Principales causas de riesgo obstétrico en el centro de salud "Roberto Astudillo" de la cuidad de Milagro enero-junio 2019 / Main causes of obstetric risk in the center of health "Roberto Astudillo" of the city of milagro

Un factor de riesgo obstétrico es una condición médica obstétrica o sociodemográfica que, en una mujer gestante puede ocasionar un aumento en la morbimortalidad que repercute como ya se ha mencionado a nivel materno -fetal con respecto al resto de la población. Objetivo: El objetivo primordial de evaluar el riesgo obstétrico, es poder realizar acciones preventivas que encaminen a evitar complicaciones que comprometan la vida materno fetal. Materiales y Métodos: Investigación cuantitativa documental, retrospectiva de corte transversal descriptivo. La investigación es cuantitativa, porque se obtiene datos los cuales son procesados, documental, porque toma la información de historia clínica que reposa en el área de estadística del centro de Salud Roberto Astudillo. Resultados: Dentro de los factores desencadenantes del alto riesgo obstétrico se encuentra el embarazo gemelar, y los embarazos mal controlados; entendiendo que el Síndrome de Hellp puede ser prevenible si hay un control exhaustivo desde el primer trimestre del embarazo, sobre todo cuando hay antecedentes de preeclampsia. Por otro lado, en los hábitos psicobiológicos se obtuvo una incidencia alta de consumo de café, de medicamentos, de consumo de alcohol y de pacientes con hábitos tabáquicos abandonados en el primer trimestre del embarazo (hábitos tóxicos). Aunque no hay una teoría que determine que el consumo de café influye directamente sobre la tensión arterial, se sabe, que las teofilinas estimulan los receptores B1 y B2 trayendo esto como consecuencia un leve incremento de la frecuencia cardíaca, y por ende un ligero incremento de la presión arterial. Conclusiones: Mantener una política de conducta expectante, generalmente incluye la atención intrahospitalaria con corticoides para la maduración pulmonar fetal, sulfato de magnesio (según sea necesario), antihipertensivos (según sea necesario) y monitoreo fetal y materno cuidadoso para identificar las indicaciones para el parto (por ejemplo, hipertensión no controlada, deterioro del estado de la madre y del feto, incluidos disfunción orgánica y sufrimiento fetal). Como parte de la conducta expectante, debe considerarse el traslado intraútero (antes del parto) a un centro de nivel terciario con capacidad para cuidados intensivos neonatales(AU)

An obstetric risk factor is a medical condition, obstetric or sociodemographic that, in a pregnant woman, can cause a increase in morbidity and mortality that has repercussions, as already mentioned, maternal-fetal level with respect to the rest of the population. Objective: The objective essential to assess the obstetric risk is to be able to carry out preventive actions that lead to avoid complications that compromise maternal and fetal life. Materials and Methods: Documentary quantitative research, retrospective of descriptive cross section. The research is quantitative, because it is obtained data which are processed, documentary because it takes the information from clinical history that rests in the statistics area of ​​the health center Robert Astudillo. Result: Within the triggering factors of the high obstetric risk is found in twin pregnancy, and miscarriages controlled; understanding that Hellp Syndrome can be preventable if there is comprehensive control from the first trimester of pregnancy, especially when there is a history of preeclampsia. On the other hand, in habits psychobiological results, a high incidence of coffee consumption, of drugs, alcohol consumption and patients with smoking habits abandoned in the first trimester of pregnancy (toxic habits). But not there is a theory that determines that coffee consumption directly influences on blood pressure, it is known that theophyllines stimulate B1 receptors and B2 bringing this as a consequence a slight increase in the frequency heart rate, and therefore a slight increase in blood pressure. Conclusions: Maintaining a watchful waiting policy generally includes inpatient care with corticosteroids for fetal lung maturation, magnesium sulfate (as needed), antihypertensives (as needed necessary) and careful fetal and maternal monitoring to identify indications for delivery (eg, uncontrolled hypertension, impaired of the condition of the mother and fetus, including organ dysfunction and distress fetal). As part of watchful waiting, transfer should be considered. intrauterine (before delivery) to a tertiary-level facility with the capacity to neonatal intensive care(AU)

Afectividad y Apoyo Social Percibido en Mujeres Gestantes: un Análisis Comparativo / Affectivity and Perceived Social Support in Pregnant Women: A Comparative Analysis / Afetividade e Apoio Social Percebido em Mulheres Gestantes: uma Análise Comparativa

Resumen El propósito de esta investigación es comparar las manifestaciones afectivas en sus dimensiones positivas y negativas, a modo de rasgo y de estado, con variables ginecobstétricas y de funcionamiento familiar en mujeres gestantes. Se seleccionaron a conveniencia 229 mujeres que ingresaron a una institución prestadora de servicios de salud en Medellín. Se utilizaron los cuestionarios PANAS (Robles & Páez, 2003), APGAR-familiar (Smilkstein, 1978) y una encuesta de variables sociodemográficas. Se encontró que las gestantes con mayor rasgo afectivo positivo presentan menor riesgo obstétrico, mientras que las mujeres con mayor rasgo afectivo negativo demuestran menor planeación del embarazo y mayor percepción de disfunción familiar. Se concluye que la percepción de apoyo familiar y los rasgos emocionales positivos son componentes que favorecen la salud gestacional, mientras que el afecto negativo es un obstáculo para la adaptación a la maternidad y las relaciones familiares percibidas.

Abstract The purpose of this research was to compare positive and negative expressions of affectivity, both as a trait and as a state, with gyneco-obstetric and family functioning variables in pregnant women. 229 women attending a health services provider in Medellín were selected through convenience sampling. The PANAS (Robles & Páez, 2003) and family-APGAR (Smilkstein, 1978) questionnaires were used, along with a survey of socio-demographic variables. According to the findings, women with higher positive affective traits show lower obstetric risk, while those with higher negative affective traits feature less planning of the pregnancy and a greater perception of family dysfunction. It was possible to conclude that the perception of family support and positive affective traits are elements that favor health during pregnancy, while negative affect constitute an obstacle for adaptation to motherhood and for the perceived family relations.

Resumo O propósito desta pesquisa é comparar as manifestações afetivas em suas dimensões positivas e negativas, a modo de traço e de estado, com variáveis ginecobstétricas e de funcionamento familiar em mulheres gestantes. Foram selecionadas convenientemente 229 mulheres que deram entrada em uma instituição prestadora de serviços de saúde em Medellín. Foram utilizados os questionários PANAS (Robles & Páez, 2003), APGAR-familiar (Smilkstein, 1978) e um inquérito de variáveis sociodemográficas. Descobriu-se que as gestantes com maior traço afetivo positivo apresentam menor risco obstétrico, enquanto as mulheres com maior traço afetivo negativo demonstram menor planejamento da gravidez e maior percepção de disfunção familiar. Conclui-se que a percepção de apoio familiar e os traços emocionais positivos são componentes que favorecem a saúde gestacional, enquanto o afeto negativo é um obstáculo para a adaptação à maternidade e para as relações familiares percebidas.

Características clínicas, epidemiológicas y riesgo obstétrico de las pacientes con preeclampsia-eclampsia / Clinical, epidemiological and obstetric risk characteristics of patients with preeclampsia-eclampsia

Introducción: la preeclampsia es un trastorno multisistémico cuyos criterios clínicos no han cambiado en la última década. De acuerdo con la OMS, la incidencia de preeclampsia oscila entre el 2 y 10% del total de embarazos, y su prevalencia es siete veces mayor en los países en vías de desarrollo que en los países desarrollados. Objetivo: describir las características epidemiológicas, clínicas y antecedentes obstétricos de las pacientes con diagnóstico de preeclampsia-eclampsia de la unidad de cuidados intensivos adultos (UCIA). Métodos: estudio descriptivo transversal retrospectivo, se incluyeron 20 expedientes clínicos de las pacientes entre 13 y 45 años de edad, con embarazo ≥ 20 semanas de gestación de la unidad de cuidados intensivos adultos, con diagnóstico confirmado de preeclampsia-eclampsia. Se aplicó un instrumento diseñado para el estudio. Resultados: edad promedio de 28.45 ± 6.57 años. El 55% presentó preeclampsia severa y síndrome de HELLP el 60%. Con estancia en la UCIA de 2.4 ± 1.43 días. Conclusiones: aunque los datos no fueron suficientes para documentar, la proporción de pacientes con hipertensión arterial y antecedentes de preeclampsia, así como, hipertensión arterial de comorbilidad fue superior a lo referido en un estudio con embarazadas en Colombia de 12.4%.

Introduction: Preeclampsia is a multisystem disorder whose clinical criteria have not changed in the last decade. According to the WHO, the incidence of preeclampsia varies between 2% and 10% of all pregnancies, and its prevalence is seven times higher in developing countries than in developed countries. Objective: To describe the epidemiological and clinical characteristics and obstetric history of patients diagnosed with preeclampsia-eclampsia of the adult intensive care unit (ICU). Methods: A retrospective cross-sectional descriptive study, 20 clinical files were included of patients between 13 and 45 years of age, with pregnancy ≥ 20 weeks gestation of the adult intensive care unit, with a confirmed diagnosis of preeclampsia- eclampsia. An instrument designed for the study was applied. Results: Average age 28.45 ± 6.57 years. 55% presented severe preeclampsia and HELLP syndrome 60%. With a stay in the UCIA of 2.4 ± 1.43 days. Conclusions: Although the data were not enough to document, the proportion of patients with hypertension and a history of preeclampsia, as well as, comorbidity hypertension were higher than that reported in a study with pregnant women in Colombia of 12.4%.

Schizophrenia and Its Association with Biological and Environmental Factors: A Community Based Study.

Aims: The aim of this study was to examine the proportion of probable schizophrenia in Arab population visiting primary health care centers and investigate its associated biologic and environmental factors. Study Design: Cross sectional study. Place and Duration of Study: Primary Health Care (PHC) centres, Supreme Council of Health, Qatar, between January 2009 to December 2010. Subjects: Of 1491 Arab patients approached, 1148 patients agreed to participate in the study (77%). Methods: The study was based on a face to face interview with a designed questionnaire including socio-demographic, biologic and environmental factors. A diagnostic screening questionnaire which consisted of 6 questions about the symptoms of schizophrenic disorders was used for the diagnosis of schizophrenia. Results: Of the studied subjects, 11.7% of them were diagnosed with schizophrenia. A significant association was observed between schizophrenic and non-schizophrenic patients in terms of age group (p=0.048), BMI (p=0.019), gender (p=0.027), ethnicity (p=0.008), marital status (p=0.001), occupation (p<0.001), household income (p<0.001) and place of residence (p=0.039). Obstetric complications were significantly higher in schizophrenic patients with a higher frequency of pregnancy stress (31.3%; p<0.001) and diabetes (20.1%; p=0.008). Among the obstetric complications, Rhesus incompatibility (OR 2.74; 95% CI (1.16-6.47); P=0.021) and pregnancy stress (OR 2.51; 95% CI (1.60-3.94); P<0.001) were the major predictors for the development of schizophrenia. Delivery complications of asphyxia (17.9%; p=0.003), uterine atony (10.4%; p=0.028) and emergency caesarean section (17.2%; p=0.024) were significantly higher in mothers of the patients. Urban upbringing (OR 1.60; 95% CI (1.02 - 2.50); P<0.037) and social isolation (OR 1.72; 95% CI (1.06-2.74); P<0.027) were the main significant environmental risk factors for schizophrenia. Conclusion: An increasing schizophrenia risk with obstetric complications was observed in the study sample. Rhesus incompatibility and pregnancy stress were the main predictors for schizophrenia.

Fatores relacionados a infecções de sítio cirúrgico apósprocedimentos obstétricos / Factors related to surgical site infections after obstetric procedures

Objetivos: A infecção de sítio cirúrgico representa a segunda maior causa de infecções hospitalares e uma das principais complicações no pós-parto. O presente estudo teve como objetivo descrever características e fatores de risco presentes em puérperas que tiveram infecção de sítio cirúrgico.Métodos: Um estudo transversal retrospectivo foi realizado no Hospital Fêmina, incluindo os partos ocorridos de janeiro de 2009 a dezembro de 2010. De um total de 9528 partos, foram detectados e avaliados 110 prontuários de pacientes com diagnóstico de infecção de sítio cirúrgico após parto vaginal ou cesáreo.Resultados: Foi encontrada taxa de infecção de sítio cirúrgico de 1,53% para cesarianas e de 1,01% para partos vaginais (risco relativo 1,5; IC 95% 1,3-1,7). Entre as pacientes com infecção de sítio cirúrgico, muitas tinham baixo nível socioeconômico, eram obesas e não haviam sido submetidas a uma correta antibioticoprofilaxia no pré-parto.Conclusões: O risco de desenvolver infecção foi uma vez e meia maior após um parto cesáreo do que após um parto vaginal. Os índices de infecção de sítio cirúrgico pós-parto encontrados neste estudo, assim como algumas características das pacientes que desenvolveram infecções, reforçam a importância de identificar possíveis fatores de risco presentes e de buscar a prevenção nas pacientes obstétricas com a normatização de condutas, incluindo o uso correto de antibioticoterapia profilática.

Aims: Surgical site infection is the second main cause of nosocomial infections and a major complication during postpartum period. This study aimed to describe characteristics and risk factors found in puerperal women who had surgical site infection.Methods: A retrospective cross-sectional study was conducted at Hospital Femina, Porto Alegre, Rio Grande do Sul, Brazil, including deliveries from January 2009 to December 2010. From a total of 9528 deliveries, 110 records of patients diagnosed with surgical site infection after vaginal delivery or cesarean section were detected and analyzed.Results: We found a rate of surgical site infection of 1.53% for cesarean deliveries and of 1.01% for vaginal deliveries (RR 1.5, 95%CI 1.3-1.7). Among the patients with surgical site infection many had low socioeconomic status, were obese and had incorrect administration of antibiotic prophylaxis in pre-partum.Conclusions: The risk of infection was one and a half times greater after a caesarean section than after a vaginal delivery. The rates of postpartum surgical site infection found in this study, as well as some characteristics of the patients who developed infections, stress the importance of identifying potential risk factors and to seek prevention in obstetric patients through standards of practice that include proper use of prophylactic antibiotics.

Factores de riesgo asociados a síntomas depresivos post parto en mujeres de bajo riesgo obstétrico atendidas en el sistema público / Risk factors for post partum depression

Background: Postpartum depression (PPD) is a public health problem with high prevalence in Chile. Many factors are associated with PPD. Aim: To analyze the factors associated with the incidence of depressive symptoms (SD) in women with low obstetric risk. Material and Methods: Cross-sectional analytical study on a sample of 105 postpartum women with low obstetric risk assessed by the Edinburgh Depression Scale at the eighth week postpartum. Results: A 37% prevalence of depressive symptoms was found. Univariate analysis showed that the perception of family functioning, overcrowding and number of siblings, were significantly associated with postpartum depressive symptoms. A multiple regression model only accepted family functioning as a predictor of depression. Conclusions: Perception of family functioning was the only variable that explained in part the presence of depressive symptoms in women with low obstetric risk.

¿Cincuenta años, el límite para donación de ovocitos en la posmenopausia? / Is reaching fifty the limit for oocyte donation in postmenopausal women?

Introducción: el número de mujeres que actualmente postergan su embarazo se encuentra en aumento, de igual forma el número de parejas que recurren a los programas de medicina reproductiva es cada día mayor. La donación de ovocitos ha permitido la consecución de embarazos en mujeres posmenopáusicas; sin embargo, no existe consenso sobre cuál es la edad máxima de la receptora. Objetivo: proponer un límite máximo para ofrecer donación de ovocitos de acuerdo al tiempo de crianza. Conclusión: debido a un mayor tiempo de crianza, se propone la donación de ovocitos hasta los 50 años.

Introduction: the number of females who now postpone their decision to become pregnant is increasing and the number of couples who use reproductive medicine programmes becomes greater every day. Oocyte donation has enabled postmenopausal women to become pregnant, even though no consensus has been reached concerning the maximum age for receiving such treatment. Objective: it is proposed that a maximum age limit be imposed for receiving a donation, due to increased upbringing time. Conclusion: patients should only be offered the chance to receive ovodonation up to age 50 due to the pertinent upbringing time occurring later in life.

Evaluación periódica del riesgo biopsicosocial prenatal en la predicción de las complicaciones maternas y perinatales en Asia 2002-2003 / Periodical assessment of the prenatal biopsychosocial risk to predict obstetric and perinatal complications in Asian countries 2002-2003

Objetivo: Describir el nivel de predicción de las complicaciones obstétricas y perinatales mediante la evaluación periódica del riesgo biopsicosocial prenatal (RBP) durante el control prenatal en mujeres asiáticas. Materiales y métodos: Durante el 2002 se evaluaron en Shanghai, China y Dhaka, Bangalesh 565 primigrávidas sanas con evaluaciones periódicas del RBP (primera: semana 14-27, segunda: semana 28-32, tercera: semana 33-42) con evaluación prospectiva del resultado materno y perinatal. Resultados: La edad promedio fue 25.1±6.4 años en su mayoría de nivel socioeconómico medio, con formación universitaria y residencia urbana. Se observaron 135 (23.9%) complicaciones obstétricas, 57 (10.1%) recién nacidos con bajo peso y 41 (7.3%) muertes perinatales. El alto riesgo biopsicosocial prenatal se asoció con las complicaciones obstétricas (área bajo la curva ROC) 0.80 IC 95% 0.71-0.89 con el parto prematuro (área bajo la curva ROC) 0.79, IC 95% 0.68-0.90) y con el bajo peso al nacer (área bajo la curva ROC) 0.85, IC 95% 0.77-0.93. El período con mayor efectividad predictiva fue el último (33-42 semanas) tanto para las complicaciones obstétricas (sensibilidad: 84.4%, especificidad: 69.3%), como para el parto prematuro (sensibilidad: 79.2%, especificidad: 67.1%) como para el bajo peso al nacer (sensibilidad: 88% especificidad: 77.3%). A pesar de las diferencias basales sociodemográficas, nutricionales, étnicas, culturales y religiosas de los dos países el efecto predictivo del instrumento fue similar. Conclusión: La evaluación del riesgo biopsicosocial prenatal fue clínicamente válida para predecir complicaciones obstétricas, parto prematuro y bajo peso al nacer en los países asiáticos comparable a los resultados en Latino-América.

Objective: To determine the effect of the periodical use of the prenatal biopsychosocial risk assessment (PBR) to predict obstetric and perinatal complications in pregnant women in Asian countries. Materials and methods: In Shanghai, China, and Dhaka, Bangladesh, 565 healthy primigravids were evaluated with PBR at inclusion (14-27 weeks), in a second time (28-32 weeks) and in a third time (33-42 weeks) with assessment of the perinatal outcome. Results: The average age was 25.1±6.4 years old. Most of the women were from middle socioeconomic level, with university academic degree and urban residence. There were 129 (25.6%) obstetric complications, 54 (10.1%) low birth weight babies and 41 (7.3%) perinatal deaths. The ROC analysis showed that the high PBR score was associated with obstetric complications (area under ROC Curves) 0.80 CI 95% 0.71-0.89, preterm birth (area under ROC curves) 0.79, CI 95% 0.68-0.90, low birth weight (area under ROC curves) 0.85, CI 95% 0.77-0.93. The best predictive period was the last (33-42 weeks) to obstetric complications (sensibility: 84.4%, specificity: 69.3%), preterm delivery (sensibility 79.2%, specificity 67.1%) and to low birth weight (sensibility 88%, specificity 77.3%). The baseline sociodemographic and nutritional characteristics and the perinatal outcome were different between the countries, however, the predictive effect of the instrument was similar. Conclusion: The prenatal biopsychosocial risk assessment was clinically valid to predict obstetric complications, preterm birth and low birth weight in two Asian countries when compared to results in Latin-American countries.