Factores de riesgo asociados a parto distócico en mujeres primíparas atendidas en el Hospital Nacional Arzobispo Loayza

Abstract

Objetivo: Determinar los factores de riesgo asociados al parto distócico en mujeres primíparas atendidas en el Hospital Nacional Arzobispo Loayza durante el período 2023. Material y métodos: Estudio analítico observacional de casos y controles, de corte transversal retrospectivo. Se incluyeron 60 primíparas con parto distócico (casos) y 60 primíparas con parto eutócico (controles), seleccionadas mediante muestreo no probabilístico por conveniencia del mismo centro hospitalario. Las variables fueron categorizadas según criterios internacionales del American College of Obstetricians and Gynecologists, la International Federation of Gynecology and Obstetrics y la Organización Mundial de la Salud. Para el análisis estadístico se empleó Odds Ratio con intervalo de confianza al 95% y prueba Chi cuadrado con corrección de Yates, considerando significativo p<0,05. Resultados: Los factores con asociación estadísticamente significativa para parto distócico fueron: obesidad materna (88,9% mayor probabilidad en comparación con mujeres sin obesidad), sobrepeso (68,4% mayor probabilidad), presentación no cefálica (97,2% mayor probabilidad), hipodinamia uterina (99,7% mayor probabilidad) y doppler fetal alterado (96,5% mayor probabilidad). La desproporción céfalo-pélvica se documentó en el 36,7% de los casos. No se encontró asociación significativa para la edad materna, el número de controles prenatales ni el inicio del trabajo de parto. Conclusiones: La obesidad materna, la presentación fetal anómala, la hipodinamia uterina y el compromiso hemodinámico fetal constituyen los principales factores de riesgo de parto distócico en primíparas, hallazgos concordantes con la evidencia internacional vigente. Objective: To determine the risk factors associated with dystocic delivery in primiparous women treated at the Hospital Nacional Arzobispo Loayza during 2023. Materials and Methods: An analytical observational case–control study with a retrospective cross-sectional design was conducted. Sixty primiparous women with dystocic delivery (cases) and 60 primiparous women with eutocic delivery (controls) were included, selected through non-probability convenience sampling at the same hospital. Variables were categorized according to international criteria established by the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the World Health Organization. Statistical analysis was performed using Odds Ratio with a 95% confidence interval and the Chi-square test with Yates correction, considering p<0.05 as statistically significant. Results: Factors with statistically significant association with dystocic delivery were maternal obesity (88.9% higher probability compared to non-obese women), overweight (68.4% higher probability), non-cephalic presentation (97.2% higher probability), uterine hypodynamia (99.7% higher probability), and abnormal fetal Doppler findings (96.5% higher probability). Cephalopelvic disproportion was documented in 36.7% of cases. No significant association was found for maternal age, number of prenatal visits, or onset of labor. Conclusions: Maternal obesity, abnormal fetal presentation, uterine hypodynamia, and fetal hemodynamic compromise constitute the main risk factors for dystocic delivery in primiparous women, consistent with current international evidence.