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1.
Rev. Fac. Cienc. Méd. (Quito) ; 42(1): 25-35, jun.2017. []
Artigo em Espanhol | LILACS | ID: biblio-1004985

RESUMO

Antecedentes: la aplicación de estándares e indicadores de atención materno neonatal en unidades que no utilizan parámetros de calidad mejora el cumplimiento de actividades en la atención prenatal, del parto, del posparto, del recién nacido y de las complicaciones perinatales relacionadas a cesárea. Objetivo: implementar y monitorizar la tendencia de cumplimiento trimestral de un sistema de estándares e indicadores de complicaciones obstétricas y neonatales relacionadas a cesárea y su impacto en la morbimortalidad materna ­ neonatal. Metodología: intervención de carácter prospectivo "antes y después", a realizarse en el Servicio de Obstetricia de la Unidad Metropolitana de Salud Sur de Quito durante 15 meses. Se realizó el levantamiento de la línea de base epidemiológica de cesárea; se socializó y capacitó al personal en el uso del "Manual de Estándares, Indicadores e Instrumentos para medir la Calidad de la Atención Materno-Neonatal" del Ministerio de Salud Pública y se realizaron monitoreos trimestrales de cumplimiento. Resultados: se alcanzan niveles de cumplimiento significativos (p≤0,05) hacia el noveno mes de intervención en 11 de los 17 estándares de calidad seleccionados. A corto plazo determina una reducción significativa de la razón de mortalidad neonatal y una estabilización de la mortalidad materna. No se disminuyó la frecuencia de cesáreas ni la estancia hospitalaria. Conclusión: los resultados apoyan el uso permanente de un sistema de monitorización utilizando estándares e indicadores de complicaciones obstétricas y neonatales relacionados a cesárea para mejorar la calidad de atención médica. (AU)


Background: the application of standards and indicators of maternal neonatal care in units that do not use quality parameters improves regulatory compliance activities on prenatal care, childbirth, postpartum, of the newborn and perinatal complications related to caesarean section. Objective: implement and monitor the trend of compliance quarterly of a system of standards and indicators of obstetric and neonatal complications related to caesarean section and its impact on maternal mortality and morbidity. Methodology: intervention prospective "before and after", to be held in the obstetrics service of the health South of Quito Metropolitan unit for 15 months. Was the lifting of the epidemiological baseline of Caesarea; were you socialized and trained staff in the use of the "Manual of standards, indicators and instruments to measure the quality of Maternal-Neonatal care" of the Ministry of public health; and quarterly monitoring of compliance were carried out. Results: significant levels of compliance are achieved (p≤0. 05) to ninth month of intervention in 11 of the 17 selected quality standards. To short term determines a reduction significant of the reason of mortality neonatal and a stabilization of the mortality maternal. Not decreased the frequency of caesarean section or hospital stay. Conclusion: the results support the use of a monitoring system using standards and indicators of obstetric and neonatal complications related to caesarean section to improve the quality of health care.


Assuntos
Humanos , Feminino , Gravidez , Procedimentos Cirúrgicos Obstétricos , Saúde da Mulher , Serviços de Saúde Materno-Infantil , Qualidade da Assistência à Saúde
2.
Rev. centroam. obstet. ginecol ; 21(2): 31-37, abr.-jun. 2016.
Artigo em Espanhol | LILACS | ID: biblio-869633

RESUMO

Objetivos: analizar el nivel de conocimientos, actitudes y prácticas que tiene una muestra voluntaria de proveedores de salud en obstetricia asistentes al XXI Congreso Nacional de Ginecología y Obstetricia del Ecuador sobre muerte materna, leyes nacionales y tratamientos relacionados al aborto incompleto. Material y Métodos: Se realizó una intervención investigativa transversal...


Objectives: To examine the level of knowledge, attitudes and practices which has voluntary sample of health care providers at obstetrician tending the 21st National Congress of Gynecology and Obstetrics of Ecuador on maternal death, national laws and treatment related to incomplete abortion. Material and Methods: a descriptive and analytical cross - sectional investigative intervention through suvery...


Assuntos
Humanos , Feminino , Aborto Incompleto , Conhecimentos, Atitudes e Prática em Saúde , Obstetrícia/educação , Médicos
3.
Rev. peru. ginecol. obstet. (En línea) ; 62(2): 169-174, abr.-jun. 2016. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1043229

RESUMO

Objetivos: Determinar el nivel de conocimientos, actitudes y prácticas en una muestra intencionada de médicos gineco-obstetras líderes provinciales de la Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO) sobre el aborto inducido. Diseño: Estudio transversal, correlacional, de corte prospectivo y analítico. Institución: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participantes: Médicos gineco-obstetras líderes provinciales de FESGO. Metodología: En una muestra intencionada de 33 médicos gineco-obstetras se aplicó una encuesta estructurada validada y basada en experiencias de la región, acerca de datos generales y sociodemográficos del encuestado, conocimientos teóricos sobre la epidemiología del aborto y la muerte materna, actitudes con relación del manejo del aborto inseguro, y la práctica de prescripción de misoprostol y tratamiento quirúrgico por aspiración. Principales medidas de resultados: Nivel de conocimientos, actitudes y prácticas. Resultados: La población encuestada tenía promedio de edad de 49 años, 16 años de práctica, con relación estable, hijos y religión declarada. Consideraron de alta prioridad la muerte materna por aborto, pues atendían pacientes públicas y privadas con intención de aborto inducido frecuente y uso de misoprostol previo. Consideraron la ampliación de motivos para aborto con la proyección de reducción de mortalidad, aunque los casos aumentaran. En su mayoría consideraron suficientes sus conocimientos de derechos reproductivos, se sentían solventes respecto a la consejería en misoprostol, aunque la satisfacción alta respecto a consejería de aborto inducido fue apenas en 51%. Conclusiones: Los líderes provinciales de esta muestra intencionada conocían la temática del aborto y su atención integral. Los conocimientos fueron altos, aunque las actitudes y prácticas resultaron diversas, con respuestas que sugieren mayor sensibilización y capacitación. Nuevos estudios necesitan ser realizados en una población más amplia de gineco-obstetras federados, así como intervenciones educativas y de sensibilización para mejorar la calidad de atención del aborto.


Objectives: To determine knowledge, attitudes and practices regarding abortion in an intentioned sample of obstetrician/gynecologists who are provincial leaders of the Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Design: Prospective, correlational, cross-sectional, and analytical survey. Setting: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participants: FESGO obstetrician/gynecologists provincial leaders. Methods: A structured and validated survey was applied to an intentional sample of 33 obstetrician/gynecologists. The survey was based on experiences in the region, general and demographic information of the respondent, theoretical knowledge about the epidemiology of abortion and maternal death, attitudes about the management of unsafe abortion, and practice on misoprostol prescription and surgical aspiration. Main outcome measures: Knowledge, attitude and practices. Results: The survey respondents were 49 years old average, had 16 years of medical practice, and stable family relations, with declared children and religion. They considered maternal death due to abortion of high priority be-cause they attended public and private patients with frequent history of induced abortion and use of misoprostol. They also considered the expansion of reasons for abortion in the light of a potential reduction in mortality, even if the number of cases increased. Most considered sufficient their knowledge on reproductive rights and felt proficient with respect to counseling on misoprostol, although high satisfaction on induced abortion counseling was just 51%. Conclusions: Provincial leaders of this sample knew about abortion and its comprehensive care. Knowledge was high, but attitude and practices were diverse and require more awareness and training. Further studies are needed in a b broader federated population of obstetrician/ gynecologists. Educational and sensitizing interventions are needed to improve the quality of abortion care.

4.
Pharmacogenomics ; 16(9): 919-28, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26122863

RESUMO

AIM: Misoprostol, a prostaglandin analogue used for the treatment of postpartum hemorrhage and termination of pregnancy, can cause high fevers. Genetic susceptibility may play a role in misoprostol-induced fever. SUBJECTS & METHODS: Body temperature of women treated with misoprostol for termination of pregnancy in the UK (n = 107) and for postpartum hemorrhage in Ecuador (n = 50) was measured. Genotyping for 33 single nucleotide polymorphisms in 15 candidate genes was performed. Additionally, we investigated the transport of radiolabeled misoprostol acid across biological membranes in vitro. RESULTS: The ABCC4 single nucleotide polymorphism rs11568658 was associated with misoprostol-induced fever. Misoprostol acid was transported across a blood-brain barrier model by MRP4 and SLCO1B1. CONCLUSION: Genetic variability in ABCC4 may contribute to misoprostol-induced fever in pregnant women. Original submitted 21 January 2015; Revision submitted 24 April 2015.


Assuntos
Abortivos não Esteroides/efeitos adversos , Febre/induzido quimicamente , Febre/genética , Misoprostol/efeitos adversos , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Transportadores de Ânions Orgânicos/genética , Polimorfismo Genético/genética , Abortivos não Esteroides/metabolismo , Adulto , Barreira Hematoencefálica/metabolismo , Temperatura Corporal , Linhagem Celular , Grupo com Ancestrais do Continente Europeu , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , América Latina , Transportador 1 de Ânion Orgânico Específico do Fígado , Misoprostol/metabolismo , Polimorfismo de Nucleotídeo Único/genética , Hemorragia Pós-Operatória/complicações , Hemorragia Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/genética , Gravidez
5.
BMC Pregnancy Childbirth ; 12: 65, 2012 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-22769055

RESUMO

BACKGROUND: Shivering and fever are common side effects of misoprostol. An unexpectedly high rate of fever above 40°C was documented among Ecuadorian women given treatment with 800mcg of sublingual misoprostol to manage postpartum hemorrhage (PPH) (36%). Much lower rates have been reported elsewhere (0-9%). METHODS: From February to July 2010, an open-label pilot study was conducted in Quito, Ecuador to determine whether a lower dose--600mcg sublingual misoprostol--would result in a lower incidence of high fever (≥40°C). Rates of shivering and fever with 600mcg sublingual regimen were compared to previously documented rates in Ecuador following PPH treatment with 800mcg sublingual misoprostol. RESULTS: The 600mcg dose resulted in a 55% lower rate of high fever compared with the 800mcg regimen (8/50; 16% vs. 58/163; 36%; relative risk 0.45 95% CI 0.23-0.88). Only one woman had severe shivering following the 600mcg dose compared with 19 women in the 800mcg cohort (2% vs. 12%; relative risk 0.17 (0.02-1.25)). No cases of delirium/altered sensorium were reported with the 600mcg dose and women's assessment of severity/tolerability of shivering and fever was better with the lower dose. CONCLUSIONS: 600mcg sublingual misoprostol was found to decrease the occurrence of high fever among Ecuadorian women when given to treat PPH. This study however was not powered to examine the efficacy of this treatment regimen and cannot be recommended at this time. Future research is needed to confirm whether other populations, outside of Quito, Ecuador, experience unusually high rates of elevated body temperature following sublingual administration of misoprostol for treatment of PPH. If indeed similar trends are found elsewhere, larger trials to confirm the efficacy of lower dosages may be justified. TRIAL REGISTRATION: Clinical trials.gov, Registry No. NCT01080846.


Assuntos
Febre/induzido quimicamente , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Hemorragia Pós-Parto/tratamento farmacológico , Tremor por Sensação de Frio/efeitos dos fármacos , Inércia Uterina/tratamento farmacológico , Administração Sublingual , Adolescente , Adulto , Relação Dose-Resposta a Droga , Feminino , Humanos , Projetos Piloto , Hemorragia Pós-Parto/etiologia , Gravidez , Adulto Jovem
6.
Int J Gynaecol Obstet ; 115(2): 135-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21872244

RESUMO

OBJECTIVE: To assess the feasibility of introducing misoprostol for the treatment of incomplete abortion in Quito, Ecuador. METHODS: In a randomized prospective study conducted at a large tertiary-level maternity hospital and a private secondary-level clinic between November 2006 and November 2007, women with incomplete abortion were treated with either 600 µg of oral misoprostol (n=122) or manual vacuum aspiration (MVA) (n=120). All participants were requested to return for follow-up care on day 7 to determine the success of the treatment and to document their satisfaction with the method and the adverse effects experienced. RESULTS: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcomes are unknown. Among those who did return, 94% (100/106) of women showed successful completion of abortion after treatment with misoprostol, as compared with 100% (97/97) of women treated with MVA. Most women described their adverse effects after treatment as tolerable (misoprostol, 95%; MVA, 91%). Nearly all women reported being satisfied with their treatment (196/203); there were no differences among the women's reports of satisfaction according to treatment received. CONCLUSION: An oral dose of 600 µg of misoprostol was found to be an acceptable and effective non-surgical option for treating incomplete abortion. Clinical trials.gov NCT00674232.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Misoprostol/uso terapêutico , Satisfação do Paciente , Abortivos não Esteroides/administração & dosagem , Aborto Incompleto/cirurgia , Administração Oral , Adulto , Equador , Feminino , Humanos , Serviços de Saúde Materna , Misoprostol/administração & dosagem , Gravidez , Estudos Prospectivos , Curetagem a Vácuo
7.
Lancet ; 375(9710): 210-6, 2010 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-20060161

RESUMO

BACKGROUND: Oxytocin, the standard of care for treatment of post-partum haemorrhage, is not available in all settings because of refrigeration requirements and the need for intravenous administration. Misoprostol, an effective uterotonic agent with several advantages for resource-poor settings, has been investigated as an alternative. This trial established whether sublingual misoprostol was similarly efficacious to intravenous oxytocin for treatment of post-partum haemorrhage in women not exposed to oxytocin during labour. METHODS: In this double-blind, non-inferiority trial, 9348 women not exposed to prophylactic oxytocin had blood loss measured after vaginal delivery at four hospitals in Ecuador, Egypt, and Vietnam (one secondary-level and three tertiary-level facilities). 978 (10%) women were diagnosed with primary post-partum haemorrhage and were randomly assigned to receive 800 microg misoprostol (n=488) or 40 IU intravenous oxytocin (n=490). Providers and women were masked to treatment assignment. Primary endpoints were cessation of active bleeding within 20 min and additional blood loss of 300 mL or more after treatment. Clinical equivalence of misoprostol would be accepted if the upper bound of the 97.5% CI fell below the predefined non-inferiority margin of 6%. All outcomes were assessed from the time of initial treatment. This study is registered with ClinicalTrials.gov, number NCT00116350. FINDINGS: All randomly assigned participants were analysed. Active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0.94, 95% CI 0.91-0.98; crude difference 5.3%, 95% CI 2.6-8.6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1.78, 95% CI 1.40-2.26). Shivering (229 [47%] vs 82 [17%]; RR 2.80, 95% CI 2.25-3.49) and fever (217 [44%] vs 27 [6%]; 8.07, 5.52-11.8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died. INTERPRETATION: In settings in which use of oxytocin is not feasible, misoprostol might be a suitable first-line treatment alternative for post-partum haemorrhage.


Assuntos
Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Hemorragia Pós-Parto/tratamento farmacológico , Administração Sublingual , Adolescente , Adulto , Países em Desenvolvimento , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Adulto Jovem
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