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ISSN 0187-5337 (Print)
Instituto Nacional de Perinatología

2000, Number 4

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Perinatol Reprod Hum 2000; 14 (4)

Efectividad del misoprostol intravaginal en la reducción de cesáreas, en primíparas y multíparas con ruptura prematura de membranas y embarazo de término

Guzmán-Sánchez A, Alfaro-Alfaro N, Valadez-Figueroa I, Morales-Rodríguez A, Aldrete-Rodríguez G

Language: Spanish
References: 22
Page: 197-205
PDF size: 334.23 Kb.


ABSTRACT

Objective: We investigate the effectivity and security of intravaginal Prostaglandine E1, in cases of premature rupture of membranes (PROM) in patients with at term pregnancy, this pathologic problem is frequently cause of fetal and maternal infection and a medical justification for practicing a cesarean section.
Material and methods: We selected 400 patients (235 primiparas and 165 multiparas) all patients included had the followings inclusion criteria: 37 to ‹ 42 weeks of pregnancy, irregular uterine contractions, a normal non stress fetal test, pelvic sufficiency, PROM of £8 hours, Bishop index £4, clear amniotic fluid and without evidence of infection. Every 6 hours patients use 50 micrograms of misoprostol by vaginal route.
Results: More than 90% of multiparas and primiparas achieve normal uterine contractility and gave birth during the followings 350 minutes after the misoprostol application. The regularization of the uterine activity in both groups were similar after one, two or three doses of prostaglandine; there were no statistics association (OR = 1.35; IC 95% = 0.78-2.34), (OR = 0.97; IC 95% = 0.46-2.02) y (OR = 1.46; IC 95% = 0.59-1.57). After three doses more babies were delivery by multiparas and these results had statistics association. (OR = 3.61; IC 95% = 1.15-12.0). The regularization of the uterine activity were in favor of multiparas only between the following 20 to 150 minutes after de PGE1 application; this results had statistic association (OR = 4.0; IC 95% = 2.49-6.45). Also the number of deliveries were in favor of multiparas only between the following 20 to 150 minutes after de PGE1 application; this results had statistic association (OR = 5.01; IC 95% = 2.57-9.88). The cesarean rates were higher in multiparas (6.6% vs 3.8%) with statistics association (OR = 1.78; IC 95% = 0.67-4.79). The Apgar score didn´t show statistics differences. The collateral effects were low in both groups (10% and 9%).
Conclusions: The security and efficacy of misoprostol is acceptable and this is another one alternative to reduce the cesarean section rates in case of PROM and unfavorable cervix. Whenever we use misoprostol is advisable to follow up a close clinical monitoring patients.


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