Publication: Análisis de la amniotomía precoz frente a la amniotomía tardía en las inducciones de trabajo de parto y su posible riesgo de distocia
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2019-03-01
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Universidad Complutense de Madrid
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Abstract
La organización mundial de la salud (OMS) en su último informe difunde la necesidad de racionalizar la tasa de cesáreas. Aconsejan no superar cifras al 10%, sin embargo, en España, nos encontramos con una media de 24%, alcanzando cotas superiores dependiendo de la comunidad autónoma. Estas cifras son similares en el resto de territorio europeo, Estados Unidos y superiores en el continente sudamericano. Una de las prácticas clínicas que contribuyen al aumento de la tasa de cesáreas es la inducción del trabajo de parto. Sus indicaciones médicas tanto desde el punto de vista del bienestar fetal y materno hacen que sea imprescindible realizarla. Uno de los motivos que provocan una mayor indicación de inducciones por motivos médicos, en relación al resto de indicaciones de la inducción, es la gestación cronológicamente prolongada (GCP). La GCP conlleva una serie de riesgos, por lo que las sociedades científicas internacionales y nacionales han llegado al consenso de finalizar la gestación mediante la inducción de trabajo de parto a la semana 41+3 días de gestación. No obstante, esto hace que el riesgo de cesárea aumente a través de la inducción, tanto por el proceso de inducción cómo por la GCP. Uno de los mecanismos que se realizan dentro de la inducción es la amniorrexis artificial. La amniorrexis artificial el mecanismo por el cual un profesional rompe la bolsa de las aguas de manera intencionada. Es un procedimiento que las matronas realizan de manera rutinaria en las inducciones de trabajo de parto, casi en el 100% de las pacientes. Es conocido como un buen mecanismo de inducción mecánico, ya que activa los diferentes mecanismos de parto y los acelera. No obstante, no es una técnica exenta de riesgos. Están descritos riesgos como son el sufrimiento fetal, la distocia de la posición fetal y el prolapso de cordón entre otros. Además, no existen protocolos que nos indiquen cual es mejor momento para realizarla dentro del proceso de inducción. En la actualidad en el proceso del parto normal, esta técnica se encuentra desaconsejada y todas las investigaciones acerca de ella coinciden en que el riesgo intrínseco a la técnica, se ve reducido en cuanto más se retrasa el momento de realizarla. Por tanto, han surgido diferentes investigaciones en el campo de las inducciones, con el fin de conocer cuál es el mejor momento para realizar la amniorrexis artificial dentro de este proceso y así poder disminuir las complicaciones. Existe poca bibliografía al respecto y controversia entre los autores. Por ello en esta investigación, se pretende conocer si la amniorrexis artificial tardía (AFT) funciona influye en el descenso de la tasa de cesáreas en las inducciones por gestaciones cronológicamente prolongadas...
The World Health Organization (WHO) in its latest report disseminates the need to rationalize the cesarean section rate. They advise not to exceed figures at 10%, however, in Spain, we find an average of 24%, reaching higher levels depending on the autonomous community. These figures are similar in the rest of European territory, the United States and higher in the South American continent. One of the clinical practices that contribute to the increase in the rate of caesarean sections is the induction of labor. The medical indications from both fetal and maternal well-being point of view make it essential to perform it. One of the reasons that cause a greater indication of inductions for medical reasons in relation to the other indications of induction is the chronologically prolonged gestation (CPG). CPG involves a series of risks, which is why international and national scientific societies have reached the consensus of ending pregnancy by inducing labor at week 41 + 3 of gestation. However, this causes the risk of caesarean section to increase through induction, both through the induction process and through CPG. One of the mechanisms that are carried out within the induction is artificial amniorrhexis. The artificial amniorrhexis is the mechanism by which a professional breaks the bag of waters intentionally. It is a procedure that midwives perform routinely in inductions of labor, almost in 100% of patients. It is known as a good mechanism of mechanical induction, since it activates the different mechanisms of delivery and accelerates them. However, it is not a risk-free technique. Risks are described, such as fetal distress, dystocia of the fetal position and cord prolapse, among others. In addition, there are no protocols that tell us what the best time is to do it in the induction process. Currently in the process of normal delivery, this technique is not recommended and all agree that the intrinsic risk to the technique is reduced the longer the time is delayed. Therefore, different investigations have emerged in the field of inductions, in order to know what the best time is to perform artificial amniorrhexis within the induction and thus be able to reduce complications. There is little literature on the subject and controversy among the authors. Therefore, in this research, it is intended to know if late artificial amniorrhexis works influences the decrease in the rate of caesarean sections in inductions for chronologically prolonged gestations...
The World Health Organization (WHO) in its latest report disseminates the need to rationalize the cesarean section rate. They advise not to exceed figures at 10%, however, in Spain, we find an average of 24%, reaching higher levels depending on the autonomous community. These figures are similar in the rest of European territory, the United States and higher in the South American continent. One of the clinical practices that contribute to the increase in the rate of caesarean sections is the induction of labor. The medical indications from both fetal and maternal well-being point of view make it essential to perform it. One of the reasons that cause a greater indication of inductions for medical reasons in relation to the other indications of induction is the chronologically prolonged gestation (CPG). CPG involves a series of risks, which is why international and national scientific societies have reached the consensus of ending pregnancy by inducing labor at week 41 + 3 of gestation. However, this causes the risk of caesarean section to increase through induction, both through the induction process and through CPG. One of the mechanisms that are carried out within the induction is artificial amniorrhexis. The artificial amniorrhexis is the mechanism by which a professional breaks the bag of waters intentionally. It is a procedure that midwives perform routinely in inductions of labor, almost in 100% of patients. It is known as a good mechanism of mechanical induction, since it activates the different mechanisms of delivery and accelerates them. However, it is not a risk-free technique. Risks are described, such as fetal distress, dystocia of the fetal position and cord prolapse, among others. In addition, there are no protocols that tell us what the best time is to do it in the induction process. Currently in the process of normal delivery, this technique is not recommended and all agree that the intrinsic risk to the technique is reduced the longer the time is delayed. Therefore, different investigations have emerged in the field of inductions, in order to know what the best time is to perform artificial amniorrhexis within the induction and thus be able to reduce complications. There is little literature on the subject and controversy among the authors. Therefore, in this research, it is intended to know if late artificial amniorrhexis works influences the decrease in the rate of caesarean sections in inductions for chronologically prolonged gestations...
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Tesis de la Universidad Complutense de Madrid, Facultad de Enfermería, Fisioterapia y Podología, leída el 18/09/2018