Induccion con prostaglandina E2 frente a oxitocina intravenosa y frente a conducta expectante en gestantes con rotura prematura de membranas

OBJETIVO DEL ESTUDIO OBJETIVO PRINCIPAL: Estudiar la efectividad de la prostaglandina administrada por via vaginal (Dinoprostona o Propess®), en la induccion de parto en gestantes con rotura prematura de membranas. OBJETIVOS SECUNDARIOS: 1. Comprobar la disminucion del tiempo total (horas), de duracion del parto cuando se administran Prostaglandinas vaginales para maduracion de cervix previa a la induccion del parto. 2. Identificar las diferencias en cuanto a comodidad para la mujer y necesidad de analgesia durante el parto. 3. Comprobar la repercusion sobre el bienestar fetal. 4. Identificar los factores que influyen en el desencadenamiento del parto despues de la administracion de Prostaglandinas. 5. Comprobar si aumenta/disminuye la necesidad de terminar el parto mediante cesarea. III. MATERIAL Se ha estudiado un total de 450 gestantes con bolsa rota (RPM), ingresadas en el Hospital Universitario San Cecilio (Granada), entre los anos 2004 y 2006. Se selecciono a todas aquellas que no presentaban, ademas, criterios de parto establecido: tres contracciones cada 10 minutos y cervix borrado con al menos 2 centimetros de dilatacion. La muestra se dividio en tres grupos: A) Gestantes con RPM e indice de Bishop desfavorable (menor de 6), sin contracciones al ingreso y que se sometieron a induccion de la forma tradicional protocolizada en nuestro servicio: transcurridas 24 horas desde la rotura de bolsa, bajo control cardiotocografico se les administraba oxitocina via intravenosa mediante bomba de infusion: GRUPO OXITOCINA B) Gestantes con RPM e indice de Bishop desfavorable (menor de 6) que, una vez transcurridas 6 horas desde la rotura de bolsa no habian iniciado el parto y se les colocaba en vagina un dispositivo de liberacion lenta de dinoprostona (Propess ®), con la finalidad de maduracion cervical previa a la induccion: GRUPO DINOPROSTONA C) Gestantes con RPM e indice de Bishop desfavorable ( menor de 6) que transcurridas 6 horas desde la rotura de las membranas inician el parto de forma espontanea: GRUPO CONTROL. Criterios de Inclusion en el estudio: Gestantes con bolsa rota y Liquido amniotico no tenido, gestacion simple mayor de 35 semanas y presentacion cefalica. Sin contracciones uterinas espontaneas y sin haber iniciado el parto. Criterios de Exclusion en el estudio: ? Cicatriz uterina ? Cervix modificado (indice de Bishop mayor de 6) ? Liquido amniotico tenido al ingreso ? Alteraciones de la frecuencia cardiaca fetal al ingreso ? Gestacion multiple ? Presentacion distinta a vertice ? Prematuridad menor de 35 semanas ? Tiempo de bolsa rota desconocido o mayor de 24 horas

[1]  Daniel B. DiGiulio,et al.  Microbial invasion of the amniotic cavity in pregnancies with small-for-gestational-age fetuses , 2010, Journal of perinatal medicine.

[2]  Daniel B. DiGiulio,et al.  Prevalence and Diversity of Microbes in the Amniotic Fluid, the Fetal Inflammatory Response, and Pregnancy Outcome in Women with Preterm Pre‐Labor Rupture of Membranes , 2010, American journal of reproductive immunology.

[3]  M. Hallman,et al.  Enhancing Functional Maturity before Preterm Birth , 2010, Neonatology.

[4]  I. Miechowicz,et al.  [The impact of premature rupture of membranes (PROM) on neonatal outcome]. , 2010, Ginekologia polska.

[5]  P. Sieroszewski,et al.  [Comparison of the predictive value of digital examination (Bishop's score) and ultrasound evaluation for labor induction success]. , 2010, Ginekologia polska.

[6]  S. Hansson,et al.  Myometrial oxytocin receptor mRNA concentrations at preterm and term delivery – the influence of external oxytocin , 2009, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology.

[7]  T. Gungor,et al.  Cervical phosphorylated insulin-like growth factor binding protein-1 in prediction of preterm delivery , 2009, Archives of Gynecology and Obstetrics.

[8]  S. Kenyon,et al.  Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial , 2008, The Lancet.

[9]  A. Ghidini,et al.  Which factors affect the occurrence of severe cerebral lesions in preterm neonates who are born with intrauterine infection? , 2008, American journal of obstetrics and gynecology.

[10]  M. Doret,et al.  [Fetal membranes: embryological development, structure and the physiopathology of the preterm premature rupture of membranes]. , 2008, Journal de gynecologie, obstetrique et biologie de la reproduction.

[11]  R. Romero,et al.  The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor. , 2008, American journal of obstetrics and gynecology.

[12]  F. Audibert,et al.  Amniocentesis for PPROM management: a feasibility study. , 2008, Journal of Obstetrics and Gynaecology Canada.

[13]  A. Kaunitz,et al.  Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. , 2008, American journal of obstetrics and gynecology.

[14]  H. Soltani,et al.  Nitrazine yellow and pre-labour rupture of membranes. , 2008, The practising midwife.

[15]  S. Kenyon,et al.  MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes , 2008, BMC pregnancy and childbirth.

[16]  M. Velemínský,et al.  Relationship of vaginal microflora to PROM, pPROM and the risk of early-onset neonatal sepsis. , 2008, Neuro endocrinology letters.

[17]  V. Ganesh,et al.  Duration of Antimicrobial Prophylaxis for Group B Streptococcus in Patients With Preterm Premature Rupture of Membranes Who Are Not in Labor , 2008 .

[18]  J. Dudenhausen,et al.  Comparison of two rapid strip tests based on IGFBP-1 and PAMG-1 for the detection of amniotic fluid. , 2008, American journal of perinatology.

[19]  R. Romero,et al.  A link between a hemostatic disorder and preterm PROM: a role for tissue factor and tissue factor pathway inhibitor , 2008, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[20]  D. Wing,et al.  A retrospective review of ampicillin-sulbactam and amoxicillin + clavulanate vs cefazolin/cephalexin and erythromycin in the setting of preterm premature rupture of membranes: maternal and neonatal outcomes. , 2007, American journal of obstetrics and gynecology.

[21]  M. Doret,et al.  [Complications and monitoring of the latency period after a preterm premature rupture of the fetal membranes: literature review]. , 2008, Journal de gynecologie, obstetrique et biologie de la reproduction.

[22]  M. Doret,et al.  Les membranes fœtales : développement embryologique , structure et physiopathologie de la rupture prématurée avant terme Fetal membranes : Embryological development , structure and the physiopathology of the preterm premature rupture of membranes , 2008 .

[23]  M. Satar,et al.  Cord blood cytokine levels in neonates born to mothers with prolonged premature rupture of membranes and its relationship with morbidity and mortality. , 2008, European cytokine network.

[24]  V. Ganesh,et al.  Duration of antimicrobial prophylaxis for group B streptococcus in patients with preterm premature rupture of membranes who are not in labor. , 2007, American journal of obstetrics and gynecology.

[25]  O. Baud,et al.  [Premature rupture of membranes: pathophysiology of neurological impact]. , 2007, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[26]  P. He,et al.  Corticotropin-releasing hormone receptor type 1 and type 2 mediate differential effects on 15-hydroxy prostaglandin dehydrogenase expression in cultured human chorion trophoblasts. , 2007, Endocrinology.

[27]  M. Oyen,et al.  Microstructure and Mechanics of the Chorioamnion Membrane with an Emphasis on Fracture Properties , 2007, Annals of the New York Academy of Sciences.

[28]  R. Romero,et al.  Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection , 2007, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[29]  M. Hannah,et al.  WITHDRAWN: Prostaglandins versus oxytocin for prelabour rupture of membranes at term. , 2007, The Cochrane database of systematic reviews.

[30]  C. Farnoux,et al.  Rupture très prématurée des membranes: physiopathologie des conséquences neurologiques , 2007 .

[31]  A. Arslan,et al.  Extra-amniotic saline infusion increases cesarean risk versus other induction methods and spontaneous labor. , 2006, American journal of perinatology.

[32]  J. Norrie,et al.  IMOP: randomised placebo controlled trial of outpatient cervical ripening with isosorbide mononitrate (IMN) prior to induction of labour – clinical trial with analyses of efficacy, cost effectiveness and acceptability , 2006, BMC pregnancy and childbirth.

[33]  B. Rovin,et al.  Modulation of Cytokine-Induced Cyclooxygenase 2 Expression by PPARG Ligands Through NFκB Signal Disruption in Human WISH and Amnion Cells1 , 2005, Biology of reproduction.

[34]  J. Kwon,et al.  Vaginal fluid β‐human chorionic gonadotropin level in the diagnosis of premature rupture of membranes , 2005 .

[35]  E. Ozkinay,et al.  The value of the insulin-like growth factor binding protein-1 in the cervical-vaginal secretion detected by immunochromatographic dipstick test in the prediction of delivery in women with clinically unconfirmed preterm premature rupture of membranes. , 2005, European journal of obstetrics, gynecology, and reproductive biology.

[36]  S. Chamnanvanakij,et al.  Incidence of neonatal infection in newborn infants with a maternal history of premature rupture of membranes (PROM) for 18 hours or longer by using Phramongkutklao Hospital Clinical Practice Guideline (CPG). , 2005, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[37]  L. Cousins,et al.  AmniSure placental alpha microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes. , 2005, American journal of perinatology.

[38]  G. Bevilacqua,et al.  [Perinatal risk factors for infection in the newborn. Multicenter clinico-epidemiologic investigation]. , 2005, La Pediatria medica e chirurgica : Medical and surgical pediatrics.

[39]  M. Gravett,et al.  Localization of prostaglandin H synthase, prostaglandin dehydrogenase, corticotropin releasing hormone and glucocorticoid receptor in rhesus monkey fetal membranes with labor and in the presence of infection. , 2005, Placenta.

[40]  J. Kwon,et al.  Vaginal fluid beta-human chorionic gonadotropin level in the diagnosis of premature rupture of membranes. , 2005, Acta obstetricia et gynecologica Scandinavica.

[41]  S. Kenyon,et al.  Antibiotics for Preterm Rupture of the Membranes: A Systematic Review , 2004, Obstetrics and gynecology.

[42]  E. Kuczynski,et al.  Increased Rates of Chorioamnionitis With Extra-Amniotic Saline Infusion Method of Labor Induction , 2004, Obstetrics and gynecology.

[43]  J. Challis,et al.  Regulation of 15-hydroxy prostaglandin dehydrogenase by corticotrophin-releasing hormone through a calcium-dependent pathway in human chorion trophoblast cells. , 2003, The Journal of clinical endocrinology and metabolism.

[44]  L. Roura,et al.  Tratado de Ginecología, Obstetricia y Medicina de la Reproducción. Tomo 1 , 2003 .

[45]  S. Kenyon,et al.  Antibiotics for preterm rupture of membranes. , 2003, The Cochrane database of systematic reviews.

[46]  H. Zeyneloglu,et al.  New rapid bed‐side test to predict preterm delivery: phosphorylated insulin‐like growth factor binding protein‐1 in cervical secretions , 2002, Acta obstetricia et gynecologica Scandinavica.

[47]  P. McCartney.  Sterile speculum exams, nitrazine, and ferning. , 2002, MCN. The American journal of maternal child nursing.

[48]  D. Taylor,et al.  Myofibroblast differentiation in the connective tissues of the amnion and chorion of term human fetal membranes-implications for fetal membrane rupture and labour. , 2000, Placenta.

[49]  K. Riegel,et al.  [Premature rupture of fetal membranes, risk of infection and infant prognosis--a comparison of 2 regions]. , 1999, Zeitschrift fur Geburtshilfe und Neonatologie.

[50]  B. Moller,et al.  Extraamniotic saline infusion is promising in preparing the cervix for induction of labor , 1998, Acta obstetricia et gynecologica Scandinavica.

[51]  M. Williams,et al.  The Value of the Cervical Score in Predicting Successful Outcome of Labor Induction , 1997, Obstetrics and gynecology.

[52]  P. Leppert,et al.  Anatomy and Physiology of Cervical Ripening , 1995, Clinical obstetrics and gynecology.

[53]  H. Itoh,et al.  Brain natriuretic peptide is present in the human amniotic fluid and is secreted from amnion cells. , 1993, The Journal of clinical endocrinology and metabolism.

[54]  M. Casey,et al.  Transforming growth factor-beta 1 stimulation of parathyroid hormone-related protein expression in human uterine cells in culture: mRNA levels and protein secretion. , 1992, The Journal of clinical endocrinology and metabolism.

[55]  J. Hobbins,et al.  Infection and labor V. Prevalence, microbiology, and clinical significance of intraamniotic infection in women with preterm labor and intact membranes , 1989 .

[56]  R. Gibbs,et al.  Management of acute chorioamnionitis. , 1980, American journal of obstetrics and gynecology.

[57]  A. Calder,et al.  Letter: Prostaglandins and the unfavourable cervix. , 1973, Lancet.