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Carnero A.M.,Cayetano Heredia Peruvian University | Mejia C.R.,Asociacion Medica de Investigacion y Servicios en Salud | Garcia P.J.,Instituto Nacional Materno Perinatal
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes. Design Retrospective cohort study. Setting National reference obstetric centre in Lima, Peru. Population Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤12 weeks of gestation (n = 8964). Methods Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling. Main outcome measures Preterm birth and its subtypes. Results Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes. Conclusions In Peruvian pregnant women starting prenatal care at a;circ12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. © 2012 RCOG.


Ventura W.,Instituto Nacional Materno Perinatal | Huaman J.,National Major San Marcos University | Nazario C.E.,National Major San Marcos University | Ingar J.,Instituto Nacional Materno Perinatal | And 2 more authors.
Journal of Clinical Ultrasound | Year: 2012

Purpose: To determine the association of fetal isolated short femur in the second-trimester ultrasound (US) examination with perinatal outcomes such as small-for-gestational age (SGA) and low-birth weight (LBW) neonates. Methods: This is a retrospective cohort study in fetuses routinely assessed by US examination at 18 to 24 weeks during 2006-2009. A fetal isolated short femur was defined as femur length below the 5th percentile and with no chromosomal or structural abnormalities. Fetuses with abdominal circumference below the 5th percentile at the time of US examination were excluded. Each case of short femur was matched with three controls according to gestational age at the time of the US examination. Results: Sixty-one fetuses met the inclusion criteria. Both the group of women carrying a fetus with isolated short femur and that of women carrying a fetus with normal femur length had similar general and obstetric characteristics. Women carrying a fetus with isolated short femur were significantly more likely to deliver a SGA neonate (19.7% versus 8.7%, p < 0.05) and a LBW neonate (19.7% versus 7.1%, p < 0.05) than women carrying a fetus with normal femur length. Logistic regression analysis found odds ratios for SGA and LBW of 2.6 (95% confidence interval, 1.1-5.9) and 2.9 (95% confidence interval, 1.2-7.1), respectively. Conclusions: Isolated short femur in the second-trimester US examination is associated with a subsequent delivery of SGA and LBW neonates. © 2011 Wiley Periodicals, Inc.


Cabeza J.,University of California at Los Angeles | Cabeza J.,Center for Research and Education | Garcia P.J.,Cayetano Heredia Peruvian University | Segura E.,University of California at Los Angeles | And 6 more authors.
Sexually Transmitted Infections | Year: 2015

Objectives: Chlamydia trachomatis, which is asymptomatic in most women, causes significant adverse effects for pregnant women and neonates. No programmes conduct antenatal screening in Latin America. We determined chlamydia prevalence, feasibility and acceptability of chlamydia screening, and adherence to treatment in pregnant women in two urban public hospitals in Lima, Peru. Methods: We offered chlamydia screening using self-collected vaginal swabs to pregnant women ≥16 years of age during their first antenatal visit. Chlamydia-infected women were contacted within 14 days and asked to bring partners for counselling and directly observed therapy with oral azithromycin. Unaccompanied women received counselling, directly observed therapy, and azithromycin to take to partners. Test of cure was performed ≥3 weeks after treatment. Results: We approached 640 women for the study and enrolled 600 (93.8%). Median age was 27.3 years (range 16-47), median lifetime partners 2.3 (range 1-50), and median gestational age 26.1 weeks (range 4-41). Chlamydia prevalence was 10% (95% CI 7.7% to 12.7%). Of 60 infected patients, 59 (98%) were treated with one dose of azithromycin. Fifty-two of 59 (88%) returned for test of cure, all of whom were treated successfully, with 46 (86%) achieving negative test of cure with one dose of azithromycin, and 6 (12%) after retreatment with a second dose. Conclusions: C. trachomatis screening and treatment in pregnancy was feasible and highly acceptable in two urban hospitals in Peru. Chlamydia prevalence was high. Clinical trials to evaluate efficacy and cost-effectiveness of chlamydia screening, and treatment of pregnant women to prevent adverse pregnancy outcomes in low-resource settings, are warranted.


Laveriano W.R.V.,Instituto Nacional Materno Perinatal | Redondo C.E.N.,National Major San Marcos University
Revista Brasileira de Ginecologia e Obstetricia | Year: 2013

PURPOSE: To examine obstetric outcomes in the second birth of women who had undergone a previous cesarean delivery. METHODS: This was a large hospital-based retrospective cohort study. We included pregnant women who had a previous delivery (vaginal or cesarean) attending their second birth from 2001 to 2009. Main inclusion criteria were singleton pregnancies and delivery between a gestation of 24 and 41 weeks. Two cohorts were selected, being women with a previous cesarean delivery (n=7,215) and those with a vaginal one (n=23,720). Both groups were compared and logistic regression was performed to adjust for confounding variables. The obstetric outcomes included uterine rupture, placenta previa, and placental-related complications such as placental abruption, preeclampsia, and spontaneous preterm delivery. RESULTS: Women with previous cesarean delivery were more likely to have adverse outcomes such as uterine rupture (OR=12.4, 95%CI 6.8-22.3), placental abruption (OR=1.4, 95%CI 1.1-2.1), preeclampsia (OR=1.4, 95%CI 1.2-1.6), and spontaneous preterm delivery (OR=1.4, 95%CI 1.1-1.7). CONCLUSIONS: Individuals with previous cesarean section have adverse obstetric outcomes in the subsequent pregnancy, including uterine rupture, and placental-related disorders such as preeclampsia, spontaneous preterm delivery, and placental abruption.


Ventura W.,Instituto Nacional Materno Perinatal | Ventura W.,National Major San Marcos University | Ventura-Laveriano J.,National Major San Marcos University | Nazario-Redondo C.,National Major San Marcos University
International Journal of Gynecology and Obstetrics | Year: 2012

Objective: To assess the perinatal outcomes of a subsequent pregnancy among adolescent mothers living in Peru. Methods: A large hospital-based retrospective cohort study was conducted to evaluate singleton births during a 9-year period (2001-2009). The study population was divided into 3 groups: adolescents aged 15-19 years who had 1 previous parturition (n = 2074), nulliparous adolescents (n = 20 721), and multiparous adults aged 20-29 years (n = 23 129). Results: No significant differences were found between multiparous adolescents and the 2 control groups with regard to preterm delivery, perinatal death, and 5-minute Apgar score below 7. Logistic regression analysis showed no significant differences in the rates of cesarean delivery or preterm birth before 34 or 37 weeks. After adjusting for confounding factors, low birth weight (LBW) and small for gestational age (SGA) were more likely to occur during a subsequent pregnancy among adolescent mothers than during the 1st pregnancy among nulliparous adolescents. The odds ratios were 1.38 (95% CI, 1.14-1.67) and 1.27 (95% CI, 1.02-1.56), respectively. Conclusion: Multiparous adolescents are more likely to experience LBW or SGA than are nulliparous adolescents. No significant differences in other perinatal outcomes were found among the 3 study groups. © 2011 International Federation of Gynecology and Obstetrics.


Hitti J.,University of Washington | Garcia P.,Instituto Nacional Materno Perinatal | Totten P.,University of Washington | Paul K.,University of Washington | And 2 more authors.
Sexually Transmitted Diseases | Year: 2010

Background: Mycoplasma genitalium is associated with cervicitis and pelvic inflammatory disease in nonpregnant women. We investigated associations between cervical M genitalium, demographic and behavioral risk factors for sexually transmitted infection and preterm birth among low-income Peruvian women. Methods: This case-control study, conducted at the Instituto Nacional Materno Perinatal, Lima, Peru, included 661 cases with a spontaneous preterm birth at <37 weeks and 667 controls who delivered at ≥37 weeks. Within 48 hours after delivery, subjects underwent interviews, medical record review, and collection of cervicovaginal specimens for M. genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae by nucleic acid amplification testing, and Trichomonas vaginalis by culture. Odds ratios and 95% confidence intervals were calculated for associations between M. genitalium, other genital infections and risk factors, and preterm birth. Multivariable logistic regression was used to adjust for potential confounders. Results: Cervical M. genitalium was detected in 3% of subjects and was significantly associated with C. trachomatis infection (P < 0.001) and preterm birth (4% vs. 2%; adjusted odds ratio: 2.5, 95% confidence interval: 1.2-5.0, P = 0.014), and marginally associated with T. vaginalis (P = 0.05). M. genitalium detection was also associated with younger maternal age (P = 0.003) but not with other risk factors for preterm birth. The association between cervical M. genitalium detection and preterm birth remained significant after adjustment for maternal age and coinfection with C. trachomatis or T. vaginalis. Conclusions: Cervical M. genitalium detection was independently associated with younger maternal age and preterm birth, suggesting that this organism may be an infectious correlate of spontaneous preterm birth. © Copyright 2010 American Sexually Transmitted Diseases Association.


Barrios Y.V.,Harvard University | Sanchez S.E.,Peruvian University of Applied Sciences | Nicolaidis C.,Portland State University | Garcia P.J.,Instituto Nacional Materno Perinatal | And 3 more authors.
Journal of Adolescent Health | Year: 2015

Purpose Childhood abuse has been associated with age of menarche in some studies, but not all, and few have assessed the independent associations of sexual and physical abuse with early menarche. We examined the association between childhood abuse and early menarche among pregnant women in Lima, Peru. Methods Multinomial logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for early menarche (11 years) in relation to any physical or sexual childhood abuse, physical abuse only, sexual abuse only, and both physical and sexual abuse in a cohort of 1,499 pregnant (first trimester) women. Results Approximately 69% of participants reported experiencing physical or sexual abuse in childhood. The frequencies of physical abuse only, sexual abuse only, and both physical and sexual abuse were 37.4%, 7.7%, and 24.5%, respectively. Compared with women who reported no childhood abuse, those who reported any childhood abuse had a 1.38-fold increased odds of early menarche (95% CI, 1.01-1.87). Compared with no abuse, the odds of early menarche was 1.60-fold among women with childhood sexual abuse only (OR, 1.60; 95% CI,.93-2.74) and 1.56-fold for those with both physical and sexual abuse (OR, 1.56; 95% CI, 1.07-2.25) during childhood. Isolated physical abuse was weakly associated with early menarche (OR, 1.23; 95% CI,.87-1.74). There was no clear evidence of association of childhood abuse with late menarche (≥15 years). Conclusions Childhood abuse, particularly joint physical and sexual abuse, is associated with early menarche. Our findings add to an expanding body of studies documenting the enduring adverse health consequences of childhood abuse. © 2015 Society for Adolescent Health and Medicine.


Ventura W.,Instituto Nacional Materno Perinatal | Ventura W.,Showa University | Nazario-Redondo C.,Instituto Nacional Materno Perinatal | Sekizawa A.,Instituto Nacional Materno Perinatal
International Journal of Gynecology and Obstetrics | Year: 2013

Current clinical practice in obstetrics has shifted the paradigm from a conventional prenatal approach based on invasive procedures, risking both fetus and mother, to non-invasive prenatal testing for some fetal conditions via the analysis of cell-free fetal DNA in maternal blood. In the past 15 years, much research has been devoted to refining the methodology for measuring cell-free fetal DNA in maternal circulation and to exploring clinical applications of this technology as a potential tool for prenatal diagnosis. Since the rapid spread around the world of prenatal diagnosis based on cell-free fetal DNA, it is time to start thinking how this cutting-edge technology might influence current practice of obstetrics in low-resource countries. © 2013 International Federation of Gynecology and Obstetrics.


A retrospective analysis is performed in three successive periods between the years 1996 and 2009, in order to evaluate the impact of the implementation of three national guidelines for the prevention of the vertical transmission of HIV. 275 births were included in 13 years. Significant statistical differences were found in the percentage of HIV cases in the children exposed to the virus between the three periods: 15% during the period in which only zidovudine (AZT) was administered to the pregnant woman, 6.4% during the second period (administration of AZT to the pregnant woman not fulfilling HAART initiation criteria and HAART to those fulfilling criteria for this treatment), and 4% during the third period in which HAART was applied to all pregnant women with HIV infection. 95% of pregnant women ended their pregnancy by cesarean section and the 100% of children received infant formula. Changes made in national guidelines have produced a positive impact in the decrease of HIV infected children in the Instituto Nacional Materno Perinatal in Peru.


Ventura W.,Instituto Nacional Materno Perinatal
Fetal Diagnosis and Therapy | Year: 2011

Objective: To determine the association of amniotic fluid sludge with impending preterm delivery in women in preterm labor with intact membranes. Methods: This was a retrospective cohort study in women at 22-34 weeks' gestation in preterm labor with intact fetal membranes between February 2008 and May 2009. 16 women with amniotic sludge were identified. Each case of amniotic sludge was matched with 3 randomly selected controls. The primary outcome was delivery within 48 h of examination. Results: Mean cervical length was shorter in women with sludge than women without sludge (20.5 ± 9.0 vs. 27.9 ± 6.9 mm, p = 0.0016). There was a significant difference in the mean ultrasound-to-delivery interval in women with and without sludge (21.7 vs. 49.4 days, p = 0.006). Logistic regression analyses demonstrated that amniotic fluid sludge is a strong independent predictor of impending preterm delivery within 48 h (OR 11.2, 95% CI 1.2-125.9), 7 days (OR 3.8, 95% CI 1.2-17.3) and 14 days (OR 7.5, 95% CI 1.8-30.4). Conclusions: Amniotic fluid sludge on ultrasound scan is associated with impending preterm delivery in women in preterm labor with intact membranes. Copyright © 2011 S. Karger AG, Basel.

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