RESUMO
Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission. Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group. Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group
Assuntos
Maturidade Cervical , Trabalho de Parto Induzido , Membranas , Misoprostol , Ocitocina , Gravidez Prolongada , Contração UterinaRESUMO
Notre enquete est une etude prospective descriptive et transversale des cas de grossesses prolongees. Elle a ete realisee a la maternite du CHU de Cocody du ler Aout 2001 au 30 Novembre 2002. L'objectif general a ete d'apprecier la prise en charge; les voies d'accouchement et le pronostic foetal des grossesses prolongees dans le service. Nous oavons analyse 122 parturientes venues accoucher dans un contexte de grossesse prolongee. Ces cas correspondent a 2pour cent des accouchements; et nous avons constate que:61.50pour cent avaient entre 25 et 35 ans54.91pour cent n'avaient pas depasse le niveau primaire69.68pour cent etaient constituees de menageres ou de revendeuses58.20pour cent etaient venues d'elles meme49.18pour cent etaient a leur premier accouchement88.5pour cent avaient fait au moins quatre consultations prenatales. Le mode d'accouchement a ete domine par les cesariennes (55.74pour cent)Le taux de mortalite perinatale etait de 57.4pour cent.o alors que la mortalite maternelle est nulle.L'examen des nouveaux-nes avait note que 66.39pour cent presentaient des signes de post-maturite et que 73.53pour cent parmi eux etaient nes par cesarienne.Un diagnostic precoce de la grossesse ainsi qu'une surveillance bien conduite avec le trepied echographie - amnioscopie - analyse du rythme cardiaque; permettront de reduire la mortinatalite et les cesariennes abusives