Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

BACKGROUND: Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES: To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY: Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA: Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS: Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS: Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS: Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT: Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

[Predictive validity of Bishop and Burnett Scores for vaginal delivery modified by parity]. / Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad.

BACKGROUND: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. METHODS: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the "La Mancha-Centro" Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. RESULTS: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). CONCLUSION: Replacing the "foetal station" parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour. Key Words. Bishop Score. Induction of labour. Outcome of labour. Parity. Predictive model.

Practice of endoscopic gynecologic surgery: a survey of Spanish gynecologists.

OBJECTIVE: To evaluate the implementation of endoscopic gynecologic surgery in Spanish hospitals. STUDY DESIGN: In January 2011, a questionnaire was sent to 198 gynecology departments to determine the diffusion and acceptance of specific endoscopic procedures (hysteroscopy and laparoscopy) in each hospital. RESULTS: The response rate was 52% (103/198). The practice of basic laparoscopy in Spain is high (90% of the hospitals surveyed reported that >50% of their specialists use this technique). Although advanced laparoscopic procedures are used in 83.4% of hospitals, 59.2% of these hospitals reported that <25% of gynecologists knew how to perform these techniques. In the case of adnexal masses, the approach used depends on the characteristics of the mass. Most hospitals (96.1%) reported routine use of a laparoscopic approach for benign adnexal masses measuring <10 cm, while 42% of hospitals reported routine use of a laparoscopic approach for masses that appear to be suspicious on ultrasound. Regarding hysterectomy, 38 hospitals (36.9%) reported that an abdominal approach was used in <25% of hysterectomies, 53 hospitals (51.5%) reported that a vaginal approach was used in 25-50% of hysterectomies, and 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of hysterectomies. For the treatment of gynecological cancers, 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of cases; this approach was reported more commonly by teaching hospitals (81.9% vs. 46.75; p<0.001) and hospitals with >200 beds (84.3% vs. 45.5%; p<0.001). In teaching hospitals, the concordance between what the respondents felt residents should be able to do, in terms of laparoscopic techniques, and what residents were actually able to do upon finishing their residency training was quite high, with the degree of concordance varying between 84.3% (adnexal mass approach) and 100% (diagnostic laparoscopy and tubal sterilization). CONCLUSIONS: More than 90% of the Spanish hospitals surveyed perform basic endoscopic techniques, and 83.4% are able to perform advanced endoscopic procedures.

[Evaluation and efficacy of preventive measures in intrapartum bleeding]. / Evaluación y eficacia de las medidas preventivas en la anemia intraparto.

OBJECTIVES: To evaluate the efficacy, applicability and safety of two recently introduced preventive-restrictive measures on the use of episiotomy and active management of the third stage of labour, in order to reduce puerperal bleeding results. MATERIAL AND METHOD: Cohort study of a prospective series of 1098 women who gave birth in the Obstetrics and Gynaecology Department of the La Mancha General Hospital. Data were collected in two phases (1st phase, before applying the measures: 591; 2nd phase, after: 507). The main objective was to assess intrapartum blood loss. The independent variables analysed were active management of the third stage of labour and episiotomy rate. Age, parity, prematurity, weight of the newborn child, analgesia, duration and type of childbirth (spontaneous or induced), tears, retained placenta and neonatal results were included as control variables. Caesarean deliveries and those cases with increased bleeding risk factors were excluded. RESULTS: Both postpartum anaemia and excessive hemorrhagic loss were significantly lowered (8.7% and 50% respectively). Likewise, episiotomy rate was also significantly reduced (8.6%) and active management of the third stage of labour increased to 86.6%. Neonatal outcome results did not change throughout the study. CONCLUSIONS: The restrictive use of episiotomy and active management during the third stage of labour were effective, and with no side effects, in reducing intrapartum blood loss and improving puerperal quality of life.

Evaluación y eficacia de las medidas preventivas en la anemia intraparto / Evaluation and efficacy of preventive measures in intrapartum bleeding

Objetivo. Evaluar la eficacia, aplicabilidad y seguridad de 2 medidas preventivas, reducción de episiotomías y tratamiento activo del alumbramiento, implantadas en nuestro servicio para disminuir el número de pacientes con anemia puerperal en los partos vaginales. Material y métodos. Estudio prospectivo de calidad asistencial realizado en el Servicio de Obstetricia del Hospital La Mancha Centro, en 2 fases (1.a fase: 591pacientes, 2.a fase: 507 pacientes; n: 1.098 partos vaginales) separadas por la aplicación de las medidas de mejora por evaluar. La variable dependiente fue la pérdida hemática intraparto. Las variables independientes fueron la tasa de episiotomías y de alumbramientos dirigidos. Las variables de control estudiadas fueron la edad, la paridad, la prematuridad, el peso del recién nacido, el inicio del parto, la analgesia, la duración del parto y el tipo de parto, los desgarros, el tipo de desgarro, la retención placentaria y los resultados neonatales. En el muestreo consecutivo no probabilístico se excluyeron las cesáreas y otras enfermedades influyentes en la hemorragia. Resultados. La tasa de episiotomía descendió un 8,6% y el alumbramiento dirigido alcanzó un 86,8%, lo que redujo la anemia posparto un 8,7% y la pérdida hemática excesiva un 50% (razón de prevalencia: 1,4). Las medidas aplicadas no modificaron los resultados neonatales. Conclusiones. La episiotomía selectiva y el tratamiento activo sistemático del alumbramiento son 2 medidas efectivas, de fácil cumplimiento, presumiblemente eficientes y sin efectos secundarios, para reducir la hemorragia y el grado de anemia tras el parto y mejorar la calidad de vida de la mujer durante el puerperio(AU)

Objectives. To evaluate the efficacy, applicability and safety of two recently introduced preventive-restrictive measures on the use of episiotomy and active management of the third stage of labour, in order to reduce puerperal bleeding results. Material and Method. Cohort study of a prospective series of 1098 women who gave birth in the Obstetrics and Gynaecology Department of the La Mancha General Hospital. Data were collected in two phases (1st phase, before applying the measures: 591; 2nd phase, after: 507). The main objective was to assess intrapartum blood loss. The independent variables analysed were active management of the third stage of labour and episiotomy rate. Age, parity, prematurity, weight of the newborn child, analgesia, duration and type of childbirth (spontaneous or induced), tears, retained placenta and neonatal results were included as control variables. Caesarean deliveries and those cases with increased bleeding risk factors were excluded. Results. Both postpartum anaemia and excessive hemorrhagic loss were significantly lowered (8.7% and 50% respectively). Likewise, episiotomy rate was also significantly reduced (8.6%) and active management of the third stage of labour increased to 86.6%. Neonatal outcome results did not change throughout the study. Conclusions. The restrictive use of episiotomy and active management during the third stage of labour were effective, and with no side effects, in reducing intrapartum blood loss and improving puerperal quality of life(AU)

Influencia de la duración del expulsivo sobre la morbilidad neonatal / No disponible

Objetivo: Conocer los factores que pueden estar relacionados con la duración del periodo expulsivo y la influencia de esta duración sobre la morbilidad neonatal. Método: Estudio observacional retrospectivo realizado en el Servicio de paritorio del Complejo Hospitalario «La Mancha-Centro» de Alcázar de San Juan durante los años 2002 y 2003. Se estudiaron 476 gestantes a término con presentación cefálica. Las variables estudiadas fueron: el tiempo de expulsivo en minutos, la edad materna, la paridad, el inicio de parto, el tipo de parto, el peso del recién nacido, los valores de pH de arteria umbilical, la puntuación del test de Apgar al minuto y a los 5, y el ingreso del recién nacido en el servicio de pediatría. Resultados: La analgesia epidural produce un aumento estadísticamente significativo en el tiempo de expulsivo con un intervalo de confianza del 95% de entre 31 a 44 minutos, asimismo, el hecho de ser multípara disminuye la duración del expulsivo entre 9,6 y 23,6 minutos. No se encontró asociación estadísticamente significativa (p >0,05) entre la duración del expulsivo y los valores de pH de arteria umbilical, las puntuaciones del test de Apgar e ingreso del recién nacido en el servicio de pediatría. Conclusiones: No se observa que la mayor duración del expulsivo esté asociada a una mayor morbilidad neonatal (AU)

Objective: To determine those factors that may be related to the length of second stage of labor delivery and the influence of the duration on neonatal morbidity. Method: This retrospective, observational study was carried out in the maternity service of the Complejo Hospitalario La Mancha-Centro de Alcázar de San Juan in 2002 and 2003. Four hundred seventy-six women with full-term pregnancies and cephalic presentation were studied. The variables measured were the length of labor in minutes, maternal age, parity, onset of labor, mode of delivery, infant birth weight, umbilical artery pH, 1-minute and 5-minute Apgar scores and admission of the newborn in the neonatal intensive care unit. Results: Epidural analgesia was associated with a statistically significant prolongation of the duration of delivery, with a 95% confidence interval of 31 to 44 minutes, and multiparity shortened the duration of delivery by 9.6 to 23.6 minutes. No statistically significant associations (p >0.05) were observed between duration of delivery and umbilical artery pH, Apgar scores or admission of the newborn in the neonatal intensive care unit (AU)