RESUMO
Endometritis is subdivided into two categories. Acute endometritis is symptomatic and characterized by microabscess formation and neutrophil invasion in the endometrial superficial epithelium, gland lumina, and uterine cavity. Chronic endometritis is rather silent and recognized as unusual plasmacyte infiltration in the endometrial stromal areas. Over the last decade, studies have disclosed the potential association between poor reproductive outcomes and endometritis, particularly chronic endometritis. The aim of this review is to address the current literature surrounding chronic endometritis and highlight recent advances in the research of this long-neglected gynecologic disease.
Assuntos
Endometrite/terapia , Endométrio/microbiologia , Endométrio/fisiologia , Infertilidade Feminina/terapia , Microbiota/fisiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Doença Crônica , Endometrite/complicações , Endometrite/microbiologia , Endométrio/efeitos dos fármacos , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/microbiologia , Microbiota/efeitos dos fármacos , GravidezRESUMO
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 , Índice de Vulnerabilidade Social , Modelos de Assistência à SaúdeRESUMO
Chronic endometritis (CE) is a local inflammatory disease characterized by unusual plasmacyte infiltration in the endometrial stromal areas. CE has been neglected in gynecologic practice, as it is a less symptomatic benign disease that requires demanding and time-consuming histopathologic examinations for the definite diagnosis. Recent studies, however, suggest the association of CE with infertility and obstetric and neonatal complications. In this review article, we aimed to update the knowledge on epidemiology, etiology, and pathogenesis of CE as well as discuss its clinical management from diagnosis to treatment.
