Browsing by Author "Vera P G, Claudio"

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    Critically appraised article: Fetal pulse oximetry and cesarean delivery
    (SOC MEDICA SANTIAGO, 2008) Cerda L, Jaime; Vera P G, Claudio
    Background: Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition at birth. Methods: We randomly assigned 5341 nulliparous women who were at term and in early labor to either << open >> or << masked >> fetal pulse oximetry. In the open group, fetal oxygen saturation values were displayed to the clinician. In the masked group, the fetal oxygen sensor was inserted and the values were recorded by computer, but the data were hidden. Labor complicated by a nonreassuring fetal heart rate before randomization was documented for subsequent analysis. Results: There was no significant difference in the overall rates of cesarean delivery between the open and masked groups (26.3% and 27.5%, respectively; p = 0.31). The rates of cesarean delivery associated with the separate indications of a nonreassuring fetal heart rate (7.1 % and 7.9%, respectively; p = 0.30) and dystocia (18.6% and 19.2%, respectively; p = 0.59) were similar between the two groups. Similar findings were observed in the subgroup of 2168 women in whom a nonreassuring fetal heart rate was detected before randomization. The condition of the infants at birth did not differ significantly between the two groups. Conclusions: Knowledge of the fetal oxygen saturation is not associated with a reduction in the rate of cesarean delivery or with improvement in the condition of the newborn.
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    Under diagnosis of fetal growth restriction by the new growth curves of the Chilean Ministry of Health
    (Wiley, 2007) Carvajal, Jorge A.; Vera P G, Claudio; Vargas, Paula, I; Jordan U, Felipe; Patillo G, Alejandro; Oyarzun E, Enrique
    Background: Fetal growth restriction (FGR) is associated with increased risk of perinatal morbidity or death, Nationwide implementation of new fetal growth charts, requires a lower fetal weight for the diagnosis of FGR, compared to previous ones. This may lead to an under diagnosis of FGR in a large proportion of neonates. Aim: To compare the morbidity, mortality and anthropometry of neonates with FGR, diagnosed by MINSAL and Juez curves, with normal weight newborns in the same period (2000-2004). Material and methods. Revision of medical records of all births occurring in a maternity hospital between 2000 and 2004. The number of neonatal deaths, and the presence of hyperbilirubinemia, polyglobulia, hypoglycemia and hypotbermia, were compared among children classified to be below percentile 10 of fetal growth according to both growth charts. Results. FGR was diagnosed in 4,4% (502/11.289) and 9% (1.029/11.289) of newborns by MINSAL and Juez curves respectively. Compared to normal weight controls, the 527 newborns without FGR according to AHNSAL curves, but below percentile 10 of Juez curves, bad an odds ratio (OR) for polyglobulina of 8.14 (95016 confidence, intervals (G): 1.01-65-34), an OR for neonatal hypoglycemia of 5.10 (95% CT 1.11-23.39) and an OR for a ponderal index below 10(th) percentile of 10.98 (95% CI- 6.84-17.64). Conclusions: Newborns without a diagnosis of FGR by MINSAL curves but below 10(th) percentile by Juez curves, have neonatal outcomes suggesting a true FGR. Juez curves should be maintained as a standard for the evaluation of fetal growth, in our population (Rev Med Chile 2007- 135.- 436-42).