Browsing by Author "Insunza, Alvaro"
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Item Cesarean rates in a Chilean public hospital and the use of a new prioritization criteria: The relevance index(2019) Yamamoto, Masami; Latorre, Rodrigo; Rojas, Juan; Walker, Bernardita; Jordán, Felipe; Carrillo, Jorge; Paiva, Enrique; Insunza, AlvaroAim:Cesarean section rates are increasing worldwide and Robson’s classification system allows a practicalapproach to study this phenomenon. C-section in Chile has been indicated as unexpectedly high, withimportant variability within the country and payment systems. The aim was to report our data using Rob-son’s system and the evolution of local C-section rate in a public hospital during a 9-year period.Methods:Retrospective analysis (2005–April 2014), in a metropolitan hospital in Santiago. All deliverieswere classified into Robson groups. Time changes were analyzed with Pearson’s correlation.Pvalue <0.05was considered significant. A‘relevance index’(RI) for each group was calculated as 100×C-S rate×rela-tive contribution.Results:The overall C-section rate increased from 24 to 27% (P< 0.05) in 53 571 deliveries, with a greaterincrease in groups 1 (nulliparous, single, term cephalic, spontaneous labor), 3 (multiparous, single, no previ-ous C-S, term cephalic, spontaneous labor) and 4 (multiparous, single, no previous C-S, term cephalic,induced or no labor). Despite no increase in Group 5 (women with one or more previous C-S) this grouphad the highest RI (20.3), which defined priority for intervention over others.Conclusion:C-S rate was lower than that reported in other centers from Chile and Latin America. Robson’sclassification and the RI allowed prioritization. Although increase in groups 1, 3 and 4, group 5 needs atten-tion because of stronger impact on overall C-S rate. This analysis allowed to define how to lower C-S rate inour institutionItem DIAGNÓSTICO INCIDENTAL DE TUMOR VESICAL POR ECOGRAFÍA GINECOLÓGICA TRANSVAGINAL(2010) Yamamoto, Masami; de Alvarado, Mercedes; Figueroa, Manuel; Barroso, Juan Pablo; Caicedo, Luis Alberto; Jorge Carrillo, Jorge; Insunza, Alvaro; Paiva, EnriqueSe presenta el caso clínico de una mujer de 60 años que acude al Servicio de Ginecología y Obstetricia del Hospital Padre Hurtado, bajo la sospecha de un mioma cervical pequeño. Se realiza una ecografía transva-ginal la cual evidencia incidentalmente un tumor vesical sólido, vascularizado, intravesical y dependiente de la mucosa. La paciente no refería espontáneamente hematuria. El estudio urológico definitivo es de un carcinoma papilar de células transicionales. El tratamiento endoscópico logró la resección completa del tumor. El hallazgo ecográfico permitió realizar el diagnóstico en una forma poco habitual para esta enfermedad, aprovechando una instancia definida para otros fines. Se rescata la importancia de observar detenidamente todas las estructuras pélvicas al alcance visual del equipo de ecografía.Item ¿Es posible disminuir la Incidencia de Encefalopatía Hipóxico Isquémica?(Sociedad Chilena de Obstetricia y Ginecología, 2017) Novoa, José; Santos, María; Latorre, Rodrigo; Insunza, Alvaro; Sakovets, loulia; Yamamoto, Masami; Paiva, EnriqueObjectives: Determine whether a local policy to reduce the incidence of neonatal hypoxic-ischemic encephalopathy (HIE), established at the Maternity Unit of Hospital Padre Hurtado (HPH), is effective without significantly increasing the cesarean rate. Design: Cohort study. Setting: Maternity unit of Hospital Padre Hurtado. Population: Newborns older than 33 weeks born at Hospital Padre Hurtado between 1999 and 2015. Methods: The results of a training policy to prevent HIE and perinatal asphyxia established at the Maternity unit of Hospital Padre Hurtado were reviewed during a period of 14 years. Results: From a total of 102.612 newborns analyzed, results showed a decrease in all grades of HIE incidence, from a rate of 4.75 / 1,000 live births prior to intervention (control group) to a rate of 1.46 per 1,000 live births after interventions, with high statistically significance (p=0.008), it reached an average rate of 0.87/1000 for the last 6 years. The moderate and severe HIE rate decreased from 1.15/1000 to 0.62/1000, also with high statistically significance (p=0.02). During the same period of time, the cesarean rate varied between 26-29%. Conclusion: The introduction of protocolized and systematized interventions trough the implantation of Management guides, obstetrics emergency trainings to the professional team and continues audit of the HIE cases at the Maternity unit Hospital Padre Hurtado was associated to a significant decrease of HIE, maintaining the rate of cesareans below 30%.Item Síndrome de transfusión feto-fetal: experiencia de 69 casos(Sociedad Peruana de Obstetricia y Ginecología, 2016) Yamamoto, Masami; Huamán, Moises; Astudillo, Julio; Pedraza, Daniel; Fleiderman, Jose; Hidalgo, Guillermo; Insunza, Alvaro; Gonzalez, MarceloFetoscopy for fetal-fetal transfusion syndrome is the most frequent fetal surgery performed in the world. The results should be reported, so that the patients can choose their choice of care. Objective: To determine the results of fetal surgery on twin-to-twin transfusion syndrome. Design: Retrospective study. Setting: Clínica Alemana, Santiago, Chile. Participants: Pregnant women with twins. Interventions: Fetal surgery was performed under local anesthesia, with 3.3mm fetoscopy-specific Storz endoscopes. Main outcome measures: Fetal survival. Results: The series of cases began in the year 2005, and to date 71 surgeries were carried out, with 69 that resolved their pregnancy. Thirty-three women had both living children (48%), 25 only one living child (36%) and 11 concluded without living children (16%). Conclusions: The rate of pregnancies with one or both children born alive was 84%, exceeding 90% in the last 30 cases. There were 6 patients from Peru, of which four had two living children.Item Item Item Tromboflebitis séptica pelviana post cesárea(2020) Insunza, Alvaro; Honorato, MagdalenaPresentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.