A Retrospective Exploration of Pre-operative Antibiotic Prophylaxis with Cefazolin in Cesarean Sections: Implications for Obstetrics and Gynecologic Surgery.

Background: Post-partum infection is a major contributor to maternal mortality and is responsible for approximately 10% of maternal fatalities worldwide. The risk of infection is substantially higher in cesarean section procedures. Approximately 8% of women who undergo cesarean sections are susceptible to infection. Although the body of evidence supporting the regular pre-operative utilization of prophylactic antibiotic treatment is steadily expanding, its usefulness in cesarean sections has not yet been standardized, and post-partum infection is still a serious medical challenge. We aimed to retrospectively assess the prophylactic effectiveness of cefazolin in combination with other antibiotic agents in cesarean sections. Materials and Methods: Both uni-variable and multi-variable analyses were conducted to identify factors that may affect cefazolin pre-operative antibiotic prophylaxis in elective cesarean section operations. The uni-variable analysis included timing of administration, operation duration, body mass index (BMI), and wound type. A multi-variable logistic regression model was then created to determine which variables provide independent information in the context of other variables. Results: Time of administration did not affect prophylactic cefazolin efficacy. However, prophylactic cefazolin was 1.43 and 1.77 times more effective when the operation lasted for 45 minutes or more, compared with operations that were shorter than 45 minutes. Patients with a BMI ranging from 18 to 29 kg/m2 showed increased efficacy of prophylactic cefazolin compared with obese patients with a BMI exceeding 30 kg/m2. The effectiveness of prophylactic cefazolin decreased by 95% in patients with clean-contaminated surgical incisions compared with those with clean surgical incisions. Conclusions: Our findings demonstrate that administering pre-operative prophylactic antibiotic agents to women undergoing cesarean section resulted in a reduction in post-partum infections, thereby reducing maternal mortality. Furthermore, optimal timing of administration, re-dosing if necessary, length of prophylactic medication, and dosing adjustments for obese patients are crucial factors in preventing surgical site infections and promoting antimicrobial stewardship.

Assessment of Human Fetuses Undergoing Acute Pain: Validation of the Fetal-7 Scale.

Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often through surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved 2 steps: 1) 4 fetuses with the indication of surgery were evaluated in 3 conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; 2) assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and 2 fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of .99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient was .95, and inter-rater reliability was .99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third-trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of postoperative pain in fetuses and its effects after birth. PERSPECTIVE: Recordings with 3-dimensional ultrasound of human fetuses undergoing preoperative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.

Counseling, informed consent, and debriefing for cesarean section in sub-Saharan Africa: A scoping review.

BACKGROUND: Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs). OBJECTIVES: To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer-reviewed literature. SEARCH STRATEGY: The databases searched were PubMed, EMBASE, PsycINFO, Africa-wide information, African Index Medicus, IMSEAR and LILACS. SELECTION CRITERIA: English-language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to high quality were included. DATA COLLECTION AND ANALYSIS: A narrative synthesis was conducted using Beauchamp and Childress's elements of informed consent as a framework. MAIN RESULTS: Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels. CONCLUSIONS: There is a paucity of research on informed consent, counseling, and debriefing for CS in sub-Saharan Africa.

Protocolo Clínico - Quirúrgico de Cesárea en la Unidad Técnica de Alto Riesgo Obstétrico / Clinical-Surgical Protocol for Cesarean Section in the Obstetric High Risk Technical Unit

El procedimiento quirúrgico cesárea con miras a la historia es considerada como un avance de suma importancia en la dismi-nución del riesgo de mortalidad materna y perinatal1.Es la intervención más realizada a nivel de especialidad lo que conlleva riesgos inherentes, quirúrgicos y anestésicos2,3.En el año 2015 la incidencia en el Ecuador de terminación del embarazo por cesárea es del 29,3% en el sector público, 49,9% en Seguridad Social y 69,9% en clínicas privadas4. Para la Or-ganización Mundial de la Salud (OMS) en el mismo año refiere que "En ninguna región del mundo se justifica la incidencia de cesárea superior al 10- 15%"5. La variabilidad de indicación de cesárea, hace que sea necesaria la creación de guías y protocolos, para de esta manera unificar los criterios médicos, de acuerdo a la mejor evidencia científica disponible.

The cesarean section surgical procedure is historically considered a very important advance in reducing the risk of maternal and perinatal mortality1.It is the most frequently performed intervention at the specialty level, which entails inherent surgical and anesthetic risks2,3.In 2015, the incidence in Ecuador of termination of pregnancy by cesarean section is 29,3% in the public sector, 49,9% in Social Security and 69,9% in private clinics4. For the World Health Or-ganization (WHO) in the same year, it states that "In no region of the world is the incidence of cesarean section higher than 10-15% justified" 5.The variability of the indication for cesarean section makes it ne-cessary to create guidelines and protocols, in order to unify me-dical criteria, according to the best scientific evidence available.

Long-term trends in the incidence and management of shoulder dystocia in a tertiary obstetric unit in Hong Kong.

INTRODUCTION: Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019. METHODS: This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital's electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods. RESULTS: The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045). CONCLUSION: More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.

Fetal station at caesarean section and risk of subsequent preterm birth - A cohort study.

OBJECTIVES: An increased risk of preterm birth (PTB) following a caesarean section (CS) in the second stage of labor has been demonstrated. We aimed to investigate the relationship between the station of the presenting fetal part and the surgical technique at first CS, and the risk of subsequent PTB. STUDY DESIGN: This was a cohort study of 11,850 women in Sweden, delivered by CS in 2001-2007 at any of 23 birth units, with a second delivery in 2001-2009. Clinical information was retrieved from electronic birth records linked to national health registers. The risk of subsequent PTB was analyzed by fetal station, defined as low (at or below the ischial spines) or high (above the ischial spines), and aspects of the surgical technique at index CS. Associations were explored with logistic regression and results are presented as odds ratios (ORs) with 95% confidence intervals (CIs), by type and severity (very early < 32 gestational weeks and moderate preterm 32-36 gestational weeks) of PTB. Multiple logistic regression included adjustments for maternal age, gestational age at first delivery, and inter-delivery interval. RESULTS: Out of 11,850 women delivered by CS, 1,016 (8.6%) delivered preterm in their subsequent pregnancy. There was an increased likelihood of spontaneous PTB, but not with medically indicated PTB, after an index CS with the fetal presenting part at a low station (aOR 1.61, 95% CI 1.23-2.11). CS performed at a low station was associated with birth < 32 gestational weeks (aOR 1.73, 95% CI 1.05-2.84) and birth at 32-36 gestational weeks (aOR 1.29, 95% CI 1.00-1.65), compared with high fetal station. Thickness of the uterine wall, incision type, and closure of the uterus at index CS did not affect the risk. CONCLUSION: A primary CS at a low station was associated with a subsequent spontaneous PTB, but not medically indicated PTB. Surgical technique at index CS did not alter the risk.

Arresting post-partum hemorrhage using the novel trans-vaginal uterine artery clamp.

OBJECTIVES: Post-partum hemorrhage (PPH) continues to be the leading cause of maternal mortality in low-resource settings. The commonest variant - Atonic PPH, is managed by additional pharmacological measures which may fail. Additional surgical interventions for hemostasis take time and are not universally available. Immediate arrest of bleeding was deemed essential and a novel Transvaginal Uterine Artery Clamp (TVUAC) was explored for its effectiveness in achieving immediate hemostasis in atonic and mixed post-partum hemorrhage. STUDY DESIGN: A retrospective chart review was performed for all patients, who underwent vaginal delivery and developed immediate post-partum atonic PPH, in a tertiary care center in South India, between 1st April 2015 and 31st December 2020. As soon as excess bleeding was observed, two TVUACs were applied trans-vaginally at 3' and 9'o clock position of the cervix to occlude the uterine arteries where it joins the isthmus of the uterus. RESULTS: Of 3999 vaginal deliveries, there were 251 patients who developed primary atonic PPH during the study period, of which 89 were managed by medical measures alone. Out of the remaining 162 patients, in 153 (94.4%) TVUAC helped to achieve hemostasis; with TVUAC alone in 120 patients (78.43%) and with an additional second line surgical intervention in 33 patients. In nine patients, TVUAC was not readily available and hence second line interventions alone were used. None required any third line surgical interventions (laparotomies) for hemostasis nor were there any incident of maternal mortality or consumptive coagulopathy. TVUAC was applied for a mean duration of 25 ± 10 min. Only 11.6% (29/251, 95% C.I 7.9-16.1%) of the patients required a blood transfusion with a median of 2 (1-4) units of packed RBC. No procedure related complications were reported up to a scheduled 6th week in-person follow-up. CONCLUSION: The novel TVUAC shows potential in limiting third line interventions, maternal morbidity and mortality. Its effectiveness and safety may be further explored as a first line surgical adjunct to medical measures, in PPH protocols in low-resource settings.

Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice.

OBJECTIVES: This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. METHODS: We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48 h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. RESULTS: This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. CONCLUSIONS FOR PRACTICE: Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.

Demoras en atención materna y complicaciones hipertensivas en el Hospital Sabogal, Callao, Perú, 2021. Estudio de casos y controles / Delays in maternal care and hypertensive complications at the Sabogal hospital, Callao, Peru, 2021. Case-control Study

RESUMEN Objetivo: Evaluar si hay asociación entre demora II en atención materna y complicaciones de la hipertensión inducida por el embrazo (HIE) en el Hospital Alberto Sabogal en el contexto de pandemia por covid-19. Materiales y métodos: Estudio de casos y controles llevado a cabo en un hospital de referencia en la región de Callao, Perú. En el estudio se incluyeron mujeres de 19 años o más, atendidas por cesárea de urgencia debida a distocias fetales, sospecha de feto grande o cesáreas iterativas, y aquellas que tuvieron cesárea por emergencia atendidas en las áreas de obstetricia covid-19 y no covid-19 en los meses de enero a abril de 2021. Se excluyeron gestantes con enfermedades preexistentes, así como a quienes presentaban otras complicaciones obstétricas. Como casos se incluyeron pacientes con complicaciones de la hipertensión inducida por el embrazo (HIE) y como controles las que no tuvieron estas complicaciones. Se midió la edad, la procedencia, la ocupación, y el tipo de demora. Se usó un cuestionario según modelo de Thadeus y Maine, y revisión documentaria. Se evaluó la asociación entre demora II y complicaciones de la HIE a través de la odds ratio (OR). Resultados: Se encontró que los casos tuvieron un mayor riesgo de haber estado expuestos a demoras tipo II que los controles (OR: 7,72; IC 95 %: 3,44-17,35). Se identificó que la demora II se asoció con la procedencia de la paciente. Conclusión: En el periodo de la pandemia por co-vid-19 las mujeres que tuvieron complicaciones de la HIE estuvieron más expuestas a demoras tipo II que los controles en el Hospital Sabogal en Callao, Perú. Se requieren estudios prospectivos que confirmen esta asociación y los efectos de la congestión de los servicios hospitalarios por pacientes con covid-19 en otros desenlaces maternoperinatales en la región.

ABSTRACT Objective: To evaluate if there is association between delay II in maternal care and complications of Pregnancy-induced hypertension (PIH) at the Alberto Sabogal Hospital in the context of the Covid19 pandemic. Material and methods: Case-control study carried out in a reference hospital in the Callao region, Peru. The study included women aged 19 or over, treated for emergency caesarean section attended in the obstetric areas COVID-19 and non-COVID-19 in the months of January to April 2021. Pregnant women with pre-existing diseases, as well as those with other obstetric complication were excluded. Patients with complications of pregnancy-induced hypertension (PIH) were included as cases, and those without these complications as controls. Age, origin, occupation, type of delay and type of complication of PIH were measured. A questionnaire was used according to the Thadeus and Mayne model and documentary review. The association between delay II and complications of PIH was evaluated through the odds ratio (OR). Results: It was found that the cases had a higher risk of having been exposed to type II delays than the controls (OR: 7.72; 95% CI: 3.44-17.35). There was an association between delay II and hypertensive complications. It was identified that delay II was associated with the origin of the patient. Conclusion: In the period of the Covid-19 pandemic, women who had complications from PIH were more exposed to type II delays than controls at the Alberto Sabogal hospital in Callao, Peru. Prospective studies are required to confirm this association and the effects of congestion of hospital services by patients with covid-19 on other maternal-perinatal outcomes in the region.

Delays in maternal care and hypertensive complications at the Sabogal hospital, Callao, Peru, 2021. Case-control Study / Demoras en atención materna y complicaciones hipertensivas en el Hospital Sabogal, Callao, Perú, 2021. Estudio de casos y controles.

Objective: To evaluate if there is association between delay II in maternal care and complications of Pregnancy-induced hypertension (PIH) at the Alberto Sabogal Hospital in the context of the Covid19 pandemic. Material and methods: Case-control study carried out in a reference hospital in the Callao region, Peru. The study included women aged 19 or over, treated for emergency caesarean section attended in the obstetric areas COVID-19 and non-COVID-19 in the months of January to April 2021. Pregnant women with pre-existing diseases, as well as those with other obstetric complication were excluded. Patients with complications of pregnancy-induced hypertension (PIH) were included as cases, and those without these complications as controls. Age, origin, occupation, type of delay and type of complication of PIH were measured. A questionnaire was used according to the Thadeus and Mayne model and documentary review. The association between delay II and complications of PIH was evaluated through the odds ratio (OR). Results: It was found that the cases had a higher risk of having been exposed to type II delays than the controls (OR: 7.72; 95% CI: 3.44-17.35). There was an association between delay II and hypertensive complications. It was identified that delay II was associated with the origin of the patient. Conclusion: In the period of the Covid-19 pandemic, women who had complications from PIH were more exposed to type II delays than controls at the Alberto Sabogal hospital in Callao, Peru. Prospective studies are required to confirm this association and the effects of congestion of hospital services by patients with covid-19 on other maternal-perinatal outcomes in the region.

Objetivo: evaluar si hay asociación entre demora II en atención materna y complicaciones de la hipertensión inducida por el embrazo (HIE) en el Hospital Alberto Sabogal en el contexto de pandemia por covid-19. Materiales y métodos: estudio de casos y controles llevado a cabo en un hospital de referencia en la región de Callao, Perú. En el estudio se incluyeron mujeres de 19 años o más, atendidas por cesárea de urgencia debida a distocias fetales, sospecha de feto grande o cesáreas iterativas, y aquellas que tuvieron cesárea por emergencia atendidas en las áreas de obstetricia covid-19 y no covid-19 en los meses de enero a abril de 2021. Se excluyeron gestantes con enfermedades preexistentes, así como a quienes presentaban otras complicaciones obstétricas. Como casos se incluyeron pacientes con complicaciones de la hipertensión inducida por el embrazo (HIE) y como controles las que no tuvieron estas complicaciones. Se midió la edad, la procedencia, la ocupación, y el tipo de demora. Se usó un cuestionario según modelo de Thadeus y Maine, y revisión documentaria. Se evaluó la asociación entre demora II y complicaciones de la HIE a través de la odds ratio (OR). Resultados: se encontró que los casos tuvieron un mayor riesgo de haber estado expuestos a demoras tipo II que los controles (OR: 7,72; IC 95 %: 3,44-17,35). Se identificó que la demora II se asoció con la procedencia de la paciente. Conclusión: en el periodo de la pandemia por covid-19 las mujeres que tuvieron complicaciones de la HIE estuvieron más expuestas a demoras tipo II que los controles en el Hospital Sabogal en Callao, Perú. Se requieren estudios prospectivos que confirmen esta asociación y los efectos de la congestión de los servicios hospitalarios por pacientes con covid-19 en otros desenlaces maternoperinatales en la región.

Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony in 50 cases / 中国基层医药

Objective:To investigate the clinical efficacy of uterine compression suture in the treatment of postpartum hemorrhage resulting from uterine atony.Methods:100 patients with postpartum hemorrhage due to uterine atony who received treatment between May 2017 and May 2018 in the First People's Hospital of Yongkang were included in this study. They were randomly assigned to undergo either conventional uterine suture (control group, n = 50) or uterine compression suture (observation group, n = 50). Clinical efficacy was compared between the observation and control groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [94.0% (47/50) vs. 68.0% (34/50), χ2 = 12.421, P < 0.01]. There was no significant difference in operative time between observation and control groups [(62.99 ± 10.87) minutes vs. (60.98 ± 8.12) minutes, t = 1.048, P > 0.05]. The amount of blood loss within 2 and 24 hours postpartum, abdominal circumference, and uterine height in the observation group were (216.85 ± 16.85) mL, (356.19 ± 25.71) mL, (98.56 ± 5.86) cm and (35.17 ± 2.33) cm respectively, which were significantly less or lower than those in the control group [(485.29 ± 28.41) mL, (596.38 ± 34.18) mL, (108.59 ± 2.65) cm, and (38.45 ± 4.19) cm, t = 85.652, 65.325, 16.584, 3.256, all P < 0.05]. The incidence of complications in the observation group was significantly lower than that in the control group [4.0% (2/50) vs. 28.0% (14/50), χ2 = 12.032, P < 0.01]. Conclusion:Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony has greater clinical efficacy and leads to lower incidence of complications than conventional suture technique.

Embarazo posterior a cirugía conservadora del útero ante hemorragia obstétrica postparto. Presentación de un caso / Pregnancy after conservative surgery of the uterus after postpartum obstetric hemorrhage. Presentation of a case

RESUMEN El embarazo es un proceso natural que debe concebirse sin complicaciones; sin embargo, los desenlaces obstétricos fatales en gestaciones previas, son marcadores importantes de un riesgo incrementado de morbimortalidad materna y perinatal en los próximos embarazos. La hemorragia obstétrica posparto es una de las más frecuentes y severas complicaciones del periparto; como una alternativa terapéutica útil en esos casos, el manejo quirúrgico conservador de útero permite mantener la fertilidad en mujeres con paridad no satisfecha, y mejorar su calidad de vida, aunque en muchas ocasiones, por causas diversas, esto no es posible. Se presenta el caso de una paciente de 26 años de edad, con historia obstétrica de tres embarazos, un parto y un aborto (provocado); y el antecedente de complicación obstétrica hemorrágica en embarazo anterior por atonía uterina, la cual requirió tratamiento quirúrgico conservador con técnicas combinadas (suturas compresivas de Hayman, Ho-Cho y ligadura bilateral de las arterias uterinas). Dos años después, acudió a los servicios obstétricos con gestación de 16 semanas (alto riesgo obstétrico). Este artículo tiene el objetivo de exponer el informe de una paciente en la que se logró la concepción de un embarazo posterior a la realización de cirugía conservadora del útero.

ABSTRACT Pregnancy is a natural process that must be conceived without complications; however, fatal obstetric outcomes in previous pregnancies are important markers of an increased risk of maternal and perinatal morbidity and mortality in future pregnancies. Postpartum obstetric hemorrhage is one of the most frequent and severe complications of the peripartum; As a useful therapeutic alternative in these cases, conservative surgical management of the uterus allows fertility to be maintained in women with unsatisfied parity, and improves their quality of life, although in many cases, for various reasons, this is not possible. The case of a 26-year-old patient is presented, with an obstetric history of three pregnancies, one delivery and one abortion (provoked); and a history of hemorrhagic obstetric complication in previous pregnancy due to uterine atony, which required conservative surgical treatment with combined techniques (Hayman, Ho-Cho compression sutures and bilateral ligation of the uterine arteries). Two years later, she attended obstetric services with a 16-week gestation (high obstetric risk). This article aims to present the report of a patient in whom the conception of a pregnancy was achieved after performing conservative surgery on the uterus.

Factores sociodemográficos y obstétricos relacionados con aplicación del consentimiento informado en procedimientos de oclusión tubárica. Cartagena-Colombia / Sociodemographic and obstetric factors related to the application of informed consent in procedures of tubal occlusion. Cartagena-Colombia

Introducción: La forma como se aplica el consentimiento informado (CI) en algunas instituciones prestadoras de salud, donde se realizan procedimientos de oclusión tubárica bilateral (OTB) en Cartagena, podría verse influenciado por factores de tipo sociodemográfico y factores de tipo obstétrico, que al final determinan la forma como se aplica el Consentimiento informado y que este sea más que un requisito para desligar responsabilidades por parte de profesionales en su relación médico- paciente. Objetivo: Determinar la influencia de los factores sociodemográficos y obstétricos en la aplicación del consentimiento informado, en procedimientos de OTB, en centros de salud de Cartagena. Material y Métodos: Se realizó un estudio descriptivo transversal prospectivo. Las fuentes de información consultadas son fuentes primarias; se encuestaron 196 pacientes que se realizaron procedimientos de cesárea por urgencias más oclusión tubárica bilateral. Se efectuó análisis Univariado y Bivariado para establecer tendencia a la asociación mediante la prueba de Chi cuadrado. Resultados: Dentro de las características sociodemográficas y obstétricas asociadas estadísticamente con conocer lo que es el consentimiento informado están tener más de 24 años (p= 0,033); ser de procedencia urbana (p=0,046); vivir en estrato superior a estrato 1 y 2 (p=0,0001), tener estudios superiores a primaria (p=0,0001); no tener más de dos embarazos (p=0,029) y asistir a control prenatal (p=0,0001). Conclusiones: La mayoría de las pacientes poseen en términos generales desconocimiento sobre el CI. El estrato socioeconómico, el nivel de escolaridad y la procedencia influyen en el nivel de conocimiento que tienen del CI, lo mismo que algunos factores obstétricos(AU)

Introduction: The way in which informed consent (IC) is applied in some healthcare institutions where bilateral tubal occlusion (OTB) procedures are performed in Cartagena could be influenced by sociodemographic and obstetric factors which ultimately determine the way at which informed consent is applied, being this more than a requirement for the professionals to be free of liability in their doctor-patient relationship. Objective: To determine the influence of sociodemographic and obstetric factors on the application of informed consent in OTB procedures in health centers in Cartagena. Material and Methods: A prospective cross-sectional descriptive study was carried out. Primary sources of information were consulted; a total of 196 patients who underwent cesarean section procedures for emergencies plus bilateral tubal occlusion were surveyed. Univariate and bivariate analyzes were performed to establish a tendency to association using the Chi-square test. Results: Some sociodemographic and obstetric characteristics statistically associated with knowledge about informed consent are to be over 24 years old (p=0.033); to be of urban origin (p=0.046); to live in stratum higher than stratum 1 and 2 (p=0.0001), to have higher education than primary (p=0.0001); not to have more than two pregnancies (p=0.029) and to attend prenatal care (p=0.0001), among others. Conclusions: Most patients are generally unaware of IC. The socioeconomic stratum, level of schooling, origin and some obstetric factors have an influence on their level of knowledge of IC(AU)

Clinical analysis of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy / 中国基层医药

Objective To investigate the clinical efficacy of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy.Methods From September 2016 to March 2018, 68 patients with cesarean scar pregnancy in the People's Hospital of He'nan Province were collected .According to different treatment methods ,the patients were divided into observation group and control group .The observation group (42 cases) firstly received bilateral uterine artery embolization ,then hysteroscopy pregnancy lesion was resected after 2 -3 days.The control group (26 cases) directly received hysteroscopy endoscopic pregnancy lesion resection . Results There were 42 cases in the observation group,2 cases(all of them III type)failed,of which 1 case was treated with laparoscopy ,and 1 case was converted to transvaginal focus clearance .In the control group ,26 cases of cesarean scar pregnancy were treated directly by hysteroscopy ,and 6 cases were failed(1 case of type I,4 cases of type II,1 case of type III),among which 3 cases were treated with uterine artery embolization .Then hysteroscopic surgery was performed in 2 cases,combined with laparoscopy for pregnancy focus debridement .One case of severe hemorrhage occurred in III type operation ,which was immediately converted to open operation .The operation time,intraoperative blood loss ,surgical success rate , length of hospital stay , blood β-HCG return to normal time , menstrual recovery time,postoperative vaginal bleeding , postoperative vaginal bleeding time in the observation group were ( 17.09 ± 3.62)min,(32.6 ±5.6)mL,95.2％(40/42),(4.76 ±1.63)d,(18.00 ±6.62)d,(30.28 ±4.23)d,(32.75 ± 8.32)mL,(3.26 ±1.06)d,respectively,which in the control group were (49.51 ±3.41)min,(60.3 ±13.6)mL, 76.9％(20/26),(7.23 ±1.96)d,(22.00 ±6.91)d,(36.41 ±7.62)d,(46.23 ±11.73)mL,(6.42 ±2.45)d, respectively,the differences between the two groups were statistically significant (t=36.68,14.09,χ2 =5.189,t=5.62,2.30,4.27,5.54,7.35,all P <0.05).Conclusion Bilateral uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has some advantages including high successful rate , short operation time,less bleeding,hospitalization time and postoperative recovery ,etc.It is a safe and effective treatment especially for type I and type II scar pregnancy .

Clinical analysis of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy / 中国基层医药

Objective@#To investigate the clinical efficacy of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy.@*Methods@#From September 2016 to March 2018, 68 patients with cesarean scar pregnancy in the People's Hospital of He'nan Province were collected.According to different treatment methods, the patients were divided into observation group and control group.The observation group (42 cases) firstly received bilateral uterine artery embolization, then hysteroscopy pregnancy lesion was resected after 2-3 days.The control group (26 cases) directly received hysteroscopy endoscopic pregnancy lesion resection.@*Results@#There were 42 cases in the observation group, 2 cases(all of them III type)failed, of which 1 case was treated with laparoscopy, and 1 case was converted to transvaginal focus clearance.In the control group, 26 cases of cesarean scar pregnancy were treated directly by hysteroscopy, and 6 cases were failed(1 case of type I, 4 cases of type II, 1 case of type III), among which 3 cases were treated with uterine artery embolization.Then hysteroscopic surgery was performed in 2 cases, combined with laparoscopy for pregnancy focus debridement.One case of severe hemorrhage occurred in III type operation, which was immediately converted to open operation.The operation time, intraoperative blood loss, surgical success rate, length of hospital stay, blood β-HCG return to normal time, menstrual recovery time, postoperative vaginal bleeding, postoperative vaginal bleeding time in the observation group were (17.09±3.62)min, (32.6±5.6)mL, 95.2%(40/42), (4.76±1.63)d, (18.00±6.62)d, (30.28±4.23)d, (32.75±8.32)mL, (3.26±1.06)d, respectively, which in the control group were (49.51±3.41)min, (60.3±13.6)mL, 76.9%(20/26), (7.23±1.96)d, (22.00±6.91)d, (36.41±7.62)d, (46.23±11.73)mL, (6.42±2.45)d, respectively, the differences between the two groups were statistically significant(t=36.68, 14.09, χ2=5.189, t=5.62, 2.30, 4.27, 5.54, 7.35, all P<0.05).@*Conclusion@#Bilateral uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has some advantages including high successful rate, short operation time, less bleeding, hospitalization time and postoperative recovery, etc.It is a safe and effective treatment especially for type I and type II scar pregnancy.

Development and validation of a technology for obstetric intraoperative care safety / Elaboración y validación de tecnología para la seguridad de la atención intraoperatoria obstétrica / Elaboração e validação de tecnologia para segurança do cuidado intraoperatório obstétrico

ABSTRACT Objectives: to develop and validate an obstetric surgical safety checklist for intraoperative care. Methods: this is a methodological study with two phases: integrative review in databases, using selection criteria and descriptors to synthesize the evidence and develop the checklist; checklist content validation, with 37 judges, who answered a Likert-type questionnaire. For analysis, a >85% content validation index was applied. Results: the checklist's first moment reached a 96.1 content validation index; the second moment, 95.5; the third moment, 98.9. Thus, the validation index of all verifying sections present in the three surgical moments was 97.1. Cronbach's Alpha value was 95.57%. Conclusions: the checklist items were validated by judges, with improvement of some items and insertion of others.

RESUMEN Objetivos: desarrollar y validar una lista de verificación de seguridad quirúrgica obstétrica para la atención intraoperatoria. Métodos: estudio metodológico con dos fases: revisión integradora en bases de datos, utilizando criterios de selección y descriptores para sintetizar la evidencia y construir la lista; validación de contenido de la lista con 37 jueces, quienes respondieron un cuestionario utilizando la escala Likert. Para el análisis se aplicó el índice de validación de contenido> 85%. Resultados: el primer momento de la lista alcanzó un índice de validación de contenido de 96,1; el segundo momento, 95,5; el tercer momento, 98,9. Con eso, el índice de validación de todas las secciones de control presentes en los tres momentos quirúrgicos fue de 97,1. El valor Alfa de Cronbach fue del 95,57%. Conclusiones: los ítems de la lista fueron validados por los jueces, con mejora de algunos ítems e inserción de otros.

RESUMO Objetivos: elaborar e validar uma lista de verificação de segurança cirúrgica obstétrica para o atendimento intraoperatório. Métodos: estudo metodológico com duas fases: revisão integrativa em bases de dados, com a utilização de critérios de seleção e descritores para a síntese das evidências e construção da lista; validação de conteúdo da lista com 37 juízes, que responderam um questionário utilizando a escala Likert. Para análise, aplicou-se o índice de validação de conteúdo >85%. Resultados: o primeiro momento da lista alcançou um índice de validação de conteúdo de 96,1; o segundo momento, 95,5; o terceiro momento, 98,9. Com isso, o índice de validação de todas as seções de checagem presentes nos três momentos cirúrgicos foi de 97,1. O valor do Alpha de Cronbach foi de 95,57%. Conclusões: os itens da lista foram validados pelos juízes, com aperfeiçoamento de alguns itens e inserção de outros.

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes.

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.

Evaluating the role of clinical officers in providing reproductive health services in Kenya.

BACKGROUND: Most sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity. In Kenya, task sharing in RH began in 2002, with the training of clinical officer(s)-reproductive health (CORH). Little is known about them and the extent of their role in the health system. METHODS: In 2016, we conducted a retrospective, quantitative two-stage study in Kenya to evaluate the use of CORH and 28 of their curriculum-derived RH competencies, to determine their contribution to expanded access to RH care. CORH were surveyed, using structured questionnaires and telephone interviews. Data on the frequency with which CORH used specified competencies were collected from health records in selected facilities. RESULTS: Forty-nine of all 104 CORH participated in the survey (47%). Forty-eight (98%) had worked in the clinical area, and 79% were still engaging in clinical work. All 48 worked in emergency obstetrics, emergency gynaecology, and nonemergency RH, and 38 (79%) filled clinical leadership positions. Vasectomy was least performed, by only 9 (18%) CORH. All other competencies were applied by at least half of the CORH, and 22 competencies by more than three quarters. Forty-one (84%) CORH performed caesarean section (CS). Teaching and management were other common responsibilities. Data were collected from 12 facilities and analysed for 11. They generally confirmed the initial survey findings: CORH worked as obstetrics and gynaecology consultants and used most of their competencies. Analysis was based on 118 months of theatre records. CORH made significant contributions to their facility's capacity to perform RH surgery: most respondents performed at least 25% of these surgeries. They performed an average of six CS per month and more than 25% of perineal tear repairs (33%), uterus repairs (33%), manual placenta removals (26%), bilateral tubal ligations (39%), and cervical cancer staging (27%). Some experienced CORH conducted procedures beyond their training. CONCLUSIONS: CORH expand access to emergency RH care. Their contributions span all areas of obstetric and gynaecological care, mentoring new health workers and expanding their scope of practice. However, the generally poor status of records documenting healthcare provision limits their usability in evaluation and research.

Caracterización de pacientes que requirieron histerectomía obstétrica de urgencia. Cienfuegos, 2013-2015 / Charaterization of patients who needed urgent obstetric hystrectomy. Cienfuegos. 2013-2015

Fundamento: La histerectomía obstétrica es una alternativa terapéutica ante procesos graves (hemorrágicos y/o sépticos), que de no solucionarse influirían directamente en la morbimortalidad materna. El conocimiento sobre el tema permite actuar de manera coherente y racional ante situaciones de riesgo.Objetivo: caracterizar las pacientes que requirieron histerectomía obstétrica de urgencia relacionada con el embarazo en Cienfuegos.Métodos: se realizó un estudio descriptivo, de serie de casos, de todas las pacientes a las cuales se realizó histerectomía obstétrica (N=37) en el Hospital Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, entre los años 2013-2015. Las variables analizadas fueron: edad de la paciente edad gestacional, paridad, eventos relacionados con el embarazo y el parto, tipo de parto y tipo de histerectomía obstétrica.Resultados: el grupo de pacientes de 31-35 años fue el más numeroso, representativo del 40,5 % de total. El 73 % de las mujeres histerectomizadas tuvieron partos anteriores y 10 (27 %) pacientes eran nulíparas. La atonía uterina constituyó la causa más habitual (45,9 %), sobre todo en el grupo de 31-35 años (41,2 %), seguida de la rotura uterina y el acretismo placentario. El tipo de histerectomía más utilizado fue la total sin anexectomía (43,3 %).Conclusión: generalmente los embarazos llegaron a término, y la atonía, como en la gran mayoría de los estudios similares, fue la indicación que predominó. Se corroboró que el parto por cesárea eleva el riesgo relativo para realizar la histerectomía.

Foundation: Obstetric hysterectomy is a therapeutic alternative on severe processes (hemorrhagic and/or septic) which if not solved would directly influenced in maternal morbi/mortality. Knowing about the topic allows to proceed rationally and coherently on risky situations.Objective: to charaterize the patients, series of cases who needed urgent obstetric hysterectomies in Cienfuegos 2013-2015.Methods: a descriptive study was developed, a series of cases of all the patients who were performed an obstetric hysterectomy (N=37) in the Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos, from 2013 to 2015. The variables analyzed were patient age, gestational age, parity, events related to pregnancy, delivery, kind of birth and type of obstetric hysterectomy.Results: the group of patients between 31-35 years old was the most numerous, representing 40,5 % of the total. The 73% of the hysterectomized women had previous deliveries and 10 (27 %) patients were nulliparous. Uterine atony was de most frequent cause (45,9 %), mainly in the 31-35 year group (41,2 %), followed by uterine rupture and placenta accreta. The total hysterectomy without ophorectomy was the most used type(43,3 %).Conclusion: in general pregnancies arrived to the term and the atony, as in many of similar studies was the predominating indication. It was corroborated that birth by cesarean section increases the relative risk to perform a hysterectomy.