Inadequate adherence to recommendations for induction of labour process as a trigger for caesarean section in women with a single-term pregnancy. A descriptive study
DOI:
https://doi.org/10.18597/rcog.3275Keywords:
Induced labor, cesarean sectionAbstract
Objective: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention.
Materials and methods: Descriptive historical cohort that included pregnant women without a history of previous cesarean section, with single term pregnancy and cephalic presentation who were subjected to labor induction in a Level III complexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indication for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guides arising from the 2012 proposal of limiting the first cesarean section were used in order to define adherence to the recommendations for induction.
Results: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, considering that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section.
Conclusion: Failure to adhere to the recommendations for adequate induction was found, added to a mistaken diagnosis of failed induction.
Author Biography
John Jairo Zuleta-Tobón, Univiersidad de Antioquia NACER, salud sexual y reproductiva.
Departamento de Obstetricia y Ginecología
Universidad de Antioquia
Profesor titular
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