Speaker: Ines Rothman
Facilitator: Elisa Segoni
The population of low-risk pregnant women whose birth is induced has been increasing steadily in many countries. Considerable inter- and intraprofessional variation regarding the medical indications for induction, induction methods and induction term exists.
The Flemish Association for Midwives did a systematic literature review on the effects of induction of labour at 41 and 39 gestational weeks, both compared to expectant management, on maternal and neonatal outcomes, and on maternal birth experience. This research included almost 40 studies across the 3 PICOs between 2017-2022 and 9 guidelines.
Clinical guidelines and current care policy are based on a limited number of research studies, with significant study limitations. The evidence from our systematic literature review shows that induction does not unambiguously lead to more favourable maternal and neonatal outcomes; new systematic reviews and the wealth of observational studies in recent years more often point to no or unfavourable iatrogenic effects of induction. Induction appears to have a higher chance of a negative birth experience and the shared informed decision-making process is flawed. Women receive insufficiently balanced information about the benefits and risks of induction, the different indications, the induction process, other interventions that may accompany an induction, the impact of induction on freedom of mobility, and the right to refuse an induction. Women often experience the induction recommendation as binding rather than as a choice, sometimes feeling pressured. An open, constructive, interdisciplinary dialogue is urgently needed to evaluate current induction policies. Our research points to several implications which can enrich this debate.
Recording: https://youtu.be/iyoz_CNYZv8
Speaker: Patricia Marianella
Facilitator: Paloma Terra
El objetivo fue comparar los resultados materno-neonatales y costos de la resolución de embarazos, en mujeres obesas y con peso normal pregestacional.
Métodos: Estudio transversal realizado en 60 gestantes con obesidad y 120 con peso normal pregestacional atendidas en un hospital público de Lima durante el 2018, seleccionadas aleatoriamente. Se recolectaron datos sociodemográficos, indicadores maternos (índice de masa corporal pregestacional, controles prenatales, edad gestacional, días de hospitalización), neonatales (Apgar, peso, morbilidad, edad gestacional por examen físico, días de hospitalización) y datos de los costos (medicamentos, procedimientos e insumos). Se utilizó la prueba estadística U de Mann Whitney.
Resultados: Se encontraron diferencias entre mujeres obesas y con peso normal pregestacional en los días de hospitalización materna (3 ±1,2 días vs 2,0 ±1,2 días; p=0,000); en el peso del recién nacido (3 615 ± 518,03 gr vs 3 245 ± 426,25 gr; p=0,000), en el costo de medicamentos ($ 19,78 ±16,47 vs $ 3,21 ±15,57; p=0,000), en el costo de procedimientos ($ 40,65 ±46,78 vs $ 27,67 ±49,47; p=0,001), y en el costo de insumos ($ 54,08 ±29,02 vs $ 9,32 ±28,26; p=0,000).
Conclusión: Las mujeres obesas presentaron recién nacidos con mayor peso, contaron con más días de hospitalización y los costos de medicamentos, procedimientos e insumos fueron superiores en comparación con las mujeres de peso normal.
English:
The objective was to compare maternal-neonatal outcomes and costs of pregnancy resolution in obese women and women with normal pregestational weight. Methods: Cross-sectional study conducted in 60 pregnant women, randomly selected, with obesity and 120 with normal pregestational weight attended in a public hospital in Lima during 2018. Sociodemographic data, maternal indicators (pregestational body mass index, prenatal controls, gestational age, days of hospitalization), neonatal (Apgar, weight, morbidity, gestational age by physical examination, days of hospitalization) and cost data (drugs, procedures and supplies) were collected. The Mann Whitney U statistical test was used. Results: Differences were found between obese and pregestational normal weight women in maternal hospitalization days (3 ±1.2 days vs. 2.0 ±1.2 days; p=0.000); in newborn weight (3 615 ± 518.03 gr vs. 3 245 ± 426.25 gr; p=0.000), in the cost of medications ($ 19.78 ±16.47 vs $ 3.21 ±15.57; p=0.000), in the cost of procedures ($ 40.65 ±46.78 vs $ 27.67 ±49.47; p=0.001), and in the cost of supplies ($ 54.08 ±29.02 vs $ 9.32 ±28.26; p=0.000).Conclusion: Obese women had heavier newborns, more days of hospitalization and the costs of medications, procedures and supplies were higher compared to women of normal weight.
Recording: https://youtu.be/McAV7M1Ub4M
