Avaliação do uso do misoprostol vaginal para amadurecimento cervical em gestações a partir de 41 semanas no Hospital Universitário Risoleta Tolentino Neves

Abstract

Introduction: pregnancy that reaches the post-term, defined in 42 weeks, is at risk of increased maternal and child morbidity and mortality. Aiming at the reduction of post term pregnancy complications, the Risoleta Tolentino Neves University Hospital's maternity service protocol states that patients with 41 completed weeks of gestation are admitted for induction of labor. Misoprostol is a synthetic prostaglandin analogue used for cervical ripening prior to induction. Objective: The study aims to evaluate the cervical ripening process outcome with misoprostol in pregnancies with 41 completed weeks or more. Patients and Methods: They were analyzed 607 pregnant women undergoing cervical ripening process with misoprostol, from July 2007 to December 2015. Data were collected retrospectively from medical records and the variables analyzed were type of delivery, age, parity, fundal height, use of oxytocin, amount of misoprostol tablets, tachysystole, amniotomy, fetal vitality, APGAR 1 and 5 minutes and weight of the newborn. Results: of 607 patients undergoing cervical ripening with misoprosol, 189 patients (31.1%) underwent cesarean section and 418 patients (68.9%) underwent vaginal delivery, 2 assisted with vacuum extractor and 46 assisted with forceps. Predictors of the final model that have statistically significant influence (p <0.05) and combined with the outcome variable Type of delivery (cesarean section or vaginal) are: patient's age (years), parity (None or 1), fundal height (cm), Misoprostol quantity (25 g), Bishop index (real index measurement) and tachysystole (Yes or No). Conclusions: the cesarean delivery rate in patients undergoing cervical ripening- 31.1% - is close to that advocated by World Health Organization- 30% and of that published by other studies. According to the results obtained in the study, the probability of an older women, nulliparous, that has greater fundal height measure, a greater amount of misoprostol used, lower Bishop Score and presence of uterine tachysystole has more chances of delivering by a cesarean section. The proposed model to predict cesarean delivery needs to be improved by other variables and factors.