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Revista Peruana de Ginecología y Obstetricia

versión On-line ISSN 2304-5132

Rev. peru. ginecol. obstet. vol.67 no.3 Lima jul./sep 2021 

Review Articles

Notes for the history of Obstetrics and Gynecology in Peru

Ricardo Álvarez-Carrasco1 

1. Physician specialist in Clinical Pathology, Departament of Pathology, Instituto Nacional Materno Perinatal, Lima, Peru; Full Member of the Peruvian Medical Association of Clinical Pathology, Pro-Secretary of the Panamerican Academy of History of Medicine


Gynecology and Obstetrics has a history of very ancient roots in Peru, rich in transcendent milestones, thanks to the intelligence, talent and tenacity of numerous doctors who contributed to the formation of the scientific and academic body that today represents an important part of Peruvian medicine. The purpose of this article is to make a synthesis of that interesting and profitable history for the memory of Peruvians in general and of the national medical order in particular.

Key words: Gynecology; Obstetrics; Peru, History of Medicine


The limited space of an article does not allow us to narrate in its entirety such a rich history as that of Obstetrics and Gynecology in Peru, this shortcoming will be compensated with a thorough and documented research on the main events that took place from pre-Columbian times to the present.

1. Pre-Columbian period

The art of Obstetrics is probably one of the oldest among humans; necessity contributed to its creation, humble in the beginning and intimately related to abortion, infections and death, since it was believed that the body of the parturient had been taken by strange spirits as a consequence of the sins committed1.

Information on the practice of obstetrics in ancient Peru has been built based on oral tradition, the persistence of certain ancestral customs and practices2, and the references left by some Spanish chroniclers during the time of the conquest. From those sources it is known that in the pre-Hispanic world the practice of medicine in general and obstetrics in particular, were inseparably related to the particular worldview of the universe that each native people had built, which were fundamentally polytheistic and pantheistic3.

With certain nuances, medicine had a magical-religious nature3, which explains why, since pre-Inca times, pregnant women used to implore the gods of the huacas and the hills for a good delivery, considered the earth as their protector and offered animal sacrifices, the burning of objects and even offered maidens1. When the time came to give birth, the shaman or sorcerer was called to make offerings to the idols of the family, which were placed on the breasts of the laboring woman, who begged for their help, showing great stoicism in the face of physical pain1.

The Inca Garcilaso de la Vega relates the details of childbirth and the great happiness that caused its successful completion, the umbilical cord was cut and kept with great care and the child was made to suck in case of a future indisposition, meanwhile the newborn was washed with cold water and almost immediately the woman returned to her daily work, as if nothing had happened1.

The twin pregnancy was known, called Chuchus or Taquihuahua, whose presence was attributed to a sin of the mother, and the podalic presentation was also described, called Chacpas, in both cases penances and sacrifices were necessary1. The Inca Pachacutec prohibited induced abortion and established severe penalties for those who practiced it1.

2. Colonial Period

The conquest of the Inca Empire by the Spaniards provoked a violent encounter between these two cultures, whose worldview of the universe was diametrically different. However, the use of force made the European perspective prevail in the different spheres of life; everything that came from the original inhabitants was scorned and even proscribed and persecuted, as happened with the pre-Hispanic medical conception, making it inevitable that the knowledge accumulated over centuries, were relegated and considered as simple sorcery or superstitions without any support3.

The training of our physicians took place at the Royal University of San Marcos, officially recognized by the Royal Decree of May 12, 1551, which extolled superficial rhetorical erudition and knowledge of theology rather than anatomy and physiology, which resulted in the discrediting of the medical profession and the consequent proliferation of charlatans throughout the viceroyalty3.

Obstetrics was still seen as a minor branch of medicine, inferior to surgery and phlebotomy4, and there was no formal teaching during the colonial period5, so it was usually left in the hands of women without any instruction and who therefore used to practice it at their own free will, by virtue of which empiricism remained as the "sole sovereign" in the obstetric art6. Valdizán refers that in Lima there were Spanish and Peruvian doctors who satisfactorily practiced the art of obstetrics in the XVIII century, but "they tried to carefully hide everything that could constitute a secret of their professional success"7.

The complications of childbirth and maternal mortality reached chilling levels in the American colonies of Spain, to such an extent that King Charles III provided, in 1781, a Royal Decree establishing the rules to which surgeons should be subject to perform cesarean sections8.

That same year, the priest Francisco Antonio Gonzales de Laguna, theologian, botanist, historian, judge, consultant and qualifier of the Holy Office residing in Lima, published his work Zelo sacerdotal para los niños no nacidos (Priestly zeal for unborn children), where he praised the cesarean section, pointing out the signs of maternal death, which once proven, the surgery should be performed, detailing such procedure9. He also described abortion and the rules to avoid it; he criticized mothers who did not breastfeed their children, considering that it was one of the major causes of infant mortality; and he was the first to mention ectopic pregnancies and the high frequency of uterine cancer9.

In spite of what has been described, there is no evidence that cesarean section was practiced in colonial Peru. One of the few references appeared in the Mercurio Peruano, on December 19, 1794, described a cesarean section performed in Tucumán, viceroyalty of La Plata, on a mother who died as a result of a lightning strike and the child, although born alive, died a few minutes later4,10.

Two articles of obstetric interest had also been published in that journal: Descripción anatómica de un monstruo (1791), which dealt with a neonate "who lacked an entire brain", i.e. a case of anencephaly11, and On a nine months old fetus which was drawn out of a woman by the urine duct in the year 1779 (1792)12.

In 1797, the mulatto from Lima José Manuel Dávalos graduated from the Medical School of Montpellier, France, with the doctoral thesis Las enfermedades reinantes en Lima y su método de curación, in whose chapter IX he described the pathologies of pregnancy and childbirth, dealing with infantile tetanus, eclampsia gravidarum, prophylaxis and management of childbirth, making precise indications on the section of the umbilical cord, the administration of colostrum to the newborn as an effective means for the expulsion of meconium and the rules of hygiene applicable to newborns6, and also recommended that in blenorrhagia, amenorrhea, childbirth and during the period of lochia, the cutting of a vein in the arm should be performed as a therapeutic measure9.

A pathology that due to its frequency and lethality deserved the attention of viceroyalty physicians was breast cancer, called zaratan at that time, and several exuberant and deadly cases were reported, as well as speculation about its origin and even some miraculous cures were described4.

Dr. José Hipólito Unanue y Pavón (b.1755-d.1833) (Figure 1), genuine founder of modern medicine in Peru, achieved the construction and operation of the Anatomical Amphitheater of the Hospital de San Andrés, inaugurated in November 1792, and then the establishment of the Royal College of Medicine and Surgery of San Fernando, in 18083. Unanue introduced Obstetrics in the national medical instruction, by including the course of Anatomical, Surgical and Medical Obstetrics in the first curriculum or Synoptic Chart of San Fernando3.

Figure 1 Doctor José Hipólito Unanue y Pavón (b.1755-d.1833). Image inserted in volume VI of the collection Documentos Literarios del Perú by Manuel Tiburcio Odriozola. Imprenta del Estado, Lima 1874. 

Unfortunately, due to the lack of "a critical mass of professors that would disrupt the old system of teaching and health", this project was never fully implemented and the course was never established13. However, this would not be the last time that Unanue showed his concern for Obstetrics, later on, at the dawn of our independent life, he inspired the foundation of the Maternity Home in Lima.

Meanwhile, the native population, generally isolated from European culture, continued with their ancestral practices regarding pregnancy and childbirth, many of which survive to this day in some communities of our highlands and jungle2.

3. Republican Period

The emancipation of Peru, which occurred after the victory in Ayacucho, on December 9, 1824, did not change the situation of our obstetrics, even tended to worsen by the chaotic scenario that took place after our independence and that extended throughout the first decades of the Republic, due to the First Militarism, a period in which senior army officers fought for power without pause until 1872, ending up ruining the country3.

3.1. XIX Century

The history of the specialty in Peru during the 19th century is dominated by the creation and development of the Maternity Hospital of Lima and the San Fernando School of Medicine, and the establishment of the Chair of Gynecology in that school.

3.1.1. Foundation of the Lima Maternity Home

Unanue achieved his long-standing desire to redeem our Obstetrics, through the promulgation of the decree of October 10, 1826, signed by General Andrés de Santa Cruz, President of the Council of Government, founding the Maternity Home of Lima and its annexed school3. This was one of the last public activities of the wise man from Arica, who that year retired from politics and began a voluntary exile in his haciendas in the valley of Cañete, where he remained until shortly before his death14.

The aforementioned decree established the hiring of Benita Paulina Cadeau de Fessel (b.1792-d.1837), a competent French obstetrician who would be in charge of its direction7; however, the fall of the Bolivarian regime and the exaltation to power of General José de la Mar, made the new ruler issue a new decree, on October 5, 1827, which reiterated the purpose of the device that preceded it7.

Madame Fessel, who had arrived in our country from Mexico in 1826, shortly before the promulgation of the decree inspired by Unanue15, dedicated herself tenaciously to erecting the Maternity Hospital and the school that would be attached to it, at the same time as creating the proper social climate to elevate the art of childbirth from the humble category in which it was cloistered to the rank of scientific subject8; to fulfill this complex task she was assigned an annual income of 3,600 pesos16.

On October 18, 182617 the French matron established a modest birthing clinic in the old Hospital of the Holy Spirit8, a hospital founded in 1573, originally dedicated to the care of sailors and that occupied the extensive lot whose front faced the street of the same name, which in con temporary Lima corresponds to the fifth block of Callao Street3. There they remained until 1830, when they were transferred to the Hospital de Santa María de la Caridad, in the current Plaza del Congreso, beginning the long institutional pilgrimage that lasted for more than half a century3.

In 1836, Mrs. Fessel decided to return to France for health reasons, which was a hard setback for the Maternity and the College, whose direction was entrusted to Dr. Francisco Faustos (b.1770-d.1850), who had been working at the Hospital de Santa María de la Caridad since 181618. In 1841 they were transferred to the nearby Hospital Santa Ana3, where they entered in frank decadence, which was evidenced in the report written on July 15, 1847 by José Manuel Pasquel, at the request of the Sociedad de la Beneficencia de Lima (SBL), in which he affirmed that in practice both had ceased to exist, being necessary to "request and even beg some young women to dedicate themselves to the learning of this interesting art"18.

In view of this terrible situation, that same year, the SBL agreed to establish a new Obstetrics School, which would replace the one that had disappeared, and to clearly delimit the Maternity sector within that hospital19.

3.1.2. Creation of the San Fernando School of Medicine

In August 1821, the Royal College of Medicine and Surgery of San Fernando, by virtue of the order of General José de San Martín, was renamed the College of Independence, with the purpose of eliminating any memory of the Spanish re-gime, since that name was given in homage to King Ferdinand VII. This corporation languished academically to the point that its rector, Dr. José Cayetano Heredia, believed that it was essential to create a different one, from the design of its organization and curriculum to the role it had to play in the development of our medicine.

In 1848, the course of Obstetrics began to be taught at the Colegio de la Independencia, which was put in charge of Dr. Francisco Faustos, who was the first to do so, when such a subject was not yet among the subjects of the curriculum20; exercising this chair until his death in 185021.

In 1851, Heredia chose his best alumni and sent them on scholarships to Paris (France), with the purpose of learning the modern tendencies of medicine and the organization of its teaching, so that upon their return they would be part of the new corporation desired by Heredia, among them was Camilo Segura who was instructed in surgery and obstetrics at the University of the Sorbonne; returning, along with the others, in 185322.

On September 9, 1856, the San Fernando School of Medicine was founded as part of the Universidad Mayor de San Marcos (UNMSM), whose first dean was Heredia, with Segura as the founding professor of the External Clinic and Childbirth course18. Since then, Obstetrics was formally taught to the students of that faculty in the same way as it had been done, since 1826, with the students of the College of Childbirth, now both in charge of Segura3.

3.1.3. Refoundation of the Maternity Hospital of Lima by Dr. Camilo Segura

In 1848, Camilo Segura had been appointed by the SBL as director of the Casa de Maternidad and the Colegio de Partos, which at that time operated inside the Hospital Santa Ana8. Upon his return from Europe in 1853, he took over the direction of both establishments and under his leadership an era of profound innovation in our Obstetrics was consolidated, implementing a set of techniques and measures in accordance with the advances of the time, which substantially reduced maternal and perinatal morbidity and mortality18, particularly puerperal fever, a terrible scourge since ancient times and whose etiology would be defined years later by Louis Pasteur23. This constituted the re-foundation of the Maternity Hospital of Lima, as we know it to this day.

In 1857, the SBL decided to move both entities to the old premises of the Recogimiento de Amparadas, today headquarters of the Escuela Nacional Superior Autónoma de Bellas Artes del Perú, in the sixth block of the jirón Ancash in the Cercado de Lima; there they opened their doors to the public on July 1st of that year20. In that Maternity Hospital, in 1861, the first postmortem cesarean section of our medical annals was performed on an indigenous woman who died during labor, the fetus still showed signs of life, but when it was removed, death was verified3,4. Although the name of the surgeon has not been documented, everything seems to indicate that it was Segura24.

Sadly, that physician died on October 24, 1863, due to a chronic pulmonary ailment that had afflicted him for some time22, being substituted by Dr. José Pro who resigned just the following year. In such circumstances Dr. Rafael Benavides Roa (b.1832-d.1915) was appointed (Figure 2), who on August 8, 1866 would be appointed founding professor of the new chair of named Puerperal and Child Diseases in the Faculty of Medicine of San Fernando25.

Figure 2 Doctor Rafael Benavides Roa (b.1832-d.1915). Photo Eugene Courret Studio, Lima, 1893. 

This famous obstetrician from Lima, who years later would be the maternal grandfather of Ramón Rafael de la Fuente Benavides, better known as Martín Adán3, was able to continue Segura's prolific work, as is supported by various reports and statistics of the time.

In 1885, Dr. Samuel García (b.1846-d.1931) (Figure 3), began to provide care in the "Free Clinic for Pregnant Women" of the Maternity Home, which was the first prenatal control service that existed in our country; this doctor developed this activity with certain irregularity for three decades until 191518. Garcia, during the Pacific War, had enlisted with the rank of captain of the national armies in the Reserve Battalion No. 3626.

Figure 3 Doctor Samuel García (b.1846-d.1931). Unknown photographer. Circa 1900. 

3.1.4. The Chair of Gynecology at the San Fernando Medical School

Gynecology in Peru began to take on a face of its own in the first decades of the Republic. However, its surgical aspect began its true impulse with the advent of anesthetic procedures, which arrived in Peru in 184727, and antisepsis, which began to be practiced in the 1860s28.

A transcendent event occurred on June 12, 1878, when Dr. José Lino Alarco performed the most daring act of his successful career, operating at home on an ovarian cyst, which was our first successful intraperitoneal surgery; the general anesthesia with chloroform was administered by Manuel Odriozola and Tomás Salazar28. The intervention, which lasted a little more than two and a half hours, was concluded leaving the drainage for the removal of the metallic loop that held the ovarian pedicle for several days, as was then the custom28.

Seventeen years later the chair of Gynecology was created, during the regime of Nicolás de Piérola, by the law of December 27, 1895. However, the controversy between the president and his Minister of Instruction prevented him from being appointed professor29.

The whole of 1896 passed without the government making a decision on the matter. However, the problem was unraveled when Dr. Manuel Pablo Olaechea left his position as minister; this settled the controversy in favor of Dr. Tendulio Constantino Carvallo Loli (b.1853-m.1920) (Figure 4), who from the beginning was Piérola's candidate29. The Supreme Resolution of June 19, 1897 named him as founding professor of that chair30.

Figure 4 Doctor Tendulio Constantino Carvallo Loli (b.1853-d.1920). Photo Courret & Cia, Lima, 1904. 

In order for this course to be really profitable, it was necessary to provide it with the appropriate facilities, so the Dean of San Fernando officiated to the SBL requesting the cession of some rooms of the Santa Ana Hospital29. The SBL gave him a room occupied by the "chronic patients" and two adjacent corralitos, which Carvallo visited and projected the indispensable modifications. Thus, on July 22, 1897, he elevated a detailed report to the inspector of that hospital29.

The works had a cost of 2,178 soles. There arose the first great inconvenience, since the SBL only delivered 651 soles, but Carvallo was not willing to be deterred, and gave the salaries of a whole year that corresponded to him as professor of Gynecology, which added up to 1,200 soles29.

The works began in March 1898, and from the first day Carvallo supervised them directly so that they would adhere to what was detailed in his technical report, and once concluded, in July of that year, he sent a detailed report to the dean of San Fernando. The new service was baptized with the name of Nuestra Señora de la Merced29.

The operating room installed there must be considered as the first one in our country that complied with the technical specifications of modern surgery. Before, the conditions in which surgery was performed in our hospitals used to be precarious, which meant a great risk for the health and life of the patients; even many surgeons preferred to operate on their private clientele in the homes of each patient29.

In that precinct, national surgery was revolutionized, particularly gynecological and obstetric surgery, since for the first time all the asepsis procedures known up to that time were applied, instruments were sterilized before each procedure, hand washing was established prior and mandatory to the interventions, and the use of rubber gloves and face masks was general-ized29. Surgeons of the stature of Eduardo Bello Porras, Pablo S. Mimbela and Miguel Cecilio Aljovin were trained there20.

New surgical techniques were also introduced, such as Mickuliz drainage, peritonization, the Doy- en procedure for the removal of uterine fibroids and even a novel method for performing abdominal hysterectomy, which was modified and perfected by Carvallo himself, clearly differentiating it from the so-called American Kelly technique4.

The inaugural lesson took place on August 17, 1898, and the statistics of the first year of work, between August 17, 1898 and the same date of the following year, revealed that a total of forty surgical and medical procedures of the most diverse nature had been performed, although most of them could be considered relatively simple for a current spectator; their results were quite flattering, since thirty-six patients had achieved cure or a significant relief of their ailments, and only the remaining four had died31.

3.1.5. The practice of the specialty in the rest of the country

In the rest of the country, the obstetric art continued to be practiced almost exclusively by midwives, whose empirical skills were extremely heterogeneous, most of them lacking the elementary knowledge to face the complications of pregnancy and childbirth, as well as lacking the most basic hygiene, with serious consequences for the parturient and the newborn.

However, in some of the main cities of the country there were Peruvian and foreign physicians who practiced obstetrics following the scientific guidelines accepted at the time. An emblematic case was the San Juan de Dios Hospital in Arequipa, founded in colonial times and extinguished in 1912, in whose last years of existence doctors Pedro José Ramírez Broussais, an obstetrician trained in Europe, and Benigno Ramírez del Villar, an obstetrician trained in Germany4, worked there.

3.2. 20th Century

The first half of the 20th century was marked by the prolific work of Dr. Enrique Febres Odriozola, who achieved the institutional autonomy of the Lima Maternity Hospital and the founding of the Peruvian Society of Obstetrics and Gynecology (SPOG). In the second half of this century, San Fernando lost its monopoly on medical education, with the appearance of other faculties in which gynecology and obstetrics would be taught at the undergraduate level, and the subsequent implementation of the second specialization, better known as the medical residency.

3.2.1. Enrique Febres Odriozola and the autonomy of the Lima Maternity Hospital

In 1909, Dr. Enrique Febres Odriozola (b.1875-d.1948) (Figure 5), became the head physician of the Lima Maternity Hospital, which at that time continued to function as a service of the Santa Ana Hospital18.

Figure 5 Doctor Enrique Febres Odriozola (b.1875-d.1948). Unknown photographer, 1919. 

In those early years of the 20th century, the definitive steps were taken to establish the cesarean section among us. Curiously enough, this would happen outside that Maternity Hospital: on May 31, 1900, Alberto Barton, then an intern at Santa Ana Hospital and who years later would discover the etiological agent of Carrion's Disease, performed such a procedure on a deceased pregnant woman and extracted a child who survived, this happy result being the first in our medical annals. And almost ten years later, on May 2, 1910, Dr. Belisario Sosa Artola (b.1878-d.1952) (Figure 6) performed the first corporal cesarean section in which the mother and child survived; this operation was performed at the Hospital San Juan de Dios del Callao21.

Figure 6 Doctor Belisario Sosa Artola (b.1878-d.1952), at the old racetrack of San Felipe, Lima. Photographer unknown. 1940s. 

Thanks to Febres' efforts, on November 26, 1915, the SBL approved the financing for substantial improvements in the Maternity Hospital, which was confirmed by the Supreme Resolution of December 23 of that year18. Such works were carried out in 1916, which forced the patients to be transferred to the then Hospicio de San Andrés, the name given to the premises of the extinct hospital of the same name3.

In 1917, the Maternity Hospital had five wards: San Ramón was for patients in labor; San Camilo was for parturients with some pathology or who required surgery; and Santa Filomena, Nuestra Señora del Carmen and Virgen de Lourdes were for uncomplicated parturients18. In October 1921, the SBL appointed Febres as director of the Maternity Hospital, who from that moment on had simultaneous operational, administrative and academic authority, which made it possible to achieve its most cherished desire: institutional autonomy3.

The first step towards this objective was the foundation of the Obstetric Gynecological Institute inside the Maternity Hospital, inaugurated on December 31, 192218, which was a highly specialized entity that would offer its services in exchange for a modest fee, being the first time that an attempt was made to attract pregnant women from all social strata, since historically the establishment served mainly the less favored classes of Lima and its surroundings. Part of the income from this brand new institute would be used to support the Maternity Hospital, which continued to be free of charge3; this contributed to the installation of an Incubator Room in the Maternity Hospital, also inaugurated in 1922, being the first one in our country, which was a true milestone in national neonatology18.

The end of the construction of the Hospital Arzobispo Loayza, at the end of 1924, destined to replace that of Santa Ana, was the propitious occasion for Dr. Febres to negotiate before the SBL the establishment of the Maternidad de Lima as an autonomous organization in the building that would leave the extinguished hospital; as it happened3.

In 1927 there was a serious disagreement between Febres and Lucas León, who was the inspector of the Maternity Hospital, due to the numerous observations made by the latter to the expense account of the establishment, which caused Febres to resign irrevocably from the direction, between the end of that year and the beginning of 1928; this also meant the extinction of the institute that he had founded in 19223.

In this hospital, during the first half of the 20th century, some milestones of the specialty took place, such as the first successful segmental cesarean section in our medical history, performed by Dr. Victor Manuel Bazul Fonseca (December 22, 1937), in a 15 year old teenager and 1.38 meters tall, who later became pregnant again, being tributary of a similar procedure (May 30, 1940)24; the cesarean section of the girl Lina Medina Loza (Figure 7), who was only five years, seven months and twenty-one days old, which made her the youngest mother in the history of the world, being operated by doctors Gerardo Lozada Murillo and Alejandro Bussalleu Herrera, acting as anesthesiologist Dr. Rolando Colareta Landa (May 14, 1939)27; and the first complete exsanguineous transfusion in the national medical annals, which was applied in a neonate suffering from hemolytic disease of the newborn; this procedure was carried out with the collaboration of the blood bank of the Hospital Dos de Mayo (June 19, 1949)3.

Figure 7 Dr. Hipólito Larrabure, director of the Maternidad de Lima, formally hands over Lina Medina Loza and her son Gerardo to Tiburcio Medina Medina and Victoria Loza, leaving the hospital that housed them with great care and affection. Photographer unknown. Friday, April 26, 1940. 

3.2.2. Foundation of the Peruvian Society of Obstetrics and Gynecology

The modern development of obstetrics and gynecology had taken significant steps since the years following the war against Chile (18791883). In spite of this, by the mid 1940's there was no institution that grouped Peruvian physicians of this specialty, until Monday June 30, 1947, when the SPOG (for its acronym in English) was founded in the old premises of the Peruvian Medical Association Daniel Alcides Carrión, with the concurrence of twenty-four physicians24.

The original associates elected Dr. Constantino José Carvallo Alzamora (b.1884-d.1952) (Figure 8) as their founding president24, who was in charge of organizing the nascent SPOG, from the regulatory and administrative point of view, providing it with the institutional stability indispensable for its later development32.

Figure 8 Doctor Constantino José Carvallo Alzamora (b.1884-d.1952). Photograph Soriano, Lima. 1940s. 

In September 1955, the first issue of the journal Gynecology and Obstetrics appeared, whose founding director was Dr. Lucas Molina Navia, who was accompanied by his colleagues Víctor Manuel Bazul Fonseca -associate director-, Roberto Gordillo Delboy -editor-in-chief-, Jorge Ascenzo Cabello, Eduardo Ponce Valdivia and Carlos Castellano -editorial secretaries-33. In 2006, this publication changed its name to Revista Peruana de Ginecología y Obstetricia (The Peruvian Journal of Gynecology and Obstetrics), and its director was Dr. José Pacheco Romero, who has directed it up to the present.

The I Peruvian Congress of Obstetrics and Gynecology, organized by the SPOG like all the others, was held in the city of Lima, between March 15 and 20, 195920 (Figure 9).

Figure 9 Obverse and reverse of the commemorative medal of the I Peruvian Congress of Obstetrics and Gynecology. Lima, March 15-20, 1959. Manufactured at the Italian Society of Metal Articles (SIAM), Lima. 

On June 19, 1998, at the request of SPOG, Ministerial Resolution No. 024-98-SA/DM was issued, signed by Marino Costa Bauer, then Minister of Health, which established June 30 as the Day of Peruvian Gynecology and Obstetrics, in memory of the founding date of this society34.

It was re-registered in the Peruvian Medical College (CMP) by Resolution No. 5366-CNCMP-2008, dated January 7, 2008, assigning it Re-registration Code No. 470630-SM-02 and the date of registration was January 9, 200834. It is a member of the International Federation of Gynecology and Obstetrics (FIGO) and the Latin American Federation of Obstetrics and Gynecology Societies (FLASOG)34. Its institutional headquarters are located at Andrés Aramburú Avenue No. 321, office 4, San Isidro district, in the city of Lima34.

3.2.3. Emergence of new Faculties of Medicine and the introduction of the second specialization in Gynecology and Obstetrics

San Fernando had a monopoly on medical education in Peru from its foundation in 1808 until the mid-twentieth century, except for a brief period in the mid-nineteenth century, when the universities San Agustín de Arequipa (UNSA) and San Antonio Abad del Cusco provided such instruction35.

This ended when the Faculty of Medicine of the UNSA began its academic activities on March 22, 1958, and a few days later, on April 1 of that year, the Faculty of Medicine of the National University of Trujillo (UNT) did the same36,37. In the following decade, medical teaching began at the Universidad San Luis Gonzaga de Ica (1961), the Universidad Privada de Ciencias Médicas y Biológicas, today Universidad Peruana Cayetano Heredia -UPCH- (1962), and the Universidad Nacional Federico Villarreal de Lima -UNFV- (1966)37. In all these faculties and those that appeared later, the undergraduate curricula, without exception, included theoretical and practical courses in gynecology and obstetrics.

Among the first teachers of gynecology at UPCH were Doctors Carlos Muñoz Torcello and Carlos Castellano, both principal professors, who were seconded by Doctors Manuel Chávarri Salas and Luis Pinillos Ganoza, as associates20. Manuel Gonzales del Riego, as main professor, his colleagues Félix Pérez Retes, Noé Ramírez Zapata and René Medina Llerena, as associates, and Manuel Gonzales del Riego Burga, as assistant professor20.

In Peru, the studies to obtain the university degree of specialist were considered since 1928, in the University Statute promulgated by Law No. 6041, a prerogative that was only granted to the Faculties of Medicine and Law of the UNMSM38. In practice, the first one to be established was oncology, under the schooling modality at the National Institute of Neoplastic Diseases (INEN), which began in 195235. San Fernando established anatomic pathology in 1957, and pediatrics and radiology in 195939.

In 1961, this university did the same with the Obstetrics residency, in the former premises of the Hospital Materno Infantil San Bartolomé, located in the ninth block of the jirón Antonio Miro Quesada, today Santa Rosa, in the Barrios Altos of Lima, under the direction of Dr. Abraham Ludmir Grimberg (b.?-m.2017) (Figure 10). As of 1964, this residency became Obstetrics and Gynecology40, thus consolidating the unification of both into a single specialty, a process that had had its first antecedents in the 1920s29.

Figure 10 Doctor Abraham Ludmir Grimberg (b.?-d.2017). Tribute paid to him at the auditorium of the San Fernando School of Medicine. Lima, November 7, 2015. 

In 1968, UPCH started a residency similar to that of San Marcos41. Over the years, residencies in this specialty began to develop in other hospitals in Lima and Callao, and also through other higher education centers, such as the UNFV, San Martin de Porres, and Ricardo Palma; This allowed the development of true schools of gynecology and obstetrics in the corresponding departments and/or services of the Hospital Arzobispo Loayza, Hospital Obrero de Lima -today Hospital Nacional EsSalud Guillermo Almenara Irigoyen (HNGAI)-, Hospital Central del Empleado -today Hospital Nacional EsSalud Edgardo Rebagliati Martins (HNERM)- and Hospital Nacional Daniel Alcides Carrión del Callao, among others.

Unfortunately, with rare exceptions, the historical beginnings of such services have been lost in the mists of time. One of the few exceptions is HNERM, whose Department of Gynecology, Obstetrics and Neonatology was inaugurated on November 3, 1958, although care began the day before. The first euthyroid delivery was attended by Dr. Cesar Burga Lang, the first cesarean section was performed by Dr. Victor Vargas Vicuña, who was the founding head of the Obstetrics service, and the first hysterectomy was performed by Dr. Américo Ballenas, as part of a cesarean section. Initially, this hospital had two Gynecology services, whose founding chiefs were Dr. Victor Vargas Vicuña and Dr. Froilán Villamon Haltenhof.

In the rest of the country, the UNSA and the UNT were the pioneers in the implementation of the second specialty in Gynecology and Obstetrics, which they initially developed in the Honorio Delgado Espinoza and Goyeneche hospitals in Arequipa, and Belén and regional teaching hospital in Trujillo, respectively. Subsequently, this teaching was extended to various cities where there was a School of Medicine and a hospital that met the minimum requirements for this purpose.

In 1974, it had been approved that the second specialization in the country could be done in the schooled and non-schooled form42. In 2019, according to statistics from the Ministry of Health (MINSA), the nationwide deficit of obstetrician-gynecologists was 1,645, the largest of all the medical specialties recognized in the country42; moreover, it was evident that they were concentrated in the large cities, since there was no incentive to work in the socioeconomically depressed areas of the country. Also in 2019, the CMP, through National Council Resolution No. 250-CN-CMP-2019, created the National Registry of Sub-specialties35.

3.2.4. Transcendental events and technological advances

During the 20th century, Peruvian gynecology and obstetrics were nourished by a series of technological advances that usually originated in developed countries, with very few exceptions, which allowed for substantial improvements in the precocity and quality of diagnoses, procedures, therapies and follow-up of various physiological and pathological processes.

Tests for the diagnosis of pregnancy

In 1928 the German gynecologists Selmar Aschheim and Bernhard Zondek developed the first scientific method for the diagnosis of pregnancy, although it was not 100% sensitive and specific43. In 1930, the Americans Maurice Harold Friedman, a researcher in reproductive medicine, and Maxwell Lapham, a gynecologist, devised a new method for such diagnosis, using virgin rabbits44. These tests had a very limited diffusion in our country; one of the few who used them was Dr. Enrique Febres Odriozola35.

In March 1947, Carlos Galli Mainini, an Argentinean endocrinologist, published a description of a method for the early diagnosis of pregnancy45, which used the Atenarium-Hensel bufo (bufo arenarum), a toad native to Argentina and Valle del Cauca, Colombia44. Sometime later, this technique began to be used as a routine assay in our country. Even inside the San Fernando School of Medicine, a male toad nursery was installed for a certain period of time, which was very popular among students and other users35.

In 1956, the Lima Maternity Hospital installed an animal vivarium to routinely perform the biological reaction for the diagnosis of pregnancy, mainly by means of the Galli Mainini technique35.

In the 1960s, the first immunological tests for such diagnosis appeared, and it was not until the following decade that an assay was designed to identify and quantify the beta subunits of chorionic gonadotrophin, which began to be used in the country in the 1980s. Over the years, these laboratory techniques diversified and improved substantially in terms of sensitivity and specificity.

Papanicolaou staining and early diagnosis of cervical cancer

Gynecological cytology began, strictly speaking, in 1943 with George Nicholas Papanicolaou. In the following years, the new method was widely accepted, perfected and disseminated worldwide, significantly modifying the early diagnosis of cervical cancer46. In Peru, this procedure began to be performed in the following decade and tended to become progressively more widespread starting in the 1960s.

In 1971, Gálvez reported that the incidence of this cancer was 59.5 per 100,000 women aged 20 years or more in the city of Lima, being the second most frequent cancer in general and the first among women47. Between 1985 and 1997, the INEN hospital registry reported 13,491 cases of this pathology, which represented an average of 1,124 cases per year; the Cancer Registry of Metropolitan Lima, between 1990 and 1993, found 2,263 cases, which meant an age-standardized rate of 26.15 per 100,000; and in 2000, the International Agency Against Cancer (IARC) calculated the number of new cases of invasive cervical cancer at the national level at 4,101 and 1,213 for Metropolitan Lima48.

Statistics from subsequent years showed that this pathology continued to be a serious public health problem in Peru, despite the simplicity of the Papanicolaou technique, since national coverage was not sufficient, there were not an adequate number of obstetrician-gynecologists to take the samples correctly and there were not enough anatomic pathologists to perform the appropriate reading.

Contraceptive methods

In 1880 the North American Samuel Smith Lungren performed the first bilateral tubal occlusion to achieve definitive sterilization. Since then more than one hundred different techniques have been described49; such procedures would begin to be performed in the country since the 1930s, usually within the operative act of cesarean sections.

Cheap and effective contraceptive methods were scarce in Peru at the beginning of the 20th century; physicians rarely discussed their availability or relevance to people's lives; however, since the early 1880s the use of pessaries and condoms had been recorded among women and men in Lima50. In the early 1920s, Limeños actively used condoms to limit family size, a custom that increased during the recession of the 1930s and beyond; in addition, high multiparity was a factor that increased maternal mortality, the first estimates of which were reported for the period 1947-1952, with 446 women dying per 100,000 live births at the Maternidad de Lima50.

In 1909, the German gynecologist Richard Richter presented the first intrauterine device (IUD), which consisted of a loop of silk thread51; in 1928 his compatriot and colleague Ernst Gräfenberg, showed one made of silver or gold wires rolled up. But it was only in the late 1940s, when the idea of the population explosion came of age, that interest in IUDs reappeared as a possible solution in developing countries50.

In late April 1962, the Population Council, an international non-profit, non-governmental organization that conducts biomedical research on public health, held the first international conference on IUDs in New York, United States of America (USA), This allowed the first IUD to be brought to the country, in this case the Zipper nylon ring50, invented in 1959 by the Chilean physician and physiologist Jaime Zipper, who, in 1967, would devise the copper T49.

In those years, Dr. Carlos Bachmann Sánchez, a doctor at the Lima Maternity Hospital, succeeded, through educational talks, in getting 60% of postpartum or post-abortion women to use an IUD50. In the following years, the aforementioned copper T and the spiral of synthetic material became popular in our country.

In 1928, the Austrian physician Hermann Knauss, and in 1930, the Japanese gynecologist Kyusaku Ogino established that in the menstrual cycle there were some fertile and infertile days and that if sexual relations were avoided on the former, the birth rate could be regulated49. Being the only contraceptive method accepted by the Catholic Church, it acquired great diffusion in Peru before the appearance of oral contraception, although it continues to be used especially by the most religious sectors.

Meanwhile, in 1957, the Food and Drug Administration (FDA) authorized the use of Enovid - a combination of mestranol (150 micrograms) and norethynodrel (10 milligrams) - not as a contraceptive, but as a drug to regulate menstruation; however, on June 23, 1960, the pill received permission to be sold explicitly as an oral contraceptive. Thus, the United States began a revolution that was to have a profound impact on the lives of millions of women around the world, including Peruvian women, ushering in a new era for humanity52.

In 1964, the Peruvian State outlined the first family planning programs, which synergized with the activities of the Peruvian Association for Family Protection (APPF), a private entity founded in 1967 by a group of Peruvian doctors, mostly obstetrician-gynecologists, which became the largest supplier of contraceptives in Peru between the end of that decade and the beginning of the next. However, the government of General Juan Velasco Alvarado deactivated the APPF in 1975, a reminder of how fragile civil society institutions are in any dictatorship50.

Studies on subdermal contraceptives, which create reservoirs of a progestogen, began in 1969. The first were approved in the USA in 198449, and from the following decade they began to be used frequently in our country, being offered initially by the private sector.

In 1985, the first National Population Policy was promulgated, which included the public offer of family planning services through the Obstetric Services of the Peruvian Institute of Social Security (IPSS) in 1986, and of MINSA in 198753. In 1986 and 1991, the I and II Demographic and Family Health Surveys were carried out by the National Institute of Statistics and Informatics (INEI), which, among other things, sought to determine the knowledge and use of available contraceptive methods and to measure changes in fertility regulation during that period54. In the first survey, 88% of the women surveyed were aware of their existence, and in the second, 92.8%; but in 1991, only 57% of those of reproductive age were using any method54.


The high mortality of breast cancer during the first decades of the 20th century was related, in most cases, to diagnosis in advanced stages. In the 1950s, mammography was introduced into clinical practice as a very useful tool for the early diagnosis of this cancer55, Leborgne being the first to describe his technique and the adjustments of the X-ray machine. However, in the 1960s, the protocols described by Egan and Gershon-Cohen are the ones that became widely disseminated56. Mammography was introduced to Peru in the 1970s by Dr. Ladis Delpino Artadi, a medical radiologist, who had learned it from Dr. Jacob Gherson-Cohen in Philadelphia, USA57. The first technique he imported was xeroradiography, which from the 1990s would be progressively replaced by digital mammography.

In 1951, Wild and Neal described the first ultrasound of the mammary gland58 and, in 1963, the English physician Ian Donald presented the first static B-mode ultrasound image of an ovarian cyst. From then on, it became possible to observe the interior of the pelvis in gynecology and the pregnant uterus in obstetrics59. However, it was only in the early 1970s that this method would become relevant, due to the concern for the side effects of X-rays58. Thus, Dr. Elio Quirós Díaz, a radiologist, introduced ultrasound to Peru in 1977; shortly after, Dr. Manuel Mancilla Barbarán, at the Maternity Hospital in Lima, put it to obstetric use3.

In 1991 the first U3D ultrasound equipment appeared in the world; in 1998 it took 25 seconds to store an image and minutes or hours to reconstruct it in 3D; by 2005, the evolution of the software would allow the capture of images in tenths of a second and reconstructions in real time, being able to obtain sequences of up to six images per second, which allows direct observation of the movement, constituting the four-dimensional (4D) modality60.

In obstetrics it significantly improved the diagnosis of facial and palatal cleft, decreasing the rate of false positives; it also increased the detection rate of dysmorphology in the extremities, such as alterations in the number of fingers, musculoskeletal dysplasias and the proportion of body segments60. In gynecology it substantially optimized the diagnosis of multiple uterine and adnexal pathologies60.

Climacteric and menopause

The development of medical science led to a significant increase in the life expectancy of women throughout the 20th century, to the point that in 1990 the world female population over 50 years of age was approximately 470 million61, and thus there was a need to develop the subspecialty of Climacteric and Menopause62.

From the 1970s onwards, specialized services were progressively installed, initially in the main public hospitals in the country, and then in lower-level hospitals and in the private sector, among the pioneers being the Maternidad de Lima, today the Instituto Nacional Materno Perinatal (INMP), the HNGAI and the HNERM, all located in Lima.

The main means of dissemination of this subspecialty was the journal Gynecology and Obstetrics, currently the Peruvian Journal of Gynecology and Obstetrics (Revista Peruana de Ginecología y Obstetricia): in 1955 the first original article on gynecological cancer during the climacteric period -Relation between endometrial hyperplasia and endometrial adenocarcinoma- was published; that same year the first article on the clinical and pathophysiological aspects of the climacteric period -Functioning feminizing ovarian tumors-appeared; four years later, in 1959, the first on hormonal therapy in climacteric and menopause -Contribution to the treatment of dysfunctional metrorrhagia- was published; much later, pioneering research was presented on cardiovascular health and climacteric -Cardiovascular impact of climacteric (1994)- and sexuality and menopause -Sexuality in menopause (1996)-63.

Reproductive Medicine

The pioneer of this subspecialty in Peru was Dr. Jorge Ascenzo Cabello, who after specializing in Buenos Aires, Argentina, began his work at the Central Police Hospital, the Italian Clinic and the Rosalía Lavalle de Morales Macedo Hospital -Hogar de la Madre-. In 1950 he founded the Peruvian Center for Marriage Fertility, dedicated exclusively to the study and treatment of childless couples, but for political reasons during the government of General Juan Velasco Alvarado, he had to change its name to Fertility Institute64.

On July 25, 1978, the birth of Louise Brown, the first human being conceived through in vitro fertilization, was a worldwide milestone65. In Peru, in 1985, the first biomedical team was formed to perform gamete to fallopian tube transfer (GIFT) procedures at the Delgado Clinic in Miraflores, Lima, and by the end of 1989 in vitro fertilization was performed for the first time thanks to a group of Peruvian physicians headed by Dr. Luis Gilberto Noriega Hoces and Dr. Ladislao María Prazak Krofta, both obstetrician-gynecologists at the Instituto de Ginecología y Reproducción in Lima, where the baby girl they named Victoria was conceived and born in August 199065.

In the 1980s, procedures such as oocyte transfer to the fallopian tube (1983), the transfer of both gametes (oocytes mixed and incubated with capacitated sperm) with the intra-fallopian gamete transfer technique (1984), and the transfer of the zygote to the tube (1987) had been developed worldwide66.

In 1993, the first embryo cryopreservation procedures were performed in Peru using a sequential temperature lowering program, and later, in the same decade, the first assisted human reproduction (AHR) procedures were performed with donated oocytes and cryopreserved embryos65. The initial development of the practice was mainly in the private sector, due to the high costs involved.

Fetal Medicine and Surgery

In 1956 the first amniocentesis was performed as a means to evaluate the severity of Rh isoimmunization67; and in 1960 the first cordocentesis was performed as a method to take a fetal blood sample68.

In 1971, Gluck and Kulovich studied the possible causes of neonatal respiratory distress in amniotic fluid obtained by amniocentesis; years later they established the predictive value of the lecithin/sphingomyelin ratio for pulmonary maturity69. In 1974, at Yale University, USA, the first fetal visualization by fetoscopy was performed, initially aimed at direct diagnosis or for obtaining biopsies; it was later applied in fetal surgery69.

On April 26, 1981, Michael Harrison, surgeon at the University of California, San Francisco, USA, performed for the first time in medical history the drainage of an obstructive megacystis, placing a vesicoamniotic catheter, under ultrasound guidance, in one of the fetuses of a dizygotic twin pregnancy; the neonate was born on May 10 and evolved favorably; for this reason, Harrison is recognized as the "Father of Fetal Surgery"69.

On May 7, 1999, the Fetal Medicine Service of the INMP was created, which from the beginning was considered a national reference center, due to the quality of its professional staff and the great variety of pathologies it diagnosed and treated, being among the largest in the country. However, the main advances of this subspecialty in Peru would occur in the first years of the following century.

Acquired Immunodeficiency Virus (HIV) and Obstetrics

The first case of AIDS in Peru was diagnosed in 1983 by Raúl Patrucco Puig, professor and researcher at UPCH; Law No. 25275, enacted on July 24, 1990, made it mandatory for all pregnant women to undergo diagnostic tests for the infection70. The course of this pandemic was significantly modified with the advent of antiretrovirals, whose administration began in Peru in 1996, with the strategy of prevention of vertical transmission, which also recommended the suspension of breastfeeding. In 1999, the Social Health Insurance (EsSalud) introduced highly active antiretroviral treatment (HAART), and then MINSA, through the 2000-2005 CONTRASIDA Plan, introduced it in its facilities, which on May 13, 2004 began providing HAART71.

Despite the years that have passed, it has not been determined exactly why some children of HIV (+) mothers become infected and others do not; however, factors that increase the risk and preventive strategies that decrease the rate of transmission have been identified72. The risk of transmission before or during delivery, without any intervention, is 15-25%; when breastfeeding occurs, the risk increases by 5-20%, raising the total risk to 20-45%; this risk could be reduced to less than 2% with a combination of elective cesarean section, antiretroviral prophylaxis for the pregnant woman and the newborn, and suppression of breastfeeding72.

The risk is also increased by maternal factors (high viral load and low CD4+ cell count), vaginal delivery, and preterm birth72. Breastfeeding has a cumulative risk; the longer the breastfeeding period, the higher the risk of transmission72.

3.3. 21st century

The beginning of the 21st century saw the emergence of numerous technologies and procedures, some substantially improving existing ones and others completely new, many of which were imported into our country and revolutionized the practice of gynecology and obstetrics. However, not all was progress, in the early years of the current century intrusion became more evident, particularly affecting obstetrics.

In June 2006, the Constitutional Court (TC) accepted the action of unconstitutionality filed by the National Council of the CMP against Law No. 28686, which created the College of Obstetricians of Peru for midwives73. This provision violated university autonomy, since it did not take into consideration that the profession of obstetrician already existed as a specialty of the obstetrician-gynecologist, who had belonged to the CMP since its foundation73. This court ruled on January 22, 2007, declaring the lawsuit unfounded, although Justice Gonzales Ojeda issued a single vote in favor of the CMP's request74.

The CMP did not relent in its fight against intrusiveness. Thus in 2016 the Transitory Advisory Committee to Fight Professional Intrusiveness was established as an advisory body to the National Council of the CMP, which would later be-come the National Committee to Fight Intrusiveness, which was organized into subcommittees, one of them being the Obstetrics Committee. Despite the various activities carried out (judicial complaints, informative forums, meetings with the authorities of the health sector and universities, among others), we are still far from putting an end to this harmful practice.

A controversial and singular issue in the evolution of Peruvian contraception was emergency oral contraception (EC), better known as the "morning-after pill" - Levonorgestrel 0.75 mg-whose use as public policy was approved by MINSA under Ministerial Resolution No. 3992001-SA/DM75. However, on October 29, 2004, the NGO Acción de Lucha Anticorrupción (Action for the Fight Against Corruption) filed an amparo lawsuit against MINSA, requesting that it refrain from initiating the distribution of the OEC pill, and from disseminating promotional information, insisting on its alleged abortive effect76.

As a consequence, the Constitutional Court declared this lawsuit well founded, through the sentence of October 22, 2009 (Case No. 20052009-PA/TC), which however did not prevent its sale in pharmacies and private drugstores in the country.

The development of minimally invasive surgery in gynecologic oncology is another contribution of recent years, which includes advanced conventional laparoscopy, robotic surgery, and single-port laparoscopy which, depending on the indications in each case, can be used in endometrial, cervical and ovarian cancer77. INEN is the facility in the country where such procedures have been developed with greater specialty and frequency.

On October 4, 2013, the new premises of the Reproductive Medicine Unit of the INMP was inaugurated, which was the pioneer in the public sector in assisted reproduction procedures of high complexity, counting with modern laboratories of Andrology and Gametes and Embryos, the latter that would work in the operating room, and was able to perform the techniques of INVO, INVOICSI, ICSI, in vitro fertilization and cryopreservation of gametes and embryos3. By virtue of this, in 2019, the first two cases of cryopreserved oocytes were recorded to ensure the fertility of two women carriers of gynecological malignancies.

However, ovodonation, which would allow a woman with ovarian deficiency to conceive through the transfer of an egg from a third party (donor), is currently not permitted according to the provisions of article 7° of the General Health Law (Law 26842)78.

Our fetal surgery also marked several milestones: in 2011, Albinagorta reported an intrauterine thoracentesis of congenital chylothorax; in 2012, Molina reported the first case of fetal surgery performed in Huancayo, which consisted of laser-argon photocoagulation in twins; in 2016, Torres reported the first case of intrauterine blood transfusion in a sacrococcygeal teratoma; that same year Ventura published four cases of fetoscopy and selective bipolar coagulation in monochorionic twins with reverse arterial perfusion syndrome (TRAP); in 2017, Ventura reported the first case of open surgery in meningococele, which involved the collaboration of a surgical team from Chile; and in 2018, Ventura reported three cases of pulmonary cystic adenomatoid cystic malformation, macrocystic variety, subjected to intrauterine therapy with thoracoamniotic shunt69.

Since 2015, MINSA introduced the vaccine against human papillomavirus (HPV) in the National Vaccination Schedule, as a preventive for cervical cancer, to be applied in girls in the fifth grade of primary school or 10 years old in case they are not in school79.

On December 31, 2019, the announcement of the first case of pneumonia caused by a new coronavirus (SARS-CoV-2) was made in the city of Wuhan, Hubei Province, People's China; since then, cases spread rapidly worldwide; on March 13, 2020, the World Health Organization (WHO) recognized it as a pandemic80.

In Peru, as in much of the world, this phenomenon constituted a formidable challenge for physicians in the specialty; most of those infected evolved in a mild form and in pregnant women the severe form constituted less than 10% and less than 2% were admitted to intensive care units (ICU). When the disease occurred in the third trimester, there was a high percentage of prematurity and a higher frequency of premature rupture of membranes. However, vertical transmission was not conclusively demonstrated and infections in newborns appeared to occur by horizontal transmission80.

This pandemic contributed to the increase in maternal mortality in Peru; although pre-pandemic trajectories could recover once extensive vaccination has been carried out. However, our health system requires urgent reengineering to guarantee access to services for those who require care81. One aspect that developed as a result of the pandemic was telemedicine and teleworking, the growth of which will continue even after the Covid-19 problem is resolved.


We have reached the end of these brief notes on the history of Gynecology and Obstetrics in Peru, which have made it possible to travel through several centuries, numerous facts, characters and places, whose memory should be imperishable for current and future generations of the Peruvian medical order. Certainly not all topics have been covered and exhausted, being the main purpose of this article to stimulate the interest of physicians and historians, so that in the future they continue to deepen in this exciting and substantial history.


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6The author declares not to have any relationship, condition or circumstance that may reduce objectivity in the interpretation of the article; which may be economic or institutional (consultancies, scholarships, travel payments, per diems, etc.)

7The author guarantees that the material contained in this article has not been previously published or submitted to another biomedical journal.

8Cite as: Álvarez-Carrasco R. Notes for the history of Obstetrics and Gynecology in Peru. Rev Peru Ginecol Obstet. 2021;67(3). DOI: https://doi. org/10.31403/rpgo.v67i2333

Received: June 01, 2021; Accepted: June 13, 2021

Corresponding author: Ricardo Álvarez-Carrasco , Jirón Junín N° 238, departamento 505, Magdalena del Mar, Lima 950 - 830526,

Conflict of interest due to financial support, material or services obtained from commercial organizations

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