Effectiveness and safety of vaginal misoprostol for induction of labour in unfavourable cervix in 3rd trimester.
BACKGROUND
The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasi-experimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery.


METHODS
This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness (delivery within 24-hours) and safety (uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity). Secondary outcome measures included neonatal outcome.


RESULTS
Out of 946 cases, successful vaginal deliveries were achieved in 843 (89.1%) cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 (12%) patients. Caesarean Section had to be done in 103 (10.8%) cases. The indications for Caesarean Section were foetal distress in 42 (40%), occipito-posterior position in 8 (7.7%), abruptioplacentae 2 (1.9%), cord around the neck 9 (7%), uterine hyperstimulation 6 (5.8%) and failure to progress in 20 (19%) cases. Admission to NICU was 28 (3.3%) and Neonatal deaths were 5 (0.5%). Postpartum Haemorrhage (PPH) was observed in 22 (2.3%) patients. There was no case of rupture uterus.


CONCLUSIONS
Vaginal Misoprostol appears to be safe and effective for cervical ripening in 3rd Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory.
Abbasi
Nasreen
N
Department of Obstetrics and Gynaecology, Frontier Medical College, Pakistan.
Danish
Nargis
N
Shakoor
Farah
F
Parveen
Zahida
Z
Bilal
Syed Ahmad
SA
D020070:Cervical Ripening / Q000187:drug effects*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010154:Pakistan / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012449:Safety; D055815:Young Adult
D010120:Oxytocics; D016595:Misoprostol