Epidural anesthesia in repeated cesarean section.

Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112)in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method

Characteristics of the obstetric patient in critical stage in Cienfuegos province.

Fundaments: The critically ill patient has an important place in the assessment of the quality of the medical assistance since around 5 % of all females who reach a full term pregnancy without potential risk factors, become this kind of patients due to different causes. Objective: To characterize the obstetric patient in a critical state in the period that covers January 1 st 1991- December 31 st 2001 in Cienfuegos province. Method: Correlational Descriptive-retrospective study carried out at the ICU of the Clinico-Surgical University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in a 10 year period and includes the 323 critically ill obstetric patients who were admitted at that ward. The variables under study were: mother´s age parity, type of labor, past history, surgical procedures, cause of admission at the ICU, patients state at discharge and cause of death. Results: 59,1 % of the patients were aged 20-29 years . The patient´s past history was related to hypertension and bronchial asthma. The procedure most widely used was the cesarean section followed by hysterectomy as emergency. The principal cause of admission at the ICU was hypovolemic shock, pre eclampsia - eclampsia and sepsis. The major amounts of patients were discharged alive. Only 8 % died. There was a predominance of direct maternal death, highlighting among them haemorrhage and hypertension in pregnancy.</p

Post operatory analgesia in caesarean surgery.

Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment

Caracterización clínico-epidemiológica de las pacientes obstétricas ingresadas en la Unidad de Cuidados Intensivos. Cienfuegos 2014-2016

Introducción: La morbilidad y la mortalidad materna tienen repercusiones para toda la familia y un impacto que se mantiene a través de generaciones.Objetivo: Caracterizar clínico y epidemiológicamente las pacientes obstétricas ingresadas en la Unidad de Cuidados Intensivos Polivalentes.Diseño metodológico: Estudio descriptivo, retrospectivo. La muestra quedó conformada por 248 pacientes obstétricas admitidas en la Unidad de Cuidados Intensivos Polivalentes desde el 1ro de enero 2014 al 31 de diciembre 2016. Variables de estudio: edad, paridad, estado materno, tipo de parto, causas de ingreso, histerectomía obstétrica y estado al egreso. Los resultados se expresaron en tablas de números y por ciento. Se aplicaron estadígrafos de chi cuadrado (p<0,05), RR con IC del 95%.Resultados: Predominó la edad de 20 a 34 años (73,4%), multíparas (51, 6 %) y puérperas (68,5 %). El tipo de parto más frecuente fue la cesárea (80 %). Las principales causas de ingreso fueron: preeclampsia–eclampsia (25,4%), hemorragia (22,2%), sepsis (12,5%) y enfermedad tromboembólica (7,3%); 98,4% de las pacientes no necesitaron ventilación mecánica, 26,6% se egresó con secuelas.Conclusiones: Las edad de 35 años y más eleva el riesgo de presentar morbilidad materna extremadamente grave. Las principales causas de ingreso fueron  preeclampsia, hemorragia, sepsis y enfermedad tromboembólica. La mortalidad materna relacionada con el ingreso en la Unidad de Cuidados Intensivos Polivalentes fue baja

Hemofilia adquirida en el postparto. Presentación de un caso

Las hemorragias del periparto son la principal causa de morbilidad materna extremadamente grave y de muerte materna en Cuba y en el mundo. La hemofilia A adquirida es un trastorno hemorrágico poco frecuente, caracterizado por la presencia de anticuerpos contra el factor VIII (FVIII) circulante. Se presenta el caso de una gestante de 36 años de edad, con embarazo a término, que tiene parto eutócico y presenta manifestaciones hemorrágicas en el postparto inmediato, secundarias a hematoma de la rafia que requiere de hemoterapia. Luego presenta hematoma del miembro superior derecho secundario a accidente vascular que requiere de reparo quirúrgico. La evolución tórpida del puerperio, caracterizada por hemorragia mantenida por la rafia y por el brazo intervenido, hace sospechar la presencia de un trastorno hematológico. Se constata una disminución del factor FVIII, que implica el diagnóstico de hemofilia A adquirida, se impone tratamiento con concentrado de factor VIIa recombinante (FVIIar) y ciclofosfamida. La evolución posterior fue favorable, la paciente se egresa sin secuelas