Correlación entre la edad cronológica y dental con los estadios de maduración vertebral / Correlation between chronological and dental age with vertebral maturation stages

Introducción: el desarrollo esquelético y dental es una condición determinante como factor principal de mala oclusión e influye en la evaluación, diagnóstico y planificación de los tratamientos de ortodoncia. Objetivo: estimar la correlación entre la edad cronológica y dental con los estadios de maduración vertebral. Material y métodos: la edad cronológica y dental se estimó por los métodos de Baccetti y el de Demirjian, con la lectura de 400 radiografías panorámicas y laterales de cráneo de 205 mujeres y 195 varones, con edades entre 4 y 17 años. La significancia estadística se estableció con el valor p < 0.05 del coeficiente de correlación de Pearson utilizando el programa SPSS v.24. Resultados: se observó un mayor porcentaje entre el estadio D de Demirjian con el estadio I de madurez de las vértebras cervicales (CVM) de Baccetti, seguido del estadio de calcificación dentaria E con el estadio CVM II. Además, existió una correlación moderada entre el método de Baccetti y el método de Demirjian en la pieza 37 (R2 = 0.3741) para la apreciación de la edad cronológica de un individuo. Conclusión: existe una buena correlación entre la edad cronológica y dental con los estadios de la maduración vertebral cervical, sin existir diferencias significativas por el sexo del individuo (AU)

Introduction: skeletal and dental development is a determining condition as the main factor of malocclusion and influences the evaluation, diagnosis, and planning of orthodontic treatments. Objective: to estimate the correlation between chronological and dental age with vertebral maturation stages. Material and methods: chronological and dental age was estimated by the Baccetti and Demirjian methods, with the reading of 400 panoramic and lateral skull radiographs of 205 women, and 195 men, aged between 4 and 17 years. Statistical significance was established with the value p < 0.05 of the Pearson correlation coefficient using the SPSS v.24 program. Results: a higher percentage was observed between Demirjian stage D with Baccetti cervical vertebral maturation (MVC) stage I, followed by dental calcification stage E with MVC stage II. In addition, there was a moderate correlation between the Baccetti method and the Demirjian method in piece 37 (R2 = 0.3741) for the assessment of the CD of an individual. Conclusion: there is a good correlation between chronological and dental age with the stages of cervical vertebral maturation, without significant differences due to the sex of the individual (AU)

Lower and extended dosage of misoprostol for cervical ripening in 1st trimester miscarriage (MISO200): A randomized clinical trial.

OBJECTIVE: To compare the efficacy of priming the uterine cervix before Manual Vaccum Aspiration (MVA) using 200 µg or 400 µg of vaginal misoprostol, inserted a mean time of 6 h before MVA in first trimester miscarriage. STUDY DESIGN: Randomized, triple-blind, non-inferiority clinical trial. Patients between 18 and 50 years old, with a diagnosis of miscarriage, were eligible for the study. Patients were allocated to receive either 200 µg or 400 µg of misoprostol before the MVA. The primary outcome was the need to dilate the uterine cervix with mechanical dilators (Hegar dilators). As a secondary outcome, cervical dilatation ≥8 mm before the procedure was considered successful. A difference of <25% was considered as non-inferior. RESULTS: Between December 21, 2016 and October 6, 2019, 269 women were screened. After screening, 105 and 106 women received 200 µg and 400 µg of misoprostol, respectively. Mechanical cervical dilatation was not necessary in 84.8% (95%CI 77% to 90%) and 96.2% (95%CI 91% to 99%), in the 200 µg and 400 µg groups, respectively [difference = 11.5% (95%CI 3.7% to 19.2%). Cervical dilatation of ≥8 mm was 52.4% (95%CI 42.9% to 61.7%) in the 200 µg misoprostol group, while in the 400 µg group was 71.7% (95%CI 62.5% to 79.4%) [difference = 19.3% (95%CI 6.5 to 32.2). CONCLUSION: After a mean time of 6 h, 200 µg of vaginal misoprostol is not inferior to 400 µg of misoprostol for cervical priming before MVA, in first trimester miscarriage. This non-inferiority was not observed when the ≥8 mm criterion was considered.

Comparison between 200 µg and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial.

OBJECTIVE: To compare between 200 and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy. METHODS: Quadruple-blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 µg,10-12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi-square tests of association, Fisher's exact and Mann-Whitney U tests were used with an α error of <5%. RESULTS: There was no statistical difference between the groups in the mean of the cervical width (800 µg: 6.5 ± 1.6 mm vs 200 µg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800-µg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800-µg group with statistical difference (100% vs 0%; P = 0.01). CONCLUSION: For cervical ripening, 200 µg misoprostol is equally effective with fewer adverse effects than 800 µg before operative hysteroscopy. CLINICALTRIALS: gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.

Sonographic cervical length predicts vaginal delivery after previous cesarean section in women with low Bishop score induced with a double-balloon catheter.

OBJECTIVE: To assess the role of cervical length when predicting vaginal delivery after a previous cesarean section (CS) in women with low Bishop score following the use of a double-balloon catheter for induction of labor (IOL). METHODS: A prospective, longitudinal study was conducted at a large teaching hospital in Santiago to recruit pregnant women at term with a previous CS and Bishop score ≤6 for IOL with a double-balloon catheter. The device was maintained for up to 24 h and the patient continued IOL with oxytocin only if the Bishop score was >6. Demographic and clinical variables were recorded and compared against vaginal delivery as the primary outcome. Multivariate logistic regression analysis was used to compare perinatal demographic and clinical variables in women achieving vaginal delivery versus those having a repeat CS. RESULTS: The final cohort included 40 pregnant women. Women achieving vaginal delivery (n = 17, 42.5%) had statistically significant differences in mean cervical length (24.8 mm versus 33.4 mm, respectively; p = .006), median Bishop score after removing the double-balloon catheter (11 versus 7, respectively; p = .005), and mean interval between double-balloon catheter placement and vaginal delivery or the decision to perform a CS (17.4 h versus 23.6 h, respectively; p = .03). Backward stepwise selection revealed an odds ratio of 0.90 (95% confidence interval = 0.82-0.98) for cervical length and a receiver operating characteristic curve area of 0.73. CONCLUSION: Cervical length, as determined by transvaginal sonography, proved to be effective in predicting vaginal delivery in women with a previous CS and low Bishop score following the use of a double-balloon catheter for IOL.

Correlación entre los estadios de maduración ósea de las vértebras cervicales y los estadios de formación del canino mandibular / Correlação entre os estágios de maturação óssea das vertebras cervicais e os estágios de formação do mandibular canino / Correlation between the skeletal maturation of the cervical vertebrae and stage of mandibular canine calcification

Resumen: La evaluación de la maduración ósea es de gran importancia en la toma de decisiones con respecto al plan de tratamiento de diferentes maloclusiones que pueden depender del pico de crecimiento mandibular. El objetivo de este estudio fue evaluar la correlación entre las etapas de calcificación del canino mandibular permanente observadas en la radiografía panorámica con los estadíos de maduración cervicales observados en la radiografía cefálica lateral. Materiales y Métodos: Se realizó un estudio descriptivo, transversal y correlacional, evaluando los estadios de maduración ósea de las vértebras cervicales utilizando el método de Baccetti, y los estadios de desarrollo del canino mandibular utilizando las etapas descritas por Demirjian. La muestra estuvo conformada por radiografías panorámicas y cefálicas laterales de 81 sujetos (hombres y mujeres) con una edad comprendida entre los 9 y los 14 años. Las variables fueron comparadas mediante estadística inferencial utilizando tablas de contingencia y la pruebas Chi2 de Pearson. Resultados: La correlación entre la maduración dental y cervical para el género masculino fue de 0,689 y para el femenino de 0,690 p<0,001. Las etapas F y G observadas en el canino mandibular coincidieron con las etapas CS1 y CS3 de maduración respectivamente. Conclusión: se observó que las etapas de formación radicular del canino mandibular presentan relación con las etapas de maduración cervical siendo útil su determinación para inferir cercanía del pico de crecimiento prepuberal.

Resumo: A avaliação da maturação óssea é de grande importância na tomada de decisões quanto ao plano de tratamento das diferentes maloclusões que podem depender do pico de crescimento mandibular. O objetivo deste estudo foi avaliar a correlação entre as etapas de calcificação de caninos mandibulares permanentes observados na radiografia panorâmica com os estágios de maturação cervical observados na radiografia cefálica lateral. Materiais e Métodos: Foi realizado um estudo descritivo, transversal e correlacional, avaliando os estágios de maturação óssea das vértebras cervicais pelo método de Baccetti e os estágios de desenvolvimento dos caninos inferiores pelas etapas descritas por Demirjian. A amostra foi composta por radiografias cefálicas panorâmicas e laterais de 81 indivíduos (homens e mulheres) com idade entre 9 e 14 anos. As variáveis foram comparadas por estatística inferencial por meio de tabelas de contingência e testes Chi2 de Pearson. Resultados: A correlação entre a maturação dentária e cervical para o gênero masculino foi de 0,689 e para o feminino, 0,690 p <0,001. As etapas F e G observadas no canino inferior coincidiram com as etapas CS1 e CS3 de maturação, respectivamente. Conclusão: observou-se que os estágios de formação radicular do canino inferior estão relacionados aos estágios de maturação cervical, sendo sua determinação útil para inferir a proximidade do pico de crescimento pré-púbere.

Abstract: Orthodontic treatment plan decisions may rely on establishing the timing of the mandibular growth peak, thus the evaluation of skeletal maturation is of importance. The aim of this study was to determine the correlation between the stages of permanent mandibular canine calcification observed in the panoramic radiography with the cervical maturation stages observed in the lateral cephalic radiography. Materials and Methods: A descriptive, cross-sectional and correlational study was performed evaluating the stages of bone maturation of the cervical vertebrae using the Baccetti method, and the stages of development of the mandibular canine using the stages described by Demirjian. The sample consisted of panoramic and lateral cephalic radiographs, obtained from 81 subjects (men and women) with ages between 9 and 14 years. The variables were compared using inferential statistics using contingency tables and Pearson's Chi2 tests. Results: The correlation between dental and skeletal maturation found for the males was 0.689 and for females, 0.690 (p <0.001). The F and G stages observed in the mandibular canine coincided with the stages CS1 and CS3 maturation respectively. Conclusion: Dental formation stages for the mandibular canine are related to cervical maturation stages and may be useful to infer timing of prepuberal growth peak.

Parto pré-termo espontâneo sem rotura de membranas: intervenções para evitar o parto pré-termo / Spontaneous preterm birth without rupture of membranes: interventions to prevent preterm birth

A prematuridade é uma síndrome com múltiplos fatores de risco e cuja causa permanece desconhecida, mas, independentemente da etiologia, a parturição converge para uma via final comum de esvaecimento, dilatação e encurtamento do colo uterino. Do ponto de vista hormonal, o responsável por esse processo é a progesterona. A prevenção de quadros de prematuridade pode basear-se em tratamentos medicamentosos como a administração diária de comprimidos de progesterona; intervenções cirúrgicas para a contenção da cérvice uterina com fios inabsorvíveis mantidos até o termo, a cerclagem cervical; e o pessário cervical, dispositivo de silicone que envolve e inclina o colo uterino, evitando sua abertura. Para propor qualquer intervenção profilática ou terapêutica, a avaliação ultrassonográfica via transvaginal no segundo trimestre gestacional desempenha papel crucial. Apresentamos neste terceiro e último artigo da série sobre parto pré-termo espontâneo as intervenções terapêuticas e o rastreamento do colo uterino.(AU)

Preterm birth is a syndrome with multiple risk factors, with unknown etiology. Parturition converges to a final path with uterine cervix effacement, dilation and shortening and progesterone is the hormone responsible for this process. Preterm birth prevention relies on daily administration of progesterone pills; cerclage as a surgical intervention; or cervical pessary, a vaginal silicone device that enfolds and deflects the cervix, avoiding its opening. To propose any of these interventions it is crucial to evaluate the cervix during the second trimester by transvaginal ultrasound. Here, in the third and last article regarding preterm birth without membrane disruption, we present therapeutic interventions and ultrasound screening.(AU)

Parto pré-termo espontâneo sem rotura de membranas: prevalência, fatores de risco e o papel do colo uterino / Spontaneous preterm birth without premature rupture of membranes: prevalence, risk factors and the role of the cervix

Cerca de 15 milhões de prematuros nascem por ano globalmente. Em 2015 ocorreram mais de 4 milhões de mortes de crianças menores de 5 anos, e as complicações da prematuridade são a principal causa de óbito em neonatos. O parto pré-termo é uma síndrome em que múltiplas etiologias convergem para uma via final única, e os fatores de risco mais importantes são antecedente de prematuridade e gestação gemelar. O colo uterino tem a função de manter a gestação desde a concepção até o parto, e seu processo de amadurecimento gera esvaecimento, dilatação e encurtamento, num continuum que pode compreender desde quadros de insuficiência cervical até o parto pré-termo espontâneo sem rotura de membranas. Este primeiro artigo, da série de três, descreve a prevalência da prematuridade, seus fatores de risco e o papel do colo uterino no processo de parturição.(AU)

Around 15 million preterm births happen globally. In 2015 over 4 million deaths in children under 5 years of age died and preterm birth complications is the leading cause in neonates. Preterm birth is a multiple etiology syndrome, in which various causes converge to a single parturition path. The most important risk factors are multiple gestation and obstetrical history of preterm birth. Uterine cervix is responsible for pregnancy maintenance from conception to birth, and its remodeling process generates effacement, dilation and shortening in a continuum that comprises conditions from cervical insufficiency to preterm birth without membrane disruption. This is a first article, of a series of three, describing preterm birth prevalence, risk factors and uterine cervix role in parturition.(AU)

Comprimento de colo uterino ao ultrassom transvaginal como preditor de risco do parto pré-termo espontâneo / Ultrasound cervical lenght predicting risk for spontaneous preterm birth

O encurtamento do colo uterino é parte da via final comum da parturição seja a termo ou pré-termo. A identificação precoce do comprimento cervical encurtado ao ultrassom transvaginal no segundo trimestre gestacional pode atuar como preditor de risco de prematuridade. Desde a década de 1990, vários estudiosos dedicaram-se a estabelecer parâmetros de referência para as medidas de colo uterino entre 16 e 24 semanas e até hoje o limite mais consensualmente aceito é de 25 mm. Especialistas são favoráveis à triagem universal, mas diretrizes internacionais são controversas quanto à investigação em casos sem antecedente de parto pré-termo, além de diversos estudos apresentarem que há custo-efetividade no rastreamento universal. Neste artigo, discutimos criticamente os parâmetros apresentados por estudos históricos e balizadores de conduta, a custo-efetividade e os guidelines internacionais. Propomos ainda uma reflexão ao pré-natalista, sugerindo a individualização da conduta perante os dados de cada gestante específica.(AU)

Cervical shortening is the final path of parturition, regardless if it is term or preterm. Precocious identification of a shortened cervix by transvaginal ultrasound during the second gestational trimester can act as a risk predictor of prematurity. Since the 1990´s decade, numerous studies established reference ranges for cervical length measurement between 16 to 24 gestational weeks and the most accepted cutoff limit is 25 mm. Experts indicate universal screening, however international guidelines are controversial, even in cases without a history of preterm birth, furthermore, many studies demonstrated cost-effectiveness about the universal screening of cervical length in middle gestation. In this article we discuss historical reference ranges, cost- -effectiveness, and international guidelines. We propose critical thinking and suggest individualized management according to specific characteristics of each patient.(AU)

Relación de la edad cronológica con la maduración ósea cervical mediante el método de Baccetti / Relationship of the chronological age with cervical bone maturation through the Baccetti method

Introducción: Es importante valorar el momento ideal en el que se producen los cambios tanto biológicos como estructurales en el crecimiento y desarrollo de los maxilares, para identificar en qué momento se inicia del crecimiento puberal en los pacientes jóvenes y corregir las alteraciones tanto dentarias como esqueléticas que se puedan presentar. Objetivo: Evaluar los estadios de maduración de las vértebras cervicales mediante el análisis propuesto por Baccetti y su relación con la edad cronológica y el sexo, en radiografías laterales de individuos de 8 a 14 años. Metodología: Estudio transversal, retrospectivo y descriptivo. Se evaluaron 280 radiografías laterales (140 de varones y 140 de mujeres). Un evaluador calibrado evaluó los estadios de maduración esquelética e identificó 6 de ellas. Se evaluó el pico de crecimiento de los individuos desde la segunda a la cuarta vértebra cervical en las radiografías y luego se relacionó con la edad y el sexo de los individuos. Se utilizaron las pruebas de asociación de Chi cuadrado p < 0,05. Resultados: En las edades de 11 y 12 años se observó que las mujeres tenían mayor grado de madurez que los varones; sin embargo, para apreciar mejor los resultados, se reagruparon según los estadios: 1 con 2, 3 con 4 y 5 con 6, y se encontraron diferencias estadísticamente significativas entre ellos (p < 0,001). Conclusiones: Existe asociación en el diagnóstico del pico de crecimiento y la maduración ósea de los pacientes según su edad cronológica, con una clara diferencia entre varones y mujeres, lo que evidencia que el método de Baccetti se pueda emplear de manera confiable en la población estudiada. (AU)

Introduction: In Orthodontics, it is important to assess the ideal moment where changes occur, both biological and structural in relation to the growth and development of the jaws, thus identifying, at what time, the onset of pubertal growth in young patients and substantiate their dental correction as skeletal, achieving a positive result through its planning and application, correcting its discrepancies or alterations that may occur. Objective: To evaluate the stages of maturation of the cervical vertebrae through the analysis proposed by Baccetti and its relationship with chronological age according to age and sex, on lateral head X-rays of individuals aged 8 to 14 years. Methodology: This was a crosssectional, retrospective, descriptive study. 280 lateral head X-rays were evaluated (140 men and 140 women). A trained and calibrated evaluator evaluated the stages of skeletal maturation with the method proposed by Baccetti, identifying 6 stages. The peak of growth of the individuals was evaluated through the second to the fourth cervical vertebra on radiographs and then related to the chronological age and sex of the individuals. Chi square association tests were used p < 0.05. Results: In the ages of 11 and 12, it is observed that women have a greater degree of maturity than men, however, in order to better appreciate the results, they were regrouped according to the stages of maturity of cervical vertebrae 1 with 2, 3 with 4 and 5 with 6 and statistically significant differences were found between the stages of maturation of the cervical vertebrae according to age and sex (p < 0.001). Conclusions: There is an association in the diagnosis of peak growth and bone maturation of patients according to their chronological age, producing a clear difference between men and women, which shows that the Baccetti method can be used reliably in the population studied. (AU)

A randomized controlled trial comparing isosorbide dinitrate-oxytocin versus misoprostol-oxytocin at management of foetal intrauterine death.

BACKGROUND: The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus. OBJECTIVE: To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD). METHODS: Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. RESULTS: The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. CONCLUSION: This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation. TRIAL REGISTRATION: Clinicaltrials.gov NCT02488642.

Inadequate adherence to the recommendations regarding labor induction as a trigger of cesarean section in women with singleton term pregnancy. A descriptive study / Cumplimiento inadecuado de las recomendaciones para el proceso de la inducción del trabajo de parto como desencadenante de la cesárea en mujeres con embarazo simple a término. estudio descriptivo

ABSTRACT Objective: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention. Materials and methods: Descriptive historical cohort that included pregnant women without a history of previous cesarean section, with singleton term pregnancy and cephalic presentation who were subjected to labor induction in a Level III complexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indication for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guidelines arising from the 2012 proposal of limiting the first cesarean section were used in order to define adherence to the recommendations for induction. Results: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, given that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section. Conclusion: Failure to adhere to the recommendations for adequate induction was found, added to an incorrect diagnosis of failed induction.

RESUMEN Objetivo: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. Materiales y métodos: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. Resultados: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas sometidas a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37 %) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se consideró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. Conclusión: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Vía de finalización en pacientes con segunda inducción al trabajo de parto en el Hospital Nacional prof. A. Posadas / Postterm pregnancy in patients with second labour induction - Author's experience

The labour induction is an intervention to initiate artificially the uterine contractions to produce the effacement and dilatation of the uterine cervix until the child-birth is achieved. It is indicated when the benefit of the termination of the pregnancy for the mother and the child is greater than its continuation. It is perfored in more or less the 20 % of the women. In our institution the rate oscillates in around the 9 % of the cases. It is understand as an successful induction the termination of the labour through the vaginal delivery. The methods for labour induction more commonly used at present are mechanical and pharmacological. Between the first group we can find the Hamilton maneuver and the amniotomy. And between the pharmacologicals we find the oxytocine. These elements are considered in the article

Vía de finalización en inducciones de embarazos postérmino, según score de Bishop / Induction of postterm pregnancies according to Bishop score

Objetivo: Determinar la vía de finalización en embarazos pos término de mujeres que fueron internadas para inducción al trabajo de parto y establecer la relación entre la vía de finalización y Bishop de comienzo. Pacientes y métodos: Estudio Observacional, Descriptivo, Transversal, de 2013 a 2014. La población se identificó del SIP de aquellas pacientes con embarazo mayor a 41 semanas internadas para inducción. Test de Fisher exacto o Chi cuadrado para evaluar la siginficancia estadística p=0.05. Resultados: De 197 pacientes, la media fue de 24 años. El 21% comenzó la inducción con Bishop entre 0 y 3 puntos, 59.5% entre 4 y 6 puntos. 13 pacientes recibieron una segunda inducción tras la primera fallida. El 67.5% de las inducciones finalizaron por parto vaginal, 32.5% cesárea. De las mujeres con score 0-3 puntos el 61,5% finalizaron por cesárea, para el segundo grupo (Bishop 4-6) el 71.8% de las inducciones finalizó por parto vaginal, encontrándose una significancia estadística en estas relaciones, test de Fisher=0.000. Conclusiones: Podríamos relacionar el score de Bishop de comienzo de inducción con la vía de finalización y si bien se han encontrado gran porcentaje de partos vaginal con score de 4 en adelante, el 61.5% de las mujeres que pertenecían al grupo de 0-3 finalizaron por la vía quirúrgica por lo que podría recomendarse la maduración cervical previa inducción en este grupo de como estatregia para la reducción de la tasa de cesáreas en inducciones por 41 semanas.

The aim of this report was to present an evaluation of induction of postterm pregnancies according to the ´Bishop score in women admitted for labor induction. Labor induction is an intervention in order to iniciate artificially the uterine contractions to produce the effacement and the dilatation of the uterine cervix and to end with a birth. At present we have three main methods for induction, oxytocin, prostaglandins and amniotomy. The pregnancy chronologically prolongued refers to that simple gestation that reaches or overcomes the 294 days since the date of the last menstruation. It is known that the pregnancies chronologically prolongued are associated with a rise of the maternal and perinatal morbimortality, and therefore, since they are diagnosed. It is mandatory the management toward a minimization of the risks. For these reasons, it is recommended, in the case of a prolonged pregnancy, to consider beneficial to begin the parturition for security reasons for the mother and the fetus. ´These considerations are referred in the article

Quantitative assessment of cervical softening during pregnancy in the Rhesus macaque with shear wave elasticity imaging.

Abnormal parturition, e.g. pre- or post-term birth, is associated with maternal and neonatal morbidity and increased economic burden. This could potentially be prevented by accurate detection of abnormal softening of the uterine cervix. Shear wave elasticity imaging (SWEI) techniques that quantify tissue softness, such as shear wave speed (SWS) measurement, are promising for evaluation of the cervix. Still, interpretation of results can be complicated by biological variability (i.e. spatial variations of cervix stiffness, parity), as well as by experimental factors (i.e. type of transducer, posture during scanning). Here we investigated the ability of SWEI to detect cervical softening, as well as sources of SWS variability that can affect this task, in the pregnant and nonpregnant Rhesus macaque. Specifically, we evaluated SWS differences when imaging the cervix transabdominally with a typical linear array abdominal transducer, and transrectally with a prototype intracavitary linear array transducer. Linear mixed effects (LME) models were used to model SWS as a function of menstrual cycle day (in nonpregnant animals) and gestational age (in pregnant animals). Other variables included parity, shear wave direction, and cervix side (anterior versus posterior). In the nonpregnant cervix, the LME model indicated that SWS increased by 2% (95% confidence interval 0-3%) per day, starting eight days before menstruation. During pregnancy, SWS significantly decreased at a rate of 6% (95% CI 5-7%) per week (intracavitary approach) and 3% (95% CI 2-4%) per week (transabdominal approach), and interactions between the scanning approach and other fixed effects were also significant. These results suggest that, while absolute SWS values are influenced by factors such as scanning approach and SWEI implementation, these sources of variability do not compromise the sensitivity of SWEI to cervical softening. Our results also highlight the importance of standardizing SWEI approaches to improve their accuracy for cervical assessment.

Inducción al parto en mujeres con score de Bishop desfavorable / LABOUR INDUCTION IN WOMEN WITH UNFAVOURABLE BISHOP'S SCORE

Objetivo: Primario: Determinar vía de finalización del embarazo en mujeres con score de Bishop desfavorable con maduración cervical previa, en relación con aquellas sin maduración, en el Hospital Nacional Posadas, 01/01/2015- 31/12/2015. Secundarios: Establecer indicación de inducción y cesárea; frecuencia de inicio de trabajo de parto y de segunda inducción; resultados perinatales y presencia de complicaciones puerperales. Material y Método: Estudio observacional, descriptivo, transversal. La población fue identificada a partir del SIP. Se realizó un relevamiento de las historias clínicas. Se incluyeron mujeres embarazadas con indicación de inducción al parto, embarazo único a partir de 24 semanas, feto vivo y score de Bishop desfavorable. Las variables se presentan como medidas de frecuencia y tendencia central. Las comparaciones se realizaron a través de Fisher exact test y Chi2 , p valor<=0.05. Resultados: En el periodo estudiado acontecieron 3312 nacimientos de fetos vivos, de los cuales 310 correspondieron a inducciones. El 46% presentaban score de Bishop desfavorable (N=141). El 33% recibió maduración cervical (n=46), de las cuales 56% finalizó por parto vaginal, en comparación con un 39% de las que no la recibieron (n=95) (p=0.04). El 85% de aquellas mujeres que recibieron maduración cervical inició trabajo de parto, frente al 68% de las que no la recibieron (p=0.03). Discusión: Determinamos la importancia de la maduración cervical para el éxito de inducciones con score de Bishop desfavorable. Consideramos de importancia la disponibilidad del mismo a nivel público, para garantizar el acceso de las mujeres a todas las herramientas disponibles para un nacimiento seguro

Objectives: Primary: To determine the mode of birth in women with unfavorable Bishop score with prior cervical ripening, compare to those without maduration, Posadas National Hospital, 01/01 / 2015-31 / 12/2015. Secondary: To establish inductions and cesarean section indications; begin labour active phase frecuency and second induction frecuency; perinatal outcomes and puerperal complications. Patients and methods: Observational, descriptive, cross-sectional study. The population was identified from SIP. A survey of medical records was performed. Inclusion criteria were labour induction, after 24 weeks, live fetus and unfavorable Bishop score. The variables are presented as measures of frequency and central tendency. Comparisons were made by Fisher exact test and Chi2 , p value <= 0.05. Results: 3312 births of live fetuses, of which 310 were inductions. 46% had unfavorable Bishop score (N=141). 33% received cervical ripening (n=46), 56% vaginal delivery , compared with 39% cesarean section (n=95) (p=0.04). 85% of women who received cervical ripening, began with labour active phase, compared with 68% of those who did not (p=0.03).Discussion: We determine the importance of cervical ripening for successful inductions with unfavorable Bishop score. We consider important the availability of the public level, to ensure access of women to all available tools for a safe birth.

Comparison between vaginal and sublingual misoprostol 50 µg for cervical ripening prior to induction of labor: randomized clinical trial.

OBJECTIVE: To compare the effectiveness and safety of sublingual versus vaginal misoprostol on improving the Bishop score after 6 h of administration. METHODS: Randomized clinical trial which includes pregnant women in gestational ages from 32/0 to 41/6, with indication of induction of labor with misoprostol. Bishop score was assessed at the time of induction and 6 h after administration of 50 µg misoprostol. Analysis was made over difference in mean Bishop score of 2 points, using a standard deviation of 2, with 90% power, reaching a 95% confidence interval. RESULTS: 102 patients were studied, 51 received sublingual misoprostol, and 51 received vaginal misoprostol. There was a statistically significant difference in cervical modifications in global terms regardless of the administration route at 6 h (P < 0.05). When analyzing each group, there was no significant difference for the mean and standard deviation for Bishop score for sublingual and vaginal route (P = 0.761). There was no significant difference in terms of mode of delivery, Apgar score, cord pH, nor in the presence of complications. CONCLUSION: There is no statistically significant difference in terms of administration route for cervical ripening using misoprostol 50 µg, whether it was sublingual or vaginal. TRIAL REGISTRATION NUMBER: NCT02732522. Registry website: https://clinicaltrials.gov/ .

Associação entre a idade óssea determinada pelas vértebras cervicais e estágios de desenvolvimento de formação dentária / Association between bone age determined by cervical vertebrae and dental formation development stages

A proposta deste estudo foi verificar a associação entre estágios de formação radicular de caninos e primeiros pré-molares em radiografias panorâmicas e a idade óssea determinada por meio da 3ª vértebra cervical em telerradiografias em norma lateral e buscar uma alternativa à determinação da idade esquelética, utilizando-se apenas uma variável de análise vértebra C3 ou Índice Nolla, dispensando-se uma segunda comprovação por meio da radiografia carpal. A pesquisa deu-se através da análise de telerradiografias e radiografias panorâmicas de 122 pacientes, com idades entre 8 e 12 anos de idade, com calibração Kappa de 100% de confiabilidade. Pela amostra analisada, pôde-se concluir que a utilização de forma isolada dos estágios de maturação esquelética é compatível com os índices de correlação positivos apresentados para a maturação vertebral. No entanto, houve uma baixa correlação entre os estágios de maturação radicular dentária pela escala de Nolla e os estágios de maturação vertebral. (AU)

The aim of this study was to verify the association between dental root formation stages of canines and first premolars in panoramic radiographies and the bone age determined by means of the third cervical vertebra in lateral teleradiography, as well as to seek for an alternative to determine skeletal age using a single analysis variable - C3 vertebra or Nolla Index eliminating the require for a second validation through carpal radiography. The research consisted on the analysis of teleradiography and panoramic radiography of 122 patients, aged between 8 and 12, with 100% Kappa calibration reliability. Through the sample analyzed, it was possible to conclude that the isolated use of skeletal maturation is compatible with the positive correlation coefficients presented for vertebral maturation. However, Nolla scale showed low correlation between the stages of dental root maturation and vertebral maturation.(AU)

Characterization of potentially avoidable cases in a 1-year series of consecutive cesarean sections in the tertiary maternity unit of Guadeloupe (French West Indies).

AIM: The global increase in the rate of cesarean sections (CS) is currently an issue. We aimed to assess the rate of CS locally and to identify cases in which this procedure may have been avoidable. METHODS: In this prospective consecutive series, we analyzed the 478 CS carried out in our unit in 2009. We analyzed the characteristics of each case, and classified each as potentially avoidable or unavoidable. RESULTS: The total rate of CS was 24.0%, including 1.7% that was scored as potentially avoidable. Parity, gestational age at birth, birthweight, cases requiring cervical ripening, cases of labor induction, and CS during labor were all significantly higher or more frequent among potentially avoidable CS. Multivariate analysis indicated that the risk of potentially avoidable CS was positively associated with gestational age and tended to be negatively associated with parity. The main indications for potentially avoidable CS were cervical dystocia and abnormal fetal heart rate, and for unavoidable CS they were abnormal fetal heart rate and history of previous CS. CONCLUSION: Labor, especially when induced, seems to be the key period for the prevention of 'avoidable' CS. This is particularly important given that potentially avoidable CS are more frequently associated with uncomplicated pregnancies than are unavoidable CS. A woman's first CS increases the likelihood of CS for subsequent deliveries, so the prevention of the first CS is a key aim for reducing the overall rate of CS.

Predicting success of labor induction in singleton term pregnancies by combining maternal and ultrasound variables.

OBJECTIVE: To assess pre-induction maternal and ultrasonographic factors in the prediction of the onset of labor within 12 h, and vaginal delivery (VD) irrespective of the induction-to-delivery interval in term pregnancies. METHODS: We performed a prospective cohort study with 204 singleton pregnant women between 37 and 42 weeks of gestation. The following maternal and ultrasonographic variables were assessed: parity, marital status, height, body mass index (BMI), previous cesarean section (Cs), Bishop score, variety of fetal position, single deepest pocket (SDP), fetal middle cerebral and umbilical artery resistance indices, cervical length (CL) measurement, posterior cervical angle (PCA), head circumference (HC) and estimated fetal weight (EFW). χ(2) test and logistic regression analysis were applied to compare the groups. Receiver operating characteristics (ROC) curves were determined. RESULTS: VD occurred in 116 (56.9%) women. Prediction of the onset of labor within 12 h was provided by the BMI and resistance index of the fetal middle cerebral artery. Prediction of the VD irrespective of the induction-to-delivery interval was provided by height, BMI, parity, number of prenatal visits, consistency, effacement and dilation of uterine cervix, PCA, oligohydramnios, HC and EFW. Area under ROC curve for PCA and EFW were 63.5 (sensibility: 66.4%, specificity: 59.1%) and 60.2 (sensibility: 54.3%, specificity: 70.4%), respectively. CONCLUSIONS: Several pre-induction maternal and ultrasonographic factors can increase the chance of achieving a successful VD. PCA and EFW were the best ultrasonographic predictors for the success of induction of labor; however, with limited potential to be used in the clinical practice.