Patrones morfológicos cardiotocográficos asociados con asfixia perinatal

La asfixia perinatal (AP) es un evento que produce acidosis neonatal durante el periodo periparto, con una incidencia general en Colombia de 40 -45 casos por cada 1000 nacidos vivos incluyendo AP leve, moderada y severa (1). Para su predicción se utiliza la cardiotocografía (CTG) interpretada con ba...

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Autores:: Mozo Acevedo, Diana Alejandra

Tipo de recurso:: https://purl.org/coar/resource_type/c_7a1f

Fecha de publicación:: 2025

Institución:: Universidad El Bosque

Repositorio:: Repositorio U. El Bosque

Idioma:: spa

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dc.title.none.fl_str_mv	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
dc.title.translated.none.fl_str_mv	Cardiotocographic morphological patterns associated with perinatal asphyxia
title	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
spellingShingle	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal Cardiotocografía Monitoria fetal Asfixia perinatal Cardiotocography Perinatal asphyxia Fetal monitoring WP 100
title_short	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
title_full	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
title_fullStr	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
title_full_unstemmed	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
title_sort	Patrones morfológicos cardiotocográficos asociados con asfixia perinatal
dc.creator.fl_str_mv	Mozo Acevedo, Diana Alejandra
dc.contributor.advisor.none.fl_str_mv	Franco Ayala, Luis Carlos
dc.contributor.author.none.fl_str_mv	Mozo Acevedo, Diana Alejandra
dc.contributor.orcid.none.fl_str_mv	0000-0002-4558-0200
dc.subject.none.fl_str_mv	Cardiotocografía Monitoria fetal Asfixia perinatal
topic	Cardiotocografía Monitoria fetal Asfixia perinatal Cardiotocography Perinatal asphyxia Fetal monitoring WP 100
dc.subject.keywords.none.fl_str_mv	Cardiotocography Perinatal asphyxia Fetal monitoring
dc.subject.nlm.none.fl_str_mv	WP 100
description	La asfixia perinatal (AP) es un evento que produce acidosis neonatal durante el periodo periparto, con una incidencia general en Colombia de 40 -45 casos por cada 1000 nacidos vivos incluyendo AP leve, moderada y severa (1). Para su predicción se utiliza la cardiotocografía (CTG) interpretada con base en la clasificación propuesta por el Colegio Americano de Ginecología y Obstetricia (ACOG), a pesar de reportar una baja capacidad predictiva de AP. Objetivo: Analizar los patrones morfológicos cardiotocográficos asociados a AP. Metodología: Estudio retrospectivo de casos y controles. Mujeres gestantes con edad gestacional mayor a 32 semanas a quienes se les realizó CTG en trabajo de parto durante el periodo comprendido entre 2018-2021. Resultados: Se incluyeron 410 pacientes en el estudio, 37 casos y 373 controles. En el análisis bivariado el estrato socioeconómico bajo, el parto instrumentado, la triple I y en la CTG la variabilidad mínima, la ausencia de aceleraciones, las desaceleraciones de respuesta lenta y la velocidad de tendencia al cambio se asociaron con mayor riesgo de AP. En el análisis multivariado, el estrato socioeconómico, el parto instrumentado, la reanimación in útero y la variabilidad mínima en la CTG se identificaron como factores de riesgo para AP. Conclusiones: Algunos patrones morfológicos cardiotográficos específicos podrían asociarse con AP y no hacen parte de las clasificaciones actuales de la CTG. Se requieren estudios de mayor potencia estadística y muestra con mayor frecuencia del evento para evaluar estas posibles asociaciones.
publishDate	2025
dc.date.accessioned.none.fl_str_mv	2025-07-22T16:30:49Z
dc.date.available.none.fl_str_mv	2025-07-22T16:30:49Z
dc.date.issued.none.fl_str_mv	2025-06
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dc.type.local.spa.fl_str_mv	Tesis/Trabajo de grado - Monografía - Especialización
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dc.language.iso.fl_str_mv	spa
language	spa
dc.relation.references.none.fl_str_mv	Piñeros J, Troncoso G, Serrano C, Espinosa E. Consenso De ExpertosDiagnóstico, Manejo, Monitoreo Y Seguimiento DelRecién Nacido Con Asfixia Perinatal, EncefalopatíaHipóxico Isquémica (Ehi), E Hipotermia Terapeutica (Ht). https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdf [Internet]. 2021;1–51. Available from: https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdf E Lawn , S. Cousens JZ. MDGs and newborn babies. Lancet [Internet]. 2005;365:891–900. Available from: http://www.measuredhs.com ACOG. Practice Bulletin Clinical Management Guidelines for Obstetrician - Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. Obstet Gynecol [Internet]. 2009;114(106):192–202. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21422879 The American College of Obstetricians and Gynaecologists. Executive summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition. Obstet Gynecol. 2014;123(4):896–901. Moshiro R, Mdoe P, Perlman JM. A Global View of Neonatal Asphyxia and Resuscitation. 2019;7(November):1–6 Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev [Internet]. 2010;86(6):329–38. Available from: http://dx.doi.org/10.1016/j.earlhumdev.2010.05.010 Weissbach T, Heusler I, Ovadia M, David L, Daykan Y, Schreiber F, et al. The temporal effect of Category II fetal monitoring on neonatal outcomes. Eur J Obstet Gynecol Reprod Biol [Internet]. 2018;229:8–14. Available from: https://doi.org/10.1016/j.ejogrb.2018.07.030 Santo S, Ayres-de-Campos D, Costa-Santos C, Schnettler W, Ugwumadu A, Da Graça LM, et al. Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines. Acta Obstet Gynecol Scand. 2017;96(2):166–75 Vintzileos AM, Mph JCS. variability : have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia ? Am J Obstet Gynecol [Internet]. 2016;215(3):261–4. Available from: http://dx.doi.org/10.1016/j.ajog.2016.05.046 L. C. Franco Ayala, S. Buitrago, J. Machado, C. Trillos, M. P. Franco Pinzon, L. F. Pinto Rueda IA. EP20.33: Frequent cardiotocography morphologies in cases of perinatal asphyxia. Ultrasound Obstet Gynecol. 2023 Bogdanovic G, Babovic A, Rizvanovic M, Ljuca D. Cardiotocography in the Prognosis of Perinatal Outcome. 2014;68(2):102–5 Evans MI, Britt DW, Eden RD, Gallagher P, Evans SM, Schifrin BS. The Fetal Reserve Index Significantly Outperforms ACOG Category System in Predicting Cord Blood Base Excess and pH : A Methodological Failure of the Category System. 2019 Bentancor, V. C. Bertoche, R. Pison, N. Martino CS. Análisis del diagnóstico de sospecha de hipoxia fetal en pacientes con indicación de cesárea por esta causa en el Centro Hospitalario. 2018;15–20. Graham EM, Adami RR, Mckenney SL, Burd I, Witter FR, Jennings JM. Diagnostic Accuracy of Fetal Heart Rate Monitoring in the Identification of Neonatal Encephalopathy. 2014;124(3):507–13 Ugwumadu A. Are we ( mis ) guided by current guidelines on intrapartum fetal heart rate monitoring ? Case for a more physiological approach to interpretation. 2014;1063–70 Cahill AG, Tuuli MG, Stout MJ, López JD, Macones GA. SC. Am J Obstet Gynecol [Internet]. 2018; Available from: https://doi.org/10.1016/j.ajog.2018.01.026 Furukawa A, Neilson D, Hamilton E, Furukawa A, Neilson D, Cumulative EH. Cumulative deceleration area : a simplified predictor of metabolic acidemia. J Matern Neonatal Med [Internet]. 2019;0(0):1–8. Available from: https://doi.org/10.1080/14767058.2019.1678130 Ibarra-r D, Mota-reyes A. Pathophysiology of Perinatal Asphyxia in Humans and Animal Models. 2022 Riesgo-prendes L, Salamanca-matta AL, Monterrey-gutiérrez PA, Bermúdez-hernández PA, Vélez JL. Hipoxia perinatal en el Hospital Mederi de Bogotá: comportamiento en los años 2007 a 2011. 2017;19(3):332–9 Semanal BE. Unidades de análisis y tableros de problemas , semanas epidemiológicas 01 a la 24 de 2023. 2023 Bogotá FSF de. Informe de gestión sostenible. Fund St Fe Bogotá. 2021 Comunicaciones. Cifras historicas de nacimientos en el Instituto Materno Infantil. Subred Integr Serv Salud Cent Oriente ESE. 2020;(Cifras historicas de nacimientos en el Instituto Materno Infantil). Gillam-Krakauer M GJC. Birth Asphyxia. StatPearls [Internet]. 2024 Terré C FL. Monitorización biofísica intraparto. Matronas Prof. 2006;7(2):5–13 Farquhar CM, Armstrong S, Masson V. Clinician Identification of Birth Asphyxia Using Intrapartum Cardiotocography Among Neonates With and Without Encephalopathy in New Zealand. 2020;3(2):1–11 Sholapurkar. Categorization of Fetal Heart Rate Decelerations in American and European Practice: Importance and Imperative of Avoiding Framing and Confirmation Biases. J Clin Med Res. 2015;7(9):672 Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118(1):29–38 Carbonne B, Pons K, Maisonneuve E. Foetal scalp blood sampling during labour for pH and lactate measurements. Best Pract Res Clin Obstet Gynaecol [Internet]. 2016;30(July):62–7. Available from: http://dx.doi.org/10.1016/j.bpobgyn.2015.05.006 Tsikouras P, Koukouli Z, Niesigk B, Manav B, Farmakides G, Csorba R, et al. Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome. J Matern Neonatal Med. 2018;31(23):3166–71 Garite TJ, Simpson KR. Intrauterine resuscitation during labor. Clin Obstet Gynecol. 2011;54(1):28–39. Simpson KR. Intrauterine Resuscitation During Labor: Review of Current Methods and Supportive Evidence. J Midwifery Women’s Heal. 2007;52(3):229–37 Bullens LM, Hulsenboom ADJ, Moors S, Joshi R, Van Runnard Heimel PJ, Van Der Hout-Van Der Jagt MB, et al. Correction to: Intrauterine resuscitation during the second stage of term labour by maternal hyperoxygenation versus conventional care: Study protocol for a randomised controlled trial (INTEREST O2) (Trials (2018) 19 (195) DOI: 10.1186/s13063-018-2567-x). Trials. 2018;19(1):1–11 Esmail A, Bland M. Caesarean section for fetal distress. Lancet. 1990;336(8718):819 Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Indian J Pediatr. 2008;75(12):1249–52 Garabedian C, De Jonckheere J, Butruille L, Deruelle P, Storme L, Houfflin-Debarge V. Understanding fetal physiology and second line monitoring during labor. J Gynecol Obstet Hum Reprod [Internet]. 2017;46(2):113–7. Available from: http://dx.doi.org/10.1016/j.jogoh.2016.11.005 Grivell RM, Alfirevic Z, Gyte GML, Devane D. Antenatal cardiotocography for fetal assessment. Cochrane Database Syst Rev. 2015;2015(9):1–39 Salcedo-Ramos Francisco, Méndez-Rodríguez Rogelio, Vallejo-Navarro Carolina. Fetal Monitoring During the Obstetric Labor. 2015;170–8 Jia YJ, Chen X, Cui HY, Whelehan V, Archer A, Chandraharan E. Physiological CTG interpretation: the significance of baseline fetal heart rate changes after the onset of decelerations and associated perinatal outcomes. J Matern Neonatal Med [Internet]. 2021;34(14):2349–54. Available from: https://doi.org/10.1080/14767058.2019.1666819 Doret M, Constans A, Gaucherand P. Bases physiologiques de l’analyse du rythme cardiaque fœtal au cours du travail. J Gynecol Obstet Biol la Reprod [Internet]. 2010;39(4):276–83. Available from: http://dx.doi.org/10.1016/j.jgyn.2010.01.004 Castelazo-ayala L. Un tributo a Roberto Caldeyro-Barcia, considerado el pionero de la Perinatología. 2017;31(1):39–43 Eden RD, Evans MI, Britt DW, Evans SM, Schifrin BS. Safely lowering the emergency Cesarean and operative vaginal delivery rates using the Fetal Reserve Index. J Matern Neonatal Med [Internet]. 2020;33(9):1473–9. Available from: https://doi.org/10.1080/14767058.2018.1519799 Gamboa SM, Moros ML, Mancho JP, Moros CL, Mateo SC. Deceleration area and fetal acidemia. J Matern Neonatal Med [Internet]. 2017;30(21):2578–84. Available from: http://dx.doi.org/10.1080/14767058.2016.1256993 Franco LC, Buitrago SM, Arbelaez I, Pinto LF, Blanco D, Pizarro MC, et al. Development, Validation, and Diagnostic Accuracy of the Fetal Lack of Responsiveness Scale for Diagnosis of Severe Perinatal Hypoxia. J Pregnancy. 2024;2024:9779831 RAM KMS. Sample size for unmatched case-control studies. cited 2024 Feb 29 Rojas Cardenas C, Sánchez León EM. FACTORES ASOCIADOS A MORTALIDAD NEONATAL EN PACIENTES CON DIAGNÓSTICO DE ASFIXIA PERINATAL. Repos Univ el Bosque. 2014;48.
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spelling	Franco Ayala, Luis CarlosMozo Acevedo, Diana Alejandra0000-0002-4558-02002025-07-22T16:30:49Z2025-07-22T16:30:49Z2025-06https://hdl.handle.net/20.500.12495/15018instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coLa asfixia perinatal (AP) es un evento que produce acidosis neonatal durante el periodo periparto, con una incidencia general en Colombia de 40 -45 casos por cada 1000 nacidos vivos incluyendo AP leve, moderada y severa (1). Para su predicción se utiliza la cardiotocografía (CTG) interpretada con base en la clasificación propuesta por el Colegio Americano de Ginecología y Obstetricia (ACOG), a pesar de reportar una baja capacidad predictiva de AP. Objetivo: Analizar los patrones morfológicos cardiotocográficos asociados a AP. Metodología: Estudio retrospectivo de casos y controles. Mujeres gestantes con edad gestacional mayor a 32 semanas a quienes se les realizó CTG en trabajo de parto durante el periodo comprendido entre 2018-2021. Resultados: Se incluyeron 410 pacientes en el estudio, 37 casos y 373 controles. En el análisis bivariado el estrato socioeconómico bajo, el parto instrumentado, la triple I y en la CTG la variabilidad mínima, la ausencia de aceleraciones, las desaceleraciones de respuesta lenta y la velocidad de tendencia al cambio se asociaron con mayor riesgo de AP. En el análisis multivariado, el estrato socioeconómico, el parto instrumentado, la reanimación in útero y la variabilidad mínima en la CTG se identificaron como factores de riesgo para AP. Conclusiones: Algunos patrones morfológicos cardiotográficos específicos podrían asociarse con AP y no hacen parte de las clasificaciones actuales de la CTG. Se requieren estudios de mayor potencia estadística y muestra con mayor frecuencia del evento para evaluar estas posibles asociaciones.Especialista en Ginecología y ObstetriciaEspecializaciónPerinatal asphyxia (PA) is an event that leads to neonatal acidosis during the peripartum period, with an general incidence of 40-45 cases per 1000 live births in Colombia including mild, moderate, and severe PA (1). Cardiotocography (CTG) is used to predict PA, interpreted based on the classification proposed by the American College of Obstetricians and Gynecologists (ACOG), despite its reported low predictive capacity for PA. Objective: To analyze CTG morphological patterns associated with PA. Methods: A retrospective case-control study. Pregnant women with a gestational age greater than 32 weeks, who underwent CTG during labor between 2018-2021 were included. Results: A total of 410 patients were included in the study, 37 cases and 373 controls. In the bivariate analysis, low socioeconomic status, instrumental delivery, triple I, and CTG findings such as minimal variability, absence of accelerations, slow response decelerations, and trend change rate were associated with a higher risk of PA. In the multivariate analysis, socioeconomic status, assisted vaginal delivery, in-utero resuscitation, and minimal CTG variability were identified as risk factors for PA. Conclusions: Certain specific CTG morphological patterns may be associated with PA and are not currently included in existing CTG classifications. Further studies with larger sample sizes and greater event frequency are needed to establish these associations.application/pdfAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2CardiotocografíaMonitoria fetalAsfixia perinatalCardiotocographyPerinatal asphyxiaFetal monitoringWP 100Patrones morfológicos cardiotocográficos asociados con asfixia perinatalCardiotocographic morphological patterns associated with perinatal asphyxiaEspecialización en Ginecología y ObstetriciaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aaPiñeros J, Troncoso G, Serrano C, Espinosa E. Consenso De ExpertosDiagnóstico, Manejo, Monitoreo Y Seguimiento DelRecién Nacido Con Asfixia Perinatal, EncefalopatíaHipóxico Isquémica (Ehi), E Hipotermia Terapeutica (Ht). https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdf [Internet]. 2021;1–51. Available from: https://ascon.org.co/wp-content/uploads/2021/02/CONSENSO-NEUROLOGIA-Y-NEONATOLOGIA1.pdfE Lawn , S. Cousens JZ. MDGs and newborn babies. Lancet [Internet]. 2005;365:891–900. Available from: http://www.measuredhs.comACOG. Practice Bulletin Clinical Management Guidelines for Obstetrician - Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. Obstet Gynecol [Internet]. 2009;114(106):192–202. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21422879The American College of Obstetricians and Gynaecologists. Executive summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition. Obstet Gynecol. 2014;123(4):896–901.Moshiro R, Mdoe P, Perlman JM. A Global View of Neonatal Asphyxia and Resuscitation. 2019;7(November):1–6Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev [Internet]. 2010;86(6):329–38. Available from: http://dx.doi.org/10.1016/j.earlhumdev.2010.05.010Weissbach T, Heusler I, Ovadia M, David L, Daykan Y, Schreiber F, et al. The temporal effect of Category II fetal monitoring on neonatal outcomes. Eur J Obstet Gynecol Reprod Biol [Internet]. 2018;229:8–14. Available from: https://doi.org/10.1016/j.ejogrb.2018.07.030Santo S, Ayres-de-Campos D, Costa-Santos C, Schnettler W, Ugwumadu A, Da Graça LM, et al. Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines. Acta Obstet Gynecol Scand. 2017;96(2):166–75Vintzileos AM, Mph JCS. variability : have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia ? Am J Obstet Gynecol [Internet]. 2016;215(3):261–4. Available from: http://dx.doi.org/10.1016/j.ajog.2016.05.046L. C. Franco Ayala, S. Buitrago, J. Machado, C. Trillos, M. P. Franco Pinzon, L. F. Pinto Rueda IA. EP20.33: Frequent cardiotocography morphologies in cases of perinatal asphyxia. Ultrasound Obstet Gynecol. 2023Bogdanovic G, Babovic A, Rizvanovic M, Ljuca D. Cardiotocography in the Prognosis of Perinatal Outcome. 2014;68(2):102–5Evans MI, Britt DW, Eden RD, Gallagher P, Evans SM, Schifrin BS. The Fetal Reserve Index Significantly Outperforms ACOG Category System in Predicting Cord Blood Base Excess and pH : A Methodological Failure of the Category System. 2019Bentancor, V. C. Bertoche, R. Pison, N. Martino CS. Análisis del diagnóstico de sospecha de hipoxia fetal en pacientes con indicación de cesárea por esta causa en el Centro Hospitalario. 2018;15–20.Graham EM, Adami RR, Mckenney SL, Burd I, Witter FR, Jennings JM. Diagnostic Accuracy of Fetal Heart Rate Monitoring in the Identification of Neonatal Encephalopathy. 2014;124(3):507–13Ugwumadu A. Are we ( mis ) guided by current guidelines on intrapartum fetal heart rate monitoring ? Case for a more physiological approach to interpretation. 2014;1063–70Cahill AG, Tuuli MG, Stout MJ, López JD, Macones GA. SC. Am J Obstet Gynecol [Internet]. 2018; Available from: https://doi.org/10.1016/j.ajog.2018.01.026Furukawa A, Neilson D, Hamilton E, Furukawa A, Neilson D, Cumulative EH. Cumulative deceleration area : a simplified predictor of metabolic acidemia. J Matern Neonatal Med [Internet]. 2019;0(0):1–8. Available from: https://doi.org/10.1080/14767058.2019.1678130Ibarra-r D, Mota-reyes A. 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FACTORES ASOCIADOS A MORTALIDAD NEONATAL EN PACIENTES CON DIAGNÓSTICO DE ASFIXIA PERINATAL. 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