FIGO good practice recommendations for induced or spontaneous labor at term: Prep-for-Labor triage to minimize risks and maximize favorable outcomes.

The goal of induced or spontaneous labor is childbirth by vaginal delivery. Delivery after 37 weeks is desirable and associated with favorable maternal and newborn outcomes. Delivery facilities should have suitable staff and resources on site for antenatal services and delivery care. FIGO's Prep-for-Labor triage method provides rapid diagnostic tools that help define patients as high or low risk to determine whether transfer to a higher-level center is needed. There is often a disconnect between a facility's designation and its ability to achieve safe deliveries. For preplanned labor induction, the designated clinical facility must have the right set-up and prenatal records available to achieve a successful outcome. However, this is often not the case if a patient arrives in labor or needs an induction and the facility has limited patient information and resources, thus requiring rapid management decisions. The practical guidance checklist in this article defines maternal and/or fetal risk factors and delineates approaches and safe practices for labor induction and management, including when antenatal information is limited to maximize safe delivery practices. Guidelines on using the Bishop score (>6 or <6) to manage labor are presented. Evidence supporting successful safe labor induction at 41-42 weeks of gestation in low-risk cases is described. This practice will increase the rate of spontaneous labor and delivery, minimizing intervention and thereby diverting limited clinical resources to those patients in need. In the right setting, this could lead to around 80% of women delivering spontaneously, which remains a desired goal.

Foley catheter plus misoprostol versus misoprostol alone for labor induction

SUMMARY OBJECTIVE: This study aimed to analyze the effects of Foley catheter combined with misoprostol in the labor induction process. METHODS: This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 μg combination and vaginal misoprostol 25 μg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil. RESULTS: A total of 230 patients with indications for labor induction were evaluated and classified into the "combined" group (Foley catheter plus misoprostol), consisting of 107 patients, and the "misoprostol" group (misoprostol only), consisting of 123 patients. The "combined" group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the "combined" group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71-0.91; RR 0.41; 95%CI 0.31-0.56; and RR 0.29, 95%CI 0.17-0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes. CONCLUSION: A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.

Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study / Análise de variáveis que influenciam na taxa de sucesso da indução do parto com misoprostol: Um estudo observacional retrospectivo

Abstract Objective Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery. Methods Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries. Results Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches,amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%. Conclusion At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of nonoperative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.

Resumo Objetivo Determinar os critérios preditivos para o sucesso na indução do trabalho de parto para fetos vivos utilizando misoprostol em gestantes. Em segundo lugar, o objetivo é determinar as taxas de parto vaginal ou cesáreo, duração da indução, intervalo de administração de misoprostol, as principais causas de indução do trabalho de parto e indicação para parto operatório. Métodos Foram revisados os prontuários de 873 gestantes internadas para amadurecimento cervical entre janeiro de 2017 e dezembro de 2018 em um estudo descritivo observacional de análise retrospectiva, considerando as variáveis-resposta: idade, paridade, Índice de Bishop, doses de misoprostol, tempo de indução do trabalho de parto. Modelos de regressão logística foram utilizados para prever o sucesso com misoprostol em partos não operatórios. Resultados Dos 873 pacientes avaliados, 72% evoluíram com parto vaginal, 23% dos casos foram cesáreos, 5% fórceps ou vácuo-extrator. Para o parto não operatório as variáveis preditivas na internação foram idade, paridade, idade gestacional e dilatação. Durante a internação, um menor número de toques vaginais, amniotomia ou amniorrexe com líquido claro, levam a menor tempo de indução e maior chance de parto não operatório. Falsos positivos e falsos negativos do modelo sempre foram inferiores a 50% e respostas corretas acima de 65%. Conclusão Na internação, idade menor que 24 anos, ocorrência de partos normais anteriores, menor idade gestacional e maior dilatação, foram preditivos de maior probabilidade de parto não-operatório. Durante a internação, o menor número de toques vaginais, amniotomia/amniorrexe com líquido claro indicam menor tempo de indução. Estudos futuros com design prospectivo e análise de outros fatores são necessários para avaliar a replicabilidade, generalização desses achados.

Cesarean-section rates in Brazil from 2014 to 2016: cross-sectional Aanalysis using the robson classification / Taxas de cesariana no Brasil de 2014 a 2016: análise transversal utilizando a classificação de robson

Abstract Objective To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. Methods A descriptive epidemiological study using data from secondary birth records fromthe Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. Results The overall rate of CSwas of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Conclusion Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.

Resumo Objetivo Identificar as taxas de cesárea de acordo com a Classificação de Robson nas cinco regiões do Brasil. Métodos Estudo epidemiológico descritivo utilizando dados secundários obtidos do Departamento de Informática do Sistema Único de Saúde (Datasus) entre 1° de janeiro de 2014 e 31 de dezembro de 2016, incluindo todos os nascidos vivos no Brasil. Resultados Cesáreas representaram 56% de todos os nascimentos. A amostra foi dividida em 11 grupos, e partos vaginais forammais frequentes nos grupos 1 (53,6%), 3(80,0%) e 4 (55,1%). As maiores taxas de cesárea foram encontradas nos grupos 5 (85,7%), 6 (89,5%), 7 (85,2%) e 9 (97,0%). A taxa geral de cesárea variou de 46,2% no Norte a 62,1% no Centro-Oeste. O grupo 5 representou a maior população obstétrica no Sul, Sudeste e Centro-Oeste, e o grupo 3, no Norte e Nordeste. O grupo 5 contribuiu mais para a taxa geral de cesárea, totalizando 30,8%. Conclusão Mais da metade dos nascimentos no Brasil ocorreu por cesárea. O Centro- Oeste apresentou a maior taxa, e o Norte, a mais baixa. A maior população obstétrica no Norte e no Nordeste foi o grupo 3, enquanto no Sul, Sudeste e Centro-Oeste foi o grupo 5. Entre todas as regiões, amaior contribuição para a taxa geral de cesárea foi do grupo 5.

Factores maternos y fetales asociados a la inducción del trabajo de parto, Hospital Vicente Corral Moscoso, Cuenca 2019 / Maternal and fetal factors associated with induction of labor, Hospital Vicente Corral Moscoso, Cuenca 2019

Antecedentes: La inducción del parto es una práctica frecuente en obstetricia, observándose un aumento de sus cifras en las últimas décadas a nivel mundial. Objetivo: Determinar los factores maternos y fetales asociados a la inducción del parto en pacientes hospitalizadas en el departamento de Ginecología y Obstetricia del hospital Vicente Corral Moscoso, Cuenca, 2019. Métodos: Estudio analítico realizado a 208 gestantes ingresadas en el área de Ginecología y Obstetricia. La información se procesó en el programa SPSS versión 15. Para el análisis utilizamos estadística descriptiva en base a frecuencias y porcentajes, se midió la asociación estadística con la prueba Chi 2 y Razón de Prevalencia (RP), intervalo de confianza 95%, considerando estadísticamente significativo p < 0,05. Resultados: La edad media fue 24,7 (DS± 5,93), predominó la instrucción secundaria, estado civil estable. Hubo asociación y significancia estadística de factores materno fetales a inducción como: ruptura prematura de membranas RP 2,97 (IC95%: 2,09­4,24 valor p 0,000); preeclampsia RP 2,13 (IC95%: 1,46­3,10 valor p 0,000); embarazo término tardío RP 2,91 (IC95%: 2,12­3,99 valor p 0,000); restricción del crecimiento RP 3,22 (IC95%: 2,62-3,95 valor p 0,000). No así para corioamnionitis RP 3,08 (IC95%: 2,53­3,76 valor p 0,33) y muerte fetal RP 1,55 (IC95%: 0,68­3,54 valor p 0,31). Conclusiones: Se encontró asociación y significancia estadística con factores materno fetales e inducción como: ruptura prematura de membranas, preeclampsia, embarazo término tardío, restricción del crecimiento. No para corioamnionitis y muerte fetal.

Background: Induction of labor is a frequent practice in obstetrics, with an increase in its numbers being observed in recent decades worldwide. Objective: To determine the maternal and fetal factors associated with labor induction in hospitalized patients in the Gynecology and Obstetrics department of the Vicente Corral Moscoso hospital, Cuenca, 2019. Methods: Analytical study carried out on 208 pregnant women admitted to the Gynecology and Obstetrics area who met the inclusion criteria. The information was processed in the SPSS version 15 program. For the analysis we used descriptive statistics based on frequencies and percentages, the statistical association was measured with the Chi 2 test and Prevalence Ratio (RP), 95% confidence interval, considering statistically significant p <0.05. Results: The mean age was 24.7 (SD ± 5.93), secondary education, stable marital status predominated. There was association and statistical significance of maternal-fetal factors to induction of labor such as: premature rupture of membranes RP 2.97 (95% CI: 2.09­4.24 p-value 0.000); preeclampsia RP 2.13 (95% CI: 1.46­3.10 p-value 0.000); late term pregnancy RP 2.91 (95% CI: 2.12­3.99 p-value 0.000); intrauterine growth restriction RP 3.22 (95% CI: 2.62-3.95 p-value 0.000). Not so for chorioamnionitis RP 3.08 (95% CI: 2.53­3.76 p value 0.33) and fetal death RP 1.55 (95% CI: 0.68­3.54 p value 0.31). Conclusions: There was an association and statistical significance with maternal-fetal factors associated with induction such as: premature rupture of membranes, pre-eclampsia, late-term pregnancy, intrauterine growth restriction. Not so for chorioamnionitis and fetal death.

Influência das características hospitalares na realização de cesárea eletiva na Região Sudeste do Brasil / Influencia de las características hospitalarias en la realización de cesáreas electivas en la Región Sudeste de Brasil / Influence of hospital characteristics on the performance of elective cesareans in Southeast Brazil

Resumo: Este artigo tem como objetivo avaliar a influência das características hospitalares sobre a chance de realização de cesariana eletiva na Região Sudeste do Brasil. Foram utilizados dados da pesquisa Nascer no Brasil, realizada entre fevereiro de 2011 e outubro de 2012. A presente análise inclui a amostra da Região Sudeste, compreendendo 10.155 mulheres. O grupo de mulheres submetidas à cesariana eletiva foi comparado ao de mulheres que entraram em trabalho de parto ou foram submetidas à indução do parto, independentemente se fizeram cesariana intraparto ou parto vaginal. Com exceção da idade gestacional, todas as características obstétricas analisadas mostraram-se associadas à cesariana eletiva. Nesse grupo, 60,5% não possuíam cesariana prévia à gestação atual e 64,7% eram de baixo risco. Dentre os partos com financiamento público, observou-se maior chance de cesárea eletiva nas mulheres que foram atendidas nos hospitais com < 1.500 (OR = 2,11; IC95%: 1,37-3,26) e entre 1.500-2.999 partos/ano (OR = 1,45; IC95%: 1,04-2,02) e nos hospitais mistos (OR = 1,81; IC95%: 1,37-2,39). Nos hospitais mistos, a magnitude da associação é maior quando localizados em não capitais com volume > 3.000 partos/ano (OR = 3,45; IC95%: 1,68-7,08) e atinge seu maior valor nos hospitais localizados em não capitais com volume < 3.000 partos/ano (OR = 4,08; IC95%: 2,61-6,37). Em contrapartida, não observou-se associação entre cesariana eletiva e os hospitais públicos localizados em não capitais do Sudeste. As prevalências de cesariana eletiva nos hospitais públicos da Região Sudeste são altas quando comparadas a outros países, e sofrem importante influência das características hospitalares.

Resumen: El objetivo de este artículo es evaluar la influencia de las características hospitalarias sobre la oportunidad de realización de cesáreas electivas en la región sudeste de Brasil. Se utilizan datos de la investigación Nacer en Brasil, realizada entre febrero de 2011 y octubre de 2012. El presente análisis incluye la muestra de la región sudeste, comprendiendo a 10.155 mujeres. El grupo de mujeres sometidas a una cesárea electiva se comparó con el de mujeres que entraron en trabajo de parto o fueron sometidas a la inducción del parto, independientemente si tuvieron cesárea intraparto o parto vaginal. Con excepción de la edad gestacional, todas las características obstétricas analizadas se mostraron asociadas con la cesárea electiva. En ese grupo un 60,5% no tuvieron una cesárea previa y un 64,7% tenían gestaciones de riesgo bajo. Entre los partos con financiación pública se observó una mayor oportunidad de cesárea electiva en las mujeres que fueron atendidas en los hospitales con < 1.500 (OR = 2,11; IC95%: 1,37-3,26) y entre 1.500-2.999 partos/año (OR = 1,45; IC95%: 1,04-2,02) y en los hospitales mixtos (OR = 1,81; IC95%: 1,37-2,39). En los hospitales mixtos, la magnitud de la asociación es mayor cuando están localizados fuera de la capital (OR = 3,45; IC95%: 1,68-7,08), en los con volumen > 3.000 partos/año, y alcanza su mayor valor en los hospitales fuera de las capitales con volumen < 3.000 partos/año (OR = 4,08; IC95%: 2,61-6,37). Como contrapartida, no se observó asociación entre cesárea electiva y los hospitales públicos localizados fuera de las capitales del sudeste. Las prevalencias de cesárea electiva en los hospitales públicos de la región sudeste son altas, cuando se comparan con las de otros países, y sufren una importante influencia de las características hospitalarias.

Abstract: This article aims to assess the influence of hospital characteristics on the odds of performing an elective cesarean in the Southeast region of Brazil. Data were obtained from the Birth in Brazil study, conducted from February 2011 to October 2012. The current analysis includes the sample from Southeast Brazil, with 10,155 women. The group of women that underwent elective cesareans was compared to the women who went into labor or underwent labor induction, regardless they had intrapartum cesarean or vaginal delivery. Except for gestational age, all the obstetric characteristics analyzed were associated with elective cesarean. In this group, 60.5% had no prior cesarean and 64.7% had low-risk gestations. Among the births with public financing, there were higher odds of elective cesareans in women treated at hospitals with < 1,500 births/year (OR = 2.11; 95%CI: 1.37-3.26) and 1,500-2,999 births/year (OR = 1.45; 95%CI: 1.04-2.02) and in mixed hospitals (OR = 1.81; 95%CI: 1.37-2.39). In the mixed hospitals, the association was stronger when located in non-capital cities with > 3,000 births/year (OR = 3.45; 95%CI: 1.68-7.08), reaching the highest level in hospitals in non-capital cities with < 3,000 births/year (OR = 4.08; 95%CI: 2.61-6.37). Meanwhile, no association was seen between elective cesarean and public hospitals located in non-capital cities of the Southeast region. Prevalence rates of elective cesareans in public hospitals in Southeast Brazil are high when compared to other countries, and they are heavily influenced by hospital characteristics.

INADEQUATE ADHERENCE TO THE RECOMMENDATIONS REGARDING LABOR INDUCTION AS A TRIGGER OF CESAREAN SECTION IN WOMEN WITH SINGLE, TERM PREGNANCY. A DESCRIPTIVE STUDY.

OBJECTIVE: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention. METHODS: Descriptive historical. cohort that included pregnant women without a history of previous cesarean section, with single term pregnancy and cephalic presentation who were subjected to labor induction in a Level III com- plexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indica- tion for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guides arising from the 2012 proposal of limiting the first cesarean section were used in order to define ad- herence to the recommendations for induction. RESULTS: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, considering that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section. CONCLUSIONS: Failure to adhere to the recommendations for adequate induction was found, added to a mistaken diagnosis of failed induction.

TITULO: CUMPLIMIENTO INADECUADO DE LAS RECOMENDACIONES PARA EL PROCESO DE LA INDUCCIÓN DEL TRABAJO DE PARTO COMO DESENCADENANTE DE LA CESÁREA EN MUJERES CON EMBARAZO SIMPLE A TÉRMINO. ESTUDIO DESCRIPTIVO. OBJETIVO: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. METODOS: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. RESULTADOS: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas sometidas a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37 %) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se consideró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. CONCLUSIONES: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Ultrasound evaluation of the cervix to predict failed labor induction / Avaliação ultrassonográfica do colo uterino na predição do insucesso na indução do parto

Abstract Objective Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. Methods We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Results Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Conclusion Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.

Resumo Objetivo Nem sempre a indução do parto termina emparto vaginal, expondo tanto a mãe quanto o feto aos riscos inerentes ao procedimento de indução, ou a uma possível cesárea. A ultrassonografia transvaginal (UTV) semostrou interessante instrumento na predição da prematuridade e, neste estudo, utilizamos este instrumento na situação inversa: indução do parto no pós-datismo. Métodos Avaliamos variáveis ultrassonográficas do colo uterino (comprimento, presença de afunilamento, dilatação do orifício interno do colo, eco glandular endocervical [EGE] evidente ou não, e alterações morfológicas do colo uterino à compressão fúndica uterina) antes do início da indução em gestantes com pósdatismo, na tentativa de encontrar um possível preditor de falha de indução. O índice de Bishop (IB) também foi utilizado para fins de comparação. Três grupos foram avaliados: indução bem-sucedida x malsucedida; parto vaginal x cesárea (excluindo casos de sofrimento fetal agudo[SFA]); e parto vaginal x cesárea (incluindo casos de SFA). Além disso, um quarto grupo composto apenas pelas primíparas dos outros três grupos também foi avaliado. Resultados Com base em todas as características estudadas e combinações de variáveis, o comprimento do colo uterino ≥ 3,0 cm e IB ≤ 2 foram os melhores preditores em todos os grupos analisados. Conclusão Apesar de a UTV do colo uterino ser um bomexame para rastreamento de indução malsucedida, não deve ser usado para se indicar uma cesariana.

Inadequate adherence to the recommendations regarding labor induction as a trigger of cesarean section in women with singleton term pregnancy. A descriptive study / Cumplimiento inadecuado de las recomendaciones para el proceso de la inducción del trabajo de parto como desencadenante de la cesárea en mujeres con embarazo simple a término. estudio descriptivo

ABSTRACT Objective: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention. Materials and methods: Descriptive historical cohort that included pregnant women without a history of previous cesarean section, with singleton term pregnancy and cephalic presentation who were subjected to labor induction in a Level III complexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indication for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guidelines arising from the 2012 proposal of limiting the first cesarean section were used in order to define adherence to the recommendations for induction. Results: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, given that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section. Conclusion: Failure to adhere to the recommendations for adequate induction was found, added to an incorrect diagnosis of failed induction.

RESUMEN Objetivo: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. Materiales y métodos: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. Resultados: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas sometidas a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37 %) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se consideró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. Conclusión: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Factors associated with intrapartum cesarean section in women submitted to labor induction / Fatores associados à cesárea intraparto em mulheres submetidas a indução do parto

Abstract Objective To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil. Methods A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016. Results During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth. Conclusion Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

Resumo Objetivo Avaliar os resultados da indução de trabalho de parto e determinar os principais fatores associados à realização de cesarianas intraparto em pacientes do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brasil. Métodos Trata-se de um estudo epidemiológico transversal que incluiu todas as gestantes de feto único e comidade gestacional > 22 semanas, submetidas a indução de trabalho de parto no HU-UFSC no período de 2013 a 2016. Resultados No período proposto, 1.491 gestantes foram submetidas ao protocolo de indução. Em 1.264 casos (84,8%), a indução resultou em trabalho de parto, com 830 (65,7%) progredindo para o parto vaginal. Gestação ≥ 41 + 0 semanas foi a causa mais comumde indicação de indução de trabalho de parto (55,2%),emisoprostol foi o método mais utilizado (72,0%). Nessas gestantes, o índice de cesariana foi de 34,3%. Considerando os casos de falha de indução, o índice de cesariana sobe para 44,3%. Os fatores associados às cesarianas foram: história prévia de cesárea (RP [razão de prevalência] = 1,48; IC [índice de confiança]: 95% 1,51-1,88), fetos com restrição de crescimento intrauterino (RP = 1,82; IC95%: 1,32-2,19), índice de Bishop ≤ 6 (RP = 1,33; IC95%: 1,01-1,82) e tempo de indução < 12 horas (RP = 1,44; IC95%: 1,17-1,66), ou > 36 horas (RP = 1,51; IC95%: 1,22-1,92) entre o início da indução e o parto. Conclusão A indução de trabalho de parto foi bem-sucedida na maioria das pacientes. Naquelas em quem o desfecho final foi a cesariana, os fatores mais fortemente associados foram: história prévia de cesárea, presença de fetos com restrição de crescimento intrauterino, e tempos muito curtos ou muito longos de indução.

Indução de parto em um Hospital Universitário: métodos e desfechos / Inducción del parto en un Hospital Universitario: métodos y resultados / Induced labor in a University Hospital: methods and outcomes

RESUMO Objetivo: identificar as indicações de indução de trabalho de parto, as práticas utilizadas e os seus desfechos, em um Hospital Universitário do Sul do Brasil. Método: estudo transversal. A população-alvo deste estudo forem 137 mulheres que foram internadas para a indução de trabalho de parto no período de janeiro a outubro de 2014. A análise dos dados foi realizada por meio de análise estatística simples, exploratória, e teste não paramétrico, adotando nível de significância de p≤0,05. Resultados: a maioria (53%) das induções foi realizada por pós-datismo. Quanto aos métodos, destacou-se o uso do Misoprostol de 25mcg via vaginal em 46%, e também o uso do Misoprostol associado à Ocitocina em 28,4%. O Misoprostol foi mais associado a parto vaginal. Conclusão: a indução, caso seja utilizada da maneira correta, é uma importante estratégia para a redução dos altos índices de cesarianas.

RESUMEN Objetivo: identificar las indicaciones de inducción de trabajo de parto, las prácticas utilizadas y sus resultados, en un Hospital Universitario del Sur de Brasil. Método: estudio transversal. La población meta de este estudio fue de 137 mujeres que ingresaron para la inducción de trabajo de parto en el período de enero a octubre de 2014. El análisis de los datos fue realizado por medio de análisis estadístico simple, exploratorio, y prueba no paramétrica, adoptando nivel de significancia de p≤0,05. Resultados: la mayoría (53%) de las inducciones fue realizada por post-datismo. En cuanto a los métodos, se destacó el uso del Misoprostol de 25 mcg vía vaginal en un 46%, y también el uso del Misoprostol asociado a Oxitocina en un 28,4%. El Misoprostol fue más asociado al parto vaginal. Conclusión: la inducción, si se utiliza de la manera correcta, es una importante estrategia para la reducción de los altos índices de cesáreas.

ABSTRACT Objective: to identify the indications, practices and outcomes of labor induction, in a University Hospital of Southern Brazil. Method: a cross-sectional study. The target population of this study were 137 women who were hospitalized for labor induction from January to October 2014. Data analysis was performed through simple, exploratory statistical analysis and non-parametric test, adopting a significance level of p≤0.05. Results: most (53%) of the inductions were performed due to post-term pregnancy. As for the methods of induction, the use of Misoprostol of 25mcg administered via the vaginal route was found in 46% of cases and the use of Misoprostol in combination with Oxytocin was found in 28.4% of cases. Misoprostol was more associated with vaginal delivery. Conclusion: Induction, if used correctly, is an important strategy for the reduction of high cesarean rates.

Can the Induction of Labor with Misoprostol Increase Maternal Blood Loss? / Pode a indução do parto com misoprostol aumentar a perda de sangue materna?

Abstract Purpose To evaluate blood loss during misoprostol-induced vaginal births and during cesarean sections after attempted misoprostol induction. Methods We conducted a prospective observational study in 101 pregnant women indicated for labor induction; pre- and postpartum hemoglobin levels were measured to estimate blood loss during delivery. Labor was induced by administering 25 μg vaginal misoprostol every 6 hours (with a maximum of 6 doses). The control group included 30 patients who spontaneously entered labor, and 30 patients who underwent elective cesarean section. Pre- and postpartum hemoglobin levels were evaluated using the analysis of variance for repeated measurements, showing the effects of time (pre- and postpartum) and of the group (with and withoutmisoprostol administration). Results Therewere significant differences between pre- and postpartum hemoglobin levels (p < 0.0001) with regard to misoprostol-induced vaginal deliveries (1.6 ± 1.4 mg/dL), non-induced vaginal deliveries (1.4 ± 1.0 mg/dL), cesarean sections after attempted misoprostol induction (1.5 ± 1.0 mg/dL), and elective cesarean deliveries (1.8 ± 1.1 mg/dL). However, the differences were proportional between the groups with and without misoprostol administration, for both cesarean (p = 0.6845) and vaginal deliveries (p = 0.2694). Conclusions Labor induction using misoprostol did not affect blood loss during delivery.

Resumo Objetivo Avaliar a perda sanguínea em partos vaginais induzidos com misoprostol, e em cesáreas com tentativa prévia de indução do parto com misoprostol. Métodos Realizou-se estudo prospectivo observacional com 101 gestantes com indicação para indução do trabalho de parto, as quais foram avaliadas pela dosagem de hemoglobina pré e pós-parto para estimativa da perda sanguínea no parto. Procedeu-se à indução do trabalho de parto com misoprostol 25 μg, via vaginal, a cada 6 horas, em um número máximo de 6 doses. O grupo controle foi composto por 30 pacientes que entraram emtrabalho de parto espontaneamente, e por 30 pacientes que se submeteram a cesárea eletiva. O estudo da hemoglobina, antes e depois do parto, foi avaliado por ANOVA paramedidas repetidas, no qual foi verificado o efeito do tempo (pré e pós-parto) e o efeito do grupo (com e sem uso do misoprostol). Resultados Existem diferenças significativas entre os níveis de hemoglobina pré e pós-parto (p < 0,0001) nos partos vaginais induzidos pelo misoprostol (1,6 ± 1,4 mg/ dL), nos partos vaginais não induzidos (1,4 ± 1,0 mg/dL), nas cesáreas com tentativa prévia de indução (1,5 ± 1,0mg/dL), e nas cesáreas eletivas (1,8 ± 1,1mg/dL). Porém, as diferenças foram proporcionais em ambos os grupos, ou seja, ocorreu diferença tanto no grupo que fez uso do misoprostol quanto no grupo que não fez uso do medicamento, tanto na cesárea (p = 0,6845) quanto no parto vaginal (p = 0,2694). Conclusões A indução do parto com misoprostol não alterou a perda sanguínea durante o parto.

APLICACIÓN DE TÉCNICAS DE MINERÍA DE DATOS EN ATENCIÓN PRIMARIA EN SALUD (APS) PARA EL ANÁLISIS DE RIESGOS EN MUJERES GESTANTES DE LA POBLACIÓN MANIZALEÑA ATENDIDA POR ASSBASALUD / APPLICATION OF DATA MINING TECHNIQUES IN PRIMARY HEALTH CARE (PHC) FOR RISK ANALYSIS IN PREGNANT WOMEN IN THE POPULATION OF MANIZALES ATTENDED BY ASSBASALUD

Objetivo: Determinar las relaciones entre los factores de riesgo existentes en las madres gestantes, a través de las técnicas de minería de datos. Materiales y Métodos: Se recolectó una muestra de 15265 registros de mujeres con edades comprendidas entre los 10 y 48 años, datos que pertenecen al período comprendido entre los años 2010 y 2012, incluyéndolos. Los datos se procesaron mediante Microsoft SQL Server 2008 R2 y Microsoft Excel 2007, teniendo en cuenta el proceso KDD y la metodología CRISP DM para la minería de datos usando los algoritmos de k-Means para Clústers, Reglas de Asociación y Métodos de Correlación. Resultados: Mediante los algoritmos de clústers se evidenció que las mujeres con antecedentes de aborto componen el 5% de la población estudiada; las mujeres con partos prematuros tienen mayor presencia en edades anormales, siendo este del 2%, mientras que en edades aptas para la gestación la cifra solo es del 1%; el 1% de las mujeres, sin importar la edad, refiere haber tomado licor durante su embarazo; las mujeres que tuvieron abortos y consumieron alcohol fueron el 20%; las mujeres con partos prematuros con consumo de alcohol fueron el 8%. Las mujeres que aceptaron haber consumido drogas fueron el 2% en edad apta para la gestación y el 3% en edades no aptas, ubicándolas en el clúster que tiene la máxima probabilidad de aborto.

Objective: To determine the relationship between existing risk factors in pregnant mothers through data mining techniques. Materials and Methods: A sample of 15,265 women aged between 10 and 48 years, data pertaining to the period between 2010 and 2012, was collected. Data was processed using Microsoft SQL Server 2008 R2 and Microsoft Excel 2007, taking into account the KDD process and CRISP-DM methodology for data mining using k-Means algorithms for Clusters, Association Rules and Correlation Methods. Results: Using Clustering algorithms it was evident that women with a history of abortion form 5% of the study population; women with premature births have a greater presence in abnormal ages being 2% of the population, while suitable age for gestation is only 1%; 1% of women, regardless of age, reported having consumed liquor during pregnancy; women who had abortions and consumed alcohol were 20%; women with induced labor showed 8% alcohol consumption. Women who admitted having used drugs were 2% in ages suitable for gestation and 3% in ages non suitable for conception, placing them in the cluster having the highest probability of abortion.

Factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to labor induction with misoprostol: a cohort study.

OBJECTIVE: To determine the factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to induction of labor with misoprostol. METHODS: A cohort study. RESULTS: The factors associated with vaginal delivery in both normotensive and hypertensive women were, respectively, Bishop score ≥ 4 (OR = 1.87; 95% CI: 1.06-3.29; p = 0.03) and (OR = 2.31; 95% CI: 1.25-4.28; p = 0.008) and parity ≥ 1 (OR = 4.36; 95% CI: 2.16-8.80; p < 0.0001) and (OR = 2.61; 95% CI: 1.36-5.04; p = 0.004). CONCLUSION: The factors associated with vaginal delivery were Bishop score ≥ 4 and parity ≥ 1 irrespective of whether or not the women were hypertensive.

Efectos del embarazo postérmino en eventos relacionados con el nacimiento y el neonato / Effects of postterm pregnancy in events related with birth and neonate

Introducción: el embarazo prolongado es una condición obstétrica que produce un grado de perturbación, aprensión y desasosiego muy elevado tanto en la gestante como en su familia. Objetivo: determinar los efectos del embarazo postérmino en diferentes eventos el nacimiento y el neonato. Material y método: se realizó una investigación retrospectiva, observacional, transversal y analítica en el Hospital General Docente "Abel Santamaría" en el segundo semestre de 2013. El universo estuvo formado por la totalidad de las gestantes que ingresaron en el periodo antes mencionado, mientras que la muestra se formó con todas las pacientes con embarazo prolongado (grupo de estudio n1=106) y el grupo control integrado por gestantes con embarazo entre 38 y 41 semanas (n2=216). Se calcularon frecuencias absolutas y relativas, media y desviación estándar. Además se utilizó la prueba ji cuadrado con nivel de confianza de alfa < 0,05. Resultados: se encontró que el embarazo prolongado es una condición obstétrica en la que se incrementa la inducción del parto (74.5%); además hubo un predominio del parto eutócico (64.15%), el líquido claro (65.1%), el peso fetal superior a 3500 gramos (53.77%) y el sexo masculino (62.3%). El 97.2% de los neonatos tuvo Apgar ≥ 7 puntos. Hubo una asociación entre la gestación postérmino y la inducción del parto, la cesárea, el neonato con peso >3500 g y el líquido amniótico meconial. Conclusión: el embarazo postérmino se considera un factor de riesgo para la inducción del parto, la cesárea, la presencia de meconio y los neonatos con peso elevado.

Introduction: prolonged pregnancy is an obstetric condition that provokes a degree of disturbances, apprehension and mounting anxiety of the pregnant woman and her family. Objective: to determine the effects of postterm pregnancy in different events related to birth and neonate. Material and method: a retrospective, observational, cross-sectional and analytical study was carried out at Abel Santamaría Cuadrado University Hospital during the second term of 2013. The target group included the total of pregnant women admitted throughout the period mentioned, the sample comprised the patients having a prolonged pregnancy (study group n1=106) and the control group consisted of pregnancies between 38 and 41 weeks (n2=216). Absolute and relative frequencies, means and standard deviation were calculated. Chi square test with a level of confidence of Α α <0, 05 was used. Results: prolonged pregnancy is an obstetric condition where labor induction increases (74,5%); eutocic delivery predominated (64,15%), clear amniotic fluid (65,1%), weight higher than 2500 grams (53,77%) and male sex (62,35%). The 97,2% of neonates had an APGAR test ≥ 7 scoring. There was an association between postterm pregnancy, labor induction, cesarean section, neonate with >3500 grams and meconium fluid. Conclusions: postterm pregnancy is considered a risk factor to labor induction, cesarean section, meconium presence and neonates with higher weight.

Aspectos clínico-epidemiológicos de la inducción del parto en el embarazo postérmino / Clinical and epidemiological features of inducing labor in post-term pregnancy

El embarazo postérmino es una entidad obstétrica muy discutida en la literatura médica debido a los diferentes criterios empleados con relación al diagnóstico, control prenatal, conducta a tomar y manejo intraparto. Con el objetivo de determinar el comportamiento de la inducción del parto en el embarazo postérmino, se realizó un estudio de casos y controles en el Hospital General Docente "Abel Santamaría" de Pinar del Río, en el trienio 2005-2007. El universo estuvo constituido por todos los nacimientos de esa institución hospitalaria, el grupo estudio por las embarazadas con 42 semanas de gestación con una labor de parto inducida (n=239) y un grupo control por las primeras 10 gestantes de cada mes con una labor de parto espontánea y edad gestacional de 37-41 semanas, con un feto vivo y con presentación de vértice (n=360). Se estudió: edad materna, paridad anterior, modo de terminación del parto, puntaje de Apgar del recién nacido, índice de Bishop, morbilidad materna y neonatal. Se utilizó frecuencia absoluta, porcentaje, Ji Cuadrado y Odds ratio al 95 % de certeza. Resultaron factores de riesgo de embarazo postérmino con labor inducida: la adolescencia (OR=5), la multiparidad (OR=7.5) y el índice de Bishop <7 puntos (OR=6.6); la forma de terminación del parto predominante en el embarazo postérmino fue la cesárea, presentando los recién nacidos una mayor incidencia de Apgar bajo (p<0.001). El embarazo postérmino con labor de parto inducida estuvo relacionado estadísticamente con la morbilidad neonatal en general (p<0.001) y con la morbilidad materna (p<0.001).

Post-term pregnancy is a controversial obstetric entity in medical literature due to the different criteria used regarding to its diagnosis, prenatal control, treatment to be followed and intra-labor management. Aimed at determining the behavior of the induction of labor in post-term pregnancy a case and control study was conducted at "Abel Santamaria Cuadrado" University Hospital, Pinar del Rio, during a three-year period (2005-2007). The universe was comprised of all the births occurring in the institution, women surpassing 42 weeks of pregnancy and inducing labor (n=239) and a control group for the first 10 pregnant women of each month with spontaneous labor and gestational age of 37-41 weeks, live fetus and with apex presentation (n=360). Maternal age, previous parity, ending of labor, Apgar score of the newborn, Bishop rate, maternal and neonatal mortality were the variables studied. Absolute frequency, percentage method, chi square test and Odss ratio to 95% of certainty were used. Post-term pregnancy with inducing labor had as risk factors: adolescence (OR=5), multiparity (OR=7.5) and the Bishop rate < 7 points (OR =6.6); prevailing cesarean section in post-term pregnancy, newborns presented a high incidence of low Apgar scores (p<0.001) and with a maternal morbidity (p<0.001).

Expansión volumttrica y comportamiento del oligoamnoss / Volumetric expansion and behavior of the oligoamnios

Con el objetivo de demostrar la efectividad de la expansión volumétrica materna en el incremento del volumen de líquido amniótico en pacientes con tiempo de gestación de 28 a 39 semanas y oligoamnios, mediante la infusión endovenosa con soluciones isotónicas, se realizó una investigación de intervención-acción, analítica y de cohorte en el Hospital "Abel Santamaría" durante el año 2007. Se seleccionó un grupo estudio conformado por las embarazadas con tiempo de gestación de 28 a 39 semanas, con oligoamnios, a las que se les indicó expansión volumétrica (n=125) y dos grupos de control: el primero conformado por las embarazadas sin oligoamnios y que parieron en ese mismo período (n=125); el segundo, por las embarazadas con oligoamnios detectado a las 40 semanas y más de gestación y que no tuvieron posibilidad de la expansión volumétrica (n=125) y finalmente, la muestra quedó constituida por 375 gestantes. En el análisis estadístico se utilizó el porcentaje y el Ji cuadrado al 95% de certeza. Se obtuvo un incremento del índice de líquido amniótico (ILA) en el 96,8% de las gestantes posterior a 3 dosis de tratamiento, las principales causas de cesárea fueron: el sufrimiento fetal agudo, la presentación pelviana e inducción fallida asociado a bajo índice de inducciones y nacimientos pretérminos con morbilidad neonatal baja. Por lo que se concluye que la expansión volumétrica es una opción terapéutica eficaz en el tratamiento del oligoamnios, pues permitió prolongar el embarazo sin incremento de la morbilidad neonatal.

An intervention-action, analytical and cohort research was conducted at "Abel Santamaria Cuadrado" University Hospital-2007, aimed at showing the effectiveness of maternal volumetric expansion in the increase of the amniotic-fluid volume in 28-39 weeks-pregnant women presenting oligoamnios by means of intravenous infusion with isotonic solutions. The study group was comprised of 28-39 weeks-pregnant women presenting oligoamnios, to whom volumetric expansion was indicated (n=125) and two control groups: the first comprised of pregnant women without oligoamnios and delivering in the same period (n=125); the second group of pregnant women that presented oligoamnios detected at 40 weeks or more of pregnancy and without the possibility of volumetric expansion (n=125), 375 pregnant women were in the final sample. To the statistical analysis the percentage method and the chi-square test with 95% of certainty were used. An increase was obtained in the amniotic-fluid rate (AFR), 96, 8% of the pregnant women after the third dose of treatment, the main causes to perform the cesarean section were: acute fetal distress, pelvic presentation and failed labor induction associated to a low rate of induction and preterm births with low neonatal morbidity. Concluding that; volumetric expansion is an efficient therapeutic option in the treatment of oligoamnios, extending pregnancy without increasing neonatal morbidity.

Parto inducido por embarazo prolongado / Induced delivery in prolonged gestation

Se realizó un estudio retrospectivo, descriptivo, explicativo y longitudinal sobre el comportamiento de la inducción del parto por embarazo prolongado en el Hospital Gineco-Obstétrico "Justo Legón Padilla", en el período comprendido entre enero del 2004 y diciembre del 2005.El universo estuvo constituido por la totalidad de los nacimientos por embarazo prolongado que se produjeron en el período, donde el grupo estudio estaba exclusivamente formado por las gestantes con trabajo de parto inducido (n=104); se estudiaron variables de la madre, del nacimiento y del producto de la concepción y a los datos obtenidos se les aplicó porcentaje. La edad materna más frecuente fue la del grupo de 20 - 35 años (65,5%); predominaron las nulíparas (40,4%), la vía del parto que predominó fue la transpelviana (42,3%); todos con un índice de Bishop >7 puntos La causa más frecuente de cesárea fue el sufrimiento fetal agudo (23%); el embarazo prolongado no constituyó una causa importante de Apgar Bajo, en el parto distócico fue donde ocurrió el mayor número de morbilidad materna y neonatal (9,5%), no se encontró valor significativo en la macrosomía fetal y predominó el sexo femenino en los recién nacidos (65,3%).

A retrospective, descriptive, explicative and longitudinal study about the behavior of the induction of labor in prolonged pregnancy was conducted at "Justo Legón Padilla" Gyneco-Obstetric Hospital during the period of January 2004 to December 2005. The whole sample was constituted by the totality of births in prolongad pregnancy during the period where the study group was exclusively formed by pregnants who underwent induced labor (n = 104).Variables of mother, birth and conception product were taken, and percentage method was applied to data collected. The group of most frequent maternal age was 20 - 35 (65,5%), prevailing nulliparous (40,4%) and transpelvic labor (42,3%), having a Bishop index = 7. The most frequent cause of cesarean section was fetal distress (23%), prolonged pregnancy was not an important cause of low Apgar score. Dystocic labor presented the greatest figures of neonatal and maternal morbidity (9,5%), no significative value of fetal macrosomia was found, predominating female sex in new born (65,3%).

Comportamiento de la inducción del parto / Behaviour of induced labor

Con el objetivo de contribuir al mejor conocimiento del comportamiento de la inducción del parto según la nueva metodología de trabajo, se realizó una investigación prospectiva, transversal y descriptiva en el Hospital Docente Gineco-Obstétrico "Justo Legón Padilla" de Pinar del Río en el período comprendido desde Enero 2002- Diciembre 2003. El universo estuvo constituido por la totalidad de los nacimientos del período, y el grupo estudio por las gestante con labor inducida (n = 360); se estudiaron variables de la madre, del nacimiento y del producto de la concepción, y a los datos obtenidos se les aplicó porcentaje y media. Las causas de cesáreas más frecuentes fueron el sufrimiento fetal agudo (45,66%) y la desproporción céfalo pélvica (26,08%), estando relacionada la primera con el oligoamnios, el crecimiento intrauterino retardado y la hipertensión arterial crónica, y la desproporción céfalo pélvica estuvo relacionada con el embarazo prolongado y la diabetes mellitus; el puntaje de Apgar < 7 en cesáreas con labor inducida fue 1,5 veces más frecuente que en el parto, la muerte fetal intraparto fue en gestantes con embarazo prolongado, hubo un 11,66% de gestantes con morbilidad, y las principales fueron las sépticas y las hemorrágicas, siendo las sépticas 2,16 veces más frecuentes que las hemorrágicas.

Aimed at contributing with better knowledge of induced labor and following the new methodology of work, a prospective, cross-sectional and descriptive research was conducted at "Justo Legón Padilla" Gineco-Obstetric Hospital in Pinar del Río during the period of January 2002-December 2003. The whole sample took the totality of births during the period, and the group of study the pregnants who underwent induced labor (n = 360); the variables of mother, birth and the conception product were analyzed, and methods of percentage and mean were applied to data collected. The most frequent causes of cesarean sections were: acute fetal distress (45.66%) and cephalo-pelvic disproportion (26.08%), being related the first one to oligoamnios, retarded intrauterine growth and chronic hypertension. Cephalo-pelvic disproportion was related to prolonged pregnancy and diabetes mellitus, Apgar score < 7 in cesarean sections, in induced labor 1.5 times more frequent than in natural labors; fetal death intralabor was present in pregnants with morbidities, and the main causes were septic and haemorrhagic infections, being the septic ones 2.16 times more frequent than the haemorrhagic.