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Fatores de risco para cesariana no segundo período do trabalho de parto
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Introdução: A cesariana é um procedimento associado a potenciais complicações a curto e longo prazo. Quando realizada no segundo período do trabalho de parto, parece apresentar riscos acrescidos. Assim, a identificação e atuação precoce nas parturientes que, apesar de alcançarem o período expulsivo, parecem ter menor probabilidade de parto vaginal poderia minimizar os riscos em questão. Objetivo: Identificar eventuais fatores de risco ante e intraparto para cesariana no segundo período do trabalho de parto. Material e Métodos: Realizou-se um estudo retrospetivo caso-controlo comparando as parturientes com gravidez de feto único, cefálico, de termo submetidas a cesariana no segundo período do trabalho de parto no Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, entre 1 de janeiro de 2020 e 30 de junho de 2021 com os partos vaginais de feto único de termo ocorridos imediatamente antes e após. Foram estudados fatores anteparto, incluindo características maternas e relacionadas com a gravidez, e fatores intraparto. Resultados: Quarenta e uma parturientes foram incluídas no grupo de estudo e oitenta e duas no grupo de controlo. A duração do primeiro período (aOR 1,17, IC 95% 1,06-1,29, p=0,002) e a presença de comorbilidades maternas (aOR 4,51, IC 95% 1,66- 12,26, p=0,003) foram significativamente superiores no grupo submetido a cesariana no segundo período. Não se verificou a presença de outras diferenças estatisticamente significativas após a realização da análise multivariada. Conclusões: A análise da progressão do primeiro período do trabalho de parto poderá permitir identificar padrões que auxiliem na estimativa da probabilidade de cesariana no segundo período, sendo necessários estudos nesse âmbito.
Background: Cesarean section is associated with potential short term and long term complications. It seems to carry additional risks when performed in the second stage of labor. Identifying and intervening precociously in the parturients which, in spite of achieving the second stage of labor, seem to have a smaller likelihood of successful vaginal birth might reduce those risks. Aim: To identify potential antepartum and intrapartum risk factors for cesarean section in the second stage of labor. Material and Methods: Parturients with singleton, cephalic, term pregnancies that were submitted to second stage cesarean section in Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, between January 1, 2020 and June 30, 2021 were included in a retrospective case-control study in which they were compared with the singleton, cephalic, term vaginal deliveries that occurred immediately before and after. Antepartum and intrapartum factors were studied. Results: Forty-one women were included in the study group and eighty-one in the control group. The duration of the first stage of labor (aOR 1,17, IC 95% 1,06-1,29, p=0,002) and the presence of maternal comorbidities (aOR 4,51, IC 95% 1,66-12,26, p=0,003) were significantly superior in the group that was submitted to second stage cesarean section. No other statistically significant differences were found in the multivariate analysis. Conclusions: Future studies analysing the progression of the first stage of labor may identify patterns that might help to estimate the risk of second stage cesarean section.
Background: Cesarean section is associated with potential short term and long term complications. It seems to carry additional risks when performed in the second stage of labor. Identifying and intervening precociously in the parturients which, in spite of achieving the second stage of labor, seem to have a smaller likelihood of successful vaginal birth might reduce those risks. Aim: To identify potential antepartum and intrapartum risk factors for cesarean section in the second stage of labor. Material and Methods: Parturients with singleton, cephalic, term pregnancies that were submitted to second stage cesarean section in Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, between January 1, 2020 and June 30, 2021 were included in a retrospective case-control study in which they were compared with the singleton, cephalic, term vaginal deliveries that occurred immediately before and after. Antepartum and intrapartum factors were studied. Results: Forty-one women were included in the study group and eighty-one in the control group. The duration of the first stage of labor (aOR 1,17, IC 95% 1,06-1,29, p=0,002) and the presence of maternal comorbidities (aOR 4,51, IC 95% 1,66-12,26, p=0,003) were significantly superior in the group that was submitted to second stage cesarean section. No other statistically significant differences were found in the multivariate analysis. Conclusions: Future studies analysing the progression of the first stage of labor may identify patterns that might help to estimate the risk of second stage cesarean section.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Cesariana Segundo período Factores de risco Obstetrícia