Placenta previa: factores de riesgo e impacto en la morbimortalidad materno-perinatal en Bogotá, Colombia

Introducción: La placenta previa puede causar hemorragias durante la segunda mitad del embarazo y comprometer la salud de la madre y del feto. Conocer los factores de riesgo asociados permite identificar precozmente a las gestantes con alto riesgo de placenta previa. Objetivo: Describir los factores de riesgo de placenta previa en una muestra de gestantes atendidas en Bogotá D.C., Colombia, así como su morbimortalidad materna y perinatal. Materiales y métodos: Estudio descriptivo retrospectivo. Se incluyeron 17 gestantes diagnosticadas con placenta previa e ingresadas a la Unidad de Alto Riesgo Obstétrico de un hospital de tercer nivel de atención entre 2013 y 2017. Se revisaron las historias clínicas para recoger datos sobre factores de riesgo de placenta previa y características clínicas y sociodemográficas. En el análisis descriptivo, se calcularon medias y desviaciones estándar y frecuencias absolutas y relativas para variables cuantitativas y cualitativas, respectivamente. Resultados: Los factores de riesgo más frecuentes fueron ≥4 embarazos (64,70%), edad materna >35 años (29,41%) e historia de aborto espontáneo (29,41%). La morbilidad materna fue superior a la fetal: tres pacientes precisaron transfusión de hemoderivados y otra fue sometida a histerectomía subtotal, mientras que no se registraron complicaciones perinatales, a excepción de un mortinato. Conclusiones: Los antecedentes de aborto espontáneo, los embarazos ≥4 y la edad materna >35 años fueron los factores de riesgo más frecuentes. Además, el grado de complicaciones materno-perinatales no dependió del tipo de placenta previa. Conocer qué gestantes tienen mayor riesgo de placenta previa como resultado de la identificación temprana de estos factores de riesgo permite un mejor abordaje clínico, reduciendo las tasas de morbimortalidad tanto en la madre como en el niño.Introduction: Placenta previa can cause bleeding during the second half of pregnancy and may compromise the health of both the mother and the fetus. Knowing the associated risk factors allows for the early identification of pregnant women at high risk of placenta previa. Objective: To describe the risk factors for placenta previa in a sample of pregnant women treated in Bogotá D.C., Colombia, as well as their maternal and perinatal morbidity and mortality. Materials and methods: Retrospective descriptive study. 17 pregnant women diagnosed with placenta previa and admitted to the High Obstetric Risk Unit of a tertiary care hospital between 2013 and 2017 were included. Medical records were reviewed to collect data on risk factors for placenta previa and clinical and sociodemographic characteristics. In the descriptive analysis, means and standard deviations and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Results: The most frequent risk factors were ≥4 pregnancies (64.70%), maternal age >35 years (29.41%), and history of miscarriage (29.41%). Maternal morbidity was higher than fetal morbidity: three patients required transfusion of blood products, and another underwent a subtotal hysterectomy, while no perinatal complications were reported, with the exception of one stillbirth. Conclusions: A history of miscarriage, ≥4 pregnancies, and maternal age >35 years were the most frequent risk factors. Furthermore, the degree of maternal-perinatal complications did not depend on the type of placenta previa. Knowing which pregnant women are at higher risk of placenta previa as a result of the early identification of these risk factors allows for a better clinical approach, reducing morbidity and mortality rates in both the mother and the child

Ductus venosus as a marker of fetal growth in first trimester in a population of Colombian pregnant women

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth

Revisión de la hemorragia feto-materna durante la gestación y el parto

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina, Departamento de Ginecología y Obstetricia. Fecha de lectura:16 de Diciembre de 2011

Biometry and pathological ultrasound findings in multiple pregnancies

Resumo Objectives: to determine the prevalence of pathological findings according to the type of chorionicity in pregnancies in two institutions in Bogotá, Colombia. Methods: descriptive, retrospective, cohort study. Biometric variables were calculated, and pathological findings were evaluated according to the type of chorionicity in multiple pregnancies. Statistical characterization was performed with absolute frequencies, calculation of relative frequencies in qualitative variables, standard deviation measures, median and interquartile range. In addition, a descriptive analysis of the information was carried out. Results: 528 studies were carried out in 141 pregnant women, 98.5% (n = 139) twins and 1.4% (n = 2) triplets. A prevalence of 35.4% of fetal complications was calculated. The most frequent was fetal growth restriction (p=0.37). According to each type of chorionicity, fetal growth restriction was presented in 50% (1/2) of the trichorionics, 16.6% (7/42) of the monochorionics, and 11.3% (11/97) of the dichorionics. Conclusion: fetal growth restriction was the most common finding, both in trichorionics, monochorionics and dichorionics pregnancies

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2