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OBJETIVO: Identificar los factores asociados a la aceptación de salpingoclasia entre mujeres infectadas por el virus de inmunodeficiencia humana (VIH), después de finalizar su embarazo. MATERIAL Y MÉTODOS: Se realizó un estudio de casos y controles con 72 pacientes embarazadas seropositivas al VIH, en el Instituto Nacional de Perinatología (INPer), entre marzo de 1988 y febrero de 1999. Se consideraron casos a 49 mujeres que al finalizar el embarazo aceptaron la realización de salpingoclasia, 23 pacientes que rechazaron este procedimiento conformaron los controles. En cada paciente se investigaron antecedentes demográficos, historia sexual y reproductiva y condiciones relacionadas con la infección por el VIH. Se realizó estadística descriptiva, las variables categóricas se compararon con ji² o prueba exacta de Fisher y las continuas con t de Student, se hizo cálculo de razón de momios (RM), con intervalo de confianza al 95% y se realizó análisis estratificado mediante ji² de Mantel Haenszel para variables potencialmente confusoras. RESULTADOS: La edad promedio de las pacientes seropositivas fue de 25.5 ± 5.5 años. Estas ingresaron al hospital con una mediana de 27 semanas de gestación (intervalo de 7 a 40 semanas); 16 (22.2%) no tuvieron control prenatal en el INPer. La mediana de tiempo de conocerse infectadas fue de nueve meses (intervalo 1 a 108). Las variables que se asociaron con la aceptación de salpingoclasia fueron: el antecedente de hijos previos, con una RM de 11.1 (IC 95% 3.4 a 36); la atención a partir del año de 1995, con una RM de 4.7 (IC 95% 1.7 a 13.3) y el tener cuando menos un hijo previo infectado, con una RM de 4.6 (IC 95% 1.1 a 23.1). El análisis estratificado no mostró modificación en la fuerza de asociación de estas variables con la aceptación de salpingoclasia. CONCLUSIONES: El tener hijos previos fue el factor que más influyó en la aceptación de salpingoclasia. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

OBJETIVO: Identificar las complicaciones médicas de las embarazadas infectadas por el virus de la inmunodeficiencia humana (VIH) y asintomáticas, y determinar el riesgo que el virus representa para el desarrollo de las mismas. MATERIAL Y MÉTODOS: Se comparó la evolución del embarazo y el resultado perinatal de 44 embarazadas seropositivas al VIH, asintomáticas y que presentaron más de 200 linfocitos CD4/mm³, con embarazadas control no infectadas; las pacientes se parearon por edad y nivel socioeconómico. RESULTADOS: En 42 (95.4%) pacientes la vía de contagio fue sexual; 35 (79.5%) tenían menos de un año de saber que estaban infectadas y 15 (34%) recibieron tratamiento antiviral durante la gestación. Las mujeres infectadas por el VIH presentaron un riesgo mayor de complicaciones infecciosas (RR3.1, IC95% 1.9-52), cervicovaginitis (RR2.2, IC95% 1- 48) y enfermedades de transmisión sexual (RR18, IC95% 2.3-137). El promedio de peso y talla de los recién nacidos y el número de complicaciones neonatales fueron similares entre los grupos comparados. El análisis estratificado mostró que la ausencia de tratamiento antirretroviral y el antecedente de tres o más parejas sexuales incrementaron el riesgo de complicaciones infecciosas. CONCLUSIONES: Las embarazadas seropositivas al VIH y asintomáticas no tuvieron un riesgo mayor de complicaciones médicas del embarazo, con excepción de problemas infecciosos.

OBJETIVO. Describir la experiencia del manejo de embarazadas con rubéola, evaluando el resultado perinatal. MATERIAL Y MÉTODOS. Del 1 de enero de 1990 al 31 de octubre de 1997 se incluyeron 67 embarazadas con diagnóstico de rubéola, corroborada con la determinación de anticuerpos séricos IgM. Se dio seguimiento hasta la resolución del embarazo en 66 de estas mujeres: en cuatro se realizó un aborto electivo y una tuvo un embarazo molar. En 61 pacientes se pudo evaluar el efecto de la rubéola sobre el producto y la gestación. A los productos con determinación positiva de IgM contra rubéola se les realizó ecocardiograma, estudio oftalmológico y potenciales provocados auditivos del tallo cerebral (PPATC). RESULTADOS. El promedio de edad de las embarazadas fue de 24.7±5.5 años; 28 pacientes cursaban su primer embarazo. Ninguna de las embarazadas presentó alguna complicación del episodio de rubéola. En 35 casos (52.2%) la infección viral se presentó durante el primer trimestre de gestación; en 23 (34.5%) sucedió durante el segundo trimestre, y en nueve (13.3%) ocurrió en el último trimestre. De los casos de infección materna durante el primer trimestre gestacional, 71% de los productos se infectaron y 51.6% desarrollaron un síndrome de rubéola congénita. Las manifestaciones de rubéola congénita más frecuentes fueron prematurez, bajo peso al nacimiento y alteración de los PPATC. CONCLUSIONES. En México la rubéola continúa causando daño fetal, de tal manera que es necesario establecer medidas de prevención, como la vacunación universal, para evitar la infección por rubéola.

Four cases of serious congenital cytomegalovirus (CMV) infections are described in this report. All cases were diagnosed postnatally using cerebrospinal fluid (3/4) or blood PCR (1/4) and histochemical study of the placenta (4/4). All infants were born prematurely. Maternal factors identified as significant were younger age at pregnancy and those from low-income social strata. The major clinical findings among patients with congenital CMV infection were hydrocephalus and persistent thrombocytopenia. The children's clinical condition did not improve over the course of the disease, leading to complications associated with extreme prematurity. Two of the children died, one of whom had severe brain malformations and showed neurological compromise at follow-up, seizures, motor impairment, and severe cognitive delay. It is essential to perform antenatal screening for possible CMV infection among pregnant women, even in countries with high population seropositivity, such as Mexico, to establish prenatal interventions to reduce the risk of fetal damage., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Saúl Flores-Medina et al.)

Introduction: Histologic chorioamnionitis (HCA) is a placental inflammatory condition associated with adverse perinatal outcomes (APOs). This historical cohort study explores the risk of APOs in pregnant women with HCA and compares the impact of clinical chorioamnionitis (CCA) with subclinical chorioamnionitis (SCCA)., Methodology: Placentas were evaluated by a perinatal pathologist tand all women with HCA were included. Two groups were integrated: (1) women with clinical chorioamnionitis (CCA) and (2) women with subclinical chorioamnionitis (SCCA). Additionally, we conducted a secondary analysis to compare the prevalence of APOs among stage 1, 2 and 3 of HCA and the risk of APOs between grades 1 and 2 of HCA. The APOs analyzed were preterm birth, stillbirth, neonatal weight < 1,500 g, neonatal sepsis. Relative risk with 95% confidence interval was calculated., Results: The study included 41 cases of CCA and 270 cases of SCCA. The mean gestational age at diagnosis and birth was 30.2 ± 5.4 weeks and 32.5 ± 5.1 weeks, for group 1 and 2, respectively. The study also found that women with HCA stage 3 and grade 2 had a higher prevalence and risk of adverse perinatal outcomes., Discussion: The findings of this study suggest the importance of placental histological study to excluded SCCA, which represents a significant risk to both maternal and neonatal health, contributing to high morbidity and mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Olguín-Ortega, Figueroa-Damian, Palafox-Vargas and Reyes-Muñoz.)

Over the last 20 years, the incidence of vertical HIV transmission has decreased from 25%-42% to less than 1%. Although there are no signs of infection, the health of HIV-exposed uninfected (HEU) infants is notoriously affected during the first months of life, with opportunistic infections being the most common disease. Some studies have reported effects on the vertical transfer of antibodies, but little is known about the subclass distribution of these antibodies. We proposed to evaluate the total IgG concentration and its subclasses in HIV+ mothers and HEU pairs and to determine which maternal factors condition their levels. In this study, plasma from 69 HEU newborns, their mothers, and 71 control pairs was quantified via immunoassays for each IgG isotype. Furthermore, we followed the antibody profile of HEUs throughout the first year of life. We showed that mothers present an antibody profile characterized by high concentrations of IgG1 and IgG3 but reduced IgG2, and HEU infants are born with an IgG subclass profile similar to that of their maternal pair. Interestingly, this passively transferred profile could remain influenced even during their own antibody production in HEU infants, depending on maternal conditions such as CD4+ T-cell counts and maternal antiretroviral treatment. Our findings indicate that HEU infants exhibit an altered IgG subclass profile influenced by maternal factors, potentially contributing to their increased susceptibility to infections., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Rodrigo T. Camacho-Pacheco et al.)

Purpose: To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH)., Method: An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg's 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman's Coping Styles Questionnaire., Results: PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles., Conclusion: PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH., (© 2023. The Author(s).)

Introduction: HIV-exposed uninfected (HEU) newborns suffer from higher risks of opportunistic infections during the first months of life compared to HIV-unexposed uninfected (HUU) newborns. Alterations in thymic mass, amounts of T helper (Th) cells, T-cell receptor diversity, and activation markers have been found in HEU newborns, suggesting alterations in T cell ontogeny and differentiation. However, little is known about the ability of these cells to produce specialized Th responses from CD4 + T cells., Method: To characterize the Th cell profile, we evaluated the frequency of Th 1 (CD183 + CD194 - CD196 - /CXCR3 + CCR4 - CCR6 - ), Th 2 (CD183 - CD194 + CD196 - /CXCR3 - CCR4 + CCR6 - ), Th 17 (CD183 - CD194 + CD196 + /CXCR3 - CCR4 + CCR6 + ), and CD4 + CD25 ++ blood T-cell phenotypes in 50 HEU and 25 HUU newborns. Early activation markers on CD4 + T cells and the Th cytokine profile produced from mononuclear cells under polyclonal T cell stimulation were also studied. Additionally, we probed the ability of CD4 + T cells to differentiate into interferon (IFN)-γ-producing Th 1 CD4 + T cells in vitro., Results: Lower percentages of differentiated Th 1 , Th 2 , Th 17, and CD4 + CD25 ++ T cells were found in blood from HEU newborns than in blood from HUU newborns. However, polyclonally stimulated Th cells showed a similar ability to express CD69 and CD279 but produced less secreted interleukin (IL)-2 and IL-4. Interestingly, under Th 1 differentiation conditions, the percentages of CD4 + IFN-γ + T cells and soluble IFN-γ were higher in HEU newborns than in HUU newborns., Conclusion: HEU neonates are born with reduced proportions of differentiated Th 1 /Th 2 /Th 17 and CD4 + CD25 ++ T cells, but the intrinsic abilities of CD4 + T cells to acquire a Th 1 profile are not affected by the adverse maternal milieu during development., (© 2021 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 [2-18] days vs. 2 [2-3] days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas., Competing Interests: The authors have declared that no competing interests exist.

The clinical effects and immunological response to the influenza vaccine in women who later become pregnant remain to be thoroughly studied. Here, we report the medical outcomes of 40 women volunteers who became pregnant after vaccination with an experimental virus-like particle (VLP) vaccine against pandemic influenza A(H1N1)2009 (influenza A(H1N1)pdm09) and their infants. When included in the VLP vaccine trial, none of the women were pregnant and were randomly assigned to one of the following groups: (1) placebo, (2) 15 μg dose of VLP vaccine, or (3) 45 μg dose of VLP vaccine. These 40 women reported becoming pregnant during the follow-up phase after receiving the placebo or VLP vaccine. Women were monitored throughout pregnancy and their infants were monitored until one year after birth. Antibody titers against VLP were measured in the mothers and infants at delivery and at six months and one year after birth. The incidence of preeclampsia, fetal death, preterm delivery, and premature rupture of membranes was similar among groups. All vaccinated women and their infants elicited antibody titers (≥1:40). Women vaccinated prior to pregnancy had no adverse events that were different from the nonvaccinated population. Even though this study is limited by the sample size, the results suggest that the anti-influenza A(H1N1)pdm09 VLP experimental vaccine applied before pregnancy is safe for both mothers and their infants.

Problem: Breastfeeding's influence on the tolerance to environmental antigens is essential for short- and long-term homeostasis for children. Colostrum is rich in leucocytes, but it is unknown whether regulatory T cells (Treg) account for part of this cell population., Method of Study: Frequencies of CD127 -  CD25 ++ Treg and levels of immunoregulatory-associated cell markers were determined in colostrum and were compared with autologous blood cells. In addition, we evaluated whether the birth conditions can affect these features., Results: Higher frequencies of CD127  - CD25 ++ Treg cells expressing Foxp3 and CD45RO were observed in the colostrum. The cells' CD25, CD152, CD279, and TGF-β expression levels were greater than those in autologous blood cells. In addition, the CD279 and TGF-β expressions of colostrum CD127 -  CD25 ++ Treg cells were influenced by gestational age and delivery mode., Conclusion: The higher proportion of these cells with a function-associated phenotype may reflect certain tolerogenic effects of breastmilk on newborns and infants, contributing to immune system homeostasis., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective of this article is to evaluate the impact of tuberculosis (TB) on perinatal outcome in a cohort of 25 pregnant women with TB treated at the National Institute of Perinatology (Mexico, City) from March 1990 to September 1995. They were compared with a cohort of normal pregnant women; both cohorts were matched by age, gestational age, and socioeconomic status. For purposes of analysis, patients with TB were further stratified into two groups: one included 9 women who started treatment either before or at the beginning of pregnancy, and the other constituted 16 women who started treatment in either the second or third trimester of gestation. Thirteen women (52%) had pulmonary TB, 7 (28%) had renal infection, and the rest of patients had diverse extrapulmonary localization of the infection. Obstetrical morbidity and neonatal mortality were significantly higher in pregnant women with TB who started treatment late in pregnancy. Perinatal morbidity was similar in pregnant women receiving antituberculous drugs early during pregnancy to that in uninfected women. We conclude that TB represents a risk factor for pregnancy. Early treatment of the disease during gestation reverts its negative impact on perinatal outcome.

Varicella-Zoster (V-Z) virus infection during pregnancy is uncommon. Nevertheless, it has importance due to the risk of vertical transmission of the infection and also because of a higher morbidity rate among pregnant women. The cases of varicella infection that occur in the first and second trimesters of pregnancy are occasionally associated to the development of congenital varicella syndrome. We studied 22 women whose pregnancy was complicated with varicella during the first 20 weeks of gestation. The average age of these patients was 20 +/- 3.6 years with a range of 16 to 20 years. None of the patients presented complications due to the V-Z virus infection. Two pregnancies finalized in preterm labor. None of the newborns had congenital anormalies; one presented microcephaly, and another low birth weight. There was no significant difference between the infants of women with varicella and those of the controls in birth weight, size, and head circumference. We concluded that varicella infection during the first 20 weeks of gestation was not associated with serious maternal morbidity, and has low repercussion in the pregnancy outcome and the fetus.

Objective: To discuss the clinical presentation and consequences of genital tuberculosis (GTB), a known cause of infertility. Although it appears to be a rare entity, usually secondary to a primary site of infection by Mycobacterium tuberculosis, its true incidence is not known owing, in part, to inadequate diagnostic procedures, particularly in less developed areas of the world., Patients and Methods: We present our experience with 25 cases of genital TB. Of these woman, 21 were seen for infertility; 3 were postmenopausal with uterine hemorrhage, and 1 was admitted with an acute abdomen. All women were treated medically and/or surgically., Results: Only five women were found to be suitable for artificial insemination. Two of the women became pregnant but aborted., Conclusions: The incidence of genital TB may be higher than one might imagine, based on the lack of reports in the literature, and may account for a significant amount of female infertility.

Tuberculosis is a public health problem in many countries, in the last ten years it has been a revival of this infection worldwide, including developed countries. Before chemotherapy emergency tuberculosis had a poor prognosis for the pregnancy, evolution change since the use of effective antituberculous drugs. In this moment if a pregnant woman receives a correct treatment, she will not experience an aggravation of the infection, nevertheless tuberculosis may cause an increase of the obstetric and neonatal mortality and morbidity rate, more frequently in women of developing countries or without treatment. Congenital tuberculosis is not frequent but is another risk for the newborns of tuberculous pregnant women.

Traditionally obstetric infections have been treated with combination antimicrobial agents that provide coverage against aerobic and anaerobic bacteria commonly found in these infections. New antibiotics may be a monotherapy alternative for this type of infections. The objective of the study was to compare the efficacy of the agent piperacillin/tazobactam against ampicillin plus gentamicin in the treatment of postcesarean endometritis. By randomized way 14 patients were enrolled in the piperacillin/tazobactam group and 42 in the ampicillin-gentamicin group. A favorable clinical response occurred in 78.6% of piperacillin/tazobactam patients and 88.1% of ampicillin and gentamicin patients (p = NS). There was no statistically significant difference in the times to recovery and days of hospitalization between the two groups. The combination piperacillin/tazobactam did not show advantage towards the standard treatment, so combination antimicrobial agent continue been the optimal approach to the management of obstetric infection.

Brucellosis is a zoonosis that affect cows, goats and pigs, but in endemic zones human beings are frequently infected. Brucella infection in animals is associated with a high incidence of abortion, in humans a cause-effect relationship has not been proven. We present four cases of pregnant women with Brucella infection, all were treated only with rifampin, the patients had adequate obstetric evolution, the deliveries were at term and there were not birth defects or intrauterine growth retardation. One woman had a relapse during her puerperium. In the medical literature review there were not enough support to attribute to brucellosis as causal factor of abortion in humans. The treatment during pregnancy must include the combination of rifampin with another antibiotic with intracellular action.

In Mexico typhoid fever (TF) is still a disease of major importance. The reports of TF complicating pregnancy are few in number, nevertheless the majority of authors agree than pregnancy does not alter the clinical presentation or the laboratory findings of the patient with TF. In these cases data suggest unfavorable perinatal outcome with a greater frequency of abortions and premature delivery. We report five cases of TF complicating pregnancy; one patient aborted, one had a preterm labor with neonatal dead of the product, and the other three had a normal pregnancy without abnormalities of the newborns. An improved outcome of the pregnant women complicated with TF is associated with a proper diagnosis and early treatment with ampicillin of ceftriaxone. Chloramphenicol is contraindicated during pregnancy.

Since 1961 cholera has spread in many countries reaching a pandemic form. Since 1991 Mexico has been involved in this pandemia. Near 20% of all cases of cholera in our country happen in fertile women, so the possibility of the association between cholera and pregnancy is high. We present the case of a pregnant woman, who during her third trimester presented a episode of cholera, developing premature labor. Furthermore is revised the medical literature about the general principles of the management of cholera, and the association between pregnancy and the intestinal infection.

A clinical case of a pregnant patient with chorioamniotis and E. coli sepsis during the third trimester, whose principal clinical symptom was an icteric syndrome, is presented. Jaundice during pregnancy represents many etiologic possibilities, nevertheless the most frequent causes are hepatic or biliary tract diseases, some systemic illness like infections or eclampsia can be associated to this syndrome. It is proposed that, although is not a common cause, chorioamniotis must be considered between the causes of jaundice during pregnancy.

The sexually transmitted diseases (STD) in pregnant women can result in pregnancy abnormalities, fetal damage or newborn infection. In this study the frequency of STD between the pregnant women of the Instituto Nacional de Perinatología, in 19 months period, was 7.3 per 100 patients in prenatal care; being vulvovaginal candidiasis, bacterial vaginosis, Ureaplasma urealyticum infection, condyloma acuminatum and Chlamydia trachomatis infection the most commonly diagnosed diseases. The 25% of the patients had two or more sexually transmitted infections simultaneously. There were no gonorrhoea cases. The early detection and treatment of the STD in pregnant women must be a common practice in the prenatal care. Primary prevention will reduce the morbidity not only for the offspring but for the pregnant women as well.

The septic shock has a low frequency in the gynecologic-obstetric patients, nevertheless several obstetric conditions like: septic abortion, chorioamnionitis or puerperal infections can be complicated with this syndrome. The infections cause near 20% of the maternal deaths. Because the high morbidity and mortality of the patients with septic shock is necessary to have an actual knowledge of its pathogenesis and treatment. Any person can be infected but only few of them will develop a septic shock, the response of the host to the microorganisms is the critical point for the develop of this syndrome. Many studies had showed the importance of the bacterial endotoxin and the tumoral necrosis factor as mediators of septic shock. The treatment include: control of the infectious process, restoration of tissue perfusion pressure, restoration of blood volume, use of inotropic agents and general support measures. The role of monoclonal antibodies against endotoxin in the management of Gram-negative sepsis is still ignored, but there are several studies that support its use.

In view of the illegal status induced abortion, it is difficult to determine the degree to which it is practiced. In our country there are a great inconsistency in the statistics on the number of abortions and the number of maternal deaths due to this cause. The principal complication of the illegal induced abortion is the septic abortion, with an uncontrolled bacterial infection and systemic complications that dominate the clinical picture. The mortality of the septic abortion is elevated, in the majority of cases due to septic shock. The treatment consist on antimicrobial agents and early surgery. A reduction on the number of illegal abortions will decrease significantly the number of septic abortion's cases.

The Enterobacteriaceae are the major cause of urinary tract infections (UTI). The Gram-positive Cocci also produce UTI, of these Staphylococcus saprophyticus are the most frequent reported. To know the clinical and microbiological characteristics of the UTI caused by Staphylococcus in the gyneco-obstetric patients, we made a prospective study of the case identified at the Instituto Nacional de Perinatología during the period from January to July 1992. There were 32 cases, 19 cystourethritis, 12 asymptomatic bacteriuria, and one pyelonephritis. Twenty nine of the Staphylococcus isolated were coagulase-negative (SCN), of them Staphylococcus epidermidis was the most regained. The 82.7% of the SCN isolated had a positive slime test. The antimicrobial susceptibility tests showed a low percent of resistance to the majority of the antimicrobial agents proved excepting penicillin and gentamicin.

Tetracyclines are antimicrobial agents that must be avoided during pregnancy. Metronidazole has showed to be carcinogenic in animals like mouse, but in humans this effect has not been proved. In developing countries the tuberculosis has a high prevalence, so tuberculosis in pregnant women isn't a rare event, all of this patient must receive antituberculosis agents. Of the extensive group of antiviral agents only few has proved clinical efficiency, of this acyclovir can be used during pregnancy with caution. At his moment there aren't sufficient information about the utility of zidovudine in pregnant women.

The use of antibiotics during pregnancy have particularly risk, choosing an antibiotic requires consideration of the effects on both the mother and the unborn child. Some antimicrobial agents are safe for use throughout pregnancy, while other are completely contraindicated. Pregnant women need treatment for serious infections, in this cases antibiotics must be used nevertheless the adverse effects of the antimicrobial agent, we must choose the antibiotic with more antimicrobial activity and less risk for the mother and the fetus.

Endometritis is the most frequent infectious complication of the puerperal period; with the objective to know the clinical characteristics, etiology and evolution of this disease we did a retrospective study of the endometritis cases among the patients of the Instituto Nacional de Perinatología (INPer) from January 1st, 1990 to May 31, 1991. During the revision period were diagnosed 120 cases, but we were able to examine only 90. In the 90% the resolution of the pregnancy was by means of caesarean. A 24.4% of the patients had premature rupture of the membranes. The 10% had diagnose of chorioamniotis. The latency period to develop postpartum endometritis was 120 +/- 66 hours, and post-caesarean 56 +/- 30 hours (p = 0.001). The symptom most frequent were fever (100), foul-smelling lochia (61.1%) and uterine tenderness (60%). The infection was polymicrobial, being the microorganisms most frequent isolated Staphylococcus coagulase negative, Escherichia coli and Peptostreptococcus. A 3.3% developed pelvi-peritonitis. One patient died.

The prevalence of tuberculosis (TB) in Mexico as in the rest of the developing countries is high and no reduction has been noted in the past years. This article describe the clinical features of the disease during the gestational period. We studied 15 cases of TB and pregnancy treated at the Infectious Diseases Department of the Instituto Nacional de Perinatología, from January 1990 to June 1991. At our Institute the incidence was 1.54 cases by 1000 obstetric patients discharged, with a lethality rate of 6.6 deaths by 100 infected patients. We treated 15 women, nine had pulmonary TB, three renal TB, two TB of the cervical lymph node and one cutaneous TB. In seven patients the diagnosis was made before pregnancy, other seven were diagnosed during gestation, and one during puerperium. All patients were treated with antituberculous drugs; the most frequent combination was isoniazid, ethambutol and rifampin. Twelve women had no complications, one died, another developed preeclampsia, and in one case the patient had a low birth weight neonate. No cases of congenital TB were identified and none of the neonates had abnormalities at birth.

The anaerobic bacteria (AB) are between the most numerous microorganisms (mo) that constitute the flora of the female genital tract, so they can participate in the etiology of obstetric and gynecologic infections (OGI). The objective of this study was to investigate the frequency of AB isolations and the clinical characteristics of the anaerobic infections (AI) in patients of the National Institute of Perinatology, from January 1st, 1988 to May 31, 1991. AB were isolated from 117 patients who developed 163 infections; 167 anaerobic and 83 aerobic bacteria were recovered from these infections. The 99.2% were obstetric patients. The 85.5% of the isolations of AB were done from patients with endometritis, and 8.5% from postsurgical wound abscesses. Most of the AI were polymicrobial with a mean of 2.1 mo by infection. Peptostreptococcus, Clostridium and Bacteroids were the AB most frequent recovered. The majority of the patients had resolution of the infection within the first 5 days of antimicrobial treatment. There was no mortality in this group. We concluded that the AB have an important role in the etiology of OGI, then it is necessary that the treatment of these infections include antibiotics that cover AB.