Riesgo de rotura uterina en el parto vaginal tras cesárea: revisión sistemática

• Autores: Pedro Hidalgo Lopezosa , María Hidalgo Maestre
• Localización: Enfermería clínica, ISSN 1130-8621, Vol. 27, Nº. 1, 2017, págs. 28-39
• Idioma: español
• DOI: 10.1016/j.enfcli.2016.08.006
• Títulos paralelos:
  • Risk of uterine rupture in vaginal birth after cesarean: Systematic review
• Texto completo no disponible (Saber más ...)
• Resumen
  • español

    Objetivo Valorar el riesgo de rotura uterina (RU) en el intento de parto vaginal después de cesárea y determinar los factores de riesgo.

    Métodos Revisión sistemática consultando las siguientes bases de datos: PubMed (MEDLINE), Biblioteca Cochrane Plus, Embase, Nursing@Ovid, Cuidatge y Dialnet. La consulta se realizó entre enero y marzo de 2015. Se utilizaron los descriptores MeSH: vaginal birth after cesarean; uterine rupture; labor induced y labor obstetric o trial of labor. No hubo restricción de fecha ni idioma. La selección de artículos se realizó por 2 revisores de forma estandarizada, independiente y no cegada. Se llevó a cabo una revisión crítica del resumen y, cuando fue necesario, se accedió al texto completo. Se incluyeron artículos prospectivos y retrospectivos.

    Resultados Se incluyeron un total de 39 documentos por su interés y relevancia. Se encontraron escasos ensayos clínicos. Los rangos de incidencia de RU en los resultados de los trabajos analizados han oscilado entre 0,15-0,98% en trabajo de parto espontáneo; 0,3-1,5% en estimulación e inducción con oxitocina, y 0,68-2,3% en inducciones con prostaglandinas.

    Conclusiones El éxito del parto vaginal tras cesárea es importante y mejora cuando las condiciones son óptimas. Sin embargo, no está exento de riesgos, siendo el principal la RU. La inducción del parto con oxitocina y/o prostaglandinas figura como el principal factor de riesgo para la RU, mientras que el inicio espontáneo del parto y el antecedente de un parto vaginal son factores protectores.

  • English

    Objective To assess the risk of uterine rupture (UR) in attempted vaginal birth after cesarean and to identify risk factors.

    Methods Systematic review by consulting the following databases: PubMed (MEDLINE), Cochrane Library Plus, Embase, Nursing@Ovid, Cuidatge and Dialnet. The search was conducted between January and March 2015. MeSH descriptors used were: vaginal birth after cesarean; uterine rupture; labor induced and labor obstetric or trial of labor. There were no restrictions on date or language. The selection of articles was performed by 2 independent reviewers, standardized and unblinded. A critical review of the summary was conducted, and if was necessary, the full text was consulted. Prospective and retrospective documents were included.

    Results A total of 39 documents were included for their relevance and interest. Few clinical trials were found. The UR incidence on the results of the studies analyzed ranged from 0.15-0.98% in spontaneous labor; 0.3-1.5% in stimulation and induction with oxytocin, and 0.68-2.3% in prostaglandin inductions.

    Conclusions The success of vaginal birth after cesarean is important and improves when conditions are optimal. However it is not without risks, the main one being UR. Induction of labor with oxytocin and/or prostaglandins appears as the main risk factor, while the spontaneous onset of labor and a prior vaginal birth are protective factors.

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