Revista Colombiana de Obstetricia y Ginecologia最新文献

Objectives: To describe the frequency and factors associated with non-adherence to prenatal follow-up in pregnant women 35 years of age or older in the department of Cauca, Colombia, between 2016 and 2018.

Materials and methods: Cross-sectional, descriptive observational study of records of pregnant women between 35 and 41 years of age affiliated to the Cauca Indigenous Association Health Benefit Plan Management Organization-I (EAPB AIC-I) and registered in the prenatal care program, between 2016 and 2018. Duplicate records and records with incomplete information were excluded. Sociodemographic and clinical variables, as well as program outcomes, were analyzed using descriptive statistics. Odds ratios and their confidence intervals were calculated.

Results: In 1016 patients between 35 and 41 years of age, a frequency of 61.3 % of non-adherence to at least six prenatal visits was found. History of abortion (adjusted OR: 0.46; 95 % CI 0.33-0.64) and pregnancy of five or more (adjusted OR: 3,22; IC 95 % 1,50-6,91) were the associated factors.

Conclusions: Non-adherence to prenatal care by pregnant women of 35 years or more affiliated to the Cauca EAPB AIC-I is high. Further qualitative studies are needed to examine the cultural and social factors present in these communities that may affect adherence to prenatal monitoring, together with prospective studies to confirm the exploratory analysis of factors associated with non adherence. Insurance organizations in the subsidized regime should be called upon to conduct promotion activities in these communities in order to improve adherence.

Objectives: To describe the prevalence of symptoms of depression and worry affecting pregnant women during the COVID-19 pandemic.

Material and methods: Descriptive crosssectional study that included pregnant women with access to a technological device (mobile phone, computer or tablet) and Internet connection, living in Antioquia, Colombia. Women with literary and technological illiteracy were excluded. An online survey was conducted to gather information about sociodemographic and baseline clinical conditions and the main concerns caused by the pandemic. Additionally, the Edinburg Depression Scale (EPDS) was applied in order to measure the risk of depression. The Jamovi software was used for data processing and statistical analysis.

Results: Overall, 345 pregnant women between 15 and 44 years of age were surveyed, with the finding of a 30.4 % prevalence of the risk of depression. Domestic violence and absence of a support network were identified in 4.9 % and 8.4 % of cases. The major sources of worry were the fear of being separated from their babies on the day of birth, the possibility of having to be alone during childbirth, and the fear of contagion due to potential effects on the fetus or the newborn.

Conclusions: Depression symptoms have been frequent among pregnant women during the COVID-19 pandemic. It is important to inquire about stress factors and depression symptoms during prenatal visits, childbirth and the postpartum period. Additional local studies are needed to assess other mental health disorders that may have increased during the COVID-19 pandemic.

Objectives: To describe maternal and perinatal outcomes in pregnant women with confirmed COVID-19 infection in a hospital in Comayagua, Honduras.

Material and methods: Descriptive case series study that included symptomatic pregnant women who came or were referred between March 1, 2020 and March 31, 2021 to a public referral institution, with PCR-confirmed diagnosis of COVID-19 infection. Sociodemographic, obstetric considerations, infection severity, length of hospital stay, and maternal and perinatal complications were the measured variables. The frequency of COVID-19 infection and the maternal and perinatal outcomes of these gestations were estimated. A descriptive analysis was performed.

Results: A total of 2258 pregnant women were seen during the study period. Of them, 23 who met the selection criteria were included, for a frequency of COVID-19 infection of 1.01 %. The study population characteristically consisted of young women living in common-law marriage. Thirteen patients were managed as outpatients because of a mild clinical condition, and 10 were hospitalized. The pregnant women managed as outpatients were delivered by cesarean section (76.9 %) due to dissatisfactory fetal status at a gestational age of 37 weeks or more, with 3 pre-term delivery cases (36 weeks) documented. Of the hospitalized patients, one had a miscarriage and nine were delivered due to an obstetric indication. There was one case of premature birth, and one maternal (4 %) and one neonatal death were documented.

Conclusions: During the study period, 1% of the pregnant women had COVID-19 infection at the Santa Teresa Hospital in Comayagua. Further studies analyzing the maternal and perinatal impact of COVID-19 infection in the Central American region are required.

Objectives: To determine the predictive performance of fetal growth restriction by Maternal Fetal Medicine Society (MFMS) definition of ultrasound, the Delphi consensus (DC) and the Barcelona Fetal Medicine (BFM) criteria for adverse perinatal outcomes, and to identify whether there is an association between the diagnosis of fetal growth restriction (FGR) and adverse perinatal outcomes.

Material and methods: A retrospective cohort study was conducted including women with singleton pregnancies between 24 and 36 weeks of gestation seen at the maternal fetal medicine unit for ultrasound assessment of fetal growth and delivery care in a public referral hospital in Popayán, Colombia. Pregnancies with ultrasound findings of congenital abnormalities were excluded. Convenience sampling was used. Sociodemographic and clinical variables were measured on admission; additional variables were gestational age, FGR diagnosis and adverse composite perinatal outcome. The predictive ability of three fetal growth restriction diagnostic criteria for poor perinatal outcomes was analyzed and asociation between FGR and adverse perinatlal outcomes.

Results: Overall, 228 pregnant women with a mean age of 26.8 years were included; FGR prevalence according to the three criteria was 3.95 %, 16.6 % and 21.9 % for DC, BFM and MFMS, respectively. None of the criteria resulted in an acceptable area under the curve for the prediction of the composite adverse neonatal outcome; FGR diagnosis by DC and MFMS were associated with adverse perinatal outcomes with a RR of 2.6 (95 % CI: 1.5-4.3) and 1.57 (95 % CI: 1.01-2.44) respectively. No association was found for BFM RR: 1.32 (95 % CI: 0.8-2.1).

Conclusions: Given a positive result for FGR, the Delphi method is significantly associated with adverse perinatal outcomes. The proportion of false negative results for a poor perinatal outcome is high for the three methods. Prospective studies that reduce measurement and attrition bias are required.

Objectives: To provide clinical recommendations based on evidence for the the prevention and management of HDP in EsSalud.Methods: A CPG for the the prevention and management of HDP in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 8 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and—when it was considered pertinent—primary studies were searched in PubMed y Central during 2021. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and flowcharts for the prevention, management and follow-up. Finally, the CPG was approved with Resolution 112-IETSI-ESSALUD-2021.Results: This CPG addressed 8 clinical questions, divided into three topics: prevention, management and follow-up of the HDP. Based on these questions, 11 recommendations (6 strong recommendations and 5 weak recommendations), 32 points of good clinical practice, and 3 flowcharts were formulated.Conclusions: The main recommendations in the guideline are the use of magnesium sulfate for the treatment of severe pre-eclampsia and eclampsia. The guideline must be updated in three years’ time.

Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used.Materials and Methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and STIs were excluded. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to post-procedural day 7 were the measured variables. A descriptive analysis was carried out.Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother’s health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7.Conclusions: MVA is a safe procedure which was not associated with complications within the first seven post-VIP days in the studied patients. Prospective studies to assess the safety and cost of the different VIP options are required.