Proceso de enfermería a embarazada con infección de vías urinarias y amenaza de aborto / A Nursing Process for a Pregnant Woman with Urinary Tract Infection and Threatened Miscarriage

Introducción: La infección de vías urinarias es recurrente en el embarazo y generadora de complicaciones. Objetivo: Presentar un plan de cuidados enfermero a una mujer con diagnóstico infección de vías urinarias y amenaza de aborto Métodos: Caso clínico de paciente admitida en unidad de Ginecología y Obstetricia del Hospital General de Teziutlán, Puebla, México, durante 2019. Siguiendo la lógica del proceso de enfermería, la valoración se fundamentó en los patrones funcionales de salud de Marjory Gordon. Fueron utilizadas las terminologías normalizadas de enfermería: Diagnósticos (NANDA.int). Resultados (NOC) e Intervenciones (NIC). Resultados: Se identificaron cuatro diagnósticos de enfermería: deterioro de la eliminación urinaria, gestión ineficaz de la propia salud, disposición para mejorar la nutrición y riesgo de alteración de la díada materno/fetal, este último diagnóstico principal. Además, un Resultado NOC (Conocimiento: Control de Infección), cuatro indicadores y la escala de nunca a siempre demostrado; cuatro Intervenciones NIC, con 19 actividades. La evaluación transitó desde 12 (puntuación inicial) a 19 (puntuación final), de 20 como puntuación diana. Conclusión: La integración de las taxonomías NANDA, NIC, NOC y los patrones funcionales de salud de Marjory Gordon permitió diseñar el plan de cuidado de la embarazada, fueron articulados diagnósticos, resultados e intervenciones de enfermería que favorecieron la relación enfermera-paciente-contexto sociocultural, para llevar el cuidado hasta una concepción sistémica que permita el seguimiento y control de la embarazada(AU)

Introduction: Urinary tract infection is recurrent in pregnancy and causes complications. Objective: To present a nursing care plan provided to a woman with a diagnosis of urinary tract infection and threatened miscarriage. Methods: Clinical case of a patient admitted to the gynecology and obstetrics unit of General Hospital of Teziutlán (Puebla, Mexico) during 2019. Following the logic of the nursing process, the assessment was based on Marjory Gordon's functional health patterns. The standard nursing terminologies were used: diagnostics (NANDA-I), outcomes (NOC) and interventions (NIC). Results: Four nursing diagnoses were identified: deterioration of urinary elimination, ineffective self-health management, willingness to improve nutrition, and risk for alterations in maternal-fetal dyad, the latter being the main diagnosis. In addition, a NOC outcome (knowledge: infection control), four indicators and the never-to-always scale upon demonstration, as well as four NIC interventions, with nineteen activities, were obtained. Evaluation ranged from twelve (initial score) to nineteen (final score), with twenty as target score. Conclusion: The integration of the NANDA, NIC and NOC taxonomies together with the Marjory Gordon's functional health patterns allowed the design of the pregnant woman's care plan, with an articulation between nursing diagnoses, outcomes and interventions, which favored the nurse-patient-sociocultural context relationship, up to considering care based on a systemic conception that allows monitoring and control of the pregnant woman(AU)

Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion

Vaginal sonograghy and serial beta-hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase [CPK] in blood. assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and beta-hCG divided into 3 groups [N=37]: tubal pregnancy [1], threatened abortion [2] and normal pregnancy [3]. Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Mean total CPK level were 96.27 +/- 63.9 u/lit [group 1], 55.37 +/- 14.1 u/lit [group 2] and 48.94 +/- 19.2 u/lit [group 3] and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62 +/- 5.2 u/lit, 17.32 +/- 6.9 u/lit, and 15.1 +/- 4.7 u/lit, respectively which was not significant. It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy

Ameaça de aborto: conduta baseada em evidências / Threatened miscarriage: conduct based on evidences

A ameaça de aborto é definida como sangramento vaginal, geralmente indolor, que ocorre na primeira metade da gravidez com concepto vivo sem dilatação cervical. Muitas intervenções são utilizadas para a ameaça de aborto espontâneo. Quando uma causa específica é identificada, o tratamento direcionado pode reduzir taxas de abortamento. No entanto, na maioria dos casos, a fisiopatologia permanece desconhecida. Intervenções inespecíficas como repouso no leito e ausência de relações sexuais, apesar de comumente aconselhadas pelos médicos, não têm comprovação de benefício. A didrogesterona, um derivado progestínico, parece reduzir o risco de abortamento. Esta revisão mostra a qualidade das evidências científicas e o grau de recomendação das várias condutas para o tratamento da ameaça de aborto, concluindo que ainda é necessário realizar outros ensaios clínicos maiores, placebo-controlados e randomizados sobre o tratamento da ameaça de aborto para definir a eficácia da maioria das intervenções

Threatened miscarriage is defined as a vaginal bleeding, usually painless, which occurs in the first half of viable pregnancy without cervical dilatation. Many interventions are used for threatened and recurrent miscarriage. When a specific cause is identified, directed treatment may reduce miscarriage rates. However, in the majority of cases, the pathophysiology remains unknown. Unspecific interventions, as bed rest and avoidance of sexual intercourse, though commonly advised, are of no proven benefit. Dydrogesterone, a progesterone derivative, may further reduce miscarriage rates. This review shows the scientific evidence and classification quality of several interventions for the treatment of threatened miscarriage. Larger, randomized and controlled trials on the treatment of threatened miscarriage are needed to support the majority of the interventions

Ultrasonography; Its value in the management of first trimester vaginal bleeding

To find the value of ultrasound in the management of first trimester vaginal bleeding. All patients reporting with vaginal bleeding in obstetrics and gynaecology Unit-Ill, Nishtar Hospital, Multan were included in the study. Non-pregnant patients and patients with vaginal bleeding due to the cause other than conception were excluded. After history, clinical examination and pregnancy test, ultrasonography was done with abdominal convex probe [3.5 Mhz] and/or vaginal [5 Mhz] probe to every patient. Overall incidence of first trimester vaginal bleeding was 12.23%. Disparity between clinical and ultrasonic diagnosis was 17.3% in cases of incomplete abortion, 11.6% in cases of inevitable abortion, 9.7% in cases of threatened abortion, 3.8% in cases of missed abortion and 1.9% in cases of lghted ovum and 1.9% in cases of molar pregnancy. The confirmation of diagnosis after histopathology of surgically obtained specimen revealed least percentage of misdiagnosis on ultrasound evaluation. While in ectopic pregnancy no disparity found on clinical, ultrasonographic and surgical results, but it was misleading as only late cases with ruptured ectopic pregnancy and obvious clinical signs and symptoms were referred to the hospital. Otherwise USG would have shown increased sensitivity and specificity. Study has confirmed the superiority of USG scanning over conventional methods in earlier and more precise diagnosis and thus better treatment of patients having first trimester vaginal bleeding. It is more accurate, safe, non-invasive and quick in diagnosis and management. It prevents from undue surgical intervention as well as undue delay in surgery when required. Once bleeding has occurred repeat pregnancy test should he ignored and better not done at all, Thus USG should he an important diagnostic tool in every emergency unit but importance of clinical diagnosis cannot be overlooked

Cytohormonal evaluation of vaginal smears by phase contrast microscopy with special reference to progesterone deficiency pattern during early pregnancy as predictor of abortion.

Cytohormonal profile of unstained vaginal smears were studied under phase contrast microscope to define various cell morphologies in detail and build up of smear pattern serially in various stages of menstrual cycle and first trimester of pregnancy. The findings were correlated clinically and found comparable to Papanicolaou stained smears. The maturation index was calculated more objectively by phase contract microscopy because of the refractile appearance of the pyknotic nuclei of superficial cells. The prognostication of abortion was done by combining abnormal maturation index and the presence of syncytiotrophoblasts in vaginal smears. Under phase contrast microscope, the sensitivity of abnormal smear was 87.5%, the specificity was 95%, the positive predictive value was 96.55% and the overall accuracy was 90% as compared to positive Papanicolaou smear whose sensitivity though 93%, had low specificity of 50% only. Phase contrast study appears to offer certain distinct advantage over the conventional light microscopy for quick, comprehensive and quantitative assessment of the study material. It allows the physician to detect changes in the material obtained from the patients without detour of laboratory fixation and staining. It is technically easy as errors in interpretation due to unsatisfactory fixation, staining and artefacts are obviated. Thus phase contrast microscopy offers an alternative and easy method of cytohormonal evaluation of wet and unstained smears.

Evaluación de un test de medición específico de la subunidad beta de la gonadotrofina coriónica humana / Evaluation of a test of specific measurement of human chorionic gonadotropin B-subunit in humans

Se investigó la eficacia de un test de mediación de la subunidad beta de la HCG en orina, en 61 pacientes bajo tratamiento de estrilidad en las cuales se sospechaba el embarazo por el tratamiento que estaban realizando. En 38 casos se obtuvo resultado positivo y en 23 negativo. Se analizan los resultados comparando edades, amenaza de aborto, embarazo ectópico y diferencias entre valores séricos y urinarios de la beta HCG. El test, demostró ser de fácil realización, rápido y confiable en cuanto a sus resultados, no reemplazando a los dosajes cuantitativos en los casos de amenaza de aborto, embarazo ectópico y progresión del embarazo normal

El diagnóstico y la decisión quirúrgica en el embarazo ectópico: un análisis probabilístico / The diagnosis and surgical decision in ectopic pregnancy: a probabilistic analysis

Se destaca la problemática que representa el diagnóstico del embarazo ectópico antes de que se presente el cuadro agudo o establezca su forma organizada, con énfasis en las diferentes tasas de morbimortalidad y pronóstico de fertilidad, cuando se ofrece a la enferma la oportunidad del tratamiento óptimo. Se muestra un análisis probabilístico calculado por microcomputadora con base en el teorema de Bayes de cómo se comportan 10 indicadores clínicos en focados de manera aislada y en conjunto en el diagnóstico diferencial del embarazo tubario y amenaza de aborto, cuerpo lúteo hemorrágico, enfermedad inflamatoria pélvica, apendicitis y tumor de ovario estudiados de manera retrospectiva en población seleccionada. Se ponen de manifiesto los alcances y limitaciones del modelo como un sistema que ayuda al médico a tomar decisiones en la práctica clínica diaria y en su formación, al hacer explícito el método sobre la manera como se debe seleccionar, ordenar y capturar los datos y sobre todo el análisis de la experiencia al procesar la información clínica. Este primer intento del autor, pretende adquirir la experiencia necesaria para el desarrollo de esta tecnología en la resolución de problemas específicos de la especialidad. Por otro lado el trabajo marca un esfuerzo preliminar en el diseño de metodología útil para el diagnóstico automatizado que, aun cuando por el momento se encuentra restringido a muy pocos centros de trabajo, promete expectativas interesantes en el ejercicio de la medicina.