Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4).

OBJECTIVE: The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. METHODS: The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. RESULTS: The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. CONCLUSION: This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

Abstract Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained fromthe charts of the patients. Obstetric and neonatal outcomes were compared between groups. Results The most common C-section indications were fetal distress and macrosomia (33.9% [n=77 and 20.7% [n=47] respectively). A bivariate correlation analysis demonstrated that mothers aged>30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p=0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p=0.006), fetal abdominal circumference (FAC) measurement>360mm (OR: 34.20; 95%CI: 8.04 -145.56; p<0.001)) and<345mm (OR: 3.06; 95%CI: 1.88-5; p<0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p=0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p=0.041), and cervical dilatation<5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p=0.001) were associated with the group requiring a C-section. Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the Csection indications.

Association between non-invasive nursing care technologies during childbirth and neonatal vitality: a cross-sectional study / Asociación entre tecnologías no-invasivas de cuidado en el parto y la vitalidad neonatal: estudio transversal / Associação entre tecnologias não invasivas de cuidado no parto e vitalidade do recém-nascido: estudo transversal

Abstract Objective: to compare the use of non-invasive midwifery care technologies (TNICEO) with the use of traditional care model practices, having as parameters the presence of meconium in the amniotic fluid and its repercussion on the newborn's vitality. Method: a cross-sectional study with secondary data of 10,219 parturients who delivered by midwives between September 2004 and October 2016. Logistic regression was used to assess Apgar> 8 Odds Ratio in exposure to noninvasive midwifery care technologies when compared to traditional care. Results: there were higher percentages of light amniotic fluid and neonates with good vitality in parturients who used only TNICEO compared with those exposed only to traditional care. Conclusion: nurse midwives' provision of TNICEO and its use by women are efficient strategies to reduce unfavorable neonatal outcomes. Implications of practice: investments in the performance of these experts is important, as their know-how to make them not medicalized through TNICEO confirms a process of humanized, safe and quality care that meets official recommendations and contributes to the change in the care model.

Resumen Objetivo: comparar el uso de tecnologías no invasivas de cuidado de enfermería obstétrica (TNICEO) con el uso de prácticas del modelo tradicional de cuidado, con la presencia de meconio en el líquido amniótico y su repercusión en la vitalidad del recién nacido. Método: estudio transversal, com datos secundários, de 10.219 parturientas, asistidas por enfermeras obstétricas entre septiembre de 2004 y octubre de 2016. Se utilizó la regresión logística para evaluar la probabilidad de Apgar> 8 en la exposición a TNICEO en comparación con la atención tradicional. Resultados: se observaron porcentajes más altos de líquido amniótico claro y recién nacido con buena vitalidad en las parturientas que solo usaron TNICEO en comparación con las expuestas solo a la atención tradicional. Conclusión: la oferta de TNICEO por las enfermeras obstétricas y su uso por las mujeres es una estrategia eficaz para reducir los resultados neonatales desfavorables. Implicaciones para la práctica: enfatizase la importancia de los investimentos en el desempeño de estos especialistas, ya que su experiencia, a través del TNICEO, constituye un proceso de atención humanizada, segura y de alta calidad, que cumple con las recomendaciones oficiales y contribuye para cambiar el modelo de atención.

Resumo Objetivo: comparar o uso de tecnologias não invasivas de cuidado de enfermagem obstétrica (TNICEO) com o emprego de práticas do modelo de assistência tradicional, tendo como parâmetros a presença de mecônio no líquido amniótico e sua repercussão sobre a vitalidade do recém-nascido. Método: estudo transversal, com dados secundários, de 10.219 parturientes que tiveram parto acompanhado por enfermeiras obstétricas entre setembro/2004 e outubro/2016. Utilizou-se a regressão logística para avaliar a chance de Apgar >8 na exposição às tecnologias não invasivas de cuidado de enfermagem obstétrica quando comparada à assistência tradicional. Resultados: constataram-se maiores percentuais de líquido amniótico claro e neonatos com boa vitalidade nas parturientes que utilizaram somente TNICEO, em comparação com aquelas expostas, apenas, à assistência tradicional. Conclusão: o oferecimento das TNICEO pelas enfermeiras obstétricas e o seu uso pelas mulheres se configuram como estratégias eficientes para reduzir desfechos neonatais desfavoráveis. Implicações para a prática: destaca-se a importância de investimentos na atuação dessas especialistas, pois seu saber fazer desmedicalizado, por meio das TNICEO, confirma um processo de cuidar humanizado, seguro e de qualidade, que atende às recomendações oficiais e contribui para a mudança do modelo assistencial.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder / Fatores pré-natais, perinatais e pós-natais associados ao transtorno do espectrodo autismo

Abstract Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

Resumo Objetivo: Identificar fatores de risco pré-natal, perinatal e pós-natal em crianças com transtorno do espectro do autismo (TEA) ao compará-las com irmãos sem transtornos de autismo. Método: Estudo é transversal e comparativo. Foi conduzido em três meses (julho a setembro de 2014). Incluiu 101 crianças: 50 com TEA diagnosticadas de acordo com os critérios do DSM-5 e 51 irmãos não afetados. A gravidade do TEA foi avaliada pela Escala de Avaliação do Autismo na Infância (CARS). Resultados: Nosso estudo revelou uma prevalência maior de fatores pré-natais, perinatais e pós-natais em crianças com TEA em comparação com irmãos não afetados. Também mostrou uma associação significativa entre fatores perinatais e pós-natais e TEA (respectivamente p = 0,03 e p = 0,042). Nesse grupo, os fatores perinatais foram principalmente do tipo sofrimento fetal agudo (26% dos casos), longa duração do parto e prematuridade (18% dos casos em cada fator), ao passo que fatores pós-natais foram representados principalmente por infecções respiratórias (24%). No que diz respeito a fatores dos pais, nenhuma correlação foi encontrada entre a idade avançada dos pais no momento da concepção e o TEA. Da mesma forma, nenhuma correlação foi estabelecida entre a gravidade do TEA e fatores diferentes.Após regressão logística, os fatores de risco de autismo encontrados no modelo final foram: sexo masculino, infecção pré-natal do trato urinário, sofrimento fetal agudo, parto difícil e infecção respiratória. Conclusões: Esta pesquisa confirma a alta prevalência de fatores pré-natais, perinatais e pós-natais em crianças com TEA e sugere a intervenção de alguns desses fatores (sofrimento fetal agudo, parto difícil) como variáveis determinantes para a gênese do TEA.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

OBJECTIVE: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. METHOD: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. RESULTS: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. CONCLUSIONS: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

Apendicitis aguda durante la cesárea / Acute appendicitis during caesarean section

Introducción: la apendicitis durante el embarazo es una entidad bastante común, se presenta en uno de cada 1500 y constituye una de las causas más frecuentes de cirugía no obstétrica en la gestante. Objetivo: exponer las características clínicas de la apendicitis aguda durante el término del embarazo. Caso clínico: gestante de 39 semanas, en inicio de trabajo de parto que es anunciada para cesárea de urgencia por sufrimiento fetal. Al abrir la cavidad abdominal se diagnosticó la presencia de pus que resultó ser una apendicitis aguda supurada. Conclusiones: la apendicitis aguda es rara al término del embarazo, de difícil diagnóstico cuando se asocia la sintomatología a los síntomas del trabajo de parto y que de ser desapercibida puede provocar serias complicaciones materno-fetales(AU)

Introduction: appendicitis during pregnancy is a common entity, occurs in one in 1500 and is one of the most common causes of non-obstetric surgery during pregnancy. Methods: exposing the clinical features of acute appendicitis during the term of pregnancy. Developing: 39 weeks pregnant at the beginning of labor which is announced for emergency cesarean section for fetal distress. When opening the abdominal cavity pus that turned out to be an acute suppurative appendicitis was diagnosed. Conclusión: Acute appendicitis is rare at term, difficult to diagnose when the symptoms associated with symptoms of labor and be undetected can cause serious maternal and fetal complications(AU)

[Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications]. / Asma na gestação: efeitos na vitalidade fetal, complicações maternas e perinatais.

OBJECTIVE: To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. METHODS: A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28(th) week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. RESULTS: Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581g). The fetal biophysical profile performed during the antepartum period (n=90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n=28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p<0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p=0.039). CONCLUSION: The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.

Asma na gestação: efeitos na vitalidade fetal, complicações maternas e perinatais / Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications

OBJETIVO: Avaliar os efeitos da asma materna sobre a gravidez, analisando as repercussões da gravidade da doença no comprometimento do bem-estar fetal, bem como as complicações maternas e perinatais associadas. MÉTODOS: Foi realizado estudo retrospectivo de 117 gestações complicadas pela asma materna e sem outras comorbidades, no período de janeiro de 2005 a dezembro de 2010. Os critérios de inclusão foram: gestação única; diagnóstico de asma prévio à gestação; início do pré-natal antes da 28ª semana de gravidez; parto realizado na instituição; peso do recém-nascido acima de 500g e idade gestacional no parto acima de 22 semanas; ausência de malformações fetais ou anomalias cromossômicas; ausência de comorbidades maternas. A gravidade da asma foi classificada em intermitente, persistente leve, persistente moderada, persistente grave. Foram analisados os resultados do perfil biofísico fetal e da dopplervelocimetria de artéria umbilical realizados até 14 dias antes do parto. RESULTADOS: Do total de 117 gestantes asmáticas analisadas: 41 (35,0%) eram intermitentes, 33 (28,2%) persistentes leves, 21 (17,9%) persistentes moderadas e 22 (18,8%) persistentes graves. Não houve diferença significativa entre os grupos quanto ao tipo de parto: a cesárea foi realizada em 65,8% dos casos, a corticoterapia materna no momento do parto em 20,5%, a idade gestacional no parto apresentou média de 38,6 semanas (DP 1,9 semanas) e o peso ao nascimento apresentou média de 3056 g (DP 581 g). O perfil biofísico fetal realizado no período anteparto (n = 90, 76,9%) apresentou resultado normal (8 ou 10) em 99% dos casos. A dopplervelocimetria de artéria umbilical foi avaliada em 23,9% (n = 28) das gestantes, e apresentou-se normal em 100% dos casos. O uso de corticoterapia sistêmica foi significativamente (p< 0,001) diferente entre os grupos intermitente (4,9%) e persistente leve (9,1%), persistente moderada (28,6%), persistente grave (45,5%). quanto ao início do parto, houve maior proporção de cesárea eletiva no grupo com asma persistente moderada (52,5%) e persistente grave (54,6%) quando comparados aos grupos intermitente (21,9%) e persistente leve (24,2%) (p = 0,039). CONCLUSÃO: A gravidade da asma materna não parece influenciar diretamente os resultados perinatais e não compromete a vitalidade fetal. A conduta ativa proporcionando melhor quadro clínico materno promove evolução favorável para a gestação complicada pela asma.

OBJECTIVE: To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. METHODS: A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteriawere as follows: singleton pregnancy; pregnantwomen diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28th week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. RESULTS: Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581 g). The fetal biophysical profile performed during the antepartum period (n = 90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n = 28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p < 0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p = 0.039). CONCLUSION: The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.

Estudios neuroconductuales en recién nacidos con Sufrimiento Fetal según dos técnicas anestésicas / Neurobehavioural studies in newborns with fetal distress based on two anesthetic techniques

La insuficiencia placentaria se invoca como la principal causa de depresión neonatal y el anestesiólogo debe lograr un equilibrio entre la anestesia aplicada y el estado clínico de la paciente y el feto. Valorar el comportamiento neuroconductual del recién nacido con sufrimiento fetal según anestesia espinal o general. Se realizó un estudio de serie de casos en el Hospital General Universitario V I Lenin, en el año 2006, en 158 pacientes del municipio Holguín, a las que le realizaron operación cesárea por sufrimiento fetal. Se analizaron variables hemodinámicas maternas como frecuencia cardiaca, tensión arterial sistólica, diastólica y saturación periférica de oxígeno. Se evaluó el puntaje APGAR al minuto y a los 5 minutos del nacimiento, el estado neuroconductual de los recién nacidos a las 48 horas, a través del test de Scanlon y el desarrollo psicomotor al año de edad con el test Brunet Lezine en relación con la técnica anestésica empleada. La técnica espinal se empleó en el 89,87 por ciento de los casos, con estabilidad hemodinámica materna y el 75 por ciento de los recién nacidos presentaron APGAR 7 - 10. A las 48 horas 149 neonatos resultaron evaluados de normal, con dominio de la anestesia general orotraqueal en los deprimidos con test de Scanlon anormal. Se alcanzó valor predictivo positivo de 0,95 en relación con la evaluación neuroconductual a las 48 horas y el desarrollo psicomotor al año. No hubo diferencias en relación con una u otra técnica anestésica aplicada(AU)

Correlación entre diagnostico clínico de sufrimiento fetal agudo y hallazgos ovulares y neonatales en cesarea de pacientes atendidas en el hospital Materno Infantil Doctor Fernando Velez Paiz, Managua julio a diciebre 2007 / Correlation between clinical diagnosis of fetal distress and acute findings in cesarea ovulares and neonatal patients treated in the hospital Mother and Child Doctor Fernando Velez Paiz

El presente trabajo titulado “CORRELACION ENTRE DIAGNOSTICO CLINICO DESUFRIMIENTO FETAL AGUDO Y HALLAZGOS TRANSOPERATORIOS EN CESAREA DE PACIENTES ATENDIDAS EN EL HOSPITAL MATERNO INFANTIL “DR.FERNANDO VELEZ PAIZ”, MANAGUA, JULIO A DICIEMBRE 2007”. es un estudio descriptivo de corte transversal con 103 pacientes con cesárea indicada por sufrimiento fetal agudo y tomada la muestra no probabilística por conveniencia. Nos planteamos como objetivos conocer la frecuencia de cesárea por sufrimiento fetal agudo, identificando los factores asociados a este diagnóstico, los criterios utilizados para realizar el diagnostico de sufrimiento fetal agudo, el manejo prequirúrgico de las pacientes, la correlacion entre el diagnostico pre y pos quirúrgico e identificar cual era lautilidad de los criterios clínicos utilizados. Los criterios de inclusión fueron: 1. Cesárea en esta Unidad Hospitalaria 2. Diagnóstico de sufrimiento fetal agudo 3. Ausencia de procesos patológicos congénitos incompatibles con la vida extrauterina(cardiopatías, malformaciones congénitas importantes) 4. Embarazo de término Encontrando los siguientes resultados: 1. La indicación y realización de cesárea por sufrimiento fetal agudo se dio en el 4,9 por ciento de casos de todos los nacidos en ese periodo de estudio y representó el 19 por ciento de todas las cesáreas realizadas. 2. Los factores asociados a sufrimiento fetal encontrados fueron las distociasfuniculares con un 43,6 por ciento, sin factor evidente con un 43,6 por ciento y el sufrimiento fetal crónico 7,7 por ciento, el síndrome hipertensivo gestacional 1,9 por ciento, amnioitis ehiperdinamia. 3. Los criterios diagnósticos utilizados fueron las alteraciones de la frecuenciacardiaca fetal, (principalmente la taquicardia fetal sostenida) y la presencia de líquido amniótico meconial (2-3 cruces). los serviciosde vigilancia del parto para discriminar mas adecuadamente los casos para decidir su cirugía...

Evolução neurologica de recem-nascidos com asfixia neonatal / Neurological outcome of newborns with neonatal asphyxia

O objetivo deste estudo foi avaliar a evolução do exame neurológico e do desenvolvimento, pelo Denver developmental screening test (DDST), no primeiro ano de vida e a associação dessa evolução com variáveis maternas, obstétricas, perinatais, neonatais e pós-neonatais, numa população de 81 recém-nascidos de termo com asfixia neonatal, na Maternidade do Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadual de Campinas, de janeiro de 1991 a janeiro de 1999. Foi realizado um estudo descritivo observacional de coorte retrospectiva, do seguimento desses recém-nascidos, realizado em consultas com três, seis meses e um ano. Asfixia neonatal foi diagnosticada pela presença de pelo menos três dos seguintes critérios: Apgar de 5º minuto menor que seis, tempo de reanimação maior que um minuto, comprometimento neurológico e comprometimento sistêmico. Inicialmente foi feita análise descritiva do exame neurológico nas diversas consultas, análise comparativa das diversas consultas, com o teste de McNemar para amostras emparelhadas e a seguir análise bivariada e múltipla para as variáveis independentes e a evolução neurológica e de desenvolvimento de um ano. Com um ano, 54 ( 66,6 por cento) crianças eram normais e destas, 34 tiveram alterações transitórias em pelo menos uma das consultas e 27 (33,3 por cento) tinham exame neurológico anormal. O DDST mostrou 66 (81,5 por cento) normais e 15 (18,5 por cento) com atraso. Na análise bivariada, as variáveis estatisticamente significativas, para exame neurológico alterado com um ano, foram a hipertensão arterial sistêmica materna, edema cerebral no ultra-som, o exame neurológico de uma semana e tempo de internação > 12 dias. Na análise múltipla, somente mostraram associação...

The aim of this study was to evaluate the neurological examination and neurodevelopment by Denver Development Screening Test (DDST) evolution, at one year and its association with clinical variables, in 81 term neonates with birth asphyxia, born in the Maternity Unit of the Center for Integral Assistance to Women?s Health at the State University of Campinas, from january 1991 to january 1999. The study had a observational rectrospective cohort design, of the folow-up of these neonates at three, six months and one year. Neonatal asphyxia was diagnosed by the presence of at least three of the folowing criteria: an Apgar score of less than six at five minutes, a need for positive pressure ventilation via an endotracheal tube for more than one minute after delivery, hipoxic-ischemic encephalopathy, and sistemic abnormalities during neonatal period. The statistical analysis employed, was innitially descriptive of different consultations, then, comparative, with McNemar test for matched samples and then, bivariate and multiple, to evaluate the relationship between independent variables or interactions of variables and abnormal neurological examination and delayed DDST. At year, 54 (66,6 per cent) infants were normal, 34 of wich, had transient abnormalities, at least in one of consultations and 27 (33,3 per cent) had normal neurological examination. The DDST showed to be normal in 66 (81,5) and delayed in 15 (18,5 per cent). In bivariate analysis, maternal chronic hipertension, ultrassonografy with brain edema, neurological examination at seven days and discharge, a lenght of hospital stay more than 12 days, were factors associated...

Pruebas vibroacústicas fetales no reactivas / Vibro acoustic test fetal not reactive

Dada la relación entre hipoxia perinatal y daño feto-neonatal nos propusimos analizar estos resultados en gestantes que han mostrado resultado no reactivo ante el estímulo vibro-acústico fetal, como prueba evaluatoria de salud fetal. Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo, Venezuela. Estudio retrospectivo descriptivo analítico de 55 pacientes. La principal patología materna fue la hipertensiva (60,82 por ciento), se emplearon 85 registros electrónicos, la resolución obstetrica determinante fue por cesárea 53/55 (96,36 por ciento), siendo la primera indicación el compromiso de la salud fetal 43/55 (81,13 por ciento). El resultado perinatal reveló morbilidad en 31/55 (56,36 por ciento), representada en particular por baja puntuación de Apgar y retardo de crecimiento fetal; hubo muerte feto-neonatal en 7/55 (12,72 por ciento), sanos 17/55 (30,90 por ciento). La prueba vibro-acústica fetal no reactiva se relaciona con elevados resultados perinatales adversos. Tal hallazgo implica manejo cuidadosos de emergencia

Dolor fetal

El dolor es una experiencia multidimensional que incorpora factores sensoriales, emocionales y cognitivos. Sólo hasta hace muy pocos años se le ha prestado algo de atención al dolor que puede sufrir el feto. La década pasada se caracterizó por cambios muy profundos en las actitudes de los anestesiólogos y en la práctica de la Anestesia, planteándose el interrogante de si el feto, el neonato y los niños pueden sentir dolor. Fitzgerald M., en 1995, revisando el desarrollo biológico del feto, planteó la posibilidad deque antes de la 26ava. semana de la gestación no podría el feto experimentar dolor porque la "corteza no es una unidad funcional" y que sus respuestas antes de esta edad son de tipo reflejo. Los niños y los adultos perciben concientemente el dolor a través de un proceso de desarrollo que el feto no ha completado antes de la semana 26 de la gestación. Sinembargo, debemos tener siempre presente que existe un momento del desarrollo fetal, cuando comienza a reaccionar a los estímulos nocivos. Las consecuencias clínicas y morales de este hecho son diferentes y altamente controversiales, pero debemos tenerlas en cuenta siempre

Variables perinatales en 34 casos con craneosinostosis. Importancia de la compresión fetal intrauterina / Perinatal variables in 34 cases presenting with craniosynestosis. Importance of intrauterine fetal compression

La craniosinostosis es una entidad propia de la infancia,caracterizada por el cierre precoz de las suturas craneales. Su causa se desconoce, pero algunos la atribuyen a la compresión fetal intrauterina. Los autores analizan diversas variables perinatales en 34 pacientes con esta afección. Todas las madres de niños escafocefálicos eran primíparas y en un elevado número de ellas predominó la forma de presentación de vértice. De los niños nacidos por vía vaginal, casi la tercera parte procedían de un parto distócico, y en éstos, la craneosinostosis fue variedad escafocefálica (AU)

Perinatal implications of meconium stained liquor: The Third Ester Archer Memorial Lecture

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital (MHWH), Trinidad during the period January 1 to December 31, 1991. The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using Epi-Info software. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years with a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress (23.9 percent), hypertension in pregnancy (14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 to 4,960 g with a mean of 3,258 g, 8 percent were <2,500 and 9.8 percent were >4,000 g. 86.3 percent were term, 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicate the need for improvement in delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment. (AU)