Pio Iván Gómez

Paracervical block in incomplete abortion using manual vacuum aspiration: Randomized clinical trial

OBJECTIVE: To estimate the effectiveness of paracervical block in controlling pain among women treated with manual vacuum aspiration for an incomplete abortion METHODS: A randomized clinical trial was conducted at Nuestra Señora de Altagracia, a maternal and perinatal referral hospital in the Dominican Republic. The sample size was based on a clinical difference of 1.5 points in the level of pain measured with the visual analog scale using 90% power and a sampling error of 0.04. Women who were at 12 weeks of gestation or less with an incomplete abortion were eligible to participate. They were randomly assigned to receive either the standard treatment of care (manual vacuum aspiration for uterine evacuation with psychological support but no paracervical block) or manual vacuum aspiration treatment with psychological support and paracervical block using 1.0% lidocaine. Patients with active infections, severe illnesses, psychiatric disorders, or allergies to lidocaine were excluded. Intraoperative pain as reported by the women and as documented by an external observer was measured. RESULTS: Although the paracervical block technique used showed a slight reduction in severe pain, there were no clinically or statistically significant differences in intraoperative pain between the 2 groups (relative risk 0.73; 95% confidence interval 0.43, 1.23) with 50% of all patients registering 7 or higher score on a visual analog pain scale of 0–10. However, statistically significant differences were found in each group when comparing the level of preoperative and intraoperative pain described by the patient (P < .001). The manual vacuum aspiration technique and the paracervical block were not accompanied by complications. CONCLUSION: The paracervical block technique used in this study along with psychological support was comparable with pain control using psychological support alone; neither pain management regimen provided sufficient pain control. It is recommended that randomized comparative studies be designed to determine the effectiveness of other paracervical block techniques and the efficacy of the use of analgesics in patients suffering from incomplete abortion treated with manual vacuum aspiration. LEVEL OF EVIDENCE: I

Guía de atención integral para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección toxoplasmosis en el embarazo?

Como parte de la Guia de atencion integral para la prevencion, deteccion temprana y tratamiento de las complicaciones del embarazo, desarrollada y financiada por el Departamento de Ciencia, Tecnologia e Innovacion, Colciencias, y el Ministerio de Salud y Proteccion Social de Colombia, se selecciono a la infeccion por Toxoplasma para el desarrollo de recomendaciones para su prevencion, diagnostico y tratamiento.

Cost Effectiveness of Calcium Supplement in Reducing Preeclampsia-Related Maternal Mortality

Objective: To estimate the cost-effectiveness of the supply of calcium of 1200mg per day from the week 14 of pregnancy to all pregnant women compared to not supplying it to reduce the incidence of preeclampsia.Methods: A decision tree was built in TreeAge® with outcome measured in life years gained (LYG) associated to the reduction in maternal deaths. The costs were included from the perspective of the Health System in Colombia. Pharmaceutical costs were obtained from 2008 SISMED (1) and the value of the procedures was calculated by adjusting the values of Tariff Manual ISS 2001 30% (2), these values were compared with information of costs supplied by three EPS. All costs are expressed in Colombian pesos of 2010. The discount rate was 0%. It was performed sensitivity univariate and probabilistic analyzes for costs and effectiveness.Results: Compared to no intervention, calcium supplement is a dominant alternative. If the incidence of preeclampsia is lower than 51.7 per 1000 pregnant women or the cost per tablet of calcium of 600mg is greater than

Cost effectiveness of diagnostic laparoscopy in reproductive aged females suffering from non-specific acute low abdominal pain

454, calcium supplement is no longer a cost-effective alternative in Colombia for a threshold of 3 times the GDP per capita in Colombia of 2010 by LYG, equal to

Clinical practice guideline. Integral Care Guidelines for the prevention, early detection and treatment of pregnancy, childbirth and puerperium complications: Section on toxoplasmosis in pregnancy

36,143,550.Conclusions: Supply of calcium to all pregnant women from week 14 of gestation is a dominant alternative compared to no intervention, which saves 200 LYG, while it decreases costs in the order of

Cost Effectiveness of Diagnostic Strategies for Opportune Detection of Toxoplasma Gondii in Pregnant Women

5,304 million pesos per 100.000 pregnant women.