RESUMO
Resumen Introducción. A pesar de que en Colombia hay una alta prevalencia de embarazos en adolescentes, aún no se han establecido los resultados obstétricos y perinatales adversos en esta población. Objetivo. Caracterizar los desenlaces obstétricos y perinatales de las gestantes adolescentes atendidas en el Hospital Militar Central de Bogotá D.C., Colombia. Materiales y métodos. Estudio observacional, retrospectivo y transversal realizado mediante la revisión de las historias clínicas de 147 gestantes adolescentes atendidas entre mayo de 2012 y diciembre de 2015 en el Hospital Militar Central de Bogotá D.C. Resultados. El promedio de edad fue 17±1.5 años; 59.8% eran estudiantes (secundaria y educación superior) y 64.6%, solteras. En cuanto a los controles prenatales, 127 (86.4%) los iniciaron tardíamente y 108 (73.5%) tuvieron menos de 4. La frecuencia general de complicaciones obstétricas fue 27.9%, entre las que se destacan los trastornos hipertensivos del embarazo (10.2%) y la amenaza de parto pretérmino (8.2%); no se presentaron muertes maternas. Por su parte, las patologías neonatales más comunes fueron ictericia neonatal (4.8%) y síndrome de dificultad respiratoria (3.4%). Conclusiones. Las complicaciones se presentaron con mayor frecuencia en las adolescentes que iniciaron los controles prenatales de forma tardía, por lo que se deben implementar estrategias para garantizar el inicio temprano de estos controles y la adherencia a los mismos. Además, es necesario evaluar el impacto de los programas de planificación familiar en esta población.
Abstract Introduction: Although adolescent pregnancy prevalence in Colombia is high, adverse obstetric and perinatal adverse outcomes in this population have not yet been established in the country. Objective: To characterize the obstetric and perinatal outcomes of pregnant adolescents treated at Hospital Militar Central, located in Bogotá D.C., Colombia. Materials and methods: Retrospective cross-sectional observational study. The medical records of 147 pregnant adolescents treated at Hospital Militar Central between May 2012 and December 2015 were reviewed. Results: Adolescents' average age was 17 ± 1.5 years, 59.8% of them were students (high school and higher education), and 64.6% were single. Regarding prenatal care, 127 (86.4%) had started getting prenatal check-ups late and 108 (73.5%) had poor prenatal care (less than 4 prenatal check-ups). Obstetric complications general frequency was 27.9%, being the most frequent hypertensive disorders of pregnancy (10.2%) and preterm birth (8.2%). There were no maternal death cases. On the other hand, the most frequent perinatal morbidities were jaundice (4.8%) and respiratory distress syndrome (3.4%). Conclusions: Pregnancy-related complications were more frequent in adolescents who started prenatal check-ups late, so strategies aimed at ensuring that adolescents have access to early prenatal care and at improving their adherence rates to prenatal check-ups must be implemented. In addition, the impact that family planning programs have on this population must also be evaluated.
RESUMO
Abstract The pharmacological management of adults with chronic-phase Chagas disease is challenging despite it being the recent focus of extensive research. One of the challenges in the current clinical practice guidelines (CPGs) landscape is the existence of non-evidence-based recommendations for the use of laboratory tests in treatment monitoring. This study aimed to systematically assess the quality and consistency of recommendations of CPGs on the pharmacological management of adults with chronic-phase Chagas disease. Systematic literature searches were conducted in MEDLINE, EMBASE, SciELO and Google to identify all published CPGs relevant to the pharmacological management of Chagas disease, between January 2010 and March 2016. Three independent reviewers assessed the quality of each CPG using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A total of five CPGs were included and the overall quality of the guidelines for therapeutic drug monitoring of Chagas disease was moderate-to-low. There was considerable variation in the quality of the CPGs across the AGREE II domains. The domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. This review showed that the methodological quality of CPGs for Chagas disease was generally inappropriate, and there was no explicit link between the best available evidence and current recommendations.