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Variación de los factores de riesgo y el momento del nacimiento para diferentes tipos de parto prematuro: un estudio
Vanessa El-Achi1,2, James Elhindi1, Sarah Melov1,2
1Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Australia.
Acta obstetricia et gynecologica Scandinavica
|August 22, 2025
Resumen
El parto prematuro iatrogénico es común, particularmente los nacimientos prematuros tardíos. El manejo del parto prematuro varía entre los hospitales, lo que indica posibles diferencias en los enfoques de atención.
Área de la Ciencia:
- Obstetricia y ginecología
- Epidemiología perinatal
- Medicina materna y fetal
Sus antecedentes:
- El parto prematuro plantea riesgos significativos para los recién nacidos.
- Comprender los factores de riesgo y el momento de los diferentes tipos de nacimientos prematuros es crucial para mejorar los resultados.
- Las rupturas de membranas iatrogénicas, espontáneas y prematuras representan vías distintas para el parto prematuro.
Objetivo del estudio:
- Investigar los factores de riesgo y el momento del nacimiento para la ruptura iatrogénica, espontánea y prematura de las membranas.
- Analizar las variaciones en el manejo del parto prematuro en los servicios de salud de Nueva Gales del Sur.
- Identificar las asociaciones entre las características maternas y los diferentes tipos de nacimiento prematuro.
Principales métodos:
- Estudio de cohorte histórico (2018-2023) en el que se utilizan registros médicos electrónicos.
- Se incluyen 113.244 embarazos individuales.
- Modelos logísticos multivariados y de regresión de Cox para analizar la incidencia y el tiempo hasta el evento para los tipos de nacimientos prematuros.
Principales resultados:
- El 7,0% de los embarazos dio lugar a un parto prematuro (7940 casos).
- Los partos prematuros iatrogénicos fueron los más comunes (49,2%), seguidos por la ruptura espontánea (36,9%) y la ruptura prematura de las membranas (13,9%).
- El nacimiento prematuro anterior y el modelo de atención prenatal se asociaron con todos los tipos de nacimiento prematuro; la capacidad del hospital influyó en el momento del nacimiento para tipos específicos.
Conclusiones:
- Alta incidencia de nacimiento prematuro iatrogénico, especialmente en el período prematuro tardío (32-36 semanas).
- Existe una variación significativa en el momento del parto para la ruptura prematura de las membranas y el parto prematuro iatrogénico en las maternidades de mayor capacidad.
- Las discrepancias sugieren posibles diferencias en el tratamiento clínico o factores de confusión no medidos.
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