Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy. / Guía anestésico-quirúrgica en el tratamiento de la cirugía de aorta ascendente y del arco aórtico. Documento de consenso de la Sociedad Española de Cirugía Cardiovascular y Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

RETRACTED: Anesthesic and surgical guideline for the treatment of the thoraco-abdominal aorta. Consensus Document of the Spanish Societies of Anesthesia and Cardiovascular Surgery. / Guía anestésico-quirúrgica en el tratamiento de la patología de aorta toracoabdominal. Documento de Consenso de la Sociedad Española de Cirugía Cardiovascular Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor.

Este artículo ha sido retirado por indicación del Editor Jefe de la revista, después de constatar que parte de su contenido había sido plagiado, sin mencionar la fuente original: European Heart Journal (2014) 35, 2873 926.: https://academic.oup.com/eurheartj/article/35/41/2873/407693#89325738 El autor de correspondencia ha sido informado de la decisión y está de acuerdo con la retirada del artículo. El Comité Editorial lamenta las molestias que esta decisión pueda ocasionar. Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal

Acretismo placentario focal tratado mediante embolización de arterias uterinas / Focal placenta accreta treated by uterine artery embolisation

El acretismo placentario es causa de hemorragia posparto y es una entidad que incrementa considerablemente la morbimortalidad materna. El diagnóstico anteparto es difícil. La embolización selectiva del vaso nutricio es una técnica conservadora que permite preservar el útero, y por lo tanto conservar la fertilidad. Presentamos el caso de una mujer con hemorragia puerperal, en el que se planteó el diagnóstico diferencial entre acretismo focal y malformación arterio-venosa uterina, que se trató exitosamente mediante embolización de arterias uterinas y posterior legrado, preservando fertilidad y consiguiendo nuevo embarazo posteriormente. Se evalúa la importancia de la interpretación de las imágenes para el diagnóstico, y la adaptación individual de los métodos terapéuticos y el manejo multidisciplinar

Placenta accreta can cause postpartum bleeding and has high maternal morbidity and mortality. Prenatal diagnosis is difficult. Selective embolisation of the uterine artery is a conservative technique that preserves the uterus and fertility. We present the case of a woman with puerperal bleeding, with a postulated differential diagnosis of focal placenta accreta and uterine arteriovenous malformation. Uterine artery embolisation and curettage successfully preserved fertility and the patient subsequently conceived again. We discuss the importance of image interpretation for correct diagnosis, the personalised adaptation of therapeutic methods and a multidisciplinary approach

Penfigoide gestacional / Pemphigoid gestationis

El penfigoide gestacional (PG) o herpes gestationis es una rara enfermedad cutánea autoinmune, que generalmente aparece en el segundo y tercer trimestre, y durante el puerperio, y que puede afectar al curso de la gestación y producir afectación neonatal. Presentamos el caso de una secundigesta con gestación gemelar y pénfigo gestacional. Se describe el proceso de diagnóstico, tratamiento y evolución

The pemphigoid gestationis or herpes gestationis is a rare autoimmune skin disease that occurs during the second or third trimester of pregnancy or in the immediate postpartum and which may affect the course of the pregnancy and cause neonatal pemphigoid gestationis. We present the case of a 40-year-old secudigravida with a twin pregnancy and pemphigoid gestationis. We describe the diagnostic process, treatment, and outcome

Fetal intracranial immature teratoma: presentation of a case and a systematic review of the literature.

OBJECTIVES: To describe a case diagnosed with intracranial teratoma in week 32 of gestation, as well as review of the literature in order to discern the appropriate treatment method and general prognosis of this anomaly. METHODS: A literature search was performed on the prenatal diagnosis of congenital intracranial teratomas in MEDLINE, EMBASE, Cochrane library data bases. Evaluated in this review are parameters such as time of prenatal diagnosis, associated pathology, size of tumors, method of terminating pregnancy, perinatal outcome and histological study of the tumor. RESULTS: A total of 49 cases were found, of which 12 were finished gestation, 28 cesarean section was performed and only nine had vaginal delivery. All died in the neonatal period except in three cases with intrauterine death after diagnosis. CONCLUSION: As the incidence of intracranial immature teratomas is very low and the prognosis is poor, their prenatal diagnosis and obstetric management present a great challenge for the planning of a follow-up and treatment of the disease in accordance with the preferences of the parents.

[Treatment of a female patient with sickle-cell anemia during cardiac surgery with cardiopulmonary bypass]. / Tratamiento de una paciente con drepanocitosis homocigota durante la cirugía cardiaca con circulación extracorpórea.

A 17-year-old girl with drepanocytic (sickle-cell) anemia who was being treated with hydroxyurea and periodic blood transfusions through a Hickman-type catheter was admitted for periodic episodes of fever. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Massive right atrial thrombosis with pulmonary embolism and bacterial endocarditis were detected by computed tomography. Surgery with a beating heart and cardiopulmonary bypass was undertaken. Drepanocytic anemia in individuals homozygous for hemoglobin S is a rare condition in Spain but we are beginning to see a few cases, in which management during anesthesia will be more complicated. High-risk surgery can be carried out in these patients without adverse events if the anesthesiologist is guided by a complete blood workup and takes precautions during and after surgery to control hydration, oxygenation, temperature, and the acid-base balance.

Documento de consenso multidisciplinar para la implantación del Proceso Asistencial Integrado Fibromialgia en el área hospitalaria dependiente del Hospital Universitario de Puerto Real / No disponible

Introducción: en el año 2005 se publicó en Andalucía el Proceso Asistencial Integrado (PAI) Fibromialgia para dotar de un protocolo válido de actuación a los profesionales sanitarios ante los pacientes con esta patología. En el año 2009 se decidió realizar un documento que permitiera la adaptación del PAI al Área Sanitaria del Hospital Universitario Puerto Real para facilitar su implantación. Objetivo: desarrollar un documento de consenso sobre la implantación del PAI Fibromialgia en el Área Sanitaria del Hospital Universitario Puerto Real realizado por representantes de las principales especialidades sanitarias que intervienen en el diagnóstico y tratamiento de dicha patología, así como representantes de las asociaciones de pacientes. Método: se revisó el documento de la Junta de Andalucía sobre el PAI Fibromialgia y los nuevos aspectos sobre dicha patología en la literatura médica actual, intentando adaptarlos a la realidad asistencial de los centros sanitarios dependientes del Hospital Universitario Puerto Real. Se emplearon algunas de las técnicas habituales para realizar consensos (grupo nominal y brainstorming). Conclusión: el PAI Fibromialgia editado por la Junta de Andalucía es un documento que, aunque importante, no se puede implementar como tal en la realidad asistencial de los centros sanitarios dependientes del Hospital Universitario Puerto Real. Tomando dicho documento como base se creó un documento de implantación del proceso, para ello se contó con la participación y consenso de Especialistas de Atención Especializada Hospitalaria y Atención Primaria así como de las Asociaciones de Pacientes con Fibromialgia. Este documento está permitiendo la implementación progresiva del PAI Fibromialgia en el Área Sanitaria del Hospital Universitario Puerto Real (AU)

Introduction: an integrated healthcare process for fibromyalgia -Proceso Asistencial Integrado (PAI) Fibromialgia- was published in 2005 in Andalusia to provide healthcare professionals with a valid protocol for the management of patients with this disease. In 2009 a decision was made to write a document allowing PAI to be adapted to the healthcare area served by Hospital Universitario de Puerto Real in order to facilitate its implementation. Objective: to develop a consensus document on the implementation of PAI Fibromialgia in the healthcare area served by Hospital Universitario de Puerto Real by representatives of the major healthcare specialties involved in the diagnosis and treatment of this condition, as well as representatives of patient associations. Method: the document published by Junta de Andalucía on the PAI Fibromialgia project, and the new aspects of this disease in the current medical literature were all reviewed in an attempt to adjust this process within the actual practice of healthcare centers served by Hospital Universitario de Puerto Real. Some common consensus techniques were used (nominal group and brainstorming). Conclusion: the PAI Fibromialgia paper edited by Junta de Andalucía is a document that, while relevant, cannot be implemented as such within the actual practice of healthcare centers served by Hospital Universitario de Puerto Real. Based on this paper a process implementation document was developed with the aid and consensus of in-hospital specialized care and primary care specialists, as well as fibromyalgia patient associations. This document is now allowing the gradual implementation of PAI Fibromialgia in the healthcare area served by Hospital Universitario de Puerto Real (AU)

Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis.

Some, but not all studies have suggested intra-operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta-analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a 'nitrous oxide group' (total 2297 patients) vs a 'no-nitrous oxide group' (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71-0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no-nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the maximal risk reduction was obtained in female patients (pooled relative risk 0.76, 95% CI 0.60-0.96). When nitrous oxide was used in combination with propofol, the antiemetic effect of the latter appeared to compensate the emetogenic effect of nitrous oxide (pooled relative risk 0.94, 95% CI 0.77-1.15). We conclude that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.

Complejo agnatia-otocefalia / Agnathia-otocephaly complex

El complejo agnatia-otocefalia es una malformación letaly muy infrecuente que puede ser diagnosticada medianteecografía de alta resolución. Describimos el caso de estaentidad en la que la ecografía reveló polihidramnios, cámara gástrica reducida y malformaciones faciales como agnatia, sinotia y protuberancia de la fusión nasobucal

Agnathia-otocephaly complex is a very unfrequentand lethal malformation that could be diagnosed by realtime ultrasonography. We report a case of prenatal diagnosis of this fetal malformation in which the ultrasound examination revealed polyhhidramnios, small stomach shadow and fetal face malformations like agnathia and a protuberance of the nose-mouth fusion

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients.

BACKGROUND: Hip fracture surgery is associated with high post-operative mortality and poor functional results: the excess mortality is 20% in the first year; of those patients who survive, only 50% recover their previous ability to walk. The purpose of this study was to assess the predictive value of six functional status and/or surgical risk scoring systems with regard to serious complications after hip fracture surgery in the elderly. METHODS: We performed a prospective study of a consecutive series of 232 patients (aged 65 years or older) undergoing hip fracture surgery. We pre-operatively applied: The American Society of Anesthesiologists classification, the Barthel index, the Goldman index, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system, the Charlson index and the Visual Analogue Scale for Risk (RISK-VAS) scale. These scales were evaluated with respect to three variables: incidence of serious complications, the ability to walk after a 3-month period and 90-day survival. The predictive value of the different scales was assessed by the calculated area under a receiver operating characteristic curve. RESULTS: The RISK-VAS scale, the POSSUM scoring system and the Charlson index reached a sufficient predictive value with regard to serious post-operative complications. The Barthel index and the RISK-VAS scale were those most useful for predicting ambulation at 3 months. None of the scales proved to be capable of predicting 90-day mortality. CONCLUSIONS: A simple index such as the RISK-VAS scale was the best predictor of serious post-operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.

Prostaglandina E2 intracervical (Prepidil) frente a dispositivo vaginal (Propess) en la maduración cervical e inicio del parto. Estudio comparativo / Comparative study of intracervical prostaglandin E2 (Prepidil) versus vaginal insert (Propress) in labor induction

Objetivo. Comparar la eficacia y seguridad de un gel de prostaglandina E2 (PGE2) intracervical (Prepidil) con la de un dispositivo vaginal de PGE2 (Propress), para la maduración cervical y la inducción de parto. Material y métodos. Un total de 200 gestantes con test de Bishop desfavorable (< 6) y que precisaban inducción de parto fueron seleccionadas en el contexto de un muestreo no probabilístico de casos consecutivos y tratadas con PGE2. Cien gestantes recibieron una dosis de PGE2 intracervical que se repitió a las 24 y 48 h si el cérvix permanecía desfavorable. Si pasadas 48 h de la dosis inicial el parto no se había desencadenado, se procedía a la amniotomía e inducción oxitócica. Del mismo modo, se procedía con otras 100 mujeres a las que se aplicó PGE2 en dispositivo vaginal. Se valoraron las características de las gestantes, el número de aplicaciones, el intervalo entre la aplicación y el comienzo del parto, el tipo de parto, el resultado perinatal y los efectos secundarios. Para la comparación estadística de resultados se utilizó el paquete informático SPSS 10,0, y se consideraron significativos valores de p < 0,05. Resultados. Las características de las pacientes fueron similares, lo que permite que la comparación sea exacta. En el 76% de los casos tratados con gel intracervical, el trabajo activo de parto comenzó tras la primera aplicación, frente al 78% de los casos en que se utilizó el dispositivo vaginal. Ambos procedimientos se mostraron más eficaces en multíparas que en nulíparas. En el 55% de los casos, el intervalo entre la aplicación del gel intracervical y el comienzo del parto fue < 12 h, frente al 40% de los casos en que se aplicó el dispositivo vaginal. No obstante, el intervalo medio entre uno y otro procedimiento apenas mostró diferencias: 17,06 h para el gel y 18,46 h para el dispositivo vaginal. Este intervalo fue menor para ambos procedimientos en las multíparas (10,82 frente a 15,40 h). La tasa de cesáreas fue del 27% para el gel intracervical y del 24% para el dispositivo vaginal. Esta diferencia no fue estadísticamente significativa. En el primer grupo se practicaron un 5% de cesáreas por fracaso de inducción y un 3% en el segundo. Una segunda aplicación se asoció a una mayor tasa de cesáreas, siendo el porcentaje mayor en el grupo tratado con gel intracervical con diferencias estadísticamente significativas (p < 0,005). En los 2 procedimientos utilizados, la cesárea fue más frecuente en nulíparas que en multíparas, con diferencias significativas en el grupo del dispositivo vaginal, si bien estas diferencias no llegaron a ser significativas en el grupo de gel intracervical debido al escaso número de multíparas en este grupo. El resultado perinatal y los efectos secundarios no mostraron diferencias en los 2 grupos estudiados. Conclusión. Ambas formas de PGE2 son seguras y eficaces, si bien la aplicación del dispositivo vaginal se asocia a una menor tasa de cesáreas cuando es necesaria una segunda aplicación, lo que puede estar en relación con una menor tasa de cesáreas por fracaso de inducción con respecto al gel intracervical y la mayor paridad en este grupo. Si a ello se une la facilidad para su colocación y retirada, es evidente que el dispositivo vaginal es una alternativa fiable para la maduración cervical e inducción del parto (AU)

Objective. To compare the efficacy and safety of prostaglandin E2 (PGE2) intracervical gel (Prepidil) with that of PGE2 vaginal insert (Propress) in cervical ripening and labor induction. Material and methods. Two hundred pregnant women with unfavorable Bishop's scores (< 6) requiring induction of labor were selected through nonprobabilistic sampling of consecutive cases. All the women were treated with PGE2. One-hundred pregnant women received an intracervical PGE2 dose, which was repeated 24 and 48 hours later if the cervix remained unfavorable. If labor was not induced 48 hours after the initial dose, amniotomy was performed and oxytocin was administered. The same procedures were performed in another 100 women who were administered PGE2 through a vaginal insert. The characteristics of the pregnant women, the number of applications, the interval between the applications and the beginning of labor, type of delivery, perinatal outcomes, and adverse effects were evaluated. For the statistical comparison of results, the SPSS 10.0 statistical package was used. Values of p < 0.05 were considered significant. Results. The patients' characteristics were similar, allowing exact comparisons. Active labor began after the first application of PGE2 in 76% of the patients treated with intracervical gel compared with 78% of those with the vaginal insert. Both procedures proved to be more effective in multiparas than in nulliparas. The interval between PGE2 application and the beginning of labor was less than 12 hours in 55% of the group with intracervical gel compared with 40% of the group with the vaginal insert. Nevertheless, the mean interval between the two procedures showed minimal differences: 17.06 hours for the gel and 18.46 hours for the vaginal device. With both procedures, this interval was lower in multiparas than in nulliparas (10.82 hours versus 15.40 hours). The rate of caesarean section was 27% in women with intracervical gel and 24% in those with the vaginal device. This difference was not statistically significant. Five percent of cesarean sections were performed for failure of induction in the group with intracervical gel compared with 3% in the group with the vaginal device. A second application was associated with a higher rate of caesarean section; the highest percentage was found in the group treated with intracervical gel, with statistically significant differences (p < 0.005). With both procedures, cesarean section was more frequent in nulliparas than in multiparas, with statistically significant differences in the vaginal insert group; however, in the intracervical gel group these differences did not reach statistical significant due to the small number of multiparas in this group. No significant differences were found between the two groups in perinatal outcomes or adverse effects. Conclusion. Both forms of PGE2 are safe and effective, although the vaginal insert was associated with a lower rate of caesarean section when a second application was required. This finding could be related to the lower rate of cesarean section for failure of induction and to the higher parity in the vaginal insert group. In view of these results and the ease of placement and withdrawal of the vaginal device, this alternative is a valid option for cervical ripening and labor induction (AU)

Doble rotura cardiaca post-infarto agudo de miocardio / Double cardiac rupture post myocardial acute infarction

No disponible

[Epidural obstetric analgesia, maternal fever and neonatal wellness parameters]. / Analgesia epidural obstétrica, fiebre materna y parámetros de bienestar neonatal.

OBJECTIVE: To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. PATIENTS AND METHODS: Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. RESULTS: Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. CONCLUSIONS: Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied.

Analgesia epidural obstétrica, fiebre materna y parámetros de bienestar neonatal / Epidural obstetric analgesia, maternal fever and neonatal wellness parameters

OBJETIVO: Estudiar la relación entre la analgesia epidural y el desarrollo de fiebre materna intraparto así como la posible repercusión de tal asociación en el bienestar neonatal y en la realización de pruebas para descartar sepsis en el recién nacido. PACIENTES Y MÉTODOS: Estudio prospectivo que incluyó a todas las mujeres que dieron a luz en la Fundación Hospital Alcorcón durante 3 años. Se ofertó la administración de analgesia epidural -basada en una perfusión de bupivacaína al 0,0625% más fentanilo a 2 μg mL-1- a todas las gestantes. Se recogieron: edad, nuliparidad, administración de analgesia epidural, inducción del parto, estimulación uterina con oxitocina, tipo de parto, peso fetal, duración de la dilatación y del expulsivo, puntuación Apgar (minutos 1 y 5), pH de la arteria umbilical y temperatura materna. RESULTADOS: Se analizaron los datos de 4.364 mujeres. El 5,7% desarrolló fiebre durante el parto. El 93,7% de los casos de fiebre intraparto ocurrieron dentro del grupo de mujeres con analgesia epidural (p < 0,05). El análisis de regresión logística reveló que la analgesia epidural (OR: 1,78, IC 95%: 1,04-3,04), la nuliparidad (OR: 2,929, IC 95%: 2,005-4,279), el peso fetal (OR: 1,484, IC 95%: 1,102- 2,001) y la duración del parto (OR: 1,003, IC 95%: 1,003- 1,004) fueron factores de riesgo independientes para desarrollo de fiebre. No se encontraron diferencias en la puntuación Apgar 5 min ni en el pH arterial umbilical entre los recién nacidos de mujeres con fiebre y sin ella. El 85,1% de los recién nacidos de madres con fiebre tras analgesia epidural fue sometido a pruebas para descartar sepsis. CONCLUSIONES: La analgesia epidural se asoció con un mayor riesgo de desarrollar fiebre materna; dicha asociación no tuvo repercusión sobre los parámetros de bienestar neonatal estudiados. OBJETIVO: Estudiar la relación entre la analgesia epidural y el desarrollo de fiebre materna intraparto así como la posible repercusión de tal asociación en el bienestar neonatal y en la realización de pruebas para descartar sepsis en el recién nacido. PACIENTES Y MÉTODOS: Estudio prospectivo que incluyó a todas las mujeres que dieron a luz en la Fundación Hospital Alcorcón durante 3 años. Se ofertó la administración de analgesia epidural -basada en una perfusión de bupivacaína al 0,0625% más fentanilo a 2 μg mL-1- a todas las gestantes. Se recogieron: edad, nuliparidad, administración de analgesia epidural, inducción del parto, estimulación uterina con oxitocina, tipo de parto, peso fetal, duración de la dilatación y del expulsivo, puntuación Apgar (minutos 1 y 5), pH de la arteria umbilical y temperatura materna. RESULTADOS: Se analizaron los datos de 4.364 mujeres. El 5,7% desarrolló fiebre durante el parto. El 93,7% de los casos de fiebre intraparto ocurrieron dentro del grupo de mujeres con analgesia epidural (p < 0,05). El análisis de regresión logística reveló que la analgesia epidural (OR: 1,78, IC 95%: 1,04-3,04), la nuliparidad (OR: 2,929, IC 95%: 2,005-4,279), el peso fetal (OR: 1,484, IC 95%: 1,102- 2,001) y la duración del parto (OR: 1,003, IC 95%: 1,003- 1,004) fueron factores de riesgo independientes para desarrollo de fiebre. No se encontraron diferencias en la puntuación Apgar 5 min ni en el pH arterial umbilical entre los recién nacidos de mujeres con fiebre y sin ella. El 85,1% de los recién nacidos de madres con fiebre tras analgesia epidural fue sometido a pruebas para descartar sepsis. CONCLUSIONES: La analgesia epidural se asoció con un mayor riesgo de desarrollar fiebre materna; dicha asociación no tuvo repercusión sobre los parámetros de bienestar neonatal estudiados

OBJECTIVE: To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. PATIENTS AND METHODS: Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 μg•mL-1. Data collected were age, nulli-parity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. RESULTS: Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. CONCLUSIONS: Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied

Trastorno de la coordinación uterina. Inversión del triple gradiente descendente / Uncoordinated uterine activity. Inversion of the triple descending gradient

Se describe el caso de una gestante que en 2 ocasiones y de forma consecutiva presentó, poco antes del término, una actividad uterina descoordinada sin modificaciones cervicales y que fue diagnosticada de distocia dinámica por inversión del “triple gradiente de contracción”. Desde los años cincuenta se conoce su existencia, pero nunca se había podido explicar la causa de este fenómeno. A través de la revisión bibliográfica se analizan las posibles causas y los distintos tratamientos empleados en su resolución

We describe the case of a pregnant woman who, on two consecutive occasions and shortly before term, presented uncoordinated uterine activity without cervical modification and who was diagnosed with dynamic dystocia due to inversion of the “triple contraction gradient”. This phenomenon has been known since the 1950s but its cause has never been explained. We performed a literature review to analyze its possible causes and the various treatments used to resolve it

[Obstetric epidural analgesia: relationship between obstetric variables and the course of labor]. / Analgesia epidural obstétrica: relación con diversas variables obstétricas y con la evolución del parto.

OBJECTIVES: To analyze the relationship between epidural analgesia and diverse obstetric and fetal variables as well as the impact of epidural analgesia on the rates of instrumental and cesarean delivery. PATIENTS AND METHODS: Observational study of women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered obstetric epidural analgesia based on 0.0625% bupivacaine plus 2 microg/mL of fentanyl. The following data were recorded: age, nulliparity (yes/no) administration of epidural analgesia (yes/no), induction of labor (yes/no), stimulation of uterine activity with oxytocin (yes/no), type of delivery, fetal weight, duration of dilation, duration of expulsion, cause of cesarean. RESULTS: The records of 4364 women were gathered. The percentages of inductions, nulliparas, oxytocin stimulation, and fetal weight greater than 4 kg and less than 2.5 kg were higher among women taking epidural analgesia. The age of women who received epidurals was significantly lower. The durations of dilation and expulsion were longer among women receiving epidural analgesia, and epidural analgesia was associated with greater risk of instrumental and cesarean deliveries. The significant increase in administration of epidural blocks over the 3-year period of the study was not accompanied by an increased rate of instrumentally assisted deliveries or cesareans. CONCLUSIONS: It is difficult to evaluate the real influence of epidural analgesia on certain aspects of labor and its evolution. The strength of the association between epidural analgesia and greater risk of increased rates of instrumental and cesarean deliveries may be influenced by factors not considered in the present study.

Ropivacaína y bupivacaína para la analgesia epidural obstétrica / Ropivacaine and bupivacaine for obstetric epidural

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