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Introduction. The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective. To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods. We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results. From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions. We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.
Introducción. El nacimiento de bebés prematuros es un problema de salud pública con gran impacto en la morbimortalidad infantil: cerca del 40 % de las muertes de niños menores de cinco años sucede en el primer mes de vida. Objetivo. Identificar la asociación entre los factores sociodemográficos maternos, el parto prematuro y la mortalidad en recién nacidos menores de 37 semanas en Santiago de Cali, 2017-2019. Materiales y métodos. Se hizo un estudio descriptivo transversal. Se evaluaron los registros de la Secretaría de Salud Pública Municipal de Cali. Se calcularon las razones de probabilidad y los intervalos de confianza (95 %) crudos y ajustados mediante el modelo de regresión logística, en tanto que los datos se procesaron en Stata 16 y los casos se georreferenciaron con el programa QGIS. Resultados. Entre el 2017 y el 2019, los nacimientos de bebés prematuros en Cali correspondieron al 11 %. El control prenatal deficiente aumentó 3,13 veces el riesgo de nacer con menos de 32 semanas (OR ajustado = 3,13; IC95% = 2,75-3,56) y, en madres de municipios fuera de la ciudad, 1,27 veces (OR ajustado = 1,27; IC95% = 1,15-1,41). La mortalidad fue de 4,29 por 1.000 nacidos vivos. Nacer con un peso menor de 1.000 g aumentó el riesgo de mortalidad en 3,42 veces (OR = 3,42; IC95% = 2,85-4,12) y, un puntaje Apgar menor de siete a los cinco minutos del nacimiento, en 1,55 veces (OR=1,55; IC95% = 1,23-1,96). Conclusiones. Se encontró que tener menos de tres controles prenatales, la procedencia de la madre fuera de Cali, ser afrodescendiente y el parto por cesárea, estaban asociados significativamente con la prematuridad de menos de 32 semanas. Hubo mayor mortalidad en los recién nacidos con menos de 1.000 gramos al nacer.
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Determinantes Sociales de la Salud , Trabajo de Parto Prematuro , Colombia , Países en DesarrolloRESUMEN
Objective: To assess the relationship between ovarian hyperstimulation syndrome (OHSS) and adverse outcomes using population-based data in the United States. The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders. Methods: This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota. Data were collected regarding pregnancy history, infertility treatment, and pregnancy outcomes. Using the Rochester Epidemiology Project, study subjects were identified from female patients, aged 18 to 49 years, who were diagnosed with infertility from January 2, 1995 to December 1, 2017, and had a pregnancy greater than 20 weeks' gestation. The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients. Chi-squared test, t test, and multivariate logistic models were used where appropriate. Results: Patients with OHSS were more likely to deliver preterm (odds ratio, 2.14; 95% confidence interval, 1.26-3.65; P < 0.01), and their neonates were more likely to be small for gestational age (odds ratio, 4.78; 95% confidence interval, 1.61-14.19; P < 0.01). No significant differences between the groups were observed in any other outcome. Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer (odds ratio, 3.03, 95% confidence interval, 1.20-7.66, P = 0.02). Conclusion: OHSS may lead to preterm birth and small-for-gestational-age neonates, which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.
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PURPOSE: This study aimed to develop and examine the validity and reliability of a self-efficacy scale for preventive health management related to premature labor (PHMSE-PL) for women of childbearing age. METHODS: Instrument development and validation were undertaken in three steps: conceptualization through a literature review and in-depth interviews, item generation and evaluation of content validity, and evaluation of construct validity and reliability. The content validity, factorial structure validity, and internal consistency reliability of the PHMSE-PL were evaluated, and cognitive interviewing was undertaken. Data were analyzed using confirmatory factor analyses, Cronbach's α, and 95% confidence intervals (CIs). RESULTS: The content validity was assessed by experts and was strengthened through cognitive interviews with women of childbearing age. The PHMSE-PL comprised 34 items across five factors. The construct validity of the PHMSE-PL was supported. Cronbach's α for the total scale was .97 (95% CI=.96-.97). CONCLUSION: An evaluation of the psychometric properties of the PHMSE-PL scale found it to be a valid and reliable tool for women of childbearing age. The scale appears to be useful for women of childbearing age to self-assess their preventive health management self-efficacy related to premature labor and for health professionals to evaluate and promote women's preventive health management.
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BACKGROUND: Worldwide, nifedipine and atosiban are the two most commonly used tocolytic agents for the treatment of threatened preterm birth. The aim of this study was to evaluate the effectiveness of nifedipine and atosiban in an individual participant data meta-analysis (IPDMA). METHODS: We investigated the occurrence of adverse neonatal outcomes in women with threatened preterm birth by performing an IPDMA, and sought to identify possible subgroups in which one treatment may be preferred. We searched PubMed, Embase, and Cochrane for trials comparing nifedipine and atosiban for treatment of threatened preterm birth between 240/7 and 340/7 weeks' gestational age. Primary outcome was a composite of perinatal mortality and neonatal morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leucomalacia, necrotising enterocolitis, and sepsis. Secondary outcomes included NICU admission, prolongation of pregnancy and GA at delivery. For studies that did not have the original databases available, metadata was used. This led to a two-stage meta-analysis that combined individual participant data with aggregate metadata. RESULTS: We detected four studies (N = 791 women), of which two provided individual participant data (N = 650 women). The composite neonatal outcome occurred in 58/364 (16%) after nifedipine versus 69/359 (19%) after atosiban (OR 0.76, 95%CI 0.47-1.23). Perinatal death occurred in 14/392 (3.6%) after nifedipine versus 7/380 (1.8%) after atosiban (OR 2.0, 95%CI 0.80-5.1). Nifedipine results in longer prolongation of pregnancy, with a 18 days to delivery compared with 10 days for atosiban (HR 0.83 (96% CI 0.69-0.99)). NICU admission occurred less often after nifedipine (46%) than after atosiban (59%), (OR 0.32, 95%CI 0.14-0.75). The sensitivity analysis revealed no difference in prolongation of pregnancy for 48 hours (OR 1.0, 95% CI 0.73-1.4) or 7 days (OR 1.3, 95% CI 0.85-5.8) between nifedipine and atosiban. There was a non-significant higher neonatal mortality in the nifedipine-exposed group (OR 1.4, 95% CI 0.60-3.4). CONCLUSIONS: In this IPDMA, we found no differences in composite outcome between nifedipine and atosiban in the treatment of threatened preterm birth. However, the non-significant higher mortality after administering nifedipine warrants further investigation of the use of nifedipine as a tocolytic drug. STUDY REGISTRATION: We conducted this study according to a prospectively prepared protocol, registered with PROSPERO (the International Prospective Register of Systematic Reviews) under CRD42016024244.
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Muerte Perinatal , Nacimiento Prematuro , Tocolíticos , Femenino , Humanos , Recién Nacido , Nifedipino/uso terapéutico , Muerte Perinatal/prevención & control , Embarazo , Nacimiento Prematuro/tratamiento farmacológico , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Revisiones Sistemáticas como Asunto , Tocólisis/métodos , Tocolíticos/uso terapéutico , Vasotocina/análogos & derivadosRESUMEN
Objetivo. Establecer la utilidad de los índices de vascularización cervical en la predicción de parto pretérmino inminente. Diseño. Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes. Pacientes con parto pretérmino en los siguientes 7 días (grupo A) y embarazadas con parto pretérmino más allá de los 7 días (grupo B). Métodos. Las embarazadas fueron evaluadas utilizando ecografía transvaginal y seguidas hasta el parto. Principales medidas de resultado. Características generales, índices de vascularización cervical (índice de vascularización, índice de flujo e índice de vascularización / flujo), parto pretérmino inminente y eficacia pronóstica. Resultados. Fueron incluidas 350 pacientes, 75 mujeres presentaron parto pretérmino inminente (grupo A) y 251 pacientes fueron consideradas como controles (grupo B). Las pacientes del grupo A tuvieron valores significativamente más bajos del índice de vascularización e índice de flujo comparado con el grupo B (p = 0,0122 y p < 0,0001, respectivamente). Las pacientes del grupo B presentaron valores significativamente más altos de índice de vascularización / flujo comparadas con las pacientes del grupo A (p = 0,0103). Los tres índices y la combinación de estos no mostraron capacidad de discriminación de parto pretérmino inminente. Conclusiones. Las pacientes con parto pretérmino inminente presentan diferencias significativas en los índices de vascularización comparado con las pacientes que presentan parto pretérmino más allá de los 7 días de la evaluación ecográfica. Sin embargo, no son útiles en la predicción del parto pretérmino inminente.
Objective: To establish the usefulness of cervical vascularization low he in the prediction of impending preterm labor. Design: Case-control study. Institution: "Dr. Urquinaona" Central Hospital, Maracaibo, Venezuela. Participants: Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery beyond 7 days (group B). Methods: Pregnant women were evaluated using transvaginal ultrasound and followed until delivery. Main outcome measures: General characteristics, cervical vascularity low he (vascularity index, low index and vascularity / low index), impending preterm delivery, and prognostic efficacy. Results: A total of 350 patients were included, 75 women presented imminent preterm labor (group A) and 251 patients were considered as controls (group B). Patients in group A had significantly lower values of vascularization index and low index compared to group B (p = 0.0122 and p < 0.0001, respectively). Patients in group B had significantly higher values of vascularization / low index compared to patients in group A (p = 0.0103). The three low he and the combination of these did not show the ability to discriminate imminent preterm labor. Conclusions: Patients with imminent preterm labor showed significant differences in the vascularization low he compared to patients presenting preterm labor beyond 7 days of ultrasound evaluation. However, they are not useful in predicting impending preterm labor.
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Introducción: La amenaza de parto pretérmino es un problema de salud pública mundial y nacional. La prematuridad viene acompañada de complicaciones como inmadurez pulmonar y lesiones del sistema nervioso central, que requieren de tratamiento oportuno.Objetivo: Establecer una comparación objetiva de los resultados del tratamiento de la ame-naza de parto prematuro, mediante el uso de Nifedipina o Atosiban, realizando una revisión teórica actualizada del tema, con el propósito de ofrecer a la comunidad científica, una he-rramienta de consulta, sobre un tema frecuente y de alto riesgo materno fetal.Materiales y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos: Google Scholar, Pubmed, Wiley Online Library, Biomed, Scopus, Medes, Medline, Pro Quest, Gale, Scopus, y ScIELO, Se incluyeron artículos publicados en revistas indexadas de alto impacto, en los últimos 5 años. Se valoró la calidad de los artículos incluidos, utilizando la metodología de Sacket, y el riesgo de sesgo, según la metodología Cochrane. Resultados: Se observó un consenso entre los autores consultados en que no existen dife-rencias significativas en el efecto tocolítico de atosiban y nifedipino Conclusiones:La literatura académica parece coincidir en que la efectividad de atosiban y ni-fedipino como agentes tocolíticos es similar, con ambos medicamentos se consigue prolongar el embarazo con riesgo de parto pretérmino, que es el propósito fundamental de la tocolisis.
Background: The threat of preterm birth is a global and national public health problem. Prematurity is linked to complications such as pulmonary immaturity and central nervous system lesions, which require timely treatment. Objective: To perform an objective comparison of the results of the treatment of the threat of premature delivery, using nifedipine or atosiban, carrying out an updated theoretical review of the subject, to offer the scientific community a tool for research on a frequent subject of high maternal and fetal risk. Materials y Methods: There was a bibliographic search in specialized databases. Articles published in high impact indexed journals in the last 5 years were included. The quality of the articles included was assessed, using the Sacket methodology, and the risk of bias, accor-ding to the Cochrane methodology. Results: There was an agreement among the authors consulted there are no significant differences in the tocolytic effect of atosiban and nifedipine. Conclusions: The academic literature seems to agree that the effectiveness of atosiban and nifedipine as tocolytic agents is similar, with both drugs prolonging pregnancy with the risk of preterm delivery, which is the fundamental purpose of tocolysis.
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Humanos , Femenino , Embarazo , Adolescente , Adulto , Trabajo de Parto Prematuro/tratamiento farmacológico , Complicaciones del Embarazo , EficaciaRESUMEN
Introducción. La progesterona es una hormona que favorece el mantenimiento del embarazo, es la protagonista de la fisiopatología del trabajo de parto pretérmino. De esta manera, se propone realizar una revisión sistemática que permita demostrar la utilidad de la progesterona natural micronizada en la mitigación de los efectos deletéreos del trabajo de parto pretérmino. Metodología. Revisión sistemática en la que se utilizaron los términos "MeSH" y "No MeSH". Se empleó el programa "Publish or Perish" y bases de datos como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus y Google Scholar. Se incluyeron artículos de revisión, meta-análisis, artículos originales (publicaciones preliminares o completas), resúmenes de congresos, seminarios publicados, libros de texto, protocolos hospitalarios regionales y consensos nacionales, en donde cada autor evaluó individualmente cada artículo y aplicó la herramienta CASPE. Resultados. En la literatura no es posible encontrar pautas concisas internacionales sobre el uso de la progesterona micronizada frente a la amenaza de trabajo de parto pretérmino (TPP). En general, para la mitigación del trabajo de parto, según lo analizado por los autores, se recomienda usar progesterona natural micronizada en cápsulas de 100 a 400 mg/día vía oral o 100 a 200 mg cada 12 a 24 horas vía vaginal. Desde la semana 16 hasta la semana 36 de gestación por vía oral y desde la semana 24 a 34 de gestación por vía vaginal. Discusión. El uso de la progesterona micronizada ha demostrado mitigar complicaciones posteriores al trabajo de parto pretérmino, sin embargo, no hay consenso sobre la dosificación y las vías de administración. Sumado a lo anterior, los estudios analizados pueden contener sesgos, por lo que se deja a elección del clínico el uso este medicamento. Conclusiones. La progesterona natural micronizada podría ser empleada para mitigar el trabajo de parto pretérmino según los artículos analizados por los autores a lo largo de la revisión. Sin embargo, se necesitan más estudios para legitimar dicha hipótesis.
Introduction. Progesterone is a hormone that favors maintaining pregnancy. It is the protagonist of the physiopathology of preterm labor. In this sense, a systematic review is proposed to demonstrate the usefulness of natural micronized progesterone in mitigating the harmful effects of preterm labor. Methodology. A systematic review in which the terms "MeSH" and "No MeSH" were used. The "Publish or Perish" program was used, as well as databases, such as: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus, and Google Scholar. Review and meta-analysis articles, original articles (preliminary or complete publications), congress summaries, published seminars, textbooks, regional hospital protocols and national consensuses were included, in which each author individually assessed each article and applied the CASPE tool. Results. It was not possible to find concise international guidelines on using micronized progesterone for the threat of preterm labor (PTL) in literature. According to what the authors analyzed, for the mitigation of labor it is generally recommended the use of natural micronized progesterone in 100 to 400 mg/day capsules orally or 100 to 200 mg every 12 to 24 hours through the vagina. From week 16 to week 36 of pregnancy orally and from week 24 to 34 through the vagina. Discussion. Using micronized progesterone has demonstrated mitigating complications subsequent to preterm labor. However, there is no consensus on dosage and routes of administration. Added to the above, the analyzed studies may contain biases, reason why using this medication is left to the physician's discretion. Conclusions. Natural micronized progesterone can be used to mitigate preterm labor according to the articles the authors analyzed throughout the review. However, more studies are needed to validate this hypothesis.
Introdução. A progesterona é um hormônio que favorece a manutenção da gravidez, é a protagonista da fisiopatologia do parto prematuro. Dessa forma, propõe-se a realização de uma revisão sistemática que permita demonstrar a utilidade da progesterona natural micronizada na mitigação dos efeitos deletérios do trabalho de parto prematuro. Metodologia. Revisão sistemática em que foram utilizados os termos "MeSH" e "NãoMeSH". Foram utilizados o programa "Publish or Perish" e bases de dados como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus e Google Scholar. Foram incluídos artigos de revisão, meta-análises, artigos originais (publicações preliminares ou completas), resumos de congressos, seminários publicados, livros didáticos, protocolos hospitalares regionais e consensos nacionais, onde cada autor avaliou individualmente cada artigo e aplicou a ferramenta CASPE. Resultados. Não é possível encontrar na literatura diretrizes internacionais concisas sobre o uso de progesterona micronizada diante da ameaça de trabalho de parto prematuro (TPP). Em geral, para a mitigação do trabalho de parto, conforme analisado pelos autores, recomenda-se o uso de progesterona natural micronizada em cápsulas de 100 a 400mg/dia por via oral ou 100 a 200mg a cada 12 a 24 horas por via vaginal. Da 16ª à 36ª semana de gestação por via oral e da 24ª à 34ª semana de gestação por via vaginal. Discussão. O uso de progesterona micronizada demonstrou mitigar as complicações após o trabalho de parto prematuro, no entanto, não há consenso sobre a dosagem e as vias de administração. Além do exposto, os estudos analisados podem conter vieses, pelo que cabe ao médico escolher o uso deste medicamento. Conclusões. A progesterona natural micronizada poderia ser utilizada para mitigar o trabalho de parto prematuro de acordo com os artigos analisados pelos autores ao longo da revisão. No entanto, mais estudos são necessários para legitimar essa hipótese.
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Progesterona , Embarazo Gemelar , Caproato de 17 alfa-Hidroxiprogesterona , Revisión Sistemática , Trabajo de Parto PrematuroRESUMEN
Introduction: The majority of pregnant women with a short cervix will deliver at term and, thus, may unnecessarily receive advanced monitoring and treatment. It is still necessary to define more accurately which sub-population of women with a short cervix is at elevated risk for early delivery. Objective: To determine if vaginal microbiome composition influenced the rate of spontaneous preterm birth in women with a short cervical length. Methods: In an exploratory, observational prospective study, vaginal secretions were obtained from 591 women at 2124 week gestation. Vaginal microbiome composition was determined by analyzing the V1V3 region of the bacterial 16S ribosomal RNA gene. Results: Lactobacillus crispatus was numerically dominant in the vagina in 41.7% of subjects, followed by L. iners in 32% and Gardnerella vaginalis in 12%. In women whose cervix was ≤25mm, the sensitivity to predict an spontaneous preterm birth was 11.8%. However, when L. crispatus was not the dominant vaginal bacterium, this sensitivity increased to 81.8%. Similarly, in women with a cervical length ≤30mm, the sensitivity to predict an spontaneous preterm birth increased from 21.7 to 78.3% when L. crispatus was not the dominant vaginal bacterium.In women with a prior spontaneous preterm birth and a cervix ≤25 or ≤30mm, L. crispatus dominance was also associated with a reduced rate of spontaneous preterm birth in the current pregnancy (p<0.001). Conclusion: In pregnant women with a cervix ≤25mm or ≤30mm, the risk for an spontaneous preterm birth is increased if L. crispatus is not dominant in the vagina.
Introdução: A maioria das mulheres grávidas com colo do útero curto dará à luz a termo e, portanto, pode receber desnecessariamente monitoramento e tratamento avançados. Permanece a necessidade de definir com mais precisão qual subpopulação de mulheres com colo do útero curto está em risco elevado de parto prematuro. Objetivo: Determinar se a composição do microbioma vaginal influenciou a taxa de parto prematuro espontâneo em mulheres com colo curto. Métodos: Em um estudo prospectivo exploratório observacional, os conteúdos vaginais foram obtidos de 591 mulheres com 2124 semanas de gestação. A composição do microbioma vaginal foi determinada pela análise da região V1V3 do gene de RNA ribossômico bacteriano 16S. Resultados: Lactobacilluscrispatus foi numericamente dominante na vagina em 41,7% dos indivíduos, seguido por L. iners em 32% e Gardnerella vaginalis em 12%. Em mulheres cujo colo do útero era <25 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo foi de 11,8%. No entanto, quando L. crispatus não era a bactéria vaginal dominante, essa sensibilidade aumentou para 81,8%. Da mesma forma, em mulheres com comprimento cervical <30 mm, a sensibilidade para prever uma taxa de parto prematuro espontâneo aumentou de 21,7 para 78,3% quando L. crispatus não era a bactéria vaginal dominante. Em mulheres com taxa de parto prematuro espontâneo anterior e colo do útero <25 ou <30 mm, a dominância de L. crispatus também foi associada a uma taxa reduzida de taxa de parto prematuro espontâneo na gravidez atual (p<0,001). Conclusão: Em mulheres grávidas com colo do útero <25 ou <30 mm, o risco de parto prematuro espontâneo é aumentado se L. crispatus não for dominante na vagina.
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Humanos , Femenino , Embarazo , Vagina/microbiología , Microbiota , Lactobacillus crispatus , Trabajo de Parto Prematuro , Estudios Prospectivos , Medición de Longitud CervicalRESUMEN
OBJECTIVE: Placental growth factor (PlGF) levels are lower at delivery in pregnancies with preeclampsia or fetuses small for gestational age (SGA). These obstetrical complications are typically mediated by placental dysfunction, most commonly related to the specific placental phenotype termed placental maternal vascular malperfusion (MVM). The objective of this study was to determine the relationship between PlGF levels in the second trimester and the development of placental diseases that underlie adverse perinatal outcomes. METHODS: We performed a secondary analysis of the prospective Placental Health Study in unselected healthy nulliparous women (nâ¯=â¯773). Maternal demographic data, Doppler ultrasound measurements, and plasma PlGF levels at 15 to 18 weeks gestation were analyzed for association with pregnancy outcomes and placental pathology following delivery. RESULTS: Low PlGF levels in the second trimester (<10th percentile; <72 pg/mL) was associated with preterm delivery (<37 weeks; 26% vs. 6%, P < 0.001; unadjusted odds ratio (OR) 5.75, 95% CI 3.2-10.5), reduced mean birth weight (2998 vs. 3320 g, P < 0.001), SGA deliveries (25% vs. 11%, Pâ¯=â¯0.001; OR 2.6, 95% CI 1.5-4.6), and preeclampsia (7% vs. 2%, Pâ¯=â¯0.02; OR 4.3, 95% CI 1.5-12.8) relative to normal PlGF levels (≥10th percentile; ≥72 pg/mL). Low PlGF was associated with lower mean placental weight (447 vs. 471 g, Pâ¯=â¯0.01), aberrant cord insertion (25% vs. 12%, Pâ¯=â¯0.001) and a pathologic diagnosis of MVM (18% vs. 11%, Pâ¯=â¯0.04; OR 1.9, 95% CI 1.01-3.55) but not with other placental pathologies. CONCLUSION: MVM placental pathology and related adverse perinatal outcomes are associated with low PlGF in the early second trimester for healthy nulliparous women.
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Placenta , Preeclampsia , Biomarcadores , Femenino , Humanos , Placenta/diagnóstico por imagen , Factor de Crecimiento Placentario , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Receptor 1 de Factores de Crecimiento Endotelial VascularRESUMEN
INTRODUCTION: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. OBJECTIVE: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. METHODS: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". RESULTS: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. CONCLUSION: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.
INTRODUÇÃO: A ruptura prematura de membranas continua a ser um desafio para os profissionais devido às altas taxas de morbimortalidade materna e neonatal, relacionada principalmente às complicações decorrentes da prematuridade. OBJETIVO: Analisar a produção científica acerca das evidências frente a ruptura prematura de membranas em gestações acima de 28 semanas e abaixo de 34 semanas. MÉTODOS: Revisão integrativa da literatura realizada nas bases de dados Lilacs, SciELO, Medline e Cochrane Library, entre 2014-2018, em português, inglês e espanhol, incluídos artigos originais, disponíveis completos online, com acesso livre, que abordassem a temática do estudo, utilizando os descritores "ruptura prematura de membranas ovulares", "trabalho de parto prematuro" e "complicações na gravidez" combinados por meio dos operadores booleanos "AND" e "OR". RESULTADOS: Foram incluídos 14 estudos, nos quais foi possível evidenciar as principais recomendações frente a ruptura prematura de membranas fetais pré-termo, divididos em seis categorias para discussão, sendo elas: indicações para o manejo expectante e indução do parto, antibioticoterapia profilática, corticosteroides pré-natais, uso de tocoliÌticos, recomendações quanto ao uso de sulfato de magnésio e realização de amniocentese. CONCLUSÃO: O estudo possibilitou identificar que o manejo expectante é a conduta ideal, com monitorização constante da gestante e do feto, além da administração de antibióticos profiláticos e corticosteroides pré-natais, frente a ruptura prematura de membranas em gestações entre 28 e 34 semanas a fim de proporcionar os melhores resultados maternos e perinatais, guiando os profissionais da saúde para uma prática baseada em evidências.
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Humanos , Femenino , Embarazo , Rotura Prematura de Membranas Fetales , Trabajo de Parto Prematuro , Tocólisis , Corticoesteroides , Profilaxis Antibiótica , Espera Vigilante , Amniocentesis , Trabajo de Parto Inducido , Sulfato de MagnesioRESUMEN
OBJECTIVE: The purpose of this study was to assess compliance with fetal fibronectin (fFN) testing recommendations at a single tertiary care perinatal centre. The secondary objective was to identify factors associated with compliance with these recommendations. METHODS: A retrospective cohort study was conducted from January 1, 2016 to December 31, 2016 of all patients who presented to the IWK Health Centre with suspected preterm labour. Inclusion criteria included symptoms of preterm labour prior to 370 weeks gestation, singleton or multiple pregnancy, and established fetal wellbeing. Exclusion criteria included severe fetal anomaly, contraindications to tocolysis, transfer from community hospital, or inadequate documentation. Provider compliance was evaluated to determine: 1) whether the test was performed for appropriate indications according to provincial fFN guidelines; 2) whether fFN results were appropriately being used to inform patient care. Logistic regression was used to determine factors associated with compliance. RESULTS: A total of 528 patients presented with symptoms of preterm labour. The overall compliance with testing recommendations was 76.1%. Compliance for patients who met criteria for fFN testing was 73%, and compliance for those not meeting criteria was 76.4%. Of patients with a negative fFN result, 85.3% were appropriately discharged home without intervention. Gestational age, time of day, and non-obstetrician provider type were found to be associated with compliance. CONCLUSION: Despite regional and national guidelines, this study demonstrates a compliance rate of 76% in our centre, indicating a gap in provider knowledge regarding proper use and interpretation of fFN. Non-obstetrician provider type was associated with decreased compliance.
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Fibronectinas/sangre , Adhesión a Directriz/estadística & datos numéricos , Trabajo de Parto Prematuro/terapia , Nacimiento Prematuro , Canadá , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Auditoría Médica , Trabajo de Parto Prematuro/diagnóstico , Valor Predictivo de las Pruebas , Embarazo , Mejoramiento de la Calidad , Estudios Retrospectivos , Atención Terciaria de SaludRESUMEN
A prematuridade é uma síndrome com múltiplos fatores de risco e cuja causa permanece desconhecida, mas, independentemente da etiologia, a parturição converge para uma via final comum de esvaecimento, dilatação e encurtamento do colo uterino. Do ponto de vista hormonal, o responsável por esse processo é a progesterona. A prevenção de quadros de prematuridade pode basear-se em tratamentos medicamentosos como a administração diária de comprimidos de progesterona; intervenções cirúrgicas para a contenção da cérvice uterina com fios inabsorvíveis mantidos até o termo, a cerclagem cervical; e o pessário cervical, dispositivo de silicone que envolve e inclina o colo uterino, evitando sua abertura. Para propor qualquer intervenção profilática ou terapêutica, a avaliação ultrassonográfica via transvaginal no segundo trimestre gestacional desempenha papel crucial. Apresentamos neste terceiro e último artigo da série sobre parto pré-termo espontâneo as intervenções terapêuticas e o rastreamento do colo uterino.(AU)
Preterm birth is a syndrome with multiple risk factors, with unknown etiology. Parturition converges to a final path with uterine cervix effacement, dilation and shortening and progesterone is the hormone responsible for this process. Preterm birth prevention relies on daily administration of progesterone pills; cerclage as a surgical intervention; or cervical pessary, a vaginal silicone device that enfolds and deflects the cervix, avoiding its opening. To propose any of these interventions it is crucial to evaluate the cervix during the second trimester by transvaginal ultrasound. Here, in the third and last article regarding preterm birth without membrane disruption, we present therapeutic interventions and ultrasound screening.(AU)
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Humanos , Femenino , Embarazo , Recién Nacido , Cuello del Útero/fisiología , Trabajo de Parto Prematuro/cirugía , Trabajo de Parto Prematuro/prevención & control , Trabajo de Parto Prematuro/tratamiento farmacológico , Pesarios , Progesterona/uso terapéutico , Incompetencia del Cuello del Útero , Ultrasonografía Prenatal , Maduración Cervical , Cerclaje Cervical , Medición de Longitud CervicalRESUMEN
O encurtamento do colo uterino é parte da via final comum da parturição seja a termo ou pré-termo. A identificação precoce do comprimento cervical encurtado ao ultrassom transvaginal no segundo trimestre gestacional pode atuar como preditor de risco de prematuridade. Desde a década de 1990, vários estudiosos dedicaram-se a estabelecer parâmetros de referência para as medidas de colo uterino entre 16 e 24 semanas e até hoje o limite mais consensualmente aceito é de 25 mm. Especialistas são favoráveis à triagem universal, mas diretrizes internacionais são controversas quanto à investigação em casos sem antecedente de parto pré-termo, além de diversos estudos apresentarem que há custo-efetividade no rastreamento universal. Neste artigo, discutimos criticamente os parâmetros apresentados por estudos históricos e balizadores de conduta, a custo-efetividade e os guidelines internacionais. Propomos ainda uma reflexão ao pré-natalista, sugerindo a individualização da conduta perante os dados de cada gestante específica.(AU)
Cervical shortening is the final path of parturition, regardless if it is term or preterm. Precocious identification of a shortened cervix by transvaginal ultrasound during the second gestational trimester can act as a risk predictor of prematurity. Since the 1990´s decade, numerous studies established reference ranges for cervical length measurement between 16 to 24 gestational weeks and the most accepted cutoff limit is 25 mm. Experts indicate universal screening, however international guidelines are controversial, even in cases without a history of preterm birth, furthermore, many studies demonstrated cost-effectiveness about the universal screening of cervical length in middle gestation. In this article we discuss historical reference ranges, cost- -effectiveness, and international guidelines. We propose critical thinking and suggest individualized management according to specific characteristics of each patient.(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Incompetencia del Cuello del Útero/diagnóstico por imagen , Medición de Longitud Cervical/métodos , Trabajo de Parto Prematuro/prevención & control , Bases de Datos Bibliográficas , Ultrasonografía Prenatal/métodos , Medición de Riesgo , Embarazo de Alto Riesgo , Maduración Cervical/fisiologíaRESUMEN
OBJECTIVES: To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. OPTIONS: To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. OUTCOMES: Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality. INTENDED USERS: Family physicians, obstetricians, midwives, and other maternal care providers. TARGET POPULATION: Pregnant women with placenta previa or low-lying placenta. EVIDENCE: Medline, PubMed, Embase, and the Cochrane Library were searched from inception to October 2018. Medical Subject Heading (MeSH) terms and key words related to pregnancy, placenta previa, low-lying placenta, antepartum hemorrhage, short cervical length, preterm labour, and cesarean. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS: This guideline has been reviewed by the Maternal-Fetal Medicine and Diagnostic Imaging committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and approved by the SOGC Board of Directors. BENEFITS, HARMS, AND/OR COSTS: Women with placenta previa or low-lying placenta are at increased risk of maternal, fetal and postnatal adverse outcomes that include a potentially incorrect diagnosis and possibly unnecessary hospitalization, restriction of activities, early delivery, or cesarean delivery. Optimization of diagnosis and management protocols has potential to improve maternal, fetal and postnatal outcomes. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Parto Obstétrico , Placenta Previa/diagnóstico por imagen , Placenta Previa/terapia , Complicaciones del Embarazo , Nacimiento Prematuro , Canadá , Cuello del Útero , Cesárea , Femenino , Humanos , Recién Nacido , Trabajo de Parto Prematuro , EmbarazoRESUMEN
OBJECTIVES: To assess the benefits and risks of progesterone therapy for women at increased risk of spontaneous preterm birth (SPB) and to make recommendations for the use of progesterone to reduce the risk of SPB and improve postnatal outcomes. OPTIONS: To administer or withhold progesterone therapy for women deemed to be at high risk of SPB. OUTCOMES: Preterm birth, neonatal morbidity and mortality, and postnatal outcomes including neurodevelopmental outcomes. INTENDED USERS: Maternity care providers, including midwives, family physicians, and obstetricians. TARGET POPULATION: Pregnant women at increased risk of SPB. EVIDENCE: Medline, PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2018 for medical subject heading (MeSH) terms and keywords related to pregnancy, preterm birth, previous preterm birth, short cervix, uterine anomalies, cervical conization, neonatal morbidity and mortality, and postnatal outcomes. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS: This guideline was reviewed by the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and approved by the SOGC Board of Directors. BENEFITS, HARMS, AND/OR COSTS: Therapy with progesterone significantly reduces the risk of SPB in a subpopulation of women at increased risk. Although this therapy entails a cost to the woman in addition to the discomfort associated with its use, no other adverse effects to the mother or the baby have been identified. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
Asunto(s)
Servicios de Salud Materna , Trabajo de Parto Prematuro/prevención & control , Nacimiento Prematuro/prevención & control , Progesterona/administración & dosificación , Administración Intravaginal , Canadá , Medición de Longitud Cervical , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo , Resultado del Embarazo , Progesterona/uso terapéutico , Sociedades MédicasRESUMEN
INTRODUCTION: This study aims to compare the use of qualitative fetal fibronectin, quantitative fetal fibronectin, and placental α-microglobulin-1 in women with symptoms of preterm labor, to evaluate which vaginal biomarker performs the best in clinical practice. MATERIAL AND METHODS: This prospective observational study included women who presented with symptoms of preterm labor at 24+0 to 34+0 weeks of gestation at a large tertiary maternity hospital in Auckland, New Zealand. Women were managed according to hospital guidelines using qualitative fetal fibronectin. Quantitative fetal fibronectin and placental α-microglobulin-1 tests were also taken, with clinicians blinded to the results. Management and delivery outcomes were collected from clinical records. The primary outcome was the rate of antenatal hospital admission. Analysis was performed according to predefined management protocols for each of the tests. RESULTS: A total of 128 women had all three biomarkers tests taken. Spontaneous preterm birth rates were 7/128 (5.5%) ≤34+0 weeks and 20/128 (15.6%) <37+0 weeks of gestation; 5/128 (3.9%) delivered within 7 days of testing. Positive results were recorded in 28 qualitative fetal fibronectin tests, 25 quantitative fetal fibronectin tests with 11 ≥200 ng/mL, and 16 placental α-microglobulin-1 tests. The use of quantitative fetal fibronectin or placental α-microglobulin-1 would have lowered antenatal admission rates: 27/128 (21.1%) for qualitative fetal fibronectin, 11/128 (8.6%) for quantitative fetal fibronectin (admission threshold ≥200 ng/mL), and 15/128 (11.7%) for placental α-microglobulin-1. No additional women with quantitative fetal fibronectin <200 ng/mL delivered within 7 days or missed corticosteroids compared with standard care (qualitative fetal fibronectin); however, an additional 3 cases had a false-negative placental α-microglobulin-1 and clinical care may have been compromised (no antenatal corticosteroids or admission). CONCLUSIONS: The use of quantitative fetal fibronectin (admission threshold ≥200 ng/mL) has the potential to reduce the rate of antenatal admissions for women with symptoms of preterm labor without compromising use of antenatal interventions that improve outcomes for babies born preterm.
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Biomarcadores/metabolismo , Trabajo de Parto Prematuro/diagnóstico , Nacimiento Prematuro/diagnóstico , Vagina/metabolismo , Adulto , alfa-Globulinas/metabolismo , Femenino , Fibronectinas/metabolismo , Humanos , Nueva Zelanda , Valor Predictivo de las Pruebas , Embarazo , Estudios ProspectivosRESUMEN
Resumo Introdução O trabalho de parto pré-termo é uma situação vivenciada por muitas mulheres, sendo que esta condição pode interferir no curso normal da gravidez, impactando na vida da parturiente e de sua família, principalmente nos domínios afetivo, cognitivo e comportamental. Objetivo Compreender os significados da vivência da família durante o trabalho de parto pré-termo. Materiais e Métodos Trata-se de uma pesquisa qualitativa realizada com 23 familiares de mulheres que tiveram trabalho de parto pré-termo, atendidas em dois hospitais públicos de Feira de Santana na Bahia. Os dados foram coletados entre março a julho de 2015 por meio de entrevistas semiestruturadas e submetidos à análise temática. Foi aprovado por comitê de ética na pesquisa. Resultados Após a análise dos dados emergiram quatro categorias: Vivenciando momentos do TPP inicialmente inesperados; Sofrimento durante o trabalho de parto prematuro intra-hospitalar; Demonstração de Fé; Alívio após o parto. Discussão Percebeu-se que a maioria dos familiares demostraram desconhecimento dos sinais e sintomas e, precisaram peregrinar por atendimento hospitalar. Diversos sentimentos são desencadeados como preocupação, angústia, tristeza e nervosismo. A fé foi identificada como o principal mecanismo de suporte. Após o nascimento, as principais emoções identificadas foram alívio e felicidade. Conclusões Diante do contexto investigado, fica claro no estudo um déficit de informações nas redes de saúde, indicando a importância de um atendimento de qualidade e eficiente. Os familiares devem receber suporte dos profissionais de saúde para que possam enfrentar essa situação da melhor forma possível.
Abstract Introduction Preterm Labor is a situation that many women experience. This condition might affect the normal course of pregnancy, impacting the life of the woman in labor and her family, primarily in the emotional, cognitive and behavioral areas. Purpose To understand the meanings of family experiences during preterm labor. Materials and Methods This is a qualitative research carried out with 23 relatives of women who had preterm labor attended at two public hospitals in Feira de Santana in Bahia. Data were collected between March and July 2015 through semi-structured interviews which were subjected to thematic analysis. It was approved by the research ethics committee. Results After analyzing data, four categories were created: Experiencing PL situations that were initially unexpected; suffering during intra-hospital preterm labor; demonstrating faith; relieving after labor. Discussion It was verified that most relatives were not aware of the signs and symptoms and needed to go searching for care provision. Diverse emotions were triggered such as worry, anguish, sadness and nervousness. Faith was identified as the main support strategy. After birth, the main identified emotions were relief and happiness. Conclusions Regarding the researched context, it is clear in the study that there is a lack of information in the health network, which calls the attention on the importance of efficient and quality care. Relatives should receive support from health care professionals to face this situation in the best possible way.
Resumen Introducción El trabajo de parto pretérmino es una situación que muchas mujeres experimentan. Esta condición puede interferir en el curso normal del embarazo, impactando en la vida de la parturienta y de su familia, principalmente en los dominios afectivo, cognitivo y comportamental. Objetivo Entender los significados de la vivencia de la familia durante el trabajo de parto pretérmino. Materiales y Métodos Se trata de un estudio cualitativo realizado con 23 familiares de mujeres que han tenido trabajo de parto pretérmino, atendidas en dos hospitales públicos de Feira de Santana na Bahia. Los datos fueron recolectados entre marzo a julio de 2015 a través de entrevistas semiestructuradas y se sometieron a un análisis temático. Fue aprobado por el comité de ética en la investigación. Resultados Después de analizar los datos surgieron cuatro categorías: Viviendo momentos del TPP inicialmente inesperados; Sufrimiento durante el trabajo de parto prematuro intrahospitalario; Demostración de fe; Alivio después del parto. Discusión Se verificó que la mayoría de los familiares demostraron desconocer los señales y síntomas y que necesitaron peregrinar por la atención hospitalaria. Se desencadenan diversos sentimientos como preocupación, angustia, tristeza y nerviosismo. Se identificó la fe como el principal mecanismo de apoyo. Después del nacimiento, las principales emociones identificadas fueron alivio y felicidad. Conclusiones Frente al contexto investigado, queda claro en el estudio que existe un déficit de información en las redes de salud, lo cual habla de la importancia de una atención eficiente y de calidad. Los familiares deben recibir apoyo de los profesionales de salud para que puedan enfrentar esa situación de la mejor posible.
Asunto(s)
Humanos , Masculino , Femenino , Personal de Salud , Emociones , Relaciones Familiares , Trabajo de Parto PrematuroRESUMEN
El presente artículo resume la guía de práctica clínica (GPC) para la prevención y manejo del parto pretérmino en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 11 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en Pubmed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron 20 recomendaciones (13 fuertes y 7 condicionales), 24 puntos de buena práctica clínica, una recomendación de implementación y un flujograma.
This paper features a summary of the Peruvian Social Security (EsSalud) Clinical Practice Guidelines (CPG) for prevention and management of preterm birth. A specialized group was formed for writing this CPG, which included clinical and methodology specialists, who formulated 11 clinical questions. Systematic searches in PubMed and CPG repositories were performed aiming to answer the questions, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In regular work meetings, the specialized group used the GRADE approach for reviewing the evidence and for developing recommendations. At the end, this CPG formulated twenty recommendations (13 strong and 7 conditional), 24 good clinical practice points, one recommendation for implementation, and a flowchart.
RESUMEN
PURPOSE: The purpose of the study was to identify to identify the nursing needs and stress levels among spouses of women hospitalized with preterm labor, and to determine factors influencing spousal stress. METHODS: Data were collected from 95 spouses of hospitalized pregnant women due to preterm labor at a hospital in Gyeonggi province from June to December of 2016. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression. RESULTS: The mean score of spouses' nursing needs was 3.06±0.42 and stress was 1.85±0.44 out of 4.00. The highest score of nursing needs was 3.37±0.51 in assurance and the highest score for stress was 2.26±0.72 for patient's illness and prognosis. There was a significant positive correlation between stress in spouse and nursing needs (p=.004). Stress was explained by nursing needs (ß=.28) and hospitalization days (ß=.21). CONCLUSIONS: The results of this study suggest that appropriate nursing interventions are required to address the nursing needs at the beginning of hospitalization and to reduce the stress among spouses of hospitalized pregnant women diagnosed with preterm labor.
RESUMEN
PURPOSE: This study aimed to test the mediating effect of uncertainty appraisal and coping style in the relation between uncertainty and anxiety in hospitalized pregnant women diagnosed with preterm labor. METHODS: The participants were 105 pregnant women diagnosed with preterm labor in hospitals in Korea. Data were collected from July to October 2017. The measurements included the Uncertainty in Illness Scale, Uncertainty Appraisal Scale, Coping Style Scale, and State Anxiety Inventory. Data were analyzed using descriptive statistics, an independent t-test, correlation, and multiple regression following the Baron and Kenny method and Sobel test for mediation. RESULTS: The mean score for anxiety was 2.29 out of 4.00 points and for uncertainty it was 2.46 out of 5.00 points. There were significant correlations among uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, problem-focused coping, emotion-focused coping, and anxiety. Uncertainty danger appraisal (ß=.64, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=4.54, p<.001). Uncertainty opportunity appraisal (ß=-.45, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=3.28, p<.001). Emotion-focused coping (ß=-.23, p=.021) had a partial mediating effect in the relation between uncertainty and anxiety (Z=2.02, p=.044). CONCLUSION: Nursing intervention programs focusing on managing uncertainty appraisal and improving emotion-focused coping are highly recommended to decrease anxiety in hospitalized pregnant women diagnosed with preterm labor.