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2.
An. pediatr. (2003. Ed. impr.) ; 84(5): 260-270, mayo 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-151593

RESUMO

Introducción: Se analizan prácticas de reanimación neonatal en salas de partos (SP) de centros hospitalarios españoles. Métodos: Se envió un cuestionario por centro a neonatólogos responsables de la atención del RN en SP de hospitales españoles. Resultados: De 180 cuestionarios enviados, se cumplimentaron 155 (86%); 71 centros fueron de nivel I-II(46%) y 84 de nivel III (54%). La familia y el equipo médico participaron en decisiones de no reanimar o interrumpir la reanimación en el 74,2% de los centros. La disponibilidad de 2 o más reanimadores fue del 80% (94,0% en nivel II I y 63,9% en nivel I-II, p < 0,001). En un 90,3% de centros se realizan cursos de Reanimación. En centros de nivel III fueron más frecuentes los mezcladores de gases, pulsioxímetros, ventiladores manuales y envoltorios de plástico. El uso de envoltorios de polietileno fue del 63,9%. En RN a término se inició la reanimación con aire en el 89,7% de los centros. El dispositivo más usado para aplicar VPP fue el «ventilador manual» (78,6% en nivel III y 42,3% en nivel I-II, p<0,001). En el 91,7% de los centros de nivel III se utilizó CPAP precoz en prematuros. En los últimos 5 años han mejorado prácticas como son la formación de profesionales, el uso de pulsioxímetros y de CPAP precoz. Conclusiones: Existe una mejora progresiva en algunas prácticas de reanimación neonatal. Se encuentran diferencias en aspectos generales, equipamientos y protocolos de actuación durante la reanimación y transporte entre unidades de diferentes niveles (AU)


Introduction: An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. Methods: A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. Results: A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level I or II hospitals, while 84 were level III hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level I-II, and 94.0% level III,P<.001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level IIIhospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level I-IIand 83.3% level III, P<.001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level I-IIand 78.6% level III, P<.001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. Conclusions: There is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar , Salas de Parto , Equipe de Respostas Rápidas de Hospitais , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/mortalidade , Asfixia Neonatal/prevenção & controle , Pulso Arterial/instrumentação , Pulso Arterial/métodos , Pulso Arterial , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/mortalidade , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro , Inquéritos Epidemiológicos/instrumentação , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos , Espanha
3.
An. pediatr. (2003. Ed. impr.) ; 84(5): 271-277, mayo 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-151594

RESUMO

Introducción: La medición de frecuencia cardíaca (FC) es esencial durante la reanimación neonatal y se realiza habitualmente mediante auscultación o pulsioximetría (PO). El objetivo de este estudio es analizar si durante la reanimación del recién nacido prematuro la medición de la FC mediante ECG es tan precoz y fiable como la PO. Material y métodos: Se realizó video-grabación de la reanimación de 39 recién nacidos prematuros (<32 semanas o <1.500g), registrando medidas de FC simultáneamente mediante ECG y PO cada 5 s desde el nacimiento hasta los 10 min de vida. Se determinó el tiempo necesario para colocación, obtención de lectura fiable y pérdida de señal de ambos dispositivos, así como la proporción de medida fiable de FC al inicio de cada maniobra de reanimación. Resultados: El tiempo de colocación fue menor en ECG que en PO (17,10±1,28 s vs. 26,64±3,01 s; p<0,05). Igualmente, el tiempo desde el fin de la colocación hasta la obtención de una lectura fiable fue menor para ECG que para PO (26,38±3,41 s vs. 87,28±12,11 s; p<0,05). La proporción de medidas fiables de la FC al inicio de la reanimación fue menor en PO (PO vs. ECG para ventilación con presión positiva: 10,52 vs. 57,89%; p<0,05; intubación: 33,33 vs. 91,66%; p<0,05). La PO subestimó la FC con medidas inferiores a las del ECG durante los primeros 6 min de vida (p<0,05 entre los 150 y 300 s). Conclusiones: En la reanimación del prematuro la obtención de la FC fiable es más tardía con la PO que con ECG; además, la PO subestima la FC en los primeros momentos de la reanimación (AU)


Background: Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. Material and methods: Thirty-nine preterm (<32 weeks of gestational age and/or<1.500g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5s for the first 10min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. Results: Time needed to connect the ECG was shorter compared with the PO (26.64±3.01 vs. 17.10±1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28±12.11 vs. 26.38±3.41 s, for PO and ECG, respectively,P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed lower HR values during the first 6min after birth (P<.05, between 150 and 300s). Conclusions: Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Recém-Nascido Prematuro , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia , Frequência Cardíaca/fisiologia , Reprodutibilidade dos Testes , Pulso Arterial/instrumentação , Pulso Arterial/métodos , Pulso Arterial , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/mortalidade , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro , Estudos Prospectivos
4.
Acta méd. peru ; 31(2): 84-89, abr.-jun. 2014. tab
Artigo em Espanhol | PERNAL | ID: pnc-17590

RESUMO

Introducción. El parto prematuro es la causa principal de morbilidad y mortalidad neonatales. Objetivo. Determinar los resultados maternos y perinatales del manejo conservador de la ruptura prematura de membranas pretérmino en gestantes de 24 a 33 semanas, en el período 2010-2011, en el Instituto Nacional Materno Perinatal (INMP). Material y método. Estudio no experimental, observacional, retrospectivo, transversal, descriptivo desarrollado en el INMP. La población estuvo compuesta por gestantes pretérmino con ruptura prematura de membranas. Se recolectó datos registrados en las historias clínicas. Resultados. Fueron 142 casos los que culminaron el parto por cesárea (71,8%), con edad de 26,36+-7,418 años. Las nulíparas fueron más frecuentes (45,8%). La edad gestacional promedio fue 29,06+-2,590 semanas; el control prenatal promedio, 2,35+-2,101; el periodo de latencia promedio, 10,68+-12,305 días. Hubo resultados maternos en 34,5% (49 casos), donde la coriamnionitis fue el más frecuente (23,9%). Hubo resultados perinatales en 32,4% (46 casos), donde el síndrome de dificultad respiratoria fue el más frecuente (21,8). El peso promedio al nacer fue de 1 653,14g +- 460,219g. La mayoría de los recién nacidos pretérminos al nacer tuvieron buen Apgar. El promedio de días de internamiento de la madre fue de 15,30 días +- 12,912. Conclusiones. La coriamnionitis y el síndrome de dificultad respiratoria fueron los resultados maternos y perinatales más frecuentes. (AU)


Introduction. Preterm birth is the leading cause of neonatal morbidity and mortality. Objectives. Determine maternal and perinatal outcomes of conservative management of preterm premature rupture of membranes in pregnancies of 24-33 weeks in the period 2010-2011. Material and method. Non-esperimental, observational, retrospective, cross-sectional, descriptive from National Institute Maternal Perinatal. Pregnancies with preterm premature rupture of membranes. I collect it of data from medical records. Results. The were 142 cases, the culminations of the delivery via was the cesarean (71,8%), the mean age was 26,36+-7,418. The nulliparous were more frequent 45,8%. The mean gestational age was 29,06+-2,590 weeks. The mean birth control was 2,35+2,101. The mean latency period was 10,68+-12,305 days. Maternal outcomes were 34,5% (49 casos) where the chorioamnionitis was most frequent 23,9%. Perinatal outcome was 32,4% (46 cases) where respiratory distress syndrome was the most frequent 21,8%. The mean birth weight was 1 653,14g +- 460,219. Most preterm infants had good Apgar scores at birth the means days of hospitalization of the mother were of 15,30 days +- 12,912. Conclusions. The chorioamnionitis and respiratory distress syndrome were the maternal and perinatal outcomes more frequent. (AU)


Assuntos
Humanos , Feminino , Adulto , Ruptura Prematura de Membranas Fetais , Corioamnionite , Diagnóstico Pré-Natal , Trabalho de Parto Prematuro/mortalidade , Epidemiologia Descritiva , Estudos Transversais , Estudo Observacional , Estudos Retrospectivos
5.
Acta méd. peru ; 31(2): 84-89, abr. 2014. tab
Artigo em Espanhol | LILACS | ID: lil-717315

RESUMO

Introducción. El parto prematuro es la causa principal de morbilidad y mortalidad neonatales. Objetivo. Determinar los resultados maternos y perinatales del manejo conservador de la ruptura prematura de membranas pretérmino en gestantes de 24 a 33 semanas, en el período 2010-2011, en el Instituto Nacional Materno Perinatal (INMP). Material y método. Estudio no experimental, observacional, retrospectivo, transversal, descriptivo desarrollado en el INMP. La población estuvo compuesta por gestantes pretérmino con ruptura prematura de membranas. Se recolectó datos registrados en las historias clínicas. Resultados. Fueron 142 casos los que culminaron el parto por cesárea (71,8 %), con edad de 26,36 ± 7,418 años. Las nulíparas fueron más frecuentes (45,8 %). La edad gestacional promedio fue 29,06 ± 2,590 semanas; el control prenatal promedio, 2,35 ± 2,101; el período de latencia promedio, 10,68 ± 12,305 días. Hubo resultados maternos en 34,5 % (49 casos), donde la coriamnionitis fue el más frecuente (23,9 %). Hubo resultados perinatales en 32,4 % (46 casos), donde el síndrome de dificultad respiratoria fue el más frecuente (21,8 %). El peso promedio al nacer fue de 1 653,14 g ± 460,219 g. La mayoría de los recién nacidos pretérminos al nacer tuvieron buen Apgar. El promedio de días de internamiento de la madre fue de 15,30 días ± 12,912. Conclusiones. La coriamnionitis y el síndrome de dificultad respiratoria fueron los resultados maternos y perinatales más frecuentes.


Introduction. Preterm birth is the leading cause of neonatal morbidity and mortality. Objectives. Determine maternal and perinatal outcomes of conservative management of preterm premature rupture of membranes in pregnancies of 24-33 weeks in the period 2010-2011. Material and method. Non-experimental, observational, retrospective, cross-sectional, descriptive from National Institute Maternal Perinatal. Pregnancies with preterm premature rupture of membranes. I collect it of data from medical records. Results. There were 142 cases, the culmination of the delivery via was the cesarean (71,8 %), the mean age was 26,36 + 7,418 years. The nulliparous were more frequent 45,8 %. The mean gestational age was 29,06 + 2,590 weeks. The mean birth control was 2,35 + 2,101. The mean latency period was 10,68 + 12,305 days. Maternal outcomes were 34,5 % (49 cases) where the chorioamnionitis was most frequent 23,9 %. Perinatal outcome was 32,4 % (46 cases) where respiratory distress syndrome was the most frequent 21,8 %. The mean birth weight was 1 653,14 g + 460,219. Most preterm infants had good Apgar scores at birth. The mean days of hospitalization of the mother were of 15,30 days + 12,912. Conclusions. The chorioamnionitis and respiratory distress syndrome were the maternal and perinatal outcomes more frequent.


Assuntos
Humanos , Feminino , Adulto , Corioamnionite , Ruptura Prematura de Membranas Fetais , Diagnóstico Pré-Natal , Trabalho de Parto Prematuro/mortalidade
6.
BJOG ; 121 Suppl 1: 32-9, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24641533

RESUMO

OBJECTIVE: To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. DESIGN: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. SETTING: A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. SAMPLE: A total of 314 623 pregnant women admitted to the participating facilities. METHODS: We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. MAIN OUTCOME MEASURES: Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. RESULTS: Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). CONCLUSIONS: Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Centros de Saúde Materno-Infantil , Trabalho de Parto Prematuro/mortalidade , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/mortalidade , Adolescente , Adulto , África/epidemiologia , Anemia/mortalidade , Ásia/epidemiologia , Estudos Transversais , Dengue/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , América Latina/epidemiologia , Malária/mortalidade , Mortalidade Materna , Centros de Saúde Materno-Infantil/normas , Oriente Médio/epidemiologia , Razão de Chances , Gravidez , Prevalência , Fatores de Risco , Organização Mundial da Saúde , Adulto Jovem
7.
Rev. méd. Minas Gerais ; 23(3)jul.-set. 2013.
Artigo em Português, Inglês | LILACS | ID: lil-702905

RESUMO

A incidência de parto pré-termo varia de 7-12% de todas as gestações e o nascimento prematuro é das principais causas de morbimortalidade neonatal, responsável por mais de três quartos das mortes neonatais, quando malformações congênitas são excluídas. Várias estratégias são adotadas com o objetivo de reduzir as taxas de partos prematuros, incluindo a identificação de fatores de risco e o uso profilático de progesterona. Destacam-se, entre as principais ações da progesterona, o efeito relaxante sobre a musculatura uterina, a capacidade de bloquear os efeitos da ocitocina, o efeito anti-inflamatório e imunossupressor. O uso de progesterona exógena reduz as taxas de prematuridade em pacientes com risco de parto prematuro, tal como história prévia de parto prematuro, e colo uterino curto demonstrado pela ultrassonografia transvaginal no segundo trimestre de gestação. Esta revisão objetiva, inicialmente, evidenciar aspectos importantes a serem abordados na assistência ambulatorial e, posteriormente descrever as principais ações preditivas e preventivas do nascimento prematuro disponíveis na assistência obstétrica.


Incidence of preterm delivery ranges from 7-12% of all gestations and premature birth is one of the main causes for newborn morbimortality. It is responsible for over three quarters of neonatal deaths, minus congenital malformations. Several strategies can be adopted to reduce premature delivery rates, including risk factor identification and prophylactic use of progesterone. Among the main actions of progesterone is its relaxingeffect upon uterine muscles, the ability to block the effects of cytokin, and its antiinflammatory and immunosuppresive effects. The use of exogenous progesterone reduces the rates of prematurity for patients under risk of premature delivery, such as those with a history of premature deliveries, and short cervix as revealed by transvaginal ultrasound in the second quarter of pregnancy. This review aims to highlight important aspects tobe considered in the outpatient clinic and describe the main predictive and preventive actions of premature birth available in obstetric care.


Assuntos
Humanos , Feminino , Gravidez , Mortalidade Infantil , Progesterona/uso terapêutico , Trabalho de Parto Prematuro/prevenção & controle , Trabalho de Parto Prematuro/mortalidade
8.
Pediatr Neonatol ; 54(4): 267-74, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23639744

RESUMO

BACKGROUND: Chorioamnionitis is closely related to premature birth and has negative effects on neonatal morbidity and mortality. METHODS: In this prospective study, 43 mothers who delivered earlier than 35 gestational weeks and their 57 infants were evaluated clinically and with laboratory findings. Placentas and umbilical cords were investigated histopathologically for chorioamnionitis and funisitis. RESULTS: The overall frequency of clinical and histological chorioamnionitis (HCA) was 8.3% and 23.2%, respectively. The frequency of HCA was 47.3% and 83.3% in mothers delivered <32 weeks and <30 weeks, respectively. Maternal demographic and clinical findings and also leukocyte and C-reactive protein values were not indicative of HCA. Infants of mothers with HCA had significantly lower Apgar scores together with higher SNAP-PE-II and CRIB scores. These infants had increased mechanical ventilator and surfactant requirements, higher incidences of patent ductus arteriosus, early sepsis, and bronchopulmonary dysplasia, and higher mortality rates. The effect of HCA on neonatal morbidity and mortality was more prominent than the effect of low birthweight and lower gestational age. CONCLUSION: Chorioamnionitis not only causes premature deliveries, but is also associated with neonatal complications and increased mortality. Clinical findings and infectious markers in mother or infant do not predict the diagnosis of histological chorioamnionitis. Therefore, placental histopathology may have a role in predicting neonatal outcome in premature deliveries, especially those below 30 weeks.


Assuntos
Corioamnionite/patologia , Doenças do Prematuro/mortalidade , Doenças do Prematuro/patologia , Recém-Nascido Prematuro , Trabalho de Parto Prematuro/patologia , Adulto , Índice de Apgar , Proteína C-Reativa/análise , Estudos de Casos e Controles , Corioamnionite/mortalidade , Feminino , Ruptura Prematura de Membranas Fetais/patologia , Idade Gestacional , Humanos , Imuno-Histoquímica , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Contagem de Leucócitos , Masculino , Idade Materna , Trabalho de Parto Prematuro/mortalidade , Placenta/patologia , Valor Preditivo dos Testes , Gravidez , Prognóstico , Estudos Prospectivos , Medição de Risco , Taxa de Sobrevida , Turquia , Cordão Umbilical/patologia
9.
Dtsch Arztebl Int ; 110(13): 227-35; quiz 236, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23596503

RESUMO

BACKGROUND: The percentage of preterm births in Germany is high at 9%, but stable. 77% of cases of perinatal death are in prematurely born infants. Intensive research efforts are being directed toward the development of new means of primary and secondary prevention, diagnostic assessment, and pharmacotherapy of premature labor. METHODS: We review pertinent publications that were retrieved by a selective search of the literature from 1966 to 2012, including current meta-analyses from the Cochrane database and the guidelines of German and foreign obstetric societies. RESULTS: Preterm labor is a multifactorial problem. The current treatment options are symptomatic, rather than causally directed. Preventive treatment with progesterone can lower the rate of preterm birth in high-risk groups by more than 30%. Transporting the pregnant women to an appropriately qualified perinatal care center and induction of fetal lung maturation lowers perinatal mortality. A variety of tocolytic drugs with different mechanisms of action (betamimetics, oxytocin antagonists, calcium-channel blockers, NO donors, and inhibitors of prostaglandin synthesis) can be used for individualized tocolytic treatment. Premature rupture of the membranes is an indication for antibiotics. CONCLUSION: The goal of all attempts to prevent and treat preterm labor is to improve preterm infants' chances of surviving with as few complications as possible. The methods discussed here can be used to prolong pregnancies at risk for preterm labor and so to reduce perinatal morbidity and mortality.


Assuntos
Mortalidade Infantil , Idade Materna , Trabalho de Parto Prematuro/terapia , Fumar/mortalidade , Comorbidade , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/mortalidade , Gravidez , Prevalência , Medição de Risco , Classe Social , Análise de Sobrevida , Taxa de Sobrevida
10.
Pak J Biol Sci ; 16(9): 446-50, 2013 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-24498811

RESUMO

Severe Preeclampsia may lead to liver and renal failure, Disseminated Intravascular Coagulopathy (DIC) and Central Nervous System (CNS) abnormalities. This study aimed at comparing of infant complication in premature labor between severe preeclampsia and normal pregnancies. In this analytical-descriptive study, one hundred pregnant with severe preeclampsia and premature delivery due to severity of preeclampsia were compared with one hundred cases of premature delivery without preeclampsia to study neonatal fate. The understudy subjects were divided into five age groups of 27-28, 29-30, 31-32, 33-34, 35-36 weeks considering type of delivery, neonate features and neonatal complications related to premature delivery. Mean age of mothers of normal delivery group was 27.28 +/- 5.42 mean age of mothers of the second group was 30.56 +/- 5.86. There was statistically meaningful difference between two groups of delivery regarding patients' systolic blood pressure (p < 0.001). The study made it clear that there was not statistically meaningful difference between two groups of delivery regarding fetus age (in weeks) at the time of delivery (p = 0.456). According to findings of this study, neonatal complications and mortality is high in preeclampsia due to stressful conditions created for the fetus.


Assuntos
Recém-Nascido Prematuro , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/diagnóstico , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Trabalho de Parto Prematuro/mortalidade , Trabalho de Parto Prematuro/fisiopatologia , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/fisiopatologia , Gravidez , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
13.
Rev. méd. hondur ; 80(4): 145-152, oct.-dic. 2012. tab
Artigo em Espanhol | LILACS | ID: lil-699555

RESUMO

Antecedentes: El parto prematuro está dentro de las principales causas de muerte neonatal a nivel mundial siendo, los prematuros vulnerables a la sepsis y sus complicaciones, generando un gran impacto a la salud, economía y la educación del país. Por lo que se planteó realizar este estudio con el objetivo de conocer la caracterización epidemiológica y factores de riesgo en recién nacidos prematuros atendidos en el Hospital Dr. Juan Manuel Gálvez, Gracias, Lempira, Honduras, 2011. Materiales y método: Estudio analítico retrospectivo de casos y controles; se realizó búsqueda de expedientes en el departamento de estadística del Hospital Juan Manuel Gálvez de enero a junio de 2011, por cada caso se tomaron dos controles de manera aleatoria; se utilizó el programa Epi Info 3.5.3 en donde analizamos medidas de frecuencia absoluta, tendencia central, razones, proporciones para las características epidemiológicas y, Odds Ratio e intervalo de confianza al 95%, para los factores de riesgo, tablas y gráficos se utilizó el programa Microsoft Excel 2010. Resultados: se incluyeron 29 casos de prematurez y 58 controles, encontrándose significancia estadística, sólo en las siguientes variables maternas: edad menor de 18 años OR 4,71(IC95% 1.40 -16.2), periodo intergenésico menor o igual a 2 años OR 5,8 (IC95% 1,03-35,07); madre con 4 o menos controles prenatales OR4,05 (IC95% 1,22-13.91), infección del tracto urinario OR 4,77 (IC95% 1,25-18.99), patología materna durante el embarazo, OR 3,99 (IC95%1,35-12,00) y anemia OR 17,5 (IC95% 3,08-129,90). Discusión: La determinación de los factores de riesgo de prematuridad constituye el primer paso para su prevención en una población determinada, a través de los resultados de este estudio se puede concluir que los factores fetales como el sexo masculino, presencia de malformaciones congénitas o productos de embarazo múltiple están relacionados al riesgo de prematurez y que los factores maternos como el embarazo...


Assuntos
Recém-Nascido , Mortalidade Infantil , Sepse/complicações , Trabalho de Parto Prematuro/mortalidade , Cuidado Pré-Natal/métodos , Recém-Nascido de muito Baixo Peso
14.
Rev. méd. hondur ; 80(4): 153-157, oct.-dic. 2012. tab, graf
Artigo em Espanhol | LILACS | ID: lil-699556

RESUMO

Antecedentes: Mundialmente, entre 8 y 10% de partos son prematuros. La Organización Mundial de la Salud estimó para Honduras en 2010 que el 12% de los partos serían prematuros. En el Departamento de Lempira, durante el 2009 el 41% de muertes neonatales fueron atribuidas a la prematurez. Objetivo: Identificar factores asociados al parto prematuro. Pacientes y métodos: Estudio de cohorte prospectivo, realizado en el departamento de Lempira, occidente de Honduras, la muestra fue de 367 mujeres embarazadas seleccionadas de un universo de 8,148 reportadas por 87 centros de salud. Se seleccionaron embarazadas con fecha de última menstruación conocida y con fecha de parto en 2010. Definiendo parto prematuro al ocurrido entre las 22 y 36 semanas gestacionales; parto a término al ocurrido a las 37 o mas semanas gestacionales. Se obtuvo datos de la historia clínica y entrevista a las mujeres. Se calculó medidas de tendencia central y de asociación (riesgo relativo RR) con intervalos de confianza al 95% (IC95%), usando Epi info version 3.5.3. Resultados:De 367 embarazadas seleccionadas, se conoció el descenlace en 358 (98%). Ocurrieron partos prematuros en 27/358 (7.5%) rango 0-20 en los municipios. 284/358 (80%) fueron partos institucionales, 22/284 (8%) de ellos prematuros. El tener bacteriuria (RR=3.21; 95%CI 1.00- 10.28), < 3 atenciones prenatales (RR=2.59; IC95%=1.20-5.60, p <0.02) y > 4 hijos (RR=2.38; IC95%=1.14-4.97, p <0,02) fue asociado con parto prematuro. Conclusiones: El parto prematuro en el Departamento de Lempira esta asociaciado con bacteriuria, pocas atenciones prenatales y multiparidad, observando variaciones entre municipios. Para reducir partos prematuros, se ha monitorizado la cantidad y calidad de atenciones prenatales y focalizando la oferta de métodos de planificación familiar en multíparas. Se Recomienda realizar estudios en municipios con altas tasas de parto prematuro...


Assuntos
Gravidez , Cuidado Pré-Natal/métodos , Morte Fetal , Trabalho de Parto Prematuro/mortalidade , Planejamento Familiar , Atenção Primária à Saúde
16.
J Matern Fetal Neonatal Med ; 25(9): 1622-6, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22220678

RESUMO

INTRODUCTION: Thrombocytopenia affects about 10% of all pregnancies. Preeclampsia/HELLP syndrome induced thrombocytopenia may associate perinatal morbidity, preterm delivery, or low-birth-weight newborns. OBJECTIVE: To assess perinatal outcome and complications of pregnancy in women presenting with thrombocytopenia. METHODS: We retrospectively analyzed 936 consecutive pregnant women admitted during a 6-month period. RESULTS: Incidence of thrombocytopenia in pregnancy was 11.11% (104/936). Thrombocytopenia represented a risk factor for premature delivery - highest risk for severe thrombocytopenia (RR=8.69, p<0.01). Thrombocytopenic preeclampsia or HELLP syndrome associated the highest rates of prematurity (RR=7.97, p=0.00, respectively 12.32). Thrombocytopenia also represented a risk factor for low-birth-weight newborns, especially severe thrombocytopenia - 2047.50 ± 938.98 g (p=0.02) versus 3224.86 ± 496.00 g in controls. Again, thrombocytopenic preeclampsia was significantly associated with low-birth-weight newborns (RR=11.94, p=0.00), with medium weight of 2462.05 ± 794.54 g versus 2932.37 ± 708.91 g in thrombocytopenic pregnancies, respectively 3224.86 ± 496.00 g (p=0.00) in normal pregnancies. CONCLUSIONS: Thrombocytopenia in pregnancy was associated with perinatal morbidity, with the strongest association for preeclampsia and HELLP syndrome - for both prematurity and low-birth-weight: the lower the platelet count, the higher the risks for the fetus/newborn. Therefore, we strongly recommend close surveillance of thrombocytopenic mothers and their babies, in order to establish the etiology and the best moment for intervention.


Assuntos
Complicações Hematológicas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Trombocitopenia/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Síndrome HELLP/epidemiologia , Síndrome HELLP/mortalidade , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/mortalidade , Morbidade , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/mortalidade , Mortalidade Perinatal , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/mortalidade , Gravidez , Complicações Hematológicas na Gravidez/mortalidade , Estudos Retrospectivos , Trombocitopenia/mortalidade , Adulto Jovem
17.
In. Santiesteban Alba, Stalina. Obstetricia y perinatología. Diagnóstico y tratamiento. La Habana, Ecimed, 2012. , ilus, tab.
Monografia em Espanhol | CUMED | ID: cum-53315
18.
An. pediatr. (2003, Ed. impr.) ; 75(3): 169-174, sept. 2011. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-94264

RESUMO

Introducción: Los recién nacidos pretérmino tardíos, entre las 34-36+6 semanas de edad gestacional son fisiológicamente más inmaduros que los recién nacidos a término y, por tanto, tienen mayor riesgo de morbi-mortalidad. Dado que los resultados de salud en la prematuridad pueden variar en función de factores locales nos hemos propuesto conocer en nuestro medio las complicaciones que presentan a corto plazo estos recién nacidos. Pacientes y métodos: Estudio observacional retrospectivo de los recién nacidos ≥ 34 semanas de edad gestacional ingresados en el Hospital Virgen del Rocío desde Mayo de 2005 hasta diciembre de 2008. Dividimos la población en dos grupos: pretérmino tardío (34-36+6 semanas de edad gestacional, n = 769) y a término (37-41+6 semanas de edad gestacional, n = 1.460) comparando la mortalidad y la morbilidad a corto plazo entre los dos grupos. Resultados: La prematuridad tardía se asoció con la reproducción asistida, la gestación gemelar, la preclampsia materna y el parto por cesárea. El riesgo de ingreso hospitalario fueseis veces mayor en estos recién nacidos, siendo cerca de dos veces mayor la necesidad de ingreso en la unidad de cuidados intensivos neonatal. El tiempo de estancia hospitalaria fue el doble en este grupo. En cuanto a los motivos de ingresos, se evidenció una mayor incidencia de distrés respiratorio e ictericia. La necesidad de surfactante, oxigenoterapia y soporte respiratorio (presión positiva continua en la vía aérea y ventilación mecánica convencional) fue igualmente mayor. No hubo diferencias significativas entre ambos grupos en relación con la presencia de hipoglucemia que precisara ingreso ni en cuanto a la mortalidad neonatal. Conclusiones: Los recién nacidos pretérmino tardíos de nuestro medio representan un colectivo bien definido de riesgo de presentar complicaciones por lo que deben disponerse los recursos necesarios para su atención diferenciada (AU)


Introduction: Late preterm infants, born at 34-36+6 weeks gestation, are physiologically more immature than term infants. As a consequence, they have an increased risk of morbidity and mortality. Since health outcomes in prematurity may change depending on local factors we have proposed determine the short-term medical problems of these infants in our hospital. Patients and methods: A retrospective observational study was carried out on all newborn ≥ 34 weeks gestation admitted to Virgen del Rocio hospital from May 2005 to December 2008. We divided this cohort into late preterm (34-36+6 weeks, n = 769) and term (37-41+6 weeks, n = 1460) groups. We compared mortality and morbidity data between the 2 groups. Results: Late preterm group was associated with assisted reproduction, twin pregnancy, caesarean delivery and preeclampsia during pregnancy. The risk of hospitalization was six times greater in these infants and neonatal intensive care admissions were twice as common. The hospital stay was double in this group. Neonatal respiratory morbidity and jaundice were greater in the preterm group. The use of surfactant, oxygen and respiratory support (CPAP and CMV ) was also higher. There were no significant differences in hypoglycaemia and neonatal mortality between both groups. Conclusions: Late preterm infants represent a well-defined risk group for developing complications and should be available the necessary resources should be made available for their special care (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/mortalidade , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Trabalho de Parto Prematuro/classificação , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Hiperbilirrubinemia Neonatal/epidemiologia , Terapia Intensiva Neonatal , Pré-Eclâmpsia/epidemiologia , Cesárea/efeitos adversos , Estudos Retrospectivos , Técnicas de Reprodução Assistida/efeitos adversos , Gravidez Múltipla
19.
Ultraschall Med ; 32 Suppl 2: E157-61, 2011 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-21877316

RESUMO

PURPOSE: Umbilical vein pulsations (UV-P) are due to various etiologies. The aim of the present study was to investigate the incidence and type of UV-P in monochorionic twins with twin-twin transfusion syndrome (TTTS). MATERIALS AND METHODS: TTTS cases diagnosed between 1999 and 2009 were examined retrospectively. The UV flow pattern taken from a free floating loop of the umbilical cord was classified as "non-pulsatile" (NP), "monophasic" (MP) and "complex" (CP). Only Doppler flow analyses prior to intervention were examined. RESULTS: Of 106 cases seen during the study period, 56 cases met the inclusion criteria. Of those, 62.5% were classified as stage III TTTS, and fetoscopic laser therapy was performed in 45 cases. NP flow patterns were more likely found in the donor twin (80.4 vs. 28.6%; p < 0.0001), while the incidence of MP (50 vs. 17.9%; p < 0.0006) and CP flow patterns (21.4 vs. 1.7%; p < 0.01) was higher in the recipient twin. Moreover, the perinatal mortality was highest in cases with CP (CP: 76.9 vs. MP 42.1 vs. NP: 26.2%; p < 0.01) as well as the rate of cases with double death. CONCLUSION: CP patterns are more frequently found in the recipient twin and are associated with a considerably high mortality rate. Studying the umbilical vein flow pattern in TTTS may provide additional information for counseling and prognosis similar to that obtained by expensive fetal echocardiography.


Assuntos
Transfusão Feto-Fetal/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Gravidez de Alto Risco , Fluxo Pulsátil/fisiologia , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Veias Umbilicais/diagnóstico por imagem , Aborto Eugênico , Feminino , Morte Fetal , Transfusão Feto-Fetal/mortalidade , Transfusão Feto-Fetal/cirurgia , Fetoscopia , Humanos , Recém-Nascido , Fotocoagulação a Laser , Trabalho de Parto Prematuro/diagnóstico por imagem , Trabalho de Parto Prematuro/mortalidade , Gravidez , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Am J Reprod Immunol ; 66(4): 310-9, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21410810

RESUMO

PROBLEM To identify the prognostic factors for pregnancy outcome in women who received emergency cerclage for dilated cervix with protruding membranes. METHOD OF STUDY A prospective cohort study was performed, and a total of 14 women who received emergency cerclage were included. Clinical features and laboratory findings including amniotic fluid cytokines and chemokines were compared between women who had successful pregnancy (survival group, n = 6) and those who had perinatal death (non-survival group, n = 8). Five healthy pregnant women served for normal controls for amniotic fluid study. RESULTS The overall neonatal survival was 42.9% in women with emergency cerclage. Serum C-reactive protein levels on postoperative day 3 and 7 were significantly higher in non-survival group when compared with those in survival group (P = 0.002, P = 0.01). Amniotic fluid levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor-α, and monocyte chemoattractant protein-1 levels of the patients were significantly higher than those of normal controls. Amniotic fluid levels of IL-1α, IL-1ß, and IL-8 were significantly increased in the non-survival group when compared with those of the survival group. CONCLUSION Systemic and local inflammatory markers including proinflammatory cytokines and chemokines may predict pregnancy outcome in women with emergency cerclage for dilated cervix with protruding membranes.


Assuntos
Biomarcadores/análise , Proteína C-Reativa/análise , Cerclagem Cervical , Corioamnionite , Citocinas/biossíntese , Trabalho de Parto Prematuro , Adulto , Líquido Amniótico/química , Líquido Amniótico/citologia , Estudos de Casos e Controles , Corioamnionite/imunologia , Corioamnionite/mortalidade , Corioamnionite/patologia , Corioamnionite/cirurgia , Citocinas/análise , Serviço Hospitalar de Emergência , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Trabalho de Parto Prematuro/imunologia , Trabalho de Parto Prematuro/mortalidade , Trabalho de Parto Prematuro/patologia , Trabalho de Parto Prematuro/cirurgia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , República da Coreia/epidemiologia
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