RESUMEN
Both cesarean surgery and induction of labor have become common procedures performed in all labor wards in an attempt to reduce adverse obstetrical and neonatal outcomes. Thus, recent evidence, led by the ARRIVE Trial, demonstrated that elective induction at 39 weeks reduced the rates of cesarean deliveries and of hypertensive disorders of pregnancy. However, some concerns must be addressed, as the benefits of universal policies have to be outweighed with the current circumstances of implementation, the economic impact, the number of procedures needed to effectively reduce complications, and, above all, women's perception towards this approach. Therefore, it would be interesting to explore individualization strategies, instead of general recommendations, to offer personalized care.
Afin de réduire les complications obstétricales et néonatales, la césarienne ainsi que le déclenchement de l'accouchement sont souvent pratiqués. Récemment, l'étude ARRIVE a démontré que le déclenchement à 39 semaines d'aménorrhée (SA) permet de diminuer le taux de césariennes et de complications hypertensives de la grossesse. Il reste à déterminer les avantages d'une recommandation universelle dans les circonstances actuelles, son impact économique, le nombre de déclenchements nécessaire pour réduire efficacement le taux des complications obstétricales et, surtout, la perception des femmes à l'égard de cette procédure. Finalement, il serait plus intéressant de développer des stratégies individualisées de prise en charge plutôt que des recommandations globales, afin d'offrir une prise en charge la plus personnalisée possible.
Asunto(s)
Cesárea , Ensayos Clínicos como Asunto , Trabajo de Parto Inducido , Obstetricia/métodos , Obstetricia/normas , Cesárea/psicología , Cesárea/normas , Procedimientos Quirúrgicos Electivos/psicología , Procedimientos Quirúrgicos Electivos/normas , Femenino , Humanos , Trabajo de Parto Inducido/psicología , Trabajo de Parto Inducido/normas , Embarazo , Resultado del EmbarazoRESUMEN
Common obstetric interventions are often for "convenience" rather than for clinical indications. Before proceeding, it should be clear who is the beneficiary of the convenience. The primary healthcare provider must make sure that women and their partners have a full understanding of what is known about the associated risks, benefits, and alternative approaches of the proposed intervention. Thorough and accurate information allows women to choose what is best for them and their infant on the basis of the individual clinical situation. Ideally, this discussion takes place during the prenatal period when there is ample opportunity to ask questions, reflect on the potential implications, and confer with partners and family members. A review of common obstetric interventions is provided. While these interventions often are medically indicated for the well-being of mothers and infants, the evidence supporting their benefits when used electively is controversial.
Asunto(s)
Cesárea/efectos adversos , Procedimientos Quirúrgicos Electivos/efectos adversos , Trabajo de Parto Inducido/efectos adversos , Procedimientos Innecesarios/efectos adversos , Actitud Frente a la Salud , Cesárea/enfermería , Cesárea/normas , Cesárea/estadística & datos numéricos , Conducta de Elección , Procedimientos Quirúrgicos Electivos/enfermería , Procedimientos Quirúrgicos Electivos/normas , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Episiotomía , Medicina Basada en la Evidencia , Humanos , Consentimiento Informado , Trabajo de Parto Inducido/enfermería , Trabajo de Parto Inducido/normas , Trabajo de Parto Inducido/estadística & datos numéricos , Enfermería Neonatal/organización & administración , Rol de la Enfermera , Investigación en Enfermería , Enfermería Obstétrica/organización & administración , Evaluación de Resultado en la Atención de Salud , Padres/educación , Padres/psicología , Defensa del Paciente , Educación del Paciente como Asunto , Factores de Riesgo , Estados Unidos , Procedimientos Innecesarios/enfermería , Procedimientos Innecesarios/normas , Procedimientos Innecesarios/estadística & datos numéricosRESUMEN
On the basis of 899 cases of uterine scarring following cesarean section, the authors carried out a prophylactic cesarean in 42% of cases. Labor ended in childbirth by the genital tract in 44% of cases. The very low incidence of uterine rupture since segmental hysterotomy has become widespread and the improved fetal and maternal prognosis are all reasons to prefer delivery by the genital tract. One of the factors in choosing the method of childbirth is radiopelvimetry and estimation of the fetal weight; however, the suspicion of a threshold pelvis is not a contraindication to the labor test which was successful in 70% of the authors cases. On condition that strict obstetrical monitoring is possible, oxytocic drugs can be used to induce labor or correct hypokinesia and to administer a peridural analgesic. Routine extraction is no longer necessary during the expulsion phase but the authors remain faithful to uterine revision. In general, the labor test should be suggested as often as possible and should receive the same monitoring and treatment methods as for an intact uterus.