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1

Brouwer, A. E. Distance-regular graphs. Berlin: Springer-Verlag, 1989.

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2

Brouwer, Andries E., Arjeh M. Cohen, and Arnold Neumaier. Distance-Regular Graphs. Berlin, Heidelberg: Springer Berlin Heidelberg, 1989. http://dx.doi.org/10.1007/978-3-642-74341-2.

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3

Jerrum, Mark. Fast uniform generation of regular graphs. Edinburgh: University of Edinburgh Department of Computer Science, 1988.

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4

Eshghi, Kourosh. The existence and construction of gas-valuations of 2-regular graphs with three components. Ottawa: National Library of Canada = Bibliothèque nationale du Canada, 1997.

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5

Klanten, Robert. Regular: Graphic design today. Berlin: Die Gestalten Verlag, 2009.

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6

Reggini, Horacio C. Regular polyhedra: Random generation, Hamiltonian paths, and single chain nets. Buenos Aires: Academia Nacional de Ciencias Exactas, Físicas y Naturales, 1991.

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7

Differentiating instruction in the regular classroom: How to reach and teach all learners, grades 3-12. Minneapolis, MN: Free Spirit Pub., 2002.

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8

Heacox, Diane. Differentiating instruction in the regular classroom: How to reach and teach all learners, grades K-12. Minneapolis, MN: Free Spirit Publishing, 2012.

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9

Affairs, United States Congress Senate Select Committee on Indian. Authorizing consolidated grants to Indian tribal governments to regulate environmental quality on Indian reservations: Report (to accompany S. 668). [Washington, D.C.?: U.S. G.P.O., 1991.

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10

Commons, Canada Parliament House of. Bill: An act to regulate freight and passenger rates on railways. Ottawa: S.E. Dawson, 2002.

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11

Affairs, United States Congress Senate Select Committee on Indian. Indian Environmental Consolidated Grant Program Act: Hearing before the Select Committee on Indian Affairs, United States Senate, One Hundred Second Congress, first session, on S. 668, to authorize consolidated grants to Indian tribes to regulate environmental quality on Indian reservations, May 16, 1991, Washington, DC. Washington, DC: U.S. G.P.O., 1991.

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12

Commons, Canada Parliament House of. Bill: An act to regulate the grain trade in Manitoba and the North-West Territories. Ottawa: S.E. Dawson, 2002.

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13

Distance Regular Graphs. Springer Verlag, 1989.

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14

Neumaier, Arnold. Distance-Regular Graphs. Springer, 2011.

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15

Vernizzi, Graziano, and Henri Orland. Complex networks. Edited by Gernot Akemann, Jinho Baik, and Philippe Di Francesco. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780198744191.013.43.

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This article deals with complex networks, and in particular small world and scale free networks. Various networks exhibit the small world phenomenon, including social networks and gene expression networks. The local ordering property of small world networks is typically associated with regular networks such as a 2D square lattice. The small world phenomenon can be observed in most scale free networks, but few small world networks are scale free. The article first provides a brief background on small world networks and two models of scale free graphs before describing the replica method and how it can be applied to calculate the spectral densities of the adjacency matrix and Laplacian matrix of a scale free network. It then shows how the effective medium approximation can be used to treat networks with finite mean degree and concludes with a discussion of the local properties of random matrices associated with complex networks.
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16

Heacox, Diane. Differentiating Instruction in the Regular Classroom: How to Reach and Teach All Learners, Grades 3-12. Free Spirit Publishing, 2001.

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17

Heacox, Diane. Differentiating Instruction in the Regular Classroom: How to Reach and Teach All Learners, Grades 3-12. Free Spirit Publishing, 2002.

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18

Desmarais, Bruce A., and Skyler J. Cranmer. Statistical Inference in Political Networks Research. Edited by Jennifer Nicoll Victor, Alexander H. Montgomery, and Mark Lubell. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780190228217.013.8.

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Researchers interested in statistically modeling network data have a well-established and quickly growing set of approaches from which to choose. Several of these methods have been regularly applied in research on political networks, while others have yet to permeate the field. This chapter reviews the most prominent methods of inferential network analysis for both cross-sectionally and longitudinally observed networks, including (temporal) exponential random graph models, latent space models, the quadratic assignment procedure, and stochastic actor oriented models. For each method, the chapter summarizes its analytic form, identifies prominent published applications in political science, and discusses computational considerations. It concludes with a set of guidelines for selecting a method for a given application.
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19

Levien, Michael. From Primitive Accumulation to Regimes of Dispossession. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198792444.003.0003.

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In order to analyze land alienation in contemporary India, Shapan Adnan follows a theoretical approach in which mechanisms of primitive accumulation are not restricted to use of force, but include land transfer by agreement, as well as indirect mechanisms that are concerned with very different objectives. Reviewing evidence on land grabs, resistance, and workforce trends, he argues that primitive accumulation under neoliberal globalization has not been substantially followed by the absorption of the dispossessed in regular capitalist employment. Adnan puts forward a set of hypotheses to explain why the self-employed constituted at least half or more of the Indian workforce over 1999–2012. While such trends indicate a partial and short-run divergence from the classic Marxian schema of the transition to capitalism, Adnan argues that, given ongoing trends in the national and global economy, the long run outcome in India remains an open question.
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20

Strain, Virginia Lee. Legal Reform in English Renaissance Literature. Edinburgh University Press, 2018. http://dx.doi.org/10.3366/edinburgh/9781474416290.001.0001.

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This book investigates rhetorical and representational practices that were used to monitor English law at the turn of the seventeenth century. While the majority of Law and Literature studies characterise the law as a force of coercion and subjugation, this book instead treats in greater depth the law’s own vulnerability, both to corruption and to correction. The dominance of law in early modern life made its failings and improvements of widespread concern: it was a regular and popular focus of criticism. The terms and techniques of legal reform provided modes of analysis through which legal authorities and literary writers alike evaluated form and character. Legal reform, together with the conflicts and anxieties that inspired and sprang from it, were represented by courtly, coterie, and professional writers. Spenser’s Faerie Queene, the Gray’s Inn Christmas revels of 1594-5, Donne’s ‘Satyre V’, and Shakespeare’s Measure for Measure and The Winter’s Tale all examine the potential, as well as the ethical and practical limitations, of legal reform’s contribution to local and national governance.
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21

Lujano, Yolanda. Niveles de comprensión lectora. Instituto Universitario de Innovación Ciencia y Tecnología Inudi Perú, 2022. http://dx.doi.org/10.35622/inudi.b.001.

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La presente investigación titulada “Niveles de comprensión lectora en los alumnos de la IES Aplicación “JCM” UNA-Puno-2009.”, cuyo objetivo general fue determinar los niveles de comprensión lectora en alumnos de la IES Aplicación “JCM” UNA PUNO. La hipótesis de investigación: Existe niveles de comprensión Lectora regular en alumnos de la IES Aplicación “JCM” UNA - 2009. El tipo de investigación es: “descriptiva”, diseño “descriptiva simple. El método que se aplicó es no experimental de corte deductivo Inductivo, cuya técnica es el examen. Se empleó el instrumento de la prueba de tipo múltiple, donde se aplicó a todos los alumnos de 1ro a 5to de la IES Aplicación “JCM” UNA – Puno, consideradas en dos tipos de pruebas, uno para el VI Ciclo, es decir, para los alumnos de 1ro y 2do grado y otro para el VII Ciclo que correspondió a los alumnos de 3ro, 4to y 5to grados. Después de la prueba se llegó a concluir que existe niveles de comprensión Lectora buena en alumnos de la IES Aplicación “JCM” UNA - 2009.
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22

Wilson Kimber, Marian. Making Elocution Musical. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252040719.003.0002.

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Poetic recitation was regularly heard at concerts and in “musical and literary entertainments.” Recitation anthologies designed for homes and schools provided sample programs. Music and elocution were combined outside of the conventions of notation: texts of songs were spoken to their accompaniments, and previously composed or improvised music was used to accompany speech. Contemporary speech pedagogy reveals that performed speech was characteristically musical due to highly-pitched practices, often notated with graphic symbols. The career of Jane Manner demonstrates the full range of melodramatic approaches available. Something between a musical composition and a genre of performed literature, accompanied recitation allowed women to exert their artistic power beyond the traditional boundaries of elocution and to usurp the place of the composer.
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23

Bisseling, Rob H. Parallel Scientific Computation. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780198788348.001.0001.

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This book explains how to use the bulk synchronous parallel (BSP) model to design and implement parallel algorithms in the areas of scientific computing and big data. Furthermore, it presents a hybrid BSP approach towards new hardware developments such as hierarchical architectures with both shared and distributed memory. The book provides a full treatment of core problems in scientific computing and big data, starting from a high-level problem description, via a sequential solution algorithm to a parallel solution algorithm and an actual parallel program written in the communication library BSPlib. Numerical experiments are presented for parallel programs on modern parallel computers ranging from desktop computers to massively parallel supercomputers. The introductory chapter of the book gives a complete overview of BSPlib, so that the reader already at an early stage is able to write his/her own parallel programs. Furthermore, it treats BSP benchmarking and parallel sorting by regular sampling. The next three chapters treat basic numerical linear algebra problems such as linear system solving by LU decomposition, sparse matrix-vector multiplication (SpMV), and the fast Fourier transform (FFT). The final chapter explores parallel algorithms for big data problems such as graph matching. The book is accompanied by a software package BSPedupack, freely available online from the author’s homepage, which contains all programs of the book and a set of test programs.
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24

Menzer, Paul. Lines. Edited by Henry S. Turner. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780199641352.013.6.

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This chapter examines the importance of the ‘line’ in the composition, reading, editing, interpretation, and performance of early modern drama. It considers the gradual emergence of the poetic verse that is characteristic of early modern drama and one of the most obviously ‘textual’ units of early modern theatre. It shows that the line, before it became a formal verse element, persisted as a graphic mark, a technology of performance shared by musicians and singers as well as actors and playwrights. It explains how the line, through the printing of plays and poems, became the immaterial metaphysical unit we associate with the period’s finest ‘literary’ writing. It also discusses physical and metaphysical lines and their attempt to regulate silence. Finally, it argues that attention at the level of the line pushes performance towards the typographic, even advancing a kind of ‘typographical acting’ alert to every piece of punctuation, every line break, every diacritically pricked out metrical inflection.
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25

Bhattacharya, Sreedeep. Consumerist Encounters. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780190125561.001.0001.

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Economic liberalization and globalization in India in the early 1990s resulted in a whirlwind of consumerist activities. New material and visual temptations swept markets, infiltrated consumer minds through media, and aroused inhibited desires. This has engendered a fast-paced and relentless relationship with things and images that permeate our everyday lives. Consumerist Encounters elucidates how our all-consuming relationship with objects and their representations have transformed rapidly over the last few decades in contemporary urban India. It argues that ephemerality, frivolousness, and multiplicity of choice regulate our flirtatious encounters with commodities and their images as we restlessly use, exhaust, dispose, and move on. Such a trend is illustrated by examining a plethora of commodity-centric phenomena such as exclusion through apparel, eroticization of body images, population of the T-shirt surface with graphics and text, rise of business process outsourcing, instantaneous seeing and sharing of images, and rejection of material goods in junkyards and ruins. These explorations collectively shed light on the constant negotiation of our identities, statuses, and mobilities in the image-saturated commodity landscape.
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26

Pascoe, Daniel. Last Chance for Life: Clemency in Southeast Asian Death Penalty Cases. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198809715.001.0001.

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All five contemporary practitioners of the death penalty in the Association of Southeast Asian Nations (ASEAN)—Indonesia, Malaysia, Thailand, Singapore, and Vietnam—have performed executions on a regular basis over the past few decades. Amnesty International currently classifies each of these nations as death penalty ‘retentionists’. However, notwithstanding a common willingness to execute, the number of death sentences passed by courts that are reduced to a term of imprisonment, or where the prisoner is released from custody altogether, through grants of clemency by the executive branch of government varies remarkably among these neighbouring political allies. This book uncovers the patterns which explain why some countries in the region award commutations and pardons far more often than do others in death penalty cases. Over the period under analysis, from 1991 to 2016, the regional outliers were Thailand (with more than 95 per cent of condemned prisoners receiving clemency after exhausting judicial appeals) and Singapore (with less than 1 per cent of condemned prisoners receiving clemency). Malaysia, Indonesia, and Vietnam fall at various points in between these two extremes. This is the first academic study anywhere in the world to compare executive clemency across national borders using empirical methodology, the latter being a systematic collection of clemency data in multiple jurisdictions using archival and ‘elite’ interview sources. Last Chance for Life: Clemency in Southeast Asian Death Penalty Cases will prove an authoritative resource for legal practitioners, criminal justice policymakers, scholars, and activists throughout the ASEAN region and around the world.
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27

Bullock, Charles S., and Karen L. Owen. Special Elections. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780197540626.001.0001.

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Special elections are a significant point of entry into the U.S. Congress. These electoral contests are not numerous, and their occurrence is largely random. They have attracted extraordinary attention from the national parties, political consultants, and the media when control of the House of Representatives is up for grabs in every regular election. Perhaps never have special elections drawn as much attention as during the first two years of the Trump presidency. This volume provides a detailed case study of the most expensive special House election ever conducted augmented with mini-cases exploring the other competitive special elections held during the first two years of the Trump era. These case studies are placed in the context of quantitative analyses of the almost three hundred House special elections held since World War II. Bullock and Owen find the factors associated with success in special elections are similar to those that help incumbents win term after term. They show that the party identification of the previous incumbent correlates strongly with the special election outcomes. Moreover, this volume explores whether the performance of the president’s party in special elections predicts the fortunes of the president’s party in the next general election. It finds that the numbers of losses by the president’s party or takeaways from the opposition is significantly related to the next election results. This work highlights not only the unique context and outcomes of special elections, but also their important role in shaping who enters, leads, and controls Congress.
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28

Gill, Steven J., and Michael H. Nathanson. Central nervous system pathologies and anaesthesia. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0081.

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Anaesthesia induces changes in many organ systems within the body, though clearly none more so than the central nervous system. The physiology of the normal central nervous system is complex and the addition of chronic pathology and polypharmacy creates a significant challenge for the anaesthetist. This chapter demonstrates a common approach for the anaesthetist and specific considerations for a wide range of neurological conditions. Detailed preoperative assessment is essential to gain understanding of the current symptomatology and neurological deficit, including at times restrictions on movement and position. Some conditions may pose challenges relating to communication, capacity, and consent. As part of the consent process, patients may worry that an anaesthetic may aggravate or worsen their neurological disease. There is little evidence to support this understandable concern; however, the risks and benefits must be considered on an individual patient basis. The conduct of anaesthesia may involve a preference for general or regional anaesthesia and requires careful consideration of the pharmacological and physiological impact on the patient and their disease. Interactions between regular medications and anaesthetic drugs are common. Chronically denervated muscle may induce hyperkalaemia after administration of succinylcholine. Other patients may have an altered response to non-depolarizing agents, such as those suffering from myasthenia gravis. The most common neurological condition encountered is epilepsy. This requires consideration of the patient’s antiepileptic drugs, often relating to hepatic enzyme induction or less commonly inhibition and competition for protein binding, and the effect of the anaesthetic technique and drugs on the patient’s seizure risk. Postoperative care may need to take place in a high dependency unit, especially in those with limited preoperative reserve or markers of frailty, and where the gastrointestinal tract has been compromised, alternative routes of drug delivery need to be considered. Overall, patients with chronic neurological conditions require careful assessment and preparation, a considered technique with attention to detail, and often higher levels of care during their immediate postoperative period.
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29

McHugh, James. An Unholy Brew. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780199375936.001.0001.

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An Unholy Brew is the first book on alcohol in premodern India. Using a wide range of sources from the Vedas to the Kāmasūtra, the book explores the drinks, styles of drinking, and sophisticated theories of abstinence found in South Asia from our earliest Sanskrit written records through the second millennium CE. It begins with the intoxicating drinks people devised over the centuries, made from grains, sugars, fruits, and herbs. Texts describe a number of types of drinking: public drinking at the brewery-tavern, and at festivals and weddings. Poetic texts depict elite drinking, often in an erotic mode. Medical texts explain how a rich man should regulate his drinking correctly, and how to cure drink sickness. Myths and epic stories explain how drink came into being and was assigned the ritual and legal status it has today. The book also explores Hindu, Buddhist, and Jain moral and legal texts on drink and abstinence. Drink is used in some Tantric rituals, and the book presents an account of drink in the work of Kashmiri Abhinavagupta. One later Tantric text contains a detailed description of the goddess Liquor, Surā, translated here in full, along with considerations of cannabis and opium. Finally, what happened to these drinks, stories, and theories in the last few centuries? An Unholy Brew brings to life the overlooked, complex world of brewing, drinking (and abstaining) in premodern India, and includes clear case studies of topics such as law and medicine, along with recipes for drinks.
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Kemeny, P. C. The New England Watch and Ward Society. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190844394.001.0001.

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The New England Watch and Ward Society provides a new window into the history of the Protestant establishment’s prominent role in late nineteenth-century public life and its confrontation with modernity, commercial culture, and cultural pluralism in early twentieth-century America. Elite liberal Protestants, typically considered progressive, urbane, and tolerant, established the Watch and Ward Society in 1878 to suppress obscene literature, including Walt Whitman’s Leaves of Grass. These self-appointed custodians of Victorian culture enjoyed widespread support from many of New England’s most renowned ministers, distinguished college presidents, respected social reformers, and wealthy philanthropists. In the 1880s, the Watch and Ward Society expanded its efforts to regulate public morality by attacking gambling and prostitution. The society not only expressed late nineteenth-century Victorian American values about what constituted “good literature,” sexual morality, and public duty but also embodied Protestants’ efforts to promote these values in an increasing intellectually and culturally diverse society. By 1930, however, the Watch and Ward Society suffered a very public fall from grace. Following controversies over the suppression of H. L. Mencken’s American Mercury as well as popular novels, including Sinclair Lewis’s Elmer Gantry and D. H. Lawrence’s Lady Chatterley’s Lover, cultural modernists, civil libertarians, and publishers attacked the moral reform movement, ridiculing its leaders’ privileged backgrounds, social idealism, and religious commitments. Their critique reshaped the dynamics of Protestant moral reform activity as well as public discourse in subsequent decades. For more than a generation, however, the Watch and Ward Society expressed mainline Protestant attitudes toward literature, gambling, and sexuality.
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31

Case, Jay R. Methodists and Holiness in North America. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780199683710.003.0009.

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Baptists in nineteenth-century North America were known as eager proselytizers. They were evangelistic, committed to the idea of a believers’ church in which believers’ baptism was the norm for church membership and for the most part fervent revivalists. Baptist numbers soared in the early nineteenth-century United States though at the cost of generating much internal dissent, while in Canada New Light preachers such as Henry Alline were influential, but often had to make headway against an Anglican establishment. The Baptist commitment to freedom of conscience and gathered congregations had been hardened over the centuries by the experience of persecution and that meant that they were loath to qualify the freedom of individual congregations. The chapter concentrates on exposing the numerous divisions in the Baptist family, the most basic of which was the disagreement over the nature of the atonement, which separated General (Arminian) from Particular (Calvinist) Baptists. Revivals induced further divisions between Regular Baptists who were reserved about them and Separate Baptists who saw dramatic conversions and fervent outbursts as external signs of inward grace. Calvinistic Baptists took a dim view of efforts to induce conversions as laying too much trust in human agency. Though enthusiasm for missions gripped American and Canadian Baptists alike, there were those who feared that missionary societies would erode congregational autonomy. Dissent over slavery and abolition constituted the biggest single division in North American Baptist life. Southern Baptists developed biblical defences of slavery and were annoyed at attempts to keep slaveholders out of missionary work. As a result they formed a separate denomination, the Southern Baptist Convention, in 1845. Baptists had been successful in converting black slaves and black Baptists such as the northerner Nathaniel Paul were outspoken abolitionists. In the South after the Civil War, though, blacks marched out of white denominations to form associations of their own, often with white encouragement. Finally, not the least cause of internal dissent were disputes over ecclesiology, with J.M. Graves and J.R. Pendleton, the founders of Old Landmarkism, insisting with renewed radicalism on denominational autonomy. The chapter suggests that by the end of the century, Baptists embodied the tensions in Dissenting traditions. Their dissent in the public square intensified the possibility of internal disagreement, even schism, their tradition of Christian democracy proving salvifically liberating but ecclesiastically messy. While they stood for liberty and religious equality, they were active in anti-Catholic politics and in seeking to extend state activism in society through the Social Gospel movement.
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32

Juri Moran, Joulia Marianita, Paulina Elizabeth Durán Mora, Estefania Vanessa Arauz Andrade, Yessenia Isabel Sarchi Guayasamin, Alejandra Elizabeth Vasquez Fuel, Cesar Wladimir Reyes Padilla, Pamela Nathaly Pastrano Coronado, Lucia Paola Rodriguez Paz, Martha Elizabeth Aguilar Villagran, and Oscar Andres Toapanta Proaño. Ginecología Obstetricia: Patologías durante el embarazo. Mawil Publicaciones de Ecuador, 2019, 2020. http://dx.doi.org/10.26820/978-9942-826-07-7.

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En Medicina, el área de aplicación de Ginecología, la ciencia de la mujer condensa el estudio de las enfermedades frecuentes y graves, el diagnóstico, detección de los factores de riesgo y establecer mecanismos de prevención, prescribir los tratamientos médicos y quirúrgicos de las enfermedades del sis- tema reproductor femenino, entiéndase, todo lo relacionado con la vagina, las mamas, el útero y los ovarios. Durante el siglo XX, motivado por el crecimiento acelerado del conocimien- to científico y médico, se acrecienta la toma de conciencia del rol que le co- rresponde desempeñar a la medicina en el sector de la salud y la protección de la mujer embarazada. Los problemas del trato genital femenino cuando se asumen como responsabilidad de los ginecólogos, quienes incluyeron dentro del proceso de auscultación, diagnóstico y tratamiento aspectos fisiológicos y endocrinos. Las barreras de la formación académica se fueron difuminando y los ginecó- logos y obstetras comenzaron a estrechar su campo laboral y como resultante se constituyó la Ginecobstetricia. En el marco de estas reflexiones, surge la idea de la presentación de un tex- to titulado Ginecología – Obstetricia, mediante el cual se pretende hacer una contribución real a nivel teórico que permita apoyar a profesionales y estu- diantes en el área de salud humana, básicamente en algunas de las patologías o complicaciones médicas asociadas al embarazo, y tratadas por la especialidad obstétrica, así mismo, se abordan dos temas (1 y 2) de conocimiento general. Cabe indicar que el texto no pretende abordar la vasta información o literatura que sobre los temas se han tratado. El libro ha sido estructurado bajo el perfil de diez (10) temas que discurren estrictamente sobre contenidos específicos, a sa- ber: 1. El parto y sus fases, 2. Pruebas de Bienestar Fetal, 3. Amenaza de Parto Pretérmino, 4. Ruptura Prematura de Membranas, 5. Amenaza de aborto, 6. Desprendimiento de placenta, 7. Infecciones de vías urinarias en embarazadas, 8. Diabetes Gestacional, 9. Hipertension en las embarazadas y 10. Preeclamp- sia y eclampsia En el primer tema, el Parto y sus fases, se precisan diferentes nociones sobre 26 GINECOLOGIA - OBSTETRICIA el proceso y el resultado de parir (dar a luz). A lo largo de la historia ha evolu- cionado el conocimiento de este tema dando como resultado una terminología precisa sobre los diferentes tipos de parto: parto natural, parto normal, parto ins- trumental, parto pretérmino, parto humanizado, etc. Estas nociones obedecen a determinadas circunstancias específicas que lo circunscribe como el uso o no de instrumentos que ayuden al nacimiento de un feto. De manera general, el parto marca el final del embarazo y el nacimiento de la criatura que se engendraba en el útero de la madre. Este proceso por el que la mujer o la hembra de una especie vivípara expulsa el feto y la placenta al final de la gestación consta de tres fases: la fase de dilatación, la de expulsión y la placentaria o de alumbramiento. En el segundo tema titulado Pruebas de Bienestar Fetal, se destaca el desa- rrollo de diferentes pruebas para el control del bienestar fetal. Éstas constitu- yen las técnicas aplicadas a las madres que permiten predecir el posible riesgo fetal o hacer un pronóstico del estado actual del feto, es decir, que tratan de conseguir a través de una valoración del feto de forma sistemática, la identifi- cación de aquellos que están en peligro dentro del útero materno, para así to- mar las medidas apropiadas y prevenir un daño irreversible. Se abordan en este contexto las indicaciones y los métodos (clínicos, biofísicos y bioquímicos más utilizados para el control de bienestar fetal. En el tema tres (3) denominado Amenaza de Parto Pretérmino, el trabajo se centra, en el desarrollo de los siguientes ítems. La Definición de Parto Pretérmi- no, la Definición de amenaza de Parto Pretérmino, la Evaluación del riesgo, la etiología, la Clínica de la Amenaza de Parto Pretérmino, el Diagnóstico precoz de la Amenaza de Parto Pretérmino, la Evaluación de gestantes que acuden a emergencia por signos y síntomas de Amenaza de Parto Pretérmino y el trata- miento. El trabajo parte de la definición de Parto Pretérmino entendido como aquel que ocurre después de la semana 23 y antes de la semana 37 de gestación, para posteriormente, tratar lo relativo a la Amenaza de Parto Pretérmino (APP) definido como el proceso clínico sintomático (Aparición de dinámica uterina regular acompañado de modificaciones cervicales) que puede conducir a un parto pretérmino. Su etiología es compleja y multifactorial, en la que pueden intervenir de forma simultánea factores inflamatorios, isquémicos, inmunológi- cos, mecánicos y hormonales. 27 GINECOLOGIA - OBSTETRICIA Por otro parte, el tema cuatro (4) expone la Ruptura Prematura de Membra- nas, la cual constituye una complicación usual en la práctica obstétrica, esta puede aumentar la incidencia en la morbilidad y mortalidad materna – fetal. Múltiples estudios se están llevando a cabo para poder dilucidar completamente su fisiopatología, lo cual se hace cada vez más necesario para poder aplicar estos conceptos en la práctica clínica, la evidencia actual indica que la Ruptura Prematura de Membrana es un proceso que puede ser afectado por factores: bioquímicos, fisiológicos, patológicos y ambientales. El capítulo cinco (5) comprende la temática sobre la Amenaza de aborto. (AA) que es la complicación más común durante el embarazo, se define como el sangrado transvaginal antes de las 20 semanas de gestación (SDG) gestación o con un feto menor de 500g, con o sin contracciones uterinas, sin dilatación cervical y sin expulsión de productos de la concepción”. Es decir, se presenta hemorragia de origen intrauterino antes de la vigésima semana completa de ges- tación, con o sin contracciones uterinas, sin dilatación cervical y sin expulsión de los productos de la concepción. Los síntomas abarcan amenorrea secundaria, presencia de vitalidad fetal y cólica abdominales con o sin sangrado vaginal entre otros. Para el diagnóstico se puede hacer una ecografía abdominal o va- ginal, examen pélvico y de laboratorio. En un principio el tratamiento consiste en recomendar reposo en cama y reposo pélvico. La identificación de factores de riesgo, el Ultrasonido obstétrico y la medición de marcadores bioquímicos son de gran importancia para realizar un diagnóstico y establecer un pronóstico oportuno. Estos aspectos y otros relacionados con el tema como son: la clínica, el protocolo a seguir, el tratamiento y la prevención, son tratados en este capí- tulo. El tema Desprendimiento de placenta es desarrollado a lo largo del tema seis (6). Su contenido aborda los aspectos importes como los factores de riesgo, etiología, síntomas y signos, diagnóstico y tratamiento de esta complicación cuyo proceso se caracteriza por el desprendimiento total o parcial, antes del parto, de una placenta que esta insertada en su sitio normal. Este hecho que puede traer grandes consecuencias para el feto y para la madre, puede ocurrir en cualquier momento del embarazo. Los desprendimientos producidos antes de las 20 semanas, por su evolución, deberán ser tratados como abortos. Los que tienen lugar después de la semana 20 de gestación y antes del alumbramiento constituyen el cuadro conocido como desprendimiento prematuro de la placenta normalmente insertada. (abrptio plantae o accidente de Baudelocque). El pro- ceso ha tenido una variedad de denominaciones a lo largo del tiempo y son consecuencia de la diversidad de cuadros clínicos que pueden producirse, sien- do las más empleadas en la actualidad: abruptio placentae, ablatio placentae, desprendimiento prematuro de placenta normalmente inserta (DPPNI), junto con el término abreviado desprendimiento prematuro de placenta (DPP). Para hablar de otra importante complicación que aqueja a la gestante y su bebe por nacer se expone en el tema (7) relacionado con las Infecciones de vías urinarias en embarazadas. Los particulares cambios morfológicos y funcio- nales que se producen en el tracto urinario de la gestante hacen que la infec- ción del tracto urinario (ITU) sea la segunda patología médica más frecuente del embarazo, por detrás de la anemia. Las 3 entidades de mayor repercusión son: Bacteriuria asintomática (BA) (2-11%), cuya detección y tratamiento son fundamentales durante la gestación, pues se asocia a prematuridad, bajo peso y elevado riesgo de progresión a pielonefritis aguda (PA) y sepsis; la Cistitis aguda (CA) (1,5%) y la Pielonefritis aguda (1-2%), principal causa de ingreso no obstétrico en la gestante, que en el 10 al 20% de los casos supone alguna complicación grave que pone en riesgo la vida materna y la fetal. La Diabetes Gestacional se ubica y desarrolla en el tema ocho (8). Este tipo de diabetes que aparece o se diagnostica durante el embarazo ha aumentado su prevalencia y cobrado gran relevancia epidemiológica en los últimos años. La Diabetes Gestacional (DG) o Diabetes Mellitius Gestacional (DMG) se carac- teriza por una secreción de insulina insuficiente para compensar la resistencia a la hormona, propia del embarazo. Después del parto, los niveles de glucosa sanguínea suelen normalizarse; sin embargo, algunas mujeres desarrollan DM tipo 2 y se asocia con complicaciones graves en la madre y el hijo, incluso años después del nacimiento. La Hipertensión en las Embarazadas, tema tan tratado y controvertido en los últimos años por su significación a nivel de que es la complicación médica 29 GINECOLOGIA - OBSTETRICIA más frecuente de la gestación y ocurre según estudios comprobados en el 7% a 10% de los embarazos y constituye una causa importante de morbimortalidad materna y perinatal. De manera clásica, la HTA en el embarazo ha sido definida como el incremento, durante la gestación, de la presión arterial sistólica (PAS) en 30 mmHg o más y/o la presión arterial diastólica (PAD) en 15 mmHg o más comparado con el promedio de valores previos a la 20va. semana de gestación. Cuando no se conocen valores previos, una lectura de 140/90 mmHg o mayor es considerada como anormal. El tema desarrollado abarca una visión general sobre algunos aspectos relativos a la definición y su clasificación, los factores predisponentes, sintomatología, diagnóstico, tratamiento, etc. Por último, el tema 10 aborda dos alteraciones íntimamente ligadas a la hi- pertensión arterial en el embarazo: la preeclampsia y la eclampsia. Éstas son en ocasiones tratadas como componentes de un mismo síndrome ya que la pree- clampsia es la hipertensión de reciente comienzo con proteinuria después de las 20 semanas de gestación y la eclampsia es la presencia de convulsiones genera- lizadas inexplicables en pacientes con preeclampsia.
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