Incidence of obstetric anal sphincter injuries according to the type of forceps used in the Mexican population.

OBJECTIVE: This study describes the frequency of obstetric anal sphincter injuries (OASIS) in patients after instrumental delivery according to the type of forceps used. METHODS: A retrospective comparative cohort study was conducted on patients who underwent instrumental delivery from January 2017 to April 2022. The primary outcome was the presence of OASIS following delivery. Patients were categorized into Cohort A if only rotation forceps were used, Cohort B for only traction forceps, and Cohort C if both types were used sequentially. Statistical analysis was performed with SPSS (IBM, New York, NY) with χ2, Fisher's exact, and analysis of variance testing. A P-value <0.05 was considered significant. RESULTS: OASIS occurred in 45 of 328 instrumental deliveries. OASIS after rotation forceps occurred in 12.9% (n = 8) of cases, after traction forceps in 13.2% (n = 34), and after sequential use of rotation and traction forceps in 37.5% (n = 3) of cases (p = 0.141). An odds ratio (OR) of 0.91 (95% confidence interval [CI] 0.40-2.08) for OASIS was obtained with the use of rotation forceps, 0.81 (95% CI 0.38-1.70) for traction forceps, and 3.97 (95% CI 0.91-17.2) for the sequential use of rotation and traction forceps. CONCLUSION: There were no significant differences in the presence of OASIS comparing traction and rotation forceps. A non-significant trend of higher OASIS following the sequential use of traction and rotation forceps was observed.

Análisis de la tasa de cesáreas por grupos de Robson en Clínica Universidad de los Andes / Analysis of the cesarean section rate by Robson's groups at Clínica Universidad de los Andes

Introducción: La tasa de cesáreas es importante para cualquier centro de atención hospitalaria. Es un indicador de calidad utilizado en muchas publicaciones y, aunque no es una estadística vital, se ha reconocido como un indicador de la calidad de atención. Objetivo: Conocer la tasa de cesáreas en una institución utilizando los grupos de Robson. Métodos: Estudio retrospectivo de bases de datos de la maternidad. Se consideraron las variables de paridad, cesárea anterior, trabajo de parto, inducción, para poder clasificar la población según los grupos de Robson. El análisis consideró los nacimientos desde octubre del 2014 hasta junio del 2021. Resultados: Se observó una tasa de 27,9% en el periodo de estudio. El grupo 5 de Robson, que considera pacientes con una o más tasa de cesáreas, mostró una elevada tasa (68%), contribuyó con el 36% de todas las cesáreas, siendo solamente el 15% de la población. El grupo 3, de multíparas con trabajo de parto espontáneo, tuvo una tasa del 1,8%, contribuyó al 0,4% de las cesáreas, siendo el 20% de la población de estudio. Se encontró una correlación significativa entre uso de parto instrumental y menor tasa de cesáreas, al realizar análisis por operador (Spearman rho: -0,45; IC95%: -0,788 a -0,0190; p = 0,043). Conclusión: La tasa de cesáreas observada fue 27,9%, y las pacientes con cesárea anterior son un grupo donde pueden concentrarse mayores esfuerzos para bajar la tasa global. Entre los operadores, los usuarios de parto instrumental tuvieron menor proporción cesáreas.

Introduction: The cesarean section rate is important for any hospital care center. It is a quality indicator used in many publications, and although not a vital statistic, it has been recognized as an indicator of the quality of care. Objective:: To know the cesarean section rate in an institution using Robson groups. Methods: Retrospective study of maternity databases. The variables of parity, previous cesarean section, labor, induction was considered in order to classify the population according to Robson groups. The analysis considered births from October 2014 to June 2021. Results: A rate of 27.9% was observed in the study period. Robson's group 5, which considers patients with one or more rate of cesarean sections, showed a high rate (68%), contributing to 36% of all cesarean sections, being only 15% of the population. Group 3, multiparas with spontaneous labor, had a rate of 1.8%, contributing to 0.4% of cesarean sections, making up 20% of the study population. A significant correlation was found between the use of instrumental delivery and a lower rate of cesarean sections, when analyzing by operator (Spearman rho: -0.45; IC95%: -0.788 to -0.0190; p = 0.043). Conclusion: The observed cesarean section rate was 27.9%, and patients with a previous cesarean section are a group where greater efforts can be concentrated to lower the overall rate. Among the operators, users of instrumental delivery had a lower proportion of cesarean sections.

Comentario sobre la asociación entre la vía de parto y el daño perineal e incontinencia urinaria y fecal / Comment on the association between the route of delivery and perineal damage and urinary and fecal incontinence

RESUMEN El parto vaginal se asocia con un riesgo más alto de daño perineal, incontinencia urinaria y fecal comparado con el parto cesárea. Dicho riesgo aumenta con el parto instrumental (ej. fórceps) y disminuye cuando la posición al momento del parto reduce la compresión sobre el sacro o si el parto ocurre bajo el agua. En otros factores que aumentan el riesgo de incontinencia se incluyen: la gran multiparidad, la duración del trabajo de parto, el peso fetal y tamaño de su cabeza, la edad muy joven al momento del primer parto, la inducción del trabajo de parto, la obesidad, la diabetes, la constipación, el tabaquismo y la historia de incontinencia urinaria o fecal. Factores sociales que se asocian a incontinencia incluyen la falta de educación, malas condiciones de hábitat, trabajo manual intenso, la falta de actividad física y el divorcio.

ABSTRACT Vaginal delivery is associated with a higher risk of perineal injury, and urinary and fecal incontinence as compared with caesarean delivery; The risk is higher in case of operative vaginal delivery and lower if the position at delivery takes the weight off the sacrum or is carried out under water immersion; A number of other factors increase the risk of incontinence, including higher parity, duration of labour, fetal weight or size of fetal head, younger age at first delivery, induction of labour, obesity, diabetes, constipation, smoking and history of urinary or fecal incontinence. Social factors such as lack of education, poor living environment, intense manual labour, the absence of physical exercise and divorce, are also associated with incontinence.

Frey Syndrome.

OBJECTIVE: To describe the features of Frey syndrome (auriculotemporal nerve dysfunction with gustatory flushing) in childhood. STUDY DESIGN: A multicenter, retrospective, descriptive observational national case series study was conducted with the help of French academic societies. Diagnostic criteria were based on clinical history, and sometimes also on photographs or provocation tests. RESULTS: Forty-eight cases were identified, with 2 subtypes: 35 unilateral and 13 bilateral. Associated sweating was reported in only 10% of cases. Diagnosis was made in only 20% of children at the first consultation and inappropriate dietary restriction was prescribed for 21%. Instrumented vaginal delivery was significantly associated with unilateral forms (OR [unilateral vs bilateral] = 29; 95% CI 3.99-311.58; P < .001). The outcome was favorable overall with 57% regression, 20% recovery, and only 23% persistence of initial symptoms. Regression was more frequent in unilateral forms (OR = 6.60; 95% CI 1.23-44.04; P = .016), observed in 69% of unilateral forms at a median age of 27 (24-48) months. Recovery predominated in bilateral forms (OR = 0.05; 95% CI 0-0.38; P = .001), observed in 58% of bilateral cases at a median age of 8 (7-9) months. CONCLUSIONS: Frey syndrome in childhood is a rare but benign condition with mild symptoms and a favorable outcome in most cases. Unilateral forms are mostly associated with instrumented delivery. Pediatricians should be familiar with this disorder in order to avoid misdiagnosis, mainly as food allergy, and unnecessary referrals and tests.

Influence of obesity on route of delivery in a population of African descent in Martinique.

OBJECTIVE: To determine whether obesity is an independent risk factor for cesarean delivery in Martinique. METHODS: A retrospective study was performed using data for deliveries that occurred at the University Hospital of Fort de France between January and September 2010. Women were divided into four groups on the basis of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters; < 25 [group 1], 25-29 [group 2], 30-39 [group 3], and ≥ 40 [group 4]). Independent risk factors for cesarean delivery were identified through multivariate analysis. RESULTS: Overall, 1286 women were included. Mean weight gain was lower in groups 2 (9.9 kg, 95% CI 9.2-10.7), 3 (5.7 kg, 4.7-6.7), and 4 (1.0 kg,-1.5 to 3.5), than in group 1 (12.3 kg, 11.9-12.7; P < 0.001 for all). In univariate analysis, cesarean deliveries were more frequent among nulliparous women in group 2 (P = 0.007) and group 3 (P = 0.053) than among those in group 1. In multivariate analysis, BMI was not associated with cesarean delivery (BMI 25-29: adjusted odds ratio 0.64, 95% CI 0.33-1.25; BMI ≥ 30: 0.61, 0.29-1.39). CONCLUSION: Obesity was not an independent risk factor for cesarean delivery. Weight control and a positive attitude towards trial of labor in obese women could have led to the findings.

Factores maternos y fetales que inducen a un parto por cesárea / Maternal and fetal factors that lead to a caesarean delivery

La presente investigación es un estudio de tipo descriptivo y retrospectivo en pacientes gestantes que se practican una cesárea, en el cual se buscó identificar los factores maternos y fetales que inducen a la práctica de esta intervención quirúrgica y la caracterización socioeconómica de estas mujeres. Los investigadores elaboraron un instrumento el cual fue validado mediante prueba de expertos y la muestra estuvo constituida por 93 gestantes que se sometieron a una cesárea. Las edades en la que las mujeres más se realizan una cesárea es entre los 20 y 22 años, el nivel socioeconómico más frecuente es el estrato 2, el factor materno más encontrado es el de cesárea electiva y la evidencia de infección intrauterina (Toxoplasmosis) es el factor fetal más encontrado

This research is a descriptive and retrospective study in pregnant patients who underwent caesarean section procedure, which looks for identifying maternal and fetal factors that lead to the practice of this surgery and socioeconomic characterization of these women. The researchers developed an instrument which was validated by experts and the test sample consisted of 93 pregnant women who underwent cesarean section. The ages at which women most performed a Caesarean section is between 20 years old and 22 years old, The most frequent socioeconomic status is "estrato 2" , the maternal factor is the elective caesarean and the most common fetal factor is the evidence of intrauterine infection (toxoplasmosis)

Embarazo y Adolescencia: Resultados Perinatales / Pregnancy and adolescence: Perinatal results

Se realizó un estudio retrospectivo de caso control con el objetivo de conocer los resultados perinatales en las adolescentes atendidas en el Hospital "Clodomira Acosta Ferrales" de Ciudad Habana, del 1ro. de enero de 1999 al 31 de marzo de 2000. El grupo de estudio, 184 adolescentes, se comparó con un grupo control representado por las gestantes de 20 a 24 años (n = 439) atendidas en dicho centro en igual periodo de tiempo. Datos referentes como edad gestacional, modo de parto y peso y Apgar del recién nacido, se recogieron en una encuesta habilitada al efecto y se procesaron utilizando el sistema estadístico computadorizado SPSS. Los resultados se exponen en gráficos,y los más relevantes fueron la mayor frecuencia del parto instrumentado y recién nacidos asfícticos entre las adolescentes. Se concluye que a pesar de la atención especializada, el embarazo precoz continúa siendo un factor de riesgo para obtener resultados perinatales desfavorables.

A retrospective case-control study was conducted aimed at knowing the perinatal results among the adolescents attended at “Clodomira Acosta Ferrales”, in Havana City, from January 1st, 1999 to March 31st, 2000. The study group (184 adolescents) was compared with a control group composed of pregnat women aged 20-24 (n = 439) that received attention in this center in the same period of time. Gestational age, mode of delivery, weight and Apgar score of the infant were some of the data collected by a survey done to this end. These data were processed by using the SPSS computerized statistical system. The results were showed in graphs. The most significant were the highest frequency of instrumental delivery and the asphyxial infants among the adolescents. It was concluded that in spite of the specialized care, early pregnancy is still a risk factor for obtaining unfavorable perinatal results.