A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour

This retrospective study looked at the outcome of using 50-100 ug misoprostol once daily to indicate labour compared to the outcome of the over all patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2 percent) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate: 9.3 percent for the misoprostol group versus 13.3 percent for the overall population (p=0.002, Odds Ratio (OR) 0.67, 95 percent CI 0.53, 0.83). The abruption rates were not significantly different: 0.8 percent for misoprostol versus 0.4 percent (p=0.09,OR 1.86, 95 percent CI 0.81, 4.09). There was more postpartum haemorrage in the misoprostol group: 5.6 percent versus 3.5 percent (p=0.0006, OR 1.63, 95 percent CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2 percent versus 7.9 percent (p=0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9 percent versus 2.4 percent (p=0.674, OR 1.09,CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.1000 (p=0.00, OR 3.5, 95 percent CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 (p=0.69, OR 1.11, 95 percent CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrage is still mandatory. (AU)

A comparison of labour and delivery outcomes in mothers induced with cytotec or pitocin

OBJECTIVE: To compare the labour and delivery outcomes among mothers induced with cytotec (misoprostol) and those induced with pitocin (oxytocin) in a retrospective study. METHODS: A stratified random sample of 40 patient records of 20 mothers induced with cytotec (Group 1) and 20 with pitocin (Group 2), was selected from the records of all of the mothers (n = 148) who had induction of labour at Victoria Jubilee Hospital, Kingston, Jamaica, in March 2000. The groups were matched for age, parity and gestation. Mothers with hypertension, diabetes mellitus, sickle cell disease and multiple pregnancies were excluded. A pretested 27-item checklist, based on the standard labour and delivery records, included a list of possible antepartum, intrapartum and immediate postpartum complications and length of hospital stay. SPSS version 7.5 was used for data analysis. RESULTS: There were no significant differences in total time of labour, blood pressure, blood loss, pre- and post-induction foetal heart rates, apgar scores and length of hospital stay. Two mothers in the cytotec group had uterine hyperstimulation and were delivered by Caesarean section. Four babies in the cytotec group and three in the pitocin group were admitted for special care. CONCLUSION: Althoygh the outcome variables for mothers induced with cytotec and those induced with pitocin were similar, the two cases of uterine hyperstimulation in the cytotec group suggest caution in the use of cytotec for the induction of labour. (Au)

Misoprostol (prostaglandin E1) for induction of labour

Introduction of labour for obstetric problems is of great value in antenatal care. The usual method is to use oxytocin and artificial rupture of membranes. When the cervix is unripe the use of prostaglandin reduces cervical dystocia and makes induction easier. The usual prostaglandin is dinoprostone which is expensive. However, prostaglandin is not without risks as hyperstimulation can occur resulting in fetal distress or demise, abruptio placentae and ruptured uterus misoprostol is a synthetic prostaglandin in use to induce labour since 1989. Some studies have shown that it is as effective as dinoprostone. Other studies have shown that it is safe but is best used under controlled conditions with strict adherence to a protocol. (AU)

Induction of labour with intravaginal misoprostol versus dinoprostone in intrauterine death: a retrospective study

Between March 1992 and November 1994, 48 patients with intrauterine death had labour induced, 36 with the prostaglandin analogue misoprostol and 12 with the prostaglandin dinoprostone. Both were used as a single dose in 24 hours intravaginally. The patients were all of low parity and all but one were in the third trimester. Of those getting misoprostol, 92 percent, and of those getting dinoprostone, 67 percent, went into spontaneous labour. Eighty-one percent of those getting misoprostol and 67 percent of those getting dinoprostone delivered within 24 hours without the need for further prostaglandin or oxytocin, a difference that was not significant. No difference were found in other outcome variables such as diagnosis or induction to delivery time or need for ocytocin, between the two groups. Only one maternal medical complication occurred, chorioanmionitis in a patient who had misoprostol, and in whom labour was delayed 6 days.(AU)

The impact of routine misoprostol (prostaglandin E1) induction on antenatal care at the University Hospital of the West Indies, Mona, Jamaica - abstract

Induction of labour for obstetric problems is of great value in antenatal care. The usual method is to use oxytocin and artificial rupture of membranes. This, however, is sometimes not easily done when the patient's cervix is unripe. The use of prostaglandin reduces cervical dystocia and should therefore make induction easier with less need to resort to caesarean section. However, prostaglandin is not without risks as hyperstimulation can occur with foetal distress or demise, abruptio placetae and ruptured uterus. Since 1992, induction of labour with misoprostol, a synthetic prostaglandin E1 analogue, has become very common in the Department of Obstetrics, U.W.I., Mona. A retrospective study was done to look at certain variables two years preceeding routine prostaglandin induction (1990 and 1991) and this was compared to the two years after routine prostaglandin induction became established, 1993 - 1994. Results showed a significantly lower mean caesarean section rate - 16.3 per cent for 1990 - 1991 versus 14.4 per cent for 1993 - 1994 with the advent of increased prostaglandin inductions (p = 0.006). There was also a significant reduction in the number of oxytocin inductions as the number of prostaglandin inductions rose - total number of oxytocin inductions for 1990 - 1991 was 431 of 6192 deliveries (7.1 per cent) and for 1993 - 1994 it was 307 of 5537 deliveries (5.5 per cent; p = 0.001). The forceps rate was higher in the prostaglandin group (1.6 per cent vs 2.4 per cent; p = -0.004). The abruption rates were almost identical (0.45 per cent vs 0.46; p= 0.97). The stillbirth and neonatal death rates were not significantly different. There were no cases of ruptured uterus in either group. Prostaglandin induction may be important in reducing caesarean section rate and appears to be a safe alternative to oxytocin induction in some patients (AU)

Extra amniotic misoprostol as a cervical ripening agent: a double blind clinical trial

Induction of labor is often necessary and patients with a ripe cervix are more easily induced. The drug of choice for ripening the cervix is dinoprostone prostaglandin E2 (PGE2). This is very expensive and often not available. We decided to use a cheaper prostaglandin misoprostol (PGE1). This was compared to placebo in a double blind clinical trial. The study was done in 45 women in the 3rd trimester who required induction of labor but had an unripe cervix. 100ug of misoprostol was the dose used. The results showed that misoprostol was superior to placebo. Mean change in Bishop Score 5.3 for misoprostol compared to 1.5 with placebo (p<0.001). Mean time from insertion to delivery 43 hours in the placebo group compared to 15.6 hours in misoprostol group (p<0.001). Need for oxytocin was significantly less with misoprostol 29 percent vs 65 percent (p<0.02). there was no difference in outcome in terms of complications foetal Apgar Score and type of delivery. (AU)

Intravaginal misoprostol versus dinoprostone as cervical ripening and labor-inducing agents

OBJECTIVE: To compare dinoprostrone (prostaglandin E2) and misoprostol (prostaglandin E1) for ripening the cervix and inducing labour at term. METHODS: Sixty-three women are randomized to receive 100 micrograms misoprostol or 3mg dinoprostone, both are intravaginal tablets. RESULTS: There was no statistical difference between the groups of pre-induction status. The mean Bishop scores before drug insertion were almost identical. Twelve hours after insertion, the mean score in the Bishop score was significantly higher in those receiving misoprostol (5.0 versus 3.3) (P= .008). However, there was no significant difference in induction-to-delivery interval, spontaneous labor rates, types of delivery, fetal outcome, or maternal complications. CONCLUSION: Misoprostol is as effective as dinoprostone for inducing labor at term. (AU)

Extra-amniotic misoprostol as a cervical ripening agent - abstract

There are many indications for induction of labour. When the cervix is ripe, induction of labour with oxytocin is easy. When the cervix is unripe, induction can fail, leading to prolonged labour and an increased Caesarean Section rate. Dinoprostone (Prostin, Upjohn) is the drug of choice used to ripen the cervix prior to induction. This drug is, however, very expensive and is sometimes not readily available. We have used a cheaper prostaglandin, misoprostol (Cytotec, Searle) as an extra-amniotic preparation in two studies, to test its efficacy in cervical ripening and achieving a safe vaginal delivery. In a double-blind controlled trial in 23 women with post-dates pregnancy, misoprostol was better than placebo in ripening the cervix (mean change in Bishop score 5.8 vs 1.9, p = 0.002) and fewer patients had no change in the Bishop score (1/12 vs 6/11, p = 0.03). Almost all of the patients given misoprostol went into spontaneous labour (10/12 vs 1/11, p = 0.002) and the mean time from insertion to delivery was shorter (34.1 hours vs 54.0 hours, p = 0.01). In a prospective randomised trial in 26 pre-eclamptic women, misoprostol was better than dinoprostone in ripening the cervix (mean change in Bishop score 5.1 vs 2.8, p = 0.015.). The mean time from insertion to delivery was also shorter (16.4 hours vs 39.3 hours, p = 0.48). In both studies, there were no significant differences between misoprostol and the other drugs in route of delivery. Maternal complications were slightly more than with placebo but of a minor nature. Maternal and foetal outcomes were not significantly different from dinoprostone (AU)

Intrapartum infusion of oxytocin and glucose water and neonatal jaundice

Two hundred and seventy-eight deliveries were studied prospectively to determine the association between the use of oxytocin during labour and the incidence of neonatal jaundice. Jaundice was seen significantly more often in neonates following maternal infusion of oxytocin in dextrose water (OT) or dextrose water alone (DW) as compared to those whose mothers did not receive either. No significant difference was seen in the incidence of jaundice between OT or DW groups. Mean umbilical cord serum sodium levels were significantly lower in the OT and DW group neonates who became jaundiced, as compared to the rest of the neonates in the same group and the control group. Sixty per cent of the jaundiced neonates in the OT as well as the DW group had frank hyponatremia as compared to only 8 percent in the control group. These findings support a probable causative association between hyponatremia at birth and neonatal jaundice in the deliveries following dextrose water and/or oxytocin infusion (AU)

Prolonged pregnancy: a rational approach to management

The optimum management of prolonged pregnancy is controversial. Eighty-two patients with this problem were managed prospectively. If the cervix was favourable for induction of labour, this was done. If the cervix was unfavourable, pregnancy was allowed to continue but the foetus was monitored with twice weekly non-stressed cardiotocography. A control group of 115 patients who were all induced at 42-weeks gestation was used to compare pregnancy outcome. Selective intervention resulted in reducing the induction rate by half. Pregnancies managed conservatively resulted in fewer (6.6 percent as opposed to 30 percent) Caesarean births in the induced pregnancies. More babies with higher Apgar scores at birth were born to the conservatively managed patients (AU)

A clinical trial of Hyoscine-N-Butylbromide in labour

Buscopan was administered to 62 primigravidae in labour and its effects were compared with those in a control group receiving Pethidine. There was a significant acceleration of labour in the group receiving Buscopan, but this drug was not useful in relieving labour pains (AU)

Induction of labour with buccal syntocinon

A clinical trial of syntocinon administered by the buccal route to 43 patients in the University Hospital of the West Indies is described. Buccal syntocinon seems to be convenient, safe, and effective as a means of inducing labour, providing its administration is closely supervised (AU)

Induction of labour up to thirty-six weeks

Experience at the University College Hospital, Jamaica, of induction of labour up to 36 weeks over a two-year period is presented. This experience illustrates, but does not prove, our contention that, at this stage of pregnancy, the soft rubber bougie is an effective method of inducing labour. A plea is made for this approach in cases and places where the alternative is Caesarean Section, particularly of the classical variety, under unfavourable circumstances especially in a young woman. This type of induction would appear to be suitable where there is a proved congential abnormality incompatible with the life of the foetus, where the diagnosis has been made before 36 weeks (AU)