Intervalos de referencia de la tirotropina durante la gestación en la provincia de Huelva / Thyrotropin reference ranges during pregnancy in the province of Huelva, Spain

Objetivo: El diagnóstico correcto de hipotiroidismo gestacional requiere determinar los intervalos de referencia trimestrales locales de la TSH. En su ausencia las guías recomiendan utilizar como límites superiores 2,5-3,0-3,0μU/ml para el 1.°-2.°-3.° trimestre. Nuestro objetivo es calcular el rango de referencia para nuestra población. Material y métodos: Estudio observacional de base poblacional realizado en gestantes sanas de 11 centros de salud de la provincia de Huelva incluidas consecutivamente durante el año 2016 en el proceso de embarazo. Excluimos las gestantes con antecedentes de enfermedad tiroidea o médica, malos antecedentes obstétricos, embarazo gemelar, autoinmunidad tiroidea y TSH en valores extremos (<0,4μU/ml o>10μU/ml), así como las que durante el estudio iniciaron tratamiento con levotiroxina por disfunción tiroidea. Resultados: Seleccionamos 186 gestantes de 30,7 años (IC 95%: 29,8-31,6) e IMC de 23,6 (IC 95%: 23,2-24,0) que mayoritariamente se hicieron la 1.ª analítica con anterioridad a la 11.ª semana de gestación. Fueron válidas para el análisis 145-105-67 gestantes en el 1.°-2.°-3.° trimestre, respectivamente, tras excluir sucesivamente abortos (18,9%), autoinmunidad (6,5%), hipo/hipertiroidismos (2,2%) y tratamientos con levotiroxina durante el 2.°/3.° trimestre (18,6%). El percentil 97,5 de la TSH para el 1.°-2.°-3.° trimestre, respectivamente, fue de 4,68-4,83-4,57μU/ml. Durante el estudio se detectaron 80 gestantes con disfunción tiroidea (55,2%), recibiendo 33 de ellas tratamiento con levotiroxina (22,7%); con los nuevos criterios la prevalencia de disfunción tiroidea se reduciría al 6,2% y la necesidad de tratamiento al 4,1%. Conclusión: El rango de normalidad de TSH de nuestra población difiere del propuesto en las guías. Un 18,6% de las gestantes fueron tratadas innecesariamente

Objective: The correct diagnosis of hypothyroidism during pregnancy requires knowledge of the local trimester-specific thyrotropin (TSH) reference ranges. When these are not available, the guidelines recommend upper limits of 2.5, 3.0, and 3.0μU/ml for the 1st, 2nd, and 3rd trimesters, respectively. The aim is to establish the reference range for our local population. Material and methods: A population-based observational study was performed on healthy pregnant women from 11 healthcare centres in the province of Huelva. Women were recruited consecutively during 2016 through the pregnancy process. Women were excluded who had a history of thyroid or medical disease, a poor obstetric history, multiple pregnancy, thyroid autoimmunity, and extreme TSH values (<0.4μU/ml or>10μU/ml), as well as women treated with levothyroxine for thyroid dysfunction. Results: The study included a total of 186 pregnant women, with a mean age of 30.7 years (95% CI: 29.8-31.6) and a body mass index (BMI) of 23.6 (95% CI: 23.2-24.0). Most of them had the first laboratory tests performed before week 11 of pregnancy. Valid subjects for analysis were 145, 105, and 67 pregnant women in the 1st, 2nd, and 3rd trimesters, respectively, after excluding those due to abortion (18.9%), autoimmunity (6.5%), hypo/hyperthyroidism (2.2%), and levothyroxine treatment during the 2nd/3rd trimester (18.6%). The 97.5% TSH percentile for the 1st, 2nd, and 3rd trimester was 4.68, 4.83, and 4.57μU/ml, respectively. Thyroid dysfunction was identified in 80 women (55.2%), 33 of whom received treatment with Levothyroxine (22.7%). With the new criteria, thyroid dysfunction prevalence would be reduced to 6.2%, and the need for treatment to 4.1%. Conclusion: The reference range for TSH in our population differs from that proposed by the guidelines. Unnecessary treatment was being given to 18.6% of pregnant women

[Thyrotropin reference ranges during pregnancy in the province of Huelva, Spain]. / Intervalos de referencia de la tirotropina durante la gestación en la provincia de Huelva.

OBJECTIVE: The correct diagnosis of hypothyroidism during pregnancy requires knowledge of the local trimester-specific thyrotropin (TSH) reference ranges. When these are not available, the guidelines recommend upper limits of 2.5, 3.0, and 3.0µU/ml for the 1st, 2nd, and 3rd trimesters, respectively. The aim is to establish the reference range for our local population. MATERIAL AND METHODS: A population-based observational study was performed on healthy pregnant women from 11 healthcare centres in the province of Huelva. Women were recruited consecutively during 2016 through the pregnancy process. Women were excluded who had a history of thyroid or medical disease, a poor obstetric history, multiple pregnancy, thyroid autoimmunity, and extreme TSH values (<0.4µU/ml or>10µU/ml), as well as women treated with levothyroxine for thyroid dysfunction. RESULTS: The study included a total of 186 pregnant women, with a mean age of 30.7 years (95% CI: 29.8-31.6) and a body mass index (BMI) of 23.6 (95% CI: 23.2-24.0). Most of them had the first laboratory tests performed before week 11 of pregnancy. Valid subjects for analysis were 145, 105, and 67 pregnant women in the 1st, 2nd, and 3rd trimesters, respectively, after excluding those due to abortion (18.9%), autoimmunity (6.5%), hypo/hyperthyroidism (2.2%), and levothyroxine treatment during the 2nd/3rd trimester (18.6%). The 97.5% TSH percentile for the 1st, 2nd, and 3rd trimester was 4.68, 4.83, and 4.57µU/ml, respectively. Thyroid dysfunction was identified in 80 women (55.2%), 33 of whom received treatment with Levothyroxine (22.7%). With the new criteria, thyroid dysfunction prevalence would be reduced to 6.2%, and the need for treatment to 4.1%. CONCLUSION: The reference range for TSH in our population differs from that proposed by the guidelines. Unnecessary treatment was being given to 18.6% of pregnant women.

Evaluación de un programa de educación sexual sobre conocimientos y conductas sexuales en embarazadas / Evaluation of a sexual education program on knowledge and sexual behaviour in pregnant

Objetivo: Evaluar el nivel de conocimientos de la sexualidad en la gestación previos y posteriores a un programa formativo implementado por un grupo de gestantes en el segundo y tercer trimestre. Material y método: diseño cuasi-experimental pre-post test de un único grupo. Participaron 40 mujeres grávidas de bajo riesgo que se encontraban en su segundo y tercer trimestre de gestación. Todas eran de raza blanca. El 85% de las gestantes comprendían una edad entre 20 y 35 años, un 60% eran primigestas. Resultados: al 60% de las mujeres del estudio les ha afectado el embarazo a su vida sexual. El trimestre que ellas creen que pueden disfrutar más del sexo, en un primer cuestionario el 62.5% contestaron que en el segundo, después de implantar el programa, el 95% dieron esa respuesta. Entre las diferentes técnicas sexuales que existen, el 87.5% la conocían en un principio, después de realizar nuestro programa el porcentaje aumentó a un 97.4%. En cuanto a los beneficios de los ejercicios de Kegel, en un primer cuestionario tan sólo el 25% sabían la respuesta correcta, mientras que más tarde aumentó a un 85% y su práctica era realizada un 12.5% antes de la intervención, y después un 40%. Discusión-Conclusión: después de aplicar nuestro programa específico se notaron algunas mejoras en el nivel de conocimientos y actitudes sexuales aunque debido probablemente a la pequeña muestra utilizada no se han encontrado resultados estadísticamente significativos salvo en una variable (práctica de Kegel) (AU)

Objective: Evaluate the level of knowledge of sexuality in pregnancy before and after a training program implemented by a group of pregnant women in the second and third trimesters. Materials and methods: A quasi-experimental pre-post test single group. A total of 40 pregnant women at low risk who were in their second and third trimester were included. Regarding the ethnical group all women were white. The 85% of pregnant women included had an age between 20 and 35 years and for the 60% it was their first pregnancy. Results: 60% of women have altered her sex life. The initially believed that the most suitable month to enjoy sex live more was on the second trimester, as shown on the first questionnaire (62.5%). After implementing the program, these results increased up to the 95%. Regarding the different sexual techniques, 87.5% knew them at first, after participating in our program this percentage increased to 97.4%. In relation to the benefits of Kegel exercises, in the first questionnaire only 25% knew the correct answer, while after the program increased to 85%. Its practice increased to 12.5% before the intervention, and then a 40% of pregnant women said they knew it and practiced it. Discussion-Conclusion: after applying our specific program noted some improvements in the level of knowledge and sexual attitudes but probably due to the small sample used was not found statistically significant results except for one variable (practice Kegel) (AU)

Consideraciones generales en la atención de urgencia a la paciente obstétrica politraumatizada / General considerations emergency care in the obstetric patient polytrauma

El presente artículo tiene como objetivo principal que los sanitarios conozcan las modificaciones fisiológicas que se producen en la mujer embarazada y que precisan consideraciones especiales en la atención de urgencias prehospitalaria para conseguir mejores resultados materno-fetales. Para su elaboración se ha procedido a una búsqueda sistemática de las principales bases de datos: Cinahl, Pubmed, Cuiden, Cochrane, Google académico y Revista Matronas Profesión con las palabras clave: Politraumatismo y Embarazo. La búsqueda obtuvo un resultado de 55 artículos de los cuales se eliminaron 33 por su falta de validez en la metodología o no estar relacionados con el objeto de estudio. Como conclusión podemos decir que el aumento de la actividad laboral de la mujer, la persistencia en su trabajo hasta el final de su gestación y el mayor uso del automóvil han incrementado las tasas de traumatismos obstétricos y de la morbi-mortalidad de la mujer en los países industrializados (1) siendo la consecuencia más importante la muerte fetal (2), es necesario conocer las modificaciones fisiológicas propias del embarazo y su repercusión en la compensación orgánica para proporcionar la mejor atención posible y mejorar los resultados maternos así como garantizar el mayor bienestar fetal (AU)

This article's main objective is that the toilets are aware of the physiological changes that occur in pregnant women who require special considerations in prehospital emergency care for better maternal and fetal outcomes. Its production has made a systematic search of major databases: Cinahl, Pubmed, Take care, Cochrane, Google Scholar and Midwifery Profession Magazine with keywords: trauma and pregnancy. The search yielded a score of 55 articles of which 33 were eliminated for lack of validity in the methodology or may not be related to the subject matter. In conclusion we can say that the increase in female labor activity, persistence in his work until the end of gestation and greater car use have increased rates of obstetric trauma and morbidity and mortality of women in the industrialized countries (1) being the most important consequence of fetal death (2), it is necessary to understand the physiological changes of pregnancy and their own impact on the organic compensation to provide the best care possible and to improve maternal outcomes and ensure the greater good fetal (AU)