A series of 10 normal cervix epithelia, 38 condylomas, 17 CIN (cervical intraepithelial neoplasm) I/II (low-grade CIN), 10 CIN III (high-grade CIN), 27 squamous cell carcinomas and 7 adenocarcinomas of the cervix were studied in paraffin-embedded sections for the expression of MHC class I antigens, using antibodies against HLA antigens and the immunoperoxidase technique. A PCR technique was also used to evaluate the presence of HPV-16 DNA. All samples from normal tissue, benign, premalignant and CIN III lesions expressed HLA class I antigens. However, 15% of the invasive carcinomas completely lacked HLA-B and HLA-C antigen expression, 20% presented a heterogeneous pattern and 2 cases lacked HLA-B and HLA-C heavy chain but retained beta 2-microglobulin. MHC class I antigen expression on tumors was compared with clinical-pathological parameters. The absence of expression of HLA class I molecules was significantly associated with the Glanz histoprognostic index of malignancy. HPV-16 sequences were detected in 60% of the condylomas, 88% of the CIN I/II, 80% of the CIN III and 82% of the cervical carcinomas. Eight-six per cent of the tumors expressing HLA class I antigen presented HPV-16, whereas only 40% of the nonexpressing tumors did. Our results lead us to the following conclusions: a) HLA class I losses occurred when the tumor became invasive, and in tumors of a more aggressive histological type; b) The presence of HPV-16 was associated with tumors expressing HLA class I antigens.

We identified 12 additional deaths not included in official registries, for an underregistration of 22.6%, and 68.1% of births did not have a BC. Lack of BC was more frequent if the mother did not speak Spanish, if she did not have Seguro Popular if the birth was attended by a traditional midwife. Conclusions. It is necessary to strengthen the registry of deaths and births in municipalities with very low HDI.

Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01). A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition.

Objetivo. Corregir la mala clasificación y mejorar la calidad de la información sobre la mortalidad materna en México. Material y métodos. A través de los registros clínicos y autopsias verbales, se estudiaron todas las defunciones certificadas como maternas y una selección de defunciones de mujeres en edad fértil, cuyas causas fueron consideradas como sospechosas de encubrir una muerte materna; todas ocurridas durante 2011 en México. Resultados. La búsqueda intencionada y reclasificación de muertes maternas permitió rescatar más de 100 muertes que no habían sido registradas ni codificadas inicialmente como maternas y se ratificaron o rectificaron las causas anotadas en los certificados de defunción. Este procedimiento también permitió reclasificar como muertes maternas 297 defunciones de la base preliminar del Instituto Nacional de Estadística y Geografía. Conclusiones. La Búsqueda Intencionada y Reclasificación de Muertes Maternas es un procedimiento muy útil para mejorar la calidad de la información sobre la mortalidad materna.