RESUMO
Objetivo: analizar los beneficios y riesgos de la conducta expectante frente a la inducción en mujeres gestantes a término con rotura prematura de membranas (RPM) sobre los resultados obstétricos y neonatales. Método: estudio observacional retrospectivo. Se incluyeron mujeres gestantes con RPM a término y sus recién nacidos (RN) ingresadas en el Hospital Universitario Marqués de Valdecilla (Santander) desde el 31 de mayo de 2016 al 1 de junio de 2017. Los datos se recuperaron de las historias clínicas. Se establecieron tres grupos de mujeres gestantes diferenciados en relación a la gestión del parto: manejo expectante, manejo activo y ambos manejos. Para el análisis inferencial se realizó una división de la muestra en función de dichos grupos. Se consideró significación estadística para p< 0,05. Se usó el programa estadístico SPSS versión 20.0. Resultados: la muestra fue de 464 mujeres gestantes. La muestra de RN que necesitaron ingreso por complicaciones fue de 42. El 81,9% (n= 380) comenzó por manejo expectante y un 17% (n=79) por manejo activo. A lo largo del proceso de parto, en algunos casos, se modificaba el plan de acción inicial. De las 380 mujeres gestantes que iniciaron con manejo expectante cambiaron su plan a inducción el 47,9% (n= 182). El 64,5% inició el parto en las primeras 12 horas de evolución espontánea, y el 82,8% a las 24 horas. No se hallaron diferencias estadísticamente significativas en cuanto a morbimortalidad materno-fetal durante las primeras 24 horas. Conclusiones: tanto el manejo expectante como activo son válidos en las primeras 24 horas de RPM
Objective: to analyze the benefits and risks of expectant management vs. induction in women with pregnancy to term who suffer a premature membrane rupture (PMR), regarding obstetric and neonatal results. Method: an observational retrospective study, including women with pregnancy to term and PMR and their newborns (NBs), admitted to the Hospital Universitario Marqués de Valdecilla (Santander) from May, 31st, 2106 to June, 1st, 2017. Clinical record data were collected. Pregnant women were classified into three different groups according to delivery management: expectant management, active management, and both managements. The sample was split according to said groups in order to conduct inferential analysis. Statistical significance was considered for p< 0.05.; and the SPSS version 20.0 statistical program was used. Results: the sample included 464 pregnant women; the sample of NBs who required admission due to complications was of 42. Expectant management was initially used for 81.9% (n= 380), and active management for 17% (n=79). Throughout the delivery process, the initial plan of action was modified in some cases. Of the 380 pregnant women for whom expectant management was initially used, this plan was switched to induction in 47.9% (n= 182); 64.5% of them initiated delivery within the first 12 hours of spontaneous evolution, and 82.8% at 24 hours. No statistically significant differences were found in terms of maternal-fetal morbimortality during the first 24 hours. Conclusions: both expectant and active management are valid within the first 24 hours of PMR
Assuntos
Humanos , Feminino , Gravidez , Ruptura Prematura de Membranas Fetais/etiologia , Trabalho de Parto Induzido , Corioamnionite , Conduta Expectante/métodos , Estudos Retrospectivos , 28599 , Idade Materna , Ruptura Prematura de Membranas Fetais/epidemiologiaRESUMO
BACKGROUND: European recent data about paediatric tuberculosis point out the importance of evaluate the trends of the disease to study the recent transmission, as well as the necessity of improving the microbiological diagnosis in paediatric cases. The aim of this paper is to study the epidemiology and trend evolution of paediatric tuberculosis in Spain during the period 2005-2009 and to establish the epidemiological differences between adult and paediatric tuberculosis. METHODS: Data reported to the National Surveillance Net (Red Nacional de Vigilancia Epidemiológica) in Spain was checked. Lineal regression was developed to establish the trend of the disease in all, adult and paediatric cases. Bivariate and multivariate logistic regression was used to compare paediatric and adult cases reported in 2009 and estimate the influence of different factors in the development of the disease. RESULTS: A total 39775, 2690 paediatrics (6.76%) cases of tuberculosis were reported during 2005-2009 period. Paediatric tuberculosis rates showed a slight increasing tendency (y=0.15x+7.8), while adult rates decrease during the period (y=-0.28x+20.2). In 2009, rates were 8.1 and 18.3 cases/100,000 inhab. for children and adults respectively. Paediatric cases presented higher proportion of pulmonary locations (84% vs. 76% in adults) and lower percentages of cases confirmed by culture (51% vs. 82% in adults) and of cases in non-Spanish population (25% vs. 34%). CONCLUSIONS: Paediatric tuberculosis rates showed a slight increasing tendency, while global and adult rates decrease slightly during the period. Tuberculosis disease shows different epidemiology in children and adults, what it is important to take into account to design public heh interventions.
Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Modelos Lineares , Modelos Logísticos , Masculino , Análise Multivariada , Vigilância da População , Espanha/epidemiologiaRESUMO
Fundamentos: Los últimos datos europeos sobre tuberculosis pediátrica señalan la utilidad de evaluar las tendencias para estudiar la transmisión así como la necesidad de mejorar el diagnóstico microbiológico en estas edades. El objetivo es estudiar la epidemiología de la tuberculosis pediátrica en España, su evolución durante el periodo 2005- 2009, y las diferencias respecto con la epidemiología de los adultos. Métodos: Se utilizaron los datos de la declaración individualizada de tuberculosis a la Red Nacional de Vigilancia Epidemiológica en 2005-2009. Se estudió la tendencia de las tasas en niños y adultos mediante modelos de regresión lineal. Para estudiar los riesgos asociados a la tuberculosis en niños en relación a la de los adultos, se realizó un análisis bivariado y otro multivariado por regresión logística, empleando los datos de 2009. Resultados: En el periodo de estudio se declararon 39.775 casos de tuberculosis, 2.690 de ellos pediátricos (6,76%). La tendencia en las tasas de tuberculosis fue ascendente para la edad pediátrica (y=0,15x+7,8) y descendente para los adultos (y=-0,28x+20,2). En 2009 las tasas fueron 8,1 casos/100.000 en niños y 18,3/100.000 en adultos. Se encontró en niños una mayor proporción de localizaciones pulmonares (84% frente a 76%), menor porcentaje de confirmaciones por cultivo (51% frente a 82%) y de casos extranjeros (25% frente a 34%). Conclusiones: En el periodo de estudio las tasas de tuberculosis pediátrica mostraron una tendencia ligeramente ascendente, mientras que las tasas globales y en adultos la tuvieron descendente . La tuberculosis muestra escenarios diferentes en niños y adultos, lo que hay que tener en cuenta para dirigir las acciones de salud pública(AU)
Background: European recent data about paediatric tuberculosis point out the importance of evaluate the trends of the disease to study the recent transmission, as well as the necessity of improving the microbiological diagnosis in paediatric cases. The aim of this paper is to study the epidemiology and trend evolution of paediatric tuberculosis in Spain during the period 2005-2009 and to establish the epidemiological differences between adult and paediatric tuberculosis. Methods: Data reported to the National Surveillance Net (Red Nacional de Vigilancia Epidemiológica) in Spain was checked. Lineal regression was developed to establish the trend of the disease in all, adult and paediatric cases. Bivariate and multivariate logistic regression was used to compare paediatric and adult cases reported in 2009 and estimate the influence of different factors in the development of the disease. Results: A total 39775, 2690 paediatrics (6.76%) cases of tuberculosis were reported during 2005-2009 period. Paediatric tuberculosis rates showed a slight increasing tendency (y=0.15x+7.8), while adult rates decrease during the period (y=-0.28x+20.2). In 2009, rates were 8.1 and 18.3 cases/100,000 inhab. for children and adults respectively. Paediatric cases presented higher proportion of pulmonary locations (84% vs. 76% in adults) and lower percentages of cases confirmed by culture (51% vs. 82% in adults) and of cases in non-Spanish population (25% vs. 34%). Conclusions: Paediatric tuberculosis rates showed a slight increasing tendency, while global and adult rates decrease slightly during the period. Tuberculosis disease shows different epidemiology in children and adults, what it is important to take into account to design public health interventions(AU)
