Vía de finalización en inducciones de embarazos postérmino, según score de Bishop / Induction of postterm pregnancies according to Bishop score

Objetivo: Determinar la vía de finalización en embarazos pos término de mujeres que fueron internadas para inducción al trabajo de parto y establecer la relación entre la vía de finalización y Bishop de comienzo. Pacientes y métodos: Estudio Observacional, Descriptivo, Transversal, de 2013 a 2014. La población se identificó del SIP de aquellas pacientes con embarazo mayor a 41 semanas internadas para inducción. Test de Fisher exacto o Chi cuadrado para evaluar la siginficancia estadística p=0.05. Resultados: De 197 pacientes, la media fue de 24 años. El 21% comenzó la inducción con Bishop entre 0 y 3 puntos, 59.5% entre 4 y 6 puntos. 13 pacientes recibieron una segunda inducción tras la primera fallida. El 67.5% de las inducciones finalizaron por parto vaginal, 32.5% cesárea. De las mujeres con score 0-3 puntos el 61,5% finalizaron por cesárea, para el segundo grupo (Bishop 4-6) el 71.8% de las inducciones finalizó por parto vaginal, encontrándose una significancia estadística en estas relaciones, test de Fisher=0.000. Conclusiones: Podríamos relacionar el score de Bishop de comienzo de inducción con la vía de finalización y si bien se han encontrado gran porcentaje de partos vaginal con score de 4 en adelante, el 61.5% de las mujeres que pertenecían al grupo de 0-3 finalizaron por la vía quirúrgica por lo que podría recomendarse la maduración cervical previa inducción en este grupo de como estatregia para la reducción de la tasa de cesáreas en inducciones por 41 semanas.

The aim of this report was to present an evaluation of induction of postterm pregnancies according to the ´Bishop score in women admitted for labor induction. Labor induction is an intervention in order to iniciate artificially the uterine contractions to produce the effacement and the dilatation of the uterine cervix and to end with a birth. At present we have three main methods for induction, oxytocin, prostaglandins and amniotomy. The pregnancy chronologically prolongued refers to that simple gestation that reaches or overcomes the 294 days since the date of the last menstruation. It is known that the pregnancies chronologically prolongued are associated with a rise of the maternal and perinatal morbimortality, and therefore, since they are diagnosed. It is mandatory the management toward a minimization of the risks. For these reasons, it is recommended, in the case of a prolonged pregnancy, to consider beneficial to begin the parturition for security reasons for the mother and the fetus. ´These considerations are referred in the article

Vía de finalización en inducciones de embarazos post término, según Score de Bishop / MODE OF DELIVERY IN POST TERM PREGNANCY INDUCTION ACCORDING TO BISHOP´S SCORE

Objetivo: Determinar la vía de finalización en embarazos post término de mujeres que fueron internadas para inducción al trabajo de parto y establecer la relación entre la vía de finalización y Bishop de comienzo. Pacientes y métodos: Estudio Observacional, Descriptivo, Transversal, de 2013 a 2014. La población se identificó del SIP de aquellas pacientes con embarazo mayor a 41 semanas internadas para inducción. Test de Fisher exacto o Chi cuadrado para evaluar la significancia estadística. p=0.05. Resultados: De 197 pacientes, la media fue de 24 años. El 21% comenzó la inducción con Bishop entre 0 y 3 puntos, 59.5% entre 4 y 6 puntos. 13 pacientes recibieron una segunda inducción tras la primera fallida. El 67.5 % de las inducciones finalizaron por parto vaginal, 32.5 % cesárea. De las mujeres con score 0-3 puntos el 61.5% finalizaron por cesárea, para el segundo grupo (Bishop 4-6) el 71.8% de las inducciones finalizo por parto vaginal, encontrándose una significancia estadística en estas relaciones, test de Fisher=0.000. Conclusiones: Podríamos relacionar el score de Bishop de comienzo de inducción con la vía de finalización y si bien se han encontrado gran porcentaje de partos vaginal con score de 4 en adelante, el 61.5% de las mujeres que pertenecían al grupo de 0-3 finalizaron por la vía quirúrgica por lo que podría recomendarse la maduración cervical previa inducción en este grupo de como estrategia para la reducción de la tasa de cesares en inducciones por 41 semanas.

Aim: To determine the mode of delivery in post-term pregnancies of women hospitalized for induction of labour and to establish the relationship between the path of completion and Bishop of onset Patients and methods: Observational, Descriptive, Transversal study, from 2013 to 2014. The population was identified from SIP of those patients with a pregnancy greater than 41 weeks hospitalized for induction. Fisher's exact test or Chi-square test to evaluate statistical significance. P = 0.05. Results: Of 197 patients, the mean was 24 years. 21% started induction with Bishop between 0 and 3 points, 59.5% between 4 and 6 points. 13 patients received a second induction after the first failed. 67.5% of the inductions were terminated by vaginal delivery, 32.5% cesarean section. Of the women with a score of 0-3 points, 61.5% were terminated by cesarean section. For the second group (Bishop 4-6), 71.8% of the inductions were terminated by vaginal delivery, a statistical significance was found in these relationships, Fisher's test = 0.000. Conclusion: We could relate Bishop's score from induction onset to completion, and although a large percentage of vaginal deliveries with a score of 4 onwards were found, 61.5% of the women in the 0-3 group were terminated By the surgical route so it could be recommended cervical maturation previous induction in this group as a strategy for the reduction of the rate of cesares in inductions by 41 weeks.

Cervical pessary in prevention of preterm birth: A case series / Philippine Journal of Obstetrics and Gynecology

Preterm birth defined as birth between 20-37 weeks age of gestation, poses major concerns as it causes serious health problems. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born and the Philippines ranks 8th out of 184 countries for the number of babies born prematurely, and ranks 17th for the total number of deaths due to complications from preterm birth. Management of incompetent cervix as one of the causes of preterm birth is cerclage. However, pessary insertion is an alternative especially in cases where cerclage may not be employed. To date, there have been no local published reports on effectiveness of pessary in prevention of preterm birth. Hence this study aims to report on cases supporting the use of pessary in preterm birth. This is a case series of three patients with short functional cervical lengths (

Adverse health effects of particulate matter

Particulate matter (PM) is known to have serious health effects in individuals with respiratory or cardiovascular disease. Recent studies have shown that they also have noxious effects on cerebrovascular, metabolic, and neuropsychiatric disorders, as well as pregnancy. The aim of this study is to review the various diseases associated with PM in each human organ. Regarding respiratory diseases, PM has been associated with increased acute exacerbation in patients with chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases, resulting in increased hospitalization and mortality. In addition, PM increases the risk of lung cancer and accelerates the decline of lung function. Individuals with cardiovascular conditions such as ischemic heart disease, heart failure, hypertension, arrhythmia, and atherosclerosis have been also found to exhibit increased morbidity and mortality when exposed to PM. PM also has been reported to cause insulin resistance and to induce increasing rates of diabetes. During pregnancy, prolonged exposure to PM has been associated with increased rates of low birth weight and preterm birth. In individuals with neurological diseases, exposure to PM reduces cognitive ability and memory, and increases stroke incidence. It has been reported that PM also exacerbates psychiatric conditions, particularly depression and anxiety disorder. Thus, PM has been shown to exert very noxious health effects on the human body, with impacts including effects on respiratory and cerebrovascular diseases, cardiovascular diseases, neuropsychiatric diseases, and low birth weight.

Cervical pessary in prevention of preterm birth: A case series / Philippine Journal of Obstetrics and Gynecology

Preterm birth defined as birth between 20-37 weeks age of gestation, poses major concerns as it causes serious health problems. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born and the Philippines ranks 8th out of 184 countries for the number of babies born prematurely, and ranks 17th for the total number of deaths due to complications from preterm birth. Management of incompetent cervix as one of the causes of preterm birth is cerclage. However, pessary insertion is an alternative especially in cases where cerclage may not be employed. To date, there have been no local published reports on effectiveness of pessary in prevention of preterm birth. Hence this study aims to report on cases supporting the use of pessary in preterm birth. This is a case series of three patients with short functional cervical lengths (

Aspectos clinicoepidemiológicos de gestantes con embarazo prolongado en el municipio de Palma Soriano / Clinical and epidemiological aspects of pregnant women with prolonged pregnancy in Palma Soriano municipality

Se realizó un estudio de tipo epidemiológico, observacional, analítico, longitudinal y prospectivo, de 44 gestantes con parto a las 42 semanas o más, atendidas en el Hospital Ginecoobstétrico Docente "Dra. Nelia I. Delfín Ripoll" del municipio de Palma Soriano, en Santiago de Cuba, de enero a diciembre de 2013, con vistas a caracterizarles clínica y epidemiológicamente y determinar la repercusión del embarazo prolongado en el binomio madre-hijo. Entre los resultados sobresalientes figuraron: la alta incidencia de la fecha no confiable de la última menstruación en el grupo de nulíparas (51,9 %), el parto por cesárea (29,5 %), cuya principal causa fue la inducción fallida (38,4 %), seguida de la desproporción céfalo-pélvica (23,1 %); el síndrome de aspiración meconial como complicación en los recién nacidos (29,5 %), y la atonía uterina y el sangrado (6,8 %, respectivamente) como complicaciones en las madres. Pudo concluirse que en la serie, el embarazo prolongado generalmente cursó en gestantes con fecha confiable de la última menstruación, el indicador de cesárea primitiva se incrementó y fue más frecuente la presencia de complicaciones en los recién nacidos que en las madres.

An epidemiological, observational, analytic, longitudinal and prospective study of 44 pregnant women with childbirth date at 42 weeks or more, assisted in "Dr. Nelia I. Delfín Ripoll" Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba municipality was carried out from January to December, 2013, with the objective of characterizing them clinically and epidemiologically and to determine the influence of prolonged pregnancy in the binomial mother-son. Among the excellent results there were: the high incidence of non reliable date of the last menstruation in the nulliparous group (51.9%), the childbirth through caesarean section (29.5%) whose main cause was the failed induction (38.4%), followed by the cephalopelvic disproportion (23.1%); the syndrome of meconium aspiration as complication in the newborns (29.5%), and the uterine atony and bleeding (6.8%, respectively) as complications in the mothers. It could be concluded that in the series, the prolonged pregnancy generally took place in women with reliable last menstruation date, the indicator of primitive cesarean section was increased and the presence of complications was more frequent in the newborns than in mothers.

Obesidad materna pregestacional como factor de riesgo para el desarrollo de macrosomía fetal / Maternal pregnat obesity as a risk factor for the development of fetal macrosomy

RESUMEN Introducción: El riesgo de un macrosomía fetal (con peso = 4.000 g) es 3,4 veces más elevado en los casos de obesidad pregestacional materna. Objetivo: determinar la asociación entre el desarrollo de macrosomía fetal y el antecedente de obesidad materna pregestacional en pacientes atendidas en el Centro Materno Infantil de la Cátedra y Servicio de Ginecología y Obstetricia, Facultad de Ciencias Médicas-Universidad Nacional de Asunción, de enero a agosto del 2013. Pacientes y métodos: diseño de casos y controles, donde se comparó la presencia de obesidad pregestacional y el desarrollo de macrosomía fetal. Resultados: ingresaron al estudio 249 recién nacidos: 110 casos y 139 controles. La prevalencia de de macrosomía en el tiempo estudiado fue 3,9%, en las mujeres obesas fue de 61,5%. Se encontró asociación significativa de macrosomía fetal con obesidad materna pregestacional (p 0,01) y diabetes gestacional (p 0,0007). El índice de masa corporal, peso pregestacional y la ganancia de peso durante el embarazo fueron estadísticamente diferentes entre casos y controles. La cesárea fue la forma de terminación del embarazo más frecuente, y el motivo fue la desproporción cefalopélvica. Conclusión: el antecedente de obesidad materna pregestacional resultó ser un factor de riesgo significativo para el desarrollo de macrosomía fetal.

ABSTRACT Introduction: The risk of macrosomy with a weight = 4000 g is 3.4 times higher in cases of maternal prepregnancy obesity. Objective: To determine the association between the development of fetal macrosomy and a history of maternalprepregnancy obesity in patients treated at the Children´s Center for Maternal and Chair Department of Obstetrics and Gynecology, Faculty of Medical Sciences, National University of Asuncion, from January to August, 2013. Patients and methods: Case-control design, where the presence of pre-pregnancy obesity and the development of fetal macrosomywere compared. Results: were admitted 249 newborns to the study: 110 cases and 139 controls. The prevalence of macrosomy in the time studied was 3.9%, in obese women was 61.5%. We found significant association between fetal macrosomy and prepregnant obesity (p 0.01) and gestational diabetes (p 0.0007). The body mass index, pre-pregnancy weight andweight gain during pregnancy was statistically different between cases and controls. Cesarean section was the morefrecuent mode of termination of pregnancy and the reason was the cephalopelvic disproportion. Conclusion: the history of prepregnancy maternal obesity was a risk significant factor for the development of fetal macrosomy.

Factores de riesgo asociados a la macrosomía fetal / Risk factors associated with fetal macrosomy

RESUMEN Introducción: la macrosomía fetal define al recién nacido con peso igual o mayor a 4000 g. Esta puede asociarse a diferentes factores de riesgo, recogidos en los antecedentes de la paciente: IMC, diabetes materna, multiparidad, embarazo prolongado y los antecedentes de hijos macrosómicos anteriores, entre otros. Objetivo: identificar los factores de riesgo asociados a la macrosomía fetal. Describir las características clínicas y socio demográficas de las madres. Materiales y métodos: se realizó un estudio de casos y controles en la Cátedra y Servicio de Clínica Gineco Obstétrica del Hospital de Clínicas San Lorenzo, dirigida por el Prof. Dr. Vicente Bataglia Doldan, donde se incluyeron 200 pacientes que tuvieron su parto en el periodo de enero a diciembre 2012. En el estudio se analizó la asociación de ciertos factores de riesgo calculando OR y sus respectivos intervalos de confianza al 95%. Resultados: la media de edad en el grupo control fue 24,4 ± 6 años y 26,5± 6 años para los casos. El mayor porcentaje de escolaridad se concentró en el nivel de secundario. Sobre la procedencia el mayor número de mujeres procedieron del Departamento Central. Los factores de riesgo maternos significativos fueron: obesidad (OR=2,7) (p<0,001), antecedente de feto macrosómico (OR=8,6) (p<0,001), embarazo postérmino (OR=14,7) (p<0,001), la paridad previa (OR=1,8) (p<0,05). No fueron estadísticamente significativos la diabetes materna, el aumento de peso mayor a 15 kg, el antecedente familiar de diabetes, la edad mayor a 35 años ni sexo fetal masculino. Conclusión: los factores de riesgo que se asociaron significativamente a la macrosomía fetal fueron la obesidad, el antecedente de feto macrosómico y embarazo postérmino.

ABSTRACT Introduction: fetal macrosomy defines to the newborn with weight equal to or greater than 4000g. This may be associated with different risk factors, collected in the background of the patient: BMI , maternal diabetes, multiparity, prolonged pregnancy and history of previous macrosomic children, among others. Objective: To identify risk factors associated with fetal macrosomy. To describe the clinical features and sociodemographic characteristics of mothers. Materials and Methods: A case-control study was conducted in the Department of Clinical Gynecology and Obstetrics Service of the Hospital de Clinicas San Lorenzo, directed by Prof. Dr. Vincent Battaglia Doldan, 200 patients where included, which gave birth in the period of January to December 2012. In the study the association of certain risk factors by calculating OR and confidence respective intervals to 95% were analyzed. Results: The mean age in the control group cases was 24.4 ± 6 and 26.5 ± 6 years. The highest schooling percentage was focused on the secondary level. Relative to procedence; mayority of women came from the Central Department. Significant maternal risk factors were obesity (OR = 2.7) (p < 0,001), history of macrosomic fetus (OR = 8.6) (p < 0.001), post-term pregnancy (OR = 14.7) (p <0.001), the previous parity (OR = 1.8) (p <0.05). Maternal diabetes, increased weight to 15 kg, family history of diabetes, age greater than 35 years and male sex where not statidtically significant. Conclusion: The risk factors significantly associated with fetal macrosomy were obesity, history of macrosomic fetus and post term pregnancy.

Induction of labour; routive induction at 40 weeks of pregnancy

The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Quasi experimental study. Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients [60%], 4 by vaccum[8%], 3 by forcep delivery [6%], 13 patients ended up into emergency LSCS [26%]. In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 [46%]. MAS was in 9[18%] babies as compared to 2% in group A and, Fetal distress [type 2 dips] were found in 3[6%] cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A [74%] induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks

Complicaciones obstétricas y perinatales en gestantes con embarazo prolongado, atendidas en el Hospital Nacional Dos de Mayo durante el periodo 2008-2012 / Obstetric and perinatal complications in pregnant women with prolonged pregnancy, treated at the National Hospital Dos de Mayo during the period 2008-2012

OBJETIVOS: Determinar las complicaciones obstétricas y perinatales en gestantes con embarazo prolongado atendidas en el Hospital Nacional Dos de Mayo durante el periodo 2010-2012. METODOLOGIA: El estudio es de tipo observacional, descriptivo, transversal y retrospectivo. Se evaluaron a 59 pacientes las cuales se atendieron en el Hospital Nacional Dos de Mayo durante el periodo 2010-2012. Se estimó para las variables cualitativas la frecuencia absoluta y relativa. Para el caso de las variables cuantitativas se estimaron las medidas de SPSS versión 20. Se aplicó Chi cuadrado con un nivel de significancia del 95 por ciento. RESULTADOS: La edad promedio de las gestantes fue 27.2±7.1 años, encontrándose la mayoría de las edades entre los rangos de 20 a 34 años (64.4 por ciento) y con estado civil "Convivientes" (66.1 por ciento). En cuanto a los datos obstétricos: El número de gestaciones promedio fue 2.4±1.4, el número de partos a término promedio fue 1.0±1.2, el número de partos pretérmino promedio fue 0.1±0.3, el número de abortos promedio fue 0.3±0.7 y el número de hijos vivos promedio fue 1.0±1.2. El 40.7 por ciento de las pacientes con embarazo prolongado fueron primíparas y el 35.6 por ciento nulíparas. El inicio del trabajo de parto en el 71.2 por ciento de las gestantes fue "Espontáneo" y en el 28.8 por ciento fue "Inducido". Respecto al tipo de parto el 55.9 por ciento de las gestantes con embarazo prolongado terminaron en cesárea. El 62.7 por ciento de los recién nacidos fueron de sexo masculino y el 37.3 por ciento de sexo femenino, encontrándose que la mayor parte de los recién nacidos tuvieron un peso menor de 3500 gr. (50.8 por ciento) y el puntaje de Apgar al minuto fue mayor o igual a 8 en 83.1 por ciento. En cuanto a la edad gestacional por Capurro, el 91.5 por ciento tuvo una edad gestacional mayor o igual a 42 semanas siendo el 72.9 por ciento de los recién nacidos adecuados para la Edad Gestacional y el 18.6 por ciento Grandes para la Edad...

OBJECTIVE: To determine obstetric and perinatal complications in pregnant women with prolonged pregnancy treated at the Hospital Nacional Dos de Mayo in 2010-2012. METHODOLOGY: The study is observational, descriptive, cross-sectional and retrospective. We evaluated 59 patients which were treated at the Hospital Nacional Dos de Mayo in 2010-2012. Was estimated for qualitative variables absolute and relative frequency. In the case of quantitative variables were estimated measures SPSS version 20. Chi square test was applied with a significance level of 95 per cent. RESULTS: The average age of pregnant women was 27.2±7.1 years, the majority with ages between ranges of 20-34 years (64.4 per cent) and marital status "cohabitants" (66.1 per cent). As obstetric data: The average number of pregnancies was 2.4±1.4, the number averaged of term deliveries was 1.0±1.2, the average number of preterm births was 0.1±0.3, the average number of abortions was 0.3±0.7 and the average number of living children was 1.0±1.2. The 40.7 per cent of patients with prolonged pregnancy were primiparous and 35.6 per cent nulliparous. The onset of labor in 71.2 per cent of pregnant women was "spontaneous" and 28.8 per cent were "induced". Regarding the type of delivery, 55.9 per cent of pregnant women with prolonged pregnancy ended in cesarean section. The 62.7 per cent of newborns were male and 37.3 per cent female, being that most of the newborns had a birth weight of less than 3500 g. (50.8 per cent) and minute Apgar score was greater than or equal to 8 in 83.1 per cent. As Capurro gestational age, 91.5 per cent had a gestational age greater than or equal to 42 weeks being 72.9 per cent of newborns appropriate for gestational age, and 18.6 per cent Large for Gestational Age. The average weight of newborns was 3.5±0.5 kg., Mean length 50.1±2.1 cm. The average per minute Apgar score was 8.2±1.6, the mean Apgar score at five minutes was 8.9±0.5 and the average gestational age Capurro was...

Effect of Iranian Ministry of Health protocols on cesarean section rate: a quasi-experimental study

High Cesarean section rate is a major health problem in developing countries. This study was established to evaluate the effectiveness of Iranian Ministry of Health and Medical Education protocols on Cesarean section rate trend. Through a non-concurrent controlled quasi-experimental study, Cesarean section rate in Shohada-e-Tajrish and Taleghani hospitals in Tehran was compared during 2008-2009. Intervention group included 578 participants hospitalized because of premature rupture of membranes, prolonged pregnancy, pre-eclampsia, intra-uterine growth retardation, vaginal bleeding and premature labor in first and second trimester underwent interventions based on MOHME new protocol. On the other hand 594 cases as control group were selected during the same time before the intervention and underwent routine treatments. Descriptive statics, t-test, chi square and univariate analysis were used when appropriate. Basic characteristics in two groups had no statistically significant difference. Cesarean section applied for 360 [67.8%] women in case group and on the other hand, 270 [48.8%] Cesarean sections were done for control group [P<0.001]. There was 19% difference between intervention and control groups. Complication of pregnancies had increased by 6% in intervention group [P<0.001]. Mortality rate in the study was zero in both groups. Applying clinical practice guidelines does not guarantee decreasing Cesarean section rate. Providing appropriate service may increase the ability of service providers to find more indications for Cesarean section

A comparison of orally administered misoprostol and membrane sweeping for labour induction in uncomplicated singleton post-term pregnancies

Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission. Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group. Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group

Pregnancy; management and outcome before and after 41 weeks

To evaluate whether serial monitoring of fetuses beyond 40 weeks with biophysical profile and non-stress test improves the fetal outcome in terms of morbidity and mortality determined by APGAR score at 5 minutes, presence of meconium in liquor, weight of baby and admission of neonate in nursery and to compare the maternal morbidity associated with prolonged pregnancy, labour induction and mode of delivery in the study and control group. It is a prospective controlled study conducted in the department of obstetrics and gynaecology Ghurki Trust Teaching Hospital, Lahore from 1st September 2007 to 31st August 2009. 200 patients at 40 weeks of pregnancy matching the inclusion criteria were enrolled for the study. They were divided into a study and a control group consisting of 100 patients each. Patients in the study group were subjected to fetal monitoring in the form of cardiotocography [CTG] and biophysical profile [BPP] while those in the control group were evaluated clinically and by kick count chart [KCC]. The outcome of the two groups beyond 40 weeks was compared with each other. The percentage of patients reaching 42 weeks was 4 in each group. The rest went into spontaneous labour, were induced or had emergency caesarean sections due to various reasons. The difference between the rest of the parameters like maternal morbidity, mode of delivery, fetal APGAR score and admission in neonatal intensive care unit [NICU] between the two groups were not statistically different. After 40 weeks of gestation fetal monitoring should be started with proper counseling of the patient, clinical assessment and fetal kick chart. NST and biophysical profile should be used selectively in patients with sluggish fetal movement or suspected reduced liquor clinically. All patients who reach 42 weeks must be induced

Condições frequentemente associadas com cesariana, sem respaldo científico: [revisão] / Conditions often associated with caesarean section, with no scientific support: [review]

Considerando as elevadas taxas de cesariana no Brasil, é possível concluir que uma elevada proporção desses procedimentos é desnecessária. Realizou-se revisão da literatura buscando as melhores evidências disponíveis sobre indicações de cesárea. As seguintes condições foram consideradas: doença cardiovascular, diabetes, pré-eclâmpsia, câncer ovariano e cervical, gestação após transplante hepático, oligo-hidrâmnio, rotura prematura das membranas, circular de cordão, gestação prolongada, malformações congênitas, macrossomia fetal, fetos prematuros em apresentação cefálica ou pélvica, pequenos para idade gestacional, baixo peso ao nascer e envelhecimento placentário precoce. Nenhuma dessas condições representa indicação absoluta de cesariana, e o parto vaginal deveria ser preferido em vários casos, exceto em algumas situações especiais.

Taking into account the elevated cesarean rates in Brazil it is possible to conclude that most of these procedures are unnecessary. A literature review was conducted searching for the best available evidences about cesarean indications. The following conditions were considered: cardiovascular disease, diabetes, preeclampsia, ovarian and cervical cancer, pregnancy after liver transplantation, olygohydramnios, premature rupture of membranes, nuchal cord, prolonged pregnancy, congenital malformations, fetal macrosomia, preterm babies in vertex or breech presentation, small-for-gestational age babies, low birth weight and early placental senescence. None of these conditions is an absolute indication for cesarean section, and vaginal delivery could be preferred in several cases, except for some special situations.

Indução do trabalho de parto com feto vivo: [revisão] / Induction of labor with live fetus: [review]

Define-se indução do parto como o início artificial do trabalho de parto. A necessidade de interrupção da gravidez é caracterizada como problema obstétrico complexo que depende das indicações, contraindicações e pré-requisitos. Os métodos para indução do parto são classificados em mecânicos e farmacológicos. Foi feita revisão da literatura por meio de consulta ao SciELO, LILACS, Medline/Pubmed e Biblioteca Cochrane. Foram selecionados os estudos de maior evidência científica (grau de recomendação B ou A da Associação Médica Brasileira). O trabalho aborda o tema sob três aspectos: assistência, quando é proposta a associação de isoprostol para amadurecimento do colo uterino, quando necessário, e ocitocina para estimular a contração uterina; ensino com ênfase na disseminação do conhecimento no meio acadêmico e leigo, uma vez que a aceitação por parte do médico e da paciente é fundamental para a prática do método; e pesquisa, com a estimulação de respostas a diversas perguntas ainda pendentes. Para respondê-las, dada a complexidade do tema, um grupo de estudos da Colaboração Cochrane elaborou um protocolo geral para revisão sistemática dos métodos de indução do parto, que vem sendo aplicado a cada método e analisado por subgrupos, de acordo com as características clínicas das pacientes.

Labor induction is defined as its artificial start. The need for the interruption of pregnancy is characterized as a complex obstetrical situation, involving indications, contraindications and preconditions. The methods used in the induction of labor were classified as mechanical ou pharmacological. A search in literature was made in SciELO, LILACS, Medline/Pubmed and Cochrane Library. The studies with the strongest scientific evidence (level B or A, classified by the Brazilian Medical Association) were selected for further analysis. The theme was studied from three different aspects: medical care with the association of misoprostol for cervical ripening with oxytocin to stimulate uterine contractions; teaching with emphasis on the education for the medical students and the general public, considering that the practice depends on the acceptance of the method by the doctors and the patients; and research, with stimulation to answers to several questions that were still not clear.. A study group was formed at the Cochrane Collaboration and, due to the complexity of the subject, a general protocol was prepared to systematically review the methods for induction of labor and analyzed by subgroups, considering the patients' clinical characteristics.

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

Indução do trabalho de parto: conceitos e particularidades / Induction of labor: concepts and particularities

O manejo das pacientes em indução do parto deve ser cuidadoso, observando-se as principais contraindicações, os riscos e as precauções. São contraindicações absolutas para indução do parto: a presença de causas obstrutivas do parto, o risco de morbidade perinatal grave e o risco materno. As contraindicações relativas são: frequência cardíaca fetal não-tranquilizadora, macrossomia fetal, gestação gemelar, apresentação pélvica, doença cardíaca materna, polidrâmnio, grande multiparidade, oligo-hidrâmnio e cesariana segmentar anterior. Suas possíveis complicações são a ruptura uterina, infecção intracavitária, prolapso de cordão umbilical, prematuridade iatrogênica, sofrimento ou morte fetal e falha da indução. A explicação e a discussão do que ocorrerá com a gestante, a seleção do local para a realização da indução do parto (de preferência com uma enfermeira por paciente) e a monitorização da vitalidade fetal são precauções importantes para evitar complicações. Diante de taquissistolia ou hiperestimulação uterina decorrente da indução do trabalho de parto, algumas medidas devem ser realizadas. Retirar o agente indutor resolve a maioria das situações. Não resolvendo, a tocólise é indicada. Caso ocorram alterações na frequência cardíaca fetal, medidas de ressuscitação intrauterina, apesar de não haver evidências suficientes de seu real benefício, podem ser tentadas. A indução em gestações com cesariana anterior é bastante controversa na literatura. Apesar de não haver evidências suficientes quanto aos riscos e benefícios, a atual recomendação é de que a indução com misoprostol seja evitada, podendo ser utilizada a ocitocina e sonda de Foley.

Management of patients submitted to labor induction must be careful with special attention to the main contraindications, risks and precautions. Absolute contraindications for labor induction include obstructive factors and increased risk of maternal or perinatal morbidity and mortality. Relative contraindications are non-reassuring fetal heart rate, fetal macrosomia, twin pregnancy, breech presentation, maternal cardiac disease, polyhydramnios, GREAT multiparity, oligohydramnios and previous segmental cesarean section. Possible complications are uterine rupture, intrauterine infectious, cord prolapsed, iatrogenic prematurity, fetal distress or death and failed induction. Some precautions are essential to avoid complications, such as discussing all the procedures with the pregnant women, defining the best local to conduct the induction (if possible, with one nurse by patient) and monitoring fetal well-being. When tachysystole or uterine hyperstimulation syndrome occurs as consequence of labor induction, some measures should be taken. Suspension of induction agent solves most of the cases, but acute tocolysis is indicated when the pattern of abnormal uterine contractility remains. In the presence of non-reassuring fetal heart rate, intrauterine resuscitation techniques may be carried out, although there is not enough evidence of their real benefits. Induction of labor in pregnancies with previous cesarean section remains controversial. Even though enough evidences about risks and benefits are not available yet, the current recommendation is to avoid induction with misoprostol but oxytocin and Foley catheter could be used in such cases.

Perfil del embarazo prolongado en pacientes de un hospital general / Prolonged pregnancy profile at general hospital

Objetivo: Determinar las características maternas y perinatales de las pacientes con diagnóstico de embarazo prolongado (EP) en un hospital general. Material y métodos: Estudio retrospectivo tipo serie de casos, realizado en el Hospital Nacional Cayetano Heredia del 1° de enero de 2000 al 31 de diciembre de 2004. Se incluyeron 341 pacientes con diagnóstico de EP (mayor 42 semanas) basado en la fecha de último periodo menstrual o ecografía del primer trimestre. Resultados: El 76% de pacientes tenían una edad entre 20 a 35 años con una media de 25,8 mas o menos 6,1 años. El 47,5% eran nulíparas. El 71,3% había ya iniciado una labor de parto espontánea; 16,4% fueron inducidas y 12,3% tuvieron indicación de cesárea al ingreso. Del grupo con inicio de trabajo de parto espontáneo el 71,6% terminó en parto vaginal; 19,3% cesárea, y 9,1% parto vaginal instrumentado. De las inducciones, el 71,4% tuvo parto vaginal espontáneo, 23,2% cesárea y 5,4% instrumentado. El 62% terminó en parto vaginal espontáneo, 29,9% en cesárea y 7,4% instrumentado. El 85,9% fue adecuado para EG, 11,1% grande para la EG, y 3% pequeño para la EG. El 53,4% de RN tuvo de 37 a 41 semanas por Capurro; 45,7% fueron mayor que 42 semanas y 0,9% tuvo menor que 37 semanas. El Apgar a los 5 minutos fue de 7 a 10 en 333 casos, menor que 7 en 4 RN. Ocurrieron 4 óbitos fetales (1,1%). Conclusión: El EP se encontró en mayor frecuencia en pacientes adultas y nulíparas, el inicio del trabajo de parto espontáneo fue el más frecuente y la vía de parto vaginal la más frecuente. Las complicaciones fueron bajas en los RN vivos, sin embargo la tasa de mortalidad fetal fue elevada de 11 por mil. La indicación más frecuente de cesárea fue DCP y sufrimiento fetal agudo.

Objective: To determine the perinatal and maternal characteristics in patients with post-term pregnancy diagnosis at general hospital. Material and methods: Retrospective study, cases series type, conducted at the Hospital National Cayetano Heredia in Lima, Perú from January 1°, 2000 to December 31, 2004. We included 341 patients with a post-term pregnancy (EP) diagnosis based on trust LMP or first trimester ecography. The data was processed in SPSS 13 program. Results: 76% of patients were 20 to 35 years old, with a mean of 25.8 more or less 6.1. The 47.5% of patients had no previous deliveries. After the first evaluation, 71.3% of patients had already began spontaneous labor; 16.4% were induced, and 12.3% had cesarean section indication. From the spontaneous labor group, 71.6% had a spontaneous vaginal delivery; 19.3% had a cesarean section, and 9,15 had a vaginal operative delivery. From the induced group, 71.4% had a spontaneous vaginal delivery, 23.2% had a cesarean section, and 5.4% had a vaginal operative delivery. 62% had a final vaginal spontaneous delivery, 29.9% had a cesarean section, and 7.4% had a final vaginal operative delivery. The newborns (RN) were adequate for the gestational age in 85.9%; 11.1% were big for their gestational age, and 3% were little for gestational age. 53.4% of newborns were 37-41 weeks by Capurro, 45.7% were major that 42 weeks by Capurro, and 0.9% were minor that 37 weeks. The 5 minute Apgar was 7 to 10 in 333 RN, minor taht 7 in 4 RN; and there were 4 stillbirths cases. Conclusion: The post - term pregnancy had a higher incidence in adult and nulipare patients. Most of the patients began a spontaneous labor, and the vaginal delivery route was the most frequent.

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.