Diabetes y embarazo / Diabetes and pregnancy

Enero 8, 2018. No. 2957

Manejo de la diabetes en el embarazo: Estándares del cuidado médico en diabetes : 2018 Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes: 2018 Diabetes Care 2018;41(Suppl. 1):S137-S143 | https://doi.org/10.2337/dc18-S013 The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. PDF Diabetes y embarazo: Manejo de la diabetes y sus complicaciones desde la preconcepción al periodo postnatal Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. Editors National Collaborating Centre for Women's and Children's Health (UK). Source London: National Institute for Health and Care Excellence (UK); 2015 Feb. National Institute for Health and Care Excellence: Clinical Guidelines . Excerpt Clinical guidelines have been defined as 'systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions'. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on: preconception information; diagnosis and management of gestational diabetes; glycaemic control in the preconception, antenatal and intrapartum periods; changes to medications for diabetes and its complications before or during pregnancy; management of diabetic emergencies (for example, hypoglycaemia and ketoacidosis) and diabetic complications (such as retinopathy) during pregnancy; the timetable of antenatal appointments to be offered to women with diabetes; timing and mode of birth (including induction of labour, caesarean section, analgesia and anaesthesia, and the use of steroids for fetal lung maturation); initial care of the newborn baby; management of diabetes and its complications during the postnatal period. PDF Diabetes mellitus y el anestesiólogo, cuidados perioperatorios Elsa Elisa Jiménez Morales, Rogelio Sánchez García Revista de Investigación Médica Sur, México Vol. 15, núm. 1, Enero-Marzo 2008 Resumen La diabetes mellitus es uno de los padecimientos con mayor prevalencia, por lo que los médicos involucrados en su manejo antes, durante y después de un acto quirúrgico, deben conocer su terapéutica. Los criterios actuales de diagnóstico para diabetes son: síntomas de diabetes (poliuria, polidipsia, y pérdida de peso inexplicable) más el resultado de una muestra aleatoria mayor o igual a 200 mg/dL de glucosa, glucosa en ayuno (> 8 horas) de 126 mg/dL o mayor. Glucosa mayor o igual a 200 mg/dL 2 horas después de la administración oral de 75 g de glucosa. Los protocolos de manejo perioperatorio de pacientes diabéticos aceptados actualmente son tres y se conocen como; régimen clásico amplio, régimen estricto tipo I y escala móvil. Palabras clave: alabras clave: Diabetes mellitus, cuidados perioperatorios, anestesiología. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Hepatitis viral y embarazo / Viral hepatitis in pregnancy. Yahoo / Buzón

Noviembre 28, 2017. No. 2916

Actualización sobre hepatitis viral y embarazo Update on viral hepatitis in pregnancy. Shao Z1, Al Tibi M2, Wakim-Fleming J3. Author information Cleve Clin J Med. 2017 Mar;84(3):202-206. doi: 10.3949/ccjm.84a.15139. Abstract Pregnant women with acute viral hepatitis are at higher risk of morbidity and death than pregnant women with chronic viral hepatitis. The risk of death is highest with acute viral hepatitis E, and the rate of transmission to the baby may be highest with hepatitis B virus (HBV) infection. Managing viral hepatitis in pregnancy requires assessing the risk of transmission to the baby, determining the gestational age at the time of infection and the mother's risk of decompensation, and understanding the side effects of antiviral drugs. PDF Conocimiento, educación y prácticas de obstetras y ginecólogos con respecto a la hepatitis B crónica en el embarazo. Obstetricians' and gynecologists' knowledge, education, and practices regarding chronic hepatitis B in pregnancy. Niu B1, Marzio DH2, Fenkel JM2, Herrine SK2. Author information Abstract BACKGROUND: In pregnant women with high viral loads, third-trimester initiation of antiviral agents can reduce the risk of vertical transmission. We aimed to assess obstetricians' and gynecologists' (OB-GYN) knowledge and clinical practice when treating pregnant women with chronic hepatitis B virus (HBV). METHODS: All program directors (PDs) from 250 US OB-GYN residency programs were invited to anonymously complete an 18-item questionnaire. Descriptive statistics were calculated and analyzed. RESULTS: A total of 323 participants responded, including both PDs (n=51, response rate 21%) and residents (n=272, response rate 11%). Responding PDs (62% university-based vs. 32% community-based) came from various practice types. All PDs and 95.2% of residents reported screening for chronic HBV in pregnant patients on the first prenatal visit. A majority of PDs (85.5%) and residents (85%) correctly interpreted HBV serologies. Referral patterns showed that 66.7% of PDs and 65.5% of residents refer to a specialist regardless of viral load. A minority of respondents (19.6% PDs and 12.6% residents) knew that third-trimester antiviral therapy is recommended for women with high viral loads (>200,000 IU/mL). Few respondents had prescribed HBV antivirals (9.8% PDs and 6.0% residents), with residents more commonly prescribing tenofovir and less frequently lamivudine. Half the PDs believed trainees from their programs were comfortable managing HBV in pregnancy, but only 41.8% of residents reported being comfortable managing pregnant patients with HBV. CONCLUSION: OB-GYNs report screening almost all pregnant patients for chronic HBV, though significant gaps still exist in practitioner comfort and training regarding the management of HBV during pregnancy. KEYWORDS: Hepatitis B virus; education; obstetricians and gynecologists; practice; pregnancy; survey PDF Hepatitis vitral aguda durante el embarazo Enrique Valdés R., Alvaro Sepúlveda M., Paula Candia P., Karina Lattes A. Rev Chil Infect 2010; 27 (6): 505-512 PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Misatenia gravis y embarazo / Myasthaenia Gravis and pregnancy

Noviembre 19, 2017. No. 2907

Miastenia gravis. Manejo clínico antes, durante y después del embarazo Myasthaenia Gravis: Clinical management issues before, during and after pregnancy. Hassan A1, Yasawy ZM1. Author information Sultan Qaboos Univ Med J. 2017 Aug;17(3):e259-e267. doi: 10.18295/squmj.2017.17.03.002. Epub 2017 Oct 10. Abstract Myasthaenia gravis (MG) is an autoimmune neuromuscular disorder which is twice as common among women, often presenting in the second and third decades of life. Typically, the first trimester of pregnancy and first month postpartum are considered high-risk periods for MG exacerbations. During pregnancy, treatment for MG is usually individualised, thus improving its management. Plasma exchange and immunoglobulin therapies can be safely used to treat severe manifestations of the disease or myasthaenic crises. However, thymectomies are not recommended because of the delayed beneficial effects and possible risks associated with the surgery. Assisted vaginal delivery-either vacuum-assisted or with forceps-may be required during labour, although a Caesarean section under epidural anaesthesia should be reserved only for standard obstetric indications. Myasthaenic women should not be discouraged from attempting to conceive, provided that they seek comprehensive counselling and ensure that the disease is under good control before the start of the pregnancy. KEYWORDS: Disease Management; Myasthenia Gravis; Neonatal Myasthenia Gravis; Postpartum Period; Pregnancy PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Paro cardiaco y embarazo / Cardiac arrest and pregnancy

Octubre 12, 2017. No. 2839

Fundamentos en el paro cardíaco durante la cesárea Essentials in cardiac arrest during cesarean section. van Liempt SW, Stoecklein K, Tjiong MY, Schwarte LA, de Groot CJ, Teunissen PW. Author information Clin Pract. 2015 Feb 17;5(1):668. doi: 10.4081/cp.2015.668. eCollection 2015 Jan 28. Abstract Cardiac arrest during cesarean section is very rare. Obstetrical teams have low exposure to these critical situations necessitating frequent rehearsal and knowledge of its differential diagnosis and treatment. A 40-year-old woman pregnant with triplets underwent cesarean sections because of vaginal bleeding due to a placenta previa at 35.2 weeks of gestation. Spinal anesthesia was performed. Asystole occurred during uterotomy. Immediate resuscitation and delivery of the neonates eventually resulted in good maternal and neonatal outcomes. The differential diagnosis is essential and should include obstetric and non-obstetric causes. We describe the consideration of Bezold Jarisch reflex and amniotic fluid embolism as most appropriate in this case. KEYWORDS: Bezold Jarisch reflex; cardiac arrest; cesarean section PDF Colapso materno: Desafiando la regla de cuatro minutos. Maternal collapse: Challenging the four-minute rule. Benson MD1, Padovano A2, Bourjeily G3, Zhou Y4. Author information EBioMedicine. 2016 Apr;6:253-257. doi: 10.1016/j.ebiom.2016.02.042. Epub 2016 Mar 2. Abstract INTRODUCTION: The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. METHODS: A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule." Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals. RESULTS: Both maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women. CONCLUSION: Once a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances. KEYWORDS: Cardiopulmonary resuscitation in pregnancy; Maternal cardiac arrest; Maternal mortality; Perimortem cesarean section; Postmortem cesarean section PDF Paro Cardíaco en el embarazo Dr. Manuel Eduardo Sáenz Madrigal, Dr. Carlos Adrián Vindas Morera Rev. Costarr. Cardiol. 2013 Julio-Diciembre, Volumen 15, N.º 2 Resumen El paro cardíaco en el embarazo presenta un escenario único en el que están incluidos dos pacientes: la madre y el feto. El manejo de este escenario requiere de un equipo multidisciplinario incluyendo especialistas en anestesia, obstetricia, neonatología, cardiología y en ocasiones cirugía cardíaca. Los protocolos de soporte vital básico y soporte cardíaco avanzado deben ser implementados, sin embargo, dados los cambios anatómicos y fisiológicos que ocurren en el embarazo, algunas modificaciones en los algoritmos son fundamentales. La evidencia existente acerca del manejo del paro cardíaco en el embarazo es relativamente insuficiente, sin estudios randomizados, por lo tanto las recomendaciones son basadas en pequeños estudios de cohorte y reportes de casos, además de la opinión de los expertos. En esta revisión hablaremos del paro cardíaco en el embarazo, sus implicaciones y el manejo adecuado por parte del equipo multidisciplinario, además del tiempo en el que se debe realizar la cesárea en caso de no retorno de circulación espontánea. Palabras clave: paro, cardíaco, reanimación, cardiopulmonar y embarazo. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org