RESUMEN
OBJECTIVE: To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS: A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS: We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION: The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.
Asunto(s)
Trabajo de Parto Prematuro , Nacimiento Prematuro , Embarazo , Femenino , Recién Nacido , Humanos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Estudios Retrospectivos , Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Segundo Trimestre del Embarazo , Cuello del Útero/diagnóstico por imagen , Medición de Longitud CervicalRESUMEN
BACKGROUND: Tobacco smoking directly affects the airway, where it triggers a very strong local inflammatory response. OBJECTIVE: To determine the predictors of improvement or worsening of asthma control in asthmatic smokers. METHODS: Observational, prospective, multicenter, single cohort study, carried out in the outpatient pulmonology departments with a follow-up period of 6 months. The treatment was adjusted according to the indications of standard clinical practice. RESULTS: 196 patients were included, with a mean age of 54.64 years.39% of the patients were active smokers. Interpreting an Asthma Control Questionnaire (ACQ) score of ≤ 0.75 as asthma control, this was achieved in 30.2% of the cases. Patients with greater adherence were more likely to improve their asthma symptoms (p < 0.05), defined as a decrease in ACQ of 0.5 points or more at the final visit, while taking concomitant medication was a negative risk factor for improvement (p < 0.001). An eosinophil value >300 was a predictor for achieving control (p < 0.01). Patients treated with fluticasone propionate/formoterol versus those receiving budesonide/formoterol or beclomethasone/formoterol had a lower ACQ score (p < 0.01 and p < 0.01, respectively). CONCLUSION: Asthmatic patients with active tobacco exposure and a higher number of anti-asthma medications are more likely to have poorer control. Correct adherence to treatment is the main intervention to be performed to achieve the control. An eosinophil count greater than 300 was the main predictor for achieving control. Fluticasone propionate/formoterol FP/FORM was associated with a greater likelihood of improving ACQ score.
Asunto(s)
Antiasmáticos , Asma , Humanos , Persona de Mediana Edad , Asma/tratamiento farmacológico , Asma/epidemiología , Asma/inducido químicamente , Budesonida/uso terapéutico , Estudios de Cohortes , Estudios Prospectivos , Etanolaminas/uso terapéutico , Administración por Inhalación , Fumarato de Formoterol/uso terapéutico , Fluticasona/uso terapéutico , Antiasmáticos/uso terapéutico , Combinación de Medicamentos , Fumar/epidemiología , Fumar Tabaco , Androstadienos/uso terapéutico , Broncodilatadores/uso terapéuticoRESUMEN
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