases have hypertension and proteinuria. There are also high levels of both transaminases, phosphatase and bilirubins and hypoglycemia. The prothrombin time is enlarged. The differential diagnostic between pre-eclampsia and AFLP is not crucial since the obstetric management is the same. The main treatment is promptly deliverance and general measures. The obstetrician must be aware of this hepatic disease.

Acute Disease↗
PubMed1999

[Trends of perinatal mortality at the National Institute of Perinatology].

The purpose of this study is to address the yearly fetal, neonatal, crude death rates observed at the Instituto Nacional de Perinatología from 1987 through 1997, and the specific death rates for birth weight, gestation age, cause of death, avoidability, and structure and process failures as proxy to quality of medical care. Data come from death certificates following the WHO criteria which includes the maternal medical history, pregnancy follow up, birth attendance, newborn characteristics, autopsy findings, microbiological results, basic cause of death (of both maternal and fetal/neonatal origin), death avoidability, and structure and process issues. The death certificates were analyzed by the Perinatal Mortality Committee and registered into a computerized database. The fetal mortality rate during 1987 was 17.67 per 1000 births, whereas in 1997 it was 21.5 per 1000 births. There was an increasing tendency from 1987 to 1992, with the highest rate being 34.13 during 1992. After 1992 this rate shows a decreasing tendency. The neonatal mortality rate decreased from 42.82 in 1987 to 17.34 per 1000 live births in 1997. The highest rates were observed among the newborns with the lowest birth weights and at the youngest gestational ages. The most frequent cause of death of maternal origin, in both fetal and neonatal deaths, was premature rupture of membranes. As for the most frequent fetal cause of death was antepartum hypoxia, and among neonatal deaths prematurity and immaturity. The percentage of avoidable perinatal deaths has declined dramatically from 27% in 1987 to less than 10% in 1996. Perinatal mortality at the Instituto Nacional de Perinatología has decreased during the period under assessment, due to the reduction of the neonatal mortality rate. Improving the quality of medical care focusing mainly on process issues will help lowering avoidable mortality rates.

Female↗