Factores de riesgo asociados con el parto distócico



Artículo original Ginecol Obstet Mex 2007;75(9):533-38 RESUMEN Antecedentes: el parto distócico es una complicación frecuente y sus consecuencias perinatales pueden incluir desde lesiones menores hasta daño cerebral grave. Existen diversos factores relacionados con esta complicación. Objetivo: identificar los factores de riesgo vinculados en forma significativa con el parto distócico. Material y métodos: estudio de casos y controles. Se incluyeron 750 pacientes, distribuidas en: 250 mujeres con partos distócicos (ca-sos) y 500 con partos eutócicos (controles). Se registraron las variables demográficas y clínicas relacionadas con el parto distócico. El análisis se efectuó mediante porcentajes, media, desviación estándar, prueba de la t de Student, c 2 y análisis de regresión logística. Se asignó un valor a de 0.05. Resultados: los factores con significación estadística fueron: edad avanzada (p < 0.001), mayor estatura (p < 0.001), mayor peso del recién nacido (p = 0.009), baja paridad (p < 0.001) y mayor duración del trabajo de parto (p = 0.04). Otras variables, como el número de embarazos, las cesáreas previas, los abortos, el peso materno, la ganancia de peso durante el embarazo, el número de consultas durante el control prenatal, los antecedentes de parto distócico y la ruptura prematura de membranas no fueron significativas. Conclusiones: la identificación de los factores de riesgo relacionados con el parto distócico durante el control prenatal puede prevenir esta complicación y sus consecuencias materno-fetales. Palabras clave: distocia, parto distócico, factores de riesgo, control prenatal. ABSTRACT Background: the dystocic delivery is a frequent complication and its perinatal repercussions vary from minor lesions to severe brain damage. It has been reported diverse factors associated with this medical complication. Objective: to identify the risk factors with significant association with dystocic delivery. Material and methods: a case-control study was carried out. There were included 750 patients, divided into 250 women with dystocic deliveries (cases) and 500 women with eutocic deliveries (controls). Demographic and clinical variables were registered. The statistical analysis was performed with percentages, arithmetic media, standard deviation, Student t test, c 2 and logistic regression analysis. An alpha value was set at 0.05. Results: the factors with statistical significance were: advanced age (p < 0.001), major patient's height (p < 0.001), major new born's weight (p = 0.009), lower parity (p < 0.001), and prolonged duration of labor (p = 0.04). Other variables such as number of pregnancies, previous cesarean sections, spontaneous abortions, weight of the patient, weight earned during pregnancy, number of medical appointments during antenatal care, previous dystocic delivery, and premature rupture of the membranes, were not significant. Conclusions: there are clinical and demographic risk factors associated with dystocic delivery. To identify this risk factors during the ante-natal care could diminish the frequency of dystocic deliveries and therefore to avoid the associated maternal-fetal complications.

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    ABSTRACT: The objective of this study was to examine factors associated with the occurrence of shoulder dystocia and subsequent perinatal outcomes. We conducted a retrospective cohort study of 29,612 consecutive term, singleton, vertex vaginal deliveries. The primary outcome was reported shoulder dystocia. Fetal position, ethnicity, and their interaction terms were examined along with maternal characteristics, induction and length of labor, operative vaginal delivery, epidural, and birth weight in both bivariate and multivariate analyses. Among women who met study criteria, 524 (1.8%) experienced a shoulder dystocia. African American women had the highest risk of shoulder dystocia (2.6%), compared with other races/ethnicities (P = .001). Women who delivered in occiput posterior position were noted to have a lower risk for shoulder dystocia (1.1%) as compared with occiput anterior position (1.8%, P = .046). However, in the setting of a shoulder dystocia, a higher risk of brachial plexus injury was observed in neonates delivered in occiput posterior position (adjusted odds ratio 10.4, 95% confidence interval 3.03 to 35.88) by vacuum-assisted vaginal delivery (adjusted odds ratio 3.24, 95% confidence interval 1.37 to 7.67) and neonates weighing 4000 g or more (adjusted odds ratio 2.53, 95% confidence interval 1.09 to 5.85). Overall African American women have an increased risk of shoulder dystocia, but their neonates are not more likely to experience birth injury. Although occiput posterior position has a protective effect for shoulder dystocia, the risk of brachial plexus injury is increased in the setting of a persistent occiput posterior delivery. These factors should be used to consider a patient's prospective risk for shoulder dystocia and associated outcomes.
    American journal of obstetrics and gynecology 10/2006; 195(3):856-62. DOI:10.1016/j.ajog.2006.06.017 · 4.70 Impact Factor
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    ABSTRACT: To compare maternal and neonatal outcomes among grandmultiparous women to those of multiparous women 30 years or older. A database of the vast majority of maternal and newborn hospital discharge records linked to birth/death certificates was queried to obtain information on all multiparous women with a singleton delivery in the state of California from January 1, 1997 through December 31, 1998. Maternal and neonatal pregnancy outcomes of grandmultiparous women were compared to multiparous women who were 30 years or older at the time of their last birth. The study population included 25,512 grandmultiparous and 265,060 multiparous women 30 years or older as controls. Grandmultiparous women were predominantly Hispanic (56%). After controlling for potential confounding factors, grandmultiparous women were at significantly higher risk for abruptio placentae (odds ratio OR: 1.3; 95% confidence intervals CI: 1.2-1.5), preterm delivery (OR: 1.3; 95% CI: 1.2-1.4), fetal macrosomia (OR: 1.5; 95% CI: 1.4-1.6), neonatal death (OR: 1.5; 95% CI: 1.3-1.8), postpartum hemorrhage (OR: 1.2; 95% CI: 1.1-1.3) and blood transfusion (OR: 1.5; 95% CI: 1.3-1.8). Grandmultiparous women had increased maternal and neonatal morbidity, and neonatal mortality even after controlling for confounders, suggesting a need for closer observation than regular multiparous patients during labor and delivery.
    Journal of Maternal-Fetal and Neonatal Medicine 05/2005; 17(4):277-80. DOI:10.1080/14767050500123798 · 1.37 Impact Factor
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    ABSTRACT: To identify factors associated with the development of neonatal injury in the setting of shoulder dystocia. Medical record ICD-9 codes and a computerized perinatal database were reviewed to identify cases of shoulder dystocia from January 1996 to January 2001 in a tertiary care center. For confirmation of the diagnosis and collection of data, both maternal and neonatal charts were then reviewed and neonatal injuries categorized as either neurological (brachial plexus injury) or skeletal (clavicular fracture, humeral fracture). Shoulder dystocia cases were divided into groups based on the presence of neonatal injury at delivery or at discharge (with or without Erb's palsy). The group with neonatal injury was compared for demographic and obstetrical factors to the group without injury (control). chi (2) test, Mann-Whitney test and logistic regression were used as appropriate. During this 5-year period, there were 25,995 deliveries and 206 (0.8%) confirmed cases of shoulder dystocia. Of these cases, 36 (17.5%) had neonatal injury diagnosed at delivery and 25 (12%) remained with significant residual injury at discharge. Of these there were 19 cases of Erb's palsy and six cases of clavicular fracture. No association was found between neonatal injury and maternal age, ethnicity, diabetes, operative vaginal delivery or number of obstetrical maneuvers. However, maternal body mass index >30 kg/m2, a second stage of labor >20 min and a birth weight >4500 g were all associated with an increased risk of neonatal injury at delivery and at discharge, including Erb's palsy. After logistic regression analysis, only a second stage of delivery >20 min remained significantly associated with neonatal injury at discharge. In our population, maternal obesity was associated with an increased risk of neonatal injury after shoulder dystocia. In addition, a short second stage of labor (<20 min) was associated with a lower rate of neonatal injury.
    Journal of Perinatology 02/2006; 26(2):85-8. DOI:10.1038/ · 2.07 Impact Factor
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