Vigilancia electrónica continua como método de control fetal intraparto: evolución en las últimas décadas / Electronic fetal heart rate monitoring as method for intrapartum fetal control: evolution on one’s last decades

La vigilancia electrónica continua del corazón fetal ha sido introducida para el uso clínico y el manejo de las pacientes hace más de 30 años y es un método convencional para la temprana identificación de la asfixia fetal. Continúa siendo el método predominante de vigilancia fetal intraparto a pesar de ponerse en duda su eficacia y resultados asociados a su uso. Actualmente existen apariencias de haber aceptación acerca de valores consoladores en los patrones normales reactivos sin desaceleraciones, es decir la sensibilidad y el valor predictivo negativo (VPN) del método es buena. Por el contrario, en patrones considerados anormales, la especificidad y el valor predictivo positivo (VPP) para parálisis cerebral y retraso mental relacionados con la asfixia e hipoxia intraparto, es pobre (AU)

[The Europe against immature lung (EURAIL) project. Strategies for the prevention and treatment of lung immaturity in neonates]. / Proyecto EURAIL. Estrategias de prevención y tratamiento contra la inmadurez pulmonar en España.

OBJECTIVE: To determine clinical practice variability in the prevention and postnatal treatment of lung immaturity in Spain. PATIENTS AND METHODS: Cross-sectional study within a larger study in 13 European countries. Data were obtained from the medical records of all very low birth weight (VLBW) infants born in participating centers, without other instrumentation. RESULTS: A questionnaire was sent to 213 centers. Seventy-two (34 %) responded, with 162,157 births (40 % of total births in 1999). Eight percent of infants were of low birth weight, 1.2 % (2,015) of very low birth weight and 0.45 % were of extremely low birth weight. A total of 52.2 % of VLBW infants received at least one dose of prenatal steroids, 28.8 % received a full course and 9.3 % received more than one cycle. All centres used surfactant and 76.8 % had a written protocol. Forty-one percent of VLBW infants were intubated, 47.6 % required mechanical ventilation for more than 6 hours, and 5 % underwent continuous positive airway pressure. A total of 80.4 % used postnatal steroids, half of them for chronic lung disease prevention, and 83.4 % used steroids to treat this disease. Steroids were most frequently indicated at 7-14 days of life for 3-9 days. The most important causes of neonatal morbidity were chronic lung disease in 14 %, ductus arteriosus in 16.7 %, intraventricular hemorrhage in 8.5 %, and necrotizing enterocolitis in 7.3 %. CONCLUSIONS: Prenatal exposure to steroids was low. Repeat cycles and postnatal steroid use to prevent chronic lung disease was high. Recent scientific evidence on the use of pre- and postnatal steroids should be more widely disseminated.

Parálisis del plexo braquial como traumatismo obstétrico / Paralysis of the brachial plexus as an obstetric trauma

La parálisis obstétrica del plexo braquial es el traumatismo obstétrico más frecuente después de la fractura de clavícula, y consiste en un traumatismo o lesión por elongación del plexo braquial en el momento del parto (AU)