Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal / Variability in the rate of episiotomies and its relation to severe perineal tears and neonatal morbility

Objetivo Determinar la variabilidad en la práctica de episiotomías entre matronas y su relación con la aparición de desgarros perineales tipo III-IV, así como sus repercusiones sobre la morbilidad neonatal. Método Cohortes históricas sobre 2.366 partos eutócicos con feto vivo único, mayor o igual a 37 semanas de gestación y 18 matronas del Hospital la Mancha-Centro de Alcázar de San Juan durante los años 2009, 2010 y 2011. Las variables principales fueron la incidencia de episiotomías, desgarros perineales y morbilidad neonatal. Resultados La variabilidad en la práctica de la episiotomía osciló entre el 19,5 y el 50,1% entre las 18 matronas a estudio, con una tasa promedio del 34,9% (824). Al agrupar por intervalo, el 22,1% (524) presentaba una tasa ≤ 25%, el 26,1% (621) entre el 26-35%, el 38% (898) entre el 36-44% y el 13,7% (323) una tasa ≥ 45%, observándose homogeneidad entre los grupos para todos los factores de confusión. No se observó asociación estadística entre mayores tasas de episiotomías y pH de arteria umbilical < 7,10, puntuaciones de apgar a los 5 min < 7 y grado de reanimación neonatal tipo III y IV. Tampoco encontramos asociación entre tasa de episiotomías con integridad perineal y desgarros tipo III-IV. ConclusiónLa variabilidad en la tasa de episiotomías es alta y no se relaciona con la mayor presencia de desgarros tipo III y IV, ni mayor morbilidad neonatal. No se justifican tasas mayores del 25% de episiotomías para prevenir el trauma perineal ni la pérdida de bienestar fetal (AU)

Objective: To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity. Method: A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in «Mancha-Centro» Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity. Results: The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524)had a rate of ≤ 25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323)a rate of ≥ 45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery <7.10, Apgar score after 5 min <7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears. Discussion: The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being (AU)

[Differences in cesarean sections between spontaneous and induced labour]. / Diferencias en el número de cesáreas en los partos que comienzan espontáneamente y en los inducidos.

BACKGROUND: The induction of labour (IOL) may be associated with complications for pregnant women. The aim was to assess the differences in the number of caesarean sections between spontaneous or induced labour. METHODS: Historical groups from 841 women with induced labour and 2,534 women with an spontaneous onset of labour over a three- year period (from 2009 to 2011). They were carried out in "Mancha Centro" Hospital (Alcázar de San Juan). It was used a multivariate analysis through binary logistic regression to control confounding variables. RESULTS: The prevalence of IOL was 22,9%. The most frequent indications were: Premature Rupture of Membranes (22,7%), bad- controlled Diabetes (22,5%). It was reported a relation between induced labour and cesarean section risk due to parity (nulliparous OR= 2.68, IC 95%: 2.15- 3.34 and multiparous OR= 2.10, IC 95%: 1.72- 2.57). Postterm pregnancy (37,1%), pathological monitor (35.3%) and hypertensive diseases of pregnancy (34%) reported the highest risks of cesarean section. The IOL was related to other factors: a long- time length first -stage of labour (OR= 6.00; IC 95%: 4.02- 8.95), use of epidural analgesia (OR= 3.10; IC 95%: 2.24- 4.29) and blood transfusion needs (OR= 3.33; IC 95%: 1.70- 9.67). CONCLUSION: Independently of parity, The IOL increases the risk to: have a longer duration first- stage, use epidural analgesia, need a blood transfusion and have a cesarean section. This relation is stronger when induction is due to postterm pregnancy, pathological monitor or hypertensive diseases. No relation was found among induced labour and second- stage duration, episiotomy, perineal tears, excessive blood loss or uterine rupture.

Relation between induced labour indications and neonatal morbidity.

PURPOSE: To assess the main neonatal morbidity results in relation to induced labour indications. METHODS: Historical groups from a total of 3,817 deliveries over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan) formed the study group. All programmed and non-avoidable caesarean sections and pregnancies under 35 weeks were excluded. The main variable result was a neonatal morbidity variable made up of the Apgar score after 5 min, pH of umbilical artery <7.10 and the neonatal need for resuscitation type III-V. Multivariate analysis was used to control confounding variables. RESULTS: The incidence of induced labour was 22.6 % (862). The highest indication was premature rupture of membranes for more than 12 h 22.8 % (190), poorly controlled diabetes 22.6 % (189) and oligoamnios 16.2 % (135). The rate of pH lower than 7.10 was 2.8 % (22), the rate of the Apgar score lower than 7 after 5 min was 0.2 % (2) and the neonatal need for resuscitation type III-IV was 5.7 % (48) for induced labour. The relation between induced labour and neonatal morbidity indicators were not statistically significant. 10.1 % (4) of induced labour for suspected intrauterine growth restriction and 8.6 % (10) of postterm pregnancies required neonatal resuscitation type III-IV. DISCUSSION: No relation was found between induced labour and the neonatal morbidity indicators. The highest neonatal risk indicator is when a intrauterine growth restriction, hypertensión/preeclampsia or a postterm pregnancy is suspected.

Diferencias en el número de cesáreas en los partos que comienzan espontáneamente y en los inducidos / Differences in cesarean sections between spontaneous and induced labour

Fundamentos: La inducción del parto (IDP) puede estar asociada a mayores complicaciones para la mujer gestante. El objetivo de este trabajo fue determinar las diferencias en el número de cesáreas entre partos espontáneos y partos inducidos. Métodos: Cohortes históricas sobre un total de 841 inducciones y 2.534 partos espontáneos realizados entre 2009 y 2011 en el Hospital "Mancha-Centro" de Alcázar de San Juan. Se empleó análisis multivariante por medio de regresión logística binaria para control de la confusión. Resultados: La prevalencia de IDP fue del 22,9%, presentándose como indicaciones más frecuentes la rotura prematura de membranas (RPM) de más de 12 horas (22,7%) y diabetes mellitus mal controlada con un 22,5%. Se observó relación entre inducción y riesgo de cesárea tanto en mujeres nulíparas (OR= 2,68; Intervalo de confianza [IC] 95%: 2,15-3,34) como en multíparas (OR=2,10; [IC] 95%:1,72-2,57). La indicación con mayor riesgo de cesárea fue la gestación cronológicamente prolongada (GCP) (37,1%) seguida del registro cardiotográfico (RCTG) patológico (35,3%) y estados hipertensivos del embarazo (EHE) (4,0%). La IDP también se relacionó con la mayor duración de la dilatación (OR=6,00; IC 95%:4,02-8,95), empleo de epidural (OR=3,10;IC95%: 2,24-4,29) y necesidades de transfusión sanguínea (OR=3,33; IC %:1,70-5,67). Conclusiones: La IDP es un factor de riesgo para una mayor duración de la dilatación, empleo de analgesia epidural, necesidad de transfusión sanguínea y de cesárea tanto en mujeres nulíparas como en multíparas, especialmente en las indicaciones de gestación cronológicamente prolongada, registro cardiotocográfico patológico y estados hipertensivos del embarazo. No se encontró relación con la duración del período expulsivo, la práctica de episiotomía, desgarros, sangrado excesivo y rotura uterina (AU)

Background: The induction of labour (IOL) may be associated with complications for pregnant women. The aim was to assess the differences in the number of caesarean sections between spontaneous or induced labour. Methods: Historical groups from 841 women with induced labour and 2,534 women with an spontaneous onset of labour over a three- year period (from 2009 to 2011). They were carried out in "Mancha Centro" Hospital (Alcázar de San Juan). It was used a multivariate analysis through binary logistic regression to control confounding variables. Results: The prevalence of IOL was 22,9%. The most frequent indi- cations were: Premature Rupture of Membranes (22,7%), bad- controlled Diabetes (22,5%). It was reported a relation between induced labour and cesarean section risk due to parity (nulliparous OR= 2.68, IC 95%: 2.15- 3.34 and multiparous OR= 2.10, IC 95%: 1.72- 2.57). Postterm pregnancy (37,1%), pathological monitor (35.3%) and hypertensive diseases of preg- nancy (34%) reported the highest risks of cesarean section. The IOL was related to other factors: a long- time length first -stage of labour (OR= 6.00; IC 95%: 4.02- 8.95), use of epidural analgesia (OR= 3.10; IC 95%: 2.24- 4.29) and blood transfusion needs (OR= 3.33; IC 95%: 1.70- 9.67). Conclusion: Independently of parity, The IOL increases the risk to: have a longer duration first- stage, use epidural analgesia, need a blood transfusion and have a cesarean section. This relation is stronger when induction is due to postterm pregnancy, pathological monitor or hyperten- sive diseases. No relation was found among induced labour and second- duration, episiotomy, perineal tears, excessive blood loss or uterine rupture (AU)

[Variability in the rate of episiotomies and its relation to severe perineal tears and neonatal morbility]. / Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal.

OBJECTIVE: To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity. METHOD: A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity. RESULTS: The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery<7.10, Apgar score after 5 min<7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears. DISCUSSION: The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.

Aceptación de una sesión grupal de educaciónmaternal antes de la semana veinte en un centrode salud rural / Acceptance of a maternal education group session before week 20 in a rural health centre

Objetivos: determinar la magnitud de mujeres que acuden a unasesión educativa ofertada en la primera mitad del embarazo enun centro de salud rural. Conocer el perfil de las mujeres queacuden a dicha sesión frente a las que no lo hacen e identificarlos factores asociados a no asistir a la sesión educativa.Material y método: estudio descriptivo transversal en una zonabásica de salud rural del Área II de la Región de Murcia sobre34 mujeres de 20 semanas o menos de gestación, a las cualesla matrona les ofertó una sesión educativa. La recogida dedatos se realizó mediante un cuestionario elaborado “ad hoc”.Variables de estudio: edad, nacionalidad, fórmula obstétrica,asistencia a la charla, causa de la no asistencia y asistencia ala charla del tercer trimestre.Resultados: acudieron a la sesión 14 mujeres (41,17% de lapoblación susceptible). La nacionalidad era en su mayor parteespañola (85,72% en las que asistieron y 40% en las queno asistieron). En el grupo que asistieron eran primíparas enun 73,44% y en el que no asistieron lo eran en un 35%. Laedad gestacional media de las que acudieron fue de 12,42 y de15,07 en las que no asistieron. Un 65% no acudió por falta deinterés. Un 92,85% de las mujeres que acudieron, lo hicieronposteriormente a la educación maternal durante el tercer trimestre.Conclusiones: la aceptación de las gestantes ante la actividadfue relativamente buena. Cabe destacar que prácticamente todaslas mujeres que se interesaron por la sesión educativa acudierondespués a las sesiones del tercer trimestre, dato que revelala importancia de la captación precoz para el fomento dela motivación materna desde el principio de la gestación (AU)

Objectives: to determine the amount of women who attendan educational session offered during the first half of pregnancyin a rural health centre. To ascertain the profile of thewomen who attend this session versus those who do not andidentify the factors associated with non-attendance to thiseducational session.Material and method: cross-sectional descriptive study in arural basic health zone of area II in Murcia on a sample of 34women who were 20 weeks or more pregnant, to whom themidwife offered an educational session. Data collection wasperformed by means of an “ad-hoc” questionnaire. Study variables:age, nationality, obstetric formula, attendance to thesession, causes of non-attendance and attendance to the sessionin the third trimester.Results: 14 women attended the session (41,17% of the susceptiblepopulation). Nationality was primarily Spanish(85,72% of those who attended, and 40% of those who didnot). 73,44% of the women who attended and 15,07% of thosewho did not were first-time mothers. 65% did not attend dueto a lack of interest. 92,85% of the women who attended alsoattended the maternal educational session held during thethird trimester.Conclusions: the acceptance of the activity on the part of thepregnant women was relatively good. It should be noted thatpractically all women who were interested in the educationalsession later attended the sessions held in the third trimester,a fact which reveals the importance of early recruitment for thepromotion of maternal motivation from the beginning of pregnancy (AU)