ABSTRACT
La Sociedad Chilena de Obstetricia y Ginecología (SOCHOG) y la Sociedad Chilena de Ultrasonido en Medicina y Biología (SOCHUMB) convocaron a un comité de expertos en el tema de ultrasonido y crecimiento fetal con el fin de proponer utilizar la curva fetal que mejor se adapte a la población chilena. Luego de la discusión, al no contar con curvas chilenas de crecimiento fetal, se concluye proponer que la curva estándar de la Organización Mundial de la Salud (OMS) sería la indicada dada la calidad de su metodología y por ser multicéntrica.
The Chilean Society of Obstetrics and Gynecology (SOCHOG) and the Chilean Society of Ultrasound in Medicine and Biology (SOCHUMB) have convened a committee of experts on the subject of ultrasound and fetal growth in order to propose using the fetal curve that best adapts to the Chilean population. After the discussion, since there are no Chilean fetal growth curves, it is concluded that the World Health Organization (WHO) standard curve would be the one to use given the quality of its methodology and the fact that it is multicentric.
Subject(s)
Humans , Female , Pregnancy , World Health Organization , Ultrasonography, Prenatal/standards , Reference Standards , Chile , Fetal Weight , ConsensusABSTRACT
La Telemedicina constituye una herramienta que permite proporcionar atención médica especializada usando la tecnología de las telecomunicaciones.Entre mayo del 2015 y julio del 2017 se realizaron 1020 atenciones a través de esta modalidad, entre el Hospital Puerto Montt (HPM) y distintos centros de Atención primaria del SS Reloncaví.Se utilizaron dos modalidades de atención: asincrónica y sincrónica con presencia virtual del paciente.Se realizaron 1020 atenciones con una resolución inmediata en el 61,7% de los casos. Esta modalidad de atención implicó un ahorro de 139.412 Km, y por concepto de pasajes de $ 10.675.200 requeridos para el desplazamiento de los pacientes desde su lugar de origen al HPM.En lugares geográficamente distantes, la Telereumatología se convierte en una herramienta fundamental que permite expandir la cobertura de atenciones de salud por especialista, reducir las listas de espera, disminuir los tiempos de traslado y el costo que estos implican.
Telemedicine constitutes a tool that allows to provide specialized medical attention using telecommunications technology.Between May 2015 and July 2017, 1,020 care were carried out through this modality, between the Puerto Montt Hospital (HPM) and different primary care centers of the SS Reloncavi.Two care modalities were used: asynchronous and synchronous with the virtual presence of the patient.1020 visits were performed with immediate resolution in 61.7% of the cases.This care modality implied a saving of 139,412 km, and for the concept of passages of $ 10,675,200 required for the movement of patients from their place of origin to the HPM.In geographically remote places, Telerheumatology becomes a fundamental tool that allows expanding the coverage of health care by specialist, reducing waiting lists, reducing travel times and the cost that these imply.
Subject(s)
Humans , Rheumatic Diseases/diagnosis , Telemedicine/economics , Telemedicine/methods , Rheumatology , Chile , Patient SatisfactionABSTRACT
AIM: Cesarean section rates are increasing worldwide and Robson's classification system allows a practical approach to study this phenomenon. C-section in Chile has been indicated as unexpectedly high, with important variability within the country and payment systems. The aim was to report our data using Robson's system and the evolution of local C-section rate in a public hospital during a 9-year period. METHODS: Retrospective analysis (2005-April 2014), in a metropolitan hospital in Santiago. All deliveries were classified into Robson groups. Time changes were analyzed with Pearson's correlation. P value <0.05 was considered significant. A 'relevance index' (RI) for each group was calculated as 100 × C-S rate × relative contribution. RESULTS: The overall C-section rate increased from 24 to 27% (P < 0.05) in 53 571 deliveries, with a greater increase in groups 1 (nulliparous, single, term cephalic, spontaneous labor), 3 (multiparous, single, no previous C-S, term cephalic, spontaneous labor) and 4 (multiparous, single, no previous C-S, term cephalic, induced or no labor). Despite no increase in Group 5 (women with one or more previous C-S) this group had the highest RI (20.3), which defined priority for intervention over others. CONCLUSION: C-S rate was lower than that reported in other centers from Chile and Latin America. Robson's classification and the RI allowed prioritization. Although increase in groups 1, 3 and 4, group 5 needs attention because of stronger impact on overall C-S rate. This analysis allowed to define how to lower C-S rate in our institution.
Subject(s)
Cesarean Section/statistics & numerical data , Hospitals, Public/statistics & numerical data , Adult , Chile , Female , Humans , Parity , Pregnancy , Retrospective Studies , Young AdultSubject(s)
Humans , Female , Pregnancy , Amniocentesis , Middle Cerebral Artery , Erythroblastosis, Fetal/physiopathology , Erythroblastosis, Fetal , Pregnancy Complications, Hematologic , Ultrasonography, Prenatal , Middle Cerebral Artery/physiopathology , Blood Flow Velocity , Rh Isoimmunization , Risk Assessment , Spectrophotometry , Ultrasonography, Doppler, PulsedABSTRACT
Thoracoamniotic shunting in fetal pleural effusion has poor results, with an overall survival of less than 50% when hydrops is associated. Those cases without hydrops presented the best evolution, but the indication in these cases remains controversial. We present a dichorionic diamniotic twin pregnancy at 29 weeks' with right pleural effusion and hydrops, in which one fetus presented diaphragm inversion and mediastinal shift, both considered as ultrasonographic signs of thoracic hypertension. A thoracoamniotic shunt reversed these signs immediately. Nevertheless, 1 week after, these signs and skin edema reappeared and the effusion increased, leading to a second thoracocenthesis for drainage and intrathoracic pressure measurement. Amniotic fluid and intrathoracic pressures were found at 21 and 39 mm Hg, respectively. A cesarean section was performed and the catheter was found to be obliterated by cellular detritus of leukocytes and fibrin. Our conclusion is that ultrasonographic signs of elevated thoracic pressure are a keystone for the shunt indication, and that this could be corroborated by direct measurements. This can be an important parameter for precise indication of thoracoamniotic shunting.
Subject(s)
Chylothorax/congenital , Chylothorax/surgery , Fetal Diseases/surgery , Fetal Therapies/methods , Amnion/surgery , Chylothorax/diagnostic imaging , Diseases in Twins , Female , Fetal Diseases/diagnostic imaging , Gestational Age , Humans , Infant, Newborn , Male , Pregnancy , Pressure , Thoracic Surgery , UltrasonographyABSTRACT
Se inducen 41 pacientes gestantes, con fetos muertos entre la 24 y 40 semanas de embarazo, mediante la administración extraamniótica de soluciones salinas isotónicas. El éxito fue de 90 por ciento de partos vaginales. Las complicaciones fueron 9,7 por ciento
Subject(s)
Humans , Female , Adolescent , Adult , Abortion, Missed/drug therapy , Labor, Induced , Isotonic Solutions/therapeutic use , Fetal Death , Instillation, Drug , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Isotonic Solutions/administration & dosageABSTRACT
Se presentaun caso clínico con diagnóstico antenatal de síndrome de Potter por agenesia renal bilateral asociado a atresia duodenal secundaria a páncreas anular en un feto portador de síndrome de Down con cariotipo 47 XY-21. Se discute el diagnóstico antenatal, manejo obstétrico y perinatal
