RESUMO

From September 1993 to March 1995 a prospective, descriptive study was performed at Obstetrical Department of the General Hospital 2A the Mexican Institute of Social Security. An attempt to know the real puerperal infection incidence in our own hospital to be able to make hypothesis and take specific measures in puerperal infection control. Dairy account of interesting data of cases under inclusion criteria. Entering data in personal computer. Graphics and analysis were accomplished using Lotus 123, Statgraphics, EPI-6 of CDC and Freelance computational programs. Search of central tendency measures were performed, (media, median, mode, standard deviation). Odds ratio and relative risk were calculated, including hospitalization time and its temporary variation to data cross. X square and pi were including hospitalization time and its temporary variation to data cross. X square and pi were determined to statistic validates. The cumulated rate of general puerperal infection were 1.2%. By stratification, the cumulated rate of infection after cesarean section, vaginal delivery and miscarriage were 5.4%, 0.8% and 0.3%, respectively. There was predominance of infection after cesarean section, over infection after vaginal delivery and after miscarriage. (monthly media of 24.6, 7.3 and 0.47, respectively). The puerperal infection was present principally in primiparous and in patients with one previous cesarean section. The patients in which the termination of pregnancy was by cesarean section, (0.015 infection cumulated incidence), had an infection risk 5.76 and 18.66 times greater than the patients with vaginal delivery and miscarriage. (Relative risk of 6.76 and 19.66) The site of puerperal infection was implicated in combinations or isolated, under nine clinical situation. The five most frequent clinical situation, between these nine, in incidence order from major to minor were the following: Endometritis alone, Endometritis combined with wound abscess. Endometritis with urinary infection, complicated endometritis, (sub vesical abscess, parametritis, peritonitis, salpingitis), and wound abscess alone). The greater hospitalization time was present in cases of complicated endometritis followed by wound abscess alone or combined. Complicated endometritis, (incidence 0.0010), compel us to hysterectomy in 15 cases. No death was registered among the patients with puerperal infection studied.

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RESUMO

Abdominal wall wound dehiscences, more frequently those involving skin and subcutaneous tissue, are a common surgical complication in Obstetrics and Gynecology. A prospective, longitudinal study was done in 65 patients presenting with wound abscess. The evolution of the wound was compared using the following methods a) Bandage, b) Bandage with 30% iron subcarbonate pomade, c) Silk, d) Silk with 30% iron subcarbonate pomade. Eighty five percent of the patients, with silk used, were completely recovered in less than 10 days; comparing this option with the others used in this study, there were significant statistical differences.

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RESUMO

The first 1000 cases of tubal sterilization post-delivery by minilaparotomy with sedation and local anesthetic, were reviewed; these procedures were realized at the Hospital of Zona Francisco del Paso y Troncoso of the IMSS, in México City, during the period comprehended between December 1990 and October 1991. The greatest group of cases by age corresponded to the period between 20 to 29 years in 52.3%. 65% of the women had 3 or 4 children alive. The range of the diastolic blood pressure was between 70-80 mmHg in 66.3%. 19.7% with a value of hemoglobin less than 10 g. 2.3% of the patients with 100-120 kgs. of weight. The contraceptive method used previously with greatest frequency was the DIU in 40.6%. In all of the cases the indication was satisfied parenthood. In 100% of the cases the same drug was used for sedation, diazepam (oral) and chlorhydrate of nalbulfine, with simple lidocaine as a local anesthetic. Likewise in all the cases the Pomeroy technique was performed. The time between the childbirth and the surgery was less than 12 hours in 92.9% of the cases. And the time between the surgery and the recuperation reset was of 12-34 hours in 96%. In 0.8% of the cases the transoperatory complication of the surgery was the bleeding as a result of tearing of the mesosalpinx. The postoperatory complications after one week were the formation of hematoma and/or abscess at the site of the incision representing 0.5% of the cases. All these procedures are realized at a unit that was created especially for this kind of surgery and treatment.

PIP: The first 1000 postpartum tubal occlusions by minilaparotomy under sedation and local anesthesia performed at a Mexican Institute of Social Security hospital in Mexico City were retrospectively reviewed. The operations took place between December 1990 and October 1991. The youngest patient was 17 and five patients were under 20. 52.3% were aged 20-29, 31.9% were aged 30-34, and 13.8% were aged 35-40. 65% of the women had three or four live births and 16.8% had two. The diastolic blood pressure was between 81 and 90 for 12.1%, between 91 and 100 for 8.9%, and between 101 and 120 for 3.7%. 19.7% had hemoglobin levels below 10 g. 37 women with hemoglobin levels between 4 and 8 g were sterilized; all received transfusions before discharge. 66.7% of the women weighed between 50 and 70 kg, but 2.3% weighed 100-120 kg. 40.6% used IUDs, 16.8% oral contraceptives, and 14.2% injectable methods. 24.8% had never used a contraceptive method. The Pomeroy technique was used in all cases. All patients were given Lidocaine. The operation was performed within 12 hours of delivery in 92.8% of cases. 96.3% of the women were discharged within 24 hours. Bleeding, resulting from tearing of the mesosalpinx, occurred in 0.8% of cases. A hematoma or abscess at the site of the incision was observed in 0.5% at one week follow-up. The data indicate that bilateral tubal occlusion by postpartum minilaparotomy under local anesthesia and sedation, rather than general anesthesia, is a rapid and safe procedure, even for obese and hypertensive women.

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