Intervenciones de la matrona ante el miedo al parto / Midwife Interventions to Reduce Fear of Childbirth

Objetivo: Analizar los factores de riesgo que influyen en el desarrollo del miedo y las diferentes intervenciones que puede ofrecer la matrona, e identificar instrumentos de medición del miedo al parto. Metodología: Revisión bibliográfica en PubMed, Biblioteca Virtual de la Salud, Cochrane Library, Dialnet, Cuiden y Medes de los estudios publicados en los últimos 5 años, mediante combinaciones booleanas de palabras clave: «miedo», «parto» y «matrona». Resultados: Han sido seleccionadas 33 referencias bibliográficas basándose en criterios de selección preestablecidos: 9 estudios secundarios, 17 cuantitativos, 4 cualitativos y 3 protocolos. Los resultados se presentan en tres categorías de acuerdo con el objetivo establecido. La nuliparidad, la depresión y el escaso apoyo social son factores de riesgo de la tocofobia, entre otros. Se ha demostrado la eficacia de varias intervenciones para el manejo del miedo al parto: asesoramiento presencial, psicoeducación, educación prenatal, terapia artística, y técnica de libertad emocional (TLE) y técnica de la conciencia respiratoria (TCR). El instrumento más utilizado para medir el miedo al parto es el Wijma Delivery Expectancy Questionnaire (W-DEQ). Conclusiones: Se asocian con la tocofobia factores socieconómicos y obstétricos de la mujer, así como las experiencias previas. Existe una gran variedad de intervenciones para el manejo del miedo al parto que han obtenido resultados positivos en la reducción de este. Además, se ha visto que la continuidad asistencial es el mejor modelo asistencial para reducirlo. La disponibilidad de herramientas que permiten detectar situaciones problemáticas relacionadas con el miedo al parto, las importantes repercusiones que este supone y la existencia de intervenciones que pueden ayudar a su reducción, reclaman la necesidad de valorar sistemáticamente la tocofobia. (AU)

Objectives: Analyze the risk factors that influence the development of fear, the different interventions that the midwife can offer and identify instruments for measuring the fear of childbirth. Methodology: Literature review in PubMed, Virtual Health Library, Cochrane Library, Dialnet, Cuiden and Medes of studies published in the last 5 years using Boolean combinations of keywords: “fear”, “parturition” and “midwife”. Results: Thirty-three bibliographic references were included based on selection criteria. Nulliparity, depression and poor social support are risk factors for tocophobia, among others . Several interventions have been found to be effective in managing fear of childbirth: face-to-face counselling, psychoeducation, prenatal education, art therapy, and Technique of Emotional Freedom (TEF) and Breathing Awareness Technique (BAT). The most widely used instrument to measure fear of childbirth is the Wijma Delivery Expectancy Questionnaire (W-DEQ). Conclusions: Socioeconomic and obstetric factors of women, as well as previous experiences, are associated with tocophobia. There is a wide variety of interventions for the management of fear of delivery that have obtained positive results in the reduction of this. In addition, continuity of care is the best care model to reduce it. The availability of tools to detect problematic situations related to fear of childbirth, the important repercussions that this implies and the existence of interventions that can help to reduce it demand the need to systematically assess tocophobia. (AU)

[Beginnings, evolution and current situation of the Newborn Screening Programs in Spain.] / Inicio, evolución y situación actual de los Programas de Cribado Neonatal en España.

Newborn Screening Programs (NSP) in Spain were born in the city of Granada in 1968. Till the 1980s, they were developed around the so-called "National Plan for Preventing Subnormality", covering up to 30% of the Spanish newborns. From 1982, when the health system management was transferred to the different autonomous regions, the NSP began to expand, and the bases to transform them into an organized and multidisciplinary activity, integrated and coordinated from the National Health System were settled. Despite this expansion, it is not until the 1990s when their coverage reaches almost 100% newborns in Spain. NSP grew up asymmetrically across the different autonomous regions. In 2005 and 2006 the scientific societies SEQC (Spanish Society of Clinical Chemistry) and AECNE (Spanish Society of Newborn Screening), coordinated by the Health Promotion Area of the General Directorate of Public Health, gathered together the necessary information to elaborate a report on the NSP in Spain addressed to the Interterritorial Council of the National Health System. In July 2013, that Council approved the seven diseases that should be part of each region newborn screening panel, being the first step towards the NSP harmonization in Spain. Currently, the NSP include between 8 and 29 diseases in their panels, thus more still more efforts are needed in order to achieve a higher uniformity.

Los Programas de Cribado Neonatal (PCN) nacen en España en Granada en el año 1968. Posteriormente, y hasta los años 80, se fueron desarrollando en torno al llamado "Plan Nacional de Prevención de la Subnormalidad" con una cobertura cercana al 30% de los recién nacidos españoles. A partir de 1982, con el inicio de la gestión de la sanidad a las comunidades autónomas (CCAA), los PCN se expandieron y se comenzaron a sentar las bases para que éstos se convirtieran en una actividad organizada y multidisciplinar, integrados y coordinados desde el Sistema de Salud. A pesar de dicha expansión no es hasta el inicio de la década de los 90 cuando se consigue una cobertura próxima al 100% de los RN en España. Los PCN fueron creciendo de forma muy asimétrica en las diferentes CCAA y en los años 2005 y 2006 las Sociedades Científicas SEQC (Sociedad Española de Química Clínica) y AECNE (Asociación Española de Cribado Neonatal), con la coordinación del Área de Promoción de la Salud de la Dirección General de Salud Pública, recopilaron la información y elaboraron un informe, sobre los PCN en España para el Consejo Interterritorial del sistema Nacional de Salud (CISNS). En julio de 2013 este Consejo aprobó las siete enfermedades que debían formar parte del panel de detección de los PCN territoriales, primer paso hacia la armonización de estos programas. Actualmente, los PCN incluyen entre 8 y 29 enfermedades por lo que es necesario seguir trabajando para conseguir una mayor uniformidad.

Labor estimation by informational objective assessment (LEIOA) for preterm delivery prediction.

PURPOSE: To introduce LEIOA, a new screening method to forecast which patients admitted to the hospital because of suspected threatened premature delivery will give birth in < 7 days, so that it can be used to assist in the prognosis and treatment jointly with other clinical tools. METHODS: From 2010 to 2013, 286 tocographies from women with gestational ages comprehended between 24 and 37 weeks were collected and studied. Then, we developed a new predictive model based on uterine contractions which combine the Generalized Hurst Exponent and the Approximate Entropy by logistic regression (LEIOA model). We compared it with a model using exclusively obstetric variables, and afterwards, we joined both to evaluate the gain. Finally, a cross validation was performed. RESULTS: The combination of LEIOA with the medical model resulted in an increase (in average) of predictive values of 12% with respect to the medical model alone, giving a sensitivity of 0.937, a specificity of 0.747, a positive predictive value of 0.907 and a negative predictive value of 0.819. Besides, adding LEIOA reduced the percentage of incorrectly classified cases by the medical model by almost 50%. CONCLUSIONS: Due to the significant increase in predictive parameters and the reduction of incorrectly classified cases when LEIOA was combined with the medical variables, we conclude that it could be a very useful tool to improve the estimation of the immediacy of preterm delivery.

Estimation of preterm labor immediacy by nonlinear methods.

Preterm delivery affects about one tenth of human births and is associated with an increased perinatal morbimortality as well as with remarkable costs. Even if there are a number of predictors and markers of preterm delivery, none of them has a high accuracy. In order to find quantitative indicators of the immediacy of labor, 142 cardiotocographies (CTG) recorded from women consulting because of suspected threatened premature delivery with gestational ages comprehended between 24 and 35 weeks were collected and analyzed. These 142 samples were divided into two groups: the delayed labor group (n = 75), formed by the women who delivered more than seven days after the tocography was performed, and the anticipated labor group (n = 67), which corresponded to the women whose labor took place during the seven days following the recording. As a means of finding significant differences between the two groups, some key informational properties were analyzed by applying nonlinear techniques on the tocography recordings. Both the regularity and the persistence levels of the delayed labor group, which were measured by Approximate Entropy (ApEn) and Generalized Hurst Exponent (GHE) respectively, were found to be significantly different from the anticipated labor group. As delivery approached, the values of ApEn tended to increase while the values of GHE tended to decrease, suggesting that these two methods are sensitive to labor immediacy. On this paper, for the first time, we have been able to estimate childbirth immediacy by applying nonlinear methods on tocographies. We propose the use of the techniques herein described as new quantitative diagnosis tools for premature birth that significantly improve the current protocols for preterm labor prediction worldwide.

Catatonia: a propósito de un caso / Catatonia: a case study

Presentamos un cuadro clínico de mutismo, acinesia y estupor con fiebre y retención urinaria en una mujer de 65 años como ejemplo de catatonia. La sintomatología catatónica se ha establecido como un síndrome común a múltiples etiologías tanto médicas como psiquiátricas. Además se han descrito factores precipitantes de tipo farmacológico, tóxico y orgánico para esta entidad. Por tanto, es necesaria una aproximación multidisciplinar a este tipo de cuadros para afinar el diagnóstico etiológico. Varios autores apuntan a un infradiagnóstico de este síndrome. Durante la evaluación, diagnóstico y tratamiento de esta paciente, hallamos la necesidad de criterios diagnósticos claros y actualizados y de algoritmos de tratamiento basados en evidencias. Las benzodiazepinas y la terapia electroconvulsiva suponen el tratamiento de primera línea, junto con las medidas de soporte y la prevención de complicaciones. Se han publicado otras estrategias no protocolizadas de tratamiento alternativas en casos refractarios (AU)

We present a clinical picture of mutism, akinesia and stupor with fever and urinary retention in a 65-year-old woman, as an example of catatonia. The catatonic symptomatology has been established as a syndrome which can have multiple etiologies, both medical and psychiatric. Beside that, pharmacological, toxic and organic precipitant factors have been described. Therefore a multidisciplinary approach is required to make more precise the etiological diagnosis. Many authors point out that this syndrome is underdiagnosed. During the assessment, diagnosis and treatment of this patient, we found that there is lack of clear and updated diagnostic criteria, as well as evidence-based treatment algorithms. Benzodiazepines and ECT are first line treatments, along with supportive care and prevention of complications. Other non-protocolized strategies have been published as an alternative in refractory cases (AU)