Revisiones_bibliográficas TyO

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viernes, 28 de abril de 2017

Más de hemorragia obstétrica / More on obstetric hemorrhage

Abril 22, 2017. No. 2667

Actualización del protocolo de tratamiento de la hemorragia obstétrica.

An update of the obstetrics hemorrhage treatment protocol.

Morillas-Ramírez F1, Ortiz-Gómez JR2, Palacio-Abizanda FJ3, Fornet-Ruiz I4, Pérez-Lucas R5, Bermejo-Albares L

Rev Esp Anestesiol Reanim. 2015 Apr;62(4):229-31. doi: 10.1016/j.redar.2014.09.008. Epub 2014 Dec 17.

Resumen

La hemorragia obstétrica es aún hoy día una importante causa de morbimortalidad maternofetal en los países desarrollados. Se trata de un problema infraestimado, que generalmente aparece de forma impredecible. La morbimortalidad de la hemorragia obstétrica se considera evitable en una elevada proporción si el manejo es adecuado. Las guías clínicas de mayor difusión mundial recomiendan por consenso protocolizar el manejo, adaptarlo al ámbito local y mantenerlo actualizado en función de la experiencia y de las nuevas publicaciones científicas. Exponemos un protocolo actualizado conforme a las últimas recomendaciones y a nuestra propia experiencia, para que pueda ser utilizado como elemento base por aquellos anestesiólogos que así lo deseen, adaptado a su ámbito local de trabajo diario. Este último aspecto es muy importante para que sea eficaz, y es una labor que debe realizarse en cada centro conforme a la disponibilidad de medios, personal y características arquitectónicas.

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Prácticas de transfusión de sangre en anestesia obstétrica.

Blood transfusion practices in obstetric anaesthesia.

Jadon A1, Bagai R2.

Indian J Anaesth. 2014 Sep;58(5):629-36. doi: 10.4103/0019-5049.144674.

Abstract

Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

KEYWORDS: Obstetric anaesthesia; obstetric haemorrhage; postpartum haemorrhage; transfusion practices; transfusion protocol

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Evaluación del cumplimiento y los resultados de un protocolo de tratamiento de hemorragia postparto masiva en un hospital de tercer nivel en Pakistán.

Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan.

Sheikh L1, Najmi N, Khalid U, Saleem T.

BMC Pregnancy Childbirth. 2011 Apr 13;11:28. doi: 10.1186/1471-2393-11-28.

Abstract

BACKGROUND: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated. METHODS: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. RESULTS: During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052). No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500-9000 ml). Emergency cesarean section was the most common mode of delivery (13/26; 50%) while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%). B-lynch suture (24%) and balloon tamponade (60%) were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12%) for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89%) and overall documentation of management (92%) were favorably observed in most cases. CONCLUSION: This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies.

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Vacante para Anestesiología Pediátrica

El Hospital de Especialidades Pediátricas de León, Guanajuato México

ofrece un contrato laboral en el departamento de anestesiología

Informes con la Dra Angélica García Álvarez

angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Foro Internacional de Medicina Crítica

Ciudad de México, Julio 13-15, 2017

Información / Information

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Asociación entre el núcleo osificante y la osteonecrosis en el tratamiento de la displasia del desarrollo de la cadera: metanálisis actualizado

http://www.ortopediapediatricaisunza.com.mx/academia/asociacion-entre-el-nucleo-ossificante-y-la-osteonecrosis-en-el-tratamiento-de-la-displasia-del-desarrollo-de-la-cadera-metanalisis-actualizado/

Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28427427

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1468-6

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397826/

De:

Niziol R1,Elvey M2,Protopapa E2,Roposch A2.

BMC Musculoskelet Disord.

2017 Apr 20;18(1):165. doi: 10.1186/s12891-017-1468-6.

© The Author(s). 2017Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

BACKGROUND:

A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small number of studies available at that time, identified a need for an update as further research emerges. We observed a trend in recent years towards delaying treatment of DDH in the absence of an ossified nucleus. Numerous new publications on this topic encouraged us to update the 2009 meta-analysis.

CONCLUSIONS:

Based on current evidence there does not appear to be a protective effect of the ossific nucleus on the development of osteonecrosis. In contrast to the previous meta-analysis, this update demonstrates that this remains the case irrespective of the grade of osteonecrosis considered relevant. This updated meta-analysis is based on twice as many studies with a higher quality of evidence.

Resumen

ANTECEDENTES:

Un metanálisis concluyó que no hubo efecto de la osificación de la cabeza femoral y la incidencia de osteonecrosis en el tratamiento de la displasia del desarrollo de la cadera (DDH), a menos que se consideraran sólo osteonecrosis grados II-IV. El metanálisis, limitado debido al escaso número de estudios disponibles en ese momento, identificó la necesidad de una actualización a medida que más investigación emerge. En los últimos años se observó una tendencia a retrasar el tratamiento de la DDH en ausencia de un núcleo osificado. Numerosas nuevas publicaciones sobre este tema nos animaron a actualizar el metanálisis de 2009.

CONCLUSIONES:
Basándose en la evidencia actual, no parece haber un efecto protector del núcleo osificante en el desarrollo de la osteonecrosis. En contraste con el metanálisis anterior, esta actualización demuestra que esto sigue siendo el caso independientemente del grado de osteonecrosis considerado relevante. Este metanálisis actualizado se basa en el doble de estudios con una mayor calidad de evidencia.

PMID: 28427427 PMCID:

PMC5397826

DOI:

10.1186/s12891-017-1468-6

Free PMC Article

#núcleo osificante #osteonecrosis #DDH #cabeza femoral #displasia del desarrollo de la cadera