Perinatologia y Reproduccion Humana最新文献

The Self-Care Model of Perinatal Nursing at the National Institute of Perinatology (INPer) Mexico has as theoretical foundation to the General Theory of Self-Care and as methodological-practical axis the steps of the nursing method. With a close theoretical and practical relationship, the implementation of the model requires nurses specialized in perinatal care, who perform the care favoring the participation of the woman and family for the optimal development of the reproductive process, through the formation of a bond of Patient-family-nurse confidence. In the INPer is implemented with a range of 7 programs according to the reproductive process, such as: Self-care of sexual and reproductive health of adolescents, Self-care of the pregnant teenager, Risk detection and pre-pregnancy self-care in couples, Prenatal self-care in pairs, Birth care in pairs, Care and support for the couple during perinatal loss and posnatal family self-care with trinomial follow-up up to 28 days after birth. The model includes the breakdown of care that the perinatal nurse practitioner must provide to the people in each of the 7 specific programs with a self-care approach in pairs to strengthen the family bond, seeking the reduction of risks from the pre-gestational stage, care (not medicalized) in labor and delivery; privileging the physiological process in adherence to human rights, considering each one of the universal requirements of self-care.

Objective

To compare the efficacy of intravenous magnesium sulphate with isoxsuprine hydrochloride in the treatment of threatened pre-term labour.

Materials and methods

A total of 82 patients with a gestational age between 24 and 34 weeks and threatened pre-term labour were selected to receive intravenous magnesium sulphate (Group A) or intravenous isoxsuprine hydrochloride (Group B). An analysis was performed on the time of ceasing of uterine contractions and maternal adverse effects.

Results

Tocolysis was successful in the first 24 hours in 61.0% of patients in Group A and 61.0% in patients of Group B (P = ns). After 7 days of treatment, 36.6% of patients in Group A and 36.6% of patients in Group B still were without contractions (P = ns). A delay in delivery over 34 weeks was obtained in 19.5% of patients treated with magnesium sulphate and 26.8% in patients treated with isoxsuprine hydrochloride (P = ns). Nausea, tremor, and vomiting were more frequent in Group A, while tremors and sweating were more frequent in Group B (P = ns).

Conclusion

Magnesium sulphate is as effective as isoxsuprine hydrochloride for tocolysis in threatened pre-term labour.

Patent ductus arteriosus is common in preterm newborns, and has an incidence inversely proportional to gestational age. The aim of this study is to present the clinical features of a neonatal population, before and after surgical ligation of ductus arteriosus.

Material and methods

This is a retrospective, descriptive study conducted on patients admitted to a Neonatal Intensive Care Unit from January 2011 to January 2015. The patients were classified into three groups: Group 1, including patients who underwent surgical ligation between the 8th and 14th day of life (9 patients); Group 2, patients who underwent surgical ligation from the 15th day to the 21st day of life (28 patients), and Group 3, patients who underwent surgical ligation after 21 days of life. Reported variables were: ductus size, weight, gestational age, weight on day of surgical intervention, days of life at diagnosis, and associated morbidity.

Results

Diagnosis was made early for Group 1, at 6.1 days of life. In the majority of cases, surgical ligation was secondary. Growth velocity increased in Group 3 after surgical ligation, reaching 15.6 g/kg/day, with a previous growth velocity of 12.6 g/kg/d. Mean arterial pressure increased after surgical ligation by 4.6, 7.7, and 6.5 mmHg in Groups 1, 2, and 3, respectively. Patients who were mechanically ventilated before surgical ligation were extubated after a mean of 10.5 days.

Conclusion

Diagnosis was established within a mean of 6.1 days. Almost all (92.8%) of cases, surgical ligation was secondary (after failure of medical treatment). Growth velocity after surgical ligation only increased in Group 3.

Introduction

In Latin America approximately 1,125,000 women of childbearing age are infected with Trypanosoma cruzi.

Methodology

A review of the literature was carried out on the immunology of congenital Chagas’ disease.

Results

In this country, T. cruzi TcI predominates. IFN-γ is the key cytokine in infection control. The macrophages of infected women who transmit the disease are less activated and release less TNF-α than those of infected women who do not transmit the disease. They also have a lower capacity to produce IFN-γ in response to T. cruzi. Severe parasitaemia favours congenital infection.

Conclusions

There are different immunological factors that involve the parasite, the maternal and foetal immune system, and the placental barrier.

Neonatal Respiratory Distress Syndrome (RDS) is caused by pulmonary surfactant deficiency. The initial respiratory support is currently nasal continuous positive airway pressure (Nasal CPAP), and is associated with the decreased need of intubation and mechanical ventilation. The INSURE procedure (Intubation-Surfactant-Extubation) for surfactant administration, is associated with a lower need of supplementary oxygen at 28 days of life. The aim of this study is to identify the frequency of failure of the INSURE procedure, defined as the need for re-intubation in the following 72 hours, the risk factors and neonatal outcomes associated with the failure of this procedure.

Material and methods

An observational, retrospective, analytical study was conducted that included all newborns with birth weight <1500 g, and in whom surfactant was administered using the INSURE procedure, between 1 March 2011 and 31 March 2014.

Results

A total of 183 cases were managed using the INSURE procedure, finding that 38.8% of the failures were due to the technique, with the main cause being apnoea. Risk factors found were, a lower gestational age, lower birth weight, and a higher grade of respiratory distress prior to using INSURE. Within the neonatal outcomes, a significant association was found with the increased use of mechanical ventilation, days of supplemental oxygen, and bronchopulmonary disease, and mortality in the failure group.

Conclusion

An increased risk of failure in the INSURE procedure was associated with lower gestational age and lower birth weight.

Objective

To compare plasma fetuin-A concentrations in patients with preeclampsia and healthy normotensive pregnant women.

Materials and method

A total of 100 patients were selected. Fifty patients with preeclampsia were selected as cases (Group A), and a control group selected with the same age and body mass index as the study group that consisted of 50 healthy normotensive pregnant women (Group B). Blood samples were collected from all patients before labour, and immediately after diagnosis in Group B to determine plasma fetuin-A concentrations.

Results

There was a statistically significant difference in plasma fetuin-A concentrations between patients in group A (279.1 ± 29.1 pg/ml) and patients in group B (328.1 ± 37.2; p<.001). There was no significant correlation with values of systolic and diastolic blood pressure (p= ns). Significant correlations were found between fetuin-A and aspartate transaminases (p<.05). A cut-off value of 300 pg/ml had a value under the curve of 0.86, sensitivity of 79.3%, specificity of 70.7%, a positive predictive value of 65.7%, and a negative predictive value of 82.6%.

Conclusion

Patients with preeclampsia had significantly higher plasma concentrations of fetuin-A when compared with healthy normotensive pregnant women.

Introduction

Gastroschisis is a congenital abdominal wall defect, with an incidence that varies between 1.6 to 4.6 cases per 10,000 live births. It is located to the side of the umbilical cord, has no sac and has a normal insertion umbilical cord.

Material and methods

A retrospective, descriptive study of cases born in the Instituto Nacional de Perinatología between 1996 and 2010. A record was made of the frequency of demographic factors, surgical management, size of the defect and organs involved, morbidity, oral feeds, time to full feed, and associated malformations.

Results

There were 228 cases, with an incidence 30.5 × 10,000 live births. The majority (55%) of the mothers were less than 20 years old, and 9% were younger than 15 years old. There was prenatal diagnosis in 93%, 77% weighed 2500 g or less, and mortality was 6%. The most frequent associated morbidity was sepsis in 28%, followed by cholestasis in 16%, and short bowel syndrome in 5%. Only 2% had bronchopulmonary dysplasia. A silo was applied at 22 hours of life, with 86% requiring assisted ventilation for a mean of 9 days. Enteral feeding began at 17 days, and full feeding at 22 days of life.

Conclusion

Gastroschisis is a frequent abdominal wall defect that must be treated by a multidisciplinary team at a third level hospital. Our results are similar those reported in international literature.

Objective

To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the management of the third phase of labour.

Materials and method

Patients to be treated with rectal misoprostol (group A) or intramuscular oxytocin (group B) were selected and randomised to attend delivery at the Central Hospital ‘Dr. Urquinaona’, Maracaibo, Venezuela. An evaluation was made of the general characteristics, changes in haemoglobin and haematocrit values, post-partum blood loss, and adverse effects.

Results

Complete data were obtained from 392 patients (195 from Group A and 197 from Group B), who were included in the final analysis. No significant differences were found between the groups with respect to the general characteristics (P = ns). No statistically significant differences were found in the mean values of haemoglobin and pre- and post-partum haematocrit (P = ns). There was a significant decrease in the duration of the third phase of labour in Group A compared to patients in Group B (P < .001). The estimated blood loss in patients in Group A was significantly lower (P < .05). It was observed that the patients in Group A had a tendency to a lower use of additional uterotonics (P < .05). Patients in Group A presented with a higher frequency of headache and shivering compared to patients in Group B (P < .05).

Conclusions

Misoprostol administered rectally is effective in minimising blood loss and duration of the third phase of labour.