Revista colombiana de obstetricia y ginecologia最新文献

Objective: To provide a conceptual framework for the management of traumatic brain injury (TBI) in pregnant women, integrating pathophysiological foundations, available scientific evidence, and current clinical strategies to support decision-making.

Materials and methods: Based on a hypothetical case that practically illustrates the topic, an explanatory document was developed using a structured narrative review. It describes the physiological changes of pregnancy relevant to TBI, the principles of initial resuscitation, the management of intracranial hypertension, the use of neuromonitoring, obstetric care, and the ethical implications associated with maternal death by neurologic criteria.

Results: Pregnancy involves anatomical and functional adaptations that alter the maternal response to trauma. These modifications affect the airway, hemodynamics, oxygenation, and cerebral autoregulation, necessitating adjustments in clinical management. Key aspects include initial stabilization, control of intracranial hypertension, neuromonitoring, obstetric care, and ethical considerations in scenarios of maternal death by neurologic criteria.

Conclusions: The management of TBI in pregnant patients is a clinical challenge that requires an understanding of maternal physiology and its impact on acute brain injury. Given the lack of specific guidelines and recommendations, those established for the general population should be applied with careful consideration of the physiological changes of pregnancy.

Editorial.

Objective: To describe the incidence, clinical characteristics, and complications of obstetric hysterectomy in a tertiary hospital in Chile from 2021 to 2023.

Methods: Retrospective descriptive cohort study including all women with a gestational age ≥20 weeks or up to six weeks postpartum who underwent obstetric hysterectomy at Santiago Oriente Dr. Luis Tisné Brousse Hospital. Clinical and surgical data were collected from institutional records. Descriptive statistics were performed.

Results: Twenty-five obstetric hysterectomies were performed during the study period. Incidence per 1,000 live births decreased from 3.22 in 2021 to 1.81 in 2023. Postpartum hemorrhage was the main indication (52%), followed by placenta accreta spectrum (32%), infection (12%), and uterine rupture (4%). Supracervical hysterectomy was performed in 52% of cases, and total hysterectomy in 48%; 68% were emergencies. One intraoperative complication (bladder injury) was reported. Postoperative complications occurred in 84% of cases, the most frequent being anemia (84%) and hemorrhagic shock (36%). No significant associations were found between baseline characteristics and complications.

Conclusion: Although its incidence is declining, obstetric hysterectomy remains associated with high morbidity. Strengthening prevention, early detection, and timely multidisciplinary care is essential. Further prospective, multicenter studies are needed to inform strategies to improve maternal outcomes.

Objective: To describe the dispensing of nervous system medications before and during pregnancy, according to the fetal risk category of the drug.

Material and methods: Descriptive drug utilization study of nervous system medications in a historical cohort (2020–2023) of pregnant women enrolled in a health insurance program in Argentina. Dispensed drugs were categorized into two groups: high fetal risk and non-high or unknown risk, based on the classification of selected regulatory agencies. The prevalence of use before and during pregnancy was measured, along with the cumulative incidence of drug discontinuation and initiation during pregnancy.

Results: Among the 6,369 pregnant women included, 4.7% received at least one drug from the evaluated group in the pre-pregnancy period, and 18.8% during pregnancy. This increase was mainly due to paracetamol, which rose from 1.5% to 13.4% during pregnancy. In contrast, the use of anxiolytics (1.6% to 0.7%), antidepressants (0.8% to 0.4%), and antiepileptics (0.7% to 0.4%) decreased. The prevalence of use of high-risk medications declined from 1.5% to 1% during pregnancy, with a cumulative discontinuation incidence of 81.3% and initiation incidence of 0.7%.

Conclusions: The dispensing of nervous system medications with high fetal risk was low in the studied cohort. Identifying the fetal risk associated with each drug is essential to optimize treatment selection for nervous system disorders in pregnant women. Prospective studies are needed to validate medication utilization patterns in the region and their associated fetal and neonatal outcomes.

Objective: This study assesses postnatal women's perceptions of Respectful Maternity Care (RMC), aiming to identify key areas for improvement.

Methods: A cross-sectional quantitative study was carried out in selected urban areas of Bhopal, India. Women aged 18 years and above, who had given birth to a healthy newborn within the previous 42 days, were eligible to participate if they resided in the study area, could understand Hindi or English, and had no cognitive impairments. Estimated sample size was 238 with 77% estimated prevalence, 5% margin of error, and 95% confidence level; 270 women were recruited using purposive sampling from 18 urban wards and 98 Anganwadi centres. Participants were approached directly and interviewed in person using a structured questionnaire and the validated RMC Scale by Sheferaw et al. The primary outcome was the level of perceived respectful maternity care, while independent variables included socio-demographic and obstetric factors such as age, education, place of delivery, and number of antenatal visits. Data were analysed using descriptive statistics and Fisher's exact test due to the non-normal distribution of variables.

Results: Of the 270 participants, 51.2% were aged 25-30 years and 75.3% were Hindus. Most deliveries (57.4%) were normal vaginal deliveries, and 75.6% occurred in government hospitals. Overall, 82.6% of women reported experiencing RMC. Domain-wise, 91% experienced Friendly Care, 93.3% Abuse-Free Care, 79.7% Timely Care, and 87.7% Discrimination-Free Care. Item-wise analysis revealed strengths in provider kindness and clear communication, though about 15-25% of women experienced delays, verbal mistreatment, or felt disrespected. Socioeconomic status had a significant influence in all four domains (p < 0.05), with women from higher income groups reporting more positive experiences. Higher education level was also associated with greater awareness and recognition of discriminatory practices (p = 0.014), Obstetric variables such as mode of delivery (p = 0.031), time of delivery (p = 0.003), antenatal visits (p = 0.017, 0.029), and high-risk pregnancy (p = 0.037) showed domain-specific associations.

Conclusion: Although most women described their childbirth experience as respectful, notable gaps remain in timely and equitable care. Addressing delays and reducing discrimination, particularly in public healthcare settings, are essential to ensuring that all women receive dignified, person-centred maternity care, regardless of their background.

Objective: To describe the prevalence of the different delays in the diagnosis and treatment of cervical cancer, to estimate its incidence in the Department of Meta (Colombia) in recent years, and to conduct an exploratory analysis of potential factors associated with these delays

Material and methods: Cross-sectional study of newly reported cases of cervical cancer in the Epidemiological Surveillance System of the National Institute of Health of Colombia between 2017 and 2023. The proportion of cases in which delays in the care process were identified was described, as well as the annual incidence rate of cervical cancer based on population data.

Results: A total of 824 cases were included. Delays of more than 60 days in the care process were observed in 56.9% of the cases. These delays were attributed to patients in 33.9% of cases due to lack of knowledge or geographic, cultural, or economic barriers; to health services in 36.2% of cases due to lack of timely care; and to insurers in 22.9% of cases due to administrative barriers.

Conclusions: Delays in the care process are common in Meta. These delays particularly affect women over 40 years of age and those residing in rural areas. Analytic and qualitative studies are needed to further explore the underlying causes of these delays.

Editorial.

Letter to the Editor

Objective: To describe a case of secondary gigantomastia following the use of a subdermal contraceptive implant, as well as to evaluate the probable causality of the implant as the cause of this condition.

Materials and methods: We present the case of a 23-year-old nulligravid patient who, one month after the insertion of a subdermal contraceptive implant, began to experience rapid breast enlargement, mastalgia, localized pruritus, back pain, and an anxiety disorder. Complementary studies ruled out a hormonal, oncological, or pregnancy-related etiology. Two months after the insertion of the subdermal implant, it was removed; however, breast gland enlargement continued after its removal. Reduction mammoplasty was required for definitive treatment. The Naranjo algorithm was applied to determine the likelihood of a causal relationship.

Conclusions: To the best of the authors' knowledge, the probable association between gigantomastia and the use of subdermal contraceptives has not been previously described in the literature. It is important to monitor patients with progesterone implants for the development of gigantomastia.