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Estudio clínico y farmacoeconómico de la eficacia de la carbetocina en cesáreas electivas respecto a la oxitocina a dosis bajas y a dosis habituales
Clinical and pharmacological study of the efficacy of carbetocin in elective caesareans compared to low and usual doses of oxytocin
J.R. Ortiz-Gómeza,
Autor para correspondencia
jortizgo@cfnavarra.es

Autor para correspondencia.
, F. Morillas-Ramírezb, I. Fornet-Ruizc, F.J. Palacio-Abizandab, L. Bermejo-Albaresb
a Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Navarra, Hospital Universitario Virgen del Camino, Pamplona, Navarra, España
b Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
c Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La prevenci&#243;n de la hemorragia por aton&#237;a uterina es una indicaci&#243;n del uso de la oxitocina en obstetricia&#44; tanto en el alumbramiento dirigido&#44; como en ces&#225;reas tras la extracci&#243;n fetal&#46; Reduce la hemorragia al inducir la activaci&#243;n de receptores acoplados a la prote&#237;na G localizados en el miometrio y la decidua&#44; provocando contracciones r&#225;pidas y duraderas que aumentan el tono basal del miometrio<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; La dosis &#243;ptima de oxitocina no est&#225; bien definida<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> y puede producir efectos adversos<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; Su empleo a dosis bajas se acompa&#241;a de una reducci&#243;n de los efectos adversos sin incrementar el riesgo de sangrado obst&#233;trico<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9&#44;10</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La carbetocina es un octap&#233;ptido sint&#233;tico an&#225;logo de la oxitocina&#46; Se une a los receptores de la oxitocina de la musculatura lisa uterina&#44; induciendo contracciones r&#237;tmicas&#44; frecuentes y un aumento del tono uterino<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Tiene un inicio de acci&#243;n de 2<span class="elsevierStyleHsp" style=""></span>min&#44; provocando contracciones tet&#225;nicas durante 6<span class="elsevierStyleHsp" style=""></span>min &#40;si se administra por v&#237;a iv&#41; o de 11<span class="elsevierStyleHsp" style=""></span>min &#40;administrada por v&#237;a im&#41; y contracciones r&#237;tmicas durante 60-120<span class="elsevierStyleHsp" style=""></span>min<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; una semivida de eliminaci&#243;n de 29-53<span class="elsevierStyleHsp" style=""></span>min y excreci&#243;n urinaria &#40;menos del 1&#37; como f&#225;rmaco sin metabolizar&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las ventajas argumentadas a favor del uso de la carbetocina respecto a la oxitocina son su mayor vida media &#40;4-10 veces&#41;&#44; una respuesta uterina m&#225;s prolongada en relaci&#243;n a la amplitud y frecuencia de las contracciones<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; menor necesidad de intervenciones uterot&#243;nicas adicionales &#40;oxit&#243;cicos&#47;masaje uterino&#41; y la comodidad de administraci&#243;n &#40;en dosis &#250;nica&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se estima que la dosis habitual de carbetocina iv &#40;100<span class="elsevierStyleHsp" style=""></span>&#956;g&#41; son equivalentes a 18<span class="elsevierStyleHsp" style=""></span>h de tratamiento con 50<span class="elsevierStyleHsp" style=""></span>UI de oxitocina &#40;infusi&#243;n continua de 20<span class="elsevierStyleHsp" style=""></span>UI a un ritmo de 700<span class="elsevierStyleHsp" style=""></span>mUI&#215;min<span class="elsevierStyleSup">&#8722;1</span> seguido posteriormente de 10<span class="elsevierStyleHsp" style=""></span>UI&#215;h<span class="elsevierStyleSup">&#8722;1</span> durante 18<span class="elsevierStyleHsp" style=""></span>h&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La carbetocina puede presentar efectos adversos<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Incidencias superiores al 10&#37; tienen la cefalea&#44; temblor&#44; hipotensi&#243;n arterial&#44; rubor&#44; sensaci&#243;n de calor&#44; n&#225;useas&#44; v&#243;mitos&#44; dolor abdominal y prurito&#44; y del 1-5&#37; el dolor tor&#225;cico o dorsal&#44; taquicardia&#44; ansiedad&#44; escalofr&#237;o&#44; v&#233;rtigo&#44; sabor met&#225;lico&#44; anemia&#44; disnea y sudoraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Por tanto&#44; deber&#237;a emplearse con precauci&#243;n cuando exista compromiso hemodin&#225;mico &#40;p&#46; ej&#46;&#44; hipovolemia&#44; valvulopat&#237;as&#44; cardiopat&#237;a isqu&#233;mica&#44; etc&#46;&#41;&#46; Apenas se excreta por la leche materna<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es realizar la comparaci&#243;n cl&#237;nica y farmacoecon&#243;mica de la carbetocina con la oxitocina &#40;a dosis habituales y a dosis bajas&#41; en el control y prevenci&#243;n de la hemorragia uterina durante ces&#225;reas programadas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="par0035" class="elsevierStylePara elsevierViewall">Tras la aprobaci&#243;n de los Comit&#233;s de &#201;tica hospitalarios y la obtenci&#243;n del consentimiento informado de las pacientes&#44; 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Posteriormente&#44; el ritmo se ajust&#243; a las necesidades de cada paciente para mantener una adecuada estabilidad hemodin&#225;mica&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El grupo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; recibi&#243; tras la extracci&#243;n fetal y coincidiendo con el clampaje del cord&#243;n umbilical 1<span class="elsevierStyleHsp" style=""></span>UI de oxitocina seguida de una perfusi&#243;n de 2&#44;5<span class="elsevierStyleHsp" style=""></span>UI&#215;h<span class="elsevierStyleSup">&#8722;1</span> durante 24<span class="elsevierStyleHsp" style=""></span>h&#59; el grupo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; una infusi&#243;n continua de 20<span class="elsevierStyleHsp" style=""></span>UI a un ritmo de 700<span class="elsevierStyleHsp" style=""></span>mUI&#215;min<span class="elsevierStyleSup">&#8722;1</span> seguido posteriormente de 10<span class="elsevierStyleHsp" style=""></span>UI&#183;h<span class="elsevierStyleSup">&#8722;1</span> durante 24<span class="elsevierStyleHsp" style=""></span>h&#44; y el grupo 3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; recibi&#243; 100<span class="elsevierStyleHsp" style=""></span>&#956;g de carbetocina en dosis bolo &#250;nica &#40;infusi&#243;n iv en un minuto&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se registraron estatura&#44; peso&#44; &#237;ndice de masa corporal&#44; semana de gestaci&#243;n&#44; historia obst&#233;trica &#40;gestaci&#243;n&#44; abortos&#44; paridad&#44; ces&#225;reas&#41;&#44; afecci&#243;n uterina&#44; cirug&#237;a uterina previa diferente a la ces&#225;rea que implicase una histerorrafia y el nivel de bloqueo sensitivo alcanzado&#46; Se consideraron para la valoraci&#243;n hemodin&#225;mica como valores basales&#44; los del momento de la extracci&#243;n fetal&#44; y posteriormente a los 3&#44; 5 y 10<span class="elsevierStyleHsp" style=""></span>min&#44; al cierre del peritoneo&#44; al finalizar la cirug&#237;a&#44; a la llegada del paciente a la unidad de recuperaci&#243;n postanest&#233;sica &#40;URPA&#41;&#44; a la primera y segunda hora del postoperatorio y al alta a la sala de hospitalizaci&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se evalu&#243; subjetivamente el grado de contractilidad uterina en el quir&#243;fano seg&#250;n el criterio del ginec&#243;logo &#40;ausencia&#44; moderada contracci&#243;n o contracci&#243;n satisfactoria&#41; y en la URPA a criterio de enfermer&#237;a&#44; valorando la posici&#243;n del &#250;tero en traveses de dedo &#40;1 o 2&#41; con respecto al ombligo &#40;por encima o por debajo&#41; como criterio de contracci&#243;n uterina&#46; En caso de contractilidad uterina ausente o moderada se aplicaba el algoritmo de actuaci&#243;n de la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">El sangrado vaginal se estableci&#243; subjetivamente en ausente&#44; leve&#44; moderado o abundante&#44; seg&#250;n el criterio del ginec&#243;logo al finalizar la cirug&#237;a y en la URPA a criterio de enfermer&#237;a&#46; Las p&#233;rdidas hemorr&#225;gicas globales se cuantificaron por la comparaci&#243;n del hematocrito y la hemoglobina previos a la cirug&#237;a y a las 4<span class="elsevierStyleHsp" style=""></span>h posces&#225;rea&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se registraron los posibles efectos secundarios a la administraci&#243;n de oxit&#243;cicos de forma continuada en los mismos tiempos de registro de las variables hemodin&#225;micas&#58; n&#225;useas&#44; v&#243;mitos&#44; malestar general&#44; cefalea&#44; enrojecimiento&#44; temblor&#44; escalofr&#237;os&#44; alteraciones en el ECG y dolor tor&#225;cico&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para la estimaci&#243;n de costes se usaron los datos disponibles en la web &#171;<a href="http://www.vademecum.es/">http&#58;&#47;&#47;www&#46;vademecum&#46;es</a>&#187; sobre el precio industrial m&#225;ximo o precio de venta del laboratorio &#40;PVL&#41; y el precio de venta al p&#250;blico &#40;PVP&#41; de la oxitocina &#40;Syntocinon<span class="elsevierStyleSup">&#174;</span>&#44; Sigma-Tau&#41; Sol&#46; Iny&#46; 10<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#44; con PVL de 0&#44;5<span class="elsevierStyleHsp" style=""></span>&#8364; y PVP de 0&#44;78<span class="elsevierStyleHsp" style=""></span>&#8364; cada envase de 1 ampolla y con PVL de 20&#44;75<span class="elsevierStyleHsp" style=""></span>&#8364; y PVP de 25&#44;24<span class="elsevierStyleHsp" style=""></span>&#8364; cada envase de 50 ampollas&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> y de la carbetocina &#40;Duratobal<span class="elsevierStyleSup">&#174;</span>&#44; Ferring GMBH&#44; Wittland&#44; Germany&#41; Sol&#46; Iny&#46; 100<span class="elsevierStyleHsp" style=""></span>&#956;g por ampolla&#44; envase de 5 ampollas&#44; con PVL 150&#44;0<span class="elsevierStyleHsp" style=""></span>&#8364; y PVP 203&#44;75<span class="elsevierStyleHsp" style=""></span>&#8364;&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los c&#225;lculos econ&#243;micos se hicieron empleando tanto el PVL como el PVP&#44; y son meramente el precio de f&#225;rmaco&#46; No se han estimado los costes de los fungibles empleados para administrar la medicaci&#243;n &#40;jeringas&#44; agujas&#41; ni para su infusi&#243;n &#40;fluidoterapia y sistemas de sueros&#44; limitadores de flujo o sistemas de infusi&#243;n continua&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSS<span class="elsevierStyleSup">&#174;</span>16&#46;0&#46; Los resultados de las variables continuas se presentan como media y desviaci&#243;n t&#237;pica&#46; El an&#225;lisis de normalidad se estudi&#243; con la prueba de Kolmogorov-Smirnov&#46; Las variables num&#233;ricas con distribuci&#243;n no normal&#44; se presentan mediante su mediana y rango intercuart&#237;lico&#44; mientras que las variables categ&#243;ricas&#44; se presentan por sus frecuencias y porcentajes&#46; La asociaci&#243;n entre variables cualitativas&#44; se estudi&#243; mediante las pruebas Chi-cuadrado de Pearson o exacta de Fisher&#46; La evoluci&#243;n de las distintas variables a lo largo del tiempo se estudi&#243; mediante la prueba ANOVA de medidas repetidas&#46; Se consideraron significativos aquellos resultados con una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La metodolog&#237;a de revisi&#243;n bibliogr&#225;fica se realiz&#243; mediante una b&#250;squeda exhaustiva no acotada por tiempo en las bases de datos de s&#237;ntesis de medicina basada en la evidencia <span class="elsevierStyleItalic">Cochrane Libray Plus&#44; BMJ Clinical Evidence&#44; UpToDate</span> y <span class="elsevierStyleItalic">Trip Database</span> y en las bases de datos de citas bibliogr&#225;ficas de revistas <span class="elsevierStyleItalic">Medline</span> &#40;mediante la plataforma <span class="elsevierStyleItalic">Ovid</span>&#41; y <span class="elsevierStyleItalic">LILACS</span>&#44; mediante la b&#250;squeda de los t&#233;rminos relativos al estudio incluidos en el Tesauro&#44; con limitaci&#243;n inicial a art&#237;culos correspondientes a revisiones&#44; metaan&#225;lisis o ensayos cl&#237;nicos aleatorizados&#46; Los principales t&#233;rminos buscados fueron&#58; <span class="elsevierStyleItalic">anesthesia&#44; anaesthesia&#44; oxytocin&#44; carbetocin&#44; uterine contractility</span> y <span class="elsevierStyleItalic">oxytocin&#47;carbetocin side effects&#46;</span></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">No hubo diferencias significativas entre ambos grupos en&#58; los datos demogr&#225;ficos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; las caracter&#237;sticas obst&#233;tricas de las pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; o el nivel de bloqueo sensitivo alcanzado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Hubo diferencias significativas en la contracci&#243;n uterina y su exploraci&#243;n &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a>&#41;&#44; en el sangrado vaginal &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; Tambi&#233;n la hubo en la incidencia de efectos secundarios&#44; concretamente cefalea y temblor&#44; que fueron m&#225;s frecuentes en el grupo de la carbetocina &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#41;&#46; El comportamiento hemodin&#225;mico se expone en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Respecto a las p&#233;rdidas hemorr&#225;gicas&#44; hubo diferencias significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; entre los valores pre y posquir&#250;rgicos de evaluaci&#243;n de la hemoglobina entre los 3 grupos&#46; Previamente a la intervenci&#243;n no hab&#237;a diferencias &#40;11&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 1&#59; 12&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 2&#44; y 12&#44;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 3&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;784&#41; y los obtenidos 4<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de la ces&#225;rea &#40;10&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 1&#59; 10&#44;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 2&#44; y 10&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;15<span class="elsevierStyleHsp" style=""></span>g&#215;dl<span class="elsevierStyleSup">&#8722;1</span> en el grupo 3&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;910&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Al analizar las necesidades de administraci&#243;n de dosis suplementarias de f&#225;rmacos uterot&#243;nicos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; no observamos diferencias estad&#237;sticamente significativas entre los grupos&#58; oxitocina &#40;5 pacientes del grupo 1&#44; con p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#44; maleato de metilergometrina &#40;3 pacientes del grupo 2&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; ni de prostaglandinas &#40;un paciente del grupo 2&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;366&#41;&#46; Una paciente del grupo 1 precis&#243; derivados ergotam&#237;nicos adem&#225;s de 1<span class="elsevierStyleHsp" style=""></span>UI de oxitocina conforme al protocolo establecido en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En cuanto a la farmacoeconom&#237;a&#44; cada paciente del grupo 1 recibi&#243; un total de 61<span class="elsevierStyleHsp" style=""></span>UI de oxitocina&#44; con un PVL de 23&#44;3<span class="elsevierStyleHsp" style=""></span>&#8364; y un PVP de<span class="elsevierStyleHsp" style=""></span>30&#44;8<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;con envases de 50 ampollas&#46; Con envases de una ampolla el PVL ser&#237;a de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#8364; y el PVP<span class="elsevierStyleHsp" style=""></span>47&#44;6<span class="elsevierStyleHsp" style=""></span>&#8364;&#41;&#46; Las pacientes del grupo 2 recibieron un total de 255&#44;2<span class="elsevierStyleHsp" style=""></span>UI de oxitocina&#44; con un PVL de 106&#44;2<span class="elsevierStyleHsp" style=""></span>&#8364; y el PVP de 129&#44;2<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;con envases de 50 ampollas&#46; Con envases de una ampolla el PVL ser&#237;a de 128&#44;0<span class="elsevierStyleHsp" style=""></span>&#8364; y un PVP de 199&#44;7<span class="elsevierStyleHsp" style=""></span>&#8364;&#41;&#46; Las pacientes del grupo 3 recibieron una dosis &#250;nica de carbetocina&#44; con un PVL de 30&#44;0<span class="elsevierStyleHsp" style=""></span>&#8364; y PVP de 47&#44;5<span class="elsevierStyleHsp" style=""></span>&#8364;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Empleando las presentaciones comerciales de oxitocina de 50 ampollas&#44; que resultan m&#225;s baratas&#44; la diferencia entre usar oxitocina a dosis bajas &#40;grupo 1&#41; respecto a dosis tradicionales &#40;grupo 2&#41; en el presente estudio supuso una diferencia de 82&#44;5<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVL&#41; o de 98&#44;4<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVP&#41; por cada paciente&#44; es decir&#44; que usar las dosis tradicionales genera un sobrecoste del 455&#37; del PVL &#40;4&#46;313&#44;40<span class="elsevierStyleHsp" style=""></span>&#8364; en total&#41; o del 419&#37; del PVP &#40;5&#46;118<span class="elsevierStyleHsp" style=""></span>&#8364; en total&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Este sobrecoste es menor si se compara el grupo 1 con el grupo 3 &#40;carbetocina&#41;&#44; resultando el &#250;ltimo m&#225;s caro&#44; concretamente 6&#44;7<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVL&#41; o de 10&#44;0<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVP&#41; por cada paciente&#44; es decir&#44; que usar carbetocina gener&#243; un sobrecoste del 128&#37; del PVL &#40;347&#44;6<span class="elsevierStyleHsp" style=""></span>&#8364; en total&#41; o del 132&#37; del PVP &#40;517&#44;7<span class="elsevierStyleHsp" style=""></span>&#8364; en total&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; comparando el uso de la carbetocina con la oxitocina a dosis tradicionales&#44; si se emplea carbetocina hay un ahorro de 76&#44;2<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVL&#41;&#44; o de 88&#44;5<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVP&#41; por cada paciente&#44; un 28 o un 31&#37; del coste que supondr&#237;a usar oxitocina respectivamente&#46; Esto supone un ahorro total en el presente estudio de 3&#46;964<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVL&#41; o de 4&#46;600<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;PVP&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">La carbetocina se ha empleado en la prevenci&#243;n de la hemorragia por aton&#237;a uterina tras parto vaginal<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;21</span></a> o ces&#225;rea&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En la evaluaci&#243;n subjetiva de la contractilidad uterina &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41; apenas se registraron diferencias entre los grupos &#40;solo al alta de la URPA&#41;&#44; mientras que la evaluaci&#243;n objetiva &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41; obtuvo mejores puntuaciones para los grupos de la oxitocina respecto a la carbetocina&#44; aspecto sin embargo que no tuvo correlaci&#243;n con la evaluaci&#243;n subjetiva del sangrado vaginal &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#44; en el que la oxitocina a dosis bajas y la carbetocina ofrecieron mejores resultados que oxitocina a dosis altas&#46; Respecto a la valoraci&#243;n objetiva del sangrado &#40;niveles de hemoglobina&#41;&#44; no hubo diferencias entre los grupos&#46; Por tanto&#44; no podemos afirmar que un grupo sea superior al resto en su eficacia cl&#237;nica&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La aparici&#243;n de la carbetocina supone una alternativa terap&#233;utica m&#225;s en el control de la hemorragia obst&#233;trica&#46; Su posible utilidad cl&#237;nica ser&#225; establecida con m&#225;s estudios&#46; El metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> recientemente publicado&#44; parece sugerir que la carbetocina es m&#225;s eficaz que la oxitocina aunque insiste en que se precisan m&#225;s estudios para validar ese resultado&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Hay grupos que muestran resultados favorables al uso de la carbetocina respecto a la oxitocina en la prevenci&#243;n de la aton&#237;a uterina&#44; con un perfil de seguridad similar<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46; El uso de diferentes pautas de oxitocina &#40;duraci&#243;n de las perfusiones de oxitocina de 8 o 16<span class="elsevierStyleHsp" style=""></span>h&#41; dificulta el an&#225;lisis comparativo de estos resultados entre los grupos&#46; Otros concluyen que aunque la carbetocina se asocia con una reducci&#243;n en el uso de uterot&#243;nicos adicionales no est&#225; claro que reduzca la incidencia de hemorragia posparto y transfusi&#243;n sangu&#237;nea<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; De Bonis et al&#46; describen adem&#225;s&#44; que la carbetocina &#40;respecto a la oxitocina&#41; se acompa&#241;a de menor dolor postoperatorio y necesidad de analg&#233;sicos durante los 3 primeros d&#237;as tras la ces&#225;rea<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; hay estudios<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> y otro metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> que no refieren diferencias significativas entre el uso de la carbetocina y la oxitocina&#44; concluyendo que no hay pruebas suficientes que la carbetocina sea tan efectiva como la oxitocina para prevenir la hemorragia posparto&#46; Dyer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> afirmaron que la oxitocina sigue siendo el uterot&#243;nico de primera l&#237;nea despu&#233;s del parto vaginal y por ces&#225;rea y recomiendan&#44; que los protocolos para la prevenci&#243;n y el tratamiento de la aton&#237;a uterina durante el parto por ces&#225;rea est&#233;n basados en la evidencia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Otros factores podr&#237;an influir&#46; Por ejemplo en los pa&#237;ses desarrollados&#44; la hemorragia posparto es menos frecuente que en los pa&#237;ses de ingresos medios o bajos&#44; donde es una de las principales causas de mortalidad y morbilidad materna&#46; En estos casos la posibilidad de dar un uterot&#243;nico en dosis &#250;nica puede ser m&#225;s &#250;til&#44; por la dificultad para mantener una infusi&#243;n de oxitocina&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Otros factores a considerar son la presencia de efectos adversos y el coste&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Los efectos secundarios observados con el uso de la carbetocina son similares a los de la oxitocina<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#44; con perfiles hemodin&#225;micos semejantes<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; En el presente estudio hemos encontrado un incremento estad&#237;sticamente significativo de las incidencias de la cefalea y el temblor en el grupo de la carbetocina&#46; No hubo diferencias entre los grupos que recibieron oxitocina&#44; si bien se observ&#243; mayor tendencia a n&#225;useas&#44; v&#243;mitos&#44; malestar general&#44; cefalea&#44; enrojecimiento&#44; alteraciones en ECG y dolor tor&#225;cico en el grupo que recibi&#243; oxitocina a dosis altas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Evidentemente&#44; el punto clave del manejo de los oxit&#243;cicos en anestesia obst&#233;trica radica en encontrar la m&#237;nima dosis que permita la contracci&#243;n uterina con los menores efectos secundarios posibles&#46; Esto&#44; que resulta obvio&#44; no es f&#225;cil de aplicar en la cl&#237;nica diaria por varios factores&#58; en primer lugar porque la dosis &#243;ptima de oxitocina no se ha establecido y a veces resulta dif&#237;cil individualizarla en cada paciente&#46; Respecto a la carbetocina&#44; solo hemos encontrado un art&#237;culo<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> que realiza un estudio de tolerancia de dosis crecientes de carbetocina en el parto vaginal &#40;establece la dosis de m&#225;xima tolerancia en 200<span class="elsevierStyleHsp" style=""></span>&#956;g im&#41;&#46; Segundo&#44; porque el sangrado obst&#233;trico por deficiente contracci&#243;n uterina es una complicaci&#243;n potencialmente grave y&#44; el miedo a una hemorragia obst&#233;trica hace que se abuse de los oxit&#243;cicos&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finalmente&#44; a menudo se subestiman los cambios hemodin&#225;micos secundarios a la administraci&#243;n de oxitocina &#40;reducci&#243;n de la presi&#243;n arterial dosis-dependiente por vasodilataci&#243;n perif&#233;rica con incremento compensatorio de la frecuencia cardiaca y del gasto cardiaco&#41;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;34&#44;35</span></a>&#44; o se atribuyen a otras causas&#44; como al bloqueo espinal&#44; a la p&#233;rdida sangu&#237;nea&#44; la compresi&#243;n aorto-cava&#44; la autotransfusi&#243;n por la contracci&#243;n uterina e incluso a la situaci&#243;n emocional de la paciente por la ces&#225;rea&#46; La oxitocina ejerce un papel preponderante en estos cambios hemodin&#225;micos<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; que en la mayor&#237;a de gestantes sin afecci&#243;n asociada son bien tolerados&#46; Todos estos aspectos hemodin&#225;micos podr&#237;an ser aplicables a la carbetocina&#44; debido a que tienen perfiles hemodin&#225;micos similares&#46; Otros efectos adversos de la oxitocina son el efecto cronotr&#243;pico negativo&#44; vasoconstricci&#243;n selectiva de las arterias coronarias&#44; renales&#44; espl&#225;cnicas&#44; del m&#250;sculo esquel&#233;tico y de los vasos umbilicales e hipertensi&#243;n pulmonar<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">El presente estudio se realiz&#243; con embarazadas j&#243;venes sin afecciones&#44; en ces&#225;reas programadas y sin trabajo de parto&#46; En pacientes con hipovolemia&#44; con enfermedad card&#237;aca o hipertensiva &#40;p&#46; ej&#46;&#44; hipertensi&#243;n arterial esencial&#44; preeclampsia o eclampsia&#41;&#44; la situaci&#243;n podr&#237;a ser distinta&#46; Reyes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> describen que la carbetocina podr&#237;a ser una alternativa v&#225;lida a la oxitocina en pacientes con preeclampsia grave&#44; sin asociarse a oliguria o hipertensi&#243;n&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Sin embargo&#44; es necesario valorar m&#225;s estudios&#44; ya que este &#250;ltimo efecto podr&#237;a deberse simplemente a la hipotensi&#243;n inducida por la carbetocina&#46; Si esto se confirmara&#44; podr&#237;a ser un factor importante a favor de la carbetocina en pacientes con preeclampsia que acaben en ces&#225;rea&#44; especialmente si adem&#225;s se intent&#243; frenar antes el parto por prematuridad &#40;con tocol&#237;ticos y corticoides para la maduraci&#243;n pulmonar fetal&#41;&#46; En estas pacientes&#44; dosis elevadas de oxitocina para controlar la hemorragia pueden desarrollar un edema pulmonar&#44; especialmente si la reposici&#243;n hidroelectrol&#237;tica resulta excesiva o inadecuada&#46; Hay siempre que recordar que en la gestante existe una alteraci&#243;n de la membrana alveolocapilar y que el efecto antidiur&#233;tico de la oxitocina disminuye de forma importante cuando la infusi&#243;n es menor de 2&#44;7<span class="elsevierStyleHsp" style=""></span>UI&#215;h<span class="elsevierStyleSup">&#8722;1</span>&#44; por lo que la infusi&#243;n para profilaxis de la hemorragia deber&#237;a ser menor que la dosis antes indicada<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46; Desconocemos en la actualidad si la carbetocina ejerce este mismo efecto&#44; y si es as&#237;&#44; a que dosis se manifiesta&#46; Conviene adem&#225;s recordar que la carbetocina una vez administrada no puede ser suprimida del sitio de acci&#243;n&#44; mientras la oxitocina puede ser suspendida de la perfusi&#243;n administrada&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Tampoco estos resultados se pueden aplicar a ces&#225;reas urgentes&#44; porque la situaci&#243;n difiere a las condiciones establecidas en el presente estudio&#58; p&#46; ej&#46;&#44; trabajo de parto ya instaurado&#44; infusiones de oxitocina previas&#44; que si son de larga evoluci&#243;n pueden producir disminuci&#243;n de su efectividad por fen&#243;menos de desensibilizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Para finalizar&#44; el &#250;ltimo factor para decidir que f&#225;rmaco y a que dosis emplear para evitar la hemorragia obst&#233;trica cuando los resultados cl&#237;nicos son similares es el coste<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&#46; En el presente estudio el grupo m&#225;s barato fue oxitocina a dosis bajas&#44; despu&#233;s la carbetocina y finalmente la oxitocina a dosis altas&#46; Higgins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> describen un sobrecoste por usar carbetocina de 18&#44;54<span class="elsevierStyleHsp" style=""></span>&#163; por paciente respecto a la oxitocina&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la introducci&#243;n de la carbetocina como f&#225;rmaco de elecci&#243;n en los protocolos de prevenci&#243;n de la hemorragia obst&#233;trica en ces&#225;reas programadas&#44; a la vista de nuestros resultados y de la revisi&#243;n bibliogr&#225;fica no permite recomendarla ya que se acompa&#241;a de mayor incidencia de efectos secundarios sin una mejora en la prevenci&#243;n de la hemorragia obst&#233;trica&#46; Adem&#225;s resulta econ&#243;micamente m&#225;s cara que el empleo de dosis bajas de oxitocina&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Keywords"
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        4 => array:2 [
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "Material y m&#233;todo"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2012-04-18"
    "fechaAceptado" => "2012-06-17"
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          "palabras" => array:5 [
            0 => "Oxitocina"
            1 => "Carbetocina"
            2 => "Contractilidad uterina"
            3 => "Efectos secundarios oxit&#243;cicos"
            4 => "Anestesia"
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          "clase" => "keyword"
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            0 => "Oxytocin"
            1 => "Carbetocin"
            2 => "Uterine contractility"
            3 => "Oxytocin side effects"
            4 => "Anaesthesia"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La prevenci&#243;n de la aton&#237;a uterina y&#44; por tanto&#44; de la hemorragia en ces&#225;reas es una indicaci&#243;n del uso de uterot&#243;nicos&#44; oxitocina y carbetocina&#46; Analizar la contracci&#243;n uterina&#44; la hemorragia&#44; los efectos hemodin&#225;micos y los efectos secundarios de la oxitocina a diferentes dosis y la carbetocina tras el alumbramiento en ces&#225;reas con anestesia subaracnoidea&#44; en pacientes sin trabajo de parto&#46; Se realiza tambi&#233;n una valoraci&#243;n farmacoecon&#243;mica&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; aleatorizado&#44; descriptivo&#44; observacional y prospectivo de 156 pacientes ASA 1&#46; El grupo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; recibi&#243; tras la extracci&#243;n fetal y coincidiendo con el clampaje del cord&#243;n umbilical 1<span class="elsevierStyleHsp" style=""></span>UI de oxitocina seguida de una perfusi&#243;n de 2&#44;5<span class="elsevierStyleHsp" style=""></span>UI&#215;h<span class="elsevierStyleSup">&#8722;1</span>&#44; el grupo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; una infusi&#243;n continua de 20<span class="elsevierStyleHsp" style=""></span>UI de oxitocina a un ritmo de 700<span class="elsevierStyleHsp" style=""></span>mUI&#215;min<span class="elsevierStyleSup">&#8722;1</span> seguido posteriormente a 10<span class="elsevierStyleHsp" style=""></span>UI&#215;h<span class="elsevierStyleSup">&#8722;1</span>&#44; y el grupo 3 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; 100<span class="elsevierStyleHsp" style=""></span>&#956;g de carbetocina en bolo en dosis &#250;nica&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias significativas en las variables antropom&#233;tricas&#44; obst&#233;tricas o anest&#233;sicas&#46; Hubo diferencias significativas en el grado de contracci&#243;n uterina&#44; la hemorragia vaginal y la incidencia de efectos secundarios &#40;cefalea y temblor&#41;&#44; m&#225;s frecuentes en el grupo de la carbetocina&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No podemos recomendar el uso rutinario de carbetocina en ces&#225;reas programadas&#44; por su mayor incidencia de efectos secundarios sin mejorar la prevenci&#243;n de la hemorragia&#46; Adem&#225;s&#44; resulta econ&#243;micamente m&#225;s cara que el empleo de dosis bajas de oxitocina&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate uterine contractility&#44; bleeding&#44; haemodynamic performance&#44; and side effects of different doses of oxytocin after delivery under spinal anaesthesia in caesarean section without prior labour in childbirth&#46; We also perform a pharmacoeconomic evaluation&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A randomised&#44; descriptive&#44; observational and multicentre prospective study was conducted&#44; which included 104 ASA 1 patients divided into 3 groups&#46; Group 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; received after removal of the foetus and coinciding with foetal umbilical cord clamping&#44; 1 IU of oxytocin followed by an infusion of 2&#46;5 UI&#215;h<span class="elsevierStyleSup">&#8722;1</span>&#59; Group 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; a continuous infusion of 20<span class="elsevierStyleHsp" style=""></span>IU oxytocin at a rate of 700<span class="elsevierStyleHsp" style=""></span>mUI<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">&#8722;1</span> followed later by 10<span class="elsevierStyleHsp" style=""></span>UI<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleSup">&#8722;1</span>&#44; and group 3&#44; 100<span class="elsevierStyleHsp" style=""></span>&#956;g bolus dose of carbetocin only&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There were no statistical differences between groups in anthropometric&#44; obstetric or anaesthetic variables&#46; Significant differences in uterine contraction in vaginal bleeding and the incidence of side effects&#44; particularly headache and tremor&#44; were more pronounced in the carbetocin group&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">With these results&#44; we cannot recommend the routine use of carbetocin in caesarean sections&#44; because it is accompanied by an increased incidence of side effects without any improvement in the prevention of obstetric haemorrhage&#46; Finally&#44; it is economically more expensive than the use of low doses of oxytocin&#44; which may be the trend that should be considered in the future&#44; due to the clinical outcomes&#44; and its lower cost&#46;</p>"
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                  """
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas obst&#233;tricas</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nivel de bloqueo sensitivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 1 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 2 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 3 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">T<span class="elsevierStyleInf">4</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">T<span class="elsevierStyleInf">5</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T<span class="elsevierStyleInf">6</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T<span class="elsevierStyleInf">7</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T<span class="elsevierStyleInf">8</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Nivel de bloqueo sensitivo alcanzado</p>"
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      5 => array:7 [
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        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Valores expresados en porcentajes&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a los 3<span class="elsevierStyleHsp" style=""></span>min</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">96&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">92&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">90&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a los 5<span class="elsevierStyleHsp" style=""></span>min</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a los 10<span class="elsevierStyleHsp" style=""></span>min</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al cierre del peritoneo</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">92&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al final de la ces&#225;rea</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">96&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al ingreso en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a la primera hora en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">92&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a la segunda hora en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al alta de la URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfactoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Nivel de contracci&#243;n uterina respecto al ombligo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por debajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por debajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;tero a nivel del ombligo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">48&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por encima&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al ingreso en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;tero a nivel del ombligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a la primera hora en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">28&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;tero a nivel del ombligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n a la segunda hora en URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;tero a nivel del ombligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contracci&#243;n al alta de la URPA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por debajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;tero a nivel del ombligo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un trav&#233;s de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 traveses de dedo por encima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Alteraciones en el ECG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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Información del artículo
ISSN: 00349356
Idioma original: Español
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2021 Septiembre 1 2 3
2020 Septiembre 1 0 1
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2020 Febrero 0 9 9
2019 Abril 1 2 3
2019 Marzo 2 0 2
2019 Enero 1 2 3
2018 Noviembre 2 0 2
2018 Octubre 1 0 1
2018 Julio 1 0 1
2018 Junio 0 2 2
2018 Mayo 0 2 2
2018 Abril 0 1 1
2018 Enero 1 0 1
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2017 Octubre 0 1 1
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2017 Enero 37 18 55
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2016 Noviembre 79 24 103
2016 Octubre 90 30 120
2016 Septiembre 131 42 173
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2016 Junio 40 15 55
2016 Mayo 33 33 66
2016 Abril 61 31 92
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2016 Enero 37 19 56
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2014 Marzo 1 2 3
2014 Febrero 1 0 1
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos