Amniotic membrane transplantation for ocular surface burns / Transplante de membrana amniótica em queimaduras da superfície ocular

ABSTRACT Objective: To analyze the morphological and functional long-term outcomes of amniotic membrane transplantation after ocular surface chemical burns. Methods: This prospective study analyzed 7 patients who suffered from severe ocular surface burn and underwent amniotic membrane transplantation from 2015 to 2020 in Hospital de Clínicas - Universidade Federal do Paraná. Results: Out of the seven patients, six (85.7%) suffered unilateral burn and one (14.3%) suffered bilateral burn. Five of them had alkali burns (71.4%), one had acid burn (14.3%) and one suffered gunpowder fireworks burn (14.3%). Mean age was 29.4 years (±standard deviation 13.3, range 14.0 to 47.0 years). Mean visual acuity at first presentation was 1.83±0.79 logMAR (0.015 decimal) and mean VA after a follow-up of 1 year was 0.85±0.70 logMAR (0.141 decimal). The visual acuity significantly improved from 1.83±0.79 to 0.85±0.70 logMAR (p<0.05). Conclusion: Amniotic membrane transplantation is an effective adjunctive treatment in the management of ocular surface chemical burns with potential to improve the final vision outcome.

RESUMO Objetivo: Analisar os resultados morfológicos e funcionais a longo prazo do transplante de membrana amniótica após queimaduras químicas da superfície ocular. Métodos: Foi realizado um estudo prospectivo com análise de sete pacientes que sofreram queimaduras graves da superfície ocular e foram submetidos a transplante de membrana amniótica no período de 2015 a 2020 no Hospital de Clínicas da Universidade Federal do Paraná. Resultados: Dos sete pacientes, seis (85,7%) sofreram queimadura unilateral e um (14,3%) sofreu queimadura bilateral. Cinco deles sofreram queimaduras por álcali (71,4%), um por ácido (14,3%) e um por pólvora de fogo de artifício (14,3%). A média de idade foi de 29,4 anos (±desvio-padrão de 13,3, intervalo de 14,0 a 47,0 anos). A acuidade visual média na primeira apresentação foi de 1,83±0,79 logMAR (0,015 decimal) e, após 1 ano de seguimento, foi de 0,85±0,70 logMAR (0,141 decimal). A acuidade visual melhorou significativamente, de 1,83±0,79 para 0,85±0,70 logMAR (p<0,05). Conclusão: O transplante de membrana amniótica é um tratamento adjuvante eficaz no manejo de queimaduras químicas da superfície ocular com potencial para melhorar a visão final.

Primary prevention with vaginal chlorhexidine before 16 weeks reduces the incidence of preterm birth: results of the Preterm Labor Prevention Using Vaginal Antiseptics study.

BACKGROUND: Preterm labor is one of the leading causes of perinatal death and is currently considered a syndrome with many causes. One of the most important causes of preterm birth is ascending infection from bacterial vaginosis. Chlorhexidine has proven to be effective against bacterial vaginosis and against bacterial biofilms without affecting gestation. OBJECTIVE: We aimed to evaluate the effectiveness of a universal primary prevention strategy for preterm birth using intravaginal chlorhexidine applied before 16 weeks (Preterm Labor Prevention Using Vaginal Antiseptics study). STUDY DESIGN: We performed a prospective observational study with 2 cohorts of pregnant women that were assigned either to prevention of preterm birth by means of intravaginal chlorhexidine (Cum Laude Chlorhexidine, chlorhexidine digluconate 0.2%) before 16 weeks (n=413), or to no treatment following the usual hospital protocol (n=704). Primary outcomes were the incidence of spontaneous preterm birth before 34 and 37 weeks; the incidence of preterm birth before 34 and 37 weeks, including inductions for premature rupture of membranes; and the incidence of preterm birth before 34 and 37 weeks, including any indication for termination of pregnancy. Both cohorts were compared using Mann-Whitney and Fisher tests. Finally, a multivariable analysis, including the odds ratio was performed, adjusting for clinical parameters, to evaluate the importance of the different determinants in the prediction of preterm birth. RESULTS: In pregnancies treated with chlorhexidine, the incidences of spontaneous preterm birth; preterm birth, including induction for premature rupture of membranas; and preterm birth, including any indication for termination of pregnancy were at 34 and 37 weeks: 0% and 0%, 0.24% and 1.69, and 2.90% and 3.15%, respectively; whereas in nontreated pregnancies, these incidences were 9% and 11%, 12% and 23%, and 35% and 43%, respectively. According to the multivariable analysis, the incidence of preterm birth among women treated with chlorhexidine before 16 weeks was halved (Odds ratio, 0.52; P<.05). CONCLUSION: Universal treatment with vaginal chlorhexidine before 16 weeks reduces the incidence of preterm birth, especially before 34 weeks.

Cirugía periapical y regeneración: revisión sistemática / Periapical surgery and regeneration: systematic review

Introducción: Tras un cirugía periapical, suele estar asociado un defecto óseo que puede ser regenerado o no según la literatura. El objetivo es analizar si la regeneración ósea asociada a la cirugía periapical tiene efectos beneficiosos en la curación de los diferentes defectos. Material y Mètodos: Revisión sistemática realizada en Medline-Pubmed, Scopus y Cochrane. Se consideraron criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Ensayos clínicos aleatorizados, estudios de casos y controles, de cohortes y transversales publicados entre enero 2011 y abril 2022, que analizaran el èxito de la cirugía periapical combinada o no con diferentes tècnicas de regeneración ósea, idioma inglès o español, realizados en humanos y adultos (≥16años) fueron incluidos. Resultados: Se incluyeron un total de 8 artículos que analizaban una "n" total de 285 sujetos con 35 abandonos. Se analizan diferentes tipos de lesiones: lesiones transversales, defectos apicomarginales y lesiones periapicales, excepto un estudio que compara las tres. Se utilizan diferentes materiales de regeneración. Se obtuvo un rango de èxito de regeneración ósea entre 81,6% y 93,7%. Discusión: Los avances en equipos de magnificación visual aumento, instrumentos y materiales endodónticos son la razón de un mayor èxito de las cirugías periapicales. Las imágenes en 3D, son valiosas para obtener un mejor diagnóstico del tamaño y tipo de defecto, y planificar así el tratamiento considerando la necesidad de regenerar o no. Aunque los resultados siguen siendo inciertos parece ser que en los defectos transversales y apicomarginales es mejor regenerar, al contrario de los defectos periapicales. (AU)

Introduction: According to the literature, after a periapical surgery there usually remains a bone defect that may be regenerated or not. The aim of this review is to analyse whether bone regeneration associated with periapical surgery is favourable on the healing of different defects. Material and Methods: A systematic review was performed in Medline-Pubmed, Scopus and Cochrane. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were considered. Randomized clinical trials, case-control, cohort and cross-sectional studies published between January 2011 and April 2022, that analyses the success of periapical surgery associated or not with different bone regeneration techniques, English or Spanish, humans and adults (≥ 16years) studies were included. Results: A total of eightreports were included. They evaluated 285 subjects, with 35 subjects that dropped out. Different types of lesions were analysed in each report: through-and-through lesions, apico-marginal lesions, and periapical lesions, except for one that compared all of them. Different kinds of bone regenerative materials were used. A range of success of between 81,6% and 93,7% of bone regeneration was achieved. Discussion: Improvements in augmentation equipment, instruments, and materials are the reason for the large success of periapical surgery. 3D images are useful to make a better diagnosis of the size and kind of the defect and, in this way, to plan the treatment considering the need to regenerate or not. Although the results remain uncertain, it seems that for through-and-thought and apico-marginal lesions, it is better to regenerate in contrast with periapical lesions. (AU)

Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Factores asociados con el éxito de una prueba de trabajo de parto después de cesárea (TOLAC) sin antecedente de parto / Factors associated with the success of a trial of labor after cesarean section (TOLAC) without a history of vaginal delivery

Resumen OBJETIVO: Determinar los factores asociados con una prueba de trabajo de parto después de una cesárea exitosa en mujeres sin antecedente de parto previo. MATERIALES Y MÉTODOS: Estudio observacional de casos y controles, longitudinal, retrospectivo y analítico efectuado en pacientes atendidas entre el 2017 y 2020 en el Hospital Ángeles Lomas, con embarazo único de más de 37 semanas, con una prueba de trabajo de parto, con una cesárea previa y sin parto previo. Se compararon las variables independientes entre el grupo que logró una prueba exitosa de trabajo de parto después de cesárea con las del grupo con prueba fallida. Para el análisis estadístico se utilizó el programa SPSS de IBM, versión 21. Todas las variables categóricas se expresan en frecuencias y porcentajes. RESULTADOS: Se incluyeron 135 pacientes con prueba de trabajo de parto después de cesárea de las que 65 (48.1%) tuvieron parto (prueba exitosa) y 70 (51.8%) cesárea (prueba fallida). Hubo una mayor proporción de trabajo de parto espontáneo en el grupo con prueba exitosa en comparación con el grupo con prueba fallida (66.2% en comparación con 37.1%). No hubo diferencias significativas en cuanto a la conducción del trabajo de parto, integridad de membranas amnióticas al ingreso, horas de trabajo de parto y peso al nacer. CONCLUSIONES: Un índice de masa corporal menor, un trabajo de parto espontáneo y una mayor dilatación al ingreso se asociaron, significativamente, con una prueba exitosa de trabajo de parto después de cesárea. La integridad de las membranas, la duración de la prueba y el peso al nacer no tuvieron diferencias significativas entre los grupos.

Abstract OBJECTIVE: To determine the factors associated with a trial of labor after a successful cesarean section in women with no history of previous delivery. MATERIALS AND METHODS: Observational case-control, longitudinal, retrospective, analytical, retrospective study performed in patient attended between 2017 and 2020 at Hospital Ángeles Lomas, with a singleton pregnancy of more than 37 weeks, with a trial of labor, with a previous cesarean section and no history of previous delivery. The independent variables were compared between the group that achieved a successful trial of labor after cesarean section with those of the group with failed trial. For statistical analysis, the IBM SPSS program, version 21, was used. All categorical variables are expressed in frequencies and percentages. RESULTS: We included 135 patients with trial of labor after cesarean section of whom 65 (48.1%) had labor (successful trial) and 70 (51.8%) had cesarean section (failed trial). There was a higher proportion of spontaneous labor in the successful trial group compared to the failed trial group (66.2% compared to 37.1%). There were no significant differences in labor conduction, amniotic membrane integrity on admission, hours of labor, and birth weight. CONCLUSIONS: Lower body mass index, spontaneous labor, and greater dilation on admission were significantly associated with a successful trial of labor after cesarean section. Membrane integrity, length of trial, and birth weight had no significant differences between groups.

Avaliação do potencial de regeneração óssea guiada e biocompatibilidade de membrana polimétrica nano estruturada à base de quitosana / Evaluation of guided bone regeneration potential and biocompatibility of nano-structured polymeric membrane based on chitosan

A regeneração óssea guiada (ROG) é uma técnica muito utilizada na odontologia para reconstrução de defeitos alveolares para posterior instalação de implantes dentários. Para que a técnica seja efetiva, uma membrana que permita o isolamento de diferentes tipos teciduais é necessária. A quitosana nanoestruturada modificada por hidróxidos duplos lamelares (HDL) é um biopolímero sintético que busca unir as características promissoras da quitosana como material bioadesivo e com propriedades antimicrobianas com a hidrocalcita buscando aprimorar suas características estruturais. O objetivo deste estudo in vivo foi avaliar a biocompatibilidade e o potencial de regeneração óssea guiada de uma nova membrana produzida à base de quitosana nanoestrutada modificada por HDL. Ratos Wistar machos adultos (n=64) foram divididos randomicamente em 2 grupos de acordo com o tratamento: Colágeno (COL) e Quitosana (QTS). Os animais foram submetidos à cirurgia para instalação de uma membrana no subcutâneo da região dorsal e à realização de 2 defeitos críticos na calota craniana, respeitando cada lado do animal. O defeito do lado direito foi coberto por uma das membranas testadas (COL ou QTS) enquanto o outro permanecia descoberto (Controle). Oito animais de cada grupo foram sacrificados em 4 tempos de acompanhamento: 3, 7, 14 e 30 dias. Amostras de calota e subcutâneo foram coletadas e preservadas em paraformaldeído 4%. As amostras de calota foram escaneadas em viii microtomógrafico para análise da quantidade de osso neoformado. Em seguida, os espécimes de calota e subcutâneo foram processados laboratorialmente para exames histológicos em parafina: para avaliação histomorfológica das características do processo cicatricial e de degradação das membranas e histomorfométrica para quantificação do processo inflamatório e do nível de reação tecidual por meio do escore global de reação tecidual (EGRT). Análises descritivas e inferenciais foram realizadas para comparação entre os grupos com nível de significância de 5%. Os resultados não demonstraram diferenças entre os grupos COL e QTS quanto à intensidade do processo inflamatório e EGRT. Já em relação aos defeitos na calota, o grupo QTS apresentou maior neoformação óssea em relação ao grupo controle aos 30 dias (p=0,04). Com base nos resultados conclui-se que as membranas de quitosana nano particuladas modificadas por HDL apresentaram biocompatibilidade compatível com a membrana de colágeno e efetividade para uso como barreira em ROG. (AU)

Guided bone regeneration (GBR) is a technique widely used in dentistry to reconstruct alveolar defects for subsequent installation of dental implants. For the technique to be effective, a membrane that allows the isolation of different tissue types is necessary. Nanostructured chitosan modified by lamellar double hydroxides (HDL) is a synthetic biopolymer that seeks to combine the promising characteristics of chitosan as a bioadhesive material with antimicrobial properties with hydrocalcite seeking to improve its structural characteristics. The objective of this in vivo study was to evaluate the biocompatibility and guided bone regeneration potential of a new membrane produced based on nanostructured chitosan modified by HDL. Adult male Wistar rats (n=64) were randomly divided into 2 groups according to treatment: Collagen (COL) and Chitosan (QTS). The animals underwent surgery to install a membrane in the subcutaneous tissue of the dorsal region and to perform 2 critical defects in the cranial vault, respecting each side of the animal. The defect on the right side was covered by one of the tested membranes (COL or QTS) while the other remained uncovered (Control). Eight animals from each group were sacrificed at 4 follow-up times: 3, 7, 14 and 30 days. Calvary and subcutaneous samples were collected and preserved in 4% paraformaldehyde. The cap samples were scanned in a microtomograph to analyze the amount of newly formed bone. Then, the cap and subcutaneous specimens were processed in the laboratory for histological examinations in paraffin: for histomorphological evaluation of the characteristics of the scarring process and membrane degradation and histomorphometric for quantification of the inflammatory process and the level of tissue reaction through the global score of tissue reaction (EGRT). Descriptive and inferential analyzes were performed for comparison between groups with a significance level of 5%. The results showed no differences between the COL and QTS groups regarding the intensity of the inflammatory process and EGRT. In relation to the defects in the calvaria, x the QTS group presented greater new bone formation in relation to the control group at 30 days (p=0.04). Based on the results, it is concluded that the nanoparticulate chitosan membranes modified by HDL showed biocompatibility compatible with the collagen membrane and effectiveness for use as a barrier in GBR. (AU)

Detergentes: De los principios físicos a las aplicaciones biofarmacéuticas (o por qué prevenimos la covid-19 con agua y jabón / Detergents: From physical principles to biopharmaceutical applications (or why we fight covid-19 with toilet soap)

Los detergentes son anfifilos solubles que poseen la capacidad de solubilizar grasas, dando lugar a micelas mixtas lípido-detergente, que son solubles en agua. Los detergentes son ampliamente utilizados en las industrias alimentaria y de bebidas, textil, médica y farmacéutica, entre otras. En biología molecular, los detergentes son herramientas insustituibles en la solubilización de las membranas celulares y la posterior purificación de proteínas de membrana. La presente revisión resume cuatro décadas de investigación sobre detergentes en el laboratorio de los autores. Una introducción sobre los detergentes y las membranas va seguida por una descripción cuantitativa detallada del mecanismo de solubilización de la membrana por los detergentes, y por una discusión crítica del concepto de membranas resistentes a los detergentes en relación con la hipótesis de las balsas lipídicas (rafts). A continuación, se incluye una sección experimental que resume los principales resultados del grupo de los autores. Finalmente, se describen algunas aplicaciones biofarmacéuticas. Como ejemplo práctico, se discute el uso de jabón de tocador en la prevención de la COVID-19. (AU)

Detergents are soluble amphiphiles that possess the capacity to solubilize fats, giving rise to water-soluble, lipid-detergent mixed micelles. Detergents find an extensive use in food and drink, textile, medical and pharmaceutical industries, among others. In molecular biology, detergents are irreplaceable tools in the solubilization of cell membranes and subsequent membrane protein purification. The present review summarizes four decades of investigation on detergents in the authors’ laboratory. An introduction on detergents and membranes is followed by a detailed, quantitative description of the mechanism of membrane solubilization by detergents, and a critical discussion of the concept of detergent-resistant membranes as related to the lipid raft hypothesis. An experimental section follows, summarizing the main results in the authors’ group. Finally, some biopharmaceutical applications are described. As a working example, the use of toilet soap in the prevention of COVID-19 is discussed. (AU)

¿Son útiles los antimicrobianos en pacientes con trabajo de parto prematuro, espontáneo, membranas intactas e infección bacteriana ascendente? Una revisión narrativa

El parto prematuro (PP) es la principal causa de morbilidad/mortalidad perinatal y frecuentemente es espontáneo, con membranas intactas (MI). La infección intrauterina es su causa más común en un hospital público de Chile. Existe evidencia que la infección bacteriana ascendente desde la vagina es responsable de la infección/inflamación intraamniótica, del PP y de los resultados adversos maternos y perinatales. Esta revisión narrativa incluye ensayos controlados aleatorizados (ECAs), publicados en PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library, sobre los mecanismos que intervienen en el ascenso de la infección vaginal, los factores infecciosos que participan en el resultado adverso materno-perinatal y la eficacia de los antimicrobianos en estos casos. Estos trabajos no recomiendan usar antimicrobianos profilácticos porque producen daño a corto y largo plazo en los hijos. Pero este resultado tiene sesgo porque no se evaluó la presencia de infección/inflamación subclínica, lo que disminuye el grado de recomendación. También existen ECAs, que erradican la infección/inflamación intraamniótica, reducen la morbilidad/mortalidad neonatal, pero son trabajos aislados, obtenidos de subanálisis, con bajo nivel de evidencia. Se requieren revisiones sistemáticas y metaanális de ECAs con estudio de infección/inflamación subclínica para evaluar si son útiles los antimicrobianos en el PP espontáneo con MI.

Preterm labor (PL) is the leading cause of perinatal morbidity/ mortality and is frequently spontaneous with intact membranes (IM). Intrauterine infection is its most common cause in a public hospital in Chile. There is evidence that ascending bacterial infection from the vagina is responsible for intraamniotic infection/inflammation, PL, and adverse maternal and perinatal outcomes. This narrative review includes randomized controlled trials (RCTs), published in PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library on the mechanisms involved in the rise of vaginal infection, the infectious factors involved in adverse maternal-perinatal outcomes, and the efficacy of antibiotics in these cases. They do not recommend the use of prophylactic antibiotics because they cause short and long-term damage to children. But this result is biased because the presence of subclinical infection/inflammation was not evaluated, which lowers the degree of recommendation. There are also RCTs that eradicate intra-amniotic infection/inflammation, reduce neonatal morbidity/ mortality, but they are isolated studies, obtained from subanalyses, with a low level of evidence. Systematic reviews and meta-analyses of RCTs with subclinical infection/inflammation study are required to assess whether antibiotics are useful in spontaneous PL with IM.

Riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria

La salud materna y perinatal es una de las prioridades actuales de la salud global. La enfermedad cardiovascular y el accidente cerebrovascular son las principales causas de mortalidad materna. La abrupción placentaria sigue siendo una preocupación crítica para la morbilidad materna debido a que se ha asociado a enfermedad vascular a largo plazo. Sin embargo, no existe mucha literatura disponible en español ni evidencia reciente que haya dilucidado algunas interrogantes sobre este tópico. Entonces, el objetivo de esta revisión consiste en sintetizar evidencia reciente sobre el riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria. Se encontró que, a través de mecanismos fisiopatológicos complejos, que involucran la estructura y funcionalidad de la red vascular placentaria con posterior extensión de lesión vascular y producción de factores proinflamatorios y procoagulantes que permanecen después del parto, se precipita la aparición de eventos cardiovasculares mayores a mediano y largo plazo. Evidencia de alta calidad ha revelado que el riesgo de sufrir de complicaciones maternas en aquellas mujeres con abrupción placentaria es de 2,14, que se eleva aún más para aquellas con desprendimiento severo. A mediano y largo plazo, el riesgo de mortalidad por cardiopatía coronaria es de 2,64, y de 1,70 para desorden cerebrovascular, con igual riesgo tanto para el tipo isquémico como hemorrágico. Entonces, se puede concluir que el riesgo cardiovascular y cerebrovascular es inminente en mujeres con antecedente de abrupción placentaria, dado por numerosos mecanismos fisiopatológicos vasculares. No obstante, este riesgo se eleva considerablemente al asociarse con factores modificables tradicionales y no tradicionales.

Maternal and perinatal health is one of today's global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors.

Correlação Inexistente entre o Ciclo Lunar no Trabalho de Parto e Ruptura Prematura de Membranas em uma Amostra de Parturientes do Sul de Santa Catarina / No Correlation between the Lunar Cycle in Labor and Premature Rupture of Membranes in a Sample of Parturients from Southern Santa Catarina

Introdução: De acordo com as culturas mais antigas, a luz da lua é responsável pela fertilidade da terra e concepção dos animais, estendendo esse entendimento ao organismo materno. Este trabalho teve como objetivo analisar a ocorrência de trabalho de parto e ruptura prematura de membranas ovulares nas diferentes fases da lua e em suas mudanças. Métodos: Amostra composta por gestantes admitidas em um hospital do sul de Santa Catarina por trabalho de parto ou ruptura prematura de membranas ovulares, no ano de 2018, baseado em informações obtidas pela análise de prontuários. Resultados: Houve discreto aumento do número de partos na lua nova (19,2%) e mudança para lua nova (11,7%), porém sem significância estatística. Motivo de internação, via de parto e paridade não estiveram associados à lua e suas mudanças de fase. Não se observou relação entre meses do ano e motivo de internação. Conclusão: Verificou-se que a lua e suas mudanças de fase não denotaram um maior número de admissões hospitalares por trabalho de parto ou ruptura prematura de membranas ovulares, contrariando a crença popular.

Introduction: According to ancient cultures, the moonlight is responsible for the fertility of the earth and the conception of animals, extending this understanding to the maternal organism. This study aimed to analyze the occurrence of labor and premature rupture of ovular membranes in different phases of the moon and its changes. Methods: The sample was composed of pregnant women admitted to a hospital in southern Santa Catarina for labor or premature rupture of ovular membranes in 2018, based on information obtained by analyzing medical records. Results: There was a slight increase in the number of deliveries during the new moon (19.2%) and a change to the new moon (11.7%) but without statistical significance. Reason for hospitalization, mode of delivery, and parity were not associated with the moon and its phase changes. No relationship was observed between the months of the year and the reason for hospitalization. Conclusion: It was verified that the moon and its phase changes did not denote a higher number of hospital admissions for labor or premature rupture of ovular membranes, contrary to popular belief.

Complicaciones materno-fetales en embarazadas añosas. Centro de salud san jacinto de buena fe, 2020 / Maternal-fetal complications in elderly pregnant women. San Jacinto de Buena Fe Health Center, 2020

El embarazo añoso representa una problemática de salud pública debido a sus repercusiones en el binomio madre-hijo. Objetivo. Determinar las complicaciones materno-fetales en embarazadas añosas atendidas en el Centro de Salud Tipo C San Jacinto de Buena Fe durante el periodo enero y diciembre del 2020. Materiales y métodos. El diseño de investigación observacional, cuantitativo, retrospectivo, descriptivo de corte transversal con una muestra de 80 gestantes mayores de 35 años, como instrumento se empleó un formulario de recolección de datos que constó de 12 ítems validados por un juicio de expertos. Resultados. Las caracteristicas sociodemográficas de interés en las pacientes del estudio fueron: grupo etario de 35-37 años con el 67,2 %, unión libre con 52,5 %, grado de instrucción primario con el 46,3 % y procedencia rural en el 95 %; entre las complicaciones maternas: ruptura prematura de membranas con el 25 %, trastornos hipertensivos en el 16,2 % y aborto espontáneo con el 13,7 %; las complicaciones fetales: prematuridad con el 17,5 %, bajo peso al nacer con el 17,5 % y síndrome de dificultad respiratoria con el 11,2%. Conclusión. Fue posible establecer las características sociodemográficas de interés en la muestra de estudio, identificar algunos factores de riesgo de complicaciones y determinar las complicaciones que comprometen a la madre y al hijo/a en embarazos de edad avanzada.

Elderly pregnancy represents a public health problem due to its repercussions on the mother-child binomial. Objective. To determine the maternal-fetal complications in elderly pregnant women treated at the San Jacinto de Buena Fe Type C Health Center during the period January and December 2020. Materials and methods. The observational, quantitative, retrospective, descriptive cross-sectional research design with a sample of 80 pregnant women over 35 years of age, as an instrument a data collection form that consisted of 12 items validated by an expert judgment was used. Results. The sociodemographic characteristics of interest in the study patients were age group 35-37 years with 67.2%, free union with 52.5%, grade of primary education with 46.3% and rural origin in 95 %; among maternal complications: premature rupture of membranes with 25%, hypertensive disorders in 16.2% and spontaneous abortion with 13.7%; fetal complications: prematurity with 17.5%, low birth weight with 17.5% and respiratory distress syndrome with 11.2%. Conclusion. It was possible to establish the sociodemographic characteristics of interest in the study sample, identify some risk factors for complications, and determine the complications that affect the mother and the child in older pregnancies(AU)

El prematuro tardío, ¿qué sabemos desde el punto de vista perinatal? / The late premature, what do we know from the perinatal point of view?

Resumen El parto prematuro es la principal causa de morbimortalidad neonatal en Chile. Los prematuros tardíos, definidos como nacimientos entre 34 semanas con 0 días (34+0) y 36 semanas con 6 días (36+6) de gestación, representan el 70-80% de los prematuros y se asocian a baja morbilidad y excepcional mortalidad si se comparan con partos bajo 34 semanas, pero significativamente mayor al compararlos con partos de término. Los prematuros tardíos son el resultado de diversas condiciones obstétricas, tales como síndromes hipertensivos del embarazo, rotura prematura de membranas, colestasia intrahepática del embarazo y comorbilidad médica. El propósito de esta revisión es actualizar la información asociada a los prematuros tardíos y dar una visión de las tendencias en el uso de corticoides y el manejo expectante de la rotura prematura de membranas con el objetivo de disminuir las complicaciones en este grupo de prematuros.

Abstract Preterm delivery is the most important cause of neonatal morbidity and mortality in Chile. Late preterm, defined as deliveries between 34 +0 and 36+6-weeks accounts for 70-80% of preterm and is associated with non-severe morbidity and extremely low mortality when compared with deliveries below 34 weeks but significantly high when compared with full term babies. Late preterm deliveries are a result of several obstetric conditions, such a hypertensive disorder, premature rupture of membranes, intrahepatic cholestasis, and maternal medical comorbidities. The purpose of this review is to update the information associated with the risks of late preterm and to guide in the new trends in the application of steroid and expectant management for premature rupture of membranes in order to reduce the frequency of late preterm.

Fibrina rica en plaquetas aplicada en conjunto con biomodificación alveolar en la regeneración ósea guiada. Reporte de caso / Platelet rich fibrin applied in conjunction with alveolar biomodification in guided bone regeneration. Case report

Resumen Debido a los diferentes problemas existentes a la hora de realizar procedimientos implantológicos por la calidad del remanente óseo y el estado de los tejidos periodontales en la zona a rehabilitar, existen opciones de regeneración ósea inducida que muestran tasas de éxito considerablemente favorables al ser empleadas en casos donde es necesario una regeneración ósea extensa capaz de soportar un implante dental. El objetivo del presente estudio es describir el éxito en la regeneración ósea por medio de alternativas combinadas de fibrina rica en plaquetas y modificación biológica con tetraciclina. Reporte del caso clínico: paciente femenina de 67 años que consulta por inflamación, supuración y dolor en la zona antero-superior. Es diagnosticada como absceso periapical crónico, se hace cirugía de extracción de órganos dentales, posterior a eso se hace descontaminación y adaptación de los alveolos con tetraciclina para realizar la regeneración ósea guiada con fibrina rica en plaquetas, hueso tipo Lumina Bone Porous y Lumina Coat, luego se espera el proceso de evolución para colocación de implantes dentales. El éxito obtenido con el uso de fibrina rica en plaquetas y la biomodificacion ósea como coadyuvante en la desinfección de la zona a tratar, logró mostrar resultados altamente favorables en el proceso de regeneración ósea guiada.

Abstract As the different problems that exist when carrying out implant procedures due to the quality of the bone remnant and the state of the existing periodontal tissues in the area to be rehabilitated, there are induced bone regeneration options that show considerably favorable success rates as they are used in cases where extensive bone regeneration is necessary to support a dental implant. The objective of the present study is to describe the success in bone regeneration using combined alternatives of platelet-rich fibrin and biological modification with tetracycline. Report of the clinical case: 67-year-old female patient consulted for inflammation and suppuration and pain in the upper antero-superior area, she was diagnosed as chronic periapical abscess, dental organ extraction surgery was performed, after that decontamination and adaptation of the alveoli was performed with tetracycline to perform guided bone regeneration with platelet-rich fibrin, Coat membrane and Lumina bone criteria, then wait for the evolution process to place dental implants. The success obtained with the use of FRP and bone biomodification as an adjuvant in the disinfection of the area to be treated achieved to show highly favorable results in the guided bone regeneration process.

Beta-gonadotropina coriónica humana cualitativa, herramienta diagnóstica de rotura prematura de membranas ovulares en Honduras / Qualitative human beta chorionic gonadotropin for the diagnosis of premature rupture of membranes in Honduras

RESUMEN Objetivo : Analizar la beta gonadotropina coriónica humana (β-hCG) cualitativa como método diagnóstico de rotura prematura de membranas ovulares (RPM). Métodos: Estudio de casos y controles, prospectivo, con muestra no probabilística por conveniencia, de 90 mujeres entre 24 y 40 semanas de gestación divididas en dos grupos: grupo de estudio (45 pacientes con diagnóstico clínico de RPM) y grupo control (45 pacientes hospitalizadas sin RPM). Se realizó lavado o aspirado vaginal para determinar cualitativamente la β-hCG en kits comerciales de medición β-hCG con umbral de 25 mUI/mL, así también la prueba en papel de nitrazina. Resultados: La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo para la prueba de β-hCG-25 fueron 77,8% (IC95%, 63,7 a 87,5), 82,2% (IC95%, 68,7 a 90,7), 81,4% y 78,7%, respectivamente. La precisión diagnóstica fue de 80,0% (0,6 índice kappa Landis & Koch) versus 75,6% para la pH-metría con nitrazina. Conclusiones: La prueba cualitativa de β-hCG mostró un valor diagnóstico representativo y puede corroborar el diagnóstico temprano de RPM, recomendándola por ser una prueba simple, rápida, accesible y de bajo costo.

ABSTRACT Objective : To analyze qualitative human beta chorionic gonadotropin (β-hCG) as a diagnostic method for premature rupture of membranes (PROM). Methods : Prospective case-control study, with a non-probabilistic sample by convenience, of 90 women between 24 and 40 weeks of gestation divided into two groups: study group (45 patients with clinical diagnosis of PROM) and control group (45 patients hospitalized without PROM). Vaginal lavage or aspirate was performed to qualitatively determine β-hCG in commercial β-hCG measurement kits with threshold of 25 mUI/mL as well as nitrazine paper test. Results : The sensitivity, specificity, positive predictive value, and negative predictive value for the β-hCG-25 test were 77.8% (95% CI, 63.7-87.5), 82.2% (95% CI, 68.7-90.7), 81.4%, and 78.7%, respectively. Diagnostic accuracy was 80.0% (0.6 Landis & Koch kappa index) versus 75.6% for nitrazine pH-metry. Conclusions : The qualitative β-hCG test showed a representative diagnostic value and can corroborate the early diagnosis of PROM, recommending it as a simple, rapid, accessible and low-cost test.

Avaliação da membrana de colágeno de peixe na regeneração óssea guiada: estudo histológico, histomorfométrico, imunoistoquímico, micro tomográfico em calotas de ratos / Evaluation of fish collagen membrane in guided bone regeneration: histological, histomorphometric, immunohistochemical, micro tomographic study on ice caps rats

O processo de regeneração óssea guiada é amplamente conhecido na literatura, e para que essa técnica possa ser realizada com sucesso a escolha da barreira biológica no tocante ao seu tempo de degradação e sua reação tecidual é de fundamental importância. Assim, o objetivo deste estudo foi avaliar o processo de reparo de defeitos ósseos críticos em calotas de ratos, utilizando o princípio de osteopromoção, comparando a membrana teste de colágeno de peixe funcionalizando com hidroxiapatita com as membrana de colágeno bovino associada à hidroxiapatita e a membrana de colágeno porcino. Para o estudo foram utilizados 96 ratos Albinus Wistar, divididos em quatro grupos, sendo 24 animais para cada grupo: Grupos BG (BioGide®); CB (ColHap®); CP (colágeno de peixe) e CG (Coágulo) analisados em quatro tempos experimentais, 7, 15, 30 e 60 dias. Os resultados mostraram um perfil inflamatório maior no grupo CP em relação aos grupos BG e CB (p< 0,05) nos primeiros 15 dias. O grupo CP, aos 60 dias apresentou um bom potencial osteopromotor ao compará-lo com o grupo BG (p = 0,199) e o grupo CB demonstrou o menor desempenho osteopromotor. Na análise tridimensional, os resultados anteriores foram confirmados com o pior desempenho em relação a menor média detecido ósseo neoformado para o grupo CP de 9,560mm3 , CB com 11,850mm3 e BG 14,247mm3 (p< 0,05). Concluí-se que as membranas aqui estudadas tiveram um bom comportamento biológico, e todas auxiliaram no processo de regeneração óssea guiada e que a membrana de colágeno de peixe teve um bom desempenho na osteopromoção óssea(AU)

Guided bone regeneration is a widely described alveolar ridge augmentation technique that has been shown to produce excellent and reproducible results with high long-term success rates in several studies. Thus, this study aimed to evaluate the bone repair of critical size defects calavaria using an osteopromotive principle the fish collagen membrane functionalized with hydroxyapatite compare to collagen membrane associated with hydroxyapatite and porcine membrane. For the study, 96 Albinus Wistar rats were used, divided into four groups, with 24 animals for each group: Groups BG (BioGide®); CB (ColHap®); CP (fish collagen) and CG (clot) analyzed in four experimental times, 7, 15, 30 and 60 days. The results showed a higher inflammatory profile in the CP group compared to the BG and CB groups (p< 0.05) in the first 15 days after the surgery. The CP group, at 60 days, showed a good osteopromotor potential when compared with the BG group (p = 0.199) and the CB group showed the smaller osteopromotor performance. In the three-dimensional analysis, the previous results were confirmed with the worst performance in relation to the lowest mean of neoformed bone tissue for the CP group of 9.56mm3 , CB with 11.85mm3 and BG 14.247mm3 (p< 0.05). In conclusion with the results obtained by this work, the membranes studied here had a good biological behavior, and all of them helped in the guided bone regeneration process and the fish collagen membrane performed well in bone osteopromotion(AU)

Caracterización tomográfica de las membranas en pacientes con hematoma subdural crónico

Introducción: El hematoma subdural crónico es un hematoma encapsulado por dos membranas interna y externa. Existen diferentes clasificaciones imagenológicas que incluyen las características de estas lesiones, pero la presencia de las membranas y sus características es un aspecto poco descrito. Objetivo: Describir las características tomográficas de las membranas de los hematomas subdurales crónicos. Métodos: Se realizó un estudio descriptivo en el Servicio de Neurocirugía en conjunto con el Servicio de Imagenología, del Hospital Universitario Manuel Ascunce Domenech durante el año 2021. Se incluyeron 20 pacientes adultos que fueron operados con el diagnóstico de hematoma subdural crónico. Las membranas se caracterizaron de acuerdo con su densidad, grosor, número de capas, morfología y extensión. Resultados: Predominaron los pacientes de más de 65 años del sexo masculino, con hematomas unilaterales más frecuentes del lado izquierdo. El volumen promedio fue de 150 ml y el diámetro fue de 3 cm. Fueron más frecuentes las membranas finas, hiperdensas, incompletas, de una sola capa y la morfología fue variable. Conclusiones: Las membranas que conforman el hematoma subdural crónico pueden observarse en la tomografía axial computarizada. Se han encontrado diferentes tipos de membranas de acuerdo con su densidad, grosor, morfología, extensión y presencia de tabiques. La presencia de una membrana gruesa o fina con tabiques, puede tener indicación de una craneotomía que permita la resección cuidadosa de la membrana parietal y la apertura suficiente de la visceral para facilitar la re expansión cerebral y disminuir la incidencia de recolecciones.

Introduction: Chronic subdural hematoma is a hematoma encapsulated by two internal and external membranes. There are different imaging classifications that include the characteristics of these lesions, but the presence of the membranes and their characteristics is a little described aspect. Objective: To describe the tomographic characteristics of the membranes of chronic subdural hematomas. Methods: A descriptive study was carried out in the Neurosurgery service in conjunction with the Imaging service of the Manuel Ascunce Domenech University Hospital during the year 2021. 20 adult patients who underwent surgery with the diagnosis of chronic subdural hematoma were included. The membranes were characterized according to their density, thickness, number of layers, morphology and extension. Results: Male patients over 65 years of age predominated, with more frequent unilateral hematomas on the left side. The average volume was 150 ml and the diameter was 3 cm. Thin, hyperdense, incomplete, single-layer membranes were more frequent, and the morphology was variable. Conclusions: The membranes that make up the chronic subdural hematoma can be seen on computerized axial tomography. Different types of membranes have been found according to their density, thickness, morphology, extension and presence of septa. The presence of a thick or thin membrane with septa may indicate a craniotomy that allows careful resection of the parietal membrane and sufficient opening of the visceral membrane to facilitate brain re-expansion and reduce the incidence of recollections.

Corioangioma asociado a rotura prematura de membranas pretérmino en gestación obtenida mediante fecundación in vitro. Presentación de un caso / Chorioangioma associated with premature rupture of preterm membranes in gestation obtained by in vitro fertilization. Presentation of a case

El corioangioma es el tumor benigno placentario no trofoblástico más frecuente, con una incidencia estimada del 1% de las gestaciones. Se presenta el caso de un corioangioma diagnosticado en una ecografía rutinaria de tercer trimestre en una gestante de edad materna avanzada cuya gestación había sido obtenida mediante técnicas de reproducción asistida. Se utilizó el ecógrafo Voluson E8 con modo 2D y Doppler color. Su imagen característica corresponde a una formación redondeada e hipoecogénica localizada en la cara fetal de la placenta. Su tamaño, sobre todo cuando es superior a 5cm, tiene importantes implicaciones pronósticas y produce afectación fetal, que puede traducirse en parto pretérmino o alteración del crecimiento fetal, entre otras. Tras el diagnóstico, debe realizarse un seguimiento periódico y requerirá tratamiento en caso de afectación materno-fetal.(AU)

Placental chorioangioma is the most common subtype of non-trophoblastic placental tumours. The incidence rate is 1% of pregnancies. We present the case of a chorioangioma diagnosed in a routine third-trimester ultrasound in a pregnant woman of advanced maternal age who conceived by assisted reproductive techniques. The Voluson E 8 ultrasound machine with 2D mode and colour Doppler was used. Chorioangioma usually presents as a single nodule in the foetal surface of the placenta. Prognosis depends on tumour size producing intrauterine growth restriction or preterm birth when the chorioangioma measures more than 5cm. After diagnosis, follow-up should be performed and treated as if there were maternal-foetal involvement.(AU)

Oclusión temporal con balón de las arterias hipogástricas en una paciente con acretismo placentario / Temporary hypogastric artery balloon occlusion in a patient with placenta accreta

El acretismo placentario es una importante causa de morbimortalidad materna. Presentamos el caso de una paciente con diagnóstico prenatal de acretismo placentario, ruptura prematura de membranas y sangrado del segundo trimestre, quien se abordó por parte de un equipo multidisciplinario. Se realizó una colocación temporal de balón oclusivo en las arterias hipogástricas previo a la cesárea-histerectomía, con buenos resultados para la madre.(AU)

Placenta accreta spectrum is an abnormal placentation that results in an increase in maternal morbidity and mortality, which mostly occurs due to severe haemorrhage. We present the case of a patient diagnosed prenatally with placenta accreta spectrum, premature rupture of membranes and bleeding, who was managed by a multidisciplinary team. Temporary bilateral hypogastric balloon occlusion was placed before caesarean hysterectomy, with good results for the mother.(AU)

Beneficios de los antibióticos en la rotura prematura de membranas de pretérmino y factores que intervienen en la eficacia del tratamiento: revisión narrativa / Benefits of antibiotics in preterm premature rupture of membranes and factors involved in the efficacy of the treatment: narrative review

Resumen El parto prematuro es la principal causa de morbilidad y de mortalidad perinatal, y hasta un tercio de los casos presentan rotura prematura de membranas. La infección intrauterina que asciende desde la vagina es su principal causa en un hospital público de Chile. Esta revisión narrativa mediante búsqueda en PubMed, Cochrane, Embase, Scielo, Science Direct y Wiley Online Library incluye estudios publicados sobre los diferentes factores infecciosos que intervienen en el resultado adverso perinatal y la eficacia de los antibióticos en la rotura prematura de membranas de pretérmino. Además, contiene recomendaciones de sociedades científicas sobre el uso de antibióticos en estos casos. Los ensayos concluyen que los antimicrobianos prolongan el embarazo, disminuyen la corioamnionitis clínica y reducen variadas morbilidades neonatales, pero no reducen la mortalidad perinatal ni las secuelas tardías en la infancia. Los resultados adversos obstétricos, especialmente los neonatales, y las secuelas dependen de la existencia de invasión microbiana de la cavidad amniótica o de infección cérvico-vaginal, de la virulencia de los microorganismos aislados, del compromiso inflamatorio/infeccioso de la placenta (corioamnionitis histológica, funisitis) y de la respuesta inflamatoria fetal. Para mejorar los resultados adversos obstétricos neonatales en la rotura prematura de membranas de pretérmino, los esquemas de antibióticos deben ser eficaces, cubriendo el amplio espectro microbiológico existente y actuando sobre los factores infecciosos implicados en la gravedad de la infección. Además, deben administrarse de manera intensiva y prolongada hasta el parto.

Abstract Preterm birth is the leading cause of perinatal morbidity and mortality, and up to a third of them have premature rupture of membranes. Intrauterine infection that rises from the vagina is its main cause in a public hospital in Chile. This narrative review by searching PubMed, Cochrane, Embase, Scielo, Science Direct and Wiley Online Library includes published studies of the different infectious factors involved in perinatal adverse outcome and of the efficacy of antibiotics in preterm premature rupture of membranes. It also contains recommendations from scientific societies on the use of antibiotics in these cases. These trials conclude that antimicrobials prolong pregnancy, decrease clinical chorioamnionitis, and reduce various neonatal morbidities, but do not reduce perinatal mortality or infant sequelae. Obstetric and especially neonatal adverse outcomes in these patients depend on the existence of microbial invasion of the amniotic cavity and/or cervicovaginal infection, of the virulence of the isolated microorganisms, of inflammatory/infectious involvement of the placenta (histological chorioamnionitis, funisitis) and fetal inflammatory response. To improve adverse neonatal obstetric outcomes in preterm premature rupture of membranes, antibiotic regimens must be effective, covering the wide existing microbiological spectrum and acting on infectious factors responsible for the severity of the infection. In addition, they must be administered aggressively and for a long time until delivery.