Analgesia obstétrica

Inducción electiva versus trabajo de parto espontáneo en América Latina Elective induction versus spontaneous labour in Latin America. Guerra GV, Cecatti JG, Souza JP, Faúndes A, Morais SS, Gülmezoglu AM, Passini R Jr, Parpinelli MA, Carroli G; WHO Global Survey on Maternal Perinatal Health in Latin America Study Group. Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, SP, Brazil. Bull World Health Organ. 2011 Sep 1;89(9):657-65. Epub 2011 Jul 5. Abstract OBJECTIVE: To assess the frequency of elective induction of labour and its determinants in selected Latin America countries; quantify success in attaining vaginal delivery, and compare rates of caesarean and adverse maternal and perinatal outcomes after elective induction versus spontaneous labour in low-risk pregnancies. METHODS: Of 37,444 deliveries in women with low-risk pregnancies, 1847 (4.9%) were electively induced. The factors associated with adverse maternal and perinatal outcomes among cases of spontaneous and induced onset of labour were compared. Odds ratios for factors potentially associated with adverse outcomes were calculated, as were the relative risks of having an adverse maternal or perinatal outcome (both with their 95% confidence intervals). Adjustment using multiple logistic regression models followed these analyses. FINDINGS: Of 11,077 cases of induced labour, 1847 (16.7%) were elective. Elective inductions occurred in 4.9% of women with low-risk pregnancies (37,444). Oxytocin was the most common method used (83% of cases), either alone or combined with another. Of induced deliveries, 88.2% were vaginal. The most common maternal adverse events were: (i) a higher postpartum need for uterotonic drugs, (ii) a nearly threefold risk of admission to the intensive care unit; (iii) a fivefold risk of postpartum hysterectomy, and (iv) an increased need for anaesthesia/analgesia. Perinatal outcomes were satisfactory except for a 22% higher risk of delayed breastfeeding (i.e. initiation between 1 hour and 7 days postpartum). CONCLUSION: Caution is mandatory when indicating elective labour induction because the increased risk of maternal and perinatal adverse outcomes is not outweighed by clear benefits http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165968/pdf/ BLT.08.061226.pdf Anestesia obstétrica- antes y ahora Obstetric anesthesia - then and now. Chadwick HS. Department of Anesthesiology, University of Washington, Seattle, 98195, USA. chadwick@u.washington.edu Minerva Anestesiol. 2005 Sep;71(9):517-20. Abstract In 1947 John Bonica as new Chief of Anesthesiology at Tacoma General Hospital organized one of the first around-the-clock labor anesthesia services and when became the first chairman of the new Department of Anesthesiology at the University of Washington (1960), caudal anesthesia was the primary technique used for providing labor analgesia. In 1967 the first volume of Bonica's classic textbook ''Principles and practice of obstetric analgesia and anesthesia'' was published. The text was a comprehensive treatise that pulled together virtually everything that was known in that field. Perhaps the most significant development in obstetric anesthesia in the past 20 years has been the introduction of spinal opioid analgesia.. Bonica predicted the probable success of these techniques in the last edition of his ''Obstetric analgesia and anesthesia'' handbook published in 1980. Current obstetric anesthetic practice, though quite different from what it was 30 or 40 years ago, has its roots in the priorities, techniques and teachings of Dr. John J. Bonica. http://www.minervamedica.it/en/getfreepdf/D34i6qkgRBiwhHtBBp9HSaNmngcaYs%252Ft8Yhb3aDINzQL1wjAsqfatYASkCt8%252FYfi5%252FRxNUMS%252B2dvTITSyjs2rQ%253D%253D/R02Y2005N09A0517.pdf

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org