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Satisfação materna no processo de maturação cervical em ambulatório
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Indução do trabalho de parto (ITP) define-se como a iniciação artificial de contrações uterinas rítmicas de forma a desencadear o trabalho de parto antes do seu início espontâneo. No entanto, numa percentagem importante de grávidas, é necessário que, previamente às contrações uterinas, haja amadurecimento cervical que, geralmente, é um processo lento e que ocorre, tradicionalmente, em meio hospitalar. A maioria dos estudos que comparam os diferentes métodos de maturação cervical (MC) focam-se preferencialmente na eficácia e perfil de segurança, negligenciando a preferência da grávida. Assim, este trabalho tem como objetivo avaliar a satisfação das grávidas relativamente ao método utilizado na MC realizada em ambulatório, comparando a utilização de mifepristone oral com o balão de foley. Foi aplicado um inquérito de satisfação materna às grávidas que participaram num ensaio clínico aleatorizado que está a decorrer no Serviço de Obstetrícia do Hospital de Santa Maria, que compara a utilização destes dois métodos em grávidas que têm indicação para ITP no termo e um índice de Bishop modificado inferior a 6. O desfecho primário do estudo foi a determinação de qual o método que se associa a maior satisfação materna na MC em ambulatório. Foram analisados 62 inquéritos. Globalmente, o processo de maturação foi considerado uma intervenção que gerou ansiedade. Contudo, as grávidas consideraram, frequentemente, que durante o procedimento conseguiram: 1. manter as suas atividades quotidianas, 2. ter momentos de relaxamento e 3. dormir. Referem, ainda, que não sentiram dor durante o processo. As grávidas que realizaram MC com o balão de foley reportaram mais desconforto comparativamente às que a realizaram com mifepristone (59% vs 23%, p = 0,005). No entanto, o balão de foley não se associou a maior perceção de dor comparativamente ao mifepristone (p = 0,485). Concluindo, este estudo mostra que a MC em ambulatório não parece ter um impacto negativo nas atividades quotidianas e no descanso das grávidas. No entanto, quando se compararam os dois métodos, não houve diferenças estatisticamente significativas no que toca à preferência das grávidas por um deles.
Induction of labour is defined as techniques to stimulate uterine contractions in order to trigger labour before its spontaneous onset. However, in a significant rate of pregnant women, previously to induction, cervical ripening is necessary. This is a slow process and traditionally takes place at hospital. Most studies comparing different methods for cervical ripening focus primarily on efficacy and safety profile, neglecting the woman's preference. Therefore, this study aims to evaluate the satisfaction of pregnant women regarding the method used in cervical ripening in an outpatient setting, comparing the use of oral mifepristone with the foley balloon. In order to evaluate maternal satisfaction, a questionnaire was applied to the pregnant women who participated in a randomised clinical trial being conducted at the Obstetrics Department of Santa Maria Hospital, which compares the use of mifepristone with foley balloon. All participants had Bishop score less than 6 and gestational age equal or above 37 weeks. The main purpose of this study was to determine which method was associated with greater maternal satisfaction in outpatient cervical ripening. Sixty-two surveys were analysed. Overall, the maturation process was considered an anxiety-producing intervention. Nevertheless, women often considered that during the procedure they were able to: 1. maintain their daily activities, 2. have moments of relaxation and 3. were able to sleep. Overall, cervical ripening was not a procedure associated with pain. However, women in foley balloon group reported more discomfort comparing to the ones in the mifepristone group (59% vs 23%, p = 0.005). Interestingly, the foley balloon was not associated with a greater perception of pain when comparing to mifepristone (p = 0.485). In conclusion, this study shows that outpatient cervical maturation does not seem to have a negative impact on either the day-to-day activities or the rest of pregnant women. Nevertheless, when the two methods were compared, there were no statistically significant differences in the preference of pregnant women for either method.
Induction of labour is defined as techniques to stimulate uterine contractions in order to trigger labour before its spontaneous onset. However, in a significant rate of pregnant women, previously to induction, cervical ripening is necessary. This is a slow process and traditionally takes place at hospital. Most studies comparing different methods for cervical ripening focus primarily on efficacy and safety profile, neglecting the woman's preference. Therefore, this study aims to evaluate the satisfaction of pregnant women regarding the method used in cervical ripening in an outpatient setting, comparing the use of oral mifepristone with the foley balloon. In order to evaluate maternal satisfaction, a questionnaire was applied to the pregnant women who participated in a randomised clinical trial being conducted at the Obstetrics Department of Santa Maria Hospital, which compares the use of mifepristone with foley balloon. All participants had Bishop score less than 6 and gestational age equal or above 37 weeks. The main purpose of this study was to determine which method was associated with greater maternal satisfaction in outpatient cervical ripening. Sixty-two surveys were analysed. Overall, the maturation process was considered an anxiety-producing intervention. Nevertheless, women often considered that during the procedure they were able to: 1. maintain their daily activities, 2. have moments of relaxation and 3. were able to sleep. Overall, cervical ripening was not a procedure associated with pain. However, women in foley balloon group reported more discomfort comparing to the ones in the mifepristone group (59% vs 23%, p = 0.005). Interestingly, the foley balloon was not associated with a greater perception of pain when comparing to mifepristone (p = 0.485). In conclusion, this study shows that outpatient cervical maturation does not seem to have a negative impact on either the day-to-day activities or the rest of pregnant women. Nevertheless, when the two methods were compared, there were no statistically significant differences in the preference of pregnant women for either method.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Maturação cervical Indução do trabalho de parto Balão de Foley Mifepristone Satisfação materna Obstetrícia