Signos de vida en la morbilidad de la gestante
Resumo
Para la valoración de las gestantes es indispensable incorporar parámetros que permitan la identificación de alteraciones de parte del personal de enfermería y medicina. Esta valoración en la atención de salud no se realiza en todas las instituciones en las cuales consultan las gestantes, llevarlo a cabo permite detectar a tiempo las alteraciones clínicas que incrementan la morbilidad y la mortalidad materna. El estudio determina las alteraciones en gestantes cuando se aplica la Escala de Alerta Temprana en una institución de alta complejidad en Colombia.
Método: Investigación observacional descriptiva, en 308 gestantes con más de un día de encontrarse en hospitalización y unidad de cuidados especial obstétrico, recolectando información contenida en las historias clínicas digitales y las evaluaciones realizadas por el personal de salud durante el periodo enero a diciembre del 2017, a través de un formato general de condiciones de salud y la escala de alerta temprana en una institución de alta complejidad.
Resultados: La edad de las gestantes se encuentra entre 14 y 45 años. El diagnóstico más frecuente de ingreso fue preclampsia con un 38.2% IC95% (32.62-43.98). La mayor frecuencia de alteraciones está en la tensión arterial sistólica con un 70.1% IC95% (50.75-62.07), tensión diastólica 56.5% IC 95% (50.75-62.07) y alteración respiratoria 28.9% IC (23.97-34.36). Se encontró significancia estadística entre la estancia y los antecedentes patológicos con p<0.03. Los procedimientos de valoración, diagnóstico y registro oportuno por el personal de enfermería y médico son de vital importancia en la detección precoz de la morbilidad materna extrema.
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Referências
(1) Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387(10017):462-74.DOI: https://doi.org/10.1016/S0140-6736(15)00838-7.
(2) Machiyama K, Hirose A, Cresswell JA, Barreix M, Chou D, Kostanjsek N, et al. Consequences of maternal morbidity on health-related functioning: a systematic scoping review. BMJ Open. 2017; 7(6): e013903. DOI: http://dx.doi.org/10.1136/bmjopen-2026-013903
(3) Arora KS, Shields LE, Grobman WA, D’Alton ME, Lappen JR, Mercer BM. Triggers, bundles, protocols, and checklists-what every maternal care provider needs to know. Am J Obstet Gynecol. 2016; 214(4):444–51. DOI: https://doi.org/10.1016/j.ajog.2015.10.011
(4) Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia 2012; 67(01):12–18 DOI: https://doi.org/10.1111 / j.1365-2044.2011.06896.x
(5) Paternina-Caicedo A, Miranda J, Bourjeily G, Levinson A, Dueñas C, Bello-Muñoz C, et al. Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Am J Obstet Gynecol. 2017; 216: 58. E1–58. E8. DOI: https://doi.org/10.1016/j.ajog.2016.09.103
(6) Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of Maternal Early Warning Trigger tool reduces maternal morbidity. Am J Obstet Gynecol 2016; 214(4): 527.E1-527. E6. DOI: https://doi.org/10. 1016/j.ajog.2016.01.154
(7) Friedman AM. Maternal early warning systems. Obstet Gynecol Clin North Am 2015;42(2):289–98.
(8) Donaldson L, Panesar SS, Darzi A. Patient-Safety-Related Hospital Deaths in England: Thematic Analysis of Incidents Reported to a National Database, 2010–2012. PLOS Med. 2014; 11(6) DOI: https://dx.doi.org/10.1371%2Fjournal.pmed.1001667
(9) Loureiro CM, Ríos-Cataño C, Torricelli L, Dos Santos JC, Gomes-Sponholz FA. Aspectos sociodemográficos e obstétricos da morbidade materna grave. Cien. enferm. 2017; 23(2): 21-32. DOI: http://dx.doi.org/10.4067/S0717-95532017000200021
(10) Wang C, Wang XY, Yang HX. Effect of Maternal Age on Pregnancy Outcomes in Beijing.Zhonghua Fu Chan Ke Za Zhi. 2017;52(8):514–520. doi: 10.3760/cma.j.issn.0529-567X.2017.08.003
(11) Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Am J Obstet Gynecol 2017; 130(2): 366-73. DOI: https://doi.org/10.1097/AOG.0000000000002114
(12) D’Alton ME, Bonanno CA, Berkowitz RL, et al. Putting the “m” back in maternal–fetal medicine. Am J Obstet Gynecol. 2013; 208 (6):442–448. DOI: https://doi.org/10.1016/j.ajog.2012.11.041
(13) Johnson PD, Duzyj CM, Howell EA, Janevic T. Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions,2019. Journal of Perinatology. doi:10.1038/s41372-019-0426-6
(14) White WM, Mielke MM, Araoz PA, Lahr BD, Bailey KR, Jayachandran M, Miller VM, Garovic VD. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol. 2016; 214(4): 519.e1–519.e8. DOI: https://doi.org/10.1016/j.ajog.2016.02.003
(15). Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010; 36(9):1465–74. DOI: https://doi.org/10.1007/s00134-010-1951-0
(16) Lumbiganon P, Laopaiboon M, Intarut N, Vogel JP, Souza JP, Gulmezoglu AM, Mori R. Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. RCOG. 2014; 121 (1): 32–39. DOI: https://doi.org/10.111/1471-0528.12647
(17) Feitosa Mourão L, Cordeiro Mendes I, Barbosa Marques AD, Ribeiro Feitosa C y Barreto de Brito B. 2018. Ingresos en UCI por causas obstétricas. Enfermería Global. 2019; 18(1):304-345. DOI: https://doi.org/10.6018/eglobal.18.1.302341
(18) Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008; 199(1):36. E1-36.E5. DOI: https://doi.org/10.1016/j.ajog.2008.03.00
(19) Paterson R, MacLeod DC, Thetford D, Beattie A, Graham C, Lam S.et al. Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Clin Med. 2006; 6(3):281–284. DOI: http://doi.org/10.7861/clinmedicine.6-3-281
(20) Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003; 58(8):797–802. DOI: https://doi.org/10.1046/j.1365-2044.2003.03258.x
(21) Bokhari SW, Munir T, Memon S, Byrne JL, Russell NH, Beed M. Impact of critical care reconfiguration and track-and-trigger outreach team intervention on out-comes of haematology patients requiring intensive care admission. Ann Hematol. 2010; 89(5):505–12. DOI: https://doi.org/10.1007/s00277-009-0853-0
(22) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation. 2011; 82(11): 1428–33. DOI: https://doi.org/10.1016/j.resuscitation.2011.05.026
(23) Elliott M. Why is Respiratory Rate the Neglected Vital Sign? A Narrative Review. Int Arch Nurs Health Care 2016, 2(3):050. URL: https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-2-050.pdf
(24) Cuthbertson BH, Boroujerdi M, McKie L, Aucott L, Prescott G. Can physiological variables and early warning scoring systems allow early recognition of the deteriorating surgical patient? Crit Care Med. 2007; 35(2): 402–9. DOI: https://doi.org/10.1097 / 01.CCM.0000254826.10520.87
(25) Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest .1990; 98:1388–92.DOI: http://dx.doi.org/10.1378/chest.98.6.1388
(26) Hillman KM, Bristow PJ, Chey T, et al. Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med. 2002; 28 (11):1629–34. URL: https://link.springer.com/article/10.1007/s00134-002-1496-y
(27) McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ .1998; 316(7):1853–8. DOI: https://doi.org/10.1136/bmj.316.7148.1853
(28) Sankey CB, McAvay G, Siner JM, MD4 , Barsky CL, Chaudhry SI. Deterioration to Door Time: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients. J Gen Intern Med.2016; 31(8):895–900. DOI: http://dx.doi.org/10.1007/s11606-016-3654-x .
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