Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction

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 weeks was the most common indication for induced labor (55.2%), and vaginal administration of misoprostol was the most commonly used method (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 in most 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.

Whether induction of labor ahead in low-risk women improves pregnancy outcomes?: A retrospective cohort, observational study

“…At present, elective labor induction is commonly performed after 41 weeks in low-risk women without labor onset. [3,4] However, with increases in gestational weeks, increases are observed in fetal weight, the probability of macrosomia, the rate of cephalopelvic disproportion, and the occurrence of shoulder dystocia, cesarean section, neonatal asphyxia and birth injury. [5][6][7][8] Thus, we sought to determine whether inducing low-risk pregnant women in advance at 40 weeks will lead to improved maternal and fetal outcomes.…”

Application of Prospect Theory in Obstetrics by Evaluating Mode of Delivery and Outcomes in Neonates Born Small or Appropriate for Gestational Age

“…4,5 The detection rate of FGR is reported to be below 40%. [6][7][8][9] Various international guidelines do not indicate cesarean delivery (CD) for fetuses with FGR; however, more obstetric interventions during labor and delivery are reported among these fetuses, 10,11 with approximately 30% of fetuses with FGR estimated to be delivered via CD. 12,13 In addition to the obvious detrimental associations of CD and operative vaginal deliveries with maternal morbidity, the neonatal benefit of CD in neonates with FGR remains unclear, and the optimal mode of delivery of neonates who are SGA remains to be determined.…”

Medicalização da assistência ao parto normal: Perfil de gestantes atendidas em uma maternidade de risco habitual

“…14 A indicação correta de antecipação do parto tem sido feita com base na determinação do índice de Bishop. 7 No nosso estudo, 61,6% profissionais afirmaram sempre ou quase sempre utilizam o índice de Bishop. Dessa forma, conclui-se que a assistência prestada considerou a estratificação do índice como preditivo para o uso de medicamento indutivo de maturação uterina.…”

“…19;21 Se no momento da indução o colo estiver maduro, índice de Bishop >6, a ocitocina será a única droga utilizada. 7 Nesta pesquisa, quando questionados sobre o uso de medicamentos, 77,8% dos médicos afirmaram utilizar misoprostol e 22,2% disseram fazer uso de ocitocina. Já entre os enfermeiros que afirmaram fazer uso de medicamentos para indução do trabalho de parto, 100% disseram fazer uso de ocitocina, o que pode ser explicado pelo fato de que os enfermeiros não possuem respaldo legal para prescrição de misoprostol.…”

“…Para que se dê início ao uso de medicamentos indutores, é necessário avaliar as condições do colo uterino e o índice de Bishop _ que se constitui na análise da dilatação, apagamento, consistência e posição do colo uterino e altura da apresentação fetal-parece ser a melhor forma de apreciação e prognóstico para o que desfecho do processo de indução seja o parto vaginal. 7 Ainda na busca de adequar o uso de tecnologias às práticas assistenciais menos invasivas, o partograma c , tem se mostrado uma ferramenta valiosa para o acompanhamento e documentação da evolução do trabalho de parto. Esse gráfico permite a identificação de falhas de progressão e guia a tomada de decisão para a correção dos desvios, contribuindo para redução da taxa de intervenções e cirurgias.…”