Atención de enfermería para la prevención terciaria de algunas complicaciones asociadas al puerperio

Introducción: En el proceso de atención de enfermería se incluyen acciones destinadas a la prevención de enfermedades durante el puerperio. Objetivo: Describir el proceso de atención de enfermería para la prevención terciaria de algunas complicaciones relacionadas con el puerperio. Métodos: Se realizó un estudio observacional descriptivo y transversal en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero hasta diciembre del 2022, que incluyó a 2 grupos poblacionales integrados por 225 puérperas y 80 enfermeras. Entre las variables estudiadas figuraron las siguientes: complicaciones, tipo de cuidado, tiempo de trabajo con puérperas y nivel de conocimientos sobre prevención. Resultados: En la serie predominaron la hemorragia (36,4 %), la preeclampsia y el tromboembolismo (26,0 y 21,1 %, respectivamente) como principales complicaciones, además del cuidado de tipo estandarizado (56,5 %) y los conocimientos inadecuados sobre prevención (58,7 %). Conclusiones: La atención de enfermería para la prevención terciaria de algunas complicaciones se brinda fundamentalmente a puérperas con preeclampsia, tromboembolismo y hemorragia, por lo que el cuidado estandarizado requiere mayor preparación del personal que interviene en el proceso.

Introduction: The nursing care process includes actions aimed at preventing diseases during postpartum period. Objective: To describe the process of nursing care for the tertiary prevention of some complications related to postpartum. Methods: An observational descriptive and cross-sectional study was carried out at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January to December, 2022, that included 2 population groups integrated by 225 newly-delivered women and 80 nurses. The variables studied were the following: complications, type of care, working time with newly-delivered women and level of knowledge about prevention. Results: In the series there was a prevalence of the hemorrhage (36.4%), pre-eclampsia and thromboembolism (26.0 and 21.1%, respectively) as main complications, besides the care of standardized type (56.5%) and the inadequate knowledge on prevention (58.7%). Conclusions: Nursing care for the tertiary prevention of some complications is offered fundamentally to newly-delivered women with pre-eclampsia, thromboembolism and hemorrhages, reason why the standardized care requires more preparation of the staff that intervenes in the process.

Risk factors of deficit and non-deficit schizophrenia: Results from a cross-sectional study.

AIM: It has been observed that deficit and non-deficit schizophrenia (SCZ-D and SCZ-ND) might be characterized by different risk factors. Therefore, the present study aimed to assess as to whether previously reported risk factors of schizophrenia are specifically associated with SCZ-D and SCZ-ND. METHOD: This study was based on a cohort of 118 stable outpatients with schizophrenia. A diagnosis of SCZ-D was established using the Schedule for the Deficit Syndrome (SDS). Risk factors were recorded using structured interview, the Operational Criteria for Psychotic Illness (OPCRIT) checklist and the Traumatic Experience Checklist (TEC). The following risk factors were explored: male sex, a history of schizophrenia in first-degree relatives, seasonality of birth, birth weight <3000g, delivery by cesarean section, a history of childhood trauma (emotional abuse, emotional neglect, physical abuse and sexual abuse) as well as substance abuse (other than nicotine) and cigarette smoking at psychosis onset. RESULTS: Individuals with SCZ-D were more likely to be males as well as reported higher rates of birth weight <3000g and any categories of childhood trauma. In turn, substance abuse (other than nicotine) at psychosis onset was significantly more frequent in patients with SCZ-ND. Binary logistic regression, controlling for multiple comparisons, revealed similar findings, except for the association with any categories of childhood trauma that appeared to be not significant. CONCLUSION: Our findings partially replicate differential patterns of risk factors for SCZ-D (male sex and birth weight <3000g) and SCZ-ND (substance abuse at psychosis onset), likely attributable to the effects of timing of exposure.

Risk factors of deficit and non-deficit schizophrenia: Results from a cross-sectional study / Factores de riesgo para la esquizofrenia deficitaria y no deficitaria: resultados de un estudio transversal

Aim: It has been observed that deficit and non-deficit schizophrenia (SCZ-D and SCZ-ND) might be characterized by different risk factors. Therefore, the present study aimed to assess as to whether previously reported risk factors of schizophrenia are specifically associated with SCZ-D and SCZ-ND. Method: This study was based on a cohort of 118 stable outpatients with schizophrenia. A diagnosis of SCZ-D was established using the Schedule for the Deficit Syndrome (SDS). Risk factors were recorded using structured interview, the Operational Criteria for Psychotic Illness (OPCRIT) checklist and the Traumatic Experience Checklist (TEC). The following risk factors were explored: male sex, a history of schizophrenia in first-degree relatives, seasonality of birth, birth weight <3000g, delivery by cesarean section, a history of childhood trauma (emotional abuse, emotional neglect, physical abuse and sexual abuse) as well as substance abuse (other than nicotine) and cigarette smoking at psychosis onset. Results: Individuals with SCZ-D were more likely to be males as well as reported higher rates of birth weight <3000g and any categories of childhood trauma. In turn, substance abuse (other than nicotine) at psychosis onset was significantly more frequent in patients with SCZ-ND. Binary logistic regression, controlling for multiple comparisons, revealed similar findings, except for the association with any categories of childhood trauma that appeared to be not significant. Conclusion: Our findings partially replicate differential patterns of risk factors for SCZ-D (male sex and birth weight <3000g) and SCZ-ND (substance abuse at psychosis onset), likely attributable to the effects of timing of exposure. (AU)

Objetivo: Se ha observado que la esquizofrenia deficitaria y no deficitaria (ES-D y ES-ND) pueden caracterizarse por diferentes factores de riesgo. El presente estudio tuvo como objetivo evaluar si los factores de riesgo de esquizofrenia previamente informados están específicamente asociados con ES-D y ES-ND. Método: Este estudio se basó en una cohorte de 118 pacientes ambulatorios. Se estableció el diagnóstico de ES-D mediante el Inventario para la Esquizofrenia Deficitaria. Los factores de riesgo se registraron mediante entrevista estructurada, la lista de verificación de Criterios Operativos para Enfermedades Psicóticas y la Lista de Verificación de Experiencia Traumática. Se exploraron los siguientes factores de riesgo: sexo masculino, antecedentes de esquizofrenia en familiares de primer grado, estacionalidad del nacimiento, peso al nacer <3.000g, parto por cesárea, antecedentes de trauma infantil, así como el abuso de sustancias (aparte de la nicotina) y el tabaquismo al inicio de la psicosis. Resultados: Las personas con ES-D tenían más probabilidades de ser varones y también informaron de tasas más altas de peso al nacer <3.000g y cualquier categoría de trauma infantil. A su vez, el abuso de sustancias (diferentes a la nicotina) al inicio de la psicosis fue significativamente más frecuente en pacientes con ES-ND. La regresión logística binaria, controlando comparaciones múltiples, reveló hallazgos similares, excepto por la asociación con cualquier categoría de trauma infantil que pareció no ser significativa. Conclusión: Nuestros resultados replican parcialmente los patrones diferenciales de los factores de riesgo para ES-D (sexo masculino y peso al nacer <3.000g) y ES-ND (abuso de sustancias al inicio de la psicosis), probablemente atribuibles a los efectos del momento de la exposición. (AU)

Eculizumab, a successful treatment for atypical postpartum hemolytic-uremic syndrome: a case report / Eculizumab, un tratamiento exitoso en el síndrome hemolítico-urémico atípico puerperal: un caso clínico

Atypical hemolytic-uremic syndrome (aHUS) is a rare entity characterized by the association of acute kidney failure, thrombocytopenia and microangiopathic hemolytic anemia due to the dysregulation of the alternative pathway of the complement system. It is included within the thrombotic microangiopathies. The following aHUS was developed in the immediate puerperium in the context of severe preeclampsia. The patient was a primiparous woman of 30+1 weeks who required hospitalization for anticonvulsant and hypotensive treatment, and who underwent an emergency cesarean section due to a pathological cardiotocographic pattern. 36 hours after delivery, the patient presented with sudden dyspnea and cognitive deterioration, progressing in a few hours to renal and multiorgan failure. Blood test showed severe anemia, thrombopenia and hypertransaminemia. In view of the fast evolution and severity, it was decided to treat with Eculizumab, although the scientific evidence was very poor. Aside from the supportive treatment performed in the Intensive Care Unit, the patient was successfully treated with Eculizumab, with favorable evolution over the following months and restoration of kidney function, although need for chronic hypotensive treatment remained.

El síndrome hemolítico-urémico atípico (SHUa) es una entidad rara caracterizada por la asociación de insuficiencia renal aguda, trombocitopenia y anemia hemolítica microangiopática debido a la desregulación de la vía alternativa del sistema del complemento. Se incluye dentro de las microangiopatías trombóticas. Se presenta un SHUa que se desarrolló en el puerperio inmediato en el contexto de una preeclampsia grave. La paciente era una primípara de 30+1 semanas que requirió hospitalización para tratamiento anticonvulsivo e hipotensor, y a la que se le practicó una cesárea de urgencia por un patrón cardiotocográfico patológico. A las 36 horas del parto, la paciente presentó una disnea súbita y un deterioro cognitivo progresivo, que evolucionó en pocas horas a un fallo renal agudo y multiorgánico. La analítica mostró anemia severa, trombopenia e hipertransaminemia. Ante la rápida evolución y gravedad, se decidió tratar con Eculizumab, aunque la evidencia científica era escasa. Aparte del tratamiento de soporte realizado en la Unidad de Cuidados Intensivos, la paciente fue tratada con éxito con Eculizumab, con evolución favorable en los meses siguientes y restablecimiento de la función renal, aunque se mantuvo la necesidad de tratamiento hipotensor crónico.

Pregnancy and systemic lupus erythematosus in Spain: Has anything changed in the 21st century?

OBJECTIVE: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. PATIENTS AND METHODS: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. RESULTS: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. CONCLUSIONS: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

Complicaciones obstétricas relacionadas con la terapia antirretroviral en gestantes infectadas por el VIH / Obstetric complications related to antiretroviral therapy in pregnant women with HIV infection

IntroducciónEl porcentaje de gestantes infectadas por VIH que demandan embarazo ha aumentado en los países desarrollados debido a la estabilidad de la infección y la disminución de la transmisión vertical por los tratamientos antirretrovirales (TAR) y las medidas preventivas. Sin embargo, existe poca información respecto al efecto del TAR sobre el embarazo.MétodosEstudio retrospectivo de las gestantes infectadas por VIH con TAR controladas en el Hospital La Paz entre los años 2000-2017. Se estudiaron las complicaciones maternofetales.ResultadosSe recogieron 141 gestaciones en 112 mujeres infectadas por VIH. El TAR más utilizado fue la combinación de 2 inhibidores de la transcriptasa inversa análogos nucleosídicos+1 inhibidor de la proteasa (58,1%), con diferencias significativas entre los distintos tratamientos en cuanto a la carga viral plasmática, siendo indetectable en mayor medida con 2 inhibidores de la transcriptasa inversa análogos nucleosídicos +1 inhibidor de la transcriptasa inversa no nucleosídico, segunda pauta más utilizada. Las tasas de neonatos a término de bajo peso (<2.500g) (11,3%), partos pretérmino (11,1%) y rotura prematura de membranas pretérmino (5,6%) fueron mayores que en la población general. Aunque no hubo asociación, estas complicaciones fueron más frecuentes en gestantes con un inhibidor de la proteasa/ritonavir. No se relacionaron con la carga viral plasmática. No se encontró aumento en la tasa de interrupciones gestacionales, malformaciones ni diabetes gestacional.ConclusiónEn las gestantes infectadas por VIH con TAR está aumentada la tasa de neonatos a término de bajo peso, prematuridad y rotura prematura de membranas pretérmino en comparación con la población general, relacionándose especialmente con el tratamiento con un inhibidor de la proteasa, aunque sin asociación significativa.

IntroductionThe percentage of HIV-infected pregnant women seeking pregnancy has increased in developed countries due to the stability of the infection and the decrease in vertical transmission due to antiretroviral treatment (ART) and preventive measures. However, there is little information regarding the effect of ART on pregnancy.MethodsRetrospective study of HIV-infected pregnant women on ART monitored at Hospital La Paz between 2000-2017. Maternal-foetal complications were studied.ResultsOne hundred and forty-one gestations were collected in 112 HIV-infected women. The most commonly used ART was the combination of 2 nucleoside reverse transcriptase inhibitor analogues+1 protease inhibitor (58.1%), with significant differences between the different treatments in terms of plasma viral load being undetectable to a greater extent with 2 nucleoside reverse transcriptase inhibitor analogues+1 non-nucleoside reverse transcriptase inhibitor, the second most used regimen. The rates of low birth weight (<2,500g) term neonates (11.3%), preterm delivery (11.1%) and preterm premature rupture of membranes (5.6%) were higher than in the general population. Although there was no association, these complications were more frequent in pregnant women with a protease inhibitor/ritonavir. They were not related to plasma viral load. No increase in the rate of gestational terminations, malformations or gestational diabetes was found.ConclusionHIV-infected pregnant women on ART have an increased rate of low birth weight, prematurity, and preterm premature rupture of membranes at term compared to the general population, especially related to treatment with protease inhibitor, although without significant association.

Embarazo y lupus eritematoso sistémico en España: ¿ha cambiado algo en el siglo xxi? / Pregnancy and Systemic Lupus Erythematosus in Spain: Has Anything Changed in the 21st Century?

Objetivo: Analizar una cohorte de pacientes embarazadas con lupus eritematoso sistémico y comparar los desenlaces tanto de la enfermedad como del embarazo con los resultados de estudios previos realizados en la misma área geográfica. Pacientes y métodos: Estudio de cohortes retrospectivo de 37 mujeres con lupus eritematoso sistémico (64 embarazos) seguidas en una consulta multidisciplinar. Estudio comparativo con los estudios españoles similares identificados tras revisión bibliográfica. Resultados: Nuestra cohorte se caracterizó por una edad más elevada y por la presencia de pacientes de origen no caucásico. Aunque no encontramos diferencias clínicas relevantes, serológicamente nuestra cohorte presentó una mayor frecuencia de anticuerpos antifosfolípido. Las pacientes incluidas en este estudio fueron tratadas más frecuentemente con antipalúdicos y aspirina. La frecuencia de brotes fue muy similar entre los distintos estudios, y no identificamos predictores claros para los mismos. Aunque la tasa de nacidos vivos fue similar, el desenlace obstétrico de nuestra serie fue mejor, con una baja tasa de preeclampsia, parto pretérmino y recién nacido de bajo peso. El único predictor de acontecimiento obstétrico adverso fue la edad. Conclusiones: Si bien los cambios en la actitud terapéutica y la planificación del embarazo no han tenido un impacto directo sobre la tasa de reactivación del lupus eritematoso sistémico durante el embarazo, sí que han supuesto una mejoría en los resultados obstétricos. La introducción de nuevas variables independientes de la enfermedad como la edad en la concepción, la procedencia sociocultural, o la disponibilidad de unidades multidisciplinares deberán ser consideradas en los resultados de próximos estudios.(AU)

Objective: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. Patients and methods: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. Results: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. Conclusions: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.(AU)

Complicaciones obstétricas y perinatales en mujeres infértiles que se embarazan / Obstetric and perinatal complications in infertile women who become pregnant

Las pacientes infértiles tienen un riesgo aumentado de resultados obstétricos y perinatales adversos que dependen de los factores de infertilidad subyacentes previos y de factores inherentes a los tratamientos recibidos para lograr el embarazo. La edad materna, las patologías previas ginecológicas, hormonales, endocrinológicas, metabólicas y anatomo funcionales son reconocidas como factores de riesgo para resultados adversos obstétricos y perinatales. Los tratamientos como la hiperestimulación ovárica y los tratamientos de reproducción asistida condicionan riesgos adicionales, especialmente por el aumento de embarazos múltiples que se generan con estas terapias. El aumento de la edad materna de pacientes tratadas por infertilidad y la necesidad creciente de tratamientos de reproducción asistida determinan probablemente, un mayor riesgo futuro de complicaciones obstétricas y perinatales. Muchos de estos factores de riesgo pueden ser modificados y manejados antes de iniciar los tratamientos con la finalidad de mejorar el pronóstico para la madre y el recién nacido. La consideración de estos factores de riesgo y sus consecuencias en el embarazo son parte esencial del consejo reproductivo que debiera recibir toda paciente que se somete a tratamientos por infertilidad.El objetivo de esta revisión es mostrar la relación existente entre las pacientes que consultan por infertilidad, los tratamientos usados y los potenciales riesgos obstétricos y perinatales cuando se produce el embarazo.

Infertile patients have an increased risk of adverse obstetric and perinatal outcomes that depend on underlying infertility factors and on those treatments recieved to become pregnant. Maternal age, hormonal, endocrinologial, metabolic and anatomic/functional gynecological diseases are widely recognized risk factors for adverse obstetric and perinatal outcomes. Infertility treatments like controlled ovarian hyperstimulation and assisted reproductive technologies add aditional risks, specially related to multiple pregnancies that are associated to. The higher maternal age of patients seeking for infertility treatment and the increasing need of assisted reproductive technologies probably determines a higher and increasing risk of obstetric and perinatal adverse outcomes. In many cases risk factors can be adequately modified and controlled before treatments are initiated thus improving maternal and neonatal prognosis. This risk factors and their consequences in pregnancy have to be strongly considered in reproductive counselling that should recieve every patient treated for infertility.The aim of this article is to show the relation between infertile patients seeking for treatment and their potential risks of obstetric and perinatal adverse outcomes when they get pregnant.

Complicaciones obstétricas en gestantes trabajadoras / Obstetric complications in pregnant workers

Objetivo: Determinar el riesgo de complicaciones obstétricas en gestantes trabajadoras atendidas en la Maternidad" Dr. Armando Castillo Plaza" de Maracaibo, estado Zulia. Métodos: Investigación comparativa, con diseño no experimental y transeccional, que incluyó 100 gestantes trabajadoras (casos) y 100 no trabajadoras (controles); evaluándoseles el riesgo de presentar complicaciones obstétricas como preeclampsia, prematuridad, bajo peso al nacer y malformaciones congénitas. Resultados: Prevalecieron trabajadoras de los servicios y vendedores de comercio y mercado(31%) y ocupaciones elementales (20%), contratadas (74%),con antigüedad entre 2-5 años (56%), trabajo en bipedestación (62%), alta-media demanda física o mental (73% y 57%,respectivamente), alta demanda laboral (51%), alta satisfacción laboral (68%), y expuestas a riesgos ergonómicos como esfuerzo físico pesado (51,8%). Se encontró que 44% de las pacientes presentaron alguna complicación obstétrica, aunque en las trabajadoras hubo mayor número de complicaciones que en las no trabajadoras, la presencia de cualquier complicación fue similar y no mostró diferencias significativas (41% vs. 47%,respectivamente; OR [IC95%]= 0,783 [0,447 ­ 1,371]; p>0,05). Aunque no constituyó un factor de riesgo, sólo el parto pretérmino predominó en las gestantes trabajadoras, aunque nore (10% vs. 1%; OR [IC95%]= 0,090 [0,011 - 0,724]; p= 0,009);mientras que la presencia de preeclampsia ocurrió mayormente en las no trabajadoras (8% vs. 16%, respectivamente; OR[IC95%]= 2,191 [0,892 ­ 5,381]; p> 0,005), representando el no tener la condición laboral un factor protector para no presentar preeclampsia, aunque no significativo. Conclusión:La condición laboral no genera mayor riesgo de presentar complicaciones en las gestantes(AU)

Aim: To determine the risk of obstetric complications in workers pregnant women attending at the Maternity "Dr.Armando Castillo Plaza" in Maracaibo, Zulia state. Methods: Comparative research, with non experimental and transactional design. We included 100 pregnant workers (cases) and 100 non-workers (controls); evaluated the risk of showed any obstetric complications such as preeclampsia, premature birth, low birth weight and birth defects. Results: Prevailed service workersand sales persons and market (31%) and elementary occupations(20%), employed (74%), with between 2-5 years old (56%),work in a standing position (62%), high-average physical ormental demand (73% and 57%, respectively), high labor demand(51%), high job satisfaction (68%) and exposed to ergonomicrisks as heavy physical exertion (51.8%). It was found that 44%of patients had some obstetric complication, although workersthere were more complications than non-workers, the presenceof any complications was similar and showed no differencesignificant (41% vs. 47%, respectively; OR [95% CI] = 0.783[0.447 to 1.371]; p> 0.05). Although was not representing a riskfactor, only preterm birth predominated in pregnant workers(10% vs. 1%; OR [95% CI] = 0.090 [0.011 to 0.724]; p =0.009); while the presence of preeclampsia occurred mostlyin non-workers (8% vs. 16%, respectively; OR [95% CI] =2.191 [0.892 to 5.381]; p> 0.005), representing not havethe employment status a protective factor for preeclampsia,although not significant. Conclusion: The employment statusdoes not create further risk of complications in pregnant women

Pregnancy and Systemic Lupus Erythematosus in Spain: Has Anything Changed in the 21st Century? / Embarazo y lupus eritematoso sistémico en España: ¿ha cambiado algo en el siglo xxi?

OBJECTIVE: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. PATIENTS AND METHODS: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. RESULTS: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. CONCLUSIONS: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

Breech presentation delivery care: A review of childbirth semiology, mechanism and care / Atención del parto con feto en presentación pelviana: revisión de la semiología, el mecanismo y la atención del parto

RESUMEN Objetivo: revisar los conceptos que subyacen al trabajo de parto con feto en presentación pelviana, su semiología y las maniobras obstétricas que facilitan un resultado materno perinatal exitoso. Materiales y métodos: a partir de un caso hipotético que ambienta de manera práctica el tema, se crea un documento explicativo construido a partir de una revisión narrativa, en donde se examinan los preceptos relacionados con el diagnóstico, el mecanismo del parto en presentación pelviana y el manejo intraparto de la gestante, con énfasis en la adecuada ejecución de las maniobras que facilitan la extracción fetal. Resultados: el parto en presentación pelviana debe ser atendido por vía vaginal cuando se encuentra en periodo expulsivo con encajamiento cumplido. Para su diagnóstico y atención es esencial hacer una adecuada identificación de la presentación, así como conocer su fisiología, la indicación y adecuada ejecución de las maniobras obstétricas que facilitan un parto sin complicaciones. Conclusiones: el mecanismo del parto en presentación pelviana es complejo y requiere, cuando no hay otra alternativa para la atención, que tanto el obstetra como el médico general conozcan su fisiología y las múltiples maniobras obstétricas que facilitan obtener buen resultado materno perinatal.

ABSTRACT Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Conclusions: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.

Complicaciones obstétricas y perinatales en pacientes con anemia / Obstetric and perinatal complications in anemic patients

Resumen OBJETIVO: Determinar la relación entre complicaciones obstétricas y perinatales con la anemia durante el embarazo. MATERIALES Y MÉTODOS: Estudio ambispectivo, observacional y transversal. Se incluyeron pacientes en trabajo de parto, con embarazo único, atendidas entre marzo y octubre de 2017 en el Hospital General Dr. Salvador Zubirán Anchondo, Chihuahua, Chih. Se excluyeron las pacientes con embarazo complicado por defectos congénitos, que hubieran recibido anticoagulantes, con diagnóstico médico de hemoglobinopatías, hemofilias, preeclampsia, síndrome de HELLP, partos instrumentados y distocias, diabetes gestacional, nefropatías, hepatopatías, tabaquismo y toxicomanías. Complicaciones valoradas: amenaza de aborto, amenaza de parto pretérmino, parto pretérmino, ruptura prematura de membranas, infección de vías urinarias, peso al nacer, valoración de Apgar al minuto y a los 5 minutos, hemorragia obstétrica. Se entrevistó a todas las pacientes para evaluar los antecedentes ginecoobstétricos y se tomó una muestra de sangre venosa para determinar: hemoglobina, hematocrito, cantidad de glóbulos rojos, volumen corpuscular medio, concentración de hemoglobina corpuscular media. Se registraron las mediciones antropométricas, valores de Apgar y complicaciones perinatales del expediente clínico. RESULTADOS: Se estudiaron 1051 pacientes divididas en dos grupos: con anemia (n = 172) y sin anemia (n = 879). Se consideró anemia a la hemoglobina menor de 11 g/dL o hematocrito menor de 33%. Se clasificaron de acuerdo con la OMS como: anemia leve 10-10.9 g/dL, moderada 7-9.9 g/dL y severa menos de 7.0 g/dL. La prevalencia de anemia fue de 16%. La anemia leve se identificó con mayor frecuencia 10% (n = 111), anemia moderada y severa 6% (n = 61). Las complicaciones maternas y neonatales no mostraron asociación con la anemia materna durante el embarazo. La hemotransfusión fue mayor en pacientes con anemia (9 vs 1%). CONCLUSIÓN: Se identificó anemia materna en 16% de los casos y se asoció con necesidad de transfusión de hemoderivados en el posparto o posquirúrgico de cesárea.

Abstract OBJECTIVE: Determinate the association between adverse perinatal outcomes and anemia in pregnant women. MATERIALS AND METHODS: Observational, prospective-retrospective and cross-sectional study. Including women in birth labor attended at Hospital General Dr. Salvador Zubirán Anchondo in Chihuahua City, during March to October 2017. Inclusion criteria considered women with single pregnancy. Exclusion criteria with present conditions: congenital deformities, use of anticoagulants, blood diseases, preeclampsia, HELLP syndrome, instrumental delivery with forceps, dystocia, maternal diabetes, kidney and liver diseases, use of tobacco and other drugs. Adverse perinatal outcomes included were: miscarriage risk, preterm labor, preterm birth, pre labor rupture of membranes, urinary infection, low birth weight, Apgar score at birth and after five minutes, obstetric hemorrhage. Patients were interviewed to evaluate obstetric background; blood venous sample was taken to determine haemoglobin, hematocrit, red blood cells number, medium corpuscular volume, medium corpuscular hemoglobin concentration. Birth data was registered from medical records. RESULTS: Two groups were integrated: with anemia (n=172) and without anemia (n=879). Patients with anemia were those with haemoglobin less than 11 g/dL or hematocrit less than 33% according World Health Organization anemia classification: mild 10-10.9 g/dL, moderate 7-9.9 g/dL and severe less than 7.0 g/dL. Anemia frequency was calculated in 16%, mild anemia frequency was 10% (111 patients), 6% moderate and severe anemia (n = 61). Both groups developed patients with adverse perinatal outcomes. Transfusion of blood products showed higher frequency in anemic patients (9% versus 1% control group). CONCLUSION: Anemia prevalence calculated in 16% associated with transfusion of blood products, during puerperium or after c-section period.

Complicaciones obstétricas en gestantes adolescentes asistidas en una maternidad pública de la ciudad de Corrientes año 2017 / Obstetric complications in adolescent pregnant women assisted in a public maternity hospital in the city of Corrientes year 2017

Introducción: El embarazo adolescente es la gestación en mujeres cuyo rango de edad es de 10 a 19 años independiente de su edad ginecológica y que conlleva a situaciones que pueden atentar la salud de la madre como la del hijo. Objetivos: Describir las complicaciones obstétricas de las madres adolescentes asistidas en una maternidad pública de la ciudad de Corrientes durante 2017. Material y métodos: Se realizó un estudio cuantitativo, descriptivo y transversal. La población fueron madres adolescentes con complicaciones obstétricas asistidas en la Maternidad E. T. de Vidal durante 2017. Las variables fueron: edad, escolaridad, número de hijos, número de controles prenatales, hipertensión gestacional, preeclampsia, diabetes gestacional, anemia, infección urinaria, flujo vaginal, amenaza de parto prematuro, ruptura prematura de membrana, parto prematuro, forma de terminación del parto y terminación del parto. La recolección de datos se realizó a través de historias clínicas y volcadas a un formulario. El cálculo muestral fue con un 95% de confiabilidad, se contó con el aval del Comité de Bioética de Investigación en Ciencias de la Salud de la Facultad de Medicina UNNE (Resolución N°20/18). Resultados: Se analizaron 128 historias clínicas de madres adolescentes con complicaciones obstétricas, las más frecuentes fueron anemia, amenaza de parto prematuro, ruptura prematura de membrana, infección urinaria y flujo vaginal. En el grupo de madres adolescentes de 15 años y menos se registró dos complicaciones en el 33% y en el 67%. En el grupo de 16 a 19 años 61% presentaron solo una complicación, el 20% dos, el 11% tres, el 7% cuatro y el 1% cinco. Conclusión: Las madres adolescentes cuyos embarazos terminan por cesárea pueden llegar a presentar hasta cinco complicaciones obstétricas respecto de aquellas por parto vaginal

SUMMARY Introduction: Adolescent pregnancy is pregnancy in women whose age range is 10 to 19 years regardless of their gynecological age and which leads to situations that can affect the health of the mother as the child. Objectives: To describe the obstetric complications of adolescent mothers assisted in a public maternity in the city of Corrientes during 2017. Material and methods: a quantitative, descriptive and transversal study was carried out. The population were adolescent mothers with obstetric complications assisted in the E. T. de Vidal Maternity during 2017. The variables were: age, schooling, number of children, number of prenatal checkups, gestational hypertension, preeclampsia, gestational diabetes, anemia, urinary infection, vaginal discharge, threat of premature birth, premature membrane rupture, premature delivery, termination labor and termination of labor. The data collection was carried out through clinical histories and turned into a form. The sample calculation was 95% reliable, it was endorsed by the Bioethics Committee of Research in Health Sciences of the UNNE School of Medicine (Resolution No. 20/18). Results: 128 clinical histories of adolescent mothers with obstetric complications were analyzed, the most frequent were anemia, threatened premature birth, premature membrane rupture, urinary infection and vaginal discharge. In the group of adolescent mothers aged 15 years and under, two complications were recorded in 33% and 67%. In the group of 16 to 19 years 61% presented only one complication, 20% two, 11% three, 7% four and 1% five. Conclusion: Adolescent mothers whose pregnancies end by caesarean section can have up to five obstetric complications compared to those due to vaginal delivery

RESUMO Introdução: A gravidez na adolescência é a gravidez em mulheres cuja faixa etária é de 10 a 19 anos, independentemente de sua idade ginecológica e que leve a situações que possam afetar a saúde da mãe como a criança. Objetivos: Descrever as complicações obstétricas de mães adolescentes atendidas em uma maternidade pública na cidade de Corrientes durante 2017. Material e métodos: foi realizado um estudo quantitativo, descritivo e transversal. A população foi de mães adolescentes com complicações obstétricas assistidas na Maternidade E. T. de Vidal durante 2017. As variáveis estudadas foram: idade, formação, número de filhos, número de consultas, hipertensão gestacional, pré-eclampsia, diabetes gestacional, anemia, infecção do trato urinário, descarga vaginal, trabalho de parto prematuro, ruptura prematura das membranas, parto prematuro, preenchimento do formulário trabalho e rescisão do trabalho. A coleta de dados foi realizada por meio de históricos clínicos e transformada em formulário. O cálculo amostral foi de 95% confiável, foi endossado pelo Comitê de Bioética de Pesquisa em Ciências da Saúde da Faculdade de Medicina da UNNE (Resolução nº 20/18). Resultados: Foram analisadas 128 histórias clínicas de mães adolescentes com complicações obstétricas, sendo as mais frequentes anemia, parto prematuro, ruptura prematura de membrana, infecção urinária e corrimento vaginal. No grupo de mães adolescentes com 15 anos ou menos, duas complicações foram registradas em 33% e 67%. No grupo de 16 a 19 anos, 61% apresentaram apenas uma complicação, 20% dois, 11% três, 7% quatro e 1% cinco. Conclusão: As mães adolescentes cujas gestações terminam por cesariana podem ter até cinco complicações obstétricas comparadas com aquelas devidas ao parto vaginal

Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism. / Impacto de la autoinmunidad antitiroidea positiva en gestantes con hipotiroidismo subclínico.

BACKGROUND: The impact of subclinical hypothyroidism (SH) and thyroid autoimmunity on obstetric and perinatal complications continues to be a matter of interest and highly controversial. AIM: To assess the impact of SH and autoimmunity in early pregnancy on the obstetric and perinatal complications in our population. MATERIAL AND METHOD: A retrospective cohort study in 435 women with SH (TSH ranging from 3.86 and 10 µIU/mL and normal FT4 values) in the first trimester of pregnancy. Epidemiological and clinical parameters were analyzed and were related to obstetric and perinatal complications based on the presence of autoimmunity (thyroid peroxidase antibodies [TPO] > 34 IU/mL). RESULTS: Mean age was 31.3 years (SD 5.2). Seventeen percent of patients had positive TPO antibodies. Presence of positive autoimmunity was associated to a family history of hypothyroidism (P=.04) and a higher chance of miscarriage (P=.009). In the multivariate analysis, positive TPO antibodies were associated to a 10.25-fold higher risk of miscarriage. No statistically significant associations were found with all other obstetric and perinatal complications. CONCLUSIONS: In our region, pregnant women with SH and thyroid autoimmunity had a higher risk of miscarriage but not of other obstetric and perinatal complications.

Experiencias del hombre ante la hospitalización por complicaciones obstétricas de su esposa / Experiences of the man before hospitalization due to obstetric complications of his wife / Experiências do homem antes da internação por complicações obstétricas de sua esposa

Introducción: Al presentarse una complicación obstétrica, donde no solo interactúan factores fisiológicos, sino culturales, sociales, religiosos y económicos que ponen en riesgo la vida del binomio madre-hijo, durante la hospitalización de su esposa la vida del hombre se ve afectada debido a las expectativas sociales de su entorno, es decir, de él se espera fortaleza, valentía, control emocional e independencia, entre otras muchas. Integrar al esposo durante esta situación permite dirigir la atención para comprender cómo el trinomio madre-padre-hijo vive este proceso y así implementar estrategias orientadas a la práctica de enfermería en su cuidado integral, ya que la literatura es escasa referente al fenómeno de estudio y en México no hay información al respecto. Objetivo: Describir las experiencias del Hombre ante la hospitalización de su esposa por complicaciones obstétricas en un hospital de segundo nivel. Metodología: Diseño cualitativo fenomenológico-hermenéutico. Los participantes fueron 6 informantes hombres que experimentaron junto a su esposa durante la hospitalización por presentar alguna complicación obstétrica durante el embarazo y/o el parto; los datos se recolectaron a través de entrevistas semiestructuradas. El número de informantes se definió por medio del criterio de saturación, el análisis de datos se realizó mediante la propuesta de Colaizzi. Hallazgos: Emergieron 3 grandes categorías: A) Efecto de cuidar a otros, con 4 sub-categorías: a1) decisiones de vida o muerte, a2) anteposición de mis necesidades personales, a3) fortalecimiento del rol de esposo, a4) ahora me toca cuidarlos; B) Contando con apoyo: b1) la familia como sostén, b2) apoyo de la comunidad, b3) religiosidad y automotivación; C) Invisibilidad del esposo por el personal de salud. Conclusiones: Tradicionalmente, el hombre no debe doblegarse ante el dolor de él o de otros ni pedir ayuda; sin embargo se observó cambios importantes como ternura, comprensión, compromiso afectivo sin que nadie cuestione su masculinidad. Se describe como esta situación afianza el rol de esposo, dando cuidado, apoyo y afecto a su esposa e hijos, es necesario fortalecer y mejorar la práctica asistencial de enfermería al brindar el cuidado al trinomio.

Introduction: When an obstetric complication occurs, where not only physiological factors, but cultural, social, religious and economic factors that endanger the life of the mother-child binomial, during the hospitalization of his wife, the life of the man is affected due to The social expectations of his environment, that is, he expects strength, courage, emotional control and independence, among many others. Integrating the husband during this situation allows directing the attention to understand how the trinomial mother-father-son lives this process and thus implement strategies oriented to the practice of nursing in its integral care, since the literature is scarce referring to the phenomenon of study and In Mexico there is no information about it. Objective: To describe the experiences of the Man before the hospitalization of his wife by obstetric complications in a second level hospital. Methodology: Qualitative phenomenological-hermeneutic design. Participants were 6 male informants who experienced with their spouse during hospitalization for having an obstetric complication during pregnancy and / or childbirth; The data were collected through semi-structured interviews. The number of informants was defined by the saturation criterion, data analysis was performed using the Colaizzi proposal. Findings: Three major categories emerged: A) Effect of caring for others, with 4 sub-categories: a1) life or death decisions, a2) preposition of my personal needs, a3) strengthening the role of husband, a4) now it's my turn Take care of them; B) With support: b1) the family as support, b2) support of the community, b3) religiosity and self-motivation; C) Invisibility of the husband by the health personnel. Conclusions: Traditionally, man should not bow to the pain of him or others or ask for help; However important changes were observed such as tenderness, understanding, affective commitment without anyone questioning their masculinity. Describing how this situation strengthens the role of husband, giving care, support and affection to his wife and children, it is necessary to strengthen and improve the nursing care practice by providing care to the trinomial.

Introdução: Quando ocorre uma complicação obstétrica, onde não apenas fatores fisiológicos interagem, mas também fatores culturais, sociais, religiosos e econômicos que colocam em risco a vida do binômio mãe-filho, durante a hospitalização de sua esposa, a vida do homem é afetada por as expectativas sociais de seu entorno, isto é, força, coragem, controle emocional e independência, são esperadas dele, entre muitos outros. A integração do marido nessa situação permite direcionar a atenção para entender como o trinômio mãe-pai-filho vive esse processo e, assim, implementar estratégias orientadas para a prática da enfermagem em seu cuidado integral, uma vez que a literatura é escassa quanto ao fenômeno de estudo e no México não há informações sobre isso. Objetivo: Descrever as experiências do Homem antes da internação de sua esposa devido a complicações obstétricas em um hospital de segundo nível. Metodologia: Desenho fenomenológico-hermenêutico qualitativo. Participaram do estudo 6 informantes do sexo masculino que sofreram com a esposa durante a hospitalização por apresentarem uma complicação obstétrica durante a gravidez e / ou parto; os dados foram coletados por meio de entrevistas semiestruturadas. O número de informantes foi definido por meio do critério de saturação; a análise dos dados foi realizada mediante proposta de Colaizzi. Resultados: surgiram três categorias principais: A) Efeito de cuidar dos outros, com quatro subcategorias: a1) decisões de vida ou morte, a2) predizer minhas necessidades pessoais, a3) fortalecer o papel do marido, a4) agora é a minha vez cuide deles; B) Com apoio: b1) a família como apoio, b2) apoio comunitário, b3) religiosidade e auto-motivação; C) Invisibilidade do marido pelo pessoal de saúde. Conclusões: Tradicionalmente, o homem não deve se curvar à dor de si ou dos outros ou pedir ajuda; no entanto, mudanças importantes foram observadas, como ternura, compreensão, comprometimento emocional sem que ninguém questionasse sua masculinidade. Descreve-se como essa situação fortalece o papel do marido, dando cuidado, apoio e afeto à esposa e aos filhos, sendo necessário fortalecer e aprimorar a prática do cuidado de enfermagem prestando assistência ao trinômio.

¿Puede un sistema de estándares e indicadores de calidad relacionados a cesárea reducir la morbi-mortalidad materna? / Can a system of quality standards and indicators related to caesarean section reduce maternal morbidity and mortality?

Antecedentes: la aplicación de estándares e indicadores de atención materno neonatal en unidades que no utilizan parámetros de calidad mejora el cumplimiento de actividades en la atención prenatal, del parto, del posparto, del recién nacido y de las complicaciones perinatales relacionadas a cesárea. Objetivo: implementar y monitorizar la tendencia de cumplimiento trimestral de un sistema de estándares e indicadores de complicaciones obstétricas y neonatales relacionadas a cesárea y su impacto en la morbimortalidad materna ­ neonatal. Metodología: intervención de carácter prospectivo "antes y después", a realizarse en el Servicio de Obstetricia de la Unidad Metropolitana de Salud Sur de Quito durante 15 meses. Se realizó el levantamiento de la línea de base epidemiológica de cesárea; se socializó y capacitó al personal en el uso del "Manual de Estándares, Indicadores e Instrumentos para medir la Calidad de la Atención Materno-Neonatal" del Ministerio de Salud Pública y se realizaron monitoreos trimestrales de cumplimiento. Resultados: se alcanzan niveles de cumplimiento significativos (p≤0,05) hacia el noveno mes de intervención en 11 de los 17 estándares de calidad seleccionados. A corto plazo determina una reducción significativa de la razón de mortalidad neonatal y una estabilización de la mortalidad materna. No se disminuyó la frecuencia de cesáreas ni la estancia hospitalaria. Conclusión: los resultados apoyan el uso permanente de un sistema de monitorización utilizando estándares e indicadores de complicaciones obstétricas y neonatales relacionados a cesárea para mejorar la calidad de atención médica. (AU)

Background: the application of standards and indicators of maternal neonatal care in units that do not use quality parameters improves regulatory compliance activities on prenatal care, childbirth, postpartum, of the newborn and perinatal complications related to caesarean section. Objective: implement and monitor the trend of compliance quarterly of a system of standards and indicators of obstetric and neonatal complications related to caesarean section and its impact on maternal mortality and morbidity. Methodology: intervention prospective "before and after", to be held in the obstetrics service of the health South of Quito Metropolitan unit for 15 months. Was the lifting of the epidemiological baseline of Caesarea; were you socialized and trained staff in the use of the "Manual of standards, indicators and instruments to measure the quality of Maternal-Neonatal care" of the Ministry of public health; and quarterly monitoring of compliance were carried out. Results: significant levels of compliance are achieved (p≤0. 05) to ninth month of intervention in 11 of the 17 selected quality standards. To short term determines a reduction significant of the reason of mortality neonatal and a stabilization of the mortality maternal. Not decreased the frequency of caesarean section or hospital stay. Conclusion: the results support the use of a monitoring system using standards and indicators of obstetric and neonatal complications related to caesarean section to improve the quality of health care.

Caracterización de hemorragia postparto en maternidad del Hospital General Dr. Agostinho Neto, Guantánamo / Characterization of the pospartum hemorrhage in the maternity of the General Hospital Dr. AgostinhoNeto, Guantánamo

La hemorragia es la complicación más significativa durante el postparto por lo que se necesita un diagnóstico y tratamiento rápidos para su atención. Se realizó un estudio descriptivo transversal con el objetivo de caracterizar el estado actual del comportamiento de las hemorragias postparto en la maternidad del Hospital General Docente Dr Agostinho Neto, Guantánamo, en el período comprendido de enero 2012 - enero 2013. Se analizaron las variables: grupo etario, procedencia, patologías asociadas, relación tiempo total de parto, entre otras Prevalecieron con el accidente obstétrico pacientes menores de 20 años y mayores de 35 años. La patología fundamental asociada fue la hipertensión arterial. Tienen mayor predisposición a la hemorragia posparto los tiempos del trabajo de parto prolongado y precipitado. Se demuestra que mientras más precoz es el diagnóstico de la hemorragia menos cantidad de reposición volumétrica requiere el paciente(AU)

The hemorrhage is the most significant complication during the postpartum for what is needed a fast diagnosis and treatment for its management. It was carried out a traverse descriptive study with the objective of characterizing the current state of the behavior of the hemorrhages post-childbirth in the maternity of the General Hospital Dr AgostinhoNeto, Guantánamo, in the period of January 2012 - January 2013. Patients younger than 20 years and older than 35 years prevailed with the obstetric accident. The main associated pathology was arterial hypertension. The times of child delivery prolonged and precipitated have bigger predisposition to the postpartum hemorrhage. It is demonstrated that while more precocious it is the diagnosis of the hemorrhage less quantity of volumetric reinstatement the patient requires(AU)

Embarazo en pacientes con esquizofrenia / Pregnancy in patients with schizophrenia

Se realizó un estudio descriptivo y de cohorte basado en la revisión de historias clínicas y base de datos del Sistema Informático Perinatal (sip) de las pacientes portadoras de esquizofrenia y embarazadas que consultaron en el Hospital Vilardebó entre 2009-2012. Se estudiaron 35 casos de gestaciones que correspondieron a 30 mujeres. Se identificaron determinadas características sociodemográficas y clínicas: mayor edad en el momento de la gestación, menor planificación del embarazo, menor cantidad de controles prenatales, la mayoría de las consultas psiquiátricas se realizaron durante el puerperio. No se evidenció asociación entre madres con esquizofrenia y menor edad gestacional, menor peso del recién nacido o Apgar bajo, así como tampoco con la presencia de complicaciones obstétricas o neonatales.

A descriptive cohort study was conducted basedon the review of medical records and Perinatal Information System database (sip) of pregnant women with schizophrenia who were assisted atthe State Mental Facility (Hospital Vilardebó) from2009 to 2012. 35 cases of pregnancies which corresponded to 30 women were studied. Certainsocio-demographic and clinical characteristics were identified: age at the time of pregnancy,lower pregnancy planning, less prenatal medicalcare, most psychiatric consultations were heldduring the post-partum period. No associationwere found between mothers with schizophreniaand lower gestational age, low birth weight or low Apgar, nor the presence of obstetric or neonatal complications are evident.

Comprehensive approach to systemic sclerosis patients during pregnancy.

Systemic sclerosis (SSc) is a connective tissue disease that usually affects women, with a male:female ratio of 1:4-10. It was thought that there was a prohibitive risk of fatal complications in the pregnancies of patients with SSc. It is now known that the majority of these women undergo a normal progression of pregnancy if the right time is chosen and a close obstetric care is delivered. The obstetric risk will depend on the subtype and clinical stage of the disease, and the presence and severity of the internal organ involvement during the pregnancy. The management of these pregnancies should be provided in a specialized center, with a multidisciplinary team capable of identifying and promptly treating complications. Treatment should be limited to drugs with no teratogenic potential, except when renal crises or severe cardiovascular complications develop.