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Master Thesis

Déclenchement artificiel du travail par misoprostol oral (Angusta®) : Étude de cohorte rétrospective et observationnelle

Abstract : Objective The number of induction of labor continues to increase in France, accounting for 22% of deliveries in 2016. Cervical maturation is sometimes necessary when the cervix is unfavourable. Several methods are currently available, each with its advantages and disadvantages. Misoprostol, a prostaglandin E1 analogue, is used in particular. It obtained its marketing authorisation in France in the form of oral tablets in April 2018. The objective of our study was therefore to evaluate the efficacy and tolerance of oral misoprostol administered in 25 µg tablets during induction of labor with an unripe cervix from 34 weeks of amenorrhea. Methods We conducted a retrospective, observational, and monocentric cohort study. It included all women who had experienced an induction of labor with an unripe cervix from 34 weeks of amenorrhea and whose fetus was alive and in cephalic presentation. It took place at the Centre Hospitalier Intercommunal in Poissy Saint-Germain-en-Laye from October 1, 2018 to November 12, 2019. For the first period from October 1, 2018 to March 19, 2019, women received one 25 µg misoprostol tablet orally every two hours. Over the second period from March 20, 2019 to November 12, 2019, women received two oral misoprostol tablets, or 50 µg every four hours. Results and conclusion The total number of women included was 735 out of which 470 were nulliparous (63.9%). The vaginal delivery rate was 78.3% and the cesarean section rate was 21.6%. 30.2% of cesarean section were performed for failure to trigger. However, there was a significant reduction in the cesarean section rate over our second study period (17.7% versus 25.7% in the first period, p=0.002). The median time between onset of maturation and delivery was 25 hours and 6 minutes. The arterial pH level at 7 was 0.7% and Apgar score below 7 to 5 minutes of life was 1%. Twelve newborns were admitted to neonatal intensive care unit. Conclusion Misoprostol administered orally as a 25 µg tablet appears to be effective in inducing delivery during induction of labour with an unripe cervix. In addition, its use appears to be associated with good maternal-fetal tolerance and a lack of impact on neonatal status. Given the reduced cesarean section rate over our second period, additional studies should be conducted to compare a dose of 25 µg every two hours versus 50 µg every four hours.
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Submitted on : Tuesday, May 11, 2021 - 2:49:47 PM
Last modification on : Wednesday, October 20, 2021 - 12:24:16 AM
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  • HAL Id : dumas-03224222, version 1

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Julie Gams. Déclenchement artificiel du travail par misoprostol oral (Angusta®) : Étude de cohorte rétrospective et observationnelle. Gynécologie et obstétrique. 2020. ⟨dumas-03224222⟩

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