Estudio perinatal del parto prematuro
Resumen
La importancia del parto prematuro se demuestra por su alta contribución al desarrollo perinatal ratio de mortalidad, es un desafío a la obstetricia y la salud pública. La presente revisión analiza Algunos asuntos sobre este obstáculo y el campo interesado de Obstretricia: 1) la epidemiología, 2) el riesgo actores, incluyendo aspectos sociales y médicos; 3) ventajas y desventajas en el uso de Medicamentos tocolíticos a través de la evaluación de las propiedades de los fármacos; 4) proceso de maduración del pulmón, Y los factores utilizados para acelerarlo, como las drogas; Y 5) la atención de la entrega prematura, Durante el trabajo de entrega así como después de él.
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1. WorI Health Organization: Prevention of-perinatal morbidity and mortality. Public Healt Papers, 42,1969.
2. Howard, J ., Hoffman, M.A., Bakketing, M„ Leiv, S.: Factores de riesgo relacionados con la aparición de un nacimiento pretérmino. Clin Obstet Ginecol, Vol. 3: 6 91, 1984.
3. US Department of Health and Human Services, Public Health Service. Vital Statistics of the United States. 1982. Vol. I.
4. [«ira. A., Orbe, E., Dávila, A., Galárraga, J ., Pérez, F,., and Barrera, A.: Prevención del Parto Prematuro. Rev Fac Cien Med, I I : 171, 1986.
5. Ivspín, V.H.: El Niño Prematuro. En: Ramos, G.: Alto Riesgo Obstétrico, p.p. 291, 1989.
6. León, E., Garcés, M.: Morbimortalidad en los recién nacidos prematuros en al año 1986 en el Hospital “Dr. Enrique Garcés”. Rev Fac Cien Med, 13: 17 ,1988
7. Denise, M.: Epidemiología del Parto Pretérmino Clin Obsl Ginecol, Vol. 3: 507, 1988.
8. Meis, P.J., MacErncsl, J. and Moore, M.L.: Causes of the low birtbwieght births in public and private patients. Am,) Obstet Gynecol, 156: 1165, 1987.
9. Pappiernik, E.: Prcdiction of the Baby Preterin. Clin Obstet Gynecol, Vol 11, 315, 1984.
10. Berkowitz, G.: An Epidemiologic study of preterm delivery. Am J Epidemiol, 58: 147, 1979.
11. Obel, E.: Pregnancy complications following legally induced abortion with spccial reference to abortion technics. Act Obst Gynecol Scandin, 5 8 : 147, 1979.
12. Berkowilz, G., Harlap, S., Beck,G. and Freedman, D.: Early gestational bleeding and pregnancy out^ come: A multivariate analysis. Inter J Epidemiol,
12: 165, 1983.
13. Hawkinson, J . and Shulman, H.: Prematury associated with cervicitis and vaginitis during pregnancy. Am J Obstet Gynecol, 94: 898, 1966.
14. Heluin, G. and Papicrnik, E.: Prematuriré et gemellité. Comunication, Jerusalem, 1981.
15. US Departament of Healt and Human Service. Report of the secretaris Task Forcé on Black and Minority Health, Publication 0 -4 8 7 -6 3 7 (QL3). Voló (Infant Mórtalityand low Birthweight) Hyattsville, Maryland, National Center for Health Statistics, 1985.
16. Meyer, M., Joña, BS. and Tonascia, J A.: Perinatal events associated with maternal smoking during pregnancy. Am J Epidemiol: 103: 4 64, 1976.
17. Shiono, PH., Klebanoff, M., and Rhoads, GG.: Smoking and drinking during pregnancy. J Am Med Assoc,82: 255, 1986.
18. Artal, R., Sokol, RJ. and Newman, M.: The Mecha7 0 Garcés, M. y cois. nical properties of prematürely and non prematurely ruprured membranes, methods and results. AmJ Obstet Gynecol 1 2 5 :6 5 5 , 1976.
19. Me Gregor, JA.* LaweUin, D. and French, JL .; Bacterial protease -induced tedilAtion of dioríoamniotic membranc sttength and elasticity. Obstet Gynecol, 69 :167,1981
20. Mead, PB.: ProphylácÜC antibiótics ánd antibiotic resístante. Semináis m ^eribátolo|y: 1 :107,1977.
21. US Department of Health áhd ffiimati Serives. Public Health Service VoL 1 Hyattsville, Maryland: National Centélr for Health Statistics, 1986.
22. Abramowicz, M. and Kass, RH.: Pathogenesis and Prognosis of Prematurity. R EngJ Méd, 275:878-938,1001,1053,1966.
23. Commfttee to Study the Preveñtíon of Low Birth. Preventig Low Birthweight. Washington, DC: National Academy Press, 1985.
24. Fcinstein, ST., Vintzileos, AM., Lodeiro, JG., et al. Amniocentesis with premature niptuie of membranes. AmJ Obstet Gynecol, 59:147,1962. logic meehanlan in the prevention of pretermltirth Clin Obstet Gynecol, 27: 592 ,1984.
26. Carftis, SN„ Chiao, JP., Moore, J J ., et al. Myometrial desenstizaeion after ritodrine infusión. Ám J Physiol, 253: 41 0,1987.
27. Ingeniarsson, I.: Use of Beta receptor agonist in obstetrics. Act Obstet Gynecol Scand, 188: 29, 1982.
28 . Harden, TK.: Agomst -mduced áesraátízation of de beta adrenergie recepto linked adenylate cyclase. Pharmacoí Eev 5 :35,1987.
29. Altura, BM. and Altura, BT.: Magnesio Ions and cóntraction of vascular smooth muscles. Relationship to some vascular discases. Fed Proc, 40: 2672, 1981.
30. L EBiol, JP.: Sdíate as a locoütye agent. t Contemp Obstet Gyneco, 1: 49, 1985.
31. Hollander, Di., Nagey, Í)A. and Pupkin, MJ: Magneshlm sulfate and ritodriné Hydrochloride: A randomízed comparison. Am J Obstet Gynecol:
32. Stanfóid, N., Roth, GJ^ Shen, TY., ct aL Lack of rovalent modifkatioa of prostaglandiii syntetase (cydo-oxygenase) by indometacin. Prostaglandins: 13: 669 ,1977.
33. Sharpe, GL., Larsson, KS. and Thalme, B.: Stüdies on closure of the ductus arteriosus XII. Iri útero effect of indonietacin and sodmm salicyiater in ratsand rabbits. Prostaglandins, 9: 585,1975. M. H.M.S.O.: Series DII3, Number 8 ,1980 .
35. Campiche, M.A., Gautier, A., Hernández, E.I. and Raynionli, A.: An electrón microscope study of thé fetal development of the human lung. Pediátrica, 32: 974 ,1963.
36. Gross, I.: Respiratory control and lung development In the fetus and newbom. In: Johnston, BM, Gluckman, PD: eds: Ithaca, New York, Perinatologjrftéss.
ppST-lOSil^Bó.
37. Rooney, SA.: Lunp Surfactant. Environ Health Perspect: 55: 205,1984.
38. Rooney, A.: The surfactant systém and lung phospholipid biochemistry. Am Rev Respir Dis, 131: ám^sss.
39. King, RJ.: Composition and metabolism of the apolipoproteins of pulmónary surfactant. Ann Rev Physiol, 47: 7 7 5 ,1985.
40. Wright, JR ., Benson, BJ., Williams, MC., et al. Protein composition of rabbit alveolar surfactant subfractions. Biochím Biophys Act, 791: 320, 1984.
41. Betg, RA_, Moss, Baum, BJ_, et al. Regulatkm of afflagen produetion by the beta adrenergic system. J din Invest, 67: 1457, 1981
42. Gross, I., Dynia, DW., Rooney, SA. et al: Influencc of epidemial growth factor on fetal rat hmg development in vitro. Pediatr Res, 20: 473, 1986.
43. Shibahara, S., Davidson, JM., Smith, K. et al: Modulation of tropoelastin production and elastin mesBenger t^ om id á c a c ü aetivity m dev*d»ping sheet lung. Boiehemistry, 20: 6577,1981.
44. Rooney, S., Dynia, D., Smart, D., et al.: Gtucocorticoid stimulation of cholinephophate cytidylytransferase aetivity in fetal rat lung: Receptor 156: 631 ,1987.
Estudio Perinatál del Parto Prematuro 71 résponse relationship. Biochim Biophys Act, 888: 208,1986.
45. Kogon, DP., Oulton, M., Gray, JH., et al.: Amniotic fluid phosphatidylglycerol and phosphatidylcoline phosphorous as predictors of fetal lung maturity. Am J Obstet Gynecol, 154: 226, 1986.
46. Oultom, M„ et al.: Assessment of fetal pulmonary maturity by phospholipid analysis of amniotic fluid lamellár bodies, Am J Obstet Gynecol, 142: 684,1982.
47. Oulton, M. and Martin, TE.: Developmental Study of a lamellar body fraction isolated from human amniotic fluid. Pediatr Res, 14:722,1980.
48. Gross, H., Wilson, CM. and Rooney SA.: Phosphatidycholine synthesis in newborn rabbit lung developmental pattern and the influence an nutrition. Biochim Biophys. Act, 528: 1901,1978.
49. Oulton, M., Fraser, M., et al: Quantification of surfactant pool sizes in rabbit lung during perinatal develoment. J Lipid Res., 27: 602-612.
50. Brehier, A., Bcnson, BJ., Williams MC., et al: Corticoesteroid induction of phosphatidic acid phosphatase in fetal rabbit lung. Biochem Biophys Res Commun, 77: 883,1977.
51. Cheng, JB., Golfiért A., et al: Glucocorticoides increase pulmonary B-adrenergic receptors in fetal rabbit. Endocrinology, 107: 1646,1980.
52. Smit, BT.: Lung naturation in the fetal rat: acceleration by injecction óf fibroblast pheumocite factor. Science, 204: 1094,1979.
53. Gross* I., and Wilson, CM.: Comparison of dexametasone, thyroxine, and methylxantines. J Appl Physiol, 48: 872,1980.
54. Góhzaléá, LW., Ballard, PL., et al.: Glucocorticoids and thyroid hormone stimulante biochemical and morfhologycal differentiation of human fetal lung in organ culture. J Clin Endocrinol Metab, 62: 678, 1986.
55. Brown, LAS, and Longmore, WJ.,: Adrenergic and cholinergic regulation of lung surfactant secretion in the isolated per fused rat lung and in the alveolar type II cell in culture. J Biol Chem., 256: 66,1981.
56. Harvey, D. and Parkinson, C.: Risk of RDS. Lancet, i, 42: 1975
57. Van Graaf, J.: The predicction of fetal pulmonary maturity from amniotic fluid contaminated by vaginal secretions. Medical J, 27: 1145, 1978.
58. Stedman, CM,: Management of preterm premature rupture of membranes: assessing amniotic fluid in téh vagina for phosphatidvl glycerol. Am J Obst Gynec, 140: 34, 1981.
59. Clemente, J., and Plátzkér, A.: Assessment of the risk of RDS by a rapid test for surfactant in amniotic fluid. New Engl J Med, 286: 1077,1972.
60. Idem cita No. 56.
61. Collaborative Group on Antenatal Steroid Therapy. Effects of antenatal dexametasone administration on de prevention óf respiratory distress syndrome. Am J Obstet Gynecol, 141: 276-286, 1981.
62. Liggins, G.: The prevention of RDS by maternal betamethasone administration. In Moore TD (ed). Columbus, Ohio, Ross Laboratories, pp 189-198, 1976.
63. Enhorning, G., Shennan, A., et al.: Pr.evention of neonatal respiratory distress syndrome by tracheal instilation of surfactant. Pediatrics, 76: 145, 1985.
64. Fujiwara, T.: Surfactant replacement in neonatal RDS. AmBterdam, The Netherlands, Élservier, pp 479,1984.
65. Morales, W. and Koerten, J.: Prevention of intraventricular hemorrage in very low birth weight infants by maternally administered phenobarbital. Obstet Gynecol, 68: 295,1986.
66. Pomerance, J., Teal, JH., Gogolok, JF., et al: Maternally administered antenatal vitamin Kl: Effect on neonatal Prothrombin activity, partial thromboplastin time, and intraventricular hemorrhage. Obstet Gynecol, 70: 235, 1987.
67. Low, JA., Galbraith, RS., Muir, DW., et al.: Factors associated with motor and cognitive déficits in children after intrapartum fetal hypoxia. Am J Obstet Gynecol, 148: 33„ 1984.
68. Bowes, WA., Jr., Gabbe, SW. and Bowes C.: Fetal heart rate monitoring in premature infants weighing 1500 grams or less. Am J Obstet Gynecol72 Garcés, M. y cois. 137: 791, 1980.
69. Luthy, DA., Kirkwood, K.S., Van Bello, ()., el al: Arandornized trial of electronie fetal monitoring in preterm labor. 69: 687, 1987
70. Pape, K.E. and Wigglesworth, J.S.: llaernorrhage, Ischaemia and the perinatal brain. Clin In Dev Med: 69, 1970.
71. Volpe, ,).: Intraventricular haernorrhage— major neurologic complications of prematurity. Neonatal neurological assesment and outoome. 77 Ross Conference on Pediatric Research, 27, 1980.
72 Garcés, M. y cois. 137: 791, 1980.
2. Howard, J ., Hoffman, M.A., Bakketing, M„ Leiv, S.: Factores de riesgo relacionados con la aparición de un nacimiento pretérmino. Clin Obstet Ginecol, Vol. 3: 6 91, 1984.
3. US Department of Health and Human Services, Public Health Service. Vital Statistics of the United States. 1982. Vol. I.
4. [«ira. A., Orbe, E., Dávila, A., Galárraga, J ., Pérez, F,., and Barrera, A.: Prevención del Parto Prematuro. Rev Fac Cien Med, I I : 171, 1986.
5. Ivspín, V.H.: El Niño Prematuro. En: Ramos, G.: Alto Riesgo Obstétrico, p.p. 291, 1989.
6. León, E., Garcés, M.: Morbimortalidad en los recién nacidos prematuros en al año 1986 en el Hospital “Dr. Enrique Garcés”. Rev Fac Cien Med, 13: 17 ,1988
7. Denise, M.: Epidemiología del Parto Pretérmino Clin Obsl Ginecol, Vol. 3: 507, 1988.
8. Meis, P.J., MacErncsl, J. and Moore, M.L.: Causes of the low birtbwieght births in public and private patients. Am,) Obstet Gynecol, 156: 1165, 1987.
9. Pappiernik, E.: Prcdiction of the Baby Preterin. Clin Obstet Gynecol, Vol 11, 315, 1984.
10. Berkowitz, G.: An Epidemiologic study of preterm delivery. Am J Epidemiol, 58: 147, 1979.
11. Obel, E.: Pregnancy complications following legally induced abortion with spccial reference to abortion technics. Act Obst Gynecol Scandin, 5 8 : 147, 1979.
12. Berkowilz, G., Harlap, S., Beck,G. and Freedman, D.: Early gestational bleeding and pregnancy out^ come: A multivariate analysis. Inter J Epidemiol,
12: 165, 1983.
13. Hawkinson, J . and Shulman, H.: Prematury associated with cervicitis and vaginitis during pregnancy. Am J Obstet Gynecol, 94: 898, 1966.
14. Heluin, G. and Papicrnik, E.: Prematuriré et gemellité. Comunication, Jerusalem, 1981.
15. US Departament of Healt and Human Service. Report of the secretaris Task Forcé on Black and Minority Health, Publication 0 -4 8 7 -6 3 7 (QL3). Voló (Infant Mórtalityand low Birthweight) Hyattsville, Maryland, National Center for Health Statistics, 1985.
16. Meyer, M., Joña, BS. and Tonascia, J A.: Perinatal events associated with maternal smoking during pregnancy. Am J Epidemiol: 103: 4 64, 1976.
17. Shiono, PH., Klebanoff, M., and Rhoads, GG.: Smoking and drinking during pregnancy. J Am Med Assoc,82: 255, 1986.
18. Artal, R., Sokol, RJ. and Newman, M.: The Mecha7 0 Garcés, M. y cois. nical properties of prematürely and non prematurely ruprured membranes, methods and results. AmJ Obstet Gynecol 1 2 5 :6 5 5 , 1976.
19. Me Gregor, JA.* LaweUin, D. and French, JL .; Bacterial protease -induced tedilAtion of dioríoamniotic membranc sttength and elasticity. Obstet Gynecol, 69 :167,1981
20. Mead, PB.: ProphylácÜC antibiótics ánd antibiotic resístante. Semináis m ^eribátolo|y: 1 :107,1977.
21. US Department of Health áhd ffiimati Serives. Public Health Service VoL 1 Hyattsville, Maryland: National Centélr for Health Statistics, 1986.
22. Abramowicz, M. and Kass, RH.: Pathogenesis and Prognosis of Prematurity. R EngJ Méd, 275:878-938,1001,1053,1966.
23. Commfttee to Study the Preveñtíon of Low Birth. Preventig Low Birthweight. Washington, DC: National Academy Press, 1985.
24. Fcinstein, ST., Vintzileos, AM., Lodeiro, JG., et al. Amniocentesis with premature niptuie of membranes. AmJ Obstet Gynecol, 59:147,1962. logic meehanlan in the prevention of pretermltirth Clin Obstet Gynecol, 27: 592 ,1984.
26. Carftis, SN„ Chiao, JP., Moore, J J ., et al. Myometrial desenstizaeion after ritodrine infusión. Ám J Physiol, 253: 41 0,1987.
27. Ingeniarsson, I.: Use of Beta receptor agonist in obstetrics. Act Obstet Gynecol Scand, 188: 29, 1982.
28 . Harden, TK.: Agomst -mduced áesraátízation of de beta adrenergie recepto linked adenylate cyclase. Pharmacoí Eev 5 :35,1987.
29. Altura, BM. and Altura, BT.: Magnesio Ions and cóntraction of vascular smooth muscles. Relationship to some vascular discases. Fed Proc, 40: 2672, 1981.
30. L EBiol, JP.: Sdíate as a locoütye agent. t Contemp Obstet Gyneco, 1: 49, 1985.
31. Hollander, Di., Nagey, Í)A. and Pupkin, MJ: Magneshlm sulfate and ritodriné Hydrochloride: A randomízed comparison. Am J Obstet Gynecol:
32. Stanfóid, N., Roth, GJ^ Shen, TY., ct aL Lack of rovalent modifkatioa of prostaglandiii syntetase (cydo-oxygenase) by indometacin. Prostaglandins: 13: 669 ,1977.
33. Sharpe, GL., Larsson, KS. and Thalme, B.: Stüdies on closure of the ductus arteriosus XII. Iri útero effect of indonietacin and sodmm salicyiater in ratsand rabbits. Prostaglandins, 9: 585,1975. M. H.M.S.O.: Series DII3, Number 8 ,1980 .
35. Campiche, M.A., Gautier, A., Hernández, E.I. and Raynionli, A.: An electrón microscope study of thé fetal development of the human lung. Pediátrica, 32: 974 ,1963.
36. Gross, I.: Respiratory control and lung development In the fetus and newbom. In: Johnston, BM, Gluckman, PD: eds: Ithaca, New York, Perinatologjrftéss.
ppST-lOSil^Bó.
37. Rooney, SA.: Lunp Surfactant. Environ Health Perspect: 55: 205,1984.
38. Rooney, A.: The surfactant systém and lung phospholipid biochemistry. Am Rev Respir Dis, 131: ám^sss.
39. King, RJ.: Composition and metabolism of the apolipoproteins of pulmónary surfactant. Ann Rev Physiol, 47: 7 7 5 ,1985.
40. Wright, JR ., Benson, BJ., Williams, MC., et al. Protein composition of rabbit alveolar surfactant subfractions. Biochím Biophys Act, 791: 320, 1984.
41. Betg, RA_, Moss, Baum, BJ_, et al. Regulatkm of afflagen produetion by the beta adrenergic system. J din Invest, 67: 1457, 1981
42. Gross, I., Dynia, DW., Rooney, SA. et al: Influencc of epidemial growth factor on fetal rat hmg development in vitro. Pediatr Res, 20: 473, 1986.
43. Shibahara, S., Davidson, JM., Smith, K. et al: Modulation of tropoelastin production and elastin mesBenger t^ om id á c a c ü aetivity m dev*d»ping sheet lung. Boiehemistry, 20: 6577,1981.
44. Rooney, S., Dynia, D., Smart, D., et al.: Gtucocorticoid stimulation of cholinephophate cytidylytransferase aetivity in fetal rat lung: Receptor 156: 631 ,1987.
Estudio Perinatál del Parto Prematuro 71 résponse relationship. Biochim Biophys Act, 888: 208,1986.
45. Kogon, DP., Oulton, M., Gray, JH., et al.: Amniotic fluid phosphatidylglycerol and phosphatidylcoline phosphorous as predictors of fetal lung maturity. Am J Obstet Gynecol, 154: 226, 1986.
46. Oultom, M„ et al.: Assessment of fetal pulmonary maturity by phospholipid analysis of amniotic fluid lamellár bodies, Am J Obstet Gynecol, 142: 684,1982.
47. Oulton, M. and Martin, TE.: Developmental Study of a lamellar body fraction isolated from human amniotic fluid. Pediatr Res, 14:722,1980.
48. Gross, H., Wilson, CM. and Rooney SA.: Phosphatidycholine synthesis in newborn rabbit lung developmental pattern and the influence an nutrition. Biochim Biophys. Act, 528: 1901,1978.
49. Oulton, M., Fraser, M., et al: Quantification of surfactant pool sizes in rabbit lung during perinatal develoment. J Lipid Res., 27: 602-612.
50. Brehier, A., Bcnson, BJ., Williams MC., et al: Corticoesteroid induction of phosphatidic acid phosphatase in fetal rabbit lung. Biochem Biophys Res Commun, 77: 883,1977.
51. Cheng, JB., Golfiért A., et al: Glucocorticoides increase pulmonary B-adrenergic receptors in fetal rabbit. Endocrinology, 107: 1646,1980.
52. Smit, BT.: Lung naturation in the fetal rat: acceleration by injecction óf fibroblast pheumocite factor. Science, 204: 1094,1979.
53. Gross* I., and Wilson, CM.: Comparison of dexametasone, thyroxine, and methylxantines. J Appl Physiol, 48: 872,1980.
54. Góhzaléá, LW., Ballard, PL., et al.: Glucocorticoids and thyroid hormone stimulante biochemical and morfhologycal differentiation of human fetal lung in organ culture. J Clin Endocrinol Metab, 62: 678, 1986.
55. Brown, LAS, and Longmore, WJ.,: Adrenergic and cholinergic regulation of lung surfactant secretion in the isolated per fused rat lung and in the alveolar type II cell in culture. J Biol Chem., 256: 66,1981.
56. Harvey, D. and Parkinson, C.: Risk of RDS. Lancet, i, 42: 1975
57. Van Graaf, J.: The predicction of fetal pulmonary maturity from amniotic fluid contaminated by vaginal secretions. Medical J, 27: 1145, 1978.
58. Stedman, CM,: Management of preterm premature rupture of membranes: assessing amniotic fluid in téh vagina for phosphatidvl glycerol. Am J Obst Gynec, 140: 34, 1981.
59. Clemente, J., and Plátzkér, A.: Assessment of the risk of RDS by a rapid test for surfactant in amniotic fluid. New Engl J Med, 286: 1077,1972.
60. Idem cita No. 56.
61. Collaborative Group on Antenatal Steroid Therapy. Effects of antenatal dexametasone administration on de prevention óf respiratory distress syndrome. Am J Obstet Gynecol, 141: 276-286, 1981.
62. Liggins, G.: The prevention of RDS by maternal betamethasone administration. In Moore TD (ed). Columbus, Ohio, Ross Laboratories, pp 189-198, 1976.
63. Enhorning, G., Shennan, A., et al.: Pr.evention of neonatal respiratory distress syndrome by tracheal instilation of surfactant. Pediatrics, 76: 145, 1985.
64. Fujiwara, T.: Surfactant replacement in neonatal RDS. AmBterdam, The Netherlands, Élservier, pp 479,1984.
65. Morales, W. and Koerten, J.: Prevention of intraventricular hemorrage in very low birth weight infants by maternally administered phenobarbital. Obstet Gynecol, 68: 295,1986.
66. Pomerance, J., Teal, JH., Gogolok, JF., et al: Maternally administered antenatal vitamin Kl: Effect on neonatal Prothrombin activity, partial thromboplastin time, and intraventricular hemorrhage. Obstet Gynecol, 70: 235, 1987.
67. Low, JA., Galbraith, RS., Muir, DW., et al.: Factors associated with motor and cognitive déficits in children after intrapartum fetal hypoxia. Am J Obstet Gynecol, 148: 33„ 1984.
68. Bowes, WA., Jr., Gabbe, SW. and Bowes C.: Fetal heart rate monitoring in premature infants weighing 1500 grams or less. Am J Obstet Gynecol72 Garcés, M. y cois. 137: 791, 1980.
69. Luthy, DA., Kirkwood, K.S., Van Bello, ()., el al: Arandornized trial of electronie fetal monitoring in preterm labor. 69: 687, 1987
70. Pape, K.E. and Wigglesworth, J.S.: llaernorrhage, Ischaemia and the perinatal brain. Clin In Dev Med: 69, 1970.
71. Volpe, ,).: Intraventricular haernorrhage— major neurologic complications of prematurity. Neonatal neurological assesment and outoome. 77 Ross Conference on Pediatric Research, 27, 1980.
72 Garcés, M. y cois. 137: 791, 1980.
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Garces M, Dávila A, Calle A. Estudio perinatal del parto prematuro. Rev Fac Cien Med (Quito) [Internet]. 16 de junio de 2017 [citado 4 de mayo de 2024];15(1-2):60-72. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/678
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