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1.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1522625

RESUMO

Objetivo : Determinar los predictores del éxito del parto vaginal posterior a cesárea segmentaria transversal primaria por causa no recurrente. Diseño : Estudio de casos y controles. Institución: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Métodos : Gestantes con inicio espontáneo del trabajo de parto y antecedentes de cesárea con incisión transversal en el segmento inferior por causa no iterativa. La prueba de parto fue considerada exitosa si terminaba en parto vaginal. Principales medidas de estudio : Edad materna, paridad, frecuencia de trabajo de parto previo a la cesárea anterior, edad gestacional al momento del parto, estación de la presentación cefálica fetal al ingreso y peso fetal. Resultados : Se seleccionó 126 gestantes, de las cuales 85 (67,4%) tuvieron pruebas exitosas (parto vaginal), mientras que 41 (32,5%) tuvieron prueba fallida. No se encontraron diferencias en las características generales entre los grupos (p = ns). El análisis univariante mostró que el peso fetal igual o menor de 3,500 gramos, la estación de la presentación cefálica fetal fija o encajada y la edad gestacional menor de 40 semanas fueron predictores significativos del resultado exitoso de la prueba de parto (p < 0,05). El análisis de regresión logística demostró que el peso fetal igual o mayor de 3,500 gramos (p = 0,04) y la estación de la presentación cefálica fetal flotante insinuada (p = 0,03) conservaron importancia como predictores. Conclusión : Los predictores para una prueba exitosa de parto vaginal posterior a cesárea fueron peso fetal menor o igual a 3,500 gramos y la estación de la presentación cefálica fetal fija o encajada.


Objective : To determine predictors of successful vaginal delivery following primary transverse segmental cesarean section for non-recurring cause. Design : Casecontrol study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Pregnant women with spontaneous onset of labor and history of cesarean section with transverse incision in the lower segment for non-recurrent cause. The trial of labor was considered successful if it ended in vaginal delivery. Main study measures : Maternal age, parity, frequency of labor prior to previous cesarean section, gestational age at delivery, station of fetal cephalic presentation at admission, and fetal weight. Results : A total of 126 pregnant women were selected, of whom 85 (67.4%) had successful trials (vaginal delivery), while 41 (32.5%) had a failed trial. No differences in general characteristics were found between groups (p = ns). Univariate analysis showed that fetal weight equal to or less than 3,500 grams, station of fixed or engaged fetal cephalic presentation, and gestational age less than 40 weeks were significant predictors of successful trial of labor outcome (p < 0.05). Logistic regression analysis showed that fetal weight equal to or greater than 3,500 grams (p = 0.04) and station of floating insinuated fetal cephalic presentation (p = 0.03) retained significance as predictors. Conclusion : Predictors for a successful trial of vaginal delivery following cesarean section were fetal weight less than or equal to 3,500 grams and station of fixed or engaged fetal cephalic presentation.

2.
Korean Journal of Obstetrics and Gynecology ; : 1397-1403, 1997.
Artigo em Coreano | WPRIM | ID: wpr-202711

RESUMO

OBJECTIVE: To evaluate the effect of fetal presentation to the measurement of amniotic fluid index(AFI) in singleton pregnancy after 20 weeks of gestation. MATERIALS AND METHODS: Review of the medical and ultrasonographic records from 1992 to 1996 including AFI value and pregnancy outcomes was performed retrospectively. The inclusion criteria were (1) singleton pregnancy delivered after 37 weeks of gestation, (2) birth weight between 10th and 90th percentile, (3) no fetal anomaly, (4) 5 minute Apgar score>or=7, (5) no maternal medical disease such as hypetensive disorders or diabetes, (6) and intact amniotic membranes at the time of ultrasonography. The results of 7,362 tests from 5,607 pregnancies were reviewed and analyzed. RESULTS: In normal pregnancies after 20 weeks of gestation, the AFI value showed the peak during 25~30 week and decreased thereafter. The range of AFI during preterm pregnancy(30~36 weeks, N=2,836) were between 9.4 and 21.8 cm(5th to 95th percentile, mean value of 15.2+/-4.1cm). The range of AFI at term(37~40 weeks, N=1,245) were 7.7 and 21.9 cm(5th to 95th percentile, mean value of 14.2+/-4.5cm), which showed significant difference (p=0.000) from that of preterm. The range of AFI after 41 weeks(N=75) were within 4.3 and 26.7cm(5th to 95th percentile, mean value of 13.8+/-6.3cm), which showed gradual decrease. The AFI among the gravidas with breech presentation showed similar values between 20~36 weeks. At term pregnancies(after 37 weeks, N=84) with breech presentation, the AFI(range 5.2cm~22.3cm, mean value 13.5+/-4.8cm) was smaller than those with cephalic presentation, but statistically insignificant(p=0.103). The commonly used criteria for oligohydramnios, AFI 5.0cm, equated to 1st percentile in cephalic presentation and 5th percentile in breech pregnancies, respectively. CONCLUSION: In this study AFI throughout pregnancies after 20 week of gestation showed difference of distribution of AFI according to gestational age and fetal presentation in term pregnancy. Further studies would be required to establish the cutoff value of oligohydramnios in cephalic and breech presentation at term pregnancy to establish different criteria according to fetal presentation.


Assuntos
Feminino , Gravidez , Âmnio , Líquido Amniótico , Peso ao Nascer , Apresentação Pélvica , Idade Gestacional , Apresentação no Trabalho de Parto , Oligo-Hidrâmnio , Poli-Hidrâmnios , Resultado da Gravidez , Estudos Retrospectivos , Ultrassonografia
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