[Effect and risk analysis of misoprostol in stimulating cervical maturity for post-term pregnancy].
OBJECTIVE
To evaluate the effect and risk of misoprostol for stimulating cervical maturity in women with post-term pregnancy negative for insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion with modified Bishop score less than 3.


METHODS
Seventy-one women with post-term pregnancy randomized into misoprostol group (n=37) and control group (n=34) received misoprostol placement at the posterior vaginal fornix and routine intravenous oxytocin infusion, respectively, to stimulate cervical maturity. Failure to respond to the treatment within the initial 24 h necessitated a repeated administration for no more than 3 times in all. Modified Bishop score was recorded and fetal heart monitored once every 24 h, and IGFBP-1 in the cervical secretion was detected at 24 and 48 h after drug administration.


RESULTS
The misoprostol group showed better effect of cervical maturity stimulation than the control group (P<0.001), and the positivity rates of IGFBP-1 24 and 48 h after drug administration were significantly higher than that of the control group (P<0.01 and 0.001). The number of cases with indication for cesarean section was significant higher in the control group (P<0.001). There were no significant differences in postpartum hemorrhage, excessive uterine contraction, incidence of fecal contamination of the amniotic fluid or Apgar score of the newborn between the two groups (P>0.05).


CONCLUSIONS
Misoprostol is safe and effective for stimulating cervical maturity in women with post-term pregnancy who have modified Bishop score lower than 3 and are negative for IGPBF-1 in cervical secretion. Oxytocin is not advised for use in such gravida for stimulating cervical maturity. IGFBP-1 in cervical secretion may serve as an important index for evaluating the cervical maturity.
Yin
Chun-yan
CY
Department of Obstetrics, Second People's Hospital of Guangdong Province, Guangzhou 510317, China.
Zhou
Jing-zhen
JZ
Wang
Bao-ping
BP
Lü
Xiao-yan
XY
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000282:Administration, Intravaginal; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D002584:Cervix Uteri / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000378:metabolism; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000188:drug therapy*; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D018970:Insulin-Like Growth Factor Binding Protein 1; D016595:Misoprostol