Decision-to-delivery interval and obstetric outcomes of emergency caesarean sections in a Nigerian teaching hospital

Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients' relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foetomaternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutesas a benchmark.

Maternal and neonatal outcome in pregnancy bbeyond 41 Weeks of Gestation: Observational study

Background: Pregnancy beyond term is associated with adverse maternal and perinatal outcome. The aim of the study was to estimate the maternal and perinatal outcome in pregnancies at and beyond 41weeks of gestation. It was a prospective study of 140 patients with pregnancy beyond Methodology:41weeks fulfilling the eligibility criteria and admitted and delivered in department of obstetrics and gynaecology at a tertiary care hospital. We examined its association with following outcomes: age, parity, genetic factors, bishop's score at admission, mode of delivery, induction rate, meconium stained amniotic fluid, oligohydramnios, perinatal and neonatal morbidity, perineal tear, postpartum haemorrhage, maternal morbidity and mortality etc. Results:Out of 140 patients, majority was the age group of 21-25 years, 68 (48.6%) patients were primigravida while 72 (51.4%) patients were multigravida. Maximum patients 65% were not in labour whereas 35% were in labour. In 51 (36.4%) patients mode of delivery was caesarean section, in which most common indication being foetal distress in 25.5% followed by meconium stained amniotic fluid in 17.6%. In present study perinatal morbidity like stillbirth, RDS were 2.86% & 25.8% respectively. Maternal morbidity like PPH, tear and wound infection were 4.31%, 6.4%, 0.7% respectively. Conclusions: With Regular antenatal check-up, incidence of post term pregnancy can be decreased and labour induction should be considered at 41weeks to prevent maternal and perinatal complications.

Fetomaternal outcome in women with hemolysis, elevated liver enzymes and low platelet count syndrome: a retrospective study

Background: HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome which is a variant form of severe preeclampsia is an important cause of maternal and fetal mortality and morbidity. The importance lies in the early diagnosis and timely intervention for better fetal and maternal outcome. The objective of this study was to assess the maternal and fetal outcome in pregnancies complicated with HELLP syndrome.Methods: This is a retrospective study analyzing fetomaternal outcome in 63 women diagnosed with HELLP syndrome in the department of obstetrics and gynecology, Government Medical College, Thrissur from 1st January 2014 to 31st December 2016. Details were collected from data records library.Results: Among 7,566 deliveries, 63 women (0.83%) had HELLP syndrome. Mean age was 29.5 years. 47.6% (n=30) women developed HELLP syndrome at gestational age less than 34 weeks. Maternal complications were abruption (27.78%), acute kidney injury (16.67%), DIC (16.67%), sepsis (11.11%) and postpartum hemorrhage (11.11%). In this study, HELLP syndrome lead to one maternal death (1.58%). The perinatal mortality was 25.75%.Conclusions: HELLP syndrome is an alarming complication, which brings high maternal and perinatal morbidity and mortality.

Study of maternal and fetal outcome in postdate pregnancy in tertiary care hospital

Background: Fetal, neonatal and maternal complications associated with pregnancy beyond 40 weeks have always been underestimated. However emerging evidence demonstrates that the incidence of complications increases after 40 weeks of gestation. The present study was conducted to find out the fetomaternal outcome of such prolonged pregnancy.Methods: This was a prospective cross-sectional study of 70 patients with uncomplicated prolonged pregnancy fulfilling the inclusion and exclusion criteria and admitted in department of obstetrics and gynecology at a tertiary care hospital B. J. Medical College, Ahmedabad, Gujarat, India.Results: Out of 70 patients, majority of the subjects belongs to 26-30 years of age (50%). The gestational age of 90% of patients were between 40-42 weeks. About 42-44% of the foetus had a birth weight of 2.5-3.5 kgs. Maximum patients underwent vaginal deliveries in spontaneous group (57%) and 64% underwent LSCS in induced group. Mode of delivery is significantly associated with presence of adequate liquor.Conclusions: With regular antenatal check-up, incidence of postdate pregnancy can be decreased and it is important because of definite risk to fetus as pregnancy continuing beyond 40 weeks of gestation is associated with increased perinatal morbidity and mortality especially those who do not come for regular antenatal check-up.

Fetomaternal outcome in pregnancy with gestational thrombocytopenia: a cross sectional study

Background: Thrombocytopenia is second to anemia as the most common haematological abnormality during pregnancy. Objective of this study was to study the clinical profile, maternal and perinatal outcomes in thrombocytopenic antenatal patients.Methods: A prospective study was carried out in tertiary hospital, 280 pregnant women who attended the Antenatal clinic regularly were enrolled. All were screened for thrombocytopenia in third trimester (after 28 weeks), women with normal platelet (n=140) were taken in control group and those with low counts less than 150×109/L (n=140) were included in study group. Maternal and fetal outcome of thrombocytopenia in third trimester of pregnancy were studied.Results: Majority of women with gestational thrombocytopenia had mild thrombocytopenia (70.71%). 30.72% patients with thrombocytopenia had hemorrhagic manifestations. Maternal and perinatal complications like PPH (27.14%), puerperial sepsis (9.28%), placental abruption (5%), need for transfusion (20%), neonatal jaundice (20%), neonatal thrombocytopenia (12.14%), birth asphyxia (12.86%), NICU admission (12.14%), low Apgar (37.14%), need for resuscitation (30%), were more in patients with thrombocytopenia as compared to their age and parity matched controls.Conclusions: According to this study results, pregnancies with gestational thrombocytopenia, as compared to the control group, were at a higher risk of cesarean section, intrauterine fetal death, preterm delivery, low Apgar scores, more NICU admission rate, intracranial hemorrhage, neonatal death, or adverse maternal outcome.

Study of obstetric and perinatal outcome of twin pregnancy

Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies.

Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome.

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

A prospective study of maternal factors and perinatal outcome of preterm birth

Background: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality, henceforth being a major concern for the obstetricians and paediatricians as well being a major health care issue. Preventing and treating the associated risk factors could play a major role in curbing the perinatal morbidity and mortality.Methods: A total 100 women with preterm labour or an indicated preterm termination of pregnancy were enrolled in the study. They were evaluated by history taking, clinical examination, and ultrasonography. Corticosteroids were given to all the patients. Maternal risk factors, obstetric outcome and perinatal outcome till discharge were studied.Results: Of the 100 women studied, mean age of the cases was 27 years, 60% of the cases belonged to lower socio-economic class, 74% of the cases were under 55 kgs weight group and 77% of cases were anaemic. 34% cases were below 34 weeks of gestation, 58% were multigravida, and 2% grand multipara with 35% labour being induced labour because of presence of various risk factors such as preterm premature rupture of membranes (PPROM), pre-eclampsia, eclampsia and chorioamnionitis. 6% cases had multiple pregnancies and 8% had history of preterm delivery in previous pregnancy. Out of 107 babies, 73% neonates required neonatal intensive care unit (NICU) admission and there was 12.14% neonatal mortality rate.Conclusions: Anaemia, malnutrition, infection, high order pregnancy are the preventable causes of preterm birth which can be prevented, screened and treated by specialised antenatal programs.

Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia in Rajarajeswari Medical College, Bangalore

Introduction: Eclampsia and pre-eclampsia is an acute life threatening complication of pregnancy. They are the leading causeof maternal and perinatal morbidity and mortality.Aim: To study the maternal and perinatal outcome in severe pre-eclampsia and eclampsia.Methods: A prospective study carried on 50 pregnant women admitted with severe pre-eclampsia and eclampsia in RajarajeswariMedical College and Hospital.Results: Out of the 50 cases, majority of the cases were transferred cases (56%) and 80% of the cases belonged to the agegroup of 20 to 30 years. Majority of the cases were seen in primigravida (58%). There was high incidence of PPH (70%), abruptioplacenta (4%), HELLP syndrome (6%). Perinatal complication were also high, 60% were low birth weight, 20% were preterm,16% were IUFD, three cases had doppler changes and three neonates had to be ventilated.Conclusion: There is high maternal and perinatal morbidity and mortality. Good and regular antenatal care can help preventpre-eclampsia and eclampsia. Therefore, proper and frequent antenatal care id needed for high risk pregnant women.

Maternal and perinatal morbidity and mortality in severe pre-eclampsia and eclampsia in a tertiary care hospital: a prospective study

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. In India, they account for the third most important cause of maternal mortality. The objective of this study was to evaluate maternal and perinatal outcome and complications in cases with severe pre-eclampsia and eclampsia and measures to prevent them.Methods: A prospective study was carried out on 100 patients with severe pre-eclampsia and eclampsia in tertiary care referral hospital over a period of one year i.e. from November 2017 to October 2018. Only those cases with initial blood pressure reading of ≥160/110mmHg or presenting with eclampsia were in included in the study. Detailed history and examination was carried out. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed.Results: 48% of women were between 21-25 years age, 82% were from rural area, and 86% cases were unbooked, 68% cases were primigravida. Liver Function Tests were deranged in 18% of the patients and 19% had abnormal Renal Function Tests. Labetalol was the most commonly used antihypertensive. Lower segment cesarean section was the mode of delivery in 59% of the cases. Most common maternal complication was Eclampsia. There were 5 maternal deaths i.e. maternal death rate was 5%. 54.3% of live births needed NICU admission and out of these 50% were preterm deliveries.Conclusions: Accessible healthcare and health education and awareness regarding antenatal checkup for all women will lead to early detection of severe pre-eclampsia. Hence, early treatment and management of patient’s complications will certainly improve the maternal and perinatal outcome.

Perinatal outcomes in abruptio placenta

Background: Abruptio placentae is an obstetric emergency where placenta completely or partially separates before delivery of the baby. It occurs approximately in one in 120 deliveries. It is an important cause of perinatal morbidity and mortality.Methods: This was a prospective hospital-based study design conducted over a period of 2 years, in the Department of Obstetrics and Gynecology at a tertiary care hospital in Mumbai comprising of 60 cases.Results: The incidence of abruption placentae in Present study is 0.51%. Authors had perinatal mortality in 6.6% of the cases. Out of 60 cases, 2 deaths occurred in utero. Out of the remaining 58 cases, 24 babies needed NICU care, out of them, 22 went home alive and 2 had neonatal deaths. Perinatal morbidity in the form of hyperbilirubinemia, CNS depression, septicemia, neonatal anemia and neonatal DIC were noted.Conclusions: High incidence of perinatal mortality in abruptio placentae is because of increased number of still births. In our studies, the perinatal mortality is 6.6% as compared to all other studies. This decline in perinatal mortality is due to improved obstetric care and excellent NICU facilities which are required for a majority of the cases.

Retrospective Analysis Of Incidence And Outcome Of Peripartum Cardiomyopathy Patients In Emergency Obstertic Cases In Rural Tertiary Care Hospital

Peri -partum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy .It is life threatening but potentially treatable heart failure affecting women during peripartum period. The aim of the study was to determine the incidence and outcome of peripartum cardiomyopathy(PPCM) patients in emergency obstetric cases over one and half year period in our college hospital. It is a retrospective observational study in emergency obstetric patient with total of 16 patients with PPCM was diagnosed in total of 10560 deliveries conducted at Government Theni Medical College Hospital between January 2017-July2018. Most of the patients are young with mean age of27.3±4.29 years ,with multigravida(62.5%).Many of them were diagnosed in postpartum period(75%).The most common risk factor was pre eclamsia(37.5%).The mean ejection fraction was found to be 30.93±7.4%.There were two maternal mortality (12.5%) and two cases refered to GRH Madurai(12.5%).Women presenting with heart failure during peripartum period should be evaluated for PPCM. Early detection and perfect management of cardiac failure provides a better prognosis

A Prospective Study on Role of IV Amino Acid Infusion in Improving Pregnancy Outcome in Cases of Oligohydramnios

Background: Adequate Amniotic fluid volume is essential for the normal growth and well-being of the foetus. Diminished liquor or oligohydramnios is quite often associated with abnormal foetal outcomes such as intrauterine growth restriction, foetal anomaly malpresentation, post maturity syndrome and foetal distress in labour Methods: The present study was conducted in the Department of Obstetrics and Gynecology, PMCH, Udaipur during the period of March 2015 to February 2016. The study group comprised of 50 clinically and sonographically proven cases of oligohydramnios in third trimester attending antenatal clinic and those admitted in antenatal ward and clean labour room at random. Results: Maximum no. (72% of patients) were in age group of 20-25 years and only 2 patients were less than 20years of age. 68% cases were from urban and 32% were from rural areas, as urban population is more aware about prenatal care. higher incidence of oligohydramnios cases were belonging to lower and middle class families i.e. 44% and 40% respectively and only 8 patients were from upper socio-economic status. Conclusion: it is suggested that for idiopathic oligohydramnios, intravenous aminoacid may prove useful in reducing maternal morbidity and perinatal morbidity and mortality and improving pregnancy outcome in developing countries.

Multiple pregnancy: epidemiology and association with maternal and perinatal morbidity / Gestação múltipla: epidemiologia e associação com morbidade materna e perinatal

Abstract Twin pregnancy accounts for 2 to 4% of total births, with a prevalence ranging from 0.9 to 2.4% in Brazil. It is associated with worse maternal and perinatal outcomes. Many conditions, such as severe maternal morbidity (SMM) (potentially life-threatening conditions and maternal near-miss) and neonatal near-miss (NNM) still have not been properly investigated in the literature. The difficulty in determining the conditions associated with twin pregnancy probably lies in its relatively low occurrence and the need for larger population studies. The use of the whole population and of databases from large multicenter studies, therefore, may provide unprecedented results. Since it is a rare condition, it ismore easily evaluated using vital statistics from birth e-registries. Therefore, we have performed a literature review to identify the characteristics of twin pregnancy in Brazil and worldwide. Twin pregnancy has consistently been associated with SMM, maternal near-miss (MNM) and perinatal morbidity, with still worse results for the second twin, possibly due to some characteristics of the delivery, including safety and availability of appropriate obstetric care to women at a high risk of perinatal complications.

Resumo A gestação gemelar é responsável por 2 a 4% do total de nascimentos, com uma prevalência variando de 0,9 a 2,4% no Brasil. Ela é associada a piores resultados maternos e perinatais. Muitas condições, como amorbidade materna grave (condições potencialmente ameaçadoras da vida e near-miss materno) e near-miss neonatal ainda não foram investigadas de forma apropriada na literatura. A dificuldade na determinação de condições associadas com a gestação gemelar provavelmente reside em sua ocorrência relativamente baixa e na necessidade de estudos populacionais maiores. O uso da população total e de bancos de dados de grandes estudosmulticêntricos podem então fornecer resultados sem precedentes. Considerando que esta é uma condição rara, ela émais facilmente avaliada usando estatísticas vitais de registros eletrônicos de

Morbimortalidad perinatal en pacientes con rotura prematura ovular ≤24 semanas según cantidad de líquido amniótico al momento del diagnóstico / Perinatal morbidity and mortality in patients with premature ovular rupture ≤24 weeks according to amount of amniotic fluid at diagnosis

Introducción: La rotura prematura ovular (RPO) antes de la viabilidad fetal consiste en una complicación obstétrica de baja incidencia, pero de alta morbimortalidad perinatal asociada. Estudios sugieren que el volumen de líquido amniótico (LA) es un factor importante a considerar. El objetivo de este trabajo es evaluar si en RPO ≤24 semanas, un bolsillo vertical máximo (BVM) <2cm al diagnóstico es un factor de riesgo para aparición de morbimortalidad fetal y neonatal. Métodos: Estudio de cohorte longitudinal retrospectivo de 94 pacientes con RPO ≤24 semanas ingresadas a un hospital terciario para manejo expectante entre los años 2005 y 2014. Embarazo gemelar o malformaciones congénitas fueron criterios de exclusión. Se obtuvieron y compararon 2 grupos según BVM al ingreso (BVM ≥ 2 cm y BVM < a 2 cms) y se comparó la edad gestacional (EG) al momento de la RPO y al parto, la latencia desde la RPO al parto, la presencia de corioamnionitis clínica, el número de óbitos fetales, muerte neonatal precoz (primeros 7 días de vida), tardía (entre los 7 y 28 días) y sobrevida global. Resultados: El 58 por ciento de las pacientes presentó un BVM <2 cm al ingreso, el cual se asoció a menor latencia al parto (p:0,01), menor EG al parto (p:0,02), más óbito fetal (p:0,04), mayor muerte neonatal precoz y tardía (p:0,02 y 0,01 respectivamente) además de menor sobrevida global (p:0,01). Conclusiones: La medición de BVM <2 cm al ingreso en pacientes con RPO ≤24 semanas, es un factor de mal pronóstico y debe ser considerado en el manejo clínico de estas pacientes.(AU)

Introduction: Previable premature rupture of membranes (pPROM) is a low-incidence obstetric complication associated with high perinatal morbidity and mortality. Studies suggest that the volume of amniotic fluid (AL) is an important factor to consider. The aim of this study is to evaluate if in RPO ≤24 weeks, a maximum vertical pocket (MVP) <2 cm to the diagnostic is a risk factor for fetal and neonatal morbidity and mortality. Objectives: Evaluate fetal and neonatal morbidity and mortality according to amniotic fluid (AL) Maximum Vertical Pocket (MVP) ≥ or

Trastornos hipertensivos durante el embarazo en gestantes del Policlínico Universitario Santa Clara (2015-2016) / Hypertensive disorders during pregnancy in the University Polyclinic Santa Clara (2015-2016)

Introducción: la preeclampsia es la complicación médica más frecuente del embarazo. En Cuba se ha encontrado una incidencia entre 5 y 10 por ciento, y constituye una de las primeras causas de morbilidad materna y perinatal. Objetivos: describir el comportamiento de los trastornos hipertensivos en las gestantes. Métodos: se realizó una investigación de tipo descriptiva transversal en el Policlínico Santa Clara en el periodo 2015-2016. La población de estudio estuvo constituida por la totalidad (210) las gestantes que pertenecen al policlínico Santa Clara, para la selección de la muestra se empleó un muestreo no probabilístico por criterios, quedando finalmente constituida por 52 pacientes. Resultados: los trastornos hipertensivos del embarazo es una entidad frecuente en el área de salud con repercusión sobre las tasas de morbilidad materna en 20 pacientes (38,5 por ciento), la morbilidad perinatal en 17 pacientes (32,7 por ciento) y la mortalidad en 2 pacientes (3,8 por ciento). Conclusiones: estos trastornos se presentan más en mujeres en las edades extremas de la vida reproductiva y con trastornos nutricionales. Las hipercolesterolemia y la HTA crónica están entre las principales afecciones asociadas. Se presentó mayormente en nulíparas y primíparas con embarazos a término completos y hubo elevado índice de inducciones del parto y cesáreas. La morbilidad puerperal fue elevada con prevalencia de la anemia y también tuvo repercusión sobre el peso y estado de los recién nacidos(AU)

Introduction: Preeclampsia is the most frequent medical complication of pregnancy. In Cuba, an incidence of between 5 and 10 percent has been found and is one of the earliest causes of maternal and perinatal morbidity. Objectives: to describe the behavior of hypertensive disorders in pregnant women. Methods: a cross-sectional descriptive study was carried out in the Santa Clara Polyclinic in the period 2015-2016. The study population consisted of all the (210) pregnant women who belonged to the Santa Clara polyclinic. For the selection of the sample a non-probabilistic sampling was used by criteria, and finally it was constituted by 52 patients. Results: hypertensive disorders of pregnancy are a frequent entity in the health area with repercussions on maternal morbidity rates in 20 patients (38.5 percent), perinatal morbidity in 17 patients (32.7 percent) and mortality in 2 patients (3.8 percent). Conclusions: these disorders present more in women in the extreme ages of reproductive life and with nutritional disorders. Hypercholesterolemia and chronic hypertension are among the main associated conditions. It was present mainly in nulliparous and primiparous women with full term pregnancies and there was a high index of labor induction and cesarean section. Puerperal morbidity was high with prevalence of anemia and also had an impact on the weight and condition of newborns(AU)

Hipoxia perinatal en el Hospital Mederi de Bogotá: comportamiento en los años 2007 a 2011 / Perinatal hypoxia at Hospital Mederi in Bogotá: behavior in the period 2007-2011

RESUMEN Objetivo Identificar los factores de riesgo maternos, fetales y neonatales asociados a la hipoxia perinatal en los recién nacidos del Hospital Universitario Mayor Mederi (HUM Mederi), período 2007 a 2011. Metodología Del total de recién nacidos (8 837) en los años 2007 a 2011, en el HUM Mederi, se tomaron los casos que presentaron asfixia perinatal (AP) según la ACOG u otro diagnóstico de Dificultad Respiratoria (DR). Fuente: Registros del sistema informático de Servicio de Neonatología del Hospital Universitario Mayor Mederi. Se analizaron los factores de riesgo materno, fetal y neonatal. Los datos se mostraron de acuerdo al número de recién nacidos en cada grupo y en forma porcentual. Resultados La tasa de mortalidad global fue de 10,7. Los valores más bajos fueron en los años 2010 y 2011: 3.3 y 1.8 respectivamente. Diabetes gestacional, hipertensión, corioamnionitis y placenta previa fueron más frecuentes en el grupo con DR, mientras que hipoglicemia y sepsis lo fueron en el grupo con AP así como hipotonía e hipoacti-vidad entre las alteraciones neurológicas. Fue baja la correspondencia entre las alteraciones neurológicas y el Test de Apgar en los casos diagnosticados con AP. Conclusiones La tasa de mortalidad fue muy baja comparada a nivel regional y local. Hubo mayor número de recién nacidos con asfixia perinatal moderada. Los resultados del estudio coinciden con lo reportado. El mayor número de pre-término en los recién nacidos con DR enfatiza la importancia de controlar el implemento de acciones para disminuir los factores de riesgo asociados a esta condición.

ABSTRACT Objective To identify maternal, fetal and neonatal risk factors associated with perinatal hypoxia in neonates at Hospital Universitario Mayor Mederi (HUM Mederi) from 2007 to 2011. Methodology In the period 2007-2011, 8 837 children were born in HUM Mederi. Only the cases that presented with perinatal asphyxia (PA), according to the American Congress of Obstetricians and Gynecologists (ACOG), or another respiratory distress (RD) diagnosis were considered for this analysis, based on the computer records of the Neonatology Service in HUM Mederi. Maternal, fetal and neonatal risk factors were analyzed. Data were shown according to the number of newborns in each group and their percentage. Results The overall mortality rate was 10.7. The lowest values were found in 2010 and 2011 (3.3 and 1.8, respectively). Gestational diabetes, hypertension, chorioamnionitis and placenta previa were more frequent in the RD group, whereas hypoglycemia, sepsis, hypotonia and hypoactivity among neurological alterations were more common in the PA group. Correspondence between neurological alterations and Apgar Test was low in the cases diagnosed with PA. Conclusions The mortality rate was very low compared to regional and local levels, and more infants presented with moderate perinatal asphyxia. These results coincide with literature reports. The high number of preterm births with DR emphasizes the importance of controlling the implementation of actions to reduce the risk factors associated with this condition.

Factores de riesgo asociados a asfixia perinatal en el Hospital Universitario Méderi, 2010-2011 / Risk Factors Associated with the Diagnosis of Perinatal Asphyxia at Méderi University Hospital, Bogotá, 2010-2011 / Fatores de Risco Associados a Asfixia Perinatal no Hospital Universitário Méderi, 2010-2011

Resumen Introducción: La hipoxemia secundaria a complicaciones fetales u obstétricas es causa de asfixia perinatal (AP) y lesión cerebral en el recién nacido; del 15 al 20 % de estos niños mueren durante el período neonatal y 25% de los que sobreviven presentan déficit neurológicos permanentes. Objetivo: Determinar factores de riesgo anteparto, intraparto y fetales asociados al diagnóstico de AP en los recién nacidos del servicio de neonatología del Hospital Universitario Mayor Méderi de Bogotá, durante los años 2010-2011. Materiales y métodos: Estudio retrospectivo de casos y controles pareado por fecha de nacimiento, con una relación 1:5 (51:306). Los casos de asfixia perinatal se diagnosticaron según los criterios de la Academia Americana de Pediatría y el Colegio Americano de Ginecología y Obstetricia. Las asociaciones se evaluaron con la prueba de Chi-cuadrado de Mantel y Haenszel o el Test de Fisher para datos pareados, con OR e intervalo de confianza del 95%. El análisis multivariado se realizó con un modelo de regresión logística condicional. Resultados: Factores de riesgo con asociación significativa: Ante parto: antecedentes patológicos maternos y primigestación. Intraparto: desprendimiento prematuro de placenta, hemorragia en el tercer trimestre, oligohydramnios, taquicardia fetal, monitoreo fetal intraparto anormal, expulsivo prolongado, fiebre materna, corioamnionitis, convulsiones maternas y bradicardia fetal. Fetales: edad gestacional por Ballard igual o < 36 semanas, vía del nacimiento instrumentado, líquido amniótico hemorrágico o teñido de meconio, circular de cordón, peso al nacer igual o < 2500 gramos. Los subrayados y el síndrome hipertensivo asociado al embarazo se encontraron como factores de riesgo significativos en el análisis multivariado. Conclusiones: El reconocimiento y el control temprano de los factores de riesgo deben contribuir a disminuir la probabilidad de asfixia perinatal en los recién nacidos.

Abstract Introduction: Hypoxemia due to fetal or obstetric complications causes perinatal asphyxia and brain injury among newborn babies. Between 15-20% of those affected die during the neonatal period and 25% of those who survive have permanent neurological deficits. Objective: To determine risk factors for the antepartum, intrapartum, and neonatal periods associated with perinatal asphyxia among newborns at Méderi University Hospital in Bogotá in 2010-2011. Materials and Methods: Case-matched controls by date of birth with a ratio of 1:5 (51:306). Cases of perinatal asphyxia were diagnosed as established by the American Academy of Pediatrics and the American College of Gynecology and Obstetrics. Associations were assessed using the Chi-square Mantel-Haenszel test or Fisher for paired data with odds ratio and confidence interval of 95 %, multivariate analysis with conditional logistic regression model. Results: The risk factors with significant association previous to birth were: Maternal medical history and primigestation. Intrapartum: Placental abruption, hemorrhage of the third quarter, oligohydramnios, fetal tachycardia, abnormal intrapartum fetal monitoring, prolonged expulsive stage, maternal fever, maternal convulsions, chorioamnionitis, and fetal bradycardia. Fetal: gestational age equal or Ballard <36 weeks, instrumented birth, bleeding or meconium-stained amniotic fluid, nuchal cord and birth weight equal to or <2500 grams. Underlined factors and hypertensive syndrome associated with pregnancy were significant in multivariate analysis. Conclusions: The early recognition and control of risk factors should contribute to decrease the probability of perinatal asphyxia among newborns.

Resumo Introdução: A hipoxemia secundária a complicações fetais ou obstétricas é causa de asfixia perinatal e lesão cerebral no recém-nascido; 15 a 20% destas crianças morrem durante o período neonatal e 25% dos que sobrevivem, apresentam déficit neurológicos permanentes. Objetivo: Determinar fatores de risco anteparto, intraparto e fetais associados ao diagnóstico de asfixia perinatal nos recém-nascidos do serviço de neonatologia do Hospital Universitário Mayor Mederi de Bogotá, nos anos 2010-2011. Materiais e métodos: Estudo retrospectivo de casos e controles pareado por data de nascimento, com uma relação 1:5 (51:306). Os casos de asfixia perinatal se diagnosticaram segundo os critérios da Academia Americana de Pediatria e o Colégio Americano de Ginecologia e Obstetrícia. As associações se avaliaram com a prova de Chi-quadrado de Mantel e Haenszel ou o Teste de Fisher para dados pareados, com OR e intervalo de confiança do 95%. A análise multivariada se realizou com um modelo de regressão logística condicional. Resultados: Fatores de risco com associação significativa: Anteparto: antecedentes patológicos maternos e primigestação. Intraparto: desprendimento prematuro de placenta, hemorragia do terceiro trimestre, oligo-hidrâmnios, taquicardia fetal, monitoramento fetal intraparto anormal, expulsivo prolongado, febre materna, corioamnionite, convulsões maternas e bradicardia fetal. Fetais: idade gestacional por Ballard igual ou <36semanas, via do nascimento instrumentado, líquido amniótico hemorrágico ou tingido de mecónio, circular de cordão, peso ao nascer igual ou <2500 gramas. Os sublinhados e a síndrome hipertensiva associado à gravidez se encontraram significativos na análise multivariada. Conclusões: O reconhecimento e controle temporão dos fatores de risco deve contribuir a diminuir a probabilidade de asfixia perinatal nos recém-nascidos.

Diagnóstico, Evaluación y Manejo de la Enfermedad Renal en el Embarazo / Diagnosis, Evaluation, and Management of renal diseases during Pregnancy

Introducción: La elevada prevalencia de enfermedad renal crónica y otras enfermedades no transmisibles crónicas, unido al incremento en la edad de embarazo ha generado nuevas investigaciones y evidencias de la relación entre la enfermedad renal crónica, el embarazo y los resultados para la madre y el feto. Objetivo: Exponer las mejores prácticas actuales y ofrece una aproximación al diagnóstico, evaluación y tratamiento de la enfermedad renal en el contexto del embarazo y su repercusión en términos de morbilidad y mortalidad para la madre y el feto. Material y Métodos: Se realizó un análisis de la literatura describiendo los mejores resultados clínicos basado en los avances científicos a la fecha actual. Resultados: Se enfatiza la evolución continua entre el daño renal agudo (incipiente) y la falla renal aguda (con necesidad de métodos dialíticos sustitutivos), también de importancia pronóstica con incrementos en la mortalidad materna asociados a pequeños incrementos en la creatinina sérica. Conclusiones: Tanto el desarrollo de un daño renal agudo, la falla renal aguda y la enfermedad renal crónica son causas importantes de morbilidad y mortalidad materno fetal(AU)

Introduction: The high prevalence of chronic kidney disease and others non contagiables diseases, jointly with its increasing frequency in gestational age women have generated new investigations and evidences of the relationship between the chronic renal diseases, the pregnancy and its consequence for the mother and fetus. Objective: This paper summarizes the best practice up to this date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the Renal Disease Disorders of Pregnancy to evaluate the impact of them on maternal and fetal morbidity and mortality. Material and Methods: An analysis of the published literature of the subject was performed, describing the best clinical results based on scientific advances available today. Results: Was emphasized the continuum evolution between acute kidney damage (incipient injury) and acute kidney failure (need to dialysis) also of importance for prognosis, with increasing of the mortality associated with small increases in serum creatinine. Conclusions: The acute kidney diseases/ acute renal failure and chronic renal diseases are important causes of maternal and perinatal morbidity - mortality(AU)