Especialización en Medicina Materno-Fetalhttps://repository.urosario.edu.co/handle/10336/12852024-03-29T10:09:25Z2024-03-29T10:09:25Z131Asociacion de la curva de crecimiento y los resultados perinatales en pacientes sin factores de riesgoCabas Córdoba, Carlos Albertohttps://repository.urosario.edu.co/handle/10336/398522023-10-18T14:42:56Zdc.title: Asociacion de la curva de crecimiento y los resultados perinatales en pacientes sin factores de riesgo
dc.description.abstract: Introduction: There is a knowledge gap in the evaluation of fetal growth according to its growth potential, especially in the Colombian population and with perinatal results. Most studies are based on the evaluation of fetuses with maternal and fetal risk factors and do not analyze fetuses and their mothers without risk factors. Objectives: To determine the association between the values of the growth curve and the perinatal results in pregnancies without risk factors. Methodology: Historical retrospective cohort study in pregnant women and their fetuses, without risk factors, who received care in one or more of the Maternal-Fetal Medicine Units of Clinica Colsanitas between 2017 and 2019, who had at least two or more obstetric ultrasounds. Results: In the study cohort, the mothers ranged in age from 15 to 43 years, with an average of 30.0±6.3 years, an average gestational age at delivery of 38.7±0.97 weeks, and 1.8% of the newborns had preterm delivery. Weight percentiles were evaluated by groups of weeks to determine Growth Potentials. No significant association was found between the Growth Potential with the percentile variation of weight with birth weight (p>0.05). It was not possible to make comparisons between the Growth Potential with the need for a NICU or low APGAR at 1 minute (only one case was presented) or at 5 minutes (no cases). Conclusion: There is no association between fetal growth potential, with the expected values of the weight percentile without risk factors. The growth potential was found to be directly related to the weight of the newborn.
dc.description: Introducción: Existe un vacío de conocimiento en la evaluación del crecimiento fetal de acuerdo con su potencial de crecimiento, en especial en población colombiana y con resultados perinatales. La mayoría de los estudios se basan en la evaluación de fetos con factores de riesgo maternos y fetales y no analizan fetos y sus madres sin factores de riesgo. Objetivos: Determinar la asociación entre los valores de la curva de crecimiento y los resultados perinatales en gestaciones sin factores de riesgo. Metodología: Estudio de cohorte retrospectivo histórica en mujeres gestantes y sus fetos, sin factores de riesgo, que recibieron atención en una o más de las unidades de medicina maternofetal de Clínica Colsanitas entre 2017 y 2019, que contaron con mínimo dos o más ecografías obstétricas. Resultados: En la cohorte de estudio se encontraron en las madres un rango de edad entre 15 y 43 años, con un promedio 30.0±6.3 años, una edad gestacional promedio al parto de 38.7±0.97 semanas y un 1.8% de los recién nacidos tuvieron parto pretérmino. Se evaluaron los percentiles de peso por grupos de semanas para determinar los Potenciales de Crecimiento. No se encontró asociación significativa entre el Potencial de Crecimiento con la variación de percentiles de peso con peso al nacer (p>0.05). No se logró hacer comparaciones entre el Potencial de Crecimiento con necesidad de UCIN ni APGAR bajo al 1er minuto (solo se presentó un caso) ni a los 5 minutos (sin casos). Conclusión: No existe una asociación entre el potencial de crecimiento fetal, con los valores esperados del percentil de peso sin factores de riesgo. El potencial de crecimiento se encontró relacionado directamente con el peso del recién nacido.
Cabas Córdoba, Carlos AlbertoIntroduction: There is a knowledge gap in the evaluation of fetal growth according to its growth potential, especially in the Colombian population and with perinatal results. Most studies are based on the evaluation of fetuses with maternal and fetal risk factors and do not analyze fetuses and their mothers without risk factors. Objectives: To determine the association between the values of the growth curve and the perinatal results in pregnancies without risk factors. Methodology: Historical retrospective cohort study in pregnant women and their fetuses, without risk factors, who received care in one or more of the Maternal-Fetal Medicine Units of Clinica Colsanitas between 2017 and 2019, who had at least two or more obstetric ultrasounds. Results: In the study cohort, the mothers ranged in age from 15 to 43 years, with an average of 30.0±6.3 years, an average gestational age at delivery of 38.7±0.97 weeks, and 1.8% of the newborns had preterm delivery. Weight percentiles were evaluated by groups of weeks to determine Growth Potentials. No significant association was found between the Growth Potential with the percentile variation of weight with birth weight (p>0.05). It was not possible to make comparisons between the Growth Potential with the need for a NICU or low APGAR at 1 minute (only one case was presented) or at 5 minutes (no cases). Conclusion: There is no association between fetal growth potential, with the expected values of the weight percentile without risk factors. The growth potential was found to be directly related to the weight of the newborn.Desenlaces maternos y perinatales asociados a infección por Sars Cov2 en pacientes de clínicas Colsanitas, 2020 -2021Castaño Toro, Yaisa Maritzahttps://repository.urosario.edu.co/handle/10336/380662023-02-15T08:08:44Zdc.title: Desenlaces maternos y perinatales asociados a infección por Sars Cov2 en pacientes de clínicas Colsanitas, 2020 -2021
dc.description.abstract: COVID 19 is a severe and acute respiratory syndrome, triggered after infection by SARS Cov2 or Coronavirus, which is characterized by a torpid progression in the mother and the child. Objective: To identify the factors of maternal and perinatal morbidity and mortality during pregnancy related to SARS CoV2 infection. Materials and methods: A retrospective, descriptive, cross-sectional observational study was carried out, that included patients treated at the Colsanitas clinics from March 1, 2020 to August 31, 2021, with a diagnosis of SARS Cov2 infection. Patients with incomplete data and loss to follow-up were excluded. Maternal and perinatal morbidity and mortality variables such as the proportion of maternal, fetal, and neonatal deaths, the proportion of patients with preeclampsia, sepsis, metabolic diseases, and complications were analyzed. Results: Out of the 471 patients included in the study, 1.1% had a serious infection. 62% ended the pregnancy by caesarean section, 4% presented IUGR and 1% had a diagnosis of SGA; about 0.6% presented stillbirth. Of the total number of patients, 4% were admitted to the ICU, and of these 1.1% died due to some secondary complication. Conclusions: SARS CoV2 infection could be related to adverse outcomes, increasing fetal mortality and maternal morbidity, being associated with a worse gestational prognosis. Comparative studies with larger sample sizes are needed to determine significant differences.
dc.description: El COVID 19, es el síndrome respiratorio agudo severo o grave, desencadenado tras la infección por SARS Cov2 o Coronavirus, el cual se caracteriza por una progresión tórpida en el binomio madre –hijo. Objetivo: Identificar los factores de morbimortalidad materna y perinatal durante la gestación relacionados con la infección por SARS CoV2. Materiales y métodos: Se realizó un estudio observacional descriptivo retrospectivo, de corte transversal que incluyó pacientes atendidas en las clínicas Colsanitas del 01 de marzo 2020 al 31 de agosto 2021, con diagnóstico de infección por SARS Cov2. Se incluyeron las pacientes mediante muestreo consecutivo por conveniencia. Se excluyeron pacientes con datos incompletos y pérdidas durante el seguimiento. Se analizaron variables de morbi-mortalidad materna y perinatal tales como proporción de muertes maternas, fetales y neonatales, proporción de pacientes con preeclampsia, sepsis, enfermedades metabólicas y complicaciones. Resultados: De las 471 pacientes incluidas en el estudio, el 1.1% cursó con infección severa. El 62% finalizó el embarazo por cesárea, el 4% presentó RCIU y 1% tuvo diagnóstico de FPEG; cerca del 0.6% presento óbito fetal. Del total de pacientes, el 4% ingresaron a UCI y de estas 1.1% fallecieron por alguna complicación secundaria. Conclusiones: La infección por SARS CoV2 podría relacionarse con resultados adversos, aumentando la mortalidad fetal y la morbilidad materna, asociándose a peor pronóstico gestacional. Se necesitan estudios comparativos con mayor tamaño de muestra para determinar diferencias significativas.
Castaño Toro, Yaisa MaritzaCOVID 19 is a severe and acute respiratory syndrome, triggered after infection by SARS Cov2 or Coronavirus, which is characterized by a torpid progression in the mother and the child. Objective: To identify the factors of maternal and perinatal morbidity and mortality during pregnancy related to SARS CoV2 infection. Materials and methods: A retrospective, descriptive, cross-sectional observational study was carried out, that included patients treated at the Colsanitas clinics from March 1, 2020 to August 31, 2021, with a diagnosis of SARS Cov2 infection. Patients with incomplete data and loss to follow-up were excluded. Maternal and perinatal morbidity and mortality variables such as the proportion of maternal, fetal, and neonatal deaths, the proportion of patients with preeclampsia, sepsis, metabolic diseases, and complications were analyzed. Results: Out of the 471 patients included in the study, 1.1% had a serious infection. 62% ended the pregnancy by caesarean section, 4% presented IUGR and 1% had a diagnosis of SGA; about 0.6% presented stillbirth. Of the total number of patients, 4% were admitted to the ICU, and of these 1.1% died due to some secondary complication. Conclusions: SARS CoV2 infection could be related to adverse outcomes, increasing fetal mortality and maternal morbidity, being associated with a worse gestational prognosis. Comparative studies with larger sample sizes are needed to determine significant differences.Evaluación características operativas: ecografía 2D y Doppler color para diagnóstico de acretismo placentario, Clínica Universitaria Colombia, BogotáVargas Barrios, IsaacGutiérrez Sánchez, Luzhttps://repository.urosario.edu.co/handle/10336/27732023-06-09T13:09:21Z2012-01-01T00:00:00Zdc.title: Evaluación características operativas: ecografía 2D y Doppler color para diagnóstico de acretismo placentario, Clínica Universitaria Colombia, Bogotá
dc.description.abstract: Placenta accreta is abnormally invasive placentation in uterine wall. It ispresent in 0. 9 percent of total pregnancies; Now, is one of the most important causes ofmaternal morbi-mortality. Echography 2D and Doppler are diagnostic methods in a firstand second line. Objective: To evaluate diagnostic utility of Echography 2D and Color Doppler fordiagnosis of placenta accreta in woman pregnat with risk factors in comparison withclinical and histopathological diagnosis; and to determinate incidence of placenta accretain consultant population at Clínica Universitaria Colombia. Material and Methods: Evaluation of diagnostic technologies. Between August to octuberof 2011 were included 134 pregnant women with 24 and 40 gestacional age with riskfactors of placenta accreta. The diagnostic yield of each test will be present by sensitivity, specificity and positive and negative predictive values. The demographic characteristics ofthe patients and neonatal results were analized calculating proportion, media and range. Results: In a 137 pacients group with risk factors of accreta placent ; this data was obtained from agroup the 119 pacients around the finish pregnang. Was showed 4 data with accreta placent, clinic and histopatologic diagnosis. Showing a prevalence of 2, 9% . The 2D ecography andsonography doppler in accreta placent diagnosis with confidence leevel 95 % andsensibility 100% (95% CI 87. 5 to 100) and specificity of 100% (95% CI 99. 6 to 100). Conclusion: With the analized data showed a incidence of accrete placent from 4 in 132 patients. Theclinic data review showed the diagnosis prenatal do that a important impact in the maternaland fetal mortality and morbility , does need clinic evaluation with the images thesonography 2D and Doppler color in the risk patients.
dc.description: La placenta ácreta es la implantación anómala de la placenta en la pared uterina. Se presenta en 0.9% de todos los embarazos; actualmente es una de las causas más importantes de morbimortalidad materna. Ecografía 2D y Doppler placentario son métodos diagnósticos de primera y segunda línea. Objetivo: Evaluar la utilidad diagnóstica de ecográfica 2D y Doppler color Placentario para diagnóstico de acretismo placentario en gestantes con factores de riesgo comparándolos con diagnóstico clínico e histopatológico; y determinar incidencia de acretismo placentario en población asistente a Clínica Universitaria Colombia. Metodología: Estudio de evaluación de tecnología diagnóstica. Entre Agosto a octubre 2011 se incluyeron 137 gestantes entre 24 y 40 semanas de gestación con factores de riesgo para acretismo placentario. El desempeño diagnóstico de las pruebas se determinará por sensibilidad, especificidad, valores predictivos positivo y negativo. Las características demográficas de las pacientes y resultados neonatales se analizaron mediante proporción, media y rango. Resultados: En un grupo de 137 pacientes con factores de riesgo de acretismo placentario analizadas se obtuvo el dato de 119 en cuanto a la finalización del embarazo. Se observaron 4 casos con diagnóstico clínico e histopatológico de acretismo placentario, evidenciando una prevalencia del 2,9%. La ecografía 2D y Doppler en la detección de acretismo placentario con un nivel de confianza del 95%, presentaron sensibilidad del 100% (IC95% 87,5-100) y especificidad de 100% (IC95% 99,6-100). Conclusión: Con los datos analizados registramos una incidencia de acretismo placentario de 4 en 132 pacientes. Revisión de literatura sustenta la necesidad de realización diagnostica prenatal que impacte en la morbimortalidad materna y fetal, haciendo necesario la evaluación diagnostica valida de herramientas como el Eco 2D y Doppler color en población a riesgo.
2012-01-01T00:00:00ZVargas Barrios, IsaacGutiérrez Sánchez, LuzPlacenta accreta is abnormally invasive placentation in uterine wall. It ispresent in 0. 9 percent of total pregnancies; Now, is one of the most important causes ofmaternal morbi-mortality. Echography 2D and Doppler are diagnostic methods in a firstand second line. Objective: To evaluate diagnostic utility of Echography 2D and Color Doppler fordiagnosis of placenta accreta in woman pregnat with risk factors in comparison withclinical and histopathological diagnosis; and to determinate incidence of placenta accretain consultant population at Clínica Universitaria Colombia. Material and Methods: Evaluation of diagnostic technologies. Between August to octuberof 2011 were included 134 pregnant women with 24 and 40 gestacional age with riskfactors of placenta accreta. The diagnostic yield of each test will be present by sensitivity, specificity and positive and negative predictive values. The demographic characteristics ofthe patients and neonatal results were analized calculating proportion, media and range. Results: In a 137 pacients group with risk factors of accreta placent ; this data was obtained from agroup the 119 pacients around the finish pregnang. Was showed 4 data with accreta placent, clinic and histopatologic diagnosis. Showing a prevalence of 2, 9% . The 2D ecography andsonography doppler in accreta placent diagnosis with confidence leevel 95 % andsensibility 100% (95% CI 87. 5 to 100) and specificity of 100% (95% CI 99. 6 to 100). Conclusion: With the analized data showed a incidence of accrete placent from 4 in 132 patients. Theclinic data review showed the diagnosis prenatal do that a important impact in the maternaland fetal mortality and morbility , does need clinic evaluation with the images thesonography 2D and Doppler color in the risk patients. Hiperecogenicidad de aorta ascendente y probabilidad de coartación aórtica y lesión estenotica de la válvula aórtica fetalAcevedo Angulo, Aylin Adrianahttps://repository.urosario.edu.co/handle/10336/209702021-06-03T05:49:36Zdc.title: Hiperecogenicidad de aorta ascendente y probabilidad de coartación aórtica y lesión estenotica de la válvula aórtica fetal
dc.description.abstract: Background: Coarctation of the aorta (CoA) represents 5-8% of congenital heart disease, and is associated with aortic stenosis in 60%. They have high morbidity and mortality, which can be prevented by prenatal ultrasound diagnosis, and early treatment; However, its diagnosis is difficult. It has been shown in patients with stenosis and coarctation, the increased echogenicity of the aortic wall, which is why it is decided to identify the frequency of presentation.Materials and methods: Descriptive study. Fetuses with a diagnosis of congenital heart disease with compromised ascending aorta (coarctation and / or aortic stenosis) were included between January 2005 and July 2019. Hyperechogenicity of the aortic wall was evaluated in each of the pathologies, and the prenatal and postnatal concordance of this finding, by means of kappa de cohen. Results: The probability of prenatal hyperechogenicity was 96.4% of fetuses with congenital heart disease with compromised ascending aorta (CoA and stenosis of the aorta). In patients who presented aortic stenosis, coarctation of the aorta or both pathologies, prenatal hyperechogenicity was a positive finding in 100% of patients (n = 25, 30 and 3 respectively). Conclusions: The probability of finding hyperechogenicity in prenatal ultrasound of congenital heart disease with compromised ascending aorta is 96.4%. Diagnostic test studies are necessary to know operational characteristics of hyperecogenicity given its high probability of outcome in patients with this pathology.
dc.description: Antecedentes: La coartación de la aorta (CoA) y la estenosis de la aorta representan el 5-8% de las cardiopatías congénitas, con alta tasa de morbimortalidad, que se pueden identificar mediante el diagnostico ecográfico prenatal, y tratamiento precoz; sin embargo, su diagnóstico es difícil. Se ha evidenciado en pacientes con estenosis y coartación, el aumento de la ecogenicidad de la pared aórtica, razón por lo que se decide identificar la frecuencia de presentación. Materiales y métodos: Estudio descriptivo. Se incluyeron fetos con diagnóstico de cardiopatía congénita con compromiso de la aorta ascendente (coartación y/o estenosis aórtica), entre enero de 2005 y julio de 2019. Se evaluó la hiperecogenicidad de la pared de la aorta y la probabilidad de su presencia como signo indirecto de la coartación aórtica y la lesión estenótica de la válvula aortica. Resultados: La probabilidad de la hiperecogenicidad prenatal fue de 96, 4% de los fetos con cardiopatía congénita con compromiso de la aorta ascendente (CoA y estenosis de la aorta). En los pacientes que presentaron estenosis aórtica, coartación aórtica o ambas patologías, la hiperecogenicidad prenatal fue un hallazgo positivo en el 100% de los pacientes (n=25, 30 y 3 respectivamente). Conclusiones: La probabilidad del hallazgo de hiperecogenicidad en la ecografía prenatal de las cardiopatías con compromiso de la aorta ascendente es del 96,4%. Es necesario estudios de prueba diagnóstica para conocer características operativas de la hiperecogenicidad dado su alta probabilidad de resultado en pacientes con esta patología.
Acevedo Angulo, Aylin AdrianaBackground: Coarctation of the aorta (CoA) represents 5-8% of congenital heart disease, and is associated with aortic stenosis in 60%. They have high morbidity and mortality, which can be prevented by prenatal ultrasound diagnosis, and early treatment; However, its diagnosis is difficult. It has been shown in patients with stenosis and coarctation, the increased echogenicity of the aortic wall, which is why it is decided to identify the frequency of presentation.Materials and methods: Descriptive study. Fetuses with a diagnosis of congenital heart disease with compromised ascending aorta (coarctation and / or aortic stenosis) were included between January 2005 and July 2019. Hyperechogenicity of the aortic wall was evaluated in each of the pathologies, and the prenatal and postnatal concordance of this finding, by means of kappa de cohen. Results: The probability of prenatal hyperechogenicity was 96.4% of fetuses with congenital heart disease with compromised ascending aorta (CoA and stenosis of the aorta). In patients who presented aortic stenosis, coarctation of the aorta or both pathologies, prenatal hyperechogenicity was a positive finding in 100% of patients (n = 25, 30 and 3 respectively). Conclusions: The probability of finding hyperechogenicity in prenatal ultrasound of congenital heart disease with compromised ascending aorta is 96.4%. Diagnostic test studies are necessary to know operational characteristics of hyperecogenicity given its high probability of outcome in patients with this pathology.Importancia de la morfología de las ondas del ductus venoso en el diagnóstico de cardiopatía congénitaHerrera, MauricioRebolledo, MarioOcoro Arrechea, Nini Ximenahttps://repository.urosario.edu.co/handle/10336/103042021-06-03T05:45:50Z2015-01-01T00:00:00Zdc.title: Importancia de la morfología de las ondas del ductus venoso en el diagnóstico de cardiopatía congénita
dc.description.abstract: The ductus venosus reflects the cardiac cycle, but currently there is no information about the morphology of each wave with the different groups of cardiac congenital disease. It aims to evaluate the importance of the waveform morphology of the ductus venosus in the diagnosis of the different types of congenital heart disease, taking into account patients attended in maternal fetal medicine unit of clinical Colombia between January 2012 and July 2014 .
dc.description: El ductus venoso refleja el ciclo cardiaco, pero actualmente no se conoce como se comporta cada onda del ductus venoso en los diferentes grupos de cardiopatías congénitas. Se pretende evaluar la importancia de la morfología de las ondas del ductus venoso en el diagnóstico de los diferentes tipos de cardiopatías congénita, teniendo en cuenta las pacientes atendidas en la Unidad De Medicina Materno Fetal de la clínica Colombia entre enero 2012 y julio de 2014.
2015-01-01T00:00:00ZHerrera, MauricioRebolledo, MarioOcoro Arrechea, Nini XimenaThe ductus venosus reflects the cardiac cycle, but currently there is no information about the morphology of each wave with the different groups of cardiac congenital disease. It aims to evaluate the importance of the waveform morphology of the ductus venosus in the diagnosis of the different types of congenital heart disease, taking into account patients attended in maternal fetal medicine unit of clinical Colombia between January 2012 and July 2014 .Infección perinatal por estreptococo del Grupo BAlarcón, ClaudiaHerrera Méndez, MauricioNúñez Martínez, Andrés Felipehttps://repository.urosario.edu.co/handle/10336/13042021-06-03T05:45:22Z2009-01-01T00:00:00Zdc.title: Infección perinatal por estreptococo del Grupo B
dc.description: Objetivo: Determinar la prevalencia de colonización vagino-rectal materna por Estreptococo Hemolítico del grupo B (SßG) entre la semana 35 y 37 de gestación, en la población obstétrica de la Clínica Universitaria Colombia, Bogotá, Colombia.
Diseño: Estudio descriptivo de prevalencia
Métodos: Entre abril y septiembre de 2008 se tomó la totalidad de pacientes obstétricas con parto atendido en la Clínica Universitaria Colombia y con tamizaje de colonización por SßG entre las semanas 35 y 37 de gestación, empleando cultivo vaginal y/o rectal. Se discriminó el sitio de toma del cultivo, se determinó la prevalencia de colonización vagino-rectal materna por SßG y se evaluó la presencia de infección neonatal temprana en la población estudio.
Resultados: Se estudiaron 928 pacientes, encontrándose una prevalencia de colonización por SGB entre la semana 35 y 37 de gestación de 7,8%. Dentro de las pacientes colonizadas el 12,5% fueron detectadas por cultivo vaginal y el 87,5 % por cultivo vaginal rectal.
Conclusiones: La prevalencia de colonización vagino-rectal por SGB entre la semana 35 y 37 de gestación en las pacientes de la Clínica Universitaria Colombia, se encuentra en el rango reportado en Norteamérica y otras poblaciones latinas. La colonización por Streptococcus agalactiae encontrada con cultivo vaginal fue menor a la colonización encontrada por cultivo vaginal y rectal; lo cual está en relación con la importancia en la realización de cultivo vaginal y rectal reportada en la literatura, ya que el tracto gastrointestinal es un reservorio mayor de SGB.
2009-01-01T00:00:00ZAlarcón, ClaudiaHerrera Méndez, MauricioNúñez Martínez, Andrés FelipeLesión renal residual después de embarazo complicado por preeclampsiaRuíz Cortés, GermánAltahona Suárez, HernandoRebolledo Ardila, MarioHerrera Mendez, Emiliano Mauriciohttps://repository.urosario.edu.co/handle/10336/400932023-07-11T08:02:36Z2010-01-01T00:00:00Zdc.title: Lesión renal residual después de embarazo complicado por preeclampsia
dc.description.abstract: OBJECTIVE: To evaluate the renal function after a pregnancy complicated by preeclampsia. Microalbuminuria, creatinine clearance and blood pressure were assessed. Microalbuminuria is an important risk factor for underlying vascular disease. ESTUDY DESIGN: Analytic prospective cohort study were we compare, after sixteen weeks postpartum, the presence of microalbuminuria, the blood pressure and creatinine clearance in 20 patients with history of a pregnancy complicated by preeclampsia and 20 patients with history of normal pregnancy. RESULTS: We didn´t find any difference in the renal functions in the two groups. No difference in the creatinine clearance and the presence of microalbuminuria. The mean arterial blood pressure in the preeclamptic group was significantly higher than in the control group (PAM 90 +/- 12.2 VS 81 +/- 7.2mm/Hg with p <0.0025) but only one patient in the study group remain hypertensive. CONCLUSIONS: Patients with a history of preeclampsia require clinical follow up. We considered that there is no need to evaluate the presence of microalbuminuria and renal function test in all the patients with history of preeclampsia. Women with medical history of preeclampsia are at increased risk for cardiovascular diseases later in life. Obesity, hypertension, cigarette smoking and diabetes all of them are cardiovascular risk factors that require intervention strategies and adjustments in life style.
dc.description: OBJETIVO: Evaluar la función renal después de embarazo complicado con preeclampsia determinando la presencia de microalbuminuria, midiendo la depuración de creatinina y cuantificando las cifras de presión arterial una vez han concluido los cambios fisiológicos propios del embarazo y del puerperio. La presencia de microalbuminuria confiere un factor de riesgo para enfermar a largo plazo desde el punto de vista cardiovascular. DISEÑO DEL ESTUDIO: Un estudio analítico de tipo cohorte prospectivo donde se compararon, después de la semana 16 posparto, la presencia de micro albuminuria, depuración de creatinina y cifras de presión arterial en 20 pacientes con antecedente de preeclampsia y en 20 pacientes con antecedente de embarazo normal. RESULTADOS: No se encontraron diferencias estadísticas en la función renal en cuanto a la presencia de microalbuminuria y a los niveles de depuración de creatinina. Las pacientes que presentaron preeclampsia presentaron cifras de presión arterial sistólica y diastólica significativamente mayores que las del grupo de pacientes sin el antecedente de preeclampsia (presión arterial media: 90 +/- 12.2 VS 81 +/- 7.2mm/Hg con una p <0.0025). Estos rangos no alcanzaron a sobrepasar el límite de normalidad y solo a una paciente con antecedente de preeclampsia se le encontró hipertensión arterial. CONCLUSIÓN: El seguimiento de las pacientes con antecedente de preeclampsia debe ser clínico y hasta que se logre demostrar lo contrario, no es necesario solicitar de rutina pruebas de función renal y microalbuminuria. Siendo el antecedente de esta enfermedad por sí misma un factor de riesgo cardiovascular a largo plazo, se debe insistir en controlar todos los factores de riesgo como obesidad, hipertensión, diabetes y cigarrillo e insistir en este grupo de pacientes en el estilo de vida saludable.
2010-01-01T00:00:00ZRuíz Cortés, GermánAltahona Suárez, HernandoRebolledo Ardila, MarioHerrera Mendez, Emiliano MauricioOBJECTIVE: To evaluate the renal function after a pregnancy complicated by preeclampsia. Microalbuminuria, creatinine clearance and blood pressure were assessed. Microalbuminuria is an important risk factor for underlying vascular disease. ESTUDY DESIGN: Analytic prospective cohort study were we compare, after sixteen weeks postpartum, the presence of microalbuminuria, the blood pressure and creatinine clearance in 20 patients with history of a pregnancy complicated by preeclampsia and 20 patients with history of normal pregnancy. RESULTS: We didn´t find any difference in the renal functions in the two groups. No difference in the creatinine clearance and the presence of microalbuminuria. The mean arterial blood pressure in the preeclamptic group was significantly higher than in the control group (PAM 90 +/- 12.2 VS 81 +/- 7.2mm/Hg with p <0.0025) but only one patient in the study group remain hypertensive. CONCLUSIONS: Patients with a history of preeclampsia require clinical follow up. We considered that there is no need to evaluate the presence of microalbuminuria and renal function test in all the patients with history of preeclampsia. Women with medical history of preeclampsia are at increased risk for cardiovascular diseases later in life. Obesity, hypertension, cigarette smoking and diabetes all of them are cardiovascular risk factors that require intervention strategies and adjustments in life style.Morbilidad en manejo quirúrgico en acretismo placentario. Clínica Colombia, Reina Sofia y PediátricaReales Najera, Francisco Javierhttps://repository.urosario.edu.co/handle/10336/394182023-05-30T08:02:03Zdc.title: Morbilidad en manejo quirúrgico en acretismo placentario. Clínica Colombia, Reina Sofia y Pediátrica
dc.description.abstract: Introduction The placenta accreta spectrum is the abnormal invasion of the trophoblast into the myometrium and potentially into adjacent tissues. Depending on the type of placenta accreta, the risk of complications and major peripartum intervention increases. Therefore, having a team that has the capabilities to diagnose, monitor, and treat this type of pathology is of vital importance. Objective To establish maternal morbidity in patients with a placenta accreta spectrum who underwent non-emergent surgical management with cesarean section and modified technical peripartum hysterectomy at the Colombia University Clinic, the Reina Sofia Clinic and the Pediatric Clinic from January 2007 to October 2022. Materials and methods This is a retrospective descriptive study. Patients with a diagnosis of placental accreta with non-emergent surgical management were included. Results The cohort was made up of 37 patients, with a mean age of 35.0±5.1 years. Intraoperative blood loss presented a median of 2000 ml and varied between 500 and 3000 ml. The most common lesion was the bladder, which occurred in 8.1% (n=3) of the cases. No cases of injury to other structures were reported. The reported post-surgical complication was superficial surgical site infection in 10.8% of cases. Conclusion Proper diagnosis, surveillance, and care can reduce complications associated with placental accreta. Early and appropriate surgery can also improve maternal and fetal outcomes. It is important to have an experienced multidisciplinary team and use advanced surgical techniques, as well as preventive measures to minimize risks.
dc.description: Introducción El espectro de acretismo placentario es la invasión anormal del trofoblasto al miometrio y potencialmente a tejidos adyacentes. Según el tipo de acretismo placentario aumenta el riesgo de aparición de complicaciones y de intervencionismo mayor periparto. Por lo tanto, contar con un equipo que tenga las capacidades para diagnosticar, vigilar y tratar este tipo de patologías es de vital importancia. Objetivo Establecer la morbilidad materna en pacientes con espectro de acretismo placentario que se realiza manejo quirúrgico no emergente con cesárea e histerectomía periparto técnica modificada en la Clínica Universitaria Colombia, Clínica Reina Sofia y Clínica Pediátrica desde Enero 2007 a Octubre 2022. Materiales y métodos El presente es un estudio descriptivo retrospectivo. Se incluyeron pacientes con diagnostico de acretismo placentario con manejo quirúrgico no emergente. Resultados La cohorte la conformaron 37 pacientes, con promedio de edad de 35.0±5.1 años. La pérdida hemática intraoperatoria presento una mediana de 2000 ml y vario entre 500 y 3000 ml. La lesión más común fue la vesical, la cual se presentó en un 8.1% (n=3) de los casos. No se reportaron casos de lesión a otras estructuras. La complicación postquirúrgica reportada fue infección de sitio operatorio superficial en un 10.8% de los casos. Conclusión El diagnóstico, vigilancia y atención adecuados pueden reducir las complicaciones asociadas al acretismo placentario. La cirugía temprana y adecuada también puede mejorar los resultados maternos y fetales. Es importante contar con un equipo multidisciplinario experimentado y utilizar técnicas quirúrgicas avanzadas, así como medidas preventivas para minimizar los riesgos.
Reales Najera, Francisco JavierIntroduction The placenta accreta spectrum is the abnormal invasion of the trophoblast into the myometrium and potentially into adjacent tissues. Depending on the type of placenta accreta, the risk of complications and major peripartum intervention increases. Therefore, having a team that has the capabilities to diagnose, monitor, and treat this type of pathology is of vital importance. Objective To establish maternal morbidity in patients with a placenta accreta spectrum who underwent non-emergent surgical management with cesarean section and modified technical peripartum hysterectomy at the Colombia University Clinic, the Reina Sofia Clinic and the Pediatric Clinic from January 2007 to October 2022. Materials and methods This is a retrospective descriptive study. Patients with a diagnosis of placental accreta with non-emergent surgical management were included. Results The cohort was made up of 37 patients, with a mean age of 35.0±5.1 years. Intraoperative blood loss presented a median of 2000 ml and varied between 500 and 3000 ml. The most common lesion was the bladder, which occurred in 8.1% (n=3) of the cases. No cases of injury to other structures were reported. The reported post-surgical complication was superficial surgical site infection in 10.8% of cases. Conclusion Proper diagnosis, surveillance, and care can reduce complications associated with placental accreta. Early and appropriate surgery can also improve maternal and fetal outcomes. It is important to have an experienced multidisciplinary team and use advanced surgical techniques, as well as preventive measures to minimize risks.Punto de corte óptimo de la hormona tiroidea para la detección de hipotiroidismo en gestantes de la unidad de medicina materno fetal en la clínica universitaria Colombia durante el 2018Botia Rodríguez, Henry Andréshttps://repository.urosario.edu.co/handle/10336/190122019-09-19T12:37:54Z2019-01-01T00:00:00Zdc.title: Punto de corte óptimo de la hormona tiroidea para la detección de hipotiroidismo en gestantes de la unidad de medicina materno fetal en la clínica universitaria Colombia durante el 2018
dc.description.abstract: Objective: The optimal cut-off point for thyroid hormone (TSH) per quarter was determined for the detection of hypothyroidism in pregnant patients with and without risk factors for thyroid dysfunction who attended a high-risk obstetric appointment in the Maternal Fetal Medicine Unit of the University Clinic Colombia in the city of Bogotá during the second semester of 2018. Design: It was a prospective descriptive study of a cohort of patients in pregnant women who attended a high-risk obstetric appointment in the maternal-fetal medicine unit of the University Clinic Colombia during the second semester of 2018. Methods: The thyroid function (TSH) requested in the routine prenatal control was reviewed for all pregnant women who attended high-risk control, for patients with risk factors for hypothyroidism or for values higher than 2.5, antiperoxidase antibodies were administered and results indicated to continue management of each specific protocol according to the pathology Results: The study group consisted of 260 patients, with an average age of 30.24, 6.36 years, a minimum age of 13 years and a maximum of 45 years, in the group predominantly the mestizo race, socioeconomic stratum 3 and a degree of university education. . The body mass index with the highest presentation was that of overweight (BMI 25-29.9) with an average weight of 69.98 and an average height was 159.78 centimeters. The mean gestational age of the patients was 24.59 weeks and the most used method for this calculation was the last rule date (FUR). The risk factors for thyroid dysfunction that occurred most in the population were maternal age greater than 30 years, followed by a history of previous abortions, then maternal obesity and the history of having a previous autoimmune disease. The optimal cut-off point (P95%) for the detection of risk of hypothyroidism of thyroid hormone in pregnant patients who attended high-risk appointment in the maternal fetal unit during the second semester of 2018 per quarter were, for the first trimester 4.79 mlU / L, second quarter 5.56 mlU / L and for the third quarter 5.40 mlU / L.
dc.description: Objetivo: Se determino cual es el punto de corte optimo de la hormona tiroidea (TSH) por trimestre para la detección de hipotiroidismo en pacientes gestantes con y sin factores de riesgo para disfunción tiroidea que acudieron a cita de alto riesgo obstétrico en la Unidad de Medicina Materno Fetal de la Clínica Universitaria Colombia en la ciudad de Bogotá durante el segundo semestre del 2018. Diseño: Fue un estudio prospectivo descriptivo de una cohorte de pacientes en mujeres gestantes que asistieron a cita de alto riesgo obstétrico en la Unidad de medicina materno fetal de la Clínica Universitaria Colombia durante el segundo semestre del 2018. Métodos: Se reviso la función tiroidea (TSH) solicitada en el control prenatal de rutina a todas las gestantes que acudieron a control de alto riesgo, a las pacientes con factores de riesgo para hipotiroidismo o que tuvieron valores superiores a 2.5 se les realizo anticuerpos antiperoxidasa y según resultados se indico continuar manejo de cada protocolo especifico acorde a la patología Resultados: El grupo de estudio lo conformaron 260 pacientes, con un promedio de edad 30.24 ± 6.36 años, una edad mínima de 13 años y una máxima de 45 años, en el grupo predomino la raza mestiza, estrato socioeconómico 3 y un grado de escolaridad universitario. El índice de masa corporal de mayor presentación fue el de sobrepeso (IMC 25-29.9) con un peso promedio de 69.98 y una talla promedio fue de 159.78 centímetros. El promedio de edad gestacional de las pacientes fue de 24.59 semanas y el método mas utilizado para este calculo fue la fecha de ultima regla (FUR). Los factores de riesgo para disfunción tiroidea que mas se presentaron en la población fueron la edad materna mayor a 30 años, seguido por el antecedente de abortos previos, luego la obesidad materna y el antecedente de tener una enfermedad autoinmune previa. El punto de corte optimo (P95%) para la detección de riesgo de hipotiroidismo de la hormona tiroidea en las pacientes gestantes que asistieron a cita de alto riesgo en la unidad materno fetal durante el segundo semestre del 2018 por trimestre fueron, para el primer trimestre 4.79 mlU/L, segundo trimestre 5.56 mlU/L y para el tercer trimestre 5.40 mlU/L.
2019-01-01T00:00:00ZBotia Rodríguez, Henry AndrésObjective: The optimal cut-off point for thyroid hormone (TSH) per quarter was determined for the detection of hypothyroidism in pregnant patients with and without risk factors for thyroid dysfunction who attended a high-risk obstetric appointment in the Maternal Fetal Medicine Unit of the University Clinic Colombia in the city of Bogotá during the second semester of 2018. Design: It was a prospective descriptive study of a cohort of patients in pregnant women who attended a high-risk obstetric appointment in the maternal-fetal medicine unit of the University Clinic Colombia during the second semester of 2018. Methods: The thyroid function (TSH) requested in the routine prenatal control was reviewed for all pregnant women who attended high-risk control, for patients with risk factors for hypothyroidism or for values higher than 2.5, antiperoxidase antibodies were administered and results indicated to continue management of each specific protocol according to the pathology Results: The study group consisted of 260 patients, with an average age of 30.24, 6.36 years, a minimum age of 13 years and a maximum of 45 years, in the group predominantly the mestizo race, socioeconomic stratum 3 and a degree of university education. . The body mass index with the highest presentation was that of overweight (BMI 25-29.9) with an average weight of 69.98 and an average height was 159.78 centimeters. The mean gestational age of the patients was 24.59 weeks and the most used method for this calculation was the last rule date (FUR). The risk factors for thyroid dysfunction that occurred most in the population were maternal age greater than 30 years, followed by a history of previous abortions, then maternal obesity and the history of having a previous autoimmune disease. The optimal cut-off point (P95%) for the detection of risk of hypothyroidism of thyroid hormone in pregnant patients who attended high-risk appointment in the maternal fetal unit during the second semester of 2018 per quarter were, for the first trimester 4.79 mlU / L, second quarter 5.56 mlU / L and for the third quarter 5.40 mlU / L.Rendimiento diagnóstico de proteinuria en 12 horas versus 24 horas para establecer compromiso renal en preeclampsiaMuñoz Morales, José AlbertoArenas, JaimeVieira Serna, Santiagohttps://repository.urosario.edu.co/handle/10336/180112020-02-10T20:03:16Z2018-01-01T00:00:00Zdc.title: Rendimiento diagnóstico de proteinuria en 12 horas versus 24 horas para establecer compromiso renal en preeclampsia
dc.description.abstract: Introduction: Pre-eclampsia is a disorder characterized by hypertension and proteinuria due to kidney injury which is diagnosed by collecting urine for 24 hours and being positive ≥300mg/dl, the importance of the study lies in determining the diagnostic yield of proteinuria in 12 hours for a value of ≥150mg/dl. Objective: To evaluate the diagnostic performance of renal lesion in hypertensive pregnant patients with proteinuria in 12 hours ≥150mg/dl and to compare with proteinuria in 24 hours ≥300mg/dl. Method: Diagnostic, prospective study in 105 pregnant women with hypertension to be classified, admitted to the Bogotá Bogotá University Clinic, during the period of 01/11/2017-31/03/018. The diagnostic performance was determined by sensitivity, specificity, PPV, NPV, likelihood ratio and prediction with ROC. Results: The cohort was composed of 105 pregnant women with hypertensive >20 weeks, the median age was 31.8 6.4 years. The optimal cut-off point found for proteinuria at 12 hours was ≥145mg/dl, showing sensitivity of 81.08% (95% CI 67.11-95.05%), 91.18% specificity (95% CI 83,7-98.6%), PPV 83.3% (69.6-96.9%) NPV 89.8% (82.01-97.7%) and LR + 9.19 (4.21-20,04), LR- 0.21(0.11-0.41), predictive area under the curve 95.5% (95% CI: 91.9-99.2% p<0.001). A direct and strong correlation was found between the numerical values of proteinuria at 12 and 24 hours (rs=0.854, p<0.001). Conclusion: The optimal cut-off point ≥145mg/dl for proteinuria during 12 hours has a high diagnostic yield and is very useful given its high predictive value of renal injury in hypertensive pregnant women and we recommend its application to obtain a faster diagnosis.
dc.description: Introducción: La pre-eclampsia es un trastorno caracterizado por hipertensión y proteinuria debido a lesión renal la cual se diagnóstica recolectando orinas durante 24 horas siendo positiva ≥300mg/dl, la importancia del estudio radica en determinar el rendimiento diagnóstico de proteinuria en 12 horas para un valor de ≥150mg/dl. Objetivo: Evaluar el rendimiento diagnóstico de lesión renal en pacientes gestantes hipertensas de proteinuria en 12 horas ≥150mg/dl y comparar con la proteinuria en 24 horas ≥300mg/dl. Método: Estudio de prueba diagnóstica, prospectivo en 105 embarazadas con hipertensión a clasificar, ingresadas en la Clínica Universitaria Colombia Bogotá, durante el período de 01/11/2017-31/03/2018. El rendimiento diagnóstico fue determinado por sensibilidad, especificidad, VPP, VPN, razón de verosimilitud y predicción con ROC. Resultados: La cohorte se conformó por 105 mujeres embarazadas hipertensas >20semanas, la mediana de edad fue 31,8 6.4 años. El punto de corte óptimo encontrado para la proteinuria a las 12 horas fue ≥145mg/dl, mostrando sensibilidad de 81,08%(IC:95% 67,11-95,05%), especificidad de 91,18%(IC:95% 83,7-98,6%), VPP 83,3%(69,6-96,9%) VPN 89,8%(82,01-97,7%) y RV+ 9,19(4,21-20,04), RV-0,21(0,11-0,41), área predictiva bajo la curva de 95,5% (IC 95%: 91,9- 99,2% p<0,001). Se encontró una correlación directa y fuerte entre los valores numéricos de la proteinuria a las 12 y las 24 horas (rs=0,854, p<0,001). Conclusión: El punto de corte óptimo ≥145mg/dl para proteinuria durante 12 horas tiene un alto rendimiento diagnóstico y es de gran utilidad dado su alto valor predictivo de lesión renal en gestantes hipertensas y recomendamos su aplicación para obtener un diagnóstico más rápido.
2018-01-01T00:00:00ZMuñoz Morales, José AlbertoArenas, JaimeVieira Serna, SantiagoIntroduction: Pre-eclampsia is a disorder characterized by hypertension and proteinuria due to kidney injury which is diagnosed by collecting urine for 24 hours and being positive ≥300mg/dl, the importance of the study lies in determining the diagnostic yield of proteinuria in 12 hours for a value of ≥150mg/dl. Objective: To evaluate the diagnostic performance of renal lesion in hypertensive pregnant patients with proteinuria in 12 hours ≥150mg/dl and to compare with proteinuria in 24 hours ≥300mg/dl. Method: Diagnostic, prospective study in 105 pregnant women with hypertension to be classified, admitted to the Bogotá Bogotá University Clinic, during the period of 01/11/2017-31/03/018. The diagnostic performance was determined by sensitivity, specificity, PPV, NPV, likelihood ratio and prediction with ROC. Results: The cohort was composed of 105 pregnant women with hypertensive >20 weeks, the median age was 31.8 6.4 years. The optimal cut-off point found for proteinuria at 12 hours was ≥145mg/dl, showing sensitivity of 81.08% (95% CI 67.11-95.05%), 91.18% specificity (95% CI 83,7-98.6%), PPV 83.3% (69.6-96.9%) NPV 89.8% (82.01-97.7%) and LR + 9.19 (4.21-20,04), LR- 0.21(0.11-0.41), predictive area under the curve 95.5% (95% CI: 91.9-99.2% p<0.001). A direct and strong correlation was found between the numerical values of proteinuria at 12 and 24 hours (rs=0.854, p<0.001). Conclusion: The optimal cut-off point ≥145mg/dl for proteinuria during 12 hours has a high diagnostic yield and is very useful given its high predictive value of renal injury in hypertensive pregnant women and we recommend its application to obtain a faster diagnosis.