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contrato de obra por administración
macro-emisión de bonos
Jul 26, 2019 07:19
4 yrs ago
4 viewers *
Spanish term

alcanzar el tiempo de los inductores de madurez pulmonar

Spanish to English Medical Medical: Health Care Guidelines on obstetric emergencies
Hi! I need help with this phrase in a text about whether/when to terminate a pregnancy if the mother has eclampsia:


En pacientes con menos de 34 semanas sin condiciones que indiquen la finalización del embarazo de manera inmediata, se recomienda alcanzar el tiempo de los inductores de madurez pulmonar. Este manejo debe realizarse en unidades que ofrezcan MONITOREO MATERNO y FETAL CONTINUO.
Proposed translations (English)
2 +1 allow for antenatal induction of lung maturation
3 complete the procedure/treatment (with corticosteroids) to induce fetal lungs maturity
3 inductors
References
To reach the time of pulmonary maturity of the maturity inductors

Discussion

Chema Nieto Castañón Jul 28, 2019:
La maduración pulmonar fetal se estimula por ejemplo por cortisol, tiroxina, prolactina o estradiol, siendo inhibida por la insulina o la testosterona. Tanto la TRH como la prolactina o la aminofilina han sido estudiadas y utilizadas como inductores de maduración pulmonar. Por otro lado, tanto la administración directa de surfactante pulmonar (postparto) como los glucocorticoides -postparto y/o preparto (pej. betametasona en un ciclo de dos administraciones separadas por 24 horas o dexametasona en 4 dosis repartidas cada 12 horas)- son los inductores de maduración pulmonar habitualmente indicados hoy en día. En tanto que tal, es razonable la alusión a inductores farmacológicos de maduración pulmonar, como sugieren Anne y Aida, aunque diría que su explicitación no parece necesaria en el caso que nos ocupa.

Por otro lado, como comenta Anne, el original trata de explicitar la necesidad de retrasar el parto el tiempo necesario para completar un ciclo de tratamiento completo. Ni menos de 24 horas ni tratamientos más prolongados en el tiempo (por encima de 72 horas) parecen ajustados. También es necesario incluir aquí pej tocolíticos para evitar un parto antes de concluir el ciclo.
Anne Schulz Jul 27, 2019:
@Aida Thank you for your support! What needs to be achieved: Induction of fetal lung maturation usually involves 2 corticosteroid injections given 12 hours apart, and the effect will only be evident from 24 hours after the second injection --> Childbirth needs to be delayed by at least 36 hours (by administering magnesia and tocolytics, bedrest etc.). During this time, close monitoring is mandatory, since many unborn babies have some good reason for trying to come out prematurely, and if you "urge" them to stay in utero, their wellbeing may sometimes deteriorate rapidly. It is therefore not always possible to complete a full course of pharmacological lung maturation induction.
Stuart and Aida Nelson Jul 27, 2019:
Inducers - source text I fully agree with Anne. Almost all the references I have found out refer to pharmaceuticals used as "inducers" to reach fetal lungs maturity. That is what I have tried to convey in my answer: 'completing the treatment to allow for the inducers to work. In addition, IMO, it seems that the source text is lacking information and is not very specific: 'alcanzar el tiempo de los inductores'= what time needs to be achieved, what are the inducers? I wonder if there is an omission of some sort.

Moreover, the following sentence starts with 'este manejo debe realizarse'. IMO, again this refers to some sort of treatment that has to be carried out in a hospital where the mother and the child can be monitored.
Anne Schulz Jul 27, 2019:
I don't think there are any non-pharmaceutical ways to induce lung maturity; and even if there was some other way, would a technique, maneuver or intervention be called an "inductor"? You may safely assume that "inductores de madurez pulmonar" are pharmaceuticals (specifically glucocorticoids), IMO.
Muriel Vasconcellos (asker) Jul 26, 2019:
@Chema Thank you for your suggestion. Please feel free to post it.

By the way, nowhere does the text specifically refer to *pharmaceutical* induction, so I would hesitate to be that specific. The two languages need to match very closely as both will be used throughout the WHO Region of the Americas.
Chema Nieto Castañón Jul 26, 2019:
Creo que la idea ya la tienes.
Una opción más, por si sirve;

... if gestational age is less than 34 weeks and delivery is not immediately indicated, it is recommended to allow for antenatal induction of lung maturation.
Muriel Vasconcellos (asker) Jul 26, 2019:
How about ... 'to allow time for the induction of pulmonary maturity in the fetus'.

I found a number of examples of 'induction of pulmonary maturity'. This solution doesn't require specification of the particular inducers.
Leda Roche Jul 26, 2019:
Another idea ...waiting the time needed for pharmacologic induction of fetal lung maturity is recommended.
Anne Schulz Jul 26, 2019:
Hi Muriel I would think the meaning is "try and (bar)gain the time inducers of fetal lung maturity need to do their work" – under continuous monitoring of mother and child.
liz askew Jul 26, 2019:
https://www.sciencedirect.com/science/article/.../S018753371... - Translate this page
by SA Gallegos - ‎2018 - ‎Related articles
Revisión sistemáticaEffects of steroids as inducers of lung maturity in ... (dexametasona o betametasona) como inductores de maduración pulmonar y ... Intrauterine growth restriction (IUGR) is associated with perinatal morbidity and mortality. .... los esteroides han demostrado mayor efecto, su aplicación en estos fetos no ...
liz askew Jul 26, 2019:
Fetal Physiology and Medicine: The Basis of Perinatology
https://books.google.co.uk/books?isbn=1483162966
Richard W. Beard, ‎Peter W. Nathanielsz - 2013 - ‎Medical
reported little effect of dipalmitoyl phosphatidylcholine on lung function when ... The physiological “inducers” of early fetal lung maturation have not been ...
liz askew Jul 26, 2019:
Pharmacologic induction of fetal lung maturity. - NCBI
https://www.ncbi.nlm.nih.gov/pubmed/1868639
by WE Roberts - ‎1991 - ‎Cited by 18 - ‎Related articles
Pharmacologic induction of fetal lung maturity. ... The primary limiting factor with most agents is the need to delay birth for 48 to 72 hours to achieve maximum ...
Muriel Vasconcellos (asker) Jul 26, 2019:
Apology Sorry I didn't highlight the passage!

Proposed translations

+1
17 hrs
Selected

allow for antenatal induction of lung maturation

I fully agree with Anne Schultz in Discussion; I would say the original idea is to wait or delay the delivery for as long as needed for lung maturation "inductors" to "do their job" -this usually takes between 48 to 72 hours.

I am not really confident with my own rendering although I feel it actually conveys the original idea.

... if gestational age is less than 34 weeks and delivery is not immediately indicated, it is recommended to allow for antenatal induction of lung maturation. [... antenatal induction of lung maturation treatment?]


Creo que en la traducción debe expresarse, explícita o implícitamente, la idea de tratamiento antenatal de inducción de maduración pulmonar, lo que no implica en absoluto que se pretenda lograr la maduración pulmonar anteparto sino únicamente que pueda administrarse dicho tratamiento inductor.
Allow for en este caso tengo la sensación de que puede funcionar como equivalente al original "alcanzar el tiempo", que creo intenta expresar precisamente esa idea de permitir el tiempo necesario de inducción para que el tratamiento produzca un efecto óptimo dadas las circunstancias.
En cuanto a (antenatal) induction of lung maturation, aunque he encontrado ejemplos equivalentes, su uso no está tan extendido como me gustaría para sentirme más cómodo, no ya con su validez sino con que sea esta la expresión más común en inglés para expresar la misma idea.

Antenatal induction of lung maturation
- https://books.google.es/books?id=34600n_aVSIC&pg=PA77&lpg=PA...
- https://www.taylorfrancis.com/books/e/9780429164880/chapters...


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Note added at 2 days 13 hrs (2019-07-28 20:49:17 GMT)
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Maybe also,
allow for induction of fetal lung maturation

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Note added at 4 days (2019-07-31 06:34:21 GMT) Post-grading
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Muchas gracias Muriel. De todas formas, no tengo dudas en cuanto al original. Se refiere específicamente a retrasar el parto (dado que no es necesario desde un punto de vista clinico que el parto se produzca de manera inminente) el tiempo necesario para completar un ciclo de tratamiento prenatal con inductores de maduración pulmonar (glucocorticoides habitualmente).
Es sobre la mejor manera de expresarlo en inglés que no estoy tan seguro.
La idea en todo caso sería la ya expresada; Delay delivery time enough so as to complete a standard course of maternal [corticosteroids] for lung maturation
Peer comment(s):
agree Anne Schulz
1 day 4 hrs
Thanks a lot Anne ;)
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2 KudoZ points awarded for this answer. Comment: "Thank you, Chema. This is the solution that I used, though I queried the authors, since none of us are 100% certain."
5 hrs

complete the procedure/treatment (with corticosteroids) to induce fetal lungs maturity


In patients with less than 34 weeks without conditions indicating immediate termination of pregnancy, it is recommended to complete the procedure/treatment (with corticosteroids) to induce fetal lungs maturity

Induction of Fetal Lung Maturity with Corticosteroids
In case of chorioamnionitis, only an expert specialized gynaecologist can decide to delay the delivery to complete the procedure to induce fetal lungs maturity.
https://www.researchgate.net/publication/272506901_Induction...

Presently, guidelines recommend one dose, repeated over 24 hours, of antenatal corticosteroid therapy (ACT) to accelerate fetal lung maturation in cases of threatened preterm birth in an effort to reduce infant mortality related to respiratory distress.
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

Fetal effects of betamethasone or dexamethasone for induction of lung maturity
https://www.sciencedirect.com/topics/biochemistry-genetics-a...

Esteroides como inductores de maduración pulmonar en pretérminos de 34 semanas y menos
https://www.monografias.com/trabajos92/esteroides-como-induc...
Peer comment(s):
neutral liz askew : the trouble with this answer is that this is not the only way of inducing lung maturation
2 hrs
That is why I inserted 'corticosteroids' in brackets.
Something went wrong...
8 hrs

inductors

Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective
https://books.google.co.uk/books?isbn=1416029443
Susan Tucker Blackburn - 2007 - ‎Medical
Examples of developmental gene families that control development include the ... at birth, whereas the long bones and lung alveoli do not reach maturity for years after birth. ... Induction requires inductors, or cells that stimulate reactions in surrounding cells ... Proliferation inhibition by teratogenic agents may cause defects.

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Note added at 8 hrs (2019-07-26 15:44:53 GMT)
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PRIME PubMed | [Fetal cardiac rhabdomyoma as a rare cause of ...
https://wwww.unboundmedicine.com/.../[Fetal_cardiac_rhabdomyoma_as_a_rare_cau...
... per minute, as well as fetal lung maturity inductors. At 30 WGA furosemide was added because of fetal hydrops. At 32 WGA a cesarean section was performed.


I would double, double check this though:)
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Reference comments

2 hrs
Reference:

To reach the time of pulmonary maturity of the maturity inductors

Cuando hablamos de madurez pulmonar nos referimos al grado de preparación del pulmón para respirar sin ayuda al nacer, lo cual depende en gran medida del surfactante en los alveolos. - https://inatal.org/noticias/blog-del-editor/481-madurez-pulm...
. En este artículo se revisan las indicaciones, la farmacología y el mecanismo de acción de los corticoesteroides
como inductores de madurez pulmonar fetal. - http://www.maternoinfantil.org/archivos/A46.PDF
La maduración pulmonar se realiza cuando necesitamos extraer el feto antes de su tiempo y sus pulmones no tienen la suficiente madurez para realizar su función: la respiración. - http://www.consultatuginecologo.com/maduracion-pulmonar/
Si has tenido un parto con menos de 34 semanas, te habrán administrado medicación para acelerar la maduración del pulmón fetal. Te lo explico con detalle. - mismo link
fetal lung maturity obtained at the time of amniocentesis should continue to be a part of modern obstetric management. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002188/
ntenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. - https://www.acog.org/Clinical-Guidance-and-Publications/Comm...
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