Publication: Impacto de la implantación de un protocolo de versión cefálica externa en un Servicio de Obstetricia y Ginecología de un hospital de tercer nivel. Análisis de costes
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2018-03-20
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Universidad Complutense de Madrid
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Abstract
La cesárea es una intervención que ha sido fundamental para disminuir la morbimortalidad maternofetal. Sin embargo, debe reservarse para casos en los que exista una indicación médica puesto que, como cualquier otra cirugía, la cesárea está asociada a riesgos a corto y a largo plazo que pueden afectar a la salud de la mujer y del neonato. El coste también es importante, puesto que las cesáreas representan un gasto significativo para los sistemas sanitarios ya de por sí sobrecargados en nuestro medio. Por otra parte, la presentación de nalgas está presente en un 3-4% de las gestaciones a término y, aunque todavía existe controversia sobre cuál es la mejor vía del parto, en lo que sí existe consenso es en que el parto vaginal en cefálica es preferible a una cesárea o a un parto de nalgas. La versión cefálica externa (VCE) es una maniobra que ha demostrado disminuir significativamente las presentaciones podálicas a término y, por tanto, las cesáreas por esta causa. Esta técnica cayó en desuso por dudas sobre la seguridad para el feto. Esto fue debido a una serie de estudios en los que la VCE se practicaba en gestaciones pretérmino. Sin embargo, a partir de los años 90, estudios aleatorizados en gestaciones a término confirmaron su seguridad. A partir de este momento, la VCE ha resurgido y la inmensa mayoría de sociedades científicas aconsejan su oferta y realización en gestantes a término sin contraindicaciones para la misma...
The cesarean section is an intervention that has been essential in decreasing the maternal and fetal morbimortality. However, it must be restricted for medical indications, given that, as with any other surgery, the cesarean section is associated with short and long term risks that can impact the women and neonatal health. The cost is also important as the cesarean sections represent an important expense for the health system, already overloaded in our medium. On the other hand, the podalic presentation is present in the 3-4% of all gestations at term. The way of delivery is still controversial but it’s clear that the vaginal delivery with a cephalic presentation is preferable to a breech vaginal delivery or a cesarean section. The external cephalic version (ECV) is a procedure that has demonstrated its value for substantially reducing the chance of breech presentation at birth and caesarean section. The popularity of this technique fell down due to a series of studies in which the ECV was practised before term. Nevertheless, from the 90s, randomized studies in term pregnancies confirmed its safety. From that moment, the ECV has resurged and the main scientifical societies recommend offering it to all women with a breech presentation at term...
The cesarean section is an intervention that has been essential in decreasing the maternal and fetal morbimortality. However, it must be restricted for medical indications, given that, as with any other surgery, the cesarean section is associated with short and long term risks that can impact the women and neonatal health. The cost is also important as the cesarean sections represent an important expense for the health system, already overloaded in our medium. On the other hand, the podalic presentation is present in the 3-4% of all gestations at term. The way of delivery is still controversial but it’s clear that the vaginal delivery with a cephalic presentation is preferable to a breech vaginal delivery or a cesarean section. The external cephalic version (ECV) is a procedure that has demonstrated its value for substantially reducing the chance of breech presentation at birth and caesarean section. The popularity of this technique fell down due to a series of studies in which the ECV was practised before term. Nevertheless, from the 90s, randomized studies in term pregnancies confirmed its safety. From that moment, the ECV has resurged and the main scientifical societies recommend offering it to all women with a breech presentation at term...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Obstetricia y Ginecología, leída el 18-04-2017