Análisis de la amniotomía precoz frente a amniotomía tardía en las inducciónes de trabajo de parto y su posible riesgo de distocia

Résumé

The World Health Organization (WHO) in its latest report disseminates the need to rationalize the cesarean section rate. They advise not to exceed figures at 10%, however, in Spain, we find an average of 24%, reaching higher levels depending on the autonomous community. These figures are similar in the rest of European territory, the United States and higher in the South American continent. One of the clinical practices that contribute to the increase in the rate of caesarean sections is the induction of labor. The medical indications from both fetal and maternal well-being point of view make it essential to perform it. One of the reasons that cause a greater indication of inductions for medical reasons in relation to the other indications of induction is the chronologically prolonged gestation (CPG). CPG involves a series of risks, which is why international and national scientific societies have reached the consensus of ending pregnancy by inducing labor at week 41 + 3 of gestation. However, this causes the risk of caesarean section to increase through induction, both through the induction process and through CPG. One of the mechanisms that are carried out within the induction is artificial amniorrhexis. The artificial amniorrhexis is the mechanism by which a professional breaks the bag of waters intentionally. It is a procedure that midwives perform routinely in inductions of labor, almost in 100% of patients. It is known as a good mechanism of mechanical induction, since it activates the different mechanisms of delivery and accelerates them. However, it is not a risk-free technique. Risks are described, such as fetal distress, dystocia of the fetal position and cord prolapse, among others. In addition, there are no protocols that tell us what the best time is to do it in the induction process. Currently in the process of normal delivery, this technique is not recommended and all agree that the intrinsic risk to the technique is reduced the longer the time is delayed. Therefore, different investigations have emerged in the field of inductions, in order to know what the best time is to perform artificial amniorrhexis within the induction and thus be able to reduce complications. There is little literature on the subject and controversy among the authors. Therefore, in this research, it is intended to know if late artificial amniorrhexis works influences the decrease in the rate of caesarean sections in inductions for chronologically prolonged gestations...