Repercusiones materno neonatales de rotura prematura de membranas pretérmino en pacientes atendidas en el Hospital Regional de Pucallpa - 2011 / Effects maternal and neonatal of the premature rupture of membranes, preterm labor in patients treated in Regional Hospital Pucallpa - 2011

OBJETIVO: Este estudio estuvo dirigido a determinar las repercusiones maternas neonatales de la ruptura prematura de membranas pretérmino del Hospital Regional de Pucallpa, durante Enero-Diciembre del 2011. MATERIALES y METODOS: Estudio observacional, analítico de casos y controles. RESULTADOS: Se estudiaron 109 pacientes con RPM. La incidencia de RPM es de 4.65 por ciento. Terminación de parto: cesárea en 33.9 por ciento (37), p=0,018800 OR:1,61 (1,08-2,42), y un 11 por ciento (12) se encuentra < a las 28 semanas, (p=0,000001 OR: 12,99 (6,46-26,1)), Sin CPN p=0,000382, OR: 2,34 (1,45-3,80), control prenatal inadecuado (de 1-3 CPN) p=0,002611 OR: 1,87 (1,24-2,83), CPN adecuado >4 en 48.6 por ciento (53), p=0,000000 OR:0,33 (0,23-0,49), En el caso de la edad gestacional al nacer, 78 por ciento (89) era prematuros leves (34 a 37 semanas) (p=0,000003 OR: 52,40 (31,72-86,5)), 10 por ciento (9) eran de prematuridad moderada (30 a 34 semanas), p=0,000048 OR: 3,77 (1,90-7,49); Hallazgos obstétricos asociados: en 10.1 por ciento (11) tuvieron Oligohidramnios severo en 11 (10.1 por ciento), p=0,000001 OR: 7,82 (3,93-15,58), podálico en 6.4 por ciento (7), p=0,001579 OR: 3,40 (1,52-7,60), preeclampsia severa en 2.8 por ciento (3), Mortalidad en 12 prematuros (11 por ciento) p=0,000001 OR: 8,25 (4,24-16,05). CONCLUSION: Se encontró estadísticamente significativa con un valor de p<0.05, en el grupo de prematuridad leve, edad gestacional < de 28 semanas, Mortalidad en el recién nacido, Oligohidramnios, recién nacido en presentación podálico, prematuridad moderada, Madre sin control prenatal, control prenatal inadecuado < de 3 controles, Los casos de RPM en el Hospital de Pucallpa, son más del tipo de prematuridad leve, y la mortalidad se asocia a prematuros de bajo peso al nacer.

OBJECTIVE: This study was aimed to determine the effects of neonatal maternal premature rupture of membranes Pucallpa Regional Hospital during January to December 2011. MATERIALS AND METHODS: A retrospective descriptive study, correlational. RESULTS: We studied 109 patients with RPM. RPM incidence is 4.65 per cent. Termination of birth: caesarean section 33.9 per cent (37), P=0.018800 OR: 1.61 (1.08 to 2.42), and 11 per cent (12) is < at 28 weeks (p=0.000001 OR 12.99 (6.46 to 26.15)), No CPN p=0.000382, OR: 2.34 (1.45 to 3.80), inadequate prenatal care (from 1-3 CPN) p=0.002611 OR: 1.87 (1.24 to 2.83), appropriate CPN>4 in 48.6 per cent (53), P=0.000000 OR: 0.33 (0.23-0.49) in the case of gestational age at birth, 78 per cent (89) was mild preterm (34-37 weeks) (p=0.000003 OR: 52.40 (31.72 to 86.56)), 10 per cent (9) were of moderate prematurity (30-34 weeks), p=0.000048 OR: 3.77 (1.90 to 7.49) associated obstetric Findings: 10.1 per cent (11) had severe in 11 Oligohidramnios (10.1 per cent)., p=0.000001 OR: 7.82 (3.93 to 15.58), breech in 6.4 per cent (7), P=0.001579 OR: 3.40 (1.52 to 7, 60), severe preeclampsia in 2.8 per cent (3), mortality in 12 infants (11 per cent) p=0.000001 OR: 8.25 (4.24 to 16.05). CONCLUSION: We found statistically significant with a p-value <0.05, in the group of mild prematurity, gestational age <28 weeks, mortality in newborn, oligohydramnios, newborn baby in breech presentation, moderate prematurity, Mother without prenatal care, inadequate prenatal care <3 controls, RPM cases at the Hospital of Pucallpa, are mild prematurity rate, and mortality associated with premature low birth weight.

Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement.

PURPOSE: We compared early results of homograft aortic root replacement (ARR) in native (NVE) and prosthetic (PVE) aortic valve endocarditis in order to identify predictors for early mortality (<30 days). METHODS: Between 05/1986 and 12/2007, 1,163 endocarditis patients were operated upon. Of these, 221 patients (n = 185 men, median age 55 years) underwent homograft ARR due to 99 cases of NVE (45%) and 122 of PVE (55%) aortic root endocarditis. Demographics, clinical differences, survival rates and predictors of early mortality were analyzed. Follow-up (mean 5.2 +/- 0.4 years, maximum 18.4 years) was completed in 96.8% with a total of 1,127 patient years. RESULTS: Main causes of the 47 (21.2%) early deaths were septic multiorgan failure in 23 (48.9%) and myocardial failure in 10 (21.3%) patients with a significantly better survival for NVE than for PVE patients (patients = 0.029). The highest ORs were found in the univariate analysis for preoperative development of septic shock (OR 14.28), preoperative necessity of ventilation (OR 7.08), high doses of catecholamines (OR 5.60), severe aortic root destruction (OR 5.12), emergency operation (OR 4.25) and persistent fever despite antibiotic treatment (OR 4.11). Multivariate analysis showed that preoperative ventilation (OR 5.43), persistent fever under antibiotic treatment (OR 2.84) and prosthetic endocarditis (OR 2.32) were independent risk factors for early mortality. CONCLUSIONS: Our results suggest that early outcome could be improved if patients were referred earlier for surgery. A multidisciplinary approach is necessary, involving at least specialists in intensive care medicine, cardiology, infectious disease and cardiac surgery in order to identify the optimal time for surgery and decrease early mortality.