Resultados materno perinatales en la consulta de alto riesgo, SES Hospital de Caldas, 2009-2011.

Resumen

Objetivo: Describir el resultado materno perinatal de las usuarias de la consulta de Alto Riesgo Obstétrico,  SES Hospital de Caldas, atendidas desde septiembre 1 de 2009 hasta el 31 de agosto de 2011; estableciendo  un comparativo con los resultados perinatales de las pacientes no consideradas de riesgo, dadas de alta de la consulta. Materiales y Métodos: Estudio de tipo prospectivo, descriptivo. Para la recolección de la  información se consultaron historias clínicas hospitalarias, obteniendo información telefónica de aquellas  pacientes que no presentaron su parto en la ciudad. Resultados: Se analizan 108 pacientes de la consulta, de las cuales 31 (28,18%) no continuaron en la consulta, por descartarse condiciones de riesgo. De las 77  embarazadas de riesgo, la edad promedio fue 29,1±7,8 años, con frecuencias de embarazo en adolescentes  del 13,15%, y primigestación tardía del 28,94%, el 31,6% eran nulíparas, y el 23,4% tenían antecedente de  aborto previo. Los antecedentes patológicos más significativos fueron: hipotiroidismo, hipertensión arterial  crónica, epilepsia, y preeclampsia-eclampsia. Los motivos de remisión más frecuentes fueron: cesárea previa, edad materna avanzada, sospecha de restricción del crecimiento fetal. No se encontraron diferencias en las  pacientes de bajo y alto riesgo, con respecto a edad, gravidez, escolaridad o procedencia; observándose  mayores frecuencias de bajo peso al nacer, macrosomía, prematurez, parto por cesárea, ingreso a UCI  neonatal y muerte perinatal, en las de alto riesgo. Conclusiones: Deben estandarizarse criterios de remisión  a la consulta de Alto Riesgo Obstétrico ya que en el 38,3% de las pacientes la evaluación inicial los descartó.

Palabras clave:

Atención prenatal

embarazo de alto riesgo

mortalidad perinatal

mortalidad materna

(fuente: DeCs, BIREME)

Prenatal care

high-risk pregnancy

perinatal mortality

maternal mortality

(source: DeCs, BIREME)

Cuidado pré-natal

gravidez de alto risco

mortalidade perinatal

mortalidade materna

(fonte: DeCs, BIREME)

Citas

World Health Organization. Essential elements of obstetric care at first referral level. Geneva: World Health Organization; 1991.

World Health Organization. Estimates of maternal mortality: a new approach by WHO and UNICEF. Geneva: World Health Organization; 1996.

Ministerio de la Protección Social. Guía para la detección temprana de las alteraciones del embarazo. Santafé de Bogotá; 2007.

Murphy DJ, Charlet P. Cohort study of near-miss maternal mortality and subsequent reproductive outcome. Eur J Obstet Gynecol Reprod Biol. 2002;102:173-178.

Dilip R, Kalpalatha K. Critical illness and pregnancy: review of a global problem. Crit Care Clin. 2004;20:555-576.

Prual A. Morbilidad obstétrica grave en los países en desarrollo: de la epidemiología a la acción. Foro de Ginecología. 2001;4:6-9.

Fescina RH, De Mucio B, Díaz Rosello JL, Martínez G, Serruya S, Durán P. Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS. CLAP/SMR. Publicación Científica 1577. 2011.

Pattinson R, Say L, Souza JP, Van den Broek N, Rooney C. On behalf of the WHO Working Group on Maternal Mortality and Morbidity Classifications. WHO maternal death and near-miss classifications. Bull World Health Organ. 2009;87:734.

Souza JP, Cecatti JP, Parpinelli A, Serruya SJ, Amaral E. Appropiate criteria for identification of near-miss maternal morbidity in tertiary care facilities: a cross sectional study. BMC Pregnancy Childbirth. 2007;7:20.

Penney G, Brace V. Near miss audit in obstetrics. Curr Opin Obstet Gynecol. 2007;19:45-150.

Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.

World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach or maternal health. Geneva: World Health Organization; 2011.

Lawton BA, Wilson LF, Dinsdale RA, Rose SB, Brown SA, Tait J, et al. Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICU. Aust N Z J Obstet Gynaecol. 2010;50:346-351.

Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ. “Near-miss” obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod Health. 2005,2:9.

Souza JP, Cecatti JG, Parpinelli MA, Sousa MH, Lago TG, Pacagnella RC, et al. Maternal morbidity and near miss in the community: findings from the 2006 brazilian demographic health survey. BJOG. 2010;117:1586-1592.

Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Belizan JM, Famot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357:1551-1564.

Carroli G, Villar J, Piaggio G, Khan-Neeelofur D, Gülmezoglu M, Mugford M, et al. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet. 2001;357:1565-1570.

World Health Organization. World health statistics. Geneva: World Health Organization; 2013.

Herrera JA. Evaluación del riesgo obstétrico en el cuidado prenatal. Colomb Med. 2002;33:21-25.

Buitendijk SE, Van Enk A, Oosterhout R, Ris M. Obstetrical outcome in teenage pregnancies in the Netherlands. Ned Tijdschr Geneeskd. 1993;137:2536-2540.

Fotso JC, Ezeh A, Oronje R. Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do? J Urban Health. 2008;85:428-442.

D’Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, et al. Preconception and interconception health status of women who recently gave birth to a live-born infant - Pregnancy Risk Assessment Monitoring System (PRAMS). MMWR. 2007;56:1-35.

Phares TM, Morrow B, Lansky A, Barfield WD, Prince CB, Marchi KS, et al. Surveillance for disparities in maternal health-related behaviors - Selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. MMWR. 2004;53:1-13.

Leung NY, Lau AC, Chan KK, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit: a 10-year retrospective review. Hong Kong Med J. 2010;16:18-25.

Stark MA, Brinkley RL. The relationship between perceived stress and health-promoting behaviors in high-risk pregnancy. J Perinat Neonat Nurs. 2007;21:307-314.

Maassen MS, Hendrix MJ, Van Vugt HC, Veersema S, Smits F, Nijhuis JG. Operative deliveries in low-risk pregnancies in the Netherlands: primary versus secondary care. Birth. 2008;35:277-282.

Barber EL, Lundserg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118:9-38.

Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics. 2002;109:399-403.

Muhieddine A, Nassar AH, Usta IM, Melhem Z, Kazma A, Khalil AM. Impact of advanced maternal age on pregnancy outcome. Am J Perinatol. 2002;19:1-7.

Gilbert WM, Nesbitt TS, Danielsen B. Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol. 1999;93:9-14.

Jahromi BN, Husseini Z. Pregnancy outcome at maternal age 40 and older. Taiwan J Obstet Gynecol. 2008;47:318-321.

Refuerzo JS. Impact of multiple births on late and moderate prematurity. Semin Fetal Neonatal Med. 2012;17:143-145.

Olusanya BO. Perinatal outcomes of multiple births in southwest Nigeria. J Health Popul Nutr. 2011;29:639-647.

Sibai BM, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785-799.

Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ. Maternal preeclampsia and neonatal outcomes. J Pregnancy. 2011;2011:214365.

Sibai BM, Caritis SN, Hauth JC, MacPherson C, VanDorsten JP, Klebanoff M, et al. Preterm delivery in women with pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. Am J Obstet Gynecol. 2000;183:1520-1524.

Weindling AM. Offspring of diabetic pregnancy: Short-term outcomes. Semin Fetal Neonatal Med. 2009;14:111-118.

Valero de Bernabé J, Soriano T, Albalajo R, Juarraz M, Calle ME, Martínez D, et al. Risks factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol. 2004;116:3-15.

Keskinoglu P, Bilgic N, Picakciefe M, Giray H, Karakus N, Gunay T. Perinatal outcomes and risk factors of Turkish adolescent mothers. J Pediatr Adolesc Gynecol. 2007;20:19-24.

Kurth F, Bélard S, Mombo-Ngoma G, Schuster K, Adegnika AA, Bouyou-Akotet MK, et al. Adolescence as risk factor for adverse pregnancy outcome in Central Africa. A cross-sectional study. PLoS One. 2010;5:e14367.

Shuaib AA, Frass KA, Al-Harazi AH, Ghanem NS. Pregnancy outcomes of mothers aged 17 years or less. Saudi Med J. 2011;32:166-170.

Miller DA. Is advanced maternal age an independent risk factor for uteroplacental insufficiency? Am J Obstet Gynecol. 2005;192(6): 1974-1980.

Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988;72:108-112.

Matalon S, Sheiner E, Levy A, Mazor M, Wiznitzer A. Relationship of treated maternal hypothyroidism and perinatal outcome. J Reprod Med. 2006;51:59-63.

Catov JM, Nohr EA, Olsen J, Ness RB. Chronic hypertension related to risk for preterm and term small for gestational age births. Obstet Gynecol. 2008;112:290-296.

Sucak A, Acar K, Celen S, Danisman N, Sucak GT. Outcome of pregnancies in women with thrombophilic disorders. J Obstet Gynaecol. 2010;30:847-851.

Boulet SL, Alexander GR, Salihu HM, Pass MA. Macrosomic births in the United States: determinants, outcomes and proposed grades of risk. Am J Obstet Gynecol. 2003;188:1372-1378.

Al-Suleiman SA, Qutub HO, Rahman J, Rahman MS. Obstetric admissions to the intensive care unit: a 12-year review. Arch Gynecol Obstet. 2006;274:4-8.

Richa F, Karim N, Yazbeck P. Obstetric admissions to the intensive care unit: an eight-year review. J Med Liban. 2008;56:215-219.

Anwari JS, Butt AA, Al-Dar MA. Obstetric admissions to the intensive care unit. Saudi Med J. 2004;25:1394-1399.

Mirghani HM, Hamed M, Ezimokhai M, Weerasinghe DS. Pregnancy-related admissions to the intensive care unit. Int J Obstet Anesth. 2004;13:82-85.

Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol. 2005;193:1923-1935.

Smith GC, Fretts RC. Stillbirth. Lancet. 2007;370:1715-1725.

Smith GC. Predicting antepartum stillbirth. Clin Obstet Gynecol. 2010;53:597-606.