Presencia de infección de sitio quirúrgico en procedimientos gineco-obstétricos en un hospital de II nivel de atención, Honduras 2017-2018 / Presence of surgical site infection in obstetric-gynecological procedures in a level II care hospital, Honduras 2017-2018

OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.

OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.

Endoscopic Retrograde Cholangiopancreatography during Pregnancy: Really Guarantee to Safety?

No abstract available.

Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy

BACKGROUND/AIMS: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. METHODS: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. RESULTS: A total of 10 ER-CPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. CONCLUSIONS: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.

Incidencia de infección nosocomial quirúrgica en ginecología y obstetricia en un hospital comarcal / Incidence of nosocomial infections in obstetrics and gynecologic surgery

Introducción: Las infecciones nosocomiales en Obstetricia y Ginecología son causa importante de morbilidad y mortalidad, siendo las más frecuente las de localización quirúrgica. Objetivo: Analizar la incidencia de infecciones nosocomiales relacionadas con las intervenciones mayores más frecuentemente realizadas en Obstetricia y Ginecología. Métodos: Estudio prospectivo de 715 pacientes intervenidas de cesárea o histerectomía abdominal o vaginal, en el Hospital La Inmaculada de Huércal-Overa (Almería, España) en el periodo comprendido entre el 31 de octubre de 2008 y de 30 de agosto de 2011. Se han analizado como variables la Incidencia Acumulada y la Densidad de Incidencia para cada tipo de infección nosocomial detectada, independientemente para cada tipo de intervención. También se han calculado las incidencias ajustadas por el índice NNIS (Nacional Nosocomial Infection Surveillance System). Resultados: Se detectaron 30 infecciones nosocomiales (4,2 por ciento). La infección nosocomial diagnosticada con mayor frecuencia fue la endometritis tras cesárea, siendo el microorganismo más frecuentemente detectado la Eschericia Coli. Conclusiones: Las infecciones nosocomiales, en concreto las infecciones de localización quirúrgica, son un problema potencialmente grave y relativamente frecuente, que se relaciona con una mayor morbilidad, siendo importante realizar una profilaxis adecuada y una correcta vigilancia para el diagnóstico e instauración precoz del tratamiento.

Introduction: Nosocomial infections in obstetrics and gynecology are an important cause of morbidity and mortality, the most frequent in the surgical site. Objective: To analyze the incidence of nosocomial infections related to major interventions most frequently performed in the service of Obstetrics and Gynaecology. Methods: Prospective study of 715 patients undergoing surgery, of caesarean section and abdominal or vaginal hysterectomy at the Hospital La Inmaculada of Huercal-Overa (Almería, Spain) in the period from October 31, 2008 and August 30, 2011. Variables were analyzed as Cumulative Incidence and Incidence Density for each type of nosocomial infection detected, separately for each type of intervention. Also calculated adjusted incidences NNIS index (Nacional Nosocomial Infection Surveillance System). Results: We detected 30 nosocomial infections (4.2 percent). The nosocomial infection most frequently diagnosed in our study was the endometritis after cesarean, being the most frequent microorganism detected E. Coli. Conclusions: Nosocomial infections, particularly surgical site infections are a potentially serious problem and relatively frequent, which is related to increased morbidity, is important to perform adequate prophylaxis and make a correct surveillance for diagnosis and an early start of treatment.

Profile of women who experienced vesicovaginal fistula due to obstetric trauma: results from survey at gynecological surgery camp 2005

To assess the demographic, sociocultural and environmental factors responsible for the causation of Vesicovaginal fistula [VVF] due to obstetric injury. This was a descriptive survey carried out among patients with Vesicovaginal fistula, recruited from free fistula repair camps arranged at the interior of Sindh Province Pakistan from 6[th] January 2005 to 18[th] January 2005. Twenty seven patients were interviewed. The information regarding demography, sociocultural and environmental factors was gathered and analyzed by SPSS V 16. The mean age of patients was 25.37 +/- 6.5 years. The mean age at first delivery was 18.55 +/- 2.4 years. Majority of patients 22[81.5%] were illiterate and 21[77.8%] belonged to poor socioeconomic class. Nineteen [70.4%] patients had availability of transport 24 hours a day. Twenty four [88.9%] patients traveled for 1-5 hours to reach health facility. Early age at the time of marriage and pregnancy, illiteracy, poor socioeconomic condition and unavailability of emergency obstetric care by skilled person are the causative factors for Vesicovaginal fistula

Cicatriz da cesariana: implicações ginecológics e aspectos atuais / Cesarean scar: gynecologic implications and current aspects

A cicatriz de cesariana como causa de morbidades ginecológicas, algo até pouco tempo ignorado pelos ginecologistas, é atualmente foco de importante discussão. O aumento atual da via abdominal para o parto faz desse tópico um assunto de extrema importância no cotidiano médico. O sangramento pós-menstrual sem causa aparente tem, na maioria das vezes, a cicatriz de cesariana como fator causal. Pode ocorrer, também, o comprometimento da fertilidade ou pela dificuldade de implantação embrionária ou pela piora da qualidade do muco cervical, em razão do sangramento uterino anormal. Discute-se, hoje em dia, qual o melhor método para o diagnóstico das alterações uterinas decorrentes da cicatriz de cesárea. A investigação pode ser feita inicialmente pela utrassonografia transvaginal, mas a histeroscopia tem maior acurácia além de permitir o tratamento específico. Em todas as situações, a investigação e o bom planejamento terapêutico só podem ser feitos quando o ginecologista conhece bem essa afecção.

The cesarean scar as cause of gynecological morbity, fact that used to be ignored by gynecologists, is the subject of an important discussion nowadays. The current increase in the number of abdominal delivery makes this subject a constant in our daily pratice. The post-menstrual uterine bleeding without an apparent cause has, in the majority of cases, the cesarean scar as only predisponent factor. There might also be infertility due to the difficulty of embryonic implantation or to the presence of the blood making the cervical mucus hostile. Currently, there is a discussion on the best method for the diagnosis of uterine alterations due to cesarean scar. The investigation may be initially accomplished by means of transvaginal ultrasound, but only the hysteroscopy may be precise in the diagnosis and allow specific treatment. In all situations, the investigation and adequate therapeutic planning can only be made if the gynecologist has ample knowledge on this pathology.

[Lower urinary trauma complicating gyneacological and obstetrical surgery]

The trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare. Discover the circumstances of their happening, their symptoms, and their methods of diagnostic and their treatment. Authors report 24 cases observed over a 12 years period. These lesions consisted on 20 bladder lesions and 4 ureteric lesions. The frequency of these urological complications was 0.21% among the 12000 surgical operations performed between 1992 and 2003. The most causal operation was caesarean and abdominal hysterectomy. Urinary trauma was more frequent in patients with history of abdominal surgery. Post operative course was uneventful in most cases. Trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare but their ignorance may seriously affect the functional urinary prognostics

Ecografía endoanal y la vectormanometría en el diagnóstico de la incontinencia fecal traumática / Anal endosonography and vectormanometry in the diagnosis of traumatic fecal incontinence

Introducción: muchos pacientes con incontinencia fecal presentan defectos del esfínter anal. La ecografía endoanal y la vectormanometría son los estudios que se utilizan para el diagnóstico de la lesión esfinteriana, sin embargo la bibliografía es contradictoria en cuanto a los resultados de los mismos. Objetivo: evaluar la sensibilidad y especificidad de la vectormanometría y compararlos con los hallazgos de la ecografía endoanal. Material y método: durante el período enero de 1999 a diciembre de 2001 se evaluaron 25 pacientes con incontinencia fecal. Se realizó ecografía endoanal y vectormanometría. Se analizó la sensibilidad y especificidad de la vectormanometría y se comparó con las de la ecografía. Resultados: la distribución según el sexo fue: 4 masculinos y 21 femeninos. La edad media fue de 68 años (38-88). La media del score de incontinencia fue de 11/20. Se diagnosticaron por ecografía 17 (100 por ciento) lesiones esfinterianas, mientras que por vectormanometría se diagnositcaron 13 lesiones. Sensibilidad del 76 por ciento y especificidad del 75 por ciento. Conclusiones: nuestra experiencia demuestra que la ecografía endoanal es el método con mayor precisión diagnóstica. La vectormanometría es el método que, si bien en nuestra experiencia no diagnóstico todas las lesiones esfinterianas, debe ser considerado porque aporta datos de importancia que tienen implicancia en el resultado del tratamiento.

Ureteric injuries during obstetric and gynecologic procedures

To review the ureteric injuries resulting from obstetric and gynecologic procedures with a comparative analysis of current pertinent literature. From January 1994 - December 1997, the medical records of all patients who sustained ureteric injuries as a result of obstetric or gynecologic procedures and managed at the Princess Basma Teaching Hospital, North of Jordan were reviewed. The clinical presentations, investigations, features of injury and treatment modalities were studied. There were 17 patients with 19 ureteric injuries incurred during obstetric or gynecologic procedures during the study period. Patients were relatively young and presented with loin pain. The left lower ureter was injured in 11 cases. Hysterectomy, alone, accounted for 13 injuries mainly in association with malignancy. Deliveries, in general, were associated with very low rate of injury. Ureteric ligation was the most common mechanism of injury [47%]. Injuries were intraoperatively recognized in 41.2% [7/17] of cases. Patients were treated by either endourological or formal surgical repair. The overall success rate after an average of 32.3 months of follow-up was achieved in 89.5% [17/19]. This outcome was not significantly altered by either the features of injury or by the treatment schedules. Iatrogenic ureteric injury is still a major cause of harm and concern. The time taken to detect the injury remains the most important morbidity-related factor. Recent trends towards earlier intervention and the use of various endourological means of repair deserve support and promotion

Mortalidad materna institucional en Caldas 1990-1994

La presente investigación analiza las muertes maternas institucionales que se presentaron en el Departamento de Caldas entre enero 1ª de 1990 y diciembre 31 de 1994. Se registraron durante dicho período un total de 62 muertes, con un porcentaje de muerte por causa directa del 82.26 por ciento y de causa indirecta del 17.74 por ciento. La tasa de mortalidad obtenida es del 7.27 x 10.000 nacidos vivos, superior a la reportada por países desarrollados. La edad promedio de las pacientes fue de 27,87 + o - 7.63 años, con un promedio de escolaridad de 5.26 + o - 7.63 años. Se demuestran además bajas frecuencias de control prenatal y altos porcentajes de inestabilidad marital. Los trastornos hipertensivos del embarazo son la primera causa de muerte materna directa, seguidos por infección y los transtornos hemorrágicos de la gestación