Eficacia y seguridad del cerclaje cervical profiláctico terapéutico y de emergencia. Resultados materno neonatales
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2019
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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El cerclaje cervical es un procedimiento quirúrgico para prevención y corrección de la insuficiencia del cuello uterino siendo su principal objetivo brindar soporte mecánico al cérvix mediante la colocación de puntos de sutura evitando o frenando la dilatación. La incidencia de esta patología es cada vez mayor y se asocia a tasas elevadas de morbimortalidad materno- fetal siendo un tema de interés científico, razón por la cual se desarrolló el presente estudio cuyo propósito fue determinar la eficacia y seguridad del cerclaje cervical con técnica de McDonald, ya sea como procedimiento profiláctico, terapéutico y de emergencia. Para la sustentación teórica se recabo información en meta buscadores médicos con enfoque en revisiones sistemáticas. Por el tipo y diseño de investigación se plantea un estudio: Analítico - Correlacional, retrospectivo, de corte transversal. Mediante aplicación de prueba de hipótesis se aceptó que la técnica de McDonald es eficaz y seguro para el manejo de pacientes con incompetencia cervico uterina. Los principales resultados maternos fueron: Amenaza de parto pre término (12.5 %), ruptura de membranas (7.50 %), amenaza de aborto (5.00 %) y hemorragia ante parto y aborto con un (2.50 %). Se observó que un (70.00 %) de casos no presentó complicaciones maternas. En cuanto a las complicaciones neonatales el (82.50 %) no presentó complicaciones un (10.00 %) presentó parto prematuro y 1 solo caso de sepsis neonatal, no se reportaron casos de muerte neonatal. En cuanto a la prueba de hipótesis el p valor obtenido para complicaciones maternas fue de (0.016) y para complicaciones neonatales (0.002).
The cervical cerclage is a surgical procedure for the prevention and correction of the insufficiency of the cervix, its main objective being to provide mechanical support to the cervix by placing stitches avoiding or stopping the dilation. The incidence of this pathology is increasing and is associated with high rates of maternal-fetal morbidity and mortality being a subject of scientific interest, which is why the present study was developed whose purpose was to determine the efficacy and safety of the cervical cerclage using the technique of McDonald, either as a prophylactic, therapeutic and emergency procedure. For the theoretical support, information was gathered in medical meta-searchers with a focus on systematic reviews. For the type and design of research, a study is proposed: Analytical - Correlational, retrospective, cross-sectional. Through hypothesis testing, it was accepted that the McDonald technique is effective and safe for the management of patients with cervical incompetence. The main maternal results were: Threat of preterm birth (12.5%), rupture of membranes (7.50%), threat of abortion (5.00%) and antepartum hemorrhage and abortion with one (2.50%). It was observed that one (70.00%) of cases did not present maternal complications. Regarding neonatal complications, (82.50%) did not present complications, one (10.00%) presented premature birth and 1 case of neonatal sepsis, no cases of neonatal death were reported. As for the hypothesis test, the p value obtained for maternal complications was (0.016) and for neonatal complications (0.002).
The cervical cerclage is a surgical procedure for the prevention and correction of the insufficiency of the cervix, its main objective being to provide mechanical support to the cervix by placing stitches avoiding or stopping the dilation. The incidence of this pathology is increasing and is associated with high rates of maternal-fetal morbidity and mortality being a subject of scientific interest, which is why the present study was developed whose purpose was to determine the efficacy and safety of the cervical cerclage using the technique of McDonald, either as a prophylactic, therapeutic and emergency procedure. For the theoretical support, information was gathered in medical meta-searchers with a focus on systematic reviews. For the type and design of research, a study is proposed: Analytical - Correlational, retrospective, cross-sectional. Through hypothesis testing, it was accepted that the McDonald technique is effective and safe for the management of patients with cervical incompetence. The main maternal results were: Threat of preterm birth (12.5%), rupture of membranes (7.50%), threat of abortion (5.00%) and antepartum hemorrhage and abortion with one (2.50%). It was observed that one (70.00%) of cases did not present maternal complications. Regarding neonatal complications, (82.50%) did not present complications, one (10.00%) presented premature birth and 1 case of neonatal sepsis, no cases of neonatal death were reported. As for the hypothesis test, the p value obtained for maternal complications was (0.016) and for neonatal complications (0.002).
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Cerclaje cervical, Insuficiencia cervical, Recién nacido, Incidencia, Profilaxis obstétrico, Indicadores de morbimortalidad, Complicaciones, Epidemiología analítica, Hospital de la Mujer Alfredo G. Paulson, Cantón Guayaquil, Ecuador, Resultante materno, Resultante neonatal