Aplicación de la guía de práctica clínica de diabetes gestacional en embarazadas del Centro de Salud Morete Puyo para disminuir complicaciones materno-neonatales.

Abstract

The objective of the research was to apply the clinical practice guideline (CPG) of gestational diabetes in pregnant women of the Morete Puyo Health Center to reduce maternal-neonatal complications. An analytical, longitudinal, prospective, quasi-experimental study (before / after without a control group) was performed. 138 pregnant women were included. The implementation process considered as a base component the "decision support" of the chronic care model, and the combined prevention methodology, for which an instrument was created that allowed us to measure and follow the steps of the implementation to be able to integrate the recommendations of the CPG in the decision-making processes of health personnel; previous baseline qualification of the component and reassessment months later to define the level of implementation. At the same time, the degree of glycemic control of pregnant women was measured before and after the intervention, and maternal and neonatal outcomes were measured during and at the end of pregnancy. 34 women with a diagnosis of gestational diabetes (24.6%) were detected. Before the intervention, only 2.9% had adequate glycemic control, after the intervention an adequate control was observed in 67.6%. 97.1% of the cases did not show adverse maternal-neonatal outcome. The baseline component grade was 1.60 / 11 points (poor level of decision support) and at the end of the process, 7.99 / 11 points (good level). The degree of implementation of the recommendations of the CPG was significantly increased. It is recommended to carry out programs of implementation of this and other CPGs in the first level health personnel in conjunction with the second level in order to achieve a global standardization of the strategies to detect, diagnose and treat gestational diabetes.