Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis / Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto.

Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Objetivos: establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Royal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: la concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto / Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis

RESUMEN Objetivos: Establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Rojal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: Estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: Se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: La concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

ABSTRACT Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insulin Pump Therapy.

BACKGROUND: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE: To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS: A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed. RESULTS: Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P < 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c <6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis. CONCLUSIONS: In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.

Profilaxis tromboembólica en pacientes posparto. Estudio de corte transversal en tres instituciones en Colombia / Thromboembolic prophylaxis in post-partum patients. Cross-sectional study in three institutions in Colombia

Describir el nivel de riesgo de enfermedad tromboembólica en pacientes posparto y hacer una aproximación al uso actual de la tromboprofilaxis.Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron pacientes que fueron hospitalizadas para atención de parto entre agosto de 2012 y abril de 2013 en tres instituciones generales de alta complejidad en Bogotá y Medellín. Se aplicó la Guía de manejo del Royal College Obstetrics & Gynecology (RCOG) para establecer el riesgo de enfermedad tromboembólica. Las pacientes fueron evaluadas en el posparto y clasificadas en alto, intermedio y bajo riesgo. Se midió la frecuencia real de aplicación de tromboproilaxis. Los resultados se presentan como proporciones.Resultados: se evaluaron un total de 3516 pacientes, el 1,9 % de las pacientes fueron clasificadas como de alto riesgo, 42 % de riesgo medio y 56,1 % de riesgo bajo. La tromboprofilaxis solo se aplicó a un 7,4 % de las pacientes con alto riesgo y riesgo intermedio.Conclusión: según los criterios de la Guía del RCOG, un 43,9 % de las pacientes tendrían indicación de tromboprofilaxis; sin embargo, solo un 7,4 % de ellas la recibió. Se requieren estudios complementarios para evaluar los riesgos y beneficios del uso de la tromboprofilaxis según la guía del Reino Unido...

To describe the risk of thromboembolic disease in post-partum patients and examine the current use of thromboprophylaxis.Materials and methods: Descriptive cross-sectional study that included patients admitted for delivery care between August 2012 and April 2013 in three high-complexity general healthcare institutions in Bogotá and Medellín. The Royal College of Obstetrics & Gynaecology (RCOG) Management Guideline was applied for determining the risk of thromboembolic disease. Patients were assessed during the post-partum period and classified as high, intermediate and low risk. The actual frequency of the use of prophylaxis was measured. Results are presented as proportions.Results: Overall, 3516 patients were assessed and 1.9 % were classified as high risk, 42 % as intermediate risk and 56.1 % as low risk. Thromboprophylaxis was only used in 7.4 % of patients with high or intermediate risk.Conclusion: According to the criteria of the RCOG guidelines, 43.9 % of the patients had an indication for thromboprophylaxis and yet only 7.4 % of them received it. Further studies are required to assess the risk and evaluate the benefits and risks of giving thromboprophylaxis in accordance with the United Kingdom guidelines...