Riesgo y beneficio del manejo conservador o interrupción temprana de embarazo pretérmino con ruptura prematura de membrana
Fecha
2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: El manejo de la Ruptura Prematura De Membranas (RPM) pretérmino todavía
es una controversia, especialmente en lo referente al manejo conservador y la interrupción
inmediata, por lo que se requieren más estudios.
Objetivos: Determinar si existen diferencias en el riesgo y beneficio neonatal y maternos
provocadas entre el manejo conservador y la interrupción temprana en embarazos
pretérminos complicados con RPM.
Metodología: Se realizó un estudio caso control que incluyó si aleatorización 20 gestantes
con indicación de interrupción temprana y 29 pacientes manejadas conservadoramente por
diagnóstico de RPM antes de término en el hospital Teodoro Maldonado Carbo, Guayaquil,
entre el 1-01-2017 al 31-06-2021.
Resultados: En la madre, el manejo conservador se asoció a menor número de cesáreas (p
0.002; OR= 0.115: IC95% 0.026 – 0.507) menor estancia prenatal (p 0.000) y postnatal (p
0.040); no hubo diferencias con relación a uso de antibióticos adicionales o desarrollo de
corioamnionitis. En neonatos, el tratamiento conservador se asoció con menor peso al nacer
(p 0.076), Apgar al minuto (p 0.018; OR= 5.777: IC95% 1.298 – 25.709) y 5 minutos (p
0.003; OR= indefinido), necesidad de surfactante (p 0.000; OR= 15.333: IC95% 3.717 –
63.243) ventilación mecánica (p 0.001; OR= 7.200: IC95% 1.933 – 26.813), infección neonatal
(p 0.000; OR= 11.500: IC95% 2.971 – 44.519), infección neonatal temprana (p 0.000; OR=
16.095: IC95% 3.564 – 72.677), ingreso a UCIN (p 0.003; OR= 7.875: IC95%
2.279 – 27.208), estancia hospitalaria (p 0.000) y estancia total (p 0.000). No hubo diferencias
en el peso al nacer,
Conclusiones: El manejo con interrupción temprana implica menos riesgos y mejores
resultados maternos y neonatales
Background: The management of preterm premature rupture of membranes (PPROM) still is controversial, especially regarding conservative management and immediate rupture, so more studies are needed. Objectives: To determine if there are differences in neonatal and maternal risks and benefits between conservative management and early rupture in preterm pregnancies complicated with PPROM. Methodology: A non-randomized control study was conducted including 20 pregnant women with indication for early rupture and 29 patients managed conservatively for a diagnosis of preterm PPROM at the Teodoro Maldonado Carbo Hospital, Guayaquil, between January 1, 2017, and June 31, 2021. Results: In the mother, conservative management was associated with fewer cesarean sections (p 0.002 / OR= 0.115; IC 95% 0.026 - 0.507), shorter prenatal (p 0.000) and postnatal stay (p 0.040) than with early rupture; there were no differences in relation to use of additional antibiotics or development of chorioamnionitis. Among neonates, conservative treatment was associated with lower birth weight (p 0.076), Apgar at 1 minute (p 0.018; OR= 5.777: IC95% 1.298 – 25.709) and 5 minutes (p 0.003; OR= undefined), need for surfactant (p 0.000; OR= 15.333: IC95% 3.717 – 63.243), mechanical ventilation (p 0.001; OR= 7.200: IC95% 1.933 – 26.813), neonatal infection (p 0.000; OR= 11.500: IC95% 2.971 – 44.519), early neonatal infection (p 0.000; OR= 16.095: IC95% 3.564 – 72.677), NICU admission (p 0.003; OR= 7.875: IC95% 2.279 – 27.208), hospital stay (p 0.000) and total length of stay (p 0.000). There were no differences in birth weight, Apgar at 10 minutes, time on oxygen therapy, necrotizing enterocolitis, NICU stay and neonatal death. Conclusions: Management with early rupture implies fewer risks and better maternal and neonatal outcomes.
Background: The management of preterm premature rupture of membranes (PPROM) still is controversial, especially regarding conservative management and immediate rupture, so more studies are needed. Objectives: To determine if there are differences in neonatal and maternal risks and benefits between conservative management and early rupture in preterm pregnancies complicated with PPROM. Methodology: A non-randomized control study was conducted including 20 pregnant women with indication for early rupture and 29 patients managed conservatively for a diagnosis of preterm PPROM at the Teodoro Maldonado Carbo Hospital, Guayaquil, between January 1, 2017, and June 31, 2021. Results: In the mother, conservative management was associated with fewer cesarean sections (p 0.002 / OR= 0.115; IC 95% 0.026 - 0.507), shorter prenatal (p 0.000) and postnatal stay (p 0.040) than with early rupture; there were no differences in relation to use of additional antibiotics or development of chorioamnionitis. Among neonates, conservative treatment was associated with lower birth weight (p 0.076), Apgar at 1 minute (p 0.018; OR= 5.777: IC95% 1.298 – 25.709) and 5 minutes (p 0.003; OR= undefined), need for surfactant (p 0.000; OR= 15.333: IC95% 3.717 – 63.243), mechanical ventilation (p 0.001; OR= 7.200: IC95% 1.933 – 26.813), neonatal infection (p 0.000; OR= 11.500: IC95% 2.971 – 44.519), early neonatal infection (p 0.000; OR= 16.095: IC95% 3.564 – 72.677), NICU admission (p 0.003; OR= 7.875: IC95% 2.279 – 27.208), hospital stay (p 0.000) and total length of stay (p 0.000). There were no differences in birth weight, Apgar at 10 minutes, time on oxygen therapy, necrotizing enterocolitis, NICU stay and neonatal death. Conclusions: Management with early rupture implies fewer risks and better maternal and neonatal outcomes.
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ANTIBIOTICS, FACTORES DE RIESGO, EMBARAZO PRETERMINO, RECIEN NACIDO, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR