[Factors associated with blood loss during precipitate labor]. / Factores asociados a la pérdida sanguínea en partos precipitados.

BACKGROUND: Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour. METHODS: This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss. RESULTS: By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92). CONCLUSION: The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers' postpartum period. Key words. Haemoglobin. Precipitate labour.

Factores asociados a la pérdida sanguínea en partos precipitados / Factors associated with blood loss during precipitate labour

Fundamento: El parto precipitado se relaciona con la aparición de hemorragia postparto por atonía uterina posterior. Sin embargo, las medidas preventivas que pueden resultar efectivas para lograr reducir las pérdidas sanguíneas en este tipo de parto son aún desconocidas. Por ello, el objetivo de este estudio fue conocer los factores relacionados con la pérdida sanguínea en los partos precipitados. Material y método: Se realizó un estudio observacional y analítico de cohortes retrospectivo sobre una muestra total de 742 mujeres con parto vaginal cuya duración fue inferior a 180 minutos durante el periodo 2010-2014. Las gestaciones con feto muerto anteparto, gemelares e inducciones de parto fueron excluidos del análisis. La variable resultado principal fue la pérdida hemática intraparto. Resultados: Mediante el empleo de análisis multivariante, los factores de riesgo asociados de manera independiente a mayores pérdidas sanguíneas (g/dL) en partos precipitados fueron la nuliparidad (0,38; p<0,001), niveles de hemoglobina preparto elevados (0,23; p<0,001), mayor edad gestacional (0,06; p<0,001), realización de alumbramiento manual (0,92; p=0,004) y empleo de episiotomía (0,34; p<0,001). La realización de alumbramiento dirigido surge como factor protector frente a mayores pérdidas sanguíneas (-0,23; p<0,001). La pérdida de hemoglobina promedio se situó en un 1,0 g/dL (desviación típica =0,92). Conclusiones: La estricción de la práctica de la episotomía y el empleo del alumbramiento dirigido se establece como medidas clave modificables por los profesinales para reducir las pérdidas sanguíneas en partos precipitados y mejorar el estado materno postparto (AU)

Background: Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour. Methods: This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss. Results: By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92). Conclusion: The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers' postpartum period (AU)

Estenosis hipertrófica de píloro y anestesia espinal / Hypertrophic pyloric stenosis and spinal anesthesia

Introducción: La realización de la piloromiotomía extramucosa con abordaje umbilical o supraumbilical bajo anestesia espinal puede contribuir a la disminución de la morbimortalidad potencial asociada al tratamiento quirúrgico de la estenosis hipertrófica de píloro (EHP).Pacientes y métodos: Se realizó un estudio retrospectivo de 60 pacientes con EHP. Se analizaron la edad al diagnóstico, clínica, tipo de anestesia y evolución postoperatoria. En 50 pacientes se indujo anestesia general con atropina,fentanilo, propofol, succinil-colina y sevoflurano. En 10pacientes se realizó bloqueo espinal con bupivacaína 0,5%hiperbárica espinal y sedación con bolos de propofol. Resultados: La edad media al diagnóstico fue de 34,07días. Todos presentaron vómitos proyectivos, y se asociaron a pérdida de peso (33,3%), irritabilidad (15%), deshidratación(6,6%), ictericia (5%) y estreñimiento (5%). El tiempo medio de evolución fue de 4,8 días. El diagnóstico se realizó mediante ecografía abdominal en todos los casos. En los casos de anestesia espinal, el bloqueo se instauró en menos de 10 minutos, los niveles sensitivos alcanzados oscilaron entre T3-T5 y el tiempo medio de duración fue de 60minutos. En ningún caso se registró bradicardia <100 latidos/minuto, saturación <95%, apneas >15 segundos, ni cambios en la tensión arterial >15%. El inicio medio de la tolerancia oral fue de 18,7 horas para los pacientes intervenidos con anestesia general, y de 9,5 horas para el grupo de anestesia espinal. Un paciente precisó ingreso postoperatorio en la UCI pediátrica por necesidad de intubación prolongada. Conclusiones: La anestesia espinal en la piloromiotomía extramucosa es una alternativa segura a la anestesia general. El acceso y las condiciones quirúrgicas son iguales a los realizados bajo anestesia general. Nuestros resultados sugieren que puede disminuir el tiempo de inicio de toleranci aoral y de ingreso hospitalarios (AU)

Background: The pyloromyotomy procedure with umbilicalor supraumbilical incision is generally performed undergeneral anesthesia. Potential morbimortality is associated with postoperative apnoea and pulmonary aspiration. Spinal anesthesia may contribute to decrease these complications. Patients and methods: We report a retrospective study of60 patients with congenital pyloric stenosis (CPS). We analyzed the age at diagnosis, symptoms, anesthesia and postoperative outcome. Fifty patients received general anesthesia with atropine, fentanyl, propofol, succinylcholine and sevoflurane. Ten patients underwent spinal anesthesia with hyperbaricbupivacaine 0,5% and bolus of propofol for sedation. Results: Mean age at diagnosis was 34,07 days. All the patients were admitted because of projectile vomiting, with weight loss (33,3%), irritability (15%), dehydratation (6,6%),jaundice (5%) and constipation (5%). Mean time of symptoms was 4,8 days. The diagnosis was made with abdominal ultrasounds in all patients. In case of spinal anesthesia, the blockade was effective in less than 10 minutes, the sensory level was between T3-T5 and it lasted a medium time of 60 minutes. In no case we registered bradycardia <100beats/minute, saturation <95%, apnoeas >15 seconds, or changes in arterial pressure >15%. Start of oral intake began18,7 hours postsurgery in the general anesthesia group, and9,5 hours in the spinal anesthesia group, although there was no statistically significant differences. One patient of the general anesthesia group was admitted in the pediatric intensive care unit for prolonged apnoea. Conclusions: Spinal anesthesia for pyloromyotomy is a safe alternative to general anesthesia. The surgical incision and conditions are the same as those related to general anesthesia. Our results suggest that the beginning of oral intake and total hospital stay could be reduced (AU)