This study examined the effects of prenatal exposure to methadone on clinical and neurobehavioural outcomes of infants between 40 and 42 weeks gestation. The aims of this study were: (a) to describe clinical and neurobehavioural outcomes of infants exposed to methadone during pregnancy, (b) to examine the effects of maternal methadone dose during pregnancy on infant clinical and neurobehavioural measures, and (c) to examine the extent to which associations between exposure to methadone during pregnancy and infant outcomes persisted after statistical control for a range of confounding variables. Two groups of study infants were recruited. These consisted of 51 consecutively recruited infants born to mothers maintained on methadone during their pregnancy and 42 randomly identified non-methadone exposed comparison infants. Prior to her child's birth, each pregnant woman completed a comprehensive maternal interview. At birth and during the infant's hospital stay a broad perinatal data-base was collected. At 42 weeks gestation infants underwent a neurobehavioural assessment including the NICU Network Neurobehavioural Scale (NNNS; Lester & Tronick, 2004) and infant cry analysis. Study results showed significant differences across several clinical and neurobehavioural measures. Infants exposed to methadone in utero were found to be significantly lighter, have smaller head circumferences, and spend longer in hospital. Neurobehaviourally, they were significantly less well regulated, less attentive, more easily aroused, more excitable, and more hypertonic. In addition, they exhibited less motor maturity, displayed more stress abstinence symptomatology, and required more support from the assessor in order to remain in an appropriate state. Concurrent analysis of infant cry characteristics revealed no significant differences between the fundamental frequencies or the melody contours of the two groups. However, infants prenatally exposed to methadone did display higher levels of frequency perturbation in their cries, as evidenced by analysis of their jitter factor and percentage of directional jitter. Analysis of the effects of maternal dose during pregnancy suggested that maternal dose levels above 60mg/day were general indicative of poorer infant outcomes than those below 60mg/day, with significant linear trends occurring across a number of measures. The extent to which associations between methadone exposure during pregnancy and infant outcomes reflected either a) the direct effects of methadone exposure and/or b) the effects of confounding factors correlated with maternal methadone use was examined using regression analysis. The results of this analysis for infant clinical outcomes showed confounding variables attenuated the effects of methadone exposure on infant birth length and, to some degree, infant head circumference. In contrast, associations between methadone exposure during pregnancy and most neurobehavioural outcomes remained significant, suggesting that maternal methadone use during pregnancy is an important, independent predictor of infant neurobehavioural functioning. These findings support the view that prenatal exposure to methadone has at least short term impacts on the infant's central nervous system (CNS) development. Important implications of possible vulnerabilities faced by these infants and their families are discussed.

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INTRODUCCIÓN: En el Perú, el 19% de las mujeres entre 12 y 49 años pa-dece de anemia, siendo la prevalencia nacional de anemia en gestantes fue 27,8%, por lo que se recomienda un buen control prenatal durante esta etapa. OBJETIVO: Demostrar que el control prenatal incompleto es el principal factor de riesgo para el desarrollo de anemia en gestantes adolescentes. METODOLOGÍA: El estudio es de tipo caso-control. Se obtuvieron los datos de la población de las gestantes adolescentes que acuden a emergencia del Hospital Nacional Dos de Mayo, en el mes de Junio-Setiembre del 2015, y que se encuentren en gestación a término. Los pacientes se dividieron en dos grupos: gestantes adolescentes a término con anemia y sin anemia; siendo casos y control respectivamente; excluyéndose a aquellas pacientes con diagnostico pregestacional de anemia crónica asociada a otra patología y a menores de 37 semanas de gestación. RESULTADOS: En el presente trabajo se encontró que el control prenatal incompleto, definido como menor de 6 controles, es un factor de riesgo para anemia en el embarazo con 21 veces más probabilidad de tener dicha enfermedad (OR= 21.3750) Resultado significativo (95% CI), muestra asociación. CONCLUSIÓN: El control prenatal incompleto es el principal factor de riesgo para el desarrollo de anemia en gestantes adolescente.

La mortalidad materna refleja las condiciones de salud y de vida, a nivel mundial se ha reducido, ya que la razón de muerte materna global ha disminuido en un 44% hasta el 2015, un total de 13.6 millones de mujeres han muerto en los últimos 25 años por causas maternas. En el Perú se han tenido importantes avances con respecto a la disminución de muerte materna en los últimos años. Objetivo General: Identificar los factores del ámbito sociodemográfico, la atención prenatal y factores asociados con condiciones del parto y complicaciones del trabajo de parto a muerte materna en pacientes que se atendieron en el servicio de gíneco-obstetricia del Hospital de Apoyo María Auxiliadora durante el periodo 2011-2015. Metodología: Es un estudio observacional, analítico, tipo caso control y retrospectivo; la información se recolecto a partir de la FIEMM, utilizado en las historias clínicas de los pacientes hospitalizados en el servicio de Gineco-Obstetricia del Hospital de Apoyo María Auxiliadora en el periodo 2011-2015. Con una población de 33, durante este periodo.Resultados: El número de muertes maternas ha descendido descendiendo a 58x 100 mil nv para el 2015 y el mayor durante el año 2012 llegando a 151 x 100 mil nv. Un 60.6% de pacientes han fallecido por causas de muerte tipo directa. La causa genérica que predomino fue la hipertensión con un 55%, en segundo lugar es por causa de aborto. Hasta un 70% de las muertes se dio en mujeres que habrían tenido más de una gestación. Conclusión: No hubo relación estadísticamente significativa de los factores estudiados y mortalidad materna. Los factores comunes en muerte materna en el periodo 2011-2015 está representado por una mujer adulta entre 20- 30 años, sin trabajo, multigesta, que a pesar de tener controles prenatales, desarrolla hipertensión asociada al embarazo, es limitada su atención debido a la demora tipo 1 y fallece durante el puerperio.

Introducción: la sífilis durante la gestación es una problemática de salud pública debido a su capacidad de transmisión de una madre infectada a su hijo, durante cualquier momento del embarazo, lo que puede originar elevadas tasas de mortalidad perinatal e infantil. Objetivo: determinar el grado de riesgo de la atención prenatal insuficiente para sífilis congénita en gestantes con sífilis atendidas en el Instituto Nacional Materno Perinatal 2010-2014. Diseño: estudio observacional, caso – control y retrospectivo. Lugar: Instituto Nacional Materno Perinatal. Participantes: ingresaron al estudio 33 pacientes con sífilis gestacional atendidas en el INMP durante el periodo 2010-2014. Intervenciones: para el estudio se utilizó muestreo no probabilístico. Para evaluar el riesgo de los factores propuestos se calculó la medida de Odds Ratio (OR), con un nivel de confianza del 95%. Resultados: de las 33 gestantes con sífilis se tuvo 25 casos de sífilis congénita, entre las principales características generales de aquellas gestantes con hijos con sífilis congénita se encontró que el 24% tenía ≤ 20 años, antecedente de drogas (8%), parejas sexuales ≤ 2 (68%), inicio de relaciones sexuales ≤ 15 años de edad (28%), antecedente de alguna infección de transmisión sexual (ITS) (20%) y la vía del parto fue vaginal principalmente (84%). En el análisis de la atención prenatal se evidenció que la falta de periodicidad de la atención prenatal (OR: 2,21), diagnóstico tardío (OR: 10,5) y tratamiento incompleto (OR: 72) son factores de riesgo para la sífilis congénita en madres con sífilis gestacional. No se encontró relación entre la atención prenatal < 4 y el inicio tardío de las consultas prenatales con la sífilis congénita. Se observó que en el 88% de los casos con sífilis congénita, no se brindó tratamiento para sífilis a los contactos. Conclusiones: la atención prenatal insuficiente en las gestantes con sífilis ha evidenciado constituir un grado de riesgo importante para sífilis congénita, cuando esta se relaciona con la falta de periodicidad de la atención prenatal. Palabras claves: sífilis congénita, atención prenatal, gestante. / --- Introduction: syphilis during pregnancy is a public health problem due to its transmission capacity, from an infected mother to her child during any stage of pregnancy; which can lead to high rates of infant and child mortality. Objective: To determine the degree of risk of inadequate prenatal care for congenital syphilis in pregnant women with syphilis treated at the “Instituto Nacional Materno Perinatal” from 2010 to 2014. Design: observational, case - control and retrospective. Location: “Instituto Nacional Materno Perinatal”. Participants: were included in the study 33 patients with gestational syphilis treated at the “INMP” during 2010-2014. Interventions: for the study non-probability sampling was used. To assess the risk of proposed factors, the measure of Odds Ratio (OR) was calculated with a confidence level of 95%. Results: Of the 33 pregnant women with syphilis 25 cases of congenital syphilis was among the main general characteristics of those pregnant women with children with congenital syphilis was found that 24% had ≤ 20 years history of drug (8%), sexual partners ≤ 2 (68%), first sexual intercourse ≤ 15 years of age (28%), history of a sexually transmitted infection (STI) (20%) pathway was primarily vaginal delivery (84%). In the analysis of prenatal care was evident that the lack of frequency of prenatal care (OR: 2.21), late diagnosis (OR: 10.5) and incomplete treatment (OR: 72) are risk factors for congenital syphilis in mothers with gestational syphilis. No relationship between prenatal care <4 and the late onset of prenatal visits with congenital syphilis was found. It was observed that in 88% of cases with congenital syphilis, no treatment for syphilis was provided contacts. Conclusions: Inadequate prenatal care in pregnant women with syphilis has shown constitute a significant degree of risk for congenital syphilis; when this is related to the lack of frequency of antenatal care. Keywords: congenital syphilis, prenatal care, pregnant women.

O autor se propõe a medir o tempo que decorre entre à inscrição e a primeira consulta médica de gestantes que curam os centros de saúde para assistência pré-natal. O propósito do estudo é dar subsídios para a identificação de instrumentos de medida da qualidade da assistência prestada a gestantes por instituições de saúde pública. Para tanto, foram desenvolvidas algumas ações básicas. Considerando a medida desse tempo, um evento sem significação quando estudado isoladamente, o autor se propos testar a hipótese de haver alguma correlação entre aquele tempo e outros eventos administrativos. O autor fez as seguintes verificações: - o tempo de espera apresenta algumas variações,segundo a região onde se localizam os centros de saúde, sendo maior em duas das focalizadas; - segundo a classificação dos centros de saúde: a variação é significativamente maior nos centros de saúde de tipo mais complexo, isto é, no tipo I, onde o atendimento é igualmente intensificado; - segundo a cobertura: foi verificado que o tempo de espera tende a crescer nas áreas onde a cobertura é maior. Quanto à idade da gestação não houve variação sob essa rubrica. O autor concluiu que a medida de tempo de espera para a primeira consulta médica de gestantes em centros de saúde pode indicar um problema de atendimento quando sua grandeza, ultrapassando o período considerado parâmetro de normalidade - O à 7 dias - estaria ligado a: cobertura aquém da meta esperada, demanda excessiva, deficiência quantitativa e/ou qualitativa da hora/instrumento responsável pela consulta e, especialmente, quando a demora se relacionasse também com inscrições feitas a partir do segundo trimestre da gestação. / The author\'s purpose is to measure the time lag between the registration on the clinic and the prenatal first visit by the pregnant woman. The study\'s purpose is to provide subsidies for the identification of quality standars in relation to the care provided to the future mothers by the public health institutions. For this purpose some basic steps were developed. Considering this time lag as non significant by itself, theauthor\'s purpose isto show the correlation between it and other administrative events, as well. The author made the folowing verifications: - the vaiting time according to the region on where the centers are located is greater, as it happened in two of the observed Regions; - in relation to the classification of the health center, the variation is significant: the lag is larger in the more complex type of heal th centers where the assistance is intensified; - according to the coverage it was verified that the waiting time increases in the areas where the coverage is larger; - as related to the age of pregnancy, there was no variation on waiting time. Considering the time lag by itself the conclusion is that the too small intervals observed are not significant because of its correlation with a too small coverage score observed all over the health centers. The author concludes that the waiting time for the pregnant woman first visit to prenatal clinic can indicate a problem at assistance when it is longer than the standard time lag -O to 7 days; when it is conected to a coverage too much behind or too much beyond objective expectations; an excessive demand; a quantitative or qualitative deficiency in instrument productivity and, specialy, when the delay was related also to the registrations starting at the second trimester ofpregnancy.

O autor se propõe a medir o tempo que decorre entre à inscrição e a primeira consulta médica de gestantes que curam os centros de saúde para assistência pré-natal. O propósito do estudo é dar subsídios para a identificação de instrumentos de medida da qualidade da assistência prestada a gestantes por instituições de saúde pública. Para tanto, foram desenvolvidas algumas ações básicas. Considerando a medida desse tempo, um evento sem significação quando estudado isoladamente, o autor se propos testar a hipótese de haver alguma correlação entre aquele tempo e outros eventos administrativos. O autor fez as seguintes verificações: - o tempo de espera apresenta algumas variações,segundo a região onde se localizam os centros de saúde, sendo maior em duas das focalizadas; - segundo a classificação dos centros de saúde: a variação é significativamente maior nos centros de saúde de tipo mais complexo, isto é, no tipo I, onde o atendimento é igualmente intensificado; - segundo a cobertura: foi verificado que o tempo de espera tende a crescer nas áreas onde a cobertura é maior. Quanto à idade da gestação não houve variação sob essa rubrica. O autor concluiu que a medida de tempo de espera para a primeira consulta médica de gestantes em centros de saúde pode indicar um problema de atendimento quando sua grandeza, ultrapassando o período considerado parâmetro de normalidade - O à 7 dias - estaria ligado a: cobertura aquém da meta esperada, demanda excessiva, deficiência quantitativa e/ou qualitativa da hora/instrumento responsável pela consulta e, especialmente, quando a demora se relacionasse também com inscrições feitas a partir do segundo trimestre da gestação. / The author\'s purpose is to measure the time lag between the registration on the clinic and the prenatal first visit by the pregnant woman. The study\'s purpose is to provide subsidies for the identification of quality standars in relation to the care provided to the future mothers by the public health institutions. For this purpose some basic steps were developed. Considering this time lag as non significant by itself, theauthor\'s purpose isto show the correlation between it and other administrative events, as well. The author made the folowing verifications: - the vaiting time according to the region on where the centers are located is greater, as it happened in two of the observed Regions; - in relation to the classification of the health center, the variation is significant: the lag is larger in the more complex type of heal th centers where the assistance is intensified; - according to the coverage it was verified that the waiting time increases in the areas where the coverage is larger; - as related to the age of pregnancy, there was no variation on waiting time. Considering the time lag by itself the conclusion is that the too small intervals observed are not significant because of its correlation with a too small coverage score observed all over the health centers. The author concludes that the waiting time for the pregnant woman first visit to prenatal clinic can indicate a problem at assistance when it is longer than the standard time lag -O to 7 days; when it is conected to a coverage too much behind or too much beyond objective expectations; an excessive demand; a quantitative or qualitative deficiency in instrument productivity and, specialy, when the delay was related also to the registrations starting at the second trimester ofpregnancy.