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Factors of Non-Compliance with a Protocol for Oral Administration of Misoprostol (Angusta(®)) 25 Micrograms to Induce Labor: An Observational Study

We set out to identify factors of non-compliance with a protocol for the oral administration of misoprostol 25 µg (Angusta(®)) every 2 h (up to eight tablets), for the induction of labor (IOL). We conducted a retrospective study on IOL at term, on singleton pregnancies from 2019 to 2021, in a univer...

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Detalles Bibliográficos
Autores principales: Pambet, Mathilde, Delabaere, Amélie, Figuier, Claire, Lambert, Céline, Comptour, Aurélie, Rouzaire, Marion, Gallot, Denis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964196/
https://www.ncbi.nlm.nih.gov/pubmed/36836056
http://dx.doi.org/10.3390/jcm12041521
Descripción
Sumario:We set out to identify factors of non-compliance with a protocol for the oral administration of misoprostol 25 µg (Angusta(®)) every 2 h (up to eight tablets), for the induction of labor (IOL). We conducted a retrospective study on IOL at term, on singleton pregnancies from 2019 to 2021, in a university hospital. The study included 195 patients, comprising 144 compliant protocols. Pain was statistically more frequent in the non-compliance group (92.2% vs. 62.5%, p < 0.001), and when a midwife was unavailable (15.7% vs. 0.7%, p < 0.001). A multivariable analysis found factors of good response (defined as going into labor before the administration of the median number of tablets, i.e., six) to be an indication for PROM (OR: 12.03, 95% CI: 5.42–26.71), and gestational age at induction (OR: 1.54, 95% CI: 1.19–2.01), independently of BMI, initial Bishop score, and parity. Patients with pain who were able to follow the protocol delivered 9 h earlier than patients with pain who interrupted the protocol and 16 h earlier than patients who experienced no pain. We identified two key elements that favored compliance: (i) providing the next tablet in advance; and (ii) offering patients early epidural analgesia when in pain in order to continue the protocol and go into labor promptly.