Scielo RSS http://www.scielo.org.co/rss.php?pid=0034-743420250002&lang=es vol. 76 num. 2 lang. es http://www.scielo.org.co/img/en/fbpelogp.gif http://www.scielo.org.co http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200001&lng=es&nrm=iso&tlng=es http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200002&lng=es&nrm=iso&tlng=es RESUMEN Objetivo: describir la prevalencia de las diferentes demoras en el diagnóstico y tratamiento del cáncer de cuello uterino, hacer una aproximación a su incidencia en el Departamento del Meta (Colombia) en los últimos años, así como un análisis exploratorio a posibles factores asociados a las demoras. Materiales y métodos: estudio de corte transversal, de los casos nuevos notificados de cáncer de cuello uterino en el Sistema de Vigilancia Epidemiológica del Instituto Nacional de Salud de Colombia en el periodo 2017 a 2023. Se describe la proporción de casos en los que se identifican demoras en el proceso de atención, y, además, se describe la tasa de incidencia de cáncer de cuello uterino, por año, a partir de los datos poblacionales. Resultados: se incluyeron 824 casos. Se evidenciaron demoras de más de 60 días en el proceso de atención en el 56,9 % de los casos. Estas demoras se atribuyen al paciente en un 33,9 % por desconocimiento o barreras geográficas, culturales o económicas, el 36,2 % a los servicios de salud por falta de oportunidad en la atención y el 22,9 % al asegurador por barreras administrativas. Conclusiones: las demoras son frecuentes en el proceso de atención en el Meta. Estas demoras afectan en especial a mujeres mayores de 40 años y residentes en zona rural. Se requieren estudios analíticos y cualitativos que exploren de manera más profunda las causas de las demoras.<hr/>ABSTRACT Objective: To describe the prevalence of the different delays in the diagnosis and treatment of cervical cancer, to estimate its incidence in the Department of Meta (Colombia) in recent years, and to conduct an exploratory analysis of potential factors associated with these delays. Material and methods: Cross-sectional study of newly reported cases of cervical cancer in the Epidemiological Surveillance System of the National Institute of Health of Colombia between 2017 and 2023. The proportion of cases in which delays in the care process were identified was described, as well as the annual incidence rate of cervical cancer based on population data. Results: A total of 824 cases were included. Delays of more than 60 days in the care process were observed in 56.9% of the cases. These delays were attributed to patients in 33.9% of cases due to lack of knowledge or geographic, cultural, or economic barriers; to health services in 36.2% of cases due to lack of timely care; and to insurers in 22.9% of cases due to administrative barriers. Conclusions: Delays in the care process are common in Meta. These delays particularly affect women over 40 years of age and those residing in rural areas. Analytic and qualitative studies are needed to further explore the underlying causes of these delays. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200003&lng=es&nrm=iso&tlng=es RESUMEN Objetivo: describir la dispensación de fármacos para el sistema nervioso antes y durante el embarazo, según la categoría de riesgo fetal del medicamento. Materiales y métodos: estudio descriptivo de utilización de medicamentos para el sistema nervioso en una cohorte histórica (2020-2023) de mujeres embarazadas, en un seguro de salud de Argentina. Los fármacos dispensados fueron categorizados en un grupo de riesgo fetal alto, y otro de no alto o desconocido, de acuerdo con la clasificación de agencias reguladoras seleccionadas. Se midió la prevalencia de uso antes y durante la gestación, así como la incidencia acumulada de retiro y de inicio durante el embarazo. Resultados: de las 6.369 embarazadas incluidas, el 4,7 % recibió algún fármaco del grupo evaluado en el periodo previo y 18,8 % durante el embarazo. Este aumento se debió principalmente al paracetamol, que ascendió de 1,5 a 13,4 % durante el embarazo. Por el contrario, descendió el uso de ansiolíticos (1,6 a 0,7 %), antidepresivos (0,8 a 0,4 %) y antiepilépticos (0,7 a 0,4 %). La prevalencia de uso de medicamentos de alto riesgo descendió de 1,5 a 1 % durante el embarazo, con una incidencia acumulada de retiro de 81,3 % y de inicio del 0,7 %. Conclusiones: la dispensación de medicamentos para el sistema nervioso con alto riesgo fetal fue baja en la cohorte estudiada. Es importante identificar el riesgo fetal de cada medicamento a fin de optimizar la selección del tratamiento para los trastornos del sistema nervioso en las mujeres gestantes. Se requieren estudios prospectivos que validen los patrones de utilización de medicamentos en la región y los desenlaces fetales y neonatales.<hr/>ABSTRACT Objective: To describe the dispensing of nervous system medications before and during pregnancy, according to the fetal risk category of the drug. Material and methods: Descriptive drug utilization study of nervous system medications in a historical cohort (2020-2023) of pregnant women enrolled in a health insurance program in Argentina. Dispensed drugs were categorized into two groups: high fetal risk and non-high or unknown risk, based on the classification of selected regulatory agencies. The prevalence of use before and during pregnancy was measured, along with the cumulative incidence of drug discontinuation and initiation during pregnancy. Results: Among the 6,369 pregnant women included, 4.7% received at least one drug from the evaluated group in the pre-pregnancy period, and 18.8% during pregnancy. This increase was mainly due to paracetamol, which rose from 1.5% to 13.4% during pregnancy. In contrast, the use of anxiolytics (1.6% to 0.7%), antidepressants (0.8% to 0.4%), and antiepileptics (0.7% to 0.4%) decreased. The prevalence of use of high-risk medications declined from 1.5% to 1% during pregnancy, with a cumulative discontinuation incidence of 81.3% and initiation incidence of 0.7%. Conclusions: The dispensing of nervous system medications with high fetal risk was low in the studied cohort. Identifying the fetal risk associated with each drug is essential to optimize treatment selection for nervous system disorders in pregnant women. Prospective studies are needed to validate medication utilization patterns in the region and their associated fetal and neonatal outcomes. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200004&lng=es&nrm=iso&tlng=es ABSTRACT Objective: To describe the incidence, clinical characteristics, and complications of obstetric hysterectomy in a tertiary hospital in Chile from 2021 to 2023. Methods: Retrospective descriptive cohort study including all women with a gestational age ≥20 weeks or up to six weeks postpartum who underwent obstetric hysterectomy at Santiago Oriente Dr. Luis Tisné Brousse Hospital. Clinical and surgical data were collected from institutional records. Descriptive statistics were performed. Results: Twenty-five obstetric hysterectomies were performed during the study period. Incidence per 1,000 live births decreased from 3.22 in 2021 to 1.81 in 2023. Postpartum hemorrhage was the main indication (52%), followed by placenta accreta spectrum (32%), infection (12%), and uterine rupture (4%). Supracervical hysterectomy was performed in 52% of cases, and total hysterectomy in 48%; 68% were emergencies. One intraoperative complication (bladder injury) was reported. Postoperative complications occurred in 84% of cases, the most frequent being anemia (84%) and hemorrhagic shock (36%). No significant associations were found between baseline characteristics and complications. Conclusion: Although its incidence is declining, obstetric hysterectomy remains associated with high morbidity. Strengthening prevention, early detection, and timely multidisciplinary care is essential. Further prospective, multicenter studies are needed to inform strategies to improve maternal outcomes.<hr/>RESUMEN Objetivos: describir la incidencia, características clínicas y complicaciones de la histerectomía obstétrica (HO) en un hospital terciario en Chile entre 2021 y 2023. Métodos: estudio descriptivo de cohorte retrospectivo que incluyó a todas las mujeres con una edad gestacional ≥20 semanas o hasta seis semanas posparto que se sometieron a HO en el Hospital Santiago Oriente, Dr. Luis Tisné Brousse. Se recolectaron datos clínicos y quirúrgicos a partir los registros institucionales. Se realizó un análisis estadístico descriptivo. Resultados: se realizaron 25 HO durante el período de estudio. La incidencia disminuyó de 3,22 en 2021 a 1,81 en 2023 por cada 1.000 nacidos vivos. La indicación principal fue hemorragia posparto (52%), seguida de espectro de acretismo placentario (32%), infección (12%) y ruptura uterina (4%). Se realizó histerectomía supracervical en el 52% y total en el 48%; el 68% fueron de urgencia. Se registró una complicación intraoperatoria (lesión vesical). Las complicaciones posoperatorias ocurrieron en el 84% de los casos, siendo las más frecuentes la anemia (84%) y el shock hipovolémico (36%). No se encontraron asociaciones significativas entre las características basales y las complicaciones. Conclusión: aunque su incidencia ha disminuido, la HO sigue asociada a una alta morbilidad. Es fundamental fortalecer la prevención, detección precoz y atención multidisciplinaria oportuna. Se requieren estudios prospectivos y multicéntricos para mejorar los resultados maternos. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200005&lng=es&nrm=iso&tlng=es ABSTRACT Objective: This study assesses postnatal women’s perceptions of Respectful Maternity Care (RMC), aiming to identify key areas for improvement. Methods: A cross-sectional quantitative study was carried out in selected urban areas of Bhopal, India. Women aged 18 years and above, who had given birth to a healthy newborn within the previous 42 days, were eligible to participate if they resided in the study area, could understand Hindi or English, and had no cognitive impairments. Estimated sample size was 238 with 77% estimated prevalence, 5% margin of error, and 95% confidence level; 270 women were recruited using purposive sampling from 18 urban wards and 98 Anganwadi centres. Participants were approached directly and interviewed in person using a structured questionnaire and the validated RMC Scale by Sheferaw et al. The primary outcome was the level of perceived respectful maternity care, while independent variables included socio-demographic and obstetric factors such as age, education, place of delivery, and number of antenatal visits. Data were analysed using descriptive statistics and Fisher’s exact test due to the non-normal distribution of variables. Results: Of the 270 participants, 51.2% were aged 25-30 years and 75.3% were Hindus. Most deliveries (57.4%) were normal vaginal deliveries, and 75.6% occurred in government hospitals. Overall, 82.6% of women reported experiencing RMC. Domain-wise, 91% experienced Friendly Care, 93.3% Abuse-Free Care, 79.7% Timely Care, and 87.7% Discrimination-Free Care. Item-wise analysis revealed strengths in provider kindness and clear communication, though about 15-25% of women experienced delays, verbal mistreatment, or felt disrespected. Socioeconomic status had a significant influence in all four domains (p &lt; 0.05), with women from higher income groups reporting more positive experiences. Higher education level was also associated with greater awareness and recognition of discriminatory practices (p = 0.014), Obstetric variables such as mode of delivery (p = 0.031), time of delivery (p = 0.003), antenatal visits (p = 0.017, 0.029), and high-risk pregnancy (p = 0.037) showed domain-specific associations. Conclusion: Although most women described their childbirth experience as respectful, notable gaps remain in timely and equitable care. Addressing delays and reducing discrimination, particularly in public healthcare settings, are essential to ensuring that all women receive dignified, person-centred maternity care, regardless of their background.<hr/>RESUMEN Objetivos: Este estudio evalúa la percepción de mujeres en el posparto sobre el Cuidado Materno Respetuoso (CMR), con el objetivo de identificar áreas clave de mejora. Materiales y métodos: Se llevó a cabo un estudio cuantitativo transversal en zonas urbanas seleccionadas de Bhopal, India. Fueron elegibles mujeres de 18 años o más que hubieran dado a luz a un recién nacido sano en los 42 días previos, que residieran en el área de estudio, entendieran hindi o inglés y no tuvieran discapacidades cognitivas. El tamaño de muestra estimado fue de 238 mujeres, con una prevalencia estimada del 77 %, un margen de error del 5 % y un nivel de confianza del 95 %. Se reclutaron 270 mujeres mediante muestreo intencional en 18 distritos urbanos y 98 centros Anganwadi. Las participantes fueron contactadas directamente y entrevistadas en persona utilizando un cuestionario estructurado y la escala validada de CMR de Sheferaw et al. El desenlace principal fue el nivel de percepción de cuidado materno respetuoso; las variables independientes incluyeron factores sociodemográficos y obstétricos, como edad, nivel educativo, lugar del parto y número de controles prenatales. Los datos se analizaron mediante estadística descriptiva y la prueba exacta de Fisher, debido a la distribución no normal de las variables. Resultados: De las 270 participantes, el 51,2 % tenía entre 25 y 30 años y el 75,3 % eran hindúes. La mayoría de los partos (57,4 %) fueron vaginales normales y el 75,6 % ocurrieron en hospitales públicos. En general, el 82,6 % de las mujeres reportó haber recibido CMR. Por dominios, el 91 % experimentó Cuidado Amable, el 93,3 % Cuidado Libre de Abuso, el 79,7 % Cuidado Oportuno y el 87,7 % Cuidado Libre de Discriminación. El análisis por ítems mostró fortalezas en la amabilidad del personal y la comunicación clara, aunque entre el 15 % y el 25 % de las mujeres reportaron demoras, maltrato verbal o sensación de falta de respeto. El nivel socioeconómico influyó significativamente en los cuatro dominios (p &lt; 0,05), siendo más positivas las experiencias entre mujeres de mayores ingresos. Un mayor nivel educativo también se asoció con mayor conciencia y reconocimiento de prácticas discriminatorias (p = 0,014). Las variables obstétricas como el tipo de parto (p = 0,031), la hora del parto (p = 0,003), los controles prenatales (p = 0,017; 0,029) y el embarazo de alto riesgo (p = 0,037) mostraron asociaciones específicas según el dominio. Conclusión: Aunque la mayoría de las mujeres describieron su experiencia de parto como respetuosa, persisten brechas importantes en el cuidado oportuno y equitativo. Abordar las demoras y reducir la discriminación, especialmente en los servicios públicos de salud, es esencial para garantizar que todas las mujeres reciban un cuidado materno digna y centrada en la persona, independientemente de su origen. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74342025000200006&lng=es&nrm=iso&tlng=es resumen está disponible en el texto completo<hr/>ABSTRACT Objective: To generate recommendations for vaccinating women at different stages of their lives, in order to reduce potential variability in current use in Colombia. Materials and Methods: The guideline development group consisted of professionals from the health sector. All participants submitted written conflict-of-interest declarations. Answerable clinical questions were formulated, outcomes were graded, and a literature search was conducted in Medline/PubMed, Embase, and LILACS. The search also included grey literature sources and was updated on May 14, 2024, with no restrictions on date or language. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to determine the quality of evidence and the strength of recommendations. Due to the limitations of the retrieved studies-particularly concerning the applicability of the evidence-expert opinion was sought. Formal consensus was achieved following the RAND/UCLA methodology (RAND Corporation/ University of California, Los Angeles). Prior to publication, the document underwent peer review. Results: The following recommendations were developed: 1. The development group suggests that women who are not immune to mumps, measles, or rubella (e.g., IgG negative) should be vaccinated during the preconception period. Quality of evidence: low ⨁⨁◯◯ 2. The development group suggests that all women in the preconception period be vaccinated against varicella if they lack confirmed natural immunity (e.g., negative varicella-zoster virus IgG antibodies). Quality of evidence: very low ⨁◯◯◯ 3. The development group suggests that women living in yellow fever endemic areas be vaccinated during the preconception period if they have not been previously immunized. Quality of evidence: very low ⨁◯◯◯ 4. The development group suggests that adolescent girls and young adult women receive the human papillomavirus (HPV) vaccine , 3 doses (0.2 and 6 months) to reduce cervical cancer incidence and mortality. Quality of evidence: moderate ⨁⨁⨁◯ 5. The development group suggests that pregnant women be immunized against tetanus, diphtheria, and pertussis during pregnancy to reduce infection risk in both the mother and newborn. Quality of evidence: low ⨁⨁◯◯ 6. The development group suggests influenza vaccination at any stage of pregnancy to reduce infection risk in the mother and in infants up to six months of age. Quality of evidence: very low ⨁◯◯◯ 7. The development group suggests maternal COVID-19 vaccination at any stage of pregnancy to reduce the risk of hospitalization and death of the mother and the newborn during the first four months of life. Quality of evidence: very low ⨁◯◯◯ 8. The development group suggests vaccination against respiratory syncytial virus (RSV) during pregnancy to reduce hospitalization risk in the newborn. Quality of evidence: very low ⨁◯◯◯ 9. The development group suggests that older adult women be vaccinated against herpes zoster to reduce morbidity associated with this condition. Quality of evidence: moderate ⨁⨁⨁◯ 10. The development group suggests that older adult women receive influenza vaccination to reduce the incidence of acute respiratory infections (ARI). Quality of evidence: moderate ⨁⨁⨁◯ 11. The development group suggests that older adult women be vaccinated against pneumococcus to reduce the incidence of pneumonia and invasive pneumococcal disease. Quality of evidence: low ⨁⨁◯◯ 12. The development group suggests that older adult women be vaccinated against RSV to reduce the incidence of ARI and lower respiratory tract infections. Quality of evidence: low ⨁⨁◯◯ 13. The development group suggests that older adult women living in yellow fever endemic areas be vaccinated if they have not been previously immunized. Quality of evidence: very low ⨁◯◯◯ Conclusions: Vaccination is recommended as a primary prevention strategy throughout the different stages of a woman's life. Given the quality of the available evidence and the significant limitations in the applicability of some studies-particularly among pregnant women-further research is needed to evaluate the safety and effectiveness of this intervention during this stage of life.