Maternal Outcome Following Intra-Vaginal Administration of Misoprostol for Induction of labor

Abstract

Introduction: The use of prostaglandin preparations with or without oxytocin infusion is widely recognized and accepted as a standard method of induction of labor. It has been shown to reduce induction time and the risk of failed induction. But the use of prostaglandin E2 is quite expensive and is not available in many developing countries. In such cases, misoprostol can also be used as an induction agent. Research regarding the complications and successful outcome rate of using misoprostol as a labor inducing agent is scarce. The present study was conducted to observe the maternal outcome of using misoprostol intravaginally as a method for inducing labor and cervical ripening. Aim of the study: The aim of the study was to observe the maternal outcome of patients following intra-vaginal administration of misoprostol for induction of labor. Methods: This open clinical trial study was conducted at the Department of Obstetrics and Gynaecology, North East Medical College Hospital, Sylhet, Bangladesh. The study duration was 1 year and was conducted with a total of 100 patients who were admitted with term pregnancy and unfavorable cervix in the study hospital, fulfilling the inclusion and exclusion criteria. Result: The age of the participants ranged from 18 to 32 years, with the mean age being 22.4 (SD ± 2.9) years. Bishop’s score increased significantly after 6 hours vaginal misoprostol. 53% were multipara and 47% primipara. The mean induction to vaginal delivery time was 14.6 (SD ± 4.6) hours (range 6 to 23 hours); the induction to vaginal delivery time was<12 hours in 44.3% and 12-24 hours in 55.7% cases. The mode of delivery was vaginal in most of the cases (70.0%) and cesarean section was in 30.0% of cases. Fetal distress was the most frequent indication of cesarean section (63.3%), followed by arrested labor (20.0%) and failed induction (16.7%). The maternal obstetric complication was postpartum hemorrhage (3.0%) with no ruptured uterus, tachysystole, hypertonus uterus, or hyperstimulation. Conclusion: The average induction to vaginal delivery time varied from 6 to 23 hours, with a delivery time of 14.6 (SD 4.6) hours; the induction to vaginal delivery time was 12 hours in 44.3 percent of cases and 12-24 hours in 55.7 percent. Vaginal birth was the most frequent mode of delivery, while fetal distress was the most prevalent reason for cesarean section. When compared to previous similar research, maternal obstetric problems were much reduced. Vaginal misoprostol appears to be a viable treatment for labor induction with minimal maternal problems.