RESUMEN
INTRODUCTION: Most of the pregnant women do not achieve the recommended dietary intake of vitamins A and E. These vitamins may counteract oxidative stress involved in some adverse perinatal outcomes. We aimed to assess the associations between maternal vitamin A and E at mid-pregnancy with both maternal and fetal outcomes and to identify possible early biomarkers during pregnancy to predict and prevent oxidative stress in the offspring. METHODS: Data on dietary and serum levels of vitamins A and E were collected from 544 pregnant women from the Nutrition in Early Life and Asthma (NELA) study, a prospective mother-child cohort set up in Spain. RESULTS: There were large discrepancies between low dietary vitamin E intake (78% of the mothers) and low serum vitamin E levels (3%) at 24 weeks of gestation. Maternal serum vitamins A and E at mid-pregnancy were associated with higher antioxidant status not only in the mother at this time point (lower hydroperoxides and higher total antioxidant activity [TAA]) but also with the newborn at birth (higher TAA). Gestational diabetes mellitus (GDM) was negatively associated with maternal serum vitamin A (OR: 0.95 CI: 0.91-0.99, p = 0.009) at mid-pregnancy. Nevertheless, we could not detect any association between GDM and oxidative stress parameters. CONCLUSIONS: In conclusion, maternal vitamin A and E serum levels may be used as an early potential biomarker of antioxidant status of the neonate at birth. Control of these vitamins during pregnancy could help avoid morbid conditions in the newborn caused by oxidative stress in GDM pregnancies.
Asunto(s)
Antioxidantes , Diabetes Gestacional , Recién Nacido , Femenino , Embarazo , Humanos , Vitamina A , Estudios Prospectivos , Sangre Fetal , Vitaminas , Vitamina ERESUMEN
Hydrogels and extracellular vesicle-based therapies have been proposed as emerging therapeutic assets in wound closure. The combination of these elements has given good results in managing chronic and acute wounds. The intrinsic characteristics of the hydrogels in which the extracellular vesicles (EVs) are loaded allow for overcoming barriers, such as the sustained and controlled release of EVs and the maintenance of the pH for their conservation. In addition, EVs can be obtained from different sources and through several isolation methods. However, some barriers must be overcome to transfer this type of therapy to the clinic, for example, the production of hydrogels containing functional EVs and identifying long-term storage conditions for EVs. The aim of this review is to describe the reported EV-based hydrogel combinations, along with the obtained results, and analyze future perspectives.
Asunto(s)
Vesículas Extracelulares , Hidrogeles , Cicatrización de HeridasRESUMEN
BACKGROUND: Hazards of traffic-related air pollution (TRAP) on the developing immune system are poorly understood. We sought to investigate the effects of prenatal exposure to TRAP on cord blood immune cell distributions; and to identify gestational windows of susceptibility. METHODS: In-depth immunophenotyping of cord blood leukocyte and lymphocyte subsets was performed by flow cytometry in 190 newborns embedded in the Nutrition in Early Life and Asthma (NELA) birth cohort (2015-2018). Long-term (whole pregnancy and trimesters) and short-term (15-days before delivery) residential exposures to traffic-related nitrogen dioxide (NO2), particulate matter (PM2.5 and PM10), and ozone (O3) were estimated using dispersion/chemical transport modelling. Associations between TRAP concentrations and cord blood immune cell counts were assessed using multivariate Poisson regression models. RESULTS: Mean number of natural killer (NK) cells decreased 15% in relation to higher NO2 concentrations (≥36.4 µg/m3) during whole pregnancy (incidence relative risk (IRR), 0.85; 95% CI, 0.72, 0.99), with stronger associations in the first trimester. Higher PM2.5 concentrations (≥13.3 µg/m3) during whole pregnancy associated with a reduced mean number of cytotoxic T cells (IRR, 0.88; 95% CI, 0.78, 0.99). Newborns exposed to higher PM10 (≥23.6 µg/m3) and PM2.5 concentrations during the first and third trimester showed greater mean number of helper T type 1 (Th1) cells (P < 0.05). Decreased number of regulatory T (Treg) cells was associated with greater short-term NO2 (IRR, 0.90; 95% CI, 0.80, 1.01) and PM10 (IRR, 0.88; 95% CI, 0.77, 0.99) concentrations. CONCLUSIONS: Prenatal exposure to TRAP, particularly in early and late gestation, impairs fetal immune system development through disturbances in cord blood leukocyte and lymphocyte distributions.
Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Asma , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/análisis , Contaminación del Aire/estadística & datos numéricos , Femenino , Sangre Fetal/química , Humanos , Recién Nacido , Dióxido de Nitrógeno/análisis , Dióxido de Nitrógeno/toxicidad , Material Particulado/análisis , Material Particulado/toxicidad , EmbarazoRESUMEN
BACKGROUND: The conversion from Prograf to Advagraf on a 1:1 (mg:mg) basis has been questioned in light of the publication of studies showing a decrease in tacrolimus blood concentrations after the administration of Advagraf. METHODS: The bioavailability of Prograf and Advagraf was evaluated in an open-label conversion study in 21 stable renal transplant paediatric patients. Serial blood samples for determining tacrolimus levels were collected during a 24-h period before (on Prograf) and after (on Advagraf) conversion. Tacrolimus pharmacokinetic parameters were calculated using a non-compartmental approach and the relative bioavailability calculated. Clinical and analytical data were obtained at 30, 90, 180 and 360 days after study enrolment. RESULTS: The mean ratio and 90 % confidence interval (CI) for peak plasma drug concentration (C(max)) and the area under the time-concentration curve during the first 24 h (AUC(0-24)) were 81.54 (95 % CI 71.6-92.87) and 87.19 (95 % CI 79.91-95.13), respectively. Renal glomerular filtration rate remained stable over the course of the follow-up. Two patients presented clinical events unrelated to tacrolimus. Tacrolimus levels decreased in the first month, the dose/level ratio increased between months 1 and 6 and slight dose adjustments were required during the follow-up period. CONCLUSIONS: Our results show that Advagraf bioequivalence cannot be ensured in this population. Significant changes in tacrolimus levels and dose were observed on long-term follow-up.
Asunto(s)
Inmunosupresores/farmacocinética , Trasplante de Riñón , Tacrolimus/farmacocinética , Adolescente , Área Bajo la Curva , Disponibilidad Biológica , Niño , Preescolar , Preparaciones de Acción Retardada , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/sangre , Inmunosupresores/uso terapéutico , Masculino , Tacrolimus/sangre , Tacrolimus/uso terapéuticoRESUMEN
Striated muscle hamartoma (SMH) is an uncommon benign lesion, that is usually congenital, polypoid, and primarily located on the head and neck. The key histopathologic sign is the existence of individualized fascicles of striated muscle affecting the dermis and subcutaneous fat tissue. Here we report the case of a newborn girl with an SMH, who presented with a congenital infiltrated plaque on her chin without any other associations.
Asunto(s)
Hamartoma/patología , Músculo Estriado/patología , Enfermedades de la Piel/patología , Piel/patología , Femenino , Humanos , Recién NacidoRESUMEN
Objective: MSCs and Platelet-Rich Plasma are the main focus in the study of new regenerative treatments aimed to reverse Osteoarthritis (OA). However, extracellular vesicles (EVs) present several advantages to cell-based treatments. Thus, the aim of this study was to compare and evaluate the regenerative potential of MSC-derived EVs (cEVs) and platelet-derived EVs (pEVs) in an OA cartilage rat model. Design: OA in vivo model was established through injection of 6 mg MIA in the rat knee joints. After 14 and 21 days, OA knee joints were treated with 1 × 1010 particles of pEVs or cEVs. At day 28, the animals were sacrificed, plasma was collected to quantify CTX-II and knee joints were excised to be evaluated by Cone Beam Computed Tomography (CBCT). After decalcification, histology was used to determine the OARSI score and to visualize collagen and glycosaminoglycan content. Results: pEVs and cEVs samples did not show significant differences per se but they did in terms of regenerative effects on OA knee joints. pEVs-treated knee joints showed better subchondral bone integrity in CT-analysed parameters when compared to cEVs or OA group, showing similar values to the healthy control group. Moreover, OARSI score indicated that pEVs showed a greater OA reversion in knee joints, especially in female rats, and so indicated the analysed histological images. Conclusions: pEVs are proposed as a viable regeneration treatment for OA since they are not only capable of exerting their regenerative potential on osteoarthritic cartilage, but also outperform cEVs in terms of efficacy, particularly in females. Significance statement: Osteoarthritis (OA) is one of the most age-related diseases. It is estimated that 500 million people suffer from OA worldwide, representing the principal cause of chronic disability in adults. In the present study we evaluated the therapeutic effect of extracellular vesicles (EVs) from different sources (platelet lysate and human umbilical cord mesenchymal stromal cells) in an in vivo rat model. Our results demonstrate that platelet-derived EVs (pEVs) induce an OA reversion in knee joints, thus evidencing the therapeutic potential of pEVs as cell-free regenerative agents for OA treatment. The translational potential of this article: Platelet-derived extracellular vesicles (pEVs) offer a promising cell-free therapy option for OA treatment. Their production could be easily standardized and reproduced without extensive platelet harvesting and amplification, thus paving the way for their clinical translation.
RESUMEN
INTRODUCTION: Freedom of movement has been identified as a key issue for pregnant individuals during the birthing process, even if they opt for epidural analgesia, which has relegated people to more static positions during birth for many years. The aims of this systematic review were to evaluate the influence of mobility and positional changes on perinatal and neonatal outcomes in people in labor with epidural analgesia, describe the range of movement interventions used during the first and second stage of labor, and describe the level of motor blockade among people with low-dose epidural analgesia. METHODS: Bibliographic databases (Web of Science, Cochrane, CINAHL) were consulted from December 2020 to January 2021. The articles selected were clinical trials and observational or analytical studies, the subject of which was mobilization during labor in people with epidural analgesia. The outcome measures were mode of birth, duration of labor, and extrauterine adaptation after birth. A narrative synthesis was used to describe the types of movements interventions employed during the stages of labor and the level of motor blockade among people with low-dose epidural analgesia. RESULTS: Ten articles were selected (8 clinical trials, one cross-sectional study, and one quasiexperimental study), with a total sample of 6086 individuals. A meta-analysis showed nonsignificant results between groups for mode of birth (relative risk [RR], 1.00; 95% CI, 0.87-1.14), duration of labor (RR, 1.64; 95% CI, -34.57 to 37.86), and extrauterine adaptation after birth (RR, 0.86; 95% CI, 0.39-1.93). There was heterogeneity among studies in the type of movement interventions used during the first and second stage of labor. DISCUSSION: Although no clear benefit was observed for mobilization in epidural labor, no detrimental effects were found either, so perinatal care providers should encourage mobilization if the laboring person so desires, throughout the entire childbirth process.
Asunto(s)
Analgesia Epidural , Analgesia Obstétrica , Embarazo , Femenino , Recién Nacido , Humanos , Cesárea , Estudios Transversales , Analgesia Obstétrica/métodos , Analgésicos , Segundo Periodo del Trabajo de PartoRESUMEN
BACKGROUND: Published data on kidneys transplanted after resecting small renal cancers during the transplantation surgery are very rare and, to the best of our knowledge, no pediatric cases have been reported in the literature. CASE-DIAGNOSIS/TREATMENT: Our patient was diagnosed with a bilateral Wilms tumor when he was 15 months old. A total bilateral nephrectomy was required to control the disease. Two years later, a human leukocyte antigen (HLA)-identical living-donor transplant from his father was performed. A small mass in the father's left kidney was diagnosed as an angiomyolipoma during the pretransplant donor evaluation. During the surgery, the mass was excised and the kidney implanted. One week later, the pathological study revealed the mass to be a clear cell renal carcinoma. After joint discussion, the urologic and nephrologic teams and the family decided to maintain the transplant, managing the patient with monotherapy based on rapamycin and close ultrasound control. To date, 8 years after transplantation, no signs of malignancy have been detected, and renal function is normal. CONCLUSION: This is the first reported pediatric case of a living-donor graft with a small renal carcinoma excised in the operating room. No malignancy has been observed in 8 years of follow-up.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Trasplante de Riñón , Donadores Vivos , Humanos , Lactante , Masculino , Nefrectomía , Tumor de Wilms/patología , Tumor de Wilms/cirugíaRESUMEN
Background: Although adherence to the Mediterranean and antioxidant-rich diets during pregnancy is suggested to improve maternal-fetal health by reducing oxidative stress, yet there is no study available. Objective: We examined whether maternal dietary patterns in pregnancy impact the biomarkers of oxidative stress in mothers and their offspring. Methods: Study population included 642 mothers and 335 newborns of the "Nutrition in Early Life and Asthma" (NELA) birth cohort. Maternal diet during pregnancy was assessed by a validated food frequency questionnaire and a priori-defined dietary indices (relative Mediterranean Diet [rMED], alternative Mediterranean Diet [aMED], Dietary Approach to Stop Hypertension [DASH], Alternate Healthy Index [AHEI], and AHEI-2010) were calculated. Biomarkers measured were: hydroperoxides, carbonyl groups, and 8-hydroxydeoxyguanosine (8OHdG) determined in maternal blood and newborn cord blood, and urinary maternal and offspring 15-F2t-isoprostane. Multivariate linear regression models were performed. Results: Maternal rMED score was inversely associated with the maternal levels of 8OHdG at mid-pregnancy (beta per 1-point increase = -1.61; 95% CI -2.82, -0.39) and the newborn levels of hydroperoxides (beta per 1-point increase = -4.54; 95% CI -9.32, 0.25). High vs. low maternal rMED score was marginally associated with the decreased levels of 8OHdG in newborns (beta = -9.17; 95% CI -19.9, 1.63; p for trend 0.079). Maternal DASH score tended to be inversely associated with maternal urinary 15-F2t-isoprostane (beta per 1-point increase = -0.69; 95% CI, -1.44, 0.06). High vs. low maternal AHEI score was associated with reduced offspring urinary levels of 15-F2t-isoprostane (beta = -20.2; 95% CI -38.0, -2.46; p for trend 0.026). Conclusion: These results suggest that maternal adherence to healthy dietary patterns during pregnancy may reduce DNA damage and lipid oxidation in mothers and offspring.
RESUMEN
BACKGROUND: Mycophenolate mofetil (MMF) is widely used for immunosuppressive therapy in renal transplantation, but comparative data regarding efficacy and safety in paediatric vs. adult kidney allograft recipients in one and the same study are lacking. METHODS: We therefore performed this subgroup analysis of the FDCC trial, a 12-month, prospective, randomised study, comparing fixed-dose (FD) with concentration-controlled (CC) MMF dosing in paediatric and adult renal transplant recipients. Sixty-two paediatric and 839 adult de novo patients in 19 countries were randomised 1:1 to receive fixed-dose or concentration-controlled MMF therapy in combination with calcineurin inhibitors and corticosteroids. RESULTS: Both patient and allograft survival proved to be excellent in paediatric patients (98.4% and 90.3%) and adults (96.8% and 95.0%). The rates of biopsy-proven acute rejections (BPAR) and treated acute rejection episodes (ARE) were comparable between paediatric (12.9% and 17.7%) and adult patients (15.5% and 20.7%). Transplant function at 12 months post-transplant was similar in paediatric (67.8 ± 45.6 mL/min/1.73 m2;) and adult recipients (64.7 ± 23.3 mL/min/1.73 m2;). Children < 6 years (n = 10) exhibited a numerically higher frequency of leucocytopaenia (20%), diarrhoea (40%) and weight loss (10%) than older children (6-18 years; 5.8%, 28.8% and 1.9%) and adults (16.1%, 24.7% and 1.5%). On the whole, the percentage of patients who experienced adverse events causing interruption of MMF therapy were numerically lower in children (4.8%) than in adults (12.5%). Conclusions. The overall efficacy and tolerability of MMF appear to be comparable between paediatric and adult patients. Further studies are needed to validate these results.
Asunto(s)
Rechazo de Injerto/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Trasplante de Riñón/mortalidad , Ácido Micofenólico/análogos & derivados , Adulto , Niño , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Pronóstico , Factores de Riesgo , Seguridad , Tasa de Supervivencia , Trasplante Homólogo , Adulto JovenRESUMEN
Maternal supplementation of docosahexaenoic acid (DHA) during pregnancy has been recommended due to its role in infant development, but its effect on materno-fetal DHA status is not well established. We evaluated the associations between DHA supplementation in pregnant women with obesity or gestational diabetes mellitus (GDM) and maternal and neonatal DHA status. Serum fatty acids (FA) were analyzed in 641 pregnant women (24 weeks of gestation) and in 345 venous and 166 arterial cord blood samples of participants of the NELA cohort. Obese women (n = 47) presented lower DHA in serum than those lean (n = 397) or overweight (n = 116) before pregnancy. Linoleic acid in arterial cord was elevated in obese women, which indicates lower fetal retention. Maternal DHA supplementation (200 mg/d) during pregnancy was associated with enhanced maternal and fetal DHA levels regardless of pre-pregnancy body mass index (BMI), although higher arterial DHA in overweight women indicated an attenuated response. Maternal DHA supplementation was not associated with cord venous DHA in neonates of mothers with GDM. The cord arteriovenous difference was similar for DHA between GDM and controls. In conclusion, maternal DHA supplementation during pregnancy enhanced fetal DHA status regardless of the pre-pregnancy BMI while GDM may reduce the effect of DHA supplementation in newborns.
Asunto(s)
Diabetes Gestacional/sangre , Suplementos Dietéticos , Ácidos Docosahexaenoicos/análisis , Ácidos Grasos/sangre , Obesidad/sangre , Complicaciones del Embarazo/sangre , Adulto , Índice de Masa Corporal , Femenino , Sangre Fetal/química , Humanos , Recién Nacido , Masculino , Fenómenos Fisiologicos Nutricionales Maternos , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: To examine the dose-response relationship between leisure time physical activity (LTPA) and self-rated health. METHODS: A survey (n=18,058) representative of the population aged 18-64years of Madrid (Spain) conducted between 2000 and 2008. A questionnaire on the frequency and duration of numerous activities was used to assess the total amount, the intensity, and the duration of LTPA. Self-rated health was classified as optimal or sub-optimal (fair/bad/very bad). Analyses were performed using logistic regression. RESULTS: Compared with no LTPA, active people in the lowest quintile for total amount of LTPA showed an odds ratio (OR) of sub-optimal health of 0.69; a linear dose-response relationship (p<0.001) was observed, with the OR gradually decreasing to 0.49 in the highest quintile of LTPA. There was an inverse gradient for LTPA intensity adjusted for energy expenditure, so that the OR of sub-optimal health was 0.69 for light LTPA, 0.60 for moderate, and 0.48 for vigorous (p linear trend <0.001). For the same duration, the frequency of optimal health increases with the intensity of LTPA. CONCLUSIONS: The total amount of LTPA shows a graded and continuous association with better self-rated health. The benefits of LTPA on self-rated health increase with the intensity of the activity.
Asunto(s)
Autoevaluación Diagnóstica , Ejercicio Físico/fisiología , Encuestas Epidemiológicas , Actividades Recreativas , Esfuerzo Físico/fisiología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
Recurrence of focal segmental glomerulosclerosis (FSGS) after renal transplantation can limit graft survival. Despite new immunosuppressive agents, the incidence of recurrence remains relatively high. To identify risk factors for recurrence and efficacy of treatment, we reviewed the outcome of 23 grafts in 16 children with FSGS who had undergone transplantation between 1985 and 2007 at La Paz Children's Hospital. Recurrence was 56.3% after the first transplantation. We did not find significant differences in age at diagnosis, age at transplantation, age at end-stage renal disease (ESRD), progression to ESRD, bilateral nephrectomy of native kidneys prior to transplantation, use of induction therapy or of different immunosuppressive regimens between patients with and without recurrence. Plasmapheresis (PP) was carried out in seven of nine patients who had suffered recurrence, achieving remission in six of them. One patient received high doses of cyclosporin (CsA) and plasmapheresis, attaining remission. Graft survival was lower (P = 0.043) in patients with FSGS than in those with other ESRD etiologies (first year 75% vs 91%; fifth year 44% vs 78%). Recurrence of FSGS limited graft survival (first year 66% vs 85%; third year 20% vs 68%) (P = 0.07). In our experience, PP can be effective in treating FSGS recurrence, although its effect on long-term graft survival seems more limited.
Asunto(s)
Glomeruloesclerosis Focal y Segmentaria/cirugía , Trasplante de Riñón/fisiología , Adolescente , Antiinflamatorios/uso terapéutico , Niño , Preescolar , Ciclosporina/efectos adversos , Ciclosporina/uso terapéutico , Progresión de la Enfermedad , Femenino , Glomeruloesclerosis Focal y Segmentaria/patología , Rechazo de Injerto/epidemiología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/fisiología , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Riñón/patología , Fallo Renal Crónico/cirugía , Masculino , Metilprednisolona/uso terapéutico , Nefrectomía , Plasmaféresis , Proteinuria/epidemiología , Proteinuria/etiología , Recurrencia , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenAsunto(s)
Dermoscopía , Fibroma/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , HumanosRESUMEN
Diffuse mesangial sclerosis (DMS) is a renal disease that usually presents as a nephrotic syndrome. It is characterized by early onset and rapid progression to end-stage renal disease, and can occur as an isolated finding or as part of the Denys-Drash syndrome. The aim of this study was to characterize clinical features and outcomes of DMS in a cohort of children. We retrospectively analyzed all cases of DMS diagnosed in our hospital between 1973 and 2008 and evaluated the progression of the disease in relation to different variables. We studied 14 patients, four with incomplete Denys-Drash syndrome and one with Frasier syndrome. All patients developed renal failure. Eight patients received a renal transplant with no relapse of the disease. Bilateral nephrectomy was performed in nine patients with end-stage renal disease. Seven patients died, with sepsis being the main cause of death. Diffuse mesangial sclerosis must be suspected in a child that presents with early onset proteinuria and/or rapidly progressive renal failure. Karyotype and WT1 gene analysis should be performed because of the predisposition of patients to develop different types of tumors. This nephropathy has a poor prognosis, but the survival rate has improved in the last decade.
Asunto(s)
Mesangio Glomerular/patología , Nefroesclerosis/patología , Síndrome Nefrótico/patología , Insuficiencia Renal/patología , Preescolar , Estudios de Cohortes , Síndrome de Denys-Drash/patología , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Síndrome de Frasier/diagnóstico , Humanos , Lactante , Recién Nacido , Trasplante de Riñón , Masculino , Nefroesclerosis/mortalidad , Nefroesclerosis/cirugía , Síndrome Nefrótico/mortalidad , Síndrome Nefrótico/cirugía , Insuficiencia Renal/mortalidad , Insuficiencia Renal/cirugía , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: The conduction of episiotomy is a questioned practice given the strong scientific evidence on its adverse effects. The study objectives were to know the episiotomy rate and its adaptation to the recommendations of the Ministry of Health, Consumption and Social Welfare and assess the associated factors. METHODS: It has been made a Observational, descriptive and transversal quantitative study, it was carried out in the university clinical hospital arrixaca. Data were collected from deliveries attended between January 1, 2016 and October 30, 2017, obtaining a sample of 10,630 women, registered in the SELENE computer program which is the clinical database of said hospital. To perform the data analysis, were used the SPSS statistical program and an Excel database. At the first level, it was carried out a descriptive analysis of the obstetric variables and, at a second level, the data were compared with the Ministry of Health indicators by means of a comparison of two proportions and the chi-square test. In order to estimate the Effect Size, the Cramer V was used for qualitative variables and the relative risk was calculated for each pair of qualitative variablesas a relative measure of the effect, to determine the strength of association between the variables. RESULTS: The episiotomy rate was 36.5%. When the birth started spontaneously, the percentage was 35.5%, when it was induced 47.2% and stimulated rate was 42.3%. The rate in eutocic deliveries was 20.6% and in instrumented was 95.25%. In primiparas, the episiotomy was 49.64% and in multiparas the conduction was 15.55%. Was observed a tendency of second-degree tears (43.40%), followed by first-degree (35.61%) and third-degree (19.81%) with episiotomy. CONCLUSIONS: The episiotomy rate in our study exceeds current recommendations. The variables associated with the performance of the episiotomy are induced or stimulated delivery, instrumentation and primiparity. There is a significant relationship between the practice of episiotomy and the greater degree of tear.
OBJETIVO: La realización de episiotomías es una práctica cuestionada dada la fuerte evidencia científica existente sobre sus efectos adversos. Los objetivos de este estudio fueron conocer la tasa de episiotomías y su adecuación a las recomendaciones del Ministerio de Sanidad, Consumo y Bienestar Social y valorar los factores asociados. METODOS: Se realizó un estudio cuantitativo observacional, descriptivo y transversal, que fue llevado a cabo en el Hospital Clinico Universitario Arrixaca. Se recogieron datos De los partos atendidos entre el 1 de enero de 2016 y el 30 de octubre de 2017, obteniendo una muestra de 10.630 mujeres, a través del programa informático SELENE, que es la base de datos clínicos de dicho hospital. Para realizar el análisis de datos se utilizó el programa estadístico SPSS y una base de datos Excel. En un primer nivel, se efectuó un análisis descriptivo de las variables obstétricas y, en un segundo nivel, se contrastaron los datos con los indicadores del Ministerio de Sanidad, Consumo y Bienestar Social mediante una comparación de dos proporciones y el test de la ji al cuadrado. Para poder estimar el Tamaño del Efecto se utilizó la V de Cramer para variables cualitativas, y se calculó el riesgo relativo para cada par de variables cualitativas como medida relativa del efecto, para determinar así la fuerza de asociación entre las variables. RESULTADOS: La tasa de episiotomías fue del 36,5%. Cuando el parto comenzó espontáneamente el porcentaje fue del 35,5%; cuando fue inducido, la tasa fue del 47,2% y cuando fue estimulado, el porcentaje fue del 42,3%. La tasa en partos eutócicos fue del 20,6% y en instrumentados fue del 95,25%. En primíparas, la realización de episiotomía fue del 49,64% y en multíparas la realización fue del 15,55%. Se observó una tendencia a desgarros de segundo grado (43,40%), seguidos de primer grado (35,61%) y de tercer grado (19,81%) con episiotomía. CONCLUSIONES: La tasa de episiotomía de nuestro estudio supera las actuales recomendaciones. Las variables asociadas a la realización de la episiotomía son el parto inducido o estimulado, la instrumentación y la primiparidad. Se evidencia una relación significativa entre la práctica de episiotomia y el mayor grado de desgarro.
Asunto(s)
Episiotomía/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Perineo/cirugía , Centros Médicos Académicos , Adulto , Femenino , Hospitales Universitarios , Humanos , Paridad , Embarazo , Riesgo , España , Universidades , Adulto JovenRESUMEN
OBJECTIVES: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). SETTING: 2 university hospitals in south-eastern Spain from April to October 2013. DESIGN: A correlational descriptive study. PARTICIPANTS: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. RESULTS: The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0-4â hours 69/93, >4â hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. CONCLUSIONS: The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model.
Asunto(s)
Parto Obstétrico/psicología , Modelos Organizacionales , Parto/psicología , Satisfacción del Paciente , Atención Perinatal/métodos , Adolescente , Adulto , Analgesia Obstétrica , Parto Obstétrico/métodos , Femenino , Humanos , Trabajo de Parto , Servicios de Salud Materna/normas , Embarazo , España , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: to understand the episiotomy rate and its relationship with various clinical variables. METHOD: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. VARIABLES: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. RESULTS: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. CONCLUSIONS: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.
Asunto(s)
Analgesia Epidural/estadística & datos numéricos , Episiotomía/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Edad Materna , Oxitocina/efectos adversos , Paridad , EmbarazoAsunto(s)
Cabello/patología , Nevo Sebáceo de Jadassohn/patología , Cuero Cabelludo/patología , Biopsia , Femenino , Humanos , Recién NacidoRESUMEN
OBJECTIVE: To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health. METHODS: We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis. RESULTS: The discourses were grouped into four categories related to participants' perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact. CONCLUSIONS: The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning.