Caracterización de los resultados adversos maternos y neonatales luego de operación cesárea en la E.S.E. Clínica de Maternidad Rafael Calvo

Introduccion: la Organizacion Mundial de la Salud (OMS) recomienda que la incidencia de cesarea no supere el 15%; sin embargo, su uso se ha incrementado en las dos ultimas decadas, lo cual implica un problema de salud publica. Objetivo: caracterizar los resultados adversos maternos y neonatales de la cesarea en la Clinica Maternidad Rafael Calvo (CMRC) de Cartagena Colombia. Materiales y metodos: estudio descriptivo de corte transversal, donde se caracterizaron los resultados adversos maternos y neonatales posteriores a cesarea. Resultados: se realizaron 1.804 cesareas (46.5%) y 2.073 partos vaginales (53.5%). Las indicaciones mas frecuentes para cesarea fueron cesarea anterior (35.5%), desproporcion cefalo pelvica (30.6%) y oligoamnios (10.8%). Los resultados adversos maternos mas frecuentes fueron hemorragia que requirio transfusion (9.17%), hematoma en la herida quirurgica (3.28%) e ingreso a UCI (1.5%). Los resultados neonatales adversos mas frecuentes fueron APGAR <7 al minuto (21.3%), taquipnea transitoria del recien nacido (9.6%) y APGAR<7 a los 5´ (4.3%). El control prenatal (CNP) fue factor protector para hemorragia uterina que requirio transfusion (OR crudo 0.54, IC 0.38 – 0.76, OR ajustado 0.53 IC 0.38 – 0.76), hemorragia uterina que requirio histerectomia (OR crudo 0.20, IC 0.01 - 0.72, OR ajustado 0.11, IC 0.11 – 0.72), shock obstetrico (OR crudo 0.06, IC 0.00 – 0.55, OR ajustado, 0.04, IC 0.04 – 0.38) y destino (alojamiento conjunto) (OR ajustado 0.66 IC 0.49 – 0.90), APGAR <7 a 1’ (OR ajustado 0.78, IC, 0.44 – 0.72), APGAR <7 a los 5’ (OR ajustado 0.48, IC 0.28 – 0.82) y la presencia de sindrome de distres respiratorio (OR crudo 0.28, IC, 0.15 – 0.51; OR ajustado 0.53, IC 0.28 – 0.98). Conclusiones: la proporcion de cesareas que se realizan en la CMRC (46,5%) es superior al 15% recomendado por la OMS. La operacion cesarea conlleva al aumento de morbilidad materno- fetal. El CNP se comporto como factor protector frente a la aparicion de resultados adversos maternos y neonatales. Rev.cienc.biomed. 2015;6(2):241-250 PALABRAS CLAVE Cesarea; Obstetricia ; Hemorragia. SUMMARY Introduction : the World Health Organization (WHO) recommends that the incidence of cesarean must not exceed 15%; however, its use has increased in the last two decades, which implies a public health problem. Objective : to characterize the maternal and neonatal adverse outcomes of caesarean in the Clinica Maternidad Rafael Calvo (CMRC),Cartagena-Colombia. Methodology: a descriptive cross-sectional study, where after cesarean maternal and neonatal adverse outcomes were characterized. Results: 1.804 cesarean sections (46.5%) and 2.073 vaginal deliveries (53.5%) were performed. The most common indications for cesarean section were before cesarean (35.5%), cephalo pelvic disproportion (30.6%) and oligoamnios (10.8%). The most common adverse maternal outcomes were bleeding requiring transfusion (9.17%), surgical wound hematoma (3.28%) and admission to ICU (1.5%). The most common  adverse neonatal outcomes were APGAR <7 per minute (21.3%), transient tachypnea of the newborn (9.6%) and Apgar <7 at 5 ‘(4.3%). Prenatal care (PNC) was protective factor for uterine bleeding requiring transfusion (OR crude 0.54, CI 0.38 to 0.76, OR adjusted 0.53 IC 0.38 to 0.76), uterine bleeding which required hysterectomy (OR crude 0.20, CI 0.01 to 0.72, OR adjusted 0.11, IC: 0.11 to 0.72), obstetric shock (OR crude 0.06, IC: 0.00 to 0.55 ,OR adjusted 0.04, CI 0.04 to 0.38) and destination (rooming) (OR 0.66, IC 0.49 to 0.90), APGAR <7 at 1 ‘( OR 0.78 IC 0.44 to 0.72), Apgar <7 at 5 ‘(adjusted OR 0.48, IC 0.28 to 0.82) and the presence of respiratory distress (OR crude 0,28 IC, 0.15 to 0.51; OR adjusted 0.53, IC 0.28 to 0.98) Conclusions: the proportion of cesarean sections performed in the CMRC (46.5%) is above 15% recommended by WHO. Cesarean section leads to increased maternal and fetal morbidity. The CNP acted as a protective factor against the occurrence of adverse maternal and neonatal outcomes. Rev.cienc.biomed. 2015;6(2):241-250 KEYWORDS Cesarean; Obstetric; Hemorrhage.