Clap1577 PDF

3a Edición
CLAP/SMR Publicación Científica Nº 1577 - 2011

6$/8'6(;8$/<5(352'8&7,9$
*XtDVSDUDHO
&217,182'($7(1&,21
GHOD0XMHU\HO5HFLpQ1DFLGR
IRFDOL]DGDVHQ$36
5LFDUGR)HVFLQD
'LUHFWRUGHO&/$3605&RRUGLQDGRUGH3URJUDPD665236206
%UHPHQ'H0XFLR
$VHVRU5HJLRQDO665&/$3605236206
-RVp/XLV'tD]5RVVHOOR
$VHVRU&/$3605236206
*HUDUGR0DUWtQH]
$VHVRU&/$3605236206
6X]DQQH6HUUX\D
$VHVRU5HJLRQDO665&/$3605236206
3DEOR'XUiQ
$VHVRU5HJLRQDO(Q6DOXG3HULQDWDO&/$3605236206
D(GLFLyQ
&HQWUR/DWLQRDPHULFDQRGH3HULQDWRORJtD
6DOXGGHOD0XMHU\5HSURGXFWLYD
&/$3605236206
0RQWHYLGHR8UXJXD\
3XEOLFDFLyQ&LHQWt¿FD&/$36051
)HVFLQD5+'H0XFLR%'tD]5RVVHOOR-/0DUWtQH]*6HUUX\D6'XUiQ36DOXGVH[XDO\UHSURGXFWLYD
JXtDVSDUDHOFRQWLQXRGHDWHQFLyQGHODPXMHU\HOUHFLpQQDFLGRIRFDOL]DGDVHQ$36D(GLFLyQ0RQWHYLGHR
&/$36053XEOLFDFLyQ&/$3605
,6%1
6$/8'0$7(512,1)$17,/
6(59,&,26'(6$/8'5(352'8&7,9$
(1)(50('$'(6'(/5(&,(11$&,'2
$7(1&,Ï135,0$5,$'(/$6$/8'
$7(1&,Ï135(1$7$/
$7(1&,Ï1'(/5(&,(11$&,'2
$%2572
*8Ë$
, 7tWXOR
,, &/$3605
1/0:4
$JUDGHFLPLHQWRVD
0DULHOD/DUUDQGDEXUXSRUVXFRODERUDFLyQHQHO³&DStWXOR3UHFRQFHSFLRQDO´
)HUQDQGR6LOYHUD0DULDQHOD5RGUtJXH]\)HUQDQGR0DFtDVSRUVXFRODERUDFLyQHQHO³&DStWXOR$WHQFLyQ
GHO5HFLpQ1DFLGR´
)DELiQ5RGUtJXH]SRUVXFRODERUDFLyQHQHO³&DStWXOR$ERUWR´
/D 2UJDQL]DFLyQ 3DQDPHULFDQD GH OD 6DOXG GDUi FRQVLGHUDFLyQ PX\ IDYRUDEOH D ODV VROLFLWXGHV GH
DXWRUL]DFLyQSDUDUHSURGXFLURWUDGXFLUtQWHJUDPHQWHRHQSDUWHDOJXQDGHVXVSXEOLFDFLRQHV/DVVROLFLWXGHV
\ODVSHWLFLRQHVGHLQIRUPDFLyQGHEHUiQGLULJLUVHD6HUYLFLRV(GLWRULDOHVÈUHDGH*HVWLyQGH&RQRFLPLHQWR
\ &RPXQLFDFLyQ .0& 2UJDQL]DFLyQ 3DQDPHULFDQD GH OD 6DOXG :DVKLQJWRQ '& (VWDGRV 8QLGRV GH
$PpULFDTXHWHQGUiVXPRJXVWRHQSURSRUFLRQDUODLQIRUPDFLyQPiVUHFLHQWHVREUHFDPELRVLQWURGXFLGRVHQ
ODREUDSODQHVGHUHHGLFLyQ\UHLPSUHVLRQHV\WUDGXFFLRQHV\DGLVSRQLEOHV
2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXG&/$3605
/DVSXEOLFDFLRQHVGHOD2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXGHVWiQDFRJLGDVDODSURWHFFLyQSUHYLVWDSRU
ODVGLVSRVLFLRQHVVREUHUHSURGXFFLyQGHRULJLQDOHVGHO3URWRFRORGHOD&RQYHQFLyQ8QLYHUVDOVREUH'HUHFKR
GH$XWRU5HVHUYDGRVWRGRVORVGHUHFKRV
/DVGHQRPLQDFLRQHVHPSOHDGDVHQHVWDSXEOLFDFLyQ\ODIRUPDHQTXHDSDUHFHQSUHVHQWDGRVORVGDWRVTXH
FRQWLHQHQRLPSOLFDQSRUSDUWHGHOD6HFUHWDUtDGHOD2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXGMXLFLRDOJXQR
VREUH OD FRQGLFLyQ MXUtGLFD GH SDtVHV WHUULWRULRV FLXGDGHV R ]RQDV R GH VXV DXWRULGDGHV QL UHVSHFWR GHO
WUD]DGRGHVXVIURQWHUDVROtPLWHV
/D PHQFLyQ GH GHWHUPLQDGDV VRFLHGDGHV PHUFDQWLOHV R GH QRPEUHV FRPHUFLDOHV GH FLHUWRV SURGXFWRV QR
LPSOLFDTXHOD2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXGORVDSUXHEHRUHFRPLHQGHFRQSUHIHUHQFLDDRWURV
DQiORJRV6DOYRHUURUXRPLVLyQODVGHQRPLQDFLRQHVGHSURGXFWRVSDWHQWDGRVOOHYDQHQODVSXEOLFDFLRQHVGH
OD236OHWUDLQLFLDOPD\~VFXOD
&HQWUR/DWLQRDPHULFDQRGH3HULQDWRORJtD6DOXGGHOD0XMHU\5HSURGXFWLYD&/$3605
2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXG2UJDQL]DFLyQ0XQGLDOGHOD6DOXG236206
&DVLOODGHFRUUHR0RQWHYLGHR8UXJXD\
7HOpIRQR)D[
SRVWPDVWHU#FODSRSVRPVRUJ
KWWSQHZSDKRRUJFODS
KWWSSHULQDWDOEYVDOXGRUJ
6$/8'6(;8$/<5(352'8&7,9$
*XtDVSDUDHO&217,182'($7(1&,21
GHOD0XMHU\HO5HFLpQ1DFLGRIRFDOL]DGDVHQ$36
D(GLFLyQ
'LVHxRJUi¿FR-XDQ&DUORV,JOHVLDV
6DOXG6H[XDO\5HSURGXFWLYD
,1',&(
PROLOGO 9
GLOSARIO 10
CAPITULO I
Renovación de la Atención Primaria de la Salud en las Américas 12
Contínuo de atención 13
Enfoque de Salud Familiar y Comunitaria 13
Valores, Principios y Elementos de un Sistema de Salud Basado en la APS 13
Referencias bibliográficas 18
CAPITULO II
Cuidado Preconcepcional 19
Objetivos: Identificar y asesorar sobre riesgo preconcepcional 19
Actividad: Consulta previa al embarazo 19
Cuidado preconcepcional 19
Consulta preconcepcional 19
Reducción de la morbimortalidad materna y feto neonatal 20
Defectos congénitos 20
Historia Clínica 20
Antecedentes reproductivos 22
Antecedentes generales 25
Enfermedades médicas no transmisibles 25
Enfermedades médicas transmisibles 29
Estilos de vida 31
Consumo de medicamentos 34
Vacunas 36
CAPITULO III
Control Prenatal, Vigilancia Durante la Gestación,
39
Evaluación del Riesgo Concepcional y Conductas
Objetivos y Actividades propuestas 40
Cronología de las actividades para las consultas prenatales de bajo riesgo 42
Objetivos: Confirmar embarazo 43
Actividad: Realización de exámenes clínicos y paraclínicos para diagnosticar embarazo 43
Objetivos: Mejorar la calidad del control prenatal 44
Actividad: Utilización de algunas tecnologías apropiadas 44
Gestograma 44
Cinta obstétrica 45
Tarjeta de Altura Uterina y Peso Materno 46
Objetivos: Obtener datos para planificar el control prenatal, la atención del parto, el puerperio y el recién nacido 47
Actividad: Empleo del Sistema Informático Perinatal 47
Historia Clínica 47
Partograma 47
Carné Perinatal 47
Procesamiento de datos 57
Objetivos: Contar con una hoja de ruta que guíe al prestador para brindar una atención prenatal de calidad 58
Actividad: Uso de la Historia Clínica Perinatal del CLAP/SMR 58
&HQWUR/DWLQRDPHULFDQRGH3HULQDWRORJtD6DOXGGHOD0XMHU\5HSURGXFWLYD
&RQWLQXRGH$WHQFLyQGHOD0XMHU\HO5HFLpQ1DFLGR
Objetivos: Detectar riesgos en la población 59

Actividad: Evaluación del riesgo perinatal 59
Objetivos: Conocer información relevante del embarazo 60
Actividad: Anamnesis 60
Objetivos: Fijar un cronograma que permita planificar las actividades del control prenatal 63
Actividad: Determinación de la edad gestacional y de la fecha probable de parto 63
Amenorrea 63
Evaluación del tamaño uterino 63
Antropometría fetal por ecografía 64
Madurez placentaria 66
Objetivos: Evaluar el estado nutricional materno 66
Actividad: Medición del peso y de la talla materna. Cálculo del incremento de peso durante la gestación. 66
Técnica de medición 67
Ganancia de peso 67
Interpretación de la medida a la primera consulta 68
Interpretación de la secuencia de medidas en consultas subsecuentes 69
Relación peso para la talla según edad gestacional 70
Evaluación del incremento ponderal materno 70
Conducta 70
Objetivos: Investigar estilos de vida de riesgo 71
Actividad: Interrogatorio sobre tabaquismo (activo y pasivo), drogas, alcohol y violencia 71
Tabaquismo activo 71
Tabaquismo pasivo 72
Alcohol 73
Drogas 73
Violencia 74
Objetivos: Prevenir el tétanos neonatal y puerperal 76
Actividad: Vacunación antitetánica 76
Objetivos: Disminuir el impacto negativo de las infecciones de transmisión vertical 78
Actividad: Prevención, detección y tratamiento de las infecciones de transmisión vertical 78
Rubeola congénita 78
Toxoplasmosis congénita 79
Hepatitis B 81
VIH/SIDA 82
Objetivos: Prevenir sífilis 83
Actividad: Tamizaje y tratamiento 83
Objetivos: Prevenir las consecuencias materno-perinatales de otras infecciones de transmisión sexual ITS y 88
otras infecciones del tracto reproductivo ITR
Actividad: Prevención, detección y tratamiento 88
Flujo (leucorrea), 88
Moniliasis vulvovaginal, vaginosis bacteriana, tricomoniasis, gonococcia, 89
Clamidiasis, herpes simple 90
Objetivos: Prevenir la transmisión vertical de la enfermedad de Chagas 90
Objetivos: Reducir la morbimortalidad materna y prevenir la transmisión vertical del Paludismo o Malaria 92
Diagnóstico de malaria 92
Malaria y embarazo 92
Prevención de la malaria durante el embarazo 93
Tratamiento en mujeres embarazadas 93
Objetivos: Reducir la morbimortalidad neonatal por estreptococo grupo% 95
Objetivos: Detectar posibles procesos sépticos buco-dentales
Actividad: Examen buco-dental 97
Objetivos: Detectar posibles alteraciones del pezón, patología inflamatoria
Actividad: Examen de las mamas 98
Objetivos: Descartar cáncer de cuello, lesiones precursoras y evaluar la competencia cervical 98
Actividad: Examen genital, colpocitología, colposcopía 98
Cáncer cervical 98
Incompetencia cervical 103
Objetivos: Pesquisar una posible incompatibilidad sanguínea materno-feto-neonatal 104
Actividad: Determinación del grupo sanguíneo, del factor Rh y de anticuerpos irregulares 104
Objetivos: Prevenir, detectar y tratar la anemia materna 106
Actividad: Determinar niveles de hemoglobina. Administración de hierro y ácido fólico 106
Prevención de la anemia 107
Prevención de los defectos del tubo neural 108
Objetivos: Descartar proteinuria, glucosuria y bacteriuria 108
Actividad: Examen de orina y urocultivo 108
Examen de orina 108
Infección urinaria y bacteriuria asintomática 109
Objetivos: Descartar diabetes mellitus clínica y gestacional 111
Actividad: Determinación de la glucemia y prueba de tolerancia oral a la glucosa 111
Diabetes gestacional 111
Glucemia en ayunas 112
Prueba de tolerancia oral a la glucosa 112
Clasificación de los estados diabéticos en el embarazo 113
Objetivos: Brindar contenidos educativo-informativos para el parto y la crianza 114
Actividad: Preparación para el parto, consejería para el amamantamiento 114
Objetivos: Confirmar la existencia de vida fetal 116
Actividad: Pesquisar movimientos y frecuencia cadíaca fetal 116
Movimientos fetales 116
Actividad cardíaca fetal 117
Estetoscopio obstétrico 118
Objetivos: Anticipar el diagnóstico y prevenir el parto prematuro 119
Actividad: Evaluar el patrón de la contractilidad uterina (frecuencia, duración e intensidad) 119
Retrasar el parto de pretérmino. Inducir la maduración pulmonar fetal.
Diagnóstico de amenaza de parto prematuro 120
Tratamiento 121
Tratamientos que no han demostrado ser efectivos en la amenaza de parto prematuro 123
Inductores de la maduración pulmonar 123
Objetivos: Pesquisar alteraciones de la presión arterial: Hipertensión previa al embarazo. 125
El síndr. de hipertensión inducida por el embarazo (pre-eclampsia). Hipotensión arterial
Actividad: Determinación de la presión arterial, identificación de edemas y proteinuria. 125
Factores que pueden modificar los valores de tensión arterial 125

Técnica de medida, 125
Modificaciones fisiológicas durante el parto 126
Clasificación de estados hipertensivos en el embarazo, 126
Factores de riesgo de hipertensión gestacional y pre-eclámpsia, Prevención 127
Conductas recomendadas 127
Objetivos: Descartar alteraciones del crecimiento fetal 130
Actividad: Evaluación del crecimiento fetal por medio de la altura uterina, ganancia de peso y ecografía. 130
Restricción del crecimiento intrauterino 130
Macrosomía fetal 131
Tecnologías para medir el crecimiento fetal 131
Ejemplos de la evaluación de la relación Altura Uterina/Edad Gastacional a la primera consulta 133
Ejemplos de la evaluación de la tendencia de la relación AU/EG en consultas subsecuentes 134
Objetivos: Detectar precozmente el embarazo múltiple para prevenir sus complicaciones 138
Actividad: Diagnóstico del número de fetos 138
Objetivos: Pesquisar las presentaciones fetales anormales 140
Actividad: Diagnóstico de presentación fetal 140
Presentación pelviana o podálica 140
Situación transversa 140
Objetivos: Detectar posibles distocias pélvicas para definir el nivel de atención del parto 142
Actividad: Examen gineco-obstétrico. Evaluación de la pelvis. 142
CAPITULO IV
Atención del Parto de Bajo Riesgo 154
Asistencia durante el ingreso 154
Objetivos: Diagnosticar el trabajo de parto e identificar el grado de riesgo 154
Actividad: Consulta en recepción 154
Interrogatorio 155
Examen clínico general 156
Examen obstétrico 158
Auscultación de la FCF 159
Patron de contractilidad uterina 161
Examen genital 163
Dilatación, borramiento y posición del cuello 164
Pérdida de secreciones por los genitales 164
Evaluación de la presentación 167
Valoración de la proporción feto-pélvica y la capacidad de la pelvis materna 170
Preparación de la embarazada en la recepción 172
Asistencia durante el período de dilatación (primer período) 173
Objetivos: Controlar bienestar materno y fetal. Detectar y evaluar desviaciones de los límites fisiológicos 173
(progreso del parto). Evaluar riesgo y referir a nivel apropiado. Aplicar maniobras correctivas
Actividad: Información a la embarazada. Controles maternos. Controles obstétricos 173
Registro de los controles en el partograma con curvas de alerta.
Acompañamiento a la madre durante el parto 173
Controles maternos 174
Controles obstétricos 175
Progreso de la dilatación y descenso de la presentación 177
Partograma con curvas de alerta 178

Trabajo de parto prolongado 183
Asistencia durante el período expulsivo (segundo período) 185
Objetivos: Detectar y evaluar desviaciones de los límites fisiológicos del período expulsivo.
Prevenir traumatismo obstétrico. Prevenir hipoxia fetal. 185
Actividad: Control de la FCF. Control de la contractilidad.
Control del avance de la presentación y desprendimiento 185
Posición de la parturienta 186
Controles a realizarse durante el período expulsivo 186
Amniotomía 187
Protección perineal 187
Avance de la presentación y desprendimiento 188
Situaciones especiales 189
Distocia de hombro 189
Atención del parto en podálica 190
Atención del recién nacido en sala de partos 193
Recomendaciones sobre uso de medicación en parto de bajo riesgo 194
Asistencia durante el alumbramiento y posalumbramiento (tercer período) 198
Objetivos: Detectar y evaluar desviaciones de los límites fisiológicos del alumbramiento y posalumbramiento 198
Actividad: Control materno. Examen de la placenta 198
Examen de la placenta y membranas 198
Controles durante el alumbramiento 198
Sutura de la episiotomía 199
Prevención para evitar la retención de restos ovulares 199
Prevención de la hemorragia post parto (HPP). 199
Tracción del cordón. 200
Masaje y compresión uterina 200
Postalumbramiento 201
Retención de placenta 202
Hemorragia post parto 203
Cuidados del post parto imediato 207
Categorías A,B,C,D (recomendaciones OMS) 207
Asistencia durante el puerperio 210
Objetivos: Controlar bienestar de la mujer puérpera. Detectar y evaluar desviaciones de los límites
fisiológicos. Evaluar riesgo y referir a nivel apropiado. Aplicar maniobras correctivas. 210
Actividad: Educación de la mujer puérpera. Controles clínicos de la mujer y su hijo.
Registro de los controles en la historia clínica perinatal. 210
Puerperio mediato 211
Puerperio alejado 212
Puerperio tardío 212
CAPITULO V
Atención del Recién Nacido 215
Objetivos: Recibir al recién nacido y valorar el inicio de la primera respiración espontánea. 216
Actividad: Observar si respira o no. Si no respira deducir si es por asfixia fetal o por depresión farmacológica. 216
Objetivos: Proteger la adaptación a la vida extrauterina en el recién nacido de pretérmino 222
Actividad: 1. Proveer cuidados inmediatos que faciliten la adaptación, especialmente en los nacidos
pretérminos que presenten signos de inmadurez ventilatoria.
2. Desarrollar estrategias tendientes a evitar la pérdida de calor, valorar el flujo bidireccional de 222
sangre desde la placenta a través del cordón umbilical al feto, apoyar y mantener el inicio de
la respiración, controlar el aporte de O2,
Esquema para el cuidado continuo del recién nacido pretérmino desde el primer minuto de vida 225
Objetivos: Identificar al recién nacido 226
Actividad: Facilitar que la madre lo identifique y cumplir los requisitos locales de identificación al nacer. 226
Objetivos: Evaluar el crecimiento y el desarrollo fetal al nacer. 226
Actividad: Realizar antropometría y valorarla según la edad gestacional y valorar las funciones de adaptación 226
Antropometría neonatal 227
Objetivos: Adecuar el manejo inicial de los recién nacidos con defectos congénitos mayores 228
Actividad: Instaurar en forma precoz las medidas específicas para cada defecto 228
Objetivos: Detectar defectos y/o enfermedades congénitas asintomáticas 230
Actividad: Detección sistémica en el período neonatal por métodos de laboratorio clínico 230
Sífilis congénita 230
Toxoplasmosis congénita 233
HIV 233
Hepatitis B 234
Estreptococo del grupo B 235
Hipotiroidismo congénito 237
Anemia falciforme 238
Hiperbilirrubinemia neonatal no hemolítica 239
Déficit auditivo severo 241
Objetivos: Prevenir la oftalmia gonocóccica 241
Actividad: Instilar antimicrobianos en las conjuntivas al nacer 241
Objetivos: Prevenir enfermedad hemorrágica del recién nacido 242
Actividad: Administrar vitamina K 242
Objetivos: Iniciar y mantener la lactancia materna exitosa 242
Actividad: 1 - No separar al recién nacido y su madre y facilitar el apoyo familiar 242
2 - Alimentar a libre demanda y no dar biberones 243
3 - Registrar la alimentación al alta de la maternidad 243
Objetivos: Prevenir tuberculosis grave en el lactante 243
Actividad: Vacuna BCG al nacer 243
Objetivos: Prevenir la muerte súbita del lactante 243
Actividad: Colocar al recién nacido boca arriba para dormir 243
Objetivos: Disminuir los riesgos en los nacidos pretérmino de 35 y 36 semanas (pretérmino tardíos) y los de
37 a 38 semanas (término precoces) 244
Actividad: Aumentar vigilancia en el período de adaptación mientras permanecen en sala con sus madres 244
Referencias Bibliográficas 248
CAPITULO VI
Atención conjunta de la madre y el niño después del nacimiento 249
Objetivos: Racionalizar los recursos y disminuir oportunidades perdidas
Controlar bienestar de la mujer puérpera y del recién nacido 249
Detectar y evaluar desviaciones de los límites fisiológicos de ambos.
Actividad: Atención conjunta de la madre y el recién nacido durante el puerperio
Educación de la mujer puérpera.
Controles clínicos de la mujer y su hijo.
249
Registro de los controles en la historia clínica perinatal.
Registros. 249
Soporte afectivo. 250
Controles de la madre y del recién nacido 251
CAPITULO VII
Planificación familiar 255
Objetivos: Contribuir al ejercicio del derecho a planificar el embarazo 255
Actividad: Asesorar sobre los principales métodos contraceptivos 255
Proceso de asesoramiento 255
Evaluación de las usuarias antes de recomendarles un método contraceptivo 256
Descripción de los métodos anticonceptivos 257
Métodos reversibles 257
Métodos comportamentales 257
Método de la lactancia exclusiva (MELA) 258
Métodos de barrera 258
Contracepción de emergencia 261
Contraceptivos hormonales 262
Dispositivos intrauterinos 267
Criterios de elegibilidad para métodos hormonales y dispositivos intra uterinos 269
Métodos irreversibles 272
Ligadura tubaria 272
Ligadura de los deferentes (vasectomía) 274
CAPITULO VIII
Aborto 277
Objetivos: Reducir la morbimortalidad por aborto 277
Actividad: Diagnóstico y asistencia del aborto en los distintos períodos 277
Definiciones 277
Prevalencia e incidencia 278
Aborto espontáneo 279
Diagnóstico clínico y etapas evolutivas del aborto 281
Diagnóstico diferencial 283
Conducta 283
Métodos de evacuación 285
Evacuación uterina 285
Cuidados post procedimiento 286
Aborto complicado 287
Complicaciones post evacuación 287
Consejería /Información 288
Anticoncepción por aborto 289
35Ï/2*2
0HMRUDU ODV FRQGLFLRQHV GH YLGD GH ODV PDGUHV \ VXV UHFLpQ QDFLGRV VRQ ORV
REMHWLYRVGHODV0HWDVGH'HVDUUROORGHO0LOHQLR¿UPDGDVSRUWRGRVORVHVWDGRV
PLHPEURV
8QD GH ODV HVWUDWHJLDV PDV FRVWR HIHFWLYD SDUD DOFDQ]DU HVWRV ORJURV HV
FDSDFLWDUDOHTXLSRGHVDOXGHQHOPDUFRGHOFRQWLQXRGHFXLGDGRVGHODPDGUH
\HOUHFLpQQDFLGRHQIRTXHTXHFRQVWLWX\HODHVHQFLDGHODSHULQDWRORJtD/D
UHQRYDFLyQGHODDWHQFLyQSULPDULDGHVDOXGSURSXHVWDHQHVWDJXtDHVWDEDVDGD
HQODVPHMRUHVHYLGHQFLDVGLVSRQLEOHV\D\XGDQDOSHUVRQDOGHORVVHUYLFLRVD
GHVDUUROODUQRUPDVTXHSURWHJHQ\SURPXHYHQPXMHUHV\QLxRVDVPiVVDQRV
/DSUHVHQWHJXtDWLHQHFRPRDQWHFHGHQWHVORVOLEURV³$WHQFLyQ3UHQDWDO\GHO
3DUWR GH %DMR 5LHVJR´ \ OD SULPHUD \ VHJXQGD HGLFLyQ GH ODV ³*XtDV SDUD HO
&RQWLQXRGHDWHQFLyQGHOD0XMHU\HO5HFLpQ1DFLGR´TXHIXHUDQSXEOLFDGRV
SRU HO &/$3 HQ HQ \ UHVSHFWLYDPHQWH (Q HVWD HGLFLyQ VH
OHKDQDFWXDOL]DGRWRGRVORVWHPDV\DPSOLDGRVXHQIRTXHSURIXQGL]DQGRORV
FRQWHQLGRV GH ORV FXLGDGRV SUHJHVWDFLRQDOHV FRQ XQ FULWHULR GH SURPRFLyQ \
SUHYHQFLyQTXHSURFXUDPHMRUDUHOHVWDGRGHVDOXGGHODPXMHUVXSDUHMD\VX
KLMRDFRQPHGLGDVUHODWLYDPHQWHVHQFLOODV,QFRUSRUDWDPELpQQXHYRVDVSHFWRV
VREUHSODQL¿FDFLyQIDPLOLDUFRQXQHQIRTXHGHGHUHFKRVGRQGHVHLQFOX\HOD
DQWLFRQFHSFLyQGHHPHUJHQFLD\HOFRQFHSWRGHDWHQFLyQLQWHJUDOSDUDHYLWDUODV
RSRUWXQLGDGHVSHUGLGDV\PHMRUDUODH¿FLHQFLDGHORVFRQWDFWRVGHOSHUVRQDOGH
VDOXGFRQODPXMHU\VXQLxRD
/D DPSOLD GLIXVLyQ TXH KDQ WHQLGR ODV HGLFLRQHV DQWHULRUHV \ VX XWLOL]DFLyQ
HQ HO SURFHVR GH FDSDFLWDFLyQ FRQWLQXD D SURIHVLRQDOHV GH OD VDOXG HQ OD
UHJLyQ FRQVWLWX\H XQ LPSXOVR D FRQWLQXDU HO WUDEDMR GH DFWXDOL]DFLyQ GH VXV
FRQWHQLGRV TXH VRQ SHUPDQHQWHPHQWH UHYLVDGRV HQ EDVH DO VXUJLPLHQWR GH
QXHYDHYLGHQFLDFLHQWt¿FDDVtFRPRDSDUWLUGHODH[SHULHQFLDDOFDQ]DGDHQODV
GLIHUHQWHVDFWLYLGDGHVGRFHQWHVHQODVTXHODV*XtDVKDQFRQVWLWXLGRHOPDWHULDO
GHDSR\RSULQFLSDO
'HVGHWDOHQIRTXHSRUWDQWRVHSUHVHQWDHVWDHGLFLyQUHYLVDGD\DFWXDOL]DGD
TXHVHHVSHUDFRQWULEX\DDFRQWLQXDU\SURIXQGL]DUODVDFFLRQHVTXHVHYLHQHQ
GHVDUUROODQGRHQODUHJLyQD¿QFXPSOLUFRQHOFRPSURPLVRGHPHMRUDUODVDOXG
SDUDPXMHUHV\QLxRVDV
'U5LFDUGR)HVFLQD
'LUHFWRU&/$3605
&RRUGLQDGRUGH3URJUDPD665236206
*ORVDULR
ACT: Terapias Combinadas en base a Artemisina.

AIC: Anticonceptivos Inyectables Combinados.
AOC: Anticonceptivos Orales Combinados.
APS: Atención Primaria de Salud.
ARA II: Antagonistas de los Receptores de la Angiotensina II.
ARV: Antirretrovíricos.
AU: Altura Uterina.
AZT: Zidovudina.
BCG: Bacilo de Calmette - Guerin.
BhCG: Fracción Beta de la hormona Gonadotropina Coriónica.
BPN: Bajo peso al Nacer.
CDC: Centros para el Control de Enfermedades de los Estados Unidos.
CLAP/SMR: Centro Latinoamericano de Perinatología / Salud de la Mujer y Reproductiva.
CIPD: Conferencia Internacional de Población y Desarrollo.
CMV: Citomegalovirus.
CU: Contracción Uterina.
D: Diámetro.
d: diámetro.
DBP: Diámetro Biparietal.
DFO: Diámetro Fronto Occipital.
DG: Diabetes Gestacional.
DIPs I: Caída de la FCF coincidente con la contracción uterina.
DIPs Variables: Caídas de la FCF de probable origen umbilical, de duración, amplitud y de comienzo
variables en relación a la contracción uterina.
DIPs II: Desaceleración tardía de la FCF en relación a la contracción uterina.
DIU: Dispositivo Intrauterino.
DM: Diabetes Mellitus.
DPPNI: Desprendimiento Previo de Placenta Normoinserta.
ECLAMC: Estudio Colaborativo Latinoamericano de Malformaciones Congénitas.
EG: Edad Gestacional.
EGB: Estreptococo del Grupo B.
EP: Enfermedad Periodontal.
FPP: Fecha Probable de Parto.
FCF: Frecuencia Cardíaca Fetal.
FTA- Abs: Prueba de detección de Anticuerpos específicos contra el Treponema pallidum, por
inmunofluorescencia.
FUM: Fecha de Última Menstruación.
GED: Enfoque de Género en el Desarrollo.
HAI: Hemoaglutinación Indirecta.
Hb : Hemoglobina.
HC: Hipotiroidismo Congénito.
HCP: Historia Clínica Perinatal.
HCG: Hormona Coriónica Gonadotrófica.
IC: Incompetencia Cervical.
IFI: Inmunofluorescencia Indirecta.
Ig G: Inmunoglobulina G.
Ig M: Inmunoglobulina M.
IECAs: Inhibidores de la Enzima conversora de la Angiotensina II.
IM: Intramuscular.
IMC: Índice de Masa Corporal.
ITR: Infecciones del Tracto Reproductivo.
ITS: Infecciones de Transmisión Sexual.

IV: Intravenoso.
LCR: Líquido Céfalo Raquídeo.
MAC: Métodos Anticonceptivos.
MELA: Método de Lactancia Exclusiva.
MHA – TP: Prueba de detección de Anticuerpos específicos contra el Treponema pallidum por
Micro – Hemaglutinación.
NVP: Neviparina.
OMS: Organización Mundial de la Salud.
OPS: Organización Panamericana de la Salud.
PAP: Papanicolau, colpocitoplogía oncológica.
P. Abd.: Perímetro Abdominal.
P. Cr.: Perímetro Craneano.
PCR: Reacción de la cadena de la polimerasa.
PEG: Pequeño para la Edad Gestacional.
P. falciparum: Plasmodio falciparum.
PG: Prostaglandinas.
PMB: Perímetro Medio Braquial.
PO2: Presión parcial de Oxígeno.
PTOG: Prueba de Tolerancia a la Glucosa.
RCI: Restricción del Crecimiento Intrauterino.
RCIU: Restricción del Crecimiento Intrauterino.
RDTs: Test Rápidos Diagnósticos.
RPM: Rotura Prematura de Membranas.
RPP: Rapid Plasma reagin.
RR: Riesgo relativo.
SAF: Síndrome Alcohólico Fetal.
SIDA: Síndrome de la Inmunodeficiencia Adquirida.
SIP: Sistema Informático Perinatal.
SDR: Síndrome de Dificultad Respiratoria.
SNC: Sistema Nervioso Central.
SRC: Síndrome de Rubéola Congénita.
T. cruzi: Tripanosoma cruzi.
T4: Hormona tiroidea 4.
Td: Tétanos más difteria.
TNN: Tétanos Neonatal.
T. pallidum: Treponema pallidum.
TP – PA: Prueba de detección de Anticuerpos específicos contra el Treponema pallidum por
Aglutinación.
TPI: Tratamiento Preventivo Intermitente.
TSH: Hormona Estimulante Tiroidea.
TT: Toxoide tetánico.
TBC: Tuberculosis.
UCIN: Unidad de Cuidado Intensivo Neonatal.
UNAIDS: (ONUSIDA), Programa conjunto de las Naciones Unidas sobre el VIH/SIDA.
UNGASS: United Nations General Assambly on AIDS Special Session.
UNICEF: Fondo de las Naciones Unidas para la Infancia.
USR: Unheated Serum Reagin.
VPH: Virus Papiloma Humano.
VDRL: Venereal Disease Research Laboratory.
VIH: Virus de la Inmunodeficiencia Humana.
V/O: Vía oral.
, 5HQRYDFLyQGHOD$WHQFLyQ3ULPDULD
GHOD6DOXGHQODV$PpULFDV
& $ 3, 7 8 /2 ,
'XUDQWH ODV ~OWLPDV GpFDGDV OD 5HJLyQ GH ODV$PpULFDV KD HYLGHQFLDGR LPSRUWDQWHV
DYDQFHVHQWpUPLQRVGHVDOXGSHURHVRVORJURVVRQLQVX¿FLHQWHV\HQWRGRVORVSDtVHV
D~QSHUVLVWHQGHVDItRV\GHVLJXDOGDGHVSRUUHVROYHU
/DVQDFLRQHVYLQFXODQODVPHMRUDVHQVDOXGDODLQFOXVLyQRDPSOLDFLyQGHODSURWHFFLyQ
VRFLDO GHQWUR GHO PDUFR GH ODV UHIRUPDV GHO VHFWRU \ D OD DSOLFDFLyQ GH OD DWHQFLyQ
SULPDULDGHVDOXG$36/DDWHQFLyQSULPDULDGHVDOXGFRPRWDOIXHGH¿QLGDHQ
HQ OD 'HFODUDFLyQ GH$OPD$WD \ GHVSXpV GH FDVL DxRV GH H[SHULHQFLD VH SXHGH
FRQFOXLUTXHORVVLVWHPDVGHVDOXGTXHFXPSOHQFRQORVSULQFLSLRVGH$36KDQORJUDGR
PHMRUHV UHVXOWDGRV VDQLWDULRV \KDQDXPHQWDGR ODH¿FLHQFLDHQODDWHQFLyQ GHVDOXG
WDQWR LQGLYLGXDO FRPR FROHFWLYD IDFLOLWDQGR XQ PHMRU UHODFLRQDPLHQWR \ SDUWLFLSDFLyQ
HQWUHXVXDULRV\SUHVWDGRUHVGHVDOXGS~EOLFRV\SULYDGRV
$SHVDUGHOWLHPSRWUDQVFXUULGRHOHVWDGRGHVLWXDFLyQGHOD$36HQORVSDtVHVGHOD
5HJLyQHVPX\GLVSDU3RUHVDUD]yQHQVHSWLHPEUHGHHO&RQVHMR'LUHFWLYRGH
OD2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXGLQVWyDORV(VWDGRV0LHPEURVDDGRSWDUXQD
VHULHGHUHFRPHQGDFLRQHVSDUDIRUWDOHFHUODDWHQFLyQSULPDULDHQVDOXGORTXHFXOPLQy
FRQOD³'HFODUDFLyQ5HJLRQDOVREUHODVQXHYDVRULHQWDFLRQHVGHOD$WHQFLyQ3ULPDULDGH
6DOXG´HQVHSWLHPEUHGHHQODUHXQLyQGHO&RQVHMR'LUHFWLYRGH236
/DUHQRYDFLyQGHODDWHQFLyQSULPDULDGHVDOXGHQODV$PpULFDVVHEDVDHQWUHRWUDV
FRVDVHQODDSDULFLyQGHQXHYRVGHVDItRVHSLGHPLROyJLFRV3DUDGDUOHVUHVSXHVWDOD
$36GHEHDVXPLUODQHFHVLGDGGHFRUUHJLUODVGHELOLGDGHVGHDOJXQRVGHVXVHQIRTXHV
GHVDUUROODUQXHYRVFRQRFLPLHQWRV\WHFQRORJtDVVREUHPHMRUHVSUiFWLFDVTXHGHEHQVHU
LQFRUSRUDGRVSDUDDXPHQWDUVXHIHFWLYLGDG7RGRHVWRFRQVWLWX\HXQDKHUUDPLHQWDTXH
IRUWDOHFHGLUHFWDPHQWHODFDSDFLGDGGHODVRFLHGDGSDUDUHGXFLUODVLQHTXLGDGHVHQVDOXG
(VWDQHFHVLGDGGHUHQRYDFLyQHVLPSUHVFLQGLEOHDGHPiVSDUDGDUFXPSOLPLHQWRDORV
FRPSURPLVRVGHOD'HFODUDFLyQGHO0LOHQLRTXHORVSDtVHVGHOD5HJLyQKDQ¿UPDGR
(Q EDVH D HVWD UHQRYDFLyQ OD $36 VH GH¿QH FRPR XQD ³DWHQFLyQ HVHQFLDO HQ
VDOXG EDVDGD HQ PpWRGRV \ WHFQRORJtDV SUiFWLFDV FLHQWt¿FDPHQWH IXQGDPHQWDGDV \
VRFLDOPHQWHDFHSWDEOHVDFFHVLEOHDORVLQGLYLGXRV\DODVIDPLOLDVHQODFRPXQLGDGD
WUDYpVGHVXSOHQDSDUWLFLSDFLyQ\DXQFRVWRTXHODFRPXQLGDG\HOSDtVSXHGDQDVXPLU
SDUDPDQWHQHUOD«/D$36IRUPDSDUWHLQWHJUDOGHOVLVWHPDGHVDOXGGHXQSDtVDVt
FRPRGHOGHVDUUROORHFRQyPLFR\VRFLDOGHODFRPXQLGDG«DFHUFDQGRODDWHQFLyQHQ
VDOXGWDQWRFRPRVHDSRVLEOHDOOXJDUGRQGHODJHQWHYLYH\WUDEDMD\FRQVWLWX\pQGRVH
HQHOSULPHUHOHPHQWRGHXQSURFHVRFRQWLQXRGHDWHQFLyQHQVDOXG´
&RQWLQXRGHDWHQFLyQ
(O SURFHVR OODPDGR ³FRQWLQXR GH DWHQFLyQ´ R ³FRQWLQXR GH FXLGDGRV´ LPSOLFD HO XVR
UDFLRQDO\DSURSLDGRGHODVQXHYDV\PHMRUHVHYLGHQFLDVGLVSRQLEOHVKDVWDHOPRPHQWR
SXHVWDVDOVHUYLFLRGHORVLQGLYLGXRV\FRPXQLGDGHVGXUDQWHWRGDVODVHWDSDVGHOFLFOR
YLWDO
/DVDOXGVH[XDO\UHSURGXFWLYDHVXQEXHQHMHPSORGHFRQWLQXRGHFXLGDGRVFRQHOOD
VHSXHGHDSUHFLDUFRPRODLQWURGXFFLyQGHDFWLYLGDGHVGHSURPRFLyQ\SURWHFFLyQGHOD
VDOXGGLULJLGDVDORVDGROHVFHQWHVFRQWULEX\HQDGHFLGLUHOPRPHQWRPiVRSRUWXQRSDUD
HOFRPLHQ]RGHODVUHODFLRQHVVH[XDOHVKDFHUOROLEUHGHFRHUFLyQ\DGLVPLQXLUHOULHVJR
GHHQIHUPDU,769,+6,'$7DPELpQVHPHMRUDHOFRQRFLPLHQWR\HOXVRGHPpWRGRV
FRQWUDFHSWLYRVFRQORFXDOVHFRQWULEX\HDUHVSHWDUHOGHUHFKRGHGHFLGLUHOPRPHQWR
DSURSLDGRSDUDHPEDUD]DUVH
6LJXLHQGRODOyJLFDGHOFRQWLQXRGHDWHQFLyQVHIRPHQWDODFRQVXOWDSUHFRQFHSFLRQDO
GH ODV PXMHUHV SDUD FRQVHJXLU XQ HPEDUD]R HQ ODV PHMRUHV FRQGLFLRQHV \ GLVPLQXLU
HO ULHVJR GH HQIHUPDU R PRULU 8QD YH] FRQVHJXLGR HO HPEDUD]R VH SUHWHQGH GDU HO
FXLGDGR GH PD\RU FDOLGDG GXUDQWH HO HPEDUD]R HO SDUWR \ HO SXHUSHULR$ SDUWLU GH
HVWHPRPHQWRFRQWLQ~DHOFRPSURPLVRFRQORVFXLGDGRVGHODPXMHUFRQWUDFHSFLyQ
SUHYHQFLyQGHOFiQFHUJpQLWRPDPDULRFOLPDWHULRHWF\FRPLHQ]DQORVFXLGDGRVGHO
UHFLpQQDFLGR\HOQLxRKDVWDOOHJDUQXHYDPHQWHDODDGROHVFHQFLD
(QIRTXHGH6DOXG)DPLOLDU\&RPXQLWDULD
(O ³FRQWLQXR GH FXLGDGRV´ QR HV GHO WRGR HIHFWLYR VL VH OR FRQ¿QD H[FOXVLYDPHQWH D
OD UHVSRQVDELOLGDG LQGLYLGXDO GH ODV SHUVRQDV D FXLGDU VX VDOXG 3RU HVR HO HQIRTXH
GH6DOXG)DPLOLDU\&RPXQLWDULDLQWHJUDHQODQXHYDHVWUDWHJLDGH$36ORVFRQFHSWRV
GH FLFOR YLWDO \ GH FRQWLQXR GH FXLGDGRV HQ EDVH D XQ WUDEDMR HQ WUHV GLPHQVLRQHV
GLIHUHQWHV\FRPSOHPHQWDULDV8QDSULPHUDGLPHQVLyQTXHSDUWHGHOKRJDUHQHOFXDOHO
HPSRGHUDPLHQWRGHODPXMHUHVODKHUUDPLHQWDFODYHSDUDHOPDQWHQLPLHQWRGHODVDOXG
RSDUDUHVWDXUDUODFXDQGRHVWDVHKDSHUGLGR/DVHJXQGDGLPHQVLyQHVODFRPXQLWDULD
GRQGH HO HPSRGHUDPLHQWR VRFLDO \ OD VROLGDULGDG MXHJDQ XQ URO GHFLVLYR /D WHUFHUD
GLPHQVLyQ LQYROXFUD D WRGRV ORV VHUYLFLRV HQ JHQHUDO \ D ORV GH VDOXG HQ SDUWLFXODU
SUHVLGLGRVSRUXQDOyJLFDHQODFXDOORVVHUYLFLRVGHOSULPHUQLYHOGHDWHQFLyQUHVROYHUiQ
HQIRUPDH¿FLHQWHPiVGHOGHODVFRQVXOWDVHQEDVHDORVUHFXUVRVKXPDQRV\
WHFQROyJLFRVORFDOHVGHELHQGRGHULYDUSDUDVXVROXFLyQDVHUYLFLRVGHPD\RUFRPSOHMLGDG
ODVVLWXDFLRQHVTXHSRUVXJUDYHGDGRGL¿FXOWDGHVGLDJQyVWLFDVRWHUDSpXWLFDVDVtOR
GHPDQGHQ (VWD VHFXHQFLD LPSOLFD FRQWDU FRQ XQ VLVWHPD GH VDOXG RUJDQL]DGR SRU
QLYHOHVLQIRUPDFLyQSDUDODRULHQWDFLyQGHODGHPDQGDVLVWHPDVGHFRPXQLFDFLyQ\
WUDQVSRUWHFRQVLGHUDQGRRWUDVIDFLOLGDGHVGHDFFHVR$GHPiVGHJDUDQWL]DUHODFFHVR
\FREHUWXUDDORVVHUYLFLRVGHVDOXGORVFXLGDGRVGHEHUiQEDVDUVHHQODFDOLGDGGHOD
SUHVWDFLyQ/DLQWHUDFFLyQHQWUHORVVHUYLFLRVGHVDOXGFRQRWURVVHUYLFLRVGDDOHQIRTXH
GH6DOXG)DPLOLDU\&RPXQLWDULDVXH¿FDFLDSDUDDOFDQ]DU\PDQWHQHUHQHOWLHPSRORV
ORJURVDOFDQ]DGRV
9DORUHV3ULQFLSLRV\(OHPHQWRVGHXQ6LVWHPDGH6DOXG%DVDGRHQOD$36
6H GHEH WHQHU HQ FXHQWD TXH OD QXHYD RULHQWDFLyQ HQ $36 GH 236 FRQVLGHUD XQ
FRQMXQWR GH YDORUHV SULQFLSLRV \ HOHPHQWRV HVHQFLDOHV SDUD FRQVWUXLU 6LVWHPDV GH
6DOXG%DVDGRVHQOD$36/D236VRVWLHQHTXHWDOHVVLVWHPDVVRQLQGLVSHQVDEOHVSDUD
DYDQ]DUHQOD¿QDOL]DFLyQGHOD³DJHQGDLQFRQFOXVDGHVDOXG´FRQVROLGDU\PDQWHQHU
ORVSURJUHVRVDOFDQ]DGRV(QOD¿JXUDTXHVHPXHVWUDDFRQWLQXDFLyQVHUHVXPHQHVRV
DVSHFWRV
$FFHVR\FREHUWXUD
XQLYHUVDO
$FFLRQHV $WHQFLyQLQWHJUDO
LQWHUVHFWRULDOHV HLQWHJUDGD
'DUUHVSXHVWDDODV
QHFHVLGDGHVGHVDOXG
5HFXUVRV GHODSREODFLyQ (QIDVLVHQ
DGHFXDGRV\ SURPRFLyQ\
VRVWHQLEOHV SUHYHQFLyQ
2ULHQWDFLyQ
KDFLDOD
,QWHUVHFWRULDOLGDG FDOLGDG
'HUHFKRVDOQLYHO
GHVDOXGPiVDOWR
5HFXUVRV SRVLEOH $WHQFLyQ
KXPDQRV DSURSLDGD
DSURSLDGRV 6ROLGDULGDG
5HVSRQVDELOLGDG
3DUWLFLSDFLyQ (TXLGDG \UHQGLFLyQGH
FXHQWDVGHORV
JRELHUQRV
2ULHQWDFLyQ
3ULPHU IDPLOLDU\
FRQWDFWR FRPXQLWDULD
6RVWHQLELOLGDG -XVWLFLDVRFLDO
3ROtWLFDV\ 0HFDQLVPRV
SURJUDPDV GHSDUWLFLSDFLyQ
SURHTXLGDG DFWLYD
2UJDQL]DFLyQ\
JHVWLyQySWLPDV

)LJ9DORUHV3ULQFLSLRV\(OHPHQWRVHVHQFLDOHVGHXQ6LVWHPDGH6DOXGEDVDGRHQ
OD$36
$FRQWLQXDFLyQDQDOL]DUHPRVH[FOXVLYDPHQWHORVDVSHFWRVFRQFHUQLHQWHVDORVYDORUHV
SRUVHUHOQ~FOHRFHQWUDOGHOD$36\FRPRHOORVVHYLQFXODQFRQODVDOXGVH[XDO\
UHSURGXFWLYD/RVYDORUHVVHEDVDQHQWUHVHQIRTXHVHVHQFLDOHV
'HUHFKRDOQLYHOPiVDOWRGHVDOXG
(TXLGDG
6ROLGDULGDG
'HUHFKRDOQLYHOPiVDOWRGHVDOXG
&RQVLGHUDU OD VDOXG FRPR XQ DVXQWR GH GHUHFKRV LPSOLFD XQ FDPELR GH SDUDGLJPD
VXVWDQFLDO (Q pO VH FRQFLEH D OD VDOXG FRPR XQ GHUHFKR KXPDQR GRQGH VH KDFH
QHFHVDULRGDUUHVSXHVWDDORVGHWHUPLQDQWHVVRFLDOHV\SROtWLFRVTXHODFRQGLFLRQDQ
(OGHUHFKRDODVDOXGLQYROXFUDHOFRPSURPLVRLQGLYLGXDO\FROHFWLYRGHORVLQGLYLGXRV
SDUDPDQWHQHUODDVtFRPRDODUHVSRQVDELOLGDGGHORV(VWDGRV\GHRWURVDFWRUHVSDUD
JDUDQWL]DU HO FXPSOLPLHQWR GH HVWH GHUHFKR 3HUR WDPELpQ KDELOLWD D ORV FLXGDGDQRV
OD SRVLELOLGDG GH UHFODPDU PHGLDQWH OD ³YtD GHO UHFXUVR´ FXDQGR VLHQWDQ TXH ORV
FRPSURPLVRVDVXPLGRVSRUORV(VWDGRVXRWURVDFWRUHVQRKDQVLGRFXPSOLGRV
(OHQIRTXHGH6DOXG\'HUHFKRV+XPDQRVDGHPiVGHORVDVSHFWRVUHFLpQPHQFLRQDGRV
VRVWLHQH TXH SDUD DOFDQ]DU ODV PHMRUDV HQ OD HTXLGDG HQ VDOXG SURSXHVWDV GHVGH
$OPD$WDGHEHRULHQWDUVHPiVKDFLDHOGHVDUUROORGHSROtWLFDV³LQFOXVLYDVGLQiPLFDV
WUDQVSDUHQWHV \ DSR\DGDV SRU FRPSURPLVRV OHJLVODWLYRV \ ¿QDQFLHURV´ TXH D
FLUFXQVFULELUVHVyORDDVSHFWRVHVSHFt¿FRVGHODHQIHUPHGDG
'HUHFKRV6H[XDOHV\5HSURGXFWLYRV
(VSHFLDO LPSDFWR KD WHQLGR HO HQIRTXH GH VDOXG \ GHUHFKRV KXPDQRV FXDQGR VH OR
DSOLFD DO FDPSR GH OD 6DOXG 5HSURGXFWLYD \ ORV 'HUHFKRV 5HSURGXFWLYRV (Q OD
&RQIHUHQFLD,QWHUQDFLRQDOGH3REODFLyQ\'HVDUUROOR&,3'UHDOL]DGDHQ(O&DLURHQ
VHLQWURGXFHHQODDJHQGDSROtWLFDLQWHUQDFLRQDODODVDOXGVH[XDO\UHSURGXFWLYD
GHVGH XQD SHUVSHFWLYD FRPSOHMD H LQWHJUDO SHUR HVWUHFKDPHQWH UHODFLRQDGD FRQ HO
HMHUFLFLR GH ORV GHUHFKRV 7DPELpQ HQ HO FDVR GH OD VDOXG VH[XDO \ UHSURGXFWLYD HO
HMHUFLFLR GH GHUHFKRV SDUD VX FXPSOLPLHQWR LQYROXFUD OD UHVSRQVDELOLGDG LQGLYLGXDO
GHODVSHUVRQDVSDUDHODXWRFXLGDGR\ODGHORV(VWDGRVHQJHQHUDUODVFRQGLFLRQHV
VRFLDOHV\ODVFRQGLFLRQHVSROtWLFDVQHFHVDULDV
(O3URJUDPDGH$FFLyQGHOD&,3'VHxDODTXHORVGHUHFKRVUHSURGXFWLYRVVRQGHUHFKRV
KXPDQRV UHFRQRFLGRV HQ OH\HV QDFLRQDOHV HQ GRFXPHQWRV LQWHUQDFLRQDOHV VREUH
GHUHFKRVKXPDQRV\HQRWURVGRFXPHQWRVGH1DFLRQHV8QLGDVDSUREDGRVSRUFRQVHQVR
³(VRVGHUHFKRVVHEDVDQHQHOUHFRQRFLPLHQWRGHOGHUHFKREiVLFRGHWRGDVODVSDUHMDV
HLQGLYLGXRVDGHFLGLUOLEUH\UHVSRQVDEOHPHQWHHOQ~PHURGHKLMRVHOHVSDFLDPLHQWRGH
ORVQDFLPLHQWRV\HOLQWHUYDORHQWUHpVWRV\DGLVSRQHUGHODLQIRUPDFLyQ\ORVPHGLRV
SDUDHOOR\HOGHUHFKRDDOFDQ]DUHOQLYHOPiVHOHYDGRGHVDOXGVH[XDOUHSURGXFWLYD
7DPELpQLQFOX\HHOGHUHFKRDDGRSWDUGHFLVLRQHVUHODWLYDVDODUHSURGXFFLyQVLQVXIULU
GLVFULPLQDFLyQ FRDFFLRQHV QL YLROHQFLD /D SURPRFLyQ GHO HMHUFLFLR UHVSRQVDEOH GH
HVWRV GHUHFKRV GHEH VHU OD EDVH SULPRUGLDO GH ODV SROtWLFDV \ SURJUDPDV HVWDWDOHV
\FRPXQLWDULRVHQODHVIHUDGHODVDOXGUHSURGXFWLYDLQFOXLGDODSODQL¿FDFLyQIDPLOLDU
&RPRSDUWHGHHVWHFRPSURPLVRVHGHEHSUHVWDUSOHQDDWHQFLyQDODSURPRFLyQGHODV
UHODFLRQHVGHUHVSHWRPXWXRHLJXDOGDGHQWUHKRPEUHV\PXMHUHV´
/RVGHUHFKRVVH[XDOHV\ORVGHUHFKRVUHSURGXFWLYRVSURSRQHQXQDUHIXQGDFLyQ\XQD
UHGH¿QLFLyQGHODUHODFLyQHQWUHORS~EOLFR\ORSULYDGR,PSOLFDQXQFDPELRGHSDUDGLJPD
HQORVFDPSRVGHODVH[XDOLGDG\ODUHSURGXFFLyQHQWHQGLHQGRTXHpVWRVVHHQFXHQWUDQ
HQ XQ FUXFH GH FDPLQRV HQWUH OR tQWLPRSHUVRQDO SULYDGR \ OR S~EOLFRVRFLDO (VWD
GLFRWRPtDHQWUHORS~EOLFR\ORSULYDGRKDVLGR\FRQWLQ~DVLHQGRXQDGHODVGL¿FXOWDGHV
HQODSURPRFLyQ\GHIHQVDGHORVGHUHFKRVVH[XDOHV\ORVGHUHFKRVUHSURGXFWLYRV
(TXLGDGHQVDOXG
*DUDQWL]DU GHUHFKRV LPSOLFD HQWUH RWUDV FRVDV GLVPLQXLU OD EUHFKD TXH H[LVWH HQ HO
HVWDGRGHVDOXGGHODVSHUVRQDVHQHODFFHVRDODDWHQFLyQ\DDPELHQWHVVDOXGDEOHV
\HQHOWUDWRTXHUHFLEHQHQORVVLVWHPDVGHVHUYLFLRVVRFLDOHV\GHVDOXG/DHTXLGDG
HVODSLHGUDDQJXODUGHORVYDORUHVVRFLDOHV\DOLJXDOTXHHQXQDFDGHQDVXIRUWDOH]D
HVWi PDUFDGD SRU HO HVODEyQ PiV GpELO OD IRUPD FRPR XQD VRFLHGDG WUDWD D VXV
PLHPEURVTXHHVWiQHQSHRUVLWXDFLyQPDUFDUiODIRUWDOH]DGHHVDVRFLHGDG/DJHQWH
GHEH VHU FDSD] GH FRUUHJLU ODV LQHTXLGDGHV PHGLDQWH HO HMHUFLFLR GH ORV GHUHFKRV
PRUDOHV\OHJDOHVSDUDH[LJLUVDOXG\RWURVELHQHVGHFDUiFWHUVRFLDO&XDQGRVHGLFH
TXHODHTXLGDGHVHOYDORUFHQWUDOGHXQ6LVWHPDGH6DOXG%DVDGRHQ$36ORTXHVH
LQWHQWDFRQVHJXLUHVTXHODVSROtWLFDV\SURJUDPDVGHVDOXGHVWpQRULHQWDGDVKDFLDOD
FRQVHFXFLyQGHODHTXLGDG
(TXLGDGGHJpQHUR
8QDGHODVSULQFLSDOHVGLPHQVLRQHVGHODHTXLGDGVHEDVDHQLQFRUSRUDUHOHQIRTXHGH
JpQHURHQVDOXG\DTXHFRQVWLWX\HXQDUHIHUHQFLDLQHOXGLEOHDODKRUDGHDQDOL]DUHO
SDSHOGLIHUHQFLDOTXHKRPEUHV\PXMHUHVMXHJDQHQODSURGXFFLyQFRWLGLDQDGHODVDOXG
'HVGHHVWDSHUVSHFWLYDODHTXLGDGHQVDOXGVHWUDGXFHHQWpUPLQRVRSHUDFLRQDOHVHQ
ODPLQLPL]DFLyQGHGLVSDULGDGHVHYLWDEOHV\VXVGHWHUPLQDQWHVHQWUHJUXSRVKXPDQRV
FRQGLIHUHQWHVQLYHOHVGHSULYLOHJLRVRFLDO
(O(QIRTXHGH*pQHURHQHO'HVDUUROOR*('SHUPLWLyIRFDOL]DUHOSDSHOGHODVDOXG

FRPRFULWHULRGHHTXLGDGHQWUHORVVH[RV*HQHUR6DOXG\'HVDUUROOR(ODQiOLVLVGHOD
GLVWULEXFLyQGHIXQFLRQHVVRFLDOHVVHJ~QVHVHDPXMHUXKRPEUHHVXQRGHORVSXQWRV
FODYHVHQODSHUVSHFWLYDGHJpQHURDOLQWURGXFLUDODQiOLVLVHOSRGHUGHODVUHODFLRQHV
HQWUH PXMHUHV \ YDURQHV R FRPR VH KD KHFKR OD FRQVWUXFFLyQ VRFLRKLVWyULFD GH OR
IHPHQLQR\GHORPDVFXOLQR1RQHFHVLWDPRVSURIXQGL]DUGHPDVLDGRHQHODQiOLVLVSDUD
YHUTXHODVH[XDOLGDG\ODVGHFLVLRQHVUHSURGXFWLYDVVRQHOSULQFLSDOFDPSRHQHOTXH
VHH[SUHVDQODVUHODFLRQHVGHSRGHUHQWUHORVJpQHURVPiVDXQHOiUHDHQHOTXHVH
PDQL¿HVWDQODVUHODFLRQHVGHSRGHUHQWUHJpQHURVVHPDWHULDOL]DHQHOFXHUSRGHOD
PXMHUSRUGRQGHSDVDQ\VHFRQFUHWDQODPD\RUtDGHHVWDVGHFLVLRQHV(OHQIRTXHGH
*pQHUR6DOXG\'HVDUUROORSURFXUDLGHQWL¿FDU\PRGL¿FDUODVFDXVDVTXHHVWUXFWXUDQ
ODVUHODFLRQHVGHSRGHU\TXHFRORFDQDODVPXMHUHVHQXQDSRVLFLyQGHVXERUGLQDFLyQ
LQFLGLHQGRHQHODFFHVR\FRQWUROGHORVUHFXUVRVGHODVDOXGSDUDVXSURSLREHQH¿FLR
(VWHHQIRTXHFRQFLEHDODPXMHUFRPRXQVHULQWHJUDOHQVXP~OWLSOHFRQGLFLyQGHVHU
VH[XDGR\VH[XDOELROyJLFRVRFLRFXOWXUDO\SROtWLFRTXHGHPDQGDVHU³PLUDGD´GHVGH
ODLQWHJUDOLGDGIDYRUHFLHQGRVXIRUWDOHFLPLHQWRFRPRVXMHWRGHGHUHFKRDXWRQRPtD\
HPSRGHUDPLHQWR
³/DVGL¿FXOWDGHVHQWpUPLQRVGHGHVLJXDOGDGGHJpQHURHQHOFDPSRSUiFWLFR\GHVGH
HOSXQWRGHYLVWDOHJDO\PRUDOVHYXHOYHQPiVGUDPiWLFDVHQVLWXDFLRQHVGHSREUH]D
/DOyJLFDGHODVLVWHQFLDOLVPRSUHSRQGHUDFRPRSROtWLFDVRFLDOHQHOFDPSRUHSURGXFWLYR
FRQWULEX\HQGRGHHVDIRUPDDOPDQWHQLPLHQWRGHODH[FOXVLyQVRFLDO\DODQRVXSHUDFLyQ
GHHVWD7UDQVIRUPDUQHFHVLGDGHVHQGHUHFKRVHVMXVWDPHQWHHOFDPLQRSDUDGHVWUXLU
HVDOyJLFD´
(O(QIRTXHGH*pQHURHQHO'HVDUUROORGHEHUtDKDEHUVXVWLWXLGRDOHQIRTXHHQHOTXH
VHKDQVXVWHQWDGRORVPRGHORVGHSODQL¿FDFLyQIDPLOLDU\PDWHUQRLQIDQWLOHVFOiVLFRV
(Q HVWH ~OWLPR HQIRTXH VH KD SULRUL]DGR OD FRQGLFLyQ GH PDGUH GH OD PXMHU FRQ HO
DIiQGHFRQVHJXLUPHMRUHVUHVXOWDGRVQHRQDWDOHVDWUDYpVGHODDWHQFLyQGHO³ELQRPLR
PDGUH ± KLMR´ (VWD LGHD GH ³ELQRPLR´ GHVSHUVRQDOL]D D DPERV PLHPEURV \D TXH VH
FHQWUDHQOD¿JXUDGHODPXMHUFRPRPDGUH\HQOD¿JXUDGHOQLxRHQWDQWRKLMRDODYH]
TXHGHMDSRUIXHUDODSDUWLFLSDFLyQGHOYDUyQHQHOHMHUFLFLRGHODSDWHUQLGDG(QHVWH
HQIRTXHDGHPiVGHDVLJQDUOHDODPXMHUFRPRUROSULQFLSDOODPDWHUQLGDGVHFRQVLGHUD
TXH ODV PXMHUHV VRQ UHFHSWRUDV SDVLYDV GHO GHVDUUROOR \ TXH OD FULDQ]D \ OD IXQFLyQ
GHO FXLGDGR GH OD IDPLOLD HV VX SULQFLSDO DSRUWH DO GHVDUUROOR (VWR KD FRQWULEXLGR HQ
WpUPLQRV JHQHUDOHV D IRUWDOHFHU XQ URO PDVFXOLQR HQ HO TXH QR VH LQFOX\H HO KDFHUVH
FDUJR GH DVSHFWRV YLQFXODGRV D OD SODQL¿FDFLyQ IDPLOLDU \ DO FXLGDGR GH OD VDOXG GHO
Q~FOHRIDPLOLDU
(ODQiOLVLVGHJpQHURHVDSHQDVXQDGHODVGLPHQVLRQHVUHOHYDQWHVHQORVSURFHVRVGH
FRQVWUXFFLyQGHODVDOXGHQIHUPHGDGODFODVHVRFLDOODHWQLD\ODJHQHUDFLyQVRQRWUDV
GHODVGLPHQVLRQHVTXHSHUPLWHQDQDOL]DUODVGLIHUHQFLDVH[LVWHQWHVSDUDHQFRQWUDUORV
LQVXPRVQHFHVDULRVSDUDUHGXFLUODEUHFKDH[LVWHQWHDXQHQWUHODVSURSLDVPXMHUHV
/DVROLGDULGDG
(V HO JUDGR HQ HO TXH ORV PLHPEURV GH XQD VRFLHGDG VH FRPSURPHWHQ D WUDEDMDU
FRQMXQWDPHQWHSRUHOELHQFRP~Q/DVROLGDULGDGVRFLDOHVXQRGHORVPHGLRVSRUORV
TXHODDFFLyQFROHFWLYDSXHGHOOHJDUDUHVROYHUORVSUREOHPDVFRPXQHVORVVLVWHPDV
GHVDOXG\GHVHJXULGDGVRFLDOVRQPHFDQLVPRVPHGLDQWHORVFXDOHVSXHGHH[SUHVDUVH
ODVROLGDULGDGHQWUHLQGLYLGXRVGHGLVWLQWDVFRQGLFLRQHVVRFLDOHV\JHQHUDFLRQDOHV/RV
6LVWHPDVGH6DOXG%DVDGRVHQ$36UHTXLHUHQGHODVROLGDULGDGVRFLDOSDUDJDUDQWL]DU
TXH ODV LQYHUVLRQHV HQ VDOXG VHDQ VRVWHQLEOHV SDUD SURYHHU SURWHFFLyQ ¿QDQFLHUD \
PDQHMRPDQFRPXQDGRGHOULHVJRHQVDOXG\SDUDSRVLELOLWDUTXHHOVHFWRUVDOXGWUDEDMH
FRQ p[LWR MXQWR D RWURV DFWRUHV VRFLDOHV FX\R LQYROXFUDPLHQWR HV IXQGDPHQWDO SDUD
PHMRUDUODVDOXG\ODVFRQGLFLRQHVTXHODGHWHUPLQDQ(VQHFHVDULDODSDUWLFLSDFLyQ\OD
UHQGLFLyQGHFXHQWDVHQWRGRVORVQLYHOHVQRVRORSDUDJDUDQWL]DUODVROLGDULGDGVLQR
SDUDPDQWHQHUODDWUDYpVGHOWLHPSR
5HIHUHQFLDVELEOLRJUi¿FDV
.HNNL 3 3ULPDU\ KHDOWK FDUH DQG WKH 0LOOHQQLXP 'HYHORSPHQW *RDOV LVVXHV IRU GLVFXVVLRQ
*HQHYD:+2
/RSH]$ %HQLD : &RQWHUD 0 *LGD & 'HO HQIRTXH PDWHUQR LQIDQWLO DO HQIRTXH GH OD VDOXG
UHSURGXFWLYD7HQVLRQHVREVWiFXORV\SHUVSHFWLYDV0RQWHYLGHR(G5RVJDO
206$WHQFLyQSULPDULDGHVDOXG,QIRUPHGHOD&RQIHUHQFLD,QWHUQDFLRQDOVREUH$WHQFLyQ
3ULPDULDGH6DOXG$OPD$WD8566GHVHSWLHPEUHGH*HQHYD:+2
236 /D WUDQVLFLyQ KDFLD XQ QXHYR VLJOR GH VDOXG HQ ODV$PpULFDV ,QIRUPH DQXDO GH OD
'LUHFWRUD:DVKLQJWRQ'&3$+2
2365HYLVLyQGHODVSROtWLFDVGH$WHQFLyQ3ULPDULDGHVDOXGHQ$PpULFD/DWLQD\HO&DULEH
:DVKLQJWRQ'&3$+2
236&RQVHMR'LUHFWLYR6HVLyQGHO&RPLWp5HJLRQDO:DVKLQJWRQ'&(8$
DOGHVHSWLHPEUHGH5HVROXFLyQ&'5$WHQFLyQ3ULPDULDGH6DOXGHQODV$PpULFDV
/DVHQVHxDQ]DVH[WUDtGDVDORODUJRGHDxRV\ORVUHWRVIXWXURV
236&RQVHMR'LUHFWLYR6HVLyQGHO&RPLWp5HJLRQDO:DVKLQJWRQ'&(8$DO
GHVHSWLHPEUHGH'HFODUDFLyQUHJLRQDOVREUHODVQXHYDVRULHQWDFLRQHVGHOD$WHQFLyQ
3ULPDULDGH6DOXGODUHQRYDFLyQGHODDWHQFLyQSULPDULDGHVDOXGHQODVDPpULFDV2ULHQWDFLyQ
HVWUDWpJLFD\SURJUDPiWLFDSDUDOD2UJDQL]DFLyQ3DQDPHULFDQDGHOD6DOXG
3$+2 6SHFLDO 6HVVLRQ RQ WKH WK $QQLYHUVDU\ RI WKH 'HFODUDWLRQ RI $OPD$WD WK
'LUHFWLQJ&RXQFLO3URYLVLRQDU\6XPPDU\3$+2SXEOLFDWLRQ&'65:DVKLQJWRQ'&
81'38QLWHG1DWLRQV3RSXODWLRQDQG'HYHORSPHQWL3URJUDPPHRI$FWLRQ$GRSWHGDW
WKH ,QWHUQDWLRQDO &RQIHUHQFH RQ 3RSXODWLRQ DQG 'HYHORSPHQW &DLUR 6HSWHPEHU
1HZ<RUN8QLWHG1DWLRQV'HSDUWPHQWIRU(FRQRPLFDQG6RFLDO,QIRUPDWLRQDQG3ROLF\$QDO\VLV
67(6$6(5$
818QLWHG1DWLRQV0LOOHQQLXP3URMHFW,QYHVWLQJLQGHYHORSPHQWDSUDFWLFDOSODQWRDFKLHYH
WKH0LOOHQQLXP'HYHORSPHQW*RDOV1HZ<RUN0LOOHQQLXP3URMHFW
:+2 $ *OREDO 5HYLHZ RI 3ULPDU\ +HDOWK &DUH (PHUJLQJ 0HVVDJHV *HQHYD :+2

,, &XLGDGR3UHFRQFHSFLRQDO
& $ 3, 7 8 /2 , ,
2EMHWLYRV,GHQWL¿FDU\DVHVRUDUVREUHULHVJRSUHFRQFHSFLRQDO
$FWLYLGDG&RQVXOWDSUHYLDDOHPEDUD]R

&DGDYH]TXHXQDPXMHUVHHPEDUD]DH[LVWHXQDSUREDELOLGDGYDULDEOHGHTXHHOODR
VX IXWXUR KLMR VXIUDQ XQ IHQyPHQR DGYHUVR GXUDQWH HO SURFHVR UHSURGXFWLYR HVWR VH
FRQRFHFRPR5LHVJR5HSURGXFWLYR+LVWyULFDPHQWHVHKDLQWHQWDGRUHGXFLUHOPLVPR
DWUDYpVGHOFRQWUROSUHQDWDOGHFDOLGDGODDWHQFLyQGHOSDUWRSRUSHUVRQDOFDSDFLWDGR
\ ORV FXLGDGRV GXUDQWH HO SXHUSHULR$ SHVDU TXH D~Q HQ OD 5HJLyQ VH HVWi OHMRV GH
XQLYHUVDOL]DUHVWDVSUHVWDFLRQHVFRQODFDOLGDGVX¿FLHQWHVHGHEHFRPHQ]DUDHPSOHDU
ODDWHQFLyQSUHFRQFHSFLRQDOFRPRPHGLGDH¿FD]GHGLVPLQXLUHOULHVJRUHSURGXFWLYR
(Q $PpULFD /DWLQD HO SRVSDUWR LQPHGLDWR HV XQ PRPHQWR ySWLPR SDUD GHVDUUROODU
DFWLYLGDGHV TXH FRQWULEX\DQ D TXH HO IXWXUR HPEDUD]R VH SURGX]FD HQ PHMRUHV
FRQGLFLRQHV3RGUtDVHUHOPRPHQWRLGHDOSDUDDGTXLULUKiELWRV VDOXGDEOHVRUHDOL]DU
FRQVXOWDVDHVSHFLDOLVWDVTXHDFRUWRSOD]RSRGUtDQUHGXFLUODPRUELPRUWDOLGDGPDWHUQR
QHRQDWDODVtFRPRORVGHIHFWRVFRQJpQLWRVHQIXWXUDVJHVWDFLRQHV
&XLGDGRSUHFRQFHSFLRQDO
(OFXLGDGRSUHFRQFHSFLRQDOHVUHFRQRFLGRFRPRXQFRPSRQHQWHFUtWLFRHQODDWHQFLyQ
VDQLWDULDGHODVPXMHUHVHQHGDGUHSURGXFWLYD(OPLVPRVHGH¿QHFRPRXQFRQMXQWRGH
LQWHUYHQFLRQHVTXHVHUHDOL]DQDQWHVGHOHPEDUD]RTXHWLHQHQFRPRSURSyVLWRLGHQWL¿FDU
\PRGL¿FDUIDFWRUHVGHULHVJRFXDQGRVHDSRVLEOHSDUDUHGXFLUGDxRVRHYLWDUORVHQXQ
SUy[LPRHPEDUD]R
&RQVXOWDSUHFRQFHSFLRQDO
/DFRQVXOWDSUHFRQFHSFLRQDOVHGH¿QHFRPRODHQWUHYLVWDSURJUDPDGDHQWUHXQDPXMHU
RXQDPXMHU\VXSDUHMDFRQHOHTXLSRGHVDOXGSUHYLRDOHPEDUD]RFRQHOREMHWLYR
GHFRUUHJLUHOLPLQDURGLVPLQXLUIDFWRUHVRFRQGXFWDVGHULHVJRUHSURGXFWLYR\RWUDWDU
HQIHUPHGDGHVTXHSXHGDQDOWHUDUODHYROXFLyQQRUPDOGHXQIXWXURHPEDUD]R/DPHWDGHO
DVHVRUDPLHQWRSUHFRQFHSFLRQDOHVTXHODPXMHU\VXSDUHMDUHFLEDQWRGDODLQIRUPDFLyQ
QHFHVDULDSDUDWRPDUGHFLVLRQHVFRQVFLHQWHVVREUHVXIXWXURUHSURGXFWLYR
(/020(172,'($/3$5$(/$6(625$0,(172(635(9,2$/$*(67$&,21
(Q DOJXQDV FRPXQLGDGHV PiV GH OD PLWDG GH ODV JHVWDFLRQHV QR VRQ SURJUDPDGDV \
ODLGHQWL¿FDFLyQGHOHPEDUD]RRFXUUHXQDRGRVVHPDQDVOXHJRGHOUHWUDVRPHQVWUXDO
FXDQGR \D WUDQVFXUULy XQD HWDSD FUtWLFD GHO GHVDUUROOR HPEULRQDULR GH HVWD IRUPD HO
HPEULyQSXHGHKDEHUHVWDGRH[SXHVWRDDJHQWHVQRFLYRV
(QWUHODVPXMHUHVTXHSODQL¿FDQXQDJHVWDFLyQXQDOWRQ~PHURGHHOORVQRSXHGHQDFFHGHU
DXQDRULHQWDFLyQSUHFRQFHSFLRQDODSURSLDGDTXHOHVSHUPLWDDIURQWDUHOHPEDUD]RHQ
PHMRUHVFRQGLFLRQHV$OJXQDVHVSHFt¿FDPHQWHDFXGHQHQE~VTXHGDGHDVHVRUDPLHQWR
SHURJHQHUDOPHQWHpVWHQRHVWiSDXWDGRRHVOLPLWDGR3RUWRGRHOORHVQHFHVDULRDVLVWLU
SUHFRQFHSFLRQDOPHQWHDODVPXMHUHVHQHGDGIpUWLO\DVHVRUDUODVVREUHORVIDFWRUHVTXH
DXPHQWDQVXVSUREDELOLGDGHVGHHQIHUPDURPRULUHOODRVXVKLMRV6HSURSRQHHQWRQFHV
DSOLFDUHQODFRQVXOWDSUHFRQFHSFLRQDOHOFOiVLFRHQIRTXHGHQLYHOHVGHSUHYHQFLyQGH
/HYHO\&ODUNSUHYHQFLyQSULPDULDVHFXQGDULD\WHUFLDULD
(VFRQYHQLHQWHDFODUDUTXHHOHQIRTXHVHJ~QQLYHOHVGHSUHYHQFLyQVHHVWDUiDSOLFDQGR
DOPLVPRWLHPSRDGRVLQGLYLGXRVODPXMHUTXHTXLHUHVHUPDGUHSRUXQODGR\HOQLxRTXH
VHJHVWDUiSRURWUR(QHVWHFDVRUHFRPHQGDFLRQHVRDFFLRQHVGHXQQLYHOGHSUHYHQFLyQ
VHFXQGDULD SDUD OD PXMHU SRGUiQ UHSUHVHQWDU XQ QLYHO GH SUHYHQFLyQ SULPDULD SDUD HO
QLxRSRUHMHPSORHIHFWXDUXQWUDWDPLHQWRFRUUHFWRSDUDODGLDEHWHVHQXQDPXMHUSXHGH
SUHYHQLUODDSDULFLyQGHFRPSOLFDFLRQHVPiVVHYHUDVGHULYDGDVGHOPDOFRQWUROPHWDEyOLFR
RGHOGDxRYDVFXODUSURGXFLGRSRUGLFKDHQIHUPHGDGSUHYHQFLyQVHFXQGDULDDOPLVPR
WLHPSRTXHHOXVRDGHFXDGRGHODLQVXOLQDSDUDPDQWHQHUODHXJOLFHPLDSURWHJHUtDGH
VXIULUGHIHFWRVFRQJpQLWRVDOHPEULyQDJHVWDUVHSUHYHQFLyQSULPDULD
5('8&&,Ï1'(/$025%,0257$/,'$'0$7(51$<)(721(21$7$/
/D FRQVXOWD SUHFRQFHSFLRQDO SURFXUD ORJUDU HO ELHQHVWDU PDWHUQR \ HO QDFLPLHQWR GH
XQQLxRVDQR(OHVWDGRGHVDOXGHVXQFRQFHSWRVXPDPHQWHDPSOLRFRQGH¿QLFLRQHV
TXH KDQ LGR HYROXFLRQDQGR GHVGH HO FRQFHSWR GH DXVHQFLD GH HQIHUPHGDG KDVWD ORV
HQIRTXHV DFWXDOHV PiV LQWHJUDGRUHV D OD YH] TXH FRPSOHMRV (VWH FDStWXOR LQFOX\H
UHFRPHQGDFLRQHVWHQGLHQWHVDHYLWDUODSpUGLGDGHOHVWDGRGHVDOXGGHODPXMHUGHORV
IHWRV\UHFLpQQDFLGRVFRQVLGHUDQGRGHVGHHYLWDUVXPXHUWHXRWURVGDxRV
'()(&726&21*e1,726
'H¿QLFLyQ
(Q OD GpFDGD GH ORV RFKHQWD FRQ OD ¿QDOLGDG GH XQL¿FDU FULWHULRV OD 2UJDQL]DFLyQ
3DQDPHULFDQDGHOD6DOXGSURSXVRGH¿QLUGHIHFWRFRQJpQLWRFRPRDTXHOTXHLQFOX\H
ODV DQRPDOtDV IXQFLRQDOHV \R HVWUXFWXUDOHV GHO IHWR GHELGDV D IDFWRUHV SUHVHQWHV
DQWHV GHO QDFLPLHQWR LQFOX\HQGR GHIHFWRV JHQpWLFRV DPELHQWDOHV R GHVFRQRFLGRV
DXQTXHWDOGHIHFWRQRVHDDSDUHQWHHQHOUHFLpQQDFLGR\VRODPHQWHVHPDQL¿HVWHPiV
WDUGtDPHQWH3RUORTXHODFHJXHUDODVRUGHUDHOUHWDUGRPHQWDO\RWURVWUDVWRUQRVGHO
QHXURGHVDUUROORHVWiQLQFOXLGRVHQHVWHFRQFHSWR
)UHFXHQFLD
/DIUHFXHQFLDGHPDOIRUPDFLRQHVFOtQLFDPHQWHLPSRUWDQWHVHQORVUHFLpQQDFLGRVHVWi
HQWRUQRGHO6LQHPEDUJRORVGHIHFWRVFRQJpQLWRVHQJHQHUDOVRQPiVIUHFXHQWHV
DIHFWDQGRHQWUHHO\HOGHOWRWDOGHORVQDFLPLHQWRV
(WLRORJtD
$~QKR\HQPiVGHOGHORVFDVRVODFDXVDGHORVGHIHFWRVFRQJpQLWRVSHUPDQHFH
GHVFRQRFLGD 'H ODV FDXVDV FRQRFLGDV OD FRPELQDFLyQ GH IDFWRUHV DPELHQWDOHV \
JHQpWLFRV KHUHQFLD PXOWLIDFWRULDO H[SOLFD DSUR[LPDGDPHQWH HO GH ORV GHIHFWRV
PRUIROyJLFRV 2WUDV FDXVDV LQFOX\HQ HQIHUPHGDG PDWHUQD \ PHGLFDFLyQ
PDWHUQD
+,6725,$&/,1,&$
7RGDFRQVXOWDPHGLFDGHEHFRPHQ]DUFRQXQDFRUUHFWDKLVWRULDFOtQLFD\HODQiOLVLVGH
DTXHOORVGDWRVHSLGHPLROyJLFDPHQWHUHOHYDQWHV
'DWRVSDWURQtPLFRV
(GDG
/DHGDGGHODPXMHU\HVSHFLDOPHQWHODVHGDGHVHQORVH[WUHPRVGHODYLGDUHSURGXFWLYD
VRQXQIDFWRUTXHVHKDDVRFLDGRGHVGHKDFHPXFKRWLHPSRFRQUHVXOWDGRVDGYHUVRV
PDWHUQRQHRQDWDOHV
(GDG0DWHUQD$YDQ]DGD
6HODKDDVRFLDGRFRQPD\RUULHVJRGHVXIULUKLSHUWHQVLyQ\GLDEHWHVTXHDVXYH]
FRQGLFLRQDQ PD\RUHV FKDQFHV GH VXIULPLHQWR IHWDO DJXGR \R FUyQLFR 2WUR ULHVJR
GHODHGDGPDWHUQDDYDQ]DGDVHYLQFXODDODVDQRPDOtDVGHOGHVDUUROORHOSULPHU
HMHPSORGHVFULWRIXHHO6tQGURPHGH'RZQ(QQXHVWUDUHJLyQODHGDGGHODPDGUH
HVHOSULQFLSDOIDFWRUGHULHVJRHQUHODFLyQFRQGLFKRVtQGURPH(Q/DWLQRDPpULFDODV
PXMHUHVGHDxRVRPiVSURGXFHQHOGHWRGRVORVQDFLPLHQWRV\HOGHORV
FDVRVFRQ6tQGURPHGH'RZQ6LQSDVDUSRUDOWRORV'HUHFKRV5HSURGXFWLYRVVH
SXHGHDVHJXUDUTXHFXDOTXLHUFDPSDxDTXHGHVHVWLPXOHODFRQFHSFLyQHQPXMHUHV
PD\RUHVGHDxRVORFXDOQRWHQGUtDLPSDFWRHQODQDWDOLGDGSRGUtDSUHYHQLUOD
PLWDGGHORVFDVRVGHXQDHQIHUPHGDGJHQpWLFDJUDYHHLQFXUDEOH
(QODWDEODVHSUHVHQWDHOLQFUHPHQWRHQHOULHVJRGHVtQGURPHGH'RZQDPHGLGD
TXHODHGDGDYDQ]D
(GDGPDWHUQDEDMD
0HQRU D DxRV WDPELpQ HV IDFWRU GH ULHVJR SDUD SUHPDWXUH] \ SDUD DOJXQDV
PDOIRUPDFLRQHVHVSHFt¿FDVFRPR*DVWURVTXLVLV\RWURVGHIHFWRV/DVPXMHUHVHQOD
DGROHVFHQFLDWHPSUDQDPHQRUHVGHDxRVWLHQHQPD\RUULHVJRGHPRUELPRUWDOLGDG
YLQFXODGDDOHPEDUD]R\VREUHWRGRDOSDUWR
(GDGSDWHUQDDYDQ]DGD
'HVGHHOSXQWRGHYLVWDSUHFRQFHSFLRQDO\HQYLVWDVDUHGXFLUHOULHVJRGHDOJXQRV
GHIHFWRVFRQJpQLWRVHVUHFRPHQGDEOHFRQRFHUODHGDGGHOFRPSDxHURVH[XDO\D
TXHFXDQGRHOFRPSDxHURVH[XDOHVPD\RUDDxRVVHKDYLVWRVXDVRFLDFLyQFRQ
XQDXPHQWRHQHOULHVJRSDUDQXHYDVPXWDFLRQHVGHWLSRGRPLQDQWH
&XDGUR
5LHVJRGHVtQGURPHGH'RZQHQUHFLpQQDFLGRVYLYRVGHDFXHUGRDODHGDGPDWHUQD
(GDGHQDxRV 5LHVJR (GDGHQDxRV 5LHVJR

y

&RQVDQJXLQLGDG
$VtFRPRHVLPSRUWDQWHFRQRFHUODHGDGGHOSDGUHSDUDHVWLPDUHOULHVJRGHGHIHFWRV
FRQJpQLWRVHVQHFHVDULRGH¿QLUHOJUDGRGHSDUHQWHVFRFRQODSDUHMD/RVLQGLYLGXRV
VRQFRQVDQJXtQHRVVLSRUORPHQRVWLHQHQXQDQWHFHVRUFRP~Q(VWHGDWRVHKDFHPiV
LPSRUWDQWHD~QHQWUHSREODFLRQHVDLVODGDV\DTXHHQJUXSRVFHUUDGRVODVSUREDELOLGDGHV
GHFRQVDQJXLQLGDGVRQPD\RUHV
(WQLD
'HPDQHUDVLPLODUTXHFRQODHGDG\ODFRQVDQJXLQLGDGVHKDYLVWRTXHODLQFLGHQFLD
GHDOJXQDVPDOIRUPDFLRQHVFRQJpQLWDVHVWiDXPHQWDGDHQJUXSRVpWQLFRVHVSHFt¿FRV
6RQHMHPSORVFOiVLFRVODPD\RUIUHFXHQFLDGHSROLGDFWLOLDSDODGDUKHQGLGRKLSRVSDGLDV
DOWHUDFLRQHV GH ODV JORELQDV FRPR OD$QHPLD )DOFLIRUPH HQ QLxRV DIURDPHULFDQRV
ODVFDUGLRSDWtDVHQQLxRVEODQFRVROD%HWD7DODVHPLDPiVIUHFXHQWHHQSHUVRQDVGH
RULJHQPHGLWHUUiQHR
2FXSDFLyQ
&LHUWDV FRQGLFLRQHV GH WUDEDMR KDQ VLGR DVRFLDGDV FRQ XQ DXPHQWR HQ UHVXOWDGRV
SHULQDWDOHVDGYHUVRVDERUWRPXHUWHIHWDOSDUWRGHSUHWpUPLQREDMRSHVRDOQDFHU\
DOJXQRVGHIHFWRVFRQJpQLWRV(QWUHGLFKDVFRQGLFLRQHVVHSXHGHQFLWDU
7UDEDMDUPiVGHKRUDVSRUGtD
3HUPDQHFHUGHSLHSRUPiVGHKRUDVHQIRUPDFRQWLQXD
([SRVLFLyQ D Wy[LFRV TXtPLFRV LQFOX\HQGR DJHQWHV DQHVWpVLFRV VROYHQWHV
\ SHVWLFLGDV /DV PXMHUHV TXH SXHGDQ WHQHU XQD H[SRVLFLyQ ODERUDO D HVWDV
VXVWDQFLDV GHEHUiQ VHU DFRQVHMDGDV SDUD FDPELDU VXV ODERUHV DQWHV GH
HPEDUD]DUVH R DSHQDV OR VHSDQ +DVWD HO PRPHQWR QR H[LVWH HYLGHQFLD GH
ULHVJRWHUDWRJpQLFRSRUH[SRVLFLyQSDWHUQDDHVWRVPLVPRVDJHQWHV
$QWHFHGHQWHV5HSURGXFWLYRV
6L VH SUHWHQGH UHGXFLU HO ULHVJR UHSURGXFWLYR OD UHDOL]DFLyQ GH XQD FRUUHFWD KLVWRULD
UHSURGXFWLYDSXHGHLGHQWL¿FDUIDFWRUHVUHODFLRQDGRVDPDORVUHVXOWDGRVHQHPEDUD]RV
DQWHULRUHV$YHFHVHVWRVIDFWRUHVSXHGHQVHUFRUUHJLGRVRLQFOXVRHOLPLQDGRVORTXH
GHEHUtDUHGXQGDUHQXQQXHYRHPEDUD]RPiVVHJXUR$OGtDGHKR\ODHYLGHQFLDSHUPLWH
D¿UPDUTXHHVSDFLDUORVHPEDUD]RVFHVDUHOKiELWRGHIXPDUHOXVDUSURJHVWHURQDV
HQ FDVR GH SDUWRV GH SUHWpUPLQR SUHYLRV X RWURV PHGLFDPHQWRV SDUD HQIHUPHGDGHV
HVSHFt¿FDVDVtFRPRDOJXQRVWUDWDPLHQWRVTXLU~UJLFRVUHGXFHQHOULHVJRGHUHVXOWDGRV
DGYHUVRVPDWHUQRQHRQDWDOHV
6HKDGHPRVWUDGRTXHDOJXQRVIDFWRUHVFRPRHOHVFDVRLQWHUYDORLQWHUJHQpVLFRDERUWRV
HVSRQWiQHRV SDUWRV GH SUHWpUPLQR UHVWULFFLyQ GH FUHFLPLHQWR LQWUDXWHULQR PXHUWH
IHWDORQHRQDWDOSDUWRTXLU~UJLFRODGLDEHWHVJHVWDFLRQDOODKLSHUWHQVLyQLQGXFLGDSRU
HPEDUD]R\ODVPDOIRUPDFLRQHVXWHULQDVLQWHJUDQXQDODUJDOLVWDTXHSXHGHUHODFLRQDUVH
FRQODSUHVHQWDFLyQGHFRPSOLFDFLRQHVHQXQQXHYRHPEDUD]R
(VFDVRLQWHUYDORLQWHUJHQpVLFR
&DGDPXMHUWLHQHGHUHFKRDGHFLGLUHOPRPHQWRTXHFRQVLGHUDRSRUWXQRSDUDWHQHUVX
SUy[LPR KLMR SUHFLVDPHQWH OD ³RSRUWXQLGDG´ GHEH HVWDU GH¿QLGD HQWUH RWURV IDFWRUHV
SRU HO FRQRFLPLHQWR UHDO GHO ULHVJR TXH LPSOLFD XQD QXHYD JUDYLGH] FRQ XQ SHUtRGR
LQWHUJHQpVLFRFRUWRRGHPDVLDGRODUJR
/RVHVWXGLRVGLVSRQLEOHVSDUDHVWDEOHFHUHOLQWHUYDORLQWHUJHQpVLFRLGHDOOXHJRGHXQ
KLMRQDFLGRYLYRQRVRQVX¿FLHQWHVSRUHOPRPHQWRGHWDOIRUPDH[LVWHQHYLGHQFLDVTXH
VXJLHUHQTXHXQLQWHUYDORPHQRUDPHVHVFRPSRUWDPD\RUULHVJRGHPRUELPRUWDOLGDG
PDWHUQRSHULQDWDO PLHQWUDV TXH RWURV DXWRUHV VRVWLHQHQ TXH HO ULHVJR KDVWD ORV
PHVHV(QEDVHDHVWDVGLVFUHSDQFLDVXQJUXSRGHH[SHUWRVFRQYRFDGRVSRUOD206
HVWDEOHFLy HQ IRUPD DUELWUDULD UHFRPHQGDU FRPR VHJXUR XQ LQWHUYDOR PtQLPR GH
PHVHV
0LHQWUDVWDQWRHQORVFDVRVGHHPEDUD]RVTXHWHUPLQDURQHQDERUWRVHUHFRPLHQGD
FRPR VHJXUR XQ LQWHUYDOR PD\RU D PHVHV /D LQYHVWLJDFLyQ TXH KD SURYLVWR HVWD
HYLGHQFLDHVHQEDVHDGDWRVODWLQRDPHULFDQRVH[WUDtGRVGHOEDQFRGHGDWRVGHO6,3
GHO&/$3:5
3DULGDG
/D SDULGDG KD VLGR GHVFULWD FRPR XQR GH ORV IDFWRUHV GH ULHVJR SDUD OD PRUWDOLGDG
SHULQDWDO\PRUELPRUWDOLGDGPDWHUQD/DSDULGDGHOHYDGDFXDWURRPiVHPEDUD]RV
DXPHQWDDOGREOHHOULHVJRGHPXHUWHIHWDOLQWUDSDUWR<DTXHHVWHHVXQIDFWRUGHULHVJR
QRPRGL¿FDEOHVHGHEHUiDGYHUWLUDODVPXMHUHVVREUHHVWHSDUDD\XGDUDGHFLGLUVLHV
FRQYHQLHQWH R QR XQD QXHYD JHVWDFLyQ (Q FDVR TXH RSWHQ SRU XQ QXHYR HPEDUD]R
VH GHEHUi H[WUHPDU HO FXLGDGR GXUDQWH HO SUHQDWDO \ HVSHFLDOPHQWH HQ HO SDUWR \
SRVWSDUWR
$ERUWRSUHYLR
<DVHPHQFLRQyODLPSRUWDQFLDGHDFRQVHMDUDODPXMHUTXHGHVHDXQQXHYRHPEDUD]R
HQDVHJXUDUXQSHUtRGRLQWHUJHQpVLFRPD\RUDPHVHVOXHJRGHXQDERUWRSDUDUHGXFLU
ORV ULHVJRV GH HQIHUPHGDG R PXHUWH PDWHUQRQHRQDWDO 3HUR WDPELpQ HV UHOHYDQWH
FRQRFHUHORORVDQWHFHGHQWHVGHDERUWRVSUHYLRV/DSpUGLGDUHFXUUHQWHGHOHPEDUD]R
GH¿QLGD FRPR OD DSDULFLyQ GH DERUWRV HVSRQWiQHRV FRQVHFXWLYRV GHEHUi RULHQWDU
DO SURIHVLRQDO HQ XQD E~VTXHGD DFWLYD GH PDOIRUPDFLRQHV XWHULQDV LQFRPSHWHQFLD
FHUYLFDO GHIHFWRV KRUPRQDOHV R LQFOXVR HQIHUPHGDGHV LQIHFFLRVDV FRPR OD Vt¿OLV \D
TXHHVWD,76HVWiHQDXPHQWR\VHFDUDFWHUL]DSRUJHQHUDUXQDSODFHQWLWLVFDSD]GH
PDWDUHPEULRQHV\IHWRV<DORVDQWLJXRVREVWHWUDVGH¿QtDQDODVt¿OLVFRPR³ODHVFDOHUD
DVFHQGHQWHDODYLGD´HQWHQGLHQGRTXHHQORVSULPHURVDxRVGHLQIHFFLyQVHSURGXFtDQ
PXHUWHVIHWDOHVFDGDYH]PiVWHPSUDQDV\TXHFRQHOSDVRGHORVDxRVODHQIHUPHGDG
VHKDFtDPHQRVDJUHVLYDSDUDHOIHWRGHMiQGRORVQDFHUDHGDGHVFDGDYH]PD\RUHV
0XHUWHIHWDOSUHYLD
(QODFRQVXOWDSUHFRQFHSFLRQDOVHLQWHQWDUiHYDOXDUHOULHVJRGHUHSHWLFLyQGHODPXHUWH
IHWDOHQXQIXWXURHPEDUD]RSDUDDVHVRUDUDODPXMHUHQODVSRVLELOLGDGHVGHUHSHWLUHO
IHQyPHQR\SDUDSODQL¿FDUHOFXLGDGRTXHGHEHUiUHFLELUHQHOIXWXURHPEDUD]R+DFHU
HVWDHYDOXDFLyQSRUODKLVWRULDFOtQLFDQRVLHPSUHHVIiFLOLQFOXVRFXDQGRVHGLVSRQHGHO
LQIRUPHGHQHFURSVLDGHOIHWR\ODKLVWRSDWRORJtDGHODSODFHQWDXRWURVyUJDQRV+DEUi
RFDVLRQHV HQ ODV TXH VH GHEHUi UHFXUULU D H[iPHQHV GH ODERUDWRULR FRPR SUXHEDV
GH WROHUDQFLD D OD JOXFRVD DQWLFXHUSRV DQWLFDUGLROLSLQDV \ HVWXGLRV HVSHFt¿FRV GH OD
FRDJXODFLyQ
'XUDQWHXQIXWXURHPEDUD]RSRGUiQUHSHWLUVHHVWRVH[iPHQHVLQWHQVL¿FDUHOFRQWURO
SUHQDWDOLQFRUSRUDUHVWXGLRVXOWUDVRQRJUi¿FRVPRUIROyJLFRV\IXQFLRQDOHVHWF
3DUWRGHSUHWpUPLQR
(OQDFLPLHQWRGHSUHWpUPLQRHVXQDGHODVSULQFLSDOHVFDXVDVGHPXHUWHQHRQDWDO/DV
PXMHUHVTXHKDQWHQLGRXQQDFLPLHQWRGHSUHWpUPLQRDQWHVGHODVVHPDQDVWLHQHQ
XQULHVJRGHDGHUHSHWLURWURQDFLPLHQWRGHSUHWpUPLQR(VHULHVJRSXHGH
OOHJDU DXPHQWD D XQ GHVSXpV GH \ D XQ GHVSXpV GH QDFLPLHQWRV GH
SUHWpUPLQR
$GHPiV GHO DQWHFHGHQWH GH SDUWR GH SUHWpUPLQR VH KD YLVWR TXH RWURV IDFWRUHV VH
DVRFLDQFRQHOULHVJRGHSUHVHQWDUXQSDUWRGHSUHWpUPLQRHQWUHHOORVVHFLWDQ
SHVRGHODPXMHUDOLQLFLRGHOHPEDUD]RPHQRUDNLORVRtQGLFHGHPDVDFRUSRUDO
PHQRUNJP
WDEDTXLVPR
LQWHUYDORLQWHUJHQpVLFRPHQRUDPHVHV
FXHOORFHUYLFDODFRUWDGRHFRJUi¿FDPHQWH
/D LPSRUWDQFLD GH HVWRV IDFWRUHV SHUPLWLUi DSOLFDU PHGLGDV FRUUHFWLYDV SUHYLDV D XQ
QXHYRHPEDUD]R
5HVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR5&,
([LVWHQIDFWRUHVGHULHVJRTXHVHYLQFXODQFRQODSRVLELOLGDGGHXQ5&,HQXQDIXWXUD
JHVWDFLyQGLFKRVIDFWRUHVVRQHOEDMRSHVRSUHFRQFHSFLRQDOGHODPXMHUPXMHUHVPHQRUHV
GHDxRVRPD\RUHVDDxRVXQFRUWRLQWHUYDORLQWHUJHQpVLFRWDEDTXLVPR\DEXVR
GHVXVWDQFLDVDVtFRPRRWUDVHQIHUPHGDGHVWDOHVFRPRDIHFFLRQHVFDUGLRYDVFXODUHV
KLSHUWHQVLyQLQVX¿FLHQFLDUHQDOLQPXQRSDWtDVDQHPLDHWF
&HViUHDSUHYLD
/DFHViUHDFRPRIRUPDGHWHUPLQDFLyQGHOHPEDUD]RHVFDGDYH]PiVFRP~QHQQXHVWUD
UHJLyQ\HQHOPXQGR'HELGRDODPHMRUDGHODVWpFQLFDVTXLU~UJLFDV\DQHVWpVLFDVORV
PDORV UHVXOWDGRV YLQFXODGRV D HOOD KDQ GLVPLQXLGR 3HUR D~Q DVt OD FHViUHD VLJXH
VLHQGRPiVULHVJRVDTXHXQSDUWRQRUPDO\ODVFHViUHDVLWHUDWLYDVUHSUHVHQWDQPD\RU
ULHVJR GH URWXUD XWHULQD H LQVHUFLRQHV SODFHQWDULDV DQRUPDOHV OR TXH SXHGH OOHYDU D
KHPRUUDJLDVJUDYHVD~QHQPXMHUHVHQODVTXHVHSODQHDXQDFHViUHDHOHFWLYD
(Q XQD PXMHU TXH VH TXLHUH HPEDUD]DU HV QHFHVDULR FRQRFHU DOJXQRV DVSHFWRV GH
OD KLVWRULD GH OD R ODV FHViUHDV SUHYLDV SDUD RULHQWDU DFHUFD GH ULHVJRV HQ IXWXUDV
JHVWDFLRQHVWDOHVDVSHFWRVVRQ
WLSRGHLQFLVLyQODVLQFLVLRQHVHQ7FRPSRUWDQPD\RUULHVJRGHURWXUDXWHULQDVREUH
ODVORQJLWXGLQDOHV\pVWDVPD\RUULHVJRTXHODVWUDQVYHUVDOHVVHJPHQWDULDV
DQWHFHGHQWH GH LQIHFFLyQ GH OD KHULGD TXLU~UJLFD HQ HVSHFLDO GH LQIHFFLRQHV
SDULHWDOHVSURIXQGDVTXHSRGUtDQSURYRFDUXQDFLFDWUL]DFLyQDQRUPDOTXHFRQOOHYH
DPD\RUULHVJRGHURWXUDXWHULQDRKHPRUUDJLDVSRUSODFHQWDFLyQDQRUPDO
WLHPSRWUDQVFXUULGRSHUtRGRVLQWHUSDUWRPHQRUHVDPHVHVWLHQHQPD\RUULHVJR
PDWHUQR
FDQWLGDGGHFHViUHDVSUHYLDVHOULHVJRGHURWXUDXWHULQDSDUHFHHVWDUPiVLQÀXLGR
SRUHOWLSRGHLQFLVLyQTXHSRUHOQ~PHURGHFHViUHDV
(Q EDVH D WRGRV HVWRV DVSHFWRV XQD PXMHU TXH DFXGH D FRQVXOWD SUHFRQFHSFLRQDO
GHEHUi VHU LQIRUPDGD VREUH HO PD\RU ULHVJR GH URWXUD XWHULQD KHPRUUDJLDV SRU
SODFHQWDFLyQ DQRUPDO \ DGYHUWLUODV GHO ULHVJR HQ HO XVR GH R[LWyFLFRV SDUD LQGXFLU HO
SDUWRHVSHFLDOPHQWHHQHOXVRGH0LVRSURVWRO
0DOIRUPDFLRQHVXWHULQDV
3XHGHQHQFRQWUDUVHHQPXMHUHVFRQXQDKLVWRULDUHSURGXFWLYDQRUPDOSHURVRQPXFKR
PiVIUHFXHQWHVHQDTXHOODVFRQSREUHVUHVXOWDGRVREVWpWULFRVHQHVSHFLDOODVTXHKDQ
VXIULGRSpUGLGDVUHFXUUHQWHVHQWUHHOSULPHU\VHJXQGRWULPHVWUHGHOHPEDUD]R
6HHVWLPDTXHKDVWDGHFDGDPXMHUHVFRQSpUGLGDUHFXUUHQWHGHOHPEDUD]RSXHGH
SUHVHQWDUXQDDQRPDOtDXWHULQD/DVDQRPDOtDVPiVIUHFXHQWHVVRQODKLSRSODVLDXWHULQD
\ORVWDELTXHVLQWUDXWHULQRV
/DKLVWRULDFOtQLFDGHSpUGLGDVUHFXUUHQWHVFDUDFWHUL]DGDSRUHOLQLFLRGHFRQWUDFFLRQHV
SUHPDWXUDVHVSRQWiQHDVDGLIHUHQFLDGHODVLQFRPSHWHQFLDVFpUYLFRtVWPLFDVGRQGHHO
SDUWRRDERUWRVXHOHLQLFLDUVH\KDVWDSURGXFLUVHVLQFRQWUDFFLRQHVSHUPLWHVRVSHFKDU
XQD DQRUPDOLGDG XWHULQD (VWXGLRV LPDJHQROyJLFRV FRPR OD XOWUDVRQRJUDItD OD
KLVWHURVDOSLQJRJUDItDODWRPRJUDItDD[LDOFRPSXWDUL]DGD\KDVWDODUHVRQDQFLDQXFOHDU
PDJQpWLFDSHUPLWHQDSUR[LPDUVHDOGLDJQyVWLFR
8QD YH] HVWDEOHFLGR HO GLDJQyVWLFR OD GHFLVLyQ GH HIHFWXDU WUDWDPLHQWRV TXLU~UJLFRV
GHEHUiVHUHYDOXDGDFRQODPXMHUVXSDUHMDVLODKD\\FRQHOHVSHFLDOLVWD
$QWHFHGHQWHVJHQHUDOHV
3DUDIDFLOLWDUHODQiOLVLVGHORVDQWHFHGHQWHVORVGLYLGLUHPRVHQ
(QIHUPHGDGHVPpGLFDVQRWUDQVPLVLEOHV\
(QIHUPHGDGHVPpGLFDVWUDQVPLVLEOHV
(QIHUPHGDGHVPpGLFDVQRWUDQVPLVLEOHV
$IHFWDQ D XQD GH FDGD PXMHUHV HPEDUD]DGDV OR TXH FRUUHVSRQGH DO GH OD
SREODFLyQIHPHQLQDHQHGDGUHSURGXFWLYD6HSUHVHQWDQSUHYLRVDODJHVWDFLyQ\SXHGHQ
DJUDYDUVHGXUDQWHHOHPEDUD]RSXGLHQGROOHYDUDODPXHUWHPDWHUQD7DPELpQSXHGHQ
DIHFWDUDOIHWRSRUDOWHUDFLRQHVGHOD¿VLRORJtDPDWHUQD\RSRUODPHGLFDFLyQTXHHOOD
UHFLEH$FRQWLQXDFLyQVHGHVFULELUiQODVPiVUHOHYDQWHVWDQWRSRUVXIUHFXHQFLDFRPR
SRUVXUHSHUFXVLyQ
'LDEHWHV
(VODHQIHUPHGDGQRWUDQVPLVLEOHPiVHVWXGLDGDHQFXDQWRDVXVHIHFWRVVREUHOD
JHVWDFLyQSRUODVDOWDVWDVDVGHSUHYDOHQFLDHQPXMHUHVHQHGDGIpUWLO(OREMHWLYR
WHUDSpXWLFR SULPDULR HV ORJUDU TXH OD PXMHU TXH VH HPEDUD]D OR KDJD FRQ QLYHOHV
QRUPDOHVGHJOXFRVD\DVtORVPDQWHQJDGXUDQWHWRGRHOSHUtRGRSHULFRQFHSFLRQDOGH
ORFRQWUDULRDXPHQWDHOULHVJRGHPXHUWHPDWHUQD\IHWDOSUHPDWXULGDGPDFURVRPtD
\PDOIRUPDFLRQHVIHWDOHV
/DPDGUHVFRQGLDEHWHVWLSR,WLHQHQDYHFHVPiVULHVJRGHGDxRIHWRQHRQDWDO
TXHODSREODFLyQJHQHUDOODVPDGUHVFRQGLDEHWHVPHOOLWXVWLSRWLHQHQXQULHVJR
YHFHVPD\RU\ODVPDGUHVFRQGLDEHWHVJHVWDFLRQDOWLHQHQHOGREOHGHULHVJRTXHOD
SREODFLyQJHQHUDO
/DVPXMHUHVFRQGLDEHWHVHVSHFLDOPHQWHODVGH7LSR,WLHQHQXQDPD\RUODELOLGDG
\HVWiQH[SXHVWDVDFRPSOLFDFLRQHVJUDYHVFRPRHOFRPDFHWRDFLGyWLFRRDOFRPD
KLSRJOXFpPLFR
/RVPHMRUHVUHVXOWDGRVREVWpWULFRVVHYHQFXDQGRHODVHVRUDPLHQWRGHODVPXMHUHV
GLDEpWLFDV FRPLHQ]D HQWUH \ VHPDQDV SUHYLR D OD FRQFHSFLyQ \ VH ORJUDQ
HVWDEOHFHUORVQLYHOHVySWLPRVGHJOXFHPLD
(OWDPL]DMHSUHFRQFHSFLRQDOGHUXWLQDSDUDGLDEHWHVSRGUtDDFRQVHMDUVHHQPXMHUHV
FRQ DQWHFHGHQWHV GH GLDEHWHV JHVWDFLRQDO HQ XQ HPEDUD]R DQWHULRU VREUH SHVR
,0&NJPXREHVDV,0&NJP\DTXHOODVTXHWLHQHQRPiVIDFWRUHV
GHULHVJR
/RJUDGRHOHPEDUD]RODJHVWDQWHGLDEpWLFDUHTXHULUiFXLGDGRSRUSDUWHGHXQHTXLSR
HVSHFLDOL]DGR
(QIHUPHGDGHVWLURLGHDV
/D LQFLGHQFLD GH PRUELOLGDG PDWHUQRQHRQDWDO HQ PXMHUHV FRQ KLSHUWLURLGLVPR
QR FRQWURODGR HV FRQVLGHUDEOH DXQTXH VX IUHFXHQFLD HV EDMD XQD FDGD
HPEDUD]DGDV(QWUHORVGLIHUHQWHVWLSRVGHPRUELOLGDGVHSXHGHQYHUSUHFODPSVLD
LQVX¿FLHQFLD FDUGtDFD FRQJHVWLYD FULVLV WLURLGHDV GHVSUHQGLPLHQWR GH SODFHQWD
yELWRIHWDO5&,%31\SDUWRGHSUHWpUPLQR
(QHORWURH[WUHPRHOKLSRWLURLGLVPRWDPELpQVHDFRPSDxDGHPRUELOLGDGFDUDFWHUL]DGD
SRUGp¿FLWLQWHOHFWXDOSUHFODPSVLD\WDPELpQSRUGHVSUHQGLPLHQWRGHSODFHQWDyELWR
IHWDO5&,%31\SDUWRGHSUHWpUPLQR
([LVWH FODUD HYLGHQFLD TXH FRQ¿UPD EXHQRV UHVXOWDGRV HQ ODV PXMHUHV TXH
FRPHQ]DURQHOWUDWDPLHQWRGHVXGLVIXQFLyQWLURLGHDSUHYLRDOHPEDUD]R
(OWUDWDPLHQWRGHORVWUDVWRUQRVWLURLGHRVGHEHUiVHUKHFKRHQFRQMXQWRSRUHOPpGLFR
WUDWDQWH\HOHQGRFULQyORJRHQDPERVFDVRVKLSHUHKLSRWLURLGLVPRHOREMHWLYRVHUi

ORJUDU HO HXWLURLGLVPR DQWHV GHO HPEDUD]R 3DUD HO KLSHUWLURLGLVPR HO DQWLWLURLGHR
GHHOHFFLyQHVHOSURSLOWLRXUDFLOR3XGLHQGRVHUQHFHVDULRHOWUDWDPLHQWRUDGLDQWHR
LQFOXVRHOTXLU~UJLFR
3DUD ORV FDVRV GH KLSRWLURLGLVPR HO WUDWDPLHQWR HV FRQ KRUPRQDV WLURLGHDV
GHELpQGRVHOH DGYHUWLU D OD PXMHU TXH FXDQGR VH HPEDUDFH QR VXVSHQGD OD
KRUPRQD
&DUGLRSDWtDV
6HHVWLPDTXHHQWUHXQ\XQGHORVHPEDUD]RVVHDVRFLDQFRQFDUGLRSDWtDV
\ TXH ODV PLVPDV VHUtDQ XQD GH ODV SULQFLSDOHV FDXVDV GH PRUWDOLGDG PDWHUQD
LQGLUHFWD
0iVDOOiGHFXDOVHDODYDULHGDGGHFDUGLRSDWtDHVSULPRUGLDOHVWDEOHFHUDQWHVGHO
HPEDUD]R HO HVWDGR IXQFLRQDO GH OD PXMHU HQ FRQGLFLRQHV EDVDOHV SRU TXH HVWi
DPSOLDPHQWH GHPRVWUDGR TXH ORV FDPELRV KHPRGLQiPLFRV TXH VH SURGXFHQ
VREUHHOVLVWHPDFDUGLRYDVFXODUGHWHFWDEOHVGHVGHODVVHPDQDVGHHPEDUD]R
H[SRQHQDXQULHVJRYLWDOHOHYDGRDODPXMHUFRQFDUGLRSDWtD3RUHOORHVPDQGDWRULR
HIHFWXDUXQDFRQVXOWDFRQFDUGLyORJR\UHDOL]DUHVWXGLRVIXQFLRQDOHVFDUGtDFRVTXH
SHUPLWDQDVHVRUDUDODPXMHUVREUHHOPRPHQWRRSRUWXQRSDUDXQHPEDUD]RVHJXUR
RVREUHODFRQYHQLHQFLDGHHYLWDUHOHPEDUD]RGHDFXHUGRDOFRPSURPLVRIXQFLRQDO
FDUGLRYDVFXODUHVWDEOHFLGR
/DFDSDFLGDGIXQFLRQDOFDUGtDFDVHFODVL¿FDVHJ~QOD³1HZ<RUN+HDUW$VVRFLDWLRQ´HQ
FODVHVVLHQGRGHVDFRQVHMDEOHVORVHPEDUD]RVHQODVFODVHV,,,\,9$FRQWLQXDFLyQ
VHSUHVHQWDXQDDGDSWDFLyQGHGLFKDFODVL¿FDFLyQ
&ODVH,3DFLHQWHVDVLQWRPiWLFDVFRQODDFWLYLGDGItVLFDKDELWXDO6RORSUHVHQWDQ
VtQWRPDVFRQHOHMHUFLFLRPX\VHYHUR
&ODVH,,$VLQWRPiWLFDVHQUHSRVR3UHVHQWDQVtQWRPDVFRQXQQLYHOGHHVIXHU]R
PRGHUDGR
&ODVH ,,, $VLQWRPiWLFDV HQ UHSRVR SHUR SUHVHQWDQ VtQWRPDV DQWH HVIXHU]RV
OHYHV
&ODVH,93DFLHQWHVTXHSUHVHQWDQVtQWRPDVD~QHQUHSRVR
(Q FDVR GH SURGXFLUVH XQ HPEDUD]R OD PXMHU GHEHUi DVLVWLUVH HQ XQ VHUYLFLR GH
DOWR ULHVJR \ DQWH HVD HYHQWXDOLGDG VH VXJLHUH HPSOHDU ODV UHFRPHQGDFLRQHV GHO
³&RQVHQVRGHH[SHUWRVGHODVRFLHGDGHXURSHDGHFDUGLRORJtD´GHODxRVREUH
FRPRVHGHEHQPDQHMDUODVHQIHUPHGDGHVFDUGLRYDVFXODUHVGXUDQWHHOHPEDUD]R
/DV PXMHUHV TXH SUHVHQWDQ XQD FDUGLRSDWtD TXH UHTXLHUH XVR GH DQWLFRDJXODQWHV
RUDOHVGXUDQWHHOHPEDUD]RQRSRGUiQXVDUORVSRUVXHIHFWRWHUDWRJpQLFR
+LSHUWHQVLyQFUyQLFD
(VXQDHQWLGDGTXHVHSUHVHQWDFDGDYH]FRQPD\RUIUHFXHQFLD
/RV WUDVWRUQRV KLSHUWHQVLYRV GHO HPEDUD]R VXHOHQ VHU XQD GH ODV SULQFLSDOHV
FDXVDV GH PRUWDOLGDG PDWHUQD 3UHFLVDPHQWH HV PiV IDFWLEOH OD LQVWDODFLyQ GH
XQDSUHHFODPSVLDRGHXQDHFODPSVLDHQPXMHUHVFRQKLSHUWHQVLyQFUyQLFD6HKD
GHPRVWUDGRTXHHVWDUHODFLyQSXHGHOOHJDUDVHUGHFDVRGHSUHHFODPSVLDSRU
FDGDPXMHUHVTXHSDGHFHQKLSHUWHQVLyQFUyQLFD
&XDQGRXQDPXMHUFRQKLSHUWHQVLyQFUyQLFDUHFXUUHDOHTXLSRGHVDOXGHQEXVFDGH
RULHQWDFLyQVREUHXQIXWXURHPEDUD]RVHGHEHUiKDFHUXQDFRUUHFWDKLVWRULDFOtQLFD\
XQH[KDXVWLYRH[DPHQItVLFRDGHPiVGHHYDOXDUDVSHFWRVYLQFXODGRVDOWUDWDPLHQWR
FRPRHOPHGLFDPHQWRTXHHVWiUHFLELHQGRODGRVLVDGKHVLyQ\ODHIHFWLYLGDGGHO
PLVPR )LQDOPHQWH GHEHUiQ HIHFWXDUVH H[iPHQHV SDUDFOtQLFRV SDUD HVWDEOHFHU HO

JUDGR GH UHSHUFXVLyQ IXQFLRQDO TXH KD RULJLQDGR OD KLSHUWHQVLyQ VREUH yUJDQRV \
VLVWHPDV$OJXQRV PHGLFDPHQWRV DQWLKLSHUWHQVLYRV SXHGHQ VHU WHUDWRJpQLFRV SRU
OR FXDO VH GHEHUi FDPELDU OD PHGLFDFLyQ SRU XQD LQRFXD SDUD HO IHWR \ SHUPLWLU HO
HPEDUD]RUHFLpQFXDQGRVHKD\DHQFRQWUDGRODGRVLVPtQLPDHIHFWLYDSDUDFRQWURODU
ODVFLIUDVGHWHQVLyQDUWHULDO8QHMHPSORORFRQVWLWX\HQORVLQKLELGRUHVGHODHQ]LPD
FRQYHUVRUDGHODDQJLRWHQVLQDYHUDQWLKLSHUWHQVLYRVSDJ
/D KLSHUWHQVLyQ DUWHULDO VLVWpPLFD VH UHODFLRQD FRQ 5&, EDMR SHVR DO QDFHU
SUHPDWXULGDG \ DOWD PRUWDOLGDG SHULQDWDO (O ULHVJR IHWDO HV Pi[LPR FXDQGR H[LVWH
SURWHLQXULD(QHOFDStWXORGHDWHQFLyQSUHQDWDOVHDPSOtDQORVDVSHFWRVYLQFXODGRV
DHVWHWHPDHQODPXMHUHPEDUD]DGD
7URPER¿OLDV
6HODVFODVL¿FDHQKHUHGDGDVRDGTXLULGDVVRQGLIHUHQWHVHQWLGDGHVTXHWLHQHQHQ
FRP~QXQHVWDGRGHKLSHUFRDJXODELOLGDGTXHSXHGHUHSHUFXWLUQHJDWLYDPHQWHHQHO
HPEDUD]R
/DWURPER¿OLDKHUHGDGDPiVFRP~QHVODPXWDFLyQGHOIDFWRU9GH/HLGHQPLHQWUDV
TXHGHQWURGHODVDGTXLULGDVODPiVFRQRFLGDHVHOVtQGURPHDQWLIRVIROLStGLFR
(QWUHODPRUELOLGDGTXHSURYRFDQVHGHVWDFDQODVWURPERVLVYHQRVDVSURIXQGDVHO
7(3ORVLQIDUWRVFDUGtDFRV\FHUHEUDOHVHOGHVSUHQGLPLHQWRGHSODFHQWDSUHFODPSVLD
DERUWRUHFXUUHQWHPXHUWHIHWDO5&,\SDUWRSUHPDWXUR
'HELGRDODFRPSOHMLGDG\FDQWLGDGGHWHVWGLDJQyVWLFRVH[LVWHQWHVHOSURIHVLRQDOGH
DWHQFLyQSULPDULDGHEHUiKDFHUXQFRUUHFWRLQWHUURJDWRULRSDUDKDFHUXQGLDJQyVWLFR
SUHVXQWLYRSHURHOGLDJQyVWLFRSDUDFOtQLFRORGHEHUiHIHFWXDUHOHVSHFLDOLVWD
(Q OD PXMHU TXH VH FRQRFH HV SRUWDGRUD GH XQD WURPER¿OLD VH OD GHEH DFRQVHMDU
DSURSLDGDPHQWHVREUHORVULHVJRVTXHUHSUHVHQWDXQDJUDYLGH]\ODQHFHVLGDGGH
FRQWUROHV HVWULFWRV HQ FDVR GH HPEDUD]DUVH (Q DTXHOODV TXH GHFLGHQ SRVSRQHU
HO HPEDUD]R R GLUHFWDPHQWH QR OR KDUiQ VH ODV GHEHUi RULHQWDU DGHFXDGDPHQWH
VREUH PpWRGRV DQWLFRQFHSWLYRV VDELHQGR TXH ORV HVWUyJHQRV FRQWHQLGRV HQ
DOJXQRVFRQWUDFHSWLYRVSURPXHYHQHVWDGRVGHKLSHUFRDJXODELOLGDG(QHVWRVFDVRV
VHUi SUHIHULEOH HO XVR GH FRQWUDFHSWLYRV GH SURJHVWHURQD VROR ',8 R PpWRGRV GH
EDUUHUD
3UHYLR \ GXUDQWH HO HPEDUD]R HO WUDWDPLHQWR LGHDO HV FRQ KHSDULQDV GH EDMR
PROHFXODU/RFXDOLPSOLFDHQWUHQDUDODPXMHUSDUDVXDXWRDGPLQLVWUDFLyQ$SHVDU
GHORDOWDPHQWHVHJXUDVTXHVRQVHGHEHUiQSUDFWLFDUFRQWUROHVGHODERUDWRULRGHOD
FUDVLVVHJ~QLQGLFDFLyQGHOHVSHFLDOLVWD
$QHPLD
/D DQHPLD HV XQD GH ODV DIHFFLRQHV PiV SUHYDOHQWHV HQ ODV PXMHUHV GH QXHVWUD
UHJLyQ (O WUDWDPLHQWR GHEH HVWDU DFRUGH FRQ HO GLDJQyVWLFR HWLROyJLFR /D DQHPLD
IHUURSULYD VXHOH VHU OD PiV IUHFXHQWH GH WRGDV ODV DQHPLDV VH DVRFLD FRQ
SODFHQWDSUHYLDKLSHUWUR¿D\GHVSUHQGLPLHQWRSODFHQWDULRSUHFODPSVLD\KHPRUUDJLD
SRVWSDUWR6LHVVHYHUDVHDVRFLDD5&,\QDWLPRUWDOLGDG7RGDPXMHUTXHSODQHD
XQHPEDUD]R\VXIUHDQHPLDIHUURSULYDGHEHUiUHFLELUPJGHKLHUURHOHPHQWDO
SRUGtD
(OHPEDUD]RGHSRUVtVXHOHVHUXQSHUtRGRDQHPL]DQWHSRUORTXHFRQVHJXLUTXHODV
PXMHUHVOOHJXHQDOHPEDUD]RFRQEXHQRVQLYHOHVKHPiWLFRVFLUFXODQWHV\GHUHVHUYD
GHEHVHUXQDGHODVSUHPLVDVGHOFRQWUROSUHFRQFHSFLRQDO/DVPXMHUHVFRQDQHPLD
WROHUDUiQSHRU\FRUUHUiQPD\RUULHVJRGHYLGDDQWHFRPSOLFDFLRQHVKHPRUUiJLFDV
GXUDQWHHOHPEDUD]RHOSDUWRRHOSXHUSHULR
$VPD
/DVPXMHUHVDVPiWLFDVTXHVHHPEDUD]DQ\QRVXIUHQFULVLVDVPiWLFDVDORODUJR
GHO HPEDUD]R WLHQHQ ORV PLVPRV UHVXOWDGRV REVWpWULFRV QHRQDWDOHV TXH ODV QR
DVPiWLFDV(QFDPELRODVDVPiWLFDVFRQXQPDOFRQWUROGHVXHQIHUPHGDGGXUDQWH
HOHPEDUD]RVXHOHQWHQHUSHRUHVUHVXOWDGRVREVWpWULFRVHQWUHORVTXHVHGHVWDFDQ
SUHFODPSVLD KLSHUWHQVLyQ KLSHUpPHVLV JUDYtGLFD DERUWR HVSRQWiQHR 5&, SDUWR
SUHPDWXUR\EDMRSHVRDOQDFHU
6HKDYLVWRTXHORDFRQWHFLGRHQHOHPEDUD]RDQWHULRUHVXQEXHQLQGLFDGRUGHOR
TXHRFXUULUiFRQHODVPDHQHOIXWXURHPEDUD]RGHWDOIRUPDODVPXMHUHVTXHQR
KDQVXIULGRDWDTXHVHQHOSULPHUHPEDUD]RHVUDURTXHORVVXIUDQHQORVVLJXLHQWHV
PLHQWUDVTXHTXLHQHVWXYLHURQDJUDYDFLyQGHODVFULVLVHVDOWDPHQWHSUREDEOHTXH
YXHOYDQDVXIULUODV
/DV PXMHUHV TXH SODQHDQ HPEDUD]DUVH GHEHUiQ XVDU WUDWDPLHQWR SUHYHQWLYR FRQ
FRUWLFRLGHVLQKDODWRULRVORVFXDOHVKDQPRVWUDGRVHUVHJXURV(QFDPELRORVFRUWLFRLGHV
RUDOHVDXPHQWDQHOULHVJRGHSDODGDUKHQGLGRODELROHSRULQR\EDMRSHVRXQDVD
YHFHV
/DWHR¿OLQDFRQWLQ~DVLHQGRXQPHGLFDPHQWRVHJXUR
/DV PXMHUHV DVPiWLFDV TXH QR GHVHDQ HPEDUD]DUVH GHEHUtDQ VHU DFRQVHMDGDV
VREUHHOXVRGHXQPpWRGRDQWLFRQFHSWLYRDGHFXDGR
&RQYXOVLRQHV
'HQWUR GH ODV DIHFFLRQHV QHXUROyJLFDV FUyQLFDV TXH RFDVLRQDQ FRQYXOVLRQHV OD
HSLOHSVLDDIHFWDDXQDGHFDGDPXMHUHVHQHGDGUHSURGXFWLYD\HVHOGLVWXUELR
QHXUROyJLFR PiV IUHFXHQWH GXUDQWH OD JHVWDFLyQ ([LVWH XQ HIHFWR FRPSUREDGR GH
DXPHQWRGHGHIHFWRVFRQJpQLWRVSDUDVXGHVFHQGHQFLDGHWDQWRSRUODSDWRORJtD
HQ Vt FRPR SRU HO XVR GH ORV IiUPDFRV HPSOHDGRV SDUD FRQWURODUOD (SLVRGLRV
UHSHWLGRVGHFULVLVWyQLFRFOyQLFDVJHQHUDOL]DGDVRSDUFLDOHVFRPSOHMDVVHDVRFLDQ
FRQDERUWRVHVSRQWiQHRVKLSR[LDIHWDOEUDGLFDUGLD\PXHUWHSHULQDWDODGHPiVGHO
SHOLJURGHWUDEDMRGHSDUWRSUHPDWXUR\5&,SRUODHYROXFLyQGHODSDWRORJtDHQVtR
HOPDOPDQHMRWHUDSpXWLFR(OFXUVRGHODSDWRORJtDGXUDQWHHOHPEDUD]RSHUPDQHFH
LQFDPELDGRHQODPLWDGGHORVFDVRVSXHGHPHMRUDUHQHOGHODVJHVWDQWHV\
HPSHRUDUHQHO
$OWHUDFLRQHVSVLTXLiWULFDV
(OHPEDUD]RHQWUHRWUDVFRVDVKDVLGRFDUDFWHUL]DGRSRUVHUXQSHUtRGRGHPDUFDGD
ODELOLGDGHPRFLRQDO0XFKDVPXMHUHVGXUDQWHHOHPEDUD]RHOSDUWRRHOSXHUSHULR
VXIULUiQ OD DSDULFLyQ GH GHVyUGHQHV SVLTXLiWULFRV GH YDULDGD JUDYHGDG R VXIULU OD
UHFXUUHQFLDGHSDWRORJtDVSVLTXLiWULFDVSUHYLDV
/RV GHVyUGHQHV VLTXLiWULFDV VH KDQ DVRFLDGR FRQ PDORV UHVXOWDGRV PDWHUQR
SHULQDWDOHV/DJDPDGHPDORVUHVXOWDGRVHVYDULDEOHGHVGHFXDGURVGHDQJXVWLD
ELHQWROHUDGRVKDVWDODGHSUHVLyQVHYHUDFRQDEDQGRQRGHORVFXLGDGRVGHOQLxR\
GHVXVSURSLRVFXLGDGRVOOHJDQGRDOVXLFLGLRRDOLQIDQWLFLGLR
'HELGRDODFDGDYH]PD\RUIUHFXHQFLDGHHVWRVWUDVWRUQRV\DODJUDYHGDGSRWHQFLDO
TXH UHSUHVHQWDQ ORV SURIHVLRQDOHV GHEHUtDQ VHU H[KDXVWLYRV HQ OD E~VTXHGD GH
VtQWRPDVTXHKLFLHUDQVRVSHFKDUORV
7UDVWRUQRV GHO KXPRU \ DQVLHGDG 6RQ WUDVWRUQRV VXPDPHQWH IUHFXHQWHV \
HQWUHHOORVVHHQFXHQWUDQODGHSUHVLyQ\ORVWUDVWRUQRVGHDQVLHGDG/DVPXMHUHV
TXHSODQHDQXQHPEDUD]RGHEHQVHUDGYHUWLGDVVREUHORVULHVJRVGHUHFDtGDV
TXHSXHGHQVXSHUDUHOGHORVFDVRVVLVHDEDQGRQDODPHGLFDFLyQ
0XFKRVGHORVPHGLFDPHQWRVTXHVHXVDQSDUDWUDWDUHVWDVDIHFFLRQHVWLHQHQ
HIHFWRV WHUDWRJpQLFRV FRQ¿UPDGRV WDO HV HO FDVR GH ODV VDOHV GH /LWLR 2WURV
PHGLFDPHQWRV QR VRQ UHFRPHQGDGRV \D TXH DXQTXH ODV HYLGHQFLDV QR VRQ
FRQFOX\HQWHVVHKDYLVWRFLHUWRJUDGRGHDVRFLDFLyQHQWUHHOORV\HIHFWRVIHWDOHV
DGYHUVRVFRPRVXFHGHFRQORVLQKLELGRUHVGHODUHFDSWDFLyQGHODVHURWRQLQD
)UHFXHQWHPHQWHHVLPSRVLEOHSRUORVDOWRVQLYHOHVGHUHFDtGDVXJHULUDEDQGRQDU
HOWUDWDPLHQWRHQHVHFDVRVHDSHODUiQDORVSODQHVPRQRGURJDV\FRQODPHQRU
GRVLVHIHFWLYDSRVLEOH
(VTXL]RIUHQLD(VXQDHQIHUPHGDGFUyQLFDTXHVHFDUDFWHUL]DSRUVXJUDYHGDG
\ OD DOWD SUREDELOLGDG GH VXIULU GHVFRPSHQVDFLRQHV GXUDQWH HO HPEDUD]R 4XH
SRUHOXVRPDQWHQLGRGHPHGLFDFLyQDGLFFLRQHV\ODIDOWDGHDXWRFXLGDGRWLHQHQ
DOWDVSRVLELOLGDGHVGHPDOIRUPDFLRQHVIHWDOHVDERUWR5&,GHVQXWULFLyQ\PXHUWH
IHWDORPDWHUQD
/DVGHVFRPSHQVDFLRQHVSXHGHQVHUGHWDOPDJQLWXGTXHOOHYHQDOLQIDQWLFLGLRR
DDXWROHVLRQDUVH
1RHVKDELWXDOTXHPXMHUHVHVTXL]RIUpQLFDVDFXGDQDFRQWUROHVSUHFRQFHSFLRQDOHV
JHQHUDOPHQWHORVHPEDUD]RVHQHOODVQRVRQSODQL¿FDGRV
(V FRQYHQLHQWH HQ OD YLVLWD SUHFRQFHSFLRQDO PLHQWUDV VH KDFH OD DQDPQHVLV
LQWHUURJDUVREUHKLVWRULDIDPLOLDUGHGHVyUGHQHVGHWLSRVLFyWLFRRDQWHFHGHQWHV
GHGHVyUGHQHVDIHFWLYRVRKLVWRULDSHUVRQDOGHVLFRVLV$SDUWLUGHOPRPHQWRGH
GHWHUPLQDUTXHODPXMHUVXIUHXQDHVTXL]RIUHQLDRSXHGHVXIULUODODSODQL¿FDFLyQ
GH XQ HPEDUD]R GHEHUi KDFHUVH FRQ HO VLTXLDWUD WUDWDQWH JDUDQWL]DQGR XQ
VHJXLPLHQWR FOtQLFR HVWULFWR GH DPERV \ FRQ SRVLELOLGDG GH FRPXQLFDFLyQ
LQPHGLDWDHQWUHODPXMHUODIDPLOLDHOVLTXLDWUD\HOUHVWRGHOHTXLSRGHVDOXG
(O WUDWDPLHQWR GH ODV HVTXL]RIUHQLDV VH GHEH UHDOL]DU FRQ DQWLVLFyWLFRV ORV
FXDOHV VRQ DOWDPHQWH WHUDWRJpQLFRV SRU HOOR VH UHFRPLHQGD VROR FXDQGR VHD
SRVLEOH\EDMRXQHVWULFWRFRQWUROFOtQLFRODVXVSHQVLyQGHORVPLVPRVGXUDQWH
OD SODQL¿FDFLyQ LQPHGLDWD GHO HPEDUD]R \ GXUDQWH WRGR HO SULPHU WULPHVWUH 6L
ODDIHFFLyQHVGHWDOVHYHULGDGTXHQRSHUPLWHHODXWRFXLGDGRRUHSUHVHQWHXQ
ULHVJR SDUD RWUD SHUVRQD R HOOD PLVPD GHEHUi PDQWHQHUVH OD PHGLFDFLyQ R
GHVDFRQVHMDUVHHOHPEDUD]R
(VWDPXMHUGHEHUiVHUYDORUDGDHQFRQMXQWRFRQHOVLTXLDWUDWUDWDQWHGHELpQGRVH
UHFRUGDUTXHDXQTXHWRGRVORVDQWLVLFyWLFRVVRQSRWHQFLDOPHQWHWHUDWRJpQLFRVOD
FORUSURPD]LQDKDGHPRVWUDGDVHUODPiVSHOLJURVD3RUHVRHVUHFRPHQGDEOHHQ
FDVRGHPDQWHQHUPHGLFDFLyQXVDUKDORSHULGROIHQRWLD]LQD\GHULYDGRVGHHVWD
FRPRODVSHUD]LQDV
(QIHUPHGDGHV0DWHUQDV7UDQVPLVLEOHV
/DPD\RUtDGHODVHQIHUPHGDGHVGHRULJHQLQIHFFLRVRTXHVHSUHVHQWDQDFRQWLQXDFLyQ
SXHGHQVHUWHUDWRJpQLFRVGXUDQWHHOGHVDUUROORHPEULRQDULR$XQTXHVXDFFLyQSXHGH
FRQWLQXDUOXHJRGHOSHUtRGRHPEULRQDULR\HQDOJXQDVRFDVLRQHVD~QKDVWDGHVSXpVGHO
QDFLPLHQWR8QHMHPSORGHHVWRORFRQVWLWX\HODVt¿OLVFRQJpQLWD3RUHVWHPRWLYRHV
TXHVHGHEHSULPDULDPHQWHHYLWDUVXRFXUUHQFLDGXUDQWHODJHVWDFLyQ\GHRFXUULUpVWD
VHGHEHWUDWDUDODHPEDUD]DGD\DOUHFLpQQDFLGRVLIXHUDQHFHVDULR
5XEpROD
6HUHFRPLHQGDHYDOXDUODVXVFHSWLELOLGDGDOD5XEpRODGHVFDUWDQGRSRUODKLVWRULD
FOtQLFD TXH OD PXMHU QR KD\D SDGHFLGR OD HQIHUPHGDG R TXH QR KD\D UHFLELGR OD
YDFXQD(QFDVRGHGXGDVVHMXVWL¿FDHIHFWXDUVHURORJtDSDUDUXEpRODDWRGDPXMHU
HQHGDGGHSURFUHDU7RGDVODVPXMHUHVQRHPEDUD]DGDVVXVFHSWLEOHVGHEHUiQVHU
YDFXQDGDVDQWHVGHOHPEDUD]RRGHVSXpVGHOSDUWR
9DULFHOD
6HUHFRPLHQGDHYDOXDUODVXVFHSWLELOLGDGDOD9DULFHODGHVFDUWDQGRSRUODKLVWRULD
FOtQLFD TXH OD PXMHU QR KD\D SDGHFLGR OD HQIHUPHGDG R TXH QR KD\D UHFLELGR OD
YDFXQD$SHVDUTXHODVPXMHUHVDGXOWDVWHQJDQXQDKLVWRULDQHJDWLYDRLQFLHUWDGH
KDEHU SDGHFLGR YDULFHOD PiV GHO VRQ LQPXQHV D HOOD (Q FDVR GH GXGDV VH
MXVWL¿FDHIHFWXDUVHURORJtDSDUDYDULFHODDWRGDPXMHUHQHGDGGHSURFUHDU6LQRVH
GLVSRQHGHVHURORJtDODYDFXQDFLyQVHUiODRSFLyQ
7RGDVODVPXMHUHVQRHPEDUD]DGDVVXVFHSWLEOHVGHEHUiQVHUYDFXQDGDVDQWHVGHO
HPEDUD]RRGHVSXpVGHOSDUWR
&LWRPHJDORYLUXV
(O&LWRPHJDORYLUXV&09HVODLQIHFFLyQFRQJpQLWDPiVIUHFXHQWH\HVODSULQFLSDO
UHVSRQVDEOHSRUORVFDVRVGHVRUGHUDQHXURVHQVRULDO\UHWDUGRPHQWDOGHHWLRORJtD
YLUDO (O &09 SHUWHQHFH DO JUXSR GH ORV YLUXV KHUSHV \ HV UHODWLYDPHQWH SRFR
FRQWDJLRVRQHFHVLWDQGRFRQWDFWRVHVWUHFKRV\SURORQJDGRV/DLQIHFFLyQHQDGXOWRV
QR WLHQH FRQVHFXHQFLDV FOtQLFDV JUDYHV H[FHSWR HQ SDFLHQWHV LQPXQRGHSULPLGDV
(VWDLQIHFFLyQRFXUUHHQGHORVQDFLPLHQWRVVRQDVLQWRPiWLFRV
6H GHEHUi DGYHUWLU D WRGDV ODV PXMHUHV HVSHFLDOPHQWH D ODV PDGUHV FRQ KLMRV
SHTXHxRV \ D DTXHOODV TXH WLHQHQ FRQWDFWR SURIHVLRQDO FRQ QLxRV PDHVWUDV
SHUVRQDOGHVDOXGORVFXLGDGRVKLJLpQLFRVODYDGRGHPDQRVTXHVHGHEHUiQWHQHU
DOPDQHMDUSDxDOHVLPSUHJQDGRVFRQRULQDGHQLxRVSHTXHxRVTXLHQHVVXHOHQVHU
ODSULQFLSDOIXHQWHGHLQIHFFLyQ
7R[RSODVPRVLV
6HGHEHUiDGYHUWLUDWRGDPXMHUTXHGHVHDHPEDUD]DUVHDFHUFDGHODVIRUPDVSDUD
HYLWDUFRQWUDHUXQDWR[RSODVPRVLVHQHOHPEDUD]R\ORVULHVJRVTXHODPLVPDSXHGH
RFDVLRQDU(QDTXHOORVSDtVHVHQGRQGHVHHIHFW~HHOWDPL]DMHSDUDWR[RSODVPRVLVVH
SRGUiDGYHUWLUDODVPXMHUHVFRQDQWLFXHUSRVDQWLWR[RSODVPDTXHODPDGUHSRUWDGRUD
GHLQIHFFLyQFUyQLFDH[FHSFLRQDOPHQWHWUDVPLWHHOSDUiVLWRDOIHWRUHDFWLYDFLyQ9HU
WR[RSODVPRVLV HQ HO FDStWXOR GH DWHQFLyQ SUHQDWDO$ WRGD PXMHU TXH FRQRFLHQGR
RGHVFRQRFLHQGRVXHVWDGRVHUROyJLFRVHOHGHEHQGDUORVFRQVHMRVJHQHUDOHVGH
SUHYHQFLyQSDUDWR[RSODVPRVLV
&XDGUR0HGLGDVHGXFDWLYDVDQWHVHURORJtDQHJDWLYDSDUDWR[RSODVPRVLV
• Eliminar el consumo de carne cruda o poco cocida.
• Usar guantes y lavarse las manos intensamente después de manipular carne cruda.
• Lavar profundamente todos los utensilios que estuvieron en contacto con carne cruda.
• Lavar profundamente los vegetales que se comerán crudos.
• Usar guantes cada vez que se esté en contacto con tierra. Y lavar las manos intensamente después de
tocar la tierra.
• Mantener los gatos domésticos dentro de la casa y alimentarlos con raciones.
• Usar guantes mientras se limpia la “cucha” y lavarse las manos después de hacerlo.
6t¿OLV
&RQRFHUHOHVWDGRVHUROyJLFRSDUDVt¿OLVDQWHVGHOHPEDUD]RFRQWULEX\HDHIHFWXDUHO
WUDWDPLHQWRGHODPXMHU\VXVFRQWDFWRVHQXQPRPHQWRLGHDO/DVPXMHUHVFRQVt¿OLV
GHEHUiQVHULQIRUPDGDVVREUHORVULHVJRVGHWUDQVPLVLyQYHUWLFDOGHHVWDLQIHFFLyQ
GHWUDQVPLVLyQVH[XDO
9,+
/DVPXMHUHVHQHGDGIpUWLOWLHQHQHOGHUHFKRGHVRPHWHUVHDSUXHEDVGHWDPL]DMHSDUD
9,+SUHYLDFRQVHMHUtD\JDUDQWL]DQGRODFRQ¿GHQFLDOLGDG(VUHFRPHQGDEOHVXJHULU
HOWDPL]DMHDWRGDPXMHUTXHVHTXLHUHHPEDUD]DU(QFDVRGHSUXHEDVSRVLWLYDVVH
GHEHUiLQIRUPDUVREUHHOULHVJRGHWUDQVPLVLyQYHUWLFDO\ORVWUDWDPLHQWRVSUR¿OiFWLFRV
H[LVWHQWHV(QDTXHOODVPXMHUHVTXHGHFLGDQQRHPEDUD]DUVHVHOHVGHEHUiRIUHFHU
PpWRGRVDQWLFRQFHSWLYRVVHJXURV
+HSDWLWLV%
/DLQIHFFLyQIHWDOSRUKHSDWLWLV%VHDVRFLDDSUHPDWXULGDG\QLxRVSHTXHxRVSDUD
OD HGDG JHVWDFLRQDO 6H GHEHQ LGHQWL¿FDU PXMHUHV QR YDFXQDGDV \ R VXVFHSWLEOHV
GHFRQWUDHUODHQIHUPHGDG7RGDODSREODFLyQ\HVSHFLDOPHQWHORVDGROHVFHQWHV\
PXMHUHV HQ HGDG IpUWLO GHEHUtDQ UHFLELU OD YDFXQD FRQWUD OD KHSDWLWLV % FXDQGR QR
WLHQHQ DQWLFXHUSRV (VWD YDFXQD SXHGH VHU DSOLFDGD D~Q GXUDQWH HO HPEDUD]R \D
TXHVHWUDWDGHXQDYDFXQDDYLUXVPXHUWRV
*ULSH
/DYDFXQDDQWLLQÀXHQ]DHVWiFRPSXHVWDSRUYLUXVLQDFWLYDGRVQRLQIHFWDQWHVSRUOR
TXHVHFRQVLGHUDVHJXUDD~QHQHOHPEDUD]R3RUORTXHODVPXMHUHVTXHSODQL¿TXHQ
HPEDUD]DUVHSRGUiQUHFLELUODYDFXQDVLQLQFRQYHQLHQWHV(QDOJXQDVLQIHFFLRQHV
SRU YLUXV LQÀXHQ]D FRPR HQ HO FDVR GH OD SDQGHPLD SRU LQÀXHQ]D $ +1 ODV
HPEDUD]DGDV SUHVHQWDQ PD\RU PRUWDOLGDG SRU OR TXH HV UHFRPHQGDEOH TXH WRGD
PXMHUTXHSODQHDHPEDUD]DUVHVHDYDFXQDGD
0DODULDR3DOXGLVPR
'HELGR D OD DQHPLD VHYHUD TXH SURYRFD HQ PXFKDV ]RQDV GH$PpULFD GRQGH HO
SDOXGLVPRHVHQGpPLFD\DRWUDVFRPSOLFDFLRQHVFRQWULEX\HDODPRUWDOLGDGPDWHUQD
3RU OD PLVPD UD]yQ SXHGH SURYRFDU DERUWR HVSRQWiQHR 5&, SDUWR SUHPDWXUR \
QDFLPLHQWRVFRQ%31
$ODVPXMHUHVTXH\DKDQVXIULGRSDOXGLVPR\TXLHUHQHPEDUD]DUVHHVQHFHVDULR
PHMRUDUOHVXVQLYHOHVQXWULFLRQDOHV\GHKHPRJORELQDDODYH]GHDGYHUWLUODVVREUH
HOHVWULFWRFRQWUROSUHFRQFHSFLRQDOTXHGHEHUiQUHFLELU
/DVPHGLGDVGHSUHYHQFLyQSDUDODVPXMHUHVTXHQRKDQWHQLGRSDOXGLVPRSDVDSRU
UHFRUGDUOHVQRYLDMDUDiUHDVHQGpPLFDVSDUDSDOXGLVPR3DUDODVTXHGHEHQYLDMDU
RYLYHQHQ]RQDVGHSDOXGLVPRODVUHFRPHQGDFLRQHVGHSUHYHQFLyQLPSOLFDQHOXVR
GHFDPDVFRQPRVTXLWHURVFRQLQVHFWLFLGDV\TXLPLRSUR¿OD[LVDQWLSDO~GLFD
7XEHUFXORVLV
/D7XEHUFXORVLV GXUDQWH HO HPEDUD]R SXHGH FDXVDU 5&, %31 VHSVLV QHRQDWDO \
PXHUWH 7RGD PXMHU TXH OOHJXH DO FRQWURO SUHFRQFHSFLRQDO GHEHUi VHU FRQVXOWDGD
DFHUFDGHVLUHFLELyYDFXQDDQWLWHWiQLFD\VLODPLVPDHVWiYLJHQWH(QFDVRGHQR
KDEHUODUHFLELGRVHFRPHQ]DUiHOHVTXHPDGHYDFXQDFLyQ
(QFDVRGHLQIHFFLyQDFWLYDVHVXJHULUiSRVSRQHUHOHPEDUD]RKDVWDKDEHUREWHQLGR
HODOWDPpGLFRSRUOD7XEHUFXORVLV
(VWLORVGHYLGD
$OJXQRV KiELWRV SXHGHQ GHWHUPLQDU XQD VHULH GH ULHVJRV SDUD ODV PXMHUHV HQ HGDG
IpUWLO/DLGHQWL¿FDFLyQ\PRGL¿FDFLyQGHGLFKRVKiELWRVSXHGHEHQH¿FLDUDODVPXMHUHV
\VXIXWXURHPEDUD]R
+iELWRVQXWULFLRQDOHV
6HGHEHQLGHQWL¿FDUHQODHYDOXDFLyQSUHFRQFHSFLRQDOPDORVKiELWRVQXWULFLRQDOHV\VXV
FRQVHFXHQFLDV VREUHSHVR GHOJDGH] DQRUH[LD EXOLPLD \ VXSOHPHQWDFLyQ YLWDPtQLFD
LQDGHFXDGD/DFDOLGDGGHODGLHWDDQWHV\GXUDQWHHOHPEDUD]RWLHQHLQÀXHQFLDVREUH
DOJXQRV UHVXOWDGRV PDWHUQRV SHULQDWDOHV SRU HVR PDQWHQHU XQD GLHWD VDOXGDEOH \
EDODQFHDGDHVWDQLPSRUWDQWHDQWHVFRPRGXUDQWHHOHPEDUD]R3RUHVWDUD]yQWRGD
PXMHU TXH DFXGD DO FRQWURO SUHFRQFHSFLRQDO GHEHUi UHFLELU LQVWUXFFLyQ YHUEDO \ SRU
HVFULWRGHFXDOHVVRQORVDOLPHQWRVLGHDOHVHQFDQWLGDG\FDOLGDGTXHGHEHUiFRQVXPLU
PLHQWUDVVHSUHSDUDSDUDHOHPEDUD]R\GXUDQWHHOPLVPR3DUDGDUHVWDFRQVHMHUtD
VH UHFRPLHQGD TXH ODV QXWULFLRQLVWDV SDUWLFLSHQ DFWLYDPHQWH GHO HTXLSR TXH EULQGD
DVLVWHQFLD SUHFRQFHSFLRQDO EULQGDQGR FRQVHMHUtD GLUHFWD R FRQWULEX\HQGR FRQ VX
FRQRFLPLHQWRDODSUHSDUDFLyQGHODLQIRUPDFLyQDGLIXQGLU\HODERUDQGRVXJHUHQFLDV
GHEDMRFRVWRSDUDLQFRUSRUDUORVDOLPHQWRVDGHFXDGRVHQDTXHOORVFRQWH[WRVGRQGHHO
IDFWRUHFRQyPLFRSXHGDVHUXQDEDUUHUDSDUDHODFFHVRDWDOHVDOLPHQWRV
+D\HVWXGLRVTXHFRQ¿UPDQTXHPXFKDVPXMHUHVQRFXPSOHQFRQORVUHTXHULPLHQWRV
GHYLWDPLQDV$%&'(\iFLGRIyOLFRFDOFLRKLHUURPDJQHVLR\]LQF
6H KD YLVWR TXH OD PDOQXWULFLyQ GXUDQWH HO HPEDUD]R VH DVRFLD D SUHPDWXUH] 5&,
PRUWDOLGDGSHULQDWDO\GHIHFWRVGHOWXERQHXUDO6HGHEHQUHDOL]DUFDPSDxDVLQIRUPDWLYDV
SULRUL]DQGRHOYDORUQXWULFLRQDOGHODGLHWDSUHYLR\GXUDQWHODJHVWDFLyQUHIRU]DQGRHO
XVR GH DOLPHQWRV ULFRV HQ IRODWRV \ FDURWHQRLGHV 0HMRUDU OD QXWULFLyQ HQ JHVWDQWHV
SREUHVDWUDYpVGHFDQDVWDVEiVLFDVSXHGHVHUXQDRSFLyQDFRUWRSOD]R
/DHYLGHQFLDDFWXDOGHPXHVWUDTXHPiVGHODPLWDGGHORVFDVRVGHGHIHFWRVGHOWXERQHXUDO
SRGUtDQVHUHYLWDGRVVLODPDGUHKXELHUDFRQVXPLGRVX¿FLHQWHiFLGRIyOLFRSRUORPHQRVXQ
PHV\PHGLRDQWHVGHOHPEDUD]R\KDVWDORVWUHVSULPHURVPHVHVGHODJHVWDFLyQ
/RV GHIHFWRV FRQJpQLWRV GH OD HVSLQD GRUVDO \ HO FHUHEUR FRPLHQ]DQ DQWHV TXH ODV
PXMHUHVVHSDQTXHHVWiQHPEDUD]DGDV
$QLYHOLQGLYLGXDOVHUHFRPLHQGDHOXVRSUHFRQFHSFLRQDOGH
D PJGtD GH ÈFLGR )yOLFR SDUD SUHYHQLU OD RFXUUHQFLD GH GHIHFWRV GHO WXER
QHXUDO
E/DVPXMHUHVTXH\DWLHQHQHODQWHFHGHQWHGHXQQLxRFRQXQGHIHFWRGHWXER
QHXUDO\SUHWHQGHQHPEDUD]DUVHGHEHQWRPDUXQDGRVLVYHFHVVXSHULRU
PJGHiFLGRIyOLFRGtDSDUDSUHYHQLUODUHFXUUHQFLD
7RPDUiFLGRIyOLFRFXDQGR\DVHFRQRFHHOHPEDUD]RQRD\XGDDSUHYHQLUHOGHIHFWR
GHOWXERQHXUDO
$ QLYHO SREODFLRQDO OD IRUWL¿FDFLyQ GH ODV KDULQDV KD VLGR LPSOHPHQWDGD HQ DOJXQRV
SDtVHVGHODUHJLyQ$~QHQHVWRVSDtVHVTXHKDQIRUWL¿FDGRORVDOLPHQWRVFRQÈFLGR
)yOLFR ODV PXMHUHV TXH FXHQWHQ FRQ DQWHFHGHQWHV GH GHIHFWRV GHO WXER QHXUDO HQ
JHVWDFLRQHVDQWHULRUHVGHEHUiQUHFLELUODGRVLVGHPJGHiFLGRIyOLFRGtDWDOFRPR
VHLQGLFySUHYLDPHQWH
2WURHMHPSORGHSUHYHQFLyQGHGHIHFWRVFRQJpQLWRVDQLYHOSREODFLRQDOHVHOVXSOHPHQWR
FRQ\RGRHQUHJLRQHVFRQDOWDIUHFXHQFLDGHFUHWLQLVPRHQGpPLFR(VWDPHGLGDOOHYD
D XQD UHGXFFLyQ LPSRUWDQWH GH HVWD SDWRORJtD VLQ HIHFWRV DGYHUVRV FRQRFLGRV (Q
YDULRVSDtVHVGHODV$PpULFDVH[LVWHSRUOH\ODREOLJDWRULHGDGGHIRUWL¿FDUODVDOSDUD
HOFRQVXPRKXPDQRFRQ\RGR(VWRKDKHFKRTXHHOWUDVWRUQRVHUHGX]FDD]RQDVGH
SREODFLyQ GH EDMRV UHFXUVRV TXH FRQVXPHQ VDO EUXWD VLQ SURFHVDPLHQWR 'RQGH OD
VXSOHPHQWDFLyQQRHVODQRUPDVHUHFRPLHQGDDFRQVHMDUDODVPXMHUHVFRQGH¿FLHQFLD
GH\RGRDPDQWHQHUXQDGLHWDGHPLFURJUDPRVGXUDQWHHOSHUtRGRSUHFRQFHSFLRQDO
ODTXHVHGHEHHOHYDUDPLFURJUDPRVGXUDQWHHOHPEDUD]R\ODFWDQFLD
2EHVLGDG
/D REHVLGDG \ HO VREUHSHVR VRQ FDGD YH] PiV IUHFXHQWHV HQ QXHVWUD UHJLyQ
(QWHQGLHQGR SRU REHVLGDG D OD PXMHU FRQ ËQGLFH GH 0DVD &RUSRUDO ,0& LJXDO R
PD\RUD.JP(QWUHODVUHSHUFXVLRQHVLQGHVHDGDVGHODREHVLGDGHQODPXMHU
GXUDQWHHOHPEDUD]RVHSXHGHREVHUYDUODDSDULFLyQGHKLSHUWHQVLyQLQGXFLGDSRU
HOHPEDUD]RGLDEHWHVWUDVWRUQRVWURPERHPEyOLFRVDXPHQWRGHOSDUWRRSHUDWRULR
LQIHFFLRQHVDQHPLDSRVWSDUWR\PXHUWHPDWHUQD0LHQWUDVTXHHQORVUHFLpQQDFLGRV
VH SXHGHQ YHU GHIHFWRV GHO WXER QHXUDO SDUWR GH SUHWpUPLQR PDFURVRPtD IHWDO
SDUWRVGLVWyFLFRVGHSUHVLyQQHRQDWDO\PXHUWHIHWDO
(VUHFRPHQGDEOHRIUHFHULQIRUPDFLyQVREUHORVULHVJRVTXHUHSUHVHQWDODREHVLGDG
\ HO VREUHSHVR \ JDUDQWL]DU HO DFFHVR D SURJUDPDV GH UHGXFFLyQ GH SHVR (Q
SULPHUOXJDUVHGHEHVXJHULUXQSODQGHFRQVHMHUtDGLHWD\HMHUFLFLRSURJUDPDGRV
PHGLGDVTXHKDQGHPRVWUDGRVHUPiVHIHFWLYDVTXHODFLUXJtD/RVWUDWDPLHQWRVFRQ
PHGLFDPHQWRVVRODPHQWHQRKDQPRVWUDGRVHUEHQH¿FLRVRV(QDOJXQRVFDVRVFRQ
IDOWDGHUHVSXHVWDDOWUDWDPLHQWRKLJLpQLFRGLHWpWLFRSXHGHSODQWHDUVHODUHDOL]DFLyQ
GHSURFHGLPLHQWRVTXLU~UJLFRV
%DMRSHVRSUHJUDYtGLFR
6HHQWLHQGHSRUEDMRSHVRDTXHOODSHUVRQDFRQXQ,0&PHQRUD.JP(O
EDMRSHVRSUHJUDYtGLFRVHKDDVRFLDGRFRQSDUWRGHSUHWpUPLQREDMRSHVRDOQDFHU
\JDVWURVTXLVLV
/DVPXMHUHVTXHDFXGDQDXQFRQWUROSUHFRQFHSFLRQDOFRQEDMRSHVRGHEHUiQVHU
HYDOXDGDV SDUD GHVSLVWDU Gp¿FLW HQ HO DSRUWH YLQFXODGR D SUREOHPDV GH DFFHVR
D DOLPHQWRV HQ FDQWLGDG \ FDOLGDG GHVyUGHQHV DOLPHQWDULRV R HQIHUPHGDGHV
FRH[LVWHQWHV
'HVyUGHQHVDOLPHQWDULRV
'HQWURGHORVGHVyUGHQHVPiVFRQRFLGRVSRGHPRVFLWDUDORVWUDVWRUQRVGHDQRUH[LD
\EXOLPLD/DVPXMHUHVFRQDQRUH[LDVHYHUDWLHQHQGL¿FXOWDGHVSDUDHPEDUD]DUVH
PLHQWUDV TXH ODV EXOtPLFDV ORJUDQ HPEDUD]DUVH FRQ PD\RU IDFLOLGDG $PEDV
SDWRORJtDVVHDFRPSDxDQGHDOWDVWDVDVGHDERUWREDMRSHVRDOQDFHU\XQDJDPD
DPSOLD GH FRPSOLFDFLRQHV REVWpWULFDV (VWDV PXMHUHV SRU VX ODELOLGDG HPRFLRQDO
SUHVHQWDQXQDPD\RUIUHFXHQFLDGHGHSUHVLyQSRVWSDUWR
(VWRVWUDVWRUQRVGHEHQVHUUHJXODUPHQWHLQWHUURJDGRVHQODFRQVXOWDSUHFRQFHSFLRQDO
VDELHQGRTXHPXFKDVYHFHVODVSDFLHQWHVVXHOHQRFXOWDUOR(QDTXHOODVRFDVLRQHV
TXHVHOOHJXHDOGLDJQyVWLFRSUHFRQFHSFLRQDOVHGHEHUiVXJHULUSRVSRQHUHOHPEDUD]R
HQWDQWRQRVHKD\DFRUUHJLGRHOGLVWXUELR\SDUDHOORVHGHEHUiHQFDPLQDUDODPXMHU
SDUDVXWUDWDPLHQWRFRQXQHTXLSRHVSHFLDOL]DGRHQODPDWHULD
(MHUFLFLR
3RU UHJOD JHQHUDO HO HMHUFLFLR \ ORV GHSRUWHV VRQ VDOXGDEOHV \D TXH SURGXFHQ
ELHQHVWDUItVLFR\SVLFROyJLFRWDQWRSDUDODVPXMHUHVFRQLQWHQFLyQGHHPEDUD]DUVH
FRPR SDUD ODV TXH \D OR HVWiQ (Q HVWDV ~OWLPDV HO HMHUFLFLR ItVLFR DHUyELFR HV
FRQYHQLHQWH GXUDQWH OD JHVWDFLyQ \ SUHYLR D HOOD SDUD IRUWDOHFHU ORV P~VFXORV \
DFWLYDUODFLUFXODFLyQYHQRVD
&RQVXPRGHVXVWDQFLDV
(OFRQVXPRGHVXVWDQFLDVOHJDOHVHLOHJDOHVVLJXHVLHQGRHOHYDGR\HVSHUMXGLFLDO
SDUDODPXMHUFRPRSDUDVXKLMR(QWpUPLQRVJHQHUDOHVODSREODFLyQHVWiLQIRUPDGD
VREUHORVULHVJRVTXHUHSUHVHQWDHOFRQVXPRGHVXVWDQFLDVLOHJDOHVHLQFOXVRHOXVR
GH WDEDFR GXUDQWH HO HPEDUD]R SHUR HVWi PHQRV LQIRUPDGD VREUH ORV SHUMXLFLRV
GHODOFRKRO6HKDYLVWRTXHHOFRQWUROSUHFRQFHSFLRQDOHVXQPHMRUPRPHQWRSDUD
LQWHUURJDU VREUH HO XVR \ DEXVR GH VXVWDQFLDV \ TXH H[LVWH XQD UHODFLyQ HQWUH
FRQVXPRSUHFRQFHSFLRQDO\FRQVXPRGXUDQWHHOHPEDUD]R6HKDGHPRVWUDGRTXH
HQPXMHUHVTXHGHVHDQHPEDUD]DUVHSRVSRQHUHOHPEDUD]R\WUDWDUODDGLFFLyQHV
XQDPHGLGDHIHFWLYD
7DEDFR
(OKiELWRGHIXPDUDFWLYR\SDVLYRDIHFWDWDQWRDOIHWRFRPRDODPDGUH
(QWUHORVGDxRVDWULEXLGRVVHGHVFULEHQLQIHUWLOLGDGDERUWRHVSRQWiQHREDMRSHVRDO
QDFHUUHVWULFFLyQGHOFUHFLPLHQWRIHWDOULHVJRGHSDUWRSUHWpUPLQRGHVSUHQGLPLHQWR
GHSODFHQWDPXHUWHIHWDO\SHULQDWDODXPHQWRGHOULHVJRGHLQIHFFLRQHVGHOWUDFWR
UHVSLUDWRULRGHOUHFLpQQDFLGR(VSULRULWDULRGHVDFRQVHMDUVXFRQVXPR\RIUHFHUXQ
SURJUDPDDFWLYRGHFHVHGHIXPDUDODVJHVWDQWHV
$OFRKRO
6HWUDWDGHXQDJHQWHSUREDGDPHQWHWHUDWRJpQLFR\QRH[LVWHXQDGRVLVFRQVLGHUDGD
VHJXUDSDUDVXXVRGXUDQWHODJHVWDFLyQ6HDVRFLDFRQPXHUWHLQWUDXWHULQDUHVWULFFLyQ
HQ HO FUHFLPLHQWR SUH \ SRVWQDWDO EDMR SHVR DO QDFHU DOWHUDFLRQHV GHO VLVWHPD
QHUYLRVRFHQWUDO\GHODFRQGXFWD(OFRQVXPRH[FHVLYRGHDOFRKROWHPSUDQDPHQWH
HQ OD JHVWDFLyQ SXHGH SURGXFLU HO VtQGURPH GHO$OFRKRO )HWDO HQ WRUQR DO GH
ORV HPEDUD]RV /DV FDPSDxDV GH HGXFDFLyQ VRQ GH H[WUHPD LPSRUWDQFLD \D TXH
QRH[LVWHODQRFLyQGHHVWHULHVJRHQODSREODFLyQ/DVPLVPDVGHEHQHQIDWL]DUVH
HQHODOFRKRO\QRHQHO³DOFRKROLVPR´0LHQWUDVQRVHFRQVLJDHODEDQGRQRGHOXVR
GHDOFRKROGHEHVXJHULUVHSRVSRQHUHOHPEDUD]RKDVWDTXHVHORJUH3DUDHVWRVH
UHFRPLHQGDLQGLFDUHOXVRGHXQFRQWUDFHSWLYRHIHFWLYR
'URJDVLOHJDOHV
'HXQDIRUPDJHQHUDOVHSXHGHD¿UPDUTXHWRGDVODVGURJDVDIHFWDQHQIRUPDQHJDWLYD
DODPXMHUVXHQWRUQR\DOIXWXURHPEDUD]R/DPD\RUSDUWHGHODVGURJDVLOtFLWDVDO
DWUDYHVDUODEDUUHUDSODFHQWDULDDIHFWDQDOIHWRHOTXHHVPX\YXOQHUDEOHODVGURJDV
GHSHVRPROHFXODUPX\EDMRSDVDQDOIHWRFRQJUDQIDFLOLGDG\XQDSHTXHxDFDQWLGDG
SXHGHWUDQVIRUPDUVHHQXQDVREUHGRVLV(OXVRGHFRFDtQDGXUDQWHODJHVWDFLyQKD
VLGR YLQFXODGR D GHIHFWRV SRU GLVUXSFLyQ YDVFXODU H[SUHVDGRV HQ DQRPDOtDV GHO
VLVWHPDQHUYLRVRFHQWUDOGHIHFWRVSRUUHGXFFLyQGHPLHPEURV\5&,/DPDULKXDQD
SUHVHQWDHIHFWRVVLPLODUHVDORVFDXVDGRVSRUHOFLJDUULOOR
$GHPiVGHH[SOLFDUORVULHVJRVGHHOFRQVXPRGHVXVWDQFLDVVHGHEHSURSRQHUXQ
SODQGHWUDWDPLHQWRSDUDHODEDQGRQRGHODDGLFFLyQPLHQWUDVHVWRQRVHFRQVLJXHVH
GHEHUiVXJHULUSRVSRQHUHOHPEDUD]RSDUDORFXDOGHEHLQGLFDUVHXQFRQWUDFHSWLYR
VHJXUR
&DIpWpPDWHEHELGDVFROD
'HEH DFRQVHMDUVH XQ XVR PRGHUDGR GH HVWRV HVWLPXODQWHV GH FRQVXPR KDELWXDO
6XXVRDDOWDVGRVLVHQHOSULPHUWULPHVWUHGHOHPEDUD]RVHKDDVRFLDGRFRQDERUWR
HVSRQWiQHR$ORODUJRGHOHPEDUD]RVRQFDSDFHVGHSURYRFDUEDMRSHVRDOQDFHU
&RQVXPRGHPHGLFDPHQWRV
(O FRQVXPR QRUPDO GH PHGLFDPHQWRV HV QHFHVDULR SDUD FXUDU R FRQWURODU XQD
GHWHUPLQDGDDIHFFLyQHQHVRVFDVRVVLHPSUHVHGHEHUiYDORUDUHOPRPHQWRRSRUWXQR
SDUDUHFRPHQGDUXQHPEDUD]R3HURHQRWUDVRSRUWXQLGDGHVHOXVRGHPHGLFDPHQWRV
SRU DXWRLQGLFDFLyQ SXHGH FRQ¿JXUDU XQ SDWUyQ DGLFWLYR HQ HVWRV FDVRV FRPR \D VH
LQGLFy FRQ HO DEXVR GH RWUDV VXVWDQFLDV VH GHEHUi LQIRUPDU VREUH ORV ULHVJRV TXH
LPSOLFDHOXVRVREUHODVDOXGGHODPXMHU\GHXQIXWXURHPEDUD]R/DSUHPLVDDGDUD
WRGDPXMHUTXHSLHQVDHPEDUD]DUVHHV³/RVPHGLFDPHQWRVGHEHQHYLWDUVHDPHQRVTXH
VHDQLQGLVSHQVDEOHV´\HQHVWRVFDVRVGHEHUiFRQVXOWDUDOHTXLSRGHVDOXGSDUDHYDOXDU
FXLGDGRVDPHQWHHOULHVJRIHWDOIUHQWHDOEHQH¿FLRPDWHUQRGHGLFKDPHGLFDFLyQ
/D FDQWLGDG GH PHGLFDPHQWRV H[LVWHQWHV HV WDQ JUDQGH TXH VROR PHQFLRQDUHPRV
DTXHOORV TXH SRU VX HIHFWR GHOHWpUHR GHEHQ VHU HYLWDGRV HQ PXMHUHV TXH SODQHDQ
HPEDUD]DUVH
,VRWUHWLQRtQD
/D YLWDPLQD $ \ DOJXQRV GH VXV GHULYDGRV iFLGR 5HWLQRLFR WLHQHQ XQD ODUJD \
FRPSUREDGDDFFLyQWHUDWRJpQLFDHQKXPDQRV
/D,VRWUHWLQRtQDSDUDHOWUDWDPLHQWRGHO$FQp4XtVWLFR\HO(WUHWLQDWRSDUDWUDWDUOD
3VRULDVLVVRQDOWDPHQWHWHUDWRJpQLFRV'HEHUiGHVDFRQVHMDUVHHOHPEDUD]RKDVWD
XQDxRGHVSXpVGHKDEHUVXVSHQGLGRVXXVRHLQGLFDQGRXQDQWLFRQFHSWLYRVHJXUR
/RV GHIHFWRV DO QDFLPLHQWR FDXVDGRV SRU ORV UHWLQRLGHV VRQ IXQGDPHQWDOPHQWH
FUDQHRIDFLDOHV FDUGLRYDVFXODUHV GHO VLVWHPD QHUYLRVR FHQWUDO \ WLPR (O UHWDUGR
PHQWDOWDPELpQKDVLGRREVHUYDGRHQODPLWDGGHORVFDVRVGHQLxRVVREUHYLYLHQWHV
PD\RUHVDDxRVXQWHUFLRGHHVWHJUXSRQRSUHVHQWDEDGHIHFWRVDOQDFLPLHQWR
/DFRQWUDLQGLFDFLyQGHOXVRGHHVWDYLWDPLQD\VXVGHULYDGRVGXUDQWHHOHPEDUD]R
GHEHVHUGLYXOJDGRHQWUHORVHTXLSRVGHVDOXG\HQODSREODFLyQJHQHUDO
7DOLGRPLGD
(VXQPHGLFDPHQWRSUREDGDPHQWHWHUDWRJpQLFRTXHSURYRFDXQFXDGURFDUDFWHUtVWLFR
FRQIRFRPHOLDFD\yHQGHVXVRKDVWDKDFHSRFRVDxRVHQTXHHQFRQWUyVXOXJDU
SDUDHOWUDWDPLHQWRGHODOHSUD\HO9,+7RGDPXMHUTXHHVWpUHFLELHQGRWDOLGRPLGD
GHEHUiVXVSHQGHUODDQWHVGHOHPEDUD]R
$QWLFRQYXOVLYDQWHV
0XFKDV GH ODV GURJDV XVDGDV SDUD HO WUDWDPLHQWR GH ODV FRQYXOVLRQHV KDQ VLGR
YLQFXODGDV FRQ P~OWLSOHV WUDVWRUQRV DXQTXH H[LVWH FLHUWD GL¿FXOWDG HQ GHWHUPLQDU
VLWRGDVODVDOWHUDFLRQHVVHGHEHQDORVPHGLFDPHQWRVRVHFRUUHVSRQGHQFRQOD
HQIHUPHGDGGHIRQGR
'L)HQLO+LGDQWRtQD6HDVRFLDFRQPD\RUULHVJRGHSURYRFDUGHIHFWRVGHOWXER
QHXUDOSRUORTXHVHGHVDFRQVHMDVXXVR\DTXHODVPLVPDVSXHGHQLQWHUIHULU
HQHOPHWDEROLVPRGHORVIRODWRVSRUORTXHVHUHFRPLHQGDHVSHFt¿FDPHQWHHO
XVRGHÈFLGR)yOLFRDUD]yQGHPJGtDGXUDQWHHOSHUtRGRSHULFRQFHSFLRQDO
3HURODHQWLGDGPiVFRQRFLGDHVHOVtQGURPHKLGDQWRtQLFRIHWDOLQFOX\HQGR5&,
PLFURFHIDOLD GLVPRU¿DV IDFLDOHV SDODGDU KHQGLGR \ ODELR OHSRULQR KLSRSODVLD
GLJLWDOGLVWDO\DYHFHVFDUGLRSDWtD
&DUEDPD]HSLQD6HODKDYLQFXODGRFRQULHVJRGHPXHUWHIHWDOGHIHFWRVGHOWXER
QHXUDOGHIHFWRVFDUGtDFRV\SDODGDUKHQGLGRDGHPiVGHRWURVGHIHFWRV
ÈFLGR9DOSURLFR+DVLGRYLQFXODGRFRQGHIHFWRVGHOWXERQHXUDO5&,UHWUDVRHQ
HOGHVDUUROOR\HQHODSUHQGL]DMHDGHPiVGHFDUGLRSDWtDFRQJpQLWD
&XPDUtQLFRV
(O HPSOHR GH DQWLFRDJXODQWHV FXPDUtQLFRV HVWi UHVWULQJLGR EiVLFDPHQWH D ODV
PXMHUHVFRQYiOYXODVFDUGtDFDVSURWpVLFDVRFRQDQWHFHGHQWHVGHWURPERVLVYHQRVD
SURIXQGD
(OHIHFWRWHUDWRJpQLFRVHH[SUHVDHQKLSRSODVLDGHOFDUWtODJRQDVDODWUR¿DySWLFD
HSt¿VLVSXQFWDWDGHQRPLQDGDHPEULRSDWtDSRUZDUIDULQDSRUORTXHVHUHFRPLHQGD
FDPELDUDKHSDULQDVGHEDMRSHVRPROHFXODUGHVGHHOPRPHQWRHQTXHVHFRPLHQ]D
DSODQL¿FDUXQHPEDUD]R
$QWLKLSHUWHQVLYRV
7RGRVORVDJHQWHVDQWLKLSHUWHQVLYRVGHEHQVHUXVDGRVFXLGDGRVDPHQWHGHELGRDORV
ULHVJRVYLWDOHVTXHUHSUHVHQWDQSDUDODPXMHUSRUHMHPSORDOSURYRFDUXQDKLSRWHQVLyQ
VHYHUD(OULHVJRGHKLSRWHQVLyQVHYHUDVXHOHVHUPiVJUDYHSDUDHOIHWR3HURPiV
DOOi GH ORV ULHVJRV KHPRGLQiPLFDV TXH JHQHUD HO XVR GH HVWR PHGLFDPHQWRV VH
KD SRGLGR HVWDEOHFHU TXH DOJXQRV GH HOORV VRQ WHUDWRJpQLFRV GH WDO PDQHUD TXH
FXDQGRXQDPXMHUSODQHDHPEDUD]DUVHRGHKHFKRSUHVHQWDXQHPEDUD]RHQHWDSDV
LQFLSLHQWHVGHEHUiLQGLFiUVHOHHOFDPELRSRUDQWLKLSHUWHQVLYRVPiVVHJXURVFRPR
ODDOIDPHWLOGRSDHQODKLSHUWHQVLyQDUWHULDOFUyQLFD\ODKLGUDODFLQDHQKLSHUWHQVLyQ
DUWHULDODJXGD
,QKLELGRUHVGHOD(Q]LPD&RQYHUVRUDGHOD$QJLRWHQVLQD,(&$V\$QWDJRQLVWDV
GH ORV 5HFHSWRUHV GH OD$QJLRWHQVLQD ,, $5$ ,, (VWRV DQWLKLSHUWHQVLYRV KDQ
VLGRYLQFXODGRVDGDxRUHQDOIHWDOHVSHFLDOPHQWHFXDQGRVRQXVDGRVGXUDQWHHO
VHJXQGR\WHUFHUWULPHVWUH
6DOHVGH/LWLR
(V XQ PHGLFDPHQWR DQWLGHSUHVLYR TXH HQ ORV IHWRV KXPDQRV SXHGH SURYRFDU
FDUGLRSDWtDFRQJpQLWDDGHPiVGHRWUDVPDOIRUPDFLRQHVHQWUHODVTXHVHLQFOX\HQ
GHIHFWRVGHOWXERQHXUDO'HEHVHUVXVSHQGLGRRFDPELDGRSRUDQWLGHSUHVLYRVPiV
VHJXURVHQDTXHOODPXMHUTXHVHHQFXHQWUDSODQL¿FDQGRXQHPEDUD]R
$QWLELyWLFRV
(OXVRGHDQWLELyWLFRVHVVXPDPHQWHH[WHQGLGR\VXQLYHOGHVHJXULGDGHVEDVWDQWH
DOWR'HWRGDVIRUPDVVLJXHDSOLFDQGRHOFRQFHSWRJHQHUDODQWHULRUPHQWHLQGLFDGR
GHUHVWULQJLUVXXVRVRORDDTXHOODVVLWXDFLRQHVHQODVTXHHOEHQH¿FLRVHDPD\RU
TXHORVULHVJRV
6HDGYLHUWHWHQHUHVSHFLDOFXLGDGRFRQORVVLJXLHQWHVDQWLELyWLFRV
(VWUHSWRPLFLQD \ .DQDPLFLQD +DQ VLGR DVRFLDGRV FRQ VRUGHUD SRU VX
RWRWR[LFLGDG
7HWUDFLFOLQDV 6X XVR GXUDQWH HO HPEDUD]R VH KD UHODFLRQDGR FRQ WUDVWRUQRV
HVTXHOpWLFRV \ GH OD FRQVWLWXFLyQ GHO HVPDOWH GH ORV GLHQWHV 7DPELpQ VH KD
DVRFLDGR D WR[LFLGDG KHSiWLFD GH ODV PXMHUHV \ D RWURV WUDVWRUQRV QHRQDWDOHV
FRPR GHIHFWRV GHO WXER QHXUDO SDODGDU KHQGLGR ODELR OHSRULQR FDUGLRSDWtDV \
UHGXFFLyQGHPLHPEURVHQWUHGHRWURVWUDVWRUQRV
0LVRSURVWRO
+D VLGR UHODFLRQDGR FRQ PDOIRUPDFLRQHV FRQJpQLWDV YLQFXODGDV DO HIHFWR GH OD
LQWHUUXSFLyQ R DOWHUDFLyQ GHO ÀXMR FLUFXODWRULR HPEULRIHWDO WDPELpQ FRQRFLGR FRPR
GLVUXSFLyQ YDVFXODU (QWUH GLFKDV PDOIRUPDFLRQHV VH GHVWDFDQ SDUiOLVLV IDFLDO
SDUiOLVLVGHODPLUDGDODWHUDOKLGURFHIDOLD\FDUGLRSDWtDV
9DFXQDV
/DFRQVXOWDSUHFRQFHSFLRQDOGHEHVHUXQiPELWRSDUDODDWHQFLyQLQWHJUDOGHODVDOXG
GHODPXMHU6LELHQYDFXQDUDQWHVGHOHPEDUD]RHVXQDPHGLGDGHSUHYHQFLyQSULPDULD
TXHKDGHPRVWUDGRVHUDOWDPHQWHHIHFWLYDSDUDGLVPLQXLUODWUDQVPLVLyQPDWHUQRIHWDO
GHFLHUWDVLQIHFFLRQHVWRGDPXMHUTXHOOHJXHDODFRQVXOWDSUHFRQFHSFLRQDOGHEHVHU
LQYHVWLJDGDVREUHVXHVWDGRLQPXQLWDULR\YDFXQDGDHQFRQVHFXHQFLDDXQTXHGHVFDUWH
ODSRVLELOLGDGGHHPEDUD]DUVH
9DULFHOD
(VLGHDOTXHWRGDVODVQLxDVVHDQYDFXQDGDVFRQWUDODYDULFHODHQHWDSDVLQFLSLHQWHV
GHVXYLGD3HURHQFDVRGHPXMHUHVTXHQRKDQVLGRYDFXQDGDV\QRKD\HYLGHQFLDV
GH TXH KD\DQ VXIULGR YDULFHOD HQ DOJ~Q PRPHQWR SRGUiQ VHU YDFXQDGDV GXUDQWH OD
FRQVXOWD SUHFRQFHSFLRQDO (VWD YDFXQD WLHQH FRQWUDLQGLFDGD VX DSOLFDFLyQ GXUDQWH HO
HPEDUD]R
5XEpROD
$XQTXHHVWDYDFXQDKDGHPRVWUDGRVHUEDVWDQWHVHJXUDVHFRQWUDLQGLFDVXDSOLFDFLyQ
GXUDQWHHOHPEDUD]R
+HSDWLWLV%7pWDQRV\*ULSH
6L ELHQ HV LGHDO DGPLQLVWUDU HVWDV YDFXQDV GXUDQWH OD FRQVXOWD SUHFRQFHSFLRQDO HV
LPSRUWDQWHVDEHUTXHWDPELpQSXHGHQVHUDSOLFDGDVGXUDQWHHOHPEDUD]R\DTXHKDQ
GHPRVWUDGRTXHVXEHQH¿FLRHVPD\RUTXHORVULHVJRVTXHFRPSRUWDQ
0XFKDVGHODVDFFLRQHVGHVFULWDVSDUDHYLWDUGHIHFWRVFRQJpQLWRVWLHQHQODYLUWXGGH
PHMRUDUODVDOXGPDWHUQDFRQWUROGHODKLSHUWHQVLyQDUWHULDOGHODGLDEHWHVHWF\SRU
ORWDQWRUHGXFHQHOULHVJRGHGDxRDODPXMHU
5HIHUHQFLDV%LEOLRJUi¿FDV
%ULJV**&RFDLQH,Q)UHPDQ5.<DIHH6-%ULJV**HGV'UXJVLQSUHJQDQF\DQGODFWDWLRQ
DUHIHUHQFHJXLGHWRIHWDODQGQHRQDWDOULVN7KHGLWLRQ%DOWLPRUH/LSSLQFRWW:LOOLDPV :LONLQV
SS
&DSLWiQ-XUDGR0&DEUHUD9pOH]5/DFRQVXOWDSUHFRQFHSFLRQDOHQ$WHQFLyQ3ULPDULD(YDOXDFLyQ
GHODIXWXUDJHVWDQWH0(',)$0
&DVLPLUR)$UHQD-2UHUD0\FRO*XtDSDUDOD3UHYHQFLyQGHGHIHFWRVFRQJpQLWRV0LQLVWHULRGH
6DQLGDG\&RQVXPR6HFUHWDULD*HQHUDOGH6DQLGDGGH(VSDxD
&DVWLOOD((/ySH]&DPHOR-63D]-(2ULROL,03UHYHQFLyQ3ULPDULDGHORV'HIHFWRV&RQJpQLWRV
5LRGH-DQHLUR(GLWRUD)LR&UX]
&RRQURG'9-DFN%:%RJJHVV.$/RQJ5&RQU\-$&R[61&HIDOR5+XQWHU.'3L]]LFD$
'XQORS$/7KHFOLQLFDOFRQWHQWRISUHFRQFHSWLRQFDUHLPPXQL]DWLRQVDVSDUWRISUHFRQFHSWLRQFDUH
$P-2EVWHW*\QHFRO'HF6XSSO6
&RRQURG'9-DFN%:6WXEEOH¿HOG3*+ROOLHU/0%RJJHVV.$&HIDOR5&R[61'XQORS$/
+XQWHU.'3UDVDG05/X0&&RQU\-$*LEEV56+RJDQ9.7KHFOLQLFDOFRQWHQWRISUHFRQFHS
WLRQFDUHLQIHFWLRXVGLVHDVHVLQSUHFRQFHSWLRQFDUH$P-2EVWHW*\QHFRO'HF6XSSO
6
'DJQLQR03UDWR$'H0HQH]HV6)ORUHV5,Q076DQVHYHULQR'6SULW]HUO6FKOHU)DFFLQL
2UJ0DQXDOGHWHUDWRJrQHVH3RUWR$OHJUH(GLWRUDGD8QLYHUVLGDGHSS
'H0XFLR%7HUDWRORJLD0HGLFDPHQWRV\RWUDVVXVWDQFLDV(Q6FKZDUF]5)HVFLQD5'XYHUJHV
&2EVWHWULFLDHGLFLyQ%XHQRV$LUHV(O$WHQHRSS
'XQORS$/*DUGLQHU306KHOOKDDV&60HQDUG0.0F'LDUPLG0$7KHFOLQLFDOFRQWHQWRISUH
FRQFHSWLRQFDUHWKHXVHRIPHGLFDWLRQVDQGVXSSOHPHQWVDPRQJZRPHQRIUHSURGXFWLYHDJH$P-
2EVWHW*\QHFRO'HF6XSSO6
'XQORS$/-DFN%:%RWWDOLFR-1/X0&-DPHV$6KHOOKDDV&6+DOOVWURP/+6RORPRQ%'
)HHUR:*0HQDUG0.3UDVDG057KHFOLQLFDOFRQWHQWRISUHFRQFHSWLRQFDUHZRPHQZLWKFKURQLF
PHGLFDOFRQGLWLRQV$P-2EVWHW*\QHFRO'HF6XSSO6
(NERP$:DNH¿HOG$=DFN0$GDPL23HULQDWDOPHDVOHVLQIHFWLRQDQGVXEVHTXHQW&URKQ¶VGLV
HDVH/DQFHW
(\QDUG$50XQR]65XL]0RUHQR/3DVTXDOLQL0('H)DEUR63$JJUHJDWRU\EHKDYLRXURISODWH
OHWVLQFXEDWHGZLWKVXEFHOOXODUIUDFWLRQVRIQRUPDODQGFKDJDVLFKXPDQV\QF\WLRWURSKREODVW5HY,QVW
0HG7URS6DR3DXOR
)LVKLQJHU0RXUD&3RQWH/,Q076DQVHYHULQR'6SULW]HUO6FKOHU)DFFLQL2UJ0DQXDOGH
WHUDWRJrQHVH3RUWR$OHJUH(GLWRUDGD8QLYHUVLGDGHSS
)OR\G5/-DFN%:&HIDOR5$WUDVK+0DKRQH\-+HUURQ$+XVWHQ&6RNRO5-7KHFOLQLFDOFRQ
WHQWRISUHFRQFHSWLRQFDUHDOFRKROWREDFFRDQGLOOLFLWGUXJH[SRVXUHV$P-2EVWHW*\QHFRO
'HF6XSSO6
)ULHGHU$'XQORS$/&XOSHSSHU/%HUQVWHLQ367KHFOLQLFDOFRQWHQWRISUHFRQFHSWLRQFDUHZRPHQ
ZLWKSV\FKLDWULFFRQGLWLRQV$P-2EVWHW*\QHFRO'HF6XSSO6
*DUGLQHU301HOVRQ/6KHOOKDDV&6'XQORS$//RQJ5$QGULVW6-DFN%:7KHFOLQLFDOFRQWHQW
RI SUHFRQFHSWLRQ FDUH QXWULWLRQ DQG GLHWDU\ VXSSOHPHQWV$P -2EVWHW *\QHFRO 'HF
6XSSO6
.DOWHU+&DVHUHSRUWVRIPDOIRUPDWLRQVDVVRFLDWHGZLWKPDWHUQDOGLDEHWHVKLVWRU\DQGFULWLTXH
&OLQ*HQHW5HYLHZ
.LHO\-/3DQHWK16XVVHU0$QDVVHVVPHQWRIWKHHIIHFWVRIPDWHUQDODJHDQGSDULW\LQGLIIHUHQW
FRPSRQHQWVRISHULQDWDOPRUWDOLW\$P-(SLGHPLRO
/DUUDQGDEXUX 0$ORQVR - *XWLHUUH] & 3UHYHQFLyQ 3ULPDULD GH ORV GHIHFWRV GH WXER QHXUDO (Q
8UXJXD\HVQHFHVDULDODIRUWL¿FDFLyQGHDOLPHQWRVFRQIRODWRV$UFKLYRVGH*LQHFRORJtD\2EVWHWULFLD

/DUUDQGDEXUX 0 9DJOLR$ /HPHV$ 4XDGUHOOL 5 'HIHFWRV FRQJpQLWRV HQ 8UXJXD\ 8Q DERUGDMH
HSLGHPLROyJLFR7HQGHQFLDVHQ0HGLFLQD
/RZH6$'UXJVLQSUHJQDQF\$QWLFRQYXOVDQWVDQGGUXJVIRUQHXURORJLFDOGLVHDVH%HVW3UDFW5HV
&OLQ2EVWHW*\QDHFRO5HYLHZ
/\QEHUJ0&.KRXU\0-/X;0DWHUQDOÀXIHYHUDQGWKHULVNRIQHXUDOWXEHGHIHFWVDSRSX

ODWLRQEDVHGFDVHFRQWUROVWXG\$P-(SLGHPLRO
0DUWtQH])UtDV0/%ROHWtQGHO(&(0&(VWXGLR&RODERUDWLYR(VSDxROGH0DOIRUPDFLRQHV&RQJpQL
WDV5HYLVWDGH'LVPRUIRORJtD\(SLGHPLRORJtD
0DUWtQH])UtDV0/(SLGHPLRORJLFDODQDO\VLVRIRXWFRPHVRISUHJQDQF\LQGLDEHWLFPRWKHUVLGHQ
WL¿FDWLRQ RI WKH PRVW FKDUDFWHULVWLF DQG PRVW IUHTXHQW FRQJHQLWDO DQRPDOLHV $P - 0HG *HQHW

-RKQVRQ.3RVQHU6)%LHUPDQQ-HWDO5HFRPPHQGDWLRQVWR,PSURYH3UHFRQFHSWLRQ+HDOWKDQG
+HDOWK &DUH 8QLWHG 6WDWHV$ 5HSRUW RI WKH &'&$76'5 3UHFRQFHSWLRQ &DUH :RUN *URXS DQG
WKH6HOHFW3DQHORQ3UHFRQFHSWLRQ&DUH00:5$SULO55>,QWHUQHW@ODVW
UHYLHZHG 'LVSRQLEOH HQ KWWSZZZFGFJRYPPZ5SUHYLHZPPZUKWPOUUDKWP
ÒOWLPRDFFHVRGHIHEUHURGH
2¶5RXUNH .0 5RGG\ 0( :LOOLDPV ' 0HQD 3UHGLFWRUV RI HDUO\ SRVWSDUWXP YLWDPLQ XVH
DPRQJZRPHQRI0H[LFDQRULJLQLPSOLFDWLRQVIRUKHDOWKFDUHSURYLGHUUHFRPPHQGDWLRQV(WKQ'LV

3RQWH / /RJXHUFLR /HLWH - ,Q 07 6DQVHYHULQR ' 6SULW]HU O 6FKOHU)DFFLQL 2UJ 0DQXDO GH
WHUDWRJrQHVH3RUWR$OHJUH(GLWRUDGD8QLYHUVLGDGHSS
5DPRV$UUR\R 0$ 5RGULJXH] 3LQLOOD ( &RUGHUR -) 0DWHUQDO GLDEHWHV WKH ULVN IRU VSHFL¿F ELUWK
GHIHFWV(XU-(SLGHPLRO-XO
5HSRUWRID:+27HFKQLFDO&RQVXOWDWLRQRQ%LUWK6SDFLQJ*HQHYD6ZLW]HUODQG±-XQH
'LVSRQLEOH HQ KWWSZZZZKRLQWPDNLQJBSUHJQDQF\BVDIHUGRFXPHQWVELUWKBVSDFLQJHQLQGH[
KWPO~OWLPRDFFHVRGHRFWXEUHGH
5RVHQQ % 0LRGRYQLN 0 &RPEV &$ .KRXU\ - 6LGGLTXL 7$ *O\FHPLF WKUHVKROGV IRU VSRQWDQH
RXVDERUWLRQDQGFRQJHQLWDOPDOIRUPDWLRQVLQLQVXOLQGHSHQGHQWGLDEHWHVPHOOLWXV2EVWHW*\QHFRO

6FKZDUF]5)HVFLQD53HQ]R60/RVFXLGDGRVSUHFRQFHSFLRQDOHV(Q6FKZDUF]5)HVFLQD5
'XYHUJHV&2EVWHWULFLDHGLFLyQ%XHQRV$LUHV(O$WHQHRSS
6XEUDPDQLDQ'0RLVH.-:KLWH$&-U,PSRUWHGPDODULDLQSUHJQDQF\UHSRUWRIIRXUFDVHVDQG
UHYLHZRIPDQDJHPHQW&OLQ,QIHFW'LV
6WXEEOH¿HOG3*&RRQURG'95HGG\806D\HJK51LFKROVRQ:5\FKOLN')-DFN%:7KHFOLQLFDO
FRQWHQWRISUHFRQFHSWLRQFDUHUHSURGXFWLYHKLVWRU\$P-2EVWHW*\QHFRO'HF6XSSO
6
7HQ.DWH/3(SLGHPLRORJ\RISRWHQWLDOO\DYRLGDEOHELUWKGHIHFWV(XU-(SLGHPLRO
7KRP'+1HOVRQ/09DXJKDQ7/6SRQWDQHRXVDERUWLRQDQGVXEVHTXHQWDGYHUVHELUWKRXWFRPHV
$P-2EVWHW*\QHFRO3W
7KRPSVRQ-63ULQFLSLRVJHQHUDOHV\DQRPDOtDVDXWRVyPLFDV(Q7KRPSVRQ 7KRPSVRQ*HQp
WLFDHQ0HGLFLQDWDHG3KLODGHOSKLD0DVVRQ
7KXUQ-+XPDQSDUYRYLUXV%KLVWRULFDODQGFOLQLFDOUHYLHZ5HY,QIHFW'LV
5HYLHZ
9LHUD6DQVHYHULQR07,Q076DQVHYHULQR'6SULW]HUO6FKOHU)DFFLQL2UJ0DQXDOGHWHUD

WRJrQHVH3RUWR$OHJUH(GLWRUDGD8QLYHUVLGDGHSS
,,, &RQWURO3UHQDWDO
9LJLODQFLD'XUDQWHOD*HVWDFLyQ
(YDOXDFLyQGHO5LHVJR&RQFHSFLRQDO\&RQGXFWDV
& $ 3, 7 8 /2 , , ,
(),&$&,$'(/&21752/35(1$7$/'(587,1$
(QHODxR+XQWLQJWRQD¿UPyTXH³HOFRQWUROSUHQDWDOVHSDJDSRUVtPLVPR´\HQHVWH
VLJORODVHYDOXDFLRQHVFUtWLFDVGHOFRQWUROSUHQDWDOKDQFRLQFLGLGRFRQHVDD¿UPDFLyQ
/DPD\RUtDGHORVDXWRUHVDFWXDOPHQWHFRLQFLGHQHQVXH¿FDFLD\ORVSDtVHVKDFHQ
ORVPD\RUHVHVIXHU]RVSRUDXPHQWDUODFREHUWXUD\PHMRUDUODFDOLGDGPLHQWUDVTXHOD
SREODFLyQORGHPDQGDFRQPD\RUGHFLVLyQ
$XQTXH ODV HYLGHQFLDV VRQ IDYRUDEOHV KDQ KDELGR IDFWRUHV TXH FRQWULEX\HURQ DO
GHVSUHVWLJLRGHOFRQWUROSUHQDWDOSUHVWDFLRQHVTXHEDMRHOUyWXORGHFRQWUROSUHQDWDOVRQ
VyORYLVLWDVHQODVTXHQRVHFXPSOHFRQORVHVWiQGDUHVPtQLPRVGHFDOLGDGKDELHQGR
XQDSREUHLQWHUDFFLyQHQWUHODXVXDULDVXIDPLOLD\ORVWUDEDMDGRUHVGHVDOXG3RUHVWD
UD]yQHVQHFHVDULRHVWDEOHFHUFXDOHVVRQORVFULWHULRVTXHGH¿QHQDOFRQWUROSUHQDWDO
GHFDOLGDG
'H¿QLFLyQ\JHQHUDOLGDGHV
6HHQWLHQGHSRUFRQWUROSUHQDWDOFRQWURODQWHQDWDODVLVWHQFLDSUHQDWDOFXLGDGRSUHQDWDO
FRQVXOWDSUHQDWDODODVHULHGHHQWUHYLVWDVRYLVLWDVSURJUDPDGDVGHODHPEDUD]DGD
FRQLQWHJUDQWHVGHOHTXLSRGHVDOXGFRQHOREMHWLYRGHYLJLODUODHYROXFLyQGHOHPEDUD]R
\REWHQHUXQDDGHFXDGDSUHSDUDFLyQSDUDHOSDUWR\ODFULDQ]D
&RQHOFRQWUROSUHQDWDOVHSHUVLJXH
ODGHWHFFLyQGHHQIHUPHGDGHVPDWHUQDVVXEFOtQLFDV
ODSUHYHQFLyQGLDJQyVWLFRWHPSUDQR\WUDWDPLHQWRGHODVFRPSOLFDFLRQHVGHO
HPEDUD]R
ODYLJLODQFLDGHOFUHFLPLHQWR\ODYLWDOLGDGIHWDO
ODGLVPLQXFLyQGHODVPROHVWLDV\VtQWRPDVPHQRUHVDVRFLDGRVDOHPEDUD]R
ODSUHSDUDFLyQSVLFRItVLFDSDUDHOQDFLPLHQWR
ODDGPLQLVWUDFLyQGHFRQWHQLGRVHGXFDWLYRVSDUDODVDOXGODIDPLOLD\ODFULDQ]D
8QFRQWUROSUHQDWDOH¿FLHQWHGHEHFXPSOLUFRQFXDWURUHTXLVLWRVEiVLFRV
3UHFR] &RPSOHWR
3HULyGLFR 'HDPSOLDFREHUWXUD
3UHFR] /D SULPHUD YLVLWD GHEH UHDOL]DUVH WHPSUDQDPHQWH HQ OR SRVLEOH GXUDQWH HO
SULPHUWULPHVWUHGHODJHVWDFLyQ(VWRSHUPLWHODHMHFXFLyQRSRUWXQDGHODVDFFLRQHVGH
SURPRFLyQSURWHFFLyQ\UHFXSHUDFLyQGHODVDOXGTXHFRQVWLWX\HQODUD]yQIXQGDPHQWDO
GHOFRQWURO$GHPiVWRUQDIDFWLEOHODLGHQWL¿FDFLyQWHPSUDQDGHORVHPEDUD]RVGHDOWR
ULHVJRDXPHQWDQGRSRUORWDQWRODSRVLELOLGDGGHSODQL¿FDUH¿FD]PHQWHHOPDQHMRGH
FDGDFDVRHQFXDQWRDODVFDUDFWHUtVWLFDVGHODDWHQFLyQREVWpWULFDTXHGHEHUHFLELU
3HULyGLFR/DIUHFXHQFLDGHORVFRQWUROHVSUHQDWDOHVYDUtDVHJ~QHOJUDGRGHULHVJRTXH
SUHVHQWDODHPEDUD]DGD/DVPXMHUHVFRQHPEDUD]RVGHEDMRULHVJRUHTXHULUiQXQQ~PHUR
PHQRUGHFRQWUROHVHQWUH\TXHODVGHDOWRULHVJR
&RPSOHWR/RVFRQWHQLGRVPtQLPRVGHOFRQWUROGHEHUiQJDUDQWL]DUHOFXPSOLPLHQWRHIHFWLYR
GHODVDFFLRQHVGHSURPRFLyQSURWHFFLyQUHFXSHUDFLyQ\UHKDELOLWDFLyQGHODVDOXG
$PSOLDFREHUWXUD(QODPHGLGDTXHHOSRUFHQWDMHGHODSREODFLyQFRQWURODGDHVPiV
DOWRORLGHDOHVTXHDEDUTXHDWRGDVODVHPEDUD]DGDVPD\RUVHUiHOLPSDFWRSRVLWLYR
VREUHODPRUELPRUWDOLGDGPDWHUQD\SHULQDWDO
(Q JHQHUDO SDUD UHDOL]DU XQ FRQWURO SUHQDWDO HIHFWLYR GH SRU Vt DPEXODWRULR QR VH
SUHFLVDQLQVWDODFLRQHVFRVWRVDVDSDUDWRVFRPSOLFDGRVQLODERUDWRULRVR¿VWLFDGRSHUR
Vt VH UHTXLHUH HO XVR VLVWHPiWLFR GH XQD KLVWRULD FOtQLFD TXH UHFRMD \ GRFXPHQWH OD
LQIRUPDFLyQ SHUWLQHQWH \ HO HPSOHR FULWHULRVR GH WHFQRORJtDV VHQVLEOHV TXH DQXQFLHQ
WHPSUDQDPHQWHODH[LVWHQFLDGHXQULHVJRPD\RUTXHHOHVSHUDGR
(OFRQWUROSUHQDWDODGHFXDGRHQFDQWLGDGFDOLGDGFRQWHQLGRVRSRUWXQLGDGGLIHUHQFLDGR
DFRUGHDOULHVJRWLHQHXQHQRUPHSRWHQFLDOGHFRQWULEXFLyQDODVDOXGIDPLOLDU\HVXQ
FODURHMHPSORGHPHGLFLQDSUHYHQWLYD'RWDGRFRQHVWDVFDUDFWHUtVWLFDV\RULHQWDFLRQHV
HVXQIHQyPHQRGHJUDQGHVDUUROORHQORV~OWLPRVFXDUHQWDDxRV$SOLFDGRHQIRUPD
UXWLQDULD\H[WHQVLYDFRQMXQWDPHQWHFRQRWUDVPHGLGDVGHVDOXGS~EOLFDFRPRODDWHQFLyQ
LQVWLWXFLRQDOGHOQDFLPLHQWRHOHPSOHRGHFULWHULRVGHULHVJRSDUDGHWHUPLQDUUHIHUHQFLD
\QLYHOHVGHDVLVWHQFLD\ODDWHQFLyQLQPHGLDWDGHORVUHFLpQQDFLGRVFRQWULEX\HDHYLWDU
PXHUWHVOHVLRQHVPDWHUQDV\SHULQDWDOHV
$GHPiVGHODPHMRUtDHQODWDVDGHPRUWDOLGDGSHULQDWDO\ODUD]yQGHPRUWDOLGDGPDWHUQD
TXHSXHGHQDVRFLDUVHFRQODLQFOXVLyQGHOFRQWUROSUHQDWDOH[WHQVLYRHQORVSURJUDPDV
PDWHUQRLQIDQWLOHVKD\SRVLEOHVHIHFWRVDGLFLRQDOHVGHLPSDFWRGLItFLOGHPHGLUSHURQR
PHQRV LPSRUWDQWHV$OHMDU ODV GXGDV GH ODV JHVWDQWHV GHVSHMDU ORV PLHGRV \ WDE~HV
UHVSHWDQGRODVSDXWDVFXOWXUDOHVORJUDUPD\RUDFHUFDPLHQWR\FRQ¿DQ]DKDFLDHOVLVWHPD
GHVDOXGXQDDFWLWXGPiVSRVLWLYDKDFLDODPDWHUQLGDGKDFLDHOHVSDFLDPLHQWRGHORV
KLMRV HO PHMRUDPLHQWR GH ORV KiELWRV IDPLOLDUHV PHMRU GLVSRVLFLyQ SDUD HO FRQWURO GHO
FUHFLPLHQWR\GHOGHVDUUROORXOWHULRUGHOQLxRIRPHQWDUODDFWLWXGKDFLDODODFWDQFLDQDWXUDO
GDUDFRQRFHUHOSODQGHYDFXQDFLyQHWFVRQHMHPSORVGHODVP~OWLSOHVYHQWDMDVTXH
WLHQHXQEXHQSURJUDPDGHFRQWUROSUHQDWDO
6RQEDUUHUDVSDUDHOFRQWUROSUHQDWDOHIHFWLYR
DVXFRVWRFXDQGRQRHVJUDWXLWRSDUDODXVXDULDDORTXHVHGHEHDJUHJDUJDVWRV
GHWUDQVSRUWHSpUGLGDGHKRUDVODERUDOHVHWF
ELQDGHFXDGDFDSDFLGDGFDOLGDGWLHPSRHWFGHOHTXLSRGHVDOXG
FSUREOHPDVHQODRUJDQL]DFLyQSDUDEULQGDUHOFRQWUROSUHQDWDO
GEDUUHUDVGHRUGHQFXOWXUDO
HLQDFFHVLELOLGDGJHRJUi¿FD
I GHVFUHLPLHQWRHQODVERQGDGHVGHOVLVWHPDGHVDOXG\HQODQHFHVLGDGGHFRQWURO
JIDOWDGHSURPRFLyQHQODVFRPXQLGDGHV\DSURSLDFLyQGHVXLPSRUWDQFLD
2%-(7,926<$&7,9,'$'(635238(67$6
(O RUGHQ HOHJLGR SDUD SUHVHQWDU ORV REMHWLYRV HVSHFt¿FRV \ ODV DFWLYLGDGHV TXH VH
SURSRQHQ SDUD HO FRQWURO SUHQDWDO GH FDOLGDG WUDWDQ GH DFRPSDxDU OD GLDJUDPDFLyQ
SUHVHQWDGD HQ OD +LVWRULD &OtQLFD 3HULQDWDO GHO &/$3605 (VWD KLVWRULD LQWHQWD VHU
OD KRMD GH UXWD SRU OD TXH GHEHUi WUDQVLWDU HO SURIHVLRQDO FXDQGR TXLHUD EULQGDU XQD
DWHQFLyQGHFDOLGDGDODJHVWDQWH\VXKLMR
Cuadro 3. Objetivos específicos y actividades propuestas para el control prenatal

Objetivos específicos Actividades propuestas
Confirmar el embarazo. Realización de exámenes clínicos y paraclínicos para

diagnosticar embarazo.
Mejorar la calidad del control prenatal. Utilización de algunas tecnologías apropiadas.
Obtener datos para planificar el control prenatal, la
Empleo del Sistema Informático Perinatal.
atención del parto, el puerperio y el recién nacido.
Contar con una hoja de ruta que guíe al prestador
Uso de la Historia Clínica Perinatal.
para brindar una atención prenatal de calidad.
Detectar riesgos en la población Evaluación del riesgo perinatal.
Conocer información relevante del embarazo Anamnesis
Fijar un cronograma que permita planificar las Determinación de la edad gestacional y fecha probable
actividades del control prenatal. de parto.
Medición del peso y de la talla materna. Cálculo del
Evaluar el estado nutricional materno.
incremento de peso durante la gestación.
Interrogatorio sobre tabaquismo (activo y pasivo),
Investigar estilos de vida de riesgo.
drogas, alcohol y violencia.
Disminuir el impacto negativo de las infecciones de Prevención, detección y tratamiento de las infecciones
transmisión vertical. de transmisión vertical.
Prevenir el tétanos neonatal y puerperal Vacunación antitetánica
Detectar posibles procesos sépticos buco dentales Examen buco-dental.
Detectar posibles alteraciones del pezón, patología
Examen de mamas.
inflamatoria y/o tumoral de la mama.
Descartar cáncer de cuello, lesiones precursoras y Examen genital, colpocitología oncológica,
evaluar la competencia cervical. colposcopía.
Pesquisar una posible incompatibilidad sanguínea
Determinación del grupo sanguíneo y el factor Rh.
materno-feto-neonatal.
Determinar niveles de hemoglobina y tratamiento con
Prevenir, detectar y tratar la anemia materna
hierro y ácido fólico
Descartar proteinuria, glucosuria y bacteriuria Examen de orina y urocultivo.
Determinación de glucemia y prueba de tolerancia oral
Detectar diabetes mellitus y gestacional
a la glucosa.
Brindar contenidos educativo-informativos para el Preparación para el parto, consejería para el
parto y la crianza. amamantamiento.
Confirmar la existencia de vida fetal. Pesquisar movimientos y Frecuencia Cardíaca Fetal
Anticipar el diagnóstico y prevenir el parto prematuro. Evaluación del patrón de contractilidad uterina.
Medición de la presión arterial, identificación de
Pesquisar alteraciones de la presión arterial
edemas y proteinuria.
Evaluación del crecimiento por medición de la altura
Descartar alteraciones del crecimiento fetal.
uterina, ganancia de peso materno, ecografía.
Detectar precozmente el embarazo múltiple para
Diagnóstico de número de fetos.
prevenir sus complicaciones.
Pesquisar presentaciones fetales anormales. Examen de la presentación fetal.
Detectar posibles distocias pélvicas. Evaluación de la pelvis.
&5212/2*Ë$'(/$6$&7,9,'$'(63$5$/$6&2168/7$635(1$7$/(6'(
%$-25,(6*2
/DVDFWLYLGDGHVSDUDHOFRQWUROSUHQDWDOGHEHQHVWDUGLVSXHVWDVHQXQFURQRJUDPDTXH
FRQWHPSOHODPD\RUFDQWLGDGGHDFWLYLGDGHVFRQOD¿QDOLGDGGHUHGXFLUDOPtQLPR~WLOHO
Q~PHURGHFRQWUROHV
(QHVWHGRFXPHQWRVHSURSRQHXQQ~PHURPtQLPRGHFRQVXOWDVTXHSHUPLWDHOFXPSOLPLHQWR
GHWRGDVODVDFWLYLGDGHVQHFHVDULDVSDUDORJUDUXQFRQWUROSUHQDWDODGHFXDGRVLHPSUH
TXHODVFDUDFWHUtVWLFDVGHOHPEDUD]RFRQWLQ~HQVLHQGRGHEDMRULHVJR
/D HOHFFLyQ GHO Q~PHUR \ RSRUWXQLGDG GH FDGD FRQVXOWD VH EDVy HQ HO FRQRFLPLHQWR
GH OD HSLGHPLRORJtD GH ORV SUREOHPDV PDWHUQRV \ SHULQDWDOHV PiV IUHFXHQWHV ODV
SRVLELOLGDGHV GH GLDJQRVWLFDUORV UHVROYHUORV R FRQWURODUORV FRQ ODV WHFQRORJtDV
DSURSLDGDVODVPHMRUHVSUiFWLFDV\FRQSURFHGLPLHQWRVGHH¿FDFLDGHPRVWUDGDSRUODV
PHMRUHV HYLGHQFLDV H[LVWHQWHV &XDQGR RFXUUD XQD FRQVXOWD WDUGtD VH UHDOL]DUiQ ODV
DFWLYLGDGHVFRUUHVSRQGLHQWHVDODVFRQVXOWDVSUHYLDVTXHQRIXHURQUHDOL]DGDV
&XDGUR&URQRORJtDGHODVDFWLYLGDGHVSDUDODVFRQVXOWDVSUHQDWDOHVGHEDMRULHVJR
Semanas de consultas
Antes de Entre las Entre las Entre las Entre las
Actividades Las 20 (*) 22 y 24 27 y 29 33 y 35 38 y 40
1ª visita 2da visita 3ª visita 4ª visita 5ª visita
Prueba de embarazo X
Cálculo de la amenorrea X X X X X
Historia clínica perinatal y evaluación de riesgo X X X X X
Examen clínico completo X
Peso corporal X X X X X
Talla X
Investigar estilos de vida de riesgo X X X
Detectar susceptibilidad a la Rubéola X
Vacuna antitetánica (**) X X
Examen odontológico X
Examen de mamas X
Ex. ginecológico, PAP, colposcopía (***) X
Grupo sanguíneo y factor Rh X
Detectar toxoplasmosis X X
Detección VIH X X
Determinación de hemoglobina X X
Suplementación con hierro y ácido fólico X X X X X
Detección Sífilis X X
Detección de Chagas X
Detección de Paludismo X
Cultivo de orina X X
Detectar diabetes X X
Detectar infección por Estreptococo B X
Contenidos educativos para el parto y la lactancia X X X X X
Determinación de la presión arterial X X X X X
Evaluación del crecimiento fetal. X X X X
Evaluación del líquido amniótico X X X X
Diagnóstico de vida fetal X X X X
Evaluación de la capacidad pelviana X
Consejería y provisión de anticoncepción X
(*) Las actividades programadas para la primer visita se deberán hacer siempre, independientemente de la edad gestacional al
momento de la consulta
(**) Si se sospecha que la gestante no volverá o porque así lo indica la norma nacional se podrá vacunar antes de la semana 20
(***) Lo más precozmente o según norma nacional.
2EMHWLYRV &RQ¿UPDUHOHPEDUD]R
$FWLYLGDG 5HDOL]DFLyQGHH[iPHQHVFOtQLFRV\SDUDFOtQLFRVSDUDGLDJQRVWLFDU
HPEDUD]R
(OGLDJQyVWLFRGHOHPEDUD]RVHEDVDUiHQORVFOiVLFRVVLJQRVGHSUREDELOLGDG\FHUWH]D
(QHOFXDGURVHUHVXPHQGLFKRVVLJQRV\WpFQLFDVHPSOHDGDVSDUDVXHYDOXDFLyQ
&XDGUR6LJQRVGHSUREDELOLGDG\FHUWH]D\WpFQLFDVGLDJQyVWLFDV
6LJQRVGHOHPEDUD]R 7pFQLFDVGLDJQyVWLFDV
3UREDELOLGDG
$PHQRUUHD ,QWHUURJDWRULR
0RGL¿FDFLRQHVXWHULQDV ([DPHQJLQHFRREVWpWULFR
'HWHFFLyQGH+&* 'HWHUPLQDFLyQHQVDQJUHXRULQD
&HUWH]D
'HWHFFLyQGHVXEXQLGDGEHWDGH+&* 'HWHUPLQDFLyQHQVDQJUHXRULQD
'HWHFFLyQGHSDUWHVIHWDOHV 3DOSDFLyQDEGRPLQDO
/DWLGRVFDUGtDFRVIHWDOHV (VWHWRVFRSLRREVWpWULFR
GHWHFWRUHV'RSSOHUR(FRJUDItD
9LVXDOL]DFLyQIHWDO (FRJUDItD
6,*126'(352%$%,/,'$'
$PHQRUUHD
$QWH FXDOTXLHU PXMHU HQ HGDG IpUWLO TXH SUHVHQWH XQ DWUDVR HQ OD DSDULFLyQ GH VX
PHQVWUXDFLyQVHGHEHUiSHQVDUHQXQDJUDYLGH]
0RGL¿FDFLRQHVXWHULQDV
/D IRUPD GHO ~WHUR VH KDFH PiV JOREXORVD ORV IRQGRV GH VDFR YDJLQDOHV VH KDFHQ
FRQYH[RVVLJQRGH1REOH%XGLQ\ODFRQVLVWHQFLDGLVPLQX\H
&XDGUR0RGL¿FDFLRQHVGHOWDPDxRXWHULQRHQODSULPHUDPLWDGGHODJHVWDFLyQ
6HPDQDVGHDPHQRUUHD 7DPDxRXWHULQR
1RDOFDQ]DHOSXELV
$OFDQ]DODVtQ¿VLVS~ELFD
(OIRQGRDPLWDGGHGLVWDQFLDHQWUHVtQ¿VLV\RPEOLJR
(OIRQGRDOFDQ]DDOWXUDGHORPEOLJR
+RUPRQD&RULyQLFD*RQDGRWUy¿FD+&*
/D+&*SXHGHGHWHFWDUVHDSHQDVGtDVGHVSXpVGHSURGXFLGDODIHFXQGDFLyQSRUOR
WDQWRD~QDQWHVTXHVHSHUFLEDXQUHWUDVRPHQVWUXDO
(OPD\RUSLFRGH+&*VHSURGXFHDORVRGtDVGHOD~OWLPDPHQVWUXDFLyQ/D
+&*SXHGHGDUIDOVRVSRVLWLYRVSRUODLQWHUIHUHQFLDTXHSURYRFDODKRUPRQD/+HVWR
VHVXHOHHYLWDUGRVL¿FDQGRODVXEXQLGDGEHWDGHOD+&*
([LVWHQ WHVW FRPHUFLDOHV UiSLGRV VHQFLOORV \ UHODWLYDPHQWH HFRQyPLFRV SDUD VHU
XVDGRVHQHOKRJDU6XHOHQVHUDOWDPHQWHVHQVLEOHV3DUDPHMRUDUVXVHQVLELOLGDGVH
UHFRPLHQGDUHDOL]DUORVFRQODSULPHURULQDGHODPDxDQD
6,*126'(&(57(=$
6XEXQLGDG%HWDGHOD+&*
/DVXEXQLGDGEHWDGHOD+&*HVGHWHFWDEOHD~QDQWHVGHODQLGDFLyQ\HVH[FOXVLYDPHQWH
SURGXFLGD SRU HO VLQFLFLRWURIREODVWR FRQ OR TXH VH HYLWDQ ODV UHDFFLRQHV FUX]DGDV
FRQ RWUDV KRUPRQDV &RQVWLWX\H HO PpWRGR GH GLDJQyVWLFR GH HPEDUD]R PiV SUHFR]
\ VHQVLEOH /RV UHVWDQWHV VLJQRV GH FHUWH]D GHO HPEDUD]R VH GHWDOODQ GHQWUR GH ODV
DFWLYLGDGHVGH³'LDJQyVWLFRGHYLGDIHWDO´
2EMHWLYRV 0HMRUDUODFDOLGDGGHOFRQWUROSUHQDWDO
$FWLYLGDG 8WLOL]DFLyQGHDOJXQDVWHFQRORJtDVDSURSLDGDV
(O &/$3605 LQWHQWD SRQHU DO DOFDQFH GH WRGRV ORV SURIHVLRQDOHV GH VDOXG WHFQRORJtDV
SUREDGDVHIHFWLYDV\GHEDMRFRVWRSDUDFRQWULEXLUDODHQWUHJDGHSUHVWDFLRQHVGHFDOLGDG
*(672*5$0$
$OFDOHQGDULRREVWpWULFRVHDJUHJDURQPHGLGDVGHDOJXQRVSDUiPHWURVVHOHFFLRQDGRVSRU
FRQ¿DEOHV\SUHFLVRVTXHSHUPLWHQDSDUWLUGHODIHFKDGH~OWLPDPHQVWUXDFLyQ)80FDOFXODU
ODHGDGJHVWDFLRQDO\GHOUHFLpQQDFLGRYLJLODUHOFUHFLPLHQWR\YLWDOLGDGIHWDO\YHUL¿FDUOD
QRUPDOLGDGGHOLQFUHPHQWRGHSHVRPDWHUQRGHODSUHVLyQDUWHULDO\GHODVFRQWUDFFLRQHV
XWHULQDV
$Vt HQ XQ GLVFR TXH JLUD VREUH RWUR DO KDFHU FRLQFLGLU OD ÀHFKD URMD FRQ HO SULPHU
GtD GH OD )80 \ EXVFDQGR OD IHFKD FRUUHVSRQGLHQWH D OD FRQVXOWD VH HQFRQWUDUi OD
HGDGJHVWDFLRQDOHQVHPDQDVFXPSOLGDV/RVYDORUHVDFRPSDUDUHVWiQXELFDGRVDOD
L]TXLHUGDGHODVHPDQDHQFRQWUDGDSHUFHQWLOHV\GHODDOWXUDXWHULQDSHUFHQWLOHV
\GHJDQDQFLDGHSHVRPDWHUQR\SHUFHQWLOHV\GHOSHUtPHWURDEGRPLQDO
IHWDOSRUHFRJUDItD
),*85$$QYHUVR\UHYHUVRGHOJHVWRJUDPD
$GHPiVGHOFiOFXORGHODHGDGJHVWDFLRQDODPHQRUUHDHVWDFDUDGHOJHVWRJUDPDSHUPLWHOD

GHWHFFLyQGHFDVRV
xFRQUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQRPHGLGDVPHQRUHVTXHORVYDORUHVPiV
EDMRVGHORVSHUFHQWLOHVUHVSHFWLYRV
xGHPDFURVRPtDPHGLGDVPD\RUHVTXHORVYDORUHVPiVDOWRVGHORVSHUFHQWLOHV
FRUUHVSRQGLHQWHV
xGHDOWHUDFLRQHVGHODGXUDFLyQGHOHPEDUD]RHQPHQRVSUHPDWXULGDGRHQPiV
SURORQJDGRFURQROyJLFDPHQWH
xFRQFRQWUDFWLOLGDGPD\RUTXHODFRUUHVSRQGLHQWHDODHGDGDQWHVGHODVVHPDQDV
6LVHGHVFRQRFHOD)80HOUHYHUVRGHOJHVWRJUDPDSHUPLWHHVWLPDUODHGDGJHVWDFLRQDO
FRQXQHUURUFRQRFLGRDSDUWLUGHPHGLGDVHFRJUi¿FDVHPEULRIHWDOHV'HVGHODVHPDQD
VH SUHVHQWDQ ORV YDORUHV GH ORV 3 \ 3 GHO SHVR IHWDO \ GHO 3 GH OD WDOOD
FRUUHVSRQGLHQWHDFDGDVHPDQD
6LVHLJQRUDOD)80\QRH[LVWHQPHGLGDVIHWDOHVUHDOL]DGDVSRUHFRJUDItDGXUDQWHHO
HPEDUD]R VH SXHGHQ XWLOL]DU ORV YDORUHV GH SHVR WDOOD \ GHO GLiPHWUR ELSDULHWDO GHO
UHFLpQQDFLGRPHGLGRFRQFRPSiVSDUDREWHQHUXQDDSUR[LPDFLyQUiSLGD\VHQFLOODGH
ODGXUDFLyQGHOHPEDUD]R
6H UHFXHUGDQ ORV SHUFHQWLOHV \ GH SUHVLyQ DUWHULDO PDWHUQD VLVWyOLFD \ GLDVWyOLFD
HVWDQGRODPDGUHVHQWDGDYiOLGRVSDUDWRGRHOHPEDUD]R
/RV GDWRV FRQWHQLGRV HQ HO JHVWRJUDPD SURYLHQHQ GH LQYHVWLJDFLRQHV UHDOL]DGDV SRU
&/$3605HQSREODFLRQHVODWLQRDPHULFDQDVVDQDVVHJXLGDVORQJLWXGLQDOPHQWH
&,17$2%67(75,&$
$ OD FLQWD PpWULFD FRQYHQFLRQDO VH DJUHJDURQ PHGLGDV GH DOJXQRV SDUiPHWURV
VHOHFFLRQDGRV SRU FRQ¿DEOHV \ SUHFLVRV TXH SHUPLWHQ YLJLODU HO FUHFLPLHQWR \ YLWDOLGDG
IHWDOYHUL¿FDUODQRUPDOLGDGGHOLQFUHPHQWRGHSHVRPDWHUQRGHODSUHVLyQDUWHULDO\GH
ODFRQWUDFWLOLGDGXWHULQDSHUPLWLHQGRDGHPiVFRQRFHUHOSHVRIHWDOSDUDXQDGHWHUPLQDGD
HGDGJHVWDFLRQDO
)LJXUD$QYHUVR\UHYHUVRGHODFLQWDREVWpWULFD
&(1752/$7,12$0(5,&$12'(3(5,1$72/2*,$
6$/8''(/$08-(5<5(352'8&7,9$
&/$3605236206
ZZZFODSRSVRPVRUJ
/DFLQWDREVWpWULFDFRQVWDGHGRVFDUDV
(ODQYHUVRGHFRORUEODQFRTXHVHSUHVHQWDHQOD¿JXUDFRQWLHQH
xHOGLEXMRTXHLOXVWUDODWpFQLFDGHPHGLFLyQDODTXHFRUUHVSRQGHQORVYDORUHVPi[LPRV
\PtQLPRVQRUPDOHVGHODDOWXUDXWHULQDHQIXQFLyQGHODHGDGJHVWDFLRQDO
x ODFLQWDPpWULFDSURSLDPHQWHGLFKDHQODTXHVHGHVWDFDQHQWUHGRVEDUUDVQHJUDVJUXHVDV
ORVYDORUHVQRUPDOHVGHDOWXUDXWHULQDSDUDXQHPEDUD]RGHWpUPLQRFRQIHWR~QLFR
x ORVYDORUHVQRUPDOHVGHSUHVLyQDUWHULDOVLVWyOLFD\GLDVWyOLFD
(OUHYHUVRGHFRORUDPDULOOR¿JXUDFRQWLHQH
xORVYDORUHVPtQLPRV\Pi[LPRVQRUPDOHVSDUDFDGDHGDGJHVWDFLRQDODSDUWLUGHOD
VHPDQD\KDVWDODVHPDQDGH
RDOWXUDXWHULQDHQFHQWtPHWURV
RJDQDQFLDGHSHVRPDWHUQRHQNLORJUDPRV
RSHVRIHWDOHQNLORJUDPRV
xORVYDORUHVPi[LPRVGHODVFRQWUDFFLRQHVXWHULQDVKDVWDODVHPDQD
xORVFXDGURVFOtQLFRVTXHGHWHUPLQDQXQDDOWXUDPHQRURPD\RUDODHVSHUDGDVHJ~Q
ODHGDGJHVWDFLRQDO
'H LJXDO IRUPD TXH HQ HO JHVWRJUDPD ORV GDWRV FRQWHQLGRV HQ HVWD FLQWD REVWpWULFD
SURYLHQHQ GH LQYHVWLJDFLRQHV UHDOL]DGDV SRU HO &/$3605 HQ SREODFLRQHV
ODWLQRDPHULFDQDVVDQDVVHJXLGDVORQJLWXGLQDOPHQWH
&8$'523ULQFLSDOHVGDWRVTXHSURSRUFLRQDQODFLQWDREVWpWULFD\JHVWRJUDPDGH&/$3605
&LQWDREVWpWULFD *HVWRJUDPD
$OWXUD8WHULQDS\S ; ;
,QFUHPHQWRGHSHVRPDWHUQRS\S ; ;
&RQWUDFFLRQHVXWHULQDVSRUKRUDSGHVGHODVHPDQD ; ;
3UHVLyQDUWHULDOPDWHUQDS\S ; ;
; ;
3HVRIHWDOSDUDFDGDHGDGJHVWDFLRQDOS\S
;
7DOODIHWDOSDUDFDGDHGDGJHVWDFLRQDOS ;
3HUtPHWURDEGRPLQDOIHWDOSRUHFRJUDItDS\S ;
&iOFXORGHODHGDGJHVWDFLRQDO ;
S SHUFHQWLO
7$5-(7$&219$/25(61250$/(6'($/785$87(5,1$
*$1$1&,$'(3(620$7(512<3(623$5$/$7$//$
%GPVTQ.CVKPQCOGTKECPQFG2GTKPCVQNQIÈC5CNWFFGNC/WLGT[4GRTQFWEVKXC%.#25/4
)LJXUD$QYHUVR\UHYHUVRGHODWDUMHWDGHDOWXUDXWHULQD\SHVRPDWHUQR
(Q XQD GH ODV FDUDV VH KDFH XQD EUHYH UHIHUHQFLD D FRPR VH HYDO~D HO FUHFLPLHQWR
IHWDO \ VXV GHVYLDFLRQHV DVt FRPR OD QXWULFLyQ PDWHUQD 7DPELpQ VH SUHVHQWDQ ORV
YDORUHVSDWURQHVQRUPDOHVGHVGHODVKDVWDODVVHPDQDVGHHGDGJHVWDFLRQDO
GHOLQFUHPHQWRGHSHVRPDWHUQR\GHODDOWXUDXWHULQD¿JXUD
(QODRWUDFDUDVHSUHVHQWDQORVYDORUHVQRUPDOHVSHUFHQWLOHV\GHOSHVRPDWHUQR

SDUDODWDOODGHVGHODDODVHPDQDGHJHVWDFLyQ(OSHVRSDUDODWDOODVHHODERUy
HQEDVHDOtQGLFHTXHPLGHODUHODFLyQSHVRDFWXDOGHODHPEDUD]DGDSHVRWHyULFRSDUD
ODWDOODGHPXMHUHVQRHPEDUD]DGDV
SHVRDFWXDOGHODHPEUD]DGD
3HVRSDUDODWDOOD
SHVRWHyULFRSDUDODWDOODGHPXMHUHVQRHPEDUD]DGDV
(OSHVRWHyULFRSDUDODWDOODGHPXMHUHVQRHPEDUD]DGDVIXHWRPDGRGH-HOLIIH'%(YDOXDFLyQ
GHOHVWDGRGHQXWULFLyQGHODFRPXQLGDG6HULH0RQRJUi¿FD1206±*LQHEUD
2EMHWLYRV 2EWHQHUGDWRVSDUDSODQL¿FDUHOFRQWUROSUHQDWDOODDWHQFLyQGHO
SDUWRHOSXHUSHULR\HOUHFLpQQDFLGR
$FWLYLGDG (PSOHRGHOVLVWHPDLQIRUPiWLFRSHULQDWDO
3DUDJDUDQWL]DUXQDFRUUHFWDHMHFXFLyQGHODQRUPDGHFRQWUROSUHQDWDOHVLPSUHVFLQGLEOH
GLVSRQHUGHXQVLVWHPDTXHSHUPLWDUHJLVWUDUWRGDODLQIRUPDFLyQUHOHYDQWHSDUDXQD
FRUUHFWDSODQL¿FDFLyQGHODDWHQFLyQGHODHPEDUD]DGD\VXKLMR(OVLVWHPDGHUHJLVWUR
HVHOLQVWUXPHQWRPiVDSURSLDGRSDUDVXSHUYLVDUHOFXPSOLPLHQWRGHODQRUPD\EULQGDU
ORVGDWRVLQGLVSHQVDEOHVSDUDVXHYDOXDFLyQXOWHULRU
(VWHVLVWHPDLQFOX\HODKLVWRULDFOtQLFD\HOFDUQpSHULQDWDOGHO&/$3605
+,6725,$&/,1,&$3(5,1$7$/
/DKLVWRULDFOtQLFDSHULQDWDO+&3LQWHQWDXQLIRUPL]DUHOFRQWHQLGRGHODGRFXPHQWDFLyQ

FRUUHVSRQGLHQWHDOHPEDUD]RSDUWRSXHUSHULR\DOUHFLpQQDFLGRHQHOSHUtRGRQHRQDWDO
LQPHGLDWR6XGLDJUDPDFLyQJHQHUDO\VXLQVWUXFWLYRGHOOHQDGRIDFLOLWDUiTXHORVGDWRV
FRQVLGHUDGRVGHLPSRUWDQFLDVHDQVLVWHPiWLFD\XQLIRUPHPHQWHUHFDEDGRV\UHJLVWUDGRV
HQHOPRPHQWRRSRUWXQR(ORUGHQDPLHQWRGHORVGDWRVSHUPLWLUiVXUHFROHFFLyQHQXQ
WLHPSREUHYHDODYH]TXHDJLOL]DUiHODQiOLVLVSRVWHULRU\DVHDSRUTXLHQUHFRJLyORV
GDWRVRSRUDTXHOTXHQRKDELHQGRKHFKRHOUHJLVWURQHFHVLWDODLQIRUPDFLyQLQFOXLGDHQ
ODKLVWRULD(VWDVLWXDFLyQVHSUHVHQWDSRUHMHPSORWRGDYH]TXHHOSDUWRQRVHUHDOL]D
HQODPLVPDLQVWLWXFLyQGRQGHVHHIHFW~DHOFRQWUROSUHQDWDO/RPLVPRRFXUUHFXDQGRHO
FRQWUROSRVWSDUWR\SHGLiWULFRVHUHDOL]DIXHUDGHODLQVWLWXFLyQGRQGHQDFLyHOQLxR
(QODV¿JXUDV\VHPXHVWUDHOPRGHORGHOD+&3GH&/$3605TXHMXQWRFRQ
HO SDUWRJUDPD &/$3605 UHFRPLHQGD SDUD WRGRV ORV FDVRV (VWRV IRUPXODULRV VRQ
VX¿FLHQWHVSDUDHOEDMRULHVJRSHULQDWDOTXHFRPSUHQGHDODPD\RUtDGHODSREODFLyQ
/D +&3 ¿JXUD UH~QH HQ XQD SiJLQD ORV GDWRV PtQLPRV LQGLVSHQVDEOHV SDUD OD
SODQL¿FDFLyQGHODDWHQFLyQGHOHPEDUD]RSDUWRSXHUSHULR\UHFLpQQDFLGR6XOLVWDGRGH
SUHJXQWDVFRQVWLWX\HXQUHFRUGDWRULRTXHRULHQWDDOSUHVWDGRUHQODDWHQFLyQDPDQHUD
GHXQDKRMDGHUXWDHVWRD\XGDDOFXPSOLPLHQWRGHODVQRUPDVGHDWHQFLyQDOWLHPSR
TXHIDFLOLWDORVSURFHVRVGHDXGLWRULD&XHQWDDGHPiVFRQXQVLVWHPDGHDGYHUWHQFLD
VREUHDOJXQRVIDFWRUHVTXHSXHGHQHOHYDUHOULHVJRSHULQDWDORTXHUHTXLHUHQPD\RU
DWHQFLyQ VHJXLPLHQWR R FXLGDGR (VWH VLVWHPD VH FDUDFWHUL]D SRU GHVWDFDU DOJXQRV
FDVLOOHURVFRQFRORUDPDULOOR(VWHFRORUVHXVDFRPRFyGLJRLQWHUQDFLRQDOGHDOHUWD
(OUHYHUVRGHOD+&3¿JXUDFRQWLHQHOLVWDVDEUHYLDGDVSDUDODFRGL¿FDFLyQGHODV

SDWRORJtDVPiVIUHFXHQWHVGHOHPEDUD]RSDUWRSXHUSHULR\GHOUHFLpQQDFLGR7DPELpQ
VH KD LQFOXLGR XQD OLVWD SDUD OD FRGL¿FDFLyQ GH ODV SULQFLSDOHV LQGLFDFLRQHV GH SDUWR
RSHUDWRULR R GH LQGXFFLyQ GHO SDUWR DGHPiV GH XQD OLVWD GH PHGLFDFLyQ HIHFWXDGD
GXUDQWHHOSDUWR
3$572*5$0$
'HEHVHUXWLOL]DGRMXQWRFRQOD+&3GXUDQWHHOWUDEDMRGHSDUWRVHGHVFULEHHQODSiJLQD
&$51e3(5,1$7$/
(O FDUQp SHULQDWDO &3 GHO &/$3605 HV XQ LQVWUXPHQWR TXH SHUPLWH LQWHJUDU ODV
DFFLRQHVTXHHOHTXLSRGHVDOXGUHDOL]DGXUDQWHHOHPEDUD]RSDUWR\SXHUSHULR7LHQGH
DHYLWDUODIDOWDGHGDWRVTXHSXHGHSURGXFLUVHHQDOJ~QPRPHQWRGHHVWDVHWDSDVGHO
SURFHVRUHSURGXFWLYR\FRQHOORFRQWULEX\HDPHMRUDUODFDOLGDGGHODDWHQFLyQ'HEH
HVWDUVLHPSUHHQSRGHUGHODHPEDUD]DGDTXLHQORXWLOL]DUiSDUDWRGDDFFLyQPpGLFD
TXHVROLFLWHHQVXHVWDGRJUiYLGRSXHUSHUDO
&RQHOFDUQpSHULQDWDOVHDVHJXUDTXHORVGDWRVGHPD\RULPSRUWDQFLD
UHODWLYRVDOFRQWUROSUHQDWDODOVHUUHJLVWUDGRVVLVWHPiWLFDPHQWHHQFDGDFRQVXOWD
OOHJXHQDPDQRVGHTXLHQDWLHQGHSRVWHULRUPHQWHDODHPEDUD]DGD\DVHDHQRWUR
FRQVXOWRULRH[WHUQRRHQHOOXJDUGHODLQWHUQDFLyQ
YLQFXODGRV D XQD LQWHUQDFLyQ GXUDQWH HO HPEDUD]R SDUWR \ SRVWSDUWR VHDQ
FRQRFLGRVSRUTXLHQWLHQHDVXFDUJRHOFRQWUROGHOSXHUSHULR
SDUDHOVHJXLPLHQWRGHOUHFLpQQDFLGROOHJXHQDFRQRFHUVHSRUTXLHQWLHQHDVX
FDUJRHOFRQWUROGHOQLxR
+,6725,$&/,1,&$3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO
(67$'2&,9,/
FDVDGD
FRQWURO
120%5( $3(//,'2 GtD PHV DxR EODQFD %(7$ XQLyQ HVWDEOH SUHQDWDO
QLQJXQR SULPDULD
LQGtJHQD QR
QRLQGLFDQHFHVDULDPHQWHULHVJRQLSUiFWLFDVLQDGHFXDGDV
'20,&,/,2 VROWHUD /XJDUGHO

PHVWL]D SDUWRDERUWR
('$' DxRV VL
VHFXQG XQLYHUV RWUR
/2&$/,'$' 7(/() QHJUD 1
GH DxRVHQHO YLYH ,GHQ
!GH RWUD PD\RUQLYHO VROD QR VL WLGDG
)$0,/,$5(6 3(5621$/(6 QR VL 2%67(75,&26 JHVWDVSUHYLDV DERUWRV YDJLQDOHV QDFLGRVYLYRV YLYHQ ),1(0%$5$=2$17(5,25
$17(&('(17(6
FLUXJtD GtD PHV DxR

QR VL QR VL JHQLWRXULQDULD
7%& , ,, * LQIHUWLOLGDG PHQRVGHDxR
GLDEHWHV 8/7,0235(9,2
FDUGLRSDW HVSRQW
KLSHUWHQVLyQ QF J FRQVHFXWLYRV PXHUWRV
QHIURSDWtD (0%$5$=23/$1($'2 QR VL
QRUPDO ñ J HPE HFWySLFR QDFLGRV UD
VHP
SUHHFODPSVLD YLROHQFLD SDUWRV FHViUHDV PXHUWRV )5$&$620(72'2$17,&21&(3
HFODPSVLD QR VL GHVSXpV
$QWHFHGHQWH QR EDUUHUD ',8 KRUPR HPHU QDWXUDO
RWUDFRQG GHJHPHODUHV
UD
VHP
PpGLFDJUDYH XVDED QDO JHQFLD
*(67$&,21$&78$/ GtD PHV DxR (* &21),$%/( SRU )80$ $&7 )80$ 3$6 '52*$6 $/&2+2/ 9,2/(1&,$ $17,58%(2/$ $17,7(7$1,&$ (;1250$/
QR VL QR VL QR VL QR VL QR VL
)80
SUHYLD QRVDEH
3(62 $17(5,25 7$//$FP )80 (FRV HUWULP YLJHQWH QR VL QR VL
GtD PHV DxR QR 2'217
WULP
D D
'26,6
HPEDUD]R QR
)33
VL PHV 0$0$6
.J HUWULP
(VWHFRORUVLJQLILFD$/(57$
JHVWDFLyQ
QR VH
QRUPDO DQRUPDO KL]R *5832 B 5K )H)2/$726
QRVH ,QPXQL] 72;23/$6026,6 9,+ 6,),/,6'LDJQyVWLFR\7UDWDPLHQWR
+EVHP +E VHP
&(59,;
KL]R
,QVS QR VHP ,J* VHP LQGLFDGRV 3UXHED 7UDWDPLHQWR 7WR GH OD
YLVXDO QR VL )H )RODWRV QRWUHSRQpPLFD WUHSRQpPLFD SDUHMD
VL VROLFL
3$3 ȖJOREXOLQDDQWL' VHP ,J*
WDGR J QR QR J
VG VG QF QR VL VG QF
QR VL
&2/3 QR VL QF DFRQVXOWD ,J0 UHDOL JGO VL VL JGO
VHPDQDV VHPDQDV
VHPDQDV VHPDQDV
]DGR
3$/8',602 %$&7(5,85,$ */8&(0,$(1$<81$6 VHP VG QF
&+$*$6
0$/$5,$ QRVH VHP (675(372 35(3$5$ &216(-(5,$

VHP QRUPDO DQRUPDO KL]R QR VL
VHP VROLFL &2&2 % &,213$5$ /$&7$1&,$
PJGO WDGR VHPDQDV (/3$572 0$7(51$ VHP QR VL
UHDOL VG VG QF QR VL VG QF
QR VH VHP QR VL QR VL
KL]R QR VH KL]R ]DGR QR VH KL]R VG QF
HGDG DOWXUD SUHVHQ )&) PRYLP SURWHL VLJQRVGHDODUPDH[iPHQHVWUDWDPLHQWRV ,QLFLDOHV SUy[LPDFLWD
GtD PHV DxR SHVR 3$
&2168/7$6$17(1$7$/(6
JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

3$ 5 72 $ % 2 5 72 +263,7$/,= &257,&2,'(6 ,1,&,2 52785$'(0(0%5$1$6$17(3$572 ('$'*(67 35(6(17$&,21 7$0$f2 $&203$f$17(
HQ $17(1$7$/(6 HVSRQWiQHR VHP DOSDUWR 6,78$&,21 )(7$/ 7'3 3
)(&+$ '( ,1*5(62 &2168/7$6 (0%$5$=2 QR GtD PHV DxR
FRPSOHWR VHPDQDV GtDV $&25'( SDUHMD
GtD PHV DxR 35( KV FHIiOLFD
1$7$/(6 QR VL LQGXFLGR VL QR
LQFRPSO IDPLOLDU
WRWDO GtDV VHPDQD WHPS &
KRUD PLQ SHOYLDQD
QLQJXQD LQLFLR SRU )80 SRU (FR RWUR
FHVDUHOHFW VL
&$51e QR VL QF WUDQVYHUVD QLQJXQR
KRUD PLQ SRVLFLyQGH 3$ SXOVR FRQWU¶ GLODWDFLyQ DOWXUD YDULHGDG PHFRQLR )&)GLSV QR VL QR VL QR VL FyGLJR
yPiV
ODPDGUH SUHVHQW SRVLF +7$SUHYLD HU

LQIHF RYXODU WULP
VL
+(0255$*,$
(1)(50('$'(6
+7$LQGXFLGD LQIHF XULQDULD

QR
GR
HPEDUD]R WULP
SUHHFODPSVLD DPHQD]D
SDUWR SUHWHU HU
WULP
WRJUDPD
GHWDOOHV
HQSDU
HFODPSVLD 5&,8
SRVWSDUWR
FDUGLRSDWtD URWXUD SUHP
GH PHPEUDQDV
QLQJXQD
LQIHFFLyQ
'(3$572
SXHUSHUDO
75$%$-2
QHIURSDWtD DQHPLD
, ,, * QRWDV
GLDEHWHV RWUD FRQG
JUDYH
1$&,0,(172 9,92 KRUD PLQ GtD PHV DxR 08/7,3/( yUGHQ 7(50,1$&,21 ,1',&$&,2135,1&,3$/'( ,1'8& 23(5
QR VL HVSRQW FHViUHD RWUD ,1'8&&,2123$57223(5$725,2
FyGLJR
08(572
DQWHSDUWR SDUWR LJQRUD IRUFHSV
PRPHQWR YDFXXP
QR '(6*$5526
326,&,213$572 2&,72&,&26 3/$&(17$ /,*$'85$ RFLWyFLFRV DQWLELRW DQDOJHVLD DQHVW DQHVW DQHVW WUDQVIXVLyQ RWURV QR VL FyGLJR
(3,6,2720,$
0(',&$&,21
QR VL HQ 7'3 ORFDO UHJLRQ JUDO PHGLF PHGLF

5(&,%,'$
VHQWDGD *UDGR D SUHDOXPEU SRVWDOXPEU &25'21

DFRVWDGD QR VL QR VL FRPSOHWD SUHFR] QR QR QR QR QR QR QR HVSHFLILFDU
VL
FXFOLOODV QR UHWHQLGD QR VL VL VL VL VL VL VL VL
'HVFULSFLyQGHFyGLJRVHQHOUHYHUVR
3&()$/,&2 FP ('$'*(67$&,21$/ $3*$5 QR VL )$//(&( $7(1',2 PpGLFR REVW HQI DX[LO HVWXG HPSLU RWUR 1RPEUH
5 ( & , ( 11 $ & , ' 2 3(62
HVWLPXODF HQ/8*$5
5($1,0$&,21
VHP GLDV (* PLQ

6(;2 3(62$/1$&(5 )80 GH3$572 3$572
I P DGHF
HU
DVSLUDFLyQ
VL
PiVFDUD QR 1(21$72
/21*,78' FP (&2
J SHT R[tJHQR 5()(5,'2
QR DORM QHRQD RWUR 38(53(5,2
GHILQLGR
J J (67,0$'$ JGH WR
PDVDMH FRQM WRORJ KRVS GtD KRUD 7& 3$ SXOVR LQYROXWHU ORTXLRV
'()(&726 7$0,=$-( 1(21$7$/ WXER
(1)(50('$'(6
&21*(1,726 0HFRQLR
9'5/ 7WR
yPiV
7R[R
QR PHQRU 76+ +ESDWtD %LOLUUXE ,J0 HUGtD
QR QR VL
PD\RU VL
QF
QLQJXQD
FyGLJR
$17,&21&(3&,21
FyGLJR
QRVH QRVH $QWLUXEHROD ȖJOREXOLQD

KL]R VG KL]R SRVWSDUWR DQWL ' QR VL
QR VL QF QR VL QF
&216(-(5,$
+&3(6$935HJLRQDO
( * 5 ( 6 25 1 YLYR WUDVODGR IDOOHFH ('$'$/(*5(62 $/,0(172 %RFD ( * 5 ( 6 20 $7 ( 5 1 2 WUDVODGR OXJDU
IDOOHFH
GXUDQWHR $/$/7$ DUULED QR VL 0(72'2(/(*,'2
HQOXJDU GtDVFRPSOHWRV ',8SRVW OLJDGXUD
GtD PHV DxR KRUD PLQ GHWUDVODGR ODFW %&* QR VL GtD PHV DxR
GtD H[FO HYHQWR WXEDULD
QR VL QDWXUDO
GtDVFRPSOHWRV ',8
SDUFLDO 3(62$/(*5(62 GHVGHHOSDUWR
IDOOHFH EDUUHUD RWUR
YLYD IDOOHFH GXUDQWHR QR VL
,G OXJDU DUWLILFLDO HQOXJDU
51 J GHWUDVODGR KRUPRQDO QLQJXQR
1RPEUH5HFLpQ1DFLGR 5HVSRQVDEOH 5HVSRQVDEOH
)LJXUD+LVWRULD&OtQLFD3HULQDWDO5HJLRQDO$QYHUVR
)LJXUD+LVWRULD&OtQLFD3HULQDWDO5HJLRQDO5HYHUVR
)LJXUD&DUQp3HULQDWDO5HJLRQDO$QYHUVR
&$51e3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO
(67$'2&,9,/
FDVDGD
FRQWURO
120%5( $3(//,'2 GtD PHV DxR EODQFD %(7$ XQLyQ HVWDEOH SUHQDWDO
LQGtJHQDQR QLQJXQR SULPDULD
7(/() SDUWRDERUWR
PHVWL]D
('$' DxRV VL
VHFXQG XQLYHUV RWUR
/2&$/,'$' QHJUD 1
RWUD PD\RUQLYHO VROD QR VL
QRLQGLFDQHFHVDULDPHQWHULHVJRQLSUiFWLFDVLQDGHFXDGDV
!GH WLGDG
$17(&('(17(6
FLUXJtD GtD PHV DxR

GLDEHWHV 8/7,0235(9,2
FDUGLRSDW HVSRQW
QRUPDO J HPE HFWySLFR QDFLGRV UD
VHP
UD
VHP
* ( 6 7$ & , 2 1$ & 7 8 $ / GtD PHV DxR (* &21),$%/( SRU )80$ $&7 )80$ 3$6 '52*$6 $/&2+2/ 9,2/(1&,$ $17,58%(2/$ $17,7(7$1,&$ (;1250$/
QR VL QR VL QR VL QR VL QR VL
)80
SUHYLD QRVDEH
3(62 $17(5,25 7$//$FP )80 (FRV HUWULP YLJHQWH QR VL QR VL
GtD PHV DxR QR 2'217
WULP
D D
'26,6
HPEDUD]R QR
)33
VL PHV 0$0$6
.J HUWULP JHVWDFLyQ
QR VH
QRUPDO DQRUPDO KL]R *5832 B 5K )H)2/$726
QRVH ,QPXQL] 72;23/$6026,6 9,+ 6,),/,6'LDJQyVWLFR\7UDWDPLHQWR
+EVHP +E VHP
&(59,;
KL]R
,QVS QR VHP ,J* VHP LQGLFDGRV 3UXHED 7UDWDPLHQWR 7WR GH OD
YLVXDO QR VL )H )RODWRV QRWUHSRQpPLFD WUHSRQpPLFD SDUHMD
VL VROLFL
3$3 ȖJOREXOLQDDQWL' VHP ,J*
WDGR J QR QR J
D QR VL
&2/3 QR VL QF FRQVXOWD ,J0 UHDOL JGO VL VL JGO
VHPDQDV VHPDQDV
VHPDQDV VHPDQDV
]DGR
3$/8',602 %$&7(5,85,$ */8&(0,$(1$<81$6 VHP VG QF
&+$*$6
0$/$5,$ QRVH VHP (675(372 35(3$5$ &216(-(5,$

VHP QRUPDO DQRUPDO KL]R QR VL
VHP VROLFL &2&2 % &,213$5$ /$&7$1&,$
PJGO WDGR VHPDQDV (/3$572 0$7(51$ VHP QR VL
UHDOL VG VG QF QR VL VG QF
QR VH VHP QR VL QR VL
KL]R QR VH KL]R ]DGR QR VH KL]R VG QF
HGDG DOWXUD SUHVHQ )&) PRYLP SURWHL VLJQRVGHDODUPDH[iPHQHVWUDWDPLHQWRV ,QLFLDOHV SUy[LPDFLWD
GtD PHV DxR SHVR 3$
&2168/7$6$17(1$7$/(6
JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

3$ 5 72 $ % 2 5 72 +263,7$/,= &257,&2,'(6 ,1,&,2 52785$'(0(0%5$1$6$17(3$572 ('$'*(67 35(6(17$&,21 7$0$f2 $&203$f$17(
HQ $17(1$7$/(6 HVSRQWiQHR VHP DOSDUWR 6,78$&,21 )(7$/ 7'3 3
)(&+$'(,1*5(62 &2168/7$6 (0%$5$=2 QR GtD PHV DxR
FRPSOHWR VHPDQDV GtDV $&25'( SDUHMD
GtD PHV DxR 35( KV FHIiOLFD
1$7$/(6 QR VL LQGXFLGR QR
LQFRPSO VL IDPLOLDU
WRWDO GtDV VHPDQD WHPS &
KRUD PLQ SHOYLDQD
QLQJXQD LQLFLR SRU )80 SRU (FR VL RWUR
FHVDUHOHFW
&$51e QR VL QF WUDQVYHUVD QLQJXQR
08/7,3/( QR VL QR VL QR VL FyGLJR
1$&,0,(172 KRUD PLQ GtD PHV DxR IHWRV
+(0255$*,$
yPiV
9,92 +7$SUHYLD LQIHF RYXODU

(1)(50('$'(6
yUGHQ HU WULP

08(572 +7$LQGXFLGD
LJQRUD LQIHF XULQDULD
DQWHSDUWR SDUWR PRPHQWR ~QLFR HPEDUD]R GR WULP
SUHHFODPSVLD DPHQD]D
7(50,1$&,21 ,1',&$&,2135,1&,3$/'(3$57223(5$725,22,1'8&&,21 ,1'8& 23(5 SDUWR SUHWHU HU WULP
FyGLJR
HVSRQW HFODPSVLD 5&,8 SRVWSDUWR

URWXUD SUHP
QLQJXQD
IRUFHSV FDUGLRSDWtD GH PHPEUDQDV LQIHFFLyQ

1RWDV SXHUSHUDO
FHViUHD RWUD QHIURSDWtD , ,, *
DQHPLD
GLDEHWHV RWUD FRQG QRWDV
YDFXXP JUDYH
QR '(6*$5526
326,&,213$572 2&,72&,&26 3/$&(17$ /,*$'85$ RFLWyFLFRV DQWLELRW DQDOJHVLD DQHVW DQHVW DQHVW WUDQVIXVLyQ RWURV QR VL FyGLJR
0(',&$&,21
(3,6,2720,$
QR VL HQ 7'3 ORFDO UHJLRQ JUDO

5(&,%,'$
VHQWDGD *UDGR D SUHDOXPEU SRVWDOXPEU &25'21 PHGLF PHGLF

DFRVWDGD QR VL QR VL FRPSOHWD SUHFR] QR QR QR QR QR QR QR
VL HVSHFLILFDU
FXFOLOODV QR UHWHQLGD QR VL VL VL VL VL VL VL VL
3&()$/,&2 FP ('$'*(67$&,21$/ $3*$5 QR VL )$//(&( $7(1',2 PpGLFR REVW HQI DX[LO HVWXG HPSLU RWUR 1RPEUH
5 ( & , ( 11 $ & , ' 2 3(62
HVWLPXODF
5($1,0$&,21
VHP GLDV (* PLQ HQ/8*$5

6(;2 3(62$/1$&(5 )80 GH3$572 3$572
I P DGHF
HU
DVSLUDFLyQ
VL
PiVFDUD QR 1(21$72
/21*,78' FP (&2
J SHT R[tJHQR 5()(5,'2
QR DORM QHRQD RWUR 38(53(5,2
GHILQLGR
J J (67,0$'$ JGH
WR
PDVDMH FRQM WRORJ KRVS GtD KRUD 7& 3$ SXOVR LQYROXWHU ORTXLRV
'()(&726 7$0,=$-( 1(21$7$/ WXER
&21*(1,726 0HFRQLR
9'5/ 7WR
yPiV
7R[R
QR PHQRU 76+ +ESDWtD %LOLUUXE ,J0 HUGtD
QR QR VL
PD\RU VL
QF
QLQJXQD
FyGLJR
$17,&21&(3&,21
FyGLJR
QRVH QRVH $QWLUXEHROD JJOREXOLQD

KL]R VG KL]R SRVWSDUWR DQWL ' QR VL
QR VL QF QR VL QF
&216(-(5,$
( * 5 ( 6 25 1 YLYR WUDVODGR IDOOHFH ('$'$/(*5(62 $/,0(172 %RFD (*5(620$7(512
IDOOHFH DUULED QR VL 0(72'2(/(*,'2
&3((6$935HJLRQDO
GXUDQWHR $/$/7$
HQOXJDU GtDVFRPSOHWRV WUDVODGR OXJDU ',8SRVW OLJDGXUD
GtD PHV DxR KRUD PLQ GHWUDVODGR ODFW %&* QR VL HYHQWR WXEDULD
GtD H[FO GtD PHV DxR
QR VL QDWXUDO
',8
SDUFLDO 3(62$/(*5(62
EDUUHUD RWUR
,G OXJDU DUWLILFLDO
51 J KRUPRQDO QLQJXQR
1RPEUH5HFLpQ1DFLGR 5HVSRQVDEOH 5HVSRQVDEOH
3DWURQHV GH DOWXUD XWHULQD H LQFUHPHQWR GH SHVR PDWHUQR VHJ~Q HGDG JHVWDFLRQDO 8QD YH] FRQRFLGD OD HGDG JHVWDFLRQDO VH OD XELFD HQ OD JUiILFD \ VH FRPSDUDQ ORV YDORUHV REWHQLGRV FRQ ORV FHQWLOHV 3 3 \ 3 JUDILFDGRV
)LJXUD&DUQp3HULQDWDO5HJLRQDO5HYHUVR
6,),/,6 VG &21',&,21 ',$*1267,&235(6817,92

',$*126 75$7$0,(172 $/,1*5(62
7,&2 3DUHMD
FyGLJR
PROD
'LDPHWUR
ORQJLWXGLQDO
3UHVXQWLYR
PP
OHVLyQ OHVLyQ
FRQWUDFRQVHMR
PpGLFR
772
/XJDU 7UDVODGR
$XWRSVLD
1R

6L
IDOOHFHGXUDQWHR 1R 6L
SUHI DFFHG Ȗ JOREXOLQD QF HQOXJDUGHWUDVODGR
SUHI DFFHG SUHI DFFHG
SVLFRORJtD DQWLFRQ RWURHVWDEO RWUR
FHSFLyQ
YLROHQFLD LQIHUWLOLGDG
DGROHV 9,+,76
FHQFLD
)LJXUD)RUPXODULRFRPSOHPHQWDULRSDUDPXMHUHVHQVLWXDFLyQGHDERUWR
QR VL ,167,78&,21
+263,7$/,=$&,211(21$7$/&/$3605236206 6,3 '(1$&,0,(172
1+,6725,$
51QRPEUH 7LHQHSXOVHUDGH,' QR VL 5(&,(11$&,'2
1+,6725,$
&/,1,&$0$'5(
0$'5(QRPEUH
HVWHFRORUVLJQLILFD$/(57$
VHHQFXHQWUDHQ PLVPRKRVSLWDO RWURKRVSLWDO GRPLFLOLR IDOOHFLGD &RQGLFLyQGHVDOXG QRUPDO FUtWLFD &RQRFLyDVXKLMR QR VL

7HOpIRQRV
3$'5(QRPEUH
&RPXQLFDFLyQ
FRQODIDPLOLD 'LUHFFLyQ (PDLO
75$163257( PLVPRKRVSLWDO RWURKRVSLWDO UHLQJUHVR 027,92

VDODGHSDUWR
QR VL
7,32 ',67$1&,$ '85$&,21 QR VL QR VL QR VL '52*$6
DpUHR +RUDV 0LQ LQFXEDGRUD PRQLWRUHR &3$3
WHUUHVWUH YHQRFOLVLV R[tJHQR LQWXEDGR 92/,9 P/ 7,32
.P
&203/,&$&,21(6 GXUDQWHHOWUDQVSRUWH QR VL
(1)(50(5$
,1*5(62 $ 1(2 (1
HUD
9$/25$&,21 0(',&2
'tD 0HV $xR +RUD 0LQ
WHPSD[LODU &LDQRVLV 6'5 3DOLGH] 'LXUHVLV
QR QR QR QR
('$' (*FRUUHJLGD & VL VL VL VL 3(62 /21*,78' 3(5&5$1($12
'tDV +RUDV 6HP GLDV 6D2 )L2
9LJLOLD &RQYXOVLRQHV
QRUPDO FRPD
QR VL J FP FP
127$6$/,1*5(62
,1)250(,1,&,$/$/$)$0,/,$ GLUHFWD WHOHIyQLFD QRVHORJUy

)+1(6$93
5HVSRQVDEOHGHOLQJUHVR )LUPD
)LJXUD+LVWRULDGH+RVSLWDOL]DFLyQ1HRQDWDO$QYHUVR
3$72/2*,$6 6(36,6 5(7,123$7,$ (1&()$/2

DJHQWH QRVH
QR QR VL QR VL WUDWDGDGHVGH DLVOy QR VL QF QR VL
DVIL[LD QHXPRWyUD[ QR VL GtD PHV DxR JHUPHQ RIWDOPRVFRStD
VL DO QDFHU HFRJUDItD
LQGLUHFWD
PHPEUDQD GLVSO
KLDOLQD EURQ SXOP VHP GtDV OHXFRPDODFLD
GtD PHV DxR
6'5 DVRF HGDG JHVWDF KHPRUUDJLD
(&1 HU
H[ FUDQHDQD
PHFRQLR FRQILUPDGD
KLSHUW SHUI LQWHVW GtD PHV DxR JUDGR
SXOPRQDU IRFDO 5HTXLHUH Pi[

GXFWXV JUDGR FLUXJtD
VtILOLV
DUW WUDWDGR GtD PHV DxR Pi[ QR VL
+,9 DVItFWLFR
DSQHDV SHULQDWDO FFRQYXOVLRQHV
2WUDVFyGLJR\QRPEUH 'HIHFWRFRQJpQLWRPD\RU
75$7$0,(1726 D &8,'$'265(63,5$725,26 &,58*,$ &5(&,0,(172

('$' GRVLV ,1,&,$/ HGDG
QR VL UHFXSHUD SHVRDODV
KRUDV PLQXWRV QR VL
QR VL &3$3SUHYHQWLO '85$&,21 SHVRPtQLPR SHVR VHP
GtDV KRUDV GXFWXV
VXUIDFWDQWH
YHQWLODGR(7 (&1 J
LQGRPHWSURILO GtDV
523
&3$3 GtDV $1752320(75,$$/(*5(62
LQGRLEXSWUDW
KLGURFHI 3(62 J /21*,78'FP 3(5 &5$1($12
R[tJHQR
GtDV FP
DPLQRIFDIHt GtDV RWUD

!G
DOLPHQWDFLyQ
SDUHQWHUDO GtDV WUDQVIXVLRQHV PO9ROWRWDO
)RWRFRSLDU JUiILFR GH SHVRHGDG
(*5(62 YLYR IDOOHFH WUDVODGR IDOOHFH ('$'$/ ('$'*(67 0$'5( +2*$5$/(*5(62
(*5(62 $/(*5(62 $/,0(172
GXUDQWHR $/(*5(62 -8172$51 FRQPDGUHSDGUH
OXJDU HQOXJDU 208(57( VHP GtDV ',$35(9,2
QHFUR
QR VL GHWUDVODGR GtD ODFWDQFLD RWURVIDPLOLDUHV
GtD PHV DxR
H[FOXVLYD GtD\QRFKH
VyORGtD DGRSFLyQ
QR VL QR VL SDUFLDO DUWLILFLDO VyORYLVLWy DPSDURLQVWLWXF
2;,*(12
(1+2*$5 QRYLVLWy QF
7$0,=$-(6,1081,=$&,21(6 35202&,21'(6$/8'7HPDVDERUGDGRV
6,),/,6 76+ $8',&,21 )$/&,)250( %&* +HS%YDF QR VL QR VL
QHJ QRUPDO QRUPDO QRUPDO QR QR /DFWDQFLD H[FOXVLYD 8VR DOFRKROJHO
WUDWDGR HOHYDGR GpILFLW DQRUPDO VL VL 'HUHFKRV
'RUPLU ERFD DUULED SURWHF VRFLDO
QR WUDWDGR VG VG VG VG VG 3UHYHQFLyQ (QWUHJR
VG FRQWDJLR UHVSLYLUXV PDWHULDO LPSUHVR
,1',&$&,21(6 5(63216$%/( 7(/()212 (0$,/

$/(*5(62
6(*8,0,(172 /XJDU 7HOpIRQR )HFKD

&225',1$'2 GtD PHV DxR
3HGLiWULFR 3RUFXiQWDVVHPDQDV
ODPDGUHQRUHDOL]DUi
GtD PHV DxR WDUHDVIXHUDGHOKRJDU"
2IWDOPROyJLFR QR VL
)+1(6593
GtD PHV DxR

$XGLROyJLFR QR VL
VHPDQDV
$SR\R3VLFRVRFLDO QR VL
)LJXUD+LVWRULDGH+RVSLWDOL]DFLyQ1HRQDWDO5HYHUVR
0,6 5(*,67526 ',$5,26 &/$3605 236206 0, 120%5( 6(36,6(1&8562 ',$ 0(6 $f2 ',$6+263 +25$6
727$/'(
0DPi 3DSi QR VL 35(9,$6 /(&+(
VyORFOtQLFD 0$7(51$ PO
&21',&,21$&78$/ EDFWHULDQD ',$69,'$ (*&255(*,'$
9$5,$&,21 %$/$1&(
KRQJRV 3(62 +,'5,&2
1,9(/'( )RWRWHUDSLD VHP G PO
021,
&8,'$'2 PtQLPR LQWHUPHGLR LQWHQVLYR FXQD VHUYRFXQD LQFXEDGRUD QR VL 725(6 )&DUG )5HVS 6D2 7HPS JHUPHQ 3(5&() 3(62DFWXDO
$3257(
0$0$ HVWH RWUR HQ RWUD PLPD\ FXLGD\ VRVWLHQH GDGH DPD &$/25,&2
FDO.JG
(67$(1 KRVSLWDO KRVSLWDO FDVD FDVD 0$0$0( DFRPSDxD OLPSLD HQEUD]RV FRPHU PDQWD FP J J
+25$'(&8,'$'26352*5$0$'26
¢48,(10(&8,'2"
VL QR VL QR VL QR VL QR VL QR VL QR VL QR VL QR VL QR VL QR VL QR VL QR
9,(1(1<0(75$(1/(&+( 0$0$
3$3$
PO PO PO PO PO PO PO PO PO PO PO PO
3527(&&,217(50,&$
+80('$' 326,&,21
(67$'2'(&21&,(1&,$
7(03(5$785$
$;,/$5 ,1&8%$'25$
)5(&8(1&,$ QR QR QR QR QR QR QR QR QR QR QR QR
5(63,5$725,$ $31($6
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
$SQHD
VL VL VL VL VL VL VL VL VL VL VL VL
)5(&8(1&,$ 35(6,21
&$5',$&$ $57(5,$/
&21752/(69,7$/(6
&2/25 7,(032GH
5(&2/25$&,21
6$1*5(
(;75$,'$
0,&&,21(6
3(5','$6
'(326,&,21(6
5(6,'8$/ *$675,&2
<920,726
7,32<
92/80(1
)250$'(
$'0,1,675$&,21
$3257(25$/
9,$
&(175$/ 3(5,)(5,&$
+V35(9,$6
9,$

)LJXUD3ODQLOODGLDULDGH(QIHUPHUtD1HRQDWDO$QYHUVR

$3257(3$5(17(5$/

)(1(6$93

+25$'(&8,'$'26352*5$0$'26
$127$5)$50$&26
'26,6\9,$
&803/,'$
0(',&$&,21
92/80(1 PO
6(71DVDO&DUSD 6HFUHFLRQHV
&DQWLGDG7LSR
3,0 )5
33& 7LHPSR,QVS
309$ 'UHQDMH7yUD[
&8,'$'26
5(63,5$725,26
)L2 6D2
$127$55(68/7$'26
62/,&,7$'26 127$6$',&,21$/(6<&8,'$'26
(;$0(1(63$5$&/,1,&26
6(5(48,(5(
VL QR
$32<236,&262&,$/
&21&855(1
36,&2/2*,$
$6,67(17(62&,$/
75$7$0,(1720(',&2XVDUOHWUDGHPROGHSHTXHxD\FODUD
)LJXUD3ODQLOODGLDULDGH(QIHUPHUtD1HRQDWDO5HYHUVR
)(1(6593

352&(6$0,(172'(/26'$726'(/$+&3
(O&/$3605KDGHVDUUROODGRXQSURJUDPDSDUDFRPSXWDGRUHVSHUVRQDOHVTXHSHUPLWH
GHVFHQWUDOL]DU HO SURFHVDPLHQWR UHDOL]iQGROR HQ HO PLVPR OXJDU GRQGH VH SUHVWD OD
DWHQFLyQ'HHVWDPDQHUDHOSHUVRQDOGHVDOXGFXHQWDFRQLQIRUPDFLyQHQWLHPSRUHDO
HQHOPRPHQWRTXHVHODUHTXLHUHSDUDIDFLOLWDUODHYDOXDFLyQGHODDVLVWHQFLD\ODWRPD
GHGHFLVLRQHV
(VWH SURJUDPD UHFLHQWHPHQWH KD VLGR DFWXDOL]DGR RSHUDQGR HQ DPELHQWH ZLQGRZV
FRQ OOHQDGR IDFVLPLODU HQ SDQWDOOD (VWRV LPSRUWDQWHV FDPELRV WHFQROyJLFRV PHMRUDQ
VX SRWHQFLD \ SURGXFWLYLGDG FRQVHUYDQGR DO PLVPR WLHPSR WRGD OD LQIRUPDFLyQ
JHQHUDGD SRU YHUVLRQHV SUHYLDV (O SURFHVDPLHQWR GH ORV GDWRV WLHQH FRPR
UHVXOWDGR XQD VHULH GH GRFXPHQWRV TXH FRQVWLWX\HQ XQ UHVXPHQ GH OD DFWLYLGDG
GH OD LQVWLWXFLyQ HQ XQ SHUtRGR GDGR HVWDGtVWLFD EiVLFD R VRQ HOHPHQWRV GH
LQYHVWLJDFLyQPiVHVSHFt¿FDSRUHMHPSORULHVJRUHODWLYRGHVFULSFLyQGHYDULDEOHVHWF
8QDVHULHGHLQGLFDGRUHVSUHYLDPHQWHGH¿QLGRV\GHIiFLOREWHQFLyQEULQGDQLQIRUPDFLyQ
UHOHYDQWHDOFOtQLFRDOJHVWRUDOHSLGHPLyORJRRDOKDFHGRUGHSROtWLFDVHQVDOXG
(O DUFKLYR GH KLVWRULDV TXHGD D GLVSRVLFLyQ GH OD UHG LQIRUPiWLFD GH OD PDWHUQLGDG
VDOYDJXDUGDQGRODFRQ¿GHQFLDOLGDGGHORVGDWRVGHODVXVXDULDVHQODVKLVWRULDVFOtQLFDV
LQIRUPDWL]DGDV(OFHQWURGHDVLVWHQFLDHPLWHVXVLQIRUPHVSHULyGLFRVKDFLHQGRXVRGH
ORVSURJUDPDVGHFyPSXWRV
/RV FHQWURV GH FyPSXWRV FHQWUDOHV R UHJLRQDOHV UHTXLHUHQ OD LQIRUPDFLyQ GH ODV
JHVWDQWHV \ UHFLpQ QDFLGRV DWHQGLGRV HQ HO QLYHO ORFDO 3RU HOOR HO FHQWUR DVLVWHQFLDO
HQWUHJDUiGXSOLFDGRVGHODEDVHGHGDWRVTXHFRQWLHQHVXVKLVWRULDV\DLQJUHVDGDV\
FRUUHJLGDV/RVFHQWURVGHFyPSXWRVUHJLRQDOHV\ORFDOHVWDPELpQRSHUDQFRQHO6,3OR
TXHSHUPLWHFRQVROLGDUWRGDODLQIRUPDFLyQ
$XQTXHQRHVORLGHDOH[LVWHWDPELpQODSRVLELOLGDGGHSURFHVDUORVGDWRVGHOD+&3
IXHUDGHOOXJDUGRQGHVHUHDOL]DODDVLVWHQFLDSHULQDWDOHQFDVRTXHHVWRIXHVHQHFHVDULR
EDVWDUiUHPLWLUGXSOLFDGRVGHODVKLVWRULDVDXQQLYHOORFDOGHPD\RUFRPSOHMLGDGFDSD]
GHSURFHVDUORVGDWRV(VWDVLWXDFLyQSXHGHGDUVHHQDTXHOORVFDVRVHQTXHQRVHD
SRVLEOHFRQWDUFRQXQFRPSXWDGRURTXHHOYROXPHQGHFDVRVPHQVXDOHVQRMXVWL¿TXH
VXDGTXLVLFLyQ
/DV FDUDFWHUtVWLFDV VDOLHQWHV GHO VLVWHPD GHVDUUROODGR SXHGHQ UHVXPLUVH HQ ORV
VLJXLHQWHVSXQWRV
(O SURFHVDPLHQWR ORFDO GH ORV GDWRV FRQ HO 6,3 IRUWDOHFH OD FDSDFLGDG GH DXWR
HYDOXDFLyQ DVLVWHQFLDO SHULQDWDO PHGLDQWH HO DQiOLVLV GH GDWRV HQ OD SURSLD
LQVWLWXFLyQDVLVWHQFLDO
+DFH WRPDU FRQFLHQFLD DO SHUVRQDO GH OD LPSRUWDQFLD GH XQD GRFXPHQWDFLyQ
FRPSOHWDGHODVDFFLRQHV\REVHUYDFLRQHVGHVDOXG
3URSRUFLRQDDORVHQWHVDVLVWHQFLDOHVSHULQDWDOHVXQDKHUUDPLHQWDiJLO\GHIiFLO
PDQHMRSDUDODVLQYHVWLJDFLRQHVRSHUDFLRQDOHV
3DUDPD\RULQIRUPDFLyQVREUHHO6LVWHPD,QIRUPiWLFR3HULQDWDO6,3\VXSURFHVDPLHQWR

YHUSXEOLFDFLRQHVFLHQWt¿FDV&/$3605\
2EMHWLYRV&RQWDUFRQXQDKRMDGHUXWDTXHJXtHDOSUHVWDGRUSDUDEULQGDUXQD
DWHQFLyQSUHQDWDOGHFDOLGDG
$FWLYLGDG8VRGHOD+LVWRULD&OtQLFD3HULQDWDOGHO&/$3605
(O&HQWUR/DWLQRDPHULFDQRGH3HULQDWRORJtD6DOXGGHOD0XMHU\5HSURGXFWLYD&/$3
605HQSXEOLFyOD+LVWRULD&OtQLFD3HULQDWDO+&3FRQODLQWHQFLyQGHWHQHUXQ
UHJLVWURXQLIRUPL]DGR\GHFDOLGDGGHODDWHQFLyQGHODVPXMHUHVHPEDUD]DGDV\GHORV
UHFLpQQDFLGRVHQOD5HJLyQ
(VWHLQVWUXPHQWRIXHGLVHxDGRSDUDFRQWULEXLUHQODWRPDGHGHFLVLRQHVUHODFLRQDGDV
FRQHOPDQHMRFOtQLFRLQGLYLGXDOGHODPXMHUHPEDUD]DGDGXUDQWHHOFRQWUROSUHQDWDO
SDUWR\SXHUSHULR\GHOQHRQDWRGHVGHHOQDFLPLHQWRKDVWDHOPRPHQWRGHODOWD9HU
3XEOLFDFLRQHV&LHQWt¿FD&/$3605\
/D+&3DGHPiVGHLQWHQWDUIDFLOLWDUODWDUHDGHORVFOtQLFRVHQHOWHUUHQR\GHHVWDQGDUL]DU
HO UHJLVWUR GH GDWRV EXVFD IDFLOLWDU OD VXSHUYLVLyQ \ HYDOXDFLyQ GHO FXPSOLPLHQWR GH
QRUPDVFOtQLFDV\SURPRYHUXQPDQHMRFOtQLFRLQGLYLGXDOL]DGR\HIHFWLYR
6LELHQORVGDWRVFRQWHQLGRVHQOD+&3SXHGHQVHUSRVWHULRUPHQWHLQJUHVDGRVDXQD
EDVHGHGDWRVODSULRULGDGGHOFOtQLFRHVFRQWDUFRQXQDEXHQDKLVWRULDFOtQLFD\SRU
pVWDUD]yQHO&/$3605SULRUL]DHOOOHQDGRFRPSOHWRGHOD+&3
'HVGHVXFUHDFLyQOD+&3KDVLGRPRGL¿FDGDHQYDULDVRFDVLRQHV(VWDVPRGL¿FDFLRQHV
REHGHFHQDODQHFHVLGDGGHPDQWHQHUDFWXDOL]DGRVXFRQWHQLGRFRQODPHMRUHYLGHQFLD
FLHQWt¿FDGLVSRQLEOHDVtFRPRLQFOXLUODVSULRULGDGHV±QDFLRQDOHVHLQWHUQDFLRQDOHV
GH¿QLGDVSRUORV0LQLVWHULRVGH6DOXGGHOD5HJLyQ6XIRUPDWR\GLVHxRVLQHPEDUJR
KDVXIULGRSRFDVPRGL¿FDFLRQHVHKLVWyULFDPHQWHVHKDLQWHQWDGRPDQWHQHUODPLVPD
GLDJUDPDFLyQ$FWXDOPHQWHHOGLVHxRGHOD+&3FRQWHPSODODVVLJXLHQWHVVHFFLRQHV
LGHQWL¿FDFLyQ
DQWHFHGHQWHVIDPLOLDUHVSHUVRQDOHV\REVWpWULFRV
JHVWDFLyQDFWXDO
SDUWRRDERUWR
HQIHUPHGDGHVGXUDQWHHOHPEDUD]R
SXHUSHULR
HJUHVRPDWHUQR
UHFLpQQDFLGR
HQIHUPHGDGHVGHOUHFLpQQDFLGR
HJUHVRGHOUHFLpQQDFLGR
DQWLFRQFHSFLyQ
2EMHWLYRV'HWHFWDUULHVJRVHQODSREODFLyQ
$FWLYLGDG(YDOXDFLyQGHOULHVJRSHULQDWDO
3DUDLPSOHPHQWDUODVDFWLYLGDGHVGHQRUPDWL]DFLyQGHOFRQWUROSUHQDWDOGLULJLGRDODV
PXMHUHV FRQ HPEDUD]RV GH EDMR ULHVJR HV QHFHVDULR XQ LQVWUXPHQWR TXH SHUPLWD
LGHQWL¿FDUODV(VWHREMHWLYRVHORJUDDOFRQVWDWDUODSUHVHQFLDRODDXVHQFLDGHIDFWRUHV
GHULHVJR
/D HYDOXDFLyQ GHO ULHVJR QR HV XQD WDUHD VHQFLOOD (O FRQFHSWR GH ULHVJR HV
IXQGDPHQWDOPHQWHSUREDELOtVWLFR\ODFDGHQDTXHDVRFLDXQIDFWRUGHULHVJRFRQGDxR
QR VLHPSUH HVWi GH¿QLGD 3RU HMHPSOR HQ RFDVLRQHV HO GDxR ³PXHUWH IHWDO´ GHULYD
FODUDPHQWHGHXQIDFWRUSHURHQRWUDVODUHODFLyQHVPXFKRPiVGLItFLOGHHVWDEOHFHU
SRUGHVFRQRFLPLHQWRGHOIDFWRURIDFWRUHVLQWHUYLQLHQWHVRSRUODGL¿FXOWDGHQHVWDEOHFHU
HOSHVRLQGLYLGXDOGHFDGDXQRGHHOORVFXDQGRHOSUREOHPDHVPXOWLIDFWRULDO
/RV SULPHURV VLVWHPDV GH HYDOXDFLyQ GH ULHVJR IXHURQ HODERUDGRV HQ EDVH D OD
REVHUYDFLyQ\ODH[SHULHQFLDGHVXVDXWRUHV\VRORUHFLHQWHPHQWHKDQVLGRVRPHWLGRVD
HYDOXDFLRQHVSHUVLVWLHQGRD~QGXGDVVREUHVXFDOLGDGFRPRGLVFULPLQDGRUHV
/RV VLVWHPDV EDVDGRV HQ SXQWDMH DGROHFHQ D~Q GH H[DFWLWXG HQ HO YDORU DVLJQDGR D
FDGDIDFWRU\DODVDVRFLDFLRQHVGHHOORV+D\JUDQGHVYDULDFLRQHVGHDFXHUGRDVX
DSOLFDFLyQVHJ~QVHWUDWHGHLQGLYLGXRVRSREODFLRQHV3DUDTXHIXHVHQPiVDGHFXDGRV
GHEHUtDQHODERUDUVHHQFDGDOXJDUOXHJRGHFRQRFHUHOUHDOSHVRTXHWLHQHQORFDOPHQWH
ORVIDFWRUHV
(OHPSOHRGHPpWRGRVFRPRHOGHODDSOLFDFLyQGHOOLVWDGRTXHFRPRHMHPSORVHPXHVWUD
D FRQWLQXDFLyQ SHUPLWH VHSDUDU D ODV HPEDUD]DGDV HQ GRV JUXSRV +D\ DOJXQDV
FDUDFWHUtVWLFDVFX\DSUHVHQFLDHQODHPEDUD]DGDODFDOL¿FDQFRPRGHDOWRULHVJR\OD
H[FOX\HQGHOFRQWUROSUHQDWDOGHEDMRULHVJR
(QWUH ORV IDFWRUHV TXH DXPHQWDQ HO ULHVJR SHULQDWDO VH FLWDQ ~QLFDPHQWH DTXHOORV
FX\RFRQWUROUHTXLHUHDFWLYLGDGHVQRFRQWHPSODGDVHQHVWDSURSXHVWD\TXHQHFHVLWDQ
DFFLRQHVGHPD\RUFRPSOHMLGDGQRUPDVGHDOWRULHVJR
&8$'52)DFWRUHVGHULHVJRSHULQDWDO
&DUGLRSDWtD 3ROLKLGUDPQLRV
+LSHUWHQVLyQ 2OLJRDPQLRV
'LDEHWHV +HPRUUDJLDJHQLWDO
7XEHUFXORVLV $PHQD]DGHSDUWRGHSUHWpUPLQR
+HPRJORELQDPHQRUGHJO 5RWXUDSUHPDWXUDGHODVPHPEUDQDVRYXODUHV
$QWHFHGHQWHVGHPXHUWHSHULQDWDO 7DOODPDWHUQDFP
$OORLQPXQL]DFLyQVHQVLELOL]DFLyQ5K 3HVRPDWHUQRSUHJUDYtGLFR.J
0DFURVRPtDIHWDO (VFDVRRH[DJHUDGRLQFUHPHQWRGHSHVRPDWHUQR
(PEDUD]RP~OWLSOH $QWHFHGHQWHVJHQpWLFRVGHVIDYRUDEOHV
5HVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR
2EMHWLYRV &RQRFHULQIRUPDFLyQUHOHYDQWHGHOHPEDUD]R
$FWLYLGDG $QDPQHVLV
&RQHOLQWHUURJDWRULRFRPLHQ]DHOH[DPHQFOtQLFRGHWRGDJHVWDQWH3RUODVFRQVHFXHQFLDV
DGPLQLVWUDWLYDV\OHJDOHV\SRUODDVRFLDFLyQTXHDOJXQRVIDFWRUHVWLHQHQFRQHOULHVJR
SHULQDWDOXQDFRUUHFWDDQDPQHVLVGHEHLQFOXLU
,GHQWL¿FDFLyQGHODJHVWDQWH 'DWRVGHOHPEDUD]RDFWXDO
(VWDGRVRFLRHGXFDFLRQDO $QWHFHGHQWHVIDPLOLDUHV
$QWHFHGHQWHVREVWpWULFRV $QWHFHGHQWHVSHUVRQDOHV

+,6725,$&/,1,&$3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO
(67$'2&,9,/
FDVDGD
FRQWURO
120%5( $3(//,'2 GtD PHV DxR EODQFD %(7$ XQLyQHVWDEOH SUHQDWDO
QLQJXQR SULPDULD
LQGtJHQD QR
PHVWL]D SDUWRDERUWR
('$' DxRV VL
VHFXQG XQLYHUV RWUR
/2&$/,'$' 7(/() QHJUD 1
)LJXUD+&36HFFLyQLGHQWL¿FDFLyQ\HVWDGRVRFLRHGXFDFLRQDO
,GHQWL¿FDFLyQ 1RPEUHV\$SHOOLGRV )HFKDGHQDFLPLHQWR\HGDG

GHODJHVWDQWH 'RPLFLOLR /XJDUGHOFRQWUROSUHQDWDO
/RFDOLGDG /XJDUGHOSDUWRDERUWR
7HOpIRQR 1GHGRFXPHQWRGHLGHQWLGDG
+D\DFXHUGRHQFRQVLGHUDUDODVJHVWDQWHVGHDDxRVFRPRHOJUXSRHWDULRGH
PHQRUULHVJRSHULQDWDO/DPRUWDOLGDGIHWDOQHRQDWDO\ORVGHIHFWRVFRQJpQLWRVVXHOHQVHU
PiVIUHFXHQWHVHQODDGROHVFHQFLDWHPSUDQDPHQRUHVGHDxRVFRPRDSDUWLUGHORV
DxRVGHHGDG
(VWDGRVRFLR (WQLD
HGXFDFLRQDO 1LYHOHGXFDFLRQDO
(VWDGRFLYLO
/D IXHUWH DVRFLDFLyQ H[LVWHQWH HQWUH PDORV UHVXOWDGRV SHULQDWDOHV \ EDMR QLYHO VRFLR
HGXFDFLRQDOREOLJDDFRQVLGHUDUHVWDVYDULDEOHVWRGDYH]TXHVHHYDO~DXQDJHVWDQWH
(OGHWHULRURVRFLRHGXFDFLRQDOVHDVRFLDDXQPHQRUQ~PHURGHFRQVXOWDVSUHQDWDOHV
DIDPLOLDVPiVQXPHURVDVDKDFLQDPLHQWRDPD\RUSRUFHQWDMHGHHPEDUD]DGDVTXH
UHDOL]DQ WUDEDMR ItVLFR DO PDQWHQLPLHQWR GH OD DFWLYLGDG ODERUDO KDVWD HWDSDV PiV
DYDQ]DGDVGHOHPEDUD]RDPHQRUQLYHOGHLQVWUXFFLyQ\DXQDPD\RUIUHFXHQFLDGH
JHVWDFLRQHVHQXQLRQHVLQHVWDEOHV/RVDVSHFWRVHQXQFLDGRVSUHYLDPHQWHVHYLQFXODQ
VHJ~QVHSHUWHQH]FDRQRDGHWHUPLQDGRVJUXSRVpWQLFRV
/RVSXHEORVLQGtJHQDV\ODVSREODFLRQHVDIURGHVFHQGLHQWHVFRQVWLWX\HQPiVGHO
GHODSREODFLyQGHOD5HJLyQ
+D\HWQLDVTXHSUHVHQWDQULHVJRVSHULQDWDOHVHVSHFt¿FRVLQGHSHQGLHQWHPHQWHGHVX
FRQGLFLyQ VRFLRHFRQyPLFRFXOWXUDO VH SXHGH FLWDU D PDQHUD GH HMHPSOR OD DQHPLD
IDOFLIRUPHHQODVSREODFLRQHVDIURGHVFHQFLHQWHV$GHPiVGHVXLPSRUWDQFLDGHPRJUi¿FD
\SRUFRQGLFLRQHVFOtQLFDVSDUWLFXODUHVHVWRVJUXSRVSREODFLRQDOHVYLYHQHQFRQGLFLRQHV
PiVGHVIDYRUDEOHVTXHRWURVJUXSRVSREODFLRQDOHV+DFHUYLVLEOHVHVWDVGLIHUHQFLDVD
WUDYpVGHLQGLFDGRUHVGHVDOXGGHVDJUHJDGRVSRUHWQLDHVXQDHVWUDWHJLDSDUDPHMRUDU
VXVLWXDFLyQ
$17(&('(17(6
FLUXJtD GtD PHV DxR

GLDEHWHV 8/7,0235(9,2
FDUGLRSDW HVSRQW
QRUPDO ñ J HPE HFWySLFR QDFLGRV UD
VHP
UD
VHP
)LJ+&36HFFLyQDQWHFHGHQWHV
$QWHFHGHQWHV 7XEHUFXORVLV 3UHHFODPSVLD

IDPLOLDUHV 'LDEHWHV (FODPSVLD
+LSHUWHQVLyQ 2WUDVFRQGLFLRQHVPpGLFDVJUDYHV
6HWUDWDUiLQYHVWLJDUHQORVSDULHQWHVFHUFDQRVPDGUHSDGUHKLMRVKHUPDQRVSDUHMD
GHODJHVWDQWHVLH[LVWHDOJ~QDQWHFHGHQWHTXHREOLJXHDDGRSWDUPHGLGDVHVSHFLDOHV
GHGLDJQyVWLFRRGHWUDWDPLHQWR
$QWHFHGHQWHV 7XEHUFXORVLV (FODPSVLD &DUGLRSDWtD

SHUVRQDOHV 'LDEHWHV 2WUDVFRQGLFPpGLFDVJUDYHV1HIURSDWtD
+LSHUWHQVLyQ &LUXJtDJHQLWRXULQDULD 9LROHQFLD
3UHHFODPSVLD ,QIHUWLOLGDG
(Q RFDVLRQHV HV LPSUHVFLQGLEOH HYDOXDU HO JUDGR GH GDxR TXH XQD HQIHUPHGDG
SUHH[LVWHQWH R OD YLROHQFLD SXGR KDEHU FDXVDGR \ FRPR HOOR SXHGH UHSHUFXWLU
GHVIDYRUDEOHPHQWHVREUHHOHPEDUD]R
$QWHFHGHQWHV 1~PHURHYROXFLyQ\WHUPLQDFLyQGHODVJHVWDFLRQHVSUHYLDV
REVWpWULFRV 1DFLGRVYLYRV\PXHUWRV
)LQDOL]DFLyQGHO~OWLPRHPEDUD]R
$QWHFHGHQWHVGHPDFURVRPtDREDMRSHVRDOQDFHU
$QWHFHGHQWHVGHJHPHODULGDG
$VSHFWRVUHIHULGRVDODSODQL¿FDFLyQGHOHPEDUD]R
/RV GDWRV UHODWLYRV D ORV HPEDUD]RV DQWHULRUHV WLHQHQ YDORU SDUD HO SURQyVWLFR GHO
DFWXDOHPEDUD]R+D\XQDWHQGHQFLDDTXHHOULHVJRVHUHSLWD
6H GHEHQ MHUDUTXL]DU DTXHOORV GDWRV TXH SRU VX UHOHYDQFLD SXHGDQ LQÀXLU VREUH ORV
UHVXOWDGRV GHO HPEDUD]R DFWXDO SRU HMHPSOR DERUWRV HVSRQWiQHRV FRQVHFXWLYRV
TXH VH PDUFDQ HQ XQ FtUFXOR DPDULOOR REOLJDQ DO SUHVWDGRU D YDORUDU OD FRQGLFLyQ
GHDERUWDGRUDKDELWXDOGHHVDPXMHU\GHVDUUROODUODVDFWLYLGDGHVTXHVHFRQVLGHUHQ
DSURSLDGDVSDUDHYLWDUXQQXHYRDERUWR
/DVQXOtSDUDVUHTXHULUiQXQDDWHQFLyQHVSHFLDO\DTXHDGHPiVGHQRWHQHUXQFDQDO
GH SDUWR SUREDGR SUHVHQWDQ SDWRORJtDV TXH VXHOHQ VHU PiV FRPXQHV HQ HOODV SRU
HMHPSORSUHHFODPSVLD
/DV JUDQGHV PXOWtSDUDV UHTXHULUiQ FXLGDGRV HVSHFLDOHV HQ HO PRPHQWR GHO SDUWR
GXUDQWHHODOXPEUDPLHQWR\HQHOSXHUSHULR\DTXHODVREUHGLVWHQVLyQGHOD¿EUDXWHULQD
VHYLQFXODFRQPD\RUULHVJRGHDWRQtDXWHULQD\KHPRUUDJLD
/D¿QDOL]DFLyQGHOHPEDUD]RDQWHULRUHVXQGDWRGHMHUDUTXtDFXDQGRLQGLTXHXQFRUWR
LQWHUYDOR LQWHUJHQpVLFR /D +&3 DGYLHUWH DO SURIHVLRQDO GH VDOXG SDUD TXH FRQVXOWH HO
LQWHUYDORLQWHUJHQpVLFR&XDQGRHOLQWHUYDORVHDPHQRUDDxRTXHGDUiUHJLVWUDGRHQ
DPDULOORFRPRVLJQRGHDOHUWD
8Q JUXSR WpFQLFR UHXQLGR SRU OD RUJDQL]DFLyQ PXQGLDO GH
ODVDOXG206KDUHFRPHQGDGRXQHVSDFLDPLHQWRGHSRU
OR PHQRV PHVHV OXHJR GHO QDFLPLHQWR GH XQ KLMR YLYR
R GH PHVHV HQ FDVR GH DERUWR \ XQ IXWXUR HPEDUD]R
FRQODLQWHQFLyQGHUHGXFLUUHVXOWDGRVDGYHUVRVPDWHUQRV
SHULQDWDOHV\QHRQDWDOHV
(VLPSRUWDQWHWHQHUHQFXHQWDHVWRVFRQFHSWRVSDUDDVHVRUDU
DODVPXMHUHVDFHUFDGHFXDOHVHOPRPHQWRELROyJLFRPiV
DSURSLDGRSDUDXQQXHYRHPEDUD]R
)LJXUD
(QGH¿QLWLYDODVGHFLVLRQHVVRQSRWHVWDGGHODVPXMHUHV\ )UDJPHQWRGHOD+&3
VXVIDPLOLDV\VRQHOODVODVTXHXQDYH]LQIRUPDGDVRSWDUiQ ,QWHUYDORLQWHUJHQpVLFR
VREUHFXDOHVHOPRPHQWRRSRUWXQRSDUDXQQXHYRHPEDUD]R
(VWDGHFLVLyQHVXQDFXHVWLyQGH'HUHFKRVHQXQFLDGDHQHO
3ODQGHDFFLyQGH(O&DLURGH
/RVSUHVWDGRUHVGHEHUiQWHQHUSUHVHQWHHODQWHFHGHQWH
GHXQUHFLpQQDFLGRFRQSHVRPHQRUDJUDPRV\D
TXHHVWRH[SRQHDODJHVWDQWHDPD\RUSUREDELOLGDGGH
UHSHWLUHOQDFLPLHQWRGHRWURKLMRFRQEDMRSHVRDOQDFHUHQ
HOQXHYRHPEDUD]R$TXHOODVJHVWDQWHVFRQDQWHFHGHQWHV
GHPDFURVRPtDIHWDOFRUUHQPD\RUULHVJRGHSUHVHQWDUXQ
QXHYRHPEDUD]RFRQXQIHWRPDFURVyPLFRHVWRGHEHUtD
JHQHUDUDFWLYLGDGHVSDUDGHVFDUWDUSRVLEOHVDOWHUDFLRQHV
GHOPHWDEROLVPRKLGURFDUERQDGR/DPDFURVRPtDIHWDOVH )LJXUD
SXHGHDFRPSDxDUGHPD\RULQWHUYHQFLRQLVPRREVWpWULFR )UDJPHQWR+&3
\SRUHQGHGHPD\RUPRUWDOLGDGSHULQDWDO $QWHFHGHQWHVGHO~OWLPR
51\JHPHODULGDG
(ODQWHFHGHQWHGHHPEDUD]RP~OWLSOHREOLJDDGHVFDUWDUHQIRUPDH[KDXVWLYDXQQXHYR
HPEDUD]R P~OWLSOH /RV HPEDUD]RV P~OWLSOHV H[SRQHQ D ODV PXMHUHV \ D VXV KLMRV D
VHULRVULHVJRV/DPRUWDOLGDGIHWDOHVYHFHVPD\RUTXHSDUDORVHPEDUD]RV~QLFRV
(ODOWRtQGLFHGHSUHPDWXULGDG\EDMRSHVRVHDVRFLDQFRQXQDDOWDPRUWDOLGDGQHRQDWDO
/D DQHPLD SUHHFODPSVLD KLSHUHPHVLV JUDYtGLFD OD DWRQtD XWHULQD \ OD KHPRUUDJLD
SRVWSDUWR VXHOHQ YHUVH PiV IUHFXHQWHPHQWH HQ ORV HPEDUD]RV P~OWLSOHV TXH HQ ORV
~QLFRV
(VLPSRUWDQWHGHWHUPLQDUVLHOHPEDUD]RQRHVWDEDSODQL¿FDGR\DTXHFRQIUHFXHQFLDKD\
XQDDVRFLDFLyQHQWUHHPEDUD]RVQRSODQHDGRV\HPEDUD]RVQRGHVHDGRV&XDQGRORV
HPEDUD]RVQRVRQGHVHDGRVDXPHQWDODSUREDELOLGDGGHTXHDSDUH]FDQFRPSOLFDFLRQHV
WDOHVFRPR
PDQLREUDVDERUWLYDVHQiPELWRVGHULHVJR
VLQWRPDWRORJtDItVLFDGHUHFKD]RKLSHUHPHVLV
JUDYtGLFD
UHSHUFXVLRQHVHPRFLRQDOHVTXHLQÀXLUiQVREUH
ODJHVWDQWH\VXKLMRGHSUHVLyQPHQRUFXLGDGR
SHUVRQDOFRQGXFWDVGHULHVJRPHQRUFXLGDGR )LJXUD
)UDJPHQWR+&33ODQL¿FDFLyQGHO
GHVXKLMR HPEDUD]R\IUDFDVRGHOPpWRGR
5HOHYDUHOXVRGHPpWRGRVFRQWUDFHSWLYRV\HOIUDFDVRGHOPpWRGRXVDGRHVSHFLDOPHQWH
HQ DTXHOODV PXMHUHV TXH QR SODQL¿FDURQ HO HPEDUD]R FRQVWLWX\H XQD LQIRUPDFLyQ
PX\YDOLRVDWDQWRGHVGHHOSXQWRGHYLVWDSREODFLRQDOSXHVWRTXHHVWRSHUPLWHDORV
JHVWRUHV HVWDEOHFHU DQiOLVLV VREUH OD DFFHVLELOLGDG D ORV PpWRGRV FRPR GHO SXQWR
GHYLVWDLQGLYLGXDO\DTXHVHSRGUiGHWHUPLQDUHQFDVRVGHIUDFDVRGHPpWRGRVODV
HVWUDWHJLDVSDUDEULQGDUODFRQWUDFHSFLyQDSURSLDGDDHVDPXMHUXQDYH]TXH¿QDOLFHHO
HPEDUD]RDFWXDO
2EMHWLYRV )LMDUXQFURQRJUDPDTXHSHUPLWDSODQL¿FDUODVDFWLYLGDGHVGHO
FRQWUROSUHQDWDO
$FWLYLGDG 'HWHUPLQDFLyQGHODHGDGJHVWDFLRQDO\GHODIHFKDSUREDEOHGHSDUWR
*HVWDFLyQDFWXDO
/XHJRGHKDEHUFRQ¿UPDGRHOHPEDUD]RVHGHEHUiHVWDEOHFHUODHGDGGHOPLVPR\OD
IHFKDSUREDEOHGHSDUWR
/RVPpWRGRVKDELWXDOPHQWHXVDGRVSDUDGHWHUPLQDUODHGDGJHVWDFLRQDOVRQ
,QWHUURJDWRULRVREUHODDPHQRUUHD
(YDOXDFLyQGHOWDPDxRGHO~WHURHVSHFLDOPHQWHHQHOHUWULPHVWUH
$QWURSRPHWUtDHFRJUi¿FDVRORHVWiLQGLFDGDVLSHUVLVWHQGXGDVFRQORVPpWRGRV
FOtQLFRV
$PHQRUUHD
/D PHGLFLyQ GHO WLHPSR WUDQVFXUULGR GHVGH OD IHFKD GH ~OWLPD PHQVWUXDFLyQ )80
HVHOPpWRGRGHHOHFFLyQSDUDFDOFXODUODHGDGJHVWDFLRQDOHQODVPXMHUHVFRQFLFORV
PHQVWUXDOHV UHJXODUHV \ TXH QR KDQ XVDGR HQ ORV ~OWLPRV PHVHV FRQWUDFHSWLYRV
KRUPRQDOHV
)LJXUD+&36HFFLyQ*HVWDFLyQ$FWXDO
(VQHFHVDULRLQWHUURJDUSRU~QLFDYH]HQIRUPDSUHFLVD\WUDQTXLODDFHUFDGHOSULPHU
GtD\HOPHVGHOD~OWLPDPHQVWUXDFLyQ6LHVWRVGDWRVVRQFRQ¿DEOHVDSDUWLUGHHOORV
VHFDOFXODUiODHGDGGHOHPEDUD]R\ODIHFKDSUREDEOHGHSDUWR
/DVVHPDQDVGHJHVWDFLyQVHSXHGHQHVWLPDUXVDQGRHO*HVWRJUDPDGHO&/$3605
)LJ+DFLHQGRFRLQFLGLUODÀHFKDURMDTXHGLFH³)HFKDHQTXHFRPHQ]yOD~OWLPD
PHQVWUXDFLyQ´FRQHOGtDGHOD)80\EXVFDQGRODIHFKDFRUUHVSRQGLHQWHDOGtDGHOD
FRQVXOWDVHREWHQGUiQODVVHPDQDVGHDPHQRUUHD(QVXGHIHFWRVXPDQGRORVGtDV
WUDQVFXUULGRVGHVGHOD)80KDVWDODIHFKDGHODFRQVXOWD\GLYLGLpQGRORVHQWUHWDPELpQ
VHREWHQGUiQODVVHPDQDVGHDPHQRUUHD
/D IHFKD SUREDEOH GH SDUWR )33 WDPELpQ VH SXHGH FDOFXODU IiFLOPHQWH FRQ HO
JHVWRJUDPD GHO &/$3605 +DFLHQGR FRLQFLGLU OD ÀHFKD URMD \D GHVFULSWD FRQ HO
SULPHUGtDGHOD~OWLPDPHQVWUXDFLyQEDVWDUiFRQREVHUYDUODIHFKDTXHFRUUHVSRQGH
DODVHPDQDSDUDREWHQHUOD)336LQRVHFXHQWDFRQJHVWRJUDPDRFDOHQGDULR
REVWpWULFRODIHFKDSUREDEOHGHSDUWRVHSXHGHGHWHUPLQDUPHGLDQWHHOXVRGHXQDGH
ODVVLJXLHQWHVUHJODV
:DKO DOSULPHUGtDGHOD)80DJUHJDGtDV\DOPHVOHUHVWD
1DHJHOHDOSULPHUGtDGHOD)80DJUHJDGtDV\DOPHVOHUHVWD
3LQDUG DO~OWLPRGtDGHOD)80DJUHJDGtDV\DOPHVOHUHVWD
GtDV SDUWLHQGRGHOSULPHUGtDGHOD)80VHFRQWDUiQGtDVVREUHXQ
FDOHQGDULRODIHFKDFRUUHVSRQGLHQWHDOGtDVHUiOD)33
(YDOXDFLyQGHOWDPDxRXWHULQR
/D )80 FXDQGR HV FRQ¿DEOH FRQVWLWX\H HO HVWiQGDU GH RUR SDUD FDOFXODU OD HGDG
JHVWDFLRQDO 6L TXHGDUDQ GXGDV VREUH OD HGDG JHVWDFLRQDO GH¿QLGD SRU OD )80 VH
SRGUiQXWLOL]DUPHGLGDVPHQRVSUHFLVDVSHURTXHSHUPLWLUiQDSUR[LPDUQRVDHOOD/D
UHDOL]DFLyQ GH XQ H[DPHQ XWHULQR ELPDQXDO DQWHV GH ODV VHPDQDV GH JHVWDFLyQ
SURYHH XQ GDWR GH JUDQ YDORU SDUD HVWLPDU OD HGDG JHVWDFLRQDO 0iV DOOi GH ODV
VHPDQDVGHJHVWDFLyQODPHGLGDGHODDOWXUDXWHULQDWLHQHSRFRYDORUSDUDFDOFXODUOD
HGDGJHVWDFLRQDO'HEHWHQHUVHSUHVHQWHTXHODHYDOXDFLyQGHOWDPDxRXWHULQRDSHQDV
HVXQDIRUPDLQGLUHFWDGHHVWLPDUODHGDGGHOHPEDUD]R\TXHODPLVPDSXHGHHVWDU
PRGL¿FDGDSRUGLVWLQWDVVLWXDFLRQHVTXHVHGHWDOODQHQHOVLJXLHQWHFXDGUR
&XDGUR
(OHPHQWRVTXHPRGL¿FDQODHGDGJHVWDFLRQDOHVWLPDGDSRUHYDOXDFLyQGHOWDPDxRXWHULQR
0LRPDV 2OLJRDPQLRV
(QIHUPHGDGWURIREOiVWLFD0ROD 5HVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR5&,
(PEDUD]RP~OWLSOH 0DOIRUPDFLRQHVIHWDOHV
3ROLKLGUDPQLRV 0DFURVRPtDIHWDO
$QWURSRPHWUtDIHWDOSRUHFRJUDItD
(Q DOJXQDV RFDVLRQHV ORV HOHPHQWRV FOtQLFRV VRQ LQVX¿FLHQWHV SDUD FDOFXODU OD HGDG
JHVWDFLRQDO HQ HVRV FDVRV VH SRGUi DSHODU D OD XOWUDVRQRJUDItD 6X DSOLFDFLyQ HVWi
EDVDGDHQODUHODFLyQTXHH[LVWHHQWUHODDPHQRUUHDHOGHVDUUROORDQDWyPLFRGHOIHWR
\ OD PHGLGD GH FLHUWRV VHJPHQWRV IHWDOHV &XDQWR PiV WHPSUDQDPHQWH VH UHDOLFH
VH REWHQGUi PD\RU SUHFLVLyQ DGHPiV GH SRGHU UHSHWLU ODV PHGLFLRQHV FRQ FLHUWD
SHULRGLFLGDGORTXHGLVPLQX\HFRQVLGHUDEOHPHQWHHOHUURUGHHVWLPDFLyQ
/DV PHGLGDV DQWURSRPpWULFDV TXH VH XVDQ DFWXDOPHQWH SRU VX PHMRU FRUUHODFLyQ FRQ OD
DPHQRUUHDVRQ
/RQJLWXGPi[LPDFpIDORFDXGDOFRQVLVWHHQPHGLUODPD\RUGLVWDQFLDH[LVWHQWHHQWUH
DPERVSRORVIHWDOHV(VHOSDUiPHWURHFRJUi¿FRPiV¿HO6HXVDHQWUHODVVHPDQDV
\
(OHUURUGHODHVWLPDFLyQVHVLW~DHQGtDVFXDGUR
&XDGUR(VWLPDFLyQGHODHGDGJHVWDFLRQDOVHJ~QORQJLWXGFpIDORFDXGDO
/RQJLWXGFpIDORFDXGDO/&& $PHQRUUHD 9DULDELOLGDG
PP VHPDQDV VHPDQDV
D
D
D
D
D
D
D
D
D
D
D
'LiPHWURELSDULHWDOVHREWLHQHPLGLHQGRGHVGHODWDEODH[WHUQDGHOSDULHWDOSUR[LPDOD
ODWDEODH[WHUQDGHOSDULHWDOGLVWDOFXDGURRGHODWDEODH[WHUQDGHOSDULHWDOSUR[LPDO
D OD WDEOD LQWHUQD GHO SDULHWDO GLVWDO FXDGUR 6H SXHGH FRPHQ]DU D SDUWLU GH OD
VHPDQD\KDVWDHOWpUPLQR
(OHUURUGHODHVWLPDFLyQYDUtDHQUHODFLyQGHORWDUGtDRWHPSUDQDGHODIHFKDHQTXH
VHKDFHODPHGLFLyQ
&XDGUR(VWLPDFLyQGHODHGDGJHVWDFLRQDODSDUWLUGHODPHGLGD
GHOGLiPHWURELSDULHWDO'%37DEODH[WHUQDH[WHUQD
Intervalo de Intervalo de
Diámetro bipa- Amenorrea Diámetro bipa- Amenorrea
confianza 90% confianza 90%
rietal (mm) (semanas) rietal (mm) (semanas)
(semanas) (semanas)
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D

&XDGUR(VWLPDFLyQGHODHGDGJHVWDFLRQDODSDUWLUGHODPHGLGD
GHOGLiPHWURELSDULHWDO'%3PHGLRGHERUGHH[WHUQRDERUGHLQWHUQR
Diámetro bipa- Amenorrea Diámetro bipa- Amenorrea
rietal (mm) (semanas) rietal (mm) (semanas)
(semanas) (semanas)
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D

/RQJLWXG GHO IpPXU VH REWLHQH PLGLHQGR OD ORQJLWXG Pi[LPD GHO IpPXU D SDUWLU GH OD
VHPDQD\KDVWDHOWpUPLQRFXDGUR(QORVIHWRVGHDVHPDQDVVHSXHGH
YLVXDOL]DUHOQ~FOHRGHRVL¿FDFLyQGHOIpPXUQ~FOHRGH%pFODUGTXHDOWpUPLQRPLGHGH
DPP
&XDGUR(VWLPDFLyQGHODHGDGJHVWDFLRQDODSDUWLUGHODPHGLGDGHODORQJLWXGGHO
IpPXU
Longitud fémur Amenorrea Longitud fémur Amenorrea
(mm) (semanas) (mm) (semanas)
(semanas) (semanas)
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
D D
0DGXUH] SODFHQWDULD DXQTXH QR HV XQ LQGLFDGRU GH HGDG JHVWDFLRQDO VH KD YLVWR
EXHQDFRUUHODFLyQHQWUHODPDGXUH]SODFHQWDULDSRUHFRJUDItD\ODPDGXUH]SXOPRQDU
IHWDO (VWR HV HVSHFLDOPHQWH UHOHYDQWH FXDQGR VH GHVFRQRFH OD HGDG JHVWDFLRQDO \
HV QHFHVDULR WRPDU XQD FRQGXFWD UHODFLRQDGD FRQ OD LQWHUUXSFLyQ R FRQWLQXDFLyQ GHO
HPEDUD]R
2EMHWLYRV (YDOXDUHOHVWDGRQXWULFLRQDOPDWHUQR
$FWLYLGDG 0HGLFLyQGHOSHVR\GHODWDOODPDWHUQD
&iOFXORGHOLQFUHPHQWRGHSHVRGXUDQWHODJHVWDFLyQ
(O SHVR PDWHUQR SUHJUDYtGLFR LQVX¿FLHQWH OD EDMD WDOOD GH OD PDGUH \ HO HVFDVR R HO
H[DJHUDGR LQFUHPHQWR GH SHVR GXUDQWH HO HPEDUD]R KDQ VLGR DVRFLDGRV FRQ PDORV
UHVXOWDGRVSHULQDWDOHV
&XDQGR HO SHVR SUHJUDYtGLFR HV FRQRFLGR R OD SULPHUD FRQVXOWD RFXUUH HQ HO SULPHU
WULPHVWUH\HOSHVRGHWHUPLQDGRVHDVXPHFRPRSUHJUDYtGLFRVHFDOFXODHOtQGLFHGH
PDVD FRUSRUDO ,0& GLYLGLHQGR HO SHVR HQ .J HQWUH OD WDOOD HQ PHWURV DO FXDGUDGR
(VWRSHUPLWHHVWLPDUORVUDQJRVGHDXPHQWRDGHFXDGRGHSHVRVHJ~QHO,0&SUHYLRDO
HPEDUD]R&RPRVHYHHQODWDEODODJDQDQFLDDGHFXDGDGHSHQGHUiGHOD,0&LQLFLDO
&XDGUR$XPHQWRGHSHVRUHFRPHQGDGRSDUDPXMHUHVVHJ~Q,0&SUHJHVWDFLRQDO
&DWHJRUtDGHSHVR ,0&NJP $XPHQWRWRWDOGHSHVR.J
%DMRSHVR ± ±
3HVRQRUPDO ± ±
6REUHSHVR ± ±
2EHVLGDG RPiV
/DYDULDFLyQGHOSHVRGXUDQWHODJHVWDFLyQHVPX\JUDQGH\RVFLODHQWUH\.JDO
WpUPLQRGHSHQGLHQGRGHOHVWDGRQXWULFLRQDOSUHYLRDOHPEDUD]R)LJXUD(OSHUtRGR
GHPi[LPRDXPHQWRGHSHVRVHSURGXFHHQWUHODVVHPDQDV\
7pFQLFDGHPHGLFLyQ
(O SHVR VH GHEH PHGLU HQ FDGD FRQWURO SUHQDWDO FRQ OD JHVWDQWH HQ URSD OLYLDQD \
VLQ FDO]DGR &RQYLHQH XVDU EDODQ]DV GH SHVDV ODV TXH GHEHUiQ VHU FDOLEUDGDV
UHJXODUPHQWH
/D WDOOD GHEHUi PHGLUVH HQ HO SULPHU FRQWURO /D WpFQLFD FRQVLVWH HQ TXH OD JHVWDQWH
VHXELTXHGHSLHVLQFDO]DGRFRQWDORQHVMXQWRVFRQVXHVSDOGDORPiVFHUFDQDDO
WDOOyPHWURELHQHUJXLGDFRQORVKRPEURVKDFLDDWUiV\FRQODYLVWDDOIUHQWH
*DQDQFLDGHSHVR
6L OD JHVWDQWH FRQRFH VX SHVR KDELWXDO SUHJUDYtGLFR VH FRQWURODUi VX LQFUHPHQWR
XWLOL]DQGR FRPR SDWUyQ GH UHIHUHQFLD ORV YDORUHV GH OD ¿JXUD TXH WDPELpQ VH
HQFXHQWUDQJUD¿FDGRVHQHOFDUQpSHULQDWDOGH&/$36056HUHVWDDOSHVRDFWXDOHO
SUHJUDYtGLFR\GHHVWDPDQHUDVHGHWHUPLQDHOLQFUHPHQWRGHSHVR(VWHLQFUHPHQWRGH
SHVRVHUHODFLRQDFRQODHGDGJHVWDFLRQDOSDUDGHWHUPLQDUHQGH¿QLWLYDHOLQFUHPHQWR
GHSHVRSDUDHVDHGDGJHVWDFLRQDO'LFKRYDORUHVWUDVODGDGRDODJUi¿FDGHOFDUQp
6XVOtPLWHVPi[LPRS\PtQLPRSWDPELpQVHSXHGHQHQFRQWUDUHQODFLQWD
PpWULFDHQODWDUMHWD3HVR7DOOD\HQHOJHVWRJUDPDGH&/$3605
NJ
3

3
$XPHQWRGHSHVR

3

3

$PHQRUUHDVHPDQDV
)LJXUD,QFUHPHQWRGHSHVRPDWHUQRHQIXQFLyQGHODHGDGJHVWDFLRQDO
,17(535(7$&,21'(/$0(','$$/$35,0(5$&2168/7$
NJ
3 El punto se sitúa entre las curvas de los percentilos
25 y 90 del peso de referencia para la edad
gestacional
DIAGNOSTICO
Buen estado nutricional
$XPHQWRGHSHVR

3

CONDUCTA
- seguir cronograma habitual de consultas

- explicar a la gestante que su peso es

adecuado para la edad gestacional

$PHQRUUHDVHPDQDV
- dar orientación nutricional
NJ
3 El punto se sitúa por debajo del percentilo 25 de la
curva de referencia

DIAGNOSTICO

Gestante de riesgo, con peso insuficiente para la
$XPHQWRGHSHVR
edad gestacional (desnutrición)

3

CONDUCTA

- investigar la historia nutricional, hiperemesis
gravídica, infecciones, parasitosis, anemia,

enfermedades debilitantes.

- citar a consulta en un intervalo menor que lo

$PHQRUUHDVHPDQDV
fijado en el cronograma habitual.
El punto se sitúa por encima del percentilo 90 de la

NJ
3
curva de referencia

DIAGNOSTICO
Gestante de riesgo, por presentar peso superior

al normal para esa edad gestacional; tanto mayor
$XPHQWRGHSHVR
será el riesgo cuanto más elevado sea su

3 sobrepeso.

CONDUCTA

- determinar causas: obesidad, edema,
polihidramnios, macrosomía, embarazo múltiple

- citar a consulta en un intervalo menor que lo
fijado en el cronograma habitual.

$PHQRUUHDVHPDQDV
- el peso ganado durante toda la gestación no
debe superar los 16 kg (p90)
,17(535(7$&,21'(/$6(&8(1&,$'(0(','$6(1&2168/7$6
68%6(&8(17(6
NJ

3 Trazado con inclinación ascendente entre las
curvas del percentil 25 y el percentil 90 del peso
de referencia para la edad gestacional

$XPHQWRGHSHVR
DIAGNOSTICO
3

Buen estado nutricional (ganancia adecuada de
peso):

CONDUCTA

- seguir cronograma habitual de consultas

- dar orientación nutricional que la gestante se
mantenga dentro de la faja de normalidad
$PHQRUUHDVHPDQDV
Trazado entre las curvas de percentil 25 y 90,

con inclinación horizontal o descendente o
NJ

3 trazado por abajo de la cuva del percentil 25, con
inclinación horizontal o ascendente, sin alcanzar la
faja considerada normal (p25)
DIAGNOSTICO
$XPHQWRGHSHVR
Gestante de riesgo con referencia a su ganancia

3 adecuada de peso:

CONDUCTA
- Identificar causas: déficit nutricional, infecciones,
parasitosis, anemia, entre otras. Tratarlas cuando

esten presentes y dar orientación nutricional

- referir a control prenatal de alto riesgo.

$PHQRUUHDVHPDQDV Estas medidas intentan que la gestante llegue al
término de la gestación con una ganancia de peso
mínima de 8 kg.
Trazado por encima de la curva del percentil 90 de

NJ
3
peso de referencia para la edad gestacional.

DIAGNOSTICO

Gestante de riesgo visto que su ganancia de peso es

superior a lo ideal para su edad gestacional; cuanto
mayor sea su sobrepeso mayor será el riesgo
$XPHQWRGHSHVR

3 CONDUCTA
- investigar posibles causas: obesidad, diabetes
y edema.

- si persiste, derivar a control de alto riesgo.
- en caso que exista polihidramnios, macrosomía,
o gravidez múltiple, está indicado derivar a
control de alto riesgo.

Esas medidas procuran que la gestante llegue al

$PHQRUUHDVHPDQDV término con un peso final dentro del rango de la
normalidad (máximo de 16 kg)
0XFKDVJHVWDQWHVGHVFRQRFHQVXSHVRKDELWXDOSUHYLRDOHPEDUD]R(QHVWRVFDVRV
VH SXHGH FRQWURODU HO DXPHQWR GH SHVR SRU ORV LQFUHPHQWRV VHPDQDOHV DFHSWDQGR
FRPRQRUPDOXQDXPHQWRSURPHGLRGHJVHPDQDOHVHQHOVHJXQGRWULPHVWUH\GH
JVHPDQDOHVHQHOWHUFHUWULPHVWUH
5HODFLyQSHVRSDUDODWDOODVHJ~QHGDGJHVWDFLRQDO
&XDQGRODPDGUHGHVFRQRFHVXSHVRSUHJUDYtGLFR\ODFDSWDFLyQHVWDUGtDH[LVWHRWUD
PDQHUDGHFRQRFHUVLHOSHVRDOFDQ]DGRKDVWDHVHPRPHQWRHVDGHFXDGRSDUDHVD
HGDGJHVWDFLRQDO3DUDHOORVHSXHGHXWLOL]DUODWDEOD¿JXUDTXHGHVFULEHORVYDORUHV
GHSHVRDOFDQ]DGRDHVDHGDGJHVWDFLRQDOVHJ~QODWDOOD
(QODLQWHUVHFFLyQGHFDGDVHPDQDGHDPHQRUUHDFRQODWDOODPDWHUQDVHSUHVHQWDQORV
SHUFHQWLORV\GHOSHVRJUDYtGLFRHVSHUDEOHSDUDHVDHGDGJHVWDFLRQDO
,QWHUSUHWDFLyQ
1RUPDO 6HUiFXDQGRDXQDHGDGJHVWDFLRQDOGHWHUPLQDGDHOSHVRDOFDQ]DGRSRUOD
PDGUHVHHQFXHQWUDHQWUHORVSHUFHQWLOHV\GHODWDEODGHUHIHUHQFLD
$QRUPDO 6HUi FXDQGR HO SHVR PDWHUQR VH VLW~H SRU HQFLPD GHO SHUFHQWLO R SRU
GHEDMRGHOSHUFHQWLO
&RQHVWH~OWLPRSURFHGLPLHQWRQRVHFRQRFHHOLQFUHPHQWRGHSHVRPDWHUQRSHURVH
SXHGHVDEHUVLHOSHVRDOFDQ]DGRSRUXQDJHVWDQWHGHDFXHUGRDVXWDOODHVDGHFXDGR
RQRSDUDXQDGHWHUPLQDGDHGDGJHVWDFLRQDO
/DVJHVWDQWHVFRQYDORUHVGHSHVRSDUDODWDOODLQVX¿FLHQWHVRFRQGp¿FLWGHLQFUHPHQWR
GHSHVRGHEHUiQUHFLELUFRQVHMRQXWULFLRQDO\VXSOHPHQWDFLyQDOLPHQWDULD

(YDOXDFLyQGHOLQFUHPHQWRSRQGHUDOPDWHUQR
(ODXPHQWRH[FHVLYRGHSHVRPDWHUQRSUHGLVSRQHDODPDFURVRPtDIHWDO\HOHVFDVR
LQFUHPHQWRVHDVRFLDFRQUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR5&,
6L DOJ~Q YDORU HV PD\RU DO SHUFHQWLO GH VX SDWUyQ UHVSHFWLYR GHEH VRVSHFKDUVH
H[FHVRGHLQJHVWDGLDEHWHVPHOOLWXVRUHWHQFLyQKtGULFD
6HVRVSHFKDUiVXEQXWULFLyQPDWHUQDFXDQGRHOLQFUHPHQWRGHSHVRVHDPHQRUTXHHO
SHUFHQWLORHOSHVRSDUDODWDOODVHDPHQRUTXHHOSHUFHQWLOGHVXVUHVSHFWLYRV
SDWURQHV(VWRVVLJQRVVRQRULHQWDGRUHVGH5&,(OLQFUHPHQWRGHSHVRPHQRUDOS
WLHQHXQDVHQVLELOLGDGFDSDFLGDGGHGLDJQRVWLFDUORVYHUGDGHURVSHTXHxRVSDUDODHGDG
JHVWDFLRQDO3(*FHUFDQDDO/DDOWXUDXWHULQDDLVODGDFXDQGRVHHQFXHQWUDSRU
GHEDMRGHOSHQUHODFLyQDVXFXUYDGHUHIHUHQFLDWLHQHXQDVHQVLELOLGDGFHUFDQDDO
3HURFXDQGRVHDVRFLDQDOWXUDXWHULQD\JDQDQFLDGHSHVRPDWHUQRODVHQVLELOLGDG
GLDJQyVWLFDDXPHQWDDO
&RQGXFWD
(QORVFDVRVFRQVRVSHFKDFOtQLFDGH5&,XQDYH]H[FOXLGRVORVFDVRVGHROLJRDPQLRV
GHHUURUGHDPHQRUUHDHWFVHGHEHUiFRQ¿UPDUHOGLDJQyVWLFRSRUXOWUDVRQLGRSDUD
GHVFDUWDUIDOVRVSRVLWLYRV\VHUHIHULUiDOVHUYLFLRGHDOWRULHVJR
2EMHWLYRV ,QYHVWLJDUHVWLORVGHYLGDGHULHVJR
$FWLYLGDG ,QWHUURJDWRULRVREUHWDEDTXLVPRDFWLYR\SDVLYRGURJDVDOFRKRO
\YLROHQFLD
)LJXUD)UDJPHQWRGH+&3(VWLORVGHYLGD
([LVWHQ HVWLORV GH YLGD TXH SXHGHQ VHU ULHVJRVRV SDUD OD PXMHU \ VX IXWXUR KLMR (O
HPEDUD]RVXHOHVHUXQPRPHQWRHVSHFLDOHQHOTXHODPD\RUtDGHODVPXMHUHVHVWiQ
GLVSXHVWDVDKDFHU³VDFUL¿FLRV´SDUDJDUDQWL]DUODVDOXGGHVXIXWXURKLMR3RUHVWDUD]yQ
PXFKRVSURJUDPDVSDUDFHVDFLyQGHOWDEDTXLVPRHODOFRKRO\ODVGURJDVVXHOHQWHQHU
PiVp[LWRGXUDQWHHVWHSHUtRGR7DPELpQRFXUUHORPLVPRFRQORVDVSHFWRVYLQFXODGRV
D OD YLROHQFLD FRQWUD OD PXMHU /DV PXMHUHV TXH VXIULHURQ YLROHQFLD GXUDQWH SHUtRGRV
SURORQJDGRV \ OR KDQ DFHSWDGR HVWiQ GLVSXHVWDV D EXVFDU D\XGD PLHQWUDV HVWiQ
HPEDUD]DGDV3RUHVWDVUD]RQHV&/$3605LQFRUSRUyHVWRVDVSHFWRVDOD+&3$~Q
VDELHQGRTXHHVGLItFLOSDUDORVSUHVWDGRUHVLQWHUURJDUHVWRVDVSHFWRV\TXHWDPELpQ
HVFRPSOHMRSDUDODVPXMHUHVDGPLWLUDOJXQDVGHHVWDVVLWXDFLRQHV\TXHODVPLVPDV
SXHGHQ YDULDU D OR ODUJR GHO HPEDUD]R VH UHFRPLHQGD UHLQWHUURJDU HVWRV DVSHFWRV
(VWD E~VTXHGD HQ GLIHUHQWHV LQVWDQFLDV SHUPLWLUi FRQVWDWDU VL ODV LQWHUYHQFLRQHV
GHVDUUROODGDVVRQH[LWRVDVRSRUHOFRQWUDULRVLODVPLVPDVIUDFDVDQ
/RVVHUYLFLRVGHEHUiQWHQHUHVWDEOHFLGRVORVSDVRVSDUDEULQGDUDSR\RHQODVVLWXDFLRQHV
HQODVTXHVHHVWDEOH]FDQHVWRVGLDJQyVWLFRV/DIDOWDGHUHVSXHVWDRODLPSURYLVDFLyQ
SXHGHQVHUDOWDPHQWHSHUMXGLFLDOHV
7DEDTXLVPRDFWLYR
(OWDEDFRHVXQDGHODVGURJDVPiVIUHFXHQWHPHQWHFRQVXPLGD/D206HVWLPDTXH
HQ ORV SDtVHV GHVDUUROODGRV HO FRQVXPR GH WDEDFR SRU ODV PXMHUHV HVWi SRU HQFLPD
GHOPLHQWUDVTXHHQORVSDtVHVHQYtDVGHGHVDUUROORODVFLIUDVGHPXMHUHVTXH
IXPDQVHXELFDQHQWRUQRDOFRQDPSOLDVRVFLODFLRQHV0XFKDVGHHVWDVPXMHUHV
SHUVLVWLUiQIXPDQGRGXUDQWHHOHPEDUD]R
/RVHIHFWRVGHOWDEDFRQRVRORSXHGHQGDxDUDODPXMHUVLQRTXHVXXVRGXUDQWHHO
HPEDUD]RSXHGHSURYRFDUVHULRVGDxRVDOIHWR\DORVUHFLpQQDFLGRV(VWiGHPRVWUDGR
TXH VX FRQVXPR HQ HO HPEDUD]R HQ IRUPD DLVODGD R FRQWLQXD DXPHQWD HO ULHVJR
UHSURGXFWLYR
$SUR[LPDGDPHQWH HO KXPR GHO FLJDUULOOR FRQWLHQH PiV GH SURGXFWRV TXtPLFRV
PXFKRVGHHOORVDOWDPHQWHQRFLYRV\RWURVGHORVTXHD~QQRVHKDQGHWHUPLQDGRVXV
YHUGDGHURVHIHFWRV
(OFRQVXPRGHFLJDUULOORVGXUDQWHHOHPEDUD]RKDVLGRDVRFLDGRFRQ
x%DMRSHVRDOQDFHU
x5HVWULFFLyQHQHOFUHFLPLHQWRIHWDO
x3DUWRVGHSUHWpUPLQR
x&RPSOLFDFLRQHVGHOHPEDUD]RGHOSDUWR\GHOSXHUSHULR
x$ERUWRVHVSRQWiQHRV
x0XHUWHIHWDO
x0XHUWHVQHRQDWDOHV
x'LVPLQXFLyQGHODFDOLGDG\FDQWLGDGGHODOHFKHPDWHUQD
/RVKLMRVGHODVIXPDGRUDVSHVDQHQSURPHGLRDOQDFHUHQWUH\JPHQRVTXH
ORVKLMRVGHODVQRIXPDGRUDV(VWDGLIHUHQFLDGHSHVRJXDUGDUHODFLyQFRQHOQ~PHUR
GHFLJDUULOORVIXPDGRV6HFDOFXODTXHFDGDFLJDUULOORGtDSXHGHVHUUHVSRQVDEOHGH
JUDPRVPHQRVGHSHVRDOQDFHU
(OSRUFHQWDMHGH%31HVPD\RUHQODVIXPDGRUDVHOLQFUHPHQWRGH%31YDUtDVHJ~Q
GLYHUVRVDXWRUHVGHVGHXQDXQ(OULHVJRGH%31SDUDORVKLMRVGHPDGUHV
IXPDGRUDVFDVLVHGXSOLFD
7DPELpQVHKDFRQ¿UPDGRODDVRFLDFLyQHQWUHSUHPDWXUH]\KiELWRGHIXPDU(OSRUFHQWDMH
GHSUHPDWXUH]HQODVIXPDGRUDVVHHOHYDHQFRPSDUDFLyQFRQODVQRIXPDGRUDVHQWUH
XQ\XQ
(OSULQFLSDOFRPSRQHQWHGHO%31HQHOFDVRGHODVIXPDGRUDVHVOD5&,\VHFXQGDULDPHQWH
ODSUHPDWXUH]
/DDVRFLDFLyQHQWUH%31\SUHPDWXULGDGDXPHQWDHOULHVJRGHTXHHOUHFLpQQDFLGRVXIUD
SUREOHPDV GH VDOXG GXUDQWH HO SHUtRGR QHRQDWDO GLVFDSDFLGDGHV SDUiOLVLV FHUHEUDO
UHWDUGRPHQWDO\SUREOHPDVGHODSUHQGL]DMHHLQFOXVRODPXHUWH
/RVKLMRVGHPDGUHVIXPDGRUDVWLHQHQYHFHVPiVSUREDELOLGDGGHVXIULUPXHUWHV~ELWD
6LODPDGUHORJUDFHVDUHOXVRGHOWDEDFRHQHOSULPHUWULPHVWUHGHOHPEDUD]RFDVLQR
VHQRWDUtDQGLIHUHQFLDVHQWUHORVKLMRVGHPDGUHVIXPDGRUDV\QRIXPDGRUDV,QFOXVR
VL OD JHVWDQWH VROR FHVD GH IXPDU HQ HO WHUFHU WULPHVWUH HV SUREDEOH TXH PHMRUH HO
FUHFLPLHQWRIHWDO
/RVFLJDUULOORVVHDVRFLDQFRQHOGREOHGHSUREDELOLGDGGHTXHODVPXMHUHVTXHIXPDQ
GXUDQWHHOHPEDUD]RGHVDUUROOHQSUREOHPDVYLQFXODGRVDODSODFHQWDSODFHQWDSUHYLD
GHVSUHQGLPLHQWRSUHPDWXURGHSODFHQWDVLVHODVFRPSDUDFRQPXMHUHVQRIXPDGRUDV
7DPELpQVHKDYLVWRXQDXPHQWRHQHOULHVJRGHURWXUDSUHPDWXUDGHPHPEUDQDVHQODV
PXMHUHVTXHIXPDQGXUDQWHHOHPEDUD]R&XDQGRHVWDVFRPSOLFDFLRQHVVHSURGX]FDQ
DQWHVGHODVVHPDQDVSRGUiQDVRFLDUVHFRQSUHPDWXULGDG
(O KiELWR GH IXPDU HQ SDUWLFXODU HQ JUXSRV GH PXMHUHV TXH DGHPiV SUHVHQWHQ RWUD
FRQGLFLyQ GH ULHVJR PD\RUHV GH DxRV JUDQGHV PXOWtSDUDV RWUDV FRQGLFLRQHV
PpGLFDV JUDYHV RWUDV DGLFFLRQHV HWF KD VLGR DVRFLDGR FRQ PD\RU PRUWDOLGDG
SHULQDWDO (VWD DVRFLDFLyQ SHUVLVWH FODUD HQ ORV SDtVHV HQ YtDV GH GHVDUUROOR HQ ORV
FXDOHV ODV SUHYDOHQFLDV VRQ DOWDV \ GRQGH ODV IXPDGRUDV VHJXUDPHQWH FRQFHQWUDQ
XQD PD\RU SURSRUFLyQ GH RWURV IDFWRUHV GH ULHVJR VRFLRFXOWXUDOHV HFRQyPLFRV GH
DWHQFLyQHWF
7DEDTXLVPRSDVLYR
6HUIXPDGRUDSDVLYDGXUDQWHHOHPEDUD]RWDPELpQSXHGHDXPHQWDUODVSUREDELOLGDGHV
GHXQD5&,FRQULHVJRGH%31
/RV SDGUHV TXH FRQWLQXHQ IXPDQGR XQD YH] QDFLGR HO QLxR GHEHUiQ KDFHUOR DO
DLUH OLEUH /RV QLxRV H[SXHVWRV DO KXPR GHO WDEDFR VXIUHQ PiV IUHFXHQWHPHQWH
LQIHFFLRQHVUHVSLUDWRULDVEDMDV\RWLWLV/RVQLxRVTXHHVWiQH[SXHVWRVHQORVSULPHURV
DxRV GH YLGD DO KXPR GH WDEDFR WLHQHQ PiV SUREDELOLGDG GH GHVDUUROODU DVPD
'HEHUiQHVWDEOHFHUVHSURJUDPDVGHFHVDFLyQGHWDEDTXLVPRSDUDDTXHOODVJHVWDQWHV
TXHORQHFHVLWHQ(VSUREDEOHREWHQHUp[LWRHQODFHVDFLyQVLODVPXMHUHV\DKDQWHQLGR
RWURVLQWHQWRVSRUGHMDUGHIXPDUWLHQHQSDUHMDVTXHQRIXPDQ\RWLHQHQDSR\RIDPLOLDU
SDUDGHMDUHOFLJDUULOOR
$OFRKRO
(O FRQVXPR GH DOFRKRO GXUDQWH HO HPEDUD]R VH KD DVRFLDGR FRQ GHIHFWRV ItVLFRV \
SVtTXLFRVDOQDFHUTXHUHFLEHQHOQRPEUHGHVtQGURPHDOFRKyOLFRIHWDO6$)
1RVHKDQGHPRVWUDGRQLYHOHVGHVHJXULGDGSDUDEHEHUDOFRKROGXUDQWHHOHPEDUD]R\OD
ODFWDQFLDSRUORFXDOQRVHUHFRPLHQGDHOFRQVXPRGHDOFRKROGXUDQWHHOHPEDUD]R
(O DOFRKRO DWUDYLHVD OD SODFHQWD \ HV PHWDEROL]DGR PX\ OHQWDPHQWH SRU OR TXH ORV
QLYHOHVHQODVDQJUHGHOIHWRVXHOHQVHUPXFKRPiVDOWRV\SHUPDQHFHUSRUPXFKRPiV
WLHPSRTXHHQODPDGUH(VWHHIHFWRSXHGHVHUWHUDWRJpQLFRSDUDHOIHWR(O6$)HVXQD
GH ODV FDXVDV PiV FRPXQHV GH UHWDUGR PHQWDO \ HV WRWDOPHQWH SUHYHQLEOH$GHPiV
GHORVVtQWRPDVQHXUROyJLFRVVXHOHQVHUSHTXHxRVSDUDODHGDGJHVWDFLRQDO\WHQHU
DOWHUDFLRQHVPRUIROyJLFDVFDUDFWHUtVWLFDVRMRV\QDUL]SHTXHxRVPHMLOODVSODQDV\HQ
RFDVLRQHVDOJXQDVYDULHGDGHVGHFDUGLRSDWtDFRQJpQLWD
6HJ~QLQIRUPHVGHO&'&FDGDDxRHQORV(VWDGRV8QLGRVQDFHQHQWUH\
QLxRVFRQ6$)(O6$)VHSUHVHQWDHQDSUR[LPDGDPHQWHHOGHORVQLxRVKLMRVGH
PDGUHVDOFRKyOLFDVFUyQLFDVRTXHWLHQHQUHLWHUDGRVHSLVRGLRVGHDEXVRFRQDOFRKRO
GXUDQWH HO HPEDUD]R SHUR WDPELpQ VH KD YLVWR HQ PXMHUHV FRQ HVFDVR FRQVXPR GH
DOFRKROGXUDQWHHOHPEDUD]R/DVDOWHUDFLRQHVPRUIROyJLFDVVXHOHQYLQFXODUVHFRQHO
FRQVXPRGHDOFRKROHQHOSULPHUWULPHVWUHORVSUREOHPDVGHOFUHFLPLHQWRHQFDPELR
HVWiQ UHODFLRQDGRV FRQ HO FRQVXPR HQ HO WHUFHU WULPHVWUH 3HUR HO HIHFWR GHO DOFRKRO
VREUHHOFHUHEURIHWDOVHSURGXFHGXUDQWHWRGRHOHPEDUD]R
+D\HVWXGLRVTXHKDQFRQ¿UPDGRTXHD~QHQPXMHUHVTXHFRQVXPHQHQIRUPDVRFLDO
XQ SURPHGLR GH WUDJRV SRU GtD SXHGHQ SUHVHQWDQ QLxRV FRQ PHQRU LQWHOLJHQFLD \
PD\RUHV SUREOHPDV GH FRQGXFWD HQ FRPSDUDFLyQ FRQ ORV KLMRV GH PDGUHV TXH QR
EHEtDQ
$GHPiVGHORVDVSHFWRVYLQFXODGRVDO6$)HOFRQVXPRGHDOFRKROGXUDQWHHOHPEDUD]R
KDVLGRDVRFLDGRFRQPD\RUULHVJRGHDERUWRPXHUWHIHWDO\%31
/RVSURIHVLRQDOHVGHVDOXGGHEHUiQKDFHUpQIDVLVHQUHFRUGDUDODVPXMHUHVJHVWDQWHV
TXHDSHQDVVHSDQRVRVSHFKHQTXHHVWiQHPEDUD]DGDVGHEHQVXVSHQGHUHOFRQVXPR
GHEHELGDVDOFRKyOLFDV\DTXHQRVHKDGHWHUPLQDGRFXDOHVHOQLYHOVHJXUR
)LQDOPHQWH HO FRQVXPR GH DOFRKRO GXUDQWH OD ODFWDQFLD SXHGH GLVPLQXLU OD H\HFFLyQ
OiFWHD\SURYRFDUDOJXQRVWUDVWRUQRVQHXUROyJLFRVPHQRUHVHQHOUHFLpQQDFLGR
(QFDVRTXHXQDPXMHUHPEDUD]DGDQHFHVLWHD\XGDSDUDVXVSHQGHUHOFRQVXPRGH
DOFRKROGXUDQWHHOHPEDUD]R\QRVHFXHQWHFRQVHUYLFLRVLQVWLWXFLRQDOHVVHODSRGUi
YLQFXODUFRQRUJDQL]DFLRQHVORFDOHVGH$OFRKyOLFRV$QyQLPRVPDQWHQLHQGRHOYtQFXOR
FRQORVHTXLSRVREVWpWULFRVD¿QGHHYLWDUTXHODPXMHUVHVLHQWDSRFRFRQWHQLGD
5HFLHQWHPHQWH VH KD GHPRVWUDGR TXH ODV PXMHUHV HQ DOWR ULHVJR GH H[SRVLFLyQ DO
DOFRKROGXUDQWHHOHPEDUD]RVHEHQH¿FLDQGHVHVLRQHVFRQXQFRQVHMHURSDUDUHGXFLU
HOFRQVXPR
'URJDV
(OSRUFHQWDMHGHPXMHUHVTXHXVDGURJDVLOHJDOHVFRPRODPDULKXDQDFRFDtQDp[WDVLV
DQIHWDPLQDVRKHURtQDHVGLItFLOGHGHWHUPLQDUSHURVHHVWLPDVHDLQIHULRUDOGHORV
HPEDUD]RVVHJ~QGDWRVFRPXQLFDGRVSRUHO&'&(VWDV\RWUDVGURJDVLOHJDOHVSXHGHQ
SURYRFDUGLYHUVRVULHVJRVGXUDQWHHOHPEDUD]R$OJXQDVGHHOODVVHDVRFLDQFRQUHFLpQ
QDFLGRVSHTXHxRVSDUDODHGDGJHVWDFLRQDORXQDPSOLRHVSHFWURGHVtQWRPDVFRPR
GHIHFWRVFRQJpQLWRVSUREOHPDVGHFRQGXFWDRDSUHQGL]DMH3HURFRPRODPD\RUtDGH
ODVJHVWDQWHVTXHFRQVXPHQGURJDVLOHJDOHVWDPELpQFRQVXPHQDOFRKRO\WDEDFRHV
GLItFLOGHWHUPLQDUFXDOHVVRQORVSUREOHPDVGHVDOXGHVSHFt¿FDPHQWHSURYRFDGRVSRU
ODVGURJDVLOtFLWDV
&RFDtQD
/DFRFDtQDXVDGDGXUDQWHHOHPEDUD]RSXHGHDIHFWDUDODPDGUH\VXIHWRGH
GLYHUVDV PDQHUDV 'XUDQWH ORV SULPHURV PHVHV SXHGH DXPHQWDU HO ULHVJR GH
DERUWRPiVWDUGtDPHQWHSXHGHGHVHQFDGHQDUXQSDUWRGHSUHWpUPLQRRJHQHUDU
XQDUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR5&,FRQHOULHVJRGHSURYRFDUXQ
UHFLpQ QDFLGR SHTXHxR SDUD OD HGDG JHVWDFLRQDO 3(* (VWi HVWDEOHFLGR TXH
ORVQLxRV3(*WLHQHQYHFHVPiVSUREDELOLGDGHVGHPRULUHQHOSULPHUPHV
GHYLGDTXHORVQLxRVFRQSHVRDGHFXDGR/RVVREUHYLYLHQWHVDVXYH]FRUUHQ
PD\RUULHVJRGHSUHVHQWDUGLVFDSDFLGDGHVLQFOX\HQGRUHWDUGRPHQWDO\SDUiOLVLV
FHUHEUDO/RVQLxRVH[SXHVWRVGXUDQWHVXYLGDLQWUDXWHULQDDODFRFDtQDVXHOHQ
WHQHU SHUtPHWUR FHIiOLFR PiV SHTXHxR OR TXH LQGLUHFWDPHQWH UHÀHMD XQ PHQRU
GHVDUUROOR GHO FHUHEUR7DPELpQ VH KD VRVWHQLGR TXH ORV QLxRV H[SXHVWRV D OD
FRFDtQDFRUUHQPD\RUULHVJRGHSUHVHQWDUGHIHFWRVFRQJpQLWRVHVSHFLDOPHQWH
GHIHFWRVGHOWUDFWRXULQDULR\SRVLEOHPHQWHFDUGLRSDWtDFRQJpQLWD
6H KD PHQFLRQDGR XQ SRVLEOH DXPHQWR GH GHVSUHQGLPLHQWR SUHPDWXUR GH
SODFHQWDQRUPRLQVHUWDHQODVJHVWDQWHVTXHFRQVXPHQFRFDtQD
/RV UHFLpQ QDFLGRV TXH KDQ HVWDGR H[SXHVWRV D OD FRFDtQD PXHVWUDQ PHQRU
DWHQFLyQ\UHÀHMRVTXHORVUHFLpQQDFLGRVQRH[SXHVWRV$OJXQRVUHFLpQQDFLGRV
SRGUtDQSUHVHQWDUH[FHVLYROODQWR\WHPEORUHVGHIRUPDVLPLODUDOVtQGURPHGH
DEVWLQHQFLDGHORVDGXOWRVRWURVSXHGHQSUHVHQWDUGL¿FXOWDGHVSDUDGRUPLURSRU
HOFRQWUDULRSHUPDQHFHUGXUPLHQGRSRUPXFKDVKRUDVVHKDFRPXQLFDGRTXHORV
KLMRVGHPDGUHVFRFDLQyPDQDVWLHQHQPD\RUSUREDELOLGDGGHVXIULUXQVtQGURPH
GHPXHUWHV~ELWD\PD\RUGL¿FXOWDGSDUDDOLPHQWDUVH(VWRVWUDVWRUQRVVXHOHQVHU
WUDQVLWRULRV\UHYLHUWHQHQORVSULPHURVPHVHVGHYLGD
0DULKXDQD
$OJXQRVHVWXGLRVVXJLHUHQTXHORVKLMRVGHPDGUHVTXHFRQVXPtDQPDULKXDQD
GXUDQWHHOHPEDUD]RWLHQHQPD\RUSUREDELOLGDGGHSUHVHQWDUXQD5&,\GHQDFHU
SUHPDWXURV$PERVDVSHFWRVIDYRUHFHQODSRVLELOLGDGTXHHOQLxRDOQDFHUWHQJD
EDMRSHVR
$OJXQRVQLxRVDOQDFHUSRGUtDQSUHVHQWDUH[FHVLYROODQWR\WHPEORUHVGHIRUPD
VLPLODUTXHHOVtQGURPHGHDEVWLQHQFLDHQORVDGXOWRV
+DVWD HO PRPHQWR QR VH KD GHPRVWUDGR XQ ULHVJR HOHYDGR GH SUREOHPDV GH
DSUHQGL]DMHRFRQGXFWDHQHVWRVQLxRV
$TXHOODV PXMHUHV TXH GHVHHQ DEDQGRQDU HO FRQVXPR GH GURJDV GXUDQWH HO
HPEDUD]RGHEHUiQVHUDSR\DGDVHQWDOHPSUHQGLPLHQWR\UHIHULGDVDRUJDQL]D
FLRQHVTXHVHHVSHFLDOLFHQHQDWHQGHUDSHUVRQDVFRQGURJRGHSHQGHQFLD
9LROHQFLD
/D 206 HQWLHQGH SRU YLROHQFLD ³(O XVR GHOLEHUDGR GH OD IXHU]D ItVLFD R HO SRGHU \D
VHD HQ JUDGR GH DPHQD]D R HIHFWLYR FRQWUD XQR PLVPR RWUD SHUVRQD R XQ JUXSR R
FRPXQLGDG TXH FDXVH R WHQJD PXFKDV SUREDELOLGDGHV GH FDXVDU OHVLRQHV PXHUWH
GDxRVSVLFROyJLFRVWUDVWRUQRVGHOGHVDUUROORRSULYDFLRQHV´
/D 236 FRQVLGHUD D OD YLROHQFLD LQWHUSHUVRQDO FRPR XQ SUREOHPD GH VDOXG S~EOLFD
/DVPXMHUHVQLxRV\DQFLDQRVVXHOHQVHUORVJUXSRVPiVYXOQHUDEOHVHQWpUPLQRVGH
YLROHQFLD
/DYLROHQFLDGHJpQHURFRUUHVSRQGHD³WRGRDFWRGHYLROHQFLDEDVDGDHQODSHUWHQHQFLD
DOVH[RIHPHQLQRTXHWHQJDRSXHGDWHQHUFRPRUHVXOWDGRGDxRRVXIULPLHQWRItVLFR
VH[XDO R VLFROyJLFR SDUD OD PXMHU DVt FRPR OD DPHQD]D GH WDOHV DFWRV OD FRDFFLyQ
RODSULYDFLyQDUELWUDULDGHOLEHUWDGWDQWRVLVHSURGXFHHQODYLGDS~EOLFDFRPRHQOD
SULYDGD´
6HHQWLHQGHSRUYLROHQFLDGRPpVWLFDD³WRGDDFFLyQXRPLVLyQGLUHFWDRLQGLUHFWDTXH
SRUFXDOTXLHUPHGLRPHQRVFDEHOLPLWDQGRLOHJtWLPDPHQWHHOOLEUHHMHUFLFLRRJRFHGH
ORVGHUHFKRVKXPDQRVGHXQDSHUVRQDFDXVDGDSRURWUDFRQODFXDOKD\DWHQLGRXQD
UHODFLyQ DIHFWLYD EDVDGD HQ OD FRKDELWDFLyQ \ RULJLQDGD SRU SDUHQWHVFR QRYLD]JR
PDWULPRQLRRSRUXQLyQGHKHFKR´
2EWHQHU HVWD LQIRUPDFLyQ VXHOH VHU GLItFLO D SHVDU GH TXH HO SUREOHPD HV EDVWDQWH
IUHFXHQWHDGHODVPXMHUHVVXIUHQDOJXQDIRUPDGHYLROHQFLDTXHVHSURGXFH
HQ WRGRV ORV JUXSRV VRFLDOHV LQGHSHQGLHQWHPHQWH GH VX QLYHO VRFLRHFRQyPLFR
HGXFDFLRQDO$YHFHVODGL¿FXOWDGDVLHQWDHQIDFWRUHVYLQFXODGRVDLJQRUDQFLDSUHMXLFLRV
R D FRVWXPEUHV GH ORV SURYHHGRUHV D ODV FDUDFWHUtVWLFDV GH OD FRQVXOWD R D IDOWD GH
FRPSHWHQFLDSDUDDERUGDUHOWHPD(QRWUDVRFDVLRQHVODVGL¿FXOWDGHVSURYHQGUiQGH
ODVSURSLDVPXMHUHVTXHSXHGHQVHQWLUVHHVWLJPDWL]DGDVRFRQWHPRUVLUHYHODQHVWDV
VLWXDFLRQHV
/D IUHFXHQFLD GH YLROHQFLD GRPpVWLFD HQWUH PXMHUHV HPEDUD]DGDV HQ SDtVHV HQ
GHVDUUROORYDUtDGHVGHXQDXQ/RVHIHFWRVGHODYLROHQFLDSXHGHQOOHJDUKDVWD
ODPXHUWHPDWHUQDSDVDQGRSRUWRGDXQDJDPDGHOHVLRQHVItVLFDV\RVLFROyJLFDV
/RV KLMRV GH PDGUHV TXH VXIUHQ YLROHQFLD SXHGHQ VXIULU EDMR SHVR DO QDFHU SDUWR GH
SUHWpUPLQRDERUWR\PXHUWHVIHWDOHVHQWUHRWUDV
$QWHVLWXDFLRQHVGHYLROHQFLDVHUiQHFHVDULRFRQVHJXLUDSR\RFRQHVSHFLDOLVWDVHQOD
WHPiWLFDSDUDSRGHUGDUXQDUHVSXHVWDHIHFWLYDDODVPXMHUHVTXHODVXIUHQ
2EMHWLYRV 3UHYHQLUHOWpWDQRVQHRQDWDO\SXHUSHUDO
$FWLYLGDG 9DFXQDFLyQDQWLWHWiQLFD
(OWpWDQRVHQIHUPHGDGDPHQXGRIDWDOHVSURGXFLGDSRUODH[RWR[LQDGHO&ORVWULGLXP
WpWDQL\HVWRWDOPHQWHHYLWDEOHPHGLDQWHLQPXQL]DFLyQDFWLYDGHODJHVWDQWH
(ODXPHQWRGHODFREHUWXUDYDFXQDOHQOD5HJLyQGHODV$PpULFDVKDFRQWULEXLGRDOD
HOLPLQDFLyQGHOWpWDQRVQHRQDWDO711FRPRSUREOHPDGHVDOXGS~EOLFD6HFRQVLGHUD
TXH HO 711 KD VLGR HOLPLQDGR FRPR SUREOHPD GH VDOXG S~EOLFD FXDQGR ODV WDVDV
DQXDOHVGH711HQWRGRVORVPXQLFLSLRVGHXQSDtVVRQLQIHULRUHVD[QDFLGRV
YLYRVQY(QHOSHUtRGRWUDQVFXUULGRHQWUH\ODLQFLGHQFLDGH711GHVFHQGLy
XQ(QHODxRODLQFLGHQFLDGH711SDUDWRGD$PpULFDIXHGH[
QY2VFLODQGRGHVGHWDVDVGHFHURHQODPD\RUtDGHORVSDtVHVSDVDQGRD[
QYHQORVSDtVHVGHOÈUHD$QGLQDSDUDOOHJDUDODPi[LPDWDVDHQHO&DULEH/DWLQR
[QYDODFXDO+DLWtFRQWULEX\HFRQHOGHORVFDVRV
/DWDVDGHOHWDOLGDGSRUWpWDQRVQHRQDWDOSDUDFDVRVQRWUDWDGRVHVFHUFDQDDO
\ GH HQ FHQWURV GH DOWD FRPSOHMLGDG TXH FXHQWDQ FRQ DVLVWHQFLD UHVSLUDWRULD
PHFiQLFD
/DLQPXQL]DFLyQDGHFXDGDGHODVPXMHUHVFRQWR[RLGHWHWiQLFR77SUHYLHQHHOWpWDQRV
QHRQDWDO \ SXHUSHUDO (O UHFLpQ QDFLGR TXHGD SURWHJLGR HQ IRUPD SDVLYD JUDFLDV D ORV
DQWLFXHUSRVDQWLWR[LQDPDWHUQRVTXHSDVDQSRUODSODFHQWDDOVLVWHPDFLUFXODWRULRGHOIHWR
/DVEXHQDVSUiFWLFDVGHKLJLHQHGXUDQWHHOSDUWR\HOFXLGDGRGHOD
KHULGDXPELOLFDOKDVWDTXHpVWDFLFDWUL]DVRQPHGLGDVTXHFRQWULEX\HQ
SDUDSUHYHQLUHOWpWDQRVQHRQDWDO\RWUDVLQIHFFLRQHV/DLQPXQL]DFLyQ
DGHFXDGDGHODVPXMHUHVJHVWDQWHVFRQ77HVH¿FD]LQFOXVRVLOD
KHULGDXPELOLFDOVHLQIHFWDFRQ&ORVWULGLXPWpWDQL
/D+&3SURYHHXQUHFRUGDWRULRDORVSURIHVLRQDOHVGHVDOXGDFHUFD
GHOHVWDGRYDFXQDODQWLWHWiQLFRGHODPXMHUHPEDUD]DGD(OHVTXHPD Fig. 22.
GHYDFXQDFLyQUHFRPHQGDGRSDUDODSULPRYDFXQDFLyQGHPXMHUHVHQ Fragmento de HCP
HGDGIpUWLOLQFOXLGDVODVHPEDUD]DGDVHVHOVLJXLHQWH Vacuna antitetánica
&XDGUR3ODQGHYDFXQDFLyQUHFRPHQGDGRSDUDODVPXMHUHVHQHGDGIpUWLOTXH
QRKDQVLGRSUHYLDPHQWHYDFXQDGDV
Dosis Plan
Los intervalos indicados en el cuadro se refieren al tiempo mínimo aceptable entre
vacunaciones; no existen intervalos máximos.
TT1 o Td1 En el primer contacto o cuanto antes durante el embarazo
TT2 o Td2 Al menos cuatro semanas después de la primera dosis
TT3 o Td3 De 6 a 12 meses después de la segunda dosis o durante un embarazo posterior
TT4 o Td4 De uno a cinco años después de la tercera dosis o durante un embarazo posterior
TT5 o Td5 De uno a 10 años después de la cuarta dosis o durante un embarazo posterior
77 7R[RLGH7HWiQLFR7G 7pWDQRVGLIWHULD
)XHQWH (OLPLQDFLyQ GHO WpWDQRV QHRQDWDO *XtD 3UiFWLFD HGLFLyQ 236 3XEO &LHQWt¿FD \
7pFQLFD$xR
$XQTXHQRKD\LQGLFLRVGHWHUDWRJHQLDSURGXFLGDSRUODYDFXQDODVGRVLVGHUHIXHU]R
HQHOSHUtRGRGHJHVWDFLyQVHUHFRPLHQGDDGPLQLVWUDUODVGHVSXpVGHOFXDUWRPHVGH
HPEDUD]R\XQPHVDQWHVFRPRPtQLPRGHODIHFKDSUHYLVWDSDUDHOSDUWR
3XHGHQ DGRSWDUVH LQWHUYDORV PiV EUHYHV VL TXHGDQ PHQRV GH VHPDQDV HQWUH OD
SULPHUDGRVLV\ODIHFKDSUREDEOHGHSDUWR/RVUHFLpQQDFLGRVD~QUHFLELUiQSURWHFFLyQ
VDWLVIDFWRULDSHURQRySWLPDFXDQGRVHDGPLQLVWUDQDODPXMHUJHVWDQWHGRVGRVLVGH
77DGVRUELGRFRQFXDWURVHPDQDVGHLQWHUYDOR/RVLQWHUYDORVPiVFRUWRVQRSXHGHQ
FRQVLGHUDUVHVDWLVIDFWRULRVSHURSXHGHQXVDUVHVLQRKD\RWUDDOWHUQDWLYD
3DUD FRQVLGHUDU TXH XQD PXMHU VH HQFXHQWUD SURWHJLGD DO PRPHQWR GHO SDUWR GHEH
KDEHUUHFLELGROD~OWLPDGRVLVDOPHQRVVHPDQDVDQWHVGHOSDUWR
(Q iUHDV GH PRGHUDGR D DOWR ULHVJR GH WpWDQRV QHRQDWDO VH UHFRPLHQGD LQLFLDU OD
SULPHUDGRVLVRDSOLFDUODGRVLVGHUHIXHU]RHQODSULPHUDFRQVXOWDTXHHIHFW~DODPXMHU
HPEDUD]DGD(OLQWHUYDORHQWUHODSULPHUD\ODVHJXQGDGRVLVVLHPSUHGHEHVHUPD\RU
GHVHPDQDV
(IHFWLYLGDGGHODYDFXQD
/XHJRGHGRVGRVLVVHORJUDXQDH¿FDFLDFRQWUDHOWpWDQRVGHDGXUDQWHXQ
PtQLPR GH WUHV DxRV HQ WRGDV ODV SHUVRQDV (¿FDFLD TXH VH HOHYD FDVL DO \
SUREDEOHPHQWHSDUDWRGDODYLGDVLVHKDQFRPSOHWDGRODVGRVLVUHFRPHQGDGDV
$SHQDVXQDGRVLVGH77DSOLFDGDDPXMHUHVGXUDQWHHOHPEDUD]RGHPRVWUyVHUHIHFWLYD
HQODSUHYHQFLyQGHOWpWDQRVQHRQDWDOHQXQ55,&±
(QFDPELRVHQHFHVLWDQQRPHQRVGHGRVGRVLVGHYDFXQDSDUDSURWHJHUDOQHRQDWRGH
ODPXHUWHSRU71155,&±
(QHOFDVRGHPXMHUHVDODVTXHVHODVYDFXQDSRUSULPHUDYH]GXUDQWHODJHVWDFLyQHO
SDUWRSUHPDWXURSRGUtDUHGXFLUODSURWHFFLyQGHOUHFLpQQDFLGR\DTXHORVDQWLFXHUSRV
DQWLWR[LQDGHODPDGUHVHUtDQLQVX¿FLHQWHVSDUDSDVDUDOIHWR
(PEDUD]DGDVDFRQWURODU
6,
9DFXQD 12
DQWLWHWiQLFD
SUHYLD
(VTXHPDSUHYLR
DGPLQLVWUDGR
77
12 777777 6, 6, 77 12 77
77DxRV 77DxRV 77
77DODFDSWDFLyQ
77yPiV
77 1RVHYDFXQD 77 77 VHPDQDVGHVSXpV
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDODLQPXQL]DFLyQDQWLWHWiQLFD
2EMHWLYRV 'LVPLQXLUHOLPSDFWRQHJDWLYRGHODVLQIHFFLRQHVGHWUDQVPLVLyQ
YHUWLFDO
$FWLYLGDG 3UHYHQFLyQGHWHFFLyQ\WUDWDPLHQWRGHODVLQIHFFLRQHVGH
WUDQVPLVLyQYHUWLFDO
/DVLQIHFFLRQHVGHWUDQVPLVLyQYHUWLFDOVHGH¿QHQFRPRDTXHOODVLQIHFFLRQHVTXHVH
WUDQVPLWHQGHVGHODPXMHUHPEDUD]DGDDOIHWRRDOUHFLpQQDFLGR
/DWUDQVPLVLyQGHHVWDVLQIHFFLRQHVSXHGHRFXUULU
'XUDQWHHOHPEDUD]RSULQFLSDOPHQWHSRUYtDWUDQVSODFHQWDULD
'XUDQWHHOSDUWRDWUDYpVGHOFRQWDFWRFRQVDQJUHRVHFUHFLRQHVLQIHFWDGDVHQ
HOFDQDOGHOSDUWR
'HVSXpVGHOSDUWRDWUDYpVGHODODFWDQFLDPDWHUQDRFRQWDFWRFRQVHFUHFLRQHV
PDWHUQDV
6RQQXPHURVDVODVLQIHFFLRQHVTXHSXHGHQVHUWUDQVPLWLGDVSRUODPXMHUDOQLxRGXUDQWH
HOHPEDUD]RHOSDUWR\HOSXHUSHULR\TXHVLJQL¿FDQXQULHVJRGHHQIHUPDURPRULUSDUD
HOIHWRRUHFLpQQDFLGR
(Q HVWH FDStWXOR GHVFULELUHPRV VROR DTXHOODV LQIHFFLRQHV TXH VH KDQ LQFRUSRUDGR
D OD KLVWRULD FOtQLFD SHULQDWDO GHO &/$3605 FRPR UHVXOWDGR GH XQD FRQVXOWD D ORV
SURJUDPDVGH³VDOXGGHODPXMHU´\³PDWHUQRLQIDQWLOHV´GHORVPLQLVWHULRVGHORVSDtVHV
GHOD5HJLyQ
(QWUHODVLQIHFFLRQHVTXHVHGHVDUUROODQVHHQFXHQWUDQ
5XEpROD7R[RSODVPRVLV9,+6t¿OLV(QIHUPHGDGGH&KDJDV3DOXGLVPR(VWUHSWRFRFR
GHOJUXSR%
5XEpRODFRQJpQLWD
/D 5XEpROD HV XQD HQIHUPHGDG IHEULO HUXSWLYD TXH SRFDV YHFHV VH FRPSOLFD \ TXH
GHVDSDUHFH HVSRQWiQHDPHQWH $ SHVDU GH VX DSDUHQWH EHQLJQLGDG VL VH DGTXLHUH
GXUDQWH HO SULPHU WULPHVWUH GHO HPEDUD]R SXHGH SURYRFDU HO VtQGURPH GH UXEpROD
FRQJpQLWR 65& FDUDFWHUL]DGR SRU PDQLIHVWDFLRQHV WDOHV FRPR DERUWR HVSRQWiQHR
yELWRIHWDOUHWUDVRPHQWDOVRUGHUDFHJXHUD\FDUGLRSDWtDFRQJpQLWD/DDOWDSUREDELOLGDG
GH LQIHFFLyQ IHWDO DOFDQ]D FDVL DO HQ FDVR TXH OD LQIHFFLyQ RFXUUD DQWHV GH OD
VHPDQDGHJHVWDFLyQ
(O65&HVWRWDOPHQWHHYLWDEOHPHGLDQWHODYDFXQDFLyQGHWRGDVODVQLxDVRPXMHUHVHQ
HGDGIpUWLO$QWHVGHODDSDULFLyQGHODYDFXQDVHSURGXFtDQSRUDxRHQOD5HJLyQXQRV
FDVRVGH65&(QHODxRVHUHSRUWDURQHQWRGDODUHJLyQDSHQDVFDVRV
GH65&
/DYDFXQDFRQWUDOD5XEpRODHVHIHFWLYD\XQDGRVLV~QLFDFRQ¿HUHLQPXQLGDGGH
SRUYLGD
$XQTXHPXFKRVSDtVHVGHOD5HJLyQVHHQFDPLQDQDODHOLPLQDFLyQGHOD5XEpROD\
HO6tQGURPHGH5XEpROD&RQJpQLWD65&HQRWURVD~QVLJXHVLHQGRXQUHWR(OLPLQDU
OD UXEpROD VLJQL¿FD LQWHUUXPSLU OD WUDQVPLVLyQ HQGpPLFD GHO YLUXV \ OD GHVDSDULFLyQ
GHFDVRVGH65&3DUDDOFDQ]DUHVWDPHWDVHUHTXLHUHXQDUiSLGDLQWHUUXSFLyQGHOD
FLUFXODFLyQ HQGpPLFD GHO YLUXV GH OD UXEpROD D WUDYpV GH SURJUDPDV \ FDPSDxDV GH
YDFXQDFLyQPDVLYDTXHDOFDQFHQWDVDVGHFREHUWXUDFHUFDQDVDOHQWRGRVORV
PXQLFLSLRV\HQWRGRVORVJUXSRVGHHGDGWDQWRHQKRPEUHVFRPRHQPXMHUHV1RORJUDU
HVWHQLYHOGHFREHUWXUDLPSOLFDGHMDUEROVRQHVGHSREODFLyQFRQHOULHVJRGHDSDULFLyQ
GHQXHYRVFDVRV
8QDIRUPDGHFRQWULEXLUDHVWHHVIXHU]RQDFLRQDO\UHJLRQDOHV
LQGDJDUHQIRUPDUXWLQDULDVREUHHOHVWDGRGHYDFXQDFLyQDQWL
UXEpRODGXUDQWHHOFRQWUROSUHQDWDO3RUHVWDUD]yQOD+&3GH
&/$3605KDLQFRUSRUDGRXQUHFRUGDWRULRVREUHHOHVWDGRGH Figura 24.
YDFXQDFLyQDQWLUXEHyOLFD Fragmento de HCP
Vacunación antirubeola
6H LQWHQWDUi JDUDQWL]DU TXH WRGD PXMHU HQ HGDG IpUWLO UHFLED OD YDFXQD DQWLUXEpROLFD
DQWHVGHHPEDUD]DUVH1RVHDFRQVHMDUiODYDFXQDFLyQHQODPXMHUJHVWDQWHSHURODV
FDPSDxDV PDVLYDV GH YDFXQDFLyQ KDQ SHUPLWLGR DFXPXODU HYLGHQFLD VX¿FLHQWH SDUD
JDUDQWL]DUTXHQRH[LVWHDVRFLDFLyQHQWUHODYDFXQDDQWLUXEHyOLFDUHFLELGDGXUDQWHOD
JHVWDFLyQ\ODDSDULFLyQGH65&RPXHUWHIHWDO
3RU HVWD UD]yQ HQ FDVR TXH XQD PXMHU HPEDUD]DGD UHFLED LQDGYHUWLGDPHQWH
OD YDFXQD VH UHFRPLHQGD XQ HVWULFWR VHJXLPLHQWR GHO IHWR \ GHO UHFLpQ QDFLGR
1RKD\MXVWL¿FDFLyQSDUDODLQWHUUXSFLyQGHODJUDYLGH]
,QWHQWDQGR DOFDQ]DU ODV Pi[LPDV FREHUWXUDV HQ HGDG IpUWLO \ HQ DUDV GH QR ³SHUGHU
RSRUWXQLGDGHV´HVUHFRPHQGDEOHYDFXQDUHQHOSXHUSHULRDWRGDPXMHUTXHKD\DOOHJDGR
DOSDUWRVLQKDEHUUHFLELGRODYDFXQD
$QWLUXEHROD
3DUD HOOR OD +LVWRULD 3HULQDWDO GH &/$3605 WUDH XQ SRVWSDUWR QR VL QF
UHFRUGDWRULRDORVSURIHVLRQDOHVSDUDLQPXQL]DUDDTXHOODV
PDGUHVQRLQPXQL]DGDVDQWHVGHOHJUHVRPDWHUQR Figura 25. Fragmento de HCP.
Antirubeola postparto
7R[RSODVPRVLVFRQJpQLWD
/D WR[RSODVPRVLV HV XQD ]RRQRVLV HQGpPLFD FDXVDGD SRU HO 7R[RSODVPD JRQGLL
SURWR]RDULR FX\R KXpVSHG GH¿QLWLYR VRQ ORV IHOLQRV \ TXH JHQHUDOPHQWH FXDQGR
FRPSURPHWH D OD HVSHFLH KXPDQD WLHQH XQ FXUVR EHQLJQR FRQ OD H[FHSFLyQ GH GRV
VLWXDFLRQHV
/DVSHUVRQDVLQPXQRVXSULPLGDV9,+6,'$7%&HQIHUPRVRQFROyJLFRV
)HWRVRQLxRVTXHKDQDGTXLULGRODLQIHFFLyQLQ~WHURWUDQVPLWLGDVSRUVXVPDGUHVD
WUDYpVGHODSODFHQWD(VWHULHVJRVRORH[LVWHFXDQGRODPXMHUDGTXLHUHODLQIHFFLyQ
DJXGDGXUDQWHHOHPEDUD]R
/D WR[RSODVPRVLV FRQJpQLWD SXHGH SURYRFDU VHYHURV GDxRV WDOHV FRPR PXHUWH
IHWDO FRULRUUHWLQLWLV FDOFL¿FDFLRQHV LQWUDFHUHEUDOHV PLFUR R KLGURFHIDOLD TXH SXHGHQ
GHWHUPLQDU UHWDUGR PHQWDO FRQYXOVLRQHV FHJXHUD HWF 7LHQH XQD IUHFXHQFLD TXH VH
HVWLPD SDUD ORV SDtVHV GHVDUUROODGRV HQ WRUQR D FDVR FDGD QDFLGRV YLYRV OD
SUHYDOHQFLD GH PXMHUHV VXVFHSWLEOHV HV DOWDPHQWH YDULDEOH HQ ORV GLIHUHQWHV SDtVHV
\ DXQ HQ ODV GLIHUHQWHV FLXGDGHV \ PXQLFLSLRV GH XQ PLVPR SDtV /D VLWXDFLyQ HQ
/DWLQRDPpULFDHQWpUPLQRVHSLGHPLROyJLFRVHVGHVFRQRFLGDSHURH[LVWHQLQIRUPHVGH
DOJXQRVSDtVHVTXHLQGLFDQSUHYDOHQFLDVVLPLODUHVDODGHORVSDtVHVGHVDUUROODGRV
+D\YDULRVHVWXGLRVTXHFRLQFLGHQHQHVWDEOHFHUTXHHOULHVJRGHODWUDQVPLVLyQPDGUH
±KLMRHVPtQLPRHQHOSULPHUWULPHVWUH\Pi[LPRHQHO~OWLPRPHV8QHVWXGLRUHFLHQWH
DFHUFDGHOULHVJRGHODWUDQVPLVLyQPDGUH±KLMRHVWLPDTXHDXPHQWDGHDODV
VHPDQDVKDVWDXQDODVVHPDQDV
([LVWHFRQWURYHUVLDVREUHODQHFHVLGDGGHLPSOHPHQWDUSURJUDPDVGHWDPL]DMHXQLYHUVDO
SDUD7R[RSODVPRVLV (Q OR TXH KD\ FRLQFLGHQFLD HV HQ LPSOHPHQWDU DO FRPLHQ]R GHO
HPEDUD]RPHGLGDVHGXFDWLYDV\GHKLJLHQHSDUDODSUHYHQFLyQ
(O GH ODV LQIHFFLRQHV SULPDULDV SRU WR[RSODVPRVLV HQ HPEDUD]DGDV
LQPXQRFRPSHWHQWHVVRQDVLQWRPiWLFDVHOGLDJQyVWLFRGHODLQIHFFLyQPDWHUQDHVVyOR
GLDJQRVWLFDEOHSRUVHURFRQYHUVLyQGHWHFWDEOHSRU,J*R,J0
(QOD+&3GHO&/$3605VHLQFOX\yXQUHFRUGDWRULRJHQHUDO
SDUDHOWDPL]DMHHQDTXHOORVSDtVHVTXHDVtORGLVSRQHQHQVXV
QRUPDVQDFLRQDOHVSHURD~QHQORVTXHQRVHKDFHWDPL]DMH
VHUYLUiSDUDTXHORVSURIHVLRQDOHVGHVDOXGUHFXHUGHQDODV
PXMHUHVJHVWDQWHVODVPHGLGDVHGXFDWLYDVSUHYHQWLYDV Figura 26. Fragmento de HCP.
Toxoplasmosis.
&XDGUR0HGLGDVHGXFDWLYDVDQWHVHURORJtDQHJDWLYDSDUDWR[RSODVPRVLV
(OLPLQDUHOFRQVXPRGHFDUQHFUXGDRSRFRFRFLGD
8VDUJXDQWHV\ODYDUVHODVPDQRVLQWHQVDPHQWHGHVSXpVGHPDQLSXODUFDUQHFUXGD
/DYDUSURIXQGDPHQWHWRGRVORVXWHQVLOLRVTXHHVWXYLHURQHQFRQWDFWRFRQFDUQHFUXGD
/DYDUSURIXQGDPHQWHORVYHJHWDOHVTXHVHFRPHUiQFUXGRV
8VDU JXDQWHV FDGD YH] TXH VH HVWp HQ FRQWDFWR FRQ WLHUUD < ODYDU ODV PDQRV
LQWHQVDPHQWHGHVSXpVGHWRFDUODWLHUUD
0DQWHQHUORVJDWRVGRPpVWLFRVGHQWURGHODFDVD\DOLPHQWDUORVFRQUDFLRQHV
8VDUJXDQWHVPLHQWUDVVHOLPSLDOD³FDPD´\ODYDUVHODVPDQRVGHVSXpVGHKDFHUOR
(QHOVLJXLHQWHFXDGURVHUHVXPHQFXDWURSRVLEOHVVLWXDFLRQHVTXHVHH[WLHQGHQGHVGHORV
FDVRVHQORVTXHVHHIHFW~DHOWDPL]DMH\DTXHOORVHQORVTXHQRVHUHDOL]D
&XDGUR$QiOLVLVIUHQWHDGLIHUHQWHVVLWXDFLRQHVHQHOWDPL]DMHGHWR[RSODVPRVLV
Posibles resultados
Interpretación Conducta
IgG IgM
No hay infección. Comunicar medidas de protección.
- - Existe riesgo de contraerla Eventual repetición de IgG según norma nacional
+ - Infección pasada Continuar control en forma habitual
Evaluar riesgo de infección fetal.

+ + Infección actual
Evaluar realización de tratamiento médico
No se hizo No se hizo Comunicar medidas de protección
Riesgo desconocido
realizar tamizaje según norma nacional
&RQGXFWD
$XQTXHH[LVWHQGXGDVVREUHODHIHFWLYLGDGGHOWUDWDPLHQWRGHODWR[RSODVPRVLVGXUDQWH
HOHPEDUD]RKD\DFXHUGRHQTXHODVPXMHUHVFRQXQDWR[RSODVPRVLVDFWLYDGHEHUiQ
VHUUHIHULGDVDFRQWUROGHDOWRULHVJRSDUDVXFRUUHFWRHVWXGLR\HYHQWXDOWUDWDPLHQWR
&XDGUR6XJHUHQFLDGHWUDWDPLHQWRHQHPEDUD]DGDVFRQLQIHFFLyQ
WR[RSOiVPLFDFRQWUDtGDGXUDQWHHOHPEDUD]R
6LWXDFLyQFOtQLFD 7UDWDPLHQWR 'RVLV 'XUDFLyQ
Infección aguda Hasta el final
materna sin 3 g/día oral repartidos en 3 dosis, del embarazo o
Espiramicina
confirmación de (separados de las comidas) que se confirme
infección fetal infección fetal.
Dosis carga: 100 mg/día oral,
Hasta final del
Pirimetamina divididos en 2 dosis, durante 2 días.
embarazo
Continua: 50 mg/día oral
Dosis carga: 75 mg/Kg/día oral,
divididos en 2 dosis, durante 2 días.
Infección fetal Hasta final del
Sulfadiazina Máximo 4 g/día.
confirmada (entre embarazo
Continua: 100 mg/Kg/día oral
las 12 y 18 emanas)
divididos en 2 dosis. Máximo 4 g/día.
Durante y hasta
una semana
Acido folínico 5 a 20 mg/día
después de usar
la Pirimetamina.
(PEDUD]DGDDFRQWURODU
6L ,J*DFRQVXOWD 1R
VHP
3RVLWLYR 1HJDWLYR
5HVXOWDGR
1HJDWLYR 3RVLWLYR &RQVHMHUtD

,J0
7tWXORVDQWLJXRV 3UREDEOH 3RVLWLYR ,J* 1HJDWLYR

GH,J* LQIHFFLyQDJXGD !VHP
3UREDEOHLQIHFFLyQDJXGD
1RKD\ULHVJR 5HIHULUSDUDHYDOXDFLyQ\ &RQWURO5HFLpQ1DFLGR

1RUHTXLHUHPiVFRQWUROHV WUDWDPLHQWRHQDOWRULHVJR
)LJXUD(VTXHPDHVFDORQDGRGHGHZFLVLRQHVSDUDODGHWHFFLyQSUHYHQFLyQ\
WUDWDPLHQWRGHODWR[RSODVPRVLVHQHOHPEDUD]R
+HSDWLWLV%
/D+HSDWLWLV%HVXQDLQIHFFLyQTXHFRQWUDHQODVPXMHUHVVXVFHSWLEOHVDOHQWUDUHQFRQWDFWR
FRQVDQJUHVHPHQ\RVDOLYDGHXQDSHUVRQDLQIHFWDGD\TXHSXHGHVHUWUDQVPLWLGDDO
UHFLpQQDFLGRSRUHOFRQWDFWRFRQVDQJUHPDWHUQDRGXUDQWHHODPDPDQWDPLHQWR
(O HPEDUD]R QR DOWHUD HO FXUVR GH OD HQIHUPHGDG \ DSDUHQWHPHQWH OD +HSDWLWLV % QR
FDXVDUtDWHUDWRJpQHVLVSHURVHKDYLVWRXQDUHODFLyQHQWUHKHSDWLWLVSUHPDWXUH]\5&,
6H HVWLPD TXH GH FDGD UHFLpQ QDFLGRV GH PDGUHV LQIHFWDGDV GXUDQWH HO WHUFHU
WULPHVWUH VHUiQ SRUWDGRUHV DVLQWRPiWLFRV FDSDFHV GH VXIULU XQD KHSDWLWLV FUyQLFD
(VWDV UD]RQHV DYDODQ HO WDPL]DMH VLVWHPiWLFR GH ORV DQWtJHQRV GH VXSHU¿FLH GH OD
+HSDWLWLV%HQODSULPHUDYLVLWDSUHQDWDO&RQHVWRVHSXHGHLGHQWL¿FDUDODVPXMHUHV
VXVFHSWLEOHV\HYLWDUODLQIHFFLyQPHGLDQWHODDSOLFDFLyQGHODYDFXQDHVSHFt¿FDD~Q
GXUDQWHHOHPEDUD]R$XQTXHVXHOHVHUPiVIUHFXHQWHODYDFXQDFLyQGHODVJHVWDQWHV
TXHSUHVHQWDQIDFWRUHVGHULHVJRSDUDODKHSDWLWLV%WDOHVFRPRGURJDVLQWUDYHQRVDV
WUDQVIXVLRQHVWDWXDMHVHWF
/D YDFXQD VH DSOLFD HQ WUHV GRVLV \ JHQHUD UiSLGD LQPXQLGDG (Q FDVR GH PXMHUHV
VHURQHJDWLYDV QR YDFXQDGDV TXH VH KDQ H[SXHVWR D +HSDWLWLV % SXHGH VHU ~WLO OD
DSOLFDFLyQGHJDPDJOREXOLQDKLSHULQPXQHDQWL+HSDWLWLV%J*+DQWL+%HQODVSULPHUDV
KRUDVTXHVLJXHQDOFRQWDFWRLQIHFWDQWH
(QORVUHFLpQQDFLGRVGHPDGUHVVHURSRVLWLYDVVHUHFRPLHQGDSURWHJHUORVFRQHOXVR
GHJ*+DQWL+%LQPHGLDWDPHQWHGHVSXpVGHQDFHU
'HELGRDTXHHVWDHVXQDLQIHFFLyQTXHSXHGHWUDQVPLWLUVHDORVWUDEDMDGRUHVGHVDOXGVH
HVWLPXODODSURWHFFLyQVLVWHPiWLFDFRQYDFXQDGHWRGRVORVSURIHVLRQDOHVGHOD6DOXG
9,+6,'$
/D SDQGHPLD GHO YLUXV GH LQPXQRGH¿FLHQFLD KXPDQD HV XQD LQIHFFLyQ TXH VH GLVWULEX\H HQ
WRGRVORVJUXSRVHWDULRVSULQFLSDOPHQWHHQWUHORVDGROHVFHQWHV\MyYHQHVDDxRV\TXH
DIHFWDFDGDYH]PiVDPXMHUHV\QLxRV/DPD\RUtDGHORVQLxRVTXHFRQWUDMHURQODLQIHFFLyQOR
KLFLHURQPHGLDQWHODWUDQVPLVLyQPDWHUQRLQIDQWLOTXHSXHGHSURGXFLUVHGXUDQWHHOHPEDUD]RHO
WUDEDMRGHSDUWRHOSDUWRRGXUDQWHODODFWDQFLDPDWHUQD6LQQLQJ~QWLSRGHLQWHUYHQFLyQHQODV
SREODFLRQHVHQODVTXHVHVXSULPHODODFWDQFLDPDWHUQDHOULHVJRGHODWUDQVPLVLyQHVGHD
/DODFWDQFLDPDWHUQDDXPHQWDHOULHVJRGHODWUDQVPLVLyQGHXQDXQ
/RV (VWDGRV 0LHPEURV GH OD 206 UHD¿UPDURQ HQ OD FXPEUH GH ODV
1DFLRQHV 8QLGDV HQ VHSWLHPEUH GH HO FRPSURPLVR SOHQR SDUD
FXPSOLUODGHFODUDFLyQGHO81*$66GHTXHFRQVLVWHHQUHGXFLUSDUD
HOODSURSRUFLyQGHODFWDQWHVLQIHFWDGRVSRUHO9,+HQXQ
3DUDHOORHVQHFHVDULRFRQRFHUHOHVWDGRVHUROyJLFRGHODVHPEDUD]DGDV
\DTXHHOULHVJRGHWUDQVPLVLyQYHUWLFDOSXHGHUHGXFLUVHDPHQRVGH
PHGLDQWHLQWHUYHQFLRQHVFRPRODSUR¿OD[LVFRQDQWLUUHWURYtULFRV$59
ODFHViUHDHOHFWLYDDQWHVGHOLQLFLRGHOWUDEDMRGHSDUWR\ODUXSWXUDGH
PHPEUDQDV\ODVXSUHVLyQWRWDOGHODPDPDQWDPLHQWR )LJXUD
)UDJPHQWRGH+&39,+
3RUHVWDUD]yQ206\81$,'6UHFRPLHQGDQRIUHFHUODSUXHEDGHGHWHFFLyQGHODLQIHFFLyQSRU
9,+DWRGDVODVPXMHUHVTXHDFXGHQDORVVHUYLFLRVGHDWHQFLyQPDWHUQRLQIDQWLO
$VHJXUDQGR
&RQ¿GHQFLDOLGDG
&RQVHMHUtD\
5HDOL]DFLyQGHODSUXHED~QLFDPHQWHGHVSXpVGHREWHQHUFRQVHQWLPLHQWRLQIRUPDGR
5HDOL]DGDVGHPDQHUDDGHFXDGDODFRQVHMHUtDMXQWRDODFRQ¿GHQFLDOLGDGDXPHQWDQODSUREDELOLGDG
TXHODPXMHUDFFHGDDWHQHUODSUXHEDHQIRUPDYROXQWDULDHLQIRUPDGD7RGRHOSHUVRQDOGHVDOXG
SXHGHEULQGDUFRQVHMHUtDVLVHHQFXHQWUDHQWUHQDGR/RVVHUYLFLRVGHEHUiQJDUDQWL]DUHODFFHVR
DODVSUXHEDVGHWDPL]DMHSUXHEDVUiSLGDVGHPXHVWUDVGHVDQJUHRVDOLYDRSUXHEDGH(OLVD
VLHVWDVVRQUHDFWLYDVGHEHUiQHIHFWXDUVHWHVWFRQ¿UPDWRULRVPHGLDQWHWpFQLFDGH:HVWHUQEORWR
SRULQPXQRÀXRUHVFHQFLD/DVSHUVRQDV9,+SRVLWLYDVGHEHUiQVHUDFRQVHMDGDVVREUHGHUHFKRV
FRQGXFWDVDVSHFWRVSVLFRVRFLDOHVHLPSOLFDQFLDVPpGLFDVGHODLQIHFFLyQSRU9,+\GHEHUtDQVHU
SXHVWDVHQFRQWDFWRFRQVHUYLFLRVHVSHFLDOL]DGRV\UHFLELUWUDWDPLHQWRGHDFXHUGRDODVQRUPDV
QDFLRQDOHV
/D236KDSXEOLFDGRXQDJXtDFOtQLFDSDUDODHOLPLQDFLyQGHODWUDQVPLVLyQPDWHUQRLQIDQWLOGHO
9,+\GHODVt¿OLVFRQJpQLWDHQ$PpULFD/DWLQD\HO&DULEHTXHSUHVHQWDODVSDXWDVGHWUDWDPLHQWR
FRPSOHWDV3XEO&/$31
/DVHPEDUD]DGDVFRQ9,+GHEHUiQUHFLELUODSUR¿OD[LVFRQDQWLUUHWURYtULFRV
=LGRYXGLQD$=7GXUDQWHHOHPEDUD]RDSDUWLUGHODVVHPDQDV
$=7\/DPLYXGLQD7&PiVXQD~QLFDGRVLVGH1HYLUDSLQD193GXUDQWHHOSDUWR
$=7GXUDQWHXQDVHPDQD\GRVLV~QLFDGH193SDUDHOUHFLpQQDFLGR6LODPDGUHUHFLELy
PHQRVGHVHPDQDVGH$=7GXUDQWHHOHPEDUD]RVHUHFRPLHQGDSURORQJDUDVHPDQDV
HO$=7DOQLxR
5HFRPHQGDFLRQHVSDUDWLSRGHSDUWRHQPXMHUHVHPEDUD]DGDVFRQ9,+
&HViUHDSURJUDPDGDDODVVHPDQDVDDTXHOODVPXMHUHVTXH
1RWHQJDQXQDFDUJDYLUDOKHFKDHQHOWHUFHUWULPHVWUHGHOHPEDUD]R
7HQJDQXQDFDUJDYLUDO!FRSLDVPO
2IUHFHUSDUWRYDJLQDODDTXHOODVPXMHUHVVLQLQGLFDFLyQREVWpWULFDGHFHViUHDHQ7$59
HVWDEOH EXHQD DGKHUHQFLD \ FDUJD YLUDO UHDOL]DGD HQ HO ~OWLPR WULPHVWUH GHO HPEDUD]R
FRSLDVPO$,93XEO&/$31
3DUDUHGXFLUDOPtQLPRHOULHVJRGHWUDQVPLVLyQGHO9,+DORVQLxRVHOJUXSRGHH[SHUWRVGH
OD5HJLyQGHODV$PpULFDVSURSXVRUHIRU]DUODHVWUDWHJLDGHVXSULPLUODODFWDQFLDPDWHUQD
HQORVKLMRVGHPXMHUHVFRQ9,+(QHVWHVHQWLGROD236RPVUHFRPLHQGDHYLWDUODODFWDQFLD
PDWHUQDVLHPSUH\FXDQGRHVWDRSFLyQVHDDFHSWDEOHIDFWLEOHDVHTXLEOHVRVWHQLEOH\VHJXUD
$)$66
/DSUR¿OD[LVFRQ7$59WULSOHWHUDSLDUHDOL]DGRDPXMHUHVFRQ9,+TXHQRUHTXLHUDQWUDWDPLHQWR

KDGHPRVWUDGRVHUPX\HIHFWLYDHQUHGXFLUODWUDQVPLVLyQYHUWLFDOGHO9,+/DVJHVWDQWHVFRQ9,+
TXHHVWiQHQWUDWDPLHQWRUHTXLHUHQUHYLVLyQGHVXWUDWDPLHQWRSRUHOHVSHFLDOLVWDSDUDRSWLPL]DUOR
\PLQLPL]DUODSRVLELOLGDGGHWR[LFLGDG
2EMHWLYR 3UHYHQLUODVt¿OLVFRQJpQLWD
$FWLYLGDG 7DPL]DMH\WUDWDPLHQWRGHODVt¿OLVHQODVHPEDUD]DGDV
/DVt¿OLVFRQWLQXDVLHQGRXQJUDYHSUREOHPDGHVDOXGS~EOLFDVHFDOFXODTXHFDGDDxR
KD\PiVGHPLOORQHVGHQXHYDVLQIHFFLRQHVSRU7UHSRQHPDSDOOLGXPGHORVFXDOHV
PiVGHPLOORQHVVHSURGXFHQHQPXMHUHVHPEDUD]DGDV'HEHPHQFLRQDUVHTXH$/&
WLHQHXQDWDVDHVWLPDGDGHVt¿OLVPDWHUQDPiVDOWDTXHFXDOTXLHURWUDUHJLyQHVWLPDGD
SRUOD206HQWUH\HQ&RQGLFKDWDVDVHFDOFXODTXHSXHGHKDEHU
DSUR[LPDGDPHQWHFDVRVGHVt¿OLVJHVWDFLRQDOHQOD5HJLyQGHODV$PpULFDV
H[FHSWXDQGR((88\&DQDGiRULJLQDQGRFDGDDxRGHDFDVRVGH
Vt¿OLVFRQJpQLWD6&(QODPD\RUSDUWHGHHVWRVFDVRVODLQIHFFLyQHVWUDQVPLWLGDDO
IHWRHQJHQHUDOHQWUHODVVHPDQDV\GHHPEDUD]R\FRQOOHYDXQSURQyVWLFRIDWDO
HQHOGHFDVRV
/D 236 SRU UHVROXFLyQ GH ORV SDtVHV PLHPEURV KD GHVDUUROODGR HO ³3ODQ SDUD OD
HOLPLQDFLyQ GH OD Vt¿OLV FRQJpQLWD´ HO TXH SUHWHQGH UHGXFLU OD LQFLGHQFLD GH Vt¿OLV
FRQJpQLWD D PHQRV GH FDVRV SRU QDFLGRV LQFOXLGRV PRUWLQDWRV /D
236MXQWRFRQRWUDVRUJDQL]DFLRQHVSURSRQHLPSXOVDUXQD,QLFLDWLYDUHJLRQDOSDUDOD
HOLPLQDFLyQGHODWUDQVPLVLyQPDWHUQRLQIDQWLOGHO9,+\GHODVt¿OLVFRQJpQLWDHQ$PpULFD
/DWLQD\HO&DULEH
/DVt¿OLVHVXQD,76SURYRFDGDSRUXQDHVSLURTXHWDHO7UHSRQHPDSDOOLGXPTXHGHMDGD
HYROXFLRQDUWLHQHHVWDGLRVFDUDFWHUtVWLFRV3XHGHVHUDVLQWRPiWLFDRSUHVHQWDUHOVLJQR
PiVSUHFR]FKDQFURHQXQOXJDURFXOWRTXHORKDJDSDVDUGHVDSHUFLELGR$VtTXHD
WRGDPXMHUHPEDUD]DGDVHOHGHEHUiUHDOL]DUSUXHEDVSDUDHOWDPL]DMHGHVt¿OLVGXUDQWH
HOHPEDUD]R
&/$3605236KDLQFRUSRUDGRHQOD+&3ODSRVLELOLGDGGHUHJLVWUDUGRVFRQWUROHV
SDUDHOWDPL]DMHGHODVt¿OLVGHDFXHUGRDORVTXHUHFRPLHQGDQODVPHMRUHVHYLGHQFLDV
\HQFRQFRUGDQFLDFRQODPD\RUtDGHODVJXtDVQRUPDWLYDVGHOD5HJLyQ
/DVHFXHQFLDFURQROyJLFDUHFRPHQGDGDFRQVLVWHHQ
HIHFWXDUODSULPHUDSUXHEDDOPRPHQWRGHODFDSWDFLyQDQWHVGHODVVHPDQDV
\UHDOL]DUVLJXLHQWHHQHOWHUFHUWULPHVWUH
6HDJUHJyXQHVSDFLRGHVWLQDGRDUHJLVWUDUVLHUDRQRQHFHVDULRHIHFWXDUHOWUDWDPLHQWR
\ HQ FDVR GH VHUOR VL HO PLVPR VH UHDOL]y 7DPELpQ VH LQFOX\H HO WUDWDPLHQWR GH OD
SDUHMD(QHOHPEDUD]RHVWDQLPSRUWDQWHHOWUDWDPLHQWRGHODHPEDUD]DGDFRPRHO
GHVXSDUHMD/DIDOWDGHWUDWDPLHQWRGHODSDUHMDHVODSULQFLSDOIXHQWHGHUHLQIHFFLyQ
GXUDQWH HO HPEDUD]R (Q WRGDV ODV YLVLWDV VH GHEH SURSRUFLRQDU FRQVHMHUtD D ¿Q GH
UHGXFLU HO ULHVJR GH DGTXLULU Vt¿OLV R 9,+ GXUDQWH HO HPEDUD]R 6H UHFRPLHQGD HQ
DTXHOODV VLWXDFLRQHV HQ TXH VH VRVSHFKD TXH QR KDEUi FRQWLQXLGDG HQ HO FRQWURO
SUHQDWDOVLHPSUHTXHKD\DGLVSRQLELOLGDGUHDOL]DUSUXHEDVUiSLGDVSDUDFRQWDUFRQ
XQGLDJQyVWLFRLQPHGLDWR
6,),/,6'LDJQyVWLFR\7UDWDPLHQWR
3UXHED 7UDWDPLHQWR 7WRGHOD
QRWUHSRQpPLFD WUHSRQpPLFD SDUHMD
QR VL
VHPDQDV VHPDQDV
VHPDQDV VHPDQDV

VHP VG QF

VHP QR VL
VG QF
)LJ)UDJPHQWRGH+&36t¿OLV
3UXHEDVGLDJQyVWLFDV
(OGLDJQyVWLFRVHUROyJLFRGHODVt¿OLVVHEDVDHQODUHDOL]DFLyQGHSUXHEDVWUHSRQpPLFDV
\SUXHEDVQRWUHSRQpPLFDV
/DVSUXHEDVQRWUHSRQpPLFDVLQFOX\HQHO9'5/9HQHUHDO'LVHDVH5HVHDUFK/DERUDWRU\
\ HO 535 UDSLG SODVPD UHDJLQ 8QD SUXHED QR WUHSRQpPLFD UHDFWLYD SXHGH LQGLFDU
LQIHFFLyQDFWXDOLQIHFFLyQUHFLHQWHWUDWDGDRQRWUDWDGDRXQUHVXOWDGRIDOVRSRVLWLYR
/RVUHVXOWDGRVIDOVRVSRVLWLYRVRFXUUHQHQDOGHODSREODFLyQ\HQJHQHUDOWLHQHQ
XQ WtWXOR EDMR 3XHGHQ VHU QHJDWLYDV HQ IDVHV LQLFLDOHV GH OD LQIHFFLyQ R FXDQGR HO
WtWXORHVPX\DOWRIHQyPHQRGHSUR]RQD\VXHOHQQHJDWLYL]DUVHRGLVPLQXLUDWtWXORV
PX\ EDMRV GHVSXpV GHO WUDWDPLHQWR (Q ORV FDVRV GH Vt¿OLV WUDWDGD FRUUHFWDPHQWH HO
9'5/WLHQGHDQHJDWLYL]DUVHFRQHOSDVRGHOWLHPSRDXQTXHHQFDVRVH[FHSFLRQDOHV
VHSXHGHPDQWHQHUSRVLWLYRGXUDQWHPXFKRWLHPSRGHSRUYLGD3XHGHQYHUVHIDOVRV
SRVLWLYRVHQHQIHUPHGDGHVDXWRLQPXQHVWXEHUFXORVLVPRQRQXFOHRVLVHQGRFDUGLWLV\
HQHOSURSLRHPEDUD]R
/DV SUXHEDV WUHSRQpPLFDV VRQ SUXHEDV HVSHFt¿FDV PiV FRPSOHMDV \ FRVWRVDV H
LQFOX\HQHO73+$7UHSRQHPDSDOOLGXPKDHPDJJOXWLQDWLRQDVVD\HO733$7UHSRQHPD
SDOOLGXPSDUWLFOHDJJOXWLQDWLRQHO0+$73PLFURKDHPDJJOXWLQDWLRQDVVD\IRUDQWLERGLHV
WR 7UHSRQHPD SDOOLGXP \ HO )7$$EV ÀXRUHVFHQW WUHSRQHPDO DQWLERG\ DEVRUSWLRQ
6HXWLOL]DQSDUDFRQ¿UPDUXQUHVXOWDGRGHXQDSUXHEDQRWUHSRQpPLFD/DVWpFQLFDV
PiVXWLOL]DGDVVRQHO0+$73\)7$$EV
(VWDV SUXHEDV SHUVLVWHQ SRVLWLYDV LQGHSHQGLHQWHPHQWH GHO WUDWDPLHQWR \ SXHGHQ
REVHUYDUVHIDOVRVSRVLWLYRVPHQRVGHOHQRWUDVHQIHUPHGDGHVSRUHVSLURTXHWDV
OHSWRVSLURVLVHQIHUPHGDGGH/\PH¿HEUHSRUPRUGHGXUDGHUDWDVHQHVWRVFDVRV
VXHOH HVWDU SUHVHQWH HO DQWHFHGHQWH HSLGHPLROyJLFR LQIHFWLYR $Vt VL XQD SUXHED
WUHSRQpPLFDHVSRVLWLYD\QRVHUH¿HUHWUDWDPLHQWRSUHYLR\RQRVHGDQODVFRQGLFLRQHV
FLWDGDVVHGHEHWUDWDU
/DV³SUXHEDVUiSLGDV´VRQSUXHEDVVHQFLOODVTXHVHSXHGHQXWLOL]DUHQHOOXJDUGHOD
FRQVXOWDSURSRUFLRQDQGRUHVXOWDGRVHQPLQXWRVORTXHSRVLELOLWDUHDOL]DUHOWUDWDPLHQWR
HQIRUPDLQPHGLDWD6XHOHQVHUWLUDVUHDFWLYDVLPSUHJQDGDVFRQDQWtJHQRVWUHSRQpPLFRV
TXHVHWRUQDQSRVLWLYRVGDQGRXQDUHDFFLyQHQFRORUHQFRQWDFWRFRQVXHURSODVPDR
VDQJUHGHXQSDFLHQWHFRQDQWLFXHUSRVSDUDVt¿OLV7LHQHQXQWLHPSRGHOHFWXUDUiSLGR
PHQRUDPLQXWRV\VHODVLQFOX\HHQODVSUXHEDVWUHSRQpPLFDV([LVWHQPiVGH
SUXHEDVHQHOPXQGRFRQYDULRVJUDGRVGHVHQVLELOLGDG\HVSHFL¿FLGDG\VHFXHQWD
FRQDOJXQRVHVWXGLRVGHFRPSDUDFLyQ\FRVWRHIHFWLYLGDG6RQHVSHFLDOPHQWH~WLOHV
FXDQGRQRVHFXHQWDFRQSUXHEDVWUHSRQpPLFDVHVWiQGDU&XDQGRODVSUXHEDVUiSLGDV
VRQ SRVLWLYDV VH UHDOL]DQ ODV SUXHEDV QR WUHSRQpPLFDV TXH SHUPLWHQ D WUDYpV GH OD
FXDQWL¿FDFLyQHYDOXDUODUHVSXHVWDDOWUDWDPLHQWR
2WUDVSUXHEDVGHODERUDWRULRSDUDHOGLDJQyVWLFRGHODVt¿OLV
9LVXDOL]DFLyQGHODVHVSLURTXHWDV(QHWDSDVPX\WHPSUDQDVGHODLQIHFFLyQFXDQGR
DSHQDVVHSXHGHYHUHOFKDQFURGHLQRFXODFLyQ\ORVHVWXGLRVVHUROyJLFRVVXHOHQVHU
QRUHDFWLYRVVHSRGUiKDFHUGLDJQyVWLFRGHFRQ¿UPDFLyQDOYHUDODVHVSLURTXHWDVDOD
PLFURVFRStDGHFDPSRRVFXURRSUXHEDVGHLQPXQRÀXRUHVFHQFLDGLUHFWDFRQWRPDGH
PDWHULDOGHODOHVLyQ
&XDGUR5HVXOWDGRVHLQWHUSUHWDFLyQGHODVSUXHEDVVHUROyJLFDV
5HVXOWDGR ,QWHUSUHWDFLyQ
17 $XVHQFLDGHLQIHFFLyQ6LODH[SRVLFLyQHVPX\UHFLHQWHVHUHFRPLHQGD
7 UHSHWLUODVSUXHEDV
17 ,QIHFFLyQDFWLYDHQHVSHFLDOFRQWtWXORVDOWRV!GHODSUXHEDQR

7 WUHSRQpPLFD$WtWXORVEDMRVSXHGHGHEHUVHDXQDVt¿OLVDQWLJXDWUDWDGD
17 (QJHQHUDOVHGHEHDXQDVt¿OLVDQWLJXDWUDWDGDQRDFWLYD
7 ([FHSFLRQDOPHQWHSXHGHVHUXQIDOVRSRVLWLYRGHODSUXHEDWUHSRQpPLFD
17 6HUHFRPLHQGDUHSHWLUXWLOL]DQGRRWURPpWRGRGHSUXHEDWUHSRQpPLFD
6LFRQWLQ~DVLHQGRQHJDWLYDVHWUDWDGHXQUHVXOWDGRIDOVDPHQWHSRVLWLYR
7 GHODSUXHEDQRWUHSRQpPLFD\DXVHQFLDGHLQIHFFLyQ
17SUXHEDQRWUHSRQpPLFD7SUXHEDWUHSRQpPLFD
7UDWDPLHQWRGHODHPEDUD]DGD
(O WUDWDPLHQWR GH OD Vt¿OLV HQ XQD PXMHU HPEDUD]DGD GHEH LQLFLDUVH GH LQPHGLDWR
GHVSXpVGHREWHQHUHOUHVXOWDGRGHXQDSUXHEDGHWDPL]DMHSRVLWLYDWUHSRQpPLFDRQR
SUHIHULEOHPHQWHHQHOSULPHUQLYHOGHDWHQFLyQDPHQRVTXHODVFRQGLFLRQHVGHODPXMHU
UHTXLHUDQXQDDWHQFLyQGHPD\RUFRPSOHMLGDG&RQYLVWDVDODSUHYHQFLyQGHODVt¿OLV
FRQJpQLWDVHFRQVLGHUDDGHFXDGRVLVHKDFHDOPHQRVXQPHVDQWHVGHOSDUWR
(O WUDWDPLHQWR SDUD Vt¿OLV SULPDULD VHFXQGDULD \ Vt¿OLV ODWHQWH WHPSUDQD FRQVLVWH HQ
XQD GRVLV ~QLFD GH PLOORQHV GH XQLGDGHV GH SHQLFLOLQD EHQ]DWtQLFD * SRU YtD
LQWUDPXVFXODU
(O WUDWDPLHQWR SDUD OD Vt¿OLV ODWHQWH WDUGtD R Vt¿OLV ODWHQWH GH GXUDFLyQ GHVFRQRFLGD
FRQVLVWHHQPLOORQHVGHXQLGDGHVGHSHQLFLOLQDEHQ]DWtQLFD*HQWRWDODGPLQLVWUDGDV
HQWUHVGRVLVXQDSRUVHPDQDGHPLOORQHVGHXQLGDGHVGHSHQLFLOLQDEHQ]DWtQLFD
*SRUYtDLQWUDPXVFXODU
6HGHEHKDFHUSUXHEDSDUDVt¿OLVDWRGRVORVFRQWDFWRVVH[XDOHVLQIRUPDGRVSRU
ODHPEDUD]DGD\WUDWDUDORVSRVLWLYRV/DUHLQIHFFLyQSRUODSDUHMDQRWUDWDGDHV
XQDGHODVFDXVDVPiVLPSRUWDQWHVGHODVt¿OLVFRQJpQLWD
7RGDVODVPXMHUHVWUDWDGDVGHEHQVHUHYDOXDGDVFRQSUXHEDVVHUROyJLFDVFXDQWLWDWLYDV
FRQXQDSHULRGLFLGDGGHDPHVHV8QDXPHQWRGHORVWtWXORVLJXDORVXSHULRUD
YHFHVFRQVWLWX\HLQGLFDFLyQGHQXHYRWUDWDPLHQWRDOFRQVLGHUDUVHIUDFDVRWHUDSpXWLFR
UHLQIHFFLyQRQHXURVt¿OLVTXHDGHPiVUHTXLHUHHOHVWXGLRGHOtTXLGRFpIDORUDTXtGHRVL
KD\GLVSRQLELOLGDGSDUDHVWDSUXHED
/D DGPLQLVWUDFLyQ GHO WUDWDPLHQWR GHEH VHU VXSHUYLVDGD \ UHJLVWUDUVH HQ OD KLVWRULD
FOtQLFD6LQRVHHQFXHQWUDHYLGHQFLDHQODKLVWRULDFOtQLFDGHVXDGPLQLVWUDFLyQHO
UHFLpQQDFLGRGHEHUtDVHUFRQVLGHUDGRXQFDVRGHVt¿OLVFRQJpQLWD
/DUHDFFLyQGH-DULVK+HU[KHLPHUHVXQDUHDFFLyQFRQVLVWHQWHHQ¿HEUH\PDOHVWDGR
JHQHUDOGHELGRDODOLEHUDFLyQGHDQWtJHQRVSRUODPXHUWHGHORVWUHSRQHPDV&XDQGR
HO WUDWDPLHQWR VH UHDOL]D HQ OD VHJXQGD PLWDG GHO HPEDUD]R HVWD UHDFFLyQ SRGUtD
H[FHSFLRQDOPHQWHGHVHQFDGHQDUHOWUDEDMRGHSDUWR
0DQHMRGHSDFLHQWHVFRQSRVLEOHDOHUJLDDODSHQLFLOLQD
1RH[LVWHQDOWHUQDWLYDVDODSHQLFLOLQDGHH¿FDFLDGHPRVWUDGDSDUDHOWUDWDPLHQWR
GHODQHXURVt¿OLVGHODVt¿OLVFRQJpQLWDGHODVt¿OLVHQPXMHUHVHPEDUD]DGDV3RU
RWURODGRYROYHUDDGPLQLVWUDUSHQLFLOLQDDXQSDFLHQWHFRQPDQLIHVWDFLRQHVDOpUJLFDV
SUHYLDVSRGUtDFDXVDUUHDFFLRQHVJUDYHVHLQPHGLDWDV
6HHVWLPDTXHXQGHODVSHUVRQDVTXHUH¿HUHQKDEHUWHQLGRUHDFFLRQHVDOpUJLFDV
JUDYHV D OD SHQLFLOLQD SHUPDQHFHQ DOpUJLFDV &RQ HO SDVR GHO WLHPSR OD PD\RUtD GH
HVWDV SHUVRQDV GHMDQ GH SURGXFLU LQPXQRJOREXOLQDV ( HVSHFt¿FDV D OD SHQLFLOLQD 6L
VH SXGLHUD GHWHUPLQDU TXH ODV ,J ( HVSHFt¿FDV KDQ GHVDSDUHFLGR HVWDV SHUVRQDV
SRGUtDQVHUWUDWDGDVGHPDQHUDVHJXUDFRQSHQLFLOLQD([LVWHQSUXHEDVFXWiQHDVFRQ
GHWHUPLQDQWHVPD\RUHV\PHQRUHVGHDOHUJLDDODSHQLFLOLQDTXHSRGUtDQLGHQWL¿FDUGH
IRUPDH¿FD]DODVSHUVRQDVGHDOWRULHVJRGHVXIULUXQDUHDFFLyQFRQWUDODSHQLFLOLQD
0XMHUHVTXHFRQFXUUHQDOFRQWURO 0XMHUHVTXHFRQFXUUHQHQWUDEDMR
GHOHPEDUD]R GHSDUWRVLQFRQWUROGHOHPEDUD]R
2IUHFHUVLVWHPiWLFDPHQWHFRQVHMHUtD 2IUHFHUVLVWHPiWLFDPHQWHFRQVHQWLPLHQWR
\SUXHEDVSDUD9,+\6tILOLV LQIRUPDGR\SUXHEDVUiSLGDVSDUD9,+\6tILOLV
6HURORJtDQHJDWLYD 6HURORJtDSRVLWLYD 3UXHEDUiSLGDSRVLWLYD 6HURORJtD

QHJDWLYD
9,+\6tILOLV 5HSHWLU 6tILOLV 9,+ 6tILOLV
3UHYHQFLyQ VHURORJtDV 7WRFRQ ,QLFLDUFRPSRQHQWHV 7UDWDPLHQWR
SULPDULD\ 9,+\6tILOLV SHQLFLOLQD LQWUD\SRVWSDUWR DODPXMHU
(YDOXDFLyQ HQHOWHUFHU DODPXMHU\ GHOD370, VXVFRQWDFWRV 3UHYHQFLyQ
GHULHVJR WULPHVWUH VXVFRQWDFWRV \DOQHRQDWR DULD
3URJDPDUHYDOXDFLyQ
GH7$59\VHURORJtD
6HURORJtDQHJDWLYD 9,+ DODVSDUHMDV
,QLFLDU7$59
3UHYHQFLyQDULD
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDODGHWHFFLyQ\WUDWDPLHQWRGH
Vt¿OLV\9,+HQHOHPEDUD]R
'HVHQVLELOL]DFLyQ
/RVSDFLHQWHVFRQSUXHEDSRVLWLYDDXQRGHORVGHWHUPLQDQWHVGHODSHQLFLOLQDSXHGHQ
VHUGHVHQVLELOL]DGRV(VXQSURFHVRUHODWLYDPHQWHVHJXURSHURODERULRVRTXHSXHGH
VHUUHDOL]DGRGHIRUPDRUDORGHIRUPDLQWUDYHQRVD&XDGURDXQTXHODVGRVIRUPDV
GHGHVHQVLELOL]DFLyQQRKDQVLGRFRPSDUDGDVODRUDOSDUHFHPiVVHJXUD\PiVIiFLOGH
UHDOL]DU/DGHVHQVLELOL]DFLyQVHGHEHUHDOL]DUHQXQPHGLRKRVSLWDODULRGHELGRDTXHODV
UHDFFLRQHVDOpUJLFDVDXQTXHSRFRIUHFXHQWHVSXHGHQRFXUULU/DGHVHQVLELOL]DFLyQVH
SXHGHFRPSOHWDUHQFXDWURKRUDVGHVSXpVGHODVFXDOHVVHDGPLQLVWUDODSULPHUDGRVLV
GH SHQLFLOLQD $OJXQRV DXWRUHV UHFRPLHQGDQ PDQWHQHU GRVLV GLDULDV EDMDV
8, SRU 92 GH SHQLFLOLQD KDVWD FRPSOHWDU ODV VHPDQDV /D GHVHQVLELOL]DFLyQ GHEH
UHDOL]DUVHEDMRVXSHUYLVLyQPpGLFD\WHQLHQGRFRUWLFRLGHV\DGUHQDOLQDDGLVSRVLFLyQSRU
VLVHSUHVHQWDUDDOJ~QHIHFWRVHFXQGDULR
(VWHHVTXHPDGHEHUiUHSHWLUVHDQWHVGHFDGDGRVLVLQ\HFWDEOHVHPDQDO
(Q FDVR GH QR SRGHU XWLOL]DU SHQLFLOLQD QR VH GLVSRQH GH DOWHUQDWLYDV HIHFWLYDV GH
WUDWDPLHQWR 3RGUtD XWLOL]DUVH HULWURPLFLQD PJ K GXUDQWH GtDV &,,, TXH
SXHGHQRVHUVX¿FLHQWHSDUDODPDGUHUHTXLULHQGRWUDWDPLHQWRFRQGR[LFLFOLQDWUDVHO
SDUWRFRQPJGtDGXUDQWHGtDV(OWUDWDPLHQWRFRQHULWURPLFLQDGHODJHVWDQWH
HVDEVROXWDPHQWHLQH¿FD]SDUDWUDWDUDOIHWRSRUORTXHVHDGPLQLVWUDUiSHQLFLOLQDDO
QLxRVHJ~QHVTXHPDUHFRPHQGDGRPiVDGHODQWH
&XDGUR3URWRFRORSDUDODGHVHQVLELOL]DFLyQRUDOSDUDSDFLHQWHVFRQSUXHED
FXWiQHDSRVLWLYD
3HQLFLOLQD9 &DQWLGDG 'RVLVDFXPXODGD

VXVSHQVLyQGHGRVLV 8,PO PO 8, 8,

3HUtRGRGHREVHUYDFLyQPLQXWRVDQWHVGHODDGPLQLVWUDFLyQSDUHQWHUDOGHODSHQLFLOLQD
)XHQWH:HQGHO*2-U6WDUN%--DPLVRQ5%0HOLQD5'6XOOLYDQ7-3HQLFLOOLQDOOHUJ\DQGGHVHQVLWL]DWLRQLQVHULRXV
LQIHFWLRQVGXULQJSUHJQDQF\1(QJO-0HG±
(OLQWHUYDORHQWUHODVGRVLVHVGHPLQXWRVWLHPSRWUDQVFXUULGRKRUDV\PLQXWRVGRVLVDFXPXODGDPLOORQHV
GHXQLGDGHV /DFDQWLGDGHVSHFL¿FDGHSHQLFLOLQDVHGLOX\HHQDSUR[LPDGDPHQWHPOGHDJXD\GHVSXpVVH
DGPLQLVWUDRUDOPHQWH
5HSHUFXVLyQIHWRQHRQDWDO
/DLQIHFFLyQGHORVIHWRVVHSURGXFHSRUHOSDVDMHWUDQVSODFHQWDULRGHODHVSLURTXHWD
$XQTXH OD WUDQVPLVLyQ VXHOH RFXUULU HQ ORV GRV ~OWLPRV WULPHVWUHV GHO HPEDUD]R OD
HVSLURTXHWD SXHGH DWUDYHVDU OD SODFHQWD HQ FXDOTXLHU PRPHQWR$GHPiV GH PXHUWH
HQODHWDSDIHWDORQHRQDWDOORVQLxRVTXHQDFHQFRQVt¿OLVFRQJpQLWDSRGUiQSUHVHQWDU
P~OWLSOHVPDQLIHVWDFLRQHVPXFRFXWiQHDVODVTXHVHREVHUYDQHQHOGHORVUHFLpQ
QDFLGRV\SXHGHQVHUHYLGHQWHVHQODVSULPHUDVVHPDQDVGHYLGD
/RVVtQWRPDVFXWiQHRVLQFOX\HQ
3pQ¿JRSDOPRSODQWDUYHVtFXODVDPSROORVDVHQSDOPDV\SODQWDVGHFRQWHQLGR
WXUELR\YHUGRVRTXHVHURPSHQUiSLGDPHQWHGHMDQGRODGHUPLVGHVFXELHUWD
6L¿OLGHVPDFXORSDSXORVDV(QH[WUHPLGDGHV\]RQDVSHULRUL¿FLDOHV,QLFLDOPHQWH
WLHQHQ XQ FRORU VRQURVDGR TXH OXHJR VH SLJPHQWDQ PDQFKDV FRORU FDIp FRQ
OHFKH
(GHPDGLIXVRGHODSLHO&RQDIHFWDFLyQSDOPRSODQWDU
$ORSHFLDDQWHULRU
5DJDGtHVSHULEXFDOHV\HQHOPDUJHQSHULDQDO
8OFHUDFLyQGHODFLFDWUL]XPELOLFDOFKDQFUR
/RVVtQWRPDVPXFRVRVLQFOX\HQ
5LQLWLVRFRUL]DVL¿OtWLFD(VHOVLJQRPiVSUHFR]GHODVt¿OLVFRQJpQLWDVHFUHFLyQ
PXFRKHPRUUiJLFD\XOFHUDFLRQHVQDVRODELDOHV
7DPELpQSXHGHQSUHVHQWDUVtQWRPDVYLVFHUDOHVHQWUHORVTXHVHLQFOX\HQ
+HSDWR\HVSOHQRPHJDOLD2WUDVYLVFHURPHJDOLDVVXHOHQDSDUHFHUWDUGtDPHQWH
<VtQWRPDVyVHRVFRPR
1DUL]HQVLOODGHPRQWDU
7LELDVHQVDEOH
'LHQWHVGH+XWFKLQVRQ
2EMHWLYR 3UHYHQLU ODV FRQVHFXHQFLDV PDWHUQRSHULQDWDOHV GH RWUDV

LQIHFFLRQHV GH WUDQVPLVLyQ VH[XDO ,76 \ RWUDV LQIHFFLRQHV GHO
WUDFWRUHSURGXFWLYR,75
$FWLYLGDG 3UHYHQFLyQGHWHFFLyQ\WUDWDPLHQWR
/D 6t¿OLV \ HO 9,+6,'$ \D KDQ VLGR GHVFULSWDV D FRQWLQXDFLyQ VH UHVXPHQ DOJXQRV
DVSHFWRVGHRWUDV,76,75TXHGHEHQVHUWHQLGDVHQFXHQWDGXUDQWHHOFRQWUROGHXQD
HPEDUD]DGD\DTXHUHSUHVHQWDQIUHFXHQWHVPRWLYRVGHFRQVXOWD
)OXMRYDJLQDOOHXFRUUHD'XUDQWHHOHPEDUD]RKD\FDPELRVFXDQWLWDWLYRV\FXDOLWDWLYRV
GHODÀRUDPLFURELDQDGHODYDJLQD$XPHQWDHOQ~PHURGHODFWREDFLORV\GLVPLQX\HQORV
RUJDQLVPRVDQDHURELRV+D\XQDFRSLRVDVHFUHFLyQYDJLQDOFRQVLVWHQWHHQSURGXFWRV
GHGHVIROLDFLyQGHOHSLWHOLR\EDFWHULDVTXHODKDFHQPDUFDGDPHQWHiFLGD
2WUDIXHQWHGHVHFUHFLyQGHPXFXVVHRULJLQDHQODVJOiQGXODVFHUYLFDOHVHQUHVSXHVWDDOD
KLSHUHVWURJHQHPLD\TXHWLHQHXQHIHFWRSURWHFWRUDQWHODVLQIHFFLRQHVDVFHQGHQWHV
/D OHXFRUUHD RFDVLRQDOPHQWH HV SDWROyJLFD HVWDQGR HQ VX JpQHVLV JpUPHQHV FRPR
&iQGLGD DOELFDQV *DUGQHUHOOD YDJLQDOLV &KODPLGLDV WUDFKRPDWLV 7ULFKRPRQDV
YDJLQDOLV0LFRSODVPD1HLVVHULDJRQRUUKRHDHHWF
0RQLOLDVLV YXOYRYDJLQDO SURYRFDGD SRU &iQGLGD DOELFDQV HVWi SUHVHQWH HQ

HO GH ODV HPEDUD]DGDV DO WpUPLQR DXQTXH OD PD\RUtD GH ODV YHFHV HVWD
LQIHFFLyQ WUDQVFXUUH HQ IRUPD DVLQWRPiWLFD /D HQIHUPHGDG VH FDUDFWHUL]D SRU
SUXULWRDUGRU\ÀXMREODQFRJUXPRVRDGKHUHQWHFRQDVSHFWRGHOHFKHFRUWDGD
$OPLFURVFRSLRDJUHJDQGRXQDVJRWDVGHKLGUy[LGRGHSRWDVLRRFRQWLQFLyQGH
*UDPVHSXHGHQYHUORVPLFHOLRV\ODVSVHXGRKLIDV(OWUDWDPLHQWRLGHDOHVFRQ
&ORWULPD]RO R 0LFRQD]RO FUHPD YDJLQDO X yYXORV SRU GtDV /D SDUHMD VH[XDO
DVLQWRPiWLFDQRVHWUDWDUi
9DJLQRVLV EDFWHULDQD SURYRFDGD SRU *DUGQHUHOOD YDJLQDOLV R +DHPRSKLOOXV
YDJLQDOLV 0LFRSODVPD KRPLQLV 3UHYRWHOOD VS 0RELOXQFXV VS 7tSLFDPHQWH VH
GHVFULEH SRU ÀXMR EODQFR JULViFHR FRQ RORU D SHVFDGR TXH VH LQFUHPHQWD FRQ
HODJUHJDGRGHKLGUy[LGRGHSRWDVLR(OS+VXHOHVHU!GH$OPLFURVFRSLR
VHHQFXHQWUDQODVFpOXODVWDFKRQDGDVFRQSHTXHxDVLPiJHQHVTXH UHFXHUGDQ
FRPDV³FOXHFHOOV´(OWUDWDPLHQWRHVFRQ0HWURQLGD]RORUDOPJYHFHVDOGtD
SRUGtDVJHOXyYXORVYDJLQDOHVWRGDVODVQRFKHVSRUGtDV(OFRPSDxHUR
VH[XDODVLQWRPiWLFRQRVHWUDWDUi
7ULFRPRQLDVLVSURYRFDGDSRU7ULFKRPRQDVYDJLQDOLV$OUHGHGRUGHOGHODV
HPEDUD]DGDVSDGHFHQLQIHFFLyQSRUHVWHSDUiVLWRODFXDOWUDQVFXUUHDVLQWRPiWLFD
ODPD\RUtDGHODVYHFHV/RVVLJQRVWtSLFRVFRQVLVWHQHQÀXMRPDOROLHQWHYHUGRVR
FODUR HVSXPRVR D YHFHV DFRPSDxDGR GH SUXULWR HQURMHFLPLHQWR \ SLTXHWHDGR
KHPRUUiJLFRGHFXHOOR\YDJLQDFXHOORGHIUHVD(QHOHVWXGLRHQIUHVFRSXHGH
YHUVH HO SURWR]RDULR DO PLFURVFRSLR (O WUDWDPLHQWR LQFOX\H D OD JHVWDQWH \ VXV
FRQWDFWRVVH[XDOHVFRQ0HWURQLGD]RORUDOJHQGRVLV~QLFDRPJYHFHV
DOGtDSRUGtDV27LQLGD]ROJRUDOHQGRVLV~QLFD/DHPEDUD]DGDWDPELpQ
SXHGHVHUWUDWDGDFRQ0HWURQLGD]ROyYXORVRJHOLQWUDYDJLQDOGXUDQWHQRFKHV
'XUDQWH PXFKR WLHPSR HVWXYR SURVFULSWR HO XVR RUDO GHO PHWURQLGD]RO HQ ODV
JHVWDQWHVGHVGHKDFHDOJXQRVDxRVKDVLGRLQFOXLGRSDUDXVRSRUOD)'$FRPR
XQPHGLFDPHQWRVHJXUR
*RQRFRFFLDSURYRFDGDSRU1HLVVHULDJRQRUUKRHDH3XHGHVHUDVLQWRPiWLFDR
SUHVHQWDUÀXMRSXUXOHQWR\SURGXFLUXQDUHDFFLyQORFDOLQÀDPDWRULDFRQH[XGDGR
PXFRSXUXOHQWRGHODVPXFRVDVHQGRFHUYLFDOHV\RXUHWUDODQDOSXGLHQGRSURYRFDU
GLVXULDSRODTXLXULD\WHQHVPRYHVLFDO$OPLFURVFRSLRVHYHQORVSROLPRUIRQXFOHDUHV
FRQ HO GLSORFRFR *UDP QHJDWLYR LQWUDFHOXODU 7DPELpQ VH SXHGH LGHQWL¿FDU HQ
FXOWLYRVFRQPHGLRVHVSHFLDOHVDJDUFKRFRODWH7KD\HU0DUWLQ
$ODVHPDQDGHODLQIHFFLyQSXHGHQVHUUHDFWLYDVODVSUXHEDVVHUROyJLFDVHQWUH
ODVTXHVHLQFOX\HQPRGHUQDVSUXHEDVSDUDLGHQWL¿FDUHO$'1GHODEDFWHULD
/DJRQRFRFFLDFXDQGRDIHFWDHOHQGRPHWULRSXHGHSURGXFLUDERUWRHQRFDVLRQHV
HVFDXVDGHDERUWRKDELWXDO$XQTXHODLQIHFFLyQGHOIHWRSRUYtDWUDQVSODFHQWDULD
HVH[FHSFLRQDOSXHGHHQFDPELRGXUDQWHHOSDUWRFRQWDPLQDUODVFRQMXQWLYDVGHO
QLxR\SURYRFDUOD³RIWDOPLDSXUXOHQWDEOHQRUUiJLFD´3RUHVWDUD]yQVHKDLQVWLWXLGR
HQIRUPDREOLJDWRULDODSUR¿OD[LVGHODRIWDOPLDSXUXOHQWDPHGLDQWHODLQVWLODFLyQ
HQ ORV VDFRV FRQMXQWLYDOHV GHO UHFLpQ QDFLGR GH XQ FROLULR FRQ VDOHV GH SODWD
PpWRGRGH&UHGpRDQWLELyWLFRVLQPHGLDWDPHQWHGHVSXpVGHOQDFLPLHQWRHQOD
SURSLDUHFHSFLyQQHRQDWDO/DJUDYLGH]SXHGHLQÀXLUQHJDWLYDPHQWHDJUDYDQGR
XQD JRQRUUHD SUHYLD GDQGR PDQLIHVWDFLRQHV HQ OD SRUFLyQ LQIHULRU GHO DSDUDWR
JHQLWDOFRQDXPHQWRGHODOHXFRUUHDFROSLWLVJUDQXORVDEDUWKROLQLWLVLUUDGLDFLyQD
]RQDVYHFLQDV\VtQWRPDVXULQDULRV\UHFWDOHV'HVSXpVGHOSDUWRSXHGHDVFHQGHU
\ SURYRFDU HQGRPHWULWLV VDOSLQJLWLV \R SHOYLSHULWRQLWLV (O WUDWDPLHQWR HV GH OD
HPEDUD]DGD\VXFRPSDxHURVH[XDOFRQXQDGRVLV~QLFDLQWUDPXVFXODUGH3HQLFLOLQD
*8RGRVLV~QLFDRUDOGH&HIWULD[RQDPJR&H¿[LPHPJ
&ODPLGLDVLV SURYRFDGD SRU &KODPLGLDV WUDFKRPDWLV *HQHUDOPHQWH HV
DVLQWRPiWLFD&XDQGRKD\ÀXMRVXHOHVHUDPDULOOHQWR\HVSHFLDOPHQWHHQGRFHUYLFDO
3XHGHDFRPSDxDUVHGHGLVSDUHXQLDVDQJUDGR\XUHWULWLV(OGLDJQyVWLFRVHSXHGH
KDFHUREVHUYDQGRODVLQFOXVLRQHVFLWRSODVPiWLFDVFRQWLQFLyQGH3DSDQLFRODRXR
FRQWpFQLFDGH*LHPVD6HSXHGHQHPSOHDUFXOWLYRVHQPHGLRVHVSHFLDOHVSDUD
FODPLGLDVDQWLFXHUSRVPRQRQXFOHDUHVÀXRUHVFHQWHVHWF(OWUDWDPLHQWRHVSDUD
ODPXMHUJHVWDQWH\VXFRPSDxHURVH[XDOVHUHFRPLHQGD$]LWURPLFLQDJRUDOHQ
GRVLV~QLFDR$PR[LFLOLQDPJRUDOYHFHVDOGtDGXUDQWHGtDV
+HUSHVVLPSOH([LVWHQGRVWLSRVGH+HUSHVKRPLQLVHOWLSR,FRQSUHGLOHFFLyQ
SRUHOWHMLGRHFWRGpUPLFRGHSLHO\PXFRVDULQRIDULQJHD\HOWLSR,,RKHUSHVYXOYDU
GHORFDOL]DFLyQJHQLWDO\FRQWDJLRYHQpUHR6HPDQL¿HVWDSRUYHVtFXODVP~OWLSOHV
SUXULJLQRVDV R GRORURVDV TXH WRPDQ XQD FRORUDFLyQ EODQFR DPDULOOHQWD \
SRVWHULRUPHQWHVHXOFHUDQ(OSDVDMHWUDQVSODFHQWDULRDXQTXHUDURSXHGHRULJLQDU
OHVLRQHVIHWDOHVWDOHVFRPRUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQRPLFURFHIDOLD
\R FDOFL¿FDFLRQHV LQWUDFUDQHDQDV TXH SXHGHQ PDQLIHVWDUVH HQ OD LQIDQFLD SRU
UHWDUGR SVLFRPRWRU /D LQIHFFLyQ HQ HO UHFLpQ QDFLGR VH SURGXFH SRU FRQWDFWR
GLUHFWRDWUDYpVGHOFDQDOGHSDUWR6XHOHVHUVLHPSUHJUDYH\DPHQXGRPRUWDO
DRFDVLRQDLFWHULFLDKHSDWRHVSOHQRPHJDOLDKHPRUUDJLDV\VHSWLFHPLD(Q
HOKtJDGRSXOPyQVXSUDUUHQDOHV\FHUHEURVHSXHGHQFRQVWLWXLUIRFRVQHFUyWLFRV
3RU HVWD UD]yQ OD H[LVWHQFLD GH XQ KHUSHV JHQLWDO DFWLYR GXUDQWH HO SDUWR VHUi
LQGLFDFLyQ GHFHViUHDHOHFWLYD6LKD\YLUXVDOPRPHQWRGHOSDUWRHOULHVJRGH
LQIHFFLyQGHOUHFLpQQDFLGRHVGHOORFXDOVHUHGXFHFRQVLGHUDEOHPHQWHVH
VHUHDOL]DODFHViUHDDQWHVGHTXHVHURPSDQODVPHPEUDQDVRYXODUHVRQRPiV
DOOi GH KRUDV GH SURGXFLGD OD UXSWXUD (O GLDJQyVWLFR VXHOH VHU FOtQLFR$ ODV
YHVtFXODV\DGHVFULSWDVVXHOHDVRFLDUVHGLVXULDGRORU\HQRFDVLRQHV¿HEUH(O
WUDWDPLHQWRVHKDUiFRQ$\FLFORYLURUDOPJWUHVYHFHVDOGtDGXUDQWHGtDV
3XHGHDVRFLDUVHFUHPDGH$F\FORYLUDOSDUDDSOLFDFLyQWySLFDGXUDQWHGtDV
29DODF\FORYLUJRUDOYHFHVDOGtDGXUDQWHGtDV(OFRPSDxHURVH[XDOVL
WLHQHVLQWRPDWRORJtDGHEHUiUHFLELUHOPLVPRWUDWDPLHQWR
2EMHWLYR 3UHYHQLUODWUDQVPLVLyQYHUWLFDOGHODHQIHUPHGDGGH&KDJDV
/D HQIHUPHGDG GH &KDJDV HV FDXVDGD SRU HO 7ULSDQRVRPD FUX]L \ HV H[FOXVLYD GH
QXHVWURFRQWLQHQWH(VFRQVLGHUDGDHQGpPLFDHQSDtVHVGHOD5HJLyQ\VHHVWLPD
TXHKD\PiVGHPLOORQHVGHSHUVRQDVLQIHFWDGDV
/DSUHYDOHQFLDGHLQIHFFLyQSRU7FUX]LHQJHVWDQWHVYDULDHQWUH\GHSHQGLHQGR
GHOiUHDJHRJUi¿FD'HELGRDODXPHQWRHQODVPLJUDFLRQHVODVLQIHFFLRQHVFRQJpQLWDVGH
7FUX]LKDQDXPHQWDGRVXIUHFXHQFLDHQ]RQDVXUEDQDV\HQSDtVHVQRHQGpPLFRV
(QDTXHOORVSDtVHVTXHKDQHOLPLQDGRODWUDQVPLVLyQYHFWRULDO\WLHQHQXQEXHQFRQWURO
GHORVEDQFRVGHVDQJUHOD~QLFDYtDSRUODTXHVHSURGXFHQQXHYRVFDVRVHVDWUDYpV
GHODWUDQVPLVLyQYHUWLFDOPDGUHKLMRGXUDQWHHOHPEDUD]R
(OQ~PHURGHUHFLpQQDFLGRVFRQ&KDJDVFRQJpQLWRYDUtDHQWUH\HOSXGLHQGROOHJDU
KDVWDHOHVWDDPSOLDYDULDFLyQVHYLQFXODFRQODUHJLyQJHRJUi¿FD\ODVFRQGLFLRQHV
VRFLRHFRQyPLFDVGHORVJUXSRVHVWXGLDGRV(QWUHHO\GHORVFDVRVGHLQIHFFLyQ
FRQJpQLWD VRQ DVLQWRPiWLFRV /RV FDVRV VLQWRPiWLFRV SUHVHQWDQ IUHFXHQWHPHQWH
SUHPDWXULGDG EDMR SHVR DO QDFHU \ KHSDWRHVSOHQRPHJDOLD (Q DOJXQRV FDVRV SXHGH
YHUVHDQDVDUFD\VtQGURPHUHVSLUDWRULRDJXGR/DPHQLQJRHQFHIDOLWLV\ODPLRFDUGLWLVVRQ
PiVIUHFXHQWHVFXDQGRFRH[LVWHLQIHFFLyQSRU9,+
1RH[LVWHXQPDUFDGRUFOtQLFRHVSHFt¿FRGHODLQIHFFLyQ Figura 31.

Fragmento de HCP.
FRQJpQLWDGHODHQIHUPHGDGGH&KDJDV
Chagas
(QDTXHOORVSDtVHVFRQLQIHFFLyQHQGpPLFDVHUHFRPLHQGDODUHDOL]DFLyQGHODSUXHED
VHUROyJLFDHQODJHVWDQWH3DUDGHWHFWDUDQWLFXHUSRVHVSHFt¿FRVDQWLWULSDQRVRPDFUX]L
\ UHDOL]DU XQD FRQ¿UPDFLyQ GLDJQyVWLFD VH XWLOL]DUiQ SRU OR PHQRV GRV UHDFFLRQHV
VHUROyJLFDVQRUPDWL]DGDVTXHSHUPLWHQDOFDQ]DUHQWUHHO\GHVHQVLELOLGDG
(QWUHHOODV+$,,),+$,(/,6$\(/,6$,),
+$,+HPRDJOXWLQDFLyQLQGLUHFWD
,),,QPXQRÀXRUHVFHQFLDLQGLUHFWD
(/,6$(QVD\RLQPXQRHQ]LPiWLFR
(O WUDWDPLHQWR TXLPLRWHUiSLFR HVSHFt¿FR GXUDQWH HO HPEDUD]R HVWi FRQWUDLQGLFDGR
SHUR OD PDGUH LQIHFWDGD SRGUi VHU HVWXGLDGD SDUD GHVFDUWDU FRPSURPLVR FDUGtDFR \
JDUDQWL]DUODDWHQFLyQREVWpWULFDVHJXUD\GHFDOLGDG6LODSUXHEDHVSRVLWLYDODIDPLOLD
GHEHVHULQIRUPDGDDFHUFDGHORVSURFHGLPLHQWRV\WUDWDPLHQWRVDVHJXLUFRQHOUHFLpQ
QDFLGR(QORVKLMRVGHPDGUHFRQVHURORJtDFKDJiVLFDSRVLWLYDVHUHFRPLHQGD
3HVTXLVDSDUDVLWROyJLFDGLUHFWDQHRQDWDOHOPLFURKHPDWRFULWR0+HVODWpFQLFD
GH HOHFFLyQ SRU VX IDFLOLGDG SRUTXH UHTXLHUH XQ SHTXHxR YROXPHQ GH VDQJUH
PO\WLHQHXQDDOWDVHQVLELOLGDGDO/RVPpWRGRVSDUDVLWROyJLFRV
LQGLUHFWRV;HQRGLDJQyVWLFR,QRFXODFLyQDUDWRQHV\HO+HPRFXOWLYRWLHQHQDOWD
VHQVLELOLGDGSHURUHTXLHUHQFRPSOHMDLQIUDHVWUXFWXUD\ORVUHVXOWDGRVWDUGDQGH
DGtDV
3HVTXLVDVHUROyJLFDFRQYHQFLRQDOGLIHULGDHQWUHORV\PHVHVGHHGDG/D
E~VTXHGDGHDQWLFXHUSRVHVSHFt¿FRVQRHV~WLOSDUDHOGLDJQyVWLFRHQORVSULPHURV
PHVHVGHYLGDSXHVWRTXHHOHVWXGLRVHUROyJLFRKDELWXDOGHWHFWDDQWLFXHUSRV,J*
ORVTXHSXHGHQKDEHUVLGRWUDQVPLWLGRVSDVLYDPHQWHSRUODPDGUH/DGHWHFFLyQ
GH OD IUDFFLyQ ,J0 HVSHFt¿FD HODERUDGD SRU HO IHWR SHUPLWH XQ GLDJQyVWLFR
SUHFR]SHURFRQEDMDVHQVLELOLGDG
(OFULWHULRSDUDFRQVLGHUDUXQFDVRGH&KDJDVFRQJpQLWRHVHOVLJXLHQWH
UHFLpQQDFLGRKLMRGHPDGUHFRQVHURORJLDSRVLWLYDSDUD7FUX]L
SDUiVLWRV LGHQWL¿FDGRV DO QDFLPLHQWR R SDUiVLWRV R DQWLFXHUSRV HVSHFt¿FRV QR
PDWHUQRVGHWHFWDGRVGHVSXpVGHOQDFLPLHQWRVLHPSUH\FXDQGRQRKD\DH[LVWLGR
WUDQVIXVLyQVDQJXtQHDSUHYLDRFRQWDPLQDFLyQYHFWRULDO
(IHFWXDUGLDJQyVWLFRDQWHQDWDOSHUPLWHDOQHRQDWyORJRHIHFWXDUWUDWDPLHQWRHVSHFt¿FR
HQHOQHRQDWRTXHJDUDQWLFHODFXUDFLyQ
$OQDFLPLHQWRXQDPXHVWUDGHVDQJUHGHOFRUGyQSXHGHVHUXWLOL]DGDSDUDODE~VTXHGD
GH SDUiVLWRV HQ OD VDQJUH (O WUDWDPLHQWR HVSHFt¿FR HV FRQ 1LIXUWLPR[ PJNJ
GtD \ SRVWHULRUPHQWH %HQ]LGD]RO PJNJGtD SRU GtDV (VWDV GURJDV VRQ GH DOWD
HIHFWLYLGDGFXDQGRVHDGPLQLVWUDQDQWHVGHORVDxRVGHYLGD\SURYRFDQSRFRVHIHFWRV
VHFXQGDULRV
2EMHWLYR 5HGXFLUODPRUELPRUWDOLGDGPDWHUQD\SUHYHQLUODWUDQVPLVLyQ
YHUWLFDOGHO3DOXGLVPRR0DODULD
/DPDODULDHVXQDLQIHFFLyQFDXVDGDSRUSURWR]RDULRVGHOJpQHUR3ODVPRGLRORVFXDOHV
VRQLQRFXODGRVDOVHUKXPDQRSRUODSLFDGXUDGHODKHPEUDGHOPRVTXLWR$QRSKHOHV(Q
QXHVWUDUHJLyQHOUHVSRQVDEOHGHORVFDVRVGHSDOXGLVPRHV3ODVPRGLXPIDOFLSDUXP
(VHQGpPLFDHQGHORVSDtVHVGHOD5HJLyQ0iVGHOGHORVFDVRVQRWL¿FDGRV
VH RULJLQDQ HQ ORV SDtVHV TXH FRPSDUWHQ OD VHOYD DPD]yQLFD 6LHQGR ODV PXMHUHV
HPEDUD]DGDV\ORVQLxRVHVSHFLDOPHQWHVXVFHSWLEOHV
/RV DVSHFWRV FOtQLFRV GHSHQGHQ HQ JUDQ PHGLGD GH ORV SDWURQHV H LQWHQVLGDG GH
OD WUDQVPLVLyQ GH OD 0DODULD HQ HO iUHD GH UHVLGHQFLD OR FXDO GHWHUPLQD HO JUDGR GH
LQPXQLGDGDGTXLULGD
(Q iUHDV HVWDEOHV DOWD WUDQVPLVLyQ ORV SREODGRUHV HVWiQ FRQWLQXDPHQWH
H[SXHVWRV D OD LQRFXODFLyQ SRU 0DODULD VXHOHQ DGTXLULU LQPXQLGDG SDUFLDO D
OD HQIHUPHGDG FOtQLFD \ ODV PDQLIHVWDFLRQHV PiV VHYHUDV ODV SUHVHQWDQ HQ OD
LQIDQFLD /RV DGROHVFHQWHV \ DGXOWRV VRQ SDUFLDOPHQWH LQPXQHV \ UDUDPHQWH
VXIUHQHQIHUPHGDGFOtQLFD/DLQPXQLGDGVHUHGXFHGXUDQWHHOHPEDUD]R\SXHGH
SHUGHUVHFXDQGRODVPXMHUHVVHPXGDQIXHUDGHODV]RQDVGHWUDQVPLVLyQ
(QiUHDVGHPDODULDLQHVWDEOHEDMDWUDQVPLVLyQWDOFRPRVHYHHQ$PpULFD
/DWLQDGRQGHODHQIHUPHGDGSHUPDQHFHHQGpPLFD/DVWDVDVGHLQRFXODFLyQVRQ
EDMDVFRQORTXHVHUHWDUGDODDGTXLVLFLyQGHODLQPXQLGDG\HOUHVXOWDGRHVOD
LQIHFFLyQDJXGDHQWRGRVORVJUXSRVGHHGDGQLxRVMyYHQHV\DGXOWRVFRQDOWR
ULHVJRGHSURJUHVLyQDODVIRUPDVVHYHUDVGHODHQIHUPHGDGGHQRVHUWUDWDGD
(QODViUHDVGHDOWDWUDQVPLVLyQORVQLxRVVHHQFXHQWUDQHQDOWRULHVJRGHPRULUSRUPDODULD
PLHQWUDVTXHHQODVGHEDMDWUDQVPLVLyQWRGRVORVJUXSRVGHHGDGHVWiQHQULHVJR
'LDJQyVWLFRGH0DODULD
6HEDVDHQFULWHULRVFOtQLFRVGLDJQyVWLFRGHVRVSHFKDRSRUODLGHQWL¿FDFLyQGHORV
SDUiVLWRVGLDJQyVWLFRGHFRQ¿UPDFLyQ
'LDJQyVWLFR&OtQLFR
(OGLDJQyVWLFRFOtQLFRDLVODGRHVPX\SRFRHVSHFt¿FR\VHUHDOL]DHQEDVHDODSUHVHQFLD
GH¿HEUHHQORVGtDVSUHYLRVVLQRWUDVHYLGHQFLDVGHHQIHUPHGDGHVVHYHUDV
/RV SULPHURV VtQWRPDV GH OD PDODULD HQ XQ FXDGUR QR FRPSOLFDGR VXHOHQ VHU
LQHVSHFt¿FRV\SXHGHQFRQIXQGLUVHFRQXQHVWDGRGHLPSUHJQDFLyQYLUDOWtSLFR3XHGH
SUHVHQWDUFHIDOHDVDVWHQLDIDWLJDPROHVWLDVDEGRPLQDOHVGRORUPXVFXODU\DUWLFXODU
VHJXLGRSRU¿HEUHHVFDORIUtRVVXGRUDFLyQDQRUH[LDHWF
(QORVHVWDGLRVVLQHYLGHQFLDVGHGLVIXQFLyQRUJiQLFDODVWDVDVGHPRUWDOLGDGVRQEDMDV
FLUFDSDUDLQIHFFLRQHVSRU3IDOFLSDUXPVLVHSURYHHWUDWDPLHQWRHIHFWLYRSUHFR]
3RVWHUJDUHOWUDWDPLHQWRRXVDUGURJDVLQHIHFWLYDVSXHGHQOOHYDUDXQDXPHQWRGHOD
VHYHULGDG\DJUDYDFLyQGHOFXDGURHQSRFDVKRUDV
/DDJUDYDFLyQVHSXHGHPDQLIHVWDUSRUXQRRPiVGHORVVLJXLHQWHVVtQWRPDVFRPD
PDODULDFHUHEUDODFLGRVLVPHWDEyOLFDDQHPLDVHYHUDKLSRJOLFHPLD\HQDGXOWRVIDOOD
UHQDODJXGDRHGHPDDJXGRGHSXOPyQ(QHVWHHVWDGLRODPRUWDOLGDGD~QHQSHUVRQDV
TXHUHFLEHQHOWUDWDPLHQWRDGHFXDGRVHHOHYDKDVWDXQ6LQRHVWUDWDGDODPDODULD
VHYHUDDPHQXGRHVPRUWDO
0DODULD\HPEDUD]R
3RU WHQHU QXHVWUD UHJLyQ XQ SHU¿O GH EDMD WUDQVPLVLyQ ODV PXMHUHV HQ HGDG
UHSURGXFWLYD WLHQHQ HVFDVD LQPXQLGDG DGTXLULGD IUHQWH D OD PDODULD (Q HVWH
HVFHQDULRVRQFRPXQHVORVFDVRVJUDYHVGHHQIHUPHGDGPDWHUQDPDODULDVHYHUD
FRQ FRPSOLFDFLRQHV GHO VLVWHPD QHUYLRVR FHQWUDO KLSRJOLFHPLD KLSHUSLUH[LD
DQHPLD KHPROtWLFD VHYHUD HGHPD SXOPRQDU \ PXHUWH 2EYLDPHQWH ORV FDVRV
JUDYHV VH SXHGHQ DFRPSDxDU GH PDORV UHVXOWDGRV UHSURGXFWLYRV WDOHV FRPR
5&,%31SUHPDWXULGDGDERUWRPXHUWHIHWDO\PXHUWHLQIDQWLO
'LDJQyVWLFRSDUDVLWROyJLFR
/RVGRVPpWRGRVVXJHULGRVSDUDHOGLDJQyVWLFRSDUDVLWROyJLFRVRQOD0LFURVFRStDGH
/X]\ORV7HVWUiSLGRVGLDJQyVWLFRV5'7V
/DPLFURVFRStDGHOX]WLHQHODYHQWDMDGHOEDMRFRVWRODDOWDVHQVLELOLGDG\HVSHFL¿FLGDG
(Q HOOD VH LQFOX\H HO ³WHVW GH OD JRWD JUXHVD´ TXH HV HO ³HVWiQGDU GH RUR´ SDUD HO
GLDJQyVWLFR \ TXH FRQVLVWH HQ DQDOL]DU XQD JRWD GH VDQJUH SHULIpULFD FRQ WLQFLyQ GH
*LHPVD HQ EXVFD GHO SDUiVLWR 6H UHTXLHUHQ WUHV IURWLV QHJDWLYRV VHSDUDGRV SRU
KRUDVSDUDGHFODUDUTXHODSHUVRQDQRWLHQHLQIHFFLyQPDOiULFD
/RVWHVWUiSLGRV5'7VSDUDGHWHFFLyQGHDQWtJHQRVGHOSDUiVLWRVRQPiVFDURV\VX
ODELOLGDGDDOWDVWHPSHUDWXUDV\KXPHGDGVRQXQDLPSRUWDQWHGHVYHQWDMD
/DVWpFQLFDVSDUDGHWHFWDU$'1GHORVSDUiVLWRVEDVDGDVHQODUHDFFLyQGHODFDGHQD
GHODSROLPHUDVD3&5VRQDOWDPHQWHVHQVLEOHV\PX\XVDGDVSDUDGHWHFWDULQIHFFLRQHV
PL[WDVHQSDUWLFXODUDQWHEDMDVFDQWLGDGHVGHSDUiVLWRV
(O GLDJQyVWLFR SDUDVLWROyJLFR GHEH VHU HIHFWXDGR D ODV PXMHUHV HPEDUD]DGDV GH ODV
iUHDVHQGpPLFDVSDUDGLVWLQJXLUODVFDXVDVGHOD¿HEUH\UHGXFLUHOXVRLQQHFHVDULRGH
DQWLELyWLFRVDQWLSDO~GLFRVHQHOHPEDUD]R
(QiUHDVGRQGHKD\DPiVGHGRVHVSHFLHVGHSDUiVLWRVSURGXFWRUHVGHODPDODULDVHUi
QHFHVDULRLGHQWL¿FDUORVSDUiVLWRVSDUDHOORVRORXQPpWRGRSDUDVLWROyJLFRSHUPLWHHO
GLDJQyVWLFRGHHVSHFLHV
3UHYHQFLyQGHODPDODULDGXUDQWHHOHPEDUD]R
&RQWURODU ORV HIHFWRV GH OD LQIHFFLyQ SRU PDODULD HQ ODV PXMHUHV HPEDUD]DGDV \ VXV
IHWRVFRQODVVLJXLHQWHVLQWHUYHQFLRQHV
7UDWDPLHQWRGHODPXMHUFRQPDODULDODDQHPLD\ODVRWUDVFRQVHFXHQFLDVGHOD
LQIHFFLyQ
8VR GH PRVTXLWHURV WUDWDGRV FRQ LQVHFWLFLGDV SRGUtDQ UHGXFLU HQ XQD FXDUWD
SDUWHODVPXHUWHVSRUPDODULD
7UDWDPLHQWR SUHYHQWLYR LQWHUPLWHQWH 73, HQ iUHDV GH DOWD WUDQVPLVLyQ GH
PDODULD
7UDWDPLHQWRHQPXMHUHVHPEDUD]DGDV
/DPXMHUHPEDUD]DGDFRQ0DODULDDJXGDVLQWRPiWLFDGXUDQWHHOVHJXQGRWULPHVWUHGHO
HPEDUD]R WLHQH PiV SRVLELOLGDG GH GHVDUUROODU XQD IRUPD VHYHUD TXH RWURV DGXOWRV
D PHQXGR FRPSOLFDGD FRQ HGHPD SXOPRQDU H KLSRJOXFHPLD /D PRUWDOLGDG HV
DSUR[LPDGDPHQWHGHOODFXDOHVPXFKRPiVDOWDTXHHQPXMHUHVQRHPEDUD]DGDV
/DPXHUWHIHWDO\HOSDUWRSUHPDWXURVRQIUHFXHQWHV3RUHOORVHLPSRQHHOWUDWDPLHQWR
FRQHOREMHWLYRSULPDULRGHVDOYDUODYLGDGHODPDGUH
/RVDQWLPDOiULFRVFRQVLGHUDGRVVHJXURVHQHOSULPHUWULPHVWUHVRQ4XLQLQD&KORURTXLQD
3URJXDQLO3LULPHWDPLQD\6XOIDGR[LQD±3LULPHWDPLQD'HHVWRVOD4XLQLQDHVODPiV
HIHFWLYD\SXHGHVHUXVDGDHQWRGRVORVWULPHVWUHVGHOHPEDUD]R6HSUH¿HUHOD4XLQLQD
GXUDQWH HO SULPHU WULPHVWUH \ ODV 7HUDSLDV &RPELQDGDV HQ EDVH D$UWHPLVLQD $&7
$UWHVXQDWRR$UWHPHWHUGXUDQWHHOVHJXQGR\WHUFHUWULPHVWUHV
&RPRORVDQWLPDOiULFRVVRQDQWLIROtQLFRVGHEHDGPLQLVWUDUVHVLHPSUHiFLGRIyOLFR
'URJDVFRQWUDLQGLFDGDVGXUDQWHHOHPEDUD]R
0HÀRTXLQD3ULPDTXLQD\7HWUDFLFOLQDV$PRGLDTXLQD&KORUSURJXDQLO'DSVRQD
+DORIDQWULQD/XPHIDQWULQD\3LSHUDTXLQD
7UDWDPLHQWRGHOD0DODULDIDOFLSDUXPQRFRPSOLFDGDGXUDQWHHOHPEDUD]R
3ULPHUWULPHVWUH4XLQLQD&OLQGDP\FLQDGXUDQWHGtDV
$&7GHEHVHUXVDGRVRORVLHVHO~QLFRWUDWDPLHQWRHIHFWLYRGLVSRQLEOH
6HJXQGR\WHUFHUWULPHVWUHV$&7&OLQGDP\FLQDGXUDQWHGtDV
R4XLQLQD&OLQGDP\FLQDGXUDQWHGtDV
/D H[SRVLFLyQ LQDGYHUWLGD D ORV DQWLPDOiULFRV QR HV XQD FDXVD GH LQWHUUXSFLyQ GH OD
JUDYLGH]
0XMHUHVDPDPDQWDQGR
/D FDQWLGDG GH DQWLPDOiULFRV TXH SDVDQ D OD OHFKH PDWHUQD VRQ EDMDV /D ~QLFD
H[FHSFLyQDHVWDUHJODODFRQVWLWX\HQODV'DSVRQDVVRQH[FUHWDGDVDODOHFKHGH
OD GRVLV GHO DGXOWR /DV7HWUDFLFOLQDV WDPELpQ HVWiQ FRQWUDLQGLFDGDV SRU VXV HIHFWRV
VREUHORVKXHVRV\GLHQWHVGHORVQLxRV
&XDGUR(VWUDWHJLDVGHLQWHUYHQFLyQSDUDODPDODULDGXUDQWHHOHPEDUD]RHQ
XQHVFHQDULRGHEDMDWUDQVPLVLyQ
Tratamiento Preventivo Mosquiteros tratados
Manejo del caso Intermitente (TPI) con insecticida
Alto riesgo de malaria activa
Proveer TPI (después de
Buscar y tratar la anemia con antimaláricos percibir los movimientos Comenzar el uso en el
recomendados y suplementos con hierro y Ac. fetales) durante los
Fólico. embarazo y continuarlo
controles prenatales, en el postparto.
Rápido reconocimiento y tratamiento de próximo a las 26 y 32
todos los casos de malaria activa con drogas semanas.
reconocidamente efectivas
(O73,FRQVLVWHHQODDGPLQLVWUDFLyQVXSHUYLVDGDGHDQWLPDOiULFRVDGRVLVGHWUDWDPLHQWR
\ D LQWHUYDORV SUH GH¿QLGRV GXUDQWH HO HPEDUD]R 6H LQLFLDQ HQ HO VHJXQGR WULPHVWUH
GHVSXpVTXHODPXMHUKDSHUFLELGRORVSULPHURVPRYLPLHQWRVIHWDOHV6HUHFRPLHQGDQ
GH D GRVLV FRQ XQ LQWHUYDOR PtQLPR HQWUH GRVLV GH XQ PHV (O PHGLFDPHQWR GH
HOHFFLyQ HV OD 6XOIDGR[LQDSLULPHWDPLQD 63 GHELGR D TXH VH KD FRQ¿UPDGR VX
VHJXULGDGFXDQGRHVXVDGDHQWUHHOVHJXQGR\HOWHUFHUWULPHVWUH
(OHVTXHPDGHXVRUHFRPHQGDGRHVHOVLJXLHQWH
GRVLVSUy[LPDDODVVHPDQDV
GRVLVSUy[LPDDODVVHPDQDV
GRVLVHQDTXHOORVSDtVHVFRQDOWDSUHYDOHQFLDGH9,+SUy[LPDDODVVHPDQDV
1R H[LVWH HYLGHQFLD TXH DGPLQLVWUDU PiV GH WUHV GRVLV GH 73, FRQ 63 GXUDQWH HO
HPEDUD]RRIUH]FDEHQH¿FLRVDGLFLRQDOHV
2EMHWLYR 5HGXFLUODPRUELPRUWDOLGDGQHRQDWDOSRUHVWUHSWRFRFRJUXSR%
(O HVWUHSWRFRFR GHO JUXSR % (*% 6WUHSWRFRFFXV DJDODFWLDH HV XQD EDFWHULD JUDP
SRVLWLYR HQFDSVXODGD FDSD] GH FDXVDU HQIHUPHGDG LQYDVLYD HQ UHFLpQ QDFLGRV \ HQ
PXMHUHVHPEDUD]DGDVVREUHWRGRHQJUXSRVFRQFRQGLFLRQHVPpGLFDVHVSHFLDOHVHM
GLDEpWLFDV
(Q ODV HPEDUD]DGDV OD LQIHFFLyQ SRU (*% FDXVD LQIHFFLyQ XULQDULD LQIHFFLyQ RYXODU
HQGRPHWULWLVRVHSVLV/DLQIHFFLyQJUDYHHVUDUDHQODVHPEDUD]DGDV(QRFDVLRQHVHO
SDUWRSUHPDWXURRODPXHUWHIHWDOSXHGHQDWULEXLUVHDODLQIHFFLyQSURYRFDGDSRU(*%
(Q ORV UHFLpQ QDFLGRV VXHOH PDQL¿HVWDUVH SRU EDFWHULHPLD QHXPRQtD R PHQLQJLWLV
3XHGHQYHUVHRWURVVLQGURPHVFHOXOLWLV\RVWHRPLHOLWLV$SUR[LPDGDPHQWHHOGH
ORVFDVRVGHLQIHFFLyQQHRQDWDOSRU(*%VHSURGXFHHQQLxRVGHSUHWpUPLQR
(Q SDtVHV GHVDUUROODGRV DQWHV GHO XVR H[WHQGLGR GH DQWLELyWLFRV SUR¿OiFWLFRV OD
LQFLGHQFLDGHHQIHUPHGDGLQYDVLYDSRU(*%SUHVHQWDEDXQDIUHFXHQFLDGHDSRUPLO
QDFLGRVYLYRV(OHPSOHRGHODVSUXHEDVGHWDPL]DMHFRQWUDWDPLHQWRSRVWHULRUUHGXMHURQ
ODLQFLGHQFLDDPHQRVGHSRUPLO\ODHQIHUPHGDGLQYDVLYDHQODVHPEDUD]DGDVFD\y
HQDxRVXQ
(Q DOJXQRV SDtVHV GH OD 5HJLyQ VH MXVWL¿FD OD LQFRUSRUDFLyQ GH HVWH WDPL]DMH D ODV
QRUPDVQDFLRQDOHVSDUDUHGXFLUDXQPiVODPRUWDOLGDGQHRQDWDODXQTXHORVFRVWRV\OD
ORJtVWLFDSXHGHQVHUXQDOLPLWDQWH/DRSFLyQGHXVDUDQWLELyWLFRVHQIRUPDUXWLQDULDHQ
EDVHDXQGHVSLVWDMHPHGLDQWHIDFWRUHVGHULHVJRQRKDGHPRVWUDGRVHUHIHFWLYR
&RORQL]DFLyQSRU(*%
(OWUDFWRJDVWURLQWHVWLQDOHVHOUHVHUYRULRQDWXUDOGHOHVWUHSWRFRFR%\VHFXQGDULDPHQWH
FRORQL]DODYDJLQD/DIUHFXHQFLDGHLQIHFFLyQYDJLQDOSRU(*%HQSDtVHVHQGHVDUUROOR
QRHVWiELHQHVWXGLDGD\PXHVWUDDPSOLDYDULDFLyQ(QDOJXQRVVHUYLFLRVGHSDtVHVGHOD
UHJLyQVHREVHUYDQLQFLGHQFLDVTXHYDQGHODOGHODVJHVWDQWHVTXHVHFRQWURODQ

/D FRORQL]DFLyQ PDWHUQD HV HO SULQFLSDO IDFWRU GH ULHVJR SDUD OD WUDQVPLVLyQ YHUWLFDO GHO
HVWUHSWRFRFRDOUHFLpQQDFLGRHVSHFLDOPHQWHFXDQGRODVPHPEUDQDVRYXODUHVHVWiQURWDV
$XQTXHODFRORQL]DFLyQWHPSUDQDHQHOHPEDUD]RQRHVSUHGLFWLYDGHVHSVLVQHRQDWDOHO
WDPL]DMHPHGLDQWHFXOWLYRGHPXHVWUDVYDJLQRUHFWDOHVSDUD(*%HQODV~OWLPDVVHPDQDVGHO
HPEDUD]RSXHGHLQGLFDUFXDOHVVRQODVPXMHUHVTXHHVWiQFRORQL]DGDVDOPRPHQWRGHOSDUWR
\DVtHVWDEOHFHUTXLHQHVHVWiQFRQPD\RUULHVJRGHWUDQVPLWLUODLQIHFFLyQDOUHFLpQQDFLGR

'LDJQyVWLFRGH(*%
6HGHEHUiWRPDUFRQKLVRSRXQDSULPHUDPXHVWUDGHOLQWURLWRYDJLQDO\FRQHOPLVPRX
RWURKLVRSRVHWRPDUiXQDVHJXQGDPXHVWUDGHOHV¿QWHUDQDO/DVPXHVWUDVGHEHUiQVHU
HQYLDGDVDOODERUDWRULRHQPHGLRVGHFXOWLYRDSURSLDGRV/DVPLVPDVGHEHQVHUH[WUDtGDV
HQWUHODV\VHPDQDVGHJHVWDFLRQSDUDPHMRUDUODVHQVLELOLGDG\HVSHFL¿FLGDGGH
ODGHWHFFLyQGHPXMHUHVTXHSHUPDQHFHQFRORQL]DGDVDOPRPHQWRGHOSDUWR
/DFRORQL]DFLyQSRU(*%HQHPEDUD]RVSUHYLRVQRGHEH
VHU FRQVLGHUDGD FRPR XQD LQGLFDFLyQ SDUD HIHFWXDU
WUDWDPLHQWRSUR¿OiFWLFRHQXQDQXHYDJHVWDFLyQ3RUTXH
OD FRORQL]DFLyQ SXHGH VHU WUDQVLWRULD SRU OR WDQWR HO
YDORUSUHGLFWLYRGHORVFXOWLYRVHVPX\EDMR\GHEHQVHU Figura 32.
Fragmento de la HCP.
HIHFWXDGRVQRPiVGHVHPDQDVDQWHVGHOSDUWR Estreptococos
)DFWRUHVGHULHVJRDGLFLRQDOSDUDHQIHUPHGDGSHULQDWDOSRU(*%
2WURVIDFWRUHVTXHDXPHQWDQHOULHVJRGHLQIHFFLyQSHULQDWDOVRQ
(GDGJHVWDFLRQDOVHPDQDV
5RWXUDGHPHPEUDQDV!KRUDV
)LHEUH!&TXHKDJDVRVSHFKDULQIHFFLyQRYXODU
3DUDUHFRUGDUHVWRVSXQWRVHQHOUHFXDGURGH5XSWXUDGH 583785$'(0(0%5$1$6$17(3$572
PHPEUDQDVVHLQFOX\HQHVWRVDVSHFWRVSDUDTXHHOHTXLSR QR GtD PHV DxR VHP
KV
GH VDOXG WRPH ODV PHGLGDV TXH FRQVLGHUH DGHFXDGDV VL
KRUD PLQ WHPS&
6H VXJLHUH HQ HVWDV VLWXDFLRQHV HIHFWXDU WUDWDPLHQWR

DQWLELyWLFRLQWUDSDUWRFRPRVHGHVFULELUiPiVDGHODQWH
Figura 33. Fragmento de la HCP.
Ruptura de membranas anteparto
&XDGUR(VTXHPDVUHFRPHQGDGRVGHWUDWDPLHQWRSUR¿OiFWLFRLQWUDSDUWR
5HFRPHQGDGR
PLOORQHVGHXQLGDGHVLYGRVLVLQLFLDO
3HQLFLOLQD*
PLOORQHVGHXQLGDGHVLYFKRUDVKDVWDHOSDUWR
$OWHUQDWLYR
JLYGRVLVLQLFLDO
$PSLFLOLQD
JLYFKRUDVKDVWDHOSDUWR
$OHUJLDDODSHQLFLOLQD
JLYGRVLVLQLFLDO
&HID]ROLQD
JLYFKRUDVKDVWDHOSDUWR

&HViUHDSODQL¿FDGD
(O(*%SXHGHDWUDYHVDUODVPHPEUDQDVRYXODUHVVDQDVSRUHVDUD]yQODFHViUHDQR
SUHYLHQH OD WUDQVPLVLyQ YHUWLFDO PDGUHKLMR 'H WRGDV IRUPDV VRQ H[FHSFLRQDOHV ORV
FDVRVGHFRORQL]DFLyQGHOIHWRFXDQGRVHSUDFWLFDXQDFHViUHDHOHFWLYDHQDXVHQFLDGH
WUDEDMRGHSDUWR\FRQPHPEUDQDVLQWHJUDV3RUHVRHQHVWRVFDVRVQRVHMXVWL¿FDHO
WUDWDPLHQWRSUR¿OiFWLFRGHUXWLQD
2EMHWLYRV 'HWHFWDUSRVLEOHVSURFHVRVVpSWLFRVEXFRGHQWDOHV
$FWLYLGDG ([DPHQEXFRGHQWDO
(O H[DPHQ EXFRGHQWDO GHEH LQFRUSRUDUVH HQ OD YDORUDFLyQ FOtQLFD GH WRGD JHVWDQWH
GHVGHXQDSHUVSHFWLYDLQWHJUDOQRVRORLPSRUWDFRQ¿UPDURGHVFDUWDUODSUHVHQFLDGH
FDULHVGHQWDOHVVLQRTXHGHEHGHVSLVWDUVHHQIHUPHGDGSHULRGRQWDO(3\OHVLRQHVGH
ERFD\OHQJXD(VSUHFLVRUHFRUGDUTXHHQHWDSDVLQLFLDOHVODVt¿OLVSXHGHPDQLIHVWDUVH
~QLFDPHQWHSRUXQDOHVLyQXOFHUDGDFKDQFURVL¿OtWLFR\TXHSXHGHDSDUHFHUHQODPX
FRVDEXFDO
/DHQIHUPHGDGSHULRGRQWDOHVXQRGHORVSURFHVRVLQIHFFLRVRVFUyQLFRVPiVIUHFXHQ
WHV VX SUHYDOHQFLD YDUtD VHJ~Q ODV FRQGLFLRQHV VRFLRVDQLWDULDV GH ODV SREODFLRQHV
HQWUHXQ\XQ
/D(3LQFOX\HODJLQJLYLWLVXQDDIHFFLyQLQÀDPDWRULDGHORVWHMLGRV
EODQGRVTXHURGHDQDOGLHQWH\ODHQFtD\ODSHULRGRQWLWLVTXHLQ
YROXFUDODGHVWUXFFLyQGHODVHVWUXFWXUDVGHVRVWpQGHORVGLHQWHV
WDOHV FRPR HO OLJDPHQWR SHULRGRQWDO HO KXHVR HO FHPHQWR \ ORV
WHMLGRVEODQGRV/D(3VHRULJLQDSRUHOFUHFLPLHQWRH[DJHUDGR Figura 34.
GH FLHUWDV HVSHFLHV GH EDFWHULDV HQ HVSHFLDO JpUPHQHV *UDP Fragmento de la HCP.
QHJDWLYRV Odontología y mamas.
/DHQIHUPHGDGSHULRGRQWDOVHYLQFXODUtDFRQPDORVUHVXOWDGRVSHULQDWDOHVHQHVSHFLDO
EDMR SHVR DO QDFHU \ SDUWR GH SUHWpUPLQR DERUWR PXHUWH IHWDO \ SUHHFODPSVLD 'H
FRQ¿UPDUVHTXHOD(3HVXQIDFWRUGHULHVJRLQGHSHQGLHQWH\PRGL¿FDEOHSHUPLWLUtD
PHGLDQWHVXSUHYHQFLyQ\WUDWDPLHQWRDGHPiVGHPHMRUDUODVDOXGGHODPXMHUPHMRUDU
ORV UHVXOWDGRV SHULQDWDOHV 5HFLHQWHV LQYHVWLJDFLRQHV SRQHQ HQ GXGD ORV UHVXOWDGRV
DQWHULRUHV\VHxDODQTXHH[LVWHQRWURVGHWHUPLQDQWHVTXHVHDVRFLDQDORVPDORVUHVXO
WDGRVSHULQDWDOHV\TXHODDVRFLDFLyQHQFRQWUDGDSUHYLDPHQWHHVWDUtDYLQFXODGDDXQ
PDOFRQWUROGHYDULDEOHVGHFRQIXVLyQ
)LQDOPHQWH HV EXHQR UHFRUGDU TXH HO HPEDUD]R UDUDPHQWH HV FRQWUDLQGLFDFLyQ SDUD
WUDWDU ODV DIHFFLRQHV EXFRGHQWDOHV ,QFOXVR GH VHU QHFHVDULR UHDOL]DU HVWXGLRV UD
GLROyJLFRVORVPLVPRVGHEHUiQHIHFWXDUVHPDQWHQLHQGRPHGLGDVGHUDGLRSURWHFFLyQ
(OXVRGHDQHVWpVLFRVORFDOHVHVGHEDMRULHVJRVLHPSUHTXHQRDVRFLHQYDVRFRQVWULF
WRUHVHQVXFRPSRVLFLyQ
2EMHWLYRV 'HWHFWDUSRVLEOHVDOWHUDFLRQHVGHOSH]yQSDWRORJtDLQÀDPDWRULD
\RWXPRUDOGHODPDPD
$FWLYLGDG ([DPHQGHODVPDPDV
(OH[DPHQGHODVPDPDVHVSDUWHGHOH[DPHQJLQHFROyJLFR\VHGHEHUiHIHFWXDUHQ
FRQGLFLRQHVGHSULYDFLGDG\UHVSHWR6HUHFRPLHQGDUHDOL]DUORHQODSULPHUDFRQVXOWD
VLHOUHODFLRQDPLHQWRFRQODXVXDULDORSHUPLWH/D+&3LQFRUSRUDXQUHFRUGDWRULRSDUD
TXHQRROYLGHQHVWDSUHVWDFLyQ
/RVFDPELRV¿VLROyJLFRVGHODPDPDFRPLHQ]DQSUHFR]PHQWH\VRQORV~OWLPRVFDP
ELRVHQUHWLUDUVHFRQGLFLRQDGRVSRUHOWLHPSRHQHOTXHVHPDQWLHQHODODFWDQFLD
(OH[DPHQGHPDPDVWLHQHFRPRREMHWLYRVLGHQWL¿FDUWUDVWRUQRVTXHSXHGDQLQWHUIHULU
FRQODODFWDQFLDFRPRDOWHUDFLRQHVHQHOSH]yQPDVWLWLV\SDWRORJtDWXPRUDOHVEHQLJQDV
\PDOLJQDV
(QFRQWUDU GXUDQWH HO HPEDUD]R XQ WXPRU VRVSHFKRVR GH PDOLJQLGDG HQ OD PDPD QR
FRQWUDLQGLFDODUHDOL]DFLyQGHHVWXGLRVGHFRQ¿UPDFLyQGLDJQyVWLFD
+DVWDHOPRPHQWRKD\FRQWURYHUVLDVREUHVLVHGHEHHIHFWXDUDOJ~QWLSRGHWUDWDPLHQ
WR HQ FDVR GH HQFRQWUDU SH]RQHV SODQRV R XPELOLFDGRV /D WHQGHQFLD PiV PRGHUQD
VXJLHUH TXH HO HMHUFLFLR GHO SH]yQ HV LQQHFHVDULR \D TXH SRU WUDWDUVH GH XQ WHMLGR
EODQGR VyOR EDVWDUtD FRQ XQD DGHFXDGD WpFQLFD GH DPDPDQWDPLHQWR SDUD FRUUHJLU
HVWDVLWXDFLyQ3RURWUDSDUWHKD\TXLHQHVUHFRPLHQGDQHIHFWXDUHMHUFLFLRVGHVGHOH
PRPHQWRGHOGLDJQyVWLFR(QWUHORVHMHUFLFLRVPiVFRPXQHVVHSXHGHQGHVFULELUORV
OODPDGRVHMHUFLFLRVGH+RIIPDQTXHFRQVLVWHQHQHOHVWLUDPLHQWRGHOWHMLGRSHULDUHRODU
GHWDOPDQHUDGHREWHQHUODHYHUVLyQSDXODWLQDGHOSH]yQ2HVWLUDU\URGDUHOSH]yQ
HQWUHHOGHGRtQGLFH\HOSXOJDUYDULDVYHFHVDOGtD(VWRVGHEHQVHULQWHUUXPSLGRVHQ
FDVRGHDPHQD]DGHSDUWRSUHPDWXUR
/RVFXLGDGRVGHODVPDPDV\ORVSH]RQHVGXUDQWHHOHPEDUD]RFRQVLVWHQHQ
/DYDGRH[FOXVLYDPHQWHFRQDJXD
(YLWDUHOXVRGHFUHPDV\ORFLRQHV
6LORVSH]RQHVVRQVHQVLEOHVVHORVSXHGHH[SRQHUDODOX]VRODUGXUDQWHD
PLQXWRVSRUGtD
8WLOL]DUVRVWHQHV¿UPHVFDSDFHVGHFRQWHQHUODVPDPDVVLQFRPSULPLUODV
2EMHWLYRV 'HVFDUWDUFiQFHUGHFXHOOROHVLRQHVSUHFXUVRUDV\HYDOXDUOD
FRPSHWHQFLDFHUYLFDO
$FWLYLGDG ([DPHQJHQLWDOFROSRFLWRORJtDRQFROyJLFDFROSRVFRStD
&$1&(5&(59,&$/
(OFiQFHUFHUYLFDOHVHOVHJXQGRFiQFHUPiVIUHFXHQWHHQWUHODVPXMHUHV\IXHUHVSRQVDEOH
GHPiVGHPXHUWHVHQHOPXQGRHQHODxRDSUR[LPDGDPHQWHHOGH
HVDV PXHUWHV VH SURGXMR HQ SDtVHV HQ GHVDUUROOR$PpULFD /DWLQD \ HO &DULEH QR VRQ
ODH[FHSFLyQ/DSUHYHQFLyQGHHVDVPXHUWHVSRUXQDGHFXDGRWDPL]DMH\WUDWDPLHQWR
FRQWULEXLUiQHQSDUWHDDOFDQ]DUODV0HWDVGH'HVDUUROORGHO0LOHQLR
/DPD\RUtDGHODVPXHUWHVHQORVSDtVHVHQGHVDUUROORVHSURGXFHHQPXMHUHVMyYHQHV
)DFWRUHVGHULHVJR
0~OWLSOHVIDFWRUHVVHKDQLGHQWL¿FDGRFRPRIDFWRUHVGHULHVJRHQWUHORVTXHVHGHVWDFDQ
PXOWLSDULGDGLQIHFFLRQHVGHWUDQVPLVLyQVH[XDO,76HVSHFLDOPHQWHODVYLQFXODGDVD
ODVYDULHGDGHV\GHOYLUXVGHOSDSLORPDKXPDQR+39WDEDTXLVPRDFWLYR\R
SDVLYRP~OWLSOHVFRPSDxHURVVH[XDOHVFRPSDxHURVH[XDOFRQPXFKDVFRPSDxHUDV
VH[XDOHVLQLFLRWHPSUDQRGHODVUHODFLRQHVVH[XDOHVOHVLRQHVSUHFXUVRUDVGHOFiQFHU
GHFXHOORGLVSODVLDVROHVLRQHVHVFDPRVDVLQWUDHSLWHOLDOHV
(OH[DPHQGHODPXMHUHPEDUD]DGD
8Q FRUUHFWR H[DPHQ JLQHFROyJLFR LQFOX\H XQD GHWHQLGD LQVSHFFLyQ YXOYDU GH ODV
SDUHGHVYDJLQDOHV\GHOFpUYL[FRQHVSpFXOR\HOWDFWRYDJLQDO6HUHFRPLHQGDKDFHU
XQD HYDOXDFLyQ HQ OD SULPHUD FRQVXOWD DXQTXH HQ RSRUWXQLGDGHV GHELGR D IDFWRUHV
SVLFRHPRFLRQDOHV TXH URGHDQ DO H[DPHQ JLQHFROyJLFR \ D OD IDOWD GH FRQRFLPLHQWR
HQWUHODHPEDUD]DGD\HOHTXLSRGHVDOXGSRGUiSRVSRQHUVHHOH[DPHQKDVWDTXHVH
FRQVLGHUHPiVDSURSLDGR
,QVSHFFLyQYLVXDO
/DLQVSHFFLyQSRGUiKDFHUVHEDMRHVSpFXOR\SRGUiDSOLFDUVHiFLGRDFpWLFRROXJROOD
WLQFLyQFRQHVWDVVXVWDQFLDVQRPHMRUDODVHQVLELOLGDGSDUDGHWHFWDUFiQFHUGHFXHOOR\
OHVLRQHVSUHPDOLJQDVSRUORFXDOQRVHUHFRPLHQGDVXXVRHQIRUPDUXWLQDULD
,QVSHFFLyQFRQiFLGRDFpWLFRYLQDJUHFXDQGRVHDSOLFDVREUHHO

FXHOOR SXHGH FDPELDU HO FRORU URVDGR QRUPDO WRPDQGR XQD FROR
UDFLyQEODQFDHSLWHOLRDFHWREODQFRTXHLQGLFDXQDDQRUPDOLGDG
,QVSHFFLyQ FRQ OXJRO VROXFLyQ GH \RGR\RGXUDGD FXDQGR VH
DSOLFDVREUHHOFXHOORQRUPDOHVWHVHWLxHGHFRORUPDUUyQRVFXUR Figura 35.
/DVOHVLRQHVVRVSHFKRVDVQRVHWHxLUiQ Fragmento de HCP.
Estudio del cérvix.
&RQWUROGHO&iQFHUGHFXHOOR
3UHYHQFLyQ SULPDULD LQWHQWD PHGLDQWH HGXFDFLyQ JHQHUDU FRQGXFWDV VH[XDOHV
VHJXUDVRLQWHQWDUFDPELDUFRQGXFWDVVH[XDOHVGHULHVJRSDUDGLVPLQXLUODH[SRVLFLyQ
DO+39XRWURVFRIDFWRUHVIDYRUHFHGRUHVGHOFiQFHUGHFXHOOR3UREDEOHPHQWHOD
LQFRUSRUDFLyQGHODVYDFXQDVFRQWUDODVYDULHGDGHV\GHO+39VHLQWHJUHQ
DODSUHYHQFLyQSULPDULDHQUHODWLYDPHQWHFRUWRWLHPSR7DPELpQODHVWUDWHJLDGH
SUHYHQFLyQSULPDULDLQWHQWDIRPHQWDUHVWLORVGHYLGDVDOXGDEOHVSDUDGLVPLQXLURWURV
IDFWRUHVYLQFXODGRVDOFiQFHUGHFXHOORHVSHFLDOPHQWHHOWDEDFR
3UHYHQFLyQVHFXQGDULDVHEDVDHQHOGLDJQyVWLFRSUHFR]HPSOHDQGRODVWpFQLFDV
GH WDPL]DMH HVSHFLDOPHQWH OD FROSRFLWRORJtD RQFROyJLFD 3$3 \ UH¿ULHQGR D OD
PXMHU DO QLYHO DSURSLDGR GH DWHQFLyQ FDGD YH] TXH VH HIHFW~D XQ GLDJQyVWLFR
SDWROyJLFR7DPELpQHVLPSRUWDQWHDGYHUWLUDODVXVXDULDVDFHUFDGHORVVtQWRPDV
\VLJQRVPiVIUHFXHQWHVFRQORVTXHVHPDQL¿HVWDHOFiQFHUFHUYLFDO
3UHYHQFLyQWHUFLDULDXQDYH]GLDJQRVWLFDGRHOFiQFHURORVHVWDGRVSUHFDQFHURVRV
VHGHEHUiJDUDQWL]DUHOWUDWDPLHQWRHOTXHIUHFXHQWHPHQWHVHUiFXUDWLYR\DYHFHV
SHUPLWLUiFRQVHUYDUHOyUJDQR\ODIXQFLyQ2WUDVYHFHVVHUiFXUDWLYRSHURPXWLODQWH
\HQRSRUWXQLGDGHVVRORVHUiSDOLDWLYR\VHLQWHQWDUiFRQVHJXLUODPHMRUFDOLGDGGH
YLGD
7DPL]DMHSDUDHOFiQFHUFHUYLFDO
3DUD OD SREODFLyQ GH PXMHUHV VH UHFRPLHQGD HPSOHDU GRV HVWUDWHJLDV ORV WDPL]DMHV
RUJDQL]DGRVRORVWDPL]DMHVGHRSRUWXQLGDG
7DPL]DMH GH RSRUWXQLGDG HQ HVWH WLSR GH LQWHUYHQFLyQ ORV HTXLSRV GH VDOXG
SURSRQHQ D FDGD PXMHU TXH OOHJD DO VHUYLFLR OD UHDOL]DFLyQ GH XQ 3$3 (VWH
HQIRTXH VH H[WLHQGH SULQFLSDOPHQWH D PXMHUHV MyYHQHV FRQ PHQRV ULHVJR TXH
DFXGHQ D OD FRQVXOWD SUHQDWDO D ODV FRQVXOWDV GH SODQL¿FDFLyQ IDPLOLDU R D ORV
VHUYLFLRV GH VDOXG LQIDQWLO &RPR LQFRQYHQLHQWHV SUHVHQWD XQD PD\RU SpUGLGD
HQHOVHJXLPLHQWR\XQDOWRFRVWRHIHFWLYLGDGVLVHORVFRPSDUDFRQORVWDPL]DMHV
RUJDQL]DGRV
7DPL]DMHRUJDQL]DGRVHGLVHxDSDUDDOFDQ]DUHOPD\RUQ~PHURSRVLEOHGHPXMHUHV
FRQ PD\RU ULHVJR GH FRQWUDHU FiQFHU FHUYLFDO 6H FDUDFWHUL]D SRU SODQL¿FDU OD
DWHQFLyQSRUQLYHOHV\DSURYHFKDUPiVUDFLRQDOPHQWHORVUHFXUVRV/RVJUXSRV
GHHGDG\ODIUHFXHQFLDGHORVH[iPHQHVUHFRPHQGDGRVVHUHVXPHHQODWDEOD
VLJXLHQWH

&XDGUR(GDGHV\IUHFXHQFLDUHFRPHQGDGDVSDUDUHDOL]DU
ODFROSRFLWRORJtDRQFROyJLFD3$3
&RPHQ]DUDSDUWLUGHORVDxRV([FHSFLRQDOPHQWHDSDUWLUGHORVDxRV
(OWDPL]DMHDQXDOQRVHUHFRPLHQGDDQLQJXQDHGDG
(QWUHORV\DxRVXQDFLWRORJtDFDGDDxRVSXHGHVHUVX¿FLHQWH
(QWUHORV\DxRVXQDFLWRORJtDFDGDDxRVSXHGHVHUVX¿FLHQWH
$SDUWLUGHORVDxRVFRQGRVFLWRORJtDVSUHYLDVQRUPDOHVQRUHSHWLUODFLWRORJtD
7DPL]DMHHQODPXMHUHPEDUD]DGD
6L OD PXMHU HPEDUD]DGD WLHQH XQ 3$3 QRUPDO UHDOL]DGR GH DFXHUGR D ORV FULWHULRV
UHVXPLGRV HQ HO FXDGUR QR VHUi QHFHVDULR UHSHWLUOR D PHQRV TXH ODV QRUPDV
QDFLRQDOHVDVtORLQGLTXHQ
$XQTXH HO HPEDUD]R QR HV HO PRPHQWR LGHDO SDUD HIHFWXDU DQiOLVLV FLWROyJLFRV SRU
ORV FDPELRV ¿VLROyJLFRV TXH VH SUHVHQWDQ HQ HVWH SHUtRGR \ TXH SXHGHQ OOHYDU D
LQWHUSUHWDFLRQHVHUUyQHDVVHUHFRPLHQGDHIHFWXDUHOWDPL]DMHHQWRGDPXMHUHPEDUD]DGD
TXHQRWHQJDYLJHQWHHOHVWXGLRFLWROyJLFRGHFXHOORRQXQFDVHORKD\DHIHFWXDGRFDGD
YH]TXHVHREVHUYHXQDDQRUPDOLGDGFHUYLFDORH[LVWDQIDFWRUHVTXHKDJDQVRVSHFKDU
TXH OD PXMHU QR UHJUHVDUi DO VHUYLFLR GH VDOXG HQ HO DIiQ GH UHGXFLU RSRUWXQLGDGHV
SpUGLGDV
2EWHQFLyQGHODPXHVWUDGH3$3
/DWRPDGH3$3GHEHVHUUHDOL]DGDHQHOSULPHUQLYHOGHDWHQFLyQODREWHQFLyQGHOD
PXHVWUDUHTXLHUHXQPtQLPRGHHQWUHQDPLHQWR\PDWHULDO
(OPDWHULDOPtQLPRUHTXHULGRHV
JXDQWHVGHVFDUWDEOHV
HVSpFXOR
IXHQWHGHOX]
PHVDJLQHFROyJLFD
PDWHULDOSDUDREWHQHUODPXHVWUDHVSiWXODGHPDGHUDFHSLOORHQGRFHUYLFDO
OiPLQDGHYLGULRSDUDPLFURVFRSLR
OiSL]SDUDURWXODUODOiPLQD\
VSUD\¿MDGRURDOFRKRODO
3URFHGLPLHQWRFRQHVSiWXODGHPDGHUD
8QDYH]YLVXDOL]DGRHOFXHOORFRQHVSpFXORVHLQVHUWDODSDUWHPiVODUJDGHODHVSiWXOD
HQHORUL¿FLRFHUYLFDO\VHURWDHQFtUFXORJUDGRV
$PERV ODGRV GH OD HVSiWXOD GHEHQ VHU H[WHQGLGRV VREUH OD OiPLQD FXLGDGRVDPHQWH
Figura 36. Instrumental para muestras de PAP. Figura 37. Fijación de lámina de PAP con spry.
a) espátula de madera
b) cepillo endocervical
c) cepillo / escoba
,QPHGLDWDPHQWHGHH[WHQGLGDODPXHVWUDHQODOiPLQD¿MDUODFRQVSUD\¿MDGRUDXQD
GLVWDQFLDGHFPHQiQJXORUHFWRR¿MDUODVXPHUJLpQGRODHQXQIUDVFRTXHFRQWHQJD
DOFRKRODO
1RROYLGDULGHQWL¿FDUODOiPLQDFRUUHFWDPHQWHFRQORVGDWRVGHODPXMHU
(VUHFRPHQGDEOHQRREWHQHUODPXHVWUDVLODPXMHUWLHQHVDQJUDGRSURIXVRRHOHPHQWRV
GHLQIHFFLyQJHQLWDOEDMD
2WUDVDOWHUQDWLYDVGLDJQyVWLFDV
&ROSRVFRStD
/DFROSRVFRStDFRQVLVWHHQHOH[DPHQGHOFXHOORODYDJLQD\ODYXOYDFROSRVFRSLRXQ
LQVWUXPHQWRTXHSURYHHLOXPLQDFLyQ\PDJQL¿FDFLyQGHODYLVLyQ
'HEHVHUUHDOL]DGDSRUXQSURYHHGRUFRQHQWUHQDPLHQWRVX¿FLHQWH
8VDGDFRPRXQDKHUUDPLHQWDGLDJQyVWLFDHQPXMHUHVFRQFLWRORJtDSRVLWLYDSDWROyJLFD
WLHQH XQD DOWD VHQVLELOLGDG \ XQD HVSHFL¿FLGDG GH SDUD OD GHWHFFLyQ GH
OHVLRQHVSUHFXUVRUDV\GHFiQFHU
%LRSVLD
/DELRSVLDFRQVLVWHHQODUHPRFLyQGHXQIUDJPHQWRGHWHMLGRVRVSHFKRVRSDUDHIHFWXDU
GLDJQyVWLFRKLVWRSDWROyJLFRFRQH[FHSFLyQGHODVOHVLRQHVPDFURVFySLFDVGHEHUtDVHU
UHDOL]DGDEDMRYLVLyQFROSRVFySLFD
0XMHUHPEDUD]DGD
1HJDWLYR 3RVLWLYR
3$3
6L 1R
'LVSRQHGH
FROSRVFRStD\ELRSVLD"
1HJDWLYR &ROSRVFRStD 3RVLWLYR

%LRSVLD
5HHYDOXDUHQ 5HIHULUSDUD 5HIHULUSDUD

DxRVRVHJ~Q WUDWDPLHQWRDQLYHOGH GLDJQyVWLFRDQLYHOGH
1RUPD1DFLRQDO PD\RUFRPSOHMLGDG PD\RUFRPSOHMLGDG
&XDQGRHO3$3HVLQIRUPDGRFRPR$6&86R6,/GHEDMRJUDGR/6,/OHVLRQHV

SHUVLVWHQWHVUHSRUWDGRVHQ3$3GHQWURGHPHVHVDDxRGHEHUtDQVHULQYHVWLJDGDV
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDHOPDQHMR
VHJ~QUHVXOWDGRVGH3$3
,QWHUSUHWDFLyQGHORVUHVXOWDGRV
([LVWHQDFWXDOPHQWHQXPHURVRVVLVWHPDVSDUDFODVL¿FDUDODVOHVLRQHVGHOFXHOORGRVGH
OORVVRQSUHGRPLQDQWHPHQWHGHWLSRFLWROyJLFRFRPRODFODVL¿FDFLyQGH3DSDQLFRODRXRHO
VLVWHPDGH%HWKHVGDPLHQWUDVTXHORVRWURVGRVVRQGHWLSRKLVWROyJLFRFODVL¿FDFLyQSRU
QHRSODVLDVLQWUDHSLWHOLDOHVFHUYLFDOHV1,&RSRUHOVLVWHPDGHGHVFULSFLyQGH206
0XFKDV YHFHV HQ XQ PLVPR LQIRUPH VH UHFLEH XQD VXSHUSRVLFLyQ GH ODV GLIHUHQWHV
FODVL¿FDFLRQHV\HVRJHQHUDFRQIXVLyQHQHOSUHVWDGRU\RHQODXVXDULDSRUHOOR\SDUD
IDFLOLWDU OD FRPSUHQVLyQ HQ OD WDEOD VLJXLHQWH VH FRPSDUDQ \ UHODFLRQDQ ORV VLVWHPDV
PHQFLRQDGRV
&XDGUR7HUPLQRORJtDVXVDGDVSDUDHOWDPL]DMH\HOGLDJQyVWLFRFLWROyJLFRH
KLVWROyJLFRGHODVOHVLRQHVGHFXHOOR
&ODVL¿FDFLyQFLWROyJLFD &ODVL¿FDFLyQKLVWROyJLFD
WDPL]DMH FRQ¿UPDWRULD
3$3 %HWKHVGD 1,& 206
FODVL¿FDFLyQGHVFULSWLYD
&ODVH, 1RUPDO 1RUPDO 1RUPDO
&ODVH,, $6&86 $WLStD $WLStD

$6&+
&ODVH,,, /6,/ 1,&LQFOX\H &RLORFLWRVLV
FRQGLORPDSODQR
&ODVH,,, +6,/ 1,& 'LVSODVLDPRGHUDGD
&ODVH,,, +6,/ 1,& 'LVSODVLDVHYHUD
&ODVH,9 +6,/ 1,& &DUFLQRPDLQVLWX
&ODVH,9 &iQFHULQYDVRU &iQFHULQYDVRU &iQFHULQYDVRU
$6&86VLJODHQLQJOpVTXHVHWUDGXFHFRPR³FpOXODVHVFDPRVDVDWtSLFDVGHVLJQL¿FDGRLQGHWHUPLQDGR´
$6&+VLJODHQLQJOpVTXHVHWUDGXFHFRPR³FpOXODVHVFDPRVDVDWtSLFDVTXHQRSHUPLWHQGHVFDUWDUOHVLyQ
HVFDPRVDGHDOWRJUDGR´
/6,/VLJODHQLQJOpVTXHVHWUDGXFHFRPROHVLyQHVFDPRVDLQWUDHSLWHOLDOGHEDMRJUDGR
+6,/VLJODHQLQJOpVTXHVHWUDGXFHFRPROHVLyQHVFDPRVDLQWUDHSLWHOLDOGHDOWRJUDGR
1,&QHRSODVLDLQWUDHSLWHOLDOFHUYLFDO
7UDWDPLHQWRGHOFiQFHUFHUYLFDOGXUDQWHHOHPEDUD]R
8VXDOPHQWH ODV PXMHUHV FRQ GLDJQyVWLFR GH FiQFHU FHUYLFDO R OHVLyQ SUHFXUVRUD GH
FiQFHU GHEHUiQ VHU DVLVWLGDV HQ XQ QLYHO GH PD\RU FRPSOHMLGDG HQ HO TXH VH SXHGD
JDUDQWL]DUXQFRUUHFWRWUDWDPLHQWR
(O WUDWDPLHQWR GHSHQGHUi GH OD HGDG JHVWDFLRQDO ORV GHVHRV GH OD JHVWDQWH \ GHO
HVWDGtRDVLJQDGR
,1&203(7(1&,$&(59,&$/,&
(QRFDVLRQHVHORUL¿FLRFHUYLFDOLQWHUQRGHOFXHOORGHO~WHURVHGLODWDHQIRUPDSDVLYD\
HVLQFDSD]GHPDQWHQHUHOHPEDUD]R(VWDHVXQDHYHQWXDOLGDGSRFRIUHFXHQWHTXHQR
VXSHUDORVFDVRVFDGDPLOSDUWRV
/D,&SXHGHVHUGHFDXVDFRQJpQLWDYLQFXODGDDPDOIRUPDFLRQHVXWHULQDVRDGTXLULGD
JHQHUDOPHQWHVHFXQGDULDDGLODWDFLyQ\FXUHWDMHSDUWRVRSHUDWRULRV\RGHVJDUURV
'LDJQyVWLFR
(OHOHPHQWRPiVRULHQWDGRUHVHODQWHFHGHQWHGHDERUWRVWDUGtRVRSDUWRVLQPDGXURV
JHQHUDOPHQWHLQGRORURVFRQH[SXOVLyQGHOIHWRYLYRHOTXHSXHGHH[SXOVDUVHHQYXHOWR
HQODVPHPEUDQDV
'XUDQWHHOHPEDUD]RHOGLDJQyVWLFRVHHIHFW~DSRUORVDQWHFHGHQWHV\RSRUHOKDOOD]JR
GHXQFXHOORFRQGLODWDFLyQPD\RUTXHODHVSHUDGDSDUDODHGDGJHVWDFLRQDOHQDXVHQFLD
GHFRQWUDFFLRQHV(QRFDVLRQHVODVPHPEUDQDVSXHGHQSURWUXLUSRUHORUL¿FLRFHUYLFDO
H[WHUQRPHPEUDQDVHQUHORMGHDUHQD
5HFLHQWHPHQWH OD HFRJUDItD WUDQVYDJLQDO VH XVD SDUD HYDOXDU HO HVWDGR GHO RUL¿FLR
FHUYLFDOLQWHUQR\GHHVDPDQHUDFRQWULEXLUDOGLDJQyVWLFRGHLQFRPSHWHQFLDFHUYLFDOHQ
HWDSDVPiVSUHFRFHV
7UDWDPLHQWR
(OWUDWDPLHQWRGHODLQFRPSHWHQFLDFHUYLFDOHVTXLU~UJLFR\FRQVLVWHHQFHUUDUHOFXHOOR
FRQXQDFLQWDHVSHFLDO\EDMRDQHVWHVLDGHVGHODVVHPDQDV\QRPiVDOOiGHODV
VHPDQDV(VWHSURFHGLPLHQWRUHFLEHHOQRPEUDGHFHUFODJH3DUDODUHDOL]DFLyQGHXQ
FHUFODJHODPXMHUHPEDUD]DGDGHEHUiVHUGHULYDGDDXQQLYHOGHPD\RUFRPSOHMLGDG
2%-(7,926 3HVTXLVDUXQDSRVLEOHLQFRPSDWLELOLGDGVDQJXtQHDPDWHUQRIHWR
QHRQDWDO
$&7,9,'$' 'HWHUPLQDFLyQGHOJUXSRVDQJXtQHRGHOIDFWRU5K\GHDQWLFXHUSRV
LUUHJXODUHV
/DV PXMHUHV 5K QHJDWLYDV TXH FXUVDQ XQ HPEDUD]R FRQ XQ IHWR 5K SRVLWLYR WLHQHQ
XQ GH SUREDELOLGDG GH LVRLQPXQL]DUVH FRPR FRQVHFXHQFLD GH HVH HPEDUD]R
/D PD\RUtD VH LQPXQL]DUiQ GXUDQWH HO SDUWR PLHQWUDV TXH XQD SHTXHxD IUDFFLyQ OR
KDUiGXUDQWHHOHPEDUD]R&XDQGRH[LVWHLQFRPSDWLELOLGDGVDQJXtQHDGHWLSR$%2OD
SUREDELOLGDGGHDORLQPXQL]DFLyQSRU5KVHUHGXFHDO
/DLVRLQPXQL]DFLyQSRUIDFWRU5KHVXQSURFHVRTXHSXHGHVHUSUHYHQLGRFRQHOXVR
GH JDPPDJOREXOLQD KLSHULQPXQH DQWL ' HQ HO SXHUSHULR R HQ HO SRVWDERUWR$~Q HQ
DTXHOODV VLWXDFLRQHV HQ ODV TXH OD SUR¿OD[LV IUDFDVD HO UHVXOWDGR SHULQDWDO SXHGH VHU
PRGL¿FDGREHQH¿FLRVDPHQWHPHGLDQWHODPRQLWRUL]DFLyQGHOJUDGRGHLVRLQPXQL]DFLyQ
\ODFRPSUREDFLyQGHODDIHFWDFLyQIHWDO
/D IRUPD GH GLVPLQXLU OD LQPXQL]DFLyQ HQ PXMHUHV JHVWDQWHV VH FRQVLJXH FRQ OD
DSOLFDFLyQGHJDPPDJOREXOLQDDQWL'GHQWURGHODVKRUDV
x GHODERUWRDWRGDPXMHU5KQHJDWLYDR
xGHO SDUWR D WRGDV ODV SXpUSHUDV 5K QHJDWLYDV FRQ KLMRV 5K SRVLWLYRV QR
LQPXQL]DGDVSUHYLDPHQWH
&RQ HVWD LQWHUYHQFLyQ HO SRUFHQWDMH GH PXMHUHV DORLQPXQL]DGDV VH UHGXFH
GUiVWLFDPHQWH
(QDTXHOORVSDtVHVGRQGHVHDSOLFDJDPPDJOREXOLQDDQWL'HQHOSRVWSDUWRODIUHFXHQFLD
GHLVRLQPXQL]DFLyQVHUHGXFHGHDPHQRVGHO6LDGHPiVVHUHDOL]DSUR¿OD[LV
LQWUDHPEDUD]RHQWUHODVVHPDQDV\ROXHJRGHXQDKHPRUUDJLDRPDQLREUDV
LQYDVLYDVSXQFLyQDPQLyWLFDFRUGRFHQWHVLVHWFODIUHFXHQFLDGHDORLQPXQL]DFLyQVH
UHGXFHDO4XHGDQGRFDVLVRORUHVWULQJLGDDORVFDVRVGHDERUWRRDIUDFDVRVGH
ODLQPXQRSUR¿OD[LV
3RU HO DOWR FRVWR TXH LPSOLFD HQ UHODFLyQ D VX HIHFWR SURWHFWRU HV GLVFXWLEOH OD
DGPLQLVWUDFLyQGHJDPPDJOREXOLQDDQWL'GXUDQWHHOHPEDUD]RHQIRUPDUXWLQDULD
'HELGRDTXHQRWRGRVORVFDVRVGHDORLQPXQL]DFLyQPDWHUQD\ULHVJRGHHQIHUPHGDG
KHPROtWLFD SHULQDWDO VH YLQFXODQ DO IDFWRU 5K QHJDWLYR HVWi MXVWL¿FDGR HIHFWXDU OD
GHWHUPLQDFLyQGHORVDQWLFXHUSRVLUUHJXODUHVWHVWGH&RRPEVLQGLUHFWRWDQWRDJHVWDQWHV
5KQHJDWLYDVFRPRSRVLWLYDV
9DORUDFLyQ&OtQLFDVHUHFRPLHQGDHIHFWXDUXQFRUUHFWRLQWHUURJDWRULRGHODJHVWDQWH
HQE~VTXHGDGH
$QWHFHGHQWHV GH DERUWR PXHUWHV SHULQDWDOHV LFWHULFLD HQ XQ UHFLpQ QDFLGR DQWHULRU
QHFHVLGDGGHH[VDQJXLQRWUDQVIXVLyQIRWRWHUDSLDDGPLQLVWUDFLyQGHJDPPDJOREXOLQD
DQWL ' WUDQVIXVLRQHV PDQLREUDV LQYDVLYDV GXUDQWH HO HPEDUD]R DPQLRFHQWHVLV
FRUGRFHQWHVLV WUDQVSODQWHV R LQMHUWRV GURJDGLFFLyQ LQWUDYHQRVD FRPSDUWLHQGR
MHULQJXLOODV
9DORUDFLyQ3DUDFOtQLFDHQODSULPHUDFRQVXOWDVHVROLFLWDUiD
ODHPEDUD]DGDODGHWHUPLQDFLyQGHOJUXSRVDQJXtQHRHOIDFWRU
5K\GHORVDQWLFXHUSRVLUUHJXODUHVWHVWGH&RRPEVLQGLUHFWR
Figura 39.
Fragmento de HCP.
Grupo y Rh
&RQGXFWD
*HVWDQWH 5K QHJDWLYD FRQ DQWLFXHUSRV LUUHJXODUHV QHJDWLYRV FRQWLQ~D HO FRQWURO
VHJ~QQRUPDLQFOX\HQGRQXHYDVGHWHUPLQDFLRQHVGHDQWLFXHUSRVLUUHJXODUHV\HYHQWXDO
SUR¿OD[LVFRQJDPPDJOREXOLQDDQWL'
*HVWDQWH5KQHJDWLYDFRQDQWLFXHUSRVLUUHJXODUHVSRVLWLYRVVHHIHFW~DGLDJQyVWLFR
GH DORLQPXQL]DFLyQ PDWHUQD (Q HVWH FDVR VH GHEHUi UHIHULU D XQ QLYHO GH PD\RU
FRPSOHMLGDGSDUDGHVFDUWDURFRQ¿UPDUSRVLELOLGDGGHHQIHUPHGDGKHPROtWLFDSHULQDWDO
DIHFWDFLyQIHWDO
*HVWDQWH 5K SRVLWLYD FRQ DQWLFXHUSRV LUUHJXODUHV QHJDWLYRV FRQWLQ~D HO FRQWURO
VHJ~Q HO FURQRJUDPD KDELWXDO \ QR UHTXHULUi QLQJXQD RWUD GHWHUPLQDFLyQ GH JUXSR
IDFWRU5KQLGHDQWLFXHUSRVLUUHJXODUHV
*HVWDQWH5KSRVLWLYDFRQDQWLFXHUSRVLUUHJXODUHVSRVLWLYRVVHHIHFW~DGLDJQyVWLFR
GH DORLQPXQL]DFLyQ PDWHUQD (Q HVWH FDVR VH GHEHUi UHIHULU D XQ QLYHO GH PD\RU
FRPSOHMLGDGSDUDLGHQWL¿FDUHODQWLFXHUSRUHVSRQVDEOH\GHVFDUWDURFRQ¿UPDUSRVLELOLGDG
GHHQIHUPHGDGKHPROtWLFDSHULQDWDODIHFWDFLyQIHWDO
(VTXHPDVGHSUR¿OD[LV
/D LQPXQRSUR¿OD[LV GHSHQGHUi GHO HVWDGR LQPXQLWDULR GH OD JHVWDQWH GH OD HGDG
JHVWDFLRQDO GH OD HYROXFLyQ GH OD JUDYLGH] PDQLREUDV LQYDVLYDV JHQLWRUUDJLD \ GH
ODGLVSRQLELOLGDGGHORVUHFXUVRVQHFHVDULRV(QFDVRGHFRQWDUFRQODSRVLELOLGDGGH
HIHFWXDU LQPXQRSUR¿OD[LV HQ DTXHOODV VLWXDFLRQHV GH ULHVJR VH VXJLHUH HPSOHDU HO
VLJXLHQWHHVTXHPDOXHJRGH
*HQLWRUUDJLDRPDQLREUDVLQYDVLYDVHQHOHUWULPHVWUH
DPFJGHJDPPDJOREXOLQDDQWL',0R,9
*HQLWRUUDJLDRPDQLREUDVLQYDVLYDVGHVSXpVGHOHUWULPHVWUH
DPFJGHJDPPDJOREXOLQDDQWL',9R
DPFJGHJDPPDJOREXOLQDDQWL',0
3RVWSDUWR
DPFJGHJDPPDJOREXOLQDDQWL',9R
DPFJGHJDPPDJOREXOLQDDQWL',0
*HVWDQWHDFRQWURODU
)DFWRU5K
DFRQVXOWD
7HVWGH 7HVWGH
&RRPEVLQGLUHFWR &RRPEVLQGLUHFWR
7&, 7&,
5HSLWH
'LDJQyVWLFRSRVLWLYRGH 7&,DPLWDGGHO
1RUHSLWH7&, DORLQPXQL]DFLyQPDWHUQD HPEDUD]R
&RQWLQ~DFRQWURO &RQWUROHQ$52SDUDFRQILUPDU &RQWLQ~DFRQWURO

GHEDMRULHVJR RGHVFDUWDUDIHFWDFLyQIHWDO GHEDMRULHVJR
6HDSOLFDUiLQPXQRSURILOD[LVDQWL'VHJ~QQRUPDQDFLRQDO
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDHOPDQHMRGHODHQIHUPHGDG
KHPROtWLFDSHULQDWDO
2%-(7,926 3UHYHQLUGHWHFWDU\WUDWDUODDQHPLDPDWHUQD

$&7,9,'$' 'HWHUPLQDUQLYHOHVGHKHPRJORELQD
$GPLQLVWUDFLyQGHKLHUUR\iFLGRIyOLFR
/DDQHPLDHVXQSUREOHPDGHVDOXGS~EOLFDSRUODVFRQVHFXHQFLDVTXHWLHQHVREUHOD
VDOXGKXPDQDHVSHFLDOPHQWHHQHOHPEDUD]RGRQGHVHDVRFLDFRQDXPHQWRGHOULHVJR
GHPRUWDOLGDGPDWHUQDPRUWDOLGDGSHULQDWDOHQHVSHFLDOHQFDVRVGHDQHPLDVHYHUD
SUHPDWXUH]EDMRSHVRDOQDFHU\5&,
'H¿QLFLyQ
6H FRQVLGHUD TXH XQD JHVWDQWH SDGHFH DQHPLD FXDQGR HO YDORU GH KHPRJORELQD HV
PHQRU D JG/ GXUDQWH HO SULPHU R HO WHUFHU WULPHVWUH R FXDQGR HO YDORU GH OD
KHPRJORELQDGXUDQWHHOVHJXQGRWULPHVWUHHVPHQRUDJG/6LODKHPRJORELQDVH
VLW~DHQWUH\JG/VHFRQVLGHUDTXHODDQHPLDHVPRGHUDGD\FXDQGRHVPHQRU
DJG/ODDQHPLDVHFRQVLGHUDVHYHUD
7DPL]DMHSDUDDQHPLDHQHOHPEDUD]R
(QODSULPHUDFRQVXOWDVHLQFOX\HGHQWURGHOH[DPHQJHQHUDOGHODJHVWDQWHODLQVSHFFLyQ
GHSLHO\PXFRVDV\HOH[DPHQFDUGLRYDVFXODUSDUDGHVFDUWDURFRQ¿UPDUXQDDQHPLD
/DSUXHEDGHKHPRJORELQDVHHIHFWXDUiGHDFXHUGRDODQRUPDQDFLRQDO(O&/$3605
VXJLHUHHIHFWXDUXQSULPHUH[DPHQDOPRPHQWRGHODFDSWDFLyQ\XQVHJXQGRH[DPHQ
GHVSXpVGHODVHJXQGDPLWDGGHOHPEDUD]R(VWRVGDWRVSXHGHQVHUUHJLVWUDGRVHQOD
+&3ODTXHDVXYH]VLUYHGHUHFRUGDWRULRVREUHODVSULQFLSDOHVPHGLGDVSUHYHQWLYDV
TXHORVSURIHVLRQDOHVGHEHQVXJHULUDODVJHVWDQWHVVXSOHPHQWDFLyQFRQKLHUUR\FRQ
IRODWRV
JG/ JG/
)LJXUD)UDJPHQWRGH+&3$QHPLD
'H¿FLHQFLDGHKLHUUR
([LVWHQGLYHUVDVIRUPDVGHDQHPLDODPiVFRP~QGHHOODVVHYLQFXODFRQGH¿FLHQFLDHQ
ORVQLYHOHVGHKLHUUR/DDQHPLDSRUGH¿FLHQFLDGHKLHUURHVWiSUHFHGLGDSRUGHSyVLWRV
GHKLHUURDJRWDGRV\VHHVWLPDTXHHVODGH¿FLHQFLDQXWULFLRQDOPiVFRP~QHQWUHODV
PXMHUHVHPEDUD]DGDV/DSUHYDOHQFLDRVFLODHQWUH\GHODVPXMHUHVJHVWDQWHV
GHORVSDtVHVHQYtDVGHGHVDUUROOR(VQHFHVDULRWHQHUHQFXHQWDTXHODDQHPLDSXHGH
WHQHUPiVGHXQDFDXVDWDOFRPRVHYHHQODGH¿FLHQFLDGHYLWDPLQD$%SLULGR[LQD
SURFHVRVLQÀDPDWRULRVFUyQLFRV9,+PDODULDHLQIHFFLRQHVSDUDVLWDULDV
'LDJQyVWLFR
$GHPiVGHOGp¿FLWGHKHPRJORELQDHQORVFDVRVGHDQHPLDIHUURSpQLFDVHHQFRQWUDUiQ
JOyEXORV KLSRFUyPLFRV \ PLFURFtWLFRV /D H[SUHVLyQ FOtQLFD GH HVWH Gp¿FLW UHSHUFXWH
FOtQLFDPHQWH HQ OD PXMHU JHVWDQWH RFDVLRQDQGR FDQVDQFLR IDWLJD SDOLGH] FXWiQHR
PXFRVD\DXPHQWRGHODIUHFXHQFLDFDUGtDFD(QRWUDVRFDVLRQHVXQDUHVWULFFLyQGHO
FUHFLPLHQWRIHWDOLQWUDXWHULQRSXHGHVHUHOHOHPHQWRGHVRVSHFKDGHODDQHPLD
'H¿FLHQFLDGHIRODWRV
/D VHJXQGD FDXVD GH DQHPLD QXWULFLRQDO GXUDQWH HO HPEDUD]R HV OD GH¿FLHQFLD GH
IRODWRV (O Gp¿FLW GH IRODWRV GXUDQWH HO HPEDUD]R HV PX\ IUHFXHQWH GHELGR D TXH HO
UHTXHULPLHQWRDXPHQWDKDVWDXQ\ODLQJHVWDVXHOHVHUPtQLPD
'LDJQyVWLFR
/D DQHPLD SRU Gp¿FLW GH IRODWRV FRPSDUWH ORV PLVPRV VLJQRV FOtQLFRV TXH OD DQHPLD
IHUURSpQLFD/DGLIHUHQFLDVHDSUHFLDHQHOHVWXGLRGHODOiPLQDHQHOFXDOORVJOyEXORV
URMRVVHUiQPHJDOREOiVWLFRV\PDFURFtWLFRV(VWDVFDUDFWHUtVWLFDVGHORVJOyEXORVURMRV
VRQFRPSDUWLGDVSRUODVDQHPLDVSRUGp¿FLWGHYLWDPLQD%TXHHVODWHUFHUDIRUPD
PiVFRP~QGHDQHPLDQXWULFLRQDO
3UHYHQFLyQGHODDQHPLD
/RVUHTXHULPLHQWRVGHKLHUUR\DFLGRIyOLFRDXPHQWDQGXUDQWHHOHPEDUD]R\HVGLItFLO
SDUDXQDPXMHUHPEDUD]DGDVDWLVIDFHUHVWDPD\RUGHPDQGDVyORFRQODGLHWDSRUOR
WDQWR ODV HVWUDWHJLDV GH SUHYHQFLyQ GH OD DQHPLD SRU GH¿FLHQFLD GH KLHUUR VH EDVDQ
HQ
x0RGL¿FDUODGLHWDSDUDDXPHQWDUHOFRQVXPRGHKLHUUR\GHORVIDFLOLWDGRUHVGHVX
DEVRUFLyQDOWLHPSRGHLQWHQWDUGLVPLQXLUHOFRQVXPRGHLQKLELGRUHV
x)RUWL¿FDUORVDOLPHQWRVGHFRQVXPRKDELWXDOFRQKLHUUR\iFLGRIyOLFR
x6XSOHPHQWDUFRQPHGLFDPHQWRVTXHFRQWHQJDQKLHUUR\iFLGRIyOLFR
x7UDWDU DTXHOODV LQIHFFLRQHV TXH SXHGHQ DOWHUDU OD DEVRUFLyQ GH KLHUUR \ RWURV
QXWULHQWHVSRUHMHPSORSDUDVLWRVLV
/RV VXSOHPHQWRV GH KLHUUR KDQ VLGR VXJHULGRV FRPR XQD HVWUDWHJLD SDUD PHMRUDU HO
QLYHOGHKLHUURPDWHUQR\DVtPHMRUDUODVREUHYLGD\VDOXGGHODPDGUHHOWDPDxRIHWDO
\GHVDUUROORGHOQLxRGXUDQWHHOSHUtRGRQHRQDWDO\SRVWQHRQDWDO
3RU WDO PRWLYR VH UHFRPLHQGD VXSOHPHQWDU D WRGDV ODV HPEDUD]DGDV FRQ PJ GH
KLHUURHOHPHQWDOSRUGtD'HVGHHOPRPHQWRHQTXHVHVRVSHFKHHOHPEDUD]R\KDVWD
HO SHULRGR SRVW SDUWR (O WLHPSR WRWDO GH VXSOHPHQWDFLyQ QR GHELHUD VHU PHQRU D
PHVHV\HQOXJDUHVGRQGHODSUHYDOHQFLDGHDQHPLDGXUDQWHODJHVWDFLyQHV!DO
HVUHFRPHQGDEOHPDQWHQHUODVXSOHPHQWDFLyQFRQKLHUURKDVWDPHVHVGHVSXpVGHO
SDUWR
9DULRVSDtVHVGHOD5HJLyQKDQIRUWL¿FDGRDOJXQRVDOLPHQWRVGHFRQVXPRKDELWXDOFRQ
KLHUUR\XRWURVQXWULHQWHVSDUDPHMRUDUHOHVWDGRGHODSREODFLyQJHQHUDO
3UHYHQFLyQGHORVGHIHFWRVGHOWXERQHXUDO
(Q HO FDStWXOR GH FXLGDGRV SUHFRQFHSFLRQDOHV \D VH KD PHQFLRQDGR TXH SDUD OD
SUHYHQFLyQGHORVGHIHFWRVGHOWXERQHXUDOODVPXMHUHVGHEHUtDQUHFLELUPJGtDGH
iFLGRIyOLFRGHVGHXQRVWUHVPHVHVDQWHVGHHPEDUD]DUVHPtQLPRVHPDQDVDQWHV
\FRQWLQXDUORVKDVWDHOWHUFHUPHVGHJHVWDFLyQ
/DVHVWUDWHJLDVGHIRUWL¿FDFLyQGHDOJXQRVDOLPHQWRVWDPELpQHVWiQVLHQGRDGRSWDGDV
SRUDOJXQRVSDtVHVGHODUHJLyQ\DTXHHQODVFRQGLFLRQHVDFWXDOHVHVSRFRSUREDEOH
TXHHOGHODVPXMHUHVTXHVHHPEDUD]DQUHFLEDQSUHFRQFHSFLRQDOPHQWHHOiFLGR
IyOLFR
7UDWDPLHQWR
/DDQHPLDUHTXHULUiWUDWDPLHQWRGHODFDXVDTXHODSURYRTXHSRUHMHPSORVLODFDXVD
GH OD DQHPLD HV GHELGD D XQD SDUDVLWRVLV VH GHEHUi DGPLQLVWUDU D OD JHVWDQWH HO
WUDWDPLHQWRDQWLSDUDVLWDULRHVSHFt¿FR3HURDOPLVPRWLHPSRVHGHEHUiWUDWDUODDQHPLD
LQGLFDQGRPJGHKLHUURHOHPHQWDOGtD\PJGHiFLGRIyOLFR
(Q FDVRV GH DQHPLD VHYHUD HO WUDWDPLHQWR SRGUi UHTXHULU FXLGDGRV LQVWLWXFLRQDOHV \
WUDQVIXVLRQHVGHFRQFHQWUDGRVJOREXODUHVRKLHUURSDUHQWHUDO
2%-(7,926 'HVFDUWDUSURWHLQXULDJOXFRVXULD\EDFWHULXULD
$&7,9,'$' ([DPHQGHRULQD\XURFXOWLYR
/DRULQDGHODPXMHUHPEDUD]DGDVXIUHPRGL¿FDFLRQHVTXHVRQFRQVLGHUDGDV¿VLROyJLFDV
(QWUH HVDV PRGL¿FDFLRQHV HV SRVLEOH HQFRQWUDU XQD GLVPLQXFLyQ SURJUHVLYD GH OD
GLXUHVLV\GHODGHQVLGDGXULQDULDWDPELpQHVUHODWLYDPHQWHIUHFXHQWHLGHQWL¿FDUXQD
JOXFRVXULD \ KDVWD HV IDFWLEOH REVHUYDU XQD SURWHLQXULD GH J/ HQ OD RULQD GH
KRUDV3RUHOFRQWUDULRHOVHGLPHQWRXULQDULRQRVHPRGL¿FDVXVWDQFLDOPHQWH
([DPHQGHRULQD
$WUDYpVGHODRULQDHVSRVLEOHGHWHFWDUDIHFFLRQHVTXHSRQHQHQULHVJRODYLGDGHOD
PXMHUGHOQLxRRDPERV/RVHOHPHQWRVPiVIUHFXHQWHVTXHVHSXHGHQLGHQWL¿FDUHQOD
RULQD\SHUPLWHQVRVSHFKDUSDWRORJtDVGXUDQWHHOHPEDUD]RVRQ
x3URWHtQDV
x%DFWHULDV
x*OXFRVD
$XQTXH OD SUHVHQFLD GH JOXFRVD HQ OD RULQD SXHGH VHU QRUPDO GXUDQWH HO HPEDUD]R
QLYHOHV!PJG/SXHGHQUHODFLRQDUVHFRQXQDGLDEHWHVJHVWDFLRQDO/DVSURWHtQDV
SXHGHQ LQGLFDU XQD LQIHFFLyQ XULQDULD HQIHUPHGDG GH ORV ULxRQHV R WUDVWRUQRV
KLSHUWHQVLYRVGHOHPEDUD]R
(OH[DPHQGHRULQDHVWiLQFRUSRUDGRDODPD\RUSDUWHGH
ODVQRUPDVGHFXLGDGRDQWHQDWDOGHFDVLWRGRVORVSDtVHV
GHOD5HJLyQDXQTXHKD\GLVFXVLyQVREUHODXWLOLGDGGHO
H[DPHQGHRULQDHQODUXWLQDDQWHQDWDO
/D +&3 SHUPLWH UHJLVWUDU XQ H[DPHQ GH SURWHtQDV HQ
OD RULQD HQ FDGD FRQWURO DXQTXH FRQ WUHV DQiOLVLV HV
VX¿FLHQWH Figura 42. Fragmento de HCP
Control prenatal
x8QH[DPHQGHRULQDHQODSULPHUDFRQVXOWDSDUDGHVFDUWDUODH[LVWHQFLDOHVLRQHV
UHQDOHVKHPDWXULDSURWHLQXULDFLOLQGUXULDHWF\GHGLDEHWHVJOXFRVXULD
x8QVHJXQGRH[DPHQSUy[LPRDODVVHPDQDVTXHWHQGUiFRPRSULQFLSDO¿QDOLGDG
ODGHWHFFLyQGHSURWHtQDVSDUDGHVFDUWDUXQDSUHHFODPSVLD
x8Q WHUFHU H[DPHQ GH RULQD HQWUH ODV \ VHPDQDV SRGUi KDFHU VRVSHFKDU
FXDOTXLHUD GH ODV WUHV FRQGLFLRQHV SDWROyJLFDV VHxDODGDV DXQTXH VX SULQFLSDO
¿QDOLGDG VHD GHVFDUWDU SUHHFODPSVLD 7DPELpQ VHUi ~WLO SDUD GHVFDUWDU XQD
LQIHFFLyQXULQDULD
/DSURWHLQXULDXVXDOPHQWHHVHOVLJQRGHDSDULFLyQPiVWDUGtRHQHOFXUVRFOtQLFRGHOD
SUHHFODPSVLD\VHUHODFLRQDFRQODPDJQLWXGGHODSUHVLyQDUWHULDO/DSURWHLQXULDVXHOH
DSDUHFHUFXDQGRODVFLIUDVGHSUHVLyQGLDVWyOLFDDOFDQ]DQORVPPGH+J\HVPD\RU
FXDQWRPD\RUVHDODKLSHUWHQVLyQ
(O DQiOLVLV GH RULQD FRQ WLULOODV UHDFWLYDV P~OWLSOHV SDUD EDFWHULXULD \ SURWHLQXULD HV
IDFWLEOHGHUHDOL]DUDXQTXHUHFLHQWHVHVWXGLRVVXJLHUHQTXHWLHQHQXQDEDMDVHQVLELOLGDG
GLDJQyVWLFDWDQWRSDUDLGHQWL¿FDUSURWHtQDVFRPRSDUDLGHQWL¿FDULQIHFFLyQ3RUORTXH
PXFKRVDXWRUHVUHFRPLHQGDQDEDQGRQDUVXXVR
/RVQLYHOHVGHDOE~PLQDHQXQDPXHVWUDGHRULQDDODFHFKRGHEHQOODPDUODDWHQFLyQ
FXDQGRVXSHUDQJ/
,QIHFFLyQXULQDULD\EDFWHULXULDDVLQWRPiWLFD
(O WpUPLQR LQIHFFLyQ XULQDULD ,8 VH UH¿HUH D OD SUHVHQFLD GH XQ Q~PHUR FUtWLFR GH
FRORQLDVEDFWHULDQDVHQODRULQDJHQHUDOPHQWHPD\RUDPO
3XHGHVHUDVLQWRPiWLFDEDFWHULXULDDVLQWRPiWLFDRPDQLIHVWDUVHSRUVtQWRPDVGLYHUVRV
WDOHVFRPRFLVWLWLVVtQGURPHXUHWUDO\SLHORQHIULWLV
/DV,8EDMDVDIHFWDQDODYHMLJDPLHQWUDVTXHODV,8DOWDVFRPSURPHWHQDORVULxRQHV
SLHORQHIULWLV/DFLVWLWLVEDFWHULDQDSXHGHSUHVHQWDUHQWUHVXVVLJQRV\VtQWRPDVGLVXULD
GRORUPLFFLRQDOSRODTXLXULDRULQDWXUELDRFDVLRQDOPHQWHKHPDWXULD\IUHFXHQWHPHQWH
SLXULDUHFXHQWRGHJOyEXORVEODQFRVHQRULQDPD\RUDPO/RVVLJQRV\VtQWRPDV
GH SLHORQHIULWLV LQFOX\HQ GRORU OXPEDU ¿HEUH HVFDORIUtRV FRQ WHPEORUHV \ PDO HVWDGR
JHQHUDODGHPiVGHORVVtQWRPDVGH,8EDMD/DSLHORQHIULWLVDJXGDHVXQDHQWLGDGJUDYH
HQODVHPEDUD]DGDV
$SUR[LPDGDPHQWH GHO DO GH ODV HPEDUD]DGDV SXHGHQ VXIULU XQD FRORQL]DFLyQ
EDFWHULDQDHQDXVHQFLDGHVtQWRPDV'HELGRDODUHSHUFXVLyQTXHSXHGHWHQHUHQOD
VDOXG GH OD PXMHU JHVWDQWH \ GH VX IXWXUR KLMR WRGD EDFWHULXULD DVLQWRPiWLFD TXH VH
GLDJQRVWLTXHHQHOHPEDUD]RGHEHUiVHUWUDWDGD
(OWDPL]DMHSDUDEDFWHULXULDDVLQWRPiWLFDPHGLDQWHXURFXOWLYRHVWi
UHFRPHQGDGRSDUDWRGDVODVJHVWDQWHVHQODSULPHUDYLVLWDSUHQDWDO
8QFXOWLYRREWHQLGRHQWUHODV\VHPDQDVGHHGDGJHVWDFLRQDO
SXHGHLGHQWL¿FDUHOGHODVPXMHUHVJHVWDQWHVFRQXQDEDFWHULXULD
Figura 43.
DVLQWRPiWLFD/DKLVWRULDFOtQLFDSHULQDWDOGHO&/$3605UHFXHUGD Fragmento de HCP.
VROLFLWDUXQDEDFWHULXULDHQODSULPHUDPLWDGGHOHPEDUD]R Bacteriuria
6HHVWLPDTXHUHSLWLHQGRHOXURFXOWLYRHQIRUPDPHQVXDOVHSXHGHLGHQWL¿FDUGHXQ
DXQDGLFLRQDOHQFDGDPHVGHEDFWHULXULDVDVLQWRPiWLFDV+DVWDHOPRPHQWRQR
H[LVWHFRQVHQVRHQODIUHFXHQFLDySWLPDSDUDUHSHWLUORVFXOWLYRVGHRULQD/DGHWHFFLyQ
WHPSUDQDGHXQDEDFWHULXULDDVLQWRPiWLFDHQXQDPXMHUHPEDUD]DGDHVXQIDFWRUGH
ULHVJRFRQRFLGRGHFRPSOLFDFLRQHVFRPRODSLHORQHIULWLVHOSDUWRGHSUHWpUPLQR\HOEDMR
SHVR DO QDFHU (Q YLVWDV D UHGXFLU HO ULHVJR GH SUHPDWXUH] YLQFXODGR D OD EDFWHULXULD
DVLQWRPiWLFDHO&/$3605VXJLHUHHIHFWXDUXQVHJXQGRFRQWUROGHEDFWHULXULDSUy[LPR
DODVVHPDQDVGHHGDGJHVWDFLRQDO
'LDJQyVWLFR
6HFRQVLGHUDUiTXHXQDEDFWHULXULDHVSRVLWLYDFXDQGRODGHWHFFLyQGHFRORQLDVHQHO
FKRUURPHGLRGHXQDPXHVWUDGHODSULPHUDRULQDGHODPDxDQDREWHQLGDHQFRQGLFLRQHV
HVSHFLDOHVGHDVHSVLDGHORVJHQLWDOHV\FRORFDGDHQXQUHFLSLHQWHHVWpULOHV!
EDFWHULDVP/
7UDWDPLHQWR
(VWXGLRVFOtQLFRVFRQWURODGRVHVWXGLRVGHFRKRUWH\PHWDDQiOLVLVKDQGHPRVWUDGRTXH
WUDWDQGRODEDFWHULXULDDVLQWRPiWLFDVHSXHGHUHGXFLUODLQFLGHQFLDGHODVFRPSOLFDFLRQHV
\DFLWDGDV
*HQHUDOPHQWHODHOHFFLyQGHODQWLPLFURELDQRVHKDUiHQIXQFLyQGHODVXVFHSWLELOLGDG
GHO JHUPHQ KDOODGR \ OD LQRFXLGDG GHO DQWLELyWLFR SDUD HO IHWR DXQTXH QR H[LVWH XQ
DQWLELyWLFRLGHDO7DPSRFRKD\DFXHUGRHQODGXUDFLyQGHOWUDWDPLHQWRSDUDPDQWHQHU
ODRULQDHVWpULO/RVWUDWDPLHQWRVGHGtDVSDUHFHQVHUORVTXHPiVVHDFHUFDQDOR
LGHDOSDUDHOWUDWDPLHQWRGHODVEDFWHULXULDVDVLQWRPiWLFDV\DTXHFRQHOORVVHREWLHQH
ODPHMRUUHODFLyQULHVJREHQH¿FLR/RVUHJtPHQHVGHDGtDVHUUDGLFDQODEDFWHULXULD
HQHODGHORVFDVRV\VRQFRQVLGHUDGRVGHHOHFFLyQSDUDHOWUDWDPLHQWRGHODV
LQIHFFLRQHVXULQDULDVVLQWRPiWLFDV/RVHVTXHPDVGHGRVLV~QLFDVKDVWDHOPRPHQWR
VRQGHVDFRQVHMDGRVSRUVXPHQRUH¿FDFLD
$ FRQWLQXDFLyQ VH SUHVHQWDQ HVTXHPDV GH WUDWDPLHQWR VXJHULGRV SDUD OD EDFWHULXULD
DVLQWRPiWLFDFXDQGRVHGHVFRQRFHHOJHUPHQ
(VTXHPDGHWUHVGtDV
x$PR[LFLOLQDPJ92FKRUDVR
x$PSLFLOLQDPJ92FKRUDVR
x&HIDOH[LQDPJ92FKRUDV
$QWHIDOODVHQHOWUDWDPLHQWRGHGtDVVHVXJLHUHHPSOHDU
x1LWURIXUDQWRLQDPJ92FKRUDVGXUDQWHGtDV
(QPXMHUHVFRQEDFWHULXULDUHFXUUHQWHVHSXHGHLQGLFDUWUDWDPLHQWRVXSUHVRU
XQDGRVLVDODFRVWDUVHFRQPJGH1LWURIXUDQWRLQD92R
&HIDOH[LQDPJ92
(VTXHPDGHGtDVDGtDV
x1LWURIXUDQWRLQDPJ92FKRUDVR
x$PR[LFLOLQDPJ92FKRUDVR
x$PSLFLOLQDPJ92FKRUDVR
x&HIDOH[LQDPJ92FKRUDV
(QFDVRGHLQIHFFLRQHVUHFXUUHQWHVVHSXHGHHPSOHDUSUR¿OD[LVSRVWFRLWDO
x'RVLV~QLFD&HIDOH[LQDPJ92R
x1LWURIXUDQWRLQDPJ92
6HJXLPLHQWR
'RVDFXDWURVHPDQDVGHVSXpVGHKDEHUFXOPLQDGRHOWUDWDPLHQWRVHGHEHUiHIHFWXDU
XQQXHYRXURFXOWLYRGHFRQWURO(QFDVRGHVHUQHJDWLYRSXHGH VHUUHSHWLGRXQDV
VHPDQDVGHVSXpV
1RKD\FRQVHQVRDFHUFDGHUHDOL]DUXQQXHYRFRQWUROGHXURFXOWLYRHQDTXHOODVPXMHUHV
TXHSUHVHQWDURQEDFWHULXULDSRVLWLYDDODVVHPDQDVGHOSDUWR
2%-(7,926 'HVFDUWDUGLDEHWHVPHOOLWXVFOtQLFD\JHVWDFLRQDO
$&7,9,'$' 'HWHUPLQDFLyQ GH JOXFHPLD \ SUXHED GH WROHUDQFLD RUDO D OD
JOXFRVD
6H HVWLPD TXH GH FDGD PXMHUHV HPEDUD]DGDV XQD VXIUH GLDEHWHV PHOOLWXV '0
\ TXH FDGD PXMHUHV HPEDUD]DGDV D GHVDUUROODUiQ XQD GLDEHWHV
JHVWDFLRQDO'*
/D IUHFXHQFLD GHO SUREOHPD HV SRFR FRQRFLGD HQ LQVWLWXFLRQHV /DWLQRDPHULFDQDV SRU
OD IDOWD GH HVWXGLRV HSLGHPLROyJLFRV SREODFLRQDOHV HVWR FRQGLFLRQD XQD IDOVD ³EDMD
SUHYDOHQFLD´GHELGDDOVXEGLDJQyVWLFR
(Q JHQHUDO ORV FDVRV GH GLDEHWHV PHOOLWXV TXH FRQFXUUHQ DO FRQWURO DQWHQDWDO VXHOHQ
VHUFODUDPHQWHLGHQWL¿FDEOHVSRUSUHVHQWDUDQWHFHGHQWHVIDPLOLDUHVGHODHQIHUPHGDG
VLQWRPDWRORJtDFOtQLFDKLVWRULDREVWpWULFDFRQPDORVUHVXOWDGRVRKDOOD]JRVREVWpWULFRV
RULHQWDGRUHV FODURV TXH SHUPLWHQ KDFHU XQ GLDJQyVWLFR VLQ GL¿FXOWDGHV 1R HV WDQ
VHQFLOORGLDJQRVWLFDUORVFDVRVGHGLDEHWHVJHVWDFLRQDOGHODSREODFLyQJHQHUDOSDUD
HOORVHUHTXLHUHHOHPSOHRGHSURFHGLPLHQWRVGHGHWHFFLyQ
'LDEHWHVJHVWDFLRQDO
6HFRQVLGHUDGLDEHWHVJHVWDFLRQDODODLQWROHUDQFLDDORVKLGUDWRVGHFDUERQRGHVHYHULGDG
\HYROXFLyQYDULDEOHVTXHVHUHFRQRFHSRUSULPHUDYH]GXUDQWHODDFWXDOJHVWDFLyQ(VWD
GH¿QLFLyQHVDSOLFDEOHHQIRUPDLQGHSHQGLHQWHGHVLVHXWLOL]DRQRLQVXOLQDFRPRWUDWDPLHQWR
RVLODDOWHUDFLyQSHUVLVWHGHVSXpVGHOHPEDUD]R7DPSRFRH[FOX\HODSRVLELOLGDGGHTXH
ODGLDEHWHVKD\DSRGLGRHVWDUSUHVHQWHDQWHVGHODJHVWDFLyQ
7DPL]DMHFOtQLFR
(QODSULPHUDFRQVXOWDGHEHUHDOL]DUVHXQDYDORUDFLyQGHOULHVJRGHGLDEHWHVJHVWDFLRQDO
SDUDHVRVHUiQHFHVDULRHIHFWXDUXQDFRUUHFWDDQDPQHVLV\H[DPHQItVLFRLQWHQWDQGR
EXVFDURGHVFDUWDUORVVLJXLHQWHVIDFWRUHVGHULHVJR
$QWHFHGHQWHV
x3UHVHQFLDGHGLDEHWHVHQIDPLOLDUHVGHSULPHUJUDGRSDGUHVKLMRVKHUPDQRV
x'LDEHWHVJHVWDFLRQDOHQHPEDUD]RVDQWHULRUHV
x0XHUWHVSHULQDWDOHVGHFDXVDGHVFRQRFLGD
x$ERUWRVHVSRQWiQHRVDUHSHWLFLyQGHFDXVDGHVFRQRFLGD
x3ROLKLGUDPQLRVDUHSHWLFLyQ
x0DFURVRPtD51FRQSHVR!JUDPRV
x0DOIRUPDFLRQHVIHWDOHV
$FWXDOHV
x(GDGPDWHUQD!DxRV
x2EHVLGDGDOLQLFLRGHOHPEDUD]RFRQtQGLFHGHPDVDFRUSRUDO,0&PD\RUD
x*DQDQFLDH[FHVLYDGHSHVRGXUDQWHHOHPEDUD]R
x3UHHFODPSVLDKLSHUWHQVLyQLQGXFLGDSRUHOHPEDUD]R
x3ROLKLGUDPQLRVHQHOHPEDUD]RDFWXDO
x,QIHFFLRQHVDUHSHWLFLyQHMXULQDULDJHQLWDO
7DPL]DMHSDUDFOtQLFR
$XQTXH QR KD\ FRQVHQVR WRWDO HQ OD OLWHUDWXUD PpGLFD DFHUFD GHO WDPL]DMH XQLYHUVDO
GH GLDEHWHV JHVWDFLRQDO HQ WRGDV ODV HPEDUD]DGDV OD LPSODQWDFLyQ GH SURJUDPDV
GHVWLQDGRV D OD GHWHFFLyQ GH OD GLDEHWHV JHVWDFLRQDO HQ IRUPD XQLYHUVDO SXHGH
MXVWL¿FDUVHSRU
x/DHOHYDGDPRUELPRUWDOLGDGSHULQDWDOTXHODDFRPSDxDHQDTXHOORVFDVRVTXHQR
HVGLDJQRVWLFDGDRSRUWXQDPHQWH
x4XH PiV GH OD PLWDG GH ORV FDVRV GH '* GHVDUUROODQ FRQ HO WLHPSR GLDEHWHV
PHOOLWXVFOtQLFD
x/DSRVLELOLGDGFLHUWDGHSUREOHPDVSRVWQDWDOHVYLQFXODGRVDODVKLSHUJOXFHPLDV
GHOHPEDUD]RWDOHVFRPRREHVLGDG\GLDEHWHV
x/DH[LVWHQFLDGHSURFHGLPLHQWRVGLDJQyVWLFRVGHUHODWLYDVHQFLOOH]GHDFHSWDEOH
H¿FDFLD\GHFRVWRQRH[DJHUDGR
x4XHVHSXHGHQPHMRUDUQRWRULDPHQWHORVUHVXOWDGRVVLHOGLDJQyVWLFRHVSUHFR]\
HOWUDWDPLHQWRDGHFXDGR\RSRUWXQR
5HFLHQWHVHVWXGLRVGHPXHVWUDQTXHHOWUDWDPLHQWRGHODGLDEHWHVJHVWDFLRQDOUHGXFLUtD
HQIRUPDLPSRUWDQWHODPRUELOLGDGSHULQDWDO\PHMRUDUtDODFDOLGDGGHYLGDGHODVPXMHUHV
DORVWUHVPHVHVGHOQDFLPLHQWR2WURVHVWXGLRVHSLGHPLROyJLFRVKDQPRVWUDGRTXHOD
SUHYDOHQFLDGHGLDEHWHVJHVWDFLRQDOHVPD\RUHQPXMHUHVLQGtJHQDVHKLVSDQDVFXDQGR
VHODVFRPSDUDFRQWUDPXMHUHVDQJORVDMRQDV(VWDVGRVUD]RQHVVHVXPDQSDUDMXVWL¿FDU
ODUHDOL]DFLyQGHHVWXGLRVGHWDPL]DMHSDUDGLDEHWHVJHVWDFLRQDOHQQXHVWUD5HJLyQ
*OXFHPLDHQD\XQDVDXQTXHQRH[LVWHDFXHUGRVREUHODXWLOLGDGGHHIHFWXDUJOXFHPLDV
HQ D\XQDV SDUD GLDJQRVWLFDU XQD GLDEHWHV JHVWDFLRQDO KD\ HYLGHQFLDV TXH VXJLHUHQ
TXH PXHVWUDV DLVODGDV GH JOXFHPLD SRGUtDQ VHU WDQ VHQVLEOHV FRPR XQD SUXHED GH
WROHUDQFLDRUDODODJOXFRVD372*SDUDGLDJQRVWLFDUGLDEHWHVJHVWDFLRQDO(QJHQHUDO
VH UHFRPLHQGD KDVWD TXH QR KD\D HYLGHQFLDV ¿UPHV TXH OR UHFKDFHQ UHDOL]DU XQD
JOXFHPLDHQD\XQDVHQODSULPHUDYLVLWDDQWHQDWDO
)LJXUD)UDJPHQWRGH+&3*OXFHPLD
(QFDVRGHREWHQHUVHXQDJOXFHPLDHQD\XQDV!PJG/GHEHUiUHSHWLUVHHOH[DPHQ
\HQFDVRGHUHJLVWUDUVHQXHYDPHQWHFLIUDVGHJOXFRVDHQVDQJUH!DPJG/VH
KDEUi KHFKR HO GLDJQyVWLFR GH GLDEHWHV JHVWDFLRQDO 6L OD QXHYD GHWHUPLQDFLyQ HV
PHQRUDPJG/GHEHUiHIHFWXDUVHXQDSUXHEDGHWROHUDQFLDDODJOXFRVD
(QDTXHOORVHQWRUQRVHQORVTXHQRVHFXHQWHFRQODSRVLELOLGDGGHHIHFWXDUXQD372*
HQWUHODV\VHPDQDVODJOXFHPLDHQD\XQDVSRGUiVHUODPHMRUDOWHUQDWLYDSDUD
GHVSLVWDUODH[LVWHQFLDGHXQDGLDEHWHVJHVWDFLRQDO3RUHVDUD]yQVHLQFOX\yHQOD+&3
XQUHFRUGDWRULRSDUDHIHFWXDUXQDQXHYDJOXFHPLDDSULQFLSLRVGHOHUWULPHVWUH
3UXHEDGHWROHUDQFLDRUDODODJOXFRVDKD\DFXHUGRJHQHUDOHQUHDOL]DUXQD372*
HQWUH ODV \ VHPDQDV GH JHVWDFLyQ FRPR SUXHED GH WDPL]DMH SDUD OD GLDEHWHV
JHVWDFLRQDO
x(QORVWUHVGtDVSUHYLRVVHSHUPLWLUiGLHWDOLEUH
x/DPXMHUFRQFXUULUiDOH[DPHQSRUODPDxDQD\FRQXQPtQLPRGHKRUDVGHD\XQR
x(QUHSRVRVHQWDGD\VLQIXPDU
x+DELHQGRGHVFDUWDQGRLQIHFFLRQHVLQWHUFXUUHQWHV
x6HH[WUDHUiPXHVWUDSDUDJOXFHPLDHQD\XQDVYDORUQRUPDOPJG/
x6HGDUiDEHEHUHQQRPiVGHPLQXWRVJGHJOXFRVDGLOXLGRVHQD
POGHDJXDFRQDPOGHMXJRGHOLPyQ
x$ODVGRVKRUDVVHREWHQGUiXQDVHJXQGDPXHVWUDGHJOXFHPLDYDORUQRUPDO
PJG/

&ULWHULRVGLDJQyVWLFRVGHFRQ¿UPDFLyQ
x'RVJOXFHPLDVHQD\XQDV!PJG/
x*OXFHPLD!PJG/DODVGRVKRUDVHQXQD372*FRQJGHJOXFRVD
/DV WLULOODV UHDFWLYDV OD GHWHUPLQDFLyQ GH KHPRJORELQD JOXFRVLODGD IUXFWRVDPLQD \
ODV JOXFHPLDV SRVWSUDQGLDOHV QR VRQ SURFHGLPLHQWRV DFHSWDEOHV SDUD FRQ¿UPDFLyQ

GLDJQyVWLFD
&ODVL¿FDFLyQGHORVHVWDGRVGLDEpWLFRVHQHOHPEDUD]R
'LDEHWHVSUHJHVWDFLRQDO
7LSR,LQVXOLQRGHSHQGLHQWHRMXYHQLO
7LSR,,QRLQVXOLQRGHSHQGLHQWHRGHODGXOWR
'LDEHWHVJHVWDFLRQDO
$JOXFHPLDHQD\XQDVPHQRUDPJG/FRQ372*DQRUPDO
$JOXFHPLDHQD\XQDV!PJGOKDVWDPJG/
%JOXFHPLDHQD\XQDV!PJG/
(Q FDVR GH FRQ¿UPDFLyQ GLDJQyVWLFD VH GHEH GHULYDU D OD JHVWDQWH D FRQWURO GH DOWR
ULHVJR/DHYDOXDFLyQHQDOWRULHVJRHVWDUiGLULJLGDHQWUHRWUDVFRVDVDGHWHUPLQDUHOSHU¿O
JOLFpPLFRGLDULRFRQpOVHGHWHUPLQDUiQORVQLYHOHVGHJOXFRVDEDVDOHV\SRVWSUDQGLDOHV
DORODUJRGHOGtD7DPELpQVHUHDOL]DUiKHPRJORELQDJOLFRVLODGDRIUXFWRVDPLQDSDUD
GHWHUPLQDUFRPRKDHVWDGRHOFRQWUROPHWDEyOLFRHQORVPHVHVSUHYLRV
*OXFHPLDHQD\XQDVSULPHUDFRQVXOWD
6L 5HVXOWDGR 1R
PJG/
5HSLWHJOXFHPLD
HQD\XQDV
6L 5HVXOWDGR 6L
PJG/
3UXHEDGHWROHUDQFLDRUDO 372*
DODJOXFRVD372* VHPDQDV
6L 5HVXOWDGR 1R 1R 5HVXOWDGR 6L
QRUPDO QRUPDO
5HSHWLU372*
DODVVHPDQDV
6L 5HVXOWDGR 1R
QRUPDO
'LDEHWHVJHVWDFLRQDO
'LDEHWHVPHOOLWXV 'HVFDUWDGLDEHWHV
(QPXMHUHVVLQIDFWRUHVGHULHVJRSDUDGLDEHWHVSXHGHVXVWLWXLUQXHYDJOXFHPLDHQWUHODVVHPDQDV
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDODGHWHFFLyQGHODGLDEHWHV
JHVWDFLRQDO
5HFODVL¿FDFLyQGHODGLDEHWHVJHVWDFLRQDOGHVSXpVGHOSDUWR
$ SDUWLU GH ORV GtDV GHO SXHUSHULR VH UHSHWLUi XQD SUXHED GH WROHUDQFLD RUDO D OD
JOXFRVD372*GDGRTXHODVFRQGLFLRQHVPHWDEyOLFDVVXHOHQYDULDU&RQHVWHH[DPHQ
VH UHFODVL¿FDUi OD PXMHU FRPR GLDEpWLFD HQ FDVR GH FRQ¿UPDUVH SHUVLVWHQFLD GH ORV
YDORUHVGHJOXFHPLDHQD\XQDV!PJG/R!PJG/DODVGRVKRUDVSRVWFDUJD
GHJGHJOXFRVD
2%-(7,926 %ULQGDU FRQWHQLGRV HGXFDWLYRLQIRUPDWLYRV SDUD HO SDUWR \ OD

FULDQ]D
$&7,9,'$' 3UHSDUDFLyQSDUDHOSDUWRFRQVHMHUtDSDUDHODPDPDQWDPLHQWR
([LVWHQ PRGL¿FDFLRQHV HQ HO FRPSRUWDPLHQWR GH OD PXMHU HPEDUD]DGD TXH VH
DFRPSDxDQ JHQHUDOPHQWH GH UHTXHULPLHQWRV HVSHFLDOHV GH FRPSDxtD \ DSR\R
SVLFRDIHFWLYR (VDV QHFHVLGDGHV KDQ VLGR FRQVLGHUDGDV VLHPSUH SRU HO SHUVRQDO GH
VDOXGDWUDYpVGHODHVSHFLDODWHQFLyQTXHVHOHEULQGDHQODVFRQVXOWDVSUHQDWDOHVODV
FODVHVGHSUHSDUDFLyQSVLFRSUR¿OiFWLFDODDWHQFLyQFRQWLQXDGXUDQWHHOWUDEDMRGHSDUWR
\SDUWR\ODGHGLFDFLyQGHODIDPLOLD\HOSHUVRQDODODVQHFHVLGDGHVGHODPXMHUPDGUH
\GHVXKLMRHQORVSULPHURVGtDV\VHPDQDVOXHJRGHOSDUWR
/DLQVWLWXFLRQDOL]DFLyQGHOSDUWRSDUWRVDVLVWLGRVHQKRVSLWDOHVFHQWURVGHVDOXGFRQ
FDPDVHWFTXHGHSHQGHQGHOVLVWHPDIRUPDOGHDWHQFLyQUHVSRQGtDDOREMHWLYRGH
UHGXFLUODHOHYDGDPRUWDOLGDGPDWHUQDTXHRFXUUtDHQORVSDUWRVGRPLFLOLDULRV3RUHOOR
ODPXMHUHUDKRVSLWDOL]DGDDOLQLFLRGHOSDUWREDMRQRUPDVJHQHUDOHVH[LVWHQWHVHQHVDV
LQVWLWXFLRQHVSDUDHOFXLGDGRGHSDFLHQWHVFRQSDWRORJtDVGLYHUVDV
/D LQVWLWXFLRQDOL]DFLyQ GHO SDUWR ORJUy SULQFLSDOPHQWH UHGXFLU OD HOHYDGD UD]yQ
GH PRUWDOLGDG PDWHUQD HQ OD PHGLGD TXH VH IXH LPSOHPHQWDQGR HQ ORV SDtVHV 6LQ
HPEDUJRORVDVSHFWRVVRFLDOHV\HOVRSRUWHSVLFRDIHFWLYRUHODFLRQDGRVFRQHOSURFHVR
UHSURGXFWLYRIXHURQUHOHJDGRVGHVDWHQGLGRVRSRFRSULRUL]DGRV
(Q OD DFWXDOLGDG HO FRQFHSWR GH ³SDUWR LQVWLWXFLRQDO´ LPSOLFD QR VROR OD YLJLODQFLD
HVWULFWDPHQWHSURIHVLRQDOGHODPXMHUHQHOPRPHQWRGHOSDUWRVLQRWDPELpQFRQVLGHUD
D LJXDO QLYHO ORV DVSHFWRV SVLFRDIHFWLYRV FXOWXUDOHV \ VRFLDOHV UHODFLRQDGRV FRQ OD
PDWHUQLGDG
/DVSULQFLSDOHVDFWLYLGDGHVTXHFRPSOHWDQODDWHQFLyQPpGLFDVRQ
x/DSDUWLFLSDFLyQGHOFRPSDxHUR\GHPiVPLHPEURVGHODIDPLOLDTXHODJHVWDQWH
GHVHHGXUDQWHODDVLVWHQFLDSUHQDWDOHOWUDEDMRGHSDUWR\HOSDUWR
x/DHGXFDFLyQ\SUHSDUDFLyQSVLFRItVLFDGHODPXMHUSDUDHOSDUWR\ODODFWDQFLD
x(OFRQWDFWRSUHFR]LQPHGLDWRDOQDFHUGHODPDGUH\HOSDGUHFRQVXKLMR
x(ODORMDPLHQWRFRQMXQWRGHODPDGUH\VXKLMRGXUDQWHHOSXHUSHULRLQVWLWXFLRQDO
MXQWRFRQODHGXFDFLyQSDUWLFLSDWLYDSDUDHOFXLGDGRGHOQLxR\HODXWRFXLGDGRGH
ODPDGUHGXUDQWHHOSXHUSHULR\ODODFWDQFLD
)LJXUD)UDJPHQWRGH+&33UHSDUDFLyQ\DFRPSDxDQWH
&XLGDGRVDQWHQDWDOHV
9LVLWD GRPLFLOLDULD GH DSR\R VRFLDO HQ PXMHUHV SULPtSDUDV DGROHVFHQWHV R HQ
DTXHOODV TXH DIURQWDQ HO HPEDUD]R VRODV R HQ FRQGLFLRQHV GH H[WUHPD SREUH]D OD
YLVLWD GRPLFLOLDULD SRU SHUVRQDO GH VDOXG KD PRVWUDGR VHU HIHFWLYD HQ LQFUHPHQWDU OD
H¿FDFLDGHORVFXLGDGRVSUHQDWDOHV/DHGXFDFLyQHODSR\RVRFLDOODLQÀXHQFLDSDUD
FHVDUGHIXPDUORVQH[RVFRQRWURVUHFXUVRVGHODFRPXQLGDG\HOPHMRUDPLHQWRGHOD
DXWRHVWLPDGHODPXMHUHPEDUD]DGDVRQORVFRPSRQHQWHVGHHVWDLQWHUYHQFLyQ
(GXFDFLyQSDUDODVDOXGFRQVLVWHHQODSDUWLFLSDFLyQGHODPXMHUJHVWDQWHHVSHFLDOPHQWH
OD SULPLJHVWD HQ DFWLYLGDGHV TXH OH SHUPLWDQ DSUHQGHU VREUH VX HPEDUD]R SDUWR \
FXLGDGRVGHVXKLMRSRUQDFHU/RVMXHJRVSDUWLFLSDWLYRVGH&/$3605³(OFDPLQRGHO
HPEDUD]R´ ³(O WUpERO GHO HPEDUD]R´ \ ³1XHVWUR SULPHU PHV´ DERUGDQ HVWD WHPiWLFD
HQIRUPDLQWHJUDOFRQHOHPHQWRVGHSURPRFLyQGHVDOXGSUHYHQFLyQGHHQIHUPHGDG\
VHxDODPLHQWRGHVLJQRVGHDOHUWDTXHUHTXLHUHQDWHQFLyQLQPHGLDWD
)LJXUD-XHJRVHGXFDWLYRV
3URPRFLyQ GH ODFWDQFLD QDWXUDO GXUDQWH OD DWHQFLyQ SUHQDWDO VH KD GHPRVWUDGR
TXHODHGXFDFLyQHVSHFLDOSDUDSURPRYHUODODFWDQFLDGXUDQWHHOHPEDUD]RHVH¿FD]HQ
GLVPLQXLUODIUHFXHQFLDGHGHVWHWHHQORVGRVSULPHURVPHVHVSRVSDUWR/RVFRQWHQLGRV
HGXFDWLYRVHVWDUiQGHVWLQDGRVDGHPRVWUDUODVYHQWDMDVGHODODFWDQFLDQDWXUDOVREUH
OD DOLPHQWDFLyQ FRQ OHFKH GH YDFD \ SUHSDUDGRV FRPHUFLDOHV FRQ OHFKH GH YDFD
PRGL¿FDGDDVtFRPRDXPHQWDUODDXWRHVWLPDGHODPXMHUSDUDFRQVHJXLUVXSHUDUODV
GL¿FXOWDGHVLQLFLDOHV(QHO&XDGURVHUHVXPHQORVGLH]SDVRVGHODHVWUDWHJLDGH
81,&()\206SDUDREWHQHUXQDODFWDQFLDH[LWRVD(VWRVGLH]SDVRVVRQXQDVHULHGH
UHFRPHQGDFLRQHV
&XDGUR(VWUDWHJLD'LH]SDVRVSDUDXQDODFWDQFLDH[LWRVD81,&()206
'LVSRQHUGHXQDSROtWLFDSRUHVFULWRUHODWLYDDODODFWDQFLDPDWHUQDTXH
VLVWHPiWLFDPHQWHVHSRQJDHQFRQRFLPLHQWRGHWRGRHOSHUVRQDOGHDWHQFLyQ
GHODVDOXG
&DSDFLWDUDWRGRHOSHUVRQDOGHVDOXGGHIRUPDTXHHVWpHQFRQGLFLRQHVGH
SRQHUHQSUiFWLFDHVDSROtWLFD
,QIRUPDUDWRGDVODVHPEDUD]DGDVGHORVEHQH¿FLRVTXHRIUHFHODODFWDQFLD
PDWHUQD\ODIRUPDGHSRQHUODHQSUiFWLFD
$\XGDUDODVPDGUHVDLQLFLDUODODFWDQFLDGXUDQWHODPHGLDKRUDVLJXLHQWHDO
DOXPEUDPLHQWR
0RVWUDUDODVPDGUHVFyPRVHGHEHGDUGHPDPDUDOQLxR\FyPRPDQWHQHUOD
ODFWDQFLDLQFOXVRVLKDQGHVHSDUDUVHGHVXVKLMRV
1RGDUDORVUHFLpQQDFLGRVPiVTXHODOHFKHPDWHUQDVLQQLQJ~QRWURDOLPHQWR
REHELGDDQRVHUTXHHVWpQPpGLFDPHQWHLQGLFDGRV
)DFLOLWDUODFRKDELWDFLyQGHODVPDGUHV\ORVODFWDQWHVGXUDQWHODVKRUDVGHO
GtD
)RPHQWDUODODFWDQFLDPDWHUQDDOLEUHGHPDQGD
1RGDUDORVQLxRVDOLPHQWDGRVDOSHFKRFKXSHWHVDUWL¿FLDOHV
)RPHQWDUHOHVWDEOHFLPLHQWRGHJUXSRVGHDSR\RDODODFWDQFLDPDWHUQD\
SURFXUDUTXHODVPDGUHVVHSRQJDQHQFRQWDFWRFRQHOORVDVXVDOLGDGHO
KRVSLWDORFOtQLFD
* Este paso fue incluido previo al conocimiento de una posible protección del chupete contra la muerte súbita del lactante
/D +&3 UHFXHUGD DO SUHVWDGRU GH VDOXG GXUDQWH HO

SUHQDWDO TXH HV DSURSLDGR EULQGDU FRQVHMHUtD SDUD HO
DPDPDQWDPLHQWR
Figura 48. Fragmento de HCP
Lactancia
2%-(7,926 &RQ¿UPDUODH[LVWHQFLDGHYLGDIHWDO
$&7,9,'$' 3HVTXLVDUPRYLPLHQWRV\IUHFXHQFLDFDUGtDFDIHWDO
/RVSDUiPHWURVFOtQLFRVPiVXVDGRVSDUDFRPSUREDUODH[LVWHQFLDGHYLGDIHWDOVRQORV
PRYLPLHQWRVIHWDOHV\ORVODWLGRVIHWDOHV3UHVHQWDQHOLQFRQYHQLHQWHGHVHUSHUFLELGRVSRU
ODPDGUHHQHWDSDVDYDQ]DGDVGHOHPEDUD]R\D~QPiVWDUGtDPHQWHSRUHOFOtQLFR
0RYLPLHQWRVIHWDOHV
$GHPiVGHVHUXQHOHPHQWRTXHLQGLFDYLWDOLGDGORVPRYLPLHQWRVIHWDOHVVHDVRFLDQ
FRQVDOXGHPEULRIHWDO/RVPRYLPLHQWRVSXHGHQVHUREVHUYDGRVPX\SUHFR]PHQWHSRU
XOWUDVRQRJUDItD\PiVWDUGHVHJXQGRWULPHVWUHVRQSHUFLELGRVSRUODPDGUH\OXHJR
SDOSDGRVSRUXQREVHUYDGRUH[WHUQRRUHJLVWUDGRV
/DSUHVHQFLDGHPRYLPLHQWRVLQGLFDLQWHJULGDGGHOVXVWUDWRDQDWyPLFR\GHODFDSDFLGDG
GHOIHWRSDUDSURGXFLUIXQFLRQHVFRPSOHMDV8QDPDUFDGDGLVPLQXFLyQRHOFHVHGHORV
PLVPRVSXHGHQLQGLFDUSUREOHPDVHQODVDOXGRODPXHUWHIHWDO
3XHGHQVHUSHUFLELGRVGHGLIHUHQWHVPDQHUDVVHJ~QVHHMHPSOL¿FDHQHOFXDGUR
&XDGUR'HWHFFLyQGHPRYLPLHQWRVHPEULRIHWDOHV
(GDGJHVWDFLRQDO 0pWRGR
VHPDQDV
GHVGHODV (FRJUDItDGHWLHPSRUHDOWUDQVYDJLQDOWUDQVDEGRPLQDO
GHVGHODV 'HWHFWRU'RSSOHU
3HUFLELGRVSRUSDOSDFLyQDEGRPLQDOODPDGUHSXHGHSHUFLELUORV
GHVGHODV GHVGHODVVHPDQDVDXQTXHHQHVWHFDVR
QRVHFRQVLGHUDVLJQRGHFHUWH]DSRUODVXEMHWLYLGDGGHOGDWR
/DVPDQHUDVGHYHUL¿FDUORVPRYLPLHQWRVIHWDOHVVRQ
x3HUFHSFLyQPDWHUQD
x3DOSDFLyQDEGRPLQDOSRUXQREVHUYDGRU
x(FRJUDItD
3HUFHSFLyQPDWHUQDODVJHVWDQWHVSHUFLEHQORVPRYLPLHQWRVIHWDOHVDHGDGYDULDEOH
VHJ~QODDJXGH]D\XPEUDOLQGLYLGXDOSDUDDSUHFLDUORV/DSULPtSDUDORKDFHHQWUHODV
\ VHPDQDV \ OD PXOWtSDUD DOJXQDV VHPDQDV DQWHV 3ULPHUR VRQ LGHQWL¿FDGRV
FRPRXQOLJHURFRVTXLOOHR\OXHJRVHKDFHQSDXODWLQDPHQWHPiVLQWHQVRV/DXELFDFLyQ
GHODSODFHQWDHQODFDUDDQWHULRUGHO~WHURSXHGHSURYRFDUXQUHWUDVRHQODSHUFHSFLyQ
GHORVPRYLPLHQWRVSRUSDUWHGHODPDGUH
5XWLQDULDPHQWHDSDUWLUGHODVVHPDQDVHOSUHVWDGRUGHVDOXGGHEHUiLQWHUURJDUHQ
ODFRQVXOWDSUHQDWDOVREUHODSHUFHSFLyQGHPRYLPLHQWRVIHWDOHVHQODV~OWLPDVKRUDV
\VLHVWRVWLHQHQXQDIUHFXHQFLDQRUPDO
(O SURPHGLR KRUDULR GH PRYLPLHQWRV IHWDOHV SHUFLELGRV SRU OD PDGUH WLHQH JUDQGHV
YDULDFLRQHV LQGLYLGXDOHV /RV IHWRV SDVDQ SRU SHUtRGRV DOWHUQDGRV GH DFWLYLGDG
SURPHGLRPLQXWRV\GHUHSRVRSURPHGLRPLQXWRVTXHLQÀX\HQVREUHODFDQWLGDG
GH PRYLPLHQWRV +D\ RWURV IDFWRUHV FDSDFHV GH SURGXFLU YDULDFLRQHV HQ OD GXUDFLyQ
GHHVWRVSHUtRGRVHQWUHHOORVVHFLWDQWDEDTXLVPRDOJXQRVPHGLFDPHQWRVDFWLYLGDG
ItVLFDPRPHQWRGHOGtDHGDGJHVWDFLRQDOHWF
(O OtPLWH LQIHULRU GH OD QRUPDOLGDG VH HVWLPD HQ PRYLPLHQWRV HQ KRUDV R
PRYLPLHQWRVHQXQDKRUD
(QFDVRGHVRVSHFKDGHFRPSURPLVRHQODVDOXGIHWDOVHSXHGHLQVWUXLUDODPDGUH
SDUDTXHFRQWUROHORVPRYLPLHQWRV\ORVUHJLVWUHHQXQDSODQLOOD(VWDWDUHDFRPRRWUDV
HQODVTXHODSDUWLFLSDFLyQGHODPDGUHSXHGHD\XGDUDODYLJLODQFLDGHOHPEDUD]RGHEH
VHUVROLFLWDGDVRORHQFDVRVHVSHFLDOHVGDGRTXHHODXWRFRQWUROGLDULRSXHGHRFDVLRQDU
DQVLHGDG\HVWUpV
/DWpFQLFDPiVVHQFLOODSDUDFRQWDUORVPRYLPLHQWRVIHWDOHVFRQVLVWHHQ
DFRQWDUORVPRYLPLHQWRVIHWDOHVSDUWLHQGRGHXQDKRUDGHWHUPLQDGD
EVLDSDUHFHQPRYLPLHQWRVHQODSULPHUDKRUDVHFRQVLGHUDQRUPDO
FVLHQODSULPHUDKRUDQRVHSURGXFHQPRYLPLHQWRVFRPRPtQLPR
VHFRQWLQXDUiKDVWDDOFDQ]DUPRYLPLHQWRVHQODVSULPHUDVKRUDV
(QFDVRGHQRDOFDQ]DUORVPRYLPLHQWRVIHWDOHVHQKRUDVVHRULHQWDUiDODJHVWDQWH
SDUDTXHFRQVXOWHHQHOFHQWURGHVDOXG
$XQTXHODWpFQLFDGHUHJLVWURPDWHUQRGLDULRGHORVPRYLPLHQWRVIHWDOHVHVWiDPSOLDPHQWH
GLIXQGLGDQRKD\HYLGHQFLDVVX¿FLHQWHVSDUDDFRQVHMDUORRGHVDFRQVHMDUORFRPRPHGLGD
GHYDORUDFLyQGHOELHQHVWDUIHWDO
3DOSDFLyQDEGRPLQDOSRUXQREVHUYDGRUHQFRQGLFLRQHVQRUPDOHVORVPRYLPLHQWRV
VXHOHQSHUFLELUVHDSDUWLUGHODVVHPDQDV&RQODJHVWDQWHHQGHF~ELWRODWHUDOL]TXLHUGR
\ODPDQRGHOREVHUYDGRUVREUHHODEGRPHQGXUDQWHDOJXQRVPLQXWRV6LQRVHSHUFLEHQ
ORV PRYLPLHQWRV GHVSXpV GH XQRV PLQXWRV SXHGH HVWLPXODUVH H[WHUQDPHQWH DO IHWR
PRYLpQGROR D WUDYpV GH OD SDUHG DEGRPLQDO PDWHUQD 6L VH H[DPLQD D OD PDGUH HQ
GHF~ELWRGRUVDOGHEHUiHYLWDUVHFRQIXQGLUORVPRYLPLHQWRVIHWDOHVFRQHOODWLGRDyUWLFR
WUDQVPLWLGR
(FRJUDItDORVPRYLPLHQWRVIHWDOHVSXHGHQVHUDGYHUWLGRVDSDUWLUGHODVpSWLPDVHPDQD
R LQFOXVR DQWHV HQ H[SORUDFLRQHV WUDQVYDJLQDOHV \ D SDUWLU GH OD QRYHQD VHPDQD R
DQWHVHQH[SORUDFLRQHVWUDQVDEGRPLQDOHV
$FWLYLGDGFDUGtDFDIHWDO
/DDXVFXOWDFLyQGHODWLGRVIHWDOHVHVWDOYH]HOVLJQRPiVFRQ¿DEOHGHYLWDOLGDGIHWDO
/DHGDGJHVWDFLRQDOLGHDOSDUDGHWHFWDUODWLGRVHVYDULDEOH\GHSHQGHGHPDQHUDSULQFLSDO
GHOPpWRGRTXHVHHPSOHH(QHOFXDGURVLJXLHQWHVHHVTXHPDWL]DQODVVHPDQDVGH
GHWHFFLyQGHORVODWLGRVIHWDOHVGHDFXHUGRDODWpFQLFDHPSOHDGD
&XDGUR'HWHFFLyQGHODWLGRVFDUGtDFRVHPEULRIHWDOHV
(GDGJHVWDFLRQDOVHPDQDV 0pWRGR
GHVGHODV (FRJUDItDGHWLHPSRUHDOYtDYDJLQDODEGRPLQDO
GHVGHODV 'HWHFWRU'RSSOHU
GHVGHODV (VWHWRVFRSLRREVWpWULFR
/DIUHFXHQFLDGHORVODWLGRVIHWDOHVRVFLODHQFRQGLFLRQHVQRUPDOHVHQWUH\
ODWLGRVSRUPLQXWRGXUDQWHORVHVSDFLRVOLEUHVGHFRQWUDFFLRQHVIUHFXHQFLDEDVDO
7DOFRPRVHPHQFLRQyHQHOFXDGURDQWHULRUORVODWLGRVIHWDOHVSXHGHQVHUGHWHFWDGRV
GHODVVLJXLHQWHVPDQHUDV
x(VWHWRVFRSLRREVWpWULFR
x'HWHFWRU'RSSOHU
x(FRJUDItD
(VWHWRVFRSLRREVWpWULFRHVXQHVWHWRVFRSLRGHGLVHxRHVSHFLDOSDUDXVRREVWpWULFR
TXHSHUPLWHODDXVFXOWDFLyQGHORVODWLGRVDSDUWLUGHODVVHPDQDVGHHGDGJHVWDFLRQDO
HQRFDVLRQHVHVSHFLDOHV\HQSDFLHQWHVGHOJDGDVGHVGHODVVHPDQDVGHJUDYLGH]
SXHGHQVHUGHWHFWDGRV7pFQLFRVGH&/$3605KDGLVHxDGRXQHVWHWRVFRSLRIHWDOHQ
PDWHULDOSOiVWLFRUHVLVWHQWHFRQH[FHOHQWHFRQGXFFLyQGHOVRQLGRDOTXHVHOHLQFRUSRUDURQ
LOXVWUDFLRQHVFRQHOPpWRGRGHDXVFXOWDFLyQ\ODUHODFLyQHQWUHODIUHFXHQFLDFDUGtDFD
IHWDO\ODVFRQWUDFFLRQHVGHULYDGDVGHLQYHVWLJDFLRQHVGHVDUUROODGDVHQ&/$3605
)LJXUD(VWHWRVFRSLRGH3LQDUGGH&/$3605
/D WpFQLFD GH DXVFXOWDFLyQ FRQVLVWH HQ DSOLFDU HO

HVWHWRVFRSLR SHUSHQGLFXODUPHQWH VREUH HO IRFR
GH DXVFXOWDFLyQ TXH FRUUHVSRQGH DO KRPEUR IHWDO
DQWHULRU ORFDOL]DGR SUHYLDPHQWH SRU SDOSDFLyQ
SDUD OR FXDO VH UHTXLHUH TXH OD JHVWDQWH VH
HQFXHQWUHHQGHF~ELWRGRUVDO/DWUDQVPLVLyQKDFLD
HO HVWHWRVFRSLR VH KDFH VLJXLHQGR FDSDV VyOLGDV
TXHVRQEXHQDVSURSDJDGRUDVGHOVRQLGR
)LJ7pFQLFDGHDXVFXOWDFLyQ
/D FDEH]D GHO H[DPLQDGRU HMHUFHUi XQD SUHVLyQ VXDYH SHUR FRQWLQXD VREUH HO
HVWHWRVFRSLR/DPDQROLEUHWRPDUiHOSXOVRGHODPDGUHD¿QGHGLIHUHQFLDUORVODWLGRV
PDWHUQRVGHORVODWLGRVIHWDOHV6HUHWLUDODPDQRTXHVXMHWDEDHOHVWHWRVFRSLRSDUDQR
LQWHUIHULUFRQUXLGRVH[WHUQRV(VDPDQRGHEHUiFRORFDUVHVREUHHO~WHURSDUDSRGHU
DSUHFLDUVLKD\FRQWUDFFLRQHV
(VWRHVHVSHFLDOPHQWHLPSRUWDQWHGXUDQWHHOWUDEDMRGHSDUWR\DTXHDXVFXOWDUGHQWUR
\ IXHUD GH OD FRQWUDFFLyQ SHUPLWH DGYHUWLU ',36 (O H[DPLQDGRU FRQWDUi ORV ODWLGRV
PLHQWUDVREVHUYDXQUHORM\ORVH[SUHVDUiHQODWLGRVSRUPLQXWR
(IHFWR'RSSOHUH[LVWHQHQODDFWXDOLGDGHTXLSRVEDVDGRVHQHOHIHFWR'RSSOHUFX\D
VHQVLELOLGDGHVVLJQL¿FDWLYDPHQWHPD\RUTXHODEULQGDGDSRUHOHVWHWRVFRSLRREVWpWULFR
3HUPLWHODGHWHFFLyQDHGDGHVPiVWHPSUDQDVVHPDQDVDQLYHOVXSUDS~ELFR
(QRFDVLRQHVHOODWLGRVHLGHQWL¿FDFODUDPHQWHPLHQWUDVTXHHQRWUDVRSRUWXQLGDGHVVH
HVFXFKDUiQUXLGRVIXQLFXODUHVTXHDORV¿QHVSUiFWLFRVWLHQHQHOPLVPRYDORUGLDJQyVWLFR
SDUDFHUWL¿FDUYLWDOLGDGIHWDO
6XHOH VHU GH JUDQ XWLOLGDG HQ DTXHOODV VLWXDFLRQHV HQ ODV TXH OD DXVFXOWDFLyQ FRQ HO
HVWHWRVFRSLRREVWpWULFRHVGL¿FXOWRVD
(FRJUDItDORVODWLGRVFDUGtDFRVVHSXHGHQYHUPHGLDQWHHFRJUDItDGLQiPLFDDSDUWLUGHODV
DVHPDQDVSRUYtDWUDQVYDJLQDO\GHODVDVHPDQDVSRUYtDWUDQVDEGRPLQDO
2%-(7,926 $QWLFLSDUHOGLDJQyVWLFR\SUHYHQLUHOSDUWRSUHPDWXUR
$&7,9,'$' (YDOXDUHOSDWUyQGHODFRQWUDFWLOLGDGXWHULQD
IUHFXHQFLDGXUDFLyQHLQWHQVLGDG
5HWUDVDUHOSDUWRGHSUHWpUPLQR
,QGXFLUODPDGXUDFLyQSXOPRQDUIHWDO
(OSDUWRGHSUHWpUPLQRRSUHPDWXURFRQWLQ~DVLHQGRXQDGHODVSULQFLSDOHVFDXVDVGH
PRUWDOLGDG\PRUELOLGDGQHRQDWDOHQWRGRHOPXQGR([FOX\HQGRDODVPDOIRUPDFLRQHV
FRQJpQLWDVH[SOLFDGHFDGDPXHUWHVSHULQDWDOHV\ODPLWDGGHODVDQRUPDOLGDGHV
QHXUROyJLFDVGHODLQIDQFLD'HDFXHUGRDODGH¿QLFLyQGHOD&ODVL¿FDFLyQ,QWHUQDFLRQDO
GH(QIHUPHGDGHV&,(WRGRQDFLPLHQWRTXHVHSURGXFHDSDUWLUGHODV\DQWHV
GHODVVHPDQDVVHFRQVLGHUDXQSDUWRSUHPDWXUR
(O SDUWR SUHPDWXUR SXHGH VHU HVSRQWiQHR HQ HVWH FDVR LQFOX\H ORV QDFLPLHQWRV GH
SUHWpUPLQR GH FDXVD FRQRFLGD R GHVFRQRFLGD UXSWXUD HVSRQWiQHD GH PHPEUDQDV
RYXODUHVHLQFRPSHWHQFLDFHUYLFDO(OSDUWRSUHPDWXURSRULQGLFDFLyQVHSURGXFHSRUOD
QHFHVLGDGPpGLFDGHDQWLFLSDUHOQDFLPLHQWRDQWHXQULHVJRPDWHUQRIHWDORDPERV
/DIUHFXHQFLDHVVXPDPHQWHYDULDEOHGHSDtVDSDtVGHWDOPDQHUDTXHHQDOJXQRV
SDtVHVGHVDUUROODGRVODIUHFXHQFLDHVPHQRUDOPLHQWUDVTXHHQDOJXQRVSDtVHV
HQ GHVDUUROOR ODV FLIUDV VXSHUDQ HO $XQTXH ORV SDtVHV GHVDUUROODGRV VH KDQ
FDUDFWHUL]DGR SRU XQD GLVPLQXFLyQ JUDGXDO GH OD SUHPDWXUH] HQ ORV ~OWLPRV DxRV
DOJXQRVGHHOORVKDQH[SHULPHQWDGRXQDVFHQVRSURJUHVLYRYLQFXODGRDODQHFHVLGDG
GHLQWHUUXPSLUORVHPEDUD]RVSRULQGLFDFLyQPpGLFDDQWHVGHOWpUPLQR
+D\YDULDGRVIDFWRUHVTXHLQFUHPHQWDQHOULHVJRGHSDUWRSUHPDWXURHOORVVHSXHGHQ
GLYLGLUHQWUHVFDWHJRUtDVSULQFLSDOHV
x&DUDFWHUtVWLFDVGHPRJUi¿FDV\JHQpWLFDV
x+iELWRVFRQGXFWDV\IDFWRUHVDPELHQWDOHV
x)DFWRUHVPpGLFRV\REVWpWULFRV
'HELGR D OD GL¿FXOWDG GH HQFRQWUDU XQD FDXVD ~QLFD TXH H[SOLTXH OD WRWDOLGDG GH
ORV SDUWRV SUHPDWXURV DFWXDOPHQWH VH ORV FRQVLGHUD FRPR XQ VtQGURPH 'H HVWD
PDQHUDHOSDUWRSUHPDWXURVHUtDXQDFRQGLFLyQGHVHQFDGHQDGDSRUP~OWLSOHVFDXVDV
JHQHUDOPHQWHFRH[LVWHQWHVTXHVHH[SUHVDQ¿QDOPHQWHFRQFRQWUDFFLRQHVXWHULQDV\
FDPELRVFHUYLFDOHV
(O IDFWRU GH ULHVJR PiV FODUDPHQWH GH¿QLGR HV HO DQWHFHGHQWH GH SDUWR SUHPDWXUR
HQXQDJHVWDFLyQSUHYLDVHKDYLVWRTXHXQDPXMHUTXHKDWHQLGRXQSDUWRSUHPDWXUR
WLHQH FDVL YHFHV PiV SUREDELOLGDG GH VXIULU XQ SDUWR SUHPDWXUR TXH OD TXH FDUHFH
GHHVHDQWHFHGHQWH6HKDUHSRUWDGRTXHHVWHULHVJRVHFRUUHODFLRQDFRQHOQ~PHUR
GHSDUWRVSUHPDWXURVDQWHULRUHV\WLHQGHDLQFUHPHQWDUVHIXHUWHPHQWHFXDQWRPHQRU
VHDODHGDGGHOSDUWRSUHPDWXURDQWHULRU2WURVIDFWRUHVDVRFLDGRVDSDUWRSUHPDWXUR
VRQ HO HPEDUD]R P~OWLSOH HQ OD DFWXDO JHVWDFLyQ OD LQFRPSHWHQFLD FHUYLFDO \ ODV
PDOIRUPDFLRQHVXWHULQDV
2WURVIDFWRUHVGHULHVJRSRVLEOHVLQFOX\HQ
xHGDGHVH[WUHPDV
xWDEDFRDOFRKRO\GURJDV
xLQIHFFLRQHVJpQLWRXULQDULDV
xGLDEHWHVPHOOLWXV
xKLSHUWHQVLyQDUWHULDO
x)DOWDRWDUGtRFRQWUROSUHQDWDO
'HWRGRVHVWRVIDFWRUHVGHULHVJRDOJXQRVVRQSRWHQFLDOPHQWHUHPRYLEOHVGXUDQWHHO
HPEDUD]RPLHQWUDVTXHRWURVQRORVRQODVSRVLELOLGDGHVGHDFFLyQVHEDVDQHQLQWHQWDU
FRQWURODURHOLPLQDUDTXHOORVIDFWRUHVUHPRYLEOHV
'LDJQyVWLFRGHDPHQD]DGHSDUWRSUHPDWXUR
(OGLDJQyVWLFRVHIXQGDPHQWDHQWUHVDVSHFWRV
x(GDGJHVWDFLRQDO
x&RQWUDFFLRQHVXWHULQDV
x(VWDGRGHOFXHOORXWHULQR
(GDGJHVWDFLRQDOGDGRTXHHOSDUWRGHSUHWpUPLQRVHGH¿QHHQEDVHDXQDUHODFLyQ
WHPSRUDOHVQHFHVDULRGHWHUPLQDUODHGDGJHVWDFLRQDOFRPR\DVHKDPDQLIHVWDGRHQ
ODGH¿QLFLyQGHFDVR
&RQWUDFFLRQHVXWHULQDVGXUDQWHODVHJXQGDPLWDGGHODJHVWDFLyQODSDOSDFLyQGHO
DEGRPHQSHUPLWLUiUHFRQRFHUHOWDPDxR\FRQVLVWHQFLDGHO~WHURWRQRRWHQVLyQDVt
FRPR OD H[LVWHQFLD GH FRQWUDFFLRQHV HVSRQWiQHDV (VWD SDOSDFLyQ GHEHUi UHDOL]DUVH
FRQODHPEDUD]DGDHQGHF~ELWRODWHUDOSUHIHUHQWHPHQWHL]TXLHUGR/DVFRQWUDFFLRQHV
QRUPDOHVSXHGHQVHUSHUFLELGDVIiFLOPHQWHSRUSDOSDFLyQRSRUXQWRFyJUDIRH[WHUQR
(Q HO FXDGUR VH SUHVHQWD HO YDORU Pi[LPR QRUPDO S GH OD IUHFXHQFLD GH ODV
FRQWUDFFLRQHVSRUKRUDVHJ~QODHGDGJHVWDFLRQDO(VWRVYDORUHVFRUUHVSRQGHQDXQD
VHULHGHHPEDUD]DGDVGHEDMRULHVJRUHJLVWUDGDVHQGHF~ELWRODWHUDOVHPDQDOPHQWH
KDVWDHOWpUPLQRGHODJHVWDFLyQ
&XDGUR&RQWUDFFLRQHVXWHULQDVGHDFXHUGRFRQODHGDGJHVWDFLRQDO
(GDGJHVWDFLRQDO

VHPDQDV
1~PHURGHFRQWUDFFLRQHV

SRUKRUDSHUFHQWLOR
/RV YDORUHV GHO FXDGUR FRUUHVSRQGHQ DO SHUFHQWLOR \ PXHVWUDQ XQ DXPHQWR
SURJUHVLYR GH OD IUHFXHQFLD GH ODV FRQWUDFFLRQHV SRU KRUD HQWUH ODV VHPDQDV \
ORTXHOXHJRVHHVWDELOL]D$VtHQODVHPDQDVHSRGUtDHVSHUDUHQHOGH
ODVHPEDUD]DGDVQRUPDOHVXQDIUHFXHQFLDGHKDVWDRFKRFRQWUDFFLRQHVSRUKRUD(V
LQWHUHVDQWHGHVWDFDUTXHHQWRGRVORVSDUWRVTXH¿QDOL]DURQSUHPDWXUDPHQWH\HQORV
TXHVHHVWXGLyVXSDWUyQGHFRQWUDFFLRQHVpVWHVHHQFRQWUDEDDXPHQWDGRSRUHQFLPD
GHOSHUFHQWLORSUHYLDPHQWHDOGHVHQFDGHQDPLHQWRGHOSDUWR
&XDQGR OD IUHFXHQFLD GH ODV FRQWUDFFLRQHV HV OLJHUDPHQWH VXSHULRU D OD HVWDEOHFLGD
SDUDHOSHUFHQWLORGHOSDWUyQQRUPDOFRQODHPEDUD]DGDDFRVWDGD\TXHGDQGXGDV
DFHUFD GHO GLDJQyVWLFR GH SRVLEOH SDWUyQ FRQWUiFWLO DOWHUDGR VH SURFHGHUi D HVSHUDU
XQDKRUD\VLHOSDWUyQGHFRQWUDFFLRQHVDXPHQWDGRSHUVLVWHVHKDUiODFRQVXOWDROD
UHIHUHQFLDGHODPDGUHDOQLYHOTXHFRUUHVSRQGDeVWRVYDORUHVVHHQFXHQWUDQLPSUHVRV
HQYDULDVGHODVWHFQRORJtDVGHO&/$3605FRPRHQHOJHVWRJUDPD¿JXUD\HQOD
FLQWDREVWpWULFD¿JXUD
(VWDGRGHOFXHOORXWHULQRORVSULQFLSDOHVVLJQRVDWHQHUHQFXHQWDVRQHOERUUDPLHQWR
OD GLODWDFLyQ \ OD SRVLFLyQ GHO FXHOOR (O DFRUWDPLHQWR R ERUUDPLHQWR GHO FXHOOR GH XQ
RPiVODGLODWDFLyQGHXQRRPiVFHQWtPHWURV\ODFHQWUDOL]DFLyQGHOFXHOORVRQ
HOHPHQWRVRULHQWDGRUHVGHXQDDPHQD]DGHSDUWRSUHPDWXUR'HWRGDVPDQHUDVORV
FDPELRVFHUYLFDOHVDLVODGRVSXHGHQUHVXOWDULQVX¿FLHQWHVSDUDHVWDEOHFHUHOGLDJQyVWLFR
GHDPHQD]DGHSDUWRSUHPDWXUR
7UDWDPLHQWR
&DGDYH]TXHVHDSRVLEOHLGHQWL¿FDUXQDFDXVDFRPRODUHVSRQVDEOHGHODDPHQD]D
GHSDUWRSUHPDWXURVHUHDOL]DUiHOWUDWDPLHQWRHWLROyJLFRSRUHMHPSORDQWLELyWLFRVHQ
ODVLQIHFFLRQHVXULQDULDVFHUFODJHHQODLQFRPSHWHQFLDFHUYLFDOHWF3HURSRUWUDWDUVH
GH XQ VtQGURPH HQ PXFKDV RFDVLRQHV QR KDEUi SRVLELOLGDG GH KDFHU WUDWDPLHQWR
HWLROyJLFR \ VROR VH SRGUi KDFHU WUDWDPLHQWR VLQWRPiWLFR (O WUDWDPLHQWR VLQWRPiWLFR
WLHQHSRU¿QDOLGDGGLVPLQXLURGHWHQHUODVFRQWUDFFLRQHVXWHULQDVDQRUPDOHVDOWLHPSR
GHHVWLPXODUODPDGXUH]SXOPRQDUIHWDOFRQFRUWLFRLGHV
(OWUDWDPLHQWRVHKDUiVLHPSUHTXH
xHOFXHOORXWHULQRQRHVWpGLODWDGRPiVGHFP
xQRKD\DDPQLRQLWLV
xQRKD\DSUHHFODPSVLDVHYHUD
xQRKD\DKHPRUUDJLDDFWLYD
xQRKD\DVXIULPLHQWRIHWDO
x\HOIHWRHVWpYLYR
5HSRVRHQFDPD
(OUHSRVRHQFDPDVLHPSUHKDVLGRLQGLFDGRFRPRXQRGHORVSULPHURVSDVRVSDUDHO
WUDWDPLHQWRGHODDPHQD]DGHSDUWRGHSUHWpUPLQR+DVWDHOPRPHQWRQRKD\HYLGHQFLDV
VX¿FLHQWHVSDUDLQGLFDUORVLVWHPiWLFDPHQWHRSURVFULELUOR'HWRGDVIRUPDVGHELGRD
ODLQVX¿FLHQWHLQYHVWLJDFLyQDOUHVSHFWRHVDFRQVHMDEOHDGHFXDUHVWDLQGLFDFLyQDODV
SRVLELOLGDGHVUHDOHVGHODHPEDUD]GD
7RFROtWLFRV
'HQWURGHORVWRFROtWLFRVPiVHIHFWLYRVVHFXHQWDFRQ
x%HWDPLPpWLFRV
x$QWLSURVWDJODQGLQDV
x%ORTXHDGRUHVGHORVFDQDOHVGHFDOFLR
x$QWDJRQLVWDVGHODRFLWRFLQD
/RVEHWDPLPpWLFRVXVDGRVSRUYtDHQGRYHQRVDWLHQHQXQUiSLGRHIHFWRTXHVHLQVWDOD
HQWUHORV\PLQXWRVGHVXDGPLQLVWUDFLyQ/RVHIHFWRVWDPELpQVXHOHQGHVDSDUHFHU
FRQEDVWDQWHUDSLGH]DPLQXWRV
6HKDGHPRVWUDGRTXHVRQHIHFWLYRVHQ
x3URORQJDUODJHVWDFLyQDOPHQRVKRUDVHQHOGHORVFDVRV
x3URORQJDUODJHVWDFLyQKRUDV\PiVHQHOGHORVFDVRV
x5HGXFLUXQODVFKDQFHVGHEDMRSHVRDOQDFHU%31
3UHVHQWDQHOLQFRQYHQLHQWHGHWHQHUHIHFWRVFRODWHUDOHVLQGHVHDEOHVFRPR
x7DTXLFDUGLDPDWHUQD
x9DVRGLODWDFLyQ
x+LSRWHQVLyQH[FHSWRODHWLOHIULQD
x+LSHUJOLFHPLD
x1DXVHDVYyPLWRV
x(VFDORIUtRV\WHPEORUHV
(OEHWDPLPpWLFRPiVXVDGRHQODUHJLyQHVHO)HQRWHUROFRPHQ]DQGRFRQGRVLVGH
PLFURJUDPRSRUPLQXWRDXPHQWDQGRD\KDVWDPLFURJUDPRVPLQXWRVLQRKDVLGR
HIHFWLYR$FRQWLQXDFLyQVHSUHVHQWDQORVHIHFWRVXWHURLQKLELGRUHV\FDUGLRYDVFXODUHV
GHORVSULQFLSDOHVEHWDPLPpWLFRV
&XDGUR(IHFWRVXWHURLQKLELGRUHV\FDUGLRYDVFXODUHVGHDOJXQDVGURJDVEHWDPLPpWLFDV
VHJ~Q6FKZDUF]'tD]\)HVFLQD
Efecto uteroinhibidor Efectos cardiovasculares maternos
Infusión I/V Contracciones
Droga Presión arterial
mg/min Frecuen- Frecuencia
Amplitud cia cardíaca Sistólica Diastólica
,VR[XSULQD

(WLOHIULQDHWLODGULDQRO

2UFLSUHQDOLQD

6DOEXWDPRO

7HUEXWDOLQD

5LWRGULQD

)HQRWHURO

(IHFWRPRGHUDGR 'LVPLQXFLyQ
,QFUHPHQWR
'LVPLQXFLyQ
(IHFWRLQWHQVR YDULDFLyQPtQLPD
$QWLSURVWDJODQGLQDV GHQWUR GH ODV DQWLSURVWDJODQGLQDV OD LQGRPHWDFLQD KD

GHPRVWUDGR VHU VXPDPHQWH SRWHQWH HQ RFDVLRQHV DXQ PiV TXH ORV EHWDPLPpWLFRV
(QWUHORVHIHFWRVORJUDGRVVHSXHGHGHVWDFDU
x3URORQJDUHOSDUWRSRUKRUDV\PiVHQHOGHORVFDVRV
x3URORQJDUHOSDUWRKDVWDXQDVHPDQD\PiVHQHOGHORVFDVRV
x5HGXFLUHQXQHO%31
x5HGXFLUODPRUWDOLGDGSHULQDWDOHQXQ
&RPRHIHFWRLQGHVHDEOHSULQFLSDOVHUHFRQRFHHOULHVJRGHOFLHUUHSUHFR]GHOFRQGXFWR
DUWHULRVR(VWDFRPSOLFDFLyQVHSURGXFLUtDDSDUWLUGHODVVHPDQDVGHJHVWDFLyQ\
VLHPSUHTXHODVGRVLVVXSHUHQORVPJ
/DGRVLVUHFRPHQGDGDHVGHPJYtDUHFWDO
(QWUH ODV FRQWUDLQGLFDFLRQHV SDUD VX XVR VH LQFOX\HQ DOHUJLD DO PHGLFDPHQWR
DOWHUDFLRQHVGHODFRDJXODFLyQRWURPERFLWRSHQLD
%ORTXHDQWHV GH ORV FDQDOHV GH FDOFLR GHQWUR GH HOORV OD PiV FRQRFLGD HV OD
1LIHGLSLQD
&XDQGR VH UHTXLHUH WUDWDPLHQWR ~WHURLQKLELGRU SDUD GHWHQHU OD DPHQD]D GH SDUWR
SUHPDWXURORVFDOFLRDQWDJRQLVWDVVRQVXSHULRUHVDFXDOTXLHURWURPHGLFDPHQWR
&RPSDUDGRVFRQORVEHWDPLPpWLFRVKDQGHPRVWUDGRPD\RUHIHFWLYLGDGSDUDWUDWDUDODV
PXMHUHVFRQDPHQD]DGHSDUWRSUHPDWXUR\DTXH
x3URORQJDQHQPiVFDVRVHOSDUWRSRUKRUDV
x3URORQJDQHQPiVFDVRVHOSDUWRSRUXQDVHPDQD
x5HGXFHQPiVHO6'5
x&DUHFHQGHHIHFWRVVHFXQGDULRVTXHREOLJXHQDVXVSHQGHUHOWUDWDPLHQWR
&XHQWDQFRQODYHQWDMDGHTXHSXHGHQVHUDGPLQLVWUDGDVSRUYtDRUDO\VXEOLQJXDOSRU
ORFXDOVRQLGHDOHVSDUDVHUXVDGRVHQDPELHQWHVGHUHFXUVRVOLPLWDGRV/DGRVLVHVGH
PJVXEOLQJXDO6HSXHGHUHSHWLUODPLVPDGRVLVFDGDPLQXWRVKDVWDFRPSOHWDU
PJHQXQDKRUD
(VWiQ FRQWUDLQGLFDGRV HQ DOJXQRV FDVRV HQ HQIHUPHGDG FDUGtDFD \ QR GHEHQ VHU
XVDGRVDOPLVPRWLHPSRTXHHOVXOIDWRGHPDJQHVLR
$QWDJRQLVWDVGHODRFLWRFLQDHOPiVFRQRFLGRHVHO$WRVLEDQ+DVWDHOPRPHQWRQRVH
KDSRGLGRGHPRVWUDUTXHVHDQVXSHULRUHVDORVEHWDPLPpWLFRVHQWpUPLQRVGHH¿FDFLD
WRFROtWLFDRGHUHVXOWDGRVLQIDQWLOHV6RORWLHQHQYHQWDMDVVREUHORVEHWDPLPpWLFRVHQ
WpUPLQRVGHSURGXFLUHVFDVRVHIHFWRVLQGHVHDEOHVHQODVPXMHUHVJHVWDQWHV(OKDOOD]JR
GHXQDXPHQWRHQODVPXHUWHVIHWDOHVHQXQHVWXGLRFX\RFRQWUROHUDSODFHERSRQHHQ
DOHUWDVREUHODQHFHVLGDGGHWRPDUSUHFDXFLRQHV
&RQWUDLQGLFDFLRQHVSDUDODXWHURLQKLELFLyQ
'HEHUiVXVSHQGHUVHRHYLWDUVHODXWHURLQKLELFLyQVLHPSUHTXHKD\D
xSUHHFODPSVLDVHYHUD
xGHVSUHQGLPLHQWRGHSODFHQWD
xLQIHFFLyQRYXODU
xGLODWDFLyQFHUYLFDODYDQ]DGD
xPXHUWHIHWDO
7UDWDPLHQWRVTXHQRKDQGHPRVWUDGRVHUHIHFWLYRVHQODDPHQD]DGHSDUWR
SUHPDWXUR
6XOIDWRGH0DJQHVLRUHFRPHQGDGRHQRFDVLRQHVSDUDHOWUDWDPLHQWRGHODDPHQD]D
GHSDUWRSUHPDWXURHVLQHIHFWLYR\DXPHQWDODPRUWDOLGDGQHRQDWDOSRUORTXHVXXVR
GHEHVHUGHVDFRQVHMDGR
+LGUDWDFLyQKD\HVFDVDHYLGHQFLDHQHVWHDVSHFWR3HURORYLVWRKDVWDHOPRPHQWR
LQGLFDTXHQRSURGXFHQLQJ~QEHQH¿FLR
2[LGRQLWURVRKDVWDHOPRPHQWRQRKD\HYLGHQFLDTXHMXVWL¿TXHVXXVRHQOXJDUGH
ORVWUDWDPLHQWRVFRQYHQFLRQDOHV
%HWDPLPpWLFRVSRUYtDRUDODSHVDUGHORDPSOLDPHQWHXVDGRVQRH[LVWHHYLGHQFLD
GHVXHIHFWLYLGDG
,QGXFWRUHVGHODPDGXUDFLyQSXOPRQDUIHWDO
1R WRGRV ORV FRUWLFRLGHV KDQ GHPRVWUDGR VHU HIHFWLYRV SDUD LQGXFLU OD PDGXUDFLyQ
SXOPRQDUIHWDOORVPiVHIHFWLYRVKDQVLGR
x%HWDPHWDVRQDHQGRVLV,0GHPJVHSDUDGDVSRUKRUDV
x'H[DPHWDVRQDHQGRVLV,0GHPJVHSDUDGDVSRUKRUDV
x+LGURFRUWLVRQDHQGRVLVGHPJ,9VHSDUDGDVSRUKRUDV
/DPD\RUSDUWHGHORVHVWXGLRVKDQGHPRVWUDGRHIHFWLYLGDGFXDQGRVRQDGPLQLVWUDGRV
HQWUH ODV \ ODV VHPDQDV DXQTXH QXHYDV HYLGHQFLDV VXJLHUHQ TXH VH MXVWL¿FD
VX XVR GHVGH ODV VHPDQDV HVSHFLDOPHQWH HQ FDVRV GH SUHHFODPSVLD URWXUD
GH PHPEUDQDV HPEDUD]R P~OWLSOH \ FDGD YH] TXH VH VRVSHFKH TXH HO SDUWR SXHGH
SURGXFLUVHHQPHQRVGHKRUDV
/RVSULQFLSDOHVHIHFWRVVRQUHGXFFLyQGH
xGHODPRUWDOLGDGSHULQDWDO
xGHO6'5
xGH+HPRUUDJLD&HUHEUR9DVFXODU
xGH(QWHUR&ROLWLV1HFURWL]DQWH
xGHLQJUHVRVD8&,1
/RVHIHFWRVEHQH¿FLRVRVGHORVFRUWLFRLGHVQRWLHQHQGLIHUHQFLDVVHJ~QVH[RFRPRVH
VRVWHQtDDQWLJXDPHQWH\QRDXPHQWDQVLJQL¿FDWLYDPHQWHHOULHVJRGHVHSVLVPDWHUQD
$FRQWLQXDFLyQVHHVTXHPDWL]DHOWUDWDPLHQWRGHDWDTXHHQODDPHQD]DGHSDUWR\SDUWR
SUHPDWXURPLHQWUDVVHWUDQV¿HUHODJHVWDQWHDXQQLYHOGHPD\RUFRPSOHMLGDGSDUDOD
DWHQFLyQHVSHFLDOL]DGDGHOQHRQDWR
7RFROLWLFR,9GHUiSLGDLQVWDODFLyQ
3HMIHQRWHUROFRPLHQ]RPJPLQ
%HWDPHWDVRQDPJ,0
,QKLELFLyQXWHULQDLQVXILFLHQWH
GRVLVFRQLQWHUYDORGH
DXPHQWDUODGRVLVDPJPLQ
KRUDVFXDQGRODJHVWDFLyQ
HVGHDVHPDQDV ,QKLELFLyQXWHULQDLQVXILFLHQWH
DXPHQWDUODGRVLVDPJPLQ
,QGRPHWDFLQDPJUHFWDO
GRVLVFRQLQWHUYDORVGH
KRUDVFXDQGRODJHVWDFLyQ 0DQWHQHUODLQIXVLyQ,9FRQHO~WHURLQKLELGR
HVVHPDQDVRSFLRQDO GXUDQWHKRUDVDQWHVGHSDVDUDO
WUDWDPLHQWRGHVRVWpQVyORLQGRPHWDFLQD
(YLWDUWDTXLFDUGLDPDWHUQDPD\RUGH
ODWLGRVSRUPLQXWR
PLQ KV
,QLFLR Pi[LPRSDUDORV
WRFROtWLFRVEPLPpWLFRV
)LJXUD(VTXHPDSDUDHOWUDWDPLHQWRGHODDPHQD]DGHSDUWRSUHPDWXUR
2%-(7,926 3HVTXLVDUDOWHUDFLRQHVGHODSUHVLyQDUWHULDO
+LSHUWHQVLyQSUHYLDDOHPEDUD]R
(OVtQGUGHKLSHUWHQVLyQLQGXFLGDSRUHOHPEDUD]RSUHHFODPSVLD
+LSRWHQVLyQDUWHULDO
$&7,9,'$' 'HWHUPLQDFLyQGHODSUHVLyQDUWHULDOLGHQWL¿FDFLyQGHHGHPDV\
SURWHLQXULD
/DKLSHUWHQVLyQHQHOHPEDUD]RHVXQDFRPSOLFDFLyQFRP~Q\SRWHQFLDOPHQWHSHOLJURVD
SDUDODPDGUHHOIHWR\HOUHFLpQQDFLGR(QPXFKRVSDtVHVVXHOHVHUODSULPHUDFDXVD
GHPRUWDOLGDGPDWHUQD3XHGHSUHVHQWDUVHVRODRDVRFLDGDFRQHGHPD\SURWHLQXULD/D
SUHVHQFLDGHHGHPDHVDOJRKDELWXDOHQODVHPEDUD]DGDV6LQHPEDUJRVLHPSUHHVWi
SUHVHQWHHQORVFDVRVGHSUHHFODPSVLDVHYHUD\HQODHFODPSVLD/DSURWHLQXULDHVXQ
LQGLFDGRU GH VHYHULGDG \ DSDUHFH WDUGtDPHQWH \ VH UHODFLRQD HQ IRUPD GLUHFWDPHQWH
SURSRUFLRQDOFRQODVFLIUDVGHSUHVLyQDUWHULDO
(QHORWURH[WUHPRODKLSRWHQVLyQDUWHULDOPDWHUQDWDPELpQVHSXHGHDVRFLDUFRQPD\RU
PRUWDOLGDGIHWDOQHRQDWDO\FRQSHTXHxRSDUDODHGDGJHVWDFLRQDO3(*
(QHOFXDGURVLJXLHQWHVHUHVXPHQORVSULQFLSDOHVGDxRVTXHVHDVRFLDQFRQYDORUHV
DQRUPDOHVGHODWHQVLyQDUWHULDOPDWHUQDGXUDQWHHOHPEDUD]R
&XDGUR7HQVLyQDUWHULDO\FRPSOLFDFLRQHVSHULQDWDOHV
&RPSOLFDFLRQHV 0DWHUQD )HWDORYXODU 1HRQDWDO
Hipertensión Alteraciones del sistema Aborto. Pequeño para la edad
de coagulación. Desprendimiento gestacional (PEG).
Diastólica > 90 mm Hg. Hemólisis. normoplacentario. Pretérmino.
Sistólica > 140 mm Hg. Hemorragia cerebral. Restricción del crecimiento Síndrome de dificultad
Insuficiencia hepática. intrauterino (RCI). respiratoria.
Insuficiencia renal. Sufrimiento fetal agudo Depresión neonatal.
Mortalidad aumentada intraparto. Mortalidad aumentada
Oligoamnios
Mortalidad aumentada
Hipotensión
Lipotimias y desmayos. Restricción del crecimiento Pequeño para la edad
Diastólica < 55 mm Hg. intrauterino (RCIU). gestacional (PEG)
Sistólica < 95 mm Hg. Mortalidad aumentada. Mortalidad aumentada.
)DFWRUHVTXHSXHGHQPRGL¿FDUORVYDORUHVGHODWHQVLyQDUWHULDO
/RV YDORUHV TXH VH REWLHQHQ GL¿HUHQ VHJ~Q OD JHVWDQWH HVWp VHQWDGD HQ GHF~ELWR
VXSLQRRHQGHF~ELWRODWHUDO([LVWHQDGHPiVIDFWRUHVGHORSHUDGRURGHOLQVWUXPHQWR
TXHVHSXHGHQFRQWURODUFRQXQDFRUUHFWDPHWRGRORJtD(OHV¿JPRPDQyPHWURGHEHVHU
FRQWURODGR SHULyGLFDPHQWH HQ UHODFLyQ DO HVWDGR GH VXV GLIHUHQWHV SDUWHV PDQJXLWR
EUD]DOHWHWXERVYiOYXODV\VLIXHVHGHWLSRDQHURLGHHQHVWHFRQWUROVHGHEHUiLQFOXLUOD
FDOLEUDFLyQFRPSDUDQGRODVPHGLGDVFRQODVGHXQPDQyPHWURGHPHUFXULRGLVSXHVWR
HQSDUDOHOR1RVRQUHFRPHQGDEOHVORVPDQyPHWURVDQHURLGHVFRQWRSHHQHOH[WUHPR
LQIHULRUGHODHVFDOD
7pFQLFDGHPHGLGD
x PLQXWRVGHUHSRVRVHQWDGDSUHYLRDODWRPD
x 3RVLFLyQVHQWDGDFRQHODQWHEUD]RGHOPLHPEURVXSHULRUTXHFRUUHVSRQGHDOD
PDQRKiELODSR\DGR\H[WHQGLGRDODDOWXUDGHOFRUD]yQ
x &RORFDFLyQGHOPDQJXLWRGHOHV¿JPRPDQyPHWURGHVLQÀDGRHQODPLWDGGHOEUD]R
OD SRUFLyQ LQÀDEOH GHEHUi FXEULU OD FDUD LQWHUQD GHO EUD]R (O ERUGH LQIHULRU GHO
PDQJXLWRGHEHUiVLWXDUVHDFPGHOSOLHJXHGHOFRGR
x %~VTXHGDSRUSDOSDFLyQGHOODWLGRDUWHULDOHQODSDUWHLQWHUQDGHOSOLHJXHDOOtVH
DSR\DUiODFiSVXODGHOHVWHWRVFRSLRELDXULFXODU
x ,QVXÀDFLyQGHOPDQJXLWRKDVWDPPSRUHQFLPDGHODPHGLGDHQTXHVHGHMDURQ
GHSHUFLELUORVODWLGRV
x $SHUWXUDOHQWDGHODYiOYXODGHOHV¿JPRPDQyPHWUR\GLVPLQXFLyQGHODSUHVLyQ
GHOPDQJXLWRDXQDYHORFLGDGGHPPSRUVHJXQGR
x 5HJLVWUDU HO YDORU GH DSDULFLyQ GH ORV ODWLGRV FRPR WHQVLyQ DUWHULDO Pi[LPD R
VLVWyOLFD
x (OYDORUFRUUHVSRQGLHQWHDODDWHQXDFLyQDSDJDPLHQWRRHQVXGHIHFWRGHVDSDULFLyQ
GHORVODWLGRVVHUHJLVWUDUiFRPRSUHVLyQDUWHULDOPtQLPDRGLDVWyOLFD
0RGL¿FDFLRQHV¿VLROyJLFDVGXUDQWHHOSDUWR
/DV FLIUDV WHQVLRQDOHV WLHQHQ VXV YDORUHV PiV EDMRV HQWUH ODV VHPDQDV \
LQFUHPHQWiQGRVHKDFLDHO¿QDOGHODJHVWDFLyQVLHQGRHVWHDXPHQWRPiVQRWRULRHQORV
QLYHOHVGHSUHVLyQDUWHULDOGLDVWyOLFD
3RU RWUD SDUWH ORV YDORUHV DOWHUDGRV GH SUHVLyQ DUWHULDO GLDVWyOLFD WLHQHQ PD\RU YDORU
SURQyVWLFRTXHORVGHODVLVWyOLFD

6HFRQVLGHUDKLSHUWHQVLyQFXDQGR
x /RVYDORUHVGHSUHVLyQ'LDVWyOLFDVRQGHPP+JRPD\RUHV
x /RVYDORUHVGHSUHVLyQ6LVWyOLFDVRQGHPP+JRPD\RUHV
x $XPHQWRGHODVLVWyOLFDGHPP+JRGHODGLDVWyOLFDGHPP+JR
PiVUHVSHFWRDORVYDORUHVQRUPDOHVGHHVDPXMHUIXHUDGHOHPEDUD]R
(QFDVRGHUHJLVWUDUYDORUHVDQRUPDOHVVHGHEHUHSHWLUODWRPDGHSUHVLyQDUWHULDOFRQOD
PXMHUVHQWDGDOXHJRGHXQDKRUDGHUHSRVRHQGHF~ELWRODWHUDO6LORVYDORUHVGHODVHJXQGD
PHGLGDVHHQFXHQWUDQGHQWURGHOtPLWHVQRUPDOHVODJHVWDQWHQRGHEHUiVHUFDWDORJDGD
FRPRKLSHUWHQVD\GHEHUiVHUFLWDGDSDUDFRQWUROVHJ~QHOFURQRJUDPDKDELWXDO
&ODVL¿FDFLyQGHORVHVWDGRVKLSHUWHQVLYRVGHOHPEDUD]R
x +LSHUWHQVLyQJHVWDFLRQDO+LSHUWHQVLyQWUDQVLWRULDRLQGXFLGDSRUHOHPEDUD]R
VHWUDWDGHXQDKLSHUWHQVLyQTXHVHGLDJQRVWLFDSRUSULPHUDYH]OXHJRGHODV
VHPDQDVGHJHVWDFLyQVLQSURWHLQXULD/DSUHVLyQYXHOYHDODQRUPDOLGDGDQWHV
GHODVVHPDQDVGHOSDUWR
x 3UHHFODPSVLDVHWUDWDGHXQHVWDGRKLSHUWHQVLYRTXHVHGLDJQRVWLFDOXHJRGH
ODVVHPDQDVGHOHPEDUD]RVHDFRPSDxDGHSURWHLQXULD\UHYLHUWHHQORVGtDV
VXFHVLYRVDOSDUWR
x (FODPSVLDVHGHQRPLQDDVtDODSUHHFODPSVLDTXHVREUHDJUHJD FRQYXOVLRQHV
\RFRPD/DHFODPSVLDHVXQDFRPSOLFDFLyQREVWpWULFDGHH[WUHPDJUDYHGDG\
DOWDPRUWDOLGDGPDWHUQD\IHWDO
x 3UHHFODPSVLD VREUHLPSXHVWD D KLSHUWHQVLyQ FUyQLFD VREUH XQ SURFHVR
KLSHUWHQVLYR FUyQLFR DXPHQWDQ ODV FLIUDV GH SUHVLyQ DUWHULDO \ VH LQVWDOD XQD
SURWHLQXULDTXHGHVDSDUHFHFRQOD¿QDOL]DFLyQGHOHPEDUD]R
x +LSHUWHQVLyQFUyQLFDHVFXDQGRVHFRQVWDWDKLSHUWHQVLyQIXHUDGHOHPEDUD]RR
HQODVSULPHUDVVHPDQDVGHOHPEDUD]R
6HFRQVLGHUDKLSRWHQVLyQFXDQGR
x/RVYDORUHVGHOD'LDVWyOLFDVRQPHQRUHVDPP+J
x/RVYDORUHVGHOD6LVWyOLFDVRQPHQRUHVDPP+J
/D SUHVLyQ DUWHULDO VH PHGLUi HQ FDGD FRQVXOWD SDUD SHVTXLVDU OD KLSHUWHQVLyQ R OD
KLSRWHQVLyQPDWHUQD3DUDGHVFDUWDUODKLSHUWHQVLyQSUHYLDDODJHVWDFLyQHVFRQYHQLHQWH
FRPHQ]DUORVFRQWUROHVGHSUHVLyQDUWHULDODQWHVGHODVVHPDQDVGHJHVWDFLyQ
)DFWRUHVGH5LHVJRGHKLSHUWHQVLyQJHVWDFLRQDO\SUHHFODPSVLD
x 1XOLSDULGDG
x $GROHVFHQFLD
x (GDG!GHDxRV
x (PEDUD]RP~OWLSOH
x 2EHVLGDG
x +LVWRULDIDPLOLDUGHSUHHFODPSVLD±HFODPSVLD
x 3UHHFODPSVLDHQHPEDUD]RVDQWHULRUHV
x 'LDEHWHVPHOOLWXVSUHJHVWDFLRQDO
x $QWHFHGHQWHVGHWURPER¿OLDV
x (QIHUPHGDGUHQDOFUyQLFD
x (QIHUPHGDGHVDXWRLQPXQHV
3UHYHQFLyQ
/D SULQFLSDO PHGLGD SUHYHQWLYD HV HVWLPXODU HO FRQWURO SUHQDWDO SUHFR] SHULyGLFR \
FRPSOHWRFRQHOREMHWLYRGHUHPRYHUDTXHOORVIDFWRUHVGHULHVJRTXHVHDVRFLHQFRQ
ODKLSHUWHQVLyQDUWHULDO2WUDVPHGLGDVGHVDOXGS~EOLFDGHOLPLWDGDHIHFWLYLGDGLQFOX\HQ
ODVGLHWDVFRQDFHLWHVULFRVHQiFLGRVJUDVRVPDULQRV\HQSREODFLRQHVFRQGLHWDVEDMDV
HQFDOFLRSURPRYHUODVXSOHPHQWDFLyQGHODGLHWDFRQFDOFLR
/DDGPLQLVWUDFLyQGLDULDGHEDMDVGRVLVGHDVSLULQDDPJGtDGXUDQWHHOWHUFHU
WULPHVWUH GHO HPEDUD]R UHGXFH OD LQFLGHQFLD GH SUHHFODPSVLD HQ SDFLHQWHV FRQ DOWR
ULHVJRGHVXIULUOD(VWHHIHFWRSUHYHQWLYRQRVHKDFRUURERUDGRHQODSREODFLyQJHQHUDO
FRQEDMRULHVJRGHVXIULUSUHHFODPSVLD
3UHGLFFLyQ
+DVWDHOPRPHQWRQRH[LVWHXQDSUXHEDGHWDPL]DMHFRQ¿DEOHSDUDDQWLFLSDUHOGHVDUUROOR
GHXQDSUHHFODPSVLD
&RQGXFWD
/DVPXMHUHVJHVWDQWHVFRQKLSHUWHQVLyQDUWHULDOGHEHUiQVHUDVLVWLGDVGHDFXHUGRDOD
QRUPDQDFLRQDOGHDOWRULHVJR
&21'8&7$65(&20(1'$'$6
+LSHUWHQVLyQLQGXFLGDSRUHOHPEDUD]R
3RGUi DVLVWLUVH HQ IRUPD DPEXODWRULD VL VH SXHGHQ PDQWHQHU FRQWUROHV GH SUHVLyQ
DUWHULDOSHULyGLFRVVHPDQDOPHQWHDQDOL]DUODRULQDHQEXVFDGHSURWHLQXULD\HYDOXDUHO
HVWDGRGHVDOXGIHWDO
6L OD SUHVLyQ DUWHULDO HPSHRUD DSDUHFH DOE~PLQD HQ OD RULQD R KD\ XQD 5&, VHYHUD
RUGHQH OD KRVSLWDOL]DFLyQ \ FRQGX]FD HO WUDWDPLHQWR FRPR VL VH WUDWDVH GH XQD SUH
HFODPSVLD
'HEHUiUHFRPHQGDUVHDODPXMHUTXHDPSOtHORVSHUtRGRVGHGHVFDQVR7DPELpQVHOH
GHEHUiDGYHUWLUDHOOD\VXIDPLOLDVREUHORVULHVJRV\ORVVtQWRPDV\VLJQRVGHDOHUWD
3UHHFODPSVLDOHYH
$GHPiVGHODVPHGLGDVGHWDOODGDVSDUDODVPXMHUHVFRQKLSHUWHQVLyQLQGXFLGDSRUHO
HPEDUD]RVHGHEHUiQWRPDUODVVLJXLHQWHVSUHFDXFLRQHV
6LODVFLIUDVGHSUHVLyQDUWHULDOGLDVWyOLFDQRDOFDQ]DQDORVPPGH+JVHSRGUi
FRQWLQXDUHOFRQWUROGHODSUHVLyQDUWHULDORULQD\HVWDGRIHWDOGRVYHFHVSRUVHPDQDQR
VHUiQHFHVDULRFRPHQ]DUFRQDQWLKLSHUWHQVLYRVQLLQGLFDUVHGDQWHVRGLHWDKLSRVyGLFD
6LHVWRQRIXHUDSRVLEOHVHGHEHUiKRVSLWDOL]DUDODJHVWDQWH6LVHWUDWDGHXQHPEDUD]R
GHWpUPLQRSURFHGDDLQWHUUXPSLUODJUDYLGH]\VLHOHPEDUD]RHVGHSUHWpUPLQRLQGX]FD
PDGXUH]SXOPRQDUFRQFRUWLFRLGHV\FRQWLQ~HFRQORVFRQWUROHVELVHPDQDOHV(QFDVR
GHDJUDYDFLyQGHORVVtQWRPDVKRVSLWDOLFHDODHPEDUD]DGD\DVtVWDODFRPRXQDSUH
HFODPSVLD VHYHUD$XQTXH SXHGH QR VHU GH¿QLWLYR VH KD GHPRVWUDGR TXH HO UHSRVR
KRVSLWDODULRUHGXFHODSUHPDWXUH]\ORVHSLVRGLRVKLSHUWHQVLYRVVHYHURV
3UHHFODPSVLDVHYHUD\ODHFODPSVLD
+DVWDHOPRPHQWRHOWUDWDPLHQWRLGHDOGHODSUHHFODPSVLDVHYHUD\ODHFODPSVLDFRQVLVWH
HQODLQWHUUXSFLyQGHODJHVWDFLyQ$HVRVHGHEHQVXPDURWUDVPHGLGDVWHUDSpXWLFDV
TXHVHGHWDOODQDFRQWLQXDFLyQ
(QWRGDVODVVLWXDFLRQHV
$VHJ~UHVHGHFRQWDUFRQORVUHFXUVRVQHFHVDULRVSDUDDVLVWLUDHVWDPXMHUGHORFRQWUDULR
GHULYHDOQLYHOGHDWHQFLyQDGHFXDGR6RQUHFXUVRVQHFHVDULRVSHUVRQDOHQWUHQDGR
HQPDQHMRGHSDFLHQWHFUtWLFRR[tJHQRODULQJRVFRSLRWXERVHQGRWUDTXHDOHVPiVFDUD
EROVDKLGUDOD]LQDRQLIHGLSLQDVXOIDWRGHPDJQHVLR\JOXFRQDWRGHFDOFLRDO
x /DJHVWDQWHGHEHHVWDUDFRPSDxDGDSRUSHUVRQDOGHVDOXGHQWRGRPRPHQWR
x &DWHWHULFHXQDYHQDGHJUXHVRFDOLEUHFiQXODRVXSHULRU
x ,QIXQGDÀXLGRV
6ROXFLyQVDOLQDRODFWDWR5LQJHUFFKRUDVLQRKD\HGHPDSXOPRQDU
x &RORTXHFDWpWHUYHVLFDOFRQEROVDFROHFWRUDSDUDPHGLUGLXUHVLV
x $GPLQLVWUHPHGLFDPHQWRVDQWLKLSHUWHQVLYRVVLODSUHVLyQGLDVWyOLFDHV!
PPGH+JEXVFDQGRHVWDELOL]DUODHQWUH\PPGH+JVHJ~QHVTXHPD
³RSFLRQHVWHUDSpXWLFDVFRQDQWLKLSHUWHQVLYRV´
&XDGUR2SFLRQHVWHUDSpXWLFDVFRQDQWLKLSHUWHQVLYRV
0HGLFDPHQWR 'RVLVGHDWDTXH
PJLYOHQWRFDGDUHSLWLHQGRGRVLVFDGDPLQXWRVKDVWDORJUDUHIHFWR
+LGUDOD]LQD
GHVHDGRVLQVXSHUDUGRVLV
PJLYOHQWRSXGLHQGRGXSOLFDUGRVLVPJPJHWFFDGD
/DEHWRORO
PLQXWRVKDVWDDOFDQ]DUHIHFWRGHVHDGRVLQVXSHUDUGRVLV
1LIHGLSLQD PJVOSXGLHQGRUHSHWLUGRVLVFDGDPLQXWRV

$GPLQLVWUHVXOIDWRGHPDJQHVLRVHJ~QHVTXHPD³RSFLRQHVWHUDSpXWLFDVFRQ
VXOIDWRGHPDJQHVLR´
x 2EWHQJDPXHVWUDVGHVDQJUH\RULQDSDUDH[iPHQHVGHYDORUDFLyQGHOD
JHVWDQWH
(QFDVRGHPXMHUHQFRPDRFRQFRQYXOVLRQHV
$WRGDVODVSUHFDXFLRQHVDQWHULRUHVVHOHGHEHDJUHJDUHQHVWHWLSRGHVLWXDFLRQHVORV
VLJXLHQWHVFXLGDGRV
x $VHJXUDUODSHUPHDELOLGDGGHODYtDDpUHDDVSLUDUIDULQJHLQWXEDU
x 3URWHJHUODOHQJXDGHPRUGHGXUDV
x $GPLQLVWUDUR[tJHQR
7UDWDPLHQWRFRQ6XOIDWRGH0DJQHVLR
(OVXOIDWRGHPDJQHVLRSRGUiVHUXVDGRHQHOSULPHUQLYHOGHDWHQFLyQVL
x VHJDUDQWL]DQORVUHFXUVRVQHFHVDULRV\DGH¿QLGRV
x ODSURGXFFLyQGHRULQDGLXUHVLVVXSHUDORVPOSRUKRUD
x ODIUHFXHQFLDUHVSLUDWRULDHV!DUHVSLUDFLRQHVSRUPLQXWR
x HOUHÀHMRSDWHODUHVWiFRQVHUYDGR
&XDGUR2SFLRQHVWHUDSpXWLFDVFRQVXOIDWRGHPDJQHVLR
0LHQWUDVKD\D
(VTXHPD 3ODQGH$WDTXH 0DQWHQLPLHQWR
FRQYXOVLRQHV
JDO,9 J,9DO
(QGRYHQRVR J,9VROXFLyQDOD FDGDPLQXWRV SRUKRUD
([FOXVLYR SDVDUHQDPLQXWRV KDVWDHOLPLQDUODV HQLQIXVLyQ
FRQYXOVLRQHV FRQWLQXD
J,9VROXFLyQDOD JDO,9
0L[WR
SDVDUHQDPLQXWRV FDGDPLQXWRV J,0DO
HQGRYHQRVR
6HJXLGRGHJ,0VROXFLyQ KDVWDHOLPLQDUODV FDGDKRUDV
LQWUDPXVFXODU
DOJHQFQDOJD FRQYXOVLRQHV
,QWR[LFDFLyQSRU6XOIDWRGH0DJQHVLR
'HSUHVLyQ5HVSLUDWRULD
(QFDVRGHLQWR[LFDFLyQHQSDFLHQWHYHQWLODGDQRVHUiQHFHVDULRXVDU
DQWtGRWR\VHSRGUiPDQWHQHUHOWUDWDPLHQWR
(QFDVRGHLQWR[LFDFLyQHQSDFLHQWHQRYHQWLODGD
x9HQWLODUHQIRUPDPDQXDORPHFiQLFD
x6XVSHQGHULQPHGLDWDPHQWHODLQIXVLyQGHOVXOIDWRGHPDJQHVLR\
DGPLQLVWUDUJOXFRQDWRGHFDOFLRJ,9OHQWRGHVROXFLyQDO
+LSRWHQVLyQVHYHUD
'HEHWHQHUVHSUHVHQWHTXHHOVXOIDWRGHPDJQHVLRHVXQDJHQWHKLSRWHQVRU\TXH
SXHGHSRWHQFLDUHOHIHFWRGHORVDQWLKLSHUWHQVLYRVXVDGRV
2WURVDQWLFRQYXOVLYDQWHV
/DVHYLGHQFLDVFLHQWt¿FDVVRQLQFRQWUDVWDEOHVHOVXOIDWRGHPDJQHVLRHVHOWUDWDPLHQWR
DQWLFRQYXOVLYDQWHGHHOHFFLyQSDUDODHFODPSVLD\HVSURWHFWRUGHODVFRQYXOVLRQHVHQOD
SUHHFODPSVLDVHYHUD([FOXVLYDPHQWHFXDQGRQRVHFXHQWHFRQpOVHGHEHUiXVDURWUR
DQWLFRQYXOVLYDQWH (O GLD]HSDP HV OD EHQ]RGLDFHSLQD PiV XVDGD VX SULQFLSDO ULHVJR
HVODGHSUHVLyQUHVSLUDWRULDSRUORTXHVHGHEHQWRPDUSUHFDXFLRQHVVLPLODUHVDODV
HPSOHDGDVFRQHOXVRGHOVXOIDWRGHPDJQHVLR
3ODQGHDWDTXH
xPJ,9OHQWRDSDVDUHQPLQXWRV
x6LSHUVLVWHQODVFRQYXOVLRQHVPLQXWRVGHVSXpVGHODSULPHUDGRVLVVHUHSLWH
XQDQXHYDGRVLVDSDVDUHQPLQXWRVKDVWDFRPSOHWDUXQDGRVLVWRWDOGH
JUDPRVHQODSULPHUDKRUD
3ODQGHPDQWHQLPLHQWR
xPJGHGLD]HSDPHQPOGHVROXFLyQVDOLQDDSDVDUHQKRUDV
,QWR[LFDFLyQSRU'LD]HSDP
'HSUHVLyQUHVSLUDWRULD
(QFDVRGHLQWR[LFDFLyQHQSDFLHQWHYHQWLODGDQRVHUiQHFHVDULRXVDU
DQWtGRWR\VHSRGUiPDQWHQHUHOWUDWDPLHQWR
(QFDVRGHLQWR[LFDFLyQHQSDFLHQWHQRYHQWLODGD
x9HQWLODUHQIRUPDPDQXDORPHFiQLFD
x6XVSHQGHULQPHGLDWDPHQWHODLQIXVLyQGHGLD]HSDP\
xDGPLQLVWUDUÀXPD]HQLODQWtGRWRGHODVEHQ]RGLDFHSLQDVPJ,9OHQWRHOHIHFWR
VXHOHVHUGHUiSLGDLQVWDODFLyQ\GHUiSLGDGHVDSDULFLyQSXHGHQQHFHVLWDUVH
GRVLVVXFHVLYDV
+LSRWHQVLyQVHYHUD
'HEHWHQHUVHSUHVHQWHTXHHOGLD]HSDPHVXQDJHQWHKLSRWHQVRU\TXHSXHGHSRWHQFLDU
HOHIHFWRGHORVDQWLKLSHUWHQVLYRVXVDGRV
8QDYH]HVWDELOL]DGDODPXMHUVHGHEHUiSURJUDPDUODLQWHUUXSFLyQGHODJUDYLGH]SRUOD
YtDPiVUiSLGD\VHJXUDSRVLEOH
2%-(7,926 'HVFDUWDUDOWHUDFLRQHVHQHOFUHFLPLHQWRIHWDO
$&7,9,'$' (YDOXDFLyQGHOFUHFLPLHQWRIHWDOSRUPHGLRGHODDOWXUDXWHULQD
JDQDQFLDGHSHVR\HFRJUDItD
/DV DOWHUDFLRQHV HQ HO FUHFLPLHQWR IHWDO SXHGHQ VHU SRU Gp¿FLW 5HVWULFFLyQ GHO
&UHFLPLHQWR,QWUD8WHULQR5&,RSRUH[FHVRPDFURVRPtDIHWDO
5HVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR
8QIHWRWLHQHXQDUHVWULFFLyQHQHOFUHFLPLHQWRLQWUDXWHULQRFXDQGRVXFUHFLPLHQWRHV
PHQRUTXHHOHVSHUDGRSDUDODHGDGJHVWDFLRQDO6LQDFLHVHHQHVHPRPHQWRVHHVWLPD
TXHVXSHVRVHUtDPHQRUTXHHOYDORUGHOSHUFHQWLORGHORVSDWURQHVQRUPDOHVGH
SHVRQHRQDWDOHQIXQFLyQGHODHGDGJHVWDFLRQDO
(QXQVHQWLGRHVWULFWRQRWRGRVORVQLxRVTXHDOQDFHUSHVHQPHQRVTXHORVYDORUHV
FRUUHVSRQGLHQWHVDOSHUFHQWLORVRQ5&,SXHGHWUDWDUVHGHQLxRVFRQPHQRUSHVR
TXHHOHVSHUDGRSHURFRQXQSRWHQFLDOGHFUHFLPLHQWRQRUPDO
(QQXHVWURVSDtVHVODSUHYDOHQFLDGHO5&,RVFLODHQWUHHO\HOGHWRGRVORV
QDFLGRVYLYRV
/RV5&,SUHVHQWDQXQDWDVDGHPRUWDOLGDGSHULQDWDORFKRYHFHVPD\RU\XQULHVJRGH
DV¿[LD VLHWH YHFHV VXSHULRU FXDQGR VH ORV FRPSDUD FRQ ORV UHFLpQ QDFLGRV GH SHVR
DGHFXDGRSDUDODHGDGJHVWDFLRQDO\HVWRHVDXQPiVJUDYHFXDQGROD5&,VHDVRFLD
FRQSUHPDWXUH]
/RV QHRQDWRV FRQ 5&, SXHGHQ VXIULU IUHFXHQWHPHQWH KLSRJOXFHPLD KLSRFDOFHPLD
SROLFLWHPLD \ HVWUpV SRU HQIULDPLHQWR (Q HWDSDV PiV DYDQ]DGDV SXHGHQ SUHVHQWDU
GL¿FXOWDGHQHODSUHQGL]DMH\WUDVWRUQRVHQVX¿VLRORJtD\PHWDEROLVPRTXHVHPDQLIHVWDUiQ
HQODHGDGDGXOWDSRUGLDEHWHVREHVLGDGKLSHUWHQVLyQ\HQIHUPHGDGFRURQDULD
)DFWRUHVTXHVHDVRFLDQFRQPD\RUIUHFXHQFLDDO5&,
x 5&,HQHPEDUD]RDQWHULRU
x +iELWRGHIXPDU
x &RQVXPRGHDOFRKRO
x &RQVXPRGHGURJDV
x ,QVX¿FLHQWHSHVRPDWHUQRDOLQLFLRGHOHPEDUD]R
x ,QVX¿FLHQWHDXPHQWRSRQGHUDOGXUDQWHODJHVWDFLyQ
x +LSHUWHQVLyQDUWHULDOSUHYLDRLQGXFLGDSRUHOHPEDUD]R
x 6tQGURPHVWURPERItOLFRV
x (PEDUD]RP~OWLSOH
x $QHPLDPDWHUQD
x ,QIHFFLRQHVLQWUDXWHULQDV
x 3ODFHQWDSUHYLD
x 'LDEHWHVFRQYDVFXORSDWtD
x 'HIHFWRVFRQJpQLWRV
0DFURVRPtDIHWDO
8QIHWRHVPDFURVyPLFRJUDQGHSDUDVXHGDGJHVWDFLRQDOFXDQGRDOQDFHUWLHQHXQ
SHVRPD\RUTXHHOYDORUGHOSHUFHQWLORGHORVSDWURQHVGHSHVRQHRQDWDOHQIXQFLyQ
GHODHGDGJHVWDFLRQDO
/DPDFURVRPtDIHWDOWLHQHXQULHVJRGHPXHUWHSHULQDWDODSDUWLUGHODVVHPDQDV
FXDWUR YHFHV PD\RU TXH ORV UHFLpQ QDFLGRV GH SHVR DGHFXDGR 7DPELpQ WLHQH XQD
IUHFXHQFLDPD\RUGHSDUWRLQVWUXPHQWDOGLVWRFLDGHKRPEURVVXIULPLHQWRIHWDODJXGR
LQWUDSDUWR GHSUHVLyQ QHRQDWDO \ VHFXHODV QHXUROyJLFDV (VWRV QLxRV WLHQHQ XQD
SHRU DGDSWDFLyQ D OD YLGD H[WUDXWHULQD HQIHUPHGDG GH PHPEUDQD KLDOLQD GL¿FXOWDG
UHVSLUDWRULDWUDQVLWRULD\RKLSRJOXFHPLD
)DFWRUHVTXHVHDVRFLDQFRQPD\RUIUHFXHQFLDDODPDFURVRPtDIHWDO
x 0DFURVRPtDHQHPEDUD]RDQWHULRU
x 'LDEHWHVPDWHUQDQRYDVFXODU
x ,VRLQPXQL]DFLyQ5K
x 0DGUHREHVDFRQH[FHVLYRDXPHQWRSRQGHUDOGXUDQWHODJHVWDFLyQ
7HFQRORJtDVSDUDPHGLUHOFUHFLPLHQWRIHWDO
/DVWHFQRORJtDVPiVXVDGDVVRQ
x(YDOXDFLyQGHOLQFUHPHQWRGHODDOWXUDXWHULQD
x(YDOXDFLyQGHODJDQDQFLDGHSHVRPDWHUQR
x$QWURSRPHWUtDIHWDOSRUHFRJUDItD
'HEHGHVWDFDUVHTXHHODQWHFHGHQWHREVWpWULFRGHSHTXHxRSDUDODHGDGJHVWDFLRQDO
3(* R GH PDFURVRPtD IHWDO HQ XQD JHVWDFLyQ DQWHULRU DXPHQWD DSUR[LPDGDPHQWH
FXDWURYHFHVHOULHVJRGHTXHHOHYHQWRVHUHSLWDHQHOHPEDUD]RDFWXDO
(YDOXDFLyQGHOLQFUHPHQWRGHODDOWXUDXWHULQD
(OIHWRDXPHQWDVXWDPDxRFRQODHGDGJHVWDFLRQDO\HVHFUHFLPLHQWRVHPLGHFOtQLFDPHQWH
SRUODPHGLFLyQGHODDOWXUDXWHULQDFRQXQDFLQWDPpWULFDÀH[LEOHHLQH[WHQVLEOHGHVGH
HO SXELV KDVWD HO IRQGR XWHULQR GHWHUPLQDGR SRU SDOSDFLyQ ¿JXUD (Q HO &/$3
605VHKDQGHVDUUROODGRFXUYDVGHDOWXUDXWHULQDHQIXQFLyQGHODHGDGJHVWDFLRQDOHQ
GRQGHORVSHUFHQWLORV\PDUFDQORVOtPLWHVGHODQRUPDOLGDG¿JXUD
3DWURQHVQRUPDOHVGHODDOWXUDXWHULQDHQIXQFLyQGHODHGDGJHVWDFLRQDO
(VWDVFXUYDVIXHURQ
GLVHxDGDVFRQSREODFLRQHV
ODWLQRDPHULFDQDVQRUPDOHV
HPSOHDQGRFRPRWpFQLFDGH
PHGLGDODVLJXLHQWH
Figura 52. Gráfico de Altura Uterina

en función de la Edad Gestacional
(O DXPHQWR LQVX¿FLHQWH GH OD DOWXUD XWHULQD FXDQGR VH WLHQHQ GDWRV FRQ¿DEOHV GH
DPHQRUUHD\VHKDGHVFDUWDGRHOIHWRPXHUWR\RHOROLJRDPQLRVSHUPLWHGLDJQRVWLFDU
5&,FRQXQDVHQVLELOLGDGGH\XQDHVSHFL¿FLGDGGH
/DVHQVLELOLGDGGHODDOWXUDXWHULQDSDUDHOGLDJQyVWLFRGHODPDFURVRPtDIHWDOHVGHO
\ODHVSHFL¿FLGDGGHXQDYH]H[FOXLGRHOHPEDUD]RJHPHODUHOSROLKLGUDPQLRV
\ODPLRPDWRVLVXWHULQD
([LVWHQGLVWLQWRVWLSRVGHPHGLGDTXHJHQHUDQGLIHUHQWHV
YDORUHVSRUORFXDOHVLPSUHVFLQGLEOHQRUPDWL]DUODIRUPD
GHPHGLU\XWLOL]DUSDWURQHVQRUPDOHVGHUHIHUHQFLDTXH
KD\DQVLGRHODERUDGRVFRQODPLVPDWpFQLFD
6HFRORFDHOFHURGHODFLQWDVREUHHOERUGHVXSHULRUGHO
SXELVFRQXQDPDQRGHVOL]iQGRODFLQWDHQWUHORVGH
Figura 53. Técnica de medida, con GRVtQGLFH\PD\RUGHODRWUDPDQRKDVWDDOFDQ]DUHO
cinta entre dedos índice y mayor IRQGRXWHULQRFRQHOERUGHFXELWDOGHHVDPDQR
2WUDIRUPDGHPHGLGDFRQVLVWHHQFRORFDUHOFHURGHOD
FLQWDVREUHHOERUGHVXSHULRUGHOSXELV\ODFLQWDVHFRORFD
GHEDMRGHOERUGHFXELWDOGHODPDQRSRUORFXDODOGHVFULELU
XQDFXUYDWXUDPD\RUHOYDORUTXHVHREVHUYDHVGH
FPVXSHULRUHQHOHUWULPHVWUHGHODJHVWDFLyQVLVH
ODFRPSDUDFRQODWpFQLFDGHPHGLGDFLWDGDDQWHULRUPHQWH
(VWDWpFQLFDGHPHGLGDQRVHFRUUHVSRQGHFRQODVWDEODV
GLVHxDGDVSRUHO&/$3605 Figura 54. Técnica de medida,
con cinta debajo del borde cubital.
(OYDORUKDOODGRHQODPHGLFLyQVHWUDVODGDDODFXUYDGHDOWXUDSDUDODHGDGJHVWDFLRQDO
GHOFDUQpSHULQDWDO
,QWHUSUHWDFLyQ
9DORUQRUPDO(VHOFRPSUHQGLGRHQWUHORVSHUFHQWLORV\GHODFXUYDSDWUyQGH
DOWXUDXWHULQDSDUDODHGDGJHVWDFLRQDO
9DORUDQRUPDO(VHOTXHH[FHGHDOSHUFHQWLORRHVWiSRUGHEDMRGHOSHUFHQWLORGH
ODFXUYDGHUHIHUHQFLD
7RGDJHVWDQWHFRQXQYDORUDQRUPDOGHEHVHUUHIHULGDDYDORUDFLyQGHDOWRULHVJR
(-(03/26'(/$(9$/8$&,21'(/$5(/$&,21
$/785$87(5,1$$8('$'*(67$&,21$/(*
$/$35,0(5$&2168/7$
6LWXDFLyQ
(OSXQWRVHVLW~DHQWUHODVFXUYDVGH
ORVSHUFHQWLORV\GHODFXUYDGH
UHIHUHQFLD
,QWHUSUHWDFLyQ
9DORU1RUPDO
&RQGXFWDV
6HJXLUFDOHQGDULRKDELWXDOGH
FRQVXOWDV
([SOLFDUDODJHVWDQWHTXHOD$8HV
DGHFXDGDSDUDVXHGDGJHVWDFLRQDO
(OQLxRFUHFHELHQ
6LWXDFLyQ
(OSXQWRVHXELFDSRUHQFLPDGHOD
OtQHDGHOSHUFHQWLOR
,QWHUSUHWDFLyQ
$OWXUDXWHULQDPD\RUTXHODDPHQRUUHD
&RQGXFWDV
'HVFDUWDUHUURUGHFiOFXORGHOD(*
'HWHUPLQDURWUDVFDXVDV
SROLKLGUDPQLRVPDFURVRPtDIHWDO
HPEDUD]RP~OWLSOHPRODPLRPDWRVLV
XWHULQDREHVLGDG
&LWDUDYDORUDFLyQSRUHTXLSRGHDOWR
ULHVJRHQPHQRVGHGtDV
6LWXDFLyQ
(OSXQWRVHXELFDSRUGHEDMRGHOD
OtQHDGHOSHUFHQWLOR
,QWHUSUHWDFLyQ
$OWXUDXWHULQDPHQRUTXHODDPHQRUUHD
&RQGXFWDV
'HWHUPLQDURWUDVFDXVDV5&,yELWR
IHWDOROLJRDPQLRV
&LWDUDYDORUDFLyQSRUHTXLSRGHDOWR
ULHVJRHQPHQRVGHGtDV
(-(03/26'(/$(9$/8$&,21'(/$7(1'(1&,$'(/$5(/$&,21
$/785$87(5,1$$8('$'*(67$&,21$/(*
(1&2168/7$668%6(&8(17(6
6LWXDFLyQ
/DOtQHDWUDQVFXUUHHQWUHODVFXUYDVGH
ORVSHUFHQWLORV\
,QWHUSUHWDFLyQ
&UHFLPLHQWRQRUPDO
&RQGXFWDV
6HJXLUFDOHQGDULRKDELWXDOGH
FRQVXOWDV
([SOLFDUDODJHVWDQWHTXHHO
FUHFLPLHQWRHVQRUPDO
6LWXDFLyQ
/DOtQHDWUDQVFXUUHSRUHQFLPDGHOD
OtQHDGHOSHUFHQWLOR
,QWHUSUHWDFLyQ
3RVLEOHHUURUGH(*FRQFUHFLPLHQWR
QRUPDO
&RQGXFWDV
(YDOXDUSRUHTXLSRGHDOWRULHVJRHQ
PHQRVGHGtDVSDUDGHVFDUWDU
PDFURVRPtDSROLKLGUDPQLRVHWF
6LWXDFLyQ
/DOtQHDWUDQVFXUUHSRUGHEDMRGHOD
OtQHDGHOSHUFHQWLOR
,QWHUSUHWDFLyQ
3RVLEOHHUURUGH(*FRQFUHFLPLHQWR
QRUPDO
&RQGXFWDV
(YDOXDUSRUHTXLSRGHDOWRULHVJRHQ
ROLJRDPQLRVR5&,
6LWXDFLyQ
/DOtQHDDVFLHQGHGHVGHODIDMDGHOD
QRUPDOLGDGSS
,QWHUSUHWDFLyQ
&UHFLPLHQWRDQRUPDOHQPiV
&RQGXFWDV
'HULYDUDFRQWUROGHDOWRULHVJRHQ
SROLKLGUDPQLRVPDFURVRPtD
HPEDUD]RP~OWLSOHHWF
6LWXDFLyQ
/DOtQHDGHVFLHQGHGHVGHODIDMDGHOD
QRUPDOLGDGSS
,QWHUSUHWDFLyQ
&UHFLPLHQWRDQRUPDOHQPHQRV
3RVLEOH5&,
&RQGXFWDV
'HULYDUDFRQWUROGHDOWRULHVJRHQ
PHQRVGHGtDV
x(YDOXDFLyQGHODJDQDQFLDGHSHVRPDWHUQR
/DVRVSHFKDGH5&,VHUHD¿UPDVLDGHPiVGHXQDDOWXUDXWHULQDPHQRUTXHHOS
H[LVWHXQDJDQDQFLDGHSHVRPDWHUQDPHQRUTXHHOSRXQSHVRPDWHUQRSDUDODWDOOD
PHQRUTXHHOS
/D DVRFLDFLyQ GH OD DOWXUD XWHULQD HQ SDUDOHOR FRQ OD JDQDQFLD GH SHVR GH OD PDGUH
GXUDQWHODJHVWDFLyQWLHQHXQDDOWDVHQVLELOLGDGSDUDSUHGHFLU3(*VyORVXSHUDGD
SRUHOSHUtPHWURDEGRPLQDOIHWDOPHGLGRSRUHFRJUDItD
&RQGXFWD
/RVFDVRVFRQVRVSHFKDFOtQLFDGH5&,H[FOXLGRHOROLJRDPQLRVHOHUURUGHDPHQRUUHD
HWFGHEHUiQVHUFRQ¿UPDGRVSRUHFRJUDItDSDUDGHVFDUWDUORVIDOVRVSRVLWLYRV\XQD
YH]FRQ¿UPDGRHOGLDJQyVWLFRVHGHEHUiUHIHULUDHVWDVJHVWDQWHVDFRQVXOWDGHDOWR
ULHVJR
x$QWURSRPHWUtDIHWDOSRUHFRJUDItDELGLPHQVLRQDO
6H WUDWD GHO H[DPHQ FRPSOHPHQWDULR PiV VHJXUR SDUD GLDJQRVWLFDU DOWHUDFLRQHV
GHOFUHFLPLHQWRIHWDO
6H KDQ GHVDUUROODGR WDEODV \ FXUYDV GH OD HYROXFLyQ GH YDULRV SDUiPHWURV
DQWURSRPpWULFRVIHWDOHVTXHSHUPLWHQFRQRFHUVXFUHFLPLHQWRHQUHODFLyQFRQODHGDG
JHVWDFLRQDO
/DHFRJUDItDSHUPLWHGLIHUHQFLDUHQWUHUHVWULFFLyQGHFUHFLPLHQWRLQWUDXWHULQRVLPpWULFR
\DVLPpWULFRDGHPiVGHGHWHFWDUORVPiVSUHFR]PHQWHTXHODVPHGLGDVFOtQLFDV7LHQH
FRPRLQFRQYHQLHQWHHOFRVWRGHOHTXLSDPLHQWR\ODQHFHVLGDGGHSHUVRQDOHQWUHQDGR
(Q5&,GHWLSRVLPpWULFRWRGDVODVPHGLGDVIHWDOHVVHHQFXHQWUDQUHGXFLGDVSHUtPHWUR
FUDQHDQRWDOOD\SHVRPLHQWUDVTXHHQHODVLPpWULFRVyORGLVPLQX\HHOSHVRSHUtPHWUR
DEGRPLQDO\ODWDOOD\SHUtPHWURFUDQHDQRVHPDQWLHQHQQRUPDOHV
/DVPHGLGDVPiVXVDGDVVRQ
DSHUtPHWURDEGRPLQDOIHWDOVHORSXHGHPHGLUGLUHFWDPHQWHGHOHTXLSRGHHFRJUDItD
UHFRUULHQGRHOSHUtPHWURH[WHUQRGHODEGRPHQIHWDODQLYHOGHO'XFWXV9HQRVRGH$UDQFLR
RGHWHUPLQDQGRHOGLiPHWURPD\RU'\HOGLiPHWURPHQRUGSHUSHQGLFXODUDODQWHULRU
DPERVPHGLGRVGHERUGHH[WHUQRDERUGHH[WHUQR$SOLFDQGRODIyUPXODGHODHOLSVHVH
REWLHQHHOSHUtPHWUR
3$EG 'G[

6HWUDWDGHODPHMRUPHGLGDSDUDHYDOXDUHOFUHFLPLHQWRIHWDOFRQXQDVHQVLELOLGDGGH
\ XQD HVSHFL¿FLGDG GH SDUD HO GLDJQyVWLFR GH UHVWULFFLyQ GH FUHFLPLHQWR
LQWUDXWHULQR \ GHO \ GH VHQVLELOLGDG \ HVSHFL¿FLGDG UHVSHFWLYDPHQWH SDUD HO
GLDJQyVWLFRGHPDFURVRPtDIHWDO
EGLiPHWURELSDULHWDOIHWDOSDUDHOGLDJQyVWLFRGH5&,WLHQHXQDVHQVLELOLGDGGH
\XQDHVSHFL¿FLGDGGH
(Q ORV IHWRV PDFURVyPLFRV ORV YDORUHV VRQ VLPLODUHV D ORV GH IHWRV FRQ FUHFLPLHQWR
QRUPDO
FSHUtPHWUR FUDQHDQR IHWDO VH FRPSRUWD GH PDQHUD VLPLODU DO GLiPHWUR ELSDULHWDO
'%3 1R VH PRGL¿FD HQ ORV IHWRV PDFURVyPLFRV 6H PRGL¿FD SRFR HQ ODV 5&,
DVLPpWULFDV \ VH DOWHUD FRQVLGHUDEOHPHQWH HQ ODV 5&, VLPpWULFDV OR TXH SHUPLWH
KDFHUGLDJQyVWLFRGLIHUHQFLDOGHWLSRGH5&,

(QHOPLVPRSODQRTXHVHPLGHHO'%3DQLYHOGHOFDYXPGHOVHSWXPSHOO~FLGXP
VH PLGH HO GLiPHWUR IURQWR RFFLSLWDO ')2 GHVGH HO ERUGH H[WHUQR GHO IURQWDO DO
ERUGHH[WHUQRGHORFFLSLWDO&RQDPERVGLiPHWURVDSOLFDQGRODIyUPXODGHODHOLSVH
VHREWLHQHHOSHUtPHWURFUDQHDQR
3&U '%3')2[

&XDGUR9DORUHVHVSHUDGRVVHJ~QODDOWHUDFLyQGHOFUHFLPLHQWR
$OWHUDFLyQ 9DORUHVHVSHUDGRV
3HUtPHWURDEGRPLQDOIHWDO 3HUtPHWURFUDQHDQRR'%3
0DFURVyPLFR !S HQWUHS\S
5&,VLPpWULFD S S
5&,DVLPpWULFD S HQWUHS\S
G 5HODFLyQ 3HUtPHWUR DEGRPLQDO IHWDO/RQJLWXG GHO IpPXU \ YHORFLGDG GH

FUHFLPLHQWR GHO SHUtPHWUR DEGRPLQDO VHJ~Q YDORU SUHYLR VRQ LQGLFDGRUHV GH
FUHFLPLHQWRLQGHSHQGLHQWHVGHODHGDGJHVWDFLRQDO(VWRHVORPiVDSURSLDGRSDUD
XVDUHQFDVRVGHJHVWDQWHVGHHGDGJHVWDFLRQDOGHVFRQRFLGD\FDSWDFLyQWDUGtD
*HVWDQWHHQFXLGDGRSUHQDWDO
(GDG
6L JHVWDFLRQDO(* 1R
FRQRFLGD\VLQ
GXGDV
0HGLGDVHULDGDGHDOWXUDXWHULQD$83HVR &DSWDFLyQ 1R

6L
PDWHUQR309ROXPHQOLTDPQLyWLFR/$ DQWHVGHODV
,QYHVWLJDFLyQGHIDFWRUHVGHULHVJR VHPDQDV
'HWHUPLQDFLyQSRU(&2GH(* (&2XWLOL]DQGRLQGLFDGRUHVGH
$8S
30S /&& GHDVHPDQDV FUHFLPLHQWRLQGHSHQGLHQWHGHOD(*
1R 6L
2OLJRDPQLRV '%3 DSDUWLUGHVHPDQDV 3HU$EG
/) DSDUWLUGHVHPDQDV 5HODF
)DFWRUHVGH /)
ULHVJR 9HOFUHFLPLHQWRVHJ~QYDORUSUHYLR
GHO3HU$EG
6RVSHFKD
5&,
$WHQFLyQVHJ~QSDXWDGHEDMRULHVJR $WHQFLyQVHJ~QSDXWDGHDOWRULHVJR
)LJXUD(YDOXDFLyQGHOFUHFLPLHQWRIHWDO
7UDWDPLHQWR
/RV FDVRV HQ ORV TXH VH GLDJQRVWLTXH 5&, GHEHUiQ VHU DVLVWLGRV HQ HO QLYHO GH DOWR
ULHVJR
0LHQWUDVODHPEDUD]DGDFRQWLQ~HVXDWHQFLyQHQHOSULPHUQLYHOVHGHEHUiLQGLFDU
x0HGLGDVJHQHUDOHV
6XVSHQGHU HO WDEDFR DOFRKRO \ GURJDV &DOPDU OD DQVLHGDG \ PHMRUDU OD
QXWULFLyQ
x$XPHQWDUHOÀXMR~WHURSODFHQWDULR
5HSRVR HQ FDPD SUHIHUHQWHPHQWH HQ GHF~ELWR ODWHUDO L]TXLHUGR GRVLV EDMDV
PJGtDGHiFLGRDFHWLOVDOLFtOLFR
x7UDWDUSDWRORJtDPDWHUQDVLH[LVWH
(OWUDWDPLHQWRGHODKLSHUWHQVLyQDUWHULDOODDQHPLDSRUKHPRUUDJLDFDUHQFLDVX
RWUDVHQIHUPHGDGHV\HOFRQWUROGHODGLDEHWHVSXHGHQJHQHUDUXQFUHFLPLHQWR
GHUHFXSHUDFLyQ

(Q ORV HPEDUD]RV GH WpUPLQR HO WUDWDPLHQWR LGHDO FRQVLVWLUi HQ OD ¿QDOL]DFLyQ GH OD
JUDYLGH]SRUODYtDPiVDGHFXDGD/RTXHVHUiGHWHUPLQDGRHQFDGDFDVRFOtQLFRHQ
SDUWLFXODU
/D FRQGXFWD REVWpWULFD HQ ORV HPEDUD]RV GH SUHWpUPLQR VRPHWHUi D ORV HTXLSRV D
ODGLV\XQWLYDGHH[WUDHUXQQLxRLQPDGXURFRQULHVJRGHPXHUWHQHRQDWDORVHFXHODV
\ PDQWHQHUOR KDVWD DOFDQ]DU OD PDGXUH] \ FRUUHU HO ULHVJR GH TXH VH SURGX]FD XQD
PXHUWH IHWDO 'H OD PLVPD PDQHUD OD YtD GHO SDUWR VH GH¿QLUi HQ IXQFLyQ GH OD HGDG
JHVWDFLRQDO\GHODVDOXGIHWDO\ODWROHUDQFLDDODVFRQWUDFFLRQHVXWHULQDV(QORVFDVRV
GHHPEDUD]RVGHSUHWpUPLQRHOWUDWDPLHQWRFRQFRUWLFRLGHVSDUDLQGXFLUODPDGXUDFLyQ
SXOPRQDUIHWDOHVXQUHFXUVRIXQGDPHQWDO
2%-(7,926 'HWHFWDU SUHFR]PHQWH HO HPEDUD]R P~OWLSOH SDUD SUHYHQLU VXV

FRPSOLFDFLRQHV
$&7,9,'$' 'LDJQyVWLFRGHOQ~PHURGHIHWRV
(PEDUD]RP~OWLSOH
/DIUHFXHQFLDGHOHPEDUD]RGREOHRJHPHODUHOPiVFRP~QGHORVHPEDUD]RVP~OWLSOHV
RVFLODHQWRUQRGHXQRFDGDDQDFLPLHQWRV~QLFRV&RQODLQWURGXFFLyQGHODV
WpFQLFDVGHHVWLPXODFLyQGHODRYXODFLyQ\ODIHUWLOL]DFLyQLQ9LWURHQPXMHUHVHVWpULOHVVH
KDLQFUHPHQWDGRHOQ~PHURGHODVJHVWDFLRQHVP~OWLSOHV$SHVDUGHHVWRODIUHFXHQFLD
GHHPEDUD]RVP~OWLSOHVHQHOWRWDOGHQDFLPLHQWRVRVFLODHQWUH\
'HORVHPEDUD]RVGREOHVXQWHUFLRVRQPRQRFLJyWLFRVRJHPHORVLGpQWLFRV\GRVWHUFLRV
VRQELFLJyWLFRVRIUDWHUQRV/DLQÀXHQFLDGHODHGDGPDWHUQDODSDULGDGODKHUHQFLDOD
UD]D\ORVPHGLFDPHQWRVVHH[SUHVD~QLFDPHQWHHQORVHPEDUD]RVP~OWLSOHVELFLJyWLFRV
WDOFRPRVHH[SUHVDHQHOFXDGUR
&XDGUR,QÀXHQFLDGHDOJXQRVIDFWRUHVVREUHODIUHFXHQFLDGHHPEDUD]RVP~OWLSOHV
ELFLJyWLFRV
3DULGDG HQSULPHUSDUWR
HQFXDUWRSDUWR
+HUHQFLD $QWHFHGHQWHVPDWHUQRVDXPHQWDQGHD
YDFHVODSUREDELOLGDG
'URJDVDQWLFRQFHSWLYDV 3RVWDQRYXODWRULRVRUDOHVHQHOPHVVLJXLHQWHD
VXLQWHUUXSFLyQ
'URJDVLQGXFWRUDVGHODRYXODFLyQ *RQDGRWUR¿QD&RULyQLFD+XPDQD
&ORPLIHQR
5D]D QHJUDF
EODQFDF
DPDULOODF
/D GXUDFLyQ GHO HPEDUD]R \ HO SHVR GH ORV UHFLpQ QDFLGRV VRQ PHQRUHV FXDQGR VH
ORV FRPSDUD FRQ HPEDUD]RV ~QLFRV (O YDORU PHGLR GH HGDG JHVWDFLRQDO DO SDUWR HV
GHXQDVVHPDQDVPHQRU\HOYDORUPHGLRGHOSHVRDOQDFHUHVJPHQRUHQORV
HPEDUD]RVP~OWLSOHV
)5
(PEDUD]RV
[ ~QLFRV
3
3

[ (PEDUD]RV
3 ~QLFRV
3
1
3
3

1

HGDG SHVRJ
JHVWDFLRQDO
)5 [
3
(PEDUD]RV 3 (PEDUD]RV
[ P~OWLSHV P~OWLSHV
3
3
1
3
3

1

HGDG SHVRJ
JHVWDFLRQDO
Figura 56. Distribución de la edad gestacional al Figura 57. Distribución del peso al nacer en
momento del parto en embarazos únicos y múltiples embarazos únicos y múltiples sin intervenciones
sin intervenciones especiales durante el prenatal especiales durante el prenatal
(Q PDWHUQLGDGHV S~EOLFDV FRQ SREODFLRQHV GH FRQGLFLyQ VRFLRHFRQyPLFD EDMD

DSUR[LPDGDPHQWHODPLWDGGHORVHPEDUD]RVP~OWLSOHVWHUPLQDQHQSDUWRVGHSUHWpUPLQR
PHQRVGHVHPDQDV'HORVTXHOOHJDQDWpUPLQRPiVGHODPLWDGVXIUHQXQD5&,
/DDV¿[LDJUDYHDOSULPHU\DOTXLQWRPLQXWRGHYLGDWUHV\FXDWURYHFHVUHVSHFWLYDPHQWH
PD\RUTXHHQORVSDUWRV~QLFRV
&XDGUR3DWRORJtDVTXHVHDVRFLDQFRQHPEDUD]RP~OWLSOH
0DWHUQDV )HWDOHV 1HRQDWDOHV
$QHPLDV 0DOIRUPDFLRQHV 3UHWpUPLQR
3UHHFODPSVLD 5&, 3(*
'HSUHVLyQ QHRQDWDO DO
$FFLGHQWHVSODFHQWDULRV 6)$LQWUDSDUWR HU\PLQXWR
3ROLKLGUDPQLRV 3UHVHQWDFLRQHVDQRUPDOHV
+HPRUUDJLDSRUDWRQtDXWHULQD
/DPRUWDOLGDGQHRQDWDOHQORVHPEDUD]RVP~OWLSOHVHVFXDWURYHFHVPiVDOWDTXHHQ
ORVHPEDUD]RV~QLFRV/DPRUELOLGDGWDPELpQHVPD\RUTXHHQORVHPEDUD]RV~QLFRV
OD LQFLGHQFLD GH UHWUDVR HQ HO GHVDUUROOR ItVLFR \ PHQWDO \ OD SDUiOLVLV FHUHEUDO HVWiQ
DXPHQWDGDVHQHVWRVQLxRV
'LDJQyVWLFRGHHPEDUD]RP~OWLSOH
6RVSHFKD
x $QWHFHGHQWHVIDPLOLDUHVPDWHUQRVRSHUVRQDOHVGHHPEDUD]RP~OWLSOH
x 7R[HPLDWHPSUDQDHQHOHPEDUD]R
x +LSHUHPHVLV
x 7UDWDPLHQWRSUHYLRDODFWXDOHPEDUD]RFRQHVWLPXODQWHVGHODRYXODFLyQ
3UHVXQFLyQ
x ÒWHURGHPD\RUWDPDxRTXHHOHVSHUDGRSDUDODHGDGJHVWDFLRQDO
x $OWXUD XWHULQD SRU HQFLPD GHO S GH OD FXUYD GH DOWXUD XWHULQD VHJ~Q HGDG
JHVWDFLRQDO
x 3DOSDFLyQGHQXPHURVDVSDUWHVIHWDOHV
x 3DOSDFLyQGHPiVGHGRVSRORVIHWDOHV
x 3DOSDFLyQGHGRVSRORVIHWDOHVLJXDOHVGRVSRORVFHIiOLFRVRGRVSRGiOLFRV
x 3DOSDFLyQGHGRVSRORVIHWDOHVGLVWLQWRVPX\FHUFDRPX\OHMRVXQRGHORWURFRPR
SDUDFRUUHVSRQGHUDOPLVPRIHWR
x $XVFXOWDFLyQGHPiVGHXQIRFRGHODWLGRVIHWDOHVFRQIUHFXHQFLDGLIHUHQWH
&HUWH]D
x 9LVXDOL]DFLyQGHGRVIHWRVSRUHFRJUDItD
x 'HWHFFLyQ GH GRV UHJLVWURV VLPXOWiQHRV GH IUHFXHQFLD FDUGtDFD IHWDO QR
VLQFUyQLFRV
'LDJQyVWLFRGLIHUHQFLDO
'HVFDUWDGR HO GLDJQyVWLFR GH HPEDUD]R P~OWLSOH D YHFHV XQD GLVFRUGDQFLD HQ PiV
HQWUH OD DOWXUD XWHULQD \ OD DPHQRUUHD HV H[SOLFDGD SRU XQD PDFURVRPtD IHWDO XQ
SROLKLGUDPQLRVRXQDPLRPDWRVLVXWHULQD7DQWRHOSROLKLGUDPQLRVFRPRODPDFURVRPtD
IHWDOSXHGHQVHUFRQVHFXHQFLDGHXQDGLDEHWHVFRQFRPLWDQWHFRQHOHPEDUD]R\DVHD
JHVWDFLRQDORQR
&RQGXFWD
&RQGLDJQyVWLFRFRQ¿UPDGRGHHPEDUD]RP~OWLSOHODJHVWDQWHGHEHVHUUHIHULGDSDUD
VX XOWHULRU FRQWURO HQ DOWR ULHVJR \ OD DWHQFLyQ GHO SDUWR VH HIHFWXDUi HQ XQ QLYHO GH
PD\RUFRPSOHMLGDG
2%-(7,926 3HVTXLVDUODVSUHVHQWDFLRQHVIHWDOHVDQRUPDOHV
$&7,9,'$' 'LDJQyVWLFRGHSUHVHQWDFLyQIHWDO
6HGH¿QHFRPRSUHVHQWDFLyQODSDUWHGHOIHWRTXHVHHQFXHQWUDHQFRQWDFWRFRQODSHOYLV
PDWHUQD FDSD] GH FXPSOLU FRQ XQ PHFDQLVPR GH SDUWR 3XHGH VHU OD FDEH]D IHWDO
SUHVHQWDFLyQFHIiOLFDRSXHGHQVHUORVPLHPEURVLQIHULRUHVRODVQDOJDVSUHVHQWDFLyQ
SHOYLDQDRSRGiOLFD6LHOTXHVHRIUHFHDODSHOYLVHVHOKRPEURIHWDOVHGHQRPLQD
VLWXDFLyQWUDQVYHUVD\QRVHUiFDSD]GHWHUPLQDUHVSRQWiQHDPHQWHHQSDUWRSRUYtD
YDJLQDO
3UHVHQWDFLyQSHOYLDQDRSRGiOLFD
/DIUHFXHQFLDGHODSUHVHQWDFLyQSHOYLDQDHQHPEDUD]DGDVGHWpUPLQRFRQIHWR~QLFR
GHSHVRLJXDORPD\RUDJYDUtDHQWUH\GHORVSDUWRV
(OSDUWRHQSHOYLDQDVHDVRFLDFRQPD\RUPRUELPRUWDOLGDGSHULQDWDO
&LUFXQVWDQFLDVTXHDXPHQWDQODIUHFXHQFLDGHSUHVHQWDFLyQSRGiOLFD
x 3DUWRGHSUHWpUPLQR
x (PEDUD]RP~OWLSOH
x 3ROLKLGUDPQLRV
x 3ODFHQWDSUHYLD
x 0DOIRUPDFLRQHVIHWDOHVDQHQFHIDOLDKLGURFHIDOLDHWF
x 0DOIRUPDFLRQHVXWHULQDV
6LWXDFLyQWUDQVYHUVD
6XIUHFXHQFLDHVPHQRUDFDGDSDUWRV6HDVRFLDFRQODVPLVPDVFLUFXQVWDQFLDV
TXHIDYRUHFHQDODSUHVHQWDFLyQSHOYLDQD'HMDGDDVXHYROXFLyQHVSRQWiQHDWHUPLQD
HQURWXUDXWHULQDPXHUWHPDWHUQD\IHWDO
'LDJQyVWLFRGHSUHVHQWDFLyQSHOYLDQDRVLWXDFLyQWUDQVYHUVD
&OtQLFR
3DUD HIHFWXDU HO GLDJQyVWLFR GH OD FRORFDFLyQ GHO IHWR HQ HO ~WHUR VH UHFRPLHQGD
IDPLOLDUL]DUVHFRQODVPDQLREUDVVLVWHPDWL]DGDVGH/HRSROG
3ULPHUD PDQLREUD SDOSDQGR HO IRQGR VH SXHGH

LGHQWL¿FDUHOSRORIHWDOTXHORRFXSD6LHOSRORHV
GXURHVIpULFRUHJXODUSHORWHD\SUHVHQWDHOVXUFR
GHOFXHOOR\WDQWRODSDOSDFLyQFRPRHOSHORWHRVRQ
GRORURVRVVHSXHGHDVXPLUTXHHOIRQGRGHO~WHUR
HVWiRFXSDGRSRUODFDEH]D6LVHFRQ¿UPDTXHOD
FDEH]DHVWiHQHOIRQGRVHKDEUiKHFKRHQWRQFHV
GLDJQyVWLFRGHSUHVHQWDFLyQSHOYLDQD Figura 58. Primera maniobra de Leopold
6HJXQGD PDQLREUD SDOSDQGR ORV ÀDQFRV VH

GHWHUPLQD VLWXDFLyQ \ XELFDFLyQ GHO GRUVR IHWDO
1RUPDOPHQWH HQ OD VLWXDFLyQ ORQJLWXGLQDO VH
SDOSDUi D XQ ODGR HO GRUVR \ HQ HO RWUR HO YLHQWUH
IHWDO3RUHOFRQWUDULRHQODVLWXDFLyQWUDQVYHUVDVH
SDOSDUiQ DPERV SRORV IHWDOHV XELFDGRV D DPERV
ODGRVGHOYLHQWUHPDWHUQR
Figura 59. Segunda maniobra de Leopold
7HUFHUD PDQLREUD SHUPLWH SDOSDU HO SROR TXH VH

RIUHFHDODSHOYLV(QODVSUHVHQWDFLRQHVGHQDOJD
VHSRGUiHQFRQWUDUXQSRORTXHSXHGHVHUJUDQGH
QDOJD FRPSOHWD R FKLFR QDOJD LQFRPSOHWD SHUR
VHDFXDOIXHUHODPRGDOLGDGHOSRORVHUiLUUHJXODU
EODQGRSRFRUHVLVWHQWH\GLItFLOGHKDFHUORSHORWHDU
1RVHUHFRQRFHUiQLODIUHQWHQLHOVXUFRGHOFXHOOR
(Q FDVR GH VLWXDFLyQ WUDQVYHUVD OD SHOYLV VH
HQFRQWUDUiYDFtD
Figura 60. Tercera maniobra de Leopold
&XDUWD PDQLREUD SHUPLWH HYDOXDU HO JUDGR GH

HQFDMDPLHQWR GH OD SUHVHQWDFLyQ HQ OD SHOYLV \ HO
JUDGR GH ÀH[LyQ 6L ORV GHGRV VH LQWURGXFHQ HQ
XQD H[FDYDFLyQ YDFtD VH VRVSHFKDUi VLWXDFLyQ
WUDQVYHUVD
Figura 61. Cuarta maniobra de Leopold

3DUDFOtQLFD
6L FRQ HO H[DPHQ FOtQLFR SHUVLVWHQ GXGDV VREUH OD XELFDFLyQ IHWDO OD XOWUDVRQRJUDItD
VHUiHOPpWRGRGHHOHFFLyQSDUDHVWDEOHFHUHOGLDJQyVWLFR&XDQGRQRVHGLVSRQJDGH
XOWUDVRQRJUDItDODUDGLRJUDItDUD\RV;SXHGHVHUXQDRSFLyQDSURSLDGD
&RQGXFWDHQODSUHVHQWDFLyQSHOYLDQD\ODVLWXDFLyQWUDQVYHUVD
$SDUWLUGHODVVHPDQDVVHGHEHGHWHUPLQDUODVLWXDFLyQ\SUHVHQWDFLyQIHWDOHQFDGD
FRQWURO
/DHYLGHQFLDH[LVWHQWHKDVWDHOPRPHQWRVXJLHUHTXHODFHViUHDSODQL¿FDGDWLHQHPHQRU
PRUWDOLGDGSHULQDWDO\PHQRUGHSUHVLyQUHVSLUDWRULDGHORVQHRQDWRVLQGHSHQGLHQWHPHQWH
GHODSDULGDGGHODPXMHU\HOHQWUHQDPLHQWRGHOSURIHVLRQDOTXHDVLVWHFXDQGRVHOD
FRPSDUDFRQHOSDUWRYDJLQDO
6HUHFRPLHQGDHQFDVRVGHSUHVHQWDFLyQSHOYLDQD\WUDQVYHUVDODUHDOL]DFLyQ
GHXQDFHViUHDHOHFWLYDDOWpUPLQR
3DUD GLVPLQXLU OD IUHFXHQFLD GH FHViUHDV DQWH HO GLDJQyVWLFR GH SUHVHQWDFLyQ R
VLWXDFLyQIHWDODQRUPDOHVFRQYHQLHQWHHYDOXDUHOFDVRSRUODSRVLELOLGDGGHLQWHQWDUOD
DFRPRGDFLyQH[WHUQDGHOIHWRSUHYLRDOFRPLHQ]RGHOWUDEDMRGHSDUWR
/DYHUVLyQH[WHUQDGHEHVHUOOHYDGDDFDERVRORHQDTXHOODVSDFLHQWHVTXH
QRWHQJDQFRQWUDLQGLFDFLRQHV~QLFDPHQWHSRUSHUVRQDOFDSDFLWDGRHQUHDOL]DU
ODPDQLREUD\HQDPELHQWHFRQUHFXUVRVSDUDUHVROYHUODVFRPSOLFDFLRQHVTXH
SXHGDQSUHVHQWDUVHSRUODPDQLREUDVXIULPLHQWRIHWDODJXGRGHVSUHQGLPLHQWR
GHSODFHQWD(VWRVUHFXUVRVVRQTXLUyIDQR\HOHPHQWRVSDUDODUHDQLPDFLyQ
GHODPDGUH\GHOQLxR
&RQWUDLQGLFDFLRQHVSDUDUHDOL]DUODYHUVLyQH[WHUQD
x (GDGJHVWDFLRQDOPHQRUDVHPDQDV
x 'HVSURSRUFLyQSpOYLFRIHWDO
x 2SHUDFLRQHVSUHYLDVVREUHHO~WHURFHViUHDVPLRPHFWRPtDVHWF
x 7RQRXWHULQRHOHYDGR
x ÒWHURPDOIRUPDGR\RFRQPLRPDV
x (PEDUD]RP~OWLSOH
x )HWRPXHUWR
x 0DOIRUPDFLRQHVIHWDOHVPD\RUHVKLGURRDQHQFHIDOLDHWF
x 3ODFHQWDSUHYLD
x 2OLJRDPQLRV
x 2EHVLGDGPDWHUQD
x 1RFRQWDUFRQSRVLELOLGDGGHUHDOL]DUFHViUHDGHHPHUJHQFLD
2%-(7,926 'HWHFWDU SRVLEOHV GLVWRFLDV SpOYLFDV SDUD GH¿QLU HO QLYHO GH

DWHQFLyQGHOSDUWR
$&7,9,'$' ([DPHQJLQHFRREVWpWULFR(YDOXDFLyQGHODSHOYLV
,QWHUURJDWRULR
'HEHUi UHFDEDUVH GDWRV VREUH SDUWRV DQWHULRUHV \ H[LVWHQFLD GH DIHFFLRQHV \
WUDXPDWLVPRV TXH SXGLHUDQ KDEHU DIHFWDGR OD SHOYLV HQ HVSHFLDO DOWHUDFLRQHV GH OD
QXWULFLyQ SRU HMHPSOR UDTXLWLVPR (Q ODV PXOWtSDUDV XQ GDWR TXH SHUPLWH VXSRQHU
TXHKD\XQEXHQFDQDOyVHRHVHODQWHFHGHQWHGHSDUWRVSUHYLRVGHUHFLpQQDFLGRV
YLYRVFRQSHVRPD\RUDJ3RUHOFRQWUDULRXQDDQRPDOtDHQODHYROXFLyQGHXQ
SDUWRDQWHULRUFRQXQUHFLpQQDFLGRPHQRUDJUDPRVGHEHKDFHUVRVSHFKDUXQD
YLFLDFLyQSHOYLDQD
'LDJQyVWLFRGHHQFDMHGHODSUHVHQWDFLyQ
/D SUHVHQWDFLyQ HVWi HQFDMDGD FXDQGR HO SODQR GHO GLiPHWUR ELSDULHWDO VH HQFXHQWUD
SRUGHEDMRGHOSODQRGHOHVWUHFKRVXSHULRUGHODSHOYLVSURPRQWRULR±OtQHDLQQRPLQDGD
±ERUGHVXSHULRUGHOSXELV(OGLDJQyVWLFRVHHVWDEOHFHPHGLDQWHSDOSDFLyQDEGRPLQDO
\WDFWR3RUSDOSDFLyQDEGRPLQDOPHGLDQWHODFXDUWDPDQLREUDGH/HRSROGVHFRQVLGHUD
TXHODSUHVHQWDFLyQHVWiHQFDMDGDFXDQGRHOSRORTXHVHRIUHFHDOHVWUHFKRVXSHULRU
QRVHSXHGHHOHYDU\RKDFHUSHORWHDU3RUHOWDFWRVHKDFHGLDJQyVWLFRUHODFLRQDQGR
ODSDUWHPiVGHVFHQGLGDGHODFDEH]DIHWDOFRQHOSODQRGHODVHVSLQDVFLiWLFDVFXDQGR
HVWRVSXQWRVVHHQFXHQWUDQHQHOPLVPRSODQRODFDEH]DHVWiXVXDOPHQWHHQFDMDGD
6HFRQVLGHUDTXHVLODSUHVHQWDFLyQFHIiOLFDHVWiHQFDMDGDHVLPSUREDEOHTXHKD\D
DOWHUDFLRQHVSHOYLDQDVDQLYHOGHOHVWUHFKRVXSHULRU
/DFRPSUREDFLyQGHXQDSUHVHQWDFLyQHQFDMDGDHVHYLGHQFLDGHVX¿FLHQFLD
SpOYLFDGHOHVWUHFKRVXSHULRU\PHGLR
3HOYLPHWUtDLQWHUQD\SHOYLJUDItDGLJLWDO
(QFDVRVGRQGHQRVHWHQJDDQWHFHGHQWHVHYLGHQWHVGHFDSDFLGDGSpOYLFDFRQYLHQH
OXHJR GH OD VHPDQD UHDOL]DU XQ H[DPHQ GHO FDQDO FRQ SHOYLPHWUtD \ SHOYLJUDItD
GLJLWDO/DSHOYLJUDItDSRUUDGLRORJtDQRKDGHPRVWUDGRVHUHIHFWLYD\SXHGHVHUULHVJRVD
SDUDHOIHWRHQXQIXWXURGHELGRDOHIHFWRDFXPXODWLYRGHODVUDGLDFLRQHV
7pFQLFDSDUDODSHOYLJUDItDGLJLWDO
x *HVWDQWHFRQYHMLJDYDFtDDFRVWDGDHQSRVLFLyQREVWpWULFD
x 6DFURELHQ DSR\DGR VREUHHOSODQR KRUL]RQWDO ODDQWHRUHWURYHUVLyQ IDOVHDORV
UHVXOWDGRV
x 7DFWRELGLJLWDO
x ,QWHQWDUWRFDUHOSURPRQWRULRGLItFLOGHDOFDQ]DUGXUDQWHHOHPEDUD]R
6LQRVHWRFDHOSURPRQWRULRVHFRQVLGHUDTXHHOGLiPHWURFRQMXJDGR
GLDJRQDOHVQRUPDO
6LVHWRFDHOSURPRQWRULRPHGLUHOGLiPHWURSURPRQWRVXESXELDQRR
FRQMXJDGR GLDJRQDO KDELWXDOPHQWH GH FP ¿JXUDV \ SDJ
$ OD PHGLGD REWHQLGD VH UHVWD FP \ VH REWLHQH HO GLiPHWUR SURPRQWR
SXELDQRPtQLPRRFRQMXJDGRREVWpWULFRRGLiPHWUR~WLOQRUPDOFP
x 5HFRUUHUODVSDUHGHVSHOYLDQDV
x 7DFWDUODVHVSLQDVFLiWLFDV
6RVSHFKDUHVWUHFKH]SpOYLFDFXDQGR
6HREVHUYDQDOWHUDFLRQHVHQODVLPHWUtDGHODSHOYLVODHVWiWLFDFRUSRUDOR
ODPDUFKD
(QODVQXOtSDUDVDWpUPLQRODSUHVHQWDFLyQVHPDQWLHQHDOWD
6HDOFDQ]DHOSURPRQWRULRFRQIDFLOLGDG
6HFRQ¿UPDHOGLDJQyVWLFRGHHVWUHFKH]SpOYLFDFXDQGR
(OGLiPHWURFRQMXJDGRGLDJRQDOHVPHQRUGHFP\SRUORWDQWRHO
FRQMXJDGRREVWpWULFRHVPHQRUGHFP
6HFRQVWDWDQREVWiFXORVTXHGLVPLQX\HQODOX]GHOFDQDORDOWHUDQVXWUiQVLWR
&RQGXFWD
$QWHVRVSHFKDGHHVWUHFKH]SpOYLFDSODQL¿FDUODUHIHUHQFLDRSRUWXQDSDUDODDWHQFLyQ
GHOSDUWRGH$OWR5LHVJR6LH[LVWHFRQ¿UPDFLyQGHHVWUHFKH]SpOYLFDVHGHEHUiSODQL¿FDU
HOPRPHQWR\OXJDUDSURSLDGRSDUDHIHFWXDUXQDFHViUHDHOHFWLYD
*HVWDQWHFRQHPEDUD]RVHPDQDV
6L 3DUWR 1R
YHJLQDODQWHULRUFRQ
51J
$QW
1R WUDXPDWLVPR
IHWDORWUDXPDWLVPRSpOYLFR (IHFW~DSHOYLPHWUtD
SRVWHULRUDO \SHOYLJUDItDGLJLWDO
SDUWR
1R
1RUPDO
$WHQFLyQGHOSDUWRVHJ~Q $WHQFLyQGHOSDUWRHQ
QRUPDGHEDMRULHVJR QLYHOGHDOWRULHVJR
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVSDUDODYDORUDFLyQSpOYLFD
5HIHUHQFLDVELEOLRJUi¿FDV
Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate
hypertension during pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1.
Ábalos E, Gulmezoglu AM, Carroli G. Assessing the scientific value of screening for antenatal infections.
In: Newell ML, McIntyre J. Congenital and Perinatal Infections. Cambridge: Cambridge University Press,
2000. pp, 64-79.
American Academy of Pediatrics. Committee on Substance Abuse and Committee on Children With
Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. 2000
Aug;106(2 Pt 1):358-61.
ACOG educational bulletin. Smoking cessation during pregnancy. Number 260, September 2000. American
College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2001 Dec;75(3):345-348. Review.
ACOG committee opinion. Number 316, October 2005. Smoking cessation during pregnancy. Obstet
Gynecol. 2005 Oct;106(4):883-888.
ACOG committee opinion. Number 316, October 2005. Smoking cessation during pregnancy. Obstet
Gynecol. 2005 Oct;106(4):883-8.
ACOG. Gestational diabetes. ACOG Practice Bulletin no. 30. American College of Obstetricians and
Gynecologists. Obstet Gynecol September 2001;98:525-538.
ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces Technical
Bulletin Number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int J
Gynaecol Obstet. 2000 Feb;68(2):175-185.
AIDS info 2006. Perinatal Guidelines. Public Health Service Task Force Recommendations for Use of
Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce
Perinatal HIV-1 Transmission in the United States - October 12, 2006. http://www.aidsinfo.nih.gov/
Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=9&ClassID=2 (Último
acceso 3 de Mayo de 2007)
American Diabetes Association: Gestational diabetes mellitus. Diabetes Care 23(Suppl. 1):S77–S79,
2000
American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2002; 25 (Suppl 1):S94-96.
Anotayanonth S, Subhedar NV, Neilson JP, Harigopal S. Betamimetics for inhibiting preterm labour.
Cochrane Database of Systematic Reviews 2004, Issue 4.
ASJOG 2004. Prevention and management of pretrm labor. http://www.asjog.org/Journal/Issue%203%20
Final/175%20tailored%20Guidelines.pdf(último acceso 10 de Julio 2007)
Bada, H.S., et al. Gestational Cocaine Exposure and Intrauterine Growth: Maternal Lifestyle Study. Obstet
Gynecol. 2002 Nov;100(5):916-924.
Bassani DG, Olinto MTA, Kreiger N. Periodontal disease and perinatal outcomes: a case-control study. J
Clin Periodontol. 2007;34(1):31-39
Berger H, Crane J, Farine D, Armson A, De la Ronde S, Keenan-Lindsay L, Reid G, Van Aerde J. Screening
for gestational diabetes mellitus. J Obstet Gynaecol Can. 2002;24(11):894-912.
Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane
Database of Systematic Reviews 2007, Issue 1.
Boggess KA, Lieff S,Murtha AP, Moss K, Beck J, Offenbacher S.Maternal periodontal disease is associated
with an increased risk for preeclampsia. Obstet Gynecol 2003;101:227–231.
Boog G. Maternal determination of fetal movements. A sure and simple method of monitoring the pregnancy.
Rev Fr Gynecol Obstet. 1988 Nov;83(11):693-695. Review.
Bower P, Rowland N. Effectiveness and cost effectiveness of counselling in primary care. Cochrane
Brocklehurst P. Interventions for reducing the risk of mother-to-child transmission of HIV infection. Cochrane
Broening HW, Morford LL, Inman-Wood SL, Fukumura M, Vorhees CV. 3,4-methylenedioxymethamphetamine
(ecstasy)-induced learning and memory impairments depend on the age of exposure during early development.
J Neurosci. 2001 May 1;21(9):3228-3235.
Calvo E, López LB. Anemias en la etapa perinatal y nutrición de la embarazada. En: Schwarcz R, Fescina
R, Duverges C. Obstetricia. 6ª edición. Buenos Aires: El Ateneo, 2005. pp 392-396.
Carlier Y, Torrico F. 2003. Congenital infection with Tripanosoma cruzi: from mechanisms of transmisión to
strategies for diagnosis and control: conclusions of round tables and sinopsis o fan interntional colloquium.
Cochabamba, Bolivia, 6-8 Novembre 2002. Revista da Sociedade Brasileira de medicina Tropical 36(6):
767-771
Carroli G, Ábalos E. Enfermedades del aparato urinario. En: Schwarcz R, Fescina R, Duverges C.
Obstetricia. 6ª edición. Buenos Aires: El Ateneo, 2005. pp, 370-376.
Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious
morbidity? An overview of evidence. Pediatric Perinat Epidemiol. 2001;15 Suppl 1:1-42
CDC 2006. Achievements in public health: Reduction in perinatal transmission of HIV infection --- United
States, 1985 - 2005. Morbidity and Mortality Weekly Report, volume 55, number 21, June 2, 2006, pages
592-597
CDC 2002. Alcohol use among women of childbearing age—United States, 1991-1999.
Morbidity and Mortality Weekly Report, volume 51, number 13, April 5, 2002, pages 273-276.
CDC 2006. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced
diphtheria toxoide and acellular pertussis vaccines. Recommendations
of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by
the Healthcare Infection Control Practices Advisory Committee
(HICPAC), for Use of Tdap Among Health-Care Personnel. MMWR 2006;55(No. RR-17):1–33.
CDC 2006. Sexually Transmitted Diseases Treatment Guidelines. MMWR Recommendations and reports
August 4, 2006 / 55(RR11);1-94. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm (Último
acceso 12 de Julio de 2007)
CDC 2001. Revised Guidelines for HIV counseling, testing and referral and Revised recommendations for
HIV Screening of Pregnant Women. MMWR 50(RR-19)
CDC 2006. Intimate Partner Violence During Pregnancy: A guide for Clinicians. www.cdc.gov/nccdphp/drh/
violence/ipvdp.htm. Ultimo acceso 4 Jun 2006.
CDC 2004. A Strategic Framework for Malaria Prevention and Control During Pregnancy in the African Region.
http://www.cdc.gov/malaria/pdf/strategic_framework_mip_04.pdf (Último acceso 15 de Julio de 2007)
Conférence de consensus. Grossesse et tabac, 7 et 8 octobre 2004, Lille (Grand Palais)
Texte de recommandations.
http://www.has-sante.fr/portail/upload/docs/application/pdf/Grossesse_tabac_long.pdf Último acceso 4 de
Junio de 2007
Cram LF, Zapata M, Toy E, Baker B 3erd. Genitourinary infections and their association with preterm labor.
Am Fam Physician. 2002;65(2):241-248.
Crowther CA. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database of Systematic
Reviews 2001, Issue 1.
Crowther CA, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for
preventing neonatal respiratory disease. Cochrane Database of Systematic Reviews 2007, Issue 3.
Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm
labour. Cochrane Database of Systematic Reviews 2007, Issue 2.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational
diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-2486.
Crowther CA, Middleton P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation.
Crowther CA, Thomas N, Middleton P, Chua M, Esposito M. Treating periodontal disease for preventing
preterm birth in pregnant women. Cochrane Database of Systematic Reviews 2005, Issue 2.
Cuervo LG, Mahomed K. Treatments for iron deficiency anaemia in pregnancy Cochrane Database of
Systematic Reviews 2006, Issue 1.
Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned early birth versus expectant
management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database
of Systematic Reviews 2006, Issue 1.
Demicheli V, Barale A, Rivetti A. Vaccines for women to prevent neonatal tetanus. Cochrane Database of
De Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, Evans AT. Postprandial versus
preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy.
N Engl J Med. 1995;333(19):1237-1241.
Díaz AG, Schwarcz R, Fescina R, Duverges C. Control prenatal. Publ. Científica CLAP Nº 1071, 1986.
Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D’Amico R, Magrini N. Prenatal education for congenital
toxoplasmosis. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 4.
Dodd JM, Crowther CA. Specialised antenatal clinics for women with a multiple pregnancy to improve
maternal and infant outcomes. Cochrane Database of Systematic Reviews 2007, Issue 2.
Dodd JM, Crowther CA, Dare MR, Middleton P. Oral betamimetics for maintenance therapy after threatened
preterm labour. Cochrane Database of Systematic Reviews 2006, Issue 1.
Dodd JM, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing
preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 1.
Doyle LW, Crowther CA, Middleton P, Marret S. Magnesium sulphate for women at risk of preterm birth for
neuroprotection of the fetus. Cochrane Database of Systematic Reviews 2007, Issue 3.
Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women.
Duckitt K, Thornton S. Nitric oxide donors for the treatment of preterm labour. Cochrane Database of
Duley L, Henderson-Smart DJ. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database
Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy.
Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its
complications. Cochrane Database of Systematic Reviews 2007, Issue 2.
Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women
with pre-eclampsia. Cochrane Database of Systematic Reviews 2003, Issue 2.
Dyson L, McCOrmick F, Renfrew MJ. Interventions for Promoting the initiation of breastfeeding. Cochrane
Database of Systematic Reviews 2005.
Ebrahim SH, Gfroerer J. Pregnancy-related substance use in the United States during 1996-1998. Obstet
Gynecol. 2003 Feb;101(2):374-379.
Enkin M, Keirse MJ, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr GJ. Effective care in pregnancy
and childbirth: a synopsis. Birth 2001 Mar;28(1):41-51.
Frank DA, Jacobs RR, Beeghly M, Augustyn M, Bellinger D, Cabral H, Heeren

T. Level of prenatal ocaine exposure and scores on the Bayley Scales of Infant
Development: modifying effects of caregiver, early intervention, and birth weight.
Pediatrics. 2002 Dec;110(6):1143-1152.
Fescina RH, Quevedo C, Martell M, Nieto F, Schwarcz R. Uterine height as a method of predicting fetal
growth. Bol Oficina Sanit Panam. 1984 May;96(5):377-386.
Fescina RH, Martell M. Intrauterine and extrauterine growth of cranial perimeter in term and preterm
infants. A longitudinal study. Am J Obstet Gynecol. 1983 Dec 15;147(8):928-932.
Fescina RH. Weight increase during pregnancy. Method for its calculation when the normal weight is
unknown. Bol Oficina Sanit Panam. 1983 Aug;95(2):156-162.
Fescina RH, Ucieda FJ, Cordano MC, Nieto F, Tenzer SM, Lopez R. Ultrasonic patterns of intrauterine fetal
growth in a Latin American country. Early Hum Dev. 1982 Jul;6(3):2392-48.
Fescina RH, Ucieda FJ. Reliability of fetal anthropometry by ultrasound. J Perinat Med. 1980;8(2):93-99.
Fescina RH, Lastra L, Sugo M, Parreño J, García A, Schwarcz R. Evaluación de diferentes métodos para
estimar la edad gestacional. Obstet Ginecol Latinoam 1984;42:237-242.
Fescina RH, Schwarcz R, Díaz AG. Vigilancia del crecimiento fetal. Manual de autoinstrucción. Montevideo,
CLAP 1992; Publ. Cient. CLAP Nº 1261.
Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both.
Gamble C, Ekwaru JP, ter Kuile FO. Insecticide-treated nets for preventing malaria in pregnancy. Cochrane
Gantes M, Schy DS, Bartasius VM, Roberts J. The use of daily fetal movement records in a clinical setting.
J Obstet Gynecol Neonatal Nurs. 1986 Sep-Oct;15(5):390-393.
Garner P, Gülmezoglu AM. Drugs for preventing malaria in pregnant women. Cochrane Database of
Garner P, Okun N, Keely E, Wells G, Perkins S, Sylvain J, Belcher J. A randomized controlled trial of
strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of
gestational diabetes: a pilot study. Am J Obstet Gynecol. 1997;177(1):190-195.
Gaunekar NN, Crowther CA. Maintenance therapy with calcium channel blockers for preventing preterm
birth after threatened preterm labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
Gibbs RS. The relationship between infections and adverse pregnancy outcomes: an overview. Ann
Periodontol 2001;6:153–163.
Gómez JE, Castaño JC, Montoya MT. 1995. Toxoplasmosis congénita en Colombia: un problema
subestimado de salud pública. http://colombiamedica.univalle.edu.co/VOL26NO2/toxoplasmosis.html.
Ultimo acceso 4 de Junio 2007
Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of
antepartum late death in normally formed singletons. Lancet. 1989;2(8659):345-349.
Grosse S, Boyle C, Kenneson A, Khoury M, Wilfond B (2005) From Public Health Emergency to Public
Health Service: The Implications of Evolving Criteria for Newborn Screening Panels. http://www.cdc.gov/
genomics/activities/publications/newborn.htm Último acceso 23 de Octubre 2006.
Gülmezoglu AM. Interventions for trichomoniasis in pregnancy. Cochrane Database of Systematic Reviews
2002, Issue 3.
Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane
Hamza H, Berkowitz LB, Khattak F. Bacterial infections and pregnancy. eMedicine, last updated: October
28, 2004. Disponible en: http://www.emedicine.com/med/topic3269.htm (Última consulta 28 de Febrero
de 2007)
Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section
versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech
Trial Collaborative Group. Lancet. 2000 Oct 21;356(9239):1375-83.
Hannah ME, Hannah WJ, Hodnett ED, Chalmers B, Kung R, Willan A, Amankwah K, Cheng M, Helewa
M, Hewson S, Saigal S, Whyte H, Gafni A; Term Breech Trial 3-Month Follow-up Collaborative Group.
Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term:
the international randomized Term Breech Trial. JAMA. 2002 Apr 10;287(14):1822-31.
Harper RG, Greenberg M, Faharian G, et al. Fetal movement, biochemical and biophysical parameters,
and the outcome of pregnancy. Am J Obstet Gynecol. 1981;141(1):39-42.
Hill-Smith I. Professional and patient perspectives of NICE guidelines to abandon maternal monitoring of
fetal movements. Br J Gen Pract. 2004 Nov;54(508):858-861. Review.
Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth. Cochrane
Hofmeyr GJ, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive
disorders and related problems. Cochrane Database of Systematic Reviews 2006, Issue 3.
Hofmeyr GJ. Corticoesteroides antes del parto prematuro: Comentario de la BSR (última revisión: 26 de
Agosto de 2003). Biblioteca de Salud Reproductiva de la OMS, Nº 9, Update Software Ltd, Oxford, 2006.
Huntington J, Connell FA. For every dollar spent—the cost-savings argument for prenatal care. N Engl J
Med. 1994 Nov 10;331(19):1303-1307.
ICSI 2005. Health Care Guideline : Routine Prenatal Care. Institute for Clinical
Systems Improvement. Ninth Edition, August 2005. Último acceso 4 de Junio de 2007.
http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html
Institute of Medicine 1996. Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment.
Washington, D.C., National Academy Press, 1996.
Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy.
Emerg Infect Dis. 2006 Nov;12(11):1638-43. Review.
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenerg RL, Hauth JC. Periodontal infection and preterm
birth: results of a prospective study. J Am Dent Assoc 2001;132:875–880.
Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, et al. Periodontal disease and
preterm birth: results of a pilot intervention study. J Periodontol 2003;74:1214–1218.
Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of
Johns Hopkins University Press. .National Toxicology Program. Marijuana. Shepard’s Catalog of Teratogenic
Agents. http://ntp.niehs.nih.gov/index.cfm?objectid=E87E5E94-BDB5-82F8-FDCBD97D0C1CE4BC. Last
updated on 04/03/2006. Último acceso 2 de Julio de 2007
Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes. Cochrane Database of
Kesmodel, U., et al. Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first
year of life. Am J Epidem. 2002 Feb;155(4):305-312.
Kiningham RB. Asymptomatic bacteriuria in pregnancy. Am Fam Physician. 1993;47(5):1232-1238.
King JF, Flenady VJ, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour.
King JF, Flenady VJ, Papatsonis DNM, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting
preterm labour. Cochrane Database of Systematic Reviews 2003, Issue 1.
Kourtis AP, Lee FK, Abrams EJ, Jamieson DJ, Bulterys M. Mother-to-child transmission of HIV-1: timing
and implications for prevention. Lancet Infect Dis. 2006 Nov;6(11):726-732. Review.
Kravetz JD, Federman DG.Toxoplasmosis in pregnancy. Am J Med. 2005 Mar;118(3):212-6. Review.
Kuzuya T. Early diagnosis, early treatment and the new diagnostic criteria of diabetes mellitus. Br J Nutr.
2000 Dec;84 Suppl 2:S177-181.
Kuzuya T, Nakazawa S, Satoh J, et al. Report of the Committee on the classification and diagnostic criteria
of diabetes mellitus. Diabetes Res Clin Pract. 2002 Jan;55(1):65-85.
Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Prophylactic use of ergot alkaloids in the third
stage of labour. Cochrane Database of Systematic Reviews 2007, Issue 2

Liljestrand J. Políticas de episiotomía en partos vaginales: Comentario de la BSR (última revisión: 20 de
Octubre de 2003). Biblioteca de Salud Reproductiva de la OMS, Nº 9, Update Software Ltd, Oxford, 2006
Lopez NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low birth weight in women with periodontal
disease. J Dent Res 2002;81: 58–63.
Lopez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in
women with periodontal disease: a randomized controlled trial. J Periodontol 2002;73:911–924.
Lumley J, Oliver SS, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during
pregnancy. Cochrane Database of Systematic Reviews 2004, Issue 4.
.Magee LA, Duley L. Oral beta-blockers for mild to moderate hypertension during pregnancy. Cochrane
Database of Systematic Reviews 2003, Issue 3
Mahomed K. Iron and folate supplementation in pregnancy. Cochrane Database of Systematic Reviews
2006, Issue 1.
Mahomed K. Iron supplementation in pregnancy. Cochrane Database of Systematic Reviews 2006, Issue 1.
Mangesi L, Hofmeyr GJ. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database
McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane
McDonald S, Abbott JM, Higgins SP. Prophylactic ergometrine-oxytocin versus oxytocin for the third stage
of labour. Cochrane Database of Systematic Reviews 2004, Issue 1
McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane
Meher S, Abalos E, Carroli G. Bed rest or without hospitalization for hypertension during pregnancy.
Meher S, Duley L. Rest during pregnancy for preventing pre-eclampsia and its complications in women with
normal blood pressure. Cochrane Database of Systematic Reviews 2006, Issue 2.
Montoya JG, Liesenfeld O.Toxoplasmosis. Lancet. 2004 Jun 12;363(9425):1965-76. Review.
Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, Buchanan W, Bofill J,
Papapanou PN, Mitchell DA, Matseoane S, Tschida PA; OPT Study. Treatment of periodontal disease and
the risk of preterm birth. N Engl J Med. 2006 Nov 2;355(18):1885-94.
Moore S, Randhawa M, Ide M. A case-control study to investigate an association between adverse
pregnancy outcome and periodontal disease. J Clin Periodontol 2005;32:1–5.
Moore S, Ide M, Coward PY, RandhawaM, Borkowska E, Baylis R, et al. A prospective study to investigate
the relationship between periodontal disease and adverse pregnancy outcome. Br Dent J 2004;197:251–
258; discussion 247.
National Institute on Alcohol Abuse and Alcoholism 2000. Fetal alcohol exposure and the brain. Alcohol
Alert, number 50, December 2000.
Neilson JP. Symphysis-fundal height measurement in pregnancy. Cochrane Database of Systematic
NICE 2003. Antenatal care Routine care for the healthy pregnant woman. Clinical Guideline 6. National
Institute for Clinical Excellence, October 2003. http://guidance.nice.org.uk/CG6/niceguidance/pdf/English/
download.dspx Último acceso 4 de Junio de 2007.
NIDA Research Report - Heroin Abuse and Addiction: NIH Publication No. 05-4165, Printed October 1997,
Reprinted September, 2000, Revised May 2005. http://www.nida.nih.gov/ResearchReports/Heroin/Heroin.
html Último acceso 2 de Julio de 2007.
Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk
factor for preterm low birth weight. J Periodontol 1996;67(10 Suppl):1103–1113.
Offenbacher S, Boggess KA, Murtha AP,et al. Progressive periodontal disease and risk of very preterm
delivery. Obstet Gynecol. 2006;107(1):29-36.
Offenbacher S, Beck J. Has Periodontal Treatment Failed to Reduce Adverse Pregnancy Outcomes? The
Answer May Be Premature. J Periodontol. 2007;78(2):195-197
OPS 2005. Boletín de Inmunización. Organización Panamericana de la Salud Volúmen XXVIII, Número 4
Agosto de 2006 http://www.ops-oms.org/spanish/ad/fch/im/sns2804.pdf Último acceso 4 de Junio de 2007.
OPS 2004. Consulta sobre Enfermedad de Chagas Congénito, su epidemiología y manejo (OPS/DPC/
CD/301/04). Unidad de Enfermedades Transmisibles Área de Prevención y Control de Enfermedades
(OPS/AD/DPC/CD) y CLAP
OPS 2005. Eliminación del tétanos neonatal: guía práctica. Washington, D.C.: OPS, © 2005. (Publicación
Científica y Técnica No. 602). http://www.paho.org/spanish/ad/fch/im/GuiaPractica_TetanosNeonatal.pdf
(Último acceso 4 de Agosto de 2007).
OPS 2003. Grupo Étnico y Salud. 37 sesión del subcomité de planificación y programación del comité
ejecutivo (SPP37/10).
OMS 2005. Infecciones de transmisión sexual y otras infecciones del tracto reproductivo. Una guía para la
práctica básica. Departamento de Salud Reproductiva e Investigación.
OPS 2006. Inmunización en las Américas. Resumen 2006 http://www.ops-oms.org/Spanish/AD/FCH/IM/
IMBrochure_2006.pdf Último acceso 2 de Junio de 2007.
OPS 2004. Informe final (Conclusiones y recomendaciones). La cultura de la prevención: un modelo de
control para las enfermedades prevenibles por vacunación. XVI Reunión del grupo técnico asesor de la
OPS sobre enfermedades prevenibles por vacunación. Washington, D.C.: OPS; 2004.
OPS 2005. Plan Regional de VIH/ITS para el sector salud 2006-2015. Unidad de VIH/Sida.
Ostlund I, Hanson U. Repeated random blood glucose measurements as universal screening test for
gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2004 Jan;83(1):46-51.
Orton L, Garner P. Drugs for treating uncomplicated malaria in pregnant women. Cochrane Database of
Pacqué M. Como prevenir y tratar la malaria durante el embarazo. INFO Project Johns Hopkins Bloomberg
School of Public Health. 2005. http://www.maqweb.org/techbriefs/stb18malpreg.pdf (Último acceso 22 de
Junio de 2007)
Papatsonis D, Flenady V, Cole S, Liley H. Oxytocin receptor antagonists for inhibiting preterm labour.
Pattinson RC, Farrell E. Pelvimetry for fetal cephalic presentations at or near term (Cochrane Review).
Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women
during pregnancy. Cochrane Database of Systematic Reviews 2006, Issue 3.
Penzo SM. Diagnóstico de vitalidad fetal. En: Schwarcz R, Fescina R, Duverges C. Obstetricia. 6ª edición.
Buenos Aires: El Ateneo, 2005. pp 121-142.
Peyron F, Wallon M, Liou C, Garner P. Treatments for toxoplasmosis in pregnancy. Cochrane Database of
Preboth M. ACOG guidelines on antepartum fetal surveillance. American College of Obstetricians and
Gynecologists. Am Fam Physician. 2000;62(5):1184, 1187-1188.
Puolakka J, Janne O, Pakarinen A. Serum ferritin as a measure of iron stores during and after normal
pregnancy with of without iron supplements. Acta Obstet Gynecol Scand Suppl 1980;95:43-51
Reveiz L, Gyte GML, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of
preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 3.
Rizzi RG. Diabetes y embarazo. En: Schwarcz R, Fescina R, Duverges C. Obstetricia. 6ª edición. Buenos
Aires: El Ateneo, 2005. pp 358-367.
Scannapieco FA, Bush RB, Paju S. Periodontal disease as a risk factor for adverse pregnancy outcomes.
Annals of Periodontology 2003;8(1):70-8.
Scott DA, Loveman E, McIntyre L, Waugh N. Screening for gestational diabetes: a systematic review and
economic evaluation. Health Technology Assessment 2002; Vol. 6: No. 11
Schkolink S, Del Popolo F. Los censos y los pueblos indígenas en América Latina: Una mitología Regional.
Seminario Internacional Pueblos indígenas y afro-descendientes de América Latina y el Caribe: relevancia
y pertinencia de la información sociodemográfica para políticas y programas. CEPAL, Santiago de Chile,
27 al 29 de Abril de 2005
Schrag S, Gorwitz R, Fultz-Butts K, Schuchat , A. Prevention of Perinatal Group B Streptococcal Disease.

(Revised Guidelines from CDC). Division of Bacterial and Mycotic Diseases National Center for Infectious
Diseases August 16, 2002 / 51(RR11);1-22
Schwarcz R, Gonzalo Diaz A, Fescina RH, Diaz Rossello JL, Martell M, Tenzer SM. Historia Clínica
Perinatal Simplificada. Propuesta de um modelo para la atención primaria de baja complejidad. Bol Oficina
Sanit Panam. 1983 Aug;95(2):163-172.
Schwarcz R. Norms of perinatal care: proposal of a program of standard information for the management
of perinatal prematurity. Bol Oficina Sanit Panam. 1979 Oct;87(4):361-365.
Scwarcz R, Uranga A, Lomuto C, Martínez I, Galimberti D, García O, Etcheverry ME, Queiruga M. El cuidado
prenatal. Guía para la práctica del cuidado preconcepcional y del control prenatal. http://www.msal.gov.ar/
htm/site/promin/UCMISALUD/CONTROLPERINATAL.PDF (Último acceso 14 de Junio de 2007).
Schwarcz R, Gonzalo Diaz A, Fescina RH. The Perinatal Information System I: The Simplified Perinatal
Clinical Record. J Perinat Med 1987;15 (Suppl. 1):9.
Schwarcz R, Fescina RH, Duverges C. Obstetricia. 6ª ed. Buenos Aires: El Ateneo, 2005.
Signorell LM, Seitz D, Merkel S, Berger R, Rudin C. Cord blood screening for congenital toxoplasmosis in
northwestern Switzerland, 1982-1999. Pediatr Infect Dis J. 2006 Feb;25(2):123-8.
Simini F, Díaz AG, López R, Schwarcz R. The Perinatal Information System: development of a software
package for perinatal care analysis. J Perinat Med 1987; 15 (Suppl. 1):131.
Smaill F. Intrapartum antibiotics for Group B streptococcal colonisation. Cochrane Database of Systematic
Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database of
Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain
management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
Smith N, Packel L, Kevany S, Doolan K, Horvath T, Grossman-Kahn R, Kennedy GE. Routine vs. voluntary
HIV testing for increasing HIV testing rates. (Protocol) Cochrane Database of Systematic Reviews 2007,
Issue 3.
Sosa C, Althabe F, Belizán J, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth.
Stan C, Boulvain M, Hirsbrunner-Amagbaly P, Pfister R. Hydratation for treatment of preterm labour.
Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database
Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of
Stephenson MJ. Screening for gestational diabetes mellitus: a critical review.
J Fam Pract. 1993;37(3):277-83. Review.
Teppa RJ, Roberts JM. The uriscreen test to detect significant asymptomatic bacteriuria during pregnancy.
J Soc Gynecol Investig. 2005;12(1):50-53.

The Internacional Nutricional Anemia Consultative Group (INACG). 2004. Report of the 2004 Symposium:
Iron deficiency in early life: Challenges and progress. Lima-Perú.
Rush D.2000. Nutrition and Maternal mortality in ten developing countries. Am J Clin Nutr 72(suppl):
212S-240S
Thiébaut R, Leroy V, Alioum A, Binquet C, Poizat G, Salmi LR, Gras L, Salamon R, Gilbert R, Chêne
G.Biases in observational studies of the effect of prenatal treatment for congenital toxoplasmosis.
Eur J Obstet Gynecol Reprod Biol. 2006 Jan 1;124(1):3-9. Epub 2005 Sep 2. Review.
Tuffnell DJ, West J, Walkinshaw SA. Treatments for gestational diabetes and impaired glucose tolerance
in pregnancy. Cochrane Database of Systematic Reviews 2003, Issue 3
Uncu Y, Uncu G, Esmer A, Bilgel N. Should asymptomatic bacteriuria be screened in pregnancy? Clin Exp
Obstet Gynecol. 2002;29(4):281-285.
UNICEF. El Paludismo. http://www.unicef.org/spanish/health/index_malaria.html (Último acceso 12 de
Junio de 2007)
U.S. Department of Health and Human Services 2004. The Health Consequences of Smoking: A Report of
the Surgeon General—2004. Centers for Disease Control and Prevention, Office on Smoking and Health,
Atlanta Georgia, May 2004.
U.S. Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy: recommendations
and rationale.Am J Prev Med. 2001 Apr;20(3 Suppl):59-61.
U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: recommendations and
rationale. Obstet Gynecol. 2003;101(2):393-5.
U.S. Preventive Services Task Force. Screening for Rh (D) Incompatibility: Recommendation Statement.
February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/
clinic/3rduspstf/rh/rhrs.htm (Último acceso 24 de Julio de 2007)
Vazquez JC, Villar J. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane
9LJLO'H*UDFLD3/DVVR05XL](HWDO6HYHUHK\SHUWHQVLRQLQSUHJQDQF\K\GUDOD]LQHRUODEHWRORO$
UDQGRPL]HGFOLQLFDOWULDO(XU-2EVWHW*\QHFRO5HSURG%LRO
Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A,
Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjø P, Bakketeig L, Berendes
H, Garcia J; WHO Antenatal Care Trial Research Group.WHO antenatal care randomised trial for the
evaluation of a new model of routine antenatal care. Lancet. 2001 May 19;357(9268):1551-1564.
Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gülmezoglu M. Patterns of routine antenatal care for low-
risk pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4.
Villar J, Widmer M, Lydon-Rochelle MT, Gülmezoglu AM, Roganti A. Duration of treatment for asymptomatic
bacteriuria during pregnancy. Cochrane Database of Systematic Reviews 2000, Issue 2.
Volmink J, Siegfried NL, van der Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother-to-
child transmission of HIV infection. Cochrane Database of Systematic Reviews 2007, Issue 1.
Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database of Systematic
WHO 1993. Breastfeeding Counseling: A training course. WHO/CDR/93.4 UNICEF/NUT/93.2
WHO 2006. Comprehensive cervical cancer control: A guide to essential practice. Organización Mundial
de la Salud. RHR Salud reproductiva e investigaciones conexas, 2006. http://www.who.int/reproductive-
health/publications/cervical_cancer_gep/index.htm (Último acceso 20 de Julio de 2007)
WHO 1999. Consultation report: Definition, diagnosis and classification of diabetes mellitus and its
complications. Part I: Geneva, WHO/NCD/NCS/99.2, World Health Org., 1999.
WHO 2001. Dept. of Nutrition for Health and Development. Iron deficiency anaemia: assessment,
prevention and control: a guide for programme managers. [Internet]. Geneva: 2001. Disponible en: http://
whqlibdoc.who.int/hq/2001/WHO NHD 01.3.pdf Ultima consulta 28 Abril de 2007

WHO 2003. Ensayo clínico aleatorizado de control prenatal de la OMS: Manual para la puesta en práctica
del nuevo modelo de control prenatal. WHO/RHR/01.30. Organización Mundial de la Salud, Ginebra,
2003.
WHO 1999. Field manual for neonatal tetanus elimination. Geneva: WHO; 1999. (Document WHO/
V&B/99.14.)
WHO 2003. HIV and Infant feeding: framework for priority action. World Health Organization
WHO 2005. Infecciones de transmisión sexual y otras infecciones del tracto reproductivo: una guía para
la práctica básica. Organización Mundial de la Salud. RHR Salud reproductiva e investigaciones conexas,
2005. http://www.who.int/reproductive-health/publications/es/stis_gep/index.htm (Último acceso 20 de
Julio de 2007)
WHO/UNICEF 2001. Joint integral workshop on maternal and neonatal tetanus elimination. Geneva: WHO;
2001.
WHO 2002. Manejo de las complicaciones del embarazo y el parto: Guía par obstetrices y médicos.
Organización Mundial de la Salud. RHR Salud reproductiva e investigaciones conexas, 2002. http://www.
who.int/reproductive-health/publications/mcpc/index_sp.html (Último acceso 20 de Junio de 2007)
WHO 2006.Pregnancy, Childbirth Postpartum and Newborne Care: A guide for essential practice. 2nd ed.
http://www.who.int/making_pregnancy_safer/publications/PCPNC_2006_03b.pdf (Último acceso 4 de
Julio de 2007).
WHO 2005. Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland
13–15 June 2005 Department of Making Pregnancy Safer (MPS) Department of Reproductive Health and
Research (RHR).
WHO 2006. Standards for Maternal and Neonatal Care. Department of Making Pregnancy Safer. 2006.
http://www.who.int/making_pregnancy_safer/publications/standards/en/index.html (Último acceso 4 de
Julio de 2007).
WHO 1996. The “high-risk” approach: the WHO-recommended strategy to accelerate elimination of
neonatal tetanus. Wlky Epidemiol Rec 1996;71:33–36.
WHO 2002. WHO antenatal Care Randomized Trial: Manual for the Implementation of the new model.
http://www.who.int/reproductive-health/publications/RHR_01_30/index.html (Último acceso 20 de Junio de
2007)
Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy
outcomes: a systematic review. BJOG. 2006 Feb;113(2):135-143.
,9 $WHQFLyQGHO3DUWRGH%DMR5LHVJR
& $ 3, 7 8 /2 , 9
2EMHWLYRVJHQHUDOHV
%ULQGDUDVLVWHQFLDGHFDOLGDGEDVDGDHQHYLGHQFLDVGXUDQWH
x(OLQJUHVR
x(OSHUtRGRGHGLODWDFLyQSULPHUSHUtRGR
x(OSHUtRGRGHH[SXOVLyQVHJXQGRSHUtRGR
x/RVSHUtRGRVGHDOXPEUDPLHQWR\SRVWDOXPEDUDPLHQWRWHUFHUSHUtRGR
$6,67(1&,$'85$17((/,1*5(62
2EMHWLYR 'LDJQRVWLFDUHOWUDEDMRGHSDUWRHLGHQWL¿FDUHOJUDGRGHULHVJR
$FWLYLGDG &RQVXOWDHQUHFHSFLyQ
/DJHVWDQWHFRQVXOWDSRUORTXHVRQRFUHHTXHVRQVtQWRPDVGHWUDEDMRGHSDUWR
x3HUFHSFLyQGHFRQWUDFFLRQHVXWHULQDVGRORURVDV
x3pUGLGDGHPXFRVLGDGOtTXLGRRVDQJUHDWUDYpVGHORVJHQLWDOHV
(VLPSRVLEOHGHWHUPLQDUHOPRPHQWRH[DFWRGHOFRPLHQ]RGHOWUDEDMRGHSDUWRSXHVWR
TXH OD WHUPLQDFLyQ GHO HPEDUD]R HV XQD VHFXHQFLD LQVHQVLEOH GH IHQyPHQRV FX\D
FDXVDOLGDGQRHVWiSOHQDPHQWHHVWDEOHFLGD3RUHVWHPRWLYRVHHVWDEOHFHDUELWUDULDPHQWH
TXHHOWUDEDMRGHSDUWRVHKDLQLFLDGRFXDQGR
x+D\FRQWUDFFLRQHVXWHULQDVSHULyGLFDV\UHJXODUHVSHUFLELGDVSRUODPDGUHRSRU
XQREVHUYDGRUSRUORPHQRVGXUDQWHGRVKRUDV
x/DVFRQWUDFFLRQHVWLHQHQXQDIUHFXHQFLDGHRPiVFDGDPLQXWRV
x(OFXHOORXWHULQRHVWiDOPHQRVSDUFLDOPHQWHERUUDGR
x/DGLODWDFLyQHVPD\RUDFPHQODVQXOtSDUDVRVHHQFXHQWUDHQSURJUHVRHQ
ODVPXOWtSDUDV
(OWUDEDMRGHSDUWRVHGLYLGHVHJ~QODGLODWDFLyQ\HOGHVFHQVRGHODSUHVHQWDFLyQHQ
WUHVHWDSDV
x3HUtRGRGHGLODWDFLyQRSULPHUSHUtRGR
x3HUtRGRGHH[SXOVLyQRVHJXQGRSHUtRGR
x3HUtRGRSODFHQWDULRDOXPEUDPLHQWRRWHUFHUSHUtRGR
(OSHUtRGRGHGLODWDFLyQHVWiSUHFHGLGRGHXQDIDVHGHGXUDFLyQYDULDEOHTXHUHFLEH
GLVWLQWRVQRPEUHVSUHSDUWRSUyGURPRVGHOSDUWRHWF/DJHVWDQWHSXHGHFRQVXOWDUHQ
FXDOTXLHUPRPHQWR\GHEHVHUDGHFXDGDPHQWHHYDOXDGDSDUDHVWDEOHFHUHOJUDGRGH
ULHVJRDOPRPHQWRGHODFRQVXOWD
,QWHUSUHWDFLyQGHO&DUQp3HULQDWDO
,QWHUURJDWRULR\([DPHQ&OtQLFRREVWpWULFR
1R 7UDEDMR 6L
GH3DUWR
6L )DFWRUHV 1R 6L )DFWRUHV 1R
GH5LHVJR GH5LHVJR
5HIHUHQFLD $GPLVLyQGLIHULGD 5HIHUHQFLDDO $GPLVLyQSDUD

D&RQVXOWD 6HJXLPLHQWR 1LYHOGH$WHQFLyQ $WHQFLyQ
$OWR5LHVJR DPEXODWRULR GH$OWR5LHVJR GHO3DUWR
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVHQODUHFHSFLyQGHXQDHPEDUD]DGD
&20321(17(6'(/$&2168/7$(15(&(3&,Ï1
x,QWHUURJDWRULR
x,QWHUSUHWDFLyQGHO&DUQpSHULQDWDO
x([DPHQFOtQLFRJHQHUDO
x([DPHQREVWpWULFR
,QWHUURJDWRULR
(VWiGHVWLQDGRDLGHQWL¿FDUODVUD]RQHVTXHPRWLYDURQODFRQVXOWD\DHYDOXDUHOJUDGR
GHULHVJRGHODJHVWDQWH(VHOFRPSOHPHQWRGHODOHFWXUDGHOFDUQpSHULQDWDO
3HUPLWHHYDOXDUVtQWRPDVGHOSDUWRDQWHFHGHQWHVGDWRVRPLWLGRVHQHOFRQWURORQXHYRV
DFRQWHFLPLHQWRVTXHDSDUHFLHURQGHVGHHO~OWLPRFRQWURO
6LODJHVWDQWHQRKDFRQWURODGRVXHPEDUD]RRDFXGHVLQHOFDUQpSHULQDWDOVHGHEHUi
LQWHUURJDUVLJXLHQGR³ODUXWD´TXHVXJLHUHOD+LVWRULD&OtQLFD3HULQDWDO
,GHQWL¿FDFLyQ
/DPD\RUtDGHORVIDFWRUHVGHULHVJRVRFLRHFRQyPLFRV\HGXFDFLRQDOHVQRGHWHUPLQDQ
FDPELRV HQ OD FRQGXFWD IUHQWH DO SDUWR VL HO HPEDUD]R OOHJD D WpUPLQR FRQ XQ IHWR \
XQDPDGUHVDQRV(QHVWDHWDSDHVWRVIDFWRUHVVRQGHLPSRUWDQFLDSDUDFRQWURODUORV
ULHVJRVSRVQDWDOHVDORVTXHSXHGHQDVRFLDUVH
$QWHFHGHQWHVIDPLOLDUHVSHUVRQDOHV\REVWpWULFRV
&LHUWDVFRQGLFLRQHVSDWROyJLFDVVHDVRFLDQFRQPD\RUULHVJRPDWHUQRIHWDO\RQHRQDWDO
GXUDQWHHOSDUWR6XH[LVWHQFLDDOPRPHQWRGHOLQLFLRGHOWUDEDMRGHSDUWRGHWHUPLQDTXH
VHDFODVL¿FDGRGHDOWRULHVJR
$QWHFHGHQWHVGHRWURVUHFLpQQDFLGRVGH%31 (QIHUPHGDGHQGyFULQRPHWDEyOLFD
(GDGGHR!GHDxRV ,QIHFFLyQXULQDULD\RWUDVLQIHFFLRQHV
3HUtRGRLQWHUJHVWDFLRQDOPHQRUDXQDxR 9,+6LGD
%DMRSHVRPDWHUQRSUHJHVWDFLRQDOHLQVX¿FLHQWH &RQGLORPDWRVLVYXOYRYDJLQDOSRU+39
JDQDQFLDGHSHVR +HUSHVYXOYRYDJLQDO
+iELWRGHIXPDU +HPRUUDJLDVGHOHPEDUD]R
&RQVXPRGHDOFRKRO\RWUDVGURJDVSURKLELGDV $QHPLDFUyQLFD
(PEDUD]RP~OWLSOH &RQWUROSUHQDWDODXVHQWHRLQDGHFXDGR
+LSHUWHQVLyQ\SUHHFODPSVLD &RORQL]DFLyQUHFWRYDJLQDOSRU(*%
&DUGLRSDWtD &LUXJtDXWHULQD
(QHOVLJXLHQWHFXDGURVHDQDOL]DQSUREDEOHVULHVJRVSURYRFDGRVSRUDOJXQDVGHHVWDV
FRQGLFLRQHV\ODVIUHFXHQFLDVFRQTXHHVWDVSDWRORJtDVVXHOHQSUHVHQWDUVHGXUDQWHHO
HPEDUD]R
&XDGUR5LHVJRGHOSDUWRDVRFLDGRDSDWRORJtDPDWHUQD
Diabetes Hipertensión Crónica Cirugía Uterina Cardiopatía
0.3% - 1% 0.3% - 2% 2% - 30% 1%-2%
DPPNI (4%) de las Insuficiencia

cardíaca.
Riesgo Traumatismo hipertensas. Rotura uterina. Edema agudo
obstétrico Accidente vascular Mayor frecuencia pulmonar.
materno en Enfermedad
Descompensación encefálico. de intervencio-
el parto metabólica Pre-eclampsia nes obstétricas tromboembólica.
Endocarditis
sobreagregada bacteriana
Malformaciones Derivado del RCI
Riesgo RCI Prematurez
Macrosomía riesgo materno.
Sufrimiento fetal agudo Sufrimiento fetal
fetoneonatal Infección neonatal Prematurez Traumatismo agudo
Hipoglicemia obstétrico Depresión neonatal
([DPHQFOtQLFRJHQHUDO
3HUPLWHHYDOXDUHOHVWDGRJHQHUDOGHODHPEDUD]DGDItVLFR\SVtTXLFRVXVIXQFLRQHV
YLWDOHV\GHVFDUWDUSDWRORJtDTXHLQFUHPHQWHHOULHVJR
(O H[DPHQ FOtQLFR UHTXLHUH VHU HIHFWXDGR SRU SHUVRQDO FDSDFLWDGR SDUD HYDOXDU
DSURSLDGDPHQWHORVSULQFLSDOHVVLJQRVGHSDWRORJtDVGHULHVJRWDOHVFRPR
x6tQGURPHKLSHUWHQVLYR x$QHPLDJUDYH
x,QIHFFLyQVHYHUD x&DUGLRSDWtDHWF
3DUDHYDOXDUORVVHGHEHH[SORUDUORVVLJXLHQWHVDVSHFWRVTXHDGHPiVSXHGHQRULHQWDU
KDFLDRWUDVSRVLEOHVSDWRORJtDV
3LHO\PXFRVDV
/DSLHO\ODVPXFRVDVGHEHQWHQHUXQDFRORUDFLyQWHPSHUDWXUD\KXPHGDGQRUPDOHV
(QRFDVLRQHVVHYHUiQVLJQRVRULHQWDGRUHVGHGLYHUVDVVLWXDFLRQHVSDWROyJLFDVORVTXH
VHHVTXHPDWL]DQDFRQWLQXDFLyQ
&XDGUR$OWHUDFLRQHVGHSLHO\PXFRVDV\VXUHODFLyQFRQ
FLHUWRVHVWDGRVSDWROyJLFRV
6LJQR 7UDVWRUQRVTXHVXJLHUH
3DOLGH] $QHPLD±6KRFN
&LDQRVLV 7UDVWRUQRVFDUGLRYDVFXODUHVRUHVSLUDWRULRV±6KRFN
,FWHULFLD &ROHVWDVLV+HSDWLWLV&ROHFLVWRSDWtDV
0XFRVDVVHFDV 'HVKLGUDWDFLyQ±DEGRPHQDJXGR±GLDEHWHVGHVFRPSHQVDGD
(GHPD 3UHHFODPSVLD,QVX¿FLHQFLDFDUGtDFD±WUDVWRUQRVUHQDOHV
/HVLRQHVGpUPLFDV +HUSHVJHQLWDO±3DSLORPDYLUDOKXPDQR6t¿OLV6FDELRVLV
3UHVLyQDUWHULDO
/RVVtQGURPHVKLSHUWHQVLYRVGHWHFWDGRVDOLQLFLRGHOSDUWRGHWpUPLQRFRUUHVSRQGHQD
KLSHUWHQVLyQDUWHULDOFUyQLFD\RLQGXFLGDSRUHOHPEDUD]RSUHHFODPSVLDHFODPSVLD6RQ
SRWHQFLDOPHQWHSHOLJURVRVSDUDODPDGUH\HOIHWRIUHFXHQWHPHQWHSDVDQLQDGYHUWLGRV
SDUDHOODSHURVXJUDYHGDGVHDVRFLDDVtQWRPDVGHLUULWDELOLGDGGHOVLVWHPDQHUYLRVR
FHQWUDO61&FRPSURPLVRUHQDO\RKHSiWLFR
(QSUHVHQFLDGHKLSHUWHQVLyQGHEHLQWHUURJDUVHVREUH
&HIDOHD 7UDVWRUQRVYLVXDOHVHVFRWRPDVDPDXURVLV

0DUHRVRYpUWLJRV 7UDVWRUQRVDXGLWLYRV
3pUGLGDGHFRQFLHQFLD 2OLJXULDRDQXULD
&RQYXOVLRQHV 'RORUDEGRPLQDOSDUWLFXODUPHQWHHOGRORUHQEDUUD
$GHPiVGHEHQH[DPLQDUVHHVSHFLDOPHQWH
5HÀHMRVRVWHRWHQGLQRVRVSDWHODU
3DOSDFLyQDEGRPLQDOHOGRORUHQKLSRFRQGULRGHUHFKRRODKHSDWRPHJDOLDVRQ
VLJQRVGHJUDYHGDG
/DSUHVHQFLDGHFXDOTXLHUDGHHVWRVVLJQRVRVtQWRPDVLQGLFDJUDYHGDGGHOVtQGURPH
KLSHUWHQVLYR
/D KLSRWHQVLyQ DO ¿QDO GHO HPEDUD]R HV PHQRV FRP~Q (Q RFDVLRQHV SXHGH VHU OD
PDQLIHVWDFLyQ GH XQ VKRFN (O VKRFN HQ REVWHWULFLD HV KDELWXDOPHQWH VHFXQGDULR
D KHPRUUDJLD FRQ PXFKR PHQRU IUHFXHQFLD HV GHELGR D VHSVLV HPEROLD GH OtTXLGR
DPQLyWLFRGHSOHFLyQVDOLQDXRWUDFRQGLFLyQPpGLFDJUDYHFDUGLRSDWtDGLDEHWHV(Q
FDVRGHKLSRWHQVLyQGHEHEXVFDUVH
+HPRUUDJLDJHQLWDO 3XOVRGHHOHYDGDIUHFXHQFLDGHELO\R¿QR
+LSHUWRQtDXWHULQD 3LHOIUtD\VXGRURVD
3DOLGH]\RFLDQRVLV 3ROLSQHD
2OLJXULD

/D SUHVHQFLD GH FXDOTXLHUD GH HVWRV VtQWRPDV GHEH DOHUWDU VREUH OD SRVLELOLGDG GH
LQVWDODFLyQGHXQVKRFN
/DWpFQLFDGHPHGLGDHLQWHUSUHWDFLyQGHORVYDORUHVGHSUHVLyQDUWHULDOVHSUHVHQWDHQ
VHFFLyQSUHQDWDO
/D+7$OHYHSXHGHWUDQVIRUPDUVHHQVHYHUDHQFXDOTXLHULQVWDQWHHVUHFRPHQGDEOHUHIHULU
DDOWRULHVJRDWRGDVODVSDFLHQWHVFRQVtQGURPHVKLSHUWHQVLYRVLQGHSHQGLHQWHPHQWH
GHVXVHYHULGDG
3XOVR
/DIUHFXHQFLDQRUPDOGHOSXOVRHQHOHPEDUD]RGHWpUPLQRHVGHDSXOVDFLRQHVSRU
PLQXWR6HFRQVWDWDSRUPHGLRGHODSDOSDFLyQGLJLWDOGHODDUWHULDUDGLDOVREUHODPXxHFD
GXUDQWHPLQXWR
,QWHUSUHWDFLyQ
1RUPDODSXOVDFLRQHVSRUPLQXWR
%UDGLFDUGLDSXOVDFLRQHVSRUPLQXWR
7DTXLFDUGLD!SXOVDFLRQHVSRUPLQXWR
&RQGXFWD
/DVDOWHUDFLRQHVGHEHQHYDOXDUVHHQFRQMXQWRFRQRWURVKDOOD]JRVGHOH[DPHQ
7HPSHUDWXUD
/D SUHVHQFLD GH ¿HEUH SXHGH VHU XQ VLJQR GH LQIHFFLyQ JUDYH R GH SURFHVRV SRFR
LPSRUWDQWHV TXH QR DOWHUDQ HO ULHVJR GHO SDUWR 'HEH SRU OR WDQWR LQYHVWLJDUVH RWURV
VLJQRV\VtQWRPDVTXHSXHGDQRULHQWDUDORULJHQGHOD¿HEUHWDOHVFRPR
3pUGLGDGHOtTXLGRDPQLyWLFRSRUURWXUDGHPHPEUDQDV
'RORUDEGRPLQDOGLIHUHQFLDEOHGHFRQWUDFFLRQHV
'LVXULDSXMRV\WHQHVPRYHVLFDO
(GHPDGRORU\HQURMHFLPLHQWRGHH[WUHPLGDGHVLQIHULRUHV
&XDOTXLHUD GH HOORV VXJLHUH LQIHFFLyQ SRWHQFLDOPHQWH VHYHUD LQIHFFLyQ RYXODU
SLHORQHIULWLVQHXPRSDWtDDEGRPHQDJXGRRVHSVLVVLOD¿HEUHHVWiDVRFLDGDDRWURV
VLJQRVGHVKRFNWURPERÀHELWLV
5HJLVWURGHODWHPSHUDWXUD
&RORFDU HO WHUPyPHWUR HQ OD D[LOD HQ OD ERFD R HQ HO UHFWR GXUDQWH PLQXWR FRPR
PtQLPR
,QWHUSUHWDFLyQ 1RUPDOKDVWD&D[LODU
KDVWD&UHFWDOREXFDO
&RQGXFWD
&XDQGR VH FRQVWDWDQ VtQWRPDV \ VLJQRV GH LQIHFFLyQ VHYHUD VH GHEH UHIHULU D
QLYHOGHDWHQFLyQGHDOWRULHVJR
&XDQGRORVKDOOD]JRVVRQVXJHUHQWHVGHSDWRORJtDVSRFRLPSRUWDQWHVVHSRGUi
DGPLWLUHQHOQLYHOGHEDMRULHVJRFRQWURODQGRODWHPSHUDWXUDSXOVR\RWURVVLJQRV
\ VtQWRPDV FDGD KRUDV 0DQWHQLHQGR D OD JHVWDQWH KLGUDWDGD RIUHFLpQGROH
OtTXLGRV SRU YtD RUDO (Q FDVR GH LGHQWL¿FDU OD FDXVD HIHFWXDU HO WUDWDPLHQWR
HVSHFt¿FRHWLROyJLFR6LFRQPHGLGDVItVLFDVWDOHVFRPRGXFKDWLELDURSDVOLJHUDV
HKLGUDWDFLyQQRVHFRUULJHODWHPSHUDWXUDVHUHFRPLHQGDHPSOHDUDQWLWpUPLFRV
3HVR
(OSHVRDFWXDOGHEHVHUHYDOXDGRPHGLDQWHXQDWDEODGHJDQDQFLDGHSHVRPDWHUQR
HQIXQFLyQGHODHGDGJHVWDFLRQDO(OSHVRPDWHUQRLQVX¿FLHQWH\HOHVFDVRLQFUHPHQWR
GHSHVRGXUDQWHHOHPEDUD]RVHUHODFLRQDQFRQUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQR
5&,(OLQFUHPHQWREUXVFR\H[DJHUDGRGHSHVRPDWHUQRSXHGHGHEHUVHDUHWHQFLyQ
KtGULFDSUHHFODPSVLD\RGLDEHWHV\GHEHUiVHUYDORUDGRHQFRQMXQWRFRQRWURVVtQWRPDV
\VLJQRVSDUDGH¿QLUODHWLRORJtD
([DPHQFOtQLFRSRUVLVWHPDV
$SOLFDUODVWpFQLFDVVHPLROyJLFDVKDELWXDOHVDODOFDQFHGHOSHUVRQDOFDOL¿FDGR
&RQGXFWD
&XDQGRVHHVWiHQSUHVHQFLDGHVtQWRPDV\VLJQRVVXJHUHQWHVGHSDWRORJtDPpGLFDJUDYH
FDUGLRSDWtDDQHPLDVHYHUDHWFVHGHEHUiUHIHULUDODJHVWDQWHDQLYHOGHDWHQFLyQGH
DOWRULHVJR
([DPHQREVWpWULFR
3HUPLWH
&RQ¿UPDUHOGLDJQyVWLFRGHWUDEDMRGHSDUWR
(YDOXDUHOULHVJRPDWHUQRIHWDOSDUDHOSDUWR\SDUDHOUHFLpQQDFLGR
3DOSDFLyQDEGRPLQDO
/RVREMHWLYRVTXHVHSHUVLJXHQVRQGHWHUPLQDU
9ROXPHQXWHULQR 3RVLFLyQ\WDPDxRIHWDO
1~PHURGHIHWRV &DQWLGDGGHOtTXLGRDPQLyWLFR
6LWXDFLyQIHWDO $OWXUDGHODSUHVHQWDFLyQ
3UHVHQWDFLyQIHWDO 3UHVHQFLDGHFRQWUDFFLRQHVXWHULQDV
(O HPEDUD]R P~OWLSOH OD SUHVHQWDFLyQ GLVWyFLFD OD GHVSURSRUFLyQ IHWRSpOYLFD R ODV
DOWHUDFLRQHVGHODFDQWLGDGGHOtTXLGRDPQLyWLFRVRQIDFWRUHVGHULHVJRGHLPSRUWDQFLD
SDUD HO SDUWR 6L ELHQ HQ OD PD\RUtD GH ORV FDVRV HVWDV VLWXDFLRQHV KDEUiQ VLGR
GHVFDUWDGDV GXUDQWH HO FRQWURO SUHQDWDO ODV JHVWDQWHV VLQ FRQWURO R SRVLEOHV HUURUHV
GLDJQyVWLFRV R FDPELRV SURGXFLGRV GHVGH HO ~OWLPR FRQWURO KDFHQ LPSUHVFLQGLEOH
FRQ¿UPDURGHVFDUWDUHVWDVVLWXDFLRQHVHQODDGPLVLyQ
(VWHH[DPHQVHFRPSOHPHQWDFRQODPHGLFLyQGHODDOWXUDXWHULQD\ODVPDQLREUDVGH
/HRSROGWDOFRPR\DVHGHVFULELHURQHQHOFDStWXORSUHQDWDO
/D VRVSHFKD GH GHVSURSRUFLyQ IHWR SpOYLFD GHEH FRQ¿UPDUVH FRQ HO H[DPHQ JHQLWDO
FRPRVHGHWDOODHQODVSiJLQDVGHSUHQDWDO
$OWXUDXWHULQD
3HUPLWHHYDOXDUHOWDPDxR\FUHFLPLHQWRIHWDOFRPRVHLQGLFyHQHOFDStWXORGHSUHQDWDO
&RQGXFWD
/DVRVSHFKDGHUHVWULFFLyQGHFUHFLPLHQWRLQWUDXWHULQR5&,8PDFURVRPtDHPEDUD]R
P~OWLSOHSUHVHQWDFLyQGLVWyFLFD\SROLKLGUDPQLRVGHWHUPLQDQODDVLVWHQFLDGHOSDUWRHQ
XQQLYHOGHDOWRULHVJR
$XVFXOWDFLyQGHODIUHFXHQFLDFDUGtDFDIHWDO)&)
3HUPLWHFRQ¿UPDUODYLWDOLGDG\HOJUDGRGHELHQHVWDUIHWDO
/DDXVFXOWDFLyQGHORVODWLGRVIHWDOHVDVHJXUDQTXHHOIHWRHVWiYLYR/DHYDOXDFLyQGH
OD IUHFXHQFLD FDUGtDFD IHWDO )&) DQWHV GXUDQWH \ GHVSXpV GH ODV FRQWUDFFLRQHV
SHUPLWH DSUHFLDU FRQ FLHUWD VHJXULGDG HO HVWDGR GH VDOXG IHWDO /D SUHVHQFLD GH
VHYHUDVDOWHUDFLRQHVGHOD)&)LQGLFDXQDIXQGDGDSUHVXQFLyQGHKLSR[LDIHWDOFRQHO
FRQVLJXLHQWHULHVJRGH
0XHUWHIHWDO 0RUELOLGDGQHRQDWDO
'HSUHVLyQDOQDFHU 0XHUWHQHRQDWDO
(Q FRQGLFLRQHV QRUPDOHV HO IHWR WROHUD DGHFXDGDPHQWH OD GLVPLQXFLyQ GH OD SUHVLyQ
SDUFLDOGHR[tJHQR32SURYRFDGDSRUODVFRQWUDFFLRQHVXWHULQDV+D\FRQGLFLRQHV
GHULHVJRTXHDIHFWDQODUHVHUYDIHWRSODFHQWDULDSURYRFDQGRXQDGLVPLQXFLyQGHOD
32SRUGHEDMRGHOQLYHOFUtWLFR6XWUDGXFFLyQFOtQLFDHVODWDTXLFDUGLDSRUDXPHQWRGHO
WRQRVLPSiWLFREUDGLFDUGLDWUDQVLWRULDSRVWFRQWUDFFLyQ',3,,REUDGLFDUGLDVRVWHQLGD
SRUDXPHQWRGHOWRQRSDUDVLPSiWLFR/DWDTXLFDUGLDDLVODGD\PDQWHQLGDSXHGHVHUHO
SULPHUVLJQRGHVXIULPLHQWRIHWDO
(VIUHFXHQWHREVHUYDUHQHOWUDQVFXUVRGHOSDUWRFDtGDVGHOD)&)FRLQFLGHQWHVFRQ
OD FRQWUDFFLyQ ',3 , HQ SDUWLFXODU VL ODV PHPEUDQDV HVWiQ URWDV \R OD FDEH]D GHO
IHWRHVWiHQFDMDGD(VWHVLJQRQRUHVSRQGHDXQDKLSR[LDIHWDOVLVWpPLFDVLQRDXQD
HVWLPXODFLyQYDJDOSRUFRPSUHVLyQ/RV',36,QRVHDVRFLDQJHQHUDOPHQWHFRQPXHUWH
IHWDOQLFRQKLSR[LDQHRQDWDO
(QRWUDVRFDVLRQHVDSDUHFHQ',36HQORVTXHQRHVIiFLOGH¿QLUVLVHWUDWDGH',36,R,,
SRUTXHSDUHFHQLQWHUFDODUVHORVXQRVFRQORVRWURV\VRQGHGLIHUHQWHPRUIRORJtDHQWUH
Vt(VWRV',36YDULDEOHVRXPELOLFDOHVVRQSURGXFWRGHXQDRFOXVLyQWUDQVLWRULDGHORV
YDVRVXPELOLFDOHVFXDQGRVHFRQWUDHHO~WHUR6LODRFOXVLyQHVEUHYHPHQRUGHR
VHJXQGRVVRORVHSURGXFHXQDHVWLPXODFLyQGHOYDJR6LHVPiVSURORQJDGDPD\RU
GHVHJXQGRVVHGHVDUUROODWDPELpQKLSR[LDIHWDO(QHVWHFDVRHO',3YDULDEOHVHUtD
VLQyQLPRGHVXIULPLHQWRIHWDO
&XDGUR,QWHUSUHWDFLyQGHODIUHFXHQFLDFDUGtDFDIHWDO
)&)HQWUHFRQWUDFFLRQHV)&)EDVDO
1RUPDO (QWUHODWPLQ
$OHUWD+LSR[LDOHYH (QWUHODWPLQEUDGLFDUGLD
6REUHODWPLQWDTXLFDUGLD
$QRUPDO
+LSR[LDVHYHUDREORTXHRFDUGtDFRFRQJpQLWR )&)ODWPLQEUDGLFDUGLD
)&)DVRFLDGDDODVFRQWUDFFLRQHV
1RUPDO
6LQYDULDFLyQVLJQL¿FDWLYDFRQODEDVDODFHOHUDFLRQHVWUDQVLWRULDV
'LSV,RGHVDFHOHUDFLyQSUHFR]VLQFUyQLFDFRQODFRQWUDFFLyQXWHULQD&8
$OHUWD
'LSVYDULDEOHVRXPELOLFDOHVGHGXUDFLyQDPSOLWXG\PRPHQWRGHFRPLHQ]R
YDULDEOHVHQUHODFLyQFRQOD&83RVLEOHSDWRORJtDIXQLFXODU
$QRUPDO
'LSV,,RGHVDFHOHUDFLyQWDUGtD,QLFLDFLyQWDUGtDHQUHODFLyQDOD&8\
UHFXSHUDFLyQGHVSXpVTXHpVWDKDWHUPLQDGR$OFDQ]DVXYDORUPtQLPRHQWUH
\VHJXQGRVGHVSXpVGHODFPpGHOD&8
%UDGLFDUGLDVRVWHQLGDODWPLQ'HVDFHOHUDFLyQLQLFLDGDHQOD&8TXHQR
VHUHFXSHUDXQDYH]WHUPLQDGDpVWD
6LKD\IDFWRUHVGHULHVJRGHEHQH[WUHPDUVHORVFXLGDGRVHQODDXVFXOWDFLyQGHOIHWR
&RQODWpFQLFDGHDXVFXOWDFLyQGHVFULSWDHQODSDJGHEHHPSOHDUVHHOVLJXLHQWH

PpWRGRSDUDGHWHFWDUFDtGDVGHOD)&)(QWUHODVFRQWUDFFLRQHVVHGHWHUPLQDOD)&)
EDVDO6HDXVFXOWDGXUDQWHVHJXQGRV\VHPXOWLSOLFDHOYDORUSRU
'XUDQWHODFRQWUDFFLyQHLQPHGLDWDPHQWHGHVSXpVGHODFRQWUDFFLyQVHSHVTXLVDUiQ
YDULDFLRQHV 6H GHEHUi DXVFXOWDU GHVGH HO FRPLHQ]R GH OD FRQWUDFFLyQ \ KDVWD
VHJXQGRVGHVSXpVGHWHUPLQDGDODPLVPDHQSHUtRGRVGHVHJXQGRV6HPXOWLSOLFDUi
FDGDYDORUSRUVHORVFRPSDUDUiHQWUHVt\FRQOD)&)EDVDO
&20,(1=2<),1$/'($86&8/7$&,21
ODWPLQ
)5(&8(1&,$ D E F G
&$5',$&$
)(7$/

)LJXUD
PP+J 'LS ,,
0pWRGR SDUD GHWHFWDU FDtGDV GH
OD )&) GXUDQWH \ GHVSXpV GH ODV

VHJ FRQWUDFFLRQHV FXDQGR VH XWLOL]D OD
&2175$&&,21
87(5,1$
DXVFXOWDFLyQ FOtQLFD SRU PHGLR GHO
HVWHWRVFRSLRREVWpWULFR

&RQGXFWD
&XDQGRVHUHJLVWUDEUDGLFDUGLDVRVWHQLGDR',36,,HOSDUWRGHEHUiVHUFRQVLGHUDGRGH
DOWRULHVJR/DWDTXLFDUGLD\ORV',36YDULDEOHVVRQVLWXDFLRQHVGHDODUPDDQWHODVTXH
VHGHEHH[WUHPDUODYLJLODQFLDGHOD)&)FRQODSDFLHQWHHQGHF~ELWRODWHUDOL]TXLHUGR
3DWUyQGHFRQWUDFWLOLGDGXWHULQD
6H GHEH GHWHUPLQDU HO WRQR XWHULQR OD IUHFXHQFLD GXUDFLyQ H LQWHQVLGDG GH ODV
FRQWUDFFLRQHV\HQTXHPRPHQWRODJHVWDQWHQRWDODLQWHQVL¿FDFLyQGHDOJXQRGHHVWRV
SDUiPHWURV
3DUD TXH VH SURGX]FD HO ERUUDPLHQWR OD GLODWDFLyQ FHUYLFDO \ HO GHVFHQVR GH
OD SUHVHQWDFLyQ VH UHTXLHUH XQ SDWUyQ DSURSLDGR GH FRQWUDFFLRQHV XWHULQDV
8QDFRQWUDFFLyQQRUPDOSURYRFDPRGL¿FDFLRQHVWUDQVLWRULDV¿VLROyJLFDVGHODFLUFXODFLyQ
~WHURSODFHQWDULD\GHODR[LJHQDFLyQIHWDO/DKLSHUDFWLYLGDGXWHULQDWDTXLVLVWROtD\R
KLSHUWRQtD SXHGH SURYRFDU KLSR[LD IHWDO 7DPELpQ SXHGH SURYRFDU URWXUD XWHULQD VL
H[LVWHQ IDFWRUHV SUHGLVSRQHQWHV FLFDWULFHV XWHULQDV PDOIRUPDFLRQHV GHVSURSRUFLyQ
IHWRSpOYLFDHWF
/RVSDUiPHWURVTXHVHFRQVLGHUDQSDUDHVWDEOHFHUHOSDWUyQGHFRQWUDFWLOLGDGXWHULQDVRQ
7RQRSUHVLyQPiVEDMDHQWUHODVFRQWUDFFLRQHV
)UHFXHQFLDQ~PHURGHFRQWUDFFLRQHVHQPLQXWRV
'XUDFLyQWLHPSRWUDQVFXUULGRGHVGHHOLQLFLRKDVWDHO¿QGHODFRQWUDFFLyQ
,QWHQVLGDGODGLIHUHQFLDHQWUHODPi[LPDSUHVLyQDOFDQ]DGDSRUODFRQWUDFFLyQ\
HOWRQR
3DUDTXHODVFRQWUDFFLRQHVVHDQSHUFLELGDVVXLQWHQVLGDGGHEHVREUHSDVDUXQFLHUWR
YDORUXPEUDOGHSHUFHSFLyQSRUSDOSDFLyQ(QFRQGLFLRQHVQRUPDOHVHOYDORUSURPHGLR
GHOXPEUDOGHSHUFHSFLyQSRUSDOSDFLyQHVGHPP+JSRUHQFLPDGHOWRQRQRUPDOGH
ODSUHVLyQDPQLyWLFDFXDGUR
&XDGUR3DUiPHWURVGHFRQWUDFWLOLGDGXWHULQD
7RQR )UHFXHQFLD 'XUDFLyQ ,QWHQVLGDG

FRQWUDFFPLQ VHJXQGRV
$QRUPDO 1RUPDO
D
,175$87(5,1$
PP+J PP+J

DOHUWD
35(6,21
0e72'2'(5(*,6752
!PP+J

!PP+J
! ! KLSHUVLVWROtD
6HSDOSDQ
SDUWHVIHWDOHV (O~WHUR
1RUPDO
6HGHSULPH QRVHGHSULPH
D D
~WHURHQWUH HQHODFPpGH
ODFRQWUDFFLyQ
FRQWUDFFLRQHV
&/,1,&2
+LSHUWRQtD +LSHUVLVWROtD
hWHURQRVH
$QRUPDO
,PSRVLEOHSDOSDU !
! GHSULPHHQ
SDUWHVIHWDOHV WDTXLVLVWROLD
QLQJ~QPRPHQWR
'RORU GHODFRQWUDFFLyQ
1RWDDORVHIHFWRVGHODHVTXHPDWL]DFLyQQRIXHURQLQFOXtGRVHQHVWHFXDGURODKLSRWRQtDQLODKLSRVLVWROtD
/DSULPHUD\OD~OWLPDSDUWHGHODFRQWUDFFLyQXWHULQDQRVRQSHUFLELGDVSRUSDOSDFLyQ
DEGRPLQDOODGXUDFLyQFOtQLFDHVWLPDGDSRUHVWHPpWRGRHVPHQRUTXHODGXUDFLyQUHDO
PHGLGDSRUXQUHJLVWURGHSUHVLyQLQWUDXWHULQD
&XDQWRPD\RUVHDODLQWHQVLGDGGHODFRQWUDFFLyQWDQWRPiVVHHQGXUHFHUiODSDUHG
XWHULQD &XDQGR OD SUHVLyQ DPQLyWLFD VREUHSDVH ORV PP+J OD SDUHG XWHULQD VH
SRQGUiWDQGXUDTXHQRSRGUiGHSULPLUVHFRQHOGHGR
(ODXPHQWRSRUHQFLPDGHORVYDORUHV¿VLROyJLFRVGHFXDOTXLHUDGHHVWRVSDUiPHWURV
SXHGH WUDGXFLUVH HQ FRPSURPLVR GH OD FLUFXODFLyQ ~WHURSODFHQWDULD UHVXOWDQGR HQ
KLSR[LDIHWDO
/DGLVPLQXFLyQGHODDFWLYLGDGXWHULQDSXHGHSURGXFLUXQOHQWRSURJUHVRGHOSDUWRRVX
GHWHQFLyQ
7pFQLFDSDUDHYDOXDUODFRQWUDFWLOLGDG
3DOSDFLyQDEGRPLQDO
(OFRQWUROFOtQLFRGHODVFRQWUDFFLRQHVXWHULQDVVHGHEHUHDOL]DUSRUSHUtRGRVQRPHQRUHVDORV
PLQXWRVFRORFDQGRODPDQRH[WHQGLGDVREUHHODEGRPHQPDWHUQRVLQHVWLPXODUHOFXHUSR
XWHULQR
&RQGXFWD
&XDGUR&RQGXFWDUHFRPHQGDGDDQWH
+LSHUGLQDPLDSULPLWLYD
&RQWUDFWLOLGDG +LSRGLQDPLDSULPLWLYD
KLSHUWRQtDWDTXLRKLSHUVLVWROtD
QRUPDO EUDGLRSROLVLVWROtD
+LSHUGLQDPLDVHFXQGDULD
$GPLWLUSDUDDWHQFLyQHQQLYHO
$GPLWLUSDUDDWHQFLyQ &RORFDUDODSDUWXULHQWDHQGHF~ELWRODWHUDO GHEDMRULHVJR
HQQLYHOGHEDMR L]TXLHUGR
ULHVJR 2EVHUYDUSURJUHVRGHOSDUWR
,QLFLDUXWHURLQKLELFLyQFRQEHWDPLPpWLFRV
SRUYtDHQGRYHQRVD
2EVHUYDUSURJUHVR 6LQRKD\SURJUHVRGHOSDUWR
GHOSDUWR 3HVTXLVDFDXVD DSOLFDURFLWRFLQDHQGRYHQRVD
6LHVWDVPHGLGDVQRVRQHIHFWLYDVUHIHULU
ODJHVWDQWHDQLYHOGHDOWRULHVJR
(PEDUD]DGDGH7pUPLQRHQ7UDEDMRGH3DUWR
12 $OWXUD8WHULQD 6,
1RUPDO
12 &RQWUDFW 12
+LSHUGLQDPLD 1RUPDO +LSRGLQDPLD
0DFURVRPtD
'LVWRFLDGH 6,
3UHVHQWDFLyQ 7UDWDPLHQWR 2EVHUYDFLyQ
*HPHODU 7UDWDPLHQWR
5&,
3UHPDWXUH]
12 6, 6, (YROXFLyQ
(IHFWLYR
QRUPDO
12 )&) 12
1RUPDO
6, 6XIULPLHQWR 12 6,
7UDWDPLHQWR
)HWDO
$WHQFLyQHQ1LYHO
GH$OWR5LHVJR $GPLVLyQD%DMR5LHVJR
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVEDVDGRHQHOH[DPHQREVWpWULFRGHOD
HPEDUD]DGDHQWUDEDMRGHSDUWR
([DPHQ*HQLWDO
7DFWRYDJLQDO
3HUPLWHHYDOXDU
$PSOLWXG\HODVWLFLGDGGHSDUWHVEODQGDV
'LODWDFLyQERUUDPLHQWR\SRVLFLyQGHOFXHOOR
(VWDGRGHODVPHPEUDQDVRYXODUHV
3UHVHQWDFLyQYDULHGDGGHSRVLFLyQ\DOWXUDGHODSUHVHQWDFLyQ
*UDGRGHHQFDMDPLHQWR
(YDOXDFLyQ GH OD HVWUXFWXUD \ GLiPHWURV SpOYLFRV iQJXOR VXES~ELFR GLiPHWUR EL
LVTXLiWLFR
3URSRUFLRQDOLGDGIHWRSpOYLFD
7pFQLFDSDUDHOWDFWRYDJLQDO
(OH[DPHQJHQLWDOGHEHHIHFWXDUVHFRQYHMLJDYDFtDPHGLDQWHPLFFLyQHVSRQWiQHDFRQ
ODJHVWDQWHHQSRVLFLyQJLQHFROyJLFDFRQHOVDFURELHQDSR\DGRHQODFDPLOOD
3URFHGLPLHQWR
,QVSHFFLyQ GH ORV JHQLWDOHV H[WHUQRV OHVLRQHV YiULFHV SpUGLGD GH VDQJUH
VHFUHFLRQHVRSUHVHQFLDGHWXPRUHV
$VHRJHQLWDOFRQVROXFLyQGHVLQIHFWDQWH
*XDQWHVHVWpULOHV
6HSDUDUORVODELRVPHQRUHVFRQORVGHGRVtQGLFH\SXOJDUGHODPDQRPHQRVKiELO
,QVSHFFLRQDUHOLQWURLWR
(Q FDVR GH SpUGLGD GH OtTXLGR R VDQJUH SRU ORV JHQLWDOHV GHEH HYDOXDUVH VX
SURFHGHQFLD\PDJQLWXGSRUHVSHFXORVFRStDSUHYLDDOWDFWRYDJLQDO
,QWURGXFLU KRUL]RQWDOPHQWH ORV GHGRV tQGLFH \ PHGLR GH OD PDQR PiV KiELO HQ OD
GLUHFFLyQGHOHMHYDJLQDOFRQORVGHGRVDQXODU\PHxLTXHÀH[LRQDGRV\HOSXOJDU
H[WHQGLGR
3DOSDUFRQODVXSHU¿FLHSDOPDUGHORVGHGRV
0DQWHQHUHODQWHEUD]RHQSRVLFLyQKRUL]RQWDO
$SR\DUHOIRQGRXWHULQRFRQODPDQRH[WHUQD
1RUHWLUDUORVGHGRVGHODYDJLQDKDVWDQRKDEHUFRPSOHWDGRHOH[DPHQ
$OUHWLUDUORVGHGRVFRPSUREDUVLHOUHFWRHVWiYDFtR
&RQWURODUHQHOJXDQWHODSRVLEOHSUHVHQFLDGHPXFRVLGDGVDQJUHROtTXLGR
)LJXUD7pFQLFDGHOH[DPHQYDJLQDO
(VSHFXORVFRStD
6HSDUDUORVODELRVPHQRUHV
,QWURGXFLUHQIRUPDGHOLFDGDHOHVSpFXORFHUUDGRGLULJLpQGRORREOLFXDPHQWHKDFLD
DWUiVGHSULPLHQGROLJHUDPHQWHHOSHULQp
$EULUHOHVSpFXOR\REVHUYDUHOFXHOORXWHULQRODVFDUDFWHUtVWLFDVGHODVVHFUHFLRQHV
TXHSXGLHVHQH[LVWLUPXFRVLGDGVDQJUHOtTXLGR
(YDOXDFLyQGHODDPSOLWXG\HODVWLFLGDGGHOFDQDOGHOSDUWR
1RFRQVWLWX\HQKDELWXDOPHQWH REVWiFXORV SDUDHOSDUWRSHUROD IDOWDGHHODVWLFLGDG \

DPSOLWXGSXHGHQSURORQJDUVXGXUDFLyQ
/RVWUDVWRUQRVGHODDPSOLWXG\HODVWLFLGDGGHOFDQDOGHSDUWRVHVXHOHQREVHUYDUHQ
FLHUWDVFRQGLFLRQHV
3ULPLJHVWDDGROHVFHQWHRDxRVD
+LSHUWUR¿DGHODPXVFXODWXUDSHULQHDO
(VWHQRVLVFLFDWUL]DOHVSODVWLDVFiXVWLFRV
7XPRUHVGHO~WHURFXHOORYDJLQDRYXOYD
FRQGLORPDWRVLVPDVLYDTXLVWHVWXPRUHVSUHYLRVHWF
7DELTXHVYDJLQDOHVWUDQVYHUVDOHV
3HUVLVWHQFLDGHOKLPHQ
'LODWDFLyQERUUDPLHQWR\SRVLFLyQGHOFXHOOR
(OERUUDPLHQWR\ODGLODWDFLyQFHUYLFDOVHSURGXFHQSRUHOHIHFWRGHODVFRQWUDFFLRQHV\
PRGL¿FDFLRQHVELRTXtPLFDVGHOFXHOORDO¿QDOGHOHPEDUD]R
(OERUUDPLHQWRHVODUHGXFFLyQGHODORQJLWXGGHOFXHOOR$OFRPSOHWDUVHHOERUUDPLHQWR
HO RUL¿FLR FHUYLFDO H[WHUQR VH FRQIXQGH FRQ HO LQWHUQR +DELWXDOPHQWH OD SULPLJHVWD
FRPSOHWDHOERUUDPLHQWRDQWHVGHLQLFLDUODGLODWDFLyQHQODPXOWtSDUDHQFDPELRORV
SURFHVRVVXHOHQVHUVLPXOWiQHRV
(O ERUUDPLHQWR VH GHVFULEH LQGLFDQGR OD ORQJLWXG GHO FDQDO HQGRFHUYLFDO \D VHD HQ
YDORUHVDEVROXWRVDFPRHQSRUFHQWDMHGHERUUDPLHQWRD
/D GLODWDFLyQ HV OD DPSOLDFLyQ GHO FXHOOR XWHULQR TXH YDUtD HQWUH DOJXQRV PLOtPHWURV
KDVWDOOHJDUDORVFP6HSURGXFHSRUXQGREOHPHFDQLVPRODWUDFFLyQGHOD¿EUD
PLRPHWULDOTXHVHDSR\DSDUDFRQWUDHUVHHQHOWHMLGRFRQMXQWLYRGHOFXHOOR\ODSUHVLyQ
GH OD EROVD GH DJXDV R GH OD SUHVHQWDFLyQ IHWDO VREUH HO RUL¿FLR FHUYLFDO LQWHUQR /D
GLODWDFLyQVHPLGHLQWURGXFLHQGRORVGHGRVH[SORUDGRUHVHQHORUL¿FLRFHUYLFDOLQWHUQR\
VHSDUiQGRORVKDVWDWRFDUORVERUGHVGHOFXHOOR
(QHOFXHOORLQPDGXURHORUL¿FRFHUYLFDOH[WHUQRVHHQFXHQWUDJHQHUDOPHQWHHQHOIRQGR
GHVDFRSRVWHULRU$OPDGXUDUVXSRVLFLyQFDPELDKDVWDKDFHUVHFHQWUDO
$~Q FRQ FRQWUDFFLRQHV QRUPDOHV DOJXQDV FRQGLFLRQHV SXHGHQ GL¿FXOWDU OD GLODWDFLyQ \ HO
ERUUDPLHQWR
DJOXWLQDFLyQFHUYLFDOGHELGDDXQDHQGRFHUYLFLWLVXRWUDSDWRORJtD
FLFDWULFHVFHUYLFDOHVFRQL]DFLyQGHVJDUURV
(GHPDFHUYLFDO
(VWDV VRQ VLWXDFLRQHV SRFR IUHFXHQWHV TXH SXHGHQ GHWHQHU HO SURJUHVR GHO SDUWR
/D SRVLFLyQ SRVWHULRU GHO FXHOOR SXHGH SURORQJDU HO WUDEDMR GH SDUWR SXHVWR TXH SRU
FRPSUHVLyQGHOODELRDQWHULRUHQWUHODSUHVHQWDFLyQ\HOSXELVVHSXHGHSURGXFLUHGHPD
FHUYLFDO
3pUGLGDGHVHFUHFLRQHVSRUORVJHQLWDOHV
&XDQGRHOPRWLYRGHFRQVXOWDHVODSpUGLGDGHVHFUHFLRQHVSRUYtDJHQLWDOVHGHEHUi
GHWHUPLQDUDTXHFRUUHVSRQGHQ
7DSyQPXFRVROLPRV
/tTXLGRDPQLyWLFR
2ULQD
6DQJUH
6HFUHFLRQHVSXUXOHQWDV
,QWHUURJDUVREUHHOPRPHQWRGHDSDULFLyQODFDQWLGDG\DOJXQDVFDUDFWHUtVWLFDVFRPR
DVSHFWR FRORU RORU HWF 'HEH SUHJXQWDUVH DGHPiV DFHUFD GH OD SHUFHSFLyQ GH ORV
PRYLPLHQWRVIHWDOHV\VLHVWRVKDQYDULDGRRKDQGHVDSDUHFLGR
7DSyQ0XFRVR (VXQDVHFUHFLyQHVSHVDDYHFHVVDQJXLQROHQWDFX\DH[SXOVLyQ
REHGHFHDOFRPLHQ]RGHOERUUDPLHQWR\ODGLODWDFLyQGHOFXHOOR

/tTXLGR$PQLyWLFR/DVPHPEUDQDVRYXODUHVSRUGHODQWHGHODSUHVHQWDFLyQIRUPDQ
ODEROVDGHODVDJXDV/DSUHVHQFLDGHXQDEROVDGHDJXDVPX\
SURPLQHQWHRHQUHORMGHDUHQDGHEHKDFHUVRVSHFKDU
'HVSURSRUFLyQIHWRSpOYLFD
3UHVHQWDFLyQFHIiOLFDGHÀH[LRQDGD
6LWXDFLyQRSUHVHQWDFLyQGLVWRFLFD
(QFRQGLFLRQHVQRUPDOHVODVPHPEUDQDVVHFRQVHUYDQtQWHJUDVKDVWDTXHODGLODWDFLyQ
VHFRPSOHWDGHODVYHFHV
)5 )5
Q 3DUWRV

)LJXUD
(WDSDGHOSDUWR
HQTXHODURWXUD
HVSRQWiQHDGH
PHPEUDQDVRYXODUHV
VHSURGXFHFXDQGR
3HUtRGR )LQDO
',/$7$&,21&(59,&$/FP
([SXO GHO
VLYR 3DUWR
VHDGRSWDXQDDFWLWXG
FRQVHUYDGRUD
$O URPSHUVH ODV PHPEUDQDV OR KDELWXDO HV OD VDOLGD GH OtTXLGR WUDQVSDUHQWH GH RORU
FDUDFWHUtVWLFRDVHPHQ RKLSRFORULWR GHVRGLR (QRFDVLRQHV SXHGH VHUDPDULOOHQWR R
YHUGRVRPHFRQLRRSXUXOHQWRVLKD\LQIHFFLyQRYXODU
(O GLDJQyVWLFR GH OD URWXUD GH ODV PHPEUDQDV HV KDELWXDOPHQWH VHQFLOOR /D PXMHU
UH¿HUHSpUGLGDEUXVFDGHOtTXLGRSRUORVJHQLWDOHV(QHOGHORVFDVRVVHFRQ¿UPD
VLPSOHPHQWHSRUODLQVSHFFLyQJHQLWDODOYHUÀXLUOtTXLGRSRUODYXOYD
'HEHKDFHUVHGLDJQyVWLFRGLIHUHQFLDOFRQODHPLVLyQLQYROXQWDULDGHRULQDGHUHODWLYD
IUHFXHQFLDDO¿QDOGHOHPEDUD]R\TXHVHUHFRQRFHSRUVXRORUFDUDFWHUtVWLFR
6HHQWLHQGHSRUURWXUDSUHPDWXUDGHPHPEUDQDVRYXODUHV530DOFXDGURFDUDFWHUL]DGR
SRUODURWXUDHVSRQWiQHDGHODVPHPEUDQDVGHVGHXQDKRUDDQWHVGHOLQLFLRGHOWUDEDMR
GHSDUWR
&XDQGROD530VHSURGXFHHQHPEDUD]RVGHWpUPLQRORXVXDOHVTXHHOWUDEDMRGHSDUWRVH
LQLFLHHVSRQWiQHDPHQWHHQPiVGHOGHORVFDVRVGHQWURGHODVSULPHUDVKRUDV
6HFRQVLGHUDSHUtRGRGHODWHQFLDDOWLHPSRWUDQVFXUULGRHQWUHHOPRPHQWRHQTXHVH
SURGXFHODURWXUDGHPHPEUDQDV\HOSDUWR&XDQGRHVWHSHUtRGRVXSHUDODVKRUDV
VH FRQVLGHUD XQD URWXUD SURORQJDGD GH PHPEUDQDV 6H HVWLPD TXH OD IUHFXHQFLD GH
URWXUDSURORQJDGDGHPHPEUDQDVHVSUy[LPDDO
/DVSULQFLSDOHVFRPSOLFDFLRQHVGHORVHPEDUD]RVFRQ530VRQ
LQIHFFLyQRYXODUFRQ530KRUDV\FRQ530!KRUDV
LQIHFFLyQIHWDOQHRQDWDOSRU(*%FRQ530!KRUDV
SUHPDWXUH]
$QWHODSUHVHQFLDGHKLGURUUHDSpUGLGDGHOtTXLGRODHYDOXDFLyQGHEHVHUUiSLGDSDUD

GHFLGLUODRSRUWXQDUHIHUHQFLDDOQLYHODSURSLDGR
3pUGLGDGH/tTXLGR$PQLyWLFR
6, ,QIHFFLyQ 12
\RVHP
12 7UDEDMR
GH3DUWR
6,
$GPLWLUVLQ &RQWLQXDU
1RHIHFWXDU 7DFWR9DJLQDO (VTXHPDGH
7DFWR9DJLQDO
(VSHUDUKV $GPLVLyQ
12 )DFWRUHV 12
7UDEDMRGH3DUWR GH5LHVJR
(VSRQWiQHR 3UHVHQWHV
6, 6,
6, 12
,QIHFFLyQ
5HIHUHQFLD $WHQFLyQGH3DUWR\GHO
DO1LYHOGH$WHQFLyQ 5HFLpQ1DFLGR6HJ~Q1RUPDV
GH$OWR5LHVJR GH%DMR5LHVJR
)LJ(VTXHPDHVFDORQDGRGHGHFLVLRQHVFXDQGRVHFRQVWDWDSpUGLGDGHOtTXLGRDPQLyWLFR
6DQJUH
(VFRP~QREVHUYDUSHTXHxRVVDQJUDGRVDVRFLDGRVDODGLODWDFLyQFHUYLFDOSHURWRGD
SpUGLGDGHVDQJUHSRUORVJHQLWDOHVGHEHHYDOXDUVHDGHFXDGDPHQWHFRQPD\RUUD]yQ
VLHOYROXPHQHVDEXQGDQWH
/DV KHPRUUDJLDV JUDYHV FRQVWLWX\HQ XQD VLWXDFLyQ GH DOWR ULHVJR TXH XVXDOPHQWH
UHTXLHUHQH[WUDFFLyQIHWDOSRUODYtDPiVUiSLGD
$SUR[LPDGDPHQWHODPLWDGGHODVKHPRUUDJLDVDOWpUPLQRVRQGHELGDVD
SODFHQWDSUHYLD
GHVSUHQGLPLHQWRSUHPDWXURGHSODFHQWDQRUPRLQVHUWD'331,
3ODFHQWDSUHYLD
/D IUHFXHQFLD HV GH D GH ORV HPEDUD]RV GH HOODV PHQRV GHO VRQ
RFOXVLYDVWRWDOHVRSDUFLDOHV(QHOGHORVFDVRVODSODFHQWDSUHYLDVHDVRFLDFRQ
PXOWLSDULGDG
'HVSUHQGLPLHQWRSUHPDWXURGHSODFHQWDQRUPRLQVHUWD'331,
/DIUHFXHQFLDRVFLODHQWUH\GHORVHPEDUD]RV
&DVLXQGHHOODVUHVXOWDQIDWDOHVSDUDHOIHWR
3XHGHYHUVHDVRFLDGDDKLSHUWHQVLyQDUWHULDOEUHYHGDGGHFRUGyQ\DODQWHFHGHQWH
GHRWUR'331,HQHPEDUD]RVSUHYLRV
2WUDVFDXVDVGHKHPRUUDJLD
6RQFDXVDVPHQRVIUHFXHQWHVGHKHPRUUDJLDODVFHUYLFRSDWtDVLQFOX\HQGRHOFiQFHU
FpUYLFRXWHULQR\ODURWXUDXWHULQD
(Q SUHVHQFLD GH KHPRUUDJLD OD HYDOXDFLyQ GHEH VHU UiSLGD SDUD GHFLGLU OD RSRUWXQD
UHIHUHQFLDDOQLYHODSURSLDGR
3pUGLGDGH6DQJUHSRU*HQLWDOHV
7RQR8WHULQR
+LSHUWRQtD 12 6,
3UREDEOH 1RUPDO
'331,
7UDQVIXVLyQR 3UREDEOH 6, +HPRUUDJLD

5HSRVLFLyQGH 3ODFHQWD $EXQGDQWH
/tTXLGRV 3UDHYLD
121
(VSHFXORVFRStD (VSHFXORVFRStD
6, +HPRUUDJLD 6, +HPRUUDJLD
LQWUDXWHULQD LQWUDXWHULQD
12 12
7UDEDMR 12 7UDEDMR
GH3DUWR 12 GH3DUWR
6, 6,
$PQLRWRPtD
5iSLGD5HIHUHQFLDDO1LYHO &RQVXOWDD $WHQFLyQGH3DUWR

GH$WHQFLyQGH$OWR5LHVJR (VSHFLDOLVWD 6HJ~Q1RUPDV
3UREDEOH&HViUHD 3DWRORJtD*LQHFROyJLFD GH%DMR5LHVJR
)LJ(VTXHPDHVFDORQDGRGHGHFLVLRQHVFXDQGRVHFRQVWDWDSpUGLGDGHVDQJUHSRUORV
JHQLWDOHV
6HFUHFLRQHVSXUXOHQWDV
6XHOHQYLQFXODUVHDSURFHVRVLQIHFFLRVRVHQYXOYDYDJLQDRFXHOORXWHULQRXRULJLQDUVH
HQXQDLQIHFFLyQRYXODU
/RVSURFHVRVLQIHFFLRVRVGHYXOYD\YDJLQDSXHGHQLQIHFWDUDOIHWRGXUDQWHVXSDVDMH
SRUHOFDQDOGHOSDUWR'HEHFRQVWDWDUVHODLQGHPQLGDGGHODVPHPEUDQDV\SUHFLVDUHO
RULJHQGHODVHFUHFLyQPHGLDQWHHVSHFXORVFRStD
(YDOXDFLyQGHODSUHVHQWDFLyQ
(OWDFWRYDJLQDOSHUPLWHLGHQWL¿FDUODSUHVHQWDFLyQ6LVHWRFDXQSRORGXUR\UHJXODU
SXHGHFRQFOXLUVHTXHODSUHVHQWDFLyQHVFHIiOLFD6LVHHQFXHQWUDODH[FDYDFLyQYDFtD
RXQSRORYROXPLQRVREODQGRHLUUHJXODU\ODSDOSDFLyQDEGRPLQDOPXHVWUDSHORWHRHQHO
IRQGRGHO~WHURRHQXQRGHORVÀDQFRVVHGHEHVRVSHFKDUXQDSUHVHQWDFLyQSRGiOLFD
RXQDVLWXDFLyQWUDQVYHUVD\SRUWDQWRHOSDUWRVHUiFRQVLGHUDGRGHDOWRULHVJR
$OWXUD\YDULHGDGGHSRVLFLyQHQODSUHVHQWDFLyQFHIiOLFDGHYpUWLFH
(OSURJUHVRGHOSDUWRVHHYDO~DSRUHOJUDGRGHHQFDMHGHODSUHVHQWDFLyQDGHPiVGH
ODFRQWUDFWLOLGDG\ODGLODWDFLyQFHUYLFDO+DELWXDOPHQWHODVQXOtSDUDVLQLFLDQHOWUDEDMR
GH SDUWR FRQ OD FDEH]D IHWDO HQFDMDGD \ HO GHVFHQVR VH DFHOHUD DO ¿QDO GHO SHUtRGR
GH GLODWDFLyQ /DV PXOWtSDUDV HQ FDPELR VXHOHQ LQLFLDU OD GLODWDFLyQ FRQ OD FDEH]D
IHWDOLQVLQXDGDR¿MDKDVWDHOPRPHQWRGHODGLODWDFLyQFRPSOHWDVXFHGLpQGRVHHQHO
SHUtRGRGHH[SXOVLyQHOHQFDMDPLHQWR\ODURWDFLyQ
3DUD YDORUDU OD DOWXUD GH OD SUHVHQWDFLyQ VH XVDQ KDELWXDOPHQWH GRV PpWRGRV TXH
UHODFLRQDQ HO SXQWR PiV GHFOLYH GH OD SUHVHQWDFLyQ FRQ OD SHOYLV \ TXH VHJ~Q ODV
GLVWLQWDVHVFXHODVVRQORVSODQRVGH+RGJHSDUDODHVFXHODHXURSHD\ODVHVWDFLRQHV

GH'H/HHSDUDODHVFXHODQRUWHDPHULFDQD
&XDGUR3ODQRVGHODSHOYLV\VXUHODFLyQFRQODDOWXUDGHODSUHVHQWDFLyQ
3ODQRVGH+RGJH (VWDFLRQHVGH'H/HH
HVFXHODHXURSHD HVFXHODQRUWHDPHULFDQD
%RUGHVXSHULRUGHO ,3ODQR (VWDFLyQ
SXELV\SURPRQWRULR
%RUGHLQIHULRUGHOSXELV ,,3ODQR (VWDFLyQ
(VSLQDVFLiWLFDV ,,,3ODQR (VWDFLyQ
9pUWLFHGHOFR[LV ,93ODQR (VWDFLyQ
3ODQRVSDUDOHORV 3ODQRVSHUSHQGLFXODUHVDOFDQDOGHOSDUWR
1
2
4
-4
-2
0 +4
)LJ3ODQRVGH+RGJH )LJ(VWDFLRQHVGH'H/HH
3DUD KDFHU HO GLDJQyVWLFR GH SUHVHQWDFLyQ FHIiOLFD PRGDOLGDG GH YpUWLFH GHEH
LGHQWL¿FDUVHODVXWXUDLQWHUSDULHWDOFRQHOGHGRTXHWDFWD\VHJXLUODKDVWDHQFRQWUDUOD
IRQWDQHODSRVWHULRUPHQRURFFLSLWDORODPEGDTXHVHLGHQWL¿FDSRUVXIRUPDWULDQJXODU
\GHPHQRUWDPDxRTXHODDQWHULRUIURQWRSDULHWDOREUHJPDGHIRUPDFXDGUDQJXODU\
PD\RUWDPDxR
3XHGH SURGXFLU XQ UHWDUGR HQ HO GHVFHQVR GH OD FDEH]D IHWDO HQ ODV YDULHGDGHV
SRVWHULRUHVODVGHÀH[LRQHV\ORVJUDGRVOtPLWHGHSURSRUFLyQIHWRSpOYLFD
/DYDULHGDGGHSRVLFLyQVHGH¿QHQSRUODUHODFLyQH[LVWHQWHHQWUHXQSXQWRGHUHSDUR
IHWDORFFLSLWDOHQHOFDVRGHODVPRGDOLGDGHVGHYpUWLFH\ODSHOYLVPDWHUQD)LJXUD
2,($ 2,'3 2,(' 2,(7
2,'7 2,'$ 26 23
)LJXUD9DULHGDGHVGHSRVLFLyQHQSUHVHQWDFLyQGHYpUWLFH2 2FFtSLWR
$ $QWHULRU3 3RVWHULRU7 7UDQVYHUVD, ,OtDFD, ,]TXLHUGD' 'HUUHFKD
/DLGHQWL¿FDFLyQGHODIRQWDQHODSRVWHULRUSHUPLWHDSUHFLDUHOJUDGRGHÀH[LyQ\DTXHVH
HQFRQWUDUiPiVH[FpQWULFDPLHQWUDVPD\RUVHDODGHÀH[LyQ)LJXUD
)LJ,GHQWL¿FDFLyQGHODIRQWDQHOD )LJ,GHQWL¿FDFLyQGHODIRQWDQHOD
SRVWHULRU DQWHULRU
&XDQGR UHVXOWD LPSRVLEOH LGHQWL¿FDU OD IRQWDQHOD SRVWHULRU \ HQ FDPELR OD IRQWDQHOD
DQWHULRUVHWDFWDHVSRVLEOHTXHODGHÀH[LyQVHDH[WUHPD\VHWUDWHGHXQDSUHVHQWDFLyQ
FHIiOLFD HQ PRGDOLGDG GH IUHQWH R GH FDUD VLWXDFLyQ GH DOWR ULHVJR TXH UHTXLHUH
UHIHUHQFLDDOQLYHODSURSLDGR)LJXUD
(Q OD SUHVHQWDFLyQ FHIiOLFD PRGDOLGDG GH IUHQWH SXHGHQ UHFRQRFHUVH ORV DUFRV
RUELWDULRVORVRMRV\ODQDUL](OGLiPHWURRIUHFLGRHVHOPHQWRRFFLSLWDOGHFPHO
PD\RUGLiPHWURGHOSRORFHIiOLFRSRUORTXHHOSDUWRVLVHORJUDHVH[WUHPDGDPHQWH
ODERULRVR\WUDXPiWLFR
/D SUHVHQWDFLyQ FHIiOLFD PRGDOLGDG GH FDUD HV HO JUDGR Pi[LPR GH GHÀH[LyQ 6H
DVRFLDDSHOYLVSODQD\PDOIRUPDFLRQHVIHWDOHV6HGLDJQRVWLFDSRUODLGHQWL¿FDFLyQGH
ORVDUFRVFLOLDUHVRMRVQDUL]ERFD\PHQWyQGXUDQWHHOWDFWRYDJLQDO
$PEDVSUHVHQWDFLRQHVPXHVWUDQHQODSDOSDFLyQDEGRPLQDOHOVLJQRGHO³JROSHGHKDFKD´
&RQGXFWD
/DVSUHVHQWDFLRQHVGLVWyFLFDVGHEHQVHUUHIHULGDVDQLYHOHVGHDWHQFLyQGHDOWRULHVJR
9DORUDFLyQGHODSURSRUFLyQIHWRSpOYLFD\ODFDSDFLGDGGHODSHOYLVPDWHUQD
$QWHVGHOSDUWRHOWDPDxRGHODFDEH]DIHWDOVRORHVVXVFHSWLEOHGHHVWLPDFLyQFOtQLFD
DSUR[LPDGDPHGLDQWHODHYDOXDFLyQGHODDOWXUDXWHULQDHOWDPDxRIHWDO\ODUHODFLyQ
GHODFDEH]DIHWDOFRQHOSODQRGHOHVWUHFKRVXSHULRU(OWLSRGHSHOYLV\VXVGLiPHWURV
SXHGHQHYDOXDUVHDSURSLDGDPHQWHPHGLDQWHHOWDFWRYDJLQDO
6LODSUHVHQWDFLyQHVWiHQFDMDGDHVXQEXHQLQGLFLRGHODSURSRUFLRQDOLGDGSDUDHVH
IHWRHQSDUWLFXODU
6LODSURSRUFLyQHVWiOHYHPHQWHDMXVWDGD\QRHVREVWiFXORSDUDHOSDUWRVHSURGXFLUi
HO HQFDMDPLHQWR SHUR OD HYROXFLyQ GHO SDUWR VHUi OHQWD \ FRQ PD\RU IUHFXHQFLD GH
GHÀH[LyQ\DVLQFOLWLVPRSHOYLVOtPLWH
/DGHVSURSRUFLyQDGHPiVGHLPSHGLUHOSDUWRYDJLQDOVHDVRFLDFRQEROVDGHDJXDV
SURPLQHQWH\HOFRQVLJXLHQWHULHVJRGHSURODSVRGHFRUGyQ
/DHYDOXDFLyQGHODSHOYLVSRUPHGLRGHOWDFWRVHHIHFW~DWUDWDQGRGHWRFDUHOSURPRQWRULR
FRQHOGHGRPHGLR6LVHORJUDWDFWDUHOSURPRQWRULRVH¿MDHOERUGHUDGLDOGHOGHGR
tQGLFHFRQWUDODVtQ¿VLV\VHVHxDODHOSXQWRGHFRQWDFWR/DPHGLGDHQWUHHVHSXQWR
\HOYpUWLFHGHOGHGRPHGLRHVHOFRQMXJDGRGLDJRQDORGLiPHWURSURPRQWRVXES~ELFR
¿JVXSHULRUHQFPDOFRQMXJDGRREVWpWULFRRSURPRQWRUHWURS~ELFRGHFP
3XHVWRTXHHOGLiPHWURELSDULHWDO'%3IHWDODWpUPLQRHVDSUR[LPDGDPHQWHGH
FPVHFRPSUHQGHUiTXHVLHVWHFRQMXJDGRVXSHUDORVFPHOSDUWRYDJLQDODWpUPLQR
HVSRVLEOH(QSHOYLVQRUPDOHVQRVHWRFDRVHWRFDFRQJUDQGL¿FXOWDGHOSURPRQWRULR
'HEHQ FRQVLGHUDUVH HQ HO H[DPHQ OD DPSOLWXG GH OD YDJLQD \ OD YXOYD OD UHODMDFLyQ
SHULQHDO\ODORQJLWXGGHORVGHGRVGHOH[SORUDGRU
)LJ3HOYLPHWUtDLQWHUQDPHGLGD )LJ&RQ¿UPDFLyQGHODPHGLGD
GHOFRQMXJDGRGLDJRQDORGLiPHWUR GHOFRQMXJDGRGLDJRQDO
6LVHWRFDHOSURPRQWRULRVHVRVSHFKDUiHVWUHFKH]SpOYLFDODTXHGHEHUiVHUFRQ¿UPDGD
SRUODVPHGLGDVDQWHGLFKDV
8QDYH]FRPSOHWDGRHOH[DPHQJHQLWDOODYDORUDFLyQGHWRGRVORVGDWRVSHUPLWH
+DFHUGLDJQyVWLFRGHWUDEDMRGHSDUWR
(YDOXDUHOULHVJRSDUDGHFLGLUVLVHWUDWDGHXQSDUWRGHEDMRRDOWRULHVJR
$GPLWLURUHIHULUVHJ~QFRQGLFLRQHVHVSHFt¿FDVGHODSDUWXULHQWD
&RQGXFWD
6L HQ HO H[DPHQ JHQLWDO QR KD\ KDOOD]JRV SDWROyJLFRV OD HPEDUD]DGD VHUi DGPLWLGD
SDUDDWHQFLyQVHJ~QQRUPDGHEDMRULHVJR
'HEHUiUHIHULUVHDQLYHOGHDWHQFLyQGHDOWRULHVJRVLODSDUWXULHQWDSUHVHQWDXQDGHODV
VLJXLHQWHVSDUWLFXODULGDGHV
3HOYLVHVWUHFKDRDVLPpWULFD
'HVSURSRUFLyQIHWRSpOYLFDHYLGHQWHRVRVSHFKRVD
530!KRUDVRFRQVLJQRVGHLQIHFFLyQ
(PEDUD]RVHPDQDVGHDPHQRUUHD
+HPRUUDJLD
7DELTXHVYDJLQDOHVWUDQVYHUVRVHVWHQyWLFRV
2WURVREVWiFXORVGHOFDQDOGHSDUWREODQGRWXPRUSUHYLRJUDQGHVTXLVWHVHVWHQRVLV
YDJLQDOHWF
(QODVLJXLHQWH¿JXUDVHUHVXPHQODVGHFLVLRQHVDWRPDUGXUDQWHHOH[DPHQFRPSOHWR
GHDGPLVLyQSDUDHOSDUWR
3DOSDFLyQ$EGRPLQDO
0DQLREUDVGH/HRSROG
([DPHQ*HQLWDO
3UHVHQWDFLyQ
R6LWXDFLyQ
7UDQVYHUVD 3RGiOLFD &HIiOLFD
6,
'HIOH[LRQDGD
12
9pUWLFH
$GHFXDGD 12
3URSRUFLyQ (QFDMDGD
12 )HWRSpOYLFD
6, 6,
'LDJQyVWLFRGH9DULHGDGGH3RVLFLyQ
5HIHUHQFLDD1LYHOGH $WHQFLyQGHO3DUWR6HJ~Q
$WHQFLyQGH$OWR5LHVJR 1RUPDVGH%DMR5LHVJR
)LJXUD(VTXHPDHVFDORQDGRGHGHFLVLRQHVVHJ~QGLDJQyVWLFR\DOWXUDGHOD
SUHVHQWDFLyQYDULHGDG\SURSRUFLyQIHWRSpOYLFD
3UHSDUDFLyQGHODHPEDUD]DGDHQODUHFHSFLyQ
$~QFRQPHPEUDQDVRYXODUHVtQWHJUDVODSURORQJDFLyQGHOWUDEDMRGHSDUWRDXPHQWD
HO ULHVJR GH LQIHFFLyQ 6H UHFRPLHQGD UHGXFLU ORV WDFWRV YDJLQDOHV DO PtQLPR
LPSUHVFLQGLEOH
/DV PHGLGDV KLJLpQLFDV DSURSLDGDV SDUD OD SUHSDUDFLyQ ItVLFD GH OD SDUWXULHQWD
GLVPLQX\HQHOULHVJRGHLQIHFFLyQ
6HUiUHFRPHQGDEOHDOLQJUHVREDxRGHGXFKD\HOXVRGHYHVWLPHQWDKROJDGD\OLPSLD
1RVHUiQQHFHVDULRVGHUXWLQDORVHQHPDVQLHOUDVXUDGRGHODJHVWDQWH
(O SDUWR SXHGH DVRFLDUVH FRQ ULHVJR GH LQIHFFLyQ VL VH SUHVHQWDQ ODV VLJXLHQWHV
FRQGLFLRQHV
0DODVFRQGLFLRQHVKLJLpQLFDVGHODPDGUH
0DODVFRQGLFLRQHVKLJLpQLFDVGHOOXJDUGHDWHQFLyQ
([FHVRGHH[iPHQHVSRUYtDYDJLQDORFRQWpFQLFDLQDGHFXDGD
(SLVLRWRPtDGHVJDUURV
7UDEDMRGHSDUWRSURORQJDGR
5RWXUDSURORQJDGDGHPHPEUDQDV
$6,67(1&,$'85$17((/3(5,2'2'(',/$7$&,2135,0(53(5,2'2
2%-(7,92 &RQWURODUELHQHVWDUPDWHUQR\IHWDO
'HWHFWDU\HYDOXDUGHVYLDFLRQHVGHORVOtPLWHV¿VLROyJLFRV
SURJUHVRGHOSDUWR
(YDOXDUULHVJR\UHIHULUDQLYHODSURSLDGR
$SOLFDUPDQLREUDVFRUUHFWLYDV
$&7,9,'$' ,QIRUPDFLyQDODHPEDUD]DGD
&RQWUROHVPDWHUQRV
&RQWUROHVREVWpWULFRV
5HJLVWURGHORVFRQWUROHVHQHOSDUWRJUDPDFRQFXUYDVGHDOHUWD
/DDWHQFLyQFRQVHUYDGRUDGHOSDUWRQRUPDOSURFXUD
x9LJLODUHOWUDQVFXUVRGHOPLVPR
x1R LQWHUIHULU FRQ DVSHFWRV ¿VLROyJLFRV \ SVLFROyJLFRV HYLWDQGR PDQLREUDV
LQQHFHVDULDV
x3URPRYHUODSDUWLFLSDFLyQDFWLYDGHODPDGUH\PLHPEURGHOJUXSRIDPLOLDUTXHOD
DFRPSDxD
x3URPRYHUFRQWDFWRSUHFR]PDGUHKLMR
,QIRUPDFLyQDODHPEDUD]DGD
(VWDGHEHLQLFLDUVHGHVGHODYLVLWDSUHFRQFHSFLRQDORHOSUHQDWDO\GHEHVHUUHIRU]DGD
HQ FDGD FRQWDFWR GHO SHUVRQDO FRQ OD PXMHU JHVWDQWH TXLHQ DGHPiV GHEH UHFLELU
XQD DWHQFLyQ WUDQTXLOL]DGRUD VLQ HVWULGHQFLD QL DQVLHGDG ,QFOX\H OD SURPRFLyQ GH OD
SDUWLFLSDFLyQGHOFyQ\XJHXRWURPLHPEURGHOJUXSRIDPLOLDUHQHOSDUWR8QDYH]LQLFLDGR
HOSDUWRVHGHEHQHQIDWL]DUORVVLJXLHQWHVFRQWHQLGRV
x ,QIRUPDFLyQVREUHHOWUDEDMRGHSDUWR
x 5HFRPHQGDFLRQHVVREUHVXSDUWLFLSDFLyQDFWLYD\IDPLOLDU
x ,PSRUWDQFLDGHODSRVLFLyQYHUWLFDO\GHDPEXODFLyQSDUDHOSHUtRGRGHGLODWDFLyQ
x ,PSRUWDQFLDGHODKLGUDWDFLyQGXUDQWHHOWUDEDMRGHSDUWR
/DLQIRUPDFLyQTXHVHHQWUHJDDODPDGUHGHEHVHUYHUD]\GHEHFRQWULEXLUDTXHVH
HVSHUHHOGHVDUUROORGHOSDUWRVLQDQVLHGDG'HEHXVDUVHXQOHQJXDMHDSURSLDGRDVX
QLYHOFXOWXUDO
'HEHHVWLPXODUVHODDFWLYDSDUWLFLSDFLyQGHODPXMHUJHVWDQWHKDFLpQGRODFRQVFLHQWH
GHODVPRGL¿FDFLRQHVTXHYDVXIULHQGRHLQVWDQGRDVXIDPLOLDUDEULQGDUHODGHFXDGR
DSR\RSVLFRItVLFRTXHODVLWXDFLyQUHTXLHUH
'HEH UHFRPHQGDUVH OD OLEUH LQJHVWD GH OtTXLGRV GH SUHIHUHQFLD D]XFDUDGRV SDUD
GLVPLQXLUHOULHVJRGHGHVKLGUDWDFLyQTXHVHDVRFLDDODDFWLYLGDGItVLFD\DODIUHFXHQWH
KLSHUYHQWLODFLyQPDWHUQD
0DQHMRFRQVHUYDGRUGHOSDUWRVHGHQRPLQDDVtDODIRUPDGHDVLVWLUHOSDUWRPHGLDQWH
ODFXDOVHORGHMDHYROXFLRQDUHQIRUPDQDWXUDOVLQLQWHUYHQFLRQHVLQMXVWL¿FDGDV
$FRPSDxDPLHQWR D OD PDGUH GXUDQWH HO WUDEDMR GH SDUWR OD SUHVHQFLD GH XQD R
PiVSHUVRQDVTXHDFRPSDxHQDODSDUWXULHQWDGXUDQWHHOWUDEDMRGHSDUWR\SDUWRHVXQ
FRPSRQHQWHFRQVWDQWHHQFDVLWRGDVODVWUDGLFLRQHV(QODDVLVWHQFLDLQVWLWXFLRQDOGHO
SDUWRKDQDSDUHFLGRUHVWULFFLRQHVTXHKDQSHUPDQHFLGRKDVWDHOGtDGHKR\&XDQGR
HVWR RFXUUH OD PXMHU HV DVLVWLGD H[FOXVLYDPHQWH SRU SHUVRQDO GH VDOXG \ HQ PXFKDV
RFDVLRQHVSHUPDQHFHVRODGXUDQWHJUDQSDUWHGHOSHUtRGRGHGLODWDFLyQ&XDQGRHVWi
SURKLELGDODGHDPEXODFLyQODPXMHUSXHGHWHQHUPD\RUDQJXVWLDORTXHVHUHÀHMDHQ
XQPD\RUUHTXHULPLHQWRGHDQDOJpVLFRVVHGDQWHVHLQWHUYHQFLRQHVREVWpWULFDVFRPR
ODLQIXVLyQGHRFLWRFLQDHOXVRGHIyUFHSVHVSiWXODVYDFXXPRLQFOXVRFHViUHD6H
KDQUHDOL]DGRP~OWLSOHVHVWXGLRVFOtQLFRVFRQWURODGRVTXHPLGHQHOLPSDFWRSRVLWLYRGHO
DFRPSDxDPLHQWRGXUDQWHHOWUDEDMRGHSDUWR\SDUWRSRUSHUVRQDVH[WHUQDVDOHTXLSR
GHVDOXG(QHVWHVHQWLGRKD\HVWXGLRVTXHHQSDUWLFXODUKDQPHGLGRHOLPSDFWRSRVLWLYR
TXH WLHQH OD SUHVHQFLD GH XQ DFRPSDxDQWH GH VH[R IHPHQLQR H[WHUQR D OD IDPLOLD \
DO HTXLSR GH VDOXG$OJXQRV LQYHVWLJDGRUHV SURSXVLHURQ OODPDUOH ³'RXOD´ GHO JULHJR
³VLUYLHQWD´ \D TXH HQ OD DQWLJXD *UHFLD ODV VLUYLHQWDV DFRPSDxDEDQ D OD SDUWXULHQWD
GXUDQWH OH WUDEDMR GH SDUWR7RGRV HVWRV HVWXGLRV FRQFOX\HQ TXH OD SUHVHQFLD GH XQ
DFRPSDxDQWHGLVPLQX\HHOXVRGHLQWHUYHQFLRQHVLQQHFHVDULDV\VHREWLHQHQPHMRUHV
UHVXOWDGRVPDWHUQRV\QHRQDWDOHVOOHJDQGRLQFOXVRDSURORQJDUVHODODFWDQFLDQDWXUDO
&/$3605 FRPR RUJDQLVPR GH OD 236206 UHFRPLHQGD HVWLPXODU XQD VHULH GH
SUiFWLFDVTXHKDQGHPRVWUDGRVHUEHQH¿FLRVDVSDUDODPXMHU\VXIXWXURKLMRHQWUHODV
TXHHQHVWHDSDUWDGRVHFLWDQVRORGRV
x$SR\RHPRFLRQDOSRUORVSUHVWDGRUHVGHVHUYLFLRGXUDQWHHOWUDEDMRGHSDUWR\HOSDUWR
x5HVSHWRDTXHODPXMHUHOLMDVXVDFRPSDxDQWHV
5HFLHQWHV LQYHVWLJDFLRQHV FOtQLFDV DOHDWRUL]DGDV VHxDODQ TXH HQ DTXHOORV VHUYLFLRV

PDUFDGRVSRUIXHUWHLQWHUYHQFLRQLVPRREVWpWULFRHODFRPSDxDPLHQWRSXHGHQRFDPELDU
ORVUHVXOWDGRVREVWpWULFRV
&RQWUROHVPDWHUQRV
3DUDHYLWDUODDSDULFLyQGHVLWXDFLRQHVGHGHVHTXLOLEULRKHPRGLQiPLFRGHEHUiQFRQWURODUVH
xHOSXOVRGHODPXMHU
xODSUHVLyQDUWHULDO
xWHPSHUDWXUDD[LODU
(VWRV FRQWUROHV VH HIHFWXDUiQ HQWUH FRQWUDFFLRQHV FDGD KRUDV 6L DSDUHFLHUDQ
VtQWRPDVWDOHVFRPR
x 'LVQHD x)RWRSVLDV
x /LSRWLPLDV x$F~VIHQRVHWF
x &HIDOHDV
'HEHUiQUHVSHWDUVHORVFRQWUROHVHQODVVLJXLHQWHVFRQGLFLRQHV
x &RORFDUDODSDUWXULHQWDHQGHF~ELWRODWHUDOL]TXLHUGR
x 9LJLODUHVWULFWDPHQWHOD)&)
x 5HSHWLUHOFRQWURODORVPLQXWRV
x 6L KD\ KLSRWHQVLyQ VH SXHGH FRQVLGHUDU OD DGPLQLVWUDFLyQ GH XQD LQIXVLyQ GH
VROXFLyQVDOLQD
6L KD\ VLJQRV R VtQWRPDV VXJHUHQWHV GH SUHHFODPSVLD VHYHUD VKRFN WUDVWRUQR
FDUGLRYDVFXODUR¿HEUHDOWDGHEHFRQVLGHUDUVHHVWDVLWXDFLyQFRPRGHDOWRULHVJR(Q
HVWH FDVR VH HYDOXDUi HO SURJUHVR GHO SDUWR SDUD GHFLGLU VX HYHQWXDO UHIHUHQFLD DO
QLYHODSURSLDGR/DPLVPDFRQGXFWDGHEHUiDGRSWDUVHVLODVPDQLREUDVLQGLFDGDVQR
FRUULJHQODVLWXDFLyQVHDVRFLDQDWUDVWRUQRVGHOD)&)RDKLSHUWRQtDXWHULQD
6HSURSLFLDUiODPLFFLyQHVSRQWiQHDSDUDHYLWDUFDWHWHULVPRYHVLFDO
&RQWUROHV2EVWpWULFRV
(O WUDEDMR GH SDUWR HV XQ SURFHVR GLQiPLFR FX\D QRUPDOLGDG SXHGH VHU DOWHUDGD HQ
FXDOTXLHUPRPHQWR(OORH[LJHHYDOXDU
&RQWUDFWLOLGDGXWHULQDFDGDDPLQXWRVHQSHUtRGRVGHPLQXWRVGHDFXHUGR
DORVFULWHULRVHQXQFLDGRVHQHOFDStWXORGHDGPLVLyQ
)UHFXHQFLDFDUGtDFDIHWDOVHVXJLHUHXQFRQWUROFDGDDPLQXWRV
'XUDFLyQGHOSDUWR(QHOFXDGURVHPXHVWUDODGXUDFLyQHQPLQXWRVGHOSHUtRGRGH
GLODWDFLyQFHUYLFDOGHVGHORVDFPKDVWDORVFPHQXQDSREODFLyQGHPDGUHVGH
EDMRULHVJRFRQHPEDUD]RV~QLFRVVLQSDWRORJtDFRQRFLGDGHWpUPLQRHQSUHVHQWDFLyQ
FHIiOLFD VLQ GHVSURSRUFLyQ FpIDORSpOYLFD GH LQLFLR \ WHUPLQDFLyQ HVSRQWiQHD \ VLQ
PHGLFDFLyQ 7HQLHQGR HQ FXHQWD OD SRVLFLyQ PDWHUQD OD SDULGDG \ HO HVWDGR GH ODV
PHPEUDQDVRYXODUHV
&XDGUR'XUDFLyQHQPLQXWRVGHOWUDEDMRGHSDUWRVHJ~QSRVLFLyQPDWHUQD
SDULGDG\HVWDGRGHPHPEUDQDVRYXODUHV
0HPEUDQDVURWDV
0HPEUDQDVtQWHJUDVKDVWDORVFP
DORV±FPV
3RVLFLyQKRUL]RQWDO 3RVLFLyQKRUL]RQWDO 3RVLFLyQYHUWLFDO
333 333 333
1XOtSDUDV

7RGDVODVSDULGDGHV
1XPHURVDV HYLGHQFLDV VHxDODQ TXH HO WUDEDMR GH SDUWR HV PiV ¿VLROyJLFR FXDQGR
VHSHUPLWHTXHODPDGUHDGRSWHOLEUHPHQWHODSRVLFLyQYHUWLFDOGXUDQWHHOSHUtRGRGH
GLODWDFLyQFX\DYHQWDMDSDUHFHUHVLGLUHQ
xHOiQJXORHQWUHHMHIHWDO\HVWUHFKRVXSHULRUIDYRUHFHHOHQFDMDPLHQWR
xODVFRQWUDFFLRQHVVRQPiVLQWHQVDV\H¿FLHQWHV
xODPXMHUHVWiPiVFyPRGD\VXIUHPHQRVGRORU
xODGXUDFLyQGHOWUDEDMRVHDFRUWD
)5 72'$6/$63$5,'$'(6
326,&,210$7(51$
+25,=217$/
1
3520(',2 PLQXWRV
0(',$1$ ³
3HUF ³
3HUF ³

',)(5(1&,$
PLQXWRV
KRUDV
7(67'(
)5 .2/02*2529
326,&,210$7(51$ S
9(57,&$/ 6LJQLILFDWLYR
'(3,(&$0,1$1'26(17$'$
1
3520(',2PLQXWRV
0(',$1$ ³
3HUF ³
3HUF ³

KRUDV
)LJ'XUDFLyQGHOSHUtRGRGHGLODWDFLyQHQWUHFP\FPGHGLODWDFLyQ
6LQPHGLDURWUDVPDQLREUDVODSRVLFLyQYHUWLFDODFRUWDODGXUDFLyQGHOWUDEDMRGHSDUWR
HQ XQ ¿JXUD (VWD QR LQÀX\H HQ HO PRPHQWR GH OD URWXUD HVSRQWiQHD GH
PHPEUDQDVQLVREUHODIUHFXHQFLDGHPRGHODMHFHIiOLFRHQSDUWLFXODUVREUHODEROVD
VHURVDQJXtQHDFXDQGRODVPHPEUDQDVHVWiQtQWHJUDV\IDYRUHFHODURWDFLyQLQWHUQD
FHIiOLFD
6L OD PDGUH HVFRJH OD SRVLFLyQ KRUL]RQWDO pVWD GHEH VHU HQ GHF~ELWR ODWHUDO GH
SUHIHUHQFLD L]TXLHUGR SDUD SUHYHQLU OD SRVLEOH DSDULFLyQ GH KLSRWHQVLyQ PDWHUQD FRQ
ULHVJRGHKLSR[LDIHWDO
/DDPQLRWRPtDDFRUWDODGXUDFLyQGHOWUDEDMRGHSDUWRSHURVHDVRFLDDXQDVHULHGH
ULHVJRVSDUDODPDGUH\VXKLMR
$OWHUDHOPRPHQWR $XPHQWDODFRPSUHVLyQ
ILVLROyJLFRGHUXSWXUDGH GHODFDEH]DIHWDO
PHPEUDQDVRYXODUHV
326,%/(6/(6,21(6 $XPHQWDODGHVDFHOHUDFLyQ
$XPHQWDHOFDSXW $/$0$'5((/)(72 SUHFR]GHOULWPRFDUGtDFR
VXFFHGDQHXP\HO IHWDO'LSWLSR,
GHVDOLQHDPLHQWRHQWUH <(/5(&,(11$&,'2
KXHVRVSDULHWDOHV )DFLOLWDODRFOXVLyQGH
HQHOUHFLpQQDFLGR 325$01,2720,$ YDVRVXPELOLFDOHVGXUDQWH
35(&2='85$17( ODVFRQWUDFFLRQHVXWHULQDV
3URGXFHULHVJRSRWHQFLDO 'LSYDULDEOHV
GHLQIHFLyQSRVSDUWR (/3$5721250$/
\QHRQDWDOVLWUDQVFXUUHQ +DFHIUHFXHQWHHOXVR
PiVGHVHLVKRUDV GHIyUFHSVHQSDUWRV
KDVWDHODOXPEUDPLHQWR GHEDMRULHVJR
)LJXUD$PQLRWRPtDSUHFR]GXUDQWHHOSDUWRQRUPDO

&RQVHUYDQGR OD SRVLFLyQ YHUWLFDO SXHGH DFRUWDUVH OD GXUDFLyQ GHO WUDEDMR GH SDUWR
/D DPQLRWRPtD QR WLHQH LQGLFDFLyQ FRPR PDQLREUD UXWLQDULD HQ HO WUDEDMR GH SDUWR
QRUPDO
6HGHEHLQGLFDUVyORDQWHODDSDULFLyQGHFRPSOLFDFLRQHVWDOHVFRPR
x 7UDEDMR GH SDUWR SURORJDQGR GHVFDUWDGD OD GHVSURSRUFLyQ IHWRSpOYLFD H

KLSRGLQDPLD
x 1HFHVLGDGGHDFRUWDUHOWUDEDMRGHSDUWRSRUSDWRORJtDPDWHUQRIHWDOQRVXVFHSWLEOH
GHUHIHUHQFLDDQLYHOGHDOWRULHVJR
x 3ROLKLGUDPQLRV
x +HPRUUDJLDSRUSODFHQWDSUHYLDPDUJLQDO
x 'HVSUHQGLPLHQWRSUHPDWXURGHSODFHQWDQRUPRLQVHUWD
x )HWRPXHUWRRPDOIRUPDFLyQIHWDOQRVXVFHSWLEOHVGHUHIHUHQFLD
x 1HFHVLGDGGHYDORUDUHOOtTXLGRDPQLyWLFR
3URJUHVRGHODGLODWDFLyQ\GHOGHVFHQVRGHODSUHVHQWDFLyQ
6HHYDOXDUiSRUPHGLRGHOH[DPHQJHQLWDO(OH[DPHQSRUYtDYDJLQDOGHEHVHUHIHFWXDGR
FRQHOGHELGRFXLGDGRSDUDQRSURYRFDUODURWXUDGHODVPHPEUDQDV
(OSURJUHVRGHODGLODWDFLyQQRHVXQDIXQFLyQOLQHDO\VXYHORFLGDGQRHVFRQVWDQWH
'RVWHUFLRVGHOWLHPSRWRWDOTXHGXUDODGLODWDFLyQVHFRQVXPHQKDVWDORV±FP\
HO WHUFLR UHVWDQWH KDVWD OD GLODWDFLyQ FRPSOHWD ¿JXUD (VWH SDWUyQ QRUPDO SXHGH
DOWHUDUVHHQHOVHQWLGRGHODSURORQJDFLyQRODDFHOHUDFLyQ
(OGHVFHQVRGHODSUHVHQWDFLyQWDPELpQHVXQIHQyPHQRSURJUHVLYRTXHVHDFHOHUDDO
¿QDOGHOSHUtRGRGHGLODWDFLyQ6HYHLQÀXLGRSRU
x ODYDULHGDGGHSRVLFLyQ
x HOJUDGRGHÀH[LyQGHODFDEH]DIHWDO
x HOJUDGRGHSURSRUFLyQSpOYLFRIHWDO
x ODSDULGDG
x ODSRVLFLyQPDWHUQD
x HOHVWDGRGHODVPHPEUDQDVRYXODUHV
'LODWDFLyQ\GHVFHQVRVRQSURFHVRVtQWLPDPHQWHUHODFLRQDGRVTXHH[LJHQVXHYDOXDFLyQ
VLPXOWiQHD
(O&/$3605KDFRQIHFFLRQDGRXQIRUPXODULRFRPSOHPHQWDULRGHOD+&3HO3DUWRJUDPD
¿JXUD HQ GRQGH VH JUD¿FD OD HYROXFLyQ GHO WUDEDMR GH SDUWR $ HVWD KRMD VH
WUDQV¿HUHQORVYDORUHVUHJLVWUDGRVSUHYLDPHQWHHQOD+&3
(O SDUWRJUDPD HV XQ LQVWUXPHQWR TXH IDFLOLWD OD UiSLGD HYDOXDFLyQ GH OD PDUFKD GHO
SDUWR\WLHQHSRUORWDQWRPXFKRYDORUSDUDODGRFHQFLD\VXSHUYLVLyQGHODFDOLGDGGH
ODDVLVWHQFLD

',/$7$&,21&(59,&$/FP
+DVWDFPGHWLHPSR
+DVWDGLODWDFLyQ
FRPSOHWD
GHWLHPSR

+25$6
)LJXUD'LODWDFLyQFHUYLFDOHQIXQFLyQGHOWLHPSRGHWUDEDMRGHSDUWR
3DUWRJUDPDFRQFXUYDVGHDOHUWD
6HWUDWDGHXQVLVWHPDGHYLJLODQFLDWDQWRSDUDODSUHYHQFLyQGHOSDUWRSURORQJDGRFRPR
SDUD OD SUHYHQFLyQ GH LQWHUYHQFLRQHV QR VLHPSUH RSRUWXQDV FRPR OD HVWLPXODFLyQ FRQ
RFLWRFLQDRODRSHUDFLyQFHViUHD(VXQRGHORVLQVWUXPHQWRVLQGLVSHQVDEOHVSDUDHYDOXDU
ODFDOLGDGGHODDWHQFLyQGHOSDUWRDODYH]TXHUHVXOWDXQDKHUUDPLHQWDSUiFWLFDSDUDYLJLODU
HOSURJUHVRGHOSDUWRHQXQFDVRLQGLYLGXDO
/DVFXUYDVPDUFDQXQOtPLWHH[WUHPRSHUFHQWLOGHODHYROXFLyQGHODGLODWDFLyQFHUYLFDO

HQIXQFLyQGHOWLHPSRTXHLQFOX\HHOGHODWRWDOLGDGGHORVSDUWRVQRUPDOHV3HUPLWHQ
DOHUWDU SUHFR]PHQWH DQWH DTXHOORV FDVRV TXH DO WUDVSDVDU HVH OtPLWH (VWpQ PRVWUDQGR
XQHQOHQWHFLPLHQWRTXHUHTXLHUDPD\RUYLJLODQFLDSDUDGHVFDUWDUDOJXQDSRVLEOHGLVWRFLD
%ULQGDQ SRU OR WDQWR WLHPSR VX¿FLHQWH SDUD SHUPLWLU OD FRUUHFFLyQ GH OD DQRPDOtD HQ HO
SURSLROXJDURSDUDODUHIHUHQFLDRSRUWXQDGHOFDVR
/DVFXUYDVGHDOHUWDSUHVHQWDQODGXUDFLyQGHODGLODWDFLyQFHUYLFDOGHVGH±FPKDVWDHO
¿QDOGHOSDUWR/RVYDORUHVSDUDVXHODERUDFLyQIXHURQREWHQLGRVGHGRVLQYHVWLJDFLRQHV
SURVSHFWLYDV UHDOL]DGDV SRU &/$3605 VREUH SDUWRV GH EDMR ULHVJR GH LQLFLR \
WHUPLQDFLyQHVSRQWiQHDVLQPHGLFDFLyQ\FRQUHFLpQQDFLGRVQRUPDOHV\YLJRURVRV
3DUD HVWDEOHFHU ODV FXUYDV SDWUyQ QRUPDOHV VH DQDOL]DURQ SUHYLDPHQWH DOJXQDV
FDUDFWHUtVWLFDVGHODSREODFLyQHVWXGLDGDTXHSXGLHVHQLQÀXLUHQODHYROXFLyQGHODGLODWDFLyQ
6HVXEGLYLGLyODPXHVWUDVHJ~QODSDULGDGODSRVLFLyQPDWHUQDGXUDQWHHOWUDEDMRGHSDUWR
\HOHVWDGRGHODVPHPEUDQDVRYXODUHV/DVSDULGDGHVVHGLYLGLHURQHQQXOtSDUDVQLQJ~Q
SDUWRSUHYLR\PXOWtSDUDVXQRRPiVSDUWRVSUHYLRV/DSRVLFLyQGXUDQWHHOSHUtRGRGH
GLODWDFLyQIXHYHUWLFDODGHOWLHPSRVHQWDGDSDUDGDRFDPLQDQGRRODKRUL]RQWDO
HQFDPD6HJ~QHOHVWDGRGHODVPHPEUDQDVRYXODUHVDORV±FPGHGLODWDFLyQ
FHUYLFDOHOJUXSRVHGLYLGLyHQPHPEUDQDVURWDV\PHPEUDQDVtQWHJUDV
(QOD¿JXUDVHPXHVWUDQORVSDWURQHVQRUPDOHVUHVXOWDQWHVGHHVWHDQiOLVLV

3$572

',/$7$&,21&(59,&$/HQFP

326,&,21 0(0%5$1$6
0$7(51$ 3$5,'$' 298/$5(6 1
+RUL]RQWDO 0XOWtSDUDV 5RWDV

9HUWLFDO 7RGDV ,QWHJUDV
+RUL]RQWDO 0XOWtSDUDV ,QWHJUDV
+RUL]RQWDO 0XOWtSDUDV 5RWDV
+RUL]RQWDO 0XOWtSDUDV ,QWHJUDV
1727$/

+25$6
)LJXUD3DWURQHVGHGLODWDFLyQFHUYLFDOHQIXQFLyQGHOWLHPSR3
(QXQDSREODFLyQGHPXMHUHVDIULFDQDV 326,&,21 9(57 +25,=217$/

3KLOSRW GHVFULELy XQD VROD FXUYD GH 3$5,'$' 72'$6 08/7,3$5$6 18/Ì3$5$6
DOHUWD$ GLIHUHQFLD GH DTXHO HVWXGLR ,17( ,17( ,17(
0(0%5$1$6 *5$6 *5$6 527$6 *5$6 527$6
OD FRQIRUPDFLyQ GH YDULDV FXUYDV GH

DOHUWD SURYHQLHQWHV GH HVWRV FLQFR
JUXSRVRIUHFHPD\RUHVSRVLELOLGDGHV
GHXELFDUHOFDVRLQGLYLGXDOGHQWURGH
XQ SDWUyQ QRUPDO TXH UHÀHMH OR PiV
¿HOPHQWH SRVLEOH HO FRPSRUWDPLHQWR
HVSHUDGR¿JXUD
$ FRQWLQXDFLyQ VH SUHVHQWD HO

IRUPXODULRGH3DUWRJUDPDFRQYDORUHV
3SDUDWUD]DUODVFXUYDVGHDOHUWD
VHJ~Q OD VLWXDFLyQ GH FDGD FDVR
¿JXUD

)LJXUD9DORUHVSDUDODFRQVWUXFFLyQGHODV
FXUYDVGHDOHUWD3
120%5(<$3(//,'2 GtD PHV DxR 1'(+,6725,$&/,1,&$
326,&,21 9(57 +25,=217$/
3$5,'$' 72'$6 08/7,3$5$6 18/Ë3$5$6 2#461)4#/#%.#25/41251/5
0(0%5$1$6
,17( ,17( 527$6 ,17( 527$6
*5$6 *5$6 *5$6 3DUWR
3/$126

,


,,

LINEA DE BASEDESDE LA QUE SE

INICIA LA CURVA DE ALERTA

,,,
3/$126'(+2'*(<
9$5,('$''(326,&,21

',/$7$&,21&(59,&$/

52785$(63217$1($0(0% 5(0

52785$$57,),&,$/0(0% 5$0

' , / $ 7 $ & , 2 1& ( 5 9 , & $ / F P

,17(16,'$' /2&$/,=$&,21
)XHUWH 6XSUDS~ELFR63
1RUPDO 6DFUR6
'pELO

,9

)5(&8(1&,$&$5',$&$)(7$/

'LSVWLSR,
'HVFHOHUDFLyQSUHFR],
'LSVWLSR,, +25$6'(5(*,6752
'HVFHOHUDFLyQWDUGtD,,
'LSVYDULDEOHV
'HVFHOHUDFLyQYDULDEOH9 +25$5($/
0HFRQLR0 H J
D E F G I K L M N O P Q R S
+25$
326,&,210$7(51$ 326,&,210$7(51$

)LJXUD3DUWRJUDPDFRQFXUYDGHDOHUWD&/$3605
/DWGHUHFKR /'
7(16,21$57(5,$/
/DWL]TXLHUGR/,
'RUVDO' 38/620$7(512
6HPLVHQWDGD66
6HQWDGD6
3DUDGDRFDPLQDQGR3& )5(&8(1&,$&$5',$&$)(7$/
3URFHGLPLHQWRSDUDJUD¿FDUODGLODWDFLyQFHUYLFDO\ODVFXUYDVGHDOHUWD

'85$&,21&2175$&&,21(6
6&+:$5&=5',$=$*
1,(72)&/$3 )5(&&2175$&&,21(6
3XEO&LHQWLILFD1
0RQWHYLGHR8UXJXD\
'2/25 /RFDOL],QWHQV
37*(6$93
PLVPRKD\DDOFDQ]DGRRVXSHUDGRORVFPGHGLODWDFLyQFHUYLFDOOtQHDGHEDVH

/RVGDWRVSDUDFRQVWUXLUODVFXUYDVSDWUyQGHDOHUWDIXHURQREWHQLGRVGHVGHORV±
FPGHGLODWDFLyQFHUYLFDOSULPHUSXQWRFRQ¿DEOHGHSDUWLGDSDUDODPHGLGDSRUHOWDFWR
3RUHOORODFXUYDTXHVHHOLMDSDUDFDGDWUDEDMRGHSDUWRVHWUD]DUiDSDUWLUGHTXHHO
(Q HO H[WUHPR VXSHULRU L]TXLHUGR GHO SDUWURJUDPD VH SUHVHQWD XQD WDEOD FRQ YDORUHV
FRUUHVSRQGLHQWHV DO SHUFHQWLO GHO WLHPSR HQ HO TXH FDGD XQR GH ORV VXEJUXSRV
DQWHULRUPHQWHPHQFLRQDGRVLQFUHPHQWDQODGLODWDFLyQGHFPDGHDGHD
GHDGHD\GHDOSDUWR
/DFXUYDGHDOHUWDVHFRPLHQ]DDWUD]DUFXDQGRODFXUYDGHGLODWDFLyQFUX]DODOtQHD
GHEDVH(VWHSXQWRGHLQWHUVHFFLyQHQWUHDPEDVFXUYDVVHUiHOSXQWRGHSDUWLGDGH
OD FXUYD GH DOHUWD (O REVHUYDGRU D SDUWLU GH HVH PRPHQWR SXHGH HOHJLU GH OD WDEOD
LPSUHVD HQ HO SDUWRJUDPD ORV YDORUHV FRUUHVSRQGLHQWHV D ODV VLWXDFLRQHV REVWpWULFDV
DUULEDVHxDODGDV8QDYH]VHOHFFLRQDGDODDOWHUQDWLYDTXHPHMRUVHDVHPHMDDOFDVR
LQGLYLGXDOGHVGHODOtQHDGHEDVHHQHOSXQWRHQTXHpVWDHVFUX]DGDSRUODFXUYDGH
GLODWDFLyQGHOFDVRVHPDUFDUDQORVYDORUHVGHOSDWUyQHOHJLGR
,QJUHVRWHPSUDQR
(Q HO HMHPSOR D ODV KRUDV UHDO VH FRPHQ]y HO UHJLVWUR GH ORV GDWRV GH XQ
QXOtSDUDFRQPHPEUDQDVRYXODUHVtQWHJUDV\HQSRVLFLyQKRUL]RQWDO(OWDFWRUHDOL]DGR
HQHVHPRPHQWRFRPSUREyXQDGLODWDFLyQFHUYLFDOGHFP(OSXQWRGHHVWDSULPHUD
REVHUYDFLyQ VH PDUFy DO LQLFLR GHO UHJLVWUR$ ODV KRUD UHDO VH FRPSUREy XQD
URWXUDHVSRQWiQHDGHODVPHPEUDQDVRYXODUHV\HOWDFWRHQFRQWUyFPGHGLODWDFLyQ
6HPDUFyXQQXHYRSXQWRHQODLQWHUVHFFLyQGHODDEFLVDDODKRUDUHDOKRUD
GHOFRPLHQ]RGHOUHJLVWURFRQODRUGHQDGDDORVFPGHGLODWDFLyQ¿JXUD
/D OtQHD TXH XQH ORV SXQWRV D ORV FP \ FP SHUPLWH YLVXDOL]DU HO SURJUHVR GH OD
GLODWDFLyQFHUYLFDO
(Q HO VLJXLHQWH H[DPHQ REVWpWULFR 3DUWR

UHDOL]DGR D OD KRUD UHDO D =21$'($/(57$
(YROXFLyQGH
KV GHO LQLFLR GHO UHJLVWUR HQ HO ODGLODWDFLyQ
' ,/ $7$& ,21 & (59,& $/ FP
SDUWRJUDPD OD GLODWDFLyQ FHUYLFDO

FHUYLFDO
DOFDQ]yORVFP
&XUYDGH$OHUWD
&RPR VH YH OD LQWHUVHFFLyQ HQWUH OD
/tQHDGH%DVH
FXUYDGHGLODWDFLyQ\ODOtQHDGHEDVH
VHSURGXMRDODVKVGHOLQLFLRGHO
5(0 3XQWRFHURGHOD
&XUYDGH$OHUWD
UHJLVWUR HQ HO SDUWRJUDPD (VWH HV HO
SXQWR GH SDUWLGD SDUD FRPHQ]DU D

+25$6'(
FRQVWUXLUODFXUYDGHDOHUWDGHVGHORV '(3$572
75$%$-2

30
FPGHGLODWDFLyQFHUYLFDO¿J +25$5($/
Figura 84. Ejemplo con ingreso temprano
'HODWDEODVHH[WUDHUiQORVYDORUHVFRUUHVSRQGLHQWHDHVWHFDVRSRVLFLyQKRUL]RQWDO
QXOtSDUDPHPEUDQDVURWDV3DUDFRPHQ]DUDWUD]DUODFXUYDGHDOHUWDGHHVWHFDVR
DODVKRUDVGHOSXQWRGHVXSDUWLGDVHPDUFDUiHOFRUUHVSRQGLHQWHDORVFPGH
GLODWDFLyQ$SDUWLUGHHVWHQXHYRSXQWRKVGHVSXpVVHPDUFDUiHOSXQWRSDUDORV
FP'HVGHpVWHVHPDUFDUiKRUDVGHVSXpVHOGHORVFP\DVtVXFHVLYDPHQWH
KDVWDHO¿QDOGHOSDUWR
(QHVWHFDVRHOWUDEDMRGHSDUWR\HOSDUWRWXYLHURQXQDHYROXFLyQQRUPDO\ODFXUYDGH
GLODWDFLyQFHUYLFDOVHPDQWXYRDODL]TXLHUGDGHODFXUYDGHDOHUWD
(Q HVWD PLVPD ¿JXUD VH SUHVHQWD RWUR FDVR HQ HO TXH D SDUWLU GH ORV FP /D
YHORFLGDG GH OD GLODWDFLyQ VH HQOHQWHFH \ VX JUi¿FD FUX]D OD FXUYD GH DOHUWD OtQHD
SXQWHDGD(QHVWHFDVRFRQLJXDOHVFRQGLFLRQHVGHLQJUHVRTXHHODQWHULRUDODV
KRUDVUHDO\KRUDVGHVSXpVGHOLQLFLRGHOUHJLVWURHQHOSDUWRJUDPDVHREVHUYyXQ
WUDEDMRGHSDUWRSURORQJDGR$OHUWDGRSRUHVWHVLVWHPDGHYLJLODQFLDHOHTXLSRGHVDOXG
UHYLVyHOFDVR\SXGRDSOLFDURSRUWXQDPHQWHODVPHGLGDVDSURSLDGDV
,QJUHVRWDUGtR
/D ¿JXUD PXHVWUD XQD QXOtSDUD 3DUWR
(YROXFLyQ =21$'($/(57$
FRQPHPEUDQDVtQWHJUDVHQSRVLFLyQ GHOD
GLODWDFLyQ
KRUL]RQWDOTXHLQJUHVyDOUHJLVWURFRQ
FHUYLFDO
',/$7$&,2 1&(59,&$/F P
FPGHGLODWDFLyQFHUYLFDO
/D FXUYD GH DOHUWD VH LQLFLy GHVGH &XUYDGH$OHUWD

HVWH SULPHU WDFWR $ SDUWLU GHO /tQHDGH%DVH
PLVPRpVWDVHWUD]yFRQORVYDORUHV
FRUUHVSRQGLHQWHV D ODV FRQGLFLRQHV
GHLQJUHVRGHOFDVR

$ GLIHUHQFLD GHO HMHPSOR DQWHULRU +25$6'(75$%$-2
HQ ORV LQJUHVRV FRQ FP R PiV GH '(3$572$0
GLODWDFLyQ HO SXQWR GH SDUWLGD GH OD +25$5($/

FXUYD GH DOHUWD VLHPSUH VHUi HO GHO Figura 85. Ejemplo con ingreso tardío
SULPHUYDORUDQRWDGRGHODGLODWDFLyQ
FHUYLFDOHQHOSDUWRJUDPD
&RQGLFLRQHVFDPELDQWHVGXUDQWHHOWUDEDMRGHSDUWR
6L YDUtDQ ODV FRQGLFLRQHV GH LQJUHVR GXUDQWH HO WUDQVFXUVR GHO WUDEDMR GH SDUWR VH
GHEHUiDFWXDOL]DUODFXUYDGHDOHUWDLQLFLDOPHQWHWUD]DGD
/D ¿JXUD PXHVWUD HO 3DUWR

FDVR GH XQD PXOWtSDUD HQ 1XHYDFXUYD =21$'($/(57$
GHDOHUWD
SRVLFLyQ KRUL]RQWDO \ FRQ (YROXFLyQGH

ODV PHPEUDQDV RYXODUHV ODGLODWDFLyQ
' , / $7$ &, 2 1 &( 59 , &$ / F P
FHUYLFDO &XUYDGH$OHUWD2ULJLQDO
tQWHJUDV ,QJUHVy DO UHJLVWUR
GHOSDUWRJUDPDDODVKV 5(0
30 FRQ FP GH GLODWDFLyQ
3XQWRGH&DPELR
FHUYLFDO\KRUDVPiVWDUGH
DOFDQ]yFP
/tQHDGH%DVH

/D JUi¿FD GH OD GLODWDFLyQ
FRUWy OD OtQHD GH EDVH D ORV

PLQXWRV GHO FRPLHQ]R
GHO SDUWRJUDPD 'HVGH HVWH +25$6'(
75$%$-2
SXQWR VH FRQVWUX\y OD FXUYD '(3$57230
GH DOHUWD DSURSLDGD SDUD HO +25$5($/
FDVR Figura 86. Ejemplo para condiciones cambiantes
'HELGRTXHDORVFPODVPHPEUDQDVVHURPSLHURQHVSRQWiQHDPHQWHIXHQHFHVDULR
FRQVWUXLU XQD QXHYD FXUYD GH DOHUWD VXVWLWX\HQGR ORV YDORUHV SUHYLRV SRU ORV GH XQD
PXOWtSDUDHQSRVLFLyQKRUL]RQWDOSHURFRQODVPHPEUDQDVURWDV
(OGLEXMRGHODQXHYDFXUYDGHDOHUWDVHLQLFLyGHVGHODFXUYDSUHYLDDQLYHOGHORVFP
HQTXHVHFRQVWDWyODURWXUDGHODVPHPEUDQDV(VWD~OWLPDFXUYDGHDOHUWDIXHODTXH
PHMRUVHFRUUHVSRQGLyFRQODQXHYDVLWXDFLyQ
3DUDIDFLOLWDUODFRQVWUXFFLyQGHODVFXUYDVGHDOHUWD&/$3605GLVHxyXQDSODQWLOODGH
SOiVWLFRFRQUDQXUDVFXUYDVFRUUHVSRQGLHQWHVDORVSDWURQHVDUULEDGHVFULWRV
(VWDSODQWLOODTXHVHWUDQVSRUWDVREUHHOIRUPXODULRGHOSDUWRJUDPDSHUPLWHGLEXMDUOD
FXUYDGHDOHUWDHOHJLGDSDUDHOFDVRHQSRFRVVHJXQGRV¿JXUD
)LJXUD3ODQWLOODGHSOiVWLFRFRQUDQXUDVSDUDWUD]DUODVFXUYDVGHDOHUWD
2WURV HOHPHQWRV GHO SDUWURJUDPD TXH D\XGDQ D OD YLJLODQFLD GHO SURJUHVR GHO
SDUWR\GHODVFRQGLFLRQHVPDWHUQR±IHWDOHV
(QODFXDGUtFXODFHQWUDOGHOSDUWRJUDPDDGHPiVGHODGLODWDFLyQFHUYLFDOFRQVXFXUYD
GHDOHUWDFRUUHVSRQGLHQWHVHSXHGHUHJLVWUDUODDOWXUDGHODSUHVHQWDFLyQODYDULHGDG
GHSRVLFLyQHOHVWDGRGHODVPHPEUDQDVRYXODUHVODIUHFXHQFLDGHODVFRQWUDFFLRQHV
XWHULQDV\ODIUHFXHQFLDFDUGtDFDIHWDO¿J
(Q OD FXDGUtFXOD LQIHULRU GHO SDUWRJUDPD VH FRQVLGHUDQ OD SUHVLyQ DUWHULDO SXOVR \
SRVLFLyQPDWHUQDLQWHQVLGDG\GRORUGHODVFRQWUDFFLRQHVHWF
7UDEDMRGHSDUWRSURORQJDGR
*HQHUDDJRWDPLHQWRItVLFRGHODPDGUHDQVLHGDGFUHFLHQWHDXPHQWDODIUHFXHQFLDGH
VXIULPLHQWRIHWDO\HOWUDXPDWLVPRREVWpWULFRFXDGUR
/D SURORQJDFLyQ GHO WUDEDMR GH SDUWR REHGHFH KDELWXDOPHQWH D XQD R YDULDV GH ODV
FDXVDVVLJXLHQWHV
x &XHOORLQPDGXURRSDWROyJLFR
x +LSRGLQDPLD
x ,DWURJHQLDXVRLQDGHFXDGRGHVHGDQWHVDQDOJpVLFRVRDQHVWpVLFRVGHFRQGXFFLyQ
x 'LVWRFLDVGHODSUHVHQWDFLyQ
x 'HVSURSRUFLyQIHWR±SpOYLFD
x 9HMLJDOOHQD
x 5HFWR
&XDGUR&RQGXFWDHQHOSHUtRGRGHGLODWDFLyQ
&RQGLFLyQ &RQGXFWD
Observación sin maniobras ni medicación y traslado a sala de parto
Evolución nornal con dilatación completa
Hiperdinama Combio de posición y uteroinhibición. Referencia a alto riesgo
Hipodinama Estimulación ocitócica
Bradicardia fetal Tratamiento del sufrimiento fetal in útero. Referencia de alto riesgo.
Dips II
Taquicardia fetal Decúbito lateral - Controlar PA materno
Dips variables Control más frecuente de FCF
Dips I con membranas íntegras
Reevaluar antecedentes de patología cervical, proporción feto-
Parto prolongando pélvica y contractilidad; corregir hipodinamia; control en una hora.
(según curva de alerta) Si no progresa, amniotomía: referencia a alto riesgo.
Hemorragia genital Según normas específicas amniotomía. Referencia a alto riesgo
Líquido amniótico meconial Control más frecuente. Aspiración inmediata del RN
,QJUHVRHQWUDEDMRGHSDUWR
&RQWUROGHVLJQRVYLWDOHVPDWHUQRV
&RQWUDFWLOLGDG)&)3URJUHVRGHOSDUWR
1R 6L
1RUPDO
&RQGXFWDV 6L
VLPSOHV
QRUPDOL]DQ
1R 1R
+LSHUGLQDPLD
6L
'HF~ELWRODWHUDO 6L
8WHURLQKLELFLyQ %UDGLFDUGLD
'LSV,,
3DUWRSURORQJDGR 1R
VHJ~QFXUYDVGHDOHUWD
6L 'HVSURSRUFLyQ
SpOYLFD
1R +LSRGLQDPLD 1R 3DUWRJUDPD
SULPLWLYD FRQFXUYDV
GHDOHUWD
6L KDVWD
2FLWRFLQD GLODWDFLyQ
$PQLRWRPtD FRPSOHWD
1R 3URJUHVR 6L
GHOSDUWR
5HIHUHQFLDDOQLYHOGH $WHQFLyQGXUDQWHSHUtRGRH[SXOVLYR
DWHQFLyQGHDOWRULHVJR VHJ~QQRUPDVGHEDMRULHVJR
)LJXUD(VTXHPDGHGHFLVLRQHVGXUDQWHHOSHUtRGRGHGLODWDFLyQ
$6,67(1&,$'85$17((/3(5,2'2(;38/6,926(*81'23(5,2'2

2%-(7,92 'HWHFWDU\HYDOXDUGHVYLDFLRQHVGHORVOtPLWHV¿VLROyJLFRVGHO
SHUtRGRH[SXOVLYR
3UHYHQLUWUDXPDWLVPRREVWpWULFR
3UHYHQLUKLSR[LDIHWDO
$&7,9,'$' &RQWUROGHOD)&)
&RQWUROGHODFRQWUDFWLOLGDG
&RQWUROGHODYDQFHGHODSUHVHQWDFLyQ\GHVSUHQGLPLHQWR
6HREVHUYDUiQHVWULFWDPHQWHODVQRUPDVGHDVHSVLD
$OFDQ]DGRHOFRPLHQ]RGHOSHUtRGRH[SXOVLYRUHVWDQD~QVLWXDFLRQHVGHULHVJRTXHGHEHQ
VHUSUHYLVWDV\DOWHUDFLRQHVGHOD¿VLRORJtDTXHGHSUHVHQWDUVHGHEHQFRUUHJLUVH
3HUtRGRH[SXOVLYRSURORQJDGRTXHSXHGHGHEHUVHD
D+LSRGLQDPLD
E3XMRPDWHUQRLQH¿FD]
F'HIHFWRVGHURWDFLyQFHIiOLFD
G'HVSURSRUFLyQIHWRSpOYLFDQRGLDJQRVWLFDGD
(OWUDXPDWLVPRREVWpWULFRSXHGHSURYRFDUHQODPDGUH
'HVJDUURVYDJLQRSHULQHDOHV
'HVJDUURFHUYLFDO\VHJPHQWDULR
5RWXUDXWHULQD
(OWUDXPDWLVPRREVWpWULFRSXHGHFDXVDUHQHOIHWR
6XIULPLHQWRIHWDO
0DUFDGRGHVDOLQHDPLHQWRyVHRFHIiOLFRSDULHWRIURQWRRFFLSLWDO
&DEDOJDPLHQWRyVHRFHIiOLFR
7XPRUVHURVDQJXtQHRRFDSXWVXFFHGDQHXPH[DJHUDGR
&pIDORKHPDWRPD
+HPRUUDJLDLQWUDFUDQHDQD
)UDFWXUDV
3DUiOLVLV
/HVLRQHVGHWHJXPHQWRV
3HUtRGRH[SXOVLYR
$OJXQDVGHODVFRPSOLFDFLRQHVPHQFLRQDGDVSXHGHQVXSHUDUVHHQFRQGLFLRQHVGHEDMR
ULHVJRHQIRUPDSUHYHQWLYDRSRUODRSRUWXQDDGRSFLyQGHPHGLGDVFRUUHFWLYDV2WUDV
VRQ LQVXSHUDEOHV VLQ OD HMHFXFLyQ GH PDQLREUDV R LQWHUYHQFLRQHV TXH HVFDSDQ D OD
QRUPDGHEDMRULHVJR\TXHGHEHQVHUHIHFWXDGDVSRUXQSURIHVLRQDOFRQDOWRJUDGRGH
HQWUHQDPLHQWRFHViUHDIyUFHSVHWF
(ORSRUWXQRGLDJQyVWLFRGHODGHVSURSRUFLyQIHWRSpOYLFDHYLWD
'HWHQFLyQGHODH[SXOVLyQ
7UDXPDWLVPRPDWHUQRIHWDO
6XIULPLHQWRIHWDO
(OSXMRPDWHUQRHVSRQWiQHRHVKDELWXDOPHQWHDGHFXDGRSDUDODH[SXOVLyQIHWDOVLHVWH
VHUHDOL]DVLQFUyQLFDPHQWHFRQODFRQWUDFFLyQXWHULQD+D\TXHHYLWDUHOSXMRGLULJLGR
FXDQGRREOLJDDODPDGUHDPDQLREUDVGH9DOVDOYDPiVSURORQJDGDVTXHODGXUDFLyQGH
ODFRQWUDFFLyQSRUTXHVHDVRFLDDDJRWDPLHQWRPDWHUQR
/DDGHFXDGDSURWHFFLyQSHULQHDOSUHYLHQHORVGHVJDUURV
&RPR QRUPD JHQHUDO QR VH DFRQVHMD UHDOL]DU OD HSLVLRWRPtD GH UXWLQD H[FHSWR HQ
DTXHOODVSDUWXULHQWDVTXHSUHVHQWHQXQSHULQpPX\UHVLVWHQWHFRQULHVJRGHGHVJDUURR
VHYD\DDHIHFWXDUXQSDUWRLQVWUXPHQWDO
(QORVHQVD\RVFOtQLFRVFRQWURODGRVVHREVHUYyTXHKXERXQQ~PHURPD\RUGHGHVJDUURV
GHOSHULQpDQWHULRUFXDQGRHOXVRGHODHSLVLRWRPtDIXHUHVWULQJLGRFRPSDUDGRFRQHOXVR
OLEHUDO3RUHOFRQWUDULRORVWUDXPDWLVPRVSHULQHDOHVSRVWHULRUHVIXHURQPHQRUHVHQHO
JUXSRUHVWULQJLGRFRPSDUDGRFRQHOOLEHUDO(OGRORUDODOWDIXHPHQRUHQHOJUXSRGHXVR
UHVWULQJLGR(OVHJXLPLHQWRUHDOL]DGRKDVWDORVWUHVPHVHVQRPRVWUyGLIHUHQFLDVHQOR
UHIHUHQWHDGRORUHVSRQWiQHRHOLQLFLR\GRORUHQODVUHODFLRQHVVH[XDOHVHLQFRQWLQHQFLD
GHRULQD
3UHSDUDFLyQ
'XUDQWHODDVLVWHQFLDGHOSHUtRGRH[SXOVLYRVHREVHUYDUiQHVWULFWDPHQWHODVQRUPDVGH
DVHSVLD8QDDGHFXDGDSUHSDUDFLyQLPSOLFD
5RSDOLPSLD
,QVWUXPHQWDOHVWpULOSDUDODDWHQFLyQGHOSDUWR
*XDQWHVHVWpULOHV
/DYDGRTXLU~UJLFRGHPDQRV
$VHSVLDSHULQHDO
&DPSRVHVWpULOHV
3RVLFLyQGHODSDUWXULHQWD
'HEHHYLWDUVHODSRVLFLyQGHOLWRWRPtDSLHUQDVHVWpQFROJDQGR\RDWDGDVDOQLYHOGHORV
WRELOORV\ODJLQHFROyJLFDFOiVLFD(OHJLUHQWUHODVVLJXLHQWHVSRVLFLRQHV
6HPLVHQWDGDUHVSDOGRGHODFDPDGHSDUWRVFRQXQiQJXORGHDJUDGRV\FRQ
DSR\DSLp
6HQWDGDHQFDPDGHSDUWRVFRQUHVSDOGRHQiQJXORGHJUDGRVRHQVLOOD
(QFXFOLOODVGL¿FXOWDODDXVFXOWDFLyQFDUGtDFDIHWDO\ODSURWHFFLyQGHOSHULQp
&RQWUROHVDUHDOL]DUVHGXUDQWHHOSHUtRGRH[SXOVLYR
)&)FDGDPLQXWRVHQWUHFRQWUDFFLRQHV(VQRUPDOTXHVHSURGX]FDQGHVFHQVRVKDVWD
DODWLGRVFDUGtDFRVIHWDOHVSRUPLQXWRGXUDQWHHOSHUtRGRH[SXOVLYRGHELGRD
XQDFRPSUHVLyQFHIiOLFD8QD)&)PHQRUGHODWLGRVSRUPLQXWRPDQWHQLGDHQWUH
SXMRVVXJLHUHVXIULPLHQWRIHWDO¿JXUD
(¿FDFLDGHODFRQWUDFWLOLGDGXWHULQD\SXMRVPDWHUQRV
'HEHUiQHYDOXDUVHHQIRUPDFRQWLQXD/DSURJUHVLyQGHOGHVFHQVR\GHODURWDFLyQGH
ODFDEH]DTXHHQFDVRGHSURJUHVRHVLQGLFDGRUDGHQRUPDOLGDG
&RQGXFWDJHQHUDO
D/DKLSRGLQDPLDSULPLWLYDGHEHWUDWDUVHFRQHVWLPXODFLyQRFLWyFLFD&XDGUR
(QODKLSRGLQDPLDVHFXQGDULDFXDQGRHVWiLQGLFDGDXVDURFLWyFLFRV
GHVFDUWDUFRQWUDLQGLFDFLyQSDUDORVPLVPRV
E(VWLPXODUHOSXMRPDWHUQRHVSRQWiQHRVHxDODQGRHOPRPHQWRDSURSLDGR
MXQWRFRQODFRQWUDFFLyQ\HYLWDQGRHODJRWDPLHQWR
F(VWLPXODUXQDDGHFXDGDYHQWLODFLyQ\UHODMDFLyQHQWUHODVFRQWUDFFLRQHV
$PQLRWRPtD
6L GHVSXpV GH PLQXWRV GH FRPSOHWDGD OD GLODWDFLyQ HQ QXOtSDUDV R GH PLQXWRV
HQPXOWtSDUDVFRQSUHVHQFLDGHSXMRPDWHUQRQRVHSURGXFHGHVFHQVR\URWDFLyQVH
HIHFWXDUiDPQLRWRPtDVLHPSUHTXHHOSRORFHIiOLFRHVWpRFXSDQGRHQWHUDPHQWHODFDYLGDG
SpOYLFDSUHVHQWDFLyQ¿MDRHQFDMDGD
7pFQLFDGHODDPQLRWRPtD
6H SURFHGH GH OD VLJXLHQWH PDQHUD FRQ HO Pi[LPR ULJRU HQ OD DVHSVLD VH LQWURGXFH XQ
LQVWUXPHQWRFRQSXQWDGHQWDGDSRUHMHPSORXQDPQLyWRPRRXQDUDPDGHSLQ]DGH.RFKHU
HQWUHHOGHGRtQGLFH\HOPD\RUGHODPDQRTXHWDFWDKDVWDOOHJDUDODEROVD\UDVJDUODFRQOD
SXQWDGHQWDGDGHGLFKDUDPD
3URWHFFLyQSHULQHDO
/DSURWHFFLyQSHULQHDOHVODSULQFLSDOPHGLGDSUHYHQWLYDSDUDHYLWDUGHVJDUURV¿JXUD
(OULHVJRGHGHVJDUURGHSHQGHGH
ODSDULGDG
ODHODVWLFLGDGGHORVWHMLGRV
HOWDPDxRIHWDO
ODYHORFLGDGGHODH[SXOVLyQ
6L VH HVWLPD TXH HVWDV FRQGLFLRQHV DXPHQWDQ HO

ULHVJR GH GHVJDUUR GHEH HIHFWXDUVH LQ¿OWUDFLyQ
SHULQHDO FRQ DQHVWHVLD ORFDO DQWHV GH LQLFLDGR HO
GHVSUHQGLPLHQWR SDUD SRVWHULRUPHQWH UHDOL]DU XQD
HSLVLRWRPtD¿J
/D HSLVLRWRPtD VH HIHFWXDUi HQ HO PRPHQWR GH OD

F
GLVWHQVLyQ SHULQHDO SRU HO SROR FHIiOLFR GXUDQWH E D
HO SXMR HQ IRUPD GLDJRQDO KDVWD OD WXEHURVLGDG

LVTXLiWLFDDEDUFDQGRHQODVHFFLyQWRGRVORVWHMLGRV
GHO ODELR PD\RU 6H LQFLGH HQ SURIXQGLGDG HQ OD )LJXUDDPHGLD
PHGLGDGHODDPSOLDFLyQYXOYDUQHFHVDULD6HSUH¿HUH EPHGLRODWHUDO
ODHSLVLRWRPtDPHGLRODWHUDO FODWHUDO
$YDQFHGHODSUHVHQWDFLyQ\GHVSUHQGLPLHQWR
3HUPLWLU HO DYDQFH GH OD SUHVHQWDFLyQ PDQWH

QLHQGR VX ÀH[LyQ KDVWD TXH OD FLUFXQIHUHQFLD
VXERFFLSLWREUHJPiWLFD KD\D WUDVSDVDGR HO DQLOOR
YXOYDUGLVWHQGLGR
,QVWUXLUDODPDGUHSDUDTXHMDGHH\QRSXMHHQHVH
PRPHQWR
(QOHQWHFHUHOGHVSUHQGLPLHQWRDSR\DQGRODPDQR
L]TXLHUGDVREUHODSUHVHQWDFLyQSDUDTXHODGHÀH[LyQ
VHUHDOLFHOHQWDPHQWHGLVWHQGLHQGRSURJUHVLYDPHQWH
ORVWHMLGRVSDUDHYLWDUGHVJDUURV,QVWUXLUOXHJRDOD
)LJXUD3URWHFFLyQSHULQHDO
PDGUHSDUDTXHSXMHVXDYHPHQWH
&RORFDUFRQODPDQRGHUHFKDXQDSyVLWRVREUHHOSHULQpDEDUFiQGRORHQWUHHOSXOJDU\
ORVGHGRVUHVWDQWHVGHODPDQR6RVWHQHUODSUHVHQWDFLyQSDUDTXHQRHIHFW~HVXDYDQFH
\GHÀH[LyQEUXVFDPHQWH$FHUFDUKDFLDHOUDIHSHULQHDOORVWHMLGRVODWHUDOHVGHOSHULQp
FRPRSDUDIUXQFLUORVKDFLHQGRGLVPLQXLUODWHQVLyQ¿JXUD
7HUPLQDUHOGHVSUHQGLPLHQWRFRQOHQWLWXGFRQODVDOLGDGHODIUHQWHODFDUD\HOPHQWyQ
,QVWUXLUQXHYDPHQWHDODPDGUHSDUDTXHQRSXMH
$XQTXH HO UHVWR GHO FXHUSR FRQ IUHFXHQFLD VH GHVSUHQGH HVSRQWiQHDPHQWH HV
KDELWXDO D\XGDU D VX VDOLGD ¿QDO 3DUD HOOR XQD YH] GHVSUHQGLGD OD FDEH]D \ URWDGD
HVSRQWiQHDPHQWH KDFLD VX SRVLFLyQ SULPLWLYD URWDFLyQ H[WHUQD GH OD FDEH]D VH
REVHUYD VL KD\ DOJXQD FLUFXODU GH FRUGyQ DMXVWDGD DO FXHOOR OD TXH GH H[LVWLU GHEH
GHVOL]DUVHVREUHODFDEH]DRVREUHHOKRPEUR6LODWHQVLyQGHODPLVPDORLPSLGHVH
VHFFLRQDGHLQPHGLDWRHOFRUGyQHQWUHGRVSLQ]DVGH.RFKHU
6HWRPDODFDEH]DFRQDPEDVPDQRVGHORVSDULHWDOHVHQSRVLFLyQDQWHULRU\SRVWHULRU
\VHODWUDFFLRQDVXDYHPHQWHSULPHURKDFLDDEDMRGHVFHQGLHQGRFRQHOORHOKRPEUR
HQ SRVLFLyQ DQWHULRU KDVWD VREUHSDVDU HO SXELV SDUD LQYHUWLU GH LQPHGLDWR HO VHQWLGR
GH OD WUDFFLyQ DKRUD KDFLD DUULED FRQ OR TXH VH REWLHQH HO GHVSUHQGLPLHQWR GHO
KRPEURSRVWHULRU(OUHVWRGHOFXHUSRDOVHUPHQRVYROXPLQRVRTXHORVVHJPHQWRV\D
GHVSUHQGLGRVVHH[SXOVDIiFLOPHQWHGHELpQGRVHFRQWHQHUDOIHWRSDUDTXHQRORKDJD
FRQEUXVTXHGDG
(OGHVFHQVRSURIXQGRGHOKRPEURHQSRVLFLyQDQWHULRUHVGHULJRUDQWHVGHFRQWLQXDU
ODVWUDFFLRQHVGHORFRQWUDULRDOUHWHQHUVHpVWHGHWUiVGHOSXELVSXHGHVHUPRWLYRGH
IUDFWXUDGHFODYtFXODRGHHORQJDFLyQGHOSOH[REUDTXLDOFRUUHVSRQGLHQWH¿JXUD
)LJXUD$\XGDPDQXDOSDUDHOGHVSUHQGLPLHQWRGHORVKRPEURV
6,78$&,21(6(63(&,$/(6 'LVWRFLDGHKRPEUR
3DUWRHQSRGiOLFD
'LVWRFLDGHKRPEUR
(VXQDVLWXDFLyQSRWHQFLDOPHQWHJUDYHTXHVHFDUDFWHUL]DSRUTXHOXHJRGHODVDOLGDGH
ODFDEH]DIHWDOVHGHWLHQHHOSDUWR
'LDJQyVWLFR
/DVPDQLREUDVKDELWXDOHVSDUDOLEHUDUHOKRPEURDQWHULRUIUDFDVDQ
6L VH SURGXFH GLVWRFLD GH KRPEUR FRQ KRPEUR DQWHULRU LPSDFWDGR WUDV OD VtQ¿VLV
SXELDQDVHGHEHQHIHFWXDUODVVLJXLHQWHVPDQLREUDV
6LQRKDKHFKRHSLVLRWRPtDKiJDODVLODKL]R\HVSHTXHxDDPSOtHOD
&RQODSDUWXULHQWDHQGHF~ELWRGRUVDOVROLFtWHOHTXHÀH[LRQHIXHUWHPHQWHVXV
SLHUQDVVREUHHOSHFKR
6ROLFLWHDXQD\XGDQWHTXHFRPSULPDODUHJLyQVXSUDS~ELFDLQWHQWDQGRGHVWUDEDU
HOKRPEURDQWHULRUHLPSXOVDUORKDFLDODYDJLQD
$SOLTXHVLHPSUHWUDFFLyQ¿UPH\FRQLQXDKDFLDDEDMR¿J6LORKDFH
GHPDVLDGRHQpUJLFDPHQWHSXHGHSURYRFDUSDUiOLVDVGHOSOH[REUDTXLDO
6LHVWDVPDQLREUDVIUDFDVDQLQWHQWHODURWDFLyQFXLGDGRVDOOHYDQGRHOKRPEUR
HQSRVLFLyQDQWHULRUKDFLDDWUiVHQVHQWLGRGHOGRUVRIHWDOTXHVXHOHOLEHUDU
HOKRPEUR¿JXUD3XHGHD\XGDUDODURWDFLyQ\DOGHVSUHQGLPLHQWRDSOLFDU
SUHVLyQVREUHHOKRPEURIHWDODQWHULRUHQGLUHFFLyQDOSHFKRIHWDO
(OIUDFDVRGHHVWDPDQLREUDREOLJDDLQWHQWDUODH[WUDFFLyQGHOEUD]RHQSRVLFLyQSRVWHULRU

,QWURGXFLUHQODYDJLQDODPDQRFRUUHVSRQGLHQWHDOYLHQWUHIHWDO
3UHVLRQDUODIRVDDQWHFXELWDOGHOEUD]RSRVWHULRUORTXHKDUiGHVFHQGHUHODQWHEUD]R
TXHVHWRPD\VHFRQGXFHSRUHOSHFKRGHOQLxRKDVWDDIXHUD¿J(VWRUHGXFLUi
HOGLiPHWURIHWDORIUHFLGRDODSHOYLV\SHUPLWLUiODOLEHUDFLyQGHOKRPEURDQWHULRU
)LJXUD0DQLREUDGHURWDFLyQ
)LJXUD/LEHUDFLyQGHOEUD]RSRVWHULRU
HQODGLVWRFLDGHKRPEUR
6L WRGDV HVWDV PDQLREUDV UHDOL]DGDV HQ HVFDVRV PLQXWRV IUDFDVDQ SURFHGD D
IUDFWXUDUODFODYtFXODIHWDO
(QRFDVLRQHVODFODYtFXODIHWDOVHIUDFWXUDDFFLGHQWDOPHQWHGXUDQWHODVPDQLREUDVGH
WUDFFLyQ (VWR GHEHUi VHU H[SOLFDGR D OD PDGUH \ QR RFXOWDUOR \D TXH HVWD VLWXDFLyQ
SRGUiFRQWULEXLUDVDOYDUODYLGDGHOIHWRTXHKDTXHGDGRUHWHQLGR
3HUtRGR([SXOVLYR
12 &RQWUDFWLOLGDG& 6,
3XMR3\'HVFHQVRGHOD
3UHVHQWDFLyQ'
(ILFDFHV
$PQLRWRPtD
&3\' 6, %UDGLFDUGLD 12
(ILFD] )HWDO
12 6,
!PLQ
2FLWRFLQD 3HUtRGR([SXOVLYR
6,
6, 12 3HULQp 12
&3\' (OiVWLFR
(ILFD]
12 (SLVLRWRPtD 6,
3URWHFFLyQ3HULQp$\XGD
'HVSUHQGLPLHQWRGHOD&DEH]D
6, 'LVWRFLD 12
GH+RPEUR
0DQLREUDVGH
'HVSUHQGLPLHQWR
'HVSUHQGLPLHQWR
(VSRQWiQHR
$SOLFDFLyQGH1RUPDV ([WUDFFLyQ)HWDO
GH$OWR5LHVJR ,QPHGLDWD 5HFHSFLyQGHO5HFLpQ1DFLGR
)LJXUD)OXMRJUDPDGHGHFLVLRQHVGHOSHUtRGRH[SXOVLYR
$WHQFLyQGHOSDUWRHQSRGiOLFD
([LVWHQHYLGHQFLDVTXHDVHJXUDQTXHHOQDFLPLHQWRSRUFHViUHDHQFDVRGHSUHVHQWDFLyQ
SRGiOLFDHVPiVVHJXURTXHHOSDUWRYDJLQDO3HURHQRFDVLRQHVQRKDEUiRWUDSRVLELOLGDG
TXHDVLVWLUHOSDUWRHQHVWDSUHVHQWDFLyQ/RVPHMRUHVUHVXOWDGRVVHORJUDUiQFXDQGR
HO SUHVWDGRU PDQWHQJD OD FDOPD H LQWHUYHQJD FXDQGR HVWp LQGLFDGR FRQ PDQLREUDV
GHOLFDGDV\SUHFLVDV&RPRPDQLREUDSUHYLDFDWHWHULFHVLVWHPiWLFDPHQWHODYHMLJDSDUD
TXHGXUDQWHHOSURFHGLPLHQWRpVWDVHHQFXHQWUHYDFtD'HKDEHUXQIyUFHSVGLVSRQLEOH
WpQJDORSURQWRHQODPHVDGHSDUWRSRUVLVHSURGXMHUDXQDUHWHQFLyQGHFDEH]D
6HLQWHQWDUiFRQVHUYDUODVPHPEUDQDVtQWHJUDVKDVWDFRQVHJXLUODGLODWDFLyQFRPSOHWD
VLODVPHPEUDQDVVHURPSHQVHGHEHYHUL¿FDUTXHQRKD\DSURFLGHQFLDSURODSVRGH
FRUGyQDGHPiVGHHYDOXDUODPRGDOLGDGGHODSUHVHQWDFLyQ
6HHYLWDUiHOSXMRPDWHUQRKDVWDFHUWL¿FDUTXHHOFXHOORGHO~WHURHVWiWRWDOPHQWHGLODWDGR
\ODSUHVHQWDFLyQVHHQFXHQWUDLQJUHVDQGRHQODYDJLQD
'HVSUHQGLPLHQWRGHORVPLHPEURVLQIHULRUHV
x6HHYLWDUiWLURQHDUGHORVPLHPEURV\VHFRORFDUiXQDPDQRRSRQLHQGRUHVLVWHQFLD
DOGHVSUHQGLPLHQWRGHODSUHVHQWDFLyQDSHQDVHVWDDVRPHHQHOSHULQp
x(IHFWXDUXQDHSLVLRWRPtDDPSOLD\SHUPLWLUTXHVHH[SXOVHQODVQDOJDVKDVWDYHU
DSDUHFHUODHVSDOGD
x6H UHFRPLHQGD HYLWDU HO SXMR KDVWD TXH ODV QDOJDV VH KD\DQ H[SXOVDGR
HVSRQWiQHDPHQWHEDMRODIXHU]DGHODVFRQWUDFFLRQHV
x8QDYH]TXHODVQDOJDVVHKDQGHVSUHQGLGRVHHQYXHOYHDODEGRPHQGHOIHWRFRQ
XQDFRPSUHVDWLELD
x$ODSDUHFHUHORPEOLJRIHWDOFRPLHQ]DODIDVHDFWLYDHQODSDUWLFLSDFLyQGHOREVWHWUD
HQHVDRSRUWXQLGDGVHWUDFFLRQDUiGHOFRUGyQ\VHKDUiXQDVD
x6LODVSLHUQDVQRVDOHQHVSRQWiQHDPHQWHH[WUDHUFRQGHOLFDGH]DXQDSLHUQDSRU
YH]ÀH[LRQDQGRODURGLOOD\WUDFFLRQDQGRGHVGHHOWRELOOR
'HVSUHQGLPLHQWRGHORVPLHPEURVVXSHULRUHV
x&XDQGRDSDUHFHQORViQJXORVGHORVRPySODWRVVHSHUPLWLUiDODPXMHUSXMDU(Q
RFDVLRQHV EDVWDUi FRQ ORV SXMRV PDWHUQRV SDUD FRQVHJXLU OD H[SXOVLyQ GH ORV
KRPEURV6LHQGRVRWUHVSXMRVQRVHORJUDHOUHVXOWDGRHVSHUDGRVHGHEHUiXVDU
ODPDQLREUDGH%UDFKWHVWDPDQLREUDWLHQHODYHQWDMDGHTXHVLUYHDOPLVPRWLHPSR
SDUDHOGHVSUHQGLPLHQWRGHKRPEURV\FDEH]D\QRUHTXLHUHODLQWURGXFFLyQGHOD
PDQRHQODYDJLQD0LHQWUDVXQD\XGDQWHFRPSULPHODFDEH]DIHWDOHQGLUHFFLyQ
DODSHOYLV(ORSHUDGRUWRPDUiDOIHWRSRUHOWURQFR\ORVPXVORVFRPSULPLHQGR
ORVPXVORVVREUHHOWURQFRVHOHYDQWDDOIHWRVLQWLUDU\VHORKDUiJLUDUHQWRUQRDO
SXELVPDWHUQR\HQGLUHFFLyQDOYLHQWUHPDWHUQR
)LJXUD0DQLREUDGH%UDFKW
x6LQRIXHVHHIHFWLYDODPDQLREUDGH%UDFKWSDUDHOGHVSUHQGLPLHQWRGHKRPEURVVH
DSOLFDUiODPDQLREUDGH5RMDVSRUODFXDOPLHQWUDVVHVRVWLHQHDOIHWRGHVXVPXVORV
FRQGHOLFDGH]D\DSR\DQGRORVSXOJDUHVHQHOVDFURVHLQWHQWDUiKDFHUURWDUDOIHWR
DSOLFDQGRXQDOLJHUDWUDFFLyQGHVFHQGHQWHSDUDFRQVHJXLUHOGHVSUHQGLPLHQWRGHO
KRPEURSRVWHULRUXQDYH]GHVSUHQGLGRHOKRPEURSRVWHULRUVHHIHFW~DXQJLURHQ
VHQWLGRRSXHVWRDODQWHULRUSDUDGHVSUHQGHUHOKRPEURDQWHULRU

)LJ0DQLREUDGH5RMDV )LJ0DQLREUDGH5RMDV
HUWLHPSR WLHPSR
x2WUDPDQLREUDSDUDHOGHVSUHQGLPLHQWRGHORVKRPEURVHVODPDQLREUDGH3DMRW
SRUODFXDOVHGHEHUiHOHYDUDOIHWRWRPDGRGHDPERVWRELOORV\FRQGRVGHGRV
VHLQWHQWDUiGHVSUHQGHUHOKRPEURSRVWHULRU\OXHJREDMDQGRHOIHWRVHLQWHQWDUi
GHVSUHQGHUHOKRPEURDQWHULRU
x&XDQGRORVEUD]RVHVWpQHOHYDGRVVREUHODFDEH]DIHWDOVHGHEHUiLQWURGXFLUOD
PDQRHQODYDJLQDSDUDÀH[LRQDUHOFRGR\GHVFHQGHUHOEUD]RSRUGHODQWHGHOD
FDUDGHOIHWRHQGLUHFFLyQDOWyUD[
Hombro
posterior
)LJXUD'HVSUHQGLPLHQWRGHEUD]RVXELFDGRVVREUHODSUHVHQWDFLyQ
'HVSUHQGLPLHQWRGHODFDEH]D
x&XDQGR OD PDQLREUD GH %UDFKW QR VHD HIHFWLYD SDUD GHVSUHQGHU OD FDEH]D VH
GHEHUi PDQWHQHU OD SUHVLyQ SRU SDUWH GH XQ D\XGDQWH GH OD FDEH]D IHWDO SRU
HQFLPD GHO SXELV HQ GLUHFFLyQ D OD YDJLQD SDUD D\XGDU HQ HO GHVFHQVR GH OD
FDEH]D\HYLWDUODGHÀH[LyQ
x$SR\DUDOIHWRERFDDEDMRFDEDOJDQGRVREUHHODQWHEUD]RGHODPDQRPiVKiELO
GHORSHUDGRUPDQLREUDGH0RULFHDX
x&RORFDU ORV GHGRV tQGLFH \ PD\RU GH OD PDQR TXH VRVWLHQH DO IHWR GHQWUR GH
OD ERFD IHWDO WUDFFLRQDQGR OD PDQGtEXOD KDFLD HO WyUD[ IHWDO SDUD ÀH[LRQDU OD
FDEH]D
x/RVGHGRVtQGLFH\PD\RUGHODRWUDPDQRVHDSR\DUiQDPDQHUDGH³WHQHGRU´
VREUHORVKRPEURVIHWDOHVHVWRVGHGRVQRGHEHQWUDFFLRQDU
x6H WUDFFLRQDUi GHOLFDGDPHQWH DO WLHPSR TXH HO IHWR VH HOHYDUi HQ GLUHFFLyQ DO
YLHQWUHPDWHUQR
)LJXUD0DQLREUDGH0RULFHDX
x6L HVWDV PDQLREUDV IUDFDVDUDQ VH UHFRPLHQGD OD DSOLFDFLyQ GH XQ IyUFHSV GH
FDEH]D~OWLPD8QD\XGDQWHHOHYDUiHOIHWRGHVGHVXVWRELOORVHORSHUDGRUDSOLFDUi
DPEDVSDODVGHOIyUFHSVSRUHOODGRYHQWUDOGHOIHWRLQWHQWDQGRUHDOL]DUXQDWRPD
VLPpWULFD/XHJRVHWUDFFLRQDUiSULPHURKDFLDDEDMRSDUDGHVFHQGHUODFDEH]D\
¿QDOPHQWHKDFLDDUULEDSDUDGHVSUHQGHUOD9HU¿JXUD
)LJXUD$SOLFDFLyQGHOIyUFHSVGHFDEH]D~OWLPD
$WHQFLyQGHO5HFLpQ1DFLGRHQVDODGHSDUWRV
$FRQWLQXDFLyQVHUHVXPHQXQDVHULHGHSDVRVSDUDODDWHQFLyQLQPHGLDWDGHOUHFLpQ
QDFLGRQRUPDOWRGRVHVWRVDVSHFWRV\RWURVVHHQFXHQWUDQGHVDUUROODGRVHQHOFDStWXOR
9$WHQFLyQGHO5HFLpQ1DFLGR
8QDYH]SURGXFLGRHOSDUWRDSR\DUDOUHFLpQQDFLGRVREUHXQDVXSHU¿FLHFXELHUWD
FRQXQSDxRVXDYHDXQQLYHOPiVEDMRTXHHOGHODPDGUHRVREUHORVPXVORVHQXQD
FHViUHD
6HFDUVXFDUDFDEH]DFXHUSR\FXEULUORSDUDTXHQRVHHQIUtH
&RQ¿UPDUTXHUHVSLUDQRUPDOPHQWH
$VSLUDUORVRORHQFDVRTXHKD\DPHFRQLR\HOUHFLpQQDFLGRD~QQRKD\DUHVSLUDGR
VLUHVSLUDDQWHVGHODDVSLUDFLyQDVSLUDUORQRVHUiGHXWLOLGDG
6LWRGRHVQRUPDOQRKD\DV¿[LDFRUWDUHOFRUGyQXPELOLFDOUHFLpQGHVSXpVTXHGHMD
GHSXOVDURORKDFHHQIRUPDFDVLLPSHUFHSWLEOH\VHHQFXHQWUDÀiFFLGR
&RORFDU XQD JDVD HPEHELGD HQ DOFRKRO HQWRUQR DO PXxyQ GHO FRUGyQ SDUD TXH HO
PLVPRVHYD\DGHVHFDQGRHQODIRUPDPiVUiSLGD
7pFQLFDSDUDODOLJDGXUDGHOFRUGyQ
6H REVHYDUiQ HVWULFWDPHQWH ODV QRUPDV GH DVHSVLD 6H FRORFD XQD SLQ]D IXHUWH
SHM3LQ]DGH.RFKHUDRFPGHODLQVHUFLyQXPELOLFDOIHWDO\RWUDSLQ]DDODPLVPD
GLVWDQFLDSHURHQGLUHFFLyQDODSODFHQWD6HFRUWDFRQWLMHUDHQWUHDPEDVSLQ]DV/DV
SLQ]DGHOODGRIHWDOVHUiVXVWLWXLGDSRUXQDSLQ]DSOiVWLFDRSRUOLJDGXUDFRQKLORJUXHVR
HVWpULOWRPDUODSUHFDXFLyQGHFHUUDU¿UPHPHQWHODSLQ]DRDQXGDUHOKLORFRQQXGRGH
FLUXMDQR\GHMDUORELHQDMXVWDGR
2WUDV LQWHUYHQFLRQHV TXH GHEHQ VHU UHDOL]DGDV HQ OD UHFHSFLyQ LQPHGLDWD GHO UHFLpQ
QDFLGR
3UHYHQLU OD RIWDOPLD JRQRFyFFLFD VHJ~Q QRUPD QDFLRQDO GLIHUHQWHV RSFLRQHV VH
GHVFULEHQHQHOFDStWXOR9
3UHYHQLU HQIHUPHGDG KHPRUUiJLFD GHO UHFLpQ QDFLGR VHJ~Q QRUPD QDFLRQDO R
UHFRPHQGDFLRQHVGHOFDStWXOR9
5HFRPHQGDFLRQHVVREUHXVRGHPHGLFDFLyQHQHOSDUWRGHEDMRULHVJR
(OSDUWRHVXQSURFHVRQDWXUDO¿VLROyJLFR\SRUWDQWRQRHVWiLQGLFDGDODDGPLQLVWUDFLyQ
UXWLQDULDGHPHGLFDPHQWRV6yORGHEHQXVDUVHSDUDODSUHYHQFLyQ\HOWUDWDPLHQWRGH
ODVFRPSOLFDFLRQHV
/DVUD]RQHVKDELWXDOHVSDUDHOXVRGHPHGLFDFLyQVRQ
DGRORU\DQVLHGDGLQWHQVRV
EWUDVWRUQRVGHODFRQWUDFWLOLGDGXWHULQD
FVXIULPLHQWRIHWDODJXGR
D'RORU\DQVLHGDGLQWHQVRV
3DUDVXFRQWUROVRQKDELWXDOPHQWHVX¿FLHQWHV
xODDGHFXDGDSUHSDUDFLyQSVLFRItVLFDGHODPDGUHHQHOSHUtRGRSUHQDWDO
xODPRWLYDFLyQGHODPDGUHSDUDHOSDUWRQDWXUDO
xHODSR\RSVLFRDIHFWLYRGXUDQWHHOWUDEDMRGHSDUWRSRUHOSDGUHXRWURIDPLOLDU
xHODSR\RSVLFRDIHFWLYRSRUSDUWHGHOHTXLSRGHVDOXG
xODOLEHUWDGGHSRVLFLyQGHODPDGUH
$SHVDUGHHOORHQDOJXQDVRFDVLRQHVKD\PDGUHVTXHSUHVHQWDQLQWHQVDDQJXVWLD\
DQVLHGDGFRQIXHUWHGRORU\SXHGHQSHUGHUHODXWRFRQWURO(VWRSXHGHLQWHUIHULUHQOD
FRQWUDFWLOLGDG XWHULQD \ HO SURJUHVR GHO SDUWR QRUPDO FRQ FRQVHFXHQFLDV TXH SXHGHQ
OOHJDUKDVWDODKLSR[LDIHWDOSRUGLVPLQXFLyQGHODLUULJDFLyQ~WHURSODFHQWDULD$GHPiV
GHJHQHUDUXQDH[SHULHQFLDSRFRJUDWL¿FDQWHSDUDODPXMHU
6L DGHPiV GH ODV PHGLGDV GH DSR\R SVLFR HPRFLRQDO ODV PHGLGDV ItVLFDV SDUD HO
WUDWDPLHQWR GHO GRORU PDVDMHV HQ OD UHJLyQ OXPER VDFUD R GXFKDV WLELDV QR ORJUDQ
GLVPLQXLUORFRQVLGHUDEOHPHQWHVHGHEHUiUHFXUULUDOXVRGHPHGLFDPHQWRV
$QDOJpVLFRV
x0HSHULGLQDPJGLVXHOWRVHQFFGHVROXFLyQVDOLQDHQLQIXVLyQLQWUDYHQRVD
OHQWD
x3RUUHJODJHQHUDOQRGHEHXVDUVHDSDUWLUGHORVFPGHGLODWDFLyQ
x/DGRVLVDGPLQLVWUDGDGHEHVHUODPtQLPDQHFHVDULDSDUDDOLYLDUHOGRORUGHOD
SDUWXULHQWD
x'HEHQSUHIHULUVHDTXHOODVGURJDVTXHWHQJDQDQWtGRWRVFRQWUDVXVHIHFWRV\HVWDU
VHJXURVGHFRQWDUFRQHOORV
/RVHIHFWRVFRODWHUDOHVLQGHVHDEOHVVRQ
x 'HSUHVLyQ GHO 61& GH PDGUH H KLMR LQFOX\HQGR HO FHQWUR UHVSLUDWRULR
6HFXQGDULDPHQWHKLSRYHQWLODFLyQPDWHUQDFRQKLSR[HPLDHKLSHUFDSQLD
x+LSRWRQtDKLSRUUHÀH[LD\DSQHDQHRQDWDO
x'LVPLQXFLyQGHORVPHFDQLVPRVIHWDOHVGHGHIHQVDFRQWUDODKLSR[LD
x,QWHUIHUHQFLDFRQODSDUWLFLSDFLyQDFWLYDGHODPDGUHHQHOSDUWR
x,QWHUIHUHQFLDFRQODUHODFLyQSUHFR]PDGUHKLMR\ODODFWDQFLD
$QHVWHVLDUHJLRQDOHSLGXUDOUDTXtGHD/DDQHVWHVLDUHJLRQDOHVXQSURFHGLPLHQWR

TXHVyORGHEHVHUHIHFWXDGRSRUSHUVRQDOPpGLFRFRQDOWRQLYHOGHHQWUHQDPLHQWR
/RVHIHFWRVFRODWHUDOHVLQGHVHDEOHVVRQ
x+LSRWHQVLyQPDWHUQDFRQUHGXFFLyQGHSHUIXVLyQSODFHQWDULDHKLSR[LDIHWDO
x,QWHUIHUHQFLDFRQODGHDPEXODFLyQPDWHUQDGXUDQWHHOWUDEDMRGHSDUWR
x,QWHUIHUHQFLDFRQHOSXMRPDWHUQRGXUDQWHHOSHUtRGRH[SXOVLYR
x$XPHQWRGHLQWHUYHQFLRQHVREVWpWULFDV
x&HIDOHD
E7UDVWRUQRVGHODFRQWUDFWLOLGDGXWHULQDGLVWRFLDVGLQiPLFDV
(OSURJUHVRGHOSDUWR\HOELHQHVWDUGHPDGUHHKLMRSXHGHQYHUVHDIHFWDGRVSRUORV
WUDVWRUQRV GH OD FRQWUDFWLOLGDG VHDQ pVWRV OD KLSRGLQDPLD R OD KLSHUGLQDPLD$PEDV
UHTXLHUHQFRUUHFFLyQ
+LSRGLQDPLD,QFOX\HODSURYRFDGDSRUODLQFRRUGLQDFLyQXWHULQD
(OPHGLFDPHQWRGHHOHFFLyQHVODRFLWRFLQDVLQWpWLFDTXHDXPHQWDODLQWHQVLGDG\OD
IUHFXHQFLDGHODVFRQWUDFFLRQHV(VXQDGURJDSHOLJURVDFXDQGRVHGHVFRQRFHQVXV
GRVLVVXYtDGHDGPLQLVWUDFLyQRVXFRQWUROGXUDQWHVXXVR
(QFDVRGHHVWLPXODUHO~WHURFRQRFLWRFLQDVHGHEHUHFRUGDUTXHODGRVLVLQLFLDOGHSHQGH
GHOJUDGRGHFRQWUDFWLOLGDGH[LVWHQWH6HUHFRPLHQGDFRPHQ]DUFRQP8PLQSRUYtD
LQWUDYHQRVD
8QDVROXFLyQGH8,GHRFLWRFLQDHQOLWURGHVXHURJOXFRVDGRDOVHFRPHQ]DUi
LQIXQGLHQGR JRWDV SRU PLQXWR PO HQ SRU PLQXWR 6L HQ PLQXWRV QR KXER
FDPELRV GXSOLFDU OD GRVLV /D QHFHVLGDG GH GRVLV PD\RUHV UHTXLHUH XQD H[KDXVWLYD
UHYLVLyQGHOFDVREDMRHVWULFWDYLJLODQFLDPpGLFD/DLQIXVLyQ\SRUHQGHODPDGUH\HO
IHWRQRSRGUiQVHUGHVFXLGDGDV
&DEHUHFRUGDUTXH
x/DUHVSXHVWDLQGLYLGXDOGHODRFLWRFLQDHVYDULDEOHHLPSUHGHFLEOH

x/DHVWLPXODFLyQPLRPHWULDOLQDGHFXDGDSXHGHFDXVDUKLSHUWRQtDKLSRSHUIXVLyQ
~WHURSODFHQWDULDHKLSR[LDIHWDO

x/DKLSHUWRQtDXWHULQDSURYRFDGDSRUODDGPLQLVWUDFLyQLQDGHFXDGDGHRFLWRFLQD
SXHGHFDXVDUURWXUDXWHULQD\RWUDVFRQVHFXHQFLDVJUDYHVFRPRHOVXIULPLHQWR
IHWDODJXGR
x 'HEH GHVFDUWDUVH VXIULPLHQWR IHWDO GHVSURSRUFLyQ IHWRSpOYLFD YLFLRV GH

SUHVHQWDFLyQ(QHOFDVRGHFHViUHDDQWHULRUFLFDWULFHVXWHULQDVRPDOIRUPDFLRQHV
XWHULQDVHOXVRGHODRFLWRFLQDGHEHUiKDFHUVHEDMRHVWULFWDYLJLODQFLD\HQFDVR
GHQRFRQWDUFRQSRVLELOLGDGGHUHVSXHVWDTXLU~UJLFDVHUiSUHIHULEOHGHULYDUDOD
PXMHUDXQQLYHOGHPD\RUFRPSOHMLGDG
+LSHUGLQDPLD(QOD~WHURLQKLELFLyQLQWUDSDUWRGHEHSUHIHULUVHHOXVRGHORVDJHQWHV
EHWDDGUHQpUJLFRVSRU
DPD\RUYHORFLGDGGHLQVWDODFLyQGHVXHIHFWR
EPD\RUSRWHQFLDXWHURLQKLELGRUD
3RUODPHQRULQWHQVLGDGGHORVHIHFWRVVHFXQGDULRVVRQGHHOHFFLyQHOIHQRWHUROROD
ULWRGULQD(QHOFXDGURVHVHxDODQVXVGRVLV\HIHFWRVXWHURLQKLELGRUHVSRULQIXVLyQ
HQGRYHQRVDFRQWLQXD
(IHFWRVVHFXQGDULRVGHORVEHWDDGUHQpUJLFRV
/RV PiV LPSRUWDQWHV VRQ ORV FDUGLRYDVFXODUHV FDUGLRDFHOHUDFLyQ YDVRGLODWDFLyQ H
KLSRWHQVLyQFXDGUR
3URGXFHQ DGHPiV DXPHQWR GH OD OLSyOLVLV \ JOXFyJHQROLVLV QiXVHDV YyPLWRV \

HVFDORIUtRV
&RQWUDLQGLFDFLRQHVSDUDVXXVR
x+LSRWHQVLyQPDWHUQD
x$QWHFHGHQWHVRVLJQRVGHFDUGLRSDWtD
x'LDEHWHVGHGLItFLOFRQWUROPHWDEyOLFR
x+LSHUWLURLGLVPR
0RGRGHDGPLQLVWUDFLyQ&RORFDUDODPDGUHHQGHF~ELWRODWHUDOL]TXLHUGR$MXVWDUOD
YHORFLGDGGHLQIXVLyQGHDFXHUGRFRQHOHIHFWRXWHURLQKLELGRU\ODIUHFXHQFLDFDUGtDFD
PDWHUQD'HEHHYLWDUVHXQDWDTXLFDUGLDVXSHULRUDODWLGRVPLQ
6LODDGPLQLVWUDFLyQGHHVWRVIiUPDFRVQRFRUULJHODKLSHUGLQDPLDHQPLQXWRVGHEH
UHIHULUVHDQLYHOGHDWHQFLyQGHDOWRULHVJR
F3pUGLGDGHELHQHVWDUIHWDOLQWUDSDUWR
(OWUDWDPLHQWRLQ~WHURGHOVXIULPLHQWRIHWDOHVXQSURFHGLPLHQWRSUHYLRDODH[WUDFFLyQ
SRUODYtDPiVUiSLGD
&DPELRGHSRVLFLyQ'HF~ELWRODWHUDOL]TXLHUGR
&RUUHFFLyQGHKLSRWHQVLyQPDWHUQD6LKD\KLSRWHQVLyQPDWHUQDTXHQRPHMRUHFRQ
HOGHF~ELWRODWHUDOL]TXLHUGRUHIHULUODDOQLYHOGHDWHQFLyQGHDOWRULHVJR
7HPSRUDOPHQWHHV~WLOODSRVLFLyQGH7UHQGHOHPEXUJRODHOHYDFLyQGHODVSLHUQDVGH
ODPDGUH
6XVSHQGHURFLWRFLQD6LVHHVWiXVDQGR
8WHURLQKLELFLyQ /DV EDVHV GHO WUDWDPLHQWR FRQ EHWDPLPpWLFRV HVWULEDQ HQ PHMRUDU
OD SHUIXVLyQ XWHURSODFHQWDULD \ OD R[LJHQDFLyQ IHWDO SRU PHGLR GH OD GLVPLQXFLyQ R
VXSUHVLyQGHODVFRQWUDFFLRQHVXWHULQDV
Cuadro 41. Efectos uteroinhibidores y cardiovasculares maternos de algunos agentes betamiméticos

Amplitud Presion
Frecuencia Instalación Duración de
Infusión arterial
de las de las con- de efectos efectos
Fármaco I/V FCM
contrac- tracciones máximos suspendido el
mg/min Sist Diast
ciones (min) fármaco (min)
5LWRGULQH

D
3UHSDU
)HQRWHURO D !

3DUWXVLVWHQ D !

'LVPLQX\H
$XPHQWD
/DUHVSXHVWDLQGLYLGXDOHVPX\YDULDEOH
&RQGXFWD
x GHEHHYDOXDUVHHOSURJUHVRGHOSDUWRSDUDGHFLGLUVLHVSRVLEOHODUHIHUHQFLDD
QLYHOGHDWHQFLyQGHDOWRULHVJRODTXHGHEHHIHFWXDUVHVLHPSUHTXHHOSDUWRQR
VHDLQPLQHQWH
x VLGHEHDWHQGHUVHHOSDUWRHQQLYHOGHEDMRULHVJRHVQHFHVDULRHVWDUSUHSDUDGRV
SDUDODUHDQLPDFLyQQHRQDWDOLQPHGLDWD
$6,67(1&,$ '85$17( (/$/80%5$0,(172 < 326$/80%5$0,(172

7(5&(53(5,2'2
2%-(7,92 'HWHFWDU \ HYDOXDU GHVYLDFLRQHV GH ORV OtPLWHV ¿VLROyJLFRV GHO
DOXPEUDPLHQWR\SRVDOXPEUDPLHQWR

$&7,9,'$' &RQWUROPDWHUQR
([DPHQGHODSODFHQWD
(ODOXPEUDPLHQWRHVHOSHUtRGRTXHVHH[WLHQGHGHVGHODVDOLGDGHOUHFLpQQDFLGRKDVWD
ODH[SXOVLyQGHODSODFHQWD(VXQSHUtRGRGHHOHYDGRULHVJR\DTXHXQDDOWDSURSRUFLyQ
GHODVPXHUWHVPDWHUQDVHVSHFLDOPHQWHODVGHELGDVDKHPRUUDJLDVHGHVHQFDGHQDQ
GXUDQWHHVWHSHUtRGR$XQTXHODSUHYDOHQFLDGHODKHPRUUDJLDSRVWSDUWRHVYDULDEOH
SHUVLVWHFRPRODSULQFLSDOFDXVDGHPXHUWHPDWHUQDHQWRGRHOPXQGR
(QORVSULPHURVPLQXWRVTXHVLJXHQDOQDFLPLHQWRVHSURGXFHQLQWHQVDVFRQWUDFFLRQHVQR
GRORURVDV\VLQPHGLDUQLQJXQDLQWHUYHQFLyQHQODPD\RUtDGHORVFDVRVHODOXPEUDPLHQWR
VHSURGXFLUiHVSRQWiQHDPHQWHHQWUHORV\ORVPLQXWRVTXHVLJXHQDOSDUWRSXGLHQGR
UHWUDVDUVHKDVWDPLQXWRVVLQFRPSRUWDUPD\RUULHVJR
6tQWRPDV\VLJQRVGHOGHVSUHQGLPLHQWRSODFHQWDULR
/DUHDSDULFLyQGHOGRORUGHODVFRQWUDFFLRQHV
/RVFDPELRVGHIRUPDGHO~WHURHOFXDOVHYXHOYHJOREXODUGLVPLQX\HVXWDPDxR
DGRSWDXQDFRQVLVWHQFLD¿UPH\HOIRQGRVHXELFDSRUGHEDMRGHORPEOLJR
/DVDOLGDGHXQYROXPHQPRGHUDGRGHVDQJUHDWUDYpVGHORVJHQLWDOHV
(OFRUGyQSURWUX\HSRUIXHUDGHORVJHQLWDOHV\DOFRPSULPLUHOIRQGRXWHULQRSRU
HODEGRPHQHOFRUGyQQRDVFHQGHUiKDFLDHOLQWHULRUGHO~WHURLQGLFDQGRTXHOD
SODFHQWD VH GHVSUHQGLy WRWDOPHQWH (VWR WDPELpQ VH FRQ¿UPD FXDQGR DO HOHYDU
FRQ XQD PDQR HO IRQGR GHO ~WHUR SRU HO DEGRPHQ QR VH SHUFLEH VHQVDFLyQ R
FDPELRDOJXQRDQLYHOGHODPDQRTXHWUDFFLRQDGHOLFDGDPHQWHGHOFRUGyQVLJQR
GHOSHVFDGRU
(QFRQGLFLRQHVQRUPDOHVXQDYH]TXHODSODFHQWDVDOLyGHO~WHURHOVDQJUDGRGLVPLQX\H
FRQVLGHUDEOHPHQWH
([DPHQGHODSODFHQWD\ODVPHPEUDQDV
8QD YH] TXH OD SODFHQWD KD VDOLGR VH SURFHGHUi D XQ H[DPHQ PLQXFLRVR GH HOOD \
GH ODV PHPEUDQDV 6H UHFRPLHQGD DSR\DU OD SODFHQWD VREUH XQD VXSHU¿FLH SODQD \
REVHUYDUODSULPHURSRUVXFDUDPDWHUQDLGHQWL¿FDQGRVLHVWiQWRGRVORVFRWLOHGRQHV\
VLORVPLVPRVVHHQFXHQWUDQtQWHJURV&XDQGRIDOWHQFRWLOHGRQHVVHDGYHUWLUiXQD]RQD
UXJRVDTXHSXHGHRQRVDQJUDU&XDQGRORTXHIDOWDHVXQIUDJPHQWRGHXQFRWLOHGyQ
VHYHUiXQDVROXFLyQGHFRQWLQXLGDGVDQJUDQWH
(OH[DPHQGHEHFXOPLQDUFRQODH[SORUDFLyQGHODFDUDIHWDOGHODSODFHQWDLQWHQWDQGR
YHUVLODGLVWULEXFLyQYDVFXODU¿QDOL]DHQHOERUGHSODFHQWDULRRVHH[WLHQGHPiVDOOiGHO
PLVPR6LVHDSUHFLDTXHORVYDVRVVHH[WLHQGHQPiVDOOiGHOGLVFRVHSXHGHHVWDUHQ
SUHVHQFLDGHXQFRWLOHGyQDEHUUDQWH(QHVWHFDVRVHGHEHUiFHUWL¿FDUTXHHQODFDUD
PDWHUQDVHHQFXHQWUDHOFRWLOHGyQFRUUHVSRQGLHQWHDHVDGLVWULEXFLyQYDVFXODU
(QHOH[DPHQGHODVPHPEUDQDVVHLQWHQWDUiUHFRQVWUXLUODEROVDDPQLyWLFDD¿QGH
GHVFDUWDUODSRVLELOLGDGGHUHWHQFLyQGHPHPEUDQDV
&RQWUROHVGXUDQWHHODOXPEUDPLHQWR
&XDQGRORVKHFKRVVHVXFHGHQHVSRQWiQHDPHQWHVHGHEHYLJLODU
3UHVLyQ\SXOVRPDWHUQR
3pUGLGDGHVDQJUHSRUJHQLWDOHV
&RORU\JUDGRGHKXPHGDGGHODVPXFRVDV
6LJQRVGHGHVSUHQGLPLHQWRGHODSODFHQWD
6XWXUDGHODHSLVLRWRPtD
&XDQGRVHSURGXFHHODOXPEUDPLHQWR\VHFRQVWDWDODUHWUDFFLyQXWHULQDGHEHUHYLVDUVH
HOFDQDOGHOSDUWRSDUDSHVTXLVDUSRVLEOHVGHVJDUURVGHFXHOORRYDJLQD6LVHHIHFWXyXQD
HSLVLRWRPtDGHEHUHDOL]DUVHODVXWXUD8QDFRQGXFWDVDOXGDEOHFRQVLVWHHQUHDOL]DUOD
HSLVLRUUD¿DPLHQWUDVVHHVSHUDHODOXPEUDPLHQWRHVWRDGHPiVGHGLVPLQXLUHOVDQJUDGR
SHUPLWLUiTXHHOWpFQLFRGLVPLQX\DHOJUDGRGHLQWHUYHQFLRQLVPRLQQHFHVDULRPLHQWUDV
HVSHUD HO DOXPEUDPLHQWR 6L VH RSWD SRU HVSHUDU TXH VH SURGX]FD HO DOXPEUDPLHQWR
DQWHVGHHIHFWXDUODHSLVLRUUD¿DHVUHFRPHQGDEOHDOPHQRVOLJDUORVYDVRVVDQJUDQWHV
GHPD\RUFDOLEUHSDUDGLVPLQXLUODSpUGLGDGHVDQJUH
7pFQLFDGHODVXWXUD
*HQHUDOPHQWHQRHVQHFHVDULRUHLQ¿OWUDUORVWHMLGRVFRQXQDQHVWpVLFRORFDO6HDIURQWDQ
WHMLGRVLJXDOHVGHDPERVODGRVGHODLQFLVLyQHVGHFLUPXFRVDFRQPXFRVDP~VFXOR
FRQP~VFXOR\SLHOFRQSLHOGHOSHULQp6HSURFHGHDODVXWXUDFRPHQ]DQGRSRUHOiQJXOR
VXSHULRU GH OD PXFRVD YDJLQDO FRQ SXQWRV VHSDUDGRV R FRQ VXUMHW D SXQWR SDVDGR
/XHJRVHDIURQWDQORVSODQRVPXVFXODUHV\FHOXODUVXEFXWiQHRHYLWDQGRGHMDUHVSDFLRV
³PXHUWRV´ FRQ SXQWRV VHSDUDGRV GH OD PLVPD VXWXUD XVDGD HQ OD PXFRVD YDJLQDO \
¿QDOPHQWHVHVXWXUDODSLHOFRQSXQWRVVHSDUDGRVRVXUMHWGHODPLVPDVXWXUDHPSOHDGD
SUHYLDPHQWH8QDULJXURVDDQWLVHSVLDGHODUHJLyQGXUDQWHORVGtDVVLJXLHQWHVJDUDQWL]DUi
HOp[LWRGHODVXWXUD
/DDWHQFLyQGHEH¿QDOL]DUFRQDVHRJHQLWDO\FRQWUROGHSUHVLyQDUWHULDOSXOVRUHWUDFFLyQ
XWHULQD\HYDOXDFLyQGHODSpUGLGDKHPiWLFD
3UHYHQFLyQSDUDHYLWDUODUHWHQFLyQGHUHVWRVRYXODUHV
3DUD HYLWDU OD UHWHQFLyQ GH UHVWRV SODFHQWDULRV R PHPEUDQDV GHEH DGRSWDUVH XQD
DFWLWXG H[SHFWDQWH SHUPLWLHQGR TXH ORV IHQyPHQRV GH HVWH SHUtRGR VH GHVDUUROOHQ
HVSRQWiQHDPHQWH$GHPiVGHUHDOL]DUWRGDVODVPDQLREUDVFRQVXDYLGDG
1RWUDFFLRQDUHOFRUGyQQLLQWHQWDUDSUHVXUDUHODOXPEUDPLHQWRPLHQWUDVQRKD\D
VLJQRVGHGHVSUHQGLPLHQWR
8QD YH] FRQVWDWDGR HO GHVSUHQGLPLHQWR GH OD SODFHQWD HIHFWXDU XQD VXDYH \
VRVWHQLGDWUDFFLyQ
$O DVRPDU OD SODFHQWD SRU OD YXOYD VRVWHQHUOD FRQ XQD PDQR SRU GHEDMR GHO
SHULQpHOHYDQGRHO~WHURFRQODRWUD
3XHGH IDFLOLWDUVH HO GHVSUHQGLPLHQWR GH ODV PHPEUDQDV URWDQGR OD SODFHQWD
GHVSUHQGLGDVREUHVXHMH
3URGXFLGR HO DOXPEUDPLHQWR GHEH FRQVWDWDUVH OD IRUPDFLyQ GHO JORER GH
VHJXULGDGGH3LQDUGLQGLFDGRUGHUHWUDFFLyQXWHULQD\H[DPLQDUODSODFHQWD\ODV
PHPEUDQDVFRQVWDWDQGRVXLQWHJULGDG
3UHYHQFLyQGHOD+HPRUUDJLD3RVW3DUWR+33
'HELGR D OD LPSRUWDQWH FDUJD GH HQIHUPHGDG \ PXHUWH TXH UHSUHVHQWD OD +33
HVSHFLDOPHQWH YLQFXODGD D DWRQtD XWHULQD HV TXH VH KDQ GHVDUUROODGR GLIHUHQWHV
HVTXHPDV GH WUDWDPLHQWR SUR¿OiFWLFR TXH LQFOX\HQ GURJDV XWHUR WyQLFDV PDVDMHV \
FRPSUHVLyQXWHULQD
'URJDV~WHURWyQLFDV
/DV GURJDV PiV XVDGDV VRQ OD 2FLWRFLQD OD 0HWLOHUJRQRYLQD HO 0LVRSURVWRO \ PiV
UHFLHQWHPHQWHORVIiUPDFRVDJRQLVWDVGHODRFLWRFLQD&DUEHWRFLQD
/RVHVTXHPDVYDUtDQVHJ~QHOIiUPDFRXVDGRODGRVLVODYtD\HOPRPHQWRHQTXH
VRQDSOLFDGRV
,QPHGLDWDPHQWHGHVSXpVGHODVDOLGDGHOKRPEURDQWHULRUODLQ\HFFLyQGHD
8,GHRFLWRFLQDHQHVWHSHUtRGRKDGHPRVWUDGRTXHGLVPLQX\HHOVDQJUDGR\HO
Q~PHURGHWUDQVIXVLRQHV7LHQHFRPRLQFRQYHQLHQWHTXHDXPHQWDODUHWHQFLyQGH
SODFHQWD\GLVPLQX\HODWUDQVIXVLyQVDQJXtQHDGHVGHODSODFHQWDDOUHFLpQQDFLGR
(VWRFRQOOHYDPD\RUULHVJRGHDQHPLDGHOQLxR
,QPHGLDWDPHQWHGHVSXpVGHOQDFLPLHQWRVHKDQXWLOL]DGRODLQ\HFFLyQGHD
8,GHRFLWRFLQDRDPJGHPHWLOHUJRQRYLQDRHOPLVRSURVWRODPJSRU
YtDRUDORWUDQVUHFWDOPRVWUDQGRDFFLRQHVVLPLODUHV7RGRVHOORVKDQLQFUHPHQWDGR
HOULHVJRGHUHWHQFLyQSODFHQWDULD\DQHPLDGHOUHFLpQQDFLGR/DPHWLOHUJRQRYLQD
SRUVXSDUWHSURYRFDHIHFWRVVHFXQGDULRVFRPRDXPHQWRGHODSUHVLyQDUWHULDO\
YyPLWRV
/XHJRGHODOXPEUDPLHQWRVHKDQXWLOL]DGRODVWUHVGURJDVHQXQFLDGDVDQWHV
HQODVGRVLV\YtDVLQGLFDGDVDORVTXHUHFLHQWHPHQWHVHDJUHJDQORVDJRQLVWDV
RFLWyFLFRVFDUEHWRFLQDTXHKDGHPRVWUDGRVHUPiVSRWHQWHTXHODRFLWRFLQD/D
JUDQYHQWDMDGHXVDUFXDOTXLHUDGHHVWRVDJHQWHVHQHVWHSHUtRGRGHVSXpVGHO
DOXPEUDPLHQWRHVTXHVHHOLPLQDHOULHVJRGHUHWHQFLyQGHSODFHQWD\GHDQHPLD
GHOQLxR
7UDFFLyQGHOFRUGyQ
/DWUDFFLyQ³FRQWURODGD´GHOFRUGyQOXHJRGHOLJDGRKDVLGRXWLOL]DGDVRODPHQWHDVRFLDGD
DOXVRGHRFLWyFLFRV\PDVDMHOXHJRGHODH[SXOVLyQSODFHQWDULD1RH[LVWHQHYLGHQFLDV
TXHHVWDPDQLREUDSRUVtGLVPLQX\DHOULHVJRGHKHPRUUDJLDSRVWSDUWRJUDYH3RUHO
FRQWUDULR VX XVR UXWLQDULR H[SRQH D PD\RU DQHPLD QHRQDWDO FXDQGR VH DVRFLD FRQ
OLJDGXUDSUHFR]HLQYHUVLyQXWHULQD
0DVDMH\FRPSUHVLyQXWHULQD
(OPDVDMH\ODDFFLyQGHFRPSULPLUHOFXHUSRXWHULQRDWUDYpVGHODSDUHGDEGRPLQDO
HVWLPXODQODFRQWUDFWLOLGDGXWHULQD\ODIRUPDFLyQGHOJORERGHVHJXULGDGGH3LQDUGSDUD
UHGXFLUODKHPRUUDJLDSRVWSDUWR
$OXPEUDPLHQWR
1R 6L
(VSRQWiQHR
!PLQy
+HPRUUDJLD
2FLWyFLFR3URILOiFWLFR
0DVDMH8WHULQR\2FLWRFLQD
5HYLVLyQ
6L &DQDO
$OXPEUDPLHQWR %ODQGR
6XWXUD
1R
6L3URFHGH
$VHR
+HPRUUDJLD *HQLWDO
LPSRUWDQWH
([WUDFFLyQ0DQXDOGH &RQWUROHV3RVW
ODSODFHQWD,QPHGLDWD DOXPEUDPLHQWR
)LJXUD(VTXHPDHVFDORQDGRGHFRQGXFWDV\GHFLVLRQHVHQHODOXPEUDPLHQWR
3RVWDOXPEUDPLHQWR
(OSHUtRGRGHSRVDOXPEUDPLHQWRFRPSUHQGHODVKRUDVVLJXLHQWHVDOSDUWR'HQWURGH
HVWDVSULPHUDVKRUDVODPXMHUHVWiH[SXHVWDDPD\RUULHVJRGHKHPRUUDJLD\VKRFN
7DPELpQHOUHFLpQQDFLGRSXHGHWHQHUKHPRUUDJLDDQWHXQGHVSLQ]DGRLQDGYHUWLGRGH
VX FRUGyQ 3RU HVWDV UD]RQHV HV UHFRPHQGDEOH TXH GXUDQWH HVWDV GRV SULPHUDV OD
PXMHU\VXKLMRSHUPDQH]FDQHQXQVHFWRUHQHOTXHVHOHVJDUDQWLFHVXSHUYLVLyQGH
HQIHUPHUtD
3RUHOORVHUHFRPLHQGDTXHODSDUWXULHQWDHVWpDFRPSDxDGDHQWRGRPRPHQWRSRUXQ
IDPLOLDUGXUDQWHODVSULPHUDVKRUDVTXHVLJXHQDODVDOLGDGHODVDODGHSDUWRV\TXH
SRUORPHQRVFDGDPLQXWRVHOHTXLSRVDQLWDULRYLJLOHORVVLJXLHQWHVDVSHFWRV
3UHVLyQDUWHULDO\SXOVRPDWHUQR
*UDGRGHUHWUDFFLyQXWHULQD
*ORERGHVHJXULGDGGH3LQDUG
6DQJUDGRJHQLWDO
6L FRPSOHWDGR HVWH SHUtRGR GH REVHUYDFLyQ WRGR HV QRUPDO OD SXpUSHUD \ VX QLxR
SRGUiQSDVDUDXQVHFWRUWUDGLFLRQDOGHDORMDPLHQWRFRQMXQWRHQHOTXHORVFRQWUROHV
VRQPHQRVIUHFXHQWHV
$FRQWLQXDFLyQVHUHVXPHHQXQHVTXHPDHVFDORQDGRGHGHFLVLRQHVODVFRQGXFWDVD
WRPDUGXUDQWHHODOXPEUDPLHQWRVHJ~QODHYROXFLyQGHOFDVR
3RVWDOXPEUDPLHQWR
6L 1R
+HPRUUDJLD
1R
$WRQtD
6L
2FLWyFLFRV 5HYLVLyQGHO&DQDO%ODQGR
6L
7UDWDPLHQWR
HILFD]
1R 1R
'HVJDUURV
6L
6XWXUD
1R &HVD
VDQJUDGR
6L
5HIHUHQFLDDO1LYHOGH$OWR5LHVJR &RPSOHWDU+RUDVGH&RQWURO
)LJXUD(VTXHPDGHGHFLVLRQHVFRUUHVSRQGLHQWHDOSRVWDOXPEUDPLHQWR
$OWHUDFLRQHVGHODOXPEUDPLHQWR
5HWHQFLyQGHSODFHQWD
+HPRUUDJLDSRVWSDUWR
5HWHQFLyQ GH SODFHQWD 6L OXHJR GH HVSHUDU PLQXWRV HQ DXVHQFLD GH
KHPRUUDJLD QR VH SURGXFH HO DOXPEUDPLHQWR VH GHEH PDVDMHDU HO ~WHUR 6L OD
UHWHQFLyQ SHUVLVWH VH DGPLQLVWUDQ XQLGDGHV LQWHUQDFLRQDOHV 8, GH RFLWRFLQD
LPRLY6LHVWDVPDQLREUDVVRQLQHIHFWLYDVVHGHEHSURFHGHUDODH[WUDFFLyQ
PDQXDOGHODSODFHQWD
/DUHWHQFLyQGHSODFHQWDSXHGHVHUWRWDORSDUFLDO
7RWDOHVFXDQGRODWRWDOLGDGGHODSODFHQWDSHUVLVWHDGKHULGDDO~WHURHVWRSXHGHVHU
SURGXFWRGHXQDFRQWUDFWLOLGDGXWHULQDLQH¿FD]DWRQtDRGHEHUVHDXQDDGKHVLYLGDG
DQRUPDOGHODSODFHQWDDO~WHURDFUHWLVPR
3DUFLDO HV FXDQGR TXHGDQ UHWHQLGRV XQR R PiV FRWLOHGRQHV SODFHQWDULRV VL ELHQ OD
UHWHQFLyQGHFRWLOHGRQHVSXHGHGHEHUVHDODVPLVPDVFDXVDVTXHJHQHUDQODUHWHQFLyQ
WRWDO GH OD SODFHQWD HQ HVWH FDVR HV PiV FRP~Q TXH VH SURGX]FD SRU PDQLREUDV
LQDGHFXDGDVGXUDQWHHODOXPEUDPLHQWR
7pFQLFDSDUDHODOXPEUDPLHQWRPDQXDO
/DH[WUDFFLyQPDQXDOGHEHHIHFWXDUVHFRQDQHVWHVLDJHQHUDOHQSODQRTXLU~UJLFR6LQR
KD\KHPRUUDJLD\ODUHIHUHQFLDDQLYHOGHDOWRULHVJRHVIiFLO\UiSLGDGHEHUHIHULUVHFRQ
YHQRFOLVLV LQIXQGLHQGR VROXFLyQ ¿VLROyJLFD DGLFLRQDGD GH 8, GH RFLWRFLQD SRU FDGD
P,GHVROXFLyQ1RHPSOHDUPHWLOHUJRQRYLQDSRUTXHSXHGHDJUDYDUODUHWHQFLyQGH
ODSODFHQWD
6XMHWDUHOIRQGRXWHULQRFRQXQDPDQR
,QWURGXFLUODPDQRPiVKiELOHQODYDJLQD\HQHO~WHURKDVWDDOFDQ]DUHOERUGH
SODFHQWDULR
'HVOL]DU ORV GHGRV HQWUH OD SODFHQWD \ ODV SDUHGHV GHVJDUUDQGR ODV
DGKHUHQFLDV
8QDYH]OLEHUDGDFRPSOHWDPHQWHUHWLUDUODPDQRFRQODSODFHQWD
$GPLQLVWUDU8,GHRFLWRFLQDHQGRYHQRVDOHQWDGLOXLUHQPO
)LJXUD7pFQLFDGHDOXPEUDPLHQWRPDQXDO
/DPDQLREUDHVKDELWXDOPHQWHH¿FD]
/D LPSRVLELOLGDG GH GHVSUHQGHU OD SODFHQWD SXHGH GHEHUVH D DFUHWLVPR SODFHQWDULR
(OIUDFDVRREOLJDDODLQPHGLDWDUHIHUHQFLDGHODSXpUSHUDDXQQLYHOFRQSRVLELOLGDGGH
HIHFWXDUFLUXJtD
/DWUDFFLyQH[DJHUDGDPHQWH¿UPHVREUHHOFRUGyQ\ODFRPSUHVLyQJURVHUDGHOIRQGR
XWHULQRSXHGHQGHVHQFDGHQDUGRORULQWHQVRURWXUDGHFRUGyQUHWHQFLyQGHUHVWRVGH
SODFHQWDRLQYHUVLyQXWHULQD
5HYLVLyQLQWUDXWHULQD
1RGHEHVHUXVDGDGHUXWLQDGHELGRDTXHHOULHVJRGHLQIHFFLyQHVPD\RUDOEHQH¿FLR
TXHRIUHFH
6LH[LVWHVRVSHFKDGHUHWHQFLyQGHUHVWRVGHSODFHQWDUHWHQFLyQSDUFLDOVHKDUiXQ

WDFWRLQWUDXWHULQR\GHVHUSRVLEOHVHH[WUDHUiQORVUHVWRVPDQXDOPHQWH$PHQRVTXH
VH WHQJD FHUWH]D GH XQD HYDFXDFLyQ FRPSOHWD VHUi DFRQVHMDEOH UHDOL]DU XQ OHJUDGR
UDVSDGRFRQFXUHWDURPDGH3LQDUG
6LKD\UHWHQFLyQGHPHPEUDQDVODVPLVPDVVHSXHGHQSLQ]DUFRQXQDSLQ]DGH.RFKHU
ODUJD\HQVD\DUVXH[WUDFFLyQPHGLDQWHWRUVLyQ\WUDFFLyQOHQWD\¿UPH
+HPRUUDJLD3RVW3DUWR
(OYROXPHQGHVDQJUHTXHVHSLHUGH¿VLROyJLFDPHQWHHQHVWHSHUtRGRWUDVXQSDUWRQR
VXHOHDOFDQ]DUORVPO\OXHJRGHXQDFHViUHDGHEHVHUPHQRUGHPO&XDQGR
HOVDQJUDGRVXSHUDHVRVYRO~PHQHVVHFRQVLGHUDTXHVHHVWiIUHQWHDXQDKHPRUUDJLD
SRVWSDUWR+33
&ODVL¿FDFLyQ
/DV+33VHVXHOHQFODVL¿FDUVHJ~QHOSHUtRGRGHWLHPSRGHVXDSDULFLyQHQ
+33SULPDULDFXDQGRDSDUHFHHQODVSULPHUDVKRUDVTXHVLJXHQDOSDUWR
+33VHFXQGDULDRWDUGtDFXDQGRVHSURGXFHHQWUHODVKRUDV\ORVGtDV
(VWD FODVL¿FDFLyQ HV LPSRUWDQWH GHELGR D TXH VH VXHOH YLQFXODU FRQ OD FDXVD TXH OD
SURGXFH 0LHQWUDV ODV +33 SULPDULDV VXHOHQ VHU SURGXFLGDV SRU DWRQtD XWHULQD ODV
VHFXQGDULDVHVWiQPiVUHODFLRQDGDVDODUHWHQFLyQGHUHVWRVRYXODUHV
)DFWRUHVGHULHVJRGHKHPRUUDJLDSRVWSDUWR
$XQTXH OD +33 HV LPSUHGHFLEOH H[LVWHQ IDFWRUHV GH ULHVJR TXH MXVWL¿FDQ DQWLFLSDU
PHGLGDV GH VHJXULGDG WDOHV FRPR DVHJXUDU TXH HO SDUWR VH UHDOLFH HQ XQ QLYHO TXH
FXHQWHFRQVDQJUHVHJXUD\GLVSRQLELOLGDGTXLU~UJLFDRHQHOSHRUGHORVFDVRVWHQHU
DVHJXUDGDVODVFRQGLFLRQHVSDUDXQWUDVODGRLQPHGLDWR
6RQIDFWRUHVGHULHVJRSDUDXQD+33
YLQFXODGRVDODSDULGDGSULPLJUDYLGH]\JUDQPXOWLSDULGDG
FDXVDVTXHGLVWLHQGHQHO~WHURPDFURVRPtDSROLKLGUDPQLRVHPEDUD]RP~OWLSOH
SDUWRSURORQJDGR\RLQGXFLGR
KHPRUUDJLDDQWHSDUWR
+33HQHPEDUD]RSUHYLR
WUDVWRUQRVGHODFRDJXODFLyQ
SDUWRRSHUDWRULRIyUFHSVYDFXXP
FHViUHDSUHYLD
REHVLGDG
LQIHFFLyQRYXODU
PLRPDWRVLV
&DXVDVGHODKHPRUUDJLDSRVWSDUWR
/DVFDXVDVGH+33VHSXHGHQUHVXPLUHQJUXSRVSULQFLSDOHV
7UDVWRUQRVGHOWRQRDWRQtDRKLSRWRQtDGHELGRVDIDFWRUHVTXHVREUHGLVWLHQGHQHO
~WHURRTXHDJRWDQOD¿EUDPXVFXODUXWHULQD6XHOHQVHUODFDXVDPiVIUHFXHQWH
IUHFXHQFLDHQWUH\GHWRGDVODV+33
5HWHQFLyQ GH UHVWRV RYXODUHV SODFHQWD R FRWLOHGRQHV GHELGR D LDWURJHQLD SRU
WUDFFLyQSRUDQRPDOtDVHQODSODFHQWDFLyQSODFHQWDFRQDOJ~QJUDGRGHDFUHWLVPR
SODFHQWDSUHYLDRGHFDXVDGHVFRQRFLGD/DUHWHQFLyQGHSODFHQWDH[SOLFDHQWUHXQ
\XQGHODV+33
7UDXPiWLFDVSRUGHVJDUURVFHUYLFDOHV\RYDJLQDOHVURWXUDRLQYHUVLyQXWHULQD
7UDVWRUQRVGHODFRDJXODFLyQGHELGRVDFRDJXORSDWtDV+(//3LQIHFFLRQHVRDO
XVRGHDQWLFRDJXODQWHV
&RQGXFWD
,QGHSHQGLHQWHPHQWH TXH OD GH¿QLFLyQ GH +33 VH VLW~D HQ YRO~PHQHV LJXDOHV R
PD\RUHVDP/ODUHSHUFXVLyQTXHRFDVLRQDHOVDQJUDGRVHUHODFLRQDFRQHOQLYHO
GHKHPRJORELQDSUHYLRGHODPDGUH8QDPXMHUFRQDQHPLDSUHYLDWROHUDUiSHRUXQD
KHPRUUDJLDGHLJXDOYROXPHQTXHRWUDPXMHUFRQQLYHOHVDGHFXDGRVGHKHPRJORELQD
3RUORWDQWRHQXQDUHJLyQGRQGHODDQHPLDFUyQLFDDIHFWDDPiVGHODWHUFHUDSDUWH
GH ODV SDUWXULHQWDV HO WUDWDPLHQWR GH OD +33 FRPLHQ]D HQ HO SUHFRQFHSFLRQDO \ HO
SUHQDWDOLQWHQWDQGRFRQVHJXLUTXHODVPXMHUHVOOHJXHQDOSDUWRFRQQLYHOHVQRUPDOHV
GHKHPRJORELQD
$QWHFXDOTXLHUKHPRUUDJLDSRVWSDUWR
3LGDFRODERUDFLyQDOUHVWRGHOSHUVRQDOGHOVHUYLFLRHQHOTXHXVWHGVHHQFXHQWUD
DVLVWLHQGRHOSDUWR
$VHJ~UHVHGHFRQVHJXLUXQDYtDYHQRVDSHULIpULFDGHEXHQFDOLEUHDJXMD1R
GHPD\RUFDOLEUH
&RPLHQFH UHSRVLFLyQ FRQ VROXFLyQ VDOLQD R GH ODFWDWR 5LQJHU D DOWD YHORFLGDG
/DYHORFLGDGGHSHUIXVLyQGHODVROXFLyQGHSHQGHUiGHVLVHGHWHFWDQVLJQRVGH
VKRFN
(QFDVRTXHHO~WHURVHHQFXHQWUHVXELQYROXFLRQDGRSRUHQFLPDGHORPEOLJR\
FRQFRQVLVWHQFLDEODQGDPDVDMpHORWDQWRFRPRVHDQHFHVDULRSDUDHYDFXDUOD
VDQJUH\FRiJXORV\FRQVHJXLUXQDPHMRUFRQWUDFWLOLGDG
$QWHXQVDQJUDGRSRUDWRQtDVLFRQ¿UPDTXHODKHPRUUDJLDHVSRUDWRQtDXWHULQD
&RQWLQ~HFRQHOPDVDMHGHOIRQGRXWHULQR
$GPLQLVWUH8,GHRFLWRFLQD\XQDDPSROODGHPHWLOHUJRQRYLQDPJLYVHJXLGD
GH 8, GH RFLWRFLQD GLVXHOWDV HQ P, GH VROXFLyQ ¿VLROyJLFD D UD]yQ GH
JRWDV PLQXWR 2WUD RSFLyQ HV XVDU PHWLOHUJRQRYLQD DPSROODV GH PJ
WRWDOPJGLVXHOWDVHQPOGHVROXFLyQ¿VLROyJLFDDJRWDVPLQXWR
6L QR VH UHVXHOYH OD KHPRUUDJLD OD VLWXDFLyQ FOtQLFD HV JUDYH \ VH FXHQWD FRQ
SRVLELOLGDGHVTXLU~UJLFDVHIHFW~HKLVWHUHFWRPtDWRWDORVXEWRWDOGHFRQYHQLHQFLD
6L QR FXHQWD FRQ FLUXJtD FRQWLQ~H OD UHSRVLFLyQ FRQ ODV VROXFLRQHV GHVFULSWDV \
FRQFHQWUDGRVGHJOyEXORVURMRVRVDQJUHWRWDO\UH¿HUDDXQFHQWURGHPD\RUQLYHO
GHUHVROXFLyQ
(IHFW~HHOWUDVODGRFRQORVPLHPEURVHOHYDGRV\HIHFWXDQGRFRPSUHVLyQELPDQXDO
GHO~WHUR/DFRPSUHVLyQELPDQXDOVHKDFHFRQJXDQWHVHVWpULOHVHOSXxRGHXQD
PDQRVHFRORFDHQODYDJLQDSUHVLRQDQGRODFDUDDQWHULRUGHO~WHURPLHQWUDVTXHOD
RWUDPDQRFRPSULPHDWUDYpVGHODEGRPHQODFDUDSRVWHULRUGHO~WHUR
)LJXUD&RPSUHVLyQELPDQXDOGHO~WHUR
$QWHXQVDQJUDGRSRUUHVWRVSODFHQWDULRVVLVHFRQ¿UPDTXHHOVDQJUDGRVHRULJLQD
HQODUHWHQFLyQGHUHVWRVSODFHQWDULRVSODFHQWDFRQIDOWDGHFRWLOHGRQHVSURFHGDD
HYDFXDUORVFRQFXUHWDGH3LQDUGH[SOLFDQGRDODPXMHUHOSURFHGLPLHQWR\HPSOHDQGR
DQDOJpVLFRVRDQHVWpVLFRV
6LTXHGDUDQGXGDVVREUHODSHUVLVWHQFLDGHUHVWRVVHSXHGHHIHFWXDUXQDH[SORUDFLyQ
HQGRXWHULQDFXLGDQGRHVWULFWDPHQWHODVPHGLGDVGHDVHSVLD\DQWLVHSVLD
(QRFDVLRQHVSRFRIUHFXHQWHVSXHGHRFXUULUTXHODSODFHQWDRDOJXQRGHVXVIUDJPHQWRV
FRWLOHGRQHVVHDQGLItFLOHVGHVHSDUDUGHO~WHURHVWRVHGHQRPLQDDFUHWLVPRSODFHQWDULR
(QHVWRVFDVRVFRQYHQGUiGHULYDUODPXMHUDXQQLYHOGHPD\RUFRPSOHMLGDG\DTXH
HVWRVSURFHGLPLHQWRVSXHGHQFRPSOLFDUVHFRQSHUIRUDFLyQXWHULQDKHPRUUDJLDVHYHUD
RUHTXHULUKLVWHUHFWRPtD
$QWH GHVJDUURV 6L HO ~WHUR HVWi UHWUDtGR \ FRQWLQ~D HO VDQJUDGR UHYLVDU HO FDQDO
EODQGR6LKD\GHVJDUURVVXWXUDUORVDSOLFDQGRSUHYLDPHQWHDQHVWpVLFRVORFDOHV6LQR
ORVKD\RVLIUDFDVDQODVPDQLREUDVUHIHULUODPDGUHDQLYHOGHDWHQFLyQGHDOWRULHVJR
DVHJXUDQGRODUHSRVLFLyQGHVDQJUHRVROXFLRQHVVDOLQDVVLHVQHFHVDULR
$QWH XQD LQYHUVLyQ XWHULQD (Q FDVRV H[FHSFLRQDOHV JHQHUDOPHQWH YLQFXODGRV D

PDQLREUDVFRPRWUDFFLyQYLROHQWDGHOFRUGyQSXHGHSURGXFLUVHXQDLQYHUVLyQXWHULQD
(QHVWRVFDVRVGHEHUiDGPLQLVWUDUVHXQDQDOJpVLFRSRWHQWH0HSHULGLQDDPSROODGH
PJGLOXLGDHQFPGHVROXFLyQVDOLQDLQ\HFWDQGROHQWDPHQWHGHDFPSUREDQGR
WROHUDQFLD6LVHFXHQWDFRQDQHVWHVLVWDHOSURFHGLPLHQWRGHEHUiVHUSUDFWLFDGRFRQ
DQHVWHVLDJHQHUDO
1RXVHPHGLFDFLyQRFLWyFLFDSRUTXHSXHGHDJUDYDUODVLWXDFLyQ
&RQPDQLREUDVPDQXDOHVWDOFRPRVHUHSUHVHQWDHQOD¿JXUDLQWHQWHUHSRQHUHO
IRQGRXWHULQRDVXOXJDU
)LJXUD&RUUHFFLyQGHODLQYHUVLyQXWHULQD
&XLGDGRVGHOSRVSDUWRLQPHGLDWR
$ORMDPLHQWRFRQMXQWRODVHSDUDFLyQLQMXVWL¿FDGDGHODPDGUH\VXUHFLpQQDFLGROXHJR
GHO SDUWR \ OD LQWHUIHUHQFLD FRQ HO DPDPDQWDPLHQWR D GHPDQGD GHVGH ODV SULPHUDV
KRUDVGHYLGDVRQSUiFWLFDVHUUyQHDVIUHFXHQWHVHQODVLQVWLWXFLRQHV\TXHGHEHQVHU
GHVHVWLPXODGDV
3RUHOFRQWUDULR&/$3605UHFRPLHQGDHVWLPXODUHQHVWHSHUtRGRHOFRQWDFWRSUHFR]
HQWUHPDGUHHKLMR\DSR\DUDOLQLFLRGHODPDPDQWDPLHQWRHQODSULPHUDKRUDSRVWSDUWR
/D UHODFLyQ HQWUH OD PDGUH \ VX UHFLpQ QDFLGR HV XQ FRPSOHMR SURFHVR ELROyJLFR \
SVLFRDIHFWLYRFX\DLPSRUWDQFLDHVHVHQFLDOHQODVREUHYLGDGHOQLxR\HOELHQHVWDUGH
DPERV(VWHLQLFLRGHUHODFLyQHVWiHQODEDVHGHOGHVDUUROOR\ODSURPRFLyQGHVXVDOXG
PHQWDO
/RV HVWXGLRV TXH DYDODQ HVWH FRQFHSWR GH FXLGDGR SVLFRDIHFWLYR KDQ HYDOXDGR ODV
FRQVHFXHQFLDV GH OD VHSDUDFLyQ LQMXVWL¿FDGD HQ OD GLVPLQXFLyQ GH OD GXUDFLyQ GH OD
ODFWDQFLDHQHOLQFUHPHQWRGHFRPSRUWDPLHQWRVPDWHUQRVQHJDWLYRVTXHDEDUFDQORV
H[WUHPRVGHOPDOWUDWRLQIDQWLO\HODEDQGRQR
/DVLQVWLWXFLRQHVTXHQRVHSDUDQDODVPDGUHVGHVXVKLMRVUHFLpQQDFLGRVKDQFUHDGR
VDODVGHLQWHUQDFLyQGRQGHDPERVSHUPDQHFHQMXQWRVWRGRHOGtD\UHFLEHQFXLGDGRV
GHHQIHUPHUtDHQIRUPDFRQMXQWDSHUPLWLHQGRTXHODVIDPLOLDVWDPELpQSDUWLFLSHQHQ
VXVFXLGDGRV\DSURYHFKDQGRHOSHUtRGRGHLQWHUQDFLyQSDUDDFWLYLGDGHVGHHGXFDFLyQ
SDUDODVDOXG(VWDVVDODVVHOODPDQKDELWXDOPHQWH³DORMDPLHQWRVFRQMXQWRV´TXHKDVWD
HOGtDGHKR\QRVHKDQXQLYHUVDOL]DGRHQOD5HJLyQ
%XVFDQGR PHMRUDU OD FDOLGDG GH DWHQFLyQ \ FRQ OD LQWHQFLyQ GH FRQVHJXLU PHMRUHV
UHVXOWDGRVDFRQWLQXDFLyQVHSUHVHQWDQODVGLYHUVDVSUiFWLFDVXVDGDVHQODDWHQFLyQ
GHOSDUWRVHJ~QFXDWURFDWHJRUtDV
(QHVWDVFDWHJRUtDVVHDJUXSDQODVSUiFWLFDVGHPRVWUDGDPHQWH~WLOHV\TXHGHEHQVHU
HVWLPXODGRVKDVWDDTXHOODVLQQHFHVDULDVRTXHSURYRFDQULHVJRV
&DWHJRUtD$
3UiFWLFDVTXHVHKDQGHPRVWUDGR~WLOHV\TXHGHEHQVHUHVWLPXODGDV
8QSODQSHUVRQDOKHFKRFRQODPXMHU\VXIDPLOLDGXUDQWHHOHPEDUD]RHQHOTXHVH
GHWHUPLQHTXLpQHIHFWXDUiHOSDUWR\GyQGH
(YDOXDFLyQGHOULHVJRGXUDQWHHOFXLGDGRSUHQDWDOUHHYDOXiQGRORHQFDGDFRQWUROHQ
HOPRPHQWRGHODSULPHUDDWHQFLyQGXUDQWHHOSDUWR\DWUDYpVGHOPLVPR
&RQWURODUHOELHQHVWDUWDQWRItVLFRFRPRHPRFLRQDOGHODPXMHUGXUDQWHHOSDUWR\DO
¿QDOL]DUHOSURFHVRGHOQDFLPLHQWR
2IUHFHUOtTXLGRVGXUDQWHHOWUDEDMRGHSDUWR
5HVSHWDUODHOHFFLyQLQIRUPDGDGHODPXMHUVREUHHOOXJDUGHOQDFLPLHQWR
3URYHHU XQ FXLGDGR GXUDQWH HO WUDEDMR GH SDUWR HQ HO QLYHO PiV SHULIpULFR GRQGH HO
SDUWRVHDSRVLEOH\VHJXUR\GRQGHODPXMHUVHVLHQWDVHJXUD\FRQ¿DGD
5HVSHWDUHOGHUHFKRGHODPXMHUDODSULYDFLGDGHQHOOXJDUGHOSDUWR
%ULQGDUDSR\RHPSiWLFRGXUDQWHHOSDUWR\QDFLPLHQWR
5HVSHWDUODHOHFFLyQGHODPXMHUVREUHTXLpQODDFRPSDxDUiHQHOSDUWR
'DUDODVPXMHUHVWDQWDVH[SOLFDFLRQHVHLQIRUPDFLyQFRPRHOODVGHVHHQ
8WLOL]DUPpWRGRVGHDOLYLRGHOGRORUGXUDQWHHOSDUWRQRLQYDVLYRV\QRIDUPDFROyJLFRV
WDOHVFRPRPDVDMHV\WpFQLFDVGHUHODMDFLyQ
0RQLWRUHRIHWDOSRUDXVFXOWDFLyQLQWHUPLWHQWH
8VR ~QLFR GH PDWHULDO GHVHFKDEOH \ HVWHULOL]DFLyQ DSURSLDGD GH ORV PDWHULDOHV
UHXWLOL]DEOHVGXUDQWHHOSDUWR
8VR GH JXDQWHV HQ HO H[DPHQ YDJLQDO HQ HO PDQHMR GHO UHFLpQ QDFLGR \ HQ OD
PDQLSXODFLyQGHODSODFHQWD
/LEHUWDGGHPRYLPLHQWRSDUDODPXMHU\DGRSFLyQGHODSRVWXUDTXHSUH¿HUDGXUDQWH
HOSDUWR
$OHQWDUODSRVLFLyQQRVXSLQDGXUDQWHHOSDUWR
(YDOXDFLyQFXLGDGRVDGHOSURJUHVRGHOSDUWRSRUHMHPSORXWLOL]DQGRHOSDUWRJUDPD
$GPLQLVWUDFLyQGHRFLWRFLQDSUR¿OiFWLFDHQHOWHUFHUSHUtRGRGHOSDUWRHQPXMHUHVFRQ
ULHVJRGHKHPRUUDJLDSRVSDUWRRTXHKD\DQVXIULGRXQDSHTXHxDSpUGLGD
(VWHULOLGDGHQHOFRUWHGHOFRUGyQXPELOLFDO
3UHYHQLUODKLSRWHUPLDGHOUHFLpQQDFLGR
3UHYHQFLyQGHODKHPRUUDJLDQHRQDWDOFRQHOXVRGHYLW.
3UHYHQFLyQGHODRIWDOPLDJRQRFyFFLFDFRQHOXVRGHQLWUDWRGHSODWDRDQWLELyWLFR
&RQWDFWR SUHFR] SLHO D SLHO HQWUH OD PDGUH \ VX UHFLpQ QDFLGR$SR\DU OD SXHVWD DO
SHFKR GXUDQWH OD SULPHUD KRUD SRVSDUWR GH DFXHUGR D ODV UHFRPHQGDFLRQHV GH OD
206SDUDDOLPHQWDFLyQDOSHFKR
$ORMDPLHQWRFRQMXQWR
6XSULPLUODODFWDQFLDHQPDGUHV9,+SRVLWLYDV
([DPHQUXWLQDULRGHODSODFHQWD\PHPEUDQDV
&DWHJRUtD%
3UiFWLFDVTXHVRQFODUDPHQWHGDxLQDVRLQHIHFWLYDV\TXHGHEHQVHUHOLPLQDGDV
8VRUXWLQDULRGHHQHPDV
8VRUXWLQDULRGHOUDVXUDGRS~ELFR
8VRUXWLQDULRGHODVLQIXVLRQHVHQGRYHQRVDVGXUDQWHHOSDUWR
8VRUXWLQDULRGHXQDFiQXODHQGRYHQRVDSUR¿OiFWLFD
8VRUXWLQDULRGHODSRVLFLyQVXSLQDGXUDQWHHOWUDEDMRGHSDUWR
([DPHQUHFWDO
([iPHQHV YDJLQDOHV UHSHWLGRV R IUHFXHQWHV HVSHFLDOPHQWH FXDQGR VRQ UHDOL]DGRV
SRUPiVGHXQDSHUVRQD
8VRGHODSHOYLPHWUtDUDGLROyJLFD
$GPLQLVWUDFLyQGHRFLWyFLFRVHQFXDOTXLHUPRPHQWRDQWHVGHOH[SXOVLYRGHPRGRWDO
TXHVXVHIHFWRVQRSXHGDQVHUFRQWURODGRV
8VR UXWLQDULR GH OD SRVLFLyQ GH OLWRWRPtD FRQ R VLQ ³FROJDU´ ODV SLHUQDV GXUDQWH HO
SDUWR
3XMRVSURORQJDGRVPDQLREUDGH9DOVDOYDGXUDQWHHOVHJXQGRSHUtRGRGHOSDUWR
0DVDMHDU\HVWLUDUHOSHULQHRGXUDQWHHOVHJXQGRSHUtRGRGHSDUWR
8VROLEHUDORUXWLQDULRGHODHSLVLRWRPtD
8VRGHSDVWLOODVGHHUJRPHWULQDHQHOWHUFHUSHUtRGRGHOSDUWRSDUDSUHYHQLURFRQWURODU
XQDKHPRUUDJLD
8VRUXWLQDULRGHHUJRPHWULQDSDUHQWHUDOHQHOWHUFHUSHUtRGRGHOSDUWR
/DYDGRUXWLQDULRGHO~WHURGHVSXpVGHOH[SXOVLYR
5HYLVLyQUXWLQDULDH[SORUDFLyQPDQXDOGHO~WHURGHVSXpVGHOH[SXOVLYR
0DQLREUD GH .ULVWHOOHU R VLPLODU FRQ IXHU]D LQDGHFXDGD DSOLFDGD DO IRQGR XWHULQR
GXUDQWHHOH[SXOVLYR
3UiFWLFDOLEHUDOGHFHViUHD
$VSLUDFLyQQDVRIDUtQJHDGHUXWLQDHQHOUHFLpQQDFLGRQRUPDO
0DQWHQLPLHQWRDUWL¿FLDOGHDLUHIUtRDVDODGHSDUWRDQWHV\GXUDQWHHOQDFLPLHQWR
&ODPSHRSUHFR]GHOFRUGyQGHUXWLQD
&DWHJRUtD&
3UiFWLFDV SDUD ODV TXH H[LVWH HYLGHQFLDV LQVX¿FLHQWHV FRPR SDUD HPLWLU XQD
UHFRPHQGDFLyQ GH¿QLWLYD \ TXH GHEHQ VHU XWLOL]DGDV FRQ SUHFDXFLyQ PLHQWUDV
LQYHVWLJDFLRQHVIXWXUDVFODUL¿FDQVXXVR
0pWRGRVQRIDUPDFROyJLFRVGHDOLYLRGHOGRORUGXUDQWHHOSDUWRWDOHVFRPRKLHUEDV
LQPHUVLyQHQDJXD\HVWLPXODFLyQQHUYLRVD
$PQLRWRPtDSUHFR]UXWLQDULDHQHOSULPHUSHUtRGRGHOSDUWR
0DQLREUDVUHODFLRQDGDVFRQODSURWHFFLyQGHOSHULQHR\HOPDQHMRGHODFDEH]DIHWDO
HQHOPRPHQWRGHOSDUWR
0DQLSXODFLyQDFWLYDGHOIHWRHQHOH[SXOVLYR
2FLWRFLQDUXWLQDULDWUDFFLyQFRQWURODGDGHOFRUGyQRXQDFRPELQDFLyQGHODVPLVPDV
GXUDQWHHOWHUFHUSHUtRGRGHOSDUWR
(VWLPXODFLyQ GHO SH]yQ SDUD DXPHQWDU ODV FRQWUDFFLRQHV XWHULQDV GXUDQWH HO WHUFHU
SHUtRGRGHOSDUWR
&DWHJRUtD'
3UiFWLFDVTXHVHXWLOL]DQIUHFXHQWHPHQWHHQIRUPDLQDSURSLDGD
5HVWULFFLyQGHDOLPHQWRV\OtTXLGRVGXUDQWHHOSDUWR
&RQWUROGHOGRORUSRUDJHQWHVVLVWpPLFRV
&RQWUROGHOGRORUSRUDQDOJHVLDSHULGXUDO
0RQLWRUHRIHWDOHOHFWUyQLFRHQEDMRULHVJR
8WLOL]DFLyQGHPiVFDUDV\FDPLVROLQHVHVWpULOHVGXUDQWHODDWHQFLyQGHOSDUWR
8VRUXWLQDULRGHRFLWRFLQDGXUDQWHHOWUDEDMRGHSDUWR
0RYLOL]DFLyQUXWLQDULDGHODPXMHUHQWUDEDMRGHSDUWRDXQDKDELWDFLyQGLIHUHQWHHQHO
FRPLHQ]RGHOVHJXQGRSHUtRGR
&DWHWHUL]DFLyQYHVLFDO
$OHQWDUDODPXMHUDSXMDUFXDQGRVHKDGLDJQRVWLFDGRXQDGLODWDFLyQFRPSOHWDDQWHV
TXHODPXMHUVLHQWDODQHFHVLGDGGHKDFHUORHOODPLVPD
0DQWHQHUVHUtJLGRHQFRQVLGHUDUQRUPDOXQDGXUDFLyQ¿MDWDOFRPRXQDKRUDSDUDHO
VHJXQGRSHUtRGRGHOSDUWRVLODVFRQGLFLRQHVPDWHUQRIHWDOHVVRQEXHQDV\HOWUDEDMR
GHSDUWRSURJUHVD
3DUWRLQVWUXPHQWDOGHUXWLQD
8VROLEHUDORUXWLQDULRGHODHSLVLRWRPtD
([SORUDFLyQPDQXDOGHO~WHURGHVSXpVGHOSDUWR
$6,67(1&,$'85$17((/38(53(5,2
2%-(7,92 &RQWURODUELHQHVWDUGHODPXMHUSXpUSHUD
'HWHFWDU\HYDOXDUGHVYLDFLRQHVGHORVOtPLWHV¿VLROyJLFRV
(YDOXDUULHVJR\UHIHULUDQLYHODSURSLDGR
$SOLFDUPDQLREUDVFRUUHFWLYDV
$&7,9,'$' (GXFDFLyQGHODPXMHUSXpUSHUD
&RQWUROHVFOtQLFRVGHODPXMHU\VXKLMR
5HJLVWURGHORVFRQWUROHVHQODKLVWRULDFOtQLFDSHULQDWDO
'H¿QLFLyQ
(O SXHUSHULR FRPR WDO FRPLHQ]D XQD YH] TXH KD WHUPLQDGR HO DOXPEUDPLHQWR \ VH
H[WLHQGHSRUXQDVVHLVVHPDQDV'XUDQWHHVWHSHUtRGRUHYHUWLUiQWRGRVORVFDPELRV
¿VRLROyJLFRV TXH VH SURGXMHURQ GXUDQWH HO HPEDUD]R FRQ OD VROD H[FHSFLyQ GH ORV
FDPELRVPDPDULRVTXHVHLQWHQVL¿FDUiQSDUDPDQWHQHUHODPDPDQWDPLHQWRH[LWRVR
3XHUSHULRLQPHGLDWRDEDUFDODVSULPHUDVKRUDVGHOSRVWSDUWRHLQFOX\HHQpODODV
KRUDVTXHFRQWLQ~DQDODOXPEUDPLHQWR6XLPSRUWDQFLDUDGLFDHQTXHHVHQHVWHSHUtR
GRHQHOFXDOVHSURGXFHODPD\RUFDQWLGDGGHFRPSOLFDFLRQHVJUDYHVHVSHFLDOPHQWH
ODVYLQFXODGDVDWUDVWRUQRVSRUVDQJUDGR
3RUVXPD\RUULHVJRGHKHPRUUDJLD\VKRFNHOSRVWDOXPEUDPLHQWRSULPHUDVKRUDV
GHOSXHUSHULR\DKDVLGRDQDOL]DGRMXQWRFRQHODOXPEUDPLHQWR
/RVFRQWUROHVGXUDQWHODVSULPHUDVKRUDVGHEHUiQLQFOXLU
(VWDGRGHFRQFLHQFLDODSDUWXULHQWDGHEHUiHVWDUO~FLGD\WUDQTXLOD
)DVFLHVODFRORUDFLyQGHSLHO\PXFRVDVGHEHUiHVWDUELHQFRORUHDGDH[FHSWRVL
WHQtDXQDDQHPLDSUHYLD
)UHFXHQFLDGHOSXOVRGHODPXMHUGHEHUiVHUOOHQR\WHQHUXQDIUHFXHQFLDQRUPDO
HQWUH\ODWLGRVSRUPLQXWRHQFRQGLFLRQHVEDVDOHV
3UHVLyQDUWHULDOQRGHEHUiDSDUWDUVHVXVWDQFLDOPHQWHGHORVYDORUHVSUHYLRV
7HPSHUDWXUDFRUSRUDOHVQRUPDO\QRGHEHUiVXSHUDUORV&(QHOSRVWDOXP
EUDPLHQWRSXHGHQREVHUYDUVHHVFDORIUtRVTXHVRQQRUPDOHV\UDUDPHQWHGXUDQ
PiVGHPLQXWRV
5HWUDFFLyQGHO~WHURJORERGHVHJXULGDGGH3LQDUGHQODVSULPHUDVKRUDVHO
IRQGRGHO~WHURQRGHEHUiVREUHSDVDUODFLFDWUL]XPELOLFDO\ODFRQVLVWHQFLDVHUi
¿UPHHOiVWLFDDGTXLULHQGRXQDFRQVLVWHQFLDOHxRVDDOVHUHVWLPXODGRSHUPDQH
FLHQGRLQGRORURDODSDOSDFLyQ6RORSRGUiSHUFLELUVHGRORUFXDQGRVHSUHQGDHO
QLxRDOSHFKRPDWHUQRHQWXHUWRV(QFDVRGHGRORUHVWDUiQLQGLFDGRVORVDQDO
JpVLFRVFRPXQHV\ORVDQWLQÀDPDWRULRVQRHVWHURLGHRV
6DQJUDGRYDJLQDOHQFDVRTXHHOVDQJUDGRYDJLQDOVHDDEXQGDQWH\VLHO~WHUR
HVWiELHQFRQWUDtGRGHEHUiHIHFWXDUVHXQDLQVSHFFLyQPLQXFLRVDGHOFDQDOGH
SDUWRLQWHQWDQGRGHVFDUWDUOHVLRQHVGHVJDUURVHQYDJLQD\HQFXHOORGH~WHUR
$OWHUDFLRQHVUHJLRQDOHVHQRFDVLRQHVVHSXHGHYHUHQHODQRKHPRUURLGHVÀX[L
YDVTXHPHMRUDQSDUFLDOPHQWHFRQKLHOR\FUHPDVORFDOHVFRQDQHVWpVLFRVWySL
FRV$QLYHOXULQDULRHVH[FHSFLRQDOODUHWHQFLyQXULQDULDVHWUDWDUiFRQFDWHWHULV
PRVYHVLFDOHVLQWHUPLWHQWHV$OFDERGHXQDVKRUDVVXHOHUHPLWLU
)LJXUD)UDJPHQWR+&3&RQWUROHVHQHOSXHUSHULR
+LJLHQHSHULQHDO
6HWUDWHGHXQSDUWRFRQRVLQHSLVLRWRPtDFDGDYH]TXHODPXMHUUHTXLHUDFDPELDUHO
DSyVLWRVHUiUHFRPHQGDEOHTXHKLJLHQLFHOD]RQDFRQDJXDOLPSLD\MDEyQRFRQDJXD
OLPSLDDODTXHVHOHDJUHJyXQDQWLVpSWLFR(OODYDGRVHKDUiSRUDUUDVWUHVLHPSUHHQ
VHQWLGRDQWHURSRVWHULRUGHODYXOYDKDFLDHODQR6HFRPSOHPHQWDUiFRQVHFDGRGH
XQSDxROLPSLRRFRQJDVDVOLPSLDV
/DURSDLQWHULRUVHUiVHSDUDGDSRUXQDSyVLWRJDVDDOJRGyQJDVDRSRUSURWHFWRUHV
³QRFWXUQRV´GHORVTXHVHFRQVLJXHQHQHOPHUFDGR
/RVODYDGRVLQWUDYDJLQDOHVVRQGHVDFRQVHMDGRV
(QFDVRGHHSLVLRWRPtDORVFXLGDGRVVHUiQVLPLODUHVSHURVHLQVLVWLUiHQPDQWHQHUOD
]RQDVHFDHOPD\RUWLHPSRSRVLEOH
&XLGDGRGHORVSH]RQHV
'XUDQWHHOHPEDUD]RODPXMHUGHEHLQWHQWDUPDQWHQHUDLUHDGDOD]RQDGHOSH]yQ\OD
DUHRODOXEULFDUODFRQXQDJRWDGHOSURSLRFDORVWUR\H[SRQHUOD]RQDDOVROHQWUHGLH]\
TXLQFHPLQXWRVSRUGtD'XUDQWHODODFWDQFLDHVUHFRPHQGDEOHUHSHWLUHOSURFHGLPLHQWR
UHHPSOD]DQGRHOFDORVWURSRUODOHFKH
2ULHQWDFLyQVREUHFXLGDGRVGHOFRUGyQ\ODFWDQFLD
6HGHVDUUROODQHQHOFDStWXORQHRQDWDO
3XHUSHULRPHGLDWR
6HH[WLHQGHGHVGHHOVHJXQGR\KDVWDHOGtDGHOSDUWR
6LJQRV YLWDOHV WHPSHUDWXUD IUHFXHQFLD FDUGtDFD \ SUHVLyQ DUWHULDO &XDOTXLHU
DOWHUDFLyQGHORVVLJQRVYLWDOHVREOLJDUiDODE~VTXHGDGHODJHQWHHWLROyJLFR\
DQWHODSUHVHQFLDGHGXGDVGHEHUiVHUHQYLDGDDXQQLYHOGHPD\RUFRPSOHMLGDG
SDUDFRQWLQXDUVXDWHQFLyQ
(YDOXDFLyQGHORVORTXLRVFDQWLGDGDVSHFWRFRPSRVLFLyQ\RORU(VGLItFLOHVWL
PDUODFDQWLGDGSRUORTXHVHUHFRPLHQGDYHUVLODPDGUHWLHQHRQRDQHPLD(O
FRORUDHVWDDOWXUDGHOSXHUSHULRGHEHVHUURMRRURVDGR(OFRORUPDUUyQDFKRFR
ODWDGRKDUiVRVSHFKDULQIHFFLyQ6XHOHQDGHPiVGHVDQJUHFRQWHQHUIUDJPHQ
WRVWLVXODUHVSHTXHxRV(ORORUSXHGHVHUIXHUWHHQFDVRGHIHWLGH]VHGHEHUi
VRVSHFKDULQIHFFLyQ
&RQWUROGHLQYROXFLyQXWHULQD/DLQYROXFLyQHVVXPDPHQWHUiSLGDDSUR[LPDGD
PHQWHDFHQWtPHWURVSRUGtD\VHPLGHPHGLDQWHSDOSDFLyQGHOIRQGRXWHULQR$
ORVGtDVGHSXHUSHULRVHVLWXDUiHQWUHHORPEOLJR\HOERUGHVXSHULRUGHOSXELV\
DORVGtDVHVWDUiSUy[LPRDOSXELV
$OWHUDFLRQHVUHJLRQDOHVHQRFDVLRQHVVHSXHGHQYHUVHKHPRUURLGHVÀX[LYDV\
GRORURVDVTXHQRPHMRUDQFRQWUDWDPLHQWRPpGLFRHQHVRVFDVRVGHEHUiGHV
FDUWDUVH XQD WURPERVLV KHPRUURLGDULD OD TXH VH VROXFLRQD IiFLOPHQWH FRQ XQ
PtQLPRGUHQDMHTXLU~UJLFRFRQDQHVWHVLDORFDO2WUDVYHFHVHOGRORUSXHGHVHU
H[SUHVLyQGHXQD¿VXUDDQDOTXHVXHOHUHYHUWLUFRQWUDWDPLHQWRPpGLFROXHJR
GHXQDVVHPDQDV&RQUHODFLyQDODYHMLJD\ORVPHFDQLVPRVGHFRQWHQFLyQHV
IDFWLEOHREVHUYDUXQDLQFRQWLQHQFLDGHRULQDTXHVXHOHUHPLWLUHVSRQWiQHDPHQWH
HQDOJXQRVGtDVRVHPDQDV
%DMDGDGHODOHFKH(QHVWRVGtDVVHVXVWLWX\HHOFDORVWURSRUODOHFKHGH¿QLWLYD
3XHUSHULRDOHMDGR
$EDUFD GHVGH HO KDVWD HO GtD GHO SRVWSDUWR (VWH HV XQ EXHQ SHUtRGR SDUD
FRQWURODUODHYROXFLyQ GHODODFWDQFLD\SUHSDUDUDODPXMHUSDUDHOUHWRUQRDVXYLGD
VH[XDO (Q HVWH PRPHQWR HV UHFRPHQGDEOH RULHQWDU VREUH DQWLFRQFHSFLyQ \ HVSDFLR
LQWHUJHVWDFLRQDO
&RQWLQ~D OD LQYROXFLyQ XWHULQD \ HO UHVWDEOHFLPLHQWR GHO HVWDGR SUHJUDYtGLFR$ SDUWLU
GHORVGtDVGHOSDUWRSXHGHDGYHUWLUVHXQVDQJUDGRYDJLQDOQRUPDOHOTXHJHQHU
DOPHQWHVHGHEHDXQDSUROLIHUDFLyQHQGRPHWULDOH[FOXVLYDPHQWHYLQFXODGDDHVWUyJH
QRV5DUDYH]SXHGHGHEHUVHDXQDSUROLIHUDFLyQHVWUyJHQR±SURJHVWDFLRQDO
(OUHLQLFLRGHODVUHODFLRQHVVH[XDOHVHVUHFRPHQGDEOHOXHJRGHODGHVDSDULFLyQGHORV
ORTXLRVORTXHVHSURGXFHHQWUHORV\ORVGtDVGHOSXHUSHULR
(QDOJXQRVFDVRVpVWHVHUiHO~OWLPRFRQWUROHQWUHODPXMHU\HOHTXLSRGHVDOXG3RU
HVRHVUHFRPHQGDEOHDGHPiVGHODFRQVHMHUtDHQFRQWUDFHSFLyQUHVWDEOHFLPLHQWRGH
ODVUHODFLRQHVVH[XDOHV\ODFWDQFLDHIHFWXDUXQH[DPHQFOtQLFRJHQHUDO\JLQHFROyJLFR
HQFDVRTXHIXHVHQHFHVDULR
3XHUSHULRWDUGtR
(VWHSHUtRGRVHH[WLHQGHPiVDOOiGHOGtD\QRPiVDOOiGHXQDxR7RPDVXLP
SRUWDQFLD HQ TXH KD\ DOJXQDV VLWXDFLRQHV PyUELGDV R LQFOXVR PRUWDOHV TXH SXHGHQ
SURGXFLUVHHQHVWHSHUtRGR
(O$OWD
(VUHFRPHQGDEOHRWRUJDUHODOWDDODVKRUDVGHOSDUWRVLHVTXHQRKXERFRPSOLFD
FLRQHV\VLHPSUHTXHODPXMHUHVWiHQFRQGLFLRQHVGHDGPLQLVWUDUFXLGDGRVDVXUHFLpQ
QDFLGRHQIRUPDFRPSHWHQWH
&XDQGR GHED RWRUJDUVH HO DOWD HQ IRUPD SUHFR] GHEHUiQ JDUDQWL]DUVH LQVWDQFLDV GH
VHJXLPLHQWRGRPLFLOLDULR\GHVHUSRVLEOHLQVWUXPHQWDUVLVWHPDVGHFRQVXOWDWHOHIyQLFD
FRQUHIHUHQWHVGHOFHQWURGHVDOXGRGHODFRPXQLGDGUHFRUGDUTXHODVSULPHUDV
KRUDVVXHOHQVHUODVGHPD\RUULHVJRYLWDOWDQWRSDUDODPXMHUFRPRSDUDVXUHFLpQ
QDFLGR
Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor
by a lay doula. J Obstet Gynecol Neonatal Nurs. 2006;35(4):456-464.
Cotter A, Ness A, Tolosa J. Prophylactic oxytocin for the third stage of labour. Cochrane Database of
Dyson L, McCormick F, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. Cochrane
Hodnett ED, Lowe NK, Hannah ME, et al. Effectiveness of nurses as providers of birth labor support in North
American hospitals: a randomized controlled trial. JAMA.2002; 288: 1373-1381.
Ekstrom A, Nissen E. A mother’s feelings for her infant are strengthened by excellent breastfeeding counseling
and continuity of care. Pediatrics. 2006;118(2):e309-314.
Escobar GJ, Braveman PA, Ackerson L, et al. A randomized comparison of home visits and hospital-based
group follow-up visits after early postpartum discharge. Pediatrics. 2001;108(3):719-727.
Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ. Prostaglandins for preventing postpartum haemorrhage.
Hodnett ED. Caregiver support for women during childbirth. Cochrane Database of Systematic Reviews 2002,
Issue 1.
Johnston RA, Sidall RS. Is the usual method of preparing patients for delivery beneficial or necessary?Am J
Obstet Gynecol. 1992;4:645-650.
Kennell J, Klauss MH, McGrath S, Hinkley C. Continuous emotional support during labor in a US hospital. A
randomized controlled trial. JAMA. 1991;265(17):2197-2201
Kominiarek MA, Kilpatrick SJ. Postpartum hemorrhage: a recurring pregnancy complication. Semin Perinatol.
2007 Jun;31(3):159-66. Review.
Labarere J, Gelbert-Baudino N, Ayral AS, et al. Efficacy of breastfeeding support provided by trained clinicians
during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs.
Pediatrics. 2005;115(2):e139-146
Langer A, Campero L, García C, Reynoso S. Effects of psychosocial support during labour and childbirth
on breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised
clinical trial. Br J Obstet Gynaecol. 1998;105(10):1056-1063.
Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Prophylactic use of ergot alkaloids in the third
stage of labour. Cochrane Database of Systematic Reviews 2007, Issue 2
Lomuto C, Albaizeta D. Lactancia Materna. En: Schwarcz R, Fescina R, Duverges C. Obstetricia. 6ª edición.
Buenos Aires: El Ateneo, 2005. pp 515-519.
Madi BC, Sandall J, Bennett R, et al. Effects of female relative support in labor: a randomized controlled trial.
Birth. 1999;26(1):4-8.
Maughan KL, Heim SW, Galazka SS. Preventing postpartum hemorrhage: managing the third stage of labor.
Am Fam Physician. 2006 Mar 15;73(6):1025-1028.
McDonald S, Abbott JM, Higgins SP. Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of
labour. Cochrane Database of Systematic Reviews 2004, Issue 1.
PATH 2004. Prevención de la hemorragia post parto: herramientas para los proveedores de atención clínica.
Versión condensada. Washington, D.C.: PATH. 2004.
Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour.
Rabe H, Reynolds G, Diaz-Rossello J. Early versus delayed umbilical cord clamping in preterm infants.
Shaw E, Levitt C, Wong S, Kaczorowski J; The McMaster University Postpartum Research Group. Systematic
review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting,
mental health, quality of life, and physical health. Birth. 2006 Sep;33(3):210-220. Review.
Schwarcz R. El parto patológico. Distocias del canal pelvigenital.En: Schwarcz R, Fescina R, Duverges C.
Obstetricia. 6ª edición. Buenos Aires: El Ateneo, 2005. pp 392-396.
Schwarcz R, Diaz AG, Fescina R, De Mucio B, Belitizky R, Delgado L. Atención Prenatal y del Parto de
Bajo Riesgo. Montevideo, CLAP 1995; Publ. Cient. CLAP Nº 1321.01
Schwarcz R, Fescina RH, Duverges C. Obstetricia. 6ª ed. Buenos Aires: El Ateneo, 2005.
Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain
management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. Cochrane
Tessier V, Pierre F; College National des Gynecologues et Obstetriciens Francais; Agence Nationale
d’Accreditation et d’Evaluation en Sante. Risk factors of postpartum hemorrhage during labor and clinical
and pharmacological prevention] J Gynecol Obstet Biol Reprod (Paris). 2004 Dec;33(8 Suppl):4S29-4S56.
Review.
Yamazaki H, Uchida K. A mathematical approach to problems of cephalopelvic disproportion at the pelvic

inlet. Am J Obstet Gynecol. 1983 Sep 1;147(1):25-37.
UNICEF. 10 pasos para la lactancia materna eficaz. http://www.unicef.org/spanish/nutrition/23964_

breastfeeding.html (Último acceso 28 de Febrero de 2007)
UNICEF/WHO. Baby Friendly Hospital Initiative, revised, updated and extended for integrated care,
preliminary version, January 2006. http://www.who.int/nutrition/topics/bfhi/en/index.html (Último acceso 28
de Febrero de 07)
Villar J, Gülmezoglu AM, Hofmeyr GJ, Forna F. Systematic review of randomized controlled trials of
misoprostol to prevent postpartum hemorrhage. Obstet Gynecol. 2002 Dec;100(6):1301-1312
Winter C, Macfarlane A, Deneux-Tharaux C, Zhang WH, Alexander S, Brocklehurst P, Bouvier-Colle MH,

Prendiville W, Cararach V, van Roosmalen J, Berbik I, Klein M, Ayres-de-Campos D, Erkkola R, Chiechi
LM, Langhoff-Roos J, Stray-Pedersen B, Troeger C. Variations in policies for management of the third
stage of labour and the immediate management of postpartum haemorrhage in Europe. BJOG. 2007
Jul;114(7):845-54.
WHO. Care in normal birth: A Practical Guide (WHO/FRH/MSM/96.24) [Internet]. Disponible en: http://
www.who.int/reproductive-health/publications/MSM_96_24/care_in_normal_birth_practical_guide.pdf
(consulta 28-2-07)
WHO 2002. Manejo de las complicaciones del embarazo y el parto: Guía par obstetrices y médicos.
Organización Mundial de la Salud. RHR Salud reproductiva e investigaciones conexas, 2002. http://www.
who.int/reproductive-health/publications/mcpc/index_sp.html (Último acceso 20 de Junio de 2007)
WHO 2006.Pregnancy, Childbirth Postpartum and Newborne Care: A guide for essential practice. 2nd
ed. http://www.who.int/making_pregnancy_safer/publications/PCPNC_2006_03b.pdf (Último acceso 4 de
Julio de 2007).
9 $WHQFLyQGHO5HFLpQ1DFLGR
& $ 3, 7 8 /2 9
(Q HVWD VHFFLyQ VH SUHVHQWDQ ORV REMHWLYRV HVSHFt¿FRV GH PD\RU UHOHYDQFLD \ ODV
DFWLYLGDGHV FRUUHVSRQGLHQWHV SDUD OD DWHQFLyQ QHRQDWDO EiVLFD 6H GHVWDFDQ ODV
YDULDEOHVGHOD+LVWRULD3HULQDWDOTXHUHJLVWUDQODVDFWLYLGDGHVGHDWHQFLyQQHRQDWDO
2%-(7,926 $&7,9,'$'(6
2EVHUYDU VL UHVSLUD R QR \ VL SHUVLVWH HQ
5HFLELUDOUHFLpQQDFLGR\YDORUDUHOLQLFLRGHOD DSQHDGHWHUPLQDUVLHVSRUDV¿[LDIHWDORSRU
SULPHUDUHVSLUDFLyQHVSRQWiQHD GHSUHVLyQIDUPDFROyJLFD\SURYHHUYHQWLODFLyQ
DVLVWLGDDO51HQDSQHD
3URYHHU FXLGDGRV LQPHGLDWRV TXH IDFLOLWHQ
3URWHJHUODDGDSWDFLyQDODYLGDH[WUDXWHULQD OD DGDSWDFLyQ HVSHFLDOPHQWH HQ ORV QDFLGRV
HQHOUHFLpQQDFLGRSUHWpUPLQR SUHWpUPLQR TXH SUHVHQWHQ VLJQRV GH
LQPDGXUH]YHQWLODWRULD
,GHQWL¿FDUDOUHFLpQQDFLGR )DFLOLWDUTXHODPDGUHORLGHQWL¿TXH\FXPSOLU
ORVUHTXLVLWRVORFDOHVGHLGHQWL¿FDFLyQDOQDFHU
(YDOXDU HO FUHFLPLHQWR \ GHVDUUROOR IHWDO DO 5HDOL]DUDQWURSRPHWUtD\YDORUDUODVIXQFLRQHV
QDFHU GHDGDSWDFLyQVHJ~QOD(GDG*HVWDFLRQDO
$GHFXDUHOPDQHMRLQLFLDOGHORVUHFLpQQDFLGRV ,QVWDXUDU PHGLGDV HVSHFt¿FDV SDUD FDGD
FRQGHIHFWRVFRQJpQLWRVPD\RUHV GHIHFWRHQIRUPDSUHFR]
(YDOXDU HQ IRUPD VLVWHPiWLFD XQLYHUVDO R
VHOHFWLYDDORVUHFLpQQDFLGRVSDUDSUHYHQLU\
'HWHFWDU SUHYHQLU \ WUDWDU GHIHFWRV \R WUDWDU HQIHUPHGDGHV LQIHFFLRVDV WUDQVPLWLGDV
HQIHUPHGDGHV FRQJpQLWDV LQIHFFLRVDV \ QR SRUVXPDGUH
LQIHFFLRVDVDVLQWRPiWLFDV 'HWHFFLyQVLVWHPiWLFDGHGHIHFWRVFRQJpQLWRV
RHQIHUPHGDGHVQRLQIHFFLRVDVSRUPpWRGRV
GHODERUDWRULRELRFOtQLFRRLQVWUXPHQWDOHV
3UHYHQLUODRIWDOPLDJRQRFyFFLFD ,QVWLODU DQWLPLFURELDQRV HQ ODV FRQMXQWLYDV DO

QDFHU
3UHYHQLU OD (QIHUPHGDG +HPRUUiJLFD GHO $GPLQLVWUDU9LWDPLQD.
5HFLpQ1DFLGR
1RVHSDUDUDOUHFLpQQDFLGR\VXPDGUH\
IDFLOLWDUHODSR\RIDPLOLDU
,QLFLDU \ PDQWHQHU OD ODFWDQFLD PDWHUQD $OLPHQWDU D OLEUH GHPDQGD \ QR GDU
H[FOXVLYD ELEHURQHV
3URPRYHUODODFWDQFLDH[FOXVLYD
3UHYHQLUOD7%&GHOODFWDQWH 9DFXQDFLyQ%&*DOQDFHU
3UHYHQLUODPXHUWHV~ELWDGHOODFWDQWH &RORFDUDO51ERFDDUULEDSDUDGRUPLU
'LVPLQXLUORVULHVJRVHQORVQDFLGRVSUHWpUPLQR $XPHQWDU OD YLJLODQFLD HQ HO SHUtRGR GH

DGDSWDFLyQPLHQWUDVSHUPDQHFHQHQODVDOD
GH\VHPDQDV FRQVXVPDGUHV
2EMHWLYRV 5HFLELUDOUHFLpQQDFLGR\YDORUDUHOLQLFLRGHODSULPHUD
UHVSLUDFLyQHVSRQWiQHD
$FWLYLGDGHV 2EVHUYDUVLUHVSLUDRQR6LQRUHVSLUDGHGXFLUVLHVSRUDV¿[LD
IHWDORSRUGHSUHVLyQIDUPDFROyJLFD
8QHYHQWR¿VLROyJLFRIXQGDPHQWDOHQODDGDSWDFLyQDODYLGDH[WUDXWHULQDHVHOLQLFLRGH
ODVSULPHUDVLQVSLUDFLRQHVHVSRQWiQHDV\ODYHQWLODFLyQSXOPRQDUGHVGHORVSULPHURV
VHJXQGRVGHQDFLGR(OPRPHQWRGHLQLFLRGHODYHQWLODFLyQHVSRQWiQHDHVYDULDEOHHQ
HOSURFHVRQRUPDOGHDGDSWDFLyQSXHVDXQSHUVLVWHODIXQFLyQGHUHVSLUDFLyQSODFHQWDULD
SRUHOFRUGyQXPELOLFDO\DOJXQRVUHFLpQQDFLGRVVDQRVSXHGHQLQLFLDUORVPRYLPLHQWRV
UHVSLUDWRULRVOXHJRGHVHJXQGRVGHQDFHU
6LXQUHFLpQQDFLGRQRLQLFLDHVSRQWiQHDPHQWHORVPRYLPLHQWRVGHLQVSLUDFLyQSXHGH
VHUSRUDV¿[LDIHWDOVHYHUDRSRUODDFFLyQGHSUHVRUDGHO6LVWHPD1HUYLRVR&HQWUDOSRU
IiUPDFRVVHGDQWHVRDQHVWpVLFRVDGPLQLVWUDGRVDODPDGUHDQWHVGHOQDFLPLHQWR
$V¿[LDIHWDOLQWUDXWHULQD
&XDQGR OD DV¿[LD IHWDO HV VHYHUD SXHGH GHWHFWDUVH SRU ODV FDUDFWHUtVWLFDV GH OD
IUHFXHQFLD FDUGLDFD IHWDO ,QLFLDOPHQWH VH PDQL¿HVWD LQ ~WHUR FRPR WDTXLFDUGLD PiV
GHODWLGRVSRUPLQXWR\SURJUHVLYDPHQWHVHGHWHULRUDFRQSHULRGRVGHEUDGLFDUGLD
SRVWFRQWUDFFLyQXWHULQD',36,,REUDGLFDUGLDVHYHUDPDQWHQLGD/DDV¿[LDDIHFWDOD
KHPRGLQDPLDIHWDO\DOQDFHUVHPDQL¿HVWDSRUEUDGLFDUGLD\HQORVFDVRVPDVVHYHURV
HOUHFLpQQDFLGRVVHHQFXHQWUDHQVKRFNFRQSDOLGH]H[WUHPD\HOFRUGyQXPELOLFDOHVWi
ÀiFFLGRSRUODKLSRWHQVLyQDUWHULDO\HOFRODSVRYHQRVR/DDV¿[LDIHWDOHVPDVIUHFXHQWH
HQORVIHWRVFRQUHVWULFFLyQGHOFUHFLPLHQWRDGHOJD]DGRVSRULQVX¿FLHQFLDSODFHQWDULD
/DVFDXVDVDJXGDVPiVIUHFXHQWHVVRQ'331,SODFHQWDSUHYLDVDQJUDQWHSURODSVR
\RQXGRUHDODMXVWDGRGHFRUGyQ\URWXUDXWHULQD
'HSUHVLyQFHQWUDOSRUGURJDV
&XDQGR OD GHSUHVLyQ IHWDO LQ ~WHUR HV H[FOXVLYDPHQWH IDUPDFROyJLFD QR GHVDUUROOD
DV¿[LDSXHVODSODFHQWDIXQFLRQDQRUPDOPHQWHKDVWDHVHPRPHQWR\SRUFRQVLJXLHQWH
QR H[LVWH DOWHUDFLyQ GH OD KHPRGLQDPLD VX FRUGyQ XPELOLFDO DO QDFHU HVWi HUpFWLO
\ WLHQH IUHFXHQFLD FDUGLDFD QRUPDO (O UHFLpQ QDFLGR FRQ GHSUHVLyQ IDUPDFROyJLFD
HVWi HQ DSQHD QR UHDOL]D PRYLPLHQWRV UHVSLUDWRULRV WLHQH XQD KLSRWRQtD H[WUHPD
GHELGDDORVIiUPDFRVGHSUHVRUHV6LVHPDQWLHQHVLQUHVSLUDUDPHGLGDTXHFHVDOD
IXQFLyQ SODFHQWDULD HQ SRFRV VHJXQGRV FRPHQ]DUi D DV¿[LDUVH FRQ GHWHULRUR GH VX
KHPRGLQDPLDEUDGLFDUGLD\SDOLGH]
5HDQLPDFLyQGHOUHFLpQQDFLGR
$SUR[LPDGDPHQWHGHORVUHFLpQQDFLGRVUHTXLHUHQGHDOJ~QWLSRGHDVLVWHQFLDSDUD
LQLFLDUORVPRYLPLHQWRVYHQWLODWRULRV6LQHPEDUJRPHQRVGHUHTXLHUHPDQLREUDVGH
UHDQLPDFLyQHVSHFt¿FDV
(QIRUPDVHQFLOODSXHGHYDORUDUVHODQHFHVLGDGGHLQVWDXUDURQRPHGLGDVGHDSR\R
YHQWLODWRULR 1R UHTXHULUiQ GH PDQLREUDV HVSHFt¿FDV GH UHDQLPDFLyQ DTXHOORV UHFLpQ
QDFLGRVFRQODVVLJXLHQWHVFDUDFWHUtVWLFDV
ż5HFLpQQDFLGRVDWpUPLQR
ż/ORUDRVHHYLGHQFLDQPRYLPLHQWRVYHQWLODWRULRV
ż3UHVHQWDEXHQWRQRPXVFXODU
$QWH XQ UHFLpQ QDFLGR GH WpUPLQR TXH OORUD \ SUHVHQWD EXHQ WRQR PXVFXODU QR HV
QHFHVDULRLPSOHPHQWDUPHGLGDVGHUHDQLPDFLyQ\HOUHFLpQQDFLGRSRUWDQWRQRGHEH
VHUVHSDUDGRGHODPDGUH
(QFDVRTXHQRVHGHQHVDVFRQGLFLRQHVHOUHFLpQQDFLGRGHEHUiUHFLELUXQDRPiVGH
ODVVLJXLHQWHVLQWHUYHQFLRQHV
$ 3DVRVEiVLFRVGHHVWDELOL]DFLyQHYLWDUHQIULDPLHQWRGHVREVWUXLUYtDDpUHDVL

HVQHFHVDULRVHFDUOR\UHDOL]DUHYDOXDFLyQGHODFRORUDFLyQGHSLHO\PXFRVDV
% 9HQWLODFLyQ
& &RPSUHVLRQHVWRUiFLFDV
' $GPLQLVWUDFLyQGHDGUHQDOLQD
/DVPHGLGDVLQFOXLGDVHQORVSXQWRV$D'FRUUHVSRQGHQDLQWHUYHQFLRQHVGHLQWHQVLGDG
FUHFLHQWH HQ UHVSXHVWD D OD JUDYHGDG \ SHUVLVWHQFLD GH ORV VLJQRV R VtQWRPDV
HVSHFt¿FRV/DGHFLVLyQDFHUFDGHOSURJUHVRHQODVLQWHUYHQFLRQHVHQWUHORVSXQWRV$
\'GHSHQGHUiGHODDWHQWDHYDOXDFLyQGHGRVVLJQRVYLWDOHV
9HQWLODFLyQSUHVHQFLDGHDSQHDRGL¿FXOWDGHQORVPRYLPLHQWRVYHQWLODWRULRV
³JDVSLQJ´
)UHFXHQFLDFDUGtDFDYDORUDQGRVLHVPD\RURQRGHODWLGRVSRUPLQXWR
8QD DGHFXDGD HYDOXDFLyQ \ VHJXLPLHQWR GXUDQWH OD JHVWDFLyQ \ HQ HO PRPHQWR GHO
SDUWRSHUPLWHLGHQWL¿FDUODSUHVHQFLDGHFRQGLFLRQHVGHULHVJR TXHVHUiQHVHQFLDOHV
SDUD SUHGHFLU OD QHFHVLGDG GH LPSOHPHQWDU PDQLREUDV GH UHDQLPDFLyQ SUHPDWXUH]
VXIULPLHQWRIHWDOUHVWULFFLyQGHOFUHFLPLHQWRLQWUDXWHULQRHWF
(VIXQGDPHQWDOLPSOHPHQWDUORVSDVRVEiVLFRVSURSRUFLRQDUFDORUDOFRORFDUDOEHEp
EDMR XQD IXHQWH GH FDORU UDGLDQWH YDORUDU OD SHUPHDELOLGDG GH OD YtD DpUHD VHFDU HO
EHEp\HVWLPXODUODUHVSLUDFLyQ\DTXHWDOHVPHGLGDVFRQVWLWX\HQHVWtPXORVEiVLFRV
HQHOUHFLpQQDFLGR
(QOD¿JXUDVHREVHUYDODVHFXHQFLDGHDVSHFWRVDHYDOXDU\FRQGXFWDDVHJXLU
6LD~QOXHJRGHKDEHULQVWDXUDGRODVPHGLGDVEiVLFDVVHREVHUYDGL¿FXOWDGYHQWLODWRULD
RODIUHFXHQFLDFDUGtDFDHVLQIHULRUDODWLGRVSRUPLQXWRVVHUHTXHULUiHQWRQFHVGH
DSR\DUDOUHFLpQQDFLGRFRQYHQWLODFLyQDVLVWLGDPHGLDQWHHOXVRGHPiVFDUD
6LQRVHREVHUYDQPHMRUDV\ODEUDGLFDUGLDVHDFHQW~DD~QPiVFRQIUHFXHQFLDFDUGtDFD
PHQRUDODWLGRVSRUPLQXWRGHEHUiQUHDOL]DUVHFRPSUHVLRQHVWRUiFLFDVUtWPLFDV'H
SHUVLVWLUODEUDGLFDUGDHQHVRVYDORUHVVHLQGLFDUiDGUHQDOLQD
(QFDVRTXHODIUHFXHQFLDFDUGtDFDVXSHUHORVODWLGRVSRUPLQXWRVSHURFRQFLDQRVLV
\GL¿FXOWDGYHQWLODWRULDSHUVLVWHQWHGHEHUiHYDOXDUVHODSRVLELOLGDGGHEULQGDUR[tJHQR
DGLFLRQDO
8QD YH] TXH OD YHQWLODFLyQ FRQ SUHVLyQ SRVLWLYD R OD DGPLQLVWUDFLyQ GH R[tJHQR
VXSOHPHQWDULR VH LQLFLy DGHPiV GH OD YDORUDFLyQ GH OD IUHFXHQFLD FDUGLDFD \ GH OD
UHVSLUDFLyQ GHEH YDORUDUVH HVWUHFKDPHQWH HO HVWDGR GH R[LJHQDFLyQ FX\D ySWLPD
HYDOXDFLyQ GHEH UHDOL]DUVH PHGLDQWH HO XVR GH XQ R[tPHWUR GH SXOVR /D IUHFXHQFLD
FDUGtDFD\VXYDULDFLyQFRQVWLWX\HQLQGLFDGRUHVGHODUHVSXHVWDFRUUHFWDDFDGDSDVR
(OLQFUHPHQWRGHODIUHFXHQFLDFDUGtDFDLQGLFDDGHFXDGDUHVSXHVWDGHOUHFLpQQDFLGR
3RU WDQWR OD DGPLQLVWUDFLyQ GHO R[LJHQR UHTXLHUH GH OD HYDOXDFLyQ GH UHVXOWDGR \ GH
VHJXULGDG
5HVXOWDGR±LQFUHPHQWRGHODIUHFXHQFLDFDUGtDFD!
6HJXULGDG±0RQLWRUHRGHODVDWXUDFLyQGHR[tJHQR
/DDGPLQLVWUDFLyQGHR[tJHQRGHEHEULQGDUVH62/2FXDQGRVHFRQVLGHUHQHFHVDULD
GDGRTXHVLQRVHDGPLQLVWUDHQIRUPDFRUUHFWDSXHGHJHQHUDUFRPSOLFDFLRQHV\GDxRV
LPSRUWDQWHVHQHOUHFLpQQDFLGR
/DSHUPHDELOLGDGGHODYtDDpUHDPHUHFHXQFRPHQWDULRHQSDUWLFXODU
([LVWHHYLGHQFLDTXHPXHVWUDTXHODDVSLUDFLyQGHODQDVRIDULQJHDVtFRPRODDVSLUDFLyQ
HQGRWUDTXHDOHQUHFLpQQDFLGRVLQWXEDGRVTXHUHFLEHQYHQWLODFLyQPHFiQLFDFXDQGRVH
UHDOL]DHQIRUPDUXWLQDULDHVGHFLUHQDXVHQFLDGHHYLGHQFLDGHVHFUHFLRQHVQDVDOHV
XRUDOHVSXHGHQIDYRUHFHUHIHFWRVQRGHVHDGRVFRPREUDGLFDUGLDRDVRFLDUVHFRQ
GHWHULRUR GHODGLVWHQVLELOLGDGSXOPRQDUODR[LJHQDFLyQ FHUHEUDO \ODUHGXFFLyQ GHOD
YHORFLGDGGHOÀXMRVDQJXtQHR
3RU OR WDQWR VH UHFRPLHQGD TXH OD DVSLUDFLyQ LQFOX\HQGR OD DVSLUDFLyQ FRQ SHUD GH
JRPDVHUHDOLFH62/2HQORVFDVRVTXHSUHVHQWDQREVWUXFFLyQHYLGHQWHDODUHVSLUDFLyQ
HVSRQWiQHDRTXHUHTXLHUHQYHQWLODFLyQFRQSUHVLyQSRVLWLYD933
/D DVSLUDFLyQ GH PHFRQLR DQWHV R GXUDQWH HO SDUWR R GXUDQWH OD UHDQLPDFLyQ SXHGH
FDXVDUVtQGURPHGHDVSLUDFLyQGHPHFRQLR1RH[LVWHHYLGHQFLDVX¿FLHQWHTXHDSR\H
XQFDPELRGHSUiFWLFDHQHVWHVHQWLGR
$ IDOWD GH HVWXGLRV DOHDWRUL]DGRV \ FRQWURODGRV QR KD\ SUXHEDV VX¿FLHQWHV SDUD
UHFRPHQGDUXQFDPELRHQODSUiFWLFDDFWXDOGHUHDOL]DUODDVSLUDFLyQHQGRWUDTXHDOGH
QLxRVQRYLJRURVRVFRQOtTXLGRDPQLyWLFRPHFRQLDO
2WURDVSHFWRIXQGDPHQWDODFRQVLGHUDUHVODDGPLQLVWUDFLyQVXSOHPHQWDULDGHR[tJHQR
WDO FRPR VH PHQFLRQy DQWHULRUPHQWH /D UHFRPHQGDFLyQ LQGLFD TXH HO LQLFLR GH ODV
PDQLREUDVGHEHUHDOL]DUVHFRQDLUHRXQDPH]FODGHR[tJHQRMXQWRFRQHOPRQLWRUHR
GHODFRQFHQWUDFLyQGHR[tJHQRFRPRVHGHVFULELyDQWHULRUPHQWH
(V IXQGDPHQWDO FRQWDU HQ ORV VHUYLFLRV FRQ SHUVRQDO DGHFXDGDPHQWH HQWUHQDGR HQ
HVWRV DVSHFWRV \ TXH HQ FDGD SDUWR VH FXHQWH FRQ SRU OR PHQRV SHUVRQD FX\D
SULQFLSDO UHVSRQVDELOLGDG VHD OD UHFHSFLyQ \ YDORUDFLyQ GH HVWRV DVSHFWRV HQ HO
UHFLpQQDFLGRHLQWHUYHQJDRSRUWXQD\DGHFXDGDPHQWH(VWDSHUVRQDGHEHVHUFDSD]
GH LQLFLDU OD UHDQLPDFLyQ LQFOX\HQGR OD DGPLQLVWUDFLyQ GH OD YHQWLODFLyQ FRQ SUHVLyQ
SRVLWLYD\FRPSUHVLRQHVHQHOSHFKRHOPRQLWRUHRGHODDGPLQLVWUDFLyQGHR[tJHQR\OD
DGPLQLVWUDFLyQGHGURJDVHQFDVRGHUHTXHULUVH
1$&,0,(172
1$&,0,(172
*HVWDFLyQDWpUPLQR"
*HVWDFLyQDWpUPLQR" %ULQGDUFXLGDGRVGHUXWLQD
%ULQGDUFXLGDGRVGHUXWLQD
/LTXLGRDPQLyWLFRFODUR
6L (YLWDUHQIULDPLHQWR
(YLWDUHQIULDPLHQWR
/LTXLGRDPQLyWLFRFODUR
'HVREVWUXLUYtDDpUHDVLHVQHFHVDULR
'HVREVWUXLUYtDDpUHDVLHVQHFHVDULR
5HVSLUDROORUD"
5HVSLUDROORUD" 6HFDUOR
6HFDUOR
%XHQWRQRPXVFXODU"
%XHQWRQRPXVFXODU" (YDOXDUFRORU
(YDOXDUFRORU
1R
1R
$
(YLWDUHQIULDPLHQWR
'HVREVWUXLUYLD
'HVREVWUXLUYLD DHUHDVLHVQHFHVDULR
DHUHDVLHVQHFHVDULR
6HFDUORHVWLPXODUORUHSRVLFLRQDUOR 1R
(YDOXDUHVIXHU]RUHVSLUDWRULRIUHFXHQFLDFDUGLDFD\FRORU
(YDOXDUHVIXHU]RUHVSLUDWRULRIUHFXHQFLDFDUGLDFD\FRORU
1R
3HUVLVWHFLDQyWLFR
5HVSLUD)&R$SQHD" 'LILFXOWDGYHQWLODWRULD
6,
6,
% 9HQWLODFLyQDVLVWLGDFRQSUHVLyQSRVLWLYDFRQPiVFDUD \$0%8 &RQVLGHUHR[tJHQRDGLFLRQDO&3$3
)& )&!
& &RPSUHVLRQHVWRUiFLFDVUtWPLFDVSRUPLQXWR
&RPSUHVLRQHVWRUiFLFDVUtWPLFDVSRUPLQXWR
&216,'(5$5,158%$&,21
(1'275$48($/
)&
' $GPLQLVWUDUDGUHQDOLQD
$GPLQLVWUDUDGUHQDOLQD
)XHQWHDSDUWLUGH.DWWZLQNHO-HWDO$PHULFDQ+HDUW$VVRFLDWLRQ1HRQDWDOUHVXVFLWDWLRQ
$PHULFDQ +HDUW$VVRFLDWLRQ *XLGHOLQHV IRU &DUGLRSXOPRQDU\ 5HVXVFLWDWLRQ DQG
(PHUJHQF\&DUGLRYDVFXODU&DUH3HGLDWULFV1RYH
)LJXUD$OJRULWPRSDUDODUHDQLPDFLyQGHOUHFLpQQDFLGR
5HFHSFLyQGHOUHFLpQQDFLGR\(YDOXDFLyQGHODYLWDOLGDGDOQDFHUHQORVSULPHURV
VHJXQGRVGHYLGD
6RVWHQHUDOUHFLpQQDFLGRTXHHJUHVDGHOYLHQWUHPDWHUQR\DSR\DUORVREUHXQD
VXSHU¿FLH FXELHUWD FRQ XQ SDxR VXDYH D QLYHO GHO SHULQp PDWHUQR R VREUH VXV
PXVORVHQXQDFHViUHD
&RQWDUODIUHFXHQFLDFDUGLDFDHQORVSULPHURVVHJXQGRVGHVSXpVGHOQDFLPLHQWR
PHGLDQWH OD REVHUYDFLyQ R OD SDOSDFLyQ GH ORV SXOVRV DUWHULDOHV GHO FRUGyQ
XPELOLFDORODDXVFXOWDFLyQGHORVODWLGRVFDUGtDFRV(OFRUGyQXPELOLFDOQRUPDOHV
HUpFWLOFRQXQDYHQDLQJXUJLWDGD\GRVDUWHULDVFRQSXOVRVYLVLEOHVFRQIUHFXHQFLD
VXSHULRUDODWLGRVSRUPLQXWR\TXHDXPHQWDKDVWDRPDVGXUDQWH
HOOODQWR(OFRUGyQÀiFFLGRRFRQSXOVRVGpELOHV\EUDGLFDUGLDHVDQRUPDO\FRQ
IUHFXHQFLDVHGHEHDODDV¿[LDIHWDO2EVHUYDUVLLQLFLDPRYLPLHQWRVUHVSLUDWRULRV
UHFRUGDQGRTXHODSULPHUDUHVSLUDFLyQSXGHUHWDUGDUVHXQRVVHJXQGRV

1R HV QHFHVDULR DVSLUDU HO OtTXLGR DPQLyWLFR H[LVWHQWH HQ OD FDYLGDG QDVRIDUtQJHD
7RGR HO WUDFWR UHVSLUDWRULR WLHQH OtTXLGR DPQLyWLFR HQ HO PRPHQWR PLVPR GH QDFHU \
HVUHDEVRUELGRQDWXUDOPHQWHSRUPHFDQLVPRV¿VLROyJLFRVHQORVSULPHURVPLQXWRVGH
YLGD/DDVSLUDFLyQDXPHQWDHOWRQRYDJDOSURGXFHEUDGLFDUGLDUHÀHMDHQOHQWHFLHQGRHO
LQFUHPHQWR¿VLROyJLFRGHODVDWXUDFLyQVDQJXtQHDGHR[tJHQR
&XDQGR HO OtTXLGR DPQLyWLFR HV PHFRQLDO OD UHFHSFLyQ GHO UHFLpQ QDFLGR GHEH
KDFHUVHSRUSHUVRQDOFDSDFLWDGRHQHOXVRGHOODULQJRVFRSLR6LHOUHFLpQQDFLGR
QRUHDOL]DLQVSLUDFLRQHVHVSRQWiQHDVLQPHGLDWDVDOQDFLPLHQWRGHEHYLVXDOL]DUVH
ODYtDDpUHDVXSHULRUVXSUDHLQIUDJOyWLFD\DVSLUDUHOFRQWHQLGRPHFRQLDODQWHV
TXH UHDOLFH OD SULPHUD LQVSLUDFLyQ R GH SURFHGHU D LQVXÀDU VXV SXOPRQHV FRQ
SUHVLyQSRVLWLYD
6LQRUHVSLUDHVWLPXODUOR\VLQRLQLFLDORVPRYLPLHQWRVLQVSLUDWRULRVFRPHQ]DU
YHQWLODFLyQDUWL¿FLDOLQVXÀDQGRODYtDDpUHD
/DPDQHUDPiVHIHFWLYDGHYHQWLODUORVDOYpRORVHVOD¿VLROyJLFDSXHVODLQVSLUDFLyQ
HVSRQWiQHD D~Q HQ ORV SUHPDWXURV SXHGH OOHYDU SUHVLRQHV QHJDWLYDV LQWUD WRUiFLFDV
VXSHULRUHVDFPGH+2VLQULHVJRGHUXSWXUDDOYHRODU
6LHOFRUGyQXPELOLFDOHVWiÀiFFLGRVHFRQVWDWDEUDGLFDUGLD\HQORVSULPHURVVHJXQGRV
QRLQLFLDORVPRYLPLHQWRVUHVSLUDWRULRVVHGHEHHVWLPXODUFRQXQSDxRVXDYHVHFDQGR
FRQYLJRUHOWURQFR\ORVPLHPEURV/DHVWLPXODFLyQH[WHUQDSXHGHVHUVX¿FLHQWHSDUD
TXHUHDOLFHODSULPHUDLQVSLUDFLyQHVSRQWiQHD
6L QR UHVSRQGH DO HVWLPXOR FXWiQHR VH GHEH FRORFDU HQ GHF~ELWR GRUVDO H LQVXÀDU
DWUDYpVGHVXERFD\QDUL]3DUDLQVXÀDUODYtDDpUHDGHEHDMXVWDUVHXQDPiVFDUD
QDVRRUDOGHWDPDxRDGHFXDGRHLQVXÀDUDLUHLQLFLDOPHQWHVLQR[LJHQRDGLFLRQDOFRQ
XQDIUHFXHQFLDGHYHFHVSRUPLQXWR6HSXHGHLQVXÀDUHQGLYHUVDVIRUPDVODPiV
IUHFXHQWH VH FRQRFH FRPR$0%8 $UWL¿FLDO 0DQXDO %UHDWKLQJ 8QLW TXH FRQVLVWH HQ
XQDEROVDDXWRLQÀDEOHFRQYiOYXODVTXHDVHJXUDQXQÀXMRXQLGLUHFFLRQDO\TXHLPSLGH
H[FHGHUVHGHFP+2GHSUHVLyQ([LVWHQRWUDVIRUPDVERFDDERFDERFDPDVFDUD
R$0%8DWUDYpVGHXQWXERQDVDO\VLVWHPDVEDVDGRVHQHOÀXMRFRQWLQXRGHVGHXQ
WDQTXHGHR[LJHQRRGHDLUHRPH]FODTXHSHUPLWHYHQWLODUFRQWURODQGRFRQSUHFLVLyQ
ODSUHVLyQGHLQVXÀDFLyQ\ODSUHVLyQUHVLGXDOHVSLUDWRULDHQODYtDDpUHD1HRSXII\
YHQWLODGRUHVQHRQDWDOHVPiVFRPSOHMRV
(YROXFLyQHVSHUDGDGHODVPDQLREUDVGHLQVXÀDFLyQGHODYtDDpUHD
6L OD LQVXÀDFLyQ SXOPRQDU HV HIHFWLYD OD IUHFXHQFLD FDUGLDFD VH UHFXSHUDUi
UiSLGDPHQWHFRPRRFXUUHHQODDV¿[LDIHWDOFXDQGRFHVDODFRQWUDFFLyQXWHULQD
\TXHVHFDUDFWHUL]DFRPR',3,,3URJUHVLYDPHQWHDGTXLULUiFRORUDFLyQURVDGD
HQ ODELRV \ OHQJXD )LQDOPHQWH LQLFLDUi OD UHVSLUDFLyQ HVSRQWiQHD \ HO OODQWR
PRPHQWRHQTXHODVPDQLREUDVGHLQVXÀDFLyQSXHGHQFHVDU
6LODLQVXÀDFLyQSXOPRQDUQRHVHIHFWLYDHOVLJQRLQLFLDOPDVFODURHVODSHUVLVWHQFLD
GHODEUDGLFDUGLD\GHEHUiHYDOXDUVHHODMXVWHGHODPiVFDUDRURQDVDOODSRVLFLyQ
QHXWUDGHOFXHOORODSUHVLyQ\IUHFXHQFLDGHODYHQWLODFLyQFRQHO$0%8PHGLDQWH
ODREVHUYDFLyQGHORVPRYLPLHQWRVWRUiFLFRV
6LQRPHMRUDFRQHVWDVFRUUHFFLRQHVSXHGHUHTXHULUVH,QWXEDFLyQ2URWUDTXHDO\
YHQWLODFLyQDWUDYpVGHOWXER
9DORUDUOD9LWDOLGDGDOHUR\WRPLQXWR3XQWDMHGH$3*$5
(Q 9LUJLQLD $SJDU DQHVWHVLVWD REVWpWULFD DPHULFDQD SURSXVR XQ SXQWDMH TXH
SHUPLWLHUDFXDQWL¿FDUODYLWDOLGDGGHORVUHFLpQQDFLGRV(VWHSXQWDMHVHUHDOL]DPHGLDQWH
ODREVHUYDFLyQGHIXQFLRQHVQHFHVDULDVSDUDHOLQLFLRGHODUHVSLUDFLyQHVSRQWiQHDORV
PRYLPLHQWRVLQVSLUDWRULRVUHJXODUHV\ODKHPRGLQDPLDUHSUHVHQWDGDSRUODIUHFXHQFLD
FDUGLDFD \ HO FRORU \ VH FRPSOHPHQWD FRQ OD REVHUYDFLyQ GHO IXQFLRQDPLHQWR GHO
VLVWHPDQHUYLRVRFHQWUDOPHGLDQWHODUHDFWLYLGDGDQWHHVWtPXORV\HOWRQRPXVFXODU/D
IUHFXHQFLDFDUGtDFDHVHOVLJQRTXHPHMRUHYDO~DHOp[LWRGHODUHDQLPDFLyQ
&XDGUR7(67'($3*$5
PUNTAJE 2 1 0
ESFUERZOS RESPIRATORIOS REGULARES IRREGULARES AUSENTES
FRECUENCIA CARDIACA MAS DE 100 MENOS DE 100 AUSENTE
COLOR TODO ROSADO CIANOTICO PALIDO
RESPUESTA ESTÍMULO ORO-NASAL INTENSA DÉBIL AUSENTE
TONO FLEXIÓN FIRME LEVE FLEXION FLACCIDO
/DYDORUDFLyQGHHVWHSXQWDMHDOFXPSOLUHOHUPLQXWR\HOWRPLQXWRGHYLGDVHKDQ
XVDGRXQLYHUVDOPHQWHGHVGHHQWRQFHV
,QWHUSUHWDFLyQGHOSXQWDMHGH$3*$5
(OSXQWDMHDOHUPLQXWRH[SUHVDODFRQGLFLyQDOQDFHUDXQTXHSXHGHHVWDULQÀXLGRSRU
ODLQWHUYHQFLyQGHTXLHQORDWLHQGHHQORVSULPHURVVHJXQGRVGHYLGD8QSXQWDMHGHR
PHQRVLQGLFDVHYHUDGHSUHVLyQ&XDQGRODGHSUHVLyQHVSRUDV¿[LDIHWDOVHYHUDH[LVWH
EUDGLFDUGLD
(OSXQWDMHDOWRPLQXWRVLQWHWL]DODVHYHULGDGGHODGHSUHVLyQLQLFLDO\HOUHVXOWDGRGH
ODVPDQLREUDVUHDOL]DGDV6LVHPDQWLHQHODEUDGLFDUGLDLQGLFDTXHODLQVXÀDFLyQQRKD
ORJUDGRLQLFLDUODYHQWLODFLyQSXOPRQDURTXHODVHYHULGDGHVH[WUHPD(OSURQyVWLFRYLWDO
PHMRUD FXDQGR HQ ORV SULPHURVPLQXWRV GH YLGD H[LVWH XQ LQFUHPHQWR VLJQL¿FDWLYR
GHVGHXQSXQWDMHLQLFLDOEDMR
5HJLVWURGHOD$FWLYLGDG
(QHOPRPHQWRGHFRPSOHWDUODDWHQFLyQHQ6DODGH3DUWRV
VH GHEH UHJLVWUDU HO 3XQWDMH GH $SJDU \ ODV PDQLREUDV
UHDOL]DGDV (O RUGHQ GH UHJLVWUR GH ODV PDQLREUDV GH
UHDQLPDFLyQHQOD+&3UHVSRQGHDXQRUGHQSRULQWHQVLGDG
GHOSURFHGLPLHQWR
(QDPDULOORVHPDUFDODUHDOL]DFLyQGHODVPDQLREUDVTXH
QR VRQ QHFHVDULDV HQ HO UHFLpQ QDFLGR VDQR TXH LQLFLD OD
Figura 108.
UHVSLUDFLyQHQIRUPDHVSRQWiQHD\TXHSXHGHQVHUXVDGDV Fragmento de HCP.
SDUDLQLFLDUODUHDQLPDFLyQGHXQUHFLpQQDFLGRFRQDSQHD Apgar y reanimación
DOQDFHURTXHUHTXLHUHVRSRUWHUHVSLUDWRULRSRULQPDGXUH]
2EMHWLYR 3URWHJHUODDGDSWDFLyQDODYLGDH[WUDXWHULQDHQHOUHFLpQQDFLGR
GHSUHWpUPLQR
$FWLYLGDG 3URYHHU FXLGDGRV LQPHGLDWRV TXH IDFLOLWHQ OD DGDSWDFLyQ

HVSHFLDOPHQWHHQORVQDFLGRVSUHWpUPLQRVTXHSUHVHQWHQ
VLJQRVGHLQPDGXUH]YHQWLODWRULD
'HVDUUROODU HVWUDWHJLDV WHQGLHQWHV D HYLWDU OD SpUGLGD
GH FDORU YDORUDU HO ÀXMR ELGLUHFFLRQDO GH VDQJUH GHVGH
OD SODFHQWD D WUDYpV GHO FRUGyQ XPELOLFDO DO IHWR DSR\DU \
PDQWHQHUHOLQLFLRGHODUHVSLUDFLyQFRQWURODUHODSRUWHGH2
(OUHFLpQQDFLGRSUHWpUPLQRVHHQFXHQWUDHQXQDVLWXDFLyQGHHVSHFLDOYXOQHUDELOLGDG
\ORVSULPHURVPLQXWRVGHYLGDWLHQHQHVSHFLDOLPSDFWRVREUHODVREUHYLGD\PRUELOLGDG
D ODUJR SOD]R (Q OD PD\RUtD GH ORV FDVRV QR UHTXLHUHQ GH PHGLGDV GH UHDQLPDFLyQ
SXHVQRHVWiQDVItFWLFRVQLHQFRODSVRFLUFXODWRULR(QJHQHUDOODSURSRUFLyQGHUHFLpQ
QDFLGRVTXHUHTXLHUHUHDQLPDFLyQHVLQIHULRUD
(YLWDUODSHUGLGDGHFDORU
/DKLSRWHUPLDSRUSpUGLGDH[FHVLYDGHFDORU\RFHVHGHODSURGXFFLyQSRUKLSR[HPLD
RGp¿FLWGHHQHUJtDHVXQDFRQGLFLyQDGYHUVDSDUDORVUHFLpQQDFLGRV\HQHVSHFLDOORV
SUHWpUPLQRSRUVXLQPDGXUH]/DKLSRWHUPLDUHWUDVDODSULPHUDUHVSLUDFLyQHVSRQWiQHD
SXHGHDOWHUDUORVFDPELRV¿VLROyJLFRVGHODDGDSWDFLyQKHPRGLQiPLFDPDQWHQLHQGRXQ
UpJLPHQGHKLSHUWHQVLyQSXOPRQDUSHUVLVWHQWH\GHDFLGRVLVPHWDEyOLFD
3DUDPDQWHQHUODWHPSHUDWXUDHQWUH\GHEHHYLWDUVHTXHODVSpUGLGDVGHFDORU
SRUFRQYHFFLyQHYDSRUDFLyQFRQWDFWRHLUUDGLDFLyQH[FHGDQDODSURGXFFLyQHQGyJHQD
GHFDORU
8QDPDQLREUDSURWHFWRUDVHQFLOODHQHOPRPHQWRGHQDFHUHVSDVDUDOUHFLpQQDFLGR
GH ODV PDQRV GHO REVWHWUD \ VLQ VHFDUOR D XQD EROVD GH SROLHWLOHQR PDQWHQLHQGR OD
FDEH]DIXHUDGHODEROVD\FXEULpQGRODFRQXQDJRUUD
)DYRUHFHUHOSDVDMHGHVDQJUHHQORV~OWLPRVPLQXWRVGHODIXQFLyQSODFHQWDULD
'XUDQWHORVSULPHURVPLQXWRVGHYLGDVHGHEHHVSHUDUHOPRPHQWRRSRUWXQRSDUDSLQ]DU
HOFRUGyQXPELOLFDO
(OFHVHGHORVSXOVRVGHOFRUGyQXPELOLFDOHQHOODGRPDWHUQRPiVFHUFDQRDOSHULQp
LQGLFD TXH HO SDVDMH GH VDQJUH GHVGH OD SODFHQWD D WUDYpV GHO FRUGyQ DO FXHUSR GHO
UHFLpQ QDFLGR VH KD FRPSOHWDGR \ OD IXQFLyQ KD FHVDGR (O SLQ]DPLHQWR GHO FRUGyQ
XPELOLFDOGHEHUHDOL]DUVHHQHVWHPRPHQWR
/DWUDQVIXVLyQSODFHQWDULDFRPSOHWDDXPHQWDHOKHPDWRFULWRHQODVSULPHUDVKRUDVGH
YLGD\GLVPLQX\HHOULHVJRGHDQHPLDIHUURSpQLFDGHOODFWDQWH/RVSUHWpUPLQRVFX\R
FRUGyQ XPELOLFDO HV SLQ]DGR DQWHV GH ORV VHJXQGRV UHTXLHUHQ PD\RU Q~PHUR GH
WUDQVIXVLRQHVUHTXLHUHQPiVWUDWDPLHQWRSRUKLSRWHQVLyQ\WLHQHQPiVIUHFXHQFLDGH
KHPRUUDJLDLQWUDFUDQHDQD
/D REVHUYDFLyQ GHO FRUGyQ XPELOLFDO SXHGH UHDOL]DUVH HQ IRUPD VHJXUD \ VLQ ULHVJR
GH KLSRWHUPLD FXDQGR HO UHFLpQ QDFLGR IXH FRORFDGR GLUHFWDPHQWH GH ODV PDQRV GHO
REVWHWUDDXQDEROVDGHSROLHWLOHQR\HODPELHQWHVHHQFXHQWUDFDOHIDFFLRQDGR
/DSUiFWLFDKDELWXDOGHUHWLUDUHQIRUPDLQPHGLDWDDOUHFLpQQDFLGRSUHWpUPLQRH[WUHPR
SDUD VX PDQHMR HQ XQ OXJDU GLVWDQWH LPSOLFD OD VHFFLyQ GHO FRUGyQ XPELOLFDO (VWD
SUiFWLFDHVWiVLHQGRUHYLVDGDDOGHPRVWUDUVHTXHODOLJDGXUDHQWHVGHORVVHJXQGRV
\DXQDQWHVGHORVPLQXWRVHVSHUMXGLFLDO(OUHFLpQQDFLGRGHEHUiSHUPDQHFHUXQLGR
D VX PDGUH SRU HO FRUGyQ PiV WLHPSR PLHQWUDV OD FLUFXODFLyQ SODFHQWDULD ¿VLROyJLFD
SHUVLVWH
$SR\DU\PDQWHQHUHOLQLFLRGHODUHVSLUDFLyQSURFXUDQGRHOPi[LPRFRQIRUW
/RVPRYLPLHQWRVWRUiFLFRVLQVSLUDWRULRVVRQLQWHUPLWHQWHVHQODYLGDIHWDO\VHHVWDEOHFHQ
HQIRUPDFtFOLFDHQORVSULPHURVPLQXWRVGHYLGD,QPHGLDWDPHQWHDOQDFLPLHQWRHVRV
HVIXHU]RVLQVSLUDWRULRVLQLFLDQODYHQWLODFLyQDpUHD\SHUVLVWHLQLQWHUUXPSLGDPHQWHSDUD
WRGDODYLGD(QORVSUHWpUPLQRVPHQRVPDGXURVHVWDGLQiPLFDYHQWLODWRULDHVPHQRV
H¿FD]\SXHGHVHULQVX¿FLHQWHSRUODLQPDGXUH]GHOFHQWURUHVSLUDWRULRODGHELOLGDGGH
ODFDMDWRUiFLFD\P~VFXORVUHVSLUDWRULRV\SRUODWHQGHQFLDDOFRODSVRGHODYtDDpUHD
DVRFLDGRDOGp¿FLWGHVXUIDFWDQWH
8QD SUDFWLFD VLPSOH GH VRSRUWH YHQWLODWRULR HQ ORV SUHWpUPLQR GHVGH ODV SULPHUDV
UHVSLUDFLRQHVHVSRQWiQHDVHQVDODGHSDUWRVFRQVLVWHHQODDGPLQLVWUDFLyQSUHFR]SRU
YtDQDVDOXRURQDVDOGHXQÀXMRGHDLUHTXHORJUHXQDSUHVLyQFRQWLQXDHQODHVSLUDFLyQ
&3$3\PDQWHQJDORVDOYpRORVGLVWHQGLGRV6LHVQHFHVDULRVHSXHGHDSOLFDUYHQWLODFLyQ
DVLVWLGDFRQLQVXÀDFLRQHVFtFOLFDVFRQXQDIUHFXHQFLDLQLFLDOGHUSP
(OVRSRUWHYHQWLODWRULRKDHYROXFLRQDGRDIRUPDVTXHHYLWDQHOGDxRSRUXVRH[FHVLYR
LQWHJUDQGRODDGPLQLVWUDFLyQGHFRUWLFRLGHVDQWHQDWDOHVHOVRSRUWHLQLFLDOFRQ&3$3
QDVDOODDGPLQLVWUDFLyQSUHFR]GHVXUIDFWDQWHODYHQWLODFLyQFRQPtQLPRVSDUiPHWURV
\ODH[WXEDFLyQSUHFR]FXDQGRUHTXLULyLQWXEDFLyQRURWUDTXHDO$~QORVPiVSHTXHxRV
(*VHPSXHGHQDGDSWDUVHFRQPtQLPRDSR\RVLQUHTXHULULQWXEDFLyQWUDTXHDO
/RV FULWHULRV GH SHVR \ HGDG JHVWDFLRQDO XVDGRV WUDGLFLRQDOPHQWH SDUD SURFHGHU
D XQD LQWXEDFLyQ LQPHGLDWD HQ HO PRPHQWR GH QDFHU QR GHEHQ XVDUVH FRPR UXWLQD
&XDQGRVHGHFLGHODLQWXEDFLyQWUDTXHDOSDUDDGPLQLVWUDUVXUIDFWDQWHRLQFUHPHQWDUHO
DSR\RYHQWLODWRULRHOSURFHGLPLHQWRGHEHVHUKHFKRFRQODPi[LPDGHVWUH]DEUHYH\
SUHIHUHQWHPHQWHFRQXQSURWRFRORGHVHGRDQDOJHVLDXOWUDFRUWD
/D DVSLUDFLyQ GH OD RURIDULQJH \ ODV IRVDV QDVDOHV SURYRFD DSQHD \ EUDGLFDUGLD SRU
ORTXHGHEHWDPELpQDEDQGRQDUVHVXXVRUXWLQDULR(QORSUHWpUPLQRVWDPSRFRGHEH
OLPSLDUVHFRQDJXDODVDQJUHGHODSLHORGHOFXHURFDEHOOXGRSXHVIDYRUHFHODSpUGLGD
GHFDORU/DVPDQLREUDVGHH[SORUDFLyQGHODSHUPHDELOLGDGHVRIiJLFD\DQDOWDPELpQ
SURYRFDQEUDGLFDUGLDSRUHVWLPXODFLyQYDJDO\QRGHEHQVHUUXWLQDULDV/DREVHUYDFLyQ
FULWHULRVDGHODDGDSWDFLyQSHUPLWHVHOHFFLRQDUDTXHOORVUHFLpQQDFLGRVTXHUHTXLHUHQ
GLFKD PDQLREUDV 3RU HMHPSOR SROLKLGUDPQLRV H[FHVR GH VDOLYDFLyQ LPSHUIRUDFLyQ
DQDODXVHQFLDGHGHSRVLFLyQPHFRQLDOHQSULPHUDVKRUDV
&RQWURODUHODSRUWHGH2VXSOHPHQWDULR
/DHYDOXDFLyQGHODR[LJHQDFLyQQHRQDWDOSUHVHQWDGL¿FXOWDGHVHQORVSULPHURVPLQXWRV
GHYLGDHLQGXFHIUHFXHQWHPHQWHDHUURUHV\XVRH[FHVLYRGHR[LJHQR/DFLDQRVLVHQ
ORV SULPHURV PLQXWRV GH YLGD HV ¿VLROyJLFD SXHV OD VDWXUDFLyQ GH R[LJHQR GHPRUD
KDVWDPLQXWRVSDUDOOHJDUDOHQORVQDFLGRVQRUPDOHVPD\RUHVGHVHPDQDV
TXHUHVSLUDQDLUH1RHVSRVLEOHGLIHUHQFLDUODKLSR[HPLD¿VLROyJLFDGHODYLGDIHWDO\
GHORVSULPHURVPLQXWRVGHDGDSWDFLyQGHORVYDORUHVGHKLSR[HPLDGHODDV¿[LD/D
SUHVHQFLDGHDSQHD\EUDGLFDUGLDSHUVLVWHQWHSHUPLWHQUHDOL]DUHOGLDJQyVWLFRGHDV¿[LD
QHRQDWDO
(Q HO SUHWpUPLQR TXH PDQWLHQH XQD IUHFXHQFLD FDUGtDFD QRUPDO \ GHELGR D OD
FRQFHQWUDFLyQGHKHPRJORELQDIHWDO\VXD¿QLGDGSRUHO2VHVXJLHUHPDQWHQHUOD6D2
HQWUH\SDUDDVHJXUDUXQDR[HPLDDGHFXDGD
(O XVR GH R[tJHQR HQ HO PRPHQWR GHO QDFLPLHQWR HV XQD SUiFWLFD PX\ IUHFXHQWH \
D YHFHV HV OD ~QLFD XVDGD SDUD OD UHDQLPDFLyQ GH XQ UHFLpQ QDFLGR 6LQ HPEDUJR
KR\H[LVWHQSUXHEDVVX¿FLHQWHVTXHLQGLFDQTXHQRHVQHFHVDULRHOXVRGHR[LJHQR
DGLFLRQDOHQWRGRVORVUHFLpQQDFLGRVHQDSQHDTXHUHTXLHUHQUHDQLPDFLyQ7DPELpQ
VHVDEHTXHHOR[LJHQRSXHGHWHQHUHIHFWRVDGYHUVRVGHVGHXQUHWDUGRHQHOLQLFLRGH
ODYHQWLODFLyQHVSRQWiQHDDGDxRVWLVXODUHVSRUWR[LFLGDGGHOR[LJHQRRGHVXVUDGLFDOHV
OLEUHVHQVLWXDFLyQGHSRVWKLSR[LDRKLSHUR[LD
/DDGPLQLVWUDFLyQGHR[LJHQRDGLFLRQDOGHEHUtDOLPLWDUVHDORVTXHSHUPDQHFHQFLDQyWLFRV
OXHJRGHORVSULPHURVPLQXWRVRHQORVTXHODPHGLFLyQGHOD6D2SRUR[LPHWUtDGH
SXOVRUHYHODYDORUHVLQIUD¿VLROyJLFRV(OXVRDGLFLRQDOGH2[tJHQR)L2!HQYH]
GHDLUHGXUDQWHODLQVXÀDFLyQSXOPRQDUGHORVQDFLGRVPD\RUHVGHVHPDQDVGHHGDG
JHVWDFLRQDOQRGHEHUtDLQLFLDUVHVLHVVX¿FLHQWHODYHQWLODFLyQFRQDLUH
(O XVR GH OD VDWXURPHWUtD GH SXOVR SDUD GHWHUPLQDU OD 6DWXUDFLyQ GH 2[LJHQR HQ OD
VDQJUHHVXQDWpFQLFDQRLQYDVLYDH[WUHPDGDPHQWHYDOLRVDSDUDDGHFXDUHODSRUWH
GHR[LJHQRDODVQHFHVLGDGHVGHOUHFLpQQDFLGR(VWDWHFQRORJtDHVWDVLHQGRFDGDYH]
PiVDFFHVLEOHSRUHOGHVDUUROORGHPRGHORVVLPSOHV\HFRQyPLFRVTXHVRQQHFHVDULRV
WDPELpQSDUDHOPDQHMRGHRWUDVVLWXDFLRQHVPX\IUHFXHQWHVHQORVVHUYLFLRVGHVDOXG
FRPR ODV HQIHUPHGDGHV FRQ LQVX¿FLHQFLD UHVSLUDWRULD GH QLxRV \ DGXOWRV DVt FRPR
SDUDODPHMRUYLJLODQFLDGXUDQWHODDQHVWHVLDJHQHUDO
7DPELpQ VRQ QHFHVDULRV ORV PH]FODGRUHV GH DLUH \ R[LJHQR TXH SHUPLWHQ HQWUHJDU OD
FRQFHQWUDFLyQGH2[LJHQRQHFHVDULDDVtFRPRORVVLVWHPDVTXHUHJXODQODKXPHGDG\OD
WHPSHUDWXUDGHODPH]FODHYLWDQGRGDxRDODPXFRVDGHODYtDDpUHDVXSHULRU
(648(0$3$5$(/&8,'$'2&217,182'(/5(&,e11$&,'235(7e50,12
'(6'((/35,0(50,1872'(9,'$
7LHPSR 2EMHWLYRV
GHYLGD
HUPLQXWR &RQVHUYDUHOFDORU\ODKXPHGDG%ROVDGHSROLHWLOHQR±JRUUR
)DYRUHFHUHOSDVDMHGHVDQJUHGHODSODFHQWDDOFXHUSRGHO513LQ]DGRXPELOLFDODOFHVH
GHOSXOVRGHODVDUWHULDVXPELOLFDOHV
2EVHUYDUHOLQLFLRGHODUHVSLUDFLyQFRQVLGHUDU&3$3SUR¿OiFWLFRRGHUHVFDWHSUHLQWXEDFLyQ
HQGRWUDTXHDO
$VLVWLU OD LQVX¿FLHQFLD YHQWLORUHVSLUDWRULD FRQ HTXLSDPLHQWR VHJXUR HYLWDQGR H[FHVR GH
SUHVLyQ
(YLWDUXVRLQQHFHVDULRGH2DGLFLRQDOHQORVSULPHURVPLQXWRV\YDORUHVSRVWHULRUHVGH
6D2VXSHULRUHVD
$VSLUDU OD YtD DpUHD VXSHULRU VROR SDUD YLVXDOL]DU JORWLV HQ LQWXEDFLyQ R H[WUDFFLyQ GH
PHFRQLRHQDVItFWLFRVVHYHURV
1RH[SORUDUSHUPHDELOLGDGHVRIiJLFD\DQDOGHUXWLQD
*DUDQWL]DU LGHQWL¿FDFLyQ FRQ VX PDGUH \ HO OLEUH DFFHVR D VX OXJDU GH LQWHUQDFLyQ VL VH
UHTXLHUHVHSDUDUORV
HUGtD 0DQWHQHUKXPHGDGDPELHQWDO\WHPSHUDWXUDFXWiQHDHQWUHD&
6LHVQHFHVDULRDGPLQLVWUDU6XUIDFWDQWHKDFHUORGHLQPHGLDWRHQODVSULPHUDVKRUDV
&3$3SUHFR]
,QWXEDFLyQ VROR SDUD DGPLQLVWUDU VXUIDFWDQWH R SRU EUHYHV SHULRGRV GH YHQWLODFLyQ LQLFLDO
SURFXUDQGRH[WXEDFLyQWHPSUDQtVLPD
(YLWDU XVR LQQHFHVDULR GH 2 DGLFLRQDO FRQ YDORUHV GH 6D2 VXSHULRUHV D ,QLFLDU
VXSOHPHQWRGH2VRORFRQYDORUHVGH6D2LQIHULRUHVD
$OLPHQWDFLyQSDUHQWHUDOSUHFR]$PLQRiFLGRVDJ.JGtD*OXFRVD!PJ.JPLQ
(YDOXDUHOLQLFLRGHODDOLPHQWDFLyQHQWHUDOFRQOHFKHKXPDQDH[FOXVLYDPHQWH
(YDOXDUODKHPRGLQDPLD\GHFLGLUUHTXHULPLHQWRVGHDSR\R
3UHYHQLU LQIHFFLRQHV 0LQLPL]DU PDQLSXODFLyQ \ H[WUHPDU DVHSVLD HQ PDQLREUDV
LQYDVLYDV
3URWRFRORUHVWULFWLYRGHH[WUDFFLyQGHVDQJUHSDUDODERUDWRULR
$WHQGHU QHFHVLGDGHV HPRFLRQDOHV PDWHUQDV \ HVWDEOHFHU FRPXQLFDFLyQ \ GLVSRQLELOLGDG
FRQODIDPLOLD
,QLFLDUDSR\RPDWHUQRSDUDODFWDQFLD
HUD 5HFRQVLGHUDUSHUPDQHQWHPHQWHODVQHFHVLGDGHVGH$90\2SURFXUDQGRODH[WXEDFLyQ
VHPDQD WHPSUDQtVLPD
,QLFLDU\DXPHQWDUDOLPHQWDFLyQHQWHUDOLQLFLRKVWUy¿FD±FRQDXPHQWRP/.JGtD
&RQVLGHUDU GD RSLQLyQ VLHPSUH TXH VH SODQWHH UHGXFLU R VXVSHQGHU DSRUWH HQWHUDO (M
$SDULFLyQGHUHVLGXDOJiVWULFR\VRVSHFKDGHSDWRORJtDGLJHVWLYD
$YDQ]DUVLQSDXVDVHODSRUWHSDUHQWHUDOREMHWLYRFDOyULFRFDONGtD
0RQLWRUHRHVWULFWRGHOEDODQFHKtGULFR\FDOyULFRPLQLPL]DQGRHOGp¿FLWDFXPXODGRHQOD
SULPHUDVHPDQD
*UD¿FDULQFUHPHQWRGHSHVRHQUHODFLyQDHVWiQGDUHVGHFUHFLPLHQWRIHWDO\SRVWQDWDO
3UHYHQLULQIHFFLRQHVPLQLPL]DULQYDVLYLGDG\PDQLSXODFLyQ
'HWHUPLQDUQHFHVLGDGHVGHFXLGDGRVPDWHUQRV\VDWLVIDFHUVXVDVSLUDFLRQHVGHSDUWLFLSDFLyQ
HQORVFXLGDGRV
)DFLOLWDUODH[WUDFFLyQGHOHFKHPDWHUQD\VXXVRIUHVFR
HUPHV *UD¿FDULQFUHPHQWRGHSHVRHQUHODFLyQDHVWiQGDUIHWDO\SRVWQDWDO
$YDQ]DU QXWULFLyQ HQWHUDO VHJ~Q UHVXOWDGRV HQ FUHFLPLHQWR PD[LPL]DU SRVLELOLGDGHV
FDOyULFDVIRUWL¿FDGRUFUHPDWRFULWR
,QLFLDUDSRUWHGHKLHUUR
3UHYHQLULQIHFFLRQHVLQYDVLYLGDGQXODKLJLHQHGHPDQRVFRQDOFRKROJHO
0DQWHQHUH[WUDFFLyQGHOHFKHPDWHUQD\SURYLVLyQRUDOGHOHFKHIUHVFD
7DPL]DMHV&RQWUROGH523GtDV!VHPDQDV
6DWLVIDFHUGLDULDPHQWHODSDUWLFLSDFLyQPDWHUQDHQUHODFLyQFRQODVQHFHVLGDGHVGHDPERV
FRPSDxtDKLJLHQHDOLPHQWDFLyQDPDPDQWDPLHQWR
9DORUDUGHSUHVLyQPDWHUQDDORVGtDV\QHFHVLGDGGHDSR\RSVLFRVRFLDODGLFLRQDO
2EMHWLYR ,GHQWL¿FDUDOUHFLpQQDFLGR
$FWLYLGDG )DFLOLWDU TXH OD PDGUH OR LGHQWL¿TXH \ FXPSOLU ORV UHTXLVLWRV
ORFDOHVGHLGHQWL¿FDFLyQDOQDFHU
/DLGHQWL¿FDFLyQGHOUHFLpQQDFLGRWLHQHFRPRREMHWLYRTXHVHDVHJXUHHOYLQFXOR¿OLDWRULR
HQWUHODPDGUH\HOUHFLpQQDFLGR'HDFXHUGRDORVUHTXLVLWRVORFDOHVVHXWLOL]DUiQORV
HOHPHQWRV FRUUHVSRQGLHQWHV TXH SXHGHQ LQFOXLU HO UHJLVWUR GH ODV KXHOODV GDFWLODUHV
GHDPERVRVLPSOHPHQWHODFRORFDFLyQGHXQDEDQGDLGHQWL¿FDWRULDFRQHOQRPEUHR
FyGLJRTXHORVLGHQWL¿TXHDDPERV
(QWRGRVORVFDVRVVHGHEHSURFXUDUTXHODPDGUHYHD\WHQJDDVXKLMRHQHOPD\RU
JUDGRGHSUR[LPLGDGSRVLEOH\SRUHOWLHPSRTXHHOODGHVHH\ORSHUPLWDODFRQGLFLyQ
GHOUHFLpQQDFLGR
(VWH DFHUFDPLHQWR LQPHGLDWR DO QDFLPLHQWR HV XQ GHUHFKR \ OD VHSDUDFLyQ SRVWHULRU
VRORVHMXVWL¿FDSRUODQHFHVLGDGGHFXLGDGRVHVSHFLDOHVGHDPERVRSRUODRSFLyQGH
ODPDGUHTXHVROLFLWHD\XGDSDUDFXLGDUOR
2EMHWLYR (YDOXDUHOFUHFLPLHQWR\HOGHVDUUROORIHWDODOQDFHU
$FWLYLGDG 5HDOL]DUDQWURSRPHWUtD\YDORUDUODVHJ~QODHGDGJHVWDFLRQDO\
YDORUDUODVIXQFLRQHVGHDGDSWDFLyQ
'XUDQWHHOFRQWURODQWHQDWDOHOFUHFLPLHQWRIHWDOSXHGHVHUHVWLPDGRSRUODVPHGLFLRQHV
LQGLUHFWDVGHOWDPDxRIHWDOODDOWXUDXWHULQD\ODDQWURSRPHWUtDIHWDOSRUHFRJUDItD
$OQDFHUHOWDPDxRHVGHWHUPLQDGRFRQSUHFLVLyQPHGLDQWHWUHVPHGLGDVVLPSOHVSHVR
ORQJLWXG \ SHUtPHWUR FHIiOLFR 'HO DQiOLVLV GH ODV PHGLGDV DQWHQDWDOHV \ SRVWQDWDOHV
SXHGHGHGXFLUVHFRPRIXHHOFUHFLPLHQWRIHWDO
3DUDHYDOXDUHOFUHFLPLHQWR\HOGHVDUUROORGHOUHFLpQQDFLGRGHEHFRPSDUDVHFRQHO
GHODSREODFLyQQRUPDODODPLVPDHGDGJHVWDFLRQDO3RUHVHPRWLYRHVLPSUHVFLQGLEOH
UHDOL]DUXQFRUUHFWRFiOFXORGHODHGDGJHVWDFLRQDOHQHOPRPHQWRGHOQDFLPLHQWR(O
PLVPRVHEDVDUiIXQGDPHQWDOPHQWHHQHOPHMRUFRQRFLPLHQWRGHODIHFKDGHOD~OWLPD
PHQVWUXDFLyQ\VXFRQ¿DELOLGDGUHJLVWUDGDGXUDQWHODJHVWDFLyQ
&iOFXORGHOD(GDG*HVWDFLRQDO
/DHGDGJHVWDFLRQDOVHFDOFXODSRUODGLIHUHQFLDHQWUHODIHFKDGHOSULPHUGtDGHOD~OWLPD
PHQVWUXDFLyQ\HOGtDGHODHYDOXDFLyQ(VQHFHVDULRFDOFXODUODHOGtDGHOQDFLPLHQWRR
GXUDQWHODDWHQFLyQQHRQDWDO
/DPD\RUXWLOLGDGGHOD(GDG*HVWDFLRQDOHVHQHOPRPHQWRGHGHFLGLUODRSRUWXQLGDGGH
QDFLPLHQWR/XHJRGHQDFHUFDGDUHFLpQQDFLGRVHYDORUDGHDFXHUGRDODVFDSDFLGDGHV
LQGLYLGXDOHVGHDGDSWDFLyQDODYLGDH[WUDXWHULQD
(QFDVRTXHH[LVWDQGXGDVVREUHOD)80HOFiOFXORSXHGHEDVDUVHHQODIHFKDGHOD
SULPHUDHFRJUDItD9HUFiOFXORHGDGJHVWDFLRQDO
(VWLPDFLyQGHOD(GDG*HVWDFLRQDO
3UHYLRDOGHVDUUROORGHODDQWURSRPHWUtDHFRJUi¿FDIHWDOVHXWLOL]DEDQODVFDUDFWHUtVWLFDV
VRPiWLFDV GHO UHFLpQ QDFLGR SDUD OD HVWLPDFLyQ GH OD HGDG JHVWDFLRQDO 0pWRGRV
GH 'XERZLW] %DOODUG R &DSXUUR (VWDV HVWLPDFLRQHV WLHQHQ XQD JUDQ YDULDELOLGDG
VHPDQDVTXHHVDXQPD\RUHQORVSUHWpUPLQR\HQORVUHFLpQQDFLGRVFRQUHVWULFFLyQ
GHFUHFLPLHQWRLQWUDXWHULQR
(VWRVPpWRGRVQRWLHQHQXWLOLGDGFOtQLFD\DTXHFDUHFHQGHSUHFLVLyQVX¿FLHQWHSDUD
RULHQWDUODDWHQFLyQGHHVRVUHFLpQQDFLGRV
3URSXHVWDVLPSOHSDUDHVWLPDFLyQUiSLGDHQSUHWpUPLQRV
&XDQGRVHSURGXFHXQQDFLPLHQWRDQWHVGHODVVHPDQDVODPHGLGDGHO3HUtPHWUR
&UDQHDQR3&DOQDFHUHVXQDPHGLGDGHVLPLODUYDORUTXHODREWHQLGDSRUHFRJUDItD
REVWpWULFD SUHFR] 3RU OR WDQWR VL QR VH FRQRFH OD )80 SRGUtD XVDUVH HO 3& HQ OD
HVWLPDFLyQGHODHGDGJHVWDFLRQDO
/D&LQWD1HRQDWDOGH&/$3605WLHQHORVYDORUHVPHGLRVGH3HUtPHWUR&UDQHDQRSDUD
FDGD(GDG*HVWDFLRQDO
&XDQGRVHGHVFRQRFHOD)80\QRKD\XQDPHGLGDHFRJUi¿FDSUHYLDGHOWDPDxRGHOD
FDEH]DIHWDORGHOIpPXUIHWDOVHSXHGHWRPDUODPHGLGDGHO3&SDUDLQLFLDUORVFiOFXORV
GH(*DSDUWLUGHHVDIHFKD6HFRQRFHODGLVWULEXFLyQGHORVYDORUHVGH(*SDUDFDGD
YDORUGH3HUtPHWUR&UDQHDQR
3RU(M6LVDEHPRVTXHSDUDORVQDFLGRVFRQ3& FPHOSGH(* VHPDQDV

HOSGH(* VHPDQDV\HOSGH(* VHPDQDV3RGHPRVHVWLPDUTXHOD(GDG
*HVWDFLRQDOGHOTXHWLHQH3& FPHVGHVHPDQDV
'DGRTXHHO3HUtPHWUR&UDQHDQRHQWUHODV\ODVVHPDQDVFUHFHDSUR[LPDGDPHQWH
FPSRUVHPDQDXQDUHJODVLPSOHSDUDODHVWLPDFLyQUiSLGDGHOD(GDG*HVWDFLRQDO
HVVXPDUOHDOYDORUGHOSHUtPHWURFUDQHDQR
3RU(M/DPHGLDGH(*GHORVUHFLpQQDFLGRVFRQXQ3& FPHVVHPDQDV
$1752320(75,$1(21$7$/
3HVRDOQDFHU
(VHOSULPHUSHVRGHVQXGRPHGLGROXHJRGHODVHFFLyQ
\SLQ]DGRGHOFRUGyQXPELOLFDO&XDQGRHOFRUGyQHV
SLQ]DGRSUHFR]PHQWHHOSHVRQHRQDWDOSXHGHVHUKDVWD
PHQRUTXHFXDQGRVHSLQ]DDO¿QDOL]DUHOSDVDMHGH
VDQJUHGHVGHODSODFHQWD\DTXHHOYROXPHQGHVDQJUH Figura 109.
WUDQVIXQGLGRSXHGHVHUPD\RUGHJUDPRV Fragmento de HCP. Datos RN
/RQJLWXG
/DORQJLWXGFpIDORSODQWDUVHPLGHFRQXQSHGLyPHWURFRQHOUHFLpQQDFLGRDFRVWDGR
SODQRHQGHF~ELWRGRUVDOPDQWHQLHQGRXQPLHPEURLQIHULRUH[WHQGLGR6HPLGHHQ
FHQWtPHWURVFRQXQGHFLPDO
3HULPHWURFHIDOLFR
(OSHUtPHWURFHIiOLFRWDPELpQGHQRPLQDGRFLUFXQIHUHQFLDFUDQHDQDVHPLGHHQHOSODQR
Pi[LPR RFFtSLWR IURQWDO 6H FRORFD OD FLQWD PpWULFD DOUHGHGRU GH OD FDEH]D PLHQWUDV
VH OD VRVWLHQH VREUH OD IUHQWH (Q HO Pi[LPR SHUtPHWUR OD FLQWD DMXVWDGD GHEH SRGHU
GHVOL]DUVHVREUHHORFFLSLWDO
)LJXUD
7(&1,&$6'(0(','$
3HUtPHWUR&UDQHDQR
3HUtPHWURGHOEUD]R
/RQJLWXG
3HVRSDUDODHGDGJHVWDFLRQDO
$OQDFHUVHSXHGHGHWHUPLQDUVLHOSHVRHV$GHFXDGR3HTXHxRR*UDQGHSDUDOD(GDG
*HVWDFLRQDO 3DUD HOOR VH OH FRPSDUD FRQ ORV SHUFHQWLOHV \ GH OD SREODFLyQ
SDUDFDGDVHPDQDGHJHVWDFLyQ3HTXHxRVVRQORVTXHQDFHQSRUGHEDMRGHOS
$GHFXDGRVHQWUHHOS\S\*UDQGHVSRUHQFLPDGHOS(VWRVYDORUHVVHSXHGHQ
HQFRQWUDUHQHOJHVWRJUDPD)LJODFLQWDREVWpWULFD\ODFLQWDQHRQDWDO
([LVWHQGRVWLSRVGHIDFWRUHVTXHSXHGHQLQÀXLUVREUHHOSDWUyQGHFUHFLPLHQWR
ORVGHRULJHQFRQVWLWXFLRQDORJHQpWLFRLQGHSHQGLHQWHPHQWHGHODRIHUWDQXWULFLRQDO\
ODVSDWRORJtDVTXHVHDVRFLDQDUHVWULFFLyQXH[FHVRGHODWDVDGHFUHFLPLHQWR
2EMHWLYR $GHFXDUHOPDQHMRLQLFLDOGHORVUHFLpQQDFLGRVFRQGHIHFWRV
FRQJpQLWRVPD\RUHV

$FWLYLGDG ,QVWDXUDUHQIRUPDSUHFR]ODVPHGLGDVHVSHFt¿FDVSDUDFDGD
GHIHFWR
/RVGHIHFWRVFRQJpQLWRVVRQXQDGHODVFDXVDVGHPXHUWHQHRQDWDOTXHSHUVLVWHQFRQ
PHQRVGHVFHQVRUHODWLYR/DIRUPDPDVH¿FLHQWHGHGLVPLQXLUODPRUWDOLGDGQHRQDWDOSRU
GHIHFWRVFRQJpQLWRVHVODSUR¿OD[LV\SUHYHQFLyQSUHFRQFHSFLRQDOLGHQWL¿FDQGRIDFWRUHV
GHULHVJR\DFWXDQGRVREUHHOORVSDUDGLVPLQXLUHQIRUPDGLUHFWDRLQGLUHFWDORVIDFWRUHV
GHWHUPLQDQWHVFRPRVHDQDOL]DGHWHQLGDPHQWHHQHOFDSLWXORFRUUHVSRQGLHQWH
&XDQGRHOGHIHFWRFRQJpQLWRIHWDOLPSLGHODDXWRQRPtDUHVSLUDWRULDVXPXHUWHSRVWQDWDO
LQPHGLDWDHVDQWLFLSDEOHFRUUHVSRQGHDVLVWLUORHQIRUPDFRPSDVLYDEULQGiQGROHFRQIRUW
DOQHRQDWR\DSR\RHPRFLRQDODVXVSDGUHV
)UHQWHDODQRWLFLDGHTXHVXKLMRYDDQDFHUFRQXQGHIHFWRODIDPLOLDFXUVDHWDSDV
HPRFLRQDOHVVLPLODUHVDODVGHVFULWDVSDUDHOGXHORXRWUDVSpUGLGDV
/D FRPXQLFDFLyQ FRQ ORV SDGUHV VREUH VX UHFLpQ QDFLGR \ HO GHIHFWR FRQJpQLWR TXH
SUHVHQWDUHTXLHUHPDVGLVSRQLELOLGDGDIHFWLYDGHTXLHQHVORVDWLHQGHQ4XLHQGHODQRWLFLD
DFRPSDxH D OD IDPLOLD GHVGH HVH PRPHQWR R GHED WRPDU GHFLVLRQHV DVLVWHQFLDOHV
GHEHHVWDUFDSDFLWDGR\WHQHUFRQTXLHQFRPSDUWLUODGLItFLOWDUHDGHDFRPSDxDUDHVD
IDPLOLDSRUSHUtRGRVODUJRV
/RV UHODWRV DQWHQDWDOHV ODV LPiJHQHV \ H[SOLFDFLRQHV TXH GLVSRQHQ ORV SDGUHV OHV
SHUPLWHQFRPSUHQGHUHOGHIHFWRSHURHQJHQHUDOQRSXHGHQLPDJLQDUVHQLFHQWUDUVX
DWHQFLyQHQODSDUWHQRUPDOGHVXKLMR(QHOPRPHQWRGHOQDFLPLHQWRORTXHORVSDGUHV
YHDQ SXHGH VHU GLIHUHQWH GH OR TXH ORV PpGLFRV \ HO SHUVRQDO GH VDOXG YHQ 3DUD HO
SHUVRQDOGHVDOXGSXHGHUHVXOWDULQHVSHUDGRTXHORVSDGUHVYHDQDVXKLMRGHIRUPD
GLIHUHQWH (V FRP~Q TXH VL VH OHV PXHVWUD HO UHFLpQ QDFLGR FRQ HO GHIHFWR FXELHUWR
ORV SDGUHV YHDQ XQD SDUWH KDVWD HVH PRPHQWR LQLPDJLQDEOH GH VX KLMR$~Q HQ ODV
VLWXDFLRQHVH[WUHPDVGHXQUHFLpQQDFLGRFRQDQHQFHIDOLDODSUDFWLFDGHPRVWUDUORFRQ
HOFUiQHRFXELHUWRSHUPLWHDORVSDGUHVUHFRUGDUDVXKLMRTXHSRVWHULRUPHQWHIDOOHFHGH
XQDIRUPDPDVKXPDQD
&XDQGR ORV GHIHFWRV FRQJpQLWRV QR LPSOLFDQ XQ SURQyVWLFR YLWDO LQH[RUDEOH \ H[LVWHQ
RSRUWXQLGDGHVGHWUDWDPLHQWRHOPDQHMRQHRQDWDOGHEHFRPHQ]DUHQHOPLVPRPRPHQWR
GHOQDFLPLHQWR
2QIDORFHOH\JDVWURTXLVLV
/RVGHIHFWRVGHFLHUUHGHODSDUHGDEGRPLQDOVHPDQL¿HVWDQSRUSURWUXVLyQGHYtVFHUDV
DEGRPLQDOHV D WUDYpV GH XQD DSHUWXUD RQIDORFHOH R DG\DFHQWH DO FRUGyQ XPELOLFDO
JDVWURTXLVLV 6X LQFLGHQFLD HV GH HQ D 51 YLYRV 3XHGHQ QDFHU SRU
YtDYDJLQDORFHViUHD\GHVGHHOQDFLPLHQWRVHSXHGHSURWHJHUPHGLDQWHXQDVRQGD
QDVRJiVWULFDFRQDVSLUDFLyQVXDYHSDUDGHJUDYLWDU\SUHYHQLUODGLODWDFLyQGHODVDVDV
LQWHVWLQDOHV(OVDFRRODVYtVFHUDVGHEHQVHUFXELHUWDVFRQXQDEROVDSOiVWLFDHVWpULO
TXHHYLWDSpUGLGDVGHFDORU\OtTXLGR(OUHFLpQQDFLGRGHEHSHUPDQHFHUHQGHF~ELWR
ODWHUDOSDUDHYLWDUHODFRGDPLHQWRGHOLQWHVWLQRTXHDOWHUDVXLUULJDFLyQ6XUHSDUDFLyQ
TXLU~UJLFD QR HV QHFHVDULDPHQWH XQD HPHUJHQFLD LQPHGLDWD DO QDFLPLHQWR \ SXHGH
VHUFRRUGLQDGD XQDYH]HVWDELOL]DGR RWUDVODGDGR DXQQLYHO GH UHIHUHQFLD TXLU~UJLFD
HVSHFLDOL]DGD

0LHORPHQLQJRFHOH
(VXQGHIHFWRGHFLHUUHyVHRGHODFROXPQDYHUWHEUDOTXHH[SRQHXQVDFRGHDUDFQRLGHV
\GXUDPDGUHFXELHUWDRQRGHSLHOFRQOtTXLGRFHIDORUUDTXtGHRHQVXLQWHULRU\PpGXOD
PDOIRUPDGD
6XLQFLGHQFLDHVGHDSRUUHFLpQQDFLGRVYLYRV
$OQDFHUVHGHEHFRORFDUiDOUHFLpQQDFLGRHQGHF~ELWRSURQRSDUDSUHYHQLUOHVLRQHV
GHODSODFD\VHFXEUHFRQFXUDFLyQHVWpULOSUHYLDGHVLQIHFFLyQFRQDQWLVpSWLFRGHOD
SLHOVDQDTXHURGHDDOGHIHFWR6HFXEUHFRQSROLHWLOHQRHVWpULOTXHVHVRVWLHQHFRQWHOD
DGKHVLYDHQORVERUGHVVREUHSLHOVDQD6LQRVHGLVSRQHGHOiPLQDGHSROLHWLOHQRHVWpULO
VHSXHGHFXEULUFRQJDVDFRQYDVHOLQDHVWpULOSDUDTXHQRVHDGKLHUDDODSODFD
+HUQLDGLDIUDJPiWLFD
(VXQDIDOODHQHOFLHUUHQRUPDOGHORVSOLHJXHVSOHXURSHULWRQHDOHVTXHSURYRFDXQ
RUL¿FLRGLDIUDJPiWLFRSRUHOFXDODVFLHQGHQYtVFHUDVDEGRPLQDOHVDOWyUD[6XLQFLGHQFLD
HV GH HQ UHFLpQ QDFLGRV YLYRV (O HV D L]TXLHUGD HO D GHUHFKD \
HOHVELODWHUDO6HPDQL¿HVWDSRUGL¿FXOWDGUHVSLUDWRULDGHLQVWDODFLyQLQPHGLDWD\
SURJUHVLYDGHVGHHOQDFLPLHQWR
6LUHTXLHUHDSR\RYHQWLODWRULRGHEHKDFHUSRULQWXEDFLyQHQGRWUDTXHDOSXHVODYHQWLODFLyQ
SRU PDVFDUD SXHGH LQVXÀDU HO WXER GLJHVWLYR LQWUDWyUDFLFR \ DXPHQWDU OD UHVWULFFLyQ
YHQWLODWRULD
/DFRORFDFLyQGHXQDVRQGDQDVRJiWULFDFRQDVSLUDFLyQVXDYHFRQWULEX\HDGHJUDYLWDU
HOWXERGLJHVWLYRKDVWDODUHSDUDFLyQTXLU~UJLFDGHOGHIHFWR
/DPDJQLWXGGHOGHIHFWRHVSURSRUFLRQDODVXJUDYHGDG\FRQGLFLRQDHQODYLGDIHWDOHO
FUHFLPLHQWRSXOPRQDUFXUVDQGRDOQDFLPLHQWRFRQVHYHUDKLSHUWHQVLyQSXOPRQDUTXH
FRQGLFLRQDVXVREUHYLGD5HTXLHUHXQFXLGDGRFRQWLQXRHQOXJDUGHPi[LPDFRPSOHMLGDG
DVLVWHQFLDO
2EMHWLYR 'HWHWDUGHIHFWRV\RHQIHUPHGDGHVFRQJpQLWDV
DVLQWRPiWLFDV
$FWLYLGDG 'HWHFFLyQVLVWHPiWLFDHQHOSHUtRGRQHRQDWDOSRUPpWRGRVGH
ODERUDWRULRELRFOtQLFR
(O PRPHQWR GH QDFHU HV XQD RSRUWXQLGDG SDUD GLVPLQXLU

HO GDxR TXH SXHGHQ SURGXFLU FLHUWDV HQIHUPHGDGHV
FRQJpQLWDV DVLQWRPiWLFDV TXH GHEHQ VHU WUDWDGDV GH
LQPHGLDWR 3DUD GHWHFWDUODV SUHFR]PHQWH HV QHFHVDULR
UHDOL]DU SURFHGLPLHQWRV GLDJQyVWLFRV HQ IRUPD VLVWHPiWLFD
D ORV UHFLpQ QDFLGRV /D GHWHFFLyQ VLVWHPiWLFD SXHGH VHU
³XQLYHUVDO´ FXDQGR HVWi LQGLFDGD SDUD WRGRV ORV UHFLpQ Figura 111.
QDFLGRV R ³VHOHFWLYD´ HQ DTXHOODV HQIHUPHGDGHV TXH VROR Fragmento HCP.
DIHFWDQ D UHFLpQ QDFLGRV FRQ IDFWRUHV GH ULHVJR SRFR Tamizaje neonatal
IUHFXHQWHVHQODSREODFLyQJHQHUDO
(OWDPL]DMHQHRQDWDOXQLYHUVDOVHUHDOL]DDWRGRVORVUHFLpQQDFLGRV\HQPXFKRVSDtVHV
GH$PpULFD/DWLQDHVWDHVWDEOHFLGRSDUDODVVLJXLHQWHVSDWRORJtDV
(QIHUPHGDGHVLQIHFFLRVDVGHWUDQVPLVLyQYHUWLFDO
6t¿OLV
7R[RSODVPRVLV
(QIHUPHGDGHVQRLQIHFFLRVDV
+LSRWLURLGLVPR IHQLOFHWRQXULD ¿EURVLV TXtVWLFD GH SiQFUHDV JDODFWRVHPLD
KLSHUSODVLD VXSUDUUHQDO FRQJpQLWD GH¿FLHQFLD GH ELRWLQLGDVD UHWLQRSDWtD GHO
SUHPDWXUR&KDJDV
(O WDPL]DMH QHRQDWDO VHOHFWLYR VH UHDOL]D VRODPHQWH D DOJXQRV UHFLpQ QDFLGRV FRQ
IDFWRUHVGHULHVJRHOHYDGRV\HQPXFKRVSDtVHVGH$PpULFD/DWLQDHVWDHVWDEOHFLGR
SDUDODVVLJXLHQWHVSDWRORJtDV
(QIHUPHGDGHVGHWUDQVPLVLyQYHUWLFDO
+HSDWLWLV%HQPDGUHV+%9SRVLWLYDV
+,9HQPDGUHV+,9SRVLWLYDV
(VWUHSWRFRFR *UXSR%HQ PDGUHV SRUWDGRUDV HQHO PRPHQWR GHO SDUWR RUHFLpQ
QDFLGRVFRQIDFWRUHVGHULHVJR
7ULSDQRVRPD&UX]LHQPDGUHV&KDJiVLFDV
(QIHUPHGDGHVQRLQIHFFLRVDV
5KVLODPDGUHHV5KQHJDWLYDLQPXQL]DGDRQR
$QHPLDIDOFLIRUPHVLORVSDGUHVVRQDIURGHVFHQGLHQWHV
5HWLQRSDWtDVHYHUDGHOSUHPDWXURVLHVGH0X\%DMR3HVR
6,),/,6&21*e1,7$
'HWHFFLyQVLVWHPiWLFDWUDWDPLHQWR\VHJXLPLHQWRGHVt¿OLVFRQJpQLWD
/DVt¿OLVHVXQDHQIHUPHGDGFDXVDGDSRUXQDEDFWHULD7UHSRQHPDSDOOLGXPODFXDOHV
WUDQVPLWLGDHQIRUPDVH[XDO
/DVt¿OLVFRQJpQLWDSXHGHVHUDGTXLULGDGHODPDGUHLQIHFWDGDYtDWUDQVSODFHQWDULDHQ
FXDOTXLHUPRPHQWRGHOHPEDUD]R\GHOSDUWR
'H¿QLFLyQ
6HGH¿QHFRPR6t¿OLVFRQJpQLWDFXDOTXLHUDGHODVVLJXLHQWHVFRQGLFLRQHV
7RGR UHFLpQ QDFLGR DERUWR R PRUWLQDWR GH PDGUH FRQ HYLGHQFLD FOtQLFD
~OFHUD JHQLWDO R OHVLRQHV FRPSDWLEOHV FRQ Vt¿OLV VHFXQGDULD R FRQ SUXHED
WUHSRQpPLFDLQFOXLGRSUXHEDVUiSLGDVRQRWUHSRQpPLFDSRVLWLYDRUHDFWLYD
GXUDQWHODJHVWDFLyQSDUWRRSXHUSHULRTXHQRKD\DVLGRWUDWDGDRKD\DVLGR
WUDWDGDLQDGHFXDGDPHQWH
2
7RGR QHRQDWR FRQ WtWXORV GH 5359'5/ FXDWUR YHFHV PD\RU TXH ORV WtWXORV
GHODPDGUHRORTXHHTXLYDOHDXQFDPELRHQGRVGLOXFLRQHVRPiVGHORV
PDWHUQRVSRUHMHPSORGHD
2
7RGR QLxR FRQ XQD R YDULDV PDQLIHVWDFLRQHV FOtQLFDV VXJHVWLYDV GH Vt¿OLV
FRQJpQLWDDOH[DPHQItVLFR\RHYLGHQFLDUDGLRJUi¿FDGHVt¿OLVFRQJpQLWD\R
UHVXOWDGRUHDFWLYRGHXQDSUXHEDWUHSRQpPLFDRQRWUHSRQpPLFD
0DQLIHVWDFLRQHV FOtQLFDV VXJHVWLYDV GH 6& 'LVWUR¿DV QHXPRSDWtDV
ODULQJLWLV OODQWR URQFR \ FRQWLQXDGR JDVWURHQWHULWLV KHSDWRHVSOHQRPHJDOLD
RVWHRFRQGULWLVGHKXHVRVODUJRVDOH[DPHQUDGLROyJLFRULQLWLVPXFRSXUXOHQWD
SVHXGRSDUiOLVLVLFWHULFLD\RDQHPLDOHVLRQHVPXFRFXWiQHDVSiSXODVSODFDV
LQ¿OWUDGDVURML]DVHQUHJLyQSHULEXFDOPLHPEURVSDOPDVSODQWDVSHULDQDOHV\
SHULJHQLWDOHVURVHRODVGHJUDQGHVPDQFKDVDPSROODVSDOPRSODQWDUHV
2
7RGR SURGXFWR GH OD JHVWDFLyQ FRQ GHPRVWUDFLyQ GH 7 SDOOLGXP SRU FDPSR
RVFXURLQPXQRÀXRUHVFHQFLDXRWUDFRORUDFLyQRSURFHGLPLHQWRHVSHFt¿FRHQ
OHVLRQHVSODFHQWDFRUGyQXPELOLFDORPDWHULDOGHDXWRSVLD
7RGDVODVPDGUHVGHEHQVHUWHVWDGDVHQHOPRPHQWRGHOSDUWRSXHVHO9'5/PDWHUQRHV
PiVVHQVLEOHTXHHO9'5/QHRQDWDO3XHGHQH[LVWLUFDVRVGH9'5/QHRQDWDOQHJDWLYR
HQPDGUHVVL¿OtWLFDVQRWUDWDGDVSRUEDMRWtWXORPDWHUQRRLQIHFFLyQPDWHUQDUHFLHQWH
7DPELpQ VH UHDOL]D HO WDPL]DMH PHGLDQWH HO HVWXGLR GHO 9'5/ HQ VDQJUH GHO UHFLpQ
QDFLGRSUHIHUHQWHPHQWHHQVDQJUHGHFRUGyQXPELOLFDO
(Q ODV PDGUHV TXH WLHQHQ XQ WHVW GH Vt¿OLV QHJDWLYR HQ HO PRPHQWR GHO SDUWR HO
H[DPHQ GH OD VDQJUH GHO FRUGyQ GH UHFLpQ QDFLGR QR HV QHFHVDULR 6LQ HPEDUJR QR
HV DFRQVHMDEOH DEDQGRQDU HVWD SUiFWLFD GH GHWHFFLyQ VLVWHPiWLFD XQLYHUVDO D WRGRV
ORVUHFLpQQDFLGRV\DTXHDXQH[LVWHXQUHOHYDQWHSRUFHQWDMHGHPDGUHVTXHQRWLHQHQ
GLFKRH[DPHQDOGtDHQHOPRPHQWRGHOSDUWR
6L OD PDGUH WLHQH XQ WHVW GH Vt¿OLV SRVLWLYR QR WUDWDGR DGHFXDGDPHQWH DGHPiV GHO
9'5/QHRQDWDOVHGHEHUHDOL]DU
([DPHQFOtQLFRGHOUHFLpQQDFLGRRULHQWDGRDODE~VTXHGDGHVLJQRVHQRUGHQGH
HVSHFL¿FLGDG
6LJQRVUDGLROyJLFRVGHRVWHtWLV\SHULFRQGULWLV ,FWHULFLD
5DJDGLHVULQRUUHDKHPRUUiJLFD +LGURSVIHWDO
&RQGLORPDWRVLV /LQIRDGHQRPHJDOLDV
/HVLRQHVPDFXODUHVEXOORVDVRHF]HPDWRVDV JHQHUDOL]DGDV
3pQ¿JRHQSDOPDV\SODQWDVGHSLH 1HXPRQLWLV
3DUFKHVPXFRVRV $XPHQWRGHOWDPDxRGHODSODFHQWD
+HSDWRHVSOHQRPHJDOLD 5HVWULFFLyQGHO&UHFLPLHQWR
,QWUDXWHULQR
(VWXGLRGHO/tTXLGR&pIDOR5DTXtGHR9DORUHVGHSUREDEOH1HXURVt¿OLV
*OyEXORVEODQFRVPiVGHPP\
3URWHtQDV HOHYDGDV PD\RU R LJXDO D PJGO HQ HO WpUPLQR R PD\RU LJXDO GH
PJGOHQHOSUHWpUPLQR
9'5/SRVLWLYRHQDXVHQFLDGHFRQWDPLQDFLyQFRQVDQJUH
5HFRPHQGDPRV TXH HQ ORV FDVRV TXH HO HVWDGR VHUROyJLFR GH ODV PDGUHV HV
GHVFRQRFLGRHVREOLJDWRULRKDFHUHO9'5/SDUDORVQLxRVDQWHVGHOHJUHVRKRVSLWDODULR
0$1(-2&/,1,&2
$ ([DPHQ ItVLFR DQRUPDO FRPSDWLEOH FRQ Vt¿OLV FRQJpQLWD R 9'5/535
FXDQWLWDWLYR YHFHV PD\RUHV D ORV QLYHOHV PDWHUQRV R FDPSR RVFXUR R
DQWLFXHUSRVÀXRUHVFHQWHVSRVLWLYRVHQOtTXLGRVFRUSRUDOHV
(YDOXDFLyQ
9'5/FRQWHRFHOXODU\SURWHtQDVHQOtTXLGRFpIDORUDTXtGHR
+HPRJUDPDFRPSOHWRFRQUHFXHQWRSODTXHWDULR
5DGLRJUDItDGHKXHVRVODUJRVGHWyUD[IXQFLRQDOKHSiWLFRHFRJUDItDWUDQVIRQWDQHODU
SRWHQFLDOHVHYRFDGRVDXGLWLYRVVLFRUUHVSRQGHQ
7UDWDPLHQWR
3HQLFLOLQD * FULVWDOLQD HQ VROXFLyQ DFXRVD ± XQLGDGHV.JGtD
DGPLQLVWUDQGRXQLGDGHVNJGRVLV,9FDGDKRUDVGXUDQWHORVSULPHURVGtDV
\FDGDKRUDVOXHJRKDVWDFRPSOHWDUGtDVR
3HQLFLOLQD*3URFDtQDXQLGDGHVNJGRVLV,0XQDYH]SRUGtDSRUGtDV
6LVHSLHUGHPiVGHGtDGHWUDWDPLHQWRGHEHUHDOL]DUVHQXHYDPHQWHHOWUDWDPLHQWR
FRPSOHWR
(Q ORV VLJXLHQWHV HVFHQDULRV GHEHUi FRQVLGHUDUVH WDPELpQ OD KLVWRULD PDWHUQD GH OD
HQIHUPHGDG\VXWUDWDPLHQWRDORVHIHFWRVGHGHFLGLUHOHVWXGLR\WUDWDPLHQWRGHOUHFLpQ
QDFLGR
%([DPHQItVLFRQRUPDOFRQ9'5/535FXDQWLWDWLYRVLJXDOHVRYHFHV
PHQRUHVTXHORVGHODPDGUH
(QFDVRTXHODPDGUH1RKD\DVLGRWUDWDGDIXHLQDGHFXDGDPHQWHWUDWDGDRKD\GXGDV
RIXHWUDWDGDFRQHULWURPLFLQD\RWURUpJLPHQQRSHQLFLOtQLFRRUHFLELyWUDWDPLHQWRSHUR
IXHPHQRVGHVHPDQDVDQWHVGHOSDUWR
(YDOXDFLyQ
&RQWHRFHOXODU\SURWHtQDVHQOtTXLGRFpIDORUDTXtGHR
+HPRJUDPDFRQUHFXHQWRGHJOyEXORV\SODTXHWDV
5DGLRJUDItDGHKXHVRVODUJRV
6LVHDGPLQLVWUDQGtDVGHWUDWDPLHQWRSDUHQWHUDOQRVHUtDQHFHVDULDODHYDOXDFLyQ
FRPSOHWDSHURODSXQFLyQOXPEDUSXHGHGRFXPHQWDUDQRPDOtDVGH/&5\FRQGLFLRQDU
XQVHJXLPLHQWRPDVHVWULFWR
7UDWDPLHQWR
3HQLFLOLQD * &ULVWDOLQD HQ VROXFLyQ DFXRVD ± XQLGDGHV.JGtD
DGPLQLVWUDQGRXQLGDGHV.JGRVLV,9FDGDKRUDVGXUDQWHORVSULPHURV
GtDV\FDGDKRUDVKDVWDFRPSOHWDUGtDVR
3HQLFLOLQD*3URFDtQDXQLGDGHV.JGRVLV,0HQXQDGRVLVGLDULDGXUDQWH
GtDVR
3HQLFLOLQD*%HQ]DWtQLFDXQLGDGHV.JGRVLV,0HQGRVLV~QLFD
6HJXLPLHQWR
7RGRVORVUHFLpQQDFLGRV9'5/SRVLWLYRVGHEHUiQVHUYLJLODGRV\HO9'5/VHUHSHWLUi
FDGD D PHVHV KDVWD TXH VHD QHJDWLYR R GHVFLHQGD YHFHV /RV WtWXORV GHEHQ
GHVFHQGHUDORVPHVHV\VHUQHJDWLYRVDORVPHVHV
&([DPHQItVLFRQRUPDO\WHVWVQRWUHSRQpPLFRVLJXDOHVRYHFHVPHQRUHV
TXHORVGHODPDGUH
(QFDVRTXHODPDGUH
)XHWUDWDGDGXUDQWHHOHPEDUD]RHQIRUPDDGHFXDGDPiVGHFXDWURVHPDQDVDQWHV
GHOSDUWR\QRWLHQHHYLGHQFLDVGHUHLQIHFFLyQ
6HUHFRPLHQGD
1RUHDOL]DURWUDVHYDOXDFLRQHV5pJLPHQUHFRPHQGDGR
3HQLFLOLQD*%HQ]DWtQLFDXQLGDGHV.J,0GRVLV~QLFD
'([DPHQItVLFRQRUPDO\WHVWVQRWUHSRQpPLFRVLJXDOHVRYHFHVPHQRUHV
TXHORVGHODPDGUH
(QFDVRTXHODPDGUH
+D\D VLGR WUDWDGD DGHFXDGDPHQWH DQWHV GHO HPEDUD]R \ VXV WtWXORV GH 9'5/ VRQ
535
1RHVQHFHVDULRKDFHURWUDVHYDOXDFLRQHVQLWUDWDPLHQWRV
72;23/$6026,6&21*e1,7$
/D7R[RSODVPRVLV&RQJpQLWDHVXQDDIHFFLyQLQIHFFLRVDRFDVLRQDGDSRUHO7R[RSODVPD
*RQGLLWUDVPLWLGRSRUODPDGUHGXUDQWHHOHPEDUD]RFXDQGRHOODFXUVDXQDSULPRLQIHFFLyQ
([LVWHQ QXPHURVRV SDtVHV FRQ DOWD SUHYDOHQFLD GH 7R[RSODVPRVLV \ HO FRQVHFXHQWH
ULHVJRPDWHUQRGHDGTXLULUODGXUDQWHHOHPEDUD]R
/RV SURJUDPDV PDV H[LWRVRV VRQ SUHYHQWLYRV UHFRPHQGDQGR D OD PDGUH SUiFWLFDV
KLJLpQLFDVSDUDQRDGTXLULUODHQIHUPHGDGHQHOHPEDUD]R~QLFRPRPHQWRHQHOTXH
VXVFRQVHFXHQFLDSXHGHQVHUGHH[WUHPDJUDYHGDGSXHVOHVLRQDHO6LVWHPD1HUYLRVR
&HQWUDO GHO IHWR /DV PHGLGDV SUHYHQWLYDV SUHFRQFHSFLRQDOHV \ GXUDQWH HO HPEDUD]R
VRQ DQDOL]DGDV HQ OD DWHQFLyQ DQWHQDWDO DVt FRPR OD LQWHUSUHWDFLyQ \ PDQHMR GH OD
WR[RSODVPRVLVDJXGDPDWHUQDGHWHFWDGDGXUDQWHODJHVWDFLyQ
(O7DPL]DMH1HRQDWDOGHWRGRVORVUHFLpQQDFLGRVLQGHSHQGLHQWHPHQWHGHODFRQGLFLyQ
PDWHUQDHVXQDLQWHUYHQFLyQGLDJQyVWLFDH¿FD](OWDPL]DMHQHRQDWDOGHWHFWDIRUPDVGH
LQIHFFLyQDVLQWRPiWLFDVTXHSXHGHQHYROXFLRQDUHQHOODFWDQWHSURYRFDQGRVHYHURGDxR
RFXODUFRQSpUGLGDSURJUHVLYDHLUUHYHUVLEOHGHODYLVLyQ
/D GHWHFFLyQ VH UHDOL]D SRU OD GHWHUPLQDFLyQ GH DQWLFXHUSRV ,J0 HVSHFt¿FRV
DQWLWR[RSODVPDHQODVDQJUHGHOUHFLpQQDFLGR/DVDQJUHSXHGHVHUUHFRJLGDGHOFRUGyQ
DOQDFHU\SXHGHVHUWUDQVSRUWDGDHQSDSHO¿OWURFRPRVHUHFRJHSDUDRWURVH[iPHQHV
GH WDPL]DMH SHM +LSRWLURLGLVPR &RQJpQLWR (Q DOJXQDV iUHDV VH KDQ GHWHFWDGR
FDVRV GH WR[RSODVPRVLV FRQJpQLWD DVLQWRPiWLFD FDGD QDFLPLHQWRV 6L QR VRQ
WUDWDGRV SXHGHQ WHQHU OHVLRQHV GH FRULRUUHWLQLWLV HQ ORV SULPHURV DxRV GH YLGD
(O PpWRGR GHWHFWD HQWUH \ GH ORV QHRQDWRV DIHFWDGRV \ WLHQH HVSHFL¿FLGDG
HVWLPiQGRVHTXHGHFDGD,J0SRVLWLYRVPiVGHHVWDUiHQIHUPR
7UDWDPLHQWR
3LULPHWDPLQD GRVLV FDUJD PJNGtD SRU GtDV GRVLV GH PDQWHQLPLHQWR PJNGtD
SRUDPHVHVFRQWLQXDQGRFRQODPLVPDGRVLVYHFHVDODVHPDQDKDVWDDxR
PDV VXOIDGLD]LQD PJNGtD HQ GRVLV KDVWD DxRV PDV iFLGR IROtQLFR PJ
YHFHV SRU VHPDQD HV OD TXLPLRWHUDSLD DQWLWR[RSODVPD TXH VH KD DGPLQLVWUDGR
FRQPiVIUHFXHQFLDDORVUHFLpQQDFLGRVTXHVHGHWHFWDQFRQLQIHFFLyQWR[RSOiVPLFD
DVLQWRPiWLFD(VWDWHUDSLDSXHGHRFDVLRQDUQHXWURSHQLDSRUWR[LFLGDGPHGXODU(VWiHQ
HVWXGLRHOWUDWDPLHQWRDOWHUQDWLYRFRQHVSLURPLFLQDFRWULPR[D]RO\D]LWURPLFLQD
+,9
(OYLUXVGHLQPXQRGH¿FLHQFLDKXPDQD7KHOSHUGHOVLVWHPDLQPXQHFDXVDQGRSURJUHVLYD
UHGXFFLyQGHVXQ~PHUR\HYHQWXDOPHQWHHO6tQGURPHGH,QPXQRGH¿FLHQFLD$GTXLULGD
6,'$
(Q DXVHQFLD GH WUDWDPLHQWR LQGHSHQGLHQWHPHQWH GH OD ODFWDQFLD PDWHUQD HQWUH HO
GH ORV UHFLpQ QDFLGRV VHUiQ LQIHFWDGRV SRU +,9$XPHQWD HQ XQ OD
WUDQVPLVLyQGXUDQWHODODFWDQFLDPDWHUQDVLFRQWLQ~DKDVWDHOVHJXQGRDxRGHYLGDGH
VXPDGUHLQIHFWDGDFRQ+,9
/DWUDQVPLVLyQYHUWLFDOSXHGHUHGXFLUVHDPHQRVGHVLODPDGUHUHFLEHSUR¿OD[LV
FRQDQWLUUHWURYLUDOHVFHViUHDHOHFWLYDDQWHVGHOLQLFLRGHOWUDEDMRGHSDUWR\ODURWXUD
GH PHPEUDQDV \ OD VXSUHVLyQ WRWDO GH OD ODFWDQFLD 3DUD HOOR HO VFUHHQLQJ GHO +,9
DQWHQDWDOXQLYHUVDOHVQHFHVDULR
7RGDHPEDUD]DGDTXHQRUHFLELyDWHQFLyQSUHQDWDOGHEHUHDOL]DUVHHOWHVWUiSLGRGH
+,9HQHOPRPHQWRTXHFRQVXOWDHQWUDEDMRGHSDUWR
6H LQLFLDUD WDQ SURQWR VHD SRVLEOH OD SUR¿OD[LV DQWLUUHWURYLUDO VLQ HVSHUDU HO WHVW
FRQ¿UPDWRULR:HVWHUQEORWRLQPXQRÀXRUHVFHQFLD
0DQHMRFOtQLFR
$ 0DGUHTXHQRUHFLELySUR¿OD[LVFRQDQWLUUHWURYLUDOHVHQHODQWHQDWDOQLHQWUDEDMRGH
SDUWR
,QLFLDU='9GHQWURGHODKVGHYLGD='9\FRQWLQXDUODKDVWDODVVHPDQDV
% 0DGUH TXH UHFLELy SUR¿OD[LV FRPSOHWD DQWHSDUWR H LQWUDSDUWR ='9 RUDO GHVGH
VHPDQDVDVHPDQDVPJYHFHVDOGtDRPJYHFHVDOGtDHLQWUDSDUWR
='9LYPJ.JGHXQDLQIXVLyQFRQWLQXDVHJXLGRGHPJNJKRUDKDVWDHOSDUWR
$O UHFLpQ QDFLGR ,QLFLDU ='9 RUDO GHQWUR GH ODV KV GH YLGD \ FRQWLQXDU SRU
VHPDQDV
R0DVGHVHPDQDVPJNGRVLVFDGDKV
RVHPDQDVPJNGRVLVFDGDKVOXHJRGHODVVHPDQDVFDGDKV
6LHVWDFRQWUDLQGLFDGDODYtDRUDORQRHVWROHUDGDDGPLQLVWUDUGRVLVLYPJNHQORV
PLVPRVLQWHUYDORV0RQLWRUL]DUODKHPRJORELQDDQWHV\GHVSXpVGHOWUDWDPLHQWRGDGR
TXHODDQHPLDHVXQHIHFWRDGYHUVR
/D ¿QDOL]DFLyQ GHO HPEDUD]R SRU FHViUHD UHGXFH VLJQL¿FDWLYDPHQWH OD WUDQVPLVLyQ
SHULQDWDOGHO9,+HQ
/DVPDGUHVTXHQRUHFLELHURQWHUDSLDDQWLUUHWURYLUDODQWHQDWDO
/DVPDGUHVTXHUHFLELHURQVRODPHQWH='9SDUDODSUR¿OD[LVGHODWUDQVPLVLyQSHULQDWDO
6LGXUDQWHHOHPEDUD]RORVQLYHOHVGH51$+,9VRQPD\RUHVGHFRSLDVPO
1RHVFODURTXHODFHViUHDOXHJRGHODURWXUDGHPHPEUDQDVRLQLFLRGHWUDEDMRGHSDUWR
WHQJDEHQH¿FLRHQUHGXFLUODWUDQVPLVLyQ
5HFRPHQGDFLRQHVVREUHODDOLPHQWDFLyQGHOUHFLpQQDFLGR
3DUDUHGXFLUDOPtQLPRHOULHVJRGHWUDQVPLVLyQGHO9,+DORVQLxRVHOJUXSRGHH[SHUWRV
GH OD 5HJLyQ GH ODV$PpULFDV SURSXVR UHIRU]DU OD HVWUDWHJLD GH VXSULPLU OD ODFWDQFLD
PDWHUQD HQ ORV KLMRV GH PXMHUHV FRQ 9,+ (Q HVWH VHQWLGR OD 236206 UHFRPLHQGD
HYLWDU OD ODFWDQFLD PDWHUQD VLHPSUH \ FXDQGR HVWD RSFLyQ VHD DFHSWDEOH IDFWLEOH
DVHTXLEOHVRVWHQLEOH\VHJXUD$)$66
+(3$7,7,6%
/DWUDQVPLVLyQGHOYLUXVKHSDWLWLV%GHVGHODPDGUHDOQLxRRFXUUHPiVIUHFXHQWHPHQWH
HQHOPRPHQWRGHOSDUWRODWUDQVPLVLyQLQWUD~WHURHVUDUD
/D PD\RUtD GH ORV UHFLpQ QDFLGRV ODFWDQWHV \ QLxRV TXH DGTXLHUHQ OD LQIHFFLyQ
SHULQDWDO SHUPDQHFHUiQ DVLQWRPiWLFRV SRU H[WHQVRV SHULRGRV 3HUR WLHQHQ DOWR
ULHVJRGHGHVDUUROODULQIHFFLyQFUyQLFD(OULHVJRGHGHVDUUROODULQIHFFLyQFUyQLFDHVWD
LQYHUVDPHQWHUHODFLRQDGDFRQODHGDGGHLQIHFFLyQ$SUR[LPDGDPHQWHHOGHORV
QLxRVTXHDGTXLHUHQODLQIHFFLyQHQODHWDSDSHULQDWDOGHVDUUROODUDQLQIHFFLyQFUyQLFD
FRPSDUDGRFRQGHORVTXHVHLQIHFWDQHQODHWDSDDGXOWD
$SUR[LPDGDPHQWHHOGHODVSHUVRQDVFRQLQIHFFLyQFUyQLFDVHFUHHTXHDGTXLULHURQ
ODLQIHFFLyQFRPRUHVXOWDGRGHODWUDQVPLVLyQSHULQDWDORHQODLQIDQFLDWHPSUDQD
/DPXHUWHSRUFLUURVLVRFDUFLQRPDKHSDWRFHOXODURFXUUHHQGHODVSHUVRQDVTXH
DGTXLULHURQOD+%HQODLQIDQFLDFRPSDUDGRFRQHOGHORVTXHODDGTXLULHURQHQOD
HWDSDDGXOWD
(VWDVUD]RQHVDYDODQHOWDPL]DMHGHDQWtJHQRVGHVXSHU¿FLHDODHPEDUD]DGD\SUHYHQLU
ODLQIHFFLyQDOUHFLpQQDFLGR
/DYDFXQDFLyQGHKHSDWLWLV%HVXQDPHGLGDHIHFWLYDSDUDSUHYHQLUODLQIHFFLyQYLUXV
+%\VXVFRQVHFXHQFLDV
0DQHMRFOLQLFR±3UHYHQFLyQGHODWUDQVPLVLyQSHULQDWDO
$ 206UHFRPLHQGDODYDFXQDFLyQXQLYHUVDOGHORVUHFLpQQDFLGRVODSULPHUDGRVLV
DOQDFHU\ODVGRVGRVLVVXEVLJXLHQWHVLQFRUSRUDUODVDOHVTXHPDGHYDFXQDFLyQGH
UXWLQDGHOSULPHUDxRGHYLGDFRPRHVWUDWHJLDSDUDSUHYHQLUODLQIHFFLyQSRU+%
% 5HFLpQQDFLGRVGHPDGUHFRQ+%V$JSRVLWLYR
6HGHEHDGPLQLVWUDUYDFXQDGHKHSDWLWLV%\DGPLQLVWUDULQPXQRJOREXOLQDDQWLKHSDWLWLV
%,*+%HQGLIHUHQWHVVLWLRVHQODVSULPHUDVKVGHYLGD6HGHEHFRPSOHWDUODV
WUHVGRVLVGHODYDFXQDDORV\DORVPHVHVGHYLGD
/DDGPLQLVWUDFLyQGHDPEDVKDGHPRVWUDGRVHUPiVGHHIHFWLYDHQODSUHYHQFLyQ
GHODLQIHFFLyQ9+%DJXGD\FUyQLFDGHQLxRVGHPDGUHVFRQ+%V$JSRVLWLYR
/XHJRGHUHFLELUODYDFXQD\OD,*+%SXHGHUHFLELUODFWDQFLDPDWHUQD
6HJXLPLHQWR WHVW DQWLFXHUSRV DQWL +%V$J D ORV D PHVHV GH HGDG QHJDWLYRV
FRQ¿UPDODHIHFWLYLGDGGHODSUR¿OD[LV
& 5HFLpQQDFLGRVGHPDGUHFRQ+%V$JGHVFRQRFLGR
'HEHUHFLELUYDFXQD+%HQODVSULPHUDVKVGHYLGD
5HDOL]DUVHURORJtDSDUD+%V$JDODPDGUHVLHVSRVLWLYDHOUHFLpQQDFLGRGHEHUHFLELU
,*+%WDQSURQWRVHDSRVLEOHQRPiVGHGtDV$PEDVLQWHUYHQFLRQHVSUHYLHQHQXQ
GHODVLQIHFFLRQHVSHULQDWDOHV
6LODVHURORJtDPDWHUQDHVQHJDWLYDORVUHFLpQQDFLGRVGHWpUPLQRPD\RUGHJ
GHEHQUHFLELUODYDFXQDDODOWD
6LHVSUHWpUPLQRSHVRPHQRUGHJODUHVSXHVWDDODYDFXQD+%HVWiGLVPLQXLGDVL
VHDGPLQLVWUDDQWHVGHOPHVGHYLGD3RUORWDQWRODYDFXQD+%GHEHVHUDGPLQLVWUDGD
PHVOXHJRGHOQDFLPLHQWRRDODOWDKRVSLWDODULD6LHOSUHWpUPLQRUHFLEHXQDGRVLVDO
QDFHUQRVHWRPDHQFXHQWDSDUDFRPSOHWDUODVGRVLV
(675(372&2&2'(/*5832%
$SUR[LPDGDPHQWH DO GH ODV PXMHUHV HPEDUD]DGDV HVWiQ FRORQL]DGDV
WUDQVLWRULDPHQWHHQIRUPDFUyQLFDRLQWHUPLWHQWHFRQHOHVWUHSWRFRFRGHOJUXSR%
HQYDJLQDRUHFWR
(Q DXVHQFLD GH SUHYHQFLyQ DSUR[LPDGDPHQWH HO GH ORV UHFLpQ QDFLGRV VH
FRORQL]DUDQFRQ(*%GXUDQWHHOSDUWR\DSUR[LPDGDPHQWHHOGHHOORVGHVDUUROODUDQ
XQDHQIHUPHGDGLQYDVLYDSRUHVWUHSWRFRFRGHOJUXSR%
/DTXLPLRSUR¿OD[LVFRQSHQLFLOLQD*RDPSLFLOLQDLQWUDSDUWRUHGXFHODFRORQL]DFLyQ
GHOUHFLpQQDFLGR\ODVHSVLVSUHFR]VLHVDGPLQLVWUDGDKVRPDVSUHYLRDOSDUWR
/DHQIHUPHGDGLQYDVLYDGHOUHFLpQQDFLGRVHGLYLGHHQLQLFLRSUHFR]GHQWURGHORV
GtDVOXHJRGHOQDFLPLHQWR\GHLQLFLRWDUGtRHQWUHORV±GtDVGHYLGD
/DWUDQVPLVLyQYHUWLFDOH[SOLFDODHQIHUPHGDGGHLQLFLRSUHFR]QRDVtODGHLQLFLRWDUGtR
/DWUDQVPLVLyQPDWHUQDH[SOLFDHOGHORVFDVRVGHVHSVLVWDUGtD
0DQHMR GH OD SUR¿OD[LV VH EDVD HQ OD H[LVWHQFLD GH OD FRORQL]DFLyQ PDWHUQD \ HQ
IDFWRUHVGHULHVJRGHWUDQVPLVLyQYHUWLFDO
$ 0DGUHFRQIDFWRUHVGHULHVJRGHWUDQVPLVLyQYHUWLFDO/DVVLJXLHQWHVVRQ
LQGLFDFLRQHVGHDGPLQLVWUDFLyQGHDQWLELyWLFRVLQWUDSDUWR
*HVWDFLyQPHQRUGHVHPDQDV
5RWXUDGHPHPEUDQDVPD\RUGHKRUDV
7HPSHUDWXUDLQWUDSDUWRPD\RUD&
TXHHQHOSDUWRSUHYLRKD\DWHQLGRXQKLMRFRQHQIHUPHGDGLQYDVLYDSRU
HVWUHSWRFRFRJUXSR%
ODSUHVHQFLDGHEDFWHULXULDHQHVWHHPEDUD]R
% 6FUHHQLQJPDWHUQRDQWHQDWDO
6HUHFRPLHQGDHOVFUHHQLQJPHGLDQWHHOFXOWLYRGHXQKLVRSDGRUHFWRYDJLQDOHQWUHODV
DVHPDQDVGHHGDGJHVWDFLRQDODXQTXHVHSODQHHXQDFHViUHDVLQWUDEDMRGHSDUWR
3UR¿OD[LVDQWLELyWLFDLQWUDSDUWR
(VWiLQGLFDGDTXHUHFLEDQSUR¿OD[LVODVPDGUHVFRQVFUHHQLQJSRVLWLYR\ODVTXHWHQJDQ
SRUORPHQRVIDFWRUGHULHVJRGHWUDQVPLVLyQYHUWLFDO
(ODQWLELyWLFRUHFRPHQGDGRHVODSHQLFLOLQDLY\HVDOWHUQDWLYRODDPSLFLOLQDRFHID]ROLQD
9HUFDS,,FRQWUROSUHQDWDO
/DSUR¿OD[LVHVDGHFXDGDFXDQGRUHFLEHHODQWLELyWLFRUHFRPHQGDGRHQIRUPDLYHQHO
WUDEDMRGHSDUWRSRUORPHQRVKRUDVDQWHVGHOSDUWR
&XDGUR
0$1(-2'(/5(&,e11$&,'26(*Ò1&21',&,Ï11(21$7$/<0$7(51$
5,(6*2 &21',&,21(60$7(51$6<1(21$7$/(6 (9$/8$&,Ï1<75$7$0,(172
1(21$7$/
(YDOXDFLyQSDUDFOtQLFDFRPSOHWD
51VLQWRPiWLFRGL¿FXOWDGUHVSLUDWRULDPDOD KHPRJUDPDFRPSOHWRKHPRFXOWLYR
SXQFLyQOXPEDU
SHUIXVLyQDSQHDRVKRFN &RPHQ]DUWUDWDPLHQWRLQWUDYHQRVR
FRQDPSLFLOLQD\JHQWDPLFLQD
$/72 51GHPDGUHVFRQVRVSHFKDGH (YDOXDFLyQ FRPSOHWD KHPRJUDPD
FRULRDPQLRQLWLVRFRQ¿UPDGDDFXDOTXLHU FRPSOHWR KHPRFXOWLYR SXQFLyQ
HGDGJHVWDFLRQDO OXPEDU
6LQWHQHUHQFXHQWDVLODPDGUHUHFLELyR \
QRDQWLELyWLFRVKVKRUDVRPDVSUHYLRDO &RPHQ]DU WUDWDPLHQWR LQWUDYHQRVR
SDUWR FRQDPSLFLOLQD\JHQWDPLFLQD
(YDOXDFLyQ FRQ KHPRJUDPD \
0(',2 3UHWpUPLQRPHQRUDVHPDQDV KHPRFXOWLYR\
2EVHUYDFLyQFOtQLFDSRUKRUDV
51PD\RURLJXDODVHPDQDVQDFLGRVGH
PDGUHV (YDOXDFLyQFRQKHPRJUDPD
&RORQL]DGDVSRU(*%RWXYLHURQ¿HEUH FRPSOHWRKHPRFXOWLYR\
2 REVHUYDFLyQFOtQLFDSRUKV
URWXUDSUHPDWXUDGHPHPEUDQDVKVR 2
%$-2 PiV 2EVHUYDFLyQFOtQLFDSRUKV\
2 KHPRJUDPDV\SURWHtQD&UHDFWLYD
+LVWRULDGHXQKLMRSUHYLRFRQHQIHUPHGDG VHULDGDVHQODVSULPHUDVKRUDV
LQYDVLYDSRU(*% 6LHVWiVLQWRPiWLFRFRPHQ]DU
2 DQWLELyWLFRVLYOXHJRGHUHDOL]DU
1RUHFLELySUR¿OD[LVDGHFXDGDSHQLFLOLQDR KHPRFXOWLYR
DPSLFLOLQDSRUPDVGHKVDQWHVGHOSDUWR
51PD\RURLJXDODVHPDQDV 2EVHUYDFLyQFOtQLFDGHD
0Ë1,02 DVLQWRPiWLFRFX\DVPDGUHVUHFLELHURQ KRUDV
SUR¿OD[LVDGHFXDGD
(1)(50('$''(&+$*$6
/DHQIHUPHGDGGH&KDJDVHVFDXVDGDSRUXQSDUDVLWR7U\SDQRVRPDFUX]L
/D WUDQVPLVLyQ FRQJpQLWD HQ ORV SDtVHV HQ GRQGH OD (QIHUPHGDG GH &KDJDV HV
HQGpPLFDDIHFWDDOGHORVUHFLpQQDFLGRVGHPDGUHVLQIHFWDGDV
'LDJQyVWLFRQHRQDWDODORVQDFLGRVGHPDGUHVLQIHFWDGDVDQWHVRGXUDQWHHO
HPEDUD]R\HQODViUHDVGRQGHODHQIHUPHGDGHVHQGpPLFDORVQDFLGRVGH
PDGUHVVLQVFUHHQLQJDQWHQDWDO
/D GHWHFFLyQ GH 7 &UX]L HV HO SURFHGLPLHQWR GLDJQyVWLFR HQ OD HQIHUPHGDG
FRQJpQLWD
([DPHQ PLFURVFySLFR XQD PXHVWUD GH VDQJUH IUHVFD DQWLFRDJXODGD SDUD OD
E~VTXHGDGHSDUiVLWRV
$LVODPLHQWR GHO DJHQWH SRU D LQRFXODFLyQ D UDWRQHV \ E FXOWLYRV HQ PHGLRV
HVSHFLDOHV
(OPpWRGRHVWiQGDUGHGLDJQyVWLFRGHODHQIHUPHGDGFRQJpQLWDHVHOPLFURPpWRGR
H[DPHQGHVDQJUHIUHVFDKHSDULQL]DGDVHSXHGHUHDOL]DUHQVDQJUHGHFRUGyQRHQ
VDQJUHSHULIpULFDFRQXQDVHQVLELOLGDGGHO
/RV QDFLGRV GH PDGUHV FKDJiVLFDV TXH QR IXHURQ GLDJQRVWLFDGRV FRQ LQIHFFLyQ
SRU7&UX]LGHEHQUHDOL]DUVHVHURORJtDDQWLFXHUSRV,J*DORVPHVHVGHHGDG
XVDQGR ORV PpWRGRV GH ,)$ \ (/,6$ GDGR TXH HQ ORV SULPHURV PHVHV GH YLGD
HOHVWXGLRVHUROyJLFRGHWHFWDDQWLFXHUSRV,J*TXHSXHGHQKDEHUVLGRWUDQVPLWLGRV
SDVLYDPHQWHSRUODPDGUH
&ULWHULRVSDUDFRQVLGHUDUXQFKDJDVFRQJpQLWR
UHFLpQQDFLGRGHPDGUHFRQVHURORJtDSRVLWLYDSDUD7&UX]L
SDUiVLWRV LGHQWL¿FDGRV DO QDFLPLHQWR R SDUiVLWRV R DQWLFXHUSRV HVSHFt¿FRV QR
PDWHUQRVGHWHFWDGRVGHVSXpVGHOQDFLPLHQWRVLHPSUH\FXDQGRQRKD\DH[LVWLGR
WUDQVIXVLyQVDQJXtQHDSUHYLDRFRQWDPLQDFLyQYHFWRULDO
7UDWDPLHQWR
%HQ]LGD]ROPJNGtDSRUPHVHV
1LIXUWLPR[PJNGtDSRUPHVHV
(OVFUHHQLQJGXUDQWHHOHPEDUD]RSHUPLWHODGHWHFFLyQ\HOWUDWDPLHQWRGHODLQIHFFLyQ
FRQJpQLWDFRQXQDFXUDFLyQGHFHUFDGHO
+,327,52,',602&21*e1,72
'HWHFFLyQVLVWHPiWLFDWUDWDPLHQWR\VHJXLPLHQWRGHKLSRWLURLGLVPRFRQJpQLWR
(O+LSRWLURLGLVPR&RQJpQLWR+&DIHFWDDFDGDUHFLpQQDFLGRV&XDQGRQRHV

GLDJQRVWLFDGR \ QR HV WUDWDGR HQ IRUPD LQPHGLDWD DIHFWD VHYHUDPHQWH HO GHVDUUROOR
SVLFRPRWRU
/RV VLJQRV FOtQLFRV GH +& DSDUHFHQ WDUGtDPHQWH HQ ORV SULPHURV PHVHV GH YLGD
FXDQGRHOGDxRGHO6LVWHPD1HUYLRVR&HQWUDO\DHVLUUHYHUVLEOH
(OPpWRGRGLDJQyVWLFRHVODGHWHUPLQDFLyQGHORVQLYHOHVVpULFRVGH76+\R7HQOD
VDQJUHGHOFRUGyQXPELOLFDOROXHJRGHODVSULPHUDVKRUDVGHYLGD(QODVSULPHUDV
KRUDV GH YLGD KD\ XQ LQFUHPHQWR ¿VLROyJLFR GH 76+ TXH SURGXFH PXFKRV IDOVRV
SRVLWLYRV
(OWDPL]DMHVLVWHPiWLFRLGHDOUHTXLHUHTXHVHGHWHUPLQHQDPEDVKRUPRQDVHQWRGRVORV
UHFLpQQDFLGRV
&XDQGRVHRSWDSRUGHWHUPLQDU76+HQWRGRV\7VRORHQORVTXHWLHQHQ76+HOHYDGD
QRVHGHWHFWDQORV+&RULJLQDGRVHQXQGHIHFWRFHQWUDOKLSRWiODPRKLSR¿VDULR
GHORVFDVRV
&XDQGRVHRSWDSRUODGHWHUPLQDFLyQGHVLVWHPiWLFDGH7QRVHGLDJQRVWLFDQIRUPDV
OHYHVGH+&FRQ7QRUPDOTXHSHUVLVWHQFRQQLYHOHVDOWRVGH76+\WDPELpQUHTXLHUHQ
WUDWDPLHQWR
/RVYDORUHVGH76+VXSHULRUHVDP8/UHTXLHUHQXQDQXHYDGHWHUPLQDFLyQLQPHGLDWD
/RVYDORUHVGH76+VXSHULRUHVDP8/FRQ7EDMRODPD\RUtDGHORV+&GHEHQVHU
WUDWDGRVHQIRUPDLQPHGLDWD
,QIRUPDFLyQDORVSDGUHV
,QLFLDOPHQWHVHGHEHLQIRUPDUDORVSDGUHVTXHHOWUDWDPLHQWRQRGHEHLQWHUUXPSLUVH
181&$\SUREDEOHPHQWHORUHTXLHUDSDUDWRGDODYLGD
(O GHVDUUROOR LQWHOHFWXDO QRUPDO GHSHQGH GH OD SUHFRFLGDG GH LQLFLR FRQWLQXLGDG \
VX¿FLHQFLDGHOWUDWDPLHQWRHQORVSULPHURVDxRVGHYLGD
7UDWDPLHQWR
6HFRPLHQ]DGHLQPHGLDWRFRQ/HYRWLUR[LQD7YtDRUDO/DGRVLVHVPFJ.JGtD
\VHDMXVWDFRQODGHWHUPLQDFLyQGHORVQLYHOHVGH7\76+/DVGRVLVHQHOUDQJRDOWR
PFJ.JGtDORJUDQODQRUPDOL]DFLyQGH7HQGtDV\GH76+HQVHPDQDV
/DGRVLVGLDULDGHEHDMXVWDUVHUiSLGDPHQWHFRQHOLQFUHPHQWRGHSHVR\GHDFXHUGR
DORVYDORUHVVpULFRVSHULyGLFRVGH7\76+(OYDORUHVSHUDGRGH7OXHJRGHXQD
VHPDQDGHWUDWDPLHQWRGHEHVHUHQWUHJGO
6HJXLPLHQWR
/DVGHWHUPLQDFLRQHVGH7\76+GHEHQUHSHWLUVHDODVGRVVHPDQDV\DOPHVGHLQLFLDGR
HOWUDWDPLHQWR\OXHJRFDGDRPHVHVHQHOSULPHUDxROXHJRSXHGHHVSDFLDUVHFDGD
PHVHVKDVWDORVDxRV
$1(0,$)$/&,)250(
'HWHFFLyQ6LVWHPiWLFD8QLYHUVDOR6HOHFWLYDGHKHPRJORELQRSDWtDV

/D DQHPLD IDOFLIRUPH HV OD KHPRJORELQRSDWtD PiV FRP~Q \ VH GHEH D XQD KHUHQFLD
DXWRVyPLFD UHFHVLYD TXH PRGL¿FD OD +HPRJORELQD$ HQ +HPRJORELQD 6 (VWD IRUPD
GH+HPRJORELQDHQFRQGLFLRQHVGHGLVPLQXFLyQGHOR[LJHQRPRGL¿FDODIRUPDGHORV
HULWURFLWRV\DXPHQWDVXDGKHVLyQDOHQGRWHOLRORTXHIDFLOLWDRFOXVLRQHVYDVFXODUHV/D
IUHFXHQFLDHQWUHODSREODFLyQQHJUDHVGHFDGD\HOWLHQHQHOFDUiFWHUGH
KHWHURFLJRWRV
(QORVSDtVHVHQTXHODSREODFLyQQHJUDHVPD\RUGHOVHGHEHUHDOL]DUWDPL]DMH
QHRQDWDOXQLYHUVDOPLHQWUDVTXHVLHVPHQRUGHOSRGUtDUHDOL]DUVHVHOHFWLYDPHQWH
HQORVUHFLpQQDFLGRVGHIDPLOLDVGHUD]DQHJUD
(OWDPL]DMHVHUHDOL]DSRUHOHFWURIRUHVLVGHOD+HPRJORELQD
6XH[SUHVLyQFOtQLFDFRPLHQ]DHQODSULPHUDLQIDQFLD
(O GLDJQyVWLFR HQ HO SHUtRGR QHRQDWDO HV QHFHVDULR SDUD HO PHMRU PDQHMR SRU VXV
IDPLOLDV HO GLDJQyVWLFR SUHFR] GH ODV FULVLV \ ODV LQWHUYHQFLRQHV SUHYHQWLYDV GH ODV
FRPSOLFDFLRQHV
/D HQIHUPHGDG VH FDUDFWHUL]D SRU DQHPLD KHPROtWLFD FUyQLFD FRQ FULVLV \ HSLVRGLRV
GH LVTXHPLD SRU RFOXVLyQ YDVFXODU TXH RFDVLRQDQ QHFURVLV yVHD DYDVFXODU LQIDUWRV
HVSLQDOHVGRORURVRVHGHPDGRORURVRGHPDQRV\SLHVGDFWLOLWLVLQIDUWRVHVSOpQLFRV
QHIURSDWtDHLQIDUWRVFHUHEUDOHV
(Q IRUPD DVRFLDGD SUHVHQWDQ SUHGLVSRVLFLyQ D LQIHFFLRQHV JUDYHV SRU 1HXPRFRFR
+HPR¿OXV\6DOPRQHOD
/D GHWHFFLyQ SUHFR] SHUPLWH DFRQVHMDU D OD IDPLOLD HQ HO FXLGDGR GHO QLxR \ UHDOL]DU
LQWHUYHQFLRQHVSUHYHQWLYDVFRPROD9DFXQDFLyQ$QWL1HXPRFyFLFD$QWLJULSDO\SUR¿OD[LV
DQWLELyWLFDFRQ3HQLFLOLQD9HQORVSULPHURVDxRVGHYLGD
+,3(5%,/,558%,1(0,$1(21$7$/12+(02/Ë7,&$
'HWHFFLyQVLVWHPiWLFDXQLYHUVDOGHKLSHUELOLUUXELQHPLD
/DLFWHULFLDHVXQKDOOD]JRFRP~QHQHOUHFLpQQDFLGRGHWpUPLQRVDQRPiVIUHFXHQWH
HQORVPHQRUHVGHVHPDQDV\HQORVDOLPHQWDGRVDSHFKRH[FOXVLYR
/DV LFWHULFLDV KHPROtWLFDV VHYHUDV TXH UHTXLHUHQ H[VDQJXLQHR WUDQVIXVLyQ DSDUHFHQ

HQ ODV SULPHUDV KRUDV GH YLGD \ VX PDQHMR GHEH VHU UHDOL]DGR SRU SHUVRQDO
HVSHFLDOL]DGR
(QODLFWHULFLDGHOUHFLpQQDFLGRVDQRORVYDORUHVGHELOLUUXELQHPLDVHLQWHQVL¿FDQKDVWD
HOHUDWRGtDSRUORTXHDQWHVGHODOWDKRVSLWDODULDVHGHEHHYDOXDUHOULHVJRTXHOOHJXH
DFLIUDVTXHSRQJDQHQULHVJRGHHQFHIDORSDWtDELOLUUXEtQLFD
(OGLDJQyVWLFRGHLQWHQVLGDG\ODYHORFLGDGGHSURJUHVLyQSHUPLWHQLQGLFDUXQFRQWURO
PiVHVWULFWR\HOXVRHYHQWXDOGHIRWRWHUDSLDSUHYLRDODOWDKRVSLWDODULD/DYDORUDFLyQ
FOtQLFDGHODLQWHQVLGDGGHODLFWHULFLDHVXQPpWRGRSRFRVHQVLEOH/DSURJUHVLyQFpIDOR
FDXGDOWDPSRFRSHUPLWHHVWLPDUORVYDORUHVGHULHVJRTXHUHTXLHUHQLQWHUYHQFLyQ
&XDQGR OD LFWHULFLD DSDUHFH DQWHV GH ODV KRUDV GH YLGD GHEH UHDOL]DUVH XQD
GHWHUPLQDFLyQGHELOLUUXELQHPLDVpULFDRGHODLQWHQVLGDGGHOFRORUDPDULOORGHODSLHO
SRULFWHUyPHWUR/DLFWHURPHWUtDFXWiQHDUHDOL]DGDFRQLQVWUXPHQWRVDGHFXDGRVWLHQH
XQD H[FHOHQWH VHQVLELOLGDG SHUR EDMD HVSHFL¿FLGDG 3RU HVWH PRWLYR VH XWLOL]D FRPR
WDPL]DMHQRLQYDVLYRSDUDUHGXFLUHOQ~PHURGHH[WUDFFLRQHVVDQJXtQHDV/RVQLYHOHV
VpULFRVGHELOLUUXELQDVHFRQ¿UPDQHQWRQFHVVRODPHQWHHQORVTXHWLHQHQYDORUHVDOWRV
SRULFWHURPHWUtD
/RVFULWHULRVGHWUDWDPLHQWR\VHJXLPLHQWRGHEHQDGHFXDUVHDOGLDJQyVWLFRGHFDXVD6L
SRUORVDQWHFHGHQWHV\ODDXVHQFLDGHKHPyOLVLVVHGHVFDUWDODSDWRORJtDKHPROtWLFDHO
PDQHMRVHUiVHJ~QORVQLYHOHVGHELOLUUXELQHPLDGHDFXHUGRODHGDGHQKRUDVGHYLGD
(Q ORV UHFLpQ QDFLGRV FRQ LFWHULFLD HQ ODV SULPHUDV KRUDV HO YDORU LQLFLDO GH
ELOLUUXELQHPLDGHEHVHUFRPSDUDGRFRQORVYDORUHVGHUHIHUHQFLDGHODWDEODDGMXQWD
HYDOXDQGRDGHPiVODYHORFLGDGGHLQFUHPHQWRKRUDULR

3

%LOLUUXELQD6pULFDPJGO )RWRWHUDSLDLQWHQVLYDVLHO XLPLHQWR

K
V 3
LQFUHPHQWRHV!PJGOK %6VHJ
KV 3
LHQWR
VHJXLP
%67F
3
KV
XLPLHQWR
7FVHJ

6HJXLPLHQWRFOtQLFR
RLFWHURPHWUtDFXWiQHD
HQKRUDV
9LJLOHLFWHULFLDFDGDKRUDV

(GDG3RVWQDWDOKRUDVVHJ~Q9LQRG%KXWDQLHWDO
)LJXUD9DORUHVGHUHIHUHQFLDSDUDODSUHYHQFLyQGHOHVWDGtRDJXGRGHODHQFHIDORSDWtD
ELOLUUXEtQLFD6HJ~Q9LQRG%KXWDQLHWDO
&RQGXFWDVXJHULGDVHJ~QYDORUHVLQLFLDOHVHQUHFLpQQDFLGRVGHWpUPLQRVLQ
HQIHUPHGDGKHPROtWLFD
x!S 6HLQLFLD)RWRWHUDSLDLQWHQVLYD
0DQWHQLHQGRODODFWDQFLDH[FOXVLYD
xS 6LHOLQFUHPHQWRHVPD\RUGHPJG/KRUD
VHLQLFLD)RWRWHUDSLD,QWHQVLYD
xS 6HRWRUJDHODOWD
FRQFRQWUROGHQLYHOHVVpULFRVGHELOLUUXELQHPLDRLFWHURPHWUtD
FXWiQHDHQKRUDV
xS 6HRWRUJDHODOWDFRQHYDOXDFLyQFOtQLFDHQKRUDV
&XDQGRVHGLVSRQHGHOLQVWUXPHQWRSDUDUHDOL]DULFWHURPHWUtDFXWiQHDHV
UHFRPHQGDEOHTXHVHUHDOLFHXQDGHWHUPLQDFLyQVLVWHPiWLFDDWRGRVORVUHFLpQ
QDFLGRVHQHOPRPHQWRGHODOWDSURFHGLHQGRFRQORVFULWHULRVDQWHULRUHV
&XDGUR&ULWHULRVVXJHULGRVSDUDWRPDUGHFLVLRQHVDOOPRPHQWRGHGHFLGLUHODOWD
KRVSLWDODULD
Edad en horas Si los valores Si el valor es
Mantener
en el momento de están dentro de este rango controlar en: igual o menor
hospitalizado si el
la determinación de controlar en:
valor es mayor que
bilirrubinemia 24 horas 48 horas 3-5 días

PDVGH
0RGL¿FDGDGH9LQRG%KXWDQLHWDO
&XDQGRSUHYLRDODOWDKRVSLWDODULDVHUHDOL]DHOWDPL]DMHDWRGRVORVUHFLpQQDFLGRV\
VH VLJXHQ ORV FULWHULRV VXJHULGRV VH ORJUD GLVPLQXLU VLJQL¿FDWLYDPHQWH OD IUHFXHQFLD
GH UHLQJUHVRV \ ORV YDORUHV H[FHVLYDPHQWH DOWRV GH ELOLUUXELQHPLD HQ UHFLpQ QDFLGRV
HQDWHQFLyQDPEXODWRULD/DWDVDGHUHDGPLVLyQQHRQDWDOVHUHGXFHDHOXVRGH
IRWRWHUDSLDHVFHUFDQR\ODWDVDGHH[VDQJXLQHRWUDQVIXVLyQPHQRUD
6L ORV YDORUHV HVWiQ GHQWUR GHO UDQJR GH IRWRWHUDSLD OD PLVPD VH GHEH KDFHU HQ HO
KRVSLWDOMXQWRDVXPDGUH\PDQWHQLHQGRODODFWDQFLDH[FOXVLYDDOVHQR
'e),&,7$8',7,926(9(52
(O Gp¿FLW DXGLWLYR ELODWHUDO SHUPDQHQWH \ VHYHUR GH PiV GH GHFLEHOHV GH RULJHQ
FRQJpQLWRDIHFWDDFDGDPLOQDFLGRV/DPLWDGGHHVWRVQLxRVQRWLHQHQIDFWRUHVGH
ULHVJR\HVLPSRVLEOHUHFRQRFHUORVFOtQLFDPHQWH
+DELWXDOPHQWH ORV SDGUHV \ ORV VHUYLFLRV GH VDOXG GHWHFWDQ OD VRUGHUD FRQJpQLWD HQ
IRUPDPX\WDUGtDOXHJRGHOHUDxRGHHGDG

([LVWHQ PpWRGRV HOHFWUR¿VLROyJLFRV TXH SHUPLWHQ GHWHFWDU HVWH Gp¿FLW HQ HO UHFLpQ
QDFLGR PXFKR DQWHV TXH ORV PpWRGRV FOtQLFRV H LQLFLDU OD UHKDELOLWDFLyQ VHQVRULDO
WHPSUDQDPHQWH/DD\XGDDXGLWLYDDXGtIRQRVLQLFLDGDHQORVSULPHURVPHVHVGH
YLGDPHMRUDVLJQL¿FDWLYDPHQWHHOGHVDUUROORYHUEDOGHHVWRVQLxRVFRPSDUDGRVFRQORV
TXHVRQGHWHFWDGRVGHVSXpVGHORVSULPHURVPHVHVGHYLGD

/DGHWHFFLyQVLVWHPiWLFDGHO'p¿FLW$XGLWLYR&RQJpQLWR'$&HVHOSULPHUSDVRRSRUWXQR
H LPSUHVFLQGLEOH HQ XQ 3URJUDPD GH $VLVWHQFLD ,QWHJUDO SXHV SHUPLWH VX FDSWDFLyQ
SUHFR]\IDFLOLWDODUHKDELOLWDFLyQHQIRUPDUHOHYDQWH
(Q DTXHOORV FRQWH[WRV HQ ORV TXH VH SXHGH LQFRUSRUDU UDFLRQDOPHQWH HO WDPL]DMH
GHO '$& VH SRGUi SRQHU HQ PDUFKD OD LQYHVWLJDFLyQ GH ODV HPLVLRQHV RWRDF~VWLFDV
FRFOHDUHV\ORVSRWHQFLDOHVDXGLWLYRVHYRFDGRVGHWURQFR
2EMHWLYR 3UHYHQLUOD2)7$/0,$*212&2&&,&$
$FWLYLGDG ,QVWLODUDQWLPLFURELDQRVHQODVFRQMXQWLYDVDOQDFHU
(QHOPRPHQWRGHOSDUWRYDJLQDOHOUHFLpQQDFLGRSXHGHVHULQRFXODGRFRQ1HLVVHULD
*RQRUUHD*RQRFRFRSUHVHQWHHQORVJHQLWDOHVGHVXPDGUHSRUWDGRUDGHXQDFHUYLFLWLV
QRWUDWDGD
/DIRUPDPiVVHYHUDGHPDQLIHVWDFLyQGHODLQIHFFLyQSRU1*HQHOUHFLpQQDFLGR
HVOD2IWDOPtD1HRQDWDO\ODVHSVLVTXHSXHGHLQFOXLUDUWULWLV\PHQLQJLWLV/DVIRUPDV
PHQRV VHYHUDV LQFOX\HQ OD ULQLWLV YDJLQLWLV XUHWULWLV /D LQIHFFLyQ RFXODU FRPLHQ]D
KDELWXDOPHQWH HQWUH \ GtDV OXHJR GHO SDUWR \ SXHGH FRPSOLFDUVH FRQ SHUIRUDFLyQ
RFXODU\FHJXHUD
(OGLDJQyVWLFRVHVRVSHFKDSRUHOKDOOD]JRGHGLSORFRFRV*UDPQHJDWLYRVHQHOH[XGDGR
FRQMXQWLYDO6HFRQ¿UPDSRUFXOWLYREDFWHULROyJLFR
3UHYHQFLyQ
/D SUiFWLFD GH ³VH[R VHJXUR´ HO GLDJQyVWLFR \ WUDWDPLHQWR DQWHQDWDO RSRUWXQRV HV OD
IRUPDGHSUHYHQLUHVWDLQIHFFLyQQHRQDWDO
3UR¿OD[LV
/DLQVWLODFLyQGHDQWLPLFURELDQRVLQPHGLDWDDOQDFLPLHQWRSRUYtDYDJLQDORFHViUHDHV
XQDSUiFWLFDVHJXUDVLPSOH\GHEDMRFRVWR
/DVRSFLRQHVVRQ
6ROXFLyQUHFLHQWHPHQWHSUHSDUDGDGH1LWUDWRGH3ODWDDO
(VWHPpWRGROOHYDHOQRPEUHGH&UHGpSRUVHUGLFKRPpGLFRTXLHQORDSOLFyHQORVRMRV
GHORVUHFLpQQDFLGRVSRUSULPHUDYH]HQHO6LJOR;,;OXHJRGHKDEHUVLGRXVDGRSRU
GpFDGDVHQHOWUDWDPLHQWRGHODVXUHWULWLVJRQRFRFyFFLFDV
8QJHQWRRIWiOPLFRGH(ULWURPLFLQDDORGH7HWUDFLFOLQDDOHQXQDVROD

DSOLFDFLyQHQHOPRPHQWRGHOQDFLPLHQWR
(OWUDWDPLHQWRGHODRIWDOPtDHV&HIWULD[RQHPJ.JQRH[FHGLHQGRPJ
DGPLQLVWUDGRSRU,9R,0HQXQDGRVLV~QLFD
2EMHWLYR 3UHYHQLUODHQIHUPHGDGKHPRUUiJLFDGHOUpFLHQQDFLGR
$FWLYLGDG $GPLQLVWUDU9LWDPLQD.
/D (QIHUPHGDG +HPRUUiJLFD GHO 5HFLpQ 1DFLGR HV XQD HQWLGDG FOtQLFD FOiVLFD
FDUDFWHUL]DGDSRUKHPRUUDJLDHVSRQWiQHDLQHVSHUDGDHQXQUHFLpQQDFLGRGHDVSHFWR
VDOXGDEOH6XIRUPDSUHFR]RFXUUHHQORVSULPHURVGtDV\WLHQHXQLQFLGHQFLDQDWXUDO
GH\HQWUHORVUHFLpQQDFLGRV/DIRUPDWDUGtDHQWUH\VHPDQDVRFXUUH
PHQRV IUHFXHQWHPHQWH HQWUH \ SRU QDFLGRV SHUR VH SUHVHQWD FRPR
KHPRUUDJLDV~ELWDLQWUDFUDQHDQDRFDVLRQDQGRPXHUWHRVHYHUDLQFDSDFLGDG
6XSULQFLSDOtQGLFHGHKLSRFRDJXODELOLGDGHVODGLVPLQXFLyQGHOWLHPSRGHSURWURPELQD

/DLQWHUYHQFLyQSUHIHULGDHVODDGPLQLVWUDFLyQHQHOPRPHQWRGHQDFHUGHXQDGRVLV
~QLFD GH PJ ,0 GH 9LWDPLQD . (VWD GRVLV HV VX¿FLHQWH SDUD SUHYHQLU OD
(QIHUPHGDG+HPRUUiJLFDGHO5HFLpQ1DFLGRTXHRFXUUHHQORVSULPHURVGtDVGHYLGD
/DDGPLQLVWUDFLyQGHXQDGRVLVRUDOGHPJPHMRUDORVtQGLFHVGHFRDJXODFLyQGXUDQWH
ORVSULPHURVGtDVGHYLGD6LQHPEDUJRQRH[LVWHQHVWXGLRVFOtQLFRVTXHGHPXHVWUHQ
OD H¿FDFLD GH OD DGPLQLVWUDFLyQ GH XQR R YDULDV GRVLV RUDOHV HQ OD SUHYHQFLyQ GH OD
+HPRUUDJLD1HRQDWDO
2EMHWLYR ,QLFLDU\PDQWHQHUODFWDQFLDPDWHUQDH[LWRVD
$FWLYLGDG 1RVHSDUDUDOUHFLpQQDFLGR\VXPDGUH\IDFLOLWDUHODSR\RIDPLOLDU
$OLPHQWDUDOLEUHGHPDQGD\QRGDUELEHURQHV
5HJLVWUDUODDOLPHQWDFLyQDODOWDGHOD0DWHUQLGDG
1RVHSDUDUDOUHFLpQQDFLGR\VXPDGUH\IDFLOLWDUHODSR\RIDPLOLDU
'HVGHHOPRPHQWRHQTXHQDFHHOUHFLpQQDFLGR\VXPDGUHWLHQHQHOGHUHFKRDQRVHU
VHSDUDGRV7RGDODDWHQFLyQGHEHUHDOL]DUVHSURFXUDQGRUHGXFLUDOPtQLPRODVLQVWDQFLDV
HQODVTXHODDWHQFLyQGHFDGDXQRGHHOORVQRSXHGDKDFHUVHMXQWRDORWUR
(VWD SUiFWLFD VH FRQRFH GHVGH KDFH DxRV FRPR

$ORMDPLHQWR&RQMXQWR
8QDLQVWLWXFLyQDVLVWHQFLDOUHVSHWXRVDGHORVGHUHFKRVGHOD
IDPLOLDGHEHDVHJXUDUTXHODPDGUHWHQJDHODSR\RIDPLOLDU
TXHVROLFLWHSDUDSRGHUFXLGDUDVXKLMR Figura 113. Fragmento HCP.
Referencia del RN
$OQDFHUXQDYH]FHVDGDODFLUFXODFLyQXPEtOLFRSODFHQWDULD\FRODSVDGRHOFRUGyQHQORV
SULPHURVPLQXWRVGHYLGDVHHVWDEOHFHODUHVSLUDFLyQUHJXODU/XHJRGXUDQWHODSULPHUD
KRUDGHYLGDHOUHFLpQQDFLGRPDQWLHQHXQOODPDWLYRHVWDGRGHYLJLOLDDOHUWDHQHOTXH
FRQIUHFXHQFLDH[SORUDHOVHQRPDWHUQRHLQLFLDORVSULPHURVLQWHQWRVGHVXFFLyQ
(OFRQIRUWGHODPDGUHORVDSR\RVIDPLOLDUHV\GHOSHUVRQDOVRQLPSUHVFLQGLEOHVSDUDHO
LQLFLRH[LWRVRGHODODFWDQFLD
$OLPHQWDUDOLEUHGHPDQGD\QRGDUELEHURQHV
(O FRPLHQ]R SUHFR] GH OD DOLPHQWDFLyQ DO VHQR OD GLVSRQLELOLGDG FRQWLQXD GH OD
RIHUWD PDWHUQD OLEUH GHPDQGD \ OD QR DGPLQLVWUDFLyQ GH ELEHURQHV FRQWULEX\HQ DO
HVWDEOHFLPLHQWR\PDQWHQLPLHQWRGHODODFWDQFLD
5HJLVWUDUODDOLPHQWDFLyQDODOWDGHOD0DWHUQLGDG
$ODOWDGHEHUHJLVWUDUVHHOWLSRGHDOLPHQWDFLyQUHFLELGDSRUHOUHFLpQ
QDFLGR HQ ODV ~OWLPDV KRUDV &XDQGR VH UHJLVWUD /DFWDQFLD
([FOXVLYD VLJQL¿FD TXH HQ HVDV KRUDV QR KD UHFLELGR QLQJ~Q
RWURDOLPHQWRTXHOHFKHGHVXSURSLDPDGUH
/D SUHFLVLyQ GH HVWH GDWR VLUYH SDUD PRQLWRUHDU OD FDOLGDG GH
OD SUiFWLFD GH OD ODFWDQFLD QDWXUDO HQ OD LQVWLWXFLyQ \ FRUUHJLU ODV
Figura 114. VLWXDFLRQHVTXHLQWHU¿HUHQFRQXQDEXHQDSUiFWLFD
Fragmento HCP.
Alimentación al alta
2EMHWLYR 3UHYHQLUOD7XEHUFXORVLV*UDYHHQHOODFWDQWH
$FWLYLGDG 9DFXQDFLyQ%&*DOQDFHU
/DUHGXFFLyQGHODWXEHUFXORVLVHQODSREODFLyQHVHOUHVXOWDGRGH
Figura 115. XQDVHULHGHPHGLGDVGHKLJLHQHSUHYHQWLYDVGHGHWHFFLyQSUHFR]
Fragmento HCP. GHFDVRV\VXWUDWDPLHQWR
Vacunación BCG
/DYDFXQDFLyQ%&*%DFLORGH&DOPHWWH\*XHULQDOQDFHUHVSDUWHGHHVHFRQMXQWR
\KDVLGRDGRSWDGD\XQLYHUVDOPHQWHDGPLQLVWUDGDDWRGRVORVUHFLpQQDFLGRVGHVGH
KDFHPDVGHDxRV,QLFLDOPHQWHVHKL]RVRORDORVQDFLGRVHQFRQWDFWRFRQIDPLOLDUHV
WXEHUFXORVRV
/DYDFXQD%&*FRQVLVWHHQODLQ\HFFLyQ0\FREDWHULXP%RULVSDUDLQGXFLUSURWHFFLyQ
FRQWUDODLQIHFFLyQSRU0WXEHUFXORVLV
/RV UHFLpQ QDFLGRV ODFWDQWHV \ QLxRV PHQRUHV VRQ H[WUHPDGDPHQWH VXVFHSWLEOHV DO
FRQWDJLRGH7%&
/DDGPLQLVWUDFLyQGHOD%&*SURWHJHHQPDVGHXQDOUHFLpQQDFLGRYDFXQDGR
VLQ LQÀXLU HQ OD FDGHQD GH WUDQVPLVLyQ /D SURWHFFLyQ WDPELpQ HV LPSRUWDQWH SXHV VL
ELHQQRLQPXQL]DFRQWUDFXDOTXLHUIRUPDGHWXEHUFXORVLVSUHYLHQHODVIRUPDVJUDYHV
PHQLQJLWLV\WXEHUFXORVLVGLVHPLQDGDRPLOLDU
3XHGH SURGXFLU XQD UHDFFLyQ SDSXODU ORFDO H KLSHUWHUPLD \ FRQ PHQRV IUHFXHQFLD
OLQIDGHQLWLV\DEVFHVRORFDO
2EMHWLYR 3UHYHQLUODPXHUWHV~ELWDGHOODFWDQWH
$FWLYLGDG &RORFDUDOUHFLpQQDFLGR%2&$$55,%$SDUDGRUPLU
/DPXHUWHV~ELWDGHOODFWDQWHRFXUUHHQXQQLxRVDQRGXUDQWHHOVXHxRVLQXQDHQIHUPHGDG
DJXGDTXHODMXVWL¿TXH\VXIUHFXHQFLDHVHQWUH\QLxRVFDGDPLOQDFLGRVYLYRV
'HVGHKDFHPiVGHXQDGpFDGDYDULRVSDtVHVKDQLPSOHPHQWDGRSUiFWLFDVGHPDQHMR
GHO QLxR \ GHO DPELHQWH TXH KDQ GLVPLQXLGR PiV GH XQ OD IUHFXHQFLD GH PXHUWH
V~ELWD
'XUDQWHHOFRQWURODQWHQDWDOODLQWHUYHQFLyQSUHYHQWLYDPiVLPSRUWDQWHHVORJUDUTXHOD
PDGUHDEDQGRQHHOKiELWRGHIXPDU\TXHQDGLHIXPHGHQWURGHVXKRJDU(OKDOOD]JR
GHXQDPD\RUIUHFXHQFLDGHSRVWXUDERFDDEDMRGXUDQWHHOVXHxRHQORVODFWDQWHVTXH
IDOOHFLHURQ GH PXHUWH V~ELWD FRPSDUDGR FRQ ODFWDQWHV VLPLODUHV HQ HGDG \ PRGR GH
FULDQ]DTXHQRIDOOHFLHURQHQVXYHFLQGDULRHQODPLVPDpSRFDLPSXOVyODSUiFWLFDGH
'250,5%2&$$55,%$SDUDSUHYHQLUODPXHUWHV~ELWD
0LHQWUDV OD PDGUH \ VX EHEp HVWiQ KRVSLWDOL]DGRV %RFD

LQPHGLDWDPHQWHGHVSXpVGHOSDUWRHVXQEXHQPRPHQWRSDUD DUULED
YHUL¿FDUVLODPDGUHDFXHVWDDVXEHEpERFDDUULED\DFRQVHMDU
VREUHODPHMRUSUiFWLFD Figura 116.
Fragmento HCP.
Posición del RN en la cuna
7DPELpQH[LVWHQRWURVIDFWRUHVSURWHFWRUHVFRPR
x(YLWDUHOH[FHVRGHDEULJR\ODWHPSHUDWXUDDPELHQWDOPD\RUD&
x(YLWDUORVFROFKRQHVGHPDVLDGREODQGRVODVDOPRKDGDV\ORVFREHUWRUHV
YROXPLQRVRV3UH¿ULHQGRFROFKRQHV¿UPHV\XQRRGRVFREHUWRUHV¿QRV
x(YLWDUTXHVHGXHUPDHQHOPLVPRVLOOyQTXHORVSDGUHVHVWiQPLUDQGRODWHOHYLVLyQ
/DODFWDQFLDPDWHUQDHVXQIDFWRUSURWHFWRULPSRUWDQWHSUREDEOHPHQWHGHELGRDOVXHxR
PDVOLJHURTXHRFXUUHGXUDQWHODQRFKH\ODIUHFXHQFLDPD\RUGHYHFHVTXHODPDGUHOR
DWLHQGHSDUDDOLPHQWDUOR
(VSUREDEOHTXHHOFKXSHWHWHQJDXQHIHFWRSURWHFWRUSHURHVWHFRQFHSWRQRHVDFHSWDGR
XQLYHUVDOPHQWH6LQHPEDUJRH[LVWHQVX¿FLHQWHVHYLGHQFLDVSDUDQRGHVDFRQVHMDUVX
XVRVLORVSDGUHVSLGHQRSLQLyQDOHTXLSRGHVDOXG
2EMHWLYR 'LVPLQXLUORVULHVJRVGHORVQDFLGRVGHDVHPDQDVSUHWpUPLQR

WDUGtRV\ORVGHDVHPDQDVWpUPLQRSUHFRFHV
$FWLYLGDG $XPHQWDU OD YLJLODQFLD HQ HO SHUtRGR GH DGDSWDFLyQ PLHQWUDV
SHUPDQHFHQHQVDODFRQVXVPDGUHV
(O DJUXSDPLHQWR FRQYHQFLRQDO GH ORV UHFLpQ QDFLGRV VHJ~Q VX (GDG *HVWDFLRQDO
GLIHUHQFLDWUHVJUXSRV3UHWHUPLQRKDVWDODVVHPDQDV7HUPLQRGHVGHODVKDVWD
ODV\3RVWHUPLQRPD\RUHVGHVHPDQDV
/D GHFLVLyQ GH OD RSRUWXQLGDG GH QDFLPLHQWR HV XQ KHFKR FOtQLFR IUHFXHQWH HQ OD
REVWHWULFLDPRGHUQD(VWRVQDFLPLHQWRVVHOHFWLYRVHVWiQLQFUHPHQWDQGRHOQ~PHURGH
UHFLpQQDFLGRVHQHGDGHVLQIHULRUHVDODVTXHRFXUULUtDQHVSRQWiQHDPHQWH
/DGHFLVLyQGHLQWHUUXPSLUGHVSXpVGHODVVHPDQDVSRUHOPD\RUULHVJRGHPXHUWH
IHWDOHVWiSOHQDPHQWHMXVWL¿FDGD
8QQ~PHURVLJQL¿FDWLYRGHQDFLPLHQWRVVHSURGXFHQOXHJRGHODVVHPDQDV\DQWHV
GHO WpUPLQR (VWRV UHFLpQ QDFLGRV VH GLIHUHQFLDQ GH ORV GH PHQRU HGDG JHVWDFLRQDO
SXHV IUHFXHQWHPHQWH WLHQHQ FRPSOHWD OD PDGXUDFLyQ SXOPRQDU \ SXHGHQ LQLFLDU OD
DOLPHQWDFLyQDOVHQR
(O PD\RU Q~PHUR GH QDFLPLHQWRV VHOHFWLYRV FRPLHQ]D D SDUWLU GH ODV VHPDQDV \
VHGLIHUHQFLDQGHORVGHPHQRUHGDGJHVWDFLRQDOSXHV\DKDQORJUDGRODPDGXUDFLyQ
SXOPRQDU\ODVXFFLyQGHJOXFLyQTXHVRQODVIXQFLRQHVFHQWUDOHVSDUDVXDXWRQRPtD
6LQHPEDUJRORVQDFLPLHQWRVVHOHFWLYRVHQWUHODV\VHPDQDVSUHVHQWDQPD\RU
PRUELOLGDGDVRFLDGDSRUWUDVWRUQRVGHODDGDSWDFLyQ/DPRUELOLGDGDXPHQWDFRQFDGD
VHPDQDGHHGDGJHVWDFLRQDOTXHVHDQWLFLSDHOQDFLPLHQWR
$SDUWLUGHODVVHPDQDV\KDVWDODVVHPDQDVHVHOSHUtRGRGHPHQRUPRUELOLGDG
'HELGR D TXH ODV VHPDQDV VH FRQVLGHUDQ SRU FRQYHQFLyQ FRPR HO LQLFLR GHO
SHUtRGRGHWpUPLQRHVWHJUXSRGHQDFLPLHQWRVVHOHFWLYRVVHKDGLYLGLGRHQGRVJUXSRV
GHQRPLQDGRV3UHWpUPLQRVWDUGtRVFXDQGRQDFHQGHVGHODVVHPDQDVKDVWDODV
VHPDQDV\7pUPLQRVSUHFRFHVDODV\VHPDQDV
3UHWpUPLQRVWDUGtRV
/RVSUHWpUPLQRVWDUGtRVVHGH¿QHQFRPRORVQDFLGRVGHVHPDQDVGtDKDVWD
VHPDQDVGtDV\FRQVWLWX\HQHOGHWRGRVORVSUHWpUPLQRVVLHQGRHOGHORV
QDFLGRVYLYRVFXDQGRODWDVDGHSUHWHUPLQRHV
/RVIDFWRUHVTXHKDQVLGRLPSOLFDGRVHQHODXPHQWRGHORVSUHWpUPLQRVWDUGtRVVRQ
0HMRUDPLHQWR GH GLDJQyVWLFR SUHQDWDO GH FRPSOLFDFLRQHV IHWDOHV R PDWHUQDV
DXPHQWDHOLQWHUYHQFLRQLVPRREVWpWULFR
,QH[DFWLWXGGHOFiOFXORGHHGDGJHVWDFLRQDO
$XPHQWRGHORVHPEDUD]RVP~OWLSOHVHQSDUWHH[SOLFDGDSRUHODXPHQWRGHOD
UHSURGXFFLyQDVLVWLGD
/DFUHHQFLDHUUyQHDTXHODPDGXUH]FRPSOHWDVHDOFDQ]DDODVVHPDQDV
$XPHQWRGHODFHViUHDVHOHFWLYDV
6L ELHQ OD PD\RUtD GH HVWRV UHFLpQ QDFLGRV WLHQHQ PDGXUDFLyQ SXOPRQDU FRPSOHWD \
IUHFXHQWHPHQWHSXHGHQDOLPHQWDUVHDOVHQRHQVDODFRQVXVPDGUHVQRRFXUUHHQHO
\SRUHVHPRWLYRWLHQHQPD\RUPRUWDOLGDG\PRUELOLGDGTXHDHGDGHVPD\RUHV
/DPRUWDOLGDGQHRQDWDODGtDVGHORVQDFLGRVGHDVHPDQDVHVYHFHV

PD\RU D ORV WpUPLQRV DO LJXDO TXH OD PRUWDOLGDG LQIDQWLO GH D GtDV GH HGDG
FURQROyJLFDHVYHFHVPD\RUTXHORVQDFLGRVGHWpUPLQR
(QFRPSDUDFLyQFRQORVQDFLGRVGHWpUPLQRWLHQHQPDVGL¿FXOWDGHVSDUDDOLPHQWDUVH
YHUVXV KLSRJOLFHPLD YHUVXV LFWHULFLD YHUVXV
LQHVWDELOLGDG WpUPLFD YHUVXV DSQHD YHUVXV PHQRV GH \ 6'5
YHUVXV7DPELpQSUHVHQWDQYHFHVPiVSUREDELOLGDGGHWHQHURPiV
FRPSOLFDFLRQHVGXUDQWHODLQWHUQDFLyQ&XDQGRHODOWDHVRWRUJDGDDQWHVGHORVGtDV
GHYLGDVXUHKRVSLWDOL]DFLyQHVDYHFHVPiVIUHFXHQWHGHELGRDLFWHULFLD
VRVSHFKDGHLQIHFFLyQ\GL¿FXOWDGSDUDDOLPHQWDUVH
7pUPLQRSUHFR]
(OUHFLpQQDFLGRGHWpUPLQRSUHFR]VHGH¿QHFRPRORVQDFLGRVHQWUHODVVHPDQDV
GtD\VHPDQDV\GtDV6RQGHORVQDFLGRVYLYRV
(VWH JUXSR WLHQHQ PD\RU LQFLGHQFLD GH GL¿FXOWDGHV HQ OD DGDSWDFLyQ UHVSLUDWRULDV
FRPR HV OD WDTXLSQHD WUDQVLWRULD GHO UHFLpQ QDFLGR VtQGURPH GH GLVWUHVV UHVSLUDWRULR
\ODKLSHUWHQVLyQSXOPRQDUSHUVLVWHQWH/RVQDFLGRVDODVVHPDQDVWLHQHQYHFHV
PiVVtQGURPHGHGLVWUHVVUHVSLUDWRULRTXHORVQDFLGRVDODVVHPDQDV\YHFHV
PiVIUHFXHQWHTXHORVQDFLGRVDODDVHPDQDVGHHGDGJHVWDFLRQDO
&XDGUR
6LQGURPHGH'L¿FXOWDG5HVSLUDWRULDHQWUHODV\VHPDQDVGH(GDG*HVWDFLRQDO
(GDGJHVWDFLRQDO ,QFLGHQFLDGH6'5
VHPDQDV SRUQDFLGRVYLYRV

'DWRVH[WUDtGRVGH0DGDU-5LFKPRQG6+H\(VXUIDFWDQWGH¿FLHQWUHVSLUDWRU\GLVWUHVVDIWHU
HOHFWLYHGHOLYHU\DWWHUP$FWD3DHGLDWU
/DFHViUHDHVXQLPSRUWDQWHIDFWRUGHULHVJRLQGHSHQGLHQWHTXHVHDVRFLDDODXPHQWRGH
ODPRUELOLGDGUHVSLUDWRULDHQORVQDFLGRVGHWpUPLQR
&XDGUR
,QFLGHQFLDGHPRUELOLGDGUHVSLUDWRULDHQSUHWpUPLQRWDUGtR\UHFLpQQDFLGRGHWpUPLQR
VHJ~QYLDGHSDUWR
2GGVUDWLR
&HViUHD 3DUWRYDJLQDO 7RWDO &,
Q Q Q SDUDFHViUHD
1DFLGRVYLYRV
7DTXLSQHDWUDQVLWRULD
6'5
+LSHUWHQVLyQSXOPRQDU
7RWDO
([WUDtGR GH /HYLQH (0 *KDL 9 %DUWRQ -- 6WURP &0 0RGH RI GHOLYHU\ DQG ULVN RI
UHVSLUDWRU\GLVHDVHVLQQHZERUQV2EVWHW*\QHFRO0DU
&XLGDGRVMXQWRDVXPDGUH
/RV UHFLpQ QDFLGRV HQWUH ODV \ VHPDQDV UHTXLHUHQ PD\RUHV FXLGDGRV GH
HQIHUPHUtDSHURVHEHQH¿FLDQGHHVWDUUiSLGDPHQWHWRGRHOGtDFRQVXVPDGUHVD~Q
FXDQGRUHTXLHUDQIRWRWHUDSLDFRQWUROHVGHJOLFHPLDSHULyGLFRVRFRQWUROHVGLDULRVGHSHVR
/DLPSOHPHQWDFLyQGHHVWRVFXLGDGRVGHHQIHUPHUtDMXQWRDODPDGUHSDUDHVWHJUXSR
GH UHFLpQ QDFLGRV HV WDPELpQ EHQH¿FLRVD SDUD ORV TXH KDELHQGR QDFLGR D HGDGHV
JHVWDFLRQDOHV PHQRUHV GH VHPDQDV \D KDQ VXSHUDGR ORV SUREOHPDV LQLFLDOHV GH
DGDSWDFLyQ&XLGDGR,QWHQVLYR\SRUVXHGDGSRVWQDWDOSHVR\PDGXUDFLyQVHEHQH¿FLDQ
VLSDVDQD6DODVGH,QWHUQDFLyQFRQVXVPDGUHV
&RQWUROGHLQIHFFLRQHV
8Q REMHWLYR HVHQFLDO HV OD SUHYHQFLyQ GH LQIHFFLRQHV HQ HO UHFLpQ QDFLGR VDQR \ GH
WpUPLQR \ SDUWLFXODUPHQWH HQ HO UHFLpQ QDFLGR TXH UHTXLHUD LQWHUYHQFLRQHV \ SUiFWLFDV
LQYDVLYDVGHSHQGLHQGRGHODVFRPSOLFDFLRQHVTXHVHSUHVHQWHQ
(Q PXFKRV FDVRV ODV LQIHFFLRQHV QRVRFRPLDOHV VRQ VXEHVWLPDGDV GHELGR D TXH HQ
PXFKRVFDVRVORVQLxRVVRQGDGRVGHDOWDDQWHVGHODDSDULFLyQGHORVVtQWRPDV
(VWDV VLWXDFLRQHV VRQ UHOHYDQWHV \ SRWHQFLDOPHQWH PiV IUHFXHQWHV HQ XQLGDGHV GH
QHRQDWRORJtD\GHFXLGDGRVLQWHQVLYRVSXGLHQGRYDULDUVXIUHFXHQFLD\FDUDFWHUtVWLFDVFRQ
ODVXQLGDGHVGHFXLGDGR\VXFRPSOHMLGDGFRQORVKiELWRVGHSUHVFULSFLyQ\UHFXUUHQFLD
DORVSURFHGLPLHQWRVLQYDVLYRV\GHSHQGLHQGRSDUWLFXODUPHQWHGHODVFDUDFWHUtVWLFDV\
FDOLGDGGHDWHQFLyQ
/D SUHYHQFLyQ GH ODV LQIHFFLRQHV LPSOLFD XQ SURFHVR FRQWLQXR TXH DEDUFD GHVGH
OD JHVWDFLyQ KDVWD HO FXLGDGR GHO QLxR HQ HO KRJDU XQD YH] GDGR GH DOWD ,PSOLFD OD
SUHYHQFLyQ GH OD SUHPDWXUH] OD SUHYHQFLyQ GLDJQyVWLFR \ WUDWDPLHQWR RSRUWXQR GH
LQIHFFLRQHVGXUDQWHODJHVWDFLyQ/DDGRSFLyQGHFRUUHFWDVPHGLGDVGHKLJLHQHSRUSDUWH
GHWRGRHOSHUVRQDOHQFRQWDFWRFRQHOUHFLpQQDFLGRDVtFRPRODPDGUH\ODVSHUVRQDVHQ
FRQWDFWRFRQpO(OLQLFLRSUHFR]GHODODFWDQFLDPDWHUQDFRQVWLWX\HFODUDPHQWHXQIDFWRU
SURWHFWRUFRQWUDODVLQIHFFLRQHVHQHOUHFLpQQDFLGR(VWRVDVSHFWRVGHEHQVHUWUDEDMDGRV
HQODVLQVWLWXFLRQHV\GHEHQIRUPDUSDUWHLPSRUWDQWHGHORVFRQVHMRVEULQGDGRVDODPDGUH
DOPRPHQWRGHODOWD(QHOFDVRGHUHTXHULUVHORVSURFHGLPLHQWRVLQYDVLYRVGHEHQVHU
OLPLWDGRVHQVXXVR\VXGXUDFLyQ
$OWD
&RQGLFLRQHVHLQGLFDFLRQHVSDUDHODOWD
(VDFRQVHMDEOHTXHHOQLxR\VXPDGUHSHUPDQH]FDQHQODLQVWLWXFLyQGXUDQWHDOPHQRV
KRUDVGHPRGRGHSRGHUYDORUDUODHYROXFLyQHQDPERVSHUPLWHGHVFDUWDUSDWRORJtDV
HYDOXDU HO LQLFLR \ WpFQLFD GH OD ODFWDQFLD PDWHUQD \ EULQGDU DSR\R H LQIRUPDFLyQ D OD
PDGUH\DOJUXSRIDPLOLDU
/RVDVSHFWRVFHQWUDOHVTXHGHEHQDERUGDUVHDOPRPHQWRGHODOWDLQYROXFUDQ
$OLPHQWDFLyQ
R ,QIRUPDUDFHUFDGHUHÀHMRVTXHHVWLPXODQXQDEXHQDODFWDGDSRVLFLRQHV
SDUDDPDPDQWDULPSRUWDQFLDGHOYDFLDGRSHULyGLFRGHODVPDPDVKLJLHQHGH
ORVSH]RQHV\SUHYHQFLyQGHSUREOHPDVPDPDULRV
R ,QIRUPDUDFHUFDGHOGHVFHQVR¿VLROyJLFRGHSHVR
+LJLHQHJHQHUDO\&XLGDGRGHOFRUGyQXPELOLFDO
3RVLFLyQ DO GRUPLU \ SUHYHQFLyQ GHO 6LQGURPH GH 0XHUWH 6~ELWD GHO /DFWDQWH
&RORFDU DO QLxR ERFD DUULED SDUD GRUPLU QR VREUHDEULJDUOR QR IXPDU HQ HO
DPELHQWHGHVHVWLPDUHOFROHFKR
2ULHQWDUSDUDHOUHFRQRFLPLHQWRGH6LJQRVGHDODUPD*HQHUDOHVGHODFRORUDFLyQ
GHSLHO\PXFRVDV5HVSLUDWRULRV&DUGLRYDVFXODUHV*DVWURLQWHVWLQDOHV8ULQDULRV
1HXUROyJLFRV0XVFXORHVTXHOpWLFRV
%ULQGDU LQIRUPDFLyQ DFHUFD GHO ,QWHUYDOR LQWHUJHQpVLFR ySWLPR \ FRQVHMHUtD HQ
VDOXGUHSURGXFWLYD
,QGLFDUODV,QPXQL]DFLRQHVFRUUHVSRQGLHQWHVDOPRPHQWRGHOQDFLPLHQWR\SULPHU
VHPDQDVHJ~QHVTXHPD
9HUL¿FDULGHQWL¿FDFLyQGHOQLxR\VXPDGUH
%ULQGDURULHQWDFLyQSDUDODLQVFULSFLyQGHOQLxRHQHO5HJLVWUR&LYLO
,QGLFDU FODUDPHQWH IHFKD \ OXJDU GHO SULPHU FRQWURO D ORV GtDV GHO DOWD
SUHIHUHQWHPHQWHFRRUGLQDUODFRQWUDUHIHUHQFLD
9DORUDUSUHYLRDODOWDFRQGLFLRQHVGHULHVJRVRFLDO
2ULHQWDUDFHUFDGHODVSUXHEDVGH3HVTXLVD\REWHQFLyQGHORVUHVXOWDGRV
(QPXFKRVFDVRVSXHGHVHU~WLOODHODERUDFLyQ\HQWUHJDGHIROOHWRVLQVWUXFWLYRVFRQORV
FRQRFLPLHQWRVEiVLFRVDWUDQVPLWLUDODOWD
McCall EM, et al. Interventions to prevent hypothermia at birth in preterm and low birth weight. Cochrane
Database Rev 2008, Jan 23.
Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR,
Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, Jagt
EW van der , Zaritsky AL.. Pediatric advanced life support: 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010 Nov;126(5):e1361-99.
Epub 2010 Oct 18.
American Academy of Pediatrics. Section on Ophthalmology, American Academy of Ophthalmology,

American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature
infants for retinopathy of prematurity. Pediatrics. 2006 Feb; 117(2):572-6.
Hutton EK et al, Late versus Early clamping Of the umbilical cord in full term neonates: Systemic review and
metanalysis of controlled trials. JAMA 2007;2007:1241-1252.
Rabe H et al. A systematic review and metanalisys of a brief delay in camping the umbilical cord of preterm
infant. Neonatology 2008;93:138-144.
Rabe H, Reynolds GJ, Diaz-Rosello JL. Early versus delayed umbilical cord clamping in preterm infants.
Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003248. DOI: 10.1002/14651858.
CD003248.pub2.
McDonald SJ, Middleton P Effect of timing of umbilical cord clamping of term infants on maternal and neonatal
outcomes. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004074.
Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EF, Wright LL, Kandefer S, Poole WK. National Institute
of Child Health and Human Development Neonatal Research Network. Delivery room continuous positive
airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial.
Pediatrics. 2004 Sep;114(3):651-7.
Morley Colin J, Davis Peter, Doyle Lex W, Brion Luc P, Hascoet Jean-Michel, Carlin John B. Nasal CPAP or
Intubation at Birth for Very Preterm Infants. N Engl J Med 2008; 358:700-708.
Engle WA, Kominiarek MA.Late preterm infants, early term infants, and timing of elective deliveries. Clin
Perinatol. 2008, 35(2):325-41, vi. Review
Engle W A, Tomashek K M, Wallman C. Committee on fetus and Newborn. American Academy of Pediatrics.
Late-preterm infants: a population at risk. A clinical report. Pediatrics 2007, 120(6):1390-401.
9, $WHQFLyQFRQMXQWDGHODPDGUH\HOQLxR
GHVSXpVGHOQDFLPLHQWR
& $ 3, 7 8 /2 9 ,
2%-(7,92 5DFLRQDOL]DUORVUHFXUVRV\GLVPLQXLURSRUWXQLGDGHVSHUGLGDV
&RQWURODUELHQHVWDUGHODPXMHUSXpUSHUD\GHOUHFLpQQDFLGR
'HWHFWDU \ HYDOXDU GHVYLDFLRQHV GH ORV OtPLWHV ¿VLROyJLFRV GH
DPERV
$&7,9,'$' $WHQFLyQ FRQMXQWD GH OD PDGUH \ HO UHFLpQ QDFLGR GXUDQWH HO
SXHUSHULR
(GXFDFLyQGHODPXMHUSXpUSHUD
&RQWUROHVFOtQLFRVGHODPXMHU\VXKLMR
5HJLVWURGHORVFRQWUROHVHQODKLVWRULDFOtQLFDSHULQDWDO
'XUDQWH OD LQWHUQDFLyQ SRVW SDUWR \ KDVWD HO DOWD D VX KRJDU OD PDGUH \ HO UHFLpQ
QDFLGRUHFLEHQDWHQFLyQHQIRUPDFRQMXQWD(OSHUVRQDOHVWiFDSDFLWDGRSDUDDWHQGHU
VLPXOWiQHDPHQWH ODV QHFHVLGDGHV GH DPERV EULQGDQGR DORMDPLHQWR FRQMXQWR WRGR
HO GtD SULYDFLGDG GHVFDQVR \ DOLPHQWDFLyQ DGHFXDGD /D GXUDFLyQ GH OD LQWHUQDFLyQ
FRQMXQWD VH H[WLHQGH PLHQWUDV HO KRVSLWDO PDQWHQJD YHQWDMDV VREUH HO KRJDU SDUD OD
DGDSWDFLyQGHOUHFLpQQDFLGR\SDUDORVFXLGDGRVSRVWSDUWRLQPHGLDWRVGHODPDGUH
(VIUHFXHQWHTXHOXHJRGHODOWDGHOD0DWHUQLGDGODDWHQFLyQGHODPDGUH\GHOUHFLpQ
QDFLGRVHUHDOLFHSRUSHUVRQDOGLIHUHQWHHQPRPHQWRV\iPELWRVItVLFRVGLIHUHQWHV
1R HV KDELWXDO TXH H[LVWD XQ SURWRFROR FRP~Q GH DWHQFLyQ D~Q FXDQGR OD FRQGLFLyQ
GH FULDQ]D GHO EHEp PDQWLHQH YtQFXORV ELROyJLFRV LQWHUDFWLYRV HQWUH OD PDGUH \ VX
QLxR(OREMHWLYRGHSODQL¿FDUODDWHQFLyQSRVWQDWDOFRQMXQWDSUHWHQGHUDFLRQDOL]DUORV
UHFXUVRVKXPDQRVTXHORVFXLGDQDSURYHFKDUWRGDVODVLQVWDQFLDVSDUDODSURPRFLyQ\
HOFXLGDGRGHODVDOXGGHDPERV\GLVPLQXLUODVRSRUWXQLGDGHVSHUGLGDV
(YLWDU ODV FRQVXOWDV SRU VHSDUDGR LPSOLFD UHGXFLU JDVWRV GH WLHPSR \ GH UHFXUVRV
HFRQyPLFRVDODVIDPLOLDV

5HJLVWURV
3DUD LQLFLDU OD DWHQFLyQ SRVW QDWDO GH PDGUH \ QLxR HV VX¿FLHQWH OD LQIRUPDFLyQ
FRQWHQLGDHQOD+LVWRULD&OtQLFD3HULQDWDOGHODPDGUH\GHVXUHFLpQQDFLGRSXGLHQGR
FRPSOHPHQWDUVHFRQODLQIRUPDFLyQGHODOWDGHKRVSLWDOL]DFLyQQHRQDWDOHQORVFDVRV
TXHVHKD\DUHTXHULGRGHLQWHUQDFLyQHQFXLGDGRVHVSHFLDOHV
)LJXUD)UDJPHQWR+&3&RQWUROHVHQHOSXHUSHULR
6RSRUWHDIHFWLYR
(QFDGDHQFXHQWURVHHVSHUDTXHHOSHUVRQDOGHVDOXGVHSUHRFXSHSRU
x HOELHQHVWDUHPRFLRQDOGHODPDGUH
x ODD\XGDTXHREWLHQHGHODIDPLOLD\GHORVGHPiVPLHPEURVGHVXFRPXQLGDG
SDUDSRGHUUHVROYHUORVSUREOHPDVGLDULRVTXHWLHQHSRUVXFRQGLFLyQGHPDGUH
6L OD IDPLOLD R OD PDGUH UHODWDQ TXH HOOD WLHQH FDPELRV HQ HO HVWDGR HPRFLRQDO R HO
FRPSRUWDPLHQWRKDELWXDOVHSURSLFLDUDODFRQVXOWDFRQXQSURIHVLRQDOTXHODHYDO~H\
DWLHQGD
/DVPDGUHV\ODVIDPLOLDVGHEHUiQVHUVLHPSUHWUDWDGDVFRQFDULxRUHVSHWR\GLJQLGDG
6XVSXQWRVGHYLVWDFUHHQFLDV\YDORUHVHQUHODFLyQDODXWRFXLGDGR\HOFXLGDGRGHO
QLxR GHEHUiQ VHU FRQWHPSODGRV \ VDOYR HQ DTXHOODV RFDVLRQHV TXH SXHGDQ UHVXOWDU
QRFLYRVVHQHJRFLDUiHQIRUPDUHVSHWXRVDFRQHOOD\VXIDPLOLDHOFDPELRQHFHVDULROHQ
EDVHDLQIRUPDFLyQYHUD]\RSRUWXQD6HHVSHUDTXHODVPDGUHVSXHGDQWRPDUVLHPSUH
ODVGHFLVLRQHVVREUHVXSURSLRFXLGDGRRWUDWDPLHQWRVQHFHVDULRV
/D EXHQD FRPXQLFDFLyQ HV HVHQFLDO /RV FXLGDGRV \ OD LQIRUPDFLyQ FRQVLGHUDUDQ HO
LGLRPDDSURSLDGR\ODVSUiFWLFDVFXOWXUDOHVGHODPDGUHWHQLHQGRHQFXHQWDQHFHVLGDGHV
HVSHFLDOHVSRUGLVFDSDFLGDGHVItVLFDVFRJQLWLYDVRVHQVRULDOHV
&DSDFLGDGHVGHOSHUVRQDO
(O SHUVRQDO TXH FXLGD D DPERV ±PDGUH \ UHFLpQ QDFLGR GHEH WHQHU FRPSHWHQFLDV
GHPRVWUDGDV\H[SHULHQFLDSDUD
x UHDOL]DU OD YDORUDFLyQ \ UHFRQRFHU VLJQRV GH DODUPD HQ OD PDGUH \ HO UHFLpQ
QDFLGR
x DSR\DUHQHOLQLFLR\PDQWHQLPLHQWRGHODODFWDQFLD
x UHFRQRFHUVLJQRV\VtQWRPDVGHSUREOHPDVGHVDOXGPHQWDOGHODPDGUH
x UHFRQRFHU ORV ULHVJRV VLJQRV \ VtQWRPDV GH YLROHQFLD GRPpVWLFD \ DEXVR
LQIDQWLO
x LGHQWL¿FDUORVUHFXUVRVGLVSRQLEOHVSDUDTXHODPDGUHREWHQJDFRQVHMR\DSR\R
'H¿QLFLRQHV
(O SXHUSHULR FRPLHQ]D XQD YH] TXH KD WHUPLQDGR HO DOXPEUDPLHQWR \ VH H[WLHQGH
VHLVVHPDQDV'XUDQWHHVWHSHULRGRUHYHUWLUiQWRGRVORVFDPELRV¿VLROyJLFRVTXHVH
SURGXMHURQGXUDQWHHOHPEDUD]RFRQODVRODH[FHSFLyQGHORVFDPELRVPDPDULRVTXH
VHLQWHQVL¿FDUiQSDUDPDQWHQHUHODPDPDQWDPLHQWRH[LWRVR
3XHUSHULRLQPHGLDWRDEDUFDODVSULPHUDVKRUDVGHOSRVWSDUWRHLQFOX\HHQpODODV
KRUDVTXHFRQWLQ~DQDODOXPEUDPLHQWR6XLPSRUWDQFLDUDGLFDHQTXHHVHQHVWHSHUtRGR
HQHOFXDOVHSURGXFHODPD\RUFDQWLGDGGHFRPSOLFDFLRQHVJUDYHVHVSHFLDOPHQWHODV
YLQFXODGDVDWUDVWRUQRVSRUVDQJUDGR
3XHUSHULRWDUGtR
(VWH SHUtRGR VH H[WLHQGH PiV DOOi GHO GtD \ QR PiV DOOi GH XQ DxR 7RPD VX
LPSRUWDQFLDHQTXHKD\DOJXQDVVLWXDFLRQHVPyUELGDVRLQFOXVRPRUWDOHVTXHSXHGHQ
SURGXFLUVHHQHVWHSHULRGR$FRQWLQXDFLyQVHLQGLFDQORVDVSHFWRVPiVUHOHYDQWHVD
FRQVLGHUDUHQORVFRQWUROHVVXEVLJXLHQWHVDODPDGUH\HOUHFLpQQDFLGR
&RQWUROHVGHODPDGUH\GHOUHFLpQQDFLGR
Madre Recién nacido

Primeras 24 horas
Puerperio inmediato Un niño saludable
• Estado de conciencia, lúcida y tranquila. • No separe al recién nacido de su madre.
• Facies, piel y mucosas, deberán estar bien coloreadas • Promueva que estén cerca físicamente.
(excepto en anemia previa). • Promueva la colocación temprana del
• Frecuencia del pulso en condiciones basales, (60 y 100 bebe al pecho si la madre lo desea.
Ipm) y lleno. • Si es primípara, explíquele que al principio
• Presión arterial en rangos normales. no todas las madres se sienten con
• Temperatura corporal, no deberá superar los 37° C. En el fuerzas y deseo de cuidar a sus bebes [as
postalumbramiento, pueden observarse escalofríos, que 24 horas del día y que eso va cambiando
son normales y raramente duran más de 30 minutos. los primeros días.
• Retracción del útero (globo de seguridad de Pinard), en • Acompañe a la madre sugiriéndole como
estas horas, el fondo del útero no sobrepasa la cicatriz poner a su niño a mamar, sin tocar sus
umbilical y la consistencia es firme adquiriendo una senos y respetando su pudor natural.
consistencia leñosa al ser estimulado. Es indoloro a la • Informe de las ventajas de mantener la
palpación y es común el dolor cuando el niño es puesto al alimentación al pecho exclusiva y que si
pecho (entuertos). tiene molestias al inicio de la lactada es
• En caso de dolor, estarán indicados los analgésicos normal pero serán pasajeras.
comunes y los antiinflamatorios no esteroideo. • No administre otra leche que no sea la de
• En caso de sangrado vaginal abundante con el útero bien su propia madre sin la debida indicación
contraído efectuar inspección minuciosa del canal del médica y consentimiento de la madre.
parto para descartar lesiones (desgarros) en vagina y en • No permita publicidad de fórmulas de
cuello de útero. leche de vaca, ni que les entreguen
• Describir los principales signos de alerta y vigilar con muestras gratis a las madres.
atención aquellas condiciones Que pueden poner en • Se alimenta y succiona bien.
riesgo la vida de la madre. (ver cuadro).
• Animarla para Que comience a movilizarse. En las • Descansa entre lactadas y se despierta
madres obesas considerar el riesgo de tromboembolismo para alimentarse. No está excesivamente
por reposo en cama. irritable.
• Mujeres que no estén inmunizadas contra el tétanos o • Tiene un color normal para su etnia
contra la rubéola deberán ser inmunizadas antes del aIta. (controlar cianosis o ictericia)
• En las Rh negativas no inmunizadas con recién nacido • Moviliza el intestino y orina varias veces
Rh positivos proceder a la inmediata administración de la al dia (sus pañales cada 3 horas están
correspondiente dosis de gammaglobulina según normas mojados).
locales. • Frecuencia respiratoria entre 30 y 60
• Orientar y facilitar el acceso a métodos de planificación respiraciones por minuto.
familiar. • Frecuencia cardiaca entre 120 y 160
• En ocasiones pueden aparecer hemorroides fluxivas que latidos por minuto.
mejoran parcialmente con hielo y cremas locales con • Temperatura no mayor a los 37° (axilar o
anestésicos tópicos. inguinal).
• La retención urinaria es excepcional; se tratará con • Mantenga al niño arropado hasta que
cateterismos vesicales intermitentes, Higiene perineal: logre el control térmico
• Cada vez que la mujer requiera cambiar el apósito, se • Mencione la administración de Vitamina
debe higienizar la zona con agua limpia y jabón o un K que ya se realizó al recién nacido e
antiséptico. El lavado se hará por arrastre, siempre en indique la repetición a los 7 días si fue
sentido antera posterior (de la vulva hacia el ano). Se administrada por vía oral.
secará con un paño o gasas limpias. • Señale que el cordón debe mantenerse
• La ropa interior será separada por un apósito (gasa- limpio y seco.
algodón-gasa) o por protectores “nocturnos” de los que
se consiguen en el mercado,
• Los lavados intravaginales son desaconsejados.
• En caso de episiotomía, los cuidados serán similares,
pero se insistirá en mantener la zona seca el mayor
tiempo posible.
Cuidado de los pezones:
• Deberá exponer la areola y el pezón al sol entre diez y
quince minutos por día lubricarla exclusivamente con
calostro o leche materna.
Información al egreso.
Durante la internación por el parto, la madre y la familia deberán haber recibido información para el cuidado
postnatal y la protección de la salud de ella y su recién nacido. Al alta deberá señalarse con precisión:
• la forma en que ella puede mantener una comunicación continua con los servicios
• las nuevas necesidades de apoyo familiar y los recursos comunitarios a los que pueda acceder para
encontrar soporte en la función parental y
• pautas que la guíen para la consulta en caso que aparezcan elementos de alarma para la salud de ambos.
• Es recomendable otorgar el alta a las 48 horas • Recuerde a la madre de las ventajas de mantener
del parto, si no ha habido complicaciones y la alimentación al pecho exclusiva. Informar acerca
siempre que la mujer está en condiciones de de importancia del vaciado periódico de las mamas,
administrar cuidados a su recién nacido. higiene de los pezones y corpiño que sostenga y no
Cuando deba otorgarse el alta en forma apriete para la prevención de problemas mamarios
precoz, deberán garantizarse instancias de • Recuerde la higiene de manos y el cuidado del cordón
seguimiento domiciliario. umbilical
• De ser necesario, instrumentar sistemas de • Prevención del Síndrome de Muerte Súbita del
consulta telefónica con referentes de! centro Lactante: colocar al niño boca arriba para dormir,
de salud o de la comunidad. Recordar que las no abrigarlo en exceso, no fumar en el ambiente,
primeras 24 horas, suelen ser las de mayor desestimar el colecho
riesgo vital, tanto para la mujer, como para su • Orientar para el reconocimiento de Signos de alarma.
recién nacido. • Indicar las Inmunizaciones correspondientes al
momento del nacimiento y primer semana, según
esquema
• Verificar identificación del niño y su madre.
• Brindar orientación para la inscripción del niño en el
Registro Civil.
• Indicar claramente fecha y lugar del primer control,
a los 7 días del alta (preferentemente coordinar la
contrarreferencia)
• Valorar, previo, al alta condiciones de riesgo social
• Orientar acerca de las pruebas de Pesquisa y
obtención de los resultados
• En muchos casos puede ser útil la elaboración y
entrega de folletos instructivos con los conocimientos
básicos a transmitir al alta.
Primera consulta conjunta entre 7 y 10 días.
Puerperio mediato: Se extiende desde • Verificar que moja los pañales con frecuencia y
el segundo y hasta el 10° día del parto elimina meconio, que la succión es audible, vigorosa
• Brindar información sobre higiene perineal o y sostenida y que la boca está húmeda.
cuidado de la cicatriz de cesárea. • Examinar al bebé sin incomodarlo procediendo a
• Recuérdele que la alimentación exclusiva obtener la información que permita detectar nuevas
(día y noche) al pecho, sin dar ningún otro condiciones que puedan requerir tratamiento.
tipo de alimento a su bebe, tiene un efecto • Investigar si tiene elementos de riesgo de displasia
anticonceptivo fugaz e impredecible y que aun de caderas. (asimetría de los miembros o pliegues
amamantando puede tener otras opciones en la región anterior de muslo, Maniobras de Barlow
contraceptivas. y Ortolani)
)LJXUD )LJXUD
0DQLREUD 0DQLREUD
GH%DUORZ GH2UWRODQL
• Signos vitales (temperatura, frecuencia cardiaca y presión • No realizar doble pesada, ni siquiera es
arterial). necesario pesarlo todos los días.
Cualquier alteración de los signos vitales, obligará a • Ante la aparición de ictericia valorar
la búsqueda del agente etiológico y ante la presencia elementos de riesgo.
de dudas, deberá ser enviada a un nivel de mayor • Promover la higiene de manos, el uso de
complejidad, para continuar su atención. alcohol gel.
• Evaluación de los loquios (cantidad, aspecto, composición • Informar sobre el riesgo de contagio de
y olor). Es difícil estimar la cantidad, por lo que se enfermedades virales respiratorias y las
recomienda ver si la madre tiene o no anemia. El color formas de evitarlas.
a esta altura del puerperio, debe ser rojo o rosado. El • Si tiene indicado alimentación por fórmula,
color marrón, achocolatado hará sospechar infección. explicar su forma de preparación y el
Suelen además de sangre, contener fragmentos tisulares cuidado e higiene de los implementos.
pequeños. El olor puede ser fuerte, en caso de fetidez, se • Investigar cuales son los apoyos sociales
deberá sospechar infección. con los que la madre o los padres cuentan.
• Control de involución uterina. La involución es sumamente
rápida, aproximadamente a 2 centímetros por día y se
estima mediante palpación del fondo uterino. A los 6
días de puerperio se situará entre el ombligo v el borde
superior del pubis. A los 10 días estaré próximo al pubis.
• En ocasiones se pueden ver hemorroides flexivas y
dolorosas, que no mejoran con tratamiento médico,
en esos casos deberé descartarse una trombosis
hemorroidal, la que se soluciona fácilmente con un
mínimo drenaje quirúrgico con anestesia local.
Otras veces el dolor puede ser expresión de una fisura
anal, que suele revertir con tratamiento médico. Luego de
unas semanas.
Es común observar una incontinencia de orina que suele
remitir espontáneamente en algunos días o semanas.
• Bajada de la leche. En estos días se sustituye el calostro
por la leche definitiva.
Segunda visita conjunta entre los 15 y 30 días
Puerperio alejado: Abarca desde el • Continuar vacunaciones según esquema.
11° hasta el 42° día del postparto • Insistir en la higiene de manos, el uso de
• Reforzar la conserjería en anticoncepción y espaciamiento Alcohol en gel y el riesgo de enfermedades
intergenésico, intentando mantener la lactancia. virales respiratorias, si están en ambiente
• Controlar la evolución de la lactancia. epidémico.
• Continúa la involución uterina y el restablecimiento del • Valorar el crecimiento y la alimentación.
estado pregravídico. Tener en cuenta la posibilidad de
• Investigar síntomas menores de depresión. Si persisten administrar hierro adicional y vitamina D.
las alteraciones depresivas más allá del día 14 deberá • Reiterar examen físico,
consultar con un profesional. • Reiterar información sobre el riesgo de
• Prevenir la reinfección por enfermedades de transmisión muerte súbita.
sexual en especial si fueron detectadas y tratadas en esta
gestación. Aconsejando que:
• Prestar atención a situaciones de desamparo y violencia El recién nacido duerma boca arriba, en
doméstica. cuna, en el cuarto de la madre los primeros
• A los 25 días del parto, puede advertirse un sangrado 6 meses.
vaginal escaso (pequeño retorno) que generalmente No prohibir el uso del chupete
se debe a una proliferación endometrial normal que no Colocar al bebé con los pies en contacto
requiere ningún estudio o tratamiento especial con la piesera de la cuna. (para evitar el
• El reinicio de las relaciones sexuales es habitual ya que desplazamiento debajo de las mantas) I
desaparecen los Loquios Esto ocurre entre los 30 y los 40 Evite:
días del puerperio. • el humo del tabaco en el hogar
• En algunos casos, éste, será el ultimo control entre la • el colecho con los padres, que se duerman
mujer y el equipo de salud, por eso es recomendable con el bebé en un sillón (frecuente si
efectuar un examen clínico general y ginecológico. existe consumo de bebidas alcohólicas,
• Analizar con los padres los planes de reinicio de las toman psicofármacos o tienen cansancio
actividades laborales o educativas, verificando la extremo).
protección de sus derechos en la nueva situación de • vestir al niño con ropas abotonadas por
maternidad. delante
Cuadro 47 PROBLEMAS COMUNES EN LAS MADRES

SIGNOS y SINTOMAS ACCIONES
Depresión puerperal. Si persisten los síntomas más de 14 días consultar
Dolor perineal, olor de los Evaluar infección o cicatrización defectuosa de la episiotomía. Recomendar
exudados vaginales, dolor en frío local, analgésicos y si no son efectivos considerar antiinflamatorios no
las relaciones sexuales esteroideos locales u orales.
Dolor en las relaciones Evaluar herida. Aconsejar lubricantes en base acuosa.
sexuales
Dolor de cabeza post anestesia Líquidos analgésicos y reposo sin almohada
epidural o raquídea
Fatiga persistente Investigar otros síntomas en especial anemia. Señalar la necesidad de
alimentación y aporte de hierro y ejercicio
Dolor de espalda Tratar como en la población general
Constipación Recomiende dieta con fibras y Líquidos. Puede usarse un laxante suave
Hemorroides Si son severas, edematizadas o prolapsadas, referir.
Incontinencia fecal Evaluar severidad, duración y Frecuencia, Si persiste> 1mes referir
Incontinencia urinaria Enseñe ejercicios de piso pélvico. Si persiste referir.
Retención de orina (en las Procure que tome una ducha tibia. Si persiste considere colocar sonda
primeras 6 horas Postparto) vesical
Cuadro 48 PROBLEMAS COMUNES EN LOS RECIEN NACIOOS

SIGNOS y SINTOMAS ACCIONES
Ictericia Consulta de emergencia
Mugget oral Tratamiento con antimicóticos tópicos
Eritema del pañal Recomendar cambio más frecuente de los pañales. De ser muy molesto
persistente usar antimicóticos
No expulsión de meconio en Consulta de EMERGENCIA
las primeras 24hs
Constipación en no alimentado Consulta
al pecho
Diarrea Aumentar frecuencia de las lactadas. Si está alimentado por fórmulas
verificar higiene de la preparación y consulta de urgencia
llanto inconsolable Consulta de urgencia
“Cólicos’ Aconsejar que alcen y sostengan al bebé mientras llora y que busquen
apoyo de otros padres si se sienten desbordados.
Cuadro 49 PROBLEMAS AL AMAMANTAR

SIGNOS Y SINTOMAS ACCIONES
Pezones dolorosos o Considere la posibilidad de que tengan infección por cándida
agrietados
Senos ingurgitados. Mastitis Aconseje lactancia a demanda, masajes de los senos, ordeñe manual,
analgesia. Si persiste por horas consultar y si hay elementos claros de
infección considerar ATB.
Pezones invertidos I Brindar más apoyo, tranquilizando a la madre.
5HIHUHQFLD%LEOLRJUi¿FD
National Collaborating Centre for Primary Care. Routine postnatal care of women and their babies London. NICE clinical
guideline 37. ISBN 1-84629-248-4 National Institute for Health and Clinical Excellence. www.nice.org.uk/CG037 Julio 2006
9,, 3/$1,),&$&,21)$0,/,$5
&$3,78/29,,
2EMHWLYRV &RQWULEXLUDOHMHUFLFLRGHOGHUHFKRDSODQL¿FDUHOHPEDUD]R
$FWLYLGDG $VHVRUDUVREUHORVSULQFLSDOHVPpWRGRVFRQWUDFHSWLYRV
$SDUWLUGHODGpFDGDGHOODSODQL¿FDFLyQIDPLOLDUVHLQFRUSRUDUHJXODUPHQWHDORV
VHUYLFLRV GH VDOXG 'HELHURQ SDVDU FDVL DxRV SDUD TXH D ¿QDOHV GHO VLJOR ;; \
FRPR UHVXOWDGR GH ODV FXPEUHV PXQGLDOHV RUJDQL]DGDV SRU ODV 1DFLRQHV 8QLGDV OD
SODQL¿FDFLyQIDPLOLDUIXHUDFRQVLGHUDGDFRPRXQGHUHFKRKXPDQRGHQWURGHOFRQWH[WRGH
ODVDOXGVH[XDO\UHSURGXFWLYD(O3URJUDPDGH$FFLyQGHOD&RQIHUHQFLD,QWHUQDFLRQDOGH
3REODFLyQ\'HVDUUROORHIHFWXDGDHQ(O&DLURHQHQXQDGHVXVSDUWHVHVWDEOHFH
«´ORVSURJUDPDVGHDWHQFLyQGHODVDOXGUHSURGXFWLYDGHEHUiQSURSRUFLRQDUORVPiV
DPSOLRVVHUYLFLRVSRVLEOHVVLQQLQJ~QWLSRGHGLVFULPLQDFLyQ7RGDVODVSDUHMDVWLHQHQHO
GHUHFKRIXQGDPHQWDOGHGHFLGLUOLEUH\UHVSRQVDEOHPHQWHHOQ~PHUR\HVSDFLDPLHQWR
GHVXVKLMRV\GHGLVSRQHUGHODLQIRUPDFLyQODHGXFDFLyQ\ORVPHGLRVQHFHVDULRVSDUD
SRGHUKDFHUOR´«
3URFHVRGH$VHVRUDPLHQWR
/D LQIRUPDFLyQ \ OD FRQVHMHUtD VREUH PpWRGRV FRQWUDFHSWLYRV VH HQPDUFD GHQWUR GHO
SURFHVRGHDVHVRUDPLHQWRHQSODQL¿FDFLyQIDPLOLDU'XUDQWHHVWHSURFHVRHOSURIHVLRQDO
SRQHDGLVSRVLFLyQGHFDGDPXMHU\FDGDKRPEUHORVFRQRFLPLHQWRVQHFHVDULRVSDUD
TXHRSWHQOLEUHPHQWHFXDOPpWRGRYDQXWLOL]DUVLHVTXHGHFLGHQKDFHUOR
(ODVHVRUDPLHQWRGHEHUiFRQVLGHUDUODVGLIHUHQWHVHWDSDVGHODYLGDUHSURGXFWLYDGHO
FLFOR YLWDO DGROHVFHQFLD MXYHQWXG SHULPHQRSDXVLD \ HO JUDGR GH DFWLYLGDG VH[XDO
3DUDODHOHFFLyQGHOPpWRGRVHGHEHUiSURYHHULQIRUPDFLyQVREUHODVHJXULGDGH¿FDFLD
IRUPDGHXVRFRPRGLGDGHIHFWRVVHFXQGDULRVDFFHVLELOLGDGHFRQyPLFDHQXQPDUFR
GH UHVSHWR D ORV GLIHUHQWHV HVWLORV GH YLGD \ YDORUHV DVt FRPR WDPELpQ OD HYHQWXDO
DFHSWDFLyQSRUSDUWHGHODSDUHMD
(OREMHWLYRSULPRUGLDOTXHHQHVWDHWDSDGHEHUiFXPSOLUHOHTXLSRGHVDOXGVHUiDSR\DU
DODSHUVRQDRODSDUHMDDHOHJLUHOPRPHQWRDSURSLDGRSDUDORJUDUXQHPEDUD]RGH¿QLU
ODFDQWLGDGGHKLMRVTXHWHQGUiQRHYLWDUHOHPEDUD]R
$VHVRUDPLHQWR\(GXFDFLyQ6H[XDO
(O SURFHVR GH DVHVRUDPLHQWR HV LQGLVSHQVDEOH \ QR VH SXHGH REYLDU DXQTXH H[LVWD
HGXFDFLyQHQVH[XDOLGDG/DHGXFDFLyQVH[XDOGHEHUiLQLFLDUVHDQWHVGHODSXEHUWDG
GHPDQHUDTXHFXDQGRODQLxDWHQJDVXSULPHUDPHQVWUXDFLyQ\DFRQR]FDVXFXHUSR
\ OD ¿VLRORJtD GH OD FRQFHSFLyQ /D LGHD TXH VH SUHWHQGH ORJUDU HV TXH SDUD HO
PRPHQWRHQTXHODQLxDDGROHVFHQWHPXMHUGHEDHQIUHQWDUVHDRSWDUVREUHPDQWHQHU
UHODFLRQHVVH[XDOHVORSXHGDKDFHUVLQORVWHPRUHVGHODLJQRUDQFLDFRQRFLHQGRODV
IRUPDV GH SURWHJHUVH GH ODV ,76 \ GH XQ HPEDUD]R QR GHVHDGR FRQ OD DXWRQRPtD
\ FRQ¿DQ]D VX¿FLHQWH SDUD QHJRFLDU HO PRPHQWR \ ODV FRQGLFLRQHV DSURSLDGDV
(OYDUyQDGHPiVGHUHFLELULJXDOHVFRQRFLPLHQWRVTXHODQLxDGHEHUiUHFLELURULHQWDFLyQ
GHVGHXQDSHUVSHFWLYDGHJpQHURTXHOHSHUPLWDDVXPLUFRQUHVSRQVDELOLGDGVXVDFWRV
\HYHQWXDOPHQWHSUHSDUDUORSDUDXQDSDWHUQLGDGUHVSRQVDEOH
'HVDIRUWXQDGDPHQWHHQOD5HJLyQGHODV$PpULFDVODHGXFDFLyQVH[XDOHVXQDPDWHULD
SHQGLHQWHHQODVDJHQGDVGHODPD\RUtDGHORVSDtVHV3HVHDTXHODHGXFDFLyQVH[XDO
QRHVUHVSRQVDELOLGDGGLUHFWDGHOVHFWRUVDOXGORVHTXLSRVQRGHEHUiQGHVDSURYHFKDU
ODVLQVWDQFLDVGHFRQWDFWRFRQODVXVXDULDVRVTXHVHSUHVHQWHQSDUDDYDQ]DUHQHVWD
WHPiWLFD
(YDOXDFLyQGHODVXVXDULDVDQWHVGHUHFRPHQGDUOHVXQPpWRGRFRQWUDFHSWLYR
6HUHFRPLHQGDTXHDQWHVGHLQGLFDUFXDOTXLHUFRQWUDFHSWLYRVHSURFHGDDXQDFRUUHFWD
YDORUDFLyQGHODPXMHUODTXHGHEHUiLQFOXLUSUXHEDV\HYHQWXDOPHQWHH[iPHQHVVHJ~Q
ODVLJXLHQWHFODVL¿FDFLyQ
&ODVH$([iPHQHVHVHQFLDOHV\PDQGDWDULRVSDUDXQXVRVHJXURGHOFRQWUDFHSWLYR
&ODVH%([iPHQHVTXHQRVRQHVHQFLDOHVSHURFRQWULEX\HQDOXVRVHJXUR\HIHFWLYR
VXUHDOL]DFLyQGHSHQGHUiGHODFDSDFLGDGGHOVHUYLFLR
&ODVH&([iPHQHVTXHQRFRQWULEX\HQDOXVRGHOPpWRGRSHURGHEHUiQVHUUHDOL]DGRV
FRQUHJXODULGDGGHVGHXQDSHUVSHFWLYDLQWHJUDOGHVDOXGGHODPXMHU
&XDGUR5HVXPHQGHORVH[iPHQHVDUHDOL]DUGHDFXHUGRDOPpWRGRFRQWUDFHSWLYR
UHFRPHQGDGR
Progesterona solo
Ligadura tubaria
Combinados
Vasectomía
Situación Específica Barrera
DIU
Examen mamario por proveedor C C C C C n/a

Examen pélvico/genital C C A C C A
Tamizaje con PAP C C C C C n/a
Hemoglobina C C B C B C
Exámenes de rutina C C C C C C
Valoración de riesgo para ITS C C A C** C C
Tamizaje para ITS/VIH C C B C** C C
Medición de la presión arterial * * C C A C***
6LHPSUH HV UHFRPHQGDEOH HO FRQWURO GH OD SUHVLyQ DUWHULDO SHUR QR FRQWDU FRQ
SRVLELOLGDGHVGHPHGLUODSUHVLyQDUWHULDOQRGHEHUiLPSHGLUHOXVRGHHVWRVPpWRGRV
FRQWUDFHSWLYRV
6HUHFRPLHQGDQRXVDUFRQGRQHVFRQQRQR[LQROHQSHUVRQDVFRQDOWRULHVJRGH
LQIHFFLyQSRU9,+
6RORSDUDSURFHGLPLHQWRVTXHVHHIHFW~DQFRQDQHVWHVLDORFDO
&ODVL¿FDFLyQGHORVPpWRGRVDQWLFRQFHSWLYRV
/RVPpWRGRVFRQWUDFHSWLYRVVRQGHGRVWLSRVUHYHUVLEOHVHLUUHYHUVLEOHV
/RV PpWRGRV UHYHUVLEOHV VRQ ORV GH PD\RU DSOLFDFLyQ \ DFHSWDFLyQ SRU SDUWH GH ODV
XVXDULDV\FRPRVXQRPEUHORLQGLFDXQDYH]VXVSHQGLGRVVHUHVWDXUDODIHUWLOLGDGHQ
FDPELRORVPpWRGRVLUUHYHUVLEOHVOLPLWDQHQIRUPDGH¿QLWLYDODFDSDFLGDGGHFRQFHELU
'(6&5,3&,Ï1'(/260e72'26&2175$&(37,926
$0pWRGRVUHYHUVLEOHV
0pWRGRV FRPSRUWDPHQWDOHV VH EDVDQ HQ OD REVHUYDFLyQ GH VLJQRV \ VtQWRPDV
TXHDSDUHFHQGHPRGRQDWXUDOHQODVIDVHVIpUWLOHVHLQIpUWLOHVGHOFLFORPHQVWUXDO$O
FRQRFHUORVGtDVIpUWLOHVXQDPXMHUSRGUiHYLWDUHOHPEDUD]RXVDQGRDOJ~QRWURPpWRGR
HQHVRVGtDVRELHQDEVWHQLpQGRVHGHPDQWHQHUUHODFLRQHVVH[XDOHV
([LVWHQYDULRVPpWRGRVFRPSRUWDPHQWDOHVSHURVRORGHVDUUROODUHPRVFXDWURGHHOORV
HQUD]yQGHVHUORVPiVGLIXQGLGRV\PiVVHQFLOORVGHUHDOL]DU
6L VH SUHWHQGH OD Pi[LPD VHJXULGDG FRQWUDFHSWLYD ORV PpWRGRV FRPSRUWDPHQWDOHV
VROR GHEHUtDQ VHU XVDGRV SRU PXMHUHV TXH WHQJDQ FLFORV UHJXODUHV \ FXHQWHQ FRQ HO
HQWHQGLPLHQWR\GLVFLSOLQDVX¿FLHQWHV
(VWRVPpWRGRVFXHQWDQFRQODYHQWDMDGHQRWHQHUJDVWRHFRQyPLFR
/RV PpWRGRV FRPSRUWDPHQWDOHV HQ FRQMXQWR SUHVHQWDQ FRPR GHVYHQWDMD TXH QR
SURWHJHQFRQWUDODV,76\HO9,+6,'$
)DOODV(QFRQMXQWRDOFDQ]DQHOSDUDWRGRVORVPpWRGRVFRPSRUWDPHQWDOHV
x 0pWRGRGHOULWPRRFDOHQGDULR2JLQR.QDXVHVHOPpWRGRFRPSRUWDPHQWDO

PiVXVDGR/RVDXWRUHVGHOPpWRGRGHPRVWUDURQTXHHQHOFLFORPHQVWUXDOH[LVWH
XQSHUtRGRGHIHUWLOLGDGTXHHQXQFLFORGHGtDVWLHQHOXJDUDOUHGHGRUGHO
GtD(OPpWRGRVHEDVDHQODDEVWLQHQFLDGXUDQWHODpSRFDGHODRYXODFLyQ&RPR
ODSXHVWDRYXODUSXHGHYDULDUD~QHQFLFORVUHJXODUHVVHLPSRQHODDEVWLQHQFLD
FRQ FLQFR GtDV GH DQWLFLSDFLyQ \ KDVWD FLQFR GtDV GHVSXpV GH OD VXSXHVWD
IHFKDGHODRYXODFLyQ 'HEH FRQVLGHUDUVH DGHPiV TXHODYLGDGH XQyYXOR HV
DSUR[LPDGDPHQWH GH KRUDV PLHQWUDV TXH HO HVSHUPDWR]RLGH FRQVHUYD VX
SRGHUIHFXQGDQWHKDVWDXQRVGtDV
/DDEVWLQHQFLDSHULyGLFDSUHVHQWDXQHOHYDGRSRUFHQWDMHGHIDOODVVXVFHSWLEOHGHVHU
PHMRUDGRFRQHOUHVSDOGRGHODWRPDGHODWHPSHUDWXUDEDVDO\FRQODPHGLFLyQGHOD
¿ODQFLDGHOPRFRFHUYLFDO
'HVYHQWDMDV6RORHVDFRQVHMDEOHHQFLFORVUHJXODUHVQRPHQRUHVDGtDVUHTXLHUH
DOWRQLYHOGHLQVWUXFFLyQPRWLYDFLyQ\GLVFLSOLQDSDUDVXDSOLFDFLyQ
x 0pWRGRGH%LOOLQJVRGHODKXPHGDGFRQVLVWHHQGLVWLQJXLUORVGtDVSHULRYXODWRULRV
EDViQGRVHHQODKXPHGDGTXHSHUFLEHODPXMHUHQVXVJHQLWDOHV$SULQFLSLRVGHO
FLFORDSHQDVSHUFLELUiXQDVHFUHFLyQHVFDVDEODQFRDPDULOOHQWDGtDVVHFRV\
DPHGLGDTXHVHDFHUFDDODRYXODFLyQODVHFUHFLyQFRPHQ]DUiDKDFHUVHPiV
¿ODQWH\PiVWUDQVSDUHQWHGtDVK~PHGRVGHVSXpVGHODRYXODFLyQODVHFUHFLyQ
VHUi HVFDVD \ FRQ FDUDFWHUtVWLFDV VLPLODUHV D OD GH ORV SULPHURV GtDV 'HVGH
TXH OD PXMHU QRWD HO DXPHQWR GH VHFUHFLyQ \ KDVWD GtDV GHVSXpV GHO SXQWR
GHPi[LPDKXPHGDGRYXODFLyQGHEHUiVXVSHQGHUODVUHODFLRQHVVH[XDOHVVLQ
SURWHFFLyQ
'HVYHQWDMDV 6H UHTXLHUH XQ DOWR QLYHO GH PRWLYDFLyQ \ GLVFLSOLQD SDUD VX XVR /DV
UHODFLRQHVVH[XDOHVHQORVGtDVSUHYLRVDOWHUDQHOJUDGRGHKXPHGDGYDJLQDO'LYHUVRV
WUDWDPLHQWRV YDJLQDOHV yYXORV FUHPDV MDOHDV H LUULJDFLRQHV R ODV ,76 DOWHUDQ OD
KXPHGDGYDJLQDO
x 0pWRGR GH OD ¿ODQFLD 6SLQQEDUNHLWFRQ HVWH PpWRGR VH LQWHQWD GHWHFWDU OD
RYXODFLyQDWUDYpVGHOD¿ODQFLDGHOPRFRFHUYLFDO&RQVLVWHHQPHGLUODHODVWLFLGDG
TXH WLHQH XQD JRWD GH OD VHFUHFLyQ YDJLQDO FRORFDGD HQWUH ORV GHGRV SXOJDU H
tQGLFH6LODJRWDOOHJDDHVWLUDUVHXQRVFPyPiVVLQURPSHUVHVHFRQVLGHUD
TXHODPXMHUVHHQFXHQWUDHQVXSHUtRGRIpUWLO<PLHQWUDVGXUHHVWD¿ODQFLDQRVH
GHEHUiPDQWHQHUUHODFLRQHVVH[XDOHV
'HVYHQWDMD5HTXLHUHDOWDPRWLYDFLyQ\SUHVHQWDHOLQFRQYHQLHQWHTXHODPHGLFLyQGHOD
¿ODQFLDGHEHVHUUHDOL]DGDGLDULDPHQWH
x 0pWRGRGHODWHPSHUDWXUDEDVDORVLQWRWpUPLFRFRQVLVWHHQWRPDU\UHJLVWUDU
GLDULDPHQWHODWHPSHUDWXUDVXEOLQJXDOGHODPXMHUDSHQDVVHGHVSLHUWH\DQWHV
GHOHYDQWDUVH&XDQGRVHUHJLVWUDXQDXPHQWRGHDSUR[LPDGDPHQWHXQRVD
&VHHVWLPDTXHVHSURGXMRODRYXODFLyQ+DVWDODVKRUDVSRVWHULRUHVDO
DVFHQVRGHODWHPSHUDWXUDEDVDOHVHOPRPHQWRGHPD\RUIHUWLOLGDG
'HVYHQWDMDV(OSULQFLSDOLQFRQYHQLHQWHUDGLFDHQTXHKD\XQUHWUDVRGHXQDVKRUDV
HQGLDJQRVWLFDUODRYXODFLyQSRUORTXHDQWHVGHLGHQWL¿FDUHODVFHQVRWpUPLFRVHSXHGH
SURGXFLUXQHPEDUD]RVLQRVHPDQWXYLHURQUHODFLRQHVVH[XDOHVFRQRWUDSURWHFFLyQ
1R VH SXHGH XWLOL]DU HQ FDVR GH ¿HEUH 5HTXLHUH XQ PtQLPR HQWUHQDPLHQWR SDUD OD
PHGLFLyQ\HOUHJLVWURGHODWHPSHUDWXUD
0pWRGRGHODODFWDQFLDH[FOXVLYDODUHODFLyQHQWUHODGXUDFLyQGHODODFWDQFLD\OD
GXUDFLyQGHODDPHQRUUHDKDVLGRVX¿FLHQWHPHQWHGHPRVWUDGD$PD\RUGXUDFLyQGHOD
ODFWDQFLDPD\RUGXUDFLyQGHOSHUtRGRGHDPHQRUUHD
/DGXUDFLyQSURPHGLRGHOSHUtRGRGHDPHQRUUHDHQODVPDGUHVTXHQRDPDPDQWDQHV
GHDGtDVUDQJRGH\GtDV/DODFWDQFLDH[FOXVLYDVHDVRFLDFRQSHUtRGRV
PiVODUJRVGHDPHQRUUHDHLQIHUWLOLGDGTXHODODFWDQFLDSDUFLDO
(O PpWRGR GH OD ODFWDQFLD H[FOXVLYD FRQVLVWH HQ XWLOL]DU OD ODFWDQFLD FRPR PpWRGR
WHPSRUDOGHFRQWUDFHSFLyQ
)DOODVPHQRVGHO
/DVIDOODVVRQPtQLPDVVLHPSUHTXH
x (ODPDPDQWDPLHQWRVHDH[FOXVLYR\DOLEUHGHPDQGD
x 1RVHKD\DQUHDQXGDGRORVFLFORVPHQVWUXDOHV
x 1RVHDOFDQFHQORVPHVHVGHOSDUWR
'HVYHQWDMDV 1R SURWHJH FRQWUD OD WUDQVPLVLyQ YHUWLFDO GHO 9,+ DO UHFLpQ QDFLGR HQ
PDGUHV9,+SRVLWLYDV
&RPSDUWHFRQORVPpWRGRVFRPSRUWDPHQWDOHVODGHVYHQWDMDGHQRSURWHJHUFRQWUDODV
,76\HO9,+6,'$\ODYHQWDMDGHQRWHQHUFRVWRHFRQyPLFR\QRDOWHUDUHOPHWDEROLVPR
GHODXVXDULD
0pWRGRV GH EDUUHUD H[LVWHQ GLYHUVRV PpWRGRV GH EDUUHUD GH ORV FXDOHV ORV PiV
GLIXQGLGRVVRQORVFRQGRQHVPDVFXOLQRV7DPELpQKD\FRQGRQHVIHPHQLQRVGLDIUDJPDV
FDSXFKRQHV\HVSHUPLFLGDV
/DV PXMHUHV FRQ FXDGURV FOtQLFRV SDWROyJLFRV TXH KDFHQ GHO HPEDUD]R XQ ULHVJR
LQDFHSWDEOH GHEHUiQ VHU LQIRUPDGDV TXH ORV PpWRGRV GH EDUUHUD SXHGHQ QR VHU OD
PHMRURSFLyQFXDQGRVRQXVDGRVGHPDQHUDLQFRQVWDQWHHLQFRUUHFWDGHELGRDVXDOWR
tQGLFHGHIDOODV
x &RQGyQPDVFXOLQRMXQWRFRQHOFRQGyQIHPHQLQRDGHPiVGHVHUDQWLFRQFHS
WLYRV VRQ ORV ~QLFRV PpWRGRV TXH SURWHJHQ GH ODV LQIHFFLRQHV GH WUDQVPLVLyQ
VH[XDO\HO9,+6,'$GREOHSURWHFFLyQ3RUHVWDUD]yQVHGHEHHVWLPXODUVXXVR
D~QHQPXMHUHVXKRPEUHVTXHXVDQRWURVPpWRGRVFRQWUDFHSWLYRV'HODPLVPD
PDQHUDVLH[LVWHULHVJRGH,769,+GXUDQWHHOHPEDUD]RVHDFRQVHMDUiVXXVR
GXUDQWHWRGRHVWHSHUtRGR
$XQTXH HVWH HV XQ PpWRGR HPLQHQWHPHQWH PDVFXOLQR ORV SURYHHGRUHV GHEHUiQ
HVWLPXODU HO HMHUFLFLR GH ORV GHUHFKRV VH[XDOHV \ UHSURGXFWLYRV GH ODV PXMHUHV SDUD
TXHDWUDYpVGHSURFHVRVGH³QHJRFLDFLyQ´FRQVLJDQHVWLPXODUHOXVRGHOFRQGyQSRU
SDUWHGHVXVSDUHMDV
&RQVHMRVDGDUDORVXVXDULRV
x 3UHFDXFLRQHV SUHYLDV DO XVR VH GHEHUi LQVWUXLU HQ YHUL¿FDU OD HODVWLFLGDG GHO
FRQWHQLGR HQ HO HQYDVH DLUH \ PRYLOLGDG VL HO FLHUUH HV KHUPpWLFR TXH QR
HVWpQYHQFLGRVHQFDVRTXHHOHQYDVHVRORFXHQWHFRQIHFKDGHIDEULFDFLyQVH
DGPLWHQKDVWDDxRVGHYDOLGH]
x 3UHFDXFLRQHV GXUDQWH HO XVR QR DEULU HO HQYROWRULR FRQ ORV GLHQWHV FRORFDUOR
SUHYLRDOFRLWRHQHOSHQHHUHFWR$OFRORFDUORVHGHEHGHMDUXQDSHTXHxDSRUFLyQ
OLEUHVREUHHOJODQGH\OXHJRGHVHQUROODUOR5HWLUDUHOSHQHGHODYDJLQDPLHQWUDV
VHHQFXHQWUDHUHFWRVXMHWDQGRHOFRQGyQGHVGHVXDQLOOR&KHTXHDUTXHQRKD
KDELGRURWXUD8WLOL]DUXQQXHYRFRQGyQHQFDGDFRLWR
5HFRUGDUTXHHQFDVRGHURWXUDRTXHKD\DTXHGDGRHOFRQGyQHQODYDJLQDVHSRGUi
HPSOHDUDQWLFRQFHSWLYRVGHHPHUJHQFLD
)DOODVHQFRQGLFLRQHVLGHDOHVODVIDOODVOOHJDQDO\HQFRQGLFLRQHVUHDOHVGHXVR
DXPHQWDQKDVWDHO
9HQWDMDVSURWHJHQFRQWUDODV,769,+6,'$1RWLHQHQRWURVHIHFWRVLPSRUWDQWHVVREUH
OD VDOXG GH OD PXMHU QL GHO KRPEUH 6RQ GH EDMR FRVWR \ VRQ IiFLOPHQWH DFFHVLEOHV
3XHGHQFRQWULEXLUDUHWDUGDUODH\DFXODFLyQSUHFR]
'HVYHQWDMDVUHTXLHUHPRWLYDFLyQSDUDVXXVRFRQVWDQWH(QSHUVRQDVDOpUJLFRVSXHGH
KDEHUKLSHUVHQVLELOLGDGDOOiWH[RDORVOXEULFDQWHVTXHFRQWLHQHQ(QFDVRGHDOHUJLD
DO OiWH[ VH SRGUiQ XVDU FRQGRQHV GH SROLXUHWDQR R GH SLHO GH FRUGHUR HVWRV ~OWLPRV
QDWXUDOHV VRQ VHQVLEOHPHQWH PHQRV HIHFWLYRV SDUD SURWHJHU FRQWUD ODV ,76 ± 9,+
6,'$TXHORVFRQGRQHVGHOiWH[
x &RQGyQIHPHQLQRHVXQDIXQGDGHOJDGDVXDYH\KROJDGDGHPDWHULDOSOiVWLFR
TXHVHFRORFDHQHOLQWHULRUGHODYDJLQDDODTXHFXEUHHQVXWRWDOLGDG7LHQH
GRVDQLOORVÀH[LEOHVXQRLQWHULRUHQHOH[WUHPRFHUUDGRTXHVHXVDSDUDLQVHUWDU
\FRORFDUHOGLVSRVLWLYRGHQWURGHODYDJLQD\XQRH[WHULRUTXHTXHGDIXHUDGHOD
YDJLQD\FXEUHORVJHQLWDOHVH[WHUQRV
&RQVHMRVDGDUDODVXVXDULDV
6HSXHGHLQVHUWDUKDVWDKRUDVDQWHVGHOFRLWR
6XFRORFDFLyQVHKDFHRSULPLHQGRHODQLOORTXHVHHQFXHQWUDHQHOH[WUHPRFHUUDGRGHO
FRQGyQHLQWURGXFLpQGRORORPiVSURIXQGDPHQWHSRVLEOHHQODYDJLQDHVWHH[WUHPR
FXEULUi HO FpUYL[ 6H UHFRPHQGDUi TXH HO H[WUHPR VXSHUH OD SUR\HFFLyQ GHO KXHVR
S~ELFR\TXHHOFRQGyQQRKD\DTXHGDGRWRUFLGR
(OH[WUHPRDELHUWRTXHGDUiSRUIXHUDGHODYDJLQDFRPRVHGHVFULELyDQWHV
$OWHUPLQDUHOFRLWRVHSUHVLRQDUiHODQLOORH[WHULRU\VHORWRUFLRQDUiGHPDQHUDTXHDO
VDFDUORHOVHPHQTXHGHFRQWHQLGRHQpOPLHQWUDVVHWUDFFLRQDVXDYHPHQWH
/RVFRQGRQHVIHPHQLQRVQRGHEHUtDQUHXWLOL]DUVH
)DOODVHQFRQGLFLRQHVLGHDOHVIDOODHQPHQRVGHOGHORVFDVRV\HQFRQGLFLRQHV
UHDOHVGHXVRWLHQHKDVWDXQGHIDOODV
9HQWDMDV3URWHJHQFRQWUDODV,769,+6,'$6XXVRGHSHQGHH[FOXVLYDPHQWHGHOD
YROXQWDGGHODPXMHU1RWLHQHQRWURVHIHFWRVLPSRUWDQWHVVREUHODVDOXGGHODPXMHU
QLGHOKRPEUH
'HVYHQWDMDVHVPiVFRVWRVRTXHHOFRQGyQPDVFXOLQRHVSRFRGLVFUHWRUXLGRVR
3XHGHVHUGLItFLOGHFRORFDU\GHH[WUDHU
x 'LDIUDJPDFRQVLVWHHQXQ³FDSXFKyQ´GHOiWH[RVLOLFRQDTXHFXEUHHOFpUYL[
'HEHFRORFDUVHHQODYDJLQDKDVWDKRUDVDQWHVGHODUHODFLyQVH[XDO\SXHGH
TXHGDU HQ YDJLQD KDVWD QR PiV GH KRUDV GHVSXpV GH OD UHODFLyQ VH[XDO
6X XVR GHEH DVRFLDUVH DO GH HVSHUPLFLGDV SDUD DXPHQWDU VX HIHFWLYLGDG
'HVSXpVGHH[WUDHUORGHEHODYDUVH\JXDUGDUVHHQXQHVWXFKHHVSHFLDO
)DOODVHQFRQGLFLRQHVLGHDOHVVHREVHUYDKDVWDXQGHIDOODV\HQFRQGLFLRQHV
UHDOHVGHXVRWLHQHKDVWDXQGHIDOODV
9HQWDMDV7LHQHSURWHFFLyQSDUFLDOFRQWUDDOJXQDV,766XXVRGHSHQGHH[FOXVLYDPHQWH
GHODYROXQWDGGHODPXMHUSXHGHVHUXVDGRGXUDQWHODPHQVWUXDFLyQHVGLVFUHWR1R
WLHQHRWURVHIHFWRVLPSRUWDQWHVVREUHODVDOXGGHODPXMHUQLGHOKRPEUH
'HVYHQWDMDV HV PiV FRVWRVR TXH ORV FRQGRQHV \ UHTXLHUH XQD YDORUDFLyQ PpGLFD
SUHYLD QR SURWHJH FRQWUD HO 9,+6,'$ SXHGH SURYRFDU DOHUJLD DO OiWH[ DOJXQDV
PXMHUHVWHQGUiQGL¿FXOWDGSDUDFRORFDUOR8VDUORHQIRUPDFRQWLQXDSRUPiVGH
KRUDVSXHGHDXPHQWDUHOULHVJRGHVXIULUXQVKRFNWy[LFR
1RGHEHQVHUXVDGRVFRQPHGLFDFLyQROXEULFDQWHVGHEDVHROHRVD
x (VSRQMDVVHWUDWDGHYHUGDGHUDVHVSRQMDVLPSUHJQDGDVHQHVSHUPLFLGDTXH
VHFRORFDQHQODYDJLQDDQWHVGHODUHODFLyQVH[XDO$OLJXDOTXHHOGLDIUDJPD
GHEHFRORFDUVHHQODYDJLQDKDVWDKRUDVDQWHVGHODUHODFLyQVH[XDO\SXHGH
TXHGDUHQYDJLQDKDVWDQRPiVGHKRUDVGHVSXpVGHODUHODFLyQVH[XDO
)DOODVYDUtDQVHJ~QVHWUDWDGHQXOtSDUDVRPXOWtSDUDV(QQXOtSDUDVHQFRQGLFLRQHV
LGHDOHVGHXVRVHREVHUYDKDVWDXQGHIDOODV\HQFRQGLFLRQHVUHDOHVGHXVR
KDVWD XQ GH IDOODV (Q PXOWtSDUDV HQ FRQGLFLRQHV LGHDOHV GH XVR VH REVHUYD
KDVWDXQGHIDOODV\HQFRQGLFLRQHVUHDOHVGHXVRKDVWDXQGHIDOODV
1RHVXQPpWRGRUHFRPHQGDEOHSDUDPXMHUHVPXOWtSDUDV
9HQWDMDV6XXVRGHSHQGHH[FOXVLYDPHQWHGHODYROXQWDGGHODPXMHUH[LVWHXQ~QLFR
WDPDxR\QRUHTXLHUHSUHVFULSFLyQPpGLFDQRWLHQHHIHFWRVLPSRUWDQWHVVREUHODVDOXG
GHODPXMHUQLGHOKRPEUH
'HVYHQWDMDVQRSURWHJHFRQWUDHO9,+6,'$SXHGHSURYRFDUDOHUJLDDOJXQDVPXMHUHV
WHQGUiQ GL¿FXOWDG SDUD FRORFDUOR \ SDUD UHWLUDUOR 1R SXHGH VHU XVDGR GXUDQWH OD
PHQVWUXDFLyQ8VDUORHQIRUPDFRQWLQXDSRUPiVGHKRUDVSXHGHDXPHQWDUHOULHVJR
GHVXIULUXQVKRFNWy[LFR
&RQWUDFHSFLyQGHHPHUJHQFLD
/RVFRQWUDFHSFLyQGHHPHUJHQFLDLQFOX\HPpWRGRVKRUPRQDOHV
/RV FRQWUDFHSWLYRV KRUPRQDOHV GH HPHUJHQFLD WDO FRPR OR GLFH VX QRPEUH KDQ VLGR
GLVHxDGRV SDUD VLWXDFLRQHV HVSHFLDOHV DO VHU PHQRV HIHFWLYRV TXH ORV PpWRGRV GH
XVRUHJXODUVRQUHFRPHQGDGRVH[FOXVLYDPHQWHSDUDVLWXDFLRQHVGHHPHUJHQFLD3RU
VLWXDFLRQHV GH HPHUJHQFLD VH HQWLHQGH D WRGD UHODFLyQ VLQ SURWHFFLyQ VLQ GHVHR GH
FRQFHSFLyQ FDVRV GH YLROHQFLD VH[XDO R FXDQGR KD KDELGR LQFRQYHQLHQWHV FRQ HO
PpWRGRDQWLFRQFHSWLYRKDELWXDO
([LVWHQFRQWUDFHSWLYRVFRPELQDGRVHVWUyJHQR±SURJHVWiJHQRV\GHSURJHVWiJHQRV

H[FOXVLYRVLQGHSHQGLHQWHPHQWHGHFXDOVHXVHH[LVWHHYLGHQFLDVX¿FLHQWHSDUDDVHVRUDU
DODVXVXDULDVD¿UPDQGRTXHQRLQWHUUXPSHQXQHPEDUD]RHVWDEOHFLGR
&RQVHMRVSDUDODVXVXDULDV
/D H¿FDFLD FRQWUDFHSWLYD VH UHODFLRQD FRQ HO WLHPSR TXH WUDQVFXUUH HQWUH OD UHODFLyQ
VH[XDO QR SURWHJLGD \ OD WRPD GHO DQWLFRQFHSWLYR GH HPHUJHQFLD 6RQ PiV HIHFWLYRV
FXDQWRPHQRUVHDHOWLHPSRWUDQVFXUULGRGHVGHHOFRLWRKDVWDODWRPDSRUORTXHVH
HVWLPXODUi WRPDU HO FRQWUDFHSWLYR OR DQWHV SRVLEOH 6H VHxDOD TXH OD HIHFWLYLGDG HV
Pi[LPD KDVWD ODV KRUDV SRVWFRLWR DXQTXH OD HIHFWLYLGDG VH GHEH DGYHUWLU D ODV
XVXDULDVTXHD~QKDVWDORVGtDVSRVWHULRUHVDOFRLWRD~QSHUVLVWHXQHOHYDGRJUDGR
GHHIHFWLYLGDG
x &RQWUDFHSWLYRV FRPELQDGRV ³UpJLPHQ GH <X]SH´ VH HPSOHDQ GRV GRVLV

GH PLFURJUDPRV GH HWLQLOHVWUDGLRO PLFURJUDPRV GH OHYRQRUJHVWUHO
FDGDXQDVHSDUDGDVSRUXQLQWHUYDORGHKRUDVLQLFLiQGRODVGHQWURGHODV
KRUDVGHODUHODFLyQQRSURWHJLGD&RPRDOWHUQDWLYDHQDTXHOORVOXJDUHVTXHQR
FXHQWHQFRQSUHSDUDGRVGHHPHUJHQFLDHVSHFt¿FRVVHSXHGHXVDUStOGRUDVGH
XQFRQWUDFHSWLYRFRPELQDGRWUDGLFLRQDOFRQGRVLVVLPLODUHVRVXSHULRUHVDODV
GHO0LFURJ\QyQ
x &RQWUDFHSWLYRV GH /HYRQRUJHVWUHO VROR VH UHFRPLHQGD OD WRPD GH ODV GRV
StOGRUDVTXHWUDHHOHQYDVHMXQWDVHQXQDVRODYH]2HQVXGHIHFWRWRPDUODV
HQIRUPDFOiVLFDXQSULPHUFRPSULPLGRORDQWHVSRVLEOH\HOVHJXQGRKRUDV
GHVSXpV
/RV FRQWUDFHSWLYRV GH HPHUJHQFLD WLHQHQ P~OWLSOHV PHFDQLVPRV GH DFFLyQ 3XHGHQ
LQWHUIHULU FRQ HO GHVDUUROOR IROLFXODU HO PRFR FHUYLFDO OD PLJUDFLyQ HVSHUPiWLFD \ OD
IHUWLOL]DFLyQ
&RQWUDLQGLFDFLRQHV
1RVHFRQRFHQSRUHOPRPHQWR
)DOODV
/DVIDOODVYDUtDQVHJ~QHOWLHPSRTXHSDVHHQWUHODUHODFLyQQRSURWHJLGD\ODWRPDGHOD
StOGRUD'HHVWDPDQHUDOD206FRPXQLFyIDOODVGHDSHQDVXQFXDQGRHOPpWRGR
VHXVyHQODVSULPHUDVKRUDV\GHFXDQGRVHXVyHQWUHODV\KRUDVGHVGH
HOFRLWR&XDQGRVHDQDOL]DQODVIDOODVHQJHQHUDOLQGHSHQGLHQWHPHQWHGHOPRPHQWRGH
WRPDODVPLVPDVVHVLW~DQDOUHGHGRUGHODO
9HQWDMDV
6RQGHFRVWREDMRGHIiFLOWRPD\QRVHFRQRFHQHIHFWRVPpGLFRVDGYHUVRVJUDYHVQL
WHUDWRJpQLFRV
'HVYHQWDMDV
1RSURWHJHQFRQWUD,769,+6,'$
3XHGHQSURYRFDUQiXVHDV\YyPLWRVHVSHFLDOPHQWHHOUpJLPHQGH<X]SHSRUORTXH
HQ FDVRV GH YyPLWRV UHLWHUDGRV VH SXHGH LQWHQWDU VX XVR SRU YtD YDJLQDO FRPR XQD
RSFLyQDOWHUQDWLYD7DPELpQSXHGHQSURYRFDURWURVHIHFWRVLQGHVHDEOHVFRPRFHIDOHDV
PDUHRVVHQVLELOLGDGPDPDULD\VDQJUDGRV
&RQWUDFHSWLYRVKRUPRQDOHV
([LVWH JUDQ YDULHGDG GH FRQWUDFHSWLYRV KRUPRQDOHV OD PD\RUtD FRPELQDQ HVWUyJHQRV
\ SURJHVWiJHQRV DXQTXH WDPELpQ H[LVWHQ ORV FRQWUDFHSWLYRV H[FOXVLYDPHQWH GH
SURJHVWiJHQRV
'HDFXHUGRDVXIRUPDGHXVRVHORVFODVL¿FDHQ
2UDOHVLQ\HFWDEOHVWUDQVGpUPLFRVYDJLQDOHVHLPSODQWHV
x&RQWUDFHSWLYRV2UDOHV&RPELQDGRV
0RGRGHXVR
(Q WRGRV ORV HVTXHPDV \D VHD GH R FRPSULPLGRV HO SULPHU SDTXHWH VH
FRPHQ]DUiHOSULPHUGtDGHODPHQVWUXDFLyQ\DSDUWLUGHDKtVHWRPDUiXQFRPSULPLGR
WRGRVORVGtDVSUHIHUHQWHPHQWHDODPLVPDKRUDSDUDJHQHUDUKiELWR\HYLWDUROYLGRV
(QORVHVTXHPDVGHFRPSULPLGRVVHKDUiXQDVHPDQDGHSDXVDHQWUHHO~OWLPR
FRPSULPLGRGHOSDTXHWHDFWXDO\HOSULPHURGHOVLJXLHQWHFRPHQ]DQGRDOGtDGHVGH
HO~OWLPRFRPSULPLGR
(QORVHVTXHPDVGHGtDVORVSDTXHWHVVHWRPDQHQIRUPDFRQWLQXD\QRVHGHEH
KDFHUSDXVDHQWUHSDTXHWHV
(QFDVRGHROYLGRVVHUHFRPHQGDUiQODVVLJXLHQWHVFRQGXFWDV
FRPSULPLGR UHFRPHQGDU VX WRPD OR DQWHV SRVLEOH \ OD VLJXLHQWH D OD KRUD
KDELWXDO SXHGH VHU QHFHVDULR WRPDU ODV GRV StOGRUDV MXQWDV 1R VH UHTXLHUHQ
FXLGDGRVHVSHFLDOHVVLVHFRQWLQ~DFRQHOPpWRGRHQIRUPDFRUUHFWD
DStOGRUDVHQODSULPHUDVHPDQDUHFRPHQGDUWRPDUOD~OWLPDStOGRUDROYLGDGD
GHVFDUWDUODVTXHIXHURQSUHYLDPHQWHROYLGDGDVFRQWLQXDUFRQHOWUDWDPLHQWR\
SURSRQHUDQWLFRQFHSFLyQFRQPpWRGRVGHEDUUHUD
D StOGRUDV HQ OD PLWDG R DO ¿QDO GHO SDTXHWH VH GHEH UHFRPHQGDU HO XVR
GHO FRQWUDFHSWLYR LJXDO TXH HQ HO FDVR DQWHULRU SHUR \D QR VHUi QHFHVDULD OD
SURWHFFLyQFRQRWURPpWRGR
6L HO ROYLGR HV GH R PiV StOGRUDV VH GHEH DFWXDU FRPR HQ OD VLWXDFLyQ
&RQWLQXDUWRPDQGRODVStOGRUDVUHVWDQWHV\XVDUPpWRGRVGHEDUUHUD
6HGHEHUiVXJHULUXQPpWRGRGHEDUUHUDHQODVVLJXLHQWHVVLWXDFLRQHV
x (QORVFDVRVGHROYLGR
x (QORVSULPHURVTXLQFHGtDVTXHVHFRPLHQ]DDXVDUXQFRQWUDFHSWLYRRUDO
x $QWHWUDVWRUQRVGLJHVWLYRVYyPLWRVGLDUUHD
x 8VRGHPHGLFDPHQWRVTXHDIHFWHQHOPHWDEROLVPRKHSiWLFR
x 6DQJUDGRVDQRUPDOHV
x 3UREDELOLGDGGH,76,75
&RQWUDLQGLFDFLRQHV
&XDGUR
&RQWUDLQGLFDFLRQHVDEVROXWDV &RQWUDLQGLFDFLRQHVUHODWLYDV
Antecedentes de Antecedentes de Enfermedades
Abuso de tabaco
tromboembolismo tromboflebitis renales
Mujeres mayores Enfermedades
Ateroesclerosis Cáncer de mama
de 40 años cardíacas
Cáncer de endometrio Hepatopatías Hipertensión Diabetes
Anemia falciforme Embarazo Hiperlipidemia
Metrorragia sin diagnóstico
)DOODV HQ FRQGLFLRQHV LGHDOHV GH XVR VRQ GH HQ FRQGLFLRQHV UHDOHV GH XVR
OOHJDQKDVWDHO
9HQWDMDV
5HJXODQHOFLFORPHQVWUXDOHQDTXHOODVPXMHUHVTXHORQHFHVLWDQ
0HMRUDQODGLVPHQRUUHD\HOGRORUSpOYLFRYLQFXODGRDODRYXODFLyQ
'LVPLQX\HQODDQHPLDFUyQLFD
'HVYHQWDMDV
1RSUHYLHQHQFRQWUDODV,76,759,+6,'$QLODKHSDWLWLVWUDQVPLWLGDVH[XDOPHQWH
1RSXHGHQXVDUVHGXUDQWHODODFWDQFLD
5HTXLHUHQHVIXHU]RGHPHPRULD\FDSDFLGDGGHFRPSUHQVLyQ
3XHGHQSUHVHQWDUHIHFWRVVHFXQGDULRVQiXVHDVYyPLWRVDXPHQWRGHSHVRHGHPD
WHQVLyQ PDPDULD GHSUHVLyQ DPHQRUUHD VDQJUDGR LQWROHUDQFLD D ORV KLGUDWRV GH
FDUERQRDVPDKLSHUOLSLGHPLDDJUDYDPLHQWRGHODVPLJUDxDVODVHQIHUPHGDGHVGHO
FRUD]yQUHQDOHVRODHSLOHSVLDVLH[LVWtDQSUHYLDPHQWH
,QFUHPHQWDQGHDYHFHVPiVHOULHVJRGHWURPERVLVYHQRVDVLVHORVFRPSDUDFRQ
PXMHUHVTXHQRXVDQPpWRGRVKRUPRQDOHV
$XPHQWDQOLJHUDPHQWHHOULHVJRGHFiQFHUGHPDPD
x $QWLFRQFHSWLYRV,Q\HFWDEOHV&RPELQDGRV
/RV$,&HVWiQFRPSXHVWRVSRUXQHVWUyJHQRQDWXUDOPiVXQDSURJHVWLQDSURJHVWiJHQR
\DFW~DQSULQFLSDOPHQWHPHGLDQWHODLQKLELFLyQGHODRYXODFLyQ
/RV DQWLFRQFHSWLYRV LQ\HFWDEOHV FRPELQDGRV $,& PiV XVDGRV FRPSUHQGHQ ODV

VLJXLHQWHVFRPELQDFLRQHV
PJ GH DFHWDWR GH PHGUR[LSURJHVWHURQD PiV PJ GH FLSLRQDWR GH HVWUDGLRO
&\FORIHP
PJ(QDQWDWRGHQRUHWLVWHURQDPiVPJYDOHUDWRGHHVWUDGLRO0HVLJ\QD
9HQWDMDV
/RVHVWUyJHQRVGHORV$,&DOVHUQDWXUDOHVWLHQHQXQDDFFLyQPiV¿VLROyJLFD\ORVHIHFWRV
VHFXQGDULRV UHVXOWDQ PHQRV SRWHQWHV TXH OD SURGXFLGD SRU ORV HVWUyJHQRV VLQWpWLFRV
FRQWHQLGRVHQORVDQWLFRQFHSWLYRVRUDOHVFRPELQDGRV$2&$GHPiVODDGPLQLVWUDFLyQ
SRUYtDSDUHQWHUDOHOLPLQDHOSDVRKRUPRQDOSRUHOKtJDGR
/RV$,&FRQVWLWX\HQXQPpWRGRUHODWLYDPHQWHQXHYRHQFRPSDUDFLyQFRQORV$2&/RV
HVWXGLRVH[LVWHQWHVVRQDFRUWRSOD]R\ORVUHVXOWDGRVPXHVWUDQHIHFWRVVHFXQGDULRV
PiVOHYHVTXHORVSURGXFLGRVSRUORV$2&VREUHHODSDUDWRFDUGLRYDVFXODUPHWDEyOLFR
ODFRDJXODFLyQ\ODIXQFLyQKHSiWLFD
6H UHTXLHUHQ GH HVWXGLRV TXH PXHVWUHQ UHVXOWDGRV D ODUJR SOD]R 6LQ HPEDUJR ODV
HYLGHQFLDV GLVSRQLEOHV GH ORV $2& VH DSOLFDQ SDUD ORV $,& HQ OD PD\RUtD GH ODV
LQVWDQFLDVFRQDOJXQDVH[FHSFLRQHV
$PERVSURGXFWRVVRQDOWDPHQWHH¿FDFHV/DWDVDGHIDOODHQGRFHPHVHVGHXVRHVWi
HQWUH\'HVSXpVGHVXVSHQGLGRHO$,&HOUHWRUQRGHODIHUWLOLGDGHQSURPHGLR
FRUUHVSRQGHDWUHVPHVHV
7LHQHHIHFWRVEHQH¿FLRVRVVREUHHOFRQWUROGHOFLFORODGLVPHQRUUHD\HOPHWDEROLVPR
yVHR1RSURGXFHPRGL¿FDFLRQHVVLJQL¿FDWLYDVHQODSUHVLyQDUWHULDOQLHQORVIDFWRUHV
GHODFRDJXODFLyQ
(IHFWRVVHFXQGDULRV
'XUDQWHORSULPHURVPHVHVGHXVRSXHGHQDVRFLDUVHLUUHJXODULGDGHVPHQVWUXDOHV
$OJXQDVXVXDULDVSXHGHQSUHVHQWDUJDQDQFLDGHSHVRWUDQVLWRULDTXHQRVXSHUDORV
.JFHIDOHDVPDUHRVRPDVWDOJLD
6HJ~Q OD 206 ORV$,& FRPSUHQGLGRV HQ OD FDWHJRUtD QR VH SXHGHQ XVDU HQ ODV
VLJXLHQWHVVLWXDFLRQHV
(PEDUD]RRVRVSHFKD
0XMHUHQSHUtRGRGHODFWDQFLDFXUVDQGRSXHUSHULRLQIHULRUDVHLVVHPDQDV
0~OWLSOHVULHVJRVFRQYDULRVIDFWRUHVDVRFLDGRVHQIHUPHGDGDUWHULDOYDVFXODU
PXMHUPD\RUIXPDGRUDKLSHUWHQVLyQDUWHULDO\GLDEHWHV&DWHJRUtD±
+LSHUWHQVLyQDUWHULDO!R
+LSHUWHQVLyQDUWHULDOFRQHQIHUPHGDGYDVFXODU
)XPDGRUDGHPiVGHFLJDUULOORVSRUGtD\PD\RUGHDxRV
&HIDOHDVGHWLSRPLJUDxDFRQVtQWRPDVQHXUROyJLFRVIRFDOHV
$QWHFHGHQWHVRSUHVHQFLDGHWURPERVLVYHQRVDSURIXQGDRHPEROLDSXOPRQDU
$QWHFHGHQWHVRSUHVHQFLDGHFDUGLRSDWtDLVTXpPLFDLQIDUWRDJXGRGHPLRFDUGLR
DFFLGHQWHYDVFXODUHQFHIiOLFRGHHQIHUPHGDGYDOYXODUFRPSOLFDGD
'LDEHWHV FRQ HQIHUPHGDG YDVFXODU FRPSOLFDGD R FRQ PiV GH DxRV GH
HYROXFLyQ&DWHJRUtD
&iQFHUGHPDPDHQFXUVR
&LUURVLVVHYHUD
+HSDWLWLVDFWLYD
7XPRUHVGHKtJDGR
&LUXJtDPD\RUFRQLQPRYLOL]DFLyQSURORQJDGD
0RGRGHXVR
(O$,&VHDGPLQLVWUDSRUYtDLQWUDPXVFXODUSURIXQGDPHQVXDOPHQWHFRQXQPDUJHQGH
FRORFDFLyQGHPiV±PHQRVWUHVGtDV
6yORHOSULPHULQ\HFWDEOHVHYLQFXODFRQODPHQVWUXDFLyQ\VHLQLFLDSUHIHUHQWHPHQWHHQ
ORVSULPHURVGtDV/RVVLJXLHQWHVLQ\HFWDEOHVVHFRORFDQXQDYH]SRUPHVHQODPLVPD
IHFKDLQGHSHQGLHQWHPHQWHGHODPHQVWUXDFLyQ
$ODVGRVVHPDQDVGHODFRORFDFLyQDSDUHFHXQVDQJUDGRPHQVWUXDOFDXVDGRSRUHO
$,&\HVQRUPDO3RVWHULRUPHQWHODPHQVWUXDFLyQVHSUHVHQWDUiXQDYH]SRUPHV
(O$,&QRGHEHVXVSHQGHUVHFRQODDSDULFLyQGHJRWHRLUUHJXODULGDGHVPHQVWUXDOHVR
DPHQRUUHD6yORVHVXVSHQGHVLORVVtQWRPDVVRQPX\LQWHQVRV\VHFRPSUXHEDTXH
VRQVHFXQGDULDVDOXVRGHOPpWRGR\WDPELpQVLVHSUHVHQWDDOJXQDGHODVFRQGLFLRQHV
LQFOXLGDVHQODFDWHJRUtDGHOD206FRUUHVSRQGLHQWHDFDGD$,&

1R VH UHFRPLHQGD VX XVR GXUDQWH OD ODFWDQFLD HVSHFLDOPHQWH GXUDQWH ORV SULPHURV
VHLV PHVHV 6L QR KD\ ODFWDQFLD HO SULPHU LQ\HFWDEOH VH DGPLQLVWUD GHVSXpV GH OD
WHUFHUDVHPDQDSRVSDUWR(QFDVRGHDERUWRVHSXHGHFRPHQ]DULQPHGLDWDPHQWHHQ
HOSHUtRGRSRVDERUWR
x 3DUFKHVFRQWUDFHSWLYRV
&RQWLHQHQHWLQ\OHVWUDGLRO\QRUHOJHVWURPLQVXPHFDQLVPRGHDFFLyQHVVLPLODUDOGH
ORVFRQWUDFHSWLYRVKRUPRQDOHVFRPELQDGRV
0RGRGHXVR
6HDSOLFDQDSDUWLUGHOSULPHUGtDGHOFLFOR\VRQFDPELDGRVGXUDQWHWUHVVHPDQDV
HQODFXDUWDVHPDQDQRVHDSOLFDXQQXHYRSDUFKHUHFLpQDODTXLQWDVHPDQDVH
FRPHQ]DUiXQDQXHYDVHULHGHWUHVSDUFKHV$GPLWHQXQUHWUDVRHQODDSOLFDFLyQGH
KDVWDKRUDV6HVXJLHUHFRORFDUORVFRQODSLHOVHFDHQGRUVRJO~WHRV\EUD]RVR
HQFXDOTXLHURWUD]RQDDOHMDGDGHPDPDV\JHQLWDOHV
&RPSDUWHQ ODV PLVPDV YHQWDMDV GHVYHQWDMDV FRQWUDLQGLFDFLRQHV \ IDOODV TXH ORV

FRQWUDFHSWLYRVRUDOHVFRPELQDGRV3UHVHQWDQODYHQWDMDGHQRSURYRFDUWUDVWRUQRV
GLJHVWLYRV/DVGHVYHQWDMDVSDUWLFXODUHVGHHVWHPpWRGRVRQVXPHQRUHIHFWLYLGDGHQ
PXMHUHVFRQSHVRPD\RUD.LORVODDOHUJLDDODGKHVLYRHQHOVLWLRGHFRORFDFLyQ\
ODSRVLELOLGDGGHGHVSHJDUVH
x $QLOORVFRQWUDFHSWLYRVYDJLQDOHV
6RQ DQLOORV ÀH[LEOHV \ WUDQVSDUHQWHV GH XQRV FHQWtPHWURV GH GLiPHWUR TXH
FRQWLHQHQHWLQ\OHVWUDGLRO\HWRQRUJHVWUHOVXPHFDQLVPRGHDFFLyQHVVLPLODUDORVGH
ORVFRQWUDFHSWLYRVRUDOHVFRPELQDGRV
0RGRGH8VR
6HGHEHFRORFDUXQDQLOORYDJLQDODOPHVGXUDQWHGtDVFRQXQSHUtRGROLEUHGHXVR
GHXQDVHPDQD$GPLWHQKDVWDXQDVHPDQDGHROYLGR
&RPSDUWHQHQJHQHUDOODVPLVPDVFRQWUDLQGLFDFLRQHVYHQWDMDVGHVYHQWDMDV\IDOODV
TXHORVFRQWUDFHSWLYRVRUDOHVFRPELQDGRV3RUVXVFDUDFWHUtVWLFDVHVSHFLDOHVSXHGHQ
SURYRFDUYDJLQLWLVOHXFRUUHD\PROHVWLDVYDJLQDOHV/DH[SXOVLyQHVXQDFRPSOLFDFLyQ
SRFRIUHFXHQWH3XHGHQHVWDUFRQWUDLQGLFDGDVXFRORFDFLyQHQSURODSVRVYDJLQDOHV
GHWHUFHUJUDGRRHQFDVRGHVLQHTXLDVYDJLQDOHV
x &RQWUDFHSWLYRVGH3URJHVWiJHQRVVRORV
([LVWHQSUHSDUDGRVHQEDVHD/LQHVWUHQROQRUHWLQGURQDDFHWDWRGHPHGUR[LSURJHVWHURQD
\OHYRQRUJHVWUHO3RUQRFRQWHQHUHVWUyJHQRVHVWiQHVSHFLDOPHQWHLQGLFDGRVHQWRGDV
DTXHOODVVLWXDFLRQHVRSDWRORJtDVHQODVTXHORVHVWUyJHQRVHVWiQFRQWUDLQGLFDGRV
SRUHMHPSORODFWDQFLDPXMHUHVFRQHQIHUPHGDGHVDXWRLQPXQHV
6HORVSXHGHFRQVHJXLUHQIRUPDGHFRPSULPLGRVGHXVRRUDOLPSODQWHVVXEGpUPLFRV
1RUSODQWRLQ\HFWDEOHVGHGHSyVLWR'HSRSURYHUDHWF
0RGRGHXVR
/RVFRPSULPLGRVGHEHQWRPDUVHWRGRVORVGtDVVLQGHVFDQVR\UHVSHWDQGRHQIRUPD
UHJXODUORVLQWHUYDORVHQWUHStOGRUDV6HDFRQVHMDUiXQUHWUDVRRXQDGHODQWDPLHQWR
GHQRPiVGHKRUDVSDUDPDQWHQHUODHIHFWLYLGDG\HYLWDUORVHIHFWRVLQGHVHDEOHV
1RUPDOPHQWHVHHVSHUDUiDOSULPHUGtDGHODPHQVWUXDFLyQSDUDFRPHQ]DUODWRPD
GHOFRQWUDFHSWLYRVHSRGUiFRPHQ]DUDODVVHLVVHPDQDVGHOSRVWSDUWRHQPXMHUHV
TXHVHHQFXHQWUDQDPDPDQWDQGR
/RV LQ\HFWDEOHV VH XVDQ HQ HVTXHPDV GH LQ\HFFLyQ GLIHUHQWHV GHSHQGLHQGR GHO
FRPSXHVWRXVDGR/RVFRPSXHVWRVHQEDVHDDFHWDWRGHPHGUR[LSURJHVWHURQDVRQ
GHXVRWULPHVWUDO/DSULPHUDLQ\HFFLyQVHDSOLFDHOSULPHUGtDGHOFLFOR\VHUHSLWH
FDGDPHVHVSXGLHQGRDGHODQWDURUHWUDVDUODGRVLVKDVWDKRUDV(QHOFXDGUR
TXHVHSUHVHQWDDFRQWLQXDFLyQVHUHVXPHQODVGLVWLQWDVSRVLELOLGDGHVSDUDHOLQLFLR
GHOWUDWDPLHQWRFRQDQWLFRQFHSWLYRVLQ\HFWDEOHV
&XDGUR0RPHQWRGHDSOLFDFLyQGHOSULPHULQ\HFWDEOH
&RQFLFORVPHQVWUXDOHV (QDPHQRUUHD /DFWDQFLD
(Q ORV SULPHURV GtDV (Q FXDOTXLHU PRPHQWR VL KD\ 6LKDQSDVDGRPHQRV
GHOVDQJUDGRPHQVWUXDO VHJXULGDGGHQRHVWDUHPEDUD]DGD GHPHVHVGHOSDUWR
\QRUHTXHULUiPHGLGDV \GHEHUiDEVWHQHUVHGHPDQWHQHU VH FRQGXFH FRPR
FRQWUDFHSWLYDV FRPSOH UHODFLRQHVRKDFHUORFRQSURWHFFLyQ HQ HO FDVR PXMHU HQ
PHQWDULDV DGLFLRQDOHQORVVLJXLHQWHVGtDV DPHQRUUHD
$SDUWLUGHOGtDSXHGH 6LKDQSDVDGRPiVGH
DSOLFiUVHOH VL KD\ PHVHV \ SUHVHQWD
VHJXULGDG GH QR HVWDU FLFORV VH GHEHUi
HPEDUD]DGD \ GHEHUi FRQGXFLU FRPR HQ
DEVWHQHUVHGHPDQWHQHU ORV FDVRV FRQ FLFORV
UHODFLRQHVRKDFHUORFRQ PHQVWUXDOHV
SURWHFFLyQ DGLFLRQDO HQ
ORVVLJXLHQWHVGtDV
/RV LPSODQWHV VXEGpUPLFRV GHEHQ VHU HPSOD]DGRV HQ IRUPD TXLU~UJLFD SRU XQ
SURYHHGRUFDSDFLWDGRVLHPSUHVHWHQJDODVHJXULGDGGHTXHODPXMHUQRVHHQFXHQWUD
HPEDUD]DGDSRUHVWDUD]yQVHUiUHFRPHQGDEOHLPSODQWDUORHQORVSULPHURVVLHWHGtDV
GHOFLFOR
(OLPSODQWHGHEHUiVHUUHWLUDGRDORVFLQFRDxRVGHKDEHUVLGRFRORFDGR
&RQWUDLQGLFDFLRQHV
/DV ~QLFDV FRQWUDLQGLFDFLRQHV DEVROXWDV SDUD HO XVR GH FRQWUDFHSWLYRV HQ EDVH D
SURJHVWLQDVH[FOXVLYDPHQWHODFRQVWLWX\HQXQFiQFHUGHPDPDDFWXDO\XQHPEDUD]R
3XHGHQVHUFRQWUDLQGLFDFLRQHVUHODWLYDVODVPHWURUUDJLDVVLQGLDJQyVWLFRKHSDWRSDWtDV
FDUGLRSDWtDVFRDJXORSDWtDV'HEHUiFRQVLGHUDUVHHVSHFLDOPHQWHHOXVRGHLQ\HFWDEOHV
GHDFHWDWRGHPHGUR[LSURJHVWHURQDHQDGROHVFHQWHV\PXMHUHVMyYHQHVSRUODSpUGLGD
GHPDVDyVHD
)DOODVSDUDODVStOGRUDVHQFRQGLFLRQHVLGHDOHVGHXVRHVPHQRUDO\HQFRQGLFLRQHVGH
XVRKDELWXDOSXHGHQOOHJDUKDVWDXQ/RVLQ\HFWDEOHV\ORVLPSODQWHVHQFRQGLFLRQHV
LGHDOHVIDOODQHQPHQRVGHXQ\HQFRQGLFLRQHVWtSLFDVGHXVRXQ
9HQWDMDV
3XHGHQ VHU XVDGRV HQ SHUtRGR GH ODFWDQFLD \ HQ PXMHUHV FRQ LQWROHUDQFLD D ORV
HVWUyJHQRV
1RDXPHQWDQHOULHVJRGHWURPERVLVRDFFLGHQWHVFHUHEURYDVFXODUHV
'LVPLQX\HQODDQHPLDFUyQLFD
'HVYHQWDMDV
1RSUHYLHQHQFRQWUDODV,76,759,+6,'$QLODKHSDWLWLVWUDQVPLWLGDVH[XDOPHQWH
/DVStOGRUDVUHTXLHUHQHVIXHU]RGHPHPRULD\FDSDFLGDGGHFRPSUHQVLyQ
3XHGHQSUHVHQWDUFRPRHIHFWRVLQGHVHDEOHVFHIDOHDVDXPHQWRGHSHVRGLVPLQXFLyQ
GHODSURGXFFLyQGHOHFKHWUDVWRUQRVPHQVWUXDOHVGLVPLQXFLyQGHODGHQVLGDGPLQHUDO
yVHDTXLVWHVIXQFLRQDOHVGHRYDULR
'LVSRVLWLYRVLQWUDXWHULQRV
(QPXFKRVSDtVHVGHOD5HJLyQVHHQFXHQWUDQGLVSRQLEOHVGRVWLSRVGHGLVSRVLWLYRV
LQWUDXWHULQRVPHGLFDGRVXQRVTXHFRQWLHQHQFREUH\RWURVTXHFXHQWDQFRQXQVLVWHPD
OLEHUDGRU GH KRUPRQD OHYRQRUJHVWUHO (Q DPERV FDVRV VH WUDWD GH GLVSRVLWLYRV GH
SROLHWLOHQRHQIRUPDGH76RQPpWRGRVLGHDOHVSDUDDTXHOODVPXMHUHVTXHGHVHDQXQD
DQWLFRQFHSFLyQUHYHUVLEOHDODUJRSOD]R
0HFDQLVPRGHDFFLyQ
/RVGLVSRVLWLYRVLQWUDXWHULQRVWLHQHQQXPHURVRVPHFDQLVPRVGHDFFLyQSHURHOSULQFLSDO
SDUHFH VHU OD SUHYHQFLyQ GH OD IHUWLOL]DFLyQ LQDFWLYDFLyQ GH ORV HVSHUPDWR]RLGHV
DOWHUDFLyQGHODYHORFLGDGGHWUDQVSRUWHGHOyYXOR
&RQWUDLQGLFDFLRQHV
/DVPXMHUHVFRQLQIHFFLRQHVSpOYLFDVHQGRPHWULWLVPLRPDVVXEPXFRVRVKLSRSODVLDR
PDOIRUPDFLRQHVXWHULQDV
9HQWDMDV
/RV',8PHGLFDGRVFRQFREUHVRQGHEDMRFRVWR\GHODUJDYLGD~WLODxRV
7RGRV FRPSDUWHQ HQWUH VXV YHQWDMDV OD UiSLGD UHYHUVLELOLGDG GHO HIHFWR FRQWUDFHSWLYR
\TXHSXHGHQVHUXVDGRVGXUDQWHODODFWDQFLD([LVWHQGXGDVVREUHHOXVRGHORV',8
PHGLFDGRV FRQ KRUPRQDV GXUDQWH OD ODFWDQFLD D VX YH] HVWRV GLVSRVLWLYRV WLHQHQ OD
JUDQYHQWDMDGHGLVPLQXLUORVVDQJUDGRVPHQVWUXDOHVHLQWHUPHQVWUXDOHV
'HVYHQWDMDV
/RV',8FRQKRUPRQDVWLHQHQODGHVYHQWDMDGHVHUPHQRVGXUDEOHVDxRV\WHQHUXQ
FRVWRVHQVLEOHPHQWHVXSHULRUTXHORVGHFREUH$PERVWLSRVGH',8QRSURWHJHQFRQWUD
ODV,76±9,+6,'$
/D 7 GH FREUH SXHGH SURYRFDU VDQJUDGR PHQVWUXDO DEXQGDQWH \ VDQJUDGRV
PHVRFtFOLFRV
)DOODVHQFRQGLFLRQHVLGHDOHVORV',8GHFREUHIDOODQHQXQ\HQFRQGLFLRQHV
WtSLFDVGHXVRIDOODQKDVWDXQ
/RV',8KRUPRQDOHVWDQWRHQFRQGLFLRQHVLGHDOHVFRPRWtSLFDVGHXVRDSHQDVIDOODQHQ
HO/RTXHORVKDFHDOWDPHQWHVHJXURV
5LHVJRV
/RVULHVJRVDVRFLDGRVFRQODLQVHUFLyQVRQODSHUIRUDFLyQXWHULQDDSRUPLOOD
H[SXOVLyQTXHYDUtDGHVGHXQDXQHQHOSULPHUDxRGHXVR
(OULHVJRGHLQIHFFLyQHVLQYHUVDPHQWHSURSRUFLRQDODOWLHPSRGHFRORFDFLyQ$XQTXH
H[LVWHQHYLGHQFLDVFRQWURYHUVLDOHVSDUHFHKDEHUXQPD\RUULHVJRGHHPEDUD]RHFWySLFR
HQODVPXMHUHVTXHXVDQ',8
&RORFDFLyQ
/RKDELWXDOHVFRORFDUORFRQODPXMHUPHQVWUXDQGR\DTXHHVWRJDUDQWL]DODDXVHQFLDGH
XQHPEDUD]R\IDFLOLWDHOSURFHGLPLHQWR
7DPELpQSXHGHFRORFDUVHIXHUDGHOSHUtRGRPHQVWUXDOGXUDQWHORVSULPHURVGtDVGHO
FLFORSDUDGHVFDUWDUXQHPEDUD]R$QWHGXGDVGHXQDSRVLEOHJHVWDFLyQVHGHEHUtDQ
VROLFLWDUH[iPHQHVGHJRQDGRWUR¿QDFRULyQLFDVXEXQLGDGEHWDSDUDGHVFDUWDUOD
/DFRORFDFLyQGHO',8DQXOtSDUDVQRHVWDFRQWUDLQGLFDGD
7DPELpQHO',8VHSXHGHFRORFDUHQPRPHQWRVHVSHFLDOHVHQODOODPDGDFRORFDFLyQ
SRVWHYHQWRREVWpWULFRDERUWRSDUWRFHViUHD
&XDGUR,QVHUFLyQHQFRQGLFLRQHVHVSHFLDOHV
Inserción en el postparto Otras situaciones

Puerperio
Post-placentario Puerperal Intracesárea Post-aborto
Inmediato
No más de En la primera Inmediatamente
Después Después de la
10 minutos semana, después de
de las 4 revisión y limpieza
después de no más allá evacuados los restos
semanas endouterina, antes
la salida de la de las 48 horas ovulares y si no hay
postparto. de la histerorrafia.
placenta. postparto signos de infección.
$QWLELyWLFRV
(O XVR GH DQWLELyWLFRV VROR HVWDUi LQGLFDGR FXDQGR OD WpFQLFD GH LQVHUFLyQ KD\D VLGR
ODERULRVD R SXHGD KDEHUVH SHUGLGR OD HVWHULOLGDG GHO GLVSRVLWLYR (Q HVH FDVR VHUiQ
VX¿FLHQWHVKRUDVGH$PR[LFLOLQDR$PSLFLOLQD
$QDOJpVLFRV
3XHGHMXVWL¿FDUVHHOXVRGHDQDOJpVLFRVGHWLSRDQWLHVSDVPyGLFRVHQODVSULPHUDV
KRUDVTXHVLJXHQDODFRORFDFLyQ
$GYHUWHQFLDV
6H LQGLFDUi FRQVXOWDU HQ FDVR GH H[SXOVLyQ GHO GLVSRVLWLYR GRORU TXH QR FDOPD FRQ
DQDOJpVLFRVFRPXQHVÀXMRIpWLGRVLHOVDQJUDGRDXPHQWDHQGXUDFLyQ\YROXPHQ2
DQWHODSUHVHQFLDGHVDQJUDGRLQWHUPHQVWUXDO
&XDGUR&ULWHULRVGHHOHJLELOLGDGSDUDPpWRGRVKRUPRQDOHV\GLVSRVLWLYRVLQWUD
XWHULQRV
Combinados Solo progesterona DIU

Condición
inyectables
implantes
vaginales
parches
orales
orales
intra-
LNG
Cu
CARACTERÍSTICAS PERSONALES E HISTORIA REPRODUCTIVA
Edad
Desde la menarca hasta los 19 años
20 a 44
45 y más años
Paridad
Nulípara
1 o más partos
Lactancia natural
< 6 semanas postparto
> 6 semanas a < 6 meses postparto
> 6 meses postparto
Postparto (amamantando o no)
< 48 horas
48 horas a < 4 semanas
> 4 semanas
Postaborto
1er trimestre
2º trimestre
Inmediatamente después de aborto séptico
Antecedente de embarazo ectópico
Historia de cirugía pélvica
Fumar
Edad < 35 años
Edad > 35 años
< 15 cigarrillos/día
> 15 cigarrillos/día
Obesidad
> 30 Kg/m2 del índice de masa corporal (IMC)
ENFERMEDADES CARDIOVASCULARES
Factores múltiples de riesgo para enfermedad
arterial cardiovascular (diabetes, HTA, etc.).
Hipertensión
Mujer con historia de HTA que no la controla
Mujer con historia de HTA que la controla
adecuadamente
P.A. sistólica de 140 a 159 y diastólica de 90 a 99
mm Hg
P.A. sistólica >160 y diastólica > 100 mm Hg
Enfermedad vascular
Trombosis venosa profunda (TVP) y embolia

pulmonar (EP)
Historia de TVP/EP
TVP/EP actual
Historia familiar de TVP/EP (parientes de primer grado)
Cirugía mayor con inmovilización prolongada
Cirugía mayor sin inmovilización prolongada
Cirugía menor sin inmovilización
Trombosis venosa superficial
Venas varicosas
Tromboflebitis superficial
Cardiopatía isquémica antecedentes personales
o enfermedad actual
Accidente cerebro vascular
Hiperlipidemias conocidas
Valvulopatías
No complicadas
Complicadas
ALTERACIONES NEUROLÓGICAS
Cefaleas
No migrañosas
Migrañosas
Sin síntomas neurológicos focales
Edad < 35 años
Edad > 35 años
Con síntomas neurológicos focales
Epilepsia
INFECCIONES Y ENFERMEDADES DEL TRACTO REPRODUCTIVO
Patrones de sangrado vaginal
Patrón irregular sin sangrado intenso
Patrones regulares e irregulares con sangrado intenso
Sangrado vaginal sin explicación
Endometriosis
Tumores benignos de ovario
Dismenorrea severa
Enfermedad trofoblástica gestacional
Benigna
Maligna
Ectropion cervical
Neoplasia intraepitelial cervical
Cáncer cervical (esperando tratamiento)
Enfermedades de la mama
Tumor sin diagnóstico anatomopatológico
Enfermedad benigna
Historia familiar de cáncer de mama
Cáncer actual
Cáncer con 5 años sin evidencias de enfermedad
Cáncer de endometrio
Cáncer ovárico
Miomas uterinos
Sin distorsión de la cavidad
Con distorsión de la cavidad
Enfermedad inflamatoria pélvica (EIP)
Pasada y sin riesgo actual de ITS
Con embarazo posterior
Sin embarazo posterior
Actual o en los últimos 3 meses
ITS
Actual o en los últimos 3 meses
Vaginitis sin cervicitis purulenta
Riesgo aumentado de ITS
VIH/SIDA
Alto riesgo de VIH
VIH Positivo
SIDA
OTRAS INFECCIONES
Tuberculosis
Malaria
ALTERACIONES ENDÓCRINAS
Diabetes
Diabetes gestacional
Diabetes no vascular
No insulino dependiente
Insulino dependiente
Nefropatía/retinopatía/neuropatía
Otra enfermedad vascular o diabetes de más de 20
años de evolución
Tiroides
Bocio simple
Hipertiroidismo
Hipotiroidismo
ALTERACIONES GASTROINTESTINALES
Enfermedad de la vesícula biliar
Sintomática
Tratada con colecistectomía
Tratada médicamente
Actual
Asintomática
Historia de colestasis
Relacionada con un embarazo
Relacionada con contraceptivos
Hepatitis viral
Activa
Portador
Cirrosis
Leve (compensada)
Severa (descompensada)
Tumores de hígado
Benigno (adenoma)
Maligno (hematoma)
ANEMIAS
Talasemia
Drepanocítica
Ferropénica
INTERACCIÓN CON DROGAS
Drogas que afectan la función del hígado
Algunos antibióticos (rifampicina, griseofulvina, etc.).
Otros antibióticos
Algunos anticonvulsivantes (fenitoina,
carbamazepina, barbitúricos, etc.).
Use el método en cualquier circunstancia

Use generalmente el método
No se recomienda el método a menos que no se disponga o no se acepten otros
No usar el método
0pWRGRVLUUHYHUVLEOHV
/RV PpWRGRV LUUHYHUVLEOHV IHPHQLQRV FRPR ORV PDVFXOLQRV FRPSDUWHQ OD PLVPD
FODVL¿FDFLyQ HQ OR TXH D FULWHULRV GH HOHJLELOLGDG VH UH¿HUH HQ OD WDEOD VLJXLHQWH VH
GH¿QHQORVFXDWURVFULWHULRVGH¿QLGRVSRUOD206
&XDGUR&DWHJRUtDVGHPpWRGRVLUUHYHUVLEOHV
A Aceptar
No hay razones médicas para negar la esterilización a una persona en esta condición.
C Cuidado
El procedimiento normalmente se realiza en un cuadro de rutina, pero con preparación y
precauciones extra.
R Retrasar
El procedimiento debe retrasarse hasta que la condición sea evaluada y/o corregida.
Deben proveerse métodos temporales alternativos de contracepción
E Especial
El procedimiento debe llevarse a cabo en un marco que involucre a un cirujano y personal
experimentados y el equipo necesario para proveer anestesia general y otro apoyo médico
de respaldo. Para estas condiciones también se necesita la capacidad de decidir sobre
el procedimiento más apropiado y el régimen de anestesia. Se deben ofrecer métodos
temporales alternos de contracepción, si es necesario referir al paciente .
'HELGR D TXH OD PD\RU SDUWH GH ODV FRQGLFLRQHV GH HOHJLELOLGDG FRLQFLGHQ FRQ ODV
FDUDFWHUtVWLFDVGHVFULSWDVHQ$\&VRORVHUHVXPLUiQSDUDORVFDVRVGHHVWHULOL]DFLRQHV
TXLU~UJLFDV ODV FRQGLFLRQHV TXH GHEHQ VHU FRQVLGHUDGDV FRQ FLHUWR JUDGR GH
H[FHSFLRQDOLGDG5\(
/LJDGXUDWXEDULD
6HWUDWDGHXQPpWRGRFRQWUDFHSWLYRGH¿QLWLYRTXHFRQVLVWHHQOLJDUFRUWDU\RFDXWHUL]DU
RFRORFDUDQLOORVXRWURVGLVSRVLWLYRVHQODVWURPSDVGH)DORSLR(VXQSURFHGLPLHQWR
TXLU~UJLFRTXHGHEHVHUHIHFWXDGRSRUSHUVRQDOFDOL¿FDGR
/DHOHFFLyQGHODOLJDGXUDWXEDULDSRUSDUWHGHODPXMHUGHEHVHUIUXWRGHODOLEUHHOHFFLyQ
D~QHQDTXHOODVVLWXDFLRQHVHQODVTXHXQDQXHYDJHVWDFLyQFRPSRUWHXQULHVJRYLWDO
3RUHVWDUD]yQVHUHTXLHUHEULQGDUODLQIRUPDFLyQQHFHVDULD\FRQODPD\RUFODULGDGD
FDGDPXMHUFRQVLGHUDQGRVXQLYHOLQWHOHFWXDO\IDFWRUHVVRFLRFXOWXUDOHV
8VXDOPHQWH OD OLJDGXUD WXEDULD VH UHDOL]D HQ WUHV WLSRV GH SURFHGLPLHQWRV ORV GRV
SULPHURV VXHOHQ VHU HVSHFt¿FRV SDUD HIHFWXDU OD OLJDGXUD WXEDULD PLHQWUDV TXH HQ HO
WHUFHURVHODUHDOL]DFRPRLQGLFDFLyQVHFXQGDULD
x 0LQLODSDURWRPtD
x /DSDURVFRStD
x ,QWUDFHViUHDRGXUDQWHRWURSURFHGLPLHQWRTXLU~UJLFR
&XDQGRHIHFWXDUODHVWHULOL]DFLyQ
/XHJRGHUHFLELUXQFRPSOHWRDVHVRUDPLHQWRFXDOTXLHUPXMHUHVWiHQFRQGLFLRQHVGH
VROLFLWDUXQDHVWHULOL]DFLyQTXLU~UJLFD1RKDEHUWHQLGRKLMRVRQRHVWDUFDVDGDQRVRQ
PRWLYRVSDUDQRUHDOL]DUXQDHVWHULOL]DFLyQTXLU~UJLFD6LHVWiFDVDGDVHUiVX¿FLHQWH
FRQODVLPSOHYROXQWDGGHODPXMHU\QRVHQHFHVLWDUiDXWRUL]DFLyQGHOPDULGR
([LVWHQVX¿FLHQWHVHYLGHQFLDVSDUDD¿UPDUTXHODSULQFLSDOFDXVDGHDUUHSHQWLPLHQWR
HQWUHODVPXMHUHVTXHVHVRPHWLHURQDHVWHULOL]DFLyQTXLU~UJLFDVHYLQFXODFRQODHGDG
WHPSUDQDSDUDODUHDOL]DFLyQGHOSURFHGLPLHQWR
6LQRKD\XQDUD]yQPpGLFDTXHORLPSLGD\VLVHKDGHVFDUWDGRXQHPEDUD]RFXDOTXLHU
PRPHQWRVHUiRSRUWXQRSDUDUHDOL]DUHOSURFHGLPLHQWRGHOLJDGXUD
(QODVPXMHUHVTXHVHHQFXHQWUDQPHQVWUXDQGR\QRXVDQPpWRGRVFRQWUDFHSWLYRVVH
UHFRPHQGDUiUHDOL]DUHOSURFHGLPLHQWRHQORVSULPHURVVLHWHGtDVGHOFLFOR
9HQWDMDV
8QDYH]UHDOL]DGDQRVHQHFHVLWDYROYHUDSHQVDUHQPpWRGRVDQWLFRQFHSWLYRV(VGH
WRWDOGHFLVLyQGHODPXMHU1RVXHOHWHQHUHIHFWRVLQGHVHDEOHV\HOLPLQDHOHVIXHU]RGH
PHPRULD
'HVYHQWDMDV
1RSURWHJHFRQWUDLQIHFFLRQHVGHWUDQVPLVLyQVH[XDO9,+6,'$
(VLUUHYHUVLEOH5HTXLHUHSHUVRQDOHQWUHQDGRLQYROXFUDSURFHGLPLHQWRVDQHVWpVLFRV\
TXLU~UJLFRV
5LHVJRV
/D UHDOL]DFLyQ GH SURFHGLPLHQWRV TXLU~UJLFRV \ DQHVWpVLFRV D~Q FRQ DQHVWpVLFRV
ORFDOHVH[SRQHDULHVJRGHFRPSOLFDFLRQHV6LELHQHOULHVJRGHHVWRVSURFHGLPLHQWRV
HVH[WUHPDGDPHQWHEDMRHVQHFHVDULRLQIRUPDUDODVPXMHUHVGHTXHHOORVH[LVWHQ
)DOODV
6HWUDWDGHXQRGHORVPpWRGRVFRQWUDFHSWLYRVPiVHIHFWLYRVVHHVWLPDTXHDSHQDV
IDOOD HQ PHQRV GHO SRU GH ORV FDVRV PiV H[DFWDPHQWH HQ GH FDGD
SURFHGLPLHQWRV HIHFWXDGRV (O ULHVJR GH IDOODV GLVPLQX\H FRQVLGHUDEOHPHQWH FRQ HO
SDVRGHOWLHPSR
&XDGUR&RQGLFLRQHVGHHOHJLELOLGDGFODVHV5\(SDUDOLJDGXUDWXEDULD
Condiciones que deben Condiciones que requieren

retrasar el procedimiento (R) consideraciones especiales (E)
Embarazo Enfermedad trofoblástica Rotura o perforación de útero
gestacional maligna
Postparto de 7 a 41 días Cáncer cervical, ovárico o de Presión arterial > 160/100
endometrio mmHg.
Pre-eclampsia severa/eclapmsia Enf. Inflamatoria Pélvica actual o Enfermedad vascular
en los últimos tres meses
Rotura prolongada de ITS actual Endometriosis
membranas
Sépsis o fiebre intraparto, Enf. de vesícula biliar actual TBC pelviana
puerperal o postaborto
Hemorragia severa antes o Hepatitis viral activa Diabetes con nefropatía,
después del parto o del aborto retinopatía y/o neuropatía
Trauma severo del tracto genital Hb < 7 g/dL Cirrosis severa
postparto o postaborto (desgarro (descompensada)
cervical o vaginal)
Hematometra aguda Infección de pared abdominal Hipertiroidismo
Trombosis Venosa Profunda o Enfermedades respiratorias Alteraciones de la coagulación
Trombo Embolismo Pulmonar agudas
actual
Cirugía mayor con inmovilización Infección sistémica Enfermedades respiratorias
prolongada crónicas
Cardiopatía isquémica actual Utero fijo
Sangrado vaginal sin explicación Hernia de la pared abdominal o
umbilical
/LJDGXUDGHORVGHIHUHQWHVYDVHFWRPtD
6HWUDWDGHXQPpWRGRFRQWUDFHSWLYRGH¿QLWLYRTXHFRQVLVWHHQFRUWDUOLJDU\RFDXWHUL]DU
ORVFRQGXFWRVGHIHUHQWHVDQLYHOHVFURWDOSDUDLPSHGLUHOSDVDMHGHHVSHUPDWR]RLGHV
(VXQSURFHGLPLHQWRTXLU~UJLFRTXHGHEHVHUHIHFWXDGRSRUSHUVRQDOFDOL¿FDGRTXHVH
SXHGHUHDOL]DUSRUGLYHUVDVWpFQLFDVTXLU~UJLFDVFRQDQHVWHVLDORFDORJHQHUDO
/DHOHFFLyQGHODYDVHFWRPtDSRUSDUWHGHOKRPEUHGHEHVHUIUXWRGHODOLEUHHOHFFLyQ
SRUORTXHVHUHTXLHUHEULQGDUODLQIRUPDFLyQQHFHVDULD\FRQODPD\RUFODULGDGDFDGD
KRPEUHFRQVLGHUDQGRVXQLYHOLQWHOHFWXDO\IDFWRUHVVRFLRFXOWXUDOHV
&XDQGRHIHFWXDUODHVWHULOL]DFLyQ
/XHJRGHUHFLELUXQFRPSOHWRDVHVRUDPLHQWR\VLQRKD\FRQWUDLQGLFDFLRQHVPpGLFDV
FXDOTXLHUPRPHQWRHVRSRUWXQRSDUDUHDOL]DUHOSURFHGLPLHQWR
9HQWDMDV
8QDYH]UHDOL]DGDQRVHQHFHVLWDYROYHUDSHQVDUHQPpWRGRVDQWLFRQFHSWLYRV(VGH
WRWDOGHFLVLyQGHOKRPEUH
'HVYHQWDMDV
1RSURWHJHFRQWUDLQIHFFLRQHVGHWUDQVPLVLyQVH[XDO9,+6,'$
(VLUUHYHUVLEOH5HTXLHUHSHUVRQDOHQWUHQDGRHLQYROXFUDSURFHGLPLHQWRVDQHVWpVLFRV
\TXLU~UJLFRV
5LHVJRV
/DV FRPSOLFDFLRQHV \ ULHVJRV VRQ H[FHSFLRQDOHV SHUR SXHGH YHUVH HQ ORV SULPHURV
PHVHV \ KDVWD DOJXQRV DxRV GRORU HVFURWDO R WHVWLFXODU KHPDWRPDV R LQIHFFLRQHV
ORFDOHV
)DOODV
6LQRVHUHDOL]DQFRQWUROHVGHOVHPHQSXHGHQYHUVHKDVWDXQGHIDOODVHQHOSULPHU
DxR(QORVKRPEUHVTXHVHHIHFW~DQH[iPHQHVGHOH\DFXODGRODVIDOODVVRQFDGD
PLOOLJDGXUDV
3DUDGLVPLQXLUODSRVLELOLGDGGHIDOODVVHUHFRPLHQGDXVDUFRQGyQHQORVWUHVPHVHV
VLJXLHQWHVDODOLJDGXUD
&ULWHULRVGHHOHJLELOLGDG
1RKD\XQDFRQGLFLyQPpGLFDTXHUHVWULQMDGHPDQHUDDEVROXWDODHOHJLELOLGDGGHXQD
SHUVRQD SDUD OD HVWHULOL]DFLyQ$OJXQDV FRQGLFLRQHV \ FLUFXQVWDQFLDV LQGLFDQ TXH VH
GHEHWRPDUFLHUWDVSUHFDXFLRQHV
&XDGUR&RQGLFLRQHVGHHOHJLELOLGDGFODVHV5\(SDUDYDVHFWRPLD
Condiciones que deben Condiciones que requieren consideraciones

retrasar el procedimiento (R) especiales (E)
Infecciones locales Hernia inguinal
(escrotal, orquitis, epididimitis, balanitis)
ITS activa Alteraciones de la coagulación
Infección sistémica o gastroenteritis SIDA
Filariasis, elefantiasis
Tumor intraescrotal
Referencias Bibliográficas
Cheng L, Gülmezoglu AM, Van Oel CJ, Piaggio G, Ezcurra E, Van Look PFA. Interventions for emergency
contraception. Cochrane Database of Systematic Reviews 2004, Issue 3.
French R, Van Vliet H, Cowan F, Mansour D, Morris S, Hughes D, Robinson A, Proctor T, Summerbell C,
Logan S, Helmerhorst F, Guillebaud J. Hormonally impregnated intrauterine systems (IUSs) versus other
forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database of
Litt IF. Placing emergency contraception in the hands of women. JAMA. 2005 Jan 5;293(1):98-99.
Ministerio de Salud Pública. Guías en Salud Sexual y Reproductiva. Capítulo Anticoncepción

(Métodos Reversibles). Montevideo - Uruguay 2005. http://www.msp.gub.uy/imgnoticias/5039.pdf
Philpott A. Re-use of the female condom: now for the practical realities.
Reprod Health Matters. 2003 Nov;11(22):185-186.
Planned Parenthood Federation of America. Facts About Birth Control. Prescription.

http://www.plannedparenthood.org/birth-control-pregnancy/birth-control/prescription.htm
(Último acceso 20 de Julio de 2007)
Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency
contraception for pregnancy prevention (full review). Cochrane Database of Systematic Reviews 2007,
Issue 2.
Power J, French R, Cowan F. Subdermal implantable contraceptives versus other forms of reversible
contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database of
Prine L. Emergency contraception, myths and facts. Obstet Gynecol Clin North Am. 2007 Mar; 34(1):127-
36, ix-x.
Santelli J, Rochat R, Hartfield-Timajchy K, Colley B, Curtis K, Cabral R, Hirsch J, Schieve L, et al. 2003.
The Measurement and Meaning of Unintended Pregnancy. Perspectives on Sexual and Reproductive
Health 35(2): 94-101
Van der Wijden C, Kleijnen J, Van den Berk T. Lactational amenorrhea for family planning. Cochrane
WHO 2005. Emergency contraception. www.who.int/entity/mediacentre/factsheets/fs244/en/

(Último acceso 20 de Julio de 2007)
WHO 2004. Medical Eligibility Criteria for Contraceptive Use. 3rd ed. 2004. http://www.who.int/reproductive-
health/publications/mec/index.htm (Último acceso 20 de Julio de 2007).
WHO 2004. Selected practice recommendations for contraceptive use. 2nd ed. 2004. http://www.who.int/
reproductive-health/publications/spr/index.htm (Último acceso 20 de Julio de 2007).
WHO 2007. Family Planning A global handbook for providers. 1st ed. 2007. http://www.who.int/reproductive-
health/publications/fp_globalhandbook/index.htm (Último acceso 15 de Agosto de 2007).
WHO.The Female Condom: A guide for planning and programming. http://www.who.int/

reproductive-health/publications/RHR_00_8/PDF/female_condom_guide_planning_programming.pdf
(Úlimo acceso 20 de Julio de 2007)
WHO 2002. WHO Information Update: Considerations regarding Reuse of the Female Condom July 2002.
http://www.who.int/reproductive-health/stis/docs/reuse_FC2.pdf (Último acceso 20 de Julio de 2007).
WHO 2004. The male latex condom

Specification and guidelines for condom procurement. http://www.who.int/reproductive-health/
publications/m_condom/who_specification_04.pdf (Último acceso 20 de Julio de 2007).
9,,, & $ 3, 7 8 /2 9 , , ,
$ERUWR
2%-(7,9265HGXFLUODPRUELPRUWDOLGDGSRUDERUWR
$&7,9,'$'(6'LDJQyVWLFR\DVLVWHQFLDGHODERUWRHQORVGLVWLQWRVSHUtRGRV
(ODERUWRUHTXLHUHSRUVXFRPSOHMLGDG\VHQVLELOLGDGXQHQIRTXHFRPSUHKHQVLYRGHORV
VHUYLFLRV \ GH ORV SURIHVLRQDOHV GH OD VDOXG 6XV P~OWLSOHV GLPHQVLRQHV LQYROXFUDQ
XQDVHULHGHDVSHFWRVFRPRORVHVSHFt¿FDPHQWHFOtQLFRVORVGHODVSHUVRQDV\HO
HQWRUQRVRFLRHFRQyPLFROHJDO\pWLFR
/DVFRPSOLFDFLRQHVGHODERUWRFRQVWLWX\HQXQDVGHODVSULQFLSDOHVFDXVDVGHPXHUWH
PDWHUQDHQODUHJLyQ/DWLQRDPHULFDQD(OPD\RUFRPSRQHQWHGHPRUWDOLGDGSRUDERUWR
VH GHEH DO DERUWR SURYRFDGR HQ FRQGLFLRQHV GH LQVHJXULGDG VLQ HPEDUJR DOJXQDV
PXHUWHVVRQVHFXQGDULDVDOFRQMXQWRGHIDFWRUHVTXHGHULYDQHQXQDPDODFDOLGDG
DVLVWHQFLDOGHORVVHUYLFLRVGHVDOXG
8QD GH ODV SULQFLSDOHV HVWUDWHJLDV VDQLWDULDV SDUD OD SUHYHQFLyQ GHO DERUWR LQVHJXUR
FRQVLVWHHQFHQWUDUODDWHQFLyQGHODPXMHUEDVDGDHQFXDWURSLODUHVIXQGDPHQWDOHV
)RPHQWDUODDWHQFLyQHQODFRPXQLGDG
3URPRYHUHODFFHVRDORV6HUYLFLRVGH6DOXG
&DSDFLWDUSURIHVLRQDOHVFRQFRQRFLPLHQWRVEDVDGRVHQODHYLGHQFLDFLHQWt¿FD
3URYHHUDOWDFDOLGDGGHDVLVWHQFLDFOtQLFD\GHVHUYLFLRVGHSODQL¿FDFLyQIDPLOLDU
'(),1,&,21(6
$ERUWRVHGH¿QHFRPRODH[SXOVLyQRH[WUDFFLyQGHOSURGXFWRGHODFRQFHSFLyQIXHUDGHO
~WHURPDWHUQRFRQXQSHVRLJXDORLQIHULRUDJUDPRVRDQWHVGHODVVHPDQDV
$ERUWR LQVHJXUR WDPELpQ OODPDGR $ERUWR HQ FRQGLFLRQHV GH ULHVJR HV FXDQGR
HO SURFHGLPLHQWR SDUD ¿QDOL]DU XQ HPEDUD]R QR GHVHDGR HV SURYRFDGR \ VH UHDOL]D
SRUSHUVRQDVTXHFDUHFHQGHOHQWUHQDPLHQWRQHFHVDULRRTXHVHOOHYDDFDERHQXQ
DPELHQWHGRQGHVHFDUHFHGHXQHVWiQGDUPpGLFRPtQLPRRDPERV
$ERUWRKDELWXDOHVODUHSHWLFLyQGHWUHVRPiVDERUWRVHVSRQWiQHRVFRQVHFXWLYRVRGH
FLQFRRPiVQRVXFHVLYRVFRQ¿JXUDHOFXDGURGHDERUWRKDELWXDO
$ERUWRFRPSOHWRFRQVLVWHHQODH[SXOVLyQRH[WUDFFLyQWRWDOGHOKXHYRIXHUDGHODFDYLGDG
XWHULQDHQXQWLHPSRFRPSOHWR\HQWHUR8QDYH]SURGXFLGRFHVDQODVFRQWUDFFLRQHV
XWHULQDVGHVDSDUHFHHOGRORUGLVPLQX\HHOWDPDxRGHO~WHUR\HOVDQJUDGRJHQLWDOH
LQYROXFLRQDQODVPRGL¿FDFLRQHVFHUYLFDOHV
$ERUWR LQFRPSOHWR HV OD H[SXOVLyQ R H[WUDFFLyQ GHO KXHYR HV SDUFLDO \ TXHGDQ
UHWHQLGDVODSODFHQWD\RODVPHPEUDQDVRYXODUHV3HUVLVWHQODVFRQWUDFFLRQHVXWHULQDV
GRORURVDV\HOVDQJUDGRJHQLWDOHO~WHURHVWiEODQGR\HOFXHOORSHUVLVWHGLODWDGR
$ERUWR HVSRQWiQHR HV FXDQGR VXFHGH VLQ OD LQWHUYHQFLyQ GH FLUFXQVWDQFLDV TXH
LQWHU¿HUDQDUWL¿FLDOPHQWHHQODHYROXFLyQGHODJHVWDFLyQ
$ERUWRIUXVWURWDPELpQOODPDGRDERUWRGLIHULGRRKXHYRPXHUWR\UHWHQLGRHVFXDQGR
HOHPEULyQRIHWRPXHUHDQWHVGHODVVHPDQDVSHURHOSURGXFWRHVUHWHQLGRD~QQR
HPSH]DURQHVSRQWiQHDPHQWHODVFRQWUDFFLRQHVXWHULQDVQLKD\GLODWDFLyQFHUYLFDO6X
GLDJQyVWLFRHVSRUHFRJUDItD
(PEDUD]R QR YLDEOH HV FXDQGR VH KD GHWHUPLQDGR TXH HO IHWR R HPEULyQ SUHVHQWDQ
XQDDIHFFLyQTXHORKDFHLQFRPSDWLEOHFRQODYLGDH[WUDXWHULQD(VWRULJHSDUDDTXHOORV
SDtVHVGRQGHH[LVWHXQPDUFROHJLVODWLYRTXHORFRQWHPSOD
$ERUWR WHUDSpXWLFR FXDQGR OD LQWHUUXSFLyQ GHO HPEDUD]R VH UHDOL]D FRQ ¿QHV
WHUDSpXWLFRV SRU HQIHUPHGDGHV HQ ODV TXH HO HPEDUD]R SRQH HQ ULHVJR OD YLGD
PDWHUQD
$ERUWRWHUDSpXWLFRIDOOLGR(VWDYDULDEOHVHUHJLVWUDHQFDVRGHLQWHUUXSFLRQHVOHJDOHV
TXHIUDFDVDQ/RVSURFHGLPLHQWRV\RODPHGLFDFLyQXWLOL]DGRVIXHURQLQDGHFXDGRVR
LQHIHFWLYRVSDUDHVD¿QDOLGDG6LVHFRQVWDWDODIDOODRVHSUHVHQWDXQDERUWRLQFRPSOHWR
VH UHTXHULUi GH XQ PpWRGR TXLU~UJLFR FRPSOHPHQWDULR SDUD OD HYDFXDFLyQ GHO ~WHUR
DVSLUDFLyQDOYDFtRRGLODWDFLyQ\FXUHWDMHSDUDORVHPEDUD]RVGHOVHJXQGRWULPHVWUH
35(9$/(1&,$(,1&,'(1&,$
(ODERUWRHVSRQWiQHRRFXUUHHQHODOSRUFLHQWRGHORVHPEDUD]RVFRQRFLGRV$
VXYH]VHHVWLPDTXHDQLYHOPXQGLDOPLOORQHVGHHPEDUD]RV¿QDOL]DQHQXQDERUWR
SURYRFDGRFDGDDxR\DSUR[LPDGDPHQWHPLOORQHVVRQLQVHJXURV(OGHODV
PXHUWHVPDWHUQDVVHDWULEX\HQDODVFRPSOLFDFLRQHVGHDERUWRVLQVHJXURV
/DVSULQFLSDOHVFDXVDVGHPXHUWHVRQODVKHPRUUDJLDVODLQIHFFLyQ\ODLQWR[LFDFLyQSRU
VXVWDQFLDVXWLOL]DGDVSDUDLQGXFLUHODERUWR(OGHHVWRVVHSURGXFHQHQSDtVHVHQ
GHVDUUROOR
&RQUHVSHFWRDODHGDGGRVGHFDGDWUHVRFXUUHQHQPXMHUHVHQWUH\DxRV
/DLQFLGHQFLDGHODERUWRLQVHJXURHQODUHJLyQGH$PpULFD/DWLQD\HO&DULEHHQHODxR
VHHVWLPyHQSRUFDGDPXMHUHVHQWUH\DxRV
'HOWRWDOGHPXHUWHVPDWHUQDVHQ6XGDPpULFDGHFDGDVHGHEHQDODERUWRLQVHJXUR
PLHQWUDVTXHHQ&HQWURDPpULFDHVGHFDGD\HQHO&DULEHFRUUHVSRQGHDGHFDGD
)LJXUD
)LJXUD (VWLPDFLRQHV GH LQFLGHQFLD DQXDO GHO DERUWR LQVHJXUR \ PRUWDOLGDG
PDWHUQDGHELGRDOPLVPRSRUUHJLRQHV\VXEUHJLRQHVGHOPXQGRFLUFDDxR
Gráfico realizado en base a los datos obtenidos del estudio de la WHO; Unsafe abortion: Global and regional
estimates of the incidence of unsafe abortion and associated mortality in 2000. Fourth edition, Geneva, 2004.
NOTA: En las regiones de América del Norte y Europa Occidental las estimaciones resultan insignificantes.
$%2572(63217È1(2
(ODERUWRHVSRQWiQHRHVODFRPSOLFDFLyQPiVIUHFXHQWHGHOHPEDUD]R(ORFXUUH
DQWHVGHODVVHPDQDVGHJHVWDFLyQ
(WLRORJtD
6HHVWLPDTXHGHOWRWDOGHyYXORVIHFXQGDGRVVHSLHUGHQHQORVSULPHURVFDWRUFH
GtDVGHOHPEDUD]RVLQGDUVLQWRPDWRORJtDVHSUHVHQWDQGHVSXpVGHXQEUHYHUHWUDVRR
FRLQFLGHQFRQODIHFKDPHQVWUXDO
&DXVDVFRQRFLGDVVHFODVL¿FDQHQRYXODUHV\H[WUDRYXODUHV
&DXVDV RYXODUHV VRQ ODV PiV IUHFXHQWHV \ PiV GH OD PLWDG GH ORV DERUWRV
WHPSUDQRV VH SURGXFHQ SRU XQ GHVDUUROOR HPEULROyJLFR DQRUPDO VHFXQGDULR D
IDFWRUHVKHUHGLWDULRVRDGHIHFWRVFURPRVyPLFRVDGTXLULGRV
/DVDQRPDOtDVFURPRVyPLFDVVXSHUDQHOGHORVFDVRV/RVSULQFLSDOHVIDFWRUHV
SUHGLVSRQHQWHVGHODVDQRPDOtDVFURPRVyPLFDVVRQHGDGGHODPXMHUPD\RUD
DxRVHQIHUPHGDGHVYLUDOHVFRQWUDtGDVHQHOSHUtRGRSUHYLRLQPHGLDWRRGXUDQWHOD
JHVWDFLyQ\SURJHQLWRUHVFRQDQWHFHGHQWHVGHDQRPDOtDVFURPRVyPLFDV
+,6725,$&/,1,&$3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO

(67$'2&,9,/
FDVDGD
FRQWURO
120%5( $3(//,'2 GtD PHV DxR EODQFD %(7$ XQLyQHVWDEOH SUHQDWDO
QLQJXQR SULPDULD
LQGtJHQD QR
PHVWL]D SDUWRDERUWR
('$' DxRV VL
VHFXQG XQLYHUV RWUR
/2&$/,'$' 7(/() QHJUD 1
)LJXUD)UDJPHQWRGH+&3DERUWR,GHQWL¿FDFLyQGHODPXMHU
(QOD6HFFLyQ$QDPQHVLVGHOD+&3VHSRGUiQHQFRQWUDUYDULDEOHVTXHLQGLFDQIDFWRUHV
GHULHVJRSDUDHODERUWRFRPRODHGDG\RWURVYLQFXODGRVDOQLYHOVRFLRHFRQyPLFR\
HGXFDFLRQDOGRPLFLOLRORFDOLGDGHWQLD\QLYHOHGXFDWLYR
&DXVDVH[WUDRYXODUHVVHGHEHQDIDFWRUHVPDWHUQRV\SDWHUQRV'HQWURGHORV
IDFWRUHVPDWHUQRVVHGHVWDFDQODVFDXVDVRUJiQLFDV
(QIHUPHGDGHV LQIHFFLRVDV JHQHUDOHV \ ORFDOHV /DV LQIHFFLRQHV
JHQHUDOHV SXHGHQ VHU GH WLSR HVSHFt¿FR R LQHVSHFt¿FR HQ DPERV FDVRV ORV
JpUPHQHV SXHGHQ DWUDYHVDU OD SODFHQWD \ DIHFWDU DO IHWR FRPR HYHQWXDOPHQWH
VXFHGHHQODVt¿OLVWXEHUFXORVLVWR[RSODVPRVLVOLVWHULRVLVHQIHUPHGDGGH&KDJDV
SDOXGLVPREUXFHORVLVHWF(QWUHODVLQIHFFLRQHVORFDOHVVHHQFXHQWUDQLQIHFFLRQHV
JHQLWDOHVSURGXFLGDVSRU0\FRSODVPDKRPLQLV8UHRSODVPDXUHDO\WLFXP&ODP\GLD
7UDFKRPDWLV\HQPHQRUSURSRUFLyQSRU1HLVVHULDJRQRUUKRHDH
(QIHUPHGDGHV SpOYLFDV ORFDOHV PDOIRUPDFLRQHV WXPRUHV \ ODV DOWHUDFLRQHV
XWHULQDV \ FHUYLFDOHV KLSRSODVLD VLQHTXLDV PLRPDWRVLV LQFRPSHWHQFLD FHUYLFDO
GHVJDUURVHWF
&DXVDV WUDXPiWLFDV HO WUDXPDWLVPR DFFLGHQWDO R LQWHQFLRQDO YLROHQFLD SXHGH
VHUFDXVDGHDERUWR
&DXVDV SDWHUQDV HVSHUPiWLFDV SULPDULDV R VHFXQGDULDV D DOWHUDFLRQHV
FURPRVyPLFDVLQIHFFLRVDVPHWDEyOLFDVHQGRFULQDVWy[LFDVHQWUHRWUDV
&DXVDV IXQFLRQDOHV$EDUFDQ HQWUH DO /D DOWHUDFLyQ SUHGRPLQD HQ OD
IXQFLyQ GH ORV yUJDQRV \ DIHFWD HO GHVDUUROOR QRUPDO GHO HPEDUD]R 6H LQFOX\HQ
HQIHUPHGDGHV PHWDEyOLFDV FRPR OD GLDEHWHV HQGRFULQDV FRPR HO KLSR H
KLSHUWLURLGLVPR HO KLSHUDQGURJHQLVPR \ ORV GLVWXUELRV HQGRFULQRV GHO RYDULR
WURIREODVWR\GHODSODFHQWD(QHO~OWLPRFDVRQRHVWiFRPSUREDGRTXHHOEDMR
QLYHOGHSURJHVWHURQDVHDODFDXVDSUREDEOHPHQWHFRQVWLWX\DODFRQVHFXHQFLDGHO
DERUWRHQGRFULQRFRULDORJRQDGDO
&DXVDVLQPXQROyJLFDV/DVPiVIUHFXHQWHVVRQGHWLSRDXWRLQPXQHVtQGURPH
GHDQWLFXHUSRVDQWLIRVIROtSLGRVDQWLFXHUSRVDQWLQXFOHDUHV\WURPER¿OLDV
,QWR[LFDFLRQHV 6HFXQGDULDV D SORPR PHUFXULR DUVpQLFR IRVIDWRV EHQ]ROHV
JDVHVDQHVWpVLFRV\DOFRQVXPRGHDOFRKRO\GURJDV
2WUDVFDXVDV,QWHUYHQFLRQHVTXLU~UJLFDVPD\RUULHVJRHQODVJLQHFROyJLFDV\HQ
ODVDEGRPLQDOHVFRQSHULWRQLWLVUDGLDFLRQHVGHVQXWULFLyQVHYHUDKLSRYLWDPLQRVLV
HQIHUPHGDGHVPDWHUQDVFUyQLFDV\DOWHUDFLRQHVSVLFRVRPiWLFDV
)LJXUD)UDJPHQWRGH+&3DERUWR$QWHFHGHQWHV
/D +&3 LQFOX\H OD VHFFLyQ DQWHFHGHQWHV SHUVRQDOHV
GRQGHVHSXHGHFRQVLJQDUODSUHVHQFLDGHHQIHUPHGDGHV
FUyQLFDVTXHSXHGHQHOHYDUHOULHVJRGHDERUWR(QHOVH
GHWDOODQDOJXQDVHQIHUPHGDGHVFRQVLJQDGDVHLQFOX\H
XQHVSDFLRHQEODQFRSDUDLQFOXLURWUDVQRGHVFULWDV
&XDGUR$ERUWRHVSRQWiQHRHQUHODFLyQDODHGDGJHVWDFLRQDOGHVDUUROORGHO
SURGXFWRFRQFHSFLRQDO\VXPRGDOLGDG
'FCF)GUVCEKQPCN
UGOCPCU

'XQNWEKÎPFGNRTQFWEVQ
EQPEGREKQPCN
8+#$+.+6
*7'81
'/$4+¦0
('61
/QFCNKFCF
24'%1< 6#4& 1
'LDJQyVWLFRFOtQLFRGHDERUWRHVSRQWiQHR
$SUR[LPDGDPHQWH HO GH ORV DERUWRV HVSRQWiQHRV WLHQHQ VLJQRV \ VtQWRPDV
HYLGHQFLDEOHV
$QDPQHVLV VH VRVSHFKDUi XQ DERUWR R DPHQD]D GH DERUWR DQWH XQD PXMHU
HQ HGDG IpUWLO FRQ UHWUDVR PHQVWUXDO R XQ HPEDUD]R FRQ¿UPDGR TXH SUHVHQWD
PHWURUUDJLD GH OD SULPHUD PLWDG GHO HPEDUD]R GRORU DEGRPLQDO WLSR FyOLFR \
HYHQWXDOPHQWHSpUGLGDGHUHVWRVRYXODUHV
([DPHQ DEGRPLQDO \ JHQLWDO WLHQHQ FRPR REMHWLYR GHWHUPLQDU HO WDPDxR
XWHULQR SDUD GHFLGLU YtD GH HYDFXDFLyQ GH VHU QHFHVDULR GHVFDUWDU LUULWDFLyQ
SHULWRQHDOSUHVHQWHHQFDVRVGHSHUIRUDFLyQXWHULQDYLQFXODGDDPDQLREUDVRHQ
HPEDUD]RV HFWySLFRV FRPSOLFDGRV WXPRUDFLRQHV DEGRPLQRSpOYLFDV GHELGDV
D FRPSOLFDFLRQHV LQIHFFLRVDV DQH[LDOHV HPEDUD]R HFWySLFR HQIHUPHGDG
WURIREOiVWLFDJHVWDFLRQDORSDWRORJtDVWXPRUDOHVFRH[LVWHQWHV
)LJXUD)UDJPHQWRGH+&3DERUWR([FOtQLFR\JLQHFROyJLFR
',$*1267,&2&/,1,&2<(7$3$6(92/87,9$6'(/$%2572
$PHQD]DGHDERUWR(QHVWDHQWLGDGHOSURGXFWRFRQFHSFLRQDOVHHQFXHQWUDGHQWURGH
ODFDYLGDGXWHULQD
(O GLDJQyVWLFR VH UHDOL]D SRU OD SUHVHQFLD GH FRQWUDFFLRQHV XWHULQDV GRORURVDV \R
PHWURUUDJLD\DOH[DPHQJHQLWDOHOFDQDOFHUYLFDOHVWiFHUUDGR
$ERUWRLQPLQHQWHLQHYLWDEOHRHQFXUVR/DPHWURUUDJLDHVDEXQGDQWH\FRQWLQXD
ODPD\RULQWHQVLGDGGHODVFRQWUDFFLRQHVXWHULQDVSURYRFDQODDEHUWXUD\GLODWDFLyQGHO
FXHOORHOFDQDOFHUYLFDOHVWiSHUPHDEOH([LVWHSpUGLGDGHOtTXLGRDPQLyWLFRHQIRUPD
GHKLGURUUHDFODUDRPH]FODGRFRQODHPLVLyQGHVDQJUH\RGHFRPSRQHQWHVRYXODUHV
(QRFDVLRQHVHOKXHYRVHGHVSUHQGH\SURWUX\HDWUDYpVGHOFHUYL[XWHULQR
$ERUWRFRQVXPDGR&RQVLVWHHQODH[SXOVLyQGHOKXHYRIXHUDGHODFDYLGDGXWHULQD
([LVWHQGRVPRGDOLGDGHVWRWDORFRPSOHWR\SDUFLDORLQFRPSOHWR
(O 'LDJQyVWLFR VH HVWDEOHFH FXDQGR HO KXHYR VH H[SXOVD FRPSOHWDPHQWH FHVDQ
ODV FRQWUDFFLRQHV GHVDSDUHFH HO GRORU HO ~WHUR GLVPLQX\H GH WDPDxR GLVPLQX\H OD
PHWURUUDJLDHLQYROXFLRQDQODVPRGL¿FDFLRQHVFHUYLFDOHVHQHVWHFDVRVHGLFHTXHHO
DERUWRKDVLGRFRPSOHWR6LHQFDPELRODH[SXOVLyQHVSDUFLDO\TXHGDQUHWHQLGRVUHVWRV
RYXODUHVODVFRQWUDFFLRQHVSHUVLVWLUiQDOLJXDOTXHHOGRORUFRQWLQXDUiODPHWURUUDJLDHO
~WHURHVWDUiVXELQYROXFLRQDGR\HOFXHOORHVWDUiSHUPHDEOHRSDUFLDOPHQWHSHUPHDEOH
HQHVWHFDVRVHHVWDUiIUHQWHDXQDERUWRLQFRPSOHWR
$ERUWR IUXVWUR R GLIHULGR 6H SURGXFH OD PXHUWH GHO SURGXFWR FRQFHSFLRQDO VLQ VX
H[SXOVLyQ/DGLQiPLFDXWHULQDHVLQVX¿FLHQWHSDUDH[SXOVDUHOKXHYR'HVSXpVGH
KRUDVFRPLHQ]DQODVPRGL¿FDFLRQHVHVWUXFWXUDOHVGHOHPEULyQ\GHOVDFRJHVWDFLRQDO
OLVLVGHIRUPDFLyQDFKDWDPLHQWRGHOHPEULyQ\GHOVDFR\HQHWDSDVPiVDYDQ]DGDV
SXHGHSURGXFLUVHPDFHUDUDFLyQRPRPL¿FDFLyQ/DLQIHFFLyQRYXODUHVPiVIUHFXHQWH
FXDQGRHOKXHYRWLHQHFRQWDFWRFRQHOH[WHULRU
#OGPC\C #DQTVQ #DQTVQEQPUWOCFQ

'6#2#5 FGCDQTVQ KPOKPGPVG +PEQORNGVQ %QORNGVQ
&+#)0¦56+%1
2VFXUD\HVFDVD 5RMDDEXQGDQWH 3HUVLVWH 0tQLPD
/GVTQTTCIKC \FRQWLQXD
%QPVTCEEKQPGU $XPHQWDQIUHFXHQFLD 3HUVLVWHQ &HVDQ\PHUPD
WVGTKPCUFQNQTQUCU 3UHVHQWHV HLQWHQVLGDG HOGRORU
/QFKHKECEKQPGU &XHOORDELHUWR
EGTXKECNGU &XHOORFHUUDGR &DQDOSHUPHDEOH 5HVWRVRYXODUHV &XHOORFHUUDGR
HQ~WHUR\RYDJLQD
&GURTGPFKOKGPVQ 3URWUXVLyQ ([SXOVLyQHQGRV ([SXOVLyQWRWDO
[GZRWNUKÎP $XVHQWHV SDUFLDOGHOKXHYR WLHPSRV5HWHQFLyQ KXHYR\DQH[RV
GHDQH[RV
+HPRUUDJLDGHFLGXDO 5HVWRV ÒWHUR
'EQITCHÈC &RiJXORVXEFRULDO ([SXOVLyQ HQGRFDYLWDULRV LQYROXFLRQDGR
(PEULyQYLYR HQFXUVR \YDJLQDOHV \YDFtR
LQWUDXWHULQR
&XDGUR(WDSDVHYROXWLYDVGHODERUWR
'LDJQyVWLFRSDUDFOtQLFR
(OGLDJQyVWLFRGHDERUWRHVSUHGRPLQDQWHPHQWHFOtQLFR/DUHDOL]DFLyQGHORVHVWXGLRV
SDUDFOtQLFRVQRFRQVWLWX\HXQLPSHGLPHQWRSDUDLQLFLDUODWHUDSpXWLFD\VRORVHUHVHUYD
SDUDDTXHOODVVLWXDFLRQHVFRQHOHYDGDFRPSOHMLGDGGLDJQyVWLFDRFXDQGRODSUHRFXSDFLyQ
GHODPXMHU\VXIDPLOLDREOLJXHQDDFHOHUDUORVSDVRVGLDJQyVWLFRV
(FRJUDItD FXDQGR VH GLVSRQJD GH XOWUDVRQRJUDItD VH SRGUi GHWHUPLQDU VL HO
HPEDUD]RHVLQWUDXWHULQRVLH[LVWHYLWDOLGDGHPEULRQDULD\RVLKD\GHFRODPLHQWRV
KHPDWRPDVUHWURFRULDOHVRVLHOKXHYRKDVLGRH[SXOVDGRWRWDOPHQWHDERUWR
FRPSOHWR R SDUFLDOPHQWH DERUWR LQFRPSOHWR 7DPELpQ SRGUi HYDOXDUVH OD
SUHVHQFLDRDXVHQFLDGHWXPRUDFLRQHVDQH[LDOHV\FROHFFLRQHVOtTXLGDVHQIRQGR
GH VDFR GH 'RXJODV (VWRV GDWRV SXHGHQ VHU FRQVLJQDGRV HQ OD KLVWRULD 6,3
$%2572
6XEXQLGDGEHWDGHODKRUPRQDFRULyQLFDJRQDGRWUy¿FD%HWD+&*FXDQWLWDWLYD
VHULDGDFXDQGRH[LVWDQGXGDVDFHUFDGHODYLWDOLGDGHPEULRQDULDHQHPEDUD]RV
PX\SUHFRFHVPHQRUHVDVHPDQDVHODVFHQVRGHORVWtWXORVGH%HWD+&*HQ
GHWHUPLQDFLRQHVVHULDGDVVHSDUDGDVSRUDKRUDVFRQ¿UPDUiODYLWDOLGDG
'LDJQyVWLFRGLIHUHQFLDO
/DVKHPRUUDJLDVGHODSULPHUDPLWDGGHOHPEDUD]RTXHVLJXHQHQIUHFXHQFLDDODERUWRVRQ
HPEDUD]RHFWySLFR
HQIHUPHGDGWURIREOiVWLFDJHVWDFLRQDOPRODKLGDWLIRUPH
JLQHFRSDWtDVFRH[LVWHQWHVSyOLSRVOHVLRQHVFHUYLFDOHVPDOLJQDVRSUHPDOLJQDV
WUDVWRUQRVGHODFRDJXODFLyQ
&XDGUR+DOOD]JRVFOtQLFRV\HFRJUi¿FRVGHORVSULQFLSDOHVGLDJQyVWLFRV
GLIHUHQFLDOHVGHODERUWRHVSRQWiQHR
CLÍNICA ECOGRAFÍA
Dolor.
Tumoración parauterina inespecífica.
EMBARAZO Sangrado negruzco y escaso.
Ausencia de saco gestacional.
ECTÓPICO Tamaño del útero < a la amenorrea.
Pseudosaco gestacional.
Tumoración parauterina.
Sangrado rojo, a veces con vesículas. Útero: imagen típica con vesículas.
MOLA
Tamaño uterino > a la amenorrea. Ovarios: quistes luteínicos uni o
HIDATIFORME
Quistes ováricos. bilaterales.
Dolor.
Sangrado inicialmente escaso y Útero ocupado por el saco o por
ABORTO oscuro, posteriormente abundante y restos ovulares y/o coágulos. Solo
rojo rutilante. estará vacío en el aborto incompleto
No hay tumoraciones anexiales
&RQGXFWD
$PHQD]DGHDERUWR
9DULDUi6HUHFRPHQGDUiUHSRVRItVLFRSVtTXLFR\VH[XDOKDVWDODGHVDSDULFLyQGHOD
VLQWRPDWRORJtD 6H HVSHUDUi SULPHUR TXH GLVPLQX\DQ ODV FRQWUDFFLRQHV \ FRQ HOOR HO
GRORU\HOVDQJUDGR(QHVWHSHUtRGRVHLQWHQWDUiGH¿QLUODFDXVD\WUDWDUODSRUHMHPSOR
HQODLQVX¿FLHQFLDGHOFXHUSRO~WHRVHSRGUiLQGLFDUJHVWiJHQRV
$ERUWRHQFXUVR
9DULDUiHQIXQFLyQGHVLH[LVWHRQRUHSHUFXVLyQKHPRGLQiPLFD
+HPRUUDJLDOHYHDPRGHUDGDVLQUHSHUFXVLyQKHPRGLQiPLFD
VHUHFRPLHQGDFDOPDUHOGRORUFRQDQDOJpVLFRV\RWUDQTXLOL]DQWHV
'LFORIHQDFPJ92R
.HWRSURIHQRPJ92R
$FHWDPLQRIHQRDPJ92R
,EXSURIHQRDPJ92
(QFDVRGHGRORULQWHQVRVHUiUHFRPHQGDEOHFRPELQDUDQDOJpVLFRVQDUFyWLFRVFRQ
QRQDUFyWLFRV
$FHWDPLQLIHQR&RGHtQDPJ92
(ODQVLROtWLFRPiVXVDGRHVHO'LD]HSDPPJ92
HVSHUDUTXHVHFRPSOHWHODHYDFXDFLyQHVSRQWiQHD
HQFDVRGHUHVWRVFRPSOHPHQWDUFRQHYDFXDFLyQSRUDVSLUDFLyQ
+HPRUUDJLDSURIXVD\RUHSHUFXVLyQKHPRGLQiPLFD
YtD YHQRVD SHULIpULFD HQ YHQD GH JUDQ FDOLEUH LQIXQGLU 6ROXFLyQ GH /DFWDWR
5LQJHUDJRWDVPLQXWR
R[tJHQRFRQPiVFDUDGHÀXMROLEUH
DQDOJHVLDGHVHUQHFHVDULDGHDFXHUGRDORUHVXPLGRHQFDVRGHKHPRUUDJLDOHYH
(QFDVRGHHYDFXDFLyQHVQHFHVDULRFRQWDUFRQDQHVWHVLDORFDORJHQHUDO
VL QR VH GLVSRQH GH SRVLELOLGDG GH HYDFXDFLyQ XWHULQD QL VDQJUH VHJXUD
GHULYDU D QLYHO GH PD\RU FRPSOHMLGDG HQ HO WUDVODGR OD PXMHU GHEHUi HVWDU
DFRPSDxDGDSRUSURIHVLRQDOHQWUHQDGRHQPDQLREUDVGHUHDQLPDFLyQ
)LJXUD)UDJPHQWRGH+&3DERUWR0HGLFDFLyQ
$ERUWRFRQVXPDGR
/DFRQGXFWDYDULDUiVHJ~QVHWUDWHGHXQDERUWRFRPSOHWRRLQFRPSOHWR
$ERUWRFRPSOHWRXDQGRVHVRVSHFKHTXHHODERUWRKDVLGRFRPSOHWRSXHGHQR
UHTXHULUVHPiVWUDWDPLHQWRHQHVHFDVRSRGUiRWRUJDUVHHODOWDKRVSLWDODULRYHU
FXLGDGRVSRVWSURFHGLPLHQWR
/DFRQ¿UPDFLyQGHXQDERUWRFRPSOHWRVHHIHFW~DSRUHFRJUDItD
$ERUWRLQFRPSOHWRVLODHYDFXDFLyQIXHLQFRPSOHWD\QRKD\VLJQRVGHLQIHFFLyQ
VHGHEHFRPSOHPHQWDUODHYDFXDFLyQFRQOHJUDGRDVSLUDWLYRRTXLU~UJLFR
$QWHVGHOSURFHGLPLHQWRHVQHFHVDULRTXHHOHTXLSRGHVDOXGGHXQDH[SOLFDFLyQ
FODUD\WUDQTXLOL]DGRUDVREUHHOSURFHGLPLHQWRDHIHFWXDU
(QFDVRGHGRORUHIHFWXDUVHGDFLyQ\RDQDOJHVLDFRPRIXHGHVFULWRHQHO
FDVRGHKHPRUUDJLDOHYH
&RORFDUYtDYHQRVDSDUDLQIXQGLU6ROXFLyQGH/DFWDWR5LQJHUDJRWDV
PLQXWR
&RQYLVWDVDOSURFHGLPLHQWRSUDFWLFDUDQDOJHVLDSDUDFHUYFLFDOODDQHVWHVLD
JHQHUDOSRGUiXVDUVHVLVHGLVSRQHGHORVUHFXUVRVKXPDQRV\PDWHULDOHV
LQGLVSHQVDEOHV
1RH[LVWHQHYLGHQFLDVTXHDYDOHQHOXVRVLVWHPiWLFRGHDQWLELyWLFRVSUR¿OiFWLFRVHQORV
SURFHGLPLHQWRVGHHYDFXDFLyQXWHULQD
0pWRGRVGHHYDFXDFLyQ
/DPD\RUtDGHORVSURIHVLRQDOHVHQWUHQDGRVSXHGHQHIHFWXDUXQDHYDFXDFLyQKDVWDODV
VHPDQDVFRPSOHWDVGHOHPEDUD]R
+DVWD ODV VHPDQDV FRPSOHWDV ORV PpWRGRV SUHIHULGRV GH HYDFXDFLyQ VRQ ORV
GH DVSLUDFLyQ DO YDFtR PDQXDO R HOpFWULFD HVWRV PpWRGRV VXHOHQ VHU PiV VHJXURV
DOSURYRFDUPHQRVSHUIRUDFLRQHVXWHULQDVHQWUHRWUDVFRPSOLFDFLRQHV(QHVFHQDULRV
HQORVTXHQRVHGLVSRQJDGHPpWRGRVDVSLUDWLYRVVHXWLOL]DUiODGLODWDFLyQ\FXUHWDMH
FOiVLFRV
&XDQGRVHDQHFHVDULRFRPHQ]DUHOSURFHGLPLHQWRGHHYDFXDFLyQVLQGLODWDFLyQFHUYLFDO
VH UHFRPHQGDUi HO XVR GH DQHVWpVLFRV ORFDOHV OLGRFDtQD SDUD REWHQHU XQ EORTXHR
SDUDFHUYLFDO(QFDVRVHVSHFLDOHVSXHGHVHUQHFHVDULRXVDUDQHVWHVLDJHQHUDOORFXDO
H[LJHUHFXUVRVKXPDQRV\PDWHULDOHVTXHVXSHUDQDORVGLVSRQLEOHVHQHOSULPHUQLYHO
0iV DOOi GH ODV VHPDQDV FRPSOHWDV \ VL QR KD\ GLODWDFLyQ QL FRQWUDFFLRQHV VH
SUHIHULUi FRPHQ]DU HO SURFHGLPLHQWR GH HYDFXDFLyQ DSHODQGR D PpWRGRV PpGLFRV
SDUD FRQVHJXLU OD GLODWDFLyQ GHO FXHOOR \ OD H[SXOVLyQ GHO IHWR GHELGR D TXH HQ HVWD
HGDGJHVWDFLRQDOORVSURFHGLPLHQWRVGHHYDFXDFLyQH[SRQHQODPXMHUDPD\RUULHVJR
SHUIRUDFLyQKHPRUUDJLD(QWDOVHQWLGRHVWiLQGLFDGRHOXVRGH
GLODWDGRUHV RVPyWLFRV WLHQHQ HO LQFRQYHQLHQWH GH VX FRVWR \ GHO WLHPSR TXH
UHTXLHUHQSDUDVHUHIHFWLYRV
SURVWDJODQGLQDVHOHPSOHRGHO0LVRSURVWROXQDQiORJRGHODSURVWDJODQGLQD(
SRUYtDYDJLQDOPFJGLVWULEXLGRVHQHOIRQGRYDJLQDO\PFJYtDRUDOFDGD
RKRUDVPi[LPRGRVLV
/XHJR GH SURGXFLGD OD H[SXOVLyQ GHO IHWR VH FRPSOHPHQWDUi FRQ HYDFXDFLyQ SRU
DVSLUDFLyQ R SRU FXUHWDMH (O FXUHWDMH HV PHQRV VHJXUR PiV GRORURVR \ PiV OHQWR
TXH OD HYDFXDFLyQ SRU DVSLUDFLyQ /D DVSLUDFLyQ SUHVHQWD DSHQDV XQ WHUFLR GH ODV
FRPSOLFDFLRQHVTXHVHVXHOHQSUHVHQWDUSRUODWpFQLFDGHFXUHWDMH
)LJ)UDJPHQWRGH+&3DERUWR7UDWDPLHQWR3URFHGLPLHQWR
(YDFXDFLyQXWHULQD
(O~WHURSXHGHVHUHYDFXDGRPHGLDQWHGLVWLQWDVWpFQLFDV$QWHVGHFDGDSURFHGLPLHQWR
ODPXMHUGHEHUHFLELUDQDOJHVLD\RDQHVWHVLDORFDOOLGRFDtQDSDUDFHUYLFDORDQHVWHVLD
JHQHUDOGHDFXHUGRDODVQHFHVLGDGHV\GLVSRQLELOLGDGGHFDGDFDVRHQSDUWLFXODU
/D DVSLUDFLyQ DO YDFtR VHD PDQXDO R HOpFWULFD HV HO PpWRGR TXLU~UJLFR PiV VHJXUR
\UiSLGRGHDPLQXWRV\SXHGHUHDOL]DUVHHQIRUPDDPEXODWRULD(VHOPpWRGR
GH HOHFFLyQ SDUD OD HYDFXDFLyQ GH HPEDUD]RV KDVWD ODV GRFH VHPDQDV FRPSOHWDV
&RQVLVWHHQXQDFiQXODSOiVWLFDRGHPHWDOXQLGDDXQDIXHQWHGHYDFtR3UHYLDPHQWHD
ODLQVHUFLyQGHODFiQXODVHUHTXLHUHGHGLODWDFLyQFHUYLFDOXVDQGRGLODWDGRUHVRVPyWLFRV
RPHFiQLFRVVRORVRDVRFLDGRVDSURVWDJODQGLQDVRELHQPDGXUDFLyQFHUYLFDO
$0(8DVSLUDFLyQPDQXDOHQGRXWHULQDHOYDFtRVHFUHDXWLOL]DQGRXQDVSLUDGRUSOiVWLFR
RMHULQJDGHPOVRVWHQLGR\DFWLYDGRPDQXDOPHQWH6HGLVSRQHGHFiQXODVHVWpULOHV
GHVFDUWDEOHV\VXWDPDxRYDUtDGHDPPGHGLiPHWUR
$(8DVSLUDFLyQHOpFWULFDHQGRXWHULQDODIXHQWHGHODERPEDDOYDFtRHVHOpFWULFD
/8,OHJUDGRXWHULQRLQVWUXPHQWDOHVXQSURFHGLPLHQWRTXLU~UJLFRTXHVHXWLOL]DSDUD
ODHYDFXDFLyQPHGLDQWHODGLODWDFLyQGLODWDGRUHVGHPHWDO\FXUHWDMHGHO~WHUR(VXQ
PpWRGRPHQRVVHJXUR\WLHQHPD\RUtQGLFHGHFRPSOLFDFLRQHVSHUIRUDFLRQHV3XHGH
VHUXVDGRHQHPEDUD]RVPHQRUHVGHVHPDQDVFXDQGRQRVHGLVSRQJDGHPpWRGRV
GH DVSLUDFLyQ DO YDFtR HQ HPEDUD]RV PD\RUHV D VHPDQDV VL QR VH GLVSRQHQ GH
PpWRGRV PpGLFRV SDUD OD GLODWDFLyQ \ H[SXOVLyQ IHWDO \ HQ IRUPD FRPSOHPHQWDULD
FXDQGRVHSURGXMRODH[SXOVLyQIHWDO\QRVHGLVSRQHGHPpWRGRVGHDVSLUDFLyQDOYDFtR
SDUDODHYDFXDFLyQXWHULQD
0HGLFDPHQWRVHOXVRGHPLVRSURVWRODQiORJRGHSURVWDJODQGLQDVHVPX\HIHFWLYR\
VHJXURSDUDODLQWHUUXSFLyQGHOHPEDUD]RGXUDQWHHOSULPHUWULPHVWUH
(V UHFRPHQGDEOH HQYLDU VLHPSUH ORV UHVWRV RYXODUHV H[WUDtGRV SDUD HVWXGLR
DQDWRPRSDWROyJLFR
)LJXUD
)UDJPHQWRGH+&3DERUWR$QDWRPtDSDWROyJLFD
&XLGDGRVSRVWSURFHGLPLHQWR
'XUDQWHODVSULPHUDVGRVKRUDVTXHVLJXHQDOSURFHGLPLHQWRGHEHUiHYDOXDUVHHOHVWDGR
GHFRQFLHQFLDVLVXIUHGRORUODFRORUDFLyQGHSLHO\PXFRVDVODIUHFXHQFLDUHVSLUDWRULD
OD SUHVLyQ DUWHULDO OD IUHFXHQFLD FDUGtDFD OD WHPSHUDWXUD FRUSRUDO HO DEGRPHQ \ OD
PDJQLWXG\FDUDFWHUtVWLFDGHODVSpUGLGDVYDJLQDOHV
6LWRGRVORVSDUiPHWURVVRQQRUPDOHV\VHFRQ¿UPyTXHODPXMHU
WLHQHXQWDPL]DMHSDUDVt¿OLVQHJDWLYR\9,+
UHFLELyDFWXDOL]DFLyQGHODVYDFXQDVFRQWUDHOWpWDQRVUXEpROD\RKHSDWLWLV%HWF
UHFLELyRULHQWDFLyQVREUHSODQL¿FDFLyQIDPLOLDURVHOHSURSRUFLRQyDQWLFRQFHSFLyQ
SRVW HYHQWR /D FRORFDFLyQ GHO ',8 HQ HO SRVW DERUWR LQPHGLDWR HV SUiFWLFD \
VHJXUDFRQWDVDVGHH[SXOVLyQVLPLODUHVDODVGHODFRORFDFLyQGHVSXpVGHXQ
LQWHUYDOR
VHOHDGPLQLVWUySUR¿OD[LVFRQLQPXQRJOREXOLQDDQWL'HQFDVRGHWUDWDUVHGHXQD
PXMHU5KQHJDWLYRQRLQPXQL]DGDFRPRVHPHQFLRQDHQHOFDStWXORGHDWHQFLyQ
SUHQDWDO
6L VH FXPSOLHURQ WRGRV ORV SDVRV UHFLHQWHPHQWH UHVHxDGRV OD PXMHU HVWDUi HQ
FRQGLFLRQHVGHUHFLELUHODOWDKRVSLWDODULDSDUDORFXDOVHGHEHUiQLQGLFDU
ORVFRQWUROHVGRPLFLOLDULRVDUHDOL]DUD¿QGHGHVSLVWDUSUHFR]PHQWHFRPSOLFDFLRQHV
WHPSHUDWXUD FRORU FDQWLGDG \ RORU GH ODV SpUGLGDV YDJLQDOHV SHUVLVWHQFLD GH
GRORUWUDVWRUQRVGHOWUiQVLWRGLJHVWLYR
ORV SDVRV D VHJXLU HQ FDVR GH VXIULU DOWHUDFLRQHV HQ ORV FRQWUROHV VXJHULGRV R
QRWDUFXDOTXLHUHOHPHQWRTXHODSUHRFXSH
UHLQLFLRGHODDFWLYLGDGVH[XDOFXDQGRGHVDSDUH]FDQODVSpUGLGDV
\ FRRUGLQDU XQD YLVLWD GH VHJXLPLHQWR HQWUH ORV \ GtDV SRVW DERUWR SDUD
HYDOXDUODHYROXFLyQ\FRPSOHWDUODVDFFLRQHVTXHQRVHKD\DQSRGLGRUHDOL]DU
DQWHVGHODOWD
$%2572&203/,&$'2
/DV FRPSOLFDFLRQHV PiV LPSRUWDQWHV GHO DERUWR LQFRPSOHWR VRQ OD KHPRUUDJLD FRQ
DQHPLDDJXGD\ODLQIHFFLyQ\VLKDQH[LVWLGRPDQLREUDVLQVWUXPHQWDOHVSUHYLDVSXHGH
KDEHUULHVJRGHSHUIRUDFLyQ
(QHODERUWRHVSRQWiQHRODVLQIHFFLRQHVPiVIUHFXHQWHVVHSURGXFHQSRUHODVFHQVR
GH ORV JpUPHQHV TXH KDELWDQ HQ HO WUDFWR JHQLWDO LQIHULRU$VLPLVPR HQ HO DERUWR QR
HVSRQWiQHRHO~WHURSXHGHLQIHFWDUVHSRUHOXVRGHPDWHULDOFRQWDPLQDGR
/DJUDYHGDGGHOFXDGURDEDUFDXQDPSOLRUDQJRTXHYDGHVGHODHQGRPLRPHWULWLVKDVWD
ODVHSVLV
/D,QIHFFLyQSXHGHVHUJHQLWDOFXDQGRH[LVWDQVtQWRPDV\VLJQRVFRPSDWLEOHVFRQ
XQD LQIHFFLyQ ¿HEUH HVFDORIUtRV VHFUHFLRQHV YDJLQDOHV IpWLGDV GRORU DEGRPLQDO R
SpOYLFRHVSRQWiQHR\RDODPRYLOL]DFLyQGHO~WHURPHWURUUDJLDSURORQJDGD\HOHYDFLyQ
GHOUHFXHQWROHXFRFLWDULRR,QIHFFLyQSHOYLDQDORVKDOOD]JRVPiVIUHFXHQWHVVRQGRORU
DEGRPLQDORSpOYLFRVLJQRVSHULWRQHDOHVHYLGHQFLDGRVSRUGRORUDODGHVFRPSUHVLyQ
DEGRPLQR SpOYLFD GRORU D OD PRYLOL]DFLyQ GHO ~WHUR ¿HEUH LJXDO R PD\RU D & \
OHXFRUUHDPXFRSXUXOHQWD\RIpWLGDUHFXHQWROHXFRFLWDULRHOHYDGR
/D6HSVLVHVXQFXDGURJUDYHFRQJUDQFRPSURPLVRGHOHVWDGRJHQHUDOSXHGHDIHFWDU
ODFRQFLHQFLDDFRPSDxDGDGH¿HEUH\WRTXHPXOWLSDUHQTXLPDWRVRLFWHULFLDDQXULDR
ROLJRDQXULDKLSRWHQVLyQDOWHUDFLRQHVUHVSLUDWRULDVWUDVWRUQRVGHODFRDJXODFLyQHWF
(VXQDFRPSOLFDFLyQTXHVHDVRFLDIUHFXHQWHPHQWHDODERUWRUHDOL]DGRHQFRQGLFLRQHV
LQVHJXUDVSRUSHUVRQDOQRFDOL¿FDGR\RHQPDODVFRQGLFLRQHVGHDVHSVLD
+HPRUUDJLD H[FHVLYD PHWURUUDJLD DEXQGDQWH \ FRQWLQXD VXSHUD ORV PO 6H
YLQFXODPiVIUHFXHQWHPHQWHDDWRQtDXWHULQDPiVFRP~QFXDQWRPD\RUVHDODHGDG
JHVWDFLRQDO WDPELpQ SXHGH VHU VHFXQGDULD D OD UHWHQFLyQ GH UHVWRV RYXODUHV R D
OHVLRQHVSHUIRUDFLRQHVGXUDQWHHOSURFHVRGHHYDFXDFLyQ
(O6KRFNKLSRYROpPLFR(VSURGXFLGRSRUXQDKHPRUUDJLDH[FHVLYD\GHHYROXFLyQ
UiSLGD VHFXQGDULD D XQD FRPSOLFDFLyQ 6H DFRPSDxD GH JUDQ FRPSURPLVR GH OD
FRQFLHQFLDGHOHVWDGRJHQHUDO\UHSHUFXVLyQKHPRGLQiPLFDVHYHUD
3HUIRUDFLyQ GHVJDUUR R GDxR OD SHUIRUDFLyQ HV XQD FRPSOLFDFLyQ UHODWLYDPHQWH
IUHFXHQWH HQ HO SURFHVR GH HYDFXDFLyQ XWHULQD HVSHFLDOPHQWH FXDQGR VH UHDOL]D
FXUHWDMH3XHGHFRUUHVSRQGHUDXQDSHUIRUDFLyQPHQRUJHQHUDOPHQWHDVLQWRPiWLFD\VH
UHVXHOYHHVSRQWiQHDPHQWHRFRQODDGPLQLVWUDFLyQGHRFLWyFLFRV6LODSHUIRUDFLyQHVGH
PD\RUHQWLGDGSXHGHSUHVHQWDUVtQGURPHGHLUULWDFLyQSHULWRQHDOVKRFNKHPRGLQiPLFR
\UHTXHULUiODUHDOL]DFLyQGHXQDODSDURWRPtDH[SORUDGRUD6HUHFRPLHQGDFRQVXOWDUOD
(QRWUDVRFDVLRQHVVHFRQVWDWDQGHVJDUURV(QFXDOTXLHUDGHODVGRVVLWXDFLRQHVVH
GHEHUi LGHQWL¿FDU OD WRSRJUDItD GH OD OHVLyQ YDJLQDO XWHULQR \R SpOYLFR 5HJLVWUDU OD
WRSRJUDItDGHOGHVJDUUR\RSHUIRUDFLyQYDJLQD~WHURVHLQWHUSUHWDSRUSpOYLFRODOHVLyQ
GHXQyUJDQRSHOYLDQRUHFWRYHMLJDRYDVRVSpOYLFRV2WURFRUUHVSRQGHDOHVLRQHVGH
RWURVyUJDQRVDEGRPLQDOHV
&RPSOLFDFLRQHVSRVWHYDFXDFLyQ
&RPSOLFDFLRQHVLQPHGLDWDV\PHGLDWDV
+HPRUUDJLDVXHOHYLQFXODUVHDXQDDWRQtDXWHULQDPiVFRP~QDPHGLGD T X H
PD\RUVHDODHGDGJHVWDFLRQDOWDPELpQSXHGHGHEHUVHDODUHWHQFLyQGHUHVWRV
RYXODUHVRDOHVLRQHVSHUIRUDFLRQHVGXUDQWHHOSURFHVRGHHYDFXDFLyQ
,QIHFFLyQVXHOHFDUDFWHUL]DUVHSRUILHEUHHVFDORIUtRVVHFUHFLRQHVY D J L Q D O H V
IpWLGDVGRORUDEGRPLQDORSpOYLFRRDODPRYLOL]DFLyQGHO~WHURXQDPHWURUUDJLD
SURORQJDGDRHOHYDFLyQGHOUHFXHQWROHXFRFLWDULR
3HUIRUDFLyQXWHULQDHVXQDFRPSOLFDFLyQUHODWLYDPHQWHIUHFXHQWHHQORVSURFHVRV
GH HYDFXDFLyQ XWHULQD HVSHFLDOPHQWH FXDQGR OD PLVPD VH HIHFW~D PHGLDQWH
FXUHWDMH (O HVSHFWUR GH PDQLIHVWDFLRQHV GH HVWD FRPSOLFDFLyQ YD GHVGH OD
SHUIRUDFLyQ DVLQWRPiWLFD TXH VyOR UHTXHULUi RFLWyFLFRV FRPR WUDWDPLHQWR D OD
FODUDPHQWHYLVLEOHFRQVtQGURPHGHLUULWDFLyQSHULWRQHDORVKRFNKHPRGLQiPLFR
&RPSOLFDFLRQHVWDUGtDV
,QIHUWLOLGDGHVXQDFRPSOLFDFLyQSRFRIUHFXHQWH\TXHVHVXHOHYHUPiV
IUHFXHQWHPHQWHUHODFLRQDGDFRQODHYDFXDFLyQSRUFXUHWDMH
6LWXDFLRQHVHVSHFLDOHV
$ERUWRLQIHFWDGRGHOSXQWRGHYLVWDFOtQLFRVHFDUDFWHUL]DSRUUHDSDULFLyQGHOGRORU
¿HEUHJHQHUDOPHQWHHQSLFRV3XHGHDVRFLDUVHJHQLWRUUDJLD\RÀXMRIpWLGR
(O~WHURHVWiDJUDQGDGREODQGX]FR\GRORURVRDODFRPSUHVLyQ
(QHVWRVFDVRVHVWiLQGLFDGRFRPHQ]DUHOWUDWDPLHQWRDQWLELyWLFRLQWHQVR\GHDPSOLR
HVSHFWURKRUDVDQWHVGHSURFHGHUDODHYDFXDFLyQGHORVUHVWRVRYXODUHV'HSHQGLHQGR
GHODJUDYHGDGGHOFXDGURVHGHEHUiYDORUDUHQTXHQLYHOGHFRPSOHMLGDGVHGHEHUi
HIHFWXDUHOPLVPR
$ERUWRUHWHQLGRHVXQDHQWLGDGHQODFXDOVHKDGLDJQRVWLFDGRODPXHUWHGHOHPEULyQR
GHOIHWRSHURDXQQRKDQFRPHQ]DGRODVFRQWUDFFLRQHVXWHULQDVQLODGLODWDFLyQFHUYLFDO
(QHVWRVFDVRVODH[SXOVLyQHVSRQWiQHDGHOFRQWHQLGRHQGRXWHULQRHVPHQRVULHVJRVD
TXHDFHOHUDUODH[SXOVLyQ\DTXHODVPDQLREUDVGHHYDFXDFLyQFRQFXHOORFHUUDGR\
UtJLGRIDYRUHFHQODVOHVLRQHVGHOFXHOORGHO~WHUR\ODHYDFXDFLyQLQFRPSOHWD
(V QHFHVDULR DGYHUWLU D OD PXMHU \ VX IDPLOLD VREUH HVWRV ULHVJRV (Q FDVR GH QR
FRQWDUFRQSRVLELOLGDGHVGHXQVHJXLPLHQWRFOtQLFRGHODPXMHUVHUiUHFRPHQGDEOHOD
HYDFXDFLyQSDUDORFXDOVHSURFHGHUiHQWRGDVODVHGDGHVJHVWDFLRQDOHVGLODWDQGRHO
FXHOOR\SRVWHULRUPHQWHHYDFXDQGRHO~WHURFRPR\DVHKDH[SOLFDGRHQPpWRGRVGH
HYDFXDFLyQSDJ
&216(-(5Ë$,1)250$&,Ï1
/DPXMHUGHEHUtDUHFLELULQIRUPDFLyQVREUH&XLGDGRVEiVLFRV6LJQRVGHDODUPD\R
$QWLFRQFHSFLyQ\VHFRRUGLQyXQD&LWDGHVHJXLPLHQWRRFRQWURO

)LJXUD
)UDJPHQWRGH+&3DERUWR&RQVHMHUtD
&XLGDGRVEiVLFRVGHVSXpVGHODOWDGXUDQWHORVSULPHURVGtDVVHUHDOL]DUiQFRQWUROHV
GRPLFLOLDULRVGH
WHPSHUDWXUDFRORUFDQWLGDG\RORUGHODVSpUGLGDVYDJLQDOHVSHUVLVWHQFLDGHOGRORU
\WUDVWRUQRVGHOWUiQVLWRGLJHVWLYR/DSUHVHQFLDGHDOJXQDRYDULDVDOWHUDFLRQHV
HQpVWRVSDUiPHWURVXRWURVVLJQRVTXHVHDQSUHRFXSDQWHVSHUPLWLUiQGHWHFWDU
SUHFR]PHQWHFRPSOLFDFLRQHV\VHGHEHUiFRQVXOWDUHQIRUPDLQPHGLDWD
/DDFWLYLGDGVH[XDOVHSRGUiUHLQLFLDUFXDQGRGHVDSDUH]FDQODVSpUGLGDVGHODV
VHFUHFLRQHVJHQLWDOHV
6HFRRUGLQDUiXQDYLVLWDGHFRQWUROHQWUHORV\GtDVSRVWDERUWRVHHYDOXDUiOD
HYROXFLyQ\UHDOL]DUiQODVDFFLRQHVTXHQRVHKD\DQVLGRFXPSOLGRDQWHVGHODOWD
6LJQRVGHDODUPDVHGHEHUiLQVWUXLUDODPXMHUDUHFRQRFHUpVWRVVLJQRV\FRQVXOWDU
LQPHGLDWDPHQWH IUHQWH D OD SHUVLVWHQFLD GHO GRORU DXPHQWR GHO VDQJUDGR ¿HEUH
&FDPELRHQODFDQWLGDGFRORURORU\DVSHFWRGHODVSpUGLGDVVHFUHFLRQHVJHQLWDOHV
IpWLGDV ORTXLRV FRQ UHVWRV RYXODUHV SDOLGH] FXWiQHR ± PXFRVD PDUHRV OLSRWLPLDV
SpUGLGDGHODFRQFLHQFLD
$QWLUXEHRODSRVWDERUWRVHUH¿HUHDVLHVQHFHVDULRDGPLQLVWUDUODYDFXQDDQWLUUXEHyOLFD
HQ HO SHUtRGR SRVWDERUWR HQ PXMHUHV FRQ KLVWRULD GH QR KDEHU VLGR LQPXQL]DGDV
SUHYLDPHQWH(VWDPHGLGDSUHYHQWLYDEXVFDSURWHJHUDODPXMHU\DGHPiVEHQH¿FLDUOD
HQHOVLJXLHQWHHPEDUD]R
*DPDJOREXOLQDSRVWDERUWRFXDQGRVHWUDWDGHXQDPXMHU5KQHJDWLYRQRLQPXQL]DGDQR
WLHQHDQWLFXHUSRVDQWL'DQWHVGHODOWDSRUDERUWRGHEHUiUHFLELUȖJOREXOLQDKLSHULQPXQH
DQWL'VHJ~QQRUPDQDFLRQDO

)LJXUD
Jglobulina QF )UDJPHQWRGH+&3DERUWR9DFXQDFLyQ
$17,&21&(3&,Ï13267$%2572
(O SRVW DERUWR LQPHGLDWR HV XQ PRPHQWR SURSLFLR SDUD DQDOL]DU MXQWR D OD PXMHU ORV
PpWRGRVDQWLFRQFHSWLYRVPiVDGHFXDGRVSDUDHOOD
SUHI DFFHG
SUHI DFFHG SUHI DFFHG
)LJXUD
)UDJPHQWRGH+&3DERUWR
$QWLFRQFHSFLyQ
/DDFWLYLGDGVH[XDOFRLWDOYDJLQDOSXHGHUHLQLFLDUVHXQDYH]TXHODPXMHUORGHVHH\QR
SUHVHQWHJHQLWRUUDJLD
3DUDODPD\RUtDGHORVPpWRGRVQRKD\UHVWULFFLRQHV6LRSWDUSRUXQDQWLFRQFHSWLYR
RUDO HO PLVPR GHEH LQLFLDUVH HQ IRUPD LQPHGLDWD (VWD HVWUDWHJLD GLVPLQX\H OD
SUREDELOLGDGGHTXHTXHGHHPEDUD]DGDDQWHVGHODSUy[LPDPHQVWUXDFLyQ
/DLQVHUFLyQLQPHGLDWDGHXQGLVSRVLWLYRLQWUDXWHULQRGHVSXpVGHXQDERUWRHVSRQWiQHR
RLQGXFLGRHVSUiFWLFD\VHJXUD/DLQVHUFLyQVHUHDOL]DGXUDQWHODSUiFWLFDGHOOHJUDGR
RKDVWDODVKUVSRVWHULRUHVSDVDGRHVWHWLHPSRHVFRQYHQLHQWHGLIHULUODLQVHUFLyQ
GXUDQWHGtDV\DTXHHOtQGLFHGHLQIHFFLRQHVDXPHQWD
(VWHPpWRGRSXHGHVHUFRQYHQLHQWHHQSDUWLFXODUSDUDDTXHOODVPXMHUHVTXHQRFXHQWDQ
FRQIiFLODFFHVRDORVVHUYLFLRVGHVDOXGRHQODVTXHVHGXGHGHODFRQWLQXLGDGGHVX
DVLVWHQFLD$GHPiVVHKDGRFXPHQWDGRTXHPXFKDVGHODVPXMHUHVTXHRSWDQSRUOD
LQVHUFLyQGLIHULGDQRUHJUHVDQDOFHQWURGHDWHQFLyQSDUDVRPHWHUVHDOSURFHGLPLHQWR
8QDGHODVGHVYHQWDMDVHVTXHHQFRPSDUDFLyQFRQODLQVHUFLyQGLIHULGDODLQPHGLDWD
WLHQHPiVSUREDELOLGDGHVGHH[SXOVLyQGHOGLVSRVLWLYR(VWDSRVLELOLGDGHVPXFKRPD\RU
FXDQGRHO',8VHLQVHUWDOXHJRGHXQDERUWRHQODPLWDGGHOHPEDUD]RTXHHQHWDSDV
PiVWHPSUDQDVGHODJHVWDFLyQRHQXQDERUWRHVSRQWiQHR
&XDQGR VH FRQVLGHUD LQFOXLU OD LQVHUFLyQ SRVWDERUWR GH XQ GLVSRVLWLYR LQWUDXWHULQR HQ
XQ VHUYLFLR GH DERUWR GHEHUtD GHVWDFDUVH OD LPSRUWDQFLD GH OD RULHQWDFLyQ SUHYLD \
SRVWHULRU DO SURFHGLPLHQWR SDUD IRPHQWDU GH HVWD IRUPD OD DFHSWDFLyQ GHO PpWRGR \
SHUPLWLUDODVPXMHUHVWRPDUGHFLVLRQHVLQIRUPDGDV
Referencias Bibliográficas
Alan Guttmacher Institute. Women, society and abortion worldwide. New York and Washington D. C., 1999.
Burrow – Ferris. Complicaciones médicas del embarazo. Editorial Médica Panamericana. Cuarta edición,
Buenos Aires, Argentina, 1996.
Centres for Disease Control and Prevention (CDC). Sexual transmitted diseases: Treatment guidelines, 2002.
CEPAL. Panorama Social de América Latina. Edición 2005. LC/G. 2288 – P. Santiago de Chile, marzo de
2006.
CEPAL. La fecundidad en América Latina: ¿Transición o revolución? LC/L 2097 – P. Santiago de Chile,
mayo de 2004.
Conferencia Internacional sobre Población y Desarrollo (CIPD), El Cairo, 1994.
Cuarta Conferencia Mundial sobre la Mujer, Beijing, 1995.
Fiala C, Swahn ML, Stephansson O, Gemzell-Danielsson K. The effect of non-steroidal anti-inflammatory

drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation. Hum Reprod.
2005;20(11):3072-3077. Epub 2005
Grimes DA, Lopez LM, Schulz KF, Stanwood N. Immediate postabortal insertion of intrauterine devices.
May W, Gülmezoglu AM, Ba-Thike K. Antibiotics for incomplete abortion. Cochrane Database of Systematic
Moulier R, Mesle B. Interrupción voluntaria del embarazo. Enciclopedia Médico Quirúrgica, Ginecología-
Obstetricia, E- 738-A-40. París: Elsevier 2007. 20 p.
OliÄnyk IuV. Using ketoprofen in gynaecological practice. Lik Sprava. 2006; (3):65-69.
OliÄnyk IuV. Using ketoprofen in gynaecological practice. Lik Sprava. 2006;(3):65-69.
Organización Panamericana de la Salud. Guía práctica del manejo del aborto. Washington D. C., 1998.
Organización Mundial de la Salud. Aborto sin riesgos. Guía técnica y de políticas para Sistemas de Salud.
Ginebra, 2003.
Organización Mundial de la Salud. Recomendaciones sobre prácticas seleccionadas para el uso de

anticonceptivos. Segunda edición, Ginebra, 2005.
Organización Mundial de la Salud. Criterios médicos de elegibilidad para el uso de anticonceptivos. Una guía
esencial de la OMS sobre Planificación Familiar. Tercera edición. Ginebra, 2005.
Organización Panamericana de la Salud. Imán Servicios: Normas de atención de salud sexual y reproductiva
de adolescentes. Washington, D. C. OPS, 2005.
Pan American Health Organization (PAHO) / World Association Sexology (WAS). Promotion of sexual health:
Recommendation for action. Washington D. C., 2000.
Penney G. Treatment of pain during medical abortion. Contraception. 2006;74(1):45-47. Epub 2006
Ramos Silvina et al. ”A comprehensive assessment of maternal deaths in Argentina translating multicentre
collaborativr research into action” in Bulletin of the World Health Organization (BLT) volume 85, Number 8,
August 2007, 569-648.
Recomendations on Ethical Issues in Obstetrics and Gynecology by The FIGO Committee for the Ethical
aspects of Human Reproduction and Women´s Health, FIGO, London, United Kingdom, November 2003.
Schwarcz R, Fescina R, Duverges C. Obstetricia. Editorial El Ateneo, 6ª edición, Buenos Aires, Argentina
2005.
Thinkhamrop J, Laopaiboon M, Lumbiganon P. Prophylactic antibiotics for transcervical intrauterine

procedures. Cochrane Database of Systematic Reviews 2007, Issue 3.
World Health Organization. Unsafe abortion. Global and regional estimates of the incidence of unsafe abortion
and associated mortality in 2000. Fourth edition, Geneva, 2004.
World Health Organization. Frecuently asked clinical questions about medical abortion. Conclusions of an
International Consensus Conference on Medical Abortion in Early First Trimester, Bellagio, Italy, 2006.
World Health Organization. Pregnancy, Chilbirth, Postpartum and Newborn Care: A guide for essential
practice, Geneva, 2003.
3a Edición
http://new.paho.org/clap
http://perinatal.bvsalud.org/
r
ISBN 978-92-75-33177-4
CLAP/SMR Publicación Científica Nº 1577 - 2011

Clap1577 PDF

Cargado por

Información del documento

Título original

Derechos de autor

Formatos disponibles

Compartir este documento

Compartir o incrustar documentos

Opciones para compartir

¿Le pareció útil este documento?

¿Este contenido es inapropiado?

Copyright:

Formatos disponibles

Clap1577 PDF

Cargado por

Copyright:

Formatos disponibles

3a Edición

CLAP/SMR Publicación Científica Nº 1577 - 2011

Objetivos: Detectar riesgos en la población 59

Factores que pueden modificar los valores de tensión arterial 125

Partograma con curvas de alerta 178

ACT: Terapias Combinadas en base a Artemisina.

ITS: Infecciones de Transmisión Sexual.

(O(QIRTXHGH*pQHURHQHO'HVDUUROOR *(' SHUPLWLyIRFDOL]DUHOSDSHOGHODVDOXG

(GDGHQDxRV 5LHVJR (GDGHQDxRV 5LHVJR

WUDWDQWH\HOHQGRFULQyORJRHQDPERVFDVRV KLSHUHKLSRWLURLGLVPR HOREMHWLYRVHUi

PLVPR )LQDOPHQWH GHEHUiQ HIHFWXDUVH H[iPHQHV SDUDFOtQLFRV SDUD HVWDEOHFHU HO

/\QEHUJ0&.KRXU\0-/X;  0DWHUQDOÀXIHYHUDQGWKHULVNRIQHXUDOWXEHGHIHFWVDSRSX

9LHUD6DQVHYHULQR07,Q076DQVHYHULQR'6SULW]HUO6FKOHU)DFFLQL 2UJ 0DQXDOGHWHUD

Cuadro 3. Objetivos específicos y actividades propuestas para el control prenatal

Confirmar el embarazo. Realización de exámenes clínicos y paraclínicos para

(***) Lo más precozmente o según norma nacional.

$GHPiVGHOFiOFXORGHODHGDGJHVWDFLRQDO DPHQRUUHD HVWDFDUDGHOJHVWRJUDPDSHUPLWHOD

(QODRWUDFDUDVHSUHVHQWDQORVYDORUHVQRUPDOHV SHUFHQWLOHV\ GHOSHVRPDWHUQR

/DKLVWRULDFOtQLFDSHULQDWDO +&3 LQWHQWDXQLIRUPL]DUHOFRQWHQLGRGHODGRFXPHQWDFLyQ

(OUHYHUVRGHOD+&3 ¿JXUD FRQWLHQHOLVWDVDEUHYLDGDVSDUDODFRGL¿FDFLyQGHODV

'20,&,/,2 VROWHUD /XJDUGHO

FLUXJtD GtD PHV DxR

0$/$5,$ QRVH   VHP (675(372 35(3$5$ &216(-(5,$

JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

ODPDGUH SUHVHQW SRVLF +7$SUHYLD HU

+7$LQGXFLGD LQIHF XULQDULD

QR VL HQ 7'3 ORFDO UHJLRQ JUDO PHGLF PHGLF

VHQWDGD *UDGR  D  SUHDOXPEU SRVWDOXPEU &25'21

VHP GLDV (* PLQ

QRVH QRVH $QWLUXEHROD ȖJOREXOLQD

&$51e3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO

FLUXJtD GtD PHV DxR

0$/$5,$ QRVH   VHP (675(372 35(3$5$ &216(-(5,$

JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

9,92 +7$SUHYLD LQIHF RYXODU

yUGHQ HU WULP

HVSRQW HFODPSVLD 5&,8 SRVWSDUWR

IRUFHSV FDUGLRSDWtD GH PHPEUDQDV LQIHFFLyQ

QR VL HQ 7'3 ORFDO UHJLRQ JUDO

VHQWDGD *UDGR  D  SUHDOXPEU SRVWDOXPEU &25'21 PHGLF PHGLF

VHP GLDV (* PLQ HQ/8*$5

QRVH QRVH $QWLUXEHROD JJOREXOLQD

6,),/,6 VG &21',&,21 ',$*1267,&235(6817,92

VHHQFXHQWUDHQ PLVPRKRVSLWDO RWURKRVSLWDO GRPLFLOLR IDOOHFLGD &RQGLFLyQGHVDOXG QRUPDO FUtWLFD &RQRFLyDVXKLMR QR VL

75$163257( PLVPRKRVSLWDO RWURKRVSLWDO UHLQJUHVR 027,92

,1)250(,1,&,$/$/$)$0,/,$ GLUHFWD WHOHIyQLFD QRVHORJUy

3$72/2*,$6 6(36,6 5(7,123$7,$ (1&()$/2

SXOPRQDU IRFDO 5HTXLHUH Pi[

75$7$0,(1726 D &8,'$'265(63,5$725,26 &,58*,$ &5(&,0,(172

,1',&$&,21(6 5(63216$%/( 7(/()212 (0$,/

6(*8,0,(172 /XJDU 7HOpIRQR )HFKD

GtD PHV DxR

3DUDPD\RULQIRUPDFLyQVREUHHO6LVWHPD,QIRUPiWLFR3HULQDWDO 6,3 \VXSURFHVDPLHQWR

,GHQWL¿FDFLyQ 1RPEUHV\$SHOOLGRV )HFKDGHQDFLPLHQWR\HGDG

FLUXJtD GtD PHV DxR

$QWHFHGHQWHV 7XEHUFXORVLV 3UHHFODPSVLD

$QWHFHGHQWHV 7XEHUFXORVLV (FODPSVLD &DUGLRSDWtD

 edad gestacional (desnutrición)

El punto se sitúa por encima del percentilo 90 de la

 será el riesgo cuanto más elevado sea su

Trazado entre las curvas de percentil 25 y 90,

 Gestante de riesgo con referencia a su ganancia

Trazado por encima de la curva del percentil 90 de

(O(QIRTXHGHpQHURHQHO'HVDUUROOR('SHUPLWLyIRFDOL]DUHOSDSHOGHODVDOXG

WUDWDQWH\HOHQGRFULQyORJRHQDPERVFDVRVKLSHUHKLSRWLURLGLVPRHOREMHWLYRVHUi

PLVPR )LQDOPHQWH GHEHUiQ HIHFWXDUVH H[iPHQHV SDUDFOtQLFRV SDUD HVWDEOHFHU HO

/\QEHUJ0&.KRXU\0-/X;0DWHUQDOÀXIHYHUDQGWKHULVNRIQHXUDOWXEHGHIHFWVDSRSX

9LHUD6DQVHYHULQR07,Q076DQVHYHULQR'6SULW]HUO6FKOHU)DFFLQL2UJ0DQXDOGHWHUD

$GHPiVGHOFiOFXORGHODHGDGJHVWDFLRQDODPHQRUUHDHVWDFDUDGHOJHVWRJUDPDSHUPLWHOD

(QODRWUDFDUDVHSUHVHQWDQORVYDORUHVQRUPDOHVSHUFHQWLOHV\GHOSHVRPDWHUQR

/DKLVWRULDFOtQLFDSHULQDWDO+&3LQWHQWDXQLIRUPL]DUHOFRQWHQLGRGHODGRFXPHQWDFLyQ

(OUHYHUVRGHOD+&3¿JXUDFRQWLHQHOLVWDVDEUHYLDGDVSDUDODFRGL¿FDFLyQGHODV

0$/$5,$ QRVH VHP (675(372 35(3$5$ &216(-(5,$

JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

ODPDGUH SUHVHQW SRVLF +7$SUHYLD HU

+7$LQGXFLGD LQIHF XULQDULD

QR VL HQ 7'3 ORFDO UHJLRQ JUDO PHGLF PHGLF

VHQWDGD *UDGR D SUHDOXPEU SRVWDOXPEU &25'21

VHP GLDV (* PLQ

&$51e3(5,1$7$/&/$3605236206 )(&+$'(1$&,0,(172 (71,$ $/)$ (678',26 /XJDUGHO

0$/$5,$ QRVH VHP (675(372 35(3$5$ &216(-(5,$

JHVW XWHULQD WDFLyQ OSP IHWDOHV QXULD 7pFQLFR

9,92 +7$SUHYLD LQIHF RYXODU

yUGHQ HU WULP

HVSRQW HFODPSVLD 5&,8 SRVWSDUWR

QR VL HQ 7'3 ORFDO UHJLRQ JUDO

VHQWDGD *UDGR D SUHDOXPEU SRVWDOXPEU &25'21 PHGLF PHGLF

VHP GLDV ( PLQ HQ/8$5

6,),/,6 VG &21',&,21 ',$*1267,&235(6817,92

VHHQFXHQWUDHQ PLVPRKRVSLWDO RWURKRVSLWDO GRPLFLOLR IDOOHFLGD &RQGLFLyQGHVDOXG QRUPDO FUtWLFD &RQRFLyDVXKLMR QR VL

SXOPRQDU IRFDO 5HTXLHUH Pi[

3DUDPD\RULQIRUPDFLyQVREUHHO6LVWHPD,QIRUPiWLFR3HULQDWDO6,3\VXSURFHVDPLHQWR

,GHQWL¿FDFLyQ 1RPEUHV\$SHOOLGRV )HFKDGHQDFLPLHQWR\HGDG

$QWHFHGHQWHV 7XEHUFXORVLV (FODPSVLD &DUGLRSDWtD

edad gestacional (desnutrición)

será el riesgo cuanto más elevado sea su

Gestante de riesgo con referencia a su ganancia

Esas medidas procuran que la gestante llegue al

77 7R[RLGH7HWiQLFR7G 7pWDQRVGLIWHULD

1RKD\ULHVJR 5HIHULUSDUDHYDOXDFLyQ\ &RQWURO5HFLpQ1DFLGR

/DSUR¿OD[LVFRQ7$59WULSOHWHUDSLDUHDOL]DGRDPXMHUHVFRQ9,+TXHQRUHTXLHUDQWUDWDPLHQWR

17 ,QIHFFLyQDFWLYDHQHVSHFLDOFRQWtWXORVDOWRV!GHODSUXHEDQR

2EMHWLYR 3UHYHQLU ODV FRQVHFXHQFLDV PDWHUQRSHULQDWDOHV GH RWUDV

0RQLOLDVLV YXOYRYDJLQDO SURYRFDGD SRU &iQGLGD DOELFDQV HVWi SUHVHQWH HQ

,QVSHFFLyQFRQiFLGRDFpWLFRYLQDJUHFXDQGRVHDSOLFDVREUHHO

&XDQGRHO3$3HVLQIRUPDGRFRPR$6&86R6,/GHEDMRJUDGR/6,/OHVLRQHV

&ODVH,, $6&86 $WLStD $WLStD

2%-(7,926 %ULQGDU FRQWHQLGRV HGXFDWLYRLQIRUPDWLYRV SDUD HO SDUWR \ OD

$QWLSURVWDJODQGLQDV GHQWUR GH ODV DQWLSURVWDJODQGLQDV OD LQGRPHWDFLQD KD

3&U '%3')2[

G 5HODFLyQ 3HUtPHWUR DEGRPLQDO IHWDO/RQJLWXG GHO IpPXU \ YHORFLGDG GH

0HGLGDVHULDGDGHDOWXUDXWHULQD$83HVR &DSWDFLyQ 1R

(Q PDWHUQLGDGHV S~EOLFDV FRQ SREODFLRQHV GH FRQGLFLyQ VRFLRHFRQyPLFD EDMD

3ULPHUD PDQLREUD SDOSDQGR HO IRQGR VH SXHGH

6HJXQGD PDQLREUD SDOSDQGR ORV ÀDQFRV VH

7HUFHUD PDQLREUD SHUPLWH SDOSDU HO SROR TXH VH

&XDUWD PDQLREUD SHUPLWH HYDOXDU HO JUDGR GH

5HIHUHQFLD $GPLVLyQGLIHULGD 5HIHUHQFLDDO $GPLVLyQSDUD

&HIDOHD 7UDVWRUQRVYLVXDOHVHVFRWRPDVDPDXURVLV

&RQODWpFQLFDGHDXVFXOWDFLyQGHVFULSWDHQODSDJGHEHHPSOHDUVHHOVLJXLHQWH

PP+J PP+J

!PP+J

1RFRQVWLWX\HQKDELWXDOPHQWH REVWiFXORV SDUDHOSDUWRSHUROD IDOWDGHHODVWLFLGDG \

$QWHODSUHVHQFLDGHKLGURUUHDSpUGLGDGHOtTXLGRODHYDOXDFLyQGHEHVHUUiSLGDSDUD

GLVWLQWDVHVFXHODVVRQORVSODQRVGH+RGJHSDUDODHVFXHODHXURSHD\ODVHVWDFLRQHV

5HFLHQWHV LQYHVWLJDFLRQHV FOtQLFDV DOHDWRUL]DGDV VHxDODQ TXH HQ DTXHOORV VHUYLFLRV

333 333 333

1XOtSDUDV

x 7UDEDMR GH SDUWR SURORJDQGR GHVFDUWDGD OD GHVSURSRUFLyQ IHWRSpOYLFD H

/DVFXUYDVPDUFDQXQOtPLWHH[WUHPRSHUFHQWLOGHODHYROXFLyQGHODGLODWDFLyQFHUYLFDO

+RUL]RQWDO 0XOWtSDUDV 5RWDV

(QXQDSREODFLyQGHPXMHUHVDIULFDQDV 326,&,21 9(57 +25,=217$/

$ FRQWLQXDFLyQ VH SUHVHQWD HO

3/$126