Auteur(s) : Boichut Caroline
Composante : MEDECINE
Date de création : 30-06-2021

Description : Médecine (gynécologie-obstétrique), Objective: The objective of this work is to compare the efficacy, tolerance, and cost of the use in real practice of Misoprostol oral tablet 25 mcgr in reference to Dinoprostone intra vaginal device 10 mg, in the artificial induction of labour. Material and methods: This is a a comparative and monocentric prospective cohort study, carried out in a level 2B maternity hospital in Colmar, Haut-Rhin, France, between January 1, 2019 and August 31, 2019. All patients who received an artificial induction of labour and mutually exclusive artificial labor induction with Misoprostol oral tablet 25 mcgr or Dinoprostone intra vaginal device 10 mg, in a single or multiple pregnancy with multiple pregnancies with live fetus(es) in first cephalic presentation after 30 weeks of amenorrhea was included. Exclusion criteria included patients and those with a scarred uterus. All obstetrical and maternal obstetrical and maternal-fetal data were collected from the standardized AUDIPOG medical record. Patient satisfaction was assessed one year after delivery by telephone questionnaire. A retrospective cost study was undertaken with the hospital pharmacy. The primary outcome was the caesarean section rate. Secondary endpoints included analysis of other obstetrical parameters, comparison of maternal-fetal outcomes, and evaluation of the tolerance and cost of each technique. Results: Over the entire study period, 198 patients were included. 87 patients in the oral Misoprostol group and 111 patients in the Dinoprostone intra vaginal group. The cesarean section rate did not differ between the two groups: 17.2% for oral Misoprostol and 20.7% for intra vaginal Dinoprostone (p= 0.5) but there were fewer instrumental deliveries with oral Misoprostol (DDRA 0.32 p=0.02). The proportion of patients delivering within the first 24 hours was higher with intra vaginal Dinoprostone than with oral Misoprostol (DDRA 2.30 p=0.01), but the mean duration of induction did not differ between the two groups (p=0.06). Maternal and neonatal outcomes were good and comparable between the two groups. The average cost of induction with oral Misoprostol was 113.30 euros per patient versus 104.07 euros per patient for intra vaginal Dinoprostone. Oral Misoprostol was however better tolerated than intra vaginal Dinoprostone, the latter having a high rate of vaginal burns during use (p - 0.01). Conclusion: Oral Misoprostol in regular clinical practice is an effective, safe and well-tolerated method of safe and well-tolerated induction method, with a modest additional cost compared to the to the gold standard usually used (intra vaginal Dinoprostone)
Mots-clés libres : Médicaments gynécologiques -- Études comparatives, Accouchement provoqué, Misoprostol, Dinoprostone, Césarienne, Soins médicaux -- Coût, 618.1-8
Couverture : FR