Utility of misoprostol for labor induction in severe pre-eclampsia and eclampsia.
OBJECTIVE
To determine the effectiveness and safety of misoprostol in severe pre-eclampsia and eclampsia patients with unripe cervix.


METHODS
A prospective observational study was carried out in 135 severe pre-eclampsia and eclampsia patients who required termination of pregnancy at the Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh during January 2002 to October 2003. Fifty micrograms of misoprostol was used every 4 h in cases of unripe cervix (Bishop score < or = 6) in severe pre-eclampsia and eclampsia patients. Maternal and perinatal outcome as well as any complications were recorded.


RESULTS
In severe pre-eclampsia and eclampsia patients vaginal delivery occurred in 79.3 and 80.5% of cases, and cesarean section was performed in 20.6 and 19.4% of cases, respectively. The maximum required responsive dose was 50-150 microg. Oxytocin augmentation was required in 29.3 and 35% of cases, respectively. Induction to delivery time was median 8 h, interquartile ranges 4.2-8.2 h in the severe pre-eclampsia group, and median 9 h, interquartile ranges 6.8-12.5 h in the eclampsia group, and average hospital stay was 3.4 +/- 1.8 and 3.7 +/- 1.7 days, respectively. The only maternal complications were hyperstimulation which occurred in 6.8 and 5.1% of cases, respectively. Neonatal death occurred in five (11.3%) and eight cases (12.1%), respectively.


CONCLUSIONS
Intravaginal misoprostol is well tolerated and very effective for the induction of labor in severe pre-eclampsia and eclampsia patients with unripe cervix.
Department of Obstetrics and Gynecology, Khulna Medical College, Khulna, Bangladesh. drlucky@khulna.bangla.net
Shamsun
S
Nahar
Choudhury Habibur
CH
Rasul
Abu
A
Sayed
Abul Kashem Mohammad Anwarul
AK
Azim
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004461:Eclampsia; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin