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

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)