Outpatient misoprostol cervical ripening without subsequent induction of labor to prevent post-term pregnancy.
BACKGROUND
Interventions that may help shorten the duration of pregnancy in an African setting where facilities for fetal monitoring in post-term pregnancy are limited, and induction is not without its hazards, are needed.


OBJECTIVE
To determine whether outpatient administration of intravaginal misoprostol safely decreases the interval to delivery in postdate pregnancies.


METHODS
Open randomized controlled trial.


METHODS
Zonal district hospitals, Kwale, Southern Nigeria (August 2000 to October 2001).


METHODS
Seventy-seven women were randomized at 40 weeks gestation to receive either 25 microg misoprostol intravaginally (38) or gentle cervical assessment only (39) on an outpatient basis. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed.


METHODS
Interval to delivery, duration of labor, and incidence of side-effects.


RESULTS
Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects.


CONCLUSIONS
Outpatient administration of low-dose misoprostol can safely shorten the length of gestation in postdate pregnancies.
Oboro
Victor O
VO
Maternity Unit, Zonal General Hospital, Kwale, Nigeria. oborovo@hotmail.com
Tabowei
Tabs O
TO
D000282:Administration, Intravaginal; D000328:Adult; D000553:Ambulatory Care; D020070:Cervical Ripening / Q000187:drug effects*; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000187:drug effects*; D018709:Statistics, Nonparametric
D010120:Oxytocics; D016595:Misoprostol