Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria.
BACKGROUND
Although supported by research evidence, misoprostol for induction of labour remains contentious.


OBJECTIVE
To assess perception and practice of obstetricians regarding use of misoprostol for labour induction.


METHODS
Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria.


RESULTS
One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P>0.05).


CONCLUSIONS
Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.
Fawole
Adeniran O
AO
Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria. fawoleo@yahoo.co.uk
Adegbola
Omololu
O
Adeyemi
Adewale S
AS
Oladapo
Olufemi T
OT
Alao
Moses O
MO
D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007751:Labor, Induced; D016595:Misoprostol / Q000009:adverse effects*; D009549:Nigeria; D010120:Oxytocics / Q000009:adverse effects*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires
D010120:Oxytocics; D016595:Misoprostol