Factores que influyen en la presentacion del aborto diferido y sus complicaciones frecuentes en el Hospital Dr. Teodoro Maldonado Carbo en el período enero 2013 a enero 2014
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2015
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
El aborto diferido se caracteriza por la retención en la cavidad uterina, de un embrión o feto muerto o la detención de la progresión normal del embarazo, puede acompañarse o no de sangrado variable. Luego de 24 horas aproximadamente, empiezan las modificaciones estructurales del embrión y del saco gestacional. El presente estudio investigativo realizado de enero 2103 a enero 2014 en el Hospital Regional Dr. Teodoro Maldonado Carbo se obtuvo de los 341 casos, el 49,3% correspondieron a aborto incompleto, aborto diferido (28,7%), aborto en curso (16,1%), y aborto espontaneo (5,95%). Al evaluar la muestra de 98 casos obtuvimos que el grupo etario más afectado esta entre los 41 a 45 años (37,6%) que representa 38 casos, mientras que el grupo con menos frecuencia fue entre 1824 años (7,9%) que corresponde a 8 pacientes. El factor de riesgo más frecuente fue edad mayor de los 40 años (38,8%), seguida de abortos previos (29,6%). El 67,3% recibió tratamiento médico farmacológico y el 32,7% tratamiento quirúrgico como el legrado intrauterino, la vía oral fue la más utilizada (62,1%), la vía vaginal (37,9%), el 43,8% presentaron algún tipo de complicación posterior al legrado intrauterino. Las complicaciones más frecuentes postlegrado fue el dolor pélvico (64.3%), endometritis (28.6%), síndrome de Asherman y perforación uterina (7,1%). De acuerdo a los resultados obtenidos en éste trabajo de investigación científica nuestras recomendaciones son que debemos actuar con rapidez y eficacia en el manejo, tanto clínico como quirúrgico del aborto diferido debido a que la agilidad en nuestro diagnóstico y tratamiento evitarán la presencia de secuelas graves en nuestras pacientes. Se deberían realizar más charlas en las casas de salud y establecimientos educativos con el fin de prevenir embarazos no deseados y disminuir al máximo factores de riesgo modificables.
The abortion is when the pregnancy is interrupted before 22 weeks. In over 80% of cases occur before 12 weeks, denominating early abortion, while if it occurs between 12-22 weeks are called late abortion. (18) However, the Committee on Ethical Aspects of Human Reproduction and Women Greet the International Federation of Gynecology and Obstetrics (FIGO), at its meeting in Moscow in 1973, established the concept of labor when a fetus born weighing 500g or more, and there, fore the abortion was defined by the expulsion of a fetus that weighed less than 500g and / or before 22 completed weeks. (8) The retained abortion is a clinical condition that occurs in approximately 20% of pregnancies in the first quarter. The management can be expectant, medical or surgical. (28) This research study from January 2103 to January 2014 the Regional Hospital Dr. Teodoro Maldonado Carbo was obtained from the 341 cases, 49.3% were incomplete abortion, missed abortion (28.7%), abortion in progress (16.1%), and spontaneous abortion (5.95%). In evaluating sample of 98 cases we got the most affected among the 41-45 (37.6%) cases representing 38 age group, while the group with less frequency was 18-24 years (7.9%) than it corresponds to 8 patients. The most frequent risk factor was age over 40 years (38.8%), followed by previous abortions (29.6%). 67.3% received pharmacological medical treatment and surgical treatment 32.7% as intrauterine curettage, the mouth was the most used (62.1%), vaginally (37.9%), 43.8 % they presented some type of complication after the intrauterine curettage. The most frequent complications postlegrado was pelvic pain (64.3%), endometritis (28.6%) of Asherman syndrome and uterine perforation (7.1%). Our recommendations are that we must act quickly and effectively in the management, clinical and surgical abortion deferred because the agility in our diagnosis and treatment will prevent the presence of serious consequences for our patients.
The abortion is when the pregnancy is interrupted before 22 weeks. In over 80% of cases occur before 12 weeks, denominating early abortion, while if it occurs between 12-22 weeks are called late abortion. (18) However, the Committee on Ethical Aspects of Human Reproduction and Women Greet the International Federation of Gynecology and Obstetrics (FIGO), at its meeting in Moscow in 1973, established the concept of labor when a fetus born weighing 500g or more, and there, fore the abortion was defined by the expulsion of a fetus that weighed less than 500g and / or before 22 completed weeks. (8) The retained abortion is a clinical condition that occurs in approximately 20% of pregnancies in the first quarter. The management can be expectant, medical or surgical. (28) This research study from January 2103 to January 2014 the Regional Hospital Dr. Teodoro Maldonado Carbo was obtained from the 341 cases, 49.3% were incomplete abortion, missed abortion (28.7%), abortion in progress (16.1%), and spontaneous abortion (5.95%). In evaluating sample of 98 cases we got the most affected among the 41-45 (37.6%) cases representing 38 age group, while the group with less frequency was 18-24 years (7.9%) than it corresponds to 8 patients. The most frequent risk factor was age over 40 years (38.8%), followed by previous abortions (29.6%). 67.3% received pharmacological medical treatment and surgical treatment 32.7% as intrauterine curettage, the mouth was the most used (62.1%), vaginally (37.9%), 43.8 % they presented some type of complication after the intrauterine curettage. The most frequent complications postlegrado was pelvic pain (64.3%), endometritis (28.6%) of Asherman syndrome and uterine perforation (7.1%). Our recommendations are that we must act quickly and effectively in the management, clinical and surgical abortion deferred because the agility in our diagnosis and treatment will prevent the presence of serious consequences for our patients.
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Factores de riesgo, Legrado uterino, Aborto diferido, Complicaciones del embarazo, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador