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Introdução: Actualmente, a frequência de indução de parto atinge 15 a 30% do total de partos. A utilização de um método efectivo pode viabilizar o parto vaginal em aproximadamente 70 a 80% dos casos. A preocupação com o excesso de cesarianas nas últimas décadas tem despertado um crescente interesse pelos métodos de indução, procurando-se o mais efectivo e seguro quer para o feto, quer para a mãe. Assim este trabalho tem como objectivos: 1) Determinar a taxa de partos induzidos no Centro Hospitalar Cova da Beira e 2) determinar a eficácia e segurança de misoprostol comparado com o sistema de libertação prolongado de dinoprostona (Propress®) para indução de trabalho de parto
Material e Métodos: Realizou-se um estudo retrospectivo, observacional envolvendo 436 pacientes que foram submetidos à indução de trabalho de parto com 50µg de misoprostol preferencialmente por via vaginal ou pelo sistema de libertação prolongado de dinoprostona (Propress®), no período de tempo compreendido entre 1 de Janeiro de 2012 e 31 de Dezembro de 2014. Os resultados obstétricos e neonatais foram analisados e comparados em ambos os grupos. A análise estatística foi realizada utilizando o teste t e o Chi quadrado, adoptando-se como nível de significância p <0,05.
Resultados: A taxa de partos induzidos no CHCB no período de tempo de estudo foi de 25,4%. A taxa de partos vaginais foi significativamente mais alta no grupo induzido com misoprostol, comparativamente com o grupo induzido com dinoprostona (82,6% versus 57,3%, p <0,001). Indução falhada foi a indicação para cesariana com maior frequência no grupo da dinoprostona comparativamente com misoprostol (38,6% versus 1,7%, p <0,001). Índice de Apgar e taxa de admissão na Unidade de Cuidados Intensivos de Recém-nascidos foram similares. Os dois grupos apresentam diferentes distribuições de variáveis que podem alterar o sucesso de indução, nomeadamente: paridade, antecedentes diabéticos, índice de Bishop e motivo de indução.
Conclusão: A percentagem de partos induzidos no Centro Hospitalar Cova da Beira é de 25,5%. Face à diferença entre as características da população nos dois grupos não é possível inferir sobre a eficácia de cada método de indução. Misoprostol e Propress® demonstram um grau semelhante de segurança para o feto.
Introduction: These days, the frequency of labor induced reaches 15 to 30% of total childbirths. The use of an effective method can enable vaginal delivery in approximately 70 to 80% of cases. Concern about the last few decades excessive cesarean has arisen an increasing interest over induction methods, trying to get the safest and most effective method for both the fetus and for the mother. Thus, this study aims at: 1) Determining the rate of labor induction at Centro Hospitalar Cova da Beira and 2) determining misoprostol effectiveness and safety compared to the dinoprostona (Propress®) prolonged release system to induce childbirth. Material and Method: An observational, retrospective study was carried out involving 436 patients who have been submitted to labor induction with 50µg of misoprostol preferentially by vaginal delivery or by the prolonged release system of dinoprostone (Propress®), in the period between 1st January 2012 and 31st December 2014. Obstetrical and neonatal results were analyzed and compared in both groups. Statistical analysis was performed by means of t-test and chi-square test, taking p <0, 05 as the level of significance. Results: The rate of induced childbirths at the CHCB over the studied time reached 25, 4%. The vaginal childbirth tax was significantly higher in the group induced with misoprostol when compared to the group induced with dinoprostona (82, 6% versus 57, 3%, p <0,001). In the group of dinoprostona the most frequent indication for cesarean was failed induction when compared to misoprostol (38, 6% versus 1, 7%, p <0,001). The Apgar score and the admission level in the newborn Intensive Care Unit were similar. Both groups table different variable distributions that can change induction success, namely: parity, diabetic antecedents, Bishop Index and cause for induction. Conclusion: The percentage of induced childbirths at the Centro Hospitalar Cova da Beira is 25, 5%. It is not possible to infer on the effectiveness of each induction method due to the different population characteristics in both groups. Misoprostol and Propress® show a similar safety profile to the fetus.
Introduction: These days, the frequency of labor induced reaches 15 to 30% of total childbirths. The use of an effective method can enable vaginal delivery in approximately 70 to 80% of cases. Concern about the last few decades excessive cesarean has arisen an increasing interest over induction methods, trying to get the safest and most effective method for both the fetus and for the mother. Thus, this study aims at: 1) Determining the rate of labor induction at Centro Hospitalar Cova da Beira and 2) determining misoprostol effectiveness and safety compared to the dinoprostona (Propress®) prolonged release system to induce childbirth. Material and Method: An observational, retrospective study was carried out involving 436 patients who have been submitted to labor induction with 50µg of misoprostol preferentially by vaginal delivery or by the prolonged release system of dinoprostone (Propress®), in the period between 1st January 2012 and 31st December 2014. Obstetrical and neonatal results were analyzed and compared in both groups. Statistical analysis was performed by means of t-test and chi-square test, taking p <0, 05 as the level of significance. Results: The rate of induced childbirths at the CHCB over the studied time reached 25, 4%. The vaginal childbirth tax was significantly higher in the group induced with misoprostol when compared to the group induced with dinoprostona (82, 6% versus 57, 3%, p <0,001). In the group of dinoprostona the most frequent indication for cesarean was failed induction when compared to misoprostol (38, 6% versus 1, 7%, p <0,001). The Apgar score and the admission level in the newborn Intensive Care Unit were similar. Both groups table different variable distributions that can change induction success, namely: parity, diabetic antecedents, Bishop Index and cause for induction. Conclusion: The percentage of induced childbirths at the Centro Hospitalar Cova da Beira is 25, 5%. It is not possible to infer on the effectiveness of each induction method due to the different population characteristics in both groups. Misoprostol and Propress® show a similar safety profile to the fetus.
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Keywords
Dinoprostona Indução Misoprostol Parto Propress