Métodos anticonceptivos elegidos por mujeres después de aborto en un hospital público de Honduras / Contraceptive methods chosen by women after abortion in a public hospital in Honduras

Antecedentes: La tasa de embarazos no planeados en Latinoamérica está entre las más altas del mundo. Las adoles- centes están entre los grupos más vulnerables para embarazos no planeados con porcentajes de 32% a 45%. Objetivo: Describir los factores asociados a la elección de un anticonceptivo por las mujeres después de un aborto, en el Hospital Dr. Roberto Suazo Córdova, La Paz, Honduras, en el periodo de julio 2017 a junio 2019. Método: Estudio retrospectivo descriptivo. Los datos fueron obtenidos usando el Sistema Informático Perinatal Aborto (SIP Aborto) en la versión SIP 4.16. Resultados: El 50.0% (67/134) de las adolescentes y 50.1% (281/550) de las mayores de 19 años eligieron un anticonceptivo postaborto. El inicio del anticonceptivo se relacionó con antecedente de aborto (p=0.006). Uso previo de anticonceptivos (p=0.007). Los anticonceptivos más elegidos fueron: Acetato de medroxiprogesterona, anticonceptivos orales combinados y condón. La elección del anticonceptivo se relacionó con evacuación instrumental del aborto (p=0.022) en adolescentes y (p=0.000) en mayores de 19 años. Se eligieron menos los mé- todos reversibles de acción prolongada. Discusión: La elección anticonceptiva postaborto fue baja. El inicio de anticonceptivos se relacionó con antecedente de aborto, uso previo de anticoncepti- vos y evacuación instrumental. Los anticonceptivos más elegidos fueron los temporales de acción corta y los menos elegidos, los temporales de acción prolongada. Se debe fortalecer el acceso a información, mejorar la consejería, garantizar acceso y disponibili- dad de anticonceptivos sobre todo de acción prolongada para ase- gurar el apego al método anticonceptivo...(AU)

Place du cathéter de Foley dans la prévention des récurrences des synéchies utérines après hystéroscopie opératoire au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine (CHRACERH)

Contexte : Les adhérences intra-utérines peuvent entraîner un dysfonctionnement partiel ou complet de l'endomètre avec une altération de la fertilité et du cycle menstruel. La récurrence des synéchies après l'hystéroscopie est l'un des facteurs les plus importants pouvant altérer le pronostic de fertilité en post-opératoire. Objectif : L'objectif de ce travail était d'évaluer l'efficacité du ballonnet du cathéter de Foley intra-utérin dans la prévention des récurrences des synéchies après une hystéroscopie opératoire au CHRACERH. Patientes et méthode : Nous avons mené une étude transversale comparative avec collecte de données rétrospective, sur deux ans (du 1er janvier 2016 au 31 décembre 2017), chez 35 femmes ayant subi une hystéroscopie opératoire pour des synéchies utérines. Chaque patient a été classé dans deux groupes, le groupe (I) avec ballonnet du cathéter de Foley (15 patientes) et le groupe (II) sans ballonnet de cathéter de Foley (20 patientes). Le ballonnet de la sonde de Foley n°14, était placé dans l'utérus des patientes du groupe I et gonflé avec 10 ml de solution saline normale puis était retiré 5 jours après l'opération. Une hystéroscopie de second look était réalisée deux mois après l'opération pour évaluer la récurrence des synéchies dans tous les groupes. La classification de March et al. a été utilisée à cette fin. L'analyse statistique a été réalisée grâce au logiciel SPSS 20 (SPSS Inc., Chicago, IL). Résultats : L'âge moyen était de 40,1 ± 7,0 ans avec un minimum à 29 ans et un maximum à 58 ans. L'IMC moyen était de 27,3 ± 3,8 kg/m2, avec un maximum de 20,6 kg/m2 et un minimum de 37,5 kg/m2. Vingt pour cent de la population étudiée était obèse. Les principaux symptômes cliniques étaient l'aménorrhée (25,7%), l'oligoménorrhée (22,9%) et la dysménorrhée (17,1%). Quarante pour cent (8,6% dans le groupe I vs 31,4% dans le groupe II) de la population étudiée avaient une synéchie légère, 42,9% (22,9% dans le groupe I contre 20% dans le groupe II) avaient une synéchie modérée et 17,1% (11,4% dans le groupe I vs 5,7% dans le groupe II) avaient une synéchie sévère selon la classification de March. Treize virgule trois pour cent des patients du groupe I ont eu des récurrences de synéchies contre 30% des patients du groupe II. Il n'y avait pas d'association significative entre l'utilisation de la sonde de Foley et la prévention des récurrences de synéchies (p = 0,42). Le taux de complication total était de 5,7%. L'association entre la survenue d'une complication et le groupe de patients n'était pas significative (p = 0,61). Conclusion : Dans cette étude, il n'y avait pas d'association significative entre l'utilisation de la sonde de Foley et la récurrence des synéchies. Cependant, nous avons eu un faible pourcentage de récurrences dans le groupe avec cathéter de Foley par rapport au groupe sans cathéter Foley

Midwives' knowledge and use of partographs at Juba Teaching Hospital, South Sudan

Background:Evidence shows that good knowledge of partographs and proper application of this knowledge results in a remarkable reduction in prolonged and obstructed labour and reduces maternal mortality. Obstructed labour can be prevented by a simple and cost-effective health intervention tool, the partograph. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. This provides an opportunity for early identification of deviation from normal progress. Early detection of prolonged labour greatly contributes to prevention of obstructed labour and related complications.Objective:To assess midwives' knowledge and use of partographs in the maternity ward of Juba Teaching Hospital, South Sudan.Methods:A cross-sectional descriptive study was conducted to assess utilisation of partographs among healthcare providers in Juba Teaching Hospital. All providers working at the time of the study were included. An interviewer administered questionnaire prepared in English was used to assess socio-demographic and other related variables of respondents as well as knowledge and practice. Ethical procedures were followed at every step. Results:Only 20% of the 30 respondents were registered midwives, 67% knew the components -of a partograph, and 93% could differentiate between normal and abnormal labour with the use of a partograph. The factors affecting the use of partographs included; shortage of partographs in the ward, lack of protocols on partograph use, understanding semantics of the English language, absence of refresher training, late reporting of mothers to the ward, and a shortage of staff. Conclusions: Despite good knowledge of the partograph, about half of the providers do not use them. We recommend training and recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes

Velocimetría Doppler de las arterias uterinas en el primer y segundo trimestre de gestación y su relación con macrosomía fetal en gestantes atendidas en el INMP año 2011-2012 / Doppler velocimetry of the uterine arteries in the first and second trimester of pregnancy and its relationship with fetal macrosomia in pregnant women at the INMP year 2011-2012

OBJETIVOS: Determinar si existe relación entre la Velocimetría Doppler de las arterias uterinas en el primer y segundo trimestre de gestación y la macrosomía fetal en gestantes atendidas en el lNMP Año 2011-2012. METODOLOGIA: Estudio observacional, descriptivo, longitudinal y prospectivo. Se trabajó 156 gestantes con edad gestacional menor de o igual a 26 semanas atendidas en la Unidad de Medicina Fetal del INMP durante el periodo Octubre 2011-Mayo 2012, Se estimaron las frecuencias absolutas y relativas de las variables de cualitativas y medidas de tendencia central y de dispersión de las cuantitativas. Se utilizó para el análisis bivariado la prueba Chi cuadrado para las variables cualitativas y t-Student para las variables cuantitativas. Se estimaron los valores diagnósticos de los indicadores de Velocimetría Doppler. RESULTADOS: La edad materna promedio de las gestantes es de 27.8 años y la edad gestacional promedio es de 20±4.5 semanas. El 63.5 por ciento de las gestantes se encuentran entre las edades de 20-35 años y el 19.9 por ciento son mayores a 35 años. La edad gestacional de la mayoría de las pacientes se encuentra entre 13-24 semanas (81.4 por ciento). El 4.5 por ciento de los fetos son macrosómicos y el 92.3 por ciento se encuentra entre los pesos de 2500-3999 gramos. La edad gestacional por Capurro de los recién nacidos se encuentra en su mayoría entre 37-40 semanas. La presión sistólica promedio de la ecografía Doppler es 101+/-36.8mmHg y la presión diastólica promedio es 42.6+/-24.4mmHg. El Índice de Pulsatilidad promedio es 1.1+/-0.4 y el Índice de Resistencia es 0.6+/-0.1. La presión sistólica promedio de los recién nacidos con Macrosomía fetal es mayor (146+/-90.3) comparado con la presión sistólica promedio de los recién nacidos que no presentaron Macrosomía (98.9+/-31.4) (p=0.001), la presión diastólica promedio en el grupo de los fetos con macrosomía es 75.9+/-65.9 comparado con los fetos que no presentaron macrosomía 41.1+/-19.9...

OBJECTIVE: To determine the correlation between Doppler velocimetry of the uterine arteries in the first and second trimester of pregnancy with fetal macrosomia in pregnant women at the INMP, during the years 2011-2012. METHODOLOGY: Descriptive, prospective, longitudinal observational study. There were evaluated 156 pregnant women with gestational age less than or equal to 26 weeks attending the Fetal Medicine Unit INMP during the period October 2011-May 2012. There were estimated absolute and relative frequencies for qualitative variables and measures of central tendency and dispersion of the quantitative. We used for bivariate analysis the test Chi-square for categorical variables and t-Student for quantitative variables. We estimated the diagnostic values of Doppler velocimetry indicators. RESULTS: The average maternal age of pregnant women is 27.8 years and the average gestational age is 20+/-4.5 weeks. The 63.5 per cent of pregnant women are between the ages of 20-35 years and 19.9 per cent are older than 35 years. The gestational age of most patients is between 13-24 weeks (81.4 per cent) and the minority, <=12 weeks (5.1 per cent). Abdominal ultrasound is the most commonly technique used (77.6 per cent). The 4.5 per cent of fetus are macrosomic and 92.3 per cent are between the weights of 2500-3999 grams. The gestational age of newborns by Capurro is mostly between 37-40 weeks. The average systolic Doppler ultrasound is 101+/-36.8 mmHg and the average diastolic pressure is 42.6+/-24.4mmHg. The average pulsatility index is 1.1+/-0.4 and resistance index is 0.6+/-0.1. The average systolic blood pressure of newborns with fetal macrosomia is higher (146+/-90.3) compared with the average systolic pressure of infants who are not macrosomic (98.9+/-31.4) (p=0.001), the average diastolic pressure in group of fetus with macrosomia is 75.9+/-65.9 compared with fetus that do not present macrosomia 41.1+/-19.9 (p<0.001). The average pulsatility index in the first...

Cardiomiopatia hipertrófica e gravidez / Hypertrophic cardiomyophaty and pregnancy

A cardiomiopatia hipertrófica (CMH) é doença incomum na gestação, caracterizada pela hipertrofia do ventrículo esquerdo, com expressão fenotípica e manifestações clínicas variáveis. O diagnóstico pode ser confirmado pelo ecocardiograma com Doppler. Trata-se de enfermidade bem tolerada na gestação, entretanto, pode desencadear insuficiência cardíaca congestiva, com grave comprometimento materno e perinatal. O tratamento para a gestante com CMH depende da obstrução do fluxo do ventrículo esquerdo. Em paciente sintomática portadora da forma obstrutiva, devem-se evitar grandes perdas sanguíneas e uso de drogas vasodilatadoras durante o trabalho de parto. O parto vaginal mostrou-se seguro, mas o período expulsivo deve ser abreviado com uso de fórceps naquelas que apresentam sintomatologia obstrutiva. Raras complicações podem acontecer, o que requer planejamento do parto e adequada monitorização materna e fetal. (AU)

The Hypertrophic Cardiomyopathy (HCM) is an uncommon condition during pregnancy, which attends with a left ventricular hypertrophy, and phenotypic expression and clinical are both variable. The diagnosis can be confirmed by Doppler echocardiography. Several studies show that it is a disease well tolerate during pregnancy, however it may trigger congestive heart failure with severe maternal and perinatal commitment. The treatment of pregnant patients with HCM depends on the presence of symptoms caused by obstruction of the left ventricle. In symptomatic patient carrying the obstructive form should be avoided large blood loss and use of vasodilator drugs during labor. Vaginal delivery is safe, but the expulsive period should be abbreviated with the use of forceps in those with obstructive symptoms. Rare complications can occur and therefore it is necessary a delivery planning and an adequate maternal and fetal monitoring. (AU)

An analytic method of wavelet energy value to evaluate the contraction intensity of uterus / 生物医学工程学杂志

The data of uterine contraction pressure is the information source for extracting uterine contractions status. Because there is a variety of interference existing in contraction pressure data, commonly used methods such as uterine contraction intensity integration method can not obtain decent evaluation results. We used the bior 2.4 biorthogonal wavelet to decompose and reconstruct the pressure data in order to obtain the best denoising effect. Combining with the denoised results, we proposed an algorithm of the wavelet energy value. Based on the algorithm, we calculated the curve of wavelet energy value. It was proved that using the curve of wavelet energy value can better identify contractions waveform and evaluation contractions intensity.

Índice de pulsatilidad medio de las arterias uterinas y su relación con preeclampsia y complicaciones perinatales. Instituto Materno Perinatal. Octubre 2010 - Mayo 2011 / Pulsatility index mean of the uterine arteries and its relation to preeclampsia and perinatal complications. Institute Materno Perinatal. October 2010 - May 2011

El objetivo del estudio fue determinar la utilidad del índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 como predictor de preeclampsia y complicaciones perinatales en gestantes durante el período comprendido entre octubre del 2010 a mayo del 2011. En el Instituto Nacional Materno Perinatal de Lima - Perú se realizó un estudio observacional, transversal, analítico y prospectivo comparando 24 gestantes con índice de pulsatilidad medio mayor del percentil 95 con otras 40 que no lo tuvieron. El análisis estadístico se realizó con el programa IBM Statistics SPSS 19. La media del índice de pulsatilidad fue 1,31+/-0,31 (rango: 0,53 - 2,08) y su distribución siguió una distribución bimodal. El riesgo de preeclampsia y de complicaciones perinatales en pacientes con índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 fue 5,23 (IC al 95 por ciento: 3,84-9,82) y 4,42 (IC al 95 por ciento: 2,98-6,34); respectivamente, en comparación con pacientes con índice de pulsatilidad medio de las arterias uterinas menor del percentil 95. El análisis multivariado demostró que las complicaciones materno perinatales independientes y significativas en gestantes con índice de pulsatilidad de las arterias uterinas mayor del percentil 95 fueron: morbilidad materna (OR 4,39; 95 por ciento IC 2,02-9,55), restricción de crecimiento intrauterino (OR 7,25; 95 por ciento IC 4,42-15,08), pequeño para la edad gestacional (OR 7,16; 95 por ciento IC 4,42-15,08), Apgar < 7 (OR 5,01; 95 por ciento IC 2,87-8,70), óbito fetal (OR 2,91; 95 por ciento IC 2,01-4,11) e ingreso a UCI (OR 3,39; 95 por ciento IC 2,19-4,30). Se concluyó que el índice de pulsatilidad medio de las arterias uterinas mayor del percentil 95 predice en forma significativa la presencia de preeclampsia y complicaciones materno-perinatales asociadas independientemente de la edad gestacional.

The objective of the study was to determine the usefulness of mean pulsatility index of the uterine arteries greater than 95th percentile as a predictor of preeclampsia and perinatal complications in pregnant women during the period October, 2010 to May, 2011. At Maternal Perinatal National Institute in Lima-Peru is was carried out an observational, cross-sectional and prospective analytical study comparing 24 pregnant women with mean pulsatility index of the uterine arteries greater than 95th percentile with 40 others that did not. Statistical analysis was performed with the IBM SPSS Statistics 19 program. The mean pulsatility index was 1.31+/-0.31 (range: 0.53 to 2.08) and itÆs continued a distribution bimodal distribution. The risk of preeclampsia and perinatal complications in patients with mean pulsatility index of the uterine arteries greater than 95th percentile was 5.23 (95 per centCI: 3.84 to 9.82) and 4.42 (95 per centCI: 2.98 to 6.34), respectively, compared with patients with mean pulsatility index lower uterine artery 95 percentile. Multivariate analysis showed that independent and significant perinatal maternal complications in pregnant with mean pulsatility index of the uterine arteries greater than 95 percentile were: maternal morbidity (OR 4.39, 95 per cent CI 2.02 to 9.55), growth restriction intrauterine (OR 7.25, 95 per cent CI 4.42 to 15.08), small for gestational age (OR 7.16,95 per cent CI 4.42 to 15.08), Apgar<7 (OR 5.01, 95 per cent CI2.87 to 8.70), stillbirth (OR 2.91, 95 per cent CI 2.01 to 4.11) and ICU admission (OR 3.39, 95 per cent CI 2.19 to 4, 30). It was concluded that half the pulsatility index of the uterine arteries predicts the 95th percentile increased significantly in the presence of preeclampsia and perinatal complications associated maternal regardless of gestational age.

Ultrassonografia do colo uterino versus índice de Bishop como preditor do parto vaginal / Cervical ultrasonography versus Bishop score as a predictor of vaginal delivery

OBJETIVO: comparar a acurácia da mensuração ultrassonográfica transvaginal do colo uterino com o escore de Bishop para predição do parto vaginal após indução do trabalho de parto com misoprostol a 25 mcg. MÉTODOS: realizou-se estudo de validação de técnica diagnóstica com 126 gestantes com indicação para indução do trabalho de parto, as quais foram avaliadas pelo escore de Bishop e por ultrassonografia transvaginal para mensuração cervical. As pacientes foram submetidas, também, à ultrassonografia obstétrica transabdominal para avaliação da estática, pesos fetais e índice de líquido amniótico, e à cardiotocografia basal para avaliação da vitalidade fetal. Procedeu-se à indução do trabalho de parto com misoprostol vaginal e sublingual, um dos comprimidos contendo 25 mcg da droga e o outro apenas placebo. Os comprimidos foram administrados a cada seis horas, em um número máximo de oito. Construíram-se tabelas de distribuição de frequência e calcularam-se medidas de tendência central e de dispersão. Curvas ROC foram construídas para avaliação do escore de Bishop e da medida ultrassonográfica do colo uterino para predição de parto vaginal. RESULTADOS: obteve-se uma área sob a curva ROC de 0,5 (p=0,8) para medição do colo uterino pela ultrassonografia transvaginal, enquanto a curva ROC do escore de Bishop (ponto de corte ³4) apresentou área de 0,6 (p=0,02). O escore de Bishop ³4 apresentou sensibilidade de 56,2 por cento e especificidade de 67,9 por cento para predição de parto vaginal, com razão de verossimilhança positiva de 1,75 e negativa de 0,65. CONCLUSÕES: a medida ultrassonográfica transvaginal do colo uterino não foi boa preditora da evolução para parto vaginal em pacientes com trabalho de parto induzido com misoprostol. O escore de Bishop foi melhor preditor para parto vaginal nestas circunstâncias.

PURPOSE: to compare the accuracy of transvaginal ultrasonographic measurement of the uterine cervix with Bishop’s score for the prediction of vaginal delivery after labor induction, with 25 mcg of misoprostol. METHODS: a prospective study for the validation of a diagnostic test was conducted on 126 pregnant women with indication for labor induction. The patients were evaluated by Bishop’s score and transvaginal ultrasonography for cervical measurement. They also undergone obstetric transabdominal ultrasound to evaluate static and fetal weight, as well as the amniotic fluid index, and basal cardiotocography for the evaluation of fetal vitality. Labor was induced with vaginal and sublingual misoprostol, one of the tablets containing 25 mcg of the drug and the other only placebo. The tablets were administered every six hours, with a maximum number of eight. Frequency tables were obtained, and measures of central tendency and dispersion were calculated. ROC curves were constructed for the evaluation of Bishop’s score and ultrasonographic measurement of the uterine cervix for the prediction of vaginal delivery. RESULTS: the area under the ROC curve was 0.5 (p=0.8) for the ultrasonographic measurement of the uterine cervix, and 0.6 (p=0.02) for Bishop’s score (cut point ³4). Bishop’s score had a sensitivity of 56.2 percent and specificity of 67.9 percent for prediction of vaginal delivery, with a positive likelihood ratio of 1.75 and a negative one of 0.65. CONCLUSIONS: ultrasonographic measurement of the uterine cervix was not a good predictor of evolution to vaginal delivery among patients with misoprostol-induced labor. Bishop’s score was a better predictor of vaginal delivery under these circumstances.

Cirurgia cardíaca na gravidez / Cardiac surgery during pregnancy

A cirurgia cardíaca na gravidez vem sendo realizada desde 1985 no Instituto Dante Pazzanese de Cardiologia, em São Paulo (SP). Inúmeras melhorias foram desenvolvidas desde essa época. Até os dias de hoje, 80 gestantes foram submetidas a cirurgia, das quais 64 foram acompanhadas (84 por cento). A doença valvar foi a afecção mais frequente (94 por cento), sendo a valvopatia mitral a doença mais prevalente (76,5 por cento). Foi necessário tratamento cirúrgico dessa valva em 82 por cento dos casos (comissurotomia mitral ou troca valvar). A maioria dessas pacientes estava em classe funcional III ou IV da New York Heart Association (NYHA) e a idade gestacional média era de 22 semanas. Houve melhora da classe funcional após a cirurgia (93 por cento dos casos em classe funcional I ou II) e a maioria das pacientes se encontra em ritmo sinusal (70,4 por cento). A reoperação foi necessária em 20 por cento dos casos. Ocorreram 5 óbitos maternos (6,2 por cento) e 11 óbitos fetais (16,2 por cento). A classe funcional é o maior fator de risco para mortalidade materna, mas também devem ser considerados o uso de drogas vasoativas, a idade da paciente, o tipo de afecção e a reoperação. Para a mortalidade fetal, devemos considerar idade materna...

Efeito da analgesia obstétrica combinada raqui-peridural no tônus uterino e na freqüência cardíaca fetal: ensaio clínico randomizado comparativo com a analgesia peridural / The effect of combined spinal-epidural labor analgesia on uterine tone and fetal heart rate: randomized comparison with epidural analgesia

A fim de investigar a associação entre alterações do tônus uterino e a ocorrência de anormalidades da freqüência cardíaca fetal (FCF) após analgesia obstétrica, em especial após o bloqueio combinado raqui-peridural, foi conduzido estudo prospectivo randomizado e encoberto, com setenta e sete parturientes que solicitaram analgesia regional durante o trabalho de parto. As pacientes do grupo estudo (41 casos) receberam duplo bloqueio com sufentanil e bupivacaína e as do grupo controle (36 casos) foram submetidas à peridural com as mesmas drogas. Monitorizou-se o tônus uterino por meio de cateter intra-amniótico de aferição da pressão intra-uterina e a freqüência cardíaca fetal durante 15 minutos antes e 30 minutos após a indução da analgesia. Pesquisaram-se os seguintes desfechos após a administração da analgesia: ocorrência de aumento do tônus uterino superior ou igual a 10mmHg em relação aos valores pré-analgesia e presença de desacelerações prolongadas da FCF ou bradicardia. Foram ainda quantificados os escores maternos de dor, a pressão arterial materna e o uso de ocitocina, antes e após o bloqueio. Observou-se associação significativa tanto do aumento de tônus uterino quanto das alterações da FCF com a analgesia combinada, nos primeiros 15 minutos após sua administração. O aumento de tônus foi encontrado em 17 de 41 casos no grupo estudo e em 6 de 36 pacientes nos controles (p=0,02). Alterações da FCF foram vistas em 11 dos 17 casos de aumento de tônus nas parturientes que receberam analgesia combinada, versus 1 de 6 no grupo peridural (p<0,001). A análise de regressão logística apontou o tipo de analgesia como fator independentemente associado ao aumento de tônus uterino, mesmo inserindo-se o uso de ocitocina como covariável. Também revelou o aumento de tônus como único fator independentemente associado ao desenvolvimento de anormalidades da FCF, mesmo com a hipotensão materna como covariável. Demonstrou-se ainda correlação entre o rápido declínio...

In order to investigate the association between uterine tone elevation and fetal heart rate (FHR) abnormalities following labor analgesia - mainly with combined spinal-epidural (CSE) technique - a prospective double-blinded randomized study was conducted with seventy seven parturients who requested labor analgesia. Study group (41 cases) received CSE with sufentanil and bupivacaine and control group (36 cases) received epidural analgesia with the same drugs. Intra-uterine pressure was monitored with intra-amniotic pressure device and FHR with external transducer, both for at least 15 minutes before and 30 minutes after analgesia induction. The primary outcomes were the occurrence of an elevation of 10mmHg or more on uterine tone compared to the values before analgesia and the presence of prolonged fetal heart rate decelerations or fetal bradycardia. Maternal pain scores, blood pressure and use of oxytocin were also computed. A significant association was noticed between elevation of uterine tone and fetal heart rate abnormalities with combined spinal-epidural analgesia, at the first 15 minutes of administration. Uterine tone elevation was observed in 17 out of 41 CSE subjects and only 6 out of 36 controls (p=0.02). Fetal heart rate abnormalities were seen in 11 out of 17 cases that had hypertonus with combined analgesia and in only one of the 6 epidural patients (p<0.001). Logistic regression analysis revealed the mode of analgesia as the independent factor for the elevation of uterine tone, even with oxytocin use as a covariate. It also pointed out the uterine tone elevation as the only independent factor related to the development of fetal heart rate abnormalities, even with maternal hipotension as a covariate. A correlation was found between the fast onset pain relief provided by CSE analgesia and the estimated probability of uterine tone elevation and simultaneous fetal heart rate abnormalities...

Retrospective Evaluation of Anesthetic Management for Pregnant Surgical Patients / 대한마취과학회지

Backgrounds: It is estimated that 0.75-2% of parturients undergo surgical procedures unrelated to delivery. However, there are few reports on pregnant surgical patients in Korea. This study was undertaken to review the clinical information on patients who have received surgery during pregnancy. METHODS: Of the 11,772 deliveries during the 7-year period 1996-2002, 101 pregnant patients underwent nonobstetric surgery. The medical records and anesthesia records were reviwed for the following data: patient's age, trimester at operation performed, type of surgery and anesthesia, fetal monitoring, preterm labor, and for the delivery of pregnant women undergoing nonobstetrical surgery, except incompetent cervix. RESULTS: As many as 0.86% of pregnant women were found to have undergone surgery, the incidence of nonobstetric surgery, except incompetent cervix, was 0.43%. The 84.3% of patients underwent appendectomies. General anesthesia was administered to 68.6%, and regional anesthesia was administered to 31.4%. The ultrasonographies for fetal monitoring were performed in 96.1% of patients. Of the patients who received abdominal surgery during the second and third trimester, the incidence of preterm labor was 25.0%. There was no premature delivery. CONCLUSIONS: The incidence of nonobstetric surgery for reasons unrelated to pregnancy was 0.43%. Appendectomy was the most common surgical procedure. I recommend the use of uterine monitoring after abdominal surgery.

Valor preditivo da monitorizaçäo das contraçöes uterinas e da ultra-sonografia transvaginal no parto prematuro / Predictive value of uterine contractions monitoring and transvaginal ultrasonography in preterm birth

O parto prematuro constitui-se na principal causa de morbidade e mortalidade neonatais apesar dos avanços obstetricos e neonatais. Nesta revisäo, procura-se dar atençäo a dois métodos que visam identificar as gestantes de risco para a prematuridade: a monitorizaçäo externa da atividade uterina e a ultra-sonografia transvaginal

Determinaçäo do risco para o parto prematuro através da detecçäo da fibronectina fetal na secreçäo cérvico-vaginal e da monitorizaçäo das contraçöes uterinas / Determination of risk for preterm delivery by cervical and vaginal fibronectin detection and by uterine activity monitoring

O objetivo do estudo foi avaliar o aparecimento da fibronectina fetal (fFN) na secreçao cérvico-vaginal e das contraçoes uterinas anormais como métodos preditivos para o parto prematuro. Setenta e duas gestantes foram submetidas, a cada duas semanas, a coletas da secreçao cérvico-vaginal para detectar a presença da fFN e, semanalmente à monitorizaçao das contraçoes uterinas, entre a 24( e a 34( semanas de gestaçao. Foi determinada a correlaçao entre a presença da fFN e o aparecimento de contraçoes uterinas anormais com o parto prematuro em três grupos: grupo l (n=38), gestantes assintomáticas, com risco elevado para o parto prematuro espontâneo; grupo 2 (n=l8), ge stantes de baixo risco para a prematuridade e grupo 3 (n=l6), gestantes com contraçoes uterinas compatíveis com trabalho de parto, com membranas íntegras e em idades gestacionais inferiores a 37 semanas completas. A taxa de parto prematuro espontâneo foi de 21,05 por cento (8/38) no grupo 1; de ll,ll por cento (2/18) no grupo 2 e de 81,25 por cento (l3/16) no grupo 3. No grupo 1, em que todos os testes foram significativos, obtivemos: teste de membrana para a fFN - sensibilidade (S) de 75 por cento; especificidade (E) de 83,33 por cento; valor preditivo positivo (VPP) de 54,54 por cento e valor preditivo negativo (VPN) de 92,59 por cento. O risco relativo (RR) associado ao teste posit ivo foi de 7,36; acurácia, O,81; odds ratio, 1,2 e p=O,0008. O teste de ELISA para a fFN mostrou: S,75 por cento; E, 90 por cento; VPP, 66,66 por cento e VPN, 93,10 por cento. O RR foi de 9,66; acurácia, O,86; odds ratio, 2,0 e p=O,0006. As contraçoes uterinas revelaram: S 50 por cento; E 63,33 por cento; VPP 26,66 por cento e VPN 82,60 por cento. O RR foi de 1,53; acurácia O,60; odds rotio O,36 e p= O,0001471. O teste de membrana e o de ELISA para a detecçao da fFN, quando utilizados entre a 24( e 34( semanas de gravidez, em gestantes assintomáticas com risco elevado para o parto prematuro, constituem melhores mercadores para a prematuridade do que as contraçoes uterinas.

Umbilical and utering doppler velocity waveform indices in normal pregnancy between 24-41 weeks

Ultrasound Doppler umbilical and uterine arteries waveforms studies were performed on obstetrically low risk "normal" population between 24-41 weeks of gestation. The established ranges [mean and 95% data interval] of three indices namely; Pulsatility index [PI], Resistance index [RI], and Systolic/Diastolic ratio [SD], compares favorably with data derived from other populations. Both umbilical and utero-placental velocity waveform indices decrease with advanced gestation, but only with umbilical artery indices that this decrease was significant. Fetal weight at birth correlate with uterine but not umbilical artery velocity waveforms indices. These data derived form our own population can be used for further studies of fetal hemodynamics in complicated pregnancies