Cirugía no obstétrica durante el embarazo, Hospital Gineco-Obstétrico Enrique C. Sotomayor 2011-2013. Creación de un algoritmo diagnóstico- terapéutico
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El manejo del abdomen agudo en la embarazada requiere una estrecha comunicación y colaboración del equipo de salud, incluyendo los servicios de obstetricia, cirugía, anestesiología y radiología, ya que su diagnóstico y manejo tempranos pueden evitar complicaciones. Algunas situaciones especiales del embarazo convierten el diagnóstico del abdomen agudo en un reto especial: el tamaño creciente del útero, que desplaza algunos órganos y dificulta el examen físico del abdomen; la alta prevalencia de náuseas, vómito y dolor abdominal durante el embarazo; la resistencia a operar innecesariamente a una mujer gestante, y la consideración por la salud de al menos dos pacientes a la vez. Se realizó un estudio de tipo descriptivo y correlacional, de diseño no experimental, retrospectivo y longitudinal, en el que se incluyó a todas las mujeres embarazadas que ingresaron al Hospital E. Sotomayor para realizarse un procedimiento quirúrgico no obstétrico en el periodo comprendido entre enero del 2011 a diciembre del 2013. El grupo de edad más afectado fue el de 26 a 30 años con 35 % de los casos. La cirugías se presentaron mayormente en el grupo de embarazadas que cursaron las primeras 20 semanas (51%) .La mayoría de las pacientes sometidas a cirugía no obstétricas estuvieron hospitalizadas en un promedio de 3 días ,47 %.El 100 % de las pacientes acudió a emergencia por presentar dolor Las principales características del dolor ,era focalizado (89%), tipo cólico (91%), y se exacerbaba con el movimiento (86%). El 54 % de las pacientes se les realizó apendicetomía, seguido de colecistectomía 27%, 16 % cerclaje por incompetencia cervical. El 100 % de las pacientes fue dado de alta en buenas condiciones. Del 100 % de los fetos , 3 fallecen (3%).
The management of acute abdomen in pregnancy requires close communication and collaboration of the health team, including obstetric services, surgery, anesthesiology and radiology, as early diagnosis and management can prevent complications. Some special situations of pregnancy make the diagnosis of acute abdomen in a special challenge: the growing size of the uterus, displacing some organs and impairs the physical examination of the abdomen; the high prevalence of nausea, vomiting and abdominal pain during pregnancy; operate unnecessarily resistance to a pregnant woman, and health considera¬ción by at least two patients at a time. A study of descriptive and correlational, not experimental, retrospective and longitudinal design in which all pregnant women admitted to E. Sotomayor Hospital for a non-obstetric surgical procedure performed in the period between January was included was conducted 2013.Finalmente December 2011 concludes that the most affected age group is 26-30 years 35% of cases. The surgeries were presented mostly in the group of pregnant women who completed the first 20 weeks (51%) .The majority of patients undergoing non-obstetric surgery were hospitalized for an average of three days, 47% .The 100% of patients attended to emergency have pain The main features of pain, was focused (89%), cramping (91%), and is exacerbated by the movement (86%). 54% of the patients underwent appendectomy, cholecystectomy followed by 27%, 16% cerclage for cervical incompetence. 100% of patients discharged in good condition. 100% of fetuses, 3 die (3%).
The management of acute abdomen in pregnancy requires close communication and collaboration of the health team, including obstetric services, surgery, anesthesiology and radiology, as early diagnosis and management can prevent complications. Some special situations of pregnancy make the diagnosis of acute abdomen in a special challenge: the growing size of the uterus, displacing some organs and impairs the physical examination of the abdomen; the high prevalence of nausea, vomiting and abdominal pain during pregnancy; operate unnecessarily resistance to a pregnant woman, and health considera¬ción by at least two patients at a time. A study of descriptive and correlational, not experimental, retrospective and longitudinal design in which all pregnant women admitted to E. Sotomayor Hospital for a non-obstetric surgical procedure performed in the period between January was included was conducted 2013.Finalmente December 2011 concludes that the most affected age group is 26-30 years 35% of cases. The surgeries were presented mostly in the group of pregnant women who completed the first 20 weeks (51%) .The majority of patients undergoing non-obstetric surgery were hospitalized for an average of three days, 47% .The 100% of patients attended to emergency have pain The main features of pain, was focused (89%), cramping (91%), and is exacerbated by the movement (86%). 54% of the patients underwent appendectomy, cholecystectomy followed by 27%, 16% cerclage for cervical incompetence. 100% of patients discharged in good condition. 100% of fetuses, 3 die (3%).
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Embarazo, Cirugía, Epidemiología descriptiva, Estudios retrospectivos, Hospital Gineco-Obstétrico Enrique C. Sotomayor, Cantón Guayaquil, Ecuador, Algoritmo de diagnóstico