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El part prematur pot sobrevenir per riscos del mateix embaràs o bé per la necessitat de realitzar algun tipus de cirurgia fetal. La probabilitat de donar a llum abans de la data estimada se situa entre 8% i el 12% als països desenvolupats. Aquest percentatge augmenta 5-6 vegades quan es tracta d'embarassos múltiples. En aquest article, investigadores de l'Hospital Universitari Vall d'Hebron fan un repàs sobre alguns dels factors de risc, i avaluen algunes tècniques de prevenció comparant els riscos que impliquen cadascuna. Les conclusions es basen en la seva pròpia experiència com a professionals, que ha estat publicada en revistes científiques d'impacte. El parto prematuro puede sobrevenir por riesgos del propio embarazo o bien por la necesidad de realizar algún tipo de cirugía fetal. La probabilidad de dar a luz antes de la fecha estimada se sitúa entre 8% y el 12% en los países desarrollados, y aumenta 5-6 veces cuando se trata de embarazos múltiples. En este artículo, investigadoras del Hospital Universitari Vall d'Hebron hacen un repaso sobre algunos de los factores de riesgo, y evalúan algunas técnicas de prevención comparando los riesgos que implican cada una. Las conclusiones se basan en su propia experiencia como profesionales, que ha sido publicada en revistas científicas de impacto. Preterm delivery can occur either due to the risks of pregnancy itself, or due to the need to perform some type of fetal surgery. There is an 8% to 12% chance of a baby being born prematurely in developed countries. A risk which increases from 5 to 6 times when it comes to multiple gestations. In this article, researchers from the Vall d'Hebron University Hospital review some of the risk factors, and evaluate a series of prevention techniques by comparing the risks involved in each one. The conclusions are based on their own experience as professionals, which has been published in scientific journals of impact.

Objectives To compare the ability of first‐trimester combined screening for pre‐eclampsia (PE) to predict early‐onset and preterm PE when pregnancy‐associated plasma protein‐A (PAPP‐A) and placental growth factor (PlGF) were assessed before vs after 11 weeks' gestation. Methods This was a secondary analysis of a prospective cohort study of singleton pregnancies undergoing routine first‐trimester screening conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between October 2015 and September 2017. Demographic characteristics, obstetric history, maternal history and biophysical markers (mean uterine artery pulsatility index and mean arterial blood pressure (MAP)) were recorded at the first‐trimester scan (at 11 + 0 to 13 + 6 weeks' gestation). Maternal serum concentrations of PAPP‐A and PlGF were assessed from the routine first‐trimester blood test (at 8 + 0 to 13 + 6 weeks). Women were classified into two groups depending on whether serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks or at 11 + 0 to 13 + 6 weeks. Probability scores for early‐onset and preterm PE were calculated by using two different algorithms: the multivariate Gaussian‐distribution model and The Fetal Medicine Foundation (FMF) competing‐risks model. Receiver‐operating‐characteristics (ROC) curves were produced and detection rates at fixed 5% and 10% false‐positive rates were computed to compare the performance of these algorithms when PAPP‐A and PlGF were assessed before vs after 11 weeks. Results Of the 2641 women included, serum biomarkers were assessed before 11 weeks in 1675 (63.4%) and at or after 11 weeks in 966 (36.6%). Of these, 90 (3.4%) women developed PE, including 11 (0.4%) cases of early‐onset PE and 30 (1.1%) of preterm PE. Five (45.5%) cases of early‐onset and 16 (53.3%) of preterm PE were identified in the group in which serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks and six (54.5%) cases of early‐onset and 14 (46.7%) of preterm PE in the group in which serum biomarkers were assessed at 11 + 0 to 13 + 6 weeks. In the prediction of early‐onset and preterm PE using the Gaussian algorithm, no differences were observed between the areas under the ROC curves (AUCs) when PAPP‐A and PlGF were measured before or after 11 weeks. In the prediction of early‐onset and preterm PE using the FMF algorithm, no differences were observed between AUCs for any of the combinations used for risk calculation when the serum biomarkers were obtained before vs after 11 weeks, except for the combination of PAPP‐A and MAP, which showed a greater AUC for the prediction of early‐onset PE when PAPP‐A was measured at or after 11 weeks. Conclusions The prediction of early‐onset and preterm PE is similar when serum biomarkers are measured before or after 11 weeks. This allows the use of a two‐step approach for PE risk assessment that permits immediate risk calculation at the time of the first‐trimester scan. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Introduction: The analysis of patients&rsquo, satisfaction with healthcare is recognised as being useful in the evaluation of health outcomes and perceived quality of care. Little is known, however, about how the psychological status of women who experience perinatal complications may affect their perceived satisfaction with care. Methods: We assessed healthcare satisfaction in 52 women who had undergone intrauterine surgery during a complicated monochorionic twin pregnancy and examined the influence that fetal loss and sociodemographic, clinical, and psychological factors had on the degree of satisfaction. Data were gathered in an individual interview and through the administration of the Medical Patient Satisfaction Questionnaire, Beck Depression Inventory, and State&ndash, Trait Anxiety Inventory. Relationships between variables were analysed using a chi-square test, Spearman&rsquo, s rho, Student&rsquo, s t test, and the Mann&ndash, Whitney U test, in accordance with the metric nature of the variables and the assumptions fulfilled. Results: Age and level of education were not associated with the degree of healthcare satisfaction. Negative but non-significant correlations were observed between the level of satisfaction and symptoms of anxiety and depression. Satisfaction with healthcare was high in the sample as a whole, although it was significantly higher among women who had not experienced fetal loss. There were no differences in satisfaction with services involving direct contact with medical staff, whereas satisfaction with indirect services was lower among women who had experienced perinatal loss. Conclusions: Due to the unique characteristics of this population, specialised care teams of both professional healthcare and indirect services are needed. Although administrative aspects of healthcare are regarded as being of secondary importance, this may not be the case with more vulnerable populations.

Un paciente paliativo oncológico es aquel que tiene una enfermedad oncológica previsiblemente incurable y sin posibilidades de beneficio terapéutico. Los cuidados paliativos previenen o tratan los síntomas siendo el dolor uno de los más prevalentes y preocupantes para dichos pacientes. Según el tipo de dolor que padezca, se deberá tratar de una forma u otra eligiendo la vía subcutánea como alternativa a la vía oral, en caso de no tener disponible ésta. Uniéndose estos tratamientos farmacológicos con otros como las técnicas de relajación. Tras la revisión bibliográfica se constata que la mayoría de los programas docentes de las Facultades de Enfermería dedican poco tiempo al tratamiento del control del dolor.

El trasplante renal de donador vivo o de cadáver, es actualmente la mejor opción de tratamiento para los pacientes con insuficiencia Renal Crónica Terminal. En Nicaragua la incidencia de insuficiencia Renal Crónica ha aumentado en los últimos años, según la base de datos del Hospital lnfantil Manuel de Jesús Rivera, hay un total de 422 niños; la mayoría se encuentran en algún tipo de terapia sustitutiva. El programa de trasplante renal se inició en el año 2005, habiéndose realizado hasta ahora un total de 39 trasplantes renales, de los cuales se tomó una muestra de 27 pacientes que fueron los que se realizaron dentro de nuestro hospital y que cumplieron con los criterios de inclusión del estudio; el objetivo de este fue el evaluar los resultados y proporcionar recomendaciones que puedan retroalimentar el programa de trasplante renal para tener una menor morbilidad y mortalidad. Se concluyó que la evolución clínica de los pacientes fue satisfactoria, logrando en estos una mejoría en su patrón de vida y desarrollo, no se consiguió recuperar el déficit de desarrollo hasta el momento del trasplante, pero si se logró evitar una mayor afectación pondo estatural mejorando el desarrollo psicointelectual y social. La mayor incidencia de IRCT se da en niños del sexo masculino diagnosticado generalmente en etapas avanzadas, el grupo etario más afectado fue 11 a 15 y de 16 a 20 años y eran provenientes de la Región 2 y 3 de Nicaragua. Las etiologías de mayor prevalencia fueron las causas no determinadas, seguida del síndrome Nefrótico cortico resistente. Se encontró que las infecciones, rechazo crónico y los eventos vasculares son causas más frecuentes de pérdida del injerto y fallecimiento. En todos los pacientes se cumplió con el protocolo diagnóstico y terapéutico de trasplante renal. En el futuro se necesitara dirigir los esfuerzos para incrementar el número de trasplante renales e implementar el trasplante preventivo 1o que reduce los costos y mejora la supervivencia del injerto, asociándose a una reducción del 25% en el fallo del injerto y del 16% en la mortalidad. Demostrando que es factible realizarlo con resultados comparables a los estándares internacionales en un hospital del Ministerio de Salud e implementando un programa con financiamiento público dirigido a la población en pobreza y extrema pobreza de nuestro país

Cervical pessary; Fetoscopic LASER coagulation, Twin-to-twin transfusion syndrome Pessari cervical; Coagulació làser fetoscòpica; Síndrome de transfusió bessó a bessó Pesario cervical; Coagulación láser fetoscópica; Síndrome de transfusión de gemelo a gemelo Background Fetoscopic LASER coagulation of the placental anastomoses has changed the prognosis of twin-twin transfusion syndrome. However, the prematurity rate in this cohort remains very high. To date, strategies proposed to decrease the prematurity rate have shown inconclusive, if not unfavourable results. Methods This is a randomised controlled trial to investigate whether a prophylactic cervical pessary will lower the incidence of preterm delivery in cases of twin-twin transfusion syndrome requiring fetoscopic LASER coagulation. Women eligible for the study will be randomised after surgery and allocated to either pessary or expectant management. The pessary will be left in place until 37 completed weeks or earlier if delivery occurs. The primary outcome is delivery before 32 completed weeks. Secondary outcomes are a composite of adverse neonatal outcome, fetal and neonatal death, maternal complications, preterm rupture of membranes and hospitalisation for threatened preterm labour. 352 women will be included in order to decrease the rate of preterm delivery before 32 weeks’ gestation from 40% to 26% with an alpha-error of 0.05 and 80% power. Discussion The trial aims at clarifying whether the cervical pessary prolongs the pregnancy in cases of twin-twin transfusion syndrome regardless of cervical length at the time of fetoscopy.