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DOI: 10.1055/s-0042-1744287
Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study
Análise de variáveis que influenciam na taxa de sucesso da indução do parto com misoprostol: Um estudo observacional retrospectivoAbstract
Objective Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery.
Methods Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries.
Results Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches, amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%.
Conclusion At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of non-operative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.
Resumo
Objetivo Determinar os critérios preditivos para o sucesso na indução do trabalho de parto para fetos vivos utilizando misoprostol em gestantes. Em segundo lugar, o objetivo é determinar as taxas de parto vaginal ou cesáreo, duração da indução, intervalo de administração de misoprostol, as principais causas de indução do trabalho de parto e indicação para parto operatório.
Métodos Foram revisados os prontuários de 873 gestantes internadas para amadurecimento cervical entre janeiro de 2017 e dezembro de 2018 em um estudo descritivo observacional de análise retrospectiva, considerando as variáveis-resposta: idade, paridade, Índice de Bishop, doses de misoprostol, tempo de indução do trabalho de parto. Modelos de regressão logística foram utilizados para prever o sucesso com misoprostol em partos não operatórios.
Resultados Dos 873 pacientes avaliados, 72% evoluíram com parto vaginal, 23% dos casos foram cesáreos, 5% fórceps ou vácuo-extrator. Para o parto não operatório as variáveis preditivas na internação foram idade, paridade, idade gestacional e dilatação. Durante a internação, um menor número de toques vaginais, amniotomia ou amniorrexe com líquido claro, levam a menor tempo de indução e maior chance de parto não operatório. Falsos positivos e falsos negativos do modelo sempre foram inferiores a 50% e respostas corretas acima de 65%.
Conclusão Na internação, idade menor que 24 anos, ocorrência de partos normais anteriores, menor idade gestacional e maior dilatação, foram preditivos de maior probabilidade de parto não-operatório. Durante a internação, o menor número de toques vaginais, amniotomia/amniorrexe com líquido claro indicam menor tempo de indução. Estudos futuros com design prospectivo e análise de outros fatores são necessários para avaliar a replicabilidade, generalização desses achados.
Palavras-chave
obstetrícia - misoprostol - complicações do trabalho de parto - trabalho de parto induzidoContributions
All authors participated in the concept and design of the present study; in the analysis and interpretation of data; in the draft or revision of the manuscript; and all have approved the manuscript as submitted. All authors are responsible for the reported research.
Publication History
Received: 01 September 2021
Accepted: 11 January 2022
Article published online:
26 April 2022
© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Marsdal KE, Sørbye IK, Gaudernack LC, Lukasse M. A comparison of misoprostol vaginal insert and misoprostol vaginal tablets for induction of labor in nulliparous women: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18 (01) 11 DOI: 10.1186/s12884-017-1647-3.
- 2 World Health Organization. Department of Reproductive Health and Research. WHO recommendations for induction of labour [Internet]. Geneva: WHO; 2011 [cited 2020 Sep 3]. Available from: http://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf
- 3 Marconi AM. Recent advances in the induction of labor. F1000 Res 2019; 8: 1829 DOI: 10.12688/f1000research.17587.1.
- 4 Hildingsson I, Karlström A, Nystedt A. Women's experiences of induction of labour–findings from a Swedish regional study. Aust N Z J Obstet Gynaecol 2011; 51 (02) 151-157 DOI: 10.1111/j.1479-828X.2010.01262.x.
- 5 American College of Obstetricians and Gynecologists (ACOG). Labor induction: FAQ 154 [Internet]. 2012 [cited 2020 Jan 7]. Available from: https://www.acog.org/Patients/FAQs/Labor-Induction
- 6 Alfirevic Z, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev 2006; (02) CD001338 DOI: 10.1002/14651858.CD001338.pub2.
- 7 Alfirevic Z, Keeney E, Dowswell T. et al. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 2016; 123 (09) 1462-1470 DOI: 10.1111/1471-0528.13981.
- 8 ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin. Clinical management guidelines for obstetricians-gynecologists. Number 55, September 2004 (replaces practice pattern number 6, October 1997). Management of Postterm Pregnancy. Obstet Gynecol 2004; 104 (03) 639-646 DOI: 10.1097/00006250-200409000-00052.
- 9 Leduc D, Biringer A, Lee L, Dy J. CLINICAL PRACTICE OBSTETRICS COMMITTEE, SPECIAL CONTRIBUTORS. Induction of labour. J Obstet Gynaecol Can 2013; 35 (09) 840-857 DOI: 10.1016/S1701-2163(15)30842-2.
- 10 Queensland Clinical Guidelines. Induction of labour [Internet] 2017 [cited 2020 Dec 10]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0020/641423/g-iol.pdf
- 11 National Institute for Health and Clinical Excellence (NICE). Induction of labour: Clinical Guideline CG70 [Internet]. 2008 [cited 2016 Oct 10]. Available from: https://www.nice.org.uk/guidance/cg70
- 12 Triola MF. Introdução à estatística. 12a ed.. Rio de Janeiro: LTC; 2017
- 13 Lehmann EL. Nonparametrics: statistical methods based on ranks. New York: Springer-Verlag; 2006
- 14 Agresti A. An introduction to categorical data analysis. New York: John Wiley & Sons; 1996
- 15 Little SE, Caughey AB. Induction of labor and cesarean: what is the true relationship?. Clin Obstet Gynecol 2015; 58 (02) 269-281 DOI: 10.1097/grf.0000000000000112.
- 16 Universidade Federal de Minas Gerais. Hospital das Clínicas. Sismater - Sistema de Informação em Saúde Materna e Neonatal [Internet]. 2018 [cited 2021 Feb 16]. Available from: https://sismater.com.br/index.php/pt/home/
- 17 Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010; (10) CD000941 DOI: 10.1002/14651858.CD000941.pub2.
- 18 Levine LD, Downes KL, Elovitz MA, Parry S, Sammel MD, Srinivas SK. Mechanical and Pharmacologic Methods of Labor Induction: A Randomized Controlled Trial. Obstet Gynecol 2016; 128 (06) 1357-1364 DOI: 10.1097/aog.0000000000001778.
- 19 Dögl M, Romundstad P, Berntzen LD. et al. Elective induction of labor: A prospective observational study. PLoS One 2018; 13 (11) e0208098 DOI: 10.1371/journal.pone.0208098.
- 20 Fajardo Rodríguez O, Humaran Martínez I, Piloto Morejón M. Inducción del parto con oxitocina, prostaglandinas o ambas. Rev Cuba Obstet Ginecol 2001; 27 (02) 135-140
- 21 Kolkman DG, Verhoeven CJ, Brinkhorst SJ. et al. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 2013; 30 (08) 625-630 DOI: 10.1055/s-0032-1331024.