L'AUTONOMIA OSTETRICA IN UN CENTRO DI TERZO LIVELLO: STUDIO PROSPETTICO OSSERVAZIONALE SULL'OUTCOME MATERNO DEI TRAVAGLI A BASSO RISCHIO.

One of the most important goals of modern obstetric care is to ensure compliance with the physiology while ensuring , with excellent supervision , good maternal and neonatal outcomes . The aim of this study was to analyze maternal and neonatal outcomes of pregnant women at term low risk ( nulliparous and multiparous ) admitted in spontaneous labor and midwife assisted autonomy in a level III center . We observed a group of low-risk women with a singleton pregnancy obstetrician , the situation in the longitudinal , cephalic presentation and admitted in spontaneous labor . Our hypothesis is that , in hospitals run by the midwife labor in women at low risk on admission may be a possible way to secure the de-medicalization . Maternal and neonatal outcomes considered were : type of delivery , episiotomy, , postpartum hemorrhage ( PPH) , transfusions , pH and Apgar score of newborns, the prevalence of SGA and LGA infants , admissions TIN , perinatal mortality . Women at low obstetric risk ( 50.3 % of all parts of the center ) have been assisted by the midwife autonomy , according to the protocol in place . Women who were in the stages of labor with obstetric risk and therefore become at risk obstetrician excluded from our work. Medical supervision for emerging risk factors in the first or second stage of labor was required in 16.1 % and 8.6 % of cases, respectively . Epidural analgesia was performed in 29.8 % of cases. , Although the latter group of women was not considered by the autonomy midwife . There are only 22.9 % of low-risk women recruited and managed autonomously by the midwife . The results suggest that in a hospital environment , labor, midwife managed independently in low-risk women with a lot of benefits can be realized without additional risks for the mother and the baby and avoiding complications due to transfers from other structures chosen for the confinement to ' hospital.