RESUMO
Se realizó un estudio de tipo epidemiológico, observacional, analítico, longitudinal y prospectivo, de 44 gestantes con parto a las 42 semanas o más, atendidas en el Hospital Ginecoobstétrico Docente "Dra. Nelia I. Delfín Ripoll" del municipio de Palma Soriano, en Santiago de Cuba, de enero a diciembre de 2013, con vistas a caracterizarles clínica y epidemiológicamente y determinar la repercusión del embarazo prolongado en el binomio madre-hijo. Entre los resultados sobresalientes figuraron: la alta incidencia de la fecha no confiable de la última menstruación en el grupo de nulíparas (51,9 %), el parto por cesárea (29,5 %), cuya principal causa fue la inducción fallida (38,4 %), seguida de la desproporción céfalo-pélvica (23,1 %); el síndrome de aspiración meconial como complicación en los recién nacidos (29,5 %), y la atonía uterina y el sangrado (6,8 %, respectivamente) como complicaciones en las madres. Pudo concluirse que en la serie, el embarazo prolongado generalmente cursó en gestantes con fecha confiable de la última menstruación, el indicador de cesárea primitiva se incrementó y fue más frecuente la presencia de complicaciones en los recién nacidos que en las madres.
An epidemiological, observational, analytic, longitudinal and prospective study of 44 pregnant women with childbirth date at 42 weeks or more, assisted in "Dr. Nelia I. Delfín Ripoll" Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba municipality was carried out from January to December, 2013, with the objective of characterizing them clinically and epidemiologically and to determine the influence of prolonged pregnancy in the binomial mother-son. Among the excellent results there were: the high incidence of non reliable date of the last menstruation in the nulliparous group (51.9%), the childbirth through caesarean section (29.5%) whose main cause was the failed induction (38.4%), followed by the cephalopelvic disproportion (23.1%); the syndrome of meconium aspiration as complication in the newborns (29.5%), and the uterine atony and bleeding (6.8%, respectively) as complications in the mothers. It could be concluded that in the series, the prolonged pregnancy generally took place in women with reliable last menstruation date, the indicator of primitive cesarean section was increased and the presence of complications was more frequent in the newborns than in mothers.
Assuntos
Inércia Uterina , Gravidez Prolongada , Síndrome de Aspiração de Mecônio , CesáreaRESUMO
La oxigenación de membrana extracorpórea se considera una terapia de rescate y soporte vital compleja, con beneficios en enfermedades cardiorrespiratorias durante el periodo neonatal, que cumple con las características de ser reversible en recién nacidos mayores de 34 semanas. El criterio de selección de los pacientes y el momento oportuno en que se indica son críticos para el resultado final, si bien las nuevas alternativas de manejo en falla respiratoria hipoxémica en recién nacidos a término y casi a término han generado una disminución de su uso, excepto en la hernia diafragmática, que continúa siendo una enfermedad compleja donde podría tener alguna aplicabilidad. Si bien nuestra experiencia está iniciándose, el entrenamiento constante hará de la oxigenación de membrana extracorpórea una opción para pacientes complejos en quienes la terapia máxima fracasa. Se hace un informe de los primeros casos neonatales por falla respiratoria hipoxémica manejados en la Fundación Cardiovascular de Colombia.
Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Even though our experience is beginning, constant training will make of extracorporeal membrane oxygenation an option for complex patients in whom maximum therapy fails. This is a report of the first neonatal cases of hypoxemic respiratory failure managed at Fundación Cardiovascular de Colombia.
Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Oxigenação por Membrana Extracorpórea/métodos , Hérnias Diafragmáticas Congênitas/complicações , Síndrome de Aspiração de Mecônio/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Insuficiência Respiratória/terapia , Infecções Bacterianas/prevenção & controle , Colômbia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Evolução Fatal , Hérnias Diafragmáticas Congênitas , Seleção de Pacientes , Avaliação de Programas e Projetos de Saúde , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Insuficiência Respiratória/etiologiaRESUMO
Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Even though our experience is beginning, constant training will make of extracorporeal membrane oxygenation an option for complex patients in whom maximum therapy fails. This is a report of the first neonatal cases of hypoxemic respiratory failure managed at Fundación Cardiovascular de Colombia.