Cuidado crítico materno: desenlaces y características de los pacientes de una unidad obstétrica combinada de alta dependencia en Medellín, Colombia
Germán A. Monsalve, Catalina M. Martínez, Tatiana Gallo, María Virginia González, Gonzalo Arango, Alejandro Upegui, Juan Manuel Castillo, Juan Guillermo González, Jorge Rubio, Leonardo Mojica, Mauricio de Jesús Vasco.
Rev. Col. Anest. Mayo - julio 2011. Vol. 39 - No. 2: 190-205 (doi:10.5554/rca.v39i2.96)
Resumen
La paciente obstétrica críticamente enferma representa un reto clínico muy complejo, que requiere un manejo multidisciplinario. El objetivo del presente estudio fue establecer las tasas de utilización, los diagnósticos de ingreso y los desenlaces materno-fetales de pacientes obstétricas críticamente enfermas admitidas a una unidad de cuidado intensivo/de alta dependencia en Colombia. Se hizo una revisión retrospectiva de tres años de los registros hospitalarios. Durante un periodo de tres años fueron admitidas 819 pacientes, que representaron el 3,3 % de todos los nacimientos, y entre las cuales el 64 % fueron preparto. Las complicaciones obstétricas representaron el 82 % de las admisiones: la preeclampsia-eclampsia y sus complicaciones fueron los diagnósticos más comunes (50,5 %), y la hemorragia obstétrica fue la principal causa de morbilidad severa y mortalidad. Hubo siete muertes (0,85 %). La estancia promedio en la unidad fue de 2,41 días (de 1 a 15). Nueve pacientes fueron transferidas a unidades de cuidado intensivo médico-quirúrgicas durante el periodo estudiado. El uso de una unidad de alta dependencia exclusiva de obstetricia -incluyendo la disponibilidad de manejo obstétrico, perinatal y de cuidado crítico, en conjunto con unos umbrales bajos de admisión, ya sea prenatal o postnatal- permiten un manejo eficiente y oportuno de las pacientes obstétricas complejas.
Palabras clave: Mortalidad materna, preeclampsia, eclampsia, hemorragia.
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341v39n02a90150249pdf001.pdf
Uso de un sistema de puntuación para guiar la tromboprofilaxis en embarazadas de alto riesgo
The use of a scoring system to guide thromboprophylaxis in a high-risk pregnant population.
Schoenbeck D, Nicolle A, Newbegin K, Hanley J, Loughney AD.
Department of Women's Services and Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK.
Thrombosis. 2011;2011:652796. doi: 10.1155/2011/652796. Epub 2011 Sep 8.
Abstract
Guidelines for thromboprophylaxis in pregnancy are usually based upon clinical observations and expert opinion. For optimal impact, their use must be attended by consistency in the advice given to women. In this observational study, we evaluated the performance of a scoring system, used as a guide for clinicians administering dalteparin to pregnant women at increased risk of venous thromboembolism. The work included 47 women treated with dalteparin prior to adoption of the scoring system and 58 women treated with dalteparin after its adoption. The indication for thromboprophylaxis was recorded in each case together with details of the regimen employed, obstetric, and haematological outcomes. The main outcome measure was to determine whether consistency improved after adoption of the scoring system. We also recorded the occurrence of any new venous thromboembolism, haemorrhage, the use of regional anaesthesia during labour, evidence of allergy, and thrombocytopenia. We found that use of the scoring system improved the consistency of advice and increased the mean duration of thromboprophylaxis. None of the subjects suffered venous thromboembolism after assessment using the scoring system. There was no increase in obstetric or anaesthetic morbidity when dalteparin was given antenatally period and no evidence of heparin-induced thrombocytopenia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200277/pdf/THROMB2011-652796.pdf
Papel del ultrasonido doppler en el embarazo de alto riesgo. Estudio comparativo
The role of doppler ultrasound in high risk pregnancy: A comparative study.
Messawa M, Ma'ajeni E, Daghistani MH, Ayaz A, Farooq MU.
Niger Med J [serial online] 2012 [cited 2012 Dec 11];53:116-20.
Background: The objective was to determine the effectiveness of Doppler velocimetry results in the management of high-risk pregnancy. Materials and Methods: This cohort study was conducted from January 2005 to December 2006 in Obstetrics and Gynecology Department of Alnoor Specialist Hospital, Makkah, Saudi Arabia. A total of 200 high-risk pregnant women with gestational age >28 weeks were selected for the study and divided into group A (100) subjected to Doppler velocimetry and group B (100) without Doppler velocimetry. Standard management protocols were followed in all cases. The primary outcome measures were mode of delivery and gestational age at the time of delivery. The secondary outcome measures were prenatal and neonatal complications. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: Preterm deliveries, preterm as well as full-term neonatal admissions were more frequent in group A than those in group B, i.e., (39% vs. 26%), (56% vs. 88%) (OR 0.2, 95% CI 0.04-0.7), and (30% vs. 57%) (OR 0.3, 95% CI 0.2-0.7), respectively. Similarly preterm and full-term neonatal deaths were rare in group A than those in group B, i.e., (9% vs. 78%) (OR 0.1, 95% CI 0.02-0.7), and (6% vs. 29%) (OR 0.2, 95% CI 0.03-1.8), respectively. Emergency caesarean section rate was rare in the subjects with normal Doppler than those with abnormal Doppler (48% vs. 100%) (OR 0.1, 95% CI 0.03-0.4) as well as in group B (48% vs. 82%) (OR 0.2, 95% CI 0.1-0.4). Conclusion: Doppler studies in high-risk pregnancies are more beneficial in the management of perinatal as well as neonatal management.
Keywords: Caesarean section, color Doppler ultrasonography, pregnancy outcome, prematurity
http://www.nigeriamedj.com/text.asp?2012/53/3/116/104377
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