Fatores maternos e fetais associados à indução do parto com misoprostol: um estudo transversal

Abstract

In Brazil, the high number of cesarean sections is a part of the obstetric scenario, being the second country with the highest rate in the world, exceeding 55% of deliveries. The World Health Organization (WHO) recommends a rate of 10-15% of cesareans, as studies show greater maternal and perinatal morbidity and mortality associated with the execution of this procedure without a real indication. In this sense, the importance of inducing labor through effective and safe methods is highlighted, aiming at encouraging vaginal delivery and, consequently, reducing maternal and perinatal morbidity and mortality. The present study aimed to evaluate maternal and fetal factors associated with misoprostol induction in term pregnancies, comparing the outcomes with the mode of delivery. This is a descriptive, retrospective, cross-sectional study with a quantitative approach carried out through analysis of medical records of patients who underwent labor induction at the Maternidade Escola Assis Chateaubriand (MEAC), in Fortaleza - CE, from 2020 and 2021. Data collection was carried out during the months of September and October 2022, using an instrument containing information on the sociodemographic and gynecological-obstetric profile, information on the current pregnancy, maternal and neonatal outcomes. The data underwent a tabulation procedure in Microsoft Excel® 2019 and processing using the R for Windows software version 3.5.1, where synthesis measures were applied (descriptive statistics and frequency distribution) and the application of analytical tests of independence Chi-square, Fisher's Exact Test and Wilcoxon rank sum test in order to establish an association between predictive variables and the outcome of the mode of delivery. The total sample consisted of 291 women, with a cesarean section rate of 88 (30,0%) and a vaginal delivery rate of 203 (70,0%). The resolution of pregnancy by surgical delivery was considered induction failure and our results showed that cesarean sections after induction occurred in primiparous women, with unpaid work, with higher levels of education, with hypertensive syndromes, who did not use oxytocin and induction time prolonged. When observing the indications for cesarean sections, the most prevalent were maternal withdrawal from the induction process (36,0%); acute fetal distress (30,0%) and progression arrest (12,0%). Analyzing the neonatal outcomes, induction failure showed some negative repercussions for the mother-baby binomial, such as lower rates of skin-to-skin contact and breastfeeding stimulation in the first hour of life. On the other hand, On the other hand, it was observed that induction can be safe for the fetus, since none was admitted to the neonatal ICU. From

the results of this study, it is suggested that the induction of labor with misoprostol can contribute to the reduction of cesarean rates, since the majority resulted in vaginal delivery, providing a quick recovery, reducing postpartum pain, promoting the bond between mother and baby and favoring breastfeeding. In addition, it is important to investigate and understand the factors associated with the process and outcome of induced deliveries, both for the mother and the newborn, in order to contribute to safe, respectful and quality care.