Resultado del uso de la claritromicina en la ruptura prematura de membranas alejada de término en el Servicio de Obstetricia del Hospital De Las Mujeres Adolfo Carit Eva en el período de enero del 2013 a enero del 2018: estudio de cohorte observacional retrospectivo
Fecha
2021
Tipo
tesis
Autores
Paniagua Briceño, Adriana
Montero Camacho, Daniela
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Resumen
Antecedentes: La ruptura prematura de membranas (RPM) pretérmino se presenta en un 3% de todos los embarazos y aproximadamente el 50-60% de las pacientes con RPM iniciarán la labor de parto en el transcurso de una semana. La RPM contribuye importantemente como desencadenante de partos pretérmino. En la actualidad es reconocido que la antibioticoterapia administrada en los casos de RPM pretérmino disminuye la morbi-mortalidad perinatal al prolongar el periodo de latencia entre la ruptura de membranas y el inicio del trabajo de parto, y disminuyendo la incidencia de infección intraamniótica.
El régimen óptimo de antibióticos aún no es claro, sin embargo, existe amplia evidencia a favor del uso de eritromicina como parte del esquema.
En la Caja Costarricense del Seguro Social (CCSS) se emplea claritromicina en lugar de eritromicina en el esquema de manejo de la RPM, debido a que la eritromicina no se encuentra dentro de la lista oficial de medicamentos de la institución. No existen estudios que comparen el uso de claritromicina en lugar de eritromicina en el manejo de la RPM pretérmino.
Objetivo principal: Describir los resultados de la antibioticoterapia utilizada para la ruptura prematura de membranas alejada de término cuando se emplea claritromicina, en el Servicio de Obstetricia del Hospital De Las Mujeres Dr. Adolfo Carit Eva (HOMACE) en el período de enero del 2013 a enero del 2018.
Metodología: Estudio observacional retrospectivo de cohorte desarrollado en pacientes con edad gestacional de 24+0 a 32+0 semanas en el periodo de enero del 2013 y enero del 2018 en control en HOMACE, considerando como exposición la presencia de ruptura prematura de membranas diagnosticada por clínica a quienes se les prescribió antibioticoterapia con ampicilina/claritromicina/amoxacilina.
Resultados: Un total de 36 pacientes corresponden con la muestra que cumplió criterios de inclusión. La prolongación del embarazo se documentó en el 72.0% (26/36) de los casos y la presencia de corioamnionitis se presentó en el 8.3% (3/36). La distribución de pacientes según días de latencia (días que se prolongó el embarazo) evidenció que lo más frecuente fue un periodo de latencia mayor o igual a 7 días en el 63.9% (23/36).
Conclusión: La antibioticoterapia utilizada para la ruptura prematura de membranas alejada de término en el Servicio de Obstetricia del Hospital De Las Mujeres Dr. Adolfo Carit Eva en el período de enero del 2013 a enero del 2018 logró tener un impacto positivo en el curso clínico obstétrico, aumentando la posibilidad de prolongar el embarazo en la mayoría de las pacientes y disminuyendo el riesgo de las complicaciones asociadas a esta condición.
Background: Preterm premature rupture of membranes (PROM) occurs in 3% of all pregnancies and approximately 50-60% of women with PROM will go into labor within a week. PROM contributes greatly as a trigger for preterm labor. At present, it is recognized that antibiotic therapy administered in cases of preterm PROM reduces perinatal morbidity and mortality by prolonging the latency period between membrane rupture and the onset of labor, and decreasing the incidence of intra-amniotic infection. The optimal antibiotic regimen is not yet clear, however, there is wide evidence in favor of the use of erythromycin as part of the scheme. In the Costa Rican Social Security Fund (CCSS), clarithromycin is used instead of erythromycin in the PRM management scheme, because erythromycin is not on the institution's official drug list. There are no studies comparing the use of clarithromycin instead of erythromycin in the management of preterm PROM. Objective: To describe the results of the antibiotic therapy used for premature rupture of membranes far from term when clarithromycin is used, in the Obstetrics Service of the Women`s Hospital Dr. Adolfo Carit Eva (HOMACE) in the period from January 2013 to January 2018. Study Design: Retrospective observational cohort study developed in patients with a gestational age of 24 + 0 to 32 +0 weeks in the period between January 2013 and January 2018 in control in HOMACE, considering as exposure the presence of premature rupture of membranes diagnosed by clinic who were prescribed antibiotic therapy with ampicillin / clarithromycin / amoxacillin. Results: A total of 36 patients were evaluated. Prolongation of pregnancy was documented in 72.0% (26/36) of cases and the presence of chorioamnionitis was present in 8.3% (3/36). The distribution of patients according to days of latency (days that the pregnancy was prolonged) showed that the most frequent was a latency greater than or equal to 7 days in 63.9% (23/36). Conclusions: The antibiotic therapy used for premature rupture of membranes far from term in the Obstetric Service of Women`s Hospital Dr. Adolfo Carit Eva in the period from January 2013 to January 2018 managed to have a positive impact on the obstetric clinical course, increasing the possibility of prolonging pregnancy in most patients and decreasing the risk of complications associated with this condition.
Background: Preterm premature rupture of membranes (PROM) occurs in 3% of all pregnancies and approximately 50-60% of women with PROM will go into labor within a week. PROM contributes greatly as a trigger for preterm labor. At present, it is recognized that antibiotic therapy administered in cases of preterm PROM reduces perinatal morbidity and mortality by prolonging the latency period between membrane rupture and the onset of labor, and decreasing the incidence of intra-amniotic infection. The optimal antibiotic regimen is not yet clear, however, there is wide evidence in favor of the use of erythromycin as part of the scheme. In the Costa Rican Social Security Fund (CCSS), clarithromycin is used instead of erythromycin in the PRM management scheme, because erythromycin is not on the institution's official drug list. There are no studies comparing the use of clarithromycin instead of erythromycin in the management of preterm PROM. Objective: To describe the results of the antibiotic therapy used for premature rupture of membranes far from term when clarithromycin is used, in the Obstetrics Service of the Women`s Hospital Dr. Adolfo Carit Eva (HOMACE) in the period from January 2013 to January 2018. Study Design: Retrospective observational cohort study developed in patients with a gestational age of 24 + 0 to 32 +0 weeks in the period between January 2013 and January 2018 in control in HOMACE, considering as exposure the presence of premature rupture of membranes diagnosed by clinic who were prescribed antibiotic therapy with ampicillin / clarithromycin / amoxacillin. Results: A total of 36 patients were evaluated. Prolongation of pregnancy was documented in 72.0% (26/36) of cases and the presence of chorioamnionitis was present in 8.3% (3/36). The distribution of patients according to days of latency (days that the pregnancy was prolonged) showed that the most frequent was a latency greater than or equal to 7 days in 63.9% (23/36). Conclusions: The antibiotic therapy used for premature rupture of membranes far from term in the Obstetric Service of Women`s Hospital Dr. Adolfo Carit Eva in the period from January 2013 to January 2018 managed to have a positive impact on the obstetric clinical course, increasing the possibility of prolonging pregnancy in most patients and decreasing the risk of complications associated with this condition.
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Palabras clave
Ruptura prematura de membranas, claritromicina, corioamnionitis, Premature rupture of membranes, clarithromycin, chorioamnionitis