Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil.
Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil.
Rev Assoc Med Bras (1992). 2024 Aug 30;70(9):e20240286. doi: 10.1590/1806-9282.20240286. eCollection 2024.
The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes.
This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1-intravaginal misoprostol 25 μg every 4 h and Group 2-intravaginal misoprostol 25 μg every 6 h.
Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47-2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop's score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002).
Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.
本研究旨在比较两种引产方案（4 小时和 6 小时），确定阴道内给予 25μg米索前列醇片引产成功的预测因素，并评估其与不良围产儿结局的关系。
这是一项回顾性队列研究，纳入了在 37 周至 42 周妊娠期间接受阴道内给予 25μg米索前列醇片引产的单胎妊娠孕妇。将孕妇分为两组：第 1 组（n=289）为阴道内给予 25μg米索前列醇片，每 4 小时 1 次；第 2 组（n=278）为阴道内给予 25μg米索前列醇片，每 6 小时 1 次。
孕妇分为第 1 组（n=289）和第 2 组（n=278）。第 1 组阴道内给予 25μg米索前列醇片的中位数数量更高（3.0 片与 2.0 片，p<0.001），产后出血发生率更低（7.6%与 32.7%，p<0.001），需要催产素的比例更高（比值比[OR]：2.1，95%CI：1.47-2.98，p<0.001）。与第 2 组相比，第 1 组中使用 4 小时和 6 小时间隔阴道内给予 25μg米索前列醇片（x2(1)=23.7，OR：4.35，p<0.0001）、产次（x2(3)=39.4，OR：0.59，p=0.031）和 Bishop 评分（x2(4)=10.8，OR：0.77，p=0.019）是引产失败的最佳预测因素。在开始（Breslow p<0.001）和活跃分娩期（Long Hank p=0.002）结束时，两组之间使用第一片阴道内米索前列醇 25μg 之间的差异具有统计学意义。
与每 6 小时阴道内给予 25μg米索前列醇片相比，每 4 小时阴道内给予 25μg米索前列醇片的孕妇从引产开始到活跃分娩期开始的时间更长，不良围产儿结局的发生率更高。
