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      Estrategia educativa para gestión del conocimiento sobre embarazo ectópico en Atención Primaria de Salud Translated title: Educative strategy to manage knowledge on ectopic pregnancy at the primary health care level

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          Abstract

          La incidencia del embarazo ectópico se ha multiplicado mundialmente en las últimas décadas, incluyendo a Cuba, causando morbimortalidad en mujeres jóvenes constituyendo un problema de investigación. Se propone una estrategia de intervención educativa para contribuir a la gestión del conocimiento sobre el embarazo ectópico, en la Atención Primaria de Salud. Se realizó estudio prospectivo descriptivo durante los años 2004 al 2007, de las pacientes ingresadas con sospecha de Embarazo Ectópico, en el Hospital Docente Ginecobstétrico de Matanzas “Dr. Julio Alfonso Medina”, para determinar el comportamiento de la entidad a través de variables operacionalizadas como: edad, diagnóstico y formas clínicas y tratamiento; en las pacientes que cumplían con los criterios de inclusión los datos se procesaron utilizando el paquete estadístico SPSS para Windows Versión 11.5, tabulando los resultados. La incidencia del EE se elevó hasta 34,2 por mil nacidos vivos, siendo más alta en el grupo de 25-34 años (54.8%), el 80.3% se diagnosticó tardíamente y predominó la forma clínica complicada (59%), lo que motivó el 87.2% de salpingectomías realizadas. Existe dificultad con el diagnóstico precoz y remisión oportuna de las pacientes con sospecha de la entidad en la Atención Primaria de Salud. Proponemos diseñar un sitio Web sobre el tema del Embarazo Ectópico, basado en las Tecnologías de la Información y la Comunicación, para mejorar la capacitación de los internos y Medicina General Integral, en la Atención Primaria de Salud, donde existe el Policlínico Universitario.

          Translated abstract

          The incidence of ectopic pregnancy has increased around the world during the last decades, including Cuba, causing morbimortality in young women, and constituting an investigative question . We propose an educative investigation strategy to contribute to the management of knowledge on ectopic pregnancy at the primary health care level. A prospective descriptive study was conducted from 2004 to 2007, on the inpatients suspected of ectopic pregnancy at Teaching Gyneco-obstetric Hospital of Matanzas “Dr. Julio Alfonso Medina”, to determine the entity´s behavior through operational variables like: age, diagnosis and treatment and clinical forms; in patients fulfilling the inclusion criteria, data were processed using the statistical packet SPSS for Windows Version 11.5. The incidence of the ectopic pregnancy leveled up to 34,2 per thousand children born alive, being higher in the 25-34 years-old group (54.8 %), the 80.3 % was lately diagnosed and there was a predominance of the complicated clinical form (59 %), motivating 87.2 % of the salpingectomies carried out. There are difficulties with the precocious diagnosis and on-time referring of the patients suspected of the entity in primary health care. We propose designing a Web site on the Ectopic Pregnancy theme, based on the Communication and Information Technologies, to improve the qualification of the interns and physicians of Integral General Medicine al the Primary Health Care level, where there is a Teaching Policlinic.

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          Evolución de la mortalidad materna en Cuba

          Se realiza el estudio de la evolución de las cifras de mortalidad materna en Cuba desde 1959 al 2004, señalándose las principales acciones que se desarrollaron en las diferentes décadas que comprende el estudio. Se destaca el hecho de que en la mortalidad materna intervienen diferentes factores socioeconómicos y políticos que influyen directamente sobre el desarrollo del sistema de salud, sin los cuales este último no podría alcanzar los resultados que hemos logrado. Se muestra cómo de una razón de muerte materna de 137,8 × 100 000 nacidos vivos en la década 1950-1959 se llega a una razón de muerte materna de 21,2 en el año 2004, lo cual significa una reducción de un 78,3 % en el período estudiado. Igualmente se muestra cómo han evolucionado las principales causas de mortalidad materna: hemorragias, aborto, toxemia y sepsis
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            Diagnosis and management of ectopic pregnancy.

            Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected. Diagnostic uterine curettage may be appropriate in patients who are hemodynamically stable and whose beta subunit of human chorionic gonadotropin levels are not increasing as expected. Appropriate treatment for patients with nonruptured ectopic pregnancy may include expectant management, medical management with methotrexate, or surgery. Expectant management is appropriate only when beta subunit of human chorionic gonadotropin levels are low and declining. Initial levels determine the success of medical treatment. Surgical treatment is appropriate if ruptured ectopic pregnancy is suspected and if the patient is hemodynamically unstable.
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              Obstetricia y ginecología

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rme
                Revista Médica Electrónica
                Rev.Med.Electrón.
                CENTRO PROVINCIAL DE INFORMACIÓN DE CIENCIAS MÉDICAS. MATANZAS (Matanzas )
                1684-1824
                April 2009
                : 31
                : 2
                : 0
                Affiliations
                [1 ] Hospital Docente Ginecobstétrico Dr. Julio R. Alfonso Medina.
                [2 ] Hospital Universitario Clínico Quirúrgico Comandante Faustino Perez Hernandez Cuba
                [3 ] Escuela Nacional de Salud Pública Cuba
                Article
                S1684-18242009000200001
                c04169a5-eb87-4d70-9c6e-fbb42e0bce2f

                http://creativecommons.org/licenses/by/4.0/

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                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=1684-1824&lng=en
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