Pidan que no rompan la bolsa amniótica

Todo el mundo tiene prisa. Nadie tiene paciencia, lo cual es un serio problema entre los profesionales sanitarios puesto que la toma de decisiones debe ser ponderada y en beneificio del/de la paciente. En asistencia obstétrica esto es aún más importante porque las decisiones afectan a la madre y al hijo.

La rotura artificial de la bolsa amniótica (amniorrexis) se ha dicho que acelera el parto. ¿Es verdad? Durante décadas se ha prodigado la rotura de la bolsa amniótica como un procedimiento admitidos en casi todas las maternidades. En una revisión sistematica de la Fundación Cochrane parece que los efectos de la amniorrexis no son beneficiosos para la evolución del nacimiento.

La revisión incluyó 14 estudios con casi 5.000 casos estudiados. La Dra. Rebecca Smyth, investigadora principal de la Universidad de Liverpool, ha recomendado en una rueda de prensa que las embarazadas cuya evolución del parto sea normal deben solicitar que se les rompa la bolsa amniótica. Su estudio demuestra, además, que mantener la bolsa amniótica hasta el final del aprto no produce ninguna complicación.

Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2007 Oct 17;(4):CD006167

University of Liverpool, Department of Public Health, School of Population, Community and Behavioural Sciences, Liverpool, UK, L69 3GB.

BACKGROUND: Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby. OBJECTIVES: To determine the effectiveness and safety of amniotomy alone for (1) routinely shortening all labours that start spontaneously, and (2) shortening labours that have started spontaneously, but have become prolonged. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2007). SELECTION CRITERIA: Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS: Two authors assessed identified studies for inclusion. Both authors extracted data. Primary analysis was by intention to treat. MAIN RESULTS: We have included 14 studies in this review, involving 4893 women. There was no evidence of any statistical difference in length of first stage of labour (weighted mean difference -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), maternal satisfaction with childbirth experience (standardised mean difference 0.27, 95% CI -0.49 to 1.04) or low Apgar score less than seven at five minutes (RR 0.55, 95% CI 0.29 to 1.05). Amniotomy was associated with an increased risk of delivery by caesarean section compared to women in the control group, although the difference was not statistically significant (RR 1.26, 95% CI 0.98 to 1.62).There was no consistency between papers regarding the timing of amniotomy during labour in terms of cervical dilatation. AUTHORS' CONCLUSIONS: On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

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