Enrique C Sotomayor Obstetrics And Gynecology Hospital

Guayaquil, Ecuador

Enrique C Sotomayor Obstetrics And Gynecology Hospital

Guayaquil, Ecuador
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Fernandez Alonso A.M.,Hospital Torrecardenas | Chedraui P.,Catholic University of Santiago de Guayaquil | Chedraui P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Perez-Lopez F.R.,University of Zaragoza
Gynecological Endocrinology | Year: 2015

Objective: To assess the risk of obstructive sleep apnea-hypopnea syndrome (OSAHS) and related factors at the end of pregnancy using the Berlin questionnaire.Methods: A total of 367 women at the end of pregnancy (median gestational age 39 weeks) were interviewed with the Berlin questionnaire and a general survey containing maternal socio-demographic and anthropometric information. Neonatal outcome data were also assessed.Results: Median age for the whole sample was 31 years. According to the Berlin questionnaire, 39.8% were positive for high risk of OSAHS. Upon bivariate analysis, higher risk of OSAHS was significantly related to church attendance, and higher pre-pregnancy body mass index (BMI), current BMI, weight, neck and arm circumference and systolic blood pressure at survey. Logistic regression analysis found that higher maternal pre-pregnancy BMI (OR 2.71 95% CI 1.84-4.00, p < 0.0001) and higher maternal weight at survey (OR 3.02, 95% CI 1.78-5.17, p < 0.0001) were significantly related to a higher risk of OSAHS.Conclusion: The risk of OSAHS is relatively high at the end of pregnancy and related to a higher pre-pregnancy BMI and higher maternal weight at survey. Further studies are needed to confirm our results with a diagnostic tool, such as polysomnography or another similar yet less complicated to carry out procedure. © 2015 Taylor & Francis.


Chedraui P.,Catholic University of Santiago de Guayaquil | Chedraui P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Perez-Lopez F.R.,University of Zaragoza
Maturitas | Year: 2015

Assessment of sexual function is a complex process, especially in women, which requires in any individual case: time, appropriate training and experience. The prevalence of female sexual dysfunction is quite variable depending on the studied population, assessment methods, comorbid conditions and treatments, and age. A large number of screening methods have been developed over the last decades which range from tedious, exhaustive and boring tools to very simple standardized questionnaires. The 19-item female sexual function index (FSFI-19) is among the most used and useful- instrument designed to assess female sexual function in all types of circumstances, sexual orientation and perform the comparison of transcultural factors. A short 6-item- version of the FSFI-19 has been developed to provide a quick general approach to the six original domains (one item per domain). Nevertheless, further studies are needed to demonstrate its validity in different clinical situations as it has been extensively demonstrated with the original tool. © 2015 Elsevier Ireland Ltd.


Pita C.P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Pazmino S.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Vallejo M.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Salazar-Pousada D.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2012

Aim To analyze the benefits of an inhaled analgesia procedure over intrapartum pain and the degree of satisfaction of using this method. Methods This was a pilot study carried out at a lowincome hospital setting in which women with singleton pregnancies, cephalic presentation and active phase of labor were requested to inhale ad libitum a 50-50 % mixture of nitrous oxide and oxygen (N2O-O2) (Oxicalm®, Indura S.A-Indura Ecuador) using a face mask with an auto-demand valve. Effect over labor pain and dynamics and side effects were recorded. Results A total of 126 gravids participated with a mean age of 21.6 ± 6.7 years, 50.8 % of which were adolescents. As assessed by the Visual Analog Scale 1 h after initiating the procedure pain significantly decreased 56.2 % on average (8.9-4.9 points, p = 0.001), while increasing cervical dilation and effacement by 28.4 and 21.7 %, respectively. Overall vaginal delivery was achieved in 96.9 % of cases, with an average procedure initiation to delivery time interval of 2 ± 1 h and mixture consumption of 0.93 kg. Vaginal delivery rates were 36.5, 78.6 and 89.7 % for the first, second and third hour, respectively. During that time maternal hemodynamic parameters remained unaltered. Mean duration of the second stage of delivery was 6.2 min. Obstetrical and neonatal outcome was otherwise favorable. Main adverse effect of using the mixture was dizziness (43.7 %) referred by gravids as mild and tolerable. A 96 % of users answered that they would recommend the method and graded it in 92.9 % as good/ excellent. Conclusion Inhaled intrapartum analgesia using a N2O-O2 50-50 % mixture provided rapid pain alleviation. It is an appealing, effective and safe method for the management of pain during labor, most useful at institutions with infrastructure and personnel limitations. © Springer-Verlag 2012.


Chedraui P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital Guayaquil | Chedraui P.,University of Guayaquil | Solis E.J.,Enrique C Sotomayor Obstetrics And Gynecology Hospital Guayaquil | Bocci G.,University of Pisa | And 9 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Objective: To measure plasma nitric oxide (NO), asymmetric dimethylarginine (ADMA) and vascular endothelial growth factor (VEGF) levels and VEGF gene polymorphisms in fetal circulation in severe preeclampsia. Methods: Cord vessels of singleton gestations complicated with severe preeclampsia 36 weeks or more (n = 31) and controls were sampled upon delivery for analyte measuring. Additionally, DNA was extracted from umbilical vein whole blood to determine the frequency of VEGF gene single nucleotide polymorphisms (SNPs): -2578 A/C, -1498 C/T, -1154 A/G, -634 C/G and +936 C/T. Coefficient correlations between analyte levels and placental and neonatal weight were calculated. Results: NO plasma levels in umbilical vessels (artery and vein) were significantly higher in preeclampsia cases as compared to controls (4.67±3.0 vs. 0.82±0.90; 4.46±3.0 vs. 0.82±0.99 mmol/L, respectively, p = 0.0001 both). ADMA levels displayed a similar increased trend in both fetal vessels, but this did not reach statistical significance (2.57±1.03 vs. 2.34±0.57; 2.74±0.94 vs. 2.42±0.59 mmol/L, respectively, p > 0.05). VEGF was significantly lower in artery but not in vein in preeclampsia cases (200.48±225.62 vs. 338.61±287.03 pg/mL, p = 0.04). A significant positive correlation was found between NO and ADMA levels (artery and vein) among preeclampsia cases. Overall, the frequency of the studied VEGF gene SNPs did not differ among pre-eclamptic cases and controls; nevertheless, a significant trend toward lower umbilical vein VEGF levels was observed in pre-eclampsia cases in the presence of -2578 CC and -1154 AG genotypes. Conclusion: Near term gestations complicated with severe preeclampsia presented higher NO levels in fetal circulation, which correlated to ADMA and lower artery VEGF values. More research is warranted to confirm that selected VEGF SNPs may be associated with lower umbilical vein VEGF. © 2013 Informa UK, Ltd.


PubMed | Enrique C Sotomayor Obstetrics And Gynecology Hospital, University of Zaragoza and University of Guayaquil
Type: | Journal: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology | Year: 2016

An imbalance between anti- and angiogenic factors during early placentation is key for the development of preeclampsia. Nevertheless, the majority of studies addressing this issue relate to maternal blood and not the fetal circulation.To measure placental growth factor (PlGF), free beta human chorionic gonadotropin (-hCG), and pregnancy-associated plasma protein-A (PAPP-A) levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia (n=20), and their controls matched for parity, and maternal and gestational age.Upon delivery, a blood sample was withdrawn from the umbilical artery and vein of each case and its control in order to measure the proposed analytes using direct fluoroimmunoassay.Preeclampsia cases showed significantly lower median PlGF levels in fetal circulation as compared to controls (25.2 versus 36.9 and 23.6 versus 33.9pg/mL, artery and vein, respectively, p<0.05). Contrarily, cases displayed higher concentrations of PAPP-A (1024.0 versus 720.9 [median] and 1027.0298.4 versus 690.3401.9 mIU/L, artery and vein, respectively, p<0.05), and free -hCG (mean: 33.94.3 versus 17.24.0 and 30.15.2 versus 13.73.3ng/mL, artery, and vein respectively, p<0.05).Lower PlGF and higher PAPP-A and free -hCG levels were found in the fetal circulation of near-term severe preeclamptic pregnancies. There is a need for more research in this regard.


PubMed | University of Amsterdam, Enrique C Sotomayor Obstetrics And Gynecology Hospital, University of Zaragoza and Academic Medical Center Amsterdam
Type: Journal Article | Journal: Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology | Year: 2016

Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia.


Chedraui P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Chedraui P.,Catholic University of Santiago de Guayaquil | Salazar-Pousada D.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Villao A.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | And 6 more authors.
Gynecological Endocrinology | Year: 2014

Objective: To determine the prevalence of C677T and A1298C Single-nucleotide polymorphisms (SNPs) of the MTHFR gene in nulliparous women complicated with preeclampsia (PE). Methods: One hundred fifty gestations complicated with PE and their corresponding controls without the disease were recruited for the genotyping of C677T and A1298C polymorphisms of the MTHFR gene using restriction fragment length polymorphism polymerase chain reaction. Secondarily, homocysteine (HCy) plasma levels were measured in preeclamptic women displaying the CC genotype of the A1298C polymorphism (homozygous) and compared to HCy levels determined among controls with the normal AA genotype for the A1298C variant. Results: Only the mutant CC genotype of the A1298C polymorphism was associated to higher risk of presenting PE, as frequency of this genotype was significantly higher among cases than controls (15.3% versus 0.7%, p<0.05). All PE women with a neck circumference ≥32cm presented the mutant CC A1298C polymorphism as compared to none among preeclamptics with a lower neck circumference (p=0.0001). Women with the mutant CC A1298C SNP displayed higher plasma HCy levels as compared to controls with normal AA A1298C genotype (8.4±2.6 versus 7.5±2.7mmoL/L p=0.04). Conclusion: Prevalence of the CC mutant genotype of the A1298C polymorphism was higher among PE women. This mutation among PE women was related to increased neck circumference and higher HCy levels. Future research should aim at linking these gestational findings with obesity and cardiovascular risk. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.


PubMed | Enrique C Sotomayor Obstetrics And Gynecology Hospital
Type: Journal Article | Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics | Year: 2012

To assess intimate partner violence (IPV) and psychoemotional disturbance among pregnant women in a low-income setting.In total, 283 pregnant women with high-risk prenatal complications were surveyed via the 20-item Self-Reporting Questionnaire (SRQ-20) and the Violence against Women screening tool. A total SRQ-20 score of at least 7 was defined as indicating psychoemotional disturbance.Median age of participants was 24 years, 65 (23.0%) came from marginal areas, 6 (2.1%) had no education, and 75 (26.5%) had fewer than 5 prenatal visits. Median gestational age at survey was 33 weeks, with 224 (79.2%) admitted for treatment of threatened preterm labor. Median age of partner was 27 years, and 72 (25.5%) consumed alcohol on a daily basis. Ninety-eight (34.6%) pregnant women experienced at least 1 type of physical abuse or violence during the current pregnancy. Median total SRQ-20 score was 7. Overall, 145 (51.2%) had scores of 7 or higher. Total SRQ-20 scores positively correlated with the presence of IPV (number of positive items) and parity, and inversely correlated with maternal education level and gestational age at survey.IPV was highly prevalent and significantly correlated with female psychoemotional disturbance.


PubMed | Enrique C Sotomayor Obstetrics And Gynecology Hospital
Type: Clinical Trial | Journal: Archives of gynecology and obstetrics | Year: 2012

To analyze the benefits of an inhaled analgesia procedure over intrapartum pain and the degree of satisfaction of using this method.This was a pilot study carried out at a low-income hospital setting in which women with singleton pregnancies, cephalic presentation and active phase of labor were requested to inhale ad libitum a 50-50% mixture of nitrous oxide and oxygen (N(2)O-O(2)) (Oxicalm(), Indura S.A-Indura Ecuador) using a face mask with an auto-demand valve. Effect over labor pain and dynamics and side effects were recorded.A total of 126 gravids participated with a mean age of 21.66.7years, 50.8% of which were adolescents. As assessed by the Visual Analog Scale 1h after initiating the procedure pain significantly decreased 56.2% on average (8.9-4.9 points, p=0.001), while increasing cervical dilation and effacement by 28.4 and 21.7%, respectively. Overall vaginal delivery was achieved in 96.9% of cases, with an average procedure initiation to delivery time interval of 21h and mixture consumption of 0.93kg. Vaginal delivery rates were 36.5, 78.6 and 89.7% for the first, second and third hour, respectively. During that time maternal hemodynamic parameters remained unaltered. Mean duration of the second stage of delivery was 6.2min. Obstetrical and neonatal outcome was otherwise favorable. Main adverse effect of using the mixture was dizziness (43.7%) referred by gravids as mild and tolerable. A 96% of users answered that they would recommend the method and graded it in 92.9% as good/excellent.Inhaled intrapartum analgesia using a N(2)O-O(2) 50-50% mixture provided rapid pain alleviation. It is an appealing, effective and safe method for the management of pain during labor, most useful at institutions with infrastructure and personnel limitations.


PubMed | Enrique C Sotomayor Obstetrics And Gynecology Hospital
Type: Journal Article | Journal: Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology | Year: 2012

This paper reports the experience of 150 B-Lynch suture applications for the management of uterine atony during caesarean section that did not respond to conventional therapeutical measures. Technique was considered effective if the need for hysterectomy was avoided. High-risk antenatal obstetrical conditions included: pre-eclampsia (12%), oligohydramnios (8%), polyhydramnios (4.7%). A total of 36% were primigravid, 66% had been in active labour, 4.7% received misoprostol and 26.7% used oxytocin for labour augmentation. Suture was successful in 95.3%, with only five cases requiring hysterectomy combined with uterine artery ligation and two uterine artery ligations alone to control bleeding and uterine atony (floppiness). Although 26.7% of cases required transfusions, no maternal deaths were reported, and overall women were discharged after a median 4-day hospital stay without further complications upon follow-up. The B-Lynch technique was an effective intraoperative measure to control uterine atony. Despite the encouraging results, long term assessment on a larger sample is needed in our clinical scenario.

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