Puesta al dia sobre atosiban denominacion del medicamento tractocile 6. 75 MG/ 0. 9 ML solución inyectable / Up to the day about atosiban name of the medicinal product tractocile 6.75 Mg/ 0.9 Ml solution for injection

Este trabajo trata de la actualización del uso de ATOSIBAN para el tratamiento de la amenaza de parto prematuro, utilizando para su aplicación el protocolo de administración de Tractocile en el servicio de partes vs internado general, a los efectos de sistematizar los cuidados de enfermería en la utilización de este medicamento.

Efectividad del tratamiento de la amenaza de parto pretérmimo con progesterona natural micronizada / Effectiveness of treatment of threatened labor preterm micronized natural progesterone

Objetivo: Evaluar la efectividad de la progesterona natural micronizada administrada vía oral y del fenoterol administrado vía endovenosa, en el tratamiento de las pacientes con diagnóstico de amenaza de parto pretérmino. Métodos: Estudio experimental tipo ensayo terapéutico en pacientes que acudieron al Hospital Universitario de Caracas. Resultados: 15 pacientes del grupo estudio con progesterona presentaron resultados satisfactorios (X² = 155,837, df = 18); del grupo control, 13 pacientes con resultados satisfactorios (X² = 133,093, df = 18). La efectividad absoluta en el grupo de estudio fue de 0,68 contra 0,59 del grupo control (X² = 0,393; df = 1; P < 0,531). Conclusiones: Los tratamientos con progesterona natural micronizada y fenoterol demostraron ser inhibitorios de la dinámica uterina, a partir de la segunda hora de iniciado el tratamiento, evitando su progreso hacia trabajo de parto en un 90 %. La progesterona natural micronizada es efectiva en el tratamiento de la amenaza de parto pretérmino y se debe considerar su uso como alternativa terapéutica.

Objective: To evaluate the effectiveness of micronized natural progesterone administered orally and intravenously administered fenoterol in the treatment of patients with a diagnosis of preterm labor. Method: The type of therapeutic trial in patients attended at the Hospital Universitario de Caracas. Results: 15 patients in the progesterone study showed satisfactory results (X² = 155.837 df = 18); the control group, 13 patients with satisfactory results (X² = 133.093 df = 18). The absolute effectiveness in the study group was 0.68 against 0.59 in the control group (X² = 0.393 df = 1, P < 0.531). Conclusions: Treatment with micronized natural progesterone and fenoterol proved inhibitory uterine dynamics from the second hour of starting treatment preventing its progress toward labor by 90 %. The micronized natural progesterone is effective in the treatment of preterm labor and should be considered as an alternative therapeutic use.

Sulfato de magnésio: um avanço na neuroproteção fetal? / Magnesium sulfate: an improvement in fetal neuroprotection?

A paralisia cerebral é a causa mais comum de deficiência motora na infância. É uma doença complexa e de caráter não progressivo, que se caracteriza por distúrbios motores secundários alesões cerebrais ou a anomalias oriundas das fases iniciais de desenvolvimento do cérebro. O fator de risco mais importante para paralisia cerebral é o nascimento pré-termo, cuja incidência tem aumentado significativamente. Como consequência, a ocorrência da paralisia cerebral também tem aumentado, a despeito da melhoria da sobrevida dos fetos pré-termos. O risco da paralisia cerebral é tanto maior quanto menores a idade gestacional e o peso ao nascimento. Dessa forma, estratégias que se mostrarem efetivas para reduzir a paralisia cerebral nesses recém-nascidos deveriam ser implementadas com o objetivo de diminuir os seus efeitos danosos nos indivíduos e suas famílias, nos serviços de saúde e na sociedade como um todo. O sulfato de magnésio tem se mostrado como um promissor agente neuroprotetor fetal. Desde a década de 1990, estudos resultantes das suas indicações para prevenção das convulsões eclâmpticas ou para tocólise têm evidenciado uma redução nas taxas de paralisia cerebral e leucomalácia periventricular em prematuros. Publicações mais recentes, incluindo diretrizes internacionais, têm avançado na recomendação sobre os regimes terapêuticos e na construção de algoritmos para utilização do sulfato de magnésio como agente neuroprotetor fetal.

Cerebral palsy is the most common cause of motor disability in childhood.It is a complex and non-progressive disorder, which is characterized by motor disturbances secundary to brain injuries or anomalies resulting from the early stages of brain development. The most important risk factor forthe occurrence of cerebral palsy is preterm birth, which has increased significantly. As a result, the incidence of cerebral paralysis has also increased despite the improvement in the survival of preterm fetuses. The risk of cerebral palsy increases with the reduction of gestational age and birth weight. Thus, strategies that have proved effective in reducing cerebral palsy in these infants should be implemented in order to decrease their harmful effects on individuals and their families, on health services and society as a whole. Magnesium sulfate has been shown as a promising fetal neuroprotective agent. Since the 1990s, studies arising from its indications for prevention of eclamptic seizures or tocolysis have shown a reduction in the rates of cerebral palsy and periventricular leukomalacia in preterm infants. More recent publications, including international guidelines,have advanced in the recommendation on treatment regimens and the construction of algorithms for use of magnesium sulfate as a fetal agent.

Parto prematuro / Premature delivery

El parto prematuro es la causa única más importante de morbilidad y mortalidad perinatal. En Chile, los partos prematuros han aumentado en la última década, aunque la morbimortalidad neonatal atribuible a ella muestra una tendencia descendente, gracias a la mejoría en el cuidado neonatal de los prematuros, más que al éxito de estrategias preventivas y terapéuticas obstétricas. En este artículo se describen entidades clínicas, procesos patológicos y condiciones que constituyen factores predisponentes del parto prematuro; por otra parte se detallan procedimientos para la prevención y manejo clínico de mujeres en riesgo de parto prematuro.

Preterm delivery is the single most important cause of perinatal morbidity and mortality. In Chile, preterm births have increased in the past decade, although neonatal morbidity and mortality attributable to it shows a downward trend, thanks to improvements in neonatal care of premature babies, rather than the success of obstetric preventive and therapeutic strategies. This article describes clinical entities, disease processes and conditions that constitute predisposing factors of preterm birth, as well as an outline for the prevention and clinical management of women at risk of preterm birth.

Nitroglicerina transdérmica versus nifedipina oral para inibição do trabalho de parto prematuro: ensaio clínico randomizado / Transdermal nitroglycerin versus oral nifedipine administration for tocolysis: a randomized clinical trial

OBJETIVO: comparar a efetividade da nitroglicerina transdérmica com a nifedipina oral na inibição do trabalho de parto prematuro. MÉTODOS: foi realizado um ensaio clínico com 50 mulheres em trabalho de parto prematuro, randomizadas em dois grupos, 24 para nifedipina oral (20 mg) e 26 para nitroglicerina transdérmica (patch 10 mg). Foram selecionadas as pacientes com gestação única, entre a 24ª e 34ª semanas e diagnóstico de trabalho de parto prematuro. Foram excluídas pacientes com malformações fetais e com doenças clínicas ou obstétricas. As variáveis analisadas foram tocólise efetiva, tempo necessário para tocólise, frequência de recorrência, progressão para parto prematuro e efeitos colaterais. RESULTADOS: a eficácia da tocólise nas primeiras 12 horas foi semelhante entre os grupos (nitroglicerina: 84,6 por cento versus nifedipina: 87,5 por cento; p=0,5). A média do tempo para tocólise também foi semelhante (6,6 versus 5,8 horas; p=0,3). Não houve diferença entre os grupos quanto à recorrência de parto prematuro (26,9 versus 16,7 por cento; p=0,3) e nem na frequência de parto prematuro dentro de 48 horas (15,4 versus 12,5 por cento; p=0,5). Entretanto, a frequência de cefaleia foi significativamente maior no grupo que usou nitroglicerina (30,8 versus 8,3 por cento; p=0,04). CONCLUSÕES: a nitroglicerina transdérmica apresentou efetividade semelhante à nifedipina oral para inibição do trabalho de parto prematuro nas primeiras 48 horas, porém com maior frequência de cefaleia.

PURPOSE: to compare the effectiveness of transdermal nitroglycerin with oral nifedipine in the inhibition of preterm delivery. METHODS: a clinical essay has been performed with 50 women in preterm delivery, randomly divided into two groups, 24 receiving oral nifedipine (20 mg), and 26, transdermal nitroglycerin (10 mg patch). Patients with a single gestation, between the 24th and the 34th weeks and diagnosis of preterm delivery were selected. Women with fetal malformation and clinical or obstetric diseases were excluded. The variables analyzed were: effective tocolysis, time needed for tocolysis, recurrence frequency, progression to preterm delivery, and side effects. RESULTS: tocolysis efficacy in the first 12 hours was similar between the groups (nitroglycerin: 84.6 percent versus nifedipine: 87.5 percent; p=0.50). The time average time needed for tocolysis was also similar (6.6 versus 5.8 hours; p=0.30). There was no difference between the groups, concerning the recurrence of preterm delivery (26.9 versus 16.7 percent; p=0.30), and neither in the rate of preterm delivery within 48 hours (15.4 versus 12.5 percent; p=0.50). Nevertheless, the cephalea rate was significantly higher in the Nitroglycerin Group (30.8 versus 8.3 percent; p=0.04). CONCLUSIONS: transdermal nitroglycerin has presented similar effectiveness to oral nifedipine to inhibit preterm delivery in the first 48 hours, however with higher cephalea frequency.

Magnesium sulphate: a life saving drug.

A retrospective study of 68 eclamptic women who received Magnesium sulphate at Koshi Zonal Hospital were analyzed during a one year period (2006-2007 AD). Maternal conditions at admission, associated complications in mothers and babies, delivery outcomes and cause of death were also studied in each case. There were 5240 deliveries during the period of analysis. Of which 4976 were live births, pregnancy induced hypertension was 0.89% (47), 0.74% (39) presented with pre-eclampsia, 0.30 (16) cases with severe pre-eclampsia and 0.43 (23) cases with mild pre-eclampsia. During this period 1.3% (68) of eclampsia presented to the hospital. Of which 67.7% presented with ante-partum eclampsia, 22.1% with intrapartum eclampsia and 10.3% with post partum eclampsia. Majority of women (63.2%) were between 20-25 years of age, while teenage pregnancy contributed 30.88% of eclamptic cases. The diastolic blood pressure was >110 mm of Hg in 45.6% of cases, 90-110 mmHg in 50% of cases and in 4.4% the it was <90 mmHg. 94.1% presented to the hospital in an unconscious state, 79.4% of eclamptic women received the full dose of magnesium sulphate (initial loading plus maintenance dose), while rest failed to receive the full dose. Nine women with severe pre-eclampsia received magnesium sulphate as a prophylactic measure. 17.7% women had home delivery, one patient left against medical advice and one was referred to a tertiary care center. Caesarian Section (Lower Segment) was performed in 35.2% of cases, 30.8% had normal vaginal deliveries and 5.8% had pre term delivery. About 69.6% babies were born alive, 8.7% were still births, 11.6% were neonatal deaths and 4.4% of babies had to be admitted to the neonatal intensive care. Eclamptic women stayed less than one week in the hospital in majority of cases (64.7%), between 1-2 weeks in 32.4% and more than two weeks in 2.9%. Maternal complications included decreased urinary output, pulmonary edema in three cases; chest and wound infection two cases each; post partum psychosis, vulval haematoma, severe headache one case each. There were seven maternal deaths during this period and eclampsia contributed to one of the deaths. Eclampsia is a major cause of maternal and perinatal morbidity and mortality in our setup. Magnesium sulphate is an excellent drug of choice in management of eclampsia and pre-eclampsia. Wider coverage of pre-natal care, timely referral and optimal management of cases of eclampsia with magnesium sulphate in hospitals are key issues to prevent mortality/morbidity associated with it.

Safety and efficacy of oral nifedipine versus terbutaline injection in preterm labor.

OBJECTIVE: To compare the safety and tocolytic efficacy of oral nifedipine with intravenous terbutaline for the management of threatened preterm labor. MATERIAL AND METHOD: Pregnant women between 24 and 36 completed weeks of single gestation with preterm labor were randomized to either oral nifedipine (n=20) or intravenous terbutaline (n=20) treatment. Nifedipine (immediate released capsule) 10 mg was crushed and swallowed, 10 mg every 20 minutes was allowed if necessary with a maximum 40 mg in the first hour. After that 20 mg nifedipine every 4 hours was given, up to 72 hours. Terbutaline was initially infused with the rate 10 g/min with an increment 5 microg/min every 10 minutes if required, until 25 microg/min was reached. Once the contractions had stopped for 2-6 hours, the patients were switched to subcutaneous injection with 0.25 mg terbutaline every 4 hours for 24 hours. The main safety outcome was the changes in maternal diastolic blood pressure from baseline and 1 hour after starting the treatment (deltaDBP(1hr)). Secondary outcomes were the efficacy to delay delivery > or =48 hours and 7 days, the adverse events and the birth outcomes. RESULTS: deltaDBP(1hr) was greater in the terbutaline group than that in the nifedipine group with no statistically significant difference. Hypotension (defined as BP < or = 90/60 mmHg) was found in one patient of the nifedipine group and two patients of the terbutaline group. Seventeen and 14 patients in the nifedipine group and 15 and 12 patients in the terbutaline group had delayed delivery > or =48 hours and 7 days, respectively. Mothers in the nifedipine group experienced fewer side effects than those in the terbutaline group. Maternal heart rate, at I hour after starting the treatment, increased significantly higher in the terbutaline group than in the nifedipine group. Birth outcomes were measured in all nifedipine group patients, but in only 16 of the terbutaline group patients. Six mothers in each group delivered after 37 weeks. Intraventricular hemorrhage (IVH) occurred in three babies (gestational aged 25, 29 and 37 weeks) born to mothers treated with terbutaline. In one baby, IVH related to trauma resulted from the delivery procedure. CONCLUSION: The safety and efficacy of nifedipine compares with that of terbutaline for treatment of preterm labor.

The efficacy of terbutaline and magnesium sulfate in the management of preterm labor.

Ninety-six patients with preterm labor at 28 weeks to 35 weeks gestation were randomized to terbutaline or magnesium sulfate untill 36 weeks gestation, 25 patients were excluded from the study. Of the remaining 71 patients, 35 patients received terbutaline and 36 patients received magnesium sulfate. The result of the study showed that, there were no significant differences (P > 0.05) regarding time to stop, mean gestational age at delivery, time gained, failure rate, time to recurrent labor and readmission for recurrent labor, birth weight, apgar score and fetal survival. Serious maternal side effects were not observed with terbutaline or magnesium sulfate, although the majority of women also received dexamethasone. Neither drug caused serious adverse neonatal effects.

Evacuación uterina con prostaglandina E-1 en el hospital nacional Edgardo Rebagliati Martins / Uterine delivery with prostaglandina E-1 in the Hospital Nacional Edgardo Rebagliati Martins

Se presenta el estudio de 113 casos de paciente tratados con Prostaglandina E-1 para evacuación uterina, realizado en el Departamento de Obstetricia del Hospital Nacional Edgardo Rebagliati Martins del Instituto Peruano de Seguridad Social, entre Enero de 1992 y Diciembre de 1993. El motivo del estudio fue la búsqueda de una alternativa al uso de la Oxitocina para la evacuación uterina, en casos en que estuviera indicado dicho procedimiento por alguna razón médica. Se utilizó la vía oral y, en ocasiones se combinó con la vía vaginal. Los resultados fueron exitosos en 103 casos y frustros en 10 (8.8 por ciento). Los efectos colaterales fueron mínimos. Su manejo por vía oral, la rara presentación de efectos secundarios y el bajo porcentaje de casos frustos, lo constituyen en producto a elegir en el diario manejo de la especialidad; su uso acorta la estancia hospitalaria; puede ser utilizado en grandes multíparas y en pacientes cesareadas anteriores; facilitando el tratamiento quirúrgico complementario.

Comparación del efecto tocolítico, in vitro, entre un anticálcico(Nifedipina) versus un B- agonista(Terbutalina) en útero de rata: estudio descriptivo. Informe preliminar

En útero de rata, previamente estrogenizado, se comparó el efecto tocolítico, nanomol(dosis de contracción 50, previamente titulada en nuestro laboratorio), alternadas con seis diferentes infusiones de tres nanomoles de terbutalina y tres nanomoles de Nifedipina. Se encontró que utilizando la misma dosis de ambos fármacos, existe un mayor efecto tocilítico(disminución del número de contracciones uterinas por minuto) con la Nifedipina que con la Terburtalina. La Nifedipina a pesar de nuevas infusiones de oxitocina, presentó un efecto tocolítico sostenido, no sucediendo lo mismo con la Terbutalina