El parto humano, prevención y cuidados

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Conferencia de Andrés Souto sobre monitorización del parto humano, prevención y cuidados

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  • Hewlett-Packard has dedicated its healthcare knowledge and computer expertise to help healthcare organizations like yours deliver care across the perinatal care continuum. As you can see, our definition of care begins and ends at home, and we do ongoing customer trend oriented research in all areas. Our monitors offer both real-time and trend monitoring for care of pre-term and sick or compromised newborns. We also offer a full range of solutions for care of newborns and critically ill children and adolescents.
    To put the continuum in perspective, let’s revisit the trends we just discussed. Through our partnership with Nellcor Puritan Bennett, we offer the new fetal SpO2 parameter* to help diagnose and monitor high-risk pregnancies. With OB TraceVue and CareVue information systems, we provide you with access to accurate and complete information to support your decision-making process and improve staff productivity.
    Responding to the trends we just discussed, HP will continue to develop state-of-the-art solutions to help you intervene faster, while containing costs. For example, we are researching ways in which our solutions can detect pre-term labor, which can lead to increased survival rates for low birth weight infants.
    *Fetal SpO2 parameter is not yet available in the United States, but is pending FDA approval.
  • As the world’s largest developer of electromedical equipment and a leading computer manufacturer, Hewlett-Packard has an unparalleled combination of clinical measurement and information management expertise. We bring expertise to you in several areas:
    Reliable, cost-effective measurement and monitoring systems that allow you to assess your patient’s condition at a glance. All of our monitors are easy to configure and update so that you can fine-tune your monitoring to meet your specific needs. Only HP offers you the ability to protect your investment and maintain flexibility.
    Information management systems that allow you to access patient information from any point on the care continuum. Our systems will help you eliminate redundancies, automate manual tasks, and gain access to accurate, useful patient information.
    Communications standards that help you leverage your existing network and lower the cost of sharing information. Proof of our commitment to meeting your needs and responding to current healthcare trends is evident in our remote solutions (Telemetry), easy-to-use fetal monitors, and continuous enhancements of our OB solutions.
    Finally, we offer comprehensive support services to help you better manage the business side of your healthcare organization.
  • As I mentioned earlier, HP was the first company to bring a non-invasive fetal monitor to market, back in 1968, and now we offer a wide range of obstetrical products and systems, such as monitors, medical software, and peripheral instrumentation.
    As we celebrate 30 years of providing long-lasting, reliable, and innovative monitors for the obstetrical environment, we are taking advantage of this occasion to renew our commitment to obstetrical care. We continue to establish alliances with healthcare and technology leaders like i-STAT and Nellcor Puritan Bennett (a Mallincrodt Inc. business unit) to offer you fully integrated solutions.
    We will also continue to enhance our own core competencies by researching physiological parameters like fetal SpO2,* which we just introduced in Asia Pacific and Europe as an integrated solution. We are also investigating parameters like uterine EMG pre-term labor detection so that we can add these capabilities to our solutions — because that’s what you’ve asked us for.
    Our goal is to continue to work with our customers and other healthcare leaders like Nellcor Puritan Bennett to offer you state-of-the-art solutions from a single, proven, and committed vendor.
    *Fetal SpO2 parameter is not yet available in the United States, but are pending FDA approval.
  • For the last 30 years, millions of babies have been safely delivered with the help of fetal monitoring technology introduced by HP. We were the first company to introduce external (non-invasive) fetal monitoring, back in 1968, and the first to introduce an OB system.
  • Comprehensive Documentation
    Fetal
    - Fetal HR derived by US, twins clearly separatable by +20 bpm offset
    - Fetal Movement Profile providing an early indication of fetal well-being and FMP %
    Maternal
    Maternal NIPB, heart rate and Sp02 are automatically printed on the trace and are sent to the Agient OB TraceVue System for viewing and archiving.
    The maternal heart rate is recorded together with the fetal heart rate, allowing a visual correlation of fetal and maternal vital signs.
    A snapshot of the maternal ECG waveform can be printed on the trace below the fetal heart rate for documentation and later review.
    CCV
    Cross Channel Verification automatically compares the maternal Pulse Rate with the fetal HR
    CCV gives additional certainty for measuring fetal heart rate (from US or DECG) avoids incorrectly monitoring maternal HR)
    CCV also compares between twins FHR's
    The algorithm has been developed by Agilent Technologies
  • Mention the fact that it is umbilical vein which is carrying the oxigenated blood. It is a vessel carrying blood TOWARDS the heart of the baby.
  • Fetal Pulse Oximetry (FSpO2) is the most promising development in fetal monitoring since HP´s introduction of its first fetal monitor 30 years ago.
    This new FSpO2 measurement parameter, when used in conjunction with Cardiotocography (CTG), provides continuous information about fetal-oxygenation in labor, particularly in cases of a non-reassuring heart-rate pattern, a common reason for an operative intervention. According to research conducted in Italy and Germany, this technology has the potential to reduce the number of cesarean sections performed as a result of non-reassuring heart-rate patterns.
    The technology has been developed by Nellcor (Perinatal Business Unit of Mallinckrrodt) and is now available from HP.
    The fetal oxygen sensor form Nellcor is non invasive to the fetus. It is inserted into the birth canal very similar to an intrauterine pressure catheter. The sensor is placed on the fetus’ cheek or temple and is held in place by the uterine wall.
    During delivery the sensor is pushed forward together with the fetal head. Repositioning of the sensor is not or only seldom required. ( 1 or 2 times during a delivery)
  • Fetal monitors have a high sensitivity (>90%) and a low specificity (<20%). This, means that you detect almost all pathological cases, however you also find a lot of cases where the fetus looks pathological, but turns out to be well and healthy. (high false-positive rate).
    This often is a source for uncertainty for the clinician, leading to maybe unnecessary cesarean sections or too much pH scalp sampling . Clinicians would want a method which is non-invasive and providing a high sensitivity and high specificity at the same time.
    Fetal Oxygen Saturation is believed to be the method to solve this issue.
  • Along with the increase in the number of high-risk pregnancies, the pressures you face to contain costs and work efficiently are also increasing. Now more than ever, you need access to accurate patient information and assurance that you are providing the highest quality of care at all times and from many locations — the bedside, a central station, in a remote office, even outside the hospital.
    To provide you with access to information and keep you updated on your patient’s condition, we created the HP Series 50 OB TraceVue. With OB TraceVue, we have combined our expertise in fetal monitoring with our expertise in computing and networking. Designed for the busy obstetrical environment that you work in, OB TraceVue offers patient status at a glance, optimum trace storage, and obstetrical data surveillance — from the bedside, as well as from central or remote locations.
    In keeping with our commitment to industry standards and open platforms, OB TraceVue can be connected to HP and nonHP fetal monitors and is built on industry standards. This means that you can leverage your existing equipment, while gaining the full benefits of OB TraceVue’s capabilities. We are currently working on the next release, which will bring OB TraceVue to a new platform, offering you a complete patient documentation system.
  • OB TraceVue provides the ability to have one continuous Obstetrical record for your patient. This includes not only the initial visit but also all outpatient visits.
    The major advantage of OB TraceVue is that anywhere the patient is seen throughout her pregnancy the clinician has immediate access to the entire Obstetrical record.
  • The Philips family of obstetrical monitoring products sets new
    standards by offering comprehensive fetal and maternal monitoring
    solutions for any stage of fetal and maternal care.
    Today’s Philips obstetrical solutions are proof of our ongoing
    commitment to obstetrical care that started three decades ago,
    when, as Hewlett-Packard, we introduced the world’s first non
    invasive fetal monitor. These products have been developed through
    understanding our customers’ needs and using advanced technology
    to provide solutions to meet these needs.
    To help you protect your technology investment and deliver the best
    possible care, Philips invites you to join us in shaping
    the future of obstetrics.
  • This slide outlines the hierarchical structure of a patient record within OB TraceVue.
    Mother is of course the “patient” within a pregnancy one will encounter a patient many times. Ie. Office visits, Obstetrical education, antepartum testing (ultrasound, NST’s) also the possibly of a non-delivery admission to the hospital for complications during the antepartum phase.
    Outcome of the pregnancy is of course baby 1, baby 2 or baby x.
    Additional future pregnancies would of course reopen the patient file for these new pregnancies: patient data information like obstetrical history etc would of course be brought forward to automatically fill in the new pregnancy information.
    Value to the customer is that they do not have to re-enter this information on the new pregnancy. It’s automatically done for them.
  • The Patient Flow
    Philips OB TraceVue is the system for complete obstetrical
    information management for your department. OB TraceVue allows
    you to begin a patient record at an initial visit and close it at
    discharge.
    The Patient Model
    OB TraceVue’s patient documentation and data management
    capabilities cover the full continuum of obstetrical care. You can
    record and document different encounters during a pregnancy as
    well as retrieve information from a patient’s previous pregnancies.
  • This slide displays the overall network infrastructure and the component hardware that make up the OB TraceVue system.
    OB TraceVue is based upon client/server architecture with all workstations connected to the “internal” database server. Thus allowing any client access to any and all patient data. In this manner you have a decentralized system in that all information and system capabilities are available at any bedside workstation.
    The system architecture allows for both a backup internal server and for charting applications a “external” database/communication server. All patient information including the fetal trace data is stored on the internal server while all patient charted data is exported to the external database server for report generation and possible export to other hospital computation systems.
    The internal server runs the OB TraceVue clinical application which of course includes the alarm functionally. This portion of the system is thus classified as a medical device.
    The external server acts as a repository for all patient data that allows patient report and statistic generations. Other hospital system queries of patient data. These operations could impair the operation of the “clinical medical device” hence the “external” which means external to the medical device portion of the system.
  • As part of the overall operation of OB TraceVue one must allow for the remote access of the system for not only system support but, for clinical operation. Remote physician office and home for both viewing of patient information and also charting is supported within OB TraceVue. This can be accomplished via a simple off the shelf software package such as pcAnywhere placed onto one of the pc workstations and giving access to it via either modem or pcAnywhere net. In addition, those offices that already have a hospital LAN connection can have this application connected via that same LAN.
    OB TraceVue has also been Web enabled for those customers that wish to use the intranet connection capabilities that have already been established within their institutions.
  • The OB TraceVue Chalkboard is a continuously updated patient list
    that displays the status of all current patients. It is accessible
    throughout the OB department and can supplement or replace the
    traditional handwritten chalkboard at the central nursing station.
  • With OB TraceVue, patient information is only a mouse-click away.
    The system keeps you updated on the progress of all patients,
    helping you achieve the highest efficiency and best quality of care.
    Maximize patient coverage with multiple displays on the overview
    screen -- monitor several beds at one time.
    With system access from the bedside PC, you are always aware ofthe progress of all other patients. You always know where you areneeded most, and you can stay with a patient who needs personal attention.
    Surveillance and access to patient OB records from any PC or Weblocation: central station, bedside, nurse’s and physician’s loungesand offices.
    High-quality, clear, trace displays with integrated fetal and maternalparameters as well as annotated trace documentation allowcontinuous monitoring of the fetus and the mother.
    Positive Differentiators:Display look - Modification of thickness of
    tracings to 3 pixels. So easy to use: fully icon driven, Light Pen
  • The sooner you know about changes in fetal condition, the more time
    you have to make an informed decision and give optimal patient care.
    OB TraceVue’s alerting feature makes you aware of questionable
    tracings and critical events based on CTG trace analysis. There are
    two levels of alerts, Basic and Advanced.
    Basic Alerting With individual settings for each patient, the Basic
    Alerting feature will inform you if:
    fetal tachycardia or bradycardia limit is exceeded for a specified duration
    unclear signal, or loss of signal from transducers
    coincidence detection (Cross Channel Verification) of two fetal heart
    rates, or fetal and maternal heart rates (with Agilent fetal monitors only)
    notification that trace paper on the fetal monitor has run out (with Philips fetal monitors only)
    Alerts can be acknowledged at any OB TraceVue PC.
  • Advanced Alerting goes beyond Basic Alerting to analyze trace
    patterns and give you detailed information, based on fetal trace
    evaluation criteria as provided by many leading obstetricians. The
    interpretation of the alert, and the decision on the appropriate clinical
    response is always left to the clinician.
  • Forms-based and flow sheet-based patient charting ensure the prompt distribution of data and can result in faster and unlimited access to complete patient records throughout your department. Accurate patient data can be stored for complete record keeping. To help you increase the quality of your patient care, the system allows you to document and manage all fetal and maternal data required in your department and retrieve it when and where it’s needed.
    Forms-based patient record
    OB TraceVue provides you with a full set of data entry screens for forms-based patient charting and viewing possibilities throughout the entire continuum of obstetrical care. OB TraceVue takes you through the progress of a patient through time, including other pregnancies, to help you give informed, high-level care. The data entry screens are optimized for your PC monitor screen. Forms-based patient information can be easily and quickly entered and accessed by clicking specific icons. Once within a patient form, you can select the specific data entry screen you need via Tabs. Extensive pull-down lists, which you can configure to suit your needs (e.g., for medication), help speed up your documentation process. The range of patient forms includes the antepartum record, obstetric admission record, labor and delivery, and postpartum/discharge record.
    Statistical Reporting
    OB TraceVue’s electronic charting capabilities allow seamless access to essential information supporting statistical evaluation and reporting for administration, research, and quality assurance purposes.
    The availability of medical history at patient admission can help improve patient care planning.
  • Flow sheet-based patient record
    To complete your documentation procedures, you have a wide choice of flow sheets for efficient patient charting, featuring immediate and easy input and retrieval of all essential maternal and fetal data you need to document or review.
    The data input on the flow sheets can be easily adapted to individual patient profiles. The default set includes maternal data, medication and infusions, vaginal examinations, intake/output, contraction documentation, and fetal data.
  • Optimum Storage and Retrieval of Patient Data and Tracings
    The current medical liability environment requires detailed and accurate documentation. Consequently, most hospitals must maintain extensive labor and delivery documentation for many years. OB TraceVue addresses this requirement directly with its optional data storage capability. It electronically stores all patient records on an optical disk that can keep the information for more than 30 years (according to accelerated lifetime test from the media manufacturer). This is necessary especially with obstetrical records. With OB TraceVue you choose a system that ensures that, regardless of the constant change in technology.
    All stored data can be easily reviewed and printed in original quality. Fetal heart rate, maternal heart rate, FMP, and uterine activity signals are sampled four times per second and stored with the same trace accuracy on the optical disk. OB TraceVue’s software also ensures the integrity of the data before it is stored.
  • ADT Interface to the Hospital Information System (HL-7-based)
    Philips OB TraceVue uses an ADT (Admission Discharge & Transfer) interface to connect to your
    hospital’s information system (HIS). The ADT interface is on a client PC or the external OB TraceVue
    server and connects to the hospital network via a second network interface card.
    The ADT interface is a bi-directional link and is based on the ANSI Health Level 7 (HL-7) specification, a
    standard in healthcare. The bi-directional link allows the transmission of demographic patient data from
    the HIS to OB TraceVue for admission, and the reporting of transfers and discharges from OB TraceVue
    to the HIS. Updates of demographics from the HIS can also be transferred to OB TraceVue.
    The ADT interface allows you to quickly pre-admit an obstetric patient by using the demographics
    transmitted from the HIS to OB TraceVue, avoiding redundant data entry. You can then do the final
    admission to your department, with all relevant patient information, at a later point in time.
    Patient Transfer
    If you have to transfer a patient from a bed to the operating theatre, for example, the data is reported
    directly from the OB TraceVue to the HIS.
    Data Export
    OB TraceVue and the 3rd-party software can exchange patient data via the OB TraceVue ADT link and
    the OB TraceVue export database server. Patient data exported from OB TraceVue to the 3rd-party
    solution can be implemented via the external database export facility as project business. The external
    OB TraceVue database is ODBC- and SQL-compliant for easy access by 3rd-party software.
  • Remote Trace Transmission
    To reduce the demands on hospital resources and the stress a hospital visit can have on the mother, an increasing number of patients are being monitored outside the hospital during the antepartum period. OB TraceVue combined with a Series 50 A (M1351A) antepartum fetal monitor with transmitting capability*, enables community healthcare providers and small antepartum clinics to transmit fetal traces over public phone lines to obtain remote consultation. The transmission of these traces is protocol secured. With the exception of alerting, these traces are handled the same way as locally retrieved traces. For review purposes the received traces can be scrolled on the screen. They can also be printed completely, or partially to show a certain time period. All trace presentation is in high quality. These traces can be stored on the optical disk with the necessary patient identification for later retrieval. Trace transmission is initiated after monitoring to minimize telephone costs. Therefore, there are no alerting capabilities for remotely transmitted traces.
    * NOTE: Not available in all countries. Please check availability in your country with your local Philips representative.
  • Web-Access
    Web-access allows you to access an OB TraceVue client from any PC via the MS Internet Explorer either connected via secure LAN connection or a modem connection with auto callback. It supports all of the facilities and features of OB TraceVue including reviewing patient data and making notes.
    Web-access delivers the efficiency, convenience and reassurance of OB TraceVue capabilities to locations outside the hospital. You can be directly in touch with your patient’s progress and you do not need to wait for a faxed trace from the care team before deciding on a plan of action. You can manage your valuable time more efficiently and respond quickly and appropriately to patients’ needs.
  • Compatibility with other software products (3rd-party)
    In your day-to-day work in the obstetrics department, you need to meet specific medical and legal
    documentation requirements. Often local 3rd-party solutions may be better suited to address specific
    requirements. The OB TraceVue application can allow parallel use of 3rd-party software (for example,
    Microsoft® Word) on your OB TraceVue client PC.
    Using this facility you can reduce the amount of equipment needed in your department and save valuable
    space. Each application runs in a separate window, each keeping its own unique user interface. The OB
    TraceVue application can be minimized and sits on top of the 3rd-party application. The icon still reflects
    any alert situation (flashing and sounding bell) and keeps you continuously informed on your patients’
    condition. Even when you are busy with a different task, you won’t miss a second of your patients’ status.
    The installation requires special testing to ensure failure-free performance and smooth operation.
    There are various ways you can set up your 3rd-party solutions with OB TraceVue. The 3rd-party software
    can be stand-alone or client/server-based departmental. Such installations can be set up with the 3rd-party
    server residing within the OB TraceVue network or outside it, but as part of the hospital network.
    Positive Differentiators:
    * 3rd party software integration at the point of care. Use the system for other applications
    * Minimization of OB TraceVue while being fully aware of alert status of all patients on the system
    NOTE to the Presenter:
    All 3rd party software must be tested for compatibility. OB TraceVue clients with data acquisition,
    connected to fetal monitors, can only run selected 3rd party software.
    The liability for the combined solution lies with the system integrator who integrates the 3rd party software
    at the OB TraceVue client PC. This includes testing and documentation (FDA). For detailed information on
    3rd-party integration and testing liability, please refer to the Electronic Sales Guide (ELSA), chapter 2.4,
    3rd-party compliance and to the Integration Guide.
  • Compatibility with other software products (3rd-party)
    In your day-to-day work in the obstetrics department, you need to meet specific medical and legal
    documentation requirements. Often local 3rd-party solutions may be better suited to address specific
    requirements. The OB TraceVue application can allow parallel use of 3rd-party software (for example,
    Microsoft® Word) on your OB TraceVue client PC.
    Using this facility you can reduce the amount of equipment needed in your department and save valuable
    space. Each application runs in a separate window, each keeping its own unique user interface. The OB
    TraceVue application can be minimized and sits on top of the 3rd-party application. The icon still reflects
    any alert situation (flashing and sounding bell) and keeps you continuously informed on your patients’
    condition. Even when you are busy with a different task, you won’t miss a second of your patients’ status.
    The installation requires special testing to ensure failure-free performance and smooth operation.
    There are various ways you can set up your 3rd-party solutions with OB TraceVue. The 3rd-party software
    can be stand-alone or client/server-based departmental. Such installations can be set up with the 3rd-party
    server residing within the OB TraceVue network or outside it, but as part of the hospital network.
    Positive Differentiators:
    * 3rd party software integration at the point of care. Use the system for other applications
    * Minimization of OB TraceVue while being fully aware of alert status of all patients on the system
    NOTE to the Presenter:
    All 3rd party software must be tested for compatibility. OB TraceVue clients with data acquisition,
    connected to fetal monitors, can only run selected 3rd party software.
    The liability for the combined solution lies with the system integrator who integrates the 3rd party software
    at the OB TraceVue client PC. This includes testing and documentation (FDA). For detailed information on
    3rd-party integration and testing liability, please refer to the Electronic Sales Guide (ELSA), chapter 2.4,
    3rd-party compliance and to the Integration Guide.
  • Compatibility with other software products (3rd-party)
    In your day-to-day work in the obstetrics department, you need to meet specific medical and legal
    documentation requirements. Often local 3rd-party solutions may be better suited to address specific
    requirements. The OB TraceVue application can allow parallel use of 3rd-party software (for example,
    Microsoft® Word) on your OB TraceVue client PC.
    Using this facility you can reduce the amount of equipment needed in your department and save valuable
    space. Each application runs in a separate window, each keeping its own unique user interface. The OB
    TraceVue application can be minimized and sits on top of the 3rd-party application. The icon still reflects
    any alert situation (flashing and sounding bell) and keeps you continuously informed on your patients’
    condition. Even when you are busy with a different task, you won’t miss a second of your patients’ status.
    The installation requires special testing to ensure failure-free performance and smooth operation.
    There are various ways you can set up your 3rd-party solutions with OB TraceVue. The 3rd-party software
    can be stand-alone or client/server-based departmental. Such installations can be set up with the 3rd-party
    server residing within the OB TraceVue network or outside it, but as part of the hospital network.
    Positive Differentiators:
    * 3rd party software integration at the point of care. Use the system for other applications
    * Minimization of OB TraceVue while being fully aware of alert status of all patients on the system
    NOTE to the Presenter:
    All 3rd party software must be tested for compatibility. OB TraceVue clients with data acquisition,
    connected to fetal monitors, can only run selected 3rd party software.
    The liability for the combined solution lies with the system integrator who integrates the 3rd party software
    at the OB TraceVue client PC. This includes testing and documentation (FDA). For detailed information on
    3rd-party integration and testing liability, please refer to the Electronic Sales Guide (ELSA), chapter 2.4,
    3rd-party compliance and to the Integration Guide.
  • Compatibility with other software products (3rd-party)
    In your day-to-day work in the obstetrics department, you need to meet specific medical and legal
    documentation requirements. Often local 3rd-party solutions may be better suited to address specific
    requirements. The OB TraceVue application can allow parallel use of 3rd-party software (for example,
    Microsoft® Word) on your OB TraceVue client PC.
    Using this facility you can reduce the amount of equipment needed in your department and save valuable
    space. Each application runs in a separate window, each keeping its own unique user interface. The OB
    TraceVue application can be minimized and sits on top of the 3rd-party application. The icon still reflects
    any alert situation (flashing and sounding bell) and keeps you continuously informed on your patients’
    condition. Even when you are busy with a different task, you won’t miss a second of your patients’ status.
    The installation requires special testing to ensure failure-free performance and smooth operation.
    There are various ways you can set up your 3rd-party solutions with OB TraceVue. The 3rd-party software
    can be stand-alone or client/server-based departmental. Such installations can be set up with the 3rd-party
    server residing within the OB TraceVue network or outside it, but as part of the hospital network.
    Positive Differentiators:
    * 3rd party software integration at the point of care. Use the system for other applications
    * Minimization of OB TraceVue while being fully aware of alert status of all patients on the system
    NOTE to the Presenter:
    All 3rd party software must be tested for compatibility. OB TraceVue clients with data acquisition,
    connected to fetal monitors, can only run selected 3rd party software.
    The liability for the combined solution lies with the system integrator who integrates the 3rd party software
    at the OB TraceVue client PC. This includes testing and documentation (FDA). For detailed information on
    3rd-party integration and testing liability, please refer to the Electronic Sales Guide (ELSA), chapter 2.4,
    3rd-party compliance and to the Integration Guide.
  • El parto humano, prevención y cuidados

    1. 1. UN PARTO HUMANO Su gestión o monitorización controlada Por Andrés Souto
    2. 2. Cuidados Obstétricos
    3. 3. El cuidado continuo perinatal Anteparto Consultas Obstétricas Intraparto UCI Neonatal UCI Pediátrica Hogar Salas Puerperales
    4. 4. CUIDADOS OBSTETRICOS Además de los retos típicos que tiene que afrontar como parte de la sanidad en general, el cuidado de las pacientes obstétricas, implica retos muy específicos de tales cuidados. He aquí algunos ejemplos de las tendencias que actualmente se tienen que encarar: • El incremento por una parte del número de embarazos de alto riesgo ejerce una presión sobre las organizaciones sanitarias para la contención de sus costes y por otro lado el incremento de episiotomías y césareas llevadas a cabo, un 35% de media en la sanidad privada y un 21,5% en la sanidad pública de estas, es otra consecuencia de esa misma presión junto con la de la redución de la estancia media individual. • Necesidad de detectar partos pretérmino, que son los responsables de aproximadamente el 70% de la mortalidad y morbidad perinatal. • Necesidad de equipos de bajo coste, fáciles de usar de manera tal que los prestadores de esos cuidados sean capaces de optimizar la información clínica facilitada así como acceder a ella, dondequiera que estén. Con estos desafios en mente, vamos a ver hoy en día qué soluciones se han desarrollado para afrontar estos temas de los Obstétricos. Cuidados
    5. 5. Factores de alto riesgo obstétrico perinatal
    6. 6. Soluciones para los cuidados obstétricos • Medición y monitorización fetal • Gestión de esa información • Comunicaciones • Archivo y explotación de datos
    7. 7. Equipos de medición y monitorización fetal actuales
    8. 8. INNOVACIONES RECIENTES
    9. 9. Nível crítico CTG con FSpO2 CTG Series 50 XM/XMO Monitor Series 50 T CTG Series 50 IP CTG Series 50 A Monitor FM-2 Philips Central Obstétrica OB TraceVue Prestaciones de los equipos
    10. 10. APLICACIONES CUIDADOS OBSTETRICOS
    11. 11. Monitorización fetal
    12. 12. Registro de un monitor fetal mostrando la FCF y la actividad Tocográfica externa Traza de un parto en su 2ª fase. Los grandes cambios de la FCF reflejan probablemente la compresión del cordón umbilical. La traza de Toco muestra artefactos respiratorios (traza regular) y esfuerzos de empuje maternales (traza irregular).
    13. 13. Relaciones entre la FCF y el Sistema Nervioso Central El dibujo muestra elementos del sistema cardio-acelerador (simpático, que inerva todo el corazón) y del sistema cardio-decelerador (nervio pneumogástrico vago del parasimpático, que inerva sólo las aurículas), divisiones ambas del Sistema Nervioso Autónomo, así como las ubicaciones de los baro o presoreceptores (áreas sensoras de presión) y quimioreceptores (áreas sensoras químicas u hormonales).
    14. 14. Documentación exhaustiva Registros fetales y maternales completos Monitorización del feto … Perfil del movimiento fetal Desplazamiento gemelar … y su garantización Monitorización de la madre … Verificación automática de la Frec. del pulso materno deducida intermodulación de los canales de la SpO² o de la PNI (CCV) de la frec. del pulso materno y de la frec. cardíaca fetal ... Instantánea de la onda del ECG
    15. 15. Embarazo Embarazo y Parto Parto < Fuente: Gráficos explicativos de salud de EL MUNDO >
    16. 16. Objetivos Fundamentos clínicos ¿Cuál es la base médica en la que se fundamenta un parto?
    17. 17. La circulación maternal y fetal “Pool” miométrico Arterias umbilicales Vena cava Aorta Vena umbilical
    18. 18. placenta pared uterina Cordón umbilical La circulación fetal
    19. 19. La placenta o “pulmón” fetal Madre Arteria Uterina PLACENTA Corión Feto Vena Umbilical PO2 100 mmHg PO2 28 mmHg PCO2 32 mmHg PCO2 40 mmHg pH 7.42 pH 7.32 Vena Uterina Arterias Umbilicales PO2 33 mmHg PO2 18 mmHg PCO2 46 mmHg PCO2 55 mmHg pH 7.30 pH 7.21
    20. 20. Cambios en el cérvix y descenso del feto durante la 1ª y 2ª etapas del trabajo del parto Borramiento cervical Dilatación cervical Quintos palpables
    21. 21. El momento del parto debe ser tal que… →Las membranas deben de estar rotas. →La dilatación cervical debe ser mayor de 2 cm.
    22. 22. ¿Qué se debe monitorizar en el feto? Evaluación de la actividad cardíaca fetal latido a latido. Evaluación de la afectación de las contracciones maternales durante el trabajo del parto.
    23. 23. ¿Qué se debe monitorizar en la madre? Su frecuencia cardíaca Su presión sanguínea Sus gases en sangre Sus contracciones
    24. 24. Las técnicas externas Las medidas por ultrasonidos (FCF, FMP) La tocografía Los parámetros maternales La PNI y la oximetría Ventajas e Inconvenientes Señales débiles Menos precisas Menos arriesgadas
    25. 25. Medida externa de la presión uterina
    26. 26. Monitorización externa ultrasónica de la FCF
    27. 27. Los movimientos fetales (FMP)
    28. 28. Monitorización del ECG Maternal (MECG)
    29. 29. Las técnicas internas La presión intrauterina (PIU) El ECG directo La pulsioximetría fetal (FSpO2) Ventajas e Inconvenientes Medidas precisas Posibilidad de trauma, infección... Posibilidad de shocks eléctricos
    30. 30. La presión intrauterina (PIU) IUP kit
    31. 31. El ECG Directo (DECG) Fetal Scalp Electrode
    32. 32. Colocación del electrodo de DECG Presentación cefálica Presentación pódalica
    33. 33. Monitorización de la FCF gemelar mediante DECG / US
    34. 34. Colocación de un electrodo de referencia para el DECG
    35. 35. La pulsioximetría fetal (FSpO2)
    36. 36. ¿Cuando está indicada la FSpO2? NO SE UTILIZA EN TODOS LOS PARTOS: Solamente cuando tengamos una traza de CTG dudosa:
    37. 37. ¿Por qué seguimos buscando un parámetro de bienestar fetal? • Los métodos utilizados actualmente para vigilar el estado del feto durante el parto son: • 1.- Monitorización Fetal (Curva de CTG) • 2.- Medida del pH (Scalp pH)
    38. 38. El valor clínico de la Pulsioximetría Fetal ¿Muestra síntomas de hiposia el feto? Cardiotocografía • Gran necesidad de redución de la incertidumbre Alta tasa de falsos creada por la alta positivos tasa de falsos Incertidumbre positivos de la CTG • Método de medida pH fetal escalpelar directa de la hiposia Cesáreas fetal • Saturación del oxígeno fetal
    39. 39. Aplicaciones clínicas de la FSpO2 • • • • Utilizada como parámetro adicional para evaluar el estado fetal cuando existen patrones de frecuencia cardíaca fetal no determinantes. Monitorización del feto en madres con alto riesgo En casos de alto riesgo fetal incluidos bloqueos cardíacos fetales congénitos Cualquier caso en dónde se requiera o se desée mas información acerca del bienestar fetal. Cuando se compara con el pH escalpelar, la FSpO2: • • • es no invasiva respecto al feto. Facilita una cuasi continua evaluación, en tiempo real, de los valores de la saturación del oxígeno fetal. reduce la ansiedad que la madre puede experimentar por los muchos muestreos de la pH escalpelar fetal.
    40. 40. Interpretación del cardiograma fetal Normal Línea base Variabilidad Sospechoso Patológico 150-170 100-110 >170 <100 5-10 >25 <5 110-150 lpm 5-25 lpm 2-6 oscil/min Aceleraciones >15 lpm >15 seg Deceleraciones ausentes durante >40 min >15 lpm >10 seg
    41. 41. Interpretación del tocograma fetal Frecuencia normal Fase intraparto 2-5 / 10 min anteparto cada 10 min Measuring the ute Intensidad normal 70 mmHg ~ External Tocodynamometer Intra-amniotic pressure (mmHg) 70 IUP 60 50 40 Duración normal 45-90 seg 30 Amplitude 20 Total intensity Resting tone 10 Time (min) 0 1 2 3
    42. 42. ¿Qué es un DIP 1? Es una deceleración temprana de la FCF, que suele indicar compresión de la cabeza fetal DIP 1
    43. 43. ¿Qué es un DIP 2? Es una deceleración tardía de la FCF, que suele indicar insuficiencia utero-placentaria DIP 2
    44. 44. ¿Qué es un DIP “V” o “U”? Es una deceleración variable de la FCF, que suele indicar compresión del cordón umbilical DIP”V”
    45. 45. Test de APGAR Efectuado al término de 1 min, 5 min y 10 min del nacimiento Una puntuación de 10 indica un estado óptimo del recién nacido. Mientras que una puntuación de 6 ó menos, indica un recién nacido con insuficiencias.
    46. 46. Postparto Cordón umbilical. Células madre < Fuente: Gráficos explicativos de salud de EL MUNDO >
    47. 47. Sistemas de gestión de la información obstétrica • Diseñados para el entorno obstétrico • Basados en los estándares industriales • Implementados modularmente
    48. 48. Soluciones para los Servicios de Obstetricia Paritorios Paritorios Pruebas anteparto Pruebas anteparto Consulta médico Clínica remota Consulta médica Clínica remota
    49. 49. Compromiso de cobertura de los Cuidados Obstétricos Monitores fetales ó CTG´s Central Obstétrica
    50. 50. Centrales Obstétricas. Sistemas departamentales de gestión de la información obstétrica centrados en las pacientes Vigilancia y Alerta Software de 3ºs Exportación de datos Gráficos Fichas Almacenamiento de datos Acceso a la Web Interfase ADT al HIS Informes y Estadísticas Ofrecen soluciones modulares para un apoyo notable en la toma de decisiones clínicas
    51. 51. Utilizan una estructura jerarquizada de los registros de las pacientes Paciente (Madre) Embarazo 1 Embarazo 2 Bebé 1 Episodio 1 Episodio 2 Episodio 3 Bebé 2 Embarazo 3
    52. 52. Documentación de pacientes Intraparto Anteparto Visita inicial de la paciente: • Comienzo del registro • Historial OB/embarazo • – Visitas siguientes: Plan de cuidados Pruebas anteparto: Laboratorio – Ecografías – Prueba NST – Prueba OCT • – Sin parto Admisión en Dilatación o Partos Admisión –Evaluación de admisión Registros gráficos de: -Parámetros maternales –Exámenes vaginales –Medicaciones –Entradas/Salidas –Anotaciones –Trazas fetales Registro del parto Registro neonatal Transferencia a UCI_Neo: – Exportación de datos Registro maternal Datos maternales: - Postparto Datos de la Madre y del Bebé: -Planificación del alta Registro de anestesia • Informe de alta • Educación de la paciente Procedimientos • Cubren los cuidados obstétricos de forma continua • Siguen el diagrama de flujo de la paciente a lo largo de su embarazo • Incluyen gráfica electrónica del trabajo del parto de la paciente
    53. 53. Arquitectura de una Central Obstétrica Estación central Cabeceras CPU Monitor fetal Servidor interno de reserva Conmutador Servidor externo de comunicaciones/ base de datos Servidor técnico/Web CPU • Estación de Monitor fetal • Monitor fetal remoto Módem trabajo remota • Soporte remoto • Consulta domicilio médico • Cliente Web Servidor interno de base de datos LINEA LAN • ADT • CDR • Simultaneidad
    54. 54. Centrales Obstétricas Se pueden acceder desde cualquier lugar, en cualquier momento, a través de la WEB www Intranet m de Mó LAN del hospital
    55. 55. Sistema Philips OBTraceVue
    56. 56. Pizarra electrónica
    57. 57. Vigilancia • Pantallas de color vívido • Pantallas de paciente única y múltiple • De uso intuitivo completamente iconográficas • Acceso a las trazas de cualquiera de las pacientes desde cualquier PC La información de las pacientes está a sólo un golpe de ratón
    58. 58. Anotación de las trazas
    59. 59. Sistema de Alertas Monitor Fetal Señales: FCF, Toco, ... Alertas Básicas: - Pérdida Señal - Bradicardia - Taquicardia - CCV - Sin Papel Alertas Básicas Conjunto Reglas de Alerta para AP/IP Análisis del patrón de FCF basado en la NICHD: - Línea Base - Variabilidad - Aceleraciones - Deceleraciones - Contraciones Alertas Avanzadas Conjunto Reglas para NST Informes NST Funciones de Entrada Autom. de Datos. Entradas al Partograma
    60. 60. Alertas básicas
    61. 61. Alertas avanzadas
    62. 62. Registro electrónico de pacientes • • • • • Registro de paciente tipo ficha Registros de pacientes basados en fichas y en gráficos Conservación de registros completamente electrónica Rápido y fácil acceso a los registros de paciente Soporte de informes estadísticos Personalización on-line del contenido de la base de datos
    63. 63. Gráfica de paciente electrónica Gestión de la información obstétrica, mas fácil, rápida y completa que nunca antes Registro de paciente tipo gráfico
    64. 64. Almacenamiento de datos • Almacenamiento a largo plazo en dispositivo óptico • Fácil acceso a la información almacenada • “Admisión Rápida” cuando el tiempo es crítico Óptimo almacenamiento y recuperación de datos de paciente y trazas
    65. 65. Interfase al HIS y Exportación de datos • Interfase ADT de conexión al HIS para la Admisión, el Alta y el Traslado de pacientes • Fácil recuperación de los datos demográficos del HIS • Reducción de datos de entrada redundantes • Exportación de datos a soluciones de 3ºs depositarias de datos clínicos Ahorro de tiempo: menor necesidad de entrada de datos, datos demográficos de ámbito hospitalario, mejora en la gestion de los datos
    66. 66. Comunicaciones • Recepción y revisión de las trazas transmitidas desde fuera del hospital – Reducción en la demanda de los recursos hospitalarios – Menor estrés para las madres Transmisión remota de las trazas
    67. 67. Comunicaciones • Acceso a la Web • Acceso remoto a la OB TraceVue desde cualquier PC via Microsoft® Internet Explorer – Para estar en contacto directo con la progresión del parto de sus pacientes – Para gestionar de forma mas eficiente sus estimables tiempos – Acceso a los datos de paciente desde cualquier PC con Microsoft® Internet Explorer via una Red de Area Local segura o una conexión modem con retrollamada automática LAN Modem
    68. 68. Explotación de datos • Impresión flexible de fichas (utilizando Microsoft® Word) • Generación automática de informes de estadísticas administrativas y cualitativas (utilizando Microsoft® Excel) • Consultas ad hoc de evaluaciones estadísticas • Logística
    69. 69. Explotación de datos El departamento completo en un PC • Uso en paralelo del software de 3ºs, (por ej. Microsoft® Word, Excel) con los PCs de la OB TraceVue • La OB TraceVue sigue reflejando las situaciones de alerta en sus tres níveles mientras está minimizada • Redución de la necesidad de mas equipamiento técnico
    70. 70. Explotación de datos All Incoming OBTV Outg. Discharge Outg. Transfer HIS
    71. 71. Explotación de datos Server OBTV 1 OBTV Link OBTV Link OBTV 2 Server

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