Desfecho perinatal e distribuição dos partos, de acordo com a classificação de Robson, em fetos com peso estimado abaixo do percentil 10
Data
2023-03-20
Autores
Mazzola, Jaqueline Brandão 
Orientadores
Nardozza, Luciano Marcondes Machado
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: gestações com complicações clínicas e obstétricas, tal como a restrição de crescimento fetal (RCF), não implicam absolutamente em parto cesáreo. Estudos atuais apontam possibilidade de parto vaginal com segurança no contexto da RCF. Objetivos: avaliar os desfechos perinatais, incluindo a via de parto pela Classificação de Robson, dos fetos com peso estimado abaixo do percentil 10 acompanhados em centro terciário segundo protocolo local. Métodos: estudo retrospectivo e observacional selecionando as gestações únicas internadas para parto no serviço de janeiro de 2018 a dezembro de 2019. Critérios de exclusão: malformações fetais e suspeita de infecção fetal. Foram categorizados três grupos na amostra: grupo RCF (restrição de crescimento fetal definida pelo consenso Delphi), grupo PIG (pequeno para a idade gestacional - fetos com peso estimado abaixo do percentil 10 mas sem critérios de RCF pelo consenso Delphi) e grupo controle (demais partos da instituição no período). Além do estudo da via de parto, os principais desfechos avaliados foram: óbito fetal, idade gestacional do parto, peso do nascimento, Apgar de 5° minuto, necessidade de reanimação neonatal, admissão em unidade de tratamento intensivo (UTI) neonatal, tempo total de internação e óbito intrahospitalar. Resultados: incluídas 852 gestantes sendo 747 pacientes do grupo controle, 85 pacientes do grupo RCF e 20 pacientes do grupo PIG. No grupo RCF a mediana da idade materna (p=0.012), da idade gestacional do parto (p<0.001) e do peso do recémnascido (p<0.001) foram menores enquanto a taxa de parto cesáreo foi maior (p<0.001). Em relação ao desfecho perinatal, houve diferença nas taxas de reanimação neonatal (p<0.001), admissão em UTI neonatal (p<0.001) e tempo total de internação em UTI (p<0.001) entre os grupos, sendo maior no grupo RCF. Apesar da maior taxa de parto cesáreo no grupo RCF (p<0.001), quando avaliamos esse grupo individualmente e categorizamos essas pacientes à admissão pela classificação de Robson percebemos que nos grupos de Robson 1 a 5.1 (onde estão alocadas as pacientes com maior chance de parto vaginal pelas características intrínsecas do grupo associadas ao nosso protocolo de seguimento e conduta) conseguimos parto pela via vaginal em quase 60% das pacientes sem aumento da morbidade perinatal. Conclusões: apesar de encontrar maior prevalência de parto cesariano e de alguns desfechos perinatais desfavoráveis no grupo RCF, não foram observadas diferenças entre as taxas de óbito fetal (p=0.723) e de óbito intra-hospitalar (p=0.213) entre os grupos, denotando seguimento adequado no grupo RCF. E mesmo na presença dessa condição, o parto vaginal deve ser considerado especialmente nos grupos de Robson onde há maior sucesso da via vaginal (grupos 1 a 5.1), buscando evitar a primeira cesariana ou a cesariana de repetição.
Introduction: pregnancies with clinical and obstetric complications, such as fetal growth restriction (FGR), absolutely do not imply cesarean delivery. Current studies point to the possibility of safe vaginal delivery in the context of FGR. Objectives: to evaluate the perinatal outcomes, including the mode of delivery according to the Robson Classification, of fetuses with an estimated weight below the 10th percentile followed up at a tertiary center according to a local protocol. Methods: retrospective and observational study selecting singleton pregnancies hospitalized for delivery from January 2018 to December 2019. Exclusion criteria: fetal malformations and suspected fetal infection. Patients were categorized in three groups: FGR group (fetal growth restriction defined by the Delphi consensus), SGA group (small for gestational age - fetuses with estimated weight below the 10th percentile but without FGR criteria by the Delphi consensus) and control group (other deliveries at the institution in the period). In addition to the study of the mode of delivery, the main outcomes evaluated were: fetal death, gestational age at delivery, birth weight, Apgar score at 5 min, neonatal resuscitation, admission to the neonatal intensive care unit (NICU), length of neonatal hospitalization and hospital death. Results: 852 pregnant women were included, 747 patients in the control group, 85 patients in the FGR group and 20 patients in the SGA group. In the FGR group, the median maternal age (p=0.012), gestational age at delivery (p<0.001) and birth weight (p < 0.001) were lower while the cesarean delivery rate was higher (p<0.001). Regarding the perinatal outcome, there was a difference in the rates of neonatal resuscitation (p<0.001), admission to the NICU (p<0.001) and length of neonatal hospitalization (p<0.001) between the groups, being greater in the RCF group. Despite the higher cesarean delivery rate in the RCF group (p<0.001), when we evaluated this group individually and categorized these patients upon admission using the Robson classification, we noticed that in Robson groups 1 to 5.1 (where were patients with a greater chance of vaginal delivery due to intrinsic characteristics of the group associated with our follow-up protocol and conduct) we managed to deliver vaginally in almost 60% of the patients without increasing perinatal morbidity. Conclusions: although finding a higher prevalence of cesarean section and some adverse perinatal outcomes in the RCF group, no differences were observed between the rates of fetal death (p=0.723) and hospital death (p=0.213) between the groups, denoting adequate follow-up in the FGR group. And even in the presence of this condition, vaginal delivery should be considered, especially in Robson's groups where the vaginal route is more successful (groups 1 to 5.1), seeking to avoid the first cesarean section or repeat cesarean section.
Introduction: pregnancies with clinical and obstetric complications, such as fetal growth restriction (FGR), absolutely do not imply cesarean delivery. Current studies point to the possibility of safe vaginal delivery in the context of FGR. Objectives: to evaluate the perinatal outcomes, including the mode of delivery according to the Robson Classification, of fetuses with an estimated weight below the 10th percentile followed up at a tertiary center according to a local protocol. Methods: retrospective and observational study selecting singleton pregnancies hospitalized for delivery from January 2018 to December 2019. Exclusion criteria: fetal malformations and suspected fetal infection. Patients were categorized in three groups: FGR group (fetal growth restriction defined by the Delphi consensus), SGA group (small for gestational age - fetuses with estimated weight below the 10th percentile but without FGR criteria by the Delphi consensus) and control group (other deliveries at the institution in the period). In addition to the study of the mode of delivery, the main outcomes evaluated were: fetal death, gestational age at delivery, birth weight, Apgar score at 5 min, neonatal resuscitation, admission to the neonatal intensive care unit (NICU), length of neonatal hospitalization and hospital death. Results: 852 pregnant women were included, 747 patients in the control group, 85 patients in the FGR group and 20 patients in the SGA group. In the FGR group, the median maternal age (p=0.012), gestational age at delivery (p<0.001) and birth weight (p < 0.001) were lower while the cesarean delivery rate was higher (p<0.001). Regarding the perinatal outcome, there was a difference in the rates of neonatal resuscitation (p<0.001), admission to the NICU (p<0.001) and length of neonatal hospitalization (p<0.001) between the groups, being greater in the RCF group. Despite the higher cesarean delivery rate in the RCF group (p<0.001), when we evaluated this group individually and categorized these patients upon admission using the Robson classification, we noticed that in Robson groups 1 to 5.1 (where were patients with a greater chance of vaginal delivery due to intrinsic characteristics of the group associated with our follow-up protocol and conduct) we managed to deliver vaginally in almost 60% of the patients without increasing perinatal morbidity. Conclusions: although finding a higher prevalence of cesarean section and some adverse perinatal outcomes in the RCF group, no differences were observed between the rates of fetal death (p=0.723) and hospital death (p=0.213) between the groups, denoting adequate follow-up in the FGR group. And even in the presence of this condition, vaginal delivery should be considered, especially in Robson's groups where the vaginal route is more successful (groups 1 to 5.1), seeking to avoid the first cesarean section or repeat cesarean section.