Browsing by Author "Latorre, Rodrigo"
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Item Betametasona Fosfato para la prevención de Síndrome de Dificultad Respiratoria (SDR) del recién nacido de pretérmino(2019) Insunza, Álvaro; Novoa, José; Carrillo, Jorge; Latorre, Rodrigo; Rubio, Tania; Paiva, EnriqueABSTRACT: The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.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 ¿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%.