Desfechos obstétricos e neonatais de parturientes submetidas à indução e/ou condução do trabalho de parto com ocitocina

Abstract

Introduction: The induction of labor consists in the use of mechanical or pharmacological methods to artificially initiate maternal uterine contractions in women with indication for vaginal delivery and who have some indication to interrupt gestation. In addition to induction, there is also the augmentation of labor, which refers to the stimulation of spontaneous uterine contractions for the acceleration of labor, or when these contractions are considered ineffective. Oxytocin is the most widely used method of induction or augmentation in the world. However, oxytocin is not a substance free from maternal and fetal risks. The greatest risk associated with the use of oxytocin is the occurrence of fetal distress due to the occurrence of uterine tachysystole. Thus, the relevance of the study was to bring to light the main outcomes of the delivery of women and fetuses in oxytocin use, and the dosages used associated with such outcomes, thus allowing the recognition of complications arising from its use, aiding in clinical judgment on which ideal dosage for labor induction or augmentation. Objectives: To analyze the outcome of delivery of full-term parturients who were submitted to induction / augmentation of labor with oxytocin, to verify the outcomes regarding the type of delivery, to identify the occurrence of adverse events related to oxytocin use and to correlate the postpartum maternal and neonatal conditions with oxytocin. Methodology: The study was descriptive, exploratory, documental, with a quantitative approach, through the analysis of the medical records of low risk patients with full term gestation, submitted to the induction or augmentation of labor with oxytocin in 2017, at Maternidade Escola Assis Chateaubriand. Women who used Misoprostol were excluded. Data were analyzed using the statistical software SigmaSTAT 3.5, using the appropriate tests. The project was approved by the Research Ethics Committee of Maternidade Escola Assis Chateaubriand. Results: The study has 113 patients, of which the mean age was 23.7 years, the majority coming from the capital (77.8%) and single (60%). Regarding parity, 61.9% of the patients were primiparous. The mean gestational age of the population was around 277 days. The major cause of medical indication for oxytocin use was for the delivery of labor due to motor dystocia (69,9%), with second place for induction. Regarding the time of induction / augmentation, the average duration was around 184 minutes and the duration of the labor lasted on average 543 minutes. Regarding the infusion rate of the drug, 97.34% of the patients had the initial infusion of the drug of 6mL / h. The final oxytocin flow rate was also 6 mL / h, corresponding to 39.82% of the patients. Regarding the occurrence of uterine tachysystole, 8.3% of the patients presented the condition. The occurrence of nausea and vomiting was the second major maternal adverse effect during infusion of the drug. Regarding labor analgesia, 11 15% of the patients needed the technique, and 73.3% had analgesia before using oxytocin. Regarding the outcome of delivery, 64.6% of the patients evolved to vaginal delivery, with 28.3% of the patients submitted to cesarean section. Regarding neonates, 1.77% presented APGAR less than 7 in the 5th minute, 15.9% needed O2 use, 14.2% were admitted to ICU and 40.5% presented meconium at birth. The variable that had the greatest influence on the occurrence of neonatal ICU admission was the number of pregnancies (p = 0.018), and the variable that most influenced the outcome of the delivery was the duration of the labor with a value of p = 0.014. Induction time was the variable that most influenced the occurrence of tachysystole (p = 0.037). Conclusion: Oxytocin had a success rate in achieving vaginal delivery in 64.6% of the patients. Regarding the outcomes, the main maternal outcome with the use of the drug was uterine tachysystole (8.3%), and the main neonatal outcome was the presence of meconium at birth (40.5%), followed by use of O2 (15.9%).