Induced delivery: when is it advisable?
The induction of labor, either maternal reasons or for fetal reasons, has increased a lot in recent years. However the induced labor it is not free of risks: postpartum haemorrhage (PPH), thromboembolic events and placental dysfunction are the most worrying problems for obstetricians because they are the main causes of maternal mortality, also in developed countries.
"In recent years, depending on the hospital, between 15 and 25% of births can be induced"says Dr. José Luis Bartha, Head of the Obstetrics and Gynecology Service of the University Hospital La Paz, Professor of Obstetrics and Gynecology at the UAM and Co-Chair of the Organizing Committee of the XXV National Congress of Perinatal Medicine.
For induction, specialists use mechanical methods or pharmacological methods that are safe. "The most frequent pharmacological methods are oxytocin and prostaglandins, generally, a vaginal delivery device is used that allows its removal if necessary," says Dr. Bartha.
Induced delivery: when is it necessary?
The induced labor It arises when the prolongation of pregnancy can endanger the life of the mother, the baby or both. It is usually recommended in these cases:
1. Pregnancy is too long. It is considered a case of chronologically prolonged pregnancy, in the week 41 + 3 days, that is to say, just one week after having fulfilled the probable date of delivery.
2. Premature membrane rupture with full term pregnancy. When the amniotic sac breaks, but the mother has not gone into labor in the next 24 hours.
3. Maternal diseases such as diabetes or hypertension, which can affect the fetus. There are also other pathologies such as heart, kidney, lung or liver that can justify the performance of an induced delivery.
4. Presence of meconium in the amniotic fluid. It is usually an indication of fetal distress.
5 Delayed intrauterine growth. It is related to some problem in the placenta and a deficient supply of nutrients. In these cases, induced delivery is recommended so that the baby continues to grow outside normally, if it is viable with the maturation of their lungs, their gestational age ...
Risks of induced labor
The Induced delivery rate is growing in our country, either for maternal reasons or for fetal reasons. Therefore, specialists need safe methods to carry it out, especially applicable to women in which the cervix has not yet matured, methods that allow to soften and shorten it to start labor effectively and above all safe for the mother and the fetus.
For Dr. Alberto Galindo, Head of the Obstetrics and Gynecology Service of the University Hospital 12 de Octubre, Professor of Obstetrics and Gynecology at the UCM and Co-Chair of the Organizing Committee of the Congress, "together with prematurity and related disorders dysfunction of the placenta, including preeclampsia and growth retardation, postpartum haemorrhage occupies a stellar place among the obstetrician's concerns "and continues" being the postpartum hemorrhage, thromboembolic accidents and placental dysfunction, the problems that most concern us as obstetricians are the main causes of maternal mortality, even in countries as developed as ours ".
In Spain, postpartum hemorrhage complicates 3 to 5% of all deliveries. According to Dr. Galindo "fortunately we have an arsenal of measures whose application is protocolized in many hospitals in order to avoid major problems in women who have just given birth that is allowing to reduce in a clear and dramatic way the serious complications related to the postpartum hemorrhage. "
Carbetocin is the drug of choice to reduce the risk of postpartum hemorrhage priorities because it has a number of advantages such as low side effects, single dose and being stable at room temperature. "Although its use is only contemplated today for the patient who has just delivered by caesarean section and not for vaginal delivery, I think that sooner or later we will see how it is applied after a vaginal delivery," says Dr. Galindo.
Marisol Nuevo Espín