Article

Metodi di induzione del travaglio di parto nella gravidanza a termine

It. Ost. Gin 01/2006; 9.

ABSTRACT INTRODUZIONE L'induzione del parto è l'insieme di interventi medici, chirurgici e farmacologici, volti a determinare l'inizio e il mantenimento del travaglio di parto (1). Per induzione del parto si dovrebbe intendere sia la stimolazione dell'attività contrattile uterina che l'induzione della maturazione cervicale, intesa come l'insieme dei fenomeni che portano ad un cambiamento della posizione dell'orifizio uterino interno (da posteriore ad anteriore), ad un rammollimento, raccorciamento e, quindi, appianamento della cervice ed alla sua successiva dilatazione. Tuttavia, esistono condizioni cliniche in cui l'obbiettivo principale è il raggiungimento di una sola di queste condizioni: ad esempio, nel caso in cui sia presente una cervice fortemente immatura o impreparata, è preferibile ottenere inizialmente un miglioramento della condizione cervicale prima di stimolare l'attività contrattile uterina; viceversa se il collo è ben preparato sarà necessario stimolare solo l'attività contrattile e le strategie d'intervento in queste due diverse condizioni saranno diverse. L'esperienza clinica insegna che l'induzione può fallire anche nella gestante con le condizioni apparentemente più favorevoli (pluriparità, score di Bishop >5) ed è uniformemente accettato che il sistema di punteggio di Bishop costituisce attualmente il principale parametro in grado di predire il successo dell'induzione al parto (2). In questa breve rassegna tratteremo fondamentalmente due gruppi di metodi di induzione del travaglio di parto, quelli non-farmacologici e quelli farmacologici (Figura 1). ABSTRACT This paper reviews methods of induction and preinduction of labour. Mechanical as well as pharmacological induction of labour are described, namely focusing on topic prostaglandins. Moreover, author's clinical experiences is reported.

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