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      Comportamiento del embarazo prolongado en el servicio de cuidados perinatales Translated title: Behavior of prolonged pregnancy at the perinatal care service

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          Abstract

          El embarazo prolongado es todavía un tema lleno de controversias. Se realizó un estudio retrospectivo longitudinal y descriptivo de todas las pacientes con diagnóstico de embarazo prolongado que ingresaron en el servicio de cuidados perinatales del hospital docente ginecoobstétrico de Guanabacoa durante el año 2002. Se seleccionó un grupo control de los 4 primeros nacimientos de cada mes con una edad gestacional entre 37 y 41 semanas. El 60,4 % del total de pacientes fueron nulíparas y el 49,4 % comenzó el trabajo de parto espontáneamente; prevaleció el parto inducido, 67,4 % en las pacientes del grupo estudio. Hubo un total de 30 mujeres a las que se les realizó cesárea y de ellas el mayor porcentaje, 46,5 %, correspondió también al grupo estudio. En este grupo se apreció líquido amniótico meconial en un mayor número de mujeres con relación al grupo control, no hubo recién nacidos severamente deprimidos y en el 16,2 % de estas pacientes el peso de sus productos fue mayor o igual a 4 000 g. Se concluyó que el comportamiento del embarazo prolongado en el hospital ginecoobstétrico de Guanabacoa fue similar en lo fundamental en lo descrito a la literatura médica revisada.

          Translated abstract

          Prolonged pregnancy is still a controversial topic. A retrospective, longitudinal and descriptive study of all patients with prolonged pregnancy that were admitted at the perinatal care service of the Gynecoobstetric Teaching Hospital of Guanabacoa during 2002, was conducted. A control group of the first four births of every month with a gestational age between 37 and 41 weeks was selected. 60.4 % of the total of patients were nulliparas and 49.4 % began the labor spontaneously. Induced delivery prevailed (67.4 %) in patients from the study group. A total of 30 women underwent cesarean section and of them, the highest percentage, 46.5 %, corresponded to the study group. The meconial amniotic fluid predominated in the study group, 46.6 %. There were no severely depressed newborn infants in the study. Only 5.4 % of the newborn infants had low Apgar score at the minute of extrauterine life. In 16.2 % of the study group, birth weight was ³ 4 000 grams.

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          Home-based neonatal care: summary and applications of the field trial in rural Gadchiroli, India (1993 to 2003).

          High levels of neonatal mortality and lack of access to neonatal health care are widespread problems in developing countries. A field trial of home-based neonatal care (HBNC) was conducted in rural Gadchiroli, India to develop and test the feasibility of a low-cost approach of delivering primary neonatal care by using the human potential available in villages, and to evaluate its effect on neonatal mortality. In the first half of this article we summarize various aspects of the field trial, presented in the previous 11 articles in this issue of the journal supplement. The background, objectives, study design and interventions in the field trial and the results over 10 years (1993 to 2003) are presented. Based on these results, the hypotheses are tested and conclusions presented. In the second half, we discuss the next questions: can it be replicated? Can this intervention become a part of primary health-care services? What is the cost and the cost-effectiveness of HBNC? The limitations of the approach, the settings where HBNC might be relevant and the management pre-requisites for its scaling up are also discussed. The need to develop an integrated approach is emphasized. A case for newborn care in the community is made for achieving equity in health care.
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            Gastroschisis in the United States 1988-2003: analysis and risk categorization of 4344 patients.

            Gastroschisis is a rare congenital abdominal wall defect through which intraabdominal organs herniate and it requires surgical management soon after birth. The objectives of this study were to profile patient characteristics of this anomaly utilizing data from two large national databases and to validate previous risk stratification categories of infants born with this condition. An analysis was performed using 13 years of the National Inpatient Sample database (1988-1996, 1998, 1999, 2001, 2002) and 3 years of the Kids' Inpatient Database (1997, 2000, 2003). These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by International Classification of Disease-9 procedure code 54.71 (repair of gastroschisis) and an age at admission of <8 days. Variables of gender, race, geographic region, co-existing diagnoses, length of stay, hospital charges adjusted to 2005 dollars, complications and inpatient mortality were collected from the databases. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis or volvulus. Comparisons between groups were performed using Pearson's chi (2) for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables. A total of 4344 infants with gastroschisis were identified. These were comprised of 44.0% female infants (n=1910), 46.4% male infants (n=2017) whereas 9.6% were not reported (n=415). Racial analysis showed the largest subset being white in 40.9% of infants (n=1775) with Hispanic infants being the next highest group reported at 17.2% (n=745). Co-existing intestinal anomalies were the most common, affecting 9.9% (n=429) infants, whereas certain cardiac (6.8%, n=294) and pulmonary (1.7%, n=72) conditions were also identified. Simple gastroschisis represented 89.1% (n=3870) of the group whereas 10.9% (n=474) were complex in nature. Simple and complex patients differed in median length of stay (28 vs 67 days, P<0.01), inpatient mortality (2.9 vs 8.7%, P<0.01) and median inflation-adjusted hospital charges (90,788 dollars vs 197,871 dollars, P<0.01). These data represent a national analysis of the largest group of infants with gastroschisis to date which further aids the characterization and understanding of this serious congenital condition.
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              Loop electrosurgical excision procedure and risk of preterm birth.

              To examine whether preterm birth is related to the loop electrosurgical excision procedure (LEEP) itself or intrinsic to the women undergoing the procedure.
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                Author and article information

                Journal
                gin
                Revista Cubana de Obstetricia y Ginecología
                Rev Cubana Obstet Ginecol
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0138-600X
                1561-3062
                August 2004
                : 30
                : 2
                Affiliations
                [01] orgnameHospital Docente Ginecoobstétrico de Guanabacoa
                Article
                S0138-600X2004000200001 S0138-600X(04)03000201
                f218edf0-1ad3-4966-ac9c-9cb225610afb

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 19 February 2004
                : 05 May 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 0
                Product

                SciELO Cuba

                Categories
                OBSTETRICIA

                Embarazo prolongado,Prolonged pregnancy
                Embarazo prolongado, Prolonged pregnancy

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