Gravidez prolongada: subsídios da literatura médica para uma defesa / Prolonged pregnancy: medical literature support for a defense

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

Comportamiento del embarazo postérmino en nuestro medio / Behavior of the post-term pregnancy in our environment

El embarazo postérmino a lo largo de los años ha sido motivo de angustia y preocupación familiar. Objetivo: Determinar cómo se comportó el embarazo postérmino en nuestro medio. Método: Se realizó un estudio prospectivo descriptivo y lineal en el hospital Ginecobstétrico Provincial Docente Ana Betancourt de Mora de Camagüey, de enero a diciembre de 2006. El universo y la muestra estuvieron constituidos por 100 gestantes que tuvieron este evento en las 42 semanas de embarazo y más. Resultados: Predominó el grupo etáreo entre 19 y 24 años, con un total de 35 para un 3,5 por ciento del universo, el 6,6 por ciento, no tenían experiencia previa de parto. El modo de terminación del embarazo más frecuente fue el inducido con 86, (86 por ciento), y el tipo de parto, el distócico con 53 para un 53 por ciento. La característica de líquido que predominó fue el meconial. Conclusiones: La depresión respiratoria moderada en el neonato fue la principal causa de morbilidad encontrada, seguido de la BALAM. Mientras que en las madres la enfermedad asociada al embarazo más frecuente fue la anemia ferripriva moderada.

The post-term pregnancy throughout the years has been reason of anguish and family concern. Objective: To determine how the pregnancy post-term behaved in our environment. Method: A prospective descriptive and lineal study was performed in the Provincial Educational Gynecobstetric Hospital Ana Betancourt de Mora of Camagüey, from January to December 2006. The universe and the sample were constituted by 100 pregnancy women that had this event in the 42 weeks of pregnancy and more. Results: The age group that prevailed was the one of 19 and 24 years, with a total of 35 for 3,5 percent of the universe, 6,6 percent didn't have previous experience of childbirth. The most frequent way of ending of pregnancy was the induced one with 86, (86 percent), and the childbirth type, the dystocic with 53 for 53 percent. The fluid characteristic that prevailed was the meconial. Conclusions: The moderate respiratory depression in the neonate was the main cause of morbility found, followed by BALAM. While in mothers the most frequent associated disease to pregnancy was the moderate ferripriva anemia.

Management and outcome of prolonged pregnancies in Shariati University Hospital

There is dearth of reports from Iran regarding the prevalence of postterm pregnancy and its complications. The present study was conducted to evaluate the prevalence, management and outcome of prolonged pregnancies. This cross-sectional study included data from the hospital records of all women referred to Shariati Hospital, Tehran, from 2001 to 2002 with pregnancies of more than 40 weeks in duration. Pregnancies >/= 40-42 weeks were considered postdate and those more than 42 weeks postterm pregnancy. The data compiled from the hospital records were subjected to t, X[2] and Mann-Whitney U tests. Of the 1500 deliveries in this hospital, 98 patients were included in this study, 66.3% of whom were nullipara and 33.7% multipara. The prevalence of postterm pregnancy was estimated to be 3.3%. Cervix dilation of 2 cm or less on admission occurred in 65 women [73.3%]. The mean Bishop score was 4.31. Of the 62 fetuses that underwent assessment tests, 54 [87.1%] were normal. The median time between the last test and induction of labor was 2.1 days, and 2.6 days for cesarean deliveries, which was not a significant difference [P = 0.6]. Cervical ripening with misoprostrol was performed in 36 cases [36.7%] and was successful in 18 cases. In this group, the median time for cervical ripening in multiparas was significantly less than nulliparas [4 vs. 7 hrs, P = 0.004]. Women not subjected to cervical ripening had a higher cesarean rate than those who did undergo cervical ripening [74.7% vs. 66.1%], although this difference was not significant [P = 0.9]. Vaginal and cesarean delivery rates showed no significant difference between cases that underwent induction with oxytocin and those subjected to cervical ripening with misoprostol [P = 0.9]. The mean Apgar score was 9.5, with all scores above 6. There were no cases of neonatal hypoglycemia, hypocalcemia, NICU admission or prenatal death. The mean nursery stay was 1.84 days with a range of 1-8 days. The prevalence of postterm pregnancies was 3.3% in this study, due in part to erroneous estimation of gestational age. Sonography exam in the first half of pregnancy can provide a better estimation of gestational age and thereby reduce the rate of postterm pregnancy. Cervical ripening and induction of labor shorten the duration of pregnancy; however, whether it has any beneficial effect on neonatal outcome remains controversial

Comportamiento del embarazo prolongado en el año 2003 / The behaviour of the postterm pregnacy in 2003

Se realizó un estudio observacional descriptivo para conocer algunas variables clínicas epidemiológicas relacionadas con el embarazo prolongado en el Hospital General Docente de Morón en el año 2003. El universo del trabajo fueron 171 gestantes a las que se les diagnosticó embarazo prolongado en este período. Del total de 2171 nacimientos que ocurrieron en nuestro hospital el 8 por ciento fueron posteriores a las 42 semanas. De los 171 embarazos prolongados 122 iniciaron espontáneamente el trabajo de parto, se indicaron 45 inducciones y 4 cesáreas electivas, 121 partos fueron eutócicos y se realizaron 40 cesáreas. Solo 11 nacidos presentaron morbilidad postnatal y 3 depresión al nacimiento.

An observational, descriptive study has been done in order to know some epidemiological and clinical variable related to the postterm preganacy in the General Hospital of Morón in 2003. There were analize 171 pregnants that had a postterm pregnacy during this period. From 2171 births that took place in our hospital, 8 percent were after 42 weeks. From 171 postterm pregnacies 122 began espontaneously the birth labour, there were indicated 45 inductions and 4 elective caesarean delivery, 121 births were normal and there were 40 caesarean delivery. Only 11 babies presented postnatal morbidity and 3 postnatal depression.