ABSTRACT
Resumen OBJETIVO: Comparar la eficacia del misoprostol intravaginal con el dispositivo vaginal de liberación prolongada de dinoprostona en la inducción del parto. Además, analizar el perfil de seguridad en relación con los desenlaces maternos y perinatales. MATERIALES Y MÉTODOS: Estudio retrospectivo y comparativo efectuado en pacientes atendidas entre 2018 y 2020 en el Área Sanitaria de Ferrol, La Coruña, España, con partos que se iniciaron con inducción con prostaglandinas. Las pacientes se dividieron en dos cohortes, en función de la prostaglandina sintética administrada (misoprostol por vía vaginal o dinoprostona en dispositivo intravaginal). Para la comparación entre ambos grupos se aplicó la prueba U de Mann-Whitney. Para las variables cualitativas se describió su cantidad total y el porcentaje, que se compararon con prueba de χ2 de Pearson. RESULTADOS: Se analizaron 508 pacientes con inducción del parto. En las indicaciones de ésta no se encontraron diferencias entre uno y otro grupo, aunque destacó la indicación del misoprostol en pacientes con embarazo cronológicamente prolongado (63%) y de dinoprostona en rotura prematura de membranas (49%). En relación con los desenlaces perinatales, se registró un Apgar menor de 7 a los 5 minutos en 2 pacientes tratadas con dinoprostona y 1 con misoprostol; así como un pH arterial umbilical menor de 7.10 en 8 pacientes tratadas con dinoprostona y 7 con misoprostol. CONCLUSIONES: Los datos aquí reportados hacen suponer que ambas prostaglandinas consiguen una tasa de inicio del parto similar, aunque la dinoprostona parece reducir el tiempo hasta el inicio del parto en mujeres con indicación de inducción.
Abstract OBJECTIVE: To compare the efficacy of intravaginal misoprostol with the dinoprostone extended-release vaginal device in labor induction. In addition, to analyze the safety profile in relation to maternal and perinatal outcomes. MATERIALS AND METHODS: Retrospective and comparative study performed in patients attended between 2018 and 2020 in the Health Area of Ferrol, La Coruña, Spain, with deliveries that were initiated with prostaglandin induction. The patients were divided into two cohorts, depending on the synthetic prostaglandin administered (misoprostol vaginally or dinoprostone in intravaginal device). The Mann-Whitney U test was used to compare the two groups. For qualitative variables, the total number and percentage were described and compared with Pearson's 2 test. RESULTS: A total of 508 patients undergoing labor induction were analyzed. No differences were found in the indications for induction of labor between one group and the other, although the indication for misoprostol in patients with chronologically prolonged pregnancy (63%) and for dinoprostone in premature rupture of membranes (49%) stood out. In relation to perinatal outcomes, an Apgar of less than 7 at 5 minutes was recorded in 2 patients treated with dinoprostone and 1 with misoprostol; as well as an umbilical arterial pH of less than 7.10 in 8 patients treated with dinoprostone and 7 with misoprostol. CONCLUSIONS: The data reported here suggest that both prostaglandins achieve a similar rate of onset of labor, although dinoprostone appears to reduce the time to onset of labor in women indicated for induction.
ABSTRACT
A pregnancy is considered high-risk when there are potential complications that may lead to dystocia or endanger the mother and unborn baby. Compared with women with a normal pregnancy, women with a high-risk pregnancy have a higher risk for poor pregnancy outcomes, which have a great impact on the maternal and infant prognosis or their families. Therefore, targeted clinical nursing care can be carried out in women who have a high-risk pregnancy to improve the prognosis of mothers and infants. Analyzing the risk factors that induce a high-risk pregnancy and actively reducing risk factors are particularly critical to achieving a good prognosis. Nursing care of women with a high-risk pregnancy should be performed based on evidence-based medicine after comprehensively analyzing the risk of each factor and weighing the pros and cons of related nursing care. Nursing care should have a clinical application value in high-risk pregnancies. This paper reviews the research advance in nursing care in high-risk pregnancies from the perspectives including risk factors, characteristics, the importance of nursing care, and the current nursing status.
ABSTRACT
A conduta para o atendimento de gestantes com gravidez prolongada sofre variações conforme o serviço pesquisado. Trabalhos de meta-análise mostram que o atendimento ideal da gravidez com mais de 41 semanas ainda requer mais estudos, alguns mostrando vantagens na indução do trabalho de parto e outros não. Por outro lado, observa-se, cada vez mais, processos judiciais contra médicos nas áreas de Ginecologia e Obstetricia, em decorrência de negligência, imperícia e imprudência, muitas vezes de difícil caracterização, no atendimento dessas pacientes. A gestação prolongada, que ocorre, aproximadamente, em torno de 10% das gestações, pode causar acometimentos irreversíveis tanto maternos quanto fetais, aumentando a morbimortalidade de ambos, além de ser um dos motivos de denúncia de erro médico. Este trabalho teve como objetivo buscar evidências científicas na literatura que ofereçam diretrizes para o melhor atendimento dessas pacientes, na tentativa de se evitar danos maternos e fetais e ainda oferecer subsídios para uma defesa profissional, caso o médico sofra denuncia por má pratica quando do atendimento de uma gestante nessa condição
Procedures for the care of pregnant women with prolonged pregnancy can vary according to the service. Meta-analysis show that the ideal treatment of pregnancy over 41 weeks still demands more studies, some of them showing advantages in the induction of delivery and others not. On the other hand, it can be increasingly observed lawsuits against doctors in Obstetrics and Gynecology as a result of negligence, malpractice and imprudent acts - which are difficult to characterize - in the care of these patients.The prolonged gestation, which occurs roughly in around 10% of pregnancies, can cause irreversible maternal and fetal attacks, increasing morbidity and mortality of both. It is also one of the reasons for denunciation of medical error. This work had the purpose of seek evidence in the scientific literature that provide guidelines to ensure a better management of these patients, in an attempt to prevent maternal and fetal damage and give subsidies for a professional defense if the doctor is accused of malpractice in the treatment of a woman in this condition
Subject(s)
Humans , Female , Pregnancy , Medical Errors/legislation & jurisprudence , Medical Errors/prevention & control , Fetal Monitoring , Gestational Age , Pregnancy, Prolonged/diagnosis , Pregnancy, Prolonged/epidemiology , Pregnancy, Prolonged/etiology , Labor, Obstetric , Perinatal Mortality , Labor, Induced , Physician-Patient RelationsABSTRACT
This study was done to evaluate transvaginal ultrasonographic measurement of cervical length at 20 to 24 weeks and 37 weeks as a predictor of prolonged pregnancy (defined as a pregnancy that extended beyond 41+2 weeks of gestation [289 days]) in nulliparous women. This prospective observational study enrolled 149 consecutive nulliparous women with singleton gestation at 37 weeks. Cervical length was measured by transvaginal ultrasonography at 20 to 24 weeks and 37 weeks. Cervical length at 37 weeks, but not at 20 to 24 weeks, was significantly longer in women delivered at >41+2 weeks than in those delivered at < or =41+2 weeks (p<0.005). There was a significant correlation between cervical length at 37 weeks and gestational age at delivery (Pearson correlation coefficient, r=0.387, p<0.0001). In the receiver operating curve, the best cut-off value of cervical length at 37 weeks for the prediction of prolonged pregnancy was 30 mm, with a sensitivity of 78% and a specificity of 62%. Cervical length assessed by transvaginal ultrasonography at 37 weeks can predict the likelihood of prolonged pregnancy in nulliparous women. However, there is no association between cervical length at 20 to 24 weeks and the occurrence of prolonged pregnancy.
Subject(s)
Pregnancy , Humans , Female , Adult , Vagina , ROC Curve , Prospective Studies , Pregnancy, Prolonged/diagnosis , Gestational Age , Cervix Uteri/anatomy & histologyABSTRACT
On studying the morphology of spiral arteries in the human placental bed, we found, both in normal term pregnancy and in prolonged pregnancy, there are not only physiological changes such as invasion of trophoblastic cells, disappearance of smooth cells and elastic tissues, but also infiltration of erythrocytes and presence of foam cells in the vessel wall. Since the foam cells are found morphologically very similer to some trophoblastic cells and since the trophoblastic cells have phagocytotic function, we assume that the foam cells may originate from the trophoblastic cells.Besides, we found frequently also thrombosis, thickening of intima and infiltration of abundant erythrocytes in the uterine spiral arteries of prolonged pregnancy. Since these phenomena can diminish blood supply to the placenta, we suppose that they are the main factors leading to placental senescence and to decline in placental functions.
ABSTRACT
Objective: To study the change of placental corticotropin releasing hormone level in pregnant women entering spontaneous labor at term and preterm or posterm,and to investigate the value of CRH as an indicator of preterm labor. Methods: Subjects( n =200) were recruited to the study at their antenatal visits,and plasma samples were obtained at their routine antental clinic visits from 28 weeks to parturition at 2 weeks intervals.CRH were measured by radioimmunoassay. Results: CRH concentrations rose significantly as pregnancy developed and reached the highest level at delivery. Plasma CRH levels were significantly higher in preterm labor and lower in postterm labor after gestational 28 weeks( P