[Predictors of use of ante-natal care]

OBJECTIVE

To establish the association and possible interactions between emotional and cognitive factors in pregnant women and their use of institutional antenatal care. It was assumed that the knowledge and attitude of a pregnant woman determines her approach to demanding antenatal care.

DESIGN

Analytic study.

SETTING

Hospitals in the Health Area of Jalisco, Mexico.

PARTICIPANTS

2955 women leaving hospital early who had had at least 2 antenatal consultations.

MAIN MEASUREMENTS

Personal and reproductive characteristics of the women, opportunity and continuity of antenatal care, knowledge of pregnancy and the antenatal care programme, attitudes towards institutional medical care of pregnancy.

RESULTS

In the logistical regression model, 6 associations or interactions between unsatisfactory antenatal care and the variables analysed were found. The strong association of positive attitudes and sufficient knowledge in achieving satisfactory antenatal care was notable, and was even placed above the question of receiving, or otherwise, free medical provision from the health service.

CONCLUSIONS

Undoubtedly, women's educational background plays a major role. This obliges the health services to strengthen their educational programmes by adjusting them to women's culture.

[An experience with public education in nutritional health in 2 communities in Jalisco, Mexico]

This study describes a popular educational process conducted in two communities in Jalisco, Mexico. The purpose was to add an alfalfa concentrate to the population's diet as an alternative, locally available food source. Previous studies had shown that alfalfa contains high protein, vitamin, and essential amino acid levels and can be useful to supplement and improve child nutrition. This resource had not been used previously due to lack of knowledge concerning its properties and harvesting and processing procedures and because it had traditionally been used as livestock feed. The current study included four steps: 1) community knowledge, 2) a community survey using interviews, home visits, and child nutrition evaluation, 3) formation of work groups in a community meeting, and 4) an educational program, working with a self-diagnostic tool taking child nutritional status into account. Our work focused on two areas simultaneously: family nutrition and the alfalfa concentrate as a way to improve it. Although this process was lengthy, it resulted in the acceptance and inclusion of alfalfa concentrate. In addition, the community groups formed in the process remain as an ongoing organizational resource.

[Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara]

Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

[Reduction of the number of cesarean sections from 28% to 13%: does it reduce or increase perinatal maternal mortality: the great doubt?]

According to the new trends related to decrease the cesarean section rates, we conducted our retrospective investigation in order to investigate if the decrease of the cesarean section from 28 to 13%, affect the perinatal mortality (before labor and during labor) and maternal mortality. The years included in this paper were 1990 and 1995. We justified our investigation because some professional in health, believe that the decrease of the cesarean section produce an increase of the maternal and perinatal mortality. In 1990 and 1995 this were our obstetric activity respectively: 1954 and 1504 cesarean section, 4899 and 9176 vaginal deliveries, 6893 and 10730 alive newborns, 172 and 199 perinatal deaths, and finally 9 and 11 maternal deaths. The comparative statistical analysis is as following: for perinatal mortality CHi2 8.00, p 0.004 and OR 1.33 (1.09-1.66) and for maternal mortality Chi2 0.34, P 0.56 and OR 1.30 (0.50-3.36). The risk of perinatal deaths increased in 1990. In relation to the maternal deaths, the risk of mortality didn't increase in 1995.