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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(06): 363-370
DOI: 10.1055/s-0039-1688966
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction

Fatores associados à cesárea intraparto em mulheres submetidas a indução do parto
Glaucia Regina Pfützenreuter
1   Hospital Regional de São José Homero de Miranda Gomes, São José, SC, Brazil
,
Juliana Coutinho Cavalieri
2   Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
,
Ana Paula de Oliveira Fragoso
2   Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
,
Karine Souza Da Corregio
2   Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
,
Paulo Fontoura Freitas
2   Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
,
Alberto Trapani  Júnior
1   Hospital Regional de São José Homero de Miranda Gomes, São José, SC, Brazil
2   Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. September 2018

09. April 2019

Publikationsdatum:
27. Juni 2019 (online)

   Lizenzen und Reprints

Abstract

Objective To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil.

Methods A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016.

Results During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weeks was the most common indication for induced labor (55.2%), and vaginal administration of misoprostol was the most commonly used method (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51–1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32–2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01–1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17–1.66) or > 36 hours (PR = 1.51; 95%CI 1.22–1.92) between the beginning of the induction and the birth.

Conclusion Labor induction was successful in most patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

Resumo

Objetivo Avaliar os resultados da indução de trabalho de parto e determinar os principais fatores associados à realização de cesarianas intraparto em pacientes do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brasil.

Métodos Trata-se de um estudo epidemiológico transversal que incluiu todas as gestantes de feto único e com idade gestacional > 22 semanas, submetidas a indução de trabalho de parto no HU-UFSC no período de 2013 a 2016.

Resultados No período proposto, 1.491 gestantes foram submetidas ao protocolo de indução. Em 1.264 casos (84,8%), a indução resultou em trabalho de parto, com 830 (65,7%) progredindo para o parto vaginal. Gestação ≥ 41 + 0 semanas foi a causa mais comum de indicação de indução de trabalho de parto (55,2%), e misoprostol foi o método mais utilizado (72,0%). Nessas gestantes, o índice de cesariana foi de 34,3%. Considerando os casos de falha de indução, o índice de cesariana sobe para 44,3%. Os fatores associados às cesarianas foram: história prévia de cesárea (RP [razão de prevalência] = 1,48; IC [índice de confiança]: 95% 1,51–1,88), fetos com restrição de crescimento intrauterino (RP = 1,82; IC95%: 1,32–2,19), índice de Bishop ≤ 6 (RP = 1,33; IC95%: 1,01–1,82) e tempo de indução < 12 horas (RP = 1,44; IC95%: 1,17–1,66), ou > 36 horas (RP = 1,51; IC95%: 1,22–1,92) entre o início da indução e o parto.

Conclusão A indução de trabalho de parto foi bem-sucedida na maioria das pacientes. Naquelas em quem o desfecho final foi a cesariana, os fatores mais fortemente associados foram: história prévia de cesárea, presença de fetos com restrição de crescimento intrauterino, e tempos muito curtos ou muito longos de indução.

Keywords

labor - induced labor - cesarean section

Palavras-chave

parto - parto induzido - cesariana

Contributions

All of the authors participated in the selection of the theme, in the gathering of references, and in the design of the present study. Fragoso A. P. O performed the data collection, the data analysis, and transcribed the results. Pfützenreuter G. and Cavalieri J. C. performed the data analysis, the interpretation of the results, and wrote the article. Trapani A., Freitas P. F., and Correggio K. S. worked as advisors for the team, collected data, guided the other authors through the interpretation of the data, as well as critically reviewed the intellectual content. All of the authors read, reviewed the article, and gave the final approval of the version to be published.


 

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